Digital Commons Network^™

The Transition From Medical Student To Junior Doctor: Today's Experiences Of Tomorrow's Doctors., Nicola Brennan, Oonagh Corrigan, Jon Allard, Julian Archer, Rebecca Barnes, Alan Bleakley, Tracey Collett, Bere Sr De

Peninsula Medical School

CONTEXT Medical education in the UK has recently undergone radical reform. Tomorrow's Doctors has prescribed undergraduate curriculum change and the Foundation Programme has overhauled postgraduate education. OBJECTIVES This study explored the experiences of junior doctors during their first year of clinical practice. In particular, the study sought to gain an understanding of how junior doctors experienced the transition from the role of student to that of practising doctor and how well their medical school education had prepared them for this. METHODS The study used qualitative methods comprising of semi-structured interviews and audio diary recordings with newly qualified doctors based at …

Fagerstrom Test For Nicotine Dependence Vs Heavy Smoking Index In A General Population Survey, M. Pérez-Ríos, M. I. Santiago-Pérez, B. Alonso, A. Malvar, X. Hervada, Jose De Leon

Psychiatry Faculty Publications

BACKGROUND: The Fagerström Test for Nicotine Dependence (FTND) is used for assessing nicotine dependence. A shorter test derived from the FTND used for the general population is the Heavy Smoking Index (HSI) (six questions vs. two). The objective of this study is to compare the validity of the HSI versus the FTND.

METHODS: A survey of tobacco use in the general population was carried out in the northern Spanish region of Galicia using both the FTND and the HSI to study a representative sample of 1655 daily smokers. The HSI was compared with the FTND, considered the gold standard. Measures …

A Critical Look At Student Resistance To Non-Traditional Law School Professors, Kathryn P. Nordick

Western New England Law Review

No abstract provided.

Hla-Dpb1 And Dpb2 Are Genetic Loci For Systemic Sclerosis: A Genome-Wide Association Study In Koreans With Replication In North Americans, Xiaodong Zhou, Jong Eun Lee, Frank C Arnett, Momiao Xiong, Min Young Park, Yeon Kyeong Yoo, Eun Soon Shin, John D Reveille, Maureen D Mayes, Jin Hyun Kim, Ran Song, Ji Yong Choi, Ji Ah Park, Yun Jong Lee, Eun Young Lee, Yeong Wook Song, Eun Bong Lee

Faculty, Staff and Student Publications

OBJECTIVE: To identify systemic sclerosis (SSc) susceptibility loci via a genome-wide association study.

METHODS: A genome-wide association study was performed in 137 patients with SSc and 564 controls from Korea using the Affymetrix Human SNP Array 5.0. After fine-mapping studies, the results were replicated in 1,107 SSc patients and 2,747 controls from a US Caucasian population.

RESULTS: The single-nucleotide polymorphisms (SNPs) (rs3128930, rs7763822, rs7764491, rs3117230, and rs3128965) of HLA-DPB1 and DPB2 on chromosome 6 formed a distinctive peak with log P values for association with SSc susceptibility (P=8.16x10(-13)). Subtyping analysis of HLA-DPB1 showed that DPB1*1301 (P=7.61x10(-8)) and DPB1*0901 (P=2.55x10(-5)) were …

Face Gender And Emotion Expression: Are Angry Women More Like Men?, Ursula Hess, Reginald B. Adams, Karl Grammer, Robert E. Kleck

Dartmouth Scholarship

Certain features of facial appearance perceptually resemble expressive cues related to facial displays of emotion. We hypothesized that because expressive markers of anger (such as lowered eyebrows) overlap with perceptual markers of male sex, perceivers would identify androgynous angry faces as more likely to be a man than a woman (Study 1) and would be slower to classify an angry woman as a woman than an angry man as a man (Study 2). Conversely, we hypothesized that because perceptual features of fear (raised eyebrows) and happiness (a rounded smiling face) overlap with female sex markers, perceivers would be more likely …

Brazilian Adolescents Infected By Hiv: Epidemiologic Characteristics And Adherence To Treatment, Julia K. C. Machado, Maria J. C. Sant'anna, Veronica Coates, Flavia J. Almeida, Eitan N. Berezin, Hatim A. Omar

Pediatrics Faculty Publications

Over the last 3 decades since the first AIDS cases appeared, we have witnessed great progress in therapeutic methodologies that have transformed the evolution of the disease from debilitating and fatal, into chronic and controllable. HIV-infected children are arriving at adolescence and bringing specific challenges, not only to themselves, but also to their families and caregivers. This retrospective study sets forth epidemiological and treatment characteristics of 46 HIV-infected adolescents followed in a specialized university service relating said characteristics to therapy adherence assessed through a combination of three indirect methods. Therapy adherence did not reveal any association with either epidemiologic characteristics …

Aging Influences The Neural Correlates Of Lexical Decision But Not Automatic Semantic Priming, Brian T. Gold, Anders H. Andersen, Greg A. Jicha, Charles D. Smith

Neuroscience Faculty Publications

Human behavioral data indicate that older adults are slower to perform lexical decisions (LDs) than young adults but show similar reaction time gains when these decisions are primed semantically. The present study explored the functional neuroanatomic bases of these frequently observed behavioral findings. Young and older groups completed unprimed and primed LD tasks while functional magnetic resonance imaging (fMRI) was recorded, using a fully randomized trial design paralleling those used in behavioral research. Results from the unprimed task found that age-related slowing of LD was associated with decreased activation in perceptual extrastriate regions and increased activation in regions associated with …

Embolic Complication Of Tako-Tsubo Cardiomyopathy., Vincent M. Figueredo, S Gupta

Department of Medical Genetics Faculty Papers

No abstract provided.

Analysis Of Globule Types In Malignant Melanoma, Jin Xu, Kapil Kumar Gupta, William V. Stoecker, Yamini Krishnamurthy, Harold S. Rabinovitz, Austin Bangert, David A. Calcara, Margaret C. Oliviero, Joseph M. Malters, Rhett J. Drugge, R. Joe Stanley, Randy Hays Moss, Mehmed Emre Celebi

Chemistry Faculty Research & Creative Works

Objective: To identify and analyze subtypes of globules based on size, shape, network connectedness, pigmentation, and distribution to determine which globule types and globule distributions are most frequently associated with a diagnosis of malignant melanoma. Design: Retrospective case series of dermoscopy images with globules. Setting: Private dermatology practices. Participants: Patients in dermatology practices. Intervention: Observation only. Main Outcome Measure: Association of globule types with malignant melanoma. Results: The presence of large globules (odds ratio [OR], 5.25) and globules varying in size (4.72) or shape (5.37) had the highest ORs for malignant melanoma among all globule types and combinations studied. Classical …

Accurate Molecular Classification Of Cancer Using Simple Rules., Xiaosheng Wang, Osamu Gotoh

Journal Articles: Genetics, Cell Biology & Anatomy

BACKGROUND: One intractable problem with using microarray data analysis for cancer classification is how to reduce the extremely high-dimensionality gene feature data to remove the effects of noise. Feature selection is often used to address this problem by selecting informative genes from among thousands or tens of thousands of genes. However, most of the existing methods of microarray-based cancer classification utilize too many genes to achieve accurate classification, which often hampers the interpretability of the models. For a better understanding of the classification results, it is desirable to develop simpler rule-based models with as few marker genes as possible.

METHODS: …

Intracranial Eeg Reveals A Time- And Frequency-Specific Role For The Right Inferior Frontal Gyrus And Primary Motor Cortex In Stopping Initiated Responses, Nicole Swann, Nitin Tandon, Ryan Canolty, Timothy M Ellmore, Linda K Mcevoy, Stephen Dreyer, Michael Disano, Adam R Aron

Faculty, Staff and Student Publications

Inappropriate response tendencies may be stopped via a specific fronto/basal ganglia/primary motor cortical network. We sought to characterize the functional role of two regions in this putative stopping network, the right inferior frontal gyrus (IFG) and the primary motor cortex (M1), using electocorticography from subdural electrodes in four patients while they performed a stop-signal task. On each trial, a motor response was initiated, and on a minority of trials a stop signal instructed the patient to try to stop the response. For each patient, there was a greater right IFG response in the beta frequency band ( approximately 16 Hz) …

Antidepressant-Induced Mania With Concomitant Mood Stabilizer In Patients With Comorbid Substance Abuse And Bipolar Disorder., Daniel Z Lieberman, George Kolodner, Suena H Massey, Kenneth P Williams

Psychiatry and Behavioral Sciences Faculty Publications

Antidepressant use in the treatment of bipolar disorder is controversial due the risks of affective switching and cycle acceleration. Studies of non-comorbid samples suggest that the risk can be mitigated with the use of a concomitant mood stabilizer. However, the majority of patients with bipolar disorder will experience a comorbid substance use disorder and little is known about these individuals because they are typically excluded from clinical trials. Patients entering a substance abuse treatment program who had a history of bipolar disorder were interviewed to evaluate antidepressant-induced affective switching with and without concomitant mood stabilizer. Among 41 comorbid participants, the …

Sour Ageusia In Two Individuals Implicates Ion Channels Of The Asic And Pkd Families In Human Sour Taste Perception At The Anterior Tongue., Taufiqul Huque, Beverly J Cowart, Luba Dankulich-Nagrudny, Edmund A Pribitkin, Douglas L Bayley, Andrew I Spielman, Roy S Feldman, Scott A Mackler, Joseph G Brand

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: The perception of sour taste in humans is incompletely understood at the receptor cell level. We report here on two patients with an acquired sour ageusia. Each patient was unresponsive to sour stimuli, but both showed normal responses to bitter, sweet, and salty stimuli.

METHODS AND FINDINGS: Lingual fungiform papillae, containing taste cells, were obtained by biopsy from the two patients, and from three sour-normal individuals, and analyzed by RT-PCR. The following transcripts were undetectable in the patients, even after 50 cycles of amplification, but readily detectable in the sour-normal subjects: acid sensing ion channels (ASICs) 1a, 1beta, 2a, …

Bridging The Care Continuum: Patient Information Needs For Specialist Referrals., Carol L. Ireson, Svetla Slavova, Carol L. Steltenkamp, F. Douglas Scutchfield

Preventive Medicine and Environmental Health Faculty Publications

BACKGROUND: Information transfer is critical in the primary care to specialist referral process and has been examined extensively in the US and other countries, yet there has been little attention to the patient's perspective of the information transfer process. This cross-sectional study examined the quality of the information received by patients with a chronic condition from the referring and specialist physician in the specialist referral process and the relationship of the quality of information received to trust in the physicians.

METHODS: Structured telephone interviews were conducted with a random sample of 250 patients who had experienced a referral to a …

There Are Multiple Contributors To The Verbal Short-Term Memory Deficit In Children With Developmental Reading Disabilities., Michelle Y. Kibby

Publications

Prior research has put forth at least four possible contributors to the verbal short-term memory (VSTM) deficit in children with developmental reading disabilities (RD): poor phonological awareness that affects phonological coding into VSTM, a less effective phonological store, slow articulation rate, and fewer/poorer quality long-term memory (LTM) representations. This project is among the first to test the four suppositions in one study. Participants included 18 children with RD and 18 controls. VSTM was assessed using Baddeley's model of the phonological loop. Findings suggest all four suppositions are correct, depending upon the type of material utilized. Children with RD performed comparably …

Sexuality And Persons With Down Syndrome. A Study From Brazil, Bruna Marques Bononi, Maria José Carvalho Sant'anna, André Chao Vasconcellos De Oliveira, Tadeu Silveira Renattini, Carla Franchi Pinto, Maria Lúcia Passarelli, Verônica Coates, Hatim A. Omar

Pediatrics Faculty Publications

In recent years, important gains and changes have been observed in the life of teenagers with Down syndrome (DS) with increased inclusion into society. This review will discuss adolescence and sexuality in teenagers with DS from a descriptive study of 50 patients with DS between the ages of 10 and 20 years. The mean age was 13.5 years, 50% females; 86% went to school with 62.2% in school for over six years. Of the patients that attended school, 60% went to special education school and only 10% read and wrote correctly. In an evaluation of autonomy, 66% took showers, 78% …

Aging And Environmental Exposures Alter Tissue-Specific Dna Methylation Dependent Upon Cpg Island Context, Brock C. Christensen, E Andres Houseman, Carmen J. Marsit, Shichun Zheng, Margaret R. Wrensch, Joseph L. Wiemels, Heather H. Nelson, Margaret R. Karagas

Dartmouth Scholarship

Epigenetic control of gene transcription is critical for normal human development and cellular differentiation. While alterations of epigenetic marks such as DNA methylation have been linked to cancers and many other human diseases, interindividual epigenetic variations in normal tissues due to aging, environmental factors, or innate susceptibility are poorly characterized. The plasticity, tissue-specific nature, and variability of gene expression are related to epigenomic states that vary across individuals. Thus, population-based investigations are needed to further our understanding of the fundamental dynamics of normal individual epigenomes. We analyzed 217 non-pathologic human tissues from 10 anatomic sites at 1,413 autosomal CpG loci …

Food Insecurity Among Homeless And Marginally Housed Individuals Living With Hiv/Aids In San Francisco, Sheri D. Weiser, David R. Bangsberg, Susan Kegeles, Kathleen Ragland, Margot B. Kushel, Edward A. Frongillo Jr.

Faculty Publications

Food insecurity is a risk factor for both HIV transmission and worse HIV clinical outcomes. We examined the prevalence of and factors associated with food insecurity among homeless and marginally housed HIV-infected individuals in San Francisco recruited from the Research on Access to Care in the Homeless Cohort. We used multiple logistic regression to determine socio-demographic and behavioral factors associated with food insecurity, which was measured using the Household Food Insecurity Access Scale. Among 250 participants, over half (53.6%) were food insecure. Higher odds of food insecurity was associated with being white, low CD4 counts, recent crack use, lack of …

Mode Of Delivery Decisions Among Hiv-Infected Mothers At An Urban Maternity Hospital In Nairobi, Kenya, Jessica Hoffmann Beard

Yale Medicine Thesis Digital Library

Purpose: The objectives of this study are to describe mode of delivery decision making among HIV positive women, understand patient knowledge and attitudes regarding elective cesarean section (ECS) for prevention of mother-to-child transmission of HIV (PMTCT), and in turn quantify the use of ECS for PMTCT at an urban Kenyan maternity hospital. Methods: This is a descriptive cross-sectional study involving the survey of postpartum HIV-infected women delivering at Pumwani Maternity Hospital (PMH) in Nairobi, Kenya. Each participant was interviewed using a standardized questionnaire. Results: 250 women participated in this study over the course of three months. The rate of delivery …

Evaluation Of A Social Support Measure That May Indicate Risk Of Depression During Pregnancy, Lori Spoozak

Yale Medicine Thesis Digital Library

The objective of this study was to evaluate the psychometric properties of the Kendler Social Support Interview modified for administration to pregnant women and to assess the relationship between social support and depression in the first trimester of pregnancy. Subjects were administered the Modified Kendler Social Support Interview (MKSSI) and the Composite International Diagnostic Index to diagnose depression. Principal components analysis was employed to construct the MKSSI score. Cronbachs coefficient alpha and principal factor analysis were run for items included in the MKSSI score. The relationship between a depressive diagnosis and the MKSSI score and subscales was assessed by logistic …

Use Of Media To Improve Human Papilloma Virus (Hpv)Vaccine Acceptability, Pavithra Venkat

Yale Medicine Thesis Digital Library

Our objective was to determine if using a video educational tool can influence (1) individual vaccine acceptability (2) parental acceptability, (3) parental views on vaccine mandates, and (4) age of vaccination accepted for the Human Papilloma Virus (HPV) vaccine. We conducted a cross-sectional study using bilingual surveys distributed at Brigham and Womens and Massachusetts General Hospital clinics and at the Coalition of Boston Public Health Association from January to March 2007. An initial 32-question survey addressing HPV knowledge, beliefs and vaccine acceptability was completed, followed by an eight-minute video about HPV and the vaccine. An additional 11-question post assessment was …

Intussusception Of The Appendix: New Trends And Comprehensive Analysis Of 140 Case Reports, Barbara Wexelman

Yale Medicine Thesis Digital Library

INTUSSUSCEPTION OF THE APPENDIX: NEW TRENDS AND COMPREHENSIVE ANALYSIS OF 140 PUBLISHED CASE REPORTS. Barbara A. Wexelman, Cassius Ochoa Chaar, and Walter Longo. Section of Colorectal Surgery, Department of Surgery, Yale University, School of Medicine, New Haven, CT. Statement of Purpose: This paper uses 139 published case reports to understand the demographic, diagnostic, and treatment trends of intussusception of the appendix. Methods: Using the PubMed literature search engine to find all English references of intussusception and appendix, and reviewing those that contained actual case reports of intussusception of the appendix, we analyzed the demographics, presentation, diagnostic methods, surgical treatment, and …

A Functional Difficulty And Functional Pain Instrument For Hip And Knee Osteoarthritis, Alan M. Jette, Christine M. Mcdonough, Pengsheng Ni, Stephen M. Haley

Dartmouth Scholarship

The objectives of this study were to develop a functional outcome instrument for hip and knee osteoarthritis research (OA-FUNCTION-CAT) using item response theory (IRT) and computer adaptive test (CAT) methods and to assess its psychometric performance compared to the current standard in the field.

Dicer Is Required For Female Reproductive Tract Development And Fertility In The Mouse, Gabriel Gonzalez, Richard R Behringer

Faculty, Staff and Student Publications

Dicer encodes a riboendonuclease required for microRNA biosynthesis. Dicer was inactivated in Müllerian duct mesenchyme-derived tissues of the reproductive tract of the mouse, using an Amhr2-Cre allele. Although Amhr2-Cre; Dicer conditional mutant males appeared normal and were fertile, mutant females were infertile. In adult mutant females, there was a reduction in the size of the oviducts and uterine horns. The oviducts were less coiled compared to controls and cysts formed at the isthmus near the uterotubal junction. Unfertilized, degenerate oocytes were commonly found within these cysts, indicating a defect in embryo transit. Beads transferred into the mutant oviduct failed to …

A Truncation Mutation In Tbc1d4 In A Family With Acanthosis Nigricans And Postprandial Hyperinsulinemia, Satya Dash, Hiroyuki Sano, Justin J. Rochford, Robert K. Semple

Dartmouth Scholarship

Tre-2, BUB2, CDC16, 1 domain family member 4 (TBC1D4) (AS160) is a Rab-GTPase activating protein implicated in insulin-stimulated glucose transporter 4 (GLUT4) translocation in adipocytes and myotubes. To determine whether loss-of-function mutations in TBC1D4 might impair GLUT4 translocation and cause insulin resistance in humans, we screened the coding regions of this gene in 156 severely insulin-resistant patients. A female presenting at age 11 years with acanthosis nigricans and extreme postprandial hyperinsulinemia was heterozygous for a premature stop mutation (R363X) in TBC1D4. After demonstrating reduced expression of wild-type TBC1D4 protein and expression of the truncated protein in lymphocytes from the proband, …

Identifying Sleep Regulatory Genes Using A Drosophila Model Of Insomnia, Laurent Seugnet, Yasuko Suzuki, Matthew S. Thimgan, Jeffrey Donlea, Sarah I. Gimbel, Laura Gottschalk, Stephen P. Duntley, Paul J. Shaw

Biological Sciences Faculty Research & Creative Works

Although it is widely accepted that sleep must serve an essential biological function, little is known about molecules that underlie sleep regulation. Given that insomnia is a common sleep disorder that disrupts the ability to initiate and maintain restorative sleep, a better understanding of its molecular underpinning may provide crucial insights into sleep regulatory processes. Thus, we created a line of flies using laboratory selection that share traits with human insomnia. After 60 generations, insomnia-like (ins-l) flies sleep 60 min a day, exhibit difficulty initiating sleep, difficulty maintaining sleep, and show evidence of daytime cognitive impairment. ins-l flies …

Memory Functioning In Developmental Dyslexia: An Analysis Using Two Clinical Memory Measures., Michelle Y. Kibby

Publications

The goals of this project were threefold: to determine the nature of the memory deficit in children/adolescents with dyslexia, to utilize clinical memory measures in this endeavor, and to determine the extent to which semantic short-term memory (STM) is related to basic reading performance. Two studies were conducted using different samples, one incorporating the Wide Range Assessment of Memory and Learning and the other incorporating the California Verbal Learning Test-Children's Version. Results suggest that phonological STM is deficient in children with dyslexia, but semantic STM and visual-spatial STM are intact. Long-term memory (LTM) for both visual and verbal material also …

Our Greatest Want: An Examination Of The Rhetorical Tendencies Employed By African American Female Abolitionist Frances Ellen Watkins Harper (1825-1911), Lauren Deborah Nye

English

You are standing at the doorway of a church in Philadelphia. Looking in, you see a mass of heads, all turned toward the podium, waiting for someone to get behind that podium. Then you see her. She is an attractive African American with “a fair figure, long, lustrous hair, and facial features pleasant to behold” (Logan 49). You overhear one person comment that she looks like “a bronze muse” (Logan 31). A reporter will later write that she has “a strong face, with a shadowed glow upon it, indicative of thoughtful fervor, and of a nature most femininely sensitive, but …

Genome Based Cell Population Heterogeneity Promotes Tumorigenicity: The Evolutionary Mechanism Of Cancer., Christine J. Ye, Joshua B. Stevens, Guo Liu, Steven W. Bremer, Aruna S. Jaiswal, Karen J. Ye, Ming-Fong Lin, Lesley Lawrenson, Wayne D. Lancaster, Markku Kurkinen, Joshua D. Liao, C. Gary Gairola, Malathy P. V. Shekhar, Satya Narayan, Fred R. Miller, Henry H. Q. Heng

Journal Articles: Biochemistry & Molecular Biology

Cancer progression represents an evolutionary process where overall genome level changes reflect system instability and serve as a driving force for evolving new systems. To illustrate this principle it must be demonstrated that karyotypic heterogeneity (population diversity) directly contributes to tumorigenicity. Five well characterized in vitro tumor progression models representing various types of cancers were selected for such an analysis. The tumorigenicity of each model has been linked to different molecular pathways, and there is no common molecular mechanism shared among them. According to our hypothesis that genome level heterogeneity is a key to cancer evolution, we expect to reveal …

Localized Biliary Ischemia In Patients With Hepatic Arteriovenous Malformations, A Newly Recognized Syndrome Occurring In Hereditary Hemorrhagic Telangiectasia Diagnosis And Management, Rasha Khoury

Yale Medicine Thesis Digital Library

The clinical manifestations of hepatic arteriovenous malformations (HAVMs) were elucidated. A review of the literature was undertaken to better understand how HAVMs specifically affect the biliary system. A retrospective review of the 50 patients with HAVMs seen at the Yale University HHT Center was done, including clinical manifestation, intervention and outcome analysis. Of 50 adults with HAVM, median age was 64 (range 17-73) and 84% were female. Initially 74% were classified as Type 1, symptomatic heart failure, 16% as Type 2, portal hypertension, and 10% as Type 3, biliary abnormalities. In Type 1 conversion to Type 3 was associated with …