Scholarly Works, Virginia Tech Carilion School of Medicine (VTCSOM)

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Exploring stress and coping skills of medical students: a repeated cross-sectional cohort study
Musick, David W.; Criss, Tracey W.; Rudd, Mariah J.; Mutcheson, R. Brock; Harrington, Daniel P.; Knight, Aubrey L. (2026-02-19)
Objectives: To examine stressors and coping skills as re-flected in the student population at a southeastern United States medical school, including identifying key stressors over time and coping mechanisms used. Methods: Repeated cross-sectional cohort, mixed-methods study conducted between 2016 and 2022 at a four-year med-ical school program. Participants were students from seven classes, with two classes providing data during each of their four years of medical school. A census sampling approach was used, with survey data collected annually from each class across four years. Two surveys were used: the Perceived Stress Scale (PSS) and a modified Coping Orientation to Problems Experienced (COPE) Inventory. Open-text ques-tions captured qualitative responses. Statistical analysis in-cluded Welch’s t-tests, Pearson correlations, and Cronbach’s alpha reliability testing. Qualitative data were examined through inductive thematic analysis. Results: Students reported moderate levels of perceived stress across all four years with fluctuations identified by year of study. There were no statistically significant differences in perceived stress based on student gender; however, qualita-tive findings identified gender differences related to coping strategies. Thematic analysis of qualitative data revealed three recurring categories of stressors: academic workload, residency application and match pressures, and personal life challenges. Stressors shifted from academic in the pre-clini-cal years to career concerns during the clinical years. Conclusions: This study highlights the presence of stress throughout medical school and underscores the importance of adaptive coping strategies and the need for phase-specific interventions to support student well-being. Future research should evaluate the effectiveness of interventions in reducing stress across training stages.
Mirtazapine Induced Tardive Dyskinesia in an Older Adult
Syed, Amin; Soni, Karishma; Bankole, Azziza; Ratnakaran, Badr (Elsevier, 2025-10)
Mirtazapine, first sold in the United States as Remeron in 1996, is a noradrenergic and specific serotonergic antidepressant FDA-approved for major depressive disorder. Its mechanism of action is referred to as NaSSA due to its alpha-2, 5-HT2, and 5-HT3 antagonism. It has also been used off-label as a third-line treatment option for akathisia, appetite stimulation, and SSRIinduced sexual dysfunction. Incidents of hyperkinetic movement disorders caused by mirtazapine have been reported, but even more infrequent for cases involving tardive dyskinesia (TD). The aim of this presentation is to highlight a case of TD with the use of mirtazapine in an older adult and search for more literature involving mirtazapineinduced tardive dyskinesia.
WVEMS Protocols 2026: Protocols, Procedures, Policies & Medications of the Western VA EMS Medical Direction Committee
Stanley, Eric K. (2026-01-15)
Regional EMS Protocols for the WVEMS Council
Epidemiological and Clinical Features of Drowning Cases in a Coastal Region of Türkiye: A Retrospective Study
Koyuncuoğlu, Halil Emre; Karakoyun, Ömer Faruk; Golcuk, Yalcin; Cantaş Türkiş, Fulden; Lareau, Stephanie (Emergency Medicine Association of Turkey, 2026-03-29)
Aim: Drowning is a critical public health issue and a leading cause of unintentional injury and death worldwide, particularly in coastal regions. This study aims to analyze the epidemiological trends, clinical features, and outcomes of drowning cases in Muğla Province, Türkiye, to guide targeted public health interventions and improve emergency care. Material and Methods: A retrospective, single-center observational study was conducted in a tertiary hospital’s emergency department from July 1, 2019, to July 1, 2024. Data from 45 patients diagnosed with drowning (ICD-10 code T75.1) were analyzed, including demographic characteristics, prehospital interventions, clinical severity scores, and outcomes. Statistical analyses were performed to evaluate predictors of 28-day mortality, with p<0.05 considered significant. Results: The median age of patients was 55 years (range: 3–83), with males comprising 53% of cases. Most incidents occurred in the summer (71.1%) and in the sea (93.3%). Abnormal electrocardiograms and radiological findings were strongly associated with mortality (p<0.001 and p=0.008, respectively). The Glasgow Coma Scale Score and Revised Trauma Score were the most accurate predictors of 28-day mortality, with an observed mortality rate of 15%. Comorbidities, including diabetes mellitus and coronary artery disease, also correlated with adverse outcomes. Conclusion: Drowning incidents remain a major challenge in coastal regions, necessitating enhanced prevention strategies, robust emergency resources, and validated scoring tools to improve patient outcomes. Future multicenter studies are needed to validate these findings and inform broader public health interventions.
Informatics as a Well-Being Strategy
Uherick, Lisa; Waasdorp, C. J. (2026-03-17)
Estrogen, Epigenetics, and Cardiometabolic Health: Mechanisms and Therapeutic Strategies in Postmenopausal Women
Edwards, Ailene; Singh, Pranjal; Shah, Vyan; Chander, Vivek; Mishra, Sumita (MDPI, 2026-03-16)
The loss of estrogen following menopause is associated with a marked increase in cardiometabolic risk, accompanied by adverse changes in lipid metabolism, insulin sensitivity, vascular function, and systemic inflammatory tone. Emerging evidence suggests that estrogen signaling interacts with chromatin regulatory mechanisms, including DNA methylation, histone modifications, and chromatin remodeling, across multiple metabolic tissues. In this review, we examine current evidence linking estrogen receptor signaling to epigenetic modulation in cardiovascular, hepatic, adipose, vascular, and immune systems. We propose that epigenetic remodeling represents a plausible and testable mechanistic framework connecting estrogen depletion to cardiometabolic disease progression, while acknowledging that much of the mechanistic evidence derives from preclinical and in vitro systems and that direct longitudinal validation in human cardiovascular tissues remains limited. We further explore how this framework may contribute to understanding the “estrogen paradox” and the heterogeneous outcomes of hormone replacement therapy (HRT), particularly within the context of the timing hypothesis. Finally, we evaluate pharmacologic and lifestyle interventions, including structured exercise, dietary modulation, and cardiometabolic therapeutics, through the lens of potential epigenetic influence. Clarifying tissue-specific and immune-integrated chromatin responses to estrogen loss will be essential for advancing precision strategies aimed at improving cardiometabolic health in postmenopausal women.
COVID-19 Discrimination and Social Anxiety in Burmese Refugees: The Role of Acculturation and Peer Social Support
Cole, Elli; Su, Shu; Zhang, Mengxi; Walls, Jill; Thang, Jenni (2026)
Amidst the COVID-19 pandemic, discrimination against Asian refugees surged. Discrimination is associated with higher social anxiety, which may be mediated by acculturation, yet the negative effects could be buffered by social support. This study examined whether COVID-19 anti-Asian discrimination would predict greater social anxiety in Burmese refugees through acculturation and whether social support moderated these effects. A moderated mediation analysis found that marginalization mediated the relationship between COVID-19 discrimination and social anxiety. Peer social support moderated the relationship between discrimination and social anxiety. These results add to the growing literature on the negative psychological effects of COVID-19 on Asian refugees.
Partial Courses of Fidaxomicin Followed by Oral Vancomycin and the Effect on Recurrence of Clostridioides difficile Infections
Papamanolis, Irene-Constantina; Stornelli, Nicholas; Everson, Nathan; Ahmad, Zayd; Kamrada, Meghan; Lockhart, Ellen Rachel; McDaniel, Lauren (Sage, 2025-12-01)
Background: Clostridioides difficile infection (CDI) causes a significant national health care burden. Literature has demonstrated lower rates of CDI recurrence with fidaxomicin compared with oral vancomycin. However, patients are sometimes switched to oral vancomycin before completing a fidaxomicin course. Objective: The objective of this study is to evaluate rates of CDI recurrence in full courses of fidaxomicin versus partial courses of fidaxomicin followed by a switch to oral vancomycin. Methods: In this single-center, retrospective, cohort study of adults with CDI, patients were screened for inclusion if they received either a full 10-day course of fidaxomicin or partial course of fidaxomicin followed by a switch to oral vancomycin. The primary outcome was the rate of CDI recurrence within 30 days after completion of initial therapy determined by a positive CDI test and initiation of treatment. Results: Ninety-nine patients received a full course of fidaxomicin, and 95 patients received a partial course of fidaxomicin followed by oral vancomycin. Mean age was lower in the full course group compared with the partial course (65.3 years vs 71.5 years, P < 0.002). Clostridioides difficile infection recurrence occurred in 5.1% of the full course group and 7.4% of the partial therapy group (P = 0.503) at 30 days and 13.1% versus 14.7% (P = 0.747) at 90 days. Clostridioides difficile infection–related readmissions at 30 days were similar in the full course and partial course groups (7.1% vs 4.2%, P = 0.389). Conclusion and Relevance: Partial courses of fidaxomicin followed by oral vancomycin had similar 30-day CDI recurrence compared with full course fidaxomicin.
Understanding health systems thinking in medical education: qualitative interviews with expert clinicians
Norris, Matthew B.; Grohs, Jacob R.; Mutcheson, R. Brock; Karp, Natalie; Katz, Andrew; Musick, David W.; Lane, Heidi; Parker, Sarah; Gonzalo, Jed (2026-01-31)
Background: Health systems science (HSS) education is an increasingly important component of undergraduate medical education. Despite curricular advances, the ways in which clinicians implement health systems science knowledge in everyday clinical practice, health systems thinking, remains understudied. A better understanding of how clinicians engage in health systems thinking to address everyday problems in clinical contexts is needed. Methods: We conducted semi-structured interviews with 10 expert clinicians experienced in undergraduate medical education, health systems science, and curriculum development to identify components of competent health systems thinking. Interview questions were informed by ecological systems theory and literature on learning professional competencies. Results: Through interviews with experts, we have come to define health systems thinking (HST) as “an approach to solving problems in healthcare systems that utilizes a deeper understanding of interconnections and behavior of the entire system. As a skill, it coordinates the application of clinical and HSS knowledge and skills toward solving a contextual problem in the healthcare environment.” Clinician comments support the idea that HST is a metacognitive process rather than a specific subset of knowledge domains or affective attributes. This process requires that clinicians understand and navigate pressures on patient care originating from surrounding meso- and macro-systems. Conclusions: Medical students require more explicit exposure to HSS knowledge being implemented in clinical environments, and varied examples highlighting how meso- and macro-system patterns can impact individual patient care. This metacognitive integration of HSS knowledge into everyday clinical practice is critical for preparing medical students to meet the requirements of the accreditation council for graduate medical education (ACGME) core competencies in residency programs. Health systems thinking requires a method of operational assessment to provide students feedback and highlight targeted interventions for further development.
Endovascular treatment of superior vena cava syndrome utilizing an iliac branch endoprosthesis
Colwell, Carter; Boateng, Bernard; Doran, Marisa; Pieroni, Cole; Dadashzadeh, Esmaeel; Adams, Joshua D. (Elsevier, 2025-12-01)
Background: Endovascular therapy is the preferred treatment for superior vena cava (SVC) syndrome, providing rapid symptom relief and high technical success. Lesions involving the confluence of the bilateral innominate veins and SVC, however, remain challenging due to complex anatomy and limited durability of standard stents. Methods: This case series describes the off-label use of the Gore Iliac Branch Endoprosthesis (IBE) for reconstruction of the SVC confluence in four patients with SVC syndrome: three with malignant etiologies and one with benign catheter-associated thrombosis. Results: Technical success was achieved in all patients, with immediate restoration of venous flow and symptom resolution. In malignant cases, patency was maintained until death from cancer at 5–20 months. The benign case demonstrated durable patency and complete symptom relief at 18-month follow-up. No procedural complications or early device failures occurred. Conclusions: The Gore IBE offers a feasible approach for anatomic reconstruction of the SVC confluence, accommodating bilateral venous inflow while maintaining luminal integrity. This technique may overcome limitations of parallel stenting, providing durable symptom relief in both malignant and benign SVC syndrome. Further investigation is warranted to evaluate long-term outcomes and broader applicability.
Quality and Safety Practices among Academic Obstetrics and Gynecology Departments
Christopher, Diane; Leininger, William M.; Beaty, Laurel; Nunziato, Jaclyn D.; Kremer, Mallory E.; Diaz Quinones, Juan J.; Rutz, Sara; Griffin, Todd R.; Klatt, Timothy E. (2023)
The objective was to quantify resources devoted to quality and patient safety initiatives, to document the development and use of key performance indicator reports regarding patient outcomes and patient feedback, and to assess the culture of safety within academic obstetrics and gynecology departments. Chairs of academic obstetrics and gynecology departments were asked to complete a quality and safety assessment survey. Surveys were distributed to 138 departments, yielding 52 completed responses (37.7%). Five percent of departments reported including a patient representative on a quality committee. Most committee leaders (60.5%) and members (67.4%) received no compensation. Formal training was required in 28.8% of responding departments. Most departments monitored key performance metrics for inpatient outcomes (95.9%). Leaders scored their departments’ culture of safety highly. Most departments provided no protected time to faculty devoted to quality efforts, generation of key performance indicators for inpatient activities was prevalent and integrating patient and community input remain unrealized opportunities.
A tool to address barriers in perinatal mental health screening, the PMH Connect: a perinatal mental health screening connection, education, and decision aid
Moyer, Sara Wagner; Nunziato, Jaclyn D.; Karjane, Nicole W.; Rivera, Alexis I.; Wisner, Katherine L.; Salisbury, Amy L.; Kinser, Patricia A. (Frontiers, 2026-02-02)
Mental disturbances and related symptoms in the perinatal period present a challenge to patients and providers alike, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis thanks to guidelines recommending the use of validated screening measures used at perinatal visits. However, patients report several concerns when completing these screeners and providers report barriers in addressing the results. To address barriers and enhance the PMH screening experience, our team of clinicians and researchers propose a tool – the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid – to be given to the patient at the same time as a PMH screener. The PMH Connect provides brief anticipatory guidance about PMH symptoms, normalizing trauma-informed language about prevalence, and provides a connection to resources in a supportive, unobtrusive manner. PMH Connect helps patients feel heard and supported and provides resources before patients need them, which decreases the burden on patients and providers alike. Inspired by the Cycle to Respectful Care framework, PMH Connect is designed to shift power to patients themselves, as valued experts on their own care team, by offering them connections to information and resources through this simple tool. Our hope is that PMH Connect will bridge many of the barriers to effective PMH screening, assessment, and treatment by improving patients’ experiences and outcomes with the ultimate goal of optimizing screening effectiveness and care connection to improve maternal and infant health.
A Community-Based Trauma-Informed Care Curriculum on Women's Health for Third-Year Medical Students
Nunziato, Jaclyn; Lessard, Chloe; Karp, Natalie; Lane, Heidi; Locklear, Tonja; Simcox, Kimberly (Association of American Medical Colleges, 2026-01)
Introduction: Trauma affects 90% of individuals and has profound impacts on health, making it essential for medical trainees to recognize its effects. Trauma-informed care (TIC) offers a framework for developing these skills. Despite its importance, no TIC curriculum integrates community feedback into its design. To address this gap, we developed a 4-hour TIC curriculum that incorporates community insight, clinical expertise, and practical communication training. Methods: The curriculum design followed community-based participatory research principles, engaging community members as contributors. The training included a dynamic combination of didactic lectures, video demonstrations, small-group role-play, and an OSCE, supported by a novel TIC toolkit. Community partners were trained as standardized patients (SPs). We assessed student outcomes through pre- and postsession surveys, employing 5-point Likert scales and open-ended responses. Additionally, a custom assessment tool was developed to evaluate OSCE performance, with SPs providing structured feedback. Results: Thirty-four third-year medical students participated, with 100% survey completion. Quantitative analysis revealed significant increases in students' understanding of TIC principles and confidence in applying them from pre- to postsession (p < .05 for all metrics). Students demonstrated strong performance on the OSCE, achieving a mean OSCE performance score of 31.4/38 (or overall score of 82.6%). SP feedback highlighted the students' ability to engage empathetically and effectively in trauma-sensitive encounters. Discussion: This novel TIC curriculum on women's health demonstrates a successful, scalable model for integrating TIC training into medical education. By embedding community voices and combining evidence-based principles with experiential learning, this program addresses educational gaps in TIC medical education.
Impact of obesity on the perinatal vaginal environment and bacterial microbiome: effects on birth outcomes
Ingram, Kelly; Eko, Embelle Ngalame; Nunziato, Jaclyn; Ahrens, Monica; Howell, Brittany (Microbiology Society, 2024-08)
Introduction. Lactobacillus species predominate the human vagina and are associated with positive vaginal health, including an acidic pH (<4.5). The prevalence of vaginal Lactobacilli increases with increased oestrogen due to increased glycogen production within the vagina. Lactobacilli produce lactic acid, thereby lowering vaginal pH, preventing growth of other bacteria, and lowering microbial diversity. Lower placental oestrogen levels in obese pregnant women could dampen the mechanism to initiate this process, which may be associated with vaginal dysbiosis and unfavourable pregnancy outcomes. Hypothesis. We hypothesize that oestrogen and glycogen levels will be lower, vaginal pH will be higher, and vaginal microbiome diversity will be greater during pregnancy in obese and overweight women compared to healthy weight women. Aim. Pregnancy complications (e.g. preterm birth) are more common in overweight and obese women. If vaginal dysbiosis plays a role, and quantifiable predictors of this increased risk can be determined, these measures could be used to prospectively identify women at risk for pregnancy complications early in pregnancy. Methodology. Vaginal samples were collected at 10–14, 18–24, 26–30, and 34–37 weeks gestation and at delivery from 67 pregnant participants (23 healthy weight, 22 overweight, 22 obese). A blood sample to quantify serum oestrogen was collected at 10–14 weeks. Vaginal samples were collected to test vaginal pH using pH paper, glycogen abundance using fluorometry, and the vaginal microbiome using 16S rRNA amplicon sequencing. Results. Vaginal pH was higher in obese participants compared to healthy weight participants (P=<0.001). Vaginal glycogen levels increased over time in obese participants (P=0.033). The vaginal bacterial alpha diversity was higher in obese participants compared to healthy weight participants (P=0.033). The relative abundances of Peptoniphilus and Anaerococcus were increased in overweight and obese participants, as well as in complicated pregnancies, at 10–14 weeks gestation. Conclusion. The relative abundance of specific vaginal bacteria, like Peptoniphilus and Anaerococcus, in early pregnancy could predict pregnancy outcomes. Our goal is to use the information gathered in this pilot study to further determine the feasibility of assessing the vaginal environment during pregnancy to identify women at risk for negative pregnancy and birth outcomes in the context of a larger study.
Building research capacity in sub-Saharan Africa: findings from a pilot scientific writing workshop in Cameroon
Dabou, Solange; Ngo, Valery N.; Dongho, Ghyslaine B. D.; Nanseu, Evrard M. K.; Sinsai, Regina Y.; Asahngwa, Constantine T.; Kibu, Odette D.; Goupeyou-Youmsi, Jessy; Cheuyem, Fabrice Z. L.; Conner, Anna; Gobina, Ronald M.; Foretia, Denis A. (2026-01-24)
Objective: Sub-Saharan Africa produces less than 4% of global scientific output, despite significant health and development challenges. This study evaluated the effectiveness of a pilot scientific writing workshop in Cameroon aimed at building writing skills and publication readiness of early career researchers. We conducted two workshops’ sessions in Yaoundé, Cameroon, in April and November 2023. A mixed-methods approach was used. Quantitative data were obtained via pre- and post-workshop questionnaires designed to capture participants’ self-assessed knowledge, skills, and confidence related to the workshop content. Qualitative data were gathered through in-depth interviews. Descriptive and inferential statistics were applied to the survey data, and thematic content analysis was used to assess qualitative responses. Results: A total of 86 participants completed both the pre- and post-workshop surveys (response rate: 86.9%). The majority had never published scientific papers (62.8%) nor had they received formal writing training (61.6%). The quantitative results showed statistically significant improvements in participants’ overall understanding of scientific writing and publishing (mean difference = 0.93, p < 0.001) and confidence regarding writing skills (mean difference = 0.94, p < 0.001). Thematic analysis of the interviews revealed high satisfaction with the learning environment, perceived knowledge gains, and a strong demand for mentorship and sustained training opportunities. Highlights: Most of the participants (61.6%) had never completed a scientific writing or publication course. Almost two thirds (62.8%) had never published a scientific paper before. Participants reported increased knowledge, skills and confidence in scientific communication. Junior researchers in Africa seek consistent mentorship and training opportunities.
The Use of Digital Neurocognitive Assessments to Assess Traumatic Brain Injury and Dementia in Older Trauma Patients: An Emergency Department Feasibility Study
Weppner, Justin; Gray, Justin; Kuehl, Damon; Sandsmark, Danielle; Mirshahi, Nazanin; Diaz-Arrastia, Ramon; Rascovsky, Katya; Peacock, W. Frank; Van Meter, Timothy E. (MDPI, 2026-01-27)
Background/Objectives: Older adults are disproportionately affected by traumatic brain injuries (TBIs), representing a significant portion of TBI-related hospitalizations and deaths. The objective of this study was to evaluate the feasibility and effectiveness of BrainCheck (Braincheck, Inc., Austin, TX, USA), a digital cognitive assessment tool, in detecting acute TBI-related cognitive deficits in the context of dementia-related cognitive impairment in older adult emergency department (ED) patients. Methods: From March 2020 to November 2023, participants aged 65+ with mild TBI, as defined by the American College of Rehabilitation Medicine (ACRM) diagnostic criteria, and individuals with isolated orthopedic injuries were recruited from 14 U.S. type 1 and 2 trauma centers. After informed consent, each subject was assessed by well-validated neurocognitive tests to characterize pre- and postinjury cognitive status. The Clinical Dementia Rating (CDR) and Functional Activities Questionnaire (FAQ) were used to assess cognitive impairment, with the informant sections used to classify preinjury status. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ16) was used to assess injury-related symptoms, and the tablet-based BrainCheck Battery was tested as a diagnostic platform for injury-related deficits across several functional domains. Spearman's correlation was used to assess BrainCheck's internal validity and its relationship with self-reported cognitive symptoms. Technology familiarity was self-reported on a 1 (lowest) to 5 (highest) Likert scale. ROC curves evaluated the tool’s accuracy in identifying cognitive impairment associated with TBI in the context of pre-existing cognitive impairment. Results: For the 101 mTBI and 52 orthopedic trauma control patients, BrainCheck demonstrated strong internal validity, with significant correlations among its component tests, indicating its effectiveness in assessing cognitive impairment. However, low correlations with RPQ16 self-reported symptoms suggest that BrainCheck and the self-reported questionnaire assess different aspects of cognitive functions. Conclusions: While BrainCheck effectively identified cognitive impairment, the composite battery and scoring did not differentiate TBI and dementia. Technology familiarity did not affect test outcomes. BrainCheck is a useful tool for evaluating cognitive function in adults aged ≥ 65 years with and without TBI in ED settings.
Education Research: Entrustable Professional Activities for General Neurology Advanced Practice Providers: Results of a Modified Delphi Consensus Process
Harrison, Daniel S.; Doherty, Elyse M.; Meffert, Cassandra C.; Doughty, Christopher T.; Morgenlander, Joel C.; Entrustable Professional Activities for General Neurology APPs (EPAGNA) Study Group; Shah, Aashit (Wolters Kluwer Health, 2026-03)
BACKGROUND AND OBJECTIVES: A dedicated didactic framework, assessment strategy, and consensus expectations for advanced practice providers (APPs) entering general neurology practice for the first time have not been described. We aimed to define entrustable professional activities (EPAs) for general neurology APPs and to provide further validity evidence for the EPAs through application of the EQual rubric. METHODS: This was a modified Delphi consensus process. Panelists were leaders of neurology APP fellowship programs and other established experts in neurology APP education. The steering committee identified putative EPA topics. Panelists voted on a 5-point Likert scale how important it was that a new general neurology APP be able to perform specific activities with indirect supervision remotely available by the end of their on-the-job training. Panelists were allowed to propose modifications to putative EPAs and suggest new EPAs. After 3 rounds of voting, full EPA descriptions were drafted by the steering committee. Full EPA descriptions were sent to external experts in neurology APP education for assessment of their structure and quality. The steering committee met again to discuss feedback from the external experts and make adjustments as needed. The full EPA descriptions were sent to the Delphi panelists for a final round of voting. RESULTS: Of 35 experts invited to participate in the Delphi process, 30 agreed to serve as panelists, 16 of whom were program leaders in neurology APP fellowship programs. The steering committee proposed 13 core and 52 nested EPA topics and the panelists proposed 6 modifications and an additional 4 nested EPAs. After 3 rounds of voting, 13 core and 46 nested EPAs were retained and full EPA descriptions were authored. All EPA descriptions met the pre-specified cut score for quality and structure and were retained in a final Delphi round. Overall entrustment expectations did not differ between panelists who were fellowship program leaders and those who were not (5-point Likert median [interquartile range], 4 [4-5] vs 4 [4-5], p = 0.980, r = 0.005). DISCUSSION: These consensus EPAs may be applied for curricular development and assessment for new general neurology APPs. Entrustment expectations did not differ between those who were leaders in fellowship programs and those who were not.
Managing the Behavioral and Psychological Symptoms of Dementia
Unwin, Brian K. (2026-02-01)
Scaffold-free 3D-Cell Culture Model System for the Study of Metastatic Cell Behavior in the Brain TME
Sarkar, Pratistha; Ahuja, Shreya; Lazar, Iuliana M. (Cold Spring Harbor Laboratory, 2025-11-03)
Cancer is a complex disease involving dynamic interactions between cancer, stromal, and infiltrating immune cells, as well as between these cells and the extracellular matrix components of the tumor microenvironment. Brain metastases arise primarily from solid tumors and often result in fatal outcomes. An in-depth understanding of the complex intercellular interactions that evolve in the brain microenvironment is essential to enabling early cancer diagnostics and improving patient outcomes. The protected tumor microenvironment of the brain hinders, however, direct access, impeding the execution of mechanistic studies and limiting the ability to derive meaningful insights. Several in vitro 2D and 3D model systems have been developed to circumvent this problem, none, however, without limitations. The 2D models fail to recapitulate the 3D architecture of the in-vivo environment lacking therefore physiological relevance, while the 3D models present challenges related to the lack of control over cell positioning, lack of vascularization, contamination from non-human scaffolds, batch-to-batch reproducibility, and high production costs. To overcome some of these limitations, we developed an in vitro scaffold-free 3D tumor model system to simulate the in vivo brain metastatic niche. The model was constructed from human brain endothelial cells (HBEC-5i) and two different cancer cell lines derived from breast (MDA-MB-231/triple negative and SK-BR-3/HER2+) and aggressive ovarian (SK-OV-3) cancers. The development of the model relies on a newly identified affinity between the endothelial and cancer cells that enables them to self-assemble in 3D networked constructs, a feature facilitated by the high collagen production by endothelial cells and the secretion of key chemokines by both endothelial and cancer cells. The model mimics the attachment of metastasized cancer cells to the brain microvasculature, enabling the study of temporal changes in endothelial morphology and molecular signaling processes that sustain cancer cell migration, survival, proliferation, and angiogenic processes. Moreover, the model exhibits long-term stability, reproducibility, and effectiveness in evaluating anti-cancer agents. Altogether, the scaffold-free, simple 3D in vitro model systems provides a low cost, physiologically relevant tool for studying the dynamic molecular crosstalk between cancer and brain endothelial cells, and for investigating the fundamental biological processes that unfold in the tumor microenvironment.
Impact of maternal obesity and mode of delivery on the newborn skin and oral microbiomes
Seifert, Allison; Ingram, Kelly; Eko, Embelle Ngalame; Nunziato, Jaclyn; Ahrens, Monica; Howell, Brittany R. (Microbiology Society, 2025-04-10)
Introduction. Previous studies have shown vast differences in the skin and oral microbiomes of newborns based on delivery method [Caesarean section (C-section) vs vaginal]. Exposure to or absence of certain bacteria during delivery can impact the neonate’s future susceptibility to infections, allergies or autoimmunity by altering immune functions. Few studies have focused on the impact of maternal obesity on the variations of newborn skin and oral microbiomes. Obese pregnant women typically have a higher vaginal microbiome diversity, and their pregnancies are at higher risk for adverse outcomes and complications. Hypothesis. We hypothesized that the skin and oral microbiomes of newborns born to obese mothers would include more diverse, potentially pathogenic bacteria and that the skin and oral microbiome in C-section delivered newborns would be less diverse than vaginally delivered newborns. Aim. We aim to begin to establish maternal obesity and mode of delivery as factors contributing to increased risk for negative newborn outcomes through impacts on newborn bacterial dysbiosis. Methodology. A skin swab was collected immediately following delivery of 39 newborns from 13 healthy weight body mass index (BMI 18.50–24.99), 11 overweight (BMI 25.0–29.99) and 15 obese (BMI ≥30.00) pregnant participants. An oral swab was collected immediately following delivery for 38 of these newborns from 13 healthy weight, 10 overweight and 15 obese pregnant participants. Bacterial genera were identified via 16S rRNA amplicon sequencing. Results. The newborn skin microbiome was comprised of typical skin bacteria (i.e. Corynebacterium). Newborns of obese participants had a higher relative abundance of Peptoniphilus in their skin microbiome compared to newborns of healthy weight participants (P=0.007). Neonates born via C-section had a higher relative abundance of Ureaplasma in their oral microbiome compared to neonates delivered vaginally (P=0.046). Conclusion. We identified differences in the newborn skin and oral microbiomes based on pre-pregnancy BMI and method of delivery. These differences could be linked to an increased risk of allergies, autoimmune disease and infections. Future longitudinal studies will be crucial in determining the long-term impact of these specific genera on newborn outcomes. Understanding these connections could lead to targeted interventions that reduce the risk of adverse outcomes and improve overall health trajectory.

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