University Of Texas Medical Branch Research Articles

The John Sealy Hospital Fire Evacuation.

Advances in fire safety and building construction have made fires in modern health care facilities uncommon and easily contained. Therefore, emergent hospital evacuations resulting from an internal fire are rare. On January 4, 2017, a fire occurred at the John Sealy Hospital, part of the University of Texas Medical Branch at Galveston, resulting in emergent evacuation of the hospital building and an adjacent office and patient care building. The internal emergency response system was quickly activated, and more than 100 patients and 200 staff members were evacuated within 27 minutes with no fire- or smoke-related injuries. Obstacles encountered during the evacuation process included difficulties with communication and confirming patient count in a timely manner. This article describes the emergent hospital evacuation during the fire, summarizes the subsequent reflections of a multiagency after-action review, and issues a call to action for further research and publication on emergency patient evacuation.

Abstract PR004: Differential gene expression analysis comparing Black and White patients with HPV-positive oropharyngeal squamous cell carcinoma reveals suppressed immune response and higher rates P16/HPV DNA discordance in Black patients

Abstract Background-Human papilloma virus (HPV-positive (+)) oropharynx cancer (OPC) are a distinct neoplastic entity associated with a significant survival advantage compared to HPV- OPCs. The survival advantage is so great that the presence of regional cervical lymph node metastasis is no longer considered an advanced stage III/IV cancer. The survival advantage associated with HPV+ OPC is not the same for Black patients compared to all other races and emerging data now suggests Black patients with HPV+ OPC have survival outcomes similar to White patients with HPV- OPC. We conducted a differential gene expression analysis and high-risk HPV serotyping comparing genomic difference between treatment naïve Black and White patients with HPV+ OPC. Methods: Surgical samples were obtained from Duke, the University of Texas Medical Branch, and the University of Mississippi, through an IRB approved protocol. HPV status determined by p16 immunohistochemistry (IHC). We performed digital spatial profiling and conducted a differential gene expression analysis in 14 Black and 13 White patients using the Nanostring™ Whole Transcriptome Atlas. Morphology markers included CD45, PANCK, and alpha SMA to label lymphocytes, epithelium, and stroma, respectively. A component of the bioinformatics pipeline included conducing a KEGG pathway analysis using pre-ranked test statistics from self-reported Black and White patients HPV+ OPC. The presence of high-risk oncogenic HPV was determined in parallel by RT-PCR (Creative Biogene). P16, CD68 and CD3 expression was measured by IHC using standard techniques. Results: There was a significant decrease in antigen processing and presentation and T-cell receptor signaling pathways in CD45+ lymphocytes (p<0.0002) and B-Cell receptor and chemokine signaling pathways in PANCK+ tumor epithelial cells (p<0.03) in Black patients compared to White patients with HPV+ OPC. There was a significant difference in p16 expression and the absence of HPV DNA in Black patients compared to White patients (p<0.017). 32% of Black patients with p16+ OPC were HPV DNA negative. There was no p16/HPV16 DNA discordance observed in the White patient cohort. Three patients were co-infected with other carcinogenic HPV serotypes (45, 51, and 59) in addition to HPV16 (two Black and one White). CD68 expression, associated with M1-like anti-tumor macrophages, was significantly decreased in Black patients with p16+/HPV16+ OPC, compared to White patients (p<0.017), suggesting alterations in tumor immune response may be important in cancer disparities. Conclusion: The favorable prognosis associated with HPV+ OPC, including recruitment in currently ongoing radiation de-escalation clinical trials cannot be widely applied to all patients with HPV+ OPC and studies addressing racial disparities, HPV/p16 discordance, and predictors of poor response represent a significant health equity gap in the field of OPC disparities. Citation Format: Tammara L. Watts, Katerine Gonzalez, Xiangfeng Shen, Layne Rogers, Nosa Osazuwa-Peters, Gina D. Jefferson, Cecilia G. Clement, Danielle Range, Russel R Kahmke, Walter T Lee, Daniel J. Rocke, Trinitia Y Cannon, Yvonne Mowery, Kouros Owzar. Differential gene expression analysis comparing Black and White patients with HPV-positive oropharyngeal squamous cell carcinoma reveals suppressed immune response and higher rates P16/HPV DNA discordance in Black patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR004.

Using one health training for interprofessional team building: implications for research, policy, and practice in Nigeria.

In recent years, the concept of One Health (OH) has arisen as an approach that helps to catalyze the creation of transdisciplinary teams needed for surveillance and investigation of emerging disease dynamics. Besides a wealth of descriptions of what the OH approach encompasses, a dearth of information is available regarding the training of individuals in OH competencies. In 2019, the Nigerian Center for Disease Control developed an OH strategic plan to meet the country's human, animal, and environmental health challenges. In response to the demand for clinicians, scientists, climatologists, conservationists, and environmentalists, who have expertise in environment, human, plant, and animal health to work collaboratively in addressing OH challenges in Nigeria. An interprofessional group of faculty from the University of Texas Medical Branch, the University of Jos, and the National Veterinary Research Institute convened to develop a novel OH course 'entitled 'One Health for Translational Team Science. The objective of the course was to explore the evolution of an emerging epidemic, capitalizing on various learning environments, including animal, environmental, human, and public health perspectives. The 6-week course comprised of three parts: 2-weeks virtual part of case-based group discussions focusing on animal and environmental aspects, 2 weeks of individual field experiences, and a final virtual part focusing on human health. Pedagogical tools used were: case-based group discussions, breakout group presentations, role-play activities, field project write-up, peer evaluation, group writing assignments, and weekly reflections with the goal of working in teams to develop and practice the fundamental leadership and management skills in addressing emerging public health challenges. Post-course evaluations showed that all participants felt more confident identifying and practicing the necessary attitudes and skills to participate effectively in the evaluation of an outbreak. Furthermore, the roles, responsibilities, and "One Health ways of thinking" for the various disciplines and professions involved in improving global health were articulated and identified.

Exploring Side Effects of Sublingual Immunotherapy: A Systemic Review and Meta-Analysis.

Objective: Sublingual immunotherapy (SLIT) has emerged as a potentially safe and convenient option for allergen immunotherapy for patients with inhalant allergy. Larger studies on the overall side effects and severe reactions anaphylaxis are still lacking. Study Design: Systematic review and meta-analysis. Setting: Author's review was completed in the University of Texas Medical Branch. Methods: A systematic review and meta-analysis of prospective clinical trials focusing on SLIT safety published from January 1, 2001, to December 31, 2021, was conducted. Results: Twenty-six studies were included with analysis of 7827 patients, representing over 2.7 million SLIT doses. All studies focused on single-antigen immunotherapy. The mean duration of treatment was 11.54 months. Local side effects were present in 40.83% of patients [95% confidence interval (CI) 24.78-57.96]. Systemic side effects were encountered in 1.09% of SLIT patients (95% CI 0.57-1.78). Anaphylaxis was reported in 0.13% of patients (95% CI 0.06-0.22). Discontinuation rates due to side effects were low, at 4.32% of patients (95% CI 3.28-5.49). Conclusion: This meta-analysis shows that single-antigen SLIT is well-tolerated, with overall low rates of systemic side effects including anaphylaxis. Although there is a high rate of minor local side effect, the treatment attrition during the first year is low. With growing allergy burden worldwide, SLIT is a convenient and economically feasible option for immunotherapy. Further work is needed to evaluate long-term safety and efficacy of single as well as multi-antigen SLIT, including quality of life assessments.

Court rules against former medical resident

Case name: Daywalker v. University of Texas Medical Branch at Galveston, et al., No. 22‐40813 (5th Cir. 01/09/24).

Disparate outcomes in Hispanic patients with metabolic dysfunction-associated steatotic liver disease/steatohepatitis and type 2 diabetes: Large cohort study.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are a growing health burden across a significant portion of the global patient population. However, these conditions seem to have disparate rates and outcomes between different ethnic populations. The combination of MASLD/MASH and type 2 diabetes increases the risk of hepatocellular carcinoma (HCC), and Hispanic patients experience the greatest burden, particularly those in South Texas. To compare outcomes between Hispanic and non-Hispanic patients in the United States, while further focusing on the Hispanic population within Southeast Texas to determine whether the documented disparity in outcomes is a function of geographical circumstance or if there is a more widespread reason that all clinicians must account for in prognostic consideration. This cohort analysis was conducted with data obtained from TriNetX, LLC ("TriNetX"), a global federated health research network that provides access to deidentified medical records from healthcare organizations worldwide. Two cohort networks were used: University of Texas Medical Branch (UTMB) hospital and the United States national database collective to determine whether disparities were related to geographic regions, like Southeast Texas. This study findings revealed Hispanics/Latinos have a statistically significant higher occurrence of HCC, type 2 diabetes mellitus, and liver fibrosis/cirrhosis in both the United States and the UTMB Hispanic/Latino groups. All-cause mortality in Hispanics/Latinos was lower within the United States group and not statistically elevated in the UTMB cohort. This would appear to support that Hispanic patients in Southeast Texas are not uniquely affected compared to the national Hispanic population.

Ocular screening for chronic graft-versus-host disease in patients with allogeneic hematopoietic stem cell transplant

ObjectiveThis study investigates ocular manifestations of graft-versus-host disease in patients following allogeneic hematopoietic stem cell transplantation (HSCT) at the University of Texas Medical Branch (UTMB). Preferred practice pattern guidelines are proposed for ocular graft-versus-host disease (oGHVD) detection. MethodsThe Epic electronic medical record database at UTMB was screened using International Classification of Diseases, Tenth Revision (ICD-10), codes for bone marrow transplants, stem cell transplants, and complications of bone marrow transplants and stem cell transplants. We identified 50 patients with the ICD-10 codes that were seen at UTMB between 2000 and 2021. Patients who received an HSCT and follow-up care with UTMB were included in this study. Thirty-eight patients met the inclusion criteria, whereas 12 patients were excluded because they had no diagnosis of HSCT or did not follow-up with UTMB. ResultsOf the 38 patients in our cohort, 23.7% (n = 9) were noted to have oGVHD. As many as 89% of the patients with oGVHD presented with an ocular surface disease including keratoconjunctivitis sicca, meibomian gland dysfunction, and dry eye syndrome. Systemic GVHD also was found in 44% of the patients with oGVHD. Only 29% (n = 11) of the study population had referrals to ophthalmology. Most referrals (55%) were made within 1 year of getting the HSCT. None of the patients in our cohort received an ocular screening before HSCT. ConclusionsMany post-HSCT patients lack routine ophthalmic care. Regularly assessing post-HSCT patients for early signs and symptoms of oGVHD may limit adverse outcomes. Management of oGVHD should involve a multidisciplinary team approach.

Title: Influence of the NASA SPRINT exercise protocol on myonuclear and satellite cell content of the vastus lateralis and soleus during 70 days of bedrest

Objectives: The purpose of this study was to assess the effcacy of the NASA SPRINT exercise protocol in preserving myonuclear and satellite cell number of the quadriceps (vastus lateralis) and triceps surae (soleus) muscles following 70 days of bedrest (i.e., simulated microgravity). These two muscles were the focus of this study because they both atrophy significantly with microgravity exposure in the absence of countermeasures. Hypotheses: The SPRINT exercise protocol will preserve myonuclear number (MNN), myonuclear domain (MND), and satellite cell number (SCN) during 70 days of bedrest. Methods: Subjects were randomized into three groups: bedrest only (BR; n=8, 37±3 y), bedrest with endurance and resistance exercise (BRE; n=9, 34±2 y) and bedrest with endurance and resistance exercise and low dose testosterone injections (BRE+T; n=8, 33±3 y). Muscle biopsies were taken before and at the end of bedrest from the vastus lateralis and soleus, and were sectioned, immunofluorescently stained, and analyzed for MNN (myonuclei/fiber), MND (μm2/myonuclei), and SCN (satellite cells/fiber) in slow (myosin heavy chain (MHC) I) and fast (MHC IIa) muscle fibers. SCN was only determined in MHC I fibers for the soleus. Results: MNN, MND, and SCN in MHC I and IIa fibers of the vastus lateralis and soleus were unchanged (p<0.05) from pre- to post-bedrest within BR, BRE, and BRE+T. However, there was a main effect for time (p<0.05) for a decrease in MND for vastus lateralis MHC I fibers (-8%), as well as soleus MHC I (-18%) and IIa (-18%) fibers. Also, there was a trend for a main effect for time (P=0.059) for an increase (+37%) in SCN for vastus lateralis MHC IIa fibers, which was driven primarily by the exercise groups (BR: -4%, BRE: +36%, BRE+T: +67%). Conclusions: Myonuclear number appears to be unaltered during 70 days of simulated microgravity with or without countermeasures exercise. As a result, any changes in myonuclear domain correspond with alterations in muscle mass. Satellite cell number also appears to be relatively refractory to change, but may be influenced in fast muscle fibers under the combined dynamic cellular control mechanisms of exercise and atrophy encountered during relatively long-duration simulated microgravity. Funding Source: This research was supported by the National Aeronautics and Space Administration, NNJ06HF59G; the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award (UR1TR000071) from the National Center for Advancing Translational Sciences, National Institutes of Health; the NASA Flight Analogs Project; and the Human Bioenergetic Program at Ball State University. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Fiber type specific myonuclear and satellite cell content comparisons between the vastus lateralis and soleus muscles in humans

Objectives: The purpose of this study was to compare fiber type specific myonuclear and satellite cell number of the vastus lateralis and soleus muscles in humans. Hypotheses: Myonuclear number (MNN), myonuclear domain (MND), and satellite cell number (SCN) would be similar within each fiber type between the vastus lateralis and soleus. Methods: Muscle biopsies from the vastus lateralis and soleus of 24 individuals (34±7y, 24-55y) were sectioned, immunofluorescently stained, and analyzed for MNN, MND, and SCN in slow (myosin heavy chain (MHC) I) and fast (MHC IIa) muscle fibers. SCN was determined only in MHC I fibers for the soleus. MNN and MND were compared for 24 individuals, while SCN was compared for 19 individuals. Results: MNN was similar in MHC I (3.32±0.81 vs. 3.66±0.65 myonuclei/fiber, P=0.067) and IIa (3.63±0.82 vs. 3.83±0.68 myonuclei/fiber, P>0.05) fibers of the vastus lateralis and soleus. Similarly, MND was not different in MHC I (1649±305 vs. 1673±340 μm2/myonuclei, P>0.05) and IIa (1705±313 vs. 1819±394 μm2/myonuclei, P>0.05) fibers of the vastus lateralis and soleus. However, SCN was 62% higher (p<0.05) in MHC I fibers of the soleus (0.127±0.039 satellite cells/fiber) compared with MHC I fibers of the vastus lateralis (0.083±0.024 satellite cells/fiber). Conclusions: The literature is void of comparisons of myonuclei and satellite numbers across different human muscles. These initial results suggest myonuclear number and the area “governed” by each myonuclei (i.e., the myonuclear domain) appears to be similar within the two main fiber types found in the vastus lateralis and soleus muscles. Interestingly, within the same slow fiber type (i.e., MHC I fibers) across these two muscles, it appears the soleus is programmed to have a substantially higher satellite cell content. The basis for this intrinsic difference in slow myofiber satellite profile may be related to the differences in daily myocellular activity between the vastus lateralis and soleus. This research was supported by the National Aeronautics and Space Administration, NNJ06HF59G; the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award (UR1TR000071) from the National Center for Advancing Translational Sciences, National Institutes of Health; the NASA Flight Analogs Project; and the Human Bioenergetic Program at Ball State University. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Racial Disparities in Selected Complications and Comorbidities among People with Type 2 Diabetes.

Type 2 diabetes (T2D) is a growing public health concern, disproportionately impacting racial and ethnic minorities. Assessing disparities is the first step towards achieving the translation goal to reduce disparities in diabetes outcomes, according to the Centers for Disease Control and Prevention (CDC)'s Division of Diabetes. We analyzed the data of patients (18+ years) diagnosed with T2D between 1 January 2012 and 31 March 2017, using the electronic health records of the University of Texas Medical Branch at Galveston. We compared the crude rate and age-standardized rate (using direct method) of selected micro- and macrovascular complication rates, associated obesity, and insulin dependence among racial and ethnic groups. Our sample included 20,680 patients who made 394,106 visits (9922 non-Hispanic White patients, 4698 non-Hispanic Black patients, and 6060 Hispanic patients). Our results suggest a higher risk of acquiring macrovascular (hypertension, ischemic disease, and stroke) and microvascular (renal, ophthalmic, and neurological) complications in Black patients compared to non-Hispanic White and Hispanic patients. The rates of stage I or II obesity were higher in Black patients compared with White and Hispanic patients. The rates of insulin use rather than oral hypoglycemics were also higher in Black patients than White and Hispanic patients. The disparities in terms of the higher susceptibility to complications among Black patients are possibly linked to the socioeconomic disadvantages of this population, leading to poorer management. Prevention strategies are warranted to reduce the incidence of T2D complications in racial minorities.

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.

Implementation of a High-Value, Evidence-Based Care Program: Impact and Opportunities for Learning Organizations.

Value-based care is not simply a matter of cost, but also one of outcomes and harms per dollar spent. This definition encompasses three key components: healthcare delivery that is organized around patients' medical conditions, costs and outcomes that are actively and consistently measured, and information technology that enables the other two components. Our objective in this project was to implement and measure a systemwide high-value, evidence-based care initiative with five pillars of high-value practices. We performed a quasi-experimental study from September 1, 2019, to August 31, 2022, of a new care program at the University of Texas Medical Branch. Drawing from the ABIM Foundation's Choosing Wisely Campaign, the program was based on five pillars-blood management and antimicrobial, laboratory, imaging, and opioid stewardship-with interdisciplinary teams led by institutional subject matter experts (i.e., administrative leaders) accompanied by nursing, information technology, pharmacy, and clinical and nonclinical personnel including faculty and trainees. Each pillar addressed two goals with targeted interventions to assess improvements during the first three fiscal years (FYs) of implementation. The targets were set at 10% improvement by the end of each FY. Monthly measurements were recorded for each FY. We tracked performance toward 30 pillar goals and determined that the teams were successful in 50%, 50%, and 70% of their goals for FY 2020, 2021, and 2022, respectively. For example, in the antimicrobial stewardship FY 2021 pillar, one goal was to decrease meropenem days of therapy (DOT) by 10% (baseline was 45 DOT/1,000 patient days; the target was 40.5 DOT/1,000 patient days). We measured quarterly DOT/1,000 patient day rates of 32.02, 30.57, and 26.9, respectively, for a cumulative rate of 26.9. Critical interventions included engaging and empowering providers and service lines (including outliers whose performance was outside norms), educational conferences, and transparent data analyses. We showed that a multidisciplinary approach to the implementation of an evidence-based, high-value care program through a partnership of engaged administrative leaders, providers, and trainees can result in sustainable and measurable high-value healthcare delivery. Specifically, structuring the program with pillars to address defined metrics resulted in progressive improvement in meeting value-based goals at the University of Texas Medical Branch. Also, challenges can be embraced as learning opportunities to inform value-based interventions that range from technological to educational tactics. The results at the University of Texas Medical Branch provide a benchmark for the implementation of a program that engages, empowers, and aligns innovative value-based care initiatives.

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

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

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

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.