The vestibular system senses head motion and facilitates gaze stabilization, allowing for clear vision during movement. The vestibulo-ocular reflex (VOR) causes the eyes to move opposite head motion, thus maintaining focus on a target. Consequently, uncompensated loss of vestibular function leads to reduced VOR function resulting in dizziness, nausea, and visual disturbance. Different testing methods have been developed to measure VOR loss. These tests generally require bulky, expensive equipment, and must be performed by a trained examiner. A newly developed digital form of the dynamic visual acuity (DVA) test requires less equipment, is cost-effective, and may be performed at home making it more accessible. The purpose of this study was to determine the validity and test-retest reliability of the digital DVA test and provide normative data for healthy adults. Fifteen adults – 10 female and 5 male (mean age = 22.0 ± 3.1, range: 19-31 years) – completed the study. Exclusion criteria included age older than 49 years, history of vestibular or neurological disorders, and history of significant head injury. Subjects were screened for normal vestibular function using video head impulse testing. The study consisted of two visits, 3-15 days apart. Participants underwent DVA testing with both the validated NeuroCom (InVision software) system and newly developed digital DVA during the initial visit and the digital DVA during the second visit. The digital DVA system consists of a laptop computer paired with a head/eye tracker (Tobii Eye Tracker 5) and Health in Motion software (Blue Marble Health Company). Outcome measures of interest were the difference between static and dynamic visual acuity measured in LogMAR (DVA loss) for rightward and leftward head movement. Pearson Product-Moment bivariate correlations were used to determine validity of the digital DVA outcomes compared to NeuroCom outcomes. Intraclass correlation coefficients (ICCs) were calculated to determine test-retest reliability of the digital DVA. Pearson correlation coefficients for validity were r = 0.025 and r = -0.015 for left and right DVA loss, respectively. ICCs for test-retest reliability were r = 0.366 and r = 0.313 for left and right DVA loss, respectively. Mean values across both sessions for left and right DVA loss measured by digital DVA were 0.26 ± 0.13 and 0.26 ± 0.11, respectively. Correlations between the digital DVA and standard computerized DVA were poor indicating the need for further development of the current digital system/software. Test-retest reliability for the digital DVA system in its current state was also poor. Tobii sensor used in the software is limited by a 200 ms delay in reporting head motion to the software. Future development of a digital DVA may need to consider other sensors. The current digital DVA will not replace the computerized system; however, it may provide important information for clinicians who do not have access to computerized DVA.

Substance use disorder (SUD) is a disease that continues to affect the lives of millions of Americans. Access to adequate treatment also continues to be a challenge for many of those suffering from substance use disorder. To better understand the barriers to treatment as well as the social challenges people face in seeking care for their substance use, we designed an observational study to capture demographic data, perceptions of stigma, and self esteem levels at a medication assisted treatment (MAT) facility in Northeast Tennessee. A robust survey was administered to patients at the MAT facility to quantify and analyze these metrics. Results from the survey showed when it came to stigma, respondents felt the highest level of internalized stigma compared to the other two types of measured stigma (enacted and anticipated). This was still the case even after stratifying based on gender. Regarding self esteem, survey results showed that as a whole, most respondents were within the normal range for self esteem, however, differences were appreciated when the data was categorized based on age. Finally, some of the most common reasons respondents selected for not seeking treatment previously were the thought that the problem could be handled alone, the lack of health insurance, and the fact that they were not ready to quit. A greater understanding of these issues is crucial for providers to better serve their patient population and tailor their services to the pertinent issues of the area.

The prevalence of Hepatitis C Virus (HCV) in the US is estimated at 3.5 million with 18,153 deaths in 2016. It is the most common bloodborne infection, with a higher age-adjusted mortality rate than Hepatitis B Virus or Human Immunodeficiency Virus. Without treatment, nearly 1.1 million people will die from HCV by 2060. About 41,200 new cases of HCV were reported in 41 states in the US in 2016. The reported cases of acute HCV in 2016 is 2.3 per 100,000 in Tennessee, which is more than twice the national goal set by Healthy People 2020. This is a descriptive study to ascertain the HCV prevalence and usefulness of screening in medical outreach settings (MO) compared to indigent healthcare clinics (IHC) in northeast Tennessee. This study period was from April 2017 – February 2019. Participants (n=250), were adults, who engaged in routine, opt-out HCV testing at 4 IHC and 3 MO sites in the Tri-Cities, TN region. During the screening, demographic information- age, gender, race- were collected and the de-identified data were analyzed using Statistical Analysis System (SAS 9.3) to perform a descriptive analysis. Also, several discrete Chi-Square tests of independence between the demographic variables, screening locations, and HCV antibody prevalence was conducted. A total of 250 clients were screened for HCV. The majority of clients screened were non-Hispanic whites 228 (91.20%); females 136 (54.40%); young adults 131 (52.40%) and at IHC clinics 187 (74.80%). Screening showed HCV antibody prevalence of 14.8%. The majority of positive cases were non-Hispanic whites 36 (97.30%; P=0.1561); females 19 (51.35%; P=0.6867) and young adults 23 (62.16%; P=0.286). The prevalence at the IHC clinics and MO settings were 36 (97.30%; P=0.0006) and 1(2.70%) respectively. This analysis shows the higher yield of targeted HCV screening at IHC clinics. Focused HCV screening is critical in the era of opioid epidemic, particularly when direct-acting antiviral agents (DAAs) which offer a Sustained Virologic Response (SVR) rate of more than 90% are available. The use of case control or cohort study designs to establish causality is recommended for improving focused HCV screening.