Recent Submissions

  • Toward assessing the functional connectivity of spinal neurons

    Zaback, Martin; Tiwari, Ekta; Krupka, Alexander J.; Marchionne, Francesca; Negro, Francesco; Lemay, Michel; Thompson, Christopher K.; Lemay|0000-0002-5636-0297 (2022-03-03)
    Spinal interneurons play a critical role in motor output. A given interneuron may receive convergent input from several different sensory modalities and descending centers and relay this information to just as many targets. Therefore, there is a critical need to quantify populations of spinal interneurons simultaneously. Here, we quantify the functional connectivity of spinal neurons through the concurrent recording of populations of lumbar interneurons and hindlimb motor units in the in vivo cat model during activation of either the ipsilateral sural nerve or contralateral tibial nerve. Two microelectrode arrays were placed into lamina VII, one at L3 and a second at L6/7, while an electrode array was placed on the surface of the exposed muscle. Stimulation of tibial and sural nerves elicited similar changes in the discharge rate of both interneurons and motor units. However, these same neurons showed highly significant differences in prevalence and magnitude of correlated activity underlying these two forms of afferent drive. Activation of the ipsilateral sural nerve resulted in highly correlated activity, particularly at the caudal array. In contrast, the contralateral tibial nerve resulted in less, but more widespread correlated activity at both arrays. These data suggest that the ipsilateral sural nerve has dense projections onto caudal lumbar spinal neurons, while contralateral tibial nerve has a sparse pattern of projections.
  • Community correlates of change: A mixed-effects assessment of shooting dynamics during COVID-19

    Johnson, Nicole J.; Roman, Caterina G. (2022-02-23)
    This study examines changes in gun violence at the census tract level in Philadelphia, PA before and after the onset of the COVID-19 pandemic. Piecewise generalized linear mixed effects models are used to test the relative impacts of social-structural and demographic factors, police activity, the presence of and proximity to drug markets, and physical incivilities on shooting changes between 2017 and June, 2021. Model results revealed that neighborhood structural characteristics like concentrated disadvantage and racial makeup, as well as proximity to drug markets and police activity were associated with higher shooting rates. Neighborhood drug market activity and police activity significantly predicted changes in shooting rates over time after the onset of COVID-19. This work demonstrates the importance of understanding whether there are unique factors that impact the susceptibility to exogenous shocks like the COVID-19 pandemic. The increasing risk of being in a neighborhood with an active drug market during the pandemic suggests efforts related to disrupting drug organizations, or otherwise curbing violence stemming from drug markets, may go a long way towards quelling citywide increases in gun violence.
  • Exosomes in Age-Related Cognitive Decline: Mechanistic Insights and Improving Outcomes

    Duggan, Michael R.; Lu, Anne; Foster, Thomas C.; Wimmer, Mathieu; Parikh, Vinay; Wimmer|0000-0002-4098-2497; Parikh|0000-0003-1939-5703 (2022-03-01)
    Aging is the most prominent risk factor for cognitive decline, yet behavioral symptomology and underlying neurobiology can vary between individuals. Certain individuals exhibit significant age-related cognitive impairments, while others maintain intact cognitive functioning with only minimal decline. Recent developments in genomic, proteomic, and functional imaging approaches have provided insights into the molecular and cellular substrates of cognitive decline in age-related neuropathologies. Despite the emergence of novel tools, accurately and reliably predicting longitudinal cognitive trajectories and improving functional outcomes for the elderly remains a major challenge. One promising approach has been the use of exosomes, a subgroup of extracellular vesicles that regulate intercellular communication and are easily accessible compared to other approaches. In the current review, we highlight recent findings which illustrate how the analysis of exosomes can improve our understanding of the underlying neurobiological mechanisms that contribute to cognitive variation in aging. Specifically, we focus on exosome-mediated regulation of miRNAs, neuroinflammation, and aggregate-prone proteins. In addition, we discuss how exosomes might be used to enhance individual patient outcomes by serving as reliable biomarkers of cognitive decline and as nanocarriers to deliver therapeutic agents to the brain in neurodegenerative conditions.
  • Effects of a 6 Week Yoga Intervention on Executive Functioning in Women Screening Positive for Adult ADHD: A Pilot Study

    Fritz, Kathryn; O'Connor, Patrick J. (2022-02-24)
    Purpose: Little is known about the effects of yoga training in adults with ADHD symptoms. This pilot study sought to determine the feasibility and selected psychological effects of 6 weeks of yoga training in women screening positive for adult ADHD compared to a wait-list control group. Methods: A randomized trial was conducted with 32 adult women (18–24 years) who volunteered after screening positive for adult ADHD as assessed by the Adult ADHD Self-Report Scale (ASRS). Participants were randomized to 6 weeks of Bikram yoga training or to a wait-list control group. The yoga intervention consisted of two 90-min classes per week. Multilevel models were used to test hypothesized interactions of yoga-induced improvements compared to controls across time (baseline, 3 weeks, and 6 weeks). The primary outcomes assessed inhibitory control, cognitive flexibility and working memory using the NIH Toolbox. Separate models with trait mindfulness, trait anxiety and expectations for change in either attention or working memory as covariates tested whether these variables mediated the changes in the three measures of executive function. Secondary outcomes included mood, perceived functional impairment and motivation for, and hyperactivity during, the cognitive tests. Results: No adverse events were observed. Attendance averaged 91.7% among the 69% of the sample that did not dropout. No significant Group X Time interactions were found for any of the psychological outcomes and the null executive function findings were unchanged when including the covariates. Conclusion: Six-weeks of yoga training twice per week is potentially feasible for women experiencing ADHD symptoms, but an exercise stimulus of this duration and magnitude yields no beneficial cognitive or mood outcomes.
  • First records of three new lizard species and a range expansion of a fourth lizard species introduced to Aruba

    Integrative Ecology Lab, Center for Biodiversity (Temple University) (2022-01-24)
    The Caribbean islands are becoming a hotspot for the spread of non-native reptiles. Consistent with this trend, we provide the first documentation of three new lizard species discovered on Aruba, Anolis gingivinus (Cope, 1864), Anolis cristatellus (Duméril and Bibron, 1837), and Hemidactylus frenatus (Duméril and Bibron, 1836). In addition, we provide an updated distribution on Aruba for a previously introduced lizard species, Anolis porcatus (Gray, 1840). All four species were identified phenotypically in the field and identifications were confirmed with genetics. Like most non-native lizards in the Caribbean, they tend to use anthropogenic habitats, and their impacts on Aruba’s resident species are not known.
  • Understanding Child-Directed Speech Around Book Reading in Toddler Classrooms: Evidence From Early Head Start Programs

    Hindman, Annemarie H.; Farrow, Jean M.; Anderson, Kate; Wasik, Barbara A.; Snyder, Patricia A.; Hindman|0000-0001-5800-0191 (2021-12-09)
    Child-directed speech (CDS), which can help children learn new words, has been rigorously studied among infants and parents in home settings. Yet, far less is known about the CDS that teachers use in classrooms with toddlers and children’s responses, an important question because many toddlers, particularly in high-need communities, attend group-care settings. This exploratory study examines the linguistic environment during teacher-led book readings in American Early Head Start classrooms serving 2-year-olds from households in poverty. Seven teachers in four classrooms were trained to emphasize target words while reading story and informational books. We first analyzed the nature and quality of their book readings from a macro-level, exploring global instructional quality [Classroom Assessment Scoring System (CLASS)] and linguistic complexity [i.e., diversity of vocabulary (D) and sophistication of syntax (MLU-w)], and we also examined micro-level teacher-child talk strategies and use of target words. Compared to prior research, these classrooms had similar global quality and syntactic complexity, although less lexical diversity. Exploratory results also revealed three distinct teacher talk patterns—teachers who emphasized (1) comments, (2) questions, and (3) a balance of the two. Question-focused teachers had more adult and child talk during reading, as well as more repetitions of target words, and stronger CLASS Engaged Support for Learning. However, comment-focused teachers used more diverse vocabulary and had stronger CLASS Emotional and Behavioral Support. Results illuminate the nature and quality of CDS in toddler classrooms, particularly in the context of an intervention emphasizing target vocabulary words, and highlight applications for professional development and questions for further research.
  • Nutraceuticals Synergistically Promote Osteogenesis in Cultured 7F2 Osteoblasts and Mitigate Inhibition of Differentiation and Maturation in Simulated Microgravity

    Braveboy-Wagner, Justin; Sharoni, Yoav; Lelkes, Peter; Braveboy-Wagner|0000-0002-6301-1394; Lelkes|0000-0003-4954-3498 (2021-12-23)
    Microgravity is known to impact bone health, similar to mechanical unloading on Earth. In the absence of countermeasures, bone formation and mineral deposition are strongly inhibited in Space. There is an unmet need to identify nutritional countermeasures. Curcumin and carnosic acid are phytonutrients with anticancer, anti-inflammatory, and antioxidative effects and may exhibit osteogenic properties. Zinc is a trace element essential for bone formation. We hypothesized that these nutraceuticals could counteract the microgravity-induced inhibition of osteogenic differentiation and function. To test this hypothesis, we cultured 7F2 murine osteoblasts in simulated microgravity (SMG) in a Random Positioning Machine in the presence and absence of curcumin, carnosic acid, and zinc and evaluated cell proliferation, function, and differentiation. SMG enhanced cell proliferation in osteogenic medium. The nutraceuticals partially reversed the inhibitory effects of SMG on alkaline phosphatase (ALP) activity and did not alter the SMG-induced reduction in the expression of osteogenic marker genes in osteogenic medium, while they promoted osteoblast proliferation and ALP activity in the absence of traditional osteogenic media. We further observed a synergistic effect of the intermix of the phytonutrients on ALP activity. Intermixes of phytonutrients may serve as convenient and effective nutritional countermeasures against bone loss in space.
  • Examining socio-spatial mobility patterns among colon cancer patients after diagnosis

    Wiese, Daniel; Lynch, Shannon M.; Stroup, Antoinette M.; MAITI, ANIRUDDHA; Harris, Gerald; Vucetic, Slobodan; Henry, Kevin A.; Wiese|0000-0002-1603-7583; Maiti|0000-0002-1142-6344; Vucetic|0000-0001-5884-6293 (2022-03)
    Given the growing number of cancer survivors, it is important to better understand socio-spatial mobility patterns of cancer patients after diagnosis that could have public health implications regarding post-diagnostic access to care for treatment and follow-up surveillance. In this exploratory study, residential histories from LexisNexis were linked to New Jersey colon cancer cases diagnosed from 2006 to 2011 to examine differences in socio-spatial mobility patterns after diagnosis by stage at cancer diagnosis, sex, and race/ethnicity. For the colon cancer cases, we summarized and compared the number of residences and changes in the residential census tract and neighborhood poverty after the diagnosis. We found only minor changes in neighborhood poverty among the cases during the follow-up period after diagnosis. During the follow-up period of up to 10 years after diagnosis, 67% of the patients did not move to a different residential census tract, and 10.8% moved from New Jersey to another state. Cases that moved to a different census tract changed after diagnosis were generally less wealthy than non-movers, but the destination of relocation varied by race/ethnicity and socioeconomic status. We also found a significant association between residential mobility and stage at diagnosis, whereby patients diagnosed with colon cancer at an early stage were more likely to be movers. This study contributes to understanding of the socio-spatial mobility patterns in colon cancer patients and may help to inform cancer research by summarizing the extent to which colon cancer patients move after diagnosis.
  • Sex differences in neural mechanisms of social and non-social threat monitoring

    Clarkson, Tessa; Karvay, Yvette; Quarmley, Megan; Jarcho, Johanna M.; Quarmley|0000-0003-2115-2196 (2021-12)
    Adolescent males and females differ in their responses to social threat. Yet, threat processing is often probed in non-social contexts using the error-related negativity (ERN; Flanker EEG Task), which does not yield sex-specific outcomes. fMRI studies show inconsistent patterns of sex-specific neural engagement during threat processing. Thus, the relation between threat processing in non-social and social contexts across sexes and the effects perceived level of threat on brain function are unclear. We tested the interactive effect of non-social threat-vigilance (ERN), sex (N = 69; Male=34; 11–14-year-olds), and perceived social threat on brain function while anticipating feedback from ‘unpredictable’, ‘nice’, or ‘mean’ purported peers (fMRI; Virtual School Paradigm). Whole-brain analyses revealed differential engagement of precentral and inferior frontal gyri, putamen, anterior cingulate cortex, and insula. Among males with more threat-vigilant ERNs, greater social threat was associated with increased activation when anticipating unpredictable feedback. Region of interest analyses revealed this same relation in females in the amygdala and anterior hippocampus when anticipating mean feedback. Thus, non-social threat vigilance relates to neural engagement depending on perceived social threat, but peer-based social contexts and brain regions engaged, differ across sexes. This may partially explain divergent psychosocial outcomes in adolescence.
  • Perceptions of Live Donor Kidney Transplantation Using Segmentation Analysis and Perceptual Mapping to Understand Differences by Self-Reported Health Status in People on Dialysis

    Risk Communication Lab (Temple University) (2022-01-05)
    Living donor kidney transplantation is a superior treatment option for those with end stage kidney disease, but most transplants are from deceased donors. Securing a living donor for living donor kidney transplantation requires effective, well-timed communication which many may find difficult or intimidating. This study uses segmentation analysis and an innovative marketing technique called perceptual mapping to create three dimensional models to compare living donor kidney transplant perceptions by self-reported health status in 160 end-stage kidney disease dialysis patients of two hospital-based dialysis units and an online forum through cross-sectional surveys. Findings indicate patients with poor self-reported health status are more concerned with not knowing what to say or being afraid a person would say no to living donor kidney transplantation. They are also concerned about the donor’s ability to care for family or donate in the future. They are, however, more likely to see benefits of living donor kidney transplantation, including the kidney lasting longer and having a greater quality of life. Findings reveal messages that could be emphasized in interventions to enhance the ability to ask for living donor kidney transplantation, especially in those assessed as having poor health status. Segmentation analysis and perceptual mapping methods can provide a more nuanced look at how best to develop intervention content to increase living donor kidney transplant.
  • Hypoxia induces stress fiber formation in adipocytes in the early stage of obesity

    Anvari, Golnaz; Bellas, Evangelia; Bellas|0000-0002-1667-7118 (2021-11-02)
    In obese adipose tissue (AT), hypertrophic expansion of adipocytes is not matched by new vessel formation, leading to AT hypoxia. As a result, hypoxia inducible factor-1⍺ (HIF-1⍺) accumulates in adipocytes inducing a transcriptional program that upregulates profibrotic genes and biosynthetic enzymes such as lysyl oxidase (LOX) synthesis. This excess synthesis and crosslinking of extracellular matrix (ECM) components cause AT fibrosis. Although fibrosis is a hallmark of obese AT, the role of fibroblasts, cells known to regulate fibrosis in other fibrosis-prone tissues, is not well studied. Here we have developed an in vitro model of AT to study adipocyte-fibroblast crosstalk in a hypoxic environment. Further, this in vitro model was used to investigate the effect of hypoxia on adipocyte mechanical properties via ras homolog gene family member A (RhoA)/Rho-associated coiled-coil kinases (ROCK) signaling pathways. We confirmed that hypoxia creates a diseased phenotype by inhibiting adipocyte maturation and inducing actin stress fiber formation facilitated by myocardin-related transcription factor A (MRTF-A/MKL1) nuclear translocation. This work presents new potential therapeutic targets for obesity by improving adipocyte maturation and limiting mechanical stress in obese AT.
  • Early life blood lead levels and asthma diagnosis at age 4–6 years

    Oktapodas Feiler, Marina; Pavia, Carly J.; Frey, Sean M.; Parsons, Patrick J.; Thevenet-Morrison, Kelly; Canfield, Richard L.; Jusko, Todd A.; Oktapodas Feiler|0000-0002-2315-9589 (2021-11-12)
    The USA has a high burden of childhood asthma. Previous studies have observed associations between higher blood lead levels and greater hypersensitivity in children. The objective of the present study was to estimate the association between blood lead concentrations during early childhood and an asthma diagnosis between 48 and 72 months of age amongst a cohort with well-characterized blood lead concentrations. Blood lead concentrations were measured at 6, 12, 18, 24, 36, and 48 months of age in 222 children. The presence of an asthma diagnosis between 48 and 72 months was assessed using a questionnaire which asked parents or guardians whether they had been told by a physician, in the past 12 months, that their child had asthma. Crude and adjusted risk ratios (RR) of an asthma diagnosis were estimated for several parameterizations of blood lead exposure including lifetime average (6 to 48 months) and infancy average (6 to 24 months) concentrations. After adjustment for child sex, birthweight, daycare attendance, maternal race, education, parity, breastfeeding, income, and household smoking, age-specific or composite measures of blood lead were not associated with asthma diagnosis by 72 months of age in this cohort.
  • Identifying profiles of brain structure and associations with current and future psychopathology in youth

    Mattoni, Matthew; Wilson, Sylia; Olino, Thomas M. (2021-09-14)
    Brain structure is often studied as a marker of youth psychopathology by examining associations between volume or thickness of individual regions and specific diagnoses. However, these univariate approaches do not address whether the effect of a particular region may depend on the structure of other regions. Here, we identified subgroups of individuals with distinct profiles of brain structure and examined how these profiles were associated with concurrent and future youth psychopathology. We used latent profile analysis to identify distinct neuroanatomical profiles of subcortical region volume and orbitofrontal cortical thickness in the ABCD study (N = 9376, mean age = 9.91, SD = 0.62). We identified a five-profile solution consisting of a reduced subcortical volume profile, a reduced orbitofrontal thickness profile, a reduced limbic and elevated striatal volume profile, an elevated orbitofrontal thickness and reduced striatal volume profile, and an elevated orbitofrontal thickness and subcortical volume profile. While controlling for age, sex, and intracranial volume, profiles exhibited differences in concurrent psychopathology measured dimensionally and categorically and in psychopathology at 1-year follow-up measured dimensionally. Results show that profiles of brain structure have incremental validity for associations with youth psychopathology beyond intracranial volume.
  • NICE shared decision making guidelines and mental health: challenges for research, practice and implementation

    Zisman-Ilani, Yaara; Chmielowska, Marta; Dixon, Lisa B.; Ramon, Shulamit; Zisman-Ilani|0000-0001-6852-2583 (2021-09-21)
    The National Institute for Health and Care Excellence (NICE) initiated an ambitious effort to develop the first shared decision making guidelines. The purpose of this commentary is to identify three main concerns pertaining to the new published guidelines for shared decision making research, practice, implementation and cultural differences in mental health.
  • The Shared Origins of Embodiment and Development

    Marshall, Peter J.; Houser, Troy M.; Weiss, Staci M. (2021-08-17)
    As a domain of study centering on the nature of the body in the functioning of the individual organism, embodiment encompasses a diverse array of topics and questions. One useful organizing framework places embodiment as a bridge construct connecting three standpoints on the body: the form of the body, the body as actively engaged in and with the world, and the body as lived experience. Through connecting these standpoints, the construct of embodiment shows that they are not mutually exclusive: inherent in form is the capacity for engagement, and inherent in engagement is a lived perspective that confers agency and meaning. Here, we employ this framework to underscore the deep connections between embodiment and development. We begin with a discussion of the origins of multicellularity, highlighting how the evolution of bodies was the evolution of development itself. The evolution of the metazoan (animal) body is of particular interest, because most animals possess complex bodies with sensorimotor capacities for perceiving and acting that bring forth a particular sort of embodiment. However, we also emphasize that the thread of embodiment runs through all living things, which share an organizational property of self-determination that endows them with a specific kind of autonomy. This realization moves us away from a Cartesian machine metaphor and instead puts an emphasis on the lived perspective that arises from being embodied. This broad view of embodiment presents opportunities to transcend the boundaries of individual disciplines to create a novel integrative vision for the scientific study of development.
  • Improving Interlayer Adhesion of Poly(p-phenylene terephthalamide) (PPTA)/Ultra-high-molecular-weight Polyethylene (UHMWPE) Laminates Prepared by Plasma Treatment and Hot Pressing Technique

    Temple Materials Institute (Temple University) (2021-08-05)
    Poly(p-phenylene terephthalamide) (PPTA) is a high-performance polymer that has been utilized in a range of applications. Although PPTA fibers are widely used in various composite materials, laminar structures consisting of PPTA and ultra-high-molecular-weight polyethylene (UHMWPE), are less reported. The difficulty in making such composite structures is in part due to the weakness of the interface formed between these two polymers. In this study, a layered structure was produced from PPTA fabrics and UHMWPE films via hot pressing. To improve the interlayer adhesion, oxygen plasma was used to treat the PPTA and the UHMWPE surfaces prior to lamination. It has been found that while plasma treatment on the UHMWPE surface brought about a moderate increase in interlayer adhesion (up to 14%), significant enhancement was achieved on the samples fabricated with plasma treated PPTA (up to 91%). It has been assumed that both surface roughening and the introduction of functional groups contributed to this improvement.
  • Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional study

    Shah, Arnav; Deak, Andrew; Allen, Shaneisha; Silfani, Elayna; Koppin, Christina; Zisman-Ilani, Yaara; Sirisena, Imali; Rose, Christina; Rubin, Daniel; Zisman-Ilani|0000-0001-6852-2583 (2021-09-11)
    Objective: To compare patients with DKA, hyperglycaemic hyperosmolar syndrome (HHS), or mixed DKA-HHS and COVID-19 [COVID (+)] to COVID-19-negative (−) [COVID (−)] patients with DKA/HHS from a low-income, racially/ethnically diverse catchment area. Methods: A cross-sectional study was conducted with patients admitted to an urban academic medical center between 1 March and 30 July 2020. Eligible patients met lab criteria for either DKA or HHS. Mixed DKA-HHS was defined as meeting all criteria for either DKA or HHS with at least 1 criterion for the other diagnosis. Results: A total of 82 participants were stratified by COVID-19 status and type of hyperglycaemic crisis [26 COVID (+) and 56 COVID (−)]. A majority were either Black or Hispanic. Compared with COVID (−) patients, COVID (+) patients were older, more Hispanic and more likely to have type 2 diabetes (T2D, 73% vs 48%, p < .01). COVID(+) patients had a higher mean pH (7.25 ± 0.10 vs 7.16 ± 0.16, p < .01) and lower anion gap (18.7 ± 5.7 vs 22.7 ± 6.9, p = .01) than COVID (−) patients. COVID (+) patients were given less intravenous fluids in the first 24 h (2.8 ± 1.9 vs 4.2 ± 2.4 L, p = .01) and were more likely to receive glucocorticoids (95% vs. 11%, p < .01). COVID (+) patients may have taken longer to resolve their hyperglycaemic crisis (53.3 ± 64.8 vs 28.8 ± 27.5 h, p = .09) and may have experienced more hypoglycaemia <3.9 mmol/L (35% vs 19%, p = .09). COVID (+) patients had a higher length of hospital stay (LOS, 14.8 ± 14.9 vs 6.5 ± 6.0 days, p = .01) and in-hospital mortality (27% vs 7%, p = .02). Discussion: Compared with COVID (−) patients, COVID (+) patients with DKA/HHS are more likely to have T2D. Despite less severe metabolic acidosis, COVID (+) patients may require more time to resolve the hyperglycaemic crisis and experience more hypoglycaemia while suffering greater LOS and risk of mortality. Larger studies are needed to examine whether differences in management between COVID (+) and (−) patients affect outcomes with DKA/HHS.
  • Novel Scalable and Simplified System to Generate Microglia-Containing Cerebral Organoids From Human Induced Pluripotent Stem Cells

    Center for Metabolic Disease Research (Temple University) (2021-07-05)
    Human cerebral organoid (CO) is a three-dimensional (3D) cell culture system that recapitulates the developing human brain. While CO has proved an invaluable tool for studying neurological disorders in a more clinically relevant matter, there have still been several shortcomings including CO variability and reproducibility as well as lack of or underrepresentation of certain cell types typically found in the brain. As the technology to generate COs has continued to improve, more efficient and streamlined protocols have addressed some of these issues. Here we present a novel scalable and simplified system to generate microglia-containing CO (MCO). We characterize the cell types and dynamic development of MCOs and validate that these MCOs harbor microglia, astrocytes, neurons, and neural stem/progenitor cells, maturing in a manner that reflects human brain development. We introduce a novel technique for the generation of embryoid bodies (EBs) directly from induced pluripotent stem cells (iPSCs) that involves simplified steps of transitioning directly from 3D cultures as well as orbital shaking culture in a standard 6-well culture plate. This allows for the generation of MCOs with an easy-to-use system that is affordable and accessible by any general lab.
  • An unusual presentation of non-IBD related colorectal primary extranodal diffuse large B cell lymphoma with a colo-colonic fistula

    Temple University. Hospital (2021-09-20)
    Diffuse large B cell lymphoma of the sigmoid colon and rectum is relatively uncommon and aggressive. Due to its nonspecific symptomatology, patients are often diagnosed late into the disease and present with life-threatening complications, such as hemorrhage, obstruction, or perforation, requiring emergent surgical intervention. Patients with colorectal lymphoma typically have inflammatory bowel disease or immunosuppression. We present a case of a 79-year-old male with no known inflammatory bowel disease or immunosuppression, who had significant weight loss, diarrhea, and abdominal fullness, found by CT to have irregular wall thickening of the recto-sigmoid colon along with a colo-colonic fistula, concerning for bowel perforation. Endoscopic evaluation and biopsy confirmed the diagnosis of recto-sigmoid Diffuse large B cell lymphoma, with a PET/CT scan revealing stage IV disease. He had a partial response to six cycles of palliative reduced dose R-CHOP and is currently receiving palliative radiation to the sigmoid colon and rectum. Surgery and/or chemoradiation remain the mainstay therapy for this condition. Clinicians, however, must consider patient's functional, nutritional, and clinical status prior to choosing an optimal therapeutic regimen. This case illustrates a unique clinical presentation of this condition and the associated diagnostic and therapeutic challenges that arise in order to prevent life-threatening complications.
  • Shared Decision Making in Primary Care Based Depression Treatment: Communication and Decision-Making Preferences Among an Underserved Patient Population

    Matthews, Elizabeth B.; Savoy, Margot; Paranjape, Anuradha; Washington, Diana; Hackney, Treanna; Galis, Danielle; Zisman-Ilani, Yaara; Zisman-Ilani|0000-0001-6852-2583 (2021-07-12)
    Objectives: Although depression is a significant public health issue, many individuals experiencing depressive symptoms are not effectively linked to treatment by their primary care provider, with underserved populations have disproportionately lower rates of engagement in depression care. Shared decision making (SDM) is an evidence-based health communication framework that can improve collaboration and optimize treatment for patients, but there is much unknown about how to translate SDM into primary care depression treatment among underserved communities. This study seeks to explore patients' experiences of SDM, and articulate communication and decision-making preferences among an underserved patient population receiving depression treatment in an urban, safety net primary care clinic. Methods: Twenty-seven patients with a depressive disorder completed a brief, quantitative survey and an in-depth semi-structured interview. Surveys measured patient demographics and their subjective experience of SDM. Qualitative interview probed for patients' communication preferences, including ideal decision-making processes around depression care. Interviews were transcribed verbatim and analyzed using thematic analysis. Univariate statistics report quantitative findings. Results: Overall qualitative and quantitative findings indicate high levels of SDM. Stigma related to depression negatively affected patients' initial attitude toward seeking treatment, and underscored the importance of patient-provider rapport. In terms of communication and decision-making preferences, patients preferred collaboration with doctors during the information sharing process, but desired control over the final, decisional outcome. Trust between patients and providers emerged as a critical precondition to effective SDM. Respondents highlighted several provider behaviors that helped facilitated such an optimal environment for SDM to occur. Conclusion: Underserved patients with depression preferred taking an active role in their depression care, but looked for providers as partner in this process. Due to the stigma of depression, effective SDM first requires primary care providers to ensure that they have created a safe and trusting environment where patients are able to discuss their depression openly.

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