Medical Specialties Commons^™

Patient And Provider-Level Factors That Underlie Alcohol Use Disorder Treatment Offer And Acceptance In Veterans With Cirrhosis, Nikki Duong

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: Untreated alcohol use disorder (AUD) is associated with poor cirrhosis outcomes. We evaluated factors associated with AUD treatment discussions and initiation in the Veterans Health Administration.

Methods: Chart reviews were conducted for veterans with International Classification of Diseases codes for both cirrhosis and AUD who were receiving care at one of three large medical centers in 2020. Factors associated with a 1-year offer of AUD treatment and its acceptance were assessed using regression models, which included as covariates demographic characteristics, comorbidities, and depression, as measured by the patient health questionnaire (PHQ-2) from the electronic health record.

Results: The cohort …

Characterizing Abdominal Pain In Patients With Gastroparesis, Dylan Vainer, Henry Parkman, Dariush Shahsavari

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

TITLE: CHARACTERIZING ABDOMINAL PAIN IN PATIENTS WITH GASTROPARESIS

AUTHORS (LAST NAME, FIRST NAME): Vainer, Dylan¹; Shahsavari, Dariush²; Parkman, Henry P.²

INSTITUTIONS (ALL): 1. Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States. 2. Temple University Health System Inc, Philadelphia, PA, United States.

ABSTRACT BODY: Introduction: Patients with gastroparesis (Gp) typically present with nausea, vomiting, and early satiety. Abdominal pain can be present in Gp. The cause of abdominal pain in patients with Gp is often unknown. In patients whose predominant symptom is abdominal pain, other causes of abdominal pain …

Firearm Curriculum For Pediatric Residents Improves Safe Storage Counseling, Hannah Hollon Md, Darina Dinov Do, Benjamin Sandifer Md, Scott Risney Md, Heemali Kamdar Do, Christopher Ferrante Do, Leroy Thacker Phd, Michael S. Ryan Md, Mehp, Elizabeth Wolf Md, Mph

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Objectives

Firearms are the leading cause of death among children and adolescents. Despite evidence to support physician training in firearm safety counseling, formal curricula are limited in pediatric residency programs. We sought to develop and implement a resident-led, feasible, sustainable, and impactful firearm safety curriculum for pediatric residents.

Methods

A firearm safety curriculum was developed by pediatric residents using Kern’s curriculum development framework and delivered to their peers at a single academic center from 2019 - 2020. The three-part series included workshops on basic firearm safety counseling principles, case-based practice, and advocacy training and a gun lock program in collaboration …

Repeated Exposure To Chlorpyrifos Is Associated With A Dose-Dependent Chronic Neurobehavioral Deficit In Adult Rats, Ana C. R. Ribeiro, Elisa Hawkins, Fay M. Jahr, Joseph L. Mcclay, Laxmikant Deshpande

Neurology Publications

Organophosphate (OP) chemicals include commonly used pesticides and chemical warfare agents, and mechanistically they are potent inhibitors of the cholinesterase (ChE) enzyme. Epidemiological studies report long-term neuropsychiatric issues, including depression and cognitive impairments in OP-exposed individuals. Chlorpyrifos (CPF) is one of the most widely used pesticides worldwide. Multiple laboratory studies have reported on either the long-term behavioral effect of an acute high-dose CPF (30-250 mg/kg) or studied sub-chronic behavioral effects, particularly the motor and cognitive effects of repeated low-dose CPF. However, studies are lacking on chronic mood and depression-related morbidities following repeated CPF doses that would mimic occupationally relevant OP …

Influence Of Extracellular Volume Fraction On Peak Exercise Oxygen Pulse Following Thoracic Radiotherapy, Justin M. Canada, Elisabeth Weiss, John D. Grizzard, Cory R. Trankle, Leila Rezai Gharai, Franklin Dana, Leo F. Buckley, Salvatore Carbone, Dinesh Kadariya, Anthony Ricco, Jennifer H. Jordan, Ronald K. Evans, Ryan S. Garten, Benjamin W. Van Tassell, W. Gregory Hundley, Antonio Abbate

Internal Medicine Publications

Background

Radiation-induced myocardial fibrosis increases heart failure (HF) risk and is associated with a restrictive cardiomyopathy phenotype. The myocardial extracellular volume fraction (ECVF) using contrast-enhanced cardiac magnetic resonance (CMR) quantifies the extent of fibrosis which, in severe cases, results in a noncompliant left ventricle (LV) with an inability to augment exercise stroke volume (SV). The peak exercise oxygen pulse (O2Pulse), a noninvasive surrogate for exercise SV, may provide mechanistic insight into cardiac reserve. The relationship between LV ECVF and O2Pulse following thoracic radiotherapy has not been explored.

Methods

Patients who underwent thoracic radiotherapy for chest malignancies with significant incidental heart …

Modified Ysk12-Mend-Sirna In Dendritic Cells For Cancer Immunotherapy, Syed S. Alam

UROP Posters

Tumors may induce tolerogenesis through signaling dendritic cells to produce tolerogenic molecules, such as indoleamine 2, 3-dioxygenase 1 (IDO1). Tumor-associated immunosuppression is associated with higher mortality in patients. Small interfering RNA (siRNA) has been shown to silence specific target genes in the target cell. The siRNA associated with these genes could support a gene knockdown of these immunosuppressors and reduce mortality. Delivery of these therapeutic nucleic acids is difficult in vivo because siRNA is easily broken down inside the cell and the bloodstream through present nucleases. Use of liposome polymers has been reviewed extensively in literature. YSK12-C4, a lipid nanoparticle …

Loss Of Smad4 Is Associated With Poor Tumor Immunogenicity And Reduced Pd-L1 Expression In Pancreatic Cancer, Daniel R. Principe, Patrick W. Underwood, Sandeep Kumar, Kaytlin E. Timbers, Regina M. Koch, Jose G. Trevino, Hidayatullah G. Munshi, Ajay Rana

Surgery Publications

Transforming Growth Factor β (TGFβ) is a key mediator of immune evasion in pancreatic ductal adenocarcinoma (PDAC), and the addition of TGFβ inhibitors in select immunotherapy regimens shows early promise. Though the TGFβ target SMAD4 is deleted in approximately 55% of PDAC tumors, the effects of SMAD4 loss on tumor immunity have yet to be fully explored. Using a combination of genomic databases and PDAC specimens, we found that tumors with loss of SMAD4 have a comparatively poor T-cell infiltrate. SMAD4 loss was also associated with a reduction in several chemokines with known roles in T-cell recruitment, which was recapitulated …

Theta Burst Brain Stimulation In Painful Diabetic Neuropathy Patients: Investigating Neural Mechanisms, Bhushan Thakkar

Theses and Dissertations

Chronic pain (CP) is a significant contributor to disability and disease burden globally. In 2019, approximately 50.2 million adults (20.4% of the US population) experienced chronic pain, contributing to $560-635 billion in direct medical costs. In addition, the worldwide prevalence of diabetes mellitus has reached epidemic proportions and is set to increase to 629 million by 2045. Almost 50% of patients with diabetes present with diabetic neuropathy (DN), and one in five patients with diabetes presents with painful DN (pDN) which is the most common cause of neuropathic pain (NP) in the US. Symptomatic treatment is the mainstay of management …

Multi-Modality Automatic Lung Tumor Segmentation Method Using Deep Learning And Radiomics, Siqiu Wang

Theses and Dissertations

Delineation of the tumor volume is the initial and fundamental step in the radiotherapy planning process. The current clinical practice of manual delineation is time-consuming and suffers from observer variability. This work seeks to develop an effective automatic framework to produce clinically usable lung tumor segmentations. First, to facilitate the development and validation of our methodology, an expansive database of planning CTs, diagnostic PETs, and manual tumor segmentations was curated, and an image registration and preprocessing pipeline was established. Then a deep learning neural network was constructed and optimized to utilize dual-modality PET and CT images for lung tumor segmentation. …

Exosomal Mirnas As Biomarkers For Radiation Toxicity In Breast Cancer Patients, Mina V. Mcginn

Theses and Dissertations

Radiotherapy (RT) is a standard treatment for most breast cancer patients (BCPs), but is often accompanied by acute and late toxic effects in normal tissue. Exosomes are nano vesicles about 30-150nm in size that originate from the endosomal network and are found in most body fluids. Exosomes are a fundamental driver of intercellular communication by transferring proteins, lipids and microRNA (miRNA). Exosomal miRNA (Exo-miRNA) signatures may serve as non-invasive prediction biomarkers of post-radiation toxicities of BCPs. Eighty six BCPs treated in the Radiation Oncology Department were enrolled in an IRB approved study. BCPs were evaluated weekly during RT and at …

Tummy Time In Infancy: Real-World Assessments And Associations With Developmental Outcomes In Early Childhood, Ketaki Inamdar

Theses and Dissertations

Tummy time or awake, supervised, prone play is an important developmental play position in infancy. Engaging in more than 15 minutes of tummy time per day is associated with a lower risk of plagiocephaly, lower body mass index, and achievement of higher motor scores in full-term and at-risk preterm infants. However, there are significant gaps in the measurement of tummy time in current literature. Conventionally used subjective parent reports have not been validated against gold standard direct observation, and the feasibility and real-world validity of objective solutions such as wearable sensors has not been examined in full-term and at-risk preterm …

Targeting Bcl-2 Family Proteins In Therapy Induced Senescent Cancer Cell Models, Wade Cook

Theses and Dissertations

Non-small Cell Lung Cancer (NSCLC) originates from numerous different cell types in the lungs and is among the deadliest of cancers. Head and Neck Squamous Cell Carcinomas (HNSCC) are derived from the mucosal membranes of the oral cavity, pharynx, and larynx. Both NSCLC and HNSCC are predominately caused by tobacco smoke inhalation and as such mutations in the tumor suppressor gene TP53 are common. Since similarities exist in the root cause of NSCLC and HNSCC, they may also share similarities in treatment methods. Cisplatin is a platinum-based DNA damaging agent that has been used as a cancer chemotherapy for decades. …

A Method For Predicting Dose Changes For Hn Treatment Using Surface Imaging, Sarah E. Holler

Theses and Dissertations

Head and neck cancer is commonly treated with a six- to seven-week course of radiotherapy, during which a patient’s anatomy may change substantially, due to target reduction or weight loss. Anatomical changes lead to reduction in treatment quality due to decreased setup reproducibility and altered dose deposition compared to the original plan. Few clinics have developed a standard method for triggering resimulation and replan due to anatomic changes. This work investigates a new method for determining when to resimulate and replan HNC patients by utilizing their topographic anatomical changes to predict differences in planned versus delivered dose distributions. The first …

Changes In Physical Activity And Relationships To Submaximal Exercise Capacity And Cardiac Function During Breast Cancer Therapy, Moriah P. Bellissimo

Theses and Dissertations

Background: Breast cancer (BC) survivors are at high risk for heart failure due to curative cancer therapies. In non-cancer populations, physical activity is a first line treatment for preventing cardiovascular disease. This study examined whether more physical activity was associated with better submaximal exercise capacity and cardiac function during the first three months of cancer therapy.

Methods: Participants included 223 women with stage I-III BC before therapy and after three months of undergoing treatment and 126 controls. Leisure time physical activity was reported using the Godin Sheppard leisure time exercise questionnaire. Cardiac function was assessed by cardiac magnetic resonance, and …

Modeling Of Patient-Specific Periaortic Mechanics And Pulmonary Artery Hemodynamics Based On Phase-Contrast Magnetic Resonance Imaging Sequences., Johane H. Bracamonte

Theses and Dissertations

Inverse modeling in cardiovascular medicine is a collection of methodologies that can provide non-invasive patient-specific estimations of clinical risk factors using medical imaging as inputs. Its incorporation into clinical practice has the potential to improve diagnosis and treatment planning with low associated risks and costs.

Herein, three different phase contrast magnetic resonance imaging (MRI) modalities were implemented as input data, displacement encoding with stimulated echoes (DENSE MRI) applied, and time-resolved velocity encoding phase-contrast MRI, in 1D and 3D, applied to pulmonary artery (PA) hemodynamics.

A model to account for the effect of periaortic interactions due to static and dynamic structures …

Determining Effective Treatment Regimens For Breast Cancer Using Combined Immunotherapy And Chemotherapy In Vivo, Akhila R. Kunuthuru, Laura Graham, Harry D. Bear Md, Phd

UROP Posters

Breast cancer has the highest incidence rate of all cancers globally in women, and those of African descent, especially West African females, face higher rates of triple-negative breast cancer (TNBC), a more aggressive form of breast cancer. Immunotherapy for breast cancer is a relatively new treatment option, and research is ongoing to identify the best combination treatments for increasing survival of those diagnosed with TNBC. Eganelisib (IPI-549: a PI3K-gamma inhibitor that works to shift M2 macrophages to M1 to augment T cell function) with other combinatory treatments has shown promising results in reducing tumor growth and increasing survival in mice. …

Dermatologic Manifestations Of Rheumatic Disease: Connective Tissue Disease, Mavra Masood, Beth Rubinstein, Julia Nunley, Fnu Nutan, Yasmin John, Haseeb Mahmud

Open Textbooks and Course Materials

This OER is a part of the Dermatologic Manifestations of Rheumatic Disease project, which provides overviews of the identification, diagnosis, and workup for different rheumatologic diseases, with a focus on providing examples from persons of color (POC). This work seeks to fill gaps and exclusionary practices in medical education practices and resources and diagnostic frameworks in regards to skin of color. This lack of representation bodes significant repercussions on the ability of future physicians to deliver equitable care for an increasingly diverse US population. Each module consists of a similar Powerpoint format, which includes key objectives, hypothetical disease cases, an …

On Wisdom, Gerontology, And Personal Aging: Through A Looking Glass, Edward F. Ansello

Director's Editorials from Age in Action

Personal discussion on the perspective of aging and teaching more interiority and self-reflection in the field of gerontology.

Leading From The Middle, Edward F. Ansello

Director's Editorials from Age in Action

A reminiscent farewell to colleagues and the Virginia Center on Aging (VCoA) as Edward F. Ansello, Ph.D., retires as Director of VCoA.

Actively Engaging With Virginia Center On Aging’S Retired Community, Leland "Bert" Waters

Director's Editorials from Age in Action

VCU is the receiver of an Age-Friendly University (AFU) Global Network designation in June 2021. The Virginia Geriatric Education Center (VGEC) maintains a diverse team, including those who make "mid/late-career" changes into the Gerontology field. Bert Waters gives examples and history on some who make up this diverse team.

Metabolic Syndrome And How To Fight It, Edward F. Ansello

Director's Editorials from Age in Action

The health condition Metabolic Syndrome is becoming increasingly prevalent. To combat this, dietary improvements and incorporating movement into our daily routines are the basics suggested.

Strengthening Capacities To Respond To Dementia With Lifelong Disabilities: Using The Project Echo Model, Edward F. Ansello

Case Studies from Age in Action

Educational Objectives

1. To discuss the need for interprofessional training about aging with lifelong disabilities and dementia.

2. To demonstrate the continuing heterogeneity among adults growing older with these conditions.

3. To report the relevance of the Project ECHO model as a means of collaborative training and practice improvement.

Lucy Corr Dental Clinic: Addressing Dental Needs Of Uninsured Older Adults, Patricia B. Bonwell

Case Studies from Age in Action

Educational Objectives

1. Discuss the critical importance of oral health and the oral-systemic relationship in older adults.

2. Describe how dental insurance determines receipt of dental treatment in older adults.

3. Share how the Lucy Corr Dental Clinic (LCDC) increases access to dental care for uninsured older adults.

4. Describe valuable collaborations with community foundations, the Virginia Dental Association, and Virginia Commonwealth University that enable the success of the LCDC.

The Vcu Nursing Home Echo, A Member Of The National Covid-19 Action Network, Bert Water, Kimberly Ivey, Annie Rhodes, Christian Bergman, Daniel Bluestein, Jenni Mathews, Laura Finch, Shannon Arnette, Joanne Coleman, Maddie Mcintyre, Tara Rouse

Case Studies from Age in Action

Educational Objectives

1. To demonstrate the tremendous impact of COVID-19 on long-term care facilities.

2. To discuss the need for continuous, current, interprofessional education of both administrative and clinical staff within long-term care facilities.

3. To discuss the value of building interconnective and interprofessional relationships between both academic health science centers and nursing homes.

Improving Guardianship Practices Through Collaborative Stakeholder Action, Erica Wood, Shasta Douglass

Case Studies from Age in Action

Educational Objectives

1. Describe the purpose of adult guardianship and its effect on fundamental rights.

2. Explain the need for guardianship reform, the obstacles to reform, and what issues need attention in Virginia.

3. Discuss the purpose of state Working Interdisciplinary Networks of Guardianship Stakeholders (WINGS) and the creation and accomplishments of Virginia WINGS.

4. Review cases in which a WINGS pilot project supported the needs and rights of adults with guardians.

Post-Traumatic Hallux Valgus: A Modified Surgical Technique, Zylyftar Gorica, Kimberly Mcfarland, John S. Lewis Jr, Karl M. Schweitzer Jr, Alexander R. Vap

Orthopaedic Surgery Publications

Post-traumatic hallux valgus, a turf toe variant, is a rare, yet limiting injury. According to the literature, the deformity has been associated with acute medial collateral ligament tears, turf toe variant injuries, Lisfranc injury patterns, and first metatarsal fractures. There have been few documented cases of post-traumatic hallux valgus secondary to medial collateral ligament tears, and the treatment has been variable. Some authors have described direct end-to-end repair of the ligament to address the deformity, while others have described a modified McBride bunionectomy involving a Silver bunionectomy, lateral soft tissue release, and medial capsular and ligamentous repair. We propose a …

Epigenetic Histone Acetylation And Bdnf Dysregulation In The Hippocampus Of Rats Exposed To Repeated, Low-Dose Diisopropylfluorophosphate, Laxmikant Deshpande

Neurology Publications

Aims: Deployment-related exposures to organophosphate (OP) compounds are implicated for Gulf War Illness (GWI) development in First GW veterans. However, reasons for the persistence of GWI are not fully understood. Epigenetic modifications to chromatin are regulatory mechanisms that can adaptively or maladaptively respond to external stimuli. These include DNA methylation and histone acetylation. DNA methylation changes have been reported in GWI but the role of histone acetylation in GWI has been less explored, despite its importance as an epigenetic mechanism for neurological disorders.

Main methods: Male Sprague-Dawley rats were exposed to OP diisopropyl fluorophosphate (DFP, 0.5 mg/kg s.c., 5-d) and …

Modeling Longitudinal Change In Cervical Length Across Pregnancy, Hope M. Wolf, Shawn J. Latendresse, Jerome F. Strauss Iii, Timothy P. York

Graduate Research Posters

Introduction: A short cervix (cervical length < 25 mm) in the mid-trimester (18 to 24 weeks) of pregnancy is a powerful predictor of spontaneous preterm delivery (gestational age at delivery < 37 weeks). Although the biological mechanisms of cervical remodeling have been the subject of extensive investigation, very little is known about the rate of change in cervical length over the course of a pregnancy, or the extent to which rapid cervical shortening increases maternal risk for spontaneous preterm delivery.

Methods: A cohort of 5,160 unique women carrying 5,971 singleton pregnancies provided two or more measurements of cervical length during pregnancy. Cervical length was measured in millimeters using a transvaginal 12-3 MHz ultrasound endocavity probe (SuperSonic Imagine). Maternal characteristics, including relevant medical history and birth outcome data, were collected for each participant. Gestational age at delivery was measured from the first day of each woman’s last menstrual period and confirmed by ultrasound. Repeated measurements of cervical length during pregnancy were modeled as a longitudinal, multilevel growth curve in MPlus. A three-level variance structure was …

Evaluating Racial And Ethnic Disparities In Access To Primary Care Among Gay And Bisexual Men In The Us, A Population At High-Risk Of Hiv Infection, Jessica S. Kiernan, April D. Kimmel

Graduate Research Posters

BACKGROUND: 69% of new HIV diagnoses in the US are among gay and bisexual men, with disparities by race and ethnicity. Primary care providers increasingly provide HIV prevention. Racial and ethnic disparities in primary care access are well-documented, but their persistence among gay and bisexual men is unknown. We examined racial and ethnic disparities in access to primary care among this population.

METHODS: We used nationally representative person-level sociodemographic, health status and utilization data, and data on organizational- and socially determinant barriers to care, from the National Health Interview Survey, 2013-2018. Outcomes were: 1) general physician visit

RESULTS: The sample …

Device-Related Adverse Events From Watchman Flx Implants As Reported By The Food And Drug Administration, Dongjin Suh Bs, Paul Eugene Kim Bs, Emmanuel Magsino Bs, Tae Shik Park

Graduate Research Posters

No abstract provided.