Publications by Year: 2025

This paper examines how people-centered accountability initiatives are operating to enforce the right to health amid Israel's genocide in Gaza. Drawing on a critical case study of Doctors Against Genocide, Healthcare Workers Watch, and the Freedom Flotilla Coalition, we situate these actors' work within international human rights law, social accountability scholarship, and decolonial and abolitionist critiques. We show how these actors are able to combine clinical documentation, survivor testimony, and direct action to monitor human rights violations, generate medically literate records of the harm inflicted, and press for remedies that state-centered mechanisms have failed to deliver despite findings of war crimes and genocide by United Nations bodies and human rights groups. Across these cases, we identify some common practices and tensions surrounding coalition-building, risks to documentation, navigating a media environment of mis/disinformation, and engaging strategically with institutions that often reproduce health harms or are directly complicit. We argue that these movements treat people-centered accountability as part of their professional duty and act on a mandate to prevent mass atrocity crimes rather than being silent. We conclude by outlining some practical implications for clinicians, professional associations, and health systems seeking to align their global health practice with a people-centered approach to accountability.

BACKGROUND: Low back pain (LBP) is a prevalent health problem affecting a large portion of the population at some point in their lives, particularly with the increase in sedentary lifestyles, leading to significant disability and healthcare costs. This study evaluates the efficacy of seated elliptical exercise on chronic LBP, hypothesizing that daily use over a period of six weeks can reduce pain levels and improve functional health measures as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS).

METHODS: A randomized controlled trial involving 54 participants with chronic LBP was conducted, comparing a six-week seated elliptical exercise plan plus standard care against standard care alone. Outcome measures included the PROMIS Pain Intensity, Pain Interference, and Global Physical and Mental Health scores.

RESULTS: The intervention group showed significant improvements in Pain Intensity (60.97±6.38 vs 57.41±6.98; P<0.001) and Pain Interference (62.61±7.10 vs 59.32±8.64; P<0.001), starting from the first week of exercise. While pain outcomes improved, no significant changes were observed in Global Physical and Mental Health measures.

CONCLUSION: Seated elliptical exercise might help reduce the pain in chronic LBP. This could be a promising intervention to relieve the pain or even prevent LBP, especially in individuals with a sedentary lifestyle.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered an essential modality for mediastinal and hilar lymph node evaluation in lung cancer and other thoracic diseases. When compared with surgical staging, EBUS-TBNA yields high sensitivity and specificity with a favorable safety profile. It now serves as the first-line approach for invasive mediastinal staging in most guidelines. In this review, we provide a comprehensive overview of EBUS-TBNA, with a focus on mediastinal staging in the era of the 9th edition of the TNM (Tumor, Node, Metastasis) classification, technical considerations, and emerging applications. We outline the limitations of noninvasive imaging and summarize current indications for invasive staging while emphasizing the prognostic importance of accurate nodal assessment in non-small cell lung cancer including the role of N1 and N2 subcategories. Then, we discuss practical aspects of systematic nodal staging such as which stations to sample, the debate around routine evaluation of station 10 and N3 nodes, and the implications of the updated TNM nodal descriptors for decision making. We also review bronchoscope and needle options and examine the role of rapid on-site evaluation (ROSE), needle gauge, needle design, and sampling techniques in optimizing diagnostic yield and tissue adequacy for immunohistochemistry and next-generation sequencing. Finally, we highlight advanced strategies for challenging non-malignant and lymphoproliferative conditions.

BACKGROUND: To enhance representation in LCS research, we examined associations between participant characteristics and their preferred mode of survey completion among individuals eligible for LCS.

METHODS: Between February 2023 and April 2024, prospective participants were identified using electronic healthcare records from Mass General Brigham and the University of Oklahoma Health Sciences (OUHSC). We offered three modes of survey completion: online, by mail, or by phone. Eligible participants were 50-80 years old, had smoked within the past 15 years, and spoke English or Spanish. We used multinomial logistic regression to estimate relative risk ratios (RRR).

RESULTS: Outreach to 2,822 individuals resulted in a sample of 315 participants. The mean age was 61.7 years (SD = 10.9). Most respondents were women (63.0%) and identified as White (63.3%), 29.8 % were Hispanic. The most common survey completion mode was mail (37.1%), followed by online (35.9%) and phone (27.0%). Characteristics associated with completion by mail were study site (RRR = 6.86, 95%CI:3.10-15.14), and race (RRR = 3.63, 95%CI:1.53-8.61); with respondents at OUHSC or who did not identify as White being more likely to choose mail over online modality. Characteristics associated with phone completion, included older age (RRR = 1.11, 95% CI: 1.03-1.20), Spanish language preference (RRR = 9.28, 95%CI:2.38-36.09), and with local government or community insurance (RRR = 9.91, 95% CI:1.92-51.3).

CONCLUSION: The current trend toward online surveys may not fully account for individual preferences for LCS research engagement, and could limit the representativeness in LCS studies if offline alternatives are not offered.

From a gender perspective, this study examines how women seek help in response to experiences of intimate partner violence, distinguishing between dynamics of intimate terrorism and situational violence in a rural community in Chiapas, Mexico. A probabilistic study was conducted between July and August 2017 with the participation of 141 women aged 15 years and older, using an adaptation of the National Survey on the Dynamics of Household Relationships (ENDIREH). In addition, from July to December 2017, in-depth interviews were conducted with intentionally selected women and local leaders, along with participant observation. Among survivors, 59% disclosed the violence, and only 7.1% sought formal help, mainly those who experienced intimate terrorism. Most sought help from their families, and 78.9% felt supported by them; this support included emotional assistance, confronting aggressors, and protecting women. Emotions such as fear and shame, impunity, traditional gender norms, socioeconomic factors, and restricted social networks inhibit help-seeking. In this context, community health programs can play a key role in strengthening social networks and providing care.

BACKGROUND: As adolescent cannabis use becomes more common, questions remain about the potential for neurocognitive recovery after stopping cannabis use.

METHOD: This study examined whether short-term abstinence from cannabis leads to cognitive improvements. A total of 238 adolescents (ages 13-19; 51% female; 55% White, 18% Black, 9% Asian, 18% other races) from Greater Boston participated, including 154 adolescents who regularly used cannabis (CB) and 84 adolescents with no cannabis use (NU). Participants who used cannabis were randomized to incentivized abstinence (CB-Abst) or a non-contingent monitoring control (CB-Mon). Non-users completed four weeks of monitoring (NU). Participants completed tests of executive function, memory, and attention weekly for four weeks.

RESULTS: At baseline, CB adolescents demonstrated worse verbal memory and processing speed than NU on (p <.006). CB-Abst performance was similar to that of the NU group at week 4. At week 4, those in the CB-Abst group showed greater improvements in inhibitory control compared to the CB-Mon group (β = -10.9, p = .037). There were no significant differences between CB groups in memory or attention task performance at week 4. Exploratory analyses revealed modest gains across all groups in some tasks.

DISCUSSION: Brief cannabis abstinence may be associated with improvements in executive function among adolescents, supporting the idea of neurocognitive recovery, which has important implications for treatment, prevention, and public health policies.

Background Two-stage hepatectomy is a well-known strategy for bilobar liver metastases, "cleaning" the future liver remnant (FLR) in the first stage, using portal vein embolization (PVE), and performing a major hepatectomy in the second stage. We used an alternative approach, performing PVE, to continue chemotherapy and perform liver resection. We describe our experience emphasizing liver hypertrophy and the tumor behavior of the contralateral liver metastasis. Methods Non-concurrent cohort study. Patients who underwent PVE before liver resection for bilobar metastases were included. Pre-PVE variables, post-PVE volumetry, variation of metastasis diameter in the FLR, perioperative variables, and overall survival were evaluated. Results Fifteen patients were included. Neoadjuvant chemotherapy was given in 14 patients (93.3%). Median FLR pre- and post-PVE were 20.4% and 31.5%. The median degree of hypertrophy was 46.2%. Median kinetic growth rate was 1.9% per week. The metastasis diameter decreased or was maintained in 11 patients (73.3%) after PVE. Twelve (80%) underwent R0 resection. Major postoperative morbidity occurred in two patients (13.3%); no early mortality was reported. Conclusions One-stage hepatectomy after PVE effectively achieves an adequate FLR, with contralateral tumor growth absent in most cases. This allows the continuation of chemotherapy during the hypertrophy period and achieves R0 resection of bilobar metastasis.