Health Services Research Commons^™

What Is The Evidence? Updates In The Use Of Antenatal Corticosteroids For Patients At Risk Of Preterm Birth, Moti Gulersen, Cynthia Gyamfi-Bannerman

Department of Obstetrics and Gynecology Faculty Papers

Antenatal corticosteroids have long been considered one of the most important antenatal therapies available for pregnant patients at risk of preterm birth based on the associated reduction of neonatal morbidity and mortality following their administration. However, despite decades of research since their incorporation into routine clinical practice, a number of key questions related to antenatal corticosteroid use remain. These include evaluating the impact of antenatal corticosteroids at gestational ages outside of the previously recommended window of 24 0/7–33 6/7 weeks of gestation, determining factors associated with optimal steroid timing in order to reduce unnecessary exposure, alterations in its dosing regimen, …

Service Provider Perceptions Of Systems Serving Individuals Experiencing Homelessness: A Needs Assessment And Strategic Plan In Johnson City, Tn, Opal Frye-Clark

Electronic Theses and Dissertations

This Integrated Learning Experience (ILE) investigates service providers' perceptions of Johnson City, Tennessee's homelessness services, aiming to inform a city-wide strategic plan for reduction. Employing a mixed-methods approach, the study gathered qualitative data through in-depth interviews with service providers in 2022 and quantitative data via a 2024 survey. The research focused on those directly involved in serving or significantly influencing the lives of individuals experiencing homelessness (IEH). Three key aims guided the investigation: (1) To analyze provider perspectives to identify community assets, opportunities, barriers, and unmet needs, informing a comprehensive needs assessment; (2) To refine these findings through SWOT analysis …

Public Health Implications Of State-Level Public Health Organizational And System Structures, Cameron Ferguson Hays

Dissertations

Public health thought leaders such as the Institute of Medicine and National Academies of Science, Engineering, and Medicine have long been concerned about the lack of standardization among state-level public health systems (IOM, 1988; NASEM, 2023). However, little research studies these systems, their structures, and whether structural constructs affect population health outcomes.

This study attempted to examine the structural constructs that make up these systems and the impact of those constructs using an exploratory sequential mixed-methods design. Variables from management science were qualitatively extracted from materials describing all 50 state-level public health systems. Those variables were then analyzed using a …

Exploring Fibroblast Interactions On Nanocrystalline Surfaces In Physiological Environments Through A Phenomenological Lens, R D K Misra, Aladin M Boriek

Faculty, Staff and Students Publications

The cytological behaviour and functional dynamics (adhesion, spreading, synthesis of proteins) of fibroblasts when interacting with biomedical surfaces are intricately influenced by the inherent nature of surface (nanocrystalline or microcrystalline), where the nanocrystalline (NC) surface is preferred in relation to the microcrystalline (MC) surface. This preference is a direct consequence of the distinct differences in physical and chemical characteristics between NC and MC surfaces, which include crystal boundary bio-physical attributes, electron work function, surface energy, and charge carrier density. The observed variances in cytological behaviour at the interfaces of NC and MC bio-surfaces can be attributed to these fundamental differences, …

Infant-Derived Human Nasal Organoids Exhibit Relatively Increased Susceptibility, Epithelial Responses, And Cytotoxicity During Rsv Infection, Gina M Aloisio, Divya Nagaraj, Ashley M Murray, Emily M Schultz, Trevor Mcbride, Letisha Aideyan, Erin G Nicholson, David Henke, Laura Ferlic-Stark, Anubama Rajan, Amal Kambal, Hannah L Johnson, Elina Mosa, Fabio Stossi, Sarah E Blutt, Pedro A Piedra, Vasanthi Avadhanula

Faculty, Staff and Students Publications

Background: Respiratory syncytial virus (RSV) causes significant morbidity and mortality, especially in young children. Why RSV infection in children is more severe compared to healthy adults is not fully understood.

Methods: We used ex-vivo human nasal organoid platforms from infants and adults to investigate the underlying mechanism of this disease disparity at the initial site of RSV replication, the nasal epithelium.

Results: Infant-derived human nasal organoid-air liquid interface (HNO-ALIs) lines were more susceptible to early RSV replication. Moreover, infant-derived HNO-ALIs elicited a statistically significant greater overall cytokine response, enhanced mucous production, and greater cellular damage compared to their adult counterparts. …

Chemogenetic Neuronal Silencing Decouples C-Jun Activation From Cell Death In The Temporal Cortex, Caleb A Wood, Preethi Somasundaram, Jacob M Dundee, Melissa A Rudy, Trent A Watkins, Joanna L Jankowsky

Faculty, Staff and Students Publications

Initial symptoms of neurodegenerative diseases are often defined by the loss of the most vulnerable neural populations specific to each disorder. In the early stages of Alzheimer's disease, vulnerable circuits in the temporal lobe exhibit diminished activity prior to overt degeneration. It remains unclear whether these functional changes contribute to regional vulnerability or are simply a consequence of pathology. We previously found that entorhinal neurons in the temporal cortex undergo cell death following transient suppression of electrical activity, suggesting a causal role for activity disruption in neurodegeneration. Here we demonstrate that electrical arrest of this circuit stimulates the injury-response transcription …

Bst2 Facilitates Activation Of Hematopoietic Stem Cells Through Erk Signaling, Marcus A Florez, Apoorva Thatavarty, Duy T Le, Holly A Hill, Youngjae Jeong, Brian M Ho, Pawel Kus, Trisha K Wathan, Bailee N Kain, Shixia Huang, Dongsu Park, Katherine Y King

Faculty, Staff and Students Publications

The proinflammatory cytokine interferon-gamma (IFNγ) is upregulated in a variety of infections and contributes to bone marrow failure through hematopoietic stem cell (HSC) activation and subsequent exhaustion. The cell surface protein, bone marrow stromal antigen 2 (BST2), is a key mediator of this process, as it is induced upon interferon stimulation and required for interferon-dependent HSC activation. To identify the mechanism by which BST2 promotes interferon-dependent HSC activation, we evaluated its role in niche localization, immune cell function, lipid raft formation, and intracellular signaling. Our studies indicated that knock out (KO) of BST2 in a murine model does not disrupt …

Veterans' Experiences Of And Preferences For Patient-Centered, Measurement-Based Ptsd Care, Marcela C Weber, Ashlyn M Jendro, Ellen P Fischer, Karen L Drummond, Trenton M Haltom, Natalie E Hundt, Michael A Cucciare, Jeffrey M Pyne

Faculty, Staff and Students Publications

Background: Up to 50% of veterans drop out of trauma-focused evidence-based psychotherapies (TF-EBP) without completing treatment or recovering; evidence suggests this is in part because their posttraumatic stress disorder (PTSD) care is insufficiently patient-centered. There is also evidence that measurement-based care (MBC) for mental health should be personalized to the patient, yet this is not common practice in VA PTSD care.

Objectives: To explore veterans' experiences and preferences for aligning measurement-based PTSD care with their own treatment goals.

Method: Qualitative interviews were conducted with veterans (n=15) with PTSD who had received at least 2 sessions of a TF-EBP.

Measures: Survey …

Percutaneous Mechanical Aspiration For Infective Endocarditis: Proceedings From An Inaugural Multidisciplinary Summit And Comprehensive Review, Lucas X Marinacci, Sanjum S Sethi, Molly L Paras, Abdallah El Sabbagh, Eric A Secemsky, M Rizwan Sohail, Christoph Starck, Benjamin Bearnot, Evin Yucel, Raymond H M Schaerf, Yasir Akhtar, Ahmad Younes, Marquand Patton, Pedro Villablanca, Seenu Reddy, Daniel Enter, John M Moriarty, William Brent Keeling, Stephanie El Hajj Younes, Charles Kiell, Kenneth Rosenfield

Faculty, Staff and Students Publications

The clinical presentation and epidemiology of infective endocarditis (IE) have evolved over time. While the cornerstones of IE treatment remain antimicrobial therapy and surgery, percutaneous mechanical aspiration (PMA) has emerged as an option for carefully selected patients as a complementary modality, based on retrospective data, case series, and expert experience. In this comprehensive review, we summarize the proceedings from an inaugural summit dedicated to the discussion of PMA in the global management of IE, consisting of experts across multiple disciplines from diverse geographic regions and care environments. After conceptualizing the 3 major roles of PMA as a bridge to decision, …

Trends In Family Planning Uptake In Tanzania: An Analysis Of National Survey Data 2021-2022, Harun Yussuf Ayoub, Sabarinah Prasetyo

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

The purpose of this study is to uncover the socioeconomic and demographic factors that influence the usage of contraceptives by analysing trends and patterns in Tanzania's family planning uptake using data from national surveys. The results show that while Tanzania has made progress in increasing contraceptive prevalence from 27% in 2010 to 39% in 2021-22, disparities persist across socioeconomic and demographic lines. Women in urban areas, from higher wealth quintiles, and with higher educational attainment have significantly higher contraceptive prevalence rates compared to their counterparts. The study also reveals that the majority of women are aware of family planning methods, …

Gambaran Perilaku Merokok Siswa Smp Negeri, R Nasrullah Nur Nugroho

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Remaja mudah terjerumus pada perilaku berisiko, seperti merokok, karena mereka tidak tahu banyak, mudah dipengaruhi, dan ingin mencoba hal-hal baru. Pada tahun 2018, proporsi merokok pada remaja berusia 10–14 tahun adalah 2,1%, dan mereka rata-rata menghisap 6–7 batang setiap hari. Dengan menggunakan konsep penelitian cross-sectional dari 406 siswa laki-laki SMP negeri di kelurahan Kebayoran Lama Utara, penelitian ini memberikan gambaran tentang perilaku merokok siswa SMP negeri. Besar sampel yang digunakan adalah 117 orang yang menjawab. Dalam penelitian ini, teknik quota sampling digunakan untuk pengambilan sampel. Data penelitian ini dikumpulkan melalui kuesioner yang diisi langsung oleh responden. Hasil analisis menunjukkan bahwa …

Faktor Kontributor Prevalensi Stunting: Studi Kasus Jawa Timur Tahun 2022, Sofiyulloh Sofiyulloh, Martya Rahmaniati

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Malnutrisi, termasuk stunting, masih menjadi masalah kesehatan yang mempengaruhi kemajuan pembangunan berkelanjutan. Stunting, akibat kekurangan gizi berkepanjangan dan infeksi berulang, menghambat pertumbuhan anak. Di Indonesia, prevalensi stunting pada tahun 2022 adalah 21,6% dan masih belum mencapai target. Dan Jawa timur, angka stunting di 2022 adalah 19,2%, mendekati angka nasional pun masih belum mencapai target. Penelitian ini bertujuan mengidentifikasi faktor-faktor yang berkontribusi terhadap stunting di Jawa Timur, dengan fokus pada faktor soial ekonomi dan kesehatan. Data sekunder dari Kementerian Kesehatan, dan Dinas Kesehatan Jawa Timur dianalisis menggunakan uji korelasi. Hasil menunjukkan bahwa Indeks Pembangunan Manusia (IPM) dan rata-rata lama sekolah memiliki …

Keunggulan Dan Tantangan Dalam Penggunaan Computer Vision Untuk Diagnosis Pneumonia Pediatri: A Systematic Review, Hafshah Farah Fadhilah, Rico Kurniawan

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Pneumonia pediatrik merupakan penyebab utama kematian anak-anak di bawah usia lima tahun. Teknologi computer vision menawarkan potensi besar untuk meningkatkan diagnosis pneumonia pediatrik dengan menganalisis gambar radiografi dada secara otomatis. Penelitian ini menggunakan metode systematic literature review dengan pendekatan PRISMA, meninjau artikel dari database IEEE Xplore, Science Direct, dan Scopus yang diterbitkan antara tahun 2020 hingga 2024. Studi ini menemukan bahwa algoritma deep learning seperti Convolutional Neural Networks (CNN) menunjukkan akurasi tinggi dalam diagnosis pneumonia pediatrik. Namun, tantangan seperti kebutuhan akan data berkualitas tinggi, interpretasi hasil AI, dan integrasi teknologi ini dengan sistem kesehatan yang ada masih perlu diatasi. Penggunaan …

Telemedicine Adoption In Developing Economies: A Systematic Review On The Enablers And Barriers, Zaidbren Macabato, Lemuel Clark Velasco, Art Brian Escabarte, Mae-Lanie Ong Poblete, Armando Isla Jr., Rentor Cafino, Sarah Lizette Aquino-Cafino, Frevy Teofilo-Orencia

Kesmas

Telemedicine’s adoption has been effective in certain contexts despite being controversial in certain settings because of its tendency to cause misdiagnosis and concerns about data privacy. This study aimed to synthesize the research findings on the factors leading to the adoption of telemedicine among developing economies. The study utilized Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology to analyze 27 related literature and the Unified Theory of Acceptance and Use of Technology to map out the factors considered enablers and barriers in adopting telemedicine. Results showed that performance expectancy, effort expectancy, social influence, and facilitating conditions were significant predictors. …

Host Dna Depletion On Frozen Human Respiratory Samples Enables Successful Metagenomic Sequencing For Microbiome Studies, Minsik Kim, Raymond C Parrish, Michael J Tisza, Viral S Shah, Thi Tran, Matthew Ross, Juwan Cormier, Aribah Baig, Ching-Ying Huang, Laura Brenner, Isabel Neuringer, Katrine Whiteson, J Kirk Harris, Amy D Willis, Peggy S Lai

Faculty, Staff and Students Publications

Most respiratory microbiome studies use amplicon sequencing due to high host DNA. Metagenomics sequencing offers finer taxonomic resolution, phage assessment, and functional characterization. We evaluated five host DNA depletion methods on frozen nasal swabs from healthy adults, sputum from people with cystic fibrosis (pwCF), and bronchoalveolar lavage (BAL) from critically ill patients. Median sequencing depth was 76.4 million reads per sample. Untreated nasal, sputum, and BAL had 94.1%, 99.2%, and 99.7% host reads, respectively. Host depletion effects varied by sample type, generally increasing microbial reads, species and functional richness; this was mediated by higher effective sequencing depth. Rarefaction curves showed …

Gut Microbiota Profiling In Injection Drug Users With And Without Hiv-1 Infection In Puerto Rico, Nirosh Aluthge, Seidu Adams, Carmen A. Davila, Nova R. Gocchi Carrasco, Kathy S. Chiou, Roberto Abadie, Sydney J. Bennett, Kirk Dombrowski, Angel M. Major, Aníbal Valentín-Acevedo, John T. West, Charles Wood, Samodha C. Fernando

School of Medicine Faculty Publications

INTRODUCTION: The full extent of interactions between human immunodeficiency virus (HIV) infection, injection drug use, and the human microbiome is unclear. In this study, we examined the microbiomes of HIV-positive and HIV-negative individuals, both drug-injecting and non-injecting, to identify bacterial community changes in response to HIV and drug use. We utilized a well-established cohort of people who inject drugs in Puerto Rico, a region with historically high levels of injection drug use and an HIV incidence rate disproportionately associated with drug use. METHODS: Using amplicon-based 16S rDNA sequencing, we identified amplicon sequence variants (ASVs) that demonstrated significant variations in the …

Nature Healing Mental Stress: What U.S. Healthcare Can Learn From Other Nations, Shannon Frank-Richter, Lindsay Gietzen

Pacific Journal of Health

The United States healthcare system lags many developed nations in healthcare access and practices, especially surrounding ecotherapy [1]. Ecotherapy is the practice of mindfulness in tandem with intentional immersion among natural spaces or with natural elements. Research from Asia, Europe and Canada indicate immense benefits from ecotherapy, or mindful nature immersion, as an effective treatment for burnout and stress. By adopting regular nature engagement, the U.S. could significantly improve mental health and reduce occupational stress. This literature review examines how nature immersion, especially with mindfulness, positively affects the brain and nervous system. Key components in nature are identified, such as …

Who Cares For The Caregiver? Exploring Extension’S Role In Informal Caregiving Support, Mckenzie R. Tuttle, Erin L. Martinez, Aimee Fox

Journal of Extension

Family caregivers provide invaluable service by taking on the responsibility of caring for older adults in the United States. With a growing aging population, the need for family caregivers and demands on their time and resources will continue to increase. Although a variety of caregiving resources and support services exist, family caregivers often lack the awareness, time, transportation, or financial resources to connect to services. There is a critical need to address the barriers that prevent caregivers from accessing services. In this commentary, we highlight barriers and make recommendations for improving conversations, research, and practice to meet this growing problem.

Lung Tissue Multilayer Network Analysis Uncovers The Molecular Heterogeneity Of Chronic Obstructive Pulmonary Disease, Nuria Olvera, Jon Sánchez-Valle, Iker Núñez-Carpintero, Joselyn Rojas-Quintero, Guillaume Noell, Sandra Casas-Recasens, Alen Faiz, Philip Hansbro, Angela Guirao, Rosalba Lepore, Davide Cirillo, Alvar Agustí, Francesca Polverino, Alfonso Valencia, Rosa Faner

Faculty, Staff and Students Publications

Rationale: Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition. Objectives: We hypothesized that the unbiased integration of different COPD lung omics using a novel multilayer approach might unravel mechanisms associated with clinical characteristics.

Methods: We profiled mRNA, microRNA and methylome in lung tissue samples from 135 former smokers with COPD. For each omic (layer), we built a patient network on the basis of molecular similarity. The three networks were used to build a multilayer network, and optimization of multiplex modularity was used to identify patient communities across the three distinct layers. Uncovered communities were related to clinical features.

Measurements …

A Case Study On The Impact Of An Adapted Community Jury In Shaping The Nutrition Standards For Hospital Menus In New South Wales Australia, Tara L. Dimopoulos-Bick, Melanie Schier, Kim Crawley, Kim Sutherland

Patient Experience Journal

Community juries are a form of deliberative democracy and can engage community groups in decision-making about healthcare and service delivery issues and priorities. They can provide insights and value-based perspectives from community groups and are particularly important in resolving perennial and complex system challenges. One such challenge is nutrition in hospitals–where there is a need to balance nutrition support, variety, taste and cost. The New South Wales (NSW) public health system in Australia operates more than 200 public hospitals. When revising the Nutrition Standards in 2021, stakeholders debated the upper limits of sodium (salt) and saturated fat in food products …