Faculty Bibliography

INTRODUCTION/UNASSIGNED:While the harms child abuse and neglect have long been recognized, a growing body of knowledge has more recently developed about the longer-term harms during adulthood and the effectiveness of prevention programs. Research into the long-term effects of Adverse Childhood Experiences has provided a framework for calculating the potential cost savings for the health care system for reductions in adult chronic disease. METHODS/UNASSIGNED:This community case study analyzed health care costs of chronic disease conditions in adulthood in the U.S. State of Michigan to construct economic models of potential savings after reductions in total Adverse Childhood Experiences scores. National estimates, state-specific incidence data, and projections from the Adverse Childhood Experiences studies were used to calculate the population-based impact and specific costs and adult health care savings. RESULTS/UNASSIGNED:This analysis compared projected costs for evidence-based prevention programs (home visiting, newborn head trauma education, and pediatric primary care) and showed that a reduction of one Adverse Childhood Experience resulted in health care savings of more than $128 million annually ($55,816,424-$202,054,506) statewide for adult cancer, diabetes mellitus, heart disease, stroke, and pulmonary disease. DISCUSSION/UNASSIGNED:Building on these analyses, this community case study concluded that the health care savings alone more than justify any costs associated with child maltreatment prevention in the health care system.

OBJECTIVE/UNASSIGNED:Chronic non-specific lower back pain (cNSLBP) is a prevalent and disabling condition, imposing a substantial socioeconomic burden due to high healthcare costs and productivity losses, with limited accessible and effective long-term treatment options. Automated Thermo-mechanical Therapy (ATT) is a promising, non-drug intervention that leverages innovative technical advances to provide multimodal pain relief, offering accessibility and low-cost delivery. This study tested ATT for immediate pain relief in individuals with cNSLBP in a single-session, double-blind, randomized controlled trial. METHODS/UNASSIGNED:= 20) in a 40-min session with urn randomization. The active device applied heated cylindrical rollers along the spine, using far-infrared heat and mechanical tissue stimulation tailored to spinal alignment. In the control condition, the device used minimal mechanical therapy intensity without heat, targeting only the cervical area to avoid lower back therapeutic effects. Pre- and post-intervention assessments measured changes in pain intensity (primary outcome) via a 100-mm Visual Analog Scale for Pain (VAS-P100), alongside secondary outcomes assessing pain characteristics, anxiety, and functional mobility. RESULTS/UNASSIGNED:= 0.0031). No adverse events were reported, and all participants tolerated the intervention well. CONCLUSIONS/UNASSIGNED:A single session of ATT provides immediate, significant pain relief in individuals with cNSLBP, supporting its potential as a safe, non-invasive option for managing chronic back pain. Future studies should examine the long-term benefits of repeated ATT sessions and explore mechanistic insights into thermo-mechanical stimulation's effects on pain and function. CLINICAL TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov, identifier: NCT06769321.

Tricalcium phosphate (TCP) bioceramics, available as α- and β-polymorphs, are frequently employed in the production of three-dimensionally (3D) printed bone scaffolds. Although hydrothermal immersion processing (HP) and sintering (S) are commonly adopted as post-printing techniques for bioceramics, a comprehensive comparative analysis of their effects on the osteogenic performance of α- and β-polymorphs in vivo remains inadequately investigated. In this study, α-TCP and β-TCP scaffolds were fabricated via direct ink writing and subjected to hydrothermal immersion processing (α-TCP/HP) and sintering (β-TCP/S) prior to implantation in n = 12 skeletally mature sheep (n = 1 scaffold per group per animal), and the outcome variables were evaluated at 3 and 12 weeks postoperatively (n = 6 sheep per time point). The quantitative results showed no significant differences in bone deposition or scaffold resorption at 3 weeks postoperatively (p = 0.618 and p = 0.898, respectively). However, at 12 weeks, there was a significant increase in osteogenesis and scaffold resorption in the β-TCP/S cohort relative to the α-TCP/HP counterparts (p < 0.001 and p = 0.004, respectively). β-TCP scaffolds subjected to post-print sintering exhibited superior osteoconductive and resorptive profiles compared to hydrothermal immersion-processed α-TCP scaffolds over the 12-week healing period.

Using a validated HIV transmission model for Zimbabwe, we simulated January 2025 U.S. President's Plan for AIDS Relief (PEPFAR) funding cuts' impacts on HIV incidence and HIV-related deaths. We found extending funding cuts through 2030 would increase HIV incidence by 78% and add 85 000 infections, producing 25 000 additional HIV-related deaths. However, if PEPFAR reinstated funding within 12  months, much or all of this harm could be offset through more efficient resource allocation, specifically, reallocating funds for oral PrEP towards long-acting PrEP.

PURPOSE OF REVIEW/UNASSIGNED:Tusi, also known as "pink cocaine," has emerged across nightlife scenes in Latin America, Europe, Australia, and the United States (US). Tusi is typically a drug mixture containing ketamine and 3,4-methylenedioxymethamphetamine (MDMA). Due to tusi's inconsistent chemical makeup, surveillance and harm reduction efforts have proven difficult for researchers and consumers alike. This review synthesizes evidence from peer-reviewed literature, drug checking programs, toxicology reports, and law enforcement data published between 2020 and 2025 to characterize tusi's composition, epidemiology, and associated risks. RECENT FINDINGS/UNASSIGNED:Drug checking services in various countries have identified ketamine and MDMA as the main components of tusi with additional substances often added (e.g., synthetic cathinones, cocaine, methamphetamine) in varying combinations. Laboratory data from Spain show that ketamine concentrations in tusi have increased over time. Surveys in Spain and Colombia highlight increases in initiation, polysubstance use involving tusi, and misclassification of its contents. Toxicology and case series reports indicate that harms associated with use stem largely from polysubstance mixtures rather than any single component, yet morbidity and mortality data typically focus on individual drugs detected. SUMMARY/UNASSIGNED:Tusi exemplifies a novel trend in emerging drugs: it is a blend of substances rather than a single compound, with its identity shaped by its distinctive color and association with nightlife. Its inconsistent composition and frequent co-use with stimulants and dissociatives elevate risk while complicating surveillance. Standardized survey items, expanded drug checking, and improved toxicological monitoring are needed to track and respond to this evolving mixture in the global drug supply.

Allostatic load provides a valuable framework for examining how cumulative stress impacts multiple physiological systems simultaneously, making it a powerful tool for understanding the mechanisms through which stress contributes to adverse pregnancy outcomes. This multisystem perspective is especially important during pregnancy, a period characterized by heightened vulnerability to stress and significant physiological changes that can themselves contribute to allostatic load. Although the impact of allostatic load during pregnancy is well documented, the mechanisms and moderators involved by trimester remain unclear, particularly given wide variation in social, cultural, and structural determinants of maternal health worldwide. In this review, we discuss the progress that has been made over the past two decades in studying prenatal allostatic load and describe the clinical implications of this by highlighting sensitive periods of interest throughout gestation. Despite these advances, key questions remain regarding the intergenerational transmission of risk, the specificity of findings to the pregnancy period, and the role of factors that often accompany elevated allostatic load, such as poor sleep, limited social support, systemic inequities, and comorbid mental or physical health conditions, which may manifest differently across global contexts. Most existing studies have been conducted in high-income settings, yet the burden of adverse pregnancy outcomes is greatest in low- and middle-income countries, where structural, environmental, and social stressors are pervasive. Expanding this framework to include diverse global contexts is essential for understanding how social inequities and chronic stressors shape maternal physiology worldwide. We discuss these issues and offer directions for future research, including the goal of developing a standardized metric for measuring allostatic load - one that we believe will advance the field's understanding of how prenatal allostatic load markers by trimester relate to maternal and infant outcomes.

Pigmented squamous cell carcinoma (pSCC) of the nail unit is an uncommon condition that can mimic benign entities. Clinically, pSCC can present as longitudinal melanonychia, onycholysis, or verrucous plaques, potentially leading to diagnostic delays. The pigmented variant is particularly challenging to diagnose, as it may be mistaken for benign melanocytic lesions. Histologically, pSCC demonstrates atypical keratinocyte proliferation with pigmentation, and immunohistochemical analysis is crucial to exclude melanocytic involvement. This case report describes a 25-year-old immunocompetent female with Fitzpatrick type IV skin who presented with progressive nail discoloration and sensitivity of the right thumb, persisting for approximately one year. Despite the absence of a personal or family history of skin malignancy, clinical evaluation and subsequent biopsy revealed focal pSCC in situ with wart-like histopathological features, including full-thickness epithelial atypia, papillomatosis, hypergranulosis, and keratohyalin granule formation. The patient was referred to Moh's micrographic surgery. This case underscores the importance of maintaining a broad differential diagnosis when evaluating persistent or evolving nail pigmentation, especially in patients without classic risk factors. The wart-associated histological changes suggest a possible link to human papillomavirus (HPV) infection, warranting further investigation into viral oncogenesis in nail unit SCC. Clinicians should maintain a high index of suspicion for atypical presentations, particularly in cases with progressive changes and associated pain, to ensure timely diagnosis and optimal management.

PURPOSE/UNASSIGNED:To evaluate short-term clinical and patient reported outcomes after gluteus maximus/tensor fascia lata (GM/TFL) transfer for abductor insufficiency. METHODS/UNASSIGNED:This was a retrospective case series. Inclusion criteria were patients who underwent GM/TFL for chronic abductor insufficiency from 2017 to 2024 at a single institution with a minimum follow-up of 6 months and at least 1 recorded postoperative visit. Demographic, clinical, and outcome data were collected, including hip range of motion, abduction strength, presence of Trendelenburg gait, postoperative rehabilitation details, complications, and patient-reported outcomes. Statistical comparisons of pre- and postoperative objective measures were performed using the Wilcoxon signed-rank test. RESULTS/UNASSIGNED:> .05), and Trendelenburg gait persisted in 80% of patients. However, patient-reported outcome scores were strong, with a mean postoperative modified Harris Hip Score of 76.5 ± 22.4 and Non-Arthritic Hip Score of 74.1 ± 21.7. Patient satisfaction was high, with 100% of patients indicating they would undergo the procedure again. Three patients experienced complications (30%), including 2 patients who had persistent pain and seroma formation, and a patient who had a recurrent hematoma. CONCLUSIONS/UNASSIGNED:GM/TFL transfer does not consistently improve hip strength or gait mechanics; however, it provides pain relief and improved quality of life, as evidenced by high patient satisfaction and favorable modified Harris Hip Score outcomes. Three patients experienced complications (30%), including two patients who had persistent pain and seroma formation, and a patient who had a recurrent hematoma. LEVEL OF EVIDENCE/UNASSIGNED:Level IV, retrospective therapeutic case series.

The rise of artificial intelligence (AI)-driven tools like ChatGPT is transforming professional fields, including pathology. This study provides early insights into how pathology trainees and practicing pathologists are integrating AI into their training and clinical practice. To assess adoption, usage patterns, perceptions, and challenges related to AI-driven tools, including large language models and vision-language models, among pathology professionals. The study also explores future directions for AI integration. A cross-sectional, anonymous survey was distributed electronically to pathology residents, fellows, and attending pathologists through the Accreditation Council for Graduate Medical Education program director registry, professional organizations, and social media (X, Reddit, LinkedIn, and The Pathologist email listserv). The survey included multiple-choice, Likert-scale, and open-ended questions on AI familiarity, usage, perceived benefits/risks, and institutional policies. Data were analyzed using descriptive and inferential statistics, with qualitative responses categorized thematically. A total of 268 respondents participated, primarily residents (41%), attendings (39%), and fellows (7%), representing 23 countries (65% from the USA). Most were affiliated with academic medical centers (72%) and aged 25-44. Whereas 73% reported some familiarity with AI, actual use was limited, 31% reported rare use and 29% no use at all, especially among residents and attendings. ChatGPT was the most used tool (84%), applied mainly for document drafting (57%), research (54%), and administrative tasks (34%). Diagnostic use was minimal. Top concerns included accuracy (81%), over-reliance (65%), and data security (63%). Only 10% reported having clear institutional AI guidelines. Familiarity was strongly associated with usage frequency (p < 0.00001). AI is increasingly used in non-diagnostic areas of pathology but adoption remains cautious. Significant gaps in clinical application, trust, and institutional support persist. Clear guidelines, targeted education, and robust validation are essential for safe, effective AI integration into pathology practice and training.