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Full-Text Articles in Medical Specialties

Evaluating The Association Of Influenza Vaccination On Long-Term Covid-19 Symptoms In U.S. Adults, Ratnakar Pingili May 2024

Evaluating The Association Of Influenza Vaccination On Long-Term Covid-19 Symptoms In U.S. Adults, Ratnakar Pingili

Capstone Experience

Objective. To evaluate the association of influenza vaccination in the past 12 months with Long COVID effects and clinical and sociodemographic factors.

Methods. Cross-sectional study with data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), covering 415,132 non-institutionalized U.S. adults with a confirmed COVID-19 diagnosis and influenza vaccination reported within the last 12 months. Logistic regression was conducted between influenza vaccination (exposure) and Long COVID (outcome), controlling for demographic variables, pre-existing health conditions, and socioeconomic status.

Results. Of 120,603 participants, 21.89% reported Long COVID symptoms and 42.04% had received an influenza vaccine. Findings indicate a statistically significant 13% reduction …


Recurrent Polymicrobial Bloodstream Infections As Harbingers Of A Duodenal-Inferior Vena Cava Fistula, Gregory E. Koval, Richard J. Hankins, Jasmine R. Marcelin Dec 2023

Recurrent Polymicrobial Bloodstream Infections As Harbingers Of A Duodenal-Inferior Vena Cava Fistula, Gregory E. Koval, Richard J. Hankins, Jasmine R. Marcelin

Graduate Medical Education Research Journal

This is a case of an 82-year-old patient who presented with recurrent polymicrobial bloodstream infections and no obvious undrained source of infection. She had prior double barrel iliocaval stenting for post thrombotic syndrome. The patient underwent exploratory laparotomy and primary repair of a duodenal-caval fistula with a fascia lata patch and an omental pedicle flap. No further bloodstream infections were documented after the repair. This discussion highlights an uncommon complication of IVC stenting, its presentation as well as the operative approach used to repair the fistula.


Pelvic Actinomycosis: A Case Report, Jacklyn Locklear, Rachel Gilbert, Neelima Sukhavasi, Elizabeth Sutton Jun 2023

Pelvic Actinomycosis: A Case Report, Jacklyn Locklear, Rachel Gilbert, Neelima Sukhavasi, Elizabeth Sutton

Graduate Medical Education Research Journal

Introduction: Actinomycosis is a bacterial infection caused by the gram positive anaerobic bacteria that most commonly infects the cervicofacial region of the body. Rarely, it can infect the pelvis and typically presents in a nonspecific manner.

Case Report: We present a case of a 43 year old female G6P6006 with Paragard® intrauterine device (IUD) who presented with purulent umbilical discharge and pelvic pain. Initial imaging was concerned for gastrointestinal or ovarian malignancy. Patient underwent diagnostic laparoscopy with pelvic washings and hysteroscopy D&C. Operative pathology returned with results for actinomyces (IUD likely source).

Conclusion: While it is established IUDs can be …


Center Based Cardiac Rehabilitation Outcomes Associated With Covid-19 Pandemic: A Retrospective Comparative Cohort Study, Haley Williams, Kayla Woodworth May 2023

Center Based Cardiac Rehabilitation Outcomes Associated With Covid-19 Pandemic: A Retrospective Comparative Cohort Study, Haley Williams, Kayla Woodworth

Doctor of Nursing Practice Projects: College of Nursing

Background: Traditional cardiac rehabilitation (CR) is a multidisciplinary, multifaceted program for cardiac patients. Throughout the Covid-19 pandemic, health care, including center-based CR (CBCR) programs, were closed to in-person sessions. Even with the return to CBCR participation, patient outcomes may have been affected by this disruption in care. The goal of this study was to determine if CR participation outcomes differed before and after CBCR program closure due to Covid-19.

Methods: A retrospective comparative cohort design was used to examine CR participant outcome data before and after the Covid-19 pandemic. Convenience sampling of CR participants at a large, urban …


Assessing The Impact Of Ebola Virus Inoculum Size On Likelihood Of Infection, Joseph Lukowski May 2023

Assessing The Impact Of Ebola Virus Inoculum Size On Likelihood Of Infection, Joseph Lukowski

Capstone Experience

Background: Indirect transmission of Ebola virus disease (EVD) is not uncommon but is poorly understood. Improving the understanding of the potential risk of EVD transmission from fomites should result in new or updated prevention or control measures for suspected or confirmed EVD cases or outbreaks.

Objective: This study aims to compile and understand pertinent data from peer-reviewed literature, establish the dose-response relationship between inoculum doses introduced to mucous membranes, and finally estimate the risk of EVD transmission from fomites.

Methods: A literature search was conducted through PubMed to obtain relevant data. This study employed this data to perform Poisson regression …


Effectiveness And Safety Of Bictegravir/Emtricitabine/Tenofovir Alafenamide In Patients With Hiv-1 Infection And Ongoing Substance Use Disorder: The Base Study, Joshua P. Havens, Sara Bares, Elizabeth Lyden, Anthony T. Podany, Kimberly Scarsi, Nada A. Fadul, Susan Swindells Jan 2023

Effectiveness And Safety Of Bictegravir/Emtricitabine/Tenofovir Alafenamide In Patients With Hiv-1 Infection And Ongoing Substance Use Disorder: The Base Study, Joshua P. Havens, Sara Bares, Elizabeth Lyden, Anthony T. Podany, Kimberly Scarsi, Nada A. Fadul, Susan Swindells

Journal Articles: Infectious Diseases

BACKGROUND: People with human immunodeficiency virus (HIV) and substance use disorder (PWH/SUD) are at higher risk of nonadherence to antiretroviral therapy. Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) exhibits high rates of efficacy with a favorable adverse event profile. The BASE study (NCT03998176) is a phase 4, single-arm study evaluating the effectiveness and safety of B/F/TAF among PWH/SUD.

METHODS: Viremic (HIV RNA >1000 copies/mL) PWH/SUD initiated B/F/TAF once daily for 48 weeks (W). The primary endpoint was proportion of participants with HIV RNA/mL at W24. Secondary endpoints were proportion of participants with HIV-1 RNA/mL at W48, safety, B/F/TAF adherence (dried blood spot [DBS] concentrations …


Factors Associated With Prevalent Mycobacterium Tuberculosis Infection And Disease Among Adolescents And Adults Exposed To Rifampin-Resistant Tuberculosis In The Household, Soyeon Kim, Anneke C. Hesseling, Xingye Wu, Michael D. Hughes, N. Sarita Shah, Sanjay Gaikwad, Nishi Kumarasamy, Erika Mitchell, Mey Leon, Pedro Gonzales, Sharlaa Badal-Faesen, Madeleine Lourens, Sandy Nerette, Justin Shenje, Petra De Koker, Supalert Nedsuwan, Lerato Mohapi, Unoda A. Chakalisa, Rosie Mngqbisa, Rodrigo Otávio Da Silva Escada, Samuel Ouma, Barbara Heckman, Linda Naini, Amita Gupta, Susan Swindells, Gavin Churchyard, Actg A5300/Impaact 2003 Phoenix Feasibility Study Team Jan 2023

Factors Associated With Prevalent Mycobacterium Tuberculosis Infection And Disease Among Adolescents And Adults Exposed To Rifampin-Resistant Tuberculosis In The Household, Soyeon Kim, Anneke C. Hesseling, Xingye Wu, Michael D. Hughes, N. Sarita Shah, Sanjay Gaikwad, Nishi Kumarasamy, Erika Mitchell, Mey Leon, Pedro Gonzales, Sharlaa Badal-Faesen, Madeleine Lourens, Sandy Nerette, Justin Shenje, Petra De Koker, Supalert Nedsuwan, Lerato Mohapi, Unoda A. Chakalisa, Rosie Mngqbisa, Rodrigo Otávio Da Silva Escada, Samuel Ouma, Barbara Heckman, Linda Naini, Amita Gupta, Susan Swindells, Gavin Churchyard, Actg A5300/Impaact 2003 Phoenix Feasibility Study Team

Journal Articles: Infectious Diseases

BACKGROUND: Understanding factors associated with prevalent Mycobacterium tuberculosis infection and prevalent TB disease in household contacts of patients with drug-resistant tuberculosis (TB) may be useful for TB program staff conducting contact investigations.

METHODS: Using data from a cross-sectional study that enrolled index participants with rifampin-resistant pulmonary TB and their household contacts (HHCs), we evaluated HHCs age ≥15 years for factors associated with two outcomes: Mycobacterium tuberculosis infection and TB disease. Among HHCs who were not already diagnosed with current active TB disease by the TB program, Mycobacterium tuberculosis infection was determined by interferon-gamma release assay (IGRA). TB disease was adjudicated …


The Epidemiology Of Extended Spectrum Beta-Lactamase-Producing Enterobacterales In Nebraska, 2018 – 2021, Axel A. Vazquez Deida May 2022

The Epidemiology Of Extended Spectrum Beta-Lactamase-Producing Enterobacterales In Nebraska, 2018 – 2021, Axel A. Vazquez Deida

Capstone Experience

Background: Extended spectrum beta-lactamase (ESBL)-producing Enterobacterales are considered a serious public health threat by the United States Centers for Disease Control and Prevention. However, surveillance of ESBL-producing Enterobacterales is currently limited to select states and the epidemiology of these antibiotic-resistant bacteria in Nebraska is still not well understood.

Objective: To describe the incidence of ESBL-producing Enterobacterales across local health department (LHD)-jurisdictions as well as at the state-level over time and assess population-specific factors associated with infection or colonization with these pathogens in Nebraska.

Methods: A retrospective, cross-sectional analysis of public health surveillance data reported to the Nebraska Department of …


Mitochondrial Redox Environments Predict Sensorimotor Brain-Behavior Dynamics In Adults With Hiv., Rachel K. Spooner, Brittany K. Taylor, Iman M. Ahmad, Kelsey Dyball, Katy Emanuel, Jennifer O'Neill, Maureen Kubat, Susan Swindells, Howard S. Fox, Sara Bares, Kelly L. Stauch, Matthew C. Zimmerman, Tony W. Wilson Jan 2022

Mitochondrial Redox Environments Predict Sensorimotor Brain-Behavior Dynamics In Adults With Hiv., Rachel K. Spooner, Brittany K. Taylor, Iman M. Ahmad, Kelsey Dyball, Katy Emanuel, Jennifer O'Neill, Maureen Kubat, Susan Swindells, Howard S. Fox, Sara Bares, Kelly L. Stauch, Matthew C. Zimmerman, Tony W. Wilson

Journal Articles: Infectious Diseases

Despite virologic suppression, people living with HIV (PLWH) remain at risk for developing cognitive impairment, with aberrations in motor control being a predominant symptom leading to functional dependencies in later life. While the neuroanatomical bases of motor dysfunction have recently been illuminated, the underlying molecular processes remain poorly understood. Herein, we evaluate the predictive capacity of the mitochondrial redox environment on sensorimotor brain-behavior dynamics in 40 virally-suppressed PLWH and 40 demographically-matched controls using structural equation modeling. We used state-of-the-art approaches, including Seahorse Analyzer of mitochondrial function, electron paramagnetic resonance spectroscopy to measure superoxide levels, antioxidant activity assays and dynamic magnetoencephalographic …


Caregiver Willingness To Give Tpt To Children Living With Drug-Resistant Tb Patients, V. Rouzier, M. Murrill, S. Kim, L. Naini, J. Shenje, E. Mitchell, M. Raesi, M. Lourens, A. Mendoza, F. Conradie, N. Suryavanshi, M. Hughes, S. Shah, G. Churchyard, Susan Swindells, A. Hesseling, A. Gupta Jan 2022

Caregiver Willingness To Give Tpt To Children Living With Drug-Resistant Tb Patients, V. Rouzier, M. Murrill, S. Kim, L. Naini, J. Shenje, E. Mitchell, M. Raesi, M. Lourens, A. Mendoza, F. Conradie, N. Suryavanshi, M. Hughes, S. Shah, G. Churchyard, Susan Swindells, A. Hesseling, A. Gupta

Journal Articles: Infectious Diseases

Pediatric household contacts (HHCs) of patients with multidrug-resistant TB (MDR-TB) are at high risk of infection and active disease. Evidence of caregiver willingness to give MDR-TB preventive therapy (TPT) to children is limited.METHODS This was a cross-sectional study of HHCs of patients with MDR-TB to assess caregiver willingness to give TPT to children aged <13 years.RESULTS Of 743 adult and adolescent HHCs, 299 reported caring for children aged <13 years of age. The median caregiver age was 35 years (IQR 27-48); 75% were women. Among caregivers, 89% were willing to give children MDR TPT. In unadjusted analyses, increased willingness was associated with TB-related knowledge (OR 5.1, 95% CI 2.3-11.3), belief that one can die of MDR-TB (OR 5.2, 95% CI 1.2-23.4), concern for MDR-TB transmission to child (OR 4.5, 95% CI 1.6-12.4), confidence in properly taking TPT (OR 4.5, 95% CI 1.6-12.6), comfort telling family about TPT (OR 5.5, 95% CI 2.1-14.3), and willingness to take TPT oneself (OR 35.1, 95% CI 11.0-112.8).CONCLUSIONS A high percentage of caregivers living with MDR- or rifampicin-resistant TB patients were willing to give children a hypothetical MDR TPT. These results provide important evidence for the potential uptake of …


Week 96 Extension Results Of A Phase 3 Study Evaluating Long-Acting Cabotegravir With Rilpivirine For Hiv-1 Treatment, Susan Swindells, Thomas Lutz, Lelanie Van Zyl, Norma Porteiro, Matthias Stoll, Essack Mitha, Alyssa Shon, Paul Benn, Jenny O. Huang, Conn M. Harrington, Kai Hove, Susan L. Ford, Christine L. Talarico, Vasiliki Chounta, Herta Crauwels, Rodica Van Solingen-Ristea, Simon Vanveggel, David A. Margolis, Kimberly Y. Smith, Kati Vandermeulen, William R. Spreen Jan 2022

Week 96 Extension Results Of A Phase 3 Study Evaluating Long-Acting Cabotegravir With Rilpivirine For Hiv-1 Treatment, Susan Swindells, Thomas Lutz, Lelanie Van Zyl, Norma Porteiro, Matthias Stoll, Essack Mitha, Alyssa Shon, Paul Benn, Jenny O. Huang, Conn M. Harrington, Kai Hove, Susan L. Ford, Christine L. Talarico, Vasiliki Chounta, Herta Crauwels, Rodica Van Solingen-Ristea, Simon Vanveggel, David A. Margolis, Kimberly Y. Smith, Kati Vandermeulen, William R. Spreen

Journal Articles: Infectious Diseases

BACKGROUND: ATLAS (NCT02951052), a phase 3, multicenter, open-label study, demonstrated that switching to injectable cabotegravir (CAB) with rilpivirine (RPV) long-acting dosed every 4 weeks was noninferior at week (W) 48 to continuing three-drug daily oral current antiretroviral therapy (CAR). Results from the W 96 analysis are presented.

METHODS AND DESIGN: Participants completing W 52 of ATLAS were given the option to withdraw, transition to ATLAS-2M (NCT03299049), or enter an Extension Phase to continue long-acting therapy (Long-acting arm) or switch from CAR to long-acting therapy (Switch arm). Endpoints assessed at W 96 included proportion of participants with plasma HIV-1 RNA less …


The Value Of A Longitudinal Human Immunodeficiency Virus Track For Medical Students: 10-Year Program Evaluation, Jasmine R. Marcelin, Paul Brosnihan, Susan Swindells, Nada A. Fadul, Sara Bares Jan 2022

The Value Of A Longitudinal Human Immunodeficiency Virus Track For Medical Students: 10-Year Program Evaluation, Jasmine R. Marcelin, Paul Brosnihan, Susan Swindells, Nada A. Fadul, Sara Bares

Journal Articles: Infectious Diseases

We surveyed graduates of a longitudinal medical school human immunodeficiency virus curriculum to evaluate its impact. Respondents felt comfortable caring for people with human immunodeficiency virus (PWH) and found value from the curriculum regardless of ultimate career path. Programs like this contribute to the development of culturally sensitive clinicians comfortable caring for PWH.


Symmetrical Drug-Related Intertriginous And Flexural Exanthema Induced By Cellulitis Prophylaxis, Tiffany Truong, Jonathan H. Ryder, Erica Lee, Clayton Mowrer, Ashley Wysong, Jasmine R. Marcelin Dec 2021

Symmetrical Drug-Related Intertriginous And Flexural Exanthema Induced By Cellulitis Prophylaxis, Tiffany Truong, Jonathan H. Ryder, Erica Lee, Clayton Mowrer, Ashley Wysong, Jasmine R. Marcelin

Graduate Medical Education Research Journal

Penicillin VK and hydroxyzine are typically well-tolerated antipruritic agents that are indicated in the prophylaxis of cellulitis. We herein report a case of a unique rash occurring during penicillin VK and hydroxyzine treatment in combination with the ingestion of cashews.

A 77-year-old male presented with new onset rash. Eleven days after the administration of penicillin VK and hydroxyzine for cellulitis prophylaxis, he developed a symmetric, erythematous, scaling rash on his buttocks and perineal region with associated pruritus and bleeding without fevers, chills, adenopathy, night sweats, or any other symptoms. He was diagnosed with symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) …


Evaluation Of Stratified Antibiograms For Use In Laboratory And Antimicrobial Stewardship, Linsey Donner Dec 2021

Evaluation Of Stratified Antibiograms For Use In Laboratory And Antimicrobial Stewardship, Linsey Donner

Theses & Dissertations

Antibiograms are critical for choosing empiric antimicrobial therapy. Cumulative antibiograms, which aggregate susceptibility data, can mask differences within specific patient subsets or clinical syndromes. This dissertation was done to determine if antibiotic susceptibilities showed substantial differences when comparing stratified antibiograms to cumulative antibiograms.

Antibiotic susceptibility data was retrospectively obtained from Nebraska Medicine January 1, 2017 – December 31, 2019 for Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecalis. The University of Nebraska Medical Center’s web antibiogram clinical decision support tool was used to export the data. Bacteria-antibiotic susceptibility rates of stratified antibiograms …


Gray Matter Volumes Discriminate Cognitively Impaired And Unimpaired People With Hiv, Mikki Schantell, Brittany K. Taylor, Brandon Lew, Jennifer O'Neill, Pamela E. May, Susan Swindells, Tony W. Wilson Jul 2021

Gray Matter Volumes Discriminate Cognitively Impaired And Unimpaired People With Hiv, Mikki Schantell, Brittany K. Taylor, Brandon Lew, Jennifer O'Neill, Pamela E. May, Susan Swindells, Tony W. Wilson

Journal Articles: Infectious Diseases

BACKGROUND: Current diagnostic criteria of HIV-associated neurocognitive disorders (HAND) rely on neuropsychological assessments. The aim of this study was to evaluate if gray matter volumes (GMV) can distinguish people with HAND, neurocognitively unimpaired people with HIV (unimpaired PWH), and uninfected controls using linear discriminant analyses.

METHODS: A total of 231 participants, including 110 PWH and 121 uninfected controls, completed a neuropsychological assessment and an MRI protocol. Among PWH, HAND (n = 48) and unimpaired PWH (n = 62) designations were determined using the widely accepted Frascati criteria. We then assessed the extent to which GMV, corrected for intracranial volume, could …


Patient-Reported Outcomes Through 1 Year Of An Hiv-1 Clinical Trial Evaluating Long-Acting Cabotegravir And Rilpivirine Administered Every 4 Or 8 Weeks (Atlas-2m), Vasiliki Chounta, Edgar T. Overton, Anthony Mills, Susan Swindells, Paul D. Benn, Simon Vanveggel, Rodica Van Solingen-Ristea, Yuanyuan Wang, Krischan J. Hudson, Mark S. Shaefer, David A. Margolis, Kimberly Y. Smith, William R. Spreen May 2021

Patient-Reported Outcomes Through 1 Year Of An Hiv-1 Clinical Trial Evaluating Long-Acting Cabotegravir And Rilpivirine Administered Every 4 Or 8 Weeks (Atlas-2m), Vasiliki Chounta, Edgar T. Overton, Anthony Mills, Susan Swindells, Paul D. Benn, Simon Vanveggel, Rodica Van Solingen-Ristea, Yuanyuan Wang, Krischan J. Hudson, Mark S. Shaefer, David A. Margolis, Kimberly Y. Smith, William R. Spreen

Journal Articles: Infectious Diseases

BACKGROUND: Advances in HIV-1 therapeutics have led to the development of a range of daily oral treatment regimens, which share similar high efficacy rates. Consequently, more emphasis is being placed upon the individual's experience of treatment and impact on quality of life. The first long-acting injectable antiretroviral therapy for HIV-1 (long-acting cabotegravir + rilpivirine [CAB + RPV LA]) may address challenges associated with oral treatment for HIV-1, such as stigma, pill burden/fatigue, drug-food interactions, and adherence. Patient-reported outcomes (PROs) collected in an HIV-1 clinical trial (ATLAS-2M; NCT03299049) comparing participants' experience with two dosing regimens (every 4 weeks [Q4W] vs. every …


Fire Service Covid-19 Infection Prevention And Control Policy Comparison, Saaddedine Dichari May 2021

Fire Service Covid-19 Infection Prevention And Control Policy Comparison, Saaddedine Dichari

Theses & Dissertations

To date, there have been over 2.7 million deaths and more than 126 million cases attributed to the COVID-19 pandemic (JHU, 2021). This pandemic has affected nearly every aspect of daily life. Among those impacted are U.S. firefighters, as they provide many services beyond simply extinguishing structure fires and are frequently dual certified as emergency medical technicians. Many of the victims of this pandemic have relied on first responders to provide them with emergency medical care and hospital transport. When caring for these infected patients, firefighters have an increased risk of exposure and must be provided with adequate …


Multimodal Neuroimaging Of Hiv And Aging, Brandon Lew May 2021

Multimodal Neuroimaging Of Hiv And Aging, Brandon Lew

Theses & Dissertations

HIV infection remains a significant contributor to disease burden, and with the success of antiretroviral therapies, the population of people with HIV is aging. A growing literature suggests a relationship between HIV-infection and a profile of age advancement, most notably in molecular studies of epigenetics. However, despite the widely-known high prevalence of HIV-related brain atrophy, functional deficits, and HIV-associated neurocognitive disorder (HAND), epigenetic age advancement has not been linked to HIV-related changes in neuroimaging metrics.

We applied three neuroimaging methods, structural MRI, resting state functional MRI, and resting state MEG, to study the brain structure and function of 121 virally-suppressed …


Clinical Consequences And Determinants Of False Positive Blood Cultures In Adult Hospitalized Patients, Sidra Liaquat May 2021

Clinical Consequences And Determinants Of False Positive Blood Cultures In Adult Hospitalized Patients, Sidra Liaquat

Theses & Dissertations

Blood cultures are the gold standard for detecting blood stream infections. However, in the US, 0.6-6% of all blood cultures get contaminated leading to adverse clinical outcomes such as unnecessarily prolonged hospital stay and antibiotic therapy. Using electronic medical records, we explored the clinical outcomes and patient-specific risk factors of contaminated blood cultures in an era where rapid blood culture testing was being utilized to provide blood culture results within hours. Rapid blood culture test results can help clinicians in early and more effective management of patients with contaminated blood cultures, thus improving clinical outcomes. We also studied the impact …


Development Of Long-Acting Antiviral Drug Nanoformulations, Denise Cobb May 2021

Development Of Long-Acting Antiviral Drug Nanoformulations, Denise Cobb

Theses & Dissertations

Antiretroviral therapy (ART) has improved the quality and duration of life for people living with human immunodeficiency virus (HIV) infection. However, opportunities to improve its profile abound. ART is limited by putative viral reservoir penetrance, emergence of viral mutations, inherent toxicities, and regimen non-adherence. These highlight the need improved drug delivery schemes. Previously, our lab has demonstrated that targeting mononuclear phagocytes for antiretroviral drug delivery extends drug half-life and improves penetrance into viral reservoirs, addressing these limitations of ART. Herein, we developed synthetic and biologic antiretroviral (ARV) drug nanocarriers improve the pharmacokinetic (PK) and pharmacodynamic (PD) profiles of ARVs through …


Multi-Level Considerations For Optimal Implementation Of Long-Acting Injectable Antiretroviral Therapy To Treat People Living With Hiv: Perspectives Of Health Care Providers Participating In Phase 3 Trials, Andrea Mantsios, Miranda Murray, Tahilin S. Karver, Wendy Davis, Noya Galai, Princy Kumar, Susan Swindells, U. Fritz Bredeek, Rafael Rubio García, Antonio Antela, Santiago Cenoz Gomis, Miguel Pascual Bernáldez, Maggie Czarnogorski, Krischan Hudson, Nicki Walters, Deanna Kerrigan Mar 2021

Multi-Level Considerations For Optimal Implementation Of Long-Acting Injectable Antiretroviral Therapy To Treat People Living With Hiv: Perspectives Of Health Care Providers Participating In Phase 3 Trials, Andrea Mantsios, Miranda Murray, Tahilin S. Karver, Wendy Davis, Noya Galai, Princy Kumar, Susan Swindells, U. Fritz Bredeek, Rafael Rubio García, Antonio Antela, Santiago Cenoz Gomis, Miguel Pascual Bernáldez, Maggie Czarnogorski, Krischan Hudson, Nicki Walters, Deanna Kerrigan

Journal Articles: Infectious Diseases

BACKGROUND: Long-acting injectable antiretroviral therapy (LA ART) has been shown to be non-inferior to daily oral ART, with high patient satisfaction and preference to oral standard of care in research to date, and has recently been approved for use in the United States and Europe. This study examined the perspectives of health care providers participating in LA ART clinical trials on potential barriers and solutions to LA ART roll-out into real world settings.

METHODS: This analysis draws on two data sources: (1) open-ended questions embedded in a structured online survey of 329 health care providers participating in the ATLAS-2 M …


The Promise Of Improved Adherence With Long-Acting Antiretroviral Therapy: What Are The Data?, Kimberly Scarsi, Susan Swindells Jan 2021

The Promise Of Improved Adherence With Long-Acting Antiretroviral Therapy: What Are The Data?, Kimberly Scarsi, Susan Swindells

Journal Articles: Infectious Diseases

As with other chronic conditions, adherence to daily medications remains a challenge for many individuals living with HIV due to structural, behavioral, and social barriers. Unfortunately, high levels of adherence to antiretroviral therapy are required to maintain virologic suppression. Alternative approaches are being explored to decrease the burden of daily pill administration, including long-acting injectable, oral, and implantable products. Phase 3 data support the efficacy of nanoformulated injectable cabotegravir and rilpivirine for HIV treatment in patients with undetectable viremia, but we have yet to learn how this strategy may benefit those with medication adherence challenges. Despite this, the affected community …


A Midwestern Academic Hiv Clinic Operation During The Covid-19 Pandemic: Implementation Strategy And Preliminary Outcomes, Nada Fadul, Nichole Regan, Layan Kaddoura, Susan Swindells Jan 2021

A Midwestern Academic Hiv Clinic Operation During The Covid-19 Pandemic: Implementation Strategy And Preliminary Outcomes, Nada Fadul, Nichole Regan, Layan Kaddoura, Susan Swindells

Journal Articles: Infectious Diseases

During the COVID-19 pandemic, HIV clinics had to transform care delivery for people with HIV (PWH). We developed a multifaceted telehealth implementation strategy and monitored number of out of care patients (OOC), medical visit frequency (MVF), gap in care (GiC) and viral suppression (VS), and compared measures to baseline data. Between April and October 2020, 1559 visits were scheduled; 328 (21%) were missed, and 63 (4%) were new to care. Of the remaining 1168 follow-up visits, 412 (35%) were telehealth visits. As of October 2020, there were 53 patients OOC, MVF was 55% and GiC was 24% compared to 34, …


Pandemic Driven Innovation: Development Of An Alternative Respiratory Pathogen Self-Collection Device, Thang Nguyen Dec 2020

Pandemic Driven Innovation: Development Of An Alternative Respiratory Pathogen Self-Collection Device, Thang Nguyen

Theses & Dissertations

The SARS-CoV-2 virus outbreak has underscored numerous weak links in our biodefense countermeasures against highly communicable diseases. Many believe it was our lack of an effective testing model that allowed the virus to become a global pandemic within a short period. The gold standard collection method for the SARS-CoV-2 virus involves mechanical debridement of the nasopharyngeal cavity with a stiff swab applicator, which has been known to cause pain and injury to patients, subsequently resulting in low patient acceptance of the procedure. Due to the invasive nature of the nasopharyngeal swab collection method, it may not be conducive to the …


Nontuberculous Mycobacterium (Ntm) Infection In Aquatic Workers With Purified Protein Derivative (Ppd) And Gold Quantiferon Tests., Lavanya Ravipati, Sarah A. Howard Dec 2020

Nontuberculous Mycobacterium (Ntm) Infection In Aquatic Workers With Purified Protein Derivative (Ppd) And Gold Quantiferon Tests., Lavanya Ravipati, Sarah A. Howard

Graduate Medical Education Research Journal

Background: Nontuberculous mycobacteria (NTM) infections are commonly caused by Mycobacterium marinum and fortuitum with M. marinum more likely to cause skin infections. Aquatic environments are a potential source of contact with M. marinum and fortuitum. Patients with NTM infections may present with positive tuberculin purified protein derivative (PPD) and/or gold QuantiFERON tests. However, PPD cannot differentiate between NTM infection and other tuberculous infections caused by different mycobacterial strains. We present a patient a marine biologist who was asymptomatic and presented for further evaluation as she has a h/o positive PPD and gold QuantiFERON test.

Methods: Patient informed consent was …


Customized Blister Packaging For Patients Living With Hiv: Assessment Of Patient Attitudes And Satisfaction, Holly Groteluschen, Harlan Sayles, Rebecca Osborn, Joshua P. Havens, Sara Bares, Jasmine R. Marcelin Dec 2020

Customized Blister Packaging For Patients Living With Hiv: Assessment Of Patient Attitudes And Satisfaction, Holly Groteluschen, Harlan Sayles, Rebecca Osborn, Joshua P. Havens, Sara Bares, Jasmine R. Marcelin

Graduate Medical Education Research Journal

Adherence to antiretroviral medication results in reduced HIV transmission and improved health outcomes, yet challenges with medication adherence remain. A Collaborative Care Program was developed with a community pharmacy integrating a multi-dose adherence packaging service. We surveyed program participants to assess their satisfaction with this program and found an overall positive sentiment toward the program, that the program helped with reducing missed doses, and all patients would recommend the program to others.


Surprisingly Low Levels Of Measles Immunity In Persons With Hiv: A Seroprevalence Survey In A United States Hiv Clinic, Lindsey Rearigh, Jennifer O'Neill, Maureen Kubat, Harlan Sayles, Susan Swindells, Sara Bares Oct 2020

Surprisingly Low Levels Of Measles Immunity In Persons With Hiv: A Seroprevalence Survey In A United States Hiv Clinic, Lindsey Rearigh, Jennifer O'Neill, Maureen Kubat, Harlan Sayles, Susan Swindells, Sara Bares

Journal Articles: Infectious Diseases

Background: Measles outbreaks have become increasingly common due to deteriorating vaccination rates, fluctuating herd immunity, and varying antibody decline. Limited knowledge exists regarding prevalence and risk factors associated with measles seronegativity among persons with HIV (PWH).

Methods: This was a cross-sectional study conducted at an academic HIV clinic in Omaha, Nebraska. Participants were screened for the presence of measles IgG antibody. Demographic and clinical information was obtained through electronic medical record review. Simple and multivariable logistic regressions were performed to identify risk factors for measles seronegativity.

Results: Three hundred fifty-one participants were enrolled, with a measles seroprevalence rate of 70.3%. …


Structural Magnetic Resonance Imaging As A Diagnostic Biomarker Of Hiv-Associated Neurocognitive Disorders (Hand), Mikki Schantell Aug 2020

Structural Magnetic Resonance Imaging As A Diagnostic Biomarker Of Hiv-Associated Neurocognitive Disorders (Hand), Mikki Schantell

Capstone Experience

Objective: The goal of this study was to do an exploratory analysis to determine if gray matter brain volumes and cortical thickness measures obtained from structural magnetic resonance imaging (sMRI) can discriminate people with HIV-associated neurocognitive disorders (HAND), neurocognitively unimpaired people with HIV (NU PWH), and HIV-negative controls (HIV- controls) using linear discriminant analyses.

Methods: A total of 231 participants, including 110 PWH and 121 HIV- controls, completed a neuropsychological (NP) battery and an sMRI protocol. The bilateral gray matter volumes and cortical thickness brain regions were analyzed using 18 linear discriminant models to assess the discriminability of gray matter …


Planning And Facilitating The Training Of Emergency Medical Services On The Safe Transport Of Patients With Highly Infectious Diseases, Mohammed Alhallaf May 2020

Planning And Facilitating The Training Of Emergency Medical Services On The Safe Transport Of Patients With Highly Infectious Diseases, Mohammed Alhallaf

Theses & Dissertations

Emergency Medical Services (EMS) personnel are the first line of treatment and are the first exposed health care workers to infectious diseases (IDs). Consequently, the EMS setting is a relatively vulnerable environment for disease transmission and cross-contamination. Also, serious and emerging IDs, such as highly pathogenic viral hemorrhagic fevers and novel Coronaviruses, in a time of increased globalization, require comprehensive EMS training and preparedness. This project had the objective of identifying best practices for the EMS transport of patients with IDs. The methods for this project were done in two phases. In the first stage, we …


Be A Hero Too, Samantha S. Rohe, Sophie Cemaj Jan 2020

Be A Hero Too, Samantha S. Rohe, Sophie Cemaj

Books: Pediatrics

This children's book explains COVID-19 and how to decrease the incidence of transmissions.