University Of Texas Health Science Center At San Antonio Research Articles

TGF-β-dependent Lymphoid Tissue Residency of Stem-like T cells Limits the Response to Tumor Vaccine

Abstract Stem-like CD8+ T cells represent the key subset responding to multiple tumor immunotherapies, including tumor vaccination. However, the signals that control the differentiation of stem-like T cells are not entirely known. Most previous investigations on stem-like T cells are focused on tumor infiltrating T cells (TIL). The behavior of stem-like T cells in other tissues remains to be elucidated. Tissue-resident memory T cells (TRM) are often defined as a non-circulating T cell population residing in non-lymphoid tissues. TILs carrying TRM features are associated with better tumor control. Here, we found that stem-like CD8+ T cells differentiated into TRMs in a TGF-β and tumor antigen dependent manner almost exclusively in tumor draining lymph node (TDLN). TDLN-resident stem-like T cells were negatively associated with the response to tumor vaccine. In other words, after tumor vaccine, TDLN stem-like T cells transiently lost TRM features, differentiated into migratory effectors and exerted tumor control. This work is supported by NIH grants AI125701 and AI139721, Cancer Research Institute CLIP program and American Cancer Society grant RSG-18-222-01-LIB to N.Z. Data generated in the Flow Cytometry Shared Resource Facility were supported by the University of Texas Health Science Center at San Antonio (UTHSCSA), NIH/NCI grant P30 CA054174-20 (Clinical and Translational Research Center [CTRC] at UTHSCSA), and UL1 TR001120 (Clinical and Translational Science Award).

Cultural Resources Investigations for the University of Texas Health Science Center at San Antonio Project, Bexar County, Texas

At the request of TriLeaf Corporation (TriLeaf), SWCA Environmental Consultants (SWCA) conducted a cultural resources investigation for the University of Texas Health Science Center at San Antonio (UTHSCSA) Project (Project) located in Bexar County, Texas. The Project involves the installation of a 432-foot-long (132-meter [m]-long) fiber-optic communication line directly south of Floyd Curl Drive in northwest San Antonio, Texas. The total disturbance of the proposed Project area measures approximately 0.28 acre (0.1 hectare [ha]) in size. The Project area is situated on the grounds of UTHSCSA and located approximately 8.48 miles (13.65 kilometers [km]) from downtown San Antonio. At its nearest, Zarzamora Creek is 40 feet (12 m) northwest of the Project area. The proposed Project includes property owned by the UTHSCSA, a political subdivision of the state of Texas, and is therefore subject to review by the Texas Historical Commission (THC) under the Antiquities Code of Texas (ACT) and the City of San Antonio Office of Historic Preservation (SA-OHP) under the Historic Preservation and Design Sections of the City of San Antonio’s Unified Development Code (UDC) (Article VI 35-606). SWCA conducted all work in accordance with the standards and guidelines set forth by the THC and the Council of Texas Archaeologists under ACT Permit No. 9311. The purpose of the investigation was to identify and assess any cultural resources, such as historic and prehistoric archaeological sites and historic buildings, structures, objects, and sites (such as cemeteries) that might be located within the boundaries of the proposed Project area and evaluate the significance of these cultural resources. Investigations consisted of a background literature and historical map review and monitoring of mechanical trench excavations within the Project area. SWCA conducted all investigations in accordance with the standards and guidelines established by the THC and the Council of Texas Archeologists. The background review determined that the Project area has not been previously surveyed for cultural resources, and three cultural resources investigations and three previously recorded cultural resources occurred within a 1.0-mile (1.6-km) radius of the Project area. SWCA’s intensive archaeological monitoring was performed during construction activities that occurred on April 7–14, 2020. All work within the Project area was conducted within moderately disturbed deposits. SWCA observed no subsurface cultural materials and no cultural features or temporally diagnostic artifacts were encountered. In accordance with the City of San Antonio UDC and the ACT, SWCA has made a reasonable and good faith effort to identify cultural resources properties within the Project area. No properties were identified within the Project area that may meet the criteria for listing as a State Antiquities Landmark, nor as a Historic Landmark or District according to the UDC. Therefore, SWCA recommends that no additional cultural resources investigations are warranted within the UTHSCSA Project Area, as currently defined. Following the review and acceptance of the final cultural resources report, all records and photographs will be curated with the Center for Archaeological Research at the University of Texas at San Antonio, per requirements of the ACT.

Abstract A85: Challenges in developing pediatric cancer care in Southern Vietnam

Abstract Worldwide, cancer has superseded infection and heart disease as the leading cause of death. Generally viewed as a lesser public health priority in lower to middle income countries (LMIC), 60% of the children worldwide have limited access to effective cancer diagnosis, therapy and supportive care measures. As a result, relapse and treatment related toxicities with fatal outcomes contribute significantly to decreased survival rates compared to developed countries. Survival rates as low as 5% have been previously been reported in Vietnam. These reports utilized surveys based on face-to-face interviews that extrapolated incidence rates and survival data. Below the 17th parallel the region of southern Vietnam remains isolated with limited access to modern research collaborations and methodologies. Currently, Ho Chi Minh City provides the region's primary pediatric oncology clinical setting. Three hospitals, Blood and Transfusion Hospital, Children's Hospital #2, and Oncology Hospital provide care for the surrounding population of 40 million. Recognizing that the definitions of underserved populations have blurred in relation to global communities, the University of Texas Health Science Center at San Antonio (UTHSCSA) and the Kids with Cancer Foundation of Vietnam have collaborated to evaluate clinical and educational challenges to improving healthcare delivery in Vietnam. Faculty from UTHSCSA have travelled to southern Vietnam on multiple occasions to interact and help identify gaps in care and academic based infrastructure. Interviews with local hospital administrators, medical school educators, physicians, and nursing staff were undertaken. Local institutional data were also reviewed. Observerships in the United States for Vietnamese pediatric oncologists were also established focusing on establishing on-going mentorship, clinical education, and the development a regional leukemia treatment protocol. Demographics and clinical data were collected at Oncology Hospital in Ho Chi Minh City, Vietnam for pediatric cancer patients diagnosed from 2003 through 2012. 4534 pediatric oncology cases were identified. The breakdown of cases by classification were similar to USA statistics with the exception of brain tumors, which represented only 5% of cases. Survival statistics were analyzed for certain disease groups. Acute lymphoblastic leukemia (ALL) cases had a 66.2% 5 yr OS. Hodgkin Lymphoma cases had a 92% 5 yr OS. NHL cases had a 41% OS. Rhabdomyosarcoma cases had a 50% 5 yr OS. Wilms Tumor analysis noted 78.67% 5 yr OS. Hepatoblastoma analysis revealed 42.8% 2 yr OS and Osteosarcoma analysis revealed 13.58% 5 yr OS. While these survival rates were better than the previously reported 5% for the region, they are still below survival rates in Western developed countries. The pronounced successes in pediatric cancer survival have been well documented and owe a significant debt to the advent of cooperative groups and a focus on basic research. Specific barriers identified in southern Vietnam included: the lack of a cooperative group structure to provide common treatment regimens amongst institutions, the lack of a central cancer registry, the lack of knowledge of genetic variance and tumor phenoptypes in the population, limited basic science infrastructure and training, the underutilization of reference laboratories, and the inability to ship specimens outside of the country. Political pressure represents a strong influencing factor in how such data is utilized. Importantly, although there are a growing number of young and clearly highly capable physicians interested in pediatric cancer, there are no formal training programs specifically focused on childhood cancer. Citation Format: Chatchawin Assanasen, Vivienne Rebel, Gail Tomlinson. Challenges in developing pediatric cancer care in Southern Vietnam. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A85.

Abstract P5-05-13: Obesity confers chemotherapy resistance in triple negative breast cancer cells

Abstract Introduction: Obesity is associated with a more aggressive breast cancer and a worse outcome following chemotherapy treatment. Triple negative breast cancer is a highly aggressive subtype of breast cancer characterized by the absence of estrogen, progesterone, and human epidermal growth factor-2 (HER2) receptors. This subtype has also been correlated with a worse prognosis. This study aims to investigate the impact of obesity on triple negative breast cancer cells’ response to chemotherapy treatment and elucidate potential therapeutic options to improve response. Methods: Sera was collected from breast cancer patients at the Cancer Therapy and Research Center at The University of Texas Health Science Center at San Antonio (UTHSCSA) and pooled according to body mass index (BMI) category (Control:18.5 to 24.9 kg/m2; Obese:≥30 kg/m2). MDA-MB-231 cells, a triple negative breast cancer cell line, were grown in serum-free media supplemented with 2% obese or control patient sera to create an in vitro model of obesity. The effects of docetaxel, a chemotherapeutic agent, on cell viability in the presence of obese versus control sera were examined by MTT. Modulation of B-cell lymphoma 2 (Bcl-2), cyclooxygenase-2 (COX-2), and mammalian target of rapamycin (mTOR) were evaluated as possible mechanisms for obesity-induced chemotherapy resistance. Results: The obese sera significantly reduced sensitivity of the MDA-MB-231 cells to docetaxel. In fact, there was no variance in the viability level of cells grown in obese patient sera for 96 hours with and without docetaxel treatment. The mechanism for resistance does not appear to involve Bcl-2 or COX-2, previously implicated in docetaxel resistance. Intriguingly, suppression of mTOR did provide significant benefit, in agreement with our previous in vivo studies investigating obesity and aromatase inhibitor (AI) response. The role of the mTOR pathway in modulating therapeutic response is still being investigated. Conclusion: Exposure to obesity-associated circulating factors confers chemotherapy resistance in triple negative breast cancer cells. Further research will be conducted to determine the mechanism by which obesity promotes chemotherapy resistance and whether modulation of the mTOR pathway will provide significant benefit. Citation Format: Victoria R Lehrmann, Laura W Bowers, Andrew J Brenner, Linda A deGraffenried. Obesity confers chemotherapy resistance in triple negative breast cancer cells [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-05-13.

Applied neuroanatomy elective to reinforce and promote engagement with neurosensory pathways using interactive and artistic activities.

One in six Americans is currently affected by neurologic disease. As the United States population ages, the number of neurologic complaints is expected to increase. Thus, there is a pressing need for more neurologists as well as more neurology training in other specialties. Often interest in neurology begins during medical school, so improving education in medical neural courses is a critical step toward producing more neurologists and better neurology training in other specialists. To this end, a novel applied neuroanatomy elective was designed at the University of Texas Health Science Center at San Antonio (UTHSCSA) to complement the traditional first-year medical neuroscience course and promote engagement and deep learning of the material with a focus on neurosensory pathways. The elective covered four neurosensory modalities (proprioception/balance, vision, auditory, and taste/olfaction) over four sessions, each with a short classroom component and a much longer activity component. At each session, students reviewed the neurosensory pathways through structured presentations and then applied them to preplanned interactive activities, many of which allowed students to utilize their artistic talents. Students were required to complete subjective pre-course and post-course surveys and reflections. The survey results and positive student comments suggest that the elective was a valuable tool when used in parallel with the traditional medical neuroscience course in promoting engagement and reinforcement of the neurosensory material.

Children’s Lives on the Border

* Abbreviations: CforC — : Community for Children ORR — : Office of Refugee Resettlement UAC — : unaccompanied alien children UTHSCSA — : University of Texas Health Science Center at San Antonio Prolonged fear can have deleterious effects on the trajectory of a child’s health and can be considered “toxic stress.”1 Hundreds of thousands of Hispanic children living along the Texas-Mexico border are exposed to fear and discrimination on a daily basis. The authors have 35 years combined experience advocating for such children. Dr Son, a professor of pediatrics in the Division of Critical Care at the University of Texas Health Science Center at San Antonio (UTHSCSA), has extensive experience teaching and providing medical care on the Texas-Mexico border and areas of limited resources. Dr Griffin is a pediatrician at Brownsville Community Health Center, a federally qualified health center in south Texas, and is clinical faculty at UTHSCSA. Eliot Shapleigh served as Texas state senator from 1997 to 2011. Senator Shapleigh’s political career continues to focus on the needs of border children. In 2006, Drs Son and Griffin cofounded Community for Children (CforC), a UTHSCSA-sponsored international elective in community pediatrics on the Texas-Mexico border. Its focus is to train young physicians to address social justice issues. Information can be found at www.communityforchildren.org. Senator Eliot Shapleigh is a frequent visiting speaker with CforC. The authors believe that the children’s situation along the Texas-Mexico border has become dire. We write this perspective to inform other pediatricians and to solicit their advocacy on behalf of these children. Two institutions have done the most research on these children: the Women’s Refugee Commission and the Vera Institute. More information regarding these institutions and the results of their research can be found in the … Address correspondence to Marsha Griffin, MD, Brownsville Community Health Center, 191 East Price Rd, Brownsville, TX 78521. E-mail: griffinmrcfc{at}gmail.com

Specialty Education in Periodontics in Japan and the United States: Comparison of Programs at Nippon Dental University Hospital and the University of Texas Health Science Center at San Antonio

Japan has institutions that train qualified postdoctoral students in the field of periodontics; however, Japan does not have comprehensive advanced periodontal programs and national standards for these specialty programs. To help Japanese programs move toward global standards in this area, this study was designed to describe overall differences in periodontics specialty education in Japan and the United States and to compare periodontics faculty members and residents' characteristics and attitudes in two specific programs, one in each country. Periodontal faculty members and residents at Nippon Dental University (NDU) and the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School participated in the survey study: four faculty members and nine residents at NDU; seven faculty members and thirteen residents at UTHSCSA. Demographic data were collected as well as respondents' attitudes toward and assessment of their programs. The results showed many differences in curriculum structure and clinical performance. In contrast to the UTHSCSA respondents, for example, the residents and faculty members at NDU reported that they did not have enough subject matter and time to learn clinical science. Although the residents at NDU reported seeing more total patients in one month than those at UTHSCSA, they were taught fewer varieties of periodontal treatments. To provide high-quality and consistent education for periodontal residents, Japan needs to establish a set of standards that will have positive consequences for those in Japan who need periodontal treatment.

Abstract P5-05-08: Obesity suppresses estrogen receptor beta expression in breast cancer cells via a HER2-mediated pathway

Abstract Purpose: Increased levels of estrogen receptor beta (ERb) are correlated with an improved breast cancer prognosis. Our preliminary data suggests that obesity may decrease ERβ expression in certain breast cancer subtypes and may contribute to the more aggressive disease associated with obesity. This study aims to elucidate a potential mechanism(s) mediating this suppression. Experimental Design: We utilized an in vitro model of obesity in which breast cancer cells were exposed to sera collected from postmenopausal breast cancer patients at the Cancer Therapy and Research Center at the University of Texas Health Science Center at San Antonio (UTHSCSA) and pooled by BMI category (obese (OB): ≥30 kg/m2; normal weight (NW): 18.5-24.9 kg/m2). Four human mammary tumor cell lines were used: SKBR3 (HER2 over-expressing, ERα negative), MCF-7 and ZR75 (ERα positive, HER2 negative) and MDA-MB-231 (triple negative), in addition to the mouse mammary tumor cell line, MMTV/neu (HER2 over-expressing). The effects of the sera on ERβ expression were assessed by qPCR. Protein expression levels were determined using Western blot analyses. Herceptin, a HER2 antagonist, was used to evaluate the role of HER2 in OB sera-induced ERβ modulation. Results: OB sera exposure led to lower ERβ expression in SKBR3 and MMTV/neu cells in comparison to NW. Treatment of the SKBR3 cells with Herceptin at the time of OB sera exposure resulted in a three-fold increase in ERβ expression. In contrast, there was only a small increase in SKBR3 cell ERβ expression when Herceptin was added to NW sera, suggesting that the effects of the OB sera may be mediated by HER2 activity. In support of this hypothesis, exposure to OB versus NW sera did not modulate ERβ expression in MDA-MB-231, MCF-7 and ZR75 cells, which have very low levels of HER2. Lapatinib, another HER2 antagonist, will be used to inhibit HER2 signaling in MMTV/neu cells. On-going studies utilizing siRNA to the HER2 receptor aim to elucidate the HER2-regulated pathways contributing to the ERβ suppressing effects of OB sera in SKBR3 cells. Conclusion: Based on our preliminary data, we hypothesize that obesity suppresses ERβ expression in breast cancer cells via a HER2-mediated pathway. Elucidation of the mechanism(s) mediating this effect could provide important insight into both the regulation of ERβ expression as well as how obesity promotes a more aggressive disease. Increased knowledge regarding the regulation of this effect may result in the identification of a new treatment target for the obese breast cancer patient population. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-05-08.

Determining the Applicability of the Landauer nanoDot as a General Public Dosimeter in a Research Imaging Facility

The Research Imaging Institute (RII) building at the University of Texas Health Science Center at San Antonio (UTHSCSA) houses two cyclotron particle accelerators, positron emission tomography (PET) machines, and a fluoroscopic unit. As part of the radiation protection program (RPP) and meeting the standard for achieving ALARA (as low as reasonably achievable), it is essential to minimize the ionizing radiation exposure to the general public through the use of controlled areas and area dose monitoring. Currently, thirty-four whole body Luxel+ dosimeters, manufactured by Landauer, are being used in various locations within the RII to monitor dose to the general public. The intent of this research was to determine if the nanoDot, a single point dosimeter, can be used as a general public dosimeter in a diagnostic facility. This was tested by first verifying characteristics of the nanoDot dosimeter including dose linearity, dose rate dependence, angular dependence, and energy dependence. Then, the response of the nanoDot dosimeter to the Luxel+ dosimeter when placed in a continuous, low dose environment was investigated. Finally, the nanoDot was checked for appropriate response in an acute, high dose environment. Based on the results, the current recommendation is that the nanoDot should not replace the Luxel+ dosimeter without further work to determine the energy spectra in the RII building and without considering the limitation of the microStar reader, portable on-site OSL reader, at doses below 0.1 mGy (10 mrad).

Differences in fibrin fiber diameters in healthy individuals and thromboembolic ischemic stroke patients

Cerebrovascular disease is one of the leading causes of death and the cause of long-term adult disability. An important characteristic of thromboembolic ischemic stroke is a prothrombotic or hypercoagulable state and altered fibrin clot structure, whereas a resistance to fibrinolysis is also present. An expansive fibrin network is created when adding thrombin, and in stroke, the network appears thickened, netted and matted, compared with that of healthy individuals. Although this is clearly visible in micrographs of patients, there is a need to quantify the changes. The current study, therefore, investigates fibrin fiber diameters in stroke patients and compares it to healthy individuals. The fiber diameters were measured in nanometres, with University of Texas Health Science Center at San Antonio (UTHSCSA) Image Tool. A total of 100 measurements were done for each of the 12 patients in the healthy control group, and the same number of measurements was done for 12 stroke patients. These measurements were statistically analysed with NCSS 2007, using a significance level of 0.05. Normality was assessed with the Shapiro-Wilk W test and the thickest and thinnest fiber of each individual in the two groups was quantified and differences between groups were assessed with the Student's t-test. Results showed that there is a statistical difference in fibrin fiber thickness during thromboembolic ischemic stroke. We conclude that the changed coagulation and hemostasis, typically associated with stroke, causes a statistically relevant change in fibrin thickness, and that this netted and matted network is more resistant to lyses.

Long-term outcomes of the ¡VIVA! Peer Tutor Project: use of MedlinePlus by former peer tutors and the adults they taught

In 2001, Biblioteca Las Americas (BLA), a school library in the South Texas Independent School District (STISD), began the Vital Information for a Virtual Age (iVIVA!) Peer Tutor Project, in which high school students promote MedlinePlus in their high schools and communities. MedlinePlus and its companion site, MedlinePlus en espanol, are consumer health information websites maintained by the National Library of Medicine (NLM) [1]. Approximately 80% of the STISD student population is Hispanic [2]. The district serves counties that are medically underserved [3] and have poverty rates that are double the national average [4].{ The iVIVA! Peer Tutor Project started as a partnership between the University of Texas Health Science Center at San Antonio (UTHSCSA) Libraries and BLA, when the former received funding from NLM to conduct health information outreach projects in the Texas Lower Rio Grande Valley [5]. Four high school students from the STISD’s South Texas High School for Health Professions (Med High), with training and guidance from a UTHSCSA medical librarian, taught their peers and faculty members about MedlinePlus in the first year of the project. The project is now administered directly by BLA and has been extended to all four high schools in the district, which consists of two health careers high schools; a science and technology high school; and a business, education, and technology high school. NLM has supported the project for almost ten years, through funding either to STISD or UTHSCSA. The school district’s administrators have strongly endorsed the project, and the BLA librarians have built a network of librarians and faculty who actively participate as mentors and advisors. Details of the project and its evaluation were published in 2005 [6]. Peer tutors promote MedlinePlus to their peers and teachers through class demonstrations, student orientations, school health fairs, and extracurricular activities such as the Health Occupations Students of America meetings. Over the years, they have extended their reach to parents and the community through school open houses, local health fairs, fun runs, and motorcycle rallies. A popular outreach site for peer tutors is the Harlingen Boys and Girls Club, where they promote health information to children and teens. The 2005 article published assessment results from a questionnaire completed by 500 Med High students in 2003, at the end of the project’s first year. Results showed that 66% of respondents reported using MedlinePlus and 52% had referred the resource to others [6]. More recent evaluation data, described in iVIVA! subcontract reports, showed high awareness of MedlinePlus among STISD students. For example, * This project was funded by the National Library of Medicine under contract (N01-LM-6-3505) with the Houston Academy of Medicine-Texas Medical Center Library through a subcontract with the South Texas Independent School District (STISD), which was solely responsible for project planning, implementation, and evaluation.

Vascular and Alzheimer's Disease pathologies in relation to cognitive decline: Data from the Einstein Aging Study Autopsy series

P2-127 THE IMPACT OF DEPRESSION ON COGNITION VARIES BYAPOE4 STATUS Andrew Dentino, James Hall, Robert Barber, Rachelle Doody, Donald Royall, Sidney O’Bryant, Texas Tech University Health Sciences Center (TTUHSC)/Texas Alzheimer’s Research and Care Consortium (TARCC), Lubbock, Texas, United States; University of North Texas Health Sciences Center (UNTHSC)/Texas Alzheimer’s Research and Care Consortium (TARCC), Fort Worth, Texas, United States; Baylor College of Medicine (BCOM)/Texas Alzheimer’s Research and Care Consortium (TARCC), Houston, Texas, United States; University of Texas Health Science Center at San Antonio (UTHSCSA)/Texas Alzheimer’s Research and Care Consortium (TARCC), San Antonio, Texas, United States.

Development and Implementation of an Online Screening Application at the University of Texas Health Science Center at San Antonio Dental School

This article describes a quality improvement (QI) initiative that is in process at the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School and the website that grew out of this effort. The process of screening and assignment of patients was selected for improvement in 2006. QI methods were used to develop a website that improves access to care for patients and assists in the matching of patients and students. The website (www.dentalscreening.com) has received more than 15,000 screening applications in the period from May 2007 to January 2010 and has provided unprecedented insight into the needs of our patients. This article outlines the process by which the website was created, the rationale for the design, and the benefits of establishing a screening website for any dental school. The program was developed entirely at UTHSCSA, but it addresses a problem that may affect many dental schools.

Case Report: Variably Compliant Transtibial Prosthetic Socket Fabricated Using Solid Freeform Fabrication

Achieving and maintaining a comfortable fit in a lower-limb prosthetic socket is an important goal to help ensure a successful rehabilitation. The purpose of this case study was to assess the performance of sockets with compliant features integrated into the socket wall to relieve in-socket pressure during transtibial amputee gait. Two sockets incorporating variably compliant areas over the fibula head and distal tibia were fabricated for a transtibial amputee. The two sockets were designed with different levels of compliance and were compared with a third more conventional socket without compliant areas. All three sockets were otherwise geometrically identical and were aligned identically to eliminate in-socket pressure differences due to alignment. The three sockets were fabricated using selective laser sintering, a form of solid freeform fabrication. The in-socket pressure measurements were acquired during normal walking. Tekscan F-Socket pressure sensors were attached to the amputee’s residual limb rather than to the socket wall, which made it possible to measure pressures in the same location on the residual limb upon change of socket. A Vicon motion capture system was used to match in-socket pressures to the subject’s gait cycle. The pressure measurements showed that the compliant socket peak pressures over the distal tibia and fibula head were similar for the two compliance levels and nearly 50% and 30% lower than the conventional socket pressures, respectively. This case study showed that selective laser sintering manufactured sockets with variably compliant regions holds great promise for reducing contact pressure in sensitive regions of the residual limb. (J Prosthet Orthot. 2008;20:1‐7.) KEY INDEXING TERMS: prosthetic socket, amputees, CAD, CAM, solid freeform fabrication T he most important aspect of a lower extremity transtibial prosthesis is the socket design. The socket introduces a new interface or a new joint between the human and the mechanical support system. The forces generated through the socket either by body weight or by gait have to be carried by the soft tissue of the residual limb, which when improperly loaded can lead to discomfort or skin breakdown. Ultimately, the design and fit of the socket is what determines patient acceptance, comfort, suspension, and energy expenditure. 1 Achieving and maintaining a comfortable and tissue-tolerant socket fit remains a significant clinical problem. This study explores the use of new manufacturing techniques to fabricate sockets with integrated compliant features specifically designed to improve comfort and fit of the prosthesis.

Advanced Trans-Tibial Socket Fabrication Using Selective Laser Sintering

There have been a variety of efforts demonstrating the use of solid freeform fabrication (SFF) for prosthetic socket fabrication though there has been little effort in leveraging the strengths of the technology. SFF encompasses a class of technologies that can create three dimensional objects directly from a geometric database without specific tooling or human intervention. A real strength of SFF is that cost of fabrication is related to the volume of the part, not the part's complexity. For prosthetic socket fabrication this means that a sophisticated socket can be fabricated at essentially the same cost as a simple socket. Adding new features to a socket design becomes a function of software. The work at The University of Texas Health Science Center at San Antonio (UTHSCSA) and University of Texas at Austin (UTA) has concentrated on developing advanced sockets that incorporate structural features to increase comfort as well as built in fixtures to accommodate industry standard hardware. Selective laser sintering (SLS) was chosen as the SFF technology to use for socket fabrication as it was capable of fabricating sockets using materials appropriate for prosthetics. This paper details the development of SLS prosthetic socket fabrication techniques at UTHSCSA/UTA over a six-year period.

Copyright Knowledge of Faculty at Two Academic Health Science Campuses: Results of a Survey

To determine whether health sciences faculty are sufficiently knowledgeable about copyright, fair use, and related precepts in their use of materials for teaching and research purposes, librarians at two comparable institutions, the University of Alabama at Birmingham (UAB) and the University of Texas Health Science Center at San Antonio (UTHSCSA), conducted a Web survey regarding copyright knowledge among their respective faculty. Responses were similar from both institutions despite the fact that UTHSCSA faculty had access to a more coordinated copyright education effort. Most respondents self-reported at least a limited familiarity with copyright law and fair use.

Copyright Knowledge of Faculty at Two Academic Health Science Campuses: Results of a Survey

To determine whether health sciences faculty are sufficiently knowledgeable about copyright, fair use, and related precepts in their use of materials for teaching and research purposes, librarians at two comparable institutions, the University of Alabama at Birmingham (UAB) and the University of Texas Health Science Center at San Antonio (UTHSCSA), conducted a Web survey regarding copyright knowledge among their respective faculty. Responses were similar from both institutions despite the fact that UTHSCSA faculty had access to a more coordinated copyright education effort. Most respondents self-reported at least a limited familiarity with copyright law and fair use.

Outcome Assessment of the Dental Early Acceptance Program

The University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School recruits a student body from a wide number of undergraduate institutions, primarily in Texas. One method supporting this effort is the Dental Early Acceptance Program (DEAP). This program is unique in that it grants conditional acceptance to dental school during a student's first year of undergraduate education and admission upon completion of three years of college coursework as directed by the student's undergraduate academic advisor. The purpose of this study was to assess and compare the academic performance of DEAP students to students accepted through the standard competitive admissions process. The academic records of all students matriculating into our dental school between 1993 and 1996 were examined. National Board Dental Examination Parts I and II scores, the cumulative dental school and college GPAs, DAT scores, and demographic data were recorded. The data were analyzed descriptively and statistically. Graduation rates were 92 percent for DEAP students and 94 percent for standard admissions students. Comparison of college cumulative GPA between the two groups showed no statistically significant difference. A significant difference was found between the groups in their dental school cumulative GPA. In a comparison of National Board Examination scores, DEAP students had a significantly lower NBDE Part I mean score (82.9) than standard admissions students (85.8). DEAP students also showed significantly lower NBDE Part II scores (80.4) than standard admissions students (82.4).

The Impact of Operative Complexity on Patient Risk Factors

The VA National Surgical Quality Improvement Program (NSQIP) formula for risk factors was applied to the University of Texas Health Science Center at San Antonio (UTHSCSA)/University Hospital (UH) database. Its applicability to a civilian organization was established. Logistic regression analysis of the UH database revealed that operative complexity was significantly related to mortality only at high complexity levels. Patient risk factors were the major determinants of operative mortality for most civilian surgical cases. Since 1994, the NSQIP has collected preoperative risk factors, intraoperative data, 30-day morbidity, and mortality within the VA health system. The VA formula to predict 30-day postoperative mortality was applied to our UH patients (N = 8593). The c-index of .907, a statistical measure of accuracy, compared favorably to the VA patient c-index of .89. The UH database did not include a surrogate for operative complexity. We were elated by the predictive accuracy but had concern that operative complexity needed further evaluation. Operative complexity was ascribed to each of the 8593 UH cases, and logistic regression analyses were compared with and without operative complexity. Operative complexity was graded on a scale of 1 to 5; 5 was the most complex. Without operative complexity, a c-index was .915. With operative complexity: an even higher c-index of .941 was reached. The large volume of level 2-3 operative cases obscured to a degree the effect of operative difficulty on mortality. Operative complexity played a major role in risk estimation, but only at the extreme. The dominance of cases of midlevel complexity masked the effect of higher complexity cases on mortality. In any individual case, operative complexity must be added to estimate operative mortality accurately. Patient risk factors alone accounted for operative mortality for operations less than level 4 (95% of patients).

The Bridge Program: Facilitating the graduate nurse's transition into the profession

The Bridge Program is an educational partnership between the University Healthcare System (UHS) in San Antonio, Texas, and the University of Texas Health Science Center at San Antonio (UTHSCSA) School of Nursing. The program consists of three undergraduate electives that are offered every semester, including summer, and is coordinated and implemented by the department of acute nursing care faculty.