Medicine and Health Sciences Commons^™

Stage Of Diagnosis Of Breast Cancer And Socioeconomic Status In A Universal Healthcare System: A Population-Based Study In Emilia-Romagna, Italy., Daniel Friedberg

Master of Public Health Capstone Presentations

Research has shown that lower socioeconomic status (SES) is associated with later stage of diagnosis of breast cancer in the United States healthcare system, where access to services may be an issue. However, limited data exists as to whether this effect is present in a universal healthcare system, without financial barriers to services. We sought to determine the association between stage of diagnosis of breast cancer and SES using data from Emilia-Romagna, a large region in northern Italy. We identified a population of women with incident breast cancer from 2002-2003 regional cancer registries, including information on cancer stage based on …

Automated Classification Of Breast Pathology Using Local Measures Of Broadband Reflectance, Ashley M. Laughney, Venkataramanan Krishnaswamy, Pilar Beatriz Garcia-Allende, Olga M. Conde, Wendy A. Wells, Keith D. Paulsen, Brian W. Pogue

Dartmouth Scholarship

We demonstrate that morphological features pertinent to a tissue's pathology may be ascertained from localized measures of broadband reflectance, with a mesoscopic resolution (100-μm lateral spot size) that permits scanning of an entire margin for residual disease. The technical aspects and optimization of a k-nearest neighbor classifier for automated diagnosis of pathologies are presented, and its efficacy is validated in 29 breast tissue specimens. When discriminating between benign and malignant pathologies, a sensitivity and specificity of 91 and 77% was achieved. Furthermore, detailed subtissue-type analysis was performed to consider how diverse pathologies influence scattering response and overall classification efficacy. The …

Developing Constructs For Psychopathology Research: Research Domain Criteria, Charles A. Sanislow, Daniel S. Pine, Kevin J. Quinn, Michael J. Kozak, Marjorie A. Garvey, Robert K. Heinssen, Philip Sung-En Wang, Bruce N. Cuthbert

Charles A. Sanislow, Ph.D.

There exists a divide between findings from integrative neuroscience and clinical research focused on mechanisms of psychopathology. Specifically, a clear correspondence does not emerge between clusters of complex clinical symptoms and dysregulated neurobiological systems, with many apparent redundancies. For instance, many mental disorders involve multiple disruptions in putative mechanistic factors (e.g., excessive fear, deficient impulse control), and different disrupted mechanisms appear to play major roles in many disorders. The Research Domain Criteria (RDoC) framework is a heuristic to facilitate the incorporation of behavioral neuroscience in the study of psychopathology. Such integration might be achieved by shifting the central research focus …

Granuloma Annulare: Not As Simple As It Seems., Lawrence Charles Parish, Joseph A. Witkowski

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Overview Of The Essential Tremor, Theresa A. Zesiewicz, Abinaya Chari, Israt Jahan, Amber M. Miller, Kelly L. Sullivan

Kelly L. Sullivan

Essential tremor (ET) is one of the most common movement disorders in the world. Despite this, only one medication (propranolol) is approved by the Food and Drug Administration (FDA) to treat it. Fortunately, recent studies have identified some additional medications as treatment of ET. Surgical procedures, such as deep brain stimulation of the ventral intermediate nucleus of the thalamus, offer treatment for refractory tremor. The epidemiology, pathogenesis, and medical and surgical treatment of ET will be discussed in this paper.

Deficits In Attention To Emotional Stimuli Distinguish Youth With Severe Mood Dysregulation From Youth With Bipolar Disorder., Brendan A Rich, Melissa A Brotman, Daniel P Dickstein, Derek G V Mitchell, R James R Blair, Ellen Leibenluft

Brain and Mind Institute Researchers' Publications

Studying attention in the context of emotional stimuli may aid in differentiating pediatric bipolar disorder (BD) from severe mood dysregulation (SMD). SMD is characterized by chronic irritability, arousal, and hyper-reactivity; SMD youth frequently receive a BD diagnosis although they do not meet DSM-IV criteria for BD because they lack manic episodes. We compared 57 BD (14.4 +/- 2.9 years old, 56% male), 41 SMD (12.6 +/- 2.6 years old, 66% male), and 33 control subjects (13.7 +/- 2.5 years old, 52% male) using the Emotional Interrupt task, which examines how attention is impacted by positive, negative, or neutral distracters. We …

Craniocerebral Aspergillosis: A Review Of Advances In Diagnosis And Management, Muhammad Shahzad Shamim, Ather Enam, Rushna Ali, Saleha Anwar

Section of Neurosurgery

Craniocerebral aspergillosis is a rare but dangerous central nervous system infection. The infection has a spectrum of presenting features, mostly affecting immunocompromised individuals. The incidence appears to be on the rise that has been especially observed in the immunocompetent population. A high index of suspicion, a comprehensive understanding of the infectious process and advanced laboratory and radiological diagnostic techniques, allow early diagnosis. Surgery, followed by systemic antifungal medications, remains the cornerstone of management. Early administration of empirical anti-fungal agents along with immunomodulators may further improve prognosis. Immunocompetent patients tend to have better outcomes as compared to those who are immunocompromised. …

Hiv: Make The Diagnosis And Take The Next Step, Julie G. Stewart, Amy R. Weinberg

Nursing Faculty Publications

With the CDC urging screening for all willing patients, providers will be testing and managing a growing number of HIV-positive individuals.

The CDC estimates that with more than 40,000 new infections annually, more than 1.2 million people in the United States are living with HIV-and 24% to 27% may not be aware of their infection status.1 Studies have shown that HIV is often diagnosed late in the disease process, when the individual has already developed AIDS, which typically occurs 8 to 11 years after HIV infection.2 Research also points to missed opportunities to offer HIV testing and diagnose the infection …

Tubercular Pancreatic Abscess Presenting As Fever And Cystic Pancreatic Lesion With Endoscopic Management., Jonathan M. Fenkel, Maya Spodik, Bheema S. Singu, Anthony Infantolino, Sandeep P. Deshmukh, David E. Loren

Division of Gastroenterology and Hepatology Faculty Papers

Isolated pancreatic tuberculosis is a rare presentation of tubercular infection. There are few reported cases of pancreatic tuberculosis diagnosed by endoscopic ultrasound with fine-needle aspiration (EUS FNA), though EUS is often used in the evaluation of pancreatic cystic lesions. We present a case of a tubercular pancreatic abscess presenting as a cystic lesion in a patient with undiagnosed immunodeficiency. The abscess was aspirated by EUS FNA and treated with endoscopic drainage and anti-mycobacterial medications.

Clinical, Radiographic And Pathological Features Of Persistent Gastroesophageal Intussusception In An Adult Dog: A Case Report, Theerayuth Kaewamatawong, Wijit Banlunara, Varaporn Wangrattanaparanee, Srireepong Kiertkrittikhoon

The Thai Journal of Veterinary Medicine

The aim of this report is to describe the clinical, radiographic and pathological appearances of a persistent gastroesophageal intussusception in associated with idiopathic egaesophagus in an adult dog. A 6-years old, male Golden Retriever was referred for evaluation of chronic regurgitation and vomiting. Radiographic diagnosis of persistent gastroesophageal intussusception (GEI) with megaesophagus was made. Survey and contrast radiography evidenced a distension of the esophageal medial and caudal portions due to a dense soft-tissue mass and the barium cloud not pass to abdominal portion, where outlined the striations of muscle of the distal esophagus around the mass.Necropsy findings revealed a completed …

Should ‘Risk Syndrome Of Psychosis’ Be Included In Dsm V As A Diagnosis? A Road Towards Preventive Psychiatry”, Amresh Srivastava

Amresh Srivastava

Psychiatric diagnosis has acquired a position of a quasi-legal document for mental health services and agencies working with mental health. Its utility has gone far beyond ‘clinical diagnosis for treatment’.

The concept of risk syndrome for schizophrenia has been thoroughly researched in last ten years or so. Significant advancement has been made in phenomenology, diagnostic criteria, classification, & neurobiology. The research of prodromal or at-risk or Ultra high-risk psychosis has significantly contributed to the body of knowledge of aetio-pathogenesis of schizophrenia.

The science of risk syndrome has apparently matured and its proponents are ready for its inclusion in DSM V …

Reinvention Of Depression Instruments By Primary Care Clinicians, Seong-Yi Baik, Junius Gonzales, Barbara J. Bowers, Jean S. Anthony, Bas Tidjani, Jeffrey L. Susman

Publications from Provost Junius J. Gonzales

PURPOSE Despite the sophisticated development of depression instruments during the past 4 decades, the critical topic of how primary care clinicians actually use those instruments in their day-to-day practice has not been investigated. We wanted to understand how primary care clinicians use depression instruments, for what purposes, and the conditions that influence their use.

METHODS Grounded theory method was used to guide data collection and analysis. We conducted 70 individual interviews and 3 focus groups (n = 24) with a purposeful sample of 70 primary care clinicians (family physicians, general internists, and nurse practitioners) from 52 offices. Investigators’ field notes …

Development Of The Lung Function Questionnaire (Lfq) To Identify Airflow Obstruction, Barbara P. Yawn, Douglas W. Mapel, David M. Mannino, Fernando J. Martinez, James F. Donohue, Nicola A. Hanania, Mark Kosinski, Regina Rendas-Baum, Matthew Mintz, Steven Samuels, Anand A. Dalal

David M. Mannino

Objective:

To describe the item-selection and item-reduction for the Lung Function Questionnaire (LFQ), being developed to help clinicians identify patients appropriate for diagnostic evaluation for chronic obstructive pulmonary disease (COPD) using spirometry.

Methods:

Item selection and reduction were based on information from 387 ≥40-year-old respondents to the third National Health and Nutrition Examination Survey who had self-reported chronic bronchitis. Item reduction involved stepwise logistic regression. The accuracy of the final subset of items for identifying individuals with airflow obstruction (forced expiratory volume in one second/forced vital capacity <0.70) versus those without it was assessed with receiver operating characteristic analysis. Content and face validity were assessed using focus groups of primary care physicians (n = 16) and interviews with COPD patients (n = 16).

Results:

The model with all five items (age; smoking history; the presence of …

Ct And Mri Features Following Uterine Fibroid Embolization, Sachit Verma Md, Carin F. Gonsalves Md, Oksana H. Baltarowich Md, Donald G. Mitchell Md, Anna Lev-Toaff Md, Diane Bergin Md

Department of Radiology Faculty Papers

Uterine artery embolization (UAE) is an effective treatment for symptomaticuterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a …

Self Diagnosis, Clare Goyder, Ann Mcpherson, Paul Glasziou

Paul Glasziou

Extract:
Some conditions can be diagnosed correctly by the patient, but self diagnosis should always undergo challenge and refinement by the general practitioner.

Prepubertal Office Gynecology, Hatim A. Omar, Wendy Jackson, Amit M. Deokar

Pediatrics Faculty Publications

Clinical presentation and complaints of the vulvo-vaginal area are quite prevalent in the pediatric population and the primary care providers the first individuals called upon to evaluate the patients. One of the most difficult tasks for an individual that rarely performs the genitourinary examination is performing one on a pediatric patient. This chapter has been written to aid the primary care provider in successful examination, documentation and diagnosis.

Eosinophilic Cholangitis And Cholangiopathy: A Sheep In Wolves Clothing, Catherine Nashed, Sujit Vijay Sakpal, Victoria Shusharina, Ronald Scott Chamberlain

Department of Surgery

BACKGROUND: Eosinophilic cholangitis (EC) is a rare benign disorder of the biliary tract which can cause biliary obstruction. Similar to other disease processes involving the bile ducts, this disorder can pose a difficult diagnostic challenge as it can mimic cholangiocarcinoma.

METHODS: A systematic search of the scientific literature was carried out using PubMed to access all publications related to EC. Search keywords that were utilized included "eosinophilic cholangitis," "etiology," "treatment," and "obstructive jaundice." Results. Twenty-three cases of EC have been reported. Nineteen patients (82.6%) who presented with EC remain disease-free; 15 of these 19 patients (78.9%) with followup time remain …

Hydatid Cyst Disease Of The Thorax, Saulat H. Fatimi, Naima Waqar Butt, Taimur Saleem, Mohammad Asim Beg

Section of Cardiothoracic Surgery

Hydatid disease is a frequently encountered entity in endemic areas and constitutes a serious health problem. The lung is the second most commonly affected organ after the liver. In three of four cases of pulmonary hydatid cyst, the cyst is solitary. The early phase after primary infection is always asymptomatic. Primary symptoms in patients with pulmonary cystic echinococcosis include cough, fever, and chest pain. The clinical and radiological manifestations for the hydatid cyst in the lung depend on the integrity of the cyst. Bronchial fistulization is an important event in the evolution of the cyst. In cases of dubious orientation …

A Comparison Of The Effects Of Parental Stressors In Parents Of Diagnosed Versus Undiagnosed Children, Alicia Gomes

Theses and Dissertations

Previous literature has shown that stress can play a major role in family functioning and can be pronounced in families of children with special needs. The purpose of this study is to analyze potential stressors in families of children with special needs to determine whether a diagnosis for a child's medical conditions has any impact on these stressors. Diagnosed and undiagnosed participants were obtained from the National Down Syndrome Society (NDSS), the National Down Syndrome Congress (NDSC), and the Syndromes Without A Name (SWAN) online discussion boards. Participants were solicited with an e-mail providing a link to an online survey …

A Case Study Of The Clinical Form Of Johne’S Disease In A Heifer, Agnieszka Wiszniewsk Laszczych, Joanna Szteyn, Aleksandra Ruszczynska

Turkish Journal of Veterinary & Animal Sciences

Johne's disease-paratuberculosis-affects domesticated and wild ruminants throughout the world. The first symptoms of the disease appear 6 months to 15 years after infection. The clinical stage of paratuberculosis usually occurs in older animals and is rare in those under 2 years of age. While performing analyses on a farm in the northeastern region of Poland a 2-year-old heifer that manifested symptoms of dyspepsia, proceeding with watery diarrhea, was observed. ELISA test (IDEXX) results demonstrated a positive serological reaction for paratuberculosis. Clinical examination, microbiological analysis of feces, autopsy, and histopathological examination confirmed the incidence of Johne's disease in the heifer.

Diverticular And Aneurysmal Structures Of The Left Ventricle In Adults: Report Of A Case Within The Context Of A Literature Review., Premraj Makkuni, Morris N Kotler, Vincent M. Figueredo

Department of Medical Genetics Faculty Papers

Left ventricular outpouchings are increasingly detected on cardiovascular imaging. Herein, we describe the case of a 45-year-old man who underwent noncardiac preoperative imaging and was found to have an asymptomatic left ventricular outpouching. The patient underwent successful surgical repair of the structure. When left ventricular outpouchings are detected, the main differential diagnoses are pseudoaneurysm, aneurysm, and diverticulum. The outcomes for these conditions differ substantially, and accurate diagnosis can be crucial in making clinical decisions. We review the relevant medical literature, outline the natural history of these left ventricular abnormalities, and discuss options in regard to their management.

Developing Constructs For Psychopathology Research: Research Domain Criteria, Charles A. Sanislow, Daniel S. Pine, Kevin J. Quinn, Michael J. Kozak, Marjorie A. Garvey, Robert K. Heinssen, Philip S. Wang, Bruce N. Cuthbert

Charles A. Sanislow, Ph.D.

There exists a divide between findings from integrative neuroscience and clinical research focused on mechanisms of psychopathology. Specifically, a clear correspondence does not emerge between clusters of complex clinical symptoms and dysregulated neurobiological systems, with many apparent redundancies. For instance, many mental disorders involve multiple disruptions in putative mechanistic factors (e.g., excessive fear, deficient impulse control), and different disrupted mechanisms appear to play major roles in many disorders. The Research Domain Criteria (RDoC) framework is a heuristic to facilitate the incorporation of behavioral neuroscience in the study of psychopathology. Such integration might be achieved by shifting the central research focus …