Traumatic Brain Injury (TBI) is an issue that seriously affects people of all ages; older adults with TBI have the highest rates of hospitalization and death. Additionally the overall recovery is significantly poorer than a younger person with a similar TBI. With normal aging, there is a reduction in the number of white blood cells (WBCs). However, in certain chronic diseases with an inflammatory component that are more common with older age, such as diabetes, there may be an ongoing activation of available WBCs which could affect viability in response to injury. This investigation used data from an ongoing parent study of the immune response following TBI in order to examine the number of and viability of peripheral blood mononuclear cells (PBMCs) within 24 hours of TBI in both older and younger adults as well as non-injured controls (N=133). Older age was defined as 55 and older for the purposes of this study. Whole blood was collected and processed for plasma and WBCs from subjects using Ficoll technique (separation of blood components). Cells were manually counted and viability of cells was determined using the trypan blue method (type of stain to observe cells). Data analysis is underway. Descriptive statistics were performed along with ANOVA to assess for group differences in cell count and viability. Time from blood draw to processing will be used as a covariate. The results of this study will enable us to determine if lower cell counts or cell viability differ by age and injury status. This will provide support for or refute the hypothesis that the immune response following injury is different in older adults which could impact patient outcomes. By understanding this relationship, we can implement clinical changes to potentially help change the immune response and improve the outcomes older adults experience post injury.

A major focus of breast cancer research has involved the catechol estrogen pathway. Estrogen DNA Adduct (EDA) is a novel biomarker that is hypothesized to play a role in initiating breast cancer. Pilot studies have shown elevated levels of EDA in women at high risk for breast cancer and with breast cancer. The overall purpose of this project was to determine whether the EDA biomarker has potential for clinical use for breast cancer prevention. The first step toward this goal was to examine the extent to which the biomarker varies over time in the same individual. The specific aim was to determine whether the variation between urine samples taken at two points in time is significantly different from samples taken at a single point in time. We utilized a convenience sample from the DEEM (Diet, Exercise and Estrogen Metabolites) study of 6 urine samples from 3 women at 2 separate clinic visits, conducted 3 months apart. Triple quadrupole mass spectrometry was used to process 37 estrogen metabolites in the urine samples. The fragmentation pattern of each metabolite was analyzed and compared to a panel of known estrogen metabolites in which the elution times were known. The correlation coefficient between the 2 clinical visits was 0.49. The results from this analysis indicate moderate correlation between 2 time points. We will await the results from the larger study to decide whether a one point in time urine collection is adequate for the overall project. The implications of the overall project are important because determining breast cancer risk from urine samples would be a sensitive and non-invasive method that could allow healthcare providers to better target the women that should receive careful monitoring, testing, and interventions.

It is known that exercise improves cancer survival, however, there is an unknown molecular link between physical activity and cancer occurrence. The purpose of this study was to determine the feasibility of studying biologic mechanisms related to exercise and cancer survival in the LIVESTRONG YMCA program. Eligible subjects were males and females who were diagnosed with prostate or breast cancer in the last three years, between 35-80 years of age, willing to provide urine samples at four time points, and enrollment in the 12-week LIVESTRONG YMCA program. Through a partnership with the University of Washington (UW) Mass Spectrometry Center and the UW Office of Nursing Research, two specific biomarkers were analyzed from the urine specimens. One of these markers is Estrogen DNA Adduct (EDA), an estrogen metabolite that binds to DNA and creates an increased potential of DNA mutation and cancer development. The other is 8-OH-dG, a biomarker related to oxidation. To determine the feasibility, we administered questionnaires to better determine patient satisfaction and calculate the percentage of participation and retention. One questionnaire surveyed the acceptability of our biospecimen collection procedures to participants, anticipated acceptability of additional biospecimen collection (blood and tissue samples) for future projects, and willingness to have a DEXA scan (for compensation). In order to determine the feasibility of conducting the study on a larger scale, we evaluated the percentage of participants enrolled out of those recruited, percentage of participants who provided urine samples out of those enrolled, and the percentage of participants who completed the program. Continuing to invest in our therapeutic, diagnostic and genetic understanding of cancer means that in the future, patients will have options based on scientific evidence.

 Breast cancer is the most common type of cancer in women, and 40,996 women died of cancer in 2010. I am working with Dr. Keryn Reding from the School of Nursing on examining estrogen DNA adducts (EDA) for their clinical utility as a biomarker for breast cancer. EDA is formed when estrone or estrodial are oxidized to form quinones. These compounds then attach to DNA, causing mutations that lead to cancerous cell growth. The EDA are then excised and released into the blood stream and excreted through urine. I will analyze urine samples in a triple quadrupole mass spectrometer in order to see if the ratio of EDA to parent estrogens is higher in women with breast cancer than women who did not develop breast cancer. My analysis will investigate the inter-variability of EDA in premenopausal and postmenopausal women to see if this biomarker can be accurate and reliable for women of all ages. We expect results to show that premenopausal women will have less EDA due to their younger age and lower risk of developing breast cancer. By May when I present at the URP, I will have results from the mass spectrometer and I will use the McNemar's test for statistical significance. We are investigating a hypothesis that a high EDA ratio will be associated with breast cancer risk, and thus the EDA ratio may have clinical applications for breast cancer prevention and screening. Because it is a non-invasive method of measuring the risk of developing breast cancer, it could be an ideal complement to current screening approaches, such as mammograms or biopsies.

The purpose of our research is to better understand older adults’ perceptions about fall detection devices. When an older adult experiences a fall, the results can be dramatically life altering or even fatal compared to an individual in a different age group. This led us to question what views older adults have about existing measures in place to monitor and analyze falls, such as fall detection devices or other technologies, as well as what demographic factors may influence these views. Using data from a parent study, we are currently in the process of analyzing focus group transcripts to compare perceptions of older adults from high and low socio-economic status using qualitative descriptive methods. We are analyzing transcripts for common themes that may lead to the identification of areas for further study. By studying older adults’ perceptions of fall detection devices, we hope to gain a better understanding of their needs and preferences when it comes to such devices. We hope exploring and understanding demographic or other factors that affect these perceptions may lead to more open conversations on falls, and thus better our ability to customize fall detection devices and their features, and fall prevention plans for older adults.

This was a study of the prevalence of post stroke fatigue in stroke survivors who participated in the larger Living Well With Stroke study in the Puget Sound area of Washington. Post stroke fatigue can delay progress of physical therapy, and interfere with activities of daily living. Within four months of a stroke, the Living Well With Stroke team approached people who had been hospitalized with a stroke to screen for eligibility to be part of the study. Questions were asked that screened for depression and fatigue. Using SPSS (Statistical Package used for Statistical analysis) we have examined screening data of the 414 patients from the larger study. We have examined the correlation of fatigue to the presence of depression, age, gender, type of stroke, severity of stroke and other variables that are in the literature. Based on existing literature, we anticipate that the presence and severity of fatigue will be correlated with age, gender, severity of stroke, depression, as well as socio-economic status. Using SPSS, data has been interpreted by the use graphs, and tables to best show the correlation between post stroke fatigue and the demographics I have just listed previously. By understanding these correlations, treatment options could be better improved or be tailored specifically to these patients.

Prior research shows that well-functioning interprofessional (IP) healthcare teams lead to greater patient satisfaction, shared clinician understanding, and stronger teamwork, yet healthcare providers are educated in separate “silos” – inhibiting the development of critical teamwork skills. IP service learning (IPSL) is one way to integrate student learning across the health professions. There is little research on how best to use IPSL in current curricular models for the health profession. Furthermore, though student engagement is central to both service learning and IP education, there are few models for how to develop IPSL. This project will explore this important area by asking: how do students who are knowledgeable in both IP and service learning envision effective IPSL? In addition, how could IPSL support current health professional education? One proposal is the creation of a common curriculum among health professional schools, as focused, year-long IPSL experiences. To explore this idea and generate other options, student experts from four of the six health science schools (Nursing, Pharmacy, Public Health, and Social Work) participated in a focus group on the UW Seattle campus. Participants were recruited based on their availability and interest, and questions were formulated using Gitlin, Lyons, and Kolodner’s extended social exchange theory. The results of this study were used to help inform current curriculum changes in the health sciences schools, and to reinforce current understandings of IP education and ways to use IPSL in educational programs. Areas for future research include pilot testing 1-3 proposals, as well as sampling health sciences faculty to uncover systems-level barriers to IPSL.