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Article ; Online: Leveraging Ethnic Backgrounds to Improve Collection of Race, Ethnicity, and Language Data.

Hussain, Cory / Podewils, Laura J / Wittmer, Nancy / Boyer, Ann / Marin, Maria C / Hanratty, Rebecca L / Hasnain-Wynia, Romana

Journal for healthcare quality : official publication of the National Association for Healthcare Quality

2024 Volume 46, Issue 3, Page(s) 160–167

Abstract: Introduction: Healthcare disparities may be exacerbated by upstream incapacity to collect high-quality and accurate race, ethnicity, and language (REaL) data. There are opportunities to remedy these data barriers. We present the Denver Health (DH) REaL ... ...

Abstract	Introduction: Healthcare disparities may be exacerbated by upstream incapacity to collect high-quality and accurate race, ethnicity, and language (REaL) data. There are opportunities to remedy these data barriers. We present the Denver Health (DH) REaL initiative, which was implemented in 2021. Methods: Denver Health is a large safety net health system. After assessing the state of REaL data at DH, we developed a standard script, implemented training, and adapted our electronic health record to collect this information starting with an individual's ethnic background followed by questions on race, ethnicity, and preferred language. We analyzed the data for completeness after REaL implementation. Results: A total of 207,490 patients who had at least one in-person registration encounter before and after the DH REaL implementation were included in our analysis. There was a significant decline in missing values for race (7.9%-0.5%, p < .001) and for ethnicity (7.6%-0.3%, p < .001) after implementation. Completely of language data also improved (3%-1.6%, p < .001). A year after our implementation, we knew over 99% of our cohort's self-identified race and ethnicity. Conclusions: Our initiative significantly reduced missing data by successfully leveraging ethnic background as the starting point of our REaL data collection.
MeSH term(s)	Humans ; Ethnicity/statistics & numerical data ; Language ; Racial Groups/statistics & numerical data ; Electronic Health Records ; Healthcare Disparities/ethnology ; Female ; Data Collection/methods ; Data Collection/standards ; Male ; Colorado ; Middle Aged ; Adult
Language	English
Publishing date	2024-02-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	1472097-8
ISSN	1945-1474 ; 1062-2551
ISSN (online)	1945-1474
ISSN	1062-2551
DOI	10.1097/JHQ.0000000000000425
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Article ; Online: Multidrug-Resistant Bovine Salmonellosis Predisposing for Severe Human Clostridial Myonecrosis.

Hussain, Cory / Ball, Matthew K / McGwire, Bradford S

The American journal of case reports

2019 Volume 20, Page(s) 268–273

Abstract: BACKGROUND The overuse of antibiotics in animals promotes the development of multidrug-resistance predisposing for severe polymicrobial human infections. CASE REPORT We describe a case of spontaneous clostridial myonecrosis due to ulcerative colonic ... ...

Abstract	BACKGROUND The overuse of antibiotics in animals promotes the development of multidrug-resistance predisposing for severe polymicrobial human infections. CASE REPORT We describe a case of spontaneous clostridial myonecrosis due to ulcerative colonic infection with multidrug-resistant Salmonella enterica subsp. enterica, serotype 4,[5],12: i: -. Serotyping of the colonic Salmonella isolate in the index case and the bovine farm outbreak isolates from where the patient worked indicated they were both serotype I 4,[5],12: i: -, which is linked with a multitude of large reported disease outbreaks. Further analysis revealed that they are highly genetically related and antibiotic susceptibility testing indicated that they are phenotypically identical. CONCLUSIONS Enteritis due to human acquisition of multidrug-resistant Salmonella from cattle led to the invasion and dissemination of Clostridium septicum resulting in devastating myonecrotic disease. This highlights the ramifications of co-existence and evolution of pathogenic bacteria in animals and humans and lends support to reducing the use of antibiotics in animals.
MeSH term(s)	Clostridium Infections/complications ; Clostridium Infections/microbiology ; Clostridium Infections/pathology ; Clostridium septicum/isolation & purification ; Drug Resistance, Multiple, Bacterial ; Female ; Humans ; Muscle, Skeletal/pathology ; Necrosis ; Salmonella Infections/complications ; Salmonella Infections/microbiology ; Salmonella Infections/pathology ; Salmonella enterica/isolation & purification ; Young Adult
Language	English
Publishing date	2019-03-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.913472
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Article ; Online: The neighborhood built environment and COVID-19 hospitalizations.

Rigolon, Alessandro / Németh, Jeremy / Anderson-Gregson, Brenn / Miller, Ana Rae / deSouza, Priyanka / Montague, Brian / Hussain, Cory / Erlandson, Kristine M / Rowan, Sarah E

PloS one

2023 Volume 18, Issue 6, Page(s) e0286119

Abstract: Research on the associations between the built environment and COVID-19 outcomes has mostly focused on incidence and mortality. Also, few studies on the built environment and COVID-19 have controlled for individual-level characteristics across large ... ...

Abstract	Research on the associations between the built environment and COVID-19 outcomes has mostly focused on incidence and mortality. Also, few studies on the built environment and COVID-19 have controlled for individual-level characteristics across large samples. In this study, we examine whether neighborhood built environment characteristics are associated with hospitalization in a cohort of 18,042 individuals who tested positive for SARS-CoV-2 between May and December 2020 in the Denver metropolitan area, USA. We use Poisson models with robust standard errors that control for spatial dependence and several individual-level demographic characteristics and comorbidity conditions. In multivariate models, we find that among individuals with SARS-CoV-2 infection, those living in multi-family housing units and/or in places with higher particulate matter (PM2.5) have a higher incident rate ratio (IRR) of hospitalization. We also find that higher walkability, higher bikeability, and lower public transit access are linked to a lower IRR of hospitalization. In multivariate models, we did not find associations between green space measures and the IRR of hospitalization. Results for non-Hispanic white and Latinx individuals highlight substantial differences: higher PM2.5 levels have stronger positive associations with the IRR of hospitalization for Latinx individuals, and density and overcrowding show stronger associations for non-Hispanic white individuals. Our results show that the neighborhood built environment might pose an independent risk for COVID-19 hospitalization. Our results may inform public health and urban planning initiatives to lower the risk of hospitalization linked to COVID-19 and other respiratory pathogens.
MeSH term(s)	Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Built Environment ; Hospitalization ; Particulate Matter
Chemical Substances	Particulate Matter
Language	English
Publishing date	2023-06-14
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0286119
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Article ; Online: The neighborhood built environment and COVID-19 hospitalizations.

Alessandro Rigolon / Jeremy Németh / Brenn Anderson-Gregson / Ana Rae Miller / Priyanka deSouza / Brian Montague / Cory Hussain / Kristine M Erlandson / Sarah E Rowan

PLoS ONE, Vol 18, Iss 6, p e

2023 Volume 0286119

Abstract	Research on the associations between the built environment and COVID-19 outcomes has mostly focused on incidence and mortality. Also, few studies on the built environment and COVID-19 have controlled for individual-level characteristics across large samples. In this study, we examine whether neighborhood built environment characteristics are associated with hospitalization in a cohort of 18,042 individuals who tested positive for SARS-CoV-2 between May and December 2020 in the Denver metropolitan area, USA. We use Poisson models with robust standard errors that control for spatial dependence and several individual-level demographic characteristics and comorbidity conditions. In multivariate models, we find that among individuals with SARS-CoV-2 infection, those living in multi-family housing units and/or in places with higher particulate matter (PM2.5) have a higher incident rate ratio (IRR) of hospitalization. We also find that higher walkability, higher bikeability, and lower public transit access are linked to a lower IRR of hospitalization. In multivariate models, we did not find associations between green space measures and the IRR of hospitalization. Results for non-Hispanic white and Latinx individuals highlight substantial differences: higher PM2.5 levels have stronger positive associations with the IRR of hospitalization for Latinx individuals, and density and overcrowding show stronger associations for non-Hispanic white individuals. Our results show that the neighborhood built environment might pose an independent risk for COVID-19 hospitalization. Our results may inform public health and urban planning initiatives to lower the risk of hospitalization linked to COVID-19 and other respiratory pathogens.
Keywords	Medicine ; R ; Science ; Q
Subject code	331
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Risk Factors for Hospitalization in People With HIV and COVID-19.

Kamis, Kevin F / Barbera, Lauren / Abdo, Mona / Rowan, Sarah E / Hussain, Cory / Gardner, Edward M / Johnson, Steven C / MaWhinney, Samantha / Davis, Amelia J / Carlson, Jesse / Kozacka, Katie A / Erlandson, Kristine M

Journal of acquired immune deficiency syndromes (1999)

2022 Volume 88, Issue 3, Page(s) e22

MeSH term(s)	Adult ; COVID-19/complications ; COVID-19/pathology ; Female ; HIV Infections/complications ; HIV Infections/pathology ; HIV-1 ; Hospitalization ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; SARS-CoV-2
Language	English
Publishing date	2022-08-31
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	645053-2
ISSN	1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
ISSN (online)	1944-7884 ; 1077-9450
ISSN	0897-5965 ; 0894-9255 ; 1525-4135
DOI	10.1097/QAI.0000000000002780
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Article ; Online: Reducing Interruptive Alert Burden Using Quality Improvement Methodology.

Chaparro, Juan D / Hussain, Cory / Lee, Jennifer A / Hehmeyer, Jessica / Nguyen, Manjusri / Hoffman, Jeffrey

Applied clinical informatics

2020 Volume 11, Issue 1, Page(s) 46–58

Abstract: Background: Increased adoption of electronic health records (EHR) with integrated clinical decision support (CDS) systems has reduced some sources of error but has led to unintended consequences including alert fatigue. The "pop-up" or interruptive ... ...

Abstract	Background: Increased adoption of electronic health records (EHR) with integrated clinical decision support (CDS) systems has reduced some sources of error but has led to unintended consequences including alert fatigue. The "pop-up" or interruptive alert is often employed as it requires providers to acknowledge receipt of an alert by taking an action despite the potential negative effects of workflow interruption. We noted a persistent upward trend of interruptive alerts at our institution and increasing requests for new interruptive alerts. Objectives: Using Institute for Healthcare Improvement (IHI) quality improvement (QI) methodology, the primary objective was to reduce the total volume of interruptive alerts received by providers. Methods: We created an interactive dashboard for baseline alert data and to monitor frequency and outcomes of alerts as well as to prioritize interventions. A key driver diagram was developed with a specific aim to decrease the number of interruptive alerts from a baseline of 7,250 to 4,700 per week (35%) over 6 months. Interventions focused on the following key drivers: appropriate alert display within workflow, clear alert content, alert governance and standardization, user feedback regarding overrides, and respect for user knowledge. Results: A total of 25 unique alerts accounted for 90% of the total interruptive alert volume. By focusing on these 25 alerts, we reduced interruptive alerts from 7,250 to 4,400 per week. Conclusion: Systematic and structured improvements to interruptive alerts can lead to overall reduced interruptive alert burden. Using QI methods to prioritize our interventions allowed us to maximize our impact. Further evaluation should be done on the effects of reduced interruptive alerts on patient care outcomes, usability heuristics on cognitive burden, and direct feedback mechanisms on alert utility.
MeSH term(s)	Clinical Governance ; Feedback ; Heuristics ; Humans ; Internet ; Medical Order Entry Systems/standards ; Nurse Practitioners ; Physicians ; Quality Improvement ; Tobacco Products
Language	English
Publishing date	2020-01-15
Publishing country	Germany
Document type	Journal Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0039-3402757
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Synthetic RNA Polymerase III Promoters Facilitate High-Efficiency CRISPR-Cas9-Mediated Genome Editing in Yarrowia lipolytica.

Schwartz, Cory M / Hussain, Murtaza Shabbir / Blenner, Mark / Wheeldon, Ian

ACS synthetic biology

2016 Volume 5, Issue 4, Page(s) 356–359

Abstract: The oleaginous yeast Yarrowia lipolytica is a valuable microbial host for chemical production because it has a high capacity to synthesize, modify, and store intracellular lipids; however, rapid strain development has been hampered by the limited ... ...

Abstract	The oleaginous yeast Yarrowia lipolytica is a valuable microbial host for chemical production because it has a high capacity to synthesize, modify, and store intracellular lipids; however, rapid strain development has been hampered by the limited availability of genome engineering tools. We address this limitation by adapting the CRISPR-Cas9 system from Streptococcus pyogenes for markerless gene disruption and integration in Y. lipolytica. Single gene disruption efficiencies of 92% and higher were achieved when single guide RNAs (sgRNA) were transcribed with synthetic hybrid promoters that combine native RNA polymerase III (Pol III) promoters with tRNA. The Pol III-tRNA hybrid promoters exploit endogenous tRNA processing to produce mature sgRNA for Cas9 targeting. The highest efficiencies were achieved with a SCR1'-tRNA(Gly) promoter and Y. lipolytica codon-optimized Cas9 expressed from a UAS1B8-TEF promoter. Cotransformation of the Cas9 and sgRNA expressing plasmid with a homologous recombination donor plasmid resulted in markerless homologous recombination efficiency of over 64%. Homologous recombination was observed in 100% of transformants when nonhomologous end joining was disrupted. The end result of these studies was the development of pCRISPRyl, a modular tool for markerless gene disruption and integration in Y. lipolytica.
MeSH term(s)	CRISPR-Cas Systems/genetics ; Fungal Proteins/antagonists & inhibitors ; Fungal Proteins/genetics ; Fungal Proteins/metabolism ; Gene Editing/methods ; Homologous Recombination ; Plasmids/genetics ; Plasmids/metabolism ; Promoter Regions, Genetic ; RNA Polymerase III/genetics ; RNA, Guide, CRISPR-Cas Systems/metabolism ; Real-Time Polymerase Chain Reaction ; Yarrowia/genetics ; Yarrowia/metabolism
Chemical Substances	Fungal Proteins ; RNA, Guide, CRISPR-Cas Systems ; RNA Polymerase III (EC 2.7.7.6)
Language	English
Publishing date	2016-01-07
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ISSN	2161-5063
ISSN (online)	2161-5063
DOI	10.1021/acssynbio.5b00162
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Reducing Interruptive Alert Burden Using Quality Improvement Methodology

Chaparro, Juan D. / Hussain, Cory / Lee, Jennifer A. / Hehmeyer, Jessica / Nguyen, Manjusri / Hoffman, Jeffrey

Applied Clinical Informatics

2020 Volume 11, Issue 01, Page(s) 46–58

Abstract	Background: Increased adoption of electronic health records (EHR) with integrated clinical decision support (CDS) systems has reduced some sources of error but has led to unintended consequences including alert fatigue. The “pop-up” or interruptive alert is often employed as it requires providers to acknowledge receipt of an alert by taking an action despite the potential negative effects of workflow interruption. We noted a persistent upward trend of interruptive alerts at our institution and increasing requests for new interruptive alerts. Objectives: Using Institute for Healthcare Improvement (IHI) quality improvement (QI) methodology, the primary objective was to reduce the total volume of interruptive alerts received by providers. Methods: We created an interactive dashboard for baseline alert data and to monitor frequency and outcomes of alerts as well as to prioritize interventions. A key driver diagram was developed with a specific aim to decrease the number of interruptive alerts from a baseline of 7,250 to 4,700 per week (35%) over 6 months. Interventions focused on the following key drivers: appropriate alert display within workflow, clear alert content, alert governance and standardization, user feedback regarding overrides, and respect for user knowledge. Results: A total of 25 unique alerts accounted for 90% of the total interruptive alert volume. By focusing on these 25 alerts, we reduced interruptive alerts from 7,250 to 4,400 per week. Conclusion: Systematic and structured improvements to interruptive alerts can lead to overall reduced interruptive alert burden. Using QI methods to prioritize our interventions allowed us to maximize our impact. Further evaluation should be done on the effects of reduced interruptive alerts on patient care outcomes, usability heuristics on cognitive burden, and direct feedback mechanisms on alert utility.
Keywords	clinical information systems ; decision support systems ; clinical alert fatigue ; health personnel ; quality improvement ; electronic health records ; human factors
Language	English
Publishing date	2020-01-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0039-3402757
Database	Thieme publisher's database

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Article ; Online: Ultrasound Criteria for Assessment of Vertebral Artery Origins.

Rice, Cory J / Cho, Sung-Min / Strohm, Tamara / Raber, Larry / Katzan, Irene L / Hussain, M Shazam / Uchino, Ken

Journal of neuroimaging : official journal of the American Society of Neuroimaging

2019 Volume 30, Issue 1, Page(s) 45–49

Abstract: Background and purpose: We sought to validate ultrasound as a reliable means of assessing vessel stenosis of vertebral artery origins.: Methods: We reviewed 1,135 patient charts with ultrasound of the posterior circulation performed in 2008-2015 in a ...

Abstract	Background and purpose: We sought to validate ultrasound as a reliable means of assessing vessel stenosis of vertebral artery origins. Methods: We reviewed 1,135 patient charts with ultrasound of the posterior circulation performed in 2008-2015 in a single hospital. Inclusion criteria for native vessels consisted of ultrasound and digital subtraction angiography (DSA) performed within 3 months. Patients with indwelling stents were analyzed separately from native vessels. Using DSA as the gold standard, we determined sensitivity and specificity of ultrasound in detecting occlusion at vertebral artery origin. All patients with nonoccluded native vertebral artery origins were evaluated for degree of stenosis on DSA, and compared to mean flow velocity (MFV), peak systolic velocity (PSV), and end-diastolic velocity (EDV) on ultrasound. Results: Among 218 vertebral artery origins in 139 patients evaluated, ultrasound showed sensitivity of 85.7% (95% confidence interval (CI): 69.7-95.2%) for occlusion and specificity of 99.5% (95%CI: 96.9-99.9%). Among 126 arteries without occlusion, <50% stenosis had average MFV (39 ± 19 cm/s), 50-69% stenosis had average MFV (68 ± 35 cm/s), and severe (70-99%) stenosis had average MFV (120 ± 93 cm/s) (P < .001). MFV cutoff value of 44 cm/s corresponded to 77% sensitivity and 70% specificity to detect vertebral artery origin stenosis >50% (C-statistic: .81). PSV value of 97 cm/s corresponded with 72% sensitivity and 70% specificity to detect >50% stenosis (C-statistic: .77). MFV cutoff value of 60 cm/s corresponded with 70% sensitivity and 82% specificity to predict 70-99% stenosis (C-statistic: .83). PSV cutoff value of 110 cm/s corresponded with 80% sensitivity and 72% specificity to predict 70-99% stenosis (C-statistic: .84). Conclusion: Ultrasound has good sensitivity and excellent specificity for detecting vertebral origin occlusion. Flow velocity can be used to screen for severe stenosis of vertebral artery at origin.
MeSH term(s)	Aged ; Angiography, Digital Subtraction ; Blood Flow Velocity/physiology ; Female ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity ; Ultrasonography/methods ; Vertebral Artery/diagnostic imaging ; Vertebral Artery/physiopathology ; Vertebrobasilar Insufficiency/diagnostic imaging ; Vertebrobasilar Insufficiency/physiopathology
Language	English
Publishing date	2019-11-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1071724-9
ISSN	1552-6569 ; 1051-2284
ISSN (online)	1552-6569
ISSN	1051-2284
DOI	10.1111/jon.12674
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Article ; Online: Standardized Markerless Gene Integration for Pathway Engineering in Yarrowia lipolytica.

Schwartz, Cory / Shabbir-Hussain, Murtaza / Frogue, Keith / Blenner, Mark / Wheeldon, Ian

ACS synthetic biology

2017 Volume 6, Issue 3, Page(s) 402–409

Abstract: The yeast Yarrowia lipolytica is a promising microbial host due to its native capacity to produce lipid-based chemicals. Engineering stable production strains requires genomic integration of modified genes, avoiding episomal expression that requires ... ...

Abstract	The yeast Yarrowia lipolytica is a promising microbial host due to its native capacity to produce lipid-based chemicals. Engineering stable production strains requires genomic integration of modified genes, avoiding episomal expression that requires specialized media to maintain selective pressures. Here, we develop a CRISPR-Cas9-based tool for targeted, markerless gene integration into the Y. lipolytica genome. A set of genomic loci was screened to identify sites that were accepting of gene integrations without impacting cell growth. Five sites were found to meet these criteria. Expression levels from a GFP expression cassette were consistent when inserted into AXP, XPR2, A08, and D17, with reduced expression from MFE1. The standardized tool is comprised of five pairs of plasmids (one homologous donor plasmid and a CRISPR-Cas9 expression plasmid), with each pair targeting gene integration into one of the characterized sites. To demonstrate the utility of the tool we rapidly engineered a semisynthetic lycopene biosynthesis pathway by integrating four different genes at different loci. The capability to integrate multiple genes without the need for marker recovery and into sites with known expression levels will enable more rapid and reliable pathway engineering in Y. lipolytica.
Language	English
Publishing date	2017-03-17
Publishing country	United States
Document type	Journal Article
ISSN	2161-5063
ISSN (online)	2161-5063
DOI	10.1021/acssynbio.6b00285
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