2024
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Item Acculturation Stress Among Older Indian Americans: Understanding the Challenges of Cultural Transition.(2024-03-21) PATIL, SHILPA; Nhpang, Roi San; Griner, Stacey; Kline, Nolane; Neelamegam, MalineeBackground: Acculturation involves the process through which immigrants assimilate the attitudes, values, traditions, beliefs, and practices of a new culture. Acculturation stress, a form of psychological distress stemming from conflicts between an immigrant or ethnic minority group's values and those of the dominant culture, is a prevalent concern among Asian Indians. This study examines acculturation stress among older Asian Indian Americans, a growing subpopulation facing unique challenges in navigating cultural transitions. Methods: The study adopted a mixed-method approach targeting older Asian Indian Americans (aged 55 and above) in the DFW area, combining survey responses with in-depth interviews. Financial incentives were provided to participants. Utilizing a qualitative framework, the research analyzed participant responses to a series of statements to elucidate their experiences of cultural stress, including perceptions of discrimination, feelings of foreignness, identity conflicts, and concerns over cultural assimilation. Data analysis was conducted using descriptive statistics in SAS 9.4, offering insights into the acculturation stress experienced by this demographic. Results: Respondents comprised of 74.19% (n=23) women and 25.81% (n=8) men. Ages range from 12.90 % (n = 4) at 50-54 years, 32.26% (n = 10) at 55-64, 35.48% (n=11) at 65-74 years, and 19.35% (n=6) at 75 and older. Several significant acculturation stress themes were identified. Key issues include identity conflict, leading to feelings of isolation; discrimination, contributing to marginalization; cultural loss, causing grief and anxiety; intergenerational conflict, straining family dynamics; and adverse mental health outcomes like depression. Most participants feel acculturated, except for notable feelings of missing their home country and family. Conclusion: The findings highlight the complexity of acculturation stress among older Asian Indian Americans, revealing a significant impact of identity conflict, discrimination, cultural loss, intergenerational conflict, and mental health issues. While age appears to be a notable factor in acculturation experiences, further research is essential to explore additional variables affecting acculturation, such as immigration status, age at immigration, and geographical location. This study underscores the need for a broader understanding of the multifaceted acculturation process within the Asian Indian American community to inform targeted support and interventions.Item ADAM19 and ADAMTS4 expression in Human Optic Nerve Head Astrocytes(2024-03-21) Easo, Tony; Rangan, Rajiv; Tovar-Vidales, TaraPurpose: Glaucoma is characterized by the degeneration and death of retinal ganglion cells and their axons causing irreversible blindness. Various risk factors contribute to glaucoma onset, including intraocular pressure (IOP), age, and family history. In glaucoma, the primary site of damage is the optic nerve head (ONH). ONH astrocytes, a major cell type in the LC, are believed to play a significant role in the pathological remodeling of extracellular matrix (ECM) during glaucoma. Glaucoma patients have increased levels of transforming growth factor beta 2 (TGFβ2) in their aqueous humor, trabecular meshwork and ONH. TGFβ2 is a profibrotic cytokine known to induce the synthesis and deposition of ECM. Previously, we performed RNA sequencing of ONH astrocytes in which disintegrin and metalloproteinases (ADAMs) and ADAM with thrombospondin motifs (ADAMTS) were significantly dysregulated with TGFβ2 treatment compared to controls. ADAMs and ADAMTS4 influence cell phenotype by affecting cell adhesion, migration, proteolysis, and signaling pathways. The purpose of the present study was to determine a) if ONH astrocytes express ADAM19 and ADAMTS4 in ONH astrocytes and b) determine if TGFβ2 regulates ADAM19 and ADAMTS4 expression in ONH astrocytes. Methods: Primary human ONH astrocyte cell strains (n=3) were treated with TGFβ2 (5ng/ml) or with a vehicle control for 48 hours. The effects of TGFβ2 on ADAM19 and ADAMTS4 were determined by qPCR and western blots using primary human ONH astrocyte cell cultures. Results: ADAM19 and ADAMTS4 were expressed in ONH astrocytes. Treatment with TGFβ2 significantly increased mRNA levels of ADAM19 and ADAMTS4. However, western blot analysis showed no significant change in ADAM19 protein expression compared to control, while ADAMTS4 was increased with TGFβ2 compared to control. Conclusions: TGFβ2 modulated the expression of ADAM19 and ADAMTS4 in ONH astrocytes. ADAM19 and ADAMTS4 may contribute to the pathogenic remodeling of the ONH in glaucoma. While further studies are needed, this research aims to shed light on the intricate mechanisms underlying glaucoma pathogenesis.Item Addressing Disparities in Treatment for Substance Use Disorder Among Individuals with Developmental Disabilities: Perspectives from Treatment Facility Employees(2024-03-21) Yip, Maggie; Phan, Cong-Bao; Espinoza, Anna; Walters, Scott; Barnett, Tracey E.; Bednar, Hannah; Garcia, Lizbeth; Taha, Suha; Miller, Jackson; Lopez, Cindy; Fulda, KimberlyPurpose Research on substance use disorder (SUD) among individuals with developmental disabilities (DD) is limited. The extant literature suggests that people with DD are less likely to use substances overall compared to people without a disability; however, they are more susceptible to SUD if they do use substances. Among facilities in the United States that provide aid for individuals with DD and treatment facilities for individuals with SUD, there are currently no interdisciplinary practice guidelines or training materials available for providers treating those with a co-diagnosis of DD and SUD. Our project aims to reduce the disparities between treatment guidelines and materials available for people with a co-diagnosis of both SUD and DD. The purpose of this analysis was to gauge overall awareness of providing treatment for individuals with SUD/DD co-diagnosis and reflect on current protocols regarding this population. Methods In this project, interviews were conducted with workers at facilities that primarily provide SUD services. Relevant facilities were identified and selected through systematic internet searches. In this study, 11 questions were asked to workers at facilities through 15-30 minute phone interviews. Questions that were used for this analysis revolved around themes of workers’ perspectives on the importance of integrating SUD/DD services, their current practices, and their future recommendations for integrating care for individuals with both SUD/DD. Results We conducted a total of 12 interviews. Responses came from the South and Midwest United States geographical regions. From these interviews, we found that most programs aim to individualize their approaches to treating this specific population. However, there is no standardized approach to how they individualize these cases. Furthermore, many programs expressed that they rarely refer individuals with a co-diagnosis of SUD/DD outside of their agency and feel inadequately prepared to treat individuals with SUD/DD co-diagnosis, which further emphasizes the need for accessible standardized guidelines. Overall, many workers expressed a need for improved access to screenings, assessment tools, specific guidelines, knowledge, training, and specialized programs for the variety of specific types of DDs. Conclusions People with DD that experience SUD are a vulnerable population with few resources. To meet the needs of this vulnerable population, standardized guidelines and training materials should be developed to address the specific needs of this patient population and equip healthcare providers and stakeholders with the tools necessary to ensure this population has proper and equitable access to treatment.Item Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among Justice-involved Populations(2024-03-21) Dhother, Bani; Caliman, Celeste; Bell, April; Bennett, Ahrein; Pankow, Jen; Lehman, Wayne; Proffitt, Randi; Knight, KevinPurpose: ACTION is a 5-year randomized controlled trial comparing the effectiveness of a patient navigation model versus a mobile health unit (MHU) model to link individuals during re-entry from incarceration to healthcare services, with emphasis on prevention and treatment for HIV, hepatitis C, opioid use disorder. The current study examined secondary outcomes, comparing the type of referrals made (treatment vs ancillary services) at the initial MHU visit and the correlation between the number of MHU visits during the first six weeks of the intervention and having a primary care physician (PCP) prior to incarceration (before joining ACTION). Methods: Participants (N=34) who attended at least one in-person MHU visit within the first six weeks of the intervention were included in the analysis. Demographics, PCP status, and referral type were collected from RealTime, an electronic health records system used on the TCU MHU and confirmed in the main study database. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) and Microsoft Excel. Results: At the initial MHU visit, 97% of participants were given referrals for medical/health needs, 94% were given referrals for socio-economic needs, and 91% received referrals for both medical/health and socio-economic needs. Top medical/health referrals made were dental (71%), general medical care (53%), vision (41%), mental health (35%), and specialty care (26%). Participants with a PCP prior to joining ACTION attended a mean of 0.97 MHU visits, while those who did not have a PCP attended an average 1.32 visits. Having a PCP prior to joining the study was negatively correlated to MHU visits (r = - 0.24). 46.2% of females (n=13) reported having a PCP, compared to 19% of males (n=21). Females averaged fewer MHU visits than males during the first six weeks of the intervention. Conclusions: More participants received referrals at the initial MHU visit for health-related needs compared to socio-economic needs such as housing, transportation, and identification documents. The negative correlation between having a PCP prior to incarceration and frequency of MHU visits suggests that participants without a PCP are likely to attend more MHU visits. Future research should examine if individuals with a PCP experience trust issues with the healthcare system (compared to those without a PCP), experiences that could impact healthcare-seeking behavior. Females averaged fewer visits to the MHU than did males, and females were more likely than males to have previously had a PCP. These findings are preliminary and based on a small sample size but suggest interesting directions for future analysis on women’s health issues.Item Addressing the Impact of COVID-19 Restrictions on Depression and Eating Disorders in Pediatric Populations(2024-03-21) Hendon, Allison; Griner, Stacey; Brosnan, AmandaPurpose: The mental health of global youth populations has been a serious topic of concern, especially following the onset of the COVID-19 pandemic. Early research has shown that the global prevalence of adolescent and pediatric mental health episodes has increased following the pandemic; with a 25% increase in depressive symptoms and a 20% increase in anxiety symptoms. It is also known that there is a strong correlation between depression and eating disorders; with each diagnosis increasing the risk of the other. Prior to the pandemic, it was estimated that the lifetime prevalence of eating disorders in adolescents was 2.7%, which was more prevalent among females (3.8%) vs. males (1.5%). Despite these known statistics, minimal research has been performed in the U.S. evaluating eating disorders among pediatric populations following the pandemic. Therefore, given the declining mental health of our youth following COVID-19, it is imperative to consider the development of eating disorders and/or depression in these vulnerable populations. The purpose of the present study is to explore the presence of eating disorders and depression in pediatric populations following the COVID-19 pandemic, and how these rates differ between males and females. Methods: A literature review was conducted using PubMed and Google Scholar electronic databases. Relevant articles were screened using the following keywords found in either the title or abstract: depression, major depressive disorder, eating disorders, anorexia nervosa, bulimia nervosa, binge eating, adolescence, pediatrics, children, COVID-19, pandemic. This search was limited to articles with the following criteria: written in English (i) inclusion of adolescents or children as research participants (ii), and research conducted after 2018 (iii). Studies selected based on the above criteria included longitudinal studies, comparative studies, and systematic reviews. Results: Recent studies have shown an increase in the prevalence of both depression and eating disorders in global youth populations following the COVID-19 pandemic. As a result of the mandated COVID-19 lockdown, many pediatric populations were isolated from their friends, classmates, and family members. A cross-sectional study in China found that children who were left alone throughout the day without a companion during COVID-19 had higher levels of depressive symptoms (22%) and anxiety (27%) as compared to those who had company throughout the day. The mandated COVID-19 lockdowns have differing affects across gender identity. A longitudinal study of children in Australia found that when compared to their male cohort, females experienced higher levels of generalized anxiety and depressive symptoms as well as lower life satisfaction during the pandemic. Conclusion: These findings indicate that children, especially females, are at increased risk for depression and eating disorders both during and following the COVID-19 pandemic. Increased rates of depression and other psychological conditions leaves the pediatric and adolescent populations vulnerable to future health and developmental complications later in life and across the life course. At the public policy level, safeguards need to be put in place to ensure that the mental health of children remains protected and a public health priority during future pandemics.Item ADHD Management in Adolescents and its Impact to Lower Incidence of Risky Sexual Behavior(2024-03-21) Gillespie, Amelia; Brosnan, Amanda; Griner, StaceyBackground: Attention-deficit/hyperactivity disorder (ADHD) is a neurological condition that is recognized by an ongoing pattern of inattention with or without hyperactivity and impulsivity that interferes with functioning or development. In 2020, it was reported that ADHD affects 9.6% of children ages 6-11 and 13.6% of adolescents ages 12-17. Therapies that include medications and/or interventions can aid in reducing symptoms and improving functioning. ADHD can be associated with sexual health outcomes such as higher rates of sexually transmitted infections and elevated rates of risky sexual behavior, like condomless sex. Adolescents with ADHD have an earlier age of intercourse, more lifetime sexual partners, higher rates of pregnancy, and higher rates of lifetime STIs. However, few studies have investigated sexual health promotion for those diagnosed with ADHD. Purpose: The purpose of the present study is to explore current literature examining the relationship between ADHD and risky sexual behavior among adolescents. Methods: A literature review process was conducted using PubMed and Google Scholar. The reference list of the relevant articles was screened for titles and abstracts containing the keywords: Attention-deficit hyperactivity disorder, ADHD, risky sexual behaviors, STI, Sexually Transmitted Infections, Syphilis, Chlamydia, human papillomavirus, herpes, sexually transmitted diseases. The retrospective search was limited to articles in English, from 2010 or later, and included the keywords listed above in the title or abstract. Articles reviewed included qualitative and quantitative studies and systematic reviews. Results: In current literature, the incidence of risky sexual behavior has been shown to decrease with either stimulant medication therapy or behavioral therapy for comorbid psychiatric disorders like substance abuse. There are varying conclusions in published literature giving attributes of lowering risky sexual behavior through drug intervention and others to behavioral therapy. These different conclusions of effective therapy come from our limited current understanding of ADHD and the vast array of patient circumstances, such as the varying severity of ADHD, other psychiatric symptoms, and other behavioral influences in the patient's life. Through these studies, we can conclude that patient-centered approaches are pivotal in addressing risky sexual behaviors. Conclusion: These results indicate that ADHD symptoms can be managed with stimulant medication; however, psychiatric therapy shows a promising effect on decreasing risky sexual behavior among adolescents with ADHD, especially for those presenting with psychiatric comorbidities. To decrease risky sexual behavior and its consequences, medication alone may not be effective for most adolescent patients with ADHD, and early intervention for adolescents with ADHD is essential. By translating these findings into clinical care, we can move toward reducing the negative sexual health outcomes experienced by adolescents with ADHD.Item ANCA positivity in the case of acute bacterial endocarditis(2024-03-21) Forsyth, Alyssa; Quresh, QuretulBackground: The case of ANCA positivity in an individual with bacterial endocarditis demonstrates the importance of thorough testing and labs prior to treatment. This case draws attention to a diagnostic conflict, as starting treatment on immunosuppressants, as would be the standard therapy for ANCA-associated vasculitis (AAV), could exacerbate the bacterial endocarditis and carry severe consequences. In this case of glomerulonephritis and associated endocarditis, the patient presented with several symptoms which mimicked AAV. Thus, it is important for providers to include cultures in routine assessments of ANCA-positive cases to allow for thorough evaluation and appropriate therapy. Case information: A 60-year-old morbidly obese male presented for right knee pain. His medical history includes hypertension, congestive heart failure (CHF), osteoarthritis, atrial fibrillation, and stage IV chronic kidney disease (CKD). The patient denied history of smoking, drugs, or alcohol use. He has no family history of autoimmune disease. Upon evaluation, the patient was found to have a deep vein thrombosis (DVT) with leg pain, as well as paroxysmal atrial fibrillation. He was started on Coumadin for anticoagulation therapy. During his hospital stay, his creatinine levels climbed from 2.0 mg/dL to 6.3 mg/dL and was given a preliminary diagnosis of acute renal failure on top of his preexisting CKD. His renal decline prompted a kidney biopsy, which revealed focal necrotizing and crescentic glomerulonephritis with C3 dominant deposition. Urinalysis showed proteinuria and was positive for active urinary sediment. Bloodwork was remarkable for MPO-ANCA positivity (MPO-ANCA 1:640). Transesophageal echocardiogram (TEE) and blood culture revealed an aortic valve vegetation positive for methicillin-sensitive staphylococcus aureus (MSSA), and the patient was started on broad-spectrum antibiotic therapy. Conclusions: The details of this case prompt reflection on the diagnostic steps taken by providers when presented with an ANCA-positive patient. The standard protocol taken in the treatment of ANCA vasculitis differs tremendously from and could even have devastating consequences in the case of infectious endocarditis. Therefore, careful evaluation for bacterial endocarditis in the case of ANCA positivity should be incorporated into the diagnostic process. Most of the current literature represents cases of c-ANCA positivity in subacute infectious endocarditis (IE), often with Streptococcus viridans responsible. This case is unique in that the patient was positive for MPO-ANCA and not PR3 and the causative organism was MSSA. While several cases of MSSA IE with ANCA positivity have been reported, this combination of MSSA endocarditis and isolated MPO-ANCA positivity has only been represented one other time in the literature to our knowledge.Item Annexin A2 mediated TNBC metastasis via small extracellular vesicles: A multi-faceted omics-based characterization(2024-03-21) Trivedi, Rucha; Ranade, Payal; Vishwanatha, Jamboor K.Purpose – Triple-negative breast cancer (TNBC), the most aggressive subtype of breast cancer poses a high risk of metastasis due to a lack of targeted therapy and reliance on conventional treatment approaches. Among the organs susceptible to metastasis, the lungs are most frequently affected sites, accounting for approximately 60% of cases. Extracellular vesicles (EV) play a crucial role in establishing a pre-metastatic niche (PMN) for tumor cell homing to secondary sites. Identifying the tumor-derived EV-specific cargo that may potentially alter the lung microenvironment could establish an understanding of the molecular targets contributing to lung PMN development and consequently improving the poor TNBC prognosis and diagnosis. TNBC exhibits elevated expression of Annexin A2 (AnxA2), a plasma and endosome membrane-associated protein. The abundant expression of AnxA2 in tumor tissues and EVs derived from TNBC patients is correlated with poor overall survival and poor distant metastasis-free survival. In previous studies, depletion of AnxA2 protein levels in TNBC-derived EVs resulted in an altered PMN establishment, leading to significantly lower metastatic lesions in the lungs and brain in in vivo system. We aim to evaluate the molecular effects mediated by AnxA2 in TNBC-derived EVs and their cargo that aid the PMN formation and identify underlying molecular targets creating a favorable microenvironment by interaction with lung stroma. Methods and Results – To assess the role of AnxA2 in TNBC lung metastasis, we utilized a lung selective metastatic TNBC cell line, MDA MB 4175 (LM2). We used the shRNA-mediated stable knockdown technique to downregulate AnxA2 protein levels in LM2 cells. We then performed expressional analysis as well as its cell surface functionality using a plasmin generation assay. Additionally, we conducted tumor cell functional assays such as proliferation and invasion assays. Decreased AnxA2 protein levels in LM2 cells significantly reduced its plasmin generation, proliferative ability, and invasive potential. Subsequently, we isolated cell derived small EVs using differential ultracentrifugation and characterized them following the MISEV 2018 guidelines. We confirmed the purity, yield, size, presence of EV-enriched proteins (ESCRT, Hsp, CD9, CD81), and absence of negative proteins (Calnexin, GM130). We then subjected the EVs to quantitative proteomic analysis and identified the differentially expressed proteins upon AnxA2 depletion. We further exposed the healthy lung stromal fibroblasts and the local less-aggressive TNBC cells with EVs to assess the differences in local and distant site uptake and cargo transfer mediated by AnxA2. Conclusion – This comprehensive approach will determine the novel EV-associated proteins that act as functional regulators in promoting TNBC metastasis to the lungs. [This work is supported by the NCI R01CA220273 awarded to Dr. Jamboor K. Vishwanatha]Item Appendiceal Mucinous Neoplasm Case Study(2024-03-21) Tamayo, Jesús; Patterson, TylerAppendiceal Mucinous Neoplasm Case Study Jesse Tamayo, Tyler Patterson, Michael Smith, Jay Patel Appendiceal Mucinous Neoplasms account for less than 1% of all malignancies in the United States. Patients with low grade neoplasms often present with symptoms of an acute appendicitis with right lower quadrant pain due to the distention of the appendix caused by the increasing levels of mucin. These patients may also have perforation of the appendix or appendicitis if the tumor growth is obstructing the orifice of the appendix. An patient with advanced disease may present with similar symptoms as well as distention of the abdomen due to mucinous ascites growing in the peritoneum. Patients may also present with weight loss, abdominal pain, and even intestinal obstruction. A majority of these primary neoplasms have mucin involved in more than 50% of the lesion, arising from low-grade appendiceal neoplasms (LAMN) seen as adenomatous changes in appendiceal mucosa. They can also arise from a polyp forming adenoma similar to those seen in patients who develop colon cancer. Histologically they can be seen with signet ring cells. The patient involved in this case report had presented to the Emergency Department on numerous occasions for right lower quadrant pain. This pain had persisted for years, CT imaging was performed and the tumor was recognized. A procedure for removal was scheduled, however prior to the day of surgery, the patient again presented to the emergency department with excruciating RLQ pain. Surgery was performed the following day. The tumor size was so great that the patient also had a right hemicolectomy performed to remove the tumor in entirety. It was 5.5 cm in greatest dimension. Surgical margins were negative for invasion and twenty six lymph nodes were biopsied and all came negative for cancer. The surgical case was successful for a appendectomy along with a right hemicolectomy to remove a 5.5 by 1.5 low grade appendiceal mucinous tumor confined to the muscularis propria of this patient.Item The Art of Diagnosis: Cyto-Histopathological Correlation in Metastatic Lung Cancers - A Rare Case Report(2024-03-21) Peddireddy, NavyaBackground Metaplastic breast carcinoma (MBC), an exceptionally rare and heterogeneous triple-negative subtype of breast cancer, accounts for less than 1% of all breast carcinomas. This case report exemplifies the pivotal role of cytohistological correlation in diagnosing lung metastasis through fine needle aspiration biopsy. The case of a 90-year-old female with a complex medical history is presented, highlighting the importance of careful clinical assessment in metastatic lung cancers. Case Information A 90-year-old female, with a history of metaplastic breast carcinoma following a left mastectomy 20 months ago, was admitted due to a four-week history of progressive dyspnea and fatigue. Despite being a non-smoker, she had a history of essential tremor, dementia, and chronic obstructive pulmonary disease. Extensive diagnostic evaluations, including laboratory results and imaging, revealed pulmonary nodules and partially calcified pleural masses bilaterally along with pleural effusions, raising concerns of metastasis. Thoracentesis initially showed negative pathology findings, along with subsequent CT-guided lung biopsies, prompting an investigation into the patient’s prior oncology history. The patient's past oncology reports were revisited, uncovering a diagnosis of metaplastic carcinoma with mesenchymal differentiation in the breast. Cytohistological correlation was performed, ultimately confirming the presence of malignant cells in the lung biopsy, leading to the diagnosis of stage IV triple-negative metaplastic breast carcinoma with malignant pleural effusion. Conclusions Metaplastic breast carcinoma is characterized by the differentiation of malignant cells toward mesenchymal and squamous elements, making it a rare and heterogeneous cancer. The patient's case, with lung metastasis originating from a metaplastic breast carcinoma, is a rare occurrence, further emphasizing the importance of accurate diagnosis in such unique situations. The report underscores the significance of meticulous medical history collection, interdisciplinary communication, expert consultation, and cyto-histopathological correlation in achieving accurate pathological and clinical diagnoses in metastatic lung cancers. Metaplastic breast carcinoma's rarity and heterogeneity contribute to its generally poor prognosis, with factors like advanced age, high-grade tumors, and distant metastasis reducing survival rates. In most cases, surgical resection remains the primary treatment approach, followed by platinum-based chemotherapy. Promising treatment avenues, including immunotherapy and molecular targeted therapies, may improve patient outcomes, but these options depend on individual circumstances. In the case presented here, the patient's age and comorbidities influenced the decision to opt for hospice care, highlighting the importance of tailoring treatment strategies to a patient's unique situation. This case report not only sheds light on a rare occurrence but also serves as a reminder of the importance of comprehensive medical assessments in managing complex clinical scenarios.Item Artificial Intelligence's Prospects and pitfalls in the field of Diagnostic Radiology(2024-03-21) Verdier, GavinOpening: Artificial Intelligence (AI) is a burgeoning field that is integrating into medicine at an accelerating pace. Its capacity for providing quantitative and qualitative image analysis is becoming an increasingly valuable tool for Diagnostic Radiology. Nowadays, a wide array of AI-based solutions are available, employing diverse approaches like Convolutional Neural Networks (CNNs), Reinforcement Learning, and Image and Texual Generation. Support: An area of implementation that is particularly intriguing is in the recent advancements in the interpretation of thoracic imaging. The interpretation of thoracic X-Rays in trauma settings might be delayed due to various hospital processes. Preliminary reads by AI algorithms could identify findings that could lower the workflow burden and allow physicians to focus on more challenging cases (Feng et al.). Additionally, datasets like those collected in these studies have contributed tens of thousands of high-quality, annotated X-Rays in open datasets, which can be used to continually enhance AI tools for the field. The AI technique of reconstruction can fill in the gaps of lower-quality imaging data, which has the potential to lower the amount of time and resources needed for scans such as Knee MRIs. These techniques could help to democratize advanced imaging to more patients and reduce facility operational costs. AI has the potential to provide standardization to the subjective nature of image interpretation, with one example being in evaluating metastatic breast lesions. However, Meta-analyses evaluating the efficacy of using AI in diagnosis and staging still display issues with sensitivity, with reported levels being as high as 20%, a figure unusable in a clinical setting. While approaches such as Deep Learning and Image Reconstruction have a promising future, the truth is that these technologies are still in their infancy. Datasets for Neuroimaging in MRIs might not contain sufficient data to provide the training necessary for certain reconstruction techniques, which could miss crucial artifacts in certain circumstances. There is a genuine concern as well that AI might exacerbate disparities in healthcare because of the inherent difference in how AI and human doctors arrive at decision-making. Concern arises around the interpretation of data and the potential for AI to propagate biases into the diagnostic image interpretation due to suboptimal AI training. Another example is that AI has been shown to deduce a patient's race without the relevant information as perceived by human clinicians being explicitly provided. The relative absence of understanding of the inner workings of AI algorithms can undermine the trustworthiness of many currently available AI systems. This, in turn, reflects the many potential areas in improving the interpretability of these often what regarded as “blackbox” systems. Conclusion: Though AI has many hurdles to overcome, it is likely to gain increasing importance in the Radiologist's toolkit over the coming years. These tools will necessitate the Radiologist to become even more familiar with the technology and data collection. The algorithms that are being developed will undoubtedly benefit from close collaboration between the physician, software developers, and engineers in order to develop effective and clinically relevant software.Item Assessing Barriers to Clinical Trial Enrollment Among African American Cancer Survivors in Louisville(2024-03-21) Ansarizadeh, YosefPurpose: Despite comprising approximately 22% of the population of Louisville, KY, African Americans comprise about 9% of cancer clinical trial (CCT) participants. Nationally, minority participation in clinical trials is also low, with African Americans making up between 4-6% of CCT participants, despite constituting 15% of all US cancer patients. The goal of this study is to examine factors contributing to low African American participation in cancer clinical trials, specifically within the Louisville area. Previous research attributes low CCT participation to generational mistrust stemming from historical abuses of Blacks in clinical research. Research has demonstrated that low cancer literacy, lack of familiarity with clinical trials, and implicit bias can contribute to low minority recruitment to clinical trials. In order to make CCTs more representative of the general population, increasing generalizability of results, barriers must be understood before successful interventions can be trialed. Methods: By conducting focus groups and individual interviews with African American cancer survivors (AACS) (n=33), we sought to understand the barriers to CCT participation in the Louisville area. Results: The qualitative study revealed that a majority of AACS had not received information about CCTs from their healthcare teams, but a majority expressed interest in receiving information about CCTs. Conclusion: This data, though potentially confounded by the composition of the cohorts analyzed, suggests a need for community outreach and education specifically centered around CCTs. Keywords:[Cancer clinical trials, representation, barriers, cancer survivors]Item Assessing Cancer Health Disparities Within Racial/Ethnic Groups in Tarrant, Dallas, and Bexar County(2024-03-21) Jayesh, Irene; Chu, Megan; Nava, MarcelaBackground: Cancer health disparities refers to significant differences in cancer incidence, prevalence, death, survivorship, and burden that exist among different population groups in the United States. Those who have limited or lack access to effective health care are often impacted more severely by cancer compared to the general population. Social and economic factors such as insurance status, income level, neighborhood poverty, and education level also play a large influence in cancer disparities observed among groups. Strong public health policies can serve an important role in reducing cancer health disparities by tackling prevention and early detection, especially within vulnerable populations. Health disparities are particularly pronounced in racial/ethnic groups such as African Americans and Latinos, and even persist when comparing groups of similar socioeconomic status. The findings of this research project will provide valuable information regarding the urgent need to address cancer disparities within Texas counties, especially Tarrant County, Dallas County, and Bexar County. Purpose: Highlight disparities in the frequency and rate of cervical, breast, prostate, lung, and colorectal cancer among racial/ethnic groups within Tarrant, Dallas, and Bexar county to increase awareness for policy making. Methods: County-level cancer data was pulled from the Surveillance, Epidemiology, and End Results (SEER) cancer registry. The statistics in this registry were categorized by the patient's racial group. Focusing only on statistically significant changes, we ranked all counties by their average annual percent change (APC) from 2000-2020 trend for frequency and age-adjusted rate per 100,000 population for cervical, breast, prostate, colorectal, and lung cancer. Results: In Tarrant County, the annual percent change of cancer frequency between 2000-2020 were as follows: 2.5% increase for cervix, 2.7% increase for breast, 0.9% increase for prostate, 1.3% increase for colorectal, and 0.6% increase for lung cancer. Also in Tarrant County, the annual percent change of cancer rates from 2000-2020 were as follows: 0.2% increase for cervix, 0.2% increase for breast, -3.1% decrease for prostate, -2.2% decrease for colorectal, and -2.8% decrease for lung cancer. Tarrant county was also ranked 1st in Texas and 5th in the nation for cervical cancer in Non-hispanic black. Dallas county was ranked 7th in Texas and 15th in the nation for cervical cancer in Hispanics. Conclusion: This data brings awareness to certain groups within Tarrant County, Dallas County, and Bexar county that are more likely to be diagnosed with cancer mainly because of their ethnicity. These findings bring up crucial discussions about the underlying factors contributing to the increase in cancer risk among specific ethnic populations, whether it is a genetic association or a socioeconomic association. For example, despite initiatives taken to tackle this disparity, the data shows that Hispanic women are still highly at risk for developing cervical cancer across all three counties. Policymakers and advocates can use this data to identify which type of cancers and ethnic groups require focused intervention and attention in the community.Item Assessing Changes to the Lower GI Tract Microbiome in Response to Neglect-related Early Life Stress Exposure(2024-03-21) Choe, Jamie; Donkor, Michael; Zhang, Yan; Gorham, Isabelle; Allen, Michael; Phillips, Nicole; Jones, HarlanGrowing evidence supports exposure to early life stress (ELS) is associated with alterations in the developing immune system and increases the risk for chronic health conditions. It is widely understood that alterations to the gut microbiome can occur from exposure to various environmental factors, including diet and stress. Early life malnutrition is a form of neglect-related ELS that refers to states of both under- and over-nutrition in which a child may have insufficient intake of one or more nutrients due to an imbalanced diet. Malnutrition during childhood is a public health concern with significant health ramifications. Recent research shows the gut microbiome is intimately involved with immune system development—especially during early life when the immune system is being trained. In the present study, we use a modified version of the maternal separation with early weaning (MSEW) model to study the impact of physical neglect and malnutrition on the gut microbiome in mice. Conditions of neglect-related stress were simulated based on scheduled dam-pup separation (physical neglect) and a high carbohydrate early-wean diet (malnutrition). C57BL/6J mice were bred in-house and ELS pups were subjected to: (1) daily dam-pup separation on postnatal days (PD) 2-13 and/or (2) early weaning (EW) to a high carbohydrate diet on PD14-21. All tissues and stool samples were collected on PD21 for analysis. Pups exposed to MSEW or EW alone were assessed separately. 16S rRNA gene sequencing revealed the neglect-related ELS condition, as described under the present model, led to significant shifts in the predominate species in the lower GI tract microbial community. ELS-mediated shifts included increased Bacteroides and Enterococcus and were accompanied by decreased Lachnospiraceae. RTqPCR of bilateral adrenal glands revealed gene expression changes in key enzymes for stress response pathways, namely those implicated in the synthesis of adrenal glucocorticoids. These results demonstrate ELS-mediated dysbiosis can be observed at PD21 under the present model. Our findings at the PD21 timepoint reveal acute changes to the gut microbiome in the context of ELS and characterizes the baseline microbial community in the lower GI tract.Item Assessing Cognitive Function: The Role of the Memory Alteration Test in Predicting Stroop Color-Word Performance within the Self-Management Program for Brain Health(2024-03-21) Aboutaj, Amin; Ross, Sarah; Soto, Isabel; Severance, JenniferPurpose: The Self-Management Program for Brain Health is designed to empower participants to make lifestyle changes that enhance cognitive function and potentially delay dementia onset. This study investigates the predictive relationship between the Memory Alteration test and Stroop Color-Word (Stroop CW) performance in these participants, aiming to contribute valuable insights to the complex interplay between memory and executive processing abilities. Methods: Cognitively healthy adults (n = 21, age range 56–90) participated in the study, meeting inclusion criteria and undergoing vital sign assessment, Memory Alteration, and Stroop CW tests. The Memory Alteration test, a reliable screening tool, employed a cut-off of < 40 for cognitive impairment. Stroop CW raw scores were age-corrected, and T-scores were obtained. Statistical analyses included correlation coefficient (r) and p-value calculations. Results: A statistically significant positive correlation (r = 0.55, p = 0.009) between Memory Alteration and Stroop CW scores was observed. Subgroup analysis confirmed the hypothesis, revealing a consistent correlation pattern for those scoring below (mean Memory Alteration 37.86±0.55, Stroop CW 48.43±2.32, r = 0.88, p = 0.009) and above (mean Memory Alteration 44.93±0.85, Stroop CW 50.79±1.89, r = 0.67, p = 0.009) the normal Memory Alteration cut-off of 40. Conclusions: The study supports the predictive ability of the Memory Alteration test on Stroop CW performance in cognitively healthy adults. It underscores the clinical relevance of the Memory Alteration test as a reliable screening tool for early cognitive impairment and processing speed changes. Clinicians are encouraged to become familiar with the Memory Alteration test, considering its inclusion as an additional cognitive screening tool. By adding this brief and non-invasive assessment into routine practice, healthcare professionals can enhance their ability to identify subtle cognitive changes early on, facilitating proactive interventions and contributing to improved patient outcomes. Limitations include sample size and variability, suggesting the need for larger, more diverse samples in future research. The ongoing Self-Management Program for Brain Health presents an opportunity to address these limitations and advance our understanding of cognitive assessment and brain health.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 Assessing the Reliability of Current AI Platforms in Delivering Health Information Related to Crohn Disease, Ulcerative Colitis, and Colorectal Cancer(2024-03-21) Isa, Salman; Elchehabi, Sahar; Jafri, Faraz; Hoang, Long; Sharma, Mukesh; Hapuarachchi, Menalee; Gonzales, Gabriel; Lewis, Trina; Richardson, Justin; Nguyen, Elizabeth; Hyman, CharlesPurpose In recent years, the advancements in artificial intelligence (AI) have revolutionized the way we seek and access health information. With more people turning towards AI for answers to their problems, it is important to question how safe it is to rely on AI for answers to health-related issues. We explored the accuracy of ChatGPT—a language model developed by OpenAI—and Gemini—Google’s AI platform—in providing health information related to Crohn disease, ulcerative colitis, and colorectal cancer. Methods We generated 10 questions relating to Crohn disease, ulcerative colitis, and colorectal cancer in relation to the social, psychological, economic, and physical aspects that patients with these diseases may face. Each query was remastered for each disease, resulting in 30 total questions which were posed to the two separate AI models. We then regenerated the responses for a total of three times ending up with 90 generated responses per AI model. We also measured the Flesch-Kincaid Readability scores for each response and analyzed the sentiment of the text using natural language processing and computational linguistics. The Centers of Disease Control and Prevention (CDC) recommend that medical information for the public be written at no higher than an eighth-grade reading level. Generated AI responses were evaluated by six gastroenterologist attendings and fellows for accuracy within the context of a patient seeking information. Sets were deemed inappropriate if any of the three responses contained inaccurate or misleading information, based on clinical judgment. Evaluators were blinded to model names and prices. Interrater agreement (94%) and reliability (κ score, 0.87) were ideal. The study was performed in July 2023. Results Of the 60 questions posed to the two different AI language models, 45% (n = 27) of the responses were found to be inaccurate. When the two AI models were compared, 43.33% (n = 13) of ChatGPT’s responses were accurate while 46.7% (n = 14) of Gemini’s responses were deemed accurate. ChatGPT also had a 13.20 average Flesch Kincaid Reading grade level and a 31.06 average Flesch Kincaid Readability score. Gemini’s responses received an average Flesch Kincaid Reading grade level of 8.34 and an average Flesch Kincaid Readability score of 56.92. ChatGPT’s average sentiment score was a 1.23 while Gemini’s average score was a 0.92. Conclusion While OpenAI’s ChatGPT and Google's Gemini platform can serve as valuable resources for information retrieval, they possess certain limitations when it comes to health-related information for Crohn disease, ulcerative colitis, and colorectal cancer. Importantly, both AI models in the study provided inappropriate responses to common patient questions regarding these conditions. Medical professionals should be aware of these limitations as they may lead to the spread of misinformation in populations with limited access to health care.Item Assessment of digit skin temperatures via infrared thermography under different climatic conditions.(2024-03-21) Boettger, Chloe; Tran, Baonhu; Ward, Lyndee; Counts, Caroline; Cowgill, Libby; Ocobock, Cara; Cho, Elizabeth; Maddux, ScottThe responsiveness of the manual/pedal digits (i.e., finger/toes) to temperature changes makes them valuable indicators of thermoregulatory function. Further, while infrared thermography is used in many medical settings, its utility in assessing acute changes in digit skin temperatures remains poorly established. Accordingly, this research investigated the use of forward-looking infrared (FLIR) imaging as a methodological tool for analyzing digital skin temperatures across varying climatic conditions. A Teledyne FLIR E76 camera and associated FLIR Studio software were used to assess peripheral digit skin temperatures in a sample of 25 living human subjects (12 female, 13 male). Images of each hand and foot were captured every 5 minutes over a 45-minute period during exposure to four controlled climatic conditions in an environmental chamber. These experimental conditions included a control (22°C and 50% humidity), hot-humid (37°C and 85% humidity), hot-dry (44°C and 15% humidity), and cold-dry (5°C and 80% humidity) exposures. All images were taken at a perpendicular angle from the skin surface at a distance of 0.45 mm, as measured using the camera’s laser-guided range finder function. Baseline images were similarly taken during a preliminary rest period prior to each experimental exposure. This resulted in a total of 2,200 images collected from the left hand and left foot of the 25 participants. Following theoretical expectations, preliminary findings indicate peripheral digit temperatures predictably decrease during the cold-dry exposure, while the hot-dry and hot-humid exposures induce increases in digit temperatures. These preliminary results suggest that infrared thermography likely provides an expedient mechanism for accurately assessing peripheral skin temperatures in humans under different climatic conditions. Infrared thermography may thus have valuable applications for assessing thermoregulatory function in both clinical and research settings.Item Assessment of Food Insecurity Amongst HSC Patients Using the Hunger Vital Signs Screening Tool(2024-03-21) Brooks, Kate; Bui, Priya; Garcia, JoannaPurpose: The US Department of Agriculture (USDA) defines food insecurity (FI) as “lack of consistent access to enough healthy food for an active healthy life.” FI is associated with negative developmental and health outcomes in children and adults but is less often associated with the physical appearance of malnourishment in children. Because of this, the American Academy of Pediatrics recommends FI screening for all pediatric patients. The Hunger Vital Signs (HVS) screening tool was developed as an efficient and effective way to screen for FI in clinical settings. Since its development, the HVS has been found to be sensitive, specific, and valid as a screening tool for FI in all populations, as compared to the USDA’s 18-item Household Food Security Survey. This project aims to assess the prevalence and distribution of food insecurity within HSC’s patient population. Methods: As part of the check-in process, patients or their caregivers completed an HVS screening at each clinic visit. HVS asks if within the past 12 months, patients “worried whether our food would run out before we got money to buy more,” and if “the food we bought just didn’t last and we didn’t have money to get more,” and allows patients to answer along a 4-point scale. Patients who screened positive for FI then received in person or mailed resources from the clinic Social Worker, including various local food resources. The results of these screenings along with various patient demographics were then analyzed for various trends and distributions via Excel. Additionally, patients who screened positive for food insecurity were then provided resources by the clinic social workers, and results of these patients’ subsequent HVS screenings were followed to assess effectiveness of these resources. Results: Overall, 10.1% of patients screened positive for FI. Disparities across various factors were present, including percent FI amongst Asian patients of 6.1% compared to that of Native American patients of 15.5%. Additionally, patients from the UNT HSC Center for Older Adults showed only a 6.0% FI percentage. After intervention by the social work team, 40% of patients experiencing FI showed improvement on subsequent screenings. Conclusions: This study shows that food insecurity is a prevalent issue in our clinic’s patient population. Disparities across various factors were present, including ethnicity and clinic location, suggesting important areas for improved interventions. While 40% of food insecure patients showed improvement following intervention, several challenges were met regarding validation of this improvement data, emphasizing important areas for future research.Item Assessment of Neuroinflammation in Cognitive and Motor Brain Regions in Female Rats Exposed to Chronic Intermittent Hypoxia(2024-03-21) Appiah, Cephas; Little, Joel; Kunwar, Kishor; Cunningham, TomSleep apnea increases the risk of neurodegenerative disorders in postmenopausal women. In this study, we tested whether chronic intermittent hypoxia (CIH), a preclinical model of sleep apnea-associated cyclical hypoxia, can be used to identify early changes in the brain that might contribute to impair neurological function in intact (INT) and ovariectomized (OVX) female rats. To test this hypothesis, we conducted immunohistochemistry studies using markers for glial activation and neuroinflammation. We hypothesize that CIH will increase glial activation in ovariectomized (OVX) relative to intact (INT) female rats. Adult female Sprague Dawley INT (n=4) or OVX (n=4) rats that were part of a larger study and underwent 7 days of CIH (10% O2 and 21% O2 cycle, every 6 mins, 8h/day during the light phase) or continuous normoxia (CON) were euthanized on day 8, and their brains were collected. Brains were processed for microglia (IBA1) and astrocytes (GFAP) activation markers in (CA1) hippocampus, medial prefrontal cortex (mPFC), and caudate putamen (CP) striatum. Confocal images from each region are being used to optimize a fractal analysis protocol to test for changes in glial morphology. Raw images will be linearly processed in Huygens Essentials software to limit noise and optimize quality for further analysis in ImageJ. Skeletal and fractal analyses will be performed on randomly selected cells in the photomicrographs to determine cell ramification (branching, junctions, endpoint voxels, branch lengths) and complexity (fractal dimension, cell span ratio, density) to complement cell counts of immunohistochemical markers of activation. Our preliminary analysis has allowed us to determine the appropriate parameters needed for image capture and subsequent analysis. We have observed some possible qualitative changes indicative of increased activation in the CA1, CP, and mPFC regions following CIH in OVX rats relative to intact rats. The results of this study aim to contribute to our understanding of the potential impact of CIH in female rats of differing ovarian function, providing insights into sleep apnea-associated CNS dysfunction in women.