Miriam Nuno's research while affiliated with University of California and other places

Publications (139)

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Introduction There has not been a recent evaluation of the association between racial and gender and surgical outcomes in children. We aimed to evaluate improvements in race- and gender-related pediatric postoperative outcomes since a report utilizing the Kids’ Inpatient Database data from 2003 to 2006. Methods Using Kids’ Inpatient Database (2009...
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OBJECTIVE Glioblastoma has been known to be resistant to chemotherapy and radiation, whereas the underlying mechanisms of resistance have not been fully elucidated. The authors studied the role of the transcription factor ZEB1 (zinc finger E-box-binding homeobox 1 protein), which is associated with epithelial-mesenchymal transition (EMT) and is cen...
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The interaction of age, sex, and outcomes of children with head injury remains incompletely understood and these factors need rigorous evaluation in prognostic models for pediatric head injury. We leveraged our large institutional pediatric TBI population to evaluate age and sex along with a series of predictive factors used in the acute care of in...
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While many higher-education institutions dramatically altered their operations and helped mitigate COVID-19 transmission on campuses, these efforts were rarely fully extended to surrounding communities. A community pandemic-response program was launched in a college town that deployed epidemiological infection-control measures and health behavior c...
Preprint
Background Wastewater-based epidemiology (WBE) has been deployed broadly as an early warning tool for emerging COVID-19 outbreaks. WBE can inform targeted interventions and identify communities with high transmission, enabling quick and effective response. As wastewater becomes an increasingly important indicator for COVID-19 transmission, more rob...
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Background Cancer is the leading cause of death among Latinos, the largest minority population in the United States (US). To address cancer challenges experienced by Latinos, we conducted a catchment area population assessment (CAPA) using validated questions from the National Cancer Institute (NCI) population health assessment supplement at our NC...
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Background Efforts to protect residents in nursing homes involve non-pharmaceutical interventions, testing, and vaccine. We sought to quantify the effect of testing and vaccine strategies on the attack rate, length of the epidemic, and hospitalization. Methods We developed an agent-based model to simulate the dynamics of SARS-CoV-2 transmission am...
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SARS-CoV-2 has infected nearly 3.7 million and killed 61,722 Californians, as of May 22, 2021. Non-pharmaceutical interventions have been instrumental in mitigating the spread of the coronavirus. However, as we ease restrictions, widespread implementation of COVID-19 vaccines is essential to prevent its resurgence. In this work, we addressed the ad...
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Background: Both obesity and chronic diverticular disease (DD) are on the rise. Understanding surgical outcomes for patients with obesity undergoing colectomy for DD is imperative to improve care and minimize complications. Our objective was to investigate the impact of obesity on outcomes after elective colectomy specifically for chronic DD. Met...
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Introduction: Uninsured pediatric trauma patients are at increased risk of poor outcomes. The impact of the Patient Protection and Affordable Care Act (ACA) on pediatric trauma patients has not been studied. We hypothesized that the expansion of Medicaid coverage under the ACA was associated with increased insurance coverage and improved outcomes....
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Objective Cancer patients and survivors may be disproportionately affected by COVID-19. We sought to determine the effects of the pandemic on thyroid cancer survivors’ healthcare interactions and quality of life. Methods An anonymous survey including questions about COVID-19 and the Patient-Reported Outcomes Measurement Information System profile...
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Highlights Key Practitioner Messages • Emergency medicine physicians demonstrate practice variation in child abuse screening in infants with skull fractures. • Previously unknown barriers may contribute to emergency medicine physicians' practice variation in child abuse screening of infants with skull fractures.
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The rapid spread of the new SARS-CoV-2 virus triggered a global health crisis disproportionately impacting people with pre-existing health conditions and particular demographic and socioeconomic characteristics. One of the main concerns of governments has been to avoid the overwhelm of health systems. For this reason, they have implemented a series...
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Background Spontaneous intracranial hypotension is diagnosed with an increasing frequency, but epidemiologic data are scarce. The aim of this study was to determine the incidence rate of spontaneous intracranial hypotension in a defined population. Methods Using a prospectively maintained registry, all patients with spontaneous intracranial hypote...
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Background The novel coronavirus pandemic has had a differential impact on communities of color across the US. The University of California hospital system serves a large population of people who are often underrepresented elsewhere. Data from hospital stays can provide much-needed localized information on risk factors for severe cases and/or death...
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Background and Objectives Superficial siderosis, bibrachial amyotropy, and spinal cord herniation are unusual but serious long-term sequelae of persistent spontaneous spinal CSF leaks in patients with spontaneous intracranial hypotension (SIH), particularly ventral spinal CSF leaks. However, the risk of developing such sequelae has not been establi...
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Background Drowning is a leading cause of death in children ≤5 years old. Detailed data on the epidemiology of drowning in this high-risk population can inform preventative efforts. We aimed to study trends in incidence and case fatality rates (CFR) in the USA among young children hospitalised after drowning. Methods Children ≤5 years old hospital...
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Spontaneous intracranial hypotension (SIH) is an important cause of headaches. For the initial evaluation of patients with suspected SIH, post-myelography computed tomography (CT myelography or CTM) has long been considered the gold standard for the detection of cerebrospinal fluid (CSF) leaks,¹ but spine magnetic resonance imaging including heavil...
Preprint
Full-text available
SARS-CoV-2 has infected nearly 3.7 million and killed 61,722 Californians, as of May 22, 2021. Non-pharmaceutical interventions have been instrumental in mitigating the spread of the coronavirus. However, as we ease restrictions, widespread implementation of COVID-19 vaccines is essential to prevent its resurgence. In this work, we addressed the ad...
Preprint
BACKGROUND Higher-than-expected heart failure (HF) readmissions affect half of US hospitals every year. The Hospital Reduction Readmission Program has reduced risk-adjusted readmissions, but it has also produced unintended consequences. Shared care models have been advocated for HF care, but the association of shared care networks with HF readmissi...
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Background Higher-than-expected heart failure (HF) readmissions affect half of US hospitals every year. The Hospital Reduction Readmission Program has reduced risk-adjusted readmissions, but it has also produced unintended consequences. Shared care models have been advocated for HF care, but the association of shared care networks with HF readmissi...
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Background. By March 2021, California had one of the least equitable vaccine distribution programs in the US. To rectify this, Governor Newsom ordered 4 million vaccine doses be reserved for the census tracts in the lowest quartile of the Healthy Places Index (HPI). California plans to lift state-wide COVID-19 restrictions on June 15th, 2021, as lo...
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Background: The coronavirus (COVID-19) pandemic has led to rapid changes in our society and healthcare system. Cancer patients and survivors may be disproportionately affected by these changes, including decreased access to healthcare, increased infection risk, and economic challenges. We sought to determine the effects of the pandemic on thyroid c...
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Purpose Prescription drug monitoring programs (PDMPs) have been established to combat the opioid epidemic, but there is no data on their efficacy in children. We hypothesized that a statewide PDMP mandate would be associated with fewer opioid prescriptions in pediatric surgical patients. Methods Patients < 18 undergoing inguinal hernia repair, orc...
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Objective To determine the frequency of multiple spinal CSF leaks in a recent group of patients with spontaneous intracranial hypotension (SIH) who were investigated with digital subtraction myelography (DSM). Methods This observational study was conducted using data from a prospectively maintained data base of patients who meet the International...
Preprint
Objectives: This study aimed to evaluate the impact of shared care networks on heart failure readmission rates. Background: Higher-than-expected heart failure (HF) readmissions affect half of US hospitals every year. The Hospital Reduction Readmission Program (HRRP) has reduced risk-adjusted readmissions, but it has also produced unintended consequ...
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Multiple Sclerosis (MS) is an immune-mediated disease that results in major locomotor deficits. However, recent studies have revealed that fatigue, slow processing speed, and memory impairment are the top variables impacting employment status for MS patients. These suggest that cognitive effects may have a greater impact on productivity, lifestyle,...
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Background: Efforts to protect residents in nursing homes involve non-pharmaceutical interventions, testing, and vaccine. We sought to quantify the effect of testing and vaccine strategies on the attack rate, length of the epidemic, and hospitalization. Methods: We developed an agent-based model to simulate the dynamics of SARS-CoV-2 transmission i...
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Background : Abusive head trauma (AHT) is a leading cause of morbidity and mortality among young children. We aimed to evaluate the long-term impact of AHT. Methods : Using administrative claims from 2000-2018, children <3 years old with documented AHT who had follow-up through ages 5 and 11 years were identified. The primary outcome was incidence...
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Background : Traumatic brain injury (TBI) is the leading cause of death and disability in young children; however, the impact of mechanism on outcomes has not been fully evaluated. We hypothesized that children with TBI due to abuse would have a higher mortality than children with accidental TBI due to motor vehicle collisions (MVC). Methods : We...
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Importance: Characterization of a diverse cohort hospitalized with COVID-19 in a health care system in California is needed to further understand the impact of SARS-CoV-2 and improve patient outcomes. Objectives: To investigate the characteristics of patients hospitalized with COVID-19 and assess factors associated with poor outcomes. Design: Patie...
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Objective. Using a pandemic influenza model modified for COVID-19, this study investigated the degree of control over pre-symptomatic transmission that common non-pharmaceutical interventions (NPIs) would require to reduce the spread in long-term care facilities. Methods. We created a stochastic compartmental SEIR model with Poisson-distributed tra...
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Objective: To determine the occurrence of cerebrospinal fluid (CSF)-venous fistulas, a type of spinal CSF leak that cannot be detected with routine computerized tomography myelography, among patients with orthostatic headaches but normal brain and spine magnetic resonance imaging. Background: Spontaneous spinal CSF leaks cause orthostatic headac...
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Objective Intracranial myeloid sarcomas (IMS) are rare CNS manifestations of malignant hematopoietic neoplasms of myeloid origin such as AML and CML. Reported cases in the literature are limited to primarily case reports. We present a systematic review of this rare CNS tumor, characterizing the clinical presentation, tumor location, histopathology,...
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Background Flap reconstruction of radiated pelvic oncologic defects decreases perineal wound-healing complications. How widely and how often reconstructions are performed, and how technical mastery and improved perioperative care has affected outcomes, is unknown. Our objective is to 1) provide a comprehensive evaluation of national trends in flap...
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PurposePresent knowledge is limited with regard to endovascular and interventional management of pediatric acute ischemic stroke (AIS). The current practice of neurointerventions in this population was analyzed via a national database.Methods The Kids’ Inpatient Database for years 2000, 2003, 2006, and 2009 was examined for patients aged < 18 years...
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Although traumatic brain injury (TBI) has been found to be associated with dementia in numerous studies, large‐scale studies of US non‐Veteran populations are scarce. The question of whether sex, insurance, and race influence the risk of dementia after a TBI is not well studied. We analyzed data from 97,736 individuals with TBI age 55+ captured in...
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Objective The objectives of this study were to identify functional limitations in COVID-19 patients admitted to acute care hospitals, to evaluate functional limitations by demographic, medical and encounter characteristics, and to examine functional limitations in relation to discharge destination. Design and Setting This is a cross sectional, ret...
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Evidence is limited on the impact of a head injury and the role of age at injury on different cognitive domains, particularly among in diverse cohorts. The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study examines cognitive aging across four racial/ethnic groups (29% White, 26% Black, 24% Asian, & 20% Latino). Head injury was deter...
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Importance The optimal level of care for older patients with rib fractures as an isolated injury is unknown. Objectives To characterize interhospital variability in intensive care unit (ICU) vs non-ICU admission of older patients with isolated rib fractures and to evaluate whether greater hospital-level use of ICU admission is associated with impr...
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Objective: To determine the effectiveness of the revised Risk Analysis Index (RAI-rev), administrative Risk Analysis Index (RAI-A), cancer-corrected Risk Analysis Index [RAI-rev (cancer-corrected)], and 5-variable modified Frailty Index (mFI-5) for predicting 30-day morbidity and mortality in patients undergoing high-risk surgery. Background: Th...
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Objective: Endovascular treatment is the mainstay therapy for brain aneurysms. About 15% of patients need re-treatment within six months due to early recanalization. In this study, we investigate risk factors associated with treatment failure. Methods: This retrospective cohort study includes endovascularly treated aneurysm cases between July 20...
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Background Controversy exists regarding the safety and feasibility of minimally invasive resection for lesions in segments 7 or 8. We compare outcomes of minimally invasive surgery (MIS) and Open parenchymal sparing liver resections at two high‐volume centers. Methods From 2003 to 2016 we identified patients who underwent MIS or Open resections fo...
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Background Anterior cervical diskectomy and fusion (ACDF) is a procedure for effectively relieving radiculopathy. Opioids are commonly overprescribed in postsurgical settings and prescriptions vary widely among providers. We identify trends in opioid dependence before and after ACDF. Methods We used the Truven Health MarketScan data to identify adu...
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Background Abusive head trauma (AHT) in children older than 1 and younger than 5 years old is thought uncommon and rarely studied. Objective This study estimates national incidence and case fatality rate of abusive head trauma (AHT), and evaluates differences by age, sex, race, and region, with a focus on children of 2-4 years. Participants and s...
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High grade gliomas are associated with poor prognosis and high mortality. Conventional treatments and management of high grade gliomas have shown little improvement in 5-year overall survival. This phase I trial evaluated the safety, immunogenicity, and potential synergy of surgical resection with Gliadel Wafer implantation, followed by autologous...
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Background: The optimal level of care for hemodynamically stable patients with isolated blunt hepatic, renal, or splenic injuries (solid organ injuries, or SOIs) is unknown. We sought to characterize inter-hospital variability in intensive care unit (ICU) admission of such patients and to determine whether greater hospital-level ICU use would be a...
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Introduction Despite the increasing use of national databases to conduct spine research, questions remain regarding their study validity and consistency. This study tested for similarity and inter-database reliability in reported measures between three commonly used national databases. Methods International Classification of Diseases, 9th edition (...
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Early surgery after traumatic spinal cord injury (TSCI) has been associated with a greater neurological recovery and reduced secondary complications. In this study, we aimed to evaluate the trend of early TSCI surgery (within 24 hours) over two decades and the effect on length of hospitalization, complications, and hospital charges. We extracted em...
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Background: In 2018, the Leapfrog Group set minimum annual lung cancer surgery hospital and surgeon volume thresholds of 40 and 15, respectively. We examined whether outcomes associated with these Leapfrog Group volume thresholds are comparable for patients at the extremes of age and comorbidities. Methods: We assessed lung cancer patients under...
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Background: Cardiopulmonary assessment for lung resection is important for risk stratification, and the American College of Chest Physicians (ACCP) guidelines provide decision support. We ascertained the cardiopulmonary assessment practices of thoracic surgeons and determined whether they are guideline concordant. Methods: An anonymous survey wa...
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OBJECTIVE Spontaneous spinal CSF–venous fistulas are a distinct type of spinal CSF leak recently described in patients with spontaneous intracranial hypotension (SIH). Using digital subtraction myelography (DSM) with the patient in the prone position, the authors have been able to demonstrate such fistulas in about one-fifth of patients with SIH in...
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Objective: We examine how esophagectomy volume thresholds reflect outcomes relative to patient characteristics. Summary background data: Esophagectomy outcomes are associated with surgeon and hospital operative volumes, leading the Leapfrog Group to recommend minimum annual volume thresholds of 7 and 20 respectively. Methods: Patients undergoi...
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Background: Enhanced recovery after surgery (ERAS) represents an evidence-based multidisciplinary approach to perioperative management after major surgery that decreases complications and readmissions and improves functional recovery. Spine surgery is a traditionally invasive intervention with an extended recovery phase and may benefit from ERAS p...
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Background: There is wide variability of transfusion practices for children with hemorrhagic injuries across trauma centers. We are planning a multicenter, randomized clinical trial evaluating tranexamic acid in children with hemorrhage. Standardization of transfusion practices across sites is important to minimize confounding. Therefore, we sough...
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MINI: Retrospective analysis of MarketScan database comparing health care utilization of SI following surgery and drug abuse with control cases. Drug abuse related SI showed the highest of complication rates, readmissions and overall payments at one year of follow-up despite the lower rate of surgical interventions. Study design: Retrospective an...
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Background: Anterior cervical discectomy with fusion (ACDF) or posterior cervical foraminotomy (PCF) are the mainstay surgical treatment options for patients with degenerative cervical radiculopathy (DCR). Objective: To compare 90-d bundled payments between ACDF and PCF for DCR in a cohort study. Methods: Data were extracted from MarketScan da...
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Background: Abusive head trauma (AHT) peaks during early infancy and decreases in toddler years. Infants and toddlers experience different injuries, possibly impacting the risk of mortality. We aimed to evaluate the association of age with mortality METHODS: We conducted a retrospective study of AHT hospitalizations in 2000, 2003, 2006, 2009, and...