Digital Commons Network^™

Helmet Use Among Alaskan Children Involved In Off-Road Motorized Vehicle Crashes, Christopher W. Snyder, Oliver J. Muensterer, Frank Sacco, Shawn D. Safford

Surgery Faculty Publications

Background: Off-road motorized vehicle crashes are a common source of trauma among Alaska children. Injury morbidity is worse in Alaska Native children than non-Native children, but the reasons are unclear.

Objective: To evaluate the differences in helmet use between the Native and the non-Native children, and to assess the impact of helmet use on injury patterns and outcomes.

Design: This retrospective cohort study identified patients aged 17 or younger admitted after all-terrain vehicle, snowmobile or motorbike injury between 2001 and 2011 from the Alaska Trauma Registry. Helmeted and non-helmeted patients were compared with respect to demographics, central nervous system (CNS) …

Obesity And Surgical Wound Healing: A Current Review, Yvonne N. Pierpont, Trish Phuong Dinh, R. Emerick Salas, Erika L. Johnson, Terry G. Wright, Martin C. Robson, Wyatt G. Payne

Surgery Faculty Publications

Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity, wound healing, adipose healing, and bariatric and surgical complications. Results. Substantial evidence exists demonstrating that obesity is associated with a number of postoperative complications. Specifically in relation to wound healing, explanations include inherent anatomic features of adipose tissue, vascular insufficiencies, cellular and composition modifications, oxidative stress, alterations in immune mediators, and nutritional …

The Heart Weight–Body Weight Coefficient In Kenyans Aged 14 Years And Above, Mbayah Etabale

Master of Medicine in Anatomic Pathology

Background: The heart size has traditionally been assessed using absolute reference weights. But the heart weight (HW) has been shown to depend on one’s body size hence a better measure is the ratio of the HW to the body weight (BW) – the HW-BW coefficient. Initially noted to be 0.43% and 0.40% in males and females respectively, recent studies have shown an increase of up to 0.51%. Objective: To determine the HW-BW coefficient in Kenyans aged 14 years and above. Methods: One hundred and four deceased Kenyans aged 14 years and above, with no heart or chronic lung disease, were …

Paracrine-Rescued Lobulogenesis In Chimeric Outgrowths Comprising Progesterone-Receptor-Null Mammary Epithelium And Redirected Wild-Type Testicular Cells, Robert D. Bruno, Corinne A. Boulanger, Sonia M. Rosenfield, Lisa H. Anderson, John P. Lydon, Gilbert H. Smith

School of Medical Diagnostics & Translational Sciences Publications

We have previously shown that non-mammary and tumorigenic cells can respond to the signals of the mammary niche and alter their cell fate to that of mammary epithelial progenitor cells. Here we tested the hypothesis that paracrine signals from mammary epithelial cells expressing progesterone receptor (PR) are dispensable for redirection of testicular cells, and that re-directed wild-type testicular-derived mammary cells can rescue lobulogenesis of PR-null mammary epithelium by paracrine signaling during pregnancy. We injected PR-null epithelial cells mixed with testicular cells from wild-type adult male mice into cleared fat-pads of recipient mice. The testicular cells were redirected in vivo to …

Acute Kidney Injury In Lymphoma: A Single Centre Experience, Muhammad Abdul Mabood Khalil, Hira Latif, Abdur Rehman, Waqar Uddin Kashif, Safia Awan, Zarghona Khalil, Uziar Mushtaq, Maria Ahmad, Muhammad Ashhad Ullah Khalil, Manickam Ranga Sami

Section of Nephrology

Background. Acute kidney injury (AKI) is a common but least studied complication of lymphoma.

Objective. To determine the frequency and predictors of AKI in lymphoma and to study the impact of AKI on hospital stay and mortality.

Methods. Retrospective review of medical records of hospitalized lymphoma patients aged ≥14 years between January 2008 and December 2011 was done.

Results. Out of 365 patients, AKI was present in 31.8% (116/365). Multivariate logistic regression analysis showed that independent predictors for AKI included sepsis (odds ratio (OR) 3.76; 95% CI 1.83-7.72), aminoglycosides (OR 4.75; 95% CI 1.15-19.52), diuretics (OR 2.96; 95% CI 1.31-6.69), …

The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety In Aga Khan University Hospital; A Cohort Study, Anthony Kamau

Master of Medicine in Anaesthesiology

Background: Preoperative anxiety is a common perioperative complication, according to studies done it is seen in approximately 11-80% of adults undergoing surgery. Various pharmacological and non pharmacological techniques have been used to reduce preop anxiety. One of the goals of the preanaesthesia clinic is to allay anxiety. Literature shows that a preanaesthesia clinic evaluation reduces anxiety however b current studies done on anxiety and the preanaesthesia clinic have not quantified this reduction. Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward. Study Design: A cohort and before – after study …

Residual Disease And Hpv Persistence After Cryotherapy For Cervical Intraepithelial Neoplasia Grade 2/3 In Hiv Positive Women In Kenya, Hugo De Vuyst, Nelly R. Mugo, Silvia Franceschi, Kevin Mckenzie, Vanessa Tenet, Julia Njoroge, Farzana S. Rana, Samah R. Sakr, Peter J.F. Snijders, Michael Chung

Pathology, East Africa

Objective: To assess residual cervical intraepithelial neoplasia (CIN) 2/3 disease and clearance of high-risk (hr) human papillomavirus (HPV) infections at 6 months after cryotherapy among HIV-positive women.

Design: Follow-up study.

Methods: 79 HIV-positive women received cryotherapy for CIN2/3 in Nairobi, Kenya, and underwent conventional cytology 6 months later. Biopsies were performed on high grade cytological lesions and hrHPV was assessed before (cervical cells and biopsy) and after cryotherapy (cells).

Results: At 6 months after cryotherapy CIN2/3 had been eliminated in 61 women (77.2%; 95% Confidence Interval, (CI):66.4–85.9). 18 women (22.8%) had residual CIN2/3, and all these women had hrHPV at …

Epidemiology Of Malaria In A Village In The Rufiji River Delta, Tanzania: Declining Transmission Over 25 Years Revealed By Different Parasitological Metrics, Anna Färnert, Victor Yman, Manijeh Vafa Homann, Grace Wandell, Leah Mhoja, Marita Johansson, Salome Jesaja, Johanna Sandlund, Kazuyuki Tanabe, Ulf Hammar, Matteo Bottai, Zul Premji, Anders Björkman, Ingegerd Rooth

Pathology, East Africa

Background: Assessments of the epidemiology of malaria over time are needed to understand changes in transmission and guide control and elimination strategies.

Methods: A longitudinal population study was established in 1985 in Nyamisati village in the Rufiji River Delta, Tanzania. A physician and research team lived in the village 1984–2000. Parasite prevalence by microscopy and two PCR methods, spleen rates and haemoglobin levels were measured in repeated cross-sectional surveys between 1985 and 2010. Passive surveillance of malaria cases was maintained until end 1999. Bed nets were distributed after the surveys 1993, 1999 and 2010.

Results: In 1985, overall parasite prevalence …

Uchunguzi (Journal Watch/Montre De Journal) April 2014, Benjamin Wachira

Family Medicine, East Africa

Content: If you want to know how we practised medicine 5 years ago, read a textbook. If you want to know how we practised medicine 2 years ago, read a journal. If you want to know how we practise medicine now, go to a (good) conference. If you want to know how we will practise medicine in the future, listen in the hallways and use FOAM (Joe Lex, 2012). FOAM is free, open-access medical education. As stated in the Hippocratic Oath: “…and to teach them this art – if they desire to learn it – without fee and covenant”, the …

Uchunguzi (Journal Watch/Montre De Journal) September 2014, Benjamin Wachira

Family Medicine, East Africa

No abstract provided.

Uchunguzi (Journal Watch/Montre De Journal) December 2014, Benjamin Wachira

Family Medicine, East Africa

No abstract provided.

Burden Of Epilepsy In Rural Kenya Measured In Disability-Adjusted Life Years, Fredrick Ibinda, Ryan Wagner, Melanie Bertram, Anthony Ngugi, Evasius Bauni, Theo Vos, Josemir Sander, Charles Newton

Family Medicine, East Africa

Objectives: The burden of epilepsy, in terms of both morbidity and mortality, is likely to vary depending on the etiology (primary [genetic/unknown] vs. secondary [structural/metabolic]) and with the use of antiepileptic drugs (AEDs). We estimated the disability-adjusted life years (DALYs) and modeled the remission rates of active convulsive epilepsy (ACE) using epidemiologic data collected over the last decade in rural Kilifi, Kenya.

Methods: We used measures of prevalence, incidence, and mortality to model the remission of epilepsy using disease-modeling software (DisMod II). DALYs were calculated as the sum of Years Lost to Disability (YLD) and Years of Life Lost (YLL) …

Exposure To Multiple Parasites Is Associated With The Prevalence Of Active Convulsive Epilepsy In Sub-Saharan Africa, Gathoni Kamuyu, Christian Bottomley, James Mageto, Brett Lowe, Patricia Wilkins, John C. Noh, Thomas B. Nutman, Anthony Ngugi, Rachael Odhiambo, Ryan Wagner, Angelina Kakooza-Mwesige, Seth Owusu-Agyei, Kenneth Ae-Ngibise, Honorati Masanja, Faith Osier, Peter Odermatt, Charles Newton

Family Medicine, East Africa

Background: Epilepsy is common in developing countries, and it is often associated with parasitic infections. We investigated the relationship between exposure to parasitic infections, particularly multiple infections and active convulsive epilepsy (ACE), in five sites across sub-Saharan Africa.

Methods and Findings: A case-control design that matched on age and location was used. Blood samples were collected from 986 prevalent cases and 1,313 age-matched community controls and tested for presence of antibodies to Onchocerca volvulus, Toxocara canis, Toxoplasma gondii, Plasmodium falciparum, Taenia solium and HIV. Exposure (seropositivity) to Onchocerca volvulus (OR = 1.98; 95%CI: 1.52-2.58, p

Conclusion: This study investigates how …

Premature Mortality In Active Convulsive Epilepsy In Rural Kenya: Causes And Associated Factors, Anthony Ngugi, Christian Bottomley, Gregory Fegan, Eddie Chengo, Rachael Odhiambo, Evasius Bauni, Brian Neville, Immo Kleinschmidt, Josemir W. Sander, Charles R. Newton

Family Medicine, East Africa

Objective: We estimated premature mortality and identified causes of death and associated factors in people with active convulsive epilepsy (ACE) in rural Kenya.

Methods: In this prospective population-based study, people with ACE were identified in a crosssectional survey and followed up regularly for 3 years, during which information on deaths and associated factors was collected. We used a validated verbal autopsy tool to establish putative causes of death. Age-specific rate ratios and standardized mortality ratios were estimated. Poisson regression was used to identify mortality risk factors.

Results: There were 61 deaths among 754 people with ACE, yielding a rate of …

Cancer Care Annual Report 2013-2014, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center.

The Role Of Scavenger Receptor Class B Type I-Regulated Inducible Glucocorticoids In Sepsis, Junting Ai

Theses and Dissertations--Nutritional Sciences

Sepsis claims over 215,000 lives in the US annually. Inducible glucocorticoids (iGC) is produced during sepsis. However, the precise effects of iGC in sepsis remain unclear due to a lack of appropriate animal models. Glucocorticoid (GC) insufficiency is associated with a marked increase in mortality and occurs in 60% of severe septic patients. Yet the conclusion of GC therapy on septic patients is still controversial.

Scavenger receptor class B type I (SR-BI) in the adrenal mediates the selective uptake of cholesteryl ester from lipoproteins for GC synthesis. SR-BI-/- mice completely lack iGC during sepsis and are highly susceptible to septic …

Automated Classification Of Malignant Melanoma Based On Detection Of Atypical Pigment Network In Dermoscopy Images Of Skin Lesions, Nabin K. Mishra

Doctoral Dissertations

“Melanoma causes more deaths than any other form of skin cancer. Early melanoma detection is important to prevent progression to a more deadly stage. Automated computer-based identification of melanoma from dermoscopic images of skin lesions is the most efficient method in early diagnosis. An automated melanoma identification system must include multiple steps, involving lesion segmentation, feature extraction, feature combination and classification. In this research, a classifier-based approach for automatically selecting a lesion border mask for segmentation of dermoscopic skin lesion images is presented. A logistic regression based model selects a single lesion border mask from multiple border masks generated by …

International Standards For Fetal Growth Based On Serial Ultrasound Measurements: The Fetal Growth Longitudinal Study Of The Intergrowth-21st Project, Aris T. Papageorghiou, Eric O. Ohuma, Douglas G. Altman, Tullia Todros, Leila Cheikh Ismail, Ann Lambert, Yasmin A. Jaffer, Enrico Bertino, Michael G. Gravett, J Alison Noble, Ruyan Pang, Cesar G. Victora, Fernando C. Barros, Maria Carvalho, Laurent J. Salomon, Zulfiqar A. Bhutta, Stephen H. Kennedy, José Villar

Obstetrics and Gynaecology, East Africa

Background: In 2006, WHO produced international growth standards for infants and children up to age 5 years on the basis of recommendations from a WHO expert committee. Using the same methods and conceptual approach, the Fetal Growth Longitudinal Study (FGLS), part of the INTERGROWTH-21st Project, aimed to develop international growth and size standards for fetuses.

Methods: The multicentre, population-based FGLS assessed fetal growth in geographically defined urban populations in eight countries, in which most of the health and nutritional needs of mothers were met and adequate antenatal care was provided. We used ultrasound to take fetal anthropometric measurements prospectively from …

Sexual Health Is Dead In My Body: Participatory Assessment Of Sexual Health Determinants By Refugees, Asylum Seekers And Undocumented Migrants In Belgium And The Netherlands, Ines Keygnaert, Nicole Vettenburg, Kristien Roelens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Although migrants constitute an important proportion of the European population, little is known about migrant sexual health. Existing research mainly focuses on migrants’ sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided. Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands define sexual health, search for sexual health information and perceive sexual health determinants.

Methods: Applying Community-based Participatory Research as the overarching research approach, we conducted 223 in-depth interviews with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. The Framework Analysis Technique …

Identifying Factors Associated With The Uptake Of Prevention Of Mother To Child Hiv Transmission Programme In Tigray Region, Ethiopia: A Multilevel Modeling Approach, Wondwossen Lerebo, Steven Callens, Debra Jackson, Christina Zarowsky, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Prevention of mother to child HIV transmission (PMTCT) remains a challenge in low and middle-income countries. Determinants of utilization occur – and often interact - at both individual and community levels, but most studies do not address how determinants interact across levels. Multilevel models allow for the importance of both groups and individuals in understanding health outcomes and provide one way to link the traditionally distinct ecological- and individual-level studies. This study examined individual and community level determinants of mother and child receiving PMTCT services in Tigray region, Ethiopia.

Methods: A multistage probability sampling method was used for this …

Characterisation Of The Vaginal Microflora Of Human Immunodeficiency Virus (Hiv) Positive And Negative Women In A Sub-Urban Population Of Kenya, Teresa N. Kiama, Rita Verhelst, Paul M. Mbugua, Mario Vaneechoutte, Hans Verstraelen, Benson Estambale, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Lactobacilli predominate normal vaginal microflora and are important in maintenance of vaginal health. The current study set out to identify and compare culture isolates of vaginal microflora of human immunodeficiency virus (HIV) positive (HIV+ ) and HIV negative (HIV- ) women at different phases during menstrual cycle from a sub-urban population of Kenya. Seventy four (74) women, 41 HIV+ and 33 HIV- , followed up two consecutive menstrual cycles, had high vaginal swabs taken to prepare Gram stains for six visits and anaerobic cultures for four. All 751 isolates identified by t-DNA polymerase chain reaction (PCR) belong to 51 species. …

Plasma Insulin-Degrading Enzyme: Characterisation And Evaluation As A Potential Biomarker For Alzheimer's Disease, Michelle Tegg

Theses: Doctorates and Masters

Alzheimer’s disease (AD) is increasing in prevalence due to increasing lifespan and altered lifestyle. It is the fourth major cause of death in Western countries, resulting in significant economic and social impact (Von Strauss, et al., 1999; Goate, 1997). There are no blood biomarkers currently accepted for the diagnosis of AD, and the identification of suitable biomarkers would eventually reduce the necessity for invasive, expensive and slow diagnostic procedures, as well as facilitate prognostic studies. An AD blood test would decrease the need for delaying diagnosis due to ambivalent presentation, and allow therapeutic intervention to commence at an earlier …

Serum Concentrations Of The Biomarkers Ca125, Ca15-3, Ca72-4, Tpsa And Papp-A In Natural And Stimulated Ovarian Cycles, Melissa J. Stemp, Peter Roberts, Allison Mcclements, Vincent Chapple, Jay Natalwala, Michael L. Black, Phillip L. Matson

Research outputs 2014 to 2021

Objective: Biomarkers associated with cancer screening (CA125, CA15-3, CA72-4, total prostate specific antigen [tPSA]) and the monitoring of pregnancy (pregnancy associated plasma protein-A [PAPP-A]) were measured during natural and stimulated ovarian cycles in disease-free non-pregnant women to determine if they could reflect normal events relating to ovulation and/or endometrial changes. Methods: A total of 73 blood samples (10 women) collected throughout the natural menstrual cycle, and 64 blood samples (11 women) taken during stimulated ovarian cycles, were analysed on the Roche Cobas e411 automated analyser. Results: Detectable levels of tPSA were measured in at least one point in the cycle …

Low Back Pain Beliefs Are Associated To Age, Location Of Work, Education And Pain-Related Disability In Chinese Healthcare Professionals Working In China: A Cross Sectional Survey, B K. Tan, Anne J. Smith, Peter B. O'Sullivan, Gang Chen, Angus F. Burnett, Andrew M. Briggs

Research outputs 2014 to 2021

Background: Low back pain (LBP) is the leading cause of disability worldwide. Evidence pointing towards a more efficacious model of care using a biopsychosocial approach for LBP management highlights the need to understand the pain-related beliefs of patients and those who treat them. The beliefs held by healthcare professionals (HCPs) are known to influence the treatment advice given to patients and consequently management outcomes. Back pain beliefs are known to be influenced by factors such as culture, education, health literacy, place of work, personal experience of LBP and the sequelae of LBP such as disability. There is currently a knowledge …

Protocol For The Rt Prepare Trial: A Multiple-Baseline Study Of Radiation Therapists Delivering Education And Support To Women With Breast Cancer Who Are Referred For Radiotherapy, Georgia Halkett, Moira O'Connor, Sanchia Aranda, Michael Jefford, Nigel Spry, Therese Shaw, Rachael Moorin, Penelope Schofield

Research outputs 2014 to 2021

Introduction: There is limited evidence to guide the preparation of patients for radiotherapy. This paper describes the protocol for an evaluation of a radiation therapist led education intervention delivered to patients with breast cancer in order to reduce psychological distress. Methods: A multiple-baseline study is being used. Usual care data is being collected prior to the start of the intervention at each of three sites. The intervention is delivered by radiation therapists consulting with patients prior to their treatment planning and on the first day of treatment. The intervention focuses on providing sensory and procedural information to patients and reducing …

Reaching Perinatal Women Online: The Healthy You, Healthy Baby Website And App, Lydia Hearn, Margaret Miller, Leanne Lester

Research outputs 2014 to 2021

Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs) to offer healthy lifestyle counselling. In response, today's Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to …

Pulmonary Function In Patients With Huntington's Disease, Alvaro Reyes, Travis Cruickshank, Mel Ziman, Ken Nosaka

Research outputs 2014 to 2021

Background: Huntington's disease (HD) is a neurodegenerative disorder characterized by progressive motor, cognitive and psychiatric disturbances. Chest muscle rigidity, respiratory muscle weakness, difficulty in clearing airway secretions and swallowing abnormalities have been described in patients with neurodegenerative disorders including HD. However limited information is available regarding respiratory function in HD patients. The purpose of this study was to investigate pulmonary function of patients with HD in comparison to healthy volunteers, and its association with motor severity.Methods: Pulmonary function measures were taken from 18 (11 male, 7 female) manifest HD patients (53 ± 10 years), and 18 (10 male, 8 female) …

Monitoring Changes In Circulating Tumour Cells As A Prognostic Indicator Of Overall Survival And Treatment Response In Patients With Metastatic Melanoma, Dragana Klinac, Elin S. Gray, James B. Freeman, Anna Reid, Samantha Bowyer, Michael Millward, Mel Ziman

Research outputs 2014 to 2021

Background: New effective treatments for metastatic melanoma greatly improve survival in a proportion of patients. However biomarkers to identify patients that are more likely to benefit from a particular treatment are needed. We previously reported on a multimarker approach for the detection of heterogenous melanoma circulating tumour cells (CTCs). Here we evaluated the prognostic value of this multimarker quantification of CTCs and investigated whether changes in CTC levels during therapy can be used as a biomarker of treatment response and survival outcomes.Methods: CTCs were captured by targeting the melanoma associated markers MCSP and MCAM as well as the melanoma stem …

Improving Sexual Health In Men With Prostate Cancer: Randomised Controlled Trial Of Exercise And Psychosexual Therapies, Prue Cormie, Suzanne K. Chambers, Robert U. Newton, Robert A. Gardiner, Nigel Spry, Dennis R. Taaffe, David Joseph, M Akhlil Hamid, Peter Chong, David Hughes, Kyra Hamilton, Daniel A. Galvão

Research outputs 2014 to 2021

Background: Despite being a critical survivorship care issue, there is a clear gap in current knowledge of the optimal treatment of sexual dysfunction in men with prostate cancer. There is sound theoretical rationale and emerging evidence that exercise may be an innovative therapy to counteract sexual dysfunction in men with prostate cancer. Furthermore, despite the multidimensional aetiology of sexual dysfunction, there is a paucity of research investigating the efficacy of integrated treatment models. Therefore, the purpose of this study is to: 1) examine the efficacy of exercise as a therapy to aid in the management of sexual dysfunction in men …

Differences In Mental Health Treatment Recommendations For Older And Younger Adults, Michelle M. Smith

Masters Theses

Failure to meet geriatric mental health needs is increasingly problematic. Research indicates that the problem is not simply a matter of insufficient numbers of mental health practitioners (MHPs), but also ageist attitudes and lack of knowledge about and training with older adults. The current study reviews the literature regarding knowledge about older people, education and training that mental health professionals receive, and the attitudes that are held by mental health professionals. The study also assessed for differences in treatment recommendations that MHP made for older versus younger clients, investigated whether MHP knowledge about the mental health of older adults, attitudes …