Medicine and Health Sciences Commons^™

Integrating Geriatrics In Primary Care: Progress And Prospects, Daniel A. Bluestein, Ryan M. Diduk-Smith

Case Studies from Age in Action

Educational Objectives

1. Demonstrate the need for primary care redesign to better meet the needs of older patients.

2. Identify prospective redesign solutions.

3. Appreciate educational implication that redesign engenders.

Living Well With Chronic Health Conditions: Chronic Disease Self-Management Education In Virginia, April Holmes, Dianne Duke, Joyce Nussbaum

Case Studies from Age in Action

Educational Objectives

1. Review the impact of chronic disease on population health and health care costs.

2. Describe Chronic Disease Self- Management Education (CDSME) programs.

3. Discuss research findings that demonstrate how the Chronic Disease Self-Management Program addresses the triple aims of better care, better health, and lower costs.

4. Explain how CDSME programs are delivered through the Live Well, Virginia! Network.

5. Highlight initiatives to expand CDSME to new target areas and populations.

Proteomic Approach For Extracting Cytoplasmic Proteins From Streptococcus Sanguinis Using Mass Spectrometry, Fadi Elrami, Kristina Nelson, Ping Xu

Philips Institute for Oral Health Research Publications

Streptococcus sanguinis is a commensal and early colonizer of oral cavity as well as an opportunistic pathogen of infectious endocarditis. Extracting the soluble proteome of this bacterium provides deep insights about the physiological dynamic changes under different growth and stress conditions, thus defining “proteomic signatures” as targets for therapeutic intervention. In this protocol, we describe an experimentally verified approach to extract maximal cytoplasmic proteins from Streptococcus sanguinis SK36 strain. A combination of procedures was adopted that broke the thick cell wall barrier and minimized denaturation of the intracellular proteome, using optimized buffers and a sonication step. Extracted proteome was quantitated …

Slowly Cycling Rho Kinase-Dependent Actomyosin Cross-Bridge "Slippage" Explains Intrinsic High Compliance Of Detrusor Smooth Muscle, Christopher J. Neal, Jia B. Lin, Tanner Hurley, Amy S. Miner, John E. Speich, Adam P. Klausner, Paul H. Ratz

Biochemistry and Molecular Biology Publications

Biological soft tissues are viscoelastic because they display timeindependent pseudoelasticity and time-dependent viscosity. However, there is evidence that the bladder may also display plasticity, defined as an increase in strain that is unrecoverable unless work is done by the muscle. In the present study, an electronic lever was used to induce controlled changes in stress and strain to determine whether rabbit detrusor smooth muscle (rDSM) is best described as viscoelastic or viscoelastic plastic. Using sequential ramp loading and unloading cycles, stress-strain and stiffness-stress analyses revealed that rDSM displayed reversible viscoelasticity, and that the viscous component was responsible for establishing a …

Developing Evidence-Based Practice In Chaplaincy: A Study Of Unit And Chaplain-Specific Integration, Heber Aviles Villegas, Juanita Claiborne, Martin Garner, Neal Green, Laura Kelly, Clara Owens, Arouna Stephen

Graduate Research Posters

Health care chaplains provide spiritual care across diverse hospital units. As a result of the complex and interprofessional nature of health care services, different units are associated with unique integration and collaboration needs. Effective chaplain practice and patient-centered care are enhanced by sensitivity to unit differences. Our research, aimed at quality improvement, examined unit and chaplain integration to promote unit-specific evidence-based practice. Integration was conceptualized by five dimensions: interdependence, newly created professional activities, flexibility, collective ownership of goals, reflection on process. data was collected using the Interprofessional Integration and Collaboration Instrument (Bronstein, 2002), which has appropriate measurement quality (Bainbridge et …

Rare Mutations And Potentially Damaging Missense Variants In Genes Encoding Fibrillar Collagens And Proteins Involved In Their Production Are Candidates For Risk For Preterm Premature Rupture Of Membranes, Bhavi P. Modi, Maria E. Teves, Laurel N. Pearson, Hardik I. Parikh, Piya Chaemsaithong, Nihar U. Sheth, Timothy P. York, Roberto Romero, Jerome F. Strauss

Human and Molecular Genetics Publications

Preterm premature rupture of membranes (PPROM) is the leading identifiable cause of preterm birth with ~ 40% of preterm births being associated with PPROM and occurs in 1% - 2% of all pregnancies. We hypothesized that multiple rare variants in fetal genes involved in extracellular matrix synthesis would associate with PPROM, based on the assumption that impaired elaboration of matrix proteins would reduce fetal membrane tensile strength, predisposing to unscheduled rupture. We performed whole exome sequencing (WES) on neonatal DNA derived from pregnancies complicated by PPROM (49 cases) and healthy term deliveries (20 controls) to identify candidate mutations/variants. Genotyping for …

Breastfeeding After Gestational Diabetes: Does Perceived Benefits Mediate The Relationship?, Jordyn T. Wallenborn, Robert A. Perera, Saba W. Masho

Family Medicine and Population Health Publications

Introduction. Breastfeeding is recognized as one of the best ways to decrease infant mortality and morbidity. However, women with gestational diabetes mellitus (GDM) may have breastfeeding barriers due to the increased risk of neonatal and pregnancy complications. While the prevalence of GDM is increasing worldwide, it is important to understand the full implications of GDM on breastfeeding outcomes.The current study aims to investigate the (1) direct effect of GDM on breastfeeding duration and (2) indirect effect of GDM on breastfeeding duration through perceived benefits of breastfeeding. Methods. Prospective cohort data from the Infant Feeding and Practices Study II was analyzed …

Do Successive Preterm Births Increase The Risk Of Postpartum Depressive Symptoms?, Timothy O. Ihongbe, Saba W. Masho

Family Medicine and Population Health Publications

Background. Postpartum depression and preterm birth (PTB) are major problems affecting women’s health. PTB has been associated with increased risk of postpartum depressive symptoms (PDS). However, it is unclear if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. This study aims to determine if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. Methods. Data come from the 2009–2011 national Pregnancy Risk Assessment Monitoring System. Study sample included 55,681 multiparous women with singleton live births in the index delivery. Multiple logistic regression was …

Leveraging Social Media To Promote Evidencebased Continuing Medical Education, Simone Flynn, Paul Hebert, Deborah Korenstein, Mark Ryan, William B. Jordan, Salomeh Keyhan

Family Medicine and Population Health Publications

Importance

New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME).

Objective

To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME.

Design

We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different “hooks” (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and …

Antimicrobial Stewardship Practices In Virginia, Kimberly B. Lee, Jesus Aaron Ramirez, Rebeccah Collins, John Bucheit, Kakotan Sanogo, Michael P. Stevens

Family Medicine and Population Health Publications

The Society of Healthcare Epidemiology of America, the Centers for Disease Control and Prevention, and the President's Council of Advisors on Science and Technology recognize the need to combat antimicrobial resistance through the promotion of antimicrobial stewardship programs. Health care facilities in Virginia were surveyed using a 23-item survey focused on facility characteristics and antimicrobial stewardship strategies. Antimicrobial stewardship activities were highly variable and many are missing key personnel and resources.

Harnessing Information Technology To Inform Patients Facing Routine Decisions: Cancer Screening As A Test Case, Alex Krist, Steven H. Woolf, Camille Hochheimer, Roy T. Sabo, Paulette Kashiri, Resa M. Jones, Jennifer Elston Lafata, Rebecca S. Etz, Shin-Ping Tu

Family Medicine and Population Health Publications

PURPOSE Technology could transform routine decision making by anticipating patients’ information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases.

METHODS Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men …

Coexisting Sickle Cell Anemia And Sarcoidosis: A Management Conundrum!, Fnu Nutan, Nagesh S. Gollahalli

Family Medicine and Population Health Publications

Sickle cell disease and Sarcoidosis are conditions that are more common in the African American population. In this report we share an unfortunate patient who had hepatic sarcoidosis but could not receive steroids since that precipitated acute liver failure. We have discussed potential therapy options but we need more options that improve mortality.

Interleukin-18 Mediates Cardiac Dysfunction Induced By Western Diet Independent Of Obesity And Hyperglycemia In The Mouse, S Carbone, P J H Lee, A G Mauro, E Mezzaroma, R Buzzetti, B Van Tassell, A Abbate, S Toldo

Family Medicine and Population Health Publications

Obesity and diabetes are independent risk factors for heart failure and are associated with the consumption of diet rich in saturated fat and sugar, Western diet (WD), known to induce cardiac dysfunction in the mouse through incompletely characterized inflammatory mechanisms. We hypothesized that the detrimental cardiac effects of WD are mediated by interleukin-18 (IL-18), proinflammatory cytokine linked to cardiac dysfunction. C57BL/6J wild-type male mice and IL-18 knockout male mice were fed highsaturated fat and high-sugar diet for 8 weeks. We measured food intake, body weight and fasting glycemia. We assessed left ventricular (LV) systolic and diastolic function by Doppler echocardiography …

Combined Cognitive And Vocational Interventions After Mild To Moderate Traumatic Brain Injury: Study Protocol For A Randomized Controlled Trial, Emilie I. Howe, Knut-Petter S. Langlo, Hans Christoffer Aargaard Terjesen, Cecilie Røe, Anne-Kristine Schanke, Helene L. Søberg, Unni Sveen, Eline Aas, Heidi Enehaug, Daniele E. Alves, Pål Klethagen, Kjersti Sagstad, Christine M. Moen, Karin Torsteinsbrend, Anne-Margrethe Linnestad, Tonje Haug Nordenmark, Birte Sand Rismyhr, Grete Wangen, Juan Lu, Jennie Ponsford, Elizabeth W. Twamley, Helene Ugelstad, Øystein Spjelkavik, Marianne Løvstad, Nada Andelic

Family Medicine and Population Health Publications

Background

A considerable proportion of patients with mild to moderate traumatic brain injury (TBI) experience long-lasting somatic, cognitive, and emotional symptoms that may hamper their capacity to return to work (RTW). Although several studies have described medical, psychological, and work-related factors that predict RTW after TBI, well-controlled intervention studies regarding RTW are scarce. Furthermore, there has traditionally been weak collaboration among health-related rehabilitation services, the labor and welfare sector, and workplaces.

Methods/design

This study protocol describes an innovative randomized controlled trial in which we will explore the effect of combining manualized cognitive rehabilitation (Compensatory Cognitive Training [CCT]) and supported employment …

Assessing Efficiency Of Public Health And Medical Care Provision In Oecd Countries After A Decade Of Reform, Yasar A. Ozcan, Jaya Khushalani

Health Administration Publications

The objective of this study was to examine the change in efficiency of health care systems of 34 OECD countries between 2000 and 2012, a period marked by significant health reform in most OECD countries. This paper uses a novel Dynamic Network Data Envelopment Analysis (DNDEA) model to analyze the efficiency of the public health system and the medical care system of these OECD countries independently along with assessing the efficiency of their overall health system. This helps understand the relative priorities for improving the overall health system. The data for this study was obtained from the OECD Health Facts …

The Dynamics Of Power And Psychological Safety On Team Cohesion During Interprofessional Simulation-Based Education, Tanya Huff

2017 Emswiller Interprofessional Symposium

No abstract provided.

Structural Modeling And Functional Analysis Of The Essential Ribosomal Processing Protease Prp From Staphylococcus Aureus, Erin A. Wall, Adam L. Johnson, Darrell L. Peterson, Gail E. Christie

Microbiology and Immunology Publications

In Firmicutes and related bacteria, ribosomal large subunit protein L27 is encoded with a conserved N-terminal extension that is removed to expose residues critical for ribosome function. Bacteria encoding L27 with this N-terminal extension also encode a sequence-specific cysteine protease, Prp, which carries out this cleavage. In this work, we demonstrate that L27 variants with an un-cleavable N-terminal extension, or lacking the extension (pre-cleaved), are unable to complement an L27 deletion in Staphylococcus aureus. This indicates that N-terminal processing of L27 is not only essential but possibly has a regulatory role. Prp represents a new clade of previously uncharacterized cysteine …

Tetr Family Regulator Brpt Modulates Biofilm Formation In Streptococcus Sanguinis, Jinlin Liu, Victoria N. Stone, Xiuchun Ge, Madison Tang, Fadi Elrami, Ping Xu

Microbiology and Immunology Publications

Biofilms are a key component in bacterial communities providing protection and contributing to infectious diseases. However, mechanisms involved in S. sanguinis biofilm formation have not been clearly elucidated. Here, we report the identification of a novel S. sanguinis TetR repressor, brpT (Biofilm Regulatory Protein TetR), involved in biofilm formation. Deletion of brpT resulted in a significant increase in biofilm formation. Interestingly, the mutant accumulated more water soluble and water insoluble glucans in its biofilm compared to the wild-type and the complemented mutant. The brpT mutation led to an altered biofilm morphology and structure exhibiting a rougher appearance, uneven …

Identification Of Naegleria Fowleri Proteins Linked To Primary Amoebic Meningoencephalitis, Melissa Jamerson, Jacqueline A. Schmoyer, Jay Park, Francine Marciano-Cabral, Guy A. Cabral

Microbiology and Immunology Publications

Naegleria fowleri (N. fowleri) causes primary amoebic meningoencephalitis, a rapidly fatal disease of the central nervous system. N. fowleri can exist in cyst, flagellate or amoebic forms, depending on environmental conditions. The amoebic form can invade the brain following introduction into the nasal passages. When applied intranasally to a mouse model, cultured N. fowleri amoebae exhibit low virulence. However, upon serial passage in mouse brain, the amoebae acquire a highly virulent state. In the present study, a proteomics approach was applied to the identification of N. fowleri amoeba proteins whose expression was associated with the highly virulent state …

Saikosaponins Induced Hepatotoxicity In Mice Via Lipid Metabolism Dysregulation And Oxidative Stress: A Proteomic Study, Xiaoyu Li, Xiaojiaoyang Li, Junxian Lu, Youyi Huang, Lili Lv, Yongfu Luan, Runping Liu, Rong Sun

Microbiology and Immunology Publications

Background

Radix Bupleuri (RB) has been popularly used for treating many liver diseases such as chronic hepatic inflammation and viral Hepatitis in China. Increasing clinical and experimental evidence indicates the potential hepatotoxicity of RB or prescriptions containing RB. Recently, Saikosaponins (SS) have been identified as major bioactive compounds isolated from RB, which may be also responsible for RB-induced liver injury.

Methods

Serum AST, ALT and LDH levels were determined to evaluate SS-induced liver injury in mice. Serum and liver total triglyceride and cholesterol were used to indicate lipid metabolism homeostasis. Liver ROS, GSH, MDA and iNOS were used to examine …

Perfluorocarbon Emulsions Radiosensitise Brain Tumors In Carbogen Breathing Mice With Orthotopic Gl261 Gliomas, Lisa A. Feldman, Marie-Sophie Fabre, Carole Grasso, Dana Reid, William C. Broaddus, Gregory M. Lanza, Bruce D. Spiess, Joel R. Garbow, Melanie J. Mcconnell, Patries M. Herst

Neurosurgery Publications

Background

Tumour hypoxia limits the effectiveness of radiation therapy. Delivering normobaric or hyperbaric oxygen therapy elevates pO2 in both tumour and normal brain tissue. However, pO2 levels return to baseline within 15 minutes of stopping therapy.

Aim

To investigate the effect of perfluorocarbon (PFC) emulsions on hypoxia in subcutaneous and intracranial mouse gliomas and their radiosensitising effect in orthotopic gliomas in mice breathing carbogen (95%O2 and 5%CO2).

Results

PFC emulsions completely abrogated hypoxia in both subcutaneous and intracranial GL261 models and conferred a significant survival advantage orthotopically (Mantel Cox: p = 0.048) in carbogen breathing mice injected intravenously (IV) with …

Cyclic-Amp Regulates Postnatal Development Of Neural And Behavioral Responses To Nacl In Rats, Jie Qian, Shobha Mummalaneni, Tam-Hao T. Phan, Gerard L. Heck, John A. Desimone, David West, Sunila Mahavadi, Deanna Hojati, Karnam S. Murthy, Mee-Ra Rhyu, Andrew I. Spielman, Mehmet H. Özdener, Vijay Lyall

Physiology and Biophysics Publications

During postnatal development rats demonstrate an age-dependent increase in NaCl chorda tympani (CT) responses and the number of functional apical amiloride-sensitive epithelial Na+channels (ENaCs) in salt sensing fungiform (FF) taste receptor cells (TRCs). Currently, the intracellular signals that regulate the postnatal development of salt taste have not been identified. We investigated the effect of cAMP, a downstream signal for arginine vasopressin (AVP) action, on the postnatal development of NaCl responses in 19–23 day old rats. ENaC-dependent NaCl CT responses were monitored after lingual application of 8-chlorophenylthio-cAMP (8-CPT-cAMP) under open-circuit conditions and under ±60 mV lingual voltage clamp. Behavioral responses were …

Effect Of Variations In Atelectasis On Tumor Displacement During Radiation Therapy For Locally Advanced Lung Cancer, Nathan Tennyson, Elisabeth Weiss, William Sleeman, Mihaela Rosu, Nuzhat Jan, Geoffrey D. Hugo

Radiation Oncology Publications

Purpose

Atelectasis (AT), or collapsed lung, is frequently associated with central lung tumors. We investigated the variation of atelectasis volumes during radiation therapy and analyzed the effect of AT volume changes on the reproducibility of the primary tumor (PT) position.

Methods and materials

Twelve patients with lung cancer who had AT and 10 patients without AT underwent repeated 4-dimensional fan beam computed tomography (CT) scans during radiation therapy per protocols that were approved by the institutional review board. Interfraction volume changes of AT and PT were correlated with PT displacements relative to bony anatomy using both a bounding box (BB) …

Virginia Dental Journal (Vol. 94, No. 3, 2017)

Virginia Dental Journal

No abstract provided.

Virginia Dental Journal (Vol. 94, No. 1, 2017)

Virginia Dental Journal

No abstract provided.

Heme Oxygenase 1 Expression After Traumatic Brain Injury And Effect Of Pharmacological Manipulation On Functional Recovery., Nicholas H. Russell

Theses and Dissertations

Traumatic Brain Injury (TBI) is an increasingly diagnosed constellation of injuries derived from acute mechanical trauma to the brain. With the rise of advanced neuroimaging techniques recent focus has oriented primarily towards the mild-moderate range of TBI which previously was missed diagnostically. Characteristically, these advances have shown increasing areas of micro-hemorrhage in susceptible areas of the brain and to date there are no treatment modalities targeting micro-hemorrhages or their sequelae. This dissertation explores the effects of the resulting heme processing response in the days following injury with a particular focus on inducing early heme clearance from the parenchyma using a …

Nitrosative Stress Sensing In Porphyromonas Gingivalis: Structure And Function Of The Heme Binding Transcriptional Regulator Hcpr, Benjamin R. Belvin

Theses and Dissertations

Porphyromonas gingivalis, a Gram negative anaerobe implicated in the progression of periodontal disease, is capable of surviving and causing infection despite high levels of reactive nitrogen species found in the oral cavity due to its efficient nitrosative stress response. HcpR is an important sensor-regulator that plays a vital step in the initiation of the nitrosative stress response in many Gram negative anaerobic bacteria. We employ a combination of X-ray crystallography, SAXS, resonance Raman spectroscopy, UV-Vis spectroscopy, and molecular biology techniques to better understand this key regulator. Knockout of the hcpR gene in W83 P. gingivalis results in the inability of …

Prevalence And Clinical Characteristics Of Teeth Extracted With A Diagnosis Of Cracked Tooth: A Retrospective Study, Riley B. Sturgill

Theses and Dissertations

The body of knowledge that exists regarding cracked teeth is limited. The purpose of this study was to determine the prevalence of cracks among extracted teeth. This retrospective longitudinal cohort study included patients of the Virginia Commonwealth University School of Dentistry that underwent extraction procedures over a 6 year period. The sample consisted of 20,408 patients and 40,870 teeth. Statistical analysis software was used to identify diagnoses of a crack, fracture, or split tooth prior to extraction of the tooth by analyzing the Electronic Health Record (EHR) (axiUm™, Version 6.03.03.1035, Exan Corporation, Vancouver, BC, Canada). There were 3,228 teeth …

Sleep Disturbances And Depression: The Role Of Genes And Trauma, Mackenzie J. Lind

Theses and Dissertations

Sleep disturbances and insomnia are prevalent, with around 33% of adults indicating that they experience at least one main symptom of insomnia, and bidirectional relationships exist with common psychopathology, particularly major depressive disorder (MDD). However, genetic and environmental (e.g., traumatic event exposure) contributions to the etiology of these phenotypes are not yet well understood. A genetically informative sample of approximately 12,000 Han Chinese women aged 30-60 (50% with recurrent MDD) was used to address several gaps within the sleep literature. Sleep disturbances were assessed in all individuals using a general item addressing sleeplessness (GS). A sleep within depression sum score …

Implementing Integrated Care In Family Medicine: Description And Outcomes In An Underserved Population, Zach Radcliff

Theses and Dissertations

Introduction: Family physicians provide access to medical and behavioral healthcare for many underserved populations. Integrating behavioral health clinicians into primary care practices has been proposed as one of the most effective ways to increase access to necessary behavioral health services for many Americans. Integrated behavioral healthcare (IBHC) has begun to be implemented in family medicine practices but there is limited research examining the impact for patients and clinic staff. This study begins to fill this gap in the literature by examining the effects of implementing integrated behavioral healthcare in an urban family medicine clinic in a medically underserved area.

Objective: …