University Of Texas Medical Branch Research Articles

The first neurosurgical service in Texas: neurosurgery at the University of Texas Medical Branch (1937-2023).

The authors present a historical analysis of the first neurosurgical service in Texas. Initially established as a subdivision within the Department of Surgery in the early 1900s, this service eventually evolved into the Department of Neurosurgery at the University of Texas Medical Branch (UTMB). The pivotal contributions of individual chiefs of neurosurgery throughout the years are highlighted, emphasizing their roles in shaping the growth of the neurosurgery division. The challenges faced by the neurosurgical division are documented, with particular attention given to the impact of hurricanes on Galveston Island, Texas, which significantly disrupted hospital operations. Additionally, a detailed account of recent clinical and research expansions is presented, along with the future directions envisioned for the Department of Neurosurgery. This work offers a comprehensive historical narrative of the neurosurgical service at UTMB, chronicling its journey of growth and innovation, and underscoring its profound contributions to Galveston's healthcare services, extending its impact beyond the local community.

150 Envisioning a Multi-Site Translational Studio to Promote Scientific Integrity and Ethical Innovation

OBJECTIVES/GOALS: The goal of this study is to develop a multi-centered Translational Studio model that can help in the development of quality translational studies using resources from four different institutional partners (University of Texas Medical Branch, Texas Southern University, University of Houston Clear Lake and Houston Methodist). METHODS/STUDY POPULATION: We conducted two rounds of four Futures Workshops for a total participation of 28 stakeholders from four different partners. Future Workshops were used to critique, envision, and articulate novel “futures” that can be achieved at least partly through design practices (Muller, 2002). In the first round of workshops, we asked participants about their institutions’ strengths, weaknesses, resources and investigator needs regarding the Studio. In the second round we asked about different studio models, pros and cons of each model and guiding principles for a studio. Alongside a pragmatic content analysis, multi-stage deductive and inductive qualitative analyses were used to understand people’s views on the future of a multi-institutional Clinical Trials Studio. RESULTS/ANTICIPATED RESULTS: The first-round workshops’ analysis described peoples’ goals for what the studio should be. The future desired studio was described as guide, matchmaker, initiator and advocate. The second-round workshops’ analysis discussed the pros and cons of a variety of possible models including, centralized, decentralized, and topic-specific (and allowed other suggestions) while also describing principles for the guidance of a studio. Here the analysis showed people wanted certain characteristics for the studio (i.e. effective, efficient, locally-responsive, consistent, etc.). They also prescribed four principles that a studio should be guided by: non-hierarchical partnership, user-centeredness, respect/collegiality, and sharing. DISCUSSION/SIGNIFICANCE: The future workshops were useful in developing a shared multi-institutional Clinical Trials Studio model that is planned to be deployed in 2025. Participants valued a studio that was both directly supportive to participants and played a role in creating or advocating for institutional resources and policy for research.

Examining Factors Impacting Encounter Length and Missed Appointments at a Student-Run Free Clinic: A Retrospective Analysis

Background: St. Vincent's Clinic (SVC) is a free, student-run clinic affiliated with the University of Texas Medical Branch that has been an invaluable resource in providing free healthcare services to marginalized populations in Galveston, Texas. The clinic offers a wide variety of specialty services along with free resources such as transportation and medication assistance, telehealth options, and interpreter services. Despite these resources, the clinic has faced challenges with consistently high no-show rates and long encounter lengths, impacting overall efficiency and patient care. We aimed to explore factors that may contribute to these challenges and uncover opportunities to improve patient satisfaction and optimize clinic efficiency.
 Methods: A retrospective chart review was conducted on all patients seen at SVC across all specialty clinics between March 2021 and March 2023. Patient demographics, appointment status, encounter length, language spoken, department specialty, and appointment modality were recorded. A series of statistical analyses were conducted on collected variables, including chi-square analysis, unpaired t-tests, and single-factor analysis of variance (ANOVA) tests, to assess significant associations.
 Results: The average encounter length varies significantly across different spoken languages and specialty clinics, but no significance was observed between different appointment modalities. The no-show rates were significantly different depending on the appointment modality, specialty clinic, and patient language spoken. Notably, while the encounter length was significantly shorter for English-speaking patients, Spanish-speaking patients had a lower no-show rate and were more likely to keep scheduled appointments.
 Conclusions: Language barriers and specialty clinic types can impact the encounter lengths and no-show rates, highlighting the need for targeted interventions such as proper resource allocation. Limitations include potential data discrepancies from factors such as human error or variations in documenting appointments. Future research should explore patient perspectives and experiences to improve patient satisfaction and overall optimize clinic operations.

Quality of Surgical Care Within the Criminal Justice Health Care System

Individuals who are incarcerated represent a vulnerable group due to concerns about their ability to provide voluntary and informed consent, and there are considerable legal protections regarding their participation in medical research. Little is known about the quality of surgical care received by this population. To evaluate perioperative surgical care provided to patients who are incarcerated within the Texas Department of Criminal Justice (TDCJ) and compare their outcomes with that of the general nonincarcerated population. This cohort study analyzed data from patients who were incarcerated within the TDCJ and underwent general or vascular surgery at the University of Texas Medical Branch (UTMB) from 2012 to 2021. Case-specific outcomes for a subset of these patients and for patients in the general academic medical center population were obtained from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) and compared. Additional quality metrics (mortality index, length of stay index, and excess hospital days) from the Vizient Clinical Data Base were analyzed for patients in the incarcerated and nonincarcerated groups who underwent surgery at UTMB in 2020 and 2021 to provide additional recent data. Patient-specific demographics, including age, sex, and comorbidities were not available for analysis within this data set. Perioperative outcomes (30-day morbidity, mortality, and readmission rates) were compared between the incarcerated and nonincarcerated groups using the Fisher exact test. The sample included data from 6675 patients who were incarcerated and underwent general or vascular surgery at UTMB from 2012 to 2021. The ACS-NSQIP included data (2012-2021) for 2304 patients who were incarcerated and 602 patients who were not and showed that outcomes were comparable between the TDCJ population and that of the general population treated at the academic medical center with regard to 30-day readmission (6.60% vs 5.65%) and mortality (0.91% vs 1.16%). However, 30-day morbidity was significantly higher in the TDCJ population (8.25% vs 5.48%, P = .01). The 2020 and 2021 data from the Vizient Clinical Data Base included 629 patients who were incarcerated and 2614 who were not and showed that the incarcerated and nonincarcerated populations did not differ with regard to 30-day readmission (12.52% vs 11.30%) or morbidity (1.91% vs 2.60%). Although the unadjusted mortality rate was significantly lower in the TDCJ population (1.27% vs 2.68%, P = .04), mortality indexes, which account for case mix index, were similar between the 2 populations (1.17 vs 1.12). Findings of this cohort study suggest that patients who are incarcerated have equivalent rates of mortality and readmission compared with a general academic medical center population. Future studies that focus on elucidating the potential factors associated with perioperative morbidity and exploring long-term surgical outcomes in the incarcerated population are warranted.

Invited Symposium 1: Traumatic Brain Injury: Highlighting the Contributions of Dr. Harvey S. Levin Ph.D., ABPP-CN, FACSM 1946 - 2022

Harvey S. Levin obtained his Bachelor’s degree from City College of New York, in New York city, Ph.D. in Clinical Psychology from the University of Iowa, in Iowa City, completed his internships in Clinical Neuropsychology and Pediatric Psychology at the University of Iowa Hospitals in Iowa City and Clinical Psychology, Psychiatry and Pediatrics at the Illinois Masonic Medical Center in Chicago, and his fellowship in Neuropsychology at University of Iowa Hospitals in Iowa City.Dr. Levin started his career in 1972 as Instructor with the Department of Psychology at the University of Iowa and transitioned to The University of Texas Medical Branch (UTMB) in Galveston, Texas, in 1974, where he began an internationally renowned career in clinical work, teaching, and, most of all, pioneering research on traumatic brain injury (TBI). He ultimately became the Chela and Jimmy Storm Distinguished Professor in Surgical Research, Division of Neurosurgery, Department of Surgery in 1987. After leaving Texas for two years to take a position with the University of Maryland Medical System and Shock Trauma Institute in Baltimore, he moved back to Houston Texas in 1995 and established the Cognitive Neuroscience Laboratory (CNL) within the Department of Physical Medicine & Rehabilitation at Baylor College of Medicine, which was supported by federal grants, including funding from the National Institutes of Health, Department of Defense, Department of Veterans Affairs, and Centers for Disease Control and Prevention, and numerous private foundations. The CNL integrated rehabilitation and neuroplasticity research with multimodality brain imaging, clinical and neuropsychological assessment, and fluid biomarkers. Dr. Levin was Professor with the Departments of Physical Medicine and Rehabilitation where he served as Director of Research (1995-2014), Pediatrics, and Neurosurgery at Baylor College of Medicine. He was also a Research Scientist and the Director of the Center of Excellence for Traumatic Brain Injury at the Michael E. DeBakey Veterans Affairs Medical Center (2008-2013), and Adjunct Professor with the Department of Psychology at Rice University in Houston, Texas.Dr. Levin’s research focused on investigating both acute and long-term outcomes of mild to severe TBI in civilian and military populations, including cognitive and behavioral sequelae in relation to neuropathology using advanced brain imaging modalities. He began prospective, longitudinal studies of adults and children who had sustained TBI associated with closed head trauma upon joining UTMB and developed, in collaboration with Drs O’Donnell and Grossman, the Galveston Orientation and Amnesia Test (GOAT). The GOAT was the first measure to assess post-traumatic amnesia and orientation following moderate to severe TBI, is still most widely used by the clinicians and researchers, and it has been translated to 16 languages. The original publication, “Levin HS, O’Donnell VM, Grossman RG. The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis. 1979 Nov;167(11):675-84. doi: 10.1097/00005053-197911000-00004. PMID: 501342”, has over 1200 citations. This work continued with participation in the NINDS Traumatic Coma Data Bank and the organization of outcome assessments for NINDS-funded clinical trials of hypothermia to treat severe TBI. To monitor the quality of outcome data across performing sites, Dr. Levin and colleagues developed a code for the reliability of data collected and implemented the role of an outcome monitor who evaluated adherence to protocol across sites. Following establishment of the CNL, he pursued investigation of TBI outcomes across the lifespan using multimodality brain imaging and biomarkers, errorless learning, translational studies in collaboration with neuroscientists using animal models, and clinical trials of methylphenidate, progesterone, CDP-choline. Dr. Levin spent over 30 years researching neurobehavioral outcomes of head injury in children, starting with a small pilot study funded by the Shriners Hospital in 1991 and continuing with several cycles of a multicenter R01 grant funded by the National Institute of Health. In later years, he used his expertise as a member of several large consortiums, including the Long-term Impact of Military-Relevant Brain Injury Consortium \ Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) funded by the VA and DoD and the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) funded by the NINDS.During his career, Dr. Levin authored and coauthored more than 400 articles in scientific journals and over 100 books, with one of them, “Levin, H. S., Benton, A. L., & Grossman, R. G. (1982). Neurobehavioral consequences of closed head injury. Oxford University Press, USA”, having over 1100 citation, as well as book chapters that advanced knowledge of TBI, epilepsy, neurodegenerative diseases, and other illnesses that affect brain functioning. He was also very active as a reviewer on federal grant panels and as an editor and reviewer for the Journal of Neurotrauma, Journal of Clinical and Experimental Neuropsychology, Archives of Physical Medicine & Rehabilitation, Neuropsychology, Journal of the International Neuropsychological Society, Lancet, JAMA, Pediatrics, and other top-cited journals. He served as president of the International Neuropsychological Society in 1989-1990. Dr. Levin was a recipient of numerous prestigious awards, including the Javits Neuroscience Investigator Award, the Jennett-Plum Award for Research on Traumatic Brain Injury, the Distinguished Career Award by the International Neuropsychological Society, the American Congress of Rehabilitation Gold Key Award, the Distinguished Lifetime Contribution to Neuropsychology Award from the National Academy of Neuropsychology, as well as awards from other head injury and psychological organizations, including the International Brain Injury Association, the National Head Injury Foundation, the North American Brain Injury Society, Texas Psychological Association, and the Defense and Veterans Brain Injury Center. In addition to his stellar scientific accomplishments, Dr. Levin trained, mentored, and provided supervision to interns, fellows, postdocs, residents, medical and psychology students. He was the Director of an NCMRR/NIH T32 Postdoctoral Research Program, and training supervisor in neuropsychology for Baylor College of Medicine and for the Memorial Hermann TIRR Neuropsychology Postdoctoral Fellowship Programs. A passionate educator, he taught classes at Baylor College of Medicine, the University of Houston, and the National and Kapodistrian University of Athens Medical School in Greece and served as an evaluator for the American Board of Clinical Neuropsychology/American Board of Professional Psychology. He was often invited as a lecturer at numerous scientific organizations.The main objective of this symposium is to provide an overview of the current state of research in TBI while highlighting Dr. Levin’s contributions to this field. The symposium will start with a brief overview of Dr. Levin’s career (Dr. Randall S. Scheibel), followed by presentations focused on the assessment of adult TBI, including posttraumatic amnesia (Dr. Felicia C. Goldstein), the current state of pediatric TBI (Dr. L. Ewing-Cobbs), and novel imaging in TBI (Dr. Erin D. Bigler). There will be a brief discussion session at the end lead by Dr. Elisabeth A. Wilde.

Diverse Clinical Manifestations and Challenges of Mucormycosis: Insights From Serial Cases

Abstract Mucormycosis is a severe and potentially life-threatening infection caused by a group of fungi classified as mucormycetes within the scientific order Mucorales. These infections are characterized by rapid and invasive fungal growth, presenting significant treatment challenges. Here we present 5 cases encountered from 2018 to 2022 at the University of Texas Medical Branch in Galveston, Texas, including a novel Apophysomyces species. These cases illustrate the diverse clinical manifestations of mucormycosis, including pulmonary, rhino-cerebral, gastrointestinal, and soft tissue involvement. Our investigation incorporates information provided by a multidisciplinary team of clinical collaborators, emphasizing the findings from radiology, histopathology, and microbiology. Given the escalating global incidence of mucormycosis, it is crucial for clinicians to become familiar with associated clinical findings, comorbidities, and risk factors to facilitate prompt recognition, appropriate diagnostic testing, and timely initiation of treatment.

Assigning lifetime occupation domains for older Mexicans: MHAS-O*NET linkage protocol.

We developed a MHAS (Mexican Health and Aging Study) and O*NET (Occupational Information Network) linkage to allow global researchers using MHAS data to assign lifetime occupation domains for older Mexicans. Three bilingual raters independently matched 440 records with 132 unique occupation codes from the 2012 MHAS. We used a modified Delphi technique to reach agreements. To assess reliability, we compared the distribution of observations between the MHAS file and the MHAS-O*NET linked file across five job categories (upper white collar, lower white collar, upper blue collar, low blue collar, and agriculture/fishing/forestry). The Institutional Review Board at the University of Texas Medical Branch reviewed and approved the research (IRB # 21-0268). Using the developed 1:1 MHAS-ONET linkage, consistency between MHAS and ONET was 97.4% across the five job categories. This MHAS-O*NET linkage will allow researchers to analyze the association between lifetime occupation and multiple dimensions of health, functionality, and retirement determinants for a low-middle income country with a large proportion of workers in the informal sector.

The Effect of Antiopioid State Laws on Prescribing Patterns in an Oculoplastic Practice

This study aimed to find out whether three Texas state policies restricting opioid prescriptions have influenced the prescribing patterns of the oculoplastic department at the University of Texas Medical Branch (UTMB). This is a retrospective chart review of 520 patients at UTMB between 2019 and 2021, reporting the amount of morphine milliequivalents (MMEs) prescribed to patients undergoing one of eight oculoplastic procedures before and after passage of each state policy. Of 520 patients, 218 received opioids. There were no changes in MMEs/month after the first policy (95% CI: −0.1531–0.1256, p = 0.85), second policy (95% CI: −0.000997–0.00093, p = 0.97), or third policy (95% CI: −0.001431–0.00164, p = 0.096). The passage and implementation of three Texas state antiopioid policies were not associated with significant changes in opioid prescribing patterns following oculoplastic and orbital surgeries at UTMB. Average MMEs/month were driven by orbital-floor fractures, which composed most procedures overall. Limitations included the small population and that only a single provider was reviewed. Future studies would be beneficial in further evaluating the role of state legislation on opioid prescribing patterns and usage among patients.

The impact of COVID-19 infection on heart transplant function

BackgroundHeart transplant recipients are a subset of immunocompromised patients at particularly high risk of morbidity and mortality from COVID-19. Acute effects of the viral infection have been well-described in the literature but the chronic effects persisting after recovery from infection have not. The aim of this study is to determine the impact of COVID-19 on heart transplant function both during and after recovery from acute infection.MethodsWe retrospectively analyzed the data of 32 heart transplant recipients at the University of Texas Medical Branch (UTMB). Echocardiograms of patients with documented COVID-19 infection were analyzed at three time points including pre-infection, peri-infection, and post-infection. Echocardiograms of patients without history of infection were analyzed as control. Left Ventricular Ejection Fraction (LVEF) and presence or absence of valvular insufficiency were collected from echocardiograms to assess systolic and valvular function.Results2 out of 10 COVID-19 positive heart transplant recipients had decreases in LVEF below 20% during the peri-infection period, and one of these patients passed away from complications of infection. Despite this, mean LVEF was not significantly different at peri-infection (p = .3, 95% CI − 11.5 to 27.6) or post-infection  (p = .6, 95% CI − 3.6 to 5.8) time points when compared to pre-infection. A statistically significant increase in valvular dysfunction was found among COVID-19 positive patients without documented history of valvular dysfunction on pre-infection echocardiograms (p = .01, 95% CI 19.3% to 96.4%). COVID-19 negative heart transplant recipients did not experience statistically significant changes in LVEF 1, 2, or 3 years after baseline echocardiogram.ConclusionCOVID-19 may induce myocardial dysfunction resulting in decreased systolic function and valvular dysfunction among heart transplant recipients. Severity of systolic dysfunction may be a useful prognostic indicator among this patient population. More research must be conducted to fully elucidate the effects of COVID-19 infection on heart transplant recipients.

DrByron J. Bailey: The Life and Legacy of an Educator, Humanitarian, and Leader.

DrByron J. Bailey, a preeminent figure in the field of Otolaryngology, exemplified an unwavering commitment to patient care, resident education, research excellence, and humanitarian endeavors throughout his illustrious career. Born in 1934, DrBailey played a pivotal role in the growth and success of the Department of Otolaryngology at the University of Texas Medical Branch. A dedicated educator and researcher, he authored groundbreaking research and the seminal textbook, Bailey's Head and Neck Surgery-Otolaryngology. His leadership in major organizations and commitment to research integrity and quality are hallmarks of his career. DrBailey's philanthropic pursuits include improving Otolaryngology care and access in Vietnam and Cuba, and local community efforts in Galveston, Texas. His enduring legacy continues to inspire future generations of Otolaryngologists, serving as a testament to the power of perseverance and dedication to excellence in the pursuit of medical education.

Editorial introductions.

Current Opinion in Clinical Nutrition and Metabolic Care was launched in 1998. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of clinical nutrition and metabolic care are divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Anastasia Z. KaleaAnastasia Z. KaleaDr Anastasia Z. Kalea is an Associate Professor in Teaching Nutrition and Dietetics at the UCL Division of Medicine, UK, and an honorary Associate Professor at the UCL Institute of Cardiovascular Science, UK. She has over 20 years of research and teaching experience in academic institutions in the US and the UK. She is an external examiner and reviewer for undergraduate nutrition and dietetics programmes in the US, UK, and Greece. Dr Kalea is a Registered Dietitian with the Health and Care Professions Council (HCPC) and a Senior Fellow of the Higher Education Academy in the UK. Her research interests focus on metabolic inflammation and associated molecular nutrition pathways, on trace mineral metabolism, on nutrigenetics, precision nutrition and public health, and she has presented her work in numerous national and international conferences. Dr Kalea leads teaching for the MSc in Clinical and Public Health Nutrition, MSc in Eating Disorders and Clinical Nutrition, and the BSc in Nutrition and Medical Sciences. She is the Programme Director for the MSc course in Obesity and Clinical Nutrition at UCL. Dorothy Klimis-ZacasDorothy Klimis-ZacasDr Klimis-Zacas is professor of clinical nutrition, cooperating professor at the Graduate School of Biomedical Sciences and Engineering and Associate Faculty of the Institute of Medicine at the University of Maine, USA. As a Fulbright Senior Fellow, she aided in the establishment and curricular development of the Human Nutrition and Dietetics Program at Harokopio University, Greece, where she is a cooperating professor. She is also cooperating professor at DeFENs-Department of Food, Environmental and Nutritional Sciences at the University of Milan, Italy. Dr Klimis-Zacas is external reviewer and examiner for undergraduate and graduate Nutrition and Dietetics programs in the US, Italy and Greece. Her research and teaching have focused on lipid and trace mineral nutrition and metabolism associated with cardiovascular disease. Additionally, she has explored the role of berry bioactive compounds and berry-enriched diets on endothelial function, inflammation, and lipid metabolism as it relates to cardiovascular disease and the metabolic syndrome in pre-clinical and clinical studies. She is currently researching the molecular mechanisms and genomic effects of polyphenols on endothelial cell migration and angiogenesis as it relates to diabetes mellitus, ischemic disorders and wound healing. For the development and preclinical testing of a biomedical product that aids in wound healing she received the Inaugural Foster Innovation Award from the University of Maine. A Fulbright Senior Specialist and Cariplo Fellow, Dr Klimis-Zacas is the author of over 130 peer reviewed publications, editor of books and a patent. She is an editorial board member for The Journal of Nutritional Biochemistry and editor and guest editor for Antioxidants, Nutrients (MDPI) and others. Bettina MittendorferBettina MittendorferBettina Mittendorfer graduated from the University of Vienna in Austria with a MSc in Human Nutrition, and from the University of Texas Medical Branch in Galveston, USA, with a PhD in Nutritional Biochemistry. In 1999 she came to Washington University School of Medicine in St. Louis, USA, for a postdoctoral research fellowship. Currently she is Associate Professor of Medicine and Nutritional Sciences and the Director of the Nutrition and Obesity Research Center Clinical Science Research Core Laboratory at Washington University in St. Louis. Her research interests focus on the regulation of muscle protein and lipid metabolism with special emphasis on obesity, aging and sexual dimorphism, which she studies in vivo in human subjects by using stable isotope labelled tracer techniques. Faidon MagkosFaidon MagkosFaidon Magkos holds a BSc degree in Clinical Nutrition and Dietetics (2000), a MSc degree in Nutrition and Exercise (2004) and a PhD degree in Human Metabolism (2008). He completed post-doctoral training at Harokopio University in Athens, Greece, and Harvard Medical School in Boston, Massachusetts. In 2011, Magkos was appointed Assistant Professor of Medicine at the Center for Human Nutrition, Division of Geriatrics & Nutritional Science, at Washington University School of Medicine in St. Louis, Missouri. He moved to Singapore in 2015 and served as Assistant Professor of Physiology at the Clinical Nutrition Research Centre, Yong Loo Lin School of Medicine, at the National University of Singapore. Since 2018, he is Associate Professor in Obesity Research at the Department of Nutrition, Exercise and Sports, at the University of Copenhagen, Denmark. The study of human metabolism lies at the core of his research interests and activity. During the course of his career, Magkos has been involved in research projects examining the effects of diet, exercise, obesity and weight gain or weight loss, sex differences, and fatty liver on energy and substrate metabolism, lipid and lipoprotein kinetics, and insulin sensitivity in skeletal muscle, liver, and adipose tissue. He is a “metabolist” at heart. Since 2003, he has published 154 peer-reviewed publications and his work has been cited more than 7200 times (h-index 46).

Editorial introductions.

Current Opinion in Infectious Diseases was launched in 1988. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of infectious diseases is divided into 11 sections that are reviewed once a year. Each section is assigned to a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Dennis L. StevensDennis L. StevensDr Dennis Stevens is an internationally-recognized authority on the pathogenesis and treatment of life-threatening toxin-mediated necrotizing soft tissue infections. He is Professor of Medicine at the University of Washington School of Medicine, Seattle, USA and former Director of the recent NIH-funded Idaho Biomedical Research Collaborative on Emerging/Reemerging Infectious Diseases at the Boise VA Medical Center. He has published more than 160 original articles and 80 book chapters. His seminal 1989 New England Journal of Medicine report alerted physicians to the reemergence of severe group A streptococcal disease and invigorated research into its pathogenesis. His research unraveled key host-pathogen interactions that mediate this infection and provided scientific rationale for improved clinical management that includes inhibition of bacterial toxin production and/or activity. His group has investigated the roles of exotoxins in the pathogenesis of other necrotizing infections, such as those caused by Clostridium species and methicillin-resistant Staphylococcus aureus (MRSA). Young investigators in his Center of Excellence now study the cellular and molecular mechanisms of adenovirus pathogenesis and host-pathogen interactions in diabetic wound infections. Dr Stevens authored an invited comprehensive review on Necrotizing Soft Tissue Infections, published in the New England Journal of Medicine in December 2017. He is Chair of the Infectious Disease Society of America's (IDSA) Guidelines Committee for the Treatment of Skin and Soft Tissue Infections and received the IDSA's Society Citation in 2000 for his outstanding achievements in infectious diseases research, clinical investigation, and clinical practice. He was a key member of the Center for Disease Control and Prevention's working group on severe streptococcal infections that established the consensus definition of Streptococcal Toxic Shock Syndrome. He has contributed chapters on severe invasive infections to major medical textbooks, to the American Society for Microbiology's Manual of Clinical Microbiology, and to the electronic medical reference, UpToDate. He has also written several in-depth basic science monographs, including the NIH e-book Streptococcus pyogenes: Basic Biology to Clinical Manifestations, The Comprehensive Sourcebook of Bacterial Protein Toxins, and The Clostridia: Molecular Biology and Pathogenesis. He is editor of Netter's Infectious Diseases, of Streptococcal Infections: Clinical Aspects, Microbiology, and Molecular Pathogenesis, volume editor for Essential Atlas of Infectious Diseases for Primary Care, and section editor for Current Opinion in Infectious Disease. Internationally, he gave an invited endowed lectureship to the Royal Society of Physicians in Edinburgh, Scotland, and has been Visiting Professor at more than 30 international institutions. In 2018, Dr Stevens received a Lifetime Achievement award from the VA Society of Practioners in Infectious Diseases for his contributions to clinical medicine, basic science research and teaching. Adarsh BhimrajAdarsh BhimrajDr Adarsh Bhimraj is the director, infectious diseases Fellowship and education at Houston Methodist Hospital. He was the head of the section of neurologic Infectious Diseases at Cleveland Clinic for 11 years. He was a panelist on IDSA's (Infectious Diseases Society of America) and NCS's (Neuro Critical care Society) guideline panel related to health care associated meningitis. He has authored book chapters on CNS infections in books like Mandell's Principles and Practice of Infectious Diseases and Greenberg's Neurosurgery. He was a speaker, panelist and moderator in several national and international conferences like ID Week (IDSA & sister society's annual conference), ECCMID (European Congress of Clinical Microbiology and Infectious Diseases), and ASM Microbe (American Society of Microbiology). In 2020 he received the Infectious Diseases Society of America citation Award. He was Associate Program director for the Internal Medicine residency program, at Cleveland Clinic, from 2011- 2015 and was the director for clinical reasoning. He was the principal director for the Cleveland Clinic Intensive Review of Internal Medicine for 10 years and won the Cleveland Clinic Internal Medicine house staff teacher of the year award twice. He was the IDSA chair for the annual conference ID Week 2022 and current chair for the IDSA COVID-19 rapid living guidelines. Rodrigo HasbunRodrigo HasbunRodrigo Hasbun, M.D., M.P.H., is Professor of Medicine; he obtained his medical degree at the Autonomous University of Central America in San Jose, Costa Rica, USA, in 1991. He completed his internal medicine residency at the University of Texas Medical Branch in Galveston, USA, in 1994 and then went to Yale University, USA, for five years for a fellowship in Infectious Diseases and Clinical Research by obtaining a National Research Service Award grant. During this time, he conducted studies in meningitis and endocarditis that have been incorporated into national guidelines. In 1999, he joined Tulane University in New Orleans, USA, where he obtained an MPH in Clinical Research and received an NIH K23 training grant to study adults with the aseptic meningoencephalitis syndrome. He joined the McGovern Medical School at UTHealth in September 2008 and has validated and expanded his meningoencephalitis study to multiple centers and to the pediatric population. He has also been an investigator and co-investigator in multiple NIH-funded studies evaluating HIV associated neurocognitive disorders and West Nile virus encephalitis. Finally, Dr Hasbun is a panel member of the first healthcare associated ventriculitis and meningitis guidelines in 2016 and is the main author for the meningitis chapters in the main textbook of infectious diseases (Principles and Practice of Infectious Diseases) and UpToDate.

Characterizing neurologist EHR use: a cross-sectional analysis (P7-7.003)

<h3>Objective:</h3> We evaluated electronic health record (EHR) use metrics across two academic systems using the same EHR vendor. <h3>Background:</h3> The use of standardized EHR metrics allows direct comparisons of individual and departmental EHR use and the ability to track changes over time. We evaluated the following ambulatory EHR metrics normalized to 8 hours of scheduled patient time: total EHR time, work outside of work (WOW), time on note documentation, time on orders, time on inbox and note length in characters. <h3>Design/Methods:</h3> Ambulatory audit log data per encounter from the University of Illinois at Chicago (UIC) and the University of Texas Medical Branch (UTMB) was evaluated for August 2022. <h3>Results:</h3> Among 36 neurologists in the analysis (22 at UIC [61%], and 12 at UTMB [39%], respectively), the average EHR-Time was 2.25 (±1.29) hours. WOW time was 2.01 (±1.53) hours. Time in Notes was 0.85 (±0.72) hours. Time on Orders was 0.33 (±0.30) hours. Times on Inbox 0.23 (±0.19) hours. Note length in characters was 5,963 (±3,062). No statistical differences were noted by metric across each EHR institutions (p&lt;0.05, t-test). <h3>Conclusions:</h3> Normalized EHR metrics can be used to evaluate EHR use by neurologists across institutions. Future initiatives to improve documentation practices (reducing note bloat and comply with E/M coding changes) can be tracked across institutions with suitable metrics. <b>Disclosure:</b> Dr. Rodriguez-Fernandez has nothing to disclose. Dr. Hier has nothing to disclose. Dr. Loeb has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Sturge Weber Foundation. Dr. Loeb has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various Law firms. The institution of Dr. Loeb has received research support from Patrick Grange Memorial Foundation. Dr. Loeb has received intellectual property interests from a discovery or technology relating to health care.

125 Thoughts on Designing a Summer Internship for Undergraduates at an Academic Medical Center

OBJECTIVES/GOALS: The overall goal is to provide tips and suggestions for designing a summer internship program for undergraduates at an institution that only offers advanced degrees. This poster seeks to highlight what worked well and items that can be improved upon from a program that ran for the first time at the University of Texas Medical Branch in Summer 2022. METHODS/STUDY POPULATION: In February 2022, we opened admissions to a summer internship program whose goals are to expose students to statistical design and analysis problems from real research, while providing them with the conceptual and technical tools to address these problems. As such, students should be able 1) to assess study designs for strengths and weaknesses in addressing specific biomedical questions, 2) to use the tools of statistical modeling, data science, and hypothesis testing along with state-of-the-art statistical software to work on problems as well as produce results and conclusions for these problems, and 3) to understand how developing these skills can lead to a wide variety of career opportunities both inside and outside of academia. We ultimately recruited 12 participants in the first summer. RESULTS/ANTICIPATED RESULTS: Based on feedback from participants, we have identified recruitment efforts that worked (and those that need improvement), teaching methods that worked (as well as those that need improving), and ideas for career development sessions (based on questions generated from current participants). Each participant was paired with another student on a research project. Each research project had both a biostatistics faculty mentor as well as a basic science/clinical faculty mentor. We will discuss what worked/what needs improvement from this sort of situation as well. The program culminated in a poster session which was very well received by participants and faculty alike. DISCUSSION/SIGNIFICANCE: This internship program is significant because developing a workforce knowledgeable in biostatistics and data science has been increasingly in demand to improve the efficiency and reliability of biomedical innovation. My providing guidance to others hoping to provide similar programs, we aim to develop such skills in the incoming workforce.

Pain in Individuals with Alzheimer’s Disease and Other Dementia-Related Diseases: Too Often Overlooked

Developments in Anaesthetics & Pain Management Pain in Individuals with Alzheimer’s Disease and Other Dementia-Related Diseases: Too Often Overlooked Marnin Joseph Romm* School of Health Professions, University of Texas Medical Branch, USA *Corresponding author: Marnin Joseph Romm, School of Health Professions, University of Texas Medical Branch, USA Submission:February 24, 2023;Published: March 09, 2023 DOI: 10.31031/DAPM.2023.02.000541 ISSN: 2640-9399 Volume2 Issue4

Beyond the Manuscript: Community-Driven Conversations: Partnership Building through CHEC-Ins

Beyond the Manuscript: Community-Driven Conversations: Partnership Building through CHEC-Ins Emma Tumilty, Joanne Glenn, Henrietta Barcelo, and Janine Ntihirageza Welcome to Progress in Community Health Partnerships'latest episode of our Beyond the Manuscript podcast. In each volume of the Journal, the editors select one article for our Beyond the Manuscript post-study interview with the authors. Beyond the Manuscript provides authors the opportunity to tell listeners what they would want to know about the project beyond what went into the final manuscript. In this episode of Beyond the Manuscript, Associate Editor, Emma Tumilty, interviews Joanne Glenn, Henrietta Barcelo, and Janine Ntihirageza, authors of "Community Driven Conversations: Partnership Building through CHEC-Ins." The transcript has been edited for clarity and accuracy. Your browser does not support the audio tag. Beyond the Manuscript. Click to hear audio Emma Tumilty: Welcome, everyone, to this episode of Beyond the Manuscriptpodcast for the journal Progress in Community Health Partnerships. Today, we're really excited to have some of the authors of a manuscript called "Community Driven Conversations: Partnership Building through CHEC-Ins." Today, with me, I have Janine Ntihirageza, Henrietta Barcelo, and Joanne Glenn, who I will let introduce themselves hopefully shortly. My name's Doctor Emma Tumilty. I'm an assistant professor in the Department of Bioethics and Health Humanities at the University of Texas medical branch, and an associate editor for the Journal of Progress in Community Health Partnerships. Maybe if we start off with introductions, can we maybe go to Miss Joanne Glenn first? Joanne Glenn: Well, good morning. It's so fabulous to be on this call today. I'm Joanne Glenn. I am an RN MBA, and those initials—ABD—All But Dissertation—of 47 years. Founder of the W.O.T. Foundation—Women on Top of their game—that guide breast cancer survivors through celebration of life. Emma Tumilty: Fantastic. Thank you. And Janine Ntihirageza. Janine Ntihirageza: Thank you so much, Emma. It is an honor for me to be invited to this conversation about CHECIns—one of the pillars of the Chicago CHEC, which is the Cancer Health Equity Collaborative, an organization that has become incredibly impactful here in Chicago. My name is Janine Ntihirageza. I'm a professor at Northeastern Illinois University here in Chicago, and I joined the collaborative about five years ago as a member of the outreach core, and since then, it's been wonderful to work with everybody—especially my colleagues here from the community—our community steering committee. So, I look forward to the conversation. Emma Tumilty: Thank you. And last, but certainly not least, Henrietta Barcelo, could you also introduce yourself? Henrietta Barcelo: Thank you very much. I'm Henrietta Barcelo. I'm an educator. I started my career as a health educator and I have over 25—or actually, now, 30 years of experience. I started off in health care, and rose [End Page 109]into health care marketing, and then, when back into post-secondary education as well, and then, finally, into high-school education for Health Sciences Career Academy at Institute for the Instituto del Progreso Latino in Chicago. I felt that the impact for community was very important. I needed to start at the grassroots level. So, I haven't yet gotten into the elementary school level, but I'm aiming to. Emma Tumilty: You're getting there. Henrietta Barcelo: Thank you. Emma Tumilty: Wonderful. So, I wonder if, for our listeners, you could start off telling us a little bit about that community steering committee and how it brought about the CHEC-Ins? Janine Ntihirageza: Okay. Maybe we could say something about Chicago CHEC so that we're really linking to the community work that we're trying to do. So, it is a National Cancer Institute partnership, led by Northwestern University, the University of Illinois at Chicago, and in Northeastern Illinois University, also in Chicago. So, in short, it's Chicago CHEC. And Chicago CHEC's mission is to advance cancer health equity through meaningful scientific discovery, education, training, and...

Abstract P6-03-07: Development of an at-home breast health assessment test, to increase compliance with screening mammography using proteins from tears

Abstract Anna E. Daily1,*, Prashanth Ravishankar1, Wanyi Wang3, Ryan Krone3, Steve Harms1,2, and V Suzanne Klimberg1,4,5 1Namida Lab Inc, Fayetteville, Arkansas; 2The Breast Center-Medical Associates of Northwest Arkansas, Fayetteville, Arkansas; 3Elite Research LLC, Irving, Texas; 4Department of Surgery, University of Texas Medical Branch, Galveston, Texas; 5Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. *anna@namidalab.com Background: There is a growing body of evidence to support tears as a non-traditional biological fluid in clinical laboratory testing. In addition to the simplicity of tear fluid processing, the ability to access key cancer biomarkers in high concentrations quickly and inexpensively make them an attractive biofluid source. Here we report our biomarker discovery study on tears to identify and validate candidate biomarkers for breast cancer and develop a model that is significantly associated with a positive breast cancer diagnosis. Methods: Participants were recruited from individuals having a yearly screening mammogram, biopsy, and/or recently diagnosed with breast cancer. Imaging results were obtained from clinical sites and samples were then classified as: control (normal imaging no biopsy) or diagnosed breast cancer pre-treatment (diagnosed by biopsy). Biomarker discovery was conducted using 102 individual tear samples collected using the Schirmer strip collection method. Liquid chromatography/tandem mass spectrometry (LC-MS/MS) was performed to identify protein biomarker candidates with altered expression levels in breast cancer patients. ELISA assay to confirm LC-MS/MS trends for biomarkers of interest was conducted using 171 tear samples. An additional round of validation utilizing 848 samples was performed which included protein concentrations determined by ELISA and collection of demographic and clinical covariates. The resulting concentration data, combined with the demographic and clinical covariates, was analyzed using logistic regression analysis to build a model for classification of samples as positive or negative. Results: A total of 301 proteins were identified by LC-MS/MS and narrowed to a list of 14 proteins (p-value &amp;lt; 0.05) with potential significance in breast cancer patients. Three biomarkers, S100A8 (p-value = 0.0069), S100A9 (p-value = 0.0048), and Galectin-3 binding protein (p-value = 0.01) with an increased expression in breast cancer patients were selected for validation using ELISA. Logistic regression analysis produced three models, which were then evaluated on breast cancer cases and controls at two diagnostic thresholds and resulted in sensitivity ranging from 52% - 90% and specificity from 31% - 79%. Conclusions: Our results demonstrate clinical feasibility for tear proteins to detect breast cancer and includes the most extensive published data set of individually analyzed tear samples. This analysis suggests that models developed using tear fluid have clinical validity and could be used in further development of a biological assay. We envision positioning this assay as a tool for activation around breast health screening for low to average risk patients who may be screening avoidant or adverse to encourage participation in screening mammography. Citation Format: Anna Daily, Prashanth Ravishankar, Victoria S. Klimberg, Steve Harms. Development of an at-home breast health assessment test, to increase compliance with screening mammography using proteins from tears [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-03-07.

Design, Implementation, and Evaluation of an N95 Respirator Decontamination and Reuse Program for Healthcare Workers During the COVID-19 Pandemic

Early in the COVID-19 pandemic, substantial disruptions in personal protective equipment (PPE) supply chains forced healthcare systems to become resourceful to ensure PPE availability for healthcare workers. Most worrisome was the global shortage of N95 respirators. In response, a collaboration between the Department of Infection Control and Healthcare Epidemiology and the Department of Biosafety at the University of Texas Medical Branch developed a PPE recycling program guaranteeing an adequate supply of respirators for frontline staff. The team successfully developed and implemented a novel workflow that included validated decontamination procedures, education, and training programs as well as transportation, labeling, and storage logistics. In total, 15,995 respirators of various types and sizes were received for recycling. Of these, 12,752 (80%) were recycled. Following the program's implementation, we surveyed 134 frontline healthcare workers who overwhelmingly graded our institution's culture of safety positively. Overall impressions of the N95 respirator recycling program were mixed, although interpretation of those results was limited by a lower survey response rate. In an era of increasing health security threats, innovative recycling programs like this one may serve as a model for other health systems to respond to future PPE supply chain disruptions.

SARS-CoV-2 infection-induced immunity reduces rates of reinfection and hospitalization caused by the Delta or Omicron variants

ABSTRACT During a pandemic, effective vaccines are typically in short supply, particularly at onset intervals when the wave is accelerating. We conducted an observational, retrospective analysis of aggregated data from all patients who tested positive for SARS-CoV-2 during the waves caused by the Delta and Omicron variants, stratified based on their known previous infection and vaccination status, throughout the University of Texas Medical Branch (UTMB) network. Next, the immunity statuses within each medical parameter were compared to naïve individuals for the effective decrease of occurrence. Lastly, we conducted studies using mice and pre-pandemic human samples for IgG responses to viral nucleocapsid compared to spike protein toward showing a functional component supportive of the medical data results in relation to the immunity types. During the Delta and Omicron waves, both infection-induced and hybrid immunities were associated with a trend of equal or greater decrease of occurrence than vaccine-induced immunity in hospitalizations, intensive care unit admissions, and deaths in comparison to those without pre-existing immunity, with hybrid immunity often trending with the greatest decrease. Compared to individuals without pre-existing immunity, those vaccinated against SARS-CoV-2 had a significantly reduced incidence of COVID-19, as well as all subsequent medical parameters. Though vaccination best reduces health risks associated with initial infection toward acquiring immunity, our findings suggest infection-induced immunity is as or more effective than vaccination in reducing the severity of reinfection from the Delta or Omicron variants, which should inform public health response at pandemic onset, particularly when triaging towards the allotment of in-demand vaccinations.

Teletransformation: Global Telesolutions and the Transformation of Surgical Care and Education.

From the Department of Surgery, UTMB Cancer Center: The University of Texas Medical Branch at Galveston Cancer Center, Galveston, TX Disclosure Information: Nothing to disclose. Disclosures outside the scope of this work: Dr Klimberg receives editorial book royalties from Saunders, Elsevier, Wolters Kluwer, and Springer. Presented at the Southern Surgical Association 134th Annual Meeting, Palm Beach, FL, December 2022 Corresponding author: V. Suzanne Klimberg, MD PhD FACS UTMB/MDACC 301 University Blvd 6.136 McCullough Bldg Galveston, TX 77555-0001