Digital Commons Network^™

Aberrant Choroid Plexus Formation Drives The Development Of Treatment-Related Brain Toxicity, Tamara Bender, Esther Schickel, Celine Schielke, Jürgen Debus, David R Grosshans, Marco Durante, Insa S Schroeder

Faculty, Staff and Student Publications

Brain tumors are commonly treated with radiotherapy, but the efficacy of the treatment is limited by its toxicity to the normal tissue including post-irradiation contrast enhanced lesions often linked to necrosis. The poorly understood mechanisms behind such brain lesions were studied using cerebral organoids. Here we show that irradiation of such organoids leads to dose-dependent growth retardation and formation of liquid-filled cavities but is not correlated with necrosis. Instead, the radiation-induced changes comprise of an enhancement of cortical hem markers, altered neuroepithelial stem cell differentiation, and an increase of ZO1+/AQP1+/CLDN3+-choroid plexus (CP)-like structures accompanied by an upregulation of IGF2 mRNA, …

The Bacterial Microbiome Modulates The Initiation Of Brain Metastasis By Impacting The Gut-To-Brain Axis, Matteo Massara, Michelle Ballabio, Bastien Dolfi, Golnaz Morad, Vladimir Wischnewski, Eleni Lamprou, Joao Lourenco, Stéphanie Claudinot, Hector Gallart-Ayala, Rui Santalla Méndez, Annamaria Kauzlaric, Nadine Fournier, Ashish V Damania, Matthew C Wong, Julijana Ivanisevic, Nadim J Ajami, Jennifer A Wargo, Johanna A Joyce

Faculty, Staff and Student Publications

Brain metastases (BrMs) are the most common brain tumors in patients and are associated with poor prognosis. Investigating the systemic and environmental factors regulating BrM biology represents an important strategy to develop effective treatments. Toward this goal, we explored the contribution of the gut microbiome to BrM development by using in vivo breast-BrM models under germ-free conditions or antibiotic treatment. This revealed a detrimental role of gut microbiota in fostering BrM initiation. We thus evaluated the impact of antibiotics and BrM outgrowth on the gut-brain axis. We found the bacterial genus Alistipes was differentially present under antibiotic treatment and BrM …

Immune Checkpoint Inhibitors Plus Debulking Surgery For Patients With Metastatic Renal Cell Carcinoma: Clinical Outcomes And Immunological Correlates Of A Prospective Pilot Trial, Sangeeta Goswami, Jianjun Gao, Sreyashi Basu, Daniel D Shapiro, Jose A Karam, Rebecca Slack Tidwell, Kamran Ahrar, Matthew T Campbell, Yu Shen, Alexandro E Trevino, Aaron T Mayer, Alexsandra B Espejo, Christian Seua, Marc D Macaluso, Yulong Chen, Wenbin Liu, Zhong He, Shalini S Yadav, Ying Wang, Priya Rao, Li Zhao, Jianhua Zhang, Sonali Jindal, Nizar M Tannir, Andrew Futreal, Linghua Wang, Padmanee Sharma

Faculty, Staff and Student Publications

Surgical removal of primary tumors reverses tumor-mediated immune suppression in pre-clinical models with metastatic disease. However, how cytoreductive surgery in the metastatic setting modulates the immune responses in patients, especially in the context of immune checkpoint therapy (ICT), is not understood. We report the first prospective, pilot, non-comparative clinical trial (NCT02210117) to evaluate the feasibility, clinical benefits, and immunologic changes of combining three different ICT-containing strategies with cytoreductive surgery or biopsy for patients with metastatic clear cell renal cell carcinoma. Primary safety endpoint of this trial has been met, with 43 patients completing cytoreductive surgery, 36 patients undergoing …

Characterization Of Rationally Designed Crispr/Cas9-Based Dna Methyltransferases With Distinct Methyltransferase And Gene Silencing Activities In Human Cell Lines And Primary Human T Cells, Rosa Selenia Guerra-Resendez, Samantha Legoff Lydon, Alex J Ma, Guy C Bedford, Daniel R Reed, Sunghwan Kim, Erik R Terán, Tomoki Nishiguchi, Mario Escobar, Andrew R Dinardo, Isaac B Hilton

Faculty, Staff and Students Publications

Nuclease-deactivated Cas (dCas) proteins can be used to recruit epigenetic effectors, and this class of epigenetic editing technologies has revolutionized the ability to synthetically control the mammalian epigenome and transcriptome. DNA methylation is one of the most important and well-characterized epigenetic modifications in mammals, and while many different forms of dCas-based DNA methyltransferases (dCas-DNMTs) have been developed for programmable DNA methylation, these tools are frequently poorly tolerated and/or lowly expressed in mammalian cell types. Further, the use of dCas-DNMTs has largely been restricted to cell lines, which limits mechanistic insights in karyotypically normal contexts and hampers translational utility in the …

Pharmacological Interventions For Negative Symptoms In Schizophrenia: A Systematic Review Of Randomised Control Trials, Lorenzo Moccia, Francesca Bardi, Maria Benedetta Anesini, Sara Barbonetti, Georgios D Kotzalidis, Sara Rossi, Romina Caso, Flavia Grisoni, Giuseppe Mandracchia, Stella Margoni, Tommaso Callovini, Delfina Janiri, Marianna Mazza, Alessio Simonetti, Silvia Montanari, Gianna Autullo, Giovanni Camardese, Maria Pepe, Marco Di Nicola, Vassilij Di Giorgio, Fabio Conti, Gabriele Sani, On Behalf Of The Gemelli Repsy Study Group

Faculty, Staff and Students Publications

Background/Objectives: While positive symptoms of schizophrenia are often satisfactorily controlled, negative symptoms are difficult to treat, persisting despite treatment. Different strategies have been devised to deal with this problem. We aimed to review drug treatment for negative symptoms of schizophrenia in controlled trials of marketed drugs.

Methods: We searched the PubMed database and the resulting records' reference lists to identify eligible trials using schizophrenia[ti] AND "negative symptom*"[ti] as a search strategy. We determined eligibility through Delphi rounds among all authors.

Results: On 11 February 2025, we identified 1485 records on PubMed and 3 more from reference lists. Eligible were 95 …

Invasion And Metastasis In Cancer: Molecular Insights And Therapeutic Targets, Yongxing Li, Fengshuo Liu, Qingjin Cai, Lijun Deng, Qin Ouyang, Xiang H-F Zhang, Ji Zheng

Faculty, Staff and Students Publications

The progression of malignant tumors leads to the development of secondary tumors in various organs, including bones, the brain, liver, and lungs. This metastatic process severely impacts the prognosis of patients, significantly affecting their quality of life and survival rates. Research efforts have consistently focused on the intricate mechanisms underlying this process and the corresponding clinical management strategies. Consequently, a comprehensive understanding of the biological foundations of tumor metastasis, identification of pivotal signaling pathways, and systematic evaluation of existing and emerging therapeutic strategies are paramount to enhancing the overall diagnostic and treatment capabilities for metastatic tumors. However, current research is …

Membrane Lipids Augment Cell Envelope Stress Signaling Via The Madrs System To Defend Against Antimicrobial Peptides And Antibiotics In Enterococcus Faecalis, William R Miller, April Nguyen, Kavindra V Singh, Samie Rizvi, Ayesha Khan, Sam G Erickson, Stephanie L Egge, Melissa Cruz, An Q Dinh, Lorena Diaz, Philip C Thornton, Rutan Zhang, Libin Xu, Danielle A Garsin, Yousif Shamoo, Cesar A Arias

Faculty, Staff and Student Publications

Enterococci have evolved resistance mechanisms to protect their cell envelopes against bacteriocins and host cationic antimicrobial peptides (CAMPs) produced in the gastrointestinal environment. Activation of the membrane stress response has also been tied to resistance to the lipopeptide antibiotic daptomycin. However, the actual effectors mediating resistance have not been elucidated. Here, we show that the MadRS (formerly YxdJK) membrane antimicrobial peptide defense system controls a network of genes, including a previously uncharacterized 3-gene operon (madEFG) that protects the Enterococcus faecalis cell envelope from antimicrobial peptides. Constitutive activation of the system confers protection against CAMPs and daptomycin in the absence of …

A Protocol To Purify Human Mediator Complex From Freestyle 293-F Cells, Hui-Chi Tang, Kuang-Lei Tsai, Ti-Chun Chao

Faculty, Staff and Student Publications

The Mediator, a multi-subunit protein complex in all eukaryotes, comprises the core mediator (cMED) and the CDK8 kinase module (CKM). As a molecular bridge between transcription factors (TFs) and RNA polymerase II (Pol II), the Mediator plays a critical role in regulating Pol II-dependent transcription. Considering its large size and complex composition, conducting in vitro studies on the Mediator complex is challenging, especially when isolating the intact and homogeneous complex from human cells. Here, we present a method to purify the intact CKM-cMED complex from FreeStyle 293-F cells (293-F cells), which offers advantages for performing large-scale protein purification. To isolate …

Zika Virus Ns1 Drives Tunneling Nanotube Formation For Mitochondrial Transfer And Stealth Transmission In Trophoblasts, Rafael T Michita, Long B Tran, Steven J Bark, Deepak Kumar, Shay A Toner, Joyce Jose, Indira U Mysorekar, Anoop Narayanan

Faculty, Staff and Students Publications

Zika virus (ZIKV) is unique among orthoflaviviruses in its vertical transmission capacity in humans, yet the underlying mechanisms remain incompletely understood. Here, we show that ZIKV induces tunneling nanotubes (TNTs) in placental trophoblasts which facilitate transfer of viral particles, proteins, mitochondria, and RNA to neighboring uninfected cells. TNT formation is driven exclusively via ZIKV non-structural protein 1 (NS1). Specifically, the N-terminal 1-50 amino acids of membrane-bound ZIKV NS1 are necessary for triggering TNT formation in host cells. Trophoblasts infected with TNT-deficient ZIKV

The Correlation Between Temporomandibular Disorder (Tmd) And Vitamin D Deficiency, Iris Kim, Claudia Freitas

Annual Research Symposium

No abstract provided.

In-Silico Modeling And Characterization Of Kcc2 Protein Interaction With A Small Molecule Direct Agonist Identifies Potential Binding Sites For Modulating Behaviors Associated With Substances Of Abuse, William Hai Dang Ho, Alfred Amendolara, Kenyon Mitchell, Jaden Miner, Ruth Northcott, Braxton Bingham, Andrew J. Payne

Annual Research Symposium

Purpose

KCC2 is a potassium-chloride cotransporter that plays a critical role in neuronal function by regulating GABAergic signaling via chloride gradients. Maintaining this concentration gradient is crucial for balancing excitation and inhibition in the brain. While KCC2 dysregulation has been implicated in epilepsy and seizures, recent studies suggest that KCC2 inhibition results in phenotypes mirroring those seen in chronic opioid dependence. As such, increasing evidence support KCC2 being a potential therapeutic target for modulating behaviors associated with substances of abuse. Currently, only a few direct small molecule agonists against KCC2 have been reported, and no definitive active site on the …

Identification Of Novel Genetic Biomarkers Linked To The Prodromal Stage Of Parkinson’S Disease (Pd) Patients, Marwa Tawfik Badawy

Theses and Dissertations

Background and Objective: The early diagnosis of neurodegenerative diseases, such as Parkinson's disease (PD), is particularly challenging because symptoms appear only after significant neuronal damage has already occurred. This study is utilizing variant call format (VCF) analysis to identify genetic variants and novel genes that could serve as early prognostic markers for prodromal PD. Materials and Methods: Data were sourced from the Parkinson's Progression Markers Initiative (PPMI), focusing on prodromal patients with gVCF data from the 2021 cohort. The study included 304 participants, comprising 100 healthy controls, 146 individuals with prodromal genetic indicators, 21 individuals with prodromal hyposmia, and 37 …

Escape From Diabetes, J E. Jochum, J Carmack, J Toon

Clinical Practice in Athletic Training

Introduction: In the past decade, interprofessional education (IPE) to promote interprofessional collaborative practice has become an integral component of pre-licensure education in the health professions. Research shows that IPE activities involving problem-solving in patient care that requires cooperation and communication among the professions is most effective. An effective activity to meet interprofessional competencies is the use of escape rooms. Escape rooms are team-based games where groups of individuals solve puzzles to accomplish a specific goal, typically in a limited amount of time. There are many benefits to using escape rooms in education, including promoting problem-solving, teamwork, and creativity, improving focus …

Modification Of Ergonomics For A World-Class Brass Instrumentalist With A Congenital Limb Difference: Level 3 Case, O G. Newhouse

Clinical Practice in Athletic Training

Background: A drum and bugle corps is a musical marching organization that consists of approximately 160 brass, percussion, and color guard performers. There are currently twenty-one drum corps organizations at the world-class level that compete. Organizations learn their 8–10-minute show in the late spring and begin traveling the country performing and competing in the early summer until August. Rehearsal days can be up to 10 hours of practice including visual and music. It has been reported that the incidence of upper limb pain is higher in those who have longer practice times, in which is a symptom of overuse. These …

Development Of A Conditional Plasmid For Gene Deletion In Non-Model Fusobacterium Nucleatum Strains, Peng Zhou, Bibek G C, Chenggang Wu

Faculty, Staff and Student Publications

Fusobacterium nucleatum is an opportunistic pathogen with four subspecies: nucleatum (FNN), vincentii (FNV), polymorphum (FNP), and animalis (FNA), each with distinct disease potentials. Research on fusobacterial pathogenesis has mainly focused on the model strain ATCC 23726 from FNN. However, this narrow focus may overlook significant behaviors of other FNN strains and those from other subspecies, given the genetic and phenotypic diversity within F. nucleatum. While ATCC 23726 is highly transformable, most other Fusobacterium strains exhibit low transformation efficiency, complicating traditional gene deletion methods that rely on non-replicating plasmids. To address this, we developed a conditional plasmid system in which …

Benefits Of Equilibrium Between Microbiota- And Host-Derived Ligands Of The Aryl Hydrocarbon Receptor After Stroke In Aged Male Mice, Pedram Peesh, Maria P Blasco-Conesa, Ahmad El Hamamy, Romeesa Khan, Gary U Guzman, Parisa Honarpisheh, Eric C Mohan, Grant W Goodman, Justin N Nguyen, Anik Banerjee, Bryce E West, Kyung Ae Ko, Janelle M Korf, Chunfeng Tan, Huihui Fan, Gabriela D Colpo, Hilda Ahnstedt, Lucy Couture, Solji Roh, Julia K Kofler, Jose F Moruno-Manchon, Michael E Maniskas, Jaroslaw Aronowski, Rodney M Ritzel, Juneyoung Lee, Jun Li, Robert M Bryan, Anjali Chauhan, Venugopal Reddy Venna, Louise D Mccullough, Bhanu Priya Ganesh

Faculty, Staff and Student Publications

Recent studies have highlighted the crucial role of microglia (MG) and their interactions with the gut microbiome in post-stroke neuroinflammation. The activation of immunoregulatory pathways, including the aryl hydrocarbon receptor (AHR) pathway, is influenced by a dynamic balance of ligands derived from both the host and microbiota. This study aimed to investigate the association between stroke-induced dysbiosis and the resultant imbalance in AHR ligand sources (loss of microbiota-derived [indole-based] and increase of host-derived [kynurenine-based]) after stroke. Microbiota-derived AHR ligands decreased in human plasma and remained low for days following an ischemic stroke highlighting the translational significance. Transient-middle-cerebral-artery-occlusion was performed in …

The Effects Of A Joint Reduction Trainer On Confidence Levels In Professional Athletic Training Students, T Franklin, S Hacherl

Clinical Practice in Athletic Training

Introduction: Dislocations are common injuries managed by athletic trainers, yet athletic training students are unlikely to practice reduction techniques during clinical experiences. Current standards set by the Commission on Accreditation of Athletic Training Education require accredited programs to prepare students to manage patients with dislocations, including joint reductions. Research indicates the use of simulation techniques, such as joint reduction simulators, in education can fill clinical experience gaps and improve student confidence and skills. Shoulder dislocations make up nearly 50% of dislocations with several reduction techniques identified in the current literature. The use of a joint reduction simulator may provide athletic …

Barriers To The Implementation Of The Amsterdam 2022 Statement In The Secondary School Setting, L Torres, J L. Baldari, F A. Gardin, A M. Price

Clinical Practice in Athletic Training

Introduction: The Amsterdam 2022 International Consensus Statement on Concussion in Sport provides a summary of contemporary best practice recommendations for healthcare providers who are involved in the care of athletes at risk of sport-related concussion (SRC). Given that athletic trainers (ATs) have a professional responsibility to continually educate themselves on topics of great importance to the population that they care for, such as SRC management, it is reasonable to expect them to evolve their concussion management protocols to better align themselves with the recommendations found this statement. The purpose of this study was to identify the barriers associated with the …

Using Ai-Generated Scenarios To Enhance Learning Of The Emergency Assessment Process, D Cobble, L Schroeder, J Vaughn, S Ford

Clinical Practice in Athletic Training

Introduction: Rigorous accreditation standards require students to demonstrate competency in various clinical proficiencies through clinical practice or simulation-based educational activities. Therefore, simulation has become an integral component of athletic training education, as scenarios can provide realistic and reproducible experiences for all students. To that end, our study had two primary objectives: investigate the ability of artificial intelligence (AI) to generate accurate and realistic athletic training simulation scenarios and evaluate AI's effectiveness in teaching and reinforcing the emergency assessment process through student-created scenarios. Methods: Phase one, AI developed three different scenarios for patients experiencing (1) an ovarian cyst, (2) a hypoglycemic …

Athletic Trainer Compensation Characteristics, J P. Young, K Ef Mair, L E. Eberman

Clinical Practice in Athletic Training

Introduction: Athletic trainers (ATs) are integral to healthcare yet face ongoing challenges that affect job satisfaction and retention. Factors such as long work hours, low pay, and work-family conflict contribute to dissatisfaction and a desire to leave the profession. Salary disparities and lack of administrative support are key factors impacting professional fulfillment and career longevity. Identifying how compensation influences job satisfaction is essential for improving retention and advancing the profession. Our study aimed to examine the compensation characteristics of ATs and determine the key factors that predict gross income. Methods: A cross-sectional, web-based survey was conducted. The survey was validated …

Clinat: In Service To Athletic Training Scholarship, Lindsey Eberman, Matthew J. Rivera

Clinical Practice in Athletic Training

To be of service to others means to help others without expecting anything in return. The ClinAT, or Clinical Practice in Athletic Training journal, is an online, open-access outlet for the dissemination of practice-based research in health care, and a donation of time, effort, and energy to the profession of athletic training. In 2018, when Indiana State University created its first issue of ClinAT, we were a faculty of 3 with 5 PhD students supporting the journal, one of whom was wholly dedicated to the effort. As the higher education landscape has changed, and the roles and responsibilities of our …

Exploring The Vitality Of Athletic Training: Insights Into Professional Identity, Commitment, And Retention, L E. Eberman, M J. Rivera, K E. Games, M J. Drescher, J P. Young, J Clifton-Gaw, K Condrey, H Mccarn, N Mondelli, X Yuan

Clinical Practice in Athletic Training

Introduction: The confluence of fluctuating retention, fewer students entering professional programs, and the profession’s identity crisis (conflict between being a sports profession or a health profession) has created a serious question about the vitality of the athletic profession. However, research on the vitality of the profession has often focused on singular variables influencing professional identity, burnout, and commitment. The purpose of this project was to explore multiple factors influencing the vitality of the profession across professional identity and commitment in athletic training. Methods: We used a convergent parallel mixed-methods design, including surveys and interviews with athletic training students and athletic …

Title: Professional Socialization And Development Of Athletic Training Professional Program Directors, N A. Wilkins, K D. Pagnotta, L Kunkel, S David, A B. Thrasher

Clinical Practice in Athletic Training

Introduction: The role of Program Directors (PD) has vastly expanded over the last decade to meet the evolving demands of athletic training education and higher education. While specific responsibilities such as programmatic planning and accreditation maintenance are directly outlined in accreditation standards, PDs often assume additional institutional and programmatic responsibilities that now include recruitment and retention efforts, mentorship of faculty and students, curriculum design and mapping, and other administrative tasks. Previous research demonstrates athletic training faculty have little formalized training in administrative roles, and Coordinators of Clinical Education (CCEs) desired more support and development for that role. Little research exists …

Preceptor Development: Identifying The Best Modality For Building Clinical Educators, G W. Cohen, R M. Lopez, A J. Tritsch

Clinical Practice in Athletic Training

Introduction: Preceptor training and development are not standardized within the athletic training profession. The Commission on Accreditation of Athletic Training Education (CAATE) requires that Athletic Training Programs provide an ongoing education plan for preceptors to promote a constructive learning environment for students. However, with the rapid expansion of clinical education opportunities outside of institutions' immediate area, programs must identify how to reach all their preceptors and uphold their programmatic expectations for clinical educators. Methods: The investigators conducted a cohort pre-test-post-test design study. A preceptor development program (PDP) was created and grounded in the theory of gamified learning and adult learning …

Adolescent Femoral Neck Fractures: A Case Study On Initial Surgical Intervention, Avascular Necrosis Development, And Subsequent Total Hip Arthroplasty, K A. Fisher

Clinical Practice in Athletic Training

Background: The patient sustained a femoral neck fracture at the age of 13 after slipping and falling in his home. He was seen in the Emergency Department the same day and underwent a closed reduction and percutaneous pinning procedure the following morning. Ten weeks after returning to full weightbearing, and 13.5 weeks after his initial fracture, he developed stress fractures of the medial distal femoral and proximal tibial metaphyses. He experienced gradual worsening of hip pain and difficulty with ambulation between 11 to 13 months post-closed reduction and percutaneous pinning (CRPP). Avascular necrosis and collapse of the femoral head was …

Musculoskeletal Tumors Disguised As Orthopedic Injuries: A Case Report, A Summers

Clinical Practice in Athletic Training

Background: Musculoskeletal tumors are relatively rare, accounting for only 0.2 to 0.5% of all malignancies across all age groups. More specifically, Pigmented Villonodular Synovitis, a type of musculoskeletal tumor, has an incidence rate of 1.8 cases per one million people in a population. This benign, proliferative disease is a type of tenosynovial giant cell tumor that can affect the soft tissue lining of joints, bursae, and tendon sheaths. These joint-related tumors often present with an insidious onset and non-specific physical exam findings. Therefore, they are often mistaken for other, more common orthopedic injuries, making them difficult to diagnose. Patient Information: …

Strength Assessment Protocol In Pre-Professional Ballet Dancers, Simona Di Nardo, Ivan Mascio

Clinical Practice in Athletic Training

Purpose: This research project aimed to investigate the effects, particularly regarding the ability to generate force, that could emerge following a ballet class. The purpose of the study was to support the thesis that low levels of fitness and performance in professional and amateur dancers, should be considered a significant gap that needs to be addressed. Larger will be the gap and bigger will be the demand of a dancer to be prepared athletically. While the shorter the gap and more efficient the artistic side of the dance performance will be. As a result, a stronger and healthier body will …

Mir-125a-3p And Its Targets: Promising Biomarkers For Ovarian, Liver, And Breast Cancers, Offering A Beacon Of Hope For More Effective Diagnosis And Treatment Strategies, Eman Kamaleldien Anwer

Theses and Dissertations

Cancer is a worldwide health problem with various genetic and epigenetic alterations, resulting in disease heterogeneity. Effective diagnostic, therapeutic, and monitoring markers have been determined recently; however, new diagnostic, prognostic, and therapeutic markers are needed. MicroRNAs (miRNA), short non-coding RNAs, have a highlighted role in cancer progression, migration, and programmed cell death. Our study aims to investigate the significance of miR-125a-3p and its downstream targets in breast (BRCA), hepatocellular (HCC), and ovarian (OVCA) malignancies and their possibility as diagnostic biomarkers and targets for therapeutic agents. Bioinformatics and online tools were used to determine the miRNA-predicted downstream targets, analyze GEO datasets, …

Prevalence, Perceptions, And Attitudes Of Accommodation For Students With Disabilities In Athletic Training Education Programs, T J. Babcock, L E. Eberman

Clinical Practice in Athletic Training

Introduction: Disability accommodation has been widely researched in healthcare education programs, including medical doctor (MD), doctor of osteopathy (DO), and physical therapy (PT). However, little research has been conducted on classroom and clinical education accommodation in athletic training education. The purpose of this study was to explore these settings and gain an understanding of student experiences with accommodation in athletic training education programs. This project was deemed exempt by Indiana State University’s Institutional Review Board. Methods: A cross-sectional 24-question survey was developed and adapted from prior qualitative research on accommodation in physical therapy education. Emails containing a link to the …

The Financial Stresses That Affect Athletic Training Students: A Qualitative Investigation, C Kuehner-Boyer, E León Zaragoza

Clinical Practice in Athletic Training

Introduction: A recent survey examining barriers that affect athletic training students found that financial-related barriers created significant stress for students in professional athletic training programs. The need to work while attending a professional athletic training program was the highest reported barrier with 54.82% of respondents indicating that this was a barrier for them during their program. Beyond the overall reporting rate, the need to work while completing a professional athletic training program was indicated by athletic training students to be the barrier that they encountered the most frequently with respondents reporting that this was a stress for them between monthly …