Browsing by Author "King, Jennifer"

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    Clinical and Genomic Features of Androgen Indifferent Prostate Cancer
    (MDPI, 2025-01-15) Masur, Jack; Ratan, Aakrosh; Wierbilowicz, Krzysztof; Ayanambakkam, Adanma; Churchman, Michelle L.; Graham, Laura S.; Grass, George Daniel; Gupta, Sumati; Kern, Sean Q.; King, Jennifer; Myint, Zin; Rounbehler, Robert J.; Salhia, Bodour; Singer, Eric A.; Zakharia, Yousef; Paschal, Bryce M.; Viscuse, Paul V.; Medicine, School of Medicine
    Androgen-indifferent prostate cancer (AIPC) is increasingly common and particularly lethal. Data describing these tumors are sparse, and AIPC remains a poorly understood malignancy. Utilizing the Oncology Research Information Exchange Network (ORIEN) database, we enriched for tumors with features of AIPC using previously described characteristics. Our AIPC cohort included three subgroups: aggressive variant prostate cancer (AVPC), neuroendocrine PC (NEPC), and double-negative PC (DNPC). Of 1496 total PC patients available for analysis, we identified 323 (22%) as MCRPC. Of those, 39 (12%) met AIPC criteria (17 AVPC, 13 NEPC, 9 DNPC) and 284 (88%) were non-AIPC. Forty-three percent of AIPC patients had de novo metastatic disease vs. 15% for non-AIPC (p = 0.003). Homologous recombination deficiency (HRD) and tumor mutational burden (TMB) did not differ between cohorts, but microsatellite instability scores (MSI) were significantly higher in AIPC (p = 0.019). Using Gene Set Enrichment Analysis (GSEA), we found that genes defining response to androgens and genes involved in oxidative phosphorylation were the most downregulated, whereas genes involved in epithelial-mesenchymal transition (EMT) and immune signaling were significantly upregulated in AIPC vs. non-AIPC. Our study demonstrates the potential for predefined criteria that aim to enrich for AIPC and suggests opportunities for therapeutic investigation.
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    Evaluating Return-to-Work Outcomes for Patients with Post-Concussion Syndrome
    (2024-04-24) King, Jennifer; Hull, Kristin; Department of Occupational Therapy, School of Health and Human Sciences; Ellis, Katherine
    Approximately 22% of all injury-related emergency department visits are due to a concussion (van der Vlegel, et al., 2021). If symptoms persist following an injury, the individual is diagnosed with post-concussion syndrome and may experience significant impacts to their occupational participation, including returning to work (Graff, et al., 2018). A local hospital's Comprehensive Outpatient Post-Concussion Rehabilitation Program provides thorough assessments and interventions to improve functioning and quality of life for individuals with post-concussion syndrome. However, research has not been completed within the program to better understand population characteristics and outcomes for post-concussion patients. This doctoral capstone student conducted research using retrospective data on return-to-work outcomes and self-appraisal scores (using the Appraisals of Disability: Primary and Secondary Scale) following a concussion for workman’s compensation patients. Results indicated that there were no significant differences in outcomes or self-appraisal scores for workman’s compensation patients compared to non-workman's compensation patients (p > 0.05). However, self-appraisal ratings of Fearful Despondency and Overwhelming Disbelief were significantly higher for individuals who did not complete therapy compared to individuals who returned within six months (p < 0.05). Therefore, the research conducted by the doctoral capstone student will serve as a pilot study for future research on self-appraisal and therapeutic outcomes for post-concussion patients.
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    Multimodality, Online Oncology Learning Curriculum: An Adaptable, Asynchronous Learning Resource
    (2024-04-26) Pham, Phillip; Dandu, Vidya; King, Jennifer; Schwartz, Jennifer
    Background/Objective: Dedicated educational sessions can improve residents’ interest in a career in oncology. Challenges remain with creating effective learning resources tailored to multiple learning styles on busy oncology rotations. Here, we aimed to build an effective and adaptable oncology curriculum for learners using online, multimodality, and interactive learning tools and resources. Methods: Using the Canvas® online learning management system, modules covering specific cancer types were created, each with a pre-survey to assess learners’ evaluation of their own knowledge and comfort of the specific cancer type, a brief video or audio file covering high-yield material about the cancer type, interactive case-based questions to review and reinforce content, and a post-survey to assess the change in knowledge and comfort in clinical application of the material. As initial modules were built, learner preference for module style was evaluated and subsequent modules were adapted based on that feedback. Pre- and post-surveys were rated on a 5-point Likert scale. Median values and interquartile ranges are reported. A one-sided t-test was used to compare responses. Results: Two initial modules were created. The lung cancer module included a high-yield voice-over PowerPoint presentation followed by interactive, case-based questions. The breast cancer module used a high-yield podcast with accompanying note handout followed by interactive case-based questions. After the completion of these two modules, six learners completed a ranking for preference of module learning style. Four learners preferred voice-over PowerPoint with case-based questions afterward, while the other two preferred upfront cases to work through followed by a voice-over PowerPoint for reinforcement. Of the listed module styles, a podcast was preferred the least. With this feedback, two additional modules were created, one with cases before a PowerPoint and another voice-over PowerPoint followed by cases. Overall, 21 learners have completed both pre- and post-survey responses for comparison. Median rating of the learners’ knowledge of a specific cancer type increased from 2-Fair (2) on the pre-survey to 4-Agree (1) after completing the learning module (p<0.001). All learners felt more comfortable with their clinical application of the cancer topic after completing the module, median 2(2) on pre-survey vs. 4(1) on post-survey (p<0.001). Median rating for feeling that knowledge of the specific cancer type increased after the module was 4-Agree (3). Discussion/Conclusions: Using learning science principles and an adaptive framework, this online, asynchronous oncology curriculum has resulted in improvements in learners’ perceived knowledge and clinical application of oncology topics. Further modules are being created and adapted in response to learners’ feedback.
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    Outcomes in Patients With Postchemotherapy Residual Nonretroperitoneal Disease in Nonseminomatous Germ Cell Tumors
    (American Medical Association, 2024) King, Jennifer; Ashkar, Ryan; Kesler, Kenneth; Althouse, Sandra K.; Hanna, Nasser H.; Einhorn, Lawrence H.; Adra, Nabil; Medicine, School of Medicine
    This case-control study assesses the association between teratoma in the primary tumor or postchemotherapy resections and survival outcomes.
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    Prediction Model for Brain Metastasis in Patients With Metastatic Germ‐Cell Tumors
    (Wiley, 2025) Salous, Tareq; Ashkar, Ryan; Althouse, Sandra K.; Cary, Clint; Masterson, Timothy; Hanna, Nasser H.; King, Jennifer; Einhorn, Lawrence H.; Adra, Nabil; Medicine, School of Medicine
    Background: Brain metastasis (BM) is an independent adverse prognostic factor in metastatic germ cell tumors (mGCT). We aimed to establish an effective and practical BM prediction model. Patients and methods: Between January 1990 and September 2017, 2291 patients with mGCT who were treated at Indiana University were identified. Patients were divided into two categories: BM present (N = 154) and BM absent (N = 2137). Kaplan-Meier methods were used to analyze progression free survival (PFS) and overall survival (OS). Logistic regression was used to determine a predictive model for whether BM was present. The data was separated into training and validation datasets with equal numbers of events in each. Results: The 2-year PFS and OS for patients with versus without BM: 17% versus 65% (p < 0.001) and 62% versus 91% (p < 0.001) respectively. Among the 154 patients with BM, 64 (42%) had radiation only (whole-brain radiotherapy or gamma knife), 22 (14%) had BM-surgery only, 14 (9%) had both radiation and BM-surgery. 54 patients (35%) did not receive local therapy for BM. Stepwise selection was used to determine the best model with p < 0.15 as the entry and staying criteria. The model with the largest ROC AUC was used moving forward. The model was tested in the validation dataset. A model was generated including age at diagnosis ≥ 40, choriocarcinoma predominant histology, pre-chemotherapy hCG≥ 5000, presence of pulmonary metastases size < 3, or ≥ 3 cm, and presence of bone metastasis. Patients with score of 0, 1, 2, 3, 4, 5, 6, 7, 8 points had a 0.6%, 1.4%, 3.5%, 8.2%, 18.3%, 36%, 58%, 78%, 90% probability of having BM, respectively. Conclusions: The prediction model developed in this study demonstrated discrimination capability of predicting BM occurrence in mGCT and can be used to identify high-risk patients.
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    Substance Use Disorders in Adolescent and Young Adult Relatives of Probands with Bipolar Disorder: What Drives the Increased Risk?
    (Elsevier, 2017-10) Hulvershorn, Leslie A.; King, Jennifer; Monahan, Patrick O.; Wilcox, Holly C.; Mitchell, Philip B.; Fullerton, Janice M.; Edenberg, Howard J.; Roberts, Gloria M. P.; Kamali, Masoud; Glowinski, Anne L.; Ghaziuddin, Neera; McInnis, Melvin; Iyer-Eimerbrink, Priya A.; Numberger, John I, Jr.; Department of Psychiatry, School of Medicine
    Background Adults with bipolar disorder (BD) have higher rates of substance use disorders (SUDs) compared to the general population. SUD rates in young offspring/relatives of BD probands, as well as factors which drive those rates, are not as well-characterized. Methods We aimed to examine SUD prevalence among adolescent/young adult offspring and relatives of probands with and without BD. Data were collected from five sites in the US and Australia during 2006–2011. Youth offspring/relatives (“Relatives of BD probands;” n = 267; mean age = 16.8 years; ± 2.9 S.D.), identified through a proband family member with DSM-IV BD (Type I or II), were compared to offspring/relatives of control probands (“relatives of control probands;” n = 149; mean age = 17.4 years; ± 2.9 S.D.). Logistic regression with generalized estimating equations was used to compare the groups across a range of substance use and SUD variables. Odds ratios were calculated for lifetime prevalence of substance outcomes. Results Bivariate analyses showed DSM-IV SUDs were more prevalent among relatives of BD probands than among relatives of control probands (29% vs. 18%; p = 0.01). Generalized estimating equation models showed BD mood and childhood-onset externalizing disorders in adolescent and young adult relatives to each significantly increase the odds (OR = 2.80–3.17; p < 0.02) for the development of several substance variables among all relatives, whereas the risk of SUDs in relatives was not increased when the relatives had no mood or externalizing disorders themselves. Conclusion Relatives of BD probands with lifetime mood and externalizing disorders report more substance use/SUDs than relatives of control probands. In contrast, SUD outcomes in relatives of BD probands without mood or externalizing disorders were no different from control relatives without psychopathology. Early recognition and treatment of psychiatric disorders may lead to less substance use in this highly vulnerable population.