Medicine and Health Sciences Commons^™

A Validated, Model-Specific Tool To Measure The Developmental Stage Of A Shared Governance, Professional Practice Model, Kim S. Hitchings Msn, Rn, Nea-Bc, Joanna Bokovoy Rn, Drph, Terry A. Capuano Mba, Msn, Rn, Fache, Ne-Bc, Janet Houser Rn, Phd

Terry A Capuano MBA, MSN, RN, FACHE, NE-BC

No abstract provided.

Daclatasvir In Combination With Asunaprevir And Beclabuvir For Hepatitis C Virus Genotype 1 Infection With Compensated Cirrhosis., Andrew J Muir, Fred Poordad, Jacob Lalezari, Gregory Everson, Gregory J Dore, Robert Herring, Aasim Sheikh, Paul Kwo, Christophe Hézode, Paul J Pockros, Albert Tran, Joseph L. Yozviak Do, Facp, Nancy Reau, Alnoor Ramji, Katherine Stuart, Alexander J Thompson, John Vierling, Bradley Freilich, James Cooper, Wayne Ghesquiere, Rong Yang, Fiona Mcphee, Eric A Hughes, E Scott Swenson, Philip D Yin

Joseph L Yozviak DO, FACP

IMPORTANCE: Effective and well-tolerated, interferon-free regimens are needed for treatment of patients with chronic hepatitis C virus (HCV) infection and cirrhosis.

OBJECTIVE: All-oral therapy with daclatasvir (nonstructural protein 5A [NS5A] inhibitor), asunaprevir (NS3 protease inhibitor), and beclabuvir (nonnucleoside NS5B inhibitor), with or without ribavirin, was evaluated in patients with HCV genotype 1 infection and compensated cirrhosis.

DESIGN, SETTING, AND PARTICIPANTS: The UNITY-2 study was conducted between December 2013 and October 2014 at 49 outpatient sites in the United States, Canada, France, and Australia. Patients were treated for 12 weeks, with 24 weeks of follow-up after completion of treatment. Adult patients …

Hla Class I Supertype Associations With Clinical Outcome Of Secondary Dengue Virus Infections In Ethnic Thais, Sasijit Vejbaesya, Rungrot Thongpradit, Siripen Kalayanarooj, Komon Luangtrakool, Panpimon Luangtrakool, Robert V. Gibbons, Duangporn Srinak, Somporn Ngammthaworn, Kusuma Apisawes, In-Kyu Yoon, Stephen J. Thomas, Richard G. Jarman, Anon Srikiatkhachorn, Sharone Green, Dasnayanee Chandanayingyong, Sangshin Park, Jennifer Friedman, Alan L. Rothman, Henry A.F. Stephens

Sharone Green

BACKGROUND: Human leukocyte antigen (HLA) supertypes are groups of functionally related alleles that present structurally similar antigens to the immune system.

OBJECTIVES: To analyze HLA class I supertype associations with clinical outcome in hospitalized Thai children with acute dengue illness.

METHODS: Seven hundred sixty-two patients and population-matched controls recruited predominantly in Bangkok were HLA-A and -B typed. HLA supertype frequencies were compared and tested for significant dengue disease associations using logistic regression analyses. Multivariable models were built by conducting forward stepwise selection procedures.

RESULTS: In the final logistic regression model, the HLA-B44 supertype was protective against dengue hemorrhagic fever (DHF) …

Traumatic Laryngeal Fracture In A Collegiate Basketball Player, Jeffery D. Kim Md, Ms, Franklin D. Shuler Md, Phd, Bi Mo, Scott R. Gibbs Md, Thomas Belmaggio Ms, Atc, Charles Giangarra Md

Scott Gibbs

Laryngotracheal trauma is a rare condition that accounts for less than 1% of blunt trauma. Laryngotracheal fractures are uncommon in sports, even in settings where athletes are more vulnerable, including football, basketball, and hockey. If a laryngeal injury is suspected, immediate evaluation is required to avoid a delay in the diagnosis of a potentially life-threatening injury. A collegiate basketball player sustained an unusual fracture involving the cricoid and thyroid cartilage during practice. This case illustrates the importance of rapid identification and early management of patients with blunt laryngotracheal trauma in sports.

Subdural Hematoma As A Consequence Of Epidural Anesthesia., Tracy M Bishop Do, Kareem S. Elsayed Ms, Kathleen E. Kane Md

Kathleen E Kane MD

Regional spinal and epidural anesthesia are used commonly in operative procedures. While the most frequent complication, postdural puncture headache (PDPH), is a clinically diagnosed positional headache that is usually self-limited, subdural hemorrhage (SDH) is a potentially fatal complication that cannot be missed. We report a case of an otherwise healthy female who presented with persistent positional headache and was ultimately found to have a large subdural hematoma with midline shift requiring surgical evacuation.

Acute Cerebellar Ataxia: An Unusual Pediatric Case., Thanhnga T. Doan, Clifford P. Masom Md, Richard J. Mazzaccaro Md, Kathleen E. Kane Md

Kathleen E Kane MD

BACKGROUND: Acute cerebellar ataxia is a clinical syndrome with sudden onset of uncoordinated gait and normal mental status in young children. Although it has a benign clinical course, it often requires an exhaustive diagnostic work-up in order to rule out potentially life-threatening etiologies that present similarly. The wide differential encompasses causes from infections, brain masses, drugs, toxins, trauma, paraneoplastic syndromes, as well as hereditary or congenital disorders.

CASE REPORT: We report on a 4-year-old boy with recent hand-foot-mouth disease who presented with acute cerebellar ataxia. In addition to his marked truncal ataxia and wide-based, staggering gait, he had slowness of …

Safety Culture In Cardiac Surgical Teams: Data From Five Programs And National Surgical Comparison., Jill A Marsteller, Mei Wen, Yea-Jen Hsu, Laura C Bauer, Nanette M. Schwann M.D., Christopher J Young, Juan A Sanchez, Nicole A Errett, Ayse P Gurses, David A Thompson, Joyce A Wahr, Elizabeth A Martinez

Nanette M Schwann MD

BACKGROUND: Little is known about safety culture in the area of cardiac surgery as compared with other types of surgery. The unique features of cardiac surgical teams may result in different perceptions of patient safety and patient safety culture.

METHODS: We measured and described safety culture in five cardiovascular surgical centers using the Hospital Survey on Patient Safety Culture, and compared the data with the Agency for Healthcare Research and Quality (AHRQ) 2010 comparative database in surgery and anesthesiology (all types). We reported mean scores, standard deviations, and percent positive responses for the two single-item measures and 12 patient safety …

The Purification Of Α1-Antichymotrypsin From Human Serum Using Dna-Cellulose Chromatography, Munir Abdullah, Anwar Ali Siddiqui, J Alan Hill, R Jeremy

Anwar Ali Siddiqui

Abstract

By exploiting its capacity for binding to DNA, the protease inhibitor α₁-antichymotrypsin has been isolated from human serum by ammonium sulfate fractionation and successive chromatography on QAE-Sephadex, DNA-cellulose, and Sephacryl S-300. This experimental procedure compares favorably with existing methods for preparing α₁-antichymotrypsin in terms of overall yield and practical convenience. The purified α₁-antichymotrypsin was homogeneous as judged by electrophoretic and immunoelectrophoretic criteria. From its inhibition of the fluorimetric titration of chymotrypsin with 4-methylumbelliferyl-p-trimethylammonium cinnamate it was shown to combine with chymotrypsin in a 1:1 molar ratio and thus to retain its …

Meningitis-Associated Low Molecular Mass Proteins In Cerebrospinal Fluid., Anwar Ali Siddiqui, Waqar Ma,, Khurshid M.

Anwar Ali Siddiqui

No abstract provided.

Proteins In Renal Stones And Urine Of Stone Formers., Anwar A. Siddiqui, Taranum Sultana, Niels-Peter Buchholz, Mohammad A. Waqar, Jamsheer J Talati

Anwar Ali Siddiqui

Knowledge of the essential characteristics of macromolecules constituting the organic matrix of the nidus of urinary stones is required to understand the mechanism of urolithogenesis. The aim of this study was to isolate and characterise those stone nidus proteins. Using an extraction buffer containing SDS and beta-mercaptoethanol, we were able to overcome known problems of protein isolation from urinary stone matrix. These proteinswere characterised by a strong tendency to aggregate under reducing and denaturing conditions. On SDS-PAGE, their molecular weights range from < or = 12 to 66 kDa. Antisera raised against stone matrix proteins showed a cross-reactivity between proteins isolated from different stonesirrespective of their origin or mineral composition. Moreover, urinary proteins from stone formers also cross-reacted with these whereas there was no reaction with urinary proteins of non-stone formers. Western blotting confirmed these findings. Given the above summarised properties, it can be safely concluded that these proteins are prevalent in urines of stone formers, that they are selectively incorporated into renal stones of all aetiologies, and that they most likely have a role in nidus and, therefore, early stone formation.

Identification Of Myeloperoxidase, Alpha-Defensin And Calgranulin In Calcium Oxalate Renal Stones., Shamim Mushtaq, Anwar Ali Siddiqui, Zulfiqar Ali Naqvi, Ahmed Rattani, Jamsheer J Talati, Carina Palmberg, Jawed Shafqat

Anwar Ali Siddiqui

BACKGROUND:

In order to understand the mechanism of stone genesis, it is essential to determine the characteristics of macromolecules constituting the urinary stones. We characterized proteins from the inner core and outer matrix of calcium oxalate (CaOx) renal stones.

METHODS:

Inner core and outer matrix of CaOx renal stones were separated and proteins were extracted with a buffer containing SDS and beta-mercaptoethanol. Proteins were analyzed and purified by SDS-PAGE and RP-HPLC respectively. The protein bands from gel and protein fractions were sequenced by MALDI TOF mass spectrometry. ELISA, western and slot blot immunoassays were performed to confirm the identity of …

Health Care Risk Factors Among Women And Personal Behaviours Among Men Explain The High Prevalence Of Hepatitis C Virus Infection In Karachi, Pakistan, N. Z. Janjua, H. B. Hamza, M. Islam, S. F. A. Tirmizi, A. Siddiqui, W. Jafri, Saeed Hamid

Anwar Ali Siddiqui

To estimate the prevalence and identify factors associated with hepatitis C virus (HCV) infection among men and women in Karachi, Pakistan. We conducted a cross-sectional study of adult men and women in a peri-urban community of Karachi (Jam Kandah). Households were selected through systematic sampling from within all villages in the study area. All available adults within each household were interviewed about potential HCV risk factors. A blood specimen was collected to test for anti-HCV antibodies by enzyme immunoassay. We used generalized estimating equations while accounting for correlation of responses within villages to identify the factors associated with HCV infection. …

Enrichment Programme In Kabul, Afghanistan: Access To Higher Education At Aga Khan University, Karachi Pakistan, Khan Basnama Ayaz, Zeenatkhanu Kanji, Kassam Zeenab

Zeenatkhanu Kanji

Introduction: Today health care institutions face issues of nursing shortage due to decline in number of nurses and the complexity of patients’ condition. Also, many countries internationally have moved towards Baccalaureate of Sciences in Nursing (BScN) as entry to professional practice. These factors enforce the schools/colleges of nursing to recruit students that fulfill the demands of the society; on the other hand recruitment and retention of these students into the programmes from a diverse population brings the challenges. Therefore, Aga Khan University School of Nursing and Midwifery (AKU-SONAM) in Karachi, Pakistan developed a pre-admission Enrichment Programme (EP) through its programmes …

Gender-Specific Research On Mental Illness In The Emergency Department: Current Knowledge And Future Directions., Megan L Ranney, Natalie Locci, Erica J Adams, Marian Betz, David B. Burmeister Do, Facep, Ted Corbin, Preeti Dalawari, Jeanne L. Jacoby Md, Judith Linden, Jonathan Purtle, Carol North, Debra E Houry

David Burmeister, DO, FACEP, CPE

Mental illness is a growing, and largely unaddressed, problem for the population and for emergency department (ED) patients in particular. Extensive literature outlines sex and gender differences in mental illness' epidemiology and risk and protective factors. Few studies, however, examined sex and gender differences in screening, diagnosis, and management of mental illness in the ED setting. Our consensus group used the nominal group technique to outline major gaps in knowledge and research priorities for these areas, including the influence of violence and other risk factors on the course of mental illness for ED patients. Our consensus group urges the pursuit …

Integrating Commercial Ambulatory Electronic Health Records With Hospital Systems: An Evolutionary Process., Susan A. Sherer, Chad D. Meyerhoefer, Michael Sheinberg Md, Donald Levick Md

Donald Levick MD

OBJECTIVE: The increase in electronic health record implementation in all treatment venues has led to greater demands for integration within and across practice settings with different work cultures. We study the evolution of coordination processes when integrating ambulatory-specific electronic health records with hospital systems.

MATERIALS AND METHODS: Longitudinal qualitative study using semi-structured interviews and archival documentation throughout a 5-year implementation and integration of obstetrical ambulatory and hospital records with a goal of achieving a perinatal continuum of care.

RESULTS: As users implement and integrate electronic health records, there is an evolution in their focus from technology acceptance to structural adaptation …

Ho-1 Induction Improves The Type-1 Cardiorenal Syndrome In Mice With Impaired Angiotensin Ii–Induced Lymphocyte Activation, Sumit R. Monu, Paola Pesce, Komal Sodhi, Massimo Boldrin, Nitin Puri, Larisa Fedorova, David Sacerdoti, Stephen J. Peterson, Nader G. Abraham, Attallah Kappas

Nader G. Abraham

Type-1 cardiorenal syndrome, characterized by acute kidney dysfunction secondary to cardiac failure and renal arteriolar vasoconstriction, is mediated by the renin–angiotensin–aldosterone axis and sympathetic nervous system activation. Previous reports indicate that angiotensin II modulates immune function and causes recruitment and activation of T-lymphocytes. The goal of this study was to evaluate the effects of postischemic heart failure on renal morphology and circulation and the beneficial effects of heme oxygenase-1 (HO-1) induction in T-lymphocyte–suppressed severe combined immune deficiency (SCID) mice. Mice were divided into 4 groups: sham, myocardial infarction (MI), MI treated with an HO-1 inducer, cobalt protoporphyrin, and with or …

Decoupling Of Normal Cd40/Interleukin-4 Immunoglobulin Heavy Chain Switch Signal Leads To Genomic Instability In Sgh-Mm5 And Rpmi 8226 Multiple Myeloma Cell Lines, William Y.K Hwang, Charles A. Gullo Phd, Jie Shen, Chee Kok Poh, S. C. Tham, G. Cow, M. Au, E. W. E. Chan, G. Teoh

Charles Gullo

The processes mediating genomic instability and clonal evolution are obscure in multiple myeloma (MM). Acquisition of new chromosomal translocations into the switch region of the immunoglobulin heavy chain (IgH) gene (chromosome 14q32) in MM, often heralds transformation to more aggressive disease. Since the combined effects of CD40 plus interleukin-4 (IL-4) mediate IgH isotype class switch recombination (CSR), and this process involves DNA double strand break repair (DSBR), we hypothesized that CD40 and/or IL-4 activation of MM cells could induce abnormal DNA DSBR and lead to genomic instability and clonal evolution. In this study, we show that MM cell lines that …

Life-Threatening Retropharyngeal Hemorrhage Secondary To Rupture Of The Inferior Thyroid Artery., Cristina G Calogero, Andrew C. Miller Do, Marna R. Greenberg Do, Mph, Facep

Marna R Greenberg DO, MPH, FACEP

Inferior thyroid artery (ITA) rupture is rare and may progress to life-threatening conditions. We present a patient who visited the emergency department after an episode of syncope and dizziness in which he had a mechanical fall that resulted in abrasions and a hematoma to his left forehead. The patient presented with dysphagia and anterior neck swelling that progressed rapidly into airway compromise requiring endotracheal intubation. Emergent computed tomography revealed a large retropharyngeal hematoma, with active arterial extravasation that was thought to be arising from the thyrocervical trunk on the left. The hematoma measured approximately 6.7 cm transversely and 3.2 cm …

Palliative Care Education In Emergency Medicine Residency Training: A Survey Of Program Directors, Associate Program Directors, And Assistant Program Directors., Chadd K. Kraus, Marna R. Greenberg Do, Mph, Facep, Daniel Ray Md, Sydney Morss Dy

Marna R Greenberg DO, MPH, FACEP

CONTEXT: Emergency medicine (EM) residents perceive palliative care (PC) skills as important and want training, yet there is a general lack of formal PC training in EM residency programs. A clearer definition of the PC educational needs of EM trainees is a research priority.

OBJECTIVES: To assess PC competency education in EM residency programs.

METHODS: This was a mixed-mode survey of residency program directors, associate program directors, and assistant program directors at accredited EM residency programs, evaluating four educational domains: 1) importance of specific competencies for senior EM residents, 2) senior resident skills in PC competencies, 3) effectiveness of educational …

Self-Report Naps In Irregular Work Schedules, June J. Pilcher, Stephen M. Popkin, Karen Adkins, Lindsay Roether

June Pilcher

Few studies have examined napping in irregular work schedules such as those experienced by freight locomotive engineers. The current study examined the effect of napping in irregular work schedules on sleep length and three subjective measures: ability to go to sleep, ability to stay asleep, and a feeling of being well-rested upon awakening. One hundred and seventy-nine freight engineers completed a 14-d activity log, providing information on sleep times and subjective evaluations of sleep. The results indicated that days with naps resulted in significantly more total sleep but less sleep in the main sleep period of the day. The days …

Clemson To Vienna, The Journey Of A Fulbright-Freud Scholar And Martial Arts Enthusiast, June J. Pilcher

June Pilcher

I applied for a Fulbright to work in the Social, Cognitive, Affective, Neuroscience Unit (SCAN) at the University of Vienna and to teach at the university. But, as sometimes happens, things worked out slightly differently than I had initially planned. Instead of being awarded a Fulbright to work exclusively at the University of Vienna, I received the Fulbright-Freud Award which allowed me to work at the university but also to work with the Sigmund Freud Museum.

Student Reflections Of Psychiatric/Mental Health: Using Journals And Creative Expressions

Melinda Hermanns

Therapists' Perspectives On Working With Interracial Couples [Book Chapter], Shruti Poulsen

Shruti Poulsen

About the book:

Go beyond cookie-cutter therapy and interventions to provide culturally relevant therapy that works for your clients in interracial relationships! With this book, you'll explore an array of relational issues faced by various configurations of interracial couples. Then you'll learn specific intervention strategies for treating these couples in therapy. The first section presents research and theoretical chapters on issues faced by interracial couples who are heterosexual; the second focuses on issues facing racially mixed gay and lesbian couples; and the third provides you with specific interventions to use with couples in interracial relationships. Clinical Issues with Interracial Couples: …

Open Relationships: A Culturally And Clinically Sensitive Approach, Deanna M. Fierman, Shruti Singh Poulsen

Shruti Poulsen

Romantic and sexual relationships that challenge the notion of monogamy are more common and visible in American society than earlier years, yet there is very little literature focusing on therapy with clients in open relationships. Concepts from the literature on open relationships that could be used in couple and family therapy are discussed in addition to specific ethical considerations for therapists who work with this population. A case description that illustrates a clinical approach that draws upon constructionist and narrative elements is provided. A discussion of how therapists can assist with the negotiation of non-monogamy, and suggestions for ways to …

Utilizing Photographs With The Genogram: A Technique For Enhancing Couple Therapy, Jennifer M. Cook, Shruti Poulsen

Shruti Poulsen

The authors propose the use of photographs in conjunction with genograms in the couple therapy process in order to create a dynamic, information rich, and experiential therapeutic environment. The authors explore family-of-origin work with genograms and clients' personal photographs, showcasing the potential usefulness of combining these therapeutic practices to enhance couple therapy. The authors present a case description illustrating how this approach can develop a richer narrative about family-of-origin patterns in the couple system and function as a stimulus for change in the couple relationship.

Patient-Centered Communication And Prognosis Discussions With Cancer Patients, Cleveland G. Shields, Casey J. Coker, Shruti S. Poulsen, Jennifer M. Doyle, Kevin Fiscella, Ronald M. Epstein, Jennifer J. Griggs

Shruti Poulsen

To examine physician communication associated with prognosis discussion with cancer patients.

Therapists' Perspectives On Working With Interracial Couples, Shruti S. Poulsen

Shruti Poulsen

This paper is based on interviews with seven marriage and family therapists (AAMFT Clinical Members) on their experiences of providing therapy to interracial couples in the course of their private practices. The interviews were conducted by the author as part of a masters thesis project. Interracial couples may frequently present for therapy with a variety of generic couples' issues and concerns. However, therapists often find that underlying these more generic concerns are issues related to the ethnic, racial, and cultural differences that the partners bring to the relationship. This paper focuses on the historical context of intermarriage, specific concerns and …

Emotionally Focused Couple Therapy With Couples Facing Terminal Illness, Sarah Tie, Shruti Poulsen

Shruti Poulsen

Research on effective therapeutic interventions for couples dealing with terminal illness is scant. Changes in daily routine, added responsibilities, role changes, and the grief process are all contributors to the enormous stress and emotional strain felt by these couples. Couples where one partner is terminally ill may experience anger, depression, guilt, and anxiety. The authors propose that emotionally focused couple therapy (EFT), originally developed by Greenberg and Johnson (Emotionally focused therapy for couples, Guilford Press, New York, NY, 1988) may be effective in addressing this distress and in facilitating the grieving and support process in couples dealing with terminal …

Awareness Of Culture: Clinical Implications For Couple Therapy [Book Chapter], Shruti Poulsen, Volker Thomas

Shruti Poulsen

This is a chapter in the book Handbook of Clinical Issues in Couple Therapy.

About the book:
Handbook of Clinical Issues in Couple Therapy provides a comprehensive overview of emerging issues that impact couple therapy. Unlike other guides that concentrate more on theoretical approaches, this invaluable resource contains the latest research and perspectives that every clinician needs when dealing with the challenging issues often found in practice. Carefully referenced, it explores a range of issues that include intimate partner violence, posttraumatic stress disorder and its effect on couple relationships, divorce therapy, remarriage and cohabitation issues, cultural issues, and couple therapist …

Open Relationships: A Culturally & Clinically Sensitive Approach [Book Chapter[, D. Fierman, Shruti S. Poulsen

Shruti Poulsen

About the book:

This Brief from the American Family Therapy Academy (AFTA) is a collection of chapters from the AFTA Monograph Series. The chapters specifically address responses to a wide range of contextual phenomena from a relational family therapy perspective. Chapters are grounded in family systems concepts and informed by postmodern perspectives including social justice. The collection provides cutting edge thinking and practices for a variety of experiences that strongly impact individuals and families. Authors address the treatment of couples and families oppressed by socio-contextual phenomena such as war and poverty, and of those marginalized by the insidious impact of …