University Of Arkansas For Medical Sciences Research Articles

Feasibility of regional center telehealth visits utilizing a rural research network in people with Parkinson's disease.

Impaired motor and cognitive function can make travel cumbersome for People with Parkinson's disease (PwPD). Over 50% of PwPD cared for at the University of Arkansas for Medical Sciences (UAMS) Movement Disorders Clinic reside over 30 miles from Little Rock. Improving access to clinical care for PwPD is needed. To explore the feasibility of remote clinic-to-clinic telehealth research visits for evaluation of multi-modal function in PwPD. PwPD residing within 30 miles of a UAMS Regional health center were enrolled and clinic-to-clinic telehealth visits were performed. Motor and non-motor disease assessments were administered and quantified. Results were compared to participants who performed at-home telehealth visits using the same protocols during the height of the COVID pandemic. Compared to the at-home telehealth visit group (n = 50), the participants from regional centers (n = 13) had similar age and disease duration, but greater disease severity with higher total Unified Parkinson's disease rating scale scores (Z = -2.218, p = 0.027) and lower Montreal Cognitive Assessment scores (Z = -3.350, p < 0.001). Regional center participants had lower incomes (Pearson's chi = 21.3, p < 0.001), higher costs to attend visits (Pearson's chi = 16.1, p = 0.003), and lived in more socioeconomically disadvantaged neighborhoods (Z = -3.120, p = 0.002). Prior research participation was lower in the regional center group (Pearson's chi = 4.5, p = 0.034) but both groups indicated interest in future research participation. Regional center research visits in PwPD in medically underserved areas are feasible and could help improve access to care and research participation in these traditionally underrepresented populations.

ASSESSMENT OF ELECTROLYTE ABNORMALITIES IN OLDER ADULTS WITH COVID-19 DELIRIUM

Abstract This retrospective study explored the impact of COVID-19 on altered sodium and potassium in older adults with delirium. EMRs from the University of Arkansas for Medical Sciences (UAMS) database were reviewed from January 7, 2018 to January 5, 2021 for electrolyte abnormalities and delirium. Inclusion criteria were age 65 or older, all races, genders, and ethnicities with COVID or non-COVID infections. We identified 319 patients with COVID-19 out of which 108 (33.8%) had delirium during COVID. In COVID-delirious patients, hypokalemia was present in 8, hyperkalemia in 10, hyponatremia in 9, and hypernatremia in 20.127/319 (39.8%) COVID patients had an electrolyte disorder at some point with hypokalemia being most represented at 58/127 (45.7%). Out of the patients who experienced hypokalemia at some point, 34/319 (10.6%) had delirium. In another cohort of 306 older adults with non-COVID pneumonias we identified 173 patients with electrolyte disorders and 106 (34.6%) with delirium during pneumonia. Electrolyte disturbances were more present in non-COVID pneumonias vs. those with COVID (p&amp;lt; 0.001). Hypokalemia was more identified in non-COVID, 56/306 (18.3%), vs. COVID patients, 34/319 (10.6%) (p&amp;lt; 0.006). Interestingly, hypernatremia was greater in COVID groups (p&amp;lt; 0.0321). There was no difference in delirium between COVID vs non-COVID patients, but electrolytes disorders and hypokalemia were observed with greater frequency in non-COVID pneumonias. Notably, hypernatremia developed more in patients suffering from COVID and since it can be associated with seizures and cerebral hemorrhage, particular attention should be paid to prevent hypernatremia from developing in order to reduce COVID-related morbidity and mortality.

Abstract A022: Assessing, understanding, and addressing social determinants of cancer health disparities through patient navigation among rural Arkansans

Abstract The Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences (UAMS), Office of Community Outreach and Engagement has developed a Cancer Patient Navigation Program dedicated to improving cancer care for everyone in Arkansas. The team includes nurse navigators and community health workers that help bridge the gap between cancer patients, and financial resources in the community, and health care providers. The Cancer Patient Navigation Program emphasizes patient empowerment through prevention, screening, and treatment for rural and underserved populations across the state. The aim of the program is to help eliminate barriers to health care by providing resources for cancer treatment to rural and underserved populations across Arkansas. Navigators and community health works are located throughout every geographic region of Arkansas and are representative of the diversity in the communities they serve. Navigators and community health workers use the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE®) to identify cancer patients’ barriers to care. PRAPARE® is a standardized patient risk assessment tool consisting of a set of national core measures as well as a process for addressing the social drivers at both the patient and population levels. Since May 2022, the Cancer Patient Navigation program has assessed and addressed the needs of 350 cancer patients. The data collected by navigators and community health workers has improved care coordination services, increased collaborations with local community partners with similar goals, and provided a unique opportunity for UAMS to better understand challenges of cancer patients and provide more appropriate services and care that is needed on a community level. The PRAPRE data has allowed the Office of Community Outreach and Engagement to understand the number of social determinants risks as well as the most common social determinant risks in our patient population. The risk tally score established a baseline to determine who might be more “at risk” by both geographic location and cancer diagnosis. To date, the data collected has been analyzed to track referrals and interventions. The data will further be used to ensure community-engagement priorities and resources are integrated into all Winthrop P. Rockefeller Cancer Institute research cores and clinical enterprises. Addressing the adverse social drivers of health will ultimately allow UAMS to improve patient well-being, facilitate access to prevention, screening, and treatment. Citation Format: Valandra L. German. Assessing, understanding, and addressing social determinants of cancer health disparities through patient navigation among rural Arkansans [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A022.

Development and Validation of an Individualized and Weighted Prognostic Model in Patients with Newly Diagnosed Multiple Myeloma

Introduction Multiple myeloma (MM) is a malignancy of terminally differentiated antibody-secreting plasma cells in the bone marrow with highly variable survival outcomes. Precise risk stratification not only plays a vital role in predicting patient prognoses, but critically can be used to develop risk-adapted treatment regimens. However, current risk stratification models do not adequately account for the heterogeneity of patients with new-diagnosed multiple myeloma (NDMM). Methods In this retrospective, multicohort study, we collected clinical data from 1792 NDMM patients and formulated a weighted Myeloma Prognostic Score System (MPSS) risk model to predict overall survival (OS). Construction of the MPSS model was carried out based on the National Longitudinal Cohort of Hematological Diseases in China (NCT04645199) cohort, external validation cohort was created using TT2, TT3a, and TT3b cohorts from a series of randomized prospective studies from the University of Arkansas for Medical Sciences (UAMS). Results Each risk factor was defined as its weighted value respectively according to their hazard ratio for OS (thrombocytopenia 2, elevated LDH 1, ISS III 2, one high-risk cytogenetic aberration [HRA] 1, and ≥2 HRA 2 points). In the training cohort, patients were furtherly stratified into four risk groups: MPSS I (22.5%, 0 points), II (17.6%, 1 points), III (38.6%, 2-3 points), and IV (21.3%, 4-7 points). MPSS risk stratification showed optimal discrimination, as well as calibration, of four risk groups with median OS of 91.0, 69.8, 45.0, and 28.0 months, for patients in MPSS I to IV groups (P&amp;lt; 0.001), respectively. Importantly, the MPSS model retained its prognostic value in the internal validation cohort and an independent external validation cohort, and exhibited significant risk distribution compared with conventional prognostic models (R-ISS, R2-ISS, and MASS). Conclusions In conclusion, we formulated and validated the MPSS risk model to predict the prognosis of patients with MM using readily available standard clinical and genetic test data. The established MPSS profile shows a better performance in risk discrimination than the current R-ISS, R2-ISS, and MASS. A score-based risk stratification is derived, and identifies patients with high and ultra-high risk of death after diagnosis and may therefore aid the development of more personalized treatment strategies, especially for patients for whom current therapies are likely to fail.

An Innovative Resource to Guide and Track Medical Resident Activity and Wellness During At-Home Assignments.

Background and objectives Medical residents may work from home for various reasons, including study electives, isolation due to exposure to illness, or during parental leave when they choose to work at home instead of taking extended time off. The University of Arkansas for Medical Sciences (UAMS) Little Rock Family Medicine residency program recognized the need for a tool that provided residents with a list of resources and approved activities for at-home work and a means of tracking their performance in those activities. Methods The administration team at the UAMS Little Rock Family Medicine residency program custom-designed a Daily Activities Log that served multiple purposes. Family medicine residents used it to choose what activities to participate in from a comprehensive list of activities and resources including virtual conferences, recorded didactics, modules, and other online materials. The program provided the framework on the log, while residents used it to document time spent on those activities. The log also gave the program a daily update on the resident's health, as one question specifically asked about well-being. Since it was built in an electronic survey format already owned by the residency program, it was completely customizable and available at no additional cost. Results In the two years covered by this project, residents logged a total of 593 hours of at-home work. In response to a survey, 76% of participating residents (N=14) rated the log as extremely or very easy to use; 64% indicated that it was a helpful resource; and 50% said that it simplified the reporting of their daily status. The residency program faculty found that having one source to track all off-site residents was an efficient means of monitoring their well-being and their work. Conclusions The Daily Activities Log is a versatile tool that provides comprehensive information, resources, and approved activities for residents, documents their work, and provides updates to residency management. It can be readily modified for use in other programs that have residents working at home.

Top-Down Genomic Surveillance Approach To Investigate the Genomic Epidemiology and Antibiotic Resistance Patterns of Enterococcus faecium Detected in Cancer Patients in Arkansas.

Control of hospital-associated Enterococcus faecium infection is a strenuous task due to the difficulty of identifying transmission routes and the persistence of this nosocomial pathogen despite the implementation of infection control measures that have been successful with other important nosocomial pathogens. This study provides a comprehensive analysis of over 100 E. faecium isolates collected from 66 cancer patients at the University of Arkansas for Medical Sciences (UAMS) between June 2018 and May 2019. In the top-down approach used in this study, we employed, in addition to the 106 E. faecium UAMS isolates, a filtered set of 2,167 E. faecium strains from the GenBank database to assess the current population structure of E. faecium species and, consequently, to identify the lineages associated with our clinical isolates. We then evaluated the antibiotic resistance and virulence profiles of hospital-associated strains from the species pool, focusing on antibiotics of last resort, to establish an updated classification of high-risk and multidrug-resistant nosocomial clones. Further investigation of the clinical isolates collected from UAMS patients using whole-genome sequencing analytical methodologies (core genome multilocus sequence typing [cgMLST], core single nucleotide polymorphism [coreSNP] analysis, and phylogenomics), with the addition of patient epidemiological data, revealed a polyclonal outbreak of three sequence types occurring simultaneously in different patient wards. The integration of genomic and epidemiological data collected from the patients increased our understanding of the relationships and transmission dynamics of the E. faecium isolates. Our study provides new insights into genomic surveillance of E. faecium to assist in monitoring and further limiting the spread of multidrug-resistant E. faecium. IMPORTANCE Enterococcus faecium is a member of the gastrointestinal microbiota. Although its virulence is low in healthy, immunocompetent individuals, E. faecium has become the third leading cause of health care-associated infections in the United States. This study provides a comprehensive analysis of over 100 E. faecium isolates collected from cancer patients at the University of Arkansas for Medical Sciences (UAMS). We employed a top-down analytical approach (from population genomics to molecular biology) to classify our clinical isolates into their genetic lineages and thoroughly evaluate their antibiotic resistance and virulence profiles. The addition of patient epidemiological data to the whole-genome sequencing analytical methodologies performed in the study allowed us to increase our understanding of the relationships and transmission dynamics of the E. faecium isolates. This study provides new insights into genomic surveillance of E. faecium to help monitor and further limit the spread of multidrug-resistant E. faecium.

Susan S. Smyth (1965-2022).

Susan S. Smyth (1965-2022).

Abstract WP85: Stroke Prevalence In Arkansas's Delta

Background: Telestroke hospitals in the southern Arkansas Delta participating in the American Heart Associations (AHA) Get With the Guidelines® (GWTG) are challenged with medically disadvantaged, vulnerable patient populations. The Delta is largely rural with a poverty rate higher than the US National average and residents suffer a 10 year lower life expectancy of when compared to neighboring northern counties. To determine the Delta’s influence on stroke recognition and outcomes, we examined 3-digit zip code, age at stroke occurrence, race, transport mode to diagnosing hospital, patient disposition at discharge, and stroke type in calendar years (CY) 2019 to 2021. Methods: We retrospectively reviewed the AHA GWTG Stroke data for the University of Arkansas for Medical Sciences (UAMS) Institute for Digital Health &amp; Innovation (IDHI) - Telestroke Program 2019 to 2021, from 47 of the Programs 58 participating hospital sites. Transport mode included transfers from other hospitals, emergency medical services (EMS) transport, or privately owned vehicle/taxi (POV). Patient age significance was determined using ANOVA and categorical differences with chi square analysis. Results: Data totals were 13,721 entries with 4,571, 4,478 and 4,672 entries by CY. Ages at stroke onset were among the lowest in the zip codes from Delta areas with a median age of 66 compared to the median age of 69 for Arkansas as a whole. Percentages of stroke among Black or African Americans were the highest in Delta areas in all CYs p=0.002, p&lt;0.0001 and p&lt;0.0001, respectively. Patient disposition at discharge with increased discharges home vs. hospice was significant by race at all CY’s p=0.01; =0.017; =0.012, respectively. Black or African Americans had an increased %death vs. Whites in 2021, 3.7% vs. 2.8%, respectively. Transport mode was significant in 2021 with increased percentages of EMS transport of ischemic and hemorrhagic strokes and increased POV transport of transient ischemic attacks (&lt; 24 hours) TIAs X 2 =535; p&lt;0.0001. Delta regions experienced a higher percentage of TIAs and ischemic strokes X 2 =836; p&lt;0.0001. Conclusions: Delta areas remain at risk for increased stroke mortality for Black or African Americans and younger populations.

The informed consent form navigator: a tool for producing readable and compliant consent documents.

Informed consent forms (ICFs) and practices vary widely across institutions. This project expands on previous work at the University of Arkansas for Medical Sciences (UAMS) Center for Health Literacy to develop a plain language ICF template. Our interdisciplinary team of researchers, comprised of biomedical informaticists, health literacy experts, and stakeholders in the Institutional Review Board (IRB) process, has developed the ICF Navigator, a novel tool to facilitate the creation of plain language ICFs that comply with all relevant regulatory requirements. Our team first developed requirements for the ICF Navigator tool. The tool was then implemented by a technical team of informaticists and software developers, in consultation with an informed consent legal expert. We developed and formalized a detailed knowledge map modeling regulatory requirements for ICFs, which drives workflows within the tool. The ICF Navigator is a web-based tool that guides researchers through creating an ICF as they answer questions about their project. The navigator uses those responses to produce a clear and compliant ICF, displaying a real-time preview of the final form as content is added. Versioning and edits can be tracked to facilitate collaborative revisions by the research team and communication with the IRB. The navigator helps guide the creation of study-specific language, ensures compliance with regulatory requirements, and ensures that the resulting ICF is easy to read and understand. The ICF Navigator is an innovative, customizable, open-source software tool that helps researchers produce custom readable and compliant ICFs for research studies involving human subjects.

Peer Specialists Can Aid in Suicide Prevention

Peer Specialists Can Aid in Suicide Prevention

Epidemiologic Trends of Cutaneous T-Cell Lymphoma in Arkansas Reveals Demographic Disparities.

Simple SummaryCutaneous T-cell lymphomas (CTCLs) are rare non-Hodgkin’s lymphomas characterized by skin-homing T-cells, most represented by mycosis fungoides (MF) and Sézary syndrome (SS). While national statistics exist, a detailed demographic analysis for CTCL has not been reported in most states. With fluctuating population demographics in the United States, we present an updated epidemiologic analysis for two common variants of CTCL. We compared the CTCL patient population from a tertiary referral center at the University of Arkansas for Medical Sciences to the national Surveillance, Epidemiology, and End Results (SEER) database to gain insight into trends in prevalence and incidence, and to understand the underlying disparities. Our retrospective analysis revealed demographic disparities, among young black males, in the Arkansas CTCL population, which were similarly identified in the total United States CTCL population. In addition, we mapped out the geographic distribution of CTCL patients in Arkansas to identify possible environmental associations to CTCL. Our epidemiologic analysis of a tertiary academic center in relation to national data may provide greater insight into the various determinants that influence the disparities of CTCL.Accurate demographic data are critical for comprehending and treating cutaneous T-cell lymphoma (CTCL). Our research aimed to determine the demographics and incidence trends of CTCL patients in Arkansas compared to those of the national CTCL population to recognize the underlying disparities. We collected data from 143 CTCL patients at the University of Arkansas for Medical Sciences (UAMS) and national CTCL patient data from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis revealed that males are affected more than females across all ages and races. CTCL incidence and mortality data show that CTCL has a steady increase at the national level and in Arkansas while disproportionately affecting the young black male population. In Arkansas, more than one-third of black patients presented at an advanced stage (IIB+) compared to one-fifth in the white population, and the mean age of death was more than a decade younger for black (60 years) than for white patients (74.6 years). Nationally, black male patients had the greatest mortality rate (0.5) compared to 0.32 for white males. CTCL is 2.23 and 2.38 times more prevalent in urban versus rural areas in Arkansas and nationally, respectively. Most Arkansas patients reside near major interstates and chemical-emitting sites. In conclusion, our demographic analysis of Arkansas and national CTCL patients verifies recent trends toward more aggressive presentations in young black male patients, and our geographic findings suggest possible environmental risk factors.

Abstract 1443: Environmental heavy metal toxicity and mammographic breast density in a Mississippi Delta southern state

Abstract Importance: Increased mammographic density (MD) is a strong independent risk factor for breast carcinoma. Ubiquitous environmental heavy metal (HM) exposure/toxicity appears pro-carcinogenic in several human cancers. However, studies in the current scientific literature have not elucidated specific connections between HM exposure and mammographically detected increases in breast density. Objective: To determine whether increases in heavy metals (ie, chromium, arsenic and cadmium) measured in urine as a biomarker for long-term exposure, associate with increased MD in a female study cohort in Arkansas. Design, Setting, Participants: One hundred thirty-nine participants in the Arkansas Rural Community Health (ARCH) study cohort, recruited through a mobile mammography unit at baseline, were included in this pilot study. Demographic/health history questionnaire data, urine, blood and saliva samples and incident mammograms classified by BI-RADS were ascertained after informed consent. Study protocol was approved by the Institutional Review Board at the University of Arkansas for Medical Sciences (UAMS). Main Outcome and Measures: Urinary chromium, arsenic and cadmium levels were determined using inductively coupled plasma mass spectrometry. The concentrations of HM were adjusted for urinary creatinine and specific gravity and the results categorized into tertiles. Multivariable logistic regression models were used to evaluate the association between HM exposure and MD. Association of both continuous and categorical variables were examined. Confounding variables in the multivariable models including age, race, BMI, age at menarche and smoking history were determined by a priori knowledge and statistical assessment. Results: Odds ratios (OR) and 95% confidence intervals (CI) for the association between each tertile of HM exposure and MD were used for the assessment. For the unadjusted model, increasing ORs for MD were noted with increased levels of both Chromium and Arsenic exposure. Increased ORs for MD were observed with increased levels of Chromium, Arsenic and Cadmium exposure in the multivariable adjusted model. However, none of these associations demonstrated statistical significance in this limited pilot study. Conclusion: Positive associations between HM exposure and MD were noted after adjusting for age, sex, BMI, age at menarche and smoking history in this pilot study. However, the association did not reach statistical significance at α = 0.05. Citation Format: Bobbie Dean Fine, Shelbie Stahr, Lora J. Rogers, Gail A. Runnells, Tung-Chin Chiang, Lihchyun J. Su. Environmental heavy metal toxicity and mammographic breast density in a Mississippi Delta southern state [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1443.

Mohs Micrographic Surgery for Dermatofibrosarcoma Protuberans in 15 Patients: The University of Arkansas for Medical Sciences Experience.

Background: Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive malignancy with wide local excision (WLE) or Mohs micrographic surgery (MMS) representing the treatment of choice. This article illustrates the experience of a single academic institution in treating DFSP with MMS and adds two particularly large, difficult closures of the glabella/central forehead and sternum to the body of literature.Objective: To report the results of 15 patients with DFSP treated with MMS over a five-year period by a single Mohs surgeon at the University of Arkansas for Medical Sciences (UAMS).Methods: A total of 15 patients between the ages of 16 and 80 years were diagnosed with DFSP and treated with MMS and were contacted in October 2021 to assess for recurrence.Results: None of the 15 patients had a recurrence of DFSP following MMS, with a mean follow-up interval of 22.4 months and an average of 1.93 Mohs layers required for tumor clearance.Conclusion: This experience reaffirms that MMS is an effective treatment for DFSP and adds additional examples of closure techniques of large, ovoid surgical defects on the glabella/central forehead and sternum to the literature.

Machine learning can identify patients at risk of hyperparathyroidism without known calcium and intact parathyroid hormone.

To prove the concept of diagnosing primary hyperparathyroidism (pHPT) without calcium and parathyroid hormone (PTH) values and identifying potential risk factors for pHPT. Data were extracted from the clinical data warehouse (CDW) at the University of Arkansas for Medical Sciences (UAMS) Epic EHR (2014-2019). 1737 patients with over 185 000 rows of clinical data were provided in a relational structure and processed/flattened to facilitate modeling. Phenotype elements were identified for pHPT without advance knowledge of calcium and PTH levels. The area under the curve (AUC) for the prediction of pHPT using our model was 0.86 with sensitivity and specificity of 0.8953 and 0.6686, respectively, using a 0.45 probability threshold. Primary hyperparathyroidism was predicted from a dataset excluding calcium and PTH data with 86% accuracy. This approach needs to be validated/refined on larger samples of data and plans are in place to do this with other regional/national datasets.

Plasma cells expression from smouldering myeloma to myeloma reveals the importance of the PRC2 complex, cell cycle progression, and the divergent evolutionary pathways within the different molecular subgroups.

Sequencing studies have shed some light on the pathogenesis of progression from smouldering multiple myeloma (SMM) and symptomatic multiple myeloma (MM). Given the scarcity of smouldering samples, little data are available to determine which translational programmes are dysregulated and whether the mechanisms of progression are uniform across the main molecular subgroups. In this work, we investigated 223 SMM and 1348 MM samples from the University of Arkansas for Medical Sciences (UAMS) for which we had gene expression profiling (GEP). Patients were analysed by TC-7 subgroup for gene expression changes between SMM and MM. Among the commonly dysregulated genes in each subgroup, PHF19 and EZH2 highlight the importance of the PRC2.1 complex. We show that subgroup specific differences exist even at the SMM stage of disease with different biological features driving progression within each TC molecular subgroup. These data suggest that MMSET SMM has already transformed, but that the other precursor diseases are distinct clinical entities from their symptomatic counterpart.

A Meta-Analysis of Genome-Wide Association Studies of Multiple Myeloma in Persons of African Ancestry [African-American Multiple Myeloma Study (AAMMS)] Identifies Suggestive Risk Variants

Background: Multiple myeloma (MM) is 2-3 times more common among persons of African ancestry (AA) compared to those of European ancestry (EA). The 2-3-fold increased risk among family members of cases suggests a genetic contribution to risk. Genome-wide association studies (GWAS) in EA populations have identified 16 novel risk loci. We previously showed that 5 of these replicated in populations of AA (Rand et al., CEBP, 2016). In order to increase the power to identify additional novel common genetic risk variants, we conducted a GWAS meta-analysis using two sets of AA MM patients recruited into the African American Multiple Myeloma Study (AAMMS) and the University of Arkansas for Medical Sciences (UAMS)) Myeloma Institute.Methods: The first GWAS included 1,305 incident AA MM cases enrolled in AAMMS, recruited from 10 clinical centers and population-based cancer registries in the NCI SEER Program from 2011 to 2013 and genotyped using the Illumina HumanCore GWAS array. Control data were obtained from 4425 male controls from the African Ancestry Prostate Cancer Consortium (consisting of 14 independent studies) and 2632 female controls from a breast cancer GWAS of African-American women (consisting of 9 independent studies) and genotyped using the Illumina 1M-Duo. The second GWAS included 95 additional AAMMS patients and 435 AA MM patients enrolled from UAMS, genotyped using the Illumina MegaBead Chip and compared to 2,390 AA controls from the Multiethnic Cohort. Both GWAS were imputed with the CAAPA Haplotype Reference panel on the University of Michigan Imputation Server http://www.caapa-project.org/. Single nucleotide polymorphisms (SNPs) with a minor allele frequency of less than 0.01 and an imputation score of less than 0.8 were excluded. Associations between SNPs and MM risk in each GWAS were calculated using unconditional logistic regression adjusted for sex, age at diagnosis (cases) or cohort sample collection (controls), and the first 10 genetic ancestry principal components. A meta-analysis of the two GWAS was conducted using a fixed effects model.Results: There were 8,715,278 overlapping SNPs in the meta-analysis with a lambda (inflation) = 1.066. Seven loci were associated with MM risk at p<10-6, but none reached genome-wide significance. We found several novel SNPs at the previously reported locus 6p21.33, with odds ratios (ORs) ranging from 1.20-1.28 and p-values ranging from 3.72-8.46 x 10-7 (Figure 1). We also identified six additional suggestive novel loci at chr4q32.1, chr9p24.3, chr12q12, chr12p13.3, chr16p12.2, chr18q12.1 with ORs ranging from 1.27-2.13 and p-values from 1.2x10-7-9.39x10-7.Of the 16 known risk loci in EA MM patients, eight replicated at p<0.05 in the AA MM GWAS meta-analysis. We previously reported better localized signals in AA patients for 7 of these known risk SNPs; five of these replicated at p< 0.05 in this meta-analysis. The highest p-value for the previously identified EA or AA SNPs was 1.90 x10-5.Conclusions: We have found suggestive loci associated with MM risk in AA's that appear distinct from risk loci identified in EA's, that may explain some of the disparity for MM risk in these two populations. Further follow-up with replication is warranted.Figure 1. A Manhattan plot showing results of a fixed effects meta-analysis of two genome wide association scans based on a total of 1,835 multiple myeloma patients and 9,468 controls of African ancestry, with genome-wide significance of p= 5x10-8 (red line). Y-axis= -Log10 of the p-value; X-axis= chromosomes; green dots= previously reported risk loci, excluding those with imputation scores<0.8 and a minor allele frequency of <1%. [Display omitted] DisclosuresAilawadhi:Amgen: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Pharmacyclics: Research Funding. Nooka:Amgen, Novartis, Spectrum, Adaptive: Consultancy. Anderson:Millenium Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; MedImmune: Membership on an entity's Board of Directors or advisory committees; C4 Therapeutics: Other: scientific founder; Gilead Sciences: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Oncopep: Other: scientific founder. Vij:Amgen: Honoraria, Research Funding; Jazz: Honoraria; Konypharma: Honoraria; Bristol-Meyers-Squibb: Honoraria; Janssen: Honoraria; Abbvie: Honoraria; Celgene: Honoraria; Takeda: Honoraria, Research Funding. Zonder:Prothena: Consultancy; Pharmacyclics: Other: Data Safety Monitoring Committee; Takeda: Consultancy; Janssen: Consultancy; BMS: Consultancy, Research Funding; Celgene: Consultancy, Research Funding. Morgan:Celgene: Consultancy, Honoraria, Research Funding; Bristol Myers: Consultancy, Honoraria; Takeda: Consultancy, Honoraria. Orlowski:BioTheryX: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Enhance Portable Radiograph for Fast and High Accurate COVID-19 Monitoring.

This work aimed to assist physicians by improving their speed and diagnostic accuracy when interpreting portable CXRs as well as monitoring the treatment process to see whether a patient is improving or deteriorating with treatment. These objectives are in especially high demand in the setting of the ongoing COVID-19 pandemic. With the recent progress in the development of artificial intelligence (AI), we introduce new deep learning frameworks to align and enhance the quality of portable CXRs to be more consistent, and to more closely match higher quality conventional CXRs. These enhanced portable CXRs can then help the doctors provide faster and more accurate diagnosis and treatment planning. The contributions of this work are four-fold. Firstly, a new database collection of subject-pair radiographs is introduced. For each subject, we collected a pair of samples from both portable and conventional machines. Secondly, a new deep learning approach is presented to align the subject-pairs dataset to obtain a pixel-pairs dataset. Thirdly, a new PairFlow approach is presented, an end-to-end invertible transfer deep learning method, to enhance the degraded quality of portable CXRs. Finally, the performance of the proposed system is evaluated by UAMS doctors in terms of both image quality and topological properties. This work was undertaken in collaboration with the Department of Radiology at the University of Arkansas for Medical Sciences (UAMS) to enhance portable/mobile COVID-19 CXRs, to improve the speed and accuracy of portable CXR images and aid in urgent COVID-19 diagnosis, monitoring and treatment.

Consolidated EHR Workflow for Endoscopy Quality Reporting.

Although colonoscopy is the most frequently performed endoscopic procedure, the lack of standardized reporting is impeding clinical and translational research. Inadequacies in data extraction from the raw, unstructured text in electronic health records (EHR) pose an additional challenge to procedure quality metric reporting, as vital details related to the procedure are stored in disparate documents. Currently, there is no EHR workflow that links these documents to the specific colonoscopy procedure, making the process of data extraction error prone. We hypothesize that extracting comprehensive colonoscopy quality metrics from consolidated procedure documents using computational linguistic techniques, and integrating it with discrete EHR data can improve quality of screening and cancer detection rate. As a first step, we developed an algorithm that links colonoscopy, pathology and imaging documents by analyzing the chronology of various orders placed relative to the colonoscopy procedure. The algorithm was installed and validated at the University of Arkansas for Medical Sciences (UAMS). The proposed algorithm in conjunction with Natural Language Processing (NLP) techniques can overcome current limitations of manual data abstraction.

Evaluation of a telemedicine program managing high-risk pregnant women with pre-existing diabetes in Arkansas's Medicaid program

ObjectiveWe aim to evaluate the effects of the telemedicine program, High-Risk Pregnancy Program at University of Arkansas for Medical Sciences (UAMS), on health services utilization and medical expenditures among pregnant women with pre-existing diabetes and their newborns. Research design and methodsThe study sample was selected from the Arkansas Medicaid claims linked to infant birth/death certificates and UAMS telemedicine records from 2013 through 2016. We used propensity score matching based on participants’ characteristics to create three groups - UAMS telemedicine care, UAMS in-person care, and non-UAMS prenatal care. We compared inpatient and outpatient care services, medication use and caesarean section rates, severe maternal morbidity, infant mortality and preterm birth rates and medical expenditures. ResultsThe UAMS telemedicine group had fewer inpatient admissions (1.18 vs 1.31; 95% CI: -0.27, 0.00), lower insulin use rates (41.86% vs 59.88%; 95% CI: -29.00%, -7.05%) and lower maternal care expenditures ($7,846 vs $10,644; 95% CI: -$4,089, -$1,507) compared with the UAMS in-person care group. Women receiving UAMS telemedicine had more prenatal care visits (10.45 vs 8.57; 95% CI: -2.96, -0.81), higher insulin use rates (41.86% vs 26.74%: 95% CI: 4.63%, 25.60%) and similar maternal care expenditures ($7,846 vs $7,051), compared with those receiving non-UAMS in-person care. Caesarean section, severe maternal morbidity, and infant mortality rates were similar across the three groups. ConclusionUAMS telemedicine was associated with improved utilization of prenatal care among pregnant women with pre-existing diabetes. Telemedicine services did not differ from usual in-person services in clinical outcomes and medical expenditures.

Incidence of chorioretinitis and endophthalmitis in hospitalized patients with fungemia.

Bloodstream candida infections can seed the eye via hematogenous spread and result in chorioretinitis or endophthalmitis. If undetected and untreated, this can result in permanent vision loss. Past studies evaluating incidence of ocular candidiasis among hospitalized patients with positive fungal blood cultures have demonstrated variable rates of occurrence, but recent studies have generally shown a lower incidence than was reported several decades ago. Given low rates of occurrence, the utility of screening patients with dilated fundus exams has been called into question. The primary aim of this investigation is to identify the rate of chorioretinitis and endophthalmitis based on dilated fundoscopy for patients with fungemia at a tertiary care hospital. This study was a retrospective chart review of adult patients admitted to the medical centre of the University of Arkansas for Medical Sciences (UAMS) between May 1, 2014 and December 31, 2017, who had positive fungal blood cultures during their hospitalization. There were 324 positive fungal cultures in 290 patients. Of this initial group, there were 161 eye exams. Ocular examination identified 7 of 161 patients (4.3%) with chorioretinitis or endophthalmitis. These outcomes along with previous studies support the current guidelines that screening with dilated fundus examination for these patients is appropriate and necessary.