Medicine and Health Sciences Commons^™

Long-Term Services And Supports (Ltss): Arlington County's Integrated Approach, Carol O'Shaughnessy, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum sponsored a local site visit looking at community-based aging programs and long-term services and supports (LTSS) in Arlington County, Virginia. Arlington County human services are integrated under an umbrella agency in the Department of Human Services (DHS) which administers multiple programs for the elderly and people with disabilities. These include the Older Americans Act services, Medicaid LTSS, transportation services, a nursing case management program, and mental health services for those living in nursing homes and assisted living facilities. Arlington County integrates its aging and disability programs under the auspices of an Administration on Aging-funded Aging …

Closing The Loop: Integrating Snapps Into An Outpatient Morning Report To Foster Self-Directed Learning And Encourage Use Of Evidence Based Medicine, Julia Magana, Jimmy Beck

E-Learning Modules

This resources describes a novel approach to outpatient morning report. This format encourages self-directed learning as well as teaches residents to use the clinical literature to ensure they were providing optimal patient care. Each resident daily chooses a clinical question from that day's patient care, investigates and brings the answer back to the group during morning report. This resource includes a description of the integration and implementation of this format as well as the handout used by the residents.

Since the implementation of our new morning report format, our residents have consistently read about their patients on a nightly basis. …

Modulation Of Gsk-3Β Activity In Venezuelan Equine Encephalitis Virus Infection, Kylene Kehn-Hall, Aarthi Narayanan, Lindsay Lundberg, Gavin Sampey, Chelsea Pinkham, Irene Guendel, Rachel Van Duyne, Svetlana Senina, Kimberly L. Schultz, Eric Stavale, M. Javad Aman, Charles Bailey, Fatah Kashanchi

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Alphaviruses, including Venezuelan Equine Encephalitis Virus (VEEV), cause disease in both equine and humans that exhibit overt encephalitis in a significant percentage of cases. Features of the host immune response and tissue-specific responses may contribute to fatal outcomes as well as the development of encephalitis. It has previously been shown that VEEV infection of mice induces transcription of pro-inflammatory cytokines genes (e.g., IFN-γ, IL-6, IL-12, iNOS and TNF-α) within 6 h. GSK-3β is a host protein that is known to modulate pro-inflammatory gene expression and has been a therapeutic target in neurodegenerative disorders such as Alzheimer's. Hence inhibition of GSK-3β …

Medicine + Health, Spring 2012, George Washington University, School Of Medicine And Health Sciences, Office Of Communications And Marketing

Medicine + Health Magazine

No abstract provided.

Genetic Manipulation Of Schistosomes - Progress With Integration Competent Vectors, Sutas Suttiprapa, Gabriel Rinaldi, Paul J. Brindley

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Draft genome sequences for Schistosoma japonicum and S. mansoni are now available. The schistosome genome encodes ∼13 000 protein-encoding genes for which the functions of few are well understood. Nonetheless, the new genes represent potential intervention targets, and molecular tools are being developed to determine their importance. Over the past 15 years, noteworthy progress has been achieved towards development of tools for gene manipulation and transgenesis of schistosomes. A brief history of genetic manipulation is presented, along with a review of the field with emphasis on reports of integration of transgenes into schistosome chromosomes.

Five-Year Longitudinal Assessment Of The Downstream Impact On Schistosomiasis Transmission Following Closure Of The Three Gorges Dam., Darren J. Gray, Aaron P. Thrift, Gail M. Williams, Feng Zheng, Yue-Sheng Li, Jiagang Guo, Honggen Chen, Tianping Wang, Xin J. Xu, Rong Zhu, Hongqing Zhu, Chun Li Cao, Dan D. Lin, Zhen Y. Zhao, Robert S. Li, George M. Davis, Donald P. Mcmanus

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Background

Schistosoma japonicum is a major public health concern in the Peoples' Republic of China (PRC), with about 800,000 people infected and another 50 million living in areas at risk of infection. Based on ecological, environmental, population genetic and molecular factors, schistosomiasis transmission in PRC can be categorised into four discrete ecosystems or transmission modes. It is predicted that, long-term, the Three Gorges Dam (TGD) will impact upon the transmission of schistosomiasis in the PRC, with varying degree across the four transmission modes.

Methodology/Principal Findings

We undertook longitudinal surveillance from 2002 to 2006 in sentinel villages of the three transmission …

Health Information Privacy In The Correctional Environment, Melissa M. Goldstein

Health Policy and Management Faculty Publications

Information technology is considered a transformative element in health care because it facilitates the transparency and sharing of health information, which have always been central to the practice of medicine and the delivery of high-quality care. The widespread use of electronic health records (EHRs) and electronic health information exchange, among other technologies, is considered essential to improving the quality of care, reducing medical errors, reducing health disparities, and advancing the delivery of patient-centered medical care.

Environmental Exposure To Polychlorinated Biphenyls And P,P'-Dde And Sperm Sex-Chromosome Disomy, Megan E. Mcauliffe, Paige L. Williams, Susan A. Korrick, Larisa M. Altshul, Melissa J. Perry

Environmental and Occupational Health Faculty Publications

Background: Chromosomal abnormalities contribute substantially to reproductive problems, but the role of environmental risk factors has received little attention.

Objectives: We evaluated the association of polychlorinated biphenyl (PCB) and dichlorodiphenyldichloroethylene (p,p´-DDE) exposures with sperm sex-chromosome disomy.

Methods: We conducted a cross-sectional study of 192 men from subfertile couples. We used multiprobe fluorescence in situ hybridization (FISH) for chromosomes X, Y, and 18 to determine XX, YY, XY, and total sex-chromosome disomy in sperm nuclei. Serum was analyzed for concentrations of 57 PCB congeners and p,p´-DDE. Poisson regression models were used to calculate incidence rate ratios (IRRs) for …

Cardiovascular Pharmacogenomics: Current Status And Future Directions—Report Of A National Heart, Lung, And Blood Institute Working Group, Kiran Musunuru, Dan M. Roden, Robin Boineau, Michael R. Bristow, Timothy A. Mccaffrey, Christopher Newton-Cheh, Dina N. Paltoo, Yves Rosenberg, Jay G. Wohlgemuth, Issam Zineh, Ahmed A.K. Hasan

Medicine Faculty Publications

No abstract provided.

A Health Needs Assessment Of Arab-Americans In The Washington, Dc Area, Reem N. Ghoneim, Amita N. Vyas

GW Research Days 2012 and Earlier

Although Arab-Americans often face various health challenges due to the stress associated with immigration, cultural conflict in the U.S., and limited knowledge of the complex U.S. health system, there is a paucity of research examining health risks and behaviors among this ethnic group. This cross-sectional study assessed the health needs among Arabs living in the Washington, DC metropolitan area. Participants were recruited to take the survey online, reporting on health care access and utilization, risk behaviors, and health status. It also measured for associations between reported depression, discrimination, acculturation, and health. Quantitative analysis showed correlations between age and current tobacco …

Access To Urgent Pediatric Primary Care Appointments In The District Of Columbia, Rachelle Pierre-Mathieu, Janice Blanchard, Adith Sekaran, Rachel Nash, Lauren Winter, Christine Prideaux

GW Research Days 2012 and Earlier

Background

Timely access to acute primary care appointments after an emergency department (ED) visit has become a challenge for both providers and patients. Previous studies have documented disparities in accessing adult primary care and pediatric specialty care, especially among those lacking private insurance. There is little data regarding urgent pediatric primary care access. Concerns over pediatric provider access need to be addressed as public and private insurance expansions begin within health reform.

Objective

This study measured pediatric access to urgent primary care appointments within the District of Columbia (D.C.) following an ED visit. We hypothesized there would be a disparity …

Progestogens To Prevent Preterm Birth In Twin Pregnancies: An Individual Participant Data Meta-Analysis Of Randomized Trials., Ewoud Schuit, Sarah Stock, Rolf H.H. Groenwold, Kimberly Maurel, C. Andrew Combs, Thomas Garite, Catherine Y. Spong, Elizabeth A. Thom, Dwight J. Rouse, Steve N. Caritis, George Saade, Julia M. Zachary, Jane E. Norman, Line Rode, Katharina Klein, Ann Tabor, Elcin Cetingoz, John C. Morrison, Everett F. Magann, Christian M. Briery, Vicente Serra, Alfredo Perales, Juan Meseguer, Anwar Nassar, Arianne C. Lim, Karel G.M. Moons, Anneke Kwee, Ben W.J. Mol

Epidemiology Faculty Publications

Background

Preterm birth is the principal factor contributing to adverse outcomes in multiple pregnancies. Randomized controlled trials of progestogens to prevent preterm birth in twin pregnancies have shown no clear benefits. However, individual studies have not had sufficient power to evaluate potential benefits in women at particular high risk of early delivery (for example, women with a previous preterm birth or short cervix) or to determine adverse effects for rare outcomes such as intrauterine death.

Methods/design

We propose an individual participant data meta-analysis of high quality randomized, double-blind, placebo-controlled trials of progestogen treatment in women with a twin pregnancy. The …

Role Of Community Health Centers In Providing Services To Low-Income Women, Peter Shin, Jessica Sharac

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Because of their location and ability to serve populations with complex health and social needs, CHCs reduce disparities in access to care and generate significant costsavings. This brief examines the role CHCs play in mitigating disparities for one population subgroup, low-income women of childbearing age (defined as age 15-44), and the challenges that they will need to overcome to build upon their success in delivering care to vulnerable populations. Key findings include:

• CHCs serve approximately one in five (21.5%) low-income women of childbearing age nationally.
• The number of women of child-bearing age receiving health center services at CHCs increased by …

Differential Analysis Of Ovarian And Endometrial Cancers Identifies A Methylator Phenotype, Diana L. Kolbe, Julie A. Deloia, Patricia Porter-Gill, Mary Strange, Hanna M. Petrykowska, Alfred Guirguis, Thomas C. Krivak, Lawrence C. Brody, Laura Elnitski

Exercise and Nutrition Sciences Faculty Publications

Despite improved outcomes in the past 30 years, less than half of all women diagnosed with epithelial ovarian cancer live five years beyond their diagnosis. Although typically treated as a single disease, epithelial ovarian cancer includes several distinct histological subtypes, such as papillary serous and endometrioid carcinomas. To address whether the morphological differences seen in these carcinomas represent distinct characteristics at the molecular level we analyzed DNA methylation patterns in 11 papillary serous tumors, 9 endometrioid ovarian tumors, 4 normal fallopian tube samples and 6 normal endometrial tissues, plus 8 normal fallopian tube and 4 serous samples from TCGA. For …

Overlap Subtype Of Chronic Graft-Versus-Host Disease Is Associated With An Adverse Prognosis, Functional Impairment, And Inferior Patient-Reported Outcomes: A Chronic Graft-Versus-Host Disease Consortium Study, Joseph Pidala, Georgia Vogelsang, Paul Martin, Xiaoyu Chai, Barry Storer, Steven Pavletic, Daniel Weisdorf, Madan Jagasia, Corey Cutler, Jeanne Palmer, David Jacobsohn, Sally Arai, Stephanie J. Lee

Pediatrics Faculty Publications

Background

The National Institutes of Health Consensus Conference proposed the term “overlap” graft-versus-host disease to describe the situation when both acute and chronic graft-versus-host disease are present.

Design and Methods

We examined whether the overlap subtype of graft-versus-host disease was associated with a different prognosis, functional limitations, or patient-reported outcomes compared to “classic” chronic graft-versus-host disease without any acute features.

Results

Prospective data were collected from 427 patients from nine centers. Patients were classified as having overlap (n=352) or classic chronic (n=75) graft-versus-host disease based on reported organ involvement. Overlap …

Community Health Centers: The Challenge Of Growing To Meet The Need For Primary Care In Medically Underserved Communities, Peter Shin, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Recommendations For The Use Of Common Outcome Measures In Pediatric Traumatic Brain Injury Research, Stephen R. Mccauley, Elisabeth A. Wilde, Vicki A. Anderson, Gary Bedell, Sue R. Beers, Thomas F. Campbell, Sandra B. Chapman, Linda Ewing-Cobbs, Joan P. Gerring, Gerard A. Gioia, Harvey S. Levin, Linda J. Michaud, Mary R. Prasad, Bonnie R. Swaine, Lyn S. Turkstra, Shari L. Wade, Keith O. Yeates

Psychiatry and Behavioral Sciences Faculty Publications

This article addresses the need for age-relevant outcome measures for traumatic brain injury (TBI) research and summarizes the recommendations by the inter-agency Pediatric TBI Outcomes Workgroup. The Pediatric Workgroup's recommendations address primary clinical research objectives including characterizing course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements (CDE) Workgroups, the Pediatric TBI Outcomes Workgroup adopted the standard three-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in pediatric TBI from …

Enhanced Protective Efficacy Of A Chimeric Form Of The Schistosomiasis Vaccine Antigen Sm-Tsp-2, Mark S. Pearson, Darren A. Pickering, Henry J. Mcsorley, Jeffrey M. Bethony, Leon Tribolet, Annette M. Dougall, Peter J. Hotez, Alex Loukas

Microbiology, Immunology, and Tropical Medicine Faculty Publications

The large extracellular loop of the Schistosoma mansoni tetraspanin, Sm-TSP-2, when fused to a thioredoxin partner and formulated with Freund's adjuvants, has been shown to be an efficacious vaccine against murine schistosomiasis. Moreover, Sm-TSP-2 is uniquely recognised by IgG1 and IgG3 from putatively resistant individuals resident in S. mansoniendemic areas in Brazil. In the present study, we expressed Sm-TSP-2 at high yield and in soluble form in E. coli without the need for a solubility enhancing fusion partner. We also expressed in E. coli a chimera called Sm-TSP-2/5B, which consisted of Sm-TSP-2 fused to …

Post-Acute Care Payment Reform Demonstration: Final Report Volume 4 Of 4, Barbara Gage, Melvin Ingber, Laura Smith, Anne Deutsch, Tracy Kline, Jill Dever, Judith Abbate, Richard Miller, Brieanne Lyda-Mcdonald, Cynthia Kelleher, Danielle Garfinkel, Joshua Manning, Christopher M. Murtaugh, Margaret Stineman, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

This is the Final Report for the Post-Acute Care Payment Reform Demonstration (PAC-PRD), authorized by section 5008 of the Deficit Reduction Act of 2005, Public Law 109-171. The report has 12 sections, which are divided into four volumes: Volume 1: Executive Summary. Volume 2: Sections 1-4 (Section 1: Introduction; Section 2: Underlying Issues of the PAC-PRD Initiating Legislation; Section 3: Developing Standardized Measurement Approaches: The Continuity Assessment Record and Evaluation (CARE); Section 4: Demonstration Methods and Data Collection) Volume 3: Sections 5-6 (Section 5: Framework for Analysis; Section 6: Factors Associated with Hospital Discharge Destination) Volume 4: Sections 7-12; References …

Post-Acute Care Payment Reform Demonstration: Final Report Volume 3 Of 4, Barbara Gage, Melissa Morley, Laura Smith, Melvin Ingber, Anne Deutsch, Tracy Kline, Jill Dever, Richard Miller, Brieanne Lyda-Mcdonald, Cynthia Mckeller, Danielle Garfinkel, Joshua Manning, Christopher M. Murtaugh, Margaret Stineman, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

This is the Final Report for the Post-Acute Care Payment Reform Demonstration (PAC-PRD), authorized by section 5008 of the Deficit Reduction Act of 2005, Public Law 109-171. The report has 12 sections, which are divided into four volumes: Volume 1: Executive Summary. Volume 2: Sections 1-4 (Section 1: Introduction; Section 2: Underlying Issues of the PAC-PRD Initiating Legislation; Section 3: Developing Standardized Measurement Approaches: The Continuity Assessment Record and Evaluation (CARE); Section 4: Demonstration Methods and Data Collection) Volume 3: Sections 5-6 (Section 5: Framework for Analysis; Section 6: Factors Associated with Hospital Discharge Destination) Volume 4: Sections 7-12; References …

Post-Acute Care Payment Reform Demonstration: Final Report Volume 1 Of 4, Barbara Gage, Melissa Morley, Laura Smith, Melvin Ingber, Anne Deutsch, Tracy Kline, Jill Dever, Judith Abbate, Richard Miller, Brieanne Lyda-Mcdonald, Cynthia Kelleher, Danielle Garfinkel, Joshua Manning, Christopher M. Murtaugh, Margaret Stineman, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

This is the Final Report for the Post-Acute Care Payment Reform Demonstration (PAC-PRD), authorized by section 5008 of the Deficit Reduction Act of 2005, Public Law 109-171. The report has 12 sections, which are divided into four volumes: Volume 1: Executive Summary. Volume 2: Sections 1-4 (Section 1: Introduction; Section 2: Underlying Issues of the PAC-PRD Initiating Legislation; Section 3: Developing Standardized Measurement Approaches: The Continuity Assessment Record and Evaluation (CARE); Section 4: Demonstration Methods and Data Collection) Volume 3: Sections 5-6 (Section 5: Framework for Analysis; Section 6: Factors Associated with Hospital Discharge Destination) Volume 4: Sections 7-12; References …

Does Secondary Inflammatory Breast Cancer Represent Post-Surgical Metastatic Disease?, Salman Hashmi, Ladan Zolfaghari, Paul H. Levine

Epidemiology Faculty Publications

The phenomenon of accelerated tumor growth following surgery has been observed repeatedly and merits further study. Inflammatory breast carcinoma (IBC) is widely recognized as an extremely aggressive malignancy characterized by micrometastasis at the time of diagnosis, with one interesting subgroup defined as secondary IBC where pathologically identifiable IBC appears after surgical treatment of a primary non-inflammatory breast cancer. One possible mechanism can be related to the stimulation of dormant micrometastasis through local angiogenesis occurring as part of posttraumatic healing. In this report, we review cases of secondary IBC and others where localized trauma was followed by the appearance of IBC …

Post-Acute Care Payment Reform Demonstration: Final Report Volume 2 Of 4, Barbara Gage, Melissa Morley, Laura Smith, Melvin Ingber, Anne Deutsch, Tracy Kline, Jill Dever, Judith Abbate, Richard Miller, Brieanne Lyda-Mcdonald, Cynthia Kelleher, Danielle Garfinkel, Joshua Manning, Christopher M. Murtaugh, Margaret Stineman, Trudy Mallinson

Clinical Research and Leadership Faculty Publications

This is the Final Report for the Post-Acute Care Payment Reform Demonstration (PAC-PRD), authorized by section 5008 of the Deficit Reduction Act of 2005, Public Law 109-171. The report has 12 sections, which are divided into four volumes: Volume 1: Executive Summary. Volume 2: Sections 1-4 (Section 1: Introduction; Section 2: Underlying Issues of the PAC-PRD Initiating Legislation; Section 3: Developing Standardized Measurement Approaches: The Continuity Assessment Record and Evaluation (CARE); Section 4: Demonstration Methods and Data Collection) Volume 3: Sections 5-6 (Section 5: Framework for Analysis; Section 6: Factors Associated with Hospital Discharge Destination) Volume 4: Sections 7-12; References …

Transcriptional Regulation Of N-Acetylglutamate Synthase, Sandra Kirsch Heibel, Giselle Yvette Lopez, Maria Panglao, Sonal Sodha, Leonardo Marino-Ramirez, Mendel Tuchman, Ljubica Caldovic

Pediatrics Faculty Publications

The urea cycle converts toxic ammonia to urea within the liver of mammals. At least 6 enzymes are required for ureagenesis, which correlates with dietary protein intake. The transcription of urea cycle genes is, at least in part, regulated by glucocorticoid and glucagon hormone signaling pathways. N-acetylglutamate synthase (NAGS) produces a unique cofactor, N-acetylglutamate (NAG), that is essential for the catalytic function of the first and rate-limiting enzyme of ureagenesis, carbamyl phosphate synthetase 1 (CPS1). However, despite the important role of NAGS in ammonia removal, little is known about the mechanisms of its regulation. We identified two regions of high …

Recent Proposals To Limit Medigap Coverage And Modify Medicare Cost Sharing, Kathryn Linehan

National Health Policy Forum

As policymakers look for savings from the Medicare program, some have proposed eliminating or discouraging “first-dollar coverage” available through privately purchased Medigap policies. Medigap coverage, which beneficiaries obtain to protect themselves from Medicare’s cost-sharing requirements and its lack of a cap on out-of-pocket spending, may discourage the judicious use of medical services by reducing or eliminating beneficiary cost sharing. It is estimated that eliminating such coverage, which has been shown to be associated with higher Medicare spending, and requiring some cost sharing would encourage beneficiaries to reduce their service use and thus reduce program spending. However, eliminating first-dollar coverage could …

Older Americans Act Of 1965: Programs And Funding, Carol O'Shaughnessy

National Health Policy Forum

This document offers a basic description of the Older Americans Act of 1965. The Act is considered the major vehicle for promoting the delivery of social services to the aging population. The Act's seven titles and multiple programs are described, along with a chart showing fiscal year 2012 federal appropriations.

Trpv1 Antagonists May Exacerbate Sepsis In Aged Mice: Should We Be Nervous?, Zenaide M.N. Quezado, Arpad Szallasi

Anesthesiology and Critical Care Medicine Faculty Publications

No abstract provided.

Characterising The Mucosal And Systemic Immune Responses To Experimental Human Hookworm Infection., Soraya Gaze, Henry J. Mcsorley, James Daveson, Di Jones, Jeffrey M. Bethony, Luciana M. Oliveira, Richard Speare, James S. Mccarthy, Christian R. Engwerda, John Croese, Alex Loukas

Microbiology, Immunology, and Tropical Medicine Faculty Publications

The mucosal cytokine response of healthy humans to parasitic helminths has never been reported. We investigated the systemic and mucosal cytokine responses to hookworm infection in experimentally infected, previously hookworm naive individuals from non-endemic areas. We collected both peripheral blood and duodenal biopsies to assess the systemic immune response, as well as the response at the site of adult worm establishment. Our results show that experimental hookworm infection leads to a strong systemic and mucosal Th2 (IL-4, IL-5, IL-9 and IL-13) and regulatory (IL-10 and TGF-β) response, with some evidence of a Th1 (IFN-γ and IL-2) response. Despite upregulation after …

Environmental Drivers Of Ross River Virus In South-East Tasmania, Australia: Towards Strengthening Public Health Interventions, Angela Werner, Sarah Goater, Scott Carver, Greg Robertson, Philip Weinstein

Global Health Faculty Publications

In Australia, Ross River virus (RRV) is predominantly identified and managed through passive health surveillance. Here, the proactive use of environmental datasets to improve community-scale public health interventions in southeastern Tasmania is explored. Known environmental drivers (temperature, rainfall, tide) of the RRV vector Aedes camptorhynchus are analysed against cumulative case records for five adjacent local government areas (LGAs) from 1993 to 2009. Allowing for a 0- to 3-month lag period, temperature was the most significant driver of RRV cases at 1-month lag, contributing to a 23. 2% increase in cases above the long-term case average. The potential for RRV to …

Integrating Spiritual Care Within Palliative Care: An Overview Of Nine Demonstration Projects, Shirley Otis-Green, Betty Ferrell, Tami Borneman, Christina Puchalski, Gwen Uman, Andrea Garcia

Medicine Faculty Publications

No abstract provided.