Medicine and Health Sciences Commons^™

Provision Of Telemedicine Services By Community Health Centers, Peter Shin, Jessica Sharac, Feygele Jacobs

Health Policy and Management Faculty Publications

The objective of this study was to assess the use of telemedicine services at community health centers. A national survey was distributed to all federally qualified health centers to gather data on their use of health information technology, including telemedicine services. Over a third of responding health centers (37%) provided some type of telemedicine service while 63% provided no telemedicine services. A further analysis that employed ANOVA and chi-square tests to assess differences by the provision of telemedicine services (provided no telemedicine services, provided one telemedicine service, and provided two or more telemedicine services) found that the groups differed by …

Planning A Safe Exit: A Multidisciplinary Approach, Srijaya K. Reddy, Nina Deutsch

E-Learning Modules

This resource is a problem-based learning discussion (PBLD) case addressing the challenges and approach to planning and safely executing an EXIT procedure. It is primarily aimed at pediatric anesthesiologists but also applies to healthcare providers in fetal medicine and surgery.

The clinical scenario involves a fetus with a large cervical neck mass requiring an EXIT procedure for tracheal obstruction. This case highlights the challenges and implications of a procedure involving a multidisciplinary team. After presentation of the case stem, the instructor moderates a student-focused group discussion using a series of questions that build upon the case and a review of …

Hiv Testing Implementation In Two Urban Cities: Practice, Policy And Perceived Barriers, Camden J. Hallmark, Jennifer Skillicorn, Thomas P. Giordano, Jessica A. Davila, Marlene Mcneese, Nestor Rocha, Avemaria Smith, Stacey Cooper, Amanda D. Castel

Epidemiology Faculty Publications

Background

Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown.

Methods

We conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions.

Results

In 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% …

Assessment Of Anthelmintic Efficacy Of Mebendazole In School Children In Six Countries Where Soil-Transmitted Helminths Are Endemic, Bruno Levecke, Antonio Montresor, Marco Albonico, Shaali M. Ame, Jerzy M. Behnke, Jeffrey M. Bethony, +15 Additional Authors

Microbiology, Immunology, and Tropical Medicine Faculty Publications

BACKGROUND:

Robust reference values for fecal egg count reduction (FECR) rates of the most widely used anthelmintic drugs in preventive chemotherapy (PC) programs for controlling soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, and hookworm) are still lacking. However, they are urgently needed to ensure detection of reduced efficacies that are predicted to occur due to growing drug pressure. Here, using a standardized methodology, we assessed the FECR rate of a single oral dose of mebendazole (MEB; 500 mg) against STHs in six trials in school children in different locations around the world. Our results are compared with those previously obtained …

Cost-Effectiveness Of Initiating Extrafine- Or Standard Size-Particle Inhaled Corticosteroid For Asthma In Two Health-Care Systems: A Retrospective Matched Cohort Study, Richard J. Martin, David Price, Nicolas Roche, Elliot Israel, Willem M.C. Van Aalderen, Jonathan Grigg, Dirkje S. Postma, Theresa W. Guilbert, Elizabeth V. Hillyer, Anne Burden, Julie Von Ziegenweidt, Gene L. Colice

Medicine Faculty Publications

Background:

Real-life studies are needed to determine the cost-effectiveness of asthma therapies in clinical practice.

Aim:

To compare the cost-effectiveness of extrafine-particle inhaled corticosteroid (ICS) with standard size-particle ICS in the United Kingdom (UK) and United States (US).

Methods:

These retrospective matched cohort analyses used large electronic databases to study asthma-related outcomes for patients in the UK (12–60 years old; n=1730) and US (12–80 years; n=10,312) prescribed extrafine beclomethasone or fluticasone as their first ICS therapy for asthma. Patients were matched on demographic characteristics and asthma severity during 1 baseline year, and asthma control and asthma-related costs were …

The Evolution Of Prostate Cancer Therapy: Targeting The Androgen Receptor (Ar), Jeanny B. Aragon-Ching

Medicine Faculty Publications

No abstract provided.

Intravenous Angiotensin Ii For The Treatment Of High-Output Shock (Athos Trial): A Pilot Study, Lakhmir S. Chawla, Laurence Busse, Ermira Brasha-Mitchell, Danielle L. Davison, Jacqueline R. Honig, Ziyad Alotaibi, Michael G. Seneff

Anesthesiology and Critical Care Medicine Faculty Publications

Introduction: Patients with distributive shock who require high dose vasopressors have a high mortality. Angiotensin II (ATII) may prove useful in patients who remain hypotensive despite catecholamine and vasopressin therapy. The appropriate dose of parenteral angiotensin II for shock is unknown.

Methods: In total, 20 patients with distributive shock and a cardiovascular Sequential Organ Failure Assessment score of 4 were randomized to either ATII infusion (N?=?10) or placebo (N?=?10) plus standard of care. ATII was started at a dose of 20?ng/kg/min, and titrated for a goal of maintaining a mean arterial pressure (MAP) of 65?mmHg. The infusion (either ATII or …

Asynchronous Remodeling Is A Driver Of Failed Regeneration In Duchenne Muscular Dystrophy, Sherry Dadgar, Zuyi Wang, Helen Johnston, Akanchha Kesari, Kanneboyina Nagaraju, Yi-Wen Chen, D. Ashley Hill, Terence A. Partridge, Robert J. Freishtat, Javad Nazarian, Jianhua Xuan, Yue Wang, Eric P. Hoffman

Genomics and Precision Medicine Faculty Publications

We sought to determine the mechanisms underlying failure of muscle regeneration that is observed in dystrophic muscle through hypothesis generation using muscle profiling data (human dystrophy and murine regeneration). We found that transforming growth factor β-centered networks strongly associated with pathological fibrosis and failed regeneration were also induced during normal regeneration but at distinct time points. We hypothesized that asynchronously regenerating microenvironments are an underlying driver of fibrosis and failed regeneration. We validated this hypothesis using an experimental model of focal asynchronous bouts of muscle regeneration in wild-type (WT) mice. A chronic inflammatory state and reduced mitochondrial oxidative capacity are …

Efficacy Of Transoral Fundoplication For Treatment Of Chronic Gastroesophageal Reflux Disease Incompletely Controlled With High-Dose Proton-Pump Inhibitors Therapy: A Randomized, Multicenter, Open Label, Crossover Study., Karim S. Trad, Gilbert Simoni, William Edris Barnes, Ahmad Bassel Shughoury, Mamoon Raza, Jeffrey Alan Heise, Daniel Gilles Turgeon, Mark Alan Fox, Peter George Mavrelis

Surgery Faculty Publications

Background

The aim of this randomized, crossover study was to determine if transoral fundoplication (TF) could further improve clinical outcomes in partial responders to high-dose (HD) proton-pump inhibitor (PPI) therapy and to evaluate durability of TF.

Methods

In seven United States centers, patients with hiatal hernia ≤2 cm and abnormal esophageal acid exposure (EAE) were randomized to TF (n = 40) or HD PPIs (n = 23) group. At 6-month follow-up, PPI patients underwent crossover. We assessed clinical outcomes 6-month post TF in crossover patients (COP), as compared to 6-month of HD PPI therapy, and 12-month outcomes in patients initially …

Hiv-1 Infection Of Macrophages Induces Retention Of Cholesterol Transporter Abca1 In The Endoplasmic Reticulum, Beda Brichacek, Christina Darwish, Anastas Popratiloff, Larisa Dubrovsky, Michael I. Bukrinsky

Microbiology, Immunology, and Tropical Medicine Faculty Publications

No abstract provided.

Neural Transcription Factors: From Embryos To Neural Stem Cells, Hyun-Kyung Lee, Hyun-Shik Lee, Sally Ann Moody

Anatomy and Regenerative Biology Faculty Publications

The early steps of neural development in the vertebrate embryo are regulated by sets of transcription factors that control the induction of proliferative, pluripotent neural precursors, the expansion of neural plate stem cells, and their transition to differentiating neural progenitors. These early events are critical for producing a pool of multipotent cells capable of giving rise to the multitude of neurons and glia that form the central nervous system. In this review we summarize findings from gain- and loss-of-function studies in embryos that detail the gene regulatory network responsible for these early events. We discuss whether this information is likely …

Children's Use Of Dental Care In Medicaid: Federal Fiscal Years 2000-2012, Erika Steinmetz, Brian K. Bruen, Leighton C. Ku

Health Policy and Management Faculty Publications

This report presents with national and state-specific analyses about dental services received by children ages 1 to 20 under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit in federal fiscal years (FFY) 2000-2012. These analyses are based on data reported by state Medicaid agencies using Form CMS-416 (Form 416); all data reflect updates received by CMS as of April 3, 2014. This report focuses on the number of children who received any dental service, any preventive dental service (e.g., dental cleaning or application of dental sealants) and any dental treatment service (e.g., filling a cavity). The national trend …

Tps Mutational Status Is A Potential Marker For Risk Stratification In Wilms Tumour With Diffuse Anaplasia, Mariana Maschietto, Richard D. Williams, Tasnim Chagtai, Sergey D. Popov, Neil J. Sebire, Gordan Vujanic, Elizabeth Perlman, James R. Anderson, Paul Grundy, Jeffrey S. Dome, Kathy Pritchard-Jones

Pediatrics Faculty Publications

Purpose

The presence of diffuse anaplasia in Wilms tumours (DAWT) is associated with TP53 mutations and poor outcome. As patients receive intensified treatment, we sought to identify whetherTP53 mutational status confers additional prognostic information.

Patients and Methods

We studied 40 patients with DAWT with anaplasia in the tissue from which DNA was extracted and analysed for TP53 mutations and 17p loss. The majority of cases were profiled by copy number (n = 32) and gene expression (n = 36) arrays. TP53 mutational status was correlated with patient event-free and overall survival, genomic copy number instability and gene expression profiling. …

Behavioral Attitudes And Preferences In Cooking Practices With Traditional Open-Fire Stoves In Peru, Nepal, And Kenya: Implications For Improved Cookstove Interventions, Evelyn L. Rhodes, Robert Dreibelbis, Elizabeth M. Klasen, Neha Naithani, Joyce Baliddawa, Diana Menya, Subarna Khatry, Stephanie Levy, James M. Tielsch, J. Jaime Miranda, Caitlin Kennedy, William Checkley

Global Health Faculty Publications

Global efforts are underway to develop and promote improved cookstoves which may reduce the negative health and environmental effects of burning solid fuels on health and the environment. Behavioral studies have considered cookstove user practices, needs and preferences in the design and implementation of cookstove projects; however, these studies have not examined the implications of the traditional stove use and design across multiple resource-poor settings in the implementation and promotion of improved cookstove projects that utilize a single, standardized stove design. We conducted in-depth interviews and direct observations of meal preparation and traditional, open-fire stove use of 137 women aged …

Hiv Infection And Cardiovascular Disease In Women, Julie A. Womack, Chung-Chou H. Chang, Kaku A. So-Armah, Charles Alcorn, Jason V. Baker, Cynthia L. Gibert, +17 Additional Authors

Medicine Faculty Publications

Background HIV infection is associated with increased risk of cardiovascular disease (CVD) in men. Whether HIV is an independent risk factor for CVD in women has not yet been established.

Methods and Results We analyzed data from the Veterans Aging Cohort Study on 2187 women (32% HIV infected [HIV⁺]) who were free of CVD at baseline. Participants were followed from their first clinical encounter on or after April 01, 2003 until a CVD event, death, or the last follow‐up date (December 31, 2009). The primary outcome was CVD (acute myocardial infarction [AMI], unstable angina, ischemic stroke, and heart …

Risk Assessment For Healthcare Workers After A Sentinel Case Of Rabies And Review Of The Literature, Virginia L. Kan, Patrick Joyce, Debra A. Benator, Kathleen Agnes, Janet Gill, Monica Irmler, Arlene Clark, George Giannakos, Audrey Gabourel, Fred M. Gordin

Medicine Faculty Publications

Background. After a case of rabies, healthcare workers (HCWs) had fear of contagion from the infected patient. Although transmission of rabies to HCWs has never been documented, high-risk exposures theoretically include direct contact of broken skin and/or mucosa with saliva, tears, oropharyngeal secretions, cerebrospinal fluid, and neural tissue. Urine/kidney exposure posed a concern, as our patient's renal transplant was identified as the infection source.

Methods. Our risk assessment included (1) identification of exposed HCWs; (2) notification of HCWs; (3) risk assessment using a tool from the local health department; (4) supplemental screening for urine/kidney exposure; and (5) postexposure prophylaxis (PEP) …

Medicine + Health, Fall 2014, George Washington University, School Of Medicine And Health Sciences, Office Of Communications And Marketing

Medicine + Health Magazine

No abstract provided.

Comparing The Effectiveness Of Small-Particle Versus Large-Particle Inhaled Corticosteroid In Copd, Dirkje S. Postma, Nicolas Roche, Gene L. Colice, Elliot Israel, Richard J. Martin, Willem Van Aalderen, Jonathan Grigg, Anne Burden, Elizabeth V. Hillyer, Julie Von Ziegenweidt, Gokul Gopalan, David Price

Medicine Faculty Publications

Purpose: Small airway changes and dysfunction contribute importantly to airway obstruction in chronic obstructive pulmonary disease (COPD), which is currently treated with inhaled corticosteroids (ICS) and long-acting bronchodilators at Global initiative for Obstructive Lung Disease (GOLD) grades 2–4. This retrospective matched cohort analysis compared effectiveness of a representative small-particle ICS (extrafine beclomethasone) and larger-particle ICS (fluticasone) in primary care patients with COPD.

Patients and methods: Smokers and ex-smokers with COPD ≥40 years old initiating or stepping-up their dose of extrafine beclomethasone or fluticasone were matched 1:1 for demographic characteristics, index prescription year, concomitant therapies, and disease severity during 1 baseline …

Neonatal Nmda Receptor Blockade Disrupts Spike Timing And Glutamatergic Synapses In Fast Spiking Interneurons In A Nmda Receptor Hypofunction Model Of Schizophrenia, Kevin S. Jones, Joshua G. Corbin, Molly M. Huntsman

Pediatrics Faculty Publications

The dysfunction of parvalbumin-positive, fast-spiking interneurons (FSI) is considered a primary contributor to the pathophysiology of schizophrenia (SZ), but deficits in FSI physiology have not been explicitly characterized. We show for the first time, that a widely-employed model of schizophrenia minimizes first spike latency and increases GluN2B-mediated current in neocortical FSIs. The reduction in FSI first-spike latency coincides with reduced expression of the Kv1.1 potassium channel subunit which provides a biophysical explanation for the abnormal spiking behavior. Similarly, the increase in NMDA current coincides with enhanced expression of the GluN2B NMDA receptor subunit, specifically in FSIs. In this study mice …

Preventing Slips And Falls Through Leisure-Time Physical Activity: Findings From A Study Of Limited-Service Restaurants, Alberto J. Caban-Martinez, Theodore K. Courtney, Wen-Ruey Chang, David A. Lombardi, Yueng-Hsiang Huang, Melanie J. Brennan, Melissa J. Perry, Jeffrey N. Katz, Santosh K. Verma

Environmental and Occupational Health Faculty Publications

Background/Objective

Physical activity has been shown to be beneficial at improving health in some medical conditions and in preventing injury. Epidemiologic studies suggest that physical activity is one factor associated with a decreased risk for slips and falls in the older (≥65 years) adult population. While the risk of slips and falls is generally lower in younger than in older adults; little is known of the relative contribution of physical activity in preventing slips and falls in younger adults. We examined whether engagement in leisure-time physical activity (LTPA) was protective of slips and falls among a younger/middle-aged (≤50 years old) …

Access To Comprehensive Perinatal Services Among Pregnant Women Enrolled In Both Medi-Cal And Covered California: Aligning And Integrating Care, Sara J. Rosenbaum, Carla Hurt, Mark Dorley, Sara Rothenberg, Nancy Lopez

Health Policy and Management Faculty Publications

Medi-Cal-enrolled women who are pregnant are entitled to coverage for enriched pregnancy-related care under Medi-Cal’s Comprehensive Perinatal Services Program (CPSP), a national landmark in the care and management of pregnant women with elevated health risks due to their low economic status. This entitlement applies to all pregnant women enrolled in Medi-Cal, including women who also are enrolled in subsidized health plans purchased through Covered California. The task that jointly faces Medi-Cal and Covered California is how best to align these two sources of pregnancy care financing in order to achieve a central goal of SB 857 – ensuring that dually …

New Roles: Participating On The Curriculum Redesign Team, Laura E. Abate, Gisela Butera, Alexandra Gomes, Thomas Harrod, Anne Linton

Himmelfarb Library Faculty Posters and Presentations

In 2011, the GW School of Medicine decided to change from a traditional curriculum for the M.D. program to an integrated, systems-based curriculum. Students will move from a traditional 2x2 curriculum (2 pre-clinical years and 2 clinical years) to one in which they complete their pre-clinical training in 18 months followed by 2 1/2 years clinical training. The purpose of this poster is to highlight the ways in which Himmelfarb Health Sciences Library librarians were engaged in and helped with this transition.

Helping Principal Investigators Comply With The Nih Public Access Policy, Paul Levett

Himmelfarb Library Faculty Posters and Presentations

Recognizing the consequences of non-compliance with the NIH Public Access Policy (NIHPAP), Himmelfarb Health Sciences Library worked to identify NIHPAP non-compliant papers by GW faculty authors and help Principal Investigators (PI's) and their delegates get them into PubMed Central (PMC).

Himmelfarb Library Liaison Letter - October 2014, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

The Association Of Meningococcal Disease With Influenza In The United States, 1989-2009, Jessica Hartman Jacobs, Cecile Viboud, Eric Tchetgen Tchetgen, Joel Schwartz, Claudia Steiner, Lone Simonsen, Marc Lipsitch

Global Health Faculty Publications

Importance and Objective

Prior influenza infection is a risk factor for invasive meningococcal disease. Quantifying the fraction of meningococcal disease attributable to influenza could improve understanding of viral-bacterial interaction and indicate additional health benefits to influenza immunization.

Design, Setting and Participants

A time series analysis of the association of influenza and meningococcal disease using hospitalizations in 9 states from 1989–2009 included in the State Inpatient Databases from the Agency for Healthcare Research and Quality and the proportion of positive influenza tests by subtype reported to the Centers for Disease Control. The model accounts for the autocorrelation of meningococcal disease and …

Many Paths To Primary Care: Flexible Staffing And Productivity In Community Health Centers, Leighton C. Ku, Bianca K. Frogner, Erika Steinmetz, Patricia Pittman

Health Policy and Management Issue Briefs

No abstract provided.

Abnormal White Matter Integrity Related To Head Impact Exposure In A Season Of High School Varsity Football, Elizabeth M. Davenport, Christopher T. Whitlow, Jillian E. Urban, Mark A. Espeland, Jung Youngkyoo, Daryl A. Rosenbaum, Gerard A. Gioia, Alexander K. Powers, Joel D. Stitzel, Joseph A. Maldjian

Psychiatry and Behavioral Sciences Faculty Publications

The aim of this study was to determine whether the cumulative effects of head impacts from a season of high school football produce magnetic resonance imaging (MRI) measureable changes in the brain in the absence of clinically diagnosed concussion. Players from a local high school football team were instrumented with the Head Impact Telemetry System (HITS™) during all practices and games. All players received pre- and postseason MRI, including diffusion tensor imaging (DTI). Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was also conducted. Total impacts and risk-weighted cumulative exposure (RWE), including linear (RWE_Linear), rotational (RWE_Rotational), and …

How To Be A Super Model: Using Role Modeling To Become An Exemplary Educator, Priti Bhansali, Geeta Singhal, Helen Fromme, Melissa Held

E-Learning Modules

Over the past several years, published studies have described the qualities and skills of exemplary medical educators. Despite its inclusion in these lists, role modeling is a skill that is not often developed as a skill for use as an educational method. The purpose of this workshop is to assist participants in better understanding the characteristics of effective role modeling and create a paradigm for how to consciously incorporate role modeling into the daily education of students, residents, and colleagues in varied domains, including teaching, professionalism, communication, and patient care.

In this workshop, participants are introduced to the concept of …

Differential Spatial Repositioning Of Activated Genes In Biomphalaria Glabrata Snails Infected With Schistosoma Mansoni, Halime D. Arican-Goktas, Wannaporn Ittiprasert, Joanna M. Bridger, Matty Knight

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Schistosomiasis is an infectious disease infecting mammals as the definitive host and fresh water snails as the intermediate host. Understanding the molecular and biochemical relationship between the causative schistosome parasite and its hosts will be key to understanding and ultimately treating and/or eradicating the disease. There is increasing evidence that pathogens that have co-evolved with their hosts can manipulate their hosts' behaviour at various levels to augment an infection. Bacteria, for example, can induce beneficial chromatin remodelling of the host genome. We have previously shown in vitro thatBiomphalaria glabrata embryonic cells co-cultured with schistosome miracidia display genes changing their …

A Delphi Process To Optimize Quality And Performance Of Drug Evaluation In Neonates, Frederic Legrand, Rym Boulkedid, Valery Elie, Stephanie Leroux, Elizabeth Valls, Adolfo Valls-I-Soler, John N. Van Den Anker

Pediatrics Faculty Publications

Background

Neonatal trials remain difficult to conduct for several reasons: in particular the need for study sites to have an existing infrastructure in place, with trained investigators and validated quality procedures to ensure good clinical, laboratory practices and a respect for high ethical standards. The objective of this work was to identify the major criteria considered necessary for selecting neonatal intensive care units that are able to perform drug evaluations competently.

Methodology and Main Findings

This Delphi process was conducted with an international multidisciplinary panel of 25 experts from 13 countries, selected to be part of two committees (a scientific …