Medicine and Health Sciences Commons^™

Serum Metabolome Profiling In Patients With Mild Cognitive Impairment Reveals Sex Differences In Lipid Metabolism, Rocio Diaz Escarcega, Vijay Kumar M J, Vasilia E Kyriakopoulos, Guadalupe J Ortiz, Aaron M Gusdon, Huihui Fan, Pedram Peesh, Maria P Blasco Conesa, Gabriela Delevati Colpo, Hilda W Ahnstedt, Lucy Couture, Stella H Kim, Miriam Hinojosa, Christine M Farrell, Sean P Marrelli, Akihiko Urayama, Bhanu P Ganesh, Paul E Schulz, Louise D Mccullough, Andrey S Tsvetkov

Faculty, Staff and Student Publications

Alzheimer's disease (AD) affects more women than men. Although women live longer than men, it is not longevity alone, but other factors, including metabolic changes, that contribute to the higher risk of AD in women. Metabolic pathways have been implicated in AD progression, but studies to date examined targeted pathways, leaving many metabolites unmeasured. Sex is often a neglected biological variable, and most metabolomic studies were not designed to investigate sex differences in metabolomic profiles. Here, we performed untargeted metabolomic profiling of sera from male and female patients with mild cognitive impairment (MCI), a common precursor to AD, and matched …

Sex Differences In Brain Iron Deposition And Microglial Ferritin In Alzheimer’S Disease, Syed Mushfiqur Rahman, Chunfeng Tan, Akiyoshi Kakita, Jose Felix Moruno-Manchon

Faculty, Staff and Student Publications

Objective

Iron is the most abundant metal in the human brain, and plays a crucial role in many biological processes. However, disruptions in brain iron metabolism can lead to iron buildup, which occurs with aging and is linked to several brain disorders, including Alzheimer's disease. Microglia, the brain's resident immune cells, have the highest capacity to store iron, which is stored intracellularly within ferritin complexes. Importantly, women are at a higher risk of developing Alzheimer's disease and experience faster disease progression compared to men.

Methods

We used postmortem brain samples from patients with Alzheimer's disease and small vessel disease patients …

Cochlear Implantation With Sporadic Inner Ear Schwannomas: Outcomes In 106 Patients From An International Multi-Institutional Study, John P. Marinelli, Torsten Rahne, James R. Dornhoffer, Christine M. Lohse, Justin Cottrell, J. Thomas Roland, Nicholas J. Thompson, Kevin D. Brown, Jacob C. Lucas, Seilesh C. Babu, Nathan R. Lindquist, Elizabeth L. Perkins, Donald Tan, John I. Lane, Jacob B. Hunter, Erin Harvey, Nicholas L. Deep, Samantha Y. Cerasiello, Matthew L. Kircher, Mana Espahbodi, Evan L. Tooker, Niels Cramer West, Per Caye-Thomasen, Matthew L. Carlson, Stefan K. Plontke

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To evaluate cochlear implant speech perception among patients with sporadic inner ear schwannoma who underwent ipsilateral implantation.

STUDY DESIGN: Retrospective multi-institutional cohort study.

SETTING: Eleven tertiary academic medical centers across Germany, Denmark, and the United States.

PATIENTS: One hundred six patients with sporadic inner ear schwannoma who received an ipsilateral cochlear implant from 2011 to 2022.

INTERVENTIONS: Ipsilateral cochlear implantation with observation, stereotactic radiosurgery, or microsurgery for tumor management.

MAIN OUTCOME MEASURES: Monosyllabic speech perception testing scores and rates of open-set speech perception.

RESULTS: Among 106 patients studied, 101 (95%) achieved open-set speech perception with a median of 24 …

Predicting Mental Health Disparities Using Machine Learning For African Americans In Southeastern Virginia, Ismail El Moudden, Michael C. Bittner, Matvey V. Karpov, Isaac O. Osunmakinde, Akosua Acheamponmaa, Breshell J. Nevels, Mamadou T. Mbaye, Tonya L. Fields, Karthiga Jordan, Messaoud Bahoura

Department of Obstetrics & Gynecology Faculty Publications

This study examined mental health disparities among African Americans using AI and machine learning for outcome prediction. Analyzing data from African American adults (18–85) in Southeastern Virginia (2016–2020), we found Mood Affective Disorders were most prevalent (41.66%), followed by Schizophrenia Spectrum and Other Psychotic Disorders. Females predominantly experienced mood disorders, with patient ages typically ranging from late thirties to mid-forties. Medicare coverage was notably high among schizophrenia patients, while emergency admissions and comorbidities significantly impacted total healthcare charges. Machine learning models, including gradient boosting, random forest, neural networks, logistic regression, and Naive Bayes, were validated through 100 repeated 5-fold cross-validations. …

Treatment Sequence With Tebentafusp And Immune Checkpoint Inhibitors In Patients With Metastatic Uveal Melanoma And Metastatic Gna11/Gnaq Mutant Melanocytic Tumors, Florentia Dimitriou, Marlana Orloff, Erica Koch Hein, Phil Cheng, Isaac Hughes, Ester Simeone, Kamaneh Montazeri, Piyush Grover, Inderjit Mehmi, Camille Gerard, Caroline Gaudy-Marqueste, Jean-Jacques Grob, Olivier Michielin, Omid Hamid, Georgina Long, Ryan Sullivan, Ellen Kapiteijn, Douglas Johnson, Paolo Ascierto, Anthony Joshua, Richard Carvajal, Marcus Butler, Jessica Hassel, Reinhard Dummer

Kimmel Cancer Center Faculty Papers

BACKGROUND: Metastatic uveal melanoma (mUM) is rare. Immune checkpoint inhibitors (ICIs) have shown modest efficacy in mUM. Tebentafusp prolonged overall survival (OS) in a phase 3 study. We aimed to investigate the efficacy and safety of the sequence of tebentafusp and ICIs.

METHODS: Patients with HLA-A * 02:01 positive mUM, or metastatic GNA11/GNAQ mutant melanocytic tumors treated with tebentafusp followed by ICIs (group 1) or the inverse sequence (group 2) at any treatment line were retrospectively identified. The primary objective was OS rate at 2 years.

RESULTS: 131 patients were included; 51 in group 1 and 80 in group 2. …

Drone-Based Medication Delivery For Rural, Flood-Prone Coastal Cities, Yin-Hsuen Chen, Amro M. El-Adle, Kevin J. O'Brien, Taylor Wentworth, Heather G. Richter

Center for Geospatial Science, Education & Analytics Faculty Publications

Access to healthcare remains a critical challenge for rural populations, particularly in flood-prone coastal communities where transportation barriers limit access to essential medical services. This study evaluates the effectiveness of drone-based medication delivery in improving healthcare accessibility for vulnerable populations on Virginia’s Eastern Shore. Compared to traditional personal vehicle travel, drone delivery reduced trip times from up to 50 minutes to under 10 minutes for more than 80% of the population, including elderly patients. Using publicly available datasets, we developed two transportation vulnerability indices that incorporate age, travel time, and flood risk to prioritize patients for drone-based pharmaceutical delivery. These …

Ambulatory Arterial Stiffness Index: Regression Method Comparison And Its Association With Pulse Pressure And Circadian Patterns, José R. Ayala-Hernández, Cristina López-Sánchez, Orlando M. Ayala, Camilo E. Palencia-Tejedor

Engineering Technology Faculty Publications

The Arterial Stiffness Index (AASI) is a calculation obtained through Ambulatory Blood Pressure Monitoring (ABPM), and is an indirect measure of the elastic properties of the arterial wall; but there is heterogeneity in its scope as a predictor of vascular wall health. A comparison is made between linear regression and exponential regression of the AASI, as well as an analysis of variance, according to circadian patterns and pulse pressure (PP) values. This work is an analytical observational study in 106 individuals, most of them women (63%) with a mean age of 53 ± 17.32 years. The coefficient of determination (r2) …

The Infected Diabetic Foot: Incidence And Risk Factors For Dehiscence After Surgery For Diabetic Foot Infections, Lawrence A Lavery, Mario C Reyes, Bijan Najafi, Tyler L Coye, Jayer Chung, Michael C Siah, Arthur N Tarricone

Center on Aging Staff Publications

Our objective was to assess the incidence, risk factors and clinical outcomes of dehiscence after foot surgery in diabetic patients. We used pooled patient‐level data from two randomised clinical trials with 240 diabetic patients who required foot surgery for infections. Most patients (n = 180, 75.0%) had surgical wound closure. We defined dehisced surgical wounds (DSW) when the surgical site was not completely epithelialized with no drainage after sutures/staples were removed with a 2‐week validation of healing. We evaluated the time to heal, re‐infection, re‐ulceration, hospital admissions and amputations. Moderate and severe infection was based on criteria of the …

Implementing A Chatbot To Promote Hereditary Breast & Ovarian Cancer Genetic Screening In Women's Health: Identifying Barriers And Facilitators To Screening Adoption, Easton N. Wollney, Shireen Madani Sims, Luisel J. Ricks-Santi, Elizabeth Eddy, Daniel Wiesman, Carla L. Fisher

Department of Biomedical and Translational Sciences Faculty Publications

Background

To promote genetic screening among women at risk for hereditary breast and ovarian cancer (HBOC), the American College of Obstetricians and Gynecologists recommends that risk assessment be integrated into practice. Chatbots like the Genetic Information Assistant (Gia®) are increasingly implemented to expand access to hereditary genetic screening. Factors that impact chatbot implementation for HBOC risk screening and women's uptake are not fully realized. To refine implementation strategies prior to full scale implementation, we sought to identify women's perceived facilitators/barriers to adopting Gia screening in a rural population within a large healthcare system in the southern United States.

Methods

We …

Use Of Machine Learning Models To Predict Microaspiration Measured By Tracheal Pepsin A., Annette Bourgault, Ilana Logvinov, Chang Liu, Rui Xie, Jan Powers Phd, Rn, Ccrn, Mary Lou Sole

Nursing Publications, Posters, & Presentations

BACKGROUND: Enteral feeding intolerance, a common type of gastrointestinal dysfunction leading to underfeeding, is associated with increased mortality. Tracheal pepsin A, an indicator of microaspiration, was found in 39% of patients within 24 hours of enteral feeding. Tracheal pepsin A is a potential biomarker of enteral feeding intolerance.

OBJECTIVE: To identify predictors of microaspiration (tracheal or oral pepsin A). It was hypothesized that variables predicting the presence of tracheal pepsin A might be similar to predictors of enteral feeding intolerance.

METHODS: In this secondary analysis, machine learning models were fit for 283 adults receiving mechanical ventilation who had tracheal and …

Dental Care Trajectories Among Formerly Incarcerated Older Adults In The United States, Alexander Testa, Luis Mijares, Mateus Renno Santos, Vahed Maroufy, Dylan B Jackson, Rafael Samper-Ternent, Rahma Mungia, Ana C Neumann

Faculty, Staff and Student Publications

A growing body of research has documented an association between prior incarceration and lower dental care use, yet the longitudinal impact of prior incarceration on dental care patterns over time among older adults remains unexplored. This study aims to investigate whether prior incarceration is associated with differing trajectories of dental care use among older adults in the United States. Data were drawn from the 2012-2020 waves of the Health and Retirement Study (HRS), a nationally representative longitudinal survey of older adults in the United States (n =  5,893). Group-based trajectory modeling was used to estimate dental care use patterns over …

Risk Of Post-Acute Symptoms Among Adults: A Comparison Study Of Severe Covid-19, Pneumonia, And Influenza, Caroline M Schaefer, Trudy Millard Krause, George L Delclos, Raymond S Greenberg

Faculty, Staff and Student Publications

Background: A retrospective cohort study was undertaken to assess the relationship between initial disease severity of COVID-19 and the risk of post-acute symptoms. The COVID-19 cohort was compared against influenza and pneumonia cohorts to assess whether risk of post-acute symptoms differed.

Methods: Administrative health claims data were obtained for commercially insured and Medicare Advantage covered adults (≥ 18 years) with symptomatic laboratory-confirmed COVID-19 diagnosed in 2020 (n=121,205), and similar cohorts of influenza (n=20,844) and pneumonia (n=29,052) patients diagnosed prior to the pandemic. Post-acute symptoms were assessed at four weeks, three and six months following initial diagnosis.

Results: Among the patients …

Improved Depression Symptoms Among Low-Income Mexican Americans Participating In A Community-Clinical Diabetes Intervention, Minjae Lee, Joseph H Conroy, Zihan Yang, Sein Lee, Paul G Yeh, Juliana Z Lopez, Natalia I Heredia, Lisa A Mitchell-Bennett, Maribel Sifuentes, Belinda M Reininger

Faculty, Staff and Student Publications

Background: Adults with type 2 diabetes mellitus and comorbid depression face complex disease management. Salud y Vida, a diabetes management intervention for Mexican Americans in the Rio Grande Valley of Texas, may mitigate depression through social support and community-clinic referrals.

Methods: In a cohort study, 292 Salud y Vida participants completed the patient health questionnaire (PHQ-9) at baseline, month 6, and month 12. A PHQ-9 score of ≥5 indicated mild depression and activated a mental health referral. Using SAS 9.4 with significance set at < .05, we conducted multivariable longitudinal negative binomial regression to assess changes in depression level.

Results: The proportion of participants with a PHQ-9 ≥5 decreased from 36% at baseline to 18% …

Effect Of Digital Health Coaching On Self-Efficacy And Patient-Reported Outcomes In Individuals With Acute Myeloid And Chronic Lymphocytic Leukemia: A Pilot Randomized Controlled Trial, Jennifer Marvin-Peek, Valerie Shelton, Kelly Brassil, Bryan Fellman, Austin Barr, Kelly Sharon Chien, Danielle Hammond, Mahesh Swaminathan, Nitin Jain, William Wierda, Alessandra Ferrajoli, Courtney Dinardo

Faculty, Staff and Student Publications

Introduction: Promotion of self-efficacy can enhance engagement with health care and treatment adherence in patients with cancer. We report the outcomes of a pilot trial of a digital health coach intervention in patients with leukemia with the aim of improving self-efficacy.

Methods: Adult patients with newly diagnosed acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) were randomized 1:1 to a digital health coach intervention or standard of care. The primary outcome of self-efficacy was measured by the Cancer Behavior Inventory (CBI) score.

Results: A total of 147 patients (37 AML, 110 CLL) were enrolled from July 2020 to December …

Perspectives On Smoking Cessation In The Oncology Environment: Insights From Brazilian Patients And Healthcare Providers, Raquel Descie Veraldi Leite, Ricardo Ribeiro Gama, Fabiana De Lima Vazquez, Gabriela Beltrami Massarão, Raiany Carvalho, Renan De Jesus Teixeira, Vinicius De Lima Vazquez, Irene Tami-Maury

Faculty, Staff and Student Publications

Objective: The aim of this study was to identify barriers and facilitators to smoking cessation among Brazilian cancer patients, considering the perspectives of both patients and healthcare professionals at a leading oncology center in the country.

Methods: A cross-sectional study was conducted, collecting smoking-related data from two groups: cancer patients and healthcare professionals at the Barretos Cancer Hospital (BCH) between 2019 and 2021. The questionnaire for healthcare professionals was adapted from the 2012 International Association for the Study of Lung Cancer and the Global Adult Tobacco Survey. For the cancer patient group, sociodemographic and clinical data were collected, along with …

Protective Effects Of Psychiatric Medications Against Covid-19 Mortality Before Vaccines, Rodrigo Machado-Vieira, Trudy M Krause, Gregory Jones, Antonio L Teixeira, Lokesh R Shahani, Scott D Lane, Jair C Soares, 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 …

Cardiovascular Risk Factors And Genetic Risk In Transthyretin V142i Carriers, Naman S Shetty, Mokshad Gaonkar, Akhil Pampana, Nirav Patel, Alanna C Morrison, Alexander P Reiner, April P Carson, 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, Peng Li, 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 …

Disparities In Cardiovascular Disease Outcomes And Economic Burdens Among Minorities In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf Alddin, Michael Bittner, Qi Zhang

Department of Obstetrics & Gynecology Faculty Publications

Background

Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.

Methods

This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular …

Type 2 Diabetes Polygenic Risk Score Interactions With Lifestyle Risk Factors In Black Americans, Ashley W Scadden, Aastha Kakar, Elizabeth M Litkowski, Mariah C Meyer, Nicole D Armstrong, Steven Buyske, Yanwei Cai, Iona Cheng, Burcu F Darst, Myriam Fornage, Mariaelisa Graff, Boya Guo, Christopher A Haiman, Heather M Highland, Charles Kooperberg, Loïc Le Marchand, Kari North, Ulrike Peters, Stephen S Rich, Jerome I Rotter, Vinodh Srinivasasainagendra, Hemant K Tiwari, Stephanie Waldrop, Kristin Young, Sridharan Raghavan, Ethan M Lange, Leslie A Lange, Marguerite R Irvin, Maggie A Stanislawski

The Brown Foundation: Institute of Molecular Medicine

Introduction: Prior work in predominantly European ancestry populations has explained how the risk associated with demographic, lifestyle, and health factors differs with underlying genetic susceptibility to type 2 diabetes (T2D), but less is known about these relationships in Black Americans.

Methods: We used covariate-adjusted logistic regression models of T2D to examine interactions between a published trans-ancestry derived T2D polygenic risk score (PRS) and various demographic, lifestyle, and health-related factors among 28,251 self-identified Black Americans from six cohort studies.

Results: The results are generally consistent with prior work in White populations. The PRS showed a significant interaction with body mass index, …

Early Structural Valve Deterioration And Cusp Tear Leading To Acute Heart Failure In A Second-Generation Trifecta Glide Technology Heart Valve, Akiyoshi Yamamoto, Kenji Kuwaki, Hidekazu Furuya, Yasunori Cho

The Texas Heart Institute Journal

This report highlights a case of early structural valve deterioration with a cusp tear in a second-generation Abbott Trifecta Glide Technology bioprosthetic heart valve. A 70-year-old man had undergone aortic valve replacement with a Trifecta Glide Technology valve 30 months earlier for severe bicuspid aortic valve stenosis. He suddenly developed acute heart failure with dyspnea resulting from severe aortic valve regurgitation, with a cusp tear in the Trifecta Glide Technology valve, as demonstrated by transthoracic echocardiography. The patient was successfully treated with urgent repeat aortic valve replacement.

Robot-Assisted Surgical Treatment Of Caseoma, Nancy Wang, Abdussalam Elsenousi, Kenneth K Liao

The Texas Heart Institute Journal

This report reviews 5 cases of mitral annular caseoma. Four patients presented with fatigue, stroke, or mitral stenosis. Robot-assisted resection of caseoma with or without mitral valve replacement was successfully performed in all patients with good outcomes. These cases demonstrate the safety and efficacy of robotic surgery in treating caseoma.

Navigating The Complexities Of Mitral Valve Clipping: Early Severe Mitral Valve Stenosis After Mitral Valve Clipping, Wassim Abouzeid, Ahmad Haddad, Chrystina Kiwan, Ahsan Khan, Addi Suleiman

The Texas Heart Institute Journal

This case study explores the journey of an 80-year-old male patient with a history of hypertension, diabetes, coronary artery disease after coronary artery bypass grafting, atrial fibrillation, and heart failure. Nine months before he presented to the emergency department, he had undergone mitral valve clipping for severe mitral valve regurgitation. Despite initial improvement, the patient experienced return of symptoms, including dyspnea at rest and lower limb edema. The results of this case-discovery of the need for mitral valve replacement-provides insights into the management of complications from mitral valve clipping and emphasizes that management requires a nuanced, meticulous approach.

The Infected Diabetic Foot: Risk Factors For Re-Infection After Treatment For Diabetic Foot Osteomyelitis, Lawrence A Lavery, Mario C Reyes, Bijan Najafi, Tyler L Coye, Matthew Sideman, Michael C Siah, Arthur N Tarricone

Center on Aging Staff Publications

Our objective was to evaluate risk factors for re-infection in patients after treatment for diabetic foot osteomyelitis (OM). We used pooled patient level data from two RTCs that evaluated patients with diabetic foot infections. We evaluated 171 patients with OM. OM was confirmed with bone culture or histopathology. Data from the 12-month follow-up were used to determine clinical outcomes. Re-infection occurred in 47 (27.5%) patients. Risk factors for re-infection were Toe Brachial Index < 0.40 (25.7% vs. 9.8%, p = 0.02), skin perfusion pressure < 40 mmHg (6.3% vs. 5.9%, p = 0.04), wound healing (55.3% vs. 75.0%, p = 0.01), time to heal (156.0, 69.5-365 vs. 91.5, 38.8-365, p = 0.001), and history of MI (14.9% vs. 3.2%, p = 0.005). During 12-month follow-up, patients with re-infections were 198.8 times more likely to require a foot related hospitalisation (81.8% vs. 0.0%, p = 0.001), 10.4 times more likely have an all-cause hospitalisation (70.2% vs. 18.5%, p = 0.001) and 9.4 times more likely to need an amputation (36.2% vs. 5.6%, p = 0.001). Patients with re-infection had a significantly longer median length of hospitalisation (20.0, 13.5-34.5 vs. 14.0, 10.0-22.0, p = 0.003) and median length of antibiotic duration (55.0, 35.0-87.0 vs. 46.0, 22.8-68.0, p = 0.03). Patients with re-infection are less likely to heal and have more foot-related hospitalizations and amputations.

Shifting Patterns In Primary Care Telehealth Utilization Among Medicare Beneficiaries And Providers, Yunxi Zhang, Lincy S Lal, Saurabh Chandra, John Michael Swint

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 …

Factors Influencing Implementation Of A Self-Measured Blood Pressure Program In Community Health Centers: An Implementation Mapping Approach, Serena A Rodriguez, Fernanda Velasco-Huerta, Mahalia Sampson-Ansah, Ella R Garza, William B Perkison, Patenne D Mathews, Catherine Pulicken, 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 …

A Mixed-Methods Usability Pilot Of A Value-Goal Elicitation Tool In The Inpatient Setting For Older Adults Anticipating Post-Acute Care, Kirstin M Piazza, Caroline Pascal, Syama R Patel, Caroline Sefcik, Marilyn M Schapira, Caroline Madrigal, Katherine C Ritchey, Longyi Yip, Aanand D Naik, Robert E Burke

Faculty, Staff and Student Publications

Age-Friendly Health Systems (AFHS) emphasize aligning care with "What Matters" most to older adults. Hospitalization represents a critical period where value-based goals could shape key decisions about post-acute care transitions. However, few tools designed for eliciting such goals have been adapted for use in the inpatient setting, where the acute nature of care poses unique challenges. This mixed-methods study evaluates the usability of the Health Priorities Primer Tool (HPPT) in older hospitalized adults who anticipate needing post-acute care, aiming to identify necessary adaptations for the inpatient setting. We conducted interviews, observations, and surveys with older hospitalized patients to understand their …

A Directed Content Analysis For Greatest Problems Among People With And Without Traumatic Brain Injury, Emily Dudek, Michael W Williams, Chung Lin Novelle Kew, Annalyn Demello, Brittany Wright, Alexandra B Holland, Alyssa Day-Gorman, Alexa S Gonzalez, Luis Leon Novelo, Xiangyi Liu, Shannon B Juengst

Faculty, Staff and Student Publications

Objective: To characterize the greatest problem or need among individuals with a history of traumatic brain injury (TBI), as compared with individuals with a history of other neurologic conditions, mental health conditions, and no history of neurologic or mental health conditions.

Design: A directed content analysis of open-text responses to a single online survey question using a framework guided by the Mayo-Portland Adaptability Inventory-4.

Setting: Community.

Participants: A total of 2861 community-dwelling adults (n=274 with TBI; n=289 with other neurologic conditions besides TBI; n=454 with mental health conditions but no neurologic conditions; and n=1844 controls).

Interventions: Not applicable.

Main outcome …

Untargeted Metabolome Atlas For Sleep-Related Phenotypes In The Hispanic Community Health Study/Study Of Latinos, Ying Zhang, Brian W Spitzer, Yu Zhang, Danielle A Wallace, Bing Yu, Qibin Qi, Maria Argos, M Larissa Avilés-Santa, Eric Boerwinkle, Martha L Daviglus, Robert Kaplan, Jianwen Cai, Susan Redline, Tamar Sofer

Faculty, Staff and Student Publications

BACKGROUND: Sleep is essential to maintaining health and wellbeing of individuals, influencing a variety of outcomes from mental health to cardiometabolic disease. This study aims to assess the relationships between various sleep-related phenotypes and blood metabolites.

METHODS: Utilising data from the Hispanic Community Health Study/Study of Latinos, we performed association analyses between 40 sleep-related phenotypes, grouped in several domains (sleep disordered breathing (SDB), sleep duration, sleep timing, self-reported insomnia symptoms, excessive daytime sleepiness (EDS), and heart rate during sleep), and 768 metabolites measured via untargeted metabolomics profiling. Network analysis was employed to visualise and interpret the associations between sleep phenotypes …

Delayed Hypertension Diagnosis And Its Association With Cardiovascular Treatment And Outcomes, Yuan Lu, John E. Brush Jr, Chungsoo Kim, Yuntian Liu, Xin Xin, Chenxi Huang, Mitsuaki Sawano, Patrick Young, Jacob Mcpadden, Mark Anderson, John S. Burrows, Jordan R. Asher, Harlan M. Krumholz

Department of Medicine Faculty Publications

Importance Hypertension is a major risk factor for cardiovascular disease, yet delays in diagnosis may limit timely treatment initiation and increase cardiovascular risk.

Objectives To examine the timing of clinical hypertension diagnosis, its association with antihypertensive medication prescribing, and its association with long-term cardiovascular outcomes.

Design, Setting, and Participants This retrospective cohort study analyzed electronic health record (EHR) data from an integrated health care system. Adults aged 18 to 85 years with at least 2 outpatient blood pressure (BP) readings of 140/90 mm Hg or more recorded at least 30 days apart from January 1, 2010, to December 31, 2021, …

Changes In Cardiovascular Risk Factors And Health Care Expenditures Among Patients Prescribed Semaglutide, Yuan Lu, Yuntian Lu, Tedi Totojani, Chungsoo Kim, Rohan Khera, Hua Xu, John E. Brush Jr., Harlan M. Krumholtz, Jason Abaluck

Department of Medicine Faculty Publications

Importance Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated substantial weight reduction and cardiovascular benefits in clinical trials. However, its association with clinical outcomes and health care expenditures remains underexplored.

Objective To evaluate changes in cardiovascular risk factors and health care expenditures among patients prescribed semaglutide across multicenter cohorts.

Design, Setting, and Participants This retrospective cohort study included 23 522 adults (≥18 years) who received an initial semaglutide prescription between January 1, 2018, and January 1, 2025, at Sentara Healthcare and between January 1, 2018, and May 1, 2025, at Yale New Haven Health System.

Exposure The first prescription of …