2020 Abstracts

Wankier, Zakary; Sinclair, Sarina PhD; Drew, Alex PhD; Taylor, Carolyn MS; Kubiak, Eric MD; Agarwal, Jayant MD (University of Utah)
Faculty Advisor: Sinclair, Sarina (School of Medicine, Orthopaedics)

Introduction:

Osseointegration (�OI�) technology is the direct skeletal attachment of a prosthetic limb to bone using an intramedullary stem. For OI to be effective and secure, bone in-growth and remodeling around the implant must be achieved. Physicians need an effective way to measure bone remodeling in order to make informed decisions on treatments. This work describes methodology that was developed that utilizes computed tomography (CT) imaging as a tool for analyzing bone remodeling around an OI implant.

Method:

Subjects implanted with a new Percutaneous Osseointegrated Prosthesis (POP) had CTs taken of their residual femur at 6 and 52-weeks post-op. The CT images were used to segment and create three-dimensional models of the femur.

Following segmentation, models were aligned to a common world coordinate system. STLs of the aligned medullary cavity and femur volume were entered into custom Matlab code to calculate cortical and medullary morphology measurements. Morphology data from 6 and 52-week scans were compared in order to determine if bone remodeling around the POP implant could be detected.

Results:

Comparing data from post-operative visits suggests that important indicators of bone remodeling around the device could be detected. One year after implantation of the POP device the medullary parameters had minimal % differences (-1.5 and 2.2) compared to 6-weeks, validating that consistent alignment was achieved between scans from different time points. Cortical area, perimeter, and thickness around the POP implant showed positive percent changes at 12-months of 19.44%, 4.04% and 14.36% respectively. Increases in cortex morphology values indicate bone remodeling around the implant, with largest increases observed at the distal end for each parameter.

Discussion:

This pilot study utilized CT imaging as a tool for quickly and accurately analyzing bone remodeling around a new osseointegrated device. Additional work will further validate and optimize these methods for clinical use.

This study described an investigational device, limited by federal law to investigational use. No long-term data exists about its performance.

Trumble, Tanner; Jensen, Francine (Utah Valley University)
Faculty Advisor: Jensen, Robert (Utah Valley University, Nursing)

Background: Individuals who experience homelessness lack the necessary components needed receive end of life care (EOL). However, due to personal and structural barriers such as cost of care, lack of insurance, addiction, and many who experience mental health and intellectual disabilities, homeless individuals are unable to receive palliative or hospice care. Because homeless individuals lack the necessary components of basic living such as food, water and shelter, their quality of life is significantly lower than that of the general population, and this affects their EOL experiences.

Purpose: To explore the factors that affect the homeless population and the barriers they face when accessing health care, including their needs at the EOL, and to provide recommendations for better EOL care.

Methods: A focused literature review was performed using the databases PubMed, Google Scholar and Science Direct using the keywords homeless, end of life, and palliative care covering the years 1985 to 2018.

Findings: Homeless individuals want to experience a "good death". Unfortunately, homeless individuals who seek medical treatment feel deterred due to unfair treatment and belittlement from previous health care experiences and the social stigma surrounding homelessness. This can delay their treatment of chronic or acute conditions and lead to long-term health consequences. One effort to aid in EOL care for homeless individuals is the Social Model Hospice, which provides holistic EOL care in home like setting. Social model hospice overcomes barriers to lack of insurance, social support and a location where EOL care can be delivered for homeless individuals.

Significance: Many barriers are limiting medical care for the homeless that should be available to them at the EOL. It is evident that healthcare providers need to be more aware of the needs of this population to help improve and provide the EOL care homeless individuals deserve.

Backman, Natalia; Ogden, Heath (Utah Valley University)
Faculty Advisor: Ogden, Heath (Utah Valley University, Biology)

The Family Baetidae, is in the order Ephemeroptera, also commonly known as Mayflies. The first baetids were described around 1815 by Leach, and since there are more than 900 species have been described. The family Baetidae is an important group of mayflies because of their position on the mayfly tree of life in that they are a key to understanding evolutionary trends, such as the origin of wings and flight. Taxon sampling for this study consisted of over 100 taxa, representing ??? genera, from lineages distributed geographically worldwide, except Antarctica. Two main datasets were constructed. The genes 12s, 16s, H3, 18s, 28s and CO1 were used as part of a traditional dataset. Targeted capture sequencing was used to generate a phylogenomic dataset, consisting of over 400 loci. Trees were reconstructed from the aligned datasets, and the results were compared. The phylogenomic data resulted in a much more resolved topology.

Daines, Savannah (Utah State University)
Faculty Advisor: Adams, Brett (College of Science, Biology Department)

Traumatic brain injury (TBI) occurs when external forces cause the brain to move rapidly within the skull, resulting in an alteration of brain function. Following the initial injury, a cascade of cellular events known as the secondary injury reduces cerebral energy production and exacerbates pathological consequences. Conditions that close the mitochondrial permeability transition pore (mPTP) provide effective treatment for TBI by restoring ionic balance and coupling of mitochondrial oxidative phosphorylation to ATP production. mPTP closure can be achieved during ketosis when the body metabolizes ketone bodies over glucose as a primary fuel source. Administration of exogenous ketones achieves therapeutic levels of ketosis more quickly and more effectively than fasting or ketogenic diets. No studies to date have evaluated the effectiveness of exogenous ketones in treating TBI in humans. This project will evaluate current scientific literature regarding the role of ketones in TBIs and identify potential future approaches to using ketones as a therapy for TBI.

Troy Madsen, MD; Brennen Holt, MD; Chad Agy, MD; Rachelle Perkins, BS; Margaret Carlson, BS; Jacob Steenblik, MPH, MHA; Joseph Bledsoe, MD; Gerry Doyle, MD (University of Utah)
Faculty Advisor: Madsen, Troy (University of Utah School of Medicine, Department of Emergency Medicine)

Pulmonary Embolism (PE) is a deadly, nondiscriminatory condition affecting all races, ethnicities, genders, and ages. There are an estimated 300,000-600,000 Americans affected every year. Sudden death is often the first symptom in a quarter of those with a PE. Chest pain is also a frequent symptom, yet it may be indicative of acute coronary syndrome (ACS). Pleuritic chest pain, defined as pain worsening with inhalation, is associated with non-ACS diseases, its presence is considered when evaluating a patient's risk for PE versus ACS. The proposed project, under the supervision of Troy Madsen M.D, attempts to determine the patients' overall risk of PE or ACS when presenting to the Emergency Department with pleuritic chest pain. The project also aims to evaluate the efficacy of using pleuritic chest pain history in a PE diagnosis. PE being of the most under-diagnosed conditions affecting hospitalized patients, this study specifically looks to include pleuritic chest pain in the decision-making process for diagnosing PE. While other studies look at age, malignancy, thrombophilia, and estrogen, our study evaluates all data collected from the presentation to the ED through the thirty-day phone call to determine the prevalence of PE in those with chest pain as their chief complaint.

McQuinn, Sophie; Love, Tiffany (University of Utah)
Faculty Advisor: Love, Tiffany (University of Utah, Psychiatry)

Chronic pain is a major health crisis, and is considered the second major cause of disability in the world. People with chronic pain that lasts 6 months or longer often experience other symptoms as well, including depression. While the causes of chronic pain are often unknown, it has been shown that people with chronic pain exhibit brain structure differences compared to those who do not. It is important to know how chronic pain and brain structure are interconnected so that we can find a better way to treat patients. Gaining more knowledge of this connection can lead to a better understanding of the underlying causes. Brain structure goes hand in hand with neuroplasticity, which plays a key role in normal brain development. While it has been shown that chronic pain can have a significant effect on brain structure, it is unknown whether different symptoms affect different areas of the brain. The effects of chronic pain on the brain have only been looked at in a holistic sense and have not been quantified according to symptoms. Because chronic pain can have a variety of causes, this makes it difficult to determine a good method of treatment for individuals. Our aim was to determine how different symptoms of chronic pain affect the brain individually and evaluate possible overlap. The categories we tested were sensory, affective, unpleasantness, intensity, and depression. We used MRI scans from both healthy individuals and participants experiencing chronic lower back pain. The relative levels of each symptom that the participants were experiencing were determined via the McGill Pain Questionnaire and the Center for Epidemiologic Studies Depression Scale. Having a better understanding of how different symptoms of chronic pain affect the brain can aid in finding more personalized treatment for those experiencing it.

Passey, Abigail; Domyan, Eric (Utah Valley University)
Faculty Advisor: Domyan, Eric (Utah Valley University, Department Of Biotechnology/Biology)

In the United States approximately 3 million people are living with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Approximately 75,000 of those patients represent pediatric cases. We aim to create a new drug delivery system with the intention of establishing a more feasible, stable, and effective form of administering treatments to those with the aforementioned autoimmune diseases, specifically attempting to provide a more ideal treatment for juvenile patients. We are focusing on first providing a rudimentary proof of concept. For the project, we will attempt to engineer mammalian cells that will produce the fusion protein CTLA4-Ig, commonly known as abatacept, a current treatment for RA, and a potential treatment for SLE. Thus far, we have completed and verified success of the molecular cloning necessary to create the recombinant molecule. We have successfully induced expression of the fusion protein in mammalian cell lines COS-7 and B16F10 via lipofections. We are currently working to optimize lipofection conditions and test for successful cellular production of CTLA4-Ig. Ideally, we aim to engineer red blood cells (RBCs) to produce the molecule. If we can complete our proof of concept, we will then attempt to reprogram myeloid and lymphoid progenitors into induced hematopoietic stem cells (iHSCs), and culture the cells ex vivo to allow for massive expansion of these iHSCs, which can then be genetically engineered. Additionally, the iHSCs will be cultured in such a way that, once in vivo, will result in them committing explicitly to erythroid lineages, and secreting the target protein as they mature into fully functional, adult RBCs. Causing RBCs to secrete CTLA4-Ig throughout the body would eliminate the need for regular injections of the drug, and thus potentially improve the quality of pediatric patients' lives.

Petersen, Chrissa; Velaytham, Anandh; Saldivar, Miguel (University of Utah)
Faculty Advisor: Velayutham, Anandh (Integrative Physiology and Nutrition)

Aging is a major risk factor for cardiovascular diseases such as atherosclerosis, which are major causes of disability and mortality in the elderly. Endothelial dysfunction plays a major role in aging-associated vascular complications. Dietary change may be one of the novel strategies to ameliorate endothelial dysfunction and aging-associated complications. Our lab recently showed that dietary supplementation of blueberries improves vascular inflammation and dysfunction in diabetic mice. In our present study, we investigated the effect of dietary blueberries on vascular function in aged mice. Adult male mice (two months old) and old male mice (17 months old) were fed a control rodent diet (Y and O respectively). The subgroups of Y and O mice were fed a diet supplemented with 3.8% freeze-dried blueberries (Y+BB, O+BB respectively) for 15 weeks. Based on normalization to body surface area, this dose in mice is equivalent to ~1.5 servings of blueberries (~240 g) in humans. Mesenteric arteries were collected and used to assess vascular function using a wire myograph system. After arteries were precontracted to ~65% of maximal phenylephrine-induced contraction and tension was stable, responses to acetylcholine (ACh, 10-8-10-6 M) were evaluated to determine endothelium-dependent vasorelaxation. In our study, there is no difference existed between Y vs. O and O vs. O+BB indicating the vascular function was similar among the groups. Our ongoing studies are focused on identifying the effect of dietary blueberries on vascular inflammation in aged mice and the possible molecular mechanisms involved.

Nelson, Andrew; Foutz, Isaac; Hunt, Porter; Wood, David; Bundy, Bradley; (Brigham Young University)
Faculty Advisor: Bundy, Bradley (Brigham Young University, Chemical Engineering)

Cell-free Protein Synthesis (CFPS), an in vitro system for producing recombinant protein, is a rapidly expanding field. To date, applications of this technology, among others, include unnatural amino acid incorporation, protein microarray fabrication, genome engineering, and the production of therapeutics, vaccines, and biocatalysts. Here, we further engineer cell-free protein synthesis as a biosensor for endocrine-disrupting chemicals (EDCs), compounds that mimic hormones and thus disrupt endocrine system physiology in the body.

Linder, Caitlin; Linder, Lauri (University of Utah)
Faculty Advisor: Linder, Lauri (College of Nursing, Nursing)

Childhood cancer disrupts children's day-to-day experiences. The purpose of this study was to analyze children's responses to two questions included in a daily symptom reporting app: "What is the best thing about today?" and "What is bothering you the most today?" Responses were part of a larger study evaluating the feasibility and acceptability of the app. Children used the app to record daily symptoms and answer short questions about their day.

Children completed a trial of the app between visits at the hospital for chemotherapy. Daily responses to each question were analyzed using descriptive qualitative content analysis with each response serving as a unit of analysis. Coding was completed by each author and reviewed together to reach agreement. Children's responses were organized into categories and subcategories.

Participants were 19 children 6-12 years of age (median 8 years) (12 boys) receiving chemotherapy who used the app for a total of 83 days (median 4.5 days/child). Children provided 72 responses about the best thing about their day that were organized into nine categories: Activities (n=22), People (n=14), Food (n=9), Well-Being (n=9), School (n=7), Nothing (n=5), Object (n=4), Going Home (n=3), and Don't Know (n=1). Children provided 60 responses about the most bothersome aspect of their day that were organized into six categories: Nothing (n=22), Symptoms (n=17), Port (n=7), Cancer Treatment (n=5), Day-to-Day Stuff (n=5), and People (n=4).

Children's responses provide perspective of the impact of cancer on their daily lives. Their responses indicate the importance of maintaining developmentally normal activities and family relationships. Children's responses further indicate the pervasiveness of the cancer experience, such as symptoms, even on days when children are away from the hospital. Mobile health apps can help children not only track symptoms but also reflect on their day. Clinicians can use children's information to better understand children's experiences.

Bobeck, Erin; McDermott, Max (Utah State University)
Faculty Advisor: Bobeck, Erin (College of Science, Biology Department)

TBD - Updated for publication

Hansen, Riley; Hooper, Victoria; Rawson, Clayton (Utah Valley University)
Faculty Advisor: Gazdik-Stofer, Michaela (Utah Valley University, Biology)

The human microbiome is the community of microbes associated with the human body. Disruption and imbalances in these microbiomes can cause diverse symptoms from depression to eczema. Celiac Disease (CD) is characterized by an immune response in the small intestine that is triggered by the protein gluten, found in wheat. Previous studies have identified microbial dysbiosis in patients with CD. To better understand how these dysbiosis can affect the disease itself we will exam the microbiome diversity and composition in CD patients and healthy individuals on gluten-free diets. This will help identify what microbiome changes are associated with CD compared to those that are caused by the CD patients lack of gluten in their diet. The microbial populations of three different groups will be analyzed: 1. those diagnosed with CD and on a gluten-free diet, 2. those who do not have CD and are on a gluten-free diet, and 3. those who do not have CD and are not on a specific diet. The dietary and disease influences on the microbiome of the gastrointestinal tract will be analyzed via a single stool sample collected from each study subject. Microbial DNA was extracted using the QIAamp PowerFecal DNA kit following manufacturer's specifications (Qiagen) V3/V4 region of 16s rRNA will be sequenced using the 600 cycle v3 MiSeq kit (Illumina) The results of the analysis will be compared to existing microbial genome databases to determine the composition of microbes present in the study groups.

Richardson, Deborah; Valentine, Julie; Miles, Leslie (Brigham Young University)
Faculty Advisor: Valentine, Julie (Brigham Young University, Nursing); Miles, Leslie (Brigham Young university, Nursing)

Purpose: Describe the minimal effect of post-assault bathing or showering on the development of FBI Combined DNA Index System (CODIS) eligible DNA profiles from sexual assault kit evidence.
Sexual assault kit (SAK) submission rates significantly decrease in cases wherein the victim has bathed or showered. The belief that these actions diminish the possibility of finding evidence heavily contributes to be a significant negative predictor of SAK submissions by law enforcement (LE). Now there are improved DNA analysis methods that can yield CODIS eligible DNA profiles from skin regardless of whether the victim bathed or showered.
SAK submission rates and DNA analysis findings from 5,423 cases were evaluated in this retrospective study. 36% of victims reported post-assault bathing or showering. These washing actions was found to be highly correlated with time between assault and sexual assault forensic examination. In a generalized estimating equation (GEE) logistic regression analysis on SAK submission rates, victim reports of post-assault bathing or showering was a consistent predictor of law enforcement not submitting kits. Yet, bivariable statistical analysis determined that victim bathing or showering post-assault was not associated with the lack of development of a DNA probative profile from SAK evidence.
The effect of post-assault bathing or showering must be reconsidered in the forensic science and criminal justice community as DNA analysis can yield probative DNA profiles, even after a victim has bathed or showered. The presentation of these research findings will encourage the submission of SAK by law enforcement and potentially increase SAK submission rates by eradicating any doubt regarding the minimal effect of bathing or showering on the development of CODIS eligible DNA profiles. New research data supports the collection, submission and testing of all SAK especially those with a victim history of post-assault bathing or showering.

Symons, John David; Cho, Jae Min; Ly, Kellsey; Thompson, Lauren; Lee, Sebastian; Hansen, Michele; Carter, Kandis (University of Utah)
Faculty Advisor: Symons, John David (University of Utah; Nutrition and Integrative Physiology)

The process of macroautophagy is operational during basal conditions to maintain organelle and protein quality control, but is upregulated during cellular stress to adapt to changing nutritional and energy demands. We tested the hypothesis that intact endothelial cell (EC) autophagy is required to observe exercise training-induced vascular improvements. Rationale for this hypothesis was provided by an earlier report that obese mice with germline, whole body mutation of a protein requisite for autophagy i.e., Bcl2-AAA mice were refractory to training-induced improvements concerning glucose homeostasis. First we demonstrated that : (i) workload achieved during a maximal treadmill test; (ii) soleus muscle citrate synthase activity; (iii) vascular indices of autophagy; and (iv) endothelium-dependent function were greater (p<0.05) in male C57Bl/6 mice that completed 10-weeks of treadmill-training vs. age-matched sedentary animals. These findings indicate that an efficacious training protocol improves vascular autophagy and arterial function. Next, age-matched male mice on a C75Bl/6 background with tamoxifen-inducible Cre/LoxP-based impairment of autophagy-related gene 3 (Atg3) specifically in ECs (iecAtg3KO mice) or wild-type (WT) littermates were trained (ETR) identically or remained sedentary (SED). Atg3 mRNA was minimal (p<0.05) in ECs obtained from iecAtg3KO vs. WT mice, but vascular smooth muscle cell Atg3 was similar between groups. These data verify that specific knockdown of Atg3 existed in ECs but not vascular smooth muscle of iecAtg3KO mice. As expected, intraluminal flow-mediated vasodilation (FMD) improved (p<0.05) in WT-ETR vs. WT-SED mice, while vascular smooth muscle responses to sodium nitroprusside were similar between groups. Further, as anticipated, intraluminal FMD was blunted (p<0.05) in iecAtg3KO-SED vs. WT-SED mice, indicating the importance of EC autophagy to FMD induced vasodilation. Contrary to our hypothesis, however, training-induced vascular adaptations were observed (p<0.05) in iecAtg3KO-ETR vs. iecAtg3KO-SED mice, while vascular smooth muscle responses were similar between groups. Indeed, training-induced vascular improvements concerning intraluminal FMD were not different between WT-ETR and iecAtg3KO-ETR mice. These findings are not congruent with our original hypothesis, and indicate that intact EC Atg3 is not required for training-induced vascular adaptations to occur.

Carrington, James; Xue, Qian; Roh-Johnson, Minna (University of Utah)
Faculty Advisor: Roh-Johnson, Minna (University of Utah, Biochemistry)

Metastasis of melanoma to distant sites of the body result in poor patient prognosis with a high mortality rate (76%). Cell migration has been studied in vitro and focal adhesions, which allow cells to move forward by attaching to extracellular matrix (ECM) on the front of the cell and breaking down at the back of the cell, have been shown to play important roles in locomotion. However, it has been difficult to visualize these structures in vivo, especially during tumor cell dissemination. Understanding how cancer cells are utilizing focal adhesions could play an important role in developing therapeutics to counteract metastasis using focal adhesion inhibitors and lead to improved patient outcomes. This research focuses on identifying if a previously observed focal adhesion marker in melanoma is formed at surfaces where cells are in contact with ECM. Because zebrafish share 80% disease homology with humans and are transparent during early embryonic development, they provide an optimal model for visualizing cell migration while still maintaining physiological significance. To identify if migrating melanoma cells are in contact with ECM, we injected fluorescently labeled melanoma cells in zebrafish. We allowed the melanoma cells to migrate and labeled components of the ECM (laminin, collagen, and fibronectin). We then imaged the zebrafish and determined the proximity of melanoma cells to the ECM. We also used transmission electron microscopy to identify the location of melanoma cells in respect to the ECM. We found that melanoma cells are in contact with ECM in vivo. The in vivo contact of focal adhesion markers in melanoma with ECM suggests that focal adhesions can be visualized and studied in zebrafish. Future studies will examine how focal adhesion formation is regulated and how inhibiting their function will impact tumor cell dissemination.

Taylor, Sarah; Fawver, Bradley; DeCouto, Brady; Lohse, Keith R.; Williams, A. Mark� (University of Utah)
Faculty Advisor: Lohse, Keith (University of Utah; Health, Kinesiology, and Recreation); Williams, Mark (University of Utah; Health, Kinesiology, and Recreation)

Achieving elite status in sport often requires athletes to overcome significant physical injuries. However, to date, there has been a paucity of studies exploring how hours engaged in practice and early developmental milestones influence injury rates in "high-risk" winter sports, such as alpine skiing. Moreover, despite numerous published reports on injury epidemiology, a lack of objective measures of performance has been a notable oversight. The purpose of this study was to assess how previous sport engagement and performance are related to injury in a sample of sub-elite youth alpine skiers. Adolescent skiers enrolled in U.S. academies (N = 169, males = 81) were given questionnaires assessing practice/injury history and sport-specific milestones, while performance in speed and technical disciplines were derived from participants' National points (i.e., ranking) for each year available. Simple correlations, MANOVAs, and linear mixed-effect regressions were used to assess relationships between predictors: age, gender, sport-specific milestones (e.g., age of first competition), practice hours, ranking; and the outcomes of interest: injury incidence (i.e., proportion of seasons an athlete sustained injuries causing them to miss > 4 weeks) and injury impact (i.e., average weeks missed due to injury each year). Results revealed that while older athletes had accumulated more injury weeks across their career (p = .020), female skiers reported greater injury incidence (p = .049). Neither injury incidence nor injury impact was associated with performance trends (all p's > .05), but they were negatively associated with time spent in group and individual practice (both p's < .05). Finally, the age of first competition was positively correlated with injury impact (p = .014). These and other findings are discussed in relation to previous studies of sport-injury, as well as applied implications for working with developmental athlete populations in high-risk domains.

Contreras, John; Forrest, Rachel T.; Bayles, Madelyn (Westminster College)
Faculty Advisor: Contreras, John (Westminster College, Public Health); Forrest; Rachel T. (Westminster College, Public Health)

Air pollution, much of which results from human activities like transportation, may significantly harm children's health, from worsening asthma to potentially even lowering I.Q. This makes idling near schools a serious concern. In response, the EPA has developed an idle-free schools campaign. This campaign will be implemented during the 2019-2020 school year at a Salt Lake City elementary school. Ground-level ozone and PM2.5 levels will be measured before and after the campaign in order to determine its efficacy. Additionally, during the spring and summer of 2019, parents' perceptions of idling, and, by extension, air pollution, were examined using a focus group and a survey. The resulting data, which was analyzed using R statistical software and Excel, found associations between gender and beliefs about air pollution, as well as between education level and beliefs about air pollution. A better understanding of the effectiveness of the EPA's campaign and of parents' perceptions may be helpful in combating air pollution, leading to improved community health.

Poudyel, Kamala; Gurung, Surya (University of Utah)
Faculty Advisor: Kamimure, Akiko (Social and Behavioral Science, Sociology)

Bhutanese refugees are often torture survivors and experience mental health issues such as post-traumatic stress disorders, anxiety and depression. However, there are few studies focusing on mental health among Bhutanese women in the US. The purpose of this proposed study is to examine mental health among Bhutanese women with a refugee background living in Utah. Specifically, this study analyzes how social support and acculturation are associated with mental health (stress) and images of mental illness. A Self-administered or interviewer-administered survey has been collected from Bhutanese women since September 2019. Preliminary results suggest stronger sense of belonging to American and Bhutanese cultures was associated with higher levels of social support. Lack of social support was associated with higher levels of stress. The notable images of people with mental illness among the participants included "People with chronic mental illness are, by far, more dangerous than the general population," and "Mental health facilities should be kept out of residential neighborhood." Those negative images were related to lower levels of understanding both American and Bhutanese cultures. It is important to maintain ethnic identity as Bhutanese as well as to learn American culture to promote social support and reduce stress. In addition, reducing negative images of mental illness may help seek help for mental health issue when they experience such problems. Strong sense of belonging to American and Bhutanese cultures is important for well-being among Bhutanese women in Utah.