Missouri School Research Articles

Creating and establishing a sustainable culture of clinical and translational research at an academic cancer center.

e23220 Background / Objectives: At the Ellis Fischel Cancer Center (EFCC) at the Univ. of Missouri (MU) School of Medicine (SOM), our recent (2016 - 2020) accurals to interventional oncology clinical trials (CT) have been suboptimal. Hence, the EFCC research leadership undertook a number of initiatives since 2021 to improve the function and productivity of the oncology CT enterprise. The objective of our retrospective review was to determine the impact of our initiatives including improving enrollments to clinical trials. Methods: These major programmatic initiatives have included the following: (1) CT portfolio analysis; (2) faculty survey to assess concerns/ needs related to enrollment; (3) Development of a "One-Pager" list of open CT; (4) Working with faculty leader "champions"; (5) Increasing the number of clinical research staff; (6) Initiation of a monthly "Clinical Trials Working Group (CTWG)" to monitor enrollment to clinical trials, troubleshooting obstacles to accruals and on-going CT portfolio analysis and adjustments; (7) Development of multi-disciplinary "Disease Working Groups" (DWGs) in Breast, GU, GYN-Onc., Lung, GI and CNS cancers to establish a Protocol Review & Monitoring System (PRMS) with the objective of aligning our clinical trials with our patient population; (9) Initiation of a monthly “Investigator Education Workshop” (IEW) to educate our faculty on the conduct of investigator initiated CT and pharma sponsored CT; (10) Initiation of a "Top Enrolling Ceremony" to honor the top enrollers to clinical trials. Results: The analysis of our CT portfolio revealed that in both December 2020 and May 2021, more than half [i.e., 52% (n = 17/33 and n = 13/25, respectively] of our CT had never enrolled a patient in the lifetime of the protocol. Since the implementation of the PRMS in late 2021, we have observed a continual decrease in the status of those clinical trials with “never” any enrollments from a historical average of 52% to 34% in January 2022, to 32% in January 2023 and to 28% in October 2023, p = 0.0173. In addition, implementation of the PRMS also had an immediate significant impact such that only 53% of all of the protocols reviewed by the Protocol Review and Monitoring Committee were approved in 2021 vs. a historical average of 75% from 2018 - 2020. Moreover, between 2021 and 2023, an average total of 82 patients were enrolled to interventional oncology clinical trials vs. the historical average of 42 patients per year from 2016- 2020, representing an overall increase of 95% p = 0.0004. Conclusions: The development and establishment of the PRMS within the last 3 years has had a very positive impact on our clinical trial enterprise at the EFCC by reducing active clinical trials that are not suitable for our patient population and significantly increasing our enrollment to interventional oncology clinical trials. For 2024, we will continue our implementation of the PRMS at the EFCC.

Period Product Resources and Needs in Missouri Schools: Focus Group Discussions with School Nurses.

This study explored period product resources and needs in Missouri schools from the perspective of school nurses. We conducted eight focus groups with school nurses (n = 51) across Missouri using purposive sampling. Focus group data were analyzed in Dedoose via multiple coders and achieved strong inter-rater reliability (Cohen's Kappa = 0.92). Several interconnected themes with associated sub-themes were identified. First, school nurses do not have sufficient resources to help students manage menstruation and minimize menstruation-related absenteeism. Second, schools' heavy reliance on donations can lead to inconsistencies in supply and a mismatch between what is donated and what is most needed. Third, school nurses desire additional educational resources around menstruation management for students and caregivers. Nurse-identified themes can help inform recommendations for improving schools' response to students' menstrual hygiene needs by highlighting priorities for educational content, resources, and product acquisition with a goal of ensuring the suitability and sustainability of MHM in schools.

2653. Duration of Respiratory Virus Detection by Multipathogen PCR Testing after Acute Respiratory Illness

Abstract Background Persons with respiratory viral infections (RVI) may shed detectable virus after symptom recovery. Duration of detection by molecular methods is not well described for non-SARS-CoV-2 respiratory viruses. Methods School KIDS is a prospective respiratory viral surveillance program in a Missouri school district. Participating students and staff with RVI symptoms can receive respiratory viral testing using self-collected nasal swabs. Symptomatic participants with detectable virus(es) on primary swabs were scheduled to receive 2 convalescent swabs weekly after initial test during weekly school surveillance testing. All convalescent tests performed within 21 days of the primary specimen were included. Only participants providing ≥ 1 convalescent swab were included. Specimens were tested using Hologic® Panther Fusion® or QIAstat-Dx PCR assays that included adenovirus (AdV); seasonal coronaviruses (sCoV) 229E, HKU1, NL63, OC43; human metapneumovirus, influenza A and B (Flu), parainfluenza viruses 1-4, respiratory syncytial virus, rhinovirus/ enterovirus (RV/EV), and SARS-CoV-2. We used survival analysis to quantify median number of days until individuals tested negative for each virus. Results From November 3, 2022 – April 14, 2023, 344 symptomatic participants (141 preK/elem, 49 middle, 22 high, 132 staff) submitted 586 primary specimens; 292 (50%) were positive for a virus. For positive primary specimens, median [IQR] time of symptom onset to specimen collection was 2 [1,3] days. A total of 320 viruses were detected; most common were RV/EV (37%) and sCoVs (25%) (Table). An additional 370 convalescent specimens were collected (87 specimens on days 1-7 following primary positive; 166 specimens on days 8-14; and 117 specimens on days 15-21). Median number of days [95% confidence interval] when repeat convalescent tests became negative varied by virus (AdV 15 [11,undefined] days, Flu A 14 [9,19] days, RV/EV 12 [11,14] days, SARS-CoV-2 14 [14,17] days, sCoV 10 [9,12] days) (Figure).Table.Characteristics of primary positive and convalescent testing (i.e. ongoing positivity) of nasal swabs from preK—12 grade students and staff with respiratory symptoms—Missouri, November 2022 -April 2023Figure.Cumulative probability of testing negative for a respiratory virus on subsequent respiratory viral testing Conclusion Students and staff continued to have detectable virus by nasal swabs 10-15 days after symptomatic positive specimen. Further data are needed to determine when participants are no longer infectious. Disclosures Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support

Extending understanding of the relationship between school district COVID-19 reopening plan signals and enrollment decline

Preceding the 2020-21 school year, school districts engaged their communities by sharing pandemic school reopening plans, outlining the learning modalities and support services to be made accessible to students. Existing research has highlighted a connection between a district’s primary reopening method and changes in student enrollment—a crucial aspect for gauging responsiveness to different learning environments. Conversely, limited research has established the relationship between new health and safety procedures, provisions for vulnerable students, learning support services, or the level of community engagement undertaken by a district in creating reopening plans and student enrollment change, independent of the method of reopening (e.g., in-person or distanced). We do so using two methodological approaches. First, we use differences-in-differences approaches to estimate the impact of reopening method on enrollment changes. Second, we leverage granular data of reopening plans for a representative sample of Missouri school districts in a triple-differences approach. We find that signaling the intent to begin the school year with distanced instruction generated a 3% decline in enrollment beyond pandemic-era declines, concentrated among the youngest students. Extending existing reopening findings, we also estimate that enrollment declined an additional 5% in middle schools where districts did not require masking.

Effective Classroom Management in Middle Level Schools: A Qualitative Study of Teacher Perceptions

Disruptive student behavior is a significant challenge in schools and a predictor of student failure. Effective classroom management is a crucial skill that middle level teachers must acquire to foster student engagement and learning. This qualitative study explored the experiences and perceptions of 35 middle level teachers in both general education and special education settings regarding effective classroom management techniques. Eight focus group interviews were conducted with 25 general education teachers and 10 special education teachers at one of five middle schools in Kansas, Missouri, or Utah. Focus group transcripts were analyzed using iterative qualitative content analysis to identify themes and subthemes. Findings revealed that effective classroom management includes teachers’ use of appropriate positive and negative reinforcement, student buy-in to reward systems, positive immediate feedback to students, teachers’ consistent follow-through with consequences, and positive teacher-student relationships. We also report similarities and differences between middle level general education and special education teachers’ perceptions. Limitations and areas for future research are addressed.

Parental Rights Laws and the Impact on Mental Health Services and Counseling for Adolescents.

Parental Rights Laws and the Impact on Mental Health Services and Counseling for Adolescents.

Right ventricular function in hearts of a mouse model of Duchenne muscular dystrophy following increased ventricular load

Duchenne muscular dystrophy (DMD) is an X-linked recessive myopathy caused by mutations in the gene encoding dystrophin. Dystrophin is present in striated muscle cells and stabilizes the sarcolemma to mitigate contraction-induced damage. The main cause of death in DMD is cardiopulmonary failure by age 30. Diaphragmatic weakness in DMD causes restrictive lung disease and excessive afterload on the right ventricle (RV). Thus, RV dysfunction in DMD patients is typically observed early in disease progression. The objective of this study was to investigate ex vivo RV function in a mouse model of muscular dystrophy and test the hypothesis that RV function is impaired following a sustained increase in ventricular preload and afterload. Right-ventricular pressure development (P dev ) and rate of pressure decay (dP/dt Min ) were monitored in isolated perfused hearts of 2-6 month normal (C57BL/6, n=5) and dystrophic (mdx 4CV , n=5) male mice. Measurements were obtained under unloaded conditions and during right-ventricular load challenge (10 mmHg preload; 20 mmHg afterload). Coronary effluent lactate dehydrogenase (LDH) levels were measured following 30 minutes of sustained load challenge to assess cardiac damage. Our results show dystrophic hearts exhibited greater RV P dev than normal hearts under unloaded conditions (24±2 mmHg mdx 4CV vs 15±2 mmHg C57BL/6, P=0.015). In response to load challenge, P dev increased (P<0.05) in both groups, but it was similar between dystrophic and normal hearts (32±1 mmHg mdx 4CV vs 33±3 mmHg C57BL/6). Rate of pressure decay was similar between dystrophic and normal hearts under both conditions. Levels of LDH following load challenge were higher (P<0.05) in dystrophic versus normal hearts. In conclusion, in the absence of ventricular load RV contractile function was enhanced in dystrophic hearts. With RV load both dystrophic and normal hearts exhibited similar contractile function, yet sustained load challenge increased cellular damage in dystrophic versus normal hearts. National Institutes of Health, University of Missouri School of Medicine, University of Missouri System This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Period Product Resources and Needs in Schools: A Statewide Survey of Missouri's School Nurses.

School nurses play a vital role in ensuring the health and well-being of their students, but little is known about menstrual products and resources available in schools. This study assessed period product resources and needs in Missouri schools from the perspective of school nurses and analyzed differences by district enrollment characteristics. An electronic survey was emailed to public, charter, private, and parochial school nurses in Missouri who served fourth grade or older. From January through March 2022, 976 self-administered surveys were completed (40% response rate). Logistic regressions examined the associations between student needs and district characteristics. Among the sample, 70.7% knew students who could not afford period products, and 68.0% knew students who had missed school because of their period. When controlling for district size, race/ethnicity, and urban/rural classification, as the percentage free- or reduced-lunch (FRL) eligibility increases in a school, awareness of students struggling to afford products increases (AOR=1.008, 95% confidence interval 1.000, 1.015). School nurses need the resources and educational materials to support students to help reduce menstruation-related absences. Issues of period poverty cut across districts of differing enrollment characteristics, yet FRL percentage is an important predictor.

Understanding and Addressing the Well-Being of School Counselors

Diminished self-care practices and heightened stress of school counselors are continuing problems in education. With role ambiguity, high student-to-counselor ratios, emotional exhaustion, and other factors adding pressure to the roles and responsibilities of school counselors, this study investigated the well-being practiced of Missouri school counselors and the internal and external factors which influence them. Findings demonstrate several ways in which school counselors fail to meet basic well-being benchmarks, examples of positive school principal supports, and systemic counselor role ambiguity, mission creep, and high caseloads that contribute to stress and burnout. These results indicate three levels of decision-making that are paramount to school counselors achieving and sustaining healthy well-being practices—the individual counselor's role in self-care and professional advocacy; the school leader's approach to defining the counselor's role and promoting a healthy workplace culture; and the ways in which policymakers affect systemic change.

Implementation of Flexibilities to the National School Lunch and Breakfast Programs and Their Impact on Schools in Missouri.

In 2018, the United States Department of Agriculture (USDA) issued flexibilities to the National School Lunch and Breakfast Programs, relaxing the nutrition standards for milk, whole grains, and sodium. This study examines the implementation decision-making among Missouri school food services and the impact of implementing these flexibilities on the meals served. We developed a survey using the Consolidated Framework of Implementation to determine schools' implementation of the flexibilities and factors related to implementation. To determine how the implementation of flexibilities affected participation, we merged the survey results with school-level meal county data from the Missouri Department of Elementary and Secondary Education. We used ordinary least squares regression to examine how flexibility adoption related to the number of meals served. Most schools implemented the wheat, milk, and sodium flexibilities. Common reasons for implementation were increasing participation, meeting students' preferences, expanding menu variety, and saving money. The implementation of flexibilities was associated with more lunches and breakfasts being served per month, particularly among free and reduced-price meals. Continued research is needed to determine how the increased uptake of school meals that do not fully meet dietary guidelines by low-income students results in inequities in health outcomes. The findings can inform the design and implementation of future policies, especially as new rules related to flexibility design are determined.

Osteitis Condensans Ilii: An Important Mimic of Sacroiliitis.

From the ∗Internal Medicine Residency Program †Division of Rheumatology, University of Missouri School of Medicine, Columbia, MO. The authors declare no conflict of interest. Correspondence: Chokkalingam Siva, MD, MS, FACP, Division of Rheumatology, University of Missouri School of Medicine, Columbia, MO. E-mail: [email protected].

Lessons learned through the implementation of a rural longitudinal integrated clerkship at the University of Missouri-Columbia.

Created in 1995, The University of Missouri School of Medicine's Rural Track Pipeline Program was designed to address physician shortages in rural Missouri through medical student participation in a series of clinical and non-clinical programs over the course of their medical training to influence graduates to choose rural practice. To increase the likelihood of students choosing rural practice, a 46-week longitudinal integrated clerkship (LIC) was implemented at one of nine existing rural training sites. Over the course of the academic year, quantitative and qualitative data was collected to evaluate effectiveness of the curriculum and for quality improvement purposes. Data collection is in progress and includes student evaluation of the clerkship, faculty evaluations of students, student evaluations of faculty, student aggregate clerkship performance, and qualitative data from student and faculty debrief sessions. Based on data collected, changes are being made to the curriculum for the following academic year to enhance the student experience. The LIC will also be offered at an additional rural training site beginning in June of 2022, and then expanded to a third site in June of 2023. As each LIC is unique, our hope is our experience and lessons learned will help others in developing a LIC or improving an existing LIC.

A Spatial Examination of COVID-19 Policies among Missouri School Districts.

As the COVID-19 pandemic spread, school district administrators in the United States were faced with difficult decisions regarding the implementation of virtual or in-person learning to reduce risk of infection throughout student and staff populations. While a coordinated effort with surrounding districts would be most beneficial when encountering a highly infectious respiratory-based infectious disease, the determinants of type of education delivery is unclear. Data from the Missouri Department of Elementary and Secondary Education assessing education delivery method at each school district across the state of Missouri (n=514) from August 2020 were used. This cross-sectional study, using results from a school district-level survey, local COVID-19 rates, and community-level sociodemographic characteristics, conducted a spatially adjusted analysis of variance (ANOVA) to determine associations between education delivery type and geographic-level sociogeographic characteristics. Among Missouri school districts, 172 (33.4%) reported starting the 2020-2021 academic year with an in-person policy, 52 (10.1%) with a distant/virtual policy, 242 (47.1%) in-person with a distance option, and 48 (9.3%) with a blended policy. This study found districts with lower household income levels were less likely to offer students any virtual learning options. Additionally, community COVID-19 infection rates were not associated with the selection of virtual or in-person education delivery. These findings suggest the presence of a specific school policy was spatially random in regard to neighboring community policies, even when accounting for community characteristics. The efficacy of policy is likely to benefit upon application of a spatial framework when addressing a crisis fundamentally tied to location. Future planning that highlights and focuses on regional coordination for community resilience in the face of a pandemic should incorporate data sources that inform decisions made for families, students, and communities.

A Retrospective Study on the Influence of Participation at a Student-Run Free Clinic on Medical Specialty Choice


 Background: The MedZou Community Health Clinic at the University of Missouri School of Medicine is a student-run free clinic (SRFC) providing primary care and specialty services to uninsured patients of Missouri. Little is published about the relationship of volunteerism in SRFCs and residency match results. This study evaluated the association of SRFC volunteering on residency placement. We hy-pothesized that there would be an increased likelihood of medical students matching into specialties correlating with specialty clinics they volunteered with as students. 
 Methods: We analyzed data on volunteers who graduated from the University of Missouri School of Medicine between 2010-2019 in this retrospective study. Selection criteria included students who per-mitted publishing their residency match results publicly and actively volunteered for MedZou (at least five volunteer shifts). Odds ratios (OR) were calculated with Fisher exact tests using a confidence in-terval (CI) of 95% to assess whether volunteering in a specialty clinic was associated with matching in that specialty. Clinics with at least five volunteers during the study period were analyzed (Dermatol-ogy, Musculoskeletal [MSK], and Neurology). 
 Results: Twenty-nine percent of the MedZou volunteers that fit the inclusion criteria volunteered for the Dermatology, MSK, or Neurology Clinic. We found significant associations between those who volunteered in a specialty clinic and those who matched in a related specialty for Dermatology (OR = 4.25, 95% CI = 1.37, 12.13), Musculoskeletal (OR = 3.49, 95% CI = 1.45, 7.98), and Neurology Clinics (OR = 10.89, CI = 1.71, 50.39). Additionally, 51% of MedZou volunteers that fit inclusion criteria volunteered for Primary Care Clinic. These students were also found to have a significant association with matching into a related primary care specialty (OR= 2.01, CI= 1.14, 3.62). 
 Conclusions: The results of this study indicated that clinical exposure at a SRFC specialty clinic was associated with residency match into related specialties.

Introduction to this special issue.

Introduction to this special issue.

Malignant Mesothelioma Manifesting in an Elderly Female without Occupational Asbestos Exposure

Sarah Steenson (1), Tarang Pankaj Patel (1), Satish Kalanjeri (2), Jeremy Carl Johnson (2) ; 1. Division of Pulmonary, Critical Care and Environmental Medicine, University of Missouri School of Medicine. 2. Division of Pulmonary, Critical Care and Environmental Medicine, Harry S Truman Veterans Affairs Hospital, University of Missouri School of Medicine.

School Desegregation as Multi-generational Narratives of Afropessimism

The Kansas City, Missouri School District (KCMSD) avoided federal oversight to comply with the desegregation ruling for nearly 30 years after Brown v. Board of Education by establishing a neighborhood concept for school attendance boundaries. Jenkins v. Missouri ended in 1995 with a U.S. Supreme Court decision to desegregate schools in this district. Our research project used BlackCrit and oral history to examine the experiences of 15 participants, who were educators, students, parents, and community members that formed the legacy of school desegregation. Their counter stories shed critical light on how they continue to grapple with persistent inequalities in today’s schools. Themes from their stories resonated with vivid accounts of the desegregation plan that guided their educational experiences; the community’s reactions to desegregation; views about integration; dangerous memories of institutional racism and antiblackness; and lessons from a contested field. Significantly, our participants’ local stories have the potential to invigorate efforts for Black liberation.

Mandating Vaccination – Is it Justified?

David A. Fleming, M.D., MA, MACP, FRCP (Center for Health Ethics, University of Missouri School of Medicine)

Real-time collaborative question-making activity to enhance students' knowledge of evidence-based dentistry.

Journal of Dental EducationVolume 85, Issue S1 p. 952-954 ADVANCING THROUGH INNOVATION Real-time collaborative question-making activity to enhance students' knowledge of evidence-based dentistry Hanan Omar BDS, MSc, PhD, Corresponding Author Hanan Omar BDS, MSc, PhD [email protected] orcid.org/0000-0002-4144-7170 Restorative Dentistry, Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, Missouri, USA Correspondence Dr Hanan Omar, BDS, MSc, PhD, Associate Professor, Restorative Dentistry, Missouri School of Dentistry and Oral Health, A.T. Still University, 800 West Jefferson Street, Kirksville, Missouri 63501, USA. Email: [email protected]Search for more papers by this authorJoan Davis PhD, Joan Davis PhD orcid.org/0000-0003-4007-0129 Research, Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, Missouri, USASearch for more papers by this authorHamid Nurrohman DDS, PhD, Hamid Nurrohman DDS, PhD Restorative Dentistry, Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, Missouri, USASearch for more papers by this author Hanan Omar BDS, MSc, PhD, Corresponding Author Hanan Omar BDS, MSc, PhD [email protected] orcid.org/0000-0002-4144-7170 Restorative Dentistry, Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, Missouri, USA Correspondence Dr Hanan Omar, BDS, MSc, PhD, Associate Professor, Restorative Dentistry, Missouri School of Dentistry and Oral Health, A.T. Still University, 800 West Jefferson Street, Kirksville, Missouri 63501, USA. Email: [email protected]Search for more papers by this authorJoan Davis PhD, Joan Davis PhD orcid.org/0000-0003-4007-0129 Research, Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, Missouri, USASearch for more papers by this authorHamid Nurrohman DDS, PhD, Hamid Nurrohman DDS, PhD Restorative Dentistry, Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, Missouri, USASearch for more papers by this author First published: 26 October 2020 https://doi.org/10.1002/jdd.12474Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume85, IssueS1Supplement: Advancing Through Innovation in a Challenging TimeJune 2021Pages 952-954 This article also appears in:Advancing Through Innovation in a Challenging Time RelatedInformation

“Improving the Race”: The Discourse of Science and Eugenics in Local News Coverage, 1905–1922

In the early twentieth century, journalism contributed to the eugenics movement before it reached national and global saliency. Local newspapers played a role in writing about eugenics in Columbia, Missouri, that integrated “scientific” discourse with questions about the social and cultural makeup. Examining the Missouri School of Journalism’s newspaper, the Columbia Missourian, and the city’s newspaper, the Columbia Tribune, shows that the media discourse focused on three themes: 1) “race suicide” and its implications for designating social value; 2) elevating the “superior race” through purity and racial difference; and 3) promoting the politics of respectability. This article contributes to previous research on early journalism by analyzing how local news production incorporated “objectivity” as a practice that in turn elevated eugenics as a legitimate form of science.