Health Services Research Commons^™

Advances In Prosthetic Technology: A Perspective On Ethical Considerations For Development And Clinical Translation, Hayden Gavette, Cody L Mcdonald, Kristin Kostick-Quenet, Ashley Mullen, Bijan Najafi, M G Finco

Faculty, Staff and Students Publications

Technological advancements of prostheses in recent years, such as haptic feedback, active power, and machine learning for prosthetic control, have opened new doors for improved functioning, satisfaction, and overall quality of life. However, little attention has been paid to ethical considerations surrounding the development and translation of prosthetic technologies into clinical practice. This article, based on current literature, presents perspectives surrounding ethical considerations from the authors' multidisciplinary views as prosthetists (HG, AM, CLM, MGF), as well as combined research experience working directly with people using prostheses (AM, CLM, MGF), wearable technologies for rehabilitation (MGF, BN), machine learning and artificial intelligence …

Toward More Rigorous And Informative Nutritional Epidemiology: The Rational Space Between Dismissal And Defense Of The Status Quo, Andrew W Brown, Stella Aslibekyan, Dennis Bier, Rafael Ferreira Da Silva, Adam Hoover, David M Klurfeld, Eric Loken, Evan Mayo-Wilson, Nir Menachemi, Greg Pavela, Patrick D Quinn, Dale Schoeller, Carmen Tekwe, Danny Valdez, Colby J Vorland, Leah D Whigham, David B Allison

Faculty, Staff and Students Publications

To date, nutritional epidemiology has relied heavily on relatively weak methods including simple observational designs and substandard measurements. Despite low internal validity and other sources of bias, claims of causality are made commonly in this literature. Nutritional epidemiology investigations can be improved through greater scientific rigor and adherence to scientific reporting commensurate with research methods used. Some commentators advocate jettisoning nutritional epidemiology entirely, perhaps believing improvements are impossible. Still others support only normative refinements. But neither abolition nor minor tweaks are appropriate. Nutritional epidemiology, in its present state, offers utility, yet also needs marked, reformational renovation. Changing the status quo …

Perspective: Developing Future Veterans Affairs Scientists Through A Diversity, Equity, And Inclusion Program, Darius B Dawson, Valerie Lewis, Terri L Fletcher, Robert Hal Scofield

Faculty, Staff and Students Publications

For >95 years, the Department of Veterans Affairs Office of Research and Development (ORD) has been improving the lives of Veterans and all Americans through health care discovery and innovation. Scientists and trainees from diverse backgrounds and life experiences bring different perspectives and creativity to address complex health-related problems, which helps to foster scientific innovation, improve quality of research, and advance the likelihood that underserved populations participate in and benefit from clinical and health services research. In this study, we will discuss our experiences in developing future scientists through mentored research supplements supported by ORD.

Effectiveness Of Elbasvir/Grazoprevir Plus Ribavirin For Hepatitis C Virus Genotype 1a Infection And Baseline Ns5a Resistance, Deanna D Hill, Jennifer R Kramer, Kassie R Chaffin, T Christopher Mast, Michael N Robertson, Fasiha Kanwal, Barbara A Haber

Faculty, Staff and Students Publications

Introduction and objectives: In clinical trials, patients with hepatitis C virus (HCV) genotype (GT)1a infection and baseline resistance-associated substitutions (RASs) at amino acid positions 28, 30, 31, or 93 receiving elbasvir/grazoprevir for 12 weeks achieved lower rates of sustained virologic response (SVR) than those without baseline RASs. SVR rates in patients with RASs were improved when elbasvir/grazoprevir treatment duration was extended from 12 to 16 weeks and administered concomitantly with ribavirin.

Materials and methods: This was a retrospective, observational analysis using electronic health record abstraction. Patients with HCV GT1a infection and RASs at positions 28, 30, 31, or 93 who …

Range And Consistency Of Cardiovascular Outcomes Reported By Clinical Trials In Kidney Transplant Recipients: A Systematic Review, Gregory J Wilson, Kim Van, Emma O'Lone, Allison Tong, Jonathan C Craig, Benedicte Sautenet, Klemens Budde, Derek Forfang, John Gill, William G Herrington, Tazeen H Jafar, David W Johnson, Vera Krane, Adeera Levin, Jolanta Malyszko, Patrick Rossignol, Deirdre Sawinski, Nicole Scholes-Robertons, Giovanni Strippoli, Angela Wang, Wolfgang C Winkelmayer, Carmel M Hawley, Andrea K Viecelli

Faculty, Staff and Students Publications

BACKGROIUND: Cardiovascular disease is a major cause of morbidity and mortality in kidney transplant recipients. Trial evidence to improve cardiovascular outcomes is limited by inconsistent reporting of outcomes, which may also lack patient-relevance. This study aimed to assess the range and consistency of cardiovascular outcomes reported by contemporary trials in kidney transplant recipients.

METHODS: A systematic review of all randomized controlled trials involving adult kidney transplant recipients that reported at least 1 cardiovascular outcome from January 2012 to December 2019 was performed, including Embase, MEDLINE, Cochrane, and ClinicalTrials.gov electronic databases. Trial characteristics were extracted and all levels of specification of …

Assessment Of The Cytolytic Potential Of A Multivirus-Targeted T Cell Therapy Using A Vital Dye-Based, Flow Cytometric Assay, Kiriakos Koukoulias, Penelope G Papayanni, Julia Jones, Manik Kuvalekar, Ayumi Watanabe, Yovana Velazquez, Sarah Gilmore, Anastasia Papadopoulou, Ann M Leen, Spyridoula Vasileiou

Faculty, Staff and Students Publications

Reliable and sensitive characterization assays are important determinants of the successful clinical translation of immunotherapies. For the assessment of cytolytic potential, the chromium 51 (51Cr) release assay has long been considered the gold standard for testing effector cells. However, attaining the approvals to access and use radioactive isotopes is becoming increasingly complex, while technical aspects [i.e. sensitivity, short (4-6 hours) assay duration] may lead to suboptimal performance. This has been the case with our ex vivo expanded, polyclonal (CD4+ and CD8+) multivirus-specific T cell (multiVST) lines, which recognize 5 difficult-to-treat viruses [Adenovirus (AdV), BK virus (BKV), cytomegalovirus (CMV), Epstein Barr …

Editorial: Health Effects And Pathophysiological Mechanisms Of One-Carbon Metabolism Nutrients Intake Throughout The Life Cycle, Jufen Liu, Yunping Lei, Lei Wang, Chao Guo

Faculty, Staff and Students Publications

No abstract provided.

The Effect Of A Plasma Next-Generation Sequencing Test On Antimicrobial Management In Immunocompetent And Immunocompromised Patients-A Single-Center Retrospective Study, Denise Marie A Francisco, Laila Woc-Colburn, Travis J Carlson, Todd Lasco, Miriam Barrett, Mayar Al Mohajer

Faculty, Staff and Students Publications

Objective: To describe the use of next-generation sequencing (NGS) and to determine whether NGS leads to changes in antimicrobial management.

Design and setting: This retrospective cohort study included patients aged ≥18 years admitted to a single tertiary-care center in Houston, Texas, with an NGS test performed between January 1, 2017, and December 31, 2018.

Patients: In total, 167 NGS tests were performed. Most patients were of non-Hispanic ethnicity (n = 129), white (n = 106), and male (n = 116), with a mean age of 52 years (SD, 16). Moreover, 61 patients were immunocompromised: solid-organ transplant (n = 30), patients …

The Small Intestinal Microbiome: Vibing With Intestinal Stem Cells, Victoria Poplaski, Faith Sawyer, Sarah E Blutt

Faculty, Staff and Students Publications

The epithelial lining of the small intestine mediates its absorptive and secretory function and thus is a critical component of human health. Regeneration and renewal of the epithelium is the result of proliferation of intestinal stem cells (ISCs). Many cell types and molecular factors are known to regulate the ability of ISCs to proliferate, including adjacent neighboring epithelial cells and the underlying, supportive stromal cells. The microbiome resides in the lumen of the small intestine and is in close contact with the epithelium. Due to its proximity to ISCs, it has been hypothesized that species within the microbiome have the …

Gene-Environment Interactions Underlying The Etiology Of Neural Tube Defects, Carlo Donato Caiaffa, Cristiane Sá Roriz Fonteles, Lei Yunping, Richard H Finnell

Faculty, Staff and Students Publications

Neural tube defects (NTDs) consist of severe structural malformations of the brain and spinal cord and are the second most common structural birth defect in humans, accounting for approximately 2700 affected pregnancies every year in the United States. These numbers are highly significant, considering that birth defects remain a leading cause of infant mortality in the United States, affecting approximately 120,000 babies born annually. Survivors of these congenital malformations face long-term disability and lifelong challenges imposed by severe physical burdens compromising the afflicted individual's overall quality of life. Clearly, birth defects, and especially NTDs remain a global public health challenge, …

Versican Provides The Provisional Matrix For Uterine Spiral Artery Dilation And Fetal Growth, Yusuke Sagae, Akihito Horie, Akihiro Yanai, Tsutomu Ohara, Baku Nakakita, Yoshimi Kitawaki, Asuka Okunomiya, Hirohiko Tani, Ken Yamaguchi, Junzo Hamanishi, John P Lydon, Takiko Daikoku, Hideto Watanabe, Masaki Mandai

Faculty, Staff and Students Publications

The extracellular matrix (ECM) in the endometrium plays a crucial role in mammalian pregnancy. We have shown that versican secreted from the endometrial epithelium promotes embryo implantation. Versican is a proteoglycan, a major player in the provisional matrix, and versikine, its N-terminal fragment cleaved by ADAMTS proteinases, serves as a bioactive molecule. Here, since versican expression in the placenta was dynamically altered in humans and mice, we investigated the role of versican in pregnancy using uterine-specific Vcan deletion mice (uKO mice) and ADAMTS-resistant versican expressing mice (V1R mice). uKO mice exhibited insufficient spiral artery dilation, followed by fetal growth restriction …

Astrocytic-Based Controller Shifts Epileptic Activity To The Chaotic State, Mojde Nahtani, Mehdi Siahi, Javad Razjouyan

Faculty, Staff and Students Publications

Introduction: Investigating an effective controller to shift hippocampal epileptic periodicity to normal chaotic behavior will be new hope for epilepsy treatment. Astrocytes nourish and protect neurons and maintain synaptic transmission and network activity. Therefore, this study explored the ameliorating effect of the astrocyte computational model on epileptic periodicity.

Methods: Modified Morris-Lecar equations were used to model the hippocampal CA3 network. Network inhibitory parameters were employed to generate oscillation-induced epileptiform periodicity. The astrocyte controller was based on a functional dynamic mathematical model of brain astrocytic cells.

Results: Results demonstrated that the synchronization of two neural networks shifted the brain's chaotic state …

Expanding Access To Evidence-Based Psychotherapy In Va Settings: Implementation Of The Brief Cognitive Behavioral Therapy For Depression Program, Joseph Mignogna, Derrecka Boykin, Raquel D Gonzalez, Andrew Robinson, Darrell Zeno, Shubhada Sansgiry, Jennifer Broderick-Mcdaniel, Richard B Roberson, Kristen Sorocco, Jeffrey A Cully

Faculty, Staff and Students Publications

Introduction: Evidence-based psychotherapies (EBPs) are effective for mental health conditions, but access to these services remains limited and rural Veterans are particularly underserved. Specialized implementation and dissemination programs are needed to improve access to known EBPs.

Methods: The current project sought to improve access to a known EBP-brief Cognitive Behavioral Therapy for depression (Brief CBT). Diverse Veterans and those from rural settings were a focus of this work. Aligned with the RE-AIM framework, a multifaceted implementation program was used to train and support VHA providers in their use of Brief CBT in VHA mental health settings, with specific outreach efforts …

Crossing The Decarbonization Chasm: A Call To Action For Hospital And Health System Leaders To Reduce Their Greenhouse Gas Emissions, Hardeep Singh, Walt Vernon, Terri Scannell, Kathy Gerwig

Faculty, Staff and Students Publications

No abstract provided.

A Pregnant Patient Presents With Leakage Of Vaginal Fluid In The Second Trimester, Alison N Goulding, Jennifer R Mckinney, Diana Crabtree Sokol, Anitra D Beasley

Faculty, Staff and Students Publications

Morning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient’s chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case.

This report examines the story of a 43-year-old (gravida 3, para 2) woman who sought evaluation for leakage of vaginal fluid at 15 weeks of gestation. Using questions, physical examination, and testing, an illness script for the presentation emerges. As her …