Medicine and Health Sciences Commons^™

Thyroid Hormone Receptor Ss (Trß) Regulation Of Runt-Related Transcription Factor 2 (Runx2) In Thyroid Tumorigenesis: Determination Of The Trß Nuclear Protein Complexes That Associate With The Runx2 Gene., Thomas Howland Taber

Graduate College Dissertations and Theses

Thyroid Tumorigenesis is typically a well understood process, with well delineated oncogenic factors. Follicular and papillary thyroid cancers are typically survivable, with 5-year survival rates being >95% for Stage I-III of both cancer types. Anaplastic thyroid cancer, in contrast, lacks this prognosis, and is the most lethal of all endocrine-related cancers. The median survival time after a diagnosis is generally between 6-8 months, with a 5-year survival rate of <10%. Current treatment for anaplastic thyroid cancers routinely meet roadblocks, as resistance is quickly developed. Even non-discriminatory kinase inactivators, such as sorafenib, which are generally considered a drug of last resort, are unable to effect survival rates. As such, there is a clear need for further investigation of the causes of anaplastic thyroid cancer mechanisms.

Previous work in the Carr lab revealed a novel regulatory pathway of an oncogene that is associated with several other endocrine-related cancers, as well as other non-endocrine-related cancers. Specifically, the Runt-related …

Naloxone Administration Route In Opioid Overdose: A Review Of Vermont Ems Data, Alden York Sacco Mph, Chris Lamonda Mph, Michael O'Keefe, Daniel Wolfson Md, Mario Trabulsy Md

Master of Public Health Culminating Projects

Objective: Emergency Medical System (EMS) personnel administer the direct opioid antagonist naloxone in cases of opioid overdose via intramuscular (IM), intravenous (IV), subcutaneous (SQ), intraosseous (IO), or intranasal (IN) routes. Some early studies suggest that the intranasal route of administration is of similar effectiveness to injectable routes. The main objective of our study was to compare the efficacy of intravenous and intraosseous (IV/IO) routes of naloxone administration to the intranasal (IN) route in suspected opioid overdoses in Vermont.

Methods: We reviewed retrospective data from Vermont EMS Statewide Incident Reporting Network (SIREN) between April 2014 and August 2016. We included all …

Increasing Pneumococcal Vaccination Among Adults 65 And Older: The Development And Implementation Of A Pneumococcal Vaccine Administration And Documentation Protocol For A Small Primary Care Practice., Marina M. Ecklund

College of Nursing and Health Sciences Nursing Master Project Publications

This project focuses on the development of a protocol to increase administration and documentation of pneumococcal vaccination among patient 65 years and older in a primary care practice setting. The project entails reviewing immunization records of all patients age ≥ 65 years at Appletree Bay Primary Care (ABPC) practice to determine current pneumococcal vaccination rates among the specified age group within the practice. A single trial vaccination clinic was it established in collaboration with the Vermont Family Pharmacy wherein patients were contacted by phone by the primary investigator, informed that they may be due for one or more pneumococcal vaccination …

Co-Localization Of Basal And Proliferative Cells In The Murine Main Olfactory Epithelium And Vomeronasal Organ After Injury With Cyclophosphamide, Kyle Barnes Joseph

Graduate College Dissertations and Theses

ABSTRACT

In humans, advanced malignancies are often targeted with broad-spectrum cytotoxic drugs that engender several detrimental side effects, in addition to their primary usage for eradicating cancerous cells. One of the lesser-researched of these effects, histological distortion of the olfactory system impedes a patient's ability to smell, perceive flavor, and ultimately may interfere with their nutritional intake and recovery from chemotherapy. Recent studies have indicated that cytotoxic drugs can damage gustatory epithelia immediately following administration (Mukherjee & Delay, 2011, 2013). We sought to observe the histological effects that cyclophosphamide (CYP), one of the oldest and most popular alkylating antineoplastic agents, …

Headphones And Adolescents: Hearing Loss Prevention, Taylor Sommer

Family Medicine Clerkship Student Projects

Headphone use of adolescents is on the rise due to increased availability of personal listening devices. Hearing loss has also increased in adolescents. This project aims at preventing noise-induced hearing loss by educating adolescents on proper use of headphones.

E-Cigarette Prevention Among Vermont Youth, Tyler W. Wark

Family Medicine Clerkship Student Projects

E-cigarettes are increasingly used by U.S. adolescents, a trend that is particularly troublesome from a public health perspective because they have been linked to conventional tobacco smoking. In Vermont, recent data from 2015 reports that 30% of high school students ever used electronic vapor products. At present the scientific, regulatory, and lay communities all have a dearth of quality information regarding e-cigarettes and their potential adverse health effects. This school-based intervention aims to promote awareness and educate at-risk youth in the Milton School District about e-cigarettes through an educational fact sheet and health blog post.

Sad Management In Lewiston, Me, Ashley L. Deeb

Family Medicine Clerkship Student Projects

Seasonal affective disorder may be a significant issue in Lewiston, ME due to it's latitude. In addition, lack of transportation and poverty are also issues in this community. This project attempts to address treatment and increase awareness of SAD in Lewiston.

Counseling Pregnant Women On Marijuana Use, Theresa B. Flanagan

Family Medicine Clerkship Student Projects

Marijuana is the most commonly used illicit substance for pregnant women nationwide, with rates of use trending upward. Marijuana use in Penobscot County is elevated well above the national average, and is likely to continue to rise with the legalization of recreational marijuana in the state of Maine. Though the American Congress of Obstetricians and Gynecologists (ACOG) discourages marijuana use during pregnancy and breastfeeding, studies have shown that providers do not emphasize counseling pregnant patients on marijuana use. This project looked at provider practices and perceptions regarding marijuana use during pregnancy at the Center for Family Medicine at Eastern Maine …

Promotion Of Skin Protection In Children In Waterbury, Vt, Kelsey M. Sullivan

Family Medicine Clerkship Student Projects

Background: Vermont has among the highest rates of skin cancer in the nation. Between 2001 and 2005, Vermont had the highest incidence of melanoma of any state, 63% higher than the national average. It is also estimated that if children under 18 regularly used sunscreen of at least SPF 15, the incidence of squamous and basal cell carcinomas would decrease by 78%. Modeling by the EPA and CDC suggests that recommended sun protection measures could prevent 11,000 cases of skin cancer, 50 deaths, and $30 million in cancer treatment costs nationwide. Intervention: To create an information sheet on skin protection …

Promoting Antibiotic Stewardship, Saurabh Patel

Family Medicine Clerkship Student Projects

Antibiotics are not always prescribed optimally in the outpatient setting for common respiratory illnesses. Providers also spend time reiterating the same facts to patients about antibiotics and why their use is not warranted for their common cold symptoms. By providing a visual aid that can capture the attention of patients and present concise, easy to retain facts, we may lessen the amount of time providers spend counseling. At the same time, we are able to get patients to contribute to the fight against antibiotic overuse, antimicrobial resistance, and healthcare associated infections.

Concussion, Kasra Sarabakhsh

Family Medicine Clerkship Student Projects

Concussions are very common, especially among young athletes and students. Most patients are encouraged to rest and avoid activities that are physically and cognitively demanding. However, there is not much education regarding alcohol use after a concussion and its detrimental effects on brain recovery.

Connecting Seniors In Franklin County Vermont To Community Resources, Autumn Reilly

Family Medicine Clerkship Student Projects

Vermont currently has the second oldest population in the country and the elderly population is continuing to increase. Senior citizens define aging successfully as having good health, strong friendships, and being able to participate in activities. In order to meet the needs of seniors it is important to find ways to better connect them with available community resources. The aim of this project was to create a pamphlet of community resources available to seniors in Franklin County, Vermont to aid in connecting them to community involvement and support.

Assessing Patient Perspective Of Current Suboxone Treatment, Midori Eckenstein

Family Medicine Clerkship Student Projects

The number of people seeking treatment for opioid abuse and heroin use. While this number is increasing the number of heroin fatalities is also on the rise. Methadone clinics are reporting better retention rates than suboxone treatment. This project explores the patient perspectives of suboxone therapy and what can be improved to help establish better practices.

Educating Patients About Behavioral Interventions And Exercises For Musculoskeletal Lower Back Pain, Alex Jacobson

Family Medicine Clerkship Student Projects

Low back pain (LBP) is a common problem which affects all genders and most ages. It results in considerable direct and indirect costs, and these costs are financial, workforce and social. The majority of lower back pain occurs due to a musculoskeletal etiology and often presents to the primary care physician. We worked with local physicians, chiropractors, physical therapists, and athletic trainers to develop exercises and behavioral modifications that patients can do to improve lower back pain symptoms.

Expanding Access To Dental Care For Patients On Suboxone, Nathan E. White

Family Medicine Clerkship Student Projects

Those using Suboxone® for medication-assisted treatment for opioid dependence are at increased risk for poor oral health for a variety of reasons including lifestyle factors, effects of opioids and the direct impact of Suboxone® on the oral environment. Medication assisted addiction treatment programs do not regularly address these concerns. This project aims to educate patients about the importance of oral health, remind providers to screen for dental issues and make referrals for dental care and to promote oral health as an important aspect of well being in this vulnerable population

Opioid Prescribing: New Vermont Regulations For Providers, Lloyd Patashnick

Family Medicine Clerkship Student Projects

Opioid abuse is serious problem in Vermont with an estimated yearly health cost of $38 million. In 2015, 28% of Windham county residents were prescribed opioids. In order to combat the ongoing crisis of opioid prescription abuse, the State of Vermont will implement new prescribing regulations which will take effect in July, 2017. To ensure compliance with these new regulations, health care providers need to be educated to allow for a seamless transition in patient care.

Use Of Opioids For Pain Management: Educating Patients And Providers On Upcoming Changes To Vermont State Law, Ashley C. Hodges

Family Medicine Clerkship Student Projects

Vermont is suffering from an opioid epidemic. With 112 opioid-related deaths in 2016, nearly every community has been touched by this crisis. In an attempt to combat this problem, new legislation (effective July 1, 2017) will change how opioids are prescribed for both acute and chronic pain management in Vermont. Changes include dose limitations for acute pain, stricter monitoring requirements, and mandated prescribing of naloxone (an overdose reversal agent) for patients on high doses of opioids or on both opioids and benzodiazepines. This project aims to educate patients about upcoming changes.

Implementing A Community Bipolar Screening Questionnaire In Vt, Suven Cooper

Family Medicine Clerkship Student Projects

The National Institute of Mental Health estimates the number of adults with a diagnosed mental disorder is nearly 1 in 5, this equates to about 43 million Americans. The national shortage of psychiatrists has hit Vermont particularly hard. There has been both a lack of funding and a lack of psychiatrists. For example there is often a waiting line for acute level 1 beds at the Vermont Psychiatric Care Hospital since it opened after the flooding of the state hospital in 2011. In light of the shortage of resources and psychiatrists in Vermont it is important to maximize the limited …

Community Awareness Of Burgeoning Prostate Cancer Screenings, Rose Kristine Leu

Family Medicine Clerkship Student Projects

Prostate cancer screening is an ever-changing field because the benefits of using PSA as a screening tool is not clear-cut, subsequently causing a lack of standardization of screening protocols among various providers. In 2012, the USPSTF published their recommendation of grade D to prostate cancer screening, which caused a decrease in its use. However, the USPSTF recently changed their recommendation from grade D to C, conceding that screening can be beneficial to a certain group of people. Patients are understandably confused about what is appropriate for them; now is the perfect time to raise awareness about the importance of prostate …

Rutland City Public School At Risk Youth Mentorship, Michael J. Marallo

Family Medicine Clerkship Student Projects

This after school program’s purpose is to address the unique challenges of Rutland, VT Middle/High School students with multiple psychosocial risk factors (as determined by comparison to the ACE questionnaire) through mentorship, health and life skills education, and by guiding the development of positive coping skills. Activities will allow for self-expression outside of the classroom in a safe environment. Focus will be placed on assisting paraeducators and teachers with meeting goals that are appropriate for each individual student.

Top Pew, Dexter C. Allen

Family Medicine Clerkship Student Projects

Problem: Patients on Suboxone (buprenorphine-naloxone) therapy break compliance by taking higher Suboxone doses, by supplementing with Suboxone purchased illicitly (“off the street”), or by taking other opiates and illicit drugs (cocaine), excluding marijuana. Need: Physicians and Medication-Assisted Treatment (MAT) counselors would benefit from an approach to counseling and treating their patients that would better address the specific vulnerabilities that Suboxone patients face that threaten their compliance.

Indirect Approach To Intimate Partner Violence, Jasmine Y. Robinson

Family Medicine Clerkship Student Projects

Discussing Intimate Partner Violence can be difficult, and has many barriers. An indirect approach to speaking with patients about domestic violence, whether is is sexual, physical, emotional or financial can be achieve with patient's trust in a physician if they withhold judgement.

My First Cookbook! Healthy Recipes That Kids Can Make, Emily Kinn

Family Medicine Clerkship Student Projects

The obesity epidemic in the United States continues to negatively impact health outcomes in every age group. Interventions aimed at the pediatric population is an especially attractive public health strategy to help kids early on develop important skills for healthy eating to carry with them into adulthood. Childhood obesity prevalence remains alarmingly high at about 17% and has a huge impact on children’s health including higher likelihood of developing risk factors for heart disease, high blood pressure, asthma, sleep apnea, psychiatric problems and problems with self-esteem. This project aims to help elementary school aged children become more involved in making …

Improving Access To Resources For The Medically Uninsured And Underinsured, Katelyn Donaldson

Family Medicine Clerkship Student Projects

Many patients are uninsured or underinsured and are burdened by paying for appointments, labs/imaging, and prescription medications. There are a number of resources available to help with financing healthcare; however, they are under often under utilized. The aim is to create a singular tool for patients to identify resources applicable to their specific healthcare needs to better empower the underserved community members.

Talking To Your Teens About Pregnancy, Sergio Andres Munoz

Family Medicine Clerkship Student Projects

Teen parents are at risk for a variety of adverse life outcomes. The rate of low birth weight and premature delivery is higher among teen mothers than the average population. Teen pregnancy and birth are major contributors to lower educational achievement and income as they are less likely to graduate High school and college, leading to increased rates of poverty among teen mothers. This project aims to educate parents of at risk teens on how to approach the topic with their kids and to provide them with a list of online sources to aid in the process.

Provider Education & Requirements For Opioid Prescriptions, Lawrence J. Leung

Family Medicine Clerkship Student Projects

Nationally, there has been a surge in the opioid prescription crisis with associated overdose deaths. Vermont is no exception, with increasing opioid overdose related deaths within the last 10 years. A sample (n=111) of opioid addiction patients at the Community Health Centers of Burlington (CHCB) have demonstrated that 25% have their initial use due to provider prescription. New Vermont regulations to decrease opioid prescriptions are inefficient. The goal of this project is to implement a streamlined intervention to improve provider education and comfort regarding new Vermont state opioid prescribing regulations.

Lyme Disease: Prevention, Recognition & Treatment, Kristen J. Bartlett

Family Medicine Clerkship Student Projects

Cases of Lyme disease have been steadily rising in Vermont every year. Though the public is becoming more aware of its presence, there is a great deal of misinformation regarding its prevention and treatment.

Sports Injury Prevention In Danbury, Ct, Cori Polonski

Family Medicine Clerkship Student Projects

Sports Injuries, especially overuse injuries, cause a significant amount of morbidity and public health cost, especially for young athletes. Importantly, many of these injuries can be prevented with proper training and some novel approaches to warm-up and training. To address this concern, I worked with Orthopedic Specialists of CT and the athletic trainers at Danbury High School to come up with some educational materials for patients on effective ways to prevent sports medicine injuries.

Mindfulness As An Effective Strategy For Anxiety Relief In Adolescent Patients, Desiree N. Dibella

Family Medicine Clerkship Student Projects

Anxiety disorders affect 6.8 million adults over the age of 18 in the United States, and anxiety disorders are the most common mental health illness in children.

Risk Factors for anxiety disorders in young adults include the following: -Shyness, or behavioral inhibition, in childhood -Being of the female sex -Having few economic resources -Exposure to stressful life events in childhood -Anxiety disorders in close biological relatives -Parental history of mental disorders -Elevated afternoon cortisol levels in the saliva Teens and young adults increasingly suffer from anxiety disorders with the CDC reporting the rate of anxiety disorders among 3 to 17 …

Evaluation Of A Cancer Risk Assessment Questionnaire To Guide Cancer Screening Decision-Making In Primary Care, Anita Li

Family Medicine Clerkship Student Projects

No abstract provided.