Publications | Center for Community Health Integration

CHI Center Publications - August 1, 2025 – August 17, 2026

Title: Embracing complexity: An opportunity for developmental evaluation

Author(s): Biroscak, BJ (Biroscak, Brian J.); Hovmand, PS (Hovmand, Peter S.)

Source: JOURNAL OF CLINICAL AND TRANSLATIONAL SCIENCE Volume: 10 Issue: 1 Article Number: e102 DOI: 10.1017/cts.2026.10767 Early Access Date: JUN 2026 Published Date: 2026 JUN 5

PubMed ID: 42375223

Title: Integration of social marketing and system dynamics modeling to address health disparities: an academic-community partnership case study

Author(s): Biroscak, BJ (Biroscak, Brian J.); Khaliq, M (Khaliq, Mahmooda); Schneider, T (Schneider, Tali); Dash-Pitts, L (Dash-Pitts, Lolita); Loi, CXA (Aguado Loi, Claudia Ximena); Ewing, AP (Ewing, Aldenise Phylicia); Hovmand, PS (Hovmand, Peter S.); Bryant, CA (Bryant, Carol A.); Parvanta, C (Parvanta, Claudia)

Source: JOURNAL OF SOCIAL MARKETING Volume: 15 Issue: 4 Pages: 579-600 DOI: 10.1108/JSOCM-02-2025-0025 Early Access Date: NOV 2025 Published Date: 2025 DEC 3

Abstract: PurposeThe purpose of this innovative case study research was to integrate community-based social marketing and system dynamics modeling to address colorectal cancer screening disparities. The resulting framework, Community-Based Prevention Marketing (CBPM) for Systems Change, was designed to build academic-community partners' social marketing and systems thinking capacities, for designing, implementing and evaluating multilevel prevention strategies.Design/methodology/approachThis case study used a CBPM framework, integrating participatory system dynamics modeling to design, implement and evaluate a multilevel intervention. Implementation of group modeling techniques during the workshops with a cancer community coalition guided development of causal loop diagrams, leverage points identification and intervention scenarios to enhance colorectal cancer screening rates in a specific US community. Refinement of qualitative and quantitative models emerged and were refined through integration of community wisdom, secondary data and rich discussions when applying systems thinking visualization tools.FindingsThe participatory system dynamics modeling process was valued by the partners. However, there was a mismatch between the community partners' expectations for quick results and the longer timelines suggested by the simulation modeling. The difference between what the partners hoped to achieve and what the simulations revealed led them to question the utility of the simulation modeling. As a result, they decided to continue developing and implementing the social marketing strategy without further using the simulation tools. Anticipation of such an outcome should be incorporated when designing systems thinking approaches with community organizations.Originality/valueTo the best of the authors' knowledge, this is the first social marketing application integrating participatory system dynamics simulation modeling and community-based social marketing. Findings suggest that the two orientations, a marketing orientation and systems thinking orientation can inform shared decision-making. Yet, more real-world applications are needed to facilitate shared learning among social marketing researchers, practitioners and clients.

Title: Accelerating Community-Based Tobacco Cessation Treatment in Ohio FQHCs: A Statewide Quality Initiative

Author(s): Boone, M (Boone, Madeline); White, T (White, Tiffany); Hughes, A (Hughes, Amy); Ballard, A (Ballard, Ashley); Vallangeon, DS (Vallangeon, Dana S.); Gullett, H (Gullett, Heidi)

Source: JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Volume: 37 Issue: 3 Pages: 140-150 Published Date: 2026 AUG Supplement: S

Abstract: Despite declines in tobacco use, disparately high use remains among low-income and rural populations. The Ohio Primary Care Association supports 60 health centers statewide that provide preventive, integrated care. These centers play a key role in tobacco cessation, successfully increasing screenings and reducing tobacco use in underserved communities.

PubMed ID: 42403325

Title: Age-stratified risk profiles for emergency colorectal cancer resection: A machine-learning analysis

Author(s): Lal, T (Lal, Trisha); Liu, FZ (Liu, Fangzhou); Cabulong, A (Cabulong, Alexander); Kang, CO (Kang, Christine O.); Hoehn, RS (Hoehn, Richard S.); Rose, J (Rose, Johnie); Koroukian, SM (Koroukian, Siran M.)

Source: JOURNAL OF GASTROINTESTINAL SURGERY Volume: 30 Issue: 8 Article Number: 102448 DOI: 10.1016/j.gassur.2026.102448 Published Date: 2026 AUG

Abstract: Background: Emergency colorectal cancer resection (ECCR) is associated with worse perioperative and oncologic outcomes than elective surgery. As the incidence of colorectal cancer rises among younger adults and disparities persist across the life course, we examined how clinical and sociodemographic factors intersect to shape ECCR risk across age groups. Methods: We conducted a retrospective cohort study of adult colorectal cancer resection admissions in the National Inpatient Sample between 2018 and 2022. Multivariable logistic regression and classification and regression tree (CART) analyzes were used to identify independent predictors of ECCR and age-specific high-risk phenotypes. Results: Among 510,135 resection admissions, 64,175 (12.6%) were ECCR. ECCR admissions more often involved patients with compromised health (weight loss, anemia, coagulopathy, and electrolyte disorders), metastatic disease, and >= 3 comorbidities across all ages. Among younger and middle-aged adults, ECCR disproportionately involved patients who were on Medicaid or who were uninsured and those from lower-income communities. In multivariable models, female sex and higher income were associated with protection across most age groups, whereas being on Medicaid or uninsured status, having a higher comorbidity burden, and admission during the COVID-19 pandemic era were more frequently associated with higher odds of ECCR. CART analysis identified age-specific phenotypes, with insurance status predominating in patients younger than 75 years, and clinical complexity and pandemic-era timing predominating in those aged 76 years or older. Conclusion: ECCR risk reflects different dominant mechanisms across age groups, suggesting that a one-size-fits-all approach is unlikely to reduce emergency presentations. Age-tailored strategies that address access barriers and optimize management of medically complex older adults may improve timely, equitable colorectal cancer care. (c) 2026 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

PubMed ID: 42263377

Title: Influence of US lung composite allocation score components on transplant candidate prioritization

Author(s): Dalton, JE (Dalton, Jarrod E.); Rose, J (Rose, Johnie); Lehr, CJ (Lehr, Carli J.); Gunsalus, PR (Gunsalus, Paul R.); Valapour, M (Valapour, Maryam)

Source: JOURNAL OF HEART AND LUNG TRANSPLANTATION Volume: 45 Issue: 7 Pages: 1064-1067 DOI: 10.1016/j.healun.2026.03.016 Published Date: 2026 JUL

Abstract: Since implementation of the Composite Allocation Score (CAS) in March 2023, exception requests have increased, suggesting potential misalignment between policy intent and the actual prioritization achieved. Using the Scientific Registry of Transplant Recipients, we computed CAS component scores and quantified each component's contribution to total CAS variability. Medical urgency constitutes 25 of the 100 possible CAS points but was responsible for 40.6% of variation in total scores. Biological disadvantage is assigned 15 points but accounted for 33.3% of CAS variation; and geographic efficiency is assigned 10 points but drove 16.6% of variation. Posttransplant survival (25 points) accounted for the most points received but explained only 6.4% of variation. These results indicate that lung transplant candidate prioritization in the United States is dominated by medical urgency, biological disadvantage, and geographic efficiency, revealing a divergence between intended and actual contributions of CAS components to total scores. (c) 2026 The Authors. Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. This is an open access article under the CC BY-NC-ND license (http://creative-commons.org/licenses/by-nc-nd/4.0/).

PubMed ID: 41856261

Title: Longitudinal effects of inpatient music therapy dosage on pain intensity and opioid utilization among patients with hematologic or oncologic conditions: a retrospective cohort study

Author(s): Rodgers-Melnick, SN (Rodgers-Melnick, Samuel N.); Gunzler, D (Gunzler, Douglas); Love, TE (Love, Thomas E.); Koroukian, SM (Koroukian, Siran M.); Beno, M (Beno, Mark); Rao, S (Rao, Santosh); Razzak, R (Razzak, Rab); Dusek, JA (Dusek, Jeffery A.); Rose, J (Rose, Johnie)

Source: SUPPORTIVE CARE IN CANCER Volume: 34 Issue: 7 Article Number: 620 DOI: 10.1007/s00520-026-10865-x Early Access Date: JUN 2026 Published Date: 2026 JUN 6

Abstract: PurposeSeveral studies support the benefits of music therapy (MT) for improving symptoms within a single session among patients with hematologic/oncologic conditions, but none have examined real-world longitudinal impacts. This study evaluated whether there was a dose-response relationship between MT intervention exposure and longitudinal changes in pain intensity and opioid utilization.MethodsA retrospective electronic health record review was conducted of 283 hospital admissions among adult patients with hematologic/oncologic conditions who received MT and either reported pain >= 4/10 on the numeric rating scale (NRS) or received opioids in the first 48 h of admission. Longitudinal changes in pain intensity on the 0-10 NRS and log-transformed morphine milligram equivalents were modeled using linear mixed-effects models with natural splines for time since first MT intervention interacting with MT exposure group (1, 2, or >= 3 MT interventions). Models were adjusted for baseline values and length of stay.ResultsOf 283 hospital admissions, 122 (43.1%) included 1, 89 (31.4%) included 2, and 72 (25.4%) included >= 3 MT interventions. No meaningful MT exposure-by-time effects were found for pain intensity (p = .131) or opioid utilization per day (p = .118).ConclusionsAmong patients admitted with hematologic/oncologic conditions, greater MT exposure does not appear to reduce pain intensity or opioid exposure over time relative to receiving 1 MT intervention. Future evaluations of inpatient programs should consider collecting more robust data on outcomes that may be more sensitive to intervention (e.g., stress, anxiety) and increasing the MT dose to have a greater impact on outcomes over time.

PubMed ID: 42249214

Title: Gaining market share for health: A social marketing framework for implementation science

Author(s): Biroscak, BJ (Biroscak, Brian J.)

Source: HEALTH MARKETING QUARTERLY DOI: 10.1080/07359683.2026.2668844 Early Access Date: MAY 2026 Published Date: 2026 MAY 22

Abstract: Implementation science struggles to bridge the evidence-to-practice gap because market dynamics at the T3 (translation to practice) and T4 (translation to populations) stages remain unaddressed. This commentary advances three theoretical claims: implementation stages constitute distinct markets where adoption failures are market failures; exchange theory must extend to multi-level ecosystems; and system dynamics-based interactive learning environments (SD-ILEs) enable mental model restructuring via co-created narrative experiences. I propose a social marketing framework across the T3-T4 continuum, differentiating it from leading implementation frameworks. The approach is illustrated through Pb-ROADS, a narrative-computational ILE for lead (Pb) exposure prevention. Implications include new outcome metrics (e.g., market share of evidence-based practices), practitioner competencies like "systems fluency," and a reassessment of academic training infrastructure.

PubMed ID: 42173683

Title: Assessing the Impact of Enhanced Primary Care on Population Health and Health Services Utilization in Singapore: A Modified Delphi Study

Author(s): Ansah, JP (Ansah, John P.); Abdullah, FNM (Abdullah, Fadzillah Nur Mohamed); Mitcham, K (Mitcham, Kala); Tummala, S (Tummala, Sanjana); Matchar, DB (Matchar, David B.)

Source: JOURNAL OF GENERAL AND FAMILY MEDICINE Volume: 27 Issue: 3 Article Number: e70129 DOI: 10.1002/jgf2.70129 Published Date: 2026 MAY 19

Abstract: Background Rapid population aging and increasing chronic disease prevalence underscore the need to strengthen primary care systems globally. The Primary Care Assessment Tool (PCAT) provides a structured framework for evaluating how well primary care systems meet population health needs. In Singapore, primary care is delivered through the main sectors: public polyclinics and private general practitioner (GP) clinics.Method A modified Delphi study was conducted with expert representatives from the primary care sector. Five primary care group practices in Singapore were recruited to form the expert panel. The study employed the short form of the PCAT-PS to assess and compare typical and enhanced models of primary care delivery, evaluating key dimensions including first-contact accessibility, service continuity, coordination, and comprehensiveness.Results With a maximum possible PCAT score of 24, typical GP clinics scored 19.09, typical polyclinics scored 18.88, enhanced polyclinics scored 20.90, and improved GP clinics achieved the highest score of 21.24. Experts estimated that patients receiving care in enhanced primary care settings would be less likely to experience deterioration in their health than those in typical settings. Enhancements were also associated with reduced hospitalizations and specialist outpatient visits, as well as increased use of primary care services.Conclusion Findings from this expert panel suggest that plausible enhancements to Singapore's public and private primary care systems could significantly improve population health outcomes, reduce reliance on high-cost specialist and hospital services, and strengthen primary care's role as the first point of contact within the healthcare system.

Title: HIV Infection: What Is New in Prevention and Treatment?

Author(s): Ganesh, PR (Ganesh, Prakash R.); Navracruz, LC (Navracruz, Lisa C.)

Source: AMERICAN FAMILY PHYSICIAN Volume: 113 Issue: 5 Pages: 479-492 Published Date: 2026 MAY

Abstract: HIV remains a significant public health challenge despite highly effective prevention and treatment strategies. Screening for HIV infection is recommended for individuals ages 15 to 65 years. The status neutral approach to care includes preexposure prophylaxis for HIV-negative patients and antiretroviral therapy for patients with HIV. The preexposure prophylaxis options approved by the US Food and Drug Administration include oral and injectable formulations, which reduce HIV acquisition risk by 99% when taken consistently. Same-day antiretroviral therapy initiation is the standard of care for patients diagnosed with HIV infection, with integrase strand transfer inhibitor-based regimens preferred for treatment-naive patients. Key clinical considerations in primary care require modified management approaches for patients with HIV. All patients 40 to 75 years of age with HIV infection and 10-year atherosclerotic cardiovascular disease risk scores between 5% and less than 20% should be prescribed a moderate-intensity statin, and those with risk scores of 20% or greater should receive a high-intensity statin. In addition to standard age-appropriate vaccines, adults with HIV should receive hepatitis A and B (if not immune), meningococcal, pneumococcal, and herpes zoster vaccines. Cancer screening for patients with HIV includes lifelong cervical cancer screening. Anal cancer screening should start at age 35 for men who have sex with men and transgender women, and at age 45 for all other patients. Family physicians are uniquely positioned to deliver comprehensive care that addresses HIV-specific needs and whole person primary care.

PubMed ID: 42202359

Title: AGE-STRATIFIED RISK PROFILES FOR EMERGENCY COLORECTAL CANCER RESECTION USING MACHINE-LEARNING ANALYSES

Author(s): Lal, T (Lal, Trisha); Liu, FZ (Liu, Fangzhou); Cabulong, A (Cabulong, Alexander); Kang, CSE (Kang, Christine); Hoehn, RS (Hoehn, Richard S.); Rose, J (Rose, Johnie); Koroukian, S (Koroukian, Siran)

Source: GASTROENTEROLOGY Meeting Abstract: Su1442 Volume: 170 Issue: 6 Pages: S291-S292 Published Date: 2026 MAY Supplement: S

Title: Understanding the Needs and Challenges of Cancer Registry Stakeholders

Author(s): Rose, J (Rose, Johnie); GeethaKumari, AS (Sarangadharan GeethaKumari, Akhil); Koroukian, SM (Koroukian, Siran M.); Kim, U (Kim, Uriel); Lyytinen, K (Lyytinen, Kalle)

Source: JCO CLINICAL CANCER INFORMATICS Volume: 10 Article Number: e2500168 DOI: 10.1200/CCI-25-00168 Published Date: 2026 MAY

Abstract: Purpose Cancer registry data represent an indispensable tool for researchers and community outreach and engagement (COE) professionals seeking to understand and mitigate cancer burden in cancer center catchment areas and beyond. To provide insights into the opportunities and obstacles for innovation in the population cancer data space, we contrast the needs and challenges of three groups of stakeholders with regard to cancer registry data. Methods We convened a nationwide panel of 18 population cancer researchers, COE professionals, and central cancer registry officials. We performed qualitative analysis of individual interviews, survey responses, and meeting transcripts to identify the cancer registry data-related needs and challenges of each stakeholder group. We identified distinct functional categories related to registry data applications, and described points of convergence and divergence within each category across the three stakeholder groups. Results We completed 8 hours of individual panelist interviews, received 16 survey responses (88.9% response rate), and conducted three meetings of working groups. All stakeholder groups agreed on the value of accurate and representative registry data. Researchers desired granular data (case-level and aggregated by small geographic levels) with more clinically relevant data fields and linked community-level access measures. COE participants valued cancer burden and social drivers of health metrics aggregated at a subcounty level as well as user-friendly data querying and visualization tools. Cancer registry officials described an imperative to comply with mandatory reporting requirements and to protect patient privacy in a setting of resource constraint that can conflict with the data use goals of researchers and COE users. Conclusion Population cancer researchers, COE professionals, and cancer registry officials understand the value of registry data, but the priorities of each are misaligned to varying degrees. Further work is needed to understand the elements of successful efforts to expand the utility and use of registry data.

PubMed ID: 42090633

Title: Age-related macular degeneration and dementia: Association through pathogenesis or visual impairment?

Author(s): Gu, XY (Gu, Xinyu); Terebuh, P (Terebuh, Pauline); Xu, R (Xu, Rong); Kaelber, DC (Kaelber, David C.); Davis, PB (Davis, Pamela B.)

Source: JOURNAL OF ALZHEIMERS DISEASE Volume: 111 Issue: 3 Pages: 1014-1024 DOI: 10.1177/13872877261438849 Early Access Date: APR 2026 Published Date: 2026 JUN

Abstract: Background Studies suggest a link between blindness, age-related macular degeneration (AMD), and dementia risk, but whether this stems from AMD pathology or blindness remains unclear. This study examines the relationship between AMD and dementia.Objective To evaluate the association between AMD and 5-year dementia risk in non-blind patients.Methods This retrospective cohort study used TriNetX to compare non-blind patients with exudative AMD (n = 35,021) and non-exudative AMD (n = 96,809) to those without AMD (n = 1,801,879) for five-year dementia risk. Blind (n = 90,615) and non-blind (n = 800,737) patients were compared. Cohorts were propensity-matched for confounding factors.Results Non-blind AMD patients had decreased Alzheimer's disease risk, while blindness showed a strong positive association. Exudative AMD had HR of 0.84 (95% CI = [0.72, 0.97]), non-exudative AMD had HR of 0.95 (95% CI = [0.87, 1.04]), but blindness increased Alzheimer's disease risk (95% HR = 1.29, CI = [1.17, 1.41]).Conclusions These findings suggest that previously reported associations between AMD and dementia may be partially mediated by visual impairment. The modest reduction in dementia risk in non-blind AMD patients may reflect differences in healthcare utilization or treatment exposure among AMD patients.

PubMed ID: 42033410

Title: Effectiveness of Music Therapy on Utilization Outcomes among Surgical Patients with Mental Health Conditions: A Propensity-Score Matched Cohort Study

Author(s): Rodgers-Melnick, SN (Rodgers-Melnick, Samuel N.); Love, TE (Love, Thomas E.); Koroukian, SM (Koroukian, Siran M.); Gunzler, D (Gunzler, Douglas); Beno, M (Beno, Mark); Razzak, R (Razzak, Rab); Dusek, JA (Dusek, Jeffery A.); Rose, J (Rose, Johnie)

Source: JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE DOI: 10.1177/27683605261444109 Early Access Date: APR 2026 Published Date: 2026 APR 20

Abstract: Background: Music interventions can be beneficial for reducing post-operative pain and opioid exposure, but few studies have investigated music therapy (MT)'s real-world effects on utilization outcomes. This study examined characteristics associated with receiving MT and its impacts on length of stay (LOS) and opioid utilization among surgical patients with mental health and/or substance use disorders (MSUD). Methods: A retrospective cohort study was conducted of 4239 inpatients (267 MT, 3972 usual care) with MSUD who underwent surgery between August 2020 and July 2023. A propensity score for receiving MT accounting for sociodemographics, pain, hospital services, and multiple comorbidities was used to create a matched cohort. The effects of MT on log-transformed LOS and mean morphine milligram equivalents (MME)/day were estimated. Results: Among patients receiving MT, the median (IQR) time to MT referral was 80.43 (39.27-179.31) hours (h). Patients received 3 (2-4) MT interventions, representing exposure on 18.18% (11.32%-29.81%) of admitted days. Covariates associated with receiving MT (adjusted odds ratio [95% CI]) included receiving palliative care (3.57 [2.02, 6.25]) and having a trauma/stress disorder (2.93 [2.00, 4.24]), anxiety (1.51 [1.11, 2.06]), heart failure (1.63 [1.05, 2.51]), a more resource-intensive admission (1.55 [1.08, 2.23]), and more opioids administered by 48 h (1.19 [1.04, 1.37]). In the analysis of 251 matched pairs, MT's estimated effect on log-transformed outcomes was 1.42 [1.27, 1.58] for LOS and 0.95 [0.75, 1.19] for MME/day. Conclusion: Patients with MSUD who undergo surgery and receive MT are more medically complex and thus may have prolonged LOS compared with those receiving usual care. Receiving MT on 18.18% of admitted days does not meaningfully impact opioid utilization within this population. Findings inform factors that may influence the decision to refer MT. LOS effects should be interpreted with caution given the inability to account for some factors that influence LOS.

PubMed ID: 42009620

Title: Breadth and depth of knowledge in generalist medicine: Navigating dual demands

Author(s): Morikawa, MJ (Morikawa, Masahiro J.); Ganesh, PR (Ganesh, Prakash R.)

Source: AMERICAN JOURNAL OF THE MEDICAL SCIENCES Volume: 371 Issue: 5 Pages: 492-493 DOI: 10.1016/j.amjms.2026.01.001 Early Access Date: APR 2026 Published Date: 2026 MAY

PubMed ID: 41513125

Title: Prognostic Value of MammaPrint in Diverse Populations: Evaluating Racial Disparities in Breast Cancer Outcomes

Author(s): Abou Zeidane, R (Abou Zeidane, Reine); Lichtman-Mikol, S (Lichtman-Mikol, Samuel); Pisano, C (Pisano, Courtney); Hauk, B (Hauk, Benjamin); Sun, YL (Sun, Yilun); Rana, PS (Rana, Priyanka S.); Lopez-Flores, C (Lopez-Flores, Citlally); McBean, BN (McBean, Breanna N.); Jungles, KM (Jungles, Kassidy M.); Lal, T (Lal, Trisha); Mehta, N (Mehta, Nihit); Bomeisl, P (Bomeisl, Philip); Amin, AL (Amin, Amanda L.); Montero, AJ (Montero, Alberto J.); Koroukian, S (Koroukian, Siran); Rose, J (Rose, Johnie); Lyons, J (Lyons, Janice); Speers, CW (Speers, Corey W.)

Source: JCO PRECISION ONCOLOGY Volume: 10 Article Number: e2500926 DOI: 10.1200/PO-25-00926 Published Date: 2026 APR

Abstract: PURPOSE MammaPrint (MP), a 70-gene expression profile assay, informs treatment decisions in early-stage breast cancer by classifying patients into high or low risk of recurrence categories. However, racial disparities in breast cancer outcomes necessitate an evaluation of MP's prognostic utility across diverse populations. This study explores differences in MP scores and associated outcomes among women of various racial backgrounds. MATERIALS AND METHODS We retrospectively analyzed women with early-stage breast cancer who underwent MP testing (2013-2023) at University Hospitals Seidman Cancer Center. Patients were stratified by self-reported race and MP scores (high v low risk). Clinical outcomes, including recurrence-free survival (RFS) and overall survival (OS), were compared using Kaplan-Meier and Cox proportional hazards models. RESULTS Among 1,349 women, 15.7% were African American (AA), 83.4% White, 0.6% Asian, and 0.3% from other racial groups. Overall, 64.7% had low-risk and 35.3% had high-risk scores. AA women had a significantly higher proportion of high-risk MP scores compared with White women (49.1% v 32.7%). Although the 5-year RFS rates were comparable between AA and White women (76.5% v 77.2%), the 5-year OS rates were slightly lower for AA women compared with White women (77.8% v 78.2%). MP remained prognostic for RFS at 3, 5, and 10 years regardless of race. Multivariable analysis revealed no significant differences in OS (hazard ratio [HR], 0.94 [95% CI, 0.47 to 1.89]; P = .866) or RFS (HR, 0.83 [95% CI, 0.43 to 1.59]; P = .572) between AA and White women after adjusting for MP risk groups and other clinical factors. High-risk MP scores were associated with worse OS (HR, 3.06 [95% CI, 1.64 to 5.70]; P < .001) and RFS (HR, 2.68 [95% CI, 1.55 to 4.62]; P < .001) compared with low-risk scores. Other factors associated with worse RFS and OS were tumor size, nodal involvement, and age. Interaction models indicated no difference is OS or RFS in AA women and White women with either low-risk or high-risk MP, respectively. CONCLUSION Despite AA women exhibiting a higher proportion of high-risk MP scores, survival outcomes were comparable with those of White women. These findings underscore MP's consistent prognostic performance across racial groups but further highlight the need to address additional clinical and social determinants influencing breast cancer outcomes beyond genomic risk alone.

PubMed ID: 41955550

Title: Re-envisioning the Concept of Styalgia and Styloidectomy

Author(s): Sivapuram, K (Sivapuram, Kavya); Ganesh, PB (Ganesh, Prakash Bhadravathi); Babu, AR (Babu, Ambale Rudrappa); Dharmarajan, S (Dharmarajan, Sandhya); Bharathi, MB (Bharathi, M. B.); Shetty, S (Shetty, Sandeep)

Source: INTERNATIONAL ARCHIVES OF OTORHINOLARYNGOLOGY Volume: 30 Issue: 02 Pages: 001-007 DOI: 10.1055/s-0046-1817133 Published Date: 2026 APR

Abstract: Introduction Prevalence of elongated styloid process (SP) is 4% and only 4-10% of these patients are symptomatic. In this study morphology was assessed among the patients unlike the dry skulls. Comparison of elongation and angulation of SP between the case and control groups, as well as symptomatic correlation was done. This study also imparts information regarding symptomatic outcomes following medical and surgical management. Objective To compare the anatomical variations in SP morphology and symptomatology in patients with and without stylalgia. Methods A prospective study was done over a period of 1.5 years on 84 participants. The required details were recorded. Radio-imaging was done through Towne's and lateral view of skull X-rays to measure length, as well as medial and anterior angulations. Pain assessment was done with the visual analogue scale before and after conservative or surgical managements. Results Mean age of participants was 37.2 +/- 8.8 years, with a female preponderance. The most common symptom was recurrent oropharyngeal pain (67.8%). Elongated SP was observed in the case group with a mean length of 4.07 cm, compared with 2.36 cm in controls. The mean medial angulation of the SP was of 21.28 degrees in the case group and of 16.77 degrees in the controls. Anterior angulation in the case group was of 32.19 degrees, compared with 21.74 degrees in the controls. A statistically significant difference was noted in in length, medial and anterior angulations in the case group when compared with controls. Conclusion Symptomatic elongated SP is a complex condition for many patients. Its precise identification will aid in early recovery from symptoms. Surgical management showed better symptomatic outcomes.

PubMed ID: 42109634

Title: Spatial Access to Cancer Care Providers in National Cancer Institute-Designated Cancer Center Catchment Areas

Author(s): Buchalter, RB (Buchalter, R. Blake); Rose, J (Rose, Johnie); Dalton, JE (Dalton, Jarrod E.); Gunsalus, PR (Gunsalus, Paul R.); Khorana, AA (Khorana, Alok A.); Schmit, SL (Schmit, Stephanie L.)

Source: JCO CLINICAL CANCER INFORMATICS Volume: 10 Article Number: e2500166 DOI: 10.1200/CCI-25-00166 Published Date: 2026 MAR

Abstract: PURPOSE Access to care is an important component of cancer center catchment area (CA) analytics, where CAs are defined as the geographic scope of cancer center operations. Spatial access to care is one piece of the access to care continuum that is useful for quantifying population travel to health care providers. As no studies have comprehensively calculated CA spatial access to providers, we examined access to oncology, cancer care, and primary care providers for all 65 National Cancer Institute-designated cancer center CAs in the 48 contiguous US states. METHODS We used the 2024 end-of-year Centers for Medicare and Medicaid Services National Downloadable File and the enhanced two-step floating CA method to compute spatial accessibility. We stratified analyses by cancer center, census division, 2020 urban/rural status, 2023 area deprivation, and cancer center type, and produced select CA maps. RESULTS Census tracts in the Montefiore Einstein Comprehensive Cancer Center CA had the highest oncology and cancer care spatial access, while the Masonic Cancer Center had the highest primary care spatial access. New Jersey, New York, and Pennsylvania CAs had the highest oncology and cancer care spatial access (P < .001), while midwestern CAs had the highest primary care spatial access (P < .001). Across area deprivation index quartiles and all provider groupings, urban tracts had higher spatial access than rural tracts (P < .001). Comprehensive cancer centers had higher spatial access to oncology and primary care than noncomprehensive cancer centers (P < .001), while noncomprehensive cancer centers had higher spatial access to cancer care providers (P < .001). CONCLUSION We observed significant differences in CA spatial access to oncology, cancer care, and primary care by region, urban/rural status, socioeconomic position, and cancer center type.

PubMed ID: 41886708

Title: Weighting by Income Probabilities as a Novel Approach to Quantifying Differences in the Burden of Cancer by Income: A Case Study of Colorectal Cancer in Ohio

Author(s): Kim, U (Kim, Uriel); Koroukian, S (Koroukian, Siran); Rose, J (Rose, Johnie)

Source: JCO CLINICAL CANCER INFORMATICS Volume: 10 Article Number: e2500171 DOI: 10.1200/CCI-25-00171 Published Date: 2026 MAR

Abstract: PURPOSE Population-based cancer registries are a key data resource for catchment area informatics, but their utility for quantifying differences in cancer burden by socioeconomic status is limited. Here, we describe an approach that estimates cancer incidence along income gradients, leveraging a newly validated method called weighting by income probabilities (WIP). METHODS We estimated income-specific colorectal cancer incidence, stratified by sex and race/ethnicity, in a catchment area (Ohio) as a case study. Income-specific numerator data (number of cancer cases per income bracket) were estimated using WIP, whereas denominators (population at risk by income bracket) were derived from US Census data. RESULTS In the case study of the 52,257 patients with invasive colorectal cancer diagnosed in the catchment area of Ohio between 2010 and 2019, lower income was generally associated with higher incidence rates, except in non-Hispanic (NH) White female individuals. The highest incidence was observed in NH Black male individuals at 0-149% of the Federal Poverty Level, with 113.7 cases per 100,000 (95% CI, 99.6 to 129.3) in 2010-2012, compared with 57.8 (95% CI, 54.7 to 61.2) in their NH White counterparts. Sensitivity analyses showed that income-specific incidence statistics were robust to sources of error in numerator and denominator estimation, with incidence estimates varying by no more than 1.98% from the reference estimates. CONCLUSION The approach described here accurately estimates cancer incidence along income gradients and can be expanded to estimate income-specific survival and mortality. The case study of colorectal cancer in Ohio demonstrates important insights into the burden of cancer by income. These granular income-specific data can enhance our understanding of the relationship between cancer burden and socioeconomic status and inform cancer surveillance, prevention, and control efforts.

PubMed ID: 41881063

Title: Higher socioeconomic status and physician accessibility linked to more early-stage but not fewer late-stage melanoma diagnoses

Author(s): Dong, WC (Dong, Weichuan); Kim, U (Kim, Uriel); Montgomery, B (Montgomery, Brock); Lal, T (Lal, Trisha); Liu, LB (Liu, Lingbo); Kakish, H (Kakish, Hanna); Rose, J (Rose, Johnie); Koroukian, SM (Koroukian, Siran M.); Bordeaux, JS (Bordeaux, Jeremy S.); Rothermel, LD (Rothermel, Luke D.); Hoehn, R (Hoehn, Richard s)

Source: CLINICAL AND EXPERIMENTAL DERMATOLOGY Volume: 51 Issue: 6 Pages: 988-996 DOI: 10.1093/ced/llaf546 Early Access Date: FEB 2026 Published Date: 2026 JUN

Abstract: Background Socioeconomic status (SES) and physician accessibility, key proxies for skin cancer screening uptake, can influence melanoma diagnosis, but their impact on reducing advanced-stage diagnoses remains unclear.Objectives To examine how SES and physician accessibility relate to the incidence of early- and late-stage melanoma across neighbourhoods in Ohio (USA).Methods This cross-sectional study analysed individuals with newly diagnosed cancer cases from the Ohio Incidence Surveillance System (2011-2020), aggregated into 259 neighbourhoods (derived from 2952 census tracts), and estimated neighbourhood-level, stage-specific incidence rates. Correlation and geospatial analyses explored dose-response relationships between SES, physician accessibility and stage-specific melanoma incidence. Classification and regression tree (CART) and logistic regression further examined these associations.Results Higher SES and physician accessibility were significantly associated with increased early-stage melanoma incidence but not with late-stage incidence. Affluent city suburbs with high physician accessibility had the highest early-stage incidence (median 20.2 per 100 000), whereas rural areas experiencing socioeconomic disadvantage (defined as below the median level of SES) and with low physician accessibility had the lowest (median 14.4 per 100 000). CART identified five neighbourhood profiles of early-stage melanoma. A nearly 100-fold difference in the odds of high early-stage incidence was observed between the high-risk and low-risk neighbourhoods. No significant results were observed for late-stage incidence in correlation analysis, CART or logistic regression.Conclusions Areas with high healthcare access measures experience increased early-stage melanoma incidence. However, this does not correspond to a reduction in late-stage incidence. The absence of a clear association between late-stage incidence and these screening proxies highlights the need for further research into the biology and progression of advanced-stage melanoma tumours, as well as the effectiveness of current screening methods in detecting the condition in such patients.

Higher socioeconomic status and greater physician accessibility - proxies for skin cancer screening uptake - were associated with increased early-stage melanoma incidence but not with reduced late-stage incidence across neighbourhoods in Ohio (USA). Specifically, neighbourhoods with higher education attainment, lower uninsured rates and lower poverty rates had nearly 100 times higher odds of high early-stage incidence, yet their late-stage incidence remained similar. The lack of association between screening proxies and late-stage incidence raises questions about the effectiveness of widespread melanoma screening in preventing advanced disease.

PubMed ID: 41388790

Title: Implementing a Precision Medicine Thoracic Service Using In-House Reflex Testing in a Large Academic-Community Practice

Author(s): Bruno, DS (Bruno, Debora S.); Mirsky, MM (Mirsky, Matthew M.); Donner, AL (Donner, Andrea L.); Kopp, SR (Kopp, Shelby R.); Jani, M (Jani, Mehul); Mneimneh, W (Mneimneh, Wadad); Yoest, JM (Yoest, Jennifer M.); Margevicius, SP (Margevicius, Seunghee P.); Shanahan, J (Shanahan, John); Fu, PF (Fu, Pingfu); Hsu, ML (Hsu, Melinda L.); Wang, Q (Wang, Qian); Chiec, LS (Chiec, Lauren S.); Dutcher, GA (Dutcher, Giselle A.); Cho, S (Cho, Sean); Dowlati, A (Dowlati, Afshin); Rose, J (Rose, Johnie); Sadri, N (Sadri, Navid)

Source: CHEST Volume: 169 Issue: 1 Pages: 280-290 DOI: 10.1016/j.chest.2025.07.4095 Early Access Date: JAN 2026 Published Date: 2026 JAN

Abstract: BACKGROUND: Broad genomic testing is necessary to treat patients with stage IV non-small cell lung cancer (NSCLC). This article describes a NSCLC precision medicine service at an academic-community practice and provides model-based estimates of the impact of a similar intervention. RESEARCH QUESTION: Will implementation of a precision medicine service increase NSCLC next-generation sequencing (NGS) rates, improve testing turnaround times (TATs), and increase rates of actionable genomic alterations (AGAs)? STUDY DESIGN AND METHODS: The Precision Medicine Thoracic (PREDICT) service consists of: (1) system-wide reflex testing of patients with stage IV NSCLC by in-house solid tumor NGS-focused assay and programmed cell death ligand 1 (PD-L1) testing; (2) nurse navigator oversight; (3) the molecular tumor board; and (4) an integrated information portal (Onco-Tracker) for real-time updates on sample processing, results, and treatment recommendations by the molecular tumor board. A decision analytic model compared 4 strategies: PREDICT vs standard care (send-out sequencing and PD-L1 testing), and sequencing of all patients with stage IV NSCLC vs patients with non-squamous histology findings only. RESULTS: From January 2016 to December 2018, a total of 626 retrospective patients with stage IV NSCLC were eligible. In the 17 months following the launch of PREDICT, 290 prospective patients were identified. NGS testing rates increased significantly (91.3% vs 60.8%; P < .0001) after PREDICT, whereas TATs from biopsy date were significantly shorter for both NGS (12 vs 18 days; P < .0001) and PD-L1 (7 vs 10 days; P < .0001). AGAs were identified in 29.3% of prospective patients vs 22% of the retrospective cohort (P = .0172). Targeted therapy use increased from 6.8% to 10.6% (P = .048). The decision analytic model predicted superior survival with the PREDICT initiative across all patients, resulting in the highest rates of AGA identification and lowest chemotherapy utilization rates in the first-line setting. INTERPRETATION: Implementation of a precision medicine service for stage IV NSCLC comprising reflex testing, nurse navigation, a molecular tumor board, and an information portal at a combined academic-community practice led to higher NGS testing rates and shorter TATs. The result was identification of more actionable mutations and higher rates of first-line targeted therapy utilization. Decision analytic modeling suggests the superiority of this initiative across all patients.

PubMed ID: 40912295

Title: A Novel Evaluation of Patient Socioeconomic Characteristics That Predict Clinical Trial Enrollment

Author(s): Dong, WC (Dong, Weichuan); Shoag, J (Shoag, Jamie); Lal, T (Lal, Trisha); Kyasaram, RK (Kyasaram, Ravi K.); Bruno, DS (Bruno, Debora S.); Rose, J (Rose, Johnie); Koroukian, SM (Koroukian, Siran M.); Vu, L (Vu, Long); Shanahan, JP (Shanahan, John P.); Hoehn, RS (Hoehn, Richard S.)

Source: JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Volume: 24 Issue: 1 Article Number: 257092 DOI: 10.6004/jnccn.2025.7092 Published Date: 2026 JAN

Abstract: Background: Clinical trial participation offers patients with cancer access to cutting-edge therapies and generates critical evidence that informs and improves future cancer treatment guidelines. However, disparities in trial enrollment hinder inclusivity and limit the generalizability of trial findings. This study investigates patient-specific factors influencing therapeutic trial enrollment to identify and address barriers to equitable participation. Methods: This retrospective cohort study included patients with cancer aged 18 to 75 years diagnosed between 2018 and 2021 at a regional hospital system in Northeast Ohio. Patients' electronic medical records were linked to the individual-level LexisNexis Social Determinants of Health data. Propensity score matching was performed to balance trial and nontrial patients with respect to age, biological sex, and cancer type. Key predictors of trial enrollment were identified using a systematic variable selection process, the Boruta machine learning algorithm, and stepwise logistic regression. Geographic variation in enrollment were examined at the ZIP code level. Results: Among 12,630 patients with cancer, 649 (5.1%) participated in treatment-related trials. After 1:7 propensity score matching, the Boruta algorithm identified income, property ownership, and household factors as the strongest predictors of enrollment, whereas race/ethnicity, college attendance, and distance to closest relatives were less influential. Logistic regression revealed that non-Hispanic Black individuals (odds ratio [OR], 0.70; 95% CI, 0.54-0.89) and those in other minority groups (OR, 0.57; 95% CI, 0.36-0.88) were less likely to enroll compared with non-Hispanic White individuals. After adjusting for income, non-Hispanic Black race was no longer significant (OR, 0.85; 95% CI, 0.64-1.11). Higher estimated income was associated with increased enrollment (up to 67% higher odds), whereas patients insured through Medicaid were 29% less likely to enroll than those with private insurance (OR, 0.71; 95% CI, 0.53-0.93). Conclusions: Findings from this study suggest that financial resources may play a greater role in clinical trial enrollment than traditional demographic characteristics. Improving equity in trial enrollment and enhancing the generalizability of trial findings will likely require increased financial and structural support for diverse and vulnerable patient populations. J Natl Compr Canc Netw 2026;24(1):e257092 doi:10.6004/jnccn.2025.7092

PubMed ID: 41671439

Title: Life is Larger Than Science

Author(s): Gotler, RS (Gotler, Robin S.); Steiner, M (Steiner, Melanie)

Source: ANNALS OF FAMILY MEDICINE Volume: 24 Issue: 1 Pages: 1-2 DOI: 10.1370/afm.250740 Published Date: 2026 JAN-FEB

PubMed ID: 41587852

Title: Beyond screening: neighborhood-level factors associated with colorectal cancer stage at diagnosis

Author(s): Lal, T (Lal, Trisha); Chakraborty, NN (Chakraborty, Natalie N.); Koroukian, S (Koroukian, Siran); Rose, J (Rose, Johnie); Dong, WC (Dong, Weichuan); Hoehn, RS (Hoehn, Richard S.)

Source: CANCER CAUSES & CONTROL Volume: 37 Issue: 1 Article Number: 14 DOI: 10.1007/s10552-025-02082-4 Published Date: 2025 DEC 27

Abstract: PurposeWhile increasing colorectal cancer (CRC) screening uptake is a major public health goal, it remains unclear whether screening rates consistently translate to high earlier-stage diagnosis at the community level. This study examined the relationship between screening and early stage CRC diagnosis, identifying barriers that may disrupt this pathway.MethodsWe used census-tract-level data on CRC patients diagnosed between 2010 and 2019 in the Ohio Cancer Incidence Surveillance System, linked to community-level screening estimates from CDC PLACES (2018). Census tracts were grouped into sociodemographically similar communities using the Max-p regionalization method. We applied geographic weighted regression (GWR) to assess spatial variation in the screening-early diagnosis relationship and used the Variable Selection Using Random Forest (VSURF) algorithm to identify key predictors of early stage diagnosis. Linear regression models evaluated associations between predictors, screening, and early stage diagnosis.Results2,952 census tracts were aggregated into 869 communities for analysis. Higher screening rates were not consistently associated with early stage diagnosis, as revealed by GWR, which showed significant regional variation. VSURF identified structural factors, rather than screening uptake, as top predictors of early stage diagnosis. In multivariable models, uninsurance (beta - 0.29) and public transportation dependence (beta - 0.31) were associated with lower early stage diagnosis, while the screening rate was not independently associated.ConclusionsStructural barriers may disrupt the screening-to-diagnosis pathway at the community level. Our findings underscore the importance of investing in follow-up infrastructure, including navigation and transportation, to ensure that screening achieves its goal of early detection.

PubMed ID: 41455016

Title: Leveraging Community-Based System Dynamics to Understand Long Covid Disparities in African American Communities: A Model for Health Equity Research

Author(s): Evans, CR (Evans, Chad R.); Echols, MR (Echols, Melvin R.); Martin, D (Martin, D.); Taylor, HA (Taylor, H. A.); Washington, JA (Washington, James A.); Gbinigie, O (Gbinigie, Olusola); Gaglioti, AH (Gaglioti, Anne H.); Wright, W (Wright, Wendi); Hovmand, P (Hovmand, Peter)

Source: HEALTH EXPECTATIONS Volume: 28 Issue: 6 Article Number: e70516 DOI: 10.1111/hex.70516 Published Date: 2025 DEC 15

Abstract: Background Long Covid disproportionately affects African American communities, exacerbating pre-existing health disparities and systemic barriers to care. Conventional public health interventions often fail to address the complex systemic issues at play due to a lack of grounding in community-certified knowledge about the broader societal context that produces the disparities and in which the interventions must operate. New methods are needed to elicit community perspectives on living with long Covid.Methods This study employed Community-Based System Dynamics (CBSD) workshops, conducted in hybrid formats (online and in-person), to engage African American communities impacted by long Covid. Participants included affected individuals, healthcare professionals and systems researchers.Results The workshops yielded system dynamics causal loop diagrams that illustrate the multifaceted societal context and impact of long Covid. Community-driven insights led to the identification of targeted interventions and informed a comprehensive action plan designed to address specific health system barriers and enhance community resilience.Conclusions CBSD workshops proved effective in fostering significant community engagement and empowerment, presenting a replicable model for gaining a deeper understanding of the socio-cultural context that underlies complex health disparities. These findings suggest that incorporating community-sourced societal context knowledge and system dynamics modelling and analysis can substantially enhance public health strategies for managing long Covid.Patient or Public Contribution People with lived experience of long Covid were actively involved throughout all phases of this study. Participants contributed to the design and facilitation of Community-Based System Dynamics (CBSD) workshops, helped construct and refine causal loop diagrams based on their experiences, and generated action ideas for future interventions. Their insights shaped both the structure and content of the system models and directly informed the interpretation of results. Several participants also reviewed and provided feedback on early drafts of the manuscript to ensure the findings reflected their perspectives and priorities.

PubMed ID: 41395800

Title: Association between County Health Rankings Factors and County-level Genitourinary Cancer Mortality

Author(s): Badreddine, J (Badreddine, Jad); Kim, E (Kim, Erin); Tang, S (Tang, Stephen); Rhodes, S (Rhodes, Stephen); Davis, L (Davis, Laura); Hartman, H (Hartman, Holly); Cullen, J (Cullen, Jennifer); Rose, J (Rose, Johnie); Vince, R (Vince, Randy)

Source: JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES DOI: 10.1007/s40615-025-02764-4 Early Access Date: DEC 2025 Published Date: 2025 DEC 4

Abstract: Objectives To explore the association between County Health Ranking (CHR) factors, county-level demographics, and county-level age-adjusted genitourinary (GU) cancer mortality rates. Materials and Methods This population-based study used county-level data from the US and CHR program. CHR bases county-level scoring on four factors: health behaviors, clinical care, social and economic factors, and physical environment-higher values per factor signify a better score. The relationship between county-level factors, demographics, and age-adjusted GU-cancer mortality rates was analyzed with linear mixed-effects models. We included interaction terms between the county-level factors and the proportion of Black residents. Results County-level variables associated with lower age-adjusted GU-cancer mortality rates included larger population (beta/SD increase: - 0.64; 95% CI, - 0.82 to - 0.4, P < 0.001), positive health behaviors (- 0.58; 95% CI, - 0.83 to - 0.33, P < 0.001), and clinical care (- 0.21; 95% CI, - 0.41 to - 0.01, P = 0.04). A higher proportion of Black residents was associated with increasing age-adjusted GU-cancer mortality rate (0.52; 95% CI, 0.28-0.75, P < 0.001). Interaction terms demonstrated a relationship between clinical care and age-adjusted GU-cancer mortality rates that was attenuated by the proportion of Black residents (interaction-beta: 0.24; 95% CI, 0.06-0.42, P = 0.01). Follow-up analysis of clinical care demonstrated that quality of care, not access, was associated with decreased mortality rates. Conclusion The beneficial association between better clinical care and decreased age-adjusted GU-cancer mortality rates was modulated by the proportion of Black residents and appears due to the healthcare access sub-component. These findings suggest that having healthcare resources within a county does not ensure equitable access to high-quality healthcare, specifically for Black residents.

PubMed ID: 41343003

Title: National trends in emergency and non-emergency colorectal cancer resections across the COVID-19 pandemic

Author(s): Lal, T (Lal, Trisha); Kang, CO (Kang, Christine O.); Liu, FZ (Liu, Fangzhou); Cabulong, A (Cabulong, Alexander); Hoehn, RS (Hoehn, Richard S.); Rose, J (Rose, Johnie); Koroukian, SM (Koroukian, Siran M.)

Source: SURGICAL ONCOLOGY INSIGHT Volume: 3 Issue: 1 Article Number: 100197 DOI: 10.1016/j.soi.2025.100197 Early Access Date: DEC 2025 Published Date: 2026 MAR

Abstract: The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. University Hospitals and its affiliates disclaim any responsibility for unauthorized disclosure of this information to anyone other than the addressee. Federal and Ohio law protect patient medical information, including psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions, alcohol, and/or drug_dependence or abuse disclosed in this email. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law.

Title: Impact of Hormone Therapy on Sexual Function in Menopausal Women: A Cross-Sectional Analysis of Cosmos Data

Author(s): Pope, R (Pope, Rachel); Ganesh, P (Ganesh, Prakash); Marino, J (Marino, Jean); Myers, A (Myers, Anna)

Source: MENOPAUSE-THE JOURNAL OF THE MENOPAUSE SOCIETY Meeting Abstract: P-142 Volume: 32 Issue: 12 Published Date: 2025 DEC

Title: Cost Burden of End of Life Care Across Gradients of Cognitive Impairment Among Nursing Home Residents with Cancer

Author(s): Vu, L (Vu, Long); Koroukian, S (Koroukian, Siran); Rose, J (Rose, Johnie); Warner, D (Warner, David); Douglas, S (Douglas, Sara); Schiltz, N (Schiltz, Nicholas)

Source: INNOVATION IN AGING Meeting Abstract: igaf122.26 Volume: 9 Special Issue: SI DOI: 10.1093/geroni/igaf122.2605 Published Date: 2025 DEC Supplement: _2

Title: BREATHTAKING BENEFITS? GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS IMPACT ON ASTHMA EXACERBATIONS

Author(s): Krishnan, V (Krishnan, Vidya); Conklin, D (Conklin, Danette); Pawar, O (Pawar, Omkar); Ganesh, P (Ganesh, Prakash)

Source: CHEST Volume: 168 Issue: 4 Pages: 5645A-5645A DOI: 10.1016/j.chest.2025.07.3155 Early Access Date: NOV 2025 Published Date: 2025 OCT Supplement: S

Title: System Dynamics Modeling for Managing Capacity and Demand for Human Services

Author(s): Biroscak, BJ (Biroscak, Brian J.)

Source: SYSTEMIC PRACTICE AND ACTION RESEARCH Volume: 38 Issue: 4 Article Number: 29 DOI: 10.1007/s11213-025-09739-w Published Date: 2025 NOV 11

Abstract: The effective delivery of human services is frequently hampered by complex challenges related to managing both service capacity (e.g., facilities, labor) and fluctuating demand (e.g., community members in need). This persistent mismatch, acutely observed in critical areas such as domestic violence (DV) programs, leads to unmet needs and significant service system strain. While existing approaches address aspects of this problem, they often struggle to capture the dynamic, interconnected nature of these challenges and the underlying system structures that drive observed trends. This paper proposed system dynamics (SD) modeling, a computer-aided methodology for understanding temporal patterns and providing strategic decision support, as a powerful approach to enhance human services management through improved capacity and demand alignment. SD offers a unique ability to shift from an event-oriented perspective to a systems-orientation, revealing endogenous feedback mechanisms and accumulations that conventional methods often overlook. DV programs are presented as a compelling case for this application due to their critical role in supporting persons in crisis and programs' ongoing struggle with demand exceeding available capacity. By demonstrating the potential of SD in this specific context, the paper highlights a generalizable framework for other human services organizations to better manage complex service delivery challenges.

Title: Expanding diagnostic testing for drug-resistant tuberculosis in high burden settings: a cost-effectiveness analysis

Author(s): Getchell, M (Getchell, Marya); Ansah, JP (Ansah, John Pastor); Lim, D (Lim, Dodge); Basilio, R (Basilio, Ramon); Tablizo, F (Tablizo, Francis); Corpuz, C (Corpuz, Carmen); Matchar, D (Matchar, David)

Source: BMC PUBLIC HEALTH Volume: 25 Issue: 1 Article Number: 3795 DOI: 10.1186/s12889-025-24934-z Published Date: 2025 NOV 5

Abstract: BackgroundNew and effective tools for detecting drug-resistant tuberculosis (DR-TB) include GeneXpert XDR and targeted Next Generation Sequencing (tNGS). However, data on their implementation in high TB-burden settings is limited. We aimed to determine cost-effectiveness of different strategies using GeneXpert XDR or tNGS for DR-TB detection in high TB-burden, low-resource settings.MethodsA dynamic simulation model was calibrated to WHO-reported TB data for Philippines and Thailand. Intervention scenarios for expanded diagnostic testing of drug-resistance were simulated for 2025 - 2035. Health benefits were estimated using disability-adjusted life years. Cost-effectiveness was calculated from a health system perspective using country-level TB diagnosis and treatment costs. Analyses include incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefit (INMB).ResultsImplementing GeneXpert XDR or tNGS for DR-TB detection improves TB health outcomes. Scenarios using GeneXpert XDR are more likely to be cost-effective than scenarios using tNGS. Interventions targeting previously treated cases reduce costs but also reduce health benefits. Testing all TB cases with GeneXpert XDR is cost-effective (Philippines ICER = $1,808, INMB = $210M; Thailand ICER = $5,251, INMB = $26M) with a 1 x GDP willingness-to-pay threshold (WTP). Targeting GeneXpert XDR to previously treated cases is also cost-effective (Philippines ICER = $1,288, INMB = $52M; Thailand ICER = $3,667, INMB = $9.2M) but results in lower INMB. tNGS is cost-effective at higher WTP.InterpretationIn high TB-burden countries, GeneXpert XDR is cost-effective as an additional DR-TB diagnostic test. tNGS is not cost-effective for routine clinical DR-TB testing but has potential for application to high-risk populations, especially with introduction of new TB treatment regimens.

PubMed ID: 41194030

Title: A cross-sectional assessment of US cancer diagnoses during the COVID-19 pandemic

Author(s): Burus, T (Burus, Todd); Kim, U (Kim, Uriel); Rose, J (Rose, Johnie); Koroukian, SM (Koroukian, Siran M.); Kuhs, KAL (Kuhs, Krystle A. Lang)

Source: CANCER EPIDEMIOLOGY Volume: 99 Article Number: 102944 DOI: 10.1016/j.canep.2025.102944 Early Access Date: OCT 2025 Published Date: 2025 DEC

Abstract: Background: Disruptions to cancer diagnoses were widely reported in the US during the early COVID-19 pandemic. Whether any cases remained unaccounted-for by the end of the pandemic has not been fully assessed. Methods: We collected data on invasive cancer diagnoses occurring among individuals aged 20-89 years between January 2020 and December 2022 from the Surveillance, Epidemiology, and End Results database. Expected cancer case counts and incidence rates with 95 % credibility intervals (95 %CrIs) were estimated for 2020-2022 from pre-pandemic trends (2005-2019) using Bayesian Age-Period-Cohort models. We compared observed rates with expected rates, and estimated unaccounted-for cases. Additional site-, stage-, and subgroup-specific analyses were performed. Results: Among 2260,704 cancer cases diagnosed in 2020-2022, the observed incidence rate was 595.5 per 100,000 persons (95 %CI, 594.7-596.2), which was 6.7 % lower than the expected rate of 638.1 (95 %CrI, 620.1-656.1) and corresponded to 160,475 fewer-than-expected cases (95 %CrI, 99,777-221,174). Annual observed rates were significantly lower than expected in 2020 (565.8 vs. 630.7), with recovery in 2021 and 2022, though not enough to overcome the existing case deficit. Incidence rates for persons aged >= 65 years, nonmetropolitan residents, and non-Hispanic White individuals, as well as site-specific rates for lung and kidney cancers and non-Hodgkin lymphoma, remained below expected levels beyond 2020. Early-stage colorectal cancer diagnoses were 14.2 % lower than expected over the period. Conclusion: While annual cancer incidence rates returned to expected levels by the end of the COVID-19 pandemic, substantial numbers of unaccounted-for cases remained, raising concerns for future increases in cancer morbidity and mortality.

PubMed ID: 41108855

Title: Timing of neurorehabilitation and subsequent Alzheimer's disease risk in patients with moderate to severe traumatic brain injury: A nationwide retrospective cohort study in the United States

Author(s): Kennemer, AA (Kennemer, Austin A.); Gao, ZX (Gao, Zhenxiang); Davis, PB (Davis, Pamela B.); Kaelber, DC (Kaelber, David C.); Xu, R (Xu, Rong)

Source: JOURNAL OF ALZHEIMERS DISEASE Volume: 108 Issue: 3 Pages: 1155-1165 DOI: 10.1177/13872877251385262 Early Access Date: OCT 2025 Published Date: 2025 DEC

Abstract: Background Traumatic brain injury (TBI) is associated with an increased risk of Alzheimer's disease (AD). It is unknown if prompt neuro-rehabilitative treatment following moderate or severe TBI mitigates this risk compared with delayed treatment. Objective To determine whether immediate neuro-rehabilitative treatment following moderate or severe TBI reduces the risk of AD and related cognitive outcomes compared with delayed treatment. Methods We conducted a retrospective cohort using the TriNetX Analytics Platform, which includes health records from over 100 million US patients. Adults aged 50-90 years with moderate or severe TBI were included if they received immediate treatment (within 1 week) or delayed treatment (>1 week). Outcomes were AD risk at 3- and 5-year follow-up, with additional outcomes of mild cognitive impairment (MCI), dementia, and AD-related medication prescriptions. Cox proportional hazards models were applied to propensity score-matched cohorts, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Results Of 37,081 eligible patients, 17,636 remained after propensity score matching. Immediate treatment was associated with lower AD risk compared with delayed treatment (HR, 0.59; 95% CI, 0.41-0.86 at 3 years; HR, 0.70; 95% CI, 0.52-0.94 at 5 years). Similar risk reductions were observed for MCI, dementia, and AD-related medication use. Conclusions Immediate treatment following moderate or severe TBI was associated with significantly reduced risk of AD and related cognitive decline. These findings suggest that prompt intervention may mitigate long-term neurodegenerative consequences of TBI.

PubMed ID: 41069042

Title: Harnessing Artificial Intelligence for Obesity Care: A Systematic Review of AI-Enabled Behavioral Coaching Platforms, Outcomes, and Ethical Implications

Author(s): Hallock, R (Hallock, Rajiev); Mehta, N (Mehta, Nihit); Patel, N (Patel, Niki); Ganesan, N (Ganesan, Niteesh); Kang, C (Kang, Christine); Pulis, M (Pulis, Melissa); Rose, J (Rose, Johnie)

Source: CURRENT CARDIOVASCULAR RISK REPORTS Volume: 19 Issue: 1 Article Number: 24 DOI: 10.1007/s12170-025-00776-7 Published Date: 2025 OCT 1

Abstract: Purpose of ReviewArtificial intelligence (AI) enabled behavioral health coaching has emerged as a potential solution for managing obesity and related complications. This review aims to evaluate the effectiveness, engagement, and ethical implications of AI-enabled behavioral coaching platforms in the management of obesity.Recent FindingsOur search identified 21 relevant studies. Of these, 8 were randomized controlled trials and 13 were observational studies (including pretest-protest, longitudinal, retrospective cohort and single-arm intervention studies). AI-based platforms were associated with clinically significant weight loss (ranging from - 0.8 kg to - 13.9% of baseline weight), systolic blood pressure reductions up to - 18.6 mmHg, improvements in HbA1c (up to - 1.2% points) and LDL cholesterol (up to - 66.6 mg/dL). Engagement levels were high, with retention rates ranging from 57 to 92%, particularly in hybrid models combining AI with human coaching. Ethical concerns reported included algorithmic opacity, lack of cultural tailoring, and unequal access due to technological barriers.SummaryAI-driven behavioral coaching platforms demonstrate promising effectiveness in obesity and cardiometabolic risk management, with outcomes comparable to traditional lifestyle interventions. However, ethical limitations, short study durations, and variability in design highlight the need for longer-term, diverse, and ethically grounded research. Future studies should emphasize algorithm transparency, data governance, equitable access, and integration into routine clinical care.

Title: Associations of selective serotonin reuptake inhibitors and long COVID risk in patients with depression: a retrospective cohort study

Author(s): Gao, ZX (Gao, Zhenxiang); Tabernacki, T (Tabernacki, Tomasz); Davis, PB (Davis, Pamela B.); Kaelber, DC (Kaelber, David C.); Xu, R (Xu, Rong)

Source: INFECTION Volume: 54 Issue: 1 Pages: 203-211 DOI: 10.1007/s15010-025-02648-z Early Access Date: SEP 2025 Published Date: 2026 FEB

Abstract: PurposeTo evaluate the potential of selective serotonin reuptake inhibitors (SSRIs) in reducing the risk of long COVID in patients with depression.MethodsThis retrospective cohort study analyzed U.S. electronic health records from TriNetX platform to compare the risk of long COVID among adults with depression who were prescribed SSRIs versus non-SSRI antidepressants between March 2020 and December 2022. The main outcome was the long COVID diagnosis. As a sensitivity analysis, CDC-defined long COVID symptoms were used as alternative outcomes. Cox proportional hazards models were used to assess outcomes occurring 3-6 and 3-12 months after the index SARS-CoV-2 infection, with hazard ratios (HRs) and 95% confidence intervals (CIs) calculated.ResultsAfter propensity score matching, the study included 31,264 patients, and the risk of long COVID diagnosis was significantly lower in the SSRI cohort compared to the matched non-SSRI antidepressant cohort, with hazard ratios of 0.57 (95% CI: 0.44-0.73) for the 3-6-month period and 0.59 (95% CI: 0.49-0.72) for the 3-12-month period. Sensitivity analyses in matched cohorts of 17,100 patients showed that SSRI use was associated with a significantly reduced risk of long COVID symptoms, consistent across symptom categories and pandemic periods.ConclusionsIn adult patients with depression, SSRIs compared with non-SSRI antidepressants were associated with a lower risk of long COVID. These results offer preliminary evidence that SSRIs may help prevent long COVID in high-risk populations and warrant further preclinical and clinical investigation.

PubMed ID: 40996671

Title: Neighborhood multi-modal spatial access to primary care is associated with improved colorectal cancer screening in NCI-designated cancer center catchment areas

Author(s): Buchalter, RB (Buchalter, R. Blake); Wang, CZ (Wang, Changzhen); Gunsalus, PR (Gunsalus, Paul R.); Dalton, JE (Dalton, Jarrod E.); Rose, J (Rose, Johnie); Schmit, SL (Schmit, Stephanie L.)

Source: CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Volume: 34 Issue: 9 Special Issue: SI Pages: A95-A95 DOI: 10.1158/1538-7755.DISP25-A095 Published Date: 2025 SEP 18

Title: Impact of sociodemographic, clinical, and intervention characteristics on pain intensity within a single music therapy session

Author(s): Rodgers-Melnick, SN (Rodgers-Melnick, Samuel N.); Gunzler, D (Gunzler, Douglas); Love, TE (Love, Thomas E.); Koroukian, SM (Koroukian, Siran M.); Beno, M (Beno, Mark); Dusek, JA (Dusek, Jeffery A.); Rose, J (Rose, Johnie)

Source: JOURNAL OF PAIN Volume: 36 Article Number: 105556 DOI: 10.1016/j.jpain.2025.105556 Early Access Date: SEP 2025 Published Date: 2025 NOV

Abstract: Several studies support the efficacy of music therapy (MT) for reducing pain, but few have examined which interventions are most effective or which patients are more likely to respond. This study investigated which sociodemographic, clinical, and intervention characteristics are associated with clinically significant reductions in pain intensity (0-10 numeric rating scale reduction >= 2 units) within a single MT session. We conducted a retrospective review of 2039 MT sessions provided across a large health system among 1203 adult patients reporting pre-session pain >= 4/10, a complete post-session pain score, and a complete pre-session stress score. We employed a multivariable logistic mixed effects model to evaluate binary pain reduction response (>= 2 units vs. < 2 units) where patients were considered nested within therapists. The model included a fixed covariate for MT intervention type: receptive only, recreative (i.e., singing or active instrument play), compositional/creative (e. g., songwriting), or music-assisted relaxation and imagery (MARI). Covariates in the model associated with higher adjusted odds ratios (aOR [95% CI]) included (1) recreative (1.37 [1.00, 1.86]) and MARI (1.48 [1.01, 2.17]) MT interventions as compared to receptive; (2) 15-minute increases in session length (1.40 [1.22, 1.61]); (3) 1-unit increases in pre-session pain (1.19 [1.11, 1.28]), (4) 5-unit increases in Elixhauser comorbidity count (1.29 [1.05, 1.60); and (5) a documented MT session goal of pain management (3.58, [2.64, 4.86]). MT interventions involving singing, active instrument play, and relaxation/imagery may be more effective for reducing pain intensity than interventions only involving live or recorded music among patients with high pre-session pain. Perspective: This study examined factors associated with meaningful reductions in pain (0-10 numeric rating scale reduction >= 2 units) within a single music therapy session. Among hospitalized patients, interventions involving singing, active instrument play, and relaxation/imagery may be more effective for reducing pain than interventions only involving live or recorded music.

PubMed ID: 40945641

Title: Beyond the Discharge Summary: 10 Critical Considerations for Primary Care Physicians Managing Postdischarge Care

Author(s): Morikawa, MJ (Morikawa, Masahiro J.); Ganesh, PP (Ganesh, Prakash P.)

Source: SOUTHERN MEDICAL JOURNAL Volume: 118 Issue: 9 Pages: 618-621 DOI: 10.14423/SMJ.0000000000001865 Published Date: 2025 SEP

PubMed ID: 41032273

Title: Charting Suicide Risk in Latina Adolescents: A Qualitative System Dynamics Approach

Author(s): Gulbas, LE (Gulbas, Lauren E.); Hovmand, PS (Hovmand, Peter S.); Calzada, EJ (Calzada, Esther J.); Hausmann-Stabile, C (Hausmann-Stabile, Carolina); Kim, SY (Kim, Su Yeong); Zayas, LH (Zayas, Luis H.)

Source: CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY DOI: 10.1037/cdp0000772 Early Access Date: AUG 2025 Published Date: 2025 AUG 11

Abstract: Objectives: Suicide risk among Latina adolescents is shaped by dynamic interactions among emotional, behavioral, and sociocultural factors. This study develops a causal feedback theory to illustrate how these factors reinforce or mitigate suicide risk over time. Method: Using grounded theory analysis, we analyzed qualitative interviews with 60 Latina adolescents (ages 11-19) recruited from New York City: 30 with a history of suicide attempts and 30 with no reported history of suicidal behaviors. Participants varied by Hispanic cultural group, place of birth, and documentation status. Results: Our feedback theory is organized around seven categories: cognitive vulnerabilities, avoidant coping, high-risk behaviors, family conflict, social support, cultural socialization, and ethnic identity. A reinforcing loop of cognitive vulnerabilities, avoidant coping, high-risk behaviors, and family conflict was more common among adolescents who had attempted suicide. In contrast, social support, cultural socialization, and ethnic identity functioned as protective mechanisms that disrupted risk loops among those without suicidal behaviors. These findings suggest that while risk factors increase the likelihood of suicidal thoughts and behaviors, access to protective resources can interrupt risk trajectories and promote resilience. Conclusions: This study highlights the importance of culturally responsive suicide prevention strategies that strengthen social support, cultural socialization, and ethnic pride. By modeling suicide risk as a dynamic system, these findings provide new insights for intervention efforts tailored to the experiences of Latina adolescents.

PubMed ID: 40788715