Digital Commons Network^™

Diabetes Prevention Of The Hispanic Population: Health Lifestyle Management Education At Our Lady Of Guadelupe Clinic In Worthington, Minnesota., Laura J. Bade, Amber E. Dionne, Erin A. Manoles, Lisa R. Milbrant

All Electronic Theses and Dissertations

The purpose of this research study was to utilize educational tools on healthy lifestyles in order to promote Diabetes Mellitus Type II (DMII) prevention in the Hispanic population in Worthington, Minnesota. Hispanic adults are 1.7 times more likely to be diagnosed with Diabetes Mellitus (DM) by a physician than non-Hispanics. Since DMII is a preventable disease, education focused on nutrition and activity will help prevent diabetes and its associated comorbidities. An educational seminar was conducted at Our Lady of Guadalupe in Worthington, Minnesota. A pretest/posttest was administered to assess the knowledge gained with the utilization of the educational tool. Despite …

Perceived Discrimination In Those At Clinical High Risk For Psychosis, M. M. Saleem, J. Stowkowy, K. S. Cadenhead, T. D. Cannon, B. Cornblatt, T. H. Mcglashan, D. O. Perkins, L. J. Seidman, M. T. Tsuang, S. W. Woods, +2 Additional Authors

Journal Articles

Aim: There is evidence to suggest that perceived discrimination may be associated with psychosis. Less is known about its potential impact on those at clinical high risk (CHR) for psychosis. The aim of this study was to determine the prevalence of perceived discrimination in a CHR sample and its possible relationship to attenuated positive symptoms and negative self-beliefs. Methods: Participants were 360 CHR individuals and 180 healthy controls. Assessments included a self-report measure of perceived discrimination, the Scale of Prodromal Symptoms and the Brief Core Schema Scale. Results: CHR participants reported significantly more perceived discrimination. Perceived discrimination was significantly associated …

Diagnosis And Treatment Of Pediatric Acquired Aplastic Anemia (Aaa): An Initial Survey Of The North American Pediatric Aplastic Anemia Consortium (Napaac), D. A. Williams, C. Bennett, A. Bertuch, M. Bessler, T. Coates, S. Corey, Y. Dror, J. Lipton, A. Vlachos, A. Shimamura, +7 Additional Authors

Journal Articles

BackgroundRandomized clinical trials in pediatric aplastic anemia (AA) are rare and data to guide standards of care are scarce. ProcedureEighteen pediatric institutions formed the North American Pediatric Aplastic Anemia Consortium to foster collaborative studies in AA. The initial goal of NAPAAC was to survey the diagnostic studies and therapies utilized in AA. ResultsOur survey indicates considerable variability among institutions in the diagnosis and treatment of AA. There were areas of general consensus, including the need for a bone marrow evaluation, cytogenetic and specific fluorescent in situ hybridization assays to establish diagnosis and exclude genetic etiologies with many institutions requiring results …

A 129-Kb Deletion On Chromosome 12 Confers Substantial Protection Against Rheumatoid Arthritis, Implicating The Gene Slc2a3, C. D. Veal, K. E. Reekie, J. C. Lorentzen, P. K. Gregersen, L. Padyukov, A. J. Brookes

Journal Articles

We describe a copy-number variant (CNV) for which deletion alleles confer a protective affect against rheumatoid arthritis (RA). This CNV reflects net unit deletions and expansions to a normal two-unit tandem duplication located on human chr12p13.31, a region with conserved synteny to the rat RA susceptibility quantitative trait loci Oia2. Genotyping, using the paralogue ratio test and SNP intensity data, in Swedish samples (2,403 cases, 1,269 controls) showed that the frequency of deletion variants is significantly lower in cases (P=0.0012, OR=0.442 [95%CI 0.258-0.755]). Reduced frequencies of deletion variants were also seen in replication materials comprising 9,201 UK samples (1,846 cases, …

Integrating Palliative Care Into The Picu: A Report From The Improving Palliative Care In The Icu Advisory Board, R. Boss, J. Nelson, D. Weissman, M. Campbell, R. Curtis, J. Frontera, M. Gabriel, D. Lustbader, A. Mosenthal, R. Hays, +5 Additional Authors

Journal Articles

Objective: This review highlights benefits that patients, families and clinicians can expect to realize when palliative care is intentionally incorporated into the PICU. Data Sources: We searched the MEDLINE database from inception to January 2014 for English-language articles using the terms "palliative care" or "end of life care" or "supportive care" and "pediatric intensive care." We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website. Study Selection: Two authors (physicians with experience in pediatric intensive care and palliative care) made final selections. Data Extraction: We critically reviewed the existing data and …

Palliative Care In The Icu: Relief Of Pain, Dyspnea, And Thirst-A Report From The Ipal-Icu Advisory Board, K. Puntillo, J. E. Nelson, D. Weissman, R. Curtis, S. Weiss, J. Frontera, M. Gabriel, R. Hays, D. Lustbader, M. Campbell, +6 Additional Authors

Journal Articles

Purpose: Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU(IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management. Methods: We conducted a comprehensive review of literature focusing on intensive care and palliative care research related to palliation of pain, dyspnea, and thirst. Results: Evidence-based methods to assess pain are the enlarged 0-10 Numeric Rating Scale (NRS) for ICU patients able …

The Treatment-Naive Microbiome In New-Onset Crohn's Disease, D. Gevers, S. Kugathasan, L. A. Denson, Y. Vazquez-Baeza, W. Van Treuren, B. Y. Ren, E. Schwager, D. Knights, J. Markowitz, R. J. Xavier, +22 Additional Authors

Journal Articles

Inflammatory bowel diseases (IBDs), including Crohn's disease (CD), are genetically linked to host pathways that implicate an underlying role for aberrant immune responses to intestinal microbiota. However, patterns of gut microbiome dysbiosis in IBD patients are inconsistent among published studies. Using samples from multiple gastrointestinal locations collected prior to treatment in new-onset cases, we studied the microbiome in the largest pediatric CD cohort to date. An axis defined by an increased abundance in bacteria which include Enterobacteriaceae, Pasteurellacaea, Veillonellaceae, and Fusobacteriaceae, and decreased abundance in Erysipelotrichales, Bacteroidales, and Clostridiales, correlates strongly with disease status. Microbiome comparison between CD patients with …

Approaching The Next Revolution? Evolutionary Integration Of Neural And Immune Pathogen Sensing And Response, K. J. Tracey

Journal Articles

Mammalian immunity evolved by the process of natural selection that produced differential survival and reproduction advantages through combinations of hereditary traits underlying the response to pathogens. Primitive animals sense the presence of microbial pathogens through recognition of pathogen-derived molecules in their rudimentary immune and nervous systems. No molecular biological mechanism assigns primacy of pathogen sensing mechanisms to immune cells over neurons. Rather, in animals as diverse as Caenorhabditis elegans to mammals, neural reflexes are activated by the presence of pathogens and transduce neural mechanisms that control the development of immunity. A coming revolution in immunological thinking will require immunologists to …

Mapping Human Brain Networks With Cortico-Cortical Evoked Potentials, C. J. Keller, C. J. Honey, P. Megevand, L. Entz, I. Ulbert, A. D. Mehta

Journal Articles

The cerebral cortex forms a sheet of neurons organized into a network of interconnected modules that is highly expanded in humans and presumably enables our most refined sensory and cognitive abilities. The links of this network form a fundamental aspect of its organization, and a great deal of research is focusing on understanding how information flows within and between different regions. However, an often-overlooked element of this connectivity regards a causal, hierarchical structure of regions, whereby certain nodes of the cortical network may exert greater influence over the others. While this is difficult to ascertain non-invasively, patients undergoing invasive electrode …

Sudden Unexpected Nocturnal Death In Chiari Type 1 Malformation And Potential Role Of Opioid Analgesics, F. Roohi, T. Gropen, R. W. Kula

Journal Articles

BACKGROUND: Chiari malformation type 1 (CM1) is a common congenital anomaly of the craniocervical junction. CM1 is reported to run a usually benign course and patients typically experience no symptoms or chronic, slowly progressive symptoms. However, recent reports indicate that a subset of patients with CM1 may present with acute deterioration and sudden unexpected death (SUD). We report a case of SUD during sleep in a young man with CM1, which we believe was related to the administration of common and therapeutic doses of narcotic analgesics for the management of pain. We will clarify the pathophysiology of acute deterioration and …

Teens Texting, Archana Srinivas, Megan White, Hatim A. Omar

Pediatrics Faculty Publications

In this chapter we summarize the current literature on texting use amongst adolescents. A brief overview will be presented on the prevalence of texting among teenagers, the use of texting for sexting and cyberbullying as well as the dangers of texting while driving. This chapter will serve as a brief overview of these topics in order to bring to light the emerging challenges that texting presents to the mental and physical well-being of adolescents in an effort to evoke further discussion regarding the need for increasing awareness and education to parents, educators, law makers and health care providers concerning these …

Self-Care Of Heart Failure In A House Call Program, Becky Bryant

Doctor of Nursing Practice Program Projects

The incidence and prevalence of persons living with heart failure (HF) is growing in the United States. Heart failure is the most common admission in hospitals among Medicare recipients aged 65 years or older. Self-care of heart failure (SCHF) has been reported to decrease HF hospital admission rates. Elderly patients who are homebound do not have access to typical HF education and follow-up care. The purpose of this evidence-based practice (EBP) project was to implement a SCHF program intervention by nurse practitioners (NPs) with homebound elderly HF patients receiving home visits in a house call program. There were 18 sample …

The Subjective Experience Of Youths At Clinically High Risk Of Psychosis: A Qualitative Study, S. Ben-David, M. L. Birnbaum, M. E. Eilenberg, J. E. Devylder, K. E. Gill, J. Schienle, N. Azimov, E. P. Lukens, L. Davidson, C. M. Corcoran

Journal Articles

Objective: Understanding the experience of individuals across stages of schizophrenia is important for development of services to promote recovery. As yet, little is known about the experience of individuals who exhibit prodromal symptoms of schizophrenia. Methods: Audiotaped interviews were conducted with 27 participants of diverse racial-ethnic backgrounds who were at clinically high risk of psychosis (15 males and 12 females; mean age 21). Phenomenological qualitative research techniques of coding, consensus, and comparison were used. Results: Emergent themes differed by gender. Themes for males were feeling abnormal or "broken," focus on going " crazy," fantasy and escapism, and alienation and despair, …

Can Clinical Decision Support Improve Medication Safety In The Ambulatory Setting?, B. Keber

Journal Articles

No abstract provided.

Considerations And Challenges In Defining Optimal Iron Utilization In Hemodialysis, D. M. Charytan, A. B. Pai, C. T. Chan, D. W. Coyne, A. M. Hung, C. P. Kovesdy, S. Fishbane

Journal Articles

Trials raising concerns about erythropoiesis-stimulating agents, revisions to their labeling, and changes to practice guidelines and dialysis payment systems have provided strong stimuli to decrease erythropoiesis-stimulating agent use and increase intravenous iron administration in recent years. These factors have been associated with a rise in iron utilization, particularly among hemodialysis patients, and an unprecedented increase in serum ferritin concentrations. The mean serum ferritin concentration among United States dialysis patients in 2013 exceeded 800 ng/ml, with 18% of patients exceeding 1200 ng/ml. Although these changes are broad based, the wisdom of these practices is uncertain. Herein, we examine influences on and …

Genome-Wide Methylation Analyses In Glioblastoma Multiforme, R. K. Lai, Y. W. Chen, X. W. Guan, D. Nousome, C. Sharma, P. Canoll, J. Bruce, A. Lee, P. Gregersen, J. Barnholtz-Sloan, +8 Additional Authors

Journal Articles

Few studies had investigated genome-wide methylation in glioblastoma multiforme (GBM). Our goals were to study differential methylation across the genome in gene promoters using an array-based method, as well as repetitive elements using surrogate global methylation markers. The discovery sample set for this study consisted of 54 GBM from Columbia University and Case Western Reserve University, and 24 brain controls from the New York Brain Bank. We assembled a validation dataset using methylation data of 162 TCGA GBM and 140 brain controls from dbGAP. HumanMethylation27 Analysis Bead-Chips (Illumina) were used to interrogate 26,486 informative CpG sites in both the discovery …

The Sorl1 Gene And Convergent Neural Risk For Alzheimer's Disease Across The Human Lifespan, D. Felsky, P. Szeszko, L. Yu, W. G. Honer, P. L. De Jager, J. A. Schneider, A. K. Malhotra, T. Lencz, T. Ikuta, A. N. Voineskos, +7 Additional Authors

Journal Articles

Prior to intervention trials in individuals genetically at-risk for late-onset Alzheimer's disease, critical first steps are identifying where (neuroanatomic effects), when (timepoint in the lifespan) and how (gene expression and neuropathology) Alzheimer's risk genes impact the brain. We hypothesized that variants in the sortilin-like receptor (SORL1) gene would affect multiple Alzheimer's phenotypes before the clinical onset of symptoms. Four independent samples were analyzed to determine effects of SORL1 genetic risk variants across the lifespan at multiple phenotypic levels: (1) microstructural integrity of white matter using diffusion tensor imaging in two healthy control samples (n = 118, age 18-86; n = …

Calyceal Diverticula: A Comprehensive Review, N. Waingankar, S. Hayek, A. D. Smith, Z. Okeke

Journal Articles

Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. Diagnosis is best made by intravenous urography or computed tomography urogram. Shock wave lithotripsy (SWL) is an option for first-line therapy in patients with stone-bearing diverticula that have radiologically patent necks in mid- to upper-pole diverticula and small stone burdens. Stone-free rates are the lowest with SWL, although patients report being asymptomatic following therapy in up to 75% of cases with …

Adolescence And Human Sexuality, Donald E. Greydanus, Hatim A. Omar

Pediatrics Faculty Publications

Human sexuality is a complex phenomenon involving the interaction of biology, sex, core gender identity, and gender role behavior. Successful completion of normal stages of sexuality development is important for children and adolescents to allow for optimal life as an adult. Controversies arise for clinicians as they work with their pediatric patients regarding health care sexuality issues. It is important that clinicians help these patients in an unbiased and neutral manner. As adults, these children and adolescents will function in a number of sexuality roles, whether heterosexual, homosexual, or bisexual. This chapter reviews many of these complex and critical issues …

Can Follow Up Phone Calls Decrease Complications Of Chemotherapy Toxicities In Adults?, Maire M. Blankenship

Doctor of Nursing Practice Technical Reports

Approximately 22% of all cancer patients in the United States receive chemotherapy. Older adults account for 60 % of new cancer diagnoses in the United States. The aging process is associated with comorbidities that potentially can increase toxicities associated with chemotherapy. These include coronary artery disease, hypertension, and diabetes. Monitoring for toxicities during treatment and intervening when needed allows patients to move forward in their treatment plan. Interruptions in the treatment plan have the potential to adversely affect treatment goals. The purpose of this study is to determine if patients receiving phone calls on predetermined days had fewer days of …

Emerging Biomarkers And Metabolomics For Assessing Toxic Nephropathy And Acute Kidney Injury (Aki) In Neonatology, M. Mussap, A. Noto, V. Fanos, John N. Van Den Anker

Pediatrics Faculty Publications

Identification of novel drug-induced toxic nephropathy and acute kidney injury (AKI) biomarkers has been designated as a top priority by the American Society of Nephrology. Increasing knowledge in the science of biology and medicine is leading to the discovery of still more new biomarkers and of their roles in molecular pathways triggered by physiological and pathological conditions. Concomitantly, the development of the so-called “omics” allows the progressive clinical utilization of a multitude of information, from those related to the human genome (genomics) and proteome (proteomics), including the emerging epigenomics, to those related to metabolites (metabolomics). In preterm newborns, one of …

Autosomal Recessive Polycystic Kidney Disease: The Prototype Of The Hepato-Renal Fibrocystic Diseases, Lisa Guay-Woodford

Pediatrics Faculty Publications

Autosomal recessive polycystic kidney disease (ARPKD) is a severe, typically early onset form of renal cystic disease. The care of ARPKD patients has traditionally been the purview of pediatric nephrologists for management of systemic hypertension and progressive renal insufficiency. However, the disease has multisystem manifestations and a comprehensive care strategy frequently requires a multidisciplinary team. In severely affected infants, the diagnosis often is first suspected by obstetricians when enlarged, echogenic kidneys and oligohydramnios are detected on prenatal ultrasounds. Neonatologists are central to the care of these infants, who may have respiratory compromise due to pulmonary hypoplasia and massively enlarged kidneys. …

The Association Of Plasma Biomarkers With Computed Tomography-Assessed Emphysema Phenotypes, Brendan J. Carolan, Grant Hughes, Jarrett Morrow, Craig P. Hersh, Wanda K. O'Neal, Stephen I. Rennard, Sreekumar G. Pillai, Paula Belloni, Debra A. Cockayne, Alejandro P. Comellas, Meilan Han, Rachel L. Zemans, Katerina Kechris, Russell P. Bowler

Journal Articles: Pulmonary & Critical Care Med

RATIONALE: Chronic obstructive pulmonary disease (COPD) is a phenotypically heterogeneous disease. In COPD, the presence of emphysema is associated with increased mortality and risk of lung cancer. High resolution computed tomography (HRCT) scans are useful in quantifying emphysema but are associated with radiation exposure and high incidence of false positive findings (i.e., nodules). Using a comprehensive biomarker panel, we sought to determine if there was a peripheral blood biomarker signature of emphysema.

METHODS: 114 plasma biomarkers were measured using a custom assay in 588 individuals enrolled in the COPDGene study. Quantitative emphysema measurements included percent low lung attenuation (%LAA) ≤ …

Randomized Study Of The Safety, Pharmacokinetics, And Bronchodilatory Efficacy Of A Proprietary Glycopyrronium Metered-Dose Inhaler In Study Patients With Chronic Obstructive Pulmonary Disease, Stephen I. Rennard, Charles Fogarty, Colin Reisner, Carlos Fernandez, Tracy Fischer, Michael Golden, Earl St Rose, Patrick Darken, Gregory Tardie, Chadwick Orevillo

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Bronchodilator medications are central to the symptomatic management of chronic obstructive pulmonary disease (COPD). Metered-dose inhalers (MDIs) are the most commonly used devices to deliver treatment to patients with COPD and asthma, comprising approximately 70% of bronchodilator prescriptions. Proprietary porous-particle technology permits the formulation of long-acting muscarinic antagonists, long-acting β2-agonists, and a combination of both in hydrofluoroalkane (HFA) MDIs, providing a solution to formulation challenges inherent to the development of HFA MDIs, which have contributed to the development of dry-powder inhalers.

METHODS: In this randomized, double-blind, 4-period, 6-treatment, placebo- and active-controlled, multicenter, crossover study, 4 ascending single doses of …

Simulating Real Life Enhances Palliative Care For Patients In The Micu, Jennifer O'Neil Bsn, Rn, Leigh Jimmie Bsn, Rn

Posters

The objective of this project was to determine whether or not a palliative care education program would increase RN knowledge and comfort in caring for palliative care appropriate patients in the Medical Intensive Care Unit.

Building Research Capacity In Africa: Equity And Global Health Collaborations, Kathryn M. Chu, Sudha Jayaraman, Patrick Kyamanywa, Georges Ntakiyiruta

Surgery Publications

Summary Points

• Global health has increased the number of high-income country (HIC) investigators conducting research in low- and middle-income countries (LMICs).
• Partnerships with local collaborators rather than extractive research are needed.
• LMICs have to take an active role in leading or directing these research collaborations in order to maximize the benefits and minimize the harm of inherently inequitable relationships.
• This essay explores lessons from effective and equitable relationships that exist between African countries and HICs.

Metabolic Effects Of Acute Thiamine Depletion Are Reversed By Rapamycin In Breast And Leukemia Cells, Shuqian Liu, Sumitra Miriyala, Mignon A. Keaton, Craig T. Jordan, Christina Wiedl, Daret K. St. Clair, Jeffrey A. Moscow

Pediatrics Publications

Thiamine-dependent enzymes (TDEs) control metabolic pathways that are frequently altered in cancer and therefore present cancer-relevant targets. We have previously shown that the recombinant enzyme thiaminase cleaves and depletes intracellular thiamine, has growth inhibitory activity against leukemia and breast cancer cell lines, and that its growth inhibitory effects were reversed in leukemia cell lines by rapamycin. Now, we first show further evidence of thiaminase therapeutic potential by demonstrating its activity against breast and leukemia xenografts, and against a primary leukemia xenograft. We therefore further explored the metabolic effects of thiaminase in combination with rapamycin in leukemia and breast cell lines. …

Cinacalcet Administration By Gastrostomy Tube In A Child Receiving Peritoneal Dialysis, Kristen R. Nichols, Chad A. Knoderer, Bethanne Johnston, Amy C. Wilson

Scholarship and Professional Work – COPHS

A 2-year-old male with chronic kidney disease with secondary hyperparathyroidism developed hypercalcemia while receiving calcitriol, without achieving a serum parathyroid hormone concentration within the goal range. Cinacalcet 15 mg (1.2 mg/kg), crushed and administered via gastrostomy tube, was added to the patient’s therapy. This therapy was effective in achieving targeted laboratory parameters in our patient despite instructions in the prescribing information that cinacalcet should always be taken whole.

Graduate Medical Education 2013-2014 Annual Report, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

Influence Of Diet And Obesity On Copd Development And Outcomes, Corrine K. Hanson, Erica P. Rutten, Emiel F.M. Wouters, Stephen I. Rennard

Journal Articles: Pulmonary & Critical Care Med

The global increase in the prevalence and incidence of obesity has called serious attention to this issue as a major public health concern. Obesity is associated with many chronic diseases, including cardiovascular disease and diabetes, and recently the role of overweight and obesity in lung disease has received new interest. Independently of obesity, diet also plays a role as a risk factor for many chronic diseases, and evidence is accumulating to support a role for diet in the prevention and management of several lung diseases. Chronic obstructive lung disease is the third-leading cause of death globally, and both obesity and …