Medicine and Health Sciences Commons^™

Central Lines In Children, Rishi Agrawal, Neha H. Shah

E-Learning Modules

Children with special health care needs are increasingly prevalent in US hospitals. The pediatric hospitalist is often the primary provider of inpatient care for these patients. However, exposure to this patient population during training varies from provider to provider. No published educational curricula are specific to the inpatient care of this population.

This publication is a self-directed education module on central lines in children, including indications for placement, types of lines available, and prevention and treatment of complications. The module includes a PowerPoint slide show, instructor guide, and questions for assessment.

The purpose of this project is to build a …

Unicef Communications For Development (C4d) Strategy For The Prevention Of Violence Against Children In South Africa., Marc C. Edberg, Rajiv N. Rimal, Hina Shaikh

Center for Social Well-Being and Development

No abstract provided.

Cross-Sectional Associations Between Exposure To Persistent Organic Pollutants And Leukocyte Telomere Length Among U.S. Adults In Nhanes, 2001-2002., Susanna D. Mitro, Linda S. Birnbaum, Belinda L. Needham, Ami R. Zota

Environmental and Occupational Health Faculty Publications

Background: Exposure to persistent organic pollutants (POPs) such as dioxins, furans, and polychlorinated biphenyls (PCBs) may influence leukocyte telomere length (LTL), a biomarker associated with chronic disease. In vitro research suggests dioxins may bind to the aryl hydrocarbon receptor (AhR) and induce telomerase activity, which elongates LTL. However, few epidemiologic studies have investigated associations between POPs and LTL.

Objectives: We examined the association between 18 PCBs, 7 dioxins, and 9 furans and LTL among 1,330 U.S. adults from NHANES 2001-2002. Methods: We created three summed POP metrics based on toxic equivalency factor (TEF), a potency measure including affinity for the …

Medicare's Post-Acute Care Payment: An Updated Review Of The Issues And Policy Proposals, Sally Coberly

National Health Policy Forum

Medicare spending on post-acute care provided by home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals accounted for about 10 percent of total program outlays in 2013. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems, as …

Standards Of Evidence For Efficacy, Effectiveness, And Scale-Up Research In Prevention Science: Next Generation., Denise C. Gottfredson, Thomas D. Cook, Frances E.M. Gardner, Deborah Gorman-Smith, George W. Howe, Irwin N. Sandler, Kathryn M. Zafft

Psychiatry and Behavioral Sciences Faculty Publications

A decade ago, the Society of Prevention Research (SPR) endorsed a set of standards for evidence related to research on prevention interventions. These standards (Flay et al., Prevention Science 6:151-175, 2005) were intended in part to increase consistency in reviews of prevention research that often generated disparate lists of effective interventions due to the application of different standards for what was considered to be necessary to demonstrate effectiveness. In 2013, SPR's Board of Directors decided that the field has progressed sufficiently to warrant a review and, if necessary, publication of "the next generation" of standards of evidence. The Board convened …

Advances In The Diagnosis Of Human Opisthorchiasis: Development Of Opisthorchis Viverrini Antigen Detection In Urine, Chanika Worasith, Christine Kamamia, Anna Yakovleva, Kunyarat Duenngai, Chompunoot Wangboon, Jeffrey M. Bethony, +8 Additional Authors

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Background

Many strategies to control opisthorchiasis have been employed in Thailand, but not in the other neighbouring countries. Specific control methods include mass drug administration (MDA) and health education to reduce raw fish consumption. These control efforts have greatly shifted the epidemiology of Opisthorchis viverrini (OV) infection over the last decade from presenting as densely concentrated "heavy" infections in single villages to widespread "light" OV infections distributed over wide geographical areas. Currently, the "gold standard" detection method for OV infection is formalin ethyl-acetate concentration technique (FECT), which has limited diagnostic sensitivity and diagnostic specificity for light OV infections, with OV …

Implementation Of The International Health Regulations (2005) Through Cooperative Bioengagement, Claire J. Standley, Erin M. Sorrell, Sarah Kornblet, Julie E. Fischer, Rebecca Katz

Health Policy and Management Faculty Publications

Cooperative bioengagement efforts, as practiced by U.S. government-funded entities, such as the Defense Threat Reduction Agency’s Cooperative Biological Engagement Program, the State Department’s Biosecurity Engagement Program, and parallel programs in other countries, exist at the nexus between public health and security. These programs have an explicit emphasis on developing projects that address the priorities of the partner country as well as the donor. While the objectives of cooperative bioengagement programs focus on reducing the potential for accidental or intentional misuse and/or release of dangerous biological agents, many partner countries are interested in bioengagement as a means to improve basic public …

Enhanced Fitness And Renal Function In Type 2 Diabetes., Eric S. Nylen, S. M. Gandhi, Raya E. Kheirbek, Peter Kokkinos

Medicine Faculty Publications

Aims

To investigate the renal effects of fitness in people with diabetes with mild renal dysfunction.

Methods

The effect of a 12-week exercise programme on estimated GFR in 128 people with diabetes was evaluated.

Results

All cardiometabolic variables improved after 12 weeks of supervised exercise. Although there was a modest 3.9% increase in estimated GFR from baseline in the 128 people who completed the study, those with baseline chronic kidney disease stages 2 and 3 were found to have significant (6 and 12%, respectively; p < 0.01) improvements in post-exercise estimated GFR. Moreover, 42% of the people with chronic kidney disease stage 3 improved to chronic kidney disease stage 2 after the intervention.

Conclusion

Short-term exercise improves renal function in those with more moderate baseline chronic kidney disease. …

Medicine + Health Magazine, Fall 2015, George Washington University, School Of Medicine And Health Sciences, Office Of Communications And Marketing

Medicine + Health Magazine

No abstract provided.

Carcinogenic Parasite Secretes Growth Factor That Accelerates Wound Healing And Potentially Promotes Neoplasia., Michael J. Smout, Javier Sotillo, Thewarach Laha, Atiroch Papatpremsiri, Gabriel Rinaldi, Rafael N. Pimenta, Paul J. Brindley, +11 More

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Infection with the human liver fluke Opisthorchis viverrini induces cancer of the bile ducts, cholangiocarcinoma (CCA). Injury from feeding activities of this parasite within the human biliary tree causes extensive lesions, wounds that undergo protracted cycles of healing, and re-injury over years of chronic infection. We show that O. viverrini secreted proteins accelerated wound resolution in human cholangiocytes, an outcome that was compromised following silencing of expression of the fluke-derived gene encoding the granulin-like growth factor, Ov-GRN-1. Recombinant Ov-GRN-1 induced angiogenesis and accelerated mouse wound healing. Ov-GRN-1 was internalized by human cholangiocytes and induced gene and protein expression changes associated …

The P53 Tumor Suppressor Protein Protects Against Chemotherapeutic Stress And Apoptosis In Human Medulloblastoma Cells., Sarah Waye, Aisha Naeem, Muhammad Umer Choudhry, Erika Parasido, Lucas Tricoli, Brian R. Rood, +6 Additional Authors

Pediatrics Faculty Publications

Medulloblastoma (MB), a primitive neuroectodermal tumor, is the most common malignant childhood brain tumor and remains incurable in about a third of patients. Currently, survivors carry a significant burden of late treatment effects. The p53 tumor suppressor protein plays a crucial role in influencing cell survival in response to cellular stress and while the p53 pathway is considered a key determinant of anti-tumor responses in many tumors, its role in cell survival in MB is much less well defined. Herein, we report that the experimental drug VMY-1-103 acts through induction of a partial DNA damage-like response as well induction of …

New-Onset Diabetes Mellitus With Exposure To Ledipasvir And Sofosbuvir., Resmi Premji, Nira Roopnarinesingh, Nazia Qazi, Eric S. Nylen

Medicine Faculty Publications

The combination therapy of ledipasvir/sofosbuvir was approved by the Food and Drug Administration in 2014 for the treatment of chronic hepatitis C. Although hyperglycemia is not well known to occur with its use, we present 2 cases of new-onset diabetes mellitus and a review of the literature suggesting an adverse event association. In the first patient with HIV, we postulate that ledipasvir/sofosbuvir increased the levels of tenofovir and thereby potentiated hyperglycemia. In the second case of a patient with prediabetes, ledipasvir/sofosbuvir appeared to increase insulin resistance. A literature review further supported an association of hyperglycemia and the use of ledipasvir/sofosbuvir. …

Developing And Pretesting A Text Messaging Program For Health Behavior Change, Lorien C. Abroms, Robyn Whittaker, Caroline Free, Judith Mendel Van Alstyne, Jennifer M. Schindler-Ruwisch

Prevention and Community Health Faculty Publications

Background: A growing body of evidence demonstrates that text messaging-based programs (short message service [SMS]) on mobile phones can help people modify health behaviors. Most of these programs have consisted of automated and sometimes interactive text messages that guide a person through the process of behavior change.

Objective: This paper provides guidance on how to develop text messaging programs aimed at changing health behaviors.

Methods: Based on their collective experience in designing, developing, and evaluating text messaging programs and a review of the literature, the authors drafted the guide. One author initially drafted the guide and the others provided input …

Community Health Workers: Health System Integration, Financing Opportunities, And The Evolving Role Of The Community Health Worker In A Post-Health Reform Landsacape, Mary-Beth Malcarney, Patricia Pittman, Leo Quigley, Naomi Seiler, Katie B. Horton

Health Workforce Research Center Publications

Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts.

The purpose of this report is to better understand the varied landscape; to offer categories of analysis that may help inform policy, management, and research; …

Video Tutorials Help Students In The Health Sciences Improve The Quality Of Their Cited Sources, Paige Mcdonald, Catherine Golden, Laurie Lyons, Paul Levett

Himmelfarb Library Faculty Posters and Presentations

Through a George Washington University Emerging Scholars program grant, faculty and instructional designers collaborated with the Himmelfarb Health Sciences Library to develop video tutorials for new graduate and undergraduate students in the Health Sciences to improve their scholarship skills.

Where Are You Storing Your Research Days Poster? Promoting An Online Repository For Research Days Submissions, Meaghan B. Corbett, Anne Linton, Catherine M. Sluder, Gisela Butera

Himmelfarb Library Faculty Posters and Presentations

In January 2015, the George Washington University Himmelfarb Health Sciences Library began to strategize how to increase student and faculty awareness of Himmelfarb's Health Sciences Research Commons (HSRC) institutional repository, and to encourage them to self-archive their GW Research Days abstracts and posters for permanent storage.

Assessing Use Of Two Discovery Services At Himmelfarb Health Sciences Library, Jolinda Thompson, Elaine Sullo, Laura Abate, Kathleen Lyons, Meaghan Corbett

Himmelfarb Library Faculty Posters and Presentations

Introduction

The Himmelfarb Health Sciences Library, at The George Washington University, introduced Health Information @ Himmelfarb, a custom health sciences focused implementation of EBSCO’s Discovery Service (EDS) in the fall of 2012. Less than a year later, the Library Catalog was migrated to Innovative’s Encore. With two different discovery tools delivering some overlapping content and features, librarians wanted to know more about how the two services were being used.

Methods

A Discovery Task Force completed a staff focus group and a brief demographic survey of Health Information @ Himmelfarb users in spring 2015. All library staff who search the services …

Being The Inspiration: Seizing The Fosce Opportunity, Alexandra Gomes, Tom Harrod

Himmelfarb Library Faculty Posters and Presentations

The launch of the revised medical school curriculum in Fall 2014 provided new opportunities for librarians to collaborate with clinical faculty. As a result of our past informatics instruction embedded in the first year curriculum, we were invited to expand this content as part of a new formative Objective Structured Clinical Examination (FOSCE) initiative. Two reference librarians worked closely with faculty to develop original case-based scenarios that were taught by a team of six reference librarians over the course of a year.

In FOSCEs, small groups of students rotated through simulated patient encounters in order to demonstrate their clinical knowledge …

Himmelfarb Library Liaison Letter - October 2015, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

Challenges Of Forecasting Physician Workforce Needs Amid Delivery System Transformation, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts grapple with whether sufficient health care providers, particularly physicians, will be available to meet that demand. Some argue there are too few physicians already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how the provision of health care services is changing in response to market forces such as payment changes, patients' expectations, provider distributions, and technology innovations. This issue brief revisits what is known about evolving practice organizations, professional …

A Single Baseline Ultrasound Assessment Of Fibroid Presence And Size Is Strongly Predictive Of Future Uterine Procedure: 8-Year Follow-Up Of Randomly Sampled Premenopausal Women Aged 35-49 Years., Donna D. Baird, T M Saldana, D L Shore, Michael C. Hill, J M Schectman

Radiology Faculty Publications

STUDY QUESTION: How well can a single baseline ultrasound assessment of fibroid burden (presence or absence of fibroids and size of largest, if present) predict future probability of having a major uterine procedure?

SUMMARY ANSWER: During an 8-year follow-up period, the risk of having a major uterine procedure was 2% for those without fibroids and increased with fibroid size for those with fibroids, reaching 47% for those with fibroids ≥4 cm in diameter at baseline.

WHAT IS KNOWN ALREADY: Uterine fibroids are a leading indication for hysterectomy. However, when fibroids are found, there are few available data to help clinicians …

Background Literature On Violence Against Children In South Africa: Foundation For A Phased Communications For Development (C4d) Strategy, Mark Edberg, Hina Shaikh, Shaneka Thurman, Rajiv N. Rimal

Center for Social Well-Being and Development

No abstract provided.

Weak Tradeoff Between Xylem Safety And Xylem-Specific Hydraulic Efficiency Across The World's Woody Plant Species., Sean M Gleason, Mark Westoby, Steven Jansen, Brendan Choat, Uwe G Hacke, Robert B Pratt, Radika Bhaskar, Tim J Brodribb, Sandra J Bucci, Kun-Fang Cao, Hervé Cochard, Sylvain Delzon, Jean-Christophe Domec, Ze-Xin Fan, Taylor S Feild, Anna L Jacobsen, Daniel M Johnson, Frederic Lens, Hafiz Maherali, Jordi Martínez-Vilalta, Stefan Mayr, Katherine A Mcculloh, Maurizio Mencuccini, Patrick J Mitchell, Hugh Morris, Andrea Nardini, Jarmila Pittermann, Lenka Plavcová, Stefan G Schreiber, John S Sperry, Ian J Wright, Amy E Zanne

Anatomy and Regenerative Biology Faculty Publications

The evolution of lignified xylem allowed for the efficient transport of water under tension, but also exposed the vascular network to the risk of gas emboli and the spread of gas between xylem conduits, thus impeding sap transport to the leaves. A well-known hypothesis proposes that the safety of xylem (its ability to resist embolism formation and spread) should trade off against xylem efficiency (its capacity to transport water). We tested this safety-efficiency hypothesis in branch xylem across 335 angiosperm and 89 gymnosperm species. Safety was considered at three levels: the xylem water potentials where 12%, 50% and 88% of …

Factors Associated With Early Growth In Egyptian Infants: Implications For Addressing The Dual Burden Of Malnutrition., Justine A Kavle, Valerie L Flax, Ali Abdelmegeid, Farouk Salah, Seham Hafez, Magda Ramzy, Doaa Hamed, Gulsen Saleh, Rae Galloway

Prevention and Community Health Faculty Publications

Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research study, which followed a longitudinal cohort of infants from birth to 1 year of age within the context of a USAID-funded maternal and child health integrated programme. We sought to determine if growth patterns …

Tnf-Α-Induced Micrornas Control Dystrophin Expression In Becker Muscular Dystrophy., Alyson A. Fiorillo, Christopher R. Heier, James S. Novak, Christopher B. Tully, Kristy J. Brown, Kitipong Uaesoontrachoon, Maria C. Vila, Peter P. Ngheim, Luca Bello, Joe N. Kornegay, Corrado Angelini, Terence A. Partridge, Kanneboyina Nagaraju, Eric P. Hoffman

Genomics and Precision Medicine Faculty Publications

The amount and distribution of dystrophin protein in myofibers and muscle is highly variable in Becker muscular dystrophy and in exon-skipping trials for Duchenne muscular dystrophy. Here, we investigate a molecular basis for this variability. In muscle from Becker patients sharing the same exon 45–47 in-frame deletion, dystrophin levels negatively correlate with microRNAs predicted to target dystrophin. Seven microRNAs inhibit dystrophin expression in vitro, and three are validated in vivo (miR-146b/miR-374a/miR-31). microRNAs are expressed in dystrophic myofibers and increase with age and disease severity. In exon-skipping-treated mdx mice, microRNAs are significantly higher in muscles with low …

Characterizing Ebola Transmission Patterns Based On Internet News Reports., J. C. Cleaton, Cecile Viboud, Lone Simonsen, A. M. Hurtado, G. Chowell

Global Health Faculty Publications

BACKGROUND:  Detailed information on patient exposure, contact patterns, and discharge status, is rarely available in real time from traditional surveillance systems in the context of an emerging infectious disease outbreak. Here we validate the systematic collection of Internet news reports to characterize epidemiological patterns of Ebola virus disease (EVD) infections during the West African 2014-2015 outbreak.

METHODS:  Based on 58 news reports, we analyzed a total of 79 EVD clusters (286 cases) of size ranging from 1 to 33 cases between January 2014 and February 2015 in Guinea, Sierra Leone and Liberia.

RESULTS AND CONCLUSIONS:  The great majority of reported …

Impact Evaluation Of A Policy Intervention For Hiv Prevention In Washington, Dc, Monica S. Ruiz, Allison O'Rourke, Sean T. Allen

Prevention and Community Health Faculty Publications

Syringe exchange programs (SEPs) lower HIV risk. From 1998 to 2007, Congress prohibited Washington, DC, from using municipal revenue for SEPs. We examined the impact of policy change on IDU-associated HIV cases. We used surveillance data for new IDU-associated HIV cases between September 1996 and December 2011 to build an ARIMA model and forecasted the expected number of IDU-associated cases in the 24 months following policy change. Interrupted time series analyses (ITSA) were used to assess epidemic impact of policy change. There were 176 IDU-associated HIV cases in the 2 years post-policy change; our model predicted 296 IDU-associated HIV cases …

Challenges And Opportunities For T Cell-Mediated Strategies To Eliminate Hiv Reservoirs, Mark A. Brockman, R. Brad Jones, Zabrina L. Brumme

Microbiology, Immunology, and Tropical Medicine Faculty Publications

HIV’s ability to establish latent reservoirs of reactivation-competent virus is the major barrier to cure. “Shock and kill” methods consisting of latency reversing agents (LRAs) followed by elimination of reactivating cells through cytopathic effects are under active development. However, the clinical efficacy of LRAs remains to be established. Moreover, recent studies indicate that reservoirs may not be reduced efficiently by either viral cytopathic or CD8+ T-cell-mediated mechanisms. In this perspective, we highlight challenges to T-cell-mediated elimination of HIV reservoirs, including characteristics of responding T-cells, aspects of the cellular reservoirs and properties of the latent virus itself. We also discuss potential …

Jan Van Der Noordaa (1934-2015); A Virologist Pur Sang., Ben Berkhout, Michael Bukrinsky

Microbiology, Immunology, and Tropical Medicine Faculty Publications

No abstract provided.

Near Misses And Unsafe Conditions Reported In A Pediatric Emergency Research Network, Richard M. Ruddy, James M. Chamberlain, Prashant V. Mahajan, Tomohiko Funai, Karen J. O'Connell, Et Al.

Emergency Medicine Faculty Publications

Objective Patient safety may be enhanced by using reports from front-line staff of near misses and unsafe conditions to identify latent safety events. We describe paediatric emergency department (ED) near-miss events and unsafe conditions from hospital reporting systems in a 1-year observational study from hospitals participating in the Pediatric Emergency Care Applied Research Network (PECARN).

Design This is a secondary analysis of 1 year of incident reports (IRs) from 18 EDs in 2007–2008. Using a prior taxonomy and established method, this analysis is of all reports classified as near-miss (events not reaching the patient) or unsafe condition. Classification included type, …