2019
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Item Developing Interprofessional Collaboration to Advance Innovative Service Delivery in Geriatric Health Settings(2019-03-05) Severance, Jennifer; Saville, Neika; Hawley, Diane; Knebl, Janice; Johnston, LeahPurpose: Interprofessional collaboration is essential in geriatric healthcare settings due to the complex needs of older adults. The University of North Texas Health Science Center and Texas Christian University’s Harris College of Nursing partnered together to design the Geriatric Practice Leadership Institute (GPLI) ten-month training program with an aim of cultivating interprofessional team development and growth in order to enhance value-based patient-focused care to older adults in the developing primary healthcare systems. Methods: Leadership training and quality improvement strategies were integrated into curricula for health professionals (n=33) attending four one-day sessions held between September-December 2018. Content focused on 4 domains: 1) Leading Self and Interprofessional Teams to Drive Patient Outcomes; 2) Leading Organizational Change Toward Quality Outcomes; and 3) the Aging Network and Safe Healthcare Delivery for Older Adults. Teams developed a geriatrics-related quality improvement project in their area of practice with support from faculty and an assigned Coach. Evaluation surveys using Likert scale items were administered after each session. Open-ended responses were examined using qualitative thematic analysis. Results: Trainee feedback shows improved knowledge and skills in collaborating as a health care team to improve patient care and safety, and improved understanding of unique and shared roles and responsibilities and of ways to work collaboratively in patient care. Ninety-six percent better understand the need for a common language for team discussion and assessment, and 92% would recommend the training. Qualitative responses indicated the trainees intended to modify their professional practice as a leader and team member; and in the development, implementation, or evaluation of their project. Perceived challenges to meeting team goals include time restraints, coordinating schedules for group meetings, and stakeholder engagement within their organizations. Conclusion: Focusing on the development of interprofessional team collaboration and communication can foster development of interventions that improve geriatrics care in health systems. Interprofessional teamwork in conjunction with leadership training can produce rapid change in health practices. Projects developed within the GPLI are sustainable, providing continuous data collection for future use.Item Effect of Enhanced External Counter pulsation on Exercise Endurance of Different Populations(2019-03-05) Quiben, Myla; Liu, Howe; Zhao, MingmingAbstract Background and Purpose: Enhanced external counter pulsation (EECP)is a beneficial adjunct therapy used widely according to Cardiac rehabilitation guideline. However, the relationship between EECP and exercise endurance in non-cardiac disease people is still unknown. So, we design this study to explore the effect of EECP on exercise endurance of normal people, athlete, and chronic obstructive disease (COPD) patients, for providing potential intervention approach to improve the exercise endurance of these people. Methods: All volunteers (24 normal people, 24 sprinter athlete,24 COPD patients,72 subjects totally enrolled) who referred for EECP therapy (i.e., 35–36 one-hour sessions within a seven-week period) to Jiangbin Hospital, Guangxi, China from June 1st to Sept 1ST, 2018 were included. Demographic data, vital signs, quadriceps femoris muscle strength (QFMS) and baseline cardiopulmonary exercise test (CPET) data were collected. Exercise endurance and MS data before and after the treatment were compared. Results: All subjects in this study who had under-gone EECP had a positive clinical response. QFMS of normal group, athlete group and COPD group improved (p2), metabolic equivalent (Mets), oxygen pulse (O2-Pulse) at anaerobic threshold significantly increased in all three groups (p2, O2puls, Mets were increased after EECP (p<0.05). Conclusions: Enhanced external counter pulsation significantly improved QFMS and the exercise endurance of normal people, athletes and COPD patients.This study’s findings support the continued use of EECP therapy in these three kinds of people and provide one putative physiological mechanism to help explain the improvements in muscle and exercise endurance. Key Words: enhanced external counter pulsation; normal people; low endurance athletes; COPD; exercise enduranceItem Evaluation of Team STEPPS training in Skilled Nursing Facilities(2019-03-05) Ross, Sarah; Severance, Jennifer; Agena, Valerie; Oderberg, Jane; Sang, NancyPurpose Skilled nursing facilities (SNF) face many challenges in providing safe and competent care to a frail population. Surveys of SNF staff reveal poorer levels of safety culture compared to their hospital counterparts. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based interprofessional training program designed to teach tool to promote teamwork, communication, and patient safety. Implementation of TeamSTEPPS has led to improvements in patient safety culture in hospital settings, but there is a lack of evidence of benefit of TeamSTEPPS in SNF. Method Our research team adapted the TeamSTEPPS curriculum for implementation at two area SNF. We conducted three TeamSTEPPS training sessions to direct care staff (n=139). The trainings were delivered between October 2017 and June 2018. Focus group sessions comprised of the direct care staff (n=119) were then conducted at each facility between August and September 2018. The questions asked focused on staff perception on using communication tools, the training program itself, and feedback on program improvements. The comments from each of the sessions were than categorized to overarching themes. Results Thematic analysis of responses resulted in six major themes, communication, accountability, leadership/authority, implementation of the training, need for training and burn out. A majority of the comments from both facilities focused on the implementation of the training, communication, and accountability. Staff comments about the training implementation were positive and that they enjoyed the delivery method of the training and were able to apply the training to practice. Staff acknowledged that the communication tool led to improvements in communication between the staff from different shifts. Staff members also noted that they became more aware of their own roles and accountability to patient safety. Conclusion TeamSTEPPS training was well received by the direct care staff, and there were reports of improved communication and safety awareness. We anticipate that as direct care staff at SNF use TeamSTEPPS tools a positive impact will be seen on patient safety culture. Considerations for implementation of TeamSTEPPS tools in SNF requires a tailored approach. Barriers to success include high turnover in both leadership and direct care staff.Item A Student-Run Clinic as an Approach to Refugee Health(2019-03-05) Miller, Dallas; Lin, Christine; Gee, Kelly; Chang, Shannon; Hughes, JonathanBackground: Texas is one of the top U.S. states for refugee resettlement, receiving 9% of the country’s refugees from October 2018 to February 2019 alone. The Congolese and Burmese comprise most of the refugee populations in Texas, holding 57% and 21% of state arrivals, respectively. Within Texas, Tarrant county is currently one of the top counties where refugees are resettled. Before a refugee resettled in the U.S., they must undergo a tedious resettlement process that consists of biographical data collection, medical and security screenings, and interviews. Once approved, refugees are assigned to a non-governmental organization that aids in the often difficult transition to their new lives in the U.S. Many challenges during the resettlement process may prevent the individual from obtaining adequate medical care. Language, cultural beliefs, and socioeconomic factors are the major barriers to accessing health care services resulting in the underutilization of resources. Access to community health resources is often also hindered by I-485 form processing times approaching 2 years. As a result, many refugees do not seek out care until medical emergencies arise. Refugee Health Initiative’s goal is to establish continuity of care by connecting refugees seen at our health clinics with pertinent healthcare resources. Case Information: From October 2018 to February 2019, we have held 4 clinics at 2 locations and have seen a total of 67 refugees, of which, 23 were males and 44 were females. The average age of patients seen was 41.73 years. While all were seen for a general screening, common co-occurring complaints included cold and flu symptoms, blood glucose screening, abdominal pain, headache, and dysuria. Patient medical histories included diabetes, hypertension, nephrolithiasis, hyperlipidemia, and hypothyroidism. Conclusions: Refugee experiences in the clinic setting reveal problems in navigating the health care system. Language barriers prevent many from understanding diagnoses and medications, while those who are unsure of their insurance status are often lost to follow-up. Although breakthroughs are being made in outreach, continued innovation in approaching these populations is essential in developing a relationship of trust with Western health care methods. The Refugee Health Initiative’s clinic has the potential to become an entry point of care that can improve health promotion and deconstruct cultural misunderstandings of the healthcare system.Item Trial of Pazopanib in a Multiply Relapsed Osteosarcoma Patient(2019-03-05) Albritton, Karen; Akers, Lauren; Ray, Anish; Basha, Riyaz; Elete, KunalBackground: Osteosarcomas (OS) are typically found among adolescents and young adults and usually affect the long bones around the knee. The current treatment options for relapsed OS include surgery, chemotherapy, targeted therapy, or some combination of these modalities. Constitutive activation of tyrosine kinase mediated pathways leading to up-regulation of cell division and growth have been implicated in OS. This study identifies a patient at Cook Children’s Medical Center (CCMC) who, upon relapse, was treated with pazopanib, a multi-tyrosine kinase inhibitor, on compassionate basis, which led to stability of disease, along with treatment related toxicities. Case Information: A 25-year-old female initially presented with left femur osteosarcoma and was treated with chemotherapy consisting of methotrexate, doxorubicin and cisplatin followed by amputation and neo-adjuvant chemotherapy. Following 6 years of remission, she presented with two lung masses that were resected along with chemotherapy and radiation. After almost 2.5 years, she presented with progressive tumor in the right pleural base for which she was treated with pazopanib. She demonstrated positive response with stable size of tumor and increased homogeneity (suggestive of tumor necrosis) but ended treatment after 3 months due to hypothyroidism and GI toxicity, namely diarrhea. Within just 1 week of discontinuation, she had a concerning increase of 17% in her lesion. Thereafter, she has relapsed multiply but remains alive 18 months after discontinuing pazopanib. Conclusion: Despite the positive response seen to pazopanib, it’s toxicity profile can be over bearing for patients. In a retrospective analysis by Velho et al, a study involving 113 patients treated with pazopanib resulted in about 12% of those discontinuing treatment due to fatigue, diarrhea, and nausea/vomiting. In another study, described by Umeda et al, 3 patients with relapsed osteosarcoma who were treated with pazopanib were all alive at 21 months or longer. Of those, two discontinued treatment despite positive response due to nausea/fatigue, lymphopenia, anemia, hypothyroidism, and elevated alkaline phosphatase. Our experience as well of those as others suggests that pazopanib may have a role in prolonging survival among patients with osteosarcoma, however the extent of the side effects has clearly contributed to a lesser than optimal length of treatment.Item Diffuse Cutaneous Mastocytosis and its potential comorbidities in pediatric patients – a case study.(2019-03-05) Basha, Riyaz; Bowman, Paul; Hamby, Tyler; Smith, JohnBackground: Mastocytosis is the pathologic proliferation and accumulation of mast cells in various tissues of the body. There are different forms of mastocytosis that can present in pediatric patients including systemic (SM), cutaneous (CM) and diffuse cutaneous mastocytosis (DCM). Both the CM and DCM forms have the potential to progress into SM as the patient reaches adulthood. Mastocytosis has been shown to be comorbid with joint pathologies including Ehlers-Danlos syndrome and inflammatory gastrointestinal conditions such as eosinophilic esophagitis. The greatest risk among patients with mastocytosis is anaphylaxis. Case information:A13-week-old male presented to his primary care physician with erythematous spots on his torso and arms, and was diagnosed with eczema. The spots grew and transformed morphologically over the next month and a referral to dermatology was made. Upon biopsy of the original lesion (on the torso), the diagnosis of DCM was made. Over the coming months, symptoms progressed and comorbidities—including joint hypermobility (diagnosed with Ehlers-Danlos syndrome), dysphagia and diarrhea—arose. The patient broke his distal radius while crawling, due to his mast cell disorder and severe vitamin D deficiency. Conclusions: In most children with DCM, symptoms will partially or fully resolve by adolescence. But for some patients, the disease can progress to SM. Numerous comorbidities can occur, as did in this case. Current treatment strategies are wide ranging, from topical glucocorticoids to specialized UV radiating therapy. The specific approaches to this disease are still being understood, with recent investigations into immunological treatment modalities. The individuality of each case is crucial for health care professionals to recognize.Item Early detection of influenza outbreaks: an application of a Bayesian online change point detection algorithm with optimal hyperparameter estimation using the CDC Influenza-Like Illness Surveillance Network (ILINet) data(2019-03-05) Suzuki, Sumihiro; Liu, JialiangIntroduction Each year, the incidence of influenza (flu) and its financial costs are substantial in the United States (US). The Centers for Disease Control and Prevention (CDC) indicates that approximately 25 million people in the US were infected with influenza during the 2015-2016 flu season, leading to 11 million flu-related medical visits, and 12,000 flu-associated deaths. Although flu outbreaks occur every year, the timing and severity of these outbreaks vary from year to year. A critical component in averting the spread of the flu and its adverse consequences is early detection of imminent flu outbreaks. The earlier the detection, the more time there is to implement proactive prevention strategies against the spread of the disease. However, under the current gold standard for flu surveillance, the US Outpatient Influenza-Like Illness Surveillance Network (ILINet) conducted by the CDC, flu activity is estimated and monitored based on clinical and laboratory data. As such, there is always a delay of up to three weeks between the occurrence of the outbreak and dissemination of this information. Thus, there is an urgent need for improving and strengthening the flu surveillance system to provide timely outbreak information for guiding public health decisions that seek to prevent and control the disease. Purpose To test the feasibility for early detection of imminent flu outbreaks by applying a Bayesian online change point detection (BOCPD) algorithm with optimized hyperparameter estimation to the CDC’s ILINet data. Method CDC ILINet data from the week of 1/16/2010 through 4/29/2017 (N = 380 weeks) were used in the analysis. The CDC ILINet data consist of weekly number of people seeking medical attention with symptoms of influenza-like illness (ILI). Change points were detected using the BOCPD algorithm with a 1-year (52 weeks) rolling window. That is, instead of using a constant set of hyperparameters for the machine learning process, new hyperparameters were used every week when detecting change points, where the new hyperparameters were estimated using the data from the previous 52 weeks. CDC declares flu outbreaks using ILINet data when the percent of ILI during that week exceeds a predetermined threshold. For each season, the first change point that satisfied the following conditions was considered informative in early detection of the subsequent outbreak: (1) its percent of ILI visit was higher than that of the last change point, (2) its percent of ILI visit was less than the predetermined CDC threshold for an outbreak, and (3) the relative change between its percent of ILI and the CDC threshold was less than 50%. Results Except for the 2011-2012 flu season, we were able to detect the imminent outbreak, on average, 6 weeks prior to the actual outbreak. Conclusion Results suggest that the BOCPD algorithm may be effective in detecting flu outbreaks weeks prior to the start of the outbreak.Item An unlikely culprit of abdominal pain in a 23-year-old female: a case study(2019-03-05) Garda, Jacqueline; Bunyard, JulieBackground: Ovarian cancer is the most common cause of gynecologic cancer death in the United States. Ovarian cancer is most commonly seen in women over the age of 60, and the incidence of women aged 20 to 29 at diagnosis is 1.8 to 2.2 per 100,000 cases. Ovarian cancer can present either acutely or subacutely, and patients can remain asymptomatic for extended periods of time. Acute presentations involve shortness of breath due to malignant pleural effusion or severe nausea and vomiting due to a bowel obstruction, whereas subacute presentations involve bloating, urinary symptoms, early satiety, and pelvic or abdominal pain. Case Information: A 23-year-old female with no past medical history presented to the Emergency Department with sharp abdominal pain for 3 days duration, associated with subjective fever, chills, and nausea. On examination, she was hypertensive and tachycardic with abdominal distension and tenderness in the left lower quadrant. Her white blood cell count was elevated, and an abdominal and pelvic CT scan showed an extremely large complex solid and cystic mass measuring 31 by 27 by 20 cm concerning for ovarian malignancy. The patient was transferred to Obstetrics and Gynecology, where she reported further history of 15 pound weight gain, early satiety and new-onset irregular heavy bleeding for the last 3 months. A heavy, immobile mass was palpated during bimanual exam. An exploratory laparotomy was conducted, at which time the right ovary was found to fill the entire abdominal cavity up to the diaphragm. Right salpingoophorectomy and pelvic washings were performed and sent for preliminary frozen pathological examination, which resulted as possible mucinous adenocarcinoma. The mass excised was more than 10 kilograms. Gynecologic Oncology was consulted, and completed omentectomy, appendectomy and staging procedure. The patient recovered well post-operatively, and was discharged home 3 days later. The final pathology report was resulted as invasive adenocarcinoma of the right ovary arising in borderline mucinous cystic neoplasm, with no evidence of tumor in omentum, appendix, or lymph nodes. Conclusions: This case calls attention to the insidious progression of ovarian cancer, which is all the more dangerous when occurring in a patient demographic with such low incidence of disease. As the most common cause of gynecologic cancer death, ovarian cancer is an important differential to consider when patients present with even one vague subacute symptom.Item Tarrant County Breast, Cervical, and Ovarian Cancer Resources(2019-03-05) Philip, Sarah; DeVille, Heather; Mickle, Rebecca; Sankar, Aparna; Dolan, Kathryn J.; Hutton, SarahPurpose Breast, cervical and ovarian cancer are significant sources of morbidity and mortality in women in the United States, Texas and Tarrant County. One of the best ways to combat these cancers is taking appropriate preventative measures as needed as well as understanding one’s individual risk . Often survivors of breast, cervical, and/or ovarian cancer require significant community resources to help them navigate and recover from their cancers. This poster describes risk factors and demographics and identifies local support in Tarrant County for these groups. Methods The primary method of gathering the information and data shown here was research on governmental and non-governmental sources regarding statistics and demographics. Tarrant County community resources for these groups were identified using tarrant211.org and the Tarrant Cares website. Results Our research showed that that breast, ovarian, and cervical cancers are most commonly diagnosed in women aged 62 and older, 50-60 years old, and 35-44 years old respectively. Risk factors for each of these three cancers are identified, as well as resources for preventative screening and support for those who have had one of these diseases. Resources identified include the local chapter of the Susan B. Komen foundation, local chapters of the National Cervical and Ovarian Cancer Coalitions, the Tarrant County Indigent Health Care Program, and JPS Connection at John Peter Smith Hospital. Conclusions In Tarrant County, there are many different resources available for those who have breast, ovarian and cervical cancer, including local and national organizations that provide financial, medical and transportation services. Lack of both awareness and access to appropriate screening tools and information about these diseases are some of the biggest obstacles women in Tarrant county face.Item How Dirty is Your Phone?—Linking Restroom Behavior to Cell Phone Contamination at a Health Science Center(2019-03-05) Reynolds, Conner; Williams, Trevor; Underwood, Jacob; Jowitt, Janet Dr.; Lindsley, Joshua1. Purpose Preventable medical errors are the third leading cause of death in the United States annually, accounting for 251,000 lives annually. Healthcare-acquired infections (HAIs) account for nearly 40% of this population, costing the healthcare system $28.4-33.8 billion each year. Current efforts monitoring sources of HAI have set their focus on device-associated infections (i.e. central line, catheter, and ventilator-associated infections). Yet, in a recent Multistate Point-Prevalence Survey of Health Care-Associated Infections, device-associated HAI only accounted for 25.6% of instances detected. The rising prevalence of smartphone usage has also prompted researchers to target mobile phones as potential vectors for infectious transmission in healthcare. One potential area accounting for significant cellphone contamination is use in restrooms. 2. Methods In the present study, we surveyed students for their restroom cell phone usage. Following the survey, we then assessed the degree of contamination using an ATP Luminometer. 3. Results Using an ATP luminometer to measure surface contamination, students’ phones demonstrated an average level of 1702.09 ± 165.90 RLU/100 cm2. When correlating these contamination levels with survey behavior, some interesting things begin to emerge. There was a significant protective effect of hand washing, with a higher likelihood of washing leading to lower contamination levels (rs(101) = -.172, p 4. Conclusion Cell phones offer a world of information at the provider’s fingertips, allowing for higher quality care than ever before. However, these can easily become contaminated and are rarely disinfected. Taken together, the results of this study establish some of the first evidence for cell phone use behavior leading to surface contamination. To prevent these new smart devices from becoming fomites for infectious spread, it is the responsibility of health systems to implement cleaning protocols. This may reduce the overall rate of HAIs and preventable medical errors for patients across the United States.Item Analysis of Acetylcholine in Cerebrospinal Fluids by Liquid Chromatography–Tandem Mass Spectrometry(2019-03-05) Nguyen, Vien; Prokai-Tatrai, Katalin; Prokai, Laszlo; Ochoa, SamanthaAnalysis of Acetylcholine in Cerebrospinal Fluids by Liquid Chromatography–Tandem Mass Spectrometry Samantha M. Brewer, Vien Nguyen, Katalin Prokai-Tatrai and Laszlo Prokai Department of Pharmacology and Neuroscience, Graduate School of Biomedical Sciences Purpose: Acetylcholine (ACh) is a neurotransmitter whose decreased levels have been associated with several diseases impacting the central nervous system. Quantification of extracellular ACh in cerebrospinal fluid (CSF) is difficult due to its low concentration (owing to its rapid hydrolysis to choline) and matric effects upon employing liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) for quantification. The purpose of this study was to develop and validate an LC-MS/MS method for the high-throughput determination of ACh in rat brain microdialysates and possibly in clinical samples in the future. Methods: All analyses were performed on a TSQ Quantum Ultra mass spectrometer connected to a Surveyor MS high-performance liquid chromatography system (Thermo Scientific, San Jose, CA). Atmospheric spray ionization was used, and analytes were detected after fragmenting their intact cations through collision-induced dissociation. Deuterium-labeled ACh (ACh-d4) was used as an internal standard for quantification. Several solvent systems were compared to identify the best conditions for the preparation of ACh and ACh-d4 stock solutions to calibrate the assay. The optimized method was used to determine the extracellular ACh levels in rat brain microdialysates using the calibration curve obtained in aCSF. Results: In order to set-up a reliable assay, the MS signals for ACh and deuterium-labeled ACh (ACh-d4) used as an internal standard had to be optimized, along with optimizing the solvent systems for the preparation of their stock solutions. The optimal solvent system afforded linear calibration and resisted signal suppression by artificial cerebrospinal fluid (aCSF). Artificial cerebrospinal fluid is used as perfusion fluid upon microdialysis as it matches the composition of actual CSF. We have established that the use of purely aqueous stock solutions of ACh and ACh-d4 afforded the best calibration in aCSF. With these measures, reliable analyses of ACh in aCSF were achieved. The obtained linear calibration could be used for quantitation of low (physiological) ACh levels in samples obtained upon in vivo intracranial microdialysis from rat cortex. Conclusions: The method presented here allows for reliable quantification of ACh in cerebrospinal fluids, and may be used to evaluate the efficiency and mode of action of potential cholinergic agents. Acknowledgment: This research has been supported in part by The Welch Foundation (endowment BK-0031). IACUC Number: 2018-0006Item Sporotrichoid Lymphocutaneous Spread of Metastatic Cutaneous Squamous Cell Carcinoma(2019-03-05) Weis, Stephen; Al-Dossari, RannaBackground: Sporotrichoid lymphocutaneous spread is a dermatologic pattern characterized by superficial cutaneous lesions that follow subcutaneous lymphatics. Typically, this is observed when an infection starts at a site of distal inoculation and leads to the development of ascending nodules. The most common causes are fungal and mycobacterial infections. Metastatic cutaneous squamous cell carcinoma (CSCC) typically presents with regional lymphadenopathy. Primary lesions of the external ear and lip have the highest risk of metastasis, followed by the temple, scalp, hands, and feet. Risk factors for metastasis of CSCC include immunosuppression, tumor recurrence, tumor thickness [greater than] 4mm, and perineural or vascular invasion. However, metastasis of CSCC is rarely seen to follow a sporotrichoid lymphocutaneous morphology. Case Information: A 64-year-old female with a past medical history of severe COPD requiring repeated courses of prednisone and continuous oxygen, presented for a rapid growing lesion on her left hand after trauma in the shower at a nursing home. Due to her poor medical condition, she declined recommended biopsy with follow-up surgery. Patient underwent electrodessication and curettage surgery (EDC) followed by imiqumod treatment as she desired the least aggressive treatment. She also complained of a growth on her forearm at the initial visit. She reported after starting imiquimod, the lesion on her left hand has bled, drained and deepened in appearance. She also reported that the previous growth on her left forearm has grown in size and new lesions appeared on her upper arm and armpit. On exam, she had no healing at EDC site. She had developed an ulcer that exceeded the size of the original EDC. She had multiple erythematous, tender nodules of varying sizes on her left arm in a sporotrichoid lymphocutaneous pattern. She had left axillary lymphadenopathy. A biopsy performed of one of the nodules showed CSCC with intravascular and perineural invasion. Tissue cultures were negative for acid-fast bacilli, aerobic bacteria, mycobacteria and fungus. Chest X-ray did not show evidence of metastatic CSCC. Conclusion: This case highlights a rare presentation of sporotrichoid lymphocutaneous spread secondary to CSCC. The differential diagnosis included infectious causes and metastatic CSCC. Surgical excision is the treatment of choice for high-risk CSCC. She presented with signs of metastasis at initial presentation but these were not recognized. At follow up, she rapidly developed signs of metastasis in an unusual pattern. As malignancy is a rare cause of sporotrichoid lymphocutaneous spread, it is important to raise awareness to physicians who may see sporotrichoid pattern to consider the possibility of malignancy in their differential diagnosis, especially when there is a history of malignancy or there is a concomitant visible mass present.Item Are There Racial Differences in Hepatitis C Virus Infection among the Baby Boomer Birth Cohort? An Examination of the National Health and Nutrition Examination Survey (NHANES) from 2007-2016(2019-03-05) Sterling, David; Moore, JonathanBackground: Hepatitis C Virus (HCV) infection disproportionately affects those in the baby boomer birth cohort which includes those born between 1946 and 1964. Additionally, those who are African-American have an unequal burden of HCV infections and disease outcomes. Previous studies have found a relationship between race and HCV infection specifically within the baby boomer birth cohort. However, no study to our knowledge has investigated this relationship with data from a national sample using laboratory test results to identify HCV infection. Methods: Data from 2007 to 2016 were obtained from the National Health and Nutrition Examination Survey (NHANES), which included 3358 participants in this analysis. SAS 9.4 and G*Power were used for analysis and logistic regression was used for inferential analyses. Results: After controlling for selected covariates, Non-Hispanic Blacks had a higher odds of HCV infection compared to both Non-Hispanic Whites (aOR: 4.28 (95% CI: 1.87, 9.79)) and those of other races (aOR: 3.39 (95% CI: 1.38, 8.34)). Gender also remained significant in the multivariable analysis (p Conclusions: Race appears to be a significant predictor of HCV infection among baby boomers in the NHANES population. Programs interested in the prevention or improvement of Hepatitis C should focus on African-American baby boomers as an especially high-risk group. Due to the exclusion of those who are homeless and incarcerated in the NHANES data, future research needs to be conducted on baby boomers from these groups.Item Is Mental Health Status Related To Alcohol Use In Pregnant Women Ages 21-35?(2019-03-05) Hartos, Jessica PhD; Ramsey, Jessie B.S.; Sdao, Alee B.S.; Warner, Mackenzie B.S.; Friesenhahn, Lindsay B.S.1. Purpose: Alcohol consumption during pregnancy is a major health concern that is entirely preventable. The purpose of this study is to determine whether mental health status during pregnancy is related to alcohol use in pregnant women ages 21-35 years in the general population. 2. Methods: This cross-sectional analysis used 2016 data from the Behavioral Risk Factor Surveillance System (BRFSS) for 418 pregnant females ages 21 to 35 in Florida, Michigan, Minnesota, and New York. Logistic regression with combined state data was used to assess the relationship between mental health and alcohol use during pregnancy while controlling for tobacco use, educational level, income level, employment status, marital status, ethnicity/race, and age. 3. Results: Across states, few participants reported any alcohol use (10-12%), about one-third reported having mental health issues in the last thirty days (27-40%), and few reported they were current smokers (0-15%). Adjusted results indicated that alcohol use during pregnancy was highly related to mental health status and tobacco use. 4. Conclusions: This study found that mental health status was significantly related to alcohol use during pregnancy for women ages 21-35 years. Clinicians in obstetrics and gynecology should expect to find approximately 1 out of 10 women to report any alcohol use during pregnancy and about one-third to have mental health issues in the last 30 days. Since these two factors are problematic and highly related, providers should screen and counsel all pregnant women about alcohol use and mental health at each appointment. Smoking was also found to be highly related to antenatal drinking. At each visit, clinicians should continue to screen and counsel any pregnant patients on smoking cessation. If additional treatment for mental health or substance use is required clinicians should provide additional resources and referrals to psychiatry or substance abuse programs.Item Senior Medical Student Attitudes Toward Radiology and Confidence in Their Imaging Skills(2019-03-05) Smith, Spencer MD; Jafri, SaadPurpose: Most medical students do not receive formal radiology training until clinical rotations which is taught in the context of medicine/surgery, or during an elective rotation that is not a part of the core curriculum, leading to young physicians who are sub-optimally prepared to interpret imaging studies. In addition, other physicians’ attitudes towards radiology may be biased by a lack of early exposure to radiologists during medical school. This study is designed to determine senior medical student attitudes toward radiology and their radiology skills confidence levels both prior to and following an elective radiology clerkship in an effort to improve radiology instruction. We hypothesize that a radiology clerkship will positively impact students’ attitudes towards radiology as well as increase their confidence in their own imaging skills. Methods: 4th-year TCOM medical students enrolled in an elective radiology clerkship were sent anonymous online pre and post-clerkship survey via email 2 weeks before the start of their clerkship and 2 weeks after conclusion of the clerkship. The 4-week course covered more than the basics of diagnostic radiology that graduating students should know in preparation for internship. Responses were restricted to 1 per student. Results: 17/25 students enrolled in the February 2019 radiology clerkship responded (68%). At the time of this abstract, only a pre-clerkship survey was conducted. Students were, on average, not confident in their overall image interpretation skills (2.47/5). However, students had higher confidence interpreting plain radiographs (2.94/5) as opposed to computed tomography scans (2.06/5, p = 0.0096). Regarding student attitudes towards radiology, most found radiology to be “interesting in its own right” (58.8%). In addition, students found having a basic working knowledge of radiology important (52.9%) and vitally important (47.1%) in becoming a competent doctor. Finally, students reported that radiology findings often (52.9%) and very often (41.2%) change patient care. Conclusion: The pre-clerkship survey results demonstrate that fourth-year medical students at TCOM lack confidence in their ability to interpret imaging studies. However, they regard radiology as quite important to the contemporary practice of medicine. An identical post-clerkship survey will be offered to the original survey respondents to determine the impact of a didactic radiology clerkship on pre-existing student impressions.Item Microbial Natural Product Drug Discovery Through Systematic Sampling of Diverse Texas Soils(2019-03-05) Patel, Rinkal; Cheng, Yi-Qiang; Currens, GrantPurpose: Microorganisms have long been a valuable source of new pharmaceutically relevant small molecules. Because of their intrinsic need to compete for scarce resources in their microenvironment, they have often adapted to produce secondary metabolites capable of exerting cytotoxic effects against competing microorganisms. Microbial natural products and their derivatives account for nearly half of the currently approved anti-infective and anti-cancer drugs. Because of the State of Texas’ rich soil diversity, systematically collecting and fermenting bacteria and fungi collected around the state should yield a library of interesting and diverse molecules which can then be screened for desirable activities and identified for use as lead compounds in pharmaceutical research. Methods: To validate this project, the chemical crude extracts from 80 fungal species were separated through reverse-phase flash chromatography and screened for cytotoxicity against MIA PaCa-2 (ATCC® CRL-1420), SH-SY5Y (ATCC® CRL-2266), and COLO 829 (ATCC® CRL-1974) cancer cell lines as measured by Promega’s CellTiter-Glo® Luminescent Cell Viability Assay (ATP-Luciferase assay). Subsequently, a short-list of fractions containing promising cytotoxic compounds was identified and those fractions were subjected to further purification through multi-step activity-guided reverse-phase high-performance liquid chromatography (HPLC). Accurate masses and isotope distributions for compounds were assessed through time-of-flight mass spectrometry (TOF MS) and compared to known compound databases for dereplication. The purified compounds then underwent high-resolution proton and carbon NMR studies to determine their structure and novelty. Results: The first 80 fungal species collected from around the state were separated into 800 flash chromatography fractions of which 17 exhibited consistent cytotoxicity against MIA PaCa-2, a human pancreatic carcinoma cell line. Early study of a further narrowed test-group of 8 fungal species has thus far yielded a few interesting compounds. Notably of these species, one produces a compound with a mass of 401.257 which has been observed in multiple HPLC generated fractions exhibiting [greater than] 99% cell clearance after 48 hours. Based upon the accurate mass and isotope distribution, this compound preliminarily does not appear to have been previously described. Sufficient quantities of purified compound have been produced to perform high-resolution proton and carbon NMR to determine compound structure. Conclusions: We have seen from our preliminary study that we can systematically construct and screen a library of natural products derived from Texas microbes as way to identify lead compounds which exert cytotoxic effects on established cancer cell lines. Further, through collaboration, this library can be screened against a wider variety of targets to aid in identifying valuable lead compounds.Item Reconstituted high-density lipoprotein as a potential delivery vehicle for TAMs re-polarization agents(2019-03-05) Sabnis, Nirupama; Raut, Sangram; Lacko, Andras G.; Dossou, AkpedjePurpose: As part of the tumor microenvironment, tumor-associated macrophages (TAMs) form a functionally heterogeneous population where the pro-inflammatory M1 type macrophages exert anti-tumoral function by enabling the activation of cytotoxic immune cells while immunosuppressive M2 type macrophages support tumor progression, angiogenesis, immune system evasion and metastasis. However, TAMs display a high ratio of M2 to M1 macrophages, and this polarization is promoted by tumor secretions. Thus, their presence in tumor microenvironment is associated with poor prognosis. Because the reversal from M2 to M1 constitutes an attractive cancer immunotherapy strategy, there is a need for targeted selective delivery carriers for reversal agents to avoid off-target effects. Reconstituted high density lipoprotein (rHDL) nanoparticles (NPs) are biocompatible with various administration routes, and they have been confirmed to deliver their cargo to targeted cells via a scavenger receptor class B type 1 (SR-B1)-mediated uptake. In addition, Apolipoprotein A1 (ApoA1), one of the components of the rHDL NP, has been shown to promote a M2 to M1 reversal of TAMs. Hence, we propose that rHDL NPs are particularly appropriate to deliver specific re-polarizing agents to TAMS to achieve a predominately M1 type TAM population, and thus enhance the effectiveness of tumor immunotherapy. Methods: The rHDL NPs were prepared using egg yolk phosphatidylcholine, free cholesterol, cholesterol oleate and the ApoA1 protein. The size, polydispersity index and zeta potential of the NPs were assessed by dynamic light scattering. Transmission electron microscopy confirmed size and uniformity of the rHDL NP preparation. Raw 264.7 macrophages were polarized to M1, M2a and M2c by using respectively lipopolysaccharide + interferon-gamma, interleukin-4, and interleukin-10. Protein expression was confirmed via immunoblot. Results: The rHDL NPs show a sub-50 nm size and form a fairly homogeneous preparation. M2 type macrophages display a higher SR-B1 expression than the M1 type (Raw 264.7 macrophages). Conclusions: Findings of these and earlier studies show that the rHDL NPs may be particularly suited to deliver reversal (re-polarizing) agents to M2 macrophages.Item Survivin as a New Target for Neuroblastoma(2019-03-05) Basha, Riyaz; Umesh, Sankpal; Hernandez, Yazmin; Zakhary, EmilyBackground: Neuroblastoma is the most common solid peripheral nervous system pediatric tumor found in pediatrics. Neuroblastoma (NB) commonly metastasizes through the lymphatic system and bone marrow, and has a particularly poor prognosis in children older than 18 months, with five-year survival rates typically around 40-50%. Our group is investigating for less toxic agents against NB cells. We found that Tolfenamic acid (TA), a small molecule had anti-cancer effects in high risk neuroblastoma (HRNB) cell lines. Survivin has been associated with poor prognosis in several types of cancers. Survivin is a protein that specifically inhibits the caspase apoptotic proteins thus negatively regulating apoptosis. We conducted a search of various databases in order to investigate the association of Survivin with the survival of NB patients. The other objective was to test an agent that could target Survivin an inhibit NB cell growth. Materials: We utilized R2 genomics and visualization platform to generate survival curves, looking specifically at overall and relapse-free survival probabilities in NB patients. The graphs were made using the data from 88 patients. We also used NB cell line for in vitro testing. SH-SY 5Y cells were cultured it in the presence of copper TA and cell viability was assessed at 24 and 48 hours. Protein extracts were prepared and analyzed for the expression of Survivin using Western blot analysis. Results: We found that the overall survival probability for NB patients with high expression of Survivin had a significantly poorer prognosis (p: 8.5e-9), than those with lower expression of Survivin. Similarly, the relapse-free survival probability curve also demonstrated that high expression of Survivin was associated with a poorer prognosis (p: 1.9e-6) than patients who had lower expression levels. Thus demonstrating that there is a strong association with high Survivin expression and poor prognosis. We also found that Cu-TA acted as an effective inhibitor to Survivin in our laboratory research with the SHSY-5Y cell line. Conclusion: The survival curves showed a strong association of Survivin with poor prognosis. The complexed agent, Cu-TA acts as an efficacious inhibitor of the HRNB cell line SHSY-5Y potentially inhibiting Survivin. Going forward, further research should be done to identify novel less toxic therapeutic agents to target Survivin, in hopes of better treating HRNB cell lines.Item Is Weight Status Related to Mental Health Status in Young Adult Females?(2019-03-05) Etzel, Amelia; Lau, Emily; Vertin, Gloria; Hartos, Jessica; Enzor, AlexandraPurpose: The aim of this study was to assess the relationship between weight status and mental health status in young adult females given limited research regarding the relation between these variables in this target population. Methods: This cross-sectional analysis used 2016 BRFSS data for young adult females ages 18-34 from Alabama (N=636), Kentucky (N=751), Louisiana (N=303), and Mississippi (N=441). Ordered logistic regression was conducted separately by state to assess the relationship between mental health status and weight status while controlling for general health status, physical activity, sleep duration, substance use, income level, education, employment status, age, and ethnicity/race. Results: About half of young adult females reported low or moderate mental health status (43-54%) in the last month, and the majority reported being overweight (26-32%) or obese (29-38%). The results of this study indicated that mental health was not significantly related to weight status in 3 out of 4 states after controlling for health-related factors, substance use, socioeconomic factors, and demographic factors. However, mental health was positively related to general health status, and inversely related to sleep and age in all four states. Conclusion: Overall, in females ages 18-34, there was a moderate prevalence of low or moderate mental health status and a high prevalence of overweight or obese weight status, but mental health status was not significantly related to weight status. Therefore, primary care practitioners should screen all patients for both but treat separately. However, mental health was positively related to general health and inversely related to sleep duration and ages 18-24. As these are significantly related, primary care practitioners should screen for all and treat concurrently. Practitioners should educate patients on improving general health status and on the importance of getting six or more hours of sleep each night, and provide referrals as necessary.Item Application of an Interprofessional Team in Pediatric Nutritional Wellness(2019-03-05) Baker, Bryan; Farmer, David; Rew, Martha; Habiba, Nusrath; Muqueet, SameeraPurpose: Childhood obesity poses a significant health risk to children in the United States and has been increasing in recent years. Childhood obesity is associated with increased risk of hyperlipidemia, diabetes, and hypertension manifesting later in life. Early intervention is crucial in preventing these health problems. Therefore, it is important that parents receive early education on nutritional wellness as well as the most accurate information possible. A team-based application of health care delivery is one possible way of achieving this patient education. This study aims to evaluate patient satisfaction with the use of an interprofessional healthcare team in delivering nutritional wellness information to parents in an outpatient pediatric clinic. Methods: Patients were seen by a three member interprofessional team consisting of a Physician or Physician Assistant (PA), medical student or PA student, and dietetic intern. At the end of the visit, patients were given a survey to assess their satisfaction with the visit. The survey evaluated patient satisfaction with the interprofessional team with, how helpful and how likely they were to use the nutritional advice given to them during the visit, and their perception on whether the interprofessional team improved the quality of their visit. Patients were asked to rank these factors on a scale of 1-5 with 1 being unsatisfied and a 5 being highly satisfied. Results: Out of 95 patients, 96.8% rated their happiness with the interprofessional team as a 5/5; 95.7% rated the helpfulness of the nutritional advice 5/5; 94.7% rated their likelihood of utilizing the nutritional advice 5/5; 94.7% rated the improvement in the quality of their visit 5/5. Conclusions: Overall, patients were satisfied with the nutritional information they received from the interprofessional team and viewed being seen by a team as an improvement in the quality of their visit. Utilizing an interprofessional team has the potential to be an efficacious method of delivery of nutritional information to patients and improve wellness and prevention. In future studies, the likelihood of patients to implement this nutritional advice will be tracked via EMR and compared to groups that were not seen by an interprofessional team in order to assess the efficacy of team-based healthcare.