Digital Commons Network^™

Sustained Attention In Children With Two Etiologies Of Early Hydrocephalus, Maegan D. Swartwout, Paul T. Cirino, Amy W. Hampson, Jack M. Fletcher, Michael E. Brandt, Maureen Dennis

Faculty, Staff and Student Publications

Several studies have shown that children with spina bifida meningomyelocele (SBM) and hydrocephalus have attention problems on parent ratings and difficulties in stimulus orienting associated with a posterior brain attention system. Less is known about response control and inhibition associated with an anterior brain attention system. Using the Gordon Vigilance Task (Gordon, 1983), we studied error rate, reaction time, and performance over time for sustained attention, a key anterior attention function, in 101 children with SBM, 17 with aqueductal stenosis (AS; another condition involving congenital hydrocephalus), and 40 typically developing controls (NC). In SBM, we investigated the relation between cognitive …

Speaking The Right Language: The Scientific Method As A Framework For A Continuous Quality Improvement Program Within Academic Medical Research Compliance Units, Kurt B. Nolte, Douglas M. Stewart, Kevin C. O'Hair, William L. Gannon, Michael S. Briggs, A Marie Barron, Judy Pointer, Richard S. Larson

Pathology Research and Scholarship

The authors developed a novel continuous quality improvement (CQI) process for academic biomedical research compliance administration. A challenge in developing a quality improvement program in a nonbusiness environment is that the terminology and processes are often foreign. Rather than training staff in an existing quality improvement process, the authors opted to develop a novel process based on the scientific method--a paradigm familiar to all team members. The CQI process included our research compliance units. Unit leaders identified problems in compliance administration where a resolution would have a positive impact and which could be resolved or improved with current resources. They …

Design And Rationale Of A Randomized Trial Comparing The Blalock-Taussig And Right Ventricle-Pulmonary Artery Shunts In The Norwood Procedure., Richard G. Ohye, J William Gaynor, Nancy S. Ghanayem, Caren S. Goldberg, Peter C. Laussen, Peter C. Frommelt, Jane W. Newburger, Gail D. Pearson, Sarah Tabbutt, Gil Wernovsky, Lisa M. Wruck, Andrew M. Atz, Steve D. Colan, James Jaggers, Brian W. Mccrindle, Ashwin Prakash, Michael D. Puchalski, Lynn A. Sleeper, Mario P. Stylianou, Lynn Mahony, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: The initial palliative procedure for patients born with hypoplastic left heart syndrome and related single right ventricle anomalies, the Norwood procedure, remains among the highest risk procedures in congenital heart surgery. The classic Norwood procedure provides pulmonary blood flow with a modified Blalock-Taussig shunt. Improved outcomes have been reported in a few small, nonrandomized studies of a modification of the Norwood procedure that uses a right ventricle-pulmonary artery shunt to provide pulmonary blood flow. Other nonrandomized studies have shown no differences between the two techniques.

METHODS: The Pediatric Heart Network designed a randomized clinical trial to compare outcomes for …

Shift Report And Sbar: Strategies For Clinical Postconference., Fatima Ascano-Martin

Nursing | Faculty Scholarship

Conducting an effective postconference continues to be challenging because of low levels of student participation. Many students are exhausted at the end of the clinical day, which lessens their participation in postconference. In my experience, students often omit important information, such as patients’ age, sex, race, and other medical problems, during initial reports. Some have trouble providing patients’ information in an organized manner as well. The SBAR (situation-background-assessment-recommendation) communication tool can be used as a strategy to conduct clinical postconference.

Mitochondrial Redox Signaling By P66shc Is Involved In Regulating Androgenic Growth Stimulation Of Human Prostate Cancer Cells., Suresh Veeramani, Ta-Chun Yuan, Fen-Fen Lin, Ming-Fong Lin

Journal Articles: Biochemistry & Molecular Biology

p66Shc is shown to negatively regulate the life span in mice through reactive oxygen species (ROS) production. Recent reports, however, revealed that p66Shc protein level is significantly elevated in several human cancer tissues and growth-stimulated carcinoma cells, suggesting a mitogenic and carcinogenic role for p66Shc. In this communication, we demonstrate for the first time that p66Shc mediates androgenic growth signals in androgen-sensitive human prostate cancer cells through mitochondrial ROS production. Growth stimulation of prostate cancer cells with 5alpha-dihydrotestosterone (DHT) is accompanied by increased p66Shc level and ROS production, which is abolished by antioxidant treatments. However, antioxidant treatments do not affect …

Infant Mortality In Delaware: The Need To Improve Maternal Health And Reduce Premature Births., David A. Paul. Md

Department of Pediatrics Faculty Papers

Delaware's high infant mortality rate continues to be driven by an increasing number of premature births. Premature birth is a complex problem with both social and medical roots. Based on the CDC road map, programs aimed at improving preconception health of women of childbearing age are blossoming in Delaware. In addition, Delaware's infant mortality rate can only be reduced if we are able to diminish disparities in health care delivery, and improve the social factors influencing infant mortality. These factors include diminishing family support, low high school graduation rate, poor housing, and a lack of health insurance.

Structures And Functions Of The Normal And Injured Human Olfactory Epithelium, Jonathan P Schuermann, Jianwen Jiang, Jorge Cuellar, Oscar Llorca, Liping Wang, Luis E Gimenez, Suping Jin, Alexander B Taylor, Borries Demeler, Kevin A Morano, P John Hart, Jose M Valpuesta, Eileen M Lafer, Rui Sousa

Faculty, Staff and Student Publications

Hsp70s mediate protein folding, translocation, and macromolecular complex remodeling reactions. Their activities are regulated by proteins that exchange ADP for ATP from the nucleotide-binding domain (NBD) of the Hsp70. These nucleotide exchange factors (NEFs) include the Hsp110s, which are themselves members of the Hsp70 family. We report the structure of an Hsp110:Hsc70 nucleotide exchange complex. The complex is characterized by extensive protein:protein interactions and symmetric bridging interactions between the nucleotides bound in each partner protein's NBD. An electropositive pore allows nucleotides to enter and exit the complex. The role of nucleotides in complex formation and dissociation, and the effects of …

Muscle-Bone Relationships In The Lower Leg Of Healthy Pre-Pubertal Females And Males, Teresa L. Binkley, Bonny Specker

Ethel Austin Martin Program Publications

Muscle-bone relationships in healthy pre-pubertal children were investigated using four muscle measures as predictors of tibial strength: 66% tibia cross-sectional muscle area (CSMA) by pQCT; leg lean mass (LLM) by DXA; and muscle power (Power) and force (Force) measured during a two-footed jump. Polar strength strain index (pSSI), a calculated surrogate for bone strength at the 20% distal tibia, was obtained on 105 (54 male) self-assessed pre-pubertal children. The amount of muscle (CSMA, LLM) may influence bone strength more than muscle strength (Power, Force) during periods of rapid growth. Correlations and multiple regression partial-R values from models controlling for age, …

A Pooled Analysis Of Two Placebo-Controlled Trials Of Desvenlafaxine In Major Depressive Disorder., Daniel Z Lieberman, Stuart A Montgomery, Karen A Tourian, Claudine Brisard, Gregory Rosas, Krishna Padmanabhan, Jean-Michel Germain, Bruno Pitrosky

Psychiatry and Behavioral Sciences Faculty Publications

The efficacy, safety, and tolerability of desvenlafaxine (administered as desvenlafaxine succinate) were evaluated in two similarly designed, phase 3, randomized, double-blind, placebo-controlled, venlafaxine-extended-release-referenced, flexible-dose studies of outpatients with a primary diagnosis of major depressive disorder. Owing to a high placebo response, the individual studies were underpowered. Therefore, a post-hoc pooled analysis was performed (desvenlafaxine and placebo data were pooled; venlafaxine extended release data were not, owing to different flexible-dose regimens in the two studies). The primary outcome measure was the change from baseline on the 17-item Hamilton Rating Scale for Depression; the Clinical Global Impressions-Improvement item score was a secondary …

The State Of The Art In Evaluating The Performance Of Assistant And Associate Deans As Seen By Deans And Assistant And Associate Deans., David G. Dunning, Timothy M. Durham, Mert N. Aksu, Brian M. Lange

Journal Articles: College of Dentistry

This study explores the little-understood process of evaluating the performance of assistant and associate deans at dental colleges in the United States and Canada. Specifically, this research aimed to identify the methods, processes, and outcomes related to the performance appraisals of assistant/associate deans. Both deans and assistant/associate deans were surveyed. Forty-four of sixty-six deans (66.7 percent) and 227 of 315 assistant/associate deans (72.1 percent) completed surveys with both close-ended and open-ended questions. In addition, ten individuals from each group were interviewed. Results indicate that 75-89 percent of assistant/associate deans are formally evaluated, although as many as 27 percent may lack …

Fat Embolism Syndrome., Renu Saigal, M Mittal, A Kansal, Y Singh, P R. Kolar, Shobhit Jain

Manuscripts, Articles, Book Chapters and Other Papers

Fat embolism syndrome is a rare complication occurring in 0.5 to 2% of patients following a long bone fracture. It is believed to be caused by the toxic effects of free fatty acids. Diagnosis is clinical, based on respiratory, cerebral and dermal manifestations. Treatment is only supportive, directed mainly at maintaining respiratory functions.

Functional Imaging Of The Auditory Processing Applied To Speech Sounds, Roy D Patterson, Ingrid Johnsrude

Brain and Mind Institute Researchers' Publications

In this paper, we describe domain-general auditory processes that we believe are prerequisite to the linguistic analysis of speech. We discuss biological evidence for these processes and how they might relate to processes that are specific to human speech and language. We begin with a brief review of (i) the anatomy of the auditory system and (ii) the essential properties of speech sounds. Section 4 describes the general auditory mechanisms that we believe are applied to all communication sounds, and how functional neuroimaging is being used to map the brain networks associated with domain-general auditory processing. Section 5 discusses recent …

Computational Models Of Tandem Src Homology 2 Domain Interactions And Application To Phosphoinositide 3-Kinase, Dipak Barua, James R. Faeder, Jason M. Haugh

Chemical and Biochemical Engineering Faculty Research & Creative Works

Intracellular signal transduction proteins typically utilize multiple interaction domains for proper targeting, and thus a broad diversity of distinct signaling complexes may be assembled. Considering the coordination of only two such domains, as in tandem Src homology 2 (SH2) domain constructs, gives rise to a kinetic scheme that is not adequately described by simple models used routinely to interpret in vitro binding measurements. To analyze the interactions between tandem SH2 domains and bisphosphorylated peptides, we formulated detailed kinetic models and applied them to the phosphoinositide 3-kinase p85 regulatory subunit/platelet-derived growth factor β-receptor system. Data for this system from different in …

Switching Language Switches Mind: Linguistic Effects On Developmental Neural Bases Of ‘Theory Of Mind’, Chiyoko Kobayashi, Gary H. Glover, Elise Temple

Dartmouth Scholarship

Theory of mind (ToM)—our ability to predict behaviors of others in terms of their underlying intentions—has been examined through false-belief (FB) tasks. We studied 12 Japanese early bilingual children (8−12 years of age) and 16 late bilingual adults (18−40 years of age) with FB tasks in Japanese [first language (L1)] and English [second language (L2)], using fMRI. Children recruited more brain regions than adults for processing ToM tasks in both languages. Moreover, children showed an overlap in brain activity between the L1 and L2 ToM conditions in the medial prefrontal cortex (mPFC). Adults did not show such a convergent activity …

Focal White Matter Changes In Spasmodic Dysphonia: A Combined Diffusion Tensor Imaging And Neuropathological Study, Kristina Simonyan, Fernanda Tovar-Moll, John Ostuni, Mark Hallett, Victor F Kalasinsky, Michael R Lewin-Smith, Elisabeth J Rushing, Alexander O Vortmeyer, Christy L Ludlow

Faculty, Staff and Student Publications

Spasmodic dysphonia is a neurological disorder characterized by involuntary spasms in the laryngeal muscles during speech production. Although the clinical symptoms are well characterized, the pathophysiology of this voice disorder is unknown. We describe here, for the first time to our knowledge, disorder-specific brain abnormalities in these patients as determined by a combined approach of diffusion tensor imaging (DTI) and postmortem histopathology. We used DTI to identify brain changes and to target those brain regions for neuropathological examination. DTI showed right-sided decrease of fractional anisotropy in the genu of the internal capsule and bilateral increase of overall water diffusivity in …

Medulloblastomas Overexpress The P53-Inactivating Oncogene Wip1/Ppm1d, Robert C. Castellino, Massimiliano De Bortoli, Xiongbin Lu, Sung-Hwan Moon, Thuy-Ai Nguyen, Mark A. Shepard, Pulivarthi H. Rao, Lawrence A. Donehower, John Y H Kim

Faculty, Staff and Students Publications

Medulloblastoma is the most common malignant brain tumor of childhood. Despite numerous advances, clinical challenges range from recurrent and progressive disease to long-term toxicities in survivors. The lack of more effective, less toxic therapies results from our limited understanding of medulloblastoma growth. Although TP53 is the most commonly altered gene in cancers, it is rarely mutated in medulloblastoma. Accumulating evidence, however, indicates that TP53 pathways are disrupted in medulloblastoma. Wild-type p53-induced phosphatase 1 (WIP1 or PPM1D) encodes a negative regulator of p53. WIP1 amplification (17q22-q23) and its overexpression have been reported in diverse cancer types. We examined primary medulloblastoma specimens …

Dissociation Predicts Later Attention Problems In Sexually Abused Children, Julie B Kaplow, Erin Hall, Karestan C Koenen, Kenneth A Dodge, Lisa Amaya-Jackson

Faculty, Staff and Students Publications

OBJECTIVE: The goals of this research are to develop and test a prospective model of attention problems in sexually abused children that includes fixed variables (e.g., gender), trauma, and disclosure-related pathways.

METHODS: At Time 1, fixed variables, trauma variables, and stress reactions upon disclosure were assessed in 156 children aged 8-13 years. At the Time 2 follow-up (8-36 months following the initial interview), 56 of the children were assessed for attention problems.

RESULTS: A path analysis involving a series of hierarchically nested, ordinary least squares multiple regression analyses indicated two direct paths to attention problems including the child's relationship to …

Combinations Of Dsm-Iv-Tr Criteria Sets For Bipolar Disorders., Daniel Z Lieberman, Roger Peele, Maryam Razavi

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: DSM-IV-TR is the standard for making psychiatric diagnoses in many countries. The diagnostic categorization of DSM-IV-TR is valued for its reliability, however it is well accepted that patients with the same diagnosis demonstrate substantial heterogeneity. In order to quantitatively characterize the degree of possible heterogeneity that can exist, combinatorial mathematics was used to calculate the number of possible ways to satisfy symptom criteria for the diagnosis of bipolar disorder as an example of this problem.

SAMPLING AND METHODS: The formula n!/(r!(n - r)!), which calculates the number of different ways of choosing an unordered number of items without repetition …

Targeting Nf-Kappab: A Promising Molecular Therapy In Inflammatory Arthritis., Jorge A. Roman-Blas, Sergio A. Jimenez

Scleroderma Center Faculty Papers

The nuclear factor-kappa B family of transcription factors is intimately involved in the regulation of the inflammatory responses that play a fundamental role in the damage of articular tissues. Thus, many studies have examined the important contributions of components of the NF-kappaB signaling pathways to the pathogenesis of various rheumatic diseases and their pharmacologic modulation. Currently available therapeutic agents including nonsteroidal anti-inflammatory drugs, corticosteroids, nutraceuticals, and disease-modifying antirheumatic drugs, as well as novel specific small-molecule inhibitors have been employed. In addition, promising nucleic acid-based strategies have shown encouraging results. However, further research will be needed before NF-kappaB-aimed strategies become an …

The Effect Of Teleradiology On Interpretation Times For Ct Pulmonary Angiography Studies, Scott Thomas Olcott Kennedy

Yale Medicine Thesis Digital Library

The purpose of this study was to evaluate the impact of a teleradiology service on the timely interpretation of computed tomography (CT) pulmonary angiography studies. A survey of clinical and imaging physicians was performed to develop achievable goals for interpretation of CT pulmonary angiography studies. Percentages of studies given preliminary written reports within these thresholds were compared for 1,102 pulmonary angiography CT studies from three months before teleradiology was implemented to three months after. Identical control data were matched over the same periods for 1,638 CT brain studies. Data are reported as averages and percentages. Statistical significance was evaluated with …

Management Of The Neck In Differentiated Thyroid Cancer, David M. Cognetti, Edmund A. Pribitkin, William M. Keane

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Differentiated thyroid cancer is characterized by an excellent long-term prognosis, which unlike other head and neck carcinomas, is not influenced definitively by regional lymph node metastasis. The relative rarity of the disease, together with its tendency for delayed metastasis and its low mortality, makes a prospective randomized trial comparing treatment outcomes difficult. As a result, the effect of cervical lymph node metastases on survival is unclear, making meaningful recommendations for their management somewhat subjective. This article discusses guidelines for the management of the neck in differentiated.

Correlates Of Tobacco Cessation Counseling Among Hispanic Physicians In The Us: A Cross-Sectional Survey Study, Francisco G Soto Mas, Héctor G Balcázar, Julia Valderrama Alberola, Chiehwen Ed Hsu

Faculty, Staff and Student Publications

BACKGROUND: Physician advice is an important motivator for attempting to stop smoking. However, physicians' lack of intervention with smokers has only modestly improved in the last decade. Although the literature includes extensive research in the area of the smoking intervention practices of clinicians, few studies have focused on Hispanic physicians. The purpose of this study was to explore the correlates of tobacco cessation counseling practices among Hispanic physicians in the US. METHODS: Data were collected through a validated survey instrument among a cross-sectional sample of self-reported Hispanic physicians practicing in New Mexico, and who were members of the New Mexico …

Community Based Epidemiological Study Of Chagas Disease In Rural Peru, Paul Walker

Yale Medicine Thesis Digital Library

The purpose of this study was to evaluate the epidemiology of Trypanosoma cruzi infection, to valuate the TESA blot, and to characterize cardiac findings of patients with Chagas disease in a rural setting near Arequipa, Peru. The study site was the town of Quequeña, Peru with a population of 774 with 236 inhabitants under the age of 18 according to the 2005 census conducted by Peru. A fumigation/insect collection campaign was done in December of 2006 to quantify household infestation levels, document housing characteristics, and GPS household locations. Of the 602 people surveyed to be living in Quequeña, blood samples …

Searching For The Majority: Algorithms Of Voluntary Control, Jin Fan, Kevin G. Guise, Xun Liu, Hongbin Wang

Faculty, Staff and Student Publications

Voluntary control of information processing is crucial to allocate resources and prioritize the processes that are most important under a given situation; the algorithms underlying such control, however, are often not clear. We investigated possible algorithms of control for the performance of the majority function, in which participants searched for and identified one of two alternative categories (left or right pointing arrows) as composing the majority in each stimulus set. We manipulated the amount (set size of 1, 3, and 5) and content (ratio of left and right pointing arrows within a set) of the inputs to test competing hypotheses …

Multiple Forms Of Atypical Rearrangements Generating Supernumerary Derivative Chromosome 15., Nicholas J Wang, Alexander S Parokonny, Karen N Thatcher, Jennette Driscoll, Barbara M Malone, Naghmeh Dorrani, Marian Sigman, Janine M Lasalle, N Carolyn Schanen

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Maternally-derived duplications that include the imprinted region on the proximal long arm of chromosome 15 underlie a complex neurobehavioral disorder characterized by cognitive impairment, seizures and a substantial risk for autism spectrum disorders1. The duplications most often take the form of a supernumerary pseudodicentric derivative chromosome 15 [der(15)] that has been called inverted duplication 15 or isodicentric 15 [idic(15)], although interstitial rearrangements also occur. Similar to the deletions found in most cases of Angelman and Prader Willi syndrome, the duplications appear to be mediated by unequal homologous recombination involving low copy repeats (LCR) that are found clustered in the …

Spinal Cord Stimulation: An Update., Steven Falowski, Amanda Celii, Ashwini Sharan

Department of Neurosurgery Faculty Papers

Spinal cord stimulation has been used in the treatment of many chronic pain disorders since 1967. In this update, the indications for spinal cord stimulation are reviewed with attention to recent publications. A focused review of the literature on abdominal and visceral pain syndromes is also provided. Furthermore, the technology has evolved from the use of monopolar electrodes to complex electrode arrays. Similarly, the power source has changed from a radio frequency-driven system to a rechargeable impulse generator. These topics are covered, along with a short discussion of implant technique. Finally, we include a review of complications of such therapy. …

Aoa Symposium. Orthopaedists Partnering With Other Physicians To Provide Musculoskeletal Care., Alan Hilibrand, Kurt P Spindler, Scott D Boden

Rothman Institute Papers

No abstract provided.

How To Prevent Perioperative Myocardial Injury: The Conundrum Continues, Jian-Zhong Sun, David Maguire

Department of Anesthesiology Faculty Papers

BACKGROUND: Perioperative myocardial injury (PMI) remains a major cause of perioperative morbidity and mortality but clinical strategies to prevent PMI are still uncertain.

METHODS AND RESULTS: We comprehensively searched PubMed for major research articles concerning clinical strategies to prevent PMI. The key findings are as follows: (1) the American College of Cardiology/American Heart Association guideline update for perioperative cardiovascular evaluation for noncardiac surgery is very useful to stratify cardiac risk preoperatively; (2) cardiac troponin has emerged as a biomarker to diagnose postoperative PMI and to predict clinical outcomes; (3) coronary revascularization before noncardiac surgery probably would provide cardiac protection in …

Developing "Human Functioning And Rehabilitation Research" From The Comprehensive Perspective., Gerold Stucki, Jan Dietrich Reinhardt, Gunnar Grimby, John Melvin

Department of Rehabilitation Medicine Faculty Papers

With the International Classification of Functioning, Disability and Health (ICF) the World Health Organization (WHO) has prepared the ground for a comprehensive understanding of Human Functioning and Rehabilitation Research, integrating the biomedical perspective on impairment with the social model of disability. This poses a number of old and new challenges regarding the enhancement of adequate research capacity. Here we will summarize approaches to address these challenges with respect to 3 areas: the organization of Human Functioning and Rehabilitation Research into distinct scientific fields, the development of suitable academic training programmes and the building of university centres and collaboration networks.

Patient Involvement In Patient Safety: What Factors Influence Patient Participation And Engagement?, Rachel Davis, Rosamond Jacklin, Nick Sevdalis, Charles A. Vincent

Faculty Publications

BACKGROUND: Patients can play an important role in improving patient safety by becoming actively involved in their health care. However, there is a paucity of empirical data on the extent to which patients take on such a role. In order to encourage patient participation in patient safety we first need to assess the full range of factors that may be implicated in such involvement. OBJECTIVE: To delineate factors that could affect the participation of the patient in quality and safety issues in their health care. METHOD: Literature review of patient involvement in health care, drawing from direct evidence (specifically from …