Nova Southeastern University
  • Florida, Florida, United States
Recent publications
Background: Demonstrating therapeutic value from the patient perspective is important in patient-centered migraine management. The objective of this study was to investigate the impact of eptinezumab, a preventive migraine treatment, on patient-reported headache impact, acute medication optimization, and perception of disease change when initiated during a migraine attack. Methods: RELIEF was a randomized, double-blind, placebo-controlled trial conducted between 2019 and 2020 in adults with ≥1-year history of migraine and 4-15 migraine days per month in the 3 months prior to screening. Patients were randomized (1:1) to a 30-min infusion of eptinezumab 100 mg or placebo within 1-6 h of a qualifying migraine attack onset. The 6-item Headache Impact Test (HIT-6) and 6-item Migraine Treatment Optimization Questionnaire (mTOQ-6) were administered at baseline and week 4, and the Patient Global Impression of Change (PGIC) at week 4. A post hoc analysis of these measures was conducted in patients who reported headache pain freedom at 2 h after infusion start. Results: Of 480 patients enrolled and treated, 476 completed the study and are included in this analysis. Mean baseline HIT-6 total scores indicated severe headache impact (eptinezumab, 65.1; placebo, 64.8). At week 4, the eptinezumab-treated group demonstrated clinically meaningful improvement in HIT-6 total score compared with placebo (mean change from baseline: eptinezumab, - 8.7; placebo, - 4.5; mean [95% CI] difference from placebo: - 4.2 [- 5.75, - 2.63], P < .0001), with greater reductions in each item score vs placebo (P < .001 all comparisons). Change in HIT-6 total score in the subgroup with 2-h headache pain freedom was - 13.8 for the eptinezumab group compared with - 4.9 for the placebo group. mTOQ-6 total score mean change from baseline favored eptinezumab (change, 2.1) compared with placebo (1.2; mean [95% CI] difference: 0.9 [0.3, 1.5], P < .01). More eptinezumab-treated patients rated PGIC as much or very much improved than placebo patients (59.3% vs 25.9%). Conclusions: When administered during a migraine attack, eptinezumab significantly improved patient-reported outcomes after 4 weeks compared with placebo, with particularly pronounced effects in patients reporting headache pain freedom at 2 h after infusion start. Trial registration: ClinicalTrials.gov Identifier: NCT04152083 . November 5, 2019.
Background The aim of this study was to evaluate the influence of increased irradiation distance on the flexural strength (FS), dentin micro-shear bond strength (μSBS), and the degree of conversion (DC) of bulk-fill flowable, conventional flowable, and packable resin composites. Methods The resin composites tested were Surefil® SDR™ (SDR), Filtek Z350 XT Flowable Restorative A2 shade (Z3F), and Filtek Z350 XT Universal Restorative A2 shade (Z3P). Specimens were cured at four irradiation distances (0, 2, 4, and 8 mm) with an Elipar DeepCure-S LED curing light for 20 s. FS tests were performed ( n = 15) using bar-shaped specimens (8 mm × 2 mm × 2 mm) of the resin composites. μSBS tests were performed on the occlusal surfaces of extracted third molars from humans that were ground to expose dentin ( n = 15). DC was measured by using Raman spectroscopy on the top and bottom surfaces of disk specimens (2-mm thick) ( n = 3). To further investigate whether extended irradiation times could compensate for reduced irradiance, additional Z3P specimens were prepared, which were light-cured at 8-mm distances for 40 and 60 s and subjected to FS tests, μSBS tests, and Raman spectroscopy. Both two-way and one-way ANOVA were used for statistical analyses. Results Both FS and DC of Z3P specimens cured at an 8-mm distance were significantly lower than those cured at shorter distances ( p < 0.05), whereas the FS and DC of the Z3F and SDR specimens were not significantly influenced by increasing distances. The μSBSs of the three types of resin composites reduced with increasing irradiation distances. The FS, μSBS, and DC of the Z3P specimen light-cured at 8 mm for 40 s were comparable to those of the Z3P specimen cured at 0 mm for 20 s. Conclusions Increasing the irradiation distance to 8 mm can have a deleterious influence on mechanical performances, including the FS, DC, and dentin μSBS, of the resin composites polymerized with high-irradiance light curing units.
This paper proposes a real-time wavelet-based power estimator using a real-time modified stationary discrete wavelet packet transform (RT-MSDWPT). The proposed method overcomes the conventional SDWPT main constraints of power estimations related to the lack of reactive power flow direction and susceptibility to off-nominal frequency operation. The introduction of a digital sampling-shifting of a quarter of the fundamental, applied to the filtered voltages, assures the reactive power flow direction. Additionally, the insertion of an adaptive sampling time procedure based on the power grid frequency estimation mitigates the errors introduced by the network frequency deviations. These modifications make the RT-MSDWPT suitable for being embedded into the standard hierarchical power flow control strategies of ac microgrids. Experimental results assessed using an ac microgrid laboratory setup, operating under different operational scenarios, demonstrate the feasibility of the proposed solution.
The substance use, violence, and AIDS (SAVA) syndemic framework is used to study risk for HIV/AIDS. As a secondary analysis from a large HIV/AIDS prevention study, we categorized participants into having from zero to three SAVA conditions based on the presence or absence of self-reported substance use in the past 4 months, history of lifetime sexual abuse, and intimate partner violence. We used Poisson regression models to examine the association between the number of SAVA conditions and sexual risk behavior. Among all participants (n = 195, median age, 20), 37.9%, 19.5%, and 6.7% reported occurrence of one, two, and all three SAVA conditions, respectively. We found that more than one SAVA condition experienced by women was significantly associated with having more than one sex partner (adjusted prevalence ratio [aPR] = 1.88; 95% confidence interval [CI] = 1.28, 2.76) and with substance use before sex (aPR = 1.61 95% CI = 1.06, 2.45).
Introduction The aim of this study is to investigate the gender distribution of first and senior authors in the most highly cited original research studies published in the top 10 surgical journals from 2015 to 2020 to identify disparities and changes over time. Methods A retrospective study analyzing the gender distribution of first and senior authors in the top 10 most cited studies from the top 10 surgical journals from 2015 to 2020. The genders of the first and senior authors of each study were assessed using National Provider Identifier (NPI) numbers or pronouns from institutional biographies or news articles. Results The genders of 1200 first and senior authors from 600 original research studies were assessed. First author gender distribution consisted of 71.8% men, 22.3% women, 0% non-binary, and 5.8% unknown. Senior author gender distribution was 82.3% men, 14.3% women, 0% non-binary, and 3.3% unknown. Studies published by first authors who are women received more citations than those published by first authors that are men in 2015 (169.1 versus 112.9, P = 0.002) and 2016 (144.2 versus 101.5, P = 0.011). There was an increase in first authorship among men from 2015 to 2020 (P = 0.035). Conclusions Men represent a significantly higher proportion of both first and senior authorships in top surgical research and the gap has widened from 2015 to 2020. However, studies written by women first authors received significantly more citations than those written by men.
While recent research finds that cooperating with local partners increases export performance, other studies show that home ties negatively affect exports. This article contributes to the discussion on the inconclusive effects of local and overseas innovation cooperation arrangements on export performance by examining the specific purpose of the innovation collaboration agreement. In analyzing StatsNZ Business Operations Survey data, we unexpectedly find that most local cooperation agreements negatively affect export performance. In contrast, research and development agreements with local partners positively influence export performance. Our results show that although collaborating with an overseas partner on marketing and prototyping positively affects export performance, counterintuitively, interfirm cooperation with an international partner with the purpose of research and development exhibits no effect on the probability of becoming an exporter. Implications for managers and policymakers are discussed.
Introduction A growing percentage of the US population is over the age of 65, and geriatrics account for a large portion of trauma admissions, expected to reach nearly 40% by 2050. Cognitive status is important for operative management, especially in elderly populations. This study aims to investigate preoperative and postoperative cognitive function assessment tools in geriatric patients following acute trauma and associated outcomes, including functional status, postdischarge disposition, mortality, and hospital length of stay (H-LOS). Methods A literature search was conducted using Medline/PubMed, Google Scholar, Embase, JAMA Networks, and Cochrane databases for studies investigating the use of cognitive assessment tools for geriatric patients with acute trauma. The last literature search was conducted on November 13, 2021. Results Ten studies were included in this review, of which five focused on preoperative cognitive assessment and five focused on postoperative. The evidence suggests patients with preoperative cognitive impairment had worse functional status, mortality, and postdischarge disposition along with increased LOS. Acute trauma patients with postoperative cognitive impairment also had worse functional status, mortality, and adverse postdischarge disposition. Conclusions Preoperative and postoperative cognitive impairment is common in geriatric patients with acute trauma and is associated with worse outcomes, including decreased functional status, increased LOS, and adverse discharge disposition. Cognitive assessment tools such as MMSE, MoCA, and CAM are fast and effective at detecting cognitive impairment in the acute trauma setting and allow clinicians to address preoperative or postoperative cognitive impairments to improve patient outcomes.
The objective of this research is to understand the service e-quality dimensions that contribute to creating value for Generation Z (Gen Z) consumers when choosing Internet-Only Banks (IOBs) services. The data were collected from a sample of Gen Z IOB users in France. Structural Equation Modeling was used to test the hypotheses. Results suggest that reliability, customer service and support, product portfolio, bank transparency, personalization, and security and privacy are positively related to IOB’s consumer perceived value and that consumers’ perceived value positively affects IOB’s consumer loyalty. This study reveals that IOBs in France should focus on those dimensions to tailor a unique customer experience to Gen Z.
The social movement‐countermovement relationship is most often one of competition. The subject of police reform has become more complex after calls for greater restrictive police policies and the emergence of Blue Lives Matter. This study demonstrates how Blue Lives Matter acts as a countermovement to police reform, frame it in a historical context, explain why it appeals to sympathizers, and illustrate how it interacts with opposing groups and individuals. This study also assesses how Blue Lives Matter operates in direct opposition to Black Lives Matter and efforts for greater police accountability. The central theme of this literature addresses how the Blue Lives Matter Movement addresses competition, criticisms, and attitudes of Blue Lives Matter adherents and detractors in local and national contexts. This study questions if reconciliation between the stated objectives and tactics of the countermovement is possible without a change in police behavior and law enforcement practices. Conflict theories identify social constructionism as a process in social and countermovements.
Determining trophic habits of predator communities is essential to measure interspecific interactions and response to environmental fluctuations. South American fur seals, Arctocephalus australis (SAFS) and sea lions Otaria byronia (SASL), coexist along the coasts of Peru. Recently, ocean warming events (2014–2017) that can decrease and impoverish prey biomass have occurred in the Peruvian Humboldt Current System. In this context, our aim was to assess the effect of warming events on long-term inter- and intra-specific niche segregation. We collected whisker from SAFS (55 females and 21 males) and SASL (14 females and 22 males) in Punta San Juan, Peru. We used δ ¹³ C and δ ¹⁵ N values serially archived in otariid whiskers to construct a monthly time series for 2005–2019. From the same period we used sea level anomaly records to determine shifts in the predominant oceanographic conditions using a change point analysis. Ellipse areas (SIBER) estimated niche width of species-sex groups and their overlap. We detected a shift in the environmental conditions marking two distinct periods (P1: January 2005—October 2013; P2: November 2013—December 2019). Reduction in δ ¹⁵ N in all groups during P2 suggests impoverished baseline values with bottom-up effects, a shift towards consuming lower trophic level prey, or both. Reduced overlap between all groups in P2 lends support of a more redundant assemblage during the colder P1 to a more trophically segregated assemblage during warmer P2. SASL females show the largest variation in response to the warming scenario (P2), reducing both ellipse area and δ ¹⁵ N mean values. Plasticity to adapt to changing environments and feeding on a more available food source without fishing pressure can be more advantageous for female SASL, albeit temporary trophic bottom-up effects. This helps explain larger population size of SASL in Peru, in contrast to the smaller and declining SAFS population.
Although the cause for the rise in melanoma incidence remains a topic of debate, its potentially aggressive nature necessitates a continual update on the pathophysiologic mechanisms of disease and current guidelines for management. Akin to other cutaneous malignancies, sun exposure remains a crucial risk factor in the development of different melanoma subtypes. There are specific non‐UV associated mutations that are commonly found in most melanomas and some nevi, such as B‐RAF V600E, that may represent an initial insult of a multistep process that eventually leads to progression of the lesion into a more aggressive phenotype. The standard of care for early melanoma management remains surgical excision with wide margins, however management changes with more advanced lesions by the addition of imaging, sentinel lymph node biopsies, genetic testing, immune, and targeted therapy. Different novel treatment regimens for advanced unresectable melanomas are being investigated with the use of targeted therapies and vaccines. Novel screening technology using artificial intelligence for detection of melanoma is currently being developed but remains in its early stages with its effectiveness being significantly lower compared to clinicians. As such, melanoma prevention and early detection through skin examinations remain crucial to avoid potentially deadly complications from more advanced lesions.
Objective: Class III malocclusion is characterized by a loss of vertical dimension associated with muscle imbalance. The present study was designed to determine electromyographic amplitude changes in temporal (T) and masseter (M) at rest and during clenching in Class III patients treated with an intraoral device (IOD) over a 24-hour period for 30 days with transcutaneous electrical nerve stimulation (TENS). Methods: Twelve patients with Class III (mean age 27.7 ± 1.2 years) were treated with TENS and IOD. Ten untreated patients composed the control group. Data were analyzed using Wilcoxon test and ANOVA. Results: Patients treated with TENS and IOD showed a marked decrease in hyperactivity of M and T at rest (p = 0.001) and an increase during clenching (p = 0.001). The control group maintained similar activity in both positions. Conclusion: This study confirms that using TENS and IOD in patients improves muscle activity of T and M.
Dystussia is prevalent in individuals with amyotrophic lateral sclerosis (ALS), leading to a diminished physiologic capacity to effectively defend the airway. We aimed to identify predictors of peak expiratory cough flow rate in individuals with ALS. One hundred and thirty-four individuals with a confirmed diagnosis of ALS (El-Escorial criteria revised) completed the ALS Functional Rating Scale-Revised (ALSFRS-R) and underwent pulmonary function and cough spirometry testing. Pearson’s correlation coefficients and hierarchical multiple regression modeling were conducted to determine predictors of voluntary cough peak expiratory flow rate (p < 0.05). The full model including age, bulbar disease, cough spirometry metrics, and respiratory parameters had a marginal R² = 0.635, F (7, 126) = 30.241, p < 0.0005, adjusted R² = 0.61. Maximum expiratory pressure, compression phase, and vital capacity did not contribute and were therefore removed (p < 0.05). The most parsimonious predictive model included age, bulbar disease, peak inspiratory flow rate and duration, peak expiratory rise time, and inspiratory pressure generation with a marginal R² = 0.543. Although expiratory pressure generation has historically served as the therapeutic target to improve dystussia in ALS, the current dataset highlighted that the inability to quickly and forcefully inspire during the inspiratory phase of voluntary cough places patients at a mechanical disadvantage to generate subsequent high-velocity expiratory airflow to clear the airway. Thus, therapeutic training programs that include both inspiratory and expiratory strength targets may optimize airway clearance capacity in this challenging patient population.
Family relationships are a critical factor in the etiology and maintenance of disordered eating (DE). Attachment theory provides a framework for how relational factors can impact DE, which can be further expanded with objectification theory. Parental relationships can either buffer or increase risk for body shame and DE. Specifically, parental psychological control (PPC) is linked to DE for adolescents and young adults. This study examined if attachment insecurity and body shame serially mediated the association between PPC and DE in young women. We applied secondary analysis to data obtained from a sample of 84 college women (Mage = 20.61; SD = 2.49). Self-reported measures included the Eating Attitudes Test, the Psychological Control Scale-Youth Report, the Body Shame Questionnaire, and the Experiences in Close Relationships-Relationship Structures Questionnaire. Hayes’ Process Macro (v. 3.5 model 80) was used to test serial mediation models linking maternal and paternal PPC to DE through anxious and avoidant attachment and body shame. Results demonstrated indirect effects of body shame on DE in the maternal and paternal PPC models. Anxious (but not avoidant) attachment and body shame showed serial indirect effects linking PPC to DE. Our findings point to the saliency of body shame and attachment anxiety in predicting DE symptoms among young women.
Depending on our mode of reasoning-moral, prudential, instrumental, empirical, dialectical, and so on-we may come to vastly different conclusions on the nature of death and the appropriate orientation toward matters such as euthanasia or procuring organs from brain-dead patients. These differing orientations have resulted in some of the most enduring conflicts in biomedical decision-making with roots in the earliest strands of philosophical discourse. Through continually grappling with questions over matters of death, we continually step closer to clarity, even if certainty on these matters remains necessarily as elusive as death itself.
Posttraumatic stress disorder (PTSD) is a debilitating stress disorder occurring in the context of a traumatic event and is characterized by intrusive and avoidance symptoms, negative alterations in cognition and mood, and arousal and reactivity changes. Despite its representation throughout literature, the pathophysiology of PTSD remains incompletely understood, thus contributing to broad, variable, and at times, experimental treatment options. The authors present the first documented case of the rapid and successful management of PTSD using valproic acid and twice daily dosing of prazosin aimed at targeting symptoms of hyperarousal and both daily and nightly intrusive symptoms of flashbacks and nightmares, respectively. The authors also discuss postulations of the underlying mechanisms of action responsible for such symptom alleviation. Further investigation is needed to expand upon our knowledge of the use of such agents in the treatment of PTSD to improve upon existing clinical guidelines, especially in the acute setting, thus providing better overall prognosis.
TLR9 is a critical nucleic acid sensing receptor in mediating periodontitis and periodontitis-associated comorbidities. Emerging evidence implicates TLR9 as a key sensor during aging, although its participation in periodontal aging is unexplored. Here, we investigated whether TLR9-mediated host responses can promote key hallmarks of aging, inflammaging, and senescence, in the course of periodontitis using a multipronged approach comprising clinical and preclinical studies. In a case-control model, we found increased TLR9 gene expression in gingival tissues of older (≥55 y) subjects with periodontitis compared to older healthy subjects as well as those who are younger (<55 y old) with and without the disease. Mechanistically, this finding was supported by an in vivo model in which wild-type (WT) and TLR9 –/– mice were followed for 8 to 10 wk (young) and 18 to 22 mo (aged). In this longitudinal model, aged WT mice developed severe alveolar bone resorption when compared to their younger counterpart, whereas aged TLR9 –/– animals presented insignificant bone loss when compared to the younger groups. In parallel, a boosted inflammaging milieu exhibiting higher expression of inflammatory/osteoclast mediators ( Il-6, Rankl, Cxcl8) and danger signals ( S100A8, S100A9) was noted in gingival tissues of aged WT mice compared to the those of aged TLR9 –/– mice. Consistently, WT aged mice displayed an increase in prosenescence balance as measured by p16 INK4a /p19 ARF ratio compared to the younger groups and aged TLR9 –/– animals. Ex vivo experiments with bone marrow–derived macrophages primed by TLR9 ligand (ODN 1668) further corroborated in vivo and clinical data and showed enhanced inflammatory-senescence circuit followed by increased osteoclast differentiation. Together, these findings reveal first systematic evidence implicating TLR9 as one of the drivers of periodontitis during aging and functioning by boosting a deleterious inflammaging/senescence environment. This finding calls for further investigations to determine whether targeting TLR9 will improve periodontal health in an aging population.
Purpose: We examined different methods to reduce the burden of accessing technology for videoconferencing during telerehabilitation for magnification devices for the visually impaired. Methods: During telerehabilitation studies over the past 5 years, vision rehabilitation providers assessed and gave training to visually impaired participants with newly dispensed magnification devices at home who connected to Zoom videoconferencing via loaner tablets or smartphones with assistance from (phase 1; n = 10) investigators by phone, (phase 2; n = 11) local Lions Club volunteers in participants' homes, or (phase 3; n = 24) remote access control software in a randomized controlled trial with 13 usual care controls who received in-office training. All participants completed the same post-telerehabilitation phone survey. Results: A significantly greater proportion of phase 3 subjects indicated they strongly or mostly agreed that the technology did not interfere with the session (96%) compared to phase 1 (60%; 95% confidence interval [CI], 1.2-12.5; P = 0.03) or phase 2 (55%; 95% CI, 1.8-188; P = 0.01). The majority indicated telerehabilitation was as accurate as in person (68%), they were comfortable with telerehabilitation (91%) and interested in a future session (83%), and their magnifier use improved (79%), with no significant differences in these responses between phases (all P > 0.10), including comparisons of participants randomized to telerehabilitation or in-office training in phase 3 who reported similar overall satisfaction levels (P = 0.84). Conclusions: Participants across all phases reported high levels of acceptance for telerehabilitation, with least interference from technology using remote access control in phase 3. Translational relevance: With accommodations for accessibility to videoconferencing technology, telerehabilitation for magnification devices can be a feasible, acceptable, and valuable option in countries with resources to support the technology.
Tattoos have become ingrained in our society and have served varied purposes throughout human civilization. So long as tattoos have existed, there has been demand for their removal. Lasers are currently the modality of choice in the removal of tattoos, as they are more efficacious than previously used methods. The most common lasers are the 532 nm and 1064 nm neodymium-doped yttrium aluminum garnet lasers, the quality-switched 694 nm Ruby laser, and the quality-switched 755 nm alexandrite laser. However, picosecond lasers are rapidly gaining favor in tattoo removal. An in-depth understanding of laser principles and how they can be applied in the setting of tattoo removal is key. Also, a greater understanding of the origin of and colors within a tattoo, the presence of tattoo layering, and a patient’s Fitzpatrick skin type increase the odds of satisfactory results. This review provides dermatologists with a comprehensive summary on laser fundamentals, an overview on treatment principles, and recent developments in the field of laser tattoo removal.
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Vladimir Beljanski
  • Cell Therapy Institute
Jean Latimer
  • Department of Pharmaceutical Sciences
Jose A. Ramos
  • Computer Science & Engineering
Santanu De
  • Halmos College of Arts and Sciences
Yadollah Omidi
  • College of Pharmacy
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