University Of Mississippi Medical Center Research Articles

Resilient Assessment During COVID‐19

Resilient Assessment During COVID‐19

Base Pair: 28 Years of Sustained High School Biomedical Research Mentorship Driving Health Sciences Career Progression

Base Pair is an ongoing (1992-present) collaboration between University of Mississippi Medical Center (UMMC) faculty mentors and Mississippi high school students and teachers. UMMC faculty and Base Pair teachers designed a course which has allowed curriculum innovations by teachers. The student component engages 15 trainees annually in laboratory experiences under direct faculty mentorship while receiving high school graduation credit. Students have a 100% high school graduation rate (vs. ~88% nationally) and 99% college entrance. These students have co-authored/ presented over 450 times in UMMC, state or national venues. Of 220 graduates, roughly 63% are in/have completed post-baccalaureate training. Of these, at least 49 have gained a terminal degree in science or law, while another 35 students have attained a Master’s degree. Over 100 teachers have been mentored in grant-writing exercises and curriculum development, resulting in over 158 applications for external funding of inquiry-based classroom activities of which 78% were funded. Teachers have also implemented several innovative STEM curricula, reaching thousands more students. These include a student team-based competition that fuses citizen science and molecular biology to assess insect infection with Wolbachia bacteria. Base Pair bolsters student engagement, promotes STEM/health career advancement for students, and enhances teacher job satisfaction.

Prevalence of Psychological Disorders in Women with Polycystic Ovary Syndrome in Mississippi

Aim: This study is aimed to assess, for the first time the prevalence of polycystic ovary syndrome (PCOS) and associated psychological disorders among women at reproductive age from a state in southeastern US. Methods: The data was collected through “the Patient Cohort Explorer” system at the University of Mississippi Medical Center (UMMC) from January 2013 to December 2018. De-identified patients were searched with diagnosis code for PCOS, age, ethnicity, and associated diagnosis including weight gain, anxiety, depression, attention-deficit/hyperactivity disorder (ADHD), and other psychological concerns. Results: Collected data from 166,748 females (19-45 years) showed 1.4% (95% CI: 1.32 – 1.44) prevalence of PCOS in women seen in UMMC clinics during the period of study. Almost 51% of patients with PCOS suffered from one or more psychological disorders; anxiety 21% (95% CI: 19.3 – 22.6), depression 20% (95% CI: 18.9 – 22.1), ADHD 3.2% (95% CI: 2.6 – 4.0), bipolar disorder 2.5% (95% CI: 1.9 – 3.2). In addition, prevalence values suggest a positive correlation between obesity, anxiety, and depression in PCOS Patients. Conclusions: Results from this study provide 1) for the first time an estimate regarding the prevalence of PCOS and associated psychological disorders in women with PCOS in a southern state, 2) associated psychological disorders in PCOS women may be diverse based on race and ethnicity. Our data clearly highlight that the psychological well-being of women with PCOS are affected. Therefore, it is critical for the primary care and specialty clinics to use appropriate psychological screenings. Left undiagnosed and/or untreated, chronic psychological disorders may exacerbate physical and mental health conditions.

A Mobile Gaming Intervention for Persons on Pre-Exposure Prophylaxis: Protocol for Intervention Development and Randomized Controlled Trial.

BackgroundIn the United States, young minority men who have sex with men (MSM) are the most likely to become infected with HIV. Pre-exposure prophylaxis (PrEP) is an efficacious and promising prevention strategy. However, PrEP’s safety and effectiveness can be greatly compromised by suboptimal adherence to treatment. To maximize the positive impact of PrEP, it is necessary to combine its prescription with cost-effective behavioral interventions that promote adherence and decrease HIV risk behaviors. In this project, we developed a theoretically informed app/gaming intervention to engage young MSM in learning information, practicing behaviors, and improving motivation for HIV preventative behaviors and PrEP adherence.ObjectiveThe goal of this project was to develop and test a cutting-edge, engaging, and entertaining app/gaming intervention for improving adherence to PrEP and building HIV prevention knowledge, skills, and behavior.MethodsThis study was conducted in two phases. In the developmental phase, we conducted qualitative interviews with young MSM (n=20) to guide the development of the gaming intervention. In the randomized controlled trial, we tested the preliminary efficacy of the gaming intervention compared to a comparison condition among young MSM. Subjects were recruited from the University of Mississippi Medical Center HIV/STI testing clinics (n=60).ResultsInstitutional review board approval was received in February 2015. Research activities began in June 2015 and are still ongoing.ConclusionsThis app/gaming intervention aimed to improve PrEP adherence and HIV preventative behaviors in young MSM. Engaging young MSM in learning information, practicing behaviors, and improving motivation for increased adherence to PrEP has the potential to decrease HIV seroconversion. It is important to develop interventions that are enjoyable, engaging, and easily incorporated into clinical settings.Trial RegistrationClinicalTrials.gov RCT02611362; https://tinyurl.com/y65gkuwrInternational Registered Report Identifier (IRRID)DERR1-10.2196/18640

Cardiovascular Risk Factors Following Vertical Sleeve Gastrectomy in Black Americans Compared with White Americans.

Bariatric surgery presents a long-term solution for clinical obesity. Given that Black Americans (BA) carry a greater burden of obesity-related comorbidities than White Americans (WA), understanding the racial disparities regarding remission of obesity comorbidities following the most common bariatric surgery, sleeve gastrectomy (SG). The goal of the current study was to provide quantitative values related to cardiovascular and lipid outcomes following SG and determine if racial disparities exist between BA and WA. Data was collected from de-identified electronic medical records for patients receiving SG surgery at the University of Mississippi Medical Center in Jackson, MS, USA. Of 464 patients who obtained SG from (2013-2019), 64% were WA, and 36% were BA. Before surgery, BA had significantly greater body weight (BW), body mass index (BMI), and systolic (SBP) and diastolic (DBP) blood pressures (BP) in comparison with WA. Compared with WA, BA were predicted to lose 5.1kg less BW than WA at 1-year follow-up. Reduction in SBP (- 0.96 vs. - 0.60mmHg/doubling of days) and DBP (- 0.51 vs. - 0.26mmHg/doubling of days) was significantly higher in WA compared with BA. There was no racial difference in the change to total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, or triglycerides by race. When normalized to weight loss, the racial disparity in BP reduction was mitigated. These data indicate that BA lose less body weight following SG; however, loss of excess body weight loss is associated with improvement to BP similarly in both BA and WA.

Evaluation of a postpartum linkage and retention quality improvement initiative for women living with HIV in the Deep South

Retention in care leading to viral suppression is critical to the health of postpartum women living with HIV (WLWH). This quality improvement (QI) intervention was aimed at postpartum WLWH. Utilization of documented barriers and facilitators to retention in care for postpartum WLWH were applied to provide individualized case management and support services for postpartum WLWH who were referred to the outpatient adult HIV program at the University of Mississippi Medical Center. Comparison of post-intervention data showed a significant (p = 0.001) increase of viral suppression rates at 12 months postpartum when compared to the pre-intervention group; 88% vs 52% respectively. Results illustrate the potential impact that individualization of case management directed toward postpartum WLWH could have on future outcomes. Scale up of a low effort, low cost intervention such as the one conducted at this clinic could significantly improve the retention and viral suppression rates of postpartum WLWH in the United States; specifically, in the Southern region where retention and viral suppression rates remain exceedingly low.

High risk of psychological disorders: anxiety and depression in adolescent girls with polycystic ovary syndrome

Study objective: This study is aimed to assess the prevalence of psychological disorders among different racial/ethnic group of normal weight and overweight adolescents with polycystic ovary syndrome (PCOS)from a state in southeastern US. Design, setting, and participants: The data of 157,459 adolescents were collected through “the Patient Cohort Explorer” system at the University of Mississippi Medical Center (UMMC) from January 2013 to December 2019.Unidentified patients were searched with diagnosis code for PCOS, age, race/ethnicity, and associated diagnosis including weight gain, anxiety, depression, ADHD, and behavioral concerns. Interventions: None. Main outcome measures: Prevalence of PCOS and psychological disorders. Results: A total of 712 adolescents with PCOS were diagnosed in clinics during the period of study. Collected data indicated that prevalence of PCOS in adolescents seen in clinics was less than 1% with no significant difference by race or ethnicity. Almost 45% of patients suffered from one or more psychological disorders. (Anxiety: 18%, Depression: 16%, ADHD: 9%). Conclusions: Results from this study provide the first evidence of prevalence of PCOS and psychological disorders in adolescents with PCOS in a southern state. Our findings of a high prevalence of psychological disorders suggest that early screening for mental health symptoms must be considered during primary care clinical assessment of adolescents with PCOS. Left undiagnosed and/or untreated, chronic anxiety and depression may exacerbate mental health issues in this vulnerable population.

Abstract B21: Factors affecting outcomes in patients with squamous cell carcinoma of oropharynx

Abstract Objective: To study factors affecting outcomes such as overall survival (OS) and locoregional control (LRC), in patients with squamous cell carcinomas of oropharynx treated with definitive radiation therapy (RT), with or without concurrent chemotherapy. Method: Retrospective analysis of 83 patients with squamous cell carcinoma of oropharynx treated with definitive radiation therapy at University of Mississippi Medical Center. All patients were treated to 70 Gy utilizing intensity-modulated radiation treatment. Stage III and IV patients also received concurrent chemotherapy with weekly cisplatin. Chi-square test was used to test the goodness of fit, OS and LRC comparing races were generated by using log rank test and Kaplan-Meier method. The covariables associated with the OS and LRC were determined by multivariate Cox regression model. Hazards ratio (HR) was used to estimate time to event outcome with associated 95% confidence intervals (CIs) and P values. Median follow-up for the entire group was 39 months. Results: Of the total 83 eligible patients 51.8% were black, 48.5% were white, and 2.4% wee other. Stage distribution (per American Joint Committee on Cancer-AJCC 7th Ed) between blacks vs. whites for Stage I and II was 50% vs. 50%; for Stage III, 41.6% vs. 58.3%; and for Stage IV, 55.2% vs. 41.8%. In the univariate analysis, insurance, HPV/p16, body mass index (BMI), and race are the variables that affected the outcomes. In the multivariate analysis, HPV/p16, BMI, race, and tonsil subsite are shown to be significant. Age, gender, income level, employment, distance from facility, smoking, alcohol, and marital status are not shown to be significant. LRC for black patients was 49% vs. 72% in white patients (P = 0.022). Three-year OS for black patients was 49.2% vs. 66% for white patients (P = 0.010). HR for black patients was 0.13 with 95% CI 0.03- 0.61 (P= 0.009); HR for white patients was 0.24 with 95% CI 0.56- 1.06 (P= 0.061). OS for Stage IV black patients was 28% vs. 82% for white patients (P=0.006). In this cohort, HPV/p16 black positive patients were 75%, black negative 33%, white positive 87%, and white negative 50%, respectively. HR for HPV/p16 positive was 0.23 with 95% CI 0.07-0.71(P = 0.01). HR for tonsil subsite was 0.37 with 95% CI 0.15-0.91 (P=0.031). HR for BMI was 5.27 with 95% CI 1.79-15.5 (P = 0.003). The race, HPV/p16, BMI, and tonsil subsite were all independently associated with worse OS on multivariate analysis. HR for black patients was 0.16 with 95% CI 0.03-0.73 (P= 0.019), HR for HPV/p16 positive was 0.24 with 95% CI 0.07-0.73 (P = 0.013), HR for tonsil subsite was 0.41 with 95% CI 0.17-0.99 (P = 0.048), and HR for BMI was 5.59 with 95% CI 1.90-16.39 (P= 0.002). Race, HPV/p16, BMI, and tonsil subsite were all independently associated with worse locoregional failure on multivariate analysis. Conclusion: Among all the covariables examined, race, HPV/p16 status, BMI, and tonsil subsite were shown to be affecting the locoregional and overall survival outcomes. Racial factor appears to be more significant in patients with Stage IV disease. Citation Format: Mary R. Nittala, Eldrin Bhanat, Srinivasn Vijayakumar, Madhava R. Kanakamedala. Factors affecting outcomes in patients with squamous cell carcinoma of oropharynx [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B21.

4146 Establishment of Screening Methods for G6DP Deficiency – Translational and Clinical Applications

OBJECTIVES/GOALS: To develop feasible screening methods for activity of the enzyme Glucose-6-phosphate dehydrogenase (G6PD) with point of care applicability. METHODS/STUDY POPULATION: Current knowledge establishes the relevance of G6PD as a critical therapeutic determinant for effective antimalarial therapy due to the occurrence of mutations that lead to post-treatment severe adverse effects. We present our findings on development of cost effective point-of-care screening methodologies to ascertain G6PD deficiency. RESULTS/ANTICIPATED RESULTS: Using Patient Cohort Explorer and data from the Department of Pathology, we established the prevalence of G6PD deficiency at the University of Mississippi Medical Center, Jackson, MS as high as 11.8% (African-American males in all population, n = 2518). Next, for selection of potential target groups, we set up a protocol for recruitment of volunteers based on ethnic background, parental ethnicity, and medical history. G6PD activity was evaluated using point of care methods [Trinity Biotech test or CareSTART Biosensor], and Gold Standard quantitative spectrophotometric assay (LabCorp). Determinations in >20 subjects have showed comparable concordance. If used with a conservative interpretation of the signal, the Trinity Biotech test showed superior potential for use in the field relative to the CareSTART Biosensor. DISCUSSION/SIGNIFICANCE OF IMPACT: We established the prevalence of G6PD deficiency in our medical center. We have also setup tests for point-of-care assessment of G6PD. Pending evaluation of the relative tests performance, we will be in position to screen individuals and select them for a prospective clinical trial to evaluate the safety of antimalarial agents on scope of G6PD deficiency.

AJP-Regulatory, Integrative and Comparative Physiology: Looking Toward the Future

<i>AJP-Regulatory, Integrative and Comparative Physiology</i>: Looking Toward the Future

Do Undergraduate Choices Predict Medical Gross Anatomy Performance?

A 2019 study conducted by Robertson et al. suggested that the amount of prior anatomy experience does not predict the performance of first‐year medical students in medical gross anatomy at the University of Mississippi Medical Center (UMMC). In recent years, it has not been possible for UMMC to accept non‐state residents to its medical program. Thus, nearly seventy‐five percent of first‐year medical students matriculate from one of five major in‐state institutions. At current writing, four of the five schools directly communicate with the UMMC admissions program regarding the relationship between their courses and UMMC’s specific institutional mission. First‐year students enter UMMC with a wide range of previous undergraduate and graduate degrees. The undergraduate choices investigated were which institution(s) students attended, what type and how many degree(s) they attained, and whether they took an anatomy course prior to attending UMMC. We hypothesized 1) that undergraduate degree does not predict performance in a medical gross anatomy course, 2) individuals with science majors are more likely to have prior anatomy experience, 3) the collaboration of the previous institution with UMMC does not predict performance in a medical gross anatomy course, and 4) students from Mississippi College who have prior anatomy experience will perform better in the medical gross course at UMMC. Mississippi College implements a gross anatomy curriculum that is nearly identical to the course taught at UMMC. Data was collected from 280 first‐year medical students at UMMC in the fall of 2016 and fall of 2017. Using a self‐reported survey, data was collected on the number and type of prior degrees and prior anatomy experience. The course director provided student performance data in the medical gross anatomy course. The office of admissions of the medical school confirmed the prior degrees and previous academic institutions of the students. Quantitative analysis was used to determine the validity of the research hypotheses. The results of this study could provide additional guidance to undergraduate students during the degree selection process prior to applying to medical school.

Medical Students’ Fear of Death in a Gross Anatomy Course with Cadaveric Dissection

BackgroundPrior research suggests that medical students with higher fear of death are more likely to feel that providing care to terminally ill patients would have a negative personal impact. This negative perception concerning end‐of‐life care may carry into students’ careers as clinicians. Previous studies have shown that physicians with higher fear of death reported more difficulty in end‐of‐life communication and decision‐making. Because cadaveric dissection serves as an important introduction to death and dying issues, it is important to understand how this experience relates to students’ fear of death.AimThe current study aimed to identify which demographic characteristics are associated with medical student fear of death and describe how fear of death changes throughout the duration of a gross anatomy course with cadaveric dissection.MethodsProcedures were carried out according to the protocol approved by the Institutional Review Board of the University of Mississippi Medical Center (IRB # 2018‐0221) and informed consent was obtained from all participants. First year medical gross anatomy students’ were surveyed during the fall semester of 2019. Fear of death was surveyed using sixteen items from three subscales of the Multidimensional Fear of Death Scale (MFODS): Fear of the Dead (6 items), Fear of Being Destroyed (4 items), and Fear for the Body After Death (6 items). For each item, students use a Likert type scale to select the degree to which they agree or disagree with the statement, with lower scores indicating a higher fear of death. Baseline fear of death scores and demographic data (age, gender, undergraduate GPA, MCAT, and prior anatomy experience) were collected on the first day of the course, prior to beginning cadaveric dissection. These baseline scores were then correlated to demographics. To determine how fear of death changed throughout the course, the MFODS was also given at each of the four block examinations. This data was analyzed using repeated measures ANOVA.ResultsOf the 170 students invited to participate, 143 (84.1%) completed the baseline survey. Of those students, 57.3% had a prior anatomy experience while only 25.2% had prior exposure to cadavers. At the time of the baseline survey, average scores for the MFODS subscales were: Fear of the Dead (20.13 out of 30); Fear of Being Destroyed (13.57 out of 20); Fear for the Body After Death (22.99 out of 30). Complete data is currently being collected and analyzed.DiscussionResults of this study will determine if medical students’ fear of death is associated with specific demographic characteristics and how fear of death changes throughout a gross anatomy course. Understanding these relationships will allow instructors to implement interventions to support students with higher fear of death and identify a time point at which an intervention would be most beneficial. Ultimately, this would provide another means to support medical students and train physicians who are well equipped to handle end‐of‐life issues.

A Cancer Center and Research Institute at the University of Mississippi Medical Center.

A Cancer Center and Research Institute at the University of Mississippi Medical Center.

The Role of Public Health Partnerships in the Success of the Jackson Heart Study Undergraduate Training and Education Center.

The Jackson Heart Study (JHS) is a single-site prospective epidemiologic investigation of cardiovascular disease (CVD) among African Americans from the central Jackson, Mississippi area. The study is a collaboration between Jackson State University (JSU), University of Mississippi Medical Center (UMMC), Tougaloo College (TC), and the Mississippi State Department of Health (MSDH). The JHS Undergraduate Training and Education Center (JHSUTEC) at TC was developed to increase the numbers of college-aged African American students entering public health and health-related fields. To achieve this goal, the UTEC designed the Jackson Heart Study (JHS) Scholars program. JHS Scholars are required to take additional classes and participate in public health and/or biomedical research. The scholars engage in research locally during the academic year. However, many scholars participate in research outside of the Jackson Metropolitan area during the summer. Because of this, national collaborators were needed to act as mentors and hosts. Since the inception of the JHSUTEC, more than 15 collaborations have been formed that have shared resources and student successes. As of May 2018, more than150 students have successfully completed the JHS Scholars program and many have continued into careers in public health, biomedical research, and medicine. Since 2004, JHS scholars have published 29 papers and 15 scholars have received diversity supplements. Collaborative activities and public health partnerships have contributed to the success of the JHSUTEC program and have served as a pathway of entry into STEM fields for minority students.

Research Highlights

Daniel Zieman, BA, University of South Alabama College of Medicine, Mobile, AL. Caroline Doo, MD, Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, MS. Vinayak K. Nahar, MD, PhD, MS, FRSPH, Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, and Department of Preventive Medicine, School of Medicine/John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS. The authors declare no conflict of interest. Correspondence concerning this article should be addressed to Vinayak K. Nahar, MD, PhD, MS, FRSPH, Department of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street–L216, Jackson, MS 39216. E-mail: [email protected]; [email protected]

Editorial.

The year 2020 has been designated as the “Year of the Nurse and Midwife” by the World Health Organization, in honor of the 200th anniversary of the birth of Florence Nightingale. Although midwives are only occasionally involved in the care of individuals with MS, the essential role of nursing professionals in the comprehensive management of the disease cannot be overemphasized. Indeed, nurses are often at the forefront, ensuring optimal continuity and coordination of care and providing ongoing communication with the patients and their families, and with other health care professionals. While we have been publishing articles specifically dedicated to nursing research and nursing practice in IJMSC, I do hope to see more submissions from our nurse colleagues in 2020.The article selected for continuing education credits in this issue focuses on an alternative treatment used and contemplated by some people with MS: helminth immunotherapy. Along with increasingly potent disease-modifying therapies targeting the immune system, other less conventional treatment avenues are being proposed, and are often the source of heated discussions on public online forums. Our patients expect us to educate them about all options available, yet the evidence regarding alternative treatments is often limited or conflicting. Donkers and colleagues give us insight into patients' thoughts about helminth immunotherapy, which is an important first step in fostering better conversations and educational opportunities.Outcome measurement is an increasingly common discussion topic in clinical practice nowadays. Two articles in this issue reflect ongoing work on the validity and clinical relevance of outcome scales in MS, whether they are clinician-administered such as the Expanded Disability Status Scale (Alonso and colleagues) or self-administered such as the Multiple Sclerosis Self-Management Scale–Revised (Saadat and colleagues).I often explain to health care professionals in training that a diagnosis of MS does not describe the impact of the disease on a person's daily activities. The study by Goverover and colleagues reminds us of the pervasive decrease in activity participation experienced by patients with MS and of the association between neurologic deficits (such as motor and cognitive impairment) and comorbidities (such as depression) and these limitations. Fortunately, we also know that physical activity and exercise can help fight the consequences of MS, as illustrated by the articles from Canning and Hicks and from Kasser and colleagues. Another common consequence of MS is chronic pain. The results from the randomized controlled trial of cognitive behavioral therapy reported by Gromisch and colleagues suggest that this therapy could be a useful intervention, at a time when nonpharmacologic interventions for chronic pain management are increasingly sought after.I am delighted to announce that Dr. Alissa Willis, Chair of the Department of Neurology at the University of Mississippi Medical Center, has joined our editorial team as Associate Editor starting January 2020 after having served as a board member for many years. Our entire team wishes you a happy and fulfilling year.

Promises Unbroken: A Commitment to Diversity and Inclusion at the University of Mississippi Medical Center.

Promises Unbroken: A Commitment to Diversity and Inclusion at the University of Mississippi Medical Center.

Continuing the Vision at the University of Mississippi Medical Center.

Continuing the Vision at the University of Mississippi Medical Center.

Acute kidney injury associated with preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome.

To determine the prevalence of acute kidney injury (AKI), placental abruption and postpartum hemorrhage in patients with preeclampsia or HELLP syndrome. A retrospective study of patients with preeclampsia or HELLP syndrome treated at the University of Mississippi Medical Center from January 2000 through December 2010. Relationships among the obstetric complications of placental abruption, postpartum hemorrhage, and AKI (serum creatinine >107µmol/L) of women with preeclampsia or HELLP syndrome. Additional analysis was undertaken to explore if there was a correlation between postpartum hemorrhage/placental abruption and the severity of HELLP syndrome according to the Mississippi classification system. Data from 1276 women over 11years were included in the analysis. 67 of 466 patients (14.4%) with HELLP syndrome and 38 of 810 preeclampsia patients (4.7%) met criteria for AKI. Women with either placental abruption or postpartum hemorrhage had statistically significant increased odds of also having AKI (p<0.01). Women with HELLP and AKI were also more likely to experience either placental abruption or postpartum hemorrhage. Women with Class 1 HELLP with placental abruption or postpartum hemorrhage were also more likely to have AKI than women with preeclampsia. HELLP syndrome, AKI and placental abruption or postpartum hemorrhage appear to be interrelated. AKI occurs more frequently in women with HELLP syndrome with or without associated postpartum hemorrhage and placental abruption.

The University of Mississippi Medical Center's Path for Quality Improvement.

The University of Mississippi Medical Center's Path for Quality Improvement.