Medicine and Health Sciences Commons^™

Leveraging Llms To Understand Narratives In Maude Reports, Yuheng Shi, Yang Gong

Faculty, Staff and Student Publications

Interest in using the MAUDE database to investigate adverse events linked to medical devices has been growing. Yet, the narrative sections of these reports remain largely unexplored, leaving valuable insights unutilized and creating an incomplete understanding of these events. To bridge this gap, we employ large language models (LLMs) to analyze and interpret these narratives. Using OpenAI's GPT-4-turbo model, we focused on MAUDE reports involving endoscopic clips to identify uncoded surgical procedures and uncover additional insights. This approach showcases the potential of LLMs in processing narrative content, offering a more efficient and cost-effective alternative to previous methods and supporting the …

Identifying The Human Olfactory And Chemosignaling Neural Networks Using Event Related Fmri And Graph Theory, Saideh Ferdowsi, Tom Foulsham, Alireza Rahmani, Dimitri Ognibene, Luca Citi, Wen Li

Faculty, Staff and Student Publications

This study aims to characterize and compare the functional neural networks associated with different olfactory stimuli, including air, non-social odours, and human body odours. We introduce a novel processing pipeline based on event-related functional magnetic resonance imaging (fMRI) and graph theory for network identification. To ensure the stability and small worldness of the characterized networks, we conduct statistical validations, network modularity assessments, and robustness measurement against local attacks. The key hypothesis is that human body odours (so-called social odours) and non-social odours engage distinct neural networks, particularly in regions responsible for social processing. We found that the posterior medial orbitofrontal …

Gpat4 Sustains Endoplasmic Reticulum Homeostasis In Endocardial Cells And Safeguards Heart Development, Tianyang Zhao, Kuipei Jin, Xiaodong Wang, Xiong Su, Youjun Wang, Mingming Gao, Wen Luo, Hongyuan Yang, Zhongzhou Yang

Faculty, Staff and Student Publications

The endocardium plays a pivotal role in governing myocardial development, and understanding the intrinsic regulatory insights will help apprehend pathological cardiomyopathy. Glycerol-3-phosphate acyltransferase 4 (GPAT4) is an endoplasmic reticulum (ER) membrane anchored protein. While the role of GPAT4 in glycerophospholipid biosynthesis is well established, its function in the ER is less explored. Here, we generate Gpat4 global and tissue-specific knockout mice and identify the essential role of GPAT4 in endocardial development. Deficiency of GPAT4 provokes endocardial ER stress response and enhances ER-mitochondrial (ER-mito) communications, leading to mitochondrial DNA (mtDNA) escape. As a result, the cGAS-STING pathway is triggered to stimulate …

Nbeal2 Knockout Mice Are Not Protected Against Hypoxia-Induced Pulmonary Vascular Remodeling And Pulmonary Hypertension, Janelle N Posey, Mariah Jordan, Caitlin V Lewis, Christina Sul, Evgenia Dobrinskikh, Delaney Swindle, Frederik Denorme, David Irwin, Jorge Di Paola, Kurt Stenmark, Eva S Nozik, Cassidy Delaney

2020-Current year OA Pubs

Inflammation drives the initiation and progression of pulmonary hypertension (PH). Platelets, increasingly recognized as immune cells, are activated and increased in the lungs of patients with PH. Platelet activation leads to the release of α-granule chemokines, many of which are implicated in PH. We hypothesized that hypoxia-induced secretion of platelet α-granule-stored proteins and PH would be prevented in Neurobeachin-like 2 knockout (Nbeal2-/-) α-granule-deficient mice. Wild-type (WT) and Nbeal2-/- mice were maintained in normoxia or exposed to 10% hypobaric hypoxia for 3, 14, 21, or 35 days. We observed macrothrombocytopenia, increased circulating neutrophils and monocytes, and increased lung interstitial macrophages (IMs) …

Molecular Subtyping Of Hypertensive Disorders Of Pregnancy, Michal Elovitz, Elaine Gee, Nathaniel Delaney-Busch, Alison Moe, Mitsu Reddy, Arkady Khodursky, Johnny La, Ilma Abbas, Kay Mekaru, Hunter Collins, Farooq Siddiqui, Rory Nolan, Rupsa Boelig, Daniel Kiefer, Pamela Simmons, George Saade, Antonio Saad, Ebony Carter, Thomas Mcelrath, Stephen Quake, Mark Depristo, Carrie Haverty, Manfred Lee, Eugeni Namsaraev, Vincenzo Berghella, Ai-Ris Collier, Antonia Frolova, Esther Park-Hwang, Luis Pacheco, Elizabeth Sutton, Maneesh Jain, Kara Rood, William A Grobman, Joseph Biggio, Cynthia Gyamfi-Bannerman, Arun Jeyabalan, Morten Rasmussen

Department of Obstetrics and Gynecology Faculty Papers

Hypertensive disorders of pregnancy (HDP), including preeclampsia, affect 1 in 6 pregnancies, are major contributors to maternal morbidity and mortality, yet lack precision medicine strategies. Analyzing transcriptomic data from a prospectively-collected diverse cohort (n = 9102), this study reveals distinct RNA subtypes in maternal blood, reclassifying clinical HDP phenotypes like early/late-onset preeclampsia. The placental gene PAPPA2 strongly predicts the most severe forms of preeclampsia in individuals without pre-existing high risk factors, months before symptoms, and its overexpression correlates with earlier delivery in a dose-dependent manner. Further, molecular subtypes characterized by immune genes are upregulated in less severe forms of HDP. …

Teaching Interprofessional Collaborative Skills In Primary Care Using Team-Based Learning With Simulation: A Pilot Study, Elaine B. Cruz, Mamta K. Singh

Faculty Scholarship

No abstract provided.

Challenges In Transitioning From Methadone To Buprenorphine-Naloxone For Chronic Pain Management: Two Cases, Jamal Hasoon, Anvinh Nguyen, Omar Viswanath, Alaa Abd-Elsayed

Faculty, Staff and Students Publications

Background: Methadone is frequently used for chronic pain management due to its long half-life and NMDA receptor activity, making it an effective option for opioid-tolerant patients. Buprenorphine-naloxone is increasingly explored as an alternative for chronic pain and opioid use disorder, offering partial opioid agonism with a ceiling effect on respiratory depression. The transition from methadone to buprenorphine-naloxone remains clinically challenging, requiring careful management to prevent withdrawal and ensure adequate pain control.

Case descriptions: Two patients with chronic pain were transitioned from methadone to buprenorphine-naloxone. The first patient, a mid-40s female, was abruptly switched from methadone 10 mg twice daily dosing …

Differential Antibody Response To Ebv Proteome Following Ebvst Immunotherapy In Ebv-Associated Lymphomas, Yomani D Sarathkumara, Nathan W Van Bibber, Zhiwei Liu, Helen E Heslop, Rayne H Rouce, Anna E Coghill, Cliona M Rooney, Carla Proietti, Denise L Doolan

Faculty, Staff and Students Publications

Epstein-Barr virus (EBV) is associated with a diverse range of lymphomas. EBV-specific T-cell (EBVST) infusions have shown promise in safety and clinical effectiveness in treating EBV-associated lymphomas; however, not all patients respond to T-cell immunotherapies. To identify EBV antigen–specific antibody responses associated with clinical outcomes, we comprehensively characterized antibody responses to the complete EBV proteome using a custom protein microarray in 56 patients with EBV-associated lymphoma who received EBVST infusions in phase 1 clinical trials. Responders (nonprogressors) and nonresponders (progressors) had distinct antibody profiles against EBV. Twenty-five immunoglobulin G (IgG) antibodies were significantly elevated in higher levels in nonresponders than …

Tumor-Derived Arachidonic Acid Reprograms Neutrophils To Promote Immune Suppression And Therapy Resistance In Triple-Negative Breast Cancer, Liqun Yu, Keziah Liebenberg, Yichao Shen, Fengshuo Liu, Zhan Xu, Xiaoxin Hao, Ling Wu, Weijie Zhang, Hilda L Chan, Bo Wei, Philip L Lorenzi, Yang Gao, Igor Bado, Luis Becerra-Dominguez, Charlotte Helena Rivas, Sergio Aguirre, Bradley C Pingel, Yi-Hsuan Wu, Yunfeng Ding, Jun Liu, David G Edwards, Livia S Eberlin, Xiang H-F Zhang

Faculty, Staff and Students Publications

The combination of immune checkpoint blockade and chemotherapies is the standard of care for triple-negative breast cancer (TNBC). However, initially, responsive tumors can still develop recurrences, suggesting acquired resistance mechanisms that remain poorly understood. Herein, we discover that TNBC cells surviving anti-programmed cell death protein-1 (anti-PD-1) and chemotherapy treatment accumulate neutral lipids. Disrupting lipid droplet formation in cancer cells reverses resistance and mitigates the immunosuppressive microenvironment. Single-cell RNA sequencing reveals a subset of neutrophils exhibiting a lipid-laden phenotype similar to adjacent tumor cells. Mechanistically, tumor-derived extracellular vesicles carrying lipids, including arachidonic acid (AA), mediate neutrophil reprogramming. Blocking dietary intake of …

The Cardiovascular Care Of The Pediatric Athlete, Peter N Dean, Julie A Brothers, Kristin Burns, Jonathan B Edelson, Susan Etheridge, Dermot M Phelan, Keri Shafer, Chris Snyder, Silvana Molossi, Alfred Danielian, Eli M Friedman, Jeff Hsu, Mustafa Husaini, Eugene H Chung, Matthew W Martinez, Aaron L Baggish, Benjamin D Levine, Jonathan H Kim, American College Of Cardiology Sports & Exercise Cardiology Council

Faculty, Staff and Students Publications

Sports cardiology broadly encompasses the cardiovascular care of individuals who place a high premium on habitual exercise, sports performance, and/or sports competition. Some of the essential aspects within sports cardiology include the preparticipation cardiac evaluation and the management of cardiac diseases in athletes. Although most sports cardiology practitioners are trained in adult cardiology, a significant number of individuals who participate in sports are pediatric-aged, < 18 years old. Up to two-thirds of children in middle and high school participate in organized sports or are involved in nonorganized recreational sports. The cardiovascular care of pediatric-aged athletes can be challenging because many of the classic tenets and principles in adult sports cardiology do not fully generalize to pediatrics, and there is a lack of the evidence base that may be present for adult athletes. The epidemiology, presentation, and progression of cardiovascular diseases can be significantly different between pediatric and adult athletes. The evaluation of potential diseases and management considerations may also differ between pediatric and adult athletes. Similar to adults, there are "gray zones" where it is difficult to differentiate between normal exercise-induced cardiac remodeling and true cardiac pathology, but the additional lack of normative standards further complicates assessments in pediatric athletes. Management decisions for pediatric athletes are generally based on limited data but carry substantial short- and long-term implications. Thus, shared decision-making as part of the determination of clinical management strategies and for sports participation is critical and requires the participation of the parents or guardian(s). In this state-of-the-art review, key differences between pediatric and adult-aged athletes are highlighted. Specifically, how to define the "pediatric athlete," consider cardiovascular adaptations observed among pediatric athletes, determine preparticipation screening options and optimal symptom-driven evaluations in children, and consider best practices for pediatric athletes with several key cardiac conditions are detailed. The purpose of this document is to represent the first primary reference available to providers who care for pediatric athletes with cardiovascular concerns.

Disentangling Effects Of The Dr And Dq Isomers Encoded By The Hla Class Ii Haplotype Drb1*15:01/Dqb1*06:02 To Help Establish The True Risk Allele For Fviii Inhibitor Development In Hemophilia A, Vincent P. Diego, Bernadette W. Luu, Marcio A. Almeida, Jacob Galan, Eron G. Manusov, Juan M. Peralta, Satish Kumar, Joanne E. Curran, Harald H. H. Goring, Sarah Williams-Blangero, John Blangero, Tom Howard

School of Medicine Publications

Introduction: Hemophilia A (HA) patients (HAPs) with the human leukocyte antigen (HLA)-class-II (HLAII) haplotype DRB1*15:01/DQB1*06:02, and thus antigen presenting cells which express HLAII β-polypeptide chains that form heterodimers of DR15- and DQ6-serotypes, respectively, have an increased risk of developing factor (F)VIII inhibitors (FEIs)—neutralizing antibodies against the therapeutic-FVIII-proteins (tFVIIIs) infused to prevent/arrest bleeding. As DRB1*15:01 and DQB1*06:02 exist in strong linkage disequilibrium, association analysis cannot determine which is the actual risk allele.

Methods: To establish the true risk allele of this haplotype, we analyzed the tFVIII-derived peptides (tFVIII-dPs) bound to either the DR or DQ molecules that comprise the individual HLAII …

84 - Effect Of Organized Sport Interventions On Motor Outcomes Of Children With Autism Spectrum Disorder - A Systematic Review., Maeren Hill, Kailash Ram, Caitlyn Warnock, Kaitlin Hardy, Sonia Khurana, Pt, Ph.D.

Undergraduate Research Symposium

Aim:

The aim of this systematic review was to synthesize randomized clinical trials to evaluate the effectiveness of sports-based interventions on motor outcomes in children with autism spectrum disorder (ASD).

Methods:

A comprehensive literature search was conducted on the following five databases from inception to November 2024: PubMed, Web of Science, CINAHL, Cochrane Library, and Clinical Trials. Gray literature was sourced from Google Scholar and ProQuest Dissertations and Theses.

Articles were eligible for inclusion if they met the following criteria: (1) published in English; (2) participants were under the age of 18 with a diagnosis of ASD; (3) interventions consisted …

76 - Cochlear Implant Candidacy In Adults: Evidence From Systematic Reviews, Madison Hastain, Stacie Raymer

Undergraduate Research Symposium

This poster provides recommendations for cochlear implant candidacy in adults based on data collected from several systematic reviews, along with information regarding the efficacy of cochlear implants in adults with varied types of hearing loss.

74 - Age And Seasonal Blood Pressure Variation In People Experiencing Homelessness In Hampton Roads, Luke Ekdahl, Katherine Schaffer, Joshua Edwards, Kean Feyzeau

Undergraduate Research Symposium

Intro: For older community members experiencing homelessness, both their housing status and age are associated with increased cardiovascular risk. Lack of consistent protection from outdoor temperatures are hypothesized to affect variation in blood pressure seasonally. In this study, we sought to compare older (55+) and younger (under 55) individuals in this cohort and identify within-group associations between blood pressure (BP) and mean daily temperature (MDT) as affected by season.

Methods: 301 patients from two student-run free clinics met BP inclusion criteria. MDT was sourced from the Global Historical Climatology Network daily dataset. Interquartile range method for outlier detection limited visits …

The Pharmaceutical Quality Of Herbal Medicinal Products And Dietary Supplements – Assessment Of Products From Lavandula Species, Banaz Jalil, Michael Heinrich

Oxford ICSB

Several Lavandula species are important aromatic and medicinal plants with great economic value as phytopharmaceuticals, foods, in perfumery, cosmetics, and aromatherapy. The genus Lavandula comprises 39 species with many hybrids. Over 20 years ago about 400 registered cultivars were recorded (1) , with the three main cultivated species being used to produce essential oils, including fine lavender oil, spike lavender oil and lavandin oil. Lavandula angustifolia Mill. is used traditionally to treat restlessness, agitation, insomnia and intestinal discomfort linked to nervousness (2). For example, Silexan® is a high-quality fine lavender oil licensed as an active ingredient in medicines for the …

Dosage Form Performance Assessment Of Four Commercially Available Turmeric-Containing Dietary Supplements To Inform Clinical Study Design., Bill Gurley

Oxford ICSB

Clinical studies assessing structure-function claims, safety, phytochemical pharmacokinetics, or drug interaction potential of botanical dietary supplements (BDS) often overlook the disintegration and dissolution characteristics of the administered dosage form. Consequently, inadequate disintegration or dissolution profiles may prevent key study endpoints from being met. Given the high cost of clinical research, no study should proceed without first verifying the disintegration and dissolution performance of the selected dosage form. Failure to do so may compromise the study’s validity and render its findings inconclusive. Assessing dosage form performance, particularly in biorelevant media, is a cost-effective strategy that can provide critical insights for optimizing …

52 - The Intersection Of Trauma Type And Alcohol Use In College Women: Examining Maladaptive Coping In A High-Risk Population, Mira I. Hopkins, Christopher T. Latourrette, Niya Richardson, Mellyssa G. Deoliveira, Sage E. Hawn

Undergraduate Research Symposium

This study examines how different types of trauma exposure, interpersonal and non-interpersonal, relate to alcohol use as a coping mechanism in college women with trauma histories. Given the unique social and environmental pressures of college life, this research aims to highlight the ways in which trauma and substance use intersect in this high-risk population.

Abstract Title: What Is Chaga? Unique Biochemistry Of The Sterile Conk., Anna Kreynes

Oxford ICSB

Fungal based supplements or functional mushrooms are growing in popularity worldwide. Among them, Chaga is attracting increasing attention for its broad immune-modulatory and anti-inflammatory properties. Chaga is unique among “mushroom” supplements as it is technically neither a mushroom (fruiting body), nor a sclerotia, as some researchers assert, but rather a sterile conk or canker that forms on trees, infected and colonized by mycelia of the pathogenic fungus Inonotus obliquus. Commonly associated with birch (Betula spp.), I. obliquus also parasitizes other hardwood species such as alder (Alnus), beech (Fagus), and ash (Fraxinus), found in boreal forests of northern Europe, Asia and …

An Update From The U.S. Drug Induced Liver Injury Network And Plans For Sentinel Surveillance For Supplement Induced Liver Injury, Victor Navarro

Oxford ICSB

Herbal and dietary supplements (HDS) are commonly used by consumers, and some have been linked to liver injury severe enough in some cases to result in transplantation and death. The U.S. Drug Induced Liver Injury is funded by the NIH to study liver injury from supplements. The DILIN investigators have identified many supplements linked to liver injury, as well as risks for the development of hepatotoxicity. The Network has also observed temporal trends in the occurrence of supplement related liver injury, some that parallel regulatory actions. In order to use these observations to promote consumer protection and supplement safety, the …

Misidentification Remains Common In Selected Historically Substituted Traditional Chinese Medicine Herbs., Wendy Applequist

Oxford ICSB

Various studies have observed that some minimally processed botanicals sold for use in Traditional Chinese Medicine are adulterated or substituted with species having similar appearance and/or traditional uses. In this study, commercial samples of several plants for which aboveground parts are used, and for which Leon & Lin’s (2017) reference work reported known substitutes, were examined. All samples of Ma Chi Xian (Portulaca oleracea), Yi Mu Cao (Leonurus japonicus), Ze Lan (Lycopus lucidus), and Zi Hua De Ding (Viola philippica) were at least mostly consistent with the stated identities, though some contained contaminants. Three of nine samples of Xi Xian …

Supplement Product Quality Woes: A Call To Action, Andrew Shao

Oxford ICSB

No abstract provided.

Digitization Of Hptlc Chromatograms For Chemometric Analysis, Menglian Zhang, Jianghao Sun

Oxford ICSB

HPTLC has been a major analytical tool for the botanical industry for many years. Its strength has been the ability to provide multiple chromatograms for parallel visual comparison of standards and samples. It’s weakness has been the lack of digitization to allow objective chemometric analysis of the data. Two studies are presented: analysis of 3 species of Echinacea (E. angustifolia, E. palida, and E. purpurea) and analysis of cranberry supplements, fruits, and juices (35 supplements, 8 dried fruits, and 4 juices). Accurate comparison of the patterns of the chromatograms required pre-processing: removing initial and final peaks, derivatization, alignment of samples …

Moving From Conundrum To Solution. Understanding The Riddle Of Data, Supply Chains And Botanical Complexity, Cris Amarillas

Oxford ICSB

No abstract provided.

Simultaneous Botanical Identification And Marker Compound Assay By High Performance Thin Layer Chromatography, James Kababick, Stacy Wise, Christine Goularte

Oxford ICSB

21 CFR part 111 (the Dietary Supplement cGMPs) require identity testing on all dietary ingredients. In many cases, botanicals are also standardized to selected marker compounds and require potency testing to ensure products meet label claim. We present a novel approach to combining the identification and assay testing into one analytical run utilizing High Performance Thin Layer Chromatography. The method eliminates the need for subsequent assay testing and greatly reduces chemical waste in the laboratory saving both time and money. Case studies will be presented.

Foraging For Methods: The Right Hptlc Method For The Right Spec, Khanh Tran, Sidney Sudberg, Anthony Fontana

Oxford ICSB

High Performance Thin Layer Chromatography (HPTLC) is a well-established analytical technique widely utilized for botanical and fungal identification. Mushrooms are known for their bioactive compounds (beta-glucans, sterols, and triterpenoids) that can have a wide range of human health benefits, such as boosting the immune system, antioxidant, and anti-inflammatory among others. The method selection for mushrooms is dependent on the species of mushroom, the compound(s) of interest, form of material, as well as standardization of extracts. Over 15 different mushroom species were analyzed by various methods by HPTLC, for both mycelia and fruiting body.

Rooted In Quality: Elevating Standards In Botanical Supplements, Katie Banaszewski

Oxford ICSB

The botanical supplement industry is currently navigating a landscape that demands an unwavering commitment to high standards of quality, transparency, and sustainability. This sector faces a host of challenges alongside new opportunities, particularly emphasizing the vital role of quality assurance in preserving the integrity of botanical products. To ensure the authenticity of botanical ingredients and safeguard consumer health, advanced scientific testing techniques have become indispensable. Methods such as DNA barcoding, mass spectrometry, and NMR spectroscopy play crucial roles in verifying the purity and identity of these natural products. Furthermore, as the market increasingly prioritizes ethical consumption, there is a growing …

Innovative Integration Of Hptlc And Ai For Detecting Adulteration And Ensuring Quality In European Elder Berry Products, Maria Monagas, Wilmer Perera, Roy Upton, Eike Reich, Tiên Do

Oxford ICSB

European Elder berry, Sambucus nigra L. has a long history of traditional use as a cold and flu remedy. Since COVID-19 pandemic, the increased demand and limited supply have increased adulteration risk. Major concerns related to adulteration are substitution of Elder berry with black rice extract, addition of synthetic dyes and species mislabeling. HPTLC analysis of a total of 167 samples from different types of ingredients marketed as containing S. nigra was conducted, including whole fruits, juice concentrates, dry juices, fruit powders, liquid extracts, aqueous extracts and Dietary Supplements (DS) products (capsules and syrups). Related species (S. cerulea, S. canadensis, …

Masld/Mash Pharmacologic Therapeutic Efficacy In A Predominately African American Medical Center Population, Reema Smadi, Michael Mello, Astha Saini, Paul Naylor, Milton Mutchnick

Medical Student Research Symposium

Introduction: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) can contribute to adverse liver-related outcomes and cardiac mediated events. Recognizing the benefits of weight loss in patients with MASLD, this study investigates the efficacy of glucagon-like peptide-1 (GLP-1) agonists in promoting weight reduction in a MASLD cohort.

Methods: We identified 52 individuals with imaging confirmed liver steatosis. Weight loss (pounds) was calculated by comparing weights before and during GLP-1 therapy. Efficacy was evaluated by comparing GLP-1 users with non-users within a similar timeframe.

Result: Of the 52 patients with a post-2020 follow-up, 33% were prescribed GLP-1 agonists. The majority were AA patients …

Progress And Plateaus: Female Representation In Interventional Radiology Training, 2008–2024, Ahmed Alzubaidi, Hailey Carruthers, Arif Musa Md, Monte Harvill Md, Ali Harb Md

Medical Student Research Symposium

Purpose:

Gender disparity in interventional radiology (IR) has been a longstanding issue. This study evaluated trends in female representation in IR training programs from 2008 to 2024, focusing on changes after the establishment of the Integrated IR residency program in 2016-2017.

Materials and Methods:

A retrospective review of residency and fellowship application data from the Electronic Residency Application Service (ERAS) and active resident data from the Accreditation Council for Graduate Medical Education (ACGME) was conducted. Linear regression assessed trends from 2008 to 2024. Segmented (piecewise) regression compared trends before and after 2021. T-tests analyzed gender proportions in Integrated IR applicants. …

Long-Term Quality Of Life Following Treatment In Head And Neck Cancer Survivors With Feeding Tubes, Raven Dunn, Emmanuel D. Meram, Eric Adjei Boakye, Katie Latack, Amy Williams, Tamer Ghanem, Farzan Siddiqui, Suhael Momin, Steven Chang, Vivian Wu, Veronica Bernacchi, Samantha Tam

Medical Student Research Symposium

Background: There is limited research on patients requiring long-term feeding tubes after head and neck cancer (HNC) treatment, despite the significant impact on post-treatment quality of life (QoL). Our study addresses this gap by assessing long-term feeding tube and long-term QoL (6 months and 1-year post-treatment).

Methods: This is a retrospective study of patients diagnosed with HNC. All patients were offered FACT-HN at baseline, and 6 months to 1 year after completion of treatment. The FACT-HN (outcome variable) is a patient reported outcome measure for well-being. Higher scores indicate better quality of life. The exposure variable is the …