Medicine and Health Sciences Commons^™

Using Whole Genome Analysis To Examine Recombination Across Diverse Sequence Types Of Staphylococcus Aureus, Elizabeth M. Driebe, Jason W. Sahl, Chandler Roe, Jolene R. Bowers, James M. Schupp, Lance B. Price, +11 Additional Authors

Environmental and Occupational Health Faculty Publications

Staphylococcus aureus is an important clinical pathogen worldwide and understanding this organism's phylogeny and, in particular, the role of recombination, is important both to understand the overall spread of virulent lineages and to characterize outbreaks. To further elucidate the phylogeny of S. aureus, 35 diverse strains were sequenced using whole genome sequencing. In addition, 29 publicly available whole genome sequences were included to create a single nucleotide polymorphism (SNP)-based phylogenetic tree encompassing 11 distinct lineages. All strains of a particular sequence type fell into the same clade with clear groupings of the major clonal complexes of CC8, CC5, …

Vaginal Douching And Racial/Ethnic Disparities In Phthalates Exposures Among Reproductive-Aged Women: National Health And Nutrition Examination Survey 2001–2004, Francesca Branch, Tracey J. Woodruff, Susanna D. Mitro, Ami R. Zota

Environmental and Occupational Health Faculty Publications

Background

Diethyl phthalate (DEP) and di-n-butyl phthalate (DnBP) are industrial chemicals found in consumer products that may increase risk of adverse health effects. Although use of personal care/beauty products is known to contribute to phthalate exposure, no prior study has examined feminine hygiene products as a potential phthalate source. In this study, we evaluate whether vaginal douching and other feminine hygiene products increase exposure to phthalates among US reproductive-aged women.

Methods

We conducted a cross-sectional study on 739 women (aged 20–49) from the National Health and Nutrition Examination Survey 2001–2004 to examine the association between self-reported use of …

Nitrate And Nitrite Ingestion And Risk Of Ovarian Cancer Among Postmenopausal Women In Iowa, Maki Inoue-Choi, Rena R. Jones, Kristin E. Anderson, Kenneth P. Cantor, James R. Cerhan, Stuart Krasner, Kimberly Robien, Peter J. Weyer, Mary H. Ward

Epidemiology Faculty Publications

Nitrate and nitrite are precursors in the endogenous formation of N-nitroso compounds (NOC), potential human carcinogens. We evaluated the association of nitrate and nitrite ingestion with postmenopausal ovarian cancer risk in the Iowa Women's Health Study. Among 28,555 postmenopausal women, we identified 315 incident epithelial ovarian cancers from 1986 to 2010. Dietary nitrate and nitrite intakes were assessed at baseline using food frequency questionnaire data. Drinking water source at home was obtained in a 1989 follow-up survey. Nitrate-nitrogen (NO₃-N) and total trihalomethane (TTHM) levels for Iowa public water utilities were linked to residences and average levels were …

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

Himmelfarb Library Liaison Letters

No abstract provided.

Neurosurgery Concepts: Key Perspectives On C2 Nerve Root Transection Following C1 Lateral Mass Screw Fixation, Choroid Plexus Cauterization In Infants With Hydrocephalus, Quality Of Life Following Treatment Of Vestibular Schwannoma, Dynamic Magnetic Resonance Imaging For Glioblastoma Pseudoprogression, Cost-Utility Analysis Of Lumbar Spinal Stenosis Treatment., Johnathan H. Sherman, Nader S Dahdaleh, Panayiotis Pelargos, Sandi Lam, Winward Choy, Isaac Yang, Zachary A Smith

Neurological Surgery Faculty Publications

No abstract provided.

Klf4-Sqstm1/P62-Associated Prosurvival Autophagy Contributes To Carfilzomib Resistance In Multiple Myeloma Models., Irene Riz, Teresa S. Hawley, Robert G. Hawley

Anatomy and Regenerative Biology Faculty Publications

Multiple myeloma (MM) is an incurable clonal plasma cell malignancy. Because of a high rate of immunoglobulin synthesis, the endoplasmic reticulum of MM cells is subjected to elevated basal levels of stress. Consequently, proteasome inhibitors, which exacerbate this stress by inhibiting ubiquitin-proteasome-mediated protein degradation, are an important new class of chemotherapeutic agents being used to combat this disease. However, MM cells still develop resistance to proteasome inhibitors such as carfilzomib. Toward this end, we have established carfilzomib-resistant derivatives of MM cell lines. We found that resistance to carfilzomib was associated with elevated levels of prosurvival autophagy, and Kruppel-like factor 4 …

Combination Of Id2 Knockdown Whole Tumor Cells And Checkpoint Blockade: A Potent Vaccine Strategy In A Mouse Neuroblastoma Model., Lina Chakrabarti, Clifford Morgan, Anthony D. Sandler

Surgery Faculty Publications

Tumor vaccines have held much promise, but to date have demonstrated little clinical success. This lack of success is conceivably due to poor tumor antigen presentation combined with immuno-suppressive mechanisms exploited by the tumor itself. Knock down of Inhibitor of differentiation protein 2 (Id2-kd) in mouse neuroblastoma whole tumor cells rendered these cells immunogenic. Id2-kd neuroblastoma (Neuro2a) cells (Id2-kd N2a) failed to grow in most immune competent mice and these mice subsequently developed immunity against further wild-type Neuro2a tumor cell challenge. Id2-kd N2a cells grew aggressively in immune-compromised hosts, thereby establishing the immunogenicity of these cells. Therapeutic vaccination with Id2-kd …

How Will Texas’ Affordable Care Act Implementation Decisions Affect The Population? A Closer Look, Sara J. Rosenbaum, Sara Rothenberg, Sara Ely

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The Affordable Care Act (ACA) gives states two key choices: Whether to expand Medicaid to cover poor uninsured adults; and whether to establish a state Exchange. No population stands to gain more from these choices than residents of Texas, who experience the nation’s highest uninsured rate. National estimates show that by not expanding Medicaid, the state has foregone coverage for 1.5 million people. County‐level estimates show that in 249 out of 254 counties, the proportion of uninsured adults exceeds 20 percent of the total adult county population. In 31 counties, the proportion of low income uninsured adults exceeds 60 percent …

Never Too Early: Introducing Illness Scripts And Narrative Medicine As Foundational Clinical Approaches, Julia B. Frank, Seema Kakar, Gisela Butera, Thomas Harrod

Medicine Faculty Posters and Presentations

Educational Challenge: The foundations course of our reformed, organ-based curriculum introduces clinical interviewing when students know little clinical medicine. An exercise that introduces the complementary concepts of “illness scripts” and “narrative medicine” helps them structure early encounters with patients. It provides a framework for organizing future clinical knowledge while reinforcing the humanistic values that may deteriorate over the course of students’ education.

Method: Students conduct and write up a semi-structured interview of someone they know with chronic illness. They reflect on their experience in pairs, and then analyze sample encounters in small groups with faculty facilitation.

Outcome: Strongly favorable student …

Medical Education Departments: A Study Of Four Medical Schools In Sub-Saharan Africa, Elsie Kiguli-Malwadde, Zohray Talib, Hannah Wohltjen, Susan C. Connors, Jonathan Gandari, Sekelani S. Benda, Lauren A. Maggio, Susan C. Van Schalkwyk

Health Policy and Management Faculty Publications

Background

Many African countries are investing in medical education to address significant health care workforce shortages and ultimately improve health care. Increasingly, training institutions are establishing medical education departments as part of this investment. This article describes the status of four such departments at sub-Saharan African medical schools supported by the Medical Education Partnership Initiative (MEPI). This article will provide information about the role of these institutional structures in fostering the development of medical education within the African context and highlight factors that enable or constrain their establishment and sustainability.

Methods

In-depth interviews were conducted with the heads or directors …

Anesthesia For Deep Brain Stimulation In Traumatic Brain Injury-Induced Hemidystonia., Jill M Jani, Chima O Oluigbo, Srijaya K Reddy

Anesthesiology and Critical Care Medicine Faculty Publications

Deep brain stimulation in an awake patient presents several unique challenges to the anesthesiologist. It is important to understand the various stages of the procedure and the complexities of anesthetic management in order to have a successful surgical outcome and provide a safe environment for the patient.

Iarc Monographs: 40 Years Of Evaluating Carcinogenic Hazards To Humans, Neil Pearce, Aaron Blair, Paolo Vineis, Wolfgang Ahrens, Aage Andersen, Melissa J. Perry, +Several Additional Authors

Environmental and Occupational Health Faculty Publications

Background: Recently, the International Agency for Research on Cancer (IARC) Programme for the Evaluation of Carcinogenic Risks to Humans has been criticized for several of its evaluations, and also for the approach used to perform these evaluations. Some critics have claimed that failures of IARC Working Groups to recognize study weaknesses and biases of Working Group members have led to inappropriate classification of a number of agents as carcinogenic to humans.

Objectives: The authors of this Commentary are scientists from various disciplines relevant to the identification and hazard evaluation of human carcinogens. We examined criticisms of the IARC classification process …

Alterations In Dna Methylation May Be The Key To Early Detection And Treatment Of Schistosomal Bladder Cancer, Simon L. Conti, Jared Honeycutt, Justin I. Odegaard, Mark L. Gonzalgo, Michael H. Hsieh

Urology Faculty Publications

No abstract provided.

Penile Microbiota And Female Partner Bacterial Vaginosis In Rakai, Uganda, Cindy M. Liu, Bruce A. Hungate, Aaron A.R. Tobian, Jacques Ravel, Lance B. Price, +8 Additional Authors

Environmental and Occupational Health Faculty Publications

Bacterial vaginosis (BV) is a common vaginal bacterial imbalance associated with risk for HIV and poor gynecologic and obstetric outcomes. Male circumcision reduces BV-associated bacteria on the penis and decreases BV in female partners, but the link between penile microbiota and female partner BV is not well understood. We tested the hypothesis that having a female partner with BV increases BV-associated bacteria in uncircumcised men. We characterized penile microbiota composition and density (i.e., the quantity of bacteria per swab) by broad-coverage 16S rRNA gene-based sequencing and quantitative PCR (qPCR) in 165 uncircumcised men from Rakai, Uganda. Associations between penile community …

Human Immunodeficiency Virus (Hiv) In Washington, D.C.: Prevalence Of Antiretroviral Resistance In Treatment Naïve Patients From 2007 To 2010, Matthew J. Swierzbinski, Virginia L. Kan, David M. Parenti

Medicine Faculty Publications

HIV treatment has been greatly impacted by transmitted resistance to antiretrovirals (ARV). Several studies have documented resistance in naïve individuals and estimates of transmitted drug resistance mutations range from <5% to as high as 25%. Washington, D.C. has one of the highest human immunodeficiency virus (HIV) prevalence rates in the United States (3.2% in 2009), but local data regarding the frequency of major mutations and antiretroviral (ARV) resistance has been limited. Medical records of HIV positive, ARV-naïve adults at two facilities in Washington, D.C., The George Washington University Medical Center and the Veterans Affairs Medical Center, were retrospectively analyzed in subjects who had genotypic resistance testing from 2007 to 2010. Of 407 ARV-naïve patients, at least one transmitted drug resistance mutation was detected in 17% of our patients, with non-nucleoside reverse transcriptase (NNRTI) mutations observed in 15%. Among patients with at least one reverse transcriptase (RT) or major protease region (Pr) resistance mutation, 85% had resistance against a single ARV class. Dual and triple class resistance mutations were seen in 8 patients (2%) and 3 patients (0.7%), respectively. Most of the multiple class resistance was seen in 2010. A gradual increase in NNRTI resistance was noted during 2008 to 2010. Our prevalence of transmitted RT, major Pr mutations (17.4%) and ARV resistance (8.6%) were high but similar to rates reported by others within the United States. Given the high HIV prevalence in the District of Columbia, this has important implications for treatment of these ARV-naïve patients.

Differential Effects Of Cold Atmospheric Plasma In The Treatment Of Malignant Glioma, Alan Siu, Olga Volotskova, Xiaoqian Cheng, Siri S. Khalsa, Ka Bian, Ferid Murad, Michael Keidar, Jonathan H. Sherman

Neurological Surgery Faculty Publications

Objective

Cold atmospheric plasma (CAP) has recently been shown to selectively target cancer cells with minimal effects on normal cells. We systematically assessed the effects of CAP in the treatment of glioblastoma.

Methods

Three glioma cell lines, normal astrocytes, and endothelial cell lines were treated with CAP. The effects of CAP were then characterized for viability, cytotoxicity/apoptosis, and cell cycle effects. Statistical significance was determined with student's t-test.

Results

CAP treatment decreases viability of glioma cells in a dose dependent manner, with the ID50 between 90-120 seconds for all glioma cell lines. Treatment with CAP for more than 120 seconds …

Sex Differences In Morbidity And Care-Seeking During The Neonatal Period In Rural Southern Nepal, Summer Rosenstock, Joanne Katz, Luke C. Mullany, Subarna K. Khatry, Steven C. Leclerq, James M. Tielsch, Et Al.

Global Health Faculty Publications

Background

South Asian studies, including those from Nepal, have documented increased risk of neonatal mortality among girls, despite their early biologic survival advantage. We examined sex differences in neonatal morbidity and care-seeking behavior to determine whether such differences could help explain previously observed excess late neonatal mortality among girls in Nepal.

Methods

A secondary analysis of data from a trial of chlorhexidine use among neonates in rural Nepal was conducted. The objective was to examine sex differences in neonatal morbidity and care-seeking behavior for ill newborns. Girls were used as the reference group.

Results

Referral for care was higher during …

An Uncommon Clinical Presentation Of Relapsing Dilated Cardiomyopathy With Identification Of Sequence Variations In Mynpc3, Kcnh2 And Mitochondrial Trna Cysteine, M. J. Guillen Sacoto, Kimberly A. Chapman, D. Heath, M. B. Seprish, Dina Zand

Pediatrics Faculty Publications

We describe a young girl with dilated cardiomyopathy, long QT syndrome, and possible energy deficiency. Two major sequence changes were identified by whole exome sequencing (WES) and mitochondrial DNA analysis that were interpreted as potentially causative. Changes were identified in the KCNH2 gene and mitochondrial tRNA for cysteine. A variation was also seen in MYPBC3. Since the launch of WES as a clinically available technology in 2010, there has been concern regarding the identification of variants unrelated to the patient's phenotype. However, in cases where targeted sequencing fails to explain the clinical presentation, the underlying etiology could be more complex …

A Model For A Structured Clinical Development Program For First-Year Residents: Utilizing The Entrance Osce, Individualized Learning Plans (Ilps), And Peer Clinical Coaching, Jill M. Krapf, Sameer Aggarwal, Larrie Greenberg, Benjamin Blatt

E-Learning Modules

Identification of incoming residents’ unique strengths and weaknesses in a clinical setting is important for developing an individualized educational curriculum and ultimately addressing specific needs. This resource presents and describes materials for a clinical development program for first year residents. The program is structured around three educational elements: an entrance Objective Structured Clinical Examination (OSCE), Individualized Learning Plan (ILP), and peer clinical coaching. The included files, which describe these three elements, are intended to serve as a resource for residency directors and/or graduate medical education faculty interested in constructing a similar program.

In the described clinical development program, first-year Obstetrics …

Revising The International Health Regulations: Call For A 2017 Review Conference., Rebecca Katz, Scott F. Dowell

Health Policy and Management Faculty Publications

No abstract provided.

Emergence Of Multidrug Resistant Influenza A(H1n1)Pdm09 Virus Variants In An Immunocompromised Child Treated With Oseltamivir And Zanamivir., Daisuke Tamura, Roberta L. Debiasi, Margaret Okomo-Adhiambo, Vasiliy P. Mishin, Angela P. Campbell, Brett Loechelt, Bernhard L. Wiedermann, Alicia M. Fry, Larisa V. Gubareva

Pediatrics Faculty Publications

Prolonged treatment of an immunocompromised child with oseltamivir and zanamivir for A(H1N1)pdm09 virus infection led to the emergence of viruses carrying H275Y and/or E119G in the neuraminidase. When phenotypically evaluated by neuraminidase inhibition, the dual H275Y-E119G substitution caused highly reduced inhibition by four neuraminidase inhibitors including oseltamivir, zanamivir, peramivir and laninamivir.

Critical Synthesis Package: The Kalamazoo Consensus Statement Assessment Tools, Michelle Yoon, Veronica Michaelsen

E-Learning Modules

This Critical Synthesis Package resource contains 1) a Critical Analysis of the psychometric properties and the application to health science education of the Kalamazoo Consensus Statement Assessment Tools and 2) a copy of each of the three instruments comprising the Kalamazoo Consensus Statement Assessment Tools developed by Elizabeth A. Rider, MSW, MD.

The Kalamazoo Consensus Statement (KCS) Tools are three content-valid, paper-based instruments that assess physician-patient communication skills. The Kalamazoo Essential Elements Communication Checklist (KEECC) is the original instrument. The Kalamazoo Essential Elements Communication Checklist-Adapted (KEECC-A) is a newer, adapted, construct-valid version, which was then further adapted into another multi-rater …

The Star Rating System And Medicare Advantage Plans, Lisa Sprague

National Health Policy Forum

With nearly 30 percent of Medicare beneficiaries opting to enroll in Medicare Advantage (MA) plans instead of fee-for-service Medicare, it’s safe to say the MA program is quite popular. The Centers for Medicare & Medicaid Services (CMS) administers a Star Ratings program for MA plans, which offers measures of quality and service among the plans that are used not only to help beneficiaries choose plans but also to award additional payments to plans that meet high standards. These additional payments, in turn, are used by plans to provide additional benefits to beneficiaries or to reduce cost sharing—added features that are …

A Case Of Pediatric Melanoma: Treatment Considerations In Advanced Disease., Frank P Albino, Benjamin C. Wood, Albert Oh, Gary F Rogers, Tina Sauerhammer

Surgery Faculty Publications

We document a 3-year-old healthy African American girl who developed malignant melanoma on her lower extremity. The clinical appearance offered little indication of the lesion’s severity (T4), and only the history of de novo presentation and disproportionate growth raised clinical suspicion. This case report highlights the subtle clinical findings of this condition and presents controversies related to surgical management of pediatric melanoma.

Himmelfarb Headlines - May/June 2015, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Headlines (2009 - present)

News and information about Himmelfarb Health Sciences Library of interest to users. Includes articles on including librarians in Blackboard, Summer Renovations, and profiles on Lionel Williams and Patricia Davis.

Hepatitis B Vaccines And Hpv Vaccines Have Been Hailed As Major Public Health Achievements In Preventing Cancer--Could A Schistosomiasis Vaccine Be The Third?, Michael H. Hsieh, Julia M L Brotherton, Afzal A Siddiqui

Urology Faculty Publications

No abstract provided.

Race And Ethnicity, Obesity, Metabolic Health, And Risk Of Cardiovascular Disease In Postmenopausal Women, Michelle D. Schmiegelow, Haley Hedlin, Rachel H. Mackey, Lisa W. Martin, Mara Z. Vitolins, Marcia L. Stefanick, Marco V. Perez, Matthew Allison, Mark A. Hlatky

Medicine Faculty Publications

Background It is unclear whether obesity unaccompanied by metabolic abnormalities is associated with increased cardiovascular disease risk across racial and ethnic subgroups.

Methods and Results We identified 14 364 postmenopausal women from the Women's Health Initiative who had data on fasting serum lipids and serum glucose and no history of cardiovascular disease or diabetes at baseline. We categorized women by body mass index (in kg/m²) as normal weight (body mass index 18.5 to P=0.05). Obese black women without metabolic syndrome had higher adjusted risk (HR 1.95) than obese white women (HR 1.07; interaction P=0.02). Among women with …

Radium-223 For The Treatment Of Castration-Resistant Prostate Cancer, Joelle El-Amm, Jeanny B. Aragon-Ching

Medicine Faculty Publications

The vast majority of patients with metastatic castration-resistant prostate cancer (mCRPC) develop bone metastases. Bone metastases are a source of significant morbidity and affect quality of life in these patients. Several bone-targeting agents are approved for the treatment of bone metastases in prostate cancer, including bisphosphonates, denosumab, and radiopharmaceuticals. Radium-223 is a novel first-in-class alpha-emitting radiopharmaceutical that has been approved for treatment of patients with mCRPC with bone metastases. Radium-223 delivers cytotoxic radiation to the sites of bone metastases and offers the advantage of minimal myelosuppression. The landmark Phase III ALSYMPCA trial demonstrated that, in addition to providing bone-related palliation, …

Impact Of Implementing The Geriatric Resource Nurse Model On Fall And Hospital Acquired Pressure Ulcer Rates, And Length Of Stay In Older Adults In An Acute Care Hospital, Elzbieta Kmiecik, Cathie E. Guzzetta, Mary-Michael Brown, Qiuping Pearl Zhou, Desale Sameer

GW Research Days 2015

Background.Older adults are at high risk for adverse care outcomes, such as injuries from falls, hospital acquired pressure ulcers (HAPUs), and prolonged length of stay (LOS). Available evidence suggests outcomes may improve when older adults are cared for by healthcare providers with competence in geriatrics. To improve outcomes, an acute care not-for-profit teaching hospital in Washington DC area implemented a Geriatric Resource Nurse (GRN) model that prepares registered nurses (RNs) as clinical experts on core geriatric principles on four general care wards (three medical-surgical and one cardiac).

Objectives. Toexamine the effects of GRN model implementation on fall and …

Fibroblast Growth Factor 9 Regulation By Micrornas Controls Lung Development And Links Dicer1 Loss To The Pathogenesis Of Pleuropulmonary Blastoma, Yongjun Yin, Angela M. Castro, Marrit Hoekstra, Thomas J. Yan, Ajay C. Kanakamedala, Louis P. Dehner, D. Ashley Hill, David M. Ornitz

Pathology Faculty Publications

Pleuropulmonary Blastoma (PPB) is the primary neoplastic manifestation of a pediatric cancer predisposition syndrome that is associated with several diseases including cystic nephroma, Wilms tumor, neuroblastoma, rhabdomyosarcoma, medulloblastoma, and ovarian Sertoli-Leydig cell tumor. The primary pathology of PPB, epithelial cysts with stromal hyperplasia and risk for progression to a complex primitive sarcoma, is associated with familial heterozygosity and lesion-associated epithelial loss-of-heterozygosity of DICER1. It has been hypothesized that loss of heterozygosity of DICER1 in lung epithelium is a non-cell autonomous etiology of PPB and a critical pathway that regulates lung development; however, there are no known direct targets of epithelial …