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Pharmacodynamic Effects Of Zsj-0228 On Complement Protein Deposition In The Kidneys Of Focal Segmental Glomerulosclerosis-Afflicted Mice., Braeden Pinkerton

Theses & Dissertations

Chronic inflammation, when left untreated, may result in significant morbidity and in severe cases, mortality. While glucocorticoids (GCs) are still being extensively used clinically as a class of very potent anti-inflammatory agents, they are also notorious for diverse adverse side effects. To mitigate these side effects, we have developed a polyethylene glycol (PEG)-based prodrug (ZSJ-0228) of dexamethasone (Dex). When tested on rodent models of Lupus Nephritis and Focal Segmental Glomerulosclerosis (FSGS), ZSJ-0228 was found to provide potent and sustained therapeutic efficacy without any detectable typical GC-associated side effects. Given ZSJ-0228’s transient renal exposure after systemic administration, it is yet to …

Gene Co-Expression And Machine Learning Approaches To Compare Sars-Cov-2 Infected Tissues In Humans, Sahil Sethi

Theses & Dissertations

The global outbreak of COVID-19, triggered by the novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has spurred an urgent need for a deeper comprehension of the molecular mechanisms involved in the host-virus interactions. Despite advancements in transcriptomic technology and computational resources, limited attention has been given to the holistic integration of molecular and clinical data to characterize the genotype/phenotype aspects of the disease.

This study analyzes gene expression patterns in various tissues, including the lung, nasal, blood, and placenta, in patients with COVID-19 to identify differentially regulated genes and pathways. We also evaluated organ-specific gene co-expression patterns that …

Community Health Assessment Collaboration: Implementing A Joint Assessment Between A Healthcare System And A Local Health Department, Briar L. Deen

Dissertations: Doctor of Public Health

Non-profit hospitals and local health departments (LHDs) often complete community health assessments (CHAs) to help understand the needs of their community and develop implementation strategies to address the community needs. Hospitals and LHDs in the same community often develop separate CHAs with similar results leading to overlap in work and funds. This project aimed to address this issue in the Dallas-Fort Worth Metroplex by convening one local health department, Denton County Public Health, and one non-profit healthcare system, Texas Health Resources, to leverage resources from each other to build a joint CHA. The Mobilizing for Action through Planning and Partnerships …

One Year Follow Up Of A Cross-Sectional Study Of Hookworm Infection And Response To Deworming In Beposo, Ghana, Taylor Clarkson

Capstone Experience: Master of Public Health

Hookworms are soil-transmitted helminths that infect over 500 million people worldwide, primarily those in low-income countries. Infection with hookworm can cause anemia, malnutrition, and stunted physical and cognitive development. Deworming campaigns have attempted to combat hookworm infections in endemic areas for decades. However, there is growing variability in the effectiveness of deworming drugs, and post-treatment reinfections are abundant. There are significant gaps in our understanding of critical host-parasite factors that mediate hookworm infection, reinfection, and response to deworming treatment in endemic communities. A five-year prospective study was undertaken to better understand drivers of hookworm infection in rural Ghana and thus …

Evaluating The Association Of Influenza Vaccination On Long-Term Covid-19 Symptoms In U.S. Adults, Ratnakar Pingili

Capstone Experience: Master of Public Health

Objective. To evaluate the association of influenza vaccination in the past 12 months with Long COVID effects and clinical and sociodemographic factors.

Methods. Cross-sectional study with data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), covering 415,132 non-institutionalized U.S. adults with a confirmed COVID-19 diagnosis and influenza vaccination reported within the last 12 months. Logistic regression was conducted between influenza vaccination (exposure) and Long COVID (outcome), controlling for demographic variables, pre-existing health conditions, and socioeconomic status.

Results. Of 120,603 participants, 21.89% reported Long COVID symptoms and 42.04% had received an influenza vaccine. Findings indicate a statistically significant 13% reduction …

Elucidating Granulocytic Myeloid-Derived Suppressor Cell Heterogeneity During Staphylococcus Aureus Biofilm Infection, Blake P. Bertrand, Cortney E. Heim, Scott A. Koepsell, Tammy Kielian

Journal Articles: Pathology and Microbiology

Myeloid-derived suppressor cells (MDSCs) are pathologically activated immature myeloid cells with immunosuppressive activity that expand during chronic inflammation, such as cancer and prosthetic joint infection (PJI). Myeloid-derived suppressor cells can be broadly separated into 2 populations based on surface marker expression and function: monocytic myeloid-derived suppressor cells (M-MDSCs) and granulocytic myeloid-derived suppressor cells (G-MDSCs). Granulocytic myeloid-derived suppressor cells are the most abundant leukocyte infiltrate during PJI; however, how this population is maintained in vivo and cellular heterogeneity is currently unknown. In this study, we identified a previously unknown population of Ly6G+Ly6C+F4/80+MHCII+ MDSCs during PJI that displayed immunosuppressive properties ex vivo. …

C1q Is Elevated During Chronic Staphylococcus Epidermidis Central Nervous System Catheter Infection, Matthew K. Beaver, Lara Bergdolt, Anna Dunaevsky, Tammy Kielian, Gwenn Skar

Journal Articles: Pathology and Microbiology

INTRODUCTION: Significant neurologic morbidity is caused by pediatric cerebrospinal fluid (CSF) shunt infections. The underlying mechanisms leading to impaired school performance and increased risk of seizures are unknown, however, a better understanding of these mechanisms may allow us to temper their consequences. Recent evidence has demonstrated important roles for complement proteins in neurodevelopment and neuroinflammation.

METHODS: We examined complement activation throughout

RESULTS: We found that MASP2 predominated early in catheter infection, but that Factor B was elevated at intermediate time points. Unexpectedly C1q was elevated at late timepoints when bacterial burdens were low or undetectable. Based on these findings and …

Antimicrobial Activity Of Gallium(Iii) Compounds: Pathogen-Dependent Targeting Of Multiple Iron/Heme-Dependent Biological Processes, Seoung-Ryoung Choi, Mohammed A. Hassan, Bradley E. Britigan, Prabagaran Narayanasamy

Journal Articles: Pathology and Microbiology

Metals play vital roles in biological systems, with iron/heme being essential for cellular and metabolic functions necessary for survival and/or virulence in many bacterial pathogens. Given the rise of bacterial resistance to current antibiotics, there is an urgent need for the development of non-toxic and novel antibiotics that do not contribute to resistance to other antibiotics. Gallium, which mimics iron, has emerged as a promising antimicrobial agent, offering a novel approach to combat bacterial infections. Gallium does not have any known functions in biological systems. Gallium exerts its effects primarily by replacing iron in redox enzymes, effectively inhibiting bacterial growth …

Pharmacokinetic-Pharmacodynamic Evidence From A Phase 3 Trial To Support Flat-Dosing Of Rifampicin For Tuberculosis, Huy X. Ngo, Ava Y. Xu, Gustavo E. Velásquez, Nan Zhang, Vincent K. Chang, Ekaterina V. Kurbatova, William C. Whitworth, Erin Sizemore, Kia Bryant, Wendy Carr, Marc Weiner, Kelly E. Dooley, Melissa Engle, Susan E. Dorman, Payam Nahid, Susan Swindells, Richard E. Chaisson, Pheona Nsubuga, Madeleine Lourens, Rodney Dawson, Radojka M. Savic

Journal Articles: Infectious Diseases

BACKGROUND: The optimal dosing strategy for rifampicin in treating drug-susceptible tuberculosis (TB) is still highly debated. In the phase 3 clinical trial Study 31/ACTG 5349 (NCT02410772), all participants in the control regimen arm received 600 mg rifampicin daily as a flat dose. Here, we evaluated relationships between rifampicin exposure and efficacy and safety outcomes.

METHODS: We analyzed rifampicin concentration time profiles using population nonlinear mixed-effects models. We compared simulated rifampicin exposure from flat- and weight-banded dosing. We evaluated the effect of rifampicin exposure on stable culture conversion at 6 months; TB-related unfavorable outcomes at 9, 12, and 18 months using …

Lung-Delivered Il-10 Therapy Elicits Beneficial Effects Via Immune Modulation In Organic Dust Exposure-Induced Lung Inflammation, Aaron D. Schwab, Todd A. Wyatt, Amy J. Nelson, Angela Gleason, Rohit Gaurav, Debra J. Romberger, Jill A. Poole

Journal Articles: Pulmonary & Critical Care Med

Efficacious therapeutic options capable of resolving inflammatory lung disease associated with environmental and occupational exposures are lacking. This study sought to determine the preclinical therapeutic potential of lung-delivered recombinant interleukin (IL)-10 therapy following acute organic dust exposure in mice. Here, C57BL/6J mice were intratracheally instilled with swine confinement organic dust extract (ODE) (12.5%, 25%, 50% concentrations) with IL-10 (1 μg) treatment or vehicle control intratracheally-administered three times: 5 hr post-exposure and then daily for 2 days. The results showed that IL-10 treatment reduced ODE (25%)-induced weight loss by 66% and 46% at Day 1 and Day 2 post-exposure, respectively. IL-10 …

Resilience Of Mental Health Services Amidst Ebola Disease Outbreaks In Africa, Frankline Sevidzem Wirsiy, Nancy B. Tahmo, Lambed Tatah, David Brett-Major

Journal Articles: Epidemiology

INTRODUCTION: Health systems including mental health (MH) systems are resilient if they protect human life and produce better health outcomes for all during disease outbreaks or epidemics like Ebola disease and their aftermaths. We explored the resilience of MH services amidst Ebola disease outbreaks in Africa; specifically, to (i) describe the pre-, during-, and post-Ebola disease outbreak MH systems in African countries that have experienced Ebola disease outbreaks, (ii) determine the prevalence of three high burden MH disorders and how those prevalences interact with Ebola disease outbreaks, and, (iii) describe the resilience of MH systems in the context of these …

Teaching Procedural Skills: Integrating Educational Theory Into Practice, Christopher J. Smith, Cory Rohlfsen, Jana L. Wardian, Khalid Sahak

Journal Articles: Hospital Medicine

Introduction: Teaching procedural skills is an essential part of health professions education, yet formal training is often lacking from traditional curricula.

Methods: A workshop on teaching procedural skills was developed as part of a clinician educator track at a large health professions university. Participants included medical residents and fellows (postgraduate years 2-6) from various training programs. The 90-minute, interactive training integrated Gagne's model of instructional design with evidence-based teaching practices. Workshop outcomes were evaluated with pre- and postworkshop surveys. Learner reactions (Kirkpatrick level 1) were assessed via course evaluation. Learning and behavior (Kirkpatrick level 2) were evaluated via attitudinal and …

Feasibility Assessment Of A Novel Isolation Care Tent In Uganda During The 2022, M. Jana Broadhurst, Rodgers R. Ayebare, David Brett-Major, Sean M. Carroll, Jacob Lacore, Alexander D. Laskey, James V. Lawler, Patricia Lord, Ruben M. Vazquez, Peter Waitt, Mohammed Lamorde

Journal Articles: Epidemiology

This case study describes a feasibility assessment of a novel isolation care tent used in health facilities in Uganda during the 2022 Sudan ebolavirus outbreak. The Isolation System for Treatment and Agile Response to High-Risk Infections Model 1B (ISTARI 1B) is a single-occupancy, portable, negative-pressure isolation tent designed for the safe delivery of standard care to patients with a communicable disease, including Ebola disease (Sudan). At the request of the Uganda Ministry of Health, the Makerere University Infectious Diseases Institute and University of Nebraska Medical Center partnered to evaluate 7 health facilities across 4 districts in Uganda for infrastructure, case …

Redesigning Surveillance Through The Global Emerging Infections Surveillance Program, David Brett-Major

Journal Articles: Epidemiology

No abstract provided.

Evaluating The Performance Of Flukecatcher At Detecting Urogenital Schistosomiasis, Louis Fok, Berhanu Erko, David Brett-Major, Abebe Animut, M. Jana Broadhurst, Daisy Dai, John Linville, Bruno Levecke, Yohannes Negash, Abraham Degarege

Journal Articles: Epidemiology

Urine filtration microscopy (UFM) lacks sensitivity in detecting low-intensity Schistosoma haematobium infections. In pursuit of a superior alternative, this study evaluated the performance of FlukeCatcher microscopy (FCM) at detecting S. haematobium eggs in human urine samples. Urine samples were collected from 572 school-age children in Afar, Ethiopia in July 2023 and examined using UFM and FCM approaches. Using the combined UFM and FCM results as a reference, the sensitivity, negative predictive value, and agreement levels for the two testing methods in detecting S. haematobium eggs in urine samples were calculated. The sensitivity and negative predictive value of detecting S. haematobium …

Efficacy Of Praziquantel In Treating Schistosoma Haematobium Infection Among Ethiopian Children, Louis Fok, David Brett-Major, Berhanu Erko, John Linville, Hongying Dai, Yohannes Negash, Abebe Animut, Abraham Degarege

Journal Articles: Epidemiology

Background/Objectives: Praziquantel is a cornerstone of schistosomiasis control and elimination efforts. Continued surveillance of praziquantel efficacy is needed to monitor for the development of resistance, as well as to help public health officials gauge the effect of mass praziquantel administration on schistosomiasis control in communities, since it is the only drug used in schistosomiasis control programs. The objective of this study was to assess the praziquantel cure rate and egg reduction rate against urogenital schistosomiasis.

Methods: This study enrolled 977 children from 12 villages in Afar and Gambella, Ethiopia, who provided urine samples that were checked for Schistosoma haematobium …

Search Strategies For "A Fatal Case Of Cns Actinomyces Mimicking Tolosa-Hunt Syndrome: Is It Time To Reevaluate Diagnostic Criteria?", Natalie A. Bristol, Courtney M. Venegas, Isha Snehal, Mathias Maisenbacher, Ryan Higgins, Thomas Auen, Cathy Cichon, Richard Hankins, Subin Mathew, Christie Barnes, Sahara J. Cathcart, Ana G. Yuil-Valdes, Jie Chen, Cynthia M. Schmidt

Search Strategies: Leon S. McGoogan Health Sciences Library

No abstract provided.

Risk-Stratified Treatment For Drug-Susceptible Pulmonary Tuberculosis., Vincent K. Chang, Marjorie Z. Imperial, Patrick P. J. Phillips, Gustavo E. Velásquez, Payam Nahid, Andrew Vernon, Ekaterina V. Kurbatova, Susan Swindells, Richard E. Chaisson, Susan E. Dorman, John L. Johnson, Marc Weiner, Amina Jindani, Thomas Harrison, Erin E. Sizemore, William Whitworth, Wendy Carr, Kia E. Bryant, Deron Burton, Kelly E. Dooley, Melissa Engle, Pheona Nsubuga, Andreas H. Diacon, Nguyen Viet Nhung, Rodney Dawson, Radojka M. Savic, Aids Clinical Trial Group, Tuberculosis Trials Consortium

Journal Articles: Infectious Diseases

The Phase 3 randomized controlled trial, TBTC Study 31/ACTG A5349 (NCT02410772) demonstrated that a 4-month rifapentine-moxifloxacin regimen for drug-susceptible pulmonary tuberculosis was safe and effective. The primary efficacy outcome was 12-month tuberculosis disease free survival, while the primary safety outcome was the proportion of grade 3 or higher adverse events during the treatment period. We conducted an analysis of demographic, clinical, microbiologic, radiographic, and pharmacokinetic data and identified risk factors for unfavorable outcomes and adverse events. Among participants receiving the rifapentine-moxifloxacin regimen, low rifapentine exposure is the strongest driver of tuberculosis-related unfavorable outcomes (HR 0.65 for every 100 µg∙h/mL increase, …

Pyrazinamide Safety, Efficacy, And Dosing For Treating Drug-Susceptible Pulmonary Tuberculosis: A Phase 3, Randomized Controlled Clinical Trial, Ava Y. Xu, Gustavo E. Velásquez, Nan Zhang, Vincent K. Chang, Patrick P. J. Phillips, Payam Nahid, Susan E. Dorman, Ekaterina V. Kurbatova, William C. Whitworth, Erin Sizemore, Kia Bryant, Wendy Carr, Nicole E. Brown, Melissa L. Engle, Nguyen Viet Nhung, Pheona Nsubuga, Andreas Diacon, Kelly E. Dooley, Richard E. Chaisson, Susan Swindells, Radojka M. Savic

Journal Articles: Infectious Diseases

Optimizing pyrazinamide dosing is critical to improve treatment efficacy while minimizing toxicity during tuberculosis treatment. Study 31/AIDS Clinical Trials Group A5349 represents the largest phase 3 randomized controlled therapeutic trial to date for such an investigation. Objectives: We sought to report pyrazinamide pharmacokinetic parameters, risk factors for lower pyrazinamide exposure, and relationships between pyrazinamide exposure and efficacy and safety outcomes. We aimed to determine pyrazinamide dosing strategies that optimize risks and benefits. Methods: We analyzed pyrazinamide steady-state pharmacokinetic data using population nonlinear mixed-effects models. We evaluated the contribution of pyrazinamide exposure to long-term efficacy using parametric time-to-event models and safety …

Preferences And Feasibility Of Long-Acting Technologies For Treatment Of Hepatitis C Virus In Low- And Middle-Income Countries: A Survey Of Providers And Policymakers, Neil Gupta, Susan Swindells, Kimberly Scarsi, Renae Furl, David L. Thomas, Ethel D. Weld, Joelle Dountio Ofimboudem, Hailemichael Desalegn, Saeed Hamid, Alethse De La Torre Rosas, Angelica E. Miranda, Andrew Owen, Steve Rannard, Lindsey Hiebert, Katherine Sun, John W. Ward

Journal Articles: Infectious Diseases

Long-acting technologies (LATs) for hepatitis C virus (HCV) are under development as a strategy to improve linkage to care, treatment adherence and outcomes. We conducted a survey of HCV treatment prescribers and HCV policymakers in low- and middle-income countries (LMICs) regarding acceptability and feasibility of HCV LATs. We included one-time intramuscular injection, subdermal implant and transdermal patch as potential LAT options. We surveyed participants regarding optimal health system and patient characteristics, concerns, potential barriers, overall feasibility and preferences for HCV LAT as compared to daily oral medication. Overall, 122 providers and 50 policymakers from 42 LMICs completed the survey. Among …

Perceptions Of The Covid-19 Vaccination Within A Convenience Sample Of Sudanese Americans, Jonathan Freese, Fatima Abuzaid Mbbs, Mujtaba Abdellatif Md, Harlan Sayles, Nada Fadul

EMET Projects

No abstract provided.

Enhancing Dissemination At Medical Conferences: A Cross-Disciplinary Approach For Learners, Raquel Lamarche, Jasmine R. Marcelin

Graduate Medical Education Research Journal

Empowering novice authors, particularly trainees and learners, this perspective piece integrates a cross-disciplinary approach to bolster scholarly dissemination at medical conferences. Through a tripartite methodology — Innovate, Implement, and Influence — the article first delves into innovation, offering four essential heuristics sourced from diverse fields, guiding the germination of ideas. Next, it demystifies the transformation of these ideas into research abstracts through a structured blueprint. The finale encompasses strategies to create compelling presentations that resonate with audiences. Woven throughout is an emphasis on craftsman-like precision in idea execution, fostering relationships, and engaging genuinely with content while maintaining audience-centricity. This blueprint …

Recurrent Polymicrobial Bloodstream Infections As Harbingers Of A Duodenal-Inferior Vena Cava Fistula, Gregory E. Koval, Richard J. Hankins, Jasmine R. Marcelin

Graduate Medical Education Research Journal

This is a case of an 82-year-old patient who presented with recurrent polymicrobial bloodstream infections and no obvious undrained source of infection. She had prior double barrel iliocaval stenting for post thrombotic syndrome. The patient underwent exploratory laparotomy and primary repair of a duodenal-caval fistula with a fascia lata patch and an omental pedicle flap. No further bloodstream infections were documented after the repair. This discussion highlights an uncommon complication of IVC stenting, its presentation as well as the operative approach used to repair the fistula.

Targeting Metabolic Switches And Dna Damage Repair For The Treatment Of Human Diseases, Rasangi Chathurika Kankanam Pathirage

Theses & Dissertations

Tuberculosis and Cancer treatments share common challenges due to prolonged therapy, the necessity of combination therapy and severe side effects. Characterization of novel drug targets and identification of new drugs modulating such targets within the context of multidrug treatments will contribute to overcoming current therapeutic challenges.

Tuberculosis (TB) is one of the challenging diseases to treat due to the persistence of Mycobacterium tuberculosis (Mtb) in the dormant phase. Current TB drugs are more effective toward actively dividing bacteria and less effective toward dormant bacteria. The metabolic transition between actively dividing bacteria and dormant bacteria is driven by pivotal metabolic enzymes …

Investigating And Targeting Iron Metabolism In Pseudomonas Aeruginosa And Klebsiella Pneumoniae, Zachary Scott

Theses & Dissertations

Antimicrobial resistance is an incredibly pressing issue in modern medicine. Because of that many researchers are pursuing just as many avenues for treatment of these pathogens. However, due to the nature of bacteria many of these methods are stop gaps and the bacteria can develop typically within years of their deployment. Therefore, more robust methods of treating infections of antimicrobial resistant bacteria that are difficult or impossible to develop resistance to are required. To produce this effect the treatment would need to target and alter or inhibit functions or structures essential to the bacteria that could not be altered, additionally …

Towards A Mode Of Action For The Anti-Schistosomal Aryl Hydantoins, Thomas Schulze

Theses & Dissertations

Schistosomiasis is a significant human disease caused by the helminth parasite Schistosoma mansoni. Praziquantel remains the only clinically used treatment, yet it is rapidly metabolized and only effective against the adult stage worm infection. Ro 13-3978 (AR02) is a potent antischistosomal compound with activity against multiple S. mansoni life stages; however, it manifests anti-androgenic activity. Additionally, the mechanism of action for worm clearance remains unknown. The structure of Ro 13-3979 was used to generate optimized derivatives, including AR102, that show increased potency towards worms, reduced off-target anti-androgen effects, and extended half-life thereby increasing the feasibility for a single-dose curative treatment. …

Understanding The Effect Of Chikungunya Virus Infection On Bone Homeostasis, Enakshi Roy

Theses & Dissertations

Chikungunya virus (CHIKV) is a mosquito-borne virus that causes Chikungunya fever (CHIKF), characterized by high fever, headache, rash, and joint pain. With global travel on the rise, infections caused by CHIKV have emerged in new regions, expanding their geographic range and infecting susceptible hosts. Currently, no approved prophylactic or therapeutic measures exist to prevent or treat these infections, with prevention strategies primarily focused on vector control. However, these measures have proven inadequate due to the emergence of mutations that enhance viral transmission or vector range. Therefore, urgent attention is needed to develop therapies to treat the infection. Although CHIKV has …

Role Of The Ganglioside Gd2 And Its Biosynthetic Enzyme Gd3 Synthase In Prostate Cancer Tumorigenesis, Aaqib Bhat

Theses & Dissertations

Despite significant advancements in managing localized prostate cancer (PC), which have notably increased survival rates, advanced PC continues to be a leading cause of cancer- related fatalities. The discovery of new pathways that can be targeted to inhibit tumor growth in PC could pave the way for innovative treatment strategies. The disialylganglioside GD2 is an FDA-approved target for antibody therapies in neuroblastoma and has not been extensively studied in the context of PC. The work done in this thesis reveals that GD2 is present on a minor subset of PC cells in certain patients and is more prevalent in metastatic …

A Cross-Sectional Analysis Of Adverse Childhood Experience Exposure On Cancer Diagnosis Utilizing The 2022 Behavioral Risk Factor Surveillance Survey Data, Emma Zipperer

Capstone Experience: Master of Public Health

Objective: To determine the association between Adverse Childhood Experiences (ACEs) and cancer diagnosis based on ACE exposure levels.

Methods: We utilized data collected in the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey. The study population (n=54,148) was restricted to states that reported on the optional model of experiencing ACEs and those who responded about cancer diagnosis. A univariate analysis, bivariate analysis and a multivariate logistic regression were performed. Odds of cancer diagnosis among those with differing ACE exposure levels were calculated.

Results: High ACE exposure had 20% higher odds of cancer diagnosis when compared to low ACE exposure. White, …

Evaluating Lack Of Access To Secondary Prevention-Based Healthcare Services Between Racial/Ethnic Groups In The United States: A Logistic Regression Analysis Using 2022 Brfss Cross-Sectional Data, Samuel Ortiz Severiano

Capstone Experience: Master of Public Health

Objective: To determine whether racial/ethnic minorities have reduced access to preventive healthcare services in the United States, with participation in routine checkups serving as the metric for access. Methods: Performing logistic regression analysis comparing the length of time since the last routine checkup between different racial/ethnic groups in the study population. Those who haven’t had a routine checkup in at least 12 months served as the comparison group. Results: Black populations were 66% less likely to not have access to preventive care compared to White populations, while Asian, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander populations were 8.5% more likely …