# East Carolina University

• Greenville, NC, United States
Recent publications
The timing of immune-related adverse events (irAE) associated with immune checkpoint inhibitors (ICI) is highly variable. Although the development of irAE has been associated with ICI clinical benefit, how irAE timing influences this association is unknown. We analyzed two independent cohorts including 154 patients with non-small cell lung cancer (NSCLC) treated with PD-1/PD-L1 inhibitors at a single institution (UTSW cohort) and a multi-center cohort of 433 patients with NSCLC who received second-line anti-PD-1/PD-L1 therapy (Global cohort) to assess the association between ICI outcomes and irAE timing. In both cohorts, late-onset irAE occurring more than 3 months after ICI initiation compared to irAE occurring earlier were associated with greater rates of radiographic response (UTSW cohort, 41% versus 28%, P = .26; Global cohort, 60% versus 35%, P = .02), longer progression-free (UTSW cohort, 13.7 versus 5.6 months, P < .01; Global cohort, not reached versus 6.0 months, P < .01) and overall survival (UTSW cohort, 30.9 versus 14.6 months, P < .01; Global cohort, not reached versus 10.6 months, P < .01). Modified landmark analysis at 6 months confirmed an overall survival difference between early- and late-onset irAE. Late-onset irAE was similarly associated with greater response rates and prolonged survival in a cohort of 130 patients with non-NSCLC malignancies, suggesting a conserved association across tumor types. The favorable association between irAE and ICI clinical outcomes may be attributed to later-onset events, which is not wholly explained by survivor bias. These results allude to a distinct biology between early- and late-onset irAE and may guide clinician expectations and thresholds for continuing or modifying immunotherapy.
Background: Delirium-related biochemical derangements lead to electrical changes that can be detected in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. Studies using limited lead EEG show a large difference between patients with and without delirium while discriminating delirium from other causes. Handheld rapid EEG devices may be capable of detecting delirium before symptom onset, thus providing an objective physiological method to detect delirium when it is most amenable to interventions. Objective: The aim of this study was to explore the potential for rapid EEG to detect waveform pattern changes consistent with delirium status. Methods: This prospective exploratory pilot study used a correlational design and mixed models to explore the relationships between handheld portable EEG data and delirium status. Results: While being under powered minimized opportunities to detect statistical differences in EEG-derived ratios using spectral density analysis, sleep-to-wake ratios tended to be higher in patients with delirium. Conclusions: Limited lead EEG may be useful in predicting adverse outcomes and risk for delirium in older critically ill patients. Although this population is at the highest risk for mortality, delirium is not easily identified by current clinical assessments. Therefore, further investigation of limited lead EEG for delirium detection is warranted.
Photodynamic therapy (PDT) utilizes photosensitizers (PSs) to produce reactive oxygen species (ROSs) upon irradiation, which causes the shutdown of vessels and deprives the tumor of nutrients and oxygen, and in turn induces adverse effects on the immune system. However, significant efforts are needed to increase the efficiency in PDT in terms of light delivery to specific PSs for the clinical treatment of tumors located deep under the skin. Even though PDT offers a disease site-specific treatment modality, current efforts are directed to improve the solubility (in body fluids and injectable solvents), photostability, amphiphilicity (for tissue penetration), elimination, and systemic toxicity of traditional PSs based on porphyrin derivatives. Nanostructured materials show promising features to achieve most of such combined efforts. They can be artificially engineered to carry multiple theranostic agents onto targeted tumor sites. However, recent studies on photosensitive Cd-based nanostructures, mostly used in PDT, indicate that leeching of Cd ²⁺ ions is stimulated when they are exposed to harsh biological conditions for continuous periods of time, thus making them acutely toxic and hindering their applications in in vivo settings. Since nanostructured materials are not completely immune to degradation, great strides have been made to seek new alternatives. In this review, we focus on the latest advances of Cd-free nanostructured metal transition sulfides (MTSs) as alternative PSs and study their high-energy transfer efficiency, rational designs, and potential applications in cancer-targeted PDT. Nanostructured MTSs are discussed in the context of their versatility to serve as phototherapy agents and superior properties, including their strong absorption in the NIR region, excellent photothermal conversion efficiency, controlled reactive oxygen species (ROS) production, versatile surface chemistry, high fluorescence, and structural and thermal stability. We discuss the latest advancements in correlating the self-aggregation of MTSs with their passive tumor cell targeting, highlighting their ability to efficiently produce ROSs, and mitigating their dark toxicity through polymeric functionalization. Treatment of deep-seated tumors by using these PSs upon preferential uptake by tumor tissues (due to the enhanced permeability and retention effect) is also reviewed. We finally summarize the main future perspectives of MTSs as next-generation PSs within the context of cancer theranostics. Graphical Abstract
Background Environmental health agencies are critical sources of information for communities affected by chemical contamination. Impacted residents and their healthcare providers often turn to federal and state agency webpages, fact sheets, and other documents to weigh exposure risks and interventions. Main body This commentary briefly reviews scientific evidence concerning per- and polyfluoroalkyl substances (PFAS) for health outcomes that concern members of affected communities and that have compelling or substantial yet differing degree of scientific evidence. It then features official documents in their own language to illustrate communication gaps, as well as divergence from scientific evidence and from best health communication practice. We found official health communications mostly do not distinguish between the needs of heavily contaminated communities characterized by high body burdens and the larger population with ubiquitous but substantially smaller exposures. Most health communications do not distinguish levels of evidence for health outcomes and overemphasize uncertainty, dismissing legitimate reasons for concern in affected communities. Critically, few emphasize helpful approaches to interventions. We also provide examples that can be templates for improvement. Conclusions Immediate action should be undertaken to review and improve official health communications intended to inform the public and health providers about the risks of PFAS exposure and guide community and medical decisions.
Studies of word class processing have found verb retrieval impairments in individuals with primary progressive aphasia (Bak et al., 2001; Cappa et al., 1998; Cotelli et al., 2006; Hillis, Heidler-Gary, et al., 2006; Hillis, Oh, & Ken, 2004; Marcotte et al., 2014; Rhee, Antiquena, & Grossman, 2001; Silveri & Ciccarelli, 2007; Thompson, Lukic, et al., 2012) associated primarily with the agrammatic variant. However, fewer studies have focused on verb comprehension, with inconsistent results. Because verbs are critical to both production and comprehension of clauses and sentences, we investigated verb processing across domains in agrammatic, logopenic, and semantic PPA and a group of age-matched healthy controls. Participants completed a confrontation naming task for verb production and an eye-tracking word-picture matching task for online verb comprehension. All PPA groups showed impaired verb production and comprehension relative to healthy controls. Most notably, the PPA-S group performed more poorly than the other two PPA variants in both domains. Overall, the results indicate that semantic deficits in the PPA-S extend beyond object knowledge to verbs as well, adding to our knowledge concerning the nature of the language deficits in the three variants of primary progressive aphasia.
Background Functional Near-Infrared Spectrometry (fNIRS) is a novel neuroimaging method that can detect brain activity during functional activities. The prefrontal cortex and supplemental motor area (SMA) are active during normal and fast speed walking. However, it is unclear how age difference affects brain activity in the dorsolateral prefrontal cortex (DLPFC) and SMA when walking at different speeds. The purpose of this study was to investigate the age differences in DLPFC and SMA activation during different walking speeds. Method 10 younger (5F; 25 ± 8 y.o.) and 10 older adults (5F; 73 ± 6 y.o.) completed three visits in this study. Functional Near-Infrared Spectroscopy was used to detect hemodynamic changes on right and left hemispheres over the DLPFC and SMA during self-selected slow, preferred, and fast walking speeds. Results The results showed significantly increased DLPFC and SMA activity in older adults compared to younger adults when walking at preferred normal, fast, and slow speeds. Older adults also had a higher left DLPFC activation during preferred fast walking speed than younger adults. Conclusion The results suggest that there are age differences in the DLPFC and SMA activation, with older adults demonstrating increased DLPFC and SMA activity across all walk conditions compared to younger adults. This may indicate older adults require higher cognitive demand and need to recruit indirect motor pathways when changing gait speed by increasing SMA activation.
Adolescent and young adult (AYA) patients diagnosed with cancer, and their caregivers, experience a wide range of biopsychosocial stressors. The systemic transactional model Bodenmann in Swiss J Psychol 54: 34–49, 1995 posits that distress and coping are interrelated when close relationships are faced with a shared stressor. This study’s purpose was to understand the interrelated nature of distress and coping among AYA cancer patients and their caregivers. The research questions were: (a) What are the within sample and dyadic outcomes associated with distress and coping strategies among matched AYA oncology patients and caregivers? and (b) To what extent will patient and caregiver engagement predict patient and caregiver distress, as well as the patient problem list? A descriptive, cross-sectional design was utilized to collect data from 19 matched patient-caregiver dyads. Outcome variables included: (a) distress, (b) patient perceived problems, and (c) perceived stress. Predictor variables included: (a) coping styles, (b) relational assessment, and (c) caregiver burden. Actor-partner interdependence modeling revealed: (a) patients’ and caregivers’ use of engagement style coping strategies has a positive impact on patients’ distress, while caregivers’ use of engagement style coping strategies also has benefits for their own distress, (b) caregivers’ use of engagement style coping strategies may help reduce patients’ endorsement of biopsychosocial or practical problems, and (c) greater use of disengagement style coping strategies may decrease caregivers’ endorsement of issues included on the patient’s problem list. Future researchers are recommended to further investigate cancer as a relational illness. Clinicians and health policy makers are encouraged to develop policies and protocols toward treating the relational unit as the standard of care rather than as the exception.
The current study explored customers' psychological responses caused by biophilic design in the context of hotels and investigated the relationship between self-image congruity, delight, and subjective well-being of hotel guests. Based on a 2 × 2 between-subject experimental design, 390 participants were randomly assigned to different manipulated conditions. Data were subjected to ANOVA, and the results show non-significant differences between biophilic elements and customer psychological reactions and subjective well-being. Moreover, the findings evoked that customer self-image congruity and delight evoked subjective well-being through regression analysis. Theoretical and managerial implications are also discussed.
Purpose Although significant racial and ethnic disparities exist in colorectal and lung cancer treatment and survival, racial differences in patient-reported experience of care are not well understood. The purpose of this study was to examine differences in patient-reported ratings of colorectal and non-small-cell lung cancer care by race/ethnicity. Methods Medicare beneficiaries with AJCC stage I–IV colorectal and non-small-cell lung cancer (2003–2013) who completed a Medicare Consumer Assessment of Healthcare Providers (CAHPS) survey within 5 years of cancer diagnosis were identified in the linked SEER-CAHPS dataset. Scores were compared by race/ethnicity, defined as White, Black, or any other race/ethnicity. Results Of the 2,621 identified patients, 161 (6.1%) were Black, 2,279 (87.0%) White, and 181 (6.9%) any other race/ethnicity. Compared to White patients, Black patients were younger, had lower educational level, and had higher census tract poverty indicator (p < 0.001). Black patients rated their ability to get care quickly significantly lower than White patients (63.5 (SE 3.38) vs. 71.4 (SE 2.12), p < 0.01), as did patients of any other race/ethnicity (LS mean 66.2 (SE 2.89), p = 0.02). Patients of any other race/ethnicity reported their ability to get needed care significantly lower than White patients (LS mean 81.9 (SE 2.46) vs. 86.7 (SE 1.75), p = 0.02); however, there was no difference in ability to get needed care between Black and White patients. Conclusion Patient ratings for getting care quickly were lower in non-White patients, indicating racial disparities in perceived timeliness of care.
Despite patients having increased access to their own electronic health record (EHR) in recent times, patients are often still not considered a primary audience of pathology reports. An alternative to in-person patient education is the use of multimedia programming to enhance health literacy. Curated video presentations designed to explain diagnosis-specific pathology terms were reviewed by a board-certified pathologist and oncologist team and then shown to patients with a primary diagnosis of either pancreatic, colorectal, or prostate cancer in-clinic; these patients then completed a secure electronic survey immediately afterwards. Seventy patients were surveyed, with 91% agreeing or strongly agreeing that the video they watched increased their understanding of the medical terms used in their pathology reports, with a corresponding average Likert score (ALS) of 4.21 (SD = 0.77, CI = ± 0.18). Furthermore, 95% agreed or strongly agreed that the video they watched both enhanced their understanding of the role of the pathologist in diagnosing cancer (ALS = 4.27; SD = 0.65, CI = ± 0.15) and reported they found the video useful (ALS = 4.27; SD = 0.53, CI = ± 0.13). Curated videos such as those utilized in this study have the potential to increase patient health literacy and inform patients of the multidisciplinary nature of cancer diagnosis.
This research compares the relationship experiences, beliefs, and intentions related to love and romantic relationships of 75 individuals who indicated they were asexual (from a sample of 2,665 young adults) with subsamples of individuals who indicated they were either heterosexual, bisexual, or gay/lesbian. Identifying as asexual generally associated with having generally less-romantic beliefs and less interest in marriage and parenthood. The asexual group also tended to have more in common with other sexual minority groups than with the heterosexual group. Multivariate analyses revealed that asexuality was especially associated with being single and with seeing oneself living with one’s parents after college.
Background Patients with end-stage kidney disease (ESKD) may choose to undergo dialysis in-center or at home, but uptake of home dialysis in the US has been minimal despite its benefits over in-center dialysis. Factors that may have led patients to select home dialysis over in-center dialysis are poorly understood in the literature, and interventions to improve selection of home dialysis have focused on patient knowledge and shared decision-making processes between patients and providers. The purpose of this study was to explore micro- and macro-level factors surrounding dialysis modality decision-making among patients undergoing in-center and home dialysis, and explore what leads patients to select home dialysis over in-center dialysis. Methods Semi-structured qualitative interviews were conducted in a dialysis clinic at a large Midwestern research hospital, from September 2019 to December 2020. Participants were 18 years or older, undergoing dialysis for ESKD, and had the cognitive ability to provide consent. Surveys assessing demographic and clinical information were administered to participants following their interviews. Results Forty patients completed interviews and surveys (20 [50%] in-center dialysis, 17 [43%] female, mean [SD] age, 59 [15.99] years). Qualitative findings suggested that healthcare access and engagement before entering nephrology care, after entering nephrology care, and following dialysis initiation influenced patients’ awareness regarding their kidney disease status, progression toward ESKD, and dialysis options. Potential modifiers of these outcomes include race, ethnicity, and language barriers. Most participants adopted a passive-approach during decision-making. Finally, fatigue, concerns regarding one’s dialyzing schedule, and problems with fistula/catheter access sites contributed to overall satisfaction with one’s dialysis modality. Conclusions Findings point to broader factors affecting dialysis selection, including healthcare access and racial/ethnic inequities. Providing dialysis information before entering nephrology and after dialysis initiation may improve patient agency in decision-making. Additional resources should be prioritized for patients of underrepresented backgrounds. Dialysis decision-making may be appropriately modeled under the social-ecological framework to inform future interventions.
Objective To ascertain the completeness of reporting of uveal melanoma cases in North Carolina to the state’s cancer registry. Methods This was a retrospective chart review performed at a single institution analyzing the completeness of information reported to the North Carolina Cancer Registry between 2010 and 2015. A list of all patients with uveal melanoma diagnosed, treated and/or followed at UNC-Chapel Hill between 2010-2015 was compared to the list of patients with uveal melanoma reported to the North Carolina Central Cancer registry during the same time frame. Results Based on ICD 9 and 10 codes, there were 66 patients with ciliary body or choroidal melanomas diagnosed, followed and/or treated at UNC between 2010 and 2015. Of those, 41 (62%) were on the list of cases reported through the UNC Cancer Registry to the NCCCR. A chart review of the excluded cases was performed and the following barriers to reporting of uveal melanoma were identified: lack of diagnostic imaging results, lack of histopathologic confirmation, inconsistent language used to communicate diagnosis, and lack of implementation of the North American Association of Central Cancer Registries’ National Interstate Data Exchange Agreement. Conclusion The diagnosis and treatment of uveal melanoma is unique when compared to other types of cancers. Diagnosis is based on clinical features and characteristic findings on ophthalmic imaging and ultrasound. There is often no pathology report or radiologic imaging which makes it difficult for hospital registrars to recognize and confirm cases of uveal melanoma. This creates significant barriers to reporting cases to state and national cancer registries. The incomplete data makes it difficult to detect changes in the incidence of uveal melanoma in North Carolina. The development of a national uveal melanoma registry should be seriously considered.
Background: Hatha yoga programs have been shown to be effective at improving low back pain among a variety of populations; however, methods to decrease low back pain of university office employees have not been studied. Objective: To examine the impact of an 8-week hatha yoga intervention on measures of health among university office employees. Method: Seven participants completed the 8-week yoga intervention. All measures, including anthropometric measures and online questionnaires, were completed at baseline and post-intervention. Results: Baseline pain intensity (6.6±3.1) and pain interference (15.6±4.7) reflected a moderate level of back pain and moderate to severe interference. Pain intensity showed a non-significant improvement with medium-to-large effect size [p = 0.07, (d = 0.7)]. There was a significant improvement with a large effect size [p = 0.002, (d = 2.4)] in pain interference. Baseline anxiety (7.4±3.6) reflected a borderline abnormal symptom level, but anxiety significantly reduced to normal levels at post-intervention with a medium effect size [p = 0.002 (d = 0.5)]. Focus group themes were improvements in health and development of a sense of community. Conclusions: Hatha yoga may be an effective mode of low-impact physical activity to decrease pain and improve mental health while facilitating a sense of community for office workers employed by a university. This study demonstrates promising results with large effect sizes; however, more research with larger sample size and randomized treatment and control groups are needed for future study efforts.
The purpose of this study is to explore the impact of persistence within STEM learning environments as a function of cumulative stress and latent trauma. The biopsychosocial impact of prolonged stressors due to hostile environments and academic demands has deleterious health effects on historically underrepresented students who enter STEM disciplines. The Trauma Symptoms Checklist for Children, clinical histories, and psychophysiomeasurement tools were used to measure the effects of cumulative stress and latent trauma as historically underrepresented students persisted through high school STEM discipline classes. Elevated responses on the inventory and history were triangulated through measures of biological markers for cumulative stress and developed into a profile combination of traits to identify those students likely to show symptomology consistent with the negative effects of cumulative stress and latent trauma. Examination of these outcomes using a latent class profile analysis model suggested the presence of cumulative stress resulting from program participation was significant.
Since 2000, robotic-assisted surgery has rapidly expanded into almost every surgical sub-specialty. Despite the popularity of robotic surgery across the United States, a national consensus for standardized training and education of robotic surgeons or surgical teams remains absent. In this quality improvement initiative, a novel, stepwise iterative Robotic Assistant Surgical Training (RAST) curriculum was developed to broaden and standardize robotic bedside assistant training. Thirteen voluntary participants, capable of fulfilling the bedside assistant role, were evaluated to determine if RAST enhanced the learner’s self-perceived level of confidence and comfort in their role as bedside assistant. A pre- and post-RAST training survey and a between-stages repeated-measures survey were conducted. All learner participants reported statistically significant increases in confidence and comfort after RAST training, (p = < 0.001), and between each stage, F (2, 24 = 60.47, p < .001; $$\eta_{{\text{p}}}^{2}$$ = 0.834). Participant feedback regarding curriculum improvement was obtained, suggesting the desire for more training and practice, in smaller groups of 2–3 participants. One hundred percent of participants felt RAST was beneficial and that it should be implemented as standardized training during onboarding for all robotic bedside assistants. Thus, a standardized, stepwise iterative robotic bedside assistant curriculum increases learner preparedness, comfort, and confidence, safely away from the patient bedside.
Numerous advancements have been made regarding how aspects of job roles and organizational environments affect work attitudes. However, less attention has been devoted to factors that might buffer attitudes against the adverse effects of job and organizational stressors. Grounded in the Buffering Hypothesis, we tested focus-matched hypotheses that considered the moderating roles of two workplace social resources—leader–member exchange (LMX) and perceived organizational support (POS)—in the relations between job and organizational stressors and job satisfaction and organizational commitment. Using multi-wave data from a sample of financial services employees (n = 1921), we found that independently, LMX did not buffer against the negative effects of job stressors (i.e., role ambiguity and role conflict) on employee attitudes, nor did POS buffer against the effects of organizational stressors (i.e., low communication and ethical climates). Rather, only in conjunction did high LMX and POS jointly reduce the negative effects of job stressors on organizational commitment. When examining the three-way interactions among job stressors, LMX, and POS, POS was significantly more influential in buffering organizational commitment than was LMX, although there were interesting nuances to these effects. In particular, role ambiguity affected commitment most negatively when either LMX or POS (but not both) was lacking, whereas role conflict did not appreciably impair commitment when POS was high, even if LMX was low. We discuss the theoretical and practical implications of our result patterns.
We examined support for type 1 diabetes in casual versus committed romantic relationships and links to blood glucose, self-care, and affect in 101 young adults (Mage 18.8). Individuals provided survey and daily measures of support and blood glucose and affect during a 14-day diary period. Survey data indicated individuals viewed partners as helpful, with partners in committed relationships rated more helpful than those in casual relationships. Daily assessments indicated partners were seen as only moderately helpful. Individuals in committed relationships discussed diabetes with partners on more diary days than those in casual relationships. When individuals in any relationship type experienced more helpful partner support than their average, they reported higher positive and lower negative affect. However, those in casual relationships also experienced more negative affect and higher mean blood glucose the next day. Results suggest tradeoffs between immediate benefits and subsequent costs of partner support to adults in casual relationships.
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