Medicine and Health Sciences Commons^™

Novel Approach To Monitoring Renal Perfusion With The Use Of Continuous Renal Oximetery In The Setting Of Aortic Dissection, Hitoshi Hirose, Philip Batista, Nicholas C. Cavarocchi

Nicholas C Cavarocchi MDJ

INTRODUCTION: Aortic dissections commonly extend beyond the renal arteries with varying effects ranging from asymptomatic to renal failure. We report a case of aortic dissection with initial renal compromise, which was continuously monitored utilizing direct renal oximetry for evaluation of real-time renal perfusion and function. CASE PRESENTATION: A 65 year-old female with a long history of uncontrolled hypertension presented with acute retrosternal chest pain radiating to the back for 12 hours. She was in stable condition except for a serum creatinine of 1.6mg/dl. Magnetic resonance angiography (MRA) demonstrated a type A dissection extending from the aortic root to the left …

Venoarterial Extracorporeal Membrane Oxygenation (Ecmo) For Support During Whole Lung Lavage For Pulmonary Alveolar Proteinosis., Hitoshi Hirose, Julie Monteagudo, Nicholas C. Cavarocchi, Boyd Hehn, Naveed Hasan

Nicholas C Cavarocchi MDJ

INTRODUCTION ECMO as support during whole lung lavage (WLL) for pulmonary alveolar proteinosis is reserved for severe cases where oxygenation is inadequate to support the patient using the ventilator alone. While most publications describe a venovenous cannulation with variable results we present a successful case using venoarterial cannulation and discuss the potential benefits of this mode of ECMO support. CASE PRESENTATION We present the case of a 44 year old female with a past medical history of Behcets disease and a BMI of 37 who was diagnosed with pulmonary alveolar proteinosis (PAP) on a lung biopsy after presenting with dyspnea. …

Successful Management Of Severe Liver Failure On Venoarterial Extracorporeal Membrane Oxygenation Using Molecular Adsorbent Recirculating Systeme., Shigeki Tabata, Nicholas Cavarocchi, Hitoshi Hirose

Nicholas C Cavarocchi MDJ

A 49-year-old female with Adriamycin induced cardiomyopathy presented with decompensated biventricular congestive heart failure. Despite multiple Inotropes, the patient’s hemodynamics deteriorated and she underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) placement as a bridge to decision. Pre-ECMO workup showed liver dysfunction with elevated total bilirubin of 5.9 mg/dl, normal liver enzymes and liver ultrasound image. Tentative diagnosis of “end-stage liver failure” was made without a biopsy. Shortly after initiation of ECMO, the patient developed massive hemoptysis which was successfully managed with continuation of ECMO and ventilator management. [i] The patient’s total bilirubin continued to increase to peak of 56 mg/dl on …

Right Ventricular Rupture And Tamponade Caused By Malposition Of The Avalon Cannula For Venovenous Extracorporeal Membrane Oxygenation., Hitoshi Hirose, Kentaro Yamane, Gregary D. Marhefka, Nicholas C. Cavarocchi

Nicholas C Cavarocchi MDJ

Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO) via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of unexpected wire migration into the right ventricle at the time of final cannula advancement, resulting in right ventricular rupture and tamponade. Transesophageal echocardiography is an important monitoring modality for appropriate placement of the VV-ECMO guidewire and Avalon cannula, and in particular, for …

Successful Liver Failure Management Using Molecular Adsorbents Recirculating System During Complicated Veno-Arterial Extracorporeal Membrane Oxygenation As A Bridge To A Left Ventricular Assist Device Placement, Hitoshi Hirose, Shigeki Tabata, Nicholas Cavarocchi

Nicholas C Cavarocchi MDJ

Successful liver failure management using molecular adsorbents recirculating system during complicated veno-arterial extracorporeal membrane oxygenation as a bridge to a left ventricular assist device placement. SHIGEKI TABATA, MD, Nicholas Cavarocchi, MD, Hitoshi Hirose, MD. Department of Surgery, Division of Cardiothoracic Surgery Thomas Jefferson University Hospital, Philadelphia, PA Introduction: Extracorporeal membrane oxygenation (ECMO) is a well-established therapy for the patients with cardiogenic shock. We present a patient who developed severe complications while on ECMO. Case presentation: A 49-year-old female presented with severe heart failure and was placed on veno-arterial ECMO for bridge to decision. While on ECMO, the patient developed massive …

Larynx-Sparing Techniques Using Intensity-Modulated Radiation Therapy For Oropharyngeal Cancer., Voichita Bar-Ad, Haibo Lin, Wei-Ting Hwang, Curtiland Deville, Pinaki R Dutta, Zelig Tochner, Stefan Both

haibo lin

The purpose of the current study was to explore whether the laryngeal dose can be reduced by using 2 intensity-modulated radiation therapy (IMRT) techniques: whole-neck field IMRT technique (WF-IMRT) vs. junctioned IMRT (J-IMRT). The effect on planning target volumes (PTVs) coverage and laryngeal sparing was evaluated. WF-IMRT technique consisted of a single IMRT plan, including the primary tumor and the superior and inferior neck to the level of the clavicular heads. The larynx was defined as an organ at risk extending superiorly to cover the arytenoid cartilages and inferiorly to include the cricoid cartilage. The J-IMRT technique consisted of an …

Analysis Of Daily Activity Data From Implanted Cardiac Defibrillators: The Minimum Clinically Important Difference And Relationship To Mortality/Life Expectancy, Michael J. Shoemaker, Amy B. Curtis, Eric Vangsnes, Michael G. Dickinson, Rajib Paul

Michael J Shoemaker, PT, DPT, PhD, GCS

Background: Daily activity is a potentially important measure for assessing prognosis in individuals with chronic heart failure (CHF), and few studies have investigated the prognostic value of daily activity measurement. The present study sought to determine whether there is an association between daily activity and mortality/mean life expectancy as predicted by the Seattle Heart Failure Model (SHFM), and to provide an estimate of the anchor-based minimum clinically important difference (MCID) for daily activity measured by single-axis accelerometers in implanted cardiac defibrillators. Methods: This study utilized a retrospective chart review of 102 medical records of patients with CHF and Medtronic® implanted …

Cerium Oxide Nanoparticles: Influence Of The High-Z Component Revealed On Radioresistant 9l Cell Survival Under X-Ray Irradiation, Adam Briggs, Stephanie Corde, Sianne Oktaria, Ryan Brown, Anatoly B. Rosenfeld, Michael Lerch, Konstantin Konstantinov, Moeava Tehei

Michael L.F. Lerch

This article pioneers a study into the influence of the high-Z component of nanoparticles on the efficacy of radioprotection some nanoparticles offer to exposed cells irradiated with X-rays. We reveal a significant decrease in the radioprotection efficacy for cells exposed to CeO2 nanoparticles and irradiated with 10 MV and 150 kVp X-rays. In addition, analysis of the 150 kVp survival curve data indicates a change in radiation quality, becoming more lethal for irradiated cells exposed to CeO2 nanoparticles. We attribute the change in efficacy to an increase in high linear energy transfer Auger electron production at 150 kVp which counterbalances …

Glutathione Redox Dynamics And Expression Of Glutathione-Related Genes In The Developing Embryo, Alicia R. Timme-Laragy, Jared V. Goldstone, Barry R. Imhoff, John J. Stegemana, Mark E. Hahn, Jason M. Hansen

Alicia R. Timme-Laragy

Embryonic development involves dramatic changes in cell proliferation and differentiation that must be highly coordinated and tightly regulated. Cellular redox balance is critical for cell fate decisions, but it is susceptible to disruption by endogenous and exogenous sources of oxidative stress. The most abundant endogenous non-protein antioxidant defense molecule is the tri-peptide glutathione (γ-glutamyl-cysteinylglycine, GSH), but the ontogeny of GSH concentration and redox state during early life stages is poorly understood. Here, we describe the GSH redox dynamics during embryonic and early larval development (0–5 days post-fertilization) in the zebrafish (Danio rerio), a model vertebrate embryo. We measured reduced and …

La Situación De Personas Con Discapacidades Intelectuales En Santiago De Chile (The Situation Of Persons With Intellectual Disabilities In Santiago, Chile), Elizabeth Ramsey

Elizabeth Ramsey

Background: Chile has among the highest rates in the world of appearance of cognitive disability. The population of adults with disabilities can be defined as any person over the age of 18 with a congenital intellectual difficulty. Additionally, the specific population of this study includes only individuals who are partially autonomous, those who require some degree of support in their everyday lives. To serve this population, diverse services and opportunities are necessary to support a vibrant and fulfilling lifestyle. This includes workplaces, programs of social inclusion, appropriate health access, and protection and support from the government. Objectives: This study aims …

Social Foundations For A Community-Based Public Health Cholera Campaign In Borgne, Haiti, John Mazzeo

John Mazzeo, Ph.D.

The rapid and widespread progression of cholera in rural Haiti can be attributed to a “perfect storm” of conditions including the widespread use of unprotected water sources, rudimentary sanitation, the lack of means to afford simple necessities, and the near absence of basic health services to treat the sick. Accessibility of essential health care and reliable sources of clean water in remote areas of rural Haiti are fundamental barriers to addressing acute public health emergencies including the ongoing cholera epidemic. This article explores the notion that positive health outcomes for hard to reach populations can be achieved through community mobilization. …

Intention To Seek Professional Psychological Help Among College Students In Turkey: Influence Of Help-Seeking Attitudes, Feyza Seyfi, Krishna C. Poudel, Junko Yasuoka, Keiko Otsuka, Masamine Jimba

Krishna C. Poudel

Risk Factors For Becoming Homeless Among A Cohort Of Veterans Who Served In The Era Of The Iraq And Afghanistan Conflicts, Stephen Metraux, Limin X. Clegg, John D. Daigh, Dennis P. Culhane, Vincent R. Kane

Dennis P. Culhane

Community-Level Characteristics Associated With Variations In Rates Of Homelessness Among Families And Single Adults, Jamison D. Fargo, Ellen A. Munley, Thomas H. Byrne, Ann Elizabeth Montgomery, Dennis P. Culhane

Dennis P. Culhane

Relationship Among Adverse Childhood Experiences, History Of Active Military Service, And Adult Outcomes: Homelessness, Mental Health And Physical Health, Ann Elizabeth Montgomery, J J. Cutuli, Michelle Evans-Chase, Dan Treglia, Dennis P. Culhane

Dennis P. Culhane

Homelessness Research: Shaping Policy And Practice, Now And Into The Future, Dennis P. Culhane, Vince R. Kane, Mark Johnston

Dennis P. Culhane

Universal Screening For Homelessness And Risk For Homelessness In The Veterans Health Administration, Ann Elizabeth Montgomery, Jamison D. Fargo, Thomas H. Byrne, Vincent R. Kane, Dennis P. Culhane

Dennis P. Culhane

Injuries Common To Tactical Personnel (A Multidisciplinary Review), Rob Orr, Michael Stierli

Rob Marc Orr

No abstract provided.

The 30-15 Intermittent Fitness Assessment As A Predictor Of Injury Risk In Police Recruits, Rob Orr, Michael Stierli, Ben Hinton, Michael Steele

Rob Marc Orr

Police recruits with lower intermittent metabolic fitness as measured by the 30-15 Intermittent Fitness Test are at a greater risk of sustaining an injury or illness during police recruit training.

The Impact Of Load Carriage On Mobility And Marksmanship Of The Tactical Response Officer, Simon D. Carlton, Rob Orr, Michael Stierli, Patrick D. Carbone

Rob Marc Orr

The loads carried by specialist tactical police officers may decrease their mobility over short distances but improve their marksmanship performance at close range.

Extreme Conditioning Programs And The Tactical Athlete, Rob Orr

Rob Marc Orr

No abstract provided.

Design, Synthesis And Cytotoxic Evaluation Of O-Carboxamido Stilbene Analogues, Kok Hoong Leong

Kok Hoong Leong

Resveratrol, a natural stilbene found in grapes and wines exhibits a wide range of pharmacological properties. Resveratrol is also known as a good chemopreventive agent for inhibiting carcinogenesis processes that target kinases, cyclooxygenases, ribonucleotide reductase and DNA polymerases. A total of 19 analogues with an amide moiety were synthesized and the cytotoxic effects of the analogues on a series of human cancer cell lines are reported. Three compounds 6d, 6i and 6n showed potent cytotoxicity against prostate cancer DU-145 (IC50 = 16.68 μM), colon cancer HT-29 (IC50 = 7.51 μM) and breast cancer MCF-7 (IC50 = 21.24 μM), respectively, which …

Experiences Of Community And Parental Violence Among Hiv Positive Young Racial/Ethnic Minority Men Who Have Have With Men, Sheldon D. Fields

Sheldon D. Fields

Adolescents and young adults (ages 13–24) in the USA are frequently exposed to violence in their community and home. While studies have examined the prevalence and impact of violence exposure among adolescents, there is a lack of data focusing specifically on adolescent men of color who have sex with men. Eight demonstration sites funded through a Special Projects of National Significance (SPNS) Initiative recruited 363 HIV-positive racial/ethnic minority young men who have sex with men (YMSM) for a longitudinal study between 2006 and 2009. Over two-thirds of participants (83.8%) had witnessed community violence, 55.1% in the prior three months. Witnessing …

Contrais: Conservative Treatment For Adolescent Idiopathic Scoliosis: A Randomised Controlled Trial, Allan Abbott, Hans Moller, Paul Gerdhem

Allan D. Abbott

Background: Idiopathic scoliosis is a three-dimensional structural deformity of the spine that occurs in children and adolescents. Recent reviews on bracing and exercise treatment have provided some evidence for effect of these interventions. The purpose of this study is to improve the evidence base regarding the effectiveness of conservative treatments for preventing curve progression in idiopathic scoliosis. Methods/design: Patients: Previously untreated girls and boys with idiopathic scoliosis, 9 to 17 years of age with at least one year of remaining growth and a curve Cobb angle of 25–40 degrees will be included. A total of 135 participants will be randomly …

Core Competencies For Clinical Supervisors, David Kalman, Stephanie Rodrigues

Stephanie Rodrigues

This chapter provides useful strategies that will help guide clinical supervisors who oversee and support the work of MISSION-VET Case Managers and Peer Support Specialists. It includes an overview of the MISSION-VET supervisor’s role and a description of each team member’s primary area of responsibility within the MISSION-VET program. The remainder of the chapter describes key strategies that MISSION-VET supervisors will need in order to establish productive working relationships with MISSION Case Managers and Peer Support Specialists. These strategies, which are designed to foster a strong supervisory alliance and assure that services are being delivered with fidelity to the MISSION-VET …

Get The Word Out: Utilizing Traditional And Emerging Tools To Disseminate And Measure The Impact Of Your Research, Sally A. Gore

Sally A. Gore

Publishing articles and presenting at conferences are tried and true ways for promoting your research within academic and professional circles, but with changes to scholarly communications and the emergence of many new forms that allow individuals to disseminate information more freely, openly, and quickly, researchers have a host of opportunities to both promote their work to a larger audience and track the impact of their research in a more accurate manner. From article-level metrics (altmetrics) to open access publications to the use of social media, this poster gives an introduction to some of the vehicles available today, how to use …

Welcome To Bogan-Ville: Reframing Class And Place Through Humour, Chris Gibson

Chris Gibson

On August 4, 2009, Australian online news commentary website the Punch announced that Albion Park, in the Australian industrial city of Wollongong, was one of the nation's top ten “most bogan” places. This paper explores what it means to be bogan in Australia, tracing historical antecedents, local debate at the time of this media event, and the manner in which the politics of class and place identity are negotiated through humour. Some local residents railed against associations with “lower-class” culture or feared damaged reputations for their neighbourhoods; others responded in sometimes unexpected and creative ways—through humour, and by claiming bogan …

Geographies Of Tourism: Space, Ethics And Encounter, Chris Gibson

Chris Gibson

At the heart of tourism is encounter - perhaps its defining, distinguishing feature (Crouch et al., 2001). We travel to encounter other places, landscapes, people, sights, weather. While the tourism industry relies on all manner of material commodities to turen a profit (hotel beds, postcards, luggage, etc.), and has been incorporated into a symbolic economy of marketing representations, its most cherished, commodified, essential elements is cncounter.

"Muting" Neoliberalism? Class And Colonial Legacies In Australia, Chris Gibson

Chris Gibson

Australian governments of left and right persuasions have seemingly embraced elements of the neoliberal agenda, as in many other parts of the world; but exactly how deeply these have been enacted, and how transformative they have been, must be understood in relation to key colonial, geographical and cultural inheritances. These inheritances include the hegemony of central government stewardship of the economy (essential in a colonized, sparsely populated continent of almost unmanageable scale), a long tradition of social democratic regulation, and cultural expectations of socio-spatial equality. Neoliberal policy projects have been "muted" by on-going equality claims, and some progressive "wins" in …

Making Things In A High-Dollar Australia: The Case Of The Surfboard Industry, Andrew Warren, Chris Gibson

Chris Gibson

In August 2011 the announcement by Bluescope Steel of mass layoffs at its Port Kembla steelworks, in the Illawarra region, sparked renewed public debate and media commentary on the future of manufacturing in Australia. The debate has since spread to cars, aluminium smelting - even Mortein fly spray - and has quickly coalesced around the unprecedented high Australian dollar, its impacts on exports, and the prospects of the production of goods shifting overseas. As Australian mining magnates such as Clive Palmer, Gina Rinehart and Twiggy Forrest attempt to remould Australia around their 'quarry vision' (Pearse, 2009) of extractive minerals exports, …