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Pumping Iron, Straining Hearts: Androgen Building Cardiomyopathy In a Middle Aged Bodybuilding Enthusiast
No full textA 46-year-old bodybuilder presenting with new onset dyspnea found to have a new onset non-ischemic cardiomyopathy (CM) attributed to exogenous trenbolone and testosterone use. Steroid cessation and guideline-directed heart failure therapy led to notable recovery in left ventricular function supported by global longitudinal strain, ejection fraction and symptomatology.
Anabolic steroid-induced CM involves multiple mechanisms including lipid disturbances, hypertrophy, reduced receptor sensitivity, and cell damage. This case emphasizes the importance of recognizing anabolic steroid misuse as a potential cause of non-ischemic cardiomyopathy in middle aged men. With prompt discontinuation of steroids, remained abstinence and early initiation of guideline-directed medical therapy, myocardial recovery can occur
From Textbooks to Clinical Practice: Selecting and Implementing Outcomes Measures in Stroke Rehabilitation
Get PDFEmotional and Metacognitive Impacts of a Human Anatomy Course Utilizing Three-Dimensional Learning Modalities
Get PDFA high school human anatomy course was designed to integrate three-dimensional learning modalities through the use of three-dimensional visualization technology, augmented reality, and whole-body donors (cadaveric specimens), and customized 3D digital models were created to support student learning. The course was organized so that each class meeting fell into one of six unique learning session types: lectures, augmented reality labs, gross anatomy (cadaveric) labs, content application (active learning) sessions, review sessions, and examination sessions.
An interval scale using ten emoji, each associated with a particular emotional valence (i.e., pleasantness) level, was developed and integrated into the course to track students’ emotional states before and after each learning session. Results indicated that students generally felt neutral or pleasant emotions and experienced significant valence level shifts over a variety of learning session types. Additionally, some correlations between their emotional valence levels and their exam scores were identified, and students experienced statistically significant changes in their emotions regarding learning in a cadaveric laboratory over the span of the course.
Four summative lecture and laboratory unit examinations were developed to assess the students’ abilities to remember and to understand information derived from unit learning objectives, using four unique question types. Student metacognitive shifts were analyzed by evaluating the alignment of a students’ pre-examination confidence level, measured on a four-factor scale, for a particular learning objective to a students’ post-response certainty level, measured on a four-factor scale, for a question assessing that particular learning objective. Knowledge levels were defined and could fall into one of four general categories: complete, partial, absent, or flawed, although more nuanced sub-categories were defined and analyzed. Results indicated that students performed best, were most confident, and were most certain on questions utilizing screenshots of 3D digital models, whereas students performed worst, were least confident, and were least certain on questions utilizing cadaveric specimens. Additionally, there were more complete knowledge levels and fewer absent knowledge levels acquired on the unit lecture examinations, as compared to the unit laboratory examinations
Evaluation of Community Healthcare Workers of Faith-Based Workers in Northern Omaha
No full textThe University of Nebraska Medical Center (UNMC) developed a training and certificate program for Community Health Workers (CHWs) in faith-based organizations in Northern Omaha. Each recruited trainee developed an experimental program they implemented in their faith-based community. This research study aims to explore and analyze the implementation of these programs in the community, the effects that these programs have on the community, and the extent to which the goals of the CHWs\u27 implemented programs were met.
To achieve this, data was collected through a 41-question survey administered via REDCap to 12 CHW trainees. Descriptive statistics of this data were analyzed using the REDCap Statistics function and open-ended data was sorted using thematic analysis. Major perceived needs of the community that were addressed by the CHWs included diabetes (83.3%), heart disease (75.0%), hypertension (75.0%), mental/behavioral health (75.0%), and obesity (66.7%). Most activities conducted by the CHWs included individual or community outreach (8, 66.7%) and promoting healthy lifestyles through nutrition and physical activity support (8, 66.7%). CHWs primarily monitored community members’ healthcare in the interventions through self-reported changes. When observing the CHWs’ perception of their work and their project’s impact on the community, most respondents reported positive experiences.
A wide range of health needs were addressed by these CHWs and were similar to important health factors that are prevalent in African American churches in Omaha, Nebraska. Areas to explore and possibly address in the future include implementing relationships between healthcare providers and the community for easier access to medical services, incorporating ways to help community members stay continuously engaged in the implemented program, and providing effective tools to assess community health outcomes and avoid self-reporting bias
Non-TNFi Biologic and Targeted Synthetic DMARDs in Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Comparative, Propensity Score-Matched Study Using National Veterans Affairs Data
No full textBackground/Objectives: There is a paucity of evidence on the safety and effectiveness of non- TNFi biologic therapies in RA-ILD, this study aimed to compare treatment outcomes in RA-ILD between rituximab, abatacept, IL-6i, and JAKi using the Target Trial Emulation Framework.
Methods: We emulated 3 trials comparing abatacept, IL-6i, and JAKi with rituximab (reference). Patients fulfilling validated RA-ILD algorithms initiating one of these non-TNFi b/tsDMARDs were propensity score (PS)-matched (1:1) using national Veterans Affairs (VA) data from 2006 to 2020. PS models included demographics, comorbidities, general health status indicators, and RA- and ILD-related severity measures. Study outcomes were death and respiratory-related hospitalization, ascertained by VA data and linkages to the National Death Index and Medicare, over 3-year and 1-year follow-up periods. Cox regression models with univariate frailty correction were used to analyze study outcomes. Sensitivity analyses were performed among cohorts with modified eligibility criteria.
Results: In the primary cohort, we 1:1 matched abatacept (n=159), IL-6i (n=78), and JAKi (n=94) with rituximab initiators [age (mean range 68.1-69.9 years), male (range 87-91%), white (range 78-84%)]. There was not a significant difference in the primary composite outcome among any of the comparisons [abatacept = HR: 0.90 [0.64, 1.26]; IL-6i = HR: 0.97 [0.62, 1.53], aHR: 0.93 [0.59, 1.47]; JAKi= HR: 0.85 [0.53,1.36], aHR: 0.69 [0.41, 1.14]]. Sensitivity analyses supported the findings.
Conclusions: We did not find significant differences in outcomes between non-TNFi b/tsDMARDs, though estimates were imprecise. These findings emphasize the need for clinical trials of advanced immunomodulatory therapies in RA-ILD
The Effect of Repetitive Transcranial Magnetic Stimulation on Brain and Cognitive Variables in Patients with Amnestic Mild Cognitive Impairment
No full textHealthy and pathological aging processes can impact human memory. Current interventions for clinical memory impairment offer little opportunity for restoration of memory ability. Fortunately, a novel therapy in the form of repetitive transcranial magnetic stimulation (rTMS) has exhibited promise in this regard. In healthy adults, rTMS of the angular gyrus (AG) has been reported to improve memory. The current study sought to determine the generalizability of these findings to individuals with clinical memory impairment by administering a clinical trial replicating an rTMS protocol reported to improve hippocampal-dependent memory in healthy individuals to individuals with amnestic mild cognitive impairment (aMCI). Individuals diagnosed with aMCI (N=15) completed two five-day sessions of rTMS with a minimum two-week washout between weeks. Brain and cognitive variables were collected before the first rTMS session of each week and the day following the final session of each week. rTMS was administered as a β-frequency pulse sequence alternating 2-sec. trains of 20 Hz stimulation with 28-sec. rest for 20 min (1600 TMS pulses total) for five consecutive days. Stimulation was administered to each participant\u27s area of left AG exhibiting peak resting-state functional connectivity (RSFC) with left hippocampus. Treatment rTMS was delivered at 100% resting motor threshold (RMT) and placebo rTMS at 10% RMT. This study followed a double-blind crossover design. The primary objective of this study was to identify any changes in hippocampal-dependent memory associated with rTMS. Secondary objectives included identifying RSFC changes of the hippocampus and AD with the DMN and any changes in the brain\u27s functional connectome associated with rTMS. Treatment rTMS was associated with significantly improved performance on select measures of hippocampal-dependent memory, specifically verbal memory. Treatment rTMS also reduced RSFC between the hippocampus and bilateral dorsolateral prefrontal cortex. However, no change in connectomic measures was observed within this study. This study\u27s findings suggest that rTMS can improve memory and modify hippocampal RSFC in individuals diagnosed with aMCI and may serve as a potential intervention for AD
Identifying the Molecular Determinants of Lung Metastatic Adaptation in Prostate Cancer
No full textProstate cancer (PC) stands as the primary diagnosed cancer in men in the US at approximately 299,010 cases in 2024 and ranks second globally, posing a significant public health challenge. Clinical presentations vary widely, from indolent to aggressive forms, necessitating stage-specific treatment regimens. Understanding its metastatic nature is critical due to the impact of cancer cell dissemination on disease morbidity, with bone and visceral organs serving as key sites of metastasis. Despite bone metastasis being the most common site for metastasis, visceral metastases at sites such as the liver and lungs correlate with poorer survival, emphasizing the role of microenvironmental factors in disease progression and treatment outcomes. Intricate molecular mechanisms and genetic variations can be gateways to further understand PC metastasis development. The aim of this thesis is to evaluate how the loss of Axlin Pten/Trp53NULL cells promote a metastatic phenotype with a potential role in metastatic adaptation. To explore this hypothesis, we generated a PC lung metastasis model with Axl knockout (KO; CRISPR) in Pten/Trp53NULLRapidCaP-derived cell lines. These in-vivo trials provided insights into the biological disparities between KO and WT cell lines using transcriptomics, immunohistochemistry, and multiphoton-photon microscopy-based collagen imaging. By assessing the metastatic capacity of parental and knockout cell lines in vivo we demonstrated faster incidence of overt metastases in the AxlNULL model, underscoring the significance of AXL loss in driving PC metastasis
Development of a National Core Indicators Dashboard of Long-Term Services and Supports Outcomes for Individuals with Intellectual and Developmental Disabilities
Get PDFThe National Core Indicators (NCI) surveys are conducted annually across the United States, including Nebraska. Individuals with intellectual and developmental disabilities and/or their guardians are surveyed to learn more about their experiences and the quality of their services and lives (National Core Indicators- IDD, 2023). However, the data is only useful when understood and applied to make informed decisions to improve the lives of those with intellectual and developmental disabilities (McDonald et al., 2013). This project designed and developed two data dashboards for the state of Nebraska that publicly track, analyze and display the NCI survey results. The In-Person Survey dashboard provides a comprehensive review of the data collected from the NCI survey, while the User- Friendly data dashboard reflects a prioritized subset of data in a simplified format. The dashboards not only allow for more transparency of the survey findings but will help to inform future decisions by policymakers as well as provide data for stakeholders and those advocating for systems change to improve the lives and services of those with intellectual and developmental disabilities in the state of Nebraska
HIV Testing Among High-Risk Individuals in the US: 2022 BRFSS
Get PDFObjective
Human Immunodeficiency Virus (HIV) infection is a global epidemic, and public health efforts are moderately effective to date. This cross-sectional study aimed to determine association between high-risk behavior (intravenous drug use, risky sexual behaviors) and odds of testing for HIV utilizing 2022 Behavioral Risk Factor Surveillance System (N= 445,132).
Methods
Using SAS 3.82, the age-stratified logistic regression model for exposure (high-risk behavior) and outcome (HIV testing) included covariates gender, race, income, mental health and checkup frequency.
Results
High-risk individuals had greater odds of testing compared to low-risk individuals (crude POR 2.98 [2.81 – 3.17]), with greatest odds observed among ages 18-24 (POR 3.2 [2.76 – 3.7]) and \u3e=55 (POR 3.21 [2.68 – 3.85]). Persons aged 18-24 were the majority reporting high-risk behavior (14.5%). Women had greater testing odds (crude OR 1.12 [1.09 – 1.15]) and among non-Whites, other/multiracial non-Hispanics had lower testing odds (crude OR 1.12 [1.06 – 1.18]).
Conclusions
This study confirmed the association between high-risk behavior and HIV testing, highlighted opportunity for prevention among persons under 25 and provided direction for future research to target public health programs for disparate populations
