2015 Summer/Fall SOAR Interns
Learn about the exceptional work the 2015 Interns accomplished with the support of their mentors. SOAR interns worked on a broad range of topics, all with the lens of health disparities and inequities.
Hannah Ayasse – The George Washington University
Mentor: Rachel Barr, PhD
Associate Professor, Georgetown University Department of Psychology, Early Learning Project Lab
“Intervention Differentially Impacts Mother-Child and Father-Child Interactional Quality: Findings from the Baby Elmo Program”
Background: Approximately 2.5 million children in the U.S. have a parent in prison and 92% of incarcerated parents are fathers (King et al., 2015). Although father absence is often associated with poor developmental outcomes for the child (Hairston, 2002), research has also demonstrated that quality of father-child interactions predicts outcomes for the child regardless of residential status (Tamis-LeMonda, 2004). Fathers may contribute uniquely to child outcomes by acting as catalysts for safe risk-taking and exploration (Paquette, 2004) and promoting language development (Rowe et al., 2004; Tamis-LeMonda et al., 2015) differently than mothers do. Due to lower numbers of incarcerated mothers, evaluations of parenting interventions often do not compare mothers and fathers. This preliminary study evaluates mothers and fathers enrolled in the Just Beginning “Baby Elmo” Program, a structured visitation program for incarcerated teen parents. Previous evaluations of this intervention have shown positive effects on father-infant interaction (Barr et al., 2011, 2013) and increasing paternal acceptance of and influence over their infant’s well-being (Barr et al., 2015). Methods: 25 teen parents (9 mothers) of children from 1 to 48 months were recruited from 5 juvenile detention centers in California. Parent training sessions included an introduction to the week’s concept modeled via “Sesame Beginnings” video clips and planning for the visit. Infants and their caregivers visited the facility within the following few days. The parent and infant’s interactions were video recorded for 20-30 minutes. Post-visit, the facilitator and parent engaged in a reflective debrief. Coding: Video-recorded sessions were coded for child-directed speech. All phrases were counted and categorized as “business,” or “conversational.” Praise, labeling, and repetitive speech were measured as frequencies. Open-ended questions were counted as a proportion of conversational talk. The quality of parent-child interactions was scored using the IGDI-IPCI coding scheme (Baggett & Carta, 2002). Results: Mothers’ and fathers’ measures of conversational talk did not significantly differ and remained fairly high across time (range 77-84%, SD range 9-19%). Measured frequency of use of labeling and open-ended questions– conversational talk modifiers associated with positive language outcomes (Hart & Risley, 1995, Tamis-LeMonda et al., 2015)– reflected a divergence in language strategies employed by mothers and fathers. Mothers used more descriptive speech than fathers (Mmother = 23%, SD = 15%; Mfather = 14%, SD = 16%) and fathers asked more open-ended questions than mothers (Mmother = 11%, SD = 7%;, Mfather = 15%, SD = 9%). These conversational strategies map onto the results from the interactional quality indices that also demonstrated diverging parenting behaviors across time. IGDI-IPCI scores, reported on a 0 to 3 scale, showed that mothers made greater gains in maintaining and extending their child’s focus (Msession1 = .60, SD = .57;, Msession4 = 1.11, SD = .57) than fathers (Msession1 = 1.09, SD = .72;, Msession4 = 1.19, SD = .97) and fathers made greater gains in following the child’s lead (Msession1 = .44, SD = .47, Msession4 = .74, SD = .52) than mothers (Msession1 = .59, SD = .68;, Msession4 = .59, SD = .66). Discussion: The intervention delivers the same curriculum to both mothers and fathers and while both sexes improve over time, they engage with their children in qualitatively different ways. In order to deliver a more specific and individualized service, some areas of focus such as following the child’s lead and labeling/describing the environment may need to be weighted differently depending on the sex of the parent.
Michelle Darko – Georgetown University
School of Nursing and Health Studies Class of 2017
Primary Mentor: Rachel K. Scott, MD, MP
Obstetrics and Gynecology, Medstar Washington Hospital Center
Co-Mentor: Katie Friday, MD
Obstetrics and Gynecology Resident, Medstar Washington Hospital Center
“Condom Knowledge and Negotiation in Women Living with Human Immunodeficiency Virus (HIV)”
Background: The Human Immunodeficiency Virus (HIV) has reached epidemic proportions among women in the United States. In 2009, an estimated 11,200 women were newly infected with HIV, comprising one quarter of new diagnoses. Women of reproductive age are at the highest risk of contracting HIV. Condoms, when used correctly, are highly effective in preventing the transmission of HIV and STIs. Proper use has been linked to an 80% reduction in HIV transmission and 70% reduction in HPV transmission, however; most patients poorly understand proper use. In the District of Columbia, the incidence of HIV and STIs is significantly higher than the national average. HIV infections among women is 1,422.4 per 100,000, compared to the national average of 7.7 per 100,000. Given these startling statistics, our research team designed a descriptive study to investigate condom use, knowledge, and negotiation in women living with HIV. A better understanding of deficits in condom knowledge and negotiation skills will allow for creation and implementation of interventions to improve condom use and compliance for safer sexual practices. Methods: To test our hypothesis we designed a questionnaire that incorporated both previous psychometrically validated questions from several studies and questions designed to gather information about our particular population’s demographics and medical history. The questionnaire consisted of five sections with a total of 31 questions. The five sections were as follows: Demographics, Obstetrical History, Sexual History, Sexual Knowledge, and Condom Negotiation Strategies. Question types included cafeteria questions, True/False, and fill in the blank. Recruitment of participants will take place at MedStar Washington Hospital Center in both the Obstetrics and Gynecology Clinic and Infectious Disease Clinic, with the goal of recruiting 108 HIV patients and 324 non-HIV patients. Patients awaiting appointments will be asked if they would like to participate, and will be informed that participation is voluntary and will in no way effect their medical care. Participants will be also informed that an incentive (ten dollar gift card) would be provided upon completion of the questionnaire. Results: Data supports that HIV status is highly correlated with condom usage/frequency, condom negotiation skills, and sexual knowledge. HIV positive women reported condom negotiation skills more frequently as compared to their HIV negative counterparts (p=.0002), as this is not traditionally emphasized in health education counseling for either group. In addition, in contrast to those women without HIV, HIV positive women demonstrated superior sexual knowledge compared than their HIV negative counterparts (p<.0001) secondary to their additional HIV related medical care. Finally, HIV positive women had more consistent use of condoms compared to their HIV negative counterparts secondary to emphasis on condom use in their medical visits (p<.0001). Conclusion: In recent years, there has been a widespread push for quality health, sexual education, and safe sex information to be made easily accessible. With the help of primary care providers, social media, technology etc., it seems the message is getting across in many respects. If all women (not just those with HIV or any other sexually transmitted infection or disease) are increasingly educated on safe sexual practices, high risk sexual behaviors and related sexually transmitted infections may be minimized.
Jennifer Thelus – American University
Mentor: Chiranjeev Dash MBBS, MPH, PhD
Professor of Oncology, Georgetown University
“An Exercise Intervention to Mitigate Side Effects Related to Androgen Deprivation Therapy Among Prostate Cancer Survivors”
Background: Prostate Cancer (PCa) is the most common cancer amongst males in the US, according to the American Cancer Society. In 2015, there were 220,800 new cases and 27,540 deaths. Black men have the highest rates of incidence (219.8 per 100,000) and mortality (49.8 per 100,000) among all racial/ethnic groups. Androgen Deprivation Therapy is a commonly used treatment for PCa. About 50% of US patients will receive ADT within 12 months of their diagnosis (Gilbert et al). It is more commonly used in advanced or metastatic disease because it slows progression, improves symptoms, and survival in selected patients. ADT however has adverse side effects (Isbarn et al). It affects the body in multiple ways: the skeletal system by decreasing bone mineral density and increasing the risk of osteoporosis and fracture incidence, body composition by increasing fat mass and decreasing lean body mass, functionally decreasing muscular strength and physical performance, as well as increasing fatigue and depression and decreasing quality of life. Research has shown that exercise, as a secondary treatment, is a beneficial therapy for cancer patients. Exercise has been proven to improve skeletal and physical functioning, decrease fat mass and increase lean mass, reduce fatigue and improve quality of life. Of the five randomized control trials that have been conducted examining the effects of exercise in patients receiving ADT, African-Americans have been underrepresented and the effects on bone mineral density and quality of life are unclear (Gardner et al). However, data from these studies have shown improvement in lean mass, muscle strength and cardiorespiratory fitness. Methods: 90 males between the ages of 40 to 75 whom are sedentary as defined as less than 60 minutes of moderate physical activity per week will be recruited. They will participate in an 8-week, 4-arm randomized control trial of aerobic and resistance exercise intervention among metabolically unhealthy prostate cancer patients receiving ADT and cancer-free buy metabolically unhealthy men. Once recruited, the men were separated by prostate cancer participants and cancer free participants. Within these two arms, the men were separated into the aerobic exercise intervention that was supplemented with strength training and the stretching control group. Prior to enrollment in the trial, the blood pressure and fasting glucose of the participants were measured and their medical history was taken. If they qualified for the study, participants filled out questionnaires regarding demographics, family history, and lifestyle information. Anthropometrics were taken. In addition to this, muscle strength, cardiorespiratory fitness, bone mineral density and body composition were measured with an isometric grip strength, VO2 max, and Dual X-ray Absorptiometry (DXA), respectively. After the trial is completed, these same measurements are repeated for comparison. Results: Data collection was started in September and at this time there is no data to report. It has been difficult to recruit participants so the eligibility criteria are being reexamined. In the future, we hope to see the data shows that aerobic exercise does improve the adverse side effects of Androgen deprivation therapy.
Nneka Mezu: University of Maryland, College Park
Mentor: Seble Kassaye, MD, MS
Assistant Professor of Medicine, Georgetown University Medical Center, Department of Infectious Diseases
“HIV Transmission Dynamics in Washington, DC”
Background: HIV or human immunodeficiency virus is a condition that is transmitted via blood, breast milk, and or genital secretions2,4. The later stages of this virus may progress to AIDS or acquired immunodeficiency syndrome, leading to opportunistic infections and diminishing quality of life. In order to look at genetic diversity of viruses like HIV, epidemiologists use phylogenetics, which is the grouping of genes or organisms based on its evolutionary history and relatedness3. Phylogenetic analyses become very useful when comparing the genotypes of HIV-infected individuals to see if they are related or in the same transmission cluster. Since Washington, DC has the highest prevalence of HIV cases in the nation at 2.5%1, this study aims to provide information about how HIV is transmitted within different sub-populations among residents of the DC-Metropolitan area. Various new HIV prevention modalities such as PrEP and TasP can be used to prevent the acquisition and transmission of HIV among high risk groups, which can potentially benefit individuals in Washington, DC. Methods: These transmission clusters will be determined using phylogenetic data of 200 participants enrolled at Georgetown University Medical Center. This data will be derived from extensive survey information paired with data extracted from the electronic medical records with a tool created on Research Electronic Data Capture (REDCap). Expected Results: It is expected that clusters will be formed using the survey and data extraction tool data displaying the at-risk groups (sexual orientation, gender, race, etc.). Also, by comparing the clustering of the individuals by genotype, it will show whether transmitted antiretroviral drug resistance is present at all in any individuals that are treatment naïve. Further Work: The data extraction tool and survey will continue to be used when enrolling participants. In addition, there will be continued surveillance of transmitted drug resistance using phylogenetic analyses. With this information, the sequence data can be used to monitor changes to the transmission dynamics after the increased uses of PrEP and TasP are implemented as targeted interventions.
Abiola Ojo: Howard University School of Pharmacy
Mentor: Sivanesan (Siva) Dakshanamurthy, Ph.D.
Associate Professor of Oncology, Clinical & Experimental Therapeutics Program, Lombardi Comprehensive Cancer Center Georgetown University Medical Center
“Polypharmacology – Analysis of Triple Negative Breast Cancer”
Specialized therapeutics for cancer are effective when the pathology of the biological elements are targeted. Nevertheless, the gene expressions, cellular pathways and the multiformity of molecular components are barriers encountered with targeted therapy. An effective strategy may be to utilize a computational algorithm to simultaneously analyze multiple mechanisms associated with the specified disease state. We utilized a computational drug repurposing polypharmacology method that is based on biological gene expressions for cancer therapeutics. As further conceptual evidence, this method was applied to triple negative breast cancer. This breast cancer subtype was characterized by differential gene expression analysis in which we compared African American women with triple negative breast cancer against other women with triple negative breast cancer. The differential gene expression analysis evaluated signaling pathways, biological functions, and enriched protein-protein interactions. This method assumes that those medications that show a potential to target the greatest amount of molecular components of triple negative breast cancer are efficacious in therapy.
Drugs were connected with biological pathways and functions through enriched protein-protein interactions if an annotation existed. The drug network pharmacology annotations were retrieved from up-to-date annotation datasets using publicly available tools to provide a comprehensive analysis. The pharmacology annotations were retrieved from DAVID Functional Annotation Tool and ConsensusPathDB. The human subtype-associated gene expression for triple negative breast cancer was retrieved from The Cancer Genome Atlas (TCGA). The subtype-associated genes were obtained using a differential gene expression analysis in R Studio Program, in which we compared African American women with triple negative breast cancer against other women with triple negative breast cancer. The up-regulated subtype-associated genes were considered to be differentially associated (t-test P<0.05). The top 3000 genes (based on fold change) obtained were selected for further analysis.
Drugs were ranked based on the differential gene expression analysis that evaluated signaling pathways, biological functions, and enriched protein-protein interactions. The highest score indicated the polypharmacological potential to target the greatest amount of signaling pathways, biological functions, and enriched protein-protein interactions associated with African American women with triple negative breast cancer against other women with triple negative breast cancer. Drugs with the highest score were considered the best medications due to their wide effect on biological processes. A medication such as Gemcitabine was identified. Genes were also ranked based on the differential gene expression analysis that evaluated signaling pathways, biological functions, and enriched protein-protein interactions. The highest score indicated that the genes prevalence in African American women with triple negative breast cancer was greater as compared to other women with triple negative breast cancer. An antibody fragment target Mesothelin (MSLN) was identified. Further analysis still needs to be conducted utilizing the computational drug repurposing polypharmacology method.