Digital Commons Network^™

Association Of Covid-19 Coinfection With Increased Mortality Among Patients With Pseudomonas Aeruginosa Bloodstream Infection In The Veterans Health Administration System, Leila S. Hojat, Brigid M. Wilson, Federico Perez, Maria F. Mojica, Mendel E. Singer, Robert A. Bonomo

Faculty Scholarship

Objective: Pseudomonas aeruginosa bloodstream infection (PA-BSI) and COVID-19 are independently associated with high mortality. We sought to demonstrate the impact of COVID-19 coinfection on patients with PA-BSI. Design: Retrospective cohort study. Setting: Veterans Health Administration. Patients: Hospitalized patients with PA-BSI in pre-COVID-19 (January 2009 to December 2019) and COVID-19 (January 2020 to June 2022) periods. Patients in the COVID-19 period were further stratified by the presence or absence of concomitant COVID-19 infection. Methods: We characterized trends in resistance, treatment, and mortality over the study period. Multivariable logistic regression and modified Poisson analyses were used to determine the association between COVID-19 …

Team-Based Learning In The Internal Medicine Clerkship Didactics, Madeline Garb, Melissa Jenkins, Elaine Cruz

Faculty Scholarship

Background: Active-learning approaches, such as team-based learning, are infrequently used in internal medicine clerkship didactics even though there is increasing evidence to suggest medical students prefer it over traditional lecture-based learning. In this study, five team-based learning sessions were incorporated into three blocks of a 12-week internal medicine clerkship. Methods: The goal of this quasi-experimental study was to compare learner engagement, satisfaction and preference between team-based learning and lecture-based learning in the internal medicine clerkship didactics. Outcomes were compared using the Classroom Engagement Survey, a satisfaction questionnaire and the Team-Based Learning Student Assessment Instrument (TBL-SAI). Findings: There was a statistically …

Risk, Responsibility, Resilience, Respect: Covid-19 And The Protection Of Health Care Workers, William M. Sage, Victoria L. Tiase

Faculty Scholarship

Medicine and nursing have long professional traditions of altruism and self-sacrifice, including undertaking not only extreme stress but also personal risk in service of patient care. With exceptions for natural disasters, humanitarian missions, and military service, however, recent concerns about professional “burnout” often have had more to do with mismanagement, exploitation, and generational or technological change than with core clinical circumstances. The COVID-19 pandemic changed that – bringing front and center the close connections between the well-being of health care workers and the well-being of the patients they serve. This chapter begins with the COVID-19 experience of health care workers …

Fear Of Missing Organisms (Fomo): The Discordance Among Broad-Spectrum Empiric Antibiotic Therapy, Microbiologic Results, And Definitive Antibiotic Therapy For Diabetic Foot Infections And Lower Extremity Osteomyelitis, Morgan K. Morelli, Yanis Bitar, Michelle T. Hecker

Faculty Scholarship

Objective: Empiric broad-spectrum antibiotic therapy is commonly prescribed for patients hospitalized with diabetic foot infections (DFI) and lower extremity osteomyelitis (OM). The primary objective was to evaluate the concordance between empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy with a focus on methicillin-resistant Staphylococcus aureus (MRSA) and resistant gram-negative organisms. The secondary objective was to evaluate the negative predictive values (NPV) of select risk factors for MRSA and resistant gram-negative organisms for microbiologic results with these organisms. Design: Retrospective cohort study. Setting: Safety-net health system in Ohio. Patients: Adults hospitalized and receiving antibiotic therapy for DFI or lower extremity …

Vaccine Development, The China Dilemma, And International Regulatory Challenges, Peter K. Yu

Faculty Scholarship

This article examines the role played by China in the development of international regulatory standards at the intersection of intellectual prop- erty, international trade, and public health. It begins by briefly discussing the role China has played in the global health arena during the COVID-19 pandemic. The article then highlights the difficulty in determining how best to engage with the country in the development of new international regula- tory standards. It shows that the preferred method of engagement will likely depend on one’s perspective on China’s potential contributions and hin- drances: a perspective that focuses on global competition—in the economic, …

Firearm Contagion: A New Look At History, Rachel Martin, Michael R. Ulrich

Faculty Scholarship

Gun violence is widely considered a serious public health problem in the United States, but less understood is what this means, if anything, for evolving Second Amendment doctrine. In New York Pistol & Rifle Association, Inc. v. Bruen, the Supreme Court held that laws infringing Second Amendment rights can only be sustained if the government can point to sufficient historical analogues. Yet, what qualifies as sufficiently similar, a suitable number of jurisdictions, or the most important historical eras all remain unclear. Under Bruen, lower courts across the country have struck down gun laws at an alarming pace, while …

Federalism, Leadership, And Covid-19: Evolving Lessons For The Public’S Health, Nicole Huberfeld

Faculty Scholarship

The COVID-19 pandemic has had an enduring effect across the entire spectrum of law and policy, in areas ranging from health equity and racial justice, to constitutional law, the law of prisons, federal benefit programs, election law and much more. This collection provides a critical reflection on what changes the pandemic has already introduced, and what its legacy may be. Chapters evaluate how healthcare and government institutions have succeeded and failed during this global 'stress test,' and explore how the US and the world will move forward to ensure we are better prepared for future pandemics. This timely volume identifies …

Polyethylene Glycol-Mediated Directional Conjugation Of Biological Molecules For Enhanced Immunoassays At The Point-Of-Care, Dheerendranath Battalapalli, Purbali Chakraborty, Disha Jain, Umut A. Gurkan, Robert A. Bonomo, Mohamed S. Draz

Faculty Scholarship

Rapid and reliable point-of-care (POC) diagnostic tests can have a significant impact on global health. One of the most common approaches for developing POC systems is the use of target-specific biomolecules. However, the conjugation of biomolecules can result in decreased activity, which may compromise the analytical performance and accuracy of the developed systems. To overcome this challenge, we present a polymer-based cross-linking protocol for controlled and directed conjugation of biological molecules. Our protocol utilizes a bifunctional thiol-polyethylene glycol (PEG)-hydrazide polymer to enable site-directed conjugation of IgG antibodies to the surface of screen-printed metal electrodes. The metal surface of the electrodes …

Dying In Isolation: Public Health Implications Of Transportation And Burial Of Human Remains During A Pandemic A Fifty State Survey, Christopher Ogolla

Faculty Scholarship

No abstract provided.

Donepezil-Associated Survival Benefits Among Alzheimer’S Disease Patients Are Retained But Not Enhanced During Covid-19 Infections, Elizabeth A. Edmiston, Taissa A. Bej, Brigid Wilson, Robin L.P. Jump

Faculty Scholarship

Background and Aim: Donepezil is a front-line treatment for Alzheimer’s disease. Donepezil treatment is associated with decreased risk of all-cause mortality. Specific protection is observed in pneumonia and cardiovascular disease. We hypothesized that donepezil treatment would improve mortality among Alzheimer’s patients following infection with COVID-19. The objective of this study is to assess the influence of ongoing donepezil treatment on survival in Alzheimer’s disease patients after polymerase chain reaction (PCR)-confirmed COVID-19 infection. Methods: This is a retrospective cohort study. We conducted a national survey of Veterans with Alzheimer’s disease to assess the influence of ongoing donepezil treatment on survival in …

Trends Over 20 Years Of Antimicrobial Prophylaxis For Artificial Urinary Sphincter Surgery, Helen H. Sun, Michael Callegari, Eric Zhou, Erin Jesse, Megan Prunty, Jonathan E. Shoag, Kyle Scarberry, Kirtishri Mishra, Shubham Gupta

Faculty Scholarship

Introduction and Objective: Perioperative antimicrobial prophylaxis is crucial for prevention of prosthesis and patient morbidity after artificial urinary sphincter (AUS) placement. While antibiotic guidelines exist for many urologic procedures, adoption patterns for AUS surgery are unclear. We aimed to assess trends in antibiotic prophylaxis for AUS and outcomes relative to American Urological Association (AUA) Best Practice guidelines. Methods: The Premier Healthcare Database was queried from 2000 to 2020. Encounters involving AUS insertion, revision/removal, and associated complications were identified via ICD and CPT codes. Premier charge codes were used to identify antibiotics used during the insertion encounter. AUS‐related complication events were …

Utilizing Neurodiverse Workplace Strategies To Support The Growing Population Of Long Covid Cases In A Neuroinclusive Workplace: A Paradigm Shift For Neuroacquired Employees, Piper Hutson, James Hutson

Faculty Scholarship

The COVID-19 pandemic has led to the emergence of long COVID, a condition in which patients report persistent symptoms after recovering from acute SARS-CoV-2 infection. A review conducted by the National Institute for Health Research (NIHR) suggests that long COVID may actually consist of four different syndromes: post-intensive care syndrome, post-viral fatigue syndrome, and long-term COVID syndrome. The absence of a clear definition for this condition may lead to under-recognition and under-treatment of the symptoms experienced by those affected. Moreover, existing programs designed for neuro diverse individuals may be adapted to support the growing neuro acquired population. Communication strategies, such …

Bacteriuria In Older Adults Triggers Confusion In Healthcare Providers: A Mindful Pause To Treat The Worry, Robin L.P. Jump

Faculty Scholarship

The evidence base for refraining from screening for or treating asymptomatic bacteriuria (ASB) in older adults is strong, but both practices remain prevalent. Clinical confusion over how to respond to a change from baseline, when to order a urinalysis and urine culture, and what to do with a positive urine culture fuels unnecessary antibiotic use for ASB. If the provider can take a mindful pause to apply evidenced-based assessment tools, the resulting increased clarity in how to manage the situation can reduce overtreatment of ASB.

Sickle Red Blood Cell-Derived Extracellular Vesicles Activate Endothelial Cells And Enhance Sickle Red Cell Adhesion Mediated By Von Willebrand Factor, Ran An, Yuncheng Man, Kevin Cheng, Tianyi Zhang, Fang Wang, Erdem Kucukal, William J. Wulftange, Utku Goreke, Allison Bode, Lalitha V. Nayak, Jane A. Little, Umut A. Gurkan

Faculty Scholarship

Endothelial activation and sickle red blood cell (RBC) adhesion are central to the pathogenesis of sickle cell disease (SCD). Quantitatively, RBC-derived extracellular vesicles (REVs) are more abundant from SS RBCs compared with healthy RBCs (AA RBCs). Sickle RBC-derived REVs (SS REVs) are known to promote endothelial cell (EC) activation through cell signalling and transcriptional regulation at longer terms. However, the SS REV-mediated short-term non-transcriptional response of EC is unclear. Here, we examined the impact of SS REVs on acute microvascular EC activation and RBC adhesion at 2 h. Compared with AA REVs, SS REVs promoted human pulmonary microvascular ECs (HPMEC) …

Black Lives Monitored, Chaz Arnett

Faculty Scholarship

The police killing of George Floyd added fuel to the simmering flames of racial injustice in America following a string of similarly violent executions during a global pandemic that disproportionately ravaged the health and economic security of Black families and communities. The confluence of these painful realities exposed deep vulnerabilities and renewed a reckoning with the long unfulfilled promise of racial equality, inspiring large-scale protests around the country and across the globe. As with prior movements for racial justice, from slavery abolition to the civil rights movement’s demand to end Jim Crow, protests have been met with extreme force, either …

Black Liberty In Emergency, Norrinda Brown

Faculty Scholarship

COVID-19 pandemic orders were weaponized by state and local governments in Black neighborhoods, often through violent acts of the police. This revealed an intersection of three centuries-old patterns— criminalizing Black movement, quarantining racial minorities in public health crises, and segregation. The geographic borders of the most restrictive pandemic order enforcement were nearly identical to the borders of highly segregated, historically Black neighborhoods.

The right to free movement is fundamental and, as a rule, cannot be impeded by the state. But the jurisprudence around state power in public health emergencies, deriving from the 1905 case Jacobson v. Massachusetts, has practically resulted …

Food And Drug Regulation: Statutory And Regulatory Supplement (2023), Adam I. Muchmore

Faculty Scholarship

This Statutory and Regulatory Supplement is intended for use with its companion casebook, Food and Drug Regulation: A Statutory Approach (2021). This is not a traditional statutory supplement. Instead, it contains selected, aggressively edited provisions of the Federal Food, Drug and Cosmetic Act (FFDCA), related statutes, and the Code of Federal Regulations. The Supplement includes all provisions assigned as reading in the casebook, as well as a few additional provisions that some professors may wish to cover. The excerpts are designed to be teachable rather than

The Nih-Moderna Vaccine: Public Science, Private Profit, And Lessons For The Future, Christopher J. Morten

Faculty Scholarship

This commentary highlights the scientific history of the NIH-Moderna COVID-19 vaccine and corroborates Sarpatwari’s theme of private capture of value created by the public. The commentary also identifies missteps by the Trump and Biden Administrations and offers policy recommendations: better contracts with and incentives for pharmaceutical manufacturers and a not-for-profit “public option” for pharmaceutical development.

Taming Online Public Health Misinformation, Tomer Kenneth

Faculty Scholarship

No abstract provided.

War On Covid: Warfare And Its Discontents, Catherine Powell

Faculty Scholarship

This essay analyzes the wartime framing of “fighting” a war on COVID-19—to “fight that invisible enemy,” coronavirus. How might lawmakers address social crises, such as COVID, with the urgency of an emergency without reinforcing our overly-militarized, securitized, and policed state? The problem with a securitized approach is that the notion of security combines conceptual ambiguity with heightened urgency and this indeterminacy can shape and even distort legality in exceptional moments.

I examine the use of the security framework in the context of war-related legal authority to address the pandemic and steps necessary for building a post-pandemic recovery. Importantly, this project …

Muted Voices: United States Employees’ Role In Regulating And Protecting Workplace Health, James J. Brudney

Faculty Scholarship

The COVID-19 pandemic has given workplace health a higher profile, perhaps its highest since passage of the Occupational Safety and Health Act of 1970 (OSH Act). Increased visibility and public support are based on national awareness of how frontline essential (FE) workers risked their health and lives to protect fellow Americans and preserve economic stability. That said, the greater attentiveness to workplace health risks, and the heroism of FE workers, has been accompanied by what is at best a limited role for employee voice and participation in improving workplace protections. In a larger context, while unions have been heavily involved …

Masking Vulnerability: Including Ppe As A Covered Service In Health Insurance, Mary Leto Pareja

Faculty Scholarship

The COVID-19 pandemic laid bare the shared vulnerability inherent in the human condition, prompting a collective recognition of our physical susceptibility to infectious diseases. While great strides have been made in combating COVID-19 through vaccinations and treatments, a portion of the population remains profoundly vulnerable due to health conditions that make the disease more dangerous, that limit vaccine efficacy, or that prevent vaccination altogether. This article explores a path forward by proposing a solution within health benefit plans—encompassing both private health insurance and public health benefits. Specifically, the article advocates for a coverage mandate for over-the-counter personal protective equipment (PPE) …

Patent Term Extensions And The Last Man Standing, Robin Feldman

Faculty Scholarship

In 1984, with the passing of the Hatch-Waxman Act, Congress orchestrated a compromise that permanently changed how drug markets operate. This piece of legislation created an expedited pathway for generics to enter the market, and, in exchange, brand drugs could extend their patents to account for time lost during their market approval process. Although this well-configured trade was supposed to help generics enter the scene quicker, the current drug market landscape makes one question whether this legislation has succeeded in its aims. The following study explores the lifecycle of top-selling brand drugs in comparison to the vision put forth by …

Restorative Justice Diversion As A Structural Health Intervention In The Criminal Legal System The Criminal Legal System, Thalia Gonzalez

Faculty Scholarship

A new discourse at the intersection of criminal justice and public health is bringing to light how exposure to the ordinariness of racism in the criminal legal system—whether in policing practices or carceral settings—leads to extraordinary outcomes in health. Drawing on empirical evidence of the deleterious health effects of system involvement coupled with new threats posed by COVID-19, advocates and academics have increasingly called for race-conscious public health-driven reforms to carcerality in the United States. Recognizing the significance of health to carceral reform, the initiation of a health justice grounded lexicon in criminal justice has opened the doorway to new …

Misinformation And Covid-19, Dorit Rubenstein Reiss

Faculty Scholarship

The COVID-19 pandemic’s impact on our world cannot be overstated. One of its noticeable features was the prominence of misinformation generally, and anti-vaccine misinformation more specifically. This article provides a breakdown of the five major themes of antivaccine misinformation and the way they were used to create fear, uncertainty, and doubt about COVID- 19 vaccines. Long before the pandemic, anti-vaccine activists argued using a five-part playbook. They argued that (1) vaccine preventable diseases were not really dangerous, (2) vaccines were dangerous and ineffective, (3) there were alternative treatments that were better than (dangerous and ineffective) vaccines, (4) there was a …

Restorative Justice Diversion As A Structural Health Intervention In The Criminal Legal System, Thalia Gonzalez

Faculty Scholarship

No abstract provided.

An Implementation Roadmap For Establishing Remote Infectious Disease Specialist Support For Consultation And Antibiotic Stewardship In Resource-Limited Settings, Robin L.P. Jump

Faculty Scholarship

Infectious Disease (ID)-trained specialists, defined as ID pharmacists and ID physicians, improve hospital care by providing consultations to patients with complicated infections and by leading programs that monitor and improve antibiotic prescribing. However, many hospitals and nursing homes lack access to ID specialists. Telehealth is an effective tool to deliver ID specialist expertise to resource-limited settings. Telehealth services are most useful when they are adapted to meet the needs and resources of the local setting. In this step-by-step guide, we describe how a tailored telehealth program can be implemented to provide remote ID specialist support for direct patient consultation and …

The Environmental, Social, Governance (Esg) Debate Emerges From The Soil Of Climate Denial, Lawrence J. Trautman, Neal Newman

Faculty Scholarship

It has been almost six decades since Rachel Carson’s ominous warning of pending environmental disaster. During 2019 the United Nations requested urgent action from world leaders, given that “just over a decade is all that remains to stop irreversible damage from climate change.” With every passing year, damage resulting from destructive climate change causes increased pain, suffering, death and massive property loss. During 2020 and 2021 alone, severe weather events have included: destructive fires in California; record breaking freeze, power outage, and threat to the electrical grid in Texas; continuation of disruptive drought in U.S. Western states; and record-breaking high …

Group B Streptococcus In The Urine In Nonpregnant Adults: Disease Or Distraction?, Nicole Mongilardi, Brigid M. Wilson, Sunah Song, Robin L.P. Jump, Federico Perez

Faculty Scholarship

In this large, retrospective cohort study, we used administrative data to evaluate nonpregnant adults with group B Streptococcus (GBS) bacteriuria. We found greater all-cause mortality in those with urinary tract infections compared to asymptomatic bacteriuria. Differences in patients' baseline characteristics and the 1-year mortality rate raise the possibility that provider practices contribute to differences observed.

Data Privacy In The Time Of Plague, Cason Schmit, Brian N. Larson, Hye-Chung Kum

Faculty Scholarship

Data privacy is a life-or-death matter for public health. Beginning in late fall 2019, two series of events unfolded, one everyone talked about and one hardly anyone noticed: The greatest world-health crisis in at least 100 years, the COVID-19 pandemic; and the development of the Personal Data Protection Act Committee by the Uniform Law Commissioners (ULC) in the United States. By July 2021, each of these stories had reached a turning point. In the developed, Western world, most people who wanted to receive the vaccine against COVID- 19 could do so. Meanwhile, the ULC adopted the Uniform Personal Data Protection …