Digital Commons Network^™

Suicide In Prepubertal Children, Kimberly K. Mcclanahan, Hatim A. Omar

Pediatrics Faculty Publications

No abstract provided.

Pregnancy In Adolescence, Donald E. Greydanus, Marlene B. Huff, Hatim A. Omar, Colleen B. Dodich

Pediatrics Faculty Publications

Over 14 million adolescents in the world annually give birth and nearly 800.000 adolescents in the United States become pregnant each year. This paper considers concepts of teen pregnancy including risks to the mother as well as offspring, the adolescent father, issues related to abortion, and concepts of prevention of unwanted pregnancy in youth. Adolescent pregnancy is a global phenomenon affecting all societies and cultures.

Physician Review Of Workers' Compensation Case Files: Can It Affect Decision Outcomes?, Mark E. Hammett, Christopher Jankosky, John Muller, Elizabeth Hughes, Francesca Litow

Community & Environmental Health Faculty Publications

Objective: To identify common attributes of Federal workers compensation cases referred to Navy physicians for medical opinions and to determine the impact of the review on the final case decision. Methods: Retrospective case study and descriptive analysis of 258 opinion letters written by physicians on referred cases from 2006 to 2010. Results: Navy physician opinions were considered in the outcome in some of the cases, and there was a statistically significant difference between the claim acceptance rate in the study population and the total population. Worker age was correlated with certain claim types. Conclusions: There is preliminary evidence that the …

Contrasting Effects Of Errorless Naming Treatment And Gestural Facilitation For Word Retrieval In Aphasia, Anastasia M. Raymer, Beth Mchose, Kimberly G. Smith, Lisa Iman, Alexis Ambrose, Colleen Casselton

Communication Disorders & Special Education Faculty Publications

Purpose- We compared the effects of two treatments for aphasic word retrieval impairments, errorless naming treatment (ENT) and gestural facilitation of naming (GES), within the same individuals, anticipating that the use of gesture would enhance the effect of treatment over errorless treatment alone. In addition to picture naming, we evaluated results for other outcome measures that were largely untested in earlier ENT studies.

Methods- In a single participant crossover treatment design, we examined the effects of ENT and GES in eight individuals with stroke-induced aphasia and word retrieval impairments (three semantic anomia, five phonological anomia) in counterbalanced phases across participants. …

Influence Of Oncotype Dx® On Chemotherapy Prescribing In Early Stage Breast Cancer Patients: A Claims-Based Evaluation Of Utilization In The Real World, Kenneth Neil Kennedy

Theses and Dissertations--Pharmacy

The decision for adjuvant therapy in women with early stage breast cancer (ESBC) has historically been guided by the presence or absence of specific biological markers (hormone and HER2 receptors), age, and extent of nodal involvement. Oncotype DX® is a validated assay that quantifies protein expression that can predict the risk of cancer recurrence. This study evaluates if the use of Oncotype DX® impacts chemotherapy prescribing in ESBC. This retrospective, cohort study identified patients with ESBC from a large commercially insured population from January 2007 through June 2009. Patients were identified as having ESBC by utilizing procedure and diagnosis codes …

Advancing Our Understanding Of The Inheritance And Transmission Of Pectus Excavatum, Lisa Horth, Michael W. Stacey, Virginia K. Proud, Kara Segna, Chelsea Rutherford, Donald Nuss, Robert E. Kelly

Bioelectrics Publications

Pectus excavatum is the most common congenital chest wall abnormality expressed in children, yet its inheritance is poorly understood. Here we present the first comprehensive assessment of the inheritance of this disorder. After evaluating 48 pedigrees and 56 clinical traits of probands and family members, we find strong evidence of autosomal recessive, genetic control for this disorder. Additionally there is likely more than one pectus disease-associated allele, as well as a relatively large number of disease allele carriers in the human population. Some clinical traits appear important and may serve as reliable indicators for predicting the likelihood of pectus excavatum …

Rapid Resident Skills Evaluation Using The Integrated Osce, Mark Brummel, Reid B. Blackwelder, J. Moore, Glenda Stockwell, Beth Anne Fox

ETSU Faculty Works

No abstract provided.

Orphan Nuclear Receptor Nur77 Regulates Androgen Receptor Gene Expression In Mouse Ovary., Anyi Dai, Guijun Yan, Qinyuan He, Yue Jiang, Qun Zhang, Ting Fang, Lijun Ding, Jianxin Sun, Haixiang Sun, Yali Hu

Center for Translational Medicine Faculty Papers

The androgen receptor (AR) is a nuclear receptor that is expressed in growing follicles and involved in folliculogenesis and follicle growth. The orphan nuclear receptor, Nur77, also has an important role in steroid signaling and follicle maturation. We hypothesized that AR levels and androgen signaling through AR are regulated by Nur77 in the ovary. In the ovaries of Nur77 knockout mice (n = 5), real-time PCR results showed that the mRNA levels of AR and an androgen signaling target gene, Kitl, were decreased by 35% and 24%, respectively, relative to wild-type mice (n = 5), which suggested transcriptional regulation of …

Mild Cognitive Impairment: Statistical Models Of Transition Using Longitudinal Clinical Data, Erin L. Abner, Richard J. Kryscio, Gregory E. Cooper, David W. Fardo, Gregory A. Jicha, Marta S. Mendiondo, Peter T. Nelson, Charles D. Smith, Linda J. Van Eldik, Lijie Wan, Frederick A. Schmitt

Sanders-Brown Center on Aging Faculty Publications

Mild cognitive impairment (MCI) refers to the clinical state between normal cognition and probable Alzheimer's disease (AD), but persons diagnosed with MCI may progress to non-AD forms of dementia, remain MCI until death, or recover to normal cognition. Risk factors for these various clinical changes, which we term "transitions," may provide targets for therapeutic interventions. Therefore, it is useful to develop new approaches to assess risk factors for these transitions. Markov models have been used to investigate the transient nature of MCI represented by amnestic single-domain and mixed MCI states, where mixed MCI comprised all other MCI subtypes based on …

Biochemical Links Between Hormonal Mediators Of Psychological Stress And The Expression Of Muc1 In Prostate Cancer Cells, Kristina Andrijauskaite

MUSC Theses and Dissertations

A growing body of scientific evidence has demonstrated that chronic psychological stress can not only increase the growth and metastasis of tumors through a number of mechanisms, such as by an increase of VEGF and Bcl-2, but also can decrease the survival of cancer patients. However, no studies have reported the effect of psychological stress with respect to the tumor marker MUC1. Therefore, building upon previous research, the purpose of the present study was to investigate the effect of the stress hormones cortisol and norepinephrine on the tumor marker MUC1, which is highly associated with tumor cell metastasis and is …

Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan

Reproductive Health

Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as …

Attitudes, Croyances Et Pratiques Des Leaders D'Opinion Clés (Loc) Et Des Prestataires Sur La Contraception D'Urgence (Cu) Au Sénégal, Babacar Mane, Saumya Ramarao, Martha Brady, Fatou Bintou Mbow, Ababacar Thiam

Reproductive Health

In Senegal, initiatives for mainstreaming the emergency contraceptive pill (ECP) in the family planning program are fairly recent. Service statistics indicate, however, that ECP distribution through the public sector is very low. While most users access ECPs through the private sector, the volume of sales is not clear, due to the absence of an operational information system of EC distribution through pharmacies. In an effort to strengthen EC provision in Senegal and reposition EC within the FP program, the Population Council conducted a study in collaboration with the Reproductive Health Division of the Ministry of Health, Senegal to document the …

Critical Issues For Integrating Srh And Hiv/Aids Services To Provide Dual Protection Against Unintended Pregnancy And Hiv/Sti Acquisition, Population Council

Reproductive Health

This document reports on a one-day symposium that was held by the STEP UP (Strengthening Evidence for Programming on Unintended Pregnancy) Research Program Consortium, coordinated by the Population Council. STEP UP generates policy-relevant research to promote an evidence-based approach for improving access to family planning and safe abortion in Bangladesh, Ghana, India, Kenya, and Senegal. The symposium’s objectives were to review and discuss critical and emerging issues around integrating SRH and HIV and AIDS services to enable dual protection, including new directions in dual protection technology and behaviour change interventions. The meeting also provided an opportunity to discuss the programmatic …

Replication Of The Community Mobilization For Postabortion Care (Commpac) Model In Naivasha District, Rift Valley Province, Kenya: An Evaluation Report, Chi-Chi Undie, Francis Obare, Saumya Ramarao

Reproductive Health

The Population Council’s RESPOND project worked with districts and communities in Kenya to: strengthen service delivery points to provide postabortion care (PAC) services; conduct community mobilization to improve involvement in and knowledge of the prevention and treatment of postabortion complications; build community capacity to address needs related to PAC; and encourage involvement in community action of those most marginalized and most affected by postabortion complications. The program succeeded at increasing knowledge of critical danger signs; enabling providers to effectively offer PAC services; and raising awareness of PAC, among other goals. The intervention was less successful in increasing FP knowledge, current …

Birth Spacing And Family Planning Uptake In Pakistan: Evidence From Falah, Arshad Mahmood

Reproductive Health

The Population Council was the lead implementing agency for the Family Advancement for Life and Health (FALAH) project in Pakistan. The project’s main objectives were to achieve a 10 percent increase in the use of moden contraceptives, to equip 80 service delivery points to provide family planning services, and to ensure birth-spacing understanding and ways to achieve it by three-quarters of the target population. The main conclusion of this research is that a sharp uptake of family planning is possible in a relatively short time, if certain investments are made to ensure better communication and greater access to quality family …

Country Mapping: Nigeria, Salisu Mohammed Ishaku, Saumya Ramarao

Reproductive Health

The Population Council conducted a three-year acceptability study of the progesterone vaginal ring (PVR) in three sub-Saharan African countries. This technical report presents results from Nigeria, laying out the country’s demographics and high fertility rates; describing the family planning program and policy context; and, finally, revealing the stakeholder support thus far with a discussion on how best to proceed with introduction activities. This country mapping confirms the likelihood that the PVR would be well received in Nigeria and fill a large need in family planning. The PVR is a safe, long-acting, user-controlled product that can be easily inserted and removed …

Country Mapping: Senegal, Babacar Mane, Nafissatou Diop, Nancy Termini Lachance, Saumya Ramarao, Heather Clark

Reproductive Health

The Population Council embarked on a three-year project to explore the acceptability of the progesterone vaginal ring (PVR) among women in sub-Saharan Africa and its potential introduction. This technical report presents results from assessments undertaken to map the existing landscape of family planning programs and new contraceptive technologies in Senegal in an effort to identify national priorities and assess the level of interest in the PVR among stakeholders and to design appropriate preintroductory activities. This country mapping exercise confirms that Senegal is a promising context for the introduction of the PVR: the government is committed to repositioning family planning and …

Contraceptive Use Dynamics In Pakistan 2008-09, Arshad Mahmood, Syeda Saman Naz

Reproductive Health

This report looks at contraceptive use dynamics in Pakistan, focusing on contraceptive discontinuation, method failure, and contraceptive switching, as well as the reasons for discontinuation. The study found that almost one-third of discontinuations were due to side effects followed by one-fifth of them by the method failure. Side effects were the most common reason for discontinuing modern methods (IUDs and hormonal methods), while failure was the most common reasons for discontinuing barrier and traditional methods (condom, rhythm, withdrawal). Based on the findings of this study, this report suggests that better training of health providers and better information and counseling of …

Attitudes, Beliefs, And Practices Of Key Opinion Leaders (Kol) And Providers About Emergency Contraception (Ec) In Senegal, Babacar Mane, Saumya Ramarao, Martha Brady, Fatou Bintou Mbow, Ababacar Thiam

Reproductive Health

In 2010, the Reproductive Health Division in Senegal, with support from Population Council, performed an assessment of the emergency contraception (EC) integration process into the national health system through a national forum on EC. This forum revealed that there was a real promotional problem regarding EC in the national health system despite the efforts made. There was widespread lack of public awareness of the product, rumors concerning EC due to the sensitive nature of the product, low inclusion of EC in routine service delivery, especially during initial counseling in family planning awareness campaigns , and a better method of keeping …

Situation Analysis Of Health Facilities With Special Reference To Family Planning Services In Pakistan, Arshad Mahmood, Muhammad Jamil Arshad, Maqsood Sadiq

Reproductive Health

The FALAH project, launched in 2007, funded by USAID and implemented by a consortium of partners led by The Population Council, sought to shift family planning (FP) perception. This report details the findings of an assessment of FALAH’s FP and birth spacing impact. The study assessed public health facility readiness for offering FP and birth spacing services by interviewing in-charges and providers, as well as assessing the types of services provided and service providers’ characteristics. The study also examined the facilities’ quality of care through observing client and provider interactions, while client satisfaction was assessed in exit interviews. FALAH’s objective …

Theoretically-Driven Infrastructure For Supporting Health Care Teams Training At A Military Treatment Facility, T. Robert Turner Jr., V. Andrea Parodi

VMASC Publications

Designated a Department of Defense Team Resource Center (TRC) in 2008, Naval Medical Center Portsmouth (NMCP) currently hosts three tri-service health care teams training courses annually. Each consists of didactic learning coupled with simulation-based training exercises to provide an interactive educational experience for health care professionals. Simulated cases are developed to reinforce specific teamwork skills and behaviors, and to incorporate a variety of technologies including standardized patients, manikins, and virtual reality. The course is also the foundation of a research program designed to explore applications of modeling and simulation for enhanced team training in health care. The TRC has adopted …

Autoethnography: Incorporating Reflective Research Into Medical Education, Casey Bonaquist Do, Breanna Henry Do, Erin Mccall Do, Elissa Foster Phd, Kristin Reihman Md

Department of Family Medicine

No abstract provided.

Retrospective Analysis Of Metabolic Syndrome: Prevalence And Distribution In Executive Population In Urban Pakistan., Niloufer Sultan Ali, Ali Khan Khuwaja, Adnan Ur Rahman, Kashmira Nanji

Department of Family Medicine

Background. Metabolic Syndrome (MetS) is a major public health concern.

Objective. The aim of this study was to estimate the frequency of MetS, its components, and factors associated with MetS amongst apparently healthy individuals in Pakistan.

Methods. A retrospective cross-sectional study was conducted at the executive Clinics of Aga Khan Hospital, Pakistan. Medical records of patients aged ≥18 years visiting the clinics from July 2011 to December 2011 were consecutively reviewed. Records in which either MetS components data or 10% of overall data was missing were excluded. A total of 1329 participants’ records was included in final analysis. Data was …

Sepa-Reads: Cardiovascular Health Literacy Coalition, Rickie Brawer, Mph, Phd, James D. Plumb Md, Mph, Rob Simmons Drph,Mph,Ches, Martha Romney Rn,Ms,Jd,Mph, Patricia Yurchick, Rn, Mba, Cphq, Leslie Stearns

Department of Family & Community Medicine Faculty Papers

Poster includes:

Health literacy definition

Factors that contribute to health literacy

Extent of the literacy problem

What do we know from a decade of research?

Readmission rates

Evaluation: long and short term outcomes

And much more.

Substance P And The Host Immune Response, Megan Elizabeth Foldenauer

Wayne State University Dissertations

This body of work examined the mechanism by which SP regulates host immunity, specifically, its control of growth factors and TLR expression in the P. aeruginosa-infected cornea. The role of mTOR and VIP in corneal infection and inflammation also was tested.

SP has a dual role in bacterial infection, unexpectedly upregulating growth factor production. This was accompanied by macrophage-specific upregulation of pro-inflammatory cytokines, downregulation of anti-inflammatory cytokines, and upregulation of anti-apoptotic genes, as well as a decrease in arginase-producing macrophages (M2 cells), important in stromal healing in these mice. All of these lead to worsened disease, despite the stimulatory effects …

Effect Of 4 Years Of Growth Hormone Therapy In Children With Noonan Syndrome In The American Norditropin Studies: Web-Enabled Research (Answer) Program® Registry., Peter A Lee, Judith Ross, John A Germak, Robert Gut

Department of Pediatrics Faculty Papers

BACKGROUND: Noonan syndrome (NS) is a genetic disorder characterized by phenotypic features, including facial dysmorphology, cardiovascular anomalies, and short stature. Growth hormone (GH) has been approved by the United States Food and Drug Administration for short stature in children with NS. The objective of this analysis was to assess the height standard deviation score (HSDS) and change in HSDS (ΔHSDS) for up to 4 years (Y4) of GH therapy in children with NS.

METHODS: The American Norditropin Studies: Web-Enabled Research (ANSWER) Program®, a US-based registry, collects long-term efficacy and safety information on patients treated with Norditropin® (somatropin rDNA origin, Novo …

The Special Care Nursery, Linda Kahn-D’Angelo, Yvette Blanchard, Beth Mcmanus

Physical Therapy Faculty Publications

Providing services to high-risk infants and their families in the neonatal intensive care unit is a complex subspecialty of pediatric physical therapy requiring knowledge and skills beyond the competencies for entry into practice. The newborns in the neonatal intensive care unit (NICU) are among the most fragile patients that physical therapists will treat, and detrimental effects can occur as the result of routine caregiving procedures. Pediatric physical therapists (PTs) need advanced education in areas such as early fetal and infant development; infant neurobehavior; family responses to having a sick newborn; the environment of the NICU, physiologic assessment and monitoring; newborn …

Contegra Valved Conduit In The Paediatric Population: An Exciting Prospect For Right Ventricle To Pulmonary Artery Reconstruction; Experience And Outcomes At Aga Khan University, Maria Tariq Siddiqui, Asif Hasan, Shazia Mohsin, Mohammad Hamid, Muneer Amanullah

Department of Anaesthesia

Objective: The focus of this study is to share the experience and outcomes of Contegra graft implantation in the paediatric and adult population in Pakistan. Methods: Between May 2007 and July 2011, 16 patients, underwent implantation of a Contegra valved conduit. All operations were performed through a median sternotomy with cardiopulmonary bypass. Indications included: Pulmonary atresia with ventricular septal defect (n=11), Tetralogy of Fallot with absent Pulmonary Valve (PV) syndrome (n=2), double outlet right ventricle, transposition of great arteries and pulmonary stenosis (n=1), isolated aortic valve disease (n=1) and a pseudo-aneurysm with infective endocarditis (n=1).Conduit sizes varied between 16-22 mm. …

Primary Closure Without Diversion In Management Of Operative Blunt Duodenal Trauma In Children, Katherine Smiley, Tiffany Wright, Sean Skinner, Joseph A. Iocono, John M. Draus

Surgery Faculty Publications

Background. Operative blunt duodenal trauma is rare in pediatric patients. Management is controversial with some recommending pyloric exclusion for complex cases. We hypothesized that primary closure without diversion may be safe even in complex (Grade II-III) injuries. Methods. A retrospective review of the American College of Surgeons' Trauma Center database for the years 2003-2011 was performed to identify operative blunt duodenal trauma at our Level 1 Pediatric Trauma Center. Inclusion criteria included ages < 14 years and duodenal injury requiring operative intervention. Duodenal hematomas not requiring intervention and other small bowel injuries were excluded. Results. A total of 3,283 hospital records were reviewed. Forty patients with operative hollow viscous injuries and seven with operative duodenal injuries were identified. …

Raising The Bar In Publishing: The Future Of Jogeca, Alfred Murage

Obstetrics and Gynaecology, East Africa

Excitement is in the air in Kenya, what with the looming elections and constitutional changes? JOGECA has not been left behind in these exciting times, we have a booming issue that readers will enjoy reading. And there are exciting developments in the pipeline to propel our journal into new heights.