SIReS Presentation Abstracts-2026

Neurospora Crassa (N. Crassa), commonly called red bread mold, belongs in the phylum Ascomycota. N. Crassa is a haploid filamentous fungus that grows rapidly under optimal lab conditions. This fungus has historically been used as a model eukaryotic organism with a quick life cycle. N. Crassa experiences polarized growth with periodic branching and environmental responsiveness.  Observations were made of N. Crassa that show extremely high resistance to gravitational force and various other high-stress environments. The control environments being tested will be under a room-temperature control and a 30 °C incubator control. The extreme environments being tested will include a 30 °C centrifuge at various gravitational forces, a vacuum environment at -0.85 kPa × 100 BAR, and a clinostat to simulate low gravity. Our samples of N. Crassa for our environments will be housed in slant tubes in a controlled refrigerated unit. All samples will be grown on minimal medium agar. After a period of twenty-four hours, the samples from each environment are collected and their growth measured. Each sample is then taken to a microscope and photographed for future measurements and observations. A hemocytometer and ruler method is used to collect these measurements, and outlier observations are noted. Tip bursting under significant gravitational force deceleration was a notable outlying observation and will be explored. Properties of the tip-bursting cytoplasmic buildup will be determined. Once data is collected, figures are made in Microsoft Excel, and speculations can be made based on their trends.

Candida albicans (C. albicans) a gut commensal fungus can form filaments and become harmful under certain conditions. Low gravity has been reported to increase microbial virulence gene expression and enhance C. albicans resistance to amphotericin B. Here, we investigated whether simulated low gravity affects C. albicans sensitivity to caspofungin and alters expression of the hyphal-associated genes HWP1 and ALS3.

SC5314 C. albicans strains were grown on Mueller-Hinton and YEPD agar plates. Simulated low gravity was generated using a clinostat. Caspofungin sensitivity was assessed using the Kirby-Bauer assay. Gene-specific primers and polymerase chain reaction (PCR) were used to evaluate HWP1 and ALS3 expression.

After 5–6 days, low gravity had no effect on caspofungin sensitivity in yeast grown on Mueller-Hinton plates. However, prolonged exposure significantly reduced the zone of inhibition (ZOI) from 273±32 mm² in controls to 174±20 mm² under low gravity at 12 days (P< 0.05), and from 248±30 mm² to 110±26 mm² at 13 days (P< 0.001). On YEPD plates, 5–6 days of low gravity exposure also produced no significant change. In contrast, low gravity significantly increased the ZOI at 12 days, from 95±31 mm² in controls to 191±13 mm² (P< 0.01). No significant differences were detected in HWP1 or ALS3 expression at any time point.

These findings indicate that simulated low gravity influences caspofungin sensitivity in a time-dependent manner and the caspofungin sensitivity varies with growth medium. Further studies are needed to determine the mechanisms underlying these effects during adaptation to altered gravity.

Previous research shows that supraphysiologic estrogen levels induce C. albicans morphology shift from yeast to invasive filamentous form. In this study, we investigated whether the level of estrogen found in critically ill patients can modulate C. albicans morphology. We measured C. albicans filament length in the presence or absence of 1nM estrogen in two  different yeast liquid media. However, the presence of estrogen made no substantial change in filament length compared (18.24±0.58 µm) to our positive control fetal bovine serum (61.27±1.11 µm). Therefore, in order to simulate the environment of the gut, C. albicans filament growth in the presence or absence of 1 nM estrogen was tested in presence of three mammalian epithelial cell lines (T84, Caco2 and MDCK). Only in the presence of MDCK cells with estrogen, filament length was longer (45.33±0.91 µm)  compared to HPBSS alone with estrogen (36.65±0.55 µm, P<0.001)  in the absence of cells. Conversely, the presence of T84 cells alone significantly decreased filament length (28.30±3.52 µm) compared to culture media (HPBSS) alone (40.23±0.77, P<0.001). In a simple phosphate buffered solution (PBS), here the presence of cells caused a significant increase in filament length (13.53±0.36 µm) compared to the absence of cells, regardless of cell type (0.00±0.00 P<0.001). In PBS, estrogen decreased filament length (12.14±0.43 µm) only in presence of T84 cells compared to T84 no estrogen (14.52±0.39 µm, P<0.001). Thus we conclude that estrogen at 1 nM has limited effect on filament length in our conditions.

Invasive candidiasis is a fungal infection originating in the gastrointestinal tract caused by an overgrowth of Candida albicans. Before invading intestinal epithelial cells, C. albicans must overcome host defense mechanisms, including chloride (Cl?)-driven fluid secretion, a process facilitating the removal of pathogens from the intestinal lumen. Preliminary research demonstrates that C. albicans decreases basolateral Na?–K?–2Cl? cotransporter (NKCC1) membrane expression, reducing fluid secretion necessary for mucosal defense and pathogen clearance. This study investigates whether C. albicans induces NKCC1 endocytosis by subverting the well-described PKC-dependent mechanism of NKCC1 internalization. Madin-Darby Canine Kidney (MDCK) cells stably expressing eGFP-NKCC1 were used as a model to study NKCC1 internalization during C. albicans infection. NKCC1 internalization was induced by treatment with the PKC activator phorbol 12-myristate 13-acetate (PMA). In contrast, treatment with Gö6850, a PKC inhibitor, resulted in a reduction of PMA-induced NKCC1 internalization. After 90 minutes of infection of MDCK cells with filamentous yeast, NKCC1 internalization was observed in some slides; however, this effect was not consistent across all slides. Treatment with Gö6850 reduced NKCC1 internalization during yeast infection in some cases, but this effect was variable and was not consistently observed in all slides. Further experimentation is necessary to assess whether or not C. albicans subverts PKC-mediated NKCC1 endocytosis.

Before Fall 2025, Dr. Iceman’s research students utilized Argonne National Labs’ Beamline to determine the contents of air samples for a wider air quality study.  The research cohort’s use of the beamline ceased, following scheduling and fiscal concerns, and with it the research on air quality.  Valparaiso University is in possession of an XL3t XRF Analyzer, which can be used to quantitatively measure the concentration of a range of elements in a sample.  For proper use, the instrument must be calibrated in such a way that the user knows the accuracy and precision of its readings.  Sets of vapor-deposited standards from Micromatter® were run on four x-ray filter ranges to calibrate the instrument.  The readings of each element were taken in a ratio with the sample’s deposition density to determine how much of the sample was being exposed.  Following the first trial run, the calibration range was determined to run from Potassium (Z=19) to Barium (Z=56), but after further analysis was done, the range was constructed from Phosphorus (Z=15) to Silver (Z=47).

Humans are exposed to indoor contaminants, from both indoor materials and outdoor pollutants. Types of air pollutants that can accumulate indoors include microplastics, metals, and volatile organic compounds (VOCs). Microplastics are plastic particles smaller than 5 mm which originate from the degradation of plastic materials and the release of fibers from materials such as clothing and household products. VOCs are emitted from natural and man-made processes. Industrial facilities, consumer products, and building materials release VOCs that can result in continuous human exposure. This is investigating the composition of indoor dust and evaluating personal exposure to VOCs from indoor areas and daily activities. Dust samples were collected from public spaces throughout Northern Lake County. Samples were examined using stereomicroscopy and processed to determine the proportion of plastic-based material. The methodology involved density separation, filtration, and oxidation of natural organic matter. Samples were analyzes using Raman spectroscopy to identify potential plastic materials. Personal exposures to VOCs were assessed using passive samplers in the form of silicone wristbands, which participants wore continuously during daily activities. VOCs absorbed by the wristbands were extracted using phase microextraction (SPME) and then analyzes using gas chromatography/mass spectrometry (GCMS). Mass spectra were compared to reference libraries to aid in the identification of the VOCs. Preliminary observations indicated that dust collected from public spaces contains diverse particulate materials, including plastic-based particles, suggesting that indoor environments may represent an important source of microplastic exposure. Continues work may help improve understanding of environmental exposures including metals and PFAS which could potentially have an impact on community health.

Microplastics are particles of plastic ranging from 1µm to 5mm and nanoplastics are particles smaller than 1 µm. Micro and nanoplastics, which are both formed from the fragmentation of plastic materials that are inhaled and ingested, have been linked to negative health effects. The conditions and extend of fragmentation are not fully understood. This research has focused on understanding the fragmentation of oxidized real world plastics using techniques previously used on pure lab plastic sourced from Sigma-Aldrich; that showed the release of small liquids. Real world plastics differ from pure plastic, namely due to the presence of numerous chemical additives. Real world plastics in the environment are exposed to conditions where the surface is oxidized, a process where plastic combines with oxygen. Pieces of oxidized real world plastic weighing roughly 10-150mg were solubilized in 15 mL of DDI water and 20 µL of n-dodecane, a compound that simulates natural conditions, with some trials exposed to UV radiation for 3 hour intervals. Infrared spectroscopy was used to determine the measure of oxidation of the plastic after each solubilization. The solubilization of microplastics seems to increase fragmentation. When combined with UV it increases oxidation and seemingly further increases fragmentation, with the surface possessing a higher level of oxidation. An oxidation plateau has also been observed for plastics surface before fragmentation occurs. Further research must be done to understand this process. 

This project builds upon the Clark research team’s goal of understanding how the transcription factor CooA (carbon monoxide oxidation activator) activates its DNA-binding function upon changes at its heme domain (i.e., an iron porphyrin complex) when bound to carbon monoxide (CO). This research has broader implications, as analogous gas-sensing proteins are potential drug targets. Previous work showed that replacing heme with a different metalloporphyrin activated DNA-binding even without carbon monoxide. However, it is poorly understood how these changes at the heme domain activate DNA-binding, which takes place remotely. This study will investigate  how the heme group affects CooA’s structure by employing chemical denaturation to elucidate differences in thermodynamic stability with various metalloporphyrins and using circular dichroism to characterize changes in the protein’s secondary structure.

The solar furnace at Valparaiso University’s Solar Energy Research Facility focuses sunlight onto high-temperature receivers. These receivers can be configured to thermochemically produce solar fuels from water and carbon dioxide, to provide process heat for the manufacture of high-value materials such as battery-anode graphite, or for transfer to a working fluid for electricity production . To reach the high temperatures necessary for these processes, the furnace  focuses sunlight using 303 mirror facets. In the current configuration of the furnace, the flux is limited to ~1500 suns, this level of concentration is insufficient to reach the temperatures needed for the most demanding fuel and material production. Development of an improved mirror focusing apparatus continued through automation of mirror alignment and the design of a stiffer cantilever structure to reduce mirror deflection. To further increase achievable temperatures, a secondary concentrator was modeled in Tonatiuh++, a Monte Carlo ray tracing software, to evaluate improvements in power density and heat flux. An IR furnace was used to simulate sun testing conditions and evaluate the efficiency and stability of prospective perovskites and other metal oxides for concentrated solar hydrogen production. Finally, pressure drop simulations across various orifice sizes established flow rate relationships that guided the fabrication of a low cost differential pressure flow meter.

While supplemental oxygen is frequently administered to premature neonates via oxygen therapy, key details, like oxygen concentration in the lungs, are difficult to measure and not well understood. We aim to simulate the breathing of premature neonates while measuring oxygen concentration through an artificial lung design. Two prototype designs were constructed to control tidal volume and breathing rate as well as observe different breathing patterns. Both designs utilize different methods to expand and compress the lung. Design 1 utilizes a stepper motor and ball screw to expand and compress the bellows, combined with C++ to control tidal volume, breathing rate, and the ratio between inspiration and expiration per breath. Design 2 is driven by two pneumatic cylinders with a spring that pushes the cylinders back. The pneumatic cylinders are controlled with a pressure regulator that converts voltage into proportional pressure output, where two bellows act as the lungs and are compressed and expanded. Both designs utilize an electrochemical oxygen sensor to monitor oxygen concentrations. The flow rate of air moved through the artificial lungs is measured through a custom orifice that forces a pressure drop. The lung designs will be tested with oxygen to replicate measurements similar to those by Sabz et al. to compare correlations, and then simulate the breathing of premature neonates for oxygen therapy. 

Objective: Evaluate the clinical, economic, and ethical implications of emergency-only dialysis under the EMTALA and examine evidence supporting pathways to kidney transplantation for uninsured patients with ESRD. The population included uninsured and undocumented patients with ESRD. The intervention was transplant pathways compared with emergency dialysis, with outcomes including transplant access, clinical outcomes, healthcare utilization, costs, and ethical considerations.

Methods: A structured narrative literature review was conducted using Google Scholar, UpToDate, and Research Rabbit. Searches focused on uninsured and undocumented populations, emergency dialysis, EMTALA, organ transplantation, health equity, ethical considerations, and post-transplant care. English-language publications after 2019 were included, with older datasets incorporated. Eligible studies evaluated emergency dialysis or transplantation among uninsured or undocumented populations and reported clinical outcomes, patient experiences, policy or cost analyses, or transplant pathways. Non-U.S. systems, opinion-only articles, and studies before 2019 were excluded.

Results: Uninsured individuals remain underrepresented among transplant recipients despite contributing to the organ donor pool. Emergency-only dialysis was associated with fragmented care, prolonged hospitalization, increased healthcare utilization and costs. Outpatient dialysis pathways reduced hospital length of stay without increasing mortality or readmissions. Qualitative evidence identified barriers in education, financial support, and care coordination limiting transplant access. Multidisciplinary transplant pathways demonstrated feasibility when financial barriers were addressed.

Conclusion: Transplant pathways may improve kidney transplantation access for uninsured patients while enhancing continuity of care and reducing healthcare utilization and costs. Future research should evaluate outcomes and implementation strategies.

Keywords: ESRD, emergency dialysis; EMTALA; kidney transplantation; uninsured patients; health equity; undocumented immigrants

Objective: 

To evaluate the current evidence regarding curcumin as an adjunctive therapy for adults with mild to moderate ulcerative colitis(UC) and determine whether using it with standard medical therapy improves clinical remission, clinical response/symptom control, and endoscopic remission compared  with standard therapy alone 

Methods:

A narrative literature review was conducted using PubMed and Google Scholar to identify randomized controlled trials, systematic reviews, and meta analyses published between 2014 and 2026 evaluating adjunctive curcumin for UC. Studies of adults with mild-moderate UC receiving adjunctive curcumin were included. Pediatric populations, severe UC, and studies lacking clinical or endoscopic outcomes were excluded.. Five studies met the inclusion criteria, consisting of three systematic reviews, one meta-analysis, and one randomized controlled trial.

Results:

Adjunctive curcumin consistently improved clinical remission with patients generally two to three times more likely to achieve remission than those receiving standard therapy alone.  Symptom control also improved with a favorable safety profile with few adverse effects.  Evidence supporting endoscopic remission and mucosal healing was favorable but remained less consistent because of variable outcome definitions, heterogeneous study designs, and sample size.

Conclusion:

Current evidence supports curcumin as a promising adjunctive therapy for adults with mild to moderate UC receiving standard therapy. Although evidence for endoscopic remission remains less consistent, curcumin improved clinical outcomes while maintaining a favorable safety profile. Larger RCT with standardized dosing and longer followup are needed to better define its long term role 

Keywords: ulcerative colitis; curcumin; inflammatory bowel disease; adjunctive therapy; clinical remission; endoscopic remission; mucosal healing

Objective:

This review evaluates the association between post-acute sequela of SARS-CoV-2 infection (PASC), also known as long-COVID, and the development of Postural Orthostatic Tachycardia Syndrome (POTS) in a symptomatic adult population. It examines the spectrum of COVID-19-related autonomic dysfunction, identifies barriers to timely diagnosis, and discusses clinical implications for screening, symptom management, and the necessary specialist referrals. 

Methods:

A narrative literature review was conducted using UpToDate, Google Scholar, citation tracking, and Research Rabbit to identify studies examining long-COVID syndrome, dysautonomia, and POTS. Peer-reviewed, English-language, full-text studies involving adults with long-COVID and dysautonomia were included, while studies published before 2020, acute COVID-19 infections, non-English publications, and studies without full-text availability were excluded.

Results:

Across the literature reviewed, approximately 22-79% of patients with symptomatic PASC met the diagnostic criteria for POTS, with prevalence varying by study methodology. Among patients who did not meet the criteria, varying degrees of dysautonomia were observed, supporting the concept that POTS falls on a spectrum of COVID-19-related autonomic dysfunction. Across all PASC patients, regardless of diagnosis, there was a significant overlap of fatigue, dizziness, and reduced physical capacity. Individuals with long-COVID-associated POTS also reported a reduced quality of life and greater socioeconomic burden. 

Conclusion: 

Current evidence supports a strong clinical correlation between long-COVID and the development of POTS, while recognizing that POTS represents only one manifestation of long-COVID dysautonomia. Proper symptomatic control, patient education, and timely specialist referrals may improve quality of life from a multidisciplinary approach. 

Keywords: Postural Orthostatic Tachycardia Syndrome; Long-COVID; Autonomic Dysfunction

Objective: The goal of this project was to explore the relationship between skeletal muscle mass and postoperative complications in order to evaluate how muscle-based surgical risk assessment could lead to actionable preoperative plans for adult surgical patients. 

Methods: A literature review was conducted using ScienceDirect and Research Rabbit to identify studies examining skeletal muscle and surgical outcomes. Full text studies involving adult surgical patients and evaluating skeletal muscle characteristics were included, while studies involving pediatric, non-surgical populations, lacking postoperative follow-up, or published before 2020 were excluded. Five total studies consisting of meta-analyses, retrospective cohort studies, a systematic review, and a randomized control trial were included.

Results: Low skeletal muscle mass, density, and index were consistently associated with increased postoperative complications across various surgical populations. CT-based body composition analysis improved identification of high-risk patients beyond traditional risk assessment. Evidence supports routine preoperative muscle assessment and suggests that prehabilitation may reduce postoperative complications and improve recovery.

Conclusion: Skeletal muscle represents a clinically actionable biomarker that influences surgical recovery and outcomes. Integrating muscle-based risk assessment into preoperative evaluation enables earlier identification of vulnerable patients and shifts surgical care from reactive complication management to proactive complication prevention, potentially especially beneficial to female patients. Prehabilitation offers a practical strategy to translate risk identification into intervention, although prospective trials are needed to confirm its impact on clinical outcomes. Together, muscle assessment and prehabilitation support a shift toward proactive, prevention-focused perioperative care.

Keywords: skeletal muscle mass; sarcopenia; postoperative complications; prehabilitation

Objective: To evaluate the efficacy of poly (ADP-ribose) polymerase (PARP) inhibitors as adjunctive therapy in patients with germline BRCA1/2-mutated, HER2-negative breast cancer by assessing their effects on invasive disease-free survival (IDFS), distant disease-free survival (DDFS), progression-free survival (PFS), and overall survival (OS) compared with standard therapy.

Methods: A systematic review was conducted using PubMed and Google Scholar to identify studies published within the past five years evaluating PARP inhibitors in BRCA1/2-mutated breast cancer. Included studies evaluated women with germline BRCA1/2 mutations and HER2-negative early-stage or metastatic breast cancer. Studies involving HER2-positive disease, male patients, or non-BRCA-associated breast cancer were excluded. 

Results: Two phase III randomized controlled trials, two meta-analyses, and one clinical review were included. Adjuvant olaparib significantly improved IDFS and DDFS in high-risk early-stage breast cancer compared with placebo, demonstrating durable reductions in recurrence and distant metastasis. Meta-analyses demonstrated significant improvements in PFS in metastatic disease and emerging evidence of a modest, time-dependent OS benefit. PARP inhibitors were generally well tolerated, with anemia, thrombocytopenia, fatigue, and gastrointestinal symptoms representing the most common adverse effects. Evidence also suggests potential expansion of PARP inhibitor therapy beyond BRCA mutations to other homologous recombination deficiency biomarkers.

Conclusion: PARP inhibitors provide clinically meaningful improvements in disease-free and progression-free survival for appropriately selected patients with germline BRCA1/2-mutated breast cancer, with growing evidence of an overall survival benefit. Continued research is needed to define long-term outcomes, optimize patient selection, and expand biomarker-directed therapy.

Keywords: BRCA1/2, PARP inhibitors, early-stage, metastatic, breast cancer 

Objective: The purpose of this paper is to evaluate the current evidence regarding the human health effects associated with exposure to oxybenzone (benzophenone-3) containing sunscreen in individuals using sunscreen products. This review examined outcomes, including systemic absorption, endocrine function, and reproductive health, while considering established benefits of sunscreen for skin cancer prevention.

Methods: A comprehensive literature review was conducted using peer-reviewed publications identified through PubMed, Google Scholar, and the Valparaiso University library database. Selected studies included systematic reviews, meta-analyses, pharmacokinetic studies, observational studies, and toxicological research. Literature evaluating systemic absorption, endocrine disruption, reproductive health effects, biomonitoring data, and regulatory safety assessments was critically appraised and synthesized to identify current evidence and clinical implications.

Results: The reviewed literature consistently demonstrated that oxybenzone is systemically absorbed following topical sunscreen application, with plasma concentrations frequently exceeding the U.S. Food and Drug Administration threshold, warranting additional safety evaluation. While experimental and animal studies suggest endocrine-disrupting activity, human studies have produced inconsistent findings regarding clinically significant reproductive, thyroid, and hormonal effects. Existing evidence does not establish a definitive causal relationship between routine sunscreen use containing oxybenzone and adverse health outcomes.

Conclusion: Although systemically absorbed, current evidence does not demonstrate a definitive causal relationship between typical oxybenzone exposure and adverse human health outcomes. Given the well-established role of sunscreen in preventing ultraviolet-induced skin damage and reducing skin cancer risk, the benefits of sunscreen use continue to outweigh the currently identified risks associated with oxybenzone exposure.

Keywords: Oxybenzone; benzophenone-3; sunscreen; systemic absorption; endocrine disruption; reproductive health

Objective: The purpose of this paper is to determine whether the class of Neurokinin -3 Receptor Antagonists (NK3) are efficacious in managing vasomotor symptoms in women who have contraindications to the gold standard treatment of hormone therapy. This research specifically includes menopausal or perimenopausal women experiencing vasomotor symptoms and compares NK-3 Antagonists to placebo, non-HRT medications, and HRT. The primary endpoints of the research include impact on VMS frequency and severity.

Methods: A narrative literature review was conducted using Google Scholar, PubMed, and EBSCO to identify studies evaluating NK-3 antagonists as nonhormonal treatments for menopausal vasomotor symptoms. Studies involving peri- or postmenopausal women treated with an NK3 antagonist and reporting vasomotor symptom outcomes were included, while studies lacking relevant outcomes or involving other treatment indications were excluded. Eligible articles were critically reviewed and synthesized to compare efficacy, safety, and patient-reported outcomes.

Results: The data reviewed suggests that NK3-Antagonists, specifically Fezolinetant, show efficacy in reducing the frequency of VMS symptoms with percent reductions from baseline ranging from 52% in some articles to 87% in others. It also reveals statistically significant reductions in severity. Fezolinetant is comparable to low dose estrogen and more efficacious than high dose antidepressants in managing VMS frequency. Notable side effects of this medication include headaches, GI upset, URI symptoms, and elevation in liver function enzymes.

Conclusion: Fezolinetant is an appropriate medication for the treatment of menopausal VMS symptoms in women who have contraindications to hormone therapy.

Keywords: NK3 Antagonists, VMS, Menopause, Fezolinetant, Hot Flashes, Hormone Therapy

Objective:

The purpose of this literature review was to evaluate the effectiveness and safety of topical retinoid and biological therapies for pediatric patients with Lamellar Ichthyosis. These therapies were compared with standard keratolytic and emollient treatments in improving scaling severity, dryness, pain, pruritus, quality of life, while minimizing infection rates and adverse effects. 

Methods:

A narrative literature review was completed using PubMed, EBSCO, Google Scholar, and Research Rabbit Al. Studies in English, within five years, were included if they evaluated pediatric patients with autosomal recessive congenital ichthyosis and had full-text availability. Studies involving adults, non-hereditary ichthyosis, or patients with comorbidities were excluded. Five primary studies, including randomized controlled trials, an interventional study, and case reports, were reviewed background literature.

Results:

Topical isotretinoin therapies, particularly lower concentrations of 0.1% PAT-001 and 0.05% TMB-001, reduced scaling severity without evidence of systemic absorption. Secukinumab improved pruritus by 50%, pain by 66.7%, and quality of life by 60%, but had minimal effect on scaling. Ustekinumb demonstrated variable improvement in disease severity; however, infection concerns, including a 15.4% hospitalization rate for sepsis, had raised safety concerns. 

Conclusion: 

Topical retinoids reduced localized scaling in pediatrics with Lamellar Ichthyosis. Biological therapies improved pruritus, pain, and quality of life, but minimal improvement in scaling. These therapies should be an adjunct to standard treatment, with management individualized. Larger studies with longer follow-ups are essential to understand their safety and effectiveness in pediatric patients. 

Keywords: lamellar ichthyosis; topical isotretinoin; biologics; pediatric dermatology; congenital ichthyosis; scaling severity

Objective 

The purpose of this paper is to explore whether prophylactic use of tocilizumab in patients with B-cell malignancies receiving CD19 Chimeric Antigen Receptor T-cell (CAR-T) therapy reduces the incidence of severe Cytokine Release Syndrome (CRS) within 30 days when compared to standard initiation of tocilizumab. 

Methods

A literature search was conducted using PubMed, Google Scholar, ClinicalTrials.gov, and the Christopher Center Library to identify studies evaluating tocilizumab for CRS in patients receiving CD19-directed CAR T-cell therapy. Studies involving patients with B-cell malignancies treated with CD19 CAR T-cell therapy were included, while studies involving non–B-cell malignancies, non-CD19 CAR T-cell therapy, or fewer than five participants were excluded. Outcomes included severe CRS (grade 3–4) and intensive care unit (ICU) admission rates.

Results

Across the reviewed studies, prophylactic initiation of tocilizumab when compared with standard initiation was associated with decreased rates of severe CRS (grades 3-4) and ICU admissions. A prospective study demonstrated a reduction in grade 4 CRS from 50 to 27% with preemptive tocilizumab. Another prospective study showed a 2% incidence of grade 3 CRS, no cases of grade 4 CRS, and no ICU admissions. 

Conclusion 

Current evidence suggests that prophylactic use of tocilizumab may reduce the severity of CRS and ICU admissions. However, data ultimately remains limited and there is not yet enough evidence to conclude that prophylactic tocilizumab should replace standard initiation. 

Keywords 

Cytokine Release Syndrome, tocilizumab, B-cell malignancies, Chimeric Antigen Receptor T-cell Therapy, CD19, intensive care unit

Objective:

The purpose of this paper is to explore the efficacy of utilizing Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RA) to prevent major adverse limb events (MALE) in patients with peripheral artery disease (PAD) versus standard treatment.

Methods: 

A narrative literature review was conducted using systematic searches of MEDLINE and Google Scholar for studies evaluating GLP-1RAs and vascular outcomes. English-language, full-text studies published since 2020 assessing GLP-1RA use and limb-related outcomes were included; older studies and those not involving GLP-1RAs were excluded. Primary outcomes include a reduction in MALE and a decrease in risk factors associated with MALE. Secondary outcomes include transcutaneous oxygen pressure (TcPO2), circulating endothelial progenitor cells, vascular endothelial growth factor-a, and 6-minute walking test (6MWT).

Results: 

Evidence demonstrated that GLP-1RAs reduce MALE in patients with PAD. Compared with standard treatment, GLP-1RAs showed a reduction in amputations compared to placebo (HR 0.65, 95% CI 0.45-0.95; p=0.03), 2.59 vs 4.33 events per 1000 person-years compared to DPP-4 inhibitors, and 3.6 vs 4.5 events per 1000 person-years compared to SGLT2. Also, a 10% increase in TcPO2 in 89% of patients in the liraglutide group and 46% in the control group. 

Conclusion:

Significant evidence displayed that GLP-1RAs can be beneficial in treating PAD. They can reduce MALE, improve endothelial function, promote angiogenesis, and provide pleiotropic effects. It should be considered in patients with PAD. Future studies need more RCTs, females, and minorities to further investigate efficacy beyond white males.

Keywords: PAD, GLP-1RA, MALE

Objective:

Pharmacogenetic-guided treatment is a recent innovation which attempts to improve the variability in individual response to pharmacological treatment. In patients with MDD, pharmacogenetic-guided treatment was evaluated for improvements in remission, symptom reduction, and drug side effect rates compared to the standard of care.

Methods:

A structured literature search was conducted using Google Scholar and Research Rabbit. Studies published within the past 10 years evaluating pharmacogenetic-guided treatment in major depressive disorder and reporting remission, symptom improvement, or adverse effects were included. Eligible studies were qualitatively synthesized to assess the clinical utility of pharmacogenetic-guided antidepressant treatment.

Results:

Three randomized controlled trials and one systematic review evaluating pharmacogenetic-guided treatment were included. Pharmacogenetic-guided treatment generally improved remission compared with usual care, with significant benefits observed in the PRIME trial (OR 1.28, 95% CI 1.05–1.57) and the GUIDED trial (15.3% vs 10.1%, P=0.007). A meta-analysis of 13 studies (4,767 patients) found that pharmacogenetic-guided therapy increased the likelihood of remission by 41% (RR 1.41, 95% CI; 1.15–1.74; P=0.001). Depressive symptom reduction also favored pharmacogenetic-guided treatment, however the difference was small and not consistently significant. Side effect rates greatly improved when switching from an incongruent medication to a congruent one (6.5% vs 16.5%; P=0.045).

Conclusion:

Pharmacogenetic-guided treatment is a promising tool that may help to improve remission rates and reduce drug side effects in MDD. However, use should be individualized considering the cost and potential benefit for each patient.

Keywords: Pharmacogenetic-guided treatment; Major depressive disorder; Remission; Adults

Objective: The purpose of this literature review was to evaluate whether <6 hour sleep duration and poor sleep quality, compared with normal >7 hour sleep duration, increase the risk of major adverse cardiovascular events in adults. Outcomes included cardiovascular disease, coronary artery disease, stroke, heart failure, cardiovascular mortality, and related cardiovascular health measures. Methods: A literature review was conducted using Google Scholar to evaluate the relationship between sleep parameters and cardiovascular outcomes. English-language, full-text studies published since 2019 involving adults were included, while pediatric studies and non-cardiovascular outcomes were excluded. The review included three prospective cohort studies, two meta-analyses, and one interventional study. Results: Evidence consistently demonstrated that short sleep duration (?5–6 hours), poor sleep efficiency, and increased wake after sleep onset were associated with increased cardiovascular risk as well as increased rates of heart failure, cardiovascular mortality, and autonomic dysfunction. A meta-analysis of 604,509 adults found a 9% higher risk of coronary artery disease and stroke among short sleepers. Sleep-inclusive cardiovascular health models showed up to a 47% reduction in cardiovascular disease risk in individuals with favorable sleep patterns. Conclusion: Current evidence supports a strong association between poor sleep and increased cardiovascular risk, although causation has not been established. Sleep assessment and counseling should be incorporated into routine cardiovascular risk evaluation as a low-cost, nonpharmacologic adjunct to established preventive therapies. Additional long-term interventional studies are needed to determine whether improving sleep directly reduces cardiovascular events. Keywords: cardiovascular disease; sleep duration; sleep quality; cardiovascular prevention; heart failure; cardiovascular mortality.

Objective:

The goal of this paper was to assess approaches to management of idiopathic chronic pelvic pain (ICPP) in females to improve health outcomes. 

Methods:

A structured literature search was conducted in the MEDLINE and CINAHL databases. Studies were included if they evaluated therapeutic interventions for primary/idiopathic chronic pelvic pain in adult females and reported treatment outcomes. Studies with adolescents, males, non-treatment topics, diagnostics, or unrelated conditions were excluded.

Results:

Myofascial therapy resulted in relief of anxiety and depression (-4.0+/-3.2, p<0.001; -3.4+/-2.5, p<0.001) and female sexual function index (FSFI) (7.8+/-6.4, p<0.001). Psychological approaches had similar results regarding pain improvement, and showed improvement in FSFI (-0.31 [ -0.95, 0.34]; -1.95 [-3.63, -0.28]). Duloxetine and amitriptyline trials displayed improvement in pain, with amitriptyline impacting urinary symptoms and duloxetine resulted in lower pain scores. Cannabidiol improved pain, sleep, and mood disturbances (p?0.001). Multimodal treatment resulted in greater improvement in pain (-2.19, [-3.17, -1.22], p=0.002) and FSFI (2.47, [1.06,3.88], p=0.030). No study showed statistically significant data displaying improvement/worsening quality of life. 

Conclusion:

Each individual treatment resulted in improvements in the measured outcomes. Multimodal treatment approaches result in greatest outcomes when compared to monotherapy. It is important to discuss all options with patients to adequately address their symptoms. 

Keywords: idiopathic chronic pelvic pain; female sexual function index; myofascial; amitriptyline; duloxetine; cannabidiol 

Objective: The purpose of the literature review is to identify factors that contribute to vaccine hesitancy and evaluate evidence-based communication techniques. Effective communication techniques can be implemented in clinical practice to address hesitancy and improve parental attitudes toward vaccination.

Methods: A literature review was conducted using PubMed and Google Scholar to identify studies examining parental vaccine hesitancy and provider communication strategies. Search terms included vaccine hesitancy, parental attitudes, childhood immunization, communication strategies, motivational interviewing, and vaccination uptake. Peer-reviewed English-language articles published between 2012 and 2025 were reviewed. Seven studies were selected based on relevance, methodological quality, and applicability to clinical practice, and were synthesized to identify common themes related to parental perceptions, trust in healthcare providers, communication strategies, and interventions.

Results: Vaccine hesitancy is influenced by a combination of individual beliefs and sociocultural factors. Major themes identified with vaccine hesitancy included parental trust in providers and vaccination, as well as communication quality. Presumptive communication, motivational interviewing, and tailored communication to parental groups were associated with improved confidence in vaccination.

Conclusion: Combined presumptive, motivational interviewing, and communication tailored to parental readiness provide healthcare professionals with the tools to improve childhood vaccine confidence. Individualized and trust-based communication strategies have been demonstrated to be more effective than information-based counseling to address vaccine hesitancy. Additional research is needed to evaluate vaccination uptake long term and interventions that begin at prenatal visits.

Keywords: vaccine hesitancy; childhood immunization; provider communication; motivational interviewing; presumptive communication; vaccine confidence

The objective of this research is to determine whether intranasal epinephrine is as effective as intramuscular epinephrine for treating anaphylaxis by comparing pharmacokinetic, pharmacodynamic, and safety outcomes in adult and pediatric populations. A literature review was conducted using PubMed and Google Scholar, including randomized crossover trials, phase 1 clinical studies, and a narrative review comparing intranasal and intramuscular epinephrine. These studies evaluated pharmacokinetic outcomes, including maximum plasma concentration (Cmax), time to maximum concentration (Tmax), and area under the curve (AUC), as well as pharmacodynamic outcomes such as changes in systolic blood pressure, diastolic blood pressure, and heart rate. Most studies included healthy participants and excluded patients with significant cardiovascular or respiratory disease that could affect the response to epinephrine. Across the reviewed studies, intranasal epinephrine consistently achieved therapeutic systemic absorption and produced increases in blood pressure and heart rate comparable to intramuscular epinephrine. Although intramuscular epinephrine generally reached peak concentrations quicker, intranasal epinephrine demonstrated comparable efficacy and the potential to reduce treatment delays associated with needle phobia and hesitation. Based on the current evidence, intranasal epinephrine appears to be a promising alternative for select patients; however, intramuscular epinephrine should remain the gold standard because the current evidence is primarily limited to pharmacokinetic and pharmacodynamic studies in healthy volunteers rather than clinical outcomes during active anaphylaxis. Additional real-world studies are needed before intranasal epinephrine can be considered an equivalent first-line treatment. Keywords: anaphylaxis; intranasal epinephrine; intramuscular epinephrine; neffy; epinephrine autoinjector; pharmacokinetics; pharmacodynamics; needle phobia.

Objective: 

This paper aims to analyze current research and outcomes of the MIND diet on preventing and slowing neurocognitive decline in adults with dementia and Alzheimer’s disease. A literature review was conducted to evaluate the correlation between the MIND diet and slowed neurodegenerative disease through structural change, transcriptomics, biomarkers, and cognitive function testing.

Methods:

A narrative literature review was conducted using Google Scholar, PubMed, and JAMA to identify studies published between 2020 and 2025 examining the MIND diet and cognitive outcomes in adults with Alzheimer’s disease or dementia. Studies using validated cognitive assessments and comparison groups were included, while studies published before 2020 or lacking a comparison group were excluded. 

Results:

Four of five studies concluded higher adherence to the MIND diet was associated with improved cognitive outcomes, while one study suggested no significance between the control and intervention group. Adherence to the diet was associated with lower risk of dementia, slowed MMSE and MoCA score decline, reduced neurodegeneration and associated biomarkers, and positively correlated epigenetic modulation. Data suggests a consistent, positive association between the MIND diet and preserved cognitive function with varied statistical strength across individual studies. 

Conclusion: 

Current evidence supports the MIND diet slows neurodegeneration through amyloid plaque and chain reduction, modulating gene expression, decreased hippocampal sclerosis, and improving co-morbid conditions, and overall systemic inflammation. These findings are promising for the reduction of neurodegenerative changes without adverse clinical outcomes; however, further long-term studies are needed to more firmly support this conclusion.

Keywords: Alzheimer’s, Dementia, Neurodegeneration, MIND diet, Nutrition

Objective:   The purpose of this review was to determine if trained diabetic alert dogs (DAD) provided detection accuracy comparable to continuous glucose monitors (CGM) for detecting hypo- and hyperglycemic events in adults with type 1 or type 2 diabetes. 

Methods: A narrative literature review was conducted using UpToDate and Google Scholar. Studies of adults with type 1 or type 2 diabetes assessing glucose detection accuracy were included; pediatric-only studies and studies shorter than 6 months were excluded. Outcomes included sensitivity, specificity, positive predictive value, hypoglycemia frequency, and HbA1c reduction.

Results:  CGMs demonstrated higher clinical accuracy, with 92-95% of glucose readings matching laboratory reference values. Additionally, CGM demonstrated a reduction in hypoglycemic events and a reduction in  HbA1c of approximately 0.5–0.6%. In contrast, DAD detection accuracy varied significantly across the studies, with objective masked CGM comparisons reporting lower accuracy than owner-reported studies (22–38% vs. 50–80%).

Conclusion:Current evidence supports CGMs as the most accurate and reliable method for glucose monitoring. Although DADs may provide psychosocial benefits and support, their variable detection accuracy does not support their use as a stand-alone glucose monitoring tool or as a replacement for CGMs. 

While some individual dogs demonstrated detection accuracy comparable to that of CGMs, these findings were inconsistent across studies and among individual dogs. Additional standardized, objective comparative studies using standardized training protocols are needed to better define the clinical role of DADs.

Keywords: diabetes mellitus; diabetic alert dogs; continuous glucose monitoring; hypoglycemia; hyperglycemia; glucose monitoring; accuracy

Objective: To evaluate evidence on pharmacologic and non-pharmacologic labor pain management strategies and provide clinicians with an evidence-based framework for patient counseling on analgesic methods and the associated maternal, obstetric, and neonatal outcomes. 

Methods: A structured literature search was conducted using Research Rabbit to identify studies on labor analgesia using keywords related to labor pain, pain relief, epidural analgesia, pharmacologic and non-pharmacologic pain management, and pain intensity. Studies evaluating parturients undergoing labor with the intention of vaginal birth and examining various pain management strategies were included. Studies involving non-laboring patients or analgesia outside the context of active labor and intended vaginal delivery were excluded. Maternal, obstetric, and fetal/neonatal outcomes were reviewed. 

Results: Evidence suggests counseling should be based on patient goals, preferences, values, and expectations. For patients prioritizing pain relief, labor epidural analgesia provided the greatest benefit, although many non-pharmacological interventions had efficacious analgesia. Several non-pharmacologic interventions were associated with shorter labor duration and were not linked to increased adverse maternal or neonatal outcomes. Among pharmacologic analgesia options, parenteral opioids demonstrated the greatest ongoing safety concerns. 

Conclusion: No single analgesia method “wins” across pain relief, safety, and satisfaction; this is because the experience of childbirth is too individualized for a one-size-fits-all solution. The future of obstetric pain management lies in multimodal, patient-centered care that integrates safe pharmacologic options with accessible, low-risk non-pharmacologic therapies to empower women and optimize outcomes for mother and baby.

Keywords: Pain management in labor; pharmacologic interventions; non-pharmacologic interventions; maternal outcomes; obstetric outcomes; fetal outcomes

Abstract

Objective: Melanoma is the deadliest form of skin cancer, and early detection significantly improves survival. The purpose of this literature review was to evaluate the diagnostic accuracy of artificial intelligence (AI)-assisted dermoscopy compared with clinician assessment for melanoma detection among adults with suspicious pigmented skin lesions. Biopsy-confirmed diagnosis served as the reference standard.

Methods: A comprehensive literature search was conducted using PubMed, EBSCO, Research Rabbit, and Google Scholar. Studies published from 2020 to 2025 involving adults with suspicious pigmented skin lesions were included if they compared AI-assisted dermoscopic analysis with clinician interpretation using biopsy-confirmed diagnosis and reported sensitivity and specificity. Randomized controlled trials, cohort studies, cross-sectional studies, systematic reviews, and meta-analyses were reviewed.

Results: Across the five included studies, AI-assisted dermoscopy demonstrated higher sensitivity for melanoma detection than clinician assessment, particularly among nonspecialist and less experienced providers. Several studies reported that AI diagnostic performance was comparable to expert dermatologists; however, AI achieved higher sensitivity at the expense of lower specificity, resulting in increased false-positive findings.  

Conclusion: Current evidence supports AI-assisted dermoscopy as a valuable clinical decision support tool for melanoma detection rather than a replacement for clinician judgment. AI appears most beneficial for improving early melanoma detection, particularly in nonspecialist settings. Limitations in specificity, real-world validation, and representation of diverse patient populations highlight the need for further research before widespread implementation.

Keywords: artificial intelligence; dermoscopy; melanoma; sensitivity; specificity; diagnostic accuracy.

Objective:

Understand whether hormonal fluctuations across the menstrual cycle in eumenorrheic women and oral contraceptive users influence exercise performance in women of reproductive age (18-40 years) including endurance, strength, power, mood, motivation, and perceived exertion.

Methods:

A literature review was conducted using Google Scholar and Research Rabbit, with search terms focused on oral contraceptive use, menstrual cycle phases, and exercise performance outcomes. Studies published within the last 10 years involving women of reproductive age (18-40 years) that followed a menstrual cycle and assessed exercise outcomes were included, while studies involving male or peri-/post-menopausal populations, unclear contraceptive tracking, or significant confounding variables were excluded.

Results:

Across studies, trivial differences in exercise performance are observed across the menstrual cycle. The follicular phase (menstruation) is consistently associated with slightly reduced strength and power, increased perceived exertion, mood symptoms, and pain. In contrast, the late follicular and ovulatory phases demonstrate slight improvements in strength and power. However, most differences are not clinically meaningful. Oral contraceptive users exhibit more stable performance across the cycle, although these findings are limited by differences in formulations and small sample sizes. Altogether, psychological factors may influence exercise performance more than hormonal fluctuations alone. 

Conclusion:

Although cycle tracking may be helpful in elite athletes, the existing literature does not support modifications in exercise based solely on menstrual phase for the general population. An individualized, flexible, and symptom-guided approach is appropriate for the majority of women.

Keywords: menstrual cycle, exercise performance, eumenorrheic women, oral contraceptives, female athletes, hormonal fluctuations

Objective: The purpose of this narrative literature review was to evaluate the role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as adjunctive therapy in adults with moderate-to-severe Hidradenitis suppurativa (HS). The clinical question explored whether GLP-1 RAs improve disease severity, flare frequency, quality of life, and metabolic outcomes in patients with obesity or metabolic dysfunction.

Methods: A literature review was conducted using Google Scholar, PubMed Central, Christopher Center Library, NIH resources, Research Rabbit, and JAMA Dermatology. Studies published from 2019 to 2025 were reviewed. Inclusion criteria included adults with clinically confirmed moderate-to-severe HS (Hurley stage II–III), measurable baseline disease severity, treatment duration of at least six months, and reported clinical or patient-centered outcomes. Exclusion criteria included prior GLP-1 RA use, uncontrolled comorbidities, recent surgical intervention, or new systemic HS therapies. Evidence included systematic reviews, retrospective cohorts, case series, and case reports.

Results: Five relevant articles were analyzed. GLP-1 RAs demonstrated improvements in disease severity, flare frequency, pain, suppuration, and quality of life measured by Dermatology Life Quality Index scores. Significant reductions in body weight and BMI were observed. Cohort studies showed improved HS-Physician Global Assessment scores by ~1 point.

Conclusion: Current evidence suggests GLP-1 RAs may be beneficial adjunctive therapy in HS, particularly in patients with obesity and metabolic dysfunction. However, evidence remains limited by small sample sizes, observational designs, and lack of randomized controlled trials. Larger studies are needed to establish efficacy and long-term utility.

Keywords: hidradenitis suppurativa; GLP-1 receptor agonists; semaglutide; liraglutide; obesity; inflammation; quality of life

Objective: Poetry can help people understand and express complex emotions that often become apparent during illness. This literature review aims to determine whether poetry therapy -i.e., reading, writing, or listening to poetry- affects patient well-being when compared with standard of care treatment.

Methods: Google Scholar and Valparaiso University’s databases were searched using primary keywords “poetry therapy” and “poetry in medicine” to find six English-language studies published after 2008 that used poetry as the primary intervention.

Results: Across three studies, poetry therapy showed reductions in anxiety and stress levels. Patients also showed improvements in emotional regulation, with one study citing reductions in fear, sadness, anger, worry, and fatigue, another citing lower anxiety and a decreased likelihood to suppress emotions, and a final study showing reduced depressive symptoms. Patients had increased hope after poetry interventions; however, one study did not reach statistical significance when compared to the control group. Finally, three studies reported quality-of-life improvements, such as reductions in pain and higher scores on a post-traumatic growth scale, but one finding was not statistically significant. 

Conclusion: The evidence largely suggests that poetry therapy is a meaningful adjunct to medical care by increasing hope and improving mood across diverse patient populations. Poetry therapy offers the advantages of being low-risk and affordable, but interventions are complementary to medical treatments. Future research is needed to explore the effects of poetry therapy in larger randomized controlled trials with standardized interventions and definitions. 

Keywords: poetry therapy; narrative medicine; medical humanities; quality of life; emotional regulation 

Objective: The purpose of this literature review was to evaluate whether adults with heart failure, compared with adults without heart failure, have an increased risk of cognitive impairment and dementia.

Methods: A narrative literature review used Google Scholar to identify studies evaluating cognitive outcomes in adults with congestive heart failure. Inclusion criteria: English-language full-text articles published since 2020, with one 2018 longitudinal study also selected due to its strong methodology. Studies involving pediatric populations or lacking cognitive outcomes were excluded. Five studies met the inclusion criteria.

Results: The review included three systematic reviews/meta-analyses, one cross-sectional study, and one longitudinal cohort study. Heart failure was consistently associated with an increased risk of cognitive impairment. One meta-analysis reported an 80% higher risk of cognitive impairment in patients with heart failure (HR=1.80, 95% CI: 1.14–2.86). Another found a pooled cognitive impairment prevalence of 41.42%, with the highest prevalence identified using the Montreal Cognitive Assessment (66.67%). Individual studies demonstrated reduced cognitive screening scores among patients with heart failure, while the association between heart failure and dementia was less consistent across studies.

Conclusion: Current evidence supports a strong association between heart failure and cognitive impairment, highlighting the importance of routine cognitive screening and early recognition. Although the relationship between heart failure and dementia remains less certain, emerging evidence suggests a potential increased risk. Additional longitudinal studies using standardized cognitive assessment tools are needed to further define this association and guide clinical practice.

Keywords: Heart failure; Cognitive impairment/decline; Dementia; Cognitive screening

Postpartum depression (PPD) affects 1 in 8 women with only 50% diagnosed by a medical professional. Epidural analgesia use during the intrapartum period has been found to have a possible effect on decreasing the risk of PPD. This paper aims to answer the question of if epidural use has a negative association with PPD. A narrative literature review was conducted to evaluate the association between epidural analgesia and PPD. A comprehensive search of Google Scholar and UpToDate was performed using relevant keywords with studies included if they compared PPD outcomes in antepartum women undergoing normal spontaneous vaginal delivery with and without epidural analgesia. Cesarean deliveries were excluded to reduce confounders. The primary outcome was PPD, defined by clinical diagnosis or validated screening tools such as the Edinburgh Postnatal Depression Scale (EDPS). Five articles were chosen to be synthesized to identify trends and associations with two systematic reviews, two cohort studies, and one observational study. After careful review of these articles, it was determined that epidural analgesia use during labor likely has no association on PPD risk. While there were studies that found that there was a negative association between epidural use and PPD, others found no association. Patients should be counseled that there is likely no association, however, there was never a harmful effect found. Further studies should focus on obtaining larger sample sizes, continuity of screening tools, and reduction of confounders to solidify the current evidence. 

Keywords: Postpartum depression, epidural, no epidural, Edinburgh Postnatal Depression Scale

Objective: To evaluate whether alternative approaches to regional citrate anticoagulation implementation may be more broadly integrated into continuous renal replacement therapy (CRRT) for critically ill intensive care unit patients compared to systemic heparin or no anticoagulation by assessing mortality, filter lifespan, electrolyte and metabolic complications, and monitoring intensity.

Methods: A narrative literature review was performed including studies from PubMed, Google Scholar, and the National Center for Biotechnology Information. Studies were included if they involved adults in the intensive care unit (ICU), patients undergoing CRRT or continuous venovenous hemofiltration (CVVHF), and evaluated anticoagulation strategies such as RCA, unfractionated heparin, or no anticoagulation. Studies were excluded if they involved pediatric populations, non-ICU patients, alternative anticoagulants, patients not requiring CRRT, were published more than 20 years prior, or where n < 30. Primary endpoints included mortality, filter lifespan, and electrolyte or metabolic abnormalities. Secondary endpoints included monitoring intensity.

Results: Evidence suggests that RCA prolonged filter lifespan, reduced bleeding, and reduced circuit clotting compared with systemic heparin with comparable mortality. Alternative RCA implementation strategies were shown to preserve treatment efficacy and maintain patient safety while reducing implementation barriers. Complications associated with RCA were able to be easily corrected with standardized protocols. 

Conclusion: Current evidence suggests that RCA may be safely implemented in a larger patient population and across larger variations of hospital size and capabilities. 

Keywords: Regional citrate anticoagulation; continuous renal replacement therapy; continuous venovenous hemofiltration; intensive care unit; filter lifespan; anticoagulation

Objective: The purpose of this paper is to evaluate current evidence regarding the effectiveness of curcumin supplementation on glycemic control in adults with Type 2 Diabetes Mellitus and Prediabetes. Specifically, this paper examines whether curcumin improves glycemic outcomes when compared to standard treatment or placebo. 

Methods: A narrative literature review was conducted to evaluate the effects of curcumin supplementation on glycemic control and ?-cell function in adults with type 2 diabetes mellitus and prediabetes. Randomized controlled trials involving adult human subjects that reported glycemic outcomes, including HbA1c, fasting plasma glucose, HOMA-IR, HOMA-?, or insulin levels, were included. Studies involving animal models, non-interventional designs, irrelevant glycemic endpoints, or combination herbal therapies in which curcumin was not the primary isolated compound were excluded.

Results: Curcumin supplementation demonstrated mild/ modest improvement in glycemic control compared with placebo or standard care. Fasting plasma glucose had the most consistent benefit, with reductions ranging from approximately 7-18 mg/dL. HbA1c improvements were smaller (approximately 0.2%-0.5%) and less consistent across studies. Greater glycemic improvements were noted at higher curcumin dosing and longer durations of treatment (typically those exceeding 12 week). The strength of evidence was limited in smaller sample sizes and studies with heterogeneity. 

Conclusion: Curcumin supplementation demonstrates mild improvement in glycemic control, particularly fasting plasma glucose, in adults with Type 2 Diabetes and prediabetes. The literature review supports its use as an adjunct to guideline directed therapy rather than independent use. Due to the best diagnostic of glucose management being HbA1c the use of long-term studies with larger patient samples and would aid further establishment of a clinical role.

Keywords: Curcumin, Type 2 diabetes mellitus, prediabetes, glycemic control, HbA1c, fasting plasma glucose, HOMA-IR, B-cell function

Objective: To evaluate the effectiveness of aerobic exercise compared with resistance training in improving metabolic and reproductive outcomes in adult women with polycystic ovary syndrome (PCOS). Primary outcomes included body mass index (BMI), insulin resistance, and menstrual regularity.

Method: A structured literature search was conducted using PubMed, the National Institutes of Health database, and ScienceDirect. Studies published from 2020 onward involving adult women diagnosed with PCOS were included. Adolescent populations or studies published before 2020 were excluded. Five studies met inclusion criteria, consisting of three systematic reviews with meta-analyses, one randomized controlled trial, and one retrospective secondary analysis. 

Results: Both aerobic and resistance training improved metabolic and reproductive outcomes in women with PCOS. Moderate-intensity aerobic exercise demonstrated the most consistent reductions in BMI,  while high intensity interval training (HIIT) produced the greatest improvements in insulin sensitivity and menstrual regularity. Resistance training improved body composition through increased lean muscle mass and favorable metabolic changes. Overall, exercise consistently improved insulin resistance and reproductive health; however, heterogeneity in study design, intervention duration, and outcome measurements limited direct comparison between exercise modalities and were generally not statistically significant.  

Conclusion: Current evidence supports both aerobic and resistance training as beneficial first line, non pharmacologic therapies for women with PCOS. Exercise prescriptions should be individualized based on patient goals and preferences. Additional high quality studies directly comparing exercise modalities are needed to determine the optimal exercise prescription.

Key Words: Polycystic ovary syndrome, PCOS, aerobic exercise, resistance training, insulin resistance, menstrual regularity, body mass index.

Objective: To evaluate the evidence surrounding aquatic therapy and scuba diving as adjunctive rehabilitation strategies for adults with neurological disorders and to assess whether these interventions improve balance, fatigue, gait, motor function, pain, quality of life, and psychosocial well-being compared with conventional rehabilitation. 

Methods: A comprehensive literature review was conducted using PubMed, Google Scholar, the National Library of Medicine, the Cochrane Library, and ScienceDirect. English-language studies involving adults with neurological disorders who participated in aquatic therapy or scuba diving interventions were included while studies involving pediatric populations, non-neurological conditions, severe cognitive impairment, or contraindications to aquatic therapy were excluded. Outcomes of interest included mobility, balance, fatigue, pain, quality of life, depression, and self-esteem.

 Results: Evidence demonstrated clinically meaningful improvements in balance, fatigue, and quality of life across multiple neurological disorders. Patients with multiple sclerosis experienced moderate-to-large reductions in fatigue and depression, while individuals with Parkinson’s demonstrated improved balance, gait performance, and quality of life despite minimal changes in overall motor symptom severity. Stroke survivors showed improvements in balance, spasticity, and functional independence following aquatic interventions. Evidence evaluating scuba diving was limited but suggested perceived psychological, physical, and social benefits.  

Conclusion: Aquatic therapy appears to be a beneficial adjunct to standard neurorehabilitation, particularly for improving balance, fatigue, and quality of life. However, evidence specific to scuba diving remains limited, highlighting the need for standardized randomized controlled trials to determine its role in neurological rehabilitation.  

Keywords: aquatic therapy; neurorehabilitation; neurological disorders; multiple sclerosis; parkinson disease; stroke; scuba diving

Objective: This paper evaluates maternal stress and post-traumatic stress disorder (PTSD) during pregnancy and associated fetal, neonatal, and childhood outcomes. The population included mothers experiencing toxic stress or PTSD during pregnancy compared with mothers without significant prenatal stress. Outcome measures included birth outcomes, neurodevelopment, and childhood mental health outcomes.  

Methods: A narrative literature review used peer-reviewed articles identified with Google Scholar and Research Rabbit. Searches focused on maternal PTSD, early childhood adversity, stress-related biomarkers, and fetal and childhood outcomes. Studies published from 2019 to the present examining maternal PTSD or trauma-related exposures were included, while studies focused on adult-onset adverse events were excluded. 

Results: The literature suggests that maternal PTSD and chronic prenatal stress may influence fetal and childhood outcomes through stress-mediated pathways, including altered HPA axis regulation and fetal programming. Several studies found associations with altered infant cortisol regulation, lower birth weight, and changes in gene expression, which were linked to neurodevelopmental disorders and behavioral issues. In contrast, acute maternal stress such as exposure to 9/11 attacks was not associated with differences in birth defects, preterm birth, or birth weight.

Conclusion: Maternal PTSD during pregnancy appears associated with altered fetal development and childhood outcomes through stress-mediated pathways. Although evidence supports an association with neurodevelopmental changes and infant cortisol dysregulation, findings remain inconclusive because of methodological limitations, small sample sizes, and reliance on observational data. These findings support trauma-informed prenatal care. 

Keywords: Maternal PTSD, prenatal stress, fetal programming, pregnancy, trauma 

Objective: Bee venom acupuncture (BVA) has been used in Asia for its anti-inflammatory effects for hundreds of years, and recently it has proposed anti-cancer effects. The purpose of this paper is to evaluate the anti-inflammatory and anti-cancer effects of bee venom to determine its use in future medical practice.  

Methods: A literature search was conducted using the databases PubMed and Google Scholar with search terms including bee venom therapy, BVA, pain, cancer, and melittin. Inclusion criteria were studies investigating bee venom in the context of pain or cancer. Exclusion criteria were studies with no evaluation of bee venom and endpoints not including pain or cancer.

Results: BVA showed an average 20-30 mm reduction on the visual analogue scale for pain and bothersomeness when used in conjunction with existing therapies for chronic pain, however additional data showed no difference between BVA and placebo. Numerous in vitro and in vivo studies established that melittin, a component of bee venom, has apoptotic properties, however it was not tumor specific. When used in conjunction with current therapies, melittin increased natural immune activity and therefore worked synergistically with current biologic immunotherapies.

Conclusion: The evidence for the anti-inflammatory effects of BVA is mixed; patients should be aware of limited benefit prior to treatment and the risk of anaphylaxis. The preliminary data showed potential for anti-tumor effects of bee venom, however there is not enough human data to support current use in cancer treatments.

Key Words: bee venom, BVA, melittin, cancer, pain relief

a)     Objective: The purpose of this paper is to determine the effects of the menstrual cycle and hormonal contraceptives on ligamentous injuries in female athletes, and if treatment/counseling should be tailored accordingly.

b)     Methods: A literature search for this narrative review was conducted using UpToDate, Google Scholar, and the Christopher Center library databases. Search terms included OCPs, ligament injuries, female athletes, menstruation, menstrual cycle, and follicular phase. English-language studies published from 2017 onward examining soft tissue or musculoskeletal injuries in female athletes of reproductive age were included. Relevant articles were identified with ligamentous, soft tissue, and MSK injuries as the primary outcomes of interest.

c)     Results: After reviewing the current evidence on OCP use and ACL injuries, it was found that oral contraceptives play a protective role on ACL injuries likely due to OCP’s affect on lowering the estrogen spike during menstrual cycle.  Soft tissue injuries including ACL tears were more likely to occur in the follicular phase partly due to the peak in estrogen, however, the specific effects on the body are still unknown.

d)     Conclusion: There is some evidence that ACL injuries are greater in the follicular phase, but the literature is contradictory. There is evidence that OCPs play a protective role in ACL injuries. Therefore, female athletes should be counseled on OCP’s protective factor and that training modifications during their follicular phase can be helpful, but is not evidence-based.

e) Keywords: ligamentous injuries, OCP, menstrual cycle, female athletes

Objective: To evaluate the effects of prenatal exercise among pregnant individuals on pregnancy complications and to determine whether exercise modality influences pregnancy outcomes.

Methods: A narrative literature review was conducted using Research Rabbit and PubMed to identify studies examining exercise during pregnancy and associated maternal and fetal outcomes. Eligible studies included English-language, full-text, peer-reviewed articles and systematic reviews published after 2020 involving healthy pregnant patients, with pregnancy outcomes as the primary outcome measure. Studies without measurable outcomes or involving pre-existing comorbidities were excluded. 

Results: Prenatal exercise was consistently found to be safe and associated with improved maternal outcomes. Four studies reported that exercise significantly reduced the risk of GDM, particularly when initiated during the first trimester and performed at a sufficient weekly volume. No exercise modality was superior, suggesting regular participation is most important. Evidence regarding hypertensive disorders in pregnancy was mixed, with one review demonstrating significant reductions in hypertensive disorders and preeclampsia, while another found no effect but suggested potential benefits of low-intensity and mind-body exercise. Pilates was shown to reduce labor pain and duration, without negatively affecting delivery outcomes.

Conclusion: Current evidence supports regular prenatal exercise as a safe and effective strategy for reducing the risk of GDM and improving labor outcomes. As no single exercise modality was shown to be superior, pregnant individuals should be encouraged to participate in the form of exercise they are most likely to enjoy and maintain throughout pregnancy.

Keywords: prenatal exercise; gestational diabetes mellitus; preeclampsia; labor pain; labor duration; pregnancy outcomes 

Objectives: This literature review examines the relationship between hormone replacement therapy (HRT) and lipid profiles in postmenopausal women and evaluates HRT’s potential role as an adjunctive or standalone therapy in lipid management.

Methods: Searches were performed in Google Scholar and the Valparaiso University library database using the terms “hormone replacement therapy and lipids,” “menopause HRT lipid levels,” and “menopause HRT cardiovascular.” Five peer-reviewed studies were selected, with designs ranging from randomized double-blind controlled trials to retrospective cohort studies, sample sizes from 22 to 562 postmenopausal women, and follow-up periods up to twelve months.

Results: Four of the five studies demonstrated statistically significant reductions in LDL cholesterol with HRT use. Three out of five studies showed statistically significant increases in HDL. Total cholesterol decreased significantly in two studies. Triglyceride changes were variable and route-dependent; oral estrogen was associated with a statistically significant increase in triglycerides, while transdermal estradiol showed no significant change. No study demonstrated worsening of any lipid parameter with HRT use.

Conclusion: HRT is associated with favorable changes in lipid profiles in postmenopausal women, particularly reductions in LDL and total cholesterol and increases in HDL. These findings suggest HRT may serve as a beneficial adjunctive therapy for lipid management in appropriate candidates. HRT should not replace statins or lifestyle modifications as primary interventions. Further research with larger cohorts, standardized HRT formulations, and studies with lipid profiles as the primary endpoint is needed to clarify HRT’s role in postmenopausal lipid management. 

Keywords: hormone replacement therapy; dyslipidemia; postmenopausal; lipid profile.

Objective

The goal of this study was to evaluate academic performance of students in professional healthcare programs utilizing hybrid learning compared to traditional in-person instruction.

Methods

A narrative literature review using Google Scholar was conducted to identify relevant studies. Inclusion criteria consisted of publication since 2019, English full text, and a focus on students in healthcare education programs participating in hybrid or distance learning models. The primary outcomes were measures of academic performance including test scores and board examination pass rates.

Results

Data regarding board pass rates were significantly limited by a lack of statistical analysis. Raw data on hybrid physician assistant programs’ board examination pass rates showed a 0.9% difference compared to the national average. Hybrid physical therapy programs’ board examination pass rates showed mixed results, with some schools being slightly higher and some slightly lower than the national average, without analysis to determine statistical significance. Studies regarding course performance in health-related professional schools yielded mainly non-significant differences between traditional and hybrid groups, with two studies showing a statistically significant difference favoring hybrid learning.

Conclusion

The results of this review show that students in professional healthcare programs utilizing hybrid learning models demonstrate similar academic performance compared to those in traditional, in-person programs.

Keywords: hybrid learning, traditional learning, healthcare, medical education, board examination

Nuclear Physics students and faculty at Valparaiso University worked on three experiments: the STAR experiment, the ePIC experiment, and the nEDM experiment. One of STAR’s goals is understanding the gluon’s contribution to the proton’s overall spin of ½ ?. At the STAR experiment, polarized proton collisions, provided by the Relativistic Heavy Ion Collider (RHIC), produce numerous neutral pions (??⁰) that promptly decay into two photons. The photon energies are measured by the Endcap Electromagnetic Calorimeter (EEMC) and used to reconstruct the ??⁰ invariant mass. Our work supports ??⁰ spin asymmetry analysis by investigating systematic uncertainties through alternate background modeling of 2013 data and Quality Assurance (QA) on the 2015 data set. Ahead of BNL’s transition from RHIC to EIC (Electron-Ion Collider), the EIC’s first detector, ePIC, had six hadronic calorimeter modules tested at a CERN test beam in May. Using this data, we have been performing HGCROC waveform analysis and analyzing the effects of changing preamplifier settings. The neutron Electric Dipole (nEDM) experiment at Los Alamos National Laboratory is designed to search for the nEDM at the level of 10^-27 e*cm. The precession frequency of neutrons in a weak magnetic field and a strong electric field are extremely sensitive to even the smallest stray magnetic fields, especially very tiny magnetic dipoles in the detector components. A process involving precise magnetic scanning, sonic cleaning, and magnetic characterization of the parts going into the MSR will be presented.

Planetary nebulae (PNe) contain either carbon-based or oxygen-based dust or a combination of the two, though the exact molecular composition remains unknown. Here we analyze oxygen-rich PNe, whose dust is suspected to include silicate (SiO₂)_n clusters. We use methods of computational quantum mechanics to determine the equilibrium structures of (SiO₂)_n clusters for n=12?24 and analyze their stability and structural features. We then calculate the binding energy and the infrared (IR) spectra of the most stable silicate structures for each value of n. By comparing these spectra to observed spectra of oxygen-rich PNe, we hope to determine the molecular composition of the dust. This knowledge will improve our understanding of PNe formation and stellar evolution.