Digital Commons Network^™

Fto And Mc4r Gene Variants Are Associated With Obesity In Polycystic Ovary Syndrome, Kathryn G. Ewens, Michelle R. Jones, Wendy Ankener, Douglas R. Stewart, Margrit Urbanek, Andrea Dunaif, Richard S. Legro, Angela Chua, Ricardo Azziz, Richard S. Spielman, Mark O. Goodarzi, Jerome F. Strauss Iii

Obstetrics and Gynecology Publications

Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility in women. It is also associated with metabolic disturbances that place women at increased risk for obesity and type 2 diabetes. There is strong evidence for familial clustering of PCOS and a genetic predisposition. However, the gene(s) responsible for the PCOS phenotypes have not been elucidated. This two-phase family-based and case-control genetic study was designed to address the question of whether SNPs identified as susceptibility loci for obesity in genome-wide association studies (GWAS) are also associated with PCOS and elevated BMI. Members of 439 families having at least one …

Challenges And Benefits Of Using A Virtual Community To Explore Nursing Concepts Among Baccalaureate Nursing Students, Linnea L. Carlson-Sabelli, Jean F. Giddens, Louis Fogg, Ruth A. Fiedler

School of Nursing Publications

This research study examines learner perceptions of benefits and challenges associated with the Neighborhood (NBH), an innovative pedagogy that fosters learner engagement and integration of nursing concepts using a “virtual community” as an alternative to lecture. First-semester students from five baccalaureate nursing programs that used the NBH intervention were divided into high (N = 78) and low faculty use (N = 203) groups. Qualitative analysis revealed that the NBH intervention promoted application of concepts to real life situation was engaging and “eye-opening,” allowing students to understand health care issues from a variety of perspectives. A major challenge was busy work …

Tryptophan Degradation In Women With Breast Cancer: A Pilot Study, Debra E. Lyon, Jeanne M. Walter, Angela R. Starkweather, Christine M. Schubert, Nancy L. Mccain

School of Nursing Publications

Background

Altered tryptophan metabolism and indoleamine 2,3-dioxygenase activity are linked to cancer development and progression. In addition, these biological factors have been associated with the development and severity of neuropsychiatric syndromes, including major depressive disorder. However, this biological mechanism associated with both poor disease outcomes and adverse neuropsychiatric symptoms has received little attention in women with breast cancer. Therefore, a pilot study was undertaken to compare levels of tryptophan and other proteins involved in tryptophan degradation in women with breast cancer to women without cancer, and secondarily, to examine levels in women with breast caner over the course of chemotherapy. …

Prognostic Variables And Surgical Management Of Foot Melanoma: Review Of A 25-Year Institutional Experience, Omar M. Rashid, Julia C. Schaum, Luke G. Wolfe, Nooshin K. Brinster, James P. Neifeld

Surgery Publications

Introduction. Cutaneous foot melanoma is rare, challenging to manage, and not adequately examined in the literature. This study evaluated the prognostic variables and surgical management of foot melanoma.Materials and Methods. Foot melanoma cases managed at an academic center from 1985 to 2010 were retrospectively reviewed. Results. 46 patients were identified with a broad range of demographic characteristics. Overall recurrence was 32.6%: 19% acral lentiginous, 57% nodular, 66% superficial spreading, 30% melanoma unspecified, 50% severely atypical; 53% ulcerated, 23% nonulcerated; 29% on the dorsum of the foot, 17% heel, 60% ankle, 22% toe, 50% plantar; 0% <1 mm thick, 47% 1–4 mm, 33% >4 mm. 13 had positive …

Complications Of Nephrogenic Systemic Fibrosis Following Repeated Exposure To Gadolinium In A Man With Hypothyroidism: A Case Report, Arpita Aggarwal, Allison A. Froehlich, Paulina Essah, Nooshin K. Brinster, Whitney A. High, Robert W. Downs

Internal Medicine Publications

Introduction Nephrogenic systemic fibrosis is a condition that has recently been recognized in patients with chronic renal disease and is associated with use of gadolinium-based contrast agents of ubiquitous use in magnetic resonance imaging scans. The condition is believed to arise through inadequate renal clearance of the gadolinium-based contrast agents, resulting in bodily deposition of the gadolinium; this is most widely recognized in the skin, but also occurs in other tissues.

Case presentation We report the case of a 52-year-old Caucasian man with hypothyroidism and chronic renal disease who developed nephrogenic systemic fibrosis upon repeated exposure to gadolinium, and who …

Individual Physician Versus Team-Based Medical Encounters: Maximizing The Efficiency Of A Medical Relief Service In Rural Honduras, Rachel Whitney, Michael P. Stevens, Gonzalo M. L. Bearman

Internal Medicine Publications

Background. For several years, the Virginia Commonwealth University (VCU) Department of Internal Medicine has traveled to the towns of La Hicaca and Coyoles in rural Honduras. In 2010, a new encounter method was employed during the brigade in Coyoles. Objectives. To examine the differences in clinical encounters and adherence with chronic diseases and public health screening between the traditional and team-based encounter methods. Methods. Chi-square analysis was used to determine statistical significance between encounter methods over several variables used in the standard interview form. Results. 314 patients were interviewed using the team-based approach, and 153 patients were interviewed with the …

Decreasing Mortality In Severe Sepsis And Septic Shock Patients By Implementing A Sepsis Bundle In A Hospital Setting, Sandra C. P. L. Shiramizo, Alexandre R. Marra, Marcelino S. Durao, Angela T. Paes, Michael B. Edmond, Oscar Fernando Pavao Dos Santos

Internal Medicine Publications

Background

The Surviving Sepsis Campaign (SSC) guidelines for the management of severe sepsis (SS) and septic shock (SSh) have been recommended to reduce morbidity and mortality.

Materials and Methods

A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize SS and SSh shock patients' clinical outcomes were performed by applying sepsis bundles (6- and 24-hour) in May 2006. We compared bundle compliance and patient outcomes before (July 2005-April 2006) and after (May 2006-December 2009) implementation of the interventions.

Results

A total of 564 SS and SSh patients were identified. Prior to the intervention, compliance with the 6 …

The Living Textbook Project For Affordable Higher Education, Dayanjan S. Wijesinghe

Surgery Presentations

A blue print for ensuring that community college education remains affordable to the future generations via elimination of the cost of textbooks.

Postoperative Refraction In The Second Eye Having Cataract Surgery, Christopher T. Leffler, Martin Wilkes, Juliana Reeves, Muneera A. Mahmood

Ophthalmology Publications

Introduction. Previous cataract surgery studies assumed that first-eye predicted and observed postoperative refractions are equally important for predicting second-eye postoperative refraction. Methods. In a retrospective analysis of 173 patients having bilateral sequential phacoemulsification, multivariable linear regression was used to predict the second-eye postoperative refraction based on refractions predicted by the SRK-T formula for both eyes, the first-eye postoperative refraction, and the difference in IOL selected between eyes. Results. The first-eye observed postoperative refraction was an independent predictor of the second eye postoperative refraction ( 𝑃<0.001 ) and was weighted more heavily than the first-eye predicted refraction. Compared with the SRK-T formula, this model reduced the root-mean-squared (RMS) error of the predicted refraction by 11.3%. Conclusions. The first-eye postoperative refraction is an independent predictor of the second-eye postoperative refraction. The first-eye predicted refraction is less important. These findings may be due to interocular symmetry.

Bound Water At Protein-Protein Interfaces: Partners, Roles And Hydrophobic Bubbles As A Conserved Motif, Mostafa H. Ahmed, Francesca Spyrakis, Pietro Cozzini, Parijat K. Tripathi, Andrea Mozzarelli, J. Neel Scarsdale, Martin A. Safo, Glen E. Kellogg

Medicinal Chemistry Publications

Background

There is a great interest in understanding and exploiting protein-protein associations as new routes for treating human disease. However, these associations are difficult to structurally characterize or model although the number of X-ray structures for protein-protein complexes is expanding. One feature of these complexes that has received little attention is the role of water molecules in the interfacial region.

Methodology

A data set of 4741 water molecules abstracted from 179 high-resolution (≤ 2.30 Å) X-ray crystal structures of protein-protein complexes was analyzed with a suite of modeling tools based on the HINT forcefield and hydrogen-bonding geometry. A metric termed …

A Modified Stokes-Einstein Equation For Aβ Aggregation, Srisairam Achuthan, Bon Jae Chung, Preetam Ghosh, Vijayaraghavan Rangachari, Ashwin Vaidya

Computer Science Publications

Background

In all amyloid diseases, protein aggregates have been implicated fully or partly, in the etiology of the disease. Due to their significance in human pathologies, there have been unprecedented efforts towards physiochemical understanding of aggregation and amyloid formation over the last two decades. An important relation from which hydrodynamic radii of the aggregate is routinely measured is the classic Stokes-Einstein equation. Here, we report a modification in the classical Stokes-Einstein equation using a mixture theory approach, in order to accommodate the changes in viscosity of the solvent due to the changes in solute size and shape, to implement a …

Ventricular Tachyarrhythmias After Cardiac Arrest In Public Versus At Home, Myron L. Weisfeldt, Siobahn Everson-Stewart, Colleen Sitlani, Thomas Rea, Tom P. Aufderheide, Diane L. Atkins, Blair Bigham, Steven C. Brooks, Christopher Foerster, Randal Gray, Joseph P. Ornato, Judy Powell, Peter J. Kudenchuk, Laurie J. Morrison

Emergency Medicine Publications

Background

The incidence of ventricular fibrillation or pulseless ventricular tachycardia as the first recorded rhythm after out-of-hospital cardiac arrest has unexpectedly declined. The success of bystander-deployed automated external defibrillators (AEDs) in public settings suggests that this may be the more common initial rhythm when outof-hospital cardiac arrest occurs in public. We conducted a study to determine whether the location of the arrest, the type of arrhythmia, and the probability of survival are associated.

Methods

Between 2005 and 2007, we conducted a prospective cohort study of out-of-hospital cardiac arrest in adults in 10 North American communities. We assessed the frequencies of …

Early Versus Later Rhythm Analysis In Patients With Out-Of-Hospital Cardiac Arrest, Ian G. Stiell, Graham Nichol, Brian G. Leroux, Thomas D. Rea, Joseph P. Ornato, Judy Powell, James Christenson, Clifton W. Callaway, Peter J. Kudenchuk, Tom P. Aufderheide, Ahamed H. Idris, Mohamud R. Daya, Henry E. Wang, Laurie J. Morrison, Daniel Davis, Douglas Andrusiek, Shannon Stephens, Sheldon Cheskes, Robert H. Schmicker, Ray Fowler, Christian Vaillancourt, David Hostler, Dana Zive, Ronald G. Pirrallo, Gary M. Vilke, George Sopko, Myron Weisfeldt

Emergency Medicine Publications

Background

In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association–International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm.

Methods

We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients …

A Trial Of An Impedance Threshold Device In Out-Of-Hospital Cardiac Arrest, Tom P. Aufderheide, Graham Nichol, Thomas D. Rea, Siobhan P. Brown, Brian G. Leroux, Paul E. Pepe, Peter J. Kudenchuk, Jim Christenson, Mohamud R. Daya, Paul Dorian, Clifton W. Callaway, Ahamed H. Idris, Douglas Andrusiek, Shannon W. Stephens, David Hostler, Daniel Davis, James V. Dunford, Ronald G. Pirrallo, Ian G. Stiell, Catherine M. Clement, Alan Craig, Lois Van Ottingham, Terri A. Schmidt, Henry E. Wang, Myron L. Weistfeldt, Joseph P. Ornato, George Sopko

Emergency Medicine Publications

Background

The impedance threshold device (ITD) is designed to enhance venous return and cardiac output during cardiopulmonary resuscitation (CPR) by increasing the degree of negative intrathoracic pressure. Previous studies have suggested that the use of an ITD during CPR may improve survival rates after cardiac arrest.

Methods

We compared the use of an active ITD with that of a sham ITD in patients with out-ofhospital cardiac arrest who underwent standard CPR at 10 sites in the United States and Canada. Patients, investigators, study coordinators, and all care providers were unaware of the treatment assignments. The primary outcome was survival to …

Right Ventricular Dysfunction Following Acute Myocardial Infarction In The Absence Of Pulmonary Hypertension In The Mouse, Stefano Toldo, Herman J. Bogaard, Benjamin W. Van Tassell, Eleonora Mezzaroma, Ignacio M. Seropian, Roshanak Robati, Fadi N. Salloum, Norbert F. Voelkel, Antonio Abbate

VCU Health Publications

Background

Cardiac remodelling after AMI is characterized by molecular and cellular mechanisms involving both the ischemic and non-ischemic myocardium. The extent of right ventricular (RV) dilatation and dysfunction and its relation to pulmonary hypertension (PH) following AMI are unknown. The aim of the current study was to evaluate changes in dimensions and function of the RV following acute myocardial infarction (AMI) involving the left ventricle (LV).

Methods

We assessed changes in RV dimensions and function 1 week following experimental AMI involving the LV free wall in 10 mice and assessed for LV and RV dimensions and function and for the …

Alterations In The Interleukin-1/Interleukin-1 Receptor Antagonist Balance Modulate Cardiac Remodeling Following Myocardial Infarction In The Mouse, Antonio Abbate, Fadi N. Salloum, Benjamin W. Van Tassell, Elena Vecile, Stefano Toldo, Ignacio M. Seropian, Eleonora Mezzaroma, Aldo Dobrina

VCU Health Publications

Background

Healing after acute myocardial infarction (AMI) is characterized by an intense inflammatory response and increased Interleukin-1 (IL-1) tissue activity. Genetically engineered mice lacking the IL-1 receptor (IL-1R1-/-, not responsive to IL-1) or the IL-1 receptor antagonist (IL-1Ra, enhanced response to IL-1) have an altered IL-1/IL-1Ra balance that we hypothesize modulates infarct healing and cardiac remodeling after AMI.

Methods

IL-1R1-/- and IL-1Ra-/- male mice and their correspondent wild-types (WT) were subjected to permanent coronary artery ligation or sham surgery. Infarct size (trichrome scar size), apoptotic cell death (TUNEL) and left ventricular (LV) dimensions and function (echocardiography) were measured prior to …

Trends In Alcohol Services Utilization From 1991–1992 To 2001–2002: Ethnic Group Differences In The U.S. Population, Karen G. Chartier, Raul Caetano

Social Work Publications

Background:  During the early 1990s in the United States, changes to the provision and financing of alcohol treatment services included reductions in inpatient treatment services and in private sector spending for treatment. We investigated trends in alcohol services utilization over the 10‐year period from 1991–1992 to 2001–2002 among U.S. whites, blacks, and Hispanics.

Methods:  Data come from 2 household surveys of the U.S. adult population. The 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey and the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions conducted face‐to‐face interviews with a multistage cluster sample of individuals 18 years of …

Forever Young, Edward F. Ansello

Director's Editorials from Age in Action

Gerontologists theorize that each of us is shaped by the influences of cohort and historical time. If there's a oneness of who we were and who we are, then Bob Dylan's music is in many of us. Forever Young is not a paean to age denial. Rather, it seems to invoke virtues or characteristics that never grow old: charity to others, acceptance of kindness, hope, righteousness, courage, fortitude, industriousness, and joy.

Falls, Edward F. Ansello

Director's Editorials from Age in Action

Falls are common, affecting about one third of community-dwelling adults over age 65 and about half over age 80. The risk factors for falling are complex, and falls may themselves be a signal for other troubling conditions. When fear of falling emerges as an issue for some elders, they are likely to reduce their activities, thinking that this will reduce their risk, and isolation and depression can ensue. There are teaching roles for nurses, physicians, and physical therapists in sharing with other professions how to assess gait, vision, or dizziness.

Baby Boomers And Stereotypes, Edward F. Ansello

Director's Editorials from Age in Action

With age we become more and more like ourselves. This would mean millions and millions of individual Baby Boomers, each with his or her own characteristics and life trajectory. Stereotyping would, therefore, be wrong, but it is happening.

The Most Terrible Poverty, Edward F. Ansello

Director's Editorials from Age in Action

Caring, private individuals and agency employees and volunteers in "direct" or "human" services regularly deliver what can be called love, the antidote to the poverty of loneliness. Let's acknowledge the essential importance of people in various forms of human services who reach out to others who are alone.

The Impact Of Providing Rehab Mobility Equipment To Those In Need, Bruce Stelmack, Brian Leitten

Case Studies from Age in Action

Educational Objectives

1. Discuss the need to provide rehabilitation mobility equipment at no cost to those who have no other means to obtain it.

2. Assess the impact on a community when mobility equipment for underinsured impaired persons (“at risk”) cannot be secured.

3. Describe a successful recycling program that provides free rehabilitation mobility equipment.

4. Explain the importance of a community- based model to provide rehabilitation equipment.

Universal Design In Housing, Steve Hansler, Beth Glas

Case Studies from Age in Action

Educational Objectives

1. Show how an aging population increases the need for housing that is accessible and adaptable.

2. Define visitability, universal design, and accessible design.

3. Explain ways to approach universal design including key factors.

4. Illustrate how universal design can be used in both renovation and new construction.

Alcohol, Medications, And Older Adults, Mailtreyee Mohanty, Patricia Slattum

Case Studies from Age in Action

Educational Objectives

1. Describe patterns of simultaneous use of alcohol and Central Nervous System (CNS) - acting medications among older adults.

2. Understand the mechanisms of interaction between alcohol and CNS-acting medications and their consequences.

3. Identify strategies to prevent alcohol-medication interactions among older adults.

4. Recommend resources for older adults and service providers for identifying and managing problematic alcohol and medication use.

Habilitation Therapy In Dementia Care, Paul Raia

Case Studies from Age in Action

Educational Objectives

1. To describe the goal of Habilitation Therapy and how it differs from other methods of dementia care, including rehabilitation.

2. To identify areas or domains in which we have opportunities to bring about and sustain positive emotions.

3. To discuss four communication strategies to use with mid- to laterstage Alzheimer’s patients.

Combinatorial Effect Of Non-Steroidal Anti-Inflammatory Drugs And Nf-Κb Inhibitors In Ovarian Cancer Therapy, Luiz F. Zerbini, Rodrigo E. Tamura, Ricardo G. Correa, Akos Czibere, Jason Coideiro, Manoj Bhasin, Fernando M. Simabuco, Yihong Wang, Xuesong Gu, Linglin Li, Devanand Sarkar, Jin-Rong Zhou, Paul B. Fisher, Towia A. Libermann

Human and Molecular Genetics Publications

Several epidemiological studies have correlated the use of non-steroidal anti-inflammatory drugs (NSAID) with reduced risk of ovarian cancer, the most lethal gynecological cancer, diagnosed usually in late stages of the disease. We have previously established that the pro-apoptotic cytokine melanoma differentiation associated gene-7/Interleukin-24 (mda-7/IL-24) is a crucial mediator of NSAID-induced apoptosis in prostate, breast, renal and stomach cancer cells. In this report we evaluated various structurally different NSAIDs for their efficacies to induce apoptosis and mda-7/IL-24 expression in ovarian cancer cells. While several NSAIDs induced apoptosis, Sulindac Sulfide and Diclofenac most potently induced apoptosis and reduced tumor …

Comprehensive Gene-Based Association Study Of A Chromosome 20 Linked Region Implicates Novel Risk Loci For Depressive Symptoms In Psychotic Illness, T. Bernard Bigdeli, Brion S. Maher, Zhongming Zhao, Edwin J. C. G. Van Den Oord, Dawn L. Thiselton, Jingchun Sun, Bradley T. Webb, Richard L. Amdur, Brandon Wormley, Francis A. O'Neill, Dermot Walsh, Brien P. Riley, Kenneth S. Kendler, Ayman H. Fanous

Human and Molecular Genetics Publications

Background

Prior genomewide scans of schizophrenia support evidence of linkage to regions of chromosome 20. However, association analyses have yet to provide support for any etiologically relevant variants.

Methods

We analyzed 2988 LD-tagging single nucleotide polymorphisms (SNPs) in 327 genes on chromosome 20, to test for association with schizophrenia in 270 Irish high-density families (ISHDSF, N = 270 families, 1408 subjects). These SNPs were genotyped using an Illumina iSelect genotyping array which employs the Infinium assay. Given a previous report of novel linkage with chromosome 20p using latent classes of psychotic illness in this sample, association analysis was also conducted …

Hybrid Spintronics And Straintronics: A Magnetic Technology For Ultra Low Energy Computing And Signal Processing, Kuntal Roy, Supriyo Bandyopadhyay, Jayasimha Atulasimha

Electrical and Computer Engineering Publications

The authors show that the magnetization of a 2-phase magnetostrictive/piezoelectric multiferroic single-domain shape-anisotropic nanomagnet can be switched with very small voltages that generate strain in the magnetostrictive layer. This can be the basis of ultralow power computing and signal processing. With appropriate material choice, the energy dissipated per switching event can be reduced to ∼45 kT at room temperature for a switching delay of ∼100 ns and ∼70 kT for a switching delay of ∼10 ns, if the energy barrier separating the two stable magnetization directions is ∼32 kT. Such devices can be powered by harvesting energy exclusively from the …

Switching Dynamics Of A Magnetostrictive Single-Domain Nanomagnet Subjected To Stress, Kuntal Roy, Supriyo Bandyopadhyay, Jayasimha Atulasimha

Electrical and Computer Engineering Publications

The temporal evolution of the magnetization vector of a single-domain magnetostrictive nanomagnet, subjected to in-plane stress, is studied by solving the Landau-Lifshitz-Gilbert equation. The stress is ramped up linearly in time, and the switching delay, which is the time it takes for the magnetization to flip, is computed as a function of the ramp rate. For high levels of stress, the delay exhibits a nonmonotonic dependence on the ramp rate, indicating that there is an optimum ramp rate to achieve the shortest delay. For constant ramp rate, the delay initially decreases with increasing stress but then saturates, showing that the …

Designing A Patient-Centered Personal Health Record To Promote Preventive Care, Alex H. Krist, Eric Peele, Steven H. Woolf, Stephen F. Rothemich, John F. Loomis, Daniel R. Longo, Anton J. Kuzel

Family Medicine and Population Health Publications

Background Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential.

Methods Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR) designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and …