Norma Ketchum

University of Texas Health Science Center at San Antonio | UT HSC

Background: Without reconstruction, mastectomy alone can produce significant detrimental effects on health-related quality of life. The magnitude of quality-of-life benefits following breast reconstruction may be unique based on timing of reconstruction. Facilitated by the BREAST-Q questionnaire, characterization of how reconstruction timing diffe...

Background: Operative morbidity is a common yet modifiable feature of complex surgical procedures. With increasing case volume, improvement in morbidity has been reported through designated procedural processes and greater repetition. Defined as a volume-outcome association, improvement in breast reconstruction morbidity with increasing free flap...

Previously an increased risk for monoclonal gammopathy of undetermined significance (MGUS), a precursor of multiple myeloma (MM), was reported among Vietnam veterans exposed to Agent Orange and its contaminant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Dysregulated expression of certain microRNAs (miRNAs) was demonstrated in MGUS and MM. Given the...

Comparison of cardiovascular disease (CVD) risk calculators in Latinx majority populations living with HIV can assist clinicians in selecting a calculator and interpreting results. 10-year CVD risks were estimated for 652 patients seen ≥ 2 times over 12 months in a public clinic using three risk calculators: Atherosclerotic CVD risk Calculator (ASC...

Introduction: Breast reconstruction plays a significant role in breast cancer treatment recovery. Introduction of the BREAST-Q questionnaire has facilitated quantifying patient-reported quality of life (QOL) measures promoting improved evidence-based clinical practice. Effects of body mass index (BMI) on patient-reported outcomes and health-relate...

Purpose The number of in vitro fertilization (IVF) cycles is increasing and the majority of patients undergoing IVF pay out of pocket. Reproductive endocrinology and infertility practitioners employ different business models to help create financial pathways for patients needing IVF but details regarding the different types of business models being...

Background Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic condition arising from clonal plasma cells and has the risk of transformation to multiple myeloma (MM). Dysregulated expression of microRNAs (miRs) has been well demonstrated in MM, but miRs are not as well characterized in MGUS. We previously found an increased...

PurposeLocation of the primary tumor is prognostic and predictive of efficacy with VEGF-inhibitors (I) versus EGFR-I given first-line to metastatic colorectal cancer (mCRC) patients. However, little is known regarding the effect of location on prognosis and prediction in refractory mCRC. We assessed the efficacy of VEGF-I and EGFR-I in regards to l...

Background: Accurate breast cancer staging is essential for optimal management of adjuvant therapies. While breast lymphatic drainage involves both axillary and internal mammary (IM) lymph node (LN) basins, IM LN sampling is not routinely advocated. The current study analyzes the incidence of IM LN metastases sampled during free flap breast recons...

430 Background: Sorafenib is the only FDA-approved systemic therapy for advanced HCC. The incidence of HCC increases with age, peaking above 70 years; however, we have limited efficacy and safety data in the elderly. Given the prevalence of HCC in South Texas, we assessed the efficacy and safety of sorafenib in the elderly. Methods: Retrospective a...

784 Background: Current clinical trial data are largely driven by younger participants, yet half the population diagnosed with CRC are 70+. Upon progression, many CRC patients (pts) with refractory cancer are referred to phase 1 clinical trials; however, tolerability and clinical benefit is unclear in the elderly. Given our robust phase 1 program,...

Introduction: Cancer screening reduces mortality rates for breast, cervical, and colon cancer. Yet cancer screening rates for Latina women are lower than for non-Latino Whites, and below Healthy People 2020 goals. Additionally, Latinos face many health care access barriers. This study examined health care access and utilization in relation to canc...

Prescription opioid misuse is a rising epidemic in the U.S., and people living with HIV are at increased risk. We assessed the association between prescription opioid use and virologic failure in HIV+ patients in the South Texas HIV Cohort. We found prescription opioid use was significantly associated with virologic failure, after adjustment for ag...

Background Acute infections with Mycoplasma pneumoniae (Mp) have been associated with worsening asthma in children. Mp can be present in the respiratory tract for extended periods; it is unknown whether the long-term persistence of Mp in the respiratory tract affects long-term asthma control. Objective To determine the effect of Mp on asthma contr...

HIV disproportionately affects racial/ethnic minorities and individuals living in the southern United States, and missed clinic visits account for much of this disparity. We sought to evaluate: (1) predictors of missed initial HIV medical visits, (2) time to initial visit, and (3) the association between initial visit attendance and retention in HI...

771 Background: Location of the primary tumor is prognostic and predictive of efficacy with VEGF-inhibitors (I) vs EGFR-I given first-line to mCRC patients (pts) (ASCO 2016). However, little is known regarding the effect of location on prognosis and prediction in heavily pretreated mCRC pts. We assessed the efficacy of VEGF-I and EGFR-I in regards...

Research suggests that mental health workers are at high risk for burnout, and that burnout can increase staff turnover and reduce quality of care. The Veterans Administration (VA) employs over 3000 psychiatrists across the United States, but little is known about burnout in this population. This study was conducted to examine predictors of burnout...

Importance: Multiple myeloma has been classified as exhibiting "limited or suggestive evidence" of an association with exposure to herbicides in Vietnam War veterans. Occupational studies have shown that other pesticides (ie, insecticides, herbicides, fungicides) are associated with excess risk of multiple myeloma and its precursor state, monoclon...

Sorafenib is the only FDA-approved systemic therapy for advanced hepatocellular carcinoma (HCC). In clinical practice, dose reductions are often required, although there are limited efficacy data related to dose modifications. Given the prevalence of HCC in South Texas, we assessed the efficacy and safety of sorafenib therapy in relation to dose an...

Bisphosphonate-induced osteonecrosis of the jaw (BONJ) represents a growing concern for dentists and patients in that it may alter clinical care. This study assessed the knowledge and perceptions of practicing dentists in relation to the risk of BONJ and how their knowledge and perceptions influence their decisions when developing treatment plans....

This preliminary study examined the relationship between burnout and the use of evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) among Veterans Health Administration (VHA) mental health clinicians. Recruitment was directed through VHA PTSD Clinical Teams (PCTs) across the United States based on a nationwide mailing lis...

Objective Prolonged exposure (PE) and cognitive processing therapy (CPT) – post-traumatic stress disorder (PTSD) treatments now available at the Veterans Health Administration (VHA) – expose the provider to graphic traumatic material. Little is known about the impact of traumatic material on VHA providers. The purpose of this study was to examine t...

369 Background: Sorafenib (SOR) is the only FDA-approved systemic therapy for advanced hepatocellular carcinoma (HCC). In clinical practice, there are limited efficacy data related to dose modifications, which are often required. Given the high prevalence of HCC in South Texas, we assessed the efficacy and safety of SOR therapy in relation to dose...

In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Department of Veterans Affairs (VA) has sought to make evidence-based psychotherapies for PTSD available at every VA facility. We conducted a national survey of providers within VA PTSD clinical teams (PCTs) to describe utilization of prolonged exposure (P...

U.S. Latinas have lower cervical cancer (CC) screening rates (75% screened within the past 3 years) compared to Healthy People 2020 goals (93% of women screened). Latinas’ low screening rates stem from barriers such as language, access to health care, and lack of insurance and knowledge—studies even found that Latinos have not heard of and cannot i...

Melanomas are vascular tumors with a high incidence of BRAF mutations driving tumor proliferation. Complete inhibition of vascular endothelial growth factor (VEGF) signaling has potential for enhanced antitumor efficacy. Patients with advanced melanoma and adequate organ function were eligible. Sorafenib was given orally at 200 mg BiD for 5 days ev...

To examine the role of body mass index (BMI) in assessment of prostate cancer (PCa) risk. 3,258 participants who underwent biopsy (including 1,902 men with a diagnosis of PCa) were identified from the Selenium and Vitamin E Cancer Prevention Trial. The associations of BMI with PCa and high-grade PCa (HGPCa) were examined using logistic regression,...

Data from recent clinical trials utilizing bevacizumab or other anti-VEGF agents in patients with metastatic colorectal cancer (mCRC) show improvements in progression-free survival (PFS) but modest, if any, improvements in overall survival (OS). Despite modest improvements, use of bevacizumab beyond first and second progression is routinely done in...

In an effort to improve our understanding of perceived treatment barriers among veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) relative to other era veterans, the current study examined veteran attitudes and beliefs about mental health treatment and treatment-seeking, and perceived patient and institution-level logistical barri...

Osteosarcoma is the most common bone malignancy in children, adolescents, and young adults. Most study cohorts have 10% to 15% Hispanic patients that encompass many different Hispanic backgrounds. This study characterizes the effect of mainly Mexican American ethnicity on the outcome of children, adolescents, and young adults with osteosarcoma. A r...

Background: Agents targeting the angiogenic pathway have been the cornerstone of metastatic colorectal cancer (mCRC) treatment for the last 10 years. Recently, regorafenib (RGF), an oral multikinase inhibitor with angiogenic inhibition, was approved for patients (pts) with mCRC who have failed standard therapies. This suggests VEGF inhibition has a...

320 Background: Sorafenib is the only approved systemic therapy in HCC. Clinical trials in HCC often exclude patients with Child-Pugh Stage (CPS) B/C cirrhosis. Furthermore, limited information on outcomes specific to HCC population are reported from early clinical trials. We evaluated the efficacy and safety of early phase clinical trial agents us...

3541 Background: Recently, regorafenib (RGF), an oral multikinase inhibitor, was approved for patients (pts) with mCRC who have failed standard therapies. Compared to placebo, the phase III CORRECT study showed RGF improved median overall survival (mOS) from 5.0 to 6.4 months (mo) and median progression-free survival (mPFS) from 1.7 to 1.9 mo, rega...

e15171 Background: Sorafenib (SOR) is the first systemic therapy to improve survival in patients (pts) with advanced (HCC), mainly amongst pts with Child-Pugh (CP) A cirrhosis. In the US however, HCC pts often present with ECOG status ≥ 1 and CP B cirrhosis. The GIDEON study reported variation in disease characteristics and treatment patterns for U...

Objective: To investigate the relation of diabetes comorbidity and the rehabilitation outcomes of patients with stroke. Design: Secondary data analysis. Setting: Inpatient rehabilitation facilities. Participants: Patients with stroke (N=35,243) who received inpatient rehabilitation in 2004 through 2008. Interventions: None. Main outcome m...

Objective: Bisphosphonate-related Osteonecrosis of the Jaw (BONJ) represents a growing concern for dental practitioners and patients that may alter clinical care. The objective of this study is to assess the relationships between dental practitioners’ concerns for risks of BONJ and practice patterns toward patients with a history of bisphosphonate...

Investigators are interested in determining whether lifetime behavioral traits and specific mood states experienced close to death affect brain gene and protein expression as assessed in post-mortem human brains. Major obstacles to conducting this type of research are the uncertain reliability of the post-mortem psychiatric diagnoses and clinical i...

Purpose: To examine the prevalence of difficult psychiatrist-patient interactions of 20 psychiatrists in the South Texas Psychiatric practice-based research network, determine what characteristics were associated with "difficult" patients, and compare findings with previous studies in primary care. During a 2-month observational study, psychiatrist...

To perform the first validation study of the finasteride-adjusted Prostate Cancer Prevention Trial Prostate Cancer Risk Calculator (finPCPTRC) in a contemporary referral population in Mexico. 837 patients referred to the Instituto Nacional de Cancerología, Mexico City, Mexico, between 2005 and 2009 were used to validate the finPCPTRC by examining v...

The three phases of cancer survivorship include the acute survival phase (ASP), the extended survival phase (ESP), and the permanent survival phase (PSP). This Institutional Review Board-approved retrospective pilot project compared races and leukemia subtypes among patients in the ASP, ESP, and PSP. Fifty-five adult patients from our National Canc...

We assessed the independent predictive values of the serum markers free prostate specific antigen, proenzyme prostate specific antigen, neuroendocrine marker and Dickkopf-1 compared to serum prostate specific antigen and other standard risk factors for early prostate cancer detection. From the prospectively collected SABOR cohort 250 prostate cance...

MicroRNAs (miRNAs) are a class of small RNAs that play a critical role in the coordination of fundamental cellular processes. Recent studies suggest that miRNAs participate in the cellular stress response (CSR), but their specific involvement remains unclear. In this study, we identify a group of thermally regulated miRNAs (TRMs) that are associate...

The Air Force makes an extraordinary effort to prevent heat-related illnesses associated with basic military training (BMT) in south Texas. However, inadequate hydration can still contribute to lost training time and qualified trainees leaving military service without completing BMT. The purpose of the present study was to determine whether equippi...

Recently, an extensive layer of intra-cellular signals was discovered that was previously undetected by genetic radar. It is now known that this layer consists primarily of a class of short noncoding RNA species that are referred to as microRNAs (miRNAs). MiRNAs regulate protein synthesis at the post-transcriptional level, and studies have shown th...

We measured levels of PCDDs, PCDFs, non-ortho, and mono-ortho substituted PCBs in 106 US Air Force Vietnam veterans, participants of the Air Force Health Study (AFHS) who attended the final medical examination in 2002. Twelve veterans were Ranch Hands involved in aerial spraying of herbicides in Vietnam (1962-1971), and 94 were Comparisons who flew...

Begun in 1982, the Air Force Health Study (AFHS) has assessed the mortality of veterans of Operation Ranch Hand, the unit responsible for aerially spraying herbicides in Vietnam. A comparison group of other Air Force veterans involved with aircraft missions in Southeast Asia during the same period, but not involved with spraying herbicides, was inc...

Operation Ranch Hand veterans were involved in spraying herbicides, including Agent Orange, during the Vietnam War in 1962-1971; Agent Orange was contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). It has been hypothesized that dioxins may be partially responsible for an increase of male reproductive tract disorders such as testicular can...

We studied diabetes in Air Force veterans exposed to Agent Orange and its contaminant 2,3,7,8 tetrachlorodibenzo-p-dioxin (dioxin) during the Vietnam War. The index subjects of the Air Force's ongoing 20-year prospective epidemiological study were veterans of Operation Ranch Hand, the unit responsible for aerial herbicide spraying in Vietnam from 1...

The Air Force Health Study (AFHS) is a prospective epidemiological study of the health, mortality, and reproductive outcomes of veterans of Operation Ranch Hand, the unit responsible for aerially spraying herbicides in Vietnam from 1962 to 1971. The study began in 1982 and concludes in 2006. This report updates the authors' mortality findings publi...

US Air Force veterans of Operation Ranch Hand sprayed herbicides contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in Vietnam from 1962 to 1971. Comparisons served in Southeast Asia (SEA) during the same time period but did not spray herbicides. Here we investigate a potential association between exposure to TCDD and prostate cancer. Dat...

Since 1982, the Air Force Health Study has continued to assess the mortality for veterans of Operation Ranch Hand, the unit responsible for aerially spraying herbicides in Vietnam. The mortality for 1,262 Ranch Hand veterans to December 31, 1999 was contrasted with that for 19,078 comparison veterans. The relative risk (RR) for all-cause death was...

We sought to examine cancer incidence in 1482 Air Force veterans who served in Southeast Asia (SEA) and who were not occupationally exposed to herbicides. Cancer incidence between 1982 and 2003 was determined by record review and Cox proportional hazards models were used to estimate risk ratios across serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD...

This report summarizes results from the Air Force Health Study (AFHS) 2002 follow-up physical examination. The AFHS was undertaken to determine whether adverse health effects attributable to exposure to herbicides existed in veterans of Operation Ranch Hand. The men assigned to Operation Ranch Hand flew aerial herbicide spray missions in Vietnam fr...

Cancer incidence and mortality were summarized in Air Force veterans of the Vietnam War. The index subjects were Operation Ranch Hand veterans who sprayed 2,3,7,8 tetrachlorodibenzo-p-dioxin (dioxin)-contaminated herbicides in Vietnam. Comparisons served in Southeast Asia during the same period but did not spray herbicides. We assessed cancer incid...

Using multivariate statistical models, no significant relationship was found between the rate of 2,3,7,8-tetrachlorodibenzo-p-dioxin ( TCDD) elimination and the occurrence or time to onset of diabetes in 343 veterans of Operation Ranch Hand, the unit responsible for the aerial spraying of Agent Orange and other TCDD-contaminated herbicides during t...

To reanalyze in a similar manner the two principal studies of TCDD (tetrachlorodibenzo-p-dioxin) and diabetes in an attempt to reconcile disparate results. Data from 990 United States Air Force veterans (Ranch Hand) and 1275 referents were reanalyzed, and a NIOSH population of 267 chemical workers and 227 referents. The Ranch Hand veterans had lowe...

We studied hepatic abnormalities and indices of hepatic function in relation to exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin) in veterans of Operation Ranch Hand, the Air Force unit responsible for the aerial spraying of herbicides in Vietnam from 1962 to 1971. The prevalence of ever having liver disease through March 1993, and level of...

The authors studied immune response and exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin) among veterans of Operation Ranch Hand, the US Air Force unit responsible for the aerial spraying of herbicides in Vietnam from 1962 to 1971. A comparison group of Air Force veterans who served in Southeast Asia but were not involved in spraying herbici...

We studied cancer prevalence and exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin) in veterans of Operation Ranch Hand, the Air Force unit responsible for the aerial spraying of herbicides in Vietnam from 1962 to 1971. A comparison group of Air Force veterans who served in Southeast Asia during the same period and who were not involved with...

The US Air Force continues to assess the mortality of veterans of Operation Ranch Hand, the unit responsible for aerially spraying herbicides in Vietnam. The authors of this study found that the cumulative all-cause mortality experience of these veterans was not different from that expected (standardized mortality ratio (SMR) = 1.0). Overall, cause...

We studied diabetes mellitus and glucose and insulin levels in Air Force veterans exposed to Agent Orange and its contaminant, 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin), during the Vietnam War. The index subjects of the Air Force's ongoing 20-year prospective epidemiologic study are veterans of Operation Ranch Hand (N = 989), the unit responsibl...

The purpose of the Air Force Health Study is to determine whether those individuals involved in the spraying of herbicides in Vietnam during the Ranch Hand operation have experienced any adverse health effects as a result of their participation in that program. The study is designed to evaluate both the mortality (death) and morbidity (disease) in...

Seventy-two Tactical Air Command (TAC) aircrew members completed one full year of soft contact lens (SCL) wear. A daily-wear regimen, using extended-wear lenses, was used to minimize corneal stress. Baseline measurements of visual acuity with SCLs and with spectacles after SCL removal and ocular indicator gradings were compared to measurements at 5...

Hydrogel extended-wear contact lenses, worn on a daily-wear regimen, were tested for 1 year by USAF aircrew members. A total of 62 eyes were fitted with Hydrocurve II (55% water content) spherical lenses, 29 with Hydrocurve II (55% water content) toric lenses, and 61 with CSI-T (38.5% water content) spherical lenses. The mean lens replacement rate...

The purpose of this expository article is to provide greater access to critical values for testing hypotheses about the shape parameter of a gamma distribution. Among the possible tests, we consider tests of exponentiality against gamma increasing failure rate and/or decreasing failure rate alternatives. Extensive tables of critical values are give...

The purpose of this expository article is to provide greater access to critical values for testing hypotheses about the shape parameter of a gamma distribution. Among the possible tests, we consider tests of exponentiality against gamma increasing failure rate and/or decreasing failure rate alternatives. Extensive tables of critical values are give...