Medicine and Health Sciences Commons^™

Cms's Proposed Rule Implementing The Aca-Mandated Medicaid Dsh Reductions, Kathryn Linehan

National Health Policy Forum

State Medicaid programs make Medicaid disproportionate share hospital (DSH) payments to hospitals to help offset costs of uncompensated care for Medicaid and uninsured patients. Unlike most Medicaid spending, annual DSH allotments for each state are capped. Under the Patient Protection and Affordable Care Act of 2010 (ACA), DSH payments will decrease starting in fiscal year (FY) 2014 and continuing through FY 2020. This paper describes the proposed rule for reducing these federal allotments, which was released on May 15, 2013, by the Centers for Medicare & Medicaid Services (CMS). Comments on the proposed rule are due July 12, 2013.

2014 …

When To Start Antiretroviral Therapy: The Need For An Evidence Base During Early Hiv Infection, James D. Lundgren, Abdel G. Babiker, Fred M. Gordin, Alvaro H. Borges, James D. Neaton

Epidemiology Faculty Publications

Background

Strategies for use of antiretroviral therapy (ART) have traditionally focused on providing treatment to persons who stand to benefit immediately from initiating the therapy. There is global consensus that any HIV+ person with CD4 counts less than 350 cells/μl should initiate ART. However, it remains controversial whether ART is indicated in asymptomatic HIV-infected persons with CD4 counts above 350 cells/μl, or whether it is more advisable to defer initiation until the CD4 count has dropped to 350 cells/μl. The question of when the best time is to initiate ART during early HIV infection has always been vigorously debated. The …

Quality Of Care In Community Health Centers And Factors Associated With Performance, Peter Shin, Jessica Sharac, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Federally funded community health centers are a key source of comprehensive primary care for medically underserved communities, serving more than 20 million patients in 2011. The Affordable Care Act (ACA) expanded the health center program significantly to help meet the increased demand for health care that is expected as millions of the uninsured gain health coverage, beginning in 2014. Especially given health centers’ growing role, evidence of the quality of care they provide is of keen interest. Most research shows high performance by health centers relative to various standards, but some gaps have also been found, and suitable benchmarks for …

The Role Of Issue Familiarity And Social Norms: Findings On New College Students' Alcohol Use Intentions, Rajiv N. Rimal, Saar Mollen

Prevention and Community Health Faculty Publications

Background. Scholars in a variety of disciplines are interested in understanding the conditions under which social norms affect human behavior. Following the distinction made between descriptive and injunctive norms by the focus theory of normative conduct, the theory of normative social behavior predicts that the influence of descriptive norms on behavior is moderated by injunctive norms, outcome expectations, and group identity. We extended the theory by testing the proposition that the influence of descriptive norms on behavior would be greater under conditions of greater issue familiarity, defined as the ease with which one can cognitively access the behavior or …

Diarrhea As A Risk Factor For Acute Lower Respiratory Tract Infections Among Young Children In Low Income Settings, Christa L. Fischer Walker, Jamie Perin, Joanne D. Katz, James M. Tielsch, Robert Black

Global Health Faculty Publications

Background

Diarrhea and acute lower respiratory tract infections (ALRI) are leading causes of morbidity and mortality among children under 5 years of age. We sought to quantify the correlation of diarrhea and respiratory infections within an individual child and to determine if infection with one illness increases the risk of infection with the other during the same time period.

Methods

We quantified the likelihood of an ALRI and a diarrhea episode occurring during the same week compared to the likelihood of each occurring independently in two cohorts of children under 3 years of age using a bivariate probit regression model. …

Hospital Ships Adrift? Part 1: A Systematic Literature Review Characterizing Us Navy Hospital Ship Humanitarian And Disaster Response, 2004-2012., Derek J. Licina

Global Health Faculty Publications

Background: United States foreign policy is tied extensively to health initiatives, many related to the use of military assets. Despite substantial resource investment by the US Department of Defense (DoD) in hospital ship humanitarian assistance and disaster response missions, the impact of this investment is unclear.

Methods: A systematic literature review of both peer-reviewed and grey literature using eight databases representing the international community and multiple sectors was conducted. Data on the characteristics of missions directly related to US Navy hospital ship humanitarian assistance and disaster response from 2004-2012 were extracted and documented.

Results: Of the 1445 sources reviewed, a …

Principles To Consider For The Implementation Of A Community Health Needs Assessment Process, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Myofascial Pain Syndrome: A Treatment Review, Mehul J. Desai, Vikramjeet Saini, Shawnjeet Saini

Anesthesiology and Critical Care Medicine Faculty Publications

Myofascial pain syndrome (MPS) is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The appropriate evaluation and management of myofascial pain is an important part of musculoskeletal rehabilitation, and regional axial and limb pain syndromes. This article reviews the current hypotheses regarding the treatment modalities for myofascial trigger points and muscle pain. Through a critical evidence-based review of the pharmacologic and nonpharmacologic treatments, the authors aim to provide clinicians with a more comprehensive knowledge of the interventions for myofascial …

Himmelfarb Library Liaison Letter - June 2013, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

Exploring Changes In Open Defecation Prevalence In Sub-Saharan Africa Based On National Level Indices, Deise I. Galan, Seung-Sup Kim, Jay P. Graham

Environmental and Occupational Health Faculty Publications

Background

In sub-Saharan Africa, it is estimated that 215 million people continue to engage in open defecation. This practice facilitates the transmission of diarrheal diseases – one of the leading causes of mortality in children under 5 in sub-Saharan Africa. The main purpose of this study is to: estimate changes in open defecation prevalence between 2005 and 2010 across countries in sub-Saharan Africa; examine the association between national level indices and changes in open defecation prevalence; and assess how many countries can achieve ‘open defecation free status’ by 2015.

Methods

After applying selection criteria, this study analyzed country-level data for …

Microproteinuria During Opisthorchis Viverrini Infection: A Biomarker For Advanced Renal And Hepatobiliary Pathologies From Chronic Opisthorchiasis, Prasert Saichua, Paiboon Sithithaworn, Amar R. Jariwala, David J. Diemert, Jiraporn Sithithaworn, Banchob Sripa, Thewarach Laha, Eimorn Mairiang, Chawalit Pairojkul, Maria V. Periago, Narong Khuntikeo, Jason Mulvenna, Jeffrey M. Bethony

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Approximately 680 million people are at risk of infection with Opisthorchis viverrini (OV) andClonorchis sinensis, with an estimated 10 million infected with OV in Southeast Asia alone. While opisthorchiasis is associated with hepatobiliary pathologies, such as advanced periductal fibrosis (APF) and cholangiocarcinoma (CCA), animal models of OV infection show that immune-complex glomerulonephritis is an important renal pathology that develops simultaneously with hepatobiliary pathologies. A cardinal sign of immune-complex glomerulonephritis is the urinary excretion of immunoglobulin G (IgG) (microproteinuria). In community-based studies in OV endemic areas along the Chi River in northeastern Thailand, we observed that over half of …

Genome Analysis Of Staphylococcus Aureus St291, A Double Locus Variant Of St398, Reveals A Distinct Genetic Lineage, Marc Stegger, Maliha Aziz, Tomsz Chroboczek, Lance B. Price, Troels Ronco, Kristoffer Kiil, Robert L. Skov, Frederic Laurent, Paal S. Andersen

Environmental and Occupational Health Faculty Publications

Staphylococcus aureus ST291 has been reported as a homologue recombinant double locus variant of the livestock associated S. aureus ST398. However, whole genome sequencing show that ST291 is a unique genetic lineage with highly variable content within its accessory genome compared to both human and livestock associated genome sequenced CC398s.

The Impact Of Interventions To Reduce Length Of Stay In The Emergency Department: A Systematic Review, Jameel Abualenain, Taibah Alabdrabalnabi, Irit R. Rasooly, Paul Levett, Jesse M. Pines

Himmelfarb Library Faculty Posters and Presentations

No abstract provided.

Rhinoscleroma Presenting As A Nasal-Palatal Mass With Airway Obstruction, Mark C. Domanski, Alexander Rivero, David E. Kardon

Surgery Faculty Publications

We report a case of a 45-year-old male with severe rhinoscleroma. The patient presented to the emergency room with dyspnea from a long-standing nasal-palatal mass. A tracheostomy was required for airway control. While dyspnea in the presence of an upper airway mass is typical of malignancy, consideration of non-oncological etiologies is important. We review the epidemiology, pathology, diagnosis, and treatment of rhinoscleroma.

Vbp15, A Glucocorticoid Analogue, Is Effective At Reducing Allergic Lung Inflammation In Mice, Jesse M. Damsker, Blythe C. Dillingham, Mary C. Rose, Molly A. Balsley, Christopher R. Heier, Alan M. Watson, Erik J. Stemmy, Rosalyn A. Jurjus, Tony Huynh, Kathleen Tatem, Kitipong Uaesoontrachoon, Dana M. Berry, Angela S. Benton, Robert J. Freishtat, Eric P. Hoffman, John M. Mccall, Heather Gordish-Dressman, Stephanie L. Constant, Erica K.M. Reeves, Kanneboyina Nagaraju

Pharmacology and Physiology Faculty Publications

Asthma is a chronic inflammatory condition of the lower respiratory tract associated with airway hyperreactivity and mucus obstruction in which a majority of cases are due to an allergic response to environmental allergens. Glucocorticoids such as prednisone have been standard treatment for many inflammatory diseases for the past 60 years. However, despite their effectiveness, long-term treatment is often limited by adverse side effects believed to be caused by glucocorticoid receptor-mediated gene transcription. This has led to the pursuit of compounds that retain the anti-inflammatory properties yet lack the adverse side effects associated with traditional glucocorticoids. We have developed a novel …

A Risk Score For Identifying Methicillin-Resistant Staphylococcus Aureus In Patients Presenting To The Hospital With Pneumonia., Andrew F. Shorr, Daniela E. Myers, David B. Huang, Brian H. Nathanson, Matthew F. Emons, Marin H. Kollef

Emergency Medicine Faculty Publications

Background

Methicillin-resistant Staphylococcus aureus (MRSA) represents an important pathogen in healthcare-associated pneumonia (HCAP). The concept of HCAP, though, may not perform well as a screening test for MRSA and can lead to overuse of antibiotics. We developed a risk score to identify patients presenting to the hospital with pneumonia unlikely to have MRSA.

Methods

We identified patients admitted with pneumonia (Apr 2005 – Mar 2009) at 62 hospitals in the US. We only included patients with lab evidence of bacterial infection (e.g., positive respiratory secretions, blood, or pleural cultures or urinary antigen testing). We determined variables independently associated with the …

Social Media And Medical Students: What Are They Thinking?, Alexandra Gomes, Gisela Butera, Terry Kind, Katherine C. Chretien

Himmelfarb Library Faculty Posters and Presentations

This poster provides a review of interim results from a qualitative study on first year medical students' attitudes and perceptions of their definition of medical professionalism in social media. Included in the study is an evaluation of changes in perspective since becoming a medical student and after participating in an E-Professionalism and Social Media instructional session.

Linking And Retaining Hiv Patients In Care: The Importance Of Provider Attitudes And Behaviors, Manya Magnus, Jane Herwehe, Michelli Murtaza-Rossini, Petera Reine, Damien Cuffie, Deann Gruber, Michael Kaiser

Epidemiology Faculty Publications

Retention in HIV treatment may reduce morbidity and mortality, as well as slow the epidemic. Myriad barriers to retention include stigma, homophobia, structural barriers, transportation, and insurance. The purpose of this study was to evaluate patient perceptions of provider attitudes among HIV-infected persons within a state-wide public hospital system in Louisiana. A convenience sample of patients attending HIV clinics throughout the state participated in an anonymous interview. Factors associated with negative perceptions of care were evaluated in conjunction with a validated stigma measure. Factors associated with having a delayed entry into or break in care were evaluated in conjunction with …

Rapid 13(C) Urea Breath Test To Identify Helicobacter Pylori Infection In Emergency Department Patients With Upper Abdominal Pain, Andrew C. Meltzer, Rebecca Pierce, Derek A.T. Cummings, Jesse M. Pines, Larissa May, Meaghan A. Smith, Joseph Marcotte, Melissa L. Mccarthy

Emergency Medicine Faculty Publications

Introduction: In emergency department (ED) patients with upper abdominal pain, management includes ruling out serious diseases and providing symptomatic relief. One of the major causes of upper abdominal pain is an ulcer caused by Helicobacter pylori (H. pylori), which can be treated and cured with antibiotics. We sought to estimate the prevalence of H. pylori infection in symptomatic patients using a convenience sample at a single urban academic ED and demonstrate the feasibility of ED-based testing.

Methods: We prospectively enrolled patients with a chief complaint of pain or discomfort in the upper abdomen for 1 year from February …

From Qualitative Work To Intervention Development In Pediatric Oncology Palliative Care Research, Terrah Foster Akard, Mary Jo Gilmer, Debra L. Friedman, Barbara Given, Verna L. Hendricks-Ferguson, Pamela S. Hinds

Pediatrics Faculty Publications

Qualitative methods can be particularly useful approaches to use with individuals who are experiencing a rare disease and thus who comprise a small sample (such as children with cancer) and are at points in care that few experience (such as end of life). This data-based methods article describes how findings from a qualitative study were used to guide and shape a pediatric oncology palliative care intervention. Qualitative data can lay a strong foundation for subsequent pilot intervention work by facilitating the development of an underlying study conceptualization, providing recruitment feasibility estimates, helping establish clinically meaningful inclusion criteria, establishing staff acceptability …

Characteristics Of Children With The Best And Poorest First- And Second-Year Growth During Rhgh Therapy: Data From 25 Years Of The Genentech National Cooperative Growth Study (Ncgs), Paul B. Kaplowitz, Dorothy I. Shulman, James W. Frane, Joan Jacobs, Barbara Lippe

Pediatrics Faculty Publications

Background

Models assessing characteristics contributing to response to recombinant human growth hormone (rhGH) response rarely address growth extremes in both years 1 and 2 or examine how children track from year to year. Using National Cooperative Growth Study (NCGS) data, we determined characteristics contributing to responsiveness to rhGH and the pattern of change from years 1 to 2.

Patients and methods

Height velocity standard deviation score (HV SDS) for 2 years for prepubertal children with idiopathic GH deficiency (IGHD) (n = 1899) and idiopathic short stature (ISS) (n = 1186) treated with similar doses for two years were computed. Group …

Himmelfarb Headlines - May/June 2013, 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 emerging technologies/Browzine, the library's new online catalog, and profiles of Dante A. Verme and Michael Blake.

Expanding Our Roles: Embedded In Curriculum Design, Gisela Butera, Alexandra Gomes, Thomas Harrod, Seema Kakar, Julia B. Frank, Jennifer Owens

Himmelfarb Library Faculty Posters and Presentations

Objectives To describe how librarians became involved in helping to design curriculum for Problem- Based Learning (PBL) Course for first- and second-year medical students. Librarians became part of a team collaborating with medical faculty to revise the PBL curriculum, incorporating innovative teaching techniques and creating effective simulated patient case scenarios.

Methods In August 2010, the PBL Director contacted the Library to help revise 10 cases for second-year problem-based learning course. Two librarians joined the PBL multi-disciplinary curriculum team meeting bi-weekly to create and revise medical tutor and student guides, and case modules. The cases successfully evolved from paper handouts to …

Himmelfarb Library Liaison Letter - May 2013, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

Vaccination With Human Hookworm Vaccine "Necator Americanus Aspartic Protease-1 M74" Generates Neutralizing Antibodies And A Potent Immune Response In Balb/C Mice, Amar R. Jariwala, Xi Chen, Mark S. Pearson, Brian Keegan, Jill B. Brelsford, Jordan L. Plieskatt, Alex Loukas, Bin Zhan, Peter J. Hotez, Jeffrey M. Bethony

Microbiology, Immunology, and Tropical Medicine Posters and Presentations

Backgound: Human Hookworm Infection, a neglected tropical disease infects more than 600 million people around the world. Hookworms ingest hemoglobin containing erythrocytes and Necator americanus Aspartic Protease-1 wild type (Na-APR-1wt) a hemoglobinase cleaves hemoglobin to form Heme and Globin. Globin is further digested by other gut enzymes and the nutritional end products are absorbed by the hookworm’s gut wall. Also, Heme which is toxic to hookworm is detoxified by the Necator americanus Glutathione Transferase-1 (Na-GST-1) a detoxification enzyme secreted by the gut of the hookworm. Necator americanus Aspartic Protease-1 M74 (Na-APR-1 M74) is the …

Conserved Structural Domains In Foxd4l1, A Neural Forkhead Box Transcription Factor, Are Required To Repress Or Activate Target Genes, Steven L. Klein, Karen M. Neilson, John Orban, Sergey Yaklichkin, Jennifer Hoffbauer, Kathy Mood, Ira O. Daar, Sally Ann Moody

Anatomy and Regenerative Biology Faculty Publications

FoxD4L1 is a forkhead transcription factor that expands the neural ectoderm by down-regulating genes that promote the onset of neural differentiation and up-regulating genes that maintain proliferative neural precursors in an immature state. We previously demonstrated that binding of Grg4 to an Eh-1 motif enhances the ability of FoxD4L1 to down-regulate target neural genes but does not account for all of its repressive activity. Herein we analyzed the protein sequence for additional interaction motifs and secondary structure. Eight conserved motifs were identified in the C-terminal region of fish and frog proteins. Extending the analysis to mammals identified a high scoring …

Male Circumcision Significantly Reduces Prevalence And Load Of Genital Anaerobic Bacteria, Cindy M. Liu, Bruce A. Hungate, Aaron A.R. Tobian, David Serwadda, Jacques Ravel, Richard Lester, Godfrey Kigozi, Maliha Aziz, Ronald M. Galiwango, Fred Nalugoda, Tania L. Contente-Cuomo, Maria J. Wawer, Paul Keim, Ronald H. Gray, Lance B. Price

Environmental and Occupational Health Faculty Publications

Male circumcision reduces female-to-male HIV transmission. Hypothesized mechanisms for this protective effect include decreased HIV target cell recruitment and activation due to changes in the penis microbiome. We compared the coronal sulcus microbiota of men from a group of uncircumcised controls (n= 77) and from a circumcised intervention group (n = 79) at enrollment and year 1 follow-up in a randomized circumcision trial in Rakai, Uganda. We characterized microbiota using16S rRNA gene-based quantitative PCR (qPCR) and pyrosequencing, log response ratio (LRR), Bayesian classification, nonmetric multidimensional scaling (nMDS), and permutational multivariate analysis of variance (PerMANOVA). At baseline, men …

Hyper-Arousal Decreases Human Visual Thresholds, Adam J. Woods, John W. Philbeck, Philip Wirtz

Neurological Surgery Faculty Publications

Arousal has long been known to influence behavior and serves as an underlying component of cognition and consciousness. However, the consequences of hyper-arousal for visual perception remain unclear. The present study evaluates the impact of hyper-arousal on two aspects of visual sensitivity: visual stereoacuity and contrast thresholds. Sixty-eight participants participated in two experiments. Thirty-four participants were randomly divided into two groups in each experiment: Arousal Stimulation or Sham Control. The Arousal Stimulation group underwent a 50-second cold pressor stimulation (immersing the foot in 0–2° C water), a technique known to increase arousal. In contrast, the Sham Control group immersed their …

Nutrition Intake In Youths With Type 1 Diabetes, Lyndsay O'Brecht, Eleanor Race Mackey, Clarissa S. Holmes, Randi Streisand

GW Research Days 2013

No abstract provided.

The Association Of Caregivers' Educational Level And Their Knowledge Of Children's Nutrition And Exercise Behavior, Hauwa Okorie, Bersabeh Medmim, Nazrat Mirza

GW Research Days 2013

BACKGROUND:

Parents play an instrumental role in modeling their children's health behaviors and exposing them to new foods, and engaging them in physical activities.

OBJECTIVE:

To assess the association of parents' educational level on their nutritional and physical activity knowledge.

METHODS:

This is a cross-sectional study of 72 participants from a nutrition and wellness program targeting parents of African American preschoolers. Socio-demographic, child's nutritional and physical exercise habit survey and anthropometric data were collected from all participants at baseline.

RESULTS:

77% of the participants were grandmothers or mothers; the mean age was 44.8 and 13% of participants were college graduates. …