Medicine and Health Sciences Commons^™

Houston Hurricane Harvey Health (Houston-3h) Study: Assessment Of Allergic Symptoms And Stress After Hurricane Harvey Flooding, Abiodun O Oluyomi, Kristen Panthagani, Jesus Sotelo, Xiangjun Gu, Georgina Armstrong, Dan Na Luo, Kristi L Hoffman, Diana Rohlman, Lane Tidwell, Winifred J Hamilton, Elaine Symanski, Kimberly Anderson, Joseph F Petrosino, Cheryl Lyn Walker, Melissa Bondy

Faculty, Staff and Students Publications

BACKGROUND: In August 2017, Hurricane Harvey caused unprecedented flooding across the greater Houston area. Given the potential for widespread flood-related exposures, including mold and sewage, and the emotional and mental toll caused by the flooding, we sought to evaluate the short- and long-term impact of flood-related exposures on the health of Houstonians. Our objectives were to assess the association of flood-related exposures with allergic symptoms and stress among Houston-area residents at two time points: within approximately 30 days (T1) and 12 months (T2) after Hurricane Harvey's landfall.

METHODS: The Houston Hurricane Harvey Health (Houston-3H) Study enrolled a total of 347 …

2021-01-18_Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services

Michigan COVID-19 Hospital Data

The webpage was obtained from Michigan's Coronavirus Cumulative Data page, under the link Hospitals. Data is self-reported by hospitals daily to the EM Resource System per MDHHS Director Robert Gordon's Emergency Order.

Contains the tables Statewide Hospital Capacity Report for COVID-19, COVID-19 Metrics, Statewide Hospital Available PPE Tracking for COVID-19, as well as the tables PPE Days On Hand and Patient Census.

2021-01-18_Michiganoverview_Covidcounts, Michigan Department Of Health & Human Services

Michigan COVID-19 Confirmed Cases by Date of Onset Data

Data was downloaded as an Excel spreadsheet which appeared in the Public Use Datasets section under the Cumulative Data link of Michigan's Coronavirus webpage, under the url https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html.

Cases are aggregated by the date of onset of COVID-19 symptoms, if known, otherwise by laboratory specimen date if known, otherwise by case referral date. Deaths are aggregated by the date of death if known, otherwise by the last date of a change to the case status.

2021-01-18_Michiganoverview_Covidvaccinestats, Michigan Department Of Health & Human Services

Michigan COVID-19 Vaccine Data

The COVID Vaccine Dashboard page was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus/0,9753,7-406-98178_103214-547150--,00.html.

Data is updated Monday through Saturday. Previously reported numbers of administered vaccine doses may change as new data are received. A possible lag in reporting vaccine doses will result in increases in numbers previously reported.

This report is created by the Michigan Department of Health and Human Services Division of Immunization from data reported to the Michigan Care Improvement Registry (MCIR).

The dashboard contained the tabs Vaccines Shipped, Distribution Trend, Doses Administered, Doses by Vaccine, Doses Metrics, Enrolled Providers, and …

2021-01-18_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …

Dare We Hope, Vivian Mcalister

Data and Test Instruments

In an era when cries of “Lock her up” can rile a crowd to frenzy, it is the duty of a responsible editor to ensure that declamatory comment is backed up by academic rigour. It is clear thatCMAJrecently failed this test.1It has compounded the error by encouraging the media to fan the flames such that the associated front page article ofThe Starclaims that the journal is calling for an end to celebrating Sir William Osler.2Neither the authors nor the editor acknowledged the debt thatCMAJhas to Osler, who not only encouraged its foundation but also frequently contributed articles when he was …

Emergency Department Use Following Incentives To Provide After-Hours Primary Care: A Retrospective Cohort Study., Michael Hong, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

BACKGROUND: Access to primary care outside of regular working hours is limited in many countries. This study investigates the relation between the after-hours premium, an incentive for primary care physicians to provide services after hours, and less-urgent visits to the emergency department in Ontario, Canada.

METHODS: We analyzed a retrospective cohort of a random sample of Ontario residents from April 2002 to March 2006, and a subcohort of patients followed from April 2005 to March 2016. We linked patient and primary care physician data with emergency department visit data. We used fixed-effects regression models to analyze the association between the …

Priority Setting During The Covid-19 Pandemic: Going Beyond Vaccines, Iestyn Williams, Elysee Nouvet

Health Studies Publications

• Development of vaccines is a major breakthrough in the fight against the SARS-CoV-2 virus.

• Much attention has been paid to how to prioritise between patient groups for vaccination and how to ensure equity, especially in low-income countries, but there are other important decisions that need to be made.

• These decisions include: (a) choosing between the various vaccines that will become available, (b) continuing to invest in other aspects of the COVID-19 response and (c) balancing the COVID-19 response with the need to invest in other healthcare that has suffered during the pandemic.

• Although these decisions are inherently difficult, principles of …

The Multiplicity Of Caregiving Burden: A Qualitative Analysis Of Families With Prolonged Disorders Of Consciousness., Laura E Gonzalez-Lara, Sarah Munce, Jennifer Christian, Adrian M Owen, Charles Weijer, Fiona Webster

Brain and Mind Institute Researchers' Publications

Objective: To understand the multiple and sometimes conflicting roles substitute decision makers (SDMs) of individuals in a vegetative state (VS), minimally conscious state (MCS), or with locked-in syndrome (LIS) perform while caring for a loved one and the competing priorities derived from these roles.Methods: We conducted semi-structured qualitative interviews using a constructive-grounded theory design. Twelve SDMs, who were also family members for 11 patients, were interviewed at two time points (except one) for a total of 21 in-depth interviews.Results: Participants described that caregiving is often the central role which they identify as their top priority …

2021-01-18_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …

2021-01-18_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services

Cumulative Michigan COVID-19 Data

The COVID Overview page was obtained from Michigan's main COVID-19 page: https:/www.michigan.gov/coronavirus/0,9753,7-406-98163-520743--,00.html.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled. It is updated Monday - Saturday.
This report is provisional and subject to change. City of Detroit and Wayne County are reported separately. MDHHS began tracking probable cases April 5, 2020. FCI indicates federal correctional institute. MDOC indicates Michigan Department of Corrections. Diagnostic tests, including nucleic acid amplification/real-time polymerase chain reaction (NAAT/RT-PCR) and rapid virus antigen detection point of …

2021-01-18_Michiganoverview_Covidschooloutbreak, Michigan Department Of Health & Human Services

Michigan COVID-19 Outbreak Reports

The School Outbreak Data page was obtained from Michigan's COVID-19 data page: https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173_102480---,00.html.

This report is created by the Michigan Department of Health & Human Services from data self-reported by local health departments. Data is updated every week.

In accordance with the Council of State and Territorial Epidemiologists’ outbreak definition, schools that have been found by their local health department to have two (2) or more COVID-19 cases who may have shared exposure at the school grounds and are not from the same household (with the exception of dorms and off-campus housing) are included. If your child’s school is …

Disparities In Cardiovascular Research Output And Disease Outcomes Among High-, Middle- And Low-Income Countries - An Analysis Of Global Cardiovascular Publications Over The Last Decade (2008-2017), Nada Qaisar Qureshi, Syed Hamza Mufarrih, Gerald S. Bloomfield, Wajeeha Tariq, Aysha Almas, Ali H. Mokdad, Muhammad Imran Nisar, Sameen Siddiqi, Zulfiqar Ahmed Bhutta, Zainab Samad

Department of Medicine

Background: Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Health research is crucial to managing disease burden. Previous work has highlighted marked discrepancies in research output and disease burden between high-income countries (HICs) and low- and lower-middle-income countries (LI-LMICs) and there is little data to understand whether this gap has bridged in recent years. We conducted a global, country level bibliometric analysis of CVD publications with respect to trends in disease burden and county development indicators.
Methods: A search filter with a precision and recall of 0.92 and 0.91 respectively was developed to extract cardiovascular publications …

The Health-Related Quality Of Life, Work Productivity, Healthcare Resource Utilization, And Economic Burden Associated With Levels Of Suicidal Ideation Among Patients Self-Reporting Moderately Severe Or Severe Major Depressive Disorder In A National Survey., Carmela Benson, David Singer, Colleen M Carpinella, May Shawi, Larry Alphs

College of Population Health Faculty Papers

Background: Suicidal ideation (SI) is a cardinal aspect of major depressive disorder (MDD); however, patient-reported outcomes data from large-scale surveys are limited concerning SI in the context of MDD. This study aims to understand the association between varying levels of SI and health-related quality of life (HRQoL), work productivity, healthcare resource utilization (HRU), and associated costs in patients with moderately severe/severe MDD.

Methods: This was a retrospective, cross-sectional analysis of 2013 national survey data. Patients who self-reported moderately severe or severe MDD and completed the Short Form Survey Version 2 (SF-36v2), Work Productivity Loss and Activity Impairment questionnaire (WPAI), and …

Prevalence Of Malaria Parasite Infections Among U.S.-Bound Congolese Refugees With And Without Splenomegaly., Moses Mwesigwa, Jessica L. Webster, Sam Lubwama Nsobya, Alexander Rowan, Mukunda Singh Basnet, Christina R. Phares, Michelle Weinberg, Alexander Klosovsky, Marwan Naoum, Philip J. Rosenthal, William Stauffer

Student Papers, Posters & Projects

All U.S.-bound refugees from sub-Saharan Africa receive presumptive antimalarial treatment before departing for the United States. Among U.S.-bound Congolese refugees, breakthrough malaria cases and persistent splenomegaly have been reported. In response, an enhanced malaria diagnostic program was instituted. Here, we report the prevalence of plasmodial infection among 803 U.S.-bound Congolese refugees who received enhanced diagnostics. Infections by either rapid diagnostic test (RDT) or PCR were detected in 187 (23%) refugees, with 78 (10%) by RDT only, 35 (4%) by PCR only, and 74 (9%) by both. Infections identified by PCR included 103 monoinfections (87 Plasmodium falciparum, eight Plasmodium ovale, seven …

An Evaluation Of A Maternal Health And Extreme Heat Exposure Training, Adelle Dora Monteblanco, Jennifer K. Vanos, Sarah Leroy, Patricia M. Juarez, Gregg M. Garfin

Journal of Social, Behavioral, and Health Sciences

Growing empirical evidence documents the potential risk of extreme heat exposure to pregnant individuals. These risks include adverse birth outcomes, such as preterm birth and low birth weight. Climate change will exacerbate extreme heat exposures to a large portion of the global population, and pregnant individuals need to understand the risks and protective measures needed. Maternal health workers are a key mechanism for conveying this information to pregnant individuals. The authors assess a training of maternal health workers in El Paso, Texas, through two research instruments. First, eight maternal health workers completed an educational workshop and consented to participation; pre- …

Important Updates To Submission Types In Topics In Exercise Science And Kinesiology, James W. Navalta, Donald L. Hoover, Robert Salatto, Whitley J. Stone, Scott Lyons

Topics in Exercise Science and Kinesiology

Topics in Exercise Science and Kinesiology Volume 2: Issue 1, Article 1, 2021. While Topics in Exercise Science and Kinesiology (TESK) was originally designed to fill a void in publishing applied information for practitioners in physical activity and sport, the TESK editors have determined a need to update the submission categories. The categories of Process of Science and Implementation Strategies have been retained, and three new types of submissions now will be accepted: Expedited Articles, Review Articles, and Case Studies. Process of Science submissions should seek to answer the question, “What was learned from the experience of performing the investigation?”, …

2021-01-17_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …

Nalfurafine Reduces Neuroinflammation And Drives Remyelination In Models Of Cns Demyelinating Disease, Lisa Denny, Afnan Al Abadey, Katharina Robichon, Nikki Templeton, Thomas E. Prisinzano, Bronwyn M. Kivell, Anne C. La Flamme

Pharmaceutical Sciences Faculty Publications

Objectives: Multiple sclerosis (MS) is a neurodegenerative disease characterised by inflammation and damage to the myelin sheath, resulting in physical and cognitive disability. There is currently no cure for MS, and finding effective treatments to prevent disease progression has been challenging. Recent evidence suggests that activating kappa opioid receptors (KOR) has a beneficial effect on the progression of MS. Although many KOR agonists like U50,488 are not suitable for clinical use because of a poor side-effect profile, nalfurafine is a potent, clinically used KOR agonist with a favorable side-effect profile.

Methods: Using the experimental autoimmune encephalomyelitis (EAE) model, the effect …

Estimating The Population Attributable Fraction Of Asthma Due To Electronic Cigarette Use And Other Risk Factors Using Kentucky Behavioral Risk Factor Survey Data, 2016-2017, W. Jay Christian, Courtney J. Walker

Epidemiology and Environmental Health Faculty Publications

Introduction: Electronic nicotine delivery systems ENDS have become popular in the United States among both new users of nicotine and those seeking less harmful alternatives to traditional cigarettes. Users often perceive ENDS as being less harmful than traditional cigarettes. This study investigated the relationship between use of ENDS and asthma in a representative sample of adults. Methods: For this cross-sectional study, we used data from the Kentucky Behavioral Risk Factor Surveillance System telephone survey data from 2016-2017. Using a weighted multivariable logistic regression analysis, we identified important covariates to adjust for to calculate the population attributable fraction (PAF) of asthma …

Low-Dose Antithymocyte Globulin Has No Disadvantages To Standard Higher Dose In Pediatric Kidney Transplant Recipients: Report From The Pediatric Nephrology Research Consortium, Isa F. Ashoor, Robbie A. Beyl, Charu Gupta, Amrish Jain, Stefan G. Kiessling, Asha Moudgil, Hiren P. Patel, Joseph Sherbotie, Donald J. Weaver Jr., Rima S. Zahr, Vikas R. Dharnidharka

Pediatrics Faculty Publications

Introduction
Rabbit antithymocyte globulin (rATG) dosing strategies for induction in pediatric kidney transplantation vary between centers. It is not known whether a lower rATG induction dose provides safe and effective immunosuppression compared with a “standard” higher dose.

Methods
We performed a retrospective multicenter study of all isolated first-time kidney transplant recipients < 21 years old who received rATG induction between 1 January 2010 and 31 December 2014 at 9 pediatric centers. An a priori cutoff of a 4.5-mg/kg cumulative rATG dose was used to identify low (≤ 4.5 mg/kg) and standard (> 4.5 mg/kg) exposure groups. Outcomes examined included 12 months posttransplant graft function (estimated glomerular filtration rate [eGFR]); the occurrence of acute rejection, donor-specific antibody (DSA), neutropenia, and viral infection …

23-Valent Polysaccharide Vaccine (Ppsv23)-Targeted Serotype-Specific Identification Of Streptococcus Pneumoniae Using The Loop-Mediated Isothermal Amplification (Lamp) Method, Jiwon Lee, Youngbae Yoon, Eun Jin Kim, Donghyun Lee, Yeoungjun Baek, Chika Takano, Bin Chang, Takahiro Iijima, Paul E. Kilgore, Satoshi Hayakawa, Tomonori Hoshino, Dong Wook Kim, Mitsuko Seki

Department of Pharmacy Practice

Reports of invasive disease due to Streptococcus pneumoniae have declined since the introduction of pneumococcal conjugate vaccines (PCV7 and PCV13). The incidence of invasive diseases due to S. pneumoniae that are not addressed by the vaccines, however, has increased in children and adults, creating a global public health problem. Previously, we established the loop-mediated isothermal amplification (LAMP) method for a PCV13 serotype-specific assay. In the current study, we developed a rapid, simple, and cost-effective assay to detect serotypes in the 23-valent pneumococcal polysaccharide vaccine (PPSV23) using the LAMP method. In this study, LAMP primer sets for serotypes 2, 8, 9N, …

2021-01-16_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …

2021-01-16_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services

Cumulative Michigan COVID-19 Data

The COVID Overview page was obtained from Michigan's main COVID-19 page: https:/www.michigan.gov/coronavirus/0,9753,7-406-98163-520743--,00.html.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled. It is updated Monday - Saturday.
This report is provisional and subject to change. City of Detroit and Wayne County are reported separately. MDHHS began tracking probable cases April 5, 2020. FCI indicates federal correctional institute. MDOC indicates Michigan Department of Corrections. Diagnostic tests, including nucleic acid amplification/real-time polymerase chain reaction (NAAT/RT-PCR) and rapid virus antigen detection point of …

A High Affinity, Partial Antagonist Effect Of 3,4-Diaminopyridine Mediates Action Potential Broadening And Enhancement Of Transmitter Release At Nmjs, Kristine S Ojala, Scott P Ginebaugh, Man Wu, Evan W Miller, Gloria Ortiz, Manuel Covarrubias, Stephen D Meriney

Department of Neuroscience Faculty Papers

3,4-Diaminopyridine (3,4-DAP) increases transmitter release from neuromuscular junctions (NMJs), and low doses of 3,4-DAP (estimated to reach ∼1 μM in serum) are the Food and Drug Administration (FDA)-Approved treatment for neuro muscular weakness caused by Lambert-Eaton myasthenic syn drome. Canonically, 3,4-DAP is thought to block voltage-gated potassium (Kv) channels, resulting in prolongation of the pre synaptic action potential (AP). However, recent reports have shown that low millimolar concentrations of 3,4-DAP have an off-Target agonist effect on the Cav1 subtype ("L-Type") of voltage-gated calcium (Cav) channels and have speculated that this agonist effect might contribute to 3,4-DAP effects on transmitter release …

2021-01-16_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …

Using Mobile Phones To Improve Young People Sexual And Reproductive Health In Low And Middle-Income Countries: A Systematic Review To Identify Barriers, Facilitators, And Range Of Mhealth Solutions, Anam Shahil Feroz, Naureen Akber Ali, Adeel Khoja, Armish Asad, Sarah Saleem

Community Health Sciences

Background: Globally, reproductive health programs have used mHealth to provide sexual and reproductive health (SRH) education and services to young people, through diverse communication channels. However, few attempts have been made to systematically review the mHealth programs targeted to improve young people SRH in low-and-middle-income countries (LMICs). This review aims to identify a range of different mHealth solutions that can be used for improving young people SRH in LMICs and highlight facilitators and barriers for adopting mHealth interventions designed to target SRH of young people.
Methods: Databases including PubMed, CINAHL Plus, Science Direct, Cochrane Central, and grey literature were searched …

[(Wr)8Wkβa]-Doxorubicin Conjugate: A Delivery System To Overcome Multi-Drug Resistance Against Doxorubicin, Khalid Zoghebi, Hamidreza Montazeri Aliabadi, Rakesh Kumar Tiwari, Keykavous Parang

Pharmacy Faculty Articles and Research

Doxorubicin (Dox) is an anthracycline chemotherapeutic agent used to treat breast, leukemia, and lymphoma malignancies. However, cardiotoxicity and inherent acquired resistance are major drawbacks, limiting its clinical application. We have previously shown that cyclic peptide [WR]₉ containing alternate tryptophan (W) and arginine (R) residues acts as an efficient molecular transporter. An amphiphilic cyclic peptide containing a lysine (K) residue and alternative W and R was conjugated through a free side chain amino group with Dox via a glutarate linker to afford [(WR)₈WKβA]-Dox conjugate. Antiproliferative assays were performed in different cancer cell lines using the conjugate and the …

Cardiac Inflammation, Oxidative Stress, Nrf2 Expression, And Coagulation Events In Mice With Experimental Chronic Kidney Disease, Abderrahim Nemmar, Suhail Al-Salam, Sumaya Beegam, Nur Elena Zaaba, Javed Yasin, Naserddine Hamadi, Badreldin H. Ali

All Works

Chronic kidney disease (CKD) is known to be associated with cardiovascular dysfunction. Dietary adenine intake in mice is also known to induce CKD. However, in this experimental model, the mechanisms underlying the cardiotoxicity and coagulation disturbances are not fully understood. Here, we evaluated cardiac inflammation, oxidative stress, DNA damage, and coagulation events in mice with adenine (0.2% w/w in feed for 4 weeks)-induced CKD. Control mice were fed with normal chow for the same duration. Adenine increased water intake, urine output, relative kidney weight, the plasma concentrations of urea and creatinine, and the urinary concentrations of kidney injury molecule-1 and …

Creating A New Normal Through Engagement In Meaningful Occupation, Jennifer K. Fortuna Phd, Otr/L

The Open Journal of Occupational Therapy

Katie Edick, an occupational therapist and artist based in Portland, Michigan, provided the cover art for the Winter 2021 edition of The Open Journal of Occupational Therapy (OJOT). “Katie Bird” is a 4” x 6” watercolor painting. After receiving a diagnosis of metastatic breast cancer (MBC), Katie set out to find a new purpose and leave a legacy. She made the decision to live with intention and choose life experiences that create joy. Through engagement in meaningful occupations, such as painting and patient advocacy, Katie is creating a new normal.