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Masters Of Public Health 2009, Nova Southeastern University

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.

Factors Influencing Early Detection Of Breast Cancer In African American Women, Tamrah Joy Parker

Nursing Theses and Capstone Projects

Background. African American women are more likely to have breast cancer diagnosed at a later stage than Caucasian women and with a five year death rate 1.5 times greater than Caucasian women. Mammography screening detects breast cancer in its early stages and can reduce mortality.

Objective. To examine factors influencing early detection of breast cancer for African American women.

Methods. A convenience sample of 39 African American women 50 years of age and older was selected from two local Baptist churches in eastern North Carolina. Eligibility criteria included ability to read and write in English with no prior or present …

Administrators’ Perceptions Of Medication Management In Assisted Living Facilities: Results From Focus Groups, Priscilla T. Ryder, Melanie Joseph, Marnie Zuckermann, Ilene H. Zuckermann

Scholarship and Professional Work – COPHS

Objective: Assisted living (AL) residents are vulnerable to adverse events as a result of using numerous medications and frequently need assistance in administering medications. Very little is known, however, about the ways in which medications are managed within this level of care. Design: AL administrators from the metropolitan Baltimore, Maryland area were invited to participate in focus groups to explore issues involved in medication management.

Setting and Participants: Four administrators from smaller (15 beds or fewer) and six larger (more than 15 beds) certified AL facilities serving primarily older residents participated. Administrators must have served in their position at least …

Research Annual Report 2008, Children's Mercy Hospital

Research Annual Reports

Annual report of the research at Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Graduate Medical Education 2008 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, and fellowship programs.

Ua94/6/1 Student / Alumni Personal Papers Western Kentucky University Small Collections, Wku Archives

WKU Archives Collection Inventories

Small collections of personal papers and oral histories relating to the Western Kentucky University.

Children's Mercy Hospital Annual Report 2008, Children's Mercy Hospital

Children's Mercy Annual Reports

Annual report for The Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Dilemma In The Diagnosis Of Mediastinal Adenopathy In The South Asian Population-Role Of Ct Guided Biopsy, Mediastinoscopy And Video-Assisted Thoracoscopy (Vats), Marium Muzaffar, Hashim M Hanif, Saulat H. Fatimi

Section of Cardiothoracic Surgery

The diagnosis of mediastinal adenopathy is a dilemma amongst treating physicians especially in South Asia. This is because although tuberculosis is endemic in this region, many a times lymphoma and sarcoidosis cannot be excluded. Often patients are being treated with medications without a confirmed diagnosis. The Video-assisted thoracoscopy (VATS) has revolutionized the way mediastinal adenopathy is diagnosed and managed in this part of the world.

Molecular Confirmation Of The Causes Of Inherited Visual Impairment In Northern Pakistan, Mehreen Adhi, Yasmin Rashid, Syed Hussain Jafri, Chris F. Inglehearn, Martin Mckibbin

Section of Ophthalmology

Families with inherited visual impairment were identified and examined from January 2000 to December 2005 and given a clinical diagnosis. Known genes and loci were screened for mutations or linkage at Institute of Ophthalmology and Neurosciences, University of Leeds, in order to provide molecular confirmation. Inherited retinal disease was the most common cause of inherited visual impairment in 38 of 57 families (66.6%) with Leber's congenital amaurosis, rod-cone dystrophy and cone-rod dystrophy being the most common diagnoses in 22, 8 and 3 families respectively. Anterior segment dysgenesis was diagnosed in 8 families (14%). Mutations in known genes or linkage to …

Breast Cancer Screening In Women Exposed In Utero To Diethylstilbestrol, Elizabeth A. Camp, Ann L. Coker, Stanley J. Robboy, Kenneth L. Noller, Karen J. Goodman, Linda T. Titus-Ernstoff, Elizabeth E. Hatch, Arthur L. Herbst, Rebecca Troisi, Raymond H. Kaufman, Ervin Adam

CRVAW Faculty Journal Articles

Purpose: To determine if women exposed in utero to diethylstilbestrol (DES) are more likely than unexposed women to receive recommended or additional breast cancer screening examinations.

Methods: 1994 Diethylstilbestrol-Adenosis (DESAD) cohort data are used to assess the degree of recommended compliance of breast cancer screenings found in 3140 DES-exposed and 826 unexposed women. Participants were enrolled at four sites: Houston, Boston, Rochester, and Los Angeles. Logistic regression modeling was used to analyze mailed questionnaire data that included reported frequency over the preceding 5 years (1990–1994) of breast-self examinations (BSEs), clinical breast examinations (CBEs), and mammograms.

Results: DES-exposed women exceeded annual …

Ethnic Disparities In Cervical Cancer Survival Among Medicare Eligible Women In A Multiethnic Population, Ann L. Coker, Katherine S. Eggleston, Xianglin L. Du, Lois Ramondetta

CRVAW Faculty Journal Articles

To determine predictors of cervical cancer survival by socioeconomic status (SES), urbanization, race/ethnicity, comorbid conditions, and treatment among elderly Medicare-eligible women whose conditions were diagnosed with cervical cancer in a multiethnic population.

Methods: A total of 538 women with cervical cancer aged 65 years or older were identified from 1999 to 2001 from the Texas Cancer Registry and were linked with the state Medicare data and Texas Vital Records to determine survival times. All women had similar access to care through Medicare fee-for-services insurance. A composite measure of SES was created using census tract-level data as was urbanization. Treatment and …

Use Of Average Mutual Information For Studying Changes In Hiv Populations, Khalid Sayood, Federico Hoffman, Charles Wood

Nebraska Center for Virology: Faculty Publications

Average mutual information (AMI) has been used in a number of applications in bioinformatics. In this paper we present its use to study genetic changes in populations; in particular populations of HIV viruses. Disease progression of HIV-1 infection in infants can be rapid resulting in death within the the first year, or slow, allowing the infant to survive beyond the first year. We study the development of rapid and slow progressing HIV population using AMI charts based on average mutual information among amino acids in the env gene from a population of 1142 clones derived from seven infants with slow …

Effects Of Provider Education On Documentation Compliance In The O.R., Brenda Kingdon

UNF Graduate Theses and Dissertations

Knowledge of The Joint Commission's National Patient Safety Goals and an effective provider cooperative practice involving communication and teamwork are essential for the delivery of safe and compliant patient care in the surgical setting. The purpose of this study was to assess the impact of an educational intervention for physicians and nurses designed to increase documentation of compliance with national patient safety standards. As events of noncompliance have impacted patient safety at the hospital where this project was conducted, measures were needed to assess barriers to compliance with standards of practice and to focus educational session plans on identified knowledge-base …

Test-Retest Reliability And Minimal Detectable Change Scores For The Timed "Up & Go" Test, The Six-Minute Walk Test, And Gait Speed In People With Alzheimer Disease, Julie D. Ries, John L. Echternach, Leah Nof, Michelle Gagnon Blodgett

Rehabilitation Sciences Faculty Publications

Background. With the increasing incidence of Alzheimer disease (AD), determining the validity and reliability Of Outcome measures for people with this disease is necessary.

Objective. The goals of this study were to assess test-retest reliability of data for the Timed "Up & Go" Test (TUG), the Six-Minute Walk Test (6MWT), and gait speed and to calculate minimal detectable change (MDC) scores for each outcome measure. Performance differences between groups With mild to moderate AD and moderately severe to severe AD (as determined by the Functional Assessment Staging [FAST] scale) were Studied.

Design. This was a prospective, nonexperimental, descriptive methodological study. …

Factors Influencing Adherence To Referral Advice Following Pre-Referral Treatment With Artesunate Suppositories In Children In Rural Tanzania, Daudi Simba, Marian Warsame, Omari Kimbute, Deodatus Kakoko, Max Petzold, Goran Tomson, Zul Premji, Melba Gomes

Pathology, East Africa

Objective: WHO recommends artemisinin suppository formulations as pre-referral treatment for children who are unable to take oral medication and cannot rapidly reach a facility for parenteral treatment. We investigated factors influencing caretakers’ adherence to referral advice following pre-referral treatment of their children with rectal artesunate suppositories.

Methods: The study was nested within an intervention study that involved pre-referral treatment of all children who came to a community dispenser for treatment because they were unable to take oral medications because of repeated vomiting, lethargy, convulsions or altered consciousness. All patients who did not comply with referral advice were stratified by actions …

Utility Of Free To Total Psa Ratio In The Prediction Of Prostate Cancer In Patients With Intermediate Total Psa Levels And Negative Digital Rectal Examination, Muthoni .J .F. Kirimi

Master of Medicine in Anatomic Pathology

Background: Prostate carcinoma is among the top 5 cancers occurring in Kenyan men. Prostate-specific antigen (PSA) is currently the most important biochemical marker for the diagnosis of prostate cancer and its widespread use as a serum tumor marker has revolutionized the management of patients with prostate cancer. The identification of early prostate cancer is vital in the management of especially men who have mild or vague prostatic symptoms. The most basic and important proxy for determining the need for a biopsy in both symptomatic and asymptomatic(screened) patients is the serum prostatic specific antigen (PSA).If a patients PSA level is above …

From Concierge Medicine To Patient-Centered Medical Homes: International Lessons And The Search For A Better Way To Deliver Primary Health Care In The U.S, Gwendolyn R. Majette

Law Faculty Articles and Essays

This paper will proceed in eight parts. Part II explores why primary care is a critical component of a country's health care delivery system. Part III describes patient and physician dissatisfaction with the current state of primary care delivery in the United States. Parts IV and V describe physician-designed solutions and Congress' responses to them. Part VI describes the role of primary care in the delivery of health services in the international context by focusing on the World Health Organization's Health for All policy and the policies supporting primary care in the United Kingdom, the Netherlands, and Belgium. Part VII …

Digest Of The Philadelphia College Of Osteopathic Medicine (Winter 2009), Philadelphia College Of Osteopathic Medicine

Digest

The Winter 2009 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Opening Remarks
• PCOM Updates and Kudos
• Development News
• Keeping the Balance True: The Rural Medicine Practice
• Health and Social Service Outcomes
• The Effects of Physician Supply
• Specialty-Specific Issues: Obstetrics and Gynecology
• Federally Qualified Health Centers for Direct Provision of Care
• Rural Sociology and the Draw for Today’s Medical Students
• Founders’ Day 2009
• O.J. Snyder Memorial Medal
• Mason W. Pressly Memorial Medal
• Preparing Medical Students for End of Life Care
• Class Notes
• In Memoriam
• My Turn Essay
• PCOM Events

Assessment, Surgeon, And Society, John Norcini, Jamsheer J Talati

Section of Urology

An increasing public demand to monitor and assure the quality of care provided by physicians and surgeons has been accompanied by a deepening appreciation within the profession of the demands of self-regulation and the need for accountability. To respond to these developments, the public and the profession have turned increasingly to assessment, both to establish initial competence and to ensure that it is maintained throughout a career. Fortunately, this comes at a time when there have been significant advances in the breadth and quality of the assessment tools available. This article provides an overview of the drivers of change in …

Does The Duration Of Type 2 Diabetes Correlate With Changes In Taste Deficits?, Ann T. Mclaughlan

PCOM Biomedical Studies Student Scholarship

The loss of insulin sensitivity in Type 2 diabetes interferes with cellular utilization of glucose. The underlying down-regulation of insulin receptors and the resulting insulin resistance is wide-spread throughout the body. The cardiovascular consequences may be indirectly responsible for decreased taste sensitivity because of diminished perfusion of the taste buds in this patient population. This study utilized an inexpensive, non-invasive technique, electrogustometry, to directly stimulate the taste buds by applying a variable, direct-current stimulus to measure taste receptor thresholds in newly-diagnosed ( < 2 years) and long-standing diagnosed (> 6 years) male and female Type 2 diabetes mellitus subjects. Taste thresholds were elicited by application of an …

Rationale And Design Of A Trial Of Angiotensin-Converting Enzyme Inhibition In Infants With Single Ventricle., Daphne T. Hsu, Seema Mital, Chitra Ravishankar, Renee Margossian, Jennifer S. Li, Lynn A. Sleeper, Richard V. Williams, Jami C. Levine, Brian W. Mccrindle, Andrew M. Atz, Darlene Servedio, Lynn Mahony, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Angiotensin converting enzyme (ACE) inhibitors are known to improve clinical outcome and ventricular function in adults with heart failure. Infants with single-ventricle physiology show abnormalities in ventricular function as well as poor growth. The ability of an ACE inhibitor to preserve ventricular function and improve growth in these infants is unknown.

METHODS: The Pediatric Heart Network designed a randomized, double-blind trial to compare outcomes in infants with single-ventricle physiology receiving enalapril or placebo. Neonates < or =45 days old were eligible. The primary outcome is weight-for-age Z-score at 14 months of age. Secondary outcomes include other measures of somatic growth, laboratory and functional measures of heart failure, developmental indices, measures of ventricular size and function, and the relationship of the renin-angiotensin-aldosterone system genotype to the response to enalapril. The incidence and spectrum of adverse events will also be compared between treatment groups.

RESULTS: A total of 1,245 neonates were screened and 533 (43%) were eligible. The consent rate was 43%; 230 subjects were enrolled. Parental reluctance to …

Posttraumatic Stress Disorder And Other Consequences Of A Picu Admission, Stephanie Ann Stowman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Currently, there is a paucity of literature regarding children's experiences in a pediatric intensive care unit (PICU) relative to caregivers' experiences. Children admitted to a PICU and their caregivers are at risk for various psychopathology. Disorders commonly identified in seriously ill children include depression, anxiety, acute stress disorder, and posttraumatic stress disorder. Caregivers of seriously ill children are at increased risk of depression, generalized anxiety disorder, acute stress disorder, and posttraumatic stress disorder. Researchers often fail to examine all relevant psychopathology and contributing factors and stressors, such as family environment, in seriously ill children and their caregivers. This study assessed …

Autistic Disorder Associated With A Paternally Derived Unbalanced Translocation Leading To Duplication Of Chromosome 15pter-Q13.2: A Case Report., David J Wu, Nicholas J Wang, Jennette Driscoll, Naghmeh Dorrani, Dahai Liu, Marian Sigman, N Carolyn Schanen

Department of Pediatrics Faculty Papers

Autism spectrum disorders have been associated with maternally derived duplications that involve the imprinted region on the proximal long arm of chromosome 15. Here we describe a boy with a chromosome 15 duplication arising from a 3:1 segregation error of a paternally derived translocation between chromosome 15q13.2 and chromosome 9q34.12, which led to trisomy of chromosome 15pter-q13.2 and 9q34.12-qter. Using array comparative genome hybridization, we localized the breakpoints on both chromosomes and sequence homology suggests that the translocation arose from non-allelic homologous recombination involving the low copy repeats on chromosome 15. The child manifests many characteristics of the maternally-derived duplication …

Expression Of Hpv16 E5 Produces Enlarged Nuclei And Polyploidy Through Endoreplication, Lulin Hu, Tamara A. Potapova, Shibo Li, Susannah Rankin, Gary J. Gorbsky, Peter C. Angeletti, Brian P. Ceresa

Nebraska Center for Virology: Faculty Publications

Anogenital cancers and head and neck cancers are causally-associated with infection by high-risk

human papillomavirus (HPV). The mechanism by which high-risk HPVs contribute to

oncogenesis is poorly understood. HPV16 encodes three genes (HPV16 E5, E6, and E7) that can

transform cells when expressed independently. HPV16 E6 and E7 have well-described roles

causing genomic instability and unregulated cell cycle progression. The role of HPV16 E5 in cell

transformation remains to be elucidated. Expression of HPV16 E5 results in enlarged, polyploid

nuclei that are dependent on the level and duration of HPV16 E5 expression. Live-cell imaging

data indicate these changes do not …

Human Papillomavirus 16 E5 Induces Bi-Nucleated Cell Formation By Cell-Cell Fusion, Lulin Ha, Kendra Plafker, Valeriya Vorozhoko, Rosemary E. Zuna, Marie H. Hanigan, Gary J. Gorbsky, Scott M. Plafker, Peter C. Angeletti, Brian P. Ceresa

Nebraska Center for Virology: Faculty Publications

Human Papillomaviruses (HPV) 16 is a DNA virus encoding three oncogenes – E5, E6, and E7. The E6 and E7 proteins have well-established roles as inhibitors of tumor suppression, but the contribution of E5 to malignant transformation is controversial. Using spontaneously immortalized human keratinocytes (HaCaT cells), we demonstrate that expression of HPV16 E5 is necessary and sufficient for the formation of bi-nucleated cells, a common characteristic of precancerous cervical lesions. Expression of E5 from non-carcinogenic HPV6b does not produce bi-nucleate cells. Video microscopy and biochemical analyses reveal that bi-nucleates arise through cell-cell fusion. Although most E5-induced bi-nucleates fail to propagate, …

In Step With Our Parents: 3-Part Educational Series, Kate Boisen-Macdonald

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this project is to educate adult children caring for their parents, so they can identify as caregivers so they can better cope with, identify with, and/or navigate the role of care giving, and be aware of the resources available to them.

Social Work Involvement In Supporting Survivors Of An Unexpected Death In An Emergency Department, Jennifer E. Buchanan

All Graduate Theses, Dissertations, and Other Capstone Projects

People occasionally present to a hospital’s emergency department (ED) after an event such as a heart attack or a motor vehicle accident that results in their sudden and unexpected death. Although members of the ED attempt to support the survivors as much as possible, due to the fast pace of the environment and responsibilities to other patients, the survivors may not always be provided with the necessary resources and support. This can leave survivors feeling isolated and confused about the appropriate course of action after this type of experience. A planned, organized approach delivered by educated and sensitive staff can …

Efficacy And Safety Of Intermittent Preventive Treatment With Sulfadoxine-Pyrimethamine For Malaria In African Infants: A Pooled Analysis Of Six Randomised, Placebo-Controlled Trials, J.J. Aponte, D. Schellenberg, A. Egan, A. Breckenridge, I. Carneiro, J. Critchley, I. Danquah, A. Dodoo, R. Kobbe, B. Lell, J. May, Zul Premji, S. Sanz, E. Sevene, R. Soulaymani-Becheikh, P. Winstanley, S. Adjei, S. Anemana, D. Chandramohan, S. Issifou, F. Mockenhaupt F., S. Owusu-Agyei, B. Greenwood, M.P. Grobusch, P.G. Kremsner, E. Macete, H. Mshinda, R.D. Newman, L. Slutsker, M. Tanner, P. Alonso, C. Menendez

Pathology, East Africa

Background: Intermittent preventive treatment (IPT) is a promising strategy for malaria control in infants. We undertook a pooled analysis of the safety and efficacy of IPT in infants (IPTi) with sulfadoxine-pyrimethamine in Africa. Methods: We pooled data from six double-blind, randomised, placebo-controlled trials (undertaken one each in Tanzania, Mozambique, and Gabon, and three in Ghana) that assessed the efficacy of IPTi with sulfadoxine-pyrimethamine. In all trials, IPTi or placebo was given to infants at the time of routine vaccinations delivered by WHO's Expanded Program on Immunization. Data from the trials for incidence of clinical malaria, risk of anaemia (packed-cell volume <25% or haemoglobin <80 g/L), and incidence of hospital admissions and adverse events in infants up to 12 months of age were reanalysed by use of standard outcome definitions and time periods. Analysis was by modified intention to treat, including all infants who received at least one dose of IPTi or placebo. Findings: The six trials provided data for 7930 infants (IPTi, n=3958; placebo, n=3972). IPTi had a protective efficacy of 30·3% (95% CI 19·8-39·4, p<0·0001) against clinical malaria, 21·3% (8·2-32·5, p=0·002) against the risk of anaemia, 38·1% (12·5-56·2, p=0·007) against hospital admissions associated with malaria parasitaemia, and 22·9% (10·0-34·0, p=0·001) against all-cause hospital admissions. There were 56 deaths in the IPTi group compared with 53 in the placebo group (rate ratio 1·05, 95% CI 0·72-1·54, p=0·79). One death, judged as possibly related to IPTi because it occurred 19 days after a treatment dose, was subsequently attributed to probable sepsis. Four of 676 non-fatal hospital admissions in the IPTi group were deemed related to study treatment compared with five of 860 in the placebo group. None of three serious dermatological adverse events in the IPTi group were judged related to study treatment compared with one of 13 in the placebo group. Interpretation: IPTi with sulfadoxine-pyrimethamine was safe and efficacious across a range of malaria transmission settings, suggesting that this intervention is a useful contribution to malaria control. Funding: Bill & Melinda Gates Foundation. © 2009 Elsevier Ltd. All rights reserved.

Chlorproguanil - Dapsone - Artesunate Versus Artemether - Lumefantrine: A Randomized, Double-Blind Phase Iii Trial In African Children And Adolescents With Uncomplicated Plasmodium Falciparum Malaria, Zul Premji, R.E. Umeh, S. Owusu-Agyei, F. Esamai, E.U. Ezedinachi, S. Oguche, S. Borrmann, A. Sowunmi, S. Duparc, P.L. Kirby, A. Pamba, L. Kellam, R. Guiguemde, B. Greenwood, S.A. Ward, P.A. Winstanley

Pathology, East Africa

Background: Chlorproguanil-dapsone-artesunate (CDA) was developed as an affordable, simple, fixed-dose artemisinin-based combination therapy for use in Africa. This trial was a randomized parallel-group, double-blind, double-dummy study to compare CDA and artemether-lumefantrine (AL) efficacy in uncomplicated Plasmodium falciparum malaria and further define the CDA safety profile, particularly its hematological safety in glucose-6-phosphate dehydrogenase (G6PD) -deficient patients. Methods and Findings: The trial was conducted at medical centers at 11 sites in five African countries between June 2006 and August 2007. 1372 patients (≥1 to <15 years>old, median age 3 years) with acute uncomplicated P. falciparum malaria were randomized (2:1) to receive CDA 2/2.5/4 …

Assessment Of Smoking Status Based On Cotinine Levels In Nasal Lavage Fluid., Mehmet Hakan Ozdener, Karen K Yee, Ryan Mcdermott, Beverly J Cowart, Aldona A Vainius, Pamela Dalton, Nancy E Rawson

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

ABSTRACT: Cotinine is a principal metabolite of nicotine with a substantially longer half-life, and cotinine levels in saliva, urine or serum are widely used to validate self-reported smoking status. The nasal cavity and olfactory system are directly exposed to tobacco smoke in smokers and in non-smokers who live with or work around smokers. However, despite the potential for a direct impact of tobacco smoke on the nasal epithelium and olfactory neurons, no prior studies have assessed cotinine levels in nasal mucus. We sought to determine whether cotinine levels in nasal lavage fluid (NLF) would provide a reasonable estimate of smoke …