Background:
Brainstem abscesses are collections of pus within the brainstem, which can cause inflammation, tissue damage, and compression of adjacent structures, leading to headache, fever, and focal neurological deficits. Brainstem abscesses are considered rare and potentially life-threatening, and pontine abscesses are even rarer. Both are often caused by the spread of infection from nearby structures like the middle ear, sinuses, and mastoid air cells but can also result from hematogenous spread. 

Case Presentation:
A 54-year-old male presented with numbness and clumsiness in his left hand and leg over a three-day period. These symptoms were preceded by a headache that awoke him the night before without accompanying fever. An initial brain magnetic resonance imaging (MRI) showed a 1.5 cm ring-enhancing lesion in the right pons. The patient’s blood cultures were negative as were screenings for tuberculosis, methicillin-resistant Staphylococcus aureus, human immunodeficiency virus, and hepatitis B virus; cysticercosis antibody testing was equivocal. The patient was started on ceftriaxone, vancomycin, and metronidazole.

Three days later, the patient showed worsening weakness in his left arm and leg. A repeat MRI showed thickening of the enhancing wall and formation of another lesion in the right dorsal paramedian pons. A lumbar puncture revealed 11 WBCs, two RBCs, a glucose level of 76 mg/dL, and a protein level of 62 mg/dL. Cerebrospinal fluid was clear, colorless, and negative for cultures, toxoplasma IgG, cryptococcal antigen, human simplex virus, and acid-fast bacteria. 

The patient underwent transfrontal stereotactic drainage of the lesion which revealed 1.3 cc of a purulent, foul-smelling material and the cultures of which grew Streptococcus pyogenes. A postoperative MRI showed a 0.85 cm abscess without hemorrhage. The patient stated improvements in strength and functionality but residual hemiparesis. After eight weeks, all antibiotics were stopped after verifying decreasing abscess size on an MRI.

Discussion:
The patient presented with a pontine abscess of both undetermined causal origins and unclear infections signs, namely the lack of fever and nausea which are commonly associated with brainstem abscess. Additionally, the stereotactic aspiration cultures grew Streptococcus pyogenes, which can exist in the oropharynx, yet our patient denied recent upper respiratory illness. 
This case reveals several learning points on cytogenic brainstem abscesses: the importance of early neuroimaging by MRI for a definitive diagnosis of brain abscesses and the value and utility of stereotactic aspiration, a minimally invasive procedure, which can treat nearly all brain abscesses measuring at least 1 cm, regardless of the location.


Cryptogenic Pontine Abscess Treated With Stereotactic Aspiration: A Case Report

Background: The larynx is important in breathing, swallowing, and speech production. The closure and opening of the space between the vocal folds (“glottis”), allows the larynx to fulfill its functions. The larynx is a symmetric organ. To move all parts of the larynx appropriately and achieve glottal sufficiency, symmetry is beneficial. Previous studies have reported on various forms of shape asymmetry and their consequence for function. Asymmetry in how the larynx is positioned within the neck has not been investigated before but could play a critical role in the development of shape asymmetry and thereby influence larynx functions. 
Methods: We investigated a stratified sample of 210 human subjects (105 females, 105 males) for positional asymmetry. Positional asymmetry was defined as the angle between the mid-sagittal organ plane and the mid-sagittal body plane. The larger the angle between the two, the greater the positional asymmetry. Positional asymmetry was measured in all subjects. With the help of regression models, the relationships between positional asymmetry and body size, larynx organ size, and larynx shape were explored. 
Results: Positional asymmetry ranged between 0 and 18°. It was larger in males (4.71°±3.05; mean±stdev) than in females (3.49°±3.11) (t-test, T105,105 = -2.85; p < 0.01). Larynx midsagittal plane was deflected either to the left or the right side. In females, the distribution was almost even (51.43%) but it was biased towards the right side in males (62.86%). Positional asymmetry was associated with larynx overall shape (females: R2= 0.05, P= 0.017; males: R2= 0.09, P= 0.002), and shape asymmetry (female: R2 = 0.059; p< 0.01, male: R2= 0.21; p<0.001), with larynx size in females (females: R2= 0.042, P= 0.036; males: R2= 0.003, P= 0.609), with age in females (females: R2 = 0.467; p= 0.027; males: R2 = 0.0232; p= 0.12), but not with body height (males: R2= 0.0082; P= 0.357 ; females: R2= 0.0061; P= 0.43) or with BMI (Body Mass Index) (female: R2 = 0.018; p= 0.169, males: R2= 0; p= 0.97). 
Conclusions: Our data highlight the value and challenges of investigating human phenotypic variation. Positional asymmetry of the larynx was associated with the shape and size variation of the vocal organ as well as with a person’s age.

Assessing Positional Asymmetry of the Larynx

Background
Imposter Phenomenon (IP) involves a pattern where individuals doubt their skills and worry they will be exposed as frauds. Students who experience IP tend to discount positive feedback and their accomplishments. Furthermore, IP predisposes to depression, anxiety, and suicidal ideation. Of concern, the estimated prevalence of IP in medical students ranges from 22.5%-46.6%. Despite this, there is scant empirical literature exploring IP in clinical medical students. The few studies that exist suggest that aspects of medical education may contribute to IP, but there is currently little longitudinal data exploring this. Therefore, the purpose of this study is to assess IP in third-year medical students prior to and after clerkships. 
Methods
A single class of medical students was surveyed immediately prior to (Time 1) and after clerkships (Time 2) using the Clance Imposter Phenomenon Scale. Data was analyzed using Wilcoxon signed-rank tests to determine significant differences in IP. After Time 2, students participated in semi-structured interviews to assess their personal experiences with IP. Interviews were conducted using a predesigned interview guide consisting of nine open ended questions. Thematic analysis was performed to determine protective and contributing factors to IP. 
Results
Of the 141 students, 18 students took both surveys and 10 participated in semi-structured interviews. There was no statistically significant difference in IP scores (p=0.970), with scores indicating “frequent imposter feelings”. Thematic analysis of student responses revealed protective factors such as increasing confidence, safe learning environments, and role model/peer interactions. Contributing factors included making comparisons to other students, perceived knowledge gaps, and evolving/new stressors. 
Conclusion
Medical students in our study reported frequent imposter feelings, with no significant difference in scores. These scores are comparable to other studies examining IP during clerkships. Students in our study suggested that while they built confidence in the clinical domain, other stressors elicited feelings of doubt and imposterism, such as upcoming board exams. Furthermore, comparisons to other students and perceived knowledge gaps can elicit these feelings. Despite this, students found that conversations with mentors and peers can build comradery and reduce feelings of IP. As other studies have noted, institutional culture is important. Students in our study suggested that preceptors who create a safe learning environment helped reduce IP feelings. Institutions may benefit from encouraging this type of dynamic, while also creating opportunities for students to build comradery during clerkships. 




A Mixed-Methods Longitudinal Assessment of Imposter Phenomenon in Third-Year Medical Students

Background
High-throughput single-cell RNA-seq (scRNA-seq) is used to describe complex tissues by characterizing transcriptional states of individual cells. Defining a cell's position, both in regard to tissue margins and its social context, is essential for understanding the intrinsic and extrinsic variables that effect the transcriptional identity of individual cells. Conventional high-throughput scRNA-seq assays, however, decouple cells from their original locations within tissues. In situ hybridization readouts of gene expression and in situ sequencing preserve spatial information in tissues, but currently have a lower total read threshold than NextGen sequencing – imposing a restriction on either cell throughput or transcriptional breadth. Combining the above methods or using regional barcodes to define 2D positions have spatially-reconstructed tissue regions but are seldom employed in unspecialized laboratories.

Methods
We describe SEgmentation by Exogenous Perfusion (SEEP), a rapid, integrated, method for providing 3D spatial-segmentation to scRNA-seq data. Tissues are divided into layers based on accessibility of a fluorescent dye allowing sorted cells to be characterized by transcriptomic and regional identity.

Results
We use SEEP to explore how the transcriptional states of cells in high-grade serous ovarian cancer vary with respect to intratumoral position. We describe an integrated method for correlating 3D radial-spatial cell positions with scRNA-seq data. By employing a basic stain-and-sort method using an off-the-shelf live-dead stain, we are able to correlate transcriptional profiles with radial-spatial positions in both radially symmetric tissues (e.g., spheroids, organoids, spherical tumor masses) and linear tissue samples (e.g., punch biopsies). SEEP uses an imaging-based calibration step to inform the parameters of a FACS and sequencing based measurement step.

Conclusion
Across spheroid, organoid, and PDX models of high-grade serous ovarian cancer, we find common positional transcriptomic profiles, ranging from single-gene proclivities to multi-gene-set enrichments across tissue layers. The results validate long-standing beliefs regarding the relationship between cell state and position while also revealing new concepts on how the spatially unique microenvironment of individual cells within tumors influences cell identity.

High-throughput spatial reconstruction of cell states within ovarian cancer structures

Background
Chimeric antigen receptor (CAR) T cells have shown remarkable clinical efficacy in hematological cancers but still face significant obstacles in the treatment of solid tumors, such as pancreatic ductal adenocarcinoma (PDAC). Two major hurdles in developing effective CAR T therapies for PDAC are the identification of tumor-associated antigens (TAA) and overcoming a complex immunosuppressive tumor microenvironment (TME). We hypothesize that the optimal CAR T cell to treat PDAC recognizes an ideal TAA and protects itself from TME immunosuppression. We propose a novel CAR T cell to target the Muc16-ectodomain (Muc16CD) combined with antagonism of the vasoactive intestinal peptide (VIP) checkpoint pathway in the PDAC TME as a viable therapy to treat pancreatic tumors. 

Methods
Patient data was assessed based upon data generated by the TCGA Research Network. Primary human T cells were retrovirally transduced to express Muc16CD-directed CARs with or without secretion of VIPR antagonists. PDAC PDX tumors and CAR T cells assayed by flow cytometry for phenotype and functional profile. In vivo, Panc1-Muc16CD-GFPffLuc tumors were engrafted into SCID/Beige mice and treated with CAR T cells.

Results
Muc16 expression is significantly increased in PDAC patient tissues compared to normal pancreas and associated with decreased overall survival. Congruently, we found that PDAC PDX tumors demonstrate robust expression of both Muc16CD and VIP and are vulnerable to Muc16CD-directed CAR T cell cytotoxicity. Additionally, VIP limits the proliferative capacity of CAR T cells, which is reversed by VIPR antagonist peptides (antVIPR). Therefore, we engineered anti-Muc16CD CARs to secrete antVIPR peptides to provide continuous and localized delivery within the TME. We find that antVIPR expression by CAR T cells enhances viability, activation profile, and demonstrate less-differentiated and less exhaustive phenotypes. Functionally, antVIPR CAR T cells have enhanced activation and proliferative advantage after chronic antigen-stimulation. In a xenograft model of PDAC, antVIPR CAR T cells reduce tumor burden and improve overall survival in mice bearing human VIP-expressing PDAC tumors. At 118 days, antVIPR CAR T-treated mice have more circulating CAR T cells than parental CAR T-treated mice. 

Conclusion
Muc16CD is a clinically relevant target for CAR T therapy in PDAC. Furthermore, antagonizing the VIP checkpoint pathway in CAR T cells produces enhanced phenotypic and functional profiles. Collectively, this data demonstrates that the combination of targeting Muc16CD and VIP with a novel CAR T cell can improve anti-tumor efficacy against PDAC. The long-term goal of this work is translating antVIPR-secreting CAR T cells for the treatment of PDAC.


Using CAR T Cell-Secreted Antagonistic Peptides to Target Distinct Immune Checkpoint Pathway in Pancreatic Tumors

Factors 8 and 9 play pivotal roles in the activation of factor 10 in the coagulation cascade. In acquired factor 8 inhibitor, IgG autoantibodies bind to factor 8 molecules causing a functional factor 8 deficiency. Incidence is exceedingly rare at one to four per million per year. We discuss a case of severe acquired factor 8 defiency and discuss the diagnostic and treatment approach.

Diagnostic and Therapeutic Complexities in a Case of Severe Acquired Factor 8 
Deficiency

Introduction: Thyroid cancer is the most common endocrine cancer reported world-wide, with an increasing incidence over the past decades. Although the effect of numerous variables on thyroid cancer has been studied, the role of socioeconomic status (SES) remains a topic of interest. SES encompasses a range of factors such as occupation, household income, education, and health insurance, which have been shown to influence health outcomes in different diseases. Understanding the correlation between SES and thyroid cancer diagnosis and prognosis is critical for determining potential disparities and developing targeted interventions to improve patient outcomes. We conducted a review to provide a comprehensive synthesis of the existing literature through which we aim to illuminate the relationship between socioeconomic status and key outcomes in thyroid cancer, including diagnostic delays, disease stage at diagnosis, and survival rates. By identifying the specific socioeconomic factors that influence thyroid cancer outcomes, we can target interventions and policies to improving access to timely diagnosis and enhancing patient outcomes in diverse socioeconomic populations.
Methods: A pubmed literature search with the following search strategy was conducted: ("effect"[All Fields] OR "effecting"[All Fields] OR "effective"[All Fields] OR "effectively"[All Fields] OR "effectiveness"[All Fields] OR "effectivenesses"[All Fields] OR "effectives"[All Fields] OR "effectivities"[All Fields] OR "effectivity"[All Fields] OR "effects"[All Fields]) AND ("socioeconomic factors"[MeSH Terms] OR ("socioeconomic"[All Fields] AND "factors"[All Fields]) OR "socioeconomic factors"[All Fields]) AND ("thyroid neoplasms"[MeSH Terms] OR ("thyroid"[All Fields] AND "neoplasms"[All Fields]) OR "thyroid neoplasms"[All Fields] OR ("thyroid"[All Fields] AND "cancer"[All Fields]) OR "thyroid cancer"[All Fields]) AND ("prognosis"[MeSH Terms] OR "prognosis"[All Fields] OR "prognoses"[All Fields]). 
Abstract review of the resulting 13 studies was performed, of which 7 studies were included in the final review per inclusion and exclusion criteria. A comparative analysis was performed considering the methods, results, and conclusions of the studies. 
Results: Socioeconomic status (SES) was examined in seven studies in relation to the outcomes of thyroid cancer. Among these studies, four specifically looked at income, one investigated insurance access, and two considered multiple SES factors. The findings consistently showed that individuals with lower SES had worse overall survival rates (based on four studies) and were more likely to be diagnosed at a later stage (based on two studies), suggesting possible delays in accessing healthcare. Additionally, one study indicated a lower incidence of papillary thyroid cancer among individuals with lower SES indicative of lower early screenings.
Conclusion: Based on findings from the included studies, lower socioeconomic status is associated with unfavorable outcomes in thyroid cancer with delayed diagnoses and poorer overall survival. 


The Effect of Socioeconomic Status on Diagnosis and Prognosis of Thyroid Cancers


Lip and face lesions are recognized in dermatology as significantly distressing for patients. There are stereotypes associated with different lesions in this area that affect patients deeply, motivating them to seek care immediately. The average population or clinician is aware of common lip lesions, the most diagnosed of which is herpes simplex virus. Dermatologists must continue to be aware of unique lip and face lesions as they may grow rapidly, be worrisome, and affect the patient’s perception of themselves and psychological well-being. We present the case of neutrophilic sebaceous adenitis, which is an incredibly rare condition that has been reported minimally in the literature. Recognition of rapidly growing lesions, like our patients, is vital for proper diagnosis and treatment.
A 74-year-old female presented to the dermatology clinic with a 5-day history of a rapidly progressive lower lip lesion. Valacyclovir and Carmex only minimally improved her condition. Examination was significant for tenderness to palpation. The patient had no other lesions, no preceding trauma or bites, and no systemic symptoms. Histopathology showed a somewhat dense, superficial and deep, perivascular and periadnexal infiltrate composed predominantly of lymphocytes. The overlying epidermis showed some interface changes with a few necrotic keratinocytes as well as a focal but prominent neutrophilic infiltrate involving a sebaceous gland lobule. No increased dermal mucin was identified on Alcian blue stain. The patient discontinued valacyclovir and treated the lesion with triamcinolone 0.1% twice a day for a few weeks until it cleared. 
Neutrophilic sebaceous adenitis is a very rare condition. Pathogenesis is unknown but triggers such as sun exposure, antibiotics, and febrile illness have been reported. Lesions can progress over days to months and are typically asymptomatic. Recognition of this lesion around the lips and face is imperative as a differential diagnosis for providers to be aware of. Histopathology typically shows an inflammatory infiltrate, particularly of neutrophils and lymphocytes, around sebaceous glands. Sebocytes may be necrosed and further inflammatory infiltrates may be noted around the dermis. There are no current dermatologic guidelines on management although case reports have shown successful treatment with topical or oral steroids, metronidazole, or isotretinoin.

Looking Beyond the Ordinary Lip Lesion: A Rapidly Progressive Case of Neutrophilic Sebaceous Adenitis

Background
While substantial progress has been made toward gender parity in dermatology, significant gender gaps remain in Mohs micrographic surgery (MMS). Less than one-third of US Mohs surgeons are women, compared to 52% of dermatologists and 37% of all physicians. Fellowship directors (FDs) play a pivotal role in shaping the future of MMS through direct mentorship and advocacy of subspecialty-wide changes. Characterizing FDs in terms of gender, research productivity, and career timeline have yielded crucial insights into mitigating future inequities. Presently, studies characterizing FDs within MMS are lacking. Herein, we aimed to explore gender trends in MMS FDs and fellows over time and analyze FD characteristics to provide a framework for improving gender diversity.

Methods
We compiled a comprehensive list of FDs and fellows for all Accreditation Council for Graduate Medical Education–accredited Micrographic Surgery & Dermatologic Oncology programs from 1996 to 2023. Publicly available data from various internet sources from February 1, 2023 to May 30, 2023 were used to assess characteristics of MMS FDs, including gender, research productivity, program type, educational background, and career timeline. Student’s t-test, Chi-square test, Fisher's exact test, and linear regression were used for statistical analysis.

Results
From 1996 to 2023, the percentage of women fellows increased from 24% to 43% and women FDs increased from 6% to 25%. Women FDs were more likely to select women fellows than men FDs (p=0.0002). Six residency programs accounted for 32% of current FDs, and 10 fellowship programs accounted for nearly 50% of current FDs. Women FDs had fewer years between fellowship completion and FD appointment (9.1 ± 4.7 years) compared to men (13.6 ± 8.8 years; p = 0.036). Women FDs also had fewer years of practice (18.3 ± 6.8 years) compared to men (24.2 ± 10.8 years; p = 0.030). H-index, program type, and academic rank were similar between men and women FDs.

Conclusion
Earlier involvement in academic leadership for women Mohs surgeons is a promising predictor of gender equality on the trainee level, though gender diversity of FDs must be improved. Limitations of this study include that our methods did not account for non-binary genders; thus, the collected data may not be entirely representative of the study population. Future studies should explore ethnic/racial representation in MMS leadership. Such endeavors will propel the field towards building a more representative medical community that delivers the best patient care.

Eeny, meeny, miny, “Mohs": Characterizing gender and leadership trends in Mohs micrographic surgery

Periprosthetic joint infections are relatively rare complications of total joint replacements that are becoming increasingly common. The standard of care involves the placement of a temporary spacer made out of polymethyl methacrylate (PMMA) bone cement combined with antibiotics. The rate of major complication can be as high as 12 % for PMMA spacers. Therefore, the purpose of this study was to develop a method to produce a biocompatible material that could be 3D printed, provide mechanical support needed for ambulation, and deliver a therapeutic dose of antibiotics. Printed structures were successfully fabricated out of Biomed Clear (BMC) doped with up to 16% Gentamicin or 10 % Vancomycin. PMMA and BMC composites were characterized with differential scanning calorimetry, dynamic mechanical analysis, wear testing, compression testing, and a 30-day drug elution study. The thermoset properties of the BMC allowed for the compressive properties to remain unchanged as antibiotics were added to the polymer, but limited the amount of drug that eluted out of the composite. In contrast, the thermoplastic properties of PMMA led to the compressive properties to decrease with the addition of antibiotics, but PMMA was able to elute significantly more antibiotics. This study described a novel method to 3D print load bearing structures that can release antibiotics over 30 days. BMC composites have some advantages and disadvantages compared to PMMA that need to be considered when developing new treatments for orthopaedic infections. 


A 3D printed, High Strength and Drug Eluting Composite for the Treatment of Periprosthetic Joint Infections


Mucosal immunity to SARS-CoV-2 is crucial in attenuating viral replication. While intramuscular mRNA vaccination has been shown to produce durable SARS-CoV-2 specific antibody responses in the systemic circulation, there are few studies pertaining to local responses in the nasal mucosa. The extent to which vaccination may recall nasal antibody responses primed by prior infection or if nasal antibody responses to infection are primed by prior vaccination remains unelucidated. In the present study, we compared SARS-CoV-2 specific nasal antibody responses among unvaccinated infected, vaccinated infected, infection-experienced vaccinated, and infection-naïve vaccinated participants.

Between June 2020 to February 2023, nasopharyngeal swab (NPS) samples were collected from participants as part of an ongoing longitudinal surveillance study. Samples collected within 14-89 days after either confirmation of an acute SARS-CoV-2 infection via RT-PCR or vaccination with a third mRNA dose were selected for the present study. Secretory-IgA (SIgA) and IgG responses to the Spike antigen of ancestral (B.1 lineage) SARS-CoV-2 were measured via enzyme-linked immunosorbent assay. SIgA was normalized to total-IgA concentration. Nonparametric continuous variables were analyzed using the Kruskal-Wallis test followed by Dunn’s multiple comparisons test. Paired groups were compared using Wilcoxon signed-ranked test. This study was approved by the Children’s Hospital Los Angeles Institutional Review Board.

Of 429 NPS samples, 176 (41.0%) were from male participants, and the mean age at collection was 27.7 years (range, 0.1-81.3 years). Median SIgA concentrations (x10 3 AU/mL) were 39.2 (unvaccinated infected), 230.2 (vaccinated infected), 22.1 (infection-experienced vaccinated), and 5.3 (infection-naïve vaccinated). Median IgG concentrations (x10 3 AU/mL) were 2.2 (unvaccinated infected), 16.0 (vaccinated infected), 5.4 (infection-experienced vaccinated), and 4.4 (infection-naïve vaccinated).

SIgA and IgG were significantly higher in vaccinated infected participants compared to unvaccinated infected (p<0.001), infection-experienced vaccinated (p<0.001), and infection-naïve vaccinated (p<0.001) participants.
SIgA was significantly lower in infection-experienced vaccinated participants compared to unvaccinated infected (p=0.045) participants whereas the opposite trend was observed for IgG (p<0.001).

Acute COVID-19 infection robustly induces SARS-CoV-2 specific nasal SIgA and IgG
responses in vaccinated participants to a greater extent than infection alone. Infection-experienced vaccinated individuals elicit a weaker SIgA response compared to infection alone, indicating that vaccination cannot completely recall nasal SIgA responses. Acquiring a better understanding of SARS-CoV-2 specific nasal antibody responses is an important step towards developing vaccines that can elicit strong mucosal immunity.

Nasal SARS-CoV-2 specific secretory-IgA and IgG are robustly induced in vaccinated individuals after infection

Background
The Pennsylvania Rural Health Model (PARHM) is a novel alternative payment model (APM) that began in 2019 and is slated to run through 2024. It is designed to test whether hospital global budgets and transformation plans can improve the financial viability of rural hospitals and the health of their patients. The expectation is that, when hospitals operate on a prospective budget, they have an incentive to reduce potentially avoidable hospitalizations (PAH) to control costs. Therefore, our objective was to assess the early impacts of PARHM on PAH for ambulatory care sensitive conditions.

Methods
We conducted a retrospective cohort study using a difference-in-differences (DID) with multiple time periods approach. Hospitals joined PARHM in three cohorts at different points in time (January 2019, 2020, and 2021), creating a natural policy experiment to study this program’s effects. The treated group included HSAs of 18 treated hospitals and the control group included HSAs of 43 eligible but not participating hospitals. We used visit-level inpatient discharge data from the Pennsylvania Health Care Cost Containment Council between 1/1/2016 and 5/31/2022. We measured PAH using the Agency for Healthcare Research and Quality Prevention Quality Indicators algorithm. Analyses were conducted at the hospital service area (HSA)-quarter level. We fit models using a doubly robust DID estimator that accounted for staggered treatment timing. All models were weighted using propensity scores and population size in each HSA.

Results
The introduction of PARHM was associated with 9.71 fewer PAHs per 100k residents per quarter (95% CI: 0.21 to 19.21) overall. This represents a 2.25% relative reduction in treated vs. control HSAs. However, when cohorts were analyzed separately, only PARHM Cohort 1 HSAs consistently a showed statistically significant (p<0.05) relative decreases in PAHs across overall, acute, chronic, and diabetes composite measures for PAH compared to changes in the control group. Results were similar across sensitivity and subgroup analyses.

Conclusion
Our findings on the early impacts of PARHM suggest that it is associated with fewer PAHs. Although, heterogeneous treatment effects by cohort were observed. This study addresses an important gap in the current literature regarding the impact of PARHM on health care utilization. Findings can be used to evaluate the success of PARHM and inform the development and implementation of future APMs across rural settings.

Underline digital video library

Cryptogenic Pontine Abscess Treated With Stereotactic Aspiration: A Case Report

Assessing Positional Asymmetry of the Larynx

A Mixed-Methods Longitudinal Assessment of Imposter Phenomenon in Third-Year Medical Students

High-throughput spatial reconstruction of cell states within ovarian cancer structures

Using CAR T Cell-Secreted Antagonistic Peptides to Target Distinct Immune Checkpoint Pathway in Pancreatic Tumors

Diagnostic and Therapeutic Complexities in a Case of Severe Acquired Factor 8 Deficiency

The Effect of Socioeconomic Status on Diagnosis and Prognosis of Thyroid Cancers

Looking Beyond the Ordinary Lip Lesion: A Rapidly Progressive Case of Neutrophilic Sebaceous Adenitis

Eeny, meeny, miny, “Mohs": Characterizing gender and leadership trends in Mohs micrographic surgery

A 3D printed, High Strength and Drug Eluting Composite for the Treatment of Periprosthetic Joint Infections

Nasal SARS-CoV-2 specific secretory-IgA and IgG are robustly induced in vaccinated individuals after infection

Pennsylvania Rural Health Model: Early Impacts on Potentially Avoidable Hospitalizations

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