Morehouse School of Medicine

Purpose More than 10 million annual global cancer deaths are exacerbated by the impact of climate change and environmental determinants of health. This brief report provides a summary of and mitigating recommendations for the complex intersection between climate change and surgical cancer care. Methods A review of scientific literature from the last 10 years was conducted to assess the current impact of climate change on cancer care with a focus on surgical interventions. Studies with an impact score of 6 or higher and the keywords of climate change, extreme weather, cancer care, and surgery were reviewed. After removing duplicates and excluded studies, 30 studies remained and were reviewed by two reviewers. Results Climate-related factors impacting surgical care result in a myriad of healthcare impacts, including disruption of services, impact on patient outcomes and survival, as well as an overburdening of hospital and surgical services. Conclusion Climate change, including extreme weather events, threatens cancer surgical care and delivery by exacerbating comorbidities, disrupting healthcare systems, and increasing disparities in cancer care. Climate change is a burgeoning threat to global health, cancer care, patients, and communities.

The convergence of mobile software, artificial intelligence, and biomedical science is ushering in a new era of precision medicine, defined not only by personalization but by real-time adaptability. This shift is exemplified by the evolution of Prescription Digital Therapeutics (PDTs): smartphone-based applications that treat a disease or condition and are regulated in the US by the FDA. Early PDTs (PDT 1.0) such as reSET for substance use disorder, reSET-O for opioid use disorder, and Somryst for chronic insomnia digitized cognitive behavioral therapy (CBT) into a smartphone app and laid the foundation for regulated digital interventions. Now in the era of PDT 2.0, we see greater personalization, multimodal approaches beyond CBT, robust clinical validation, and targeting drug-like endpoints with Rejoyn for major depressive disorder, CT-132 for episodic migraine prevention, Luminopia for amblyopia, and CT-155 in development for negative symptoms of schizophrenia. Despite promising results, widespread adoption remains limited by reimbursement, clinician and patient awareness, and integration into clinical workflows. On the horizon is smart medicine: a convergence of traditional pharmacotherapy with PDTs that work together to enhance overall effectiveness, safety and tolerability, and engagement, adherence, and personalization. These medicines optimize outcomes in ways conventional therapies cannot and, in true closed-loop principles, assess for disease and symptoms and modulate both the digital and drug interventions. Drawing from my work experience on multiple PDTs, this paper highlights how PDTs are transforming care. The FDA’s Prescription Drug Use-Related Software (PDURS) guidance affirms the regulatory foundation for integrating PDTs and drugs. Meaningful therapeutic advancements now depend not only on the molecular design but also on the mechanisms, digital or otherwise, that support its success. I postulate that within the next five years, omitting digital interventions when indicated will not just be outdated, it may be malpractice.

Objective Beyond aesthetic implications, craniosynostosis can profoundly impact neurocognitive development. There is a notable gap in standardized methodologies for identifying which of these patients are at-risk for developing adverse neuropsychosocial outcomes through screening techniques. This research aims to identify and recommend a standardized, routine approach inclusive of free or low-cost screening instruments for patients with craniosynostosis that are easily administered in clinic with or without a trained examiner. Design A systematic review was conducted. Data related to various developmental assessments were extracted and subsequently reviewed by two trained neuropsychologists for analysis, categorization, and recommendation. Main Outcomes Measures Neurocognitive screening assessments for patients with craniosynostosis. Results In total, 114 different tests regarding neurocognitive examination of patients with craniosynostosis were cited. We identified six areas of neuropsychosocial development that are relevant for routine screening: Development, Social-Emotional/Behavioral, Adaptive Functioning, Academic Achievement, Autism, and ADHD/Attention. Within each category, screening recommendations are made, including instruments that are free or low-cost and can be easily administered in clinic with or without a trained examiner. Conclusions Literature supports the impact of craniosynostosis on neuropsychosocial development, so we urge teams to screen patients from an early age using these suggestions as they are free or relatively low-cost, can be administered to a wide range of patient ages, and can be administered in clinic with or without a trained examiner. This study serves as a starting point towards a more standardized approach to effectively evaluate and address the neurocognitive implications of craniosynostosis, ultimately enhancing patient care and treatment outcomes.

Justice-involved individuals, encompassing those with prior interactions with the correctional system, represent a population with significant unmet healthcare needs. Approximately 95% of incarcerated individuals return to society, often with unresolved chronic conditions or infectious diseases such as HIV and Hepatitis C, and face considerable barriers to accessing healthcare. Institutional constraints, logistical complications, inadequate resources, and cultural biases exacerbate disparities, contributing to suboptimal health outcomes and public health risks. Healthcare access for justice-involved individuals is hindered by multiple factors, including limited availability of medications like opioid use disorder treatments, restricted surgical and preventive care, and systemic challenges in initiating healthcare. The suspension of Medicaid during incarceration, compounded by high uninsurance rates post-release, further exacerbates these inequities. Despite legislative efforts such as the Affordable Care Act and state-level policies addressing restraint use, healthcare services for this population remain inadequate and inconsistent. Recommendations include leveraging correctional facilities to enhance healthcare delivery, incorporating justice-involved populations in hospital design and planning, and fostering collaborations between correctional facilities and healthcare organizations. Training healthcare professionals in correctional medicine and tailoring care programs to justice-involved patients’ needs are critical. Research should focus on improving care models, expanding insurance enrollment initiatives, and addressing long-term health outcomes for this vulnerable group. Efforts to integrate justice-involved individuals into broader healthcare frameworks can reduce health disparities, improve public health, and promote equitable access to care. Addressing these systemic issues requires collaborative approaches across healthcare, correctional, and policy sectors.

Background and Aims Sexual health among older adults (ages 50 and above) remains under‐addressed in clinical settings, often due to ageism and misconceptions about older adults being asexual. Despite high rates of sexual activity in this age group, healthcare providers rarely initiate discussions about sexual wellness, particularly related to HIV and STIs. This project aimed to explore how health communication tools, specifically film and reflexive exercises, can challenge implicit bias and improve provider comfort with sexual health conversations across the lifespan. Methods A 24‐min documentary film, Even Me, focusing on HIV wellness and prevention among older adults, was screened at a professional conference attended by sexual health clinicians and researchers. Participants first engaged in a word‐association activity reflecting on the phrase “82‐years‐old” to surface implicit associations with aging. After the film, attendees participated in a facilitated discussion and completed a Qualtrics‐based postevaluation survey (n = 35/50, 70% response rate). Results Initial word‐association responses revealed ageist stereotypes, including terms like “frail,” “bent,” and “almost dead.” Post‐screening dialogue reflected a shift in awareness and sparked robust conversations. Survey responses indicated that 65% of attendees lacked a standardized tool to assess sexual history in older clients. Many reported an intention to integrate sexual health screenings into their practice and to educate peers and students. Educators emphasized a need to normalize sexual health education for older adults in academic curricula. Conclusion Health communication films like Even Me, paired with self‐awareness activities, are promising tools to disrupt ageist assumptions and promote sexual health conversations among providers. Such interventions can help foster inclusive, routine clinical practices that support sexual wellness throughout the aging process.

Pulmonary hypertension (PH) is defined hemodynamically as a mean pulmonary arterial pressure (mPAP) ≥ 20 mmHg, measured at right heart catheterization (RHC). Pulmonary arterial hypertension (PAH) is defined as a mPAP ≥ 20 mmHg with a pulmonary capillary wedge pressure (PCWP) or left ventricular end‐diastolic pressure (LVEDP) of ≤ 15 mmHg and a pulmonary vascular resistance (PVR) > 2 Woods Units (WU). The reported prevalence of PAH in the general population is 0.03–0.05 per 1000 population. However, several studies suggest that the prevalence may be higher among specific sub‐populations. Using Medicaid Analytic Extract (MAX) files, we identified Medicaid beneficiaries who were diagnosed with PH or PAH between 2009 and 2012. The prevalence of PH and PAH was calculated for the overall study population and subgroups based on demographics or co‐morbidities. We used one‐way analysis of variance (ANOVA) tests to compare the differences in hospital bed days and total Medicaid cost across racial subgroups among those with PH and those without PH; Tukey post hoc tests were performed to calculate p‐values for comparing White and Black subpopulations. Prevalence rates ranged between 1.7 and 1.8 per 1000 persons, and the PAH prevalence ranged between 0.4 and 0.5 per 1000 persons for the years reviewed. Significant racial/ethnic disparity in PH and PAH prevalence was observed (p‐value < 0.001), with Black patients having the highest prevalence and Asian patients having the lowest prevalence. Prevalence of PH and PAH were noted to be higher for the Medicaid population than for the general population for all years reviewed. PH and PAH prevalence was noted to be higher among Blacks compared to Non‐Hispanic Whites, while it was significantly lower in Hispanics and Asians. PH/PAH Medicaid patients were noted to account for a greater economic burden compared to the general Medicaid population. Stratifying economic burden by race revealed that American Indian and Alaska Natives with PH had the highest total Medicaid cost for all years reviewed.

Introduction Understanding the contextual fit and feasibility of evidence-based interventions (EBIs) constitutes an important aspect of implementation research to inform policy decisions for their uptake and sustainability in any given context (eg, setting, sector and population). Yet current methodologies, which attempt to assess contextual fit and feasibility of EBI as key preimplementation outcomes using a reductionist approach with summative scores, fall short in capturing the multiple forms of interactions and influences of constructs and contextual factors associated with EBI implementation in a real-world situation. Methods Between 18 February 2023 and 5 August 2023, we designed a novel tool through an ongoing collaborative effort of researchers, global health practitioners, policy makers and populations from low- and middle-income countries and high-income countries using a five-step sequential process. This process included step 1 (stakeholder envisioning), step 2 (evidence synthesis), step 3 (evidence deconstruction), step 4 (stakeholder consensus and conceptual framework development) and step 5 (tool development, deployment and standardisation). Results Following this process, a pragmatic contextual fit and feasibility (PCoF) tool was developed with acceptability and preference derived as potentially stable constructs for contextual fit outcome and willingness to use and resource availability for feasibility outcome. The assessment of contextual fit and feasibility outcomes with strong, somewhat, and weak ratings was determined by a total of nine real-world scenarios of construct interactions in either case. Strong, somewhat and weak ratings of contextual fit or feasibility accounted for one, seven and one construct interaction(s), respectively. Conclusion This initial development of PCoF is a step in the right direction for addressing the complexity associated with EBI implementation that is in part posed by contextual factors and cannot be completely explained by summative scoring and arbitrary rating approaches of existing tools. The use of PCoF as a research and policy decision-support tool, once extensively refined, validated and standardised across multiple contexts, has the potential to generate robust evidence on the contextual fit and feasibility of EBI and to meaningfully support researchers, policy makers and other stakeholders in informing the prioritisation, adaptation and equity-focused uptake and scale-up of EBI for improved population health and social outcomes.

Despite the longstanding underrepresentation of Black physicians in the U.S., greater representation of Black physicians in the physician workforce can positively impact health outcomes. In Georgia, racial and ethnic health inequities are prevalent, and physician workforce shortages are acute. This study aims to assess the impact of Black physician representation on three health outcomes: Years of Potential Life Lost (YPLL) before age 75 and hospital discharges and emergency room visits related to chronic Ambulatory Care Sensitive Conditions (ACSC) or coronavirus disease 2019 (COVID-19). Data sources included a survey administered by the Georgia Composite Medical Board and the Online Analytical Statistical Information System (OASIS) to analyze county-level outcomes for non-Hispanic Black (NHB) and non-Hispanic White (NHW) populations from 2016 to 2019 and 2020 to 2022. We used linear regression models to assess the association between Black physician representativeness in the county physician workforce and NHB-NHW disparities in the outcome measures. We found that counties with higher Black physician representativeness experienced better health outcomes for both NHB and NHW populations, with reduced racial disparities in hospital discharges and YPLL, particularly during the COVID-19 pandemic. The study underscores the importance of increasing Black physician representation in the workforce to advance health equity in Georgia.

Objective Unconditional cash transfers (UCTs)—no strings attached monthly payments—to low-income families may reduce financial stress and improve health outcomes. We sought to determine the feasibility and acceptability of randomizing low-income caregivers of preterm infants to a high- or low-value UCT for 4 months. Study design Parallel, pilot randomized controlled trial that was preregistered (ClinicalTrials.gov NCT05930327). We enrolled 24 birthing parent-infant dyads. The intervention was a $325 monthly UCT and the active control was a$25 monthly UCT. Result The intervention was feasible and universally acceptable among families in the high-value cash transfer arm. Exploratory outcomes revealed a high degree of financial strain, stress, and depressive symptoms. Conclusion This study provides feasibility, acceptability, and preliminary efficacy data to inform a future, larger trial to examine the impacts of UCTs to low-income birthing parents of preterm infants. Clinical trial registration ClinicalTrials.gov ID NCT05930327.

Access to surgical care represents a significant and widespread issue that impacts millions of Americans across varying demographics. It is estimated that nearly 100 million Americans—approximately 1 in 3—lack access to quality surgical care. Additionally, the financial implications of this lack of access lead to an estimated annual cost of $1 billion in preventable healthcare spending, coupled with increased morbidity and mortality rates. Reliable access to care includes sufficient and affordable health insurance and the ability to easily locate and receive care that meets the patient’s health needs. The barriers to timely, affordable, quality surgical care are complex and multifaceted. They include population-based factors such as rural geography, the repercussions of hospital closures, access challenges faced by justice-involved individuals, LGBTQ+ patients, and other marginalized groups, language and cultural barriers as well as the impact of natural disasters on supply and health system infrastructure, bias and discrimination, and policy.

Background Glioblastoma is a highly aggressive brain tumor, and the transition from the proneural to mesenchymal subtype is associated with more aggressive and therapy-resistant features. However, the signaling pathways and genes involved in this transition remain largely undefined. Methods We utilized patient-derived xenograft (PDX) samples of glioblastoma, specifically PDX-L14, which exhibit both negative and overexpressed FOSL1 expression. mRNA expression profiles were assessed by RNA sequencing in these samples, followed by gene ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and Gene Set Enrichment Analysis (GSEA). Validation of the hub genes was performed using qPCR and immunohistochemistry assays. Results Differentially expressed genes (DEGs) between FOSL1 overexpression groups were predominantly involved in ferroptosis, immune response, angiogenesis, vascular mimicry, autophagy, epithelial-mesenchymal transition (EMT), cancer cell stemness, temozolomide (TMZ) resistance, and NF-κB signaling. Downregulated DEGs were associated with TMZ resistance, glioma proliferation, RNA processing, and Wnt/β-catenin signaling. Key enrichment pathways, including NF-κB, Want, and BMP, are all critical for maintaining glioma stemness. FOSL1 was found to regulate RNA processing and ubiquitination. Notably, 8 upregulated (ITGA5, SDC1, PHLDB2, TNFRSF8, ADAM8, TLR7, STEAP3, and POU3F2) and 4 downregulated (IFIT1, FBXO16, ARL3, and BEX1) genes were identified, with implications for glioblastoma prognosis. Conclusion This transcriptome investigation emphasizes the diverse functions of FOSL1 in different biological processes and signaling networks during the shift from proneural to mesenchymal state in glioblastoma.