Browsing by Author "Smith, Margaret"

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    A Collaborative Assessment of Barriers to Oral Health Care: Are Social Workers Needed?
    (IUPUI, 2021-06-14) Lyons, Stephanie; Schrader, Stuart; Galyean, Erika; Romito, Laura; Everidge, Caroline; Smith, Margaret; Mandapati, Surendra Reddy; School of Social Work
    Oral health disparities are pervasive. Interprofessional education and collaborative practice experiences may be a means to address this problem in oral healthcare settings. This project aimed to determine: (1) barriers involved in patients’ access to oral health care at an academic dental school clinic, (2) dental students’ perceived ability to address patients’ needs and/or care barriers, (3) the ability of current clinical operations’ to address access to care issues, and (4) the potential role of a licensed health care social worker integrated into the clinic. Investigators conducted three focus groups –one student group (n=5), one clinical staff group (n=7), and one clinical faculty group (n=5). Further, investigators administered two needs assessment surveys in the dental school – one with students, staff, and faculty (n=144) and the second with the school’s dental patients (n=150). Investigators employed descriptive and inferential statistical analyses to evaluate the survey data. Five principal barriers to oral health care for dental patients were identified from focus group and survey data, inclusive of patients, students, staff and faculty perspectives: (1) lack of financial means, (2) lack of/inadequate insurance, (3) limited/no transportation, (4) general health problems, and (5) language barriers. More female patients (38.7%) than male patients (8.1%) reported financial barriers to accessing oral care. Including licensed social workers in an academic dental clinic may help address patient barriers to care and support interprofessional collaborative practice.
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    Genomic Signature for Initial Brain Metastasis Velocity (iBMV) in Non-Small-Cell Lung Cancer Patients: The Elusive Biomarker to Predict the Development of Brain Metastases?
    (MDPI, 2025-03-15) Glynn, Sarah E.; Lanier, Claire M.; Choi, Ariel R.; D'Agostino, Ralph, Jr.; Farris, Michael; Abdulhaleem, Mohammed; Wang, Yuezhu; Smith, Margaret; Ruiz, Jimmy; Lycan, Thomas; Petty, William Jeffrey; Cramer, Christina K.; Tatter, Stephen B.; Laxton, Adrian W.; White, Jaclyn J.; Su, Jing; Whitlow, Christopher T.; Soto-Pantoja, David R.; Xing, Fei; Jiang, Yuming; Chan, Michael; Helis, Corbin A.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Background/Objectives: No prior studies have attempted to identify a biomarker for initial brain metastasis velocity (iBMV), with limited studies attempting to correlate genomic data with the development of brain metastases. Methods: Patients with non-small-cell lung cancer (NSCLC) who underwent next-generation sequencing (NGS) were identified in our departmental database. iBMV was calculated by dividing the number of BMs by the interval of time between primary cancer and BM diagnosis. Two-sample t-testing was used to identify mutations statistically associated with iBMV (p < 0.1). A value of +1 was assigned to each mutation with a positive association ("deleterious genes"), and a value of -1 to each with an inverse association ("protective genes"). The sum of these values was calculated to define iBMV risk scores of -1, 0 and 1. Pearson correlation test was used to determine the association between iBMV risk score and calculated iBMV, and a competing risk analysis assessed for death as a competing risk to the development of BMs. Results: A total of 312 patients were included in the analysis, 218 of whom (70%) developed brain metastases. "Deleterious genes" included ARID1A, BRAF, CDK4, GNAQ, MLH1, MSH6, PALB2, RAD51D, RB1 and TSC1; "protective genes" included ARAF, IDH1, MYC, and PTPN11. iBMV risk scores of 1, 0 and -1, predicted an 88%, 61% and 65% likelihood of developing a BM (p < 0.01). A competing risk analysis found a significant association between iBMV risk scores of 1 vs. 0 and 1 vs. -1, and the likelihood of developing a BM using death as a competing risk. Overall survival (OS) at 1 and 2 years for patients with iBMV risk scores of 1, 0 and -1 was 72% vs. 84% vs. 85% and 46% vs. 69% vs. 70% (p < 0.02). Conclusions: Development of a genomic signature for iBMV via non-invasive liquid biopsy appears feasible in NSCLC patients. Patients with a positive iBMV risk score were more likely to develop brain metastases. Validation of this signature could lead to a biomarker with the potential to guide treatment recommendations and surveillance schedules.
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    Modulation of oxidative phosphorylation and mitochondrial biogenesis by cigarette smoke influence the response to immune therapy in NSCLC patients
    (Elsevier, 2023-04) Wang, Yuezhu; Smith, Margaret; Ruiz, Jimmy; Liu, Yin; Kucera, Gregory L.; Topaloglu, Umit; Chan, Michael D.; Li, Wencheng; Su, Jing; Xing, Fei; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    The treatment regimen of non-small cell lung cancer (NSCLC) has drastically changed owing to the superior anti-cancer effects generated by the immune-checkpoint blockade (ICB). However, only a subset of patients experience benefit after receiving ICBs. Therefore, it is of paramount importance to increase the response rate by elucidating the underlying molecular mechanisms and identifying novel therapeutic targets to enhance the efficacy of IBCs in non-responders. We analyzed the progression-free survival (PFS) and overall survival (OS) of 295 NSCLC patients who received anti-PD-1 therapy by segregating them with multiple clinical factors including sex, age, race, smoking history, BMI, tumor grade and subtype. We also identified key signaling pathways and mutations that are enriched in patients with distinct responses to ICB by gene set enrichment analysis (GSEA) and mutational analyses. We found that former and current smokers have a higher response rate to anti-PD-1 treatment than non-smokers. GSEA results revealed that oxidative phosphorylation (OXPHOS) and mitochondrial related pathways are significantly enriched in both responders and smokers, suggesting a potential role of cellular metabolism in regulating immune response to ICB. We also demonstrated that all-trans retinoic acid (ATRA) which enhances mitochondrial function significantly enhanced the efficacy of anti-PD-1 treatment in vivo. Our clinical and bioinformatics based analyses revealed a connection between smoking induced metabolic switch and the response to immunotherapy, which can be the basis for developing novel combination therapies that are beneficial to never smoked NSCLC patients.