Isolated aneurysmal degeneration and dissection of the iliac artery, without involving the aorta, are uncommon, with an overall incidence in the general population being as low as approximately 0.03%. Solitary iliac artery aneurysm represents approximately 0.4 to 1.9% of all cases of aneurysmal disease; with involvement of external iliac artery being the least common and extremely rare and present in only 10% of these cases. Risk factors for external iliac dissection resulting from an aneurysm, are similar to that of abdominal aorta aneurysm and include male gender, white race, advancing age, history of smoking, hypertension and known atherosclerotic disease. We present a case of a 70 year old Caucasian male, with a past medical history of well controlled hypertension, dyslipidemia and remote history of smoking, who underwent a contrast enhanced CT Abdomen and pelvis to evaluate a renal cyst. However, was found to have short segment right external iliac artery dissection without distal propagation. He reported no symptoms - denied intermittent leg pain on exertion, lumbosacral pain, lower extremity edema, weakness or numbness/tingling in his legs. Also, denied urinary or bowel complains including urinary retention, pain during defecation and constipation. He reported a 28 pack year history of smoking and had quit smoking 50 years ago. Vital signs were recorded as: blood pressure 114/68 mmHg, pulse rate 66 bpm, respiratory rate 16 breaths/min and body temperature 96.6F. On physical examination, abdomen was soft, non tender, non distended and bowel sounds were present in all four quadrants. No guarding or rigidity was noted. Peripheral pulses were well palpable and equal. Laboratory data including CBC and CMP were within normal limits. ESR and CRP were 12 and In conclusion, this is a rare case of isolated asymptomatic external iliac artery dissection, diagnosed as an incidental finding. The treatment of this condition is unclear because of its rare occurrence. Cases complicated with rupture/ symptomatic patients should be treated surgery or endovascular repair. Asymptomatic patients with smaller size of

Rural communities across the United States suffer from multiple health disparities that range from access to care to awareness of medical information. These disparities are characterized by increased incidence of illnesses, mortality rates, lower quality of life, and lower life expectancy when compared to the general urban population. Several risk factors have been identified that play a direct role in these characteristics. These include geographic isolation, lower socioeconomic status, higher rates of health risk behaviors, and limited job opportunities, and less health education. Hawkins County Tennessee is one such rural community that suffers from these disparities. The leading cause of death in Hawkins County is cardiovascular disease (CVD). Due to the nature of disease, early life long modifiable risk factors play a critical role in its development. Health education and awareness of the disease is also a key factor in the disease's effects in the community. Studies have shown that early life healthcare awareness is an “important determinant of adult health status.” This led us to examine the current state of cardiovascular disease awareness and perception among teens in the community. To examine the current perception of CVD in Hawkins country we created an assessment for ninth grade students attending Cherokee Highschool during their health class block. We also aimed to assess the effectiveness of an interactive interventional educational program targeted at both educating the technical knowledge surrounding CVD and at reducing modifiable risk factors that lead to CVD. The interactive educational program was designed and given to students (n=82; 47 Male 35 Female) across 5 class period in two sections (Cardiovascular health and Nutritional & Physical health) that were taught one week apart. Students underwent a Pre-test/survey that examined four areas of interest: perception & technical knowledge of CVD, perception of physical activity, perception of nutrition and diet, and current family health. After completing the program students were then given an identical post-test/survey. Result means were compared between Pre and Post survey using Independent sample T-test. Analysis showed that technical understanding of CVD and of modifiable risk factor significantly increased across all areas (P

INTRODUCTION: The purposes of this study are to determine whether Thiel-embalmed cadavers are an effective educational tool in teaching medical students to perform knee arthrocentesis, to compare the use of Thiel-embalmed cadavers to formalin-embalmed cadavers in arthrocentesis education, and to determine whether the use of Thiel-embalmed cadavers is potentially generalizable to the instruction of other orthopedic procedures. METHODS: Sixty-eight third-year medical students participated in the study. The participants first completed a pre-survey to assess their prior experience with arthrocentesis procedures and Thiel-embalmed cadavers. Participants then attended an instructional session where the knee arthrocentesis procedure was demonstrated on a Thiel-embalmed cadaver. Participants then individually performed the simulated knee arthrocentesis procedure twice: once on a Thiel-embalmed cadaver and once on a formalin-embalmed cadaver. Success of each attempt was determined through the visualization of aspirated joint fluid. Following the laboratory session, each participant completed a post-survey to determine whether the session improved their perceived confidence in performing knee arthrocentesis, if they preferred the use of Thiel-embalmed cadavers or formalin-embalmed cadavers as a teaching tool, and if they believed simulated practice using Thiel-embalmed cadavers would be effective for learning other orthopedic procedural skills. RESULTS: Sixty-eight students participated in the laboratory session and successfully completed both pre- and post-course surveys. 96% of participants reported that they felt confident performing knee arthrocentesis under physician supervision following their participation in the laboratory session (versus 15% of participants in the pre-survey). 96% of participants reported that the Thiel-embalmed cadavers provided a more realistic teaching model than formalin-embalmed cadavers for learning knee arthrocentesis. 100% of participants believed the incorporation of simulated practice using Thiel-embalmed cadavers is an effective method in teaching students to perform knee arthrocentesis. 100% of participants reported that they would participate in future sessions using Thiel-embalmed cadavers to learn and practice other orthopedic procedural techniques. DISCUSSION: This study used a moderate sample size of third-year medical students to provide data regarding the suitability of using Thiel cadavers in arthrocentesis education. Results indicate that Thiel cadavers are effective tools in teaching medical students to perform knee arthrocentesis, that students preferred the Thiel cadavers to the formalin cadavers, and that the use of Thiel cadavers is a safe, engaging, and high-quality teaching modality for demonstrating proper arthrocentesis procedural technique to medical students. Since this study looked specifically at teaching knee arthrocentesis to medical students, it is uncertain whether the benefits of Thiel cadavers are generalizable to the education of other orthopedic procedures and subject groups such as residents, fellows, and practicing physicians. Further studies should be performed to assess whether Thiel cadavers are beneficial in teaching other orthopaedic procedures and if these benefits extend to other subject groups.

Introduction Tennessee (TN) ranked 16th among US states for the number of HIV diagnoses in 2015. By TN grand division region (East, Middle, and West), the highest rate of persons living with HIV/AIDS (PLWH) were in the Middle and West. Barriers to HIV testing are still very much unknown in research studies. Further, understanding how Adverse Childhood Experience (ACEs) play a role in HIV testing and specifically in marginalized groups is not fully understood. The present study sought to understand the relationship between ACEs, living in poverty, and testing for HIV among adults in Tennessee. Methods Behavioral Risk Factor Surveillance System data for 2016 and 2017 were obtained from the Tennessee Department of Health. Sociodemographic factors, diagnosis of depression, binge drinking behaviors, HIV risk behaviors (one or more of these in the past year: injection drug use, anal sex, sex without a condom, paid sex, four or more sexual partners), grand division, poverty level, and ACEs were analyzed to determine if an association exists with having been tested for HIV in the past year (yes or no). ACEs were categorized into 0, one to three, or four or more, all having occurred before the age of 18. Frequencies, percents, chi-square, and independent T-tests were completed. Sex stratified simple and multiple logistic regression models were conducted to determine the strength of association with having been tested for HIV (N=1,506 males; N=1,433 females). Results Males who reported HIV risk behaviors were 46% less likely to be tested for HIV (aOR: 0.54, 95% CI: 0.53-0.55) whereas females with HIV risk behaviors were 61% less likely to test for HIV (aOR: 0.39, 95% CI: 0.39-0.40) compared to those without HIV risk behaviors. Males with 4 or more ACEs were 38% more likely to be tested for HIV compared to males with 0 ACEs (aOR: 1.38, 95% CI 1.36-1.39), whereas females with 4 or more ACEs were two times more likely to be tested for HIV (aOR: 2.09, 95% CI: 2.07-2.11) compared to females with 0 ACEs. Males making <$25,000 annually were only 5% more likely to be tested for HIV (aOR: 1.05, 95% CI: 1.04-1.06), whereas women making the same income were 30% less likely to be tested for HIV (aOR: 0.70, 05% CI: 0.69-0.71) compared to incomes greater than $25,000. Males in West TN were 12% less likely to be tested for HIV compared to males in East TN (aOR: 0.88, 95% CI: 0.87-0.89). Similarly, females in West TN were 15% less likely to be tested for HIV compared to females in East TN (aOR: 0.85, 95% CI: 0.84-0.86). Conclusion Education and awareness may be too focused on adults with more ACEs rather than ensuring individuals with HIV risk behaviors, living in poverty, or residing in West TN, understand their risk and have access to HIV testing. Regions of TN, specifically West TN compared to East TN, may require additional resources to ensure the general population understands their risk for HIV; however further research is warranted through longitudinal studies.

INTRODUCTION Depression affects over 18 million American adults yearly and has been identified as the leading cause of disability in people between the ages of 15 and 44 years in the United States. The purpose of this study was to analyze the association between individuals who felt unloved or unwanted during their formative years and the occurrence of depressive symptoms in adulthood. METHODS We examined 5,114 participants aged 24–32 years at Wave IV of the National Longitudinal Study of Adolescent Health (Add Health) public use dataset. We used logistic regression analysis to determine the association between an individual feeling unloved or unwanted by their parent or adult caregiver prior to age 18, closeness with their parents, and a host of risk and protective factors with lifetime depression. We controlled by race, income, education, and age. RESULTS Overall (16.2%; n=827) reported lifetime depression diagnosis. Feeling unloved by a parent/ adult caregiver was associated with higher odds of lifetime depression among males (OR= 2.95, 2.22, 3.92) than females (OR=2.16, 1.78-2.61). The participant report of a biological father spending time in prison (OR= 1.40, 1.14, 1.72) was also associated with lifetime depression. CONCLUSION Our results reveal that feeling unloved/unwanted is associated with depression in both males and females. Therefore, it creates the awareness that depression is not gender-based, and that both females and males require the love of their parents and adult caregivers.

Lack of theoretical coherence in the field of gifted education has given rise to multiple attempts at a grand unification, including most recently the work of Subotnik, Olszewski-Kubilius, and Worrell (2011). The authors argue that the incoherence is an inevitable consequence of the fundamental incompatibility of theoretical and definitional features desired by psychologists and educators. Our field could best progress by splitting into the two related but distinct disciplines of high-ability psychology and advanced academics. Furthermore, the prospective adoption of Subotnik et al.'s eminence framework as an organizational principle for either advanced academics or high-ability psychology is criticized.

Tamora Pierce’s work has been cited by many Young Adult fantasy authors as a major influence in recent years. Despite this, her work remains relatively obscure among librarians and readers of Young Adult literature. This paper examined one of Pierce’s Young Adult fantasy series, Protector of the Small, by comparing the series to existing works of Young Adult fantasy literature commonly accepted as classic or canonical literature. Among the comparative works were titles authored by J. R. R Tolkien, C. S. Lewis, J. K. Rowling, and Philip Pullman. Comparison was character-focused, with emphasis on the representation of parents, other sympathetic adults, peers, and family units. Some comparison was also focused on the representation of antagonists in the selected works. The aim of the comparative analysis was to serve as a guide for librarians, teachers, and readers of Young Adult literature to better understand potential target audiences for the Protector of the Small quartet. It was found that target audiences for the series would likely seek or benefit from the Protector of the Small quartet’s inclusion of supportive parental and mentor figures, strong familial bonds, and supportive and communicative peers. Target audiences would also seek literature with nuanced antagonists capable of character growth. Most prominently, target audiences would seek Young Adult fantasy literature that addresses real-world issues and challenges for young women, including sexism, puberty, and reproductive healthcare.

Amyloidosis involves extracellular deposition of abnormal proteins/fibrils with potential end organ damage. AL type amyloidosis is one subtype and a clonal plasma cell disorder. A 74-year-old completely asymptomatic male presented with progressive renal dysfunction. Work up with serum protein electrophoresis (SPEP) and immunofixation revealed monoclonal IgG Lamda spike of 1.1 g/dL. Urine protein electrophoresis noted Bence Jones proteins. Notable labs, hemoglobin 10.6 g/dL, calcium was 8.2 mg/dL, and creatinine 2.4 mg/dL. Quantitative immunoglobulins IgA, IgG, and IgM, were 59 mg/dL, 1,939 mg/dL, and 23 mg/dL, respectively. Lambda and Kappa free light chains 26.37 mg/L and 127.87 mg/L, respectively, with a ratio of 0.21. Skeletal survey noted a 4 mm lucency of the left frontal bone. Bone marrow biopsy confirmed 21% plasma cells. Renal biopsy revealed AL lambda light chain confirming final diagnosis AL Lambda light chain Amyloidosis and IgG Lambda Multiple Myeloma. Treatment with daratumumab, cyclophosphamide, bortezomib, and dexamethasone initiated. His clinical course was complicated by COVID 19 infection prior to treatment initiation and with congestive heart failure secondary to cardiac amyloidosis (elevated Troponin and Brain Natriuretic Peptide level) during induction therapy requiring hospitalization, diuresis and optimization of cardiac medications. Very Good Partial Response (VGPR) noted after 2 cycles and near Complete Response (CR) after 4 cycles. Patient was evaluated and approved for Stem cell transplant (SCT) but decided against SCT and has now proceeded to single agent daratumumab maintenance. Amyloidosis is an uncommon disease seen in older adults (median age 64) with deposition of fibrils composed of low molecular weight subunits derived from normal proteins. Various subtypes and protien/fibrils include AL amyloidosis (immunoglobulin light chain), hereditary/ familial transthyretin amyloidosis (mutated transthyretin, apolipoprotien, fibrinogen A, lysozyme), wildtype transthyretin Amyoidosis/senile amyloidosis (unmutated transthyretin) and AA amyloidosis (serum amyloid A fibril). AL amyloidosis is a systemic disorder that presents with nephrotic syndrome or restrictive cardiomyopathy (as in this case). Other presentations involve peripheral neuropathy, hepatomegaly, macroglossia, arthropathy with “shoulder pad” sign, bleeding diathesis, purpura including “racoon eyes”. Biopsy of the affected organ (kidney, liver, fat pad aspirate, bone marrow) with Congo red staining confirms the histologic diagnosis. Amyloid light chains can be confirmed with proteomic analysis (mass spectrometry or immuno-electron-microscopy). AL amyloidosis treatment entails high dose chemotherapy and autologous SCT. Long term prognosis in advanced stage is poor. Survival can be short (4-6 months), heart failure causing about 50% of deaths. Daratumumab-regimens offer a 40-55% CR and with SCT data (83% five year and 50% ten-year survival) the outlook is improving.

Of poetry, Lacan remarked in the preface to Seminar XI, “I am not a poet, but a poem. A poem that is being written, even if it looks like a subject.” In understanding the subject as a poem, one begins to appreciate the literary mode of poetry. Traditions set by Judith Butler have inundated the use of a Lacanian analysis in the theoretical lives of transgender subjects. In the use of theoretical arguments that Butler uses the transsexual subject for, such as her essay “Doing Justice to Someone: Sex Reassignment and Allegories of Transsexuality,” there has been an injustice to transgender poets, in renown and the answers transsexuals have to the problems of materialism within Butler and Lacan. In other words, the real lives of transsexuals’ bodies are proof of the relevance of sex and gender. Jos Charles’ poem “Origin as Wetdream” loudly answers Butler’s apathetic attitude to the relevance of sex in the transsexual’s life. Furthering, this essay aims to examine the attitudes of sex and gender held within gender studies. This essay frames itself within the concept of “egg theory,” an argument held by Grave Lavery in her essay “Egg Theory’s Early Style.” In understanding Charles’ poem, one understands the transsexual subject. Through this understanding, the material of transition can be appreciated.

Breast cancer is the most commonly diagnosed cancer in women with an estimated 287,850 cases in 2022. Approximately 684,000 deaths each year are associated with breast cancer across the world. Risk factors of breast cancer include increased estrogen exposure, family history of breast cancer, and environmental factors. Treatment of breast cancer is highly dependent on the presence of HER2, estrogen, and progesterone receptors. Breast cancers that present with increased receptors for estrogen, progesterone, and HER2 are typically the least aggressive and the easiest to treat. The percentage of cases in the United States associated with hormone receptor positive and HER-2 negative or positive are approximately 82%. Absence of receptors for estrogen, progesterone, and HER2 is known as triple negative breast cancer. In the United States, only about 10% of cases are associated with this form. However, it is considered the most aggressive and difficult to treat. Two emerging flavonoids known as CT1 and CT3 have shown cytotoxic activity against cell lines that represent some of the most common breast cancers: MCF7, MDA-MB-231, and SKBr3. CT1 and CT3 were extracted from the leaves of Chromolaena tacotana using a Soxhlet extractor and the compounds then underwent isolation and purification. The cells were then treated with CT1 or CT3 at concentrations of 5, 10, 20, 40 and 80 µM. MTT assays were then used to determine cell viability. MDA-MB-231, the most aggressive type of breast cancer cells, responded to both CT1 and CT3. The most profound cytotoxic effects of CT1 were seen with MCF7 and MDA-MB-231, while CT3 exhibited a greater toxicity against SKBr3 cells. Preliminary results indicate that CT1 and CT3 target the MEK-ERK signaling pathway. Further studies need to be completed to determine mechanistically how these compounds lead to receptor-independent toxicity.