Publications by Year: 2025

BACKGROUND: The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the gold standard measure of OCD and the most common tool to assess OCD severity and treatment outcome. Relying on Y-BOCS total scores likely to capture overall severity well, but may obscure important qualitatively different OCD profiles. The current study aimed to identify profiles of OCD and their association to obsession/compulsion content domains (e.g., contamination), and treatment outcomes.

METHODS: Participants were adults 759 (49% women) seeking partial/residential treatment for severe OCD. The sample was on average 29.81(SD=11.95) years old and predominantly White (85%). Latent profile analysis was used to identify patterns of OCD symptoms using the self-reported Y-BOCS severity scale (Y-BOCS-SS). Profiles were validated using generalized linear models to capture the association between profiles and obsession/compulsion content and changes in OCD severity, depression, and quality-of-life.

RESULTS: Three profiles were identified: a "Severe with Lower Resistance" Profile (69% of sample) characterized by high severity with the greatest relative effort to resist symptoms, a "Moderate" profile (25%) characterized by uniform endorsement of items in the moderate range, a "Low Compulsion" (6%) profile characterized by high mean endorsement of obsession items and low endorsement of compulsion items. The profiles varied significantly in terms of endorsement of different obsession/compulsion domains but did not vary significantly in terms of treatment outcomes as measured by changes in OCD, depression, and quality-of-life.

CONCLUSIONS: Relying on Y-BOCS total score may fail to capture qualitatively different, albeit rare, presentations of OCD. However, these profiles were not predictive of treatment response.

INTRODUCTION: Climate change leads to an increasing risk of heat exposure and pre-emptive alerting to patients may be an important intervention to limit health risks related to heat. The process of providing counseling and resources related to impending dangerous heat in an ambulatory clinic setting has not been described. In this pilot project utilizing an electronic heat alert system, we describe the implementation of a clinic-level protocol for providing alert-based heat health information and proactively educating rheumatology patients in an ambulatory setting on dangerous heat conditions.

METHODS: Physicians, nurses and medical assistants received electronic notifications of dangerous heat forecasts via a external heat alert system (Realtime Climate Heat Risk). Participating staff completed surveys at the midpoint and end of the heat season. The primary endpoint was a self-reported estimate of the percentage of patients engaged regarding heat safety on days where heat alerts were issued.

RESULTS: There were 4 heat alert days during the study period. Half of participating staff members reported they had engaged 50 % or more of their patients on this topic. Self-reported levels of engagement by medical assistants were significantly higher than those of physicians and nurses, (W = 4.5, p-value = 0.036).

CONCLUSIONS: Heat and other environmental exposures present risks to patients as the effects of climate change worsen. Heat alerts may help staff address health risks with their patients. This pilot study demonstrates that an external heat alert system can be implemented utilizing providers of different skill levels and at all points of patient interaction in an ambulatory clinic setting.

INTRODUCTION: Community health centers and clinics are on the frontlines of climate change and adverse health effects, providing essential care to millions of low-income, uninsured, and underinsured populations across the country. The Climate Resilience for Frontline Clinics Toolkit ("the toolkit") was developed to support frontline clinicians in preparing for climate-related health risks. The objectives of this study were to assess the utilization and challenges in the implementation of the toolkit in real-world clinic settings and to guide further development of clinic-based risk reduction resources.

METHODS: A qualitative, semi-structured interview and post-intervention assessment approach was used to interview 28 clinicians and staff from 15 clinics across six states.

RESULTS: Participants generally found the toolkit valuable, noting that it addressed an unmet need by providing actionable information on climate health risks in resource-constrained settings. However, challenges included information overload, the complexity of patient-facing materials, and concerns about literacy barriers. Many participants felt that the toolkit could benefit from more concise and visually supported materials, as well as adjustments to better align with patient literacy levels.

DISCUSSION: These findings highlight the importance of tailoring resources to the specific needs of frontline clinics and their patient populations. Future research should examine the long-term impacts of integrating such resources on patient behaviors and health outcomes and explore strategies for integrating climate resilience into routine clinical care.

BACKGROUND: While some interactions between climate change and health have been well documented, the complex relationship between climate change, its proximate causes, and cancer is less clear. This scoping review was conducted to survey specific elements within existing peer-reviewed and grey literature addressing the impacts of climate change-related exposures on 1) cancer risks, 2) outcomes, and 3) care delivery.

METHODS: Following PRISMA guidelines, peer-reviewed and selected grey literature on these topics were identified using pre-specified eligibility criteria. Structured searches by independent reviewers and data extraction from multiple electronic databases were performed, from which syntheses were generated and research gaps identified.

RESULTS: Of 542 studies identified by title/abstract for full-text review, 182 studies were eligible for data extraction. Of these, 127 examined fossil fuel-related pollutant levels and excess cancer risks, 29 investigated the impact of climate change on cancer outcomes, and 31 examined the impact of climate change-related events on cancer care delivery. Overall, the effects of climate change-related exposures, or climate change's proximate causes, lead to increases in cancer risk. Climate change effects such as extreme weather events disrupt care and impact survival outcomes. Across these subject areas, climate change-related events' exacerbation of existing healthcare disparities was an emergent theme.

CONCLUSIONS: Climate change has impacts across the cancer care continuum. Research gaps include limited data on the direct effect of climate change on cancer outcomes and care delivery, population health research, and mitigation efficacy. More work is needed in education, adaptation, and climate preparedness for cancer patients and healthcare systems.

Acute food bolus impaction is frequently encountered in pediatric patients with underlying esophageal conditions. Traditional endoscopic methods for removing friable boluses, such as meat, are often time-intensive and challenging. This report explores the novel application of cryoadhesion, or freezing and adhering an object to a cryoprobe, for esophageal meat bolus extraction. A 25-year-old man with trisomy 21 and eosinophilic esophagitis presented with acute food bolus impaction. After unsuccessful conventional endoscopic maneuvers, a cryoprobe was externally attached to an endoscope and used to achieve cryoadhesion and extraction of the meat bolus. Within 10 minutes, the meat bolus was successfully removed attached to the cryoprobe without mucosal injury. The patient tolerated the procedure well and was discharged the next day without adverse events. Cryoadhesion via a flexible cryoprobe may offer a feasible alternative for removing challenging food impactions. Further investigation is warranted to evaluate its safety and efficacy.

INTRODUCTION: Climate change is contributing to unprecedented levels of migration with complex impacts on the health of displaced populations. Immigrant and refugee health professionals are well positioned to understand the issues at the intersection of climate change, forced migration, and health, and to participate in the development of solutions to this crisis. However, little has been done to equip these professionals to join the dialogue around climate change.

MATERIALS AND METHODS: We developed an interdisciplinary, case-based workshop to introduce refugee and immigrant health professionals at an international conference to the ways in which climate change is impacting the health of the communities they serve. We employed a community organizing approach to show participants how their existing skills, knowledge base, and networks can be used to identify and mitigate climate impacts.

RESULTS: The workshop was attended by approximately fifty participants. In a post workshop survey, sixty percent of participants agreed with the statement that the workshop would change their professional work, and there was a significant increase both in those who reported that they understood how climate change impacts immigrant communities and in how to use their relationships and resources to combat climate change.

DISCUSSION: The discussion themes illustrated the breadth of knowledge of participants, especially regarding the social determinants of health, the health inequities that shape climate vulnerability, and myriad problem-solving processes.

CONCLUSION: This workshop offers one model for how a brief educational intervention using case-based learning and the tenets of community organizing can be used to introduce a new community of providers to climate change work.

BACKGROUND AND AIMS: Studies assessing gastrointestinal stromal tumors (GISTs) have found no survival differences based on margin status; however, small sample sizes, merged anatomic locations, and limited follow-up have been limitations. This study examined the impact of margin status on overall survival in a large national cohort of patients with resected gastric GISTs.

METHODS: Data on patients with gastric GISTs were abstracted from the National Cancer Database, with data collected over a 16-year period (2004-2020). Exclusion criteria included the presence of other primary tumors, unknown patient/tumor characteristics, macroscopic residual margins, metastasis at diagnosis, and prior chemotherapy. The cohort was stratified according to tumor size. R0 is defined as microscopically negative margin, and R1 is microscopically positive margin.

RESULTS: After exclusions, there were 8448 patients in the analysis cohort: 8221 (97.3%) had R0 resections, and 227 (2.7%) had R1 resections. On univariate analysis, tumor size ≤5 cm (P < .001), T1 stage (P < .001), low grade (P < .001), and low mitotic index (P < .001) were associated with a decreased risk of death. Margin status (R0 vs R1) did not have an impact on survival in the combined (P = .249), ≤5 cm (P = .961), ≤3 cm (P = .595), or ≤2 cm (P = .614) cohorts. There was also no difference in the risk of death based on the resection margin, in which the hazard ratio (R1 vs R0) with a 95% confidence interval was 1.206 (.862-1.633). In multivariate analysis, the resection margin status did not affect overall survival (P = .666).

CONCLUSIONS: Congruent with prior studies, there was no difference in survival when comparing R0 with R1 resections in gastric GIST patients without metastasis over an extended follow-up period. These data may be helpful in assessing suitability for endoscopic resection for patients with gastric GISTs.