Impact Of School Nurse Education On Factors Influencing Hpv Vaccine Communication With Parents, Jihye Choi, Efrat K Gabay, Jeanette Deason, Elizabeth Baumler, Diane Santa Maria, Daisy Mullassery, Lara S Savas, Erika Thompson, Sanghamitra M Misra, Paula M Cuccaro

Faculty, Staff and Student Publications

Human papillomavirus (HPV) can cause six cancer types but can be prevented with timely vaccination in early adolescence. However, despite the wide availability of the HPV vaccine, uptake remains suboptimal among US adolescents. School nurses are invaluable resources to students and their families regarding adolescent immunization needs. As part of the All for Them vaccination program, we assessed the impact of the continued nurse education (CNE) intervention on school nurses’ HPV vaccine communication with parents. Seventy-two school nurses and nurse administrators in Texas participated in the study. Using a single-arm study design, we measured participants’ potential barriers to and self-efficacy …

Improving Assessment And Documentation Adherence In An Age-Friendly Health System With A Focus On "What Matters", Thelma I. Arzu

Doctor of Nursing Practice Final Project Abstract

Purpose

To improve adherence in assessing and documenting “What Matters” (WM) using a standardized assessment and documentation process.

Background

The project was implemented within a large Age-Friendly Health System (AFHS) in Houston, Texas, comprised of a geriatric outpatient clinic and a House Call program. Although the 4Ms of AFHS were regularly documented in the outpatient setting, there was limited documentation in the House Call Program.

Methodology

A standardized process was established with clinician stakeholders to assess and document WM using simplified assessment criteria, the electronic medical record (EMR) 4Ms documentation phrase, and a designated location for the 4Ms phrase in …

Lidocaine Combined With Low-Dose Esketamine For Movement-Evoked Pain After Hepatectomy: A Double-Blind Randomised Controlled Trial, Yan Xu, Li Zhou, Qianqian Tang, Feng Yu, Jingwen Wu, Siyu Yan, Min Cai, Jialu Wan, Yi Kang, Lajing Luowu, Mengmeng Zhou, Lulong Bo, Daniel I Sessler, Chunling Jiang

Faculty, Staff and Student Publications

Introduction: Pain following hepatectomy may delay recovery and increase opioid use. We tested the primary hypothesis that combining lidocaine and low-dose esketamine would reduce movement-evoked pain 24 h after hepatic resection. We also evaluated whether this approach reduced opioid consumption and improved quality of recovery.

Methods: Patients having elective hepatic resections were allocated randomly to receive lidocaine-esketamine or placebo from induction of anaesthesia until the end of surgery. After surgery, patients allocated to lidocaine-esketamine were given a continuous infusion of lidocaine with esketamine for 72 h. All patients received transversus abdominis plane blocks with ropivacaine 2 mg.kg-1 after induction of …

Hydroxyethyl Starch And Perioperative Complications: A Systematic Review And Meta-Analysis, Daniel I Sessler, Lorenzo Pradelli, Massimiliano Povero, Daniel Chappell, E Wang

Faculty, Staff and Student Publications

Background: Based on renal injury reported in critically ill and septic patients, the U.S. Food and Drug Administration issued a black box warning regarding hydroxyethyl starch (HES 130/0.4) use in 2013 and expanded the warning to surgical and trauma patients in 2021. Similarly, the European Medicines Agency initiated withdrawal of hydroxyethyl starch in 2022. This study was a new meta-analysis focused on renal injury designed to complement a 2021 meta-analysis of perioperative hydroxyethyl starch use, adding 45 trials and 6,895 patients. The focus was acute kidney injury and preoperative-to-postoperative change in creatinine concentration in surgical patients.

Methods: This study searched …

Early Immune Dysregulation In Mtb/Siv Co-Infection Resists Cart Treatment At The Single-Cell Level, Riti Sharan, Yi Zou, Zhao Lai, Korri Weldon, Todd Bradley, Xi Luo, Hulin Wu, Shabaana A Khader, Deepak Kaushal

Faculty, Staff and Student Publications

Using single-cell transcriptomics of bronchoalveolar lavage cells from Mtb/SIV co-infected rhesus macaques on cART, we reveal profound immune dysregulation during early SIV co-infection of latent tuberculosis. SIV induces a sharp decline in CD4+ T cells, NK, and NKT cells, with incomplete recovery of Mtb-specific TH1 effector responses despite viral suppression. Instead, a persistent TH17-skewed environment emerges, alongside sustained myeloid inflammation driven by Type I interferon signaling and pro-inflammatory regulators such as KLF6 and NFKB1. Ligand-receptor network analyses demonstrate expanded CD4+ T cell-macrophage crosstalk and loss of immune homeostasis that cART fails to fully restore. These findings expose …

Formative Work To Guide Implementation Of An Evidence-Based Breast And Cervical Cancer Prevention And Early Detection Behavioral Health Program In Clinics: Qualitative Study Guided By The Consolidated Framework For Implementation Research, Marlyn A Allicock, Crystal Costa, Ashley Hedrick Mckenzie, Preena Loomba, Roshanda S Chenier, Ross Shegog, Angelita Alaniz, Maria E Fernandez, Lara S Savas

Faculty, Staff and Student Publications

Background: Salud en Mis Manos (SEMM) is a community health worker-delivered evidence-based intervention shown to increase breast and cervical cancer screening in medically underserved Latinas. Despite SEMM's success in community-based settings, clinic-based implementation is limited.

Objective: This study aimed to identify factors influencing the implementation of SEMM in clinic settings using the Consolidated Framework for Implementation Research (CFIR) to inform and refine implementation strategy development.

Methods: We developed theory-informed (eg, CFIR, Social Cognitive Theory, and Readiness) interview guides to elicit barriers and facilitators of SEMM clinic implementation. We conducted 12 semistructured interviews with clinic leaders, outreach coordinators, and community health …

Long-Term Poverty, Rurality, And Geographic Disparities In Colorectal Cancer: A Spatial Analysis In Texas, Ryan Ramphul, Tracey Farrigan, Yixiao Chen, Yanchen Liu, Jooyeon Lee, Ruth Rechis, Karen Basen-Engquist, Lorna Mcneill

Faculty, Staff and Student Publications

Purpose: Colorectal cancer (CRC) remains a leading cause of cancer morbidity and mortality in the United States and shows substantial geographic variation. Socioeconomically disadvantaged communities experience elevated CRC incidence, yet few studies have analyzed multi-decade poverty measures for long-term structural disadvantage.

Methods: We analyzed CRC incidence from 2017 to 2021 across Texas using Texas Cancer Registry data. Age-sex-race/ethnicity standardized cases were incorporated as offsets in Bayesian spatial models to generate tract-level posterior mean relative risks. We evaluated four tract-level poverty measures (high poverty in 2021; persistent poverty since 1990; enduring poverty since 1980 and 1970), Rural-Urban Commuting Area (RUCA) classifications, …

Reducing Potentially Preventable Emergency Department Visits (Ppvs) Through A Telehealth Intervention In Children With Asthma Within A Managed Care Organization (Mco), Renee A. Roker

Doctor of Nursing Practice Final Project Abstract

Abstract

Purpose:  The purpose of this quality improvement project was to reduce unnecessary ED utilizations among children with asthma enrolled in a Medicaid managed care health plan. The project aimed to improve access to care and enhance asthma self-management.

Background:  Asthma is one of the leading causes of Emergency Department (ED) utilization, among vulnerable populations. Members experience barriers to timely primary and specialist care, contributing to Potentially Preventable ED Visits (PPV) rates. This places managed care organizations (MCOs) at risk for financial penalties if not meeting the Texas PPV benchmark.

Methodology:  Guided by the Chronic Care Model, Lean Six Sigma …

Staphylococcus Aureus Urease Is Controlled By A Complex Regulatory Network To Promote Dissemination During Cauti, Jana Gomez, Jesus Duran-Ramirez, Maristhela Alvarez, Shane Cristy, Jennifer N Walker

Faculty, Staff and Student Publications

Catheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-associated infections in the United States, accounting for >1 million cases annually. One CAUTI pathogen, Staphylococcus aureus, is commonly found persisting asymptomatically in the bladder of catheterized individuals, increasing these individuals' risk of developing infection. Importantly, S. aureus is not only associated with severe symptoms during CAUTI, including bacteremia and septic shock, but it also produces a common uropathogen-associated virulence factor, urease. Despite its importance, urease has only been well-studied in another uropathogen, Proteus mirabilis. While previous studies identified three S. aureus urease regulators, including CodY, …

An Online Epilepsy Self-Management Tool For Patients With Epilepsy: A Formative Usability Study, Katarzyna Czerniak, Ross Shegog, Refugio Sepulveda, Robert Addy, Youngran Kim, Sahiti Myneni, Alejandra Garcia-Quintana, Kimberly Martin, David M Labiner

Faculty, Staff and Student Publications

Background: Epilepsy is a serious chronic neurological condition with no permanent cure. Continual self-management is important to mitigate seizure frequency and optimize quality of life in people with epilepsy who have greater disparities in accessing epilepsy care. The Management Information & Decision Support Epilepsy Tool (MINDSET [UTHealth, University of Arizona, and Radiant Digital]) was developed to enhance accessibility to epilepsy self-management (ESM) assessment and treatment. The purpose of this formative usability pilot study was to assess the user experience and functionality of MINDSET 2.0, an enhanced cross-platform online version of MINDSET, among a sample of patients with epilepsy prior to …

Conceptual Framework And Key Considerations For Field-Based Infrastructure In Food Is Medicine Research, Shreela V Sharma, Colleen Tewksbury, Christopher R Long, Colleen Spees, Ronit A Ridberg, Reshma Gupta, Erin P Ferranti, Naomi Tice, Eric Peterson, Brian Levine

Faculty, Staff and Student Publications

In 2023, the American Heart Association launched the Healthcare by Food (HCXF) initiative to establish a rigorous evidence base for Food Is Medicine (FIM) programs, so that patients with acute or chronic disease could access FIM programs as a covered benefit under their health insurance. The HCXF initiative is engaging in research, advocacy, and education to support the development and testing of interventions that improve health outcomes. The HCXF initiative launched 9 task forces aligned with research progress, including the Field-Based Infrastructure task force designed to examine broader questions to help support either earlier or later stages of the HCXF …

The Comfort Cart Initiative: A Quality Improvement Intervention To Improve Patient Satisfaction In The Emergency Department, Heidy Cladimir Ayala

Doctor of Nursing Practice Final Project Abstract

The Comfort Cart Initiative: A Quality Improvement Intervention to Improve Patient Satisfaction in the Emergency Department

Purpose

The Comfort Cart QI project aimed to improve Emergency Department patient, parent, and guardian satisfaction by 10% over an 8-week implementation period.

Background

In healthcare, patient satisfaction is an important indicator of the quality of care provided, and many literature reviews suggest it is closely associated with patient-centered care.

 Methodology

The Comfort Cart intervention is an evidence-based quality improvement project employing a pre- and post-intervention design, conducted over an 8-week period, in the Emergency Department. The project was guided by Kolcaba's Comfort Theory …

Adamts13 And Von Willebrand Factor In Relation To Vascular Cognitive Impairment And Cerebral Small Vessel Disease: The Heart-Brain Connection Study, Amos C Pomp, Mathijs T Rosbergen, Moniek P M De Maat, Paul S De Vries, M Arfan Ikram, Mat J A P Daemen, Imo E Hoefer, Wiro J Niessen, Jeroen De Bresser, Esther E Bron, Charlotte E Teunissen, Geert Jan Biessels, Robert J Van Oostenbrugge, Frank J Wolters

Faculty, Staff and Student Publications

Background: Reduced activity of a disintegrin-like and metalloprotease with thrombospondin type 1 repeats 13 (ADAMTS13) is associated with an increased risk of dementia, independent of Von Willebrand factor (VWF) levels. Pathways underlying this association remain poorly understood.

Objectives: Investigate the associations of VWF levels and ADAMTS13 activity with vascular cognitive impairment (VCI) and cerebral small vessel disease (CSVD).

Methods: In this cross-sectional study, we included 147 participants with VCI and 120 reference subjects (mean age: 67.5 years, 41% women). Using multivariable logistic regression, we determined the cross-sectional association of ADAMTS13 activity and VWF levels in plasma with VCI. Additionally, across …

Clinical Machine Learning Model For Predicting Pathological Complete Response In Patients With Esophageal And Gastroesophageal Junction Adenocarcinoma After Trimodality Therapy, Kohei Yamashita, Evan Kwiatkowski, Matheus Sewastjanow-Silva, Jane E Rogers, Katsuhiro Yoshimura, Melissa Pool Pizzi, Qiong Gan, Jenny J Li, Rebecca E Waters, Mariela Blum Murphy, Masaaki Iwatsuki, Wayne L Hofstetter, Aileen Chen, Ying Yuan, Jaffer A Ajani

Faculty, Staff and Student Publications

Background: Accurate prediction of pathological complete response (pCR) after preoperative chemoradiation therapy, followed by surgery (trimodality therapy) in esophageal adenocarcinoma (EAC) and gastroesophageal junction adenocarcinoma (GEJAC) may improve clinical decision-making and patient counseling before esophagectomy. This study aimed to develop predictive models for pCR after trimodality using machine learning (ML) approaches.

Patients and methods: A total of 569 patients with EAC and GEJAC who received trimodality therapy at MD Anderson Cancer Center between 2002 and 2022 were included. Clinicopathological characteristics and survival benefit of patients who achieved a pCR were reviewed via descriptive and survival analyses. Subsequently, ML models based …

Safety And Efficacy Of Tranexamic Acid In Urologic Surgery: Results From The International, Randomized, Placebo-Controlled Poise-3 Trial, Kari A O Tikkinen, Maura Marcucci, Alex L E Halme, Sandra N Ofori, Flavia K Borges, Charlotte T B Kanstrup, Lily J Park, Farhad Tondroanamag, Tuomas P Kilpeläinen, Sara V Tornberg, Thomas W Painter, David Conen, Vladimir Lomivorotov, Daniel I Sessler, Matthew T V Chan, Maria Jose Martinez-Zapata, Chew Y Wang, Denis B Xavier, Michael K Wang, Wojciech Szczeklik, Kate Leslie, Luke T Lavallee, Rodney H Breau, Kumar Balasubramanian, P J Devereaux

Faculty, Staff and Student Publications

Background and objective: Perioperative bleeding is common. Evidence for tranexamic acid (TXA) in urology remains limited and conflicting, and major urologic guidelines provide no recommendations. In an a priori planned analysis, we evaluated TXA among patients undergoing urologic surgery in POISE-3.

Methods: POISE-3 was an international randomized trial of patients undergoing surgery with bleeding and cardiovascular risk factors. Participants received TXA (1 g intravenous bolus at surgery start and end) or placebo. The primary efficacy outcome was a 30-day bleeding composite (life-threatening/major/critical organ), and the primary safety outcome was a 30-day thrombosis composite (myocardial injury after noncardiac surgery [MINS], nonhemorrhagic …

Computable Phenotypes For Research Using Real-World Data: Experiences From The Nih Pragmatic Trials Collaboratory, Marisa L Conte, Judith M Schlaeger, Guilherme Del Fiol, James R Campbell, Andrea L Cheville, Keith Marsolo, Kari A Stephens, Miriam O Ezenwa, Andrew D Boyd, Juanita E Darby, Nadine S Matthie, P Michael Ho, Alice Pressman, Morgan Justice, Carol Reynolds Geary, Keturah R Faurot, Alex Fist, Karen Staman, Hulin Wu, Rachel L Richesson

Faculty, Staff and Student Publications

Objectives: Embedded pragmatic clinical trials (ePCTs) are conducted as part of routine clinical care and therefore use data collected from real-world data sources, such as electronic health record systems and administrative claims. A common approach for using these types of data across all phases of trial conduct is to create a computable phenotype (an explicitly defined data query data, including specified data types, data codes, and logical parameters) to capture patients with a clinical condition, exposure, symptom, characteristic, treatment, or outcome of interest.

Materials and methods: The Electronic Health Record (EHR) Core Working Group of the NIH Pragmatic Trials Collaboratory …

Fuimos Olvidados Y Descuidados [Forgotten And Neglected]: Lessons Learned And Findings From On-Farm Covid-19 Education And Vaccine Clinics For Agricultural Workers And Their Multigenerational Families In Texas, Anabel Rodriguez, David I Douphrate, Ana L Pineda Reyes, Susana Zavala, Lus Chavez, Sofia Nicole Lopez, Andrea V Cabrera Cruz, Annie J Keeney, Nora Hernandez, Brenda Berumen-Flucker, Eva M Shipp, Matthew W Nonnenmann, Shannon P Guillot-Wright, Bethany Boggess Alcauter, G Lopez Ixta, Paula M Cuccaro, Higinio Fernandez-Sanchez, David Gimeno Ruiz De Porras

Faculty, Staff and Student Publications

Background: Despite being deemed essential non-healthcare workers, agricultural workers were excluded from COVID-19 vaccine prioritization in Texas. This professional practice report describes the multifaceted worker health and safety approaches to protecting agricultural workers and their families during the COVID-19 pandemic.

Methods: Between March 2020 and January 2025, several outreach, education, and training grants from various funding agencies were leveraged to deliver training, personal protective equipment, vaccines, and economic relief to agricultural workers in partnership with community-based organizations, industry, local public health departments, and academic institutions.

Findings: Timely funding efforts led to the distribution of 1,000 PPE kits, with more than …

The Association Between Apoe Genotype, Race, And Dementia: An Analysis Of 7 Population-Based Cohort Studies, Natalia Lakomski, Katherine Giorgio, John Stephen, Maxwell Mansolf, Aïcha Soumaré, Alden L Gross, Allison E Aiello, Archana Singh-Manoux, M Arfan Ikram, Catherine Helmer, Claudia L Satizabal, Deborah A Levine, Donald M Lloyd-Jones, Emily M Briceño, Farzaneh A Sorond, Frank J Wolters, Jayandra J Himali, Lenore J Launer, Djass Mbangdadji, David Li, Lihui Zhao, Oscar L Lopez, Stéphanie Debette, Sudha Seshadri, Suzanne E Judd, Timothy M Hughes, Vilmundur Guðnason, Michael Griswold, Paul S De Vries, Alison Fohner, Pamela L Lutsey, Rachel Zmora, Elizabeth A Peterson, Denise Scholtens, Norrina B Allen, Sanaz Sedaghat

Faculty, Staff and Student Publications

Background and objectives: The apolipoprotein E (APOE) haplotypes are known to be associated with dementia, with the ε4 haplotype associated with higher risk. It has been suggested that the APOE ε2 allele serves as a protective factor for dementia. However, data on the effects of the homozygous APOE ε2/ε2 genotype are limited, likely due to the rarity of the APOE ε2/ε2 genotype. Furthermore, the association between APOE genotypes and dementia may differ across self-reported race. We aim to investigate the association between APOE genotypes and dementia overall and across self-reported race, with a focus on the potential protective …

Loss Of Atp-Dependent Citrate Lyase Drives Left Ventricular Dysfunction By Metabolic Remodeling, Shijie Liu, Seth T Gammon, Lin Tan, Yaqi Gao, Kyoungmin Kim, Mahmoud H Elbatreek, Adrian Arrieta, Ian K Williamson, Rebecca L Salazar, Janet Pham, Angela Davidian, Radhika Khanna Neicheril, Benjamin D Gould, Heidi Vitrac, Alia Sadiq, An Q Dinh, Evan C Lien, Francisca N De Luna Vitorino, Joanna M Gongora, Sara A Martinez, Melanie T Odenkirk, Anna K Boatman, Jessie R Chappel, Lawrence S C Czer, Evan P Kransdorf, David J Lefer, Blake M Hanson, Benjamin A Garcia, Erin M Baker, Matthew G Vander Heiden, Philip L Lorenzi, Heinrich Taegtmeyer, David Piwnica-Worms, James F Martin, Anja Karlstaedt

Faculty, Staff and Student Publications

Background: Metabolic adaptation and maladaptation are hallmarks of the failing heart and may be a target for therapeutic interventions. For example, sustained glucose oxidation during cardiac stress is associated with increased activity and abundance of ACL (ATP-dependent citrate lyase, Acly), which produces acetyl-coenzyme A (CoA) from citrate and CoA and supports de novo lipid synthesis. However, our understanding of how ACL supports cardiac metabolic adaptation and its potential to modulate disease pathophysiology has not yet been investigated.

Methods: We used human heart tissue samples from healthy donors and patients with nonischemic cardiomyopathy. Next, we used CRISPR (clustered, regularly interspaced …

Molecular Mechanism Leading To Human Coronary Atherosclerosis Assessed By Proteomic Analysis And Rna Sequences, Sarah J Parker, Chunhong Mao, David L Caudell, Austin Lyle Seals, Yizhi Wang, Thomas D Green, Joseph M Mcclung, Joshua T Maxwell, Jacolby T Roddey, Kiarash Shakeriastani, Chiung-Ting Wu, Yingzhou Lu, Do-Kyun Kim, Justyna Fert-Bober, Dongping Du, Archana Bhat, Niveda Sundararaman, Matthew Ayres, Rakhi Pandey, Saurabh Bhardwaj, Genesio M Karere, Dana Troxclair, Fannie Jackson, Gordon L Love, Richard Vander Heide, James Hixson, Jennifer E Van Eyk, Yue Wang, David Herrington

Faculty, Staff and Student Publications

Background and aims: Atherosclerosis results from cellular and extracellular changes in the arterial wall, preceded by molecular shifts that initiate disease and drive tissue conversion, yet these changes are not yet fully described. More data are needed concerning these early changes in the coronary artery molecular landscape that signify the initiation of atherosclerosis and the subsequent tissue pheno-conversion to atherosclerotic plaque. This report summarizes results from a large biorepository of human coronary artery tissue, applying state-of-the-art omics technology, advanced data analytic methods, and an arterial organoid model system to predict molecular dynamics and identify potential regulatory mechanisms that could interrupt …

Quality Of Life And Depressive Symptoms In Older Adults: Findings From An Integrated Epilepsy Self-Management Data Set, Elaine T Kiriakopoulos, Farren Briggs, Nicole Fiorelli, Robin E Mcgee, Erica K Johnson, Barbara C Jobst, Ross Shegog, Refugio Sepulveda, Tanya Sprulli, Cam Escoffery, Rakale C Quarells, Molly Mcvoy, Sakshi Priy, Clara Adeniyi, Martha Sajatovic

Faculty, Staff and Student Publications

Background: In the U.S., about one million people with active epilepsy are adults aged 55+. Older adults with epilepsy (OAWE) experience complex health conditions that compromise quality of life (QOL). The contribution of depressive symptom dimensions to health-related QOL remains underexplored in OAWE.

Methods: We analyzed baseline data from 13 epilepsy self-management studies in the CDC-sponsored MEW-DB (Managing Epilepsy Well Database), including adults ages 55 and older (N = 198). The primary outcome was health-related QOL, assessed via the 10-item Quality of Life in Epilepsy scale (QOLIE-10), which was inverse rank normalized (mean = 0, SD = 1). Primary predictors …

Metabolic Syndrome Is Associated With Increased Mortality In Patients With Breast Or Prostate Cancer, Jessica P Hwang, Ning Zhang, Mercy W Misoi, Sabhi Gull, Zayd A Razouki, Justin R Gregg, Natalia I Heredia, Sharon H Giordano

Faculty, Staff and Student Publications

We investigated the association of metabolic syndrome (MetS) with mortality in patients with breast and prostate cancer. Breast and prostate cancer cohorts were created retrospectively using the SEER-Medicare database. Patients with first primary breast or prostate cancer diagnosed in 2008-2019 were identified using ICD-O-3 site and histology codes. Among those, patients with MetS were identified using ICD-9/10-CM codes, CPT/HCPCS codes, and prescription drug use from Medicare claims files. We defined continuous enrollment from 12 months before through 12 months after diagnosis, exposure during the first 12 months after diagnosis, and survival follow-up starting 12 months after diagnosis. We used multivariable …

Promoting Equity For Children And Adolescents Through Implementation Processes In Health And Social Care: A Scoping Review, Michelle Gooey, Heather Morris, Rebecca Madill, Callie Walsh-Bailey, Ahlia Griffiths, Melissa Savaglio, Claire Blewitt, Amanda O'Connor, Sara Holton, Helia Khalesi, Sofia Grage-Moore, Maria Fernandez, Echezona E Ezeanolue, Allison Metz, Ana Baumann, Helen Skouteris

Faculty, Staff and Student Publications

Background: Despite the many existing implementation methods, theories, and frameworks, implementation science is insufficiently closing the research-to-practice gap. Bridging this gap is critical to achieving healthy and thriving communities globally, and requires implementation processes that promote equity and reach diverse populations, especially those most in need. The aim of this scoping review was to identify, thematically analyse, categorise, and provide examples of implementation processes described in equity-focused literature, with a focus on health and social care interventions for children and adolescents from birth to 18 years of age.

Methods: A comprehensive search of literature was undertaken across six electronic databases …

Longitudinal Genomic Surveillance Of Sars-Cov-2 In A University Microcosm Reflects Global Evolutionary Trends, Sankar Prasad Chaki, Melissa M Kahl-Mcdonagh, Benjamin W Neuman, Loni A Taylor, Rebecca S B Fischer, Blake M Hanson, Marlisa S Hardy, Jo Ann Culpepper, Eric Boerwinkle, Kurt A Zuelke

Faculty, Staff and Student Publications

SARS-CoV-2 transmission has declined, yet ongoing viral evolution continues to pose public health challenges. This study conducted long-term (2020-2024) genomic surveillance within a large and globally diverse university community. Viral genomes obtained from clinical (n = 1,786) and surveillance (n = 888) testing samples were classified under clade, lineage, and variant systems, and compared with global genomic data sets. Local patterns broadly paralleled global evolutionary trends, including the phased emergence of major variants, episodic introductions of new lineages, and shifts in dominant clades. Lineage diversity peaked during fall semesters and was highest among undergraduate-aged individuals, with similar distributions …

Neighbourhood Social Vulnerability And Preterm Birth Risk Among Infants With Trisomy 21: A Statewide Analysis, Fatima R Sheriff, Renata H Benjamin, Qian Xiao, Jenil Patel, Charles Shumate, Alejandra Fernandez, A J Agopian

Faculty, Staff and Student Publications

Background: Residing in socioeconomically vulnerable areas is known to be associated with increased preterm birth (PTB) risk in the general population. However, the relationship between social vulnerability and PTB remains unexplored among infants with trisomy 21, who experience more than twice the PTB rate of the general population.

Objectives: The primary objective was to examine the association between maternal socioeconomic vulnerability, as measured by the SVI, and PTB among infants with trisomy 21.

Methods: We conducted a retrospective cohort study among infants with trisomy 21 born in Texas (1999-2018). We examined the association between neighbourhood vulnerability, measured by Social Vulnerability …

Pangenome Analysis Of Proteus Mirabilis Reveals Lineage-Specific Antimicrobial Resistance Profiles And Discordant Genotype-Phenotype Correlations, Namrata Deka, Aimee L Brauer, Katherine Connerton, Blake M Hanson, Jennifer N Walker, Chelsie E Armbruster

Faculty, Staff and Student Publications

Urinary tract infections (UTIs) impose a large healthcare burden, with escalating antimicrobial resistance (AMR), and treatment failure. Proteus mirabilis is an undercharacterized and challenging UTI pathogen due to intrinsic resistance and biofilm formation. To understand P. mirabilis population genomics, we combined pangenome analysis, in silico AMR prediction, and phenotypic antimicrobial susceptibility testing (AST) across 1,027 P. mirabilis genomes derived from human urine specimens. This revealed a mosaic pangenome driven by extensive accessory genome plasticity. Multilocus sequence typing (MLST) identified 213 MLSTs, with only 7% having ≥10 genomes, highlighting strain diversity. AMR gene profiles were largely lineage-specific, with 25% of genomes …

Mosaic Loss Of Y Chromosome Associates With Lung Function, Emphysema, And Epigenetic Aging, Woei-Yuh Saw, Kangjin Kim, Yichen Huang, Jeong H Yun, Xiaolong Ma, Jason Bacon, Yash Pershad, Daniel Levy, George T O'Connor, Eric Boerwinkle, R Graham Barr, Stephen S Rich, Jerome I Rotter, April P Carson, Laura M Raffield, Sina A Gharib, Traci M Bartz, Bruce M Psaty, Tamar Sofer, Kari E North, Robert C Kaplan, Elizabeth C Oelsner, Ani Manichaikul, Alexander G Bick, Paul Scheet, Alexander P Reiner, Nhlbi Trans-Omics For Precision Medicine Consortium, Yasminka A Jakubek, Paul L Auer, Michael H Cho, Dawn L Demeo

Faculty, Staff and Student Publications

Rationale: As the global population ages, identifying risk factors for age-related diseases, such as COPD, is crucial for public health. Mosaic loss of Y chromosome (mLOY) in blood cells is an age-related somatic mosaicism event, but its relationship with pulmonary health remains undercharacterized.

Objectives: To examine the association between mLOY and pulmonary outcomes in men.

Methods: Leveraging mLOY assessment (cell fraction ≥ 5%) in over 12 000 men, including 5097 from the COPDGene Study and 7235 from six additional cohorts in the Trans-Omics for Precision Medicine program, we investigated mLOY associations with respiratory outcomes and epigenetic aging using multivariable cross-sectional, …

Harmonizing Intervention, Context, And Implementation Strategies With Context-Driven Co-Design (Cd2), Sarah A Birken, Emily R Haines, Cheyenne R Wagi, Bonny B Morris, Kathryn E Weaver, Kathleen M Lisborg, Sara J Landes, Geoffrey M Curran, Miriam Bender, Maria E Fernandez, Ashley Strahley, Kimberly Wiseman, Kristie L Foley

Faculty, Staff and Student Publications

Background: Extant approaches to close the gap between implementation evidence and practice have been unsuccessful due in part to overreliance on researcher engagement. In practice, change is often driven by mid-level managers. We developed Context-Driven Co-Design (CD2) to equip mid-level managers with a theory- and evidence-based approach to implementation planning.

Methods: We used a two-pronged design. First, we engaged six established implementation researchers in a modified Delphi process, involving two hour-long meetings and asynchronous feedback to develop and refine a CD2 prototype. Second, we piloted an in-person CD2 training and conducted an hour-long focus group to solicit feedback from mid-level …

Qualitative Evaluation Of The Seated Physical Activity Intervention (Spin) Randomized Controlled Trial For Wheelchair Users With Multiple Sclerosis (Ms): Formative Feedback And Future Directions, Angela J Piasecki, Robert W Motl, Katherine Froehlich-Grobe, Stephanie L Silveira

Faculty, Staff and Student Publications

Background/objectives: Wheelchair users with multiple sclerosis (MS) often face barriers that restrict participation in physical activity and exercise training. This manuscript reports on participant feedback to guide evaluating and refining a novel exercise training program, Seated Physical activity INtervention (SPIN). SPIN was adapted from the Guidelines for Exercise in MS (GEMS) approach using a three-step community-engaged research framework based on meeting the needs of wheelchair users with MS.

Methods: Semi-structured interviews were conducted with 9 participants who completed the 16-week SPIN intervention. The key SPIN intervention components were the exercise prescription, exercise equipment, and behavioral coaching grounded in Social Cognitive …

Toolkit For Multistate Disease Progression Simulation And Treatment Decision-Making Aid, Can Xie, Ruosha Li, Wael Saber, Jorge E Cortes, Nicholas J Short, Xuelin Huang

Faculty, Staff and Student Publications

Background: The optimal timing of a treatment within therapy lines can maximize its benefit while minimizing risks and side effects. Because patients differ in clinical and biological characteristics, personalized treatment planning can support physicians' decision-making. However, multistate disease progression complicates the comparison of treatment strategies, motivating the development of a user-friendly web tool for multistate disease progression simulation and treatment decision support. Microsimulation is a natural approach for comparing prespecified treatment-timing strategies, where it generates disease trajectories for a large number of virtual patients matched to an individual patient's observed data. In our framework, microsimulation is performed using a multistate …