Digital Commons Network^™

A Criteria To Reduce Interhospital Transfer Of Traumatic Brain Injuries In Greater East Texas, Jason Murry, Alan D. Cook, Rebecca J. Swindall, Hirofumi Kanazawa, Carly R. Wadle, Musharaf Mohiuddin, Stephen V. Nalbach, Tuan D. Le, Brandi N. Pero, Scott H. Norwood

School of Medicine Faculty Publications and Presentations

Background

Traumatic brain injury (TBI) due to single-level falls (SLF) are frequent and often require interhospital transfer. This retrospective cohort study aimed to assess the safety of a criteria for non-transfer among a subset of TBI patients who could be observed at their local hospital, vs mandatory transfer to a level 1 trauma center (L1TC).

Methods

We conducted a 7-year review of patients with TBI due to SLF at a rural L1TC. Patients were classified as transfer/non-transfer according to the Brain Injuries in Greater East Texas (BIGTEX) criteria. The primary outcome measure was the occurrence of a critical event defined …

The Clinical Application Of Incisional Negative Pressure Wound Therapy In Severe Subcutaneous Emphysema: A Case Series, Luis Fernandez, Reginald Carl Baptiste, Rebekah Bjorklund, Ala'a Alkhatib, Nesiya Sheriff, Claudia Sanchez, Mary Anne Obst, Rebecca Swindall

School of Medicine Faculty Publications and Presentations

Severe subcutaneous emphysema (SSE) is the presence of a high-volume accumulation of air in the subcutaneous tissue caused by traumatic injuries, infections, iatrogenic causes, or can also manifest spontaneously. A variety of techniques have been reported, with varying levels of success.

We present a multicenter case series detailing four patients who developed SSE and were treated with Incisional Negative Pressure Wound Therapy (INPWT). All patients significantly improved with the INPWT treatment within 6 to 48 h. Our experience suggests INPWT is a valuable procedure available for treating SSE and recommend prospective randomized studies be conducted to determine targeted patient selection …

Faculty Bridging Individual And Organizational Resilience: Results Of A Qualitative Analysis, Meera Deva, Gary L. Beck Dallaghan, Neva Howard, Brenda J.B. Roman

School of Medicine Faculty Publications and Presentations

Background: Medical student burnout and anxiety has received growing attention in the past decade. The culture of competition and assessment has resulted in increasing stress levels amongst medical students, causing a decline in their academic performance and overall mental health. The objective of this qualitative analysis was to characterize recommendations from educational experts to aid students’ academic progress. Methods: At an international meeting in 2019, worksheets were completed by medical educators during a panel discussion. Participants responded to four scenarios representing common challenges medical students face in school (eg. Postponing Step 1, failing clerkships, etc.). For each case, participants addressed …

Evaluating Situational Judgment Test Use And Diversity In Admissions At A Southern Us Medical School, Chelsea E. Gustafson, Crystal J. Johnson, Gary L. Beck Dallaghan, O'Rese J. Knight, Kimberly M. Malloy, Kimberley R. Nichols, Lisa Rahangdale

School of Medicine Faculty Publications and Presentations

Introduction Situational judgment tests have been adopted by medical schools to assess decision-making and ethical characteristics of applicants. These tests are hypothesized to positively affect diversity in admissions by serving as a noncognitive metric of evaluation. The purpose of this study was to evaluate the performance of the Computer-based Assessment for Sampling Personal Characteristics (CASPer) scores in relation to admissions interview evaluations. Methods This was a cohort study of applicants interviewing at a public school of medicine in the southeastern United States in 2018 and 2019. Applicants took the CASPer test prior to their interview day. In-person interviews consisted of …

The Effect Of Naloxone Access Laws On Fatal Synthetic Opioid Overdose Fatality Rates, Mohammad Tabatabai, Robert L. Cooper, Derek M. Wilus, Ryan D. Edgerton, Aramandla Ramesh, Samuel A. Macmaster, Parul N. Patel, Karan P. Singh

School of Medicine Faculty Publications and Presentations

Background: Increases in fatal synthetic opioid overdoses over the past 8 years have left states scrambling for effective means to curtail these deaths. Many states have implemented policies and increased service capacity to address this rise. To better understand the effectiveness of policy level interventions we estimated the impact of the presence of naloxone access laws (NALs) on synthetic opioid fatalities at the state level. Methods: A multivariable longitudinal linear mixed model with a random intercept was used to determine the relationship between the presence of NALs and synthetic opioid overdose death rates, while controlling for, Good Samaritan laws, opioid …

Commentary On Ultrasound Instruction In Undergraduate Medical Education: Perspective From Two Students, Austin J. Allen, Alexander B. White, Daniel R. Bacon, Gary L. Beck Dallaghan, Sheryl G. Jordan

School of Medicine Faculty Publications and Presentations

Background: Ultrasound integration in undergraduate medical education (UME) has been a focused endeavor in recent years. According to the American Institute of Ultrasound in Medicine, more than a third of all US medical schools have adopted a focused ultrasound training program for medical students. Medical student perspectives on best practices in ultrasound education are lacking in the literature. Curricula Experiences: Two students' reflections are presented regarding two different didactic approaches, flipped classroom and self-study learning models, to teaching ultrasound in the pre-clinical medical education curriculum. Students present reflections on these didactic approaches to facilitate further improvement in ultrasound education curricula. …

Financing Benefits And Barriers To Routine Hiv Screening In Clinical Settings In The United States: A Scoping Review, Hani Serag, Isabel Clark, Cherith Naig, David Lakey, Yordanos M. Tiruneh

School of Medicine Faculty Publications and Presentations

The Centers for Disease Control and Prevention recommends everyone between 13--64 years be tested for HIV at least once as a routine procedure. Routine HIV screening is reimbursable by Medicare, Medicaid, expanded Medicaid, and most commercial insurance plans. Yet, scaling-up HIV routine screening remains a challenge. We conducted a scoping review for studies on financial benefits and barriers associated with HIV screening in clinical settings in the U.S. to inform an evidence-based strategy to scale-up routine HIV screening. We searched Ovid MEDLINE®, Cochrane, and Scopus for studies published between 2006-2020 in English. The search identified 383 Citations; we screened 220 …

Addressing Substance Use And Misuse In East Texas: Stakeholder-Driven Needs And Priorities, Yordanos M. Tiruneh, Kimberly S. Elliot, Linda Oyer, Emmanuel Elueze, Vanessa Casanova

School of Medicine Faculty Publications and Presentations

Background: This project sought to assess needs, perceived challenges, and priorities regarding substance use disorder (SUD) in East Texas and develop a community-driven research agenda to address those challenges. Methods: Data were gathered through nine focus-group discussions (FGDs) with stakeholders: people living with SUD, families, medical providers, counselors, representatives of community-based organizations, and law enforcement officers. We asked participants how substance use manifests in their communities, which challenges they confronted in coping with substance use and misuse, and in which order their needs should be prioritized. Findings were reported at community forums to confirm the list of challenges and prioritize …

In Search Of A Value Proposition For Covid-19 Testing In The Work Environment: A Social Marketing Analysis, Claudia Parvanta, Alberto J. Caban-Martinez, Naciely Cabral, Cynthia K. Ball, Kevin G. Moore, Adrienne Eastlake, Jeffrey L. Levin, Dalia E. Nessim, Matthew S. Thiese, Paul A. Schulte

School of Medicine Faculty Publications and Presentations

Background: This study examined employer experience with SARS-CoV-2 (COVID-19) asymptomatic testing through a social marketing lens. Social marketing uses commercial marketing principles to achieve socially beneficial ends including improved health and safety behavior. Method: Twenty employers across 11 occupational sectors were interviewed about implementation of COVID-19 testing from January through April 2021. Recorded transcripts were coded and analyzed using marketing's "Four P's": "product," "price," "place," "promotion." Results: COVID-19 tests (product) were uncomfortable, were easily confused, and didn't solve problems articulated by employers. Testing was not widely available or didn't line up with shifts or locations (place). The perceived price, which …

Barriers To Sars-Cov-2 Testing Among U.S. Employers In The Covid-19 Pandemic: A Qualitative Analysis Conducted January Through April 2021, Alberto J. Caban-Martinez, Claudia Parvanta, Naciely Cabral, Cynthia K. Ball, Adrienne Eastlake, Jeffrey L. Levin, Kevin Moore, Dalia Nessim, Ernie Stracener, Matthew S. Thiese, Paul A. Schulte

School of Medicine Faculty Publications and Presentations

During the first year of the COVID-19 pandemic, U.S. companies were seeking ways to support their employees to return to the workplace. Nonetheless, the development of strategies to support the access, use, and interpretation of SARS-CoV-2 testing was challenging. In the present study, we explore, from the perspective of owners and company leadership, the barriers to SARSCoV-2 testing among U.S. companies. Key informant interviews with company representatives were conducted during January--April 2021 about SARS-CoV-2 testing. A pre-interview survey assessed respondent socio-demographic and organizational characteristics. Interview sessions were transcribed, coded, and analyzed using MaxQDA. A total of twenty interviews were completed …

Early Il-17a Production Helps Establish Mycobacterium Intracellulare Infection In Mice, Bock-Gie Jung, Buka Samten, Kristen Dean, Richard J. Wallace, Jr., Barbara A. Brown-Elliott, Torry Tucker, Steven Idell, Julie V. Philley, Ramakrishna Vankayalapati

School of Medicine Faculty Publications and Presentations

Nontuberculous mycobacteria (NTM) infection is common in patients with structural lung damage. To address how NTM infection is established and causes lung damage, we established an NTM mouse model by intranasal inoculation of clinical isolates of M. intracellulare. During the 39-week course of infection, the bacteria persistently grew in the lung and caused progressive granulomatous and fibrotic lung damage with mortality exceeding 50%. Lung neutrophils were significantly increased at 1 week postinfection, reduced at 2 weeks postinfection and increased again at 39 weeks postinfection. IL-17A was increased in the lungs at 1–2 weeks of infection and reduced at 3 weeks …

Inhalation Injury Is Associated With Endotheliopathy And Abnormal Fibrinolytic Phenotypes In Burn Patients: A Cohort Study, John W. Keyloun, Tuan D. Le, Kathleen E. Brummel-Ziedins, Melissa M. Mclawhorn, Maria C. Bravo, Thomas Orfeo, Laura S. Johnson, Lauren T. Moffatt, Anthony E. Pusateri, Jeffrey W. Shupp

School of Medicine Faculty Publications and Presentations

Burn injury is associated with endothelial dysfunction and coagulopathy and concomitant inhalation injury (IHI) increases morbidity and mortality. The aim of this work is to identify associations between IHI, coagulation homeostasis, vascular endothelium, and clinical outcomes in burn patients. One hundred and twelve patients presenting to a regional burn center were included in this retrospective cohort study. Whole blood was collected at set intervals from admission through 24 hours and underwent viscoelastic assay with rapid thromboelastography (rTEG). Syndecan-1 (SDC-1) on admission was quantified by ELISA. Patients were grouped by the presence (n = 28) or absence (n = 84) of …

Il-22 Produced By Type 3 Innate Lymphoid Cells (Ilc3s) Reduces The Mortality Of Type 2 Diabetes Mellitus (T2dm) Mice Infected With Mycobacterium Tuberculosis, Deepak Tripathi, Rajesh Kumar Radhakrishnan, Ramya Sivangala Thandi, Padmaja Paidipally, Kamakshi Prudhula Devalraju, Venkata Sanjeev Kumar Neela, Madeline Kay Mcallister, Buka Samten, Vijaya Lakshmi Valluri, Ramakrishna Vankayalapati

School of Medicine Faculty Publications and Presentations

Previously, we found that pathological immune responses enhance the mortality rate of Mycobacterium tuberculosis (Mtb)-infected mice with type 2 diabetes mellitus (T2DM). In the current study, we evaluated the role of the cytokine IL-22 (known to play a protective role in bacterial infections) and type 3 innate lymphoid cells (ILC3s) in regulating inflammation and mortality in Mtb-infected T2DM mice. IL-22 levels were significantly lower in Mtb-infected T2DM mice than in nondiabetic Mtb-infected mice. Similarly, serum IL-22 levels were significantly lower in tuberculosis (TB) patients with T2DM than in TB patients without T2DM. ILC3s were an important source of IL-22 in …

Author Correction: Cancer Testis Antigen Promotes Triple Negative Breast Cancer Metastasis And Is Traceable In The Circulating Extracellular Vesicles (Scientific Reports, (2019), 9, 1, (11632), 10.1038/S41598-019-48064-W), Anbarasu Kannan, Julie V. Philley, Kate L. Hertweck, Harrison Ndetan, Karan P. Singh, Subramaniam Sivakumar, Robert B. Wells, Ratna K. Vadlamudi, Santanu Dasgupta

School of Medicine Faculty Publications and Presentations

Triple negative breast cancer (TNBC) has poor survival, exhibits rapid metastases, lacks targeted therapies and reliable prognostic markers. Here, we examined metastasis promoting role of cancer testis antigen SPANXB1 in TNBC and its utility as a therapeutic target and prognostic biomarker. Expression pattern of SPANXB1 was determined using matched primary cancer, lymph node metastatic tissues and circulating small extracellular vesicles (sEVs). cDNA microarray analysis of TNBC cells stably integrated with a metastasis suppressor SH3GL2 identified SPANXB1 as a potential target gene. TNBC cells overexpressing SH3GL2 exhibited decreased levels of both SPANXB1 mRNA and protein. Silencing of SPANXB1 reduced migration, invasion …

Prothonotary Warbler Demography And Nest Site Selection In Natural And Artificial Cavities In Bottomland Forests Of Arkansas, Usa [Démographie Et Sélection Du Site De Nidification De La Paruline Orangée Dans Des Cavités Naturelles Et Artificielles En Forêts Sur Terres Basses De L'Arkansas, É.-U.], Morgan C. Slevin, Alix E. Matthews, Than J. Boves

School of Medicine Faculty Publications and Presentations

Anthropogenic alterations to bottomland forests in the United States that occurred post-European settlement likely negatively affected many avian species. The Prothonotary Warbler (Protonotaria citrea), a secondary cavity nester that breeds predominantly in these forests, has steadily declined over the past 60 years, and our ability to mitigate this trend is partially limited by a lack of basic biological data. Although much research has been devoted to Prothonotary Warblers, most studies have focused on local breeding populations that use nest boxes; we lack information about habitat selection behavior and demographic parameters of individuals that use natural cavities, which includes the vast …

Giant Siliconoma Mimicking Locally Advanced Breast Cancer: A Case Report And Review Of Literature, Bryce Carson, Steven Cox, Hishaam Ismael

School of Medicine Faculty Publications and Presentations

Introduction: Silicone prosthetics are widely used for breast augmentation and reconstruction. These devices may extrude free silicone into surrounding tissue, stimulating a granulomatous foreign body reaction. The resulting mass can mimic breast cancer. Presentation of Case: 71 year old female with a history of a ruptured silicone implant presents with an enlarging left breast mass. Exam demonstrated and ulcerated, fungating mass with active infection. CT scan demonstrated a 23 × 15 cm mass involving the breast and chest wall with axillary lymphadenopathy. Preoperative biopsies were inconclusive and the patient underwent a modified radical mastectomy. Pathology demonstrated a siliconoma. Discussion: While …

Primary Intrahepatic Mesotheliomas: A Case Presentation And Literature Review, Hishaam Ismael, Steven Cox

School of Medicine Faculty Publications and Presentations

Introduction Primary Intrahepatic mesotheliomas are malignant tumors arising from the mesothelial cell layer covering Glisson's capsule of the liver. They are exceedingly rare with only fourteen cases reported in the literature. They have nonspecific signs and symptoms and need a high index of suspicion and an extensive workup prior to surgery. Surgery remains the mainstay of treatment. Presentation of case 48 year old male presented with a 3 months history of abdominal pain, productive cough, anemia and weight loss. He had no history of asbestos exposure. A computed tomography scan and magnetic resonance study demonstrated a heterogeneous subscapular mass within …

Serious Adverse Events Of Cell Therapy For Respiratory Diseases: A Systematic Review And Meta-Analysis, Runzhen Zhao, Zhenlei Su, Jing Wu, Hong-Long Ji

School of Medicine Faculty Publications and Presentations

Background: Cell therapy holds the most promising for acute and chronic deleterious respiratory diseases. However, the safety and tolerance for lung disorders are controversy. Methods: We undertook a systematic review and meta-analyses of all 23 clinical studies of cell therapy. The outcomes were odds ratio (OR), risk difference (RD), Peto OR, relative risk, and mean difference of serious adverse events. Results: 342 systemic infusions and 57 bronchial instillations (204 recipients) of cells were analyzed for acute respiratory distress syndrome (ARDS), bronchopulmonary dysplasia, pulmonary arterial hypertension, silicosis, sarcoidosis, extensively drug-resistant tuberculosis, chronic obstructive pulmonary diseases (COPD), and idiopathic pulmonary fibrosis. The …

Transcription Factor Runx3 Is Induced By Influenza A Virus And Double-Strand Rna And Mediates Airway Epithelial Cell Apoptosis, Huachen Gan, Qin Hao, Steven Idell, Hua Tang

School of Medicine Faculty Publications and Presentations

Influenza A virus (IAV) targets airway epithelial cells and exploits the host cell machinery to replicate, causing respiratory illness in annual epidemics and pandemics of variable severity. The high rate of antigenic drift (viral mutation) and the putative antigenic shift (reassortant strains) have raised the need to find the host cell inducible factors modulating IAV replication and its pathogenesis to develop more effective antiviral treatment. In this study, we found for the first time that transcription factor Runx3, a developmental regulator and tumor suppressor, was induced by IAV H1N1 and H3N2, viral RNA, a synthetic analog of viral double-stranded RNA …

Treatment Practices, Outcomes, And Costs Of Multidrug-Resistant And Extensively Drug-Resistant Tuberculosis, United States, 2005-2007, Suzanne M. Marks, Jennifer Flood, Barbara Seaworth, Yael Hirsch-Moverman, Lori Armstrong, Sundari Mase, Katya Salcedo, Peter Oh, Edward A. Graviss, Paul W. Colson, Lisa Armitige, Manuel Revuelta, Kathryn Sheeran, Tb Epidemiologic Studies Consortium

School of Medicine Faculty Publications and Presentations

To describe factors associated with multidrug-resistant (MDR), including extensively-drug-resistant (XDR), tuberculosis (TB) in the United States, we abstracted inpatient, laboratory, and public health clinic records of a sample of MDR TB patients reported to the Centers for Disease Control and Prevention from California, New York City, and Texas during 2005–2007. At initial diagnosis, MDR TB was detected in 94% of 130 MDR TB patients and XDR TB in 80% of 5 XDR TB patients. Mutually exclusive resistance was 4% XDR, 17% pre-XDR, 24% total first-line resistance, 43% isoniazid/rifampin/rifabutin-plus-other resistance, and 13% isoniazid/rifampin/rifabutin-only resistance. Nearly three-quarters of patients were hospitalized, 78% …

High-Level Relatedness Among Mycobacterium Abscessus Subsp. Massiliense Strains From Widely Separated Outbreaks, Hervé Tettelin, Rebecca M. Davidson, Sonia Agrawal, Moira L. Aitken, Shamira Shallom, Nabeeh A. Hasan, Michael Strong, Vinicius Calado Nogueira De Moura, Mary Ann De Groote, Rafael S. Duarte, Erin Hine, Sushma Parankush, Qi Su, Sean C. Daugherty, Claire M. Fraser, Barbara A. Brown-Elliott, Richard J. Wallace Jr., Steven M. Holland, Elizabeth P. Sampaio, Kenneth N. Olivier, Mary Jackson, Adrian M. Zelazny

School of Medicine Faculty Publications and Presentations

Three recently sequenced strains isolated from patients during an outbreak of Mycobacterium abscessus subsp. massiliense infections at a cystic fibrosis center in the United States were compared with 6 strains from an outbreak at a cystic fibrosis center in the United Kingdom and worldwide strains. Strains from the 2 cystic fibrosis outbreaks showed high-level relatedness with each other and major-level relatedness with strains that caused soft tissue infections during an epidemic in Brazil. We identified unique single-nucleotide polymorphisms in cystic fibrosis and soft tissue outbreak strains, separate single-nucleotide polymorphisms only in cystic fibrosis outbreak strains, and unique genomic traits for …

Deletion Of Foxn1 In The Thymic Medullary Epithelium Reduces Peripheral T Cell Responses To Infection And Mimics Changes Of Aging, Jianfei Guo, Yan Feng, Peter Barnes, Fang-Fang Huang, Steven Idell, Dong-Ming Su, Homayoun Shams

School of Medicine Faculty Publications and Presentations

Aging increases susceptibility to infection, in part because thymic involution culminates in reduced naïve T-lymphocyte output. Thymic epithelial cells (TECs) are critical to ensure normal maturation of thymocytes and production of peripheral T cells. The forkhead-class transcription factor, encoded by FoxN1, regulates development, differentiation, and function of TECs, both in the prenatal and postnatal thymus. We recently showed that expression of FoxN1, by keratin 14 (K14)-expressing epithelial cells is essential for maintenance of thymic medullary architecture, and deletion of FoxN1 in K14 promoter-driven TECs inhibited development of mature TECs and reduced the number of total thymocytes. These findings are reminiscent …

Assembly And Regulation Of The Membrane Attack Complex Based On Structures Of C5b6 And Sc5b9, Michael A. Hadders, Doryen Bubeck, Pietro Roversi, Svetlana Hakobyan, Federico Forneris, B. Paul Morgan, Michael K. Pangburn, Oscar Llorca, Susan M. Lea, Piet Gros

School of Medicine Faculty Publications and Presentations

Activation of the complement system results in formation of membrane attack complexes (MACs), pores that disrupt lipid bilayers and lyse bacteria and other pathogens. Here, we present the crystal structure of the first assembly intermediate, C5b6, together with a cryo-electron microscopy reconstruction of a soluble, regulated form of the pore, sC5b9. Cleavage of C5 to C5b results in marked conformational changes, distinct from those observed in the homologous C3-to-C3b transition. C6 captures this conformation, which is preserved in the larger sC5b9 assembly. Together with antibody labeling, these structures reveal that complement components associate through sideways alignment of the central MAC-perforin …