I have had the opportunity to participate in some fascinating research projects that have shed light on unecessary and costly hospital practices and have revealed processes that regulate cellular aging. My thesis research titled "The Effects of HIV and Lifestyle Factors on Cellular Aging in Transgender Women" was a study which analyzed the DNA of local transgender women to identify links between HIV, diet, and exercise to telomere attrition.
THE EFFECTS OF HIV DISEASE AND LIFESTYLE FACTORS ON CELLULAR AGING IN TRANSGENDER WOMEN by Scott Stephen Sohn
Background: Telomeres are short tandem repeats of nucleotides at the ends of chromosomes. These specialized structures serve as caps on the end of the chromosomes, which protect DNA integrity. Telomeres get shorter each time a cell replicates, but the DNA remains intact as long as the telomere caps are a sufficient length. In time, telomeres become too short to protect DNA, which leads to cellular death. Previous research has shown that disease and negative lifestyle factors play a role in accelerated telomere attrition throughout the cellular life cycle. Objective: The purpose of this study was to determine if HIV infection and lifestyle factors in a transgender population living in Atlanta Georgia are associated with telomere length reduction.
Participants/setting: This study is a secondary analysis of data provided by a Georgia State University study entitled “Telomere Length, Environmental Stressors and Health Related Outcomes among Transgender Women”. The study included 92 transgender women from Atlanta, Georgia with 49 reporting HIV infection. Two sources of data were collected, survey responses collected during face to face interviews and a saliva sample for DNA analysis.
Statistical analysis: Frequency statistics were used to describe the sample population. A Mann Whitney U was used to evaluate telomere length using the T/S ratio by HIV status, by physical activity level (healthy active or low active) and by fruit and vegetable intake category (Don’t eat, 1-2 servings/day, 3-4 servings/day vs. >5 servings/day) in the total
Population. Multiple regression analysis was used to examine the association between independent variables (activity level, body mass index, fruit and vegetable intake, hormone use, race, HIV status and age) and telomere length.
Results: The majority of the population was Black (84%) with a median age of 33 years (range, 18 to 65 years). No significant association was observed between HIV infection and T/S ratio. The vast majority of the population reported low activity level and only 9% reported consuming >5 servings of fruits and vegetables daily. No significant association was found between fruit and vegetable intake or physical activity level and T/S ratio in this population.
Conclusion: HIV infection, Fruit and vegetable intake, and physical activity were not found to impact telomere length in an urban population of transgender women. Future research is needed to further understand the mechanisms that impact telomere length throughout the cellular life cycle within the transgender population.
Routine monitoring of GRV (gastric residual volume) in patients receiving EN (enteral nutrition) is a common practice in hospitals throughout the world. While the practice is wide-spread, current evidence does not support its efficacy related to patient care. In addition to the limited benefit of GRV monitoring in the patient
population, it has been shown to result in high associated costs while diverting limited nursing resources. Misguided perceptions related to the effectiveness of continuous GRV monitoring among health care providers has led to a practice that drains hundreds of thousands of dollars each year from any given hospital. These added time and labor costs have been shown to be unnecessary when related to patient outcomes in the hospitalsetting. In the past, providers assumed that continuous monitoring of patients receiving enteral feeding was a necessary precaution to avoid aspiration pneumonia. Several studies have now shown no association between GRV and pneumonia as well as no correlation with ICU mortality, or hospital mortality. These studies have demonstrated that elevated residual volumes have little clinical meaning by themselves. Only when increased GRV are combined with signs of intolerance such as vomiting, sepsis, sedation, or the need for vasopressor agents does a correlation exist. Additionally, frequent holding of tube feeds may adversely affect patient outcomes due to decreased energy and nutrient delivery during critical healing and recovery periods. Routine GRV checks have also been linked to increased EAD (enteral access devise) clogging which leads to inadequate nutrient delivery and increased utilization of nursing time. Current ASPEN guidelines recommend not discontinuing EN for GRVs < 500 ml in the absence of other signs of intolerance. This study confirmed the high cost and limited benefits realized through continuous GRV monitoring. Only 13% of patients showed signs of intolerance, and of those, only 3 had elevated GRV of 200-400 ml. One patient out of 84 experienced aspiration pneumonia which was not correlated with documented GRV.