Roseman University 6th Annual Research Symposium Abstract Book

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TH

An n ual

Roseman Universit y Research Symposium Wednesday, March 11, 2020

Wednesday, March 11, 2020

Table of Contents Welcome from President Renee Coffman…………………………………………….3 Keynote Speakers…………………………………………………………………………………4 Utah Abstracts…………………………..………………..……….………………………….....6 Nevada Abstracts………………………………………………………………………..……..87

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Friends and Colleagues, Welcome to the Sixth Annual Roseman University of Health Sciences Research Symposium. As we celebrate our 20th Anniversary this year, we are pleased to continue this tradition. This year, we received over 150 abstracts which include research done across our three campuses in South Jordan, UT and Henderson & Summerlin, NV as well as that from our colleagues outside of Roseman. We look forward to featuring the discoveries and scholarly work of our faculty members, staff, post-doctoral researchers, residents, and students from all of Roseman’s health disciplines. Many of the presenting authors both inside and outside of Roseman carry affiliations with other great universities and entities worldwide. This year’s abstracts cover a wide range of topics in various areas including bench-top science, clinical research, and educational research. These works independently and collectively represent prodigious planning, methodical execution, and deeply insightful findings. With a wide breadth and depth of scientific subject matter, they are steps towards solutions, solutions that advance not only our work and our national and international reputation, but advance the human race. Some of these presentations address a number of diseases including infectious agents, HIV/AIDS, diabetes, cancer, depression and fatty liver disease. Other presentations address important health issues such as e-cigarette usage, geriatric health, cannabinoids and opioid prescribing trends. These are in addition to presentations that discuss ways to improve student learning and general wellness in the population. As you can see, the work being conducted is truly transformational and holds great possibility in evolving our understanding of critically important issues.

We believe that this thinking, input and collaboration not only showcases current thinking, but sparks new ideas, new modes of thinking, and imagination. We are proud of the minds and hearts of those participating in this symposium.

Thank you to all those responsible for making this important event happen, as well as to all those attending the symposium and supporting the work of colleagues, students and friends. We believe this symposium will continue to grow and serve as a platform for the best thinking and research and a home for sparking imagination, solutions, discovery and learning.

Sincerely, Renee Coffman, President

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Keynote Speaker: South Jordan Presidential Scholar for Drug Discovery and the Ralph C. Corley Distinguished Professor of Chemistry at Purdue University

Dr. Philip S. Low is the Presidential Scholar for Drug Discovery and the Ralph C. Corley Distinguished Professor of Chemistry at Purdue University. Dr. Low has devoted over >45 years to exploring novel drugs for treatment of human diseases, characterizing the structure of the human red blood cell membrane, and defining signal transduction pathways in plants.

He has published >450 scientific articles and has >80 US patents/patents pending. Eight drugs stemming from his research are undergoing human clinical trials in the areas of: i) tumor-targeted drugs for the imaging and therapy of cancer, ii) a new therapy for malaria, iii) a novel treatment for sickle cell disease, iv) tumor-targeted fluorescent dyes for image-guided surgery of cancer, and v) novel imaging and therapeutic agents for inflammatory and autoimmune diseases. Six companies (Endocyte Inc., OnTarget Laboratories Inc., Novosteo Inc., Umoja Biopharma Inc., ErythroCure Inc. and MorphImmune Inc.) have been founded to commercialize these discoveries. Dr. Low has received an NIH MERIT Award, the American Chemical Society’s Award for Cancer Research (Sosnovsky Award), the American Association for Cancer Research’s (AACR) Award for Outstanding Chemistry in Cancer Research, both of Purdue's awards for outstanding research (McCoy and Sigma Xi Awards), the University’s highest career achievement award (Morrill Award), and numerous other National and International awards. Dr. Low received his B.S. in Chemistry from Brigham Young University (1971) and his Ph.D. in Biochemistry from UCSD (1975).

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Keynote Speaker: Henderson

Infectious Diseases Specialist Expert Sterwardship, Inc. Newport Beach, CA Adjunct Faculty; David Geffen School of Medicine, UCLA

Dr. Ravina Kullar is an Infectious Diseases Global expert and researcher. She is a Roseman University of Health Sciences alumnus, having graduated the doctor of pharmacy program (PharmD) in 2007. Since then, Dr. Kullar has spent over 10 years researching novel ways to optimize the treatment in patients with antibiotic-resistant infections. She is actively leading strategies worldwide to control the escalating rate of antibiotic resistance, having collaborated with the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and national organizations such as the Infectious Diseases Society of America (IDSA). She has been invited to provide 3 TED talks, sharing her own personal patient stories and giving action items that everyone can implement to be a part of the solution. She has published over 30 research papers addressing solutions to this global threat, and has been an invited speaker worldwide, educating both clinicians and the public on the consequences of antibiotic resistance. She also serves as an infectious diseases consultant expert on the CBS educational show The Doctors, informing the public on important infectious diseasestopics. Recently, Dr. Kullar was invited as the keynote speaker at the 72nd World Health Assembly held at the WHO in Geneva. Dr. Kullar is passionate about empowering each individual worldwide with the educational tools to join in the fight against antibiotic resistance. She says: “We are in the post-antibiotic era. We cannot wait. It is now we make a change or it will be too late.�

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Roseman University of Health Sciences Utah Abstracts

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Acute eCig Vapor or SHS Exposure Induces Inflammatory Signaling in the Adult Murine Lung KM Hirschi Budge;1 KW Homer;1 KYF Tsai;1 H Graviet McCusker;1 SH Rock;1 TS Davis;1 SJ Llavina;1 RS Fowers;1 M Long;1 TJ Jensen;1 JT Graff;1 JA Arroyo;1 PR Reynolds.1 Author Affiliations 1 Brigham Young University, College of Life Sciences Purpose The detrimental effects of exposure to tobacco smoke have been confirmed repeatedly over the last several decades. Primary smoking produces the greatest damage; however, secondhand smoke (SHS) is also notably detrimental. More recently the development of electronic cigarettes (eCigs) has introduced a new aspect to the study of smoke exposure. A heating element is used by eCigs to vaporize an oil-based carrier that contains nicotine and various flavorings. eCig liquid and aerosols have been linked to increased cytotoxicity, inflammation, and production of reactive oxygen species. Negative effects on respiratory health have also been confirmed. Both tobacco smoke and eCig vapor have been found to alter cellular signaling and activate inflammatory responses. Of note, inflammatory pathways include signaling through receptors for advanced glycation end-products (RAGE).

Methods Our objective in this study was to examine effects of acute exposure to eCig vapor compared to SHS in the murine lung. Wild type mice were exposed to vapor containing Apple or Cinnamon flavoring, or to SHS for a period of four days using a nose-only delivery system (Scireq). Exposure consisted of 30 minutes of eCig vapor or SHS generated by three cigarettes over a period of 30 minutes. Control mice were exposed to room air. Animal use was in accordance with approved IACUC protocols at Brigham Young University.

Results After exposure, lung tissue was collected: the left lung lobe was inflated for histological analysis, and the right lung lobes were snap frozen for protein and RNA analysis. H&E stained lung sections did not show changes in morphology and staining for pulmonary cell types using cell-specific antibodies (SPC, CCSP, T1a and Fox J1) revealed evidence of cell population alterations potentially explaining increases in proapoptotic cleaved caspase-3 following exposure. Immunoblotting for RAGE and signaling intermediates activated by RAGE such as NF-kB and pERK revealed differential expression following eCig or SHS exposure. These results indicate that activation of inflammatory signaling pathways occurs following an acute four-day exposure.

Conclusions Such signaling in eCig vapor exposed mice has the potential to lead to chronic inflammatory disease characteristics with longer exposures potentially leading to chronic obstructive disorders resulting from tobacco smoke exposure.

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01: A Validated Stability Indicating RP-HPLC Method to Determine Physical and Chemical Stability of Testosterone in Compounded Topical Creams Odily Alvarado;1 Heidi Schiller;1 Krushit Patel;1 Anna C. Burrows;1 Meagan Wakefield;1 David Jackson;1 Omid Yazanpannah;1 Christopher Cox;1 Casey Sayre.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose As women age, they may experience altered levels of testosterone and other sex hormones leading to peri and postmenopausal symptoms. Testosterone is used to treat these symptoms. They’re commercially available products to treat menopausal symptoms, but some patients may require a dosage or strength form that is not available. The objective of this study was to use a validated stability indicating HPLC method to determine both the physical and chemical stability of testosterone in compounded topical creams at ambient and accelerated conditions.

Methods Using RP-HPLC with a gradient mobile phase consisting of methanol and water in a ratio of 75:25 and set the detection wavelength for testosterone to 240 nm. Our stability study tested two dosage strengths of testosterone in compounded creams – 5 mg and 200 mg. This six-month study consisted of ambient and accelerated conditions - room temperature and relative humidity. All creams were weighed and inspected for visual appearance, size, brittleness, color, scent, and texture; those observations were recorded at the beginning of every time point.

Results The average sample weight for 5mg and 200mg-RT the creams did not vary greatly. On the other hand, the average sample weight for 5mg and 200mg-AC the creams did fluctuate extremely. This difference can be explained by the interaction between the sample’s hygroscopic nature and the stability chamber parameters: higher relative humidity in the chamber introduces more moisture, increasing the sample weight, which in turn leads to a higher percent yield that is false. The samples on the benchtop started to change on the ninth time point, while the samples in the stability chamber started to change on the fourth time point. The rapid degradation seen at the accelerated conditions is understandable since higher heat and humidity will break down the cream faster.

Conclusions This method was utilized to successfully quantify the stability of testosterone at ambient and accelerated conditions of topical compounded creams. We have successfully applied this method to the chemical stability of testosterone in compounded topical creams. This method is now available for other pharmacists to be able to put their testosterone creams on the upper shelf of compounding quality.

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02: Mechanistically Elucidating the In-Vitro Safety and Efficacy of a Novel Doxorubicin Derivative Casey Sayre;1 Samaa Alrushaid;2 Zaid Maayah;3 Yunqi Zhao;4 Laird Forrest;4 Sanjeewa Senadheera;4 Kevin Chaboyer;2 Hope Anderson;2 Ayman El-Kadi;3 Neal Davies.3 Author Affiliations 1 Roseman University, College of Pharmacy 2 University of Manitoba, College of Pharmacy 3 University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences 4 University of Kansas, College of Pharmacy Purpose The objective of this study is to examine for the first time the efficacy, metabolism and safety of DoxQ in comparison to doxorubicin with a potential to enhance the bioavailability, safety and efficacy of the parent compound utilizing several in-vitro assays. Additionally, the effects of DoxQ on adult rat cardiomyocytes and human cardiomyocytes were tested in comparison to doxorubicin to assess its cardiotoxicity and suggest possible mechanisms involved in cardioprotection or cardiotoxicity. The effects of the novel derivative were also examined on human breast cancer cells to assess efficacy.

Methods Drug Release Studies: The release of doxorubicin (Dox) and quercetin from the conjugate was monitored over time at physiological pH (PBS, 37°C) and measured by HPLC with fluorescent detector (Ex/Em 480/590). Drug Uptake Studies: Multi-drug resistant canine kidney cells (MDCK-MDR) P-gp positive cells were treated then stained with DAPI and imaged by epifluorescence microscope. The fluorescence signals were analyzed by ImageJ. The cellular uptake was by quantified by HPLC. Pharmacological Activities: In-vitro anti-oxidant, cytochrome P450 (CYP450) inhibitory activities, and P-glycoprotein activities were examined using commercial assay kits. Effects on Adult Rat Cardiomyocytes: Ventricular cardiomyocytes were isolated from adult rats and maintained. The effect of the novel derivative on cell viability was examined in comparison to doxorubicin by trypan blue assay. Effects on Human Cardiomyocytes (RL-14): The cell viability was determined by MTT assay, while the level of reactive oxygen species(ROS) was determined by dichlorofluorescein (DCF) assay. RT-PCR was used to examine the expression of cardiotoxicity markers, oxidative stress markers, or CYP450 enzymes. Effects on Human Breast Cancer Cells: The potency of DoxQ was examined in a triple negative murine breast cancer line in comparison to the parent compound doxorubicin, quercetin, and a mixture of doxorubicin and quercetin by resazurin blue assay.

Results DoxQ was less toxic than doxorubicin in both rat and human cardiomyocytes and retained anticancer activity in triplenegative murine breast cancer cells. The lower level of reactive oxygen species generated

by DoxQ compared to doxorubicin as well as the results of the oxidative stress markers examined also suggests cardioprotection in vitro. DoxQ inhibited both the expression of CYP1B1 and also its catalytic activity, proposing an additional mechanism by which DoxQ attenuates cardiotoxicity induced by doxorubicin and improves its tolerability. In terms of mitigating the drug delivery barriers of poor oral bioavailability, the initial in vitro results of DoxQ are promising. The cellular uptake of DoxQ by MDCKMDR cells was higher than that of doxorubicin alone or a doxorubicin plus quercetin mixture.

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Conclusions Safety and Efficacy: DoxQ improves doxorubicinâ&#x20AC;&#x2122;s safety and retains efficacy. DoxQ is less toxic than doxorubicin to both rat and human cardiomyocytes. ROS and oxidative stress markers of DoxQ < doxorubicin suggesting a cardioprotective mechanism. DoxQ inhibited the expression and catalytic activity of CYP1B1 proposing an additional mechanism by which DoxQ attenuates cardiotoxicity and improves its tolerability. Improving Oral Bioavailability: The cellular uptake by MDCK-MDR cells: DoxQ >doxorubicin+quercetin mixture or doxorubicinCYP3A4 inhibition: DoxQ P-gp ATPase inhibition: Doxorubicin+quercetin > DoxQ or doxorubicin. The results imply that DoxQ is less susceptible to first pass effect and that the release of quercetin from DoxQ may lower the P-gp efflux effect and increase the oral absorption of doxorubicin. Future in vivo experiments to confirm the in vitro observations are warranted and are in progress by our laboratory.

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03: The small molecule Epigallocatechin-3-gallate acts to inhibit Matrix Metalloproteinases in the context of HPV+/HPV- Oral Squamous Cell Carcinoma.

Joell Chen;1 Jordy Geiler;1 Catalina Matias;1 Val Cheever;1 Andrew Gross;2 Author Affiliations 1 Roseman University, College of Dental Medicine 2 The University of Tennessee, Department of Oral and Maxillofacial Surgery Purpose Oral Squamous Cell Carcinoma (OSCC) is the sixth most common cancer worldwide, yet the 5-yearsurvival of patients affected with HPV+/- OSCC remains beneath 50%. Late diagnosis and a high incidence of metastasis are recognized as primary contributors to low survival rates. Several green tea polyphenols, including epigallocatechin‐ 3‐gallate (EGCG) and tannic acid, have shown anti-carcinogenic properties to tumor cell lines, including activation of caspases to promote apoptosis, induction of cell arrest, as well as decrease in tissue invasion. Mechanisms to which these cells are rendered less metastatic are poorly understood.

Methods HPV-/- oral squamous cell carcinoma cells (Cal-27) and HPV 16+ oral squamous cell carcinoma cells (SCC-25) were incubated with varying concentrations of EGCG (0, 5, 25, 50 100 M) for 48 hours. Matrix metalloproteinase (MMP) activation, a known property of metastatic activity, was evaluated via enzyme zymography, while transcription protein phosphorylation, and protease quantification were measured via Western blotting.

Results The small molecule epigallocatechin‐ 3‐gallate (EGCG) inhibits the upregulation and proteolytic activity of MMP-2 and MMP-9 in a dose-dependent manner, beginning at 5uM. Conclusions Our data show that polyphenols, particularly EGCG, have potential to effectively reduce expression of MMPs known to propagate cellular invasiveness of the HPV+/- oral squamous cell carcinoma lines: Cal27 and SCC-25. These data present a mechanism to which a particular small molecule (EGCG) has promising inhibitory effects within two OSCC cell lines.

As protease activity lends to the metastatic risks of oropharyngeal squamous cell carcinoma, targeting and controlling the expression of proteases and delineating the mechanisms involved in metastatic tumor activity is critical to future therapeutic interventions.

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04: Improvements to the Small-Scale Synthesis Of the Pharmaceutical Phenytoin Arikka Gooch;1 Emily Christiansen;1 Kent Pitcher;1 Rebeca Zimmermann;1 Veronica Moeung;1 Garrett Battaglia.1 Author Affiliations 1 Roseman University Purpose Phenytoin is an important antiepileptic drug (AED) that is used in impoverished areas around the world.

The purpose of this project was to improve the small-scale synthesis of Phenytoin for possible practical use in these areas. Phenytoin was first synthesized in 1908 by the Biltz synthesis, which involves base catalyzed addition of urea to benzil followed by Pinacol rearrangement to form Phenytoin. The outcome of this research resulted in two important procedural improvements over the previous technique.

Methods One, modification of the reflux time from ninety minutes to a range of sixty minutes to two hours and two, the method of dissolving benzil in absolute ethanol or methanol before refluxing begins.

Results These changes resulted in an increase in total percent yield, and the total synthesis can now be achieved within a three to four-hour time frame.

Conclusions Phenytoin product verification can be readily established using traditional spectroscopic/spectrometric methods.

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05: Role of CD5 on T cell function in oral inflammation and periodontal disease Dallin Cardon;1 Jessica Townsend;2 Yuko Sperry;2 Scott Weber;2 Claudia Freitas.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 Brigham Young University, College of Life Sciences Purpose The World Health Organization reported in 2016 that oral diseases affected half of the worldâ&#x20AC;&#x2122;s population. This is mainly due to poor oral hygiene and tobacco use which can develop into periodontal disease. Periodontal disease is caused by an immune response to microbial challenge, which initiates an immune response by lymphocytes and other white cells to the site of inflammation. Untreated periodontal disease begins as gingivitis and progresses to periodontitis, where the immune response causes resorption of bone, destruction of periodontal ligaments, and consequently, the loss of teeth. Additionally, periodontitis is a risk factor for heart and lung disease. Patients with severe periodontitis have increased autoreactive B lymphocytes that express the CD5 co-receptor and these cells are influenced by T cells.

We propose to investigate the relationship between oral inflammation, CD5, and the T helper immune response.

Methods We are comparing oral inflammation in T cells with and without CD5. CD5 is a T cell co-receptor that regulates T cell development and function and we hypothesize CD5 plays an important role in helper T cell dependent periodontal diseases. We are testing this hypothesis by co-culturing T cells expressing or lacking CD5 with oral mucosal or gingival epithelial cells that have been exposed to LPS (lipopolysaccharide, a major component of gram-negative bacteriaâ&#x20AC;&#x2122;s wall) and will examine differences in cell number, T cell subtype, and cell function.

Results While we are currently gathering preliminary data, previous research on CD5 outside of an oral environment suggests that CD5 expression is linked to the intensity of the bodyâ&#x20AC;&#x2122;s immune response. We anticipate that we will observe these differences as well in the T cells with and without CD5 immune response in the gingival and mucosa epithelial cells.

Conclusions We suggest that CD5 plays a critical role in helper T cell function in the periodontal immune response which could open new avenues in prevention and treatment of periodontal disease.

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06: E-cigarettes and Oral Cell Damage Olivia Kalloo;1 Caileen Sylvester;1 Reeya Shrestha;1 Claudia Freitas;1 Kamran Awan.1 Author Affiliations 1 Roseman University, College of Dental Medicine Purpose The purpose of this study is to provide scientific evidence of the effect e-cigarette smoke has on oral cells by measuring mitochondrial function, as it is highly sensitive to environmental toxins, and mitochondrial dysfunction may promote the onset of cancer .

Methods Human gingival fibroblast (HGF-1) cells were exposed to e-cigarette smoke extract media at different concentrations and time points. We measured the NAD+/NADH ratio using a colometric assay to show any changes associated with cell toxicity and mitochondrial function at each time and concentration. We also measured MT-COX1 ((Mitochondrially Encoded Cytochrome C Oxidase I) and SHA (encoded in the nucleus) using western blot to measure regulation of mitochondrial biogenesis and cellular stress response to the vape extraction.

Results Our preliminary data suggests that the higher the concentration and the longer the time the cells are exposed to e-cigarette, the higher is the damage effect of the mitochondrial function. It could be seen as the NAD+/NADH ratio changed through time, as well as the expression of the succinate dehydrogenase subunit A (SDHA) and cytochrome c oxidase subunit I. Conclusions E-cigarette exposure to oral cells induces changes in mitochondrial respiration and metabolism, oxidant generation, mitochondrial DNA (mtDNA) damage and dysfunctional reduction-oxidation (redox) signaling. These changes may lead to a long to midterm cell transformation that could potentially lead towards cancer.

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07: An analysis of modified-histone sequence preference in R Nolan Cole;1 David Bates.1 Author Affiliations 1 Brigham Young University, College of Life Sciences Purpose We determine which chemical alterations to histone tails modifies positioning and occupancy within the C. elegans genome via sequence preference.

Methods Nucleosomes were reconstituted using recombinant histones and C. elegans DNA. Data was analyzed using a novel pipeline written in R and a chi-squared test.

Results We find that some modifications resulted in a moderate change of preferences for certain regions within the genome.

Conclusions Certain modifications alter sequence preference.

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08: Baseline effects of lysophosphatidylcholine and nerve growth factor in a rat model of sciatic nerve regeneration after crush injury Parker Paulsen;1 Ryan Wood;2 Keaton Karlinsey;1 Austin Thompson;1 Mark Rigby;1 Greggory Boatright;1 William Pitt;2 Beverly Roeder;1 Scott Steffensen;1 Alonzo Cook.2 Author Affiliations 1 Brigham Young University, College of Life Sciences 2 Brigham Young University, Chemical Engineering Purpose Schwann cells play a major role in helping heal injured nerves. They help clear debris, produce neurotrophins, upregulate neurotrophin receptors, and form bands of BĂźngner to guide the healing nerve.

But nerves do not always produce enough neurotrophins and neurotrophin receptors to repair themselves.

Nerve growth factor (NGF) is an important neurotrophin for promoting nerve healing and lysophosphatidylcholine (LPC) has been shown to stimulate NGF receptors (NGFR).

Methods This study tested the administration of a single intraneural injection of LPC (1 mg/mL for single LPC injection and 10 mg/mL for multiple LPC injections) at day 0 and one (day 7), two (days 5 and 7), or three (days 5, 7, and 9) injections of NGF (160 ng/mL for single injections and 80 ng/mL for multiple injections) to determine baseline effects on crushed sciatic nerves in rats. The rats were randomly divided into four groups: control, crush, crush-NGF, and crush-LPC-NGF. The healing of the nerves was measured weekly by monitoring gait; electrophysiological parameters: compound muscle action potential (CMAP) amplitudes; and morphological parameters: total fascicle areas, myelinated fiber counts, fiber densities, fiber packing, and mean g-ratio values at weeks 3 and 6.

Results The crush, crush-NGF, and crush-LPC-NGF groups statistically differed from the control group for all six weeks for the electrophysiological parameters but only differed from the control group at week 3 for the morphological parameters. The crush, crush-NGF, and crush-LPC-NGF groups did not differ from each other over the course of the study. Single injections of LPC and NGF one week apart or multiple treatments of NGF at 5, 7 and 9 days post-injury did not alter the healing rate of the sciatic nerves during weeks 1-6 of the study Conclusions These findings are important to define the baseline effects of NGF and LPC injections, as part of a larger effort to determine the minimal dose regimen of NGF to regenerate peripheral nerves

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09: RAGE and phospho-ATM correlation during DNA Double Strand Breaks in trophoblast cells J Taylor Greff;1 KYF Tsai;1 KM Hirschi Budge;1 TS Davis;1 SJ Llavina;1 BC Tullis;1 N Jones;1 RS Fowers;1 PR Reynolds;1 JA Arroyo.1 Author Affiliations 1 Brigham Young University, College of Life Sciences Purpose Trophoblasts are critical for successful pregnancies and they mediate important steps including implantation, immune protection of the fetus, maternal blood flow to the placenta, and delivery. Increased DNA double strand breaks (DNA-DSBs) in trophoblasts has been implicated in complicated pregnancies such as intrauterine growth restriction. Previous studies in our laboratory showed increased expression of the receptor for advanced glycation end-products (RAGE) following cigarette smoke extract (CSE) treatment of trophoblast cells. More recently, a role for nuclear RAGE (nRAGE) has been implicated in DNA-DSB repair in these cells. ATM is a regulator known to be involved in the repair of DNA-DSBs through interaction with molecules associated with DNA repair.

Methods We tested the hypothesis that RAGE associates with ATM in facilitating DNA-DSB repair in trophoblast cells. DSBs were induced in human trophoblasts by exposure to cigarette smoke extract (CSE) or bleomycin (BLM). Assessment of nRAGE and Ć´-H2AX (involved in DNA-DSB repair) was done by immunoblotting. Immunoprecipitation was used to quantify RAGE and p-ATM complexing in cells.

Invasion was measured after CSE and BLM treatment in the presence or absence of a RAGE neutralizing antibody (nAb).

Results Increased expression of RAGE and Ć´-H2AX was detected (1.4-fold and 1.6-fold; p <0.05) in treated trophoblast cells compared to controls. Trophoblast invasion was decreased by 65% with BLM treatment compared to controls (p< 0.0005) and diminished invasion was further enhanced (73%, p <0.0004) when RAGE nAb was added. Similarly, trophoblast invasion was decreased by 58% (p <0.002) when treated with 1% CSE and further decreased (79%, p <0.0006) in the presence of RAGE nAb. There was also a significant increase (56%, p <0.002) in RAGE expression when p-ATM was immunoprecipitated from trophoblasts treated with CSE. Conclusions We conclude that CSE and BLM cause DNA-DSBs in trophoblast cells and that DNA-DSB repair may plausibly involve nRAGE association with ATM. We further conclude that DNA-DSBs could be a factor that inhibits trophoblast invasion. Nuclear RAGE may be a potential target that maintains trophoblastic invasion by assisting in the repair of DNA-DSBs. These studies provide a critical insight into dissecting tobacco-mediated placental deficiency.

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10: RNA Sequencing of Gas6 induced Preeclamptic Rat Placenta KM Hirschi Budge;1 KYF Tsai;1 SJ Llavina;1 JT Hill;1 JA Arroyo;1 PR Reynolds.1 Author Affiliations 1 Brigham Young University, College of Life Sciences Purpose Preeclampsia (PE) is an obstetric complication that affects 2-8% of pregnancies and remains a leading cause of morbidity and mortality for both the mother and fetus. Recent research has focused on biomarkers that may indicate disease onset and models for the study of PE. One such potential biomarker is the growth arrest specific protein 6 (Gas6). Gas6 binds to the TAM family of tyrosine kinase receptors, with primary affinity for the Axl receptor. Axl-mediated signaling is implicated in cellular proliferation and migration, and weâ&#x20AC;&#x2122;ve demonstrated that Axl activation by Gas6 during pregnancy induces PE in the rat, including symptoms such as increased blood pressure, proteinuria, altered trophoblast invasion, and increased inflammatory cytokines.

Methods Our objective was to elucidate changes in gene expression induced by Gas6/Axl in the developing placenta. Pregnant Holtzman Sprague Dawley rats were treated with Gas6, or Gas6 and the Axl inhibitor R428, from gestational day (GD) 7.5-17.5. Control rats received saline injections during the same period.

Tissues were collected at GD 18 and snap frozen in liquid nitrogen. Placental RNA was isolated and submitted to the sequencing center at Brigham Young University. Quality filtering was performed prior to alignment, and alignment for each sample was between 98.0-98.4%. Significance was noted as an adjusted p value of < 0.05.

Results Analysis of the RNA sequencing data identified 123 genes that were affected by Gas6 administration. Of these, 44 genes were not responsive to Axl inhibition, 29 were returned to baseline levels, and 50 were mildly to moderately responsive to Axl inhibition. Examination of enriched gene ontologies identified several impacted biological processes including cellular proliferation and apoptosis, RNA stability, lipoxin processes and metabolism, and transcription in response to stress.

Conclusions These initial findings highlight several options for clarifying the molecular mechanisms of PE mediated

by Gas6. Further research should examine translational effects in greater detail.

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11: Co-expression of placental RAGE and ƴ-H2AX during intrauterine growth restriction and preeclampsia in rodents.

KYF Tsai;1 KM Hirschi Budge;1 TS Davis;1 SJq Llavina;1 RS Fowers;1 PR Reynolds;1 JA Arroyo.1 Author Affiliations 1 Brigham Young University, College of Life Sciences Purpose Intrauterine growth restriction (IUGR) and preeclampsia (PE) are obstetrics complications associated with poor outcomes for the both the mother and fetus. Although both characteristically differ, both diseases are associated with placental malfunction that stems in part from increased placental apoptosis. DNA double strand breaks (DNA-DSBs) represent some of the most destructive forms of genomic damage in which both strands of DNA are ruptured. H2AX is a component of the histone octomer and is phosphorylated to form ƴ-H2AX in response to the sensing of DNA-DSBs. The receptor for advanced glycation endproducts (RAGE) is a multi-ligand receptor primarily expressed on cell membranes, where it functions as a progression factor in inflammatory signaling; however, the nuclear isoform of RAGE (nRAGE) has been described as having a crucial role in DNA-DSBs repair.

Methods The purpose of this study was to identify placental DNA damage, placental nRAGE and ƴ-H2AX expression in a secondhand smoke exposed rodent model of IUGR and a Gas6 induced PE model.

Placental and fetal weights were determined at the time of necropsy in the IUGR model. Blood pressure and proteinuria was assessed in the PE model. Characterizing DNA degradation was used to confirm placental DNA damage during these pregnancy complications. Immunohistochemistry was used to determine localization of both molecules in the placenta.

Results Relative to controls we observed: 1) decreased placental and fetal weights (1.4-fold and 2.3-fold; p<0.003) during IUGR; 2) significantly increased systolic and diastolic blood pressure and proteinuria (80%; p<0.05) during PE; 3) increased DNA degradation in the IUGR and PE placentas and 4) Increased staining for RAGE and ƴ-H2AX in the IUGR and PE placentas.

Conclusions These results may provide insight into the physiological relevance of these molecules, and if so, their modification during gestation may help alleviate placental disease.

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12: eCig vapor extract (EVE) regulation of invasiveness in oral squamous cell carcinoma cells (OSCC) Anthony Lepre;1 Michael Reese;1 K. Tsai; K. Hirschi; Paul Reynolds;2 Juan Arroyo.2 Author Affiliations 1 Roseman University, College of Dental Medicine 2 Brigham Young University Purpose The electronic cigarette (eCig) is a new avenue of tobacco use that has gained significant popularity in recent years. Generally supposed to be less harmful than traditional smoking, knowledge about the toxicity of the e-liquid in electronic devices is still scarce. OSSC is a common disease affecting 30,000 people in the United States each year. We sought to determine the invasive differences of gingival and tongue cell carcinoma exposed to vaporized eCig. Methods Ca9-22 and Cal-27 OSCC cells were incubated in the presence or absence of Red Hot or Green Apple eCig vapor extract (EVE) with and without nicotine. Real time invasion was assessed over 6 hours in both cell types using a RTCA DP instrument. Immunoblot was used to determine EVE-induced expression of MMP9 and MMP13.

Results Compared to controls we observed: 1) decreased cell invasion in the Red Hot EVE Ca9-22 treated cells without nicotine (1.2-fold; p<0.0002) and increased invasion when nicotine was added (2.2-fold; p<0.0003) 2) no differences in cell invasion in the Green Apple EVE Ca9-22 treated cells; 3) decreased cell invasion in the Red Hot Cal-27 EVE treated cells regardless of nicotine (1.1-fold, 2.2-fold; p<0.0003); 4) no differences in cell invasion for the Cal-27 Green Apple EVE treated cells. 5) decreased MMP9 in CAL-27 Red Hot EVE treated cells and increased MMP13 when nicotine was present; 6) decreased MMP13 in the CAL-27 Red Hot EVE treated cells.

Conclusions We conclude that eCig EVE and nicotine orchestrate differential regulation of cell invasion by regulating metalloproteases. This study provides an important step in dissecting eCig vapor mediated mechanisms of cancerous invasion and may be helpful in determining key molecular avenues of invasion employed by OSCC. This work was supported by a grant from FAMRI (PRR and JAA) and by institutional research funds from Roseman University.

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13: Deciphering Inflammatory signaling intel cell lines exposed to eCigarette Vapor Extract (EVE) Michael Rhees;1 A. Lepre;1 K Hirschi;2 K Thai;2 J. Arroyo.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 Brigham Young University, Department of Anatomy and Physiology Purpose Objectives: Electronic cigarettes (eCig) has encouraged a new, mostly unregulated product line within the smoking industry. eCigs involve heating oil-based liquids and the delivery of aerosolized flavors with or without nicotine, yet little is known about their health impact. The oral cavity is an anatomic gateway for exposure, so we hypothesized that exposure compromises the oral cavity by activating inflammatory signaling networks. The purpose of this study was to determine the effects of eCig liquid by examining the expression of pro- inflammatory molecules.

Methods Methods: Gingiva-derived Ca9-22 cells and tongue-derived Cal-27 cells were exposed to eCig vapor extract (EVE) generated by bubbling Red Hot or Green Apple flavored eCig solution +/- nicotine with a mod atomizer. Exposure occurred for 6 hours followed by immediate isolation of protein lysates and conditioned media.

Results Results: Immunoblotting and immunostaining showed that RAGE, a membrane bound inflammatory receptor, was inhibited by Ca9-22 cells and increased in Cal27 cells exposed to either flavor with nicotine. Activity of pJNK, a signaling intermediate involved in cellular stress responses, was increased in Ca9-22 cells with either flavor plus nicotine but only activated in Cal27 cells when nicotine was absent. pERK activated during survival responses was increased in Ca9-22 cells with Green Apple lacking nicotine and in Cal27 cells with Red Hot plus nicotine and Green Apple without nicotine. Cytokines including TNF-a were increased by Green Apple in Ca9-22 cells and by both flavors regardless of nicotine in Cal27 cells.

Conclusions Conclusions: These results add clarity relative to inflammatory signaling of exposed cells in the oral mucosae. While inflammatory signaling coincides with eCig exposure, important additional steps must be taken to clearly elucidate to what extent signaling is required for inflammatory disease progression.

This work was supported by a grant from FAMRI (PRR and JAA) and by institutional research funds from Roseman University.

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14: Of mice and men... and alligators! Tales of heterotopic ossification Jared Barrott;1 Ben Dubansky;2 Brooke Dubansky;3 Austen Kalivas;4 Matt Kirkham;4 Kaniz Fatema;5 Sarah Luelling.4 Author Affiliations 1 Idaho State University, College of Pharmacy 2 University of North Texas, College of Life Sciences 3 Tarleton State University, Department of Anatomy and Physiology 4 Idaho State University, College of Pharmacy 5 Idaho State University, College of Nursing Purpose Heterotopic ossification is characterized by abnormal bone growth. Models to study this disease have been limited. Our objective was to find parallels between heterotopic ossification in humans, mice and even alligators.

Methods We characterized the process of heterotopic ossification in humans histologically and compared to the developmental stages of dermal ossification in the juvenile American alligator. We characterized the frequency of ossification that occurs in a genetic mouse model of muscle cancer. We examined the phenotype histologically, radiographically, and transcriptionally.

Results The process of dermal ossification in the juvenile American alligator mimicked the step wise progression of heterotopic ossification seen in humans, namely fibrosis followed by immune cell infiltration and then osteoid matrix production. In the muscle cancer study in mice, the penetrance of an ossifying phenotype was comparable to the frequency seen in humans with the same cancer, ~11%. An immune cell presence increased the likelihood of developing ossification in the muscle cancer. Even when visible ossification was absent, a strong transcriptional profile of ossification genes was observed in most mice with the muscle cancer and even more so in metastatic mice. However, ossification did not portend a worse outcome for mice.

Conclusions The triangulation of three separate models of ossification underline the significance of immune cells within the microenvironment. Both juvenile alligators and mice with muscle cancer can serve as model systems to further understand the complexity of heterotopic ossification and provide a pathway for testing preclinical drugs to treat this disease.

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15: Arid1a deletion results in enhanced osteosarcomagenesis and altered chromosome structure Kaniz Fatema;1 Shawn Plyler;1 Adriene Pavek;1 Chris Nartker;1 Yanliang Wang;1 Kevin Jones;2 Jared Barrott.1 Author Affiliations 1 Idaho State University, College of Pharmacy 2 University of Utah, Huntsman Cancer Institute Purpose Osteosarcoma (OS) is a primary malignant bone tumor mainly affecting children and young adults. Early metastasis, chemoresistance and stagnation in the treatment options for the last 4 decades resulting in a less than 20% chance of long-term survival in metastatic OS. Investigating the molecular mechanisms underlying a more aggressive phenotype in osteosarcoma will certainly help develop novel treatment alternatives. Through a transposon-mediated forward genetic screen, we were able to increase osteosarcomagenesis by random mutagenesis. Among the possible candidate genes on our list, we discovered a loss-of-function mutation in ARID1A. ARID1A is a member of the SWI/SNF chromatinremodeling protein complex and has been implicated as a tumor suppressor in other cancers. We hypothesized that loss of ARID1A in osteosarcoma would increase the rate of tumor progression and metastasis by impacting the epigenetic configuration of the chromatin.

Methods In-vitro (CRISPR/Cas9) deletion in human OS cell lines and cell behavioral studies validated that ARID1A loss contributes to faster tumorigenesis. To understand its effect in-vivo, we have developed mice cohorts with or without ARID1A with a Cre-mediated, Osteoblast specific (Osx) conditional knockout system.

Results We observed that Arid1a-mutant mice develop tumors and die on an average 13 weeks earlier than that of the wildtype cohort. By 3D micro CT scanning, we further confirmed a relatively higher number of primary and metastatic tumors in the Arid1a mutant mice, albeit the histology and morphology of the tumors did not change. The analysis of genome-wide chromatin accessibility by ATAC-seq confirmed an open chromatin organization in Arid1a mutant mouse samples.

Conclusions We conclude that acting as an epigenetic regulator, ARID1A plays a significant role in osteosarcoma progression and metastasis. Further investigation to strengthen this link would present the opportunity for alternatively targeting genetically unstable cancers with epigenetic drugs.

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16: Treatment of Sarcoma Using HSP90 Inhibitors in Combinatorial Synergy with Doxorubicin Matthew Kirkham;1 Jared Barrott;1 Sarah Luelling;1 Kaniz Fatema.1 Author Affiliations 1 Idaho State University, College of Pharmacy Purpose The investigation synergistic effects of combinatorial treatment of Synovial Sarcoma using HSP90 inhibitors and doxorubicin. Synergism would allow decreased dosing of doxorubicin and increase the safety profile for cardiac related side effects.

Methods In vitro culturing and analysis of synovial sarcoma cell lines is performed, using increasing concentrations of HSP90 inhibitors and doxorubicin. Cell proliferation is measured using MTT and resazurin viability assays, and apoptosis and necrosis are measured using flow cytometry.

Results A noticeable shifting point is apparent with increasing concentrations of HSP90 inhibitor, at which doxorubicin is considerably more effective. Two of the HSP90 inhibitors hold a similar trend, while one is deemed too bulky to provide any sort of synergism.

Conclusions Synergistic effects of HSP90 inhibition and doxorubicin provide an effective means of achieving cell death while allowing doxorubicin dosing to decrease. This decrease in dosing should theoretically allow for longer treatment periods, as cardiotoxic levels will not build up as quickly, and more effective tumor treatment can be achieved.

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17: Oncostatin M Receptor as a Therapeutic Target of Radio-Immune Therapy in Metastatic Synovial Sarcoma Sarah Luelling;1 Matt Kirkham;1 Timothy Gardner;2 Christina Mottishaw;2 Jared Barrott.1 Author Affiliations 1 Idaho State University, College of Pharmacy 2 Idaho State University, Idaho Accelerator Center Purpose Synovial sarcoma is a soft tissue malignancy of the muscle tissue which primarily affects adolescents.

While it is a rare disease, little advancement has been made in the treatment of this cancer. With an overall survival rate of roughly 40%, the need for new treatments for synovial sarcoma is evident.

Oncostatin M Receptor (OSMR) is a type I cytokine receptor and is overexpressed in metastatic synovial sarcoma. OSMR does not have high expression in normal tissues, making it an ideal target for cancer therapy. We hypothesize that by using an anti-OSMR monoclonal antibody conjugated to a radioactive Cu67 isotope, synovial sarcoma can be targeted at both primary and metastatic locations through systemic therapy.

Methods Copper 67 is a gamma radiation emitting isotope which is tissue damaging and able to induce cell death in cancer cells. By conjugating the chelating molecule p-SCN-Bn-NOTA to an anti-OSMR antibody, Cu67 was able to be captured to the antibody.

Results Capture efficiency of Cu67 was measured through TLC and found to be 64 % efficient. Binding studies through Surface Plasmon Resonance (SPR) found that the conjugation did not interfere with the binding affinity of the antibody.

Conclusions This data suggests that targeting OSMR through radio-immune therapy is a viable treatment and indicates further testing in animal models.

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18: A Systematic Review of Cost-benefit Analysis, Published Clinical Trials and Compounded Formulations for Dry Eye Disease Hayden Gerrard;1 Josh Christensen;1 Braxton DeFriez;1 Siddharth Kesharwani;1 Surajit Dey.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Dry eye disease (DED) could be defined as a heterogeneous group of a condition characterized by tear film insufficiency and ocular surface irritation. It has a high prevalence and is known to affect a substantial population, especially adults. It is estimated that approximately 17 million people suffer from DED with an increasing economic burden on patients. DED can impact vision, visual function, daily activities, and the overall quality of life. The objective of this work is to perform a comprehensive and systematic review of medications as it pertains to the cost-benefit, a review of published clinical trials and currently employed compounded formulations for DED. Methods The current work involves: (a) a cost-benefit analysis of currently employed drugs for the treatment of DED, (b) a systematic review of published literature, clinical trials and databases for assessing the efficacy of the treatments of DED, and (c) a market research of currently compounded drugs and formulations for DED. A comparison of currently prescribed eye drops (Lifitegrast, and Cyclosporin) in comparison to over the counter eye drops (Systane, Refresh, etc.) will be performed by completing a retrospective analysis and systematic review of current research utilizing various databases, referencing current drug formulations, and evaluating costs. Then a systematic review of currently available medications will be conducted to determine the efficacy and safety of the drugs clinically evaluated and currently prescribed.

The purpose is to provide information to providers, pharmacies, and patients about the safety and efficacy of each medication. Finally, a comprehensive and thorough review of currently compounded drugs and formulations for DED will be done. This will be accomplished through informational interviews, primary research by speaking with prescribers, pharmacists, and pharmacies.

Results Our preliminary results indicate positive information on all 3 distinct aims related to the study. The study is currently underway and results will be reported upon a comprehensive investigation.

Conclusions In summary, the results from this study will provide useful information regarding the current efficacy and effectiveness of therapeutics for DED. This will aid in the development of effective strategies for prescribers, pharmacists, and pharmacies.

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19: Product Development from Apple, Grapes and Berries Food Waste: Market Research, Industry Analysis and Opportunity Assessment Siddharth Kesharwani;1 Sahil Ghate;2 Foram Madiyar.2 Author Affiliations 1 Roseman University, College of Pharmacy 2 Embry Riddle Aeronautical University Purpose The products developed from food waste and other sources such as fertilizers, animal edibles, etc. are finally gaining widespread attention that they deserve. There has been substantial social and environmental pressure for the efficient utilization of agricultural and food industry residues. According to estimates from the Food and Agriculture Organization (FAO) in the United States, 1-2 billion metric tons (Mt) of edible food produced for human consumption is wasted among which fruit processing industries contribute ~0.3-0.5 billion tons. Food processing waste fractions example pomace contains skin peel, seeds, that are rich in biologically active compounds (BACs) such as pectin, lipids, antioxidants, polyphenols and dietary fibers. These BACs could potentially aid in substantial economic benefits and health incentives to develop several types of products. To this end, the current research seeks to perform a thorough and comprehensive market research study on the food waste management market and the products developed from food waste, thereby developing future research strategies on the type of products that could be potentially developed.

Methods The market research, historical trend, global industry analysis and opportunity assessment (2019-2029) for global food waste management and product development from food waste was performed using a combination of primary (in-depth interviews, questionnaire design and speaking with key opinion leaders), secondary (company websites, annual reports, white papers and financial reports) research and company analysis.

Results Through a comprehensive and systematic research analysis by market profiling, formulating decision guides, data collection, validation and analysis we were able to study the market research, historical trend, global industry analysis and opportunity assessment for product development from food waste for apple, berries, and grape pomace.

Conclusions The key conclusions obtained from the study for product development for apple, grapes and berries food waste provided insights on market size and market share assessments for the regional and country level segments, market share analysis of top industry players, providied strategic recommendations for developing new market penetration strategies, studying market trends, competitive landscaping mapping the key common trends and company profiling with detailed strategies, financials, and recent developments.

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20: A Nanotechnology-based Platform to Enhance the Systemic Circulation Time and Tumor Accumulation Efficiency of Nanomedicine in Cancer Siddharth Kesharwani;1 Pratik Muley;2 Anvay Ukidve;3 Jayarama Bhat Gunaje;2 Samir Mitragotri;3 Hemachand Tummala.2 Author Affiliations 1 Roseman University, College of Pharmacy 2 South Dakota State University, College of Pharmacy 3 Harvard John A. Paulson School of Engineering and Applied Sciences, School of Engineering and Applied Sciences Purpose Delivering nanoparticles (NPs) through a systemic route poses a major challenge due to the recognition of the circulating NPs by the reticuloendothelial system (RES). The conventional approach to improve the circulation of nanocarriers has been surface modification with polyethylene-glycol (PEG) (PEGylation).

To this end, the purpose of the study is to enhance the pharmacokinetic behavior and tumor accumulation ability of NPs by conjugating glucose on their surface (GLU-NPs) to ride on the RBCs through NPsglucose interaction with glucose transporter-1 (GLUT1).

Methods Fluorescent polystyrene NPs (200 nm) with surface carboxyl group were surface modified by coupling to glucose (GLU), hydroxylamine (HA) or PEG-2000 using carbodiimide chemistry. The binding and binding kinetics of GLU-NPs to human RBCs was investigated in-vitro. The in-vivo binding, pharmacokinetics, biodistribution and circulation times of GLU-NPs were compared with other NPs in BALB/c mice using radiolabeled-NPs. The tumor accumulation potential of GLU-NPs loaded with nearinfra-red dye Dil-C18 was determined in BALB/c mice subcutaneously injected with mouse breast cancer cells followed by imaging the mice using Bruker-Xtreme in-vivo imager.

Results Glucose, HA and PEG surface-modified NPs were ~275-300 nm in diameter with a slightly positive charge. The GLU-NPs bound to human RBCs in-vitro. The presence of serum did not hinder the binding of GLU-NPs to human RBCs. The binding of GLU-NPs to RBCs was through GLUT1 as confirmed by the absence of binding in the presence of genistein and the interaction of GLU-NPs to GLUT1 as demonstrated by affinity precipitation. Results from the in-vivo pharmacokinetics clearly showed that glucose conjugation significantly increased the circulation of NPs in mice. The t1/2 of GLU-NPs was significantly more (~126 Âą 12.56 mins) as compared to PEG-modified NPs (75.80 Âą 1.52 mins). GLUNPs showed enhanced tumor accumulation at 12, 24, and 36 h post-injection than PEG-NPs. The ability of tumor accumulation by GLU-NPs did not alter even after 2nd injection of the NPs. Conclusions In summary, we have developed a novel approach to enhance the systemic circulation time and tumor accumulation of polymeric NPs through surface-expressed nutritional transporters.

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21: Identification of natural extracts that inhibit myeloperoxidase (MPO) for the treatment of periodontal disease Regan LeeMaster;1 Yun Nancy Lee;1 Jennifer Campbell;1 Tyler Rose.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose There are several enzymes in the mouth that cause tooth decay. Specific herbal extracts were selected to find what inhibits myeloperoxidase (MPO) enzyme. Inhibition of MPO may be useful because MPO is the main activator of MMP-8, one of the enzymes in the mouth that causes periodontal disease. If MPO can be inhibited, it will potentially help reduce the amount of periodontal disease and tooth decay.

Methods A Myeloperoxidase Inhibitor Screening Assay Kit from Cayman Chemical was used. Fluorescence was detected using 2-[6-(4-aminophenoxy)-3-oxo-3H-xanthen-9-yl]-benzoic acid (APF), a fluorogenic substrate for the MPO enzyme. Test solutions that inhibited MPO lowered fluorescence in the MPO assay. Herbs were selected based on those that were already determined to be inhibitors of MMP-8 by previous experiments in Roseman Universityâ&#x20AC;&#x2122;s lab. The solvents were tested to decide which would work best with the herbs and ingredients without affecting MPO activity. The test solvents were water, 100% ethanol, 100% methanol, 100% DMSO, 50% ethanol, 50% methanol, and 50% DMSO. Some commercial mouthwashes were also tested in the assay. Three commercial mouthwashes (JASON, Crest, Listerine) were tested in the MPO assay to see which had ingredients that would inhibit MPO the most.

Bulk herbs that had previously shown to be active in inhibiting MMP-8 were pulverized using a food processor and extracted in 50% ethanol in water, heated to boiling. The extractions occurred over 1.5 to 2 hours, then the extracts were filtered through 0.45 micron syringe-tip filters and tested in the MPO inhibition assay. The experiment was conducted again, but this time the herbs were extracted in boiling water only.

Results The water and 50% solutions of ethanol and methanol did not affect MPO activity, but addition of 100% solvent or 50% DMSO inhibited MPO activity. So 50% ethanol and 100% water were used to deliver the herbal extracts in the assay. JASON and Listerine inhibited MPO by about 50%, but Crest inhibited it by 80%. The active ingredient in Crest is 0.07% cetylpyridinium chloride. This compound was used as a control inhibitor at a 0.07% in-well concentration. All the herbs tested inhibited MPO by more than 50%, but the water extracts of green tea (98%) and allspice (97%) and the 50% ethanol extract of rhubarb (99%) provided the best inhibition.

Conclusions Based on their ability to inhibit both MPO and MMP-8, allspice and rhubarb extracts could potentially be helpful additions to mouthwashes for treating periodontal disease. The MPO peroxidation reaction depends on the formation of free radicals, so it could be that the antioxidant activity of the herbal extracts accounts for the general inhibitory activity found. This would be something to explore in future experiments.

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22: Eliminating Biofilm Production Through Competition Kian Tingey;1 Nathan Baker;1 Brayden Elsmore;1 Logan Reese.1 Author Affiliations 1 Utah Valley University, College of Life Sciences Purpose Acidogenic bacteria, especially Streptococcus mutans, colonize the surface of our teeth and cause biofilm growth and dental caries through the processing of fermentable carbohydrates, sucrose and fructose, found on our teeth. Dental caries causes tooth decay that cad to serious pain and eventually loss of teeth.

Due to financial or other burdens, treatment is often neglected. We seek to find a cost effective, easily attained method to decrease biofilm growth, minimize the negative effects of dental caries, and increase overall oral health worldwide. Our goal was to identify bacteria that share a similar niche as that of Streptococcus mutans and thus can potentially decrease tooth decay via competition.

Methods We chose eight species of bacteria (Kocuria sp. Bacillus sp., Staphylococcus capitis, Escherichia coli, Lactobacillus gasseri, Lactobacillus johnsonii, Lactobacillus acidophilus, Streptomyces viridochromogenes to examine the impact on biofilm growth. We obtained a pooled oral bacterial sample by taking oral swabs from multiple participants and growing in Brain Heart Infusion (BHI) broth. Cell culture plates were used for each test organism with the 24 wells split between oral inoculum alone, oral inoculum with test organism, and negative controls. Biofilms were quantified using a crystal violet assay analyzed by an Epoch plate reader.

Results All tested strains either had no significant effect (Kocuria sp., Bacillus sp., Staphylococcus capitis, Lactobacillus gasseri, Lactobacillus johnsonii, Lactobacillus acidophilus) or significantly increased biofilm quantity (Escherichia coli, Streptomyces viridochromogenes). Therefore, we can show that our competitors were unable to decrease biofilm growth.

Conclusions Our selected competitors were unable to decrease biofilm growth. However, despite our insignificant findings with these selected organisms we are better able to narrow down future searches for biofilm reducing bacteria.

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23: Synthesis of the Pharmaceutical Phenytoin (diphenylhydantoin) for Demonstrating Pinacol Rearrangement Jordan Cook;1 Simmi Kaur;1 Jameson Dâ&#x20AC;&#x2122;Amato-Faulkner;1 Jenni Orr;1 Richard Dorrans;1 Charles Kingston;1 Theo Stowell;1 Ron Valcarce.1 Author Affiliations 1 Salt Lake Community College , ACS Purpose Phenytoin is an anticonvulsant medication effective in the treatment of tonic-clonic and focal seizures.

Phenytoin is largely regarded as non-profitable to distribute in the developing world. The chemical synthesis of phenytoin is a two-step process: Benzil and Urea precursors are combined via addition reaction to form the intermediate imidazolidinone. Imodazolidinone then is altered via the pinacol rearrangement to form crude phenytoin.Our goal is two-part: 1) determine the most efficient process of small-scale Phenytoin synthesis, and integrate the process into an undergraduate Organic Chemistry laboratory and 2) introduce small-scale phenytoin manufacturing techniques to developing countries.

Methods In the laboratory experiment, starting materials benzil (2.2g) urea (1.2g), and sodium hydroxide (1.2g) are mixed in 95% ethanol (50ml) in a 250 round bottom flask. This mixture is refluxed for sixty minutes at moderate heat using a heating mantle. Boiling stones are added to prevent bumping of the solution.

When the reflux solution was cooled to room temperature, it was transferred to a beaker containing approximately 50ml of ice water. The solution is mixed thoroughly and then filtered using a small Buchner funnel. The filtrate contains imidazolidinone and should have a pH value of 13.5. Aqueous sulfuric acid (6M) is added to the filtrate solution dropwise until the pH value is between 5.5-6. Addition of sulfuric acid into the filtrate solution will result in a white precipitate (crude phenytoin) demonstrating the PInacol rearrangement. The crude product is collected using a Buchner funnel and dried. Pure phenytoin is achieved after recrystallization using 15 ml of hot 95% ethanol. Spectroscopic analysis will be carried out on the dried product using a Thermo Scientific Nicolet iS10 FT-IR. Melting point will also be carried out.

Results In progress Conclusions In progress

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24: Conductive Atomic Force Microscopy Analysis of Silver Micro- Nanostructures Electrodeposited in Capillaries Kasielynn Bussard;1 Hunter Fourt;2 Spencer Ashworth;2 Aaron Barnett;2 Hardin Beaudry;2 Ezekiel Curran;2 Hayden Duffin;2 Nolan Chandler Turner;2 Wesley Sanders;2 Glen Johnson;2 Ron Valcarce;2 Peter Iles.2 Author Affiliations 1 Salt Lake Community College, Nanotechology 2 Salt Lake Community College Purpose This project involves elucidating the electrical properties of silver micro- nanostructures using conductive atomic force microscopy (CAFM). A previous report describes template-assisted electrodeposition of metallic micro- nanostructures in the capillaries of polydimethylsiloxane (PDMS) stamps modified with hydrophilic, polyvinyl alcohol (PVA) thin films. As seen in the previous study, metallic micronanostructures are created when metal cations are reduced in the recessed regions of modified PDMS stamps. However, no conductivity analyses of the structures have been reported.

Methods In this current study, an atomic force microscope operating in contact mode is used, in conjunction with a conductive probe, to generate conductivity maps of the electrodeposited structures. In addition, this project involves the use of CAFM to examine the effects PVA and silver nitrate concentration on the conductivity of the structures.

Results In progress Conclusions In progress

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25: Determination of Fluoride content in Dental Varnish via solvent extraction and measurement

by Fluoride ISE in Flow Injection analysis Kacey Green;1 Jordan Cook.1 Author Affiliations 1 Salt Lake Community College Purpose To determine the amount of fluoride in Dental Varnish.

Methods The dental varnished is place and weighed into a beaker. An organic solvent (chloroform) is added to the varnish and stirred with a stirring rod. Next we add the same volume of an aqueous phase base (sodium bicarbonate) to the mixture. The mixture is then added to a separatory funnel. The upper layer (aqueous) is then separated from the bottom layer (organic). The aqueous layer is added to a volumetric flask then made up to 100ml. A 5.0 ml sample is mixed with 5.0 ml of TISAB. The mixture with the TISAB is injected into the Flow injection analysis using a carrier solution (0.4M KCl) which impinges on the fluoride ion selective electrode and is washed away response is shown in a graph (shown below). The peak shaped results which is proportional to the concentration of Fluoride, as shown in the plot below.

The plot shows the triplicate measurements of both samples and standards. The unknown is calculated and the results tell us the amount of fluoride in the dental varnish.

Results In progress Conclusions In progress

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26: Identification of Nicotine in the Jordan River Brendan Schnopp;1 Christopher Peak;1 Luther Giddings;1 Emily Morgan.1 Author Affiliations 1 Salt Lake City Community College, Salt Lake City Community College Purpose The Jordan River is a principal source of ground water along Utah's Wasatch front. Treated waste water is discharged by multiple facilities into its source, Utah Lake and into the river itself as several locations before it drains into the Great Salt Lake. The presence of nicotine may be present in natural water sources, like the Jordan River. The ability of available instrumentation to detect these compounds in river water was investigated.

Methods To establish suitability of instrumentation, several standards of various concentrations of the nicotine compound were prepared to test against samples taken from the Jordan river. The samples were concentrated for analysis using a HPLC/MS analysis of the Jordan River water samples to ascertain if any nicotine was found in the river and determine the viability of this method.

Results In progress Conclusions In progress

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27: Microstructure analysis after Ceramic Layering of presintered Cobalt-Chromium compared to presintered Zirconia and Cast Alloys Elie E Daou;1 Mutlu Ozcan;2 Pascale Salameh;3 Ziad Salameh.4 Author Affiliations 1 Lebanese University , School of Dentistry 2 Zurich University , School of Dentistry 3 Lebanese University , College of Life Sciences 4 Lebanese University , School of Dentistry Purpose This study aimed to evaluate Ceramic-alloys interface and to emphasize on alloys microstructure alteration after ceramic layering.

Methods Thirty-two discs (N=32) made from ceramicâ&#x20AC;&#x201C;alloy combination (Ceramill-Sintron, Girobond-nb, Wiron99 and Ceramill-Zi) were prepared (n=8). Half of the specimens in each group (n=16) were examined as milled or cast. The other half (n=8) was ceramic-layered. Morphology and chemical-analysis were studied using Scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS).

Non-layered specimens were submitted to ceramic fire-heating protocol. Materials crystalline structure and surface roughness were investigated in all specimens (N=32) using XRD and AFM. Alloys microstructure (within same group) was compared prior and after ceramic-veneering, or after heating.

Results: SEM images showed alloys-ceramic intimate bonding interface. Some voids were visible in ceramic. EDX quantification report some differences when compared to manufacturers declared composition. XRD difference was only found for Girobond after ceramic or heating. ANOVA, Student test and Bonferroni were used for statistical analysis.

Results Significant difference in grains size was found in all groups after ceramic veneering (P=0.016), and after heat treatment in CoCr groups (P=0.013) Conclusions Presintered materials showed fine homogenous surface and stable microstructure that can influence the bonding with layering ceramic.

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28: The use of Commercial test kit reagents for the determination of nitrate in sea water Kristin Starr;1 William Bartlett;1 Elizabeth Lee;1 Peter Iles;1 Rajan Kochambilli.1 Author Affiliations 1 Salt Lake Community College Purpose Nitrate is initially reduced to nitrite before developing the color Nitrite is commonly measured using the colorimetric measurement via the azo dye. In this study, replacement of the environmentally hazardous cadmium for the reduction with a commercial test kit reagents have been investigated for fresh water samples. The test kit provides an estimate of nitrate levels via a color strip comparison after 5 minutes of mixing with the sample and two unidentified test kit reagents. An instrumental measurement was adapted to the test kit procedure which produce reasonable fast measurement which were accurate and precise.

Flow Injection Analysis (FIA) can provide a multichannel flow approach in developing a continuous and automated method for monitoring nitrate.

Methods TPI test kits and included reagents were employed for colorimetric measurement at 540 nm detection wavelength in a Spectronic 20 visible spectrometer and in the FIA experiments, with Cary 8454 UV VIS spectrometer with flow through cell as the detector. 60 ÂľL injection volumes and a flow rate of 1.25 mL per minute were employed via a Gilson MP3 peristaltic pump and a Rheodyne injection valve in a single line FIA. The color development reaction proceed for 5 minutes to produce a stable color prior to measurement. In the FIA mode the color reactions were done in the loading syringe of the FIA system.

Both water and saltwater blank solutions were investigated as the carrier solution. Salt water based standards were all made with a background of 3.5 % Sodium Chloride Sigma Aldrich ACS. Potassium Nitrate, Sigma Aldrich ACS was used in ultra pure water from a Barnstead, E pure; 17.9 megaohms for the standard solutions in the range 0 to 20 ppm nitrate in both fresh water and salt water. 3.5 m/m% sodium chloride was chosen as an approximation of sea water.

Results The aim of the research group was to develop a fast and where possible an automatable onsite method for nitrate in water without the waste problems associated with cadmium reduction. The commercial TPI test kit provides reagents that meet this goal and shows excellent results when used in visible spectroscopy.

The central panel of the poster shows the calibration plots for both fresh water and salt water solutions.

The salt water plots shown are firstly for the manual test kit method employing a Spectronic 20 spectrometer for visible wavelength. measurements and secondly for the flow injection measurement mode. Typical FIA peaks for this work are also shown. The manual method shows good linearity with R2 = 0.99 for fresh water and R2 = 0.99 for salt water. The FIA plot also exhibits good linearity with R2 = 0.98 and a relative standard deviation of 0.8% for triplicate injections.

Conclusions The TPI test kit with a Spec 20 as a lab method gave excellent results with integer discrimination in the low ppm range for both fresh and salt water.The measurements made in the FIA mode gave comparable results but also with the ability to provide relative standard deviation data and the possibility a developing an automated method where the addition of the two TPI test Kit reagents could be added to the samples online via merging streams and the use of appropriate mixing coils before detection at 540 nm. Future work will involve the investigation of the online mixing techniques. and the automation of test sample solutions directly from aquariums.

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29: Detection of N-Nitrosodimethylamine (NDMA) in Histamine-2 Receptor Antagonists Bradford Stockman;1 Jenni Orr.1 Author Affiliations 1 Salt Lake Community College, American Chemical Society Student Affiliates of Salt Lake Community College Purpose N-Nitrosodimethylamine (NDMA) is a yellow, volatile, combustible, and oily organic chemical that is highly toxic to the liver and assumed to be a human carcinogen which has recently been detected in ranitidine. Ranitidine is a histamine H2-receptor antagonist which blocks enterochromaffin-like cells (ECL cells) from producing histamine. Histamine stimulates the parietal cells to release acid causing irritation of the gullet (acid reflux), which can lead to inflammation of the gullet (oesophagitis). NDMA is a known contaminant in some brands of over-the-counter (OTC) H2-receptor antagonists. The contamination source is likely due to an inherent instability of the ranitidine molecule, which contains both a nitrite and a dimethylamine (“DMA”) group which are known to combine to form NDMA. Methods Two compatible methods were used to detect NDMA in ranitidine, gas chromatography–mass spectrometry (GCMS) using low temperature head space injection and high-performance liquid chromatography–mass spectrometry (HPLCMS).

Results In progress Conclusions In progress

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30: Analysis of Fluoride in dietary samples with Flow Injection Analysis employing a Fluoride IonSelective Electrode Tyler Lambourne;1 Jordan Cook;1 Kacey Green;1 Dallin Beck;1 Peter Iles;1 Sarah Moore;1 Rajan Kochambilli;1 Ron Valcarce.1 Author Affiliations 1 Salt Lake Community College Purpose Municipal water sources are supplemented with Fluoride to prevent tooth decay. Researchers are looking into the negative effects of ingesting toxic levels of Fluoride. Toxic levels of Fluoride may lead to decreasing bone health and cause dental fluorosis (colored streaks staining the teeth). Fluoride is difficult to measure, especially in a laboratory environment, when water is used as a common solvent to clean and prepare experimental equipment. Previous students discovered Kaytee Brand rat pellets contained 0.5mg of Fluoride per gram. Our goal is to reproduce the same amount of Fluoride from the same brand, ten times over. Thus, ensuring our method is accurate and reliable. Using ultra-pure water (free from Fluoride) we digested the pellets and developed an accelerated method to analyze the amount of Fluoride; we specifically tested Kaytee Brand rat pellets. This method allows us to obtain instant results, measure multiple samples at a time, and is specific to measuring free Fluoride ions.

Methods Flow Injection Analysis was to measure the fluoride for the three solutions in this experiment. pH measurements were made with a Thermo Scientific Orion 4-star pH/ISE meter and a Thermo Scientific Ross Ultra glass pH combination electrode. Fluoride measurements were made with a Thermo Scientific Orion Fluoride Ion Selective Electrode. All fluoride samples and standards were treated with equal volumes of TISAB II (29.30 grams of sodium acetate (UNIVAR), 29.0 g of sodium chloride (NHD), 6 g of trisodium citrate dehydrate, (BHD), 2 g of CDTA (ALDRICH) and 8.2 mL of glacial acetic acid (BHD) per 1000 mL water. The pH was adjusted to 5.5 using 10M sodium hydroxide prior to being made to volume). Ultra pure water was used for all prepared solutions: Barnstead, E-pure; 17.9 megaohms. Sodium Fluoride: ScholAR Chemistry, Sodium Hydroxide Pellets: J.T.Baker, AR. Sodium Fluorophosphate, Aldrich>;95%.

FIA measurements were made using a Chemflow FIP-3 flowcell wall-jet configuration and a MicroLab FS-522 in conjunction with a Dell laptop. 60 ÂľL injection volumes with a Reodyne injection valve were used. Flow rates of 2 - 5 mL per minute were employed via a Gilson peristaltic pump.

Alkaline hydrolysis Treatment: Rat feces was boiled with water and Sodium Hydroxide to perform Alkaline Hydrolysis. Acid neutralization was employed using Hydrochloric Acid.

Fluoride standards with concentrations of 10, 25, and 50 ppm were treated to match the ionic strength of the feces solution. A second rat feces solution was made as stated above spiked with Fluoride Results In progress Conclusions In progress

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31: The bias of important cancer screening advice across gender and education levels Nicole Bayliss;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine Purpose Cancer screenings are tests that help find cancer at an early stage, even before symptoms appear.

Without these tests, cancer might be harder to treat or cure if the spread of abnormal tissue is found past the time when symptoms have appeared. The mere suggestion of the importance of cancer screening may be the advice that saves a life. The main objective in this study was to see if there was a significant difference in receiving suggestive advice about the importance of cancer screenings across gender and education levels.

Methods Data were obtained by using the 2015-2016 National Health and Nutrition Examination Survey, a large national database representative of the US population. The database contained a total of 3,473 adults 20 years and older questioned if they were informatively advised on cancer screening with 2,699 not advised. Among the advised population 54% were female. The advised highest education level by 98% of the database representation reported 12% below high school/GED equivalent, 16% high school/GED equivalent, 33% some college/AA degree, and 37% college graduate or above. The marital status of subjects consisted of 55% married persons, 16% were never married and 10% were divorced. The annual household income of $100K and over was reported in 25% of the population, $75-99K was reported in 11%, and 10% reported an annual household income of $25-34K. Chi-square test was used to compare the categorical data of the gender and education levels groups advised of the value in cancer screenings, among those with and without cancer.

Results There was a significant difference between being informed of the importance of cancer screening between males and females, where more females were being informed of the benefits of screening at a Chi-square statistic of 2.031, p=0.154. Most of those informed about screening benefits did not have any higher education, yet those who had a college degree or higher were the least informed and this denoted is denoted by Chi-square 32.363, p=0.000002. We noticed a difference between being told the importance of cancer screening between cancer and non-cancer respondents (p=0.01). Most respondents had no cancer and were not told and were not told the importance of checking for cancer with evidence of Chi-square 7.643, p=0.06.

Conclusions It is more likely that one is less likely to be informed if you are a male with a college education, whereas those more likely are females with less than a high school degree. A bias seems to exist among physicians freely giving advice to women with less education than themselves versus men.

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32: Diabetes, prediabetes, and the association with cancer Nicole Bayliss;1 Jerry Bounsanga;2 Val Joseph Cheever;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah, College of Dental Medicine Purpose To examine the association between diabetes and prediabetes with cancer.

Methods This study used data from the 2015 â&#x20AC;&#x201C; 2016 National Health and Nutritional Examination study from the Centers for Disease Control and Prevention. Descriptive statistics and chi-square tests were conduct to examine the association between cancer and diabetes.

Results There was a total of 549 respondents. Of which, 49% were males, 59.9% Whites and 50.5% married.

There was a significant relationship between diabetes and cancer (Chi-Square = 27.233, p<0.001). There were 14.1% of people who had diabetes also had cancer, while 8.7% who did not have diabetes also had cancer. There was a significant relationship between prediabetes and cancer (Chi-Square = 11.322, p=0.001). Among people who had prediabetes, there was 12.8% had cancer. Among those without prediabetes, 8.2% had cancer. There was also a significant relationship between nutritional diet and cancer (Chi-Square = 25.182, p<0.001). Those who had an excellent healthy diet had a lower chance of getting cancer.

Conclusions It is important to have a healthy diet and pay attention of signs of diabetes in order to minimize the occurrence of cancer.

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33: To determine the racial composition of various cancer types in the United States Nicole Bayliss;1 Evelyn Lauren;2 Val Joseph Cheever;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah, College of Dental Medicine Purpose To determine the racial composition of various cancer types in the United States Methods This study used the 2015 â&#x20AC;&#x201C; 2016 National Health and Nutrition Examination data to perform the analyses.

The database contained 5,714 participants responded to questions regarding whether they had cancer or not, and if so, what type of cancer they had. We analyzed their responses based on their racial composition (Mexican American, White, Asian, Other Hispanic and Other Race).

Results Breast cancer was most prevalent in White (2.1% of the population), closely followed by Other Hispanic (2.0%). Colon cancer was most prevalent in Other Race (1.0%), followed by White (0.8%). Melanoma was most prevalent in White (1.6%), followed by Other Race (1.0%). Prostate cancer was most prevalent in Other Race (3.4%), followed by Black (2.6%). For non-melanoma skin cancer, White was the most prevalent (3.7%), followed by Other Race (1.0%). For bladder cancer, Other Race the most prevalent (1.0%), followed by White (0.8%).

Conclusions White and Other Race seem to be more prone to many cancer types.

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34: Vitamin Supplements Intake and Cancer (30-day total intake) Nicole Bayliss;1 Evelyn Lauren;2 Val Joseph Cheever;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah, College of Dental Medicine Purpose To examine the relationship between vitamin supplements intake and cancer profiles of individuals in the United States.

Methods We used the 2015 â&#x20AC;&#x201C; 2016 National Health and Nutrition Examination study data to perform analyses on vitamin supplements intake and cancer. The following vitamin supplements were examined: Thiamin, Riboflavin, Niacin, Vitamin B6, Folic Acid, Folate, Choline, Vitamin C, Vitamin K and Vitamin D. Results In general, there was no significant relationship between 30-day total intake of vitamin dietary supplements and whether a person had cancer or not (p> 0.05). People who had cancer tended to take more Niacin than those without cancer. People with cancer consumed more dietary supplements than people without cancer. People with cancer took an average of 1.9 dietary supplements, while people without cancer took an average of 1.2 dietary supplements.

Conclusions Cancer patients consumed more vitamin supplements. This is to be expected as they require more nutrition than other people. A question is whether this amount of supplement is sufficient.

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35: Alcohol consumption and cancer Weston Boyack;1 Man Hung;1 Evelyn Lauren.2 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah, College of Dental Medicine Purpose To examine alcohol drinking habits of those with and without cancer.

Methods This study utilized the public database from the 2015-2016 National Health and Nutritional Examination Survey. We examined and compared the patterns of alcohol consumption of individuals with and without cancer. Chi-square tests were performed to investigate the relationship.

Results There were a total of 435 respondents who have cancer, and 3,647 without cancer included in the dataset.

People who have cancer tend to drink less on average compared to people without cancer (p<0.05).

People without cancer have a greater variation in drinking habits compared to people with cancer. A greater proportion of people with cancer had drank 4/5 or more drinks every day at some point of time in their life compared to people without cancer (p<0.05).

Conclusions Heavy alcohol consumption in an individualâ&#x20AC;&#x2122;s life is potentially related to cancer. Individuals tend to drink less after cancer diagnoses.

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36: Colon cancer survivorsâ&#x20AC;&#x2122; demographics and health profile Weston Boyack;1 Man Hung;1 Jerry Bounsanga.2 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah, College of Dental Medicine Purpose The objective of this study was to examine the physical and mental health experiences of colon cancer survivors across demographics.

Methods We used data from the 2016 Medical Expenditure Panel Survey. Descriptive statistics were conducted to look at sample characteristics. Chi-square tests were performed to compare physical and mental health status across demographics.

Results There was a total of 140 colon cancer survivors included in this study. Out of those, 49% were males and 72% were Whites. The respondentsâ&#x20AC;&#x2122; average was 68 years old (standard deviation = 12 years old). Across race, there was not a significant difference in pain (p>0.05), fatigue (p>0.05), general health (p>0.05), physical health (p>0.05), and mental health (p>0.05), of the cancer survivors. Across gender, there was also not a significant difference in general health (p>0.05), physical health (p>0.05), and mental health (p>0.05). However, those cancer survivors who had their cancer treatment covered by health insurance tended to have a better mental health than those who were not covered (p<0.05), and they felt less productive when their mental health was lower (p>0.05).

Conclusions To minimize adverse mental health outcomes, public policy on health insurance coverage should be reexamined.

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37: Exposure to Sun and Melanoma Risk, Profiles of Melanoma Patients Weston Boyack;1 Man Hung;1 Evelyn Lauren.2 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah, College of Dental Medicine Purpose We examined the profile of melanoma patients who had exposure to sun and investigated risks and exposures.

Methods We extracted data from the 2015-2016 National Health and Nutrition Examination Survey for use in this study. Fisherâ&#x20AC;&#x2122;s exact test was conducted to examine the relationship of sun exposure and melanoma.

Results There were 0.9% of males and 0.5% of the females in the general US population who had melanoma.

There were 1.9% of those who served in active duty of the US military had melanoma. If after several months of not being in the sun, individuals who then went out in the sun without sunscreen or protective clothing for a half hour, there were significant worse skin reactions in those who had melanoma comparing to those who did not have melanoma (p<0.05). There was no significant difference between those with and without melanoma who would stay in the shade when they went out on a sunny day (p<0.05).

Conclusions Those who had melanoma need to pay more attention to having protective measures of their skin.

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38: Relationship between Epstein-Barr virus and oral squamous cell carcinoma: A qualitative and quantitative analysis of the published literature Mohammed Jarab;1 Shankargouda Patil.1 Author Affiliations 1 Jazan University in Saudi Arabia, College of Dental Medicine Purpose To systematically review the relationship between Epstein-Barr virus and oral squamous cell carcinoma.

Methods Search terms including EBV or Epstein Barr virus and Oral cancer or Oral squamous cell carcinoma were used in Scopus, Web of Science, and PubMed to obtain case-control studies published until August 2019.

Results 985 articles were identified from the search and their titles and abstracts were screened for duplicates and relevance to the topic. Only 19 articles passed the screening and their full texts were assessed using the selection criteria. 7 articles satisfied the criteria and were included in the qualitative analysis. 4 of the 7 included studies had odds ratio compatible for quantitative analysis and were subjected to a metaanalysis. Immunohistochemistry, polymerase chain reaction and in situ hybridization were the commonly used diagnostic modality to identify EBV. Epstein-Barr virus determined nuclear antigen-1, latent membrane protein-1, and the Epstein-Barr virus-encoded small non-polyadenylated RNA-2 were the diagnostic targets assessed. An association (odds ratio 1.61 for a 95% confidence interval of 0.22-11.72) was noted from the meta-analysis between the Epstein-Barr virus and oral squamous cell carcinoma.

Conclusions Although the meta-analysis revealed an association with EBV, the results must be interpreted with caution due to the relatively lower number (4) of studies included in the quantitative analysis.

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39: Social Determinants of Health and Unmet Dental Care Needs Gagandeep Gill;1 Evelyn Lauren;2 Joseph Cheever;1 Eric Hon;3 Jungweon Park;1 Tanner Barton;4 Weicong Su;4 Ryan Moffat;1 Nicole Bayliss;1 Weston Boyack;1 Bianca Ruiz-Negron;4 Lourdes Peralta;1 David Prince;1 Frank Licari;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah, Department of Economics and Mathematics 3 University of Chicago, Department of Economics 4 University of Utah, College of Medicine Purpose It has been previously suggested that unmet dental needs impact quality of life and that social determinants of health are the root cause of unmet dental needs. However, there are few if any large nationally representative studies that look at an array of factors to explore dental needs disparities.

Therefore, the aim of this study was to look at the relationship between unmet dental needs and social determinants of health.

Methods The data for this study was from the 2016 Medical Expenditure Survey (MEPS). Descriptive statistics were performed to look at the sample population characteristics using mean, standard deviation, count and proportion. Sample weights were applied to obtain nationally representative prevalence estimates. Chisquare test was then used to study the difference in social determinants of health in individuals with unmet dental needs and without unmet dental needs.

Results This studyâ&#x20AC;&#x2122;s sample population included 33,929 participants, which represented 323,141,687 people in the US. The average age of our sample population was 46.5 years. Out of the entire sample population, 52.3% were females and 42.0% were males. Out of individuals with unmet dental needs, more people reported not having dental coverage (7%) rather than having dental coverage (4%). More people with public healthcare coverage (8.8%) had unmet dental needs than those with private healthcare coverage (4.6%). There were a larger percentage of individuals born in the US who had unmet dental care needs (6.3%) than individuals born outside of the US (5.0%).

Conclusions This study found a strong association between social determinants of health and unmet dental needs. This provides us with information that can aide us in more effectively identifying individuals who suffer from unmet dental needs.

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40: Quality of life for working cancer survivors Sara Moazzami;1 Jerry Bounsanga;2 Jungweon Park;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah Purpose This study sought to determine the quality of life of cancer survivors who were working.

Methods This study used the 2016 Medical Expenditure Panel Survey data from the Agency for Healthcare Research and Quality. Chi square tests were used to study differences in quality of life of cancer survivors who were working versus non-working. A total sample size of 657 participants was examined to explore gender, race, paid or unpaid positionsâ&#x20AC;&#x2122; impact on cancer survivors who were employed.

Results There were 56% of cancer survivors rated their quality of life as very good or excellent, but the proportion who rated very good or excellent was much higher at 65% for cancer survivors who were employed. There was a significant difference in the quality of life among cancer survivors of various races (p<0.05). No difference was found in quality of life between cancer survivors that had and did not have paid time off during their treatment (p<0.05), or between males and females (p>0.05).

Conclusions Being employed seems to help cancer survivors in attaining better quality of life. Findings from this study can aid in understanding what support services our healthcare system can provide to help improve quality of life for patients.

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41: Cancer pain and the link to mental tasks and physical activities Sara Moazzami;1 Jerry Bounsanga;2 Jungweon Park;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah Purpose Although cancer is associated with pain, how that correlates with mental and physical activity is an area that is not fully explored. The intention of this study is to quantify the impact cancer has on mental and physical activities.

Methods This research study utilized public data gathered from 1,178 participants from the 2016 Medical Expenditure Panel Survey. One-Way ANOVA and Independent sample t-tests were used to address the research questions.

Results Both mental tasks and physical activities were affected by cancer (p<0.05). The higher the can pain level, the more negative effect that it has on oneâ&#x20AC;&#x2122;s physical and mental health (p<0.05). There were differential effects of cancer pain on mental tasks across races. Specifically, for individuals whose mental tasks were affected by cancer, American Indians had the lowest pain tolerance level (at 9 on a scale of 0 to 10 with 10 being the highest pain level possible, and Asians had the highest pain tolerance level (at 2 on a scale of 0 to 10).

Conclusions We need to pay attention when caring for cancer patients from different racial and ethnic background.

This study can potentially affect how we address the impact of pain on cancer patients.

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42: Perception of health issues from tobacco and e-cigarette consumption across genders Jungweon Park;1 Eric Hon;2 Sara Moazzami;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Chicago Purpose This study aimed to identify the perception of different health issues related to tobacco and e-cigarette usage across gender.

Methods This research used data from the 2015-2016 Population Assessment of Health Study from the National Institute on Drug Abuse. Statistical analyses were conducted using chi-square tests to examine perception of health issues arising from tobacco and e-cigarette consumption across genders.

Results A total of 28,148 cases were included in this study. Most people (65.53%) strongly believe conventional cigarettes can cause mouth cancer, while most people (55.72%) do not believe e-cigarettes can cause health problems. Females believe (1) it is harder to stop smoking tobacco products; (2) that tobacco products control them; (3) their urge to use e-cigarettes is out of control; (4) it is harder to quit using tobacco products; and (5) smoking can cause mouth cancer. More males do not believe (1) smoking tobacco products help them think better; and (2) deny e-cigarettes can cause health problems. All of these findings were statistically significant at p<0.05.

Conclusions This study demonstrated men and women perceive tobacco and e-cigarette-related health issues differently. Despite the fact that more females believe usage of tobacco products is hard to quit and it can also cause mouth cancer, most people do not believe e-cigarettes can cause health issues. This study can help strengthen e-cigarette policy to regulate and determine how future regulations might affect user profile and perception especially in its usage, marketing, and distribution. Different educational intervention may be needed for males versus females.

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43: Effect of psychological distress on physical and mental health outcomes of cancer survivors Jungweon Park;1 Jerry Bounsanga;2 Sara Moazzami;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah Purpose This study investigated the effect of cancer survivorsâ&#x20AC;&#x2122; concern about cancer recurrence and medical bill payment on their physical and mental health.

Methods Data from the 2016 Medical Expenditure Panel Survey were utilized in this research. ANOVA, multiple linear regression, and chi-squared tests were used to examine the physical and mental health of cancer survivors from their concerns of recurrence and medical bill payment.

Results There was a total of 2,241 cancer survivors included in this study, with an average of 64 years old (standard deviation = 14 years), 82% Caucasian, 14% Hispanic, and 60% females. For cancer survivors who worried about cancer recurrence, their mental health (p<0.05) and physical health (p<0.05) were substantially worse than those who did not worry about recurrence. Additionally, those who did not worry about medical bills had better mental health (p<0.05) and physical health (p<0.05).

Conclusions This study can help understand cancer survivors in regaining or maintaining a good quality of life during their recession period. Efforts are needed to minimize cancer survivorsâ&#x20AC;&#x2122; psychological distress from worries of recurrence and medical bills.

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44: Quality of life in cancer patients with asthma Jungweon Park;1 Jerry Bounsanga;2 Sara Moazzami;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah Purpose This study aimed to compare the quality of life in patients with and without asthma.

Methods This study used data from the 2016 Medical Expenditure Panel Survey and included all individuals who had cancer. Logistic Regression, chi-square test, and independent sample t-test were used to examine the quality of life in individuals who had cancer and diagnosed with or without asthma.

Results From the respondents (n = 2,262) that had cancer, 11.7% was identified as having or has had asthma.

Average age was 58 years (SD = 16) and 75% were females. Majority of those who had cancer and asthma (55%), have been diagnosed with breast cancer or other types of cancer. There was 1.3 times more chance of suffering with cancer in individuals who had asthma comparing to those who did not have asthma (crude Odds Ratio = 1.33; 95% CI = 1.13 - 1.56; p <0.05). Cancer patients without asthma had significantly better physical health, mental health and quality of life than those with asthma (p <0.05).

Cancer patients with asthma also showed higher pain levels than those without asthma p <0.05).

Conclusions This large nationally representative study demonstrated that having asthma can greatly decrease cancer patientsâ&#x20AC;&#x2122; quality of life. More attention is needed to alleviate asthma.

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45: Is caffeine a risk factor for cancer?

Sharon Su;1 Jerry Bounsanga;2 Martin Lipsky;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah Purpose Caffeine is a central nervous system stimulant that is found naturally in several foods and artificially added to many drinks and snacks. With its ubiquitous presence in the American diet, even a small risk from caffeine intake raises health concerns. For cancer, most previous studies exploring a link between caffeine and cancer either looked solely at coffee consumption or restricted their analyses to limited types of cancers. This study sought to evaluate whether there is an association with dietary caffeine intake and the risk of developing cancer.

Methods This study used data from the 2015-2016 National Health and Nutritional Examination Survey. Statistical analyses were conducted using ANOVA, logistic regression, Pearson correlation, and independent samples.

Results There was a total of 549 respondents, with 51% females. Although respondents with cancer had a higher average caffeine intake compared to those without cancer, there was not a significant difference of caffeine intake between cancer and non-cancer respondents (p>0.05). There was also not a significant effect of caffeine on cancer after controlling for demographics, poverty ratio, marital status, dietary intake, BMI, health conditions, and smoking status (p>0.05). Generally, female cancer respondents consumed more caffeine on average compared to males (p<0.05).

Conclusions This study demonstrated that caffeine consumption has no effect on cancer.

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46: Peer influences on teenagers’ usage of e-cigarettes Sharon Su;1 Eric Hon;2 Martin Lipsky;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Chicago Purpose In recent years, the increasing popularity of e-cigarettes among teens and young adults in the US has led to a so-called e-cigarette “epidemic”. With the rise of e-cigarette popularity and usage and its potential for negatively impacting health, this study sought to examine peer influences on teenagers’ usage of ecigarettes. Understanding these influences should give helpful insights into curbing E-cigarette use.

Methods This study used data obtained from the 2018 Population Assessment of Tobacco and Health of Youth from the National Institute on Drug Abuse. Statistical analyses were conducted using descriptive statistics, chi-square tests, and independent samples t-tests to examine peer influences on e-cigarette use by teenagers.

Results The sample consisted 11,736 subjects. Of which, 51.8% were boys and 48.2% were girls, and 67.7% of the study group were Caucasian, 16.0% Black, and 16.3% of other races. There were 30.1% Hispanic and 69.9% Non-Hispanic. Among current e-cigarette teenage users, 20% were from 12 to 14 years old and 80% were from 15 to 17 years old. Teenagers who identified having best friends who used e-cigarettes, smoked cigarettes, smoked traditional cigars, smoked filtered cigarettes, and/or used smokeless tobacco were more likely to be e-cigarette users (all p<0.05).

Conclusions This study found that teenagers with best friends who used tobacco products were more likely to use ecigarettes, highlighting the importance of peer influences on teenagers. Future research examining and confirming this find and identifying other factors that contribute to teenage usage of e-cigarettes is needed with the continuing rise of e-cigarette popularity and usage across the nation.

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47: Secondhand smoke and cancer Sharon Su;1 Jerry Bounsanga;2 Martin Lipsky;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah Purpose The link between tobacco use and cancer is well documented. Less established is the effect of secondhand smoke on the risk of cancer. With millions of individuals exposed to secondhand smoke, it is important to understand the impact of secondhand smoke on cancer risk. Using a national database, this study sought to explore the effect of secondhand smoke on cancer.

Methods This study used data from the 2015-2016 National Health and Nutritional Examination Survey. Statistical analyses were conducted using chi-square tests to examine the relationship of secondhand smoke and cancer.

Results The analysis yielded a significant association between secondhand smoke and cancer (p<0.05). The study also found that men were more likely to be exposed to secondhand smoke than females in all studied settings (car, job, home, other) with the exception of restaurants and bars. Individuals with prostate cancer exhibited the greatest exposure to secondhand smoke. There was no difference in smoking exposure between cancer survivors who had and did not have asthma (p>0.05).

Conclusions Our findings revealed a significant association with exposure to secondhand smoke and cancer. The findings add to the body of literature that indicate a potential benefit from developing strategies and strengthening smoking policies with the goal of decreasing secondhand smoke exposures.

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48: Nutrient intakes of those who have had cancer Clara Ashton;1 Eric Hon;2 Tyler Rose;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Pharmacy 2 University of Chicago Purpose This study aimed to determine differences in the nutrient intakes of those who have had cancer compared to those who have not.

Methods Data were pulled from the 2015-2016 National Health and Nutrition Examination Survey that included 5,714 men and women who were at least 20 years old (y.o.) who either had or had not ever been told they had a cancer or malignancy. Multi-variable regression, chi-square, and independent samples t-tests were used to analyze the data.

Results Individuals who had ever been diagnosed with cancer accounted for 10% of the total sample. The mean age of individuals in the sample was 50 y.o. (SD = 18). The mean age of those without cancer was 47 y.o., and the mean age of those who had cancer was 67 y.o. (95% CI: 17.4 â&#x20AC;&#x201C; 20.4, p<0.05). The proportions of people with and without cancer were significantly different across race/ethnicity (Pearson Chi-Square = 227.0, p is less than 0.05). Of 21 vitamins and minerals, only vitamin D, calcium, and zinc were found to have statistically significant differences in intake between cancer patients and individuals without cancer. Specifically, those who had cancer had an average daily vitamin D intake of 47 mcg compared to 35 mcg for those without cancer of (95% CI: 2.45 - 21.72, p<0.05); those who had cancer had an average daily calcium level of 404 mg compared to 300 mg for those without cancer (95% CI: 57.14 â&#x20AC;&#x201C; 152.17, p<0.05); and, those who had cancer had an average daily zinc level of 17 mg compared to 12 mg for those without cancer (95% CI: 2.05 â&#x20AC;&#x201C; 6.41, p<0.05). After controlling for age and race/ethnicity in a regression analysis, there were no statistically significant differences in the intakes of vitamin D, calcium, or zinc in patients who had cancer (p<0.05).

Conclusions No differences in the intakes of 18 of 21 vitamin and minerals were observed between those who had ever been diagnosed with cancer and those who had not. After controlling for age and race/ethnicity, there were also no significant differences in the intakes of vitamin D, calcium, or zinc. The greater average age of those who had cancer likely explains why vitamin D and calcium were used at higher rates than for those without cancer, as these supplements are commonly used to prevent bone loss in older adults.

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49: Smoking, oral health, and the risk of cancer Sara Moazzami;1 Jerry Bounsanga;2 Jungweon Park;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine 2 University of Utah Purpose This study aimed to understand oral health and the risk of cancer in individuals with or without smoking.

Methods This study used the 2015-2016 data from the National Health and Nutritional Examination Survey.

Logistic regression and chi square tests were used to analyze the data gathered from 549 respondents to understand the impact educational level, race, smoking, and oral cancer exams had on the risk of cancer.

Results In general, those cancer patients who had completed college degree had the least proportion who smoke.

For non-smokers, whether they had cancer or not, their oral health status was similar. However, for smokers, their oral health was worse if they also had cancer, compared to no cancer (p<0.05). The findings showed that for participants with cancer, there was both a significant difference between oral health for smokers and non-smokers (p<0.05), as well as those that either received or didnâ&#x20AC;&#x2122;t receive an oral cancer exam (p<0.05).

Conclusions Findings from this study may aid government agencies and educational institutions to better make decisions on allocating resources and targeting the right population to help them make better informed decisions regarding their health.

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50: Blood Composition Among Individuals With and Without Cancer Rex Beazer;1 Eric Hon;2 Jerry Bounsanga;2 Man Hung.3 Author Affiliations 1 Roseman University, College of Pharmacy 2 University of Utah 3 Roseman University, College of Dental Medicine Purpose This study aimed to identify differences in blood composition in individuals with and without cancer.

Methods This study used 2015-2016 data from the National Health and Nutrition Examination Survey. All individuals who responded to the question of whether they had been diagnosed with cancer were included in this study. Independent samples t-tests were utilized to examine whether there was a difference in blood composition between those with and without cancer.

Results Of the 5,714 individuals included in this study, 52% were females and approximately 10% were diagnosed with cancer. Individuals with cancer showed increased levels of blood lead, manganese, and glycohemoglobin than those without cancer (All p<0.05).

Conclusions Blood levels of lead, manganese, and glycohemoglobin are increased in patients with cancer. This difference in blood composition may have diagnostic potential.

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51: Association of Adult BMI with Cancer Rex Beazer;1 Jerry Bounsanga;2 Martin Lipsky;3 Evelyn Lauren;2 Man Hung.3 Author Affiliations 1 Roseman University, College of Pharmacy 2 University of Utah 3 Roseman University, College of Dental Medicine Purpose Body fatness has been linked to an increased risk of cancer. A report by the International Agency for Research on Cancer working group, which reviewed over 1,000 epidemiologic studies, concluded that excess body fatness causes cancer of the esophagus (adenocarcinoma), gastric cardia, liver, gallbladder, pancreas, colon and rectum, kidney, thyroid, female breast (postmenopausal), endometrium, ovary, multiple myeloma and meningioma. A recent umbrella review of meta-analyses also found strong evidence of positive associations between body fatness and those cancers. Taken together with plausible biological mechanisms such as systemic and tumor microenvironmental inflammation and immune mediated responses, insulin resistance, insulin-like growth factors (IGFs) and sex hormones pathways, the harmful effect of body fatness on cancer etiology is clear. What is less clear is whether BMI plays a significant role in cancer after adjusting for smoking habits among other factors. This study examined the association between cancer and body mass index adjusting for smoking, general health and social determinants of health.

Methods This study used data from the 2015 â&#x20AC;&#x201C; 2016 National Health and Nutritional Examination Survey.

ANOVA, logistic regression, Chi-Square, Pearson correlation, and independent samples t-test were applied as appropriate to examine the association between cancer and BMI. It represented the first study to explore this link using a large representative national dataset.

Results A total of 549 subjects were included in this study, with 49% males and 60% Whites. Age, general health condition and educational levels significantly impacted the likelihood of having cancer (All p<0.05).

After controlling for age, gender, race/ethnicity, marital status, income, health insurance, general health, and smoking, there was no significant effect of BMI on cancer (p>0.05). Additionally, there was not a significant difference of BMI across the types of cancer (p>0.05). Those with cancer who had lower BMI indicated better general health (p<0.05).

Conclusions This study demonstrates that BMI is not a good indicator of whether an individual will develop cancer, nor increase incidence of a specific type of cancer. Patients with cancer who maintain good nutrition and lower BMI during cancer treatment may experience overall better health.

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52: Exploring Preventative Measure of Skin Cancer Rex Beazer;1 Jerry Bounsanga;2 Martin Lipsky;3 Bianca Ruiz-Negron;3 Man Hung.3 Author Affiliations 1 Roseman University, College of Pharmacy 2 University of Utah 3 Roseman University, College of Dental Medicine Purpose In this study we explored the impact of preventive measures on the incidence of skin cancer.

Methods This study analyzed data from the 2015 â&#x20AC;&#x201C; 2016 National Health and Nutritional Examination Survey.

Logistic regression and Chi-Square were applied where appropriate to explore the relationship between skin cancer and prevention methods. Preventive methods included shade, long-sleeved shirt and sunscreen. Covariates included age, gender, race/ethnicity, marital status, income, health insurance and general health.

Results The sample included a total of 161 participants, with 55.3% males, 87.6% White, and approximately one third had college degree or above. Among the study population, non-melanoma skin cancer was the most prevalent kind of skin cancer. Additionally, males had skin cancer more frequently than females, and were less likely than females to use sunscreen. After controlling for staying in the shade, wearing a longsleeved shirt, age, gender, race/ethnicity, marital status, income, health insurance, and general health, sunscreen usage had a significant inverse association with developing skin cancer (p<0.05). Though the skinâ&#x20AC;&#x2122;s reaction to the sun after non-exposure was correlated with general health, the level of reaction had no impact on skin cancer (p>0.05).

Conclusions Consistent with previous studies, our finding reveal that photo protective measures reduce skin cancer risk. Men are less likely to use sun screen and male oriented educational strategies may be an effective strategy to decrease the incidence of skin cancer in men.

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53: A Comparison of the Epigenetic Marks of Diabetes and Sleep Apnea Nancy Wilson.1 Author Affiliations 1 Brigham Young University, College of Life Sciences Purpose To see if the epigenetic marks of diabetes and sleep apnea shed any light on the co-prevalence of the two conditions Methods Meta-analyisis of published data on epigenetics of diabetes and epigenetics of sleep apnea Results Some of the epigenetic marks in common between the two conditions suggest potential causes for overlapping etiology.

Conclusions Findings are suggestive, but not conclusive; further research needs to be done.

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54: Safer Dental Opioid Prescribing via Peer to Peer Academic Detailing in Utah Adrienne Butterwick;1 Sarah Woolsey;1 David Anderson.2 Author Affiliations 1 Comagine Health, College of Dental Medicine 2 Roseman University, College of Dental Medicine Purpose Utah has ranked within the top 10 in the nation for overdose deaths over the last 10 years, and presently, prescription drug overdoses remain the leading cause of injury in Utah, surpassing deaths due to firearms, motor vehicle crashes and falls. (1) Dental professionals frequently prescribe opioid pain relievers (2,3) and may be missed by public health interventions that typically focus on medical prescribers of opioids.

Methods Recently, Utah mandated the use of the state prescription drug monitoring program (PDMP). To ensure dental providers were updated on best practices and mandates, an academic detailing (AD) intervention was deployed from March - December 2019 through a partnership between Comagine Health, a dental university, and public health. A comprehensive curriculum for AD for dentists was developed and individual and group sessions were conducted with dentists and their support staff. Data were collected via pre, post, and follow-up surveys to evaluate effectiveness of AD sessions, determine changes to prescribing behavior, awareness and usage of resources.

Results As of August 15, 2019, a total of 14 AD sessions have been completed in Utah, Carbon, Weber and Salt Lake Counties with a total of 139 attendees, 37 of which are active prescribing dentists. Of those, 46 consented to participate in the evaluation. The average years licensed was 14.8 years, 60.89% are dental professionals.

Conclusions Results based on preliminary review show an increase in the intent to use the PDMP and a planned reduction of unnecessary opioid prescriptions. Provider self-reported results indicate a 9.1% increase in co-prescribing naloxone and a 20% increase in providers indicating they have an office process in place to check the CSD when prescribing opioids.

Areas also positively impacted (large effect size) include: providerâ&#x20AC;&#x2122;s confidence using the CSD to monitor opioid prescriptions and provider knowledge regarding where to refer patients for help with prescription opioid misuse.

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55: Tactile Learning vs. Virtual Learning in Dentistry Peter Dang;1 David McMillan;1 Lourdes Peralta;1 Evelyn Lauren;1 Rebekah Carleton;1 Inderdeep Kaur;1 Alexa McAneney;1 Brian Hadfield;1 Frank Licari;1 Man Hung.1 Author Affiliations 1 Roseman University, College of Dental Medicine Purpose Tactile learning was compared to virtual learning in a dental histology course. Students were given either actual tooth models or virtual images of tooth models to complete two learning activities. Their levels of engagement and comprehension were assessed.

Methods One hundred first-year dental students were divided into twenty teams of five students. Teams were then divided into Group A and Group B. For the first lecture breakout, Group A teams were given five actual tooth models and Group B teams were given online access to five virtual images of tooth models. Both groups completed the same learning exercise followed by a formative assessment (quiz). For the second lecture breakout, Group A was given online access to five images of tooth models and Group B was given five actual tooth models. Both groups completed the same learning exercise and formative assessment followed by a survey to assess studentsâ&#x20AC;&#x2122; learning preferences.

Results Results showed that there was no significant difference between student engagement (p>0.05) and learning comprehension (p>0.05) between Groups A and B. More students preferred learning with images of tooth models (51%) than the actual tooth models (38%) and 11% preferred both the images and actual models.

Conclusions This study suggests that learning activities involving the handling an actual object versus manipulating a virtual image of an object on a screen produce similar outcomes in student engagement and comprehension. More research needs to be conducted to determine when providing tangible objects as teaching aids is worth the cost and preparation time.

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56: Making The Connection in Nursing School Natalie Maughan.1 Author Affiliations 1 Roseman University, College of Nursing Purpose Creating an environment of safe and effective care through real life experiences. Preventing nurse complications and errors by gaining hangs on experience utilizing senior students and others as volunteers. Our primary purpose is to have skills performed by the students safely and effectively.

Methods A qualitative chart review will be presented to show course outcomes and how students did on skills assessments the first time. Dates of evaluation will be from July 2018 - October 2019.

Results Pass or No pass first time results on skills assessments and research is still in progress.

Conclusions Students are meeting the six-point mastery model by integrating active learning, performing competencybased education, passing assessments, starting in their second block with experiential learning in an atmosphere of close proximity.

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57: Retrospective analysis of claims utilization data of medications indicated to treat osteoporosis in the Medicare Part D population Kyle Knudsen;1 S. Russell Spjut;2 Julia Jarmoszko.2 Author Affiliations 1 Roseman University, College of Pharmacy 2 MagellanRx Management Purpose To determine if the percentage of all osteoporosis medication claims, in proportion to total overall claims, has changed in the Medicare Part D population from 2012-2017. Secondarily, to determine if any trend seen is consistent in both the oral and injectable osteoporosis medication.

Methods The information that was reviewed was publicly available data that contained all pharmacy claims for the Medicare Part D population between the years 2012 and 2017. The percent of overall Medicare Part D claims that osteoporosis medications accounted for each year was then calculated. The medications were then grouped by active ingredient and were separated into oral only (alendronate, raloxifene and risedronate), injectable only (denosumab, teriparatide and zoledronic acid), and oral/injectable (ibandronate). The utilization of each of these groups, as a percent of total osteoporosis claims and percent of total Medicare Part D prescription claims, was then calculated as well.

Results The data showed a decrease in osteoporosis medication claims each year of the 6 years, as compared to total Medicare Part D prescription claims. In 2012, osteoporosis medication claims accounted for 1.092% of all Medicare Part D prescription claims, this decreased to 0.683% by the year 2017. This amounts to a decrease of 37.5% over this 6-year span. For our secondary outcome, we were able to see that oral medications decreased by 2.7% over the 6-year span, while injectables increased by 117.2%.

Conclusions The decrease in total claims for osteoporosis medications, as a percent of all claims in the Medicare Part D population, seems to confirm data seen in other studies regarding the utilization of drugs to treat osteoporosis. The study was limited by the amount of information available and additional research is needed to determine if the decrease in osteoporosis claims over this time period is consistent across all Medicare benefits and to determine what the decrease can be attributed to.

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58: Low Back Compression Force Differences Using Various Side Sheets: Preliminary Results Robert Larson;1 Ulrike Mitchell.1 Author Affiliations 1 Brigham Young University, Exercise Science Purpose Due to the high rate of musculoskeletal injury among healthcare workers, it is vital to the longevity of these professionals to choose safe methods of handling patients. One way to reduce the risk of musculoskeletal injury when performing patient handling tasks is to utilize friction reducing materials.

These lower the amount of stress placed on the healthcare workerâ&#x20AC;&#x2122;s body. This study investigated the effects of 3 different transfer devices upon low back forces while performing the task of boosting a patient up in bed. The devices used were a standard cotton sheet, a Skil-Care Super Sling 4 Handle Transfer Pad, and an Airpal air assisted device.

Methods Participants being recruited are healthcare workers between the ages of 18-65. Data is being collected at Brigham Young University via a 3 dimensional movement analysis system along with in ground force plates to collect ground reaction forces. These forces will be used to estimate low back forces with the University of Michiganâ&#x20AC;&#x2122;s 3DSSPP computer program. This study was approved by the IRB from BYU and data collection is set to conclude by the end of January.

Results A repeated measures design will be employed to analyze the data. Currently there is not sufficient data to make comparisons between participants. However, the cotton sheet resulted in an average of 1667 N of compressive force at the L5/S1 joint and 2679 N at the L4/L5 joint while the Skil-Care Super Sling 4 Handle Transfer Pad resulted in 1640 N of force at L5/S1 and 2632 N at L4/L5 with the Airpal air assisted device resulting in the lowest compression force with 1021 N at the L5/S1 joint and 2356 N at L4/L5.

Conclusions This study shows that healthcare workers choosing to use friction reducing slide sheets when engaging in patient handling tasks can potentially reduce the stress placed on their bodies. The current results are inconclusive due to the small sample size, as this is an ongoing project.

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59: Retrospective Observational Changes to Mandibular Bone and surrounding Tooth Socket of the lower Central Incisor following Root Canal Procedure Kaiwi Chung-Hoon;1 Chris Crawford;2 Rick Leishman;2 Andrea Ashley.2 Author Affiliations 1 Rocky Mountain University of Health Professions, Physical Therapy 2 Crawford/Leishman Dental Group, Private Clinic Purpose Background/Purpose: A male in his early 50â&#x20AC;&#x2122;s presented with a prior history of root canal to lower central incisor. The purpose is to characterize retrospectively, observational changes to mandibular bone and the surrounding tooth socket of the lower central incisor following a second root canal therapy (RCT), delayed healing and cavitation and subsequent external force application to the central incisor and mandibular bone.

Methods Methods: Two attending medical practitioners (Doctors of Dentistry Surgery) collaborated on the patientâ&#x20AC;&#x2122;s prior history of root canal procedure to the lower central incisor and presented with demineralization to the bone tooth socket in the mandible and a piece of a broken drill bit left within the tooth cavity following radiologic imaging. Patient was referred to endodontist for a second RCT and bit extraction. A cavitation or sulcus in the mandible and tooth socket developed over time following RCT and identified via radiological imaging. The sulcus was monitored over the course of three years via biannual dental checkups. Attending DDS clinical concerns were the lack of healing to the tooth socket and mandible and potential compromised stability of adjacent teeth. Subsequently, the patient (a practicing physical therapist) began applying external forces (Grade III to IV Maitland approach) directed in a superior to inferior (compressional) to the central incisor and anterior to posterior (sheer) to the central mandible three times per day for one-minute bouts in each direction. Changes to the mandibular tooth socket were observed over the course of time resulting in tissue healing to the tooth socket and mandibular bone.

Results Results: This retrospective case report characterizes a unique change observed to the mandibular bone and tooth socket when external forces were applied to the central incisor and mandible respectively.

Though the generalizability of these findings are limited, further investigation is warranted to determine whether conservative treatment methods such as externally applied forces may be beneficial to patients with compromised mandibular bone and tooth socket deterioration.

Conclusions Though the generalizability of these findings are limited, further investigation is warranted to determine whether conservative treatment methods such as externally applied forces may be beneficial to patients with compromised mandibular bone and tooth socket deterioration.

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60: Comparative Study of Two Different Tooth Restorative and Finishing/Polishing Techniques, and the Post-Restorative Impact Brooke; Roberto Wilder-Corrigan; Lara;1 David Howard;1 Claudia Freitas;1 Katherine Velasco.1 Author Affiliations 1 Roseman University, College of Dental Medicine Purpose This study seeks to find a significant difference in the use of modern and traditional composite restorative dentistry and the impact that rotary instruments have on composite during the finishing and polishing phases. Our hypothesis is that traditional restorative dentistry using the GV Black prep and incremental technique leads to easily compromised tensile joints along restoration margins, and voids or defects between layers that can easily be fractured during finishing and polishing. Restorative flaws such as tension or voids can further compromise the tooth by creating small spaces for bacterial-recolonization, which may lead to recurrent restorations of the same tooth. Modern composite restorative dentistry, however, uses a monolithic injection molding technique that results in compression joints, and few if any, voids or defects between polymerized layers. The main goals of this study are to have a clear vision about restoration techniques, the impact of rotary instruments on restorations, and the longevity, functionality and aesthetics of these restorations after having undergone different finishing and polishing techniques.

Methods Extracted human molars were evaluated microscopically after treatment with traditional and modern composite restorative techniques coupled with different finishing and polishing materials. Micro-CT scanning records were collected in order to observe any significant differences in fractures, voids or bacterial recolonization between each experimental group.

Results Our preliminary data suggests that the traditional restoration technique shows multiple voids in restorations after using carbide burs versus diamonds burs for the finishing/polishing phases, which might be reflected in a high rate of recurrent caries and bacterial infections within dentinal tubules.

Conclusions The integrity of composite changes with the use of different finishing and polishing techniques, specifically during the use of traditional restorative dentistry. In order to confirm this finding, we used Micro-CT scanning to analyze molars treated with traditional and modern composite restoration techniques. These findings may aid improved restorative techniques and patient outcomes.

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61: Dispensing omalizumab: to syringe or not to syringe?

Jason Walker;1 Borgny Gerth;2 Michael Rowlett;1 Danielle Gundrum.2 Author Affiliations 1 Intermountain Healthcare, College of Pharmacy 2 Roseman University, College of Pharmacy Purpose Asthma patients sensitive to aeroallergens that cannot maintain symptoms with prescription inhalers utilize omalizumab for immunotherapy to obtain asthma control. With few outlets for appropriate management of care, it is important to look at cost saving resources to alleviate the expense of therapy.

Vials of omalizumab are available in 150mg increments, yet patientâ&#x20AC;&#x2122;s doses are not always easily divisible by 150mg increments, leading to higher cost and waste. Pre-prepared syringes are available from a local supplier in 75mg and 150mg increments. This project was designed to investigate whether these pre-prepared syringes would reduce medication cost and waste associated with omalizumab.

Methods Physician orders of omalizumab sent to the pharmacy were reviewed by infusion clinic pharmacists.

These prescriptions were evaluated for appropriate indication, dose, route, and frequency according to clinical standards and individual patient characteristics. The pharmacist then entered the appropriate order into the patientâ&#x20AC;&#x2122;s electronic medical record and appropriately dispensed the product when necessary.

Omalizumab doses (in milligrams) dispensed between June 1 through July 31, 2019 were documented into a de-identified table that was only accessible to project participants. These data points were then analyzed to evaluate the cost of dispensing each dose with the use of reconstituted vials or the use of preprepared syringes. Waste in milligrams was also analyzed. This study did not include any protected health information and did not require IRB approval.

Results Dosing increments from the 44 encounters included doses of 150mg (16%), 225mg (16%), 300mg (39%), and 375mg (29%). Cost per dose was calculated with each dosing group for both vials and syringes. Both 150mg and 300mg dosing groups did not benefit from switching to pre-prepared omalizumab syringes but 225mg and 375mg dosing groups had a larger savings than the deficit of 150mg and 300mg groups.

Overall, dispensing pre-prepared omalizumab syringes saved $5,794.62 (5%) in the 2 month sample period, resulting in a yearly savings of $34,767.72 when compared to dispensing reconstituted omalizumab vials. Additionally, dispensing pre-prepared syringes decreased drug waste, with a yearly cost savings estimated to be $61,349.40 (9,000mg).

Conclusions While switching to pre-prepared syringes does not decrease cost on every patientâ&#x20AC;&#x2122;s dose (150mg and 300mg), the overall savings for the sample population and the hospital is benefited by the change. This change would also have a positive impact on the amount of wasted drug from approximately 45% of doses dispensed from the infusion clinic.

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62: Discontinuation of pre-pharmacy checklists: assessing patient wait times Chase Daybell;1 Michael Edwards;1 Alice Reid;2 Danielle Gundrum;1 Kelsey Brown.2 Author Affiliations 1 Roseman University, College of Pharmacy 2 Intermountain Healthcare Purpose Patient wait time to the start of infusion is an important patient satisfaction measure in an outpatient infusion center setting. Our outpatient infusion pharmacy has implemented numerous workflow modifications, with both nursing and pharmacy staff, since October 2018 in attempt to decrease overall wait times to appease patients while still keeping safety a priority. This project was designed to determine if wait times decreased after a policy went into effect of discontinuing pre-therapy nursing checklists for nivolumab and pembrolizumab therapy.

Methods Per hospital policy, the use of pre-therapy nursing checklists to review medication toxicities for nivolumab and pembrolizumab was discontinued. This was placed into effect after nursing complaints prompted pharmacy management to evaluate their processes, at which it was deemed these checklists were not a manufacturer requirement prior to dosing. These checklists were time intensive for both patients and nurses, as the checklist for nivolumab has 54 questions and the checklist for pembrolizumab has 53 questions. A pharmacy technician from the clinic collected data points in real time on a deidentified spreadsheet. Data points included the patient check in time, medication name, time a medication label was given to the pharmacy technician for preparation, and month of medication preparation. The data was compared from 16 infusions in the two months prior to the new policy versus 18 infusions after policy implementation. This data was then condensed and analyzed by pharmacists and pharmacist interns from the clinic. This project was a quality improvement project and qualified for IRB exemption.

Results The cessation of pre-therapy checklists resulted in significantly lower time to start of medication preparation. Wait time dropped from an average of 55.8 to 29.1 minutes, which is a 47.8% decrease.

There are confounding variables that need to be considered, including nurse staffing and clinic scheduling. Another variable includes whether labs were drawn and reported before the infusion appointment. Most importantly, the variable of whether orders were received prior to the appointment must be considered. If orders were received prior, the pharmacist first and second anti-cancer agent safety checks were able to occur before the patient arrived. If not, this could have significantly delayed time to giving labels to the technician for preparation.

Conclusions The discontinuation of pre-therapy checklists for nivolumab and pembrolizumab therapies decreased patient wait time to start of medication preparation by 47.8%. This has most likely increased patient satisfaction with their infusion experience, as well as decreased nursing workload. Further policies should be put in place to continually improve patient experience. Of note, the clinic is currently attempting to work with oncologists to have anti-cancer therapy orders placed the day before infusion. Evaluation of wait times after implementation of this policy will be an important indicator of continual clinic improvement in regard to patient satisfaction.

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63: A Simple Phone Call: Community Pharmacist Led Intervention at a Large Community Pharmacy Chain to Promote Antidepressant Adherence Andrea Do.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose While depression is extremely responsive to antidepressant therapy, benefits can only be seen when patients are adherent to the medication. Patients who are non-adherent during the first six weeks of treatment are at an even increased risk of poor outcomes. This study aims to establish the importance of a community pharmacist as part of the mental health care team by determining if follow-up by a community pharmacist after pick-up of a new antidepressant medication has an impact on medication adherence. The second objective is to determine the feasibility of this service being offered in a large chain community pharmacy by identifying barriers to implementation and patient participation.

Methods Study subjects will be patients 18 years or older identified as receiving a truly new antidepressant medication, defined as a medication that the patient has not taken within the past year. Medications included are selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and bupropion. At point of sale in six pharmacies in one regional division of a large community pharmacy chain, pharmacists will identify patients who are picking up a truly new antidepressant medication. Their information will be sent to the primary investigator who will create interventions in the pharmacy computer system. Pharmacists will be notified at days 5, 25, and 55 to call the patient and provide education to the patient via phone call. The phone calls will provide the patients with medication education, with a focus on unwanted side effects in the first 2 weeks of treatment and that it can take up to 8 weeks for patients to experience the full benefit of the medication. Control arm patients will be selected from the same pharmacies but will receive no additional contact from pharmacists after the medication is picked up. At day 70 after pick-up, fill history will determine adherence and continuation of therapy. In order to standardize the pharmacist intervention, all participating pharmacists will receive training in the form of a live training delivered by the primary investigator and will follow a script when talking to patients.

Results After completion of this study, it is expected that the patients enrolled in the pharmacist intervention group will have greater adherence at the 70-day mark and will continue to take the medication beyond the 70-day mark as compared to the control group. It is also expected that after this study patients will have a greater understanding and appreciation of the pharmacistâ&#x20AC;&#x2122;s role on their mental health care team.

Conclusions It is anticipated that pharmacist follow-up after initiating antidepressant therapy will have a positive impact on adherence.

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64: Cost savings analysis of oral vs. intravenous diphenhydramine for premedication of intravenous therapy in an outpatient setting Michael Rowlett;1 Allison Snoke;2 Borgny Gerth;1 Jason Walker;1 Danielle Gundrum.1 Author Affiliations 1 Roseman University, College of Pharmacy 2 Intermountain Healthcare Purpose Diphenhydramine is a premedication recommended prior to certain chemotherapy and monoclonal antibody therapies to prevent infusion-related reactions. An outpatient infusion clinic previously prepared diphenhydramine by diluting drug into an intravenous (IV) bag for infusion. Diphenhydramine can be administered orally as a premedication at a lesser cost; therefore, this project evaluated the cost savings associated with its use and whether switching patients from intravenous to oral would generate additional savings for an outpatient infusion clinic.

Methods This was a retrospective cost savings evaluation of transitioning from IV to oral diphenhydramine in an outpatient infusion clinic. The prescribing physician sent patient-specific diphenhydramine premedication orders to the infusion clinic. Pharmacists reviewed the orders and determined its appropriateness based on published standards and enters the order into the electronic medical record. Diphenhydramine doses administered in the infusion clinic from 6/1/19 to 7/31/19 were recorded on a de-identified spreadsheet.

The following data were collected: prescribed dose (mg), route (PO/IV), IV infusion bag volume, infusion rate, the medication diphenhydramine is pre-medicating, and cost to the institution.

Results A total of 160 doses of diphenhydramine were recorded during the project period. Oral doses represented 67% (107) and 34% (53) were IV. The total cost of combined oral and IV dosage forms was $150.35, with oral doses accounting for $1.65 and IV accounting for $148.70. If all doses were switched to oral, the total cost to the institution would be $2.92, a savings of over 98% ($147.43). The potential annual cost savings can be projected to a total of $884.58. Further investigation is required to assess the necessity of IV vs. oral premedication for each individual medication the diphenhydramine is pre-medicating.

Conclusions There is a significant cost savings to an outpatient infusion clinic by switching diphenhydramine premedications from IV to oral formulations. This project will help the infusion clinic make continued optimization improvements that will streamline workflow, reduce cost of care and ultimately pass on savings to the patient.

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65: Cost analysis of medication vial size selection for sterile compounded products in an infusion Dina Valle;1 David Jackson;1 Kelsey Brown;2 Danielle Gundrum.1 Author Affiliations 1 Roseman University, College of Pharmacy 2 Intermountain Healthcare Purpose Infusion clinic pharmacy technicians prepare sterile medications in the outpatient infusion center. Due to high volume of medication requests, technicians attempt to prepare medications as efficiently as possible without compromising sterility. Therefore, technicians will request medications to be entered into the electronic medical record with the fewest vials needed. The purpose of this project was to evaluate the cost changes when products are made with different vial size combinations.

Methods Seventeen medications were identified and evaluated based upon, multiple vial size availability and incidence of pharmacy technician-requested order entry changes. This process improvement project recorded de-identified medication doses admixed in an outpatient infusion clinic from July 2, 2019 to August 21, 2019 using a prepared tracking sheet. Collected information included: preparation date, medication name and medication dose, original order entry vial size combination and cost, technicianrequested order entry vial size combination and cost. Descriptive statistics were used to calculate the cost difference by subtracting the cost of the original order entry vial size combination from the cost of technician-requested order entry vial size combination. This project did not include any protected health information and did not require institutional review board (IRB) approval.

Results A total of 97 medication doses were evaluated. Of the 97 doses, a total of 44 doses increased cost to pharmacy $7,449.50 when the technician requested a different order entry vial size combination. A total of 25 orders decreased the cost to pharmacy $4,875.46 when the technician requested a different order entry vial size combination. A total of 28 doses showed no cost changes for pharmacy when the technician requested a different order entry vial size combination. In total, technician-requested order entry vial size combinations increased cost to pharmacy by $2,574.04 over a 50-day period. This can be extrapolated to $18,018 increased pharmacy costs annually. On average, dexamethasone, immunoglobulin, diphenhydramine, rituximab, ondansetron, and omalizumab increased pharmacy cost when the technician requested a change in the vial size combination entered into the electronic medical record. On average, iron sucrose and leucovorin decreased pharmacy cost when the technician requested a change in the vial size combination entered into the electronic medical record.

Conclusions Before the results of this process improvement project, it was believed compounding sterile products using the fewest number of vials would reduce overall cost. Although this is true for some sterile compounds, this project demonstrated vial size selection is critical to evaluate for additional cost savings.

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66: Patient satisfaction after adjustable acuity implementation: a four month retrospective comparison Pooja Shah;1 Scott Shipley;1 Jeff Kolb;1 Philip Harvey;1 Spencer Smith.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Implementation of adjustable acuity in a hospital setting aims to minimize patient movement throughout the hospital by adjusting nursing ratios around patient acuity. By minimizing patient movement there is potential to increase patient satisfaction, increase communication between staff, and decrease adverse medical events. The aim of this study was to evaluate the difference in patient satisfaction following implementation of adjustable acuity on adult medical units throughout the hospital.

Methods Data was gathered from Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys from four months prior to implementation of adjustable acuity (September 2018 to December 2018) and four months post implementation (February 2019 to May 2019). Medical oncology, medical surgical, and progressive care units were included in the transition to adjustable acuity while intensive care and pediatric units were excluded. Chi squared statistics were performed using SPSS v. 25 to compare survey questions regarding nursing, physician, and medication communications between pre and post implementation periods. Each unit was individually compared pre-implementation vs. postimplementation, as well as a composite of all three units pre-implementation and post-implementation of adjustable acuity for all three sections of the HCAHPS survey.

Results With the transition from a progressive care unit to an adjustable acuity unit, Nursing Communication HCAHPS scores were unaffected on the medical surgery floor and the medical oncology floor. For the progressive care unit, HCAHPS scores regarding nurses treating patients with respect and nurses listening carefully to patients decreased (92.6% to 81.6%, p-Value=0.042; 82.1% to 65.6%, p-Value=0.016 respectively). Communication about Medication HCAHPS scores followed a similar trend with the medical surgery floor and the medical oncology floor being largely unaffected, while the progressive care unit scores decreased for communication regarding what a medication was for and its potential side effects (87.5% to 68.8%, p-Value=0.033; 63.1% to 35.8%, p-Value=0.004 respectively). Although communication with physicians was included in the analysis, there were no statistically significant changes in HCAHPS scores.

Conclusions The adjustable acuity model has been implemented with a goal of increased patient satisfaction and safety. The review of HCAHPS data shows overall the transition did not affect the general medicine floors, but negatively affected the progressive care unit. Education and feedback from nurses and patients allow the hospital to identify gaps in satisfaction. Reasoning behind the decreased scores in the progressive care units may be caused by nursing staff not being used to the 5:1 ratio, increased level of acuity, lack of disease state familiarity in cases of overflow, and high levels of responsibility due to restructuring of hospital.

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67: Impact of iMobile implementation on patient satisfaction Hong Phuong Tran;1 Leila Khurshid;1 Scott Shipley.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are used to assess patient’s satisfaction of hospital care. HCAHPS scores directly impact a healthcare organization’s reputation. This research project aims to compare HCAHPS scores before and after implementation of iMobile. iMobile is a new secure smartphone app that has recently been used at St. Mark’s Hospital – a 314-bed trauma II community hospital. iMobile may improve patient-centered care in many ways: more efficient communication between healthcare providers, faster delivery of care leading to rapid resolution, and finally avoiding multiple calls and leaving messages (“phone tag”).

Methods The study collected HCAHPS score 6 months before switching to the iMobile (May 31st, 2018-December 1st, 2018), and again 6 months after the switching to iMobile (January 1st, 2019-June 30th, 2019). Data collecting includes the response to these following subjects: Overall hospital rating; Response of hospital staff ("Call button help as soon as patients wanted", "Toileting help as soon as patients wanted"); Communication with nurses ("Nurses treat patients with courtesy/respect", "Nurses listen carefully to patients"; Communication with doctors ("Doctors treat patients with courtesy/respect", "Doctors listen carefully to patients").

Results This research project yielded the following results: 69.8% from pre-implementation and 69.4% from postimplementation rated 9 to 10 for their stay at St. Marks’ Hospital. 62.1% from pre-implementation and 57.1% from post-implementation stated they always got help as soon as they pressed the call button.

72.9% from pre-implementation and 70.1% from post-implementation stated they always got toileting help as soon as they wanted. 85% from pre-implementation, and 83.1% from post-implementation stated nurses always treated them with courtesy and respect. 73.2% from pre-implementation and 71.4% from post-implementation stated nurses always listen to them carefully. 87.3% from pre-implementation and 85.1% from post-implementation stated doctors always treated them with courtesy and respect. 78% from pre-implementation and 76.6% from post-implementation stated doctors always listen to them carefully.

Conclusions Implementation of iMobile did not appear to impact patient satisfaction based on HCAPHS scores at St. Marks’ Hospital significantly. However, some studies demonstrated that healthcare professionals prefer using secure application for smartphones over the conventional method (such as paging). The implementation of iMobile provides an overall improvement in patient care.

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68: Community pharmacistsâ&#x20AC;&#x2122; perspective to confidently dispense and counsel patients on oral chemotherapy with consideration to years of experience and average time spent counseling David Jackson;1 Jacqueline Cano-Errecart;1 Joseph Koyle;1 Simon Pence.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose The purpose of this study is to evaluate community pharmacistsâ&#x20AC;&#x2122; perspective to confidently dispense and counsel patients on oral chemotherapy with consideration to years of pharmacy practice experience and average time spent counseling.

Methods A survey was constructed to gather: years of pharmacy practice, the average time spent counseling patients on oral chemotherapy, and numerical scale scores of pharmacist's confidence in their knowledge level to dispense and counsel on oral chemotherapy. Descriptive statistics using linear regression models were used to analyze the data.

Results A total of 83 surveys were completed to entirety. Of those identifying their primary practice site as a community chain or community independent pharmacy [41 (49.4%)], 22 (26.5%) reported dispensing at least one or more oral chemotherapy agents. Pharmacists that counsel patients on oral chemotherapy, 6 (28.6%) reported practicing pharmacy for more than 10 years, 3 (14.3%) for 7-10 years, 4 (19%) for 4-6 years, and 8 (38.1%) for 0-3 years. On a scale of 1-10, 22 community pharmacists reported an average 4.6 confidence level in their knowledge to dispense and counsel patients on oral chemotherapy medications.

Pharmacists that counseled 5 to 10 minutes and with 0 to 3 years of pharmacy practice experience, demonstrated the highest average confidence level of 7.7. Pharmacists that counseled greater than 10 minutes and with greater than 10 years of experience demonstrated the lowest median confidence level of 2.

Conclusions Nearly half of all community-based pharmacists dispense oral chemotherapy medications. This study demonstrates a weak, negative correlation of community pharmacistsâ&#x20AC;&#x2122; perspective to confidently dispense and counsel patients on oral chemotherapy based on years of pharmacy practice and average time spent counseling. These findings may indicate that community pharmacists may become less confident in their ability to confidently dispense and counsel patients in a rapidly changing field of medicine such as oral chemotherapy.

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69: Evaluation of Glycemic Control and Insulin Dosing in Patients with NPO Status David Jackson;1 Dave Kim;1 Justen Hawks;1 Tressa McMorris.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Per American Diabetes Association (ADA) Standards of Care 2019, a scheduled subcutaneous insulin regimen is the preferred method of glycemic control in non-critically ill patients. In patients who are NPO, basal insulin or basal insulin plus correction insulin are the preferred regimens, but dosing strategies in these patients are not addressed. The purpose is to evaluate the effects of basal insulin dose reductions or no reductions in patients who are NPO. Methods This is a prospective data collection, observational study. Patients will be screened daily using Intermountain Healthcare iCentra, according to pre-specified inclusion and exclusion criteria. Patient specific data points will be collected and tracked in a secure, online tracker. The primary outcome is mean daily blood glucose value during NPO status between patients receiving 75-100% of home dose vs. patients receiving <75% of home dose. Secondary outcomes include incidences of glucoses > 180 mg/dL or >299 during NPO status and incidence of hypoglycemia Results In progress Conclusions In progress

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70: Adherence of Tdap administration to ACIP guidelines and its implications on the healthcare system Bryanna Monkurai;1 Phillip Lawrence;1 Katherine Smith.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose The purpose of this study was to identify 1) over administration of the Tdap (tetanus toxoid, diphtheria toxoid and acellular pertussis antigens) vaccine, 2) pharmacists and providersâ&#x20AC;&#x2122; knowledge of Tdap administration guidelines and 3) cost implications of overuse.

Methods 1) Tdap administration data was gathered for the time period of January 1, 2006 to December 31, 2018 from the Utah Statewide Immunization Information System (USIIS) and from Nevadaâ&#x20AC;&#x2122;s WebIZ immunization information system for all adult males aged 18 years and older and all adult females aged 55 years and older. 2) All pharmacists, physicians, physician assistants and nurse practitioners holding an active professional license and practicing in Utah were surveyed via Qualtrics on knowledge of current guidelines regarding Tdap administration. 3) Cost information for Tdap and Td (tetanus and diphtheria toxoid), was collected from pharmacies, wholesalers and published sources.

Results 1) 520,551 records from Utah and 346,219 records from Nevada were included in the analysis. 51,861 (9%) Tdap vaccines were inappropriately administered in Utah and 27,952 (7%) in Nevada. Of the inappropriate vaccines administered, 60% in Utah and 76% in Nevada were administered within less than 5 years of initial vaccination. 2) Responses to the survey were collected between July 23 and August 9 of 2019. 12,594 pharmacists and providers were included in the study. 606 respondents completed survey.

37% pharmacists and 51% providers believe that Tdap has replaced Td. 28% pharmacists and 43% providers always check USIIS prior to vaccination. When presented with a scenario, 73% pharmacists and 82% providers answered it incorrectly. Reported barriers include access to records, access to Td, frequent guideline changes and lack of insurance coverage. 3) Average cost of one Tdap vaccine is $58, approximately $15 more than one Td vaccine (p-value 0.03). Between 2006 and 2018, the inappropriate administration of the Tdap vaccine and its implication on healthcare in Utah alone is estimated to be over $2,000,000.

Conclusions Tdap is being administered more than once to the general population. Additional doses of Tdap generates increased healthcare costs but offers a limited impact on the overall burden of pertussis in the United States.

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71: Monitoring of vitamin B12 in patients using metformin: is it being done in your clinic?

Melissa Moulton;1 Jenny Tran.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Typical first line treatment for Diabetes mellitus type II consists of metformin, due to reduction in risk of lifetime myocardial infarction as well as mortality. The use of metformin, however, has been shown to decrease serum vitamin B12 levels, which can lead to neuropathies, cognitive impairment, and even hematological disease such as macrocytic anemia. The purpose of this study was to determine how well B12 levels were being monitored in patients taking metformin within the outpatient clinic setting.

Methods This study was designed as a single-center, retrospective, electronic medical record and chart review.

After institutional review board (IRB) approval, a total of 22 patients were included in the study for analysis. Inclusion criteria consisted of patients that were 18 years old or greater and on metformin for greater than 6 months. Exclusion criteria included those not currently on metformin, had celiac disease, a history of gastric bypass surgery, pernicious anemia, or were previously on vitamin B12 prior to starting metformin. Vulnerable populations such as pregnant patients, pediatric patients, those with oncological histories, and transplant recipients were excluded from the study.

Results Of the 22 included patients at the outpatient clinic, 68.2% had their serum vitamin B12 levels measured.

Only 40% of those patients had levels drawn before and after the initiation of metformin. The remaining 60% of patients demonstrated mixed results on whether B12 level was drawn before or after initiating metformin. Further analysis of those patients demonstrated that 33.3% of patients had their vitamin B12 levels drawn prior to starting metformin with no follow up labs whereas 26.7% of patients had vitamin B12 levels after initiating metformin only.

Conclusions The study demonstrates that vitamin B12 labs were being obtained in the outpatient setting, though well below 50% within the study population received adequate measurements before and after initiating metformin. Although the labs were being measured, there were some inconsistencies with timing and frequency of the lab draws.These inconsistencies highlight the need for a dedicated and standardized vitamin B12 lab protocol for patients using metformin.

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72: Role of pharmacy interns in reducing bulk medication waste through implementing a standardized discharge and counseling process in a new community hospital.

Abigail Christoffersen;1 Elizabeth Thompson;1 Rex Beazer;1 Tyson Bigelow;1 Pam Bjerk.1 Author Affiliations 1 Intermountain Healthcare Purpose At Intermountain Layton Hospital, our pharmacy department noticed the large amount of bulk medications (e.g. inhalers, nasal sprays, topicals) that were being brought back to the pharmacy from discharged patients for destruction. Prior to implementing a standardized process to address this, we can account for wasting $4,187.46 (average wholesale price) worth of inhaled medications from January 2019 to August 2019. Our goal is to discharge patients with bulk medications supplied by the inpatient pharmacy when ordered by the physician to continue upon discharge. This will reduce patient expenses and possibly improve medication compliance upon hospital discharge.

Methods Collaborating with interdisciplinary teams, our inpatient pharmacy department has developed a standardized process to help ensure bulk medications are sent home with patients upon hospital discharge when these medications are ordered to continue upon discharge by the provider. This process was implemented in August 2019. In September 2019, we implemented a process where our pharmacy interns take responsibility of assuring bulk medications are going home with patients during the Saturday and Sunday discharges. During the weekend shifts, interns print a patient list for the medical, surgical, and intensive care unit patients, ascertain from the charge nurse which patients are being discharged, review which patients have bulk medications ordered, check that these medications have been ordered for discharge, are appropriately labeled with an outpatient label, and ensure that the nurse will give the medication to the patient. The interns also properly educate patients on the appropriate use of the bulk medication. Key counseling points include correct technique of medication, the importance of the medication to the patientâ&#x20AC;&#x2122;s health and how to incorporate the medication into their home medication regimen.

Results Since implementing this new process as a department in August 2019, the cost (average wholesale price) in wasted inhaled medications for discharged patients has been reduced from an average of $598.21 per month to $194.06 per month.

Conclusions Since implementing this new process, we have seen a reduction in wasted bulk medications. Because this process has only been in effect for two months, we anticipate further reduction in wasted bulk medications and associated cost as the involved departments become more accustomed to this new workflow process. Given our hospitalâ&#x20AC;&#x2122;s reduced pharmacist staffing on weekends, pharmacy interns can play an important role in ensuring this process is carried out on weekends, when there is no decentralized pharmacist. We expect we will continue to reduce costs to our patients and provide excellent discharge counseling to help improve medication compliance.

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73: Assessing patient health attitudes and knowledge after attending student pharmacist led community health outreaches Brittany Harnicher;1 Bertha Castrellon;1 Jeffrey Bower;1 Angela Chu.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose This study seeks to quantify patient reported change in health attitudes and knowledge from community health outreach provided by student pharmacists over a one-year period. Outcomes assessed included patients' general health knowledge, personal health status awareness, available health resources, confidence in communicating with healthcare providers, understanding of medications, confidence in personal health management and overall benefit of the outreach event.

Methods Study Design: This study was an observational pre-post survey design conducted between January 1st, 2019 and September 28th, 2019.

Methodology: A patient survey assessing patients' general health knowledge was offered to all patients seen during student pharmacist led community health outreach events in Salt Lake City, UT. Prior to performing any health screening or providing education, student pharmacists obtained informed consent by asking patients if they would like to be included in the study. A standardized student script was read to each patient to assess for eligibility for inclusion into the study before any pre-outreach survey answers were collected. The survey consisted of 7 questions with a 5-point Likert scale from 1 being strongly disagree to 5 being strongly agree. After the patient interaction, patients took the post-outreach portion of the survey.

Inclusion Criteria: The patient population was limited to adults aged eighteen years and older, able to read English and cognitively able to provide informed consent.

Exclusion Criteria: Minors (17 years of age or younger) due to lack of legal ability to provide informed consent. Patients who are cognitively impaired or unable to read English due to inability to understand survey questions and subsequent invalidity of survey responses.

Results A total number of 31 participants across a variety of demographics and educational backgrounds completed the study. The surveys from the outreach events showed statistically significant increases in the participantsâ&#x20AC;&#x2122; confidence in their general health knowledge, personal health status awareness, confidence in communicating with healthcare providers, and confidence in personal health management.

However, the study failed to determine a statistically significant increase in knowledge of health resources available to the participants and the reasons for taking their medications.

Conclusions This study was approved by the IRB to extend until January 31st, 2020. However, due to the limited number of scheduled health outreach events, data collection concluded early on September 28, 2019. The study showed student pharmacist led community outreach events to have a statistically significant impact in improving the participantsâ&#x20AC;&#x2122; confidence of their health knowledge, general health status awareness, confidence when speaking to healthcare professionals, their medication side effects, and managing their medication therapies. Limitations to the study include a small sample size and a lack of emphasis on providing information about healthcare resources to the participants.

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74: Evaluation of Alert Fatigue in Clinical Pharmacists Using Electronic Medical Record (EMR) Eric Wu;1 Jennifer Bishop;2 Caitlin Oderda;3 Jen Calvey;3 Megan Evans.3 Author Affiliations 1 St. Mark's Hospital , St. Mark's Hospital PGY1 2 St. Mark's Hospital , St. Mark's Hospital Residency Program 3 St. Mark's Hospital , St. Mark's Hospital Purpose With rapid integration of technology, our health systems have achieved improved patient care and clinical practices. The technology that we currently use to improved patient care also created an oversight in the number of alert being shown to clinicians. Many of the alerts are insignificant and are ultimately ignored.

Clinicians generally override the majority of warnings, even critical alerts that warn of the potential of severe harm in our patients. This study will assess the possibility of reducing the frequency of insignificant alerts, which will benefit pharmacists by providing higher quality alerts to increase patient safety.

Methods Retrospective study This project is a quality improvement project not requiring oversight by an Institutional Review Board Data analyzed from medication orders: Sept. 16 to Sept. 22, 2019 Exclusion criteria: Alerts not viewed by pharmacists Hospitals and clinics other than SMH and its associated free-standing emergency departments Limitations: One week of data Plan to increase time frame and data for final project Inconsequential alerts will be submitted to SMHâ&#x20AC;&#x2122;s Pharmacy and Therapeutics (P&T) Committee and Medical Executive Committee (MEC) for review to approve suppression of inconsequential alerts.

Results of this study will be submitted to HCA Healthcare for possible quality improvement projects in the future Results Potential to decrease the number of alerts by: combining alerts to be viewed as one alert instead of several individual alerts. For example, ondansetron alerts with QT prolonging agents AND possible QT prolonging agents. Removing alerts of the same medications ordered together on order sets For example, magnesium alerts with other magnesium doses and formulations ordered together on order sets approved by SMHâ&#x20AC;&#x2122;s P&T committee. Removal of inconsequential drug-allergy from inactive ingredients: latex, lactose, milk, egg-yolk, etc. A pharmacist satisfaction survey will be completed before the removal of alerts and be compared with another pharmacist satisfaction survey after the removal of alerts. Reduction of alerts is expected to improve pharmacist reported satisfaction and encourage more accurate override documentation

Conclusions In progress

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75: Hyperammonemia in patients receiving valproic acid in an inpatient setting Lynn Vu;1 Stephen Nwankpa;1 Amanda Bernardini;1 Angela Chu;1 Tressa McMorris.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Valproic acid (VPA) is widely used for the treatment of epilepsy, migraine, and a variety of psychiatric conditions. However, the reported incidences of hyperammonemia in regards to valproic acid use is highly variable. The purpose of this study is to evaluate the incidence of VPA-associated hyperammonemia in the general adult inpatient population setting and the risk factors related to its development.

Methods The institutional review board approved this retrospective analysis, where electronic medical records at Intermountain Medical Center identified patients who received valproic acid and derivatives (valproate, valproic acid, divalproex) between June 1, 2017 to May 31, 2018. Patients were excluded from this study if they were less than 18 years of age, did not have VPA administered during their inpatient stay, or if they had elevated ammonia levels (>33Âľmol/L) prior to initiation of VPA. Patients with a confirmed diagnosis of liver cirrhosis were also excluded since hyperammonemia can occur independently from VPA in this specific patient population. The primary endpoint of this analysis will be the presence of hyperammonemia. Hyperammonemia will be defined as a new ammonia level of > 33Âľmol/L after VPA initiation. Secondary endpoints will include symptomatic hyperammonemia, identification of potential risk factors for hyperammonemia, and how hyperammonemia was treated.

Results From July 1, 2017 to January 31, 2018, a total of 162 patients were identified that matched the criteria for this study. A total of 13 patients were identified with VPA-associated hyperammonemia, with 12 displaying symptomatic hyperammonemia. Treatment modalities included administration of lactulose, levo-carnitine; disconuiting VPA administration, or decreasing the VPA dose.

Conclusions The administration of VPA in the general adult inpatient resulted in an 8% incidence of hyperammonemia, greater than reported incidences in drug references. Of those that did develop hyperammonemia, a large percentage had symptomatic presentation.

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76: Safety and efficacy evaluation of the clinical pharmacist directed multimodal pain management in postoperative orthopedic hospitalized patients Bradley Merrill;1 Braden Adamson;2 Megan Evans;3 Jeannette Bean.1 Author Affiliations 1 St. Mark's Hospital 2 Roseman University, College of Pharmacy 3 Healthtrust Purpose Safe and effective pain management is integral for orthopedic surgery patients. Complications such as uncontrolled pain, respiratory depression, and constipation are common if not properly managed. As of December 2017, the Medical Executive Committee of St. Markâ&#x20AC;&#x2122;s Hospital approved a clinical pharmacist directed pain management protocol for post-operative orthopedic patients. The protocol allows for the consulted pharmacist to manage pain, constipation, and rescue medications. Our primary purpose is to investigate if this service has been performed safely and effectively. The second purpose will be to see how well this service is received by providers.

Methods A retrospective chart review of the electronic medical record system will be performed to evaluate the safety and efficacy of patients managed by a clinical pharmacist. Safety parameters that will be monitored are time to first bowel movement, utilization of multi-modal pain regimens, utilization of morphine milliequivalent for acute pain, and use of an opioid reversal agent. Efficacy will be measured by using HCAP interview scores regarding patient perceived pain control, and a short satisfaction and understanding questionnaire given to providers who use the service. Dates considered will be October December 2017 prior to the initiation of the protocol and October â&#x20AC;&#x201C; December 2018 after initiation of protocol. This study did not require IRB approval.

Results In progress.

Conclusions In progress.

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77: Valproic Acid Induced Hyperammonemic Encephalopathy: A Case Report Rosa Vu;1 Dave Kim;1 Tressa McMorris.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Valproic acid (VPA) is a common antiepileptic medication, commonly used among psychiatric patients.

Hyperammonemia is a potential adverse reaction to high levels of VPA, which if left untreated can be fatal and cause life-threatening encephalopathy. The purpose of this poster is to bring more awareness to cases of VPA induced hyperammonemic encephalopathy.

There is an increasing number of cases and it is becoming more prevalent.This is often missed because not many providers see this drug related adverse effect. In our patient case, the levels of the VPA and the ammonia were highly elevated to indicate a possible drug induced adverse event.

Methods The patient is a 35 yo female who had initially presented to the emergency department for the pneumonia with 4/4 SIRS criteria. Patient had undergone multiple bowel resections. There was then a drug-drug interaction during her stay that induced the patient into neuroleptic malignant syndrome (NMS). After withholding the medications, the patient was still having hallucinations with slight improvement. It was then revealed that the patient had been continuing her depakote during her course of stay. VPA and ammonium levels were tested to reveal that they were elevated. This was quickly corrected with the possibility of her symptoms resulting in VPA induced hyperammonemic encephalopathy. After the correction, her levels had returned to normal and the patient showed improvement upon discharge.

Results The patient's VPA induced hyperammonemic encephalopathy was treated with Levocarnitine 3000mg every 8 hours daily and lactulose 20 g twice daily for one day to quickly reverse the hyperammonemia from the VPA. The dose of of the patient's VPA was also decreased to slowly taper the dose for the patient. Both the patient's VPA and ammonia levels returned to normal over the course of a few days.

Conclusions This case report presented a complex patient with multiple medical needs. Her treatment team primarily focused their attention on immediate treatment based on priority. As a result, the VPA and ammonia labs were ordered after into the patient's admission as the more emergent issues were resolved. When the labs were being interpreted, the providers were unsure of the best approach as there was limited experience with VPA induced hyperammonemia. This emphasizes the need to bring more awareness for this case and how to appropriately treat it.

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78: Toothpaste Turmoil:Quest for the Best Anti-Bacterial Effect Snehashish Ghosh;1 Amber Singh; Manoj Kumar Upadhyay;1 Monika Singh; Shankargouda Patil.2 Author Affiliations 1 M.B.Kedia Dental College Pvt. Ltd. 2 College of Dentistry, Jazan University, Jazan, Saudi Arabia Purpose The dentifrices aids in mechanical tooth cleansing, their effectiveness has been proved pivotal in maintaining oral hygiene. Their composition supposedly plays a major role in reducing the microbial load and warrants an evaluation of the same.

Methods Three groups of anti-bacterial toothpastes were selected, with group 1 containing triclosan based, group 2 containing neem and group 3 containing both triclosan and neem. Three groups, each containing 30 healthy subjects aging between 25- 30 years were included in the study. Each subject was given respective dentifrices pertaining to the group, soft bristle toothbrush and advised one brushing technique to be followed for a week. Following which plaque samples were collected and inoculated on blood agar plates and colony forming units (CFU’s) were calculated. The results were tabulated and statistically analysed.

Results Results showed that the CFU’s were present in the plaque samples obtained from all the three groups.

However, the CFU’s present in the group 3 were comparatively less than group 1 and group 2.

Conclusions The results negate the absolute anti-bacterial effect of all the three dentifrices. Therefore we conclude that not only dentifrices but also other oral hygiene aids like flossing, mouthwashes, periodic oral prophylaxis are important and must be included for a having a maximal anti-bacterial effect.

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Roseman University of Health Sciences Nevada Abstracts

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01: Public Perception and Understanding of Risks of Do-It-Yourself (DIY) Orthodontics. A Survey Study Claudia Acosta-Lenis;1 Karthikeyan Subramani;1 Prashanti Bollu;1 Kishore Chaudhry;1 Richard Stevens.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose Do-It-Yourself (DIY) Orthodontics has recently been introduced as an alternative strategy to treat malocclusions by laypeople themselves with online alliance. However, orthodontics is a specialized field with different approaches and needs, thus continuous supervision is required. The reason that some laypeople are performing DIY is probably due to their lack of awareness of the potential risks involved.

So far, there is no literature available to inform the public regarding whether laypeople understand the differences between professional orthodontic treatment done by an orthodontist, and DIY orthodontic treatment done by laypeople. There is also no literature examining the associated risks from DIY orthodontic treatment.

The main purpose of this project is to evaluate laypeopleâ&#x20AC;&#x2122;s preference and knowledge of orthodontic treatment done by an orthodontist vs. DIY Orthodontics without professional supervision of an orthodontist. A secondary purpose of this project is to examine the reasons that laypeople utilize DIY Orthodontics, and if they are aware of the risks and limitations.

Methods A questionnaire will be administered to approximately 500 laypeople, who have no professional experience and background in dentistry or orthodontics. The SPSS (version 25) statistical software will be utilized to analyze the data. Frequency tables for various variables will be constructed. Chi-square tests will be used to analyze association between categorical variables Results This study has not completed yet, but it is expected that the main reason laypeople utilize DIY in orthodontics as well as in other health fields is because of the lower cost. Other reasons include the possibility of no more visits to the dental office, no brackets or wires, less treatment time because they consider their problem easy to fix, or they consider themselves to have enough knowledge in dentistry and orthodontics to feel confident enough to treat themselves. Additionally, the promise of having their money back if aligners do not fit is probably another reason for choosing DIY orthodontics.

Conclusions This research provides evidence and advancements that are meant to guide and improve practice. Having information about the reasons why laypeople utilize DIY orthodontic treatment instead of looking for professional assistance is crucial for the future of the orthodontic specialty.

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02: FL-41 Lenses for the Treatment of Meige Syndrome Taylor Campbell;1 Aroucha Vickers;1 Andrew Lee.2 Author Affiliations 1 Valley Hospital Medical Center 2 Houston Methodist Hospital, Department of Ophthalmology Purpose Meige syndrome is a rare disorder characterized by blepharospasm and oromandibular dystonia. Several treatment modalities have been described in the literature previously to various effect. Although FL-41 lenses have been used with success in blepharospasm, to our knowledge this is the first description of successful use in Meige syndrome. We propose the use of FL-41 glasses as another therapeutic option for patient with Meige syndrome.

Methods A 65-year-old African-American male presented with a ten-year history of refractory Meige syndrome.

His past medical history was also significant for hypertension, dyslipidemia, and cervical dystonia.

Physical exam was notable for episodic involuntary contractions of bilateral orbicularis oculi muscle consistent with blepharospasm as well as concurrent intermittent spasms of the lower facial muscles and jaw consistent with oromandibular dystonia. Magnetic resonance imaging and laboratory studies were unremarkable for secondary causes of Meige syndrome. He was trialed without improvement on several medications, including tetrabenazine, deutetrabenazine, valbenazine, clonazepam, baclofen, trihexyphenidyl, zolpidem, and several rounds of botulinum toxin injections. He also underwent a brow lift without improvement. Patient was then trialed on FL-41 rose-tinted lenses.

Results The addition of FL-41 lenses provided significant subjective and objective relief of the patientâ&#x20AC;&#x2122;s signs and symptoms. He noted significant decrease in severity and frequency of his blepharospasm and facial grimacing.

Conclusions The exact pathophysiology of Meige syndrome is not well understood. Blepharospasm has been shown to be associated with photophobia. The authors thereby suggest a correlation between Meige syndrome and the trigeminovascular system, given that our patient experienced significant relief of both blepharospasm and oromandibular dystonia when using FL-41 lenses. We therefore propose FL-41 lenses as an alternate noninvasive therapeutic option for patients with Meige syndrome.

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03: Zerumbone, a novel dual inhibitor of Jak2-Stat3 and NF-κB signaling pathways, inhibits GCSF-mediated migration of pancreatic cancer cells.

Jenny Casiello;1 Taylor Murray;1 Arup Chakraborty.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Pancreatic cancer is highly metastatic and now the third leading cause of cancer-related deaths (after lung and colon) in the United States with an overall 5-year survival rate of <5%. In 2019, there were 56,770 newly diagnosed cases of pancreatic cancer in the United States, and of those 45,750 men and women are predicted to die as a result. We reported previously that granulocyte colony-stimulating factor receptor (G-CSFR) and G-CSF are aberrantly expressed in a variety of primary cancers including pancreatic cancer (PaCa). The biological axis of G-CSF/G-CSFR promotes the metastatic property of pancreatic cancer cells. G-CSF signaling involves Jak2/Stat3 and NF-κB pathways and zerumbone is a novel dual inhibitor of these pathways.

Aim: Determine the role of Zerumbone in G-CSF/G-CSFR-mediated invasion of PaCa cells.

Methods Previously we have shown that both G-CSF and G-CSFR were expressed in MIAPaCa-2 cells while PANC-1 cells expressed only G-CSFR. NF-κB, Jak2, and Stat3 activation were determined by measuring phosphorylation level by western blot. Transmigration of PaCa cells were determined by using the Boyden chamber.

Results NF-κB, Jak2, and Stat3 were activated and increased transmigration was observed when Panc-1 cells were incubated with G-CSF. Activation and transmigration were attenuated in MIAPaCa-2 cells when incubated with G-CSF neutralizing antibody. Stat3 specific inhibitor STATTIC (5µM) or NF-κB inhibitor Bay-11-7085 (4 µM) significantly inhibited transmigration and inhibited completely when combined, of Panc-1 cells in the presence of G-CSF. Zerumbone (10 µM), a dual inhibitor, also completely inhibited transmigration of Panc-1 cells in the presence of G-CSF. Conclusions These data suggest that aberrant autocrine/paracrine G-CSF/G-CSFR signaling significantly contributes to Stat3 and NF-κB-mediated invasion of pancreatic cancer cells. Zerumbone, a nutraceutical from Asian ginger may be a safer alternative than current chemotherapy regimen to be used to combat such invasiveness of pancreatic cancer.

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04: Review of aPTT levels after initiation of heparin for patients with a BMI less than 30 compared to patients with a BMI greater than or equal to 30 Stacy Henry;1 Ragini Bhakta.2 Author Affiliations 1 Dignity Health St. Rose Dominican 2 Roseman University, College of Pharmacy Purpose The nomogram at St. Rose Dignity Health Hospital, Siena Campus, utilizes actual body weight (ABW) for dosing UFH in the two protocols under review: the ACS protocol and the DVT/PE protocol. The pharmacy department at St. Rose Siena has noticed varying reliability in obese patients when using ABW. We are aiming to conduct a retrospective chart review to report the aPTT levels of patients after initiation of both the ACS and DVT/PE protocol and comparing the results between patients with a BMI less than 30 kg per m2 to those with a BMI greater than or equal to 30 kg per m2.

Methods This is a retrospective chart review of patients that were admitted to St. Rose Dignity Health Hospital, Siena campus and initiated on UFH with either the ACS or DVT/PE protocol during their hospital stay.

Patients will be included if they are 18 years of age or older, have a baseline aPTT noted in the chart, received the bolus dose of UFH and at least one follow-up aPTT level. We will collect patient demographic information; such as, height, weight and BMI, as well as protocol initiated and doses given.

We will compare the aPTT levels of patients using SPSS 25 software. The study was submitted and approved by the Dignity Health IRB. Results There was no statistically significant difference in mean time-to-therapeutic between patients with a BMI < 30 compared to a BMI >; 30 (13.65 hours and 16.15 hours respectively, p= 0.87). A higher percentage of patients with a BMI < 30 were therapeutic by the third aPTT level, 65.2% compared to 51.3%.

Number of patients with a critical high first aPTT (level >; 120) was significantly higher in patients with a BMI >; 30 (70% versus 20%, p < 0.001).

Conclusions Based on our findings, we propose capping the bolus dose for the DVT/PE protocol in patients with a BMI >; 30 kg/m2.

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05: H. Pylori in the Presence of Type 2 Diabetes: Impact of an Antimicrobial Protocol on Blood Sugar Regulation Savannah Johnson.1 Author Affiliations 1 Roseman University, College of Nursing Purpose Treatment and eradication of Helicobacter pylori (H. Pylori) infection has become an increased topic of interest as related to Type 2 diabetes mellitus, insulin resistance, and associated treatment regimens. This case report presents a 65 year-old overweight male (LG). LG sought medical care and nutrition counseling to address Type 2 Diabetes. H. Pylori infection was also treated.

Methods LGâ&#x20AC;&#x2122;s supplement and dietary protocol included nutrient replenishment and fortification, targeted antimicrobial and ROS reduction, and increased glycemic control which all contributed to reducing inflammatory processes from both exogenous sources and endogenous manufacture.

Results LGâ&#x20AC;&#x2122;s treatment protocols demonstrate an overall remarkable recovery as indicated by biomarkers (anthropometric and lab values) and reports of marked overall improved vitality. Improvement appears to directly correlated to decreased measures of weight, blood pressure, fasting glucose and HgA1C, ferritin and other measures. Additions of lifestyle interventions including mindfulness exercises, vagal nerve stimulation, increased exercise and intermittent fasting likely synergized anti-inflammatory effects, especially with increased immune effect to assist in GI infection fighting.

Conclusions he results support eradication of H. Pylori as a component of the nutrition and lifestyle intervention of Type 2 Diabetes. Additional research is needed to further identify the components of successful treatment regimens.

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06: Using Word Clouds to Identify Trends in Paclitaxel Resistance Research Lovnit Kaur;1 Breanne Moore;1 Paris Van;1 Leilanie Vu Tran;1 Kim Le;1 Quoc Do;1 Ashley Namasondhi;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Research trends could vary from year to year as new scientific advances and concepts are adopted. The challenge is then to identify them in order to convey the most up to date pertinent research information to a clinical audience as well as help anticipate future needs within the medical and scientific fields. In this study, we evaluate the use of Word Clouds to help identify trends in research concerning cancer cell resistance to paclitaxel (Taxol), a major issue within cancer treatment.

Methods Publications from 4 years of research (2013-2017), identified using Pubmed inputting terms “paclitaxel” and “resistance”, were identified and their associated keywords, entered by the authors themselves, were collected, if available. With these keywords, word clouds for each year were then generated by Tagcrowd (https://tagcrowd.com/) with words “paclitaxel”, “resistance” and “cancer” omitted. This was done to visualize keyword frequency. The generated word clouds were then analyzed visually to identify trends that vary from year to year. Keywords that trended up or down were noted and the area explored further so we can find a possible reason why the prevalence of the keywords are changing. This is done using resources such as pubmed, google scholar and clinicaltrials.gov.

Results Some keywords are continuously prevalent when comparing the years 2013, 2014, 2016 and 2017 between each other, such as the keyword 'chemotherapy', whose prevalence over the 5 years of research stayed relatively consistent year to year. However, there are certain keywords which have become more prevalent over the years, such as 'P-glycoprotein', 'miRNA' and 'breast cancer'. This may imply increased popularity in these areas in regards to drug treatment, movement of research from "benchside" to "bedside" or increased prevalence of a form of cancer, respectively. Certain keywords, on the other hand, is becoming less prevalent, such as 'nanoparticles', 'multidrug resistance' and 'ovarian cancer' over the years. This may relate to nearing completion of a drug development phase (such as completed clinical trials, approved general usage for various forms of cancer), changes in direction of basic medical research away from combination therapeutics involving paclitaxel because of already improved therapeutic regimens and changes in paclitaxel research focus toward other cancers, respectively.

Conclusions Using word clouds, it may be possible to identify trends in particular areas of research in paclitaxel resistance. This may be useful in the future to anticipate needs of the health care industry and for patient care. For instance, identifying trends can forecast future clinical applications and therefore help educators to best prepare medical professionals to adopt these new practices into their regular treatment regimens.

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07: CBCT Evaluation of Maxillary Transverse Dimension Short-Term Relapse in Orthodontic Patients with Hyrax-Type Palatal Expanders Eugene Kim;1 Prashanti Bollu;1 Kishore Chaudhry.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose The purpose of this retrospective cohort study is to measure the net maxillary transverse dimension changes: skeletal and dental, of patients treated at the Roseman University orthodontic clinic with Hyraxtype palatal expanders using 3D cone beam (CBCT).

Methods Patients treated with Hyrax-type palatal expanders will be selected with appliances stabilized for at least 3 months that had CBCT scans from T0 (pretreatment), T1 (time of appliance removal or within 3 months prior to appliance removal), and T2 (completion of all orthodontic treatment). The scans will be utilized to measure: T1-T0 (realized expansion), T2-T1 (short-term relapse), and T2-T0 (net expansion). The scans will be imported and cross-sectional slices will be made with Dolphin dental software. The slices will be coronal bisections through the most apical region of the palatal roots of the maxillary first molars and the most apical region of the roots of the maxillary permanent canines. The CBCT images will be oriented in the frontal, sagittal, and transverse planes on the Dolphin imaging software and the following measurements are found: external maxillary width, internal maxillary width, and angular measurements.

Statistical analysis will be performed using SPSS 25.0.

Results Study is in progress. The key findings are as follows on the results that have been completed (updates will be made as needed on the poster presentation): T1-T0 (realized expansion) for the skeletal expansion (Δ JR-JL) was 3.02 ± 1.41 mm for the sample group and 1.62 ± 1.31 mm for the control group, and for the dental expansion (Δ DA.E) was 5.64 ± 2.98mm for the sample group and -1.00 ± 2.78mm for the control group. T2-T1 (short-term relapse) for the skeletal expansion was -0.34 ± 1.17mm for the sample group and 0.44 ± 0.43mm for the control group, and for the dental expansion was -4.50 ± 3.19mm for the sample group and 0.90 ± 1.14 for the control group. T2-T0 (net expansion) for the skeletal expansion was 2.68 ± 1.48mm for the sample group and 2.06 ± 1.44mm for the control group, and for the dental expansion was 1.14 ± 2.33mm for the sample group and 0.10 ± 2.92mm for the control group.

Conclusions The results, tentatively, can be interpreted as minimal skeletal expansion relapse and difference between the sample and control group but a significant dental expansion relapse and difference between the sample and control group.

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08: Financial analysis of purchasing an existing orthodontics practice vs. starting one from scratch Guneet Kohli Kainth;1 Christopher Rodgers;2 Richard Stevens.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics 2 Roseman University, MBA Program Purpose This purpose of this study is to address gaps in existing evidence, rather currently accepted thinking, that it is easier and/or more cost-effective to purchase a practice due to systems for patients, materials, etc. being in place, rather than building one from the ground up.

Methods This study will be completed using a financial analysis of a hypothetical orthodontics practice in Henderson, NV. The study will create a proxy business and will compare it to an existing practice of the same size and capacity over a 10-year business model. All expenses for operation management will be inserted into an excel business model, with certain variables kept constant (i.e. rent). This will help standardize numbers in comparing purchasing a practice or starting a new practice.

Results Anticipated completion 2/1/2020 with final results presented at Research Symposium. This research study will primarily be completed through the acquisition and analysis of costs associated with a practice. The financial metrics used to serve as a basis for this comparison include the Net Present Value (NPV), Internal Rate of Return (IRR), Modified Internal Rate of Return (MIRR), and break-even point. The independent variables include expense and revenue estimates, cost of start-up and costs of practice; the dependent variables include cash flow, profitability, ROI, IRR, and NPV. This should provide the audience with a basic background of the methods and how the value of a practice can be assessed. It is understood that the specific data will not correlate directly to different markets, however, a trend analysis could be completed to better provide the audience with the metrics to assess their region of interest.

Conclusions Final conclusions will be presented at Research Symposium.

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09: Incorporating Daily Use of Oral Health Hygiene Strategies to Decrease Reinfection of Oropharyngeal Sexually Transmitted Infections in a Family Medicine Practice Seung-Ha Lee;1 Selina Liang;1 Rithy Khim;1 Christina Madison.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose To collect data in order to evaluate recurrence rates of oropharyngeal manifestations of sexually transmitted infections (STIs) by offering oral health counseling and tools such as daily mouthwash and toothbrushes to those who have been previously diagnosed with gonorrhea, chlamydia, or both.

Methods Oral hygiene kits which include a toothbrush, toothpaste, floss, and a bottle of alcohol-based mouthwash with instructions for best practices are offered to the patient at time of assessment and treatment. The products were donated by Roseman University (RU) of Health Sciences (College of Dental Medicine) and compiled by RU student pharmacists completing an advanced pharmacy practice experience at the Huntridge Family Clinic which offers extensive amount of testing and care for LGBTQ community of LV. Total of 35 kits were created with the initial donated supplies and distributed to 31 patients at the Huntridge Family Clinic, 4 kits were requested by patients to give to their partners. The goal is to prevent recurrence of gonorrhea and chlamydia infections with the continued best practice of oral health counseling.

Results A six-question survey were provided to patients via iPad upon arrival for health assessment. Preliminary results consisted of 35 patients have been provided with oral hygiene kits with demographics including all genders between age 17 to 63 years with two or more sexual partners in the past three months.

Conclusions Based on the current data that we collected, so far there is a larger male population that required STI therapy. In addition, there was also a higher co-infection rate of both chlamydia and gonorrhea.By focusing on oral health counseling and offering oral health hygiene kits, we could see a reduction in STI recurrence rates and overall improvement in oral health in patients at a high risk of STI acquisition.By bringing awareness of replacing oral hygiene tools, we hope to see a reduction in recurrence rates of oropharyngeal STIs in the primary care setting.

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10: Right Lower Lobe Pneumonia in a Patient with Severe Right Upper Quadrant Pain Luis Armando Moreno.1 Author Affiliations 1 The Valley Health System Family Medicine Resident Purpose The differential diagnosis of patients with right upper quadrant pain include biliary colic, acute cholecystitis, hepatitis, cholangitis, acute pyelonephritis, congestive heart failure, retrocecal appendicitis and less common-right lower lobe pneumonia. Pneumonia is associated with high morbidity and mortality. A high index of suspicion is essential for prompt diagnosis, treatment and prevention of complications. History, physical exam and imaging such as chest x-rays are the main diagnostic modalities. Medically stable patients with pneumonia can be managed as an outpatient with antibiotics, while some patients may require hospital admission for appropriate management of pneumonia and associated complications. I present a case report of a patient with severe right upper quadrant pain and an unusual presentation of right lower lobe pneumonia.

Methods case report Results Pneumonia, despite being the cause of significant morbidity and mortality, is often misdiagnosed, mistreated, and underestimated, especially when the main complaint is severe right upper abdominal pain.

I present a case of a patient with pneumonia who presented to our institution with an unusual severe right upper quadrant pain. This case exemplifies a recognized differential diagnosis of right upper quadrant pain in this patient population and is followed by a review of literature, including pathogenesis, clinical presentation and treatment options.

Conclusions Clinical presentation for a patient with pneumonia may very from being with specific symptoms of pneumonia to unusual symptoms such as gastrointestinal symptoms (right upper quadrant pain). Right upper quadrant pain may be suggestive of pneumonia. History, a physical exam, blood work and chest xrays are the initial diagnostic tools and provides information about the severity of pneumonia and other differential diagnosis. Chest CT angiogram is often required to provide more accurate images and to rule out other serious conditions such as pulmonary embolism, especially if the patient is having chest pain.

Community-acquired pneumonia is associated with high morbidity and mortality and treatment options available can also be associated with adverse effects such as acute kidney injury induced by vancomycin.

This mandate the need for a high clinical suspicion for pneumonia when the patient presents with atypical gastrointestinal symptoms, especially severe right upper quadrant pain.

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11: Lithium Toxicity and Non-Convulsive Status Epilepticus: A Case Report Adena Shahinian;1 Lisa Conners;1 Aleksandra Betcher;1 Jasmine Chopra;1 Svetlana Villano;1 Sidra Tahseen;1 Scott Silver;1 Mark Mckenzie;1 Paul Janda.1 Author Affiliations 1 Valley Hospital Medical Center, College of Graduate Studies Purpose IntroductionThe spectrum of Lithium toxicity may present anywhere from a mild hand tremor to a comatose state. The effects tend to be diverse in nature and effect almost every system Altschul. Renal injury as a result of lithium toxicity is variable and can present in many forms. The most common renal side effect of lithium is nephrogenic diabetes insipidus (NDI)Trepiccione, McKnight. The neurologic sequelae of lithium toxicity tend to occur later on, especially in those with chronic lithium therapy; as it takes time for the lithium to be absorbed and eventually cross the blood brain barrier Oakley.

Methods The Case Presentation was reviewed in the literature.

Results Case PresentationA 58-year-old Caucasian male with a past medical history of Bipolar I Disorder on Lithium therapy presented to the hospital with an acute alteration in mental status from a psychiatric facility. Patient was found to have Lithium toxicity, and upon obtaining an urgent electroencephalogram (EEG), He was found to be in nonconvulsive status epilepticus (NCSE). Throughout the course of his hospitalization he was treated with numerous antiepileptic drugs, which eventually led to him having a normal EEG clear of epileptiform discharges, with an appropriate background rhythm.

Conclusions Conclusion This case report summarizes some of the effects of lithium toxicity, particularly the association of lithium toxicity and NCSE. It also discusses the utility of obtaining an EEG, specifically an urgent EEG, when a patient presents with Lithium toxicity and altered mental status, as any delay in diagnosis and treatment of status epilepticus generally portends a worse prognosis.Yip

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12: A comparison of CBCT soft tissue with a Bellus3D Facial Scan Superimposition Gerald Sherrick;1 Glen Roberson;1 Jahnavi Rao;1 Richard Stevens.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose Bellus3D facial scanners give us a realistic 3D view of individuals’ faces that include proportional structures, color, and texture. These realistic 3D facial models allow us to involve various dental applications. In orthodontics the data capture is important to allow faster, better treatment planning.

Before mainstream use of this application it is important to know the Bellus3D scanner is accurate. In order to achieve this accuracy this study will compare CBCT soft tissue with a Bellus3D facial scan superimposition. If proven accurate then the technology would be a large cost savings compared to competitors that are almost 50 times the costs.

Methods One investigator will perform the analysis on the difference in measurement on the following soft tissue landmarks for CBCT and Bellus3D in sagittal, axial and coronal view.

Sagittal View Na’ in anterior/posterior dimension En (Tip of nose) in anterior/posterior dimension En (Tip of nose) in superior/inferior dimension Me’ in anterior/posterior dimension Pog’ in anterior/posterior dimension Axial View En (Tip of nose) in mediolateral dimension En (Tip of nose) in anteroposterior dimension Coronal View Lateral ala of nose Zygomatic arch For measurements intra-observer consistency will be done on the same CBCT/Bellus3D superimposition investigator 1 week later For measurements outside of CBCT soft tissue the measurement will correspond to a positive value and for measurements inside of CBCT soft tissue the measurement will correspond to a negative number.

Results In progress Conclusions In progress

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13: Evaluating the role of G protein coupled receptor kinases 2 and 5 in mediating the effect of cisplatin on cervical cancer hela cells Phillip Tran;1 Jigisha Patel;1 Jane Ammon;1 Li Feng Feng;1 Michael Gi;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose One of the biggest issues with cisplatin usage in treating cancers is that some cancer cells may be resistant to this drug. Furthermore, cancer cells may also react differently to cisplatin, potentially resulting in increased resistance to the damage caused by this drug. This could limit the effectiveness of combination treatments that involve this drug and increase the likelihood of a poor treatment outcome. Here, we explore the function of G protein coupled receptor kinase (GRK) 2 and 5, 2 protein kinases implicated in cancer development, in mediating the effect of cisplatin in the cervical cancer HeLa cell line.

Methods Cervical cancer HeLa cells with and without GRK2 or GRK5 protein expression were treated with varying concentrations (0-20 uM) of cisplatin for 24-72 hours. The extent of cell death was assessed by a cell proliferation detection kit, Cell Counting Kit-8 (CCK-8, Dojindo Molecular Technologies) and by trypan blue exclusion. CCK-8 detects NADPH levels produced by dehydrogenases in living cells. The signal detected using this kit is assumed to be proportional to the number of viable cells. Trypan blue exclusion is a dye-based assay that identifies live and dead cells by manual counting stained (dead) or unstained (live) cells with a microscope.

Results Using the CCK-8 cell counting kit, GRK2-null HeLa cells showed supposedly decreased sensitivity to cisplatin compared to the other cell lines, as this kit showed that these cells were able to survive cisplatin treatment better than the other cell lines tested. However, using trypan blue exclusion to observe cell death as a result of cisplatin treatment, no differences were observed with cisplatin exposure comparing all cell lines tested, with all cell lines tested dying the same extent. This discrepancy of the results from the 2 assays with completely different methodologies suggests that, since the CCK-8 proliferation assay kit is dehydrogenase-dependent and does not directly count total cell number, unlike trypan blue exclusion, GRK2 null HeLa cells may be reacting differently to cisplatin at the level of dehydrogenase activity to produce more NADPH and thus giving us false results in regards to cell viability in the presence of cisplatin. However, GRK2 null cells are still dying at the same degree as the other cell lines in the presence of cisplatin.

Conclusions The results in this study suggest that GRK2 may be a part of different cellular pathways, compared to GRK5, that modify the reaction of cancer cells to cisplatin. Without GRK2, NADPH production would spike upon cisplatin exposure. This difference may give cancer cells that have low levels of GRK2 different cellular behaviors in response to cisplatin, potentially giving them special survival advantages.

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14: Comparison of force generation and force decay of non-latex elastics from four different manufacturers: an in-vitro study Miriam Behpour;1 Glen Roberson;1 Karthikeyan Subramani;1 Kishore Chaudhry.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose The purpose of this study is to assess whether the force level delivered by a given non-latex elastic matches the manufacturerâ&#x20AC;&#x2122;s stated force level.

This study will also compare the force levels generated by different manufacturerâ&#x20AC;&#x2122;s non-latex elastics.

This study will find answers to the following questions: - Do non-latex elastics of comparable size from different manufacturers vary in inner or outer diameter, width, or height?

- Do non-latex elastics of comparable size from different manufacturers vary in force delivery for a given stretch?

Methods Three sizes of non-latex elastics from each of four manufacturers will be used.

20 samples will randomly be selected from each manufacturer for each size of non-latex elastic, for a total of 220 samples (* for RMO only 2 sizes will be tested at 4.5 oz, since the non-latex 5/16â&#x20AC;? size has been discontinued) The internal diameter, external diameter, width, and height will be measured in millimeter.

Static dry testing will be performed to measure force level. Each non-latex elastic will be extended to 3x Inner Diameter (ID) on two metal posts on an acrylic block jig. After 5 seconds, the initial force level will be measured. Each non-latex elastic will then be stretched for 4 hours on the metal posts, and the force level will be measured after 4 hours have elapsed.

Forces will be measured in Newtons (N).

Mean, standard deviated (SD), and range of the measured dimensions of the elastics will be generated.

Mean, SD, and range of force values will be generated by the elastics when stretched to 3xID and to 3xID after 4 hours.

Results In progress Conclusions In progress

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15: Using Caenorhabditis Elegans as an Experimental Model to Test the Importance of the G Protein Coupled Receptor Kinase 2 Inhibitor Paroxetine in Controlling the Heartâ&#x20AC;&#x2122;s Responses to Oxidative Stress.

Magdalena Cybulska;1 Mary Nguyen;1 NgocSong Hoang;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Oxidative stress is an important stress that the body encounters, which can lead to damage if not counteracted appropriately. Of note, oxidative stress may be key to the human heart, where it is damaged by oxygen radicals generated post-ischemia. The GRK2 inhibitor, Paroxetine, has been shown in some clinical studies to improve cardiovascular function in patients with myocardial infarction. In this study, we explore if paroxetine can protect the model organism, Caenorhabditis Elegans, to the effects of oxidative stress.

Methods In this study, we used the nematode, C. elegans, to determine if Paroxetine can protect C. elegans form oxidative damage. We treated the worms with the drug either acutely (30 minutes in water with paroxetine or fluoxetine) or the day before (16 hours grown on plates with paroxetine or fluoxetine) and then moved the worms to plates treated with the oxidant Juglone. Survival was queried from 1-4 hours on the plate by prodding and survival was recorded per plate.

Results Previously, we found that C. elegans without GRK2 survived oxidative stress better in response to juglone compared to the other worms. In this study, we found that the GRK2 inhibitor paroxetine was able to increase the survival of the wild type nematode to the oxidant juglone. Worms pre-treated with 100 nM paroxetine for 16 hours was able to survive either 120 nM or 240 nM juglone better compared to those treated with fluoxetine, which is not a GRK2 inhibitor. Furthermore, treating the worm for 30 minutes in water with paroxetine prior to juglone treatment was able to increase survival of the worms.

Those treated with fluoxetine in the same experiment did not show increased survival to oxidative stress.

Conclusions In this study, we studied if the GRK2 inhibitor, paroxetine, increased survival of c. elegans to oxidative stress because GRK2 knockout worms showed increased survival to this stressor. This study showed that worms treated with paroxetine did increase survival. This suggests that, in addition to paroxetine being a selective serotonin reuptake inhibitor, this drug could also be effective work as a GRK2 inhibitor, helping an organ, like the heart, deal with oxidative damage. This means that paroxetine, in addition to inhibiting GRK2 in the damaged heart to alleviate heart disease effects, may also blunt the effects of oxidative damage by blocking GRK2-mediated pathways.

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16: Characterization of Exosomes from Activated Retinal Microglia in Vitro Annette Eom;1 Vladimir Bondarenko;1 Rouel Roque.2 Author Affiliations 1 Touro University, College of Medicine 2 Roseman University, College of Medicine Purpose Numerous reports support a potential role for activated microglial cells in the mechanisms of degenerative retinal and brain diseases. Although the exact mechanism remains unknown, our study and those of others describe the transport and release of cytotoxic substances by activated microglia during the initial stages of neuronal cell death. Among these substances, galectin-3 has emerged as an important player in inflammatory conditions and neurodegenerative diseases by mediating and/or modulating microglial activation. Galectin-3, a member of an evolutionary conserved family of carbohydrate-binding lectins, lacks a signal peptide and is most likely secreted via a non-classical exocytic pathway involving extracellular vesicles (exosomes and microparticles).

Methods To investigate the role of galectin-3-derived retinal microglia in degenerative retinal diseases, activated microglia were isolated from 4-5-week-old mice retinas with a targeted mutation of the c-mer protooncogene tyrosine kinase gene (Mertk-/-) and characterized for expression of microglia specific markers.

Extracellular vesicles were purified from 48h conditioned media of cultured microglia and characterized for expression of galectin-3 and Alix, an exosome marker, using immunocytochemistry and Western blots.

Results Retinal microglia from Mertk-/- mice displayed an activated phenotype characterized by expression of CX3Cr1, CD11b, and Griffonia simplicifolia isolectin B4 but not of the MĂźller glial marker glial fibrillary acidic protein (GFAP) nor the vascular endothelial cell marker PECAM-1. Intense galectin-3 immunofluorescence was observed throughout the cell body and processes of microglial cells; producing a ~30 kDa galectin-3 reactive band in the cytosolic component in Western blots. Abundant amounts of extracellular vesicles (~100-200 nm in size) secreted by the cells in 48h conditioned medium displayed a ~30 kDa galectin-3-reactive band and an Alix-reactive band, consistent with exosomes, in Western blots.

Conclusions Our study shows that activated microglia isolated from early Mertk-/- mice with retinal degeneration expressed high levels of galectin-3. Moreover, galectin-3 co-localized with Alix-expressing exosomes secreted by cultured microglia. The increased production and release of exosomal galectin-3 by activated retinal microglia support a potential role for galectin-3 and microglial cells in the mechanisms of degenerative retinal diseases.

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17: Bronchial Blocker To Achieve Hemostasis in a Patient Presenting with Hemoptysis due to an Aortobronchial Fistula Variant Rahul Farwaha;1 Sai Karan Vamsi Guda;2 Trent Peterson;3 Sharis Shimarian;3 Svetlana Villano;3 Jeremy Oh;3 Hooman Sazegar;2 Mark McKenzie;4 Scott Silver.4 Author Affiliations 1 Valley Hospital Medical Center, Residency - Internal Medicine 2 Valley Hospital Medical Center, GME - Pulmonary/Critical Care Fellowship 3 Valley Hospital Medical Center, IM residency 4 Valley Hospital Medical Center, Administration/Staff Purpose This case explores the novel use of a bronchial blocker to achieve hemostasis in pulmonary hemorrhage refractory to conservative measures in an aortobronchial fistula variant, a pseuodoaneurysm-bronchial fistula.

Methods Pseuodoaneurysm-bronchial fistulas represent a rare subset of a rare phenomena known as an aortobronchial fistula (ABF). Mortality rates can be high, although early surgical intervention can bring survival rates up to 75% in reported cases1,2,5. Supportive measures are used in the time between presentation and surgery. These measures include blood products and flexible bronchoscopy for diagnosis and therapy.

Results • 71-year-old female with a PMH of type 1 aortic aneurysm s/p endovascular repair presented to the ED with a complaint of hemoptysis and hematemesis which was not associated with dyspnea, abdominal pain or nausea.

• CTA of the chest demonstrated air within native aneurysm wrap around the ascending interposition graft with the abutting the distal anastomosis of the graft. Patient was immediately intubated with an 8.0 ET tube and underwent emergent flexible bronchoscopy for diagnostic and possible therapeutic purposes.

• Frank blood and clotted blood appreciated throughout both lung fields which were thoroughly cleaned using 0.9% Cold Saline. After removal of blood clots the apicoposterior segment of left upper lobe (LUL) was identified to have active bleeding.

• Conservative attempts to control bleeding via cold saline flushes, lidocaine with epinephrine were unsuccessful. 10 cc of 1 gm tranexamic acid was flushed into this segment to achieve temporary hemostasis.

• Following this, the 8.0 ET tube was exchanged for a 6.5 UNIVENT with a bronchial blocker and introduced into the LUL and subsequently inflated to achieve balloon tamponade. Patient was then transferred to tertiary care center for CVT surgery.

Conclusions Flexible bronchoscopy during the evaluation of hemoptysis proves useful in visualizing and evaluating ABFs, although exceptionally rare3,4,5. Given the nature of ABFs, bleeding may be difficult to control.

Conservative measures such as saline flushes and suctioning may help visualize the bleeding but rarely stop it. Therapies such as tranexamic acid and epinephrine may be attempted.

However, should a physician face difficult to control bleeding during bronchoscopy, we believe the use of a bronchial blocker is a reasonable approach to achieve hemostasis until surgical correction can be preformed.

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18: The Role of the Microbiome in Chronic Pain Conditions: Rheumatoid Arthritis, Fibromyalgia, Migraine Headaches, & Multiple Sclerosis Savannah Johnson.1 Author Affiliations 1 Roseman University, College of Nursing Purpose This literature review examines the microbiome profiles of those with chronic pain disorders as well as the therapeutic potential of probiotics in these conditions. In general, the microbiota profile in patients with rheumatoid arthritis (RA), fibromyalgia (FM), and multiple sclerosis (MS) have shown significant differences from healthy controls. Migraines, however, have been associated with other gastrointestinal disorders independent of dysbiosis.

Methods The methodology used in this review consisted of literature found in a database search of PubMed, Google Scholar, and Cochrane Database of Systematic Reviews. Search terms included “microbiota,” “probiotics,” “dysbiosis,” “intestinal permeability,” “intestinal barrier,” “gut-brain axis,” “rheumatoid arthritis,” “fibromyalgia,” “migraines,” and “multiple sclerosis.” 55 full-text articles matched the search criteria in the PubMed database. References of articles meeting criteria were also searched. Only articles published between 2002 to 2018 were used.

Results The primary differences found in those with rheumatoid arthritis were low diversity and prevalence of Prevotella copri. Although not all strains had significant results, supplementation with Lactobacillus casei in those with RA resulted significantly reduced pain and improved wellbeing. RA animal models attribute these effects to probiotic supplementation attenuating dysbiosis and modulating inflammatory mechanisms. In fibromyalgia, there is a substantial prevalence of SIBO (hydrogen dominant), along with increased permeability and IBS. In those with MS, microbial dysbiosis is also present, specifically low diversity of short-chain fatty acid-producing bacteria and increased pathogenic species including Clostridium perfringes type B. Probiotic use in MS animal models indicate potential to reduce the severity of symptoms, as well as improve inflammatory markers and mental health. No evidence was found that support there are commonalities of the microbiota profiles in those with migraines, but strong associations were found with gastrointestinal conditions such as intestinal permeability, IBS, celiac disease, and cyclic vomiting syndrome. Despite the lack of dysbiosis observed in migraine patients, probiotics were still found to contribute to improved quality of life and reduction of symptoms.

Conclusions Overall, although clinical research in this area is in the early stages, our findings suggest that dysbiosis plays a vital role in the pathogenesis of most of these inflammatory conditions. The use of probiotics may serve as a potential therapeutic approach given their ability to improve the gut barrier function for those suffering from such chronic pain disorders.

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19: Remineralization of White Spot Lesions with Bioactive Glass Air Abrasion Camy Kwok;1 Karthikeyan Subramani;1 Kishore Chaudhry.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose To investigate the capability of bioactive glass air abrasion in remineralization of enamel.

Methods Fifty extracted human incisors are subjected to a demineralizing solution of 2.2 mM calcium chloride, 2.2 mM monopotassium phosphate, 0.05 mM acetic acid adjusted to pH of 4.4 using 1M potassium hydroxide for 96 hours to create artificial white spot lesions (WSLs) on their labial surfaces. The teeth are then analyzed by quantitative light-induced fluorescence (QLF) to record a base mineral status. After induction of demineralization, the presence of the artificial WSLs is then verified by QLF and surface characteristics and roughness via scanning electron microscopy (SEM). The percentage of fluorescence change is used to confirm whether demineralization has taken place. Pre-treatment surface roughness is recorded by surface profilometry. All samples are then subjected to bioglass air abrasion. Subsequently, they are divided into two groups of 25 teeth. The teeth then undergo thermal treatment at intraoral temperatures of 37°C. In addition, the experimental group is to be treated with mechanical stress at periodic intervals. Teeth are removed from the water bath for evaluation at pre-determined timepoints between 1-28 days. The remineralization of the artificial WSLs is re-evaluated by QLF and surface characteristics and roughness via SEM and surface profilometry. Comparison is done with pre-treatment baseline records.

Results We anticipate that bioactive glass will initiate remineralization of white spot lesions. The bioglass embedded within demineralized enamel will aid in the chemical remineralization of enamel. There should be a measurable increase in remineralization but with diminishing returns within the time frame of the study.

Conclusions Air abrasion has been demonstrated as an effective mean to remove residual orthodontic cement. The result of this in vitro study can lend credence to the use of air abrasion in clinic usage to further streamline the efficiency of orthodontic practices while providing added benefits to patientsâ&#x20AC;&#x2122; oral health.

Additionally, further modification to existing formulations of bioactive glass may yield greater benefits by maximizing exclusivity in removing residual cement and reduction in collateral damage to enamel.

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20: Predicting G protein coupled receptor kinase 2 interactions with proteins in the TGFbeta pathway involved in modulating breast cancer behaviors Kim Le;1 Ashley Namasondhi;1 Quoc Do;1 Paris Van;1 Leilanie Vu Tran;1 Lovnit Kaur;1 Breanne Moore;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose In addition to their role in mediating the desensitization of G protein coupled receptors, G protein coupled receptor kinases (GRKs) can also control non- receptor functions in cancer cells that could be important in moderating breast cancer behaviors, such as metastasis, chemosensitivity and growth. In this study, we use the online databases Phosphonet (Kinexus Corporation) and Group-based Prediction System, Version 3.0 (The CUCKOO Workgroup) to identify new GRK substrates in the transforming growth factor beta (TGFbeta) signaling pathway, which is involved in breast cancer cell activities.

Methods First, we focused on a select number of proteins that are involved in some cancer cell behaviors, like cell growth, metastasis, cancer cell death and chemosensitivity. We then queried if GRK2, a protein kinase expressed higher than usual in breast cancer cells compared to normal breast cancer cells, can phosphorylate some of these proteins. To do this, we used the proprietary kinase prediction modules within Phosphonet and GPS 3.0 to determine the likelihood of being phosphorylated by GRK2. Both these modules rely on different algorithms based on protein sequences. For Phosphonet results, the higher the average rank, the more likely a protein is a GRK2 substrate. For GPS 3.0, the higher the average score, the more likely a protein is a GRK2 substrate. From these results, we can determine if GRK2 is involved in a particular process associated with the TGFbeta pathway, it is most likely through interaction with this protein.

Results Comparing the results from Phosphonet and GPS 3.0, it is clear that the predictions vary for some proteins, suggesting differences in the predictions made depend on the algorithm utilized. However, some proteins, such as SMAD5 (a known GRK2 substrate) and SMAD7, are still predicted to be GRK2 substrates by both GPS 3.0 and Phosphonet. Of note, SMAD5 moderates breast cancer cell resistance to daunorubicin, an anthracycline antibiotic similar to doxorubicin. Therefore, a potential factor that regulates breast cancer sensitivity to anthracyclines could be GRK2 interactions with SMAD5. Similarly, since SMAD7 controls cancer cell metastasis, GRK2 may control TGFbeta-mediated metastasis through interactions with SMAD7.

Conclusions Using phosphonet and GPS 3.0, even with differences in protein predictions due to their individual algorithms utilized, it may be possible to pinpoint potential GRK2 substrates within the TGFbeta signaling pathways that are implicated in breast cancer behaviors. These GRK2-protein interactions could control some of these abnormal functions, especially since GRK2 expression levels are higher than normal in cancer cells. Therefore, these connections could be targeted in the future by drugs to control the activity of these pathways.

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21: Evaluation of time to empiric gram-positive spectrum antibiotic administration in sepsis and septic shock patients presenting to the emergency department Mark Nguyen;1 Shannon Ruiz;1 Michael Ta.1 Author Affiliations 1 Dignity Health St. Rose Dominican, College of Pharmacy Purpose Sepsis continues to be a leading cause of death, accounting for 30% to 50% of in-hospital mortality. With the recent release of the updated Surviving Sepsis Campaign recommendations, the 3 hour sepsis bundle has now been reduced to 1 hour. The change places an even greater emphasis on initiating antibiotics as soon as possible.

In order to meet Centers for Medicare and Medicare Service (CMS) requirements, broad-spectrum antibiotics need to be administered within 3 hours. However, additional methicillin-resistant staphylococcus aureus (MRSA) coverage is required when MRSA infection is suspected. Current literature suggests that early administration of antibiotics decreases mortality, but lacks insight on the impact of combination antibiotics not being given concomitantly within the 3 hour window.

Methods A retrospective chart review will be completed for patients who had MRSA positive cultures and an ICD10 diagnosis for any classification of sepsis from September 1st, 2018 to August 31st, 2019 across two community hospitals. Antibiotics will be separated into two groups: broad-spectrum/aminoglycoside (BSA) or GPSA. MRSA coverage will be considered appropriate given a physicianâ&#x20AC;&#x2122;s GPSA order. Only the first set of each type of specimen will be evaluated. LOS is evaluated from day of emergency department presentation to day of discharge or transfer to another facility. In-hospital mortality will include expired or comfort measure patients.

Results In progress Conclusions In progress

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22: Evaluating Chemotheropeutic Effects of Cisplatin or Paclitaxel Resistant Cervical Cancer Cells Samuel Njoku;1 Truman Tsang;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose The National Comprehensive Cancer Network (NCCN) guidelines for cervical cancer recommend concurrent treatment involving radiation and chemotherapy. Combinations of chemotherapeutic drugs, such as cisplatin and paclitaxel, are often used. Resistance to chemotherapeutic regimens that involve these medications has been a long standing issue in medical practice. This resistance limits the overall effectiveness of the drugs and suggests that combination therapies with cisplatin or paclitaxel would be beneficial, although the success of these treatments is still ambiguous.

The purpose of this study is to examine the effects of chemotherapeutic treatments involving cisplatin and paclitaxel on cervical cancer HeLa cells.

Methods Cancer cell death, after treatments involving cisplatin and paclitaxel, was determined in cervical cancer cells that are either cisplatin or paclitaxel resistant. To establish resistant cells, cervical cancer HeLa cells were treated with cisplatin or paclitaxel for approximately 2 months. Cisplatin resistant cells were then treated with low or high concentrations of cisplatin alone or together with 5-fluorouracil (5-FU) or paclitaxel. Paclitaxel resistant cells were also treated with low or high concentrations of paclitaxel alone or together with cisplatin or topotecan. Live and dead cells were then collected after 72 hours of drug treatment and trypan blue exclusion assays were conducted to determine cell death mediated by the drugs alone and within particular combinations. The Studentâ&#x20AC;&#x2122;s t-tests were performed with the statistical significance threshold set at p <0.05 using GraphPad Prism.

Results In testing the different drug regimens, a wide array of outcomes were observed, suggesting that some combination therapies may not be as beneficial as previously thought. For instance, cisplatin with 5-FU increased cell death compared to cisplatin alone by 21.6% (n=3) in non-resistant HeLa cells. However, this was not observed in cisplatin-resistant cells. In certain cases, the drug combinations actually decreases the effectiveness of one drug when tested alone. For example, in cisplatin resistant cells, a cisplatin-paclitaxel mixture decreased cell death compared to paclitaxel alone by 34.2% (n=6).

Conclusions In this study, we analyzed cancer cell death in order to better gauge the effectiveness of various chemotherapeutic regimens. Based on these results, combination therapy in resistant cells may provide variable results. Although some regimens increased cell death, others decreased cell death depending on if it was tested on resistant cells. Therefore, combination therapy for recurrent cervical cancer patients should be individualized and administered with caution.

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23: A Creative Alternative for Proning in an ARDS Patient Phillip Oberg;1 Priyanka Attri Attri;1 Saikaranvamsi Guda;1 Michael Grosher;1 Syed Akbarullah;1 Mark McKenzie.1 Author Affiliations 1 Valley Hospital Medical Center, College of Medicine Purpose Mortality in patients diagnosed with Acute Respiratory Distress Syndrome (ARDS) was as high as 4070% in the 1990’s, however due to advances in early diagnosis and treatment, recent studies have shown mortality rates as low as 30-40% in recent years. Early identification of the underlying cause of lung injury and prompt treatment with mechanical ventilation, antibiotics (if warranted), and proning are important to improve survival of which, only high PEEP low tidal volume and prone ventilation alone gave demonstrated an improvement in mortality. Benefits of prone ventilation are seen as early as within 18 hours of prone position in a 24 hour period. This case outlines a patient with severe ARDS who underwent a modified proning schedule of 6 hours prone with 2 hours supine for several days of maximized ventilator support with a positive outcome.

Methods This is a 60 year old Hispanic male who presented with severe sepsis and multifocal pneumonia developing severe ARDS. Despite adequate antibiotic coverage and fluid management with utilization of high PEEP low tidal volume strategy the patient’s PaO/FiO ratio was 72 at the 48 hr mark. Prone positioning was then initiated despite the lack of proning bed at our facility. Initially the patient was positioned for 18 hours and then made supine with improvement in oxygenation however patient developed diffuse pressure wounds on his bilateral chest, abdomen and pelvis at the ASIS prominences.

Due to the lack of alternating pressure relieving bed and the patients pressure sores, an alternative schedule for pronining was initiated. The modified technique included prone position for only 6 hours and reversed to supine for 2 hours. This schedule was maintained for several days until O2 requirements decreased and adequate oxygenation attained while in supine position. ABG’s were obtained 1 hour after proning and 1 hour after reversing to supine position. The proning was weaned to 4 hours prone and 4 hours supine and eventually 2 hours prone with 6 hours supine over 48 hours before proning was eventually discontinued.

Results The FiO2 requirements, PaO2 and O2 saturation measurements were substantially different with positioning showing drastic improvement in the prone position and during supine positioning, the FiO2 requirements often exceed 80% and peep increased to 15 mmH2O. The patient’s skin lesions were treated and with more frequent pressure relief began to improve over the first few days. After several days of aggressive treatment, oxygenation improved and patient improved clinically.

Conclusions In this case study, our modified proning schedule of 6 hours prone and 2 hours supine was an effective strategy in treating a patient with severe ARDS. The patient did not sustain any significant complications with frequent repositioning using 6 person technique. The patient was eventually extubated after clinical improvement.

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24: Assessing metformin usage in the treatment of veterans with type II diabetes mellitus Riley Sherman;1 Francis Agustin.1 Author Affiliations 1 VA Southern Nevada Healthcare System Purpose Metformin decreases hepatic gluconeogenesis, decreases intestinal glucose absorption, and increases peripheral insulin sensitivity. Additionally, metformin may reduce risk of cardiovascular events and death. According to the American Diabetes Association, when no contraindications exist, metformin should be considered the first-line agent for all patients with type two diabetes mellitus (T2DM).

Unfortunately, contraindications and adverse effects may limit its use. The intent of our project is to provide a baseline incidence of patients at the Veteranâ&#x20AC;&#x2122;s Affairs Southern Nevada Healthcare System with T2DM who are not receiving treatment with metformin and to identify reasons for its occurrences.

Methods This quality improvement project has been reviewed and approved by the Veterans Affairs (VA) Office of Research Administration. Searchable data from the VAâ&#x20AC;&#x2122;s Computerized Patient Record System (CPRS) will be utilized to identify patients to be included in our project. Patients will be identified during a two-year period of August 1, 2017 through July 31, 2019. Patient inclusion criteria will include patients age 18 or older and diagnosis of T2DM (using various ICD-9 and ICD-10 codes). Patients with type I diabetes mellitus will be excluded. Information collected from each patient will include: documented allergy or intolerance to metformin, renal function, other diabetes medication classes tried by the patient, and pertinent laboratory and vital findings. Individual chart review will be done to further assess all identified patients for: type of allergy or intolerance, proper dose titration, and metformin formulations trialed.

Results In progress Conclusions In progress

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25: Radiographic Evaluation of Mandibular Growth, Development & Volume in Unilateral Cleft Lip & Palate (UCLP) Patients Laurel Shin;1 Glen Roberson;1 Kishore Chaudhry;1 Donald Linck;1 Richard Stevens.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose Unilateral Cleft Lip & Palate comprises one of the most common birth defects in the United States and is characterized by maxillary deficiency. Even though orofacial clefts have the most profound affect on the maxilla, the craniofacial complex does not exist in isolation where growth and development of the maxilla is independent of the mandible or vice versa. Whether orofacial clefts truly play a role in mandibular growth and development is still unclear. Currently, no studies have been performed that attempts to elucidate mandibular growth & development in UCLP patients in both 2-Dimensional and 3-Dimensional views. The purpose of this study is to determine whether a statistically significant relationship exists between UCLP and the following dependent variables: mandibular volume and mandibular growth & development, namely corpus length, ramus length, and gonial angle when compared to non-cleft subjects.

Methods This research study is a retrospective cohort design. 25 UCLP orthodontic patients who have had Diagnostic Records taken at the Roseman University of Health Sciences Orthodontic Clinic with an available CBCT scan and an additional CBCT scan that is available at a second time point that has elapsed at a minimum of 18 months after the initial scan performed at the Diagnostic Records appointment will be the sample population. The experimental population consists of non-cleft orthodontic patients matched by age, gender and skeletal maturation as described by Baccettiâ&#x20AC;&#x2122;s most recent method for staging CVM in lateral cephalograms. Measurements will be compared between T1 and T2 for the following landmarks using InVivo software using Measurement Tab in 3D Superimposition: Gonial Angle (Formed by tangent to the posterior border/ramus of the mandible and tangent to the lower border of the mandible through Gn), Corpus length (Go-Gn), and Ramus length (Go-Co). Mandibular volume will be calculated using the "Volume Measurement" in InVivo in Hounsfield Units (HU). Data will be analyzed using SPSS Version 25 Statistical Software. Independent T-Test will be performed to compare independent variable (presence/absence of UCLP) with the following dependent & continuous variables: Gonial angle, Corpus length, Ramus length, Mandibular volume.

Results In progress Conclusions In progress

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26: Identifying New G protein Coupled Receptor Kinase 2 Substrates among Proteins Closely Linked to Breast Cancer with Poor Prognosis Theresa Tran;1 Ngan Nguyen;1 Jodie Gee;1 Raghavendra Rathore;1 Tri Mai;1 Jasmine Tolentino;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Breast cancer is increasingly becoming one of the deadliest forms of cancer. Proteins that are associated with poor prognosis have been identified, and this information could help us determine how cancers with this potential outcome may develop and what type of treatment strategies should be employed.

Interactions of these proteins with others may give us an idea as what type of signaling pathway is active or inactive that could lead to this poor prognosis. In this study, we wished to determine if 20 of the top proteins associated with poor prognosis of breast cancer may be related to G protein coupled receptor kinase 2, a protein whose expression is downregulated in breast cancer. This is done using in silico approaches using online phosphorylation site predictors and databases.

Methods In this study, the top 20 proteins associated with poor prognosis of breast cancer from the Protein Atlas project were queried using the phosphorylation site predictors Phosphonet, GPS 3.0 and GPS 5.0. These programs gave predictions on if these proteins are phosphorylated by GRK2. The results were subsequently analyzed, ranked based on the strength of the predictions and then scored. The top 5 proteins that scored the highest were examined further using online curated databases PHOSIDA and STRING to determine their functions, protein kinases that control these proteins and their interacting proteins. From these studies, we can determine how GRK2 can regulate these proteins and what may happen if GRK2 is absent in cancer cells.

Results In this study, we found a number of proteins that could be a good GRK2 substrate among the proteins analyzed. The predictors utilized gave predictions that were in agreement with some, but not all proteins.

This is because of the different theories these programs were built upon. When the data was sorted based on strengths of the predictions given by all three programs, 5 notable proteins were discovered, all with some defined functions as determined by PHOSIDA. PHOSIDA also gave us curated information as to what protein kinases phosphorylate these proteins. This could let us know what type of functions a protein kinase like GRK2 may have. STRING gave us information as to how these proteins interact with others and, thus, what types of pathways GRK2 may control if present in cancer cells.

Conclusions In this study, we used a number of in silico approaches to determine GRK2 substrates among proteins associated with poor prognosis of breast cancer. This study showed that there were a number of proteins within this list that may be more likely to be GRK2 substrates than others. These substrates have defined functions that GRK2 may control, such as cancer cell metastasis and metabolism. The loss of GRK2 in these cells may mean that there is a loss of control of these signaling pathways, which may give these cells survival advantages, potentially leading to their poor prognosis.

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27: Utilizing a customized aptitude test as an admissions instrument to predict readiness and performance in an accelerated 3-year pharmacy program.

Helen Park;1 Arup Chakraborty;1 Christopher Hernandez.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose As more pharmacy schools move toward a holistic admissions process, assessing an applicantâ&#x20AC;&#x2122;s likelihood of performing well in a doctor of pharmacy (PharmD) program has become increasingly subjective. This is exacerbated by the removal of the Pharmacy College Admissions Test (PCAT) requirement by many programs which had previously served as a standardized measuring tool.

Additionally, grade point averages and coursework varies extensively across institutions and is also a subjective process. With the high level of variability across domestic and international institutions, a more effective method to standardize the evaluation of applicants in the admissions process was needed. As such, the critical thinking aptitude test was developed as a customized instrument to add a standardized measure to evaluate and identify applicants who may be more successful in an accelerated 3-year pharmacy program. In addition to traditional quantitative and qualitative data on applicants, the critical thinking aptitude test serves as an additional data point to consider when assessing the applicant holistically and determining their readiness for pharmacy school. The purpose of the test is to determine whether higher performance on the critical thinking skills test can measure critical thinking abilities and whether stronger critical thinkers perform better in pharmacy schools. The hypothesis is that an onsite test of critical thinking will be a crucial tool to identify students that will be successful in our pharmacy program, and to differentiate applicants on our wait list to make better admissions decisions.

Methods Applicants who meet the admissions requirements of the PharmD program at Roseman University of Health Sciences are invited to an on-campus interview. On the interview day, applicants are required to complete an onsite critical thinking aptitude test and writing assessment. Under a proctored environment, applicants have approximately 30 minutes to complete both their critical thinking test and writing assessment. The critical thinking test consists of five questions. The five questions include questions of the following type: number series, vocabulary, syllogism, problem solving, and spatial reasoning. Each question is in a multiple choice test format.

Results A retrospective study is currently underway. The data set is to include academic performance data with dependent variables including average assessment and reassessment scores, number of pass/fail, number of summer remediations, and attrition. Independent variables include the highest degree earned, critical thinking aptitude test score, and writing score.

Conclusions Since similar academic credentials from different programs are not equivalent, critical thinking scores can be used as a valuable tool to identify individual strengths in the areas of basic math skills, vocabulary, problem solving and spatial reasoning. The instrument offers a standardized method of comparing and evaluating the academic record of applicants, as opposed to comparing the institutions in which they attended. The onsite delivery of the assessment also eliminates any external influences on test. The successful completion of this project will be beneficial to other programs, including those outside of pharmacy.

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28: Impact of implementing a meningitis/encephalitis panel rapid diagnostic test on antimicrobial de-escalation Selina Crivello;1 Velliyur Viswesh;2 Rebecca Jayakumar.1 Author Affiliations 1 Valley Hospital Medical Center, College of Pharmacy 2 Roseman University, College of Pharmacy Purpose Cerebrospinal fluid (CSF) cultures, which take days to process, remain the gold standard for pathogen identification in bacterial meningitis and encephalitis. This can delay time to appropriate antimicrobial utilization. In March 2019, six institutions in our hospital system, implemented the Biofire速 FilmArray速 Meningitis/Encephalitis Panel (MEP). The MEP detects the fourteen most common pathogens involved in CNS infections within one hour of collection, and may speed up antimicrobial de-escalation. The objective of this study is to assess the impact of the MEP on duration of antimicrobial use in the setting of meningitis or encephalitis, when compared to traditional microbiologic testing.

Methods This retrospective study will be submitted to the Institutional Review Board. Patients admitted to any of the six institutions in our hospital system, who had a CSF culture ordered between January 2017 and November 2019 will be included if the following criteria are met: >;18 years old, CSF culture via lumbar puncture, and receiving antimicrobial treatment. Patients with intraventricular drains or shunts will be excluded. Data collected will include: demographic characteristics, duration of hospitalization, duration of antimicrobial therapy, antimicrobial acquisition costs, ICU admission and length of stay, serum white blood cell count with differential and temperature on admission, CSF cell counts with differential, CSF glucose and protein, BioFire速 FilmArray速 MEP results, CSF cultures and blood cultures, receipt of dexamethasone, seizure prior to presentation, and mortality during admission. Outcomes will be compared between patients who received only traditional culture-based microbiologic testing and patients who received MEP-based microbiologic testing. Data analysis will be performed using SPSS version 25.

Results In progress Conclusions In progress

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29: Force Decay of Pre-Treated Low Temperature Orthodontic Thermoset-Elastomeric Chains (OTEC’s) Daniel Dalanhese;1 Richard Stevens;1 Glen Roberson;1 Calvin Heinrich;1 Kishore Chaudhry.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose In orthodontics the need for constant light continuous force is essential. This need has caused product manufactures to create many products, such as OTEC’s. Studies illustrate that force decay has been consistently problematic amongst all types of OEC’s. This force decay may be susceptible to manipulation by changing the OTEC at the molecular level in order to decrease and stabilize the force decay rate. Further knowledge will benefit our orthodontic community – both clinicians and patients, if the OTEC force decay rate can be reduced and sustained for a longer time interval.

Methods 4 specimen groups (-80 C, -20 C, 4 C, 21.5 C,) with a total sample size of 120 six link clear elastomeric chains. Specimen were held on acrylic block jigs 25mm apart. Force measurements were taken at fivetime points (initial, 1 hr, 24 hr, 14 d, 28 d) by a Lutron force gauge.

Results Data collection in process Conclusions Pending data collection and analysis

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30: Curcumin nanogel for the treatment of diabetic retinopathy Gowthamarajan Kuppuswamy;1 Arun Radhakrishnan;1 Surajit Dey.2 Author Affiliations 1 Department of Pharmaceutics, JSS College of Pharmacy, Ooty, India 2 Roseman University, College of Pharmacy Purpose The main objective of the present research was to prepare a non-invasive, cost effective, natural polymer based mucoadhesive nanoparticulated formulation of curcumin for ocular delivery by employing factorial statistical design to target VEGF-A /PKCβ2 /HIF-1α receptor and thereby reduce the limitations associated with intravitreal injection.

Methods The curcumin was selected based on docking studies with PKC-beta II/VEGF-A/HIF-1α receptors. The molecular modelling studies was carried out using Glide (version 5.7) Schrodinger suit 2011. The compatibility studies of curcumin in combination with different polymers, mucilages and gum in 1:1 ratio were carried out by FT-IR and DSC. Analytical method development and solubility studies of curcumin were performed. Nanoparticles were prepared by modified coacervation method using various polymers with the help of Design of Experiments (DoE) factorial design approach. Optimized formulation was selected on the basis of particle size, zeta potential (in between 30-35 mV), shape, morphology, entrapment efficiency and invitro release study.

Results DSC and FT-IR thermograms showed that the selected polymers, mucilages and gum were found to be compatible with curcumin. UFLC analysis was carried out by gradient elution using C18 column with a mobile phase of acetonitrile–phosphate buffer (pH 6.5) and monitored at 418 nm. Solubility studies of curcumin was performed with Tween 80 and with Brij 78 (0.1%-0.5% w/v). The factorial design was validated by the Yates method and by the Design Expert software. In Yates method the predicted response of batches showed particle size more than 150 nm, zeta potential less than 30 mV was found to be within limits with high values of R2 (0.979-0.999) indicating excellent goodness of fit (p < 0.001). The in-vitro release studies of optimized freeze-dried nanoparticles were carried out for 24 h in simulated tear fluid and the cumulative drug release was found in the range of 86-95 % at the end of 24 h. All batches of nanoparticles prepared form curcumin were found to be stable for 9 months at room temperature and did not show any significant change in the particle size, zeta potential and entrapment efficiency.

Conclusions The prepared Curcumin nanogels could be used as a viable alternative to intravitreal injection and result in better patient compliance.

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31: Physiological Effects of Fasting: A Review Savannah Johnson.1 Author Affiliations 1 Roseman University, College of Nursing Purpose To examine the physiological effects of fasting with emphasis on pain and mood disorders, autoimmune disease, cardiovascular disease, metabolic syndrome, cancer, and aging.

Methods Literature search of PubMed, Google Scholar, and Cochrane Database of Systematic Reviews of peerreviewed, full text articles between 2001-2017. Search terms included “Fasting,” “Fasting Mimicking Diet,” “water and fasting,” and “Water Fasting.” References of articles retrieved were also reviewed, but not restricted by year. Fifteen full-text articles met the criteria described above.

Results The review presents a synthesis of the available scientific literature observing the effects of fasting and the fast mimicking diet on human health and physiology with regard pain and mood disorders, autoimmune disease, cardiovascular disease, metabolic syndrome, cancer, and aging. Mechanisms of action and clinical applications are also discussed.

Conclusions In this review, fasting was associated with improved physical and psychological well-being presumably via evolutionary co-developed adaptation responses. Further research is needed to reveal how fasting and the FMD can capitalize on these evolutionary adaptations in the prevention, management, and treatment of chronic disease.

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32: Investigating the effects of G protein-coupled receptor kinase 2 in mediating the reaction of MDA MB 231 breast cancer cells to chemotherapeutics Jacqueline Lee;1 Christopher Sana;1 Danielle Valls;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose The sensitivity of the triple negative breast cancer (TNBC) MDA MB 231 cells against chemotherapeutic agents could be modified by the function of various proteins and protein kinases within cell signaling pathways. One such protein kinase that could play a role in cancer cell survival is the G protein-coupled receptor kinase 2 (GRK2), which is elevated in breast cancers. This kinase is linked to the progression of breast cancer and potentially the sensitivity to chemotherapies. In this study, we investigate the impact of eliminating GRK2 in cancer cell proliferation and its survival versus chemotherapeutic agents within the FAC regimen (5-Fluorouracil-Doxorubicin-Cyclophosphamide).

Methods In MDA MB 231 cells stably transfected with control, GRK2 or GRK3 shRNA, 1) cell proliferation and 2) chemotherapeutics-mediated cell death by reagents within the FAC regimen were assessed. Cell proliferation was measured every 24 hours, up to 72 hours, with the Dojindo cell counting kit-8. Trypan blue exclusion was performed to quantify cell death when the cells were exposed to different chemotherapeutics for 72 hours. First, control, GRK2 and GRK3 shRNA cells were treated with either of the three drugs alone or in combination. Then, in a separate set of experiments, control and GRK2 shRNA cells were treated with doxorubicin alone or within different combinations (doxorubicin + 5-fluorouracil, + cyclophosphamide or all three together).

Results Cell proliferation was delayed in MDA MB 231 GRK2 shRNA cells with low GRK2 protein expression, unlike that for control and GRK3 shRNA transfected cells, at the 72 hour time point. This is similar to what was reported previously by other studies. Within our cytotoxicity experiments, we found varying results between the cell lines tested. For the FAC regimen, GRK2 and GRK3 shRKNA cells were both more sensitive to FAC compared to control shRNA treated cells. However, GRK2 shRNA cells were also more sensitive to doxorubicin alone compared to the other cells. When treating control and GRK2 shRNA cells with various combinations involving doxorubicin, the mix of doxorubicin and cyclophosphamide, without 5-fluorouracil, was observed to cause as much cell death in GRK2 shRNA cells as the composite of all three drugs.

Conclusions The MDA MB 231 cells transfected with GRK2 shRNA, to reduce GRK2 protein expression, showed reduced ability to grow and were also more sensitive to doxorubicin compared to the control and GRK3 shRNA cells. Notably, treating these cells with just doxorubicin plus cyclophosphamide (A+C) was as effective as the FAC regimen in GRK2 shRNA cells. This means that, in the future, proteomic testing that could determine GRK2 levels in patients with TNBC may be useful in choosing the best drug regimen tailored to an individualâ&#x20AC;&#x2122;s cancer.

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33: Evaluating the Impact of Nutritional Status on Malocclusion: Crowding Sunny Lee;1 Pramod Sinha;1 Wendy Chu;1 Martin Lipsky;1 Frank W. Licari;1 Man Hung.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose Nutritional status and its relationship with oral health have been and continue to be a focus of research. A limited number of studies on pediatric subjects has been conducted where malnutrition measured with nutritional status indicators was associated with some types of malocclusion, where the mode of breathing was assumed to be a moderator. The goal of this study was to examine the association between nutritional status and crowding among adolescent patients.

Methods This was a retrospective study utilizing pre-treatment records from an academic orthodontic clinic in the west region of the United States between the years of 2000 and 2019. Three nutritional status indicators defined by The Centers for Disease Controls and Prevention (CDC) were used: stature-for-age, weightfor-age, and BMI-for-age. Exclusion criteria included patients with severe medical conditions and with the history of early loss of dentition due to caries. Regression analyses were used to address the research questions, using odds ratios along with 95% confidence intervals.

Results Patients with below-average nutritional status indicators are expected to have more crowding, after controlling for the confounding variables. Also, patients with above-average nutritional status indicators are expected to have higher presence and severity of crowding, moderated and potentially mediated by mouth breathing, after controlling for the effect of confounding variables such as habits and presence of hypertrophic tonsils and adenoids.

Conclusions Nutritional status has a huge impact on children's growth and development. This study aims to provide a screening tool for oral health clinicians. Especially for orthodontists, they can utilize this tool to assess their possible malnutrition status, when patients present with certain types of malocclusion. Future research is needed to assess the duration that subjects have been exposed to low or high nutrition and the presence of sleep disturbances in order to track the status of mouth breathing longitudinally.

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34: Interaction of CYP3A5 with AR-HSP90 complex regulating AR activation in prostate cancer cells Ranjana Mitra;1 Priyatham Gorjala;1 Oscar Goodman Jr.1 Author Affiliations 1 Roseman University, College of Medicine Purpose Previously we have demonstrated that CYP3A5 stimulates prostate cancer cell growth by promoting AR activation and downstream signaling. We further investigated the mechanism of CYP3A5â&#x20AC;&#x2122;s interaction with the AR-HSP90 complex known to regulate AR activation process. AR activation is tightly regulated and is very complex, it involves several chaperons (HSP90, HSP70, HSP40, and HSP27), multiple cofactors, and protein kinases. We hypothesize that stoichiometric CYP3A5 binding to the HSP90-AR complex can induce conformational changes in the chaperone complex, promoting AR nuclear migration and activation.

Methods We used co-immunoprecipitation to identify the interaction of CYP3A5 with the components of the ARHSP90 complex. Immunofluorescence studies was performed to identify the components of the ARHSP90 complex that co-localize with CYP3A5. FRET analysis was used to confirm the interactions of CYP3A5 with the AR-HSP90 complex.

Results We performed a co-immunoprecipitation (co-IP) experiments with extracts from flag-tagged CYP3A5 transfected LNCaP cells. Our data demonstrates that CYP3A5 co-immunoprecipitates with HSP90, AR, HSP70 and HSP40, all known to be a component of the HSP90-AR complex. We further confirmed using reverse immunoprecipitation with AR/ HSP90 antibodies and agarose A/G beads that CYP3A5 is a part of the HSP90-AR mature complex. Empty vector transfected cell extract and IgG were used as controls for pull down and reverse IP respectively. Immunofluorescence studies demonstrated that HSP70 and HSP40 co-localized with CYP3A5 in the cytoplasm. Additionally, the native MDAPCa2b and LNCaP cells show co-localization of CYP3A5 and AR in the nucleus, whereas in non-transformed prostate cells CYP3A5 remains in the cytoplasm. The nuclear presence of CYP3A5 is more pronounced in MDAPCa2b cells carrying the wild type CYP3A5. The FRET analysis further confirmed direct interaction between CYP3A5 and HSP40 a chaperon in the AR-HSP90 complex.

Conclusions Our data confirms that CYP3A5 directly interacts with the AR-HSP90 complex regulating AR activation process. Further understanding of this interaction can help establish CYP3A5-AR axis as a novel therapeutic target.

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35: Deep Brain Stimulation for Treatment-Resistant Substance Addiction: A Systematic Review Sheshanna Phan;1 Omron Hassan;1 Vladimir Bondarenko.1 Author Affiliations 1 Touro University, College of Osteopathic Medicine Purpose The socioeconomic repercussions of substance addiction necessitate more treatment options for affected patients. Many patients treated with traditional treatments such as pharmacotherapy are unsuccessful at abstaining from their substance addiction. Deep brain stimulation (DBS) is a well-established surgical treatment for Parkinsonâ&#x20AC;&#x2122;s disease and has been adapted to treat other neurological diseases. Recently, DBS has been successfully used to treat substance addiction in humans by targeting the nucleus accumbens to reduce cravings and attenuate substance addiction. This study aims to examine the efficacy of DBS as a treatment for substance addiction in treatment-resistant patients.

Methods This systematic review was conducted following the standard procedures of Preferred Reporting Items for Systematic Review and Meta-Analysis statement. A literature search of the PubMed database was carried out for publications with human subjects and in English from the earliest records to January 2020. Two independent reviewers screened publications for eligibility based on the following inclusion criteria: it is a case report, substance abuse patients were treatment-resistant, DBS was the treatment modality, and patients were followed for at least 12 months. The risk of bias was scored using the Cochrane Collaboration bias assessment tool.

Results The search yielded 2,305 publications, of which 12 publications met the inclusion criteria. It was found that 55% of patients (n = 38) were relapse-free for 12 months after treatment. Specifically, the relapsefree rate was 67% for alcohol (n = 6) and heroin (n = 18) dependence, 50% for methamphetaminedependence (n = 2), 36% for nicotine-dependence (n = 11), and 0% for cocaine-dependence (n = 1).

Conclusions DBS is already considered a viable treatment option for Parkinsonâ&#x20AC;&#x2122;s patients with a success rate between 60-85%. It is a promising treatment alternative for patients with a substance addiction that could potentially further alleviate the burden of disease, especially considering that these patients were previously resistant to all other available treatment options. Further studies implementing DBS in randomized controlled trials may provide valuable information to increase the efficacy of DBS treatment for substance addiction in the future.

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36: Evaluating the chemotherapeutic effects of the FAC regimen in MDA MB 231 breast cancer cells with reduced beta arrestin 2 protein expression Christopher Sana;1 Jacqueline Lee;1 Danielle Valls;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Contemporary treatment of breast cancer is dependent on the presence of human epidermal growth factor receptor 2 and progesterone and estrogen receptors. However, despite having numerous clinical studies illustrating the efficacy of receptor-based therapies, breast cancer remains the second deadliest cancer in women. Uncovering new biomarkers, therefore, can help further categorize breast cancer treatment subgroups. Beta arrestin 2 could be a potential biomarker because it is observed to have increased expression in some breast cancer cell lines. In this study, we examine the efficacy of the FAC regimen on breast cancer cells with reduced beta arrestin 2 protein expression.

Methods In MDA MB 231 cells stably transfected with control or beta arrestin 2 shRNA cells, 1) nuclear morphologies and 2) cell death after treatment with reagents within the FAC regimen were assessed.

Nuclear morphologies (normal, multi-lobel, fragmented or enlarged) were assessed by fluorescence microscopy in DAPI stained fixed cells, previously grown for 24-72 hours. At least 4 random frames of dapi-stained cells (~10-40 cells per) were counted per slide. To quantify cell death, trypan blue exclusion was performed 72 hours after the cells were exposed to different chemotherapeutics alone or in different combinations. First, control and beta arrestin 2 shRNA cells were treated with either of the three drugs alone or in combination. Then, in a separate set of experiments, control and beta arrestin 2 shRNA cells were treated with doxorubicin alone or within different combinations (doxorubicin + 5-fluorouracil, + cyclophosphamide or all three together).

Results Examining nuclear morphologies using fluorescent microscopy, MDA MB 231 beta arrestin 2 shRNA cells with low beta arrestin 2 protein levels showed an increase in abnormal nuclear morphologies when compared to control shRNA transfected cells. Within our cytotoxicity experiments, we found that beta arrestin 2 knockout cells were more sensitive to doxorubicin and the entire FAC regimen compared to control shRNA treated cells. Because of this increased sensitivity doxorubicin, we explored the effects of doxorubicin combinations (doxorubicin+5-fluorouracil, doxorubicin+cyclophosphamide, all three drugs combined) on the beta arrestin 2 shRNA cells. We found that we still needed all three drugs together for maximum cancer cell death. However, the addition of 5-fluorouracil reduced the sensitivity of beta arrestin 2 shRNA cells to doxorubicin.

Conclusions In this study, we analyzed MDA MB 231 cells with reduced beta arrestin 2 expression for its nuclear morphologies and its responses to the drugs within the FAC regimen. These cells have a higher proportion of abnormal nuclei and were more sensitive to doxorubicin. In particular, the combination of doxorubicin and 5-fluorouracil resulted in a lower percentage of cell death as compared to doxorubicin alone in these cells. This last result suggests that, in breast cancer cells with low beta arrestin 2 protein expression, the addition of 5-fluorouracil may reduce doxorubicin effectiveness when combined to treat breast cancer.

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37: Determining Optimal Properties for Resins Used to Print Ophthalmic Drug-Delivery Devices with a 3D Printer Chi May Do;1 Saxon Evans;1 Valerie Buckley;1 David B. Rawlins.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose A major challenge in the treatment of ocular diseases is the delivery of drugs to the eye. The most common method for delivery in the anterior segment of the eye is through topical administration since it is non-invasive and allows for patient administration. However, the delivery of eye drops is inefficient and rarely accurate. The purpose of this study is to use common 3D printing techniques to print hydrogel films similar to contact lenses. The incorporation of drug molecules on the monomeric pieces will allow for the printing of a lens or film for drug delivery on the eye. The covalent attachment decreases the initial elimination of the drug in the eye seen with topical drops, and will allow for the control of dosing and drug release to the anterior of the eye.

Methods A commercially-available stereo lithographic (SLA) printer manufactured by Peopoly was used with polyacrylate resins to print either disks, or contact lens-shaped solids. The SLA printer uses a laser that emits at 405 nM wavelength, and is suitable for the polymerization of acrylate monomers. Various ratios of monomers in the resin were explored to determine the optimal mixture for printing drug-delivery devices. The incorporation of a small molecule drug was mimicked using dansyl chloride modified 2hydroxyethyl methacrylate resin and analyzed using fluorescence spectroscopy.

Results We observed that with increasing levels of hydroxyethyl methacrylate the integrity of the printed layer deteriorated. We then set out to explore systematically the best mixture for printing.

Conclusions We have successfully shown the incorporation of a small molecule into printed layers, but are still searching for the best resin mixture. This work is ongoing.

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38: In vitro Comparison of Force Delivery of Interarch Latex Elastics from Different Manufacturers Stephanie Steiner;1 Glen Roberson;1 Kishore Chaudhry;1 Karthikeyan Subramani.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose The purpose of this in vitro study is to assess whether the force level delivered by a given elastic matches the manufacturer’s stated force level. The study will also compare the force levels generated by different manufacturers’ latex elastics.

Methods Static, dry testing of the latex elastics will be performed to measure force level. One end of each latex elastic will be placed on a metal post on an acrylic block jig, and the other end will be extended to another metal post at a distance of 3xID of the elastic. After 5 seconds, the elastic will be measured for force delivery using the Lutron FG 5005 Digital Force Tester (Taipei, Taiwan) for initial force level. The latex elastic will then be placed back on to the metal post and remain stretched for 4 hours. The 4-hour force level will then be measured for each elastic. Forces will be reported in units of Newton.

Mean, standard deviation, and range of measured dimensions of elastics will be generated. Average measured inner diameter length will be compared to the manufacturer’s specified inner diameter length using a t-test for two independent samples (P <0.05). Mean, standard deviation, and range of force values will be generated by the elastics when stretched to 3xID. Initial force generated by the elastics when stretched to 3xID will be compared to the manufacturer’s specified force using a t-test for two independent samples (P <0.05). Mean, standard deviation, and range of force values will be calculated when the elastics are stretched to 3xID after 4 hours. 4-hour force levels generated by the elastics when stretched to 3xID for 4 hours will be compared to the manufacturer’s specified force using a t-test for two independent samples (P <0.05).

Results In progress Conclusions In progress

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39: A Molecular Imaging and Proteomics Lab for Biomedical Research Yasuyo Urasaki;1 Thuc Timothy Le.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Our lab integrates advanced optical imaging and proteomic technologies to identify biomarkers for fatty liver disease and cancers. We develop stimulated Raman scattering (SRS) microscopy and nanofluidic proteomic assay. Recently, we also apply these two systems to study the biological functions of essential oils.

Methods In progress Results In progress Conclusions In progress

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40: Local to Global in Nursing Education: Early Experiential Learning and Active & Collaborative Learning. Roseman University Nursing Students’ Cultural Immersion in Uganda Marife Aczon-Armstrong;1 Juliana Morone.1 Author Affiliations 1 Roseman University, College of Nursing Purpose To describe the utilization of Roseman University Six-Point Mastery Learning Model during local and international mission trips and the formation and collaboration of an inter-professional international mission trip. The focus on early experiential learning and active and collaborative learning are keys to a successful nursing education and cultural immersion experiences. These types of experiences take students out of their comfort zone and challenge them both personally and professionally.

Methods Faculty and students from Roseman University of Health Sciences College of Nursing formed an international mission team to explore and compare health issues, disparities in chronic illness care and social inequities. In preparation for the international mission trip during Summer 2019, Uganda Mission Trip 2019 Team faculty and nursing students were assigned to zip code: UGANDA during their Community Health Nursing didactic course. At the end of the trip, faculty and students discussed how the international clinical rotations impact the students’ learning process. Students presented the Final Group Project on the last day of the mission trip at Uganda Christian University Mukono campus.

Results Cultural awareness and ideas about improving health occur through education and collaboration with local Ugandan physicians and nurses during clinical rotations. Uganda Mission Trip 2019 Team provided over 1000 free medical care, medications and health education to the people of Uganda specifically in Nateete, a slum area in Kampala, the capital city of Uganda, Africa and at SIITA Nest Mother’s Home, an orphanage in Bugembe, Jinja near Source of the Nile. Faculty and students discover the controversies surrounding barriers to providing standard healthcare practices due to lack of resources and struggles with cultural practice barriers. The mission trip experience provided students with meaningful clinical experiences and addressing the needs of diverse populations in the U.S. and abroad.

Conclusions Nursing students bring creativity, enthusiasm, and gain genuine desire to learn more about other culture.

Faculty and students gained some understanding of the cultural influences on health systems with interpretations related to nursing education. Their cultural learning stimulates career plans that include international mission and attention to vulnerable populations.

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42: The anti-inflammatory property of essential oils Morgan Fine;1 Xuan Dai;1 Arup Chakraborty.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Inside many plants - hidden in roots, seeds, flowers, bark - are concentrated, highly potent essential oils, which are historically believed to cure diseases, promote healing and good health by various civilizations.

In this study, 12 essentials oils were assessed for their potential anti-inflammatory property.

Methods The anti-inflammatory property of essential oils was evaluated by their ability to inhibit; a) interleukin-1 (IL-1) mediated Nuclear Factor-κB (NF-κB) activation and b) tumor necrosis factor-α (TNF-α) secretion.

Inhibition of NF-κB activation was measured by using the NF-κB reporter (luc)-HEK293 cell line that is established from primary embryonic human kidney cells. Lipopolysaccharides (LPS) was used to activate TNF-α secretion in monocytic histiocytic lymphoma cells (U937). Inhibition of TNF-α secretion was determined by performing TNF-α ELISA assay on differentiated U937 cells treated with essential oils.

Cytotoxicity property was measured by trypan blue dye exclusion method. Essential oils were diluted initially with Dimethyl sulfoxide (DMSO) and then with cell culture media, 20,000 – 60,00 times.

Results Cinnamon, Copaiba, and DDR indicated significant inhibition of NF-κB activation by IL-1. DDR is a mixture of essential oils from Clove, Thyme, Litsea, Wild Orange, Frankincense, Lemongrass, Summer Savory, and Niaouli. Copaiba also significantly blocked TNF-α secretion from differentiated U937 cells treated with LPS. Interestingly, Frankincense and Blue Tansy significantly cytotoxic to U937 cells even with as low as 40,000 times diluted without any cytotoxic effect on normal primary HUVEC cells.

Conclusions Cinnamon, Copaiba, and DDR were identified with a potential to be used as anti-inflammatory agents.

Frankincense and Blue Tansy showed a strong cytotoxic effect which was very selective to cancer cells.

The NF-κB reporter (luc)-HEK293 cell line system can be an efficient tool in monitoring NF-κB activation by essential oils.

Future study: We need to screen more cancer cell lines to establish the anti-cancer property of essential oils.

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43: Factors associated with naloxone usage in a community teaching hospital Clay Fogle;1 Mark Decerbo;2 Stephen Chromi.2 Author Affiliations 1 MountainView Hospital, College of Pharmacy 2 Roseman University, College of Pharmacy Purpose Naloxone is utilized as a rescue medication in suspected or confirmed opioid overdose. It is a lipophilic drug that acts as a competitive opioid receptor antagonist displacing opioids at the receptor sites. This reverses the unwanted effects of opioids such as profound sedation and respiratory depression. Patients who are at a higher risk for oversedation or respiratory depression should be identified, so alternative agents or lower doses of opioids can be utilized. This would help improve patient care and decrease the need to use naloxone.

Methods This evaluation is approved by the institutionâ&#x20AC;&#x2122;s Research Oversite Committee and met exemption criteria from the Institutional Review Board. Clinical decision support software will identify patients who received complete or partial doses of naloxone. Patients will be excluded if naloxone administration occurred within 24 hours of admission or in the emergency department, operating room, or postanesthesia care units. Retrospective chart review of the remaining patientsâ&#x20AC;&#x2122; electronic medical records will be utilized to collect data which will be recorded in a secure spreadsheet. Data collected will include demographic information, number and time of naloxone administrations, if there was a standing order for naloxone as needed, a list of opioids received twelve hours prior to administration (including dose and route), a list of other central nervous system depressants received 12 hours prior to administration (including dose), and if naloxone was administered by the rapid response team.

Results In progress Conclusions In progress

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44: Emotional Intelligence Curriculum and its Impact on Dental Students Monica Freifeld;1 Deborah Hedderly;2 L. Kris Munk;3 Richard Stevens.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics 2 Roseman University, MBA Program 3 Roseman University, College of Dental Medicine Purpose The purpose of this study is to understand the relationship between emotional intelligence (EI) curriculum and the development of emotional intelligence in second year dental students. Currently, there is no requirement for EI to be integrated into dental school curriculum. However, at Roseman University, EI is part of the dental schools’ curriculum and is integrated throughout dental students’ tenure.

Based on the literature, EI is a skill that can be developed through education and can be fostered with the proper infrastructure. The assumption is dental students and in turn, dentists with higher EI, will have more success in practice in terms of business and interpersonal relationships. In addition, a dentist with higher EI will be more adept at handling intrapersonal conflicts, have more confidence, and higher wellbeing.

This study will fill a gap in the literature of the effect of EI curriculum on dental students’ EI development.

The primary objective of the study is to determine the relationship between EI curriculum and Roseman second year dental students’ (class of 2023) EI. A secondary objective of the study is to establish a baseline of EI prior to Roseman EI curriculum in first year dental students (class of 2024).

Methods This study will be longitudinal and cross-sectional. The longitudinal portion will be before current second year dental students (class of 2023) take DMD 6100, and 6 months after the course. In this class, emotional intelligence theory is reviewed, and students can practice and apply the theory. The crosssectional portion will be conducted with incoming dental students (class of 2024), before they take their first course, DMD 5100. This will provide a baseline for EI in Roseman first year dental students.

Multi-Health Systems Inc. Psychological Assessments & Services (MHS Assessments) will be used as a third-party service to assess Emotional Intelligence using their EQ-i 2.0 instrument. MHS will provide a portal to send out the invitation with a link to the survey.

Once the data has been de-identified, the research committee will use SPSS v25 for data analysis. Paired sample t-test, Median (M), and Chi Square will be the basic statistical analyses.

Results In progress Conclusions In progress

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46: Prevalence and measurement of white spot lesions post orthodontic treatment Nischal Natha;1 Prashanti Bollu;1 Man Hung;2 Kishore Chaudhry.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics 2 Roseman University, College of Dental Medicine Purpose White spot lesions pose a significant challenge in achieving esthetic excellence in orthodontic treatment.

The primary aim of this study is to investigate the prevalence of white spot lesions (WSLs) on the anterior teeth. The secondary aim of this study is to measure the proportion of tooth affected by WSL using image mapping software across severity categories of modified WSL index of Gorelick et al Methods A total of 879 patients who have completed comprehensive fixed orthodontic treatment from orthodontic clinic in the Western part of the United States will be evaluated for inclusion and exclusion criteria.

Patients demographic information, treatment start and completion dates, oral hygiene status for all appointments will be collected from patientsâ&#x20AC;&#x2122; records for this retrospective study. Post treatment digital photographs of four upper front teeth from patientsâ&#x20AC;&#x2122; records will be evaluated for the presence of WSL. Each tooth affected by WSL, will further be assessed for severity and distribution using modified WSL index of Gorelick et al and image mapping software Results This study anticipates a prevalence of about 30% which is on the lower end of the range as only the 4 upper front teeth are being examined. Also, the severity of the lesions mostly is expected to be mild as treatment is monitored by faculty and treating resident. When using modified WSL index of Gorelick et al and image mapping software, there is possibility for majority of lesions to fall under category 2 of modified WSL index of Gorelick et al and the percentage of the tooth affected is forecasted to be around 10%; and for category 3 about 30% of the tooth surface involved with WSL; for category 4 about 40% of tooth surface being affected by WSL Conclusions White spot lesions are the most undesired consequence of orthodontic treatment. Understanding their severity and prevalence will help in evaluating or revising treatment and prevention protocols. This study will also aid in understanding the effectiveness of modified WSL index of Gorelick et al and image mapping software, image j as these methods are commonly used in studies to describe the severity and distribution of WSLs

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47: The antidepressant-like activity of the rapid-acting antidepressant RO-25-6981 and its analogs does not correlate with in vitro and in vivo glutamatergic antagonism Bora Shim;1 Jiratchaya Suriyachottakul;1 Danielle C. Valls;1 Robert D. Kirsh;2 Christopher H. So;1 David B. Rawlins;1 Jeffrey N. Talbot.1 Author Affiliations 1 Roseman University, College of Pharmacy 2 Roseman University Purpose Rational design of lead compounds targeting glutamatergic receptors is critical to developing novel therapeutics for treating psychiatric disorders. The glutamatergic antagonist, RO-25-6981, has previously been shown to exert both rapid and sustained antidepressant-like activity. The purpose of the current study is to delineate its putative antidepressant mechanisms of NR2B-selective NMDA receptor antagonism and monoamine reuptake transporter inhibition.

Methods Heterozygous transgenic mice deficient in expression of the NR2b subunit of the NMDA receptor (Grin2btm1.1(Grin2a)Bjha)) and wild-type C57BL/6J mice were housed with same-sex littermates and behavioral testing was conducted during the light phase between 12:00pm â&#x20AC;&#x201C; 5:00pm. To assess antidepressant-like behaviors, the tail suspension test and locomotor activity tests were performed using Ro-25-6981 and traditional antidepressant drugs, including the serotonin selective reuptake inhibitor fluoxetine and the tricyclic antidepressant desipramine, as positive controls for monoaminergic reuptake activity. All procedures were approved by the local Institutional Animal Care and Use Committee and followed the NIH guidelines outlined in â&#x20AC;&#x153;Using Animals in Intramural Research.â&#x20AC;?

Results In the tail suspension test, four RO-25-6981 analogs (TR-2, TR-4, TR-5, and TR-6) were found to exhibit antidepressant-like activity in wild-type mice following acute administration (30 mg/kg, i.p., 30 min) with maximal reductions in immobility by approximately half compared to vehicle-treated controls. By contrast, RO-25-6981 (10 mg/kg, i.p., 30 min) reduced immobility by approximately 90%, an effect comparable to that exhibited by the traditional monoaminergic antidepressants fluoxetine and desipramine. However, unlike RO-25-6981, TR-2, TR-4, TR-5 and TR-6 profoundly limited generalized locomotor activity suggesting increased activity in the tail suspension test was related to psychotropic vs. generalized drug effects. In contrast, other TR analogs tested showed no antidepressant-like activity in the tail suspension test, despite possessing robust NMDA receptor antagonist activity via mid- to lownanomolar binding affinity at the NR2B subunit. Interestingly, RO-25-6981 and TR-5 exhibited similar antidepressant-like activity in wild-type and NR2B-deficient mice, despite possessing low-nanomolar NR2B binding. In addition, cellular serotonin transport assays showed functional inhibitory activity of both agents Conclusions Taken together, these data suggest that the antidepressant-like activity of RO-25-6981 and its analogs does not correlate with the degree of NMDA receptor antagonism. Furthermore, these data point to monoamine reuptake inhibition contributing to the overall antidepressant-like activity of RO-25-6981 in animal models of mood.

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48: Does The Timing Of High-Fidelity Simulation Impact Student Self-Confidence And Clinical Competence? A Comparative Study: Before Clinical Versus During Clinical Barbara Tanner.1 Author Affiliations 1 Roseman University, College of Nursing Purpose The purpose of this study was to establish appropriate timing for when simulation is best offered. The research question asked was; For pre-licensure baccalaureate nursing students, will the use of simulation affect clinical competence, self-confidence, and self-efficacy if done before clinical rotations as compared to during clinical rotations?

Methods Using HFS, this study utilized a non-experimental prospective quantitative design which compared a before experiential group with a during experiential group. The sample (n = 180) consisted of entry-level baccalaureate nursing students participating in HFS followed by 13 survey questions related to selfconfidence and satisfaction.

Results The results of the study yielded p values of each of the survey questions, with the exception to question 11, greater than the cutoff for significance value of 0.05, indicating no statistical worth and the null hypothesis was accepted.

Conclusions The general conclusion of this study implies that specific times for use of HFS during an experiential experience does affect student self-confidence levels thus clinical competency. The overall findings do support previous research findings that the use of HFS in nursing education does, in fact, provide nurse educators with a modifiable teaching method to evaluate studentsâ&#x20AC;&#x2122; clinical decision-making efforts that may aid in development of clinical competency.

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49: Maximizing Orthodontist Returns on Non-Practice Investments using Interest Rate Movements order to Construct an Optimal Investment Portfolio Dennis Tran;1 Christopher Rodgers;2 Glen Roberson.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics 2 Roseman University, MBA Program Purpose With the increasing amount of student debt incurred by dental school and orthodontic residencies, it is of utmost importance that Orthodontists become financially literate. This study will prove useful for Orthodontists seeking ways to offset debt by creating an investment strategy that will maximize returns.

Methods Using the United States Federal Interest Rate values from the timepoints between January 1st, 1980 to Dec 31st, 2017 for a period of 38 years, I will track the growth of an initial investment allocation of $1000 in several different investment portfolios. The interest rate values will be obtained from the United States Federal Reserve. The following investment portoflios will be included: a S&P 500 Index Fund (VFINX), a Long-Term Bond Fund (VWESC), a Money Market Fund, a Balanced Fund (VWESC), and a portfolio that uses the Money Movement Strategy founded by Charles J. Givens. The Money Movement Strategy is an investment strategy that suggests one can maximize returns by moving investment allocations in response to changes in the United States Federal Interest Rate within these different funds: a S&P 500 Index Fund, a Bond Fund, and a Money Market fund. This study will examine and compare these different investment portfolios.

Results In progress Conclusions In progress

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50: Once Conquered, Back with Vengeance: Recent Measles Epidemic in USA. Meghana Veeramachaneni;1 Sohini Mandal;2 Manas Mandal.3 Author Affiliations 1 Ed W. Clark High School, Las Vegas, NV., High School 2 Green Valley High School, Henderson, NV., High School 3 Roseman University, College of Pharmacy Purpose Measles is a contagious, vaccine preventable disease, and have been declared eradicated from USA. Yet, there have been reported cases of measles in USA, and other parts of the world in recent years. Many of the recent measles outbreaks have been linked to the non-vaccinated status of the infected individuals.

Purpose of the study is to understand the reason(s) behind the recent measles outbreak in US, particularly looking into vaccine awareness of the young adults in this context.

Methods Our research begins with review of existing data on MMR vaccination, and its success in eradication of measles. Subsequently, resurgence of (vaccine concurred) measles nation-wide, and internationally will be analyzed. We will then attempt to identify the causes of resurgence of measles in parts of USA. The primary question for the proposed research is why there is a growing trend towards ‘vaccine hesitancy’ in US population? The particular age-group in which we are interested in to find the answer is 'youngadults', as they will be the decision makers in near future. To that end, we plan to survey high school students on their perceptions and awareness on vaccine and immunization with a 10-question survey with IRB approval and parental consent.

Results It is expected that review of literature on MMR vaccination would demonstrate its success in eradication of measles, resurgence of vaccine-concurred infectious diseases, and identify the cause of resurgence of measles in parts of USA and European countries. Also, analysis of the influence of 'anti-vaxxer' movement altering the rate of immunization, causal link of autism in altered perception on immunization, and growing trend towards ‘vaccine hesitancy’ will be performed. Finally, high school students' perception on vaccine awareness, efficacy-safety, factors responsible for drop in vaccination, childhood immunization and autism, religious beliefs in vaccination, and legislation to mandate vaccination may provide answers to observed recent measles outbreak.

Conclusions Study-in-progress, conclusions will be made after completion of the research.

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51: Efficacy of albumin in potentiation of diuresis when added to furosemide in hypoalbuminemic ICU patients Sally Voong;1 Alana Whittaker;2 Velliyur Viswesh.2 Author Affiliations 1 Valley Hospital Medical Center, College of Pharmacy 2 Roseman University, College of Pharmacy Purpose Addition of albumin to increase urine output in hypoalbuminemic patients receiving furosemide is a controversial practice due to insufficient data supporting its efficacy. The purpose of our study is to assess the efficacy of albumin in potentiation of diuresis when added to furosemide in hypoalbuminemic intensive care unit (ICU) patients.

Methods Patients who received albumin between June 2016 and September 2019 and meet these criteria will be included: age 18 years or greater; receipt of intravenous (IV) furosemide and albumin while in the ICU; serum albumin less than 3.5 g/dL; receipt of IV furosemide alone in the 24 to 72 hours preceding albumin administration, followed by receipt of both IV furosemide and albumin within 24 hours after albumin; and placement of a Foley catheter for duration of drug administration noted above. Patients on hemodialysis at enrollment or who received thiazide diuretics, mannitol, vasopressin, or other loop diuretics between 72 hours before and 24 hours after albumin will be excluded. Baseline characteristics and the following will be collected: mechanical ventilation any time during the 96-hour drug administration window, cumulative doses of IV furosemide and albumin, death within 30 days from albumin, Sequential Organ Failure Assessment score at time of albumin administration, and use of potassium-sparing diuretics during the 96-hour drug administration window. Cumulative urine output, cumulative fluid intake, and net fluid balance will be collected for two time periods (receiving furosemide pre- and post-albumin): 24 hours after IV furosemide given prior to albumin and 24 hours after albumin and furosemide coadministration. Data will be analyzed using IBM SPSS Statistics version 25.

Results In progress Conclusions In progress

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52: Using Caenorhabditis elegans as an experimental model to test the importance of G protein coupled receptor kinases in controlling reactions to hyperosmotic stress Nasma Awada;1 Nazgol Emami;1 Nazokat Nigmatova;1 Jonathan Woodward;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose The ability of an organ to adjust to hyperosmotic environments is important for the well being of an individual with various diseases that may lead to high salt retention, such as kidney disease. In this report, we explored the effect of G protein coupled receptor kinases (GRKs) in modifying reactions to high salt environments using the nematode Caenorhabditis (C.) elegans.

Methods Different GRK expression knockout strains of young adult C. elegans (wild type N2, GRK1 and GRK2 knockouts) were exposed to different treatment regimens involving high concentrations (300-500 mM) of sodium chloride, causing either long-term hyperosmotic stress or short-term hyperosmotic shock, for various times (1-16 hours). Worm responsiveness during or after the stresses were then probed to determine viability and thus their ability to survive the stress. The egg laying abilities of various C. elegans strains during and after long- term hyperosmotic stress were also assessed to determine their abilities to recover developmentally during and after stress. A decrease in egg laying in the stressed worm compared to their unstressed counterpart could suggest that the worm may be having trouble recovering from the stress.

Results Mutant c. elegans without GRK1 or GRK2 showed increased survival in response to long- term (16 hour) hyperosmotic stress. More C. elegans without GRK2 survived the short-term hyperosmotic shock (1 hour) compared to the other strains. Hyperosmotic stressed mutant C. elegans without GRK1 or GRK2 showed similar egg laying abilities compared to unstressed GRK1 and GRK2 lacking worms. Stressed wild type N2 worms, on the other hand, laid significantly less eggs compared to unstressed N2 worms, suggesting that they have difficulty recovering from the select stress. When egg laying ability was assessed in hyperosmotic environments that the worms were able to survive in (300- 400 mM NaCl), GRK1 KO mutant worms were less able to lay eggs compared to the other 2 strains tested, suggesting a difference in the ability of these worms to survive in this environment.

Conclusions The results in this report demonstrate that C. elegans GRKs are involved in hyperosmotic stress reactions.

Since the strains tested showed varying effects compared to the wild type in hyperosmotic stress environments, GRKs may have different abilities to modify the way the body copes with high salt or hyperosmotic situations. In humans where GRK levels could vary in different diseases in different parts of the body, like the kidney, this implies that GRKs play an important role in modulating organ reactions to disease states where hyperosmolality occurs.

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53: Use of SHARP Tool During Post-Simulation Debriefing Rowena Bermundo.1 Author Affiliations 1 Roseman University, College of Nursing Purpose The purpose of the study was to determine if there was a difference in nursing student satisfaction and self-confidence between two different post-simulation debriefing methods: structured post-simulation debriefing with the utilization of the SHARP tool (WS) and post-simulation free-from debriefing (NS).

Methods This study utilized a quantitative, quasi-experimental design to examine if there was a difference in student satisfaction and self-confidence when the SHARP tool is used as a guide during post-simulation debriefing. Participants of the study (n = 58) included undergraduate nursing students who had simulation in the nursing curriculum. One group received the SHARP debriefing method (With SHARP, WS) and the other group received the regular debriefing method (No SHARP, NS). Student satisfaction and self-confidence were evaluated using the NLNâ&#x20AC;&#x2122;s Student Satisfaction and Self-Confidence in Learning questionnaire. The hard copies of the questionnaire were distributed after each post-simulation debriefing. IBM SPSS version 25 was used to perform the statistical tests. The study was approved by the American Sentinel Universityâ&#x20AC;&#x2122;s Institutional Review Board (IRB) and deemed exempt by the Roseman University of Health Scienceâ&#x20AC;&#x2122;s IRB. Results A Mann-Whitney U test was performed and revealed no significant difference in student satisfaction and self-confidence in WS (Md = 55.5, n = 28) and NS (Md = 60, n = 30), U = 365.500, z = -.804, p = .421 (p >; .05). Even though the finding of the study did not yield a statistically significant difference between the WS and NS groups, both debriefing processes delivered student satisfaction and self-confidence in their learning. The results of the questionnaire for both groups yielded in general, agree to strongly agree answers from the participants. The high scores of the participants suggested that one debriefing method was not better than the other.

Conclusions Overall, the results validate the continued use of best practices during the debriefing experience. While the results did not reveal a statistically significant difference, participants reported satisfaction and selfconfidence in learning. This study expands the research on the critical role of debriefing in improving the learning of undergraduate nursing students.

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54: Hydrocortisone loading dose versus no loading dose followed by maintenance therapy in patients with septic shock Eddy Chan;1 Mark Decerbo;2 Stephen Chromi.3 Author Affiliations 1 MountainView Hospital , PGY1 Pharmacy Residency 2 Roseman University, College of Pharmacy 3 MountainView Hospital Purpose A standardized regimen of intravenous hydrocortisone is used to increase hemodynamic stability in patients that are hemodynamically unstable while on vasopressors when being treated for septic shock.

Data is lacking evaluating the effectiveness of the addition of a loading dose to a standardized regimen of intravenous hydrocortisone. The purpose of this study is to evaluate the efficacy and safety of a loading dose followed by maintenance therapy of intravenous hydrocortisone compared to a standardized regimen of intravenous hydrocortisone for the treatment of septic shock in the intensive care unit (ICU).

Methods This is a retrospective cohort study to be conducted at a 408-bed community teaching hospital. Patients greater than 18 years old, admitted to medical, surgical, or neuro critical care units from January 1, 2018 to Oct 1, 2019 with a diagnosis of sepsis, on one or more vasopressors and antibiotic therapy will be included. Patients who received a loading dose of 200-300 mg intravenous hydrocortisone followed by a maintenance dose of 200-300 mg/day in the ICU will be included in the loading dose group, those receiving 200-300 mg/day without a loading dose will be in the standard therapy group. The primary outcome will be the duration of vasopressor therapy in hours. Secondary outcomes include the rates of adverse events, median days to resolution of shock, mortality, ICU length of stay, and hospital length of stay. A power analysis conducted a priori estimates 1363 patients are needed in each group to detect a difference of 6 hours in duration of vasopressor use, assuming a standard deviation of 55.91 hours with 80% statistical power and an alpha of 0.05. Student t-test and chi square will be used to analyze outcomes for continuous and categorical data, respectively. The Mann Whitney-U test will be done for nonparametric data, as appropriate. The association between outcomes and predictors will be analyzed using Pearsonâ&#x20AC;&#x2122;s correlation or parametric regression analysis.

Results In progress Conclusions In progress

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55: Using Caenorhabditis Elegans as an Experimental Model to Test the Importance of G Protein Coupled Receptor Kinases in Controlling the Heart's Responses to Stress Christian Heilman;1 Janeen Ibarreta;1 Michelle Hon;1 Glecille Ann Salonga;1 Angela Caracci;1 Stacy Henry;1 Tina Nguyen;1 Selina Crivello;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose It is well known that the protein expression of G protein coupled receptor kinase 2 (GRK2) is significantly increased in humans during early stage heart failure. The pharmaceutical applicability of this is unknown. Here, we will use the nematode, Caenorhabditis (C.) elegans, to determine how important G protein coupled receptor kinases (GRKs) are in dealing with stresses that are similar to what the heart is exposed to during heart disease.

Methods C. elegans will be treated to temperatures beyond their usual cultivation temperatures (18-23 degrees Celsius) of 34-37 degrees Celsius for different amounts of time (2-6 hours), and their longevity (aging) and viability behaviors (ie. egg laying) will be quantified.

Results Mutant C. elegans without GRK2 showed increased resistance to heat stress at 34 degrees Celsius for 6 hours compared to N2 (wild type) and GRK1-knockout strain. The GRK2-knockout strain showed increased egg laying post-6 hour stress and also increased viability post-2 or 6 hour stress compared to the other two lines. The GRK2 knockout strain also showed continued growth during the stress, suggesting that it shows increased resistance to stress compared to the others.

Conclusions These results in this report suggest that inhibiting GRK2 in C. elegans increases their viability during and post-heat stress. This may indicate that GRK2 may have a negative impact on survival because of its ability to activate signaling pathways that lead to death in response to the heat stress response. This suggests that, in humans, GRK2 inhibitors may be important to reduce the likelihood of heart failure.

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56: Evaluating the incidence of gabapentin dosing above renal dose recommendations in Veterans Affairs Southern Nevada Healthcare System (VASNHS) Jessica Helou;1 Ted Turner.2 Author Affiliations 1 VA Southern Nevada Healthcare System, PGY-1 Pharmacy Residency Program 2 VA Southern Nevada Healthcare System, Mental Health Pharmacist Purpose Gabapentin is an anticonvulsant commonly used to treat pain. As a medication that is excreted renally, it is important to dose the medication appropriately according to creatinine clearance. If over dosing occurs, serum concentrations may rise and lead to adverse events such as dizziness, ataxia, and nystagmus. The Veterans Affairs Southern Nevada Healthcare System (VASNHS) includes a large geriatric population that is susceptible to reduced renal function and falls. For this reason, it is important to evaluate gabapentin prescribing habits. The purpose of this study is to evaluate the incidence of gabapentin dosing above renal dose recommendations in VASNHS. Methods This quality improvement project was submitted to Veterans Affairs (VA) Office of Research Administration for review and approval. Patients were identified by utilizing the Veterans Information Systems and Technology Architecture (VISTA) program to detect and review patients who were prescribed gabapentin between March 18th 2019 and April 18th 2019. Data was collected via routine patient chart review through the VAâ&#x20AC;&#x2122;s Computerized Patient Record System (CPRS). A total of 1000 patient charts were reviewed for appropriate gabapentin dosing. Data collected included: demographic data, CrCL (mL/min), and gabapentin prescription information. Prescriptions were evaluated for appropriate dosing and those dosed inappropriately according to renal function will be tallied.

The primary outcome of this quality improvement project is to assess the percentage of gabapentin dosing above renal dosing recommendations. Data collection from this project will serve as a basis for future projects to improve prescribing habits of gabapentin at VASNHS. Results In progress Conclusions In progress

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57: The Effects of Model Height on the Thickness of Thermoplastic, Vacuum-formed Orthodontic Appliances Daniel Hoopes;1 Glen Roberson;1 Kishore Chaudhry;1 Karthikeyan Subramani.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose It has been established in the literature that the clinical effectiveness of vacuum-formed orthodontic appliances is dependent upon material thickness. Due to the thermoforming process, there are multiple variables that could impact the thickness of the final appliances such as model height, model angulation, initial material thickness and tooth morphology. This study will answer the following questions: Does model height impact final appliance thickness?

Does model height impact final appliance thickness differently depending on initial material thickness?

What are the effects of model height on thickness in specific regions of the final appliance?

Methods A digital scan of the maxillary arch of a standard typodont will be obtained and models of four different cast heights will be 3D-printed. The cast heights will be 15mm, 20mm, 25mm, and 30mm.

The models will be printed so that the base outlines are identical. The base outline will be traced on the BIOSTAR platform to ensure consistent placement. The machine will then be used to fabricate five appliances in each of the four initial material thicknesses â&#x20AC;&#x201C; 0.5mm, 0.75mm, 1.0mm, and 1.5mm â&#x20AC;&#x201C; for each of the four different cast heights (stated above). The total sample will include 80 appliances. The manufacturer-prescribed BIOSTAR heating times for each of the material thicknesses will be used.

Material thickness measurements from ten different sites on each appliance will be obtained using digital calipers. The sites that will be used will be UR1: mid-incisal, mid-facial, mid-palatal; UR3: cusp, midfacial, mid-palatal; UR6: mesiopalatal cusp tip, buccal pit, mid-palatal (at lingual groove), and central fossa. The data will be inputted to a Microsoft Excel Spreadsheet and then transferred to SPSS after all data are obtained. The data will then be analyzed using Analysis of Variance (ANOVA) and Pearsonâ&#x20AC;&#x2122;s Chi-Squared Test.

Results Data has been gathered but has not yet been analyzed. Preliminary findings suggest that increased model height decreases the appliance thickness and that model height impacts appliance thickness differently depending on the initial material thickness.

Conclusions Based on our anticipated results, our conclusions will include standardized fabrication and assessment guidelines for thermoplastic appliances.

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58: Punch biopsy of breast reveals inflammatory breast cancer with primary lung adenocarcinoma Sarel Iskender;1 Svetlana Villano;1 Priya Nileshwar;1 Sai Karan Guda;1 Scott Silver;1 Lloyd Delmundo;1 Ryan Huang;1 Paul Stewart.1 Author Affiliations 1 Valley Hospital Medical Center, College of Medicine Purpose Breast metastasis from extra-mammary malignancy is rare. Inflammatory breast cancer among the breast cancers is also rare, accounting for 1-5% of diagnosed breast cancers in the US. We present an extremely rare case of a patient with primary lung cancer that spread to the breast in a reverse metastasis pattern.

Punch biopsy of left breast tissue confirmed inflammatory breast cancer revealed lung adenocarcinoma deposits.

Methods 58 year old African American female presented to Valley Hospital complaining of dyspnea worse on exertion for the last several days. CTA reveal diffuse adenopathy and a large right effusion along with diffuse edema of the left breast. She underwent a right US gudied thoracentesis that returned as exudative per Lights criteria. Patients left breast was swollen, warm and tender to touch with skin thickening and no nipple retraction. She was started on Keflex to treat for possible cellulitis. CT results revealed skin thickening involving the left breast concerning for inflammatory carcinoma as well as mediastinal, hilar, axillary and retroperitoneal lymphadenopathy concerning for metastatic lymphadenopathy. Also noted was a masslike consolidation of the right middle lobe. Oncology was consulted and a punch biopsy of the skin overlying her breast was recommended in order to prove dermal lymphatic invasion. Fluid studies from second US thoracentesis were negative for atypical cells therefore patient also underwent EBUS (endobronchial ultrasound) with biopsies of lymph nodes. FNA biopsies from EBUS revealed metastatic carcinoma. Pathology report of the left breast punch biopsy were interpretted as carcinoma cutis, consisitent with lung adenocarcinoma deposits confirmed with CK7 and TTF-1 positive markers. She was diagnosied with primary lung adenocarcinoma with metastasis to the breast manifesting as inflammatory breast cancer.

Results Lung adenocarcinoma in the breast tissue led us to believe patients lung cancer had spread to her breasts, a very rare occurrence.

Conclusions Inflammatory breast cancer is a rare and aggressive form of breast cancer particularly common among younger African American females.Confirmation is made by full thickness punch biopsy of the skin overlying the breast with dermal lymphatic invasion of tumor cells. Treatment varies and prognosis is poor.

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59: Characterization of the Clinical Presentations of Patients with Documented Marijuana Use at the University Medical Center (UMC) of Southern Nevada H Stephen Lee;1 Badrunnisa Hanif;2 Mark Decerbo.1 Author Affiliations 1 Roseman University, College of Pharmacy 2 University of Nevada, Las Vegas, College of Medicine Purpose Marijuana (Cannabis) is a psychoactive chemical substance produced by the Cannabis sativa plant. It is commonly consumed by human through inhalation (e.g. smoking as a cigarette) or by mouth. The primary active ingredient is thought to be deltaâ&#x20AC;?9â&#x20AC;?tetrahydrocannabinol (THC) which can be identified in urine samples. Recreational consumption of marijuana has recently been legalized in the state of Nevada, even though it continues to be classified as a Class 1 controlled substance by the Drug Enforcement Administration (DEA). Despite the many purported therapeutic and beneficial effects of marijuana, the adverse effects from consuming marijuana is not well characterized, especially for those at the adult acute medical setting. The purpose of this study is to identify the clinical presentations for adults with selfreported use of marijuana and the causes of seeking medical care at the University Medical Center (UMC) of Southern Nevada in Las Vegas, NV. Methods This is a retrospective analysis of adult male and female patients presented to the emergency department (ED) of UMC from May to August of 2019. Subjects are identified by positive testing result of THC from urine testing. The medical record during ED stay and the course of the hospital stay of eligible subject is individually reviewed. Specific, targeted findings are identified and analyzed by the investigators.

Results Initial clinical presentations at the ED are recorded, in addition to the admission status, length of stay, and additional clinical presentations. Specifically, neurological symptoms (e.g. altered mental status, seizure, psychosis), gastrointestinal and liver symptoms (e.g. nausea, vomiting, diarrhea, constipation, elevated levels of liver enzymes), pulmonary symptoms (inhalation injury), cardiac abnormalities (e.g. abnormal EKG), as well as evidence or diagnosis of rhabdomyolysis are identified from the patientâ&#x20AC;&#x2122;s inpatient medical record.

Conclusions Findings from this study should enrich our understanding of patients who present with marijuana-related presentations. Better patient care can be established in individuals with recent marijuana use.

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60: The Relationship Between Salivary Estrogen and Testosterone with Height, Weight, and Skeletal Maturation in Orthodontic Patients Payal Patel;1 Kayla Bateman;1 Casey Luu;1 Prashanti Bollu;1 Manas Mandal.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics 2 Roseman University, College of Pharmacy Purpose Cervical Vertebral Maturation Staging (CVMS) is inconsistent in predicting skeletal growth. This study evaluated the potential of salivary estrogen (sE2) and salivary testosterone (sT) as biomarkers for predicting skeletal growth by comparing their changes with skeletal maturation, and changes in height and weight.

Methods Cone beam computed tomography was obtained at initial records (T0) appointment. Saliva sample, height, and weight were obtained at T0 and T1 (1 year after T0). sE2 and sT changes, measured by enzyme-linked immunosorbent assay (ELISA), were compared with changes in height, weight, and initial CVMS. Results Correlation of sT and initial CVMS was poor for females. The largest increase in mean percent change of sT was for patients who were CVMS III at T0. A decline in the mean percent change of sT is observed in patients who were CVMS IV and V. Correlation of sT and initial CVMS was moderate for males, with the largest percent change in sT in patients who were CVMS I at T0. The largest negative percent change occurred for those who were CVMS V at T0. Percent change differences in sE2 are not as large as compared to sT. But overall, there is a decrease in sE2 at each CVMS stage for males and females. With changes in height and weight, there are also changes in sT and sE2; but most of these changes are poorly correlated. Percent change in sT and change in height for males shows moderate correlation.

Conclusions This study suggests a relationship exists between sT with changes in height and initial CVMS for males, but not females. However, the correlation between sE2 with height, weight, and skeletal maturation for both genders is poor. A tightly controlled future study with CVMS at each time point may better reveal utility of sT or sE2 to assess skeletal growth potential in orthodontic patients.

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61: De-escalation of cefepime, meropenem, and piperacillin-tazobactam Arnitta Singh;1 Henry Kim.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose The purpose of doing this Medication Use Evaluation is to reduce resistant rates by the process of pharmacy led de-escalation of three broad spectrum antibiotics: cefepime meropenem piperacillin tazobactam The benefits of de-escalation will be measured by evaluating the decrease in length of hospitalization, improvement in appropriate drug use, and appropriate days of therapy Methods Patients on the fifth floor of a community hospital will be actively looked at for broad spectrum antibiotics and possible deescalations. If patients meet the inclusion and exclusion criteria they will be attempted to deescalate. After three months of deescalation we will see whether this pharmacy led deescalation improved rates or not.

Results In the months of July (half the month) and August as we can see from the tables below, Zosyn was prescribed appropriately in approximately 57% of patients, after several months of observation and physicians being more aware that we are monitoring antibiotics use the number of patients on appropriate Zosyn therapy in October , November and December (quarter of the month) was approximately 80%.

This improvement in appropriateness of use can be observed for cefepime as well.

From the several months of data, it is evident that at least on the fifth floor patients who are on Meropenem, for the most part, have been placed on this therapy appropriately.

Conclusions The biggest issue moving forward is the over prescribing of Zosyn empirically, as observed the amount of Zosyn prescribed was much greater than any of the other antibiotics. Zosyn has both pseudomonas and anaerobic coverage making it an excellent choice for empiric coverage. However, purely because more patients are prescribed Zosyn it becomes a harder task to de-escalate when appropriate, simply due to the large amount of patients, time constraints, and inability to reach various prescribers.

Moving forward, I believe that implementing pharmacy resident led de-escalation during the Infectious Disease rotation should be permanently implemented as part of the daily tasks of this rotation. This MUE has shown that pharmacy led de-escalation has made an improvement in de-escalation rates and overall appropriateness of use.

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62: Survey of Orthodontists that Screen for Obstructive Sleep Apnea in the United States Andrew Triggs;1 Karthikeyan Subramani;1 Kishore Chaudhry;1 Glen Roberson.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose The purpose of this study is to investigate trends across the United States of orthodontist’s preferred screening methods for Obstructive Sleep Apnea (OSA). The objectives are to determine the frequency in which orthodontists are screening their patients for OSA, which screening modalities are most commonly used, the confidence level orthodontists have in screening for OSA, and to determine if there is any correlation between the screening methods used and an orthodontist’s length of time in practice, age, practice setting, practice location, residency location, or number of continuing education hours completed on the subject of OSA post-residency.

Methods The questionnaire was created, reviewed, and approved by the Research Advisory Committee at Roseman University of Health Science’s Advanced Education in Orthodontics and Dentofacial Orthopedics (AEODO) program and subsequently sent to the American Association of Orthodontists’ (AAO) Partners in Research Program for approval. The questionnaire was administered via Qualtrics and disseminated by the AAO’s Partners in Research Program to a random sample of 2,225 orthodontists from their database of 9,558 active orthodontic members in the United States. A sample size of 358 orthodontists was determined to be sufficient for this project. Data will be analyzed using SPSS statistical software; frequency and proportion of similar responses will be calculated for each item on the questionnaire and logistic regression will be used to determine if the different demographic factors were associated with screening for OSA. Significant differences will be identified by Tukey’s multiple comparison procedure.

Results In progress Conclusions In progress

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63: The Current Landscape of College-Sponsored Postgraduate Teaching and Learning Curriculum (TLC) Programs Velliyur Viswesh;1 Amy Sheehan;2 Tracy Sprunger;3 Jacob Gettig;4 Jaclyn Boyle.5 Author Affiliations 1 Roseman University, College of Pharmacy 2 Purdue University, College of Pharmacy 3 Butler University, College of Pharmacy 4 Midwestern University - Chicago, College of Pharmacy 5 Northeast Ohio Medical University, College of Pharmacy Purpose To describe the landscape of college-sponsored teaching and learning curriculum (TLC) programs and evaluate adoption of published best practice recommendations.

Methods A 28-item electronic survey instrument was developed based on AACP, ASHP, and ACCP published best practice recommendations for the conduct of TLC programs. The survey instrument was electronically distributed to 137 accredited colleges and schools of pharmacy in the US. Results A total of 88 institutions responded resulting in a response rate of 64%. Sixty-one TLC programs were included in the final analysis. Use of published best practice recommendations was reported by 75% of TLC programs, with 10% of respondents indicating that they were not aware of the published recommendations. Inconsistencies among programs were noted in required teaching experiences, participant evaluation, and ongoing programmatic assessment.

Conclusions Most institutions offering TLC programs are aware of published best practice guidelines and have adopted a majority of the published best practices. However, considerable variability exists across the country. Development of a formal external validation process for TLC programs is necessary to ensure consistent quality.

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64: Exploring the toxic and developmental effects of antidepressants in caenorhabditis elegans Alexander Bonca;1 Jacquelyn Hyatt;1 Chao Ran Li;1 Danielle Valls;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose In addition to their purported beneficial outcomes, antidepressants also show unpredicted side effects often not seen in humans and animals during the drug development period. These side effects could lead to a future detriment to an individualâ&#x20AC;&#x2122;s financial and social well-being. In this study, we tested if Caenorhabditis (C.) elegans could be a potential model organism to predict possible side effects associated with select antidepressants.

Methods We treated C. elegans with different selective serotonin reuptake inhibitors (SSRIs), fluoxetine and paroxetine, and serotonin norepinephrine reuptake inhibitors (SNRIs), duloxetine and venlafaxine. We then assessed for toxicity, developmental impacts and recovery from toxicity. The results obtained from our toxicity experiments in C. elegans were then compared to that for mice and rats for the same drugs from scientific literature. For our development studies, we treated the worms at different developmental stages in their life cycles (egg, L1-L4, adult) and assessed how they matured. For acute toxicity, we used a range of concentrations on the worms whereas for developmental impacts we used a sublethal dose based on our acute studies.

Results By testing various ways by which toxicity affects C. elegans, we found a variety of different outcomes.

When comparing the acute drug toxicities, we found a dose dependent effect for all the drugs tested except for venlafaxine. When treating L4-staged larvae with drugs and observing their development into adulthood, we found no statistically significant change in the number of adult worms compared to untreated worms. When analyzing egg laying in these treated worms, however, we found a decrease in egg laying in treated compared to their untreated counterparts except for venlafaxine. Finally, when treating worms at earlier stages in their developmental cycle, we found that paroxetine significantly hindered development in all study parameters. Upon removing the growth-stunted, paroxetine-treated worms and placing them in a drug-free environment, they were able to recover and mature similar to that of untreated worms.

Conclusions In this study, we used C. elegans to examine the toxic effects of SSRIs and SNRIs. Our results show that some of these drugs are detrimental with respect to the viability and developmental parameters tested.

What we saw in these nematodes could be predictive for humans. For example, since paroxetine stunts worm development, this could correlate with early fetal development defects seen in human studies when paroxetine is taken in the first trimester of pregnancy. Therefore, because these drugs at high concentrations cause adverse effects in C. elegans, caution may need to be employed when prescribing to patients.

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65: Orthodontistsâ&#x20AC;&#x2122; Preference on type of Fixed Functional Appliance for Skeletal Class II Correction: A Survey Study Sarah Borghei;1 Karthikeyan Subramani;1 Kishore Chaudhry;1 James Broadbent;1 Richard Stevens.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose The purpose of this study is to determine which skeletal Class II functional appliance is most commonly used amongst orthodontists to correct Class II skeletal discrepancies and to determine why orthodontists prefer to use specific functional appliances to correct Class II skeletal discrepancies.

Methods A survey will be developed to elicit information about current methods of preference for Class II skeletal correction using functional appliances. The survey will be e-mailed to 2,300 active orthodontic specialists through the member directory of the AAO selected at random from the 2018 Directory of Members of the American Association of Orthodontists. The surveys will be e-mailed in 2019, utilizing Qualtrics, and those returned/answered will be accepted for the study. Anonymity will be assured as names will not be used in the study except in the e-mail. In addition to asking the age, year of graduation from residency and affiliation with an academic institution, each respondent will be asked their skeletal Class II functional appliance of choice, opinion on functional appliances, and method of skeletal Class II correction. Data analysis will be performed with the Statistical Package for the Social Sciences (SPSS).

Descriptive statistics compiled will include frequencies and means (where appropriate) of responses.

Discontinuation of this study will take place if less there is a less than 5% response rate since that will only include less than 384 responses and will not allow for adequate results.

Results In progress Conclusions In progress

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66: Person-Centered Care in a Long-term Care Facility: Implementing Best Practice Recommendations Tamra Carley.1 Author Affiliations 1 Roseman University, College of Nursing Purpose The purpose of this evidence-based practice project was to implement the 2018 Alzheimer’s Association Dementia Care Practice Recommendations at a long-term care facility to improve person-centered care approaches (PCC) of the direct care providers (DCP) when caring for a person with dementia (PwD).

Methods This project employed a quasi-experimental, pre- and posttest design to measure the intervention effects of PCC approaches by the participants. The intervention consisted of training based on PCC and the CARES approach to dementia care. This evidence-based, interactive program was provided for 12 direct care providers at a long term care facility in a memory care unit. The participants’ perceptions of the presence of PCC was measured using the Person-Centred Care Assessment Tool (P-CAT) prior to the training and 8 weeks after the training was completed. The CARES Observational Tool was used as a formative assessment to evaluate PCC as the participant provided care.

Results The findings of this project indicated that the implementation of the Alzheimer’s Association Dementia Care Practice Recommendation and the CARES Dementia Basics Training program provided DCPs with the knowledge to improve the presence of PCC approaches when caring for the PwD. The participants in this project indicated a statistically significant increase in the extent of PCC 8 weeks after the completion of the training. The changes in the extent of PCC (z = 2.62, p = .009) and the total PCC score (z = 2.56, p = 0.011) were found to be statistically significant.

Conclusions The results of this project indicate that the implementation of best practice recommendations can improve the quality of nursing care and improve the quality of life for the PwD. This project outlines an effective and feasible plan for increasing the nursing staff’s knowledge of PCC and increasing the presence of PCC. The results contribute to the current body of scientific knowledge that training and education can increase the presence of PCC.

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67: A Unique Presentation of an Uncommon Platypnea-Orthodeoxia Syndrome Matthew Hanewich;1 Sai Karan Vamsi Guda;1 Jeremy Oh;1 Mohi Alkadri;1 Anil Fotedar;1 Hooman Sazegar;1 Eugene Van;1 Mark Mckenzie;1 Scott Silver;1 Paul Stewart;1 Alan Walsh.1 Author Affiliations 1 Valley Hospital Medical Center, GME Purpose Platypnea-Orthodeoxia syndrome is characterized by dyspnea that is accentuated by standing or sitting positions due to a marked fall in blood oxygen saturation found in conditions of intracardiac and/or pulmonary shunting. Below, we outline a case of Platypnea-Orthodeoxia syndrome in the setting of large patent foramen ovale, overlaid with right ventricular inflow obstruction (RVIO) due to culture negative infective endocarditis.

Results A 40 year old female presented with progressive dyspnea and severe hypoxia. Patient’s hypoxia did not meaningfully improve with LFNC or with NIPPV. Equalization of PaO2 on VBG and ABG was observed and an intracardiac shunt was suspected. Oxygenation improved when in supine position and her dyspnea reduced. Transthoracic echocardiogram demonstrated a right atrial mass causing obstruction of the right ventricular inflow tract at the site of the tricuspid valve. Transesophageal echocardiogram with agitated saline in addition to an echo dense mass noted on the tricuspid valve also demonstrated a large atrialseptal defect (ASD) creating a bidirectional shunt causing mixing of venous and arterial blood within 2 cardiac beat cycles. The hypoxia in this patient was two-fold. Apart from the decrease in pulmonary blood flow from the RVIO, the large ASD undergoes a change in its original position that puts it directly in line with the blood flow from the inferior vena cava at its entrance into the right atrium causing significant hypoxia. This displacement is much more marked in upright posture1. Patient received surgical excision of the right atrial mass, bovine tricuspid valve replacement, and ASD primary closure. Pathology demonstrated fibrinous material associated with aggregates of neutrophils consistent with septic vegetation. Laboratory investigation did not reveal any typical or atypical organism. Following surgery there was immediate and complete resolution of hypoxemia.

Conclusions Given Platypnea-Orthodeoxia syndrome’s uncommon presentation, combined with its accompanying significant disease processes, even a low suspicion ought to be followed by thorough cardiopulmonary diagnostic modalities. Correction of the patient’s anatomical defects are typically curative, which highlights the necessity for prompt evaluation followed by appropriate specialist consultation.

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68: Using Caenorhabditis Elegans as an Experimental Model to Explore the Role of G Protein Coupled Receptor Kinases in Modulating Responsiveness to Fluoxetine Jacquelyn Hyatt;1 Alexander Bonca;1 Chao Ran Li;1 Danielle Valls;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Overall response to selective serotonin reuptake inhibitors (SSRIs) varies within the population.

However, the factors that may influence drug responsiveness remains unclear. In this study, we explored the role that G Protein Coupled Receptor Kinases (GRKs) may play in modulating responsiveness to fluoxetine. To achieve our goal, we used the model organism, Caenorhabditis (C.) elegans, with or without various GRKs, to determine fluoxetine effectiveness.

Methods In this study, we used C. elegans, wild type and GRK knockout strains (GRK1 and GRK2), to determine if GRKs might affect response to fluoxetine treatment. To accomplish this, we introduced fluoxetine to the worms for 18 hours and then counted the amount of eggs they laid. We then compared this egg laying behavior to that of the untreated worms. In addition, we also analyzed the egg laying ability of previously treated worms when drug administration is discontinued for 18 hours.

Results GRK KO worms had altered egg laying behavior compared to the untreated worms, suggesting that GRKs do play a significant role in the effectiveness of fluoxetine. For instance, in the adult worms chronically treated with fluoxetine, GRK2 KO worms did not seem to produce many more eggs than their untreated brethren, unlike the wild type and GRK1 KO worms. When fluoxetine treatment was discontinued for these adult worms, there was still an increase in egg laying in N2 worms, but GRK1 KO and GRK2 KO worms decreased back to the untreated baseline after 18 hours. These behaviors varied, however, depending on when the worms were given the drug during their development cycle. For the L4 worms chronically treated with fluoxetine, for example, both GRK1 and GRK2 KO worms did not seem to produce many more eggs than their untreated counterparts, unlike the wild type, which demonstrated an increase in egg laying. Interestingly, when fluoxetine treatment was discontinued for these adult worms that were treated at the L4 stage, egg laying in N2 worms not only went back down to baseline after 18 hours, but their egg laying actually decreased even further past the untreated cohort. GRK1 KO and GRK2 KO worms eventually went back down to baseline after 18 hours of discontinued treatment.

Conclusions In this study, we analyzed the serotonin-dependent egg laying behavior in C. elegans in order to investigate whether GRKs may be a factor in fluoxetine effectiveness. Our results show that GRKs do affect egg laying in response to fluoxetine, with effects differing depending on when the worms were exposed. Therefore, these results in C. elegans can potentially be extrapolated to humans, where varying GRK levels in the brain could play an important role in responsiveness to fluoxetine treatment.

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69: Effectiveness of academic detailing in prescribing naloxone to patients with opioid use disorders Ashley Juan;1 William Kuykendall.1 Author Affiliations 1 VA Southern Nevada Healthcare System, PGY-1 Pharmacy Residency Purpose Opioid use disorder (OUD) is a problematic pattern of opioid use that can lead to significant deleterious effects such as physical and psychological impairment or distress. OUD is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. The Veterans Health Administration (VHA) developed the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard to help promote patient-centered care and improve opioid safety. Patients identified through the dashboard are at risk for adverse events such as suicide and drug overdose. In order to implement veteran-centered opioid safety risk mitigation strategies, educational sessions about opioid safety with naloxone were performed through academic detailing. Academic detailing is a service-oriented outreach to health care professionals, providing information and guidance on topics that will help providers make appropriate clinical decisions.

Health care professionals are encouraged to proactively review patient profiles and provide decisions to identify high risk patients who would benefit from receiving naloxone. This project aims to evaluate the effectiveness of academic detailing in naloxone prescribing to OUD patients at VA Southern Nevada.

Methods A cross-sectional study will be conducted to evaluate the effectiveness of academic detailing in naloxone prescribing from August 2019 to December 2019 in patients with OUD. During the study period, academic detailing with information on naloxone prescribing will be utilized as a mitigation strategy for healthcare professionals. Data on the number of actionable patients who are identified as high risk and do not have a naloxone prescription will be collected utilizing the STORM dashboard on a weekly basis.

Data will be analyzed by assessing each actionable patient and identifying the patients type of opioid use disorder. The project will assess multiple factors of academic detailing to include duration of academic detailing, mode of communication, and the type of provider that prescribed the opioid. Other exploratory endpoints that will be analyzed will be other medications that patients have active on their profile that treat OUD other than naloxone. The primary endpoint will be to evaluate the change in number of actionable patients after academic detailing sessions on naloxone prescribing have been completed.

Results In progress Conclusions In progress

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70: A Comparative Study of ClinCheck® Software by Invisalign® providers in the Las Vegas Metropolitan Area Hye Sung Kim;1 Jahnavi Rao;1 Richard Stevens;1 Ji Hyun Ahn.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose Invisalign is used by both general dentists and orthodontists to offer aligners to patients however, the number of general dentist providers far exceeds its orthodontic specialist providers. Every Invisalign provider must be well versed in the use of Invisalign ClinCheck® Software evaluate, modify and treatment plan with virtual models. However, Invisalign providers may overlook the importance of careful assessment of the ClinCheck® virtual models and their set ups during various stages of treatment such as, Initial evaluation, mid-course correction and final refinement. Errors in accuracy of virtual set ups may lead to extended treatment time, increased patient cost, and higher treatment inefficiencies with poor treatment experience. Our study aims to investigate the utilization of ClinCheck® Software by various providers. The purpose of this study is to give information on the frequency and the amount of time Invisalign providers are spending on initial ClinCheck, midcourse correction and final refinement, and evaluate if there are variables such as volume of patients seen per day, providers’ experience with Invisalign, adjustment of fee, and the status of employment that affect an Invisalign provider’s ability to utilize ClinCheck® Software.

Methods In this cross-sectional survey study, a web-based survey of 20 questions, with Qualitrics as the platform, will be emailed to 605 Invisalign providers in the Las Vegas Metropolitan Area (515 general dentists and 90 orthodontists). The resulting data will be analyzed with statistical software, SPSS version 25.0 through Pearson’s Chi-square test in order to study the association among categorical variables of our interest.

Results We expect to see a greater amount of time and a larger number of modifications to be made by orthodontists than general dentists for ClinCheck modifications, probably due to their specialty training and detailed finishing techniques included in their goals of treatment. Likewise, the variables such as volume of patients seen per day and providers’ experience with Invisalign will inversely correlate with the amount of time spent for ClinCheck modification, as the providers will become more accustomed to ClinCheck® Software system, while the variable such as adjustment of fee will positively correlate, since they will be more willing to spend greater time for each Invisalign case after greater compensation.

Conclusions In progress

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71: Utilizing a strategy combining bioinformatics and trend analysis approaches to identify potential g protein coupled receptor kinase substrates among proteins involved in prostate cancer prognosis Chao Li;1 Ashley Namasondhi;1 Kim Le;1 Quoc Do;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Prostate cancer progression is associated with the abnormal functions of various proteins. Understanding if these proteins are phosphorylated by protein kinases, like G protein coupled receptor kinases (GRKs), could be important to determine how to best treat this form of cancer. In this study, we utilize a strategy combining bioinformatics and trends analysis approaches to deduce GRK phosphorylation substrates among proteins linked to either favorable or unfavorable prognosis of prostate cancer.

Methods To carry out our study, Phosphonet, a bioinformatic phosphorylation predictor, was utilized. Data was then compared to spot characteristics that differed the most between the known GRK substrates and the known non-GRK substrate, calmodulin. An algorithm was then developed based on the characteristics that differed the most from the non-GRK substrate. We then used this on proteins that we do not know are phosphorylated by GRKs from a list associated with either favorable or unfavorable prognosis of prostate cancer from Protein Atlas. From this, we obtained a score that would give us an idea of how likely a protein is a GRK substrate. The higher the score, the more likely it is a substrate. We then looked for any common functions associated with proteins that scored the highest within the two prognoses.

Results By using an algorithm derived from exploring the similarities and differences between known GRK phosphorylation substrates, we were able to identify potential GRK substrates among proteins that are known to be associated with either favorable or unfavorable prognosis of prostate cancer. Those found most likely to be GRK substrates among proteins associated with unfavorable prognosis of prostate cancer were involved with DNA and RNA transcription. These include a number of DNA and RNA binding zinc finger proteins. On the other hand, highly likely GRK substrates among proteins associated with favorable prognosis were linked to cell signaling and development. These include proteins such as various enzymes and transmembrane proteins.

Conclusions In this study, we were able to identify potential GRK substrates by utilizing characteristics that differed the most between known GRK substrates and the non-GRK substrate, calmodulin. Amongst the proteins associated with prostate cancer, either favorable or unfavorable, certain proteins were identified that are more likely to be associated with GRKs. Interestingly, their functions correlated with separate cellular processes. These results could indicate that, by using a more comprehensive approach towards bioinformatics that involves trend analysis, we may be able to more succinctly identify functions associated with GRKs in prostate cancer.

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72: Evaluation of anti-inflammatory agents in human and rabbit corneal epithelial cells for the treatment of chronic dry eyes Liang Tea;1 Selina Liang;1 Surajit Dey.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Dry eye disease (DED) occurs when inflammation disrupts the pathway of tear production or when the eye does not make the appropriate type of tears or tear film. Current treatments for DED include synthetic compounds, such as Systane. We looked into three known phytochemicals that have anti-inflammatory properties. Our model compounds were chosen because of their documented and well established anti inflammatory properties. Our study evaluated the safety and toxicity of the three anti-inflammatory agents in human and rabbit corneal epithelial cells for used in the treatment of DED. Methods Curcurmin, tea tree oil and trans caryophyllene were used as model anti inflammatory compounds. These were tested in both human (hPCEC, primary) and rabbit (SIRC, cell line) corneal epithelial cells. We characterized and validated the human corneal cells since this cell type has not been previously used for inflammatory studies in the past. Characterization was done by determining cell morphology and structure, and tight junction functionality was performed using transepithelial electrical resistance (TEER) measurements using an EVOM Epithelial Voltohmmeter. Curcurmin was dissolved in DMSO and then resuspended and diluted in cell culture media. Tea tree oil was dissolved (1:2) in 85% ethanol and diluted in cell culture media. Trans caryophyllene was emulsified and made into a simple oil/water emulsion.

Cell cytotoxicity was performed using at least two different assays and used according to manufacturerâ&#x20AC;&#x2122;s guidelines. Cells were plated in 96 well plates for cytotoxicity and cell proliferation studies. Cytotoxicity and proliferation studies were done at 24, 48 and 72 h respectively with different concentrations of the anti inflammatory agents and samples were read using Spectramax i3x mutliplate reader.

Results Both human and corneal cells were grown to 80 - 90% confluency before all experiments. SIRC cell doubling rate was calculated at 22 (+/-) 1.5 hr whereas hPCEC cells are slow growing cells and the doubling rate was 45 (+/-) 3.2 hr. hPCEC cells showed typical cuboidal epithelial structure and morphology. Since epithelial cells are known to express tight junction protein complexes, we wanted to calculate TEER values across both cell types. 12 well Transwell plates were coated with collagen and fibronectin and cells were grown for approximately 14 days. TEER values were checked everyday and it was found to be around 100 - 120 ohm.cm2. There was no significant increase after 10 days. The optimum safest concentration of curcurmin was found to be 50 microM in hPCEC cells but 75 microM in SIRC cells. This may be due to the difference in tolerance between the two cell types. The optimum safest concentration of tea tree oil and trans Caryophyllene was calculated between 1 - 5%. All three compounds were better tolerated in SIRC cells compared to hPCEC cells.

Conclusions These agents were chosen because of their documented anti-inflammatory effects. The results from this evaluation determined the appropriate safe concentrations for further evaluation in chronic dry eye models. The safe concentrations will be used in our future studies to make ocular formulations for further evaluation in preventing inflammation for DED. Additional studies will also be performed to determine the efficacy of these anti inflammatory agents in animal models.

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73: A survey on microimplant assisted rapid palatal expansion (MARPE) usage and protocols among orthodontists in the United States Alvin Trinh;1 Kishore Chaudhry;1 Ji Hyun Ahn.1 Author Affiliations 1 Roseman University, AEODO/Orthodontics Purpose Microimplant assisted rapid palatal expansion (MARPE) is a relatively new and developing maxillary expansion technique in orthodontics. This technique consists of a rigid appliance that delivers expansion force directly to the hard palate utilizing temporary skeletal anchorage devices. The MARPE concept was created to help reduce undesirable side effects observed from traditional tooth-borne and tooth-and-tissueborne rapid maxillary expansion such as the Hyrax and Haas type expanders. Various MARPE appliance designs exist and different activation protocols are being utilized by orthodontic practitioners. The aim of this study is primarily to better understand MARPE usage prevalence and MARPE protocols utilized by actively practicing orthodontists in the United States. A secondary purpose is to understand why MARPE may not be used by actively practicing orthodontists in the United States.

Methods A survey will be sent to actively practicing U.S. orthodontists who are members of the American Association of Orthodontists (AAO) via email by AAO Partners in Research. Exclusion criteria include retired orthodontists, orthodontists who are not actively practicing, orthodontic residents, and orthodontists outside of the U.S. AAO members who are not orthodontists will also be excluded. The survey will be a questionnaire with multiple choice, fill-in-the-blank, and ranking questions regarding MARPE usage and protocols. Survey responses will be evaluated, and statistical analyses of the responses will be conducted using SPSS Statistics (version 25).

Results Expected results: Younger orthodontists are more likely to use MARPE in their practices. Orthodontists practicing in a corporate setting are less likely to use MARPE, while orthodontists working in academic settings are more likely to implement MARPE. Tooth-bone-anchored MARPE is the most common type of MARPE appliance design. Lack of training or education on MARPE and risk of complications and invasiveness of MARPE will be the top two reasons why orthodontic practitioners choose not to utilize MARPE. Conclusions In progress

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74: Exploring the Effects of Adding Amlexanox to Paclitaxel and Cisplatin Treatments in Killing Cervical Cancer HeLa Cells.

Ashley Zendejas;1 Trang Gonzalez;1 Chuc Phan;1 Netsanet Bedasso;1 Christopher So.1 Author Affiliations 1 Roseman University, College of Pharmacy Purpose Cervical cancer is one of the deadliest forms of cancer. Improvements have been made in the past several years to treat this form of cancer. One notable strategy is to combine drugs, like chemotherapies, to improve therapeutic outcomes. Another strategy is to add inhibitors of pathways that lead to chemotherapeutic resistances to pre-existing treatment regimens. One such drug that has recently been of interest as a drug to evaluate for this purpose is the anti-inflammatory agent Amlexanox. In this study, we co-treated this drug with 2 drugs commonly used to treat cervical cancer- cisplatin and paclitaxel- to determine if it increases the effectiveness of these chemo drugs to kill cervical cancer HeLa cells.

Methods In this study, we treated cervical cancer HeLa cells with either Amlexanox alone (24 hours), 24 hours before or with the chemotherapeutics (Cisplatin or Paclitaxel, 72 hours) and assayed for cell death and cell number with trypan blue exclusion under light microscopy.

Results In this study, treatment with Amlexanox with the chemotherapeutics did not lead to increased cell death.

Amlexanox was able to, by itself, kill cells but at high concentrations. When given at low concentrations that did not cause cell death, increased cell death compared to chemotherapeutics alone was not seen when either Amlexanox was co-treated with the drugs or Amlexanox was given first followed by the drugs. However, we saw that there was an increased in cell number when given with cisplatin when Amlexanox was given first. These cells continued to live, but did not grow, 72 hours post treatment.

Conclusions In this study, we queried if Amlexanox can increase the effectiveness of cisplatin and paclitaxel in killing cervical cancer cells. In this study, we observed that this drug did not increase the effectiveness of either drug in causing cell death. There was more cells that remained after the treatment. This suggests that, potentially, the addition of Amlexanox may have improved survival of cancer cells treated with cisplatin and paclitaxel. This may suggest that Amlexanox may not be a good drug to add in combination with cisplatin and paclitaxel.

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2020 Sponsors

Presenting Sponsor MedQuest Pharmacies

Hospitality Sponsor US Bank

Speaker and Awards Sponsor doTERRA

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Roseman University Research Symposium Organizing Committee South Jordan Campus Tressa McMorris, PharmD, BCPS – Chair College of Pharmacy Lana Crichton, BA Chancellor’s Administrative Assistant Claudia M. Tellez Freitas, PhD College of Dental Medicine Siddharth Kesharwani, PhD College of Pharmacy

Phillip Lawrence, PharmD College of Pharmacy Shamar Lejardi, RN, MSN-L College of Nursing Rachael Thomas, BA Marketing

Henderson Campus Dr. David B. Rawlins, PhD – Chair College of Pharmacy Christopher So, PhD College of Pharmacy Arup Chakraborty, PhD College of Pharmacy Mickayla Clark, PharmD College of Pharmacy Kristi Singer College of Pharmacy Dawn Benson College of Pharmacy

Jené Hurlbut, RN, MSN, MS, PhD, CNE College of Nursing Kishore Chaudry, MD College of Dental Medicine Anna Ferri, MLIS Research and Learning Librarian Nancy Crabtree, MLIS Research and Learning Librarian Joslyn Hatfield Marketing

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