Medicine and Health Sciences Commons^™

Bone Conduction Transmission And Head‐Shadow Effects For Unilateral Hearing Losses Fit With Transcranial Cic Hearing Aids, Marc A. Fagelson, Colleen Noe, Jennifer Blevins, Owen Murnane

Owen D. Murnane

Bone conduction transmission and head‐shadow effects were determined with transcranial completely‐in‐the‐canal (TCCIC) CROS hearing aids. Five subjects with documented profound unilateral hearing loss and experience with traditional CROS/BICROS fittings (TCROS) were tested with a CIC hearing aid placed in their poorer ear. Peak SPL was measured at the tympanic membrane and ranged from 105–115 dB SPL at 2000 Hz. Pure‐tone crossover thresholds and functional gain tested at frequencies from 250–8000 Hz varied considerably more than the SPL measures. The pure‐tone results indicated that sensitivity in the better ear was moderately associated with functional gain across frequency. Speech recognition was then …

Gap Discrimination And Speech Perception In Noise, Marc A. Fagelson

Marc A. Fagelson

The relation between discrimination of silent gaps and speech‐in‐noise perception was measured in 20 normal‐hearing listeners using speech‐shaped noise as both the gap markers and the noise source for speech testing. In the gap discrimination experiment, subjects compared silent gaps marked by 60 dB SPL 250‐ms noise bursts to standards of either 5, 10, 20, 50, 100, or 200 ms. The gap results were most similar to those reported by Abel [S. M. Abel, J. Acoust. Soc. Am. 52, 519–524 (1972)] as ΔT/T decreased non‐monotonically with increased gap length. In a second experiment, the California Consonant Test (CCT) was administered …

Advancing Drug Delivery Systems For The Treatment Of Multiple Sclerosis, I. Tabansky, M. D. Messina, C. Bangeranye, J. Goldstein, K. M. Blitz-Shabbir, S. Machado, V. Jeganathan, P. Wright, S. Najjar, J. N. Stern

Joel N.H. Stern

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. It is characterized by demyelination of neurons and loss of neuronal axons and oligodendrocytes. In MS, auto-reactive T cells and B cells cross the blood-brain barrier (BBB), causing perivenous demyelinating lesions that form multiple discrete inflammatory demyelinated plaques located primarily in the white matter. In chronic MS, cortical demyelination and progressive axonal transections develop. Treatment for MS can be stratified into disease-modifying therapies (DMTs) and symptomatic therapy. DMTs aim to decrease circulating immune cells or to prevent these cells from crossing the BBB and reduce the …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Lisa Sullivan Vedder, MD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Does The Expression Of Ki-67, P16 And Cox-2 At Initial Diagnosis Of Breast Atypia Or Usual Ductal Hyperplasia Predict A Second Clinically Significant Event?, Judy Tjoe, Philippe Gascard, Jianxin Zhao, Gary Neitzel, Maharaj Singh, Brittany Last, James Marx, Thea Tlsty, Sanjay Kansra

Judy Tjoe, MD

Background: Women diagnosed with atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH) have a fivefold increased risk of developing breast cancer. Because ADH/ALH can be precursors or predictive markers of a subsequent clinically significant event (SCSE), i.e. atypia, in situ or invasive carcinoma, the clinical outcome for these patients ranges anywhere from remission to invasive malignancy. Currently we cannot predict which atypical breast lesion is likely to be associated with future cancer, resulting in aggressive management and, possibly, overtreatment. Kerlikowske et al. reported that a combination of three biomarkers (cell cycle regulator p16INK4a, proliferation antigen Ki-67 and stress response …

Development And Validation Of A Preprocedural Risk Score To Predict Access Site Complications After Peripheral Vascular Interventions Based On The Vascular Quality Initiative Database, Daniel Ortiz, Maharaj Singh, Arshad Jahangir, Suhail Allaqaband, Anjan Gupta, Tanvir Bajwa, Mark W. Mewissen

Arshad Jahangir, MD

Purpose

Access site complications following peripheral vascular intervention (PVI) are associated with prolonged hospitalization and increased mortality. Prediction of access site complication risk may optimize PVI care; however, there is no tool designed for this. We aimed to create a clinical scoring tool to stratify patients according to their risk of developing access site complications after PVI.

Methods

The Society for Vascular Surgery’s Vascular Quality Initiative database yielded 27,997 patients who had undergone PVI at 131 North American centers. Clinically and statistically significant preprocedural risk factors associated with in-hospital, post-PVI access site complications were included in a multivariate logistic regression …

Essentials Of Herb-Drug Interactions In The Elderly With Cardiovascular Disease, Sulaiman Sultan, Maria Viqar, Rabaiya Ali, A. Jamil Tajik, Arshad Jahangir

Arshad Jahangir, MD

As the number of individuals, particularly the elderly, using herbal products with prescription drugs continues to grow, the risk for adverse interactions increases but remains poorly recognized. The true incidence and nature of adverse herb reactions or herb-drug interactions remains unknown since no postmarketing surveillance mechanism exists. Adverse events are greatly underreported, and information regarding safety mainly comes from case reports and suboptimally conducted studies in a limited number of healthy young volunteers or patients with limited comorbidities. Therefore, convincing evidence for the safety of herbal products in the elderly is lacking, and the true magnitude of problems that herb-drug …

Microrna Cargo Of Extracellular Vesicles From Alcohol-Exposed Monocytes Signals Naive Monocytes To Differentiate Into M2 Macrophages, Banishree Saha, Fatemeh Momen-Heravi, Karen Kodys, Gyongyi Szabo

Gyongyi Szabo

Membrane-coated extracellular vesicles (EVs) released by cells can serve as vehicles for delivery of biological materials and signals. Recently, we demonstrated that alcohol-treated hepatocytes cross-talk with immune cells via exosomes containing microRNA (miRNAs). Here, we hypothesized that alcohol-exposed monocytes can communicate with naive monocytes via EVs. We observed increased numbers of EVs, mostly exosomes, secreted by primary human monocytes and THP-1 monocytic cells in the presence of alcohol in a concentration- and time-dependent manner. EVs derived from alcohol-treated monocytes stimulated naive monocytes to polarize into M2 macrophages as indicated by increased surface expression of CD68 (macrophage marker), M2 markers (CD206 …

Variation In Avian Pathogenic Escherichia Coli Colonization Levels In Chickens, Melissa Monson, Michael Kaiser, Susan Lamont

Melissa Monson

Colonization levels in five tissues after avian pathogenic Escherichia coli (APEC) inoculation were investigated in chickens to generate phenotypic data for a genome wide association study (GWAS). Bacterial loads were measured in 370 birds and varied among individuals and tissues. Mean bacterial levels were significantly different between tissues (right lung > spleen > left lung and liver > blood). There were also significant correlations in bacterial load between tissues. These data suggest that colonization levels could be used as phenotypes in GWAS and could help identify markers associated with poultry resistance to APEC infections. After verification, these markers could be used for genetic …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Deborah Simpson, PhD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Structural Basis For Mutation-Induced Destabilization Of Profilin 1 In Als, Sivakumar Boopathy, Tania Silvas, Maeve Tischbein, Silvia Jansen, Shivender Shandilya, Jill Zitzewitz, John Landers, Bruce Goode, Celia Schiffer, Daryl Bosco

Celia A. Schiffer

Mutations in profilin 1 (PFN1) are associated with amyotrophic lateral sclerosis (ALS); however, the pathological mechanism of PFN1 in this fatal disease is unknown. We demonstrate that ALS-linked mutations severely destabilize the native conformation of PFN1 in vitro and cause accelerated turnover of the PFN1 protein in cells. This mutation-induced destabilization can account for the high propensity of ALS-linked variants to aggregate and also provides rationale for their reported loss-of-function phenotypes in cell-based assays. The source of this destabilization is illuminated by the X-ray crystal structures of several PFN1 proteins, revealing an expanded cavity near the protein core of the …

Hysteresis As A Measure Of Ankle Dysfunction, Alissa Cohen, James Mertz, Peggy Stewart, Michael Warner, Michael Kuchera

Michael Kuchera

There is no abstract for this article.

Metastatic Brain Tumors: Current Therapeutic Options And Historical Perspective, Mark Rivkin, Richard Kanoff

Mark Rivkin

Metastatic brain tumors affect more than 150,000 patients annually in the United States. The therapeutic paradigms for these tumors have evolved over the years and currently encompass numerous modalities implemented by treating physicians across several medical disciplines. The armamentarium of brain tumor treatment involves neurosurgical intervention, whole-brain and focused radiation modalities, chemotherapy, and immunotherapy. Patient selection, however, remains critical to achieve maximal therapeutic benefit and depends on functional status, number and location of lesions, and tissue histologic findings. Best outcomes can be expected with a multidisciplinary approach to patient care where state-of-the-art treatment options are readily available.

Professionalism Under Fire: Conflict, War And Epidemics, Michelle Mclean, Vikram Jha, John Sandars

Michelle McLean

Today’s medical students (tomorrow’s doctors) will be entering a world of conflict, war and regular outbreaks of infectious diseases. Despite numerous international declarations and treaties protecting human rights, the last few decades has been fraught with reports of ‘‘lapses’’ in medical professionalism involving torture and force-feeding of detainees (e.g. captured during the War on Terror) and health care professionals refusing to treat infected patients (e.g. HIV and Ebola). This paper provides some historical background to the changing status of a physician’s duty to treat and how medical practitioners came to be involved in the inhumane treatment of detainees during the …

Rapid Door To Balloon Time In The Treatment Of Acute St- Elevation Myocardial Infarction Meaningfully Reduces Overall Hospital Stay, Amit N. Nanavati Md, Nainesh Patel Md, Bruce Feldman Do, J Patrick Kleaveland Md, Orlando E. Rivera Rn, David A. Cox Md

Nainesh C Patel MD

No abstract provided.

Door To Balloon Times Less Than 30 Minutes: The Lehigh Valley Health Network (Lvhn) Experience, M Sarkees, Matthew Martinez, Bruce Feldman, J Kleaveland, Orlando Rivera, Michael Rossi, William Combs, David Cox, Ronald Freudenberger, Nainesh Patel

Nainesh C Patel MD

No abstract provided.

The Impact Of Hiv-Related Stigma On Older And Younger Adults Living With Hiv Disease: Does Age Matter?, Charles A. Emlet, David J. Brennan, Sarah Brennenstuhl, Sergio Rueda, Trevor A. Hart, Sean B. Rourke

Charles Emlet

Care-Seeking Patterns And Outcomes Of Hospitalized Pneumonia Patients Who Are Socioeconomically Disadvantaged, Jay Shen, Johnathan Perlin, Yi-Hua Xu, Thomas Wan

Thomas T.H. Wan

No abstract provided.

Role Of Gluk1 Kainate Receptors In Seizures, Epileptic Discharges, And Epileptogenesis, Brita Fritsch, Janine Reis, Maciej Gasior, Rafal M. Kaminski, Michael A. Rogawski

Michael A. Rogawski

Kainate receptors containing the GluK1 subunit have an impact on excitatory and inhibitory neurotransmission in brain regions, such as the amygdala and hippocampus, which are relevant to seizures and epilepsy. Here we used 2-amino-3-(3-hydroxy-5-tert-butylisoxazol-4-yl) propanoic acid (ATPA), a potent and selective agonist of kainate receptors that include the GluK1 subunit, in conjunction with mice deficient in GluK1 and GluK2 kainate receptor subunits to assess the role of GluK1 kainate receptors in provoking seizures and in kindling epileptogenesis. We found that systemic ATPA, acting specifically via GluK1 kainate receptors, causes locomotor arrest and forelimb extension (a unique behavioral characteristic of GluK1 …

Door To Balloon Times Less Than 30 Minutes: The Lehigh Valley Health Network (Lvhn) Experience, M Sarkees, Matthew Martinez, Bruce Feldman, J Kleaveland, Orlando Rivera, Michael Rossi, William Combs, David Cox, Ronald Freudenberger, Nainesh Patel

Bruce A. Feldman DO

No abstract provided.

Upper Endoscopy In Children: Do Symptoms Predict Positive Findings?, Baraa Alabd Alrazzak, Tarek Husien, Deborah Preston, Yoram Elitsur

Yoram Elitsur

No abstract provided.

Primordium Of An Artificial Bruch's Membrane Made Of Nanofibers For Engineering Of Retinal Pigment Epithelium Cell Monolayers, Patrick Warnke, Mohammad Alamein, Stuart Skabo, Sebastien Stephens, Robert Bourke, Peter Heiner, Qin Liu

Qin Liu

Transplanted Retinal Pigment Epithelium(RPE) cells hold promise for treatment of Age-related Macular Degeneration(AMD) and Stargardt Disease(SD), but it is conceivable that the degenerated host Bruch's membrane(BM) as a natural substrate for RPE might not optimally support transplanted cell survival with correct cellular organization. We fabricated novel ultrathin 3-dimensional(3D) nanofibrous membranes from Collagen type I and poly(lactic-co-glycolic acid) (PLGA) by an advanced clinical-grade needle-free-electrospinning process. The nanofibrillar 3D networks highly mimicked the fibrillar architecture of the native inner collagenous layer of human BM. Human RPE cells grown on our nanofibrous membranes bore striking resemblance to native human RPE. They exhibited a …

Risk And Protective Factors Associated With Health-Related Quality Of Life Among Older Gay And Bisexual Men Living With Hiv Disease, Charles A. Emlet, Karen I. Fredriksen-Goldsen

Charles Emlet

No abstract provided.

A Multidisciplinary, Resident-Run Clinic For The Treatment Of Hepatitis C In An Underserved, Urban Primary Care Setting, Suzanne J. Templer Do, Joseph L. Yozviak Do, Facp, Vishal Patel Md, Edward Norris Md, Fapm, Eric J. Gertner Md, Mph

Edward R Norris MD, FAPA, FAPM

No abstract provided.

Relationship Between Plasma Glucose And Mortality In Non-Diabetic Patients With Acute Coronary Syndrome And Systolic Heart Failure: Insights From The Ephesus Trial, Prakash Deedwania Md, Ravi V. Desai Md, Marjan Mujib Md, Mph, Bertram Pitt, Ali Ahmed Md, Mph

Ravi V Desai MD

No abstract provided.

Selective Effects Of Intrinsic A2aar Activity On Cardiac And Coronary Injuries With Lps Challenge, Melissa Reichelt, Kevin Ashton, S Mustafa, B Tang, Catherine Ledent, Xing Tan, John Headrick, R Morrison

Kevin Ashton

We assessed the impact of A2A adenosine receptor (A2AAR) knockout (KO) on LPS-triggered cardiovascular injuries, inflammation, gene expression and mortality. LPS precipitated cardiac injury, with 7-fold elevations in serum cardiac troponin I (cTnI) and 25–35% reductions in ventricular contractility. Coronary dysfunction was evident as a 20% reduction in reactive hyperaemic flows. A2AAR KO augmented cTnI release 3-fold without modifying ventricular dysfunction. Coronary effects of LPS and A2AAR KO were identical, and LPS no longer modified hyperaemia in A2AAR KO hearts. Effects of A2AAR activity were largely independent of shifts in acute phase reactants (CRP, haptoglobin) and circulating cytokines. Thus, up …

Cardiovascular Adenosine Receptors: Expression, Actions And Interactions, John Headrick, Kevin Ashton, Roselyn Rose'meyer, Jason Peart

Kevin Ashton

Intra- and extracellular adenosine levels rise in response to physiological stimuli and with metabolic/energetic perturbations, inflammatory challenge and tissue injury. Extracellular adenosine engages members of the G-protein coupled adenosine receptor (AR) family to mediate generally beneficial acute and adaptive responses within all constituent cells of the heart. In this way the four AR sub-types—A1, A2A, A2B, and A3Rs—regulate myocardial contraction, heart rate and conduction, adrenergic control, coronary vascular tone, cardiac and vascular growth, inflammatory–vascular cell interactions, and cellular stress-resistance, injury and death. The AR sub-types exert both distinct and overlapping effects, and may interact in mediating these cardiovascular responses. The …

The Adenosine A2a Receptor — Myocardial Protectant And Coronary Target In Endotoxemia, Melissa Reichelt, Kevin Ashton, Xing Tan, S Mustafa, Catherine Ledent, Lea Delbridge, Polly Hofmann, John Headrick, R Morrison

Kevin Ashton

Background: Cardiac injury and dysfunction are contributors to disease progression and mortality in sepsis. This study evaluated the cardiovascular role of intrinsic A2A adenosine receptor (A2AAR) activity during lipopolysaccharide (LPS)-induced inflammation.

Methods: We assessed the impact of 24 h of LPS challenge (20 mg/kg, IP) on cardiac injury, coronary function and inflammatory mediator levels in Wild-Type (WT) mice and mice lacking functional A2AARs (A2AAR KO).

Results: Cardiac injury was evident in LPS-treated WTs, with ~ 7-fold elevation in serum cardiac troponin I (cTnI), and significant ventricular and coronary dysfunction. Absence of A2AARs increased LPS-provoked cTnI release at 24 h by …

Cultural Adaptation Of The Hiv Felt Stigma Scale For Puerto Ricans With Hiv In Allentown, Pa, Julio Jiménez Md, Joseph L. Yozviak Do, Facp, Timothy J. Friel Md, D Adams Psyd, Cynthia Beitler, Eric J. Gertner Md, Mph, E Rivera Ba, M Reyes Ba, L Santiago Phd

Joseph L Yozviak DO, FACP

No abstract provided.

A Multidisciplinary, Resident-Run Clinic For The Treatment Of Hepatitis C In An Underserved, Urban Primary Care Setting, Suzanne J. Templer Do, Joseph L. Yozviak Do, Facp, Vishal Patel Md, Edward Norris Md, Fapm, Eric J. Gertner Md, Mph

Joseph L Yozviak DO, FACP

No abstract provided.