University of North Texas
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Impact of a Feedback Processing Framework on Feedback Orientation in First Year Pharmacy Students
No full textPurpose: Despite the widely accepted value of feedback within pharmacy school curricula and clinical practice, there are limited tools and resources to help students effectively process feedback they receive. The 6 Ps of processing feedback (poise, process, positionality, percolate, proceed, and perspective) may be a useful method for teaching pharmacy students how to best evaluate and utilize feedback. Therefore, the purpose of this study is to determine the impact of this stepwise feedback processing framework on feedback orientation in first year pharmacy students. Methods: First-year pharmacy students enrolled at the University of North Texas System College of Pharmacy (COP) beginning August 2024 were included in this quasi-experimental pre-post study. Students were introduced to the 6 Ps of Processing Feedback framework via didactic lecture in Fall 2024 and were required to complete the validated Feedback Orientation Scale (FOS) via Qualtrics at baseline and immediately following the didactic lecture. The FOS is a 20-item assessment, broken into four dimensions of feedback orientation, 1) Utility, 2) Accountability, 3) Social Awareness, and 4) Feedback Self-efficacy. Each dimension contains five items which are ranked on a five-point Likert Scale. Higher FOS scores indicate stronger positive orientation towards feedback. Differences in overall pre- and post-FOS scores as well as scores on individual items, were evaluated via Sign tests. Students who did not complete both pre- and post-FOS due to tardiness or absences were excluded from data analysis. Results: Seventy-seven first-year students were enrolled in the COP at the time of this study. Sixty-six students completed both assessments and were included in the study analysis. The median overall FOS score increased from 86.5 points pre-intervention to 97 points post-intervention (p = 0.006). Analyzing individual items, three of five significantly increased in the Utility dimension, two of five significantly increased in the Accountability dimension, and all five items significantly increased in the Social Awareness and Feedback Self-efficacy dimensions when comparing pre-post intervention scores. Conclusions: This study demonstrates that implementation of a stepwise feedback processing framework into the pharmacy school curriculum improves feedback orientation in first year pharmacy students. Future research is planned to focus on whether this improvement is sustained once students receive substantial feedback during experiential rotations
Simulated High Risk Pediatric Trauma Scenarios Leads to Increased Team Confidence and Communication
No full textPoster Highlight: Texas College of Osteopathic Medicine - Research, RAD 2025 Award Winning Posters & Oral PresentationsBackground: Preventable trauma is the leading cause of death among children, with many of these fatalities linked to insufficient "pediatric readiness" in emergency departments (EDs), as highlighted by the Emergency Medical Services for Children (EMSC) National Pediatric Readiness Project (NPRP). Critically ill children are four times more likely to die in EDs not designated as pediatric-ready. Alarmingly, 83% of pediatric emergency care is provided in non-specialized, adult-focused EDs where pediatric emergencies are infrequent. Trauma simulations offer an immersive, controlled environment that allows healthcare teams to enhance technical skills, team dynamics, and decision-making. Evidence suggests that these simulations significantly improve individual and team confidence, individual and facility preparedness and most importantly lead to improved patient outcomes. This study examines the impact of in situ trauma simulations on boosting individual and team confidence and interdisciplinary communication among healthcare professionals by providing a realistic in-situ platform for practicing high-risk trauma skills. Purpose: Create simulations aimed at improving trauma readiness. Assess improvements in confidence and communication using pre and post surveys. Design/Methods: Four simulations and four skill labs were completed with pre- and post- surveys gathered. A total of 11 sessions across an entire year were performed with pre and post survey data recorded. A Wilcoxon signed rank was performed to compare to pre and post survey scores. Results: Following multiple trauma simulations at a pediatric emergency facility, survey data from healthcare professionals were analyzed to assess confidence levels in communication and performance both before and after the simulations. When asked about personal communication among an interprofessional team respondents reported significant improvement after the simulation. z=-6.01 p=<.001, r=.41. Significant increases in confidence were also seen across multiple domains including team performance, communication, role assignment, and familiarity with supply locations. Nearly 90% of respondents reported that the simulations were highly effective in enhancing their confidence in these areas. Conclusion(s): The implementation of interprofessional trauma simulations improves healthcare providers' confidence in both procedural skills and communication. The continued development of pediatric trauma simulations is expected to lead to enhanced team performance and, more importantly, improved patient outcomes
A Case Report: Drainage of an Impostrous Bartholin Gland Cyst Causes a Life Threatening Hemorrhage
No full textBackground: Arteriovenous malformations (AVMs) are a grouping of poorly formed arteries and veins that connect without a capillary bed. Pelvic AVMs are rare and are thought to make up only 0.02% of reported AVMs. 20% of pelvic AVMs remain asymptomatic however they have been known to cause symptoms like pelvic pain, abdominal pain, abnormal vaginal bleeding, tenesmus, etc. Most pelvic AVMs are congenital. Case Presentation: A 33-year-old female patient presented to clinic for a painless, non-enlarging, non-pulsatile labial mass that had been present for 3 weeks. Her history and physical exam were consistent with that of a Bartholin gland cyst: a non-painful “bump” on the genitals that caused discomfort when wearing pants. There were no changes to urination, sexual function, or menses. The patient had a history of fluctuating blood pressures, seizures of unknown etiology, migraines, and premature ventricular contractions (PVCs). She had gone through a trial of several antihypertensives and vasopressors to control her blood pressure but was not taking any antihypertensives at the time. There was no history of sexually transmitted diseases. Family history revealed a relative who had passed from sudden cardiac death. The plan was to incise and drain the "cyst". The area was prepped and numbed with lidocaine with epinephrine. After a few minutes, she described a tingling sensation in her jaw and ears but was otherwise unchanged. The mass was incised and brisk bleeding began. Attempts to control the bleeding were unsuccessful. The operating room was called for an emergent exam under anesthesia. During transit, the patient lost about 2 liters of blood within 15 minutes despite continued pressure. Mental status had changed and blood products were ordered. The patient was induced under anesthesia and splash-prepped with Betadine. A total of four figure-of-eight sutures were placed to achieve hemostasis. Sonography showed a cystic dilated structure with arterial and venous blood flow, consistent with an arteriovenous malformation (AVM). With hemostasis now controlled and etiology identified, the patient was transferred to the intensive care unit (ICU). She had received four units of packed red blood cells, four units of fresh frozen plasma, and 500cc of lactated ringers. Postoperative hemoglobin and hematocrit labs were 10.1 and 31. In the ICU, she was managed with several anti-hypertensives and had computed tomography imaging of her pelvis and head and neck. Imaging showed that the AVM originated from the left pudendal artery and no cerebral AVMs. Interventional radiology was able to embolize her malformation on postoperative day one. She was discharged on day two and scheduled for clinic follow-up one week later but could not be seen until 5 weeks. Pelvic exam at follow-up showed well-healing incisions. She was advised to continue care with primary care, cardiology, and gynecology. Conclusion: This case illustrated a unique presentation of a pelvic AVM. There were no suggestive features of this lesion that would have indicated a need for imaging. Given the rarity of pelvic AVMs, routine sonography of lesions would not be recommended due to undue financial burden on patients
High Expression of N-acetyl transferase 9 in Cholangiocarcinoma and its Possible Role in Tumor Progression
No full textPoster Highlight: College of Biomedical and Translational Science, RAD 2025 Award Winning Posters & Oral PresentationsPurpose: Cholangiocarcinoma (CCA) is a rare and aggressive subtype of liver cancer known for its resistance to anticancer drugs and its limited number of biomarkers, which leads to difficulty in its early detection. The five-year survival rate of CCA varies between 2% and 24%, depending on factors such as the severity of the cancer, the presence of metastasis, and the timing of diagnosis. The most effective treatment option is surgery, but only under certain criteria, such as early cancer detection and absence of metastasis. Consequently, identifying new molecular targets for CCA is crucial. N-terminal acetylation is an epigenetic modification that plays an important role in the regulation of cellular growth and function. This process is modulated by the enzyme N-acetyl transferase (NAT), which is involved in various functions, such as protein stability, membrane targeting, gene silencing, and drug resistance. These functions can regulate cell cycle progression, cell proliferation, and energy metabolism, all of which are key characteristics of cancer. NAT9, a subset of NATs, has abundant transcripts in breast, ovarian, and endometrial cancers; however, its expression and role in CCA have not been studied. Methods: In this study, we aimed to assess the expression and function of NAT9 in CCA progression and metastasis using cell lines and patient tissue samples. Results: According to The Cancer Genome Atlas (TCGA) database, NAT9 is overexpressed in patients with CCA, and its expression increases with the increase in the grade of CCA. NAT9 was also overexpressed in CCA cell lines and patient tissue samples compared to their normal and non-cancerous counterparts at both RNA and protein levels. In vitro, knocking down NAT9 revealed that NAT9 plays a role in CCA cellular proliferation and migration. Conclusion: These findings suggest that NAT9 plays a critical role in the progression of cholangiocarcinoma
Validation of key molecular signature profiles of advanced HCV liver disease in hepatocellular carcinoma patients.
No full textPoster Highlight: College of Biomedical and Translational Science, RAD 2025 Award Winning Posters & Oral PresentationsValidation of key molecular signature profiles of advanced HCV liver disease in hepatocellular carcinoma patients. Hope K. Fiadjoe¹, In-Woo Park¹, Pankaj Chaudhary¹. ¹Department of Microbiology, Immunology, and Genetics, University of North Texas Health Sciences Center, Fort Worth, Texas Purpose: Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is a leading cause of cancer-related deaths globally. Our previous transcriptome analysis revealed that chronic hepatitis C virus (HCV) infection, a major risk factor for hepatocarcinogenesis, regulates the expression of numerous hepatocellular genes that could serve as prognostic and diagnostic markers and novel therapeutic targets. Method: Based on the fold changes observed at different stages and the known functions of these genes, we selected two upregulated genes — Hexokinase Domain Containing Protein 1 (HKDC1) and Aldo-Keto Reductase Family 1 Member B10 (AKR1B10)—along with three downregulated genes—Glycine N-Methyltransferase (GNMT), Histidine Ammonia-Lyase (HAL), and C-Type Lectin Domain Family 4 Member M (CLEC4M)—to validate their differential expression in HCV subgenomic replicon cells (APC140) and non-HCV-infected HCC tumor tissues using quantitative real-time PCR and Western blot analysis. Results: Consistent with our microarray data, we found that the mRNA and protein expression of HKDC1 and AKR1B10 were significantly upregulated, while GNMT and CLEC4M were notably downregulated in both HCC tumor tissues and HCV-positive APC140 cell line compared to their normal counterparts. Interestingly, HAL expression showed downregulation in HCC tumor tissues but was upregulated in the APC140 cell line. Conclusion: These findings suggest that the molecular mechanisms driving HCC development, whether due to HCV infection or not, may overlap, providing valuable insights for the diagnosis and treatment of both HCV-associated and non-HCV-associated HCC
Association between Renal Hypoplasia and Postoperative Acute Kidney Injury (AKI) in Infants with Congenital Heart Disease (CHD) Undergoing Cardiothoracic Surgery (CTS)
No full textPurpose: AKI remains a frequent postoperative complication, increasing morbidity and mortality in patients with CHD undergoing CTS. Etiology for AKI is multifactorial in these patients. Previous studies have identified prolonged cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times as intraoperative risk factors. Our objective is to evaluate renal hypoplasia as a risk factor for postoperative AKI in these patients. We hypothesize that patients with hypoplastic kidneys on ultrasound (US) will experience a higher incidence of AKI following CTS compared to those with normal kidneys. Methods: The study is a retrospective cohort study of infants undergoing CTS. Infants (0 to 6 months) who underwent CTS and were admitted to the cardiac intensive care unit (CICU) at Cook Children’s Medical Center, between April 2018 and December 2018 were included. Patients who died within 24 hours of admission, >6 months of age at the time of CTS or had no renal US were excluded. AKI was defined using the modified KDIGO AKI criteria for neonates based on pre- and post- operative creatinine values. Renal hypoplasia was defined as kidney length (either right or left) less than the 2.5th percentile based on body and kidney length normative nomograms. Descriptive summaries included means (± standard deviation), medians (interquartile ranges) for continuous variables, and frequencies for categorical variables. AKI and non-AKI groups were compared in univariate analysis using t-tests and chi-squared tests. Multivariate analysis was performed using regression with a significance threshold of p < 0.05. Statistical analyses were conducted with SAS software. Results: Of 292 admissions to the CICU, 80 patients met inclusion criteria. Mean kidney lengths were 4.33 cm and 4.37 cm (right and left, respectively; p = 0.32 and 0.49) in the AKI group compared to 4.60 cm and 4.54 cm in the non-AKI group. Postoperative AKI was observed in 7 patients, 6 of whom had hypoplastic kidneys (OR 7.5, CI 0.86–65.52, p = 0.07). Mean ACC time was 149.20 minutes in the AKI group vs. 75.78 minutes in the non-AKI group (p < 0.01), while CPB time was 168.71 minutes versus 150.00 minutes (p = 0.50). Mean modified ultrafiltration (MUF) mL/Kg was 218.76 mL in the AKI group versus 208.65 mL in the non-AKI group (p = 0.70). Conclusion: No statistical significance was noted between preoperative kidney length and the incidence of AKI in patients with CHD undergoing CTS. Future research will be focused on increasing the sample size and evaluating additional risk factors associated with postoperative AKI in infants with CHD undergoing CTS
Role of Glutaredoxin Loss in Lens Epithelial Cell Aging and Cataractogenesis: Insights from RNA-Seq Analysis
No full textPurpose: The Glutaredoxins (Grxs) system is a key regulator of redox homeostasis. Their loss disrupts antioxidant defenses and exacerbates oxidative stress, contributing to cellular dysfunction. This study investigates gene regulation in mouse lens epithelial cells (LECs) using RNA sequencing (RNA-seq) analysis of Grx1/Grx2 double knockout (DKO) mice. The findings aim to provide insights into the molecular mechanisms of LEC aging and cataractogenesis by exploring the interplay between cellular senescence, inflammation, and oxidative damage. Methods: LECs were collected from wild-type (WT) and DKO mice across 1-month and 12-month groups, with three biological replicates per group. RNA-seq libraries were prepared using Illumina Stranded mRNA Library Prep kits and sequenced on the Illumina NextSeq 550 platform. Differentially expressed genes (DEGs) were identified based on log2 fold change (log2FC) and adjusted p-values. Data visualization included volcano plots and heatmaps, highlighting the top 10 DEGs across different age groups. Results: RNA-seq analysis identified distinct age-dependent gene expression changes in DKO LECs. In the 1-month group, ECM-related genes were significantly upregulated (Efemp1: log2FC -8.679, adjusted p-value 1.47E-08; Fmod: log2FC -7.712, adjusted p-value 1.39E-04, n=3), while genes related to DNA-binding (Shox2: log2FC 8.337, adjusted p-value 1.82E-07, n=3) and inflammatory response (Alox5: log2FC 8.112, adjusted p-value 1.87E-07,n=3) were downregulated. These changes suggest disruptions in critical processes such as cell differentiation and oxidative defense, predisposing cells to degeneration and cataract formation. In the 12-month group, DKO LECs showed upregulation of genes involved in NAD(P)H oxidase activity (Cyba: log2FC -6.959, adjusted p-value 1.86E-05,n=3), inflammation and senescence-associated secretory phenotype (SASP) (Il1rl2: log2FC -7.347, adjusted p-value 1.68E-06; Irag1: log2FC -7.426, adjusted p-value 9.89E-07, n=3), and ECM remodeling (Col6a3: log2FC 9.536, adjusted p-value 4.31E-31, n=3). These findings point to structural and molecular changes associated with aging and cataract progression. Conclusions: This study establishes a previously uncharacterized connection between oxidative stress, inflammation, and senescence in LECs due to Grx1/Grx2 loss. Activating inflammatory and SASP pathways highlights mechanisms driving cataractogenesis and age-related LEC dysfunction. These findings provide valuable insights into cellular senescence and oxidative damage, paving the way for potential therapeutic strategies to delay cataract progression and mitigate senescence-associated lens pathologies
Can a Ganglion Cyst Be Career-Ending? A Physiatric Approach to Recovery in a Violinist with Post-Surgical Wrist Pain
No full textBackground: Ganglion cysts are common benign wrist masses that may significantly impact wrist and hand function, especially in musicians. Ganglion cysts are benign masses from joint capsules or tendon sheaths that often cause pain and functional impairment. Most patients experience improvement post-ganglionectomy. However, our patient had a challenging recovery, especially due to her occupation. Conventional treatments including aspiration, corticosteroid injections, and surgery are often inadequate for classical musicians such as our patient. In this unique case, despite conservative management and surgery, the patient continued to experience symptoms that impacted her ability to perform professionally. Case Presentation: A 45-year-old female violinist presented to our Performing Arts Medicine clinic with a two-year history of left wrist pain that is "possibly career-ending." Symptoms started during an intensive summer festival. Diagnosed with a ganglion cyst, she underwent conservative treatment, including corticosteroid injection and occupational therapy. After conservative management without success, she underwent ganglion cyst excision. However, she experienced persistent aching, stiffness, and tightness that significantly limited her ability to perform. Our physical examination revealed an intact active and passive wrist range of motion (A/PROM), with a harder end-feel at end extension and flexion on the left compared to the right. The carpal joints and the carpal bones were non-tender. While there was no pain over the extensor tendons, playing the violin induced pain over the wrist's extensor tendons while playing difficult passages suspicious of possible extensor tendinopathy/tendonitis. MRI confirmed fluid around the second, third, and fourth dorsal extensor tendons. After a discussion of treatment options, the patient opted for a corticosteroid injection. Before the procedure, the patient was asked to play the violin to identify the precise area of pain over the wrist. Then, this area was marked and visualized under ultrasound to reveal that the third dorsal compartment was the most painful region. A local anesthetic block was performed, and the patient was then asked to play immediately to confirm the pain relief. Once confirmed, a corticosteroid injection was performed. After the procedure, the patient was referred to an occupational therapist who was experienced in working with violinists. The OT and our team also implemented a structured return-to-play protocol to increase playing time, dexterity, and endurance gradually. The patient also received Osteopathic Manipulative Treatment, and lifestyle changes were also implemented, including sleep optimization, nutrition, and strengthening. The tailored approach led to significant improvements. The pain subsided, fine motor control and endurance improved, and the patient successfully returned to professional performance with minimal discomfort. Conclusion: This case highlights the importance of our physiatric approach to treating performing artists’ injuries focusing on the patient’s function. A straightforward musculoskeletal pathology could derail a professional musician's career due to the demands of their occupation. However, a physiatric approach that includes precise ultrasound-guided injections, multidisciplinary care, osteopathic manipulative treatment, and tailored return-to-play instructions is necessary to allow musicians to safely return to their peak performance
Calcium Crisis: Unveiling Calcitriol's Role in Rare Primary Pancreatic Lymphoma
No full textHypercalcemia of malignancy is a complex and potentially life-threatening condition most commonly associated with parathyroid hormone-related peptide, parathyroid hormone, or bone metastases. However, calcitriol-mediated hypercalcemia accounts for less than 1% of these cases and is rarely linked to malignancies. Primary pancreatic lymphoma (PPL) is an exceptionally rare malignancy, constituting less than 1% of extranodal lymphomas. This case report highlights the diagnostic challenges and therapeutic options in a rare presentation of calcitriol-mediated hypercalcemia due to PPL. Case Information: An 89-year-old female presented with generalized weakness, fatigue, anorexia, and a 15-pound unintentional weight loss over six months. Her medical history included breast cancer (treated with lumpectomy and adjuvant therapy 15 years prior), hypertension, chronic kidney disease (stage 3), and hyperlipidemia. Initial evaluation revealed severe hypercalcemia (13.2 mg/dL), low serum phosphate, suppressed parathyroid hormone (PTH 12 pg/mL), undetectable parathyroid-related peptide, and markedly elevated calcitriol (105 pg/mL). Following this, she was treated with intravenous fluids, which led to normalization of calcium levels on day 3, before discharge. She was discharged with a hematology-oncology referral, where her calcium level remained high at 11.8 mg/dL. She received zoledronate for hypercalcemia. Normal serum and urine electrophoresis and a nuclear bone scan ruled out multiple myeloma and paraproteinemias. She was further referred to an endocrinologist, and with oncological workup negative, treatment focused on sarcoidosis. She was started on low-dose prednisone (10 mg/day) and cinacalcet (30 mg/day). A repeat admission to the hospital with persistently elevated calcium levels prompted further evaluation. An abdominal and pelvis CT scan revealed pancreatic cancer and ascitic fluid cytology confirmed the patient has a B-cell lymphoma of pancreatic origin, with immunostaining positive for CD45 and CD20. The patient was further referred to hematology and oncology for outpatient treatment and a PET-CT. Given the poor prognosis and the patient's advanced age, the family chose palliative care, and the patient unfortunately passed away within weeks. Conclusions: This case highlights the complexity of diagnosing calcitriol-mediated hypercalcemia in the setting of rare malignancies such as PPL. The use of cinacalcet offers a promising therapeutic option for managing hypercalcemia in such cases
Examining the occasion-level association of alcohol-induced blackouts and negative consequences above and beyond alcohol use
No full textPoster Highlight: College of Public Health, RAD 2025 Award Winning Posters & Oral PresentationsPurpose: The current study aims to investigate the associations of occasion-level blackout behaviors and alcohol related consequences above and beyond alcohol use. It was hypothesized that across drinking days, days where participants blackouts will be associated with higher count of alcohol related consequences compared to drinking days where they do not black out. It was further expected that across drinking days, the above association is stronger among those with a greater history of blackouts. Methods: The analytic sample included adolescents and young adults in Texas (N = 126; Mean age = 21.0 (SD = 2.5); 53.2% female; 36.5% White Non-Hispanic) who completed a longitudinal ecological momentary assessment study and reported at least one blackout event after drinking. Data were analyzed with mixed effects zero-inflated negative binomial regression model. Results: After controlling for the demographics and the number of drinks, the analysis showed that participants experienced significantly higher number of consequences on days they reported blacking out; however, contrary to the hypothesis, such association was stronger among those with a less history of blackout. Conclusion: The current findings suggest on days one experiences a blackout, there is a higher risk of a greater number of negative consequences above and beyond the amount of drinks consumed. These findings could be used to inform targeted individual-level intervention approaches by incorporating risk information of daily-level blackouts above and beyond alcohol use to mitigate and reduce the risk of alcohol-related negative consequences