Publications by Year: 2026

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.

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.

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.

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.

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.

OBJECTIVES: This study investigates the co-occurrence between autism spectrum disorder (ASD) and major depressive disorder (MDD) in pediatric populations, focusing on prevalence rates, comorbid psychiatric conditions, and their impact on clinical presentation and treatment outcomes.

METHODS: We conducted a retrospective study of children and adolescents (ages 3-17) referred for psychiatric care to ambulatory care clinics (pediatric psychopharmacology [N = 2,307] and specialized autism spectrum disorder [N = 416] programs) at a major academic medical center. Psychopathology was assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version and the Child Behavior Checklist (CBCL). ASD was diagnosed using DSM criteria.

RESULTS: Our findings revealed a co-occurrence and bidirectional relationship between ASD and MDD (55% of ASD patients had MDD, while 9% of MDD patients had ASD). The symptom profile of depression in youth with ASD was consistent with the typical DSM-based presentation. The burden of psychopathology was significantly greater in the presence of ASD and MDD comorbidity, and in particular the rates of comorbid anxiety disorders, OCD, and psychosis were significantly elevated. Social competence and global functioning were worse in the presence of ASD and MDD comorbidity.

CONCLUSIONS: A high prevalence of comorbidity with MDD was observed in psychiatrically referred youth with ASD, with a clinical presentation of MDD that is typical of the disorder. Higher prevalence of anxiety disorders and psychosis was observed in the presence of ASD and MDD comorbidity. These findings underscore the need for comprehensive assessment and tailored interventions for children with co-occurring ASD and MDD, particularly in addressing anxiety and ensuring adequate access to mental health services.

The lack of biomarkers to identify individuals at risk of asthma exacerbations remains a significant limitation to improving patient outcomes. To address this need, we analyze data from three asthma cohorts, combining up to 25 years of electronic medical records with sequential metabolomics studies, to develop and replicate a predictive model for asthma exacerbation risk. We identify asthma-associated biochemical pathways via global circulatory metabolomics and then apply targeted mass spectrometry methods to quantify selected steroids, sphingolipids, and microbial-derived metabolites. The sphingolipid-to-steroid ratios robustly associate with 5-year exacerbation risk (discovery p value = 1.63×10⁻26-0.029; replication p value = 1.89×10⁻36-0.033). Based upon these findings, we derive and replicate a simple 5-year predictive model of asthma exacerbations using 21 sphingolipid-to-steroid ratios that outperforms current clinical measures (discovery AUC = 0.90; replication AUC = 0.89). These findings underscore the value of metabolomic profiling to develop a practical, cost-effective clinical assay for asthma exacerbation risk that may improve patient care.

The O1 serogroup of Vibrio cholerae has caused all cholera pandemics and for over a century V. cholerae O1 outbreak strains have been characterized by their serotype. The two V. cholerae serotypes differ by the presence (Ogawa) or absence (Inaba) of methylation of the terminal sugar on the lipopolysaccharide O1-antigen. Serotype switching often occurs during epidemics and has historically been attributed to the pathogen adapting to immune pressures. Here we address the impact of serotype on V. cholerae pathogenicity using otherwise isogenic Ogawa and Inaba versions of several clinical V. cholerae O1 isolates. Our findings indicate that O1 antigen methylation in Ogawa strains promotes V. cholerae colonization, infectivity and resistance to antimicrobial peptides. We propose that methylation of the O1 antigen elevates colonization by shielding the bacterium from cationic antimicrobial peptides at the pH of the small intestine. These observations provide insights into the biological significance of the V. cholerae O1 serotypes.

Amyloid-β (Aβ) plaques and neurofibrillary tau tangles are hallmarks of Alzheimer's disease (AD). While the intracellular localization of tau tangles within neurons nominates them as the primary producers of tau, the cellular origin of Aβ is less clear as plaques accumulate extracellularly. Neurons have been considered the sole source of Aβ, leading to the generation of many AD animal models expressing familial AD protein variants specifically in neurons. However, emerging evidence showed that non-neuronal cells abundantly express amyloid precursor protein (APP) and its processing machinery. Among these, oligodendrocytes (OLs) exhibit the highest expression of amyloidogenic components, produce Aβ, and contribute to plaque burden in vivo. Here, we highlight reports on non-neuronal Aβ production in the context of AD and the function of APP processing in these cells. Understanding Aβ processing in non-neuronal cells might enable the identification of novel therapeutic targets, especially in humans whose brain structures differ greatly from animal models.

BACKGROUND AND PURPOSE: Middle meningeal artery embolization (MMAE) is an effective treatment for non-acute subdural hematoma (NASDH) patients, and it is increasingly being adopted into routine clinical practice as standard of care. This study aims to determine whether additional surgery is necessary to prevent treatment failure for NASDH patients treated with MMAE.

MATERIALS AND METHODS: We conducted a retrospective cohort study using the 2016-2022 Nationwide Readmissions Database. NASDH patients were stratified into standalone MMAE vs. combined MMAE+surgery groups. Propensity score matching (PSM) accounted for presenting symptoms and discharge functional status. The Elixhauser Comorbidity Index (ECI) quantified comorbidity burden. The primary outcome was treatment failure, defined as NASDH-related death, readmission, or surgical evacuation within 180 days post-discharge.

RESULTS: Among 3,213 NASDH patients (1,669 MMAE-only; 1,544 MMAE+surgery), 1,108 patients per group remained after PSM. Overall, surgery was not associated with lower treatment failure (5.3% vs 7.5%; HR 0.67 [95% CI, 0.37-1.21]; p=0.19). A significant interaction between surgery and ECI was observed (p-interaction=0.002). Surgery reduced treatment failure in patients with low comorbidity burden (ECI<5; HR 0.29 [95% CI, 0.11-0.78]; p=0.01). For patients with medium (ECI 5-14, n=996) or high (ECI≥15, n=589) comorbidity burden, surgery was not associated with different outcomes (p=0.56 and 0.43, respectively).

CONCLUSIONS: For neurologically stable NASDH patients who underwent MMAE, baseline comorbidity burden significantly blunted the marginal benefit of surgery. Additional surgical evacuation was not associated with different rates of treatment failure for the majority of NASDH patients with medium to high comorbidity burdens.

ABBREVIATIONS: MMAE = Middle Meningeal Artery Embolization; NASDH = Non-Acute Subdural Hematoma; ECI = Elixhauser Comorbidity Index; PSM = Propensity Score Matching; HFRS = Hospital Frailty Risk Score; NRD = Nationwide Readmissions Database.