Mauro D'Amato, PhD, is Ikerbasque Research Professor and head of the Gastrointestinal Genetics Lab at CIC bioGUNE.

From Physiology to Genetics: A New Lens on Gut Motility, With Mauro D’Amato, PhD

Gut motility plays a central role in digestive health, yet the biological mechanisms that regulate how frequently the bowel moves and why this varies so widely among individuals remain incompletely understood. This challenge is especially pronounced in disorders of gut–brain interaction, such as irritable bowel syndrome (IBS), where symptoms like constipation and diarrhea reflect underlying dysmotility but arise from complex, multifactorial processes.

, Mauro D’Amato, PhD, Ikerbasque Research Professor and head of the Gastrointestinal Genetics Lab at CIC bioGUNE, and colleagues took an unconventional approach to this challenge, examining gut motility as a physiological trait. Specifically, they analyzed stool frequency as a measurable outcome across large populations, with the goal of identifying genetic mechanisms that influence bowel movement patterns and could ultimately be targeted therapeutically.

“The problem in studying these diseases, I do genetics, so I try to identify what could be the eventual genetic causes or partial cause of these diseases, is that they're very complex. There are so many factors playing a role,” D’Amato explained to 

. “Instead of looking at the actual disease, we had the idea to look at the physiology, with the idea that if we identify genes that are relevant to gut motility, we identify mechanisms relevant to gut motility, and then eventually we can target these mechanisms to cure or treat alterations of the of the gut motility and peristalsis.”

He and a team of investigators performed a multiancestry genome-wide association study (GWAS) meta-analysis of stool frequency in 268,606 European and East Asian individuals. Heritability and genetic correlations with other traits were estimated, and Mendelian randomization was used to test causal relationships. GWAS signals were fine-mapped and functionally annotated to prioritize candidate genes and pathways. Findings implicating thiamine metabolism were followed-up with dietary interaction analyses in UK Biobank.

Results showed strong genetic correlations with gastrointestinal and psychiatric disorders (rg=0.18–0.47), and causal effects on IBS. Novel correlations with cardiovascular traits (rg=0.12–0.14) were supported by drug signature enrichment analyses.

They identified 21 independent loci, including 10 novel signals implicating bile acid synthesis (

). Fine-mapping converged on vitamin B1 metabolism, highlighting single-variant causal effects at 

, a phosphate exporter essential for thiamine activation.

In 98,449 UK Biobank participants, thiamine intake was positively associated with SF (

 genotype score significantly modulated this effect (

“I’ve already heard people saying ‘Oh, well, how much vitamin B? What should I eat every day now?’ We're not there yet, at least this is not what we do in the lab,” D’Amato explained, describing the need for future animal studies and eventual human clinical trials to determine whether vitamin B1 supplementation can meaningfully improve real-world outcomes.

He additionally pointed to study findings highlighting both established and unexplored compounds behind the regulation of gut motility, the latter of which offers a potential next wave of candidates to be tested.

Editors’ Note: D’Amato reports no relevant disclosures.

Díaz-Muñoz C, Bozzarelli I, Lopera-Maya EA

Genetic dissection of stool frequency implicates vitamin B1 metabolism and other actionable pathways in the modulation of gut motility. 

CIC bioGUNE. DNA ties gut motility to vitamin B1. EurekAlert! January 20, 2026. Accessed January 23, 2026. 

https://www.eurekalert.org/news-releases/1112772

Videos

D’Amato explains his research on the biological mechanisms that control bowel movements and vitamin B1’s potential role in gut motility.

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Vivian Fonseca, MD, is professor of medicine, assistant dean for clinical research, and the Tullis-Tulane Alumni Chair in Diabetes at Tulane University School of Medicine.

CAPTAIN-T2D: New Trial Investigates Treating Elevated Cortisol in T2D, With Vivian Fonseca, MD

The phase 2 Clofutriben And Placebo Against INtractable Type 2 Diabetes (CAPTAIN-T2D) trial, investigating clofutriben to improve glycemic control and metabolic health in patients with difficult-to-control 

 and elevated cortisol, has officially enrolled its first patient.

CAPTAIN-T2D directly follows positive results from the CATALYST trial in 2025, which saw 136 patients with T2D and hypercortisolism randomly assigned in a 2:1 ratio to either mifepristone 300-900 mg once daily (n = 91) or placebo (n = 45) for 24 weeks. The primary endpoint was the change in HbA1c, which worked out to a -1.32% difference compared to placebo. Additionally, patients receiving mifepristone saw reductions in body weight and waist circumference.

“So, what we want to do now in CAPTAIN-T2D is to use another approach at treating this elevated cortisol,” Vivian Fonseca, MD, professor of medicine, assistant dean for clinical research, and the Tullis-Tulane Alumni Chair in Diabetes at Tulane University School of Medicine, told 

 in an exclusive interview. “In this instance, we’re using an 11-beta hydroxysteroid dehydrogenase inhibitor, which uses a completely different approach from mifepristone. You’re addressing intracellular cortisol by blocking this enzyme that leads to conversion of the inactive cortisone to cortisol, and so you’re decreasing cortisol activity in the tissues.”

CAPTAIN-T2D is a 2-part trial – the first part will see patients with poorly controlled T2D despite being on multiple medications screened for elevated cortisol using an overnight dexamethasone suppression test. This period will last between 5 and 9 weeks for most participants.

Eligible patients will then be randomly assigned to either clofutriben 0.2 mg, 2 mg, 6 mg, or 12 mg, or a placebo control, all of which will be administered daily. This second part will last for 24 weeks, with a follow-up phone call 4 weeks after the final dose.

To be eligible for inclusion, patients must be ≥18 years old with an HbA1c ≥7.5% documented within 3 months prior to screening. Additionally, patients require ≥1 of the following:

Diabetes complications – retinopathy, nephropathy, neuropathy, 

Hypertension needing ≥2 adequately dosed AHMs

Adequately dosed basal or basal plus prandial insulin on top of ≥1 other ADM

Adequately dosed incretin agonists on top of ≥1 other ADM

Evidence or history of osteoporosis or non-traumatic fracture

Established diagnosis of a neoplastic source of hypercortisolism and have failed, are ineligible for, or declined surgery.

CAPTAIN-T2D has 2 primary endpoints: the first is the percentage of patients with both morning serum cortisol >1.8 mg/dL and morning plasma dexamethasone >-140 ng/dL after a single dexamethasone 1 mg dose taken the night prior. The second endpoint involves glycated hemoglobin A1c percent change from baseline to week 24 by treatment. Secondary endpoints include fasting plasma glucose change from baseline and the frequency of treatment-emergent adverse events.

The trial is expected to enroll a total of 1500 patients and is planned to end in June of 2028.

“We’ve begun to use this method a lot in other conditions, such as cancer: you find a particular defect, and you treat it with therapy that’s specifically targeted to that defect,” Fonseca said. “Unfortunately, we don’t have much of that in diabetes. We’ve been using a one-glove-fits-all approach, giving everybody every new medication that comes along, and the success has been mixed. Overall, control is better than it was 20 years ago, but it’s still not right, and I think identifying abnormalities could help with better outcomes.”

Editor’s Note: Fonseca reports disclosures with Abbott, AstraZeneca, Novo Nordisk, Sanofi-Aventis, Eli Lilly, Bayer, and others.

Sparrow Pharmaceuticals. Sparrow Pharmaceuticals Announces First Patient Enrolled in Phase 2b Clinical Trial Evaluation Clofutriben for Difficult-to-Control Type 2 Diabetes. 

. January 6, 2026. Accessed January 23, 2026. 

https://www.biospace.com/press-releases/sparrow-pharmaceuticals-announces-first-patient-enrolled-in-phase-2b-clinical-trial-evaluating-clofutriben-for-difficult-to-control-type-2-diabetes

DeFronzo RA, Fonseca V, Aroda VR, et al. Inadequately controlled type 2 diabetes and hypercortisolism: Improved glycemia with mifepristone treatment. 

Sparrow Pharmaceuticals. Trial Against INtractable Type 2 Diabetes (CAPTAIN-T2D) (CAPTAIN-T2D). ClinicalTrials.gov Identifier: NCT07296484. Updated January 22, 2026. Accessed January 23, 2026. 

https://clinicaltrials.gov/study/NCT07296484?term=NCT07296484&rank=1

Fonseca explains the structure and goals of the ongoing trial, which has enrolled its first patient to clofutriben treatment against hard-to-control T2D.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Type 2 Diabetes

Autoclaved Peanuts Reduce IgE Binding, Improve Tolerability, With Casey Cohen, PhD

Heat- and pressure-based food processing is not new to allergy research, but new data suggest it may meaningfully alter peanut allergenicity in ways that traditional cooking cannot. In a recent interview with 

, Casey Cohen, PhD, of McGill University, discussed findings from a study demonstrating that autoclaving peanuts, a process combining high temperature, pressure, and moisture, substantially reduces immunoglobulin E (IgE) binding and improves oral tolerability in individuals with a 

“The way people eat peanuts is often roasted peanuts if they're eating peanut butter or just roasted peanuts,” Cohen said. “Or sometimes they boil peanuts in different places of the world, often in Asia. Autoclaving is rather untraditional…the process of autoclaving is used for sterilization. What we found is that it's actually changing the proteins in a different way. It's not just using heat, but the presence of water is changing them differently. It’s actually taking these proteins, breaking them down, not completely, but enough, where we have a lot of fragments, and we think that that is what is introducing different forms of peanut proteins to the immune system. That is not happening with say, boiled or roasted peanut.”

The study evaluated how autoclaving peanuts at 130°C and 2.4 atmospheres for 30 minutes alters peanut proteins compared with raw or roasted preparations. Using mass spectrometry-based proteomics, the investigators showed that autoclaving extensively fragments major peanut allergens, including Ara h 1 and Ara h 2, and completely degrades Ara h 8. These molecular changes translated into a 74% reduction in peanut-specific IgE binding in sera from highly allergic patients compared with raw peanuts.

Clinically, the effects were notable. In skin prick testing of 41 peanut-allergic participants, autoclaved peanut extract produced significantly smaller wheal sizes than standard commercial extract (median 5 mm vs 10 mm; 

 <.001). Although responses were heterogeneous, patients with the greatest wheal size reductions tended to have lower IgE levels to peanut (

 <.05), suggesting a potential role for autoclaved extracts in phenotyping peanut allergy risk. However, Cohen said this remains exploratory.

All 10 peanut-allergic participants undergoing an oral food challenge (OFC) tolerated the maximum cumulative dose of autoclaved peanut (444 mg), equivalent to ≥ 1 whole peanut, with only mild to moderate symptoms. In contrast, all participants reacted to blanched peanuts at much lower doses (median 9 mg), often requiring treatment, including epinephrine.

Cohen cautioned clinicians against extrapolating these findings directly to patient practice. Autoclaved peanuts are not ready for home use, nor should patients attempt self-experimentation. It is uncertain whether any patient with a food allergy can tolerate autoclaved peanuts.

“What is more interesting, we believe, is that we can actually use this autoclave peanut as a starting substrate for immunotherapy,” Cohen said. “Right now, a lot of people who are allergic to peanuts severely will have to start with incredibly small amounts of peanuts. It's… smaller than my pinky nail. In that case, it's hard to be consistent. We get a lot of variability, and the peanut proteins themselves are a lot more rigid and [a] lot more likely to induce a more dangerous reaction. By autoclaving the peanuts, we think it'll give us more leeway. We can start at a higher dose of autoclaving peanuts, especially if there's no dangerous symptoms coming with it, and then we can work our way up to maybe, eventually, transfer over to the regular, traditional peanut.”

Cohen CG, Toscano-Rivero D, Ahmed EA, et al. Autoclaved Peanuts Exhibit Reduced Immunoglobulin E Binding and Improved Oral Tolerability. 

. Published online January 6, 2026. doi:10.1111/all.70208

New data show heat- and pressure-treated peanuts significantly reduce IgE binding, skin test reactivity, and oral challenge severity in allergic patients.

Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Food Allergy

Anaphylaxis

The HCPLive anaphylaxis page is a comprehensive resource for clinical news and insights on acute allergic reactions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for preventing anaphylaxis, and more.

Carly Maucione, MD, a resident physician at Washington University in St. Louis

Blending Education, Machine Learning to Detect IV Fluid Contaminated CBCs, With Carly Maucione, MD

Improved detection of IV fluid contamination in complete blood counts (CBCs) could prevent a subset of unnecessary downstream blood transfusions, whether through clinician education or machine learning, according to new research.

Findings from a multicenter machine learning study identified a surprising frequency of contaminated blood specimens, underscoring the clinical consequences of acting on erroneous laboratory results.

“I would be happy if more people read about this problem and familiarized themselves with what IV fluid contamination could look like in their patient specimens,” said study investigator Carly Maucione, MD, a resident physician at Washington University in St. Louis, in an interview with 

. “When they’re working on the floor, and they do see something suspicious, they might say, ‘I remember hearing about this. I think this might be a contaminated specimen.’ Then they do a double check before ordering blood products, or take a moment to make sure they’re not acting on a false basic metabolic panel result.”

IV fluid contamination can be difficult to distinguish from true clinical changes, particularly in hospitalized patients with multiple lines and ongoing infusions, increasing the risk of downstream clinical interventions. Since blood transfusions are commonly initiated in response to abnormal laboratory values, even small rates of undetected contamination can have meaningful clinical implications.

Maucione and colleagues identified machine learning as a potential method to standardize CBC evaluation and assist pathologists with greater precision. Within laboratory practice, there are limited techniques for detecting IV fluid contamination, and commonly used approaches, such as delta checks, are not designed to have high sensitivity for this issue.

“There’s a lot of potential, at least in the laboratory, for machine learning in areas like flow cytometry,” said Maucione. “A lot of the preprocessing and gating is really manual. It’s pattern recognition, and that’s something machine learning can do really well. That’s a hang-up in our workflow, and anything that could do it faster is where I think we should be putting our efforts.”

The retrospective, multicenter machine learning diagnostic validation study used real-world inpatient data from 2 institutions, developing and testing 2 machine learning models with areas under the receiver operating characteristic curve of 0.972 and 0.957 and areas under the precision-recall curve of 0.723 and 0.619 for identifying IV fluid contamination in CBC results.

Results from the models revealed IV fluid contamination in approximately 2% of CBCs, with investigators estimating 6-9% of subsequent transfusions may have been unnecessary.

After identifying the unexpectedly high frequency of contaminated specimens and potentially avoidable transfusions, Maucione and colleagues aimed to address the gap. She acknowledged, however, that there is no gold standard for confirming IV fluid contamination and that further validation will be necessary to ensure the findings are not attributable to other confounding factors. Improving the positive predictive value of the models would be required before using them to delay the release of blood products when contamination is suspected, although this remains a longer-term goal.

While real-time implementation remains a longer-term goal, Maucione underscored that education represents a more immediate and achievable intervention. Increasing awareness among pathologists, laboratorians, phlebotomists, nurses, and other clinicians who draw blood could help prevent misinterpretation of contaminated specimens and reduce unnecessary transfusions.

Ultimately, the study highlights both the promise and the limitations of machine learning in laboratory medicine. Although artificial intelligence may help close gaps in detecting IV fluid contamination, Maucione stressed that thoughtful integration, rigorous validation, and clinician education will remain essential to ensuring patient safety and improving care.

Editor’s Note: Maucione reports no relevant disclosures.

Maucione C, McLamb N, Zaydman MA, Pearson LN, Metcalf RA, Spies NC. Identification of IV fluid contamination in complete blood counts and subsequent unnecessary red blood cell transfusions using artificial intelligence. 

. Published online August 2026:10.1111/trf.70072. doi:

Spies NC, Farnsworth CW. Impact and frequency of IV fluid contamination on basic metabolic panel results using quality metrics. 

Study investigator Carly Maucione, MD, discusses how artificial intelligence could support laboratory workflows while emphasizing education as a near-term solution.

Hematology

Kristi B. Hawley, DO, is the founder and owner of The Derm Institute of West Michigan.

The Medical Sisterhood: Advocacy and Systemic Change, With Kristi Hawley, DO

 in January 2026 opens with a candid and timely conversation about advocacy, autonomy, and the quiet breaking points many women physicians experience within modern medicine. Hosted by Mona Shahriari, MD, of Yale School of Medicine, the episode features Kristi B. Hawley, DO, founder and owner of The Derm Institute of West Michigan, whose journey as a dermatologist, practice owner, and physician advocate offers a powerful lens into the systemic challenges facing clinicians today.

Rather than framing the new year around resolutions or productivity goals, Shahriari sets the tone by addressing a reality familiar to many women in medicine: the feeling that January simply brings renewed pressure from a system that continues to demand more while offering less control. Hawley shares how her own advocacy journey began not from ambition, but from frustration and moral distress early in her career. After joining a practice where patient care conflicted with her values, she describes the emotional toll of witnessing care that felt misaligned with her ethics, and the sleepless nights that followed.

Opening her own practice in 2019 provided a degree of autonomy, but Hawley quickly realized that independence alone did not shield her from larger systemic forces. Insurance barriers, pharmacy benefit managers, reimbursement cuts, and corporate medicine continued to dictate patient access to care, often leaving physicians blamed for decisions they do not control. This realization marked a turning point, pushing Hawley to move beyond venting privately and toward advocacy at the state and national levels.

Throughout the conversation, Shahriari and Hawley unpack the misconception that physicians are the primary drivers of rising healthcare costs, noting how patients often perceive doctors as gatekeepers rather than allies. Both emphasize the importance of patient advocacy alongside physician advocacy, highlighting how patient voices can resonate more strongly with lawmakers than professional lobbying alone. Their shared experiences working with dermatology advocacy organizations underscore the power of bringing patient stories directly to Capitol Hill.

The episode also explores the gendered dynamics of advocacy. Hawley reflects on how women are often socialized to remain agreeable and quiet, and how speaking assertively, whether in the exam room or legislative settings, can be perceived differently when voiced by women. She candidly discusses the confidence it took to overcome fears of being labeled “too loud” or “difficult,” emphasizing that advocacy does not require aggression, but does require persistence and self-trust.

Importantly, the discussion demystifies advocacy by addressing its “unsexy” realities. Hawley shares how political engagement is often slow, frustrating, and deeply influenced by financial power. Still, she stresses that small actions, joining professional organizations, donating modestly to PACs, responding to advocacy emails, and participating in state-level efforts, can collectively drive meaningful change.

As the episode closes, both physicians underscore that burnout is not always about workload, but about powerlessness. Advocacy, even in small forms, can restore a sense of agency and purpose. Hawley leaves listeners with a resonant message: there is more than one seat at the table, and progress depends on women lifting one another rather than competing. Together, Shahriari and Hawley reaffirm 

’s mission—to create space for honest dialogue, shared strength, and collective action among women physicians.

Editor’s note: This summary was edited with the help of AI tools.

Want to join The Medical Sisterhood community? Click here to join our LinkedIn Group!

This first episode of 2026 highlights ways to advocate for change in healthcare, empowering each other and patients while navigating systemic challenges.

The Medical Sisterhood, with Mona Shahriari, MD

The Medical Sisterhood, hosted by Mona Shahriari, MD, is a podcast dedicated to empowering female physicians by providing a platform for shared experiences, mentorship, and support. 

Each episode delves into the unique challenges women in medicine face, including work-life balance, leadership roles, and overcoming gender biases. Shahriari aims to inspire women to lead fulfilling professional and personal lives on their own terms through candid discussions and expert interviews. 

e as we foster a community where women can uplift and support each other in achieving their goals!

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Spyridon Fortis, MD, from the division of pulmonary, critical care, and occupational medicine at the University of Iowa Hospital and Clinics.

Fortis discusses new data that challenge the use of bronchodilator response as a tool for distinguishing asthma from COPD.

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

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COPD condition center page, resources on the topics of medical news and expert insight into chronic obstructive pulmonary disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COPD research, treatment, and drug development.

Bronchodilator Response Predicts COPD Risk, With Spyridon Fortis, MD

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

Articles

However, key secondary endpoints, including measures of erythema, were not met in all analyses.

Atopic Dermatitis

Atopic Dermatitis condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatitis research, treatment, and drug development.

Amlitelimab Effective, Safe for Atopic Dermatitis in Patients 12 Years and Older

Niels Lund, MSc is the vice president of Changing Diabetes at Novo Nordisk.

Lund discusses a recent study detailing the comparatively lower greenhouse gas emissions caused by preventive care versus diabetes management.

Managing Prediabetes Lowers Carbon Footprint Compared to T2D Care, With Niels Lund, MSc

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

GRI-0621 shows promise as a safe, effective treatment for idiopathic pulmonary fibrosis, improving biomarkers and lung function in a Phase 2a trial.

Pulmonary Fibrosis

GRI-0621 Well-Tolerated, Shows Positive Biomarker and FVC Data in IPF

In these new phase 3b/4 data from LEVEL UP, findings on switching from dupilumab to upadacitinib in patients with atopic dermatitis are explored.

LEVEL UP: New Data on Switching from Dupilumab to Upadacitinib in Atopic Dermatitis

Diane MacDougall, MS, is the vice president of science and research at the Family Heart Foundation.

MacDougall discusses the Family Heart Foundation’s recent study indicating that very few adults with ASCVD are receiving guideline-directed therapy.

Cardiology

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Dyslipidemia

LDL-C Management is Dangerously Low Among US Adults With ASCVD, With Diane MacDougall, MS

Nancy Reau, MD, is Professor of Internal Medicine, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center.

Reau and Brown discuss recent research in hepatitis B, C, and D, including use of statins, GLP-1s, and more.

Hepatology

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Liver Lineup: Updates & Unfiltered Insights

Introducing Liver Lineup: Updates & Unfiltered Insights — an exciting new podcast delivering timely, candid perspectives on the most pressing topics in the fast-moving world of hepatology. Created by Nancy Reau, MD, and Kimberly Brown, MD, and hosted by HCPLive, this series dives into the cutting edge of liver disease research, clinical care, and real-world practice.

Liver Lineup: Advances, Gaps, and What’s Next in Viral Hepatitis

This summary of the 2026 Maui Derm Conference highlights some of the sessions and interviews to look forward to.

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

What to Expect at the 2026 Maui Derm Conference

COPDGene data show bronchodilator response more accurately predicts FEV₁ decline and disease progression than polygenic risk scores, including among smokers with preserved spirometry.

Why Bronchodilator Response Matters in COPD Risk, With Spyridon Fortis, MD

Latha Palaniappan, MD, MS, is the associate dean for research at Stanford University.

Palaniappan explains what steps to take in managing cardiovascular disease risk among a population that does not adhere to the Life’s Essential 8 guidelines.

Heart Failure

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Hypertension

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Latest News

From Physiology to Genetics: A New Lens on Gut Motility, With Mauro D’Amato, PhD

CAPTAIN-T2D: New Trial Investigates Treating Elevated Cortisol in T2D, With Vivian Fonseca, MD

Autoclaved Peanuts Reduce IgE Binding, Improve Tolerability, With Casey Cohen, PhD

Blending Education, Machine Learning to Detect IV Fluid Contaminated CBCs, With Carly Maucione, MD

The Medical Sisterhood: Advocacy and Systemic Change, With Kristi Hawley, DO