Medicine and Health Sciences Commons^™

Oncology Patients’ Willingness To Report Their Medication Safety Concerns From Home: A Qualitative Study, Deema Bunni, Grace Walters, Misun Hwang, Katie Gahn, Heidi Mason, Milisa Manojlovich, Yang Gong, Yun Jiang

Faculty, Staff and Student Publications

Purpose: Oncology patients often struggle to manage their medications and related adverse events during transitions of care. They are expected to take an active role in self-monitoring and timely reporting of their medication safety events or concerns to clinicians. The purpose of this study was to explore the factors influencing oncology patients' willingness to report adverse events or concerns related to their medication after their transitions back home.

Methods: A qualitative interview study was conducted with adult patients with breast, prostate, lung, or colorectal cancer who experienced care transitions within the previous year. A semi-structured interview guide was developed to …

Postnatal Brain Trajectories And Maternal Intelligence Predict Childhood Outcomes In Complex Chd, Vincent K Lee, Rafael Ceschin, William T Reynolds, Benjamin Meyers, Julia Wallace, Douglas Landsittel, Heather M Joseph, Daryaneh Badaly, J William Gaynor, Daniel Licht, Nathaniel H Greene, Ken M Brady, Jill V Hunter, Zili D Chu, Elisabeth A Wilde, R Blaine Easley, Dean Andropoulos, Ashok Panigrahy

Faculty, Staff and Student Publications

Objective: To determine whether early structural brain trajectories predict early childhood neurodevelopmental deficits in complex CHD patients and to assess relative cumulative risk profiles of clinical, genetic, and demographic risk factors across early development.

Study Design: Term neonates with complex CHDs were recruited at Texas Children’s Hospital from 2005–2011. Ninety-five participants underwent three structural MRI scans and three neurodevelopmental assessments. Brain region volumes and white matter tract fractional anisotropy and radial diffusivity were used to calculate trajectories: perioperative, postsurgical, and overall. Gross cognitive, language, and visuo-motor outcomes were assessed with the Bayley Scales of Infant and Toddler Development and …

Ire1Α Determines Ferroptosis Sensitivity Through Regulation Of Glutathione Synthesis, Dadi Jiang, Youming Guo, Tianyu Wang, Liang Wang, Yuelong Yan, Ling Xia, Rakesh Bam, Zhifen Yang, Hyemin Lee, Takao Iwawaki, Boyi Gan, Albert C Koong

Faculty, Staff and Student Publications

Cellular sensitivity to ferroptosis is primarily regulated by mechanisms mediating lipid hydroperoxide detoxification. We show that inositol-requiring enzyme 1 (IRE1α), an endoplasmic reticulum (ER) resident protein critical for the unfolded protein response (UPR), also determines cellular sensitivity to ferroptosis. Cancer and normal cells depleted of IRE1α gain resistance to ferroptosis, while enhanced IRE1α expression promotes sensitivity to ferroptosis. Mechanistically, IRE1α's endoribonuclease activity cleaves and down-regulates the mRNA of key glutathione biosynthesis regulators glutamate-cysteine ligase catalytic subunit (GCLC) and solute carrier family 7 member 11 (SLC7A11). This activity of IRE1α is independent of its role in regulating the UPR and is …

Seasonality, Clinical Characteristics, And Outcomes Of Respiratory Syncytial Virus Disease By Subtype Among Children Aged <5 Years: New Vaccine Surveillance Network, United States, 2016-2020., Ariana P. Toepfer, Justin Z. Amarin, Andrew J. Spieker, Laura S. Stewart, Mary Allen Staat, Elizabeth P. Schlaudecker, Geoffrey A. Weinberg, Peter G. Szilagyi, Janet A. Englund, Eileen J. Klein, Marian G. Michaels, John V. Williams, Rangaraj Selvarangan, Christopher J. Harrison, Joana Y. Lively, Pedro A. Piedra, Vasanthi Avadhanula, Brian Rha, James Chappell, Meredith Mcmorrow, Heidi Moline, Natasha B. Halasa

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of acute respiratory illnesses in children. RSV can be broadly categorized into 2 major subtypes: A and B. RSV subtypes have been known to cocirculate with variability in different regions of the world. Clinical associations with viral subtype have been studied among children with conflicting findings such that no conclusive relationships between RSV subtype and severity have been established.

METHODS: During 2016-2020, children aged/guardian interviews, chart reviews, and collection of midturbinate nasal plus/minus throat swabs for RSV (RSV-A, RSV-B, and untyped) using reverse transcription polymerase chain reaction.

RESULTS: Among 6398 RSV-positive …

Heterogeneous Profile Of Ror1 Protein Expression Across Tumor Types, Maria Gabriela Raso, Elizve Barrientos Toro, Kurt Evans, Yasmeen Rizvi, Rossana Lazcano, Argun Akcakanat, Patrizia Sini, Francesca Trapani, Eva Johanna Madlener, Lorenz Waldmeier, Alexander Lazar, Funda Meric-Bernstam

Faculty, Staff and Student Publications

The Wnt receptor ROR1 has generated increased interest as a cancer therapeutic target. Research on several therapeutic approaches involving this receptor is ongoing; however, ROR1 tissue expression remains understudied. We performed an immunohistochemistry analysis of ROR1 protein expression in a large cohort of multiple tumor and histologic types. We analyzed 12 anonymized multi-tumor tissue microarrays (TMAs), including mesothelioma, esophageal and upper gastrointestinal carcinomas, and uterine endometrioid carcinoma, among other tumor types. Additionally, we studied 5 different sarcoma types of TMAs and 6 patient-derived xenografts (PDX) TMAs developed from 19 different anatomic sites and tumor histologic types. A total of 1142 …

Youth Interest In Reusable Menstrual Hygiene Products: An Opportunity For Improving Menstruation Management, Makenna R. Eccles

College Honors Program

Adolescents experience inconsistent menstrual hygiene material access that is exacerbated by poverty and results in menstruation management difficulty, health risks, and interruptions to school attendance. The study centered the adolescent menstruation management experience through qualitative interviews to identify management difficulties and to assess knowledge, interest, and perceived feasibility of implementing reusable menstrual hygiene materials such as reusable sanitary pads, period underwear, menstrual cups, and menstrual disks to improve both menstrual hygiene access and menstrual management experiences. Inductive and deductive coding was used to analyze interview data and identify key themes. Adolescents expressed interest in reusable menstrual hygiene materials due to …

Dose-Dependent Effects Of Gamma Radiation Sterilization On The Collagen Matrix Of Human Cortical Bone Allograft And Its Influence On Fatigue Crack Propagation Resistance, Dylan B. Crocker, Thomas M. Hering, Ozan Akkus, Clare M. Rimnac

Student Scholarship

Fatigue crack propagation resistance and high-cycle S–N fatigue life of cortical bone allograft tissue are both negatively impacted in a radiation dose-dependent manner from 0 to 25 kGy. The standard radiation sterilization dose of 25–35 kGy has been shown to induce cleavage of collagen molecules into smaller peptides and accumulation of stable crosslinks within the collagen matrix, suggesting that these mechanisms may influence radiation-induced losses in cyclic fracture resistance. The objective of this study was to determine the radiation dose-dependency of collagen chain fragmentation and crosslink accumulation within the dose range of 0–25 kGy. Previously, cortical bone compact tension specimens …

Give Penicillin Or Ceftriaxone: Neurosyphilis Does Not Deal In Absolutes, Nicolás W Cortés-Penfield, Daniel M Musher

Faculty, Staff and Students Publications

No abstract provided.

Jag1/2 Maintain Esophageal Homeostasis And Suppress Foregut Tumorigenesis By Restricting The Basal Progenitor Cell Pool, Haidi Huang, Yu Jiang, Jiangying Liu, Dan Luo, Jianghong Yuan, Rongzi Mu, Xiang Yu, Donglei Sun, Jihong Lin, Qiyue Chen, Xinjing Li, Ming Jiang, Jianming Xu, Bo Chu, Chengqian Yin, Lei Zhang, Youqiong Ye, Bo Cao, Qiong Wang, Yongchun Zhang

Faculty, Staff and Students Publications

Basal progenitor cells are crucial for maintaining foregut (the esophagus and forestomach) homeostasis. When their function is dysregulated, it can promote inflammation and tumorigenesis. However, the mechanisms underlying these processes remain largely unclear. Here, we employ genetic mouse models to reveal that Jag1/2 regulate esophageal homeostasis and foregut tumorigenesis by modulating the function of basal progenitor cells. Deletion of Jag1/2 in mice disrupts esophageal and forestomach epithelial homeostasis. Mechanistically, Jag1/2 deficiency impairs activation of Notch signaling, leading to reduced squamous epithelial differentiation and expansion of basal progenitor cells. Moreover, Jag1/2 deficiency exacerbates the deoxycholic acid (DCA)-induced squamous epithelial injury and …

Optical Coherence Tomography-Guided Brillouin Microscopy Highlights Regional Tissue Stiffness Differences During Anterior Neural Tube Closure In The Mthfd1l Murine Mutant, Yogeshwari S Ambekar, Carlo Donato Caiaffa, Bogdan J Wlodarczyk, Manmohan Singh, Alexander W Schill, John W Steele, Jitao Zhang, Salavat R Aglyamov, Giuliano Scarcelli, Richard H Finnell, Kirill V Larin

Faculty, Staff and Students Publications

Neurulation is a highly synchronized biomechanical process leading to the formation of the brain and spinal cord, and its failure leads to neural tube defects (NTDs). Although we are rapidly learning the genetic mechanisms underlying NTDs, the biomechanical aspects are largely unknown. To understand the correlation between NTDs and tissue stiffness during neural tube closure (NTC), we imaged an NTD murine model using optical coherence tomography (OCT), Brillouin microscopy and confocal fluorescence microscopy. Here, we associate structural information from OCT with local stiffness from the Brillouin signal of embryos undergoing neurulation. The stiffness of neuroepithelial tissues in Mthfd1l null embryos …

Optical Coherence Tomography-Guided Brillouin Microscopy Highlights Regional Tissue Stiffness Differences During Anterior Neural Tube Closure In The Mthfd1l Murine Mutant, Yogeshwari S Ambekar, Carlo Donato Caiaffa, Bogdan J Wlodarczyk, Manmohan Singh, Alexander W Schill, John W Steele, Jitao Zhang, Salavat R Aglyamov, Giuliano Scarcelli, Richard H Finnell, Kirill V Larin

Faculty, Staff and Students Publications

Neurulation is a highly synchronized biomechanical process leading to the formation of the brain and spinal cord, and its failure leads to neural tube defects (NTDs). Although we are rapidly learning the genetic mechanisms underlying NTDs, the biomechanical aspects are largely unknown. To understand the correlation between NTDs and tissue stiffness during neural tube closure (NTC), we imaged an NTD murine model using optical coherence tomography (OCT), Brillouin microscopy and confocal fluorescence microscopy. Here, we associate structural information from OCT with local stiffness from the Brillouin signal of embryos undergoing neurulation. The stiffness of neuroepithelial tissues in Mthfd1l null embryos …

A Bivalent Human Norovirus Vaccine Induces Homotypic And Heterotypic Neutralizing Antibodies, Robert L Atmar, Khalil Ettayebi, Sasirekha Ramani, Frederick H Neill, Lisa Lindesmith, Ralph S Baric, Amanda Brinkman, Ralph Braun, James Sherwood, Mary K Estes

Faculty, Staff and Students Publications

A GII.2 outbreak in an efficacy study of a bivalent virus-like particle norovirus vaccine, TAK-214, in healthy US adults provided an opportunity to examine GII.4 homotypic vs GII.2 heterotypic responses to vaccination and infection. Three serologic assays-virus-like particle binding, histoblood group antigen blocking, and neutralizing-were performed for each genotype. Results were highly correlated within a genotype but not between genotypes. Although the vaccine provided protection from GII.2-associated disease, little GII.2-specific neutralization occurred after vaccination. Choice of antibody assay can affect assessments of human norovirus vaccine immunogenicity.

Seasonality, Clinical Characteristics, And Outcomes Of Respiratory Syncytial Virus Disease By Subtype Among Children Aged <5 Years: New Vaccine Surveillance Network, United States, 2016-2020, Ariana P Toepfer, Justin Z Amarin, Andrew J Spieker, Laura S Stewart, Mary Allen Staat, Elizabeth P Schlaudecker, Geoffrey A Weinberg, Peter G Szilagyi, Janet A Englund, Eileen J Klein, Marian G Michaels, John V Williams, Rangaraj Selvarangan, Christopher J Harrison, Joana Y Lively, Pedro A Piedra, Vasanthi Avadhanula, Brian Rha, James Chappell, Meredith Mcmorrow, Heidi Moline, Natasha B Halasa

Faculty, Staff and Students Publications

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of acute respiratory illnesses in children. RSV can be broadly categorized into 2 major subtypes: A and B. RSV subtypes have been known to cocirculate with variability in different regions of the world. Clinical associations with viral subtype have been studied among children with conflicting findings such that no conclusive relationships between RSV subtype and severity have been established.

METHODS: During 2016-2020, children aged/guardian interviews, chart reviews, and collection of midturbinate nasal plus/minus throat swabs for RSV (RSV-A, RSV-B, and untyped) using reverse transcription polymerase chain reaction.

RESULTS: Among 6398 RSV-positive …

Unintentionally Intentional: Unintended Effects Of Spinal Stimulation As A Platform For Multi-Modal Neurorehabilitation After Spinal Cord Injury, Gerson N Moreno Romero, Avery R Twyman, Maria F Bandres, Jacob Graves Mcpherson

2020-Current year OA Pubs

Electrical stimulation of spinal neurons has emerged as a valuable tool to enhance rehabilitation after spinal cord injury. In separate parameterizations, it has shown promise for improving voluntary movement, reducing symptoms of autonomic dysreflexia, improving functions mediated by muscles of the pelvic floor (e.g., bowel, bladder, and sexual function), reducing spasms and spasticity, and decreasing neuropathic pain, among others. This diverse set of actions is related both to the density of sensorimotor neural networks in the spinal cord and to the intrinsic ability of electrical stimulation to modulate neural transmission in multiple spinal networks simultaneously. It also suggests that certain …

Benefits And Advances Of Cone Beam Ct Use In Prostatic Artery Embolization: Review Of The Literature And Pictorial Essay, Nassir Rostambeigi, Daniel Crawford, Jafar Golzarian

2020-Current year OA Pubs

Prostatic artery embolization (PAE) has proven to be an efficacious treatment for urinary symptoms of benign prostatic hyperplasia. PAE is performed in a complex and challenging anatomical field which may pose difficulties from procedural standpoint. Cone beam computed tomography (CBCT) has been proposed as an invaluable tool during the PAE procedure. A review of different techniques and advancements, as well as demonstration of CBCT benefits via a pictorial overview of the salient examples is lacking. The techniques of CBCT are discussed herein and the virtual injection technology as an advancement in CBCT is discussed. To show the merits of CBCT …

Quantitative T2 Mapping-Based Longitudinal Assessment Of Brain Injury And Therapeutic Rescue In The Rat Following Acute Organophosphate Intoxication, Alita Jesal D Almeida, Brad A Hobson, Naomi Saito, Donald A Bruun, Valerie A Porter, Danielle J Harvey, Joel R Garbow, Abhijit J Chaudhari, Pamela J Lein

2020-Current year OA Pubs

Acute intoxication with organophosphate (OP) cholinesterase inhibitors poses a significant public health risk. While currently approved medical countermeasures can improve survival rates, they often fail to prevent chronic neurological damage. Therefore, there is need to develop effective therapies and quantitative metrics for assessing OP-induced brain injury and its rescue by these therapies. In this study we used a rat model of acute intoxication with the OP, diisopropylfluorophosphate (DFP), to test the hypothesis that T

Transcriptomic Signature, Bioactivity And Safety Of A Non-Hepatotoxic Analgesic Generating Am404 In The Midbrain Pag Region, Hernan A. Bazan, Surjyadipta Bhattacharjee, Madigan M. Reid, Bokkyoo Jun, Connor Polk, Madeleine Strain, Linsey A. St Pierre, Neehar Desai, Patrick W. Daly, Jessica A. Cucinello-Ragland, Scott Edwards, Javier Recio, Julio Alvarez-Builla, James J. Cai, Nicolas G. Bazan

School of Medicine Faculty Publications

Safe and effective pain management is a critical healthcare and societal need. The potential for acute liver injury from paracetamol (ApAP) overdose; nephrotoxicity and gastrointestinal damage from chronic non-steroidal anti-inflammatory drug (NSAID) use; and opioids’ addiction are unresolved challenges. We developed SRP-001, a non-opioid and non-hepatotoxic small molecule that, unlike ApAP, does not produce the hepatotoxic metabolite N-acetyl-p-benzoquinone-imine (NAPQI) and preserves hepatic tight junction integrity at high doses. CD-1 mice exposed to SRP-001 showed no mortality, unlike a 70% mortality observed with increasing equimolar doses of ApAP within 72 h. SRP-001 and ApAP have comparable antinociceptive effects, including the complete …

Life-Space Mobility And Cognitive Function: The Reasons For Geographic And Racial Differences In Stroke (Regards) Study, Emiri Matsuda, Michael Crowe, Virginia J. Howard, Cynthia J. Brown, Madeline R. Sterling, Emily B. Levitan

School of Medicine Faculty Publications

No abstract provided.

Standardizing Clinical Ethics Consultation Documentation, Yoo Sun (Sunny) Jeong, Stephanie Kukora, Ásdís Finnsdóttir Wagner, Dawn Hood Patterson

Research Days

Background:

Clinical ethics consultations (CECs) require documentation. There is a paucity of literature and resources to guide clinical ethicists in documenting consults. High quality documentation encourages transparency between patients and clinicians, while keeping interdisciplinary team members knowledgeable about evolving care plans. However, there are discrepancies in the details captured in the CEC notes and accompanying recommendations.

Objectives/Goal:

To identify how CECs are documented in the medical record and assess whether there is consistent inclusion of relevant information.

Methods/Design:

Retrospective review of CECs conducted at a free-standing children’s hospital from January 2018- June 2023 was conducted. CECs were captured by cross-referencing …

To Bpd Or Not To Bpd: A Comparison Of The 2022 Versus 2011 Nichd Web-Based Risk Estimator For Bronchopulmonary Dysplasia, Mitch Kinkor, Jake Schneider, Farhath Sulthana, Janelle R. Noel-Macdonnell Phd, Alain Cuna

Research Days

This study compares the performance of the 2022 National Institute of Child Health and Human Development (NICHD) Bronchopulmonary Dysplasia (BPD) Outcome Estimator and its original 2011 version in identifying high-risk infants.

Institutional Pilot Changes Lead To A Reduction In Emergency Department Boarding Patients, Rohan Akhouri, Jennifer Watts, Christopher S. Kennedy, Kelly A. Sinclair, Bethany Bolt, Ashley Daly

Research Days

Background: Crowding and boarding pediatric emergency departments (ED) is an ongoing problem associated with a mismatch in resources and patient care demands. ED boarding can be defined as a patient admitted to an inpatient unit who remains in the ED. ED boarding occurs when there is limited availability of inpatient bed space – either due to patient volume or decreased staffing. ED boarding is associated with adverse events, and increased mortality. Few studies address the impact of inpatient strategies on ED boarding. The objective of our study was to evaluate hospital-based strategies within a single institution and their effect on …

Outcomes Of Toddler’S Fractures After Implementation Of Comprehensive Care Management Protocol With Controlled Ankle (Cam) Boots, Sheena J. Amin Md, Janet K. O'Rear Bsn, Julia Leamon Msn, Olivia R. Pruss Bs, Mckenna C. Noe Bs, Micah K. Sinclair Md, Caleb W. Grote Md, Phd

Research Days

A study comparing skin breakdown complications in patients being treated for toddler's fractures at a single academic medical center before and after implementation of a new management and immobilization protocol involving the use of CAM boots.

Pediatric Readiness In The Ambulatory Care Setting, Mary Haywood, Chris Kennedy, Robert D. Schremmer Md, Emily Cramer, Kevin Meilak Md

Research Days

Background: Emergent presentations are a relatively uncommon occurrence in the ambulatory care setting. However, when they do occur, they can be life threatening. Given their uncommon occurrence, many clinicians believe that emergencies do not present or do not occur in these settings. However, there can be up to 42 emergent presentations per office site per year, depending on location. Most commonly pediatric patients present with respiratory distress, but seizures, anaphylaxis, dehydration, and psychological/behavioral complaints can also present emergently to these clinics. Despite this, most offices are not prepared to handle these presentations. According to various studies, this is typically due …

Oscillometry In Term Neonates Without Respiratory Disease, Anna Nelson, Cheri Gauldin, Brooke Smith, Venkatesh Sampath, Winston Manimtim

Research Days

This feasibility study aims to determine normative values of oscillometry for neonates without respiratory disease.

Conservative Management Of Medial Femoral Condyle Osteochondritis Dissecans In The Pediatric Knee, Kennedy J. Morey, Brian Harvey, Kennison Adams, El Domingo-Johnson, Angie Vanderpool, Natalie Stork, Donna Pacicca, Brian Lee, Kevin Latz

Research Days

This study investigates the effectiveness of various non-operative treatments for osteochondritis dissecans (OCD) lesions in the medial femoral condyle (MFC) of the knee, a condition commonly affecting pediatric populations. Our project aims to evaluate outcomes such as symptom resolution, return to activity, and the potential for avoiding surgical intervention among patients undergoing different methods of conservative management. Through a retrospective analysis of patients, the study identifies trends in the effectiveness of different conservative treatment methods.

Increasing The Rate Of Infants Rooming In With Their Mothers With Low-Acuity Congenital Heart Disease, Anna Nelson, Amy Marks, Ekta Patel

Research Days

This quality improvement study aimed to increase the number of infants with low-acuity congenital heart disease that could room-in with their mothers in a high-risk delivery center.

Automate Isolation Infection-Prevention Precautions (Aid-Ip): Improving The Efficiency Of Hospital Isolation With Viral Respiratory Infections, Timothy Burchard, Michael Platt, La'sonya Buford

Research Days

The AID-IP project is a QI study working to improve the process of isolation and de-isolation regarding respiratory viruses at Children's Mercy Hospital. Specifically, we aim to improve adherence to proper isolation precautions, minimize cognitive workload regarding the maintenance of isolation for staff, and improve family satisfaction with isolation practice.

Nrp, Pals, And Their Utilization During Code Events In A Pediatric Quaternary Hospital: A 'Compressed' Analysis, Mitch Kinkor, Deepa Kumar, Allison Taber, Stephen Pfeiffer, Jessica Brunkhorst, Danielle Reed

Research Days

Both the Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP) algorithms are utilized for resuscitation during pediatric codes. The optimal time period to transition from NRP to PALS is not well studied. This study describes the utilization of chest compressions, prescribed medications, and patient outcomes during and after code events organized by the algorithm used to direct resuscitation (PALS or NRP) in a similarly aged patient population.

Identification Of Genetic Disorders Based On Phenotype And Subsequent Medical Management, Sara J. Strandlund, Jotishna Sharma, Bonnie R. Sullivan, Ashley K. Sherman, Laura A. Cross

Research Days

Many genetic disorders in the neonatal period contribute to significant morbidity and mortality. This study evaluates the indications for genetic testing based on phenotype and compares these with the diagnostic yield of symptom driven exome sequencing and chromosome microarray in the NICU. Overall, this study highlights that while there are diagnostic limitations to exome sequencing, genetic testing remains an important adjunct to clinical care.

Health Disparities In Slipped Capital Femoral Epiphysis (Scfe) Presentation, Rithika Ginjupalli, George Thomas, Rohit Siddabattula, Richard M. Schwend, Caleb Grote

Research Days

This study identifies various health disparities in SCFE presentations using neighborhood-level determinants COI and ICE in addition to sociodemographic determinants such as race and gender.