Medicine and Health Sciences Commons^™

The Effect Of Pediatric Hospital Specialization On Patient Safety And Effectiveness Of Care, James Mitchell Harris Ii

Theses and Dissertations

Provider specialization is an area of interest in health care as patients, payers and policy makers are now demanding better performance and demonstrated proof of the benefits of specialization. While previously ignored in the specialization debate, now even the hospitals focusing on pediatric care (i.e. children's hospitals) are experiencing pressure to demonstrate their value. The current study attempts to answer the questions: do hospitals specializing in pediatric care provide better quality pediatric inpatient care; and do they do so for differing types of patient outcomes and across different levels of care complexity? Contingency Theory is used to develop and assess …

Prediction Of In-Vivo Antimuscarinic Activity (Ama) By In-Vitro Receptor Binding Assessment And Pk/Pd Modeling For Prototypical Drugs, Taghrid Y. Obied

Theses and Dissertations

Purpose: To establish a tool, termed as antimuscarinic activity (AMA), to predict the incidence of antimuscarinic adverse events (AMAEs).Methods: A literature review, focused on drugs having off-target interaction with muscarinic receptors, was performed. Prototypical drugs olanzapine, diphenhydramine, paroxetine were selected for the analysis. Scopolamine and darifenacin were included as positive and negative controls, respectively. Physiochemical properties, pharmacokinetic data, and clinical incidence of AMAEs for the selected drugs were collected from reported literature. Extrapolation of literature data was carried-out to obtain exposure data. To determine the drugs muscarinic affinity (Ki values), experiments were performed using 3H-QNB and membrane suspensions of M1, …

Disparities In The Use Of Emergency Contraceptives, Rebecca Dallman

Theses and Dissertations

Purpose: Unintended pregnancies are often a burden to pregnant women and to the health care system. The rates of unintended pregnancies have decreased since the wide use of contraceptives has increased; however, young women, women with low income, and racial/ethnic minorities are more likely to use contraceptives inconsistently, which increases the risk of an unintended pregnancy. This risk could be reduced with the proper use of emergency contraceptives (ECs).Methods and Analysis: A cross-sectional study was conducted using the data from the female respondents of the 2002 Cycle 6 NSFG. Logistic regression was used to determine rates of use of ECs …

Outcomes Of Status Epilepticus In The Elderly, Alan R. Towne

Theses and Dissertations

Background: Status epilepticus (SE) is a serious medical condition associated with significant morbidity and mortality. Few studies have addressed this condition in the elderly. The present study examines predictors of SE mortality in this growing population.Methods: SE patients visiting the Virginia Commonwealth University Medical Center from July 1, 1989, to June 30,2006 were included in the study. Data on demographic characteristics, SE type, etiology, time to treatment and mortality were collected. Logistic regression analysis was conducted to examine the determinants of mortality due to SE. Data was stratified by age to examine the characteristics of SE among the elderly population.Results: …

Self-Care And Quality Of Life In Patients With Heart Failure, Chantira Chiaranai

Theses and Dissertations

Although it is well known that self-care reduces the frequency of hospital admissions and exacerbations and enhances quality of life (QOL) in heart failure (HF) patients, little is known about self-care in this population. Therefore, the study purpose was to examine relationships among selected individual characteristics (demographics, severity of illness, comorbidities, and social support), self-care strategies, and QOL using Reigel's Model of Self Care in Patients with Heart Failure as the guiding framework. In this descriptive correlational study, self-care was measured using the Self-Care of Heart Failure Index (SCHFI), which measures self-care maintenance (SC-Mt), self-care management (SC-Mn), and self-care self-confidence …

Visual Contributions To The Vestibulo-Ocular Reflex During Balance Recovery Tasks, Mark D. Diehl

Theses and Dissertations

Introduction: The Vestibulo-ocular reflex (VOR) is quantified by computing the ratio of head angular velocity and eye angular velocity (VOR Gain). This measure only includes head angular movements; linear translations are not accounted for. These investigations postulate an alternative method of VOR quantification, one that assesses retinal image stability during head angular and linear movements (Foveal fixation (FF)). This method was used to assess the role of vision in balance reactions. Methods: Experiment 1 : Ten Young subjects were fitted with an eye tracker linked to an EM kinematic recording system. This allowed for the recording of head, trunk and …

Cd23'S Role As A Negative Regulator Of Allergic Disease: In Vivo Effects Of Murine Cd23 Destabilization And Allelic Mutations, Jill Wallace Ford

Theses and Dissertations

Through underexpression and overexpression studies, CD23 has been shown to negatively regulate IgE production. To investigate CD23 destabilization and its effects on CD23 shedding and IgE synthesis in vivo, we utilized an anti-CD23 stalk monoclonal (19G5) which has previously been shown to enhance proteolysis of CD23 in vitro. Compared to isotype control-treated mice, mice injected with 19G5 displayed enhanced serum soluble CD23 and IgE. Because 19G5 injection substantially enhanced CD23 shedding, it was useful in investigating the identity of the CD23 sheddase. 19G5 enhanced CD23 shedding in ADAM8-/-, ADAM9-/-ADAM15-/-, and ADAM9-/-ADAM12-/-ADAM15-/- mice, ruling out these ADAMs as candidate CD23 sheddases. …

Resilience And Risk-Taking Behavior Among Thai Adolescents Living In Bangkok, Thailand, Patcharin Nintachan

Theses and Dissertations

The major purposes of this study were to determine the relationships among resilience, risk-taking behavior and personal characteristics of Thai adolescents living in Bangkok and to examine the differences in risk-taking behavior by school grades or gender. To accomplish these, a cross-sectional correlational research design was conducted. Resilience was measured by using the State-Trait Resilience Inventory developed by Hiew, Mori, Shirnizu and Torninaga.Risk-taking behavior was measured by the Risk-taking Behavior Questionnaire for Thai Adolescents which is a modified version of the 2003 Youth Risk Behavior Survey (YRBS) originally developed by the U.S. Centers for Disease Control and Prevention. In order …

Concurrent Whitening And Orthodontic Treatment, Jason Thomas Gladwell

Theses and Dissertations

The aim was to evaluate whether a whitening system, when used during the final stages of orthodontics, would yield results comparable to whitening alone. Patients were assigned to either the control (n=20) or experimental (n=26) groups. At T1, patients were given a ten day supply of Trèswhite™ by Opalescence®, instructions on use, and initial shade determination was made and photographs were taken. At T2 and T3, shade determination was accomplished and updated photographs were taken. Whitening of the teeth occurred in both groups on average, but significantly more whitening was experienced in the experimental group (p < 0.004). An average of 87% of teeth whitened during orthodontic treatment compared to 97% of control teeth (p < 0.01) were judged to be uniform in appearance. In conclusion, the data do not contraindicate the concurrent accomplishment of teeth whitening during orthodontic treatment.

The Effect Of Pre-Cure Bracket Movement On The Shear Bond Strength Of Metal Brackets, Thomas Luther Roberts Iv

Theses and Dissertations

The effect on shear bond strength of bracket movement after seating the brackets and before light curing has not been reported. The purpose of this study was to determine the effect of linear and rotational pre-cure bracket movement on the shear bond strength of orthodontic brackets. 100 extracted human maxillary premolars were divided into 5 groups of 20 teeth each. The control group was bonded with no pre-cure bracket movement, and test groups were bonded with pre-cure bracket movement of 2 mm, 4 mm, 45¢ª or 180¢ª. Debonding force was measured with an Instron universal testing machine. Results were analyzed …

Accuracy And Consistency Of Radiographic Interpretation Among Clinical Instructors In Conjunction With A Training Program, Sharon K. Lanning, Al M. Best, Henry J. Temple, Philip S. Richards, Alllison Carey, Laurie K. Mccauley

Periodontics Publications

There are inaccuracies and inconsistencies of radiographic interpretation among clinical instructors. The purpose of this investigation was to determine if a training program could improve the accuracy and consistency of instructors’ ratings of bone loss. A total of thirty-five clinical instructors consisting of periodontal faculty (periodontists and general dentists), dental hygiene faculty, and periodontal graduate students viewed projected digitized radiographic images and quantified bone loss for twenty-five teeth into four descriptive categories. Ratings of bone loss were made immediately before (pretest) and after (post-test 1) initiation of the training program and then again three months later (post-test 2). Ratings were …

Lactate Versus Non-Lactate Metabolic Acidosis: A Retrospective Outcome Evaluation Of Critically Ill Patients, Kyle J. Gunnerson, Melissa Saul, Shui He, John A. Kellum

Anesthesiology Publications

Introduction

Acid–base abnormalities are common in the intensive care unit (ICU). Differences in outcome exist between respiratory and metabolic acidosis in similar pH ranges. Some forms of metabolic acidosis (for example, lactate) seem to have worse outcomes than others (for example, chloride). The relative incidence of each type of disorder is unknown. We therefore designed this study to determine the nature and clinical significance of metabolic acidosis in critically ill patients.

Methods

An observational, cohort study of critically ill patients was performed in a tertiary care hospital. Critically ill patients were selected on the clinical suspicion of the presence of …

Acute Brochitis, Richard P. Wenzel, Alpha A. Fowler Iii

Internal Medicine Publications

A 40-year-old man with no underlying lung disease has a 7-day history of mild shortness of breath with exertion, as well as cough that is now productive of purulent sputum. He reports no paroxysms of cough and no contact with ill persons in his community. He does not appear to be in distress. His temperature is 37°C, his pulse 84 beats per minute, and his respiratory rate 17 breaths per minute. On auscultation of the lungs, no rales are heard; scattered wheezes are heard in the lung bases. How should he be evaluated and treated?

Summary and Recommendations

The patient …

Accuracy And Consistency Of Radiographic Interpretation Among Clinical Instructors Using Two Viewing Systems, Sharon K. Lanning, Al M. Best, Henry J. Temple, Philip S. Richards, Alllison Carey, Laurie K. Mccauley

Periodontics Publications

Accurate and consistent radiographic interpretation among clinical instructors is needed for assessment of teaching, student performance, and patient care. The purpose of this investigation was to determine if the method of radiographic viewing affects accuracy and consistency of instructors’ determinations of bone loss. Forty-one clinicians who provide instruction in a dental school clinical teaching program (including periodontists, general dentists, periodontal graduate students, and dental hygienists) quantified bone loss for up to twenty-five teeth into four descriptive categories using a view box for plain film viewing or a projection system for digitized image viewing. Ratings were compared to the correct category …

Deficiency Of Cartilage-Associated Protein In Recessive Lethal Osteogenesis Imperfecta, Aileen M. Barnes, Weizhong Chang, Roy Morello, Wayne A. Cabral, Maryann Weis, David R. Eyre, Sergey Leikin, Elena Makareeva, Natalia Kuznetsova, Thomas E. Uveges, Aarthi Ashok, Armando W. Flor, John J. Mulvihill, Patrick L. Wilson, Usha T. Sundaram, Brendan Lee, Joan C. Marini

VCU Health Publications

Classic osteogenesis imperfecta, an autosomal dominant disorder associated with osteoporosis and bone fragility, is caused by mutations in the genes for type I collagen. A recessive form of the disorder has long been suspected. Since the loss of cartilage-associated protein (CRTAP), which is required for post-translational prolyl 3-hydroxylation of collagen, causes severe osteoporosis in mice, we investigated whether CRTAP deficiency is associated with recessive osteogenesis imperfecta. Three of 10 children with lethal or severe osteogenesis imperfecta, who did not have a primary collagen defect yet had excess post-translational modification of collagen, were found to have a recessive condition resulting in …

The Shepherd’S Center Of Richmond: Opportunities For Meaning And Personal Growth Through Service, Linda Frank

Case Studies from Age in Action

Educational Objectives

1. To inform Virginians about The Shepherd’s Center of Richmond, a non-profit service organization by, with, and for older adults.

2. To demonstrate the impact of volunteer service as a means to finding a sense of meaning and purpose in later life.

Parish Nursing: A Vital Piece To The Puzzle Of Care For Older Adults, Donna B. Coffman

Case Studies from Age in Action

Educational Objectives

1. To generate awareness of the emerging practice of faith community/parish nursing and its implications for the overall improvement of health care.

2. To explore specific ways parish nursing can help meet the holistic health needs of older adults in local congregations

Elderfriends: Relieving Loneliness Among Elders, Kiersten Seeger Ware, Sarah Coble

Case Studies from Age in Action

Educational Objectives

1. To discuss social isolation among older adults.

2. To promote awareness of the ElderFriends program, an intervention newly established in greater Richmond

3. To seek friendly visitors for the ElderFriends program.

Brain Health: Mending The Mind After Age 50, Susan Hardwicke

Case Studies from Age in Action

Educational Objectives

1. Increase understanding of brain function and its potential to improve with age.

2. Describe an application of neuroscience, cognitive training, and nutrition for solving a problem associated with aging.

3. Evaluate neural plasticity with aging.

Barriers For Latino Immigrants Seeking Health Care Services, Jennier Ng'andu

2006 Latino Health Summit

At the time of the presentation Ms. Ng'andu was Health Policy Analyst, National Council of La Raza.

This presentation was part of a larger track "Immigrants, Refugees, Asylees and the Undocumented: Understanding Laws that Impact their Health and Well-Being"

From the brochure:

Participants will gain a better understanding of the various status types (e.g., immigrants, refugees) of Latinos residing in the United States and learn how these status types impact individual legal rights. Specific areas to be addressed include employment, bad debt and collections, domestic violence, human trafficking, access to culturally and linguistically appropriate health care services, and access to …

Brochure And Schedule Of Events, Latino Health Summit, Virginia Commonwealth University

2006 Latino Health Summit

Brochure and Schedule of Events, including abstracts for the Latino Health Summit, November 16-17, 2006

Nectin-2-Mediated Entry Of A Syncytial Strain Of Herpes Simplex Virus Via Ph-Independent Fusion With The Plasma Membrane Of Chinese Hamster Ovary Cells, Mark G. Delboy, Jennifer L. Patterson, Aimee M. Hollander, Anthony V. Nicola

Microbiology and Immunology Publications

Background

Herpes simplex virus (HSV) can utilize multiple pathways to enter host cells. The factors that determine which route is taken are not clear. Chinese hamster ovary (CHO) cells that express glycoprotein D (gD)-binding receptors are model cells that support a pH-dependent, endocytic entry pathway for all HSV strains tested to date. Fusion-from-without (FFWO) is the induction of target cell fusion by addition of intact virions to cell monolayers in the absence of viral protein expression. The receptor requirements for HSV-induced FFWO are not known. We used the syncytial HSV-1 strain ANG path as a tool to evaluate the complex …

Surgical Infection Society Guidelines For Vaccination After Traumatic Injury, Thomas R. Howdieshell, Daithi Heffernan, Joseph T. Dipiro

Publications from the Office of the Dean

Background: Recommendations for vaccination of injured patients against infection are evolving. Newly-recognized infections, safety considerations, changing epidemiology, and redefinition of patient groups at risk are factors that may influence vaccine development priorities and recommendations for immunization. However, recommendations must often be formulated based on incomplete data, forcing reliance on expert opinion to address some crucial questions. These guidelines provide evidence-based recommendations for the prevention or treatment of infectious morbidity and mortality after traumatic injury, such as soft tissue wounds, human or animal bites, or after splenectomy.

Methods: A panel of experts conducted a thorough review of published literature, …

Organic Anion And Cation Transporter Expression And Function During Embryonic Kidney Development And In Organ Culture Model Systems, Douglas H. Sweet, Satish A. Eraly, Kevin T. Bush, Sanjay K. Nigam

Pharmaceutics Publications

Background

Organic anion and cation transporters (OATs, OCTs and OCTNs) mediate the proximal tubular secretion of numerous clinically important compounds, including various commonly prescribed pharmaceuticals. Here, we examine the ontogeny of these transporters in rat embryonic kidney in detail, both in vivo and in two in vitro organ culture models of kidney development, whole embryonic kidney (WEK) culture and culture of induced metanephric mesenchyme (MM).

Methods

We used QPCR to determine expression levels of transporter genes in rat embryonic kidneys on each day of gestation from ed13 to ed18, in induced and un-induced MM, and on each day of one …

The Impact Of An Hematocrit Of 20% During Normothermic Cardiopulmonary Bypass For Elective Low Risk Coronary Artery Bypass Graft Surgery On Oxygen Delivery And Clinical Outcome – A Randomized Controlled Study [Isrctn35655335], Christian Von Heymann, Michael Sander, Achim Foer, Anja Heinemann, Bruce Spiess, Jan Braun, Michael Krämer, Joachim Grosse, Pascal Dohmen, Simon Dushe, Jürgen Halle, Wolfgang F. Konertz, Klaus-Dieter Warnecke, Claudia Spies

Anesthesiology Publications

Introduction

Cardiopulmonary bypass (CPB) induces hemodilutional anemia, which frequently requires the transfusion of blood products. The objective of this study was to evaluate oxygen delivery and consumption and clinical outcome in low risk patients who were allocated to an hematocrit (Hct) of 20% versus 25% during normothermic CPB for elective coronary artery bypass graft (CABG) surgery.

Methods

This study was a prospective, randomized and controlled trial. Patients were subjected to normothermic CPB (35 to 36°C) and were observed until discharge from the intensive care unit (ICU). Outcome measures were calculated whole body oxygen delivery, oxygen consumption and clinical outcome. A …

Virginia Dental Journal (Vol. 83, No. 4, 2006)

Virginia Dental Journal

No abstract provided.

Metro Richmond Latino Health Services & Resource Guide – 2006, Virginia Commonwealth University

2006 Latino Health Summit

This Guide was produced by the VCU Institute for Women’s Health, VCU Center on Health Disparities, and CLAS Act Virginia as a resource for the fall 2006 Latino Health Summit: Latino Cultures and Beliefs in Health Care. The purpose of this Guide is to provide a practical tool for community health care professionals to use in their work by assisting in cataloguing key provider and patient resources and services. The guide will be posted on the VCU Institute for Women’s Health and VCU Center on Health Disparities websites, which will be updated on a regular basis.

Survival Analysis Of Complete Veneer Crowns Vs. Multisurface Restorations: A Dental School Patient Population, Charles E. Janus, John W. Unger, Al M. Best

Prosthodontics Publications

The purpose of this study was to compare the longevity of crowns versus large multisurface restorations in posterior teeth. The investigation used the treatment database at Virginia Commonwealth University School of Dentistry. The inclusion criteria for the final data set used for analysis were: only one restored tooth per patient, premolars with three or more restored surfaces, molars with four or more restored surfaces, molars and premolars restored with complete veneer metal crowns, or crowns veneered with metal and porcelain. The Kaplan-Meier approach was used to visualize the survival curves, and the Cox proportional hazards model was used for analysis …

Empirical Validation Of The S-Score Algorithm In The Analysis Of Gene Expression Data, Richard Ellis Kennedy, Kellie J. Archer, Michael F. Miles

Biostatistics Publications

Background Current methods of analyzing Affymetrix GeneChip® microarray data require the estimation of probe set expression summaries, followed by application of statistical tests to determine which genes are differentially expressed. The S-Score algorithm described by Zhang and colleagues is an alternative method that allows tests of hypotheses directly from probe level data. It is based on an error model in which the detected signal is proportional to the probe pair signal for highly expressed genes, but approaches a background level (rather than 0) for genes with low levels of expression. This model is used to calculate relative change in probe …

Virginia Dental Journal (Vol. 83, No. 3, 2006)

Virginia Dental Journal

No abstract provided.