Digital Commons Network^™

The Efficacy Of Intravenous Hyoscine-N-Butylbromide (Buscopan®) For The Acceleration Of Labour In First Time Parturients: A Randomised, Double-Blind, Placebo-Controlled Trial, Mukaindo A. Mwaniki

Master of Medicine in Obstetrics and Gynecology

Objective: to establish the safety and efficacy of hyoscine-N-butylbromide (Buscopan®) in accelerating labour in first time parturients. Design: a randomised, double-blinded, placebo-controlled clinical trial. Setting: the antenatal clinic and maternity unit of the Aga Khan University Hospital Nairobi, Kenya. Population: first time parturients in spontaneous labour at term. Methods: women were randomised to receive 40mg of hyoscine-N-butylbromide or sterile water for injection intravenously once they were confirmed to be in active labour. The dose could be repeated once after four hours. Outcome measures: the main outcome measure was the duration of labour from diagnosis of active stage to delivery. Secondary …

Com Outlook Summer 2010, College Of Osteopathic Medicine

COM Outlook

No abstract provided.

Updating The Dermatologic Nomenclature: Names That Are Good Or Bad., Lawrence Charles Parish, Joseph A. Witkowski

Department of Dermatology and Cutaneous Biology Faculty Papers

Dermatology probably has the largest vocabulary of any of the medical specialties,¹ a statement to which we can attest when we reviewed aspects of the Dermatology Lexicon project. Some terms are derived from the Latin or Greek and present spelling problems to all but a select few. Examples include acrokeratosis verruciformis and pterigium. Other diseases carry names that are such a mouthful that few can call them out without the interruption of breathing. These might include erosio interdigitalis blastomycetica and dermatitis exudative discoid and lichenoid of Sulzberger and Garbe. No wonder the former is now referred to simply as …

Development Of A P.O.I. And A Blended Learning Ecology For Use In Combat Lifesaver Skills Training For The Army, Bea Babbitt

Telemedicine & Advanced Technology Research Center

The primary purpose of the project, as originally conceived, was to design and implement a series of applied research studies to validate the effectiveness of a blended learning ecology in the teaching of life saving medical skills to US Army combat military personnel. The project has undergone several changes to include changing the focus to the development of a Program of Instruction (POI) for Combat Lifesaver Skills (CLS). The new scope of work which has been followed for the past year includes the completion of the POI as well as the integration of the Personal Response System (PRS) into the …

Oncolog Volume 55, Number 07, July 2010, Joe Munch, Sunni Hoseman

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Refining Approaches to Thyroid Cancer: Time-proven treatments and newer biologic agents offer hope, particularly for patirnts with advanced disease.
• Thyroid Cancer in Children.
• Compass Summer 2010: Locoregional Cancer of the Esophagus: Timimg Surgery and Other Therapies for Resectable Disease.
• HOUSE CALL: Understanding Clinical Trials

White Matter Diffusion Alterations In Normal Women At Risk Of Alzheimer's Disease, Charles D. Smith, Himachandra Chebrolu, Anders H. Andersen, David A. Powell, Mark A. Lovell, Shuling Xiong, Brian T. Gold

Neurology Faculty Publications

Increased white matter mean diffusivity and decreased fractional anisotropy (FA) has been observed in subjects diagnosed with mild cognitive impairment (MCI) and Alzheimer's disease (AD). We sought to determine whether similar alterations of white matter occur in normal individuals at risk of AD. Diffusion tensor images were acquired in 42 cognitively normal right-handed women with both a family history of dementia and at least one apolipoprotein E4 allele. These were compared with images from 23 normal women without either AD risk factor. Group analyses were performed using tract-based spatial statistics. Reduced FA was observed in the fronto-occipital and inferior temporal …

A Randomized Controlled Trial Of The Effect Of Additional Ultrasound Therapy To Analgesia Treatment Protocol For Acute Low Back Pain At Akuh (N), Shamshudin Mohammedali

Master of Medicine in General Surgery

Background: Acute low back pain is a common condition that is encountered by many physicians. Varied treatments are instituted in its management with no defined standard protocol in our institution. Additional physiotherapy has had minimal impact in terms of pain control and the time to return to work in the available literature. Controversy remains regarding effectiveness of ultrasound physiotherapy and its role in management of acute low back pain. Objective: To investigate the effectiveness of the addition of ultrasound physiotherapy to analgesia in patients with acute low back pain at the Aga Khan University Hospital, Nairobi. Methods: A randomized controlled …

Histamine Reduces Flash Sensitivity Of On Ganglion Cells In The Primate Retina, Nikolay P Akimov, David W Marshak, Laura J Frishman, Randolph D Glickman, Rafail G Yusupov

Faculty, Staff and Student Publications

PURPOSE. In Old World primates, the retina receives input from histaminergic neurons in the posterior hypothalamus. They are a subset of the neurons that project throughout the central nervous system and fire maximally during the day. The contribution of these neurons to vision, was examined by applying histamine to a dark-adapted, superfused baboon eye cup preparation while making extracellular recordings from peripheral retinal ganglion cells. METHODS. The stimuli were 5-ms, 560-nm, weak, full-field flashes in the low scotopic range. Ganglion cells with sustained and transient ON responses and two cell types with OFF responses were distinguished; their responses were recorded …

Desvenlafaxine In Major Depressive Disorder: An Evidence-Based Review Of Its Place In Therapy., Daniel Z Lieberman, Suena H Massey

Psychiatry and Behavioral Sciences Faculty Publications

INTRODUCTION: Desvenlafaxine, the active metabolite of venlafaxine, is a serotonin norepinephrine reuptake inhibitor (SNRI) recently approved for the treatment of major depressive disorder. It is one of only three medications in this class available in the United States.

AIMS: The objective of this article is to review the published evidence for the safety and efficacy of desvenlafaxine, and to compare it to other antidepressants to delineate its role in the treatment of depression.

EVIDENCE REVIEW: At the recommended dose of 50 mg per day the rate of response and remission was similar to other SNRIs, as was the adverse effect …

Optimizing Radiology Peer Review: A Mathematical Model For Selecting Future Cases Based On Prior Errors, Yun Robert Sheu, Elie Feder, Igor Balsim, Victor F. Levin, Andrew G. Bleicher, Barton F. Branstetter Iv

Publications and Research

Introduction: Peer review is an essential process for physicians because it facilitates improved quality of patient care and continuing physician learning and improvement. However, peer review often is not well received by radiologists, who note that it is time intensive, subjective, and lacks demonstrable impact on patient care. Current advances in peer review include the RADPEER system with its standardization of discrepancies and incorporation of the peer review process into the PACS itself. Our purpose was to build on RADPEER and similar systems by using a mathematical model to optimally select the types of cases to be reviewed, for each …

Oncolog Volume 55, Number 06, June 2010, John Lebas

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• The BATTLE Results Are IN: Phase II trial reveals molecular signatures in lung cancer that may guide treatment decisions.
• Endoscopic Repair of Colon Perforations: Nonsurgical techniques for closing gestrointestinal defects may yiels benefits for patients undergoing colonoscopy.
• INBRIEF: Stem Cells Seen Repairing Heart Attack Damage Over Time/Additional Blood Data May Improve Pediatric Leukemia Predictions/Pediatric Patients with Rare Tumor May benefit from Heated Chemotherapy/New Findings Refute Link Between UVA, Melanoma.
• HOUSE CALL: Skin Cancer Screening: What is It and Who Should Get It ?: Types of skin cancer/Who should be screened ?/What to expect/Self-examination: Check your skin regularly and tell your …

Vampirism, Vampire Cults And The Teenager Of Today, Megan White, Hatim A. Omar

Pediatrics Faculty Publications

The aim of this paper is to summarize the limited literature on clinical vampirism, vampire cults and the involvement of adolescents in vampire-like behavior. The various definitions of clinical vampirism are outlined and the emergence of vampire cults from Gothic culture is examined. Further, the clinical features of cult behavior, the attraction to cults, the risk factors for cult involvement, and the clinical management of cult members are discussed. Additionally, vampire popular media is briefly introduced and a case study presented.

Association Between Obesity, Depression, And Inflammation Among Seventh-Day Adventists In The Biopsychosocial Religion And Health Study, Michael Paalani

Loma Linda University Electronic Theses, Dissertations & Projects

The effects of obesity and depression on morbidity and mortality may be mediated by inflammatory processes. Homeostasis within the immune system depends on a balance of pro-inflammatory and anti-inflammatory cytokine molecules, so chronic inflammatory diseases may result from cytokine dysregulation. The target population consisted of 508 Seventh Day Adventists (SDAs) who participated in the Biopsychosocial Religion and Health Study (BHRS), a sub-study of the Adventist Health Study-2. The study was a cross-sectional analysis of the association between obesity, depression, and inflammation after controlling for demographic, socioeconomic, health behavioral, and health status variables among BHRS participants.

Obesity was assessed by body …

Emergency Department Staff Adherence To Bad News Delivery Recommendations, Kristen R. Myers

Loma Linda University Electronic Theses, Dissertations & Projects

Emergency department (ED) staff is responsible for giving bad news regarding death, diagnoses, and other traumatic losses to patients and loved ones. Individuals receiving traumatic and sudden bad news are at increased risk of serious psychological and physiological consequences of disrupted grief. Despite published recommended practices for providers to help prevent maladaptive grief responses, little research is available on actual bad news delivery practices and factors promoting or hindering adherence to recommendations, and no study specifically explored the ED context.

The study used a qualitative design to explore bad news delivery practices, awareness of recommendations, factors perceived to hinder or …

Ricin B Chain-Insulin Fusion Protein Immunomodulation Of Type 1 Diabetes, James Edward Carter Iii

Loma Linda University Electronic Theses, Dissertations & Projects

Type 1 diabetes mellitus (T1D) is a debilitating chronic inflammatory disease of the insulin-producing pancreatic islet β-cells that results from a combination of genetic and environmental factors. Attempts to suppress Th1-mediated autoimmune diseases such as T1D by mucosal delivery of autoantigens for immunotolerization have yielded only partial success. Attainment of satisfactory levels of sustained immunological tolerance remains to be accomplished. To restore self-tolerance requires delivery of sufficient amounts of autoantigen to stimulate regulatory T helper cells that function to survey the gut and induce tolerance to consumed antigens such as food. Oral delivery of autoantigens has previously been shown to …

Regulation Of Pim1 Under Hypoxia In Prostate Cancer, Eva Sahakian

Loma Linda University Electronic Theses, Dissertations & Projects

A defining characteristic of solid tumors is the capacity to divide and spread under conditions of nutrient deprivation and limited oxygen availability. These microenvironmental stresses arise from structural abnormalities in tumor vessels that lead to aberrant microcirculation. Hypoxia acts as a physiological “selection pressure” in the progression of cancer by activating pathways and enhancing the expression of specific genes in tumor cells which eventually diminish their apoptotic potential. Ultimately, hypoxic microenvironment functions as a “stress factor”, selecting cells with the ability to survive and divide under anoxic conditions. The members of the PIM family of cytoplasmic serine threonine kinases are …

Progressive Regression Of Left Ventricular Hypertrophy Two Years After Bariatric Surgery, Mohamed F Algahim, Thomas R Lux, Joshua G Leichman, Anthony F Boyer, Charles C Miller, Susan T Laing, Erik B Wilson, Terry Scarborough, Sherman Yu, Brad Snyder, Carol Wolin-Riklin, Ursula G Kyle, Heinrich Taegtmeyer

Faculty, Staff and Student Publications

BACKGROUND: Obesity is a systemic disorder associated with an increase in left ventricular mass and premature death and disability from cardiovascular disease. Although bariatric surgery reverses many of the hormonal and hemodynamic derangements, the long-term collective effects on body composition and left ventricular mass have not been considered before. We hypothesized that the decrease in fat mass and lean mass after weight loss surgery is associated with a decrease in left ventricular mass.

METHODS: Fifteen severely obese women (mean body mass index [BMI]: 46.7+/-1.7 kg/m(2)) with medically controlled hypertension underwent bariatric surgery. Left ventricular mass and plasma markers of systemic …

Cellular Dynamic Simulator: An Event Driven Molecular Simulation Environment For Cellular Physiology, Michael J Byrne, M Neal Waxham, Yoshihisa Kubota

Faculty, Staff and Student Publications

In this paper, we present the Cellular Dynamic Simulator (CDS) for simulating diffusion and chemical reactions within crowded molecular environments. CDS is based on a novel event driven algorithm specifically designed for precise calculation of the timing of collisions, reactions and other events for each individual molecule in the environment. Generic mesh based compartments allow the creation / importation of very simple or detailed cellular structures that exist in a 3D environment. Multiple levels of compartments and static obstacles can be used to create a dense environment to mimic cellular boundaries and the intracellular space. The CDS algorithm takes into …

A Direct Role For Secretory Phospholipase A2 And Lyso-Phosphatidylcholine In The Mediation Of Lipopolysaccharide-Induced Gastric Injury, Elizabeth J Dial, Duy M Tran, Jimmy J Romero, Mayssa Zayat, Lenard M Lichtenberger

Faculty, Staff and Student Publications

Endotoxemia from sepsis can injure the gastrointestinal tract through mechanisms that have not been fully elucidated. We have shown that LPS induces an increase in gastric permeability in parallel with the luminal appearance of secretory phospholipase A2 (sPLA2) and its product, lysophosphatidylcholine (lyso-PC). We proposed that sPLA2 acted on the gastric hydrophobic barrier, composed primarily of phosphatidylcholine (PC), to degrade it and produce lyso-PC, an agent that is damaging to the mucosa. In the present study, we have tested whether lyso-PC and/or sPLA2 have direct damaging effects on the hydrophobic barriers of synthetic and mucosal surfaces. Rats were administered LPS …

Defining And Measuring The Patient-Centered Medical Home., Kurt C Stange, Paul A Nutting, William L Miller, Carlos R Jaén, Benjamin F Crabtree, Susan A Flocke, James M Gill

Department of Family & Community Medicine Faculty Papers

The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices' internal capabilities, and 4) related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare. The value of the fundamental tenets of primary care is well established. This value includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities compared to …

Thoracic Aortic Disease In Tuberous Sclerosis Complex: Molecular Pathogenesis And Potential Therapies In Tsc2+/- Mice, Jiumei Cao, Limin Gong, Dong-Chuan Guo, Ulrike Mietzsch, Shao-Qing Kuang, Callie S Kwartler, Hazim Safi, Anthony Estrera, Michael J Gambello, Dianna M Milewicz

Faculty, Staff and Student Publications

Tuberous sclerosis complex (TSC) is a genetic disorder with pleiotropic manifestations caused by heterozygous mutations in either TSC1 or TSC2. One of the less investigated complications of TSC is the formation of aneurysms of the descending aorta, which are characterized on pathologic examination by smooth muscle cell (SMC) proliferation in the aortic media. SMCs were explanted from Tsc2(+/-) mice to investigate the pathogenesis of aortic aneurysms caused by TSC2 mutations. Tsc2(+/-) SMCs demonstrated increased phosphorylation of mammalian target of rapamycin (mTOR), S6 and p70S6K and increased proliferation rates compared with wild-type (WT) SMCs. Tsc2(+/-) SMCs also had reduced expression of …

Parent-Child Communication About Sexual And Reproductive Health In Rural Tanzania: Implications For Young People's Sexual Health Interventions, Joyce Wamoyi, Angela Fenwick, Mark Urassa, Basia Zaba, William Stones

Obstetrics and Gynaecology, East Africa

Background

Many programmes on young people and HIV/AIDS prevention have focused on the in-school and channeled sexual and reproductive health messages through schools with limited activities for the young people's families. The assumption has been that parents in African families do not talk about sexual and reproductive health (SRH) with their children. These approach has had limited success because of failure to factor in the young person's family context, and the influence of parents. This paper explores parent-child communication about SRH in families, content, timing and reasons for their communication with their children aged 14-24 years in rural Tanzania.

Methods …

Telemedicine And Advanced Technology Research Center: Quarterly Report, January 18, 2010 To April 17, 2010, Bea Babbitt

Telemedicine & Advanced Technology Research Center

Development of a P.O.I. and a Blended Learning Ecology for use in Combat Lifesaver Skills Training for the Army.

Multihospital Outbreak Of Clostridium Difficile Infection, Cleveland, Ohio, Usa, Robin L.P. Jump, Ajay K. Sethi, Curtis J. Donskey

Faculty Scholarship

To determine whether a multihospital Clostridium difficile outbreak was associated with epidemic strains and whether use of particular fl uoroquinolones was associated with increased infection rates, we cultured feces from C. difficile-infected patients. Use of fl uoroquionolones with enhanced antianaerobic activity was not associated with increased infection rates.

Perfusion In Rat Brain At 7 T With Arterial Spin Labeling Using Fair-Truefisp And Quipss, Emilio Esparza-Coss, Jarek Wosik, Ponnada A Narayana

Faculty, Staff and Student Publications

Measurement of perfusion in longitudinal studies allows for the assessment of tissue integrity and the detection of subtle pathologies. In this work, the feasibility of measuring brain perfusion in rats with high spatial resolution using arterial spin labeling is reported. A flow-sensitive alternating recovery sequence, coupled with a balanced gradient fast imaging with steady-state precession readout section was used to minimize ghosting and geometric distortions, while achieving high signal-to-noise ratio. The quantitative imaging of perfusion using a single subtraction method was implemented to address the effects of variable transit delays between the labeling of spins and their arrival at the …

Self-Efficacy And Educational Interventions In Heart Failure: A Review Of The Literature, Karen S. Yehle, Kimberly Plake

School of Nursing Faculty Publications

Purpose: The purpose of this study was to conduct a systematic review of the literature to better understand how to structure educational interventions for heart failure patients to improve their self-efficacy for self-care behaviors.

Methods: A computer search of the literature from 1966 through May 2009 was conducted, yielding 84 manuscripts. All manuscripts were reviewed in relation to the search criteria, resulting in 12 articles that were evaluated.

Results: Each of the reviewed studies utilized an intervention plus education to improve self-efficacy. Self-efficacy was a primary outcome for seven of the studies, and a secondary outcome for five on the …

Use Of An Animal Model To Explore Prenatal Predictors Of Insulin And Glucose Metabolism In Southwestern Alaskan Yupiit, Julie Jo Kachinski

UNLV Theses, Dissertations, Professional Papers, and Capstones

Compared to other North American indigenous populations, Southwest Alaskan Yupiit exhibit very low rates of type 2 diabetes despite the occurrence of common risk factors. Contemporary Yupiit obtain a substantial portion of their calories from traditional foods, which contain high amounts of omega-3 polyunsaturated fatty acids. Epidemiological and experimental animal research has linked glucose and insulin homeostasis with a diet high in omega-3s. This study used an experimental animal model to explore potential diabetes protective effects (for adult offspring) of prenatal maternal nutrition modeled on traditional locally-obtained Yupiit diets. The results of this study showed that the adult offspring whose …

Oral Cancer In Nevada: A Public Health Perspective, Karl Kingsley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Cancer is the second leading cause of death in the United States, and oral cancer remains the eighth leading cause of cancer death among US males. Although previous epidemiologic studies have found that overall rates of cancer, including oral cancer, have declined in the US in recent decades – these declines are neither uniform nor consistent within this population. Anecdotal evidence has suggested that rates of oral cancer in Nevada are relatively high, although no evidence was available to support these assertions.

Oral Cancer Epidemiology: Based upon this information, a detailed and thorough epidemiologic examination of oral cancer rates in …

Health Care Access Disparities Among Children Entering Kindergarten In Nevada, Nadia Deashinta

UNLV Theses, Dissertations, Professional Papers, and Capstones

Access to health care is an important factor for the well-being of America's children. The principal goal of this study was examine the 2008-2009 Kindergarten Health Survey data to advance understanding and appreciation of the health status of children in addition to their discrepancies in accessing health care in the state of Nevada (n = 11,073). This dataset serves as a secondary data source to determine whether socio-demographic and medical factors are associated with disparity in accessing health care for children entering kindergarten. This study looked at both independent and combined effects of annual household income, race/ethnicity, primary language spoken …

The Interim Window: Women’S Experiences During In Vitro Fertilization Leading To Maternal Embryo Attachment, Tammy Mackinnon Lampley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Infertility affects about 7.3 million women and their partners in the U.S., about 12% of the reproductive-age population. In vitro fertilization (IVF) has been used successfully in the United States since 1981. The number of women seeking artificial reproductive techniques (ART) has increased dramatically and the number of ART cycles performed in the United States has more than doubled, from 64,681 in 1996 to 134,260 in 2005 and 99% of these are IVF. Studies indicated that women rank waiting for the outcome of and IVF treatment and a negative pregnancy result as the most stressful events during their treatment. Although …