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Cross-Sectional Analysis Of Primary Care Clinics' Policies, Practices, And Availability Of Patient Support Services During The Covid-19 Pandemic, Kendra Ratnapradipa, Runqiu Wang, Josiane Kabayundo, Walter Marquez Lavenant, Eleanore Nelson, Muskan Ahuja, Ying Zhang, Hongmei Wang Jan 2024

Cross-Sectional Analysis Of Primary Care Clinics' Policies, Practices, And Availability Of Patient Support Services During The Covid-19 Pandemic, Kendra Ratnapradipa, Runqiu Wang, Josiane Kabayundo, Walter Marquez Lavenant, Eleanore Nelson, Muskan Ahuja, Ying Zhang, Hongmei Wang

Journal Articles: Epidemiology

BACKGROUND: Healthcare accessibility and utilization are important social determinants of health. Lack of access to healthcare, including missed or no-show appointments, can have negative health effects and be costly to patients and providers. Various office-based approaches and community partnerships can address patient access barriers.

OBJECTIVES: (1) To understand provider perceptions of patient barriers; (2) to describe the policies and practices used to address late or missed appointments, and (3) to evaluate access to patient support services, both in-clinic and with community partners.

METHODS: Mailed cross-sectional survey with online response option, sent to all Nebraska primary care clinics (n = 577) …


Understanding Gendered Risks For Severe Covid-19 Through Surveying The Gender Diverse Community, Arden Kimme Aug 2023

Understanding Gendered Risks For Severe Covid-19 Through Surveying The Gender Diverse Community, Arden Kimme

Capstone Experience

Early on in the pandemic, the medical community began noticing that men were more likely to be hospitalized, require admission to the ICU, and die of COVID-19 than women but few studies of COVID-19 make mention of gender diverse people, an often-overlooked population who may have vastly different experiences than non-gender diverse men or women. Their variations in gender and sex characteristics may also help provide further insight into which traits are protective or risk factors for this disease. This project used Poisson regression in order to analyze self-reported survey data. The major associations of interest will be between disease …


Assessing Occupational Exposure Risk And Covid-19 Incidence Rates In Nebraska By Industry And Occupation, 2020, Christopher Austin May 2023

Assessing Occupational Exposure Risk And Covid-19 Incidence Rates In Nebraska By Industry And Occupation, 2020, Christopher Austin

Capstone Experience

Occupational outbreaks of COVID-19 have been described during the pandemic, yet the epidemiology of COVID-19 across a larger workforce population is currently not well characterized in the United States. Describing COVID-19 incident rates by industry and occupation will elucidate how the pandemic affected the workforce in Nebraska. However, nonresponse bias occurs in the employment information when participants are unwilling or unable to respond to contract tracer questions, thus affecting the results. Nonresponse bias will be analyzed, and appropriate statistical approaches will be utilized to adjust for any bias in the data. Adjusting for bias, incidence rates by detailed industry and …


Comprehensive Literature Review: Assessing The Impact Of Covid-19 Policies, School Closures And Social Distancing, On The Mental Health Of School Age Children, Fatuma A. Hassan May 2023

Comprehensive Literature Review: Assessing The Impact Of Covid-19 Policies, School Closures And Social Distancing, On The Mental Health Of School Age Children, Fatuma A. Hassan

Capstone Experience

Mental health is vital to the well-being of all individuals, especially children. COVID-19 unveiled a significant public health issue with poor mental health during the pandemic. There is limited literature about the mental health implications of COVID-19 policies for children and adolescents and preventive strategies for future pandemics. This comprehensive literature review seeks to further investigate the mental health impacts of school shutdowns and social distancing, which were nonpharmaceutical strategies, on school-aged children, 5-18 years old, and propose recommendations for public health officials to mitigate the mental health impacts for future pandemics. Additionally, the review aims to highlight the potential …


Angiopoietin-Like4 Is A Novel Marker Of Covid-19 Severity, Pavan K. Bhatraju, Eric D. Morrell, Ian B. Stanaway, Neha A. Sathe, Avantika Srivastava, Radu Postelnicu, Richard Green, Adair Andrews, Martin Gonzalez, Christopher J. Kratochvil, Vishakha K. Kumar, Tien-Ying Hsiang, Michael Gale, George L. Anesi, David Wyles, M. Jana Broadhurst, David Brett-Major, Vikramjit Mukherjee, Jonathan E. Sevransky, Douglas Landsittel, Chi Hung, William A Altemeier, Sina A. Gharib, Timothy M. Uyeki, J. Perren Cobb, Janice M. Liebler, David R. Crosslin, Gail P. Jarvik, Leopoldo N. Segal, Laura Evans, Carmen Mikacenic, Mark M. Wurfel Jan 2023

Angiopoietin-Like4 Is A Novel Marker Of Covid-19 Severity, Pavan K. Bhatraju, Eric D. Morrell, Ian B. Stanaway, Neha A. Sathe, Avantika Srivastava, Radu Postelnicu, Richard Green, Adair Andrews, Martin Gonzalez, Christopher J. Kratochvil, Vishakha K. Kumar, Tien-Ying Hsiang, Michael Gale, George L. Anesi, David Wyles, M. Jana Broadhurst, David Brett-Major, Vikramjit Mukherjee, Jonathan E. Sevransky, Douglas Landsittel, Chi Hung, William A Altemeier, Sina A. Gharib, Timothy M. Uyeki, J. Perren Cobb, Janice M. Liebler, David R. Crosslin, Gail P. Jarvik, Leopoldo N. Segal, Laura Evans, Carmen Mikacenic, Mark M. Wurfel

Journal Articles: Epidemiology

IMPORTANCE: Vascular dysfunction and capillary leak are common in critically ill COVID-19 patients, but identification of endothelial pathways involved in COVID-19 pathogenesis has been limited. Angiopoietin-like 4 (ANGPTL4) is a protein secreted in response to hypoxic and nutrient-poor conditions that has a variety of biological effects including vascular injury and capillary leak.

OBJECTIVES: To assess the role of ANGPTL4 in COVID-19-related outcomes.

DESIGN SETTING AND PARTICIPANTS: Two hundred twenty-five COVID-19 ICU patients were enrolled from April 2020 to May 2021 in a prospective, multicenter cohort study from three different medical centers, University of Washington, University of Southern California and New …


How The Commonwealth Of The Northern Mariana Islands Stalled Covid-19 For 22 Months And Managed Its First Significant Community Transmission, Dwayne Davis, Stephanie Kern-Allely, Lily Muldoon, John M. Tudela, Jesse Tudela, Renea Raho, Heather S. Pangelinan, Halina Palacios, John Tabaguel, Alan Hinson, Guillermo Lifoifoi, Warren Villagomez, Joseph R. Fauver, Haley L. Cash, Esther Muña, Sean T. Casey, Ali S. Khan Jan 2023

How The Commonwealth Of The Northern Mariana Islands Stalled Covid-19 For 22 Months And Managed Its First Significant Community Transmission, Dwayne Davis, Stephanie Kern-Allely, Lily Muldoon, John M. Tudela, Jesse Tudela, Renea Raho, Heather S. Pangelinan, Halina Palacios, John Tabaguel, Alan Hinson, Guillermo Lifoifoi, Warren Villagomez, Joseph R. Fauver, Haley L. Cash, Esther Muña, Sean T. Casey, Ali S. Khan

Journal Articles: Epidemiology

OBJECTIVE: The Commonwealth of the Northern Mariana Islands (CNMI) is a remote Pacific island territory with a population of 47 329 that successfully prevented the significant introduction of coronavirus disease (COVID-19) until late 2021. This study documents how the response to the introduction of COVID-19 in CNMI in 2021 was conducted with limited resources without overwhelming local clinical capacity or compromising health service delivery for the population.

METHODS: Data from COVID-19 case investigations, contact tracing, the Commonwealth's immunization registry and whole genome sequencing were collated and analysed as part of this study.

RESULTS: Between 26 March 2020 and 31 December …


Overlooked Sex And Gender Aspects Of Emerging Infectious Disease Outbreaks: Lessons Learned From Covid-19 To Move Towards Health Equity In Pandemic Response, Lynn Lieberman Lawry, Roberta Lugo-Robles, Vicki Mciver Jan 2023

Overlooked Sex And Gender Aspects Of Emerging Infectious Disease Outbreaks: Lessons Learned From Covid-19 To Move Towards Health Equity In Pandemic Response, Lynn Lieberman Lawry, Roberta Lugo-Robles, Vicki Mciver

Journal Articles: Epidemiology

Sex and gender issues are especially important in emerging infectious diseases (EIDs) but are routinely overlooked despite data and practice. Each of these have an effect either directly, via the effects on vulnerability to infectious diseases, exposures to infectious pathogens, and responses to illness, and indirectly through effects on disease prevention and control programs. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the viral agent of coronavirus disease 2019 (COVID-19) has underscored the importance of understanding the sex and gender impacts on pandemics. This review takes a broader looks at how sex and gender impact vulnerability, exposure risk, and treatment and …


Accelerated Sars-Cov-2 Intrahost Evolution Leading To Distinct Genotypes During Chronic Infection, Chrispin Chaguza, Anne M. Hahn, Mary E. Petrone, Shuntai Zhou, David Ferguson, Mallery I. Breban, Kien Pham, Mario A. Peña-Hernández, Christopher Castaldi, Verity Hill, Yale Sars-Cov-2 Genomic Surveillance Initiative, Wade Schulz, Ronald I. Swanstrom, Scott C. Roberts, Nathan D. Grubaugh, Kendall Billig, Rebecca Earnest, Joseph R. Fauver, Chaney C. Kalinch, Nicholas Kerantzas, Tobias R. Koch, Bony De Kumar, Marie L. Landry, Isabel M. Ott, David Peaper, Irina R. Tikhonova, Chantal B. F. Vogels Jan 2023

Accelerated Sars-Cov-2 Intrahost Evolution Leading To Distinct Genotypes During Chronic Infection, Chrispin Chaguza, Anne M. Hahn, Mary E. Petrone, Shuntai Zhou, David Ferguson, Mallery I. Breban, Kien Pham, Mario A. Peña-Hernández, Christopher Castaldi, Verity Hill, Yale Sars-Cov-2 Genomic Surveillance Initiative, Wade Schulz, Ronald I. Swanstrom, Scott C. Roberts, Nathan D. Grubaugh, Kendall Billig, Rebecca Earnest, Joseph R. Fauver, Chaney C. Kalinch, Nicholas Kerantzas, Tobias R. Koch, Bony De Kumar, Marie L. Landry, Isabel M. Ott, David Peaper, Irina R. Tikhonova, Chantal B. F. Vogels

Journal Articles: Epidemiology

The chronic infection hypothesis for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant emergence is increasingly gaining credence following the appearance of Omicron. Here, we investigate intrahost evolution and genetic diversity of lineage B.1.517 during a SARS-CoV-2 chronic infection lasting for 471 days (and still ongoing) with consistently recovered infectious virus and high viral genome copies. During the infection, we find an accelerated virus evolutionary rate translating to 35 nucleotide substitutions per year, approximately 2-fold higher than the global SARS-CoV-2 evolutionary rate. This intrahost evolution results in the emergence and persistence of at least three genetically distinct genotypes, suggesting …


Nasal Host Response-Based Screening For Undiagnosed Respiratory Viruses: A Pathogen Surveillance And Detection Study, Nagarjuna R. Cheemarla, Amelia Hanron, Joseph R. Fauver, Jason Bishai, Timothy A. Watkins, Anderson F. Brito, Dejian Zhao, Tara Alpert, Chantal B. F. Vogels, Albert I. Ko, Wade L. Schulz, Marie L. Landry, Nathan D. Grubaugh, David Van Dijk, Ellen F. Foxman Jan 2023

Nasal Host Response-Based Screening For Undiagnosed Respiratory Viruses: A Pathogen Surveillance And Detection Study, Nagarjuna R. Cheemarla, Amelia Hanron, Joseph R. Fauver, Jason Bishai, Timothy A. Watkins, Anderson F. Brito, Dejian Zhao, Tara Alpert, Chantal B. F. Vogels, Albert I. Ko, Wade L. Schulz, Marie L. Landry, Nathan D. Grubaugh, David Van Dijk, Ellen F. Foxman

Journal Articles: Epidemiology

BACKGROUND: Symptomatic patients who test negative for common viruses are an important possible source of unrecognised or emerging pathogens, but metagenomic sequencing of all samples is inefficient because of the low likelihood of finding a pathogen in any given sample. We aimed to determine whether nasopharyngeal CXCL10 screening could be used as a strategy to enrich for samples containing undiagnosed viruses.

METHODS: In this pathogen surveillance and detection study, we measured CXCL10 concentrations from nasopharyngeal swabs from patients in the Yale New Haven health-care system, which had been tested at the Yale New Haven Hospital Clinical Virology Laboratory (New Haven, …


Viral Kinetics Of Sequential Sars-Cov-2 Infections, Stephen M. Kissler, James A. Hay, Joseph R. Fauver, Christina Mack, Caroline G. Tai, Deverick J. Anderson, David D. Ho, Nathan D. Grubaugh, Yonatan H. Grad Jan 2023

Viral Kinetics Of Sequential Sars-Cov-2 Infections, Stephen M. Kissler, James A. Hay, Joseph R. Fauver, Christina Mack, Caroline G. Tai, Deverick J. Anderson, David D. Ho, Nathan D. Grubaugh, Yonatan H. Grad

Journal Articles: Epidemiology

The impact of a prior SARS-CoV-2 infection on the progression of subsequent infections has been unclear. Using a convenience sample of 94,812 longitudinal RT-qPCR measurements from anterior nares and oropharyngeal swabs, we identified 71 individuals with two well-sampled SARS-CoV-2 infections between March 11th, 2020, and July 28th, 2022. We compared the SARS-CoV-2 viral kinetics of first vs. second infections in this group, adjusting for viral variant, vaccination status, and age. Relative to first infections, second infections usually featured a faster clearance time. Furthermore, a person's relative (rank-order) viral clearance time, compared to others infected with the …


Nonsystematic Reporting Biases Of The Sars-Cov-2 Variant Mu Could Impact Our Understanding Of The Epidemiological Dynamics Of Emerging Variants, Mary E. Petrone, Carolina Lucas, Bridget Menasche, Mallery I. Breban, Inci Yildirim, Melissa Campbell, Saad B. Omer, Edward C. Holmes, Albert I. Ko, Nathan D. Grubaugh, Akiko Iwasaki, Craig B. Wilen, Chantal B. F. Vogels, Joseph R. Fauver Jan 2023

Nonsystematic Reporting Biases Of The Sars-Cov-2 Variant Mu Could Impact Our Understanding Of The Epidemiological Dynamics Of Emerging Variants, Mary E. Petrone, Carolina Lucas, Bridget Menasche, Mallery I. Breban, Inci Yildirim, Melissa Campbell, Saad B. Omer, Edward C. Holmes, Albert I. Ko, Nathan D. Grubaugh, Akiko Iwasaki, Craig B. Wilen, Chantal B. F. Vogels, Joseph R. Fauver

Journal Articles: Epidemiology

Developing a timely and effective response to emerging SARS-CoV-2 variants of concern (VOCs) is of paramount public health importance. Global health surveillance does not rely on genomic data alone to identify concerning variants when they emerge. Instead, methods that utilize genomic data to estimate the epidemiological dynamics of emerging lineages have the potential to serve as an early warning system. However, these methods assume that genomic data are uniformly reported across circulating lineages. In this study, we analyze differences in reporting delays among SARS-CoV-2 VOCs as a plausible explanation for the timing of the global response to the former VOC …


1-Check Unmc Mobile App Usage: A Quantitative Analysis Of The Data, Molly Pofahl May 2022

1-Check Unmc Mobile App Usage: A Quantitative Analysis Of The Data, Molly Pofahl

Theses & Dissertations

As COVID-19 cases continued to rise in Nebraska, universities and colleges were faced with unique challenges in the effort to continue providing quality education for students. The University of Nebraska Medical Center (UNMC) took on especially difficult challenges due to its status as an academic medical center. By the Fall of 2021, students, faculty, and staff were beginning to return to campus. The 1-Check UNMC app was created to help keep sick people from coming to campus. The UNMC community was expected to screen themselves for COVID-19 using this app each day before coming to campus. This thesis is an …


A Systematic Literature Review Of The Use Of Technology As An Emergency Preparedness Tool To Control And Contain The Covid-19 Pandemic, Alyssa Spartz May 2022

A Systematic Literature Review Of The Use Of Technology As An Emergency Preparedness Tool To Control And Contain The Covid-19 Pandemic, Alyssa Spartz

Capstone Experience

Various tools and strategies have been utilized in response to the COVID-19 pandemic. In addition to preexisting measures, novel mechanisms and methods have also been developed since the COVID-19 pandemic began to address several different needs worldwide. Technology, for example, has served as a unique and multifunctional tool to aid with controlling and containing the pandemic. While studies and reviews have been conducted to analyze specific types of technology, such as digital applications, a gap in the literature currently exists that fails to comprehensively understand and compare how multiple types of technology were implemented to address the COVID-19 pandemic. This …


Severe Acute Respiratory Infection-Preparedness: Protocol For A Multicenter Prospective Cohort Study Of Viral Respiratory Infections, Radu Postelnicu, Avantika Srivastava, Pavan K. Bhatraju, Mark M. Wurfelc, George L. Anesi, Martin Gonzalez, Adair Andrews, Karen Lutrick, Vishakha K. Kumar, Timothy M. Uyeki, Perren J. Cobb, Leopoldo N. Segal, David Brett-Major, Janice M. Liebler, Christopher J. Kratochvil, Vikramjit Mukherjee, M. Jana Broadhurst, Richard Lee, David Wyles, Jonathan E Sevransky, Laura Evans, Douglas Landsittel Jan 2022

Severe Acute Respiratory Infection-Preparedness: Protocol For A Multicenter Prospective Cohort Study Of Viral Respiratory Infections, Radu Postelnicu, Avantika Srivastava, Pavan K. Bhatraju, Mark M. Wurfelc, George L. Anesi, Martin Gonzalez, Adair Andrews, Karen Lutrick, Vishakha K. Kumar, Timothy M. Uyeki, Perren J. Cobb, Leopoldo N. Segal, David Brett-Major, Janice M. Liebler, Christopher J. Kratochvil, Vikramjit Mukherjee, M. Jana Broadhurst, Richard Lee, David Wyles, Jonathan E Sevransky, Laura Evans, Douglas Landsittel

Journal Articles: Epidemiology

OBJECTIVES: Respiratory virus infections cause significant morbidity and mortality ranging from mild uncomplicated acute respiratory illness to severe complications, such as acute respiratory distress syndrome, multiple organ failure, and death during epidemics and pandemics. We present a protocol to systematically study patients with severe acute respiratory infection (SARI), including severe acute respiratory syndrome coronavirus 2, due to respiratory viral pathogens to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with clinical outcomes and severity.

DESIGN: Prospective cohort study.

SETTING: Multicenter cohort of patients admitted to an acute care ward or ICU from at least 15 hospitals …


Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection: A Case Series From A 12-Month Longitudinal Occupational Cohort, Christina D. Mack, Caroline Tai, Robby Sikka, Yonatan H. Grad, Lisa L. Maragakis, Nathan D. Grubaugh, Deverick J. Anderson, David Ho, Michael Merson, Radhika M. Samant, Joseph R. Fauver, James Barrett, Leroy Sims, John Difiori Jan 2022

Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection: A Case Series From A 12-Month Longitudinal Occupational Cohort, Christina D. Mack, Caroline Tai, Robby Sikka, Yonatan H. Grad, Lisa L. Maragakis, Nathan D. Grubaugh, Deverick J. Anderson, David Ho, Michael Merson, Radhika M. Samant, Joseph R. Fauver, James Barrett, Leroy Sims, John Difiori

Journal Articles: Epidemiology

Findings are described in 7 patients with severe acute respiratory syndrome coronavirus 2 reinfection from the National Basketball Association 2020-2021 occupational testing cohort, including clinical details, antibody test results, genomic sequencing, and longitudinal reverse-transcription polymerase chain reaction results. Reinfections were infrequent and varied in clinical presentation, viral dynamics, and immune response.


Lineage Abundance Estimation For Sars-Cov-2 In Wastewater Using Transcriptome Quantification Techniques, Jasmijn A. Baaijens, Alessandro Zulli, Isabel M. Ott, Ioanna Nika, Mart J. Van Der Lugt, Mary E. Petrone, Tara Alpert, Joseph R. Fauver, Chaney C. Kalinich, Chantal B. F. Vogels, Mallery I. Breban, Claire Duvallet, Kyle A. Mcelroy, Newsha Ghaeli, Maxim Imakaev, Malaika F. Mckenzie-Bennett, Keith Robison, Alex Plocik, Rebecca Schilling, Martha Pierson, Rebecca Littlefield, Michelle L. Spencer, Birgitte B. Simen, Yale Sars-Cov-2 Genomic Surveillance Initiative, William P. Hanage, Nathan D. Grubaugh, Jordan Peccia, Michael Baym Jan 2022

Lineage Abundance Estimation For Sars-Cov-2 In Wastewater Using Transcriptome Quantification Techniques, Jasmijn A. Baaijens, Alessandro Zulli, Isabel M. Ott, Ioanna Nika, Mart J. Van Der Lugt, Mary E. Petrone, Tara Alpert, Joseph R. Fauver, Chaney C. Kalinich, Chantal B. F. Vogels, Mallery I. Breban, Claire Duvallet, Kyle A. Mcelroy, Newsha Ghaeli, Maxim Imakaev, Malaika F. Mckenzie-Bennett, Keith Robison, Alex Plocik, Rebecca Schilling, Martha Pierson, Rebecca Littlefield, Michelle L. Spencer, Birgitte B. Simen, Yale Sars-Cov-2 Genomic Surveillance Initiative, William P. Hanage, Nathan D. Grubaugh, Jordan Peccia, Michael Baym

Journal Articles: Epidemiology

Effectively monitoring the spread of SARS-CoV-2 mutants is essential to efforts to counter the ongoing pandemic. Predicting lineage abundance from wastewater, however, is technically challenging. We show that by sequencing SARS-CoV-2 RNA in wastewater and applying algorithms initially used for transcriptome quantification, we can estimate lineage abundance in wastewater samples. We find high variability in signal among individual samples, but the overall trends match those observed from sequencing clinical samples. Thus, while clinical sequencing remains a more sensitive technique for population surveillance, wastewater sequencing can be used to monitor trends in mutant prevalence in situations where clinical sequencing is unavailable.


Uncertainty, Scarcity And Transparency: Public Health Ethics And Risk Communication In A Pandemic, Abigail Lowe, Teck Chuan Voo, Lisa M. Lee, Kelly K. Dineen Gillespie, Christy Feig, Alva O. Ferdinand, Seema Mohapatra, David Brett-Major, Matthew K. Wynia Jan 2022

Uncertainty, Scarcity And Transparency: Public Health Ethics And Risk Communication In A Pandemic, Abigail Lowe, Teck Chuan Voo, Lisa M. Lee, Kelly K. Dineen Gillespie, Christy Feig, Alva O. Ferdinand, Seema Mohapatra, David Brett-Major, Matthew K. Wynia

Journal Articles: Epidemiology

Communicating public health guidance is key to mitigating risk during disasters and outbreaks, and ethical guidance on communication emphasizes being fully transparent. Yet, communication during the pandemic has sometimes been fraught, due in part to practical and conceptual challenges around being transparent. A particular challenge has arisen when there was both evolving scientific knowledge on COVID-19 and reticence to acknowledge that resource scarcity concerns were influencing public health recommendations. This essay uses the example of communicating public health guidance on masking in the United States to illustrate ethical challenges of developing and conveying public health guidance under twin conditions of …


Gut Microbiome Dysbiosis In Antibiotic-Treated Covid-19 Patients Is Associated With Microbial Translocation And Bacteremia, Lucie Bernard-Raichon, Mericien Venzon, Jon Klein, Jordan E. Axelrad, Chenzhen Zhang, Alexis P. Sullivan, Grant A. Hussey, Arnau Casanovas-Massana, Maria G. Noval, Ana M. Valero-Jimenez, Juan Gago, Gregory Putzel, Alejandro Pironti, Evan Wilder, Yale Impact Research Team, Lorna E. Thorpe, Dan R. Littman, Meike Dittmann, Kenneth A. Stapleford, Bo Shopsin, Victor J. Torres, Albert I. Ko, Akiko Iwasaki, Ken Cadwell, Jonas Schluter, Abeer Obaid, Alice Lu-Culligan, Allison Nelson, Anderson Brito, Angela Nunez, Anjelica Martin, Annie Watkins, Bertie Geng, Chaney Kalinich, Christina Harden, Codruta Todeasa, Cole Jensen, Daniel Kim, David Mcdonald, Denise Shepard, Edward Courchaine, Elizabeth B. White, Eric Song, Erin Silva, Eriko Kudo, Giuseppe Deluliis, Harold Rahming, Hong-Jai Park, Irene Matos, Jessica Nouws, Jordan Valdez, Joseph R. Fauver, Joseph Lim, Kadi-Ann Rose, Kelly Anastasio, Kristina Brower, Laura Glick, Lokesh Sharma, Lorenzo Sewanan, Lynda Knaggs, Maksym Minasyan, Maria Batsu, Mary Petrone, Maxine Kuang, Maura Nakahata, Melissa Campbell, Melissa Linehan, Michael H. Askenase, Michael Simonov, Mikhail Smolgovsky, Nicole Sonnert, Nida Naushad Jan 2022

Gut Microbiome Dysbiosis In Antibiotic-Treated Covid-19 Patients Is Associated With Microbial Translocation And Bacteremia, Lucie Bernard-Raichon, Mericien Venzon, Jon Klein, Jordan E. Axelrad, Chenzhen Zhang, Alexis P. Sullivan, Grant A. Hussey, Arnau Casanovas-Massana, Maria G. Noval, Ana M. Valero-Jimenez, Juan Gago, Gregory Putzel, Alejandro Pironti, Evan Wilder, Yale Impact Research Team, Lorna E. Thorpe, Dan R. Littman, Meike Dittmann, Kenneth A. Stapleford, Bo Shopsin, Victor J. Torres, Albert I. Ko, Akiko Iwasaki, Ken Cadwell, Jonas Schluter, Abeer Obaid, Alice Lu-Culligan, Allison Nelson, Anderson Brito, Angela Nunez, Anjelica Martin, Annie Watkins, Bertie Geng, Chaney Kalinich, Christina Harden, Codruta Todeasa, Cole Jensen, Daniel Kim, David Mcdonald, Denise Shepard, Edward Courchaine, Elizabeth B. White, Eric Song, Erin Silva, Eriko Kudo, Giuseppe Deluliis, Harold Rahming, Hong-Jai Park, Irene Matos, Jessica Nouws, Jordan Valdez, Joseph R. Fauver, Joseph Lim, Kadi-Ann Rose, Kelly Anastasio, Kristina Brower, Laura Glick, Lokesh Sharma, Lorenzo Sewanan, Lynda Knaggs, Maksym Minasyan, Maria Batsu, Mary Petrone, Maxine Kuang, Maura Nakahata, Melissa Campbell, Melissa Linehan, Michael H. Askenase, Michael Simonov, Mikhail Smolgovsky, Nicole Sonnert, Nida Naushad

Journal Articles: Epidemiology

Although microbial populations in the gut microbiome are associated with COVID-19 severity, a causal impact on patient health has not been established. Here we provide evidence that gut microbiome dysbiosis is associated with translocation of bacteria into the blood during COVID-19, causing life-threatening secondary infections. We first demonstrate SARS-CoV-2 infection induces gut microbiome dysbiosis in mice, which correlated with alterations to Paneth cells and goblet cells, and markers of barrier permeability. Samples collected from 96 COVID-19 patients at two different clinical sites also revealed substantial gut microbiome dysbiosis, including blooms of opportunistic pathogenic bacterial genera known to include antimicrobial-resistant species. …


Quantifying The Impact Of Immune History And Variant On Sars-Cov-2 Viral Kinetics And Infection Rebound: A Retrospective Cohort Study, James A. Hay, Stephen M. Kissler, Joseph R. Fauver, Christina Mack, Caroline G. Tai, Radhika M. Samant, Sarah Connolly, Deverick J. Anderson, Gaurav Khullar, Matthew Mackay, Miral Patel, Shannan Kelly, April Manhertz, Isaac Eiter, Daisy Salgado, Tim Baker, Ben Howard, Joel T. Dudley, Christopher E. Mason, Manoj Nair, Yaoxing Huang, John Difiori, David D. Ho, Nathan D. Grubaugh, Yonatan H. Grad Jan 2022

Quantifying The Impact Of Immune History And Variant On Sars-Cov-2 Viral Kinetics And Infection Rebound: A Retrospective Cohort Study, James A. Hay, Stephen M. Kissler, Joseph R. Fauver, Christina Mack, Caroline G. Tai, Radhika M. Samant, Sarah Connolly, Deverick J. Anderson, Gaurav Khullar, Matthew Mackay, Miral Patel, Shannan Kelly, April Manhertz, Isaac Eiter, Daisy Salgado, Tim Baker, Ben Howard, Joel T. Dudley, Christopher E. Mason, Manoj Nair, Yaoxing Huang, John Difiori, David D. Ho, Nathan D. Grubaugh, Yonatan H. Grad

Journal Articles: Epidemiology

BACKGROUND: The combined impact of immunity and SARS-CoV-2 variants on viral kinetics during infections has been unclear.

METHODS: We characterized 1,280 infections from the National Basketball Association occupational health cohort identified between June 2020 and January 2022 using serial RT-qPCR testing. Logistic regression and semi-mechanistic viral RNA kinetics models were used to quantify the effect of age, variant, symptom status, infection history, vaccination status and antibody titer to the founder SARS-CoV-2 strain on the duration of potential infectiousness and overall viral kinetics. The frequency of viral rebounds was quantified under multiple cycle threshold (Ct) value-based definitions.

RESULTS: Among individuals detected …


Access, Socioeconomic Environment, And Death From Covid-19 In Nebraska, He Bai, Michelle M. Schwedhelm, John-Martin Lowe, Rachel Lookadoo, Daniel R. Anderson, Abigail Lowe, James V. Lawler, M. Jana Broadhurst, David Brett-Major Jan 2022

Access, Socioeconomic Environment, And Death From Covid-19 In Nebraska, He Bai, Michelle M. Schwedhelm, John-Martin Lowe, Rachel Lookadoo, Daniel R. Anderson, Abigail Lowe, James V. Lawler, M. Jana Broadhurst, David Brett-Major

Journal Articles: Epidemiology

Our study assesses whether factors related to healthcare access in the first year of the pandemic affect mortality and length of stay (LOS). Our cohort study examined hospitalized patients at Nebraska Medicine between April and October 2020 who were tested for SARS-CoV-2 and had a charted sepsis related diagnostic code. Multivariate logistic was used to analyze the odds of mortality and linear regression was used to calculate the parameter estimates of LOS associated with COVID-19 status, age, gender, race/ethnicity, median household income, admission month, and residential distance from definitive care. Among 475 admissions, the odds of mortality is greater among …


Impact Of Local Covid-19 Policies On The Homeless Population: Case Study In Two Montana Counties, Franchesca D. Talbot Dec 2021

Impact Of Local Covid-19 Policies On The Homeless Population: Case Study In Two Montana Counties, Franchesca D. Talbot

Capstone Experience

COVID-19 has had a significant impact on people experiencing homelessness in Montana. In each Montana County, local policies in addition to individual shelter policies determine the requirements for homeless shelters in relation to capacity, distancing, and other public health measures designed to prevent the spread of COVID-19. The policies often differ from county to county, which often lead to different outcomes across the state. This case study analyzed data from multiple sources on the number of COVID-19 cases and deaths among the homeless populations in Missoula and Lewis and Clark Counties in Montana and linked them to the effectiveness of …


The Impact Of Obesity On Covid-19 Outcomes In A High-Risk, Majority Hispanic Community Sample, Maxwell A. Lawlor Aug 2021

The Impact Of Obesity On Covid-19 Outcomes In A High-Risk, Majority Hispanic Community Sample, Maxwell A. Lawlor

Capstone Experience

The novel coronavirus disease 2019 (COVID-19) pandemic has caused over 33.7 million cases and 605,000 deaths in the United States1. Factors associated with increased odds for hospitalization, death, and other poor outcomes include age, comorbid conditions like cardiovascular disease and lung disease, and obesity. COVID-19 has also disproportionately affected Hispanic communities across the United States and in Omaha. Potential explanations for this disparity include social determinants of health, particularly occupational factors, structural challenges to access healthcare services, and increased medical comorbidities including obesity. In this retrospective cohort study, we used patient data from April to May 2020 (N=1,000) …


Case Study Of Nursing Home Residents: The Association Between Carbapenemase-Producing Enterobacteriaceae (Cpe) And Covid-19, Jordan Ranta May 2021

Case Study Of Nursing Home Residents: The Association Between Carbapenemase-Producing Enterobacteriaceae (Cpe) And Covid-19, Jordan Ranta

Capstone Experience

None


Factors Affecting The Mortality Rate Of Older Patients With Covid-19 In Nebraska: A Retrospective Cohort Study, Erin Johnson May 2021

Factors Affecting The Mortality Rate Of Older Patients With Covid-19 In Nebraska: A Retrospective Cohort Study, Erin Johnson

Capstone Experience

The pandemic spread of COVID-19 is a continued global health emergency. The objectives of this paper were to examine Factors affecting the mortality rate of older patients with COVID-19 in Nebraska. A longitudinal analysis of data gathered from the Nebraska Electronic Disease Surveillance System (NEDSS) was performed. Included were 322 individuals who tested positive for COVID-19 in the month of October 2020. The Kaplan-Meier method was used to estimate the time to death of individuals over the age of 65 after a positive COVID-19 diagnosis and the probability of survival to any given time point. The effect of multiple risk …


Workforce Assessment: Measuring The Impacts Of Covid-19 On The Maternal And Child Health Workforce, Ashleigh M. Sutphen May 2021

Workforce Assessment: Measuring The Impacts Of Covid-19 On The Maternal And Child Health Workforce, Ashleigh M. Sutphen

Capstone Experience

Workforce assessments provide an opportunity to assess, evaluate, and identify the needs of a particular workforce. The use of workforce assessments in the field of maternal and child health (MCH) has been an ongoing and a strongly supported effort by the Health Resources & Services Administration: Maternal and Child Health Bureau (MCHB). The maternal and child health workforce is responsible for providing essential public health services to some of the most vulnerable populations such as mothers, children, and people living with disabilities. Thus, the continuation of providing these essential public health services is critical – even in the midst of …


The Spatial-Temporal Model Of Covid-19 Tests, Cases, And Deaths In The State Of Nebraska, Makayla Schissel May 2021

The Spatial-Temporal Model Of Covid-19 Tests, Cases, And Deaths In The State Of Nebraska, Makayla Schissel

Capstone Experience

The goal of this project was to illustrate the spread of COVID-19 tests, cases, and deaths within the state of Nebraska and identify non-random clusters using a spatial-temporal model. This project is pertinent and innovative, as few spatial-temporal models in the United States revolving around COVID-19 offer information at the county, let alone, the state level. De-identified data was extracted from the State of Nebraska’s Department of Health and Human Services COVID-19 dashboard, transformed and prepared for analysis using SAS coding language. Clusters were identified though SaTScan software using a space-time permutation model. The model identified 5 different clusters related …


A Deeper Look: The Impacts Of Covid-19 Among Latinos In Omaha, Diana Molina May 2021

A Deeper Look: The Impacts Of Covid-19 Among Latinos In Omaha, Diana Molina

Capstone Experience

The COVID-19 pandemic has manifested worldwide distress, affecting the lives of all population groups. Racial disparities are evident as minority populations are being disproportionately affected by the impacts of COVID-19. Data indicate that the Latino population may experience more severe cases of COVID-19 and have a higher mortality rate. However, little is known about the effects that the pandemic is having on day-to-day life. Thus, the purpose of this study is to investigate COVID-19's impact on life aspects including employment situation, finances, mental health, and experiences of discrimination among the Omaha Latino community. A survey collected data from 311 participants …


Outpatient Visits At A Geriatric Psychiatry Clinic During The Covid-19 Pandemic, Thomas D. Bainter May 2021

Outpatient Visits At A Geriatric Psychiatry Clinic During The Covid-19 Pandemic, Thomas D. Bainter

Capstone Experience

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic led to a significant rise in the use of telehealth for healthcare delivery. The University of Nebraska Medical Center (UNMC) outpatient psychiatry clinic began using telehealth for nearly all patient visits shortly after the pandemic began. This project was intended to evaluate the effects of this change on patient visits with the geriatric psychiatry department at UNMC. For the months of April-August 2020 and April-August 2019, when in-person visits were still the norm, the following were compared: (1) no show and cancel frequency; (2) patient visit duration; (3) frequency of patient phone calls …


Assessment Of A Program For Sars-Cov-2 Screening And Environmental Monitoring In An Urban Public School District, John Crowe, Andy T. Schnaubelt, Scott Schmidtbonne, Kathleen Angell, Julia Bai, Teresa Eske, Molly Nicklin, Catherine Pratt, Bailey White, Brodie Crotts-Hannibal, Nicholas Staffend, Vicki L. Herrera, Jeramie Cobb, Jennifer Conner, Julie Carstens, Jonell Tempero, Lori Bouda, Matthew Ray, James V. Lawler, Walter S. Campbell, John-Martin Lowe, Joshua L. Santarpia, Shannon Bartelt-Hunt, Michael R. Wiley, David Brett-Major, Cheryl Logan, M. Jana Broadhurst Jan 2021

Assessment Of A Program For Sars-Cov-2 Screening And Environmental Monitoring In An Urban Public School District, John Crowe, Andy T. Schnaubelt, Scott Schmidtbonne, Kathleen Angell, Julia Bai, Teresa Eske, Molly Nicklin, Catherine Pratt, Bailey White, Brodie Crotts-Hannibal, Nicholas Staffend, Vicki L. Herrera, Jeramie Cobb, Jennifer Conner, Julie Carstens, Jonell Tempero, Lori Bouda, Matthew Ray, James V. Lawler, Walter S. Campbell, John-Martin Lowe, Joshua L. Santarpia, Shannon Bartelt-Hunt, Michael R. Wiley, David Brett-Major, Cheryl Logan, M. Jana Broadhurst

Journal Articles: Epidemiology

Importance: Scalable programs for school-based SARS-CoV-2 testing and surveillance are needed to guide in-person learning practices and inform risk assessments in kindergarten through 12th grade settings.

Objectives: To characterize SARS-CoV-2 infections in staff and students in an urban public school setting and evaluate test-based strategies to support ongoing risk assessment and mitigation for kindergarten through 12th grade in-person learning.

Design, Setting, and Participants: This pilot quality improvement program engaged 3 schools in Omaha, Nebraska, for weekly saliva polymerase chain reaction testing of staff and students participating in in-person learning over a 5-week period from November 9 to December 11, 2020. …


Covid-19 Vaccine Acceptance: We Need To Start Now, Krutika Kuppalli, David Brett-Major, Tara C. Smith Jan 2021

Covid-19 Vaccine Acceptance: We Need To Start Now, Krutika Kuppalli, David Brett-Major, Tara C. Smith

Journal Articles: Epidemiology

In this perspective, we discuss the importance of developing a vaccine to help curb transmission of severe acute respiratory syndrome coronavirus 2. The question remains: Once a safe and effective vaccine is developed, will the public be willing to get it? We present information from one of the first tracking polls to assess public attitudes and perceptions toward a possible coronavirus disease 2019 vaccine that suggests public hesitancy over a potential vaccine, concern regarding accelerating clinical trials, and unease over the vaccine approval process. Public health experts, government officials, advocates, and others in the scientific community should respect the signals …