Digital Commons Network^™

Host- And Pathogen-Related Determinants Of Pulmonary Versus Extrapulmonary Tuberculosis, Begna Tulu, Thomas Theo Brehm, Reinout Van Crevel, Tobias Dallenga, Andrew R Dinardo, Keertan Dheda, Johanna Eggeling, Wendemagegn Enbiale, Matthias I Gröschel, Jialun Hao, Vinod Kumar, Arjan Van Laarhoven, Rolanda Londt, Gareth Prosser, Philippa Randall, Norbert Reiling, Jan Rybniker, Ulrich E Schaible, Erwin Schurr, Isabelle Suarez, Sebastian J Theobald, Robert J Wilkinson, Christoph Lange

Faculty, Staff and Students Publications

Tuberculosis (TB) primarily manifests as pulmonary TB (PTB), but extrapulmonary TB (EPTB) remains a major clinical challenge. Distinct diagnostic and therapeutic difficulties arise from differences in immune responses, pathogen behaviour and host susceptibility. However, the factors driving disease localisation are still incompletely understood. We conducted a comprehensive narrative review of studies examining differences between PTB and EPTB in terms of epidemiology, mycobacterial factors, genetic and epigenetic determinants, host immune responses, transcriptomic profiles, cytokine and chemokine patterns, and immunophenotypes. EPTB is more common among females, children, older adults and immunocompromised individuals with deficient granuloma formation. This review is intended to provide …

Use Of A Medication Management Algorithm In Depressed Youth Living With Hiv: Secondary Analysis Of A Multisite Randomized Controlled Trial, Graham J Emslie, Beth D Kennard, Kristin Baltrusaitis, Sophia M Jones, Jessica M Jones, Jaime G Deville, Kathleen Pitts, David E Shapiro, Allison Eliscu, Larry K Brown

Faculty, Staff and Students Publications

Objectives: Depression is a prevalent co-occurring condition in youth living with HIV. This report is a secondary analysis of a multisite cluster randomized trial evaluating the efficacy of a health and wellness cognitive behavioral therapy (CBT) combined with a medication management algorithm utilizing measure-based care (COMB-R) compared with enhanced standard of care (ESC). We describe and compare antidepressant prescribing strategies (i.e., antidepressant treatment, type of antidepressant) for youth living with HIV at COMB-R sites to those at ESC sites over the 24-week intervention. We also describe self-reported adherence to antidepressants.

Methods: Participants (12-24 years) were youth living with HIV diagnosed …

Updates In The Management Of Peanut Allergy, S Shahzad Mustafa, Aikaterini Anagnostou, Matthew Greenhawt

Faculty, Staff and Students Publications

Peanut allergy is a significant rising public health problem affecting both children and adults. Early peanut introduction has been adopted in multiple westernized nations as a preventative strategic measure to reduce the risk of developing peanut allergy, although implementation faces barriers. Multiple therapies to treat peanut allergy have been developed, including oral immunotherapy and omalizumab as approved treatments to provide protection against reactions from accidental exposure and reduce the risk of anaphylaxis, offering options beyond strict avoidance. Strategies in the developmental pipeline include epicutaneous immunotherapy and sublingual immunotherapy. The future is bright for individuals with peanut allergy, as these breakthroughs …

Improving Compliance With Safe Sleep Guidelines For Vulnerable Patients In A Community Safety Net Hospital Neonatal Intensive Care Unit, Andrew Beverstock, Samantha Carlton, Hillary Lee, Thomas Lu, Kelsi Morgan, Ashlee Smith-Patel, Kelli Phillips, Joseph Hagan, Pablo Lohmann, Caraciolo Fernandes, Lisa Owens, Daniela Dinu

Faculty, Staff and Students Publications

Objectives: Congenital diaphragmatic hernia (CDH) often coexists with fetal growth restriction (FGR). The observed-to-expected (O/E) total fetal lung volume (TFLV) is used to assess CDH severity, predict outcomes, and direct fetal interventions. Expected TFLV measurements traditionally rely only on gestation age (GA). This simulation assesses how incorporating weight-adjusted GA norms affects O/E TFLV calculations in patients with isolated CDH and FGR.

Methods: A simulated dataset (n=1,005) utilized published mean fetal weight and TFLV references. Computer-generated variables included observed weights (3rd-10th %ile), O/E TFLV (10-65 %), and percent liver herniation (0-42 %). GA estimates were corrected by weight and used to …

Sodium Supplementation Algorithm To Promote Growth In Infants Who Are Preterm: Randomized Clinical Trial, Brianna M Liberio, Gregory M Sokol, Hannah Rakow, Kelly Mosesso, Valerie Hole, William W Wong, Shaji K Chacko, Jeffrey L Segar

Faculty, Staff and Students Publications

Objective: Evaluate the effectiveness of an algorithm using urine sodium (Na) concentration to guide dietary Na supplementation compared with standard care to promote growth in infants who are preterm.

Methods: A randomized trial was conducted in 4 neonatal units in Indianapolis, Indiana, involving infants between 250/7 to 296/7 weeks gestation with birthweight > 500 g. Study arms consisted of standard care or use of algorithm beginning at 14 to 17 days postnatal age. The primary outcomes were somatic growth (weight, length, and head circumference) measured by change in Z-score between aged 2 weeks and 36 weeks postmenstrual age (PMA). Secondary outcomes …

A Practical Approach To The Management Of Percutaneous Coronary Intervention Complications, Tanawat Attachaipanich, Hafeez Ul Hassan Virk, Muzamil Khawaja, Mahboob Alam, Ravi S Hira, Jacob A Doll, Chayakrit Krittanawong

Faculty, Staff and Students Publications

Introduction: Despite advances in stent design, pharmacotherapy, and procedural techniques that have improved percutaneous coronary intervention (PCI) outcomes and reduced PCI-related complications, these events still occur and are associated with adverse outcomes. Moreover, complex PCI procedures, which predispose to increased risk of complications, are increasingly performed. Understanding risk factors, underlying mechanisms, evidence-based management, and preventive strategies are essential to optimize procedural outcomes. This review aims to summarize current evidence and highlight gaps in knowledge related to PCI-associated complications.

Methods: This narrative review used a focused PubMed search through October 2025, prioritizing randomized trials, large observational studies, guidelines, and consensus statements. …

Left Atrial Appendage Closure Devices: A Contemporary Review Of Techniques, Tips And Tricks, Kamran Namjouyan, Hafeez Ul Hassan Virk, Affan Rizwan, Muzamil Khawaja, Mahboob Alam, Markus Strauss, Chayakrit Krittanawong

Faculty, Staff and Students Publications

Atrial fibrillation (AF) affects approximately 3%-5% of adults and is projected to double in prevalence by 2060, significantly increasing the burden of thromboembolic stroke. This risk is largely attributed to thrombus formation within the left atrial appendage (LAA), particularly in nonvalvular AF, where the LAA's trabeculated anatomy, diverse morphologies (e.g., chicken wing, windsock, cactus, cauliflower), and impaired contractility allows for blood stasis and thrombogenesis. As a result, the LAA has become a focus for stroke prevention strategies. This review demonstrates current evidence on LAA closure by discussing patient selection, anatomical feasibility, procedural workflow, imaging guidance (transesophageal echocardiography vs. intracardiac echocardiography), …

The ‘Obesity Paradox’ In Patients Undergoing Transcatheter Aortic Valve Implantation. A Specialized Narrative Review, Johao Escobar, Iqra Riaz, Muzamil Khawaja, Hafeez Ul Hassan Virk, Joshua Hahn, Fu''Ad Al-Azzam, Zhen Wang, Mahboob Alam, Markus Strauss, Chayakrit Krittanawong

Faculty, Staff and Students Publications

Obesity has long been identified as a noteworthy risk factor for cardiovascular diseases, including aortic stenosis. Nevertheless, an unexplained phenomenon known as the obesity paradox has arisen in the context of transcatheter aortic valve implantation (TAVI), inquiring conventional beliefs. The obesity paradox refers to better clinical outcomes observed in obese individuals undergoing TAVI. These include reduced all-cause mortality, lower rates of procedural complications, and improved long-term survival rates compared to their lean counterparts. Several theories have been proposed to explain the obesity paradox in TAVI. One of the most popular is the adipose tissue-mediated cardioprotective effect hypothesis. It is known …

Duration Of Antimicrobial Therapy In Cardiovascular Implantable Electronic Device Associated Systemic Infections: A Retrospective Analysis, Emily Y Xiao, Patrick T Lynch, Sarwat Khalil, Derrick A Draeger, Alexandra M Lewis, Faiz M Baqai, Mihail G Chelu, M Rizwan Sohail

Faculty, Staff and Students Publications

Background: While the need for complete device removal is well-established for cardiovascular implantable electronic device (CIED) infections, there is insufficient evidence on the optimal duration of antimicrobial therapy.

Objectives: To examine how antimicrobial duration affects clinical outcomes of patients presenting with CIED-associated bacteremia and lead endocarditis.

Design: This is a retrospective cohort study conducted at a quaternary care hospital in Houston, TX, USA.

Methods: Patients who underwent device removal for a primary indication of bacteremia or lead endocarditis over a 10-year period were stratified by prescribed duration of antibiotics as ⩽2 weeks or >2 weeks post-extraction. Measured outcomes included all-cause …

Editorial: New Insights On Vascular And Metabolic Diabetic Complications, Hua Mao, John D Imig, Ricardo Espinosa-Tanguma

Faculty, Staff and Students Publications

No abstract provided.

Definitions Of Arginine Availability: A Critical Metabolic Marker Of Physiological Processes, Mustafa Tosur, Farook Jahoor, Ashok Balasubramanyam

Faculty, Staff and Students Publications

No abstract provided.

Assessment Of In-Frame Indel Variants In An Unsolved Cohort Of Inherited Retinal Diseases Using Machine Learning, David E Rauch, Meng Wang, Muhammad Jafar Hussain Hafiz, Daniel C Brock, Yumei Li, Molly Marra, Mark E Pennesi, Paul Yang, Everett Lesley, Irma Lopez, Robert Koenekoop, Edward Ryan Collantes, Joanne Bolinao, Rui Chen

Faculty, Staff and Students Publications

The standard for in silico pathogenicity prediction of in-frame insertions and deletions (indels) is less established compared to other types of variations. We aimed to systematically assess the performance of in silico machine learning (ML) tools on a patient cohort with inherited retinal diseases (IRDs). The performance of four ML tools (CADD, FATHMM-indel, VEST4, and MetaRNN-indel) was compared. Among them, MetaRNN-indel showed the best overall results. MetaRNN-indel was then applied to 1013 unsolved IRD patients, identifying two likely pathogenic causal variants in two unrelated IRD patients by confirming clinical phenotypes. Hence, our findings indicate that reliable prediction of the pathogenicity …

Strategies And Challenges For The Recruitment Of Young Healthy Participants In The Dietary Approaches To Longevity And Health (Dial Health) Pilot Trial, Hannah E Cabre, Courtney M Peterson, Gareth R Dutton, Kimberly L Drews, Stephanie T Broyles, Robert Dubin, Laura Q Rogers, Catherine Champagne, Dennis T Villareal, Daniel S Hsia, Leanne M Redman, Corby K Martin

Faculty, Staff and Students Publications

Background: Understanding the impact of nutrition on human aging requires long-term trials in young, healthy, unmedicated adults. As part of the Dietary Approaches for Longevity and Health (DiAL Health) pilot project, we evaluated strategies for recruiting this population for aging-related dietary intervention studies.

Methods: We analyzed recruitment costs to enroll 70 participants (ages 25-49, BMI 22.0-29.9 kg/m2) across two DiAL Health sites and used NHANES data (2017-March 2020) to estimate the proportion of U.S. adults meeting partial trial eligibility. Additionally, a formative study surveyed 492 U.S. adults (≥18 years) to assess interest in aging-focused dietary trials.

Results: Of 2049 applicants …

Inducible Pou Class 2 Homeobox 3 Expression In Human Intestinal Organoids As A Model Of Human Tuft Cells, Carolyn Bomidi, Luqiong Wang, Hoa Nguyen-Phuc, Mary K Estes, Sarah E Blutt

Faculty, Staff and Students Publications

No abstract provided.

Sewers To Solutions: A Guide To Wastewater Pathogen Monitoring, Justin R Clark, Anthony W Maresso

Faculty, Staff and Students Publications

Wastewater-based epidemiology (WBE) is the analysis of wastewater to detect pathogen levels or activity for public health awareness or action. Pioneered in the 1940s, WBE underwent a resurgence during the COVID-19 pandemic, providing important information about number of cases, outbreaks, and seasonal impact. With advancements in detection technologies and growing interest in environmental surveillance, WBE is poised to become a standard practice in public health monitoring. Here, we provide an overview of the current state of the art of pathogen WBE, including methods of molecular detection, analysis of wastewater data, real-world applications and programs, public health interventions, and benefits and …

A Narrative Review Of The Central Neural Control Of Swallowing And Its Implications For Dysphagia Rehabilitation, Kuo-Chang Wei, Tyng-Guey Wang, Ming-Yen Hsiao

Rehabilitation Practice and Science

Swallowing is controlled by a distributed neural network spanning the brainstem central pattern generator, subcortical modulatory circuits, and cortical regions responsible for volitional planning and sensorimotor integration. Evidence from lesion studies, neuroimaging, and neurophysiology demonstrates that dysphagia arises from disruptions at different nodes of this network, producing lesion-specific impairment profiles rather than a uniform swallowing deficit. This network-based perspective has shifted rehabilitation from predominantly compensatory management toward mechanism-driven interventions aimed at restoring physiological function. Behavioral skill-training and resistance-based exercises harness motor learning and cortical plasticity, whereas neuromodulatory approaches—including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), pharyngeal electrical …

Experience And Barriers In Pediatric Dysphagia Rehabilitation: A Quantitative Survey Study, François-Xavier Brajot, Ai-Ju Wu, Pao-Chuan Torng

Rehabilitation Practice and Science

Purpose: Despite an important need for health care services targeting pediatric dysphagia, there exist a number of barriers to doing so, including workforce competence. The current study surveyed practicing Speech-Language Pathologists to determine (1) the importance of pediatric dysphagia in their caseload, (2) the adequacy of existing educational resources, and (3) perceived barriers to providing quality care in Taiwan.

Methods: An anonymous survey was completed by Speech-Language Pathologists working in Taiwan. Responses were analyzed with respect to current work setting, experience, preparation, and perceived barriers.

Results: Survey results from 122 respondents indicated that the pediatric dysphagia caseload is unexpectedly low …

Bridging The Gap Between Function-Based And Iddsi Standards In Dysphagia Care, Chien-Hui Cheng

Rehabilitation Practice and Science

No abstract provided.

A Scoping Review Of Non-Instrumental Dysphagia Screening Tools: Building Flowcharts To Guide Tool Selection, Yu-Chun Chang, Ming-Jhuan Wang, Shu-Fen Siao, Yu-Juan Xu, Meng-Shan Wu, Tyng-Guey Wang, Cheryl Chia-Hui Chen

Rehabilitation Practice and Science

Selecting an appropriate non-instrumental dysphagia screening tool is a complex process. This scoping review aimed to identify dysphagia screening tools with established reliability and validity, and to develop administrator-based flowcharts to guide tool selection across different clinical populations. A scoping review was conducted using studies identified in CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Our search was guided by five keywords: “dysphagia,” “deglutition,” “screening,” “test,” and “measure.” Original studies about the development and validation of non-instrumental dysphagia screening tools were selected. Six reviewers were involved in the review process, and at least two reviewers independently completed each step of …

Does In-Bed Cycling Delivered Within 48 Hours Of Mechanical Ventilation, Reduce The Occurrence Of Delirium In Critically Ill Patients: A Mixed-Methods Feasibility Randomised Controlled Trial Protocol, Jacqueline Bennion, Mark Hudson, Mary Hickson, Victoria Allgar, Bridie Kent, David Mcwilliams, Daniel Martin

Peninsula Medical School

Background: Delirium is a severe neuropsychiatric clinical state presenting as an acute onset of cognitive deficits. Patients receiving invasive mechanical ventilation (IMV), have the highest incidence (50%–80%) of delirium amongst patients admitted to intensive care units. Preliminary data indicates that early mobilisation is associated with reduced delirium in critically ill patients. However, definitive evidence is lacking. Current practice varies due to many barriers to patients, who require IMV, receiving early mobilisation interventions. In-bed cycling may address some of these barriers. This research aims to evaluate the feasibility and acceptability of early in-bed cycling to reduce delirium in critically ill patients. …

The Effectiveness Of Digital Therapeutics Intervention In Oral Anticoagulation Management: A Systematic Review And Meta-Analysis, Jiayue Guo, Lili You, Lu Liu, Xitong Jiao, Debasish Kar, Jitendra Jonnagaddala

Peninsula Medical School

Objective: To summarize the key intervention characteristics and evaluate the effectivenessand safety of digital therapeutics (DTx) in patients receiving oral anticoagulation, witheffectiveness evaluated using time in therapeutic range (TTR), thromboembolic events (TEE),and mortality, and safety evaluated based on bleeding events.Patients and Methods: We searched PubMed, Embase, Web of Science, and the CochraneLibrary from inception to June 20, 2025, and identified ten randomized controlled trialsinvolving 7,237 patients. The criteria required studies to assess software-based DTxsupporting anticoagulation management and report effectiveness or safety outcomes. Studyquality was evaluated using the Grading of Recommendations, Assessment, Development,and Evaluation (GRADE) framework, and random-effects models were applied.Results: …

Microbial Collagenase Activity Is Linked To Oral–Gut Translocation In Advanced Chronic Liver Disease, Shen Jin, Aurelie Cenier, Daniela Wetzel, Bethlehem Arefaine, Mar Moreno-Gonzalez, Marilena Stamouli, Merianne Mohamad, Mariia Lupatsii, Emilio Ríos, Sunjae Lee, Ane Zamalloa, Shilpa Chokshi, Adil Mardinoglu, Saeed Shoaie, Naiara Beraza, Vishal C. Patel, Melanie Schirmer

Peninsula Medical School

Microbiome perturbations are associated with advanced chronic liver disease (ACLD), but how microorganisms contribute to disease mechanisms is unclear. Here we analysed metagenomes of paired saliva and faecal samples from an ACLD cohort of 86 individuals, plus 2 control groups of 52 healthy individuals and 14 patients with sepsis. We identified highly similar oral and gut bacterial strains, including Veillonella and Streptococcus spp., which increased in absolute abundance in the gut of patients with ACLD compared with controls. These microbial translocators uniquely share a prtC gene encoding a collagenase-like proteinase, and its faecal abundance was a robust ACLD biomarker (area …

Prevalence And Determinants Of Diabetes-Related Psychological Distress In A Tertiary Care Setting In Tamil Nadu: India: Cross-Sectional Study, Rohit Shankar, Samuel Tromans

Peninsula Medical School

BackgroundDiabetes distress, whereby people with diabetes experience distressing psychological symptoms associated with living with their condition, is an emerging problem in India. Diabetes distress leads to self-care deficits, suboptimal glycaemic control (which can lead to increasing risks of complications) and impaired quality of life.AimsTo determine the burden of diabetes distress and its associated factors in an Indian tertiary care centre in Trichy, Tamil Nadu, India, covering a population of 1.25 million.MethodThis prospective observational study involved a structured questionnaire covering demographic and clinical details, which was given to patients. The Diabetes Distress Scale 17 (DDS-17) was used to assess diabetes distress …

Measuring Outcomes In Evaluations Of Interventions To Prevent Youth Crime And Violence: Challenges And Potential Solutions, Sajid Humayun, Finlay Green, Helen Downham, Nick Axford

Peninsula Medical School

There is a clear imperative to prevent youth crime and violence owing to the significant social and economic costs for individuals involved and wider society. A considerable evidence base for ‘what works’ in this space exists but gaps remain. To address these, it is necessary to evaluate intervention effectiveness. The aim of this article is to explore challenges and potential solutions regarding outcome measurement in such evaluations. To do this we draw on the literature and our experience as evaluators. We argue that outcome selection should be informed by a robust theory of change, and that normally this will mean …

Rapid Electrochemical Biosensor With Enhanced Accuracy And Repeatability Using Pyrene Nhs Ester Modified 3d Graphene Electrodes, S. Nazir, D. Jenkins, G. Pan

School of Engineering, Computing and Mathematics

A consistent and reproducible chemical modification of the transducer interface is essential to ensure effectiveimmobilization of bioreceptors, thereby improving the sensitivity and reproducibility of biosensors. Althoughnotable progress has been made in fabricating graphene-based biosensors, the effects of surface biofunctionalization on sensing performance remain not fully understood. This study shows that combining threedimensional (3D) graphene foam electrodes with a straightforward, single-step surface biofunctionalizationmethod is key to enhancing the performance of graphene-based biosensors. Specifically, it presents a single-stepapproach to functionalize the 3D graphene foam (Gii-Sens) with 1-pyrenebutyric acid N-hydroxysuccinimideester (Pyrene-NHS ester). Electrochemical techniques, including cyclic voltammetry (CV) and differential pulsevoltammetry (DPV), confirmed …

Designing A Mobile App For Post Traumatic Stress Disorder: Insights From Lived Experience And Clinical Practice, Rohit Shankar, Richard Laugharne, Michael Loizou, Marius Varga, Sivia Lin, Bojana Daw Srdanovic, Roger Farrell

Peninsula Medical School

Post-traumatic stress disorder (PTSD) is a disabling anxiety disorder precipitated by severe trauma. Many people with this condition have little access to clinical interventions, especially in low-middle-income countries. For the development of any digital health intervention, it is vital to know the opinions of PLE and clinicians to guide the developers. We conducted two focus groups, one with clinicians (n = 5) and one with people with lived experience (PLE) (n = 11), to gain knowledge of their views on the development of a PTSD App. Transcripts of both focus groups were coded and thematically analysed. The key themes that …

From Predictions To Explanations: Explainable Ai For Autism Diagnosis And Identification Of Critical Brain Regions: 18th International Joint Conference, Biostec 2025, Kush Gupta, Amir Aly, Emmanuel Ifeachor, Rohit Shankar

School of Engineering, Computing and Mathematics

Autism spectrum disorder (ASD) is a neurodevelopmentalcondition characterized by atypical brain maturation. However, the adaptationof transfer learning paradigms in machine learning for ASD researchremains notably limited. In this study, we propose a computeraideddiagnostic framework with two modules. This chapter presents atwo-module framework combining deep learning and explainable AI forASD diagnosis. The first module leverages a deep learning model finetunedthrough cross-domain transfer learning for ASD classification. Thesecond module focuses on interpreting the model’s decisions and identifyingcritical brain regions. To achieve this, we employed three explainableAI (XAI) techniques: saliency mapping, Gradient-weighted Class ActivationMapping, and SHapley Additive exPlanations (SHAP) analysis.This framework demonstrates that …

Biocompatibility Of Silver And Hydroxyapatite Antimicrobial Nanocoatings On Titanium Alloy Dental Implants With Human Gingival Fibroblasts, S Morgan, R D Handy, V M Salih, R N Salaie, C J Tredwin, A Besinis

School of Engineering, Computing and Mathematics

OBJECTIVES: Peri-implantitis compromises soft and hard tissues around dental implants, often leading to implant failure. Antibacterial nanocoatings offer a promising infection control strategy, but maintaining biocompatibility is essential. This study investigated, through a range of assays and analytical techniques, the biocompatibility of antimicrobial silver and hydroxyapatite (HA) nanocoatings applied to titanium implants with human gingival fibroblasts (HGFs).

METHODS: Silver and hydroxyapatite nanocoatings were applied to the surface of titanium alloy specimens using electroplating, deposition and sintering techniques. The biocompatibility of the nanocoatings with HGFs was assessed by measuring cell metabolic activity (alamarBlue), lactate dehydrogenase (LDH) release, collagen production (Sircol assay), …

Alcohol Awareness, Prevention, And Education In Greek Life, Vivian J. Mcmechen, Kara Ann Lasater, Page Dobbs

2026 Honors Symposium

Background: Alcohol consumption is normalized in Greek Life culture, and this social standard can lead to risky health behaviors and overconsumption. At the University of Arkansas, approximately one-third of students are members of Greek Life; there is a need for prevention methods that understand students’ lived experiences. Purpose: The purpose of this study is to examine students’ experiences with alcohol prevention, awareness, and education as current members of Greek Life at the University of Arkansas. Through student interviews and surveys, this project aims to inform and provide recommendations for relatable and student-centered alcohol prevention and education efforts. Methodology: This study …