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Item 365 DAYS OF INFANT MORTALITY USING PHOTOVOICE TO UNDERSTAND INFANT MORTALITY AS AN ISSUE FOR SOCIAL CHANGE(2014-03) Paul, Marcy; Eley, Lindsey; Miller, Jennifer M.; Espinoza, AnnaPurpose (a): African Americans have an infant mortality rate more than twice the rate of Whites; yet there is limited information about parents' experience of an infant death and their perceptions about the causes of racial disparity in infant mortality. Photovoice, a documentary photography technique, was used to give a voice to parents who experienced an infant loss, and to better understand the causes and effects of racial disparity in infant mortality. To date, no known Photovoice projects have focused solely on the perceptions of parents who suffered an infant death. Methods (b): North Texas parents who experienced an infant loss were recruited using convenience sampling techniques. Participants were provided digital cameras, and asked to photograph and journal about community resources which were helpful to them as they grieved, and community resources, or lack thereof, they felt may have contributed to the death of their baby. Participants were divided into two groups based on current residency (Fort Worth or Dallas, Texas). These groups met monthly, giving participants an opportunity to discuss their photos, journal entries, and experiences during the project. Photographs and journal entries will be on display at a local art gallery as an exhibit, "Eight Warrior Mamas: Survivors of Infant Mortality - Empty Arms, Broken Hearts, and Grieving Wombs." Results (c): African American women (n=6) and White women (n=2) participated in the project. From their photographs and group discussions three themes emerged. The first theme was poor post-partum care. Many of the mothers reported feeling that the health provider they visited after delivery was insensitive, and the post-partum examinations were uncomfortable. The second theme was loneliness and isolation. The mothers described finding it difficult to locate support groups and other resources to help them during the grieving process. The third theme was the poor/inappropriate response from health insurers and regulatory agencies such as Child Protective Services. The mothers expressed that they were treated in a cold and distant manner when communicating with different systems about their deceased child. Conclusions (d): This project is an innovative approach to identifying systemic issues that contribute to racial disparity in infant mortality. Through the exhibit parents who suffered an infant death have a platform to voice their loss and their concerns about needed social change. Additionally, the exhibit increases community awareness of the issue of infant mortality. These findings suggest the importance of continuing to raise awareness about infant mortality and the need to further assess institutional polices' effect on racial disparities in infant mortality.Item A CADAVERIC STUDY OF HEAD AND NECK NEUROVASCULAR ANATOMICAL VARIATIONS(2014-03) Wehring, Spencer; Kirchhoff, Claire A.This study reports the incidence of head and neck neurovascular branching variations. While there is an extensive literature on the incidence of many anatomical variations because of their relevance to surgical cases, the incidence of some variations are still unknown. In addition, whether the incidence of variations differs between samples is under-explored. We therefore set out to determine whether incidence of neurovascular branching variations in a cadaveric sample in north Texas match previously reported findings, and also to document variations in the location of the vagus nerve, which has not been reported previously. Purpose (a): While anatomical variations have long been documented because of their surgical relevance, some remain unknown. In addition, between-sample differences in the incidence of variations is under-explored. We tested whether incidence of head and neck neurovascular branching variations in a cadaveric sample from UNTHSC match previous findings. We also document previously unreported positional variations for the vagus nerve. Methods (b): First-year students from the Texas College of Osteopathic Medicine recorded neurovascular variations using a standardized data sheet during their dissections. Cadavers in this study (n=29) were donated through the University of North Texas Health Science Center Willed Body Program. Results (c): The ascending pharyngeal artery branched from the external carotid artery (ECA) in 74% of cases, from the common carotid artery (CCA) in 11%. The lingual artery branched from the ECA in 82% of cases; 6% shared a common trunk with the facial artery. The vagus nerve was located between the CCA and internal jugular vein in 62% of cases, posterior to the internal jugular vein in 24%, and anterior to the CCA in 4%. Conclusions (d): Incidence of arterial branching variations mostly fell within previously reported ranges (Bergman, 1996). Differences with previous work are attributable to the small sample size of this study, which emphasizes the need for large samples when estimating the frequency of a variation. We also report information on positional variation of the vagus nerve. These data must be treated with caution due to possible inter-observer error, but further investigation of vagus nerve positional variation is warranted due to implications for patient safety.Item A LIFE-THREATENING CASE OF SEXUAL ASSAULT(2014-03) Miller, Brighton R.; Hinkle, KollierThe case presents a victim of sexual assault who suffered a stab wound which required life-saving surgical intervention to repair a laceration to the myocardium. The case report analyzes the appropriate protocol for a sexual assault victim with life threatening injuries. It summarizes the operative note for the surgical repair and uses medical references to comment on the method of treatment used. While immediate evaluation of trauma remains the primary focus in the emergency room, it is important to arrange follow up and psychological counseling for complete recovery. Purpose (a): Once reported to police, cases of sexual assault must be assessed by appropriate hospital staff who are trained in gathering biologic evidence of the sexual encounter and examining the patient for possible injuries. According to the Bureau of Justice Statistics, "Seventeen percent of the 135,550 completed or attempted sexual assaults annually against females ages 12 or older resulted in injury"5. Victims of sexual assault who are injured are more likely to receive medical treatment if reported to police. The case presented exemplifies the importance of seeking medical attention after sexual assault because it involved life-threatening injuries. Methods (b): Assessment - A 28-year-old woman who had suffered sexual assault presented to the emergency department with a total of nineteen stab-wounds to the face, neck, anterior chest, upper abdomen, back, both upper extremities and lower extremities. A primary and secondary survey of the patient was completed and the patient presented hemodynamically stable. A Sexual Assault Nurse Examiner completed a thorough medical forensics exam, collected evidence of assault and treated patient prophylactically for possible infection and pregnancy. A Computed Tomography was completed which showed concern for a hemopneuothorax. The patient remained in stable condition in the emergency department for three hours. Treatment - A right tube thoracostomy was placed for the patient's hemopneumothorax. Next, a diagnostic laparoscopy was performed. Exploration of the abdomen was initiated and a laceration to the diaphragm was noted through which the patients beating heart could be seen. A decision was made to convert to an open exploratory laparotomy. A pericardial window was made in the preperitoneal space below the xiphoid. A 1.5 to 2 cm laceration in the apex of the heart was seen. The laceration was repaired. The laceration to the diaphragm was repaired. All stab wounds were thoroughly irrigated and closed with staples. Finally, a flexible esophagoscopy and sigmoidoscopy was performed to screen for any other possible injuries. Results (c): Literature Review - The assessment and treatment of the present case proved to be effective in identifying an underlying heart laceration. The necessary steps were taken to evaluate a hemodynamically stable stab wound patient. Berardoni et al, explain, "Although it is widely accepted that patients demonstrating signs of hemodynamic instability, peritonitis or evisceration should undergo timely exploratory laparotomy, the proper conservative evaluation in hemodynamically stable patients with AASWs remain indefinable despite the multitude of proposed clinical pathways"1. Another study by Paydar et al, comparing the use of conservative management versus exploratory laparotomy found that "of the patients in the CM group, 11% needed delayed laparotomy"4. When an anterior abdominal stab wound patient is hemodynamically stable, it can be difficult to determine the proper course of management for that patient as shown by the statistical evidence of these studies. The conversion to exploratory laparotomy in this case was therapeutic in providing surgical intervention for a myocardial stab wound. Conclusions (d): In conclusion, it is important to fully evaluate victims of violent sexual assault both surgically and psychologically. A study by Koss et al. stated, "Findings indicated that severely victimized women, compared with nonvictims, reported more distress and less well-being, made physician visits twice as frequently in the index year, and had outpatient costs that were 2.5 times greater…long-term deleterious effects suggest that criminally victimized women's needs for medical treatment transcend the traditional focus on emergency care and forensic evaluation."3. After a victim of rape recovers physically, the need for emotional, spiritual and psychological healing is indicated. it is important to treat the whole patient; keeping in mind that complete healing occurs when all aspects of human disease are treated.Item A PROCESS IMPROVEMENT TOOL TO ENHANCE AND MONITOR THE TREATMENT OF CHILDREN AND ADOLESCENTS WITH DIABETIC KETOACIDOSIS (DKA)(2014-03) Wilson, Don; Nelson, Ashley; Bowman, W. PaulDiabetic ketoacidosis remains a significant cause of morbidity and mortality in children with diabetes mellitus with complications ranging from severe dehydration, electrolyte imbalance, hypercoagulability, pulmonary aspiration, and cerebral edema. Hourly monitoring of laboratory values, especially glucose and sodium [Na+], and fluid status of patients is utilized in many treatments. These values are generally recorded on static sheets next to the patient’s bedside or in an electronic medical record. Such static measures provide limited tools to evaluate trends in treatment and deviations from standard treatment protocols, therefore a process improvement tool was developed to enhance and monitor the treatment of children with DKA. A retrospective chart analysis from fifteen (15) children who were previously admitted to the pediatric intensive care unit (PICU) for treatment of DKA at Cook Children’s Medical Center was conducted. The data previously obtained during the child’s inpatient hospital course was used to assess the functionality of a newly developed computer monitoring tool. Purpose (a): The purpose of this research is to conduct a proof of concept study to determine the ability of a novel process improvement tool to enhance the treatment of children < 18 years of age with diabetic ketoacidosis (DKA). Methods (b): A process improvement tool was developed using an Excel platform. A retrospective study of fifteen patients admitted to the pediatric intensive care unit (PICU) at Cook Children's Medical Center for the treatment of DKA was used to evaluate the functionality of the process improvement tool. Results (c):The process improvement tool enables visual assessment of treatment trends and outcomes along with immediate feedback on the treatment course upon discharge from the PICU. Conclusions (d): A process improvement tool with visual monitoring and tracking of treatment trends is desirable in the treatment if DKA.Item A PROPOSED MODEL FOR POST-APPROVAL MONITORING (PAM) OF INSTITUTIONAL BIOSAFETY PROTOCOL IN AN ACADEMIC ENVIRONMENT(2014-03) Uche, Uloma I.; Nair, MayaThe main goal of this project is to develop inspection program over research work involving biological agents and to ensure compliance with National Institute of Health guidelines. Purpose (a): Hypothesis: I hypothesize that a well-defined model for post-approval monitoring will enhance the efficiency of biosafety program. Purpose: To ensure that approved protocols are appropriately executed and any changes are reported for approval. Methods (b): Materials: Approved protocols/IBC application. Forms to conduct the post approval monitoring. A program out line or Post approval monitoring. An evaluation process or tool to validate the efficiency of the proposed model. Methods: Prior to PAM, a project protocol has to be approved by the Institutional Biosafety Committee (IBC) and the principal Investigator proceeds with the research. With the current Biosfaty program at UNTHSC, the institutional biosafety officer will conduct an annual inspection of each of these laboratories with containment level BSL2 and BSL2+. We are proposing to develop a model for PAM of Biosafety protocols. The process involve the following steps. Critically examined the existing biosafety auditing program. Research on existing biosafety auditing program in other academic institutions in Texas. Development of the proposed model for Post Approval monitoring program. Timeline and major steps involved in the proposed model are: Inspection of the laboratory and laboratory procedures of the on-going research for compliance must be done by the Biosafety officer within 2-3 weeks after the protocol approval. The crucial component of this inspection will be an on the spot education about any deficiencies identified during the inspection. After the first year of approval, a thorough review of the protocol and laboratory procedures should be conducted by an assigned member of the institutional biosafety committee. Post-visit communication to the principal investigator about any deficiency or compliance found should be recorded and communicated with the principal investigator. Any training requirement should be communicated effectively. Finally towards the end of the research, another lab procedure evaluation should be conducted. Results (c): Results: From the post-approval monitoring, there will be compliance with IBC policies/NIH guidelines and the facility and laboratory workers will be protected from hazardous materials. Conclusions (d): Conclusion: Institutional Biosafety protocol guides and ensures safety and compliance with policies. An efficient post-approval monitoring would be a tool to assist the IBC with its obligations and facilitate a successful program oversight.Item ACCEPTABILITY OF SELF-ADMINISTERED PAP SMEARS AMONG SUBSTANCE ABUSING POPULATIONS(2014-03) Bangara, Saritha; Shuler, Monique; Qualls-Hampton, Raquel Y.; Felini, Martha J.The objective of this study was to assess the acceptability of self-administered Pap tests among a high risk subset of women with substance abuse issues. Our findings have been used to develop a trauma-informed, culturally sensitive cervical cancer education program that can be integrated into substance abuse treatment centers as part of this project. Purpose (a): Prior studies have revealed high acceptability rates for using self-administered Pap smears as an alternative in populations where barriers may prevent access to conventional in-office cervical screening examinations. However, few studies to date have examined whether this self-screening tool would be an option among indigent women engaging in high-risk behaviors. The objective of this study was to assess the acceptability of self-administered Pap smears among women in treatment for substance abuse and co-occurring disorders at the Nexus Recovery Center, Dallas's largest female substance abuse treatment center. Methods (b): Six focus groups (N=48 women) were conducted among women participating in treatment at the Nexus Recovery Center. A separate focus group was conducted among members of our project advisory board (medical professionals, social workers, and recovering addicts) who guided the research. A mixed methods approach was used to analyze the data and identify themes from participants' responses. Results (c): In assessing the participants' utilization of cervical cancer screenings, 30 (63%) had a Pap smear in the last two years. Preliminary analysis suggests that the acceptability of self-administered Pap smears in our study population is low. Conclusions (d): The low acceptability of self-administered Pap tests in our study population is due to a perceived lack of trust in the effectiveness of this tool. This finding will be considered when developing a trauma-informed, culturally sensitive cervical cancer education program that can be integrated into substance abuse treatment centers as part of this project.Item ADENO-ASSOCIATED VIRUS CONSTRUCT ENABLES DIFFERENTIATION OF VASOPRESSIN AND OXYTOCIN NEUROPEPTIDE-EXPRESSING MAGNOCELLULAR NEURONS IN THE HYPOTHALAMIC SUPRAOPTIC NUCLEUS IN RAT(2014-03) Knapp, Blayne A.; Little, Joel; Cunningham, TomAdeno-associated viral (AAV) vectors are useful tools for transfecting specific cell populations through the use of cell-type specific promoters. Recently, promoters that are specific for either vasopressin (AVP) or oxytocin (OXT) magnocellular neurosecretory cells (MNCs) have been designed that can be used with AAVs to selectively drive gene expression in these cells. The goal of this study was to validate this approach and determine whether it can cause the selective transfection of AVP versus OXT MNCs in the supraoptic nucleus of the hypothalamus (SON). In these studies, an AAV2 vector with an AVP promoter and GFP (p2.OVPI.EGFP) was stereotaxically injected into the SON of adult male Sprague-Dawley rats (226 - 250g bw) during isoflurane anesthesia. After 14 days, the rats were each anesthetized with inactin (100 mg/kg ip) and their brains where prepared for immunofluorescence. Two separate sections of coronal sections containing the SON were processed for either AVP or OXT immunohistochemistry using a Cy3 conjugated secondary antibody. Colocalization of GFP with either AVP or OXT immunofluorescence was determined by light microscopy. Our results indicate the colocalization of GFP and AVP in MNCs of the SON (89% GFP-AVP double labeling, n=3), and not GFP and OXT (0.08% GFP-OXT double labeling, n=3). Given this demonstration of successful vector transduction, we can conclude that the AAV2 vector is selective to AVP expressing MNCs, enabling us to distinguish AVP versus OXT MNCs in the SON. This capability will permit differentiation of neuronal types and their respective properties during later electrophysiological studies. R56 HL62569. Purpose (a): The goal of this study was to validate this approach and determine whether it can cause the selective transfection of AVP versus OXT MNCs in the supraoptic nucleus of the hypothalamus (SON). Methods (b): In these studies, an AAV2 vector with an AVP promoter and GFP (p2.OVPI.EGFP) was stereotaxically injected into the SON of adult male Sprague-Dawley rats (226-250g bw) during isoflurane anesthesia. After 14 days, the rats were each anesthetized with inactin (100 mg/kg ip) and their brains where prepared for immunofluorescence. Two separate sections of coronal sections containing the SON were processed for either AVP or OXT immunohistochemistry using a Cy3 conjugated secondary antibody. Colocalization of GFP with either AVP or OXT immunofluorescence was determined by light microscopy. Results (c): Our results indicate the colocalization of GFP and AVP in MNCs of the SON (89% GFP-AVP double labeling, n=3), and not GFP and OXT (0.08% GFP-OXT double labeling, n=3). Conclusions (d): Given this demonstration of successful vector transduction, we can conclude that the AAV2 vector is selective to AVP expressing MNCs, enabling us to distinguish AVP versus OXT MNCs in the SON. This capability will permit differentiation of neuronal types and their respective properties during later electrophysiological studies.Item ADULT ANNULAR PANCREAS: A CASE REPORT(2014-03) Yurvati, Albert; Jeyarajah, D. Rohan; Patel, Shirali; Jacob, Rhema S.Annular pancreas is a rare congenital abnormality, more often seen in the pediatric patient population. This abnormality results from failure of the ventral pancreatic bud during normal migration during development. Ectopic pancreatic tissue persists, encircling the duodenum. Hence, this can lead to duodenal obstruction. Despite the fact that annular pancreas is extremely rare in an adult patient population, annular pancreas deserves to be a part of a clinician’s differential diagnosis. The authors describe a 61 year old man presenting with annular pancreas. A discussion of the typical presentation, prevalence, and surgical management is included. Purpose (a): In modern medicine, annular pancreas remains a rare congenital abnormality yet it is the second most common kind of pancreatic fusion abnormality after pancreas divisum.1 Annular pancreas is more often seen in the pediatric patient population so it is an uncommon find among adults. In the adult population, it usually presents between 20 and 50 years of age. This abnormality results from failure of the ventral pancreatic bud during normal migration during development. Ectopic pancreatic tissue persists, encircling the duodenum.2 Most commonly the second portion of the duodenum is involved in 74% of cases.1 Hence, this can lead to duodenal obstruction. Only 737 reported cases of annular pancreas are found in English scientific literature.1,2 Imaging modalities often have their limitations in the management of this anomaly as well. In addition, treatment is still not entirely straightforward in adults as this condition can mimic many other conditions that have to be ruled out. Treatment is always surgical once the diagnosis of symptomatic annular pancreas is clearly formulated.1 Surgical options include duodenoduodenostomy, gastrojejunostomy with vagotomy, duodenojejunostomy, or very rarely, pancreatic resection.1,2,3 In the following case, the patient underwent a duodenoduodenostomy, which is the treatment of choice. Methods (b): A 61 year-old Caucasian male presented to an outside facility with a one month history of intermittent, postprandial right upper quadrant pain and a knot-like sensation and fullness after meals. He arrived at the facility after one week of increasing pain precipitated after eating a Reuben sandwich. Though the patient did not have a history of dyspepsia, he described a burning pain much like indigestion that had become severe and was now located in the epigastric region. He reported no nausea, vomiting, or change in bowel movements. However, he did state an increase in eructation. Laying supine aggravated the pain while belching alleviated the pain. He had no fever, chills, shortness of breath, cough or chest pain. Nevertheless, his initial lab work indicated a white count of 12,600 with left shift. He also had no jaundice and labs indicated normal liver function tests (LFTs). His past medical history included hypertension, high cholesterol, and benign prostatic hyperplasia. Past surgical history included three orthopedic surgeries. At the outside facility he received computerized tomography (CT) of the abdomen and pelvis with IV and p.o. contrast. CT revealed an annular pancreas with no free air or free fluid in the pancreas along with a moderately dilated stomach, and nondilated fluid-filled small bowel loops in the right lower quadrant potentially suggesting gastroenteritis. After transfer to our facility, he was seen in clinic and admitted. His symptoms had abated by this point and his white blood count had fallen to 9,400. Next, he was seen by a gastroenterologist. An upper gastrointestinal series unmistakably revealed moderate to severe stricture of the second part of the duodenum. Repeat CT again indicated an annular pancreas with no free air or free fluid in the pancreas along with a moderately dilated stomach, nondilated fluid-filled small bowel loops in the right lower quadrant potentially suggesting gastroenteritis along with a normal appendix. Moreover, the gastroenterologist performed an esophagogastroduodenoscopy (EGD) that denoted gastritis in the antrum, food debris in the bulb of the duodenum, and stenosis in the descending portion of the duodenum. The endoscope could not be passed distally. Furthermore, the esophagus and gastroesophageal junction had a normal appearance. Surgery was recommended. The patient’s preoperative diagnoses were annular pancreas and gastric outlet obstruction. He consented to either a duodenoduodenostomy or duodenojejunostomy for bypass of the duodenal obstruction and he understood the risks involved. The patient was taken to the operating room, placed under general anesthesia in the supine postion, and the abdomen was prepped and draped sterilely. An upper midline incision was made, adhesions present in the right upper quadrant were removed, and the gallbladder was noted to be intact. Afterward, the duodenum was kocherized and isolated. An annular pancreas was noted that was causing obstruction. The duodenum was entirely mobilized and a side-to-side duodenoduodenostomy was created. This was done by making a transverse incision in the first portion of the duodenum followed by a longitudinal incision in the distal duodenum. A single layer anastomosis was created in a running fashion. Air leaks were checked for by threading the nasogastric (NG) tube through the anastomosis and insufflating air under water immersion. No bubbling was present. Subsequently, the omentum was placed over the right upper quadrant, an On-Q pain pump was positioned in the preperitoneal area and Seprafilm was applied. Finally, the abdomen was closed. The patient tolerated the procedure well and was discharged on the fifth postoperative day. The patient made a complete recovery and was in good health at his two week follow-up visit. Results (c): Annular pancreas was first described in 1818 by Tieddman and the first surgical intervention was implemented by Vidal in 1905.1,2 Though Vasconcelos and Sadek reported only a sole annular pancreas case among 22,243 autopsies, this incidence may not be accurate since duodenal dissection is not performed customarily during autopsy. Thus, the 1.14% incidence reported by Karasaki et al. may be more correct as it based on institutional CT scans.1 Many theories have been conceived about the possible origins of annular pancreas. In 1910, Baldwin speculated that this abnormality arose from aberrant movement and the failure of atrophy of the ventral pancreatic bud. Lecco theorized that adherence of the ventral pancreas to the duodenum in place of normal migration was responsible.1,2 Verga believed that a narrow duodenum was the primary problem; the pancreas simply attempted to rectify the defect by filling the space around the duodenum.2 Most reported cases are among the pediatric population and demonstrate a female preponderance. In the pediatric population, other congenital abnormalities such as cardiac defects, intestinal atresia, biliary anomalies, tracheoesophageal fistulae, intestinal malrotation and trisomy-21 are also often present with annular pancreas.5 In the adult population, 70% of patients present with abdominal pain while 47% present with nausea and vomiting because of proximal duodenal obstruction.2 Patients may also present with asymptomatic pancreatic hyperenzymemia.3 According to an estimate, only 33% of infants and adults are symptomatic.2 Annular pancreas is a great imitator of other conditions because of its variability in presentation among the adult population. Peptic ulcer disease, acute and chronic pancreatitis, and gastroduodenal tuberculosis (if in endemic areas) have to be ruled out. It is seldom associated with obstructive jaundice or malignancy.1,2 Many options exist for imaging including CT, Magnetic resonance cholangiopancreatography (MRCP), Endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS). CT clearly delineates the ventral pancreatic ring encircling the duodenum (a complete ring is not required for diagnosis).4 In fact, 75% of annular pancreas cases have a partial ring around the duodenum.3 MRCP can show a pancreatic duct surrounding the duodenum but a dilated pancreatic ductal system is mandatory.2 ERCP can also be used to rule out other conditions but it is an invasive procedure that can be impeded by stenosis of the duodenum. ERCP can also cause or worsen acute pancreatitis.2,3 EUS can assess not only the pancreatic duct but also the parenchyma.3 Surgery is indicated in all symptomatic cases.1,2 Duodenoduodenostomy is preferred because it produces the least amount of blind loop segment.1 Gastrojejunostomy can be performed if vagotomy is also done; vagotomy prevents the risk of peptic ulcer and anastomotic ulcer by decreasing gastric acid secretion.1,2 Pancreatic resection is frequently avoided because of the risk of pancreatic or duodenal fistula, pancreatitis, and pancreatic insufficiency. Even minor pancreatic leaks after resection can result in serious inflammation and fibrosis, ultimately leading to luminal compromise of nearby structures. Resection is only employed if malignancy cannot be excluded.1 Conclusions (d): In modern medicine, physicians are frequently instructed to think of horses, not zebras when they hear hoofbeats. Despite the fact that annular pancreas is extremely rare in an adult patient population, annular pancreas deserves to be a part of a clinician’s differential when a patient presents with abdominal pain, nausea and vomiting, and other signs of gastric outlet or duodenal obstruction. Certainly, other probable conditions like peptic ulcer disease and acute and chronic pancreatitis have to excluded. CT is the imaging modality that is most frequently utilized to derive a diagnosis of annular pancreas but modalities like EUS, MRCP, and ERCP are also viable options. In symptomatic patients, treatment remains strictly surgical. Duodenoduodenostomy or duodenojejunostomy remain as the preferred bypass techniques to relieve obstruction. Gastrojejunostomy with vagotomy is another potential surgical option.Item AGING OF THYMIC EPITHELIAL PROGENITOR POOL IS DETERMINED BY THE P63-FOXN1 REGULATORY AXI(2014-03) Burnley, Preston I.; Su, Dong MingThe thymus is a vital organ necessary to fight infections. Unfortunately, it shrinks with age resulting in a compromised function. Our lab uses mice to study the events leading to the shrinkage, hoping to one day develop therapeutic agents to reverse the compromised function. Purpose (a): The postnatal thymic epithelial progenitor (TEP) pool is proposed to be regulated by the p63 and FoxN1 genes through proliferation and differentiation, respectively. However, the combined role of these two genes in the aging TEP is still a mystery. Evidence from murine models has elucidated contrasting roles of the p63 isoforms during the aging process. Methods (b): Wild type and FoxN1 cKO mice were used throughout the experiment to evaluate the amount of p21, p63, and FoxN1 present. Immunofluorescence and senescence staining was performed on frozen sections harvested from euthanized mice. PEI intrathymic injections were performed with either TAp63 or FoxN1 cDNA. Results (c): We found that TAp63+, but not ΔNp63+, thymic epithelial cells (TECs) were increased with age, accompanied with increased senescence associated β-gal clusters and p21+ TECs. Senescent clusters also developed after intrathymic infusion of exogenous TAp63 cDNA into young wild-type mice. Using our conditional FoxN1 gene knockout mouse model to disrupt TEP differentiation accelerated this senescent phenotype to early middle age. However, upon infusion of exogenous FoxN1 cDNA into aged wild-type mice resulted in only an increase in ΔNp63+ TECs, but no change in TAp63+ TECs in the partially rejuvenated aged thymus. Interestingly, using a novel FoxN1 transgenic mouse model to enhance TEP differentiation, ΔNp63+ TECs were decreased in young thymus. Additionally, the TAp63+ population contained a high percentage of phosphorylated-p53 and apoptotic TECs, but showed no changes in BrdU-labeled proliferation. Conclusions (d): FoxN1 controlled TEC differentiation as a bottleneck to determine TEP pool via affecting TAp63 and DNp63 levels. Thus, TEC homeostasis during aging has been determined through the p63-FoxN1 regulatory axis.Item ALLELE CHARACTERIZATION OF FIFTEEN SHORT TANDEM REPEAT LOCI OF NORTH AMERICAN GOLDEN (AQUILA CHYSAETOS) AND BALD (HALIAEETUS LEUCOCEPHALUS) EAGLES USING NEXT-GENERATION SEQUENCING(2014-03) Howard, Taylor E.; Kreutzer, McKensie; Curtis, Mary; Allen, Michael; Planz, JohnPurpose (a): The purpose of this study was to characterize by deep sequencing fifteen short tandem repeat (STR) loci in North American bald and golden eagles currently utilized by the US Fish and Wildlife Service. These STR loci are used for eagle identification in North America, however they were all developed from related species of European eagles. We hypothesized that using next-generation sequencing techniques we would be able to not only show concordance between allele calls using capillary electrophoresis (CE) methods and our new sequencing method, but also have an increased discrimination power of individuals by using this technique. Methods (b): Five samples of both bald and golden eagles were provided by the US Fish and Wildlife Service and deoxyribonucleic acid (DNA) was extracted from each using organic extraction. The current method of analysis through polymerase chain reaction (PCR) using fluorescent CE size based detection was adapted to create a protocol with increased specificity for the 15 sets of primers. Once the amplicon pool was developed, the amplicons were combined into a library using Library Prep Set for Ion Torrent™ kit for sequencing on the Ion Torrent™ Personal Genome Machine (PGM™) Sequencer® (Life Technologies™, Carlsbad, CA) with individual samples identified through barcodes embedded in the sequencing adaptors of the kit. After sequencing, the alleles were analyzed to identify the allele classification and determine the repeat structure of the STR motifs. The sequence data was used to determine if the sequences of North American population differed from existing reference sequences in GenBank®. Data was evaluated with the NextGENe® software using a virtual allelic ladder developed for each locus and contigs were assembled by anchoring the reads with the primer sequence. Results (c): Variants of alleles and allele distributions were recorded. The data revealed that the presence of sequence motif variation can increase the power of discrimination when using sequence analysis as compared to CE. Concordance was observed between the allele calls made using CE and with the sequence determined alleles. Conclusions (d): The method developed can be used to identify individual eagles with a higher discrimination power, which will be helpful in determining identity of individuals when needed for law enforcement investigations of harmed protected species such as bald and golden eagles.Item ALLELE CHARACTERIZATION OF TEN SHORT TANDEM REPEAT LOCI OF NORTH AMERICAN BEARS (URSIDS) USING NEXT-GENERATION SEQUENCING(2014-03) Kreutzer, McKensie; Howard, Taylor; Curtis, Mary; Allen, Michael; Planz, JohnPurpose (a): In the areas of conservation genetics and wildlife forensics, it is important to be able to accurately identify an individual and relate that individual back to the population from whence it came. With the low levels of genetic diversity possessed by some isolated North American bear populations, an identification method is needed that can provide higher resolution in short tandem repeat (STR) regions than current capillary electrophoresis assays. High resolution sequencing methods, such as those provided by next-generation sequencing (NGS) technologies, allow sequence motif changes within STR regions to be detected, whereas capillary electrophoresis only detects STR size. In this study, I hypothesized that when compared to capillary electrophoresis, NGS of STR loci would attain better genetic resolution among bear populations and thereby improve the accuracy of assigning an individual to its true population. Methods (b): Polymerase chain reaction (PCR) conditions were optimized for ten Ursid STR loci. An amplicon pool was generated and used to develop a library for NGS on the Ion Torrent™ Personal Genome Machine™ (PGM™) Sequencer (Life Technologies™, Carlsbad, CA). Deoxyribonucleic acid (DNA) barcode adaptors were ligated to the amplicons, thus allowing multiple samples to be sequenced in one run. Sequencing reads were aligned to a virtual ladder, first by sample via barcode, then by locus via primer. Sequence analysis was then performed using NextGENe® (SoftGenetics®, State College, PA) software. Results (c): Successful sequencing of ten loci for seven black bear (Ursus americanus) samples was carried out in one run. Allele call concordance was shown between capillary electrophoresis and NGS technologies. Variants within alleles (base changes) were evaluated and showed that NGS provided higher genetic resolution. Conclusions (d): In conclusion, NGS provided better genetic resolution than current capillary electrophoresis assays. Higher resolution has implications for increasing the accuracy of assigning an individual to its true population. Better assignment could improve genetic monitoring for conservation officers, as well as help wildlife forensic analysts improve evidentiary weight in wildlife crime cases that go to court.Item AN ACADEMIC-COMMUNITY-CLINIC PARTNERSHIP TO REDUCE WEIGHT IN HISPANIC YOUTH: FIT FOR HEALTH(2014-03) Nguyen, Dawn; Waverka, Rachael; Kitzman-Ulrich, Heather; Wilson, DonFIT for Health is a family-based weight management program taught by medical and graduate students delivered in a neighborhood clinic that includes behavioral skills, self-monitoring and a social networking website. Purpose (a): To develop an academic-community partnership, FIT for Health, to deliver a weight management program to low-income underserved communities who experience obesity related health disparities. Methods (b): Families with an overweight child (N=12; mean age = 11.8 (SD=2.1) years, 83% female, 100% Hispanic, mean BMI% = 96.3) were recruited by medical staff in a neighborhood clinic. Results (c): Youth maintained their weight over the 9-week program and demonstrated a small decrease in BMI percentile (96.3 to 96.0). The program demonstrated high satisfaction with an 84% attendance rate and 100% of families reporting enjoyment of the program, 89% were happy with their progress, and 100% felt they did a good job getting healthier. In addition, 78% of volunteer students reported an increase in knowledge about delivering community-based health promotion programs. Conclusions (d): The FIT academic-community-clinic model is a novel, cost-effective, and promising health promotion program that can provide resources to underserved low-income, ethnic minority families along with opportunities for students to participate in community-based health promotion.Item AN EVALUATION OF DIABETES KNOWLEDGE AMONGST TYPE 2 DIABETICS, HIGH RISK, AND LOW RISK DIABETIC POPULATIONS IN A RURAL COMMUNITY(2014-03) Riezenman, Ariel R.; Mendoza, Irwin; Chiapa-Scifres, Ana; Bowling, JohnPurpose (a): It has been predicted that 1 of 3 adults in the US will have diabetes by 2050. Most Texas rural communities lack adequate healthcare professionals and resources to serve their residents. The assessment of diabetes knowledge in a rural community identifies groups that may benefit from diabetes education in efforts to prevent diabetes and its associated medical complications. Methods (b): A cross-sectional study was performed within Guadalupe County at hospital and clinical settings. A consent and 24-item survey was provided to each participant. Data abstracted from 122 individual surveys were analyzed on SAS. Participants were classified as either having type 2 diabetes or being of high/low risk for type 2 diabetes. Risk status was based on the number of diabetes risk factors outlined by the National Diabetes Informational Clearinghouse. Diabetes exposure was determined by either having diabetes or knowing someone with diabetes, such as a family member or friend. Diabetes knowledge was categorized based on number of correct questions: poor (poor (<8), average (9-16), good (17-24). Results (c): Participants had an average age of 43 years, were predominantly white (63.87%), and female (61.34%). The average number of correct responses from the diabetes knowledge questionnaire was 12.38 (±3.43), with majority of participants having average diabetes knowledge, 78.15%. Independent sample t-tests were conducted to compare the average number of correct responses from the diabetes knowledge questionnaire and both diabetes exposure and age. Specifically, those with diabetes exposure had a significantly higher average number of correct responses (M = 12.69, SD = 3.23) when compared to participants not exposed to diabetes (M = 9.27, SD = 3.88), t (117) = -3.28, p = 0.001. Similarly, the average number of correct responses was significantly different between participants aged 18 to 25 (M = 10.87, SD = 3.13) and those aged 26 and older (M = 13, SD = 3.28), t (113) = -3.10, p = 0.003. A one-way ANOVA noted a significant effect for risk status on average number of correct responses, F (2, 118) = 5.14, p=0.007. Post hoc analysis using the Tukey HSD test indicated that the average number of correct response for those with diabetes (M = 13.7, SD = 2.69) was significantly different from those at low risk (M = 11.29, SD = 3.85). However, those at high risk (M = 12.68, SD = 3.02) did not differ significantly from either those at low risk or those with type 2 diabetes. A one-way ANOVA showed no significant effect for gender on average number of correct responses, F (2, 118) = 1.78, p=0.173. Conclusions (d): Overall, this study supports targeted diabetes education for persons aged 18-25 years, regardless of gender, in rural communities due to their lower levels of diabetes knowledge compared to persons aged 26 and older. Through diabetes awareness programs and health education classes, diabetes prevention and future medical complications may be reduced in rural settings.Item ANATOMICAL VARIATION OF THE LATERAL THORACIC ARTERY: WHAT THE TEXTBOOKS AREN'T TELLING YOU(2014-03) Miller, Kendall R.; Kirchhoff, Claire A.The lateral thoracic artery is the blood supply to the serratus anterior muscle and is typically described as arising directly from the second part of the axillary artery. Students expect to find this “normal” branching pattern, as variations are seldom mentioned. Variations are, however, relatively common, suggesting that they merit inclusion in regular anatomical instruction. Students at the Texas College of Osteopathic Medicine completed a standardized data sheet on the axillary artery branches during axillary dissection. All cadavers used in this study were acquired through the Willed Body Program at the University of North Texas Health Science Center (n=80; 20 males, 20 females). An observable lateral thoracic artery directly branching from the second part of the axillary artery was found in only 48% of the axillae observed. In 46% of axillae, an artery was observed traveling to the serratus anterior muscle branching from the thoracodorsal artery. In 25% of axillae, the lateral thoracic artery from the axillary artery was doubled by an artery branching from the thoracodorsal artery. In approximately half of all axillae, the lateral thoracic artery was observed to branch from the thoracodorsal artery rather than branching directly from the axillary artery, as “normally” expected. These results support previous work on variations of the lateral thoracic artery. Given the high frequency of anatomical variations, we also propose that information on variations ought to be incorporated into anatomical education.Item ANGIOTENSIN CONVERTING ENZYME 1 (ACE1) KNOCKDOWN IN THE MEDIAN PREOPTIC NUCLEUS (MNPO) ATTENUATES SUSTAINED DIURNAL HYPERTENSION FOLLOWING CHRONIC INTERMITTENT HYPOXIA(2014-03) Faulk, Katelynn; Cunningham, J. Thomas; Nedungadi, Thekkethil P.In order to study hypertension associated with Sleep Apnea, our lab uses a hypoxia model on rats. Rats are routinely used to model cardiovascular diseases of humans. We try to discover how the brain controls blood pressure in certain cardiovascular risk groups such as sleep apnea patients. This will help the scientific community better understand how sustained hypertension develops and progresses in sleep apnea patients and may lead to other discoveries about cardiovascular diseases. Purpose (a): Chronic Intermittent Hypoxia (CIH) is a model for the arterial hypoxemia seen in sleep apnea and is associated with a sustained increase in blood pressure throughout the diurnal cycle. Studies indicate that the MnPO contributes to this sustained component of CIH hypertension that persists during normoxia. MnPO neurons from rats show increased expression of the transcription factor FosB following CIH. Dominant-negative inhibition of a FosB splice variant in MnPO attenuates the sustained hypertension in CIH. We identified the pro-hypertensive ACE1 as a possible FosB target gene that may contribute to the sustained hypertension seen in CIH. Methods (b): We tested this hypothesis using a viral vector to knockdown ACE1 in the MnPO. Isoflurane anesthetized adult male rats were microinjected in the MnPO with 500nl of an adeno-associated virus containing GFP and either shRNA against ACE1 (shACE1) or a scrambled shRNA (shSCM). Changes in Mean arterial blood pressure (MAP) were recorded using radio telemetry. Rats were then exposed to CIH for 7 days through 3 minute periods of hypoxia (10% oxygen) and 3 minute periods of normoxia (21% oxygen) for 8 hours per day (0800-1600 h). Normoxic controls were exposed to room air. Laser capture microdissection followed by qRT-PCR showed that shACE1 significantly decreased ACE1 message in MnPO. Results (c): During CIH exposure, MAP significantly increased in both shACE1 and shSCM treated rats. During the normoxic dark phase, knockdown of ACE1 in the MnPO statistically decreased the sustained MAP component of CIH as compared to shSCM controls (P<0.001). Conclusions (d): These results show that ACE1 in the MnPO contributes to the sustained hypertension seen in our CIH model.Item ANGIOTENSIN II RECEPTOR TYPE-1A KNOCKDOWN IN SUBFORNICAL ORGAN PREVENTS SUSTAINED INCREASE IN MEAN ARTERIAL PRESSURE ASSOCIATED WITH CHRONIC INTERMITTENT HYPOXIA(2014-03) Saxena, Ashwini; Little, Joel T.; Nedungadi, Thekkethil P.; Cunningham, J. ThomasPurpose (a): Sleep apnea (SA) is associated with a sustained increase in mean arterial pressure (MAP) even during waking hours. Chronic intermittent hypoxia (CIH) models the hypoxemia associated with SA and produces elevated MAP during CIH and normoxia. Angiotensin II (Ang II) is implicated in the CIH associated increase in MAP. Subfornical organ (SFO), a forebrain circumventricular organ, lacks blood brain barrier and is a major site for the central effects of circulating Ang II. We investigated the effects of Ang II type 1a receptor knockdown (AT1aRKD) in the SFO on CIH hypertension in adult male rats. Methods (b): Adeno-associated viral vectors carrying GFP and either AT1aR shRNA or scrambled shRNA (SCM) were injected in SFO. Continuous measurements of mean arterial pressure, heart rate, respiratory rate, and activity were measured using radio-telemetry device implanted in abdominal aorta. Rats were exposed to cyclic hypoxia (3 min 21% O2 - 3 min 10% O2) for 8 hours/day for 7 days. Rats were sacrificed on Day 8. Results (c): Using laser-capture microdissection and qRT-PCR of amino-allyl RNA, AT1aRKD rats showed decreased SFO AT1aRmRNA in comparison with SCM rats. During intermittently-hypoxic light phase, the AT1aRKD rats exposed to CIH (3 min 10% O2 and 3 min room air cycles for 8 h during light phase for 7 d) exhibited significant increases in MAP vs. AT1aRKD-Normoxia group (p(p<0.05). During the normoxic dark phase, there was no difference in MAP between CIH and normoxic AT1aRKD rats (p=0.69). SCM-CIH group showed significant increase in MAP from SCM-Normoxia group during light phase CIH (p<0.001) and the normoxic dark phase (p<0.001). Conclusions (d): Our data indicate that AT1aRs in SFO may play a role in the sustained increases in MAP during normoxia associated with CIH.Item ANTI-NMDA RECEPTOR ANTIBODY ENCEPHALITIS: A CASE STUDY(2014-03) Mantilla, Emmanuel C. Jr.; Smith-Barbaro, Peggy; Brown, Allene; Khan, SaudWe present the case of a 25 year old Hispanic female, who presented to the ED with status epilepticus. She has had frequent hospital admissions since her seizures started six months ago, described as tonic clonic jerking. Her episodes have been associated with receptive and expressive aphasia, changes in personality, aggression, and flat affect. Work up revealed a normal MRI, intermittent slowing on EEG (Fig. 1), and lymphocytic pleocytosis with 4+ oligoclonal bands. NMDA receptor antibody encephalitis was highly suspected. Intravenous Solumedrol was given, with minimal improvement. Serology sent came back positive for NMDA receptor antibodies. Anti-N-methyl-D-asparate receptor (NMDAR) antibody encephalitis is a paraneoplastic syndrome affecting younger women, characterized by psychiatric symptoms, autonomic instability, neurologic abnormalities, and tonic-clonic type of seizures. CSF usually reveals lymphocytic pleocytosis, and MRI findings are non-specific. Diagnosis is confirmed with serology. 1 A large percentage of patients diagnosed also present with a detectable tumor, the most common of which is ovarian teratoma. 2 Anti-NMDA receptor antibody encephalitis is very responsive to treatment. The first line of management includes steroids, immunoglobulins, and plasma exchange. Rituximab and cyclophosphamide have shown to improve outcome in refractory cases. 3 Purpose (a): To describe a patient with anti-NMDA Receptor Antibody Encephalitis, discuss the clinical features based on this case study, and explore the management options for this condition. Methods (b): This is a case study on a 25 year old Hispanic female with no history of childhood seizures, who presented to the ED with status epilepticus. She has had frequent hospital admissions since her seizures started six months ago, described as tonic clonic jerking. Her episodes have been associated with intermittent receptive and expressive aphasia, changes in personality, aggression, and flat affect. During these admissions, all of her work-up, including MRI, CT scan, and CSF analysis have been negative for causing seizures. Her EEG has showed seizure focus and slowing of waves during these episodes. She has been followed by an outpatient neurologist, who has placed her on several anti-seizure medications, including Depakote, Tegretol, and Zonegran. On her latest admission, she presented to the ED with partial complex status epilepticus, exhibited generalized tonic-clonic movements, with associated tongue biting and urinary incontinence. Two days prior, she had bouts of nausea and vomiting. She was given Ativan and Cerebryx, which eventually resolved seizure activity. Further work up later revealed a normal MRI, intermittent slowing on repeat EEG, and lymphocytic pleocytosis with 4+ oligoclonal bands. Results (c): NMDA receptor antibody encephalitis was highly suspected. She was given Intravenous Solumedrol, minimal improvement was noted. Abdominal and pelvic CT were negative any neoplastic disease, including ovarian teratoma. Serology sent later came back positive for NMDA receptor antibodies. Conclusions (d): Anti-NMDA receptor antibody diagnosis should be high suspected in a young person presenting with seizures, psychiatric symptoms, speech disturbance, orofacial dyskinesias, and autonomic instability. Work-up should include serum and CSF titers for antibodies to NMDA receptors (NR1/NR2), as well as an extensive screen for any neoplasitic diseases, most especially ovarian teratomas in females.Item ANTI-TUMOR IMMUNE RESPONSES AGAINST MTLn3 MAMMARY ADENOCARCINOMA(2014-03) Carter, KiahRae J.; Orlowski, Ashley; Hodge, LisaBreast cancer is the leading cause of cancer-related deaths. More research needs to be done to examine the role of the lymphatic system during metastasis and therapies directed at the lymphatic system. Our rat model was used because it closely mimics human breast cancer. These results will allow for the future studies of therapies targeting the lymphatic system and if they will prevent metastasis. Purpose (a): Breast cancer is the leading cause of cancer-related morbidity and mortality. New research suggests the lymphatic vessels play a key role during the metastasis of breast cancer and therapies directed at the lymph system may aid in the treatment of breast cancer. MTLn3 is a mammary adenocarcinoma that is commonly used to study the effects of tumor metastasis in Fischer 344 rats. MTLn3 closely mimics human breast cancer pathogenesis, making it ideal for the study of breast cancer disease; however, little is known about the role of the lymphatic and immune systems in this disease model. The purpose of this study was to identify the type of immune response generated during MTLn3 disease. Specifically, we proposed that natural killer cells (NK), T cells, B cells and macrophages (MO) would increase in response to disease. Methods (b): To test our hypothesis, rats were randomized into control group or were sub-cutaneously injected in the right mammary fat pad with 1x106 MTLn3 tumor cells/mL on day 0. At days 0, 7, 14, 21 and 25 post-injection, lungs, tumor-adjacent lymph nodes (ALN), tumor–opposite lymph nodes (OLN) and spleens were removed and the concentration of leukocytes was determined. Primary tumors were excised and measured to calculate tumor volume. Blood was analyzed for the complete blood count and serum was measured for cancer-specific biomarkers. Results (c): All animals gained weight until day 14 post-injection. However, rats injected with MTLn3 suffered weight loss between days 14-25 post-injection. Furthermore, primary tumor size significantly (p < 0.05) increased during this time, suggesting weight loss may be related to disease. CD4+ T cells, B cells and MO in the spleen at day 21 decreased by day 25. Tumor adjacent lymph nodes experienced an increase in all cell populations, T cells, B Cells, MO, dendritic cells and NK. There were no differences in cell populations between ALN and OLN, except MO were significantly (p < 0.05) increased in ALN at Day 25. There was no change in pulmonary leukocytes by day 25. Neutrophils, monocytes and lymphocytes in the blood were significantly (p < 0.05) increased between control and 25 days post-injection rats, suggesting there is an immune response against MTLn3 tumor cells. Conclusions (d): Collectively, our results suggest MTLn3 initiates an immune response mediated by T cells, B cells, macrophages and NK cells between days 14-25 of disease. Of interest, these cells increase in the ALN at day 25 post-injection, suggesting they migrate into the lymph nodes in response to disease. In future studies, we will determine if MTLn3 metastasizes to the sentinel lymph nodes and the lung and determine if therapies targeting the lymphatic system inhibit this process.Item ANTIBODY ENCAPSULATION WITHIN POLYMERIC NANOPARTICLES(2014-03) Gdowski, Andrew; Ranjan, Amalendu; Mukerjee, Anindita; Vishwanatha, JamboorAntibodies represent a large class of drugs that have a number of different therapeutic uses. However, side effects can persist due to off target toxicity that may result when the antibody affects a tissue other than where it is intended to act. The use of targeted nanoparticles is one potential way to deliver an antibody to a specific organ where the antibody can be released in a controlled manner and limit side effects. Purpose (a): The purpose of this study is to characterize a human monoclonal antibody encapsulated within a poly(lactic-co-glycolytic) acid (PLGA) nanoparticle. We hypothesized that encapsulation of an antibody within PLGA nanoparticles is feasible and will release in a favorable manner. Methods (b): AnnexinA2 (AnxA2) IgG antibody was encapsulated within PLGA nanoparticles. Encapsulation efficiency and release kinetics were determined using polyacrylamide gel electrophoresis and coomassie brilliant blue staining. Dynamic light scattering (DLS) from Malvern Zetasizer was used to determine hydrodynamic size and zetapotential. Western blot was accomplished with cell lysates from known AnxA2 expressing cell lines to determine functionality of antibody once released from PLGA nanoparticles. Results (c): Our results show acceptable encapsulation efficiency of AnxA2 within the PLGA nanoparticle. Nanoparticles were formed in a favorable monodisperse manner. Release experiments demonstrate that AnxA2 is released in a controlled manner over a period of 15 days. In addition after release the antibody maintained functionality as evidenced through Western Blot analysis. Conclusions (d): We conclude that encapsulation of IgG monoclonal antibodies is feasible, exhibits sustained release kinetics, and maintains functionality upon release. Further, this encapsulation technique may be used as a method to load antibodies in targeted nanoparticles for release in a tissue specific manner.Item APPLICATION OF TREATMENT SUCCESS INDEX ON MULTIPLE VARIABLES IMPLICATED IN SLEEP APNEA(2014-03) Welch, Lindsey; Bentkowski, Olivia; Jouett, Noah; Raven, Ph.D., PeterThe NIH states that Positive Airway Pressure (PAP) is the optimal treatment for obstructive sleep apnea (OSA), with successful treatment benefits ranging from an increased quality of sleep to decreasing or preventing high blood pressure. Previous research has explored the positive effects of PAP use on various health indicators, however this data is based on subjective PAP use data from patients. The goal of this study was to evaluate the relationship between various health indicators and the success of using PAP with a Treatment Success Index (TSI), a measured value of treatment success based on PAP compliance and treatment efficacy. The TSI assumes that usage and effectiveness are equally important, and that decrements in either impose multiplicative impact on treatment quality. Purpose (a): The goal of this study was to evaluate the relationship between various health indicators and the success of using PAP with a Treatment Success Index (TSI), a measured value of treatment success based on PAP compliance and treatment efficacy. The literature demonstrates quite clearly that untreated OSA issues in a wide array of physical malady, ranging from obesity to cardiovascular disease. Therefore, we hypothesize that Obstructive Sleep Apnea (OSA) patients treated with Positive Airway Pressure (PAP) will demonstrate more favorable values of health indicators as compared to untreated patients (classified by Treatment Success Index). Methods (b): Data collection was performed at an office visit for each subject. PAP machines were brought from home to provide at-home data. Health indicators collected included Epworth score, heart rate, systolic and diastolic blood pressure and BMI. Subjects were assigned a Treatment Success Index (TSI) percentage based on compliance and at-home effectiveness data. Analysis was completed to determine the relationship between TSI score and the health indicators collected. Subjects with a TSI greater than or equal to 85 were considered treated, while subjects with a TSI less than 85 were considered untreated. Analysis was run on these groups to compare health indicators to their treated or untreated status. Results (c): The Epworth score was found to be decreased in the treated group, determined by the Mann-Whitney U Test results of a median value of 5 in the treated group and 7 in the untreated group (p<0.001). Systolic blood pressure was increased in the treated group, with a Mann-Whitney U Test demonstrating a median of 130 for the treated group and 124 for the untreated group (p <0.001). BMI was also increased in the treated group at 33.6, compared to 31.7 in the untreated group (p=0.002, Mann-Whitney U). There were no significant findings related to changes in heart rate of diastolic blood pressure. Conclusions (d): While Epworth score showed a favorable response to PAP treatment as determined by TSI values, systolic blood pressure and BMI were found to be higher in the treated groups. This does not indicate a negative effect of PAP use on these variables, but rather suggests other underlying mechanisms.