Medicine and Health Sciences Commons^™

Differential Methylation Patterns In Lean And Obese Non-Alcoholic Steatohepatitis-Associated Hepatocellular Carcinoma, Emma Hymel, Kurt W. Fisher, Evi A. Farazi

Journal Articles: Epidemiology

BACKGROUND: Nonalcoholic fatty liver disease affects about 24% of the world's population and may progress to nonalcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma (HCC). While more common in those that are obese, NASH-HCC can develop in lean individuals. The mechanisms by which HCC develops and the role of epigenetic changes in the context of obesity and normal weight are not well understood.

METHODS: In this study, we used previously generated mouse models of lean and obese HCC using a choline deficient/high trans-fat/fructose/cholesterol diet and a choline supplemented/high trans-fat/fructose/cholesterol diet, respectively, to evaluate methylation differences in HCC progression in lean versus …

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

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.

Sequencing Sars-Cov-2 Genomes From Saliva, Tara Alpert, Chantal B. F. Vogels, Mallery I. Breban, Mary E. Petrone, Anne L. Wyllie, Nathan D. Grubaugh, Joseph R. Fauver

Journal Articles: Epidemiology

Genomic sequencing is crucial to understanding the epidemiology and evolution of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Often, genomic studies rely on remnant diagnostic material, typically nasopharyngeal (NP) swabs, as input into whole-genome SARS-CoV-2 next-generation sequencing pipelines. Saliva has proven to be a safe and stable specimen for the detection of SARS-CoV-2 RNA via traditional diagnostic assays; however, saliva is not commonly used for SARS-CoV-2 sequencing. Using the ARTIC Network amplicon-generation approach with sequencing on the Oxford Nanopore MinION, we demonstrate that sequencing SARS-CoV-2 from saliva produces genomes comparable to those from NP swabs, and that RNA extraction is …

Differential Progression Of Unhealthy Diet-Induced Hepatocellular Carcinoma In Obese And Non-Obese Mice, Emma Hymel, Elizabeth M. Vlock, Kurt W. Fisher, Paraskevi A. Farazi

Journal Articles: Epidemiology

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) ranks first among liver diseases in Western countries. NAFLD is typically associated with obesity and diabetes, however it also develops in lean individuals without metabolic syndrome. The prevalence of lean NAFLD is 7 percent in the U.S. and 25-30 percent in some Asian countries. NAFLD starts with excess liver fat accumulation (NAFL), progresses to nonalcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC). The pathogenesis of lean NASH-HCC and how it differs from obese NASH-HCC is not well understood.

METHODS: In this work, we generated a mouse model of lean and obese NASH-HCC using a …

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.

Knowledge And Attitudes Of Cypriots On Melanoma Prevention: Is There A Public Health Concern?, Demetra Kyprianou, Iris Charalambidou, Oluwaseun Famojuro, Hongmei Wang, Dejun Su, Evi A. Farazi

Journal Articles: Epidemiology

BACKGROUND: Melanoma is the deadliest type of skin cancer. It is the eighth most common cancer in males and the tenth in females in Cyprus, an island in the Mediterranean with a high ultraviolet (UV) index. Cyprus is expected to be strongly affected by climate change and consequently, melanoma will likely become an increasing public health problem. Melanoma prevention is possible; however, it is unknown if people living in Cyprus are aware of melanoma and prevention methods. To this end, we used a validated survey to evaluate the level of melanoma knowledge and factors associated with it in the Cypriot …

Exposure To Toxicants Associated With Use And Transitions Between Cigarettes, E-Cigarettes, And No Tobacco, Hongying Dai, Neal L. Benowitz, Chandran Achutan, Evi A. Farazi, Abraham Degarege, Ali S. Khan

Journal Articles: Epidemiology

Importance: Transitions between e-cigarettes and cigarettes are common among tobacco users, but empirical evidence on the health outcomes of switching tobacco products is scarce.

Objectives: To examine changes in urinary biomarkers between baseline and 1-year follow-up among adult tobacco users switching between e-cigarettes and cigarettes.

Design, Setting, and Participants: This cohort study used data from wave 1 (baseline, September 2013 to December 2014) and wave 2 (1-year follow-up, October 2014 to October 2015) of the Population Assessment of Tobacco and Health Study. A subset of the probability sample of US adults who voluntarily provided biospecimens at 2 waves was analyzed. …

Comparative Transmissibility Of Sars-Cov-2 Variants Delta And Alpha In New England, Usa, Rebecca Earnest, Rockib Uddin, Nicholas Matluk, Nicholas Renzette, Katherine J. Siddle, Christine Loreth, Gordon Adams, Christopher H. Tomkins-Tinch, Mary E. Petrone, Jessica E. Rothman, Mallery I. Breban, Robert Tobias Koch, Kendall Billig, Joseph R. Fauver, Chantal B.F. Vogels, Sarah Turbett, Kaya Bilguvar, Bony De Kumar, Marie L. Landry, David R. Peaper, Kevin Kelly, Greg Omerza, Heather Grieser, Sim Meak, John Martha, Hannah H. Dewey, Susan Kales, Daniel Berenzy, Kristin Carpenter-Azevedo, Ewa King, Richard C. Huard, Sandra C. Smole, Catherine M. Brown, Timelia Fink, Andrew S. Lang, Glen R. Gallagher, Pardis C. Sabeti, Stacey Gabriel, Bronwyn L. Macinnis, New England Variant Investigation Team, Ryan Tewhey, Mark D. Adams, Daniel J. Park, Jacob E. Lemieux, Nathan D. Grubaugh

Journal Articles: Epidemiology

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant quickly rose to dominance in mid-2021, displacing other variants, including Alpha. Studies using data from the United Kingdom and India estimated that Delta was 40-80% more transmissible than Alpha, allowing Delta to become the globally dominant variant. However, it was unclear if the ostensible difference in relative transmissibility was due mostly to innate properties of Delta's infectiousness or differences in the study populations. To investigate, we formed a partnership with SARS-CoV-2 genomic surveillance programs from all six New England US states. By comparing logistic growth rates, we found that Delta …

Disparities In Awareness Of And Willingness To Participate In Cancer Clinical Trials Between African American And White Cancer Survivors, Gaurav Kumar, Jungyoon Kim, Paraskevi A. Farazi, Hongmei Wang, Dejun Su

Journal Articles: Epidemiology

BACKGROUND: Cancer clinical trials (CCTs) are essential for cancer care, yet the evidence is scarce when it comes to racial disparities in CCT participation among cancer survivors in the Midwest. This study aimed to 1) assess disparities in the awareness of and willingness to participate in CCTs between African American and White cancer survivors; and 2) compare perceptions about CCTs between the two racial groups.

METHODS: The study was based on cross-sectional data from the survey "Minority Patient Participation in Cancer Clinical Trials" that collected information from 147 Black and White cancer survivors from Nebraska between 2015 and 2016. Chi-square …

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 …

Matters Of Trust: A Comparison Of Patient-Provider Trust In Colorectal Cancer Survivors Using The Trust In Oncologist Scale, Krista Brown, Jungyoon Kim, Shinobu Watanabe-Galloway, Lynn Harland, Jason M. Foster

Journal Articles: Epidemiology

Objective: Trust is a vital component of the patient-provider relationship. Higher trust is associated with increased adherence to treatment and improved outcomes. The purpose of this study was to compare colorectal cancer (CRC) survivors' reported trust toward their primary care physician (PCP) and oncologist (ONC).

Methods: CRC survivors (n=62) were surveyed using the Trust in Oncologist (TiOS) instrument that assessed five domains (honesty, fidelity, caring, competence, and global/overall) using a 5-point Likert scale. Social and demographic variables were analyzed using nonparametric tests.

Results: Mean trust was higher toward the ONC compared to the PCP across all TiOS domains (P=0.001-0.023). Trust …

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

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 …

Qualitative Analysis Of Cancer Care Experiences Among Rural Cancer Survivors And Caregivers, Kendra L. Ratnapradipa, Jordan Ranta, Krishtee Napit, Lady Beverly Luma, Tamara Robinson, Danae Dinkel, Laura Schabloske, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

PURPOSE: Rural (vs urban) patients experience poorer cancer outcomes and are less likely to be engaged in cancer prevention, such as screening. As part of a community needs assessment, we explored rural cancer survivors' and caregivers' experiences, perceptions, and attitudes toward cancer care services.

METHODS: We conducted 3 focus groups (N = 20) in Spring 2021 in rural Nebraska.

FINDINGS: Three patterns of cancer diagnosis were regular care/screening without noticeable symptoms, treatment for symptoms not initially identified as cancer related, and symptom self-identification. Most participants, regardless of how diagnosis was made, had positive experiences with timely referral for testing (imaging …

Intestinal Helminth Infection, Anemia, Undernutrition And Academic Performance Among School Children In Northwestern Ethiopia, Abraham Degarege, Berhanu Erko, Yohannes Negash, Abebe Animut

Journal Articles: Epidemiology

This study examined the prevalence and intensity of intestinal helminth infections and their association with anemia, undernutrition, and academic performance among school children in Maksegnit, northwestern Ethiopia. A total of 1205 school children, who attended Maksegnit Number Two Elementary School between May and July 2021, participated in this study. To determine helminth infection status, two thick Kato–Katz slides were examined for each child. Hemoglobin level was measured using a HemoCue machine. Academic performance was assessed using the mean score of all subjects children have taken for the Spring 2020/2021 academic term. Out of 1205 children examined, 45.4% were infected with …

Fielding Vaccines-Challenges And Opportunities In Outbreaks, Complex Emergencies, And Mass Gatherings, Laura J. Fischer, Robert C. Rains, Sherry M. Brett-Major, Mikiko Senga, Debra Holden, David Brett-Major

Journal Articles: Epidemiology

With the recent COVID-19 pandemic, the importance of vaccine development, distribution, and uptake has come to the forefront of the public eye. Effectively fielding vaccines during an emergency-whether that emergency is a result of an infectious disease or not-requires an understanding of usual vaccine-related processes; the impact of outbreak, complex emergencies, mass gatherings, and other events on patients, communities, and health systems; and ways in which diverse resources can be applied to successfully achieve needed vaccine uptake. In this review, both the emergency setting and briefly vaccine product design are discussed in these contexts in order to provide a concise …

Addressing And Evaluating Health Literacy In Mhealth: A Scoping Review, Margaret Emerson, Sydney Buckland, Maxwell A. Lawlor, Danae Dinkel, David J. Johnson, Maria S. Mickles, Louis Fok, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

BACKGROUND: Recent surveys have revealed many adults have basic or below basic health literacy, which is linked to medical errors, increased illness, and compromised public health. Health literacy as a concept is multi-faceted extending beyond the individual to include social structures and the context in which health information is being accessed. Delivering health information via mobile devices (mHealth) expands the amount of information available while presenting challenges to ensuring these materials are suitable for a variety of literacy needs. The aims of this study are to discover how health literacy is addressed and evaluated in mHealth app development.

METHODS: A …

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 …