The Ponce Health Sciences University (PHSU), formerly Ponce School of Medicine & Health Sciences, is a private, for-profit university in Ponce, Puerto Rico. It awards graduate degrees in Medicine (MD), Clinical Psychology (PsyD and PhD), Biomedical Sciences (PhD), Medical Sciences (MS), and Public Health (MPH and DrPH). The university has 360 students in its medical school and, as of 11 February 2019, was authorized to increase the student body at the medical school to 600 which, when fully in place, will make it the largest private medical school in Puerto Rico and one of the largest under the American flag.
Dengue remains a major public health challenge, particularly in endemic areas like Puerto Rico, where its economic burden is substantial. This study aimed to update the economic burden of dengue in Puerto Rico using recent data from patients, hospitals, and insurance companies, providing a clearer picture of the current situation. We estimated the total number of dengue cases with fever who sought care by adjusting for underreporting through a robust statistical framework linking island-wide passive surveillance data to sentinel acute febrile illness surveillance. We obtained cost data from hospitals and conducted interviews with a random sample of people diagnosed with dengue (n = 101) from December 2021–November 2022, collecting detailed information on direct medical costs, non-medical costs, and indirect costs. We analyzed median, epidemic and long-term dengue incidence patterns from 2010–2023. We conducted a cost-of-illness analysis using Bayesian multiplier methods to adjust for underreporting, followed by a bottom-up costing approach during a typical median incidence year and an epidemic year to illustrate the current economic burden of dengue in Puerto Rico. In the median incidence year (2014), from 597 reported dengue cases we estimated 4500 [95
Identifying molecular biomarkers of pulmonary fibrosis (PF) would improve monitoring the disease progression and response to treatment. Hermansky-Pudlak syndrome (HPS)PF is an inherited type of progressive PF with accelerated onset of PF in patients with HPS type 1 (HPS-1). HPSPF could serve as a model to study biomarkers of progressive PF, given that all individuals with HPS-1 eventually develop HPSPF. We used a multiomics strategy to discover progressive blood biomarkers that can recognize factors contributing to the fibrotic cascade in the lungs of individuals with HPS. Metabolomic and cytokine/chemokine profiling were performed on serum samples from patients with HPS-1, HPS-1 with PF (HPSPF), HPS-3, HPS-5, or idiopathic PF and healthy volunteers. Metabolomics, cytokine/chemokine, pulmonary function, and age data from subjects with HPS-1 and HPSPF were integrated into a multiomics network. The analysis highlighted alterations in the transsulfuration pathway, arginine metabolism, and redox balance with the progression of PF in HPS-1. Among those, CCL22 and choline were significantly elevated in HPSPF compared with HPS-1 in two independent cohorts together with age and were associated with decline of pulmonary function. In receiver operating characteristic curve analysis, both CCL22 and choline demonstrated high accuracy in predicting PF in subjects with HPS-1 and therefore could serve as prognostic blood biomarkers of HPSPF. We noted similarity in molecular signatures of CCL22 in progressive idiopathic PF and HPSPF. We found that inducible nitric oxide synthase is an upstream regulator of releasing profibrotic mediators (CCL22, CCL24, IL-18, IL-1α, IL-1β), suggesting the therapeutic potential of inducible nitric oxide synthase inhibition in progressive HPSPF.
BACKGROUND:We previously showed that ancestral-specific anti-Spike binding IgG concentration and 50% inhibitory dilution neutralizing antibody titer (nAb-ID50) measured at 2 weeks postdose 2 (∼peak) were inverse correlates of risk (CoRs) of COVID-19 over 2 months post ∼peak in the PREVENT-19 trial of the NVX-CoV2373 vaccine; there were not sufficient data to assess CoRs of severe COVID-19. METHODS:Here, we assessed, in the same vaccinated cohort, Delta- and ancestral-specific Spike IgG and nAb-ID50 at ∼peak and over time as CoRs of severe COVID-19 and of Delta COVID-19 over 3.5-10 months post ∼peak (287 breakthrough Delta cases, including 8 severe; 446 noncases). RESULTS:Peak antibody levels were much higher for noncases versus severe cases (all inferred Delta), with nAb-ID50 Delta geometric mean 209.5 arbitrary units (AU)/mL (95% CI: 176.1, 249.1) versus 9.6 AU/mL (95% CI: 2.4, 38.6), respectively. Frequency of detectable nAb-ID50 titer was 98.3% (97.2, 99.0) for noncases versus 62.5% (22.3, 93.9) for severe cases. All markers were inverse CoRs of severe COVID-19, with a ∼peak hazard ratio (HR) of 0.13 (95% CI: .03, .57) per 10-fold nAb-ID50 Delta increase. Severe COVID-19 risk through 305 days postday 35 was 0.0338 (0.0043, 0.206) at the nAb-ID50 Delta 2.5th percentile (8.4 AU/mL), and 0.002 (0.0000, 0.0108) and 0.0002 (0.0000, 0.0035) at the 50th and 95th percentiles (210, 2522 AU/mL). CONCLUSIONS:Postvaccination NVX-CoV2373 antibody levels are stronger predictors of severe COVID-19 than any-severity Delta COVID-19. Low antibody responses indicate vulnerability to severe COVID-19.
OBJECTIVE:CAD-CAM technology enables biomimetic dentistry by producing highly accurate, minimally invasive restorations that replicate the biomechanical behavior of intact teeth. This study evaluated the fracture resistance of overlays with margins at different supragingival levels, including a flat occlusal design and compared them with conventional full crowns. All restorations were fabricated from chairside CAD/CAM resin-matrix ceramic for maxillary premolars. METHODS AND MATERIALS:Sixty-four CAD/CAM resin-matrix ceramic restorations were fabricated and randomly assigned to four groups (n = 16): (1) overlay with a margin 2 mm above the gingiva (Ov2m); (2) overlay with a 4 mm supragingival margin (Ov4m); (3) overlay with a 4 mm margin and flat occlusal surface (OvF4m); and (4) full-coverage crown with a gingival-level margin (FCC). Preparations were standardized by one operator. Restorations were adhesively cemented to resin dies, thermocycled 10,000 times (5-55 °C), and loaded to failure in a universal testing machine (1 mm/min). Data were analyzed using one-way ANOVA and post hoc tests (α = 0.001). RESULTS:Among overlays, Ov2m showed the highest fracture resistance (1605 ± 88 N), followed by Ov4m (1403 ± 63 N). OvF4m recorded the lowest value (1257 ± 73 N). FCC exhibited the greatest overall resistance (1838 ± 106 N), significantly higher than that of any overlay group. CONCLUSIONS:Overlays with margins 2 mm above the gingiva had higher fracture resistance than those with more coronal margins or flat occlusal designs. Full-coverage crowns showed the greatest strength, highlighting the impact of margin position and preparation design on restoration performance.
This article explores the impact of energy insecurity on chronic disease management among older adults (≥ 50 years) in rural areas of Puerto Rico. It documents their lived experiences during power outages and assesses the role of community-driven solar energy initiatives led by the community-based organization Casa Pueblo in enhancing health resilience in a disaster-prone region. An exploratory-descriptive qualitative approach was employed, incorporating semi-structured interviews with 60 participants across three levels of solar energy access (direct, indirect, and no access) and key stakeholders. Thematic analysis was conducted using NVivo to explore the health impacts of energy insecurity and the resilience strategies used to address it. Energy insecurity exacerbated health vulnerabilities by disrupting the use of critical medical equipment and the refrigeration of medications, worsening chronic conditions such as diabetes and respiratory ailments. Participants reported significant psychological stress, including elevated anxiety during blackouts. Casa Pueblo’s solar initiative proved essential, mitigating immediate health risks while fostering a sense of security and well-being. Yet systemic challenges—such as insufficient government support—highlighted the urgent need for scalable, sustainable solutions that ensure equity. Reliable energy access is crucial for managing chronic diseases among older adults and strengthening public health resilience in disaster-prone settings like Puerto Rico. Community-driven solar initiatives, exemplified by Casa Pueblo, offer scalable models to enhance health outcomes in vulnerable populations. Realizing their full potential will require coordinated efforts, including public-private partnerships, policy reforms, and measures to overcome structural barriers. This study provides actionable insights for disaster-prone regions worldwide, emphasizing the integration of energy resilience into public health planning.
