Karen Lutrick

Interests

Research

Public Health Emergency Research, Respiratory Viruses (influenza and SARS-CoV-2), Health Equity, Translational Research Education, Emergency Medicine/Critical Care Trial Methodology, Precision Health Implementation

Teaching

Health Equity, Disaster Medicine Research, Translational Research Methods

Courses

Scholarly Contributions

Chapters

• Huff, A. J., & Lutrick, K. (2023).

  Impact of COVID-19 on Drug Use and Treatment-Seeking in Females With Substance Use Disorder in Southern Arizona: An Exploratory Study in a Female-Only Outpatient Drug Treatment Program. 

  . In Real-World Solutions for Diversity, Strategic Change, and Organizational Development: Perspectives in Healthcare, Education, Business, and Technology(pp 26-41). IGI Global. doi:ttps://doi.org/10.4018/978-1-6684-8691-7.ch002

Journals/Publications

• Chan, L. Y., Morris, S. E., Stockwell, M. S., Bowman, N. M., Asturias, E., Rao, S., Lutrick, K., Ellingson, K. D., Nguyen, H. Q., Maldonado, Y., McLaren, S. H., Sano, E., Biddle, J. E., Smith-Jeffcoat, S. E., Biggerstaff, M., Rolfes, M. A., Talbot, H. K., Grijalva, C. G., Borchering, R. K., , Mellis, A. M., et al. (2025). Estimating the generation time for influenza transmission using household data in the United States. Epidemics, 50, 100815.
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  The generation time, representing the interval between infections in primary and secondary cases, is essential for understanding and predicting the transmission dynamics of seasonal influenza, including the real-time effective reproduction number (Rt). However, comprehensive generation time estimates for seasonal influenza, especially since the 2009 influenza pandemic, are lacking. We estimated the generation time utilizing data from a 7-site case-ascertained household study in the United States over two influenza seasons, 2021/2022 and 2022/2023. More than 200 individuals who tested positive for influenza and their household contacts were enrolled within 7 days of the first illness in the household. All participants were prospectively followed for 10 days, completing daily symptom diaries and collecting nasal swabs, which were then tested for influenza via RT-PCR. We analyzed these data by modifying a previously published Bayesian data augmentation approach that imputes infection times of cases to obtain both intrinsic (assuming no susceptible depletion) and realized (observed within household) generation times. We assessed the robustness of the generation time estimate by varying the incubation period, and generated estimates of the proportion of transmission occurring before symptomatic onset, the infectious period, and the latent period. We estimated a mean intrinsic generation time of 3.2 (95 % credible interval, CrI: 2.9-3.6) days, with a realized household generation time of 2.8 (95 % CrI: 2.7-3.0) days. The generation time exhibited limited sensitivity to incubation period variation. Estimates of the proportion of transmission that occurred before symptom onset, the infectious period, and the latent period were sensitive to variations in the incubation period. Our study contributes to the ongoing efforts to refine estimates of the generation time for influenza. Our estimates, derived from recent data following the COVID-19 pandemic, are consistent with previous pre-pandemic estimates, and will be incorporated into real-time Rt estimation efforts.
• Feldstein, L. R., Ruffin, J., Wiegand, R., Grant, L., Babu, T. M., Briggs-Hagen, M., Burgess, J. L., Caban-Martinez, A. J., Chu, H. Y., Ellingson, K. D., Englund, J. A., Hegmann, K. T., Jeddy, Z., Kuntz, J., Lauring, A. S., Lutrick, K., Martin, E. T., Mathenge, C., Meece, J., , Midgley, C. M., et al. (2025). Protection From COVID-19 Vaccination and Prior SARS-CoV-2 Infection Among Children Aged 6 Months-4 Years, United States, September 2022-April 2023. Journal of the Pediatric Infectious Diseases Society, 14(1).
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  To understand how coronavirus disease 2019 vaccines impact infection risk in children
• Chan, L. Y., Morris, S. E., Stockwell, M. S., Bowman, N. M., Asturias, E., Rao, S., Lutrick, K., Ellingson, K. D., Nguyen, H. Q., Maldonado, Y., McLaren, S. H., Sano, E., Biddle, J. E., Smith-Jeffcoat, S. E., Biggerstaff, M., Rolfes, M. A., Talbot, H. K., Grijalva, C. G., Borchering, R. K., , Mellis, A. M., et al. (2024). Estimating the generation time for influenza transmission using household data in the United States. medRxiv : the preprint server for health sciences.
  More info

  The generation time, representing the interval between infections in primary and secondary cases, is essential for understanding and predicting the transmission dynamics of seasonal influenza, including the real-time effective reproduction number (Rt). However, comprehensive generation time estimates for seasonal influenza, especially post the 2009 influenza pandemic, are lacking. We estimated the generation time utilizing data from a 7-site case-ascertained household study in the United States over two influenza seasons, 2021/2022 and 2022/2023. More than 200 individuals who tested positive for influenza and their household contacts were enrolled within 7 days of the first illness in the household. All participants were prospectively followed for 10 days completing daily symptom diaries and collecting nasal swabs, which were tested for influenza via RT-PCR. We analyzed these data by modifying a previously published Bayesian data augmentation approach that imputes infection times of cases to obtain both intrinsic (assuming no susceptible depletion) and realized (observed within household) generation times. We assessed the robustness of the generation time estimate by varying the incubation period, and generated estimates of the proportion of transmission before symptomatic onset, infectious period, and latent period. We estimated a mean intrinsic generation time of 3.2 (95% credible interval, CrI: 2.9-3.6) days, with a realized household generation time of 2.8 (95% CrI: 2.7-3.0) days. The generation time exhibited limited sensitivity to incubation period variation. Estimates of the proportion of transmission that occurred before symptom onset, the infectious period, and the latent period were sensitive to variation in incubation periods. Our study contributes to the ongoing efforts to refine estimates of the generation time for influenza. Our estimates, derived from recent data following the COVID-19 pandemic, are consistent with previous pre-pandemic estimates, and will be incorporated into real-time Rt estimation efforts.
• Feldstein, L. R., Britton, A., Grant, L., Wiegand, R., Ruffin, J., Babu, T. M., Briggs Hagen, M., Burgess, J. L., Caban-Martinez, A. J., Chu, H. Y., Ellingson, K. D., Englund, J. A., Hegmann, K. T., Jeddy, Z., Lauring, A. S., Lutrick, K., Martin, E. T., Mathenge, C., Meece, J., , Midgley, C. M., et al. (2024). Effectiveness of Bivalent mRNA COVID-19 Vaccines in Preventing SARS-CoV-2 Infection in Children and Adolescents Aged 5 to 17 Years. JAMA, 331(5), 408-416.
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  Bivalent mRNA COVID-19 vaccines were recommended in the US for children and adolescents aged 12 years or older on September 1, 2022, and for children aged 5 to 11 years on October 12, 2022; however, data demonstrating the effectiveness of bivalent COVID-19 vaccines are limited.
• Grant, L., Whitaker, J. A., Yoon, S. K., Lutrick, K., Bhargava, S., Brown, C. P., Zaragoza, E., Fink, R. V., Meece, J., Wielgosz, K., El Sahly, H., Hegmann, K. T., Lowe, A. A., Southworth, A., Tatum, T., Ball, S. W., Levine, M. Z., Thiese, M. S., Battan-Wraith, S., , Barnes, J., et al. (2024). Relative Effectiveness and Immunogenicity of Quadrivalent Recombinant Influenza Vaccine Versus Egg-Based Inactivated Influenza Vaccine Among Adults Aged 18-64 Years: Results and Experience From a Randomized, Double-Blind Trial. Open forum infectious diseases, 11(10), ofae559.
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  Immunogenicity studies suggest that recombinant influenza vaccine (RIV) may provide better protection against influenza than standard-dose inactivated influenza vaccines (SD IIV). This randomized trial evaluated the relative vaccine effectiveness (VE) and immunogenicity of RIV versus SD IIV in frontline workers and students aged 18-64 years.
• Hollister, J., Porter, C., Sprissler, R., Beitel, S. C., Romine, J. K., Uhrlaub, J. L., Grant, L., Yoo, Y. M., Fowlkes, A., Britton, A., Olsho, L. E., Newes-Adeyi, G., Fuller, S., Zheng, P. Q., Gaglani, M., Rose, S., Dunnigan, K., Naleway, A. L., Gwynn, L., , Caban-Martinez, A., et al. (2024). Risk reduction in SARS-CoV-2 infection and reinfection conferred by humoral antibody levels among essential workers during Omicron predominance. PloS one, 19(12), e0306953.
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  The extent to which semi-quantitative antibody levels confer protection against SARS-CoV-2 infection in populations with heterogenous immune histories is unclear. Two nested case-control studies were designed within the multisite HEROES/RECOVER prospective cohort of frontline workers to study the relationship between antibody levels and protection against first-time post-vaccination infection and reinfection with SARS-CoV-2 from December 2021 to January 2023. All participants submitted weekly nasal swabs for rRT-PCR testing and blood samples quarterly and following infection or vaccination. Cases of first-time post-vaccination infection following a third dose of monovalent (origin strain WA-1) mRNA vaccine (n = 613) and reinfection (n = 350) were 1:1 matched to controls based on timing of blood draw and other potential confounders. Conditional logistic regression models were fit to estimate infection risk reductions associated with 3-fold increases in end titers for receptor binding domain (RBD). In first-time post-vaccination and reinfection study samples, most were female (67%, 57%), non-Hispanic (82%, 68%), and without chronic conditions (65%, 65%). The odds of first-time post-vaccination infection were reduced by 21% (aOR = 0.79, 95% CI = [0.66-0.96]) for each 3-fold increase in RBD end titers. The odds of reinfection associated with a 3-fold increase in RBD end titers were reduced by 23% (aOR = 0.77, 95% CI = [0.65-0.92] for unvaccinated individuals and 58% (aOR = 0.42, 95% CI = [0.22-0.84]) for individuals with three mRNA vaccine doses following their first infection. Frontline workers with higher antibody levels following a third dose of mRNA COVID-19 vaccine were at reduced risk of SARS-CoV-2 during Omicron predominance. Among those with previous infections, the point estimates of risk reduction associated with antibody levels was greater for those with three vaccine doses compared to those who were unvaccinated.
• Mak, J., Khan, S., Britton, A., Rose, S., Gwynn, L., Ellingson, K. D., Meece, J., Feldstein, L., Tyner, H., Edwards, L., Thiese, M. S., Naleway, A., Gaglani, M., Solle, N., Burgess, J. L., Lamberte, J. M., Shea, M., Hunt-Smith, T., Caban-Martinez, A., , Porter, C., et al. (2024). Association of mRNA COVID-19 vaccination and reductions in Post-COVID Conditions following SARS-CoV-2 infection in a US prospective cohort of essential workers. The Journal of infectious diseases.
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  While there is evidence that COVID-19 vaccination protects against development of post-COVID conditions (PCC) after severe infection data are limited on whether vaccination reduces the risk after cases of less-severe non-hospitalized COVID-19 disease with more recent SARS-CoV-2 variant viruses. This study assessed whether COVID-19 vaccination was protective against subsequent development of PCC in persons with predominantly mild initial infections during both Delta and Omicron variant predominance.
• Mukherjee, V., Postelnicu, R., Parker, C., Rivers, P. S., Anesi, G. L., Andrews, A., Ables, E., Morrell, E. D., Brett-Major, D. M., Broadhurst, M. J., Cobb, J. P., Irwin, A., Kratochvil, C. J., Krolikowski, K., Kumar, V. K., Landsittel, D. P., Lee, R. A., Liebler, J. M., Segal, L. N., , Sevransky, J. E., et al. (2024). COVID-19 Across Pandemic Variant Periods: The Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study. Critical care explorations, 6(7), e1122.
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  The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has evolved through multiple phases in the United States, with significant differences in patient centered outcomes with improvements in hospital strain, medical countermeasures, and overall understanding of the disease. We describe how patient characteristics changed and care progressed over the various pandemic phases; we also emphasize the need for an ongoing clinical network to improve the understanding of known and novel respiratory viral diseases.
• Porter, C., Lyski, Z. L., Uhrlaub, J. L., Ellingson, K. D., Jeddy, Z., Gwynn, L., Rivers, P., Sprissler, R., Hegmann, K. T., Coughlin, M. M., Fowlkes, A. L., Hollister, J., LeClair, L., Mak, J., Beitel, S. C., Fuller, S., Zheng, P. Q., Vaughan, M., Rai, R. P., , Grant, L., et al. (2024). Evaluating Immunologic and Illness Outcomes of SARS-CoV-2 Infection in Vaccinated and Unvaccinated Children Aged ≥ 5 Years, in a Multisite Longitudinal Cohort. Diseases (Basel, Switzerland), 12(8).
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  Hybrid immunity, as a result of infection and vaccination to SARS-CoV-2, has been well studied in adults but limited evidence is available in children. We evaluated the antibody responses to primary SARS-CoV-2 infection among vaccinated and unvaccinated children aged ≥ 5 years.
• Rivers, P., Porter, C., LeClair, L. B., Jeddy, Z., Fowlkes, A. L., Lamberte, J. M., Herder, K., Smith, M., Rai, R., Grant, L., Hegmann, K. T., Jovel, K., Vaughan, M., Mathenge, C., Phillips, A. L., Khan, S., Britton, A., Pilishvili, T., Burgess, J. L., , Newes-Adeyi, G., et al. (2024). Longitudinal parental perception of COVID-19 vaccines for children in a multi-site, cohort study. Vaccine, 42(7), 1512-1520.
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  Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months-17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months.
• Romine, J. K., Li, H., Coughlin, M. M., Jones, J. M., Britton, A., Tyner, H. L., Fuller, S. B., Bloodworth, R., Edwards, L. J., Etolue, J. N., Morrill, T. C., Newes-Adeyi, G., Olsho, L. E., Gaglani, M., Fowlkes, A., Hollister, J., Bedrick, E. J., Uhrlaub, J. L., Beitel, S., , Sprissler, R. S., et al. (2024). Hybrid Immunity and SARS-CoV-2 Antibodies: Results of the HEROES-RECOVER Prospective Cohort Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 79(1), 96-107.
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  There are limited data on whether hybrid immunity differs by count and order of immunity-conferring events (infection with severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] or vaccination against coronavirus disease 2019 [COVID-19]). From a multi-site cohort of frontline workers, we examined the heterogeneity of the effect of hybrid immunity on SARS-CoV-2 antibody levels.
• Sans-Fuentes, M., Sierra, L. A., Cruz, N. S., Rubio, V., Lutrick, K., Hamm, K., Connick, E., Shroff, P., Billheimer, D., Sorensen, R., Dinsmore, A., Wolfersteig, W., Ayers, S., Nikolich-Zugich, J., Doubeni, C., Tilburt, J., Rosales, C., Moreno, F., Derksen, D., , Oesterle, S., et al. (2024). Temporal Changes in Vaccine-Specific Willingness Across Race/Ethnicity Following Serious Adverse Event Reports. American journal of public health, 114(S1), S37-S40.
• Smith-Jeffcoat, S. E., Mellis, A. M., Grijalva, C. G., Talbot, H. K., Schmitz, J., Lutrick, K., Ellingson, K. D., Stockwell, M. S., McLaren, S. H., Nguyen, H. Q., Rao, S., Asturias, E. J., Davis-Gardner, M. E., Suthar, M. S., Kirking, H. L., & , R. S. (2024). SARS-CoV-2 Viral Shedding and Rapid Antigen Test Performance - Respiratory Virus Transmission Network, November 2022-May 2023. MMWR. Morbidity and mortality weekly report, 73(16), 365-371.
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  As population immunity to SARS-CoV-2 evolves and new variants emerge, the role and accuracy of antigen tests remain active questions. To describe recent test performance, the detection of SARS-CoV-2 by antigen testing was compared with that by reverse transcription-polymerase chain reaction (RT-PCR) and viral culture testing during November 2022-May 2023. Participants who were enrolled in a household transmission study completed daily symptom diaries and collected two nasal swabs (tested for SARS-CoV-2 via RT-PCR, culture, and antigen tests) each day for 10 days after enrollment. Among participants with SARS-CoV-2 infection, the percentages of positive antigen, RT-PCR, and culture results were calculated each day from the onset of symptoms or, in asymptomatic persons, from the date of the first positive test result. Antigen test sensitivity was calculated using RT-PCR and viral culture as references. The peak percentage of positive antigen (59.0%) and RT-PCR (83.0%) results occurred 3 days after onset, and the peak percentage of positive culture results (52%) occurred 2 days after onset. The sensitivity of antigen tests was 47% (95% CI = 44%-50%) and 80% (95% CI = 76%-85%) using RT-PCR and culture, respectively, as references. Clinicians should be aware of the lower sensitivity of antigen testing compared with RT-PCR, which might lead to false-negative results. This finding has implications for timely initiation of SARS-CoV-2 antiviral treatment, when early diagnosis is essential; clinicians should consider RT-PCR for persons for whom antiviral treatment is recommended. Persons in the community who are at high risk for severe COVID-19 illness and eligible for antiviral treatment should seek testing from health care providers with the goal of obtaining a more sensitive diagnostic test than antigen tests (i.e., an RT-PCR test).
• White, E. B., Grant, L., Mak, J., Olsho, L., Edwards, L. J., Naleway, A., Burgess, J. L., Ellingson, K. D., Tyner, H., Gaglani, M., Lutrick, K., Caban-Martinez, A., Newes-Adeyi, G., Duque, J., Yoon, S. K., Phillips, A. L., Thompson, M., Britton, A., Flannery, B., & Fowlkes, A. (2024). Influenza Vaccine Effectiveness Against Illness and Asymptomatic Infection in 2022-2023: A Prospective Cohort Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.
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  Previous estimates of vaccine effectiveness (VE) against asymptomatic influenza virus infection based on seroconversion have varied widely and may be biased. We estimated 2022-2023 influenza VE against illness and asymptomatic infection in a prospective cohort.
• Anesi, G. L., Andrews, A., Bai, H. J., Bhatraju, P. K., Brett-Major, D. M., Broadhurst, M. J., Campbell, E. S., Cobb, J. P., Gonzalez, M., Homami, S., Hypes, C. D., Irwin, A., Kratochvil, C. J., Krolikowski, K., Kumar, V. K., Landsittel, D. P., Lee, R. A., Liebler, J. M., Lutrick, K., , Marts, L. T., et al. (2023). Perceived Hospital Stress, Severe Acute Respiratory Syndrome Coronavirus 2 Activity, and Care Process Temporal Variance During the COVID-19 Pandemic. Critical care medicine, 51(4), 445-459.
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  The COVID-19 pandemic threatened standard hospital operations. We sought to understand how this stress was perceived and manifested within individual hospitals and in relation to local viral activity.
• Ellingson, K. D., Hollister, J., Porter, C. J., Khan, S. M., Feldstein, L. R., Naleway, A. L., Gaglani, M., Caban-Martinez, A. J., Tyner, H. L., Lowe, A. A., Olsho, L. E., Meece, J., Yoon, S. K., Mak, J., Kuntz, J. L., Solle, N. S., Respet, K., Baccam, Z., Wesley, M. G., , Thiese, M. S., et al. (2023). Risk Factors for Reinfection with SARS-CoV-2 Omicron Variant among Previously Infected Frontline Workers. Emerging infectious diseases, 29(3), 599-604.
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  In a cohort of essential workers in the United States previously infected with SARS-CoV-2, risk factors for reinfection included being unvaccinated, infrequent mask use, time since first infection, and being non-Hispanic Black. Protecting workers from reinfection requires a multipronged approach including up-to-date vaccination, mask use as recommended, and reduction in underlying health disparities.
• Hollister, J., Caban-Martinez, A. J., Ellingson, K. D., Beitel, S., Fowlkes, A. L., Lutrick, K., Tyner, H. L., Naleway, A. L., Yoon, S. K., Gaglani, M., Hunt, D., Meece, J., Mayo Lamberte, J., Schaefer Solle, N., Rose, S., Dunnigan, K., Khan, S. M., Kuntz, J. L., Fisher, J. M., , Coleman, A., et al. (2023). Serum per- and polyfluoroalkyl substance concentrations and longitudinal change in post-infection and post-vaccination SARS-CoV-2 antibodies. Environmental research, 239(Pt 1), 117297.
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  Per- and polyfluoroalkyl substances (PFAS) are ubiquitous throughout the United States. Previous studies have shown PFAS exposure to be associated with a reduced immune response. However, the relationship between serum PFAS and antibody levels following SARS-CoV-2 infection or COVID-19 vaccination has not been examined. We examined differences in peak immune response and the longitudinal decline of antibodies following SARS-CoV-2 infection and COVID-19 vaccination by serum PFAS levels in a cohort of essential workers in the United States. We measured serum antibodies using an in-house semi-quantitative enzyme-linked immunosorbent assay (ELISA). Two cohorts contributed blood samples following SARS-CoV-2 infection or COVID-19 vaccination. We used linear mixed regression models, adjusting for age, race/ethnicity, gender, presence of chronic conditions, location, and occupation, to estimate differences in immune response with respect to serum PFAS levels. Our study populations included 153 unvaccinated participants that contributed 316 blood draws over a 14-month period following infection, and 860 participants and 2451 blood draws over a 12-month period following vaccination. Higher perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) concentrations were associated with a lower peak antibody response after infection (p = 0.009, 0.031, 0.015). Higher PFOS, perfluorooctanoic acid (PFOA), PFHxS, and PFNA concentrations were associated with slower declines in antibodies over time after infection (p = 0.003, 0.014, 0.026, 0.025). PFOA, PFOS, PFHxS, and PFNA serum concentrations prior to vaccination were not associated with differences in peak antibody response after vaccination or with differences in decline of antibodies over time after vaccination. These results suggest that elevated PFAS may impede potential immune response to SARS-CoV-2 infection by blunting peak antibody levels following infection; the same finding was not observed for immune response to vaccination.
• Horwitz, L. I., Thaweethai, T., Brosnahan, S. B., Cicek, M. S., Fitzgerald, M. L., Goldman, J. D., Hess, R., Hodder, S. L., Jacoby, V. L., Jordan, M. R., Krishnan, J. A., Laiyemo, A. O., Metz, T. D., Nichols, L., Patzer, R. E., Sekar, A., Singer, N. G., Stiles, L. E., Taylor, B. S., , Ahmed, S., et al. (2023). Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design. PloS one, 18(6), e0286297.
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  SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis.
• Lyski, Z. L., Porter, C., Uhrlaub, J. L., Ellingson, K. D., Jeddy, Z., Gwynn, L., Rivers, P., Sprissler, R., Hegmann, K. T., Coughlin, M., Fowlkes, A., Hollister, J., LeClair, L., Mak, J., Beitel, S. C., Fuller, S., Grant, L., Newes-Adeyi, G., Yoo, Y. M., , Olsho, L., et al. (2023). Humoral Immune Response to Messenger RNA Coronavirus Disease 2019 Vaccination Among Children Aged 5-11 Years in a Multisite Prospective Cohort Study, September 2021-September 2022. Open forum infectious diseases, 10(8), ofad431.
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  The PROTECT study is a longitudinal cohort study initiated in July 2021 with weekly testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 4 states: Arizona, Florida, exas, and Utah. This study aims to examine vaccine-elicited antibody response against postvaccination SARS-CoV-2 infections.
• Quirk, G. E., Schoenle, M. V., Peyton, K. L., Uhrlaub, J. L., Lau, B., Burgess, J. L., Ellingson, K., Beitel, S., Romine, J., Lutrick, K., Fowlkes, A., Britton, A., Tyner, H. L., Caban-Martinez, A. J., Naleway, A., Gaglani, M., Yoon, S., Edwards, L., Olsho, L., , Dake, M., et al. (2023). Determinants of B cell responses to drifted epitopes in post-vaccination SARS-CoV-2 infections. medRxiv : the preprint server for health sciences.
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  Vaccine-induced immunity may impact subsequent responses to drifted epitopes in SARS-CoV-2 variants, but this has been difficult to quantify due to the challenges in recruiting unvaccinated control groups whose first exposure to SARS-CoV-2 is a primary infection. Through local, statewide, and national SARS-CoV-2 testing programs, we were able to recruit cohorts of individuals who had recovered from either primary or post-vaccination infections by either the Delta or Omicron BA.1 variants. Regardless of variant, we observed greater Spike-specific and neutralizing antibody responses in post-vaccination infections than in those who were infected without prior vaccination. Through analysis of variant-specific memory B cells as markers of responses, we observed that Delta and Omicron BA.1 infections led to a marked shift in immunodominance in which some drifted epitopes elicited minimal responses, even in primary infections. Prior immunity through vaccination had a small negative impact on these responses, but this did not correlate with cross-reactive memory B cells, arguing against competitive inhibition of naïve B cells. We conclude that dampened B cell responses against drifted epitopes are mostly a function of altered immunodominance hierarchies that are apparent even in primary infections, with a more modest contribution from pre-existing immunity, perhaps due to accelerated antigen clearance.
• Rivers, P., Jovel, K., Ramadan, F., Barnett, J. J., Ellingson, K. D., Burgess, J. L., & Lutrick, K. (2023). Disease and social factors associated with healthcare utilization for the treatment of SARS-CoV-2 infections in a longitudinal cohort of essential workers in Arizona. BMC health services research, 23(1), 1118.
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  Demands on health systems due to COVID-19 are substantial, but drivers of healthcare utilization are not well defined in non-severe SARS-CoV-2 infections. Among a prospective cohort of frontline workers from July 2020 to February 2023, we assessed predictors of healthcare utilization during SARS-CoV-2 infection.
• Rolfes, M. A., Talbot, H. K., McLean, H. Q., Stockwell, M. S., Ellingson, K. D., Lutrick, K., Bowman, N. M., Bendall, E. E., Bullock, A., Chappell, J. D., Deyoe, J. E., Gilbert, J., Halasa, N. B., Hart, K. E., Johnson, S., Kim, A., Lauring, A. S., Lin, J. T., Lindsell, C. J., , McLaren, S. H., et al. (2023). Household Transmission of Influenza A Viruses in 2021-2022. JAMA, 329(6), 482-489.
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  Influenza virus infections declined globally during the COVID-19 pandemic. Loss of natural immunity from lower rates of influenza infection and documented antigenic changes in circulating viruses may have resulted in increased susceptibility to influenza virus infection during the 2021-2022 influenza season.
• Smith-Jeffcoat, S. E., Biddle, J. E., Talbot, H. K., Morrisey, K. G., Stockwell, M. S., Maldonado, Y., McLean, H. Q., Ellingson, K. D., Bowman, N. M., Asturias, E., Mellis, A. M., Johnson, S., Kirking, H. L., Rolfes, M. A., Olivo, V., Merrill, L., Battan-Wraith, S., Sano, E., McLaren, S. H., , Vargas, C. Y., et al. (2023). Symptoms, viral loads, and rebound among COVID-19 outpatients treated with nirmatrelvir/ritonavir compared to propensity score matched untreated individuals. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.
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  Nirmatrelvir/ritonavir (N/R) reduces severe outcomes among patients with COVID-19; however, rebound after treatment has been reported. We compared symptom and viral dynamics in community-based individuals with COVID-19 who completed N/R and similar untreated individuals.
• Thaweethai, T., Jolley, S. E., Karlson, E. W., Levitan, E. B., Levy, B., McComsey, G. A., McCorkell, L., Nadkarni, G. N., Parthasarathy, S., Singh, U., Walker, T. A., Selvaggi, C. A., Shinnick, D. J., Schulte, C. C., Atchley-Challenner, R., Alba, G. A., Alicic, R., Altman, N., Anglin, K., , Argueta, U., et al. (2023). Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA, 329(22), 1934-1946.
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  SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.
• , H. N., Thompson, M. G., Yoon, S. K., Naleway, A. L., Meece, J., Fabrizio, T. P., Caban-Martinez, A. J., Burgess, J. L., Gaglani, M., Olsho, L. E., Bateman, A., Lundgren, J., Grant, L., Phillips, A. L., Groom, H. C., Stefanski, E., Solle, N. S., Ellingson, K., Lutrick, K., , Dunnigan, K., et al. (2022). Association of mRNA Vaccination With Clinical and Virologic Features of COVID-19 Among US Essential and Frontline Workers. JAMA, 328(15), 1523-1533.
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  Data on the epidemiology of mild to moderately severe COVID-19 are needed to inform public health guidance.
• Brown, J., Bhatnagar, M., Gordon, H., Goodner, J., Cobb, J. P., & Lutrick, K. (2022). An Electronic Data Capture Tool for Data Collection During Public Health Emergencies: Development and Usability Study. JMIR human factors, 9(2), e35032.
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  The Discovery Critical Care Research Network Program for Resilience and Emergency Preparedness (Discovery PREP) partnered with a third-party technology vendor to design and implement an electronic data capture tool that addressed multisite data collection challenges during public health emergencies (PHE) in the United States. The basis of the work was to design an electronic data capture tool and to prospectively gather data on usability from bedside clinicians during national health system stress queries and influenza observational studies.
• Burns, J., Rivers, P., LeClair, L. B., Jovel, K. S., Rai, R. P., Lowe, A. A., Edwards, L. J., Khan, S. M., Mathenge, C., Ferraris, M., Kuntz, J. L., Lamberte, J. M., Hegmann, K. T., Odean, M. J., McLeland-Wieser, H., Beitel, S., Odame-Bamfo, L., Schaefer Solle, N., Mak, J., , Phillips, A. L., et al. (2022). Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT): Protocol for a Multisite Longitudinal Cohort Study. JMIR research protocols, 11(7), e37929.
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  Assessing the real-world effectiveness of COVID-19 vaccines and understanding the incidence and severity of SARS-CoV-2 illness in children are essential to inform policy and guide health care professionals in advising parents and caregivers of children who test positive for SARS-CoV-2.
• Fowlkes, A. L., Yoon, S. K., Lutrick, K., Gwynn, L., Burns, J., Grant, L., Phillips, A. L., Ellingson, K., Ferraris, M. V., LeClair, L. B., Mathenge, C., Yoo, Y. M., Thiese, M. S., Gerald, L. B., Solle, N. S., Jeddy, Z., Odame-Bamfo, L., Mak, J., Hegmann, K. T., , Gerald, J. K., et al. (2022). Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine in Preventing SARS-CoV-2 Infection Among Children Aged 5-11 Years and Adolescents Aged 12-15 Years - PROTECT Cohort, July 2021-February 2022. MMWR. Morbidity and mortality weekly report, 71(11), 422-428.
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  The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine was recommended by CDC's Advisory Committee on Immunization Practices for persons aged 12-15 years (referred to as adolescents in this report) on May 12, 2021, and for children aged 5-11 years on November 2, 2021 (1-4). Real-world data on vaccine effectiveness (VE) in these age groups are needed, especially because when the B.1.1.529 (Omicron) variant became predominant in the United States in December 2021, early investigations of VE demonstrated a decline in protection against symptomatic infection for adolescents aged 12-15 years and adults* (5). The PROTECT prospective cohort of 1,364 children and adolescents aged 5-15 years was tested weekly for SARS-CoV-2, irrespective of symptoms, and upon COVID-19-associated illness during July 25, 2021-February 12, 2022. Among unvaccinated participants (i.e., those who had received no COVID-19 vaccine doses) with any laboratory-confirmed SARS-CoV-2 infection, those with B.1.617.2 (Delta) variant infections were more likely to report COVID-19 symptoms (66%) than were those with Omicron infections (49%). Among fully vaccinated children aged 5-11 years, VE against any symptomatic and asymptomatic Omicron infection 14-82 days (the longest interval after dose 2 in this age group) after receipt of dose 2 of the Pfizer-BioNTech vaccine was 31% (95% CI = 9%-48%), adjusted for sociodemographic characteristics, health information, frequency of social contact, mask use, location, and local virus circulation. Among adolescents aged 12-15 years, adjusted VE 14-149 days after dose 2 was 87% (95% CI = 49%-97%) against symptomatic and asymptomatic Delta infection and 59% (95% CI = 22%-79%) against Omicron infection. Fully vaccinated participants with Omicron infection spent an average of one half day less sick in bed than did unvaccinated participants with Omicron infection. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.
• Herring, M. K., Romine, J. K., Wesley, M. G., Ellingson, K. D., Yoon, S. K., Caban-Martinez, A. J., Meece, J., Gaglani, M., Grant, L., Olsho, L. E., Tyner, H. L., Naleway, A. L., Khan, S. M., Phillips, A. L., Schaefer Solle, N., Rose, S., Mak, J., Fuller, S. B., Hunt, A., , Kuntz, J. L., et al. (2022). SARS-CoV-2 infection history and antibody response to three COVID-19 mRNA vaccine doses. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.
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  Three doses of coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines produce robust antibody responses, but data are limited among individuals previously infected with SARS-CoV-2. From a cohort of health care personnel (75.5%), first responders (4.6%), and other frontline workers (19.8%) in 6 US states, we longitudinally assessed antibody waning after dose-2, and response to dose-3, according to SARS-CoV-2 infection history.
• Jergović, M., Coplen, C. P., Uhrlaub, J. L., Beitel, S. C., Burgess, J. L., Lutrick, K., Ellingson, K. D., Watanabe, M., & Nikolich-Žugich, J. (2022). Cutting Edge: T Cell Responses to B.1.1.529 (Omicron) SARS-CoV-2 Variant Induced by COVID-19 Infection and/or mRNA Vaccination Are Largely Preserved. Journal of immunology (Baltimore, Md. : 1950), 208(11), 2461-2465.
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  Several studies have demonstrated that the SARS-CoV-2 variant-of-concern B.1.1.529 (Omicron) exhibits a high degree of escape from Ab neutralization. Therefore, it is critical to determine how well the second line of adaptive immunity, T cell memory, performs against Omicron. To this purpose, we analyzed a human cohort ( = 327 subjects) of two- or three-dose mRNA vaccine recipients and COVID-19 postinfection subjects. We report that T cell responses against Omicron were largely preserved. IFN-γ-producing T cell responses remained equivalent to the response against the ancestral strain (WA1/2020), with some (∼20%) loss in IL-2 single or IL-2IFN-γ polyfunctional responses. Three-dose vaccinated participants had similar responses to Omicron relative to post-COVID-19 participants and exhibited responses significantly higher than those receiving two mRNA vaccine doses. These results provide further evidence that a three-dose vaccine regimen benefits the induction of optimal functional T cell immune memory.
• Lane, C. J., Bhatnagar, M., Lutrick, K., Maves, R. C., Weiner, D., Rios Olvera, D., Uyeki, T. M., Cobb, J. P., & Brown, J. C. (2022). ICU Resource Limitations During Peak Seasonal Influenza: Results of a 2018 National Feasibility Study. Critical care explorations, 4(1), e0606.
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  Demonstrate the feasibility of weekly data collection and analysis of public health emergency (PHE) data. Assess fluctuations in, and challenges of, resource matching and potential effect on patient care for influenza in ICUs.
• Lutrick, K., Fowlkes, A., Rivers, P., Herder, K., Santibanez, T. A., LeClair, L., Groover, K., Lamberte, J. M., Grant, L., Odame-Bamfo, L., Ferraris, M. V., Phillips, A. L., Sokol, B., Lowe, A. A., Mathenge, C., Pubillones, F. A., Cottam, B., McLeland-Wieser, H., Jovel, K. S., , Ochoa, J. S., et al. (2022). Parental Intentions and Perceptions Toward COVID-19 Vaccination Among Children Aged 4 Months to 4 Years - PROTECT Cohort, Four States, July 2021-May 2022. MMWR. Morbidity and mortality weekly report, 71(35), 1109-1114.
• Lutrick, K., Groom, H., Fowlkes, A. L., Groover, K. D., Gaglani, M., Rivers, P., Naleway, A. L., Nguyen, K., Herring, M., Dunnigan, K., Phillips, A., Parker, J., Mayo Lamberte, J., Prather, K., Thiese, M. S., Baccam, Z., Tyner, H., & Yoon, S. (2022). COVID-19 vaccine perceptions and uptake in a national prospective cohort of essential workers. Vaccine, 40(3), 494-502.
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  In a multi-center prospective cohort of essential workers, we assessed knowledge, attitudes, and practices (KAP) by vaccine intention, prior SARS-CoV-2 positivity, and occupation, and their impact on vaccine uptake over time.
• Naleway, A. L., Grant, L., Caban-Martinez, A. J., Wesley, M. G., Burgess, J. L., Groover, K., Gaglani, M., Yoon, S. K., Tyner, H. L., Meece, J., Kuntz, J. L., Yoo, Y. M., Schaefer-Solle, N., Olsho, L. E., Gerald, J. K., Rose, S., Thiese, M. S., Lundgren, J., Groom, H. C., , Mak, J., et al. (2022). Incidence of SARS-CoV-2 infection among COVID-19 vaccinated and unvaccinated healthcare personnel, first responders, and other essential and frontline workers: Eight US locations, January-September 2021. Influenza and other respiratory viruses, 16(3), 585-593.
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  We sought to evaluate the impact of changes in estimates of COVID-19 vaccine effectiveness on the incidence of laboratory-confirmed infection among frontline workers at high risk for SARS-CoV-2.
• Postelnicu, R., Srivastava, A., Bhatraju, P. K., Wurfelc, M. M., Anesi, G. L., Gonzalez, M., Andrews, A., Lutrick, K., Kumar, V. K., Uyeki, T. M., Cobb, P. J., Segal, L. N., Brett-Major, D., Liebler, J. M., Kratochvil, C. J., Mukherjee, V., Broadhurst, M. J., Lee, R., Wyles, D., , Sevransky, J. E., et al. (2022). Severe Acute Respiratory Infection-Preparedness: Protocol for a Multicenter Prospective Cohort Study of Viral Respiratory Infections. Critical care explorations, 4(10), e0773.
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  Respiratory virus infections cause significant morbidity and mortality ranging from mild uncomplicated acute respiratory illness to severe complications, such as acute respiratory distress syndrome, multiple organ failure, and death during epidemics and pandemics. We present a protocol to systematically study patients with severe acute respiratory infection (SARI), including severe acute respiratory syndrome coronavirus 2, due to respiratory viral pathogens to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with clinical outcomes and severity.
• Yoon, S. K., Hegmann, K. T., Thiese, M. S., Burgess, J. L., Ellingson, K., Lutrick, K., Olsho, L. E., Edwards, L. J., Sokol, B., Caban-Martinez, A. J., Schaefer-Solle, N., Jones, J. M., Tyner, H., Hunt, A., Respet, K., Gaglani, M., Dunnigan, K., Rose, S., Naleway, A., , Groom, H., et al. (2022). Protection with a Third Dose of mRNA Vaccine against SARS-CoV-2 Variants in Frontline Workers. The New England journal of medicine, 386(19), 1855-1857.
• Yoon, S. K., Yoo, Y. M., Tyner, H. L., Thompson, M. G., Thiese, M. S., Solle, N. S., Sokol, B. E., Rose, S., Rivers, P., Rai, R. P., Pubillones, F. A., Poe, B., Phillips, A. L., Olsho, L. E., Odame-bamfo, L., Ochoa, J. S., Naleway, A. L., Mcleland-wieser, H., Mathenge, C., , Mak, J., et al. (2022). Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine in Preventing SARS-CoV-2 Infection Among Children Aged 5-11 Years and Adolescents Aged 12-15 Years - PROTECT Cohort, July 2021-February 2022.. MMWR. Morbidity and mortality weekly report, 71(11), 422-428. doi:10.15585/mmwr.mm7111e1
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  The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine was recommended by CDC's Advisory Committee on Immunization Practices for persons aged 12-15 years (referred to as adolescents in this report) on May 12, 2021, and for children aged 5-11 years on November 2, 2021 (1-4). Real-world data on vaccine effectiveness (VE) in these age groups are needed, especially because when the B.1.1.529 (Omicron) variant became predominant in the United States in December 2021, early investigations of VE demonstrated a decline in protection against symptomatic infection for adolescents aged 12-15 years and adults* (5). The PROTECT† prospective cohort of 1,364 children and adolescents aged 5-15 years was tested weekly for SARS-CoV-2, irrespective of symptoms, and upon COVID-19-associated illness during July 25, 2021-February 12, 2022. Among unvaccinated participants (i.e., those who had received no COVID-19 vaccine doses) with any laboratory-confirmed SARS-CoV-2 infection, those with B.1.617.2 (Delta) variant infections were more likely to report COVID-19 symptoms (66%) than were those with Omicron infections (49%). Among fully vaccinated children aged 5-11 years, VE against any symptomatic and asymptomatic Omicron infection 14-82 days (the longest interval after dose 2 in this age group) after receipt of dose 2 of the Pfizer-BioNTech vaccine was 31% (95% CI = 9%-48%), adjusted for sociodemographic characteristics, health information, frequency of social contact, mask use, location, and local virus circulation. Among adolescents aged 12-15 years, adjusted VE 14-149 days after dose 2 was 87% (95% CI = 49%-97%) against symptomatic and asymptomatic Delta infection and 59% (95% CI = 22%-79%) against Omicron infection. Fully vaccinated participants with Omicron infection spent an average of one half day less sick in bed than did unvaccinated participants with Omicron infection. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.
• Brown, J., Bhatnagar, M., Gordon, H., Lutrick, K., Goodner, J., Blum, J., Bartz, R., Uslan, D., David-DiMarino, E., Sorbello, A., Jackson, G., Walsh, J., Neal, L., Cyran, M., Francis, H., & Cobb, J. P. (2021). Clinical Data Extraction During Public Health Emergencies: A Blockchain Technology Assessment. Biomedical instrumentation & technology, 55(3), 103-111.
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  We sought to explore the technical and legal readiness of healthcare institutions for novel data-sharing methods that allow clinical information to be extracted from electronic health records (EHRs) and submitted securely to the Food and Drug Administration's (FDA's) blockchain through a secure data broker (SDB).
• Cairns, C. B., Lutrick, K., Campbell, E. S., Bedrick, E. J., Hypes, C., Fisher, J. M., & Mosier, J. M. (2021). A Target for Increased Mortality Risk in Critically Ill Patients: The Concept of Perpetuity. Journal of Clinical Medicine.
• Ellingson, K. D., Gerald, J. K., Sun, X., Hollister, J., Lutrick, K., Parker, J., Rivers, P., Beitel, S. C., Baccam, Z., Lamberte, J. M., Grant, L., Kim, E., Bhattarai, R., Komatsu, K., Meece, J., Kutty, P. K., Thompson, M. G., & Burgess, J. L. (2021). Incidence of SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential Workers During a Prevaccination COVID-19 Surge in Arizona. JAMA health forum, 2(10), e213318.
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  Understanding the relative risk of SARS-CoV-2 infection across occupations can inform guidance to protect workers and communities. Less is known about infection risk for first responders and other essential workers than for health care personnel.
• Lutrick, K., Rivers, P., Yoo, Y. M., Grant, L., Hollister, J., Jovel, K., Khan, S., Lowe, A., Baccam, Z., Hanson, H., Olsho, L. E., Fowlkes, A., Caban-Martinez, A. J., Porter, C., Yoon, S., Meece, J., Gaglani, M., Burns, J., Mayo Lamberte, J., , Nakayima Miiro, F., et al. (2021). Interim Estimate of Vaccine Effectiveness of BNT162b2 (Pfizer-BioNTech) Vaccine in Preventing SARS-CoV-2 Infection Among Adolescents Aged 12-17 Years - Arizona, July-December 2021. MMWR. Morbidity and mortality weekly report, 70(5152), 1761-1765.
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  The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine has demonstrated high efficacy in preventing infection with SARS-CoV-2 (the virus that causes COVID-19) in randomized placebo-controlled Phase III trials in persons aged 12-17 years (referred to as adolescents in this report) (1); however, data on real-word vaccine effectiveness (VE) among adolescents are limited (1-3). As of December 2021, the Pfizer-BioNTech vaccine is approved by the Food and Drug Administration (FDA) for adolescents aged 16-17 years and under FDA emergency use authorization for those aged 12-15 years. In a prospective cohort in Arizona, 243 adolescents aged 12-17 years were tested for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR) each week, irrespective of symptoms, and upon onset of COVID-19-like illness during July 25-December 4, 2021; the SARS-CoV-2 B.1.617.2 (Delta) variant was the predominant strain during this study period. During the study, 190 adolescents contributed fully vaccinated person-time (≥14 days after receiving 2 doses of Pfizer-BioNTech vaccine), 30 contributed partially vaccinated person-time (receipt of 1 dose or receipt of 2 doses but with the second dose completed
• Mosier, J. M., Fisher, J. M., Hypes, C. D., Bedrick, E. J., Campbell, E. S., Lutrick, K., & Cairns, C. B. (2021). A Target for Increased Mortality Risk in Critically Ill Patients: The Concept of Perpetuity. Journal of clinical medicine, 10(17).
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  Emergency medicine is acuity-based and focuses on time-sensitive treatments for life-threatening diseases. Prolonged time in the emergency department, however, is associated with higher mortality in critically ill patients. Thus, we explored management after an acuity-based intervention, which we call perpetuity, as a potential mechanism for increased risk. To explore this concept, we evaluated the impact of each hour above a lung-protective tidal volume on risk of mortality.
• Pogreba-brown, K., Lutrick, K., Harris, R. B., Farland, L. V., Cordova-marks, F. M., Shilen, A., Pogreba-brown, K., Lutrick, K., Kohler, L. N., Klimentidis, Y. C., Khan, S. M., Jehn, M., Jacobs, E. T., Hunsaker, J. R., Hoskinson, J., Heslin, K. M., Harris, R. B., Garcia-filion, P., Farland, L. V., , Ernst, K. C., et al. (2021). Design of the Arizona CoVHORT: A Population-Based COVID-19 Cohort.. Frontiers in public health, 9, 620060. doi:10.3389/fpubh.2021.620060
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  This study is a prospective, population-based cohort of individuals with a history of SARS-CoV-2 infection and those without past infection through multiple recruitment sources. The main study goal is to track health status over time, within the diverse populations of Arizona and to identify the long-term consequences of COVID-19 on health and well-being. A total of 2,881 study participants (16.2% with a confirmed SARS-CoV-2 infection) have been enrolled as of December 22, 2020, with a target enrollment of 10,000 participants and a planned follow-up of at least 2 years. This manuscript describes a scalable study design that utilizes a wide range of recruitment sources, leveraging electronic data collection to capture and link longitudinal participant data on the current and emerging issues associated with the COVID-19 pandemic. The cohort is built within a collaborative infrastructure that includes new and established partnerships with multiple stakeholders, including the state's public universities, local health departments, tribes, and tribal organizations. Challenges remain for ensuring recruitment of diverse participants and participant retention, although the electronic data management system and timing of participant contact can help to mitigate these problems.
• Snider, J. M., You, J. K., Wang, X., Snider, A. J., Hallmark, B., Zec, M. M., Seeds, M. C., Sergeant, S., Johnstone, L., Wang, Q., Sprissler, R., Carr, T. F., Lutrick, K., Parthasarathy, S., Bime, C., Zhang, H. H., Luberto, C., Kew, R. R., Hannun, Y. A., , Guerra, S., et al. (2021). Group IIA secreted phospholipase A2 is associated with the pathobiology leading to COVID-19 mortality. The Journal of clinical investigation, 131(19).
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  There is an urgent need to identify the cellular and molecular mechanisms responsible for severe COVID-19 that results in death. We initially performed both untargeted and targeted lipidomics as well as focused biochemical analyses of 127 plasma samples and found elevated metabolites associated with secreted phospholipase A2 (sPLA2) activity and mitochondrial dysfunction in patients with severe COVID-19. Deceased COVID-19 patients had higher levels of circulating, catalytically active sPLA2 group IIA (sPLA2-IIA), with a median value that was 9.6-fold higher than that for patients with mild disease and 5.0-fold higher than the median value for survivors of severe COVID-19. Elevated sPLA2-IIA levels paralleled several indices of COVID-19 disease severity (e.g., kidney dysfunction, hypoxia, multiple organ dysfunction). A decision tree generated by machine learning identified sPLA2-IIA levels as a central node in the stratification of patients who died from COVID-19. Random forest analysis and least absolute shrinkage and selection operator-based (LASSO-based) regression analysis additionally identified sPLA2-IIA and blood urea nitrogen (BUN) as the key variables among 80 clinical indices in predicting COVID-19 mortality. The combined PLA-BUN index performed significantly better than did either one alone. An independent cohort (n = 154) confirmed higher plasma sPLA2-IIA levels in deceased patients compared with levels in plasma from patients with severe or mild COVID-19, with the PLA-BUN index-based decision tree satisfactorily stratifying patients with mild, severe, or fatal COVID-19. With clinically tested inhibitors available, this study identifies sPLA2-IIA as a therapeutic target to reduce COVID-19 mortality.
• Thompson, M. G., Burgess, J. L., Naleway, A. L., Tyner, H., Yoon, S. K., Meece, J., Olsho, L. E., Caban-Martinez, A. J., Fowlkes, A. L., Lutrick, K., Groom, H. C., Dunnigan, K., Odean, M. J., Hegmann, K., Stefanski, E., Edwards, L. J., Schaefer-Solle, N., Grant, L., Ellingson, K., , Kuntz, J. L., et al. (2021). Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines. The New England journal of medicine, 385(4), 320-329.
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  Information is limited regarding the effectiveness of the two-dose messenger RNA (mRNA) vaccines BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) in preventing infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in attenuating coronavirus disease 2019 (Covid-19) when administered in real-world conditions.
• Tyner, H. L., Burgess, J. L., Grant, L., Gaglani, M., Kuntz, J. L., Naleway, A. L., Thornburg, N. J., Caban-Martinez, A. J., Yoon, S. K., Herring, M. K., Beitel, S. C., Blanton, L., Nikolich-Zugich, J., Thiese, M. S., Pleasants, J. F., Fowlkes, A. L., Lutrick, K., Dunnigan, K., Yoo, Y. M., , Rose, S., et al. (2021). Neutralizing Antibody Response to Pseudotype SARS-CoV-2 Differs between mRNA-1273 and BNT162b2 COVID-19 Vaccines and by History of SARS-CoV-2 Infection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.
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  Data on the development of neutralizing antibodies against SARS-CoV-2 after SARS-CoV-2 infection and after vaccination with messenger RNA (mRNA) COVID-19 vaccines are limited.
• Yoo, Y. M., Yoo, Y. M., Thornburg, N. J., Thornburg, N. J., Thompson, M. G., Thompson, M. G., Sun, X., Sun, X., Rivers, P., Rivers, P., Parker, J., Parker, J., Nikolich-zugich, J., Nikolich-zugich, J., Meece, J. K., Meece, J. K., Lutrick, K., Lutrick, K., Lamberte, J. M., , Lamberte, J. M., et al. (2021). COVID-19 Infection, Reinfection, and Vaccine Effectiveness in a Prospective Cohort of Arizona Frontline/Essential Workers: The AZ HEROES Research Protocol.. JMIR research protocols. doi:10.2196/28925
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  The Arizona Healthcare, Emergency Response, and Other Essential workers Study (AZ HEROES) aims to examine the epidemiology of SARS-CoV-2 infection and COVID-19 illness among adults with high occupational exposure risk..Study objectives include estimating incidence of SARS-CoV-2 infection in essential workers by symptom presentation and demographic factors, determining independent effects of occupational and community exposures on incidence of SARS-CoV-2 infection, establishing molecular and immunologic characteristics of SARS-CoV-2 infection in essential workers, describing the duration and patterns of rRT-PCR-positivity, and examining post-vaccine immunologic response..Eligible participants include Arizona residents aged 18-85 years who work at least 20 hours per week in an occupation involving regular direct contact (within three feet) with others. Recruitment goals are stratified by demographic characteristics (50% aged 40 or older, 50% women, and 50% Hispanic or American Indian), by occupation (40% healthcare personnel, 30% first responders, and 30% other essential workers), and by prior SARS-CoV-2 infection (with up to 50% seropositive at baseline). Information on sociodemographics, health and medical history, vaccination status, exposures to individuals with suspected or confirmed SARS-CoV-2 infection, use of personal protective equipment, and perceived risks are collected at enrollment and updated through quarterly surveys. Every week, participants complete active surveillance for COVID-19-like illness (CLI) and self-collect nasal swabs. Additional self-collected nasal swab and saliva specimens are collected in the event of CLI onset. Respiratory specimens are sent to Marshfield Laboratories and tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (rRT-PCR) assay. CLI symptoms and impact on work and productivity are followed through illness resolution. Serum specimens are collected every 3 months and additional sera are collected following incident rRT-PCR positivity and after each COVID-19 vaccine dose. Incidence of SARS-CoV-2 infections will be calculated by person-weeks at risk and compared by occupation and demographic characteristics and by seropositivity status and infection and vaccination history..The AZ HEROES study was funded by the Centers for Disease Control and Prevention. Enrollment began July 27, 2020 and as of May 1, 2021 a total of 3,165 participants have been enrolled in the study..AZ HEROES is unique in aiming to recruit a diverse sample of essential workers and prospectively following strata of SARS-CoV-2 seronegative and seropositive adults. Survey results combined with active surveillance data on exposure, CLI, weekly molecular diagnostic testing, and periodic serology will be used to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, assess the intensity and durability of immune responses to natural infection and COVID-19 vaccination, and contribute to the evaluation of COVID-19 vaccine effectiveness..DERR1-10.2196/28925.
• Zunie, T., Yoon, S. K., Yoo, Y. M., Wesley, M. G., Tyner, H. L., Thompson, M. G., Thiese, M. S., Sun, X., Stefanski, E. L., Smith, M. E., Schaefer-solle, N., Rivers, P., Phillips, A. L., Olsho, L. E., Odean, M. J., Naleway, A. L., Morrill, T. C., Meece, J. K., Mak, J., , Lutrick, K., et al. (2021). Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021.. MMWR. Morbidity and mortality weekly report, 70(13), 495-500. doi:10.15585/mmwr.mm7013e3
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  Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine.† Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days.§ In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.
• Chen, J. T., Roberts, R., Fazzari, M. J., Kashani, K., Qadir, N., Cairns, C. B., Mathews, K., Park, P., Khan, A., Gilmore, J. F., Brown, A. R., Tsuei, B., Handzel, M., Lee Chang, A., Duggal, A., Lanspa, M., Herbert, J. T., Martinez, A., Tonna, J., , Ammar, M. A., et al. (2020). Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study. Critical care medicine, 48(10), 1436-1444.
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  To characterize the association between the use of physiologic assessment (central venous pressure, pulmonary artery occlusion pressure, stroke volume variation, pulse pressure variation, passive leg raise test, and critical care ultrasound) with fluid and vasopressor administration 24 hours after shock onset and with in-hospital mortality.
• Lutrick, K., Clark, R., Nuño, V. L., Bauman, S., & Carvajal, S. (2020). Latinx bullying and depression in children and youth: a systematic review. Systematic reviews, 9(1), 126.
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  Bullying is associated with negative health outcomes such as depression. Most studies target non-Latinxs, though they often experience higher rates of bullying and depression. This review examines the inclusion of Latinxs in studies of bullying and depression and factors unique to them.
• Lutrick, K., Lane, C., Bhatnagar, M., Rios, D., Cobb, J. P., Weiner, D. L., Uyeki, T. M., & Maves, R. C. (2020). 621: DATA COLLECTION DURING PUBLIC HEALTH EMERGENCIES: LESSONS LEARNED OVER THREE INFLUENZA SEASONS. Critical Care Medicine, 48(1), 291-291. doi:10.1097/01.ccm.0000626224.76138.93
• Roberts, R. J., Miano, T. A., Hammond, D. A., Patel, G. P., Chen, J. T., Phillips, K. M., Lopez, N., Kashani, K., Qadir, N., Cairns, C. B., Mathews, K., Park, P., Khan, A., Gilmore, J. F., Brown, A. R., Tsuei, B., Handzel, M., Chang, A. L., Duggal, A., , Lanspa, M., et al. (2020). Evaluation of Vasopressor Exposure and Mortality in Patients With Septic Shock. Critical care medicine, 48(10), 1445-1453.
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  The objectives of this study were to: 1) determine the association between vasopressor dosing intensity during the first 6 hours and first 24 hours after the onset of septic shock and 30-day in-hospital mortality; 2) determine whether the effect of vasopressor dosing intensity varies by fluid resuscitation volume; and 3) determine whether the effect of vasopressor dosing intensity varies by dosing titration pattern.
• Cobb, J. P. (2019). Clinical Investigation During Public Health Emergencies: The Resilience Intelligence Network. American journal of public health, 109(S4), S268-S270.
• Johnston, K. C., Bruno, A., Pauls, Q., Hall, C. E., Barrett, K. M., Barsan, W., Fansler, A., Van de Bruinhorst, K., Janis, S., Durkalski-Mauldin, V. L., & , N. E. (2019). Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke: The SHINE Randomized Clinical Trial. JAMA, 322(4), 326-335.
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  Hyperglycemia during acute ischemic stroke is common and is associated with worse outcomes. The efficacy of intensive treatment of hyperglycemia in this setting remains unknown.
• Mosier, J. M., Stolz, U., Milligan, R., Roy-Chaudhury, A., Lutrick, K., Hypes, C. D., Billheimer, D., & Cairns, C. B. (2019). Impact of Point-of-Care Ultrasound in the Emergency Department on Care Processes and Outcomes in Critically Ill Nontraumatic Patients. Critical Care Explorations, 1(6).
• Mosier, J. M., Stolz, U., Milligan, R., Roy-Chaudhury, A., Lutrick, K., Hypes, C. D., Billheimer, D., & Cairns, C. B. (2019). Impact of Point-of-Care Ultrasound in the Emergency Department on Care Processes and Outcomes in Critically Ill Nontraumatic Patients. Critical care explorations, 1(6), e0019.
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  Outcomes data on point-of-care ultrasound (POCUS) in critically ill patients are lacking. This study examines the association between POCUS in the emergency department and outcomes in critically ill patients.
• Johnston, S. C., Easton, J. D., Farrant, M., Barsan, W., Conwit, R. A., Elm, J. J., Kim, A. S., Lindblad, A. S., Palesch, Y. Y., & , C. R. (2018). Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. The New England journal of medicine, 379(3), 215-225.
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  Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population.
• Iuliano, J. E., Lutrick, K., Maez, P., Nacim, E., & Reinschmidt, K. M. (2017). Dance for Your Health: Exploring Social Latin Dancing for Community Health Promotion. American journal of health education, 48(3), 142-145. doi:10.1080/19325037.2017.1292875
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  ABSTRACTThe goal of Dance for Your Health was to explore the relationship between social Latin dance and health as described by members of the Tucson social Latin dance community. Social Latin dance was selected because of the variety of dances, cultural relevance and popularity in Tucson, and the low-key, relaxed atmosphere. Dance has been prescribed to help manage diseases such as Parkinson’s; however, not much is known about the use of dance for health promotion. Through qualitative methodologies, the project focused on the role dance can play in health promotion and in creating community connections. The project explored personal stories and experiences on the broader impact of health, the meaning of community from the social Latin dancer’s point of view, thoughts on how social Latin dancing could be applied to help people in the community live healthier lives, and how to demystify social Latin dancing for people who are not currently dancing.
• Natt, B., Lutrick, K., Hypes, C., Kazui, T., Cairns, C. B., Natt, B., Mosier, J., Malo, J., Lutrick, K., Kazui, T., Hypes, C., & Cairns, C. B. (2016). 993: DEMOGRAPHICS OF SEVERE INFLUENZA DURING THE 2016 SEASON: A TERTIARY CARE HOSPITAL EXPERIENCE.. Critical Care Medicine, 44(12), 324-324. doi:10.1097/01.ccm.0000509669.58415.c6

Proceedings Publications

• Ellingson, K. D., Gerald, J. K., Sun, X., Hollister, J., Lutrick, K., Parker, J., Rivers, P., Beitel, S. C., Baccam, Z., Lamberte, J. M., & others, . (2021). Incidence of SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential Workers During a Prevaccination COVID-19 Surge in Arizona. In JAMA Health Forum, 2.

Presentations

• Lutrick, K. (2024). Bias and Stigma in Clinical Research: How Real-World Evidence Helps Us Care for Real Patients. Society for Critical Care Medicine Annual CongressSociety for Critical Care Medicine.
• Lutrick, K. (2024). Data Science: Access, Governance, and Ethics in Critical Care. Society for Critical Care Medicine Annual CongressSociety for Critical Care Medicine.
• Lutrick, K. (2024). Long-COVID and Social Determinants of Health. Project ECHO: Long COVID.
• Lutrick, K. (2023). Racial/Ethnic Differences in COVID-19 Symptoms, Length of Stay, and Outcomes in a National Cohort of Critically Ill Patients. American Public Health Association Annual MeetingAmerican Public Health Association.
• Lutrick, K. (2023). SARI-PREP: Outcomes from a Multicenter Consortium. Society for Critical Care Medicine Congress. San Francisco, CA: Society for Critical Care Medicine.
• Lutrick, K. (2023). SPARC Presentations: Strategic Plans to Advance Research Capacity by graduates of the Building Research Capacity Fellowship. North American Primary Care Research Group Annual MeetingNorth American Primary Care Research Group.
• Lutrick, K., Lane, C., Maves, R., Bhatnagar, M., Rios, D., Weiner, D., Uyeki, T., & Cobb, J. P. (2020, February). Data Collection during Public Health Emergencies: Lessons Learned Over Three Influenza Seasons. Society for Critical Care Medicine Annual Congress. Orlando, FL: Society for Critical Care Medicine.
• Ellingson, K., & Lutrick, K. (2021, March). Epidemiology and Immunology of COVID-19 in Essential Workers – The AZ-HEROES Cohort. Emerging Viruses and Pandemics Symposium. University of Arizona.
• Lutrick, K., Miller, A., Bennett, A., Ramsey, S., Cobb, J. P., Pearson, J. L., & Galluzzo, B. (2020, November). Integrating clinical and public health data after chemical disasters: A case study from a multidisciplinary workshop in Tucson, Arizona”. American Public Health Association Annual Meeting. Virtual: American Public Health Association.
• Lutrick, K., Miller, A., Kwok, R., Packenham, J., Horney, J., Rohlman, D., Haynes, E., & Mistry, A. (2020, August). Crossing Silos and Networking to Advance Environmental Health Disaster Research. International Society for Environmental Epidemiology Annual Conference. Washington DC/Virtual: International Society for Environmental Epidemiology.
• Lutrick, K., Yeskey, K., Miller, A., Abramson, D., & Kirsch, T. (2020, September). The Action Collaborative on Disaster Research Webinar: Back to the Future - Moving the Nation’s Disaster Research Capacity Forward. NASEM Action Collaborative Webinar Series. Virtual: National Academies of Sciences, Engineering, and Medicine.
• Lutrick, K. (2019, Spring). Community Data Collection. NIEHS Disaster Response Recovery (DR2) Workshop. Tucson, AZ.
• Lutrick, K., & Ramsey, S. (2019, Spring). Overview of Steps and Information Needs for Health Care and Community Studies & Introduction to Data Map. NIEHS Disaster Research Response (DR2) Workshop. Tucson, AZ: NIH NIEHS.
• Lutrick, K., Miller, A., & Cobb, J. P. (2019, Spring). NIH & University of Arizona Disaster Research Response Workshop: Clinical and Community Responses to a Chemical Public Health Emergency. Preparedness Summit. St. Louis, MO.

Poster Presentations

• Lutrick, K. (2024).

  Changes in Family Medicine Department Funding Between 2016 and 2021

  . North American Primary Care Research Group.
• Lowe, A., Arreola, M., Lutrick, K., & Macpherson, A. J. (2020, August). Vaping Among LatinX Adolescents: A Systematic Review. Border Latino American Indian Summer Exposure to Research (BLAISER). Virtual: Arizona Area Health Education Centers Program.
• Lutrick, K., Rivers, P. S., Aceves, B., & Muramoto, M. L. (2019, Fall). The state of dissemination and implementation science research focused on clinical interventions in primary care: a scoping review. Dissemination & Implementation Science. Washington, DC: Academy Health & NIH.