Virginia Commonwealth University Research Articles

From the Editor and Chair of the Award Committee: 2022 Clemen–KleinmuntzDecision AnalysisBest Paper Award

From the Editor and Chair of the Award Committee: 2022 Clemen–Kleinmuntz<i>Decision Analysis</i>Best Paper Award

The power of difference: Where the complexities of diversity and inclusion meet practical solutions by SimonFanshawe (Ed.), New York, NY: Kogan Page. 2022. p. 250. $25.95 soft cover

Personnel PsychologyEarly View BOOK REVIEW The power of difference: Where the complexities of diversity and inclusion meet practical solutions by Simon Fanshawe (Ed.), New York, NY: Kogan Page. 2022. p. 250. $25.95 soft cover Megan Burroughs, Megan Burroughs Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USASearch for more papers by this authorDeborah DiazGranados, Corresponding Author Deborah DiazGranados [email protected] orcid.org/0000-0002-0624-7093 School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA Correspondence Deborah DiazGranados, PhD, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA. Email: [email protected]Search for more papers by this author Megan Burroughs, Megan Burroughs Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USASearch for more papers by this authorDeborah DiazGranados, Corresponding Author Deborah DiazGranados [email protected] orcid.org/0000-0002-0624-7093 School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA Correspondence Deborah DiazGranados, PhD, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA. Email: [email protected]Search for more papers by this author First published: 08 May 2023 https://doi.org/10.1111/peps.12591Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

The Importance of Collaboration Elevating Cardio-Oncology Care

The Importance of Collaboration Elevating Cardio-Oncology Care

First Author Highlights

AnnouncementFirst Author HighlightsPublished Online:19 May 2023https://doi.org/10.1152/ajprenal.2023.324.5.AUMoreSectionsPDF (362 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations DANIELLE L. KIRKMANDepartment of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United StatesFigure 1.Danielle KirkmanDownload figureDownload PowerPointDanielle Kirkman is an Assistant Professor in the Department of Kinesiology and Health Sciences at Virginia Commonwealth University. She received her PhD in Clinical Exercise Physiology from Bangor University in Wales before completing her postdoctoral fellowship in vascular physiology at the University of Delaware. Her research is focused on applied, integrative physiology at the nexus of cardiovascular and renal health. As an exercise physiologist by training, a large body of her work has investigated the cardiovascular and metabolic effects of exercise in patients across the spectrum of kidney diseases. In her spare time, she enjoys the outdoors [Photo: Fig. 1].https://doi.org/10.1152/ajprenal.00046.2023FERNANDO MARMOLNorthwestern University Feinberg School of Medicine, Chicago, Illinois, United StatesFigure 2.Fernando MarmolDownload figureDownload PowerPointFernando Marmol is a research scholar at Northwestern University in Chicago, IL, mentored by Dr. Daniel Batlle. He is an International Medical Graduate MD from Ecuador. His research interests focus on acid-base and electrolyte disorders as well as angiotensin-converting enzyme 2 and its potential therapeutic use. Like Dr. Batlle, he is a fan of the soccer team Barcelona FC. Away from the laboratory bench, he loves practicing basketball, soccer, and cycling. He is pursuing becoming a nephrologist [Photo: Fig. 2].https://doi.org/10.1152/ajprenal.00312.2022LINDSEY A. RAMIREZDepartment of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia, United StatesFigure 3.Lindsey RamirezDownload figureDownload PowerPointLindsey Ramirez completed her PhD in Physiology at Augusta University under the mentorship of Jennifer Sullivan. In 2022, she successfully defended with distinction. In her doctoral laboratory, she studied the role of inflammation in mediating high-fat diet-induced changes in adiposity and blood pressure. Currently, she is a postdoctoral fellow in the laboratory of Elizabeth Glover at the University of Illinois in Chicago, IL. In her current role, she is investigating the neural mechanisms that mediate aversion to ethanol. She enjoys learning about true crime, collecting rocks, and various crafts such as sewing, knitting, and crocheting [Photo: Fig. 3].https://doi.org/10.1152/ajprenal.00308.2022YU TAODepartment of Physiology and Anatomy, University of North Texas Health Science Center, Texas, United StatesFigure 4.Yu TaoDownload figureDownload PowerPointYu Tao is a PhD student in the Integrative Physiology Department in the University of North Texas Health Science Center, mentored by Dr. Rong Ma. She got her MS from Wuhan University, China. Her research focused on the podocyte and mesangial cell physiology in diabetic kidney disease. She enjoys cooking, baking, and hiking in her spare time [Photo: Fig. 4].https://doi.org/10.1152/ajprenal.00297.2022This article has no references to display. Download PDF Previous Back to Top Next FiguresReferencesRelatedInformation Related ArticlesCall for Papers: Exercise and the kidneys in health and disease 27 Apr 2023American Journal of Physiology-Renal PhysiologyFecal ammonium in mice with CKD: gastrointestinal sequestration by sodium zirconium cyclosilicate 02 May 2023American Journal of Physiology-Renal PhysiologyPerinatal intermittent hypoxia increases early susceptibility to ANG II-induced hypertension in adult male but not in female Sprague–Dawley rats 27 Apr 2023American Journal of Physiology-Renal PhysiologyStore-operated Ca2+ entry inhibition ameliorates high glucose and ANG II-induced podocyte apoptosis and mitochondrial damage 27 Apr 2023American Journal of Physiology-Renal Physiology More from this issue > Volume 324Issue 5May 2023Pages i-ii Crossmark Copyright & PermissionsCopyright © 2023 the American Physiological Society.https://doi.org/10.1152/ajprenal.2023.324.5.AUPubMed37204405History Published online 19 May 2023 Published in print 1 May 2023 Metrics

PO-02-079 SAFETY AND FEASIBILITY OF DEVICE EXTRACTION OF THE HIS 3830 SELECTSECURE© LEAD

The 3830 SelectSecure© Lead (Medtronic, MN) is widely used for conduction system pacing. Data regarding the safety and complexity of lead extraction from the septum with this lumenless 4.1 Fr ETFE coated lead is limited to a few reports. To evaluate safety, efficacy, and complexity of 3830 lead extractions implanted on the interventricular septum. Consecutive patients undergoing SelectSecure© lead extractions between Jan 2015 and Jan 2021 at Virginia Commonwealth University were analyzed. Procedural tools, lead dwell times, complications, and indications for lead failure were tabulated. A total of 23 patients had lead extractions during the study period. All leads were implanted in the His bundle region with median dwell time of 190 days (IQR 34-319 days) and mean dwell time of 290 days. Devices were implanted for sick sinus syndrome (13, 57%), AV block (9, 39%), and planned CRT (1, 4%) The most common indication for extraction was lead failure (75%) followed by device upgrade (17%), infection (4%), or a combination of need for upgrade with lead failure (4%). The mean capture threshold prior to extraction was 2.8V±1.9V @ 1 ms. 21 (91%) of patients had successful explant with manual traction alone, 2 (4%) leads required laser sheath, and 1 (4%) patient required both laser and mechanical tools. The only complication was a femoral vein hematoma; total lead extraction with no remnants, was achieved in all patients. Procedural success was complete and safety outcomes were excellent with the caveat that the cohort primarily fell into the low to intermediate risk category, as calculated by the SAFeTY TLE score. The dwell times are relatively short given the more recent advent of the technique. Device extraction of the entirety of the 3830 lead can be done safely despite its placement in the septum and a unique lumenless design. However, most extractions took place after relatively short implant times and more information is needed about extraction of 3830 after long implant times.

PO-03-019 ECHOCARDIOGRAPHIC OUTCOMES OF HIS BUNDLE AND LEFT BUNDLE BRANCH AREA PACING: A SINGLE CENTER EXPERIENCE

Traditional right ventricular apical pacing is associated with risk of pacing induced cardiomyopathy (PICM), atrial fibrillation, and heart failure. Conduction system pacing (CSP) via the His or left bundle branch area (HBP, LBBAP) may mitigate or even prevent the development of these complications. To evaluate the effects of CSP on cardiac function as measured by standard 2D-echocardiography. Consecutive patients undergoing HBP or LBBAP implantation between Feb 2014 and July 2022 at Virginia Commonwealth University were analyzed. Ejection fraction (EF), left ventricular diastolic dimension (LVIDd), left ventricular systolic dimension (LVIDs), tricuspid regurgitation severity, and mitral regurgitation severity were compared pre- and post- CSP. Only patients with echo data at 90 days or greater from time of implant were included. A total of 340 patients with CSP had echocardiographic data available. Mean clinical follow up time was 810 days from implant, and median time until post-implant EF was 483 days (IQR 324-763). 77 had reduced EF (<50%) at baseline. Pacing burden exceeded 20% across the cohort. The mean pre- and post- CSP implantation EF in the overall group was 53.8% ±10.9% vs 54.7% ±9.1% (p=0.08). Mean pre- and post- CSP implant LVIDd was 4.59±0.73cm vs 4.37 ±0.72 cm (p<0.001). Mean pre- and post- CSP implant LVIDs was 3.23± 0.79cm vs 3.05± 0.76cm (p<0.001). TR and MR severity were unchanged after pacemaker implantation. In the subset of patients with reduced EF, mean pre-implant EF was 37% ±9.4% and post-implant EF was 47% ±11.6% (p<0.001). Mean pre-implant LVIDd was 5.02cm ±0.86cm and post-implant LVIDd was 4.60cm ±0.75cm (p<0.001). Mean pre-implant LVIDs was 4.05cm ±1.0cm and post-implant this dropped to 3.44cm ±0.96 (p<0.001). CSP via HBP or LBBAP is not associated with PICM in patients requiring high ventricular pacing burdens. In patients with a reduced EF, it may significantly improve systolic function along with positive structural remodeling.

PO-03-044 EFFECT OF V1 PACED MORPHOLOGY DURING IMPLANTATION OF LEFT BUNDLE BRANCH AREA PACEMAKERS ON ECHOCARDIOGRAPHIC OUTCOMES

Left bundle branch area pacing (LBBAP) is an established form of physiologic pacing. Our group has reported on positive structural remodeling associated with LBBAP, but it is unknown whether implantation characteristics of LBBAP are predictive of subsequent ventricular function. To evaluate the effects of implant morphology and LBBAP on heart function as measured by standard 2D-echocardiography. Consecutive patients undergoing LBBAP implantation between Jan 2019 and July 2022 at Virginia Commonwealth University were analyzed. Ejection fraction (EF%), left ventricular end-diastolic dimension (LVIDd), and end-systolic dimension (LVIDs) as a function of paced morphology in V1 (qR, RSR, QS) were recorded. Patients with moderate to severe valvular regurgitation were evaluated irrespective of paced morphology. Regurgitation severity was coded on a three point scale, with moderate as ‘2’ and severe as ‘3’. A total of 247 patients with LBBAP had echocardiographic data and implant morphology available, with mean ventricular pacing burden of 67%. Mean follow up duration was 613 days ± 478 days. 29 patients had QS morphology at implant, with mean pre-implant EF of 56.8% ± 9.7% vs 57.0% ± 8.1% after implantation (p=0.821). In the 145 patients with qR morphology the mean pre and post-EF was 54.8% ± 10.8% vs 55.5% ± 7.9% (p=0.400). In the 73 patients with rSR morphology the pre-implant EF was 55.2% ± 10.9% vs 54.5% ± 10% (p=0.257). Left ventricular cavity measurements can be found in Table 1. In patients with moderate to severe tricuspid regurgitation (n=25) the mean severity was 2.16 ± 0.37 prior to LBBAP, and decreased to 1.28 ± 0.93 post-implant (p<0.001). Patients with moderate to severe MR (n=37) likewise decreased regurgitant severity from 2.16 ± 0.37 to 1.46 ± 0.83 (p<0.001). V1 paced morphology at time of implant was not associated with significant change in post-procedural systolic function or left ventricular dimensions. Conduction system pacing via LBBAP was associated with improved valvular regurgitation.

Consumers´ Decision-Making under Salop´s Model: Key Study on Starbucks Prague and Richmond business model

This study thesis analyses the Starbucks business model in Prague and Richmond from the location perspective, focusing on the company’s consumers and their decision-making towards commuting to the stores. Using modified Salop’s circle model, the transportation costs of the average Starbucks consumer in both cities are calculated, explained, and compared. It is revealed that the average Starbucks consumer in Richmond bears, on average, 1.255x higher transportation costs than the one in Prague and is willing to travel 2.54x higher distances to purchase the average Starbucks product. In addition, after analyzing transportation costs, the study offers a real-life applicable business proposal for where to place a new Starbucks store in both cities, based on several techniques often used in business consulting for solving case studies. The suggested most suitable location for the new store in Prague is the Prague main railway station. In contrast, the best location in Richmond is the intersection of West Broad Street E and North Lombardy Street, close to Virginia Commonwealth University. The study’s main contribution is the inverting of Salop’s circle model and emphasizing transportation costs as an endogenous variable. In general terms, this study may guide spatial optimization in business strategies, from circular economy applications to strategic managerial decisions in locations with different consumer sensitivity to transportation costs.

Restoration of CD4 +T helper cells without modulating the hepatic inflammatory pattern is not sufficient to prevent HCC

Abstract Recent studies suggest that progression of nonalcoholic fatty liver disease (NAFLD) to hepatocellular carcinoma (HCC) is associated with a decreased frequency of the hepatic CD4 +T cells, as well as a predominance of the inflammatory immunological pattern. To determine whether the inhibition of chronic inflammation could prevent the progression of NAFLD to HCC, we used a novel LRP-1 agonistic peptide, SP16, during a progressive NAFLD in an animal model of NAFLD, i.e., DIAMOND mice. Tumor progression, circulating inflammatory cytokines as well as the hepatic immune cells were analyzed using 44-plex cytokine array and multi-color flow cytometry. Although SP16 restored the hepatic CD4 +T cells and slightly increased Th2 subset, it failed to modulate the CD4 +Th1 dominant pattern in the liver or prevent HCC. These data suggest that the hepatic immune pattern, which could produce a collective function independent from its cellular components, is more important than CD4 +T cell recovery during disease progression. Our data also suggest that administration of SP16 very early during NAFLD could shift a predominant Th1 pattern towards an equilibrium Th1=Th2=Th17 pattern which has been found to protect DIAMOND mice from from the progression of NAFLD to HCC. Future studies will determine if modulation of the inflammatory immune response by SP16 when administered early during NAFLD progression will prevent HCC. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Breast Cancer Research Program under Award No. W81XWH2210793, Massey Cancer Center Multi-Investigator Award, grant number 2017-MIP-02, NIH R01DK105961, and VA Merit Award 1I01BX003275. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the U.S. Department of Defense. Services and products in support of the research project were generated by the Virginia Commonwealth University Flow Cytometry Shared Resource, supported, in part, with funding from NIH-NCI Cancer Center Support Grant P30 CA016059.

CORR Insights®: What Factors Are Associated With Revision Cubital Tunnel Release Within 3 Years?

1Chief, Division of Hand Surgery, Virginia Commonwealth University Medical Center, Orthopaedic Surgery, Richmond, VA, USA J. Isaacs, Virginia Commonwealth University Medical Center, Orthopaedic Surgery, 1250 East Marshall Street, Richmond, VA 23298, USA, Email: [email protected] This CORR Insights® is a commentary on the article “What Factors Are Associated With Revision Cubital Tunnel Release Within 3 Years?” by Schloemann and colleagues available at: DOI: 10.1097/CORR.0000000000002629. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Patient Reported Impact of Symptoms in Spinal Bulbar Muscular Atrophy (PRISM-SBMA) (S33.007)

Patient Reported Impact of Symptoms in Spinal Bulbar Muscular Atrophy (PRISM-SBMA) (S33.007)

Spinraza in Adults with Spinal Muscular Atrophy (SAS) – 14 month results (S33.010)

Spinraza in Adults with Spinal Muscular Atrophy (SAS) – 14 month results (S33.010)

The Limb Girdle Muscular Dystrophy Health Index (S7.003)

The Limb Girdle Muscular Dystrophy Health Index (S7.003)

Valbenazine Decreases Disease Burden in Patients with Chorea Associated with Huntington Disease: Patient-Reported Huntington Disease Health Index (HD-HI) Results From the KINECT-HD Trial (P2-11.012)

Valbenazine Decreases Disease Burden in Patients with Chorea Associated with Huntington Disease: Patient-Reported Huntington Disease Health Index (HD-HI) Results From the KINECT-HD Trial (P2-11.012)

Reducing Gadolinium Exposure in Patients Undergoing Monitoring for Meningiomas.

Background Due to the non-malignant and slow-growing nature of many meningiomas, surveillance with serial magnetic resonance imaging (MRI) serves as an acceptable management plan. However, repeated imaging with gold-standard contrast-based studies may lead to contrast-associated adverse effects. Non-gadolinium T2 sequences may serve as a suitable alternative without the risk of adverse effects of contrast. Thus, this study sought to investigate the agreement between post-contrast T1 and non-gadolinium T2 MRI sequences in the measurement of meningioma growth. Methodology The Virginia Commonwealth University School of Medicine (VCU SOM) brain tumor database was used to create a cohort of meningioma patients and determine the number of patients who had T1 post-contrast imaging accompanied by readily measurable imaging from either T2 fast spin echo (FSE) or T2 fluid-attenuated inversion recovery (FLAIR) sequences. Measurements of the largest axial and perpendicular diameters of each tumor were conducted by two independent observers using T1 post-contrast, T2 FSE, and T2 FLAIR imaging series.Lin's concordance correlation coefficient (CCC) was calculated to assess inter-rater reliability between observers and agreement between measurements of tumor diameter among the different imaging sequences. Results In total, 33 patients (average age = 72.1 ± 12.9 years, 90% female) with meningiomas were extracted from our database, with 22 (66.7%) undergoing T1 post-contrast imaging accompanied with readily measurable imaging from T2 FSE and/or T2 FLAIR sequences. The inter-rater reliability between the measurements of T1 axial and perpendicular diameters was 0.96 (95% confidence interval (CI) = 0.92-0.98) and 0.92 (95% CI = 0.83-0.97), respectively. The inter-rater reliability between the measurements of T2 axial perpendicular diameters was 0.93 (95% = CI 0.92-0.97) and 0.89 (95% CI = 0.74-0.95), respectively. The agreements between the measurement of T1 and T2 FSE axial diameter by each observer were 0.97 (95% CI = 0.93-0.98) and 0.92 (95% CI = 0.81-0.97). The agreements between the measurements of T1 and T2 FSE perpendicular diameter measurements by each observer were 0.98 (95% CI = 0.95-0.99) and 0.88 (95% CI = 0.73-0.95). Conclusions Two-thirds of our patients had meningiomas that were readily measurable on either T2 FSE or T2 FLAIR sequences. Additionally, there was excellent inter-rater reliability between the observers in our study as well as an agreement between individual measurements of T1 post-contrast and T2 FSE tumor diameters. These findings suggest that T2 FSE may serve as a safe and similarly effective surveillance method for the long-term management of meningioma patients.

Understanding Academic Self-Concept and Performance in Medical Education.

Medical students' academic self-concept (ASC) is an important factor in better understanding noncognitive mediators of performance in medical school. However, research is limited on ASC in medical students across multiple phases of undergraduate medical education curriculum. This pilot study explored the relationship between ASC and academic performance across different phases of a U.S. medical school curriculum, specifically at the end of the second (preclinical) and third (clinical) years. Medical students across 2 cohorts at Virginia Commonwealth University School of Medicine, Richmond, Virginia, were surveyed using an ASC confidence subscale in 2019. Multiple linear regression analysis was conducted using medical student ASC scores in preclinical (n = 190) and clinical (n = 149) phases and performance data. Clinical performance was calculated through a weighted mean of clerkship grades based on the number of weeks for each clerkship. Preclinical performance was related to ASC, gender, and performance after year 1. ASC scores varied significantly by gender in the preclinical cohort ( P < .01), with men reporting higher ASC than women (mean [SD], 2.94 [0.41] vs 2.78 [0.38]). Significant gender differences in performance were found at the end of year 3 ( P < .01), with women performing more favorably compared with men (mean [SD], 94.1 [59.04] vs 124.24 [64.54]). The relationship between ASC and performance at the end of year 2 suggested students with higher ASC perform better during their preclinical phase. This pilot study supports future scholarship in 2 areas: (1) identification and assessment of additional factors that influence the relationship between ASC and academic performance across the entire undergraduate medical education curriculum and (2) development and implementation of evidence-based interventions to support student ASC and performance and enhance the learning environment. Analyzing longitudinal trends across multiple cohorts will drive evidence-based interventions at learner and programmatic levels.

OpNotes and Clinical Exercises: Activities to Enhance the Clinical Context of the Preclerkship Anatomy Dissection Laboratory.

Despite numerous pedagogical approaches and technologies now available for medical gross anatomy, students can find it difficult to translate what occurs in a dissection laboratory into the context of clinical practice. Using complementary and collaborative approaches at 2 different medical schools, Virginia Commonwealth University (VCU) and University of Maryland (UM), we designed and implemented a series of clinical activities in the preclerkship medical gross anatomy laboratory that directly link dissected structures to clinical procedures. These activities specifically direct students to perform simulated clinically related procedures on anatomic donors during laboratory dissection sessions. The activities are called OpNotes at VCU and Clinical Exercises at UM. Each activity in the VCU OpNotes requires about 15 minutes of group activity at the end of a scheduled laboratory and involves faculty to grade the student responses submitted via a web-based-assessment form. Each exercise in UM Clinical Exercises also requires about 15 minutes of group activity during the schedule laboratory but does not involve faculty to complete grading. Cumulatively, the activities in OpNotes and Clinical Exercises both brought clinical context directly to anatomical dissections. These activities began in 2012 at UM and 2020 at VCU, allowing a multiyear and multi-institute development and testing of this innovative approach. Student participation was high, and perception of its effectiveness was almost uniformly positive. Future iterations of the program will work to assess the efficacy of the program as well as to streamline the scoring and delivery of the formative components. Collectively, we propose that the concept of executing clinic-like procedures on donors in anatomy courses is an effective means of enhancing learning in the anatomy laboratory while concurrently underscoring the relevance of basic anatomy to future clinical practice.

O.O.10.1 - Sexual Orientation and Gender Identity Disclosure Among Oncology Patients: Describing Current Trends: Presenter(s): Viktor Clark, Virginia Commonwealth University, United States; Richard Brown, Virginia Commonwealth University, United States

O.O.10.1 - Sexual Orientation and Gender Identity Disclosure Among Oncology Patients: Describing Current Trends: Presenter(s): Viktor Clark, Virginia Commonwealth University, United States; Richard Brown, Virginia Commonwealth University, United States

Session on Firearm Violence to Stress Nonpartisanship

Back to table of contents Previous article Next article Annual MeetingFull AccessSession on Firearm Violence to Stress NonpartisanshipTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:26 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.24AbstractUnderstanding the epidemiology of gun violence will equip psychiatrists for public health advocacy.In 2018, the National Rifle Association posted a tweet that began with “Someone should tell self-important anti-gun doctors to stay in their lane.” Many in the medical community considered that to be a gauntlet thrown, and since then health professionals have demonstrated the myriad ways they have seen firearm violence harm and kill their patients. At APA’s 2023 Annual Meeting, a session titled “I Am in My Lane: A Public Health Approach to the Role of Health Care Providers in Firearm Violence” will offer strategies on how health professionals can convey the message that preventing firearm violence is a matter of public health, not politics or partisanship.Psychiatrists who wish to address firearms violence should focus on public health, says Aradhana Bela Sood, M.D., M.S.H.A.“Firearm violence is a polarizing topic, where any discussion of it is often equated with gun control,” session chair Aradhana Bela Sood, M.D., M.S.H.A., told Psychiatric News. She is a senior professor for child and mental health policy at Children’s Hospital of Richmond at Virginia Commonwealth University. “As medical providers who deal with the aftermath of firearm-related morbidity and mortality, we would be well served to shift rhetoric that appears to infringe on individual rights to a focus on gun safety and preventive practices.”The session will cover the epidemiology of firearm violence and provide a historical perspective of the polarization surrounding the causality of firearm violence that will better enable attendees to frame the issue in terms of public health.Attendees will come away from the session with an understanding of regional firearm laws, including Extreme Risk Protection Orders (“red flag” laws) that allow family members or law enforcement to petition a judge to remove a firearm from the environment of a person considered to be at risk of harming themselves or others. The session will explore the challenges and barriers to implementing these laws and delve into how these laws have reduced morbidity and mortality from firearm violence, thus equipping attendees to be more effective as advocates for public health strategies to address the issue.Finally, attendees will learn how to get involved at the hospital, city, and state levels to advocate for policies and legislation that support safe firearm practices. ■ ISSUES NewArchived

Abstract P1-13-04: Potentiating Alpelisib in PI3K Pathway Overactive Triple Negative Breast Cancers

Abstract Potentiating Alpelisib in PI3K Pathway Overactive Triple Negative Breast Cancers David C. Boyd1,2, Amy L. Olex3, Tess Leftwich1, Nicole Hairr1, Alex K. Duong1, Narmeen S. Rashid1,3, Mohammad A Alzubi1,2, Holly Byers1, Aaron D. Valentine1, Julia E. Altman1, Emily Zboril1, Jacqueline M. Grible1, Madelyn Esquivel1, Scott A. Turner1, Andrea Ferreira-Gonzalez1, Mikhail G. Dozmorov5, J. Chuck Harrell1,2,6 1Department of Pathology, Virginia Commonwealth University; 2Integrative Life Sciences Program, VCU; 3Wright Center for Clinical and Translational Research, VCU; 4Department of Biology, University of Richmond; 5Department of Biostatistics, VCU; 6Massey Cancer Center, VCU. There is an urgent need for new therapeutic options for basal-like Triple Negative Breast Cancers (TNBC). To mirror the NCI-ComboMATCH study, and identify new synergistic drug combinations, we analyzed a set of 20 breast cancer patient-derived xenografts and 14 cell lines to identify targetable targets in each model. The Oncomine Comprehensive Assay v3 was performed to assess 161 genes for hotspot mutations, focal copy number variants, amplification/deletions, and RNA-fusion genes. Next, each PDX and their isogenic drug-resistant sublines were analyzed with bulk RNA-sequencing (217 samples) and cell single-cell RNA-sequencing (~100,000 cells). Of all NCI-MATCH defined targetable mutations, 37% of the models contained pathogenic PIK3CA amplifications or mutations. PIK3CA is one of the most common oncogenic aberrations identified in patients and the PI3K pathway is overactive in the majority of TNBCs, therefore we sought to target it across all models and identify the most efficacious synergistic drug partner. Short-term cultures of each PDX model were screened with a library of &amp;gt;1,000 FDA-approved/experimental drugs to identify compounds that were cytotoxic. Synergistic drug screens were then performed with each drug in combination with the PI3K inhibitor byl-719 (alpelisib) a current standard-of-care drug used for PI3K mutant ER+ disease. Synergism was identified using coefficient of drug interaction (CDI) calculations and 10 drugs were identified as synergistic across several models. Using several criteria, including clinical status and pathway analysis, 3 drugs were selected for CompuSyn-based synergism testing and each was confirmed to be synergistic in vitro. Testing with in vivo models of each drug combination has thus far confirmed that each is synergistic per CDI metrics. Those combinations are currently being tested for efficacy in the metastatic setting with a set of basal-like PDXs. Citation Format: David Boyd, Chuck Harrell. Potentiating Alpelisib in PI3K Pathway Overactive Triple Negative Breast Cancers [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-13-04.