Improved Network Integrity and Patient Follow-up After In-Office Needle Arthroscopy Compared to Outpatient Advanced Diagnostic Imaging for Intra-articular Pathology

Purpose To evaluate network integrity for diagnostic testing and patient follow-up comparing in-office needle arthroscopy and outpatient advanced diagnostic imaging for intra-articular pathology. Methods A retrospective chart review was performed to identify patients who were indicated for either in-office needle arthroscopy (IONA) or outpatient advanced diagnostic imaging (OADI). Current Procedural Terminology (CPT) codes 29870 and 29805 with place of service modifier 11 were used to identify patients who underwent IONA of the knee and shoulder, respectively, between January 2020 and March 2023. CPT codes 73721-3 and 73221-3 were utilized to identify patients indicated for outpatient advanced magnetic resonance imaging of the knee or shoulder. All patients who were indicated for the procedure and denied by the insurance were identified and recorded. Inclusion criteria consisted of patients older than 18 years with suspected intra-articular pathology who had failed conservative treatment. Exclusion criteria included patients younger than 18 years, non-English speaking, or those who failed to follow up due to death. The location of where the imaging was performed was recorded (within the health system vs an unaffiliated center). Additionally, patient follow-up with the provider after the diagnostic testing was indicated was recorded. Results Two separate groups of 100 consecutive patients who were indicated for IONA or OADI were identified and retrospectively chart reviewed. Ninety-four percent of the IONA patients underwent the procedure after it was indicated within the physician office. Sixty-eight percent underwent the procedure the day they were indicated for the procedure. All 94 patients were deemed to have a follow-up with a definitive plan of care after the procedure. Eighty-seven percent of the OADI patients completed their ordered testing. Sixty-two percent (54/87) of the patients had the study performed at one of the primary hospital-affiliated imaging centers. Thirty-eight percent of the studies (33/87) were deemed to have leaked from the system. Of the 87 patients who had the imaging performed, 79% (69/87) had a definitive treatment plan rendered with the lead author (S.M.) based on the imaging results. Twenty-one percent (18/87) of the patients who underwent imaging did not follow up with the treating provider or show for a scheduled follow-up appointment. Nineteen percent (13/69) of the patients who had a definite treatment plan rendered did not come into the office for their results but requested and received them over the phone from the provider. The IONA cohort demonstrated statistically significant (P \u3c .001) network integrity in terms of location of service remaining within the system compared to the OADI group. Furthermore, patient follow-up for definitive treatment plans after IONA was also higher (P \u3c .001) than in the OADI group. Conclusions IONA results in greater network integrity and patient follow-up compared to conventional imaging. Clinical Relevance In-office needle arthroscopy performed for the diagnosis of intra-articular pathology may offer a valuable clinical diagnostic tool while providing a meaningful avenue for network integrity and patient retention

TRAJECTORIES OF DEPRESSION SEVERITY IN THE FIRST SEMESTER OF COLLEGE

Depression is a major public health concern among students in higher education. Prior work suggests that depressive symptoms increase during the transition to college. Transfer students face unique challenges during the transition to a new academic institution that may make them particularly vulnerable. There is a critical need to expand prevention efforts. Research that improves identification of students at greatest risk for developing impairing depressive symptoms, and etiological processes contributing to depressive symptoms could aid in the provision of limited prevention resources. Furthermore, longitudinal research tracking symptom trajectories during the transition to college could help inform the timing of preventive interventions for new students. We propose to conduct secondary data analysis from a prospective cohort study designed to model mental health symptoms among first-year students and incoming transfer students during their first semester at a large university. Our goal is to model the course and predictors of depression severity as captured by measures of depression-related impairment. We propose two hypotheses: (1) depression severity will follow a nonlinear trajectory with increasing severity in the early part of the semester followed by a plateau in symptom change; (2) transfer students will report higher levels of depression severity throughout the semester relative to first year students

An exploratory metabolomic comparison of participants with fast or absent functional progression from 2CARE, a randomized, double-blind clinical trial in Huntington\u27s disease.

Huntington\u27s disease (HD) is increasingly recognized for diverse pathology outside of the nervous system. To describe the biology of HD in relation to functional progression, we previously analyzed the plasma and CSF metabolome in a cross-sectional study of participants who had various degrees of functional impairment. Here, we carried out an exploratory study in plasma from HD individuals over a 3-year time frame to assess whether differences exist between those with fast or absent clinical progression. There were more differences in circulating metabolite levels for fast progressors compared to absent progressors (111 vs 20, nominal p \u3c 0.05). All metabolite changes in faster progressors were decreases, whereas some metabolite concentrations increased in absent progressors. Many of the metabolite levels that decreased in the fast progressors were higher at Screening compared to absent progressors but ended up lower by Year 3. Changes in faster progression suggest greater oxidative stress and inflammation (kynurenine, diacylglycerides, cysteine), disturbances in nitric oxide and urea metabolism (arginine, citrulline, ornithine, GABR), lower polyamines (putrescine and spermine), elevated glucose, and deficient AMPK signaling. Metabolomic differences between fast and absent progressors suggest the possibility of predicting functional decline in HD, and possibly delaying it with interventions to augment arginine, polyamines, and glucose regulation

Social Support of First-Generation College Applicants During the Transition to College Onboarding Phase: A Mixed Methods Sequential Explanatory Case Study

This mixed methods case study sought to explain first-generation college applicant melt with respect to support provided through a digital onboarding platform at State University. Data were analyzed to understand use of the platform for social support purposes, resulting in a predictive model that demonstrated social support was a greater predictor of melt among first-generation college applicants than both distance from home and adjusted gross income. Additionally, staff were interviewed regarding support practices and platform usage. Three key findings emerged: the onboarding platform did not provide adequate support to applicants; enrollment management staff scrambled to compensate for this support gap; and ultimately, this resulted in untrackable and potentially inequitable support practices. The findings demonstrated that support has a positive relationship with melt reduction, but support practices and technology use alignment is required to ensure systematic, equitable, and effective support distribution

Fundal Anterior to Posterior Hysterotomy and Cesarean Myomectomy in Fibroid Uterus

Fibroids are a common benign tumor located in the female reproductive tract and affect up to 10 percent of women, leading to challenges during cesarean section. Few cases of myomectomy at the time of cesarean section have been described and most describe uteri with only a few fibroids present. Our case describes a 39 year old G1P0101female with extensive fibroids including large fibroids located at the lower uterine segment. This patient underwent cesarean section and myomectomy at 27 weeks and five days gestation with a fundal, vertical hysterotomy, extending from the anterior to posterior wall of uterus. This is the first case described in the literature of a cesarean section performed on a uterus with innumerable intramural fibroids and first case documented of a fundal, anterior to posterior hysterotomy

A QUALITATIVE CASE STUDY: NCAA DIVISION III FIRST-GENERATION STUDENT-ATHLETES AND TRANSFERABLE SKILLS

The development of transferable skills is seen as an important factor for higher education institutions to enhance the employability of their graduates (Holmes, 2013; Tymon, 2013). An overarching purpose of the higher education system is to prepare students for their professional careers and lives. This qualitative instrumental single case study explored how first-generation student-athletes develop transferable skills through intercollegiate athletics at a public, Division III university in New Jersey. Further, it sought to understand how the university validates these transferable skills for first-generation student-athletes. Data was collected using semi-structured in-depth open-ended interviews to capture rich details from the participants related to the phenomenon. This study assists in filling the void in research regarding the transferable skills first-generation student-athletes develop through intercollegiate athletics and how the university validates these experiences for them that may contribute to a more career ready first-generation student-athlete

Efficacy of Psilocybin in the Treatment of Substance and Alcohol Use Disorders

Introduction: Substance use disorder (SUD) and alcohol use disorder (AUD) are major public health crises, affecting millions of Americans. Current treatment options include behavioral therapies and medications. In this review, we explored psilocybin’s efficacy in treating SUD and AUD. Methods: Key terms were used to search databases to identify articles that addressed psilocybin in the treatment of SUD. Included in the review were indexed, peer-reviewed, primary sources that were published within the last 10 years. Excluded studies were non-peer reviewed, not relevant to the thesis, and did not have an English translation. Results: The psychodynamic antidepressant effects of psilocybin mark its potential as treatment for depression and other mental health disorders. Clinical trials investigating the efficacy of psilocybin as a complement to psychotherapy for AUD reported notable an overall decrease in alcohol consumption compared to control groups. Similarly, other trials concluded that participants reported improvement of depressive symptoms. Furthermore, participants suffering from mental health disorders who experimented with microdosing reported improved focus, confidence, and relationships alongside decreased social anxiety. Animal models proved that psilocybin disrupted alcohol-related memories and alcohol-seeking behaviors; thus, psilocybin therapy may be beneficial in preventing relapse in patients with AUD. Discussion: Current studies show that psilocybin has potential as a treatment for SUD and AUD. Studies on psilocybin have various limitations, such as small sample sizes, reliance on self-reported data, and the inability to fully replicate the psychedelic experience in animal models. Despite limitations, these findings provide a strong rationale for conducting future high quality research

Efficacy of Mcl-1 Inhibitors in Multiple Myeloma Cells Resistant to Bortezomib

Multiple myeloma (MM) is a type of cancer that affects plasma B cells. Patients with MM often experience frequent relapses and can develop resistance to drugs. As a medical researcher, it is important to understand the role of Mcl-1 in preventing intrinsic apoptosis and drug resistance. Mcl-1 belongs to the anti-apoptotic subgroup of Bcl-2 family proteins and plays a crucial role in these processes. Mcl-1 plays a crucial role in driving disease progression and contributing to drug resistance in MM. It has been observed that there is an increased expression of Mcl-1 in 52% of patients with MM during diagnosis, which further rises to 81% during relapse. Thus, researchers are investigating the potential of Mcl-1 inhibitors as a viable treatment option for patients with MM, particularly those who have not responded to previous therapies. Proteasome inhibitor Bortezomib (BTZ) is commonly prescribed as the initial treatment for MM, but unfortunately, patients eventually develop resistance to it. For this study, we created cells that are resistant to BTZ in order to explore the potential mechanisms behind the development of resistance. These cells have been treated with BTZ over a period of 6 months. Regrettably, there are currently no Mcl-1 inhibitors that have been approved by the FDA. However, there are several agents, such as S63845, AZ5991, and VU661013, that are currently undergoing clinical trials. Interestingly, Mcl-1 inhibitors demonstrated effectiveness against sensitive cells but showed a decrease in efficacy against BTZ resistant cells. Our research indicates that cells resistant to BTZ require a higher concentration of Mcl-1 inhibitors in order to undergo cell death. This suggests that these resistant cells may possess a compensatory mechanism that stabilizes the Mcl-1 protein and alters the effectiveness of Mcl-1 inhibitors in treatment. It is worth noting that the anti-apoptotic Bcl-2 protein exhibits heightened expression in resistant cells, even when inhibitors are present. This observation may provide valuable insights into a potential resistance mechanism and calls for further investigation into the compensatory mechanisms that play a crucial role in drug resistance

Effect of Food Selectivity on Dyslipidemia in Autism Spectrum Disorder

This survey-based study sought to determine whether there is a correlation between food selectivity and blood lipid levels in autistic patients

A SOCIAL ECOLOGY MODEL FOR SOCIAL DETERMINANTS OF HEALTH AS PSYCHOSIS RISK FACTORS

Social determinants of health (SDOHs) significantly impact psychosis risk beyond heritability. However, there is a need for an organizing framework to observe how these diverse elements concurrently predict psychosis risk. This study examines SDOHs as psychosis risk factors using a four-level model, aligned with Bronfenbrenner\u27s social ecology theory. The study aims to assess the proposed model’s ability to predict psychosis risk. Specifically, it is hypothesized that each socioecological level of the model would predict psychosis risk with more proximal SDOHs (e.g., individual level vs community) exhibiting stronger predictive power, aligning with Social Ecology theory. College students (N = 210) completed self-report measures of schizotypy, childhood trauma, minority group position, social connectedness, urbanicity, health care access, and SES via online surveys. The overall model accounted for a significant amount of psychosis risk variance (34.8%) with each level contributing significantly. However, contrary to expectations, SDOH proximity did not correspond with predictive ability. Rather, social connectedness, childhood trauma, and healthcare access emerged as salient predictors. The current study provides evidence that a Social Ecology Model, despite limitations, may provide an advantageous framework for future research, risk measurement, and interventions. Current findings reinforce that many of these SDOHs, particularly social connectedness, may be worthwhile targets for interventions