Health Services Research Commons^™

Sox2 Regulates Foregut Squamous Epithelial Homeostasis And Is Lost During Barrett’S Esophagus Development, Ramon U Jin, Yuanwei Xu, T Mamie Lih, Yang-Zhe Huang, Toni M Nittolo, Blake E Sells, Olivia M Dres, Jean S Wang, Qing K Li, Hui Zhang, Jason C Mills

Faculty, Staff and Students Publications

Esophageal adenocarcinoma is increasingly prevalent and is thought to arise from Barrett's esophagus (BE), a metaplastic condition in which chronic acid and bile reflux transforms the esophageal squamous epithelium into a gastric-intestinal glandular mucosa. The molecular determinants driving this metaplasia are poorly understood. We developed a human BE organoid biobank that recapitulates BE's molecular heterogeneity. Bulk and single-cell transcriptomics, supported by patient tissue analysis, revealed that BE differentiation reflects a balance between SOX2 (foregut/esophageal) and CDX2 (hindgut/intestinal) transcription factors. Using squamous-specific inducible Sox2-KO (Krt5CreER/+ Sox2Δ/Δ ROSA26tdTomato/+) mice, we observed increased basal proliferation, reduced squamous differentiation, and expanded metaplastic glands at …

Culturally Responsive Occupational Therapy Treatment Guide For African-American And Hispanic People With Eating Disorders, Desere N. Cooper

Student Capstone Papers

This capstone project addressed the critical need for a culturally responsive approach to occupational therapy in the treatment of African-American and Hispanic with eating disorders (EDs) in the United States. Although EDs impair physical, cognitive, and psychosocial functioning, these communities often encounter systemic barriers such as cultural stigma, food insecurity, and inadequate assessment tools rooted in Eurocentric norms—that contribute to underdiagnosis, limited access to care, and poorer outcomes. The central issue addressed was the absence of clear, culturally relevant guidance for occupational therapy practitioners working with these underserved populations. The project was informed by a comprehensive literature review and synthesis …

Co-Targeting Bcl-Xl With Mcl-1 Induces Lethal Mitochondrial Dysfunction In Diffuse Mesothelioma, Yuan Xu, Cristian G Medina, Deborah R Surman, Lacey E Dobrolecki, Monica Vilchis, Maheshwari Ramineni, Susan G Hilsenbeck, Yanming Li, Naren Li, Siqi Wu, Jaylon C Aggison, Xi Chen, Yi Zhu, Ying H Shen, R Taylor Ripley

Faculty, Staff and Students Publications

Diffuse mesothelioma (DM) is a rare but highly aggressive and treatment resistant neoplasm with low survival rates. Effective therapeutic strategies are limited, and resistance to treatment is a major obstacle. Myeloid Cell Leukemia (MCL)-1 and B-cell leukemia (BCL)-xL are anti-apoptotic B-cell lymphoma 2 (Bcl-2) family proteins that block cell-intrinsic apoptosis through interactions on the mitochondrial outer membrane which contribute to therapeutic resistance.

We investigated whether B-cell homology domain (BH)-3 profiles were consistent between intra-patient fresh tumor sample, patient-derived cells (PDC), and patient-derived xenografts (PDX) by BH3 profiling; we observed striking consistency which enabled cross model comparisons. Next, we co-targeted BCL-xl …

Adherence To Inhaled Corticosteroid Medications After An Asthma Exacerbation And The Risk Of Subsequent Exacerbations, Mina Khezrian, Marjan Kerkhof, Tham T Le, Tim Harrison, Tianshi David Wu, Bill Cook, Jonatan Hedberg, Kirsty Rhodes, Nicole Zubizarreta, Joshua Enxing, Trung N Tran

Faculty, Staff and Students Publications

Background: Data on the duration of improved adherence to controller medications after an exacerbation and its impact on asthma outcomes are inconsistent.

Objective: To describe levels and changes in adherence to inhaled corticosteroid (ICS)-containing medication after a severe exacerbation and the association with future exacerbation risk.

Methods: This retrospective cohort study used data from Optum's deidentified Clinformatics Data Mart Database (October 2015-December 2023). Patients with asthma, 1 or more severe exacerbations, and adherence to ICS-containing therapy (proportion of days covered [PDC]) of less than 80% in the 3 months before an exacerbation were included. Primary and secondary end points were …

Macrophage Phagocytosis Of Human Norovirus-Infected Cells In An Ex Vivo Human Enteroid-Macrophage Coculture Model, Ngan Fung Li, Sue E Crawford, Sydney R Mittiga, Cristian Coarfa, Hoa Nguyen-Phuc, Budi Utama, Sarah E Blutt, Sasirekha Ramani, Mary K Estes

Faculty, Staff and Students Publications

Human norovirus (HuNoV) causes acute gastroenteritis in immunocompetent hosts and chronic infection in immunocompromised individuals. Many recent studies of replication and innate immune responses following HuNoV infection have utilized epithelium-only human intestinal enteroids (HIEs), which lack immune cells. Here, we utilized an ex vivo enteroid-macrophage coculture model consisting of HIEs and different subtypes of human peripheral blood mononuclear cell-derived macrophages to better recapitulate in vivo gut biology and explore the role of macrophages in HuNoV replication and pathogenesis. We show that HuNoV infection in HIEs polarized on Transwells leads to bilateral release of the viral genome, with predominant apical virus …

Established And Emerging Asthma Biomarkers With A Focus On Biologic Trials: A Narrative Review, Philip F Lavere, Kaitlin M Phillips, Nicola A Hanania, Muhammad Adrish

Faculty, Staff and Students Publications

Chronic airway inflammation with variable airflow obstruction is clinical asthma, and it arises from distinct molecular and pathological mechanisms called endotypes. Biomarkers allow for precise endotype characterization and have been used in clinical trials to design, monitor, and evaluate outcomes for asthma biologic therapies. This review will highlight the central and evolving role of biomarkers for past, present, and future asthma, with a focus on regulatory-approved biologic therapies and emerging biomarkers. Established biomarkers, including serum immunoglobulin E (IgE), blood eosinophils, the fraction of exhaled nitric oxide (FeNO), and serum periostin, helped elucidate the complex pathophysiology of the eosinophilic type 2 …

Holistic Approach To Managing Grade 3 Vaginismus: An Obg Physiotherapy Perspective, Nagma Khan

Internet Journal of Allied Health Sciences and Practice

Background: Vaginismus is a condition characterized by involuntary pelvic floor muscle contractions, which can make vaginal penetration painful or impossible. This disorder has both physical and psychological components, often leading to significant emotional distress, anxiety, and relationship difficulties. Effective management requires a holistic, multidisciplinary approach, combining physical therapy with psychological support. This case report examines the treatment of a 29-year-old woman with grade 3 vaginismus, highlighting the role of Obstetrics & Gynaecology (OBG) physiotherapy in improving both physical symptoms and emotional well-being.

Case Presentation: A 29-year-old female presented with grade 3 vaginismus, with a history of severe pelvic floor tension …

Micbg406a Polymorphism Reduces Risk Of Mechanical Ventilation And Death During Viral Acute Lung Injury, Harry Pickering, Narges Alipanah-Lechner, Ernie Chen, Dylan Duchen, Holden T Maecker, Seunghee Kim-Schulze, Ruth R Montgomery, Chris Cotsapas, Hanno Steen, Florian Krammer, Charles R Langelier, Ofer Levy, Lindsey R Baden, Esther Melamed, Lauren Ir Ehrlich, Grace A Mccomsey, Rafick P Sekaly, Charles B Cairns, Elias K Haddad, Albert C Shaw, David A Hafler, David B Corry, Farrah Kheradmand, Mark A Atkinson, Scott C Brakenridge, Nelson I Agudelo Higuita, Jordan P Metcalf, Catherine L Hough, William B Messer, Bali Pulendran, Kari C Nadeau, Mark M Davis, Ana Fernandez Sesma, Viviana Simon, Monica Kraft, Chris Bime, David J Erle, Joanna Schaenmann, Al Ozonoff, Bjoern Peters, Steven H Kleinstein, Alison D Augustine, Joann Diray-Arce, Patrice M Becker, Nadine Rouphael, Matthew C Altman, Steve Bosinger, Walter Eckalbar, Carolyn S Calfee, Oscar A Aguilar, Elaine F Reed, John R Greenland, Daniel R Calabrese

Faculty, Staff and Students Publications

MHC class I polypeptide-related sequence B (MICB) is a ligand for NKG2D. We have shown NK cells are central to lung transplant acute lung injury (ALI) via NKG2D activation, and increased MICB in bronchoalveolar lavage predicts ALI severity. Separately, we found a MICB polymorphism (MICBG406A) is associated with decreased ALI risk. We hypothesized this polymorphism would protect against severe SARS-CoV-2 respiratory disease. We analyzed 1,036 patients hospitalized with SARS-CoV-2 infection from IMPACC. Associations between MICBG406A and outcomes were determined by linear regression or Cox proportional hazards models. We also measured immune profiles of peripheral blood and the upper and lower …

A Comprehensive Evidence-Based Educational Initiative For Improving Hand Hygiene, Lyanna L. Chan

Master's Projects and Capstones

Abstract

Problem: Healthcare-associated infections (HAIs) are a persistent concern in assisted living facilities, often resulting from inconsistent hand hygiene practices. Although national guidelines exist, adherence remains suboptimal, especially where staff training and compliance monitoring are limited.

Context: This project took place in a 53-bed assisted living facility without a formal system to track or reinforce hand hygiene. The aim was to improve staff knowledge and promote infection prevention through education.

Interventions: A Clinical Nurse Leader (CNL) led an evidence-based hand hygiene education program. The intervention included interactive training, visual reminders, personal sanitizers, and leadership support during clinical huddles.

Measures: Pre- …

Increasing The Feasibility, Impact, And Equity Of The Medicare Annual Wellness Visit (Awv) With A Practice Tailored Awv Intervention: A Stepped Wedge Clinical Trial Protocol, Chi-Hong Tseng, Neil S. Wenger

Faculty Scholarship

Background Older adults vastly underutilize evidence-based preventive health services and screenings that reduce illness, morbidity and mortality. The free-to-patient Medicare Annual Wellness Visit (AWV) is an opportunity to enhance preventive healthcare use, but also is underused. Objectives To evaluate the effect of a practice-tailored intervention on the sustained use of Medicare AWVs and on guideline-recommended preventive services and racial/ethnic disparities in 3 types of practice settings. Methods This is a stepped wedge cluster randomized controlled trial. The intervention will be implemented at the practice level in 24 primary care practices across the country (8 community-based, 8 academic, and 8 serving …

Dual-Function Polyester Nanoparticles For Amplified Anti-Inflammatory Effects, Ingrid M Heyns, Abiodun T Wahab, Raghu Ganugula, David Sheikh-Hamad, M N V Ravi Kumar, Meenakshi Arora

Faculty, Staff and Students Publications

This study investigates a dual-acting drug delivery system using naringenin (NAR) as a folate receptor ligand to enhance intestinal uptake and encapsulated NAR for combating inflammation. The dual-acting systems were tested in vitro on cisplatin-induced human kidney-2 cells and in vivo in a mouse model of cisplatin-induced acute kidney injury (AKI). NAR-loaded passive nanoparticles [P2Ns(NAR)] and dual-acting systems [P2Ns-NAR(NAR)] showed notable advantages over unformulated NAR, reducing the required dose by up to 57 and 79%, respectively. These nanoparticles modulated immune responses, restored T cell function, and shifted macrophage polarization from proinflammatory M1 to tissue-repairing M2. In addition, P2Ns-NAR(NAR) alleviated AKI …

Chlamydia And Gonorrhea Infections In Genital And Extragenital Samples Among Men And Women, Kristal J. Aaron, Charlotte A. Gaydos, Edward W. Hook, Max Chernesky, Jeanne Moncada, Stephanie N. Taylor, Harold C. Wiesenfeld, Kenneth H. Mayer, Matthew R. Golden, Alexander Boutwell, Barbara Van Der Pol

School of Medicine Faculty Publications

Background For people who have anal and/or oral sex, many programs recommend genital and extragenital (defined here as anorectal and oropharyngeal) screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) to identify all potential sites of infection. Methods We assessed genital and extragenital CT and NG prevalence among people reporting extragenital sexual exposure. Results Among 343 gay and bisexual men who reported sex with men (GBMSM), 42 (12.2%) had CT with positivity of 3.5%, 9.3% and 1.8% in the genital, anal, and oral samples, respectively. In this same group, 55 (16.0%) had NG with positivity of 5.2%, 8.5%, and 7.6% …

Drug Development Studies Supporting Zileuton As A Parenteral Adjuvant To Attenuate Antibiotic-Associated Nephrotoxicity, Cole S Hudson, James E Smith, Linh T Vuong, Nicholas S Teran, Nazanin Pouya, David Sheikh-Hamad, Xinli Liu, Shama Kajiji, Vincent H Tam

Faculty, Staff and Students Publications

Glycopeptide, polymyxin, and aminoglycoside antibiotics are among the most commonly used agents to treat drug-resistant bacterial infections; however, their clinical use is hindered by nephrotoxicity. We previously reported that zileuton has the potential to attenuate antibiotic-associated nephrotoxicity in an animal model. Here, we further report the development of a parenteral formulation and exploration of dosing strategies for zileuton. The solubility, stability, and multi-dose safety of two zileuton formulations were evaluated. Zileuton serum and renal tissue pharmacokinetics were evaluated after a single dose and compared to steady state after 10 days. Different dosing strategies of zileuton to attenuate vancomycin-, polymyxin B-, …

Increased Fungal Burden In The Gastrointestinal Tract Of Brain-Dead Organ Donors, Erika J Nachman, Colleen K Ardis, A Kyle B Ardis, Javier Nieto, Madeline M Bresson, Clare M Robertson, Maggie N Seale, Nora M Villafuerte, Zhe Lyu, Eva C Preisner, Heather A Danhof, Sara C Di Rienzi, Yolanda T Becker, Robert A Britton

Faculty, Staff and Students Publications

Approximately 3% of organ transplant recipients will be diagnosed with an invasive fungal infection (IFI), with 10%-47% being fatal. The source of IFI is typically not known, but Candida spp. cause the majority of IFI cases. We obtained intestines from two types of organ donors, brain-dead (BD) (n = 7) and donation after circulatory death (DCD) (n = 5), to sample microbes from the mucosal surface and the lumen. BD donors were parenterally fed and treated with corticosteroids in the days before procurement, whereas DCD donors were enterally fed and not given corticosteroids. We found fungi present in …

Three Things We Can Do Now To Reduce The Risk Of Avian Influenza Spillovers, Kenneth B Yeh, William P Bahnfleth, Elaine Bradford, Carol Cardona, Kristen K Coleman, Peter J Hudson, Bernadeta Dadonaite, Rebecca J Hutchins, Anthony Maresso, C Raina Macintyre, Matthew Scotch

Faculty, Staff and Students Publications

No abstract provided.

Comparative Outcomes Of Coil Embolization And Surgical Clipping In Elderly Patients With Subarachnoid Hemorrhage: A Systematic Review And Meta-Analysis, Yohanna Idsabella Rossi, Gabriel Bolner, Jonathan Costa Dall'acqua, Fabiana Dolovitsch De Oliveira, Lucas V. Zacaria, Taís L. Denicol, Michel Frudit, Natália Vasconcellos De Oliveira Souza

Department of Neurology Faculty Papers

BACKGROUND AND OBJECTIVES: Elderly patients with subarachnoid hemorrhage (SAH) face a disproportionately high burden of morbidity and mortality. While endovascular coiling is often favored in this population, direct comparisons with surgical clipping are limited. We conducted a meta-analysis to compare outcomes of clipping versus coiling in SAH patients aged ≥ 60 years.

METHODS: A systematic search of PubMed, Embase, and Cochrane databases identified studies comparing the two treatments in this age group. The primary outcome was a composite of unfavorable outcomes (modified Rankin Scale [mRS] > 2 and mortality). Secondary outcomes included mortality, favorable outcome (mRS 0-2), rebleeding, and hospital length …

Mental Health Service Utilization Among Arab/Middle Eastern In The Us: Structural Disparities, Digital Access, And Stigma-Related Barriers., Fatima M. Aldarweesh

Electronic Theses and Dissertations

Arab Middle Eastern (AME) United States (US) college-attending students are more susceptible to disproportionate mental health problems and underutilization of mental healthcare services due to cultural, structural, and psychosocial barriers. The study examines mental health service utilization and mental health outcomes among AME, particularly focusing on the impact of structural, cultural, and psychosocial determinants grounded in Andersen and Aday’s Health Services research model and Corrigan’s stigma framework. The three interconnected aims use secondary nationally representative data from the Healthy Minds Study (HMS) 2019-2024. The study was analyzed using logistic regression and generalized structural equation modeling across three aims to identify …

Honoring Childhood Agency In Developmental Research: Best Practices, Applications, And Insights, Amanda N. Howery, Olivia J. Lashley, Hanna R. Wright, Julia L. Williams, Olivia K. Nomura, Eline Lenne, Elizabeth K. Wood, Hanna C. Gustafsson, Elinor L. Sullivan

School of Social Work Faculty Publications and Presentations

Pediatric research requires caregivers to provide informed consent on behalf of their children. While not a formal requirement for children under the age of seven, it is important to involve child participants in the assent and decision-making processes in developmentally appropriate ways. This is especially important in longitudinal research, where the extent to which a developing child understands study tasks evolves over time. Although there is consensus that assent procedures are important and necessary, limited resources synthesizing strategies for pediatric researchers to encourage positive and respectful research experiences for young children exist. We describe methods used in an ongoing longitudinal …

Did California's Mental Health Services Act Improve Mental Health? Evidence From Self-Reported Data, Bennett Rider

All Theses

This analysis evaluates the impact of California’s Mental Health Services Act (MHSA), which was implemented in 2006 to increase access and improve quality of mental health care for Californians. Difference-in-differences analyses were applied to evaluate the impact of the MHSA on the number of poor mental health days in the past month (PMHDs) that survey respondents had self-reported, relative to a control group with similar pre-policy trends. Using survey data from the Behavioral Risk Factor Surveillance System (BRFSS), this study found that the MHSA’s full implementation is associated with California respondents reporting 0.118 fewer poor mental health days in the …

Plasminogen Mutation-Associated Thrombotic Microangiopathy And Role Of Anticoagulation: A Single Institution Case Series, Shreya Agarwal, Nicola Pozzi, Senthil Sukumar, Camila Masias, Anuja Java, Spero Cataland

Faculty, Staff and Students Publications

Background: Knowledge gaps exist regarding the role of coagulation pathway mutations such as those in the plasminogen (PLG) gene in the pathogenesis of thrombotic microangiopathy (TMA) and treatment outcomes.

Objectives: This study aims to describe the unique phenotypic features of patients with PLG mutations and perform structural mapping of the variants to enhance variant interpretation.

Methods: This was a single-center retrospective study of patients with TMA in whom genetic testing was performed between 2011 and 2023. Data were collected regarding demographics, clinical features at their first presentation, renal outcomes, genetic mutations, and recurrence for those who were found …