Digital Commons Network^™

Shifting Patterns In Primary Care Telehealth Utilization Among Medicare Beneficiaries And Providers

Faculty, Staff and Student Publications

Introduction: The COVID-19 pandemic accelerated telehealth adoption, but disparities in its utilization persist. This study examines primary care patient sociodemographic characteristics, telehealth utilization patterns, and provider adoptions before and during the pandemic.

Methods: A retrospective cohort study analyzed data from Mississippi Medicare beneficiaries continuously enrolled in Parts A, B, and D who accessed primary care services from 2019 to 2021.

Results: Among 201 677 Medicare beneficiaries accessing primary care, 1364 used telehealth before the pandemic, compared to 73 994 during the pandemic. Telehealth utilization shifted during the pandemic to younger, female, White beneficiaries, and those enrolled in Medicare due to …

Prediction Of Preterm Birth Among Infants With Orofacial Cleft Defects, A J Agopian

Faculty, Staff and Student Publications

Objective: To develop risk prediction models for preterm birth among infants with orofacial clefts.

Design: Data from the Texas Birth Defects Registry for infants with orofacial clefts born between 1999-2014 were used to develop preterm birth predictive models. Logistic regression was used to consider maternal and infant characteristics, and internal validation of the final model was performed using bootstrapping methods. The area under the curve (AUC) statistic was generated to assess model performance, and separate predictive models were built and validated for infants with cleft lip and cleft palate alone. Several secondary analyses were conducted among subgroups of interest.

Setting: …

Factors Influencing Implementation Of A Self-Measured Blood Pressure Program In Community Health Centers: An Implementation Mapping Approach, William B Perkison, Maria E Fernandez

Faculty, Staff and Student Publications

Objectives: Uncontrolled hypertension is a leading cause of cardiovascular disease, particularly among adults aged 45 years and older. Self-measured blood pressure (SMBP) is an evidence-based intervention that can help patients manage hypertension outside of the clinical setting. We conducted a needs and assets assessment to identify (1) health center adopters and implementers and (2) barriers and facilitators to SMBP adoption and implementation in six community health centers in Texas.

Methods: Data sources included: (1) needs and assets assessment surveys and semi-structured interviews; (2) site visits with participating health centers; and (3) detailed meeting notes and logs. Leaders and administrators from …

Adaptation Using Im Adapt Of An Evidence-Based Lifestyle Intervention To Support The Management Of Metabolic-Dysfunction Associated Steatotic Liver Disease Among Hispanic/Latino Adults, Lorna H Mcneill

Faculty, Staff and Student Publications

The high prevalence of metabolic-dysfunction associated steatotic liver disease (MASLD), formerly non-alcoholic fatty liver disease (NAFLD), necessitates the availability of an evidence-based intervention to manage the condition among patients to prevent severe chronic liver disease and other cardiometabolic-related illnesses. IM Adapt (Intervention Mapping for Adaptation) is a systematic approach for planning modifications in interventions to improve fit and potential effectiveness. Following this stepped approach, we conducted interviews with the target population, conducted a literature review, solicited expert advice, and created a logic model describing expected program outcomes for the new population and setting. We searched for, selected, and adapted an …

Organizational Readiness And Implementation Of Colorectal Cancer Screening Evidence-Based Interventions In Federally Qualified Health Centers: A Cross-Sectional Study, Lauren Workman

Faculty, Staff and Student Publications

Introduction: Evidence-based interventions (EBIs) exist to increase colorectal cancer (CRC) screening, but implementation remains slow in federally qualified health centers (FQHCs). Assessing organizational readiness can improve EBI implementation outcomes, but no studies have quantitatively examined the relation between organizational readiness subcomponents and implementation outcomes. This study examines associations between readiness subcomponents and CRC screening EBI implementation outcomes in FQHCs.

Methods: We used data from an ongoing parent study to develop an organizational readiness measure using the R = MC2 heuristic. We conducted descriptive and cross-sectional analyses using FQHC clinic (n = 57) data across three states. A clinic contact …

Co-Creation Of Staff Training To Address Health-Related Social Needs In Emergencies

Faculty, Staff and Student Publications

Background: Health-related social needs (HRSN), such as housing and transportation barriers, contribute to poor health outcomes and increased healthcare costs. Patient navigators help connect patients to community resources, but workforce training gaps are a challenge. The Strengthening Peer AHC Navigation (SPAN) study aimed to enhance navigation training during the COVID-19 Public Health Emergency.

Methods: Using a stakeholder-driven peer planning approach, SPAN co-developed a quality improvement plan for patient navigation training. Training focused on housing and transportation navigation and included didactic sessions, hands-on case studies, and biweekly expert consultations. Self-efficacy surveys measured navigator confidence pre- and post-training, and changes in navigation …

Recovery Housing And On-The-Ground Research Priorities: A Scoping Study Through The Lens Of Community Based Participatory Research, James Tompkins, Michelle A Cruz, Kathryn Babbitt, Amy A Mericle, Ashli J Sheidow

Faculty, Staff and Student Publications

Introduction: Though communities have featured recovery housing (RH) for several decades, the base of evidence for best practices continues to grow - especially evidence needed by, and known to, those who operate and receive these services. The Initiative for Justice and Emerging Adult Populations (JEAP) engaged with three community boards (CBs) - consisting of young adults with experience in recovery from substance use issues, people who have a history of criminal legal system involvement and recovery, and payers and provider of substance use services and harm reduction - to understand on-the-ground priorities for research into recovery support services.

Methods: JEAP …

Sustaining Substance Use Recovery Housing For People Taking Medications For Opioid Use Disorder: Diverse Funding, Strategic Partnerships, And Charging Rent, Serena A Rodriguez

Faculty, Staff and Student Publications

Introduction: Opioid use disorder is a U.S. epidemic, and recovery housing plays a critical role by providing stable, supportive environments that promote long-term recovery. However, little is known about the sustainability of recovery homes, particularly those serving people taking medications for opioid use disorder.

Methods: We applied thematic analysis to interviews with 29 staff and operators from 10 recovery homes serving people taking medications for opioid use disorder across five Texas cities.

Results: Operators relied on diverse funding sources, leveraged strategic partnerships and professional certifications, and planned to charge rent when public funding ended. Staff and operators balanced financial sustainability …

Impact Of Pre-Transplant Immune Checkpoint Inhibitor Use On Post-Transplant Outcomes In Hcc: A Systematic Review And Individual Patient Data Meta-Analysis, Parissa Tabrizian, Tarek I Hassanein, Shravan Dave, Veeral Ajmera, Sherrie Bhoori, Vincenzo Mazzaferro, David M H Chascsa, Margaret C Liu, Elizabeth S Aby, John R Lake, Miguel Sogbe, Bruno Sangro, Maen Abdelrahim, Abdullah Esmail, Andreas Schmiderer, Yasmina Chouik, Mark Rudolph, Davendra Sohal, Manon Allaire, Mehmet Akce, Jessica Guadagno, Clara Y Tow, Hatef Massoumi, Paolo De Simone, Elise Kang, Robyn D Gartrell, Mercedes Martinez, Ricardo Paz-Fumagalli, Beau B Toskich, Nguyen H Tran, Gabriela Azevedo Solino, Dra Mariana Poltronieri Pacheco, Richard S Kalman, Vatche G Agopian, Neil Mehta, Neehar D Parikh, Amit G Singal, Ju Dong Yang

Faculty, Staff and Student Publications

Background & aims: Treatment with immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC) prior to liver transplantation (LT) has been reported; however, ICIs may elevate the risk of allograft rejection and impact other clinical outcomes. This study aims to summarize the impact of ICI use on post-LT outcomes.

Methods: In this individual patient data meta-analysis, we searched databases to identify HCC cases treated with ICIs before LT, detailing allograft rejection, HCC recurrence, and overall survival. We performed Cox regression analysis to identify risk factors for allograft rejection.

Results: Among 91 eligible patients, with a median (IQR) follow-up of 690.0 (654.5) …

Community Engagement Studios To Improve Racial Diversity And Health Equity In Parkinson’S, Peter S Myers, Joyce E Balls-Berry, Erin R Foster

Faculty, Staff and Student Publications

Background: Black or African Americans (AA) with Parkinson's disease (PD) are underrepresented in both care and research and experience significant health disparities. The existing literature provides limited guidance on how to enhance the engagement of AA individuals in PD care and research, particularly from the perspectives of AA patients, care partners, and healthcare providers. This project aimed to (1) describe the use of Community Engagement (CE) Studios as a community-engaged research approach to inform culturally appropriate and inclusive research and (2) examine factors influencing AA engagement in PD-related activities.

Methods: We conducted three CE Studios: one with AA with PD …

Prevalence Of Cannabis Use Disorders And Associated Factors Among Privately Insured Adults With Epilepsy, Robert Addy

Faculty, Staff and Student Publications

Background: As cannabis is increasingly used as a treatment option for epilepsy, people with epilepsy (PWE) may be at higher risk of developing cannabis use disorder (CUD). This study aimed to estimate the prevalence of CUD among privately insured PWE in the United States using IQVIA's 2022 PharMetrics® Plus for Academics health plan claims database.

Methods: A cross-sectional analysis was conducted using 2022 IQVIA PharMetrics® Plus for Academics health plan claims data containing longitudinal view of inpatient and outpatient services, prescription and office/outpatient administered drugs, costs and detailed enrollment information. Individuals with epilepsy aged 18 years and older were included. …

Large-Vessel Occlusion Stroke Knowledge And Training For Stroke Severity Assessment Among Emergency Medical Services Personnel In The United States, Youngran Kim, Alicia Castonguay, Prateek Kumar, Ashutosh P Jhadav, Dileep Yavagal, May Nour, Gabor Toth, Maxim Mokin, Sunil A Sheth, Mouhammad A Jumaa, Alhamza Al-Bayati, Mohamed Teleb, Ossama Y Mansour, Shashvat M Desai, Joshua Hartman, David S Liebeskind, Ameer E Hassan, Brijesh P Mehta

Faculty, Staff and Student Publications

Background: Prehospital identification of large-vessel occlusion (LVO) stroke facilitates the development of a regional triage protocol that could lead to an improvement in intrahospital and interhospital workflows. This requires stroke education of emergency medical services (EMS) personnel to improve stroke recognition, severity assessment, and prenotification. However, the current state of EMS personnel's knowledge of LVO stroke, their training for stroke severity assessment, and their preferences for educational methods are unknown. We conducted a nationwide EMS survey across the United States to glean insights that can inform and customize future EMS educational efforts.

Methods: The Society of Vascular and Interventional Neurology, …

Cardiovascular Risk Factors And Genetic Risk In Transthyretin V142i Carriers, Alanna C Morrison, Bing Yu, Bruce M Psaty, Charles Kooperberg, Diane Fatkin, Eric Boerwinkle, Jerome I Rotter, Kent D Taylor, Lifang Hou, Marguerite R Irvin, Michael E Hall, Mathew Maurer, Myriam Fornage, Nicole D Armstrong, Nicole Bart, Parag Goyal, Stephen S Rich, Ramachandran S Vasan, Garima Arora, Pankaj Arora

Faculty, Staff and Student Publications

Background: Nearly 3% to 4% of Black individuals in the United States carry the transthyretin V142I variant, which increases their risk of heart failure. However, the role of cardiovascular (CV) risk factors (RFs) in influencing the risk of clinical outcomes among V142I variant carriers is unknown.

Objectives: This study aimed to assess the impact of CV RFs on the risk of heart failure in V142I carriers.

Methods: This study included self-identified Black individuals without prevalent heart failure from 6 TOPMed (Trans-Omics for Precision Medicine) cohorts, the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, and the All of …

Formication With Destruction Of The Nasal Septum: A Rare Case Report

Faculty, Staff and Student Publications

Delusions of parasitosis are known by several names, one of which is formication. It is an uncommon psychiatric disorder listed in the DSM V under the classification of delusional disorders. Patients experience an established, incorrect belief that they have an infection of living organisms such as parasites. There are two types of delusions of parasitosis, primary and secondary. In the primary form, the symptom is the delusion of a parasitic infection without secondary cause. The secondary form includes this symptom as well as additional psychiatric disorder, drug abuse, or medical illness. Patients often seek consultation with dental providers for dental …

Correction: Roles Of Specialized Pro-Resolving Mediators And Omega-3 Polyunsaturated Fatty Acids In Periodontal Inflammation And Impact On Oral Microbiota

Faculty, Staff and Student Publications

This corrects the article "Roles of specialized pro-resolving mediators and omega-3 polyunsaturated fatty acids in periodontal inflammation and impact on oral microbiota" in volume 4, 1217088.

Protective Effects Of Psychiatric Medications Against Covid-19 Mortality Before Vaccines, Lokesh R Shahani, Chau N Truong

Faculty, Staff and Student Publications

The coronavirus disease pandemic caused by the coronavirus SARS-CoV-2, which emerged in the United States in late 2019 to early 2020 and quickly escalated into a national public health crisis. Research has identified psychiatric conditions as possible risk factors associated with COVID-19 infection and symptom severity. This study aims to determine whether specific classes of psychiatric medications could reduce the likelihood of infection and alleviate the severity of the disease. The objective of this study is to investigate the relationship between neuropsychiatric medication usage and COVID-19 outcomes before the widespread utilization of COVID-19 vaccines. This cross-sectional study used Optum's de-identified …

Risk And Prognosis Of Hepatocellular Carcinoma In Mexican Americans With Type 2 Diabetes Mellitus, Prasun K Jalal, Yun Shin Chun, Asif Rashid, Ahmed O Kaseb, Paul A Scheet, Manal M Hassan

Faculty, Staff and Student Publications

INTRODUCTION: Hepatocellular carcinoma (HCC) disproportionately affects Hispanic persons with higher age-specific incidence and increased mortality rates compared to non-Hispanic Whites. These high rates of incidence and mortality may be explained by the variation in risk factors. Given the high prevalence of type 2 diabetes mellitus (DM) among the Hispanic population, we aimed to assess the risk and prognosis of HCC in Mexican Americans with type 2 DM with consideration of treatment for DM.

METHODS: A case-control study of 241 Mexican American HCC patients and 500 healthy controls in Texas was conducted. Multivariable logistic regression analysis was performed to determine the …

A Systematic Review And Narrative Synthesis Of Factors Affecting Pre-Exposure Prophylaxis Willingness Among Black Women For Hiv Prevention, Nivedhitha Parthasarathy

Faculty, Staff and Student Publications

Pre-exposure prophylaxis (PrEP) can significantly reduce human immunodeficiency virus (HIV) transmission among Black women in the United States (U.S.), a group disproportionately affected by HIV. However, PrEP uptake in this HIV-vulnerable population is low. This review analyzes the factors influencing Black women's PrEP willingness using the Behavioral Model for Vulnerable Populations (BMVP). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison, Outcome, Study Design (PICOS) framework, we conducted a systematic literature search and selected 24 peer-reviewed studies on PrEP willingness. Narrative synthesis revealed a heterogeneous landscape of the determinants affecting PrEP willingness …

Spiritual Exercises In Novarodok Mussar And The Early Work, Martin Zwick

Complex Systems Faculty Publications and Presentations

This paper compares aspects of the teachings launched in pre-revolutionary and revolutionary Russia of two spiritual figures: Rabbi Yoseph Yozel Horwitz and George Gurdjieff. Yozel founded the Novarodok school of Mussar within Judaism; Gurdjieff founded the spiritual tradition known as “the Work” or “Fourth Way.” There are of course great differences between Judaism and the Work, but some similarities might be expected between spiritual disciplines, especially similarities in practice as opposed to doctrine. This paper explores similarities of some spiritual exercises in the Mussar school of Novarodok and secondarily in later or other Mussar teachings and in the early Gurdjieff …

Largely Enhanced Out-Of-Plane Electromechanical Coupling Effects In Two-Dimensional Molybdenum-Disulfide/Boron-Nitride Heterostructures, Qiong Liu, Vijay Kumar Choyal, James E. Morris, Timon Rabczuk, Xiaoning Jiang, Xiaoying Zhuang

Electrical and Computer Engineering Faculty Publications and Presentations

The electromechanical coupling effects in two-dimensional (2D) transition metal dichalcogenides (TMDs) have attracted great interest. However, for 2D TMDs, piezoelectricity is confined to the basal plane, and the flexoelectricity-derived out-of-plane electromechanical response is usually faint, limiting the applications of this material family using the out-of-plane electromechanical effects. Here, this work reports a facile strategy to greatly enhance the out-of-plane electromechanical response of hexagonal molybdenum disulfide (2H-MoS₂) nanoflakes by stacking monolayer hexagonal boron nitride (h-BN) on 2H-MoS₂ nanoflakes to form MoS₂/BN heterostructures. The d^eff/₃₃ coefficient of MoS₂/BN can reach a value comparable …

Ecobuoys For Scalable Oceanography, Anuscheh Nawaz, Michael Steele, Ruth Branch, David Burnett, Kuotian Liao, Mallory Parker, Eleftheria Roumeli

Electrical and Computer Engineering Faculty Publications and Presentations

An approach to scalable surface-drifting buoys is needed to enable the high spatial and temporal resolution of oceanographic data that the science and meteorological communities are asking for. With the number of active buoys predicted to increase by a factor of 100 or more, the impact on the environment becomes even more important. Here, we present a pathway to a scalable and sustainable generation of buoys. We identify the main criteria to be used when developing such buoys to be low cost, with reliable data and neutral or even positive environmental impact. For each buoy subsystem—hull, electronics, energy generation and …

An Offline Approach For Frequency Event Detection In Power Systems: Tkeo And Statistical Analysis, Hussain A. Alghamdi, Midrar Adham, Umar Farooq, Robert Bass

Electrical and Computer Engineering Faculty Publications and Presentations

The increasing integration of renewable energy sources in power grids and the transition from conventional thermal-based generation to inverter-based resources for power generation have reduced power system inertia and increased the rate of change of frequency, which constitutes a challenge for frequency stability in modern power systems. These changes necessitate robust frequency event detection algorithms that can rapidly and accurately identify events, providing essential support to maintain stability. This paper proposes a frequency event detection algorithm with six tunable parameters for offline post-processing, leveraging the Teager-Kaiser Energy Operator method and statistical analysis. The algorithm is tested on a dataset comprised …

Work In Progress: Using Internships As Means For Indirect Assessment Of Abet Criteria 3 “1-7” Student Outcomes, Robert Bass

Electrical and Computer Engineering Faculty Publications and Presentations

The Electrical & Computer Engineering (ECE) Department at Portland State University (PSU) has developed a Power Engineering Internship (PEI) program that provides engineering career development pathways within the electric utility industry. The PEI is supported by several U.S. Department of Energy grants that aim to develop quality career opportunities and develop a future electric utility workforce that represents the nation’s diverse populations. The PSU ECE Department intends to use surveys of internship participants as assessment tools for its ABET accreditation process, in particular, the ABET Criteria 3 Student Outcomes (SOs). SOs relate to the knowledge, skills, and behaviors that students …

Building Patient-Facing Technology: A Redcap-Based Approach, Yun Jiang, Yang Gong

Faculty, Staff and Student Publications

This work describes the architecture design of a patient-facing technology (PFT) based on the Research Electronic Data Capture (REDCap) platform and other tools to support cancer patients in self-tracking and managing medication concerns and symptoms during transitions of care. The design is guided by the Chronic Care Model (CCM) and User-Centered Design (UCD) principles for a personalized application to inform, engage, and empower patients. We describe the evolutional details of four major versions, which represent milestones of our PFT, highlighting how specific objectives were achieved and the barriers encountered. Additionally, patient representatives were involved in the evaluation of prototypes, and …

Unraveling Complex Temporal Patterns In Ehrs Via Robust Irregular Tensor Factorization, Joyce C Ho, Xiaoqian Jiang, Sivasubramanium V Bhavani

Faculty, Staff and Student Publications

Electronic health records (EHRs) contain diverse patient data with varying visit frequencies. While irregular tensor factorization techniques such as PARAFAC2 have been used for extracting meaningful medical concepts from EHRs, existing methods fail to capture non-linear and complex temporal patterns and struggle with missing entries. In this paper, we propose REPAR, an RNN REgularized Robust PARAFAC2 method to model complex temporal dependencies and enhance robustness in the presence of missing data. Our approach employs Recurrent Neural Networks (RNNs) for temporal regularization and a low-rank constraint for robustness, enabling precise patient subgroup identification and improved clinical decision-making in noisy EHR data. …

Generalizable Self-Supervised Learning For Brain Cta In Acute Stroke, Sunil A Sheth, Luca Giancardo

Faculty, Staff and Student Publications

Acute stroke management involves rapid and accurate interpretation of CTA imaging data. However, generalizable models for multiple acute stroke tasks able to learn from unlabeled data do not exist. We propose a linear probed self-supervised contrastive learning utilizing 3D CTA images and the findings section of radiologists' reports for pretraining. Subsequently, the pretrained model was applied to four disparate tasks: large vessel occlusion (LVO) detection, acute ischemic stroke detection, acute ischemic stroke, intracerebral hemorrhage classification, and ischemic core volume prediction. The tasks chosen are particularly challenging as they cannot be directly extracted from the radiology reports findings with keywords. The …

Pain Phenotyping Indicators In Older Adults With Chronic Low Back Pain: A Secondary Analysis Of A Randomized Controlled Trial, Jennifer Kawi, Constance M Johnson, Paul J Christo, Claudia M Campbell

Faculty, Staff and Student Publications

Purpose: A multimodal approach to clinical care is often recommended for chronic low back pain (cLBP); however, treatment responses are highly variable. Phenotyping could help determine subgroups of patients, allowing for targeted and tailored interventional approaches.

Patients and methods: 263 (Mage=69.8 (7.2); 64.6% female) individuals with cLBP participated in the parent study, a 3-arm, randomized clinical trial examining auricular point acupressure treatment outcomes. Parent study participants were randomized (1:1:1) to APA ear points targeted to cLBP (T-APA, n=92), non-targeted to cLBP (NT-APA, n=91), or education control (n=89). The current study used latent class analysis to identify clustering for pain severity …

Explainable Diagnosis Prediction Through Neuro-Symbolic Integration, Jinlian Wang, Liwei Wang, Jungwei W Fan, Hongfang Liu

Faculty, Staff and Student Publications

Diagnosis prediction is a critical task in healthcare, where timely and accurate identification of medical conditions can significantly impact patient outcomes. Traditional machine learning and deep learning models have achieved notable success in this domain but often lack interpretability which is a crucial requirement in clinical settings. In this study, we explore the use of neuro-symbolic methods, specifically Logical Neural Networks (LNNs), to develop explainable models for diagnosis prediction. Essentially, we design and implement LNN-based models that integrate domain-specific knowledge through logical rules with learnable weights and thresholds. Our models, particularly Mmulti-pathway and Mcomprehensive, demonstrate superior performance over traditional models …

Reusable Generic Clinical Decision Support System Module For Immunization Recommendations In Resource-Constraint Settings, Hua Min, Yang Gong, Dean F Sittig, Paul Biondich, Adam Wright, Christian Nøhr, Timothy Law, David Robinson, Arild Faxvaag, Nina Hubig, Ronald Gimbel, Lior Rennert, Xia Jing

Faculty, Staff and Student Publications

Clinical decision support systems (CDSS) are routinely employed in clinical settings to improve quality of care, ensure patient safety, and deliver consistent medical care. However, rule-based CDSS, currently available, do not feature reusable rules. In this study, we present CDSS with reusable rules. Our solution includes a common CDSS module, electronic medical record (EMR) specific adapters, CDSS rules written in the clinical quality language (CQL) (derived from CDC immunization recommendations), and patient records in fast healthcare interoperability resources (FHIR) format. The proposed CDSS is entirely browser-based and reachable within the user's EMR interface at the client-side. This helps to avoid …

Temporal Ensemble Logic For Integrative Representation Of The Entirety Of Clinical Trials, Hongyu Chen, Pengze Li, Xing He, Shiqiang Tao, Cui Tao, Jiang Bian, Licong Cui, Guo-Qiang Zhang

Faculty, Staff and Student Publications

Clinical trials are typically specified with protocols that define eligibility criteria, treatment regimens, follow-up schedules, and outcome assessments. Temporality is a hallmark of all clinical trials, reflected within and across trial components, with complex dependencies unfolding across multiple time points. Despite their importance, clinical trial protocols are described in free-text format, limiting their semantic precision and the ability to support automated reasoning, leverage data across studies and sites, or simulate trial execution under varying assumptions using Real-World Data. This paper introduces a formalized representation of clinical trials using Temporal Ensemble Logic (TEL). TEL incorporates metricized modal operators, such as “always …