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Item Patient Perspectives Unveiled: An Analysis of Common Questions and Concerns to Empower Informed Healthcare Dialogues with Elderly Patients Taking Multiple Medications(2024-03-21) Schneider, Clara; Lal, Kevin; Espinoza, Anna; Xiao, Yan; Hendrix, Noah; Young, Richard; Fulda, KimberlyPurpose: Health literacy is often a barrier to patient understanding and effective communication with healthcare providers. Patients are often unaware of what questions to ask during their visits and leave their provider offices without fully understanding their conditions or medication regimens. Past studies have shown that facilitating patient dialogue through structured questions during the encounter results in fewer patient callbacks and improved comprehension. The goal of this study was to identify the most common questions and concerns that patients 50 years and older who are on five or more medications would like to discuss with their physicians about their medications. Such data could help physicians anticipate and educate patients with information most valuable to them during office visits. Methods: We designed a 20-question survey to better understand what patients desired from their primary care visit including questions to ask, concerns to tell, and positive behaviors to report to their provider. We focused on the ask and tell sections which involved presenting questions or concerns that were pertinent to the patient's conditions or medications. Participants included patients at family medicine clinics from a county hospital system (240) and a private practice (211) in Fort Worth who were 50 years of age or older and taking five or more medications. Surveys were administered at a clinical visit by the medical assistant before the physician/patient encounter. Descriptive statistics are provided. Results: Out of 451 surveys completed, the questions that patients were most interested in talking with their physician included: 1) What should I eat, and what should I not eat for my condition? (20.4%) 2) Can I take fewer medicines than I am taking? (15.3%) 3)How do I learn more about my condition? (14.6%) The least common questions were 1) Why do I need several medications for my condition? (8.2%) 2) Other questions: (8.6%) 3) How can I stop my blood sugar, heart rate, or blood pressure from getting too low? (9.1%) The most common concerns about their medications were: 1) I stopped or skipped these medicines, due to: cost, side effects, or other reasons (11.1%) 2) I have new medicines from other doctors (offices, hospitals or emergency rooms) (8%) 3) I have concerns with my medicines (examples: cost, hard to read, not helping much) (5.7%) Conclusions: It is evident that patients are interested in learning about their conditions and making appropriate lifestyle changes. The most commonly raised concerns were related to medication access, polypharmacy, and efficacy. These data show some of the potential topics patients want to discuss with their providers. The most common topics from this study can be implemented into a question prompt lists (QPL [https://onlinelibrary.wiley.com/doi/abs/10.1111/ecc.12489?casa_token=kGVvFBSWANEAAAAA:NOhQ46f92KtdNp9XgslcAiwEoB6MI0N4K1vOA2P7FyFQ_BBgv0BycKPBy4sLKk_e9Cki971trjdfoL1k]) specific to medications and chronic disease management. Providers could give lists to patients to review while waiting for care. Having these topics beforehand would help the patients be prepared when presented with “what questions do you have?”; thus, revealing the patient's perspective and helping to increase their health literacy.Item Optimizing Medical Education: Integrating Palpation and Radiologic Imaging in Simulation Labs(2024-03-21) Sankhavaram, Mira; Selby, Samuel; Mize, Will; Wieters, Matthew; Isa, Salman; Smith, Spencer; Papa, FrankPurpose: UNTHSC’s Regional Simulation Lab has created many opportunities for faculty to move beyond traditional, classroom-based approaches to an advanced, simulation-based learning environment. Unfortunately, there is minimal literature regarding the effective integration of distinct skills given that these sophisticated technologies can portray case scenarios that require the successful application of several skill sets. The investigators will utilize approximately 10 – 15 minutes of the two hours of time scheduled in the year two GI course, to support students in integrating the two primary skill sets introduced 'separately' earlier. This instructional activity will provide students an opportunity to simultaneously see CT and Ultrasound scans representing an abnormal abdominal finding while simultaneously palpating (on a high-fidelity abdominal simulator) the associated abnormal physical examination findings. Methods: UNTHSC utilizes a post-course evaluation tool collecting student feedback for continuous quality assurance of its curriculum. This year's post-course evaluation questions contain both a standardized set of questions and an additional set of questions designed to gather student opinions about how the course might be improved. Included in the survey were two sets of questions about the skills developed in this two-hour GI training activity. The first set of questions is about the adequacy of the time spent in: 1) Ultrasound training in isolation, 2) abdominal palpation training in isolation, 3) the simultaneous training of both Ultrasound and CT images, and palpation training. The second set of questions represents student opinion regarding the percentage of the two hours of instructional activity that should be spent with 4) Ultrasound training in isolation, 5) abdominal palpation training in isolation, and 6) simultaneous training in both Ultrasound and CT images, and palpation. Results: Our findings, based upon a survey of 99 students, reveal the value of integrating palpation with radiologic imaging more than performing either skill in isolation. The survey suggests that students would prefer spending about three times longer in the lab integrating these two skill sets compared to the original 15 minutes allocated. Conclusion: While traditionally topics in medical education are delivered to students in a piecemeal fashion, with the focus on mastering each skill in isolation before moving on to the next, this survey demonstrates that students value more opportunities to integrate various skills as they are first being introduced. This provides students with a more realistic understanding of how to use the resources they will have in the clinical setting to arrive at a diagnosis. This notion is further supported by the open-ended feedback solicited from the participants. In their comments, there is a strong desire for a more case-based approach to learning, in which students have the autonomy to work to solve a patient problem and dictate their diagnostic process in a more realistic, linear fashion rather than learning by simple demonstration and repetition. While more research is needed, these results demonstrate the value students place in integrating emerging simulation technology with pre-clinical medical education to help prepare students for their role in the clinical environment.Item An Evaluation of School-Based Health Centers' Program Elements(2024-03-21) Seiffert, Amanda; Nguyen, SharonPurpose: School-Based Health Centers (SBHCs) are being evaluated for their effectiveness worldwide. They consist of facilities providing health care services to children located on or near a school campus. SBHCs have a goal of advancing equity at the intersection of health and education, especially for students facing barriers to needed services. SBHCs use differing strategies that need to be assessed to identify which are most effective in implementing positive change for students. The purpose of this study is to analyze which aspects of SBHC mental and behavioral health services have been demonstrated to be successful in providing the best possible care to students. Three specific research questions were addressed: 1) what SBHC outcomes have been evaluated in the literature 2) what barriers to implementation are identified, 3) are there models that integrate on-site and telehealth service delivery. Methods: This study was conducted in accordance with PRISMA guidelines for rapid systematic reviews using Covidence software. Key words were searched in PubMed, Scopus, Cinahl, and PsycINFO databases, and resulted in 436 articles being identified. After duplicates were removed, 230 studies remained. Titles and abstracts of these studies were screened using defined inclusion and exclusion criteria screen. Following the screening, 13 studies were included for complete review. Data extraction was performed addressing the three research questions above and included use of school-based health centers before and after the 2020 pandemic. Results: 1) SBHC outcomes identified in the 13 studies included academic performance, tardiness, attendance, discipline, school connectedness, and commitment to educational future. 2) Two studies examined barriers to implementation and identified high turnover among staff and patients, insufficient buy-in, and insufficient time for training and planning. 3) Two studies were identified that examined hybrid models combining telehealth and on-site care Conclusions: SBHC use is significantly associated with increases in GPA over time and these effects are moderated by the types of services used. SBHC use indirectly impacts academic performance by improving health and emotional well-being, but the association with attendance was variable. Tardiness was increased in SBHC users, but SBHC users reported higher scores relating to school bonding. This implied that the users reported happiness at school and looked forward to going to school. While these outcomes are of importance to school stakeholders, students, and families, the measurement of mental health outcomes in existing studies is limited. Implementation of school-based health centers had its challenges, including high turnover among staff, lack of buy-in and leadership among staff, and insufficient time for planning and training. Integrating educators and school-based health clinics could create more buy-in as staff would be more aware and potentially more supportive of school-based mental health clinics overall. There was limited evidence that met inclusion criteria regarding the hybrid model, however, the evidence showed that the hybrid model increased access to care. Studies also found that SBHC use increased significantly following the pandemic of 2020, due to increased health awareness and mental health struggles that occurred during this time.Item Understanding the Pressure Recovery Phenomenon: A Case Study on the Discrepancies Between Echocardiography and Cardiac Catheterization in Aortic Stenosis Assessment(2024-03-21) Jafferji, Fatema; Patel, Kavita; Kline, GeoffreyThis detailed case study addresses the significant clinical implications of the pressure recovery phenomenon in the assessment of aortic stenosis (AS), emphasizing the discrepancies that can arise between echocardiography (ECHO) and cardiac catheterization measurements. The focal point of this study is an 80-year-old male patient with a complex medical history of coronary artery disease, hypertension, diabetes, and dyslipidemia, who underwent evaluation for AS. Our patient presented with a grade 3/6 systolic murmur loudest at the right upper sternal border consistent with AS but was asymptomatic for common cardiac-related symptoms such as angina, dyspnea, extremity edema, and syncope. The echocardiographic assessment indicated severe AS, with the aortic valve area measured at0.79 cm² and pressure gradients at 50 mmHg (mean) and86 mmHg (peak). However, a significant divergence was observed during cardiac catheterization, which showed a considerably lower gradient of30 mmHg, indicative of moderate AS. This discrepancy is analyzed through understanding the pressure recovery phenomenon. This phenomenon occurs when blood, having flowed through a narrowed valve at high velocity (and hence low pressure), enters a larger vessel like the ascending aorta, leading to a reconversion of kinetic energy into potential energy, and thus, a recovery of pressure. This results in an overestimation of pressure gradients when using ECHO, as opposed to the direct measurements obtained via cardiac catheterization. The study delves into the broader clinical implications of this phenomenon, particularly its influence on the categorization of AS severity and the subsequent impact on clinical management decisions. The case demonstrates how a diagnosis of severe AS based on ECHO findings might lead to considerations for surgical or percutaneous interventions, which could be unnecessary or even risky for the patient, as highlighted by the more moderate classification derived from catheterization results. In conclusion, this study emphasizes the necessity for clinicians to be aware of the pressure recovery phenomenon and its potential to skew AS assessments. It advocates for a comprehensive, multimodal diagnostic approach, integrating both echocardiography and catheterization findings along with a thorough clinical evaluation. This approach would ensure a more accurate assessment of AS severity, leading to safer and more effective patient management strategies. The study also suggests the need for enhanced educational efforts to increase awareness and understanding of this phenomenon among healthcare providers.Item Investigating the mechanism of action of metformin and tolfenamic acid in medulloblastoma cells(2024-03-21) Sharna, Ansley; Mata, Fernanda; Sankpal, UmeshPurpose: Medulloblastoma, a highly malignant CNS tumor primarily diagnosed in children, presents a complex challenge in the field of medicine. While current multimodal treatment approaches, including total excision, chemotherapy, and radiation, yield relatively high survival rates, they are often accompanied by a range of significant adverse effects in adulthood, including neurological and motor deficits, endocrine dysfunction, hearing loss, and secondary tumors. Thus, more recent studies have shifted their focus to developing alternative, more precisely targeted anti-tumor therapies to mitigate the toxicity associated with existing therapies and enhance patient quality of life. An approach to address this problem involves investigating the synergistic potential of drug combination therapy using FDA-approved drugs to treat medulloblastoma. Among the drugs being investigated are Metformin (Met), an antidiabetic medication, and Tolfenamic Acid (TA), a nonsteroidal anti-inflammatory drug (NSAID) used for migraine treatment. Both drugs have been shown to exhibit anti-cancer activity. Previous work conducted in our laboratory has provided evidence of TA’s anticancer activity being mediated through the downregulation of pro-cancer Sp1 and survivin protein expression. The objective of this study was to enhance understanding of the mechanisms of action of metformin and tolfenamic acid by assessing their cell cycle-associated effects on DAOY human medulloblastoma cancer cells using Western blotting and flow cytometry techniques. Methods: The efficacies of Met and TA in terms of their anticancer effects were evaluated by determining the IC50 values of each drug using CellTiter-Glo and CCK-8 cell viability assays. The cell cycle effects of TA and Met were studied by Western blot analysis using protein extracts from treated DAOY cells. In addition, a cell cycle analysis of treated cells was performed using flow cytometry. Results: In our studies, both TA and Met were found to demonstrate anti-proliferative effects on DAOY cells. As demonstrated by Western blotting and flow cytometry analysis, the antiproliferative effects of both TA and Met were mediated through cell cycle arrest. Conclusion: This study suggests the significant potential of utilizing Met and TA in novel drug combination therapy for medulloblastoma. Their effects on protein expression open possibilities for enhancing cell cycle arrest or inducing apoptosis while decreasing the use of toxic therapies. Given the importance of minimizing long-term effects in children being treated for medulloblastoma and enhancing their quality of life, the mechanisms of Tolfenamic Acid and Metformin can be further explored.Item Maternal Risk Factors Do Not Correlate With AKI in Patients With Congenital Heart Disease (CHD)(2024-03-21) Carl, Christopher; Najjar, Sam; Ogunyankin, Fadeke; Modem, Vinai; Lanier, LanePurpose: Acute kidney injury (AKI) is a common complication in children who undergo cardiopulmonary bypass (CPB) and is correlated with longer hospital courses and worse outcomes. Several risk factors exist which increase the risk of AKI in pediatric populations, including premature birth, congenital heart disease (CHD), and prolonged CPB time. Maternal risk factors can impair nephrogenesis in utero, thereby increasing the likelihood for developing AKI. However, it is yet to be shown if maternal risk factors lead to an increased incidence in AKI in pediatric patients with CHD who undergo CPB. We examine the incidence of four maternal risk factors—pre-eclampsia, maternal hypertension, gestational diabetes mellitus, and maternal smoking—in 252 pediatric CHD patients who underwent CPB surgery. The purpose of this project was to examine the incidence and predictors of AKI in pediatric patients who underwent cardiopulmonary bypass (CPB) surgery at our institution. We hypothesize an association between maternal risk factors and AKI incidence in pediatric patients with CHD who underwent CPB surgery. Methods: We performed a retrospective study on 252 patients who underwent CPB for repair of a CHD between March1, 2020, and March 1, 2022. Patients were between ages 0-12 months at time of surgery and received care in the cardiac intensive care unit (CICU). P-value of 0.05 was used to determine statistical significance. NGAL levels and Cystatin C levels were also obtained. Results: Forty-four patients (17.5%) developed AKI by KDIGO criteria, with only 2.4% of those meeting stage 2 or 3 AKI. Fifty-one (24%) patients demonstrated elevated urine NGAL levels after bypass (>125). Eighteen patients (8.4%) had elevated levels of Cystatin C. Pre-eclampsia was not protective in regards to AKI in our population. Maternal smoking, maternal gestational diabetes and maternal hypertension did not correlate with development of AKI in children with CHD undergoing CPB. Conclusion: We found no association between maternal risk factors and AKI incidence in CHD patients undergoing CPB surgery in this cohort. Elevated NGAL levels and Cystatin C levels following CPB did not individually correlate with increased odds of developing AKI.Item Resources and Opportunities Available for Allopathic and Osteopathic Medical Students Pursuing Otolaryngology: A Comprehensive Analysis(2024-03-21) Stucki, Brenton; Patel, Arpan; Judd, Dallin; Bruner, WilliamIntroduction: Otolaryngology, commonly known as Ear, Nose, and Throat (ENT), is a surgical subspecialty dedicated to addressing conditions of the head and neck. It is no surprise that matching into surgical subspecialties such as otolaryngology - head and neck surgery becomes more and more competitive each year. Data indicates that each year on average, students are performing at higher levels than years previous. This increase in competitiveness prompts the development of resources including specialty-specific information to be made more readily available to students. This review aims to identify key ENT organizations in the United States that may provide pivotal tools for medical students. Through an analysis of these organizations, this study reveals opportunities available to medical students through organizations such as research opportunities, conference scholarships, mentorship programs, and avenues for leadership roles. Furthermore, emphasizes the significance of research experience, leadership roles, academic performance, and compelling letters of recommendation, which are crucial in the application process. By focusing on these critical aspects, the primary aim is to highlight resources that can equip medical students with the necessary skills and experiences to apply for an ENT residency successfully.Methods:147 organizations were identified by the University of North Texas Health Science Center (UNTHSC) Gibson Library. A search conducted then by three independent researchers via Google Search contributed an additional 30 organizations. The combination of these sources resulted in a preliminary list of 177 organizations. Three duplicates were eliminated, thus decreasing the list to 174 unique organizations. The next stage of screening was predicated on the relevance of these organizations to the field of Otolaryngology. Three independent researchers excluded 129 entities sourced from the UNTHSC Gibson Library. Further reviews were conducted and a finalized cohort of fourteen national otolaryngology - head and neck surgery organizations were selected for comprehensive evaluation. Information regarding the following information was gathered and compiled for review and comparison: Organization Focuses on a Subspecialty of Otolaryngology, Organization Allows Both MD and DO Student Membership, Medical Student Cost to Join Organization, Annual Meeting, Research Presented at Annual Meeting, Medical Students can Present at Annual Meeting, Medical Student Registration Fee for Annual Meeting, Annual Meeting Registration / Travel Scholarships Available for Medical Students, Mentorship Available Within the Organization for Medical Students, Leadership Opportunities Available for Medical Students, Scholarships/Grants Available for Medical Students, Educational Material Available to Medical Students. Results: The comprehensive analysis highlighted resources and opportunities available for allopathic and osteopathic medical students pursuing otolaryngology. These entities offer numerous benefits, including research opportunities, educational materials, annual meetings, and access to subspecialties. These organizations can provide a competitive edge to medical students who take advantage of these benefits. Conclusion: In conclusion, this analysis underscores the vital support that professional organizations offer to medical students pursuing otolaryngology, highlighting the significance of mentorship, research opportunities, and educational materials. It urges medical students to actively engage with these organizations to enhance their career prospects in this field. However, identified gaps in mentorship, travel financial aid, and leadership roles point towards areas needing enhancement.Item Impact of gross anatomy review on ultrasound learning in first-year medical students: A pilot study(2024-03-21) Robertson, Taylor; Reeves, Rustin; Meyer, Kimberly; Satsky Kerr, Marcel; Handler, EmmaIntroduction: Ultrasound (US) integration in undergraduate medical education (UME) has been a popular topic for the past decade. Current literature indicates ultrasound inclusion in UME is commonly integrated in gross anatomy instruction or clinical skills courses. US inclusion in gross anatomy focuses on overall anatomy understanding, whereas US in clinical skills courses focuses on the diagnostic application of medical imaging. Although there is plenty of literature demonstrating the benefits of US inclusion in gross anatomy, there is little research looking at the use of gross anatomy reviews prior to learning clinical ultrasound. Further, there is little research investigating how transferable gross anatomy identification is to ultrasound anatomy identification. Therefore, this study's purpose is to assess the effects of gross anatomy review prior to learning clinical ultrasound. Methods: 22 first year medical students interested in joining the ultrasound interest group (USIG), an extracurricular student group, participated in the study in the spring semester of 2023. There were four ultrasound imaging modules taught during the semester: cardiopulmonary, liver/biliary, E-fast, and musculoskeletal. Students were divided into two groups where they were required to participate in a pre-module quiz, attend the ultrasound instruction, then complete a post-module quiz and survey after the ultrasound instruction. The EXP group had to participate in an additional anatomy review prior to the ultrasound instruction session. Pre- and post-module quizzes contained gross anatomy structures of the relevant anatomy for the module, along with paired ultrasound images of that anatomical structure. The quizzes for each module were identical to each other allowing repeated measures. This allows for tracking students ability to transfer knowledge from gross anatomy identification to ultrasound anatomy identification. Groups switched treatments for each module, allowing equal exposure to both treatments. Quiz scores were compared within and between groups, setting significance level at p<0.05. Results: Both CON and EXP groups significantly improved in their performance from pre-quiz to post-quiz in all four sub-scores for Module 1 (p<.001 for overall; d=1.3, US; d=1.16 and transfer; d=1.34, p<.05 for anatomy; d=.51) and Module 4 (p<.001 for overall; d=1.1,and transfer; d=.74, p<.01 for anatomy; d=.67, and US; d=1.47). Significant increases were seen in three sub-scores for module 2 (p<.01 for overall; d=.77, and US; d=.65, p<.05 for transfer; d=.46). There were no significant increases in performance from pre-quiz to post-quiz in module 3. Looking at self-improvement between groups, the EXP group did show higher mean gains than the CON group and mild to moderate effect sizes, although these comparisons were not significant. The EXP group showed higher mean scores on post-quiz assessments for most sub-scores, including mild to moderate effect sizes, although none of these were significant. Conclusion: Ultrasound is a valuable tool in all areas of medicine, especially in anatomy learning. This study shows that a gross anatomy review does have a positive impact on student performance when learning US. Medical students learning US may receive benefit from a gross anatomy review to reintroduce previously learned material and further reinforce US instruction.Item Assessing Metabolic Changes in the Retina & Optic Nerve During Glaucoma(2024-03-21) Sepke, Katelynn; Morgan, Autumn; Inman, DenisePurpose: Glaucoma is an optic neuropathy characterized by retinal ganglion cell (RGC) death and optic nerve degeneration. Glial cells such as astrocytes form a metabolic unit with neurons to exchange metabolic substrates and neurotransmitters. When exposed to ocular hypertension (OHT), this metabolic unit is disrupted as astrocytes undergo morphological changes in response to increased pressure. ONHAs also reduce their GLUT1 expression, further exacerbating their metabolic function. It is unknown how these changes impact RGC axon structure and function, so we aim to gain insight into the metabolic relationship between glia and neurons during glaucoma. We hypothesize that glaucoma induces metabolic strain in optic nerve head astrocytes (ONHAs), preventing the exchange of metabolites between neurons, ultimately causing a decline in RGC structure and function. Methods: We have taken a two-sided approach to studying these neural-glial interactions. First, we have induced OHT as well as glucose transport inhibition in ONHAs in vivo to examine the effect of pressure-induced stress on metabolism and the visual system. Currently, we are working in vitro to study the metabolic exchange between RGCs and ONHAs co-cultured in microfluidic chambers when the ONHAs are exposed to biaxial strain as well as GLUT1 KO. Results: Preliminary results in vivo have shown that OHT and glucose transport inhibition in ONHAs disrupt anterograde transport. However, RGCs can compensate for glucose transport inhibition in astrocytes by upregulating GLUT3 and MCT2.In vitro we expect to see RGCs respond to alterations in ONHA metabolism, similarly, upregulating their lactate transporters and relying on mitochondrial metabolism to maintain their energetic needs. Conclusion: Using this model will allow us to directly observe the metabolic changes in the neural-glial unit induced by glaucoma, ultimately providing us insight into targets for future glaucoma therapies.Item Type II Diabetes Mellitus and COVID-19: A Case Series Exploring Insulin Management in Patients from Two Family Medicine Clinics(2024-03-21) Nukala, NihithaPurpose: About 37 million Americans have diabetes and out of this population, over 90% of them have type 2 diabetes. An estimated $200 billion per year is spent on managing this disease. There is limited data on factors that could explain whether diabetic patients experienced better HgbA1C control during the COVID-19 pandemic. The relationship between diabetes medications (DM) and diabetes outcomes during the COVID era is not well-characterized. In this case series, we aimed to evaluate type II diabetes outcomes pre-COVID-19 vs. COVID-19 era. Methods: This case series was conducted in two family medicine clinics that included patients with type II diabetes. The following data from all patients at least 18 years or older on 3/1/2019 were extracted: hemoglobin A1c, medication prescriptions (insulin use patterns, non-insulin prescription patterns oral diabetes medications), and number of prescriptions discontinued. We followed a guidance statement from the American College of Physicians in terms of how outpatient diabetes is managed and used A1c of less than 8% as the threshold to assess the clinical outcomes for this outpatient population. A1c values were compared between two cohorts, a pre-COVID-19 cohort (March 1, 2019-March 13, 2020) and a COVID-19 era cohort (March 14, 2020-March 31, 2021). An analysis was performed on all patients whose A1c control status was changed, defined as the last A1c in each of the two study periods changed either from > 8% to =< 8% (got better), or from =< 8% to > 8% (got worse). For each of the patients with A1c control status change, we identified patterns of diabetic medication prescriptions during the COVID-19 era: (1) insulin and other DM medications, (2) no insulin but other DM medication, or (3) insulin-only prescriptions. Results: Eighty-one patients fulfilled the study criteria. Fifty-three patients got better, and 28 patients got worse. Of the 52 cases, 28 got better due to insulin use. Eighteen of these patients discontinued their insulin at some point during the study period. Of the 28 patients that got worse. Out of the 26 cases, 10 of them got worse while on insulin. Nine out of 10 of these patients discontinued their insulin at some point during the study period. Only 1 patient was on their insulin medication throughout the entire study. Out of the 28 cases with some form of diabetes management therapy, 16 of them were on non-insulin medications. Thirteen out of 16 of these patients discontinued at least one of their medications at some point during the study period. 23 out of 26 patients discontinued at least one prescription. Conclusion: This case series demonstrates how two family medicine clinics treated diabetic patients during a pandemic. The majority were using insulin throughout COVID-19 era and did experience changes to their medication profile with other DM medications. A1c levels did change significantly from pre-COVID-19 to COVID-19 era, while prescriptions for diabetic treatment were reduced. This study identified the importance of keeping insulin and other DM medication prescriptions through a pandemic and how COVID-19 impacted Hemoglobin A1C and overall diabetes care.Item Epigenetic Changes of Nuclear-Encoded Oxidative Phosphorylation Genes and Cognitive Function: A Study of Mexican Americans and Non-Hispanic Whites(2024-03-21) Swami, Anjana; Daniel, Ann Abraham; Silzer, Talisa; Sun, Jie; Barber, Robert; Phillips, NicolePurpose: There is a higher prevalence of metabolic disease and Alzheimer’s Disease (AD) in Mexican Americans (MA). Despite this data, there has been minimal research done on the methylation status of genes involved in mitochondrial oxidative phosphorylation (OXPHOS)/cellular metabolism and how this influences the risk for developing cognitive impairment (CI). Methods: Results were derived from 299 MAs and 252 non-Hispanic Whites (NHW), all of whom were participants of the Texas Alzheimer’s Research and Care Consortium (TARCC). Themethylation status of CpG sites was assessed by running peripheral blood samples on the InfiniumMethylationEPIC BeadChip array. Results: Based on a Bonferroni adjusted alpha of7.36485 x 10⁶, six differentially methylated sites were significant in MAs: cg07470503, cg10057295, cg13823120, cg26891598, cg21490662, and cg17904988. All the sites were hypomethylated in CI/AD cohorts compared to NC except for cg26891598. There were no sites of significance in NHWs. Conclusions: The strongest association with CI/AD within the MA cohort was at cg07470503, with a p-value of 1.00 x 10⁶ in MAs. This CpG site is found within the DGUOK gene. The DGUOK gene is responsible for making the enzyme deoxyguanosine kinase, which is needed to properly create mitochondrial DNA; a dysfunctional gene leads to impaired mitochondrial function that could decrease the efficiency of OXPHOS. The abnormal cellular metabolism that ensues could set up the foundation for neurodegeneration to occur. Moving forward, the cg07470503 site could serve as a marker to identify the risk of metabolic disease and consequent CI/AD in MA patients.Item Neuroprotection by Novel Sigma 1 ligands(2024-03-21) Kinariwala, Kush; Taylor, Michelle; Schreihofer, DerekPurpose: Identify neuroprotective compounds that could potentially be used for conditions like Alzheimer’s disease. Sigma 1 receptors are an intracellular chaperone protein involved in endoplasmic reticulum stress response. Ligands of sigma 1 receptor have been shown to be acutely neuroprotective in a number of in vitro and in vivo brain injury models including stroke and traumatic brain injury. We are examining potential for novel sigma 1 compounds to protect the mouse hippocampal cell line HT22 from oxidative stress and endoplasmic reticulum stress. Among the compounds tested are haloperidol, cutamesine, oxeladin which are neuroprotective in stroke, and additional proprietary ligands derived from substituted haloperidol. Methods: Cell death in HT22 cells was determined using Cell Counting Kit 8. Cells were plated in quadruplicate in 96 well plates for 24 hours in DMEM/10%FBS. Cells were then treated with either hydrogen peroxide (H2O2, 0.5 mM) or Tunicamycin (50 ng/mL) for 24 hours with or without sigma 1 ligands (100 nM). Results: Haloperidol, a mixed sigma 1 and dopamine agonist, dose dependently protected cells from both H2O2 and Tunicamycin induced cell death. However, the sedative actions of Haloperidol make it unsuitable for use against neuroprotective diseases in vivo. We tested 3 sigma 1 compounds without dopamine activity to determine whether sigma 1 activity would protect cells against these insults. Preliminary results suggests that all sigma 1 compounds tested show some efficacy against oxidative stress and ER stress dependent cell death. Average percent live cells after treatment with 0.5 mM hydrogen peroxide was 59.55% (n = 3) and average percent live cells after treatment with 0.5 mM hydrogen peroxide and 100 nM Haloperidol was 101.06% (n = 5). Average percent live cells after treatment with 50 ng/mL Tunicamycin and 100 nM Haloperidol was 85.8% (n = 2). Average percent live cells after treatment with 50 ng/mL Tunicamycin and 100 nM Oxeladin was 49.7% (n = 2). Average percent live cells after treatment with 50 ng/mL Tunicamycin and 100 nM Cutamesine was 74.4% (n = 2). Average percent live cells after treatment with 50 ng/mL Tunicamycin and 100 nM of a novel sigma 1 agonist was 85.7% (n = 2). Ongoing studies are examining the intracellular pathways responsible for neuroprotective effects. Conclusion: Novel sigma 1 agonists may be suitable for protecting neurons against neurodegenerative diseases like Alzheimer’s. In terms of examining mechanisms, we are exploring endoplasmic reticulum stress pathways and more traditional apoptotic signaling.Item Early Life Sex Differences and Alterations in Mitochondrial Function in IUGR Offspring after Weaning may Contribute to Adult Sex Differences in Cerebrovascular Dysfunction and Hypertension in Rodents(2024-03-21) Hart, Savannah; Smith, Savanna; Smith, Jonna; Jones, Kylie; Castillo, Angie; Davis, Zandria; Springfield, Alex; Rollings, Alyssa; Narra, Sreeram; Cunningham, MarkBackground: Preeclampsia is a hypertensive pregnancy disorder that usually occurs in the third trimester. Preeclampsia, due to placental ischemia, decreases nutrient and oxygen delivery to the fetus, causing intrauterine growth restriction (IUGR). IUGR increases the risk for chronic conditions such as cerebrovascular dysfunction (CVD) and hypertension (HTN). Human and animal studies show sex differences in CVD and HTN development in IUGR offspring, with males exhibiting a higher prevalence of both. Preliminary data from our lab showed that 17-week-old IUGR male rodents developed CVD, HTN and mitochondrial dysfunction (mtDYS), while IUGR female rodents only developed CVD. The reason for these sex differences is unknown but may be attributed to mtDYS. Although mitochondrial differences appear at 17 weeks, earlier mitochondrial function is unknown. This study investigates changes in mitochondrial function in IUGR offspring after weaning. We hypothesize that mtDYS is elevated in3-week-old IUGR rodent offspring, with greater dysfunction in IUGR males. Methods: Pregnant Sprague Dawley rats were divided into two groups: normal pregnant (NP) and preeclamptic pregnant rats, which underwent reduced uterine perfusion pressure (RUPP) surgery on gestational day 14. RUPP dams gave birth to IUGR offspring, and NP dams gave birth to control (CON) offspring. After 3 weeks of weaning, offspring were separated by sex and dam pregnancy status. Brains were collected from the following groups: IUGR males (n=6), IUGR females (n=6), CON males (n=4), and CON females (n=6) to measure mitochondrial function via respiration, electron transport chain (ETC) protein amounts, and mitochondrial dynamics of fission (DRP-1) and fusion (MFN-1) proteins. Mitochondrial respiration was assessed using the Oroboros Oxygraph O2K. Protein amounts of ETC complexes (I-V), DRP-1, and MFN-1 were quantified using Western blots. Results: 3-week-oldIUGR females had increased cerebral mitochondrial respiration suggested by State 3 (490.41 ± 49.85 vs 257.32 ± 69.76pmol O2/sec/mg; p=0.02) and increased protein amounts of ETC Complex I (135.91 ± 9.27 vs 107.77 ± 4.23IU/Protein/CON%; p=0.02) and Complex III (141.76 ± 13.99 vs 110.43 ± 7.73IU/Protein/CON%; p=0.07). MFN-1 protein amounts (133.42 ± 18.75 vs 84.67 ± 6.89IU/Protein/CON%; p=0.03) and DRP-1 protein amounts (111.31 ± 1.89 vs 95.24 ± 2.14IU/Protein/CON%; p<0.0003) were increased in IUGR compared to CON females. Conversely, 3-week-old IUGR males showed decreased cerebral mitochondrial respiration in Basal state (21.48±5.49 vs 55.79 ± 6.96pmol O2/sec/mg; p=0.03) and State 2 (146.22 ± 25.55 vs 224.70 ± 23.13pmol O2/sec/mg; p=0.13). DRP-1 protein amounts were decreased in IUGR males (85.72 ± 3.07 vs 110.18 ± 1.82IU/Protein/CON%; p=0.02), with no changes in mitochondrial ETC complexes or MFN-1 protein amounts compared to CON males. Conclusion: Early on, IUGR females show mitochondrial function, while IUGR males display mtDYS. Furthermore, the mtDYS in IUGR males at 3 weeks may contribute to HTN development observed in IUGR males and not IUGR females at 17 weeks of age. Future studies are warranted to investigate mtDYS and HTN development in IUGR males and possible protective mechanisms in IUGR females. This study highlights sex differences in cerebral mitochondrial function in prepubescent IUGR offspring, offering insight into the pathophysiology of HTN and CVD development in adulthood, along with suggestions for novel therapeutic targets to prevent HTN and CVD in adult IUGR offspring.Item Upper Gastrointestinal Bleed with an Unusual Etiology: A Difficult Case with Unclear Imaging Findings.(2024-03-21) Wazir, Ali; Ngyuen, Michael; Takata, TheodoreBackground: Atrial fibrillation (AF) is a cardiac arrhythmia which can be managed with AF ablations, used to control aberrant electrical activity. A serious complication of ablations includes atrioesophageal fistulas (AEF), with clinical manifestations of hematemesis, fever, neurological deficits, and mental status changes. A majority of documented cases utilize computed tomography (CT) scans which demonstrate the presence of a fistula, but there remains a paucity of AEF cases with unclear imaging findings. Case Presentation: A 63-year-old Caucasian male with symptomatic persistent AF underwent radiofrequency ablation with PVs and left atrial posterior wall isolation on December 12, 2016. The patient tolerated the procedure well. On January 11, 2017, the patient returned to the emergency department with hematemesis one day prior. The patient reported chills, nausea, mild headache and a temperature of 103.2F. Patient reported taking ibuprofen with no relief. Vital signs at admission: T 98.5 F, BP 107/57, HR 62 bpm, and oxygen saturation of 100% on room air. PE: normal with no neurologic deficits. Labs: CBC indicated leukocytosis with neutrophilic shift and bandemia, thrombocytopenia, and low hemoglobin. CMP: low serum albumin and total protein. Coagulation studies: elevated aPTT and INR. Serum troponin I: minimally elevated. ECG: nonspecific T wave changes. CXR: no evidence of cardiopulmonary disease. Cranial CT scan: nonspecific bilateral subcortical frontal lobe white matter changes. Chest CTA with contrast was recommended by the EP to assess for an AEF and revealed no atrial wall defects. Gastroenterology was consulted for an upper GI bleed (UGIB) caused by NSAID usage based on imaging findings. Patient further experienced vision changes, confusion, chills, and myalgias. Blood Gram stain was positive for gram-positive cocci. Patient was started on a course of piperacillin-tazobactam and vancomycin. Magnetic Resonance Imaging illustrated bihemispheric ischemic infarctions. EGD revealed a protuberance with a small opening thirty centimeters from the incisors. Patient continued to deteriorate, and a repeat CT angiogram displayed a possible atrial wall defect but no overt fistula, pneumomediastinum, or contrast media within the esophagus. Based on high clinical suspicion of an AEF, a cardiothoracic surgery consult was requested. A cardiothoracic surgery was performed with repair of the left atrium and esophageal fistula. A 2-3 millimeter punctate defect was present between the left and right inferior pulmonary veins. Fibrinous adhesions were present on the anterior esophagus at the level of the left atrium. A punctate mucosal perforation was present in the esophageal wall measuring 2-3 millimeters in diameter. A pericardial patch was placed. The patient tolerated the procedure well and was transferred to the cardiovascular ICU. Post-operatively, the patient developed sepsis, delirium, and difficulty swallowing and was placed on tube feeding. Over the following days, mental status improved. Final culture results on postoperative day seven confirmed Streptococcus oralis, Streptococcus mitis, and Granulicatella adiacens and were treated with IV ceftriaxone outpatient. On postoperative day nine, the patient was discharged with no neurological deficits. Conclusion: This case highlights the importance of including AEFs within differential diagnoses of UGIB given recent AF ablations when imaging results are inconclusive.Item Perioperative Complications in Swan Neck Deformity Repair Case Report(2024-03-21) Patterson, Tyler; Carpenter, Brayden; Boody, Taylor; Heidenrich, Taylor; Tamayo, Jesse; Hyatt, BrookeBackground Excessive vagal stimulation in the intraoperative and perioperative periods can lead to bradycardia, asystole, and death. Painful stimulus or excessive pressure on the vagus nerve can lead to bradycardia. Increased stretch from a mechanical standpoint can also lead to more vagal nerve firing and input. Case Summary This case investigates the disease process of a 69-year-old female who presented to the surgical team following multiple failed conservative treatments for cervical chin on chest spinal deformity, requiring three months of hospitalization. Given the expected airway edema and swallowing dysfunction, surgical risks were high, and the patient was informed of potential complications. She consented for surgery and was educated on risks and benefits, including the possibility of requiring a tracheostomy and a Percutaneous Endoscopic Gastrostomy placement. The patient underwent a closed reduction of cervicothoracic spinal deformity, anterior cervical C4-5 osteotomy, C4-C7 corpectomies, C3-T1 anterior cervical fusion, posterior cervical C5-6 osteotomy, C2-T6 laminectomies, posterior cervical instrumented fusion C2-T8, and left L4 hemilaminectomy for placement of drains. On post op day 6, the patient requested PEG and tracheotomy placement. On post op day 10, the patient compounded a necrotizing soft tissue infection of the anterior neck that required emergent washout. The wound displayed profuse black fluid upon incision which along with imaging and crepitus on physical exam led to the diagnosis of acute necrotizing fasciitis. The patient also acquired persistent cervical esophageal perforation with a non-healed fistula and was taken to the OR two days later for tracheotomy revision and esophageal perforation repair. On post op day 20, the patient developed a neck hematoma requiring OR incision and drainage. On post op day 30, the patient was being turned by nursing to clean cervical wounds and became unresponsive. The patients became bradycardic, then developed asystole with no palpable pulses. After a few seconds, telemetry showed sinus rhythm and vitals became stable. Cardiology was consulted and attributed the patient’s episodes of asystole to pressure on the carotid sinus causing stimulation of the vagus nerve. The care team was instructed to minimize turning the patient to avoid further asystole. Local anesthesia was advised for future procedures. With an arrhythmia lasting longer than 90 seconds, pacemaker placement was indicated and performed. Discussion The interprofessional team effort allowed us to quickly identify the cause and treatment, which were vagal nerve compression and pacemaker placement, respectively. There are several explanations as to what contributed to the vagal stimulation. These include anatomical reconstruction, postoperative infection, neck hematoma, esophageal perforation, or mechanical ventilation stimulation. These may have caused vagal nerve stretching, causing increased vagal sensitivity. Above all, the increased vagal stimulation mostly occurred due to the drastic change in the patient’s anatomy, going from an extreme hyper flexed cervical position to hyperextension. This causes stretching and pulling on the structures in that region, which includes the vagus nerve. As anesthesia providers, it is crucial to recognize these possible complications and be able to adapt to care for these patients inside and outside of the operating room.Item Exploring Racial/Ethnic Disparities in Multimorbidity Among Cancer Patients at a Safety-Net Health System(2024-03-21) Kalman, Kyra; Singh, Anand; Meadows, RachelPurpose: Multimorbidity, defined as having two or more chronic health conditions, can substantially impact quality of life and mortality. Multimorbidity also increases the complexity of healthcare and treatment decision-making, particularly during cancer treatment. Racial/ethnic minorities may have higher risk for multimorbidity, potentially attributed to socioeconomic or other health-related factors. Therefore, we aimed to investigate racial/ethnic disparities in multimorbidity and potential explanatory factors among newly diagnosed cancer patients at a safety-net health system. Methods: We used electronic health record and cancer registry data from JPS Health Network, an urban safety-net health system in North Texas. Our eligible population included patients ≥18 years of age diagnosed with a first primary cancer in 2016–2020 (excluding in situ cases), whose initial diagnosis or at least part of the first course cancer treatment was received at JPS. Our outcomes were prevalence of multimorbidity (≥2 chronic conditions) and severe multimorbidity (≥3 chronic conditions). We included 30 chronic conditions defined by the Centers for Medicare & Medicaid Services and used up to a 2-year lookback period before cancer diagnosis. We used descriptive statistics to summarize sociodemographic characteristics and assess the proportions of multimorbidity by race/ethnicity. We used logistic regression to assess unadjusted and adjusted associations between race/ethnicity and multimorbidity and severe multimorbidity. Results: Our study included5,019 patients newly diagnosed with cancer. The most common cancer types were breast (13%), lung (12%), and colorectal (11%). The median age was 58 years (interquartile range: 50 – 64) and the majority were females (51%), racial/ethnic minority (59%), and uninsured (51%).Overall, 79% had multimorbidity and 62% had severe multimorbidity. Non-Hispanic Black (NHB) patients had the highest proportion of multimorbidity (86%) and severe multimorbidity (73%),whereas Hispanic patients had the lowest proportions (74% and 54%, respectively). In our unadjusted logistic regression model for multimorbidity, NHB patients had 1.75[95% CI: 1.44, 2.12]times higher odds and Hispanic patients had 0.80[95% CI: 0.69, 0.94]times the odds of multimorbidity compared with non-Hispanic White (NHW) patients. After adjusting for age, sex, body mass index, insurance status, and marital status, NHB patients maintained higher odds of multimorbidity (1.77 times [95% CI: 1.45, 2.17]), but Hispanic patients had no substantial difference (OR: 0.91[95% CI: 0.79, 1.07]) compared with NHW patients. In the unadjusted model for severe multimorbidity, NHB patients had 1.68 [95% CI: 1.44, 1.96]times higher odds and Hispanic patients had 0.71 [95% CI: 0.62, 0.81] times the odds of severe multimorbidity compared with NHW patients. In our adjusted model, NHB patientshad1.66 [95% CI: 1.41, 1.96] times higher odds and Hispanic patients had 0.77 [95% CI: 0.66, 0.89]times the odds of severe multimorbidity compared with NHW patients. Conclusions: We observed substantial racial/ethnic disparities in multimorbidity and severe multimorbidity among newly diagnosed cancer patients at a safety-net health system. Racial/ethnic disparities did not decrease after controlling for sociodemographic factors. Additional factors that are currently undocumented in electronic health records (e.g., social determinants of health) may help explain racial/ethnic disparities in multimorbidity and identify targetable points for interventions.Item Right on Target? Analysis of LDL Levels and Medication Use in a Very High-Risk ASCVD Population(2024-03-21) Xavier, Christy; Aguiniga, AshlynPurpose: The American College of Cardiology (ACC) released an expert consensus pathway in 2022, introducing a new low-density lipoprotein (LDL) goal < 55 for very high-risk individuals with atherosclerotic vascular disease (ASCVD) and highlighting the need for additional non-statin therapies to achieve that goal and reduce the risk of recurrent cardiovascular (CV) events, hospitalization, and death. This study seeks to investigate whether this LDL target is being achieved and the antihyperlipidemic medications used in a very high-risk ASCVD primary care population at the UNTHSC Family Medicine Clinic. Methods: This is a retrospective chart review using the NextGen electronic record to evaluate patients at the UNTHSC Family Medicine Clinic. Living adults with very high-risk ASCVD were included. Very high-risk was defined as multiple major ASCVD events (myocardial infarction [I25.2, I22] or stroke [I63, Z86.73]) or one major ASCVD event and multiple high-risk conditions (heart failure [I50], diabetes [E10-E13], hypertension [I10-16], chronic kidney disease [N18], age > 65 years old, and current tobacco use). Demographics such as gender, race/ethnicity, insurance, and medications were also collected. Very high-risk ASCVD patients were then stratified based on LDL goal achievement and analyzed using Chi-square analysis, independent sample T-test, and descriptive statistics using SPSS. Results: Of the identified very high-risk ASCVD patients (n = 199), 60 (30.2%) had achieved an LDL goal < 55 mg/dL. The average LDL achieved in this group was 44.2 + 10.8 mg/dL vs. 98.6 + 44.0 mg/dL for non-achievers. All those who achieved an LDL goal < 55 mg/dL were on at least one antihyperlipidemic medication. Of those who achieved an LDL goal < 55 mg/dL, 49 (81.7%) were on a high-intensity statin, 8 (13.33%) were on ezetimibe, 6 (10%) were on fish oil, and 3 (5%) were on a PCSK9 inhibitor. No patients were prescribed bempedoic acid or inclisirin. For non-achievers, 81 (58.2%) were on a high-intensity statin, 10 (7.2%) were on ezetimibe, 14 (10.1%) were on fish oil, and only one (0.72%) patient was on a PCSK9 inhibitor. Twenty (14.4%) of the non-achievers were not on any antihyperlipidemic agents. This subset of patients had a much higher average LDL (108.1 + 33.3 mg/dL), and 20% had a history of multiple ASCVD events. LDL goal achievers were slightly older (average age 68.2 + 9.9 years vs. 65.5 + 10.5 years), male (60% vs. 33.6%), and commercially insured compared to non-achievers. Conclusions: A majority of very high-risk ASCVD patients at the UNTHSC Family Medicine Clinic are not currently achieving the LDL goal < 55 mg/dL. Additionally, non-statin therapies are not being widely used to augment statin therapy. Further investigation is needed to determine potential barriers and limitations to achieving this lower LDL target.Item Cardiac troponin elevation in a middle-aged female consistent with COVID myocarditis(2024-03-21) Segovia, Alicia; Gulley, Taylor; Bautista, TrisshaBackground: Coronavirus (SARS-CoV-2) is known to cause severe acute respiratory syndrome, but more recently, it has been linked to increased cardiac involvement. It has recently been suggested by evidence that increased troponin levels seen in patients with severe COVID-19 reliably identifies myocardial damage. However, few longitudinal observations on troponin levels in mild COVID-19 cases over time have been published. Given its recent discovery, our understanding of the long-term effects of Coronavirus infections on individuals remains incomplete. The Center for Disease Control has recently estimated an overall incidence of myocarditis secondary to COVID-19 infection to be at around 150 cases per 100000 individuals in the United States alone. Case Presentation: A 45 year-old caucasian female with past medical history of T2DM, HTN, HLD, CKD, PCOS, and past COVID-19 infection presented to the Emergency Department with recurrent chest pain associated with shortness of breath, left hand numbness, and diaphoresis while at rest. A month prior, this female was admitted for NSTEMI with cardiac catheterization showing normal coronary arteries, echo demonstrating EF of 50-55% without wall motion abnormalities, and CTA demonstrating no signs of PE. Patient had been compliant with all medications since discharge, states nitroglycerin helped with pain, and had not been taking aspirin due to scheduled hysterectomy. Initial troponin levels were 3.409 ng/mL (0.00-0.013), glucose level 107, and platelet count was 426. A focused cardiac ultrasound performed by the emergency physician demonstrated absence of pericardial effusion, normal LV function, mild LV dilation, absent RV dilation, and absence of pericardial tamponade. EKG showed no signs of acute ischemia and repeated EKG was normal. However, cardiology was consulted due to evidence of myocardial injury as indicated by elevated troponins. The patient received ASA, Plavix, and Lovenox in the ED and heparin was started as part of ACS protocol. Tylenol 650 mg Q6H PRN and Morphine 2mg Q30M PRN were added for pain. Troponin levels continued to trend upward to 7.115 over the course of 7 days. Normal studies and images led to the conclusion that this patient would benefit from a heart MRI and outpatient medical management. Conclusions: This case highlights the long-term impact of Coronavirus infections on cardiac health, as indicated by notable elevations in troponin levels. It also demonstrates the atypical presentation of elevated troponin levels in the absence of acute ischemic myocardial injury.Item GW525701 Treatment Alters Cellular Morphology and Decreases Triple-Negative Breast Cancer Viability(2024-03-21) Rinderle, Caroline; Bunnell, BrucePurpose: Breast cancer is the second leading cause of death in women in the United States. Triple-negative breast cancer (TNBC) is named for its lack of estrogen (ER) and progesterone (PR) receptors, as well as HER2. The lack of receptors makes these tumors increasingly more difficult to treat, resulting in worser clinical outcomes compared to other receptor-positive subtypes. Kinase inhibitor compounds have been of great interest for treating TNBC patients. Specific kinase inhibitors have been successful against other cancer subtypes, namely chronic myeloid leukemia (CML), which has substantially bettered the outcomes associated with this disease. However, in total, only 72 kinase inhibitors have been approved for clinical use, many of which are not used as cancer therapeutics at all, let alone for breast cancer. Much more research remains to determine the role of other, understudied kinases in cancer proliferation and survival. One kinase inhibitor compound, GW525701, targets STK10, TNIK, SLK, MAP4K4, MINK, and DDR1, none of which are targeted by FDA-approved therapeutics. If treating cancer cells with this kinase inhibitor compound reduces cancer survival and proliferation, then it may be a potential future therapeutic, and will give better insight into the mechanisms controlling TNBC survival. Methods: Breast cancer cells (4IC, BT-549, MCF-7) were treated with GW525701 for 72 hours at a range of concentrations (1nM, 10nM, 100nM, 1µM, 10µM), then stained with phalloidin to visualize cytoskeletal changes. Cellular proliferation and viability were tested using a Cell Titer Glo assay. Migration changes were visualized and quantified using a Boyden migration chamber and ImageJ analysis. All treatment groups were compared to vehicle-treated controls. Results:GW525701 treatment at all concentrations caused morphologic changes consistent with senescence and apoptotic cell death. Cellular proliferation and viability were inversely correlated with GW525701 treatment concentration. Conclusions: Treatment with GW525701 may give insight into the roles of STK10, TNIK, SLK, MAP4K4, MINK, and DDR1 in TNBC survival. This information will be crucial to determining an effective means of targeting TNBC in a therapeutic manner in the future. The specific kinase(s) responsible for the phenotypic outcomes in this experiment will be elucidated in the future as well.Item Oral Health Educational Needs Among HIV Health Care Providers in North Texas(2024-03-21) Garcia-Ponce, Alejandra; Teplitskiy, Nathaniel; McRae, Alison; Hodge, Crystal; Brosnan, Amanda; Neelamegam, Malinee; Allison, Waridibo; Griner, StaceyPurpose: Understanding connections between HIV and oral health is vital for providing comprehensive care to people with HIV (PWH). Due to compromised immune function associated with HIV, PWH are more susceptible to oral health disease and infections. In Texas, there is a need for improved access and provision of oral healthcare services for PWH, particularly amongst marginalized populations. The purpose of this study is to identify HIV/AIDS healthcare providers’ (HCPs) and non-clinical providers’ gaps in oral health knowledge and preferred educational strategies and models. Results can inform educational programming for providers, ultimately improving the quality of oral healthcare to PWH in North Texas. Methods: A targeted needs assessment (Qualtrics survey) was conducted among a sample of major HIV organizations in North Texas to assess the educational and training needs of their HCPs. The survey, administered in January 2024, featured multiple-choice and open-ended questions. Participants were presented with lists of topics based on existing programming and literature: (i) topics on oral health and HIV, such as oral microbiome and antiretroviral therapy; (ii) key populations, such as pregnant persons; and (iii) preferred learning models, such as workshops, webinars, and case studies. They were asked to select all topics of interest. Results: Of the 33 total responses, 8 were excluded due to incomplete surveys. The respondent’s credentials included DMD/DDS (n=4), MD/DO (n=1), PharmD (n=1), RN/NP (n=2), RDH (n=2), LSW/LPC (n=2). When prompted about general areas of interest within the HIV/AIDS care continuum, there was interest in learning about approaches to reduce patients lost to care, reduce HIV stigma in healthcare settings, and expand pre-exposure prophylaxis in routine oral care. Substance use disorder as it relates to HIV and oral healthcare was reiterated as an educational need. Specific educational gaps included oral manifestations of HIV (60%), HIV-related oral cancers (56%), and therapeutics such as antiretroviral therapy (48%) and other emerging treatments (48%). Clinical management of oral health conditions and HIV, dental implants and prosthetics, and innovations in diagnostics in the dental setting were other educational needs selected. Additionally, respondents indicated a need to learn more about specific key populations such as people living with substance use disorders (80%), people living without housing (76%), and transgender and gender diverse communities (64%). Pregnant persons, incarcerated persons, and aging populations were other groups of interest. Results indicate a significant preference for webinar (68%), seminar (52%), and workshop (44%) learning models. Podcasts (24%) and case studies (20%) were also selected often, but other major telementoring models (ECHO, self-paced learning and adapted community health clubs) did not receive the same preference. Conclusion: The results of this survey reveal knowledge gaps and oral healthcare needs among HCPs that should be addressed in order to enhance oral healthcare for PWH in North Texas. While synchronous educational methods like webinars and workshops were favored, HCPs may benefit from additional active learning models (e.g., ECHO) into their continuing education. By developing and implementing education on the identified topics, HCPs can advance efforts to end the HIV epidemic and ensure PWH receive comprehensive care, including addressing their oral health needs.