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UC San Francisco Previously Published Works

Grounding global health in care: connecting decoloniality and migration through racialization

(2025)

ABSTRACTRecent academic and activist critiques raise important points about the ways in which coloniality, migration and racialization are often overlooked in global health research and practice. In particular, these critiques highlight how such structural forces perpetuate inequalities and exclusions, as well as processes of epistemic violence in global health. While agreeing with these critical interventions, this paper argues for a focus on care and the importance that concrete acts and systems of care in postcolonial, migratory and racialized contexts have on the suffering and vulnerability of individuals and communities. Drawing on case studies from multiple different geographic and social contexts, we argue that the perspective of racialization can highlight how multi-layered inequalities in global healthcare are shaped by the intertwined processes of coloniality and migration; thereby explaining the contextual, structural vulnerability of specific groups of people to certain health conditions and their exclusion from adequate healthcare resources. We argue that social scientists and critical global health scholars and practitioners can play a central role in bringing the three strands of research - coloniality, migration and racialization - into conversation to explore their potential for jointly advancing the care and well-being of individuals and communities in different geographical and social contexts.

Cover page of Development and Initial Validation of Mindfulness-Based Pain Reduction (MBPR) in Patients With Chronic Low Back Pain

Development and Initial Validation of Mindfulness-Based Pain Reduction (MBPR) in Patients With Chronic Low Back Pain

(2025)

Purpose

Mindfulness-Based Stress Reduction (MBSR) has shown efficacy for alleviating chronic low back pain (cLBP) and is included in current treatment guidelines. However, benefits are moderate. We aimed to optimize MBSR for chronic pain by using recent research to develop Mindfulness-Based Pain Reduction (MBPR) and test it in patients with cLBP.

Patients and methods

Phase 1: We modified the MBSR curriculum with theory-driven components and convened focus groups with local and international mindfulness and clinical pain management experts to refine an 8-week MBPR program. Phase 2: We recruited participants with cLBP from Northern California using outreach in newsletters, social media, and other methods to test and iteratively modify the curriculum. MBPR was delivered in a group format by videoconference. The first three groups received MBPR; a fourth group was randomized to MBSR or MBPR to assess randomization feasibility. We assessed feasibility and acceptability by attendance, practice logs, and exit interviews. We assessed changes in patient-reported outcome measures for low back pain trials using a single arm (treatment group only) approach at 2 and 6 months with linear mixed models (primary: pain intensity and interference (PEG) scores).

Results

Phase 1: The MBPR curriculum included: 1) mindful interoceptive exposure to pain, 2) pain neuroscience education, and 3) yoga postures specifically for cLBP. Phase 2: we enrolled 58 patients in 4 cohorts; 49 completed post-intervention and 41 completed 6-month follow-up assessments; 29 of the 41 received MBPR. Participants attended a mean of 80% of sessions and 23 of 24 participants accepted randomization in the 4th cohort. Mean PEG scores improved for 20 of 29 MBPR participants in a clinically meaningful way (PEG scores >30%).

Conclusion

MBPR was feasible and acceptable. Two-thirds of MBPR participants experienced clinically meaningful improvements in pain intensity and interference scores. MBPR warrants further investigation through a randomized, controlled trial.
Cover page of Patient-derived tumor explant models of tumor immune microenvironment reveal distinct and reproducible immunotherapy responses.

Patient-derived tumor explant models of tumor immune microenvironment reveal distinct and reproducible immunotherapy responses.

(2025)

Tumor-resident immune cells play a crucial role in eliciting anti-tumor immunity and immunomodulatory drug responses, yet these functions have been difficult to study without tractable models of the tumor immune microenvironment (TIME). Patient-derived ex vivo models contain authentic resident immune cells and therefore, could provide new mechanistic insights into how the TIME responds to tumor or immune cell-directed therapies. Here, we assessed the reproducibility and robustness of immunomodulatory drug responses across two different ex vivo models of breast cancer TIME and one of renal cell carcinoma. These independently developed TIME models were treated with a panel of clinically relevant immunomodulators, revealing remarkably similar changes in gene expression and cytokine profiles among the three models in response to T cell activation and STING-agonism, while still preserving individual patient-specific response patterns. Moreover, we found two common core signatures of adaptive or innate immune responses present across all three models and both types of cancer, potentially serving as benchmarks for drug-induced immune activation in ex vivo models of the TIME. The robust reproducibility of immunomodulatory drug responses observed across diverse ex vivo models of the TIME underscores the significance of human patient-derived models in elucidating the complexities of anti-tumor immunity and therapeutic interventions.

Cover page of Facilitators and barriers of alcohol goals for Latinx men hospitalized with alcohol use disorder seen by an Addiction Consult Team.

Facilitators and barriers of alcohol goals for Latinx men hospitalized with alcohol use disorder seen by an Addiction Consult Team.

(2025)

INTRODUCTION: Latinx individuals are disproportionately affected by alcohol use disorder (AUD). Understanding Latinx individuals barriers and facilitators to reach AUD-related goals can help implement culturally and linguistically concordant interventions to improve alcohol-related outcomes. METHODS: We conducted semi-structured qualitative interviews with Latinx, Spanish-speaking men with AUD within 20 weeks of hospital discharge who were seen by an addiction consult team during hospitalization in an urban, safety-net hospital in San Francisco. Interviews focused on the facilitators and barriers to participants AUD-related goals pre-, during, and post-hospitalization. We recorded and transcribed interviews and used a mixed deductive and inductive analytic approach until we reached thematic saturation (n = 10). RESULTS: We identified three major themes: 1. Hospitalization was an actionable moment for change; 2. Social factors were closely intertwined with AUD goals; and 3. Accessible addiction, physical health, and mental health services can help achieve AUD goals. CONCLUSIONS: Hospitalization may serve as a facilitator for Latinx individuals with AUD to achieve AUD goals. Addressing social determinants of health including housing, immigration status, and social support networks before, during, and after hospitalization, may help facilitate AUD goals. Providing language-concordant and accessible services may decrease barriers to achieving AUD goals.

Cover page of Placental malaria induces a unique methylation profile associated with fetal growth restriction.

Placental malaria induces a unique methylation profile associated with fetal growth restriction.

(2025)

Fetal growth restriction (FGR) is associated with perinatal death and adverse birth outcomes, as well as long-term complications, including increased childhood morbidity, abnormal neurodevelopment, and cardio-metabolic diseases in adulthood. Placental epigenetic reprogramming associated with FGR may mediate these long-term outcomes. Placental malaria (PM), characterized by sequestration of Plasmodium falciparum-infected erythrocytes in placental intervillous space, is the leading global cause of FGR, but its impact on placental epigenetics is unknown. We hypothesized that placental methylomic profiling would reveal common and distinct mechanistic pathways of non-malarial and PM-associated FGR. We analyzed placentas from a US cohort with no malaria exposure (n = 12) and a cohort from eastern Uganda, a region with a high prevalence of malaria (n = 12). From each site, 8 cases of FGR and 4 healthy controls were analyzed. PM was diagnosed by placental histopathology. We compared the methylation levels of over 850K CpGs of the placentas using Infinium MethylationEPIC v1 microarray. Non-malarial FGR was associated with 65 differentially methylated CpGs (DMCs), whereas PM-FGR was associated with 133 DMCs, compared to their corresponding controls without FGR. One DMC (cg16389901, located in the promoter region of BMP4) was commonly hypomethylated in both groups. We identified 522 DMCs between non-malarial FGR vs. PM-FGR placentas, independent of differing geographic location or cellular composition. Placentas with PM-associated FGR have distinct methylation profiles compared to placentas with non-malarial FGR, suggesting novel epigenetic reprogramming in response to malaria. Larger cohort studies are needed to determine the distinct long-term health outcomes in PM-associated FGR pregnancies.

Cover page of Ultrafine‐Grained Materials With Antibacterial Properties: A Novel Approach to Reducing Spinal Implant‐Associated Infections

Ultrafine‐Grained Materials With Antibacterial Properties: A Novel Approach to Reducing Spinal Implant‐Associated Infections

(2025)

Background

Implant-associated infection remains a serious complication of instrumented spinal surgery. Since biofilm formation on the implant surface is a key factor in the pathogenesis of such infections, current preventive strategies include the use of implants with antibiotic coatings. However, these approaches raise concerns related to antibiotic resistance and cytotoxicity. Ultrafine-grained (UFG) stainless steel, characterized by nanoscale grain sizes, has demonstrated superior mechanical properties and potential antimicrobial effects. This study aimed to evaluate the antibacterial properties of UFG stainless steel implants against Staphylococcus aureus biofilm formation in both in vitro and in vivo models.

Methods

UFG and conventional SUS316L stainless steel wires were incubated with bioluminescent Staphylococcus aureus Xen36 for up to 7 days in vitro. Biofilm formation was assessed using crystal violet (CV) staining, colony-forming unit (CFU) counting, and quantitative PCR (qPCR) for 16S rRNA and luxA genes. In vivo antibacterial effects were evaluated using two mouse models: a subcutaneous pouch model and a postoperative spinal implant infection model. Wires were harvested at 1, 3, and 7 days post-infection and analyzed using the same assays.

Results

In vitro, UFG wires had significantly lower CFU counts than standard wires at 4 h (p = 0.0005), 1 day (p = 0.0001), and 3 days (p = 0.0314). In the subcutaneous pouch model, UFG wires showed significantly reduced bacterial load at Day 1 by CFU (p = 0.011). In the spinal implant model, CFU counts were significantly lower on UFG wires at Day 3 (p = 0.015).

Conclusions

UFG stainless steel implants demonstrated a significant reduction in early biofilm formation by Staphylococcus aureus in both in vitro and in vivo, suggesting a delay in the biofilm formation process. These findings support the potential of UFG materials as promising candidates for infection-resistant spinal implants.
Cover page of Cyberbullying Victimisation Was Associated With Greater Manic Symptoms in Early Adolescence: A Prospective Cohort Study

Cyberbullying Victimisation Was Associated With Greater Manic Symptoms in Early Adolescence: A Prospective Cohort Study

(2025)

Aim

Cyberbullying has been linked to various adverse psychological outcomes, but prospective associations with manic symptoms in early adolescents remain unexplored. We examined the prospective relationship between cyberbullying victimisation and manic symptoms in a diverse cohort of American children and adolescents.

Method

We analysed data from the Adolescent Brain Cognitive Development study from the period 2 follow-up (2018-2020) to the period 3 follow-up (2019-2021). Linear regression models estimated the associations between cyberbullying victimisation (lifetime and past 12 months) and manic symptoms. We adjusted for age, sex, race and ethnicity, household income, parental education, manic symptoms, anxiety, depression, total screen time, and study site.

Results

The average age of our 9095 adolescents (51.3% male) was 12.0 ± 0.7 years. The prevalence of cyberbullying victimisation was 9.2% for lifetime and 6.1% for the past 12 months. Adjusting for the covariates, lifetime cyberbullying victimisation was associated with a 0.41 higher manic symptom sum score (95% CI 0.18-0.65, p = 0.001), and past 12-month cyberbullying victimisation was associated with a 0.38 higher manic symptom sum score (95% CI 0.11-0.66, p = 0.007).

Conclusion

These findings highlight the need for early identification and intervention for adolescents experiencing cyberbullying to mitigate its adverse effects on mental health.
Cover page of The development of aperiodic neural activity in the human brain.

The development of aperiodic neural activity in the human brain.

(2025)

The neurophysiological mechanisms supporting brain maturation are fundamental to attention and memory capacity across the lifespan. Human brain regions develop at different rates, with many regions developing into the third and fourth decades of life. Here, in this preregistered study ( https://osf.io/gsru7 ), we analysed intracranial electroencephalography recordings from widespread brain regions in a large developmental cohort. Using task-based (that is, attention to to-be-remembered visual stimuli) and task-free (resting-state) data from 101 children and adults (5.93-54.00 years, 63 males; n electrodes = 5,691), we mapped aperiodic (1/ƒ-like) activity, a proxy of neural noise, where steeper slopes indicate less noise and flatter slopes indicate more noise. We reveal that aperiodic slopes flatten with age into young adulthood in both association and sensorimotor cortices, challenging models of early sensorimotor development based on brain structure. In the prefrontal cortex (PFC), attentional state modulated age effects, revealing steeper task-based than task-free slopes in adults and the opposite in children, consistent with the development of cognitive control. Age-related differences in task-based slopes also explained age-related gains in memory performance, linking the development of PFC cognitive control to the development of memory. Last, with additional structural imaging measures, we reveal that age-related differences in grey matter volume are similarly associated with aperiodic slopes in association and sensorimotor cortices. Our findings establish developmental trajectories of aperiodic activity in localized brain regions and illuminate the development of PFC control during adolescence in the development of attention and memory.

Effective Treatment of Disseminated Prostate Cancer Using CD46-Targeted 225Ac Therapy

(2025)

Purpose

Metastatic castration-resistant prostate cancer has limited treatment options and a poor prognosis. Recently, prostate-specific membrane antigen (PSMA)-targeted alpha-particle therapy agents using actinium-225 (225Ac) have shown promising results in prostate cancer treatment, but a significant fraction of patients with advanced mCRPC demonstrate loss of PSMA expression. We have previously reported that PSMA-null and PSMA-positive tumors can be detected and treated effectively with CD46-targeted radiopharmaceuticals. This study evaluates the CD46-targeting PET imaging agent [89Zr]DFO-YS5, and the radioimmunotherapy agent [225Ac]Macropa-PEG4-YS5, in disseminated prostate cancer tumors.

Experimental design

Microtumor lesions, primarily observed in the liver, kidneys, and lungs, were successfully detected with [89Zr]DFO-YS5 PET imaging. We used disseminated 22Rv1 tumors for biodistribution studies, dosimetry assessments, and therapeutic efficacy evaluations of [225Ac]Macropa-PEG4-YS5.

Results

Quantitative digital alpha-particle autoradiography revealed high radiation dose deposition from [225Ac]Macropa-PEG4-YS5 in microtumors compared with surrounding liver tissues, although in larger lesions (>1 mm diameter), the dose distribution was heterogeneous. Early treatment of smaller disseminated tumors with a uniform radiation dose was more effective in ablating tumors and promoting survival. In late-stage lesions of large size, heterogeneous dose deposition limited therapeutic efficacy, requiring higher administered activity to achieve a complete response.

Conclusions

Our findings highlight that [225Ac]Macropa-PEG4-YS5 holds the potential for clinical translation for metastatic prostate cancer and reinforces the value of microdosimetry in understanding the efficacy of and resistance to targeted alpha therapy. See related commentary by Patel et al., p. 2847.
Cover page of Collagen Biosynthesis and Its Molecular Ensemble: What Remains Unexplored.

Collagen Biosynthesis and Its Molecular Ensemble: What Remains Unexplored.

(2025)

Collagen embodies an intriguing paradox in protein biology. Despite being one of the most abundant protein superfamilies in vertebrates and having a seemingly simple structural organization, its biosynthesis is anything but straightforward. This apparent simplicity masks a complex and often contradictory biosynthetic landscape that poses significant challenges, particularly for newcomers to the field. Rather than following a linear or uniform pathway, collagen biosynthesis involves a coordinated series of tightly regulated steps, cotranslational post-translational modifications (PTMs), chain selection and registration, triple helix formation, and secretion, orchestrated by a specialized machinery, collectively termed the collagen molecular ensemble. This ensemble must overcome unconventional paradigms in protein biogenesis, rife with exceptions and unresolved questions. In this perspective, I examine underexplored aspects of the collagen biosynthetic machinery, spotlighting challenges in decoding the regulatory logic of PTMs, the spatial dynamics of trimer assembly, the functional consequences of chain registration, and the type-specific routes of secretion. By charting these uncertainties, I aim to challenge prevailing assumptions and invite interdisciplinary insight to help unravel the remaining mysteries of collagen biosynthesis.