Clinical Practice Implementation to Address ASCVD Risk: A Practice Change in Primary Care

Practice Problem: Heart disease stands as the leading cause of mortality in the United States. While healthcare providers strive to identify and optimize prevention strategies, particularly in high-risk patient populations, notable gaps in care persist, notably in the management of modifiable risk factors such as low-density lipoprotein cholesterol (LDL). By harnessing the power of artificial intelligence (AI) integrated software within clinical settings, we can revolutionize the landscape of this devastating chronic disease. PICOT: The PICOT question that guided this project was: In Primary Care Advanced Practice Providers (APP) caring for high-risk and/or very high-risk patients with atherosclerotic cardiovascular disease (ASCVD) (P), how do automated electronic alerts with guideline-based recommendations (I) compare to standard notification practice (C) affect referral initiation to cardiology or prompt medication change (O) within 10 weeks (T)? Evidence: In the realm of modern healthcare, it is crucial to recognize the impact of AI on Electronic Health Records (EHRs). This fusion of data analysis and health information technology provides an opportunity for healthcare treatments to become much more effective, resulting in better patient outcomes. Fifteen studies that matched the inclusion criteria were collected and used as substantiating evidence for this project. Intervention: AI software integrated into the EHR system computed comprehensive data analytics, consequently discovering a substantial cohort of patients with an elevated risk profile for ASCVD, accompanied by an LDL-C level that exceeded established clinical guidelines. Subsequently, an automated communication was sent to the APP, furnishing them with pertinent notifications and offering referral recommendations. Outcome: By integrating AI processes into the EHR, data management is streamlined and real-time disease prevention analysis is achieved. The primary goal was to identify high-risk ASCVD patient groups using AI within the EHR and assess the effectiveness of AI-generated electronic alerts with clinical guidance in encouraging behavior change. The clinical significance of this data collection and implementation was substantial. While the statistical analysis produced relevant metrics, it also exhibited applicability in the clinical context. The data exposed a patient population lacking aggressive medical management or referrals, a concern noted by APPs. Conclusion: Introducing AI-based tools can direct the pathway of care and bridge crucial gaps in care in high-risk populations. The result of this technology utilization and integration offers timely screening strategies, education, clinical decision support, and opportunities to address vital pathways for providers and health systems to address ASCVD treatment gaps

Evaluating Differences in Mental Health Outcomes in the Transgender Community

Transgender people experience disproportionate rates of discrimination and marginalization. These negative life experiences influence mental health, such that trans people often struggle with poor mental health outcomes such as depression, anxiety, and posttraumatic stress disorder (PTSD). In this study, a transgender sample was examined to see whether these mental health outcomes were different between trans men and trans women. Based on the previous research done in this area, I hypothesized that trans women would report higher rates of depression, anxiety, and PTSD. The sample was found through the paid platform Prolific, and was surveyed on these mental health outcomes using the standard measures: the PHQ-9, GAD-7, and PCL-5 respectively. Three t tests were performed to examine the potential differences between trans men and trans women, all three of which had insignificant results. However, trans men had the higher average score on all three measures, which does not match the previous literature. While the results were not found to be significant, it just shows that more research is needed in this area to better examine how mental health outcomes can differ within the transgender community

Haldane pseudopotentials and Landau level mixing in the quantum Hall effect

The discovery of the quantum Hall effect in 1980 opened to physics one of the simplest systems for studying many-body correlations. Numerical techniques and trial wavefunctions have proven useful for describing the novel collective behavior of the electrons, but have not fully explained all features of the fractional quantum Hall effect. For example, it is predicted that Landau level mixing should have a moderate effect on the system for all but the very strongest magnetic fields, but this effect has not been extensively studied. Among the tools most useful to modeling and describing the quantum Hall system is the Haldane pseudopotential, which is the energy of electron pairs as a function of their coupled total angular momentum. Because the pseudopotential uniquely determines the correlative behaviors in the quantum Hall system, the study of the pseudopotential is particularly important. In this dissertation I will first derive novel analytic expressions for the pair interactions and the pseudopotential using the techniques of angular momentum algebra. Then, I will use these results to numerically determine the effect of Landau level mixing on the pair pseudopotentials

Mental Health Outcomes from Adverse Childhood Experiences and the Role of Natural and Service-Based Community Involvement

Despite the literature that exists on adverse childhood experiences (ACEs) related to relationships and mental health outcomes, there is a gap that exists in how community involvement can be a moderating factor. Studies do not address how extended family and community influence childhood development as it relates to mental health outcomes. This study is a mixed-method research design. Participants included 61 individuals with at least 1 ACE score and who were at least 18 years of age. They were recruited through social media sharing. Phase 1 assessed demographics, ACE scores, depression and anxiety severity, involvement with a service-based community, and self-perceived relationship quality with natural community. Phase 2 was an open-ended questionnaire on lived experiences related to natural and service-based communities. There were 20 participants that were randomly selected for analysis. This study utilized a moderation analysis for Phase 1 and a narrative analysis for Phase 2. The relationships showed that the community can moderate the relationship between ACEs and mental health severity, specifically anxiety severity scores. The narrative analysis identified common themes of perceptions on community impacts on mental health such as supportive, knowledgeable, distrust, and avoidance. Furthermore, the results suggest that there is a need for additional programs, policies, screening, and prevention to support communities that have faced trauma. This can provide safeguard programs for community involvement and educate policymakers and preventionists. Furthermore, faith-based programs can integrate this knowledge to better support their communities and uplift them

Rediscovery of red wolf ghost alleles in canid population along the American Gulf Coast

Rediscovering species once thought to be extinct or on the edge of extinction is rare. Red wolves have been extinct along the American Gulf Coast since 1980, with their last populations found in coastal Louisiana and Texas. We report the rediscovery of red wolf ghost alleles in a canid population on Galveston Island, Texas. We analyzed over 7000 single nucleotide polymorphisms (SNPs) in 60 canid representatives from all legally recognized North American Canis species and two phenotypically ambiguous canids from Galveston Island. We found notably high Bayesian cluster assignments of the Galveston canids to captive red wolves with extensive sharing of red wolf private alleles. Today, the only known extant wild red wolves persist in a reintroduced population in North Carolina, which is dwindling amongst political and taxonomic controversy. Our rediscovery of red wolf ancestry after almost 40 years introduces both positive opportunities for additional conservation action and difficult policy challenges

Common Raven Impacts on Nesting Western Snowy Plovers: Integrating Management to Facilitate Species Recovery

The U.S. Pacific coast population of the western snowy plover (Charadrius nivosus nivosus; plover) has declined due to loss and degradation of coastal habitats, predation, and anthropogenic disturbance. The U.S. Fish and Wildlife Service listed the subspecies in 1993 as threatened under the Endangered Species Act due to the population declines and habitat loss. Predation of nests and chicks has been identified as an important cause of historic population declines, and thus, most predator management actions for this subspecies are focused on reducing this pressure. In recent years, common ravens (Corvus corax; ravens) have become the most common and pervasive predators of plover nests and chicks, especially in areas with subsidized food sources for ravens and sites without predator management. We compiled data from a variety of sources to document the impact of raven predation on plover nesting success. We discuss current raven management and suggest several tools and strategies to increase plover nesting success, including multi-state approval for the use of the avicide DRC-1339, the use of lures and new trap types, and an increase in funding for predator management. The lack of coordinated and integrated management continues to impede the recovery of the Pacific coast plover population

Exploring How We Teach: Lived Experiences, Lessons, and Research about Graduate Instructors by Graduate Instructors

This book combines the knowledge of 30 graduate student instructors sharing about how they teach and how they’ve learned how to teach

Rockport Comprehensive Plan

This document was developed and prepared by Texas Target Communities (TxTC) at Texas A&M University in partnership with the City of Rockport, Texas Sea Grant, Texas A&M University - Corpus Christi, Texas A&M University - School of Law and Texas Tech University.Founded in 1871, the City of Rockport aims to continue growing economically and sustainably. Rockport is a resilient community dedicated to sustainable growth and attracting businesses to the area. Rockport is a charming town that offers a close-knit community feel and is a popular tourist destination for marine recreation, fairs, and exhibitions throughout the year. The Comprehensive Plan 2020-2040 is designed to guide the city of Rockport for its future growth. The guiding principles for this planning process were Rockport's vision statement and its corresponding goals, which were crafted by the task force. The goals focus on factors of growth and development including public participation, development considerations, transportation, community facilities, economic development, parks, and housing and social vulnerability

The stigma turbine:A theoretical framework for conceptualizing and contextualizing marketplace stigma

Stigmas, or discredited personal attributes, emanate from social perceptions of physical characteristics, aspects of character, and “tribal” associations (e.g., race; Goffman 1963). Extant research emphasizes the perspective of the stigma target, with some scholars exploring how social institutions shape stigma. Yet the ways stakeholders within the socio-commercial sphere create, perpetuate, or resist stigma remain overlooked. We introduce and define marketplace stigma as the labeling, stereotyping, and devaluation by and of commercial stakeholders (consumers, companies and their employees, stockholders, institutions) and their offerings (products, services, experiences). We offer the Stigma Turbine (ST) as a unifying conceptual framework that locates marketplace stigma within the broader sociocultural context, and illuminates its relationship to forces that exacerbate or blunt stigma. In unpacking the ST, we reveal the critical role market stakeholders can play in (de)stigmatization, explore implications for marketing practice and public policy, and offer a research agenda to further our understanding of marketplace stigma and stakeholder welfare

27. Hepatitis B Virus Screening and Vaccination in Patients with HIV: A Survey of Physicians’ Current Clinical Practices

Abstract Background Hepatitis B virus (HBV) and HIV co-infection is associated with high morbidity and mortality, but data and guidelines vary in terms of the best vaccination, re-vaccination, and monitoring practices. The purpose of this study was to evaluate the current HBV monitoring and vaccination practices of physicians who care for patients living with HIV. Methods A Web-based survey was distributed to the University of California San Diego (UCSD) Infectious Diseases division via the UCSD ID listserv, Infectious Disease Society of America (IDSA) members via the IDea Exchange listserv, and to ID and HIV social network members via Twitter and Facebook. The survey consisted of demographic questions followed by two sets of case-based questions. The case questions focused on type, timing, and dosage of HBV vaccination administration among people living with HIV, HBV monitoring post-vaccination, and clinical approach to patients with isolated hepatitis B core antibody. Results A total of 67 clinicians from 24 states completed the survey (Table 1). Most (55%) provide care for more than 20 patients living with HIV per month. The majority of participants (82%) would not defer HBV vaccination until HIV virologic suppression. Almost half of participants (43%) indicated they would use Heplisav-B over older HBV vaccine formulations (Energix-B or Recombivax-HB) for initial vaccination of susceptible patients. The majority (88%) would repeat a vaccination series if the patient does not seroconvert; 23% would repeat with a standard dose series of Energix-B or Recombivax-HB, 24% with a double dose series of Energix-B or Recombivax-HB, and 45% would repeat with Heplisav-B. Approach to management of a patient living with HIV with isolated hepatitis B core antibody was varied. The majority would check a HBV DNA level (42%), while 25% would initiate a vaccination series and 24% would not pursue further intervention (Table 2). Table 1: Clinician Demographics Table 2: HBV Vaccination Practices of Physicians Caring for People Living with HIV Conclusion This study provides insight into current HBV vaccination and monitoring practices of physicians who care for patients with HIV. The results revealed varied practice preferences and opportunities for improvement through standardization. Additional research is needed to elucidate the impact these various practices have on patient outcomes and healthcare expenditure. Disclosures All Authors: No reported disclosure