2017
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Item Strategies for Promotion of a Patient Portal in the UNT Geriatrics Clinic for Improved Satisfaction and Access(2017-03-14) Loza, Cynthia; Henderson, Leslie; Booker, Sandra; Prasad, Subhada; Ross, SarahPurpose: The use of electronic health records has become a vital part of patient care. Electronic health records have many benefits, including assisting providers with tracking tasks important for health maintenance and chronic disease management. Electronic health records also have patient portals, which are secure online websites that give patients access to their personal health information. NexGen is the electronic health records system used at the University of North Texas Health Sciences Center, and we have recently started using their Patient Portal. Our team has worked on promotion and training in the patient portal to assist with participation by both clinical staff and patients. The goal is improve patient and caregiver access to their personal health information, improved satisfaction, and improved communication with their care team. Additionally, the patient portal will support improved chronic disease management by providing a way to send electronic messages to patients with reminders of any necessary testing or notifications of any educational programs relevant to their condition. In the Geriatric population, we want to make use of a patient portal user friendly for those with low computer literacy and also usable by caregivers of patients with cognitive impairments. Methods: The team has used several tools for promotion of the patient portal. A video was produced to train staff on how to enroll patients in the portal and how view messages receive through the portal. A kiosk was set up in the waiting room of the UNT Geriatrics clinic with student volunteers to assist patients one-on-one with enrollment. Buttons for advertisement and awareness were distributed to office staff. We also created an icon in NexGen to easily recognize which patients have already enrolled. When the goal of 60% enrollment is achieved, the team plans to evaluate outcomes of improved access and satisfaction. Both a general and a patient portal specific patient satisfaction survey will be distributed to the UNT Geriatrics patients. We will also compare communication received from patients by phone which electronic communication through the patient portal. Results/Conclusions: Enrollment in the NexGen patient portal in the UNT Geriatrics clinic is on the rise. Patients who are participating have enjoyed the ability to email their care team with questions. In particular, we have had success in providing improved access for our hearing impaired patient, as the Geriatrics office staff have emailed for coordination of acute appointments to address urgent needs. As more patients and caregivers utilize this tool we hope to show improved patient satisfaction. Regarding access to the care team, we anticipate a slight decrease in phone calls with more use of the patient portal for electronic communication. Adjustments to the patient portal will be made over time to ensure that it is patient centered and providing patients and caregivers with the information they need to manage their health.Item A STEP in the Right Direction: An Interdisciplinary Approach to Transitional Care (2017)(2017-03-14) Connally, Patrica; Allen, John G.Background: The Affordable Care Act, calls for more focus on finding innovative delivery systems that improve care, increase efficiency, and reduce costs. Purpose: Hospital readmissions, excessive falls, and poor quality of life are factors that unnecessarily increase healthcare costs. The Safe Transitions for the Elderly Patients (STEP) program is a hybrid transitional care model developed by the UNT Health Science Center (UNTHSC) as part of an 1115 Waiver to address these factors in a home care setting in Tarrant County. Objectives: The primary goals of STEP are to reduce all-cause 30 day hospital readmissions, improve quality of life, and decrease falls among Medicaid patients over 50 years through a collaborative and interdisciplinary approach to patient care. Methods: An interprofessional team that includes a physician/geriatrician, nurse practitioner, physician assistant, social workers, physical therapists and a dietician assess and treats the patient in the home for up to 90 days post hospital discharge based on the individual patient needs. Conclusions: Through this model, UNT Health Science Center has the opportunity to demonstrate a unique transitional care model that will improve health care delivery post-hospitalization.Item Characteristics of Physical Activity among African American women in the Better Me Within Program(2017-03-14) Taskin, Tanjila; Iqbal, Ahmed; Kitzman-Ulrich, Heather PhD; Dodgen, LeilaniBackground: African American (AA) women experience the highest rates of obesity at 57.2% compared to other groups in the United States (38.2% white women, 46.9% Hispanic women); and have the lowest levels of physical activity with only 30% of adult AA women meeting national aerobic guidelines compared to 44% of white women. Physical fitness is an important driver of health and may be even more critical than weight loss for improving health and longevity. A recent study demonstrated that individuals with good cardiorespiratory fitness, even with a BMI in the overweight or obese category (BMI [greater than] 25), had similar mortality rates to people whose BMI was in a healthy range (BMI Methods: Data were collected from participants in the BMW program (2013-2016). Variables were explored from five domains at baseline and 16 weeks to assess the relationship with physical activity (total weekly minutes) including: 1) Demographic characteristics (age, education, number of children, marital status, income, insurance); 2) Existing medical conditions (weight and height to calculate body mass index (BMI), cholesterol levels, waist circumference, blood pressure, hemoglobin A1C, and fasting glucose); 3) Health behaviors (smoking, drinking, sedentary time); 4) Mental conditions (body appreciation, physical activity and nutrition self-efficacy, confidence for exercise, mood, stress, and motivation for eating and exercise); and 5) Diet (fruit intake, vegetable intake, total calories, total fat, total carbohydrates, and total protein). Results: A total of 221 AA women were randomized to intervention or control (mean age=48.8+11.2; mean BMI=36.7+8.4; 52% technical or high school). There is a hypothesized positive effect expected between the intervention and physical activity between baseline and 16 week measures. Variables are being assessed through correlations and regressions to determine the effects on physical activity using SAS (version 9.4). The results will be expanded upon proper analysis. Conclusions: Increasing physical activity among AA women is critical to improving long term health and risk for chronic disease. This study will provide information to improve evidence-based lifestyle programs for AA women.Item Crosstalk Between Transforming Growth Factor Beta-2 and Toll-Like Receptor 4 in the Trabecular Meshwork(2017-03-14) Medina-Ortiz, Wanda E.; Curry, Stacy; Luan, Tomi; Clark, Abbot; McDowell, Colleen; Hernandez, HumbertoPurpose: The trabecular meshwork (TM) plays an important role in the regulation of aqueous humor outflow and intraocular pressure (IOP). Regulation of the ECM by TGFβ2 in the TM and toll-like receptor 4 (TLR4) in fibrogenesis has been extensively studied. Here, we investigate the role of TGFβ2-TLR4 signaling crosstalk and BMP/activin membrane-bound inhibitor (BAMBI) in the regulation of the TM ECM and ocular hypertension. Methods: TLR4 expression was evaluated in cross-sections of human donor eyes, primary human TM cells, and dissected mouse TM rings. TM cells were treated with TGFβ2 (5ng/ml), TLR4 inhibitor (TAK-242, 15mM), and/or TLR4 ligand (cFN-EDA, 10mg/mL). A/J (n=13), AKR/J (n=7), BALBc/J (n=8), C3H/HeJ (n=20), and C3H/HeOuJ (n=10) were injected intravitreally with Ad5.hTGFβ2. Further, B6;129S1-Bambitm1Jian/J mice were injected intravitreally with either Ad5.TGFβ2 (n=10), Ad5.Cre (n=9), or Ad5.TGFβ2 + Ad5.Cre (n=10). The uninjected contralateral eyes served as controls. Mouse TM (MTM) cells were isolated from B6;129S1-Bambitm1Jian/J mice using magnetic beads and transduced with Ad5.TGFβ2 or Ad5.Cre in cell culture. Results: TLR4 is expressed in the human and mouse TM. Inhibition of TLR4 signaling in the presence of TGFβ2 decreases fibronectin expression. Activation of TLR4 by cFN-EDA in the presence of TGFβ2 further increases fibronectin, laminin, and collagen-1 expression, and TLR4 signaling inhibition blocks this effect. Ad5.hTGFβ2 induces ocular hypertension in wild-type mice but has no effect in Tlr4 mutant (C3H/HeJ) mice. Ad5.Cre, Ad5.TGFβ2, or Ad5.TGFβ2 + Ad5.Cre each induced ocular hypertension significantly throughout the time course compared to uninjected control eyes. Bambi knockdown by Ad5.Cre leads to increased fibronectin expression in MTM cells. Conclusions: Here we show a TGFβ2-TLR4 crosstalk pathway that we hypothesize is regulated by TGFβ2 negative regulator BAMBI. Conditional knockdown of BAMBI in the TM with Ad5.Cre induces fibronectin expression, reduces aqueous humor outflow facility and causes ocular hypertension. These data provide a novel pathway involved in the development of glaucomatous TM damage and provide potential new targets to lower IOP.Item Investigating the affinity of human plasma lipoproteins and albumin to the anti-cancer drug valrubicin(2017-03-14) Sabnis, Nirupama; Prabhulkar, Shradha; Lacko, Andras G.; Dossou, AkpedjeBackground: Reconstituted lipoproteins and albumin are promising targeted drug delivery agents. Valrubicin is a hydrophobic anti-cancer drug currently approved for the treatment of in situ BCG –resistant bladder carcinoma through intra-vesical instillation. An injectable formulation with the patients’ own lipoproteins or albumin as carriers would not only make valrubicin an attractive therapy candidate for other types of cancer, but also limit immunological response and off-target effects including cardiotoxicity. Purpose: This study aimed to assess the binding of valrubicin to human plasma lipoproteins and serum albumin (HSA) under different incubation conditions. We hypothesize valrubicin will preferentially associate with high density lipoprotein (HDL) due to its high hydrophobicity index. Materials and Methods: A solution of valrubicin in dimethyl sulfoxide was incubated for up to 24 hours with either pooled whole human plasma or with individual plasma components at room temperature (RT) or 37 degrees Celsius. Plasma component fractions were separated by ultracentrifugation. A 45 mg/mL albumin solution was used for individual incubation. Absorbance at 490 nm was used to estimate valrubicin concentration in low density lipoprotein (LDL), HDL and HSA. Results: Incubation for 2 hours at RT yielded the highest valrubicin concentration in plasma components. Overall, valrubicin association with plasma components moderately increased with the amount of valrubicin added prior to incubation. For instance, 0.185 mg and 1.121 mg of valrubicin was recovered with respectively 1 mg and 5 mg of valrubicin initially added to 1 mL of plasma. About 4%, 10% and 86% of the initial valrubicin added to whole plasma were respectively distributed in the LDL, HDL and the HSA –containing plasma fractions after ultracentrifugation. The incorporation of valrubicin in HDL increased-though not proportionally- with 10 fold concentration of HDL. However, prolonged incubation of valrubicin with 45mg/mL HSA resulted in the dissociation of valrubicin and HSA. Conclusions: Our preliminary data suggests differential interaction of valrubicin with plasma components with preferential binding to HSA. The optimization of the HSA/ valrubicin complex will be required to develop an efficient drug transport formulation. HSA stabilizing agents such as sodium acetyltryptophanate and sodium caprylate could potentially facilitate and stabilize the binding of valrubicin to HSA.Item For General Health, Does Alcohol Affect Sleep Patterns In Males Ages 45-80?(2017-03-14) Bennett, Kaitlin; Hartos, Jessica; Waxali, Aleah; Zafar, Sophia; Oropeza, JennaIntroduction: More than 60 million Americans experience long-term sleep problems. Although alcohol use is related to sleep issues, little is known about the relationship between alcohol and sleep in middle aged to elderly males. The purpose of this study was to evaluate the relationship between adequate sleep and alcohol use in males ages 45-80 years old. Methods: This cross sectional analysis used 2014 BRFSS data for males ages 45-80 from Ohio, Montana, Wisconsin, and Wyoming. Multiple logistic regression analysis was used to assess the relationship between alcohol use and adequate sleep, which controlled for age, ethnicity, children at home, employment status, exercise, marital status, and tobacco use (chew and smoke). Results: The majority of males ages 45-50 years old reported that they averaged at least 7 hours of sleep in the past 30 days (64-72%), and few reported that they binge drink (14-23%). After controlling for various factors, sleep was not related to binge drinking in any of the four states but was related to exercise habits (moderate effect sizes) in all four states. Conclusions: Overall, alcohol use was not related to sleep in males ages 45-80 years old in any states, but exercise was related (moderate effect sizes) in all states. The results of this study may generalize to primary care practice patients, but not to other clinical populations. This cross-sectional study did not assess sleep “patterns” or quality of sleep. Although alcohol was not found to be related to sleep, it is standard practice to screen all patients for alcohol use and adequate sleep. It’s indicated to screen for exercise habits in those who have inadequate sleep.Item Is Obesity a Risk Factor for COPD in Females Ages 55 and Older?(2017-03-14) Mehta, Tarjani; Schmidt, Katherine; Feeney, Patrick; Hartos, Jessica PhD; Martinez, WendyPurpose: Research has shown a relationship between COPD and weight status; however, the information was not specific to a gender or age groups. Thus, the purpose of our study is to determine whether obesity is a risk factor for COPD in females who are 55 years and older. Methods: This cross sectional analysis used data from the BRFSS 2014 survey for females aged 55 and older from Alabama, Kentucky, Oklahoma, and Ohio. Multiple logistic regression analyses was used to assess the relationship between obesity and COPD, while controlling for age, race/ethnicity, asthma, diabetes, exercise, heart disease, and tobacco use. Results: Few of the target population reported having lifetime diagnosis of COPD (15-18%) and the majority reported being obese (67-70%). After controlling for demographic factors, COPD was significantly related to obesity in Oklahoma (small effect size), and significantly related to exercise (small effect sizes), heart disease (moderate effect sizes), tobacco use (moderate effect sizes) and asthma (large effect sizes) in all four states. Conclusions: The majority of the states found that obesity was not related to COPD in females aged 55 and older. However, asthma, exercise, heart disease, and current smoking were significant in all states. A limitation to this study was that it lacked information on COPD severity and history. Primary care providers should screen and educate patients with COPD symptoms for tobacco use, heart disease, and lack of exercise. Providers should also screen, educate, and refer for obesity as necessary.Item Current Endeavors to Support the Homeless Population of Fort Worth(2017-03-14) Alavi, Michael; Burgess, Lauren; Dolan, Kathryn J.; Phillips, KaitlinPurpose: The aim of this research was to identify and explore current solutions in supporting the homeless population in Fort Worth, Texas, particularly through the services provided by local non-profit organizations. Methods: We identified the terms of eligibility, services provided, service access, and barriers to effective outreach provided by five local non-profit organizations, including John Peter Smith Health Network, Tarrant County Samaritan Housing, Arlington Life Shelter, Salvation Army DFW, and Union Gospel Mission of Tarrant County. Results/Conclusions: Frequent terms of eligibility include valid U.S. identification and proof of low-income or homeless status, and common service access methods include hospital referrals, word of mouth, and flyers in well-populated public areas. Services provided included shelter, aid in employment search, navigation to health services, and a variety of supportive services to integrate those who have been recently homeless into society. These organizations have encountered multiple barriers to effective outreach, such as client mental illness, client lack of appropriate paperwork, shortage of affordable housing, and transportation difficulties. Non-profit organizations in Fort Worth provide varying degrees of support for the homeless population and have identified areas for improvement that that citizens, volunteers, local government, and the organizations themselves can consider in broadening their outreach.Item Atypical eye movements and postural control in Autism Spectrum Disorders (2017)(2017-03-14) Miller, Haylie; Bugnariu, Nicoleta; Mattingly, Laura; Green, KaitlynHypothesis: Research shows a link between pursuit eye movements, visual processing, and postural control; current evidence suggests these links are different in individuals with Autism Spectrum Disorder (ASD). For those with ASD, few studies quantitatively examine visuomotor integration and its influence on postural stability. The purpose of this study was to observe individuals with ASD and those with typical development (TD) in order to identify and characterize differences in how visual information and eye movement are used for postural control. Materials/Methods: This study was conducted in community sites in the Dallas-Fort Worth metroplex. Five adolescents with ASD and 5 age matched TD controls completed the study. The experiment consisted of balance testing, including the Limits of Stability (LOS) and The Clinical Test for Sensory Integration (CTSIB), on a force plate while wearing the ETG 2.0 eye tracking system. The CTSIB requires quiet standing with eyes open, eyes closed, and wearing a translucent dome. The LOS requires a shift in center of pressure (CoP) to reach 9 target positions displayed on the screen. Data were analyzed with t-tests. Results: ASD adolescents had higher sway and stability indices than TD across all conditions of the CTSIB. During LOS testing the ASD group had lower postural control than the TD group in 5 of the 9 target positions. Overall, ASD group took a longer time to complete the task, which is a proxy for movement accuracy, since the task advances when participants meet “hit” criteria for each target. Pursuit eye movements and stabilization of targets showed greater variability in ASD group compared to TD. Moreover, the ASD participants did not improve their performance across the 3 trails of the LOS. Conclusions: These preliminary data support our hypothesis that individuals with ASD would have greater postural instability than TD controls. These impairments may be linked to increased variability and less accuracy of pursuit eye movements. When visual context was eliminated, individuals with ASD demonstrated markedly greater impairment in stability. When LOS were tested, the ASD group showed greater difficulty maintaining postural control during CoP shift. Preliminary eye movement data suggests that atypical gaze patterns relate to impairments in stability. Further studies are necessary to investigate this atypical visiomotor integration and its possible role as a fundamental feature of ASD.Item Cell Ghost Coated Polymeric Nanoformulation For Brain Metastasized Triple Negative Breast Cancer(2017-03-14) Van Treuren, Timothy; Ranjan, Amalendu; Chaudhary, Pankaj; Vishwanatha, Jamboor; Kumar, PiyushBackground: Nanoparticle-mediated targeted delivery has become the buzzword in cancer therapy due to its small size and ease in modulation. Cell ghost derived from cancer cells that mimic the cellular environment can be used for specific targeting of tumor in personalized therapy. Purpose: The purpose of this study is to design drug delivery system for personalized medicine to check the brain metastasized Triple Negative Breast Cancer (TNBC). We speculate that cell ghost derived from the tumor of the cancer patient can also be used as a personalized treatment of metastatic cancer. Methods: Cell ghost isolated from brain metastasized TNBC cells was coated on polymeric nanoparticles. Dynamic Light Scattering & Zeta Size analyzer (Malvern Instruments, USA) were used to determine the hydrodynamic size & surface charge of the cell ghost coated nanoparticles(CGNP) respectively. SDS-PAGE was used for comparative analysis of proteins in the cell ghost & CGNP. The Cell uptake of the dye-loaded CGNP was studied using the confocal microscope (Zeiss microscope USA). Results: We have successfully formulated cell ghost coated polymeric nanoparticles (CGNP).The size & surface charge of the CGNP are in desirable range to cross the blood-brain barrier to target brain metastasized TNBC. The SDS-PAGE analysis confirmed that protein contents of cell ghost are stable in CGNP. Confocal microscopic image analysis showed that maximum cellular uptake of these nanoparticles by TNBC cell line. Conclusions: In summary, we concluded that cell ghost isolated from TNBC cells could be used as targeting agents for brain metastatic TNBC. These nanoparticles have maximum cellular uptake and retain the protein contents of cell ghost on nanoformulation infers its possible role in generating personalized medicine for the brain metastasized TNBC treatment.Item Concomitant Opioid and Benzodiazepine Use: A Systematic Review(2017-03-14) White, PharmD, MS, PhD, Annesha; Vernachio, Kimberly PharmD; Pfluger, KassieObjective: In opioid users, the concomitant use of a benzodiazepine medication is associated with an increased risk of adverse reactions and overdose due to the synergistic effects on sedation and respiratory depression. The degree to which adverse events and overdoses occur is unclear when assessing patient characteristics, dosage and formulation. The objective of this study was to review the literature on the incidence and prevalence of an adverse event or death after concomitantly taking an opioid and benzodiazepine prescription medication and to assess the impact on the formulation, dosing, or administration of the medication in overdose. Methods: A review of the literature was performed using the following databases: PubMed, PsycINFO, the Cochrane Library, and Scopus for peer-reviewed journal articles in English to identify studies regarding concomitant benzodiazepine and opioid medication overdose in adolescents and adults for non-cancer pain August 2006 through August 2016. Relevant publications and their reference lists were reviewed to assess for inclusion criteria based upon relevance and quality. Applicable publications were reviewed and included whether outcomes of patients were clearly documented by medication use. Information on the study design, sample characteristics, purpose of study, intervention components, primary outcome, key findings and risk of bias were abstracted for each article and presented in a table. Articles were excluded from the review if concomitant use of benzodiazepine and opioid analgesic was not clear or intentional suicide was indicated as the cause of mortality. Key search terms utilized were: ‘opioid analgesic’, ‘benzodiazepine’, ‘non-cancer pain’, ‘substance-related disorders’, ‘polypharmacy’, ‘co-prescribing’, ‘illicit use’, and ‘overdose’. Results: Findings revealed 11 articles in the literature. Results are presented in a summary of findings table. Relevant studies assessed morbidity and mortality associated with opioid and benzodiazepine use, incidence of non-prescribed medications or illicit drug use, and descriptive information on patient populations of greatest risk of overdose. Common reasons for not selecting a particular article were due to study design and incomplete information of medications within each class. Conclusions: The prevalence of opioid and benzodiazepine misuse and abuse has warranted international attention due to the increased overdose risk with concomitant use. More information is needed regarding dosing, formulation, and particular agent for opioids and benzodiazepines. Assessment of mortality risk is lacking when comparing acute versus chronic drug users and abusers. The incidence of overdose increases as potency increases or when an illicit agent is included due to the central nervous system (CNS) depressant effects.Item Combination of Vincristine and Tolfenamic Acid induces Anti-proliferative activity in Medulloblastoma Cells.(2017-03-14) Sankpal, Umesh; Hafeez, Areeba; Bowman, W. Paul; Basha, Riyaz; Patil, ShrutiBackground: Medulloblastoma (MB) is the most common pediatric malignant brain tumor and usually originates in the cerebellum. These tumors have the propensity to disseminate throughout the central nervous system and are often difficult to treat. Chemotherapy is widely accepted as part of the multimodality treatment approach for MB. However, it is associated with debilitating toxicity and potential long term disabilities. Vincristine, a commonly used chemotherapeutic agent for MB treatment, is known to induce some toxic effects including peripheral neuropathy. Reducing the dose of the drug to minimize the toxic effect also reduces the cytotoxic efficacy of the drug. Purpose: The aim of this study was to test a combination treatment involving vincristine and an anti-cancer non-steroidal anti-inflammatory drug, Tolfenamic acid (TA) against MB cell lines. Previously, we showed that TA inhibited MB cell proliferation and tumor growth in mice by targeting the transcription factor specificity protein-1 (Sp1) and an inhibitor of apoptosis protein, survivin. The overexpression of survivin is associated with aggressiveness and poor prognosis in several cancers. Methods: DAOY and D283 cells were treated with vehicle (DMSO) or low dose of vincristine (DAOY: 2ng/ml; D283: 1ng/ml) or TA (10 µg/ml) or combination of vincristine + TA and the cell viability was measured at one and two days post-treatment using Cell-TiterGlo kit. Flow cytometry was employed to analyze apoptotic cells using Annexin-V staining and cell cycle phase distribution using propidium iodide staining. The activation of apoptotic pathways was further investigated by assessing the levels of effector caspases with Caspase 3/7-Glo kit and the expression of apoptotic markers [c-PARP, Bcl2, and survivin] by Western blot (WB) analysis. The expression of key proteins associated with cell cycle [Cyclin A, B, D CDK4/6 and p21] was also determined by WB analysis. Results: When compared to individual agents, the combination of TA and vincristine increased MB cell growth inhibition which is accompanied by an induction of apoptotic markers and the modulation of proteins associated with cell cycle phase distribution. Conclusions: These results suggest that vincristine and TA combination treatment is effective for inducing anti-proliferative response in MB cells. The experiments to evaluate the effect of this combination in animal model for MB are currently under study.Item A Matter of Balance Service Learning Activities Positively Impact both Physical Therapy Students and Seniors Confidence(2017-03-14) Bugnariu, Nicoleta; Kinzler, BrendaPurpose/Hypothesis: The purposes of this study were to investigate the impact of Service Learning (SL) activities consisting of A Matter of Balance (AMOB) classes on: 1) physical therapy (PT) students’ self-perceived confidence in working with older adults and 2) seniors’ attitude towards fear of falling. We hypothesized PT students will have an increase in confidence working with seniors after participating in SL activities. Secondly, we hypothesize seniors who participate in the fall prevention course will have a decreased fear of falling as well as an increase in physical activity levels. Materials/Methods: The PT department established a collaborative relationship with Senior Citizen Services (SCS), an organization which identified a community need for senior education regarding fall risk reduction. The SL activities consisted of 86 PT students from two consecutive cohorts of a first-year geriatrics course: 1) attending an 8-hour training class in AMOB: A Fall Prevention Course and 2) leading 8 classes of AMOB workshops at senior community centers in Tarrant County, TX. PT students completed a 25-question questionnaire rating self-perceived levels of competence at pre-training, post-training and post workshops. 490 older adults ranging from 62-96 years of age, whom voluntarily signed up for a fall prevention course through the Senior Citizens Service (SCS) completed a questionnaire addressing their fall concerns and fears; pre and post AMOB workshops. The questionnaires for the older adults were collected over the course of a two-year period by the SCS. Results: Both student cohorts had similar confidence levels at the beginning of SL activities. All students reported increased confidence in essential competencies for assessing and mediating the risk for falls in older adults post AMOB trainings. Conclusions: Integrating SL into a first-year geriatric course improved students’ confidence and competence when working with the older adult population. PT students will apply this confidence in the clinical setting and will be prepared to effectively evaluate and treat the growing older adult population. Providing education regarding fall reduction may improve the safety and wellness for older adults, possibly leading to injury reduction and hospitalization.Item Hemophagocytic Lymphohistiocytosis Secondary to Malignancy and Chemotherapy in Pediatric Patients(2017-03-14) Kaheri, Mahdi; Ray, Anish; Haloot, JustinBackground: Hemophagocytic lymphohistiocytosis (HLH) is an uncommon yet potentially devastating systemic disease arising from uncontrolled activation of the immune system. While the primary form of this disease can be caused by genetic mutation(s), the secondary form maybe triggered by infection, hematologic, malignant and metabolic conditions. Here, we present 3 cases of HLH secondary to malignancy and chemotherapy in pediatric patients. Purpose: The diagnosis of HLH remains a clinical challenge due to nonspecific symptoms such as fever, skin rash, cytopenias and splenomegaly found at presentation. Proper diagnosis is significantly more difficult among patients with acute leukemia who have received chemotherapy and present with fever and pancytopenia. The objective of this study is to describe three unique cases of secondary HLH, describe the specific treatment for this entity, and improve the awareness of this condition Methods: Three patients were diagnosed with HLH at Cook Children’s Medical Center (CCMC) between June 2006 and June 2016. They were treated per HLH-2004 guidelines. Medical records of these patients were reviewed at CCMC. Data collected included timeline of diagnosis of HLH in relation to primary diagnosis and treatment, laboratory values, pathology studies, outcome of HLH after treatment, and overall survival. Conclusions: Two patients with acute myeloid leukemia (AML) and one with acute lymphoblastic leukemia (ALL) were diagnosed with HLH, having fulfilled the criteria as outlined in HLH 2004 protocol. They then received HLH specific treatment. One patient passed from refractory HLH, one from primary disease (i.e. AML) and one patient remains alive 22 months from her allogeneic bone marrow transplant. The diagnosis of HLH requires the presence of any of the five following criteria: fever, splenomegaly, bicytopenia, hypertriglyceridemia and/or hypofibrinogenemia, hemophagocytosis, low/absent NK cell activity, hyperferritinemia, and elevated soluble interleukin 2 receptor level. Due to its heterogeneous presentation, it remains imperative that treating clinicians remain cognizant about HLH so that prompt diagnosis may allow appropriate treatment. Two out of 3 patients in our study were in remission with regard to HLH, while 1 patient succumbed to refractory disease. We hope to improve awareness of HLH among pediatric oncologists that will lead to improved survival and better outcome for these patients.Item Association between Self-Reported Diabetes Mellitus and Latent Tuberculosis Infection in a U.S.-Born Homeless Population(2017-03-14) Mallampati, Rajesh; Board, Amy; Miller, Thaddeus; Taskin, TanjilaBackground: Latent TB infection (LTBI) is disproportionately prevalent among certain US populations, including homeless persons.Diabetes mellitus (DM) is also more common among those with LTBI and suggests higher risk for development of TB disease.A significant association between LTBI and self-reported DM in homeless populations would support self-report as potentially useful to ascertain this important risk. Objectives: To evaluate associations between self-reported DM and LTBI among persons using night shelters in an urban Texas county. Methods: We analyzed data from U.S.-born persons using night shelters in Tarrant County, Texas during January 2013 to December 2016. Study data are a local subset of data collected by the Tuberculosis Epidemiologic Studies Consortium, a 10-site study funded by the Centers for Disease Control and Prevention to assess sensitivity and specificity of three commercially-available tests for LTBI: the tuberculin skin test and two interferon-gamma release blood assays: QuantiFERON®-TB Gold In-Tube, and T-SPOT®.TB test. We defined LTBI as a positive result on any test. Multiple logistic regression was used to evaluate relationships between LTBI and self-reported DM while controlling demographic and other factors. Results: Among 1,030 shelter users, we found no association between self-reported DM and LTBI (Odds ratio, 1.22; 95% confidence interval, 0.68 to 2.20). Conclusions: Diabetes is an important TB-related risk factor and its ascertainment can help prioritize targeted screening and intervention. We found self-reported DM did not effectively predict LTBI in our sample, suggesting it is an insufficiently reliable measurement for homeless screenings.Item Diastolic Properties in Older Mice: Comparison Between C57Bl6J and C57BL6N.(2017-03-14) Taffet, George; Acharya, Deepak; Reddy, Anilkumar; Yechoor, Poornima; Pham, Thuy; Hermosillo, Jesus; Harley, Craig; Knebl, Janice; Karim, SanaaPurpose: Cardiac aging in both humans and mice is associated with diastolic dysfunction, and impairment of the left ventricle filling. Age-related factors contributing to this filling impairment include fibrosis of the ventricle and impaired calcium handling by cardiomyocytes. Most aging studies use the C57Bl6/J (J mouse), but the C57Bl6/N (N mouse) has similar longevity without extensive cardiac fibrosis at comparable ages. Hence, this study is designed to identify the effect of fibrosis on diastolic function. Methods: We performed Doppler and 2-D echocardiography on fourteen 29 months old C57B16 (J and N’s) mice under 1% Isoflurane. The parameterized diastolic filling (PDF) formalism was used to comprehensively evaluate the diastolic dysfunction modeling the ventricle as a damped spring with spring stiffness (k), damping constant (c), initial stretch (x0). Small doses of Ivabradine were given to control heart rate for this assessment. Results: The N mice showed a c value of 205 ± 15, k of 7940 ± 530 and a xo of -.23 ± .004 in comparison to the J mice that showed a c value of 195 ± 14, a k value of 10,420 ± 800 and a xo value of -.016 ± .001. Conclusions: Though systolic function was preserved in old N’s and J’s, the spring stiffness (k) was significantly higher for the old J’s. This suggests fibrosis stiffens the old heart dramatically, but the larger LV diameter in the N’s suggests that fibrosis may prevent chamber enlargement with aging.Item The Need for Review and Improvement of Laboratory training Program in UNTHSC(2017-03-14) Adeyemi, Adebola; Otakore, Catherine; Moncus, Matthew; Nair, Maya; Sadiq-Onilenla, RasheedatIntroduction: The three main components of an efficient safety program are policies that outline the regulatory requirements, training programs that educate the research community about the risk involved and the audit program that ensure the effective safety practice implementation. The importance of an excellent safety program cannot be undermined in an academic setting because it is an essential tool for smooth running of daily activities on the campus. An efficient safety program ensures that the research activities are in compliance with the federal, state and institutional level regulations. Thus the safety program protects the employees and environment from exposure to hazardous materials The objective of this study is to improve the training aspect of the UNT HSC Environmental Health and Safety Laboratory Inspection Program. Methods: Unscheduled inspections were carried out to examine safety practices in laboratories across campus. A total of 92 laboratories were inspected in which some of the laboratories use strong chemicals, some work with cell lines, biohazard pathogens and some work with laser materials. Minor deficiencies identified during the inspection were analyzed and a program improvement plan was created. Results: Data analysis revealed minor deficiencies in the safety practices in the laboratories inspected. Defaults in the use of Personal Protective Equipment (PPE), laboratory manuals, chemical inventory keeping, and other safety procedures were discovered. Recommendations: Training and retraining of laboratory personnel; quarterly lab inspections.Item Personal, Psychological, and Family History Risk Factors for Emotional Eating Related to Obesity (2017)(2017-03-14) Franks, Susan; Mandy, Fanni; Lee, Michelle; Fulda, Kimberly; Tiu, CindyBackground: The concept that emotion strongly influences eating, referred to as “emotional eating” (EE), recently gained considerable interest in research. Previous evidence suggested that overeating by overweight individuals reduces anxiety and drives hyperphagia leading to obesity. The obesity literature indicated EE significantly differentiates obese from normal weight women. However, little is known about what other factors may contribute to EE. This exploratory study aims to better understand personal, psychological, and family history factors that might be associated with EE. Factors explored included gender, weight class, coping (COP), anxiety (ANX), stress (STR), and family histories (FH) of obesity and anxiety. Methods: Participants included adult men and women (n=59) with an average age of 31.38 years (sd=12.24) and an average BMI of 24.60 kg/m2 (sd=5.44). Self-report surveys included demographics, the State-Trait Anxiety Inventory to measure state ANX and the Eating and Appraisal Due to Emotions and Stress to measure STR, EE, and COP. Subjects were categorized into high and low EE based on standard error distance from the median. Chi square analyses were used to compare high and low EE with gender, weight class, FH of obesity, and FH of anxiety. T-tests were used to analyze differences between high and low EE for COP and STR. Results: EE was greater among women (n=14, 70.0%) than men (n=3, 21.4%), p=005. EE was greater with a FH of obesity (n=7, 77.8%) as compared to subjects without a FH (n=9, 37.5%), (p=.039). EE was greater among subjects with a FH of anxiety (n=10, 71.4%) as compared to subjects without a FH (n=7, 36.8%), p=.049. Coping was lower for subjects with higher EE (mean=80.00) as compared to subjects with lower EE (mean=84.94), p=.050. Anxiety was higher for subjects with higher EE (mean=36.13) as compared to subjects with lower EE (mean=29.06), p=.027. There were no differences in EE for weight class or recent stress. Conclusions: Women appear to be more at risk for EE than men. EE is also more likely with higher anxiety and poor coping skills. Additionally a FH of obesity or anxiety appears to put individuals at risk for EE. Clinicians should be aware of the factors related to EE in order to identify patients who are at risk and provide targeted interventions in order to prevent obesity and promote weight loss. Acknowledgement: Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R25HL125447 to Dr. J.K. Vishwanatha. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Item Faculty, Resident, and Nursing Attitudes Regarding Transitions of Care of Antepartum, Postpartum, and Gynecology Patients in the County Hospital Setting(2017-03-14) Hoang, Christine; Jackson, Angalene; Marshall, Hayley; Kremer, TimothyPurpose: To evaluate attitudes about a transition of care system and identify opportunities to improve the safety and quality of care involving antepartum, postpartum, and gynecology patients. Background: Handoffs and transitions of care have been a central part of patient safety goals at John Peter Smith Hospital. With twice daily shift changes for physician and nurses, the Department of Obstetrics and Gynecology introduced a new interdisciplinary team transition of care system. Initial anecdotal feedback suggested that the handoff process was suboptimal and communication efforts could be improved. A survey was developed to evaluate opinions about the process and identify areas for improvement. Methods: An anonymous online survey was administered to physicians and nurses participating in the new handoff system. The results were analyzed to identify opportunities for improvement. Results: Responses were analyzed from 21 members of the interdisciplinary team. 47% of the respondents found the transition of care system helpful. 55% felt their goals for handoffs were accomplished. All respondents reported importance in addressing updates on patient plans of care and anticipated discharge dates. Content of handoffs should focus on the acute and critically ill patients. The attending physician, chief resident, and nursing team leaders should participate in the handoff process. Conclusions: Differences in goals and content focus between nurses and physician contributed to suboptimal communication and handoffs. Identifying the deficits allow opportunities for improvement in transitioning care and ultimately the safe and quality of care provided to patients. Participation in the process should include faculty physicians, chief residents, and nursing leaders.Item Pilot Testing a Brief Elder Abuse and Neglect Screening Tool for Emergency Medical Services: Results from the DETECT Project(2017-03-14) Cannell, Brad; Reingle Gonzales, Jennifer; Livingston, Doug; Jetelina, Katelyn; Animashaun, RafiuObjective: To pilot test and evaluate the effectiveness of a brief elder abuse and neglect screening tool (DETECT) for Emergency Medical Services. Methods: The DETECT screening tool was pilot tested from September 17th, 2015 to October 27th, 2015 at a large mobile healthcare provider in North Texas. During this testing period, all medics were prompted to complete the DETECT tool when responding to a call for a community-dwelling patient who was 65 years of age or older. If the DETECT tool indicated a suspected cases of elder abuse, medics were instructed to contact APS. . The frequency of change in medic reporting to APS was evaluated, along with the predictive performance of the individual screening items. Results: The DETECT screening tool was successfully pilot tested for more than a month. Following the introduction of the DETECT screening tool, there was a 152% improvement in reporting rates with an increase of 3.6 (p Conclusions: Our study provides support for DETECT as an effective intervention for enhancing medics’ ability to identify and report EA.