Digital Commons Network^™

Pop-Up Books, Magic, And Health, John Kilburn

School of Art, Design and Architecture

No abstract provided.

Welcoming 2024: Supporting Students' Well-Being, Eric A Storch, Rick Yang

Faculty, Staff and Students Publications

No abstract provided.

Fuzzy Similarity Analysis Of Effective Training Samples To Improve Machine Learning Estimations Of Water Quality Parameters Using Sentinel-2 Remote Sensing Data, Alireza Taheri Dehkordi, Mohammad Javad Valadan Zoej, Ali Mehran, Mohsen Jafari, Amir Masoud Chegoonian

Faculty Research, Scholarly, and Creative Activity

Continuous monitoring of water quality parameters (WQPs) is crucial due to the global degradation of water quality, primarily caused by climate change and population growth. Typically, machine learning (ML) models are employed to retrieve WQPs, but they require a large amount of training samples to accurately capture the data relationships. Even with sufficient training data, discrepancies still exist between values of predicted and in-situ WQPs. This study proposes a fuzzy similarity analysis (FSA) technique to enhance ML estimates of WQPs by using the prediction errors in effective training samples. The method was successfully applied to retrieve turbidity (Turb) and specific …

Emergency And Disaster Preparedness For Individuals Who Use Augmentative And Alternative Communication: A Pilot Study On Supported Planning Using A Toolkit, Andrea Barton-Hulsey, Miriam C. Boesch, Yoosun Chung, Tina Caswell, Amy Miller Sonntag, Wendy Quach

Faculty Research, Scholarly, and Creative Activity

Purpose: When emergencies or disasters arise, individuals who use augmenta-tive and alternative communication (AAC) are particularly vulnerable. It is critical that individuals who use AAC are supported to make decisions that impact their own lives and are able to communicate during such a crisis. Preparedness efforts that include a plan around communication needs and supports are necessary for ensuring that individuals who use AAC are able to understand options that ensure personal safety and express their needs during a time of crisis. Method: Qualitative methods were used to identify and describe the experi-ences of two young adults who use AAC …

Co-Producing Ethics Guidelines Together With People With Learning Disabilities, Mary Bottomley, Jodie Bradley, Lisa Clark, Bryan Collis, Bojana Daw Srdanovic, Victoria Farnsworth, Annie Ferguson, Dan Goodley, Andrew Fox, Nikita K. Hayden, Charlotte Lawthom, Rebecca Lawthom, Claudia Magwood, Robert Mclean, Ian Middleton, Alison Owen, Matty Prothero, Simon Rice, Simon Richards, Katherine Runswick-Cole, Kelly Scargill, Rohit Shankar, Toni Ann Wood

Peninsula Medical School

Background: We are a research team of clinical, academic and advocacy-based researchers with and without learning disabilities, working on the Humanising Healthcare (for people with learning disabilities) project. The project is dedicated to finding and sharing healthcare practices that enhance the lives of people with learning disabilities. As part of our ethics applications to access National Health Service study sites for fieldwork, we worked together to write guiding principles for co-producing research ethics with researchers with learning disabilities. In this paper, we introduce these Participatory Ethics Good Practice Guidelines and reflect on our collaboration. Methods: We reflect on developing the …

Perioperative Oxygenation—What's The Stress?, Joseph Larvin, Mark Edwards, Daniel S. Martin, Martin Feelisch, Michael P.W. Grocott, Andrew F. Cumpstey

Peninsula Medical School

Oxygen is the most used drug in anaesthesia. Despite such widespread use, optimal perioperative oxygen administration remains highly controversial because of concerns about the competing harms of both hyperoxia and hypoxia. Notwithstanding a Cochrane review concluding that routinely administering a fractional inspired oxygen concentration (FiO₂) >0.6 intraoperatively might increase postoperative morbidity and mortality, the World Health Organization (WHO) currently recommends all anaesthetised patients receive 0.8 FiO₂ during and immediately after surgery to reduce surgical site infections. Results from the largest trial available at the time of these two reviews (suggesting long-term survival may be worse with high …

Protecting The Mental Health Of People Seeking Sanctuary In The Uk's Evolving Legislative Landscape, Rohit Shankar

Peninsula Medical School

No abstract provided.

The Policy And Politics Of Healthcare Corporatisation: The Case Of The English Nhs, Rod Sheaff, Pauline Allen, Mark Exworthy, Russell Mannion

Peninsula Medical School

Rationale: Few accounts of healthcare corporatisation examine the effects of the 2008 financial crisis. New Politics of the Welfare State (NPWS) theories recognise the relevance of crises but give more attention to programmatic than systemic (structural) retrenchment, and little to healthcare corporatisation. Objective: To examine what changes the 2008 financial crisis produced in the pattern of healthcare corporatisation, and the implications for NPWS theories. Methods: Using administrative data from the English NHS during 1995–2019 we formulated a multi-dimensional index of corporatisation, tested its validity, and used it to analyse longitudinally how the financial crisis affected the balance between the responsibilization …

Editorial: Sex Differences In Cancer Incidence, Mortality, And Survival: Methodological Perspectives, Syed Ahsan Raza, Wilson Luiz Da Costa, Aaron P Thrift

Faculty, Staff and Students Publications

No abstract provided.

Folate Regulation Of Planar Cell Polarity Pathway And F-Actin Through Folate Receptor Alpha, Xiao Han, Xuanye Cao, Robert M Cabrera, Paula Andrea Pimienta Ramirez, Ying Linda Lin, Bogdan J Wlodarczyk, Cuilian Zhang, Richard H Finnell, Yunping Lei

Faculty, Staff and Students Publications

Folate deficiency contribute to neural tube defects (NTDs) which could be rescued by folate supplementation. However, the underlying mechanisms are still not fully understood. Besides, there is considerable controversy concerning the forms of folate used for supplementation. To address this controversy, we prepared culture medium with different forms of folate, Folic acid (FA) and 5-methyltetrahydrofolate(5mTHF), at concentration of 5uM, 500nM, 50nM and folate free, respectively. Mouse embryonic fibroblasts (MEFs) were treated with different folates continuously for three passages and cell proliferation and F-actin was monitored. We determined that compared to 5mTHF, FA showed stronger effects on promoting cell proliferation and …

Traf4-Mediated Nonproteolytic Ubiquitination Of Androgen Receptor Promotes Castration-Resistant Prostate Cancer, Yosi Gilad, Ortal Shimon, Sang Jun Han, David M Lonard, Bert W O'Malley

Faculty, Staff and Students Publications

Steroid receptor coactivators (SRCs) are master regulators of transcription that play key roles in human physiology and pathology. SRCs are particularly important for the regulation of the immune system with major roles in lymphocyte fate determination and function, macrophage activity, regulation of nuclear factor κB (NF-κB) transcriptional activity and other immune system biology. The three members of the p160 SRC family comprise a network of immune-regulatory proteins that can function independently or act in synergy with each other, and compensate for - or moderate - the activity of other SRCs. Recent evidence indicates that the SRCs are key participants in …

Targeting Sars-Cov-2 Nonstructural Protein 3: Function, Structure, Inhibition, And Perspective In Drug Discovery, Xin Li, Yongcheng Song

Faculty, Staff and Students Publications

As a highly contagious human pathogen, severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) has infected billions of people worldwide with more than 6 million deaths. With several effective vaccines and antiviral drugs now available, the SARS-CoV-2 pandemic been brought under control. However, a new pathogenic coronavirus could emerge in the future, given the zoonotic nature of this virus. Natural evolution and drug-induced mutations of SARS-CoV-2 also require continued efforts for new anti-coronavirus drugs. Nonstructural protein (nsp) 3 of CoVs is a large, multifunctional protein, containing a papain-like protease (PLpro) and a macrodomain (Mac1), which are essential for viral replication. Here, we …

Designing A Best Possible Caregiver History To Facilitate Disposition Planning For Older Adults In Emergency Departments, Karen De Sola-Smith, Matthew Growdon, Anita N Chary, Jennifer D Portz, Kenneth Lam

Faculty, Staff and Students Publications

Introduction: Detailed information about caregivers is crucial for planning disposition from emergency departments (EDs), but it is unclear what specific information is useful for ED clinicians and how that information should be presented.

Methods: We used a Design Thinking approach to develop a standardized format-which we call a "Best Possible Caregiver History" (BPCH)-for displaying useful caregiver information to ED clinicians. The key steps of this approach are needfinding, followed by iterative cycles of ideation, rapid prototyping, and testing. For needfinding, we used semi-structured interviews of four ED clinicians on current practices for discovering and documenting caregiver information. For ideation and …

Diagnostic And Prognostic Performance Of The Neutrophil-To-Lymphocyte Ratio In Acute Coronary Syndromes: A Meta-Analysis Of 90 Studies Including 45 990 Patients, Michał Pruc, Jacek Kubica, Maciej Banach, Damian Swieczkowski, Zubaid Rafique, William Frank Peacock, Zbigniew Siudak, Krzysztof Kurek, Prabath Nanayakkara, Łukasz Szarpak

Faculty, Staff and Students Publications

Background: Cardiovascular disease is a leading cause of mortality worldwide and is likely to rise. Acute coronary syndrome (ACS) is consequent on inflammation. As a common and cost-effective inflammatory biomarker, the neutrophil-to-lymphocyte ratio (NLR) may be beneficial in cardiovascular medicine.

Aims: This meta-analysis examines the diagnostic and prognostic performance of the NLR in ACS.

Methods: We systematically searched PubMed Central, Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrial.gov databases. The search spanned from databases inception to January 10, 2024. The findings were aggregated into normalized mean differences with 95% confidence intervals.

Results: Ninety articles, with 45 990 …

Family Medicine Clerkship Directors' Remediation Of Faculty With Mistreatment Concerns: Results From A Cera Clerkship Directors Survey, William Y Huang, Yuanyuan Zhou, Jonnae Atkinson, Kenneth Barning, Misbah Keen, Joel Purkiss

Faculty, Staff and Students Publications

Introduction: Little is known about how frequently family medicine (FM) clerkship directors remediate faculty with student mistreatment concerns and their comfort level in performing the remediations. In this exploratory study, we investigated factors associated with the number of faculty remediated for student mistreatment concerns by FM clerkship directors and the comfort level of FM clerkship directors in remediating these faculty.

Methods: Data were collected as part of the 2022 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of FM clerkship directors. FM clerkship directors provided responses on how frequently they remediated faculty with mistreatment concerns and their comfort …

Could Workplace-Based Assessments Improve Faculty Teaching Confidence And Competence?, Arindam Sarkar, Kelly L Smith, Brian D Keisler, Kenneth Barning

Faculty, Staff and Students Publications

No abstract provided.

Project Echo Tele-Mentoring Primary Care For Individuals With Idd, K Jordan Kemere, Nital Appelbaum, Ellen Fremion

Faculty, Staff and Students Publications

Background: As the prevalence of intellectual and developmental disabilities (IDD) has increased over time, more youth with IDD will be transitioning into adult care. Individuals with IDD have a spectrum of behavioral, medical, adaptive, and home/community support needs depending on their cognitive ability, behavior concerns, mobility impairment, and/or medical complexity. Unfortunately, data suggests that adult primary care providers often lack knowledge about the condition-specific medical and adaptive needs of the IDD population leading to decreased access to adequate primary care.

Methods: To ultimately improve access to high quality healthcare for individuals with IDD, we created a 6-session virtual Project ECHO(R) …

Best Practices For Point Of Care Ultrasound: An Interdisciplinary Expert Consensus, Brandon Oto, Robert Baeten, Leon Chen, Puja Dalal, Ria Dancel, Steven Fox, Carl William Lange Iv, Cameron Baston, Paul Bornemann, Siddharth Dugar, Andrew Goldsmith, Meghan Kelly Herbst, James N Kirkpatrick, Abhilash Koratala, Michael J Lanspa, Viveta Lobo, Jason T Nomura, Aliaksei Pustavoitau, Mourad H Senussi, Vincent L Sorrell, Frances Mae West, Aarti Sarwal

Faculty, Staff and Students Publications

Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on …

Inhibition Of Src-3 As A Potential Therapeutic Strategy For Aggressive Mantle Cell Lymphoma, Imani Bijou, Yang Liu, Dong Lu, Jianwei Chen, Shelby Sloan, Lapo Alinari, David M Lonard, Bert W O'Malley, Michael Wang, Jin Wang

Faculty, Staff and Students Publications

Mantle cell lymphoma (MCL) has a poor prognosis and high relapse rates despite current therapies, necessitating novel treatment regimens. Inhibition of SRC-3 show effectiveness in vivo and in vitro in other B cell lymphomas. Additionally, previous studies have shown that SRC-3 is highly expressed in the lymph nodes of B cell non-Hodgkin's lymphoma patients, suggesting SRC-3 may play a role in the progression of B cell lymphoma. This study aimed to investigate novel SRC-3 inhibitors, SI-10 and SI-12, in mantle cell lymphoma. The cytotoxic effects of SI-10 and SI-12 were evaluated in vitro and demonstrated dose-dependent cytotoxicity in a panel …

The 6 Degrees Of Curriculum Integration In Medical Education In The United States, Julie Youm, Jennifer Christner, Kevin Hittle, Paul Ko, Cinda Stone, Angela D Blood, Samara Ginzburg

Faculty, Staff and Students Publications

Despite explicit expectations and accreditation requirements for integrated curriculum, there needs to be more clarity around an accepted common definition, best practices for implementation, and criteria for successful curriculum integration. To address the lack of consensus surrounding integration, we reviewed the literature and herein propose a definition for curriculum integration for the medical education audience. We further believe that medical education is ready to move beyond “horizontal” (1-dimensional) and “vertical” (2-dimensional) integration and propose a model of “6 degrees of curriculum integration” to expand the 2-dimensional concept for future designs of medical education programs and best prepare learners to meet …

Rurality, Resilience, & Identity: A Soft Systems Methodology Approach To Understanding Self-Reported Issues In Rural America, Kayla M. Gabehart, Allegra H. Fullerton, Kristin Olofsson

Michigan Tech Publications

This study investigates how rural communities In Oklahoma conceive of their socioeconomic position in larger systems, as well as their resiliency and ability to withstand challenges. Utilizing systems thinking and polycentricity literature, we analyze interviews to construct an understanding of how rural communities perceive themselves, and how this impacts interactions with other communities and governments. Rural communities and their associated challenges are complex and impacted by a range of factors. We find that rural residents also feel this complexity, and understand their issues as products of overlapping systems and structures, and both internal and external factors. Additionally, we observe little …

A Comprehensive Analysis Of Neuroblastoma Incidence, Survival, And Racial And Ethnic Disparities From 2001 To 2019, Kevin Campbell, David A Siegel, Puja J Umaretiya, Shifan Dai, Andras Heczey, Philip J Lupo, Jeremy M Schraw, Trevor D Thompson, Michael E Scheurer, Jennifer H Foster

Faculty, Staff and Students Publications

BACKGROUND: We characterize the incidence and 5-year survival of children and adolescents with neuroblastoma stratified by demographic and clinical factors based on the comprehensive data from United States Cancer Statistics (USCS) and the National Program of Cancer Registries (NPCR).

METHODS: We analyzed the incidence of neuroblastoma from USCS (2003-2019) and survival data from NPCR (2001-2018) for patients less than 20 years old. Incidence trends were calculated by average annual percent change (AAPC) using joinpoint regression. Differences in relative survival were estimated comparing non-overlapping confidence intervals (CI).

RESULTS: We identified 11,543 primary neuroblastoma cases in USCS. Age-adjusted incidence was 8.3 per …

Combined Bioinformatic And Splicing Analysis Of Likely Benign Intronic And Synonymous Variants Reveals Evidence For Pathogenicity, Owen R Hirschi, Stephanie A Felker, Surya P Rednam, Kelly L Vallance, D Williams Parsons, Angshumoy Roy, Gregory M Cooper, Sharon E Plon

Faculty, Staff and Students Publications

PURPOSE: Clinical variant analysis pipelines likely have poor sensitivity to the effects on splicing from variants beyond 10 to 20 bases of exon-intron boundaries. Here, we demonstrate the value of SpliceAI to inform curation of rare variants previously classified as benign/likely benign (B/LB) under current guidelines.

METHODS: Exome sequencing data from 576 pediatric cancer patients enrolled in the Texas KidsCanSeq study were filtered for intronic or synonymous variants absent from population databases, predicted to alter splicing via SpliceAI (>0.20), and scored >10 by combined annotation-dependent depletion. Rare synonymous or intronic B/LB variants in 61 genes submitted to ClinVar were …

Use Of Botulinum Toxin In The Management Of Dystonia In Parkinson’S Disease, Charenya Anandan, Joseph Jankovic

Faculty, Staff and Students Publications

Botulinum toxin is one of the most potent neurotoxins, but when injected into an overactive muscle, it can transiently alleviate an involuntary movement, such as dystonia. The primary aim of this article is to provide a comprehensive review of the various forms of dystonia observed in patients with Parkinson's disease who can benefit from a therapeutic trial of botulinum toxin. Although most of these indications are not supported by randomized controlled clinical trials and, therefore, not approved by the Food and Drug Administration, there are many open-label trials supporting a large body of empirical experience testifying to the benefits of …

Tracking Updates In Clinical Databases Increases Efficiency For Variant Reanalysis, Lele Li, Xia Tian, Vaughan Woodzell, Richard A Gibbs, Bo Yuan, Eric Venner

Faculty, Staff and Students Publications

PURPOSE: Variant interpretation, guided by American College of Medical Genetics and Genomics guidelines, can inform clinical decision-making. However, interpretations may change over time for a variety of reasons. Periodic reanalysis of previous variant interpretations is important to ensure that reported genetic findings remain accurate according to current knowledge.

METHODS: We performed automated filtering by comparing ClinVar variants available in August 2020 with those from August 2021 to screen for potential reanalysis candidates from 3 projects. These variants were subsequently interpreted based on the American College of Medical Genetics and Genomics/Association for Molecular Pathology variant interpretation guideline or ClinGen revised gene-specific …

Screening For Adhd In Adult Patients With Epilepsy: Prevalence Of Symptoms And Challenges To Diagnosis, Trung Nguyen, Emily Xiao, Allison Clark, Afroz Shamim, Atul Maheshwari

Faculty, Staff and Students Publications

OBJECTIVE: Given the complex nature of seizure disorders and their treatments, ADHD may be underdiagnosed in this population. We hypothesized that a higher percentage of patients presenting to a seizure clinic would endorse ADHD symptoms compared to rates reported in the general population and that formal screening for ADHD symptoms would identify patients with previously undiagnosed comorbid ADHD.

METHODS: In this study, we surveyed 312 adults in a seizure clinic using the Adult ADHD Self-Report Scale (ASRS-v1.1).

RESULTS: We found that 90 patients (28.8%) screened positive with the ASRS-v1.1, but only nine of these patients were able to complete neuropsychological …

Wall Motion Assessment By Feature Tracking In Pediatric Patients With Coronary Anomalies Undergoing Dobutamine Stress Cmr, Shagun Sachdeva, Silvana Molossi, Dana Reaves-O'Neal, Prakash Masand, Tam T Doan

Faculty, Staff and Students Publications

BACKGROUND: Left ventricular (LV) wall motion assessment is an important adjunct in addition to perfusion defects in assessing ischemic changes. This study aims to investigate the feasibility and utility of performing feature tracking (FT) in pediatric patients with coronary anomalies undergoing dobutamine stress CMR to assess wall motion abnormalities (WMA) and perfusion defects.

METHOD: This is a retrospective study where 10 patients with an inducible first-pass perfusion (FPP) defect and 10 without were selected. Global LV circumferential strain/strain rate (GCS/GCSR) was measured at rest and at peak stress (systole and diastole) using a commercially available feature tracking software. Peak GCS …

Anomalous Aortic Origin Of A Coronary Artery In Pediatric Patients, Tam T Doan, Charles Puelz, Craig Rusin, Silvana Molossi

Faculty, Staff and Students Publications

PURPOSE OF REVIEW: We present a contemporary approach to risk assessment and management of patients with anomalous aortic origin of a coronary artery (AAOCA).

RECENT FINDINGS: Anomalous left coronary artery from the right aortic sinus (L-AAOCA) with interarterial course carries a high risk of sudden cardiac death (SCD); therefore, current guidelines recommend exercise restriction and surgical intervention. Recent data in intraseptal and juxtacommissural L-AAOCA showed inducible perfusion abnormalities, leading to consideration of surgical intervention. Anomalous right coronary artery from the left aortic sinus (R-AAOCA) carries a much lower risk and stress perfusion imaging is helpful in identifying patients with inducible …

Treatment Of High- And Intermediate-High-Risk Pulmonary Embolism By The Pulmonary Embolism Response Team: Focus On Catheter-Directed Therapies, Arkadiusz Pietrasik, Paweł Kurzyna, Piotr Szwed, Karolina Jasińska-Gniadzik, Aleksandra Gąsecka, Szymona Darocha, Dariusz Zieliński, Łukasz Szarpak, Janusz Kochman, Marcin Grabowski, Grzegorz Opolski, Adam Torbicki, Marcin Kurzyna

Faculty, Staff and Students Publications

BACKGROUND: Multidisciplinary Pulmonary Embolism Response Teams (PERTs) were established to individualize the treatment of high-risk (HR) and intermediate-high-risk (IHR) pulmonary embolism (PE) patients, which pose a challenge in clinical practice.

METHODS: We retrospectively collected the data of all HR and IHR acute PE patients consulted by PERT CELZAT between September 2017 and October 2022. The patient population was divided into four different treatment methods: anticoagulation alone (AC), systemic thrombolysis (ST), surgical embolectomy (SE), and catheter-directed therapies (CDTx). Baseline clinical characteristics, risk stratification, PE severity parameters, and treatment outcomes were compared between the four groups.

RESULTS: Of the 110 patients with …

Meta-Analysis Of Postoperative Myocardial Injury As A Predictor Of Mortality After Living Donor Liver Transplantation, Krzysztof Jankowski, Frank W Peacock, Michal Pruc, Teresa Malecka-Massalska, Lukasz Szarpak

Faculty, Staff and Students Publications

BACKGROUND: The purpose of this study was to perform a systematic review and meta-analysis to investigate postoperative myocardial injury, as expressed by the postoperative concentration of high-sensitivity cardiac troponin I (hs-cTnI) as a predictor of mortality among living donor liver transplantation (LDLT) patients.

METHODS: PubMed, Scopus, Embase and the Cochrane Library were searched through to September 1st 2022. The primary endpoint included in-hospital mortality. Secondary endpoints were 1-year mortality and re-transplantation occurrence. Estimates are expressed as risk ratios (RRs) and 95% confidence intervals (95% CIs). Heterogeneity was assessed with the I² test.

RESULTS: During the search, 2 studies were found …