Medicine and Health Sciences Commons^™

Risk Factors For Hospital Morbidity And Mortality After The Norwood Procedure: A Report From The Pediatric Heart Network Single Ventricle Reconstruction Trial., Sarah Tabbutt, Nancy Ghanayem, Chitra Ravishankar, Lynn A. Sleeper, David S. Cooper, Deborah U. Frank, Minmin Lu, Christian Pizarro, Peter Frommelt, Caren S. Goldberg, Eric M. Graham, Catherine Dent Krawczeski, Wyman W. Lai, Alan Lewis, Joel A. Kirsh, Lynn Mahony, Richard G. Ohye, Janet Simsic, Andrew J. Lodge, Ellen Spurrier, Mario Stylianou, Peter Laussen, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial.

METHODS: Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality.

RESULTS: Analysis included 549 subjects prospectively …

Comparison Of Upper Lip Bite Test With Mallampati Test In The Prediction Of Difficult Intubation At A Tertiary Care Hospital Of Pakistan, Muhammad Asghar Ali, Muhammad Qamar-Ul-Hoda, Khalid Samad

Department of Anaesthesia

Objective: To determine the accuracy of the Upper lip bite test and Mallampati test in predicting difficult endotracheal intubation.Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, a tertiary care facility in Karachi, Pakistan. Between June 1,2007 and May 31, 2008, 324 adult patients undergoing elective surgeries requiring general anaesthesia with endotracheal intubations were enrolled. Pre-operatively upper lip bite test and Mallampati test were performed for the assessment of airway by a specifically trained observer. Laryngoscopic view was rated by using Cormack and Lehane laryngoscopic grading once the patient was fully anaesthetised using standard anaesthesia technique. Completed …

Anaesthetic Management Of Neonatal Primary Hyperparathyroidism, Anwar-Ul-Huda, Sanam Dost Mohammad, Tauseef Ahmed

Department of Anaesthesia

Neonatal primary hyperparathyroidism (NPHP) is a rare disease that presents in the first 6 months of life. It is almost invariably fatal unless a prompt diagnosis is made and urgent surgical intervention is instituted. Patients with hyperparathyroidism require special preoperative considerations. They require proper work-up from cardiac, renal and neurological point of view, correction of intravenous volume and electrolytes irregularities. We are presenting a case of an infant who started to have cyanosis and lethargy at 21st day of life. Initial diagnosis of pneumonia was made but later on diagnosed as hyperparathyroidism. He was planned for parathyroidectomy under general anaesthesia. …

Anti-Cancer Drug Screening Of Dual Tubulin And Hsp27 Inhibitors With 2d And 3d Lung Cancer Cell Assays, Janine Maria Naim, Rati Lama

Undergraduate Research Posters 2012

Cancer is the leading cause of death worldwide. The current treatment options available for lung cancer are limited and have drawbacks such as poor bioavailability, numerous side effects, poor efficacy and drug resistance. 3D model serve as a novel approach for drug screening purposes and the evaluation of compounds in the platform can help identify potent compounds for further in vivo xenograft studies.

Normalizing For Noise Removal From Electrocardiogram Signals, Dominique Diamond Brooks, Daniel J. Simon

Undergraduate Research Posters 2012

Electrocardiography (ECG) measures the electrical impulse of the heart over time using electrodes that attached to the body. Designing a computational program using a synthetic ECG to test Normalized Least Mean Square (NLMS) filter serves as a basis to remove noise from the signal.

Investigating Axonal Biology Using Microfluidic Devices, James Deyling, Brittany Kastan

Undergraduate Research Posters 2012

During nervous system development, various diffusing biomolecules play a critical role in neurite outgrowth and guidance, resulting in the formation of a complex circuitry. However, the precise mechanism by which these molecules are spatio-temporally delivered to the growing tip of the neurites is unclear. Overall, the results suggest to the utility of this device for studying neurobiology, tissue engineering and cell migration.

Biological Evaluation Of Cyclooxygenase-2 Inhibitor Nimesulide Derivatives As Anti-Agents, Amandeep Singh, Snigdha Chennamaneni

Undergraduate Research Posters 2012

Cyclooxygenase-2 (COX-2) inhibitor nimesulide inhibits the proliferation of various types of cancer cells mainly via COX-2 independent mechanisms, which makes it a good lead compound for anti-cancer drug development. A series of new nimesulide analogs were evaluated with cell proliferation assay based on a non-small lung cancer cell line H292. The results showed that several derivatives were very active to against H292 cell growth with IC50s of sub nano mole. These results suggest the possibility of using these nimesulide derivatives as chemo preventive agents.

The Crucial Role Of Bilateral Infraclavicular Nerve Blocks In The Anesthetic Management Of A Trauma Patient, Eric P. Chiang, Paul Dangerfield, Jaideep H. Mehta, Marian Sherman, Jeffrey S. Berger

Anesthesiology and Critical Care Medicine Faculty Publications

Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques.

Rapid Detection Of Streptococcus Mutans In Saliva, Catherine E. Holtman

Electronic Theses and Dissertations

Documentation exists that mothers can pass the cariogenic bacteria Streptococcus mutans to their infants. The newest technology to identify Streptococcus mutans is a rapid detection saliva test. Two hundred patients above the age of 18 were targeted using random selection in a Louisville, Kentucky dental office. Patients signed an informed consent form and were given a qualifying questionnaire. Patients received 2 bitewing x-rays and a charted DMFT index and were administered the saliva test. While the null hypothesis was rejected using the chi square test, the results were inconclusive due to expected values. However, other chi square results revealed that …

A Digital X-Ray Tomosynthesis Coupled Near Infrared Spectral Tomography System For Dual-Modality Breast Imaging, Venkataramanan Krishnaswamy, Kelly E. Michaelsen, Brian W. Pogue, Steven P. Poplack, Ian Shaw, Ken Defrietas, Ken Brooks, Keith D. Paulsen

Dartmouth Scholarship

A Near Infrared Spectral Tomography (NIRST) system has been developed and integrated into a commercial Digital Breast Tomosynthesis (DBT) scanner to allow structural and functional imaging of breast in vivo. The NIRST instrument uses an 8-wavelength continuous wave (CW) laser-based scanning source assembly and a 75-element silicon photodiode solid-state detector panel to produce dense spectral and spatial projection data from which spectrally constrained 3D tomographic images of tissue chromophores are produced. Integration of the optical imaging system into the DBT scanner allows direct co-registration of the optical and DBT images, while also facilitating the synergistic use of x-ray contrast as …

Sleep Hygiene And Problem Behaviors In Snoring And Non- Snoring School-Age Children, Lisa A. Witcher, David Gozal, Dennis L. Molfese, Scott M. Salathe, Karen Spruyt, Valerie Mclaughlin Crabtree

Center for Brain, Biology, and Behavior: Faculty Publications

Objectives—The effects of sleep-disordered breathing, sleep restriction, dyssomnias, and parasomnias on daytime behavior in children have been previously assessed. However, the potential relationship(s) between sleep hygiene and children’s daytime behavior remain to be explored. The primary goal of this study was to investigate the relationship between sleep hygiene and problematic behaviors in non-snoring and habitually snoring children.

Methods—Parents of 100 5- to 8-year-old children who were reported to snore “frequently” to “almost always,” and of 71 age-, gender-, and ethnicity-matched children who were reported to never snore participated in this study. As part of a larger, ongoing study, …

Spinal Anaesthesia For Caesarean Section: Plain Vs Hyperbaric Bupivacaine, Gurmukh Das Punshi, Gauhar Afshan

Department of Anaesthesia

Objective: To compare the clinical characteristics of sensory and motor block as well as haemodynamic stability using plain and hyperbaric bupivacaine in spinal anaesthesia for caesarean section.Methods: Two equal groups were formed from a total of 60 patients who were enrolled in this prospective randomised double-blinded study that was done at tertiary care hospital in Karach, during 2005 to 2006. Equal volume of plain and hyperbaric bupivacaine 10 mg with 25 mcg of fentanyl was used for spinal anaesthesia in the two groups that were formed on the basis of random allocation. Characteristics of sensory and motor block, episodes of …

Modeling The Adoption Of Identification Standards Within The Healthcare Supply Chain, Angelica Burbano

Graduate Theses and Dissertations

The adoption of identification standards and its associated technology in the healthcare supply chain has been slow over the past twenty five years, despite the evidence of the benefits that can be achieved. The widespread use of identification standards in the form of barcode labeled medical products can contribute to the reduction of point of care errors and can increase the efficiency of healthcare supply chain related processes. This research is focused on the analysis of the adoption of identification standards in the healthcare supply chain with a particular focus on the healthcare provider adoption challenges. The research is divided …

Evaluation Of Smoking Cessation Services In Ireland: Design And Pilot Of A Smoking Cessation Treatment Database, Sheila Keogan

Masters

A reduction in tobacco use is one of the stated aims of the National Health Promotion Strategy
(2000-2005) (Department of Health and Children, 2000a) as well being the core activity of
membership for all health promoting hospitals (HPH).
AIMS OF THE STUDY

1. To develop a database of smoking cessation services in Ireland.

2. Do a census of the smoking cessation services in Ireland and evaluate the range and
availability of them.
3. Develop a database for use in smoking cessation treatment services which would schedule
consultations with patients and gather all relevant demographics, treatments and their outcomes,
(cessation treatment …

The Effect Of Pre-Operative Coumadin Therapy On Patients Who Develop Hemorrhagic Events Post Bariatric Surgery, Richard Boorse Md, Peter J. Bechtel Md, Cathleen Webber Rn, Mshs, Suzanne L. Smith Mba, Rrt, Tas, Cathy Fuhrman Rn, Msn

Department of Surgery

No abstract provided.

Diagnostic Potential Of The Nmda Receptor Peptide Assay For Acute Ischemic Stroke, Svetlana A. Dambinova, Kerstin Bettermann, Theodore Glynn, Matthew Tews, David Olsen, Joseph D. Weissman, Richard K. Sowell

Faculty Articles

Background

The acute assessment of patients with suspected ischemic stroke remains challenging. The use of brain biomarker assays may improve the early diagnosis of ischemic stroke. The main goal of the study was to evaluate whether the NR2 peptide, a product of the proteolytic degradation of N-methyl-D-aspartate (NMDA) receptors, can differentiate acute ischemic stroke (IS) from stroke mimics and persons with vascular risk factors/healthy controls. A possible correlation between biomarker values and lesion sizes was investigated as the secondary objective.

Methods and Findings

A total of 192 patients with suspected stroke who presented within 72 h of symptom onset …

Evaluation Of A Surgical Intervention To Experimentally Compare Co2 Laser To Scalpel Incisions, Added Growth Factor, And Suture Material To Reduce Cutaneous Scarring, Rhian E. Davies

PCOM Biomedical Studies Student Scholarship

Introduction The goal of this study was to determine if the repair of full thickness skin incisions in an animal model could be improved by using a CO2 laser vs. scalpel, commercial vs. swine intestinal submucosa (SIS) sutures, and addition of exogenous nerve growth factor (NGF).

Materials and Methods A rat model was used to evaluate the following tissue components: prevalence of mast cell granules, thickness of epidermis, organization of collagen, infiltration of tissue into SIS, neutrophil presence around suture holes, and granulation tissue production around suture holes.

Results Added NGF led to a significant decrease in the number of …

Intermediate-Term Mortality And Cardiac Transplantation In Infants With Single-Ventricle Lesions: Risk Factors And Their Interaction With Shunt Type., James S. Tweddell, Lynn A. Sleeper, Richard G. Ohye, Ismee A. Williams, Lynn Mahony, Christian Pizarro, Victoria L. Pemberton, Peter C. Frommelt, Scott M. Bradley, James F. Cnota, Jennifer Hirsch, Paul M. Kirshbom, Jennifer S. Li, Nancy Pike, Michael Puchalski, Chitra Ravishankar, Jeffrey P. Jacobs, Peter C. Laussen, Brian W. Mccrindle, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: The study objective was to identify factors associated with death and cardiac transplantation in infants undergoing the Norwood procedure and to determine differences in associations that might favor the modified Blalock-Taussig shunt or a right ventricle-to-pulmonary artery shunt.

METHODS: We used competing risks methodology to analyze death without transplantation, cardiac transplantation, and survival without transplantation. Parametric time-to-event modeling and bootstrapping were used to identify independent predictors.

RESULTS: Data from 549 subjects (follow-up, 2.7 ± 0.9 years) were analyzed. Mortality risk was characterized by early and constant phases; transplant was characterized by only a constant phase. Early phase factors associated …

Racial Inequality In The Valuation Of Health Outcomes Expressed By The 1992 Acs Guidelines For Prostate Cancer Screening, C. A. Beam

Journal of Health Disparities Research and Practice

In 1992, the American Cancer Society (ACS) recommended annual screening for prostate cancer for men 50 and older using PSA. In this article, I introduce a method to use race and age-specific PSA accuracy data to evaluate differences in the valuation of outcomes by race and age that were expressed by the ACS guidelines. Using this new method, it can be concluded that the guidelines implied a 4-fold greater valuation was assigned to screening young white males with prostate cancer than the value that was assigned to young black males with cancer. Future implementation of guidelines for screening and testing …

Sensitive Fluorescence Detection Using A Camera From The Gaming Industry, Brian L. Van Hoozen Jr.

Lawrence University Honors Projects

The detection limit for fluorescence imaging has been improved by more than two orders of magnitude by a modulation technique that minimizes the influence of noise. Since most noise sources have a 1/f dependence, higher modulation frequencies result in less noise in the detected signal. Typical cameras used for imaging have frame rates of 50 or 100 hertz which is too low for substantial noise reduction. However, new time-of-flight cameras developed for the gaming industry have modulation frequencies of up to 20 MHz, allowing for a substantial reduction in noise in the detected signal. In this study, the improved detection …

Muscle Contraction Duration And Fibre Recruitment Influence Blood Flow And Vo2 Independent Of Contractile Work During Steady-State Exercise In Humans, Jennifer C. Richards, Anne R. Crecelius, Brett S. Kirby, Dennis G. Larson, Frank A. Dinenno

Health and Sport Science Faculty Publications

We tested the hypothesis that, among conditions of matched contractile work, shorter contraction durations and greater muscle fibre recruitment result in augmented skeletal muscle blood flow and oxygen consumption (O2) during steady-state exercise in humans. To do so, we measured forearm blood flow (FBF; Doppler ultrasound) during 4 minutes of rhythmic handgrip exercise in 24 healthy young adults and calculated forearm O2 via blood samples obtained from a catheter placed in retrograde fashion into a deep vein draining the forearm muscle. In Protocol 1 (n = 11), subjects performed rhythmic isometric handgrip exercise at mild and moderate intensities under conditions …

A Knowledge-Based Clinical Toxicology Consultant For Diagnosing Single Exposures, Joel D. Schipper, Douglas D. Dankel Ii, A. Antonio Arroyo, Jay L. Schauben

Publications

Objective: Every year, toxic exposures kill twelve hundred Americans. To aid in the timely diagnosis and treatment of such exposures, this research investigates the feasibility of a knowledge-based system capable of generating differential diagnoses for human exposures involving unknown toxins.

Methods: Data mining techniques automatically extract prior probabilities and likelihood ratios from a database managed by the Florida Poison Information Center. Using observed clinical effects, the trained system produces a ranked list of plausible toxic exposures. The resulting system was evaluated using 30,152 single exposure cases. In addition, the effects of two filters for refining diagnosis based on …

Does Initial Shunt Type For The Norwood Procedure Affect Echocardiographic Measures Of Cardiac Size And Function During Infancy?: The Single Vventricle Reconstruction Trial., Peter C. Frommelt, Lin T. Guey, L Luann Minich, Majeed Bhat, Tim J. Bradley, Steve D. Colan, Greg Ensing, Jessica Gorentz, Haleh Heydarian, J Blaine John, Wyman W. Lai, Jami C. Levine, William T. Mahle, Stephen G. Miller, Richard G. Ohye, Gail D. Pearson, Girish S. Shirali, Pierre C. Wong, Meryl S. Cohen, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The Pediatric Heart Network trial comparing outcomes in 549 infants with single right ventricle undergoing a Norwood procedure randomized to modified Blalock-Taussig shunt or right ventricle-pulmonary artery shunt (RVPAS) found better 1-year transplant-free survival in those who received RVPAS. We sought to compare the impact of shunt type on echocardiographic indices of cardiac size and function up to 14 months of age.

METHODS AND RESULTS: A core laboratory measured indices of cardiac size and function from protocol exams: early after Norwood procedure (age 22.5 ± 13.4 days), before stage II procedure (age 4.8 ± 1.8 months), and at 14 …

Interactive Concept To Aid In Understanding Dimensional Analysis, Alicia Hicks

Symposium 2012

Many students struggle with learning how to utilize dimensional analysis. This confusion is due to not understanding the concept of dose per volume, leading to difficulty when starting the sequencing. This could be one of the contributing causes to medication errors in clinical practice. Does using models, such as Play-doh and pebbles, help students learn the concept of milligrams per milliliters when calculating dosages using dimensional analysis method? A series of pre- and post-tests are used to measure learning growth in each of the treatment groups. Three treatment groups were utilized: Control: one group had no intervention between the pre …

Digital And Clinical Refractometers Are Valid Instruments For The Measure Of Hydration Status, A. J. Niemann, S. W. Yeargin, L. E. Eberman, H. M. Mata, H. A. Adams, D. J. Dziedzicki

Symposium 2012

Although some instruments have been validated for clinical measure of hydration status, new and currently invalid instruments are available for purchase and clinical use. Athletic trainers commonly use these instruments to assess hydration status for weight checks and body mass loss charts due to their ease of use. However, the validity of these popular instruments has not yet been established.

A Consensus Model For Electroencephalogram Data Via The S-Transform, Andrew Coady Young

Electronic Theses and Dissertations

A consensus model combines statistical methods with signal processing to create a better picture of the family of related signals. In this thesis, we will consider 32 signals produced by a single electroencephalogram (EEG) recording session. The consensus model will be produced by using the S-Transform of the individual signals and then normalized to unit energy. A bootstrapping process is used to produce a consensus spectrum. This leads to the consensus model via the inverse S-Transform of the consensus spectrum. The method will be applied to both a control and experimental EEG to show how the results can be used …

A Modular Framework For Home Healthcare Monitoring, Blake Puryear

Computer Science and Computer Engineering Undergraduate Honors Theses

Many patients with chronic health problems have multiple ailments but different patients may have different such ailments. Home monitoring systems for individual ailments exist but a patient may have multiple of these, all designed independently. There are no standard architectures so this leads to unmanageable diversity which causes problems for patients in having to learn to use a variety of monitors and for physicians in trying to monitor many patients. The purpose of this project was to design and prototype a next generation modular remote healthcare monitoring system capable of monitoring multiple ailments and extensible to new ailments in order …

Screening Mammograms In Alzheimer’S Disease Patients, George M. Yousef, Piyush Sovani, Sirisha Devabhaktuni, Lynne J. Goebel

Internal Medicine

Very little guidance exists to help clinicians and families decide whether mammograms are useful in elderly women with Alzheimer’s Disease (AD). We present a case of a patient with moderate AD who had a positive mammogram and discuss the dilemma faced by the family and clinician in deciding what was best to do for the patient. In this case, the family opted for breast conserving surgery (BCS) followed by palliative care which brought up the question of whether screening was appropriate with this treatment goal in mind. We reviewed the literature on AD and breast cancer screening and summarize these …

Kinesio Taping On Short-Term Changes In Shoulder Strength In Healthy Adults: A Randomized Clinical Trial, Dario A. Callegari, Cristobal E. Cordova, Julia R. Dunievitz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Study Type: A Randomized Clinical Trial

Introduction:

Kinesio tape is an elastic tape used in various settings and it is purported to assist in strengthening weakened muscles. The mechanism behind this claim is neuromuscular facilitation. The purpose of this study was to determine if the claims of Kinesio tape would be supported in its role in strength enhancing properties.

Methods:

Twenty-nine healthy, untrained male and female college-aged individuals participated in this study. Two baseline measurements assessing shoulder external rotation (ER) strength were collected using isokinetic dynamometry. Subjects were then randomized into two groups, Kinesio tape with ER strengthening (KT-Ex) and …

Novel Use Of Dual Anti-Inflammatory Therapy To Overcome Drug Resistance And Improve Functional Recovery Following Spinal Cord Injury, Jennifer Dulin

Dissertations and Theses (Open Access)

Over 1.2 million Americans are currently living with a traumatic spinal cord injury (SCI). Despite the need for effective therapies, there are currently no proven effective treatments that can improve recovery of function in SCI patients. Many therapeutic compounds have shown promise in preclinical models of SCI, but all of these have fallen short in clinical trials.

P-glycoprotein (Pgp) is an active transporter expressed on capillary endothelial cell membranes at the blood-spinal cord barrier (BSCB). Pgp limits passive diffusion of blood-borne drugs into the CNS, by actively extruding drugs from the endothelial cell membrane. Pgp can become pathologically up-regulated, thus …