Digital Commons Network^™

Human Thalamocortical Structural Connectivity Develops In Line With A Hierarchical Axis Of Cortical Plasticity, Valerie J Sydnor, Deanna M Barch, Et Al.

2020-Current year OA Pubs

Human cortical development follows a hierarchical, sensorimotor-to-association sequence. The brain's capacity to enact this sequence indicates that it relies on unknown mechanisms to regulate regional differences in the timing of cortical maturation. Given evidence from animal systems that thalamic axons mechanistically regulate periods of cortical plasticity, here we evaluate in humans whether the development of structural connections between the thalamus and cortex aligns with cortical maturational heterochronicity. By deriving a new tractography atlas of human thalamic connections and applying it to diffusion data from three youth samples (8-23 years; total n = 2,676), we demonstrate that thalamocortical connectivity matures in …

Shared And Disease-Specific Pathways In Frontotemporal Dementia And Alzheimer's And Parkinson's Diseases, Muhammad Ali, Yike Chen, Ying Xu, Katherine Gong, Menghan Liu, Jigyasha Timsina, Daniel Western, Chengran Yang, Gyujin Heo, Carlos Cruchaga, Et Al.

2020-Current year OA Pubs

Neurodegenerative diseases (NDs), such as Alzheimer's disease (AD), Parkinson's disease (PD) and frontotemporal dementia (FTD), exhibit distinct yet overlapping pathological mechanisms. Leveraging large-scale plasma proteomics data from the Global Neurodegeneration Proteomics Consortium, we analyzed 10,527 plasma samples (1,936 AD, 525 PD, 163 FTD, 1,638 dementia and 6,265 controls) to identify disease-specific and shared proteins across NDs. We identified 5,187 proteins significantly associated with AD, 3,748 with PD and 2,380 with FTD that revealed both common and divergent proteomic signatures, which were confirmed by multiple analytical approaches and orthogonal validation. PD and FTD showed the highest overlap (r

The Global Neurodegeneration Proteomics Consortium: Biomarker And Drug Target Discovery For Common Neurodegenerative Diseases And Aging, Farhad Imam, Muhammad Ali, Carlos Cruchaga, Chengran Yang, Et Al.

2020-Current year OA Pubs

More than 57 million people globally suffer from neurodegenerative diseases, a figure expected to double every 20 years. Despite this growing burden, there are currently no cures, and treatment options remain limited due to disease heterogeneity, prolonged preclinical and prodromal phases, poor understanding of disease mechanisms, and diagnostic challenges. Identifying novel biomarkers is crucial for improving early detection, prognosis, staging and subtyping of these conditions. High-dimensional molecular studies in biofluids ('omics') offer promise for scalable biomarker discovery, but challenges in assembling large, diverse datasets hinder progress. To address this, the Global Neurodegeneration Proteomics Consortium (GNPC)-a public-private partnership-established one of the …

Do Risk Factors For Hcc Impact The Association Of Ct/Mri Lirads Major Features With Hcc? An Individual Participant Data Meta-Analysis, Robert G Adamo, Daniel R Ludwig, Tyler J Fraum, Et Al.

2020-Current year OA Pubs

No abstract provided.

Integrative Genomic Reconstruction Reveals Heterogeneity In Carbohydrate Utilization Across Human Gut Bifidobacteria, Aleksandr A Arzamasov, Dmitry A Rodionov, Matthew C Hibberd, Janaki L Guruge, James E Kent, Marat D Kazanov, Semen A Leyn, Marinela L Elane, Kristija Sejane, Annalee Furst, Lars Bode, Michael J Barratt, Jeffrey I Gordon, Andrei L Osterman

2020-Current year OA Pubs

Bifidobacteria are beneficial saccharolytic microbes that are widely used as probiotics or in synbiotic formulations, yet individual responses to supplementation can vary with strain type, microbiota composition, diet and lifestyle, underscoring the need for strain-level insights into glycan metabolism. Here we reconstructed 68 pathways for the utilization of mono-, di-, oligo- and polysaccharides by analysing the distribution of 589 curated metabolic gene functions (catabolic enzymes, transporters and transcriptional regulators) across 3,083 non-redundant Bifidobacterium genomes of human origin. Thirty-eight predicted phenotypes were validated in vitro for 30 geographically diverse strains, supporting genomics-based predictions. Our analysis uncovered extensive inter- and intraspecies functional …

Active Dna Demethylation Upstream Of Rod-Photoreceptor Fate Determination Is Required For Retinal Development, Ismael Hernández-Núñez, Alaina Urman, Xiaodong Zhang, William Jacobs, Christy Hoffmann, Ellen G. Harding, Shiming Chen, Meelad M. Dawlaty, Philip A. Ruzycki, John R. Edwards, Brian S. Clark

2020-Current year OA Pubs

Retinal cell fate specification from multipotent retinal progenitors is governed by dynamic changes in chromatin structure and gene expression. Methylation at cytosines in DNA (5mC) is actively regulated for proper control of gene expression and chromatin architecture. Numerous genes display active DNA demethylation across retinal development; a process that requires oxidation of 5mC to 5-hydroxymethylcytosine (5hmC) and is controlled by the ten-eleven translocation (TET) methylcytosine dioxygenase enzymes. Using an allelic series of conditional TET enzyme mutants in mice, we determine that DNA demethylation is required upstream of NRL and NR2E3 expression for the establishment of rod-photoreceptor fate. Using histological, behavioral, …

Muscle Biopsy Findings In Valosin-Containing Protein Multisystem Proteinopathy, Marianela Schiava, Manouela V. Valtcheva, Conrad Weihl, Et Al.

2020-Current year OA Pubs

BACKGROUND AND OBJECTIVES: Valosin Containing Protein-associated multisystem proteinopathy (VCP-MSP) is a progressive, autosomal dominant disorder caused by pathogenic variants in the VCP gene, resulting in a heterogeneous clinical presentation. Muscle biopsy findings are characteristic but not pathognomonic. This study aimed to comprehensively analyse VCP-related myopathology and explore correlations with clinical phenotypes, genetic variants, and disease progression.

METHODS: Muscle biopsy images and data were collected retrospectively from adults (≥18 years) with pathogenic or likely pathogenic VCP variants enrolled in the VCP Multicentre International Study. Biopsy data were standardized using the "Common Data Elements for Muscle Biopsy Reporting." Variations in biopsy findings …

Validation Of The Brugia Test Plus To Detect Igg4 Antibodies In Individuals From Belitung Timur, A Brugia Malayi Endemic Area In Indonesia, Taniawati Supali, Elisa Iskandar, Noviani Sugianto, Yenny Djuardi, Katherine Gass, Jean M. Saunders, Peter U. Fischer, Marco A. Biamonte

2020-Current year OA Pubs

The Brugia Test Plus (BT+) is a new rapid diagnostic test for Brugia species which detects human IgG4 antibodies specific for the immunogenic Brugia protein BmR1. The aim of this study was to evaluate the BT+ assay with several types of sample-matrices: whole blood, plasma, and dried blood spots (DBS) from individuals living in Belitung Timur, a Brugia malayi endemic area in Indonesia. Night blood was collected from residents living in four presumed endemic villages, while DBS were collected from schoolchildren living in those four villages. The sensitivity of BT+ was measured by comparing the BT+ results to microscopic examination …

Germline Genetic Variation Impacts Clonal Hematopoiesis Landscape And Progression To Malignancy, Jie Liu, Duc Tran, Brian J Wiley, Irenaeus C C Chan, Indraniel Das, Li Ding, Yin Cao, Matthew J Walter, Daniel C Link, Kelly L Bolton, Et Al.

2020-Current year OA Pubs

With age, clonal expansions occur pervasively across normal tissues yet only in rare instances lead to cancer, despite being driven by well-established cancer drivers. Characterization of the factors that influence clonal progression is needed to inform interventional approaches. Germline genetic variation influences cancer risk and shapes tumor mutational profile, but its influence on the mutational landscape of normal tissues is not well known. Here we studied the impact of germline genetic variation on clonal hematopoiesis (CH) in 731,835 individuals. We identified 22 new CH-predisposition genes, most of which predispose to CH driven by specific mutational events. CH-predisposition genes contribute to …

Longer Scans Boost Prediction And Cut Costs In Brain-Wide Association Studies, Leon Qi Rong Ooi, Scott Marek, Nico U F Dosenbach, Timothy O Laumann, Evan M Gordon, Et Al.

2020-Current year OA Pubs

A pervasive dilemma in brain-wide association studies

Comparing Machine Learning Techniques For Neonatal Mortality Prediction: Insights From A Modeling Competition, Brynne A Sullivan, Alvaro G Moreira, Ryan M Mcadams, Lindsey A Knake, Ameena Husain, Jiaxing Qiu, Avinash Mudireddy, Abrar Majeedi, Wissam Shalish, Douglas E Lake, Zachary A Vesoulis

2020-Current year OA Pubs

BACKGROUND: Predicting mortality risk in neonatal intensive care units (NICUs) is challenging due to complex, variable clinical and physiological data. Machine learning (ML) offers potential for more accurate risk stratification.

OBJECTIVE: To compare the performance of various ML models in predicting NICU mortality using a team-based modeling competition.

METHODS: We conducted a modeling competition with five neonatologist-led teams applying ML techniques-logistic regression, CatBoost, neural networks, random forest, and XGBoost-to a shared dataset from over 6,000 NICU admissions. The dataset included static demographic and clinical variables, alongside daily samples of heart rate and oxygen saturation. Each team developed models to predict …

Impact Of Transcatheter Aortic Valve Replacement Use Ratio On Outcomes In Patients With Aortic Valve Disease, Theodore Marghitu, Sophia H Roberts, June He, Nicholas Kouchoukos, Puja Kachroo, Harold Roberts, Ralph Damiano, Alan Zajarias, Marc Sintek, John Lasala, Alexander A Brescia, Tsuyoshi Kaneko

2020-Current year OA Pubs

OBJECTIVE: Use of the Heart Team has been the standard of care for the treatment of aortic valve disease; however, its efficacy has not been evaluated. We sought to analyze its impact using the transcatheter aortic valve replacement (TAVR) use ratio (number of TAVR/total aortic valve replacement [AVR] volume) on TAVR, surgical aortic valve replacement (SAVR), and overall AVR outcomes.

METHODS: We analyzed all TAVRs and SAVRs sampled by the National Readmissions Database between 2016 and 2020. Hospitals were stratified into quartiles on the basis of their TAVR/AVR ratio. Centers with a ratio below the first quartile were considered "low …

Medicaid Accessibility For Ophthalmologists And Optometrists In Florida: A Pilot Study, Darby D Miller, Isabella V. Wagner, Michael W. Stewart, Abhimanyu S. Ahuja, Syril Dorairaj, Richard D. Ten Hulzen, Aaron Y. Lee

2020-Current year OA Pubs

OBJECTIVE AND METHODS: This study aimed to evaluate Medicaid accessibility for ophthalmologists and optometrists in Florida. A cross-sectional telephone survey was conducted between February and March 2018 using a geographically uniform sample of 22 ophthalmologists and 80 optometrists registered with Medicaid. Providers were asked whether they accepted new Medicaid patients (adult and/or pediatric) and for the earliest available appointment. Categorical variables were compared using Fisher's exact test, and time to next appointment was analyzed using the Wilcoxon rank-sum test (α = 0.05).

RESULTS: Across all age groups, a greater proportion of ophthalmologists (95.4%) accepted some form of Medicaid compared to …

Inter-Organ Communication Is A Critical Machinery To Regulate Metabolism And Aging, Kyohei Tokizane, Shin-Ichiro Imai

2020-Current year OA Pubs

Inter-organ communication (IOC) is a complex mechanism involved in maintaining metabolic homeostasis and healthy aging. Dysregulation of distinct forms of IOC is linked to metabolic derangements and age-related pathologies, implicating these processes as a potential target for therapeutic intervention to promote healthy aging. In this review, we delve into IOC mediated by hormonal signaling, circulating factors, organelle signaling, and neuronal networks and examine their roles in regulating metabolism and aging. Given the role of the hypothalamus as a high-order control center for aging and longevity, we particularly emphasize the importance of its communication with peripheral organs and pave the way …

Characteristics Of Responders To Interventions For Parkinson Disease: A Scoping Systematic Review, Sidney T. Baudendistel, Gammon M Earhart

2020-Current year OA Pubs

AIMS: The purpose of this review is to identify the characteristics of responders in interventions targeting motor function for individuals with Parkinson disease.

MATERIALS & METHODS: The primary search included, 'Parkinson' + 'responder.' A second, broader, search further included 'response' + 'responsiveness' + 'responsive.' Records were sorted by intervention: neuromodulation, pharmaceutical, physical, and placebo.

RESULTS: Thirteen studies were identified in the primary and 19 studies in the secondary search, culminating in 120 characteristics. For neuromodulation interventions, responders were younger at onset, more responsive to levodopa, and had more difficulties with activities of daily living. Responders to pharmaceuticals were younger at …

Massively Parallel Immunopeptidome By Dna Sequencing Provides Insights Into Cancer Antigen Presentation, Quanming Shi, Cheryl F Lichti, Et Al.

2020-Current year OA Pubs

Human leukocyte antigens (HLAs) are encoded by the most polymorphic genes in the human genome. HLA class I alleles control antigen presentation for T cell recognition, which is pivotal for autoimmunity, infectious diseases and cancer. Current knowledge of HLA-bound peptides is limited, skewed and falls short of population-wide HLA binding profiles for high-value targets. Here we present ESCAPE-seq (enhanced single-chain antigen presentation sequencing), a massively parallel platform for comprehensive screening of class I HLA-peptide combinations for antigen presentation via deep DNA sequencing. ESCAPE-seq demonstrates programmability, high throughput, sensitivity and nominated viral and cancer epitopes. We simultaneously assessed over 75,000 peptide-HLA …

Building Capacity And Equity In Implementation Science: Evaluation Of A National Mentored Training Program, Ross C Brownson, Shelly J Kannuthurai, Rebekah R Jacob, Leopoldo J Cabassa, Lisa M Klesges, Rachel G Tabak, Debra Haire-Joshu, Et Al.

2020-Current year OA Pubs

BACKGROUND: As implementation science evolves, it is essential to expand training capacity to build intellectual capital continually. The demand for training in implementation science far outstrips the current supply. This paper presents the methods and findings from the Institute for Implementation Science Scholars (IS-2) national training program (2020-2024).

METHODS: The IS-2 was a US-based, two-year training program that provided mentored training for early- and mid-career researchers interested in applying implementation science principles to reduce the burden of chronic disease disparities. Scholars attended two annual, 2.5-day intensive training sessions, received ongoing remote and in-person mentoring, and were supported by other activities …

Impact Of Hereditary Angioedema Attacks On Health-Related Quality Of Life And Work Productivity, Maeve O'Connor, Paula J Busse, Timothy J Craig, Cristine Radojicic, H James Wedner, Sherry Danese, Julie Ulloa, Vibha Desai, Tomas Andriotti, Paul K Audhya, Sandra Christiansen

2020-Current year OA Pubs

BACKGROUND: Hereditary angioedema (HAE) negatively impacts health-related quality of life (HRQoL). Few studies have characterized impairments to HRQoL, work productivity, and well-being during and following HAE attacks.

METHODS: Patients with ≥1 HAE attack in the previous 3 months were recruited by the United States (US) HAE Association (HAEA) to complete an online survey. Respondents were categorized into those who did (Treated Cohort) and did not (Untreated Cohort) manage their last attack with on-demand treatment (OD). Adapted versions of the EuroQol-Five Dimensions-Five Levels (EQ-5D-5L), EuroQol Visual Analogue Scale (EQ VAS), and Work Productivity and Activity Impairment-General Health assessments were used.

RESULTS: …

The Ccjr® Charles A. Engh, Sr, Md. Excellence In Hip Research Award: Pelvic Tilt And Cup Position Change Significantly In Most Young Patients 10 Years After Hip Arthroplasty, Joseph J Kromka, William A Zuke, Caroline J Granger, John C Clohisy, Robert L Barrack

2020-Current year OA Pubs

BACKGROUND: Acetabular cup position is fundamental to total hip arthroplasty (THA) and surface replacement arthroplasty (SRA). Even if initial cup placement is adequate, changes in spinopelvic relationships alter functional acetabular position over time. This can lead to late complications. The purpose of this study was to examine changes in pelvic tilt and acetabular position in patients with at least 10 years of follow-up after THA or SRA.

METHODS: A retrospective review was conducted of patients from one academic practice who underwent THA or SRA and had at least 10 years of follow-up. Pelvic ratio was measured and converted to pelvic …

Wearing The Keffiyeh: Solidarity, Resistance, Activism, Catherine Harper Ph.D, Tasnim Alahdal, Rawan Gamal Agha

Arts and Design

The Palestinian keffiyeh is a distinctly patterned black-and-white woven double-cloth, hand-stitched scarf, originally used by farmers of the region. It became a prominent symbol of Palestinian nationalism from mid-twentieth century. Adopted by Yasser Arafat in the 1960s, it became a masculinist icon of Palestine’s politics of resistance, extended by female Palestinian liberationist Leila Khaled’s hijabi-like use, and then mobilised by wider leftist, activist, even Israel-critical Jewish, protest groups in the West.

In recent years, keffiyeh-patterned scarves, accessories, even dresses and skirts – in a range of colours – have appeared periodically in Western fashion stores, on couture catwalks, and …

High-Density Lipoprotein-Associated Cholesterol Abnormalities In A Clinical Outcomes Study Of Dysferlin-Deficient Limb-Girdle Muscular Dystrophy Type R2, Zoe White, Alan Pestronk, Et Al.

2020-Current year OA Pubs

BACKGROUND: Limb-girdle muscular dystrophy (MD) type R2 (LGMDR2, formerly LGMD2B) is an autosomal recessive form of MD caused by variants in the dysferlin gene, DYSF. It leads to slow proximal and distal muscle weakening that generally results in loss of ambulation around early adulthood but without the lethal cardiorespiratory dysfunction observed in the more severe Duchenne MD. How loss of dysferlin causes muscle fibre death is poorly understood, but recent evidence suggests a link between muscle wasting and loss of muscle cholesterol homeostasis with circulating lipoprotein abnormalities in many forms of MD.

METHODS: Cross-sectional circulating total cholesterol (CHOL), high-density lipoprotein-associated …

Sex-Related Variability In The Perception Of Symptoms Associated With Common Otolaryngologic Complaints, Sabrina K Wagner, Jakob L Fischer, Alvaro Navarro, Lily Trinh, Waleed M Abuzeid, Ian M Humphreys, Nadeem A Akbar, Sharan Shah, Jivianne T Lee, Tara Wu, John S Schneider, Edward D Mccoul, Charles A Riley, Anthony M Tolisano

2020-Current year OA Pubs

OBJECTIVE: To assess the differences in the symptoms associated with common otolaryngology complaints between male and female patients.

METHODS: Between June 2020 and July 2023, a multi-institutional cross-sectional study was performed at six tertiary academic otolaryngology practices using semantics-based questionnaires to assess the symptoms patients associate with the complaints of sinus infection, reflux, congestion, and dizziness. Patients selected symptoms from lists of proposed terms to describe the various conditions. The primary outcome measure was sex-related differences in respondent symptom selection.

RESULTS: Four separate questionnaires were completed by a total of 1495 patients (46.0% male, 54.0% female). Female patients more often …

Barriers And Facilitators To Accessing Healthcare For People With Parkinson's Disease In Latin America: A Qualitative Study, Christine Jeyachandran, Catherine Spooner, Ana Margarita Rodriguez Salgado, Matthew Prina, Joel Rhee, Jorge Jesus Llibre-Guerra, Dani Kim, Juan J Llibre-Rodriguez, Mark F Harris

2020-Current year OA Pubs

AIMS: The aim of the study was to identify the barriers and facilitators to healthcare access for people with Parkinson's disease (PWP) in Spanish-speaking Latin American countries (LAC) in Central and South America, to understand their drivers and consider the implications for health systems in LAC.

METHODS: Four online semi-structured focus groups were conducted with 25 PWP who provide education and/or support to PWP. The study was designed and implemented by a person with lived experience of PD. Data were mapped to an existing model of access to healthcare that incorporates provider and consumer abilities.

FINDINGS: There were multiple provider …

Genetic Diversity And Expanded Phenotypes In Dystonia: Insights From Large-Scale Exome Sequencing, Mirja Thomsen, Joel S Perlmutter, Et Al.

2020-Current year OA Pubs

OBJECTIVE: Dystonia is one of the most prevalent movement disorders, characterized by significant clinical and etiological heterogeneity. Despite considerable heritability (~25%), the etiology in most patients remains elusive. Moreover, understanding correlations between clinical manifestations and genetic variants has become increasingly complex.

METHODS: Exome sequencing was conducted on 1924 genetically unsolved, mainly late-onset isolated dystonia patients, recruited primarily from two dystonia registries (DysTract and the Dystonia Coalition). Rare variants in genes previously linked to dystonia (n = 406) were examined, confirmed via Sanger sequencing, and analyzed for segregation when possible.

RESULTS: We identified 137 distinct likely pathogenic/pathogenic variants (according to ACMG …

Plasminogen Mutation-Associated Thrombotic Microangiopathy And Role Of Anticoagulation: A Single Institution Case Series, Shreya Agarwal, Nicola Pozzi, Senthil Sukumar, Camila Masias, Anuja Java, Spero Cataland

2020-Current year OA Pubs

BACKGROUND: Knowledge gaps exist regarding the role of coagulation pathway mutations such as those in the plasminogen (

OBJECTIVES: This study aims to describe the unique phenotypic features of patients with

METHODS: This was a single-center retrospective study of patients with TMA in whom genetic testing was performed between 2011 and 2023. Data were collected regarding demographics, clinical features at their first presentation, renal outcomes, genetic mutations, and recurrence for those who were found to have a

RESULTS: Over the 12-year study period, we identified 6 individuals in our TMA cohort with

CONCLUSION: Patients with

Association Between Nt-Probnp Changes And Clinical Outcomes In Paediatric Patients With Heart Failure: Insights From Panorama-Hf And Paradigm-Hf, Robert Shaddy, Charles Canter, Et Al.

2020-Current year OA Pubs

AIMS: The PANORAMA-HF trial demonstrated significant N-terminal pro-B-type natriuretic peptide (NT-proBNP) reductions in paediatric patients with left ventricular systolic dysfunction with sacubitril/valsartan or enalapril treatment over 52 weeks. This post hoc analysis aims to correlate changes in NT-proBNP levels with clinical outcomes in PANORAMA-HF patients receiving either sacubitril/valsartan or enalapril. Additionally, NT-proBNP reductions in the paediatric population were compared with a subset of adult heart failure with reduced ejection fraction (HFrEF) patients from the PARADIGM-HF trial.

METHODS AND RESULTS: This post hoc analysis utilized data from Part 2 of the PANORAMA-HF trial. Associations between baseline NT-proBNP levels, changes post-baseline and …

Bridging Generations: Intergenerational Transfers And Time Use In A Changing World, Christine Ho

Research Collection School Of Economics

This Special Issue brings together nine papers that examine how families allocate time and money across generations. Spanning aging societies in East Asia to informal settlements in the Pacific, the contributions employ diverse methodological approaches, from natural experiments and policy variation to administrative data linkage and cross-generational panel surveys. The findings converge on a central insight: intergenerational transfers of time and money are not merely cultural practices, but systematic responses to changing economic environments and institutional frameworks. Family decisions are critical to the provision of long-term care, investment in children’s human capital, and the transmission of preferences, opportunities, and well-being …

Trust In Healthcare Ai Can’T Just Be Designed – It Must Be Felt By Clinicians And Patients, Adriana Banozic-Tang, Heng Wang

Research Collection Yong Pung How School Of Law

Trust in healthcare AI currently over-relies on system design, not lived medical realities.Continuous feedback loops are necessary to embed trust in healthcare AI that is responsive to clinician and patient needs.Initiatives in South-East Asia show how trust in technology can be extended from policy to practice.

Preface, Special Issue For The 16th International Conference On Graph Transformation (Icgt 2023), Maribel Fernández, Christopher M. Poskitt

Research Collection School Of Computing and Information Systems

This special issue contains six extended versions of papers presented at the 16th International Conference on Graph Transformation (ICGT 2023), held in Leicester, UK, on 19–20 July 2023. The conference was part of STAF 2023 (Software Technologies: Applications and Foundations) and was held under the auspices of the European Association for Theoretical Computer Science (EATCS), the European Association of Software Science and Technology (EASST), and the IFIP Working Group 1.3, Foundations of Systems Specification.

Cami: A Counselor Agent Supporting Motivational Interviewing Through State Inference And Topic Exploration, Yizhe Yang, Palakorn Achananuparp, Heyan Huang, Jing Jiang, Phey Ling Kit, Nicholas Gabriel Lim, Cameron Shi Ern Tan, Ee-Peng Lim

Research Collection School Of Computing and Information Systems

Conversational counselor agents have become essential tools for addressing the rising demand for scalable and accessible mental health support. This paper introduces CAMI, a novel automated counselor agent grounded in Motivational Interviewing (MI) – a client-centered counseling approach designed to address ambivalence and facilitate behavior change. CAMI employs a novel STAR framework, consisting of client’s state inference, motivation topic exploration, and response generation modules, leveraging large language models (LLMs). These components work together to evoke change talk, aligning with MI principles and improving counseling outcomes for diverse clients. We evaluate CAMI’s performance through both automated and expert evaluations, utilizing simulated …