Medicine and Health Sciences Commons^™

Simulation And Optimization Modeling For Drive-Through Mass Vaccination – A Generalized Approach, Aman Gupta, Gerald W. Evans, Sunderesh S. Heragu

Aman Gupta

Proper planning and execution of mass vaccination at the onset of a pandemic outbreak is important for local health departments. Mass vaccination clinics are required to be setup and run for naturally occurring pandemic outbreaks or even in response to terrorist attacks, e.g., anthrax attack. Walk-in clinics have often been used to administer vaccines. When a large percentage of a population must be vaccinated to mitigate the ill-effects of an attack or pandemic, drive-through clinics appear to be more effective because a much higher throughput can be achieved when compared to walk-in clinics. There are other benefits as well. For …

Socioeconomic-Status And Mental Health In A Personality Disorder Sample: The Importance Of Neighborhood Factors, Zach Walsh, M. Tracie Shea, Shirley Yen, Emily B. Ansell, Carlos M. Grilo, Thomas H. Mcglashan, Robert L. Stout, Donna S. Bender, Andrew E. Skodol, Charles A. Sanislow, Leslie C. Morey, John G. Gunderson

Charles A. Sanislow, Ph.D.

This cross-sectional study examined the associations between neighborhood-level socioeconomic-status (NSES), and psychosocial functioning and personality pathology among 335 adults drawn from the Collaborative Longitudinal Personality Disorders Study. Participants belonged to four personality disorder (PD) diagnostic groups: Avoidant, Borderline, Schizotypal, and Obsessive Compulsive. Global functioning, social adjustment, and PD symptoms were assessed following a minimum two-year period of residential stability. Residence in higher-risk neighborhoods was associated with more PD symptoms and lower levels of functioning and social adjustment. These relationships were consistent after controlling for individual-level socioeconomic-status and ethnicity; however, the positive association between neighborhood-level socio-economic risk and PD symptoms was …

Authoring Simulations For High Stakes Student Evaluation, Janet Willhaus, Gail Burleson, Janice Palaganas, Pamela Jeffries

Janet Willhaus

Although simulation methods have primarily been used for teaching in nursing education, there is a growing interest in the use of simulation for student and program evaluation. Developing simulation scenarios for high stakes evaluation differs from traditional teaching/learning scenario authorship in a number of ways. This manuscript describes the process used to write, pilot test, and revise scenarios used in the National League for Nursing High Stakes Testing feasibility study. Observations and reported differences in scenario development and facilitation may provide insight to others regarding the best use of summative simulation scenarios.

Design Of An Enterprise Architecture For Electronic Patient Care Record (Epcr) Information Exchange In Ems, Ben Schooley, Neset Hikmet

Neset Hikmet

EMS is an organized and collaborative effort between several organizations providing different levels or tiers of care designed to transport sick or injured patients to the hospital. Significant challenges to efficient, accurate, and integrated inter-organizational information exchange exist for communicating pre-hospital patient information to hospital emergency departments. The goal of this research was to investigate the requirements and design of a business process-oriented inter-organizational enterprise architecture from a multi-stakeholder perspective. This paper describes an action-design research effort aimed at improving information exchange across pre-hospital and hospital organizations in the Santa Clara County, CA Health and Hospital System. In this paper, …

Addressing The Persistence Of Tuberculosis Among The Canadian Inuit Population: The Need For A Social Determinants Of Health Framework, Kassandra C. Kulmann Ma Candidate, Chantelle Am Richmond Professor

Chantelle Richmond

Canadian Aboriginal people have poorer levels of health than the general population. A serious issue is the high rate of tuberculosis (TB) among the Inuit population; rates are much higher than those of the general Canadian population. Several social determinants of health (SDOH), including household crowding and poverty, are strongly correlated with TB prevalence. In this paper, we describe the medical and social determinants of TB, and critically examine the TB literature specific to the Inuit population. The majority of studies recommend biomedical interventions for the treatment of TB. Few researchers have employed the social determinants of health theory to …

Pharmacist Empathy In Smoking Cessation Counseling, Caleb Lyman, Megan Mcnicol, Maria Miller, Yevgeniy Solokha, Kelly J. Wright, Aleda M.H. Chen

Kelly J. Wright, R.Ph., Pharm.D.

Cigarette smoking and nicotine addiction are prevalent in today’s society. Approximately 19% of American adults (43.8 million people) smoke cigarettes. Smoking is associated with health risks such as Chronic Obstructive Pulmonary Disease (COPD), infertility, low birth weight, respiratory symptoms, heart disease, and lung cancer and is responsible for roughly $96 billion in health care costs. Provider empathy has been proven effective in other treatments like cold and cancer; however, its effectiveness in smoking cessation has not yet been studied. Empathy is defined in two realms: cognitive and affective. In the cognitive domain, individuals have the ability to understand and view …

5 Steps To Emotionally Recovering From A Car Crash, Denver Burke

Denver Burke

A car accident can be a life changing event which creates many problems for a person, both physically and mentally. This post helps review certain things to help alleviate the pain for a more satisfied, more productive mentality.

The Concomitant Relationship Shared By Sleep Disturbances And Type 2 Diabetes: Developing Telemedicine As A Viable Treatment Option, Pennie S. Seibert, Jennifer Valerio, Codieann Dehaas

Pennie S. Seibert

Individually, sleep disturbances and type 2 diabetes pose pervasive challenges to health. In addition, the negative symptomology associated with each condition is exacerbated further when presenting concomitantly. This relationship formulates a destructive loop wherein those with diabetes experience decreased sleep quality, which, in turn, worsens a wide range of health threats experienced by those with diabetes, including obesity and glucose intolerance. Because major lifestyle changes and daily care are needed to effectively manage both diabetes and sleep disturbances, an efficient and timely modality of treatment is essential. Advanced technology incorporating telemedicine and telehealth has the potential to enhance treatment by …

Definition Of An Hla-Dpw2-Restricted Epitope On Ns3, Recognized By A Dengue Virus Serotype-Cross-Reactive Human Cd4+ Cd8- Cytotoxic T-Cell Clone, Ichiro Kurane, Li Chen Dai, Peter G. Livingston, Elaine Reed, Francis A. Ennis

Li Dai

We previously reported that the clone JK34 was cross-reactive for dengue virus types 1, 2, 3, and 4 and recognized NS3 (I. Kurane, M. A. Brinton, A. L. Samson, and F. A. Ennis, J. Virol. 65:1823-1828, 1991). In the present experiments, we defined the epitope at the amino acid level, with 93 15-mer overlapping peptides which cover the entire NS3. A peptide 4 which contains amino acids 251 to 265 of NS3 sensitized the autologous B lymphoblastoid cell line (LCL) to the lysis by JK34. The smallest peptide recognized by JK34 was a 10-mer peptide which contains amino acids 255 …

Mutation Of Human Immunodeficiency Virus Type 1 At Amino Acid 585 On Gp41 Results In Loss Of Killing By Cd8+ A24-Restricted Cytotoxic T Lymphocytes, Li Chen Dai, Kim West, Rebecca A. Littaua, Kazuo Takahashi, Francis A. Ennis

Li Dai

A human leukocyte antigen A24-restricted CD8+ cytotoxic T-cell clone specific for gp41 of human immunodeficiency virus type 1 was isolated from an infected individual. The epitope was localized to amino acids 584 to 591 (YLKDQQLL, NL43 env sequence) of gp41 by using a panel of recombinant vaccinia viruses that contain truncated env genes and synthetic peptides. The clone killed autologous B-lymphoblastoid cell lines pulsed with a synthetic peptide reflecting the sequence of the IIIB and MN strains. This clone, however, failed to kill target cells pulsed with the peptides that have a mutation from Lys to Arg or Gln at …

A Prospective Study Of The Transient Decrease In Ovarian Cancer Risk Following Childbirth, Qin Liu, Mats Lambe, Inkyung Baik, Sven Cnattingius, Tomas Riman, Anders R. Ekbom, Hans-Olov Adami, Chung-Cheng Hsieh

Qin Liu

Epidemiologic evidence shows that the risk of ovarian cancer is decreased following childbirth. We examined the time points when the decreased risk of postpartum maternal ovarian cancer reaches the lowest point and whether the protective effect diminishes over time. A case-control study nested within the Swedish Fertility Register included 10,086 cases of epithelial ovarian cancer recorded in the Swedish Cancer Register from 1961 to 2001. From the Fertility Register, 49,249 eligible subjects matched to the cases by age were selected as controls. The analysis contrasted risk between adjacent parities through logistic regression models that included indicator variables representing each year …

Profiles Of Human Serum Antibody Responses Elicited By Three Leading Hiv Vaccines Focusing On The Induction Of Env-Specific Antibodies, Michael Vaine, Shixia Wang, Qin Liu, James Arthos, David C. Montefiori, Paul Goepfert, M. Juliana Mcelrath, Shan Lu

Qin Liu

In the current report, we compared the specificities of antibody responses in sera from volunteers enrolled in three US NIH-supported HIV vaccine trials using different immunization regimens. HIV-1 Env-specific binding antibody, neutralizing antibody, antibody-dependent cell-mediated cytotoxicity (ADCC), and profiles of antibody specificity were analyzed for human immune sera collected from vaccinees enrolled in the NIH HIV Vaccine Trial Network (HVTN) Study #041 (recombinant protein alone), HVTN Study #203 (poxviral vector prime-protein boost), and the DP6-001 study (DNA prime-protein boost). Vaccinees from HVTN Study #041 had the highest neutralizing antibody activities against the sensitive virus along with the highest binding antibody …

The Impact Of Worksite Weight-Related Social Norms On Associated Behaviors, Stephenie C. Lemon, Qin Liu, Robert P. Magner, Kristin L. Schneider, Lori Pbert

Qin Liu

Objective: To assess the association between descriptive social norms for weight and weight-related behaviors and associated behaviors at the worksite. Design and Sample: Baseline data from site-randomized trial of a worksite ecological intervention for weight control; 12 public high schools in central Massachusetts; Sample of 844 employees enrolled (~ 2/3 of all employees). Conclusions: Associations of weight loss and eating social norms with behavior; Unique from social support; No association of physical activity social norms with physical activity; May be little opportunity for and therefore little exposure to physical activity during the workday; Results support the development of weight loss …

Correlation Of Umbilical Cord Blood Hormones And Growth Factors With Stem Cell Potential: Implications For The Prenatal Origin Of Breast Cancer Hypothesis, Todd M. Savarese, William C. Strohsnitter, Hoi Pang Low, Qin Liu, Inkyung Baik, William C. Okulicz, David P. Chelmow, Pagona Lagiou, Peter J. Quesenberry, Kenneth L. Noller, Chung-Cheng Hsieh

Qin Liu

INTRODUCTION: Prenatal levels of mitogens may influence the lifetime breast cancer risk by driving stem cell proliferation and increasing the number of target cells, and thereby increasing the chance of mutation events that initiate oncogenesis. We examined in umbilical cord blood the correlation of potential breast epithelial mitogens, including hormones and growth factors, with hematopoietic stem cell concentrations serving as surrogates of overall stem cell potential. METHODS: We analyzed cord blood samples from 289 deliveries. Levels of hormones and growth factors were correlated with concentrations of stem cell and progenitor populations (CD34+ cells, CD34+CD38- cells, CD34+c-kit+ cells, and granulocyte-macrophage colony-forming …

A Functional Notch-Survivin Gene Signature In Basal Breast Cancer, Connie Wing-Ching Lee, Karl Simin, Qin Liu, Janet Plescia, Minakshi Guha, Ashraf Khan, Chung-Cheng Hsieh, Dario C. Altieri

Qin Liu

INTRODUCTION: Basal-type, or triple-negative, breast cancer (lacking estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 expression) is a high-risk disease for which no molecular therapies are currently available. We studied genetic signatures of basal breast cancer potentially suitable for therapeutic intervention. METHODS: We analyzed protein expression of the Notch-1 intracellular domain and survivin by immunohistochemistry in a series of basal breast cancer patients. A hierarchical clustering and overall survival analysis was carried out on a microarray mRNA database of 232 breast cancer patients. Fifteen published mRNA datasets containing estrogen receptor-negative or estrogen receptor-positive samples were subjected to meta-analysis …

A Comunicação Da Equipe De Enfermagem Com O Paciente Em Cuidados Paliativos; The Communication Of The Nursing Team With Patients In Palliative Care, Everton Fernando Alves

Everton Fernando Alves

The article consists of a contextualized reflection on the communication in palliative care with the purpose of explaining strategies used for effective communication among the nursing, terminally ill and his family. In that sense, it was observed that for the nurse to assist the terminally ill is a difficult task, which raises sensation of sadness, frustration, impotence and even failure in the rendered attendance. This way, many professionals use denial, escaping, and the apparent coldness as defense mechanisms to cope with situation. Throughout this discussion are exposed some aspects that enable developing empathic communication skills, perceived as a task that …

Increasing Fruit And Vegetable Consumption And Offerings To Somali Children: The Fav-S Pilot Study, Mary Hearst, Rebecca Kehm, Shelley Sherman, Kate E. Lechner

Mary Hearst

No abstract provided.

Revisiting The Roles And Responsibilities Of Speech-Language Therapists In South African Schools, Anna Maria Wium, Brenda Louw

Brenda Louw

Diabetes Alters Contraction-Induced Mitogen Activated Protein Kinase Activation In The Rat Soleus And Plantaris, Anjaiah Katta, Deborah L. Preston, Sunil K. Kakarla, Shinichi Asano, Sarath Meduru, Sriram P. Mupparaju, Ellie Yokochi, Kevin M. Rice, Devashish H. Desai, Eric R. Blough

Deborah L Preston

The prescription of anaerobic exercise has recently been advocated for the management of diabetes; however exercise-induced signaling in diabetic muscle remains largely unexplored. Evidence from exercise studies in nondiabetics suggests that the extracellular-signal-regulated kinases (Erk1/2), p38, and c-JUN NH2-terminal kinase (Jnk) mitogen-activated protein kinases (MAPKs) are important regulators of muscle adaptation. Here, we compare the basal and the in situ contraction-induced phosphorylation of Erk1/2- p38- and Jnk-MAPK and their downstream targets (p90rsk and MAPKAP-K2) in the plantaris and soleus muscles of normal and obese (fa/fa) Zucker rats. Compared to lean animals, the time course and magnitude of Erk1/2, p90rsk and …

Diabetes Alters Vascular Mechanotransduction: Pressure-Induced Regulation Of Mitogen Activated Protein Kinases In The Rat Inferior Vena Cava, Kevin M. Rice, Devashish H. Desai, Sunil K. Kakarla, Anjaiah Katta, Deborah L. Preston, Paulette Wehner, Eric R. Blough

Deborah L Preston

Background Diabetes mellitus is an important risk factor for increased vein graft failure after bypass surgery. However, the cellular and molecular mechanism(s) underlying vessel attrition in this population remain largely unexplored. Recent reports have suggested that the pathological remodeling of vein grafts may be mediated by mechanically-induced activation of the mitogen activated protein kinase (MAPK) signaling pathways and the MAPK-related induction of caspase-3 activity. On the basis of these findings, we hypothesized that diabetes may be associated with alterations in how veins "sense" and "respond" to altered mechanical loading. Methods Inferior venae cavae (IVC) from the non-diabetic lean (LNZ) and …

Uniaxial Stretch-Induced Regulation Of Mitogen-Activated Protein Kinase, Akt And P70s6 Kinase In The Ageing Fischer 344 × Brown Norway Rat Aorta, Kevin M. Rice, Devashish H. Desai, Deborah L. Preston, Paulette S. Wehner, Eric R. Blough

Deborah L Preston

The effects of ageing on the cardiovascular system contribute to substantial alterations in cellular morphology and function. The variables regulating these changes are unknown; however, one set of signalling molecules that may be of particular importance in mediating numerous cellular responses, including control of cell growth, differentiation and adaptation, are the proteins associated with the mitogen-activated protein kinase (MAPK) signalling systems. The MAPKs, in conjunction with the p70 S6k signalling cascade, have emerged as critical components for regulating numerous mechanotransduction-related cellular responses. Here we investigate the ability of uniaxial stretch to activate the MAPK and p70 S6k pathways in adult …

An Old Problem With A New Therapy: Gi Bleeding In Vad Patients And Deep Bowel Enteroscopy (Double Balloon. Spiral Enteroscopy)., Hitoshi Hirose, Konrad Sarosiek, Linda Bogar, Pitcher Harrison, Barbara Ebert, Nicholas Cavarocchi

Nicholas C Cavarocchi MDJ

An old problem with a new therapy: GI Bleeding in VAD patients and deep bowel enteroscopy (Spiral and Double Balloon Enteroscopy) Purpose: Evidence suggests that patients treated with non-pulsatile ventricular assist devices (VAD) are at an increased risk for gastrointestinal bleeding (GIB) beyond what is expected from routine anticoagulation. Diagnostic and treatment algorithms are currently undefined. We reviewed our experience of GIB in VAD patients and propose a new algorithm utilizing deep bowel enteroscopy (DBE) aimed to speed diagnosis and limit transfusions. (471) Methods & Procedures From 2004 to 2011, we studied 62 patients who received a non-pulsatile VAD at …

Cerebral And Lower Limb Near-Infrared Spectroscopy In Adults On Extracorporeal Membrane Oxygenation, Joshua K Wong, Thomas N Smith, Harrison T Pitcher, Hitoshi Hirose, Nicholas C. Cavarocchi

Nicholas C Cavarocchi MDJ

Percutaneous femoral venoarterial (VA) or jugular venovenous (VV) extracorporeal membrane oxygenation (ECMO) can result in delivery of hypoxic blood to the brain, coronaries, and upper extremities. Additionally, VA-ECMO by percutaneous femoral artery cannulation may compromise perfusion to the lower limbs. Use of near-infrared spectroscopy (NIRS) detects regional ischemia and warns of impending hypoxic damage. We report the first known series with standardized monitoring of this parameter in adults on ECMO. This is an institutional review board-approved single institution retrospective review of patients with NIRS monitoring on ECMO from July 2010 until June 2011. Patients were analyzed for drops in NIRS …

Tension Pneumothorax On Extracorporeal Membrane Oxygenation Leading To Significant Pneumoperitoneum., Hitoshi Hirose, Nicholas C. Cavarocchi, Kathleen Holoyda

Nicholas C Cavarocchi MDJ

Veno-venous and veno-arterial extracorporeal membrane oxygenation (ECMO) therapy is used to support the cardiac and pulmonary systems in the setting of acute failure. Maintaining adequate ECMO flow is crucial for the success of the therapy. Sudden decrease in venous return on ECMO has multiple etiologies, such as intravascular hypovolemia, malposition or kink of the venous cannula, suction occlusion of a cannula, and venous or arterial thrombi. Pathology within the chest, including pneumothorax, tension hemothorax and pericardial tamponade, may also decrease the ECMO flow because of compression of the cannula and decreased atrial volume. Air from a tension pneumothorax may be …

Efficacy Of Miniaturized Imacor Trans-Esophageal Echocardiografm (Tee) Prove In Mechanical Circulatory Support., Hitoshi Hirose, Christopher Y. Kang, Joshua K. Wong, Harrison T. Pitcher, Caitlyn M. Johnson, Konrad Sarosiek, Linda J Bogar, Nicholas C. Cavarocchi

Nicholas C Cavarocchi MDJ

Application of the miniaturized ImaCor Trans-Esophageal Echocardiogram (TEE) probe in Heart Transplant/Mechanical Cardiac Support Patients In the surgical cardiac care unit (SCCU), therapeutic interventions often need to be done at the bedside, necessitating the need for a rapidly employable diagnostic tool for the cardiac intensivist. We report the clinical utility of the miniature ImaCor TEE-probe in guiding management of post heart transplant (H-Txp) and mechanical cardiac support patients (MCS) and describe the economic benefit of such a device. This is an IRB approved retrospective review of MCS/H-Txp patients who had ImaCor TEE monitoring in the SCCU of our institution in …

Fate Of The Lower Extremity In Patients With Va-Ecmo Via Femoral Cannulation, Hitoshi Hirose, Kathleen Lamb, Neil Moudgill, Paul Dimuzio, Megan Mccullough, Pawel Karbowski, Atul Rao, Nicholas Cavarocchi, Joshua Eisenberg

Nicholas C Cavarocchi MDJ

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a salvage therapy in patients with severe cardiopulmonary failure. Femoral cannulation is associated with limb complications including ischemia, limb loss, arterial infections and wound infections. This study aims to evaluate these complications and management related to successful outcomes. Methods: A retrospective review was conducted in 17 patients requiring VA- ECMO support via femoral cannulation from 1/ 2010 till 4/2012. After cannulation, all patients had near infared spectroscopy (NIRS) monitoring after cannula placement and most had placement of distal arterial perfusion catheters (DPC). At decannulation, all patients had femoral cutdown with closure of arteriotomies …

Extracorporeal Membranous Oxygenation Mimics Aortic Dissection On Cat Scan., Philip Batista, Nicholas C. Cavarocchi, Hitoshi Hirose

Nicholas C Cavarocchi MDJ

A 66 year-old female presented with refractory acute congestive heart failure, cardiogenic shock, and ventricular tachyarrhythmia. Veno-arterial extracorporeal membrane oxygenation (ECMO) was placed via femoral cannulation for salvage and stabilized. CAT scan of the chest performed as a part of heart transplant work-up, demonstrated an unequal distribution of intravenous contrast in the aortic arch (Figure 1). Radiologist’s preliminary reading was of “aortic dissection” while in fact this is truly “normal ECMO flow”.

Rewarming For Accidental Hypothermia In An Urban Medical Center Using Extracorporeal Membrane Oxygenation., David Morley, Kentaro Yamane, Rika O'Malley, Nicholas Cavarocchi, Hitoshi Hirose

Nicholas C Cavarocchi MDJ

BACKGROUND: Accidental hypothermia complicated by cardiac arrest carries a high mortality rate in urban areas. For moderate hypothermia cases conventional rewarming methods are usually adequate, however in severe cases extracorporeal membrane oxygenation (ECMO) is known to provide the most efficient rewarming with complete cardiopulmonary support. We report a case of severe hypothermia complicated by prolonged cardiac arrest successfully resuscitated using ECMO. CASE REPORT: A 45 year old female was brought to our emergency department with a core body temperature CONCLUSIONS: This case demonstrates the advantages of advanced internal rewarming techniques, such as ECMO, for quick and efficient rewarming of severely …

Percutaneous Gastrostomy (Peg) Tube Placement In Patients With Continuous Flow Left Ventricular Assist Device. (Lvad)., Hitoshi Hirose, Chris Rizzi, Linda Bogar, Jay S. Jenoff, Nicholas Cavarocchi

Nicholas C Cavarocchi MDJ

Percutaneous gastrostomy (PEG) tube placement in patients with continuous flow left ventricular assist device. (LVAD). CHRIS RIZZI, BS, Linda Bogar, MD, Jay Jenoff, MD, Nicholas Cavarocchi, MD, Hitoshi Hirose, MD. Department of Surgery, Thomas Jefferson University, Philadelphia, PA. Introduction: Inadequate nutritional support after LVAD placement is known to increase postoperative infections and to decrease survival. The LVAD patients with complicated postoperative recovery requiring prolonged mechanical ventilation may require long-term tube feedings. Placement of a PEG requires knowledge of the location of the LVAD pocket and driveline to avoid device infection and injury. Methods: Between August 2008 and December 2011, 39 …

Massive Haemoptysis On Veno-Arterial Extracorporeal Membrane Oxygenation., Meredith Harrison, Scott W. Cowan, Nicholas C. Cavarocchi, Hitoshi Hirose

Nicholas C Cavarocchi MDJ

A 49-year old female presented with severe heart failure with end-organ dysfunction and was placed on veno-arterial extracorporeal membrane oxygenation (ECMO) as a bridge to a decision for end-organ recovery. While on ECMO, the patient developed massive haemoptysis after a Swan-Ganz catheter manipulation. The haemoptysis was not controllable by conventional methods including bronchoscopy with cold saline and epinephrine lavage, bronchial blocker or angiography. The endotracheal tube was clamped to provide tamponade and the patient relied on full ECMO support for 36 h. After the haemoptysis resolved, the endotracheal tube was unclamped. The patient developed adult respiratory distress syndrome and was …