Linking Health to Learning: Gaps and Insights from a Rapid Review supported by the American School Health Association (ASHA)

Purpose: In the past year, the American School Health Association (ASHA) has been updating its statement of core beliefs to align with the current evidence base. ASHA has been particularly interested in school health education following the COVID-19 pandemic. ASHA ‘s initiatives are aligned with and support the Whole School Whole Community Whole Child Model (WSCC) developed by the Centers for Disease Control. One element of the WSCC model is health education, which is most clearly related to ASHA Core Belief 1.3: “Health and learning are linked and essential to the development of healthy, resilient individuals and communities. Students’ health and well-being are foundational to achievement and serve as a primary predictor of overall outcomes across the life span.” This core belief was chosen in collaboration with ASHA as the focus of the rapid review, using a lens of health education. Specifically, ASHA leadership requested a rapid review of studies that examine the impact of health education on the relationship between health and learning from 2020 to the present.   Methods: We developed our inclusion/exclusion criteria based on our discussion with ASHA leadership, constructed a search query, and conducted a rapid literature review among three databases: PubMed, Scopus, and ERIC, yielding 665 articles. We used Covidence software to perform the review. We screened articles based on title/abstract, which resulted in 62 articles. Next, we conducted a full-text screening and applied inclusion and exclusion criteria, resulting in twenty-one articles retained for data extraction. Results: Fifteen studies focused on a specific health topic; reproductive health education was the most common research focus and appeared in six studies. Other specific health education topics include mental health in schools, school-based health centers (SBHCs), physical activity, and other specific health behaviors. Most studies were observational with descriptive outcomes. Demographic data was limited, with 18.8% of studies not including information on the race/ethnicity of participants. The authors provided recommendations for health education strategies based on their initiatives. Community-based collaborations were the most frequently recommended strategy, appearing in fourteen studies. Conclusion: We observed that most interventions recommended multiple, overlapping strategies to support health education. The two most frequent recommendations were community-Based Approaches and Focus on Specific Health Topics. The lack of reporting racial and ethnic data was a limitation of studies. Inconsistencies in study outcomes and the definition of fundamental terms such as “health” and “health education”, further limited the comparability and generalizability of study findings. Harmonizing terms and outcomes will help accelerate research to define best practices in school health and support the potential for reproducibility. This rapid review suggests that inadequate research has been done to determine how health education has impacted the relationship between health and learning from 2020 to the present, revealing a gap in the literature. This project also supports the potential value of partnerships between academic health science centers and school health organizations to strengthen evidence-based health education

Leading Predictors of Depression among Working Age Adults with Cognitive Limitations: An Interpretable Machine Learning Approach

Objectives: There are research knowledge gaps in depression in adults with cognitive disabilities. This study identified the leading predictors and their associations with depression working age adults with cognitive disabilities using machine learning methods. Methods: This cross-sectional study used data from the 2022 National Health Interview Survey and included working age adults (18-64 years) with cognitive disabilities (weighted N=464,453). We employed eXtreme Gradient Boosting (XGBoost) regression to determine key predictors. Global and local interpretations of associations were performed using SHapley Additive exPlanations (SHAP). Our predictive model used 20 features such as age, health status, and social determinants of health (SDoH) such as education, and poverty. The model building steps included 70% training and 30% testing split of the data, 10-fold cross-validations, and six rounds of optimization using Python 3.9.12. Model performance was evaluated using the test dataset. Results: Model performance metrics was: area under the curve (0.83,0.77) for training and test curves, respectively. The top 10 leading predictors of depression in working age adults with cognitive disabilities included less than high school, high income, employment, health insurance, marital status, and health status. SHAP plots suggested a complex relationship between age and depression as well as race and depression. Marital status and perceived physical health were associated with lower depression. Being a smoker was associated with higher depression. Conclusions: 1 in 2 adults with cognitive disabilities reported depression in 2022. SDoH were some of the leading predictors of depression. Our findings suggest developing policies that target SDoH to reduce the risk of depression and promote optimal treatment for mental health. The model performance was good with the AUC as 0.83

Impairments in Semantic Fluency and Naming: A Cognitive Profile of Alzheimer’s Disease

Purpose: Alzheimer's disease (AD) is characterized by distinct cognitive impairments that differentiate it from other neurodegenerative conditions. This study explores the hypothesis that a combination of poor performance on the Boston Naming Test (BNT) and semantic fluency tasks, alongside relatively preserved phonemic fluency, serves as a reliable cognitive profile for identifying AD. The degradation of semantic memory, a hallmark of AD, is assessed through the BNT and semantic fluency measures, while intact phonemic fluency reflects the relative preservation of executive functioning in the early to moderate stages of the disease. Participants, including individuals with clinically diagnosed AD and age-matched controls, were assessed using these neuropsychological measures. This study explores the hypothesis, indicating that AD patients exhibit significant deficits in the BNT and semantic fluency tasks, whereas phonemic fluency remains comparatively unaffected based on observed clinical patterns. The primary objective is to investigate whether this cognitive profile can reliably differentiate AD and other dementias, specifically vascular dementia from age-matched controls, with implications for early diagnosis and targeted interventions. Specifically, the study will investigate whether a cognitive profile consisting of poor performance on the Boston Naming Test (BNT) and semantic fluency tasks, combined with relatively preserved phonemic fluency, reliably identifies Alzheimer's disease (AD). Methods: Retrospective data from neuropsychological evaluations of 40 patients (25 with AD and 15 age-matched controls) would be collected from an outpatient clinic. Cognitive performance will be assessed using the BNT, semantic fluency, and phonemic fluency tasks. Group comparisons are to be conducted using independent samples t-tests, and effect sizes (Cohen's d) calculated to determine the magnitude of differences between groups. A discriminant function analysis will evaluate the diagnostic utility of the cognitive profile. Results: It is hypothesized that patients with AD will exhibit significantly lower BNT scores compared to controls. It is hypothesized that semantic fluency scores will be significantly reduced in the AD group versus controls. It is hypothesized that no significant differences will be found in phonemic fluency performance. It is hypothesized that a discriminant function analysis will correctly classify 85% of cases, with naming and semantic fluency measures showing strong predictive power. Conclusions: The proposed findings aim to support the hypothesis that a combination of poor performance on the BNT and semantic fluency tasks, coupled with relatively intact phonemic fluency, is indicative of AD. These results have implications for early diagnosis and differentiation of AD from other dementias in clinical settings. Future research should aim to validate these findings in larger and more diverse samples to enhance the generalizability of these diagnostic markers. Additionally, longitudinal studies could provide insight into how these cognitive profiles evolve over the course of the disease, further informing early diagnosis and intervention strategies

CAIDE Dementia Score and Cognition Association in Dementia-Free Hispanics from the HABS-HD Cohort

Background: Hispanics have a higher prevalence of cardiovascular risk factors compared to its non-Hispanic White counterparts. Studies have consistently shown a positive association between cardiovascular risk factors and cognitive decline. The Cardiovascular Risk Factors, Aging, and Incidence of Dementia risk score (CAIDE) predicts the risk of dementia later in life. CAIDE has been utilized in primarily non-Hispanic Whites. The aim of this study is to examine the relationship between CAIDE scores and cognitive function in Hispanics from the Health and Aging Brain Study (HABS-HD). We hypothesize that a higher CAIDE score will be associated with poorer cognitive performance in this cohort. Methods: Data from 1116 dementia-free Hispanic participants were analyzed. CAIDE was used as a predictor of cognitive performance on multiple cognitive domains. Cognitive scores were converted to Z scores, except for the MMSE, with lower Z scores meaning worse performance. CAIDE scores were used as a continuous variable; and were also categorized into two groups: low risk (CAIDE score 9). Linear regression was used to estimate the association between CAIDE and cognitive performance while adjusting for APOE4 status. Results: Sixty-eight percent of the total sample were female, mean age 61 (9.26), and 11 (4.54) years of education. Twenty-four percent of the sample were APOE4 carriers. Participants in the high-dementia risk group were older, had less years of education, higher systolic blood pressure and BMI compared to the low-dementia risk group. Cognitive performance was significantly lower in the high-risk group participants except for SEVLT delayed and FAS. Linear regression showed that CAIDE risk scores significantly predicted MMSE, Trails A, Trails B, and DSS, after adjusting for APOE4 status. Results did not change when using CAIDE as a binary variable. Conclusion: Our analysis suggests that higher CAIDE risk scores are associated with poorer performance in multiple cognitive domains. Further research is needed to validate the utility the CAIDE dementia score to predict cognitive decline in this population. This can aid targeted interventions to reduce dementia risk

Pseudopheochromocytoma: An Endothelial Cyst of the Adrenal Gland Case Study

Background: Benign endothelial cyst of the adrenal gland (ECAG) with pheochromocytoma-like symptoms, also called pseudopheochromocytoma (pseudoPHEO), is an extremely rare condition. Adrenal cysts are extremely rare with an incidence of 0.06% in the general population. ECAG represents approximately 45% of all cystic tumors involving the adrenal glands. There are two subtypes of ECAG: angiomatous and lymphangiomatous. These cysts occur predominately in females. The association of adrenal cysts with pseudopheochromocytoma is a rare but well-documented relationship. Occasionally these cysts can create pressure symptoms in the medulla and cause elevated metanephrines. PseudoPHEO is a diagnosis of exclusion, with pheochromocytoma being an important differential diagnosis and must be ruled out. Patients usually present like pheochromocytoma with symptomatic paroxysmal hypertension. Catecholamine-secreting tumors are diagnosed in fewer than 0.5% of patients with hypertension. If adrenal cortical tumors are involved, elevated catecholamines can be found on evaluation. Treatment of pseudoPHEO is dependent on the severity and etiology of the disease process. Because patients can be normotensive between symptomatic episodes, medical management may lead to unpredictable hypotensive episodes. In cases of pseudopheochromocytoma caused by ECAG, adrenalectomy is indicated. Case Information: A 63-year-old female with a history of an adrenal nodule, first discovered in 2017 during a colon resection for diverticulitis, and poorly controlled hypertension, presented for a planned adrenalectomy due to suspected pheochromocytoma. The patient was followed by general surgery prior to the planned procedure. Patient’s normetanephrine levels were 342 with metanephrine of 50. A CT of the abdomen revealed a 3 cm adrenal lesion with features suggestive of benign etiology. She underwent robot-assisted laparoscopic right adrenalectomy with corresponding ICU post-operative care. The adrenal gland showed a 3 cm cyst arising in the adrenal medulla and abutting the adrenal cortex (figure available). Microscopic examination revealed a multilocular cyst associated with hemorrhage involving the adrenal medulla (figure available). The cells were positive for CD31 and negative for calretinin, confirming their endothelial origin. Biopsy was consistent with benign ECAG. The cyst can create pressure symptoms in the adrenal medulla and cause elevated metanephrines, as seen in this patient. Results were negative for pheochromocytoma. Two days postoperatively, the patient had regular bowel function, stable hemodynamics, and was cleared for discharge. Conclusions: The patient’s biopsy results were consistent with benign endothelial cyst of the adrenal gland. The criteria for diagnosing pseudopheochromocytoma include negative tests ruling out pheochromocytoma and symptomatic paroxysmal hypertension with or without elevated catecholamines. The criteria for diagnosing ECAG include biopsy with hematoxylin and eosin staining. Immunohistochemistry may show CD31 and calretinin, which is consistent with endothelial cells. While the prognosis for ECAG is generally favorble, ECAG with associated pseudopheochromocytoma can cause life-threatening complications. For this reason, surgical intervention is indicated for patients with adrenal cysts presenting with pheochromocytoma-like symptoms

Impact of a Feedback Processing Framework on Feedback Orientation in First Year Pharmacy Students

Purpose: 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

Investigating the relationship between skin color, ethnicity, and the Fitzpatrick skin scale

Background: The Fitzpatrick skin scale has long been used as a proxy for skin tone categorization.¹,² However, its initial creation was to classify reactivity of white skin to ultraviolet A radiation.¹,² A reported one-third of dermatologists conflate the Fitzpatrick skin scale for race and ethnicity.³ Approximately half of the dermatologists also reported utilizing the Fitzpatrick scale to describe skin color.³ The goal of this study was to compare the Fitzpatrick scale to skin color and ethnicity in a larger, cohort including the full spectrum of skin tones. Methods: Subjects completed a standardized questionnaire. The questionnaire encompassed subjective classification methods: self-reported skin color descriptors (very fair, fair, olive, light brown, dark brown, and very dark), self-assessed Fitzpatrick skin type (I-VI) and ethnicity. The questionnaire included the following ethnicities: White, Asian, African American or Black, Hispanic or Latino, Native Hawaiian or Pacific Islander, Multiple Ethnicities, and Other. If more than one ethnicity was chosen, the subject was reported as “multiple ethnicities.” Chi-squared tests were performed comparing skin color and ethnicity to Fitzpatrick skin type. Results: 440 subjects completed the questionnaire. Chi squared test revealed that each Fitzpatrick type was composed of significantly different proportions of skin colors (p < 2.2e-16). There was a weak association between Fitzpatrick type and self‐described skin color (Cramér’s V=0.3). While there is a significant difference in the percentage of each ethnicity found in each Fitzpatrick type (p < 2.2e-16), each ethnicity could not be modeled off individual Fitzpatrick types. There was representation from all ethnicities in each Fitzpatrick type. There was a weak association between Fitzpatrick-type and ethnicity (Cramér’s V=0.3). Conclusion: This study confirms previously cited flaws of the Fitzpatrick scale. Our study found no statistically significant proportion of a singular skin color descriptor or ethnicity within each Fitzpatrick skin type. This serves as emphasis that there is no relationship between physical traits or cultural identity with the Fitzpatrick scale

Integrating Residents’ Rights and Infection Prevention in Nursing Homes: ICARE Education and Skills Fair Pilot Assessment

Poster Highlight: College of Public Health, RAD 2025 Award Winning Posters & Oral PresentationsBackground: During the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) implemented required regulations in participating nursing homes (NH) to deliver person-centered care (PCC), including infection prevention and control (IPC). Barriers to implementing person-centered IPC (PC-IPC) include variations in understanding how to incorporate IPC and PCC. Post-COVID barriers to implementing PC-IPC included time constraints and variations in understanding IPC and PCC. The Infection Control Advocate and Resident Education (ICARE) program, which integrates evidence-based practices in IPC and residents’ rights, piloted a PC-IPC education and skills fair to address this barrier. The current study describes changes in fair participant knowledge and perceptions. Methods: Expert Recommendations for Implementing Change (ERIC) Domains 3 (adapt and tailor) and 5 (train and educate) were identified as aligning with barriers results in the creation of the ICARE program. The pilot was conducted in two urban and one rural nursing home. Clinical and non-clinical staff were invited to participate. Participants completed stations that integrated residents' rights with core IPC practices, including environment of care, hand hygiene, prevention precautions, catheter-associated urinary tract infection prevention, antibiotic stewardship, and public health emergencies. Upon station completion, a quiz and survey were completed; quiz scores ≥ 80% were considered passing. Participants' demographics, station evaluation, and job benefit perceptions were collected; descriptive analysis was performed. Results: Ninety nursing home staff participated in the fairs. Most participants were female (84%), almost half (49%) were self-described as Hispanic or non-Hispanic Black, and over half were nursing staff (67%). Most participants passed the station quizzes on their first attempt (1.24 attempt average); 90% indicated learning information to enhance job performance, and 88% indicated they better understood the role of residents’ rights in IPC. Compared to the average, participants in the rural facility were roughly 15% less likely to indicate learning information to enhance job performance or understanding the role of residents’ rights in IPC. Conclusion: The ICARE fair improved the nursing home staff’s understanding of PC-IPC by integrating residents’ rights. Rural participants reported a lower understanding of learning outcomes. ICARE is a unique tool that can provide a means for decreasing NH barriers and integrating PCC approaches to IPC practices. These findings emphasize the need for tailored approaches to address barriers in rural settings and ensure equitable education effectiveness across locations

Beta 2 Receptors Mediate Adrenergic Relaxation of the Rat Femoral Artery

Poster Highlight: College of Biomedical and Translational Science, RAD 2025 Award Winning Posters & Oral PresentationsPurpose: The purpose of this study was to determine: a) the extent to which β-adrenergic agonists relax vascular smooth muscle, b) the β-receptor subtype(s) that are activated; and c) the signaling mechanisms involved. Methods: Isometric tension was recorded from 2 mm segments of femoral arteries from male and female Sprague Dawley rats. Arterial rings were contracted with the α1 agonist phenylephrine (10 µM) or 60 mM K+, which produced a stable contraction upon which mechanisms of relaxation were studied. Various pharmacological agents, including isoproterenol, dobutamine, glibenclamide, 4-aminopyridine, and ouabain were used to determine the mechanism underlying β-adrenergic mediated relaxation. Results: Isoproterenol (10 nM to 10 µM), an agonist of β1 and β2 receptors, produced full relaxation. Dobutamine (10 nM to 10 µM), a selective β1 agonist, also produced full relaxation. Contracting arteries with 60 mM K+, which depolarizes the membrane and shifts the reversal potential, abolished β-adrenergic mediated relaxation. Application of 100 µM glibenclamide (an inhibitor of ATP-dependent K+ channels) or 1 mM 4-aminopyridine (an inhibitor of voltage-gated K+ channels) affected β-adrenergic relaxation of PE contractions. Ouabain (30 µM), an inhibitor of the Na+/K+-ATPase, partially blocked β-adrenergic relaxation following PE contractions. Conclusion: These results suggest that stimulation of β2 receptors antagonize α1 adrenergic contraction through cellular mechanisms which activate the Na+/K+-ATPase. Understanding β-adrenergic mediated relaxation can reveal the basic mechanisms behind vascular regulation. Additionally, it can help guide the development of more targeted treatments for vascular diseases like hypertension by selectively focusing on those specific receptors and pathways

Enhancing Student Skills: The Impact of Peer-Led Mock OSCE on Competence and Perceptions

Purpose: This study evaluates the impact of a peer-led mock OSCE (MOSCE) before a low-stakes OSCE on students' performance in both low- and high-stakes OSCEs, perceptions of OSCE readiness, and peer tutors’ experiences. Methods: P2 and P3 students served as peer graders and simulated patients for a P1 physical assessment MOSCE that tested students on communication, blood pressure and pulse assessment, and diabetic foot exam assessment skills. P1 participants completed pre- and post-MOSCE surveys assessing confidence and preparedness for the high-stakes OSCE, while non-participants were also surveyed for comparison. Peer graders provided feedback via post-MOSCE surveys. OSCE station grades were analyzed to assess the link between MOSCE participation and student performance, preparedness, and confidence using Chi-square, independent samples t-tests, and paired t-tests in SPSS version 29. Results: 30 (39%) attended the MOSCE before the low-stakes OSCE. Among them, 20 (66.7%) passed the low-stakes OSCE (p=0.09), and 26 (86.7%) passed the high-stakes OSCE (p=0.14), compared to pass rates of 46.8% and 72.3% for non-participants, respectively. While MOSCE participants had higher average low-stakes OSCE scores (48.59±3.77 vs. 46.57±6.09, p=0.11), the difference was not statistically significant. However, participation was associated with significantly higher high-stakes OSCE scores (49.56±3.20 vs. 47.56±4.72, p=0.03). When the MOSCE was offered in Fall 2023 before the high-stakes OSCE, participation (n=34) was not associated with improved high-stakes OSCE scores (50.1±2.75 vs. 50.0±3.36, p=0.88) or pass rates (p=0.77). Survey results indicated that 50% of MOSCE participants (n=10) had prior clinical or pharmacy experience, and 80% had practiced beforehand. Post-MOSCE, participants reported significantly greater preparedness (3.30±0.48 vs. 2.50±0.53, p<0.001), confidence in taking medical and social histories (3.10±0.57 vs. 2.50±0.53, p=0.005), and confidence in performing a diabetic foot exam (3.20±0.42 vs. 2.50±0.53, p=0.001). All survey respondents agreed that the MOSCE was beneficial, improved communication skills, and valued peer feedback. Among peer tutors (n=17), responses indicated that the MOSCE reinforced physical assessment skills, fostered an appreciation for peer-led learning, and provided a valuable teaching experience. The most appreciated aspects included the peer-led format (82.4%), clinical scenario simulation (70.6%), and peer-driven feedback (58.8%). Conclusions: While MOSCE participation did not significantly impact low-stakes OSCE performance, it was associated with improved high-stakes OSCE performance; whether this was due to increased exposure and practice or participation in the low-stakes OSCE remains unclear. Moreover, the benefit of timing the MOSCE before the low-stakes vs. the high-stakes OSCE is not completely understood. However, MOSCE attendance significantly enhanced OSCE readiness and was beneficial to both participants and peer tutors. Expanding MOSCE availability and incorporating multiple practice opportunities may further enhance skill development through peer-led learning