• Egr3-­/-­ Mice, a Mouse-Model of Schizophrenia, Show Decreased Levels of Htr2a mRNA in the Anterior Frontal Cortex after Sleep Deprivation Compared to WT Mice

      Elizalde-Rodriguez, Diana; The University of Arizona College of Medicine – Phoenix; Gallitano-Medel, Amelia (The University of Arizona., 2019)
      In the U.S., 1 in 25 adults experience serious mental illness each year. Despite ongoing research efforts, the pathogenesis of schizophrenia remains unknown. The aim of this study is to answer the question “Do Egr3-­/-­ mice, a mouse-­model of schizophrenia, show decreased levels of Htr2a mRNA in the prefrontal cortex (PFC) region of the brain after sleep deprivation (SD) compared to wild type (WT) mice?” Data resulting from the study will shed light on the pathogenesis of such a disabling mental disorder. Our study investigates the interaction between two of the genes linked to increased risk of schizophrenia, the early growth response (Egr) 3 gene and Htr2a, which encodes the serotonin 2a receptor (5HT2AR) in response to SD, a form of stress. We used a cohort of age-­matched pairs of C57BL/6 Egr3-­/-­ and WT male mice. Half of these underwent a SD protocol, while the other half served as a control group. Htr2a mRNA was quantified in four different brain regions via densitometry after it was visualized using in-­situ hybridization. Our findings that Egr3-­/-­ mice show statistically significant decreased expression levels of Htr2a mRNA in the PFC support our proposed biological pathway for schizophrenia risk.
    • An Analysis of Mortality, Morbidity, and Primary Care Providers in Arizona's 126 Primary Care Areas

      Wassermann, Michael; The University of Arizona College of Medicine – Phoenix; Cartsonis, Jonathan (The University of Arizona., 2019)
      The United States is currently facing a primary care provider shortage. Medical schools nationwide have increased enrollment in order offset the effects of the shortage. In order to justify the effects of increasing total quantity of future physicians, there should be a demonstrated relationship between total quantity of providers and a reduction in morbidity / mortality at a population health level. This study investigates if there is any association between the total number of primary care providers and mortality per 100,000 persons (all deaths, heart disease, all cancer, chronic lower respiratory disease, and all accidents), or morbidity per 100,000 persons (chronic diseases, congestive heart failure, hypertension, uncontrolled diabetes, and stroke)? Is there any difference in total number of primary care providers, mortality per 100,000 persons, or morbidity per 100,000 persons in rural vs urban primary care areas? Data was gathered from the Arizona Department of Health Services community profiles dashboard. 2013 morbidity / mortality data for all 126 of Arizona’s Primary Care Areas was analyzed utilizing linear regression and Wilcoxon rank sum. Linear regression demonstrated a statistically significant reduction in a number of mortality / morbidity categories as total number of primary care providers increased. Correlation data demonstrated a statistically significant relationship between number of primary care providers and increase in chronic lower respiratory diseases (p value = 0.027). Additionally, rural primary care areas showed higher incidence of congestive heart failure (p < 0.001) and chronic diseases (p = 0.02) and lower total numbers of primary care providers (p < 0.001) compared with urban primary care areas. Our findings demonstrate distinct differences between urban and rural primary care areas. There may be some association between total number of primary care providers and their potential effect on mortality/morbidity incidence. Further research needs to be completed in order to elucidate a greater understanding of these potential relationships.
    • Determination of the Correlation Between Types of Strabismus and Certain Medical Conditions

      Warrington, Nicole; The University of Arizona College of Medicine – Phoenix; Salevitz, Mark (The University of Arizona., 2019)
      There are numerous subtypes of strabismus: esotropia where one eye deviates inward compared to the other, exotropia where one eye deviates outward compared to the other, hypertropia where one eyes is higher than the other, concomitant strabismus where the degree of deviation is the same in each gaze, incomitant strabismus where the degree of deviation varies in different gazes. Adult strabismus can be caused by various conditions including vasculopathic diseases (diabetes, hypertension, and stroke), compressive CNS lesions, myasthenia gravis, sensory strabismus, thyroid ophthalmopathy, multiple sclerosis, trauma, post-surgical strabismus, recurrent childhood strabismus, longstanding adult strabismus without proven cause, syndrome related strabismus, restrictive orbital masses, and congenital fibrosis of the extraocular muscles. It is currently unknown whether any of these underlying conditions correlate with a specific type of strabismus. The purpose of this study is to determine if underlying conditions correlate with a certain misalignment (i.e. esotropia, exotropia, hypertropia, concomitant, or incomitant). If there is a statistically significant correlation between a certain misalignment and systemic disease, this could add to the algorithm that physicians use to diagnose these systemic conditions. This was a retrospective review of 692 patients >=21 years of age who presented to a pediatric ophthalmologist with adult strabismus from September 2008 to September 2015. The inclusion criteria were: (1) an age of 21 years or older, (2) a confirmed diagnosis of new-onset or recurrent childhood strabismus, (3) any severity and type of deviation, and (4) documentation of diplopia in any field of gaze. The variables that were extracted from the files were: the type of misalignment (esotropia, exotropia, hypertropia, concomitant, incomitant) and the underlying disorder (vasculopathic diseases (diabetes, hypertension, and stroke), compressive central nervous system (CNS) lesions, myasthenia gravis, sensory strabismus, thyroid ophthalmopathy, multiple sclerosis, trauma, post-surgical strabismus, recurrent childhood strabismus, longstanding adult strabismus without proven cause, syndrome related strabismus, restrictive orbital mass caused strabismus, and congenital fibrosis). Interpretation of the data consisted of determining if a correlation between type of misalignment and underlying condition exists. The average age of the population is 60.5 years with a standard deviation of 16.9, of which 49.6% were male. Results of this study indicate that multiple conditions that cause strabismus have a proclivity to negatively or positively predict a certain type of strabismus. Specifically, post-surgical patients are more likely to have hypertropia than esotropia or exotropia, sensory strabismus patients are more likely to have exotropia. Adult patients with recurrent childhood strabismus are more likely to have exotropia and concomitancy. Compressive CNS lesions, thyroid ophthalmopathy, and traumatic causes of strabismus are more likely to cause incomitant strabismus. Vasculopathic causes of strabismus do not have a tendency to cause any certain type of strabismus. These findings will assist ophthalmologists in delineating a cause of their patient’s strabismus based on which types of strabismus correlate with certain conditions.
    • Willingness to Receive HPV Vaccine from Community Pharmacists: Exploring the Perspectives of Rural Caregivers of HPV Vaccine Age Eligible Children

      Dominick, Lauren; The University of Arizona College of Medicine – Phoenix; Koskan, Alexis (The University of Arizona., 2019)
      This study explores the perspectives of caregivers of HPV vaccine age-eligible children living in rural Arizona – in terms of having their child vaccinated by a community retail pharmacist.
    • The Effect of Radiated vs Non-Irradiated Blood Transfusions on Extracellular Potassium Levels in Infants Undergoing Craniosynostosis Repair

      Dunn, Tyler; The University of Arizona College of Medicine – Phoenix; Singhal, Raj (The University of Arizona., 2019)
      Transfusion Associated Graft Versus Host Disease (TA-GVHD), a risk of blood transfusions, has a mortality rate > 90%. This results when viable donor T-lymphocytes within the transfused product proliferate and attack host tissue. The risk is reduced with irradiation of blood prior to transfusion. The downside to irradiating cellular blood products is that irradiation also affects other cellular components in the blood product causing the level of extracellular potassium to rise due to hemolysis of the red blood cells. The rapid infusion of high potassium blood products has been associated with fatal cardiac arrhythmias. This study evaluated the effect of irradiated versus non-irradiated blood transfusions on extracellular potassium levels if washing irradiated blood prior to transfusion results in less of a change in extracellular potassium.
    • Retrospective Study Comparing the Efficacy of Epidural Analgesia to Perineural Nerve Catheter Analgesia for Postoperative Pain Management in Pediatric Patients Following a Unilateral Lower Limb Surgery

      Trif, Daniel; The University of Arizona College of Medicine – Phoenix; Belthur, Mohan (The University of Arizona., 2019)
      The primary aim of this study was to determine if peripheral nerve catheterization offers a better analgesic alternative than an epidural catheter in pediatric patients who undergo a unilateral lower limb surgery. Postoperative pain management is not only important in promoting comfort to patients in pain but can also promote rehabilitation and optimal healing. Multimodal analgesia is the use of multiple modalities to treat patients’ pain; two of these methods include epidural and peripheral catheters. Epidural catheter infusions offer global analgesia from the waist to both of the lower extremities. Epidurals do pose side effect risks that include infection, urinary retention, hypotension, pruritus, nausea/vomiting, headaches, backaches, and respiratory depression. Peripheral nerve infusions can act more locally at a targeted area and deliver carefully dosed anesthetics to nerve fibers that can hinder the sensory function of nerves while preserving the motor function, allowing for earlier rehabilitation. The use of multimodal analgesia as a postoperative pain management plan can still vary greatly from clinician to clinician, so it would be of benefit to determine which subset of patients may benefit from having a catheter infusion as part of their treatment regimen and whether a peripheral infusion is superior to an epidural infusion. This was a retrospective study that looked at 65 pediatric patients, ages 5-15, that received either an epidural infusion (n = 53) or a peripheral nerve block infusion (n = 12) for a unilateral lower limb operation. Their charts were analyzed to determine pain scores, PCA usage, PRN morphine equivalents, total morphine equivalents, adverse events, length of catheter use, and length of hospital stay, amongst other things. The epidural group was used as the control for the study and the data analysis revealed that the patients that received a peripheral infusion had 43% higher (p = 0.35) pain scores, received 98% less (p = 0.001) continuous morphine equivalents in their infusions, required 31% less (p = 0.34) PRN morphine equivalents, had 68% less (p = 0.049) PCA usage rates, received 32% less (p = 0.39) total morphine equivalents, had 30% less (p = 0.45) adverse effects, and left the hospital 0.54 days earlier (p = 0.13) on average when compared to patients that received continuous epidural infusions. The data indicates that although the pains scores were higher for the peripheral infusion patients, these patients required less opioid exposure, which indicates relatively acceptable pain management for the patient and healthcare team while also allowing for the opportunity to engage in rehabilitation and avoid the global effects of epidural infusions and the associated increased profile risk. The conclusion of this study suggests that continuous peripheral infusions are a valid alternative to epidural infusions for pediatric patients that undergo a unilateral lower limb surgery and that a randomized control trial would be warranted to offer more definitive insight.
    • Systematic Review of Quality of Life for Family Members of Children with Autism Spectrum Disorder in Asia and Mindfulness Based Interventions for Children with Autism Spectrum Disorder and Their Parents: Mechanism, Evidence, and Feasibility

      Vincent, Kathleen; The University of Arizona College of Medicine – Phoenix; Melmed, Raun (The University of Arizona., 2019)
      Autism Spectrum Disorder (ASD) is a lifetime neurodevelopmental disorder with presence of symptoms early in development. About 1 in 68 children have been identified with ASD globally. Parents of children with ASD face diverse hurdles that can have a significant impact on their quality of life (QOL), and interventions may be able to improve these outcomes. A systematic review was conducted to assess the QOL for family members of children with ASD in Asia and to elucidate interventions that can impact QOL outcome measures. This study sought to synthesize QOL outcomes for parents of children with ASD across Asia by drawing from currently available primary research. It also sought to examine interventions that have been used in this population to investigate their impact on QOL outcomes in order to unveil the most efficacious interventions for impacting a given outcome. A total of 34 studies were included for review; 17 were used for quantitative analysis and 17 used for qualitative review. Parents of children with ASD in Asia were found to have lower QOL in the areas of general health, role physical, social, vitality, mental health, stress, and overall well-being than parents of typically developing (TD) children. High sense of coherence was shown to be associated with higher parental QOL and lower parental stress. Certain factors were found to be associated with higher sense of coherence including: male gender, parent age greater than 45, and child age greater than seven. Mothers were broadly found to have lower QOL than fathers. Mothers had a lower sense of coherence, lower health-related QOL, poorer overall well-being, and higher stress levels. Coping strategies that parents of children with ASD were found to use most often were religion and a focus on positive growth to create meaning. Not all interventions resulted in positive outcomes. A Mindfulness Based Intervention in Jordan positively impacted QOL outcomes. A Multidisciplinary Parent Education program in China had a significant positive impact on family functioning, while a Cognitive Behavioral Therapy (CBT) intervention for children with ASD decreased parental stress. Additionally, parents having and maintaining contact with parents in a similar situation helped improve well-being, parental stress and family functioning, following an intervention. This preliminary work investigating QOL for family members of children with ASD emphasizes the importance of discovering QOL outcome targets and pairing these with efficacious interventions that are specific to the needs of the population.
    • The Long Term Efficacy of a Behavioral Based Diabetes Prevention Program for High Risk Hispanic Youth

      Wright, Mia; The University of Arizona College of Medicine – Phoenix; Lee, Maurice (The University of Arizona., 2019)
      There is little known about the long term efficacy of diabetes prevention programs in adolescents targeting high risk youth. In this study a chart review was performed to recruit 21 adolescents from the intervention arm and 9 from the control. The HbA1c, BMI% and BP were measured and they all took a health behavior questionnaire. The results varied but the data suggest that there is not an overall decrease in diabetes risk as there was no statistically significant difference in the A1c or BMI.
    • C-Terminally Truncated Apolipoprotein A1 Glutamate Residue 243 Is a Biomarker for Oxidative Stress in Coronary Artery Disease and Chronic Kidney Disease

      Wilson, Zachary; The University of Arizona College of Medicine – Phoenix; Breberda, Christian S. (The University of Arizona., 2019)
      High density lipoprotein (HDL) oxidation is a potential biomarker for coronary artery disease (CAD) severity. Methionine sulfoxidation, tyrosine chlorination and C-terminal truncation are Apo A- I modifications that inactivate HDL and lead to pro-oxidant action. We hypothesize that C-terminal truncation of apolipoprotein A1 glutamate residue 243 (Apo A-I Des-Q243) is a byproduct of a protease, such as a matrix metalloprotease (MMP), and it is associated with the presence and severity of coronary artery disease and chronic kidney disease (CKD). We enrolled 103 patients presenting for evaluation of chest pain in this cross-sectional study at Maricopa Medical Center. Plasma and serum samples were collected, processed, and transferred to Arizona State University (ASU) Biodesign Institute for high pressure liquid chromatography-mass spectrometry (HPLC-MS). A statistical analysis was conducted with a spearman’s coefficient, two-tailed linear regression and multivariate analysis of the relative fractional abundance (RFA) of Apo A-I Des-Q243 and clinical variables. Multivariate analysis revealed significantly reduced levels of Apo A-I Des-Q243 in the presence of male gender (-1.5%, P=0.035), atrial fibrillation (-2.8%, P=0.04), and ACEi/ARB use (-2.4%, P=0.001). Additionally, a diagnosis of CKD (2.3%, P=0.037) and the presence of four (9.6%, P=0.005) or five (4.7%, P=0.045) coronary stents, regardless of vessel location, were associated with significantly increased levels of Apo A-I Des-Q243. American Indian/Alaskan race as compared to Caucasian race (Plasma -5.8%, 95% CI -9.9- -1.8%, P=0.005; Serum -4.6%, 95% CI -8.5- -0.8%, P=0.02), and the eGFR (Plasma ρ=-0.024, P=0.014, Serum ρ=-0.291, P=0.003) only reached significance in the linear regression and spearman’s correlation analysis respectively. Apo A-I Des-Q243 is elevated in patients with multiple coronary stents, and thus may be contributing to vascular inflammation and plaque formation. Furthermore, Apo A-I Des-Q243 is elevated in CKD and is directly correlated with its severity as determined by eGFR. These findings highlight the renin-aldosterone system’s (RAS) role in HDL oxidation and the anti-oxidant action of ACEi/ARBs. Apo A-I Des-Q243 appears to be an important link between CAD and CKD and is a promising biomarker that warrants further study.
    • Outcomes after massive honeybee envenomation in patients with comorbid conditions during hospital admission: a retrospective review

      Zelic, Maximilian; The University of Arizona College of Medicine – Phoenix; Ruha, Michelle (The University of Arizona., 2019)
      This study’s aim was to discover the outcomes associated with massive honeybee envenomation. Additionally, we wanted to observe what trends might be seen with regard to outcomes in patients with comorbidities and those without. Honeybees belong to the insect family of Hymenoptera, which includes wasps, yellow jackets and hornets. Hymenoptera are responsible for more deaths than any other venomous insects and pose a risk to the public due to the emergence of well-established populations of Africanized honeybees. These honeybees are prevalent in southwestern states such as Arizona. Africanized bees are more aggressive and take less to provoke stings than non-hybridized bees, and mass envenomations can cause fatal accidents. This study was a retrospective review of patient charts based on ICD-9 and ICD-10 records indicating massive honeybee envenomation and screened to include only patients meeting our inclusion criteria of ≥ 50 stings over a 10 year period at Banner – University Medical Center Phoenix. 25 total patients were included and epidemiological, clinical, and therapeutic data were obtained and compared for noticeable trends in the data with regard to demographics and comorbidities. The 25 patients ranged in age from 16 to 82 years old. Total number of stings varied from an estimated 50 stings, to over 1000. The majority of patients were estimated to have been stung by between 100 to 500 bees representing thirteen patients (52%). Four patients (16%) had a history of CAD, fourteen patients had hypertension (56%), nine patients had diabetes (36%), and one patient had asthma. In terms of outcomes, five patients (20%) required intubation for airway management, two patients were dialyzed (8%), and the average length of stay was 84.2 hours over the course of hospital admission. Our results showed that there was no obvious trend in the outcomes of patients with and without CAD, asthma, hypertension, and diabetes. Significant trends were primarily seen in the total number of stings sustained. In patients with a greater number of stings, the total length of stay increased dramatically. Number of stings also seemed to indicate a greater risk of requiring intubation as well. Finally, creatine kinase levels were also significantly elevated in patients with a higher sting count, supporting prior work done regarding the effect of mass envenomations with resulting rhabdomyolysis. This research supports that fact that ultimately the biggest determinant of a patient’s clinical course is the number of stings that they present with. It seems safe to assume that a mass envenomation on the scale of hundreds to thousands of stings will greatly increase the chance that this particular patient is going to have significant rhabdomyolysis, be at greater risk of requiring advanced airway measures such as intubation, and be admitted to the hospital for a longer period. Future work would be enhanced by implementing a multicenter review to increase the power of the study to allow for statistical comparisons to be made, creating an opportunity to delineate potential differences in outcomes based on comorbid conditions.
    • Does Animal Assisted Therapy (AAT) have an effect on mood in United States Veterans?

      Baumann, Alysa; The University of Arizona College of Medicine – Phoenix; Nelson, Erin (The University of Arizona., 2019)
      Research has shown benefit for United States veterans with service dogs and emotional support animals. However, the literature is lacking in research on the beneficial effects and impact of therapy animals specifically on the disabled veteran population. This pilot study explored the effects of a single therapy dog on various aspects of mood, including depression and anxiety, in disabled veterans by incorporating five weeks of thirty-minute therapy sessions to a group of eight veterans. Although this was a small sample population, we concluded that five weeks of consecutive animal assisted therapy resulted in a general decrease in anxiety and depression, and an overall positive increase in mood as evidenced by Beck Anxiety Inventory, Beck Depression Inventory, and Trauma Symptom Inventory scores. Further large-scale studies will need to be conducted with a greater number of participants to help support the data in this study.
    • Effect of Donor Demographics on Transfusion Recipient Outcomes

      Asprer, Jeanine Elaine; The University of Arizona College of Medicine – Phoenix; Lifshitz, Jonathan (The University of Arizona., 2019)
      Over 21M units of blood are transfused every year, making blood transfusion one of the most common medical interventions in the US. It can be lifesaving, but like many medical interventions, it is not without risks. Thus, most of transfusion research has focused on making the process safer and more accessible. Recent developments in stem cell science – where the transfusion of young blood was shown to reverse stem cell aging and improve physiological function in older mice and conversely, the transfusion of old blood was shown to accelerate stem cell aging and worsen physiological function in younger mice – raise important questions regarding the content of blood being transfused and its associated risks and/or benefits. The purpose of this study is to determine if donor demographics such as age and sex affect patient outcomes. Our hypothesis is that patients receiving blood from younger donors of the same sex have better over-all survival and shorter hospital and ICU stays.
    • Pediatric RSV Patients: Radiographic Findings on Admission and Clinical Outcomes

      Shoshan, Dor; The University of Arizona College of Medicine – Phoenix; Connell, Mary (The University of Arizona., 2019)
      Respiratory Syncytial Virus (RSV) is a common cause of respiratory tract infection in children. This retrospective review attempts to evaluate the association of admission chest radiographs with severity of clinical outcome. Radiographic findings were correlated with ‘severe’ and ’non-severe’ clinical outcomes, whereby a severe outcome was defined as hospitalization > 2 days, PICU admission, or mechanical ventilation during hospitalization. A non-severe outcome was defined as absence of the previous criteria. The most common abnormal chest radiograph findings were: interstitial prominence (n=182 [61.5%]), airspace opacity (n=106 [35.8%]), and hyperinflation (n=78 [26.3%]). The radiographic findings found to be associated with a severe clinical outcome were hyperinflation (p=0.033) and airspace opacity (p<0.001). Clinicians should consider more aggressive treatment and closer monitoring when these findings are present on admission chest radiography.
    • Comparing the Effects of Narrative Nonfiction and Literary Fiction on Empathy Retention in Medical Students

      Shi, Aishan; The University of Arizona College of Medicine – Phoenix; Hartmark-Hill, Jennifer (The University of Arizona., 2019)
      Integration of medical humanities into medical student curricula has been shown to improve medical student empathy and resilience. The purpose of this study is to determine if narrative nonfiction pieces help students retain equal or more empathy skills compared to reading literary fiction. Previous studies show that interventions that utilize medical humanities can vary in medium and genre, and face the challenge of small sample size and confirmation bias due to a lack of randomized trials. In contrast, this study compares the reading of Narrative Nonfiction and Literary Fiction in building empathy in second year medical students randomized to each genre. Participants were asked to read selections from their assigned genre during the intervention period. Baseline, pre-intervention, and post-intervention assessments were measured by the Reading the Mind in the Eyes –Revised. Results demonstrated a statistically significant decrease in empathy across the overall study period, and there was no empathy retention difference between genres. Additionally, female gender identity and increased engagement in the arts and humanities prior to medical school were correlated with higher empathy scores across time. These findings indicate the need for longitudinal and personalised learning in medical humanities for more thorough studies and maximised benefits on empathy retention.
    • Does triptolide alter c-Myc expression through regulation of its associated transcriptional factors and coactivators?

      Cao, Thanh; The University of Arizona College of Medicine – Phoenix; Han, Haiyong (The University of Arizona., 2019)
      In this study we investigated whether triptolide regulates c-Myc expression by inhibiting FBP1 protein expression at the transcription and/or protein level. We performed an RNA sequence to determine global regulation of transcriptome in response to triptolide treatment. In addition, we determined the effects of triptolide on c-Myc, FBP1 and FIR protein expression. We found that 100nM of triptolide inhibited gene expression of c-Myc, FBP1, FIR and XBP. This finding is consistent with a decrease in protein expression of c-Myc and FIR. These finding suggest that triptolide may inhibit FBP1 ability to bind with XBP.
    • Comparison of Occipito-atlanto-axial Parameters on Computed Tomography in Pediatric Trauma Patients

      Calhoun, Matthew; The University of Arizona College of Medicine – Phoenix; Connell, Mary (The University of Arizona., 2019)
      Spinal cord injury without radiographic abnormality is a prevalent issue within the pediatric population. Children under the age of 10 are prone to sustaining injury at C1 to C4 because their biomechanical fulcrum exists between C2 and C3. The incidence of spinal cord injury in pediatric population has been estimated to be 4.6 per million per year or 1-2 % of all pediatric trauma cases. There may be subtle findings on computed tomography (CT) that may be able to identify occult cervical spine injury in pediatric trauma patients, which would be evident on magnetic resonance imaging (MRI). This study aims to measure various dimensions of the atlantoaxial and atlantooccipital joints in the pediatric cervical spine in patients with normal spines to detect subtle irregularities on CT scans to warrant further work up with an MRI in trauma patients. Additionally, having an accurate diagnosis will help guide the appropriate type and duration of treatment, which can range from conservative treatment with immobilization to surgery.
    • Hepatitis C Virus Knowledge, Attitudes, and Practices among Arizona Providers

      Appleton, Leslie; The University of Arizona College of Medicine – Phoenix; Villarroel, Lisa (The University of Arizona., 2019)
      Hepatitis C virus (HCV) is the most common chronic blood borne infection in the U.S. and it is estimated that there are 80,000 Arizonans infected with HCV (ADHS). HCV is the leading cause of liver cancer and transplants (Ly et al., 2012). Research shows vast variation in the availability and uptake of HCV testing, screening, and treatment (Jones et. al, 2013), in part because HCV literacy is low among healthcare professionals (Bruggman, Grebely, 2014). A Knowledge, Attitudes, and Practices (KAP) survey elicits quantitative and qualitative information that can reveal misunderstandings or misconceptions regarding a certain topic (USAID, 2011). Through this, we aimed to better understand the extent to which Arizona providers serve as a barrier to care for HCV patients.
    • Readability of After Visit Summaries: Comparing the Level of Information in After Visit Summaries from Internal Medicine and Family Medicine Residencies

      Amundsen, Tyson; The University of Arizona College of Medicine – Phoenix; Coles, Sarah (The University of Arizona., 2019)
      Written advice can improve compliance with medical instructions. The Centers for Medicaid and Medicare Services expect physicians to provide a summarized report following at least most patient encounters. We analyzed 400 after visit summaries (AVS) provided to patients at Internal Medicine and Family Medicine residency clinics. The Flesch-Kincaid Grade Level Test and the Flesch Reading Ease Score were used to evaluate readability. We demonstrated that AVS are usually written at a level that is too high to be helpful to patients. We conclude that patient visit summaries are not written to the appropriate recommended grade levels of <-8th grade for the average patient population. Further studies are needed to show if appropriate grade level summaries will improve quality of care.
    • Deep Interarytenoid Notch in Young Children Managed with Systematic Thickener Wean and Injection Laryngoplasty

      Basharat, Usmaan; The University of Arizona College of Medicine – Phoenix; Williams, Dana (The University of Arizona., 2019)
      A deep interarytenoid notch (DIN) is a normal congenital variation of the larynx where the interarytenoid notch height is below average. It is frequently found in young children and often associated with dysphagia and aspiration. The Aerodigestive Clinic (ADC) at PCH reported that 30% of young patients presenting with dysphagia and aspiration in 2013 were diagnosed with DIN. There exists both functional management with thickeners2 and surgical management with injection laryngoplasty (IL) 3-5. Thickener Wean Protocol (TWP) is a PCH developed 6 month protocol where thickening agents are systematically reduced on a weekly basis while clinical signs of aspiration, respiratory health, and oral motor skills are monitored to ensure safety with the least restrictive diet. An initial modified barium swallow (MBS) score is used in equivalence of thickener level, and patients do not repeat MBS during TWP. A gel (IL) is injected into the interarytenoid notch to close the anatomical gap. Our objective was to evaluate DIN patients who were managed with both thickeners and IL.
    • Tumor Infiltrating Lymphocytes as a Predictive Biomarker for Response to CTLA-4 and PDL-1 Therapies

      Mousa, Abeer; The University of Arizona College of Medicine – Phoenix; Chang, John (The University of Arizona., 2019)
      Recently approved immunotherapies capitalize on antitumor mechanisms of the patient’s immune system by inhibiting CTLA-4 and PD-1 pathways. Studies have shown better overall survival with increased tumor infiltrating lymphocyte (TIL) across multiple cancer. Recent trials with anti-PDL-1 has shown better response with high PDL-1 expression. However, studies have not evaluated whether TIL level would correlate with anti-PDL-1 or anti-CTLA-4 responses. The aim of this study is to determine if the level of TIL in metastatic melanoma and lung cancer correlates with patient response to modern immunotherapies. We identified 10 patients with melanoma or lung cancer treated with an immune checkpoint inhibitor. The biopsy samples were stratified according to level of TIL. The TIL categories ranged from 0 to 3, with 0 indicating no TIL detected and 3 indicating 67-100% TIL infiltration. Survival analysis was achieved with Kaplan-Meier curve, and tumor size change was evaluated with linear mixed model analysis. Overall survival was significantly longer in patients who had TIL (TIL0-0.3 yr; TIL1-2-2.4 yr; TIL3-1.6 yr, p=0.024). Tumor size also dramatically decreased at first follow up based on TIL level (TIL 1-2: 371% greater decrease than TIL 0, p < 0.01; TIL 3: 406%; p<0.01). Decrease in tumor size for TIL0 was 0.12cm2 at first follow-up. Baseline tumor size for TIL0 was 41.9cm2; TIL1-2 0.4 cm2; TIL3 1.4cm2. Our study shows that TIL level may serve as a biomarker to predict tumor response to immunotherapy, without specific histochemical staining. This study is limited by the low number; a larger review is currently taking place.