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Who’s going to sue? A look at environmental citizen suits
Get PDFThe author reviews the history of citizen-plaintiff suit provisions embedded in federal and state environmental legislation
A Systematic Review of Digital Technology Use for the Treatment and Management of PTSD
Get PDFThe COVID-19 pandemic led to rapid growth in telemental health services and investment in digital mental health technologies. Digital mental health technologies could expand access to mental health care in a time of increasing provider deficit by providing tools for expedited psychiatric symptom assessment and management. This systematic review explores the current evidence for the use of scalable digital treatment modalities, including virtual reality (VR), machine learning, wearables, mobile apps, and neurofeedback training in the diagnosis and treatment of PTSD. Our findings support the current literature suggesting VR interventions are efficacious for combat-related PTSD treatment and that conclusions of studies investigating apps and neurofeedback training (NFT) are limited by low sample size and methodological hetogeneity. Digital technologies such as digital phenotyping, wearables, and machine learning show promise in their ability to identify PTSD symptoms in the absence of provider intervention but standardized approaches to both data collection and machine learning modeling are needed before these technologies can be applied to clinical settings. Nevertheless, leveraging these digital modalities have the potential to address barriers in healthcare access and to improve patient engagement by providing personalized, remote care. Further research with standardized controlled trials utilizing diverse patient populations is needed to determine evidence-based protocols for implementation into clinical practice. Emerging technologies such as augmented reality could have potentials for the future of PTSD treatment as well
Healthy Hearts: An interactive demonstration to increase interest in medicine in elementary/ middle school students in/around Detroit.
Get PDFThere continues to be a lack of representation and diversity in higher education today, especially in medicine and healthcare. As part of the Healthy Hearts student organization at Wayne State University School of Medicine, we developed a one-time educational session and interactive demonstration to teach students about heart and lung health and fuel students’ enthusiasm for healthcare. This project serves as a quality improvement study to understand how we can increase STEM interest in elementary and middle school students in and around Detroit, Michigan. A three question pre- and post-intervention survey was constructed to measure change in: 1) interest in health and science education; 2) perceived importance of heart, lung, nutrition, and exercise education; and 3) intent to pursue a career in health or sciences. Out of 27 students surveyed, 26 surveys were completed fully and used for analysis by independent unpaired t-tests for each survey statement. Following the intervention, mean student interest in health and science education improved by 15.6% (p = 0.187). Mean student-perceived importance of heart, lung, nutrition, and exercise education improved by 18.5% (p = 0.210). Mean student intent of pursuing a career in health or sciences improved by 6.41% (p = 0.612). Although there was a raw improvement in student agreement with the three statements, we found no statistically significant increase in interest in medicine based on pre- and post-intervention survey questions. We will evaluate areas needing improvement in our presentation/demonstration and collect additional data to further evaluate the efficacy of the proposed intervention
M-CHAT Implementation Strategies to Improve Autism Screening Rates in Pediatric Clinics in Metro Detroit
Get PDFThe Modified Checklist for Autism in Toddlers (M-CHAT) is the most widely used autism screening tool. However, current practices for M-CHAT roll-outs and follow-ups are not wide-reaching, culturally sensitive, or consistent. This study aims to address the existing barriers to universal autism screenings and design a sustainable implementation strategy for a successful M-CHAT roll-out. We implemented strategies in five Henry Ford Health pediatric clinics, incorporating iPad-administered M-CHAT in waiting rooms, multilingual options, task shifting for referrals, forced choice mechanisms, and audit-and-feedback support. A Clinical Screening Dashboard tracked real-time M-CHAT data, including demographic information, collected from EPIC. Our goal is to reach a 95% universal screening rate for autism and an 80% eligible referral rate to the Center for Autism and Developmental Disabilities (CADD) at the five Henry Ford Health pediatric clinics. Although early in the data collection process, the implementation strategies aimed at increasing screening rates show promising outcomes. We anticipate that our study will demonstrate a successful model for improving accessibility, accuracy, and equity in ASD screenings. Despite limitations such as language constraints and potential workload increases in Early Intervention Programs, we hope these implementation strategies can be applied across more Henry Ford Health Pediatric Clinics as well as be used as a model for other health systems
Active Surveillance vs. Curative Treatment: Longitudinal Quality of Life 2-years after Low-Risk Prostate Cancer Diagnosis
Get PDFBackground: Active surveillance (AS) allows patients with low-risk prostate cancer (LRPC) to be monitored for disease progression, thereby avoiding or delaying invasive curative treatment (CT) (i.e., surgery or radiation) and related side effects. Here we compare quality of life (QOL) two-years after diagnosis between men who underwent CT overall and by race.
Methods: Black and white men with LRPC were recruited through population-based cancer registries in metropolitan Detroit and Georgia. Participants were grouped by their treatment type (CT or AS). QOL measures SF-12 and EPIC-26 were assessed at baseline and 2-year follow up using mailed surveys. Differences between groups at baseline and follow-up was assessed using mixed design ANCOVA overall and stratified by race.
Results: Of the 1688 participants enrolled at baseline, 1057 were followed-up 2-years after diagnosis. Among these, 475 underwent curative treatment, and 582 remained on AS. There were significant declines in all the QOL measures from baseline in the treatment group while there were minimal changes in most of the measures in the AS group. The time by group interaction was significant in MCS, urinary incontinence, and sexual and hormonal function. The largest decline was in sexual function in the treatment group (70 vs. 43, p\u3c0.001) while there was a much smaller decline (69 vs. 64, p\u3c0.001) in the AS group. These results were similar between races, but black men reported lower sexual function scores at baseline and follow-up.
Discussion: Understanding the differences in QOL between men with LRPC who choose to pursue AS or CT and how race and socioeconomic factors may affect this is critical to interpreting guidelines and give physicians and generating patient-centered decisions about the plan of care that provides the best patient outcomes for their LRPC diagnosis
Examining Vaccine Hesitancy Trends in an Underserved Population at a Student-Run Free Clinic
Get PDFTitle: Examining Vaccine Hesitancy Trends in an Underserved Population at a Student-Run Free Clinic
Authors: John Pum, Cameron Bear, Dhiraj Tadikamalla, Hasti Nema, Robert Sherwin M.D.
Introduction:
The global debate surrounding the safety and efficacy of COVID-19 vaccines has triggered widespread vaccination hesitancy, impacting not only COVID-19 immunizations but also other vaccines. This study investigates whether a parallel trend exists within a Student-Run Free Clinic (SRFC), focusing on an underserved population disproportionately affected by the pandemic.
Methods:
Retrospective analysis was conducted by coordinators of Cass Clinic, a Detroit-based SRFC. Patients included were individuals 18 or older who received the influenza vaccine at Cass Clinic from 2013 to 2022. Data collected through optional pre-vaccination surveys involved 248 individuals divided into pre-COVID (2012-2019, n=193) and post-COVID (2020-2022, n=55) groups. Demographic details, vaccine concerns, and their impact on the decision to vaccinate were assessed to understand patient decision-making factors and how SRFCs are bridging the gap in providing vaccination care. T-tests and z-tests were used for statistical analysis, with significance set at p \u3c 0.05.
Results:
Pre-COVID, 42.55% of patients receiving flu vaccination had concerns and post-COVID 15.09% of patients had concerns which demonstrates a significant decrease in vaccine concerns among the Cass patients (p=0.00019, \u3c0.05).
Conclusion:
Contrary to the global trend, Cass Clinic observed a noteworthy reduction in vaccine hesitancy post-COVID, highlighting the distinctive role of SRFCs in fostering vaccination adherence, especially among vulnerable and underserved populations. This unexpected divergence prompts further investigation into the clinic\u27s effective strategies, contributing valuable insights to public health efforts aimed at promoting vaccination in marginalized communities
Fueling survival: Adipocyte-mediated modulation of iron metabolism and oxidative stress pathways in bone metastatic prostate cancer
Get PDFFueling survival: Adipocyte-mediated modulation of iron metabolism and oxidative stress pathways in bone metastatic prostate cancer
Authors: Shrila Rajendran1*, Alexis Wilson1,2, Shane Mecca1, Mackenzie Herroon1, Laimar Garmo1, and Izabela Podgorski1,2
Department of Pharmacology, Wayne State University School of Medicine1 and Cancer Biology Graduate Program, Wayne State University School of Medicine and Karmanos Cancer Institute2
Prostate cancer (PCa) commonly metastasizes to the bone marrow, where cancer cells interact with a variety of cell types that compose the bone tumor microenvironment. The interaction of interest for this research is between metastatic PCa cells and adipocytes, a major cell type in bone marrow. Numbers of marrow adipocytes increase with age, obesity and metabolic pathologies, and their impact on tumors that grow in bone is being increasingly recognized. The PCa cells in bone marrow have increased survivability and chemoresistance that may be related to their communication with bone marrow adipocytes. One mechanism of interest is the balance of lipid peroxides and iron stores within PCa during adipocyte exposure. The aim of this research is to test the hypothesis that bone marrow adipocytes support PCa survival in the bone tumor microenvironment through the modulation of iron stores and lipid peroxides. Our analysis of single-cell RNAseq data from patients with PCa bone metastases demonstrated changes in genes related to the regulation of iron and lipid peroxides, suggesting their possible role in PCa survival. Specifically, high expression of ferritin (FTH1), an iron storage protein, and low levels of nuclear receptor coactivator 4 (NCOA4), a ferritin degradation protein, were observed in tumor clusters, along with high expression of glutathione peroxidase 4 (GPX4), an enzyme that protects cells from lipid peroxides. Interestingly, when PCa cells were exposed to bone marrow-derived adipocytes in vitro, similar patterns of expression were observed (i.e., increased levels of FTH1 and GPX4, but reduced levels of NCOA4), indicating the potential role of marrow adipocytes in the regulation of iron storage and ferritin turnover. IHC staining of tumor sections from mice fed either high fat (HFD) or low fat (LFD) diet showed increased FTH1 expression in tumors from HFD mice. Notably, particularly high FTH1 presence was observed in the areas rich in adipocytes, demonstrating a potential relationship between the iron storage protein and lipids. In addition, tumor areas with augmented FTH1 showed increased expression of heme oxygenase 1 (HO-1), an antioxidant enzyme responsible for the breakdown of heme into iron and biliverdin. This was in line with our in vitro results showing an increase in HO-1 levels with adipocyte exposure, and a high FTH1 expression in cells stably overexpressing HO-1. One notable observation is that PCa cells exposed to adipocytes in Transwell co-culture in vitro, showed initially increased lipid peroxidation levels, which declined upon prolonged interaction with adipocytes. This suggests an adaptive mechanism present in PCa cells, potentially involving modulation of iron stores and HO-1 and GPX4 activity. Upon treatment with iron citrate, FTH1 protein levels increased while GPX4 protein levels decreased particularly in PCa cells cultured with adipocytes, indicating a potentially more direct relationship between FTH1 levels and GPX4 activity. To further explore this relationship, PCa cells were cultured alone or exposed to adipocytes in the presence or absence of GPX4 inhibitor, RSL3. Inhibition of GPX4 led to an increase in FTH1 and HO-1 protein levels in PCa cells, suggesting their possible roles in reducing oxidative stress from lipid peroxides during adipocyte exposure. Collectively, our data indicate that the modulation of iron storage and lipid peroxides in PCa cells by bone marrow adipocytes may play a role in the survival of metastatic PCa within the harsh bone marrow microenvironment
Breast Cancer and Colorectal Cancer Screening in Arab Americans from 2021-2023
Get PDFBreast Cancer and Colorectal Cancer Screening in Arab Americans from 2021-2023
Nicole Oska1, Hasti Nema1, Deni Peterson1, Kendall Brothers1, Mohammed Najeeb Al Hallak1,2
1Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA; 2Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
Introduction:
Breast cancer (BC) and colorectal cancer (CRC) are among the most commonly diagnosed cancers in the United States1,2; screening for these cancers is a pivotal component of preventative healthcare. Arab Americans represent a diverse, yet understudied, patient population that may encounter distinct barriers in undergoing cancer screening. This study provides insight into factors influencing BC and CRC screening rates among Arab Americans.
Methods:
CRC screening and BC screening data for screening-eligible Arab and non-Arab patients from 2021-2023 was obtained from ACCESS clinic in Dearborn, MI. Data was coded for ethnicity, gender, and screening status then analyzed using frequencies and chi-square analyses with SPSS version 28.
Results:
In 2021, 16.7% of Arab and 13.6% of non-Arab patients underwent CRC screening. In 2022, 29.4% of Arab and 23.6% non-Arab patients were screened for CRC. In 2023, 47.3% Arab and 35.8% of non-Arab patients were screened for CRC, which was significant (χ²=5.557, p=0.018). Interestingly, in 2022, Arab females underwent screening at a significantly higher rate than Arab males (χ²=5.521, p=0.019).
In 2021, 19.2% of Arab patients, and 17.8% of non-Arab patients were screened for BC. In 2022, 22.4% of Arab and 14.1% of non-Arab patients were screened, which was significant (χ²=5.630, p=0.018). In 2023, 25.4% of Arab and 20.5% of non-Arab patients underwent screening.
Conclusion:
From 2021 to 2023, the increase in CRC and BC screening rates in Arab patients shows progress in preventive care for Arab patients. Community interventions should be made to address barriers to preventative screenings in the Arab American patient population.
References: Colorectal cancer facts & figures 2020-2022 - American cancer society. (n.d.). https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf Cancer facts & figures 2023. American Cancer Society. (n.d.). https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/2023-cancer-facts-figures.htm
Purine and pyrimidine monophosphate vs polyphosphate homeostasis in human retinal endothelial cells
Get PDFIntroduction: A major cause of blindness is proliferative diabetic retinopathy (PDR), and there is limited data on the nucleic acid (NA) profiles in PDR. We characterized the profiles of NAs in human retinal endothelial cells (HRECs) subjected to high glucose (HG) and hypoxia (Hyp) - common risk factors associated with PDR.
Methods: HRECs were treated with osmotic control (Mannitol, 25 mM) or high glucose (HG, 25 mM) for 5 days, followed by normoxia or hypoxia (Hyp, 2% O2) for 24 hours. Pathway enrichment analysis from the significant metabolites in the Hyp+HG vs control comparison was subsequently performed.
Results: The precursors ribose-5-phpshate and inosine monophosphate were elevated in the HG+Hyp condition. The purines adenosine and the combined concentration of adenosine monophosphate (AMP) and adenosine diphosphate (ADP) exhibited a similar pattern. The ratio of adenosine triphosphate to AMP + ADP was decreased in the same inter-groups contrast. The same exact pattern for the combination mono and diphosphate as well as the ratio of the triphosphate to mono and diphosphate was observed for the nucleotides guanosine, uridine and cytidine. Pathway analysis revealed 18 significant pathways, including phosphate bond hydrolysis by NTPDase proteins and interconversion of nucleotide di-and triphosphates.
Conclusion: We show that nucleotide mono and diphosphates are selectively elevated when compared to their triphosphate analogues in HRECs in an experimental model of PDR. These findings suggest that in a stressful environment of high glucose and low oxygen, both vitreous and endothelial cells may not favor the utilization of energy rich nucleotide triphosphates
Distance Learning and Perceived Social Support: Identifying Protective Factors for Families’ COVID-Related Stress and Psychological Distress During the COVID-19 Pandemic
No full textIt is critically important to understand the environmental contexts and demographic factors that put families at greater risk of COVID-related parenting stress. The current study examined a new scale measuring situational stress caused by concern about family safety and stability during the COVID-19 pandemic. We examined how this stress differed by socioeconomic status and children’s schooling modality, and how this stress and parent social support affected parents’ severity of overall psychological distress. Parents of children in distance learning experienced significantly less COVID-related family safety/stability stress. COVID-related family safety/stability stress was a significant predictor for severity of psychological distress, and this positive relationship was significantly moderated by perceived parent social support, controlling for all other predictors. Going forward, financial resources and perceived parent social support should be incorporated in plans to assist parents during the pandemic, as these serve as protective factors from COVID-related family safety/stability stress