Medicine and Health Sciences Commons^™

Modified Linear Peptides Effectively Silence Stat-3 In Breast Cancer And Ovarian Cancer Cell Lines, Dindyal Mandal, Sandeep Lohan, Muhammad Imran Sajid, Abdulelah Alhazza, Rakesh Kumar Tiwari, Keykavous Parang, Hamidreza Montazeri Aliabadi

Pharmacy Faculty Articles and Research

RNA interference (RNAi) has drawn enormous attention as a powerful tool because of its capability to interfere with mRNA and protein production. However, designing a safe and efficient delivery system in RNAi therapeutics remains challenging. Herein, we have designed and synthesized several linear peptides containing tryptophan (W) and arginine (R) residues separated by the β-alanine (βA) spacer and attached to a lipophilic fatty acyl chain, cholesterol, or PEG. The peptide backbone sequences were: Ac-C-βA-βA-W4-βA-βA-R4-CO-NH2 and Ac-K-βA-βA-W4-βA-βA-R4-CO-NH2, with only a difference in N-terminal amino acid. The cysteine side chain in the first sequence was used for the conjugation with PEG2000 and …

Comparative Pharmacology Of A Bis-Pivaloyloxymethyl Phosphonate Prodrug Inhibitor Of Enolase After Oral And Parenteral Administration, Victoria C Yan, Yasaman Barekatain, Yu-Hsi Lin, Nikunj Satani, Naima Hammoudi, Kenisha Arthur, Dimitra K Georgiou, Yongying Jiang, Yuting Sun, Joseph R Marszalek, Steven W Millward, Florian L Muller

Faculty, Staff and Student Publications

Metabolically labile prodrugs can experience stark differences in catabolism incurred by the chosen route of administration. This is especially true for phosph(on)ate prodrugs, in which successive promoiety removal transforms a lipophilic molecule into increasingly polar compounds. We previously described a phosphonate inhibitor of enolase (HEX) and its bis-pivaloyloxymethyl ester prodrug (POMHEX) capable of eliciting strong tumor regression in a murine model of enolase 1 (ENO1)-deleted glioblastoma following parenteral administration. Here, we characterize the pharmacokinetics and pharmacodynamics of these enolase inhibitors in vitro and in vivo after oral and parenteral administration. In support of the historical function of lipophilic …

Associations Of Financial Toxicity With Symptoms And Unplanned Healthcare Utilization Among Cancer Patients Taking Oral Chemotherapy At Home: A Prospective Observational Study, Yongfeng Chen, Zhenxiang Chen, Haiyun Jin, Yanrong Chen, Jinbing Bai, Guifen Fu

Faculty, Staff and Student Publications

Background: Cancer patients with financial toxicity experience psychological distress and often miss medical appointments and quit treatments early, which could be a barrier to the effective management of oral chemotherapy drugs at home. This study explores whether financial toxicity predicts symptoms and unplanned healthcare utilization among cancer patients taking oral chemotherapy at home, which will contribute to the safe management of oral chemotherapy.

Methods: Data in this study was from a prospective observational study, which was conducted between October 2018 and December 2019. 151 patients completed the Comprehensive Score for Financial Toxicity at discharge and completed the MD Anderson Symptom …

Patterns Of Cannabis- And Substance-Related Congenital General Anomalies In Europe: A Geospatiotemporal And Causal Inferential Study, Albert Stuart Reece, Gary Kenneth Hulse

Research outputs 2022 to 2026

Introduction:

Recent series of congenital anomaly (CA) rates (CARs) have showed the close and epidemiologically causal relationship of cannabis exposure to many CARs. We investigated these trends in Europe where similar trends have occurred.

Methods:

CARs from EUROCAT. Drug use from European Monitoring Centre for Drugs and Drug Addiction. Income data from World Bank. Results: CARs were higher in countries with increasing daily use overall (p = 9.99 × 10⁻¹⁴, minimum E-value (mEV) = 2.09) and especially for maternal infections, situs inversus, teratogenic syndromes and VACTERL syndrome (p = 1.49 × 10⁻¹⁵, mEV = 3.04). In …

Hmgb1/Gpc3 Dual Targeting Vaccine Induces Dendritic Cells-Mediated Cd8+T Cell Immune Response And Elicits Potential Therapeutic Effect In Hepatocellular Carcinoma, Xiaoqing Shi, Jiage Ding, Yanyan Zheng, Jiawei Wang, Navid Sobhani, Praveen Neeli, Gang Wang, Junnian Zheng, Dafei Chai

Faculty, Staff and Students Publications

Hepatocellular carcinoma (HCC) is a fatal malignant tumor, but effective clinical interventions are limited. PLGA/PEI-mediated DNA vaccine encoding the dual targets of high-mobility group box 1 (HMGB1) or GPC3 was developed for HCC treatment. Compared with PLGA/PEI-GPC3 immunization, PLGA/PEI-HMGB1/GPC3 co-immunization significantly inhibited the subcutaneous tumor growth, while increasing the infiltration of CD8

A Multicenter Study Of Clinical Impact Of Variant Of Uncertain Significance Reclassification In Breast, Ovarian And Colorectal Cancer Susceptibility Genes, Sukh Makhnoon, Brooke Levin, Megan Ensinger, Kristin Mattie, Robert J Volk, Zhongming Zhao, Tito Mendoza, Sanjay Shete, Laila Samiian, Generosa Grana, Andrew Grainger, Banu Arun, Brian H Shirts, Susan K Peterson

Faculty, Staff and Student Publications

BACKGROUND: Clinical interpretation of genetic test results is complicated by variants of uncertain significance (VUS) that have an unknown impact on health but can be clarified through reclassification. There is little empirical evidence regarding VUS reclassification in oncology care settings, including the prevalence and outcomes of reclassification, and racial/ethnic differences.

METHODS: This was a retrospective analysis of persons with and without a personal history of cancer carrying VUS (with or without an accompanying pathogenic or likely pathogenic [P/LP] variant) in breast, ovarian, and colorectal cancer predisposition genes seen at four cancer care settings (in Texas, Florida, Ohio, and New Jersey) …

Sit Less, Move More: A National Study Of Physical-Activity Behavior And Cancer, Stella O. Nwogugu

Dissertations, Theses, and Capstone Projects

Background: Physical activity is associated with lower risks of cancer, the second leading cause of death among Americans. Yet, sedentary behavior is the prevailing lifestyle for about 80% of American adults. Additionally, cancer survivors remain significantly inactive, even though physical activity has been shown to decrease risk of cancer and cancer recurrence, improve tolerance of cancer therapy, and reduce mortality. This research explores the relative impact of personal agency, social support, and key demographic variables on physical-activity behavior for a national sample of adults as well as how these relationships differ for cancer survivors and their counterparts.

Methods: Using the …

Race, Gender, Physical Activity, And Cancer: A Quantitative Investigation, Shawna A. Townsend

Dissertations, Theses, and Capstone Projects

Black women are more likely to die from cancer than any other population in the United States. Physical activity is known to be associated with preventing and reducing cancer burden. However, Black women are less physically active than their White counterparts and have a higher prevalence of diseases related to lack of physical activity than any other female group. To better understand these issues, this study employed the self-and-family management framework and intersectionality as theoretical frameworks through a secondary analysis of the Health Information National Trends Survey (HINTS) dataset and hierarchical regression modeling to examine the relative impact of (a.) …

Outdoor Light At Night And Risk Of Endometrial Cancer In The Nih-Aarp Diet And Health Study, Danielle N Medgyesi, Britton Trabert, Jared A Fisher, Qian Xiao, Peter James, Alexandra J White, Jessica M Madrigal, Rena R Jones

Faculty, Staff and Student Publications

PURPOSE: Outdoor light at night (LAN) can result in circadian disruption and hormone dysregulation and is a suspected risk factor for some cancers. Our study is the first to evaluate the association between LAN and risk of endometrial cancer, a malignancy with known relationship to circulating estrogen levels.

METHODS: We linked enrollment addresses (1996) for 97,677 postmenopausal women in the prospective NIH-AARP cohort to satellite imagery of nighttime radiance to estimate LAN exposure. Multivariable Cox models estimated hazard ratios (HR) and 95% confidence intervals (95% CI) for LAN quintiles and incident endometrial cancer overall (1,669 cases) and endometrioid adenocarcinomas (991 …

Fucosylation Of Hla-Drb1 Regulates Cd4+ T Cell-Mediated Anti-Melanoma Immunity And Enhances Immunotherapy Efficacy, Daniel K Lester, Chase Burton, Alycia Gardner, Patrick Innamarato, Krithika Kodumudi, Qian Liu, Emma Adhikari, Qianqian Ming, Daniel B Williamson, Dennie T Frederick, Tatyana Sharova, Michael G White, Joseph Markowitz, Biwei Cao, Jonathan Nguyen, Joseph Johnson, Matthew Beatty, Andrea Mockabee-Macias, Matthew Mercurio, Gregory Watson, Pei-Ling Chen, Susan Mccarthy, Carlos Moransegura, Jane Messina, Kerry L Thomas, Lancia Darville, Victoria Izumi, John M Koomen, Shari A Pilon-Thomas, Brian Ruffell, Vincent C Luca, Robert S Haltiwanger, Xuefeng Wang, Jennifer A Wargo, Genevieve M Boland, Eric K Lau

Faculty, Staff and Student Publications

Immunotherapy efficacy is limited in melanoma, and combinations of immunotherapies with other modalities have yielded limited improvements but also adverse events requiring cessation of treatment. In addition to ineffective patient stratification, efficacy is impaired by paucity of intratumoral immune cells (itICs); thus, effective strategies to safely increase itICs are needed. We report that dietary administration of l-fucose induces fucosylation and cell surface enrichment of the major histocompatibility complex (MHC)-II protein HLA-DRB1 in melanoma cells, triggering CD4+ T cell-mediated increases in itICs and anti-tumor immunity, enhancing immune checkpoint blockade responses. Melanoma fucosylation and fucosylated HLA-DRB1 associate with intratumoral T cell abundance …

Pd-L1 Translocation To The Plasma Membrane Enables Tumor Immune Evasion Through Mib2 Ubiquitination, Xinfang Yu, Wei Li, Haidan Liu, Xu Wang, Cristian Coarfa, Chao Cheng, Xinlian Yu, Zhaoyang Zeng, Ya Cao, Ken H Young, Yong Li

Faculty, Staff and Students Publications

Programmed death-ligand 1 (PD-L1), a critical immune checkpoint ligand, is a transmembrane protein synthesized in the endoplasmic reticulum of tumor cells and transported to the plasma membrane to interact with programmed death 1 (PD-1) expressed on T cell surface. This interaction delivers coinhibitory signals to T cells, thereby suppressing their function and allowing evasion of antitumor immunity. Most companion or complementary diagnostic devices for assessing PD-L1 expression levels in tumor cells used in the clinic or in clinical trials require membranous staining. However, the mechanism driving PD-L1 translocation to the plasma membrane after de novo synthesis is poorly understood. Herein, …

Clinical Epigenomic Explanation Of The Epidemiology Of Cannabinoid Genotoxicity Manifesting As Transgenerational Teratogenesis, Cancerogenesis And Aging Acceleration, Albert Stuart Reece, Gary Kenneth Hulse

Research outputs 2022 to 2026

As global interest in the therapeutic potential of cannabis and its’ derivatives for the management of selected diseases increases, it is increasingly imperative that the toxic profile of cannabinoids be thoroughly understood in order to correctly assess the balance between the therapeutic risks and benefits. Modern studies across a number of jurisdictions, including Canada, Australia, the US and Europe have confirmed that some of the most worrying and severe historical reports of both congenital anomalies and cancer induction following cannabis exposure actually underestimate the multisystem thousand megabase-scale transgenerational genetic damage. These findings from teratogenic and carcinogenic literature are supported by …

Geospatiotemporal And Causal Inferential Study Of European Epidemiological Patterns Of Cannabis- And Substance-Related Congenital Orofacial Anomalies, Albert Stuart Reece, Gary Kenneth Hulse

Research outputs 2022 to 2026

Introduction:

Since high rates of congenital anomalies (CAs), including facial CAs (FCAs), causally attributed to antenatal and community cannabis use have been reported in several recent series, it was of interest to examine this subject in detail in Europe.

Methods:

CA data were taken from the EUROCAT database. Drug exposure data were downloaded from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Income was taken from the World Bank’s online sources.

Results:

On the bivariate maps of both orofacial clefts and holoprosencephaly against resin, the Δ9-tetrahydrocannabinol concentration rates of both covariates increased together in France, Bulgaria, and the …

Association Between Covid-19 And Postoperative Neurological Complications And Antipsychotic Medication Use After Cancer Surgery: A Retrospective Study, Juan P Cata, Jian Hu, Lei Feng, Caroline Chung, Scott E Woodman, Larissa A Meyer

Faculty, Staff and Student Publications

Introduction: Millions of Americans infected with the severe acute respiratory syndrome-associated coronavirus-19 (COVID-19) need oncologic surgery. Patients with acute or resolved COVID-19 illness complain of neuropsychiatric symptoms. How surgery affects postoperative neuropsychiatric outcomes such as delirium is unknown. We hypothesize that patients with a history of COVID-19 could have an exaggerated risk of developing postoperative delirium after undergoing major elective oncologic surgery.

Methods: We conducted a retrospective study to determine the association between COVID-19 status and antipsychotic drugs during postsurgical hospitalization as a surrogate of delirium. Secondary outcomes included 30 days of postoperative complications, length of stay, and mortality. Patients …

Prediction Of Pathologic Complete Response To Neoadjuvant Systemic Therapy In Triple Negative Breast Cancer Using Deep Learning On Multiparametric Mri, Zijian Zhou, Beatriz E Adrada, Rosalind P Candelaria, Nabil A Elshafeey, Medine Boge, Rania M Mohamed, Sanaz Pashapoor, Jia Sun, Zhan Xu, Bikash Panthi, Jong Bum Son, Mary S Guirguis, Miral M Patel, Gary J Whitman, Tanya W Moseley, Marion E Scoggins, Jason B White, Jennifer K Litton, Vicente Valero, Kelly K Hunt, Debu Tripathy, Wei Yang, Peng Wei, Clinton Yam, Mark D Pagel, Gaiane M Rauch, Jingfei Ma

Faculty, Staff and Student Publications

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer. Neoadjuvant systemic therapy (NAST) followed by surgery are currently standard of care for TNBC with 50-60% of patients achieving pathologic complete response (pCR). We investigated ability of deep learning (DL) on dynamic contrast enhanced (DCE) MRI and diffusion weighted imaging acquired early during NAST to predict TNBC patients' pCR status in the breast. During the development phase using the images of 130 TNBC patients, the DL model achieved areas under the receiver operating characteristic curves (AUCs) of 0.97 ± 0.04 and 0.82 ± 0.10 for the training and the …

Identifying Biomarkers Of Differential Chemotherapy Response In Tnbc Patient-Derived Xenografts With A Ctd/Wgcna Approach, Varduhi Petrosyan, Lacey E Dobrolecki, Lillian Thistlethwaite, Alaina N Lewis, Christina Sallas, Ramakrishnan R Srinivasan, Jonathan T Lei, Vladimir Kovacevic, Predrag Obradovic, Matthew J Ellis, C Kent Osborne, Mothaffar F Rimawi, Anne Pavlick, Maryam Nemati Shafaee, Heidi Dowst, Antrix Jain, Alexander B Saltzman, Anna Malovannaya, Elisabetta Marangoni, Alana L Welm, Bryan E Welm, Shunqiang Li, Gerburg M Wulf, Olmo Sonzogni, Chen Huang, Suhas Vasaikar, Susan G Hilsenbeck, Bing Zhang, Aleksandar Milosavljevic, Michael T Lewis

Faculty, Staff and Students Publications

Although systemic chemotherapy remains the standard of care for TNBC, even combination chemotherapy is often ineffective. The identification of biomarkers for differential chemotherapy response would allow for the selection of responsive patients, thus maximizing efficacy and minimizing toxicities. Here, we leverage TNBC PDXs to identify biomarkers of response. To demonstrate their ability to function as a preclinical cohort, PDXs were characterized using DNA sequencing, transcriptomics, and proteomics to show consistency with clinical samples. We then developed a network-based approach (CTD/WGCNA) to identify biomarkers of response to carboplatin (MSI1, TMSB15A, ARHGDIB, GGT1, SV2A, SEC14L2, SERPINI1, ADAMTS20, DGKQ) and docetaxel (c, MAGED4, …

Editorial: Hallmark Of Cancer: Reprogramming Of Cellular Metabolism, Baljinder Kaur, Yahya Sohrabi, Abhinav Achreja, Michael P. Lisanti, Ubaldo Emilio Martinez-Outshoorn

Department of Medical Oncology Faculty Papers

No abstract provided.

Identification Of Tp53 Mutations In Circulating Tumour Dna In High Grade Serous Ovarian Carcinoma Using Next Generation Sequencing Technologies, Leslie Calapre, Tindaro Giardina, Aaron B. Beasley, Anna L. Reid, Colin Stewart, Benhur Amanuel, Tarek M. Meniawy, Elin S. Gray

Research outputs 2022 to 2026

Plasma circulating tumour DNA (ctDNA) has been suggested to be a viable biomarker of response to treatment in patients with high grade serous ovarian carcinoma (HGSOC). TP53 mutations are present in more than 90 % of HGSOCs but somatic variants are distributed across all exonic regions of the gene, requiring next generation sequencing (NGS) technologies for mutational analysis. In this study, we compared the suitability of the Accel (Swift) and Oncomine (ThermoFisher) panels for identification of TP53 mutations in ctDNA of HGSOC patients (N = 10). Only 6 patients (60 %) were found to have TP53 mutations using the ACCEL …

Three-Dimensional (3d) In Vitro Cell Culture Protocols To Enhance Glioblastoma Research, Janith Wanigasekara, Lara Carroll, Patrick J. Cullen, Brijesh K. Tiwari, James Curtin

Articles

Three-dimensional (3D) cell culture models can help bridge the gap between in vitro cell cultures and in vivo responses by more accurately simulating the natural in vivo environment, shape, tissue stiffness, stressors, gradients and cellular response while avoiding the costs and ethical concerns associated with animal models. The inclusion of the third dimension in 3D cell culture influences the spatial organization of cell surface receptors that interact with other cells and imposes physical restrictions on cells in compared to Two-dimensional (2D) cell cultures. Spheroids’ distinctive cyto-architecture mimics in vivo cellular structure, gene expression, metabolism, proliferation, oxygenation, nutrition absorption, waste excretion, …

Nutritional Medicine: Education For Advanced Practice Providers, Natalie Organ

DNP Research Projects

Abstract

OBJECTIVE: The project's primary goal was to educate the APP and develop positive attitudes and beliefs concerning plant-based nutrition regarding obesity, diabetes, cardiovascular disease, and cancer. The project addressed a crucial gap in healthcare education. APPs were not routinely given the chance to learn nutritional medicine, leading to decreased confidence in providing nutritional guidance in clinical practice.

METHODS: The DNP project participants were practicing advanced practice providers. The Knowledge, Attitude, Behavior (KAB) education theory and CREATION Life were used. This project used Qualtrics to send a pre-and post-intervention survey titled Student Survey for Nutritional Medicine. The intervention was a …

Demographic Factors In Adult Low-Grade Glioma Survival: A Seer Study, Mathew Krick

Public Health Theses

PURPOSE: It is unclear what role sociodemographic predictors have on the subtype-specific survival patterns of patients with low-grade gliomas. Understanding these effects may help guide and improve public health intervention strategies for patients with this relatively rare, understudied condition. METHODS: Using the Surveillance, Epidemiology, and End Results Program, we identified adult cases (aged 20-79 years) diagnosed with a World Health Organization Central Nervous System grade II supratentorial astrocytoma, oligodendroglioma, or mixed glioma between 1975-2019. Kaplan-Meier estimates and multivariable Cox models were utilized to assess factors associated with survival. RESULTS: The final cohort included 4,684 adult grade II glioma cases with …

Surface Guided Radiation Therapy Versus Traditional Triangular Positioning, Katelyn Sausser

Medical Imaging Senior Posters

Surface-guided Radiation Therapy (SGRT) is a positioning monitoring system utilizing 3D nonionizing optical surface imaging. This system assists in patient set-up and allows for real-time monitoring of the patient’s skin surface during radiation therapy treatment. Surface-guided imaging can be used for many treatment sites such as breast, abdomen, head and neck, and extremities. SGRT is believed to have more advantages than the traditional triangular positioning including shorter set-up times, improved accuracy and reproducibility of treatment area, decreased dose, and improved patient comfort. Studies have also shown the planned dose delivery can also be monitored with SGRT and decrease dose to …

Benefits Of The Cyberknife For Prostate Treatment, Emily Baro

Medical Imaging Senior Posters

Radiation therapy is a type of cancer treatment that uses high- energy rays to kill cancer cells. There are a lot of cancers that can be treated with radiation, but a common type is prostate cancer. Prostate cancer is the most common type of cancer diagnosed in men. The types of radiation therapy used to treat prostate cancer are external beam radiation, brachytherapy, and radiopharmaceuticals. The most common machine used for radiation treatment is the linear accelerator. Most patients are treated using the linear accelerator but a select few can be treated using the cyber knife. The cyber knife is …

Sgrt Eliminates Need For Patient Tattoos In Radiation Therapy, Gina Hemsley

Medical Imaging Senior Posters

Surface Guided Radiation Therapy, or SGRT, is a rapidly growing technology designed to improve radiation treatment accuracy of nearly every cancer type without the need for permanent skin tattoos. Patients were typically marked with 3 tattoos, indicating patient setup marks and isocenter marks. SGRT is an external beam radiation therapy technique which uses three-dimensional camera technology to accurately target and kill cancer cells. During patient setup and treatment, the technology uses the patient’s external surface to guarantee that the radiation dose is being consistently applied in accordance with the treatment plan, as well as tracking any patient motion throughout treatment. …

Institute Of Public Health Newsletter- Volume5, Issue1, Institute Of Public Health (Iph)

Institute of Public Health Newsletter (IPHNL) and Other Publications

No abstract provided.

Systemic Treatment Of Advanced And Metastatic Urothelial Cancer: The Landscape In Australia, Howard Gurney, Timothy D. Clay, Niara Oliveira, Shirley Wong, Ben Tran, Carole Harris

Research outputs 2022 to 2026

The 5-year survival rate of metastatic urothelial carcinoma (mUC) is estimated to be as low as 5%. Currently, systemic platinum-based chemotherapy followed by avelumab maintenance therapy is the only first-line treatment for mUC that has an overall survival benefit. Cisplatin-based chemotherapy (usually in combination with gemcitabine) is the preferred treatment but carboplatin is substituted where contraindications to cisplatin exist. Treatment with immune checkpoint inhibitors, antibody-drug conjugates, and kinase inhibitors has not yet demonstrated superiority to chemotherapy as first-line therapy and remains investigational in this setting. A recent media release indicates that chemotherapy plus nivolumab gives an OS advantage as first-line …

Implementation Of A Functional Pain Scale In An Adult Cancer Center, Kristine Pantchenko

DNP Projects

Background: Best practices include assessing functional status in addition to pain intensity in patients with cancer experiencing pain. The Defense and Veterans Pain Rating Scale (DVPRS) is an effective tool for assessing pain intensity and functional status in patients with cancer.

Objective: To improve pain assessment among outpatient oncology patients in an adult cancer center by implementing the DVPRS and evaluating patient and nurse satisfaction with this tool.

Methods: The Model for Healthcare Improvement was followed for the planning, implementation, and evaluation of this project. Nurses completed an online education module and self-assessment quiz before an in-person simulation checkoff demonstrated …

Identification Of Novel Biosynthetic Gene Clusters Encoding For Polyketide/Nrps-Producing Chemotherapeutic Compounds From Marine-Derived Streptomyces Hygroscopicus From A Marine Sanctuary, Hannah Ruth Flaherty

Honors Theses and Capstones

Nearly one out of six deaths in 2020, around ten million people, were caused by cancer, making it a leading cause of death worldwide (WHO, 2022). This major public health issue, in addition to the rise of multidrug-resistant (MDR) pathogens, provides a high demand for the discovery of new pharmaceutical drugs to be used clinically to treat these conditions. The Streptomyces genus accounts to produce 39% of all microbial metabolites currently approved for human health, indicating its potential as an important species to study for antimicrobial and anticancer agents. The long linear genome of Streptomyces contains specialized sequences known as …

Using Family Focused-Care Solutions To Improve Child’S Quality Of Life, Joshua M. Del Sol

Nursing | Senior Theses

Chronic illness in children impacts not only themselves but their families too. Everyone in the family supports each other and provides each other with pretty much all our physiological needs including our emotional needs. Parents/caregivers are the role models for their young children and really shape the person they become because basic values and their early relationships are formed. A family provides that consistent balance in our life that is the center of our life at a young age. When children are diagnosed with a chronic illness, parents may feel responsible, ashamed, guilty, or angry. Families may turn on each …

Health Disparities In Rural Kentucky Counties: Mortality Outcomes And The “Rural Penalty”, Aaron R. Tims

Scholarship in Medicine - All Papers

Objective: The object of this paper is to investigate the relationship between rurality and the national top five causes of death in Kentucky counties.

Methods: We used Spearman correlations to quantify the relationship between percent rurality and the crude death rate for heart disease, malignant neoplasia, unintentional injury, chronic lower respiratory disease, and cerebrovascular disease for each Kentucky county. We also used a Spearman correlation to compare and correlate percent rurality and mortality due to heart disease as these two factors changed between data from 2000 and 2010.

Results: Our research demonstrated statistically significant correlations between percent rurality and the …