Publications by Year: 2026

Immunization is a significant health care tool to protect against crisis-related threats to human health, particularly in underserved populations such as hill tribes and stateless people in Thailand. A mixed method aimed to identify the barriers to and facilitators of the use of vaccines among five-year-old hill tribe and stateless children living in the border areas of northern Thailand and Myanmar. Logistic regression was used to detect associations in the quantitative data, and content analysis was used for qualitative data analysis. A total of 188 cases and 188 controls were analyzed; 54.0 % were boys, and 54.3 % were from the Akha tribe. Children without a birth certificate (AOR = 8.57), children who received a vaccine at a provincial/district hospital (AOR = 14.76), private hospital or clinic (AOR = 7.29), children living with ≥3 other children aged 6-12 years (AOR = 3.61), children living with mothers who were non-Thai citizens (AOR = 4.40), children living with mothers who had not attended school (AOR = 4.08), children living with a primary caregiver who was Yao (AOR = 4.58) or Lisu (AOR = 2.94), children living with a Christian or Muslim primary caregiver (AOR = 2.76), and children living with elderly individuals who brought them for vaccinations (AOR = 2.30) had greater odds of having incomplete vaccination than children with the opposite characteristics. Communication challenges, different perspectives on vaccines among different generations, stages of citizenship, mobility, disasters, and a lack of effective health policies were detected as barriers to vaccination. While seeking a new life for younger generations was a facilitator for vaccination. A public health policy for vaccine services without a Thai citizenship requirement should be implemented to increase coverage for hill tribe and stateless children living in the border areas of Thailand and Myanmar.

OBJECTIVE: Mistreatment by patients and families is linked to adverse patient outcomes and physician burnout, and particularly affects women and underrepresented in medicine (UIM) physicians. We sought to explore how this source of mistreatment affects trainee professional identity formation (PIF), a key process in the development of altruistic physicians.

METHODS: We conducted this multi-institutional qualitative study between May and October 2023 with semistructured interviews of pediatric residents. We used the constant comparative method consistent with modified grounded theory to analyze data through a lens of Cruess et al's model of PIF in medicine.

RESULTS: We interviewed 32 pediatric residents and identified 4 primary themes, which we used to develop a conceptual model. 1) Residents identify patient- and family-centered care as core to their professional identity, while acknowledging their vulnerability to mistreatment from patients and families. 2) Mistreatment threatens resident PIF through fractured patient-provider relationships, negative impacts on patient care, and decreased psychological safety of the learning environment. 3) Mistreatment that is frequent, unaddressed, and centered around personal traits is particularly damaging to PIF. 4) Residents employ various strategies to mitigate the negative impacts of mistreatment and ultimately deepen their professional identity.

CONCLUSIONS: Mistreatment from patients and families negatively affects pediatric residents' well-being, learning, and professional identity, with particular impacts on women and UIM residents. Our study informs ways that institutions can best structure support to navigate mistreatment while optimizing trainee learning and PIF, along with patient care.

PURPOSE: To examine factors associated with moving during pregnancy and impacts of assigning nSES at enrollment, delivery, or a time-weighted average on birth outcomes (birthweight, birthweight-for-gestational-age z-score, low birthweight, gestational age, small-for-gestational age, preterm birth).

METHODS: We used data from the Environmental influences on Child Health Outcomes (ECHO) Cohort Study (2010-2019) with nSES data from the American Community Survey (ACS) matched by time and location to monthly residential histories. We used multivariable logistic models with Generalized Estimating Equations to identify factors associated with moving and quantify exposure misclassification in model estimates.

RESULTS: Approximately 7 % of 15,376 participants moved at least once during pregnancy. Maternal age (OR: 0.97, 95 % CI: 0.95, 0.98) and other race vs. White (OR: 0.39, 95 % CI: 0.20, 0.80) were associated with lower odds of moving; lower neighborhood-level education (OR: 1.34, 95 % CI: 1.11, 1.62) and living in urban neighborhoods (OR: 3.03, 95 % CI: 1.39, 6.59) were associated with higher odds. Among movers, estimates between nSES and birth outcomes changed ≥ 16 % by address assignment; birthweight-for-gestational-age z-score was significant only when using nSES at delivery.

CONCLUSION: Sociodemographic and nSES characteristics are associated with moving during pregnancy; movers may experience exposure misclassification and underestimated effects on birth outcomes.

BACKGROUND: In 2019, the PlaNeT-2 trial reported an increased risk of death and/or major bleeding among neonates transfused with platelets at liberal compared to restrictive thresholds. However, especially in the perioperative setting, clinicians often administer platelet transfusions to neonates at higher platelet count thresholds in hopes of reducing the risk of bleeding. In this study, we investigated if platelet transfusion practices changed in neonates with primary surgical diagnoses after the implementation of a restrictive platelet transfusion guideline in January of 2019.

METHODS: In this retrospective study, platelet transfusions administered to infants who underwent at least one operation between January 2017 and December 2020 were classified as either indicated or non-indicated using the new guideline. Patient characteristics, diagnoses, platelet counts, and transfusion indications were collected.

RESULTS: 58 surgical patients received 221 platelet transfusions. The number of indicated platelet transfusions did not change between periods, but the number of non-indicated transfusions significantly decreased (73 pre-vs 20 post-guideline, p < 0.0001). The median platelet count prompting transfusion decreased from 31 × 109/L to 26 × 109/L, p = 0.0074. There were no differences in the number of platelet transfusions administered for active bleeding in either period.

CONCLUSION: Platelet transfusions pose risks in neonates and data from a large, randomized trial supports the use of restrictive guidelines to minimize harm. In this study, we found that implementation of a restrictive platelet transfusion guideline decreased the number of non-indicated platelet transfusions in neonates with primary surgical diagnoses without an increase in transfusions given in the setting of active bleeding.

F-box only protein 31 (FBXO31), a substrate adapter of SKP1-Cullin1-F-box (SCF) E3 ubiquitin ligase, was first identified as a candidate tumor suppressor in breast cancer due to its role in inducing senescence. Over the past two decades, FBXO31 has emerged as a crucial regulator in several human cancers, where it promotes the proteasomal degradation of various oncoproteins. FBXO31 plays a crucial role in regulating the cell cycle to maintain genomic integrity and inhibits processes such as epithelial-to-mesenchymal transition (EMT), invasion, and metastasis. This review examines the molecular mechanisms underlying the potent tumor-suppressive functions of FBXO31 in diverse human cancers. We also discuss the underlying causes of FBXO31 deregulation in cancer, providing insights into the intricate regulatory networks governing its expression. Additionally, we also examine the unexpected oncogenic functions of FBXO31 in certain cellular contexts. Finally, we highlight the clinical potential of FBXO31 in human malignancies, discussing its implications as both a biomarker and a therapeutic target. In conclusion, understanding the nuanced biology of FBXO31 is crucial for unravelling its role in tumorigenesis and advancing future therapeutic strategies.

OBJECTIVE: To investigate the categories of Mainstream Smart Home technology (MSHT) that are commonly owned by individuals with spinal cord injury and disease (SCI/D), their perceived benefits, and barriers to obtaining or using.

DESIGN: Cross-sectional.

SETTING: Spinal Cord Injury (SCI) Model Systems.

PARTICIPANTS: Individuals (N=417) aged ≥18 years enrolled in a participating SCI Model Systems Center between October 2022 and May 2025.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Participants were surveyed on 18 categories of MSHT and indicated for each ownership status, perceived benefit of owning (yes, no, and unsure), acquisition method, satisfaction, and barriers to ownership or use.

RESULTS: The median number of MSHT categories owned per participant was 4 (interquartile range, 2-6), with 7 (interquartile range, 3-10) categories perceived as beneficial but not owned. Most devices (88.4%) were acquired through self-pay. Common barriers to ownership were cost (63.6%) and installation difficulty (35.2%). Individuals with greater upper extremity (UE) impairment were significantly more likely to perceive benefit from voice assistants, smart plugs, smart bed controls, and smart televisions. Multivariate logistic regression identified higher education (odds ratio, 1.97; P=.03), higher income (odds ratio, 2.25; P<.01), and greater UE impairment (odds ratio, 1.75; P=.03) as significant predictors for owning ≥4 categories of MSHT.

CONCLUSION: MSHT was highly valued among individuals with SCI/D, although the rate of ownership of MSHT was low, especially for costlier or more complex devices. Barriers stem largely from affordability and limited support for installation and training. Integrating MSHT training into rehabilitation programs and improving funding, education, and service delivery could enhance access and autonomy for people with SCI/D.

Immunosuppressive drugs remain essential for preventing rejection but carry significant toxicities, underscoring the need for safer, physiology-based immunomodulators. Tributyrin, a prodrug of butyrate with improved systemic bioavailability, has emerged as a metabolically driven immune regulator. Here, we evaluated whether oral tributyrin promotes immune tolerance and improves graft outcomes in preclinical transplantation models. In minor mismatch skin transplantation, tributyrin-treated recipients exhibited a significant, regulatory T cell-dependent prolongation of graft median survival time (33 [interquartile range {IQR} 24.0-40.5] vs 15.5 [IQR 12.0-18.0] days; P = .0007). In a semiallogeneic heart model, tributyrin similarly extended graft survival (52 [IQR 27.0-67.5] vs 14.5 [IQR 12.25-22.0] days; P = .0038). Oral tributyrin increased the frequency and activation of graft-infiltrating regulatory T cells, marked by elevated interleukin (IL)-10, cytotoxic T lymphocyte-associated protein 4 (CTLA-4), lymphocyte-activation gene 3 (LAG-3), and CD25, while reducing CD8+ T cell infiltration and their interferon gamma (IFN-γ) and granzyme B production. Tributyrin treatment also modulated the intragraft innate compartment, reducing proinflammatory M1 macrophage signatures while promoting M2 macrophages with increased IL-10 expression. Systemically, splenocytes from treated recipients produced more IL-10 and displayed selective hyporesponsiveness to donor, but not to third-party antigens, consistent with antigen-specific regulation. Collectively, these findings demonstrate that oral tributyrin enhances regulatory pathways, suppresses alloreactive effector responses, and prolongs allograft survival, supporting its potential as a safe metabolic adjunct in transplantation.

PURPOSE: Changes in menstrual cycle characteristics following COVID-19 vaccination have been reported in women and adolescent girls, yet the biological mechanisms underlying these changes remain poorly understood. Inflammation, though frequently hypothesized as a possible mechanism underlying this finding, has yet to be explicitly studied. Thus, the present study examined the relationships of ovarian hormones and inflammatory processes pre- and post-COVID-19 booster vaccination to menstrual changes among adolescent girls.

METHODS: 47 adolescent girls aged 13-20 who received a COVID-19 booster vaccination provided saliva samples and completed self-reported measures at five time points across the menstrual cycle. Saliva samples were assayed for inflammatory markers IL-1β, IL-6, TNF-α and ovarian hormones estradiol (E2) and progesterone.

RESULTS: Higher levels of IL-1β, measured 24 h post-vaccination, were significantly associated with shorter cycle length in the cycle during which the booster was administered. No significant effects were found for ovarian hormones or other inflammatory markers. Cluster analyses based on anti-spike immunoglobulin G (IgG) levels identified two distinct immune response profiles (high and low responders), though this was not significantly associated with menstrual cycle changes.

CONCLUSIONS: Pro-inflammatory cytokine IL-1β plays a significant role in explaining the shortening of the menstrual cycle following COVID-19 vaccination in adolescent girls, primarily impacting the cycle in which the vaccine was received This finding suggests that vaccine-induced inflammation can influence menstrual cycle regulation in adolescents, possibly due to the immaturity of the HPO-axes during adolescence.

BACKGROUND: Social determinants of health (SDOH) can affect metabolic health.

OBJECTIVE: To determine the effect of social vulnerability on the comparative effectiveness of metabolic bariatric surgery or medical and lifestyle intervention on glycemia and weight outcomes in people with type 2 diabetes (T2D).

DESIGN: Analysis of the effect modification of baseline Area Deprivation Index (ADI; a metric of social vulnerability) on longitudinal outcomes between randomized treatment groups using linear mixed-effects models. (ClinicalTrials.gov: NCT02328599).

SETTING: 4 U.S. academic centers.

PARTICIPANTS: 258 participants with T2D enrolled in 4 randomized controlled trials of surgical versus medical management and a longitudinal observational follow-up study.

MEASUREMENTS: ADI linked to ZIP code data at randomization; weight loss and hemoglobin A1c (HbA1c) level at the end of the active intervention period (7 to 12 years).

RESULTS: Baseline characteristics were well balanced between the surgical and medical therapy groups after adjustment for study site and stratification by high versus low ADI. Surgery was more effective than medical therapy in reducing HbA1c level among persons with high ADI (net difference, -1.29% [95% CI, -1.95% to -0.63%]) and those with low ADI (net difference, -0.95% [CI, -1.29% to -0.62%]). Surgery was also more effective than medical therapy at producing weight loss across ADIs, with respective net differences of -10.6% (CI, -15.2% to -5.9%) for high ADI and -13.3% (CI, -15.7% to -10.9%) for low ADI. The interaction between ADI and intervention group was not significant for either HbA1c (P = 0.37) or weight loss (P = 0.31).

LIMITATIONS: Small sample size; parent trials were not designed to address effect modification by ADI.

CONCLUSION: Surgery was superior to medical therapy for people with T2D regardless of social deprivation. This study did not detect statistically significant differences in the comparative advantage of surgery over medical therapy by ADI.

PRIMARY FUNDING SOURCE: National Institutes of Health.