Digital Commons Network^™

Diagnosing Neurocysticercosis In Skeletonized Human Remains Of Forensic Importance, John O. Obafunwa, Karl Reinhard

Karl Reinhard Publications

Neurocysticercosis is endemic in many parts of the underdeveloped and developing countries, with continuous presence in developed countries due to the influx of migrants from regions where the diseases are endemic. Neuroimaging, anatomic pathological techniques, immunodiagnostic tests, clinical examination and epidemiologic considerations will easily provide the diagnosis. However, physicians in developed countries are perhaps progressively missing the diagnosis, and need to re-acquaint themselves with the condition and acquire a high suspicion index. The authors present a medicolegal case where the forensic team made a conclusion of neurocysticercosis (among other diagnoses), following post mortem examination of a largely skeletonized and mummified …

Exploring The Evolution Of Trypanosoma Cruzi And The Emergence Of Chagas Disease In The Context Of Environmental Change: Applying The Stockholm Paradigm To Archaeoparasitology, Part I, Aida Romera Barbera, Daniel R. Brooks, T. Michael Fink, Karl J. Reinhard

Karl Reinhard Publications

The Stockholm Paradigm is an evolutionary synthesis that explains the emergence of novel pathogens in the context of environmental disturbances. Considering the urgent climate change situation, anticipation stands as key to prevent and mitigate the effects that climate change can have in the emergence of pathogens. However, the success of preventive measures is hindered by a limited knowledge of the interplaying dynamics between biology, environment, and culture leading to emerging infectious diseases. For many decades, bioarchaeologists have been gathering data on past human-environment interactions, therefore contributing to the conversation. Archaeoparasitology, at the intersection between pathology, bioarchaeology, and biology, is uniquely …

Documenting The Presence Of Chagas Disease In Prehistoric North America: Applying The Stockholm Paradigm To Archaeoparasitology, Part Ii, Karl J. Reinhard, Daniel R. Brooks, Aida Romera Barbera, T. Michael Fink

Karl Reinhard Publications

The DAMA protocol (Document, Assess, Monitor, Act) is the applied aspect of the Stockholm Paradigm. Evidence from archaeology and history of medicine has a demonstrated value in documenting infection risk for specific study areas. Bioarchaeological remains and historical documents show vivid examples of pathology related to the Chagas disease life cycle. The science of archaeology defines the lifestyles that created risk of triatomine kissing bug infestations and trypanosome protozoa infections. Paleogenetics, in the form of molecular analyses of Trypanosoma cruzi, elucidate the temporal origins of genetic variants and adaptation to human environments. We illustrate how these fields reveal the risk …

Still, We Thrive: Understanding How Gay, Bisexual, Transgender, And Other Men Who Have Sex With Men (Gbtmsm) Experience Structural Barriers & Facilitators To Wellness, Lucas Gergyek

Theses and Dissertations (Comprehensive)

Historically and concurrently, structural violence has been a significant force influencing the sexual health and broader health of gay, bisexual, transgender and other men who have sex with men (GBTMSM). Yet to date, the majority of projects exploring the health inequities facing GBTMSM have focused on intrapsychic and behavioural factors as most related to poor health outcomes. As well, these studies are sometimes deficits focused, and fail to evaluate how GBTMSM continue to thrive, and maintain positive health. As a result, the ways in which systems and policies underlie and perpetuate health inequities facing GBTMSM have been somewhat obscured. Connectedly, …

Hpv Vaccine Hesitancy In The Adolescent Population, Angela Parrish

Graduate Research Projects

No abstract provided.

Residential Segregation And County-Level Covid-19 Booster Coverage In The Deep South: Surveillance Report And Ecological Study, Chengbo Zeng, Jiajia Zhang Ph.D., Zhenlong Li, Xiaowen Sun, Huan Ning, Xueying Yang, Sharon Weissman, Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Background: COVID-19 had a greater impact in the Deep South compared with other regions in the United States. While vaccination remains a top priority for all eligible individuals, data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age are sparse. Despite existing evidence of racial and ethnic disparities in COVID-19 vaccinations at the individual level, there is an urgent need for evidence at the population level. Such information could highlight vulnerable communities and guide future health care policy-making and resource allocation.

Objective: We aimed to evaluate county-level COVID-19 booster coverage …

Using Geospatial Social Media Data For Infectious Disease Studies: A Systematic Review, Fengrui Jing, Zhenlong Li, Shan Qiao Ph.D., Jiajia Zhang Ph.D., Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Geospatial social media (GSM) data has been increasingly used in public health due to its rich, timely, and accessible spatial information, particularly in infectious disease research. This review synthesized 86 research articles that use GSM data in infectious diseases published between December 2013 and March 2022. These articles cover 12 infectious disease types ranging from respiratory infectious diseases to sexually transmitted diseases with spatial levels varying from the neighborhood, county, state, and country. We categorized these studies into three major infectious disease research domains: surveillance, explanation, and prediction. With the assistance of advanced computing, statistical and spatial methods, GSM data …

The Effect Of An Educational Handout On Knowledge, Awareness And Attitudes Of Pre-Exposure Prophylaxis (Prep) Among Participants At A Needle And Syringe Exchange Site, Mckenzie Buckel

DNP Projects

Background: In 2018, the total number of HIV cases in the United States was 1.2 million. Almost 186,500 of these cases were attributed to intravenous drug use. With the adherence to pre-exposure prophylaxis (PrEP) there is approximately a 49% decrease in the rates of HIV among people who inject drugs and the most significant barrier to PrEP among this population is a lack of awareness and knowledge.

Objective: The purpose of this study was to determine participants’ of a needle and syringe exchange site knowledge, awareness and attitudes of PrEP after reviewing an educational handout about PrEP.

Methods: A quasi …

Ecologic Analysis Of Antimicrobial Use In South Carolina Hospitals During 2020–2022, Pamela Bailey, Shujie Chen, Majdi N. Al-Hasan, Bankole Olatosi Ph.D., Xiaoming Li Ph.D., Jiajia Zhang Ph.D.

Faculty Publications

Background:

Factors influencing excessive antimicrobial utilization in hospitalized patients remain poorly understood, particularly with the COVID-19 pandemic.

Methods:

In this retrospective cohort, we compared administrative data regarding antimicrobial prescriptions in hospitalized patients in South Carolina from March 2020 through September 2022. The study examined variables associated with antimicrobial use across demographics, COVID status, and length of stay, among other variables.

Results:

Significant relationships were seen with antimicrobial use in COVID-19 positive patients (OR 2.00, 95% Confidence Interval (CI): 1.9–2.1), young adults (OR 1.08, 95% CI: 0.99–1.12, COVID-19 positive Blacks and Hispanics (OR 1.06, 95% CI: 1.01–1.11, OR 1.05, 95% CI: …

A Deeper Dive Into Food Insecurity Among Women Involved In The Criminal Justice System, Jessica Robles

Public Health Theses

Background: The U.S. has the highest incarceration rate globally and a recent study found that 91% of formerly incarcerated individuals report being food insecure. Given that, women have become the fastest-growing segment in the incarceration system. Women who are involved in the criminal justice system (WICJ) are more at risk for experiencing food insecurity and chronic diseases. Therefore, this study aims to contribute to existing knowledge on the overall health of WICJ by assessing the prevalence of food insecurity and the social determinants of health (SDOH) that may contribute to food insecurity.Objective: To provide information on the overall health of …

Towards A Saliva-Based Pcr Test For The Detection Of Mpox, Russell J. Thomas

Public Health Theses

Current recommendations for the diagnosis of mpox (monkeypox) rely on lesion-swabs as the gold-standard specimen type even though many patients experience symptoms prior to lesion-onset. Earlier detection could bolster the mpox response by mitigating transmission and facilitating access to antiviral treatments. In this study, we validated five PCR assays and compared their detection of mpox virus DNA extracted from 30 saliva specimens collected into Spectrum SDNA-1000 tubes. We found the Logix Smart™ Mpox (2-Gene) RUO assay (Co-Diagnostics, Inc., Salt Lake City, UT) performed statistically significantly better than the other assays. Next, we tested five raw (unsupplemented) known-positive saliva samples in …

A Robust Bayesian Model Averaging Method For Basket Trials With Different Endpoints, Xueting Wang

Public Health Theses

Oncology drug research in the last few decades has been driven by the development of targeted agents. In the era of targeted therapies, basket trials are often used to test the antitumor activity of a novel treatment in multiple indications sharing the same genomic alteration. As patient population are further fragmented into biomarker-defined subgroups in basket trials, novel statistical methods are needed to facilitate cross-indication learning to improve the statistical power in basket trial design. Here we propose a robust Bayesian model averaging (rBMA) technique for the design and analysis of phase II basket trials. We consider the posterior distribution …

Hiv Treatment Patterns Across A Us Data Network: 2012-2021, Raechel Elizabeth Davis

Public Health Theses

IntroductionOnce-daily combination antiretroviral therapy is recognized as the standard treatment for people living with Human Immunodeficiency Virus (HIV) in the United States.1,2 Treatment strategies for HIV have changed substantially over the years, influenced by individual and clinical factors, new medication options, and changing clinical guidelines.1–3 Observational data sources provide a unique opportunity to characterize populations and provide insight into medication usage under real-world conditions that differ systematically from controlled trial scenarios.3,4 Methods We evaluated the treatment patterns and characteristics of 12288 individuals diagnosed with HIV and continuously treated with antiretroviral medications across four, US-based observational databases using the Observational Health …

“You Are Just Trying To Make It Work”: A Qualitative Exploration Of Healthcare Provider Implementation Considerations For Integrating Mental Health And Hiv Care In Central Uganda, Divya Gumudavelly

Public Health Theses

There is a growing push to integrate mental health services within HIV care in urban Uganda. Amidst HIV clinics becoming comprehensive healthcare centers, there is a critical need to understand how providers can better adopt and implement mental health specific protocols in HIV practice. Semi-structured interviews were conducted with 16 healthcare providers at two different HIV care centers to understand current practices, routines, barriers, and facilitators to implementing mental health care services within HIV care. Abductive thematic analysis, drawing from Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) frameworks, was used in conjunction with constructivist grounded theory …

Effect Of Digital Public Health Campaigns By The World Health Organization On Self-Reported Behavior, Recall/Knowledge, And Attitude Toward Interventions Related To Covid-19: A Meta-Analysis, Zili Zhou

Public Health Theses

The COVID-19 pandemic highlighted the need for effective scientific communication. The success of public health interventions are largely dependent on public knowledge and behavior. With the global rise of social media usage, as well as the increased prevalence of social media advertisement campaigns, the platforms present a tool with the potential to be utilized by public health authorities to deliver information and influence broad populations within a short period of time. From 2020 to 2022, the World Health Organization conducted 58 social media campaigns, totaling 176 brand-lift studies, in partnership with Meta on the subject of COVID-19. The campaigns conveyed …

Primary Liver Cancer In China From 2000-2020: Evolution Of Epidemiology, Clinical Disease, And Therapy, Wanqing Chi

Public Health Theses

Background & Aims: China contributed to 49% of all liver cancer deaths worldwide in 2020. We sought to investigate the relationship between clinical characteristics, antiviral therapy (ART), and multiple risk factors that affect the prognosis of primary liver cancer (PLC) patients over time to highlight proper chronic liver disease management.Methods: We identified 1322 PLC patients diagnosed between 2000 to 2020 in a major academic teaching hospital in Shanghai, China. We used descriptive epidemiology to characterize the evolution of liver cancer in China, and Cox proportional hazard models and Kaplan-Meier survival analysis to assess the relationship between evolving ART and survival …

Protection Against Cholera From Killed Whole-Cell Oral Cholera (Kocv) Vaccines: Systematic Review And Meta-Regression Of Randomized Control Trials And Observational Studies, Helena Hojeong Kwon

Public Health Theses

Introduction: Although killed whole-cell oral cholera vaccines (kOCVs) are widely used as a part of cholera control strategy, mixed evidence around the vaccine induced protection remains.Objectives: The primary objective of this systematic review was to update estimates of kOCV protection: vaccine efficacy and effectiveness. A secondary objective was to estimate the waning dynamic of kOCV protection by duration of follow-up. Methods: On August 15th, 2022, we searched for randomized control trials and observational studies that reported kOCV protection in low- and middle-income countries on PubMed, EMBASE, Scopus, ISI Web of Science, and The Cochrane Review Library with a start date …

The Ethical And Legal Considerations Of Ai-Driven Healthcare In Infectious Diseases, Natalie Makableh

Public Health Theses

Artificial intelligence (AI) has been rapidly growing in the healthcare sector, with the potential to improve patient outcomes, increase efficiency, and reduce costs. However, as with any technological advancement, AI-driven healthcare presents ethical and legal challenges that must be addressed to ensure the responsible and beneficial use of the technology. To the best of our knowledge this is the first study to examine the ethical and legal considerations of using AI technology in healthcare, with a particular focus on infectious diseases. With the growing use of AI in healthcare, it is crucial to evaluate its potential benefits and challenges in …

The Impact Of The Covid-19 Pandemic On Non-Typhoidal Salmonella Incidence And Exposures In Connecticut, 2015-2022, Adeline Morris

Public Health Theses

Background: During 2020, Salmonella incidence decreased by 22% in the United States.1 At the same time, many common activities were reduced or restricted, including travel and eating food prepared at restaurants or events, which are known risk factors for Salmonella infection. Methods: A descriptive analysis using Salmonella surveillance data collected in Connecticut between 2015 to 2022 was performed to characterize the changes in travel and outside food exposures. Frequencies of exposures were compared before the pandemic, during the pandemic, and after the vaccine was implemented and restrictions eased. Rate ratios of observed to expected cases were calculated to explore trends …

Impact Of The Covid-19 Outbreak On Mental Health And Public Practices In Rural Communities In China, Wenxin Liang

Public Health Theses

Coronavirus disease (COVID-19) has significant impact on people’s mental health. However, no nationwide study has investigated the mental health among rural residents during the COVID-19 outbreak in China. This study was aimed to investigate the impact of the COVID-19 outbreak on the mental health and public practices for controlling and preventing the COVID-19 in rural communities in China. An anonymous online survey was sent to participants through WeChat, the most widely used Chinese social-networking app, from March 2 to 11, 2020. We recruited 4607 individuals from 11 representative provinces in mainland China. The analytical sample was 2159 rural residents. The …

Epidemiology Of Human Hookworm (Necator Americanus) Infection In Rural Ghana: Investigating Host-Parasite Factors That Mediate Infection, Savanna Randi

Public Health Theses

Abstract

Introduction: Hookworms are soil-transmitted helminths (STHs) that cause significant morbidity in high-risk populations, posing a global health concern in locations of rural poverty [1-5]. While there have been ventures by the World Health Organization to eliminate hookworms in Africa by 2030, there is variability in the effectiveness of current chemotherapy regimens. Studies have shown that benzimidazole anthelmintics have reduced effectiveness, and people living in endemic areas are quickly reinfected [6]. Critical gaps remain in understanding parasite-host interactions within communities, further challenging successful disease control. A study initiated in 2022 investigated the epidemiology of human hookworm infection in Beposo, Ghana. …

Antibiotic Prophylaxis For Prevention Of Surgical Site Infections In Orthopedic Surgery, Edwin Ruiz Fuentes

Public Health Theses

Background: In the past decades, there has been an increase in the proportion of orthopedic surgical site infections (SSIs) caused by gram-negative bacilli in various healthcare settings. SSI prevention guidelines suggest that gentamicin can be added to prophylactic antibiotic treatment to target gram-negative bacilli. However, the effectiveness of this strategy remains to be confirmed in orthopedic surgery.

Methods: A retrospective cohort study was conducted to investigate the association between antibiotic prophylaxis with adjunctive gentamicin and SSI rates in orthopedic surgeries. 5,571 patients who underwent hip, knee, spine, and hip fracture surgeries between January 2019 and July 2021 at Yale-New Haven …

From Theory To Practice: Zoonotic Spillover, One Health And The Role Of Local Indigenous Communities, Pranav Prabhu Savanur

Public Health Theses

This paper discusses the impact of zoonotic spillovers on public health and the need for a One Health approach to preventing future pandemics. Zoonotic spillovers occur when pathogens are transmitted from animals to humans, facilitated by anthropogenic land changes, migration or trade, increased human-animal contact, and poor biosafety. However, anthropogenic land use change is the primary driver for zoonotic spillovers. Most emerging infectious diseases in humans are of zoonotic origin, and the impact of these spillovers on public health is significant. The paper emphasizes the need to prevent spillover events for primary pandemic prevention, which requires a coordinated and collaborative …

Iga-Biome Profiles Correlate With Clinical Parkinson's Disease Subtypes, Eric L Brown, Heather T Essigmann, Kristi L Hoffman, Ashley S Alexander, Michael Newmark, Zhi-Dong Jiang, Jessika Suescun, Mya C Schiess, Craig L Hanis, Herbert L Dupont

Faculty, Staff and Student Publications

BACKGROUND: Parkinson's disease is a heterogeneous neurodegenerative disorder with distinctive gut microbiome patterns suggesting that interventions targeting the gut microbiota may prevent, slow, or reverse disease progression and severity.

OBJECTIVE: Because secretory IgA (SIgA) plays a key role in shaping the gut microbiota, characterization of the IgA-Biome of individuals classified into either the akinetic rigid (AR) or tremor dominant (TD) Parkinson's disease clinical subtypes was used to further define taxa unique to these distinct clinical phenotypes.

METHODS: Flow cytometry was used to separate IgA-coated and -uncoated bacteria from stool samples obtained from AR and TD patients followed by amplification and …

Regional Outbreak Of Multidrug-Resistant Klebsiella Pneumoniae Carbapenemase-Producing Pseudomonas Aeruginosa, Bekana K Tadese, Anna Nutt, Ifrah Chaudhary, Charlene Offiong, Charles Darkoh

Faculty, Staff and Student Publications

Klebsiella pneumoniae carbapenemase-producing P. aeruginosa (KPC-CRPA) are rare in the United States. An outbreak of KPC-CRPA was investigated in Texas using molecular and epidemiologic methods and 17 cases of KPC-CRPA were identified. The isolates were genetically related and harbored the emerging P. aeruginosa multilocus sequence type 235, the first in the United States.

Understanding The Implications Of Under-Reporting, Vaccine Efficiency And Social Behavior On The Post-Pandemic Spread Using Physics Informed Neural Networks: A Case Study Of China, Samiran Ghosh, Alonso Ogueda-Oliva, Aditi Ghosh, Malay Banerjee, Padmanabhan Seshaiyer

Faculty, Staff and Student Publications

In late 2019, the emergence of COVID-19 in Wuhan, China, led to the implementation of stringent measures forming the zero-COVID policy aimed at eliminating transmission. Zero-COVID policy basically aimed at completely eliminating the transmission of COVID-19. However, the relaxation of this policy in late 2022 reportedly resulted in a rapid surge of COVID-19 cases. The aim of this work is to investigate the factors contributing to this outbreak using a new SEIR-type epidemic model with time-dependent level of immunity. Our model incorporates a time-dependent level of immunity considering vaccine doses administered and time-post-vaccination dependent vaccine efficacy. We find that vaccine …

Age-Induced Changes In Anti-Tumor Immunity Alter The Tumor Immune Infiltrate And Impact Response To Immuno-Oncology Treatments, Suzanne I Sitnikova, Jennifer A Walker, Laura B Prickett, Michelle Morrow, Viia E Valge-Archer, Matthew J Robinson, Robert W Wilkinson, Simon J Dovedi

Faculty, Staff and Student Publications

INTRODUCTION: Immuno-oncology (IO) research relies heavily on murine syngeneic tumor models. However, whilst the average age for a cancer diagnosis is 60 years or older, for practical purposes the majority of preclinical studies are conducted in young mice, despite the fact that ageing has been shown to have a significant impact on the immune response.

METHODS: Using aged (60-72 weeks old) mice bearing CT26 tumors, we investigated the impact of ageing on tumor growth as well as the immune composition of the tumor and peripheral lymphoid organs.

RESULTS: We found many differences in the immune cell composition of both the …

Access To Hiv Prevention, Care, And Treatment Services In The Us: The Role Of Primary Care, Jessica S. Kiernan

Theses and Dissertations

This dissertation examines the role of access to primary care in benefitting HIV outcomes through increased access to HIV prevention, care, and treatment services, among populations disproportionately affected by HIV in the US. Over 30,000 individuals are newly diagnosed with HIV annually in the US and diagnoses are concentrated in specific populations. At an individual-level, ~ 70% of new diagnoses are among gay and bisexual men and of those diagnoses, 70% are among Non-Hispanic Black and Hispanic gay and bisexual men. At a community-level, over 50% of new HIV diagnoses occur in less than 2% of US counties (48), Washington, …

Hpv-Related Oropharyngeal Cancer Early Detection In Gay And Bisexual Men Is An “Orphan” Practice: A Qualitative Analysis Among Healthcare Providers, I Niles Zoschke, Sarah L Bennis, J Michael Wilkerson, Cynthia L Stull, Alan G Nyitray, Samir S Khariwala, C Mark Nichols, B R Simon Rosser, Charlene Flash, Michael W Ross

Faculty, Staff and Student Publications

Introduction: Among US men, oropharyngeal cancer (cancer of the back of the mouth and throat) is the 8th most common cancer. If detected early, human papillomavirus (HPV)-16-associated oropharyngeal cancer has a high 5-year survival rate. Risk factors such as high numbers of oral sex partners, disparities in smoking and drinking, and low rates of HPV vaccination may put gay and bisexual men at even higher risk for oropharyngeal cancer.

Methods: We recruited 21 healthcare providers in Minneapolis-St. Paul, Minnesota and Houston, Texas to participate in semi-structured interviews. Nurses, physician assistants, dental hygienists, and dentists were asked about their clinical experiences …

Assessing Pandemic Preparedness, Response, And Lessons Learned From The Covid-19 Pandemic In Four South American Countries: Agenda For The Future, Andrea Ramírez Varela, Michael Touchton, J Jaime Miranda, Juliana Mejía Grueso, Rachid Laajaj, Gabriel Carrasquilla, Martha Vives Florez, Ana María Vesga Gaviria, Ana María Ortiz Hoyos, Esteban Orlando Vanegas Duarte, Alejandra Velásquez Morales, Nubia Velasco, Silvia Restrepo Restrepo

Faculty, Staff and Student Publications

INTRODUCTION: The COVID-19 pandemic emerged in a context that lacked adequate prevention, preparedness, and response (PPR) activities, and global, regional, and national leadership. South American countries were among world's hardest hit by the pandemic, accounting for 10.1% of total cases and 20.1% of global deaths.

METHODS: This study explores how pandemic PPR were affected by political, socioeconomic, and health system contexts as well as how PPR may have shaped pandemic outcomes in Argentina, Brazil, Colombia, and Peru. We then identify lessons learned and advance an agenda for improving PPR capacity at regional and national levels. We do this through a …