Education, Perceptions, and Delivery: Factors Shaping the Perceived Role in the Pre-Exposure Prophylaxis (PrEP) Care Continuum Among a Sample of Osteopathic Medical Students.

Pre-exposure prophylaxis (PrEP) uptake has been suboptimal despite its demonstrated efficacy in reducing the risk of HIV acquisition. Medical education is one distal determinant that shapes medical providers' perceived role in the PrEP care continuum. However, there is limited understanding of how osteopathic medical students and those wanting to practice in rural areas perceive their role in the PrEP care continuum in the domains of PrEP awareness, uptake, and adherence and retention. Twenty-one semistructured interviews were conducted (March 2019-April 2020) to assess what shapes osteopathic medical students' perceived role in the PrEP care continuum. Participants noted a lack of adequate sexual health training, personal perceptions concerning PrEP use, and ambiguity concerning which of the medical specialties should deliver PrEP. Osteopathic medical schools can incorporate more inclusive and holistic sexual health and PrEP curricula to address these barriers and better prepare osteopathic medical students for their future role in the PrEP care continuum.

Estimating the daily pollen concentration in the atmosphere using machine learning and NEXRAD weather radar data.

Millions of people have an allergic reaction to pollen. The impact of pollen allergies is on the rise due to increased pollen levels caused by global warming and the spread of highly invasive weeds. The production, release, and dispersal of pollen depend on the ambient weather conditions. The temperature, rainfall, humidity, cloud cover, and wind are known to affect the amount of pollen in the atmosphere. In the past, various regression techniques have been applied to estimate and forecast the daily pollen concentration in the atmosphere based on the weather conditions. In this research, machine learning methods were applied to the Next Generation Weather Radar (NEXRAD) data to estimate the daily Ambrosia pollen over a 300 km × 300 km region centered on a NEXRAD weather radar. The Neural Network and Random Forest machine learning methods have been employed to develop separate models to estimate Ambrosia pollen over the region. A feasible way of estimating the daily pollen concentration using only the NEXRAD radar data and machine learning methods would lay the foundation to forecast daily pollen at a fine spatial resolution nationally.

Rates of Synthetic Cannabinoid Use in Adolescents Admitted to a Treatment Facility.

OBJECTIVE: Many forms of synthetic marijuana are available in the United States for recreational use. Although the composition of these synthetic forms is unclear, consumption has been on the rise among adolescents. The objective of this study is to understand the usage rates and identify the reasons and risk factors for synthetic cannabinoid use. METHODS: We recruited 637 adolescents (aged 13 to 17 years) admitted to the Children's Recovery Center, Norman, Oklahoma, from August 11, 2014, to March 30, 2016, for the study. Descriptive statistics and Pearson χ² test were used to analyze the data. Logistic regression and adjusted odds ratio (OR) were performed to determine the risk factors for synthetic marijuana use. RESULTS: The mean age of synthetic cannabinoid users was 16 years. Increased prevalence of synthetic marijuana use was observed in 16- to 17-year-old adolescent males, in the white population, and in individuals living in urban areas. Synthetic marijuana was preferred by subjects over the regular form, as it is less expensive, produces a better high, is undetectable on drug tests, and is perceived as legal. Male sex (OR = 2.63, P < .0001), aged 16 to 17 years (OR = 1.99, P < .0001), and residing in an urban locality (OR = 1.57, P = .05) were identified as risk factors for consuming synthetic marijuana. Adolescents who use synthetic marijuana are more at risk of having substance use disorder (OR = 11.87, P < .0001) than those who do not. CONCLUSIONS: Synthetic marijuana use is increasing in the adolescent age group and could potentially have a negative impact on the health of teenagers. Hence, enforcing strict laws against synthetic marijuana use and promoting awareness programs targeting adolescents would be beneficial.​.

Relationship of American Indian blood quantum with osteoporosis risk: a cross-sectional study of American Indian women in Oklahoma.

Information regarding the prevalence and risk of osteoporosis among American Indian (AI) women is limited. This study showed that with increasing AI blood quantum, the prevalence of osteoporosis at the hip based on BMD T-scores decreased and this appeared to be independent of other risk factors. INTRODUCTION: This study was designed to investigate the effects of AI blood quantum (BQ) on osteoporosis prevalence and risk in a cohort of AI women in Oklahoma. METHODS: Women (n = 301), aged 50 years and older, were recruited to participate in the Oklahoma American Indian Women's Osteoporosis Study. Baseline bone density, fracture history, bone biochemical markers, and potential risk factors were assessed. Participants were stratified by AI BQ into BQ1 ≤ 25%, BQ2 = 25-49%, BQ3 = 50-74%, and BQ4 = 75-100%. The effects of BQ on the prevalence and risk of osteoporosis were evaluated. RESULTS: Based on T-scores, one in approximately eight women in the study was osteoporotic at one or more sites. The prevalence of osteoporosis decreased (p < 0.05) with increasing BQ, especially at the hip, trochanteric, and intertrochanter regions. No differences in bone-specific alkaline phosphatase and C-telopeptide were observed across BQ that could account for the differences in bone density. 25-OH vitamin D decreased with increasing BQ, but mean for each BQ1-4 was > 40 ng/mL. Fracture history did not differ across BQ, and though 52% of the population consumed less than the RDA for calcium, no effect of BQ was observed. CONCLUSIONS: In this cohort of women who identified as AI, greater Indian BQ was associated with a decrease in the prevalence of osteoporosis.

Evidence for exposure to selenium by breeding interior snowy plovers (Charadrius nivosus) in saline systems of the Southern Great Plains.

Interior snowy plover (Charadrius nivosus) population declines and deteriorating conditions throughout the Southern Great Plains (SGP) of Texas, New Mexico, and Oklahoma may be linked to environmental contaminants. Concentrations of V, As, Cd, Pb, and Se were quantified in breeding snowy plover blood, feathers (5th primary; P5), and potential prey (tiger beetles [Cicindela circumpicta and C. togata]). Se was (a) most commonly detected relative to other quantified elements and (b) frequently quantified at levels exceeding background or toxicity thresholds. Of samples greater than instrumentation detection limits, 98% of snowy plover blood and 22% of feather samples were greater than Se toxicity thresholds of 1 ppm ww for blood and 5 ppm dw for feathers (blood quantifiable range: 0.83-15.12 ppm; feathers quantifiable range: 1.90-27.47 ppm). Almost all tiger beetle Se concentrations were below reported invertebrate thresholds of 30 ppm dw (quantifiable range: 0.54-45.84 ppm). Snowy plover blood Se concentrations were related to sex, individual body condition, and local tiger beetle Se concentrations, while plover P5 Se concentrations were related to state, sex, and presence of body molt. Tiger beetle Se concentrations were related to individual study sites in Texas. These results provide some of the first evidence of Se exposure risk for interior snowy plovers nesting in saline lake and alkali flat environments of the SGP. Future efforts should focus upon specific Se uptake pathways during breeding and nonbreeding seasons, as snowy plovers breeding in the SGP appear to be exposed to Se throughout their annual cycle.

A Metagenome-Based Investigation of Gene Relationships for Non-Substrate-Associated Microbial Phosphorus Cycling in the Water Column of Streams and Rivers.

Phosphorus (P) is a nutrient of primary importance in all living systems, and it is especially important in streams and rivers which are sensitive to anthropogenic P inputs and eutrophication. Microbes are accepted as the primary mineralizers and solubilizers of P improving bioavailability for organisms at all trophic levels. Here, we use a genomics approach with metagenome sequencing of 24 temperate streams and rivers representing a total P (TP) gradient to identify relationships between functional genes, functional gene groupings, P, and organisms within the P biogeochemical cycle. Combining information from network analyses, functional groupings, and system P levels, we have constructed a System Relational Overview of Gene Groupings (SROGG) which is a cohesive system level representation of P cycle gene and nutrient relationships. Using SROGG analysis in concert with other statistical approaches, we found that the compositional makeup of P cycle genes is strongly correlated to environmental P whereas absolute abundance of P genes shows no significant correlation to environmental P. We also found orthophosphate (PO43-) to be the dominant factor correlating with system P cycle gene composition with little evidence of a strong organic phosphorous correlation present even in more oligotrophic streams.

Increasing Juniperus virginiana L. pollen in the Tulsa atmosphere: long-term trends, variability, and influence of meteorological conditions.

In the Tulsa area, the Cupressaceae is largely represented by eastern red cedar (Juniperus virginiana L.). The encroachment of this species into the grasslands of Oklahoma has been well documented, and it is believed this trend will continue. The pollen is known to be allergenic and is a major component of the Tulsa atmosphere in February and March. This study examined airborne Cupressaceae pollen data from 1987 to 2016 to determine long-term trends, pollen seasonal variability, and influence of meteorological variables on airborne pollen concentrations. Pollen was collected through means of a Burkard sampler and analyzed with microscopy. Daily pollen concentrations and yearly pollen metrics showed a high degree of variability. In addition, there were significant increases over time in the seasonal pollen index and in peak concentrations. These increases parallel the increasing population of J. virginiana in the region. Pollen data were split into pre- and post-peak categories for statistical analyses, which revealed significant differences in correlations of the two datasets when analyzed with meteorological conditions. While temperature and dew point, among others were significant in both datasets, other factors, like relative humidity, were significant only in one dataset. Analyses using wind direction showed that southerly and southwestern winds contributed to increased pollen concentrations. This study confirms that J. virginiana pollen has become an increasing risk for individuals sensitive to this pollen and emphasizes the need for long-term aerobiological monitoring in other areas.

A Social Marketing Approach to 1% Milk Use: Resonance Is the Key.

The U.S. Dietary Guidelines recommend low-fat milk consumption, and Supplemental Nutrition Assistance Program Education (SNAP-Ed) programs follow these guidelines to develop health education programs for SNAP recipients. This study evaluated a multilevel media intervention promoting low-fat milk use among Oklahoma SNAP recipients, a population often missed. Behavior change was measured with pre- and postintervention telephone interviews with SNAP recipients ( n = 860). Immediately following the intervention, self-reported purchases of 1% milk, the focus of behavior change, significantly increased to 7.9% from 4.1%-a relative improvement of 92.7%, χ2(1, n = 824) = 5.8, p = .02. Milk nutrition knowledge scores significantly improved as well, t(846) = 2.9, p = .004, and low-fat milk users exhibited more milk nutrition knowledge than high-fat milk users, t(437) = 4.0, p = .000. The intervention, which resonated with the priority audience, was well received ( Mdn = 6, 1, 7). Factors contributing to its success included a gain-based message strategy and clearly articulating the desired behavior. Salient messages personalized the issues and concerns raised by the priority audience-all the vitamins and minerals without the fat. Findings suggest that matching gender and ethnicity mediated the effect among those most resistant to substituting low-fat for high-fat milk.

Introducing High School Students to Careers in Osteopathic Medicine.

An aging population and expansion of health care coverage under the Patient Protection and Affordable Care Act have led to a predicted deficit of primary care physicians by 2025. In response, medical schools must develop new strategies to identify students early in their educational pathways to encourage exploration of careers in science, technology, engineering, and mathematics (STEM) fields, especially medicine. Oklahoma State University Center for Health Sciences developed 2 internship programs, Oklahoma Science Training and Research Students (OKStars) and Native OKStars, to introduce high school students to osteopathic medicine. Native OKStars was designed to encourage Native American students, who are underrepresented in STEM fields, to pursue osteopathic medicine. These programs provided students with a 6-week immersion in biomedical research, along with weekly discussion groups with mentors. Participant questionnaire responses suggested that these programs were effective in introducing them to careers in osteopathic medicine as well as other STEM fields.

Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM.

The physician shortage in Oklahoma coupled with geographic maldistribution of primary care physicians limits access to care in rural and underserved areas. One of the most effective strategies to recruit and retain physicians in rural areas is to create undergraduate and graduate medical education training sites in these locations. Oklahoma State University Center for Health Sciences College of Osteopathic Medicine has implemented a rural training program that begins with early recruitment of rural high school students, introduces medical students to rural practice options through rural clinical training opportunities, and provides opportunities to remain in rural Oklahoma for residency training through ongoing graduate medical education development. The purpose of this article is to provide a case study of the development of the college's Rural Medical Track. Preliminary findings indicate that rural-based clinical training for third- and fourth-year students strengthens performance on standardized tests.

Comparing Access to Laser Capsulotomy Performed by Optometrists and Ophthalmologists in Oklahoma by Calculated Driving Distance and Time.

PURPOSE: To quantify Medicare beneficiary proximity to his or her yttrium-aluminum-garnet (YAG) laser capsulotomy-providing ophthalmologist and optometrist in Oklahoma by calculating driving distances and times. DESIGN: Cross-sectional cohort study using 2014 Oklahoma Medicare 100% and 5% data sets and Google Maps distance and travel time application programming interfaces. PARTICIPANTS: U.S. fee-for-service Medicare beneficiaries and Oklahoma ophthalmologist and optometrist laser capsulotomy providers. METHODS: The 2014 Medicare Provider Utilization and Payment Limited 100% and 5% datasets from the Centers for Medicare and Medicaid (CMS) were obtained to identify the office street addresses of Oklahoma ophthalmologists and optometrists who submitted claims to Medicare for a YAG laser capsulotomy, and the county addresses of the corresponding Medicare beneficiaries who received the laser capsulotomy. The shortest travel distances and travel times between the beneficiary and the laser provider were calculated by using Google Maps distance and travel time application programming interfaces. MAIN OUTCOME MEASURES: Beneficiary driving distances and times to his or her YAG laser capsulotomy-providing Oklahoma ophthalmologist and optometrist. RESULTS: In 2014, 90 (57%) of 157 Oklahoma ophthalmologists and 65 (13%) of 506 Oklahoma optometrists submitted a total of 7521 and 3751 YAG laser capsulotomy claims to Medicare, respectively. By using the Medicare Limited 5% dataset, there was no difference in driving distance between beneficiaries who received a laser capsulotomy from an ophthalmologist (median, 39 miles; interquartile range [IQR], 13-113 miles) compared with an optometrist (median, 46 miles; IQR, 13-125 miles; P = 0.93) or in driving time to an ophthalmologist (median, 47 minutes; IQR, 19-110 minutes) compared with an optometrist (median, 50 minutes; IQR, 17-117 minutes; P = 0.76). CONCLUSIONS: For Medicare beneficiaries, there was no difference in geographic access to YAG laser capsulotomy whether performed by an Oklahoma ophthalmologist or optometrist as determined by calculated driving distances and times.

Molecular analysis confirms the long-distance transport of Juniperus ashei pollen.

Although considered rare, airborne pollen can be deposited far from its place of origin under a confluence of favorable conditions. Temporally anomalous records of Cupressacean pollen collected from January air samples in London, Ontario, Canada have been cited as a new case of long-distance transport. Data on pollination season implicated Juniperus ashei (mountain cedar), with populations in central Texas and south central Oklahoma, as the nearest source of the Cupressacean pollen in the Canadian air samples. This finding is of special significance given the allergenicity of mountain cedar pollen. While microscopy is used extensively to identify particles in the air spora, pollen from all members of the Cupressaceae, including Juniperus, are morphologically indistinguishable. Consequently, we implemented a molecular approach to characterize Juniperus pollen using PCR in order to test the long-distance transport hypothesis. Our PCR results using species-specific primers confirmed that the anomalous Cupressacean pollen collected in Canada was from J. ashei. Forward trajectory analysis from source areas in Texas and the Arbuckle Mountains in Oklahoma and backward trajectory analysis from the destination area near London, Ontario were completed using models implemented in HYSPLIT4 (Hybrid Single-Particle Lagrangian Integrated Trajectory). Results from these trajectory analyses strongly supported the conclusion that the J. ashei pollen detected in Canada had its origins in Texas or Oklahoma. The results from the molecular findings are significant as they provide a new method to confirm the long-distance transport of pollen that bears allergenic importance.

Essential fatty acid deficiency during parenteral soybean oil lipid minimization.

OBJECTIVE: To determine if parenteral lipid minimization in infants results in essential fatty acid (EFA) deficiency. STUDY DESIGN: Prospective study of infants >30 days old and >34 weeks postmenstrual age receiving parenteral lipid minimization (<1.5 g kg-1 per day) with either soybean oil or fish oil and >90% of total nutritional intake parenterally in the 14 days before a serum EFA sample. Nonparametric tests were used for statistical analyses with significance at 0.05. RESULTS: Fifteen samples on soybean oil and nine on fish oil were included. Energy and macronutrient intakes and weight gain were similar between groups. Biochemical EFA deficiency occurred in 60% receiving soybean oil but none receiving fish oil (P<0.01). Average daily weight gain was 49% less in EFA deficient infants than EFA sufficient infants (P=0.02). CONCLUSION: Infants on lipid minimization with parenteral soybean oil, but not fish oil, are at high risk of biochemical EFA deficiency with slower weight gain.

Molecular approaches for the analysis of airborne pollen: A case study of Juniperus pollen.

BACKGROUND: Pollen monitoring is a common and vital tool in the field of allergy, creating awareness in pollen sensitive individuals. Traditionally, pollen monitoring has been based on conventional microscopic counting techniques that are labor intensive and limited in the identification to the genus or family level. Molecular techniques provide an alternative approach that is less labor intensive and enable identification of any species by its genetic fingerprint. OBJECTIVE: To use quantitative polymerase chain reaction (qPCR) to evaluate pollen concentrations in air samples. METHODS: Juniperus pollen was selected as our model because of the importance of this pollen in the southcentral United States. We analyzed 105 air samples collected with a Burkard spore trap from 2013 to 2015 using species-specific primers and probes. To evaluate the feasibility of a molecular approach, we used duplicate air samples that allowed us to compare results from classical identification based on light microscopy with our qPCR results. RESULTS: Pollen concentrations from the qPCR data were significantly correlated with concentrations determined through light microscopy (R = 0.902, P < .001). We also confirmed an overlap in the pollination seasons between Juniperus ashei and Juniperus pinchotii and between J ashei and Juniperus virginiana. CONCLUSION: We found that this method correctly identified different Juniperus species present in mixed air samples in the southcentral United States, an accomplishment that cannot be achieved using microscopic identification. We conclude that the qPCR method is more accurate and sensitive than current pollen monitoring techniques and, therefore, has the potential to be used in various pollen monitoring stations.

Consumption of a calcium and vitamin D-fortified food product does not affect iron status during initial military training: a randomised, double-blind, placebo-controlled trial.

Ca/vitamin D supplementation maintains bone health and decreases stress fracture risk during initial military training (IMT); however, there is evidence that Ca may negatively affect the absorption of other critical micronutrients, particularly Fe. The objective of this randomised, double-blind, placebo-controlled trial was to determine whether providing 2000 mg/d Ca and 25 µg/d vitamin D in a fortified food product during 9 weeks of military training affects Fe status in young adults. Male (n 98) and female (n 54) volunteers enrolled in US Army basic combat training (BCT) were randomised to receive a snack bar with Ca/vitamin D (n 75) or placebo (snack bar without Ca/vitamin D; n 77) and were instructed to consume 2 snack bars/d between meals throughout the training course. Circulating ionised Ca was higher (P0·05) in markers of Fe status between placebo and Ca/vitamin D groups. Collectively, these data indicate that Ca/vitamin D supplementation through the use of a fortified food product consumed between meals does not affect Fe status during IMT.

Patterns of Care for Localized Breast Cancer in Oklahoma, 2003-2006.

Despite well-established clinical guidelines for breast cancer treatment, Standard of Care (SOC) is not universal in the U.S. The purpose of this study was to describe the extent to which patients receive guideline-based, stage-specific treatments for localized female breast cancer in Oklahoma. Data were obtained from the Oklahoma Central Cancer Registry for the period 2003-2006. We included localized, invasive female breast cancers and analyzed both treatment and demographic factors. We used the National Comprehensive Cancer Network (NCCN) treatment guidelines to determine SOC. Among women who received breast conserving surgery (BCS), we used logistic regression to evaluate factors related to SOC. In Oklahoma, 92 percent of the 4,177 localized breast cancer patients were treated with recognized SOC. In women aged ≥65 years with BCS, those ≥75 years had a lower adjusted odds of meeting SOC than did those without insurance, with comorbid conditions, or whose comorbid status was unknown. Among women aged <65 years, those with Medicare/Medicaid, Medicare only, or without insurance, along with comorbid conditions, had a lower adjusted odds of meeting SOC. Overall, 92 percent of women met SOC. Factors such as age, insurance type, and comorbid conditions were associated with meeting SOC.