Kaeli Samson’s research while affiliated with University of Nebraska at Omaha and other places

INTRODUCTION This is a prospective, interventional pilot study that seeks to evaluate the impact of MediaSense, a media-literacy-based vaping prevention program, in adolescents including an oversample of those with asthma. METHODS During July and December 2022, participants in Nebraska were recruited via electronic health record (EHR)-based messaging, and MediaSense was self-administrated by interactive e-learning with REDCap surveys before and after the intervention. Regression analysis evaluated changes in vaping media literacy, vaping expectancy, and harm perception pre- and post-intervention. Factor analysis was conducted on 22 items on usability, to determine which latent factors were most related to interactive e-learning modules. RESULTS Adolescents aged 12–17 years participated in the MediaSense intervention (n=67; 59.7% with asthma). The pre- and post-intervention surveys showed a 148% increase in vaping media literacy (ranging 0–6; 2.9 vs 4.5, p<0.0001). Vaping expectancy (ranging1–5) decreased from 3.6 to 1.2 (p<0.0001), and the perception of vaping as harmful rose from 40.3% to 86.0% (p<0.0001). Participants rated the intervention highly on usability, technical assistance, design, content clarity, navigation, flow, multimedia, interactivity, and learning outcomes. Two distinct factors were identified in the factor analysis: motivating and engaging content (Factor 1) and user-friendly module design (Factor 2). Participants with higher usability ratings of the e-modules (Factor 1: B=0.6; 95% CI: 0.3–0.9, p=0.0004; Factor 2: B=0.7; 95% CI: 0.4–1.0, p=0.0001), and those with asthma (vs no asthma: B=0.5; 95% CI: 0.1–0.9, p=0.01) had significantly higher vaping refusal and media literacy. CONCLUSIONS The MediaSense program demonstrated acceptability and feasibility in recruiting and preventing adolescent vaping through EHR and digital interventions. Media literacy helps adolescents to critically evaluate vaping-related marketing messages, resist persuasive marketing, and make informed decisions.

Introduction Studies focused on rural–urban disparities in patients with prostate cancer have demonstrated minimal differences in incidence and overall survival (OS). However, available data are limited, especially in understudied geographic locations. In this study, we investigated additional measures of potential cancer disparity and focused on examining rural–urban prostate cancer disparity in Nebraska residents. Methods Patients diagnosed with prostate cancer from 1991 to 2023 living in Nebraska were identified in the integrated Cancer Repository for Cancer Research (iCaRe2) and categorized as rural and urban by rural–urban commuting area (RUCA) codes. Results Results are presented as mean ± standard deviation. The iCaRe2 patient registry contained data on 765 men with prostate cancer living in Nebraska, 621 (81.2%) of whom were urban residents and 144 (18.8%) of whom were rural residents. Rural residents were diagnosed with prostate cancer 3.1 years younger than urban residents (rural: 65.6 ± 8.21 years, urban: 68.7 ± 9.08 years, p < 0.001). Rural residents died of prostate cancer 4.2 years younger than urban residents (rural: 72.9 ± 9.75 years, urban: 77.1 ± 8.85 years, p < 0.001). Analyses of Gleason score and AJCC stage did not reveal statistically significant differences between rural and urban residents. OS was similar between rural and urban men in Nebraska with prostate cancer, congruent with currently published literature. Conclusions Our analysis demonstrates that rural patients in Nebraska are diagnosed and die with prostate cancer at younger ages compared to urban patients. Our findings offer strategies to better define and delineate rural–urban cancer disparity and support future, more robust investigations to consider novel approaches to determining disparities in cancer disease course.

122 Background: Androgen deprivation therapy (ADT) is essential for management of advanced prostate cancer, yet it carries risks including osteoporosis and fragility fractures. Antiresorptive therapy is recommended to reduce fractures for patients at high risk. However, precisely which patients should undergo formal screening with dual-energy X-ray absorptiometry (DEXA) at baseline has been relatively unexplored. This study aims to describe these baseline fracture risks, the utility of DEXA screening based upon Fracture Risk Assessment Tool (FRAX) scores, and the impact of specific risk factors in this population. Methods: We performed a retrospective cross-sectional study of patients at our institution with prostate cancer treated with ≥1 year of ADT between 2011 and 2024. Patients were excluded if their FRAX scores were incalculable or if they received antiresorptive therapy prior to starting ADT. Ten-year hip and combined major osteoporotic fracture risks were calculated using FRAX without femoral neck T-scores for all patients and with femoral neck T-scores for patients who received DEXA scans. A high fracture risk was defined as a 10-year hip fracture ≥3% or a combined major osteoporotic fracture risk ≥20%. Differences between dichotomous groups were assessed using independent samples t-tests, Chi-square tests, or Fisher’s exact tests. Results: We identified 515 patients with an average age of 70.1 years and average BMI of 29.5 kg/m ² . Four hundred and forty-eight (87%) patients received leuprolide as ADT, 70 (13.6%) patients were on a prednisone-containing regimen, and 66 (12.8%) patients were active smokers. Based upon clinical data at ADT initiation (without including T-scores from DEXA), 201 (39.0%) patients had a high 10-year risk of hip or combined major osteoporotic fracture by FRAX. Among the 183 patients who did have DEXA scans, 85 (46.4%) met criteria for osteopenia while 14 (7.7%) had osteoporosis by T-score. Additionally, 48 (26.2%) patients had high 10-year fracture risks by FRAX and met criteria for initiation of antiresorptive therapy. The patients meeting criteria for antiresorptive therapy, in general, were older (73.3 years vs. 67.9 years) and weighed less (87.8 kilograms vs. 96.3 kilograms). Conclusions: In our institutional experience, nearly half of patients starting long term ADT have significant fracture risk warranting further risk stratification and risk mitigation strategies. This baseline data should inform systematic approaches to select those that do—and do not—require bisphosphonate or denosumab in the hormone sensitive setting.

Background Obesity is widely recognized as a significant risk factor for postoperative complications of breast reconstruction. Despite extensive research, there remains a lack of consensus regarding the specific complications and outcomes experienced by patients with obesity who undergo deep inferior epigastric perforator (DIEP) flap reconstruction. To provide a clearer understanding of the challenges faced by patients with obesity, we present a single-center outcome analysis of individuals who underwent DIEP flap reconstruction. Methods A cohort of 194 patients who underwent at least 1 DIEP flap was retrospectively analyzed at the University of Nebraska Medical Center utilizing electronic medical records. Patients who underwent DIEP flap breast reconstruction were organized into 5 categories using World Health Organization weight status by body mass index (BMI) obtained from the day of surgery. Surgical complications within 120 days and postsurgical complication-related procedural interventions were also evaluated and compared. Comparisons of variables of interest between weight groups were assessed using Mantel–Haenszel chi-square tests or Spearman correlations. Results Increases in patient weight category were associated with increased length of operation ( P = 0.003), increased rates of breast fat necrosis ( P = 0.04), breast wound dehiscence ( P = 0.01), abdominal wound dehiscence ( P = 0.02), numbers of abdominal complications ( P = 0.001), and rates of requiring an intervention ( P = 0.03). Conclusions The findings imply that higher BMI values may lead to a higher likelihood of postoperative complications and the need for intervention. It is crucial for patients with obesity to be aware of the elevated risk associated with rising BMI values.

Background: Sepsis is a major cause of mortality worldwide. Early identification and treatment are critical to improve survival. Band count has been used as part of SIRS criteria for the early identification of potentially septic patients. Unfortunately, band count requires manual interpretation. This leads to increased potential for intraobserver variability. Immature granulocytes are counted in an automated fashion, which has the potential to improve accuracy and reduce costs. Research Objective: We aim to compare the band percentage and immature granulocyte percentage to set the threshold for immature granulocyte percentage equal to the sensitivity of > 10% band count. Methods: A retrospective chart review was conducted at a single academic medical center. Data from patients with SIRS criteria and measured immature granulocyte and band percentages were utilized to explore potential associations between immature granulocyte percentages and band percentages. Data were analyzed using Spearman correlations, Wilcoxon rank-sum tests, and logistic regressions. Results: We found no significant associations between immature granulocyte percentage and band percentage or other SIRS criteria. Conclusion: We conclude that immature granulocyte percentage does not correlate with band percentage in the setting of possible infection.