2015
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Item 1,2,4-Trimethylbenzene (Pseudocumene) Formation of Photochemical Smog and Contribution to Atmospheric Greenhouse Gases (GHGs)(2015-03) Patel, Devang A.; Rich, Alisa A.Objective: To examine 1,2,4-Trimethylbenzene’s contribution to photochemical smog and affect cardiac and pulmonary disease. Introduction: 1,2,4-Trimethylbenzene, a chemical derivative of benzene, is an industrial solvent and easily volatilizes to the atmosphere. In the presence of other VOCs, it was found to contribute to formation of photochemical smog. Photochemical smog is known to exacerbate respiratory conditions, including asthma and may contribute to cardiac and pulmonary disease. This study examined 1,2,4-Trimethylbenzene in hydraulic fracturing fluids and produced water and its ability to contribute to atmospheric levels of GHGs and photochemical smog. Methods and Materials: A meta-analysis was performed and articles related to1,2,4-Trimethylbenzene evaluated. Databases searched include PubMed, Scopus, Web of Science, TOXNET and Science direct. Keywords 1,2,4-Trimethylbenzene, pseudocumene, Trimethylbenzene, atmospheric conversion, atmospheric degradation/reaction, hydraulic fracturing, and health effects. Published article dates ranged from 1994 – 2011. Inclusion criteria were chemical properties of 1,2,4-Trimethylbenzene, atmospheric degradation and reaction, and atmospheric sustainability, and health effects. Exclusion criteria were articles related to 1,2,4-Trimethylbenzene and water pollution, and animal toxicology studies. Articles meeting inclusion criteria were retrieved as full-text and examined. Results: This study confirmed high concentrations of 1,2,4-Trimethylbenzene in hydraulic fracturing fluids and produced water, and ability to aerosolize to the atmosphere from water and soil. Degradation of 1,2,4-TMB in the atmosphere by reactions with hydroxyl radicals are an indirect contributor to atmospheric GHG levels from hydroxyl radical scavenging, and may contribute to local/regional climate change. Slow atmospheric conversion of 1,2,4-TMB in the presence of ozone was found to occur with a half -life of more than 24 years, making it a candidate for long-range transportation. Conclusion: 1,2,4-Trimethylbenzene may be present in tanks and ponds in areas where hydraulic fracturing is occurring. The general public in close contact with these tanks and ponds may be exposed to 1,2,4-Trimethylbenzene in air and may experience adverse health effects.Item 22 year old male trisomy 21 with Syncope and intermittent hyper-production of C-peptide: A Case Report(2015-03) Diver, Thomas; Wong, LongPurpose: There are multiple causes of syncope, which is a short loss of consciousness and muscle strength, characterized by a fast onset, short duration, and spontaneous recovery. Most of time, it is difficult to figure out the exact reason for syncope in a young adult. Ruling out cardiac, non-cardiac or neurological life-threatening conditions is important. We offer a case report that manifests as syncope in a young adult with multiple intermittent high C-peptide levels upon testing. Methods: A 22-year old white male with Down’s syndrome presented to a family medicine clinic with increased intermittent episodes of syncope. These episodes lasted approximately 3-5 minutes and the patient awoke without recall. The patient presented with two main complaints, seizures and syncope frequently over the last two years. The seizures were consistent with epilepsy and he was given standard anti-convulsants which controlled these symptoms. However, the syncope remained. Further testing was conducted including workups for neurology, cardiology, emergency room evaluation and endocrinology. Results: Neurological causes were ruled out because of a normal brain MRI , Cardiogenic causes were ruled out because of normal results for EKG and echocardiogram. Meanwhile, he went to the emergency room for loss of conscious symptoms and his medication Keppra was increased from 500 milligrams to 750 milligrams controlling his seizures. Repeated blood chemistries indicated that blood glucose levels were normal but C-peptide levels were elevated with each episode of syncope, which could indicate Insulin Hypersecretion Syndrome or a cellular insulinoma. Future testing needs to be conducted at the cellular level, including repeated MRI’s of the pancreas; however, insurance issues are barriers to this process. Conclusions: No other case reports for young adults with a primary complaint of syncope and similar test results have surfaced in the literature thus far. Without further testing, a definitive cause cannot be determined.Item A Biopsychosocial Analysis of Professional Undergraduate Medical Education in the United States(2015-03) Jaini, Paresh; Herd, VanThe biopsychosocial model of illness asserts that treating patients is a holistic process, thus emphasizing the importance of holistic medical training. In this light, I have conducted a novel biopsychosocial analysis of three (3) key components (basic sciences, psychology, and sociology) of 21st-century professional medical education in the United States. I conducted a literature review of empirical research, news articles, and medical school curriculum web pages. I found a strong emphasis on the hard sciences in the basic sciences component of (primarily) allopathic medical education. The present analysis is thus limited in scope, due to limited data available for osteopathic, homeopathic, and naturopathic modalities, which are utilized by many patients. Research in these areas is highly recommended. Moreover, the analysis of the psychological component of medical education concludes that professional medical education should teach patient-desired skills and qualities, such as communication and empathy, to their students via practice with simulated and virtual patients, as well exposure to theatre and the humanities. Likewise, medical schools should encourage students to enter primary care and also train their students in sociology to tackle the problems of health inequalities in the United States healthcare system. The final conclusion of this study is that, in order to deliver the most holistic health care possible, it is necessary to expose medical students to the vast array of topics that affect medicine.Item A Case Presentation of Acute CHF Exacerbation in the Presence of Several Co-mobordities(2015-03) Wong, Long; Amlani, Farah M.; Colmenero, EvanPurpose: To highlight clinical features and management of congestive heart failure (CHF) exacerbation in a patient with several co-morbidities such as chronic kidney disease (CKD), hypertension (HTN), and diabetes (DM). Methods: A 66 year old African American male with a history of systolic CHF, CKD with anemia, DM, HTN, hyperlipidemia, and tobacco abuse presented to his primary care physician with complaints of fatigue, a cough productive of pink sputum, and intermittent chest pain. For 9 months, he had worsening dyspnea with exertion, cough with chest pain, and orthopnea. On physical exam, lung auscultation revealed 50% rales with diminished breath sounds. 2+ edema was present on the lower extremities bilaterally. An EKG in clinic showed left ventricular hypertrophy. The patient was sent to Plaza Medical for evaluation of CHF exacerbation due to fluid overload while on high dose Lasix and a history of CKD. Results: Labs showed an elevated BUN, creatinine, and BNP. He was anemic with a Hgb of 10.3. Troponins were negative. Initial CXR showed interstitial edema with cardiomegaly and pleural effusions. IV Lasix was started. During his hospital stay, his Hgb dropped to 8.3 and he was started on procrit. Cardiology and nephrology consults were ordered. An echocardiogram showed a dilated left ventricle with an ejection fraction of 25-30% with diffuse hypokinesis. The cardiologist began him on nitrates and digoxin. The nephrologist diagnosed end stage renal disease. A permcath was placed for dialysis. He received 3 treatments of inpatient dialysis. After 6 days, the patient was discharged home and put on outpatient dialysis. Procrit, isosorbide mononitrate, digoxin, hydralazine, and lisinopril were prescribed. The doses of furosemide and simvastatin were increased. Conclusions: Community based studies show that 30-40% of patients die within 1 year of diagnosis of CHF, 60-70% die within 5 years. NYHA class IV patients have a 30-70% annual mortality rate, while NYHA class II patients have an annual mortality rate of 5-10%. Thus, functional status is an important predictor of patient outcome. In our case, the functional status of the patient had deteriorated to the point of hospitalization. In addition, the patient had co-morbidities that affected the functionality of the heart. HTN, CKD, and DM can all play a role in the functional and morphological changes in the heart resulting in CHF. Management of all co-morbidities is imperative to improve patient outcomes.Item A Case Report on Low Back Pain in the Third Trimester of Pregnancy addressed with Osteopathic Treatment(2015-03) Stanley, Russell F.; Smith-Barbaro, PeggyPurpose: The objective of this case report is to document the use of osteopathic manipulative articulatory, myofascial, soft tissue, and muscle energy techniques as safe adjunctive treatments for low back pain in the third trimester of pregnancy. The author describes a case of worsening low back pain in an obstetrical patient who was a G1P0 33 year old female in the 36th week of gestation and constantly on her feet at her workplace. The patient complained of stiffness in her lumbar spine as well as pain in the area of the round ligaments in the anterior pelvis. Following two osteopathic manipulative treatment sessions in addition to the patient stretching at home and using a massage therapist, the patient gained increased pain relief in her lumbar spine and sacrum as well as her anterior pelvis along the pubic symphysis. This enabled the patient to continue working her regular job up until the time of a full term vaginal delivery at 39 weeks. Methods: The author employed the use of the PROMOTE study OMT protocol developed by Dr. Kendi Hensel in order to address the patient with third trimester low back pain in this case report. The patient was treated twice using a series of techniques found in the PROMOTE study with great overall improvement in the patient’s pain. The author used seated thoracic articulation, cervical soft tissue, occipito-atlantal decompression, thoracic inlet myofascial release, lateral recumbent scapulothoracic soft tissue, lateral recumbent lumbar soft tissue, abdominal diaphragm myofascial release, pelvic diaphragm myofascial release, sacroiliac articulation, pubic symphysis decompression, and frog-leg sacral release. These OMT techniques were used in sequence to address the patient with third trimester low back pain. Results: In this case report, a multimodal approach was taken to address the patient’s back pain in the third trimester. The patient utilized home stretches and also attended massage therapy in addition to undergoing OMT treatments twice at the doctor’s office. The techniques from the PROMOTE study were utilized with great success in the patient and greatly relieved the patient’s low back pain in the weeks leading up to delivery. Through the treatments the patient was able to continue working and also was able to improve her ability to stay active in an exercise program in the weeks leading up to delivery. Conclusion: This case study does not prove that osteopathic treatment is the sole factor responsible for the improvement in low back pain within the third trimester of pregnancy. However, the case study does show that osteopathic manipulation was a vital component to the improvement that was shown in the pain and function of the patient in this particular case study. Further studies are indicated to focus more on the aspects of preparing the pelvis for the labor and delivery process as well as addressing other postural factors and improving overall hemodynamic functioning.Item A Comparative Study of Rural Communities for Colorectal Cancer Screening by Means of Colonoscopy Provided by Family Physicians(2015-03) Stanley, Russell F.; Deen, Briar; Luz Chiapa-Scifres, Ana; Bowling, JohnPurpose: Colorectal cancer has a high incidence and prevalence in the United States and in particular, rural Texas. Some rural family physicians in Texas do colonoscopy procedures whereas other rural family physicians refer their patients to urban centers. This study will look at whether or not patients with access to family medicine physicians who perform colonoscopy exams within their own rural community are more likely to comply with colorectal cancer screening guidelines as opposed to rural patients in another community who are referred to urban centers. Methods: A 24 question survey pertaining to colon cancer and adapted from the Behavior Risk Factor Surveillance System (BRFSS) was given to patients at primary care clinics in Clifton and Haskell. Both clinics are located in small, rural towns in Texas. The family medicine physicians at the Clifton clinic provide colonoscopies within the community whereas the residents in Haskell drive to urban centers for colonoscopies. In order to take the survey, participants had to be patients of either the Clifton or Haskell clinic and be at least 50 years of age. Logistic regression was used to look at an association between the two clinics and patient colon cancer screening awareness, knowledge of what age a person should be screened for colon cancer and whether or not patients had ever had either a sigmoidoscopy or a colonoscopy. All statistics were done using SAS 9.3. Results: 92 surveys were collected at Clifton and 76 were collected at Haskell for a total of 168 surveys. Of the collected patient surveys, 80.12% patients were white and 62.05% were female with a mean age of 63.90. A higher odds (OR=3.61; CI = (1.11, 11.69)) was seen in Clifton compared to Haskell for patient colon cancer screening awareness after being adjusted for gender, race, age, employment status and family history of colon cancer. There was a higher odds (OR=2.50; CI = (1.13, 5.54) of knowing what age a person should be screened for colon cancer in Clifton compared to Haskell after being adjusted for gender, age, employment status, education level and family history of colon cancer. A higher odds (OR=3.61; CI = (1.42, 9.20)) was seen in Clifton compared to Haskell for patients ever having a colonoscopy or sigmoidoscopy after being adjusted for patient race, age, gender, education, employment status and for the patient not having insurance. Conclusion: This study supports the idea that having family medicine physicians perform colonoscopies within a rural community leads to a higher odds of patients following cancer screening guidelines. Therefore, it is beneficial to have colonoscopies performed locally in a rural community in order to better prevent colorectal cancer.Item A comparison of photophysical characteristics of rHDL encapsulated anti-cancer drug valrubicin and free valrubicin.(2015-03) Shah, Sunil Ajit; Chib, Rahul; Raut, Sangram; Bermudez, Jaclyn Y.; Sabnis, Nirupama; Duggal, Divya; Kimball, Joseph; Lacko, Andras G.; Borejdo, Julian; Gryczynski, Zygmunt; Gryczynski, IgnacyNanotechnology as a channel for drug delivery is one of the rapidly developing fields in cancer therapeutics. Targeted drug delivery has the advantage of having minimal interaction with healthy tissue, thereby reducing the toxicity of the drug to the rest of the body. rHDL nanoparticles have been found to be an efficient delivery system for highly lipophilic anti-cancer drugs. This is achieved through the interaction of scavenger receptors class B type I (SR-BI), which are highly expressed on cancer cells interact with rHDL nanoparticles for effective drug delivery to the cancer cell and tumor. The drug under investigation is Valrubicin, which, apart from being an effective anti-cancer drug, also has intrinsic fluorescence. This allowed for the comparison of photophysical properties of free Valrubicin and rHDL Valrubicin via steady state and time resolved fluorescence measurements. The steady-state anisotropy of rHDL Valrubicin is higher as compared to free Valrubicin, suggesting its encapsulation in rHDL nanoparticles. A longer rotational correlation time was observed for rHDL Valrubicin in time resolved anisotropy measurements compared to free Valrubicin, further supporting steady state anisotropy data.. We also studied the cellular internalization of free Valrubicin and rHDL Valrubicin using confocal microscopy. This could help track the movement of rHDL nanoparticles within the cancer cells.Item A Direct Observational Study Evaluating Prehospital Medical Documentation of a Simulated Combat Casualty by Military Medical Providers(2015-03) Mott, Jeffrey; McGarry, Adam B.; Kotwal, Russ S.BACKGROUND: In order to reduce preventable prehospital death on the battlefield there needs to be an increase in prehospital medical documentation. The purpose of this study was to determine if there is a lack of training on utilizing Department of the Army Form 7656/Tactical Combat Casualty Care card during pre-deployment medical training at Tactical Combat Medical Care course, at the Center for Predeployment Medicine and the AMEDD Center and School. This form captures prehospital injury and intervention data from point of injury to definitive medical treatment. METHODS: A direct observational study of prehospital medical documentation was conducted on simulated Combat Casualties by Military Medical Providers, utilizing Department of the Army Form 7656/Tactical Combat Casualty Care card. Completion of one form during trauma lane training, per simulated combat casualty satisfied the inclusion criteria for qualitative results. Our hypothesis was there is no training deficit on Department of the Army Form 7656/Tactical Combat Casualty Care card at Tactical Combat Medical Care course. RESULTS: During the period studied, every other week over four months January – April 2013, 130 Department of the Army (DA) Form 7656/Tactical Combat Casualty Care (TCCC) cards were collected and evaluated from 131 simulated combat casualties. The quantity of the form completed was 99.20% with an accuracy of completed prehospital medical documentation at 80.70%. CONCLUSION: Leaders enforcing standards will be the driving force for increased prehospital medical documentation. This study demonstrates there is not a lack of training at Tactical Combat Medical Care course on completing Department of the Army Form 7656/Tactical Combat Casualty Care card. Keywords: DA Form 7656, Prehospital Medical documentation, Prehospital battlefield death.Item A Qualitative Analysis on the Effects of Social Support among Women of the Reentry Population(2015-03) Cantu, Katherine; Spence-Almaguer, Emily; Rohr, Danielle; Chhetri, ShlesmaPurpose: Promotion of positive social support through family reunification and mentorship through the Second Chance Mentoring (SCM) program reduces risk of recidivism among moderate-to-high risk incarcerated women. Methods: The SCM program is offered through a collaboration between Family Pathfinders and three partner organizations in Tarrant County. SCM provides assistance to women who have been incarcerated to support their successful reintegration in to the community. Information is collected during incarceration to determine the recidivism risk level using the Ohio Risk Assessment Scale (ORAS) scores. Participants are enrolled in 12 months of mentoring services upon their release from prison or jail. Post-release, Family Pathfinders uses progress notes to monitor SCM service activities and other information which may contribute to reentry success or failure. These progress notes were analyzed by the evaluation team at UNTHSC to code for different types and levels of support which may promote or reduce recidivism among women. Results: The initial analysis of a sample size made of 50 women indicates that those who actively engage in a mentoring relationship are more likely to seek assistance elsewhere in order to promote successful reentry. Women who have support of negative influences have more issues becoming self-sufficient and set minimal goals for behavior change by the end of the 12 month program. Conclusions: A mentoring relationship with women who pose a high risk of recidivism upon release provides a foundation for building additional supportive relationships. Ensuring a reliable support system to incarcerated women may increase the effectiveness of successful community reintegration.Item A Reliable Method for MRI Volumetric Assessment of Hippocampal Resection Following Anterior Temporal Lobectomy(2015-03) Wilson, Jacob; Donahue, MD, DavidPurpose: Surgical management of temporal lobe epilepsy in children is an established management of temporal lobe epilepsy (TLE). Surgery for TLE ranges from standard anterior temporal lobectomy (ATL) to selective resections which seek to spare temporal neocortex. Cortical dysplasia (CD) represents the most frequent non-neoplastic cause of TLE in children. Extent of resection (ER) of cortical dysplastic processes has been correlated with seizure control. The goal of this study was to design and test a standardized protocol based on anatomical boundaries for pre-operative (pre-op) and post-operative (post-op) imaging in order to measure hippocampal ER. Methods: Medical records and neuroimaging of a 2 year old developmentally delayed female TLE patient with CD in her right temporal lobe were reviewed. Seizure semiology, electrodiagnostics, and imaging studies indicated independent bilateral temporal dysfunction with the most severe deficit of activity in the right temporal lobe. Pathological analysis of temporal neocortex and mesial structures disclosed evidence of cortical dysplasia in all specimens. Pre-op MRI studies were performed using a Seimens Verio 3T unit generating 3 sequences: 1) T1 Magnetization Prepared Rapid Gradient Echo 3D with 1.0mm slice thickness, 2) T2 Turbo Spin Echo (TSE) Axial with 4.0mm slice thickness and, 3) T2 TSE Coronal with 3.0mm slice thickness. Post-op MRI studies were performed using a Seimens Espress 1.5T unit generating 3 sequences: 1) T1 Spin Echo (SE) Axial with 5.0mm slice thickness, 2) T2 TSE Axial with a 5.0mm slice thickness and, 3) T2 TSE Coronal with a 3.0mm slice thickness. Studies were co-registered via Hermes, a product of Hermes Medical Solutions, which rendered multiple image studies into one file. The resulting 3D brain map was then loaded into Amide, a free image viewing tool for registering and analyzing medical data image sets, which allowed a slice by slice evaluation of both pre-op and post-op images. After hippocampal boundaries were identified on each coronal slice, a region of interest (ROI) was created outlining hippocampal area. Amide calculated ROI areas for each slice and summed ROI areas to yield hippocampal volume. Results: Analysis of ROI yielded pre-op hippocampal volume of 2.691 cm3 vs. post-op volume of 0.259 cm3. ATL in our patient removed 96.25% of the hippocampus, leaving 3.75% of hippocampal tail remaining. Analysis completed after construction of protocol used to determine hippocampal anatomical borders. Conclusions: This project successfully designed and tested a standardized protocol based on anatomical boundaries for pre-op and post-op imaging in order to measure hippocampal volume ER. This protocol will allow for measurement of ER in future studies of TLE in pediatric populations.Item A STEP in the Right Direction: An Interdisciplinary Transitional Care Approach to Preventing Hospital Readmissions (2015)(2015-03) Loewen, Ashlee; Knebl, Janice; Yarabinec, Ashley; Camp, Kathlene E.; Johnson, Valerie; Stafford, Ashley; Allen, John G.; Shoukry, Emad; Wagner, Teresa; Greenlee, Quante; Turpin, ShirleyPurpose: The Affordable Care Act, calls for more focus on finding “innovative delivery systems that improve care, increase efficiency, and reduce costs” (Centers for Medicare and Medicaid Services, n.d., para. 4). The Safe Transitions for the Elderly Patients (STEP) program is a hybrid transitional care model developed to reduce readmission rates for Medicaid patients over 50 years of age in Tarrant County. Background: The STEP Program provides high quality transition of care services for discharged Medicaid elders of Tarrant County. A medical director, nurse practitioner, physician assistant, physical therapies, social workers, pharmacist, and nutritionist make up the in home care team. The foundation of the STEP Program was developed by the University of North Texas Health Science Center (UNTHSC) as part of an 1115 Waiver approved by CMS in 2012. The STEP Program is designed to improve the coordination and continuity of care for Medicaid patients 50 years of age and older transitioning from the hospital to the home setting following discharge. The primary goal of the STEP program is to identify discrepancies in transitional care and find solutions toward reducing all-cause 30-day hospital readmissions. Through the CMS 1115 waiver guidelines, we are also tracking patient BMI, smoking status, and pneumococcal vaccine status. Methods: The STEP Program will provide care transition services for 750 patients from October 1, 2013, to September 30, 2016, via referrals received from local hospital partners. STEP faculty and staff have developed evidence-based protocols and communication strategies aimed at meeting or exceeding performance metrics for reducing hospital readmission. The NextGen EMR is the primary means for gathering data for these metrics and assessing the impact of the evidence based protocols and communication strategies. Plan-Do-Study-Act methodology is used to regularly to evaluate and re-evaluate STEP Program practices to meet and exceed performance metrics, while improving overall performance. Current Results: The current 30-day readmission rate for patients enrolled in the STEP program is 9%, which is a significant improvement from the recent national readmission rate at 18.5% and Texas at 18.4% for Medicare specific beneficiaries (CMS, 2012). Conclusion: By reducing hospital readmission, the STEP Program can contribute to improving the quality of transitional care services as a sustainable practice model. This example of transitional care services can serve as a model to help reduce hospital expenditures, decrease hospital penalization for readmissions, and help provide quality outpatient management and coordinated care for this vulnerable patient population. Centers for Medicare and Medicaid Services. (n.d.). Section 1115 demonstrations. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstrations.html Centers for Medicare and Medicaid Services. (2012). National Medicare readmission findings: Recent data and trends. Retrieved from http://www.academyhealth.org/files/2012/sunday/brennan.pdfItem A Study of Consistency of Dexamethasone Responsiveness between Paired Bovine Eyes(2015-03) Hickman, Colton; Bermudez, Jaclyn Y.; Mao, Weiming; Clark, Abbot F.Purpose: Glucocorticoid (GC) therapy can lead to elevated intraocular pressure (IOP) and GC-induced glaucoma. IOP elevation is also a major risk factor for the development and progression of primary open angle glaucoma (POAG). Glaucomatous and GC-induced IOP elevation is due to increased aqueous outflow resistance in the trabecular meshwork (TM). Because the pathological findings and clinical presentations of the two types of glaucoma are similar, GC-induce ocular hypertension is often used as a model to study POAG. Although the bovine eye perfusion culture model has been established, the consistency of paired bovine eyes to GC treatment has not been determined. Therefore, this study is to determine if Dexamethasone (DEX) changes IOP similarly in paired bovine eyes. Methods: Fresh bovine eyes were obtained from local abattoir, transferred to the lab and carefully dissected. The vitreous, uveal tract, retina, retinal pigment epithelium, and lens were removed. The remaining anterior segment, which contained the cornea, sclera, and TM, was mounted and sealed on a custom-made acrylic dish with an O-ring. Perfusion medium was infused by a syringe pump at a constant infusion rate of 5 μL/min. After IOP was stable, bovine eyes were perfused with medium containing 0.1% dexamethasone for 6-7 days. Bovine eyes with IOP elevation of more than 2.82mmHg was defined as a responder eye according to our published results. Results: Of the seven pairs of bovine eyes tested, one pair of eyes were DEX responders and the other six pairs were non-responders. The responder pair had IOP elevation of greater than 2.82mm Hg in both eyes. The other six pairs of non-responder eyes showed IOP change between -0.6 and 1.7 mm Hg. Conclusion: Our study showed that the DEX-responsiveness in paired bovine eyes are highly consistent. As suggested by early studies, it is very likely that induced IOP elevation and glaucoma are highly associated with genetic background. These results further validate the use of paired bovine eyes in glaucoma research. Due to the small samples size, further experiments are required. We will also try to determine possible genetic components such as the ratio between GC receptor isoforms GRα and GRβ in the TM cells.Item A Variant of Extensor Medii Proprius: A Case Report(2015-03) Holmes, Victor L.; Liu, Hao (Howe); Rosales, Armando; Kirchhoff, Claire A.Purpose: The extensor medii proprius (EMP), a documented variation of human hand extensor muscles, originates from the distal 1/3 of the ulna and inserts on the dorsal aponeurosis (extensor expansion) of the 3rd manual digit. This case report describes an anomaly in which the EMP originates from the lunate, an origination reported in the medical literature. Methods: During routine gross anatomy dissection of the left hand of a 67-year old female who died of “stroke,” an unusual EMP muscle was observed and documented. Results: The flat, fleshy muscle originated from the lunate bone, narrowed into a flat tendon near the 3rd metacarpophalangeal joint, and continued distally to insert on the extensor expansion of the 3rd digit. A branch from the posterior interosseous nerve was traced to the EMP. We propose that this previously unreported variation be termed extensor medii proprius brevis (EMPB). Conclusions: Several anomalies found here have not been previously reported in the literature. First, the EMP originated at the lunate, which means the muscle does not cross the radiocarpal joint as described in previous reports. Second, the co-existence of the EMP with the extensor indicis or related muscles was not observed in this case. Third, the EMP tendon traveled deep to the intertendinous connection between the 2nd and 3rd tendon slips of the extensor digitorum muscle. Finally, this is the first time that the EMP was found to be innervated by a branch from the posterior interosseous nerve. In functional terms, the EMP/EMPB may act as an accessory MCP extensor. Due to its small size, however, the impact of EMP/EMPB on MCP extension may be negligible. Clinicians should still be aware of this variation, since swelling or tenderness of the muscle may lead to misdiagnoses of ganglion cysts or adipose tumors around this area of the dorsal hand.Item Abuse liability of the novel benzofuran 6-APDB(2015-03) Dolan, Sean B.; Gatch, Michael B.Benzofurans, sold online as “benzo-fury,” represent a class of designer drugs that have gained popularity on the ever-expanding market of “legal highs.” Users report that these compounds produce entactogen-like effects similar to MDMA. The current study aims to investigate the behavioral effects and abuse liability of the novel benzofuran 6-APDB. The locomotor effects of 6-APDB were tested in male Swiss-Webster mice over an 8-hour period in an open-field assay of locomotor activity. The discriminative stimulus effects of 6-APDB were tested in separate groups of male Sprague-Dawley rats trained to discriminate cocaine, methamphetamine, or MDMA from vehicle. The rewarding effects of 6-APDB were tested in male Swiss-Webster mice using a conditioned place preference assay. 6-APDB produced locomotor stimulation at 5 and 10 mg/kg starting 30-minutes post-injection and lasting approximately 3 hours. 6-APDB fully substituted for the discriminative stimulus effects of MDMA at 1 mg/kg, but produced low levels of drug-appropriate responding for cocaine- and methamphetamine-trained rats at the same dose. 6-APDB produced conditioned place preference. Our results indicate that 6-APDB produces hyperlocomotion, conditioned place preference, and discriminative stimulus effects similar to MDMA, suggesting that 6-APDB may have potential for abuse. The substitution of 6-APDB for MDMA, but not cocaine or methamphetamine, suggests that this compound may be used as a substitute for MDMA in a club or rave setting, especially as MDMA becomes more difficult to obtain.Item Acid-sensing ion channel modulation by nonproton ligands: the influence of divalent cations(2015-03) Smith, Rachel N.; Gonzales, Eric B.1. The acid-sensing ion channel (ASIC) is emerging as a potential mediator for a variety of pathologies, such as stroke, pain, and mental health diseases. Despite their involvement in multiple age-related pathologies, the ability to selectively target the ASIC subtypes remains unidentified. As their name suggests, ASICs are activated by an increase in extracellular protons, however other ASIC ligands include natural venom toxins, guanidine containing compounds, and calcium. Nonproton ligands, like 2-guanidine-4-methylquinazoline (GMQ), have been identified to selectively activate the peripheral ASIC3 via the nonproton ligand sensor domain (NPLSD). A pair of glutamates in rat ASIC3 (E79 and E423) responsible for GMQ activation is present in the structural determinant chicken ASIC1, despite having no direct modulation effect on the channel. We previously showed that cASIC1 could be activated by GMQ following a based on a partially activated channel state. Interestingly, low calcium concentrations cause the peripherally located ASIC3 subtype to be partially activated. We proposed that direct nonproton ligand activation of ASIC3 is possible due to the actions of the transmembrane domains (TMD) where calcium sensitivity resides. Additionally, the introduction of ASIC3 TMDs into a GMQ insensitive ASIC subtype (cASIC1) will reveal nonproton ligand sensitivity. 2. Chimeric receptors combining the extracellular, transmembrane, and intracellular domains of rat ASIC3 and chicken ASIC1 were generated to individually isolate the calcium and nonproton ligand effects on channel activation. Each chimeric receptor was assessed for function using whole cell patch clamp electrophysiology. 3. We confirmed that rASIC3 is activated and held open when extracellular calcium concentrations are reduced with minimal proton influence (pH 8.0). Low-calcium-activation of rASIC3 is further enhanced by the addition of GMQ in a concentration dependent manner. These effects are absent in cASIC1. The chimera termed cASIC1 (rASIC3-TM/ITC) is comprised of the extracellular domain of cASIC1 and the transmembrane/intracellular domains of rASIC3, and can be activated by GMQ in the absence of calcium, although its sensitivity to GMQ is reduced. Thus, GMQ activation was introduced in cASIC1 by replacing the transmembrane domains with those of ASIC3. 4. This data suggests that the ASIC3 TM domains dictate NPLSD influence on channel activity. Fully understanding how we can interrupt or enhance channel activation will allow us to preferentially target these ion channels, potentially leading to the promotion of developing novel therapeutics to interact with ASICs.Item Acid-sensing ion channel proton sensitivity is modulated by a guanidine containing dietary supplement(2015-03) Agharkar, Amruta S.; Smith, Rachel N.; Gonzales, Eric B.Acid-sensing ion channels (ASICs) belong to the epithelial/degenerin family. ASICs are sodium selective and are sensitive to extracellular protons specifically those following ischemia and injury. The ASIC1a subtype has been implicated centrally in the neurodegeneration following ischemic stroke while ASIC3 is involved in pain sensation and is expressed peripherally. Protons and inflammatory mediators can activate or modulate ASIC1a and ASIC3, suggesting that ASICs can be a pharmacological target for ischemic stroke and pain. The large extracellular domain of ASICs offers multiple sites for interacting with protons and guanidinium group containing compounds. Guanidinium compounds such as 2-guanidine-4-methylquinazoline (GMQ), amiloride, and agmatine are known to modulate the electrophysiological properties of ASICs. Here we identified a dietary supplement, GL-001 that shares molecular similarity to these ASIC ligands and modulate ASICs. We utilize whole-cell patch-clamp electrophysiology to determine the interaction of GL-001 with endogenous human ASIC1a (hASIC1a) and transiently expressed rat ASIC3 (rASIC3). Our data suggests that GL-001 reduces the hASIC1a pH sensitivity at physiologically relevant supplement concentrations consistent with suggested dietary supplementation. The rASIC3 peak current amplitude and steady-state current is reduced in the presence of GL-001. In the absence of extracellular calcium, GL-001 reduces the rASIC3 proton sensitivity by shifting pH-activation profile to lower pH. This suggests that the effect of GL-001 on rASIC3 is calcium dependent. Future studies will focus on determining the effect of GL-001 on the rASIC3 window current and other ASIC3 properties to resolve the mechanism of action of the GL-001 influence on channel activity.Item Adaptation of the CDC Evaluation Framework to Design the Evaluation of Reaching Teens, a Multi-Institutional, Region Wide Teen Resiliency Training Program(2015-03) Homan, Sharon; Spence-Almaguer, Emily; Gonzalez-Pons, KwynnPurpose: Mental Health Connection of Tarrant County (MHC) is a collaboration of public and private agencies working together to revolutionize the mental health service delivery system in Tarrant County, Texas. MHC is partnering with the American Academy of Pediatrics (AAP) on a multi-institutional region‐wide staff training program. This program, Reaching Teens, uses the teen resiliency curricula developed by Dr. Kenneth Ginsburg, a pediatrician specializing in Adolescent Medicine. The goals of reaching Teens are to develop a trauma‐informed workforce, improve system integration and increase the use of evidence-informed practices in youth behavioral care in Tarrant County. Our research purpose was to adopt the Centers for Disease Control and Prevention (CDC) evaluation framework to planning the evaluation of Reaching Teens. The CDC evaluation framework engages stakeholders in the evaluation with the goal of stimulating innovation that leads to improving outcomes and detecting program effects. Methods: We engaged agency stakeholders (Step 1), described the program using a logic model (Step 2), and focused the evaluation design on the issues most important to MHC and the organizational partners (Step 3). We conducted a baseline assessment of knowledge, attitudes and beliefs about teen resiliency and approaches for successfully working with adolescents in the mental health system. Results: Our results consist of: (1) a logic model and (2) baseline survey findings. The Reaching Teens logic model is a roadmap to guide the ongoing planning, program activities and evaluation. With stakeholders, we prioritized three program components: (1) staff development; (2) organizational capacity building; and (3) system‐wide collaboration. We identified key program outcomes: (1) engaging youth; (2) boundary-setting; (3) trauma-informed care; (4) commitment to “care” factor; (5) strengths-focussed; (6) resiliency; (7) job satisfaction; (8) system recognized for effective communication with youth; and (9) decreased turnover. Key baseline survey findings (n=438 staff participants from 15 agencies) are: high levels of job satisfaction (4.2 - 4.5, 5-point scale), congruence of personal and organizational values (3.3 - 4.0, 5-point scale), average teamwork in workplace (3.4 - 4.0, 5-point scale). Conclusion: The Reaching Teens logic model is a powerful tool to guide system-wide collaboration toward the goal of more effectively reaching adolescents in mental health care. There are three program components: staff development, building organizational capacity, and strengthening system-wide collaboration. Baseline levels of the outcome measures (job satisfaction, teamwork, and value congruity) are relatively high among participating staff; thus, it may be difficult to demonstrate program impact by increasing these scores post-intervention.Item Adverse Child Experiences and Their Effects on Child Behavior and Mental Health(2015-03) Pulvino, Steven; Mbise-Floyd, Lilian; Patel, Neha; Patel, Tarang; Davis, Ann; Homan, SharonBackground: The association between Adverse Child Exposures (ACEs) and risk for child mental health outcomes such as depression, anxiety problems, and behavior/conduct problems has not been thoroughly investigated for three age groups - ages 6 to 10 (elementary school), ages 11 to 13 (middle school), and ages 14 to 17 (high school). We examined the relationship of these three mental health outcomes with a variety of ACEs among children 6 to 17 years old. We also examined the prevalence of ACEs for each mental health outcome in order to better understand the nature of any influential exposures. Methods: National Survey of Children’s Health 2011-2012 dataset was used to investigate nine ACEs: socioeconomic hardship, divorce/separation of parent, death of a parent, parent served time in jail, witness to domestic violence, victim of neighborhood violence, lived with someone who was mentally ill or suicidal, lived with someone with an alcohol/drug problem, and treated or judged unfairly due to race/ethnicity. Total number of ACE exposures were categorized cumulatively into 5 classes: 0, 1, 2, 3, ≥4. They were then compared with the three child mental health outcomes: depression, anxiety problems, and behavior/conduct problems. Results: A dose response relationship was observed between each of the child mental health outcomes and the number of ACEs for the full model (where age groups are included as a co-variable). The odds for depression in the full model increases by 2.59, 3.08, 6.24, and 9.66 for those exposed to 1, 2, 3, or 4 or more ACEs respectively, when compared to those who had not been exposed to an ACE. Children with 1, 2, 3, or 4 or more ACEs were 2.01, 2.28, 2.88, and 5.45 times more likely to have anxiety problems, respectively. Children with 1, 2, 3, or 4 or more ACEs were 3.21, 3.80, 6.96, and 10.51 times more likely to have behavior/conduct problems, respectively. Conclusion: A dose response relationship was observed between the number of ACEs and risk of developing each of the examined child mental health outcomes (depression, anxiety problems, and behavior/conduct problems). Further examination of relationships between specific ACEs and the chosen mental health outcomes may help researchers identify significant or influential combinations of ACE risk factors.Item African Tick-Bite Fever: A Case Report(2015-03) McCormick, Callum G.; Eisner, Hailey; Atkinson, BarbaraPurpose: In this report we review the clinical features of African tick bite fever (ATBF) and compare them to domestic rickettsial infections. Methods: Information and records were obtained on a 70 year old female diagnosed with ATBF who initially presented with febrile illness, eschars and a history of recent travel to South Africa. She had been misdiagnosed with a staphylococcus infection and treated with Bactrim prior to presentation. Review of the literature was also conducted to research the presentation of rickettsial spotted fever group (RSFG) infections. Results: Clinical features and history lead to the diagnosis of ATBF and administration of appropriate treatment with doxycycline. Conclusion: African tick bite fever is an acute febrile illness commonly seen in travelers to sub-Saharan Africa and the West Indies. It is a mild illness characterized by fever, lymphadenopathy and multiple eschars. Physicians should consider the diagnosis of ATBF in febrile patients and skin lesions in the appropriate epidemiologic setting.Item Age-related Thymic Involution Perturbs Negative Selection Leading to Autoreactive T Cells That Induce Chronic Inflammation (Inflammaging)(2015-03) Coder, Brandon; Wang, Hongjun; Ruan, Linhui; Su, Dong-MingThe presence of chronic low-level pro-inflammatory factors in elderly individuals (termed inflammaging) is a significant risk factor for morbidity and mortality. Recently, inflammaging has been partially attributed to the persistent activation of immune cells thought to arise from latent viral infection, but the contribution of activated autoreactive T cells towards the development of inflammaging remains unclear. To address our hypothesis that age-related thymic involution leads to the persistent release and activation of autoreactive T cells capable of inducing inflammaging, we performed experiments including: adoptive transfer, kidney capsule transplantation, and tetramer detection of autoreactive T cells on a FoxN1 conditional knock-out (FoxN1-cKO) mouse model that mimics natural thymic involution while maintaining a young periphery. We found that thymic involution leads to T cell activation shortly after thymic egress, which is accompanied by a chronic inflammatory phenotype consisting of cellular infiltration into non-lymphoid tissues and elevated serum IL-6 and TNFα levels. Autoreactive T cell clones were detected in the periphery of FoxN1-cKO mice. A failure of negative selection, facilitated by decreased expression of Aire rather than impaired regulatory T cell (Treg) generation, led to autoreactive T cell generation. Furthermore, the young environment can reverse age-related Treg accumulation but not inflammatory infiltration. Together, these findings identify thymic involution and the persistent activation of autoreactive T cells as a source of chronic age-related inflammation (inflammaging).