Medicine and Health Sciences Commons^™

Use Of Dried-Blood-Spot Samples And In-House Assays To Identify Antiretroviral Drug Resistance In Hiv-Infected Children In Resource-Constrained Settings, Carrie Ziemniak, Yohannes Mengistu, Andrea Ruff, Ya-Hui Chen, Leila Khaki, Abubaker Bedri, Birgitte B. Simen, Paul Palumbo

Dartmouth Scholarship

Monitoring HIV drug resistance is an important component of the World Health Organization's global HIV program. HIV drug resistance testing is optimal with commercially available clinically validated test kits using plasma; however, that type of testing may not be feasible or affordable in resource-constrained settings. HIV genotyping from dried blood spots (DBS) with noncommercial (in-house) assays may facilitate the capture of HIV drug resistance outcomes in resource-constrained settings but has had varying rates of success. With in-house assays for HIV reverse transcriptase, we evaluated the yield of genotyping DBS samples collected from HIV-infected children who were enrolled in two clinical …

Strain-Dependent Variation In The Early Transcriptional Response To Cns Injury Using A Cortical Explant System, David J. Graber, Brent T. Harris, William F. Hickey

Dartmouth Scholarship

While it is clear that inbred strains of mice have variations in immunological responsiveness, the influence of genetic background following tissue damage in the central nervous system is not fully understood. A cortical explant system was employed as a model for injury to determine whether the immediate transcriptional response to tissue resection revealed differences among three mouse strains. Immunological mRNAs were measured in cerebral cortex from SJL/J, C57BL/6J, and BALB/cJ mice using real time RT-PCR. Freshly isolated cortical tissue and cortical sections incubated in explant medium were examined. Levels of mRNA, normalized to β-actin, were compared using one way analysis …

Supplier-Induced Demand For Psychiatric Admissions In Northern New England, Bradley V. Watts, Brian Shiner, Gunnar Klauss, William B. Weeks

Dartmouth Scholarship

The development of hospital service areas (HSAs) using small area analysis has been useful in examining variation in medical and surgical care; however, the techniques of small area analysis are underdeveloped in understanding psychiatric admission rates. We sought to develop these techniques in order to understand the relationship between psychiatric bed supply and admission rates in Northern New England. Our primary hypotheses were that there would be substantial variation in psychiatric admission across geographic settings and that bed availability would be positively correlated with admission rates, reflecting a supplier-induced demand phenomenon. Our secondary hypothesis was that the construction of psychiatric …

Coordinated Regulation By Agra, Sara, And Sarr To Control Agr Expression In Staphylococcus Aureus, Dindo Reyes, Diego O. Andrey, Antoinette Monod, William L. Kelley, Gongyi Zhang, Ambrose L. Cheung

Dartmouth Scholarship

The agr locus of Staphylococcus aureus is composed of two divergent transcripts (RNAII and RNAIII) driven by the P2 and P3 promoters. The P2-P3 intergenic region comprises the SarA/SarR binding sites and the four AgrA boxes to which AgrA binds. We reported here the role of AgrA, SarA, and SarR on agr P2 and P3 transcription. Using real-time reverse transcription (RT)-PCR and promoter fusion studies with selected single, double, triple, and complemented mutants, we showed that AgrA is indispensable to agr P2 and P3 transcription, whereas SarA activates and SarR represses P2 transcription. In vitro runoff transcription assays revealed that …

Bioluminescent Imaging Reveals Divergent Viral Pathogenesis In Two Strains Of Stat1-Deficient Mice, And In Αßγ Interferon Receptor-Deficient Mice, Tracy Jo Pasieka, Lynne Collins, Megan A. O'Connor, Yufei Chen, Zachary M. Parker, Brent L. Berwin, David R. Piwnica-Worms, David A. Leib

Dartmouth Scholarship

Pivotal components of the IFN response to virus infection include the IFN receptors (IFNR), and the downstream factorsignal transducer and activator of transcription 1 (Stat1). Mice deficient for Stat1 and IFNR (Stat12/2 and IFNaßcR2/2 mice) lack responsiveness to IFN and exhibit high sensitivity to various pathogens. Here we examined herpes simplex virus type 1 (HSV-1) pathogenesis in Stat12/2 mice and in IFNaßcR2/2 mice following corneal infection and bioluminescent imaging. Two divergent and paradoxical patterns of infection were observed. Mice with an N-terminal deletion in Stat1 (129Stat12/2(N-term)) had transient infection of the liver and spleen, but succumbed to encephalitis by day …

Protoporphyrin Ix Fluorescence Contrast In Invasive Glioblastomas Is Linearly Correlated With Gd Enhanced Magnetic Resonance Image Contrast But Has Higher Diagnostic Accuracy, Kimberley S. Samkoe, Summer L. Gibbs-Strauss, Harold H. Yang, S. Khan Hekmatyar, P. Jack Hoopes, Julia A. O'Hara, Risto A. Kauppinen, Brian W. Pogue

Dartmouth Scholarship

The sensitivity and specificity of in vivo magnetic resonance (MR) imaging is compared with production of protoporphyrin IX (PpIX), determined ex vivo, in a diffusely infiltrating glioma. A human glioma transfected with green fluorescent protein, displaying diffuse, infiltrative growth, was implanted intracranially in athymic nude mice. Image contrast from corresponding regions of interest (ROIs) in in vivo MR and ex vivo fluorescence images was quantified. It was found that all tumor groups had statistically significant PpIX fluorescence contrast and that PpIX contrast demonstrated the best predictive power for tumor presence. Contrast from gadolinium enhanced T1-weighted (T1W+Gd) and absolute T2 …

Estimating Water Supply Arsenic Levels In The New England Bladder Cancer Study, John R. Nuckols, Laura E. Beane-Freeman, Jay H. Lubin, Matthew S. Airola, Dalsu Baris, Joseph D. Ayotte, Anne Taylor, Chris Paulu, Margaret R. Karagas, Joanne Colt

Dartmouth Scholarship

Background: Ingestion of inorganic arsenic in drinking water is recognized as a cause of bladder cancer when levels are relatively high (≥ 150 µg/L). The epidemiologic evidence is less clear at the low-to-moderate concentrations typically observed in the United States. Accurate retrospective exposure assessment over a long time period is a major challenge in conducting epidemiologic studies of environmental factors and diseases with long latency, such as cancer.

Objective: We estimated arsenic concentrations in the water supplies of 2,611 participants in a population-based case–control study in northern New England.

Methods: Estimates covered the lifetimes of most study participants and were …

Deletion Of Rb Accelerates Pancreatic Carcinogenesis By Oncogenic Kras And Impairs Senescence In Pre-Malignant Lesions, Catherine Carrière, A. Jesse Gore, Alixanna M. Norris, Jason R. Gunn, Alison Young, Daniel Longnecker, Murray Korc

Dartmouth Scholarship

Rb1 encodes a cell-cycle regulator that is functionally disrupted in most human cancers. Pancreatic ductal adenocarcinomas (PDACs) have a high frequency of mutations in KRAS and INK4A/CDKN2A that might allow cells to bypass the regulatory actions of retinoblastoma (RB). To determine the role of loss of RB function in PDAC progression, we investigated the effects of Rb disruption during pancreatic malignant transformation initiated by oncogenic Kras.We generated mice with pancreas-specific disruption of Rb, in the absence or presence of oncogenic Kras, to examine the role of RB in pancreatic carcinogenesis.

Step-Wise Loss Of Bacterial Flagellar Torsion Confers Progressive Phagocytic Evasion, Rustin R. Lovewell, Ryan M. Collins, Julie L. Acker, George A. O'Toole, Matthew J. Wargo, Brent Berwin, Craig R. Roy

Dartmouth Scholarship

Phagocytosis of bacteria by innate immune cells is a primary method of bacterial clearance during infection. However, the mechanisms by which the host cell recognizes bacteria and consequentially initiates phagocytosis are largely unclear. Previous studies of the bacterium Pseudomonas aeruginosa have indicated that bacterial flagella and flagellar motility play an important role in colonization of the host and, importantly, that loss of flagellar motility enables phagocytic evasion. Here we use molecular, cellular, and genetic methods to provide the first formal evidence that phagocytic cells recognize bacterial motility rather than flagella and initiate phagocytosis in response to this motility. We demonstrate …

Characterization Of Vibrio Cholerae O1 El Tor Biotype Variant Clinical Isolates From Bangladesh And Haiti, Including A Molecular Genetic Analysis Of Virulence Genes, Mike S. Son, Christina J. Megli, Gabriela Kovacikova, Firdausi Qadri, Ronald K. Taylor

Dartmouth Scholarship

Vibrio cholerae serogroup O1, the causative agent of the diarrheal disease cholera, is divided into two biotypes: classical and El Tor. Both biotypes produce the major virulence factors toxin-coregulated pilus (TCP) and cholera toxin (CT). Although possessing genotypic and phenotypic differences, El Tor biotype strains displaying classical biotype traits have been reported and subsequently were dubbed El Tor variants. Of particular interest are reports of El Tor variants that produce various levels of CT, including levels typical of classical biotype strains. Here, we report the characterization of 10 clinical isolates from the International Centre for Diarrhoeal Disease Research, Bangladesh, and …

Alpha-Defensins 1-3 Release By Dendritic Cells Is Reduced By Estrogen, Maria M. Escribese, Marta Rodríguez-García, Rhoda Sperling, Stephanie M. Engel

Dartmouth Scholarship

During pregnancy the immune system of the mother must protect any activation that may negatively affect the fetus. Changes in susceptibility to infection as well as resolution of some autoimmune disorders represent empirical evidence for pregnancy related alterations in immunity. Sex hormones reach extremely high levels during pregnancy and have been shown to have direct effects on many immune functions including the antiviral response of dendritic cells. Among the immunologically active proteins secreted by monocyte derived DCs (MDDC) are the alpha-defensins 1-3. This family of cationic antimicrobial peptides has a broad spectrum of microbicidal activity and has also been shown …

Adaptive Security And Privacy For Mhealth Sensing, Shrirang Mare, Jacob Sorber, Minho Shin, Cory Cornelius, David Kotz

Dartmouth Scholarship

As healthcare in many countries faces an aging population and rising costs, mobile Health (mHealth) sensing technologies promise a new opportunity. However, the privacy concerns associated with mHealth sensing are a limiting factor for their widespread adoption. The use of wireless body area networks pose a particular challenge. Although there exist protocols that provide a secure and private communication channel between two devices, the large transmission overhead associated with these protocols limit their application to low-power mHealth sensing devices. We propose an adaptive security model that enables use of privacy-preserving protocols in low-power mHealth sensing by reducing the network overhead …

Exposing Privacy Concerns In Mhealth, Aarathi Prasad, Jacob Sorber, Timothy Stablein, Denise Anthony, David Kotz

Dartmouth Scholarship

We conducted several exploratory focus groups to understand what privacy concerns Patients might have with the collection, storage and sharing of their personal health information, when using mHealth devices. We found that Patients want control over their health information, and we noticed privacy trends that were particular to Patients in the same age group and with similar health experiences.

Synergistic Combination Of Hyperoxygenation And Radiotherapy By Repeated Assessments Of Tumor Po2 With Epr Oximetry, Huagang Hou, Ruhong Dong, Jean P. Lariviere, Sriram P. Mupparaju, Harold M. Swartz, Nadeem Khan

Dartmouth Scholarship

The effect of hyperoxygenation with carbogen (95% O₂ + 5% CO₂) inhalation on RIF-1 tumor pO₂and its consequence on growth inhibition with fractionated radiotherapy is reported. The temporal changes in the tumor pO₂ were assessed by in vivo Electron Paramagnetic Resonance (EPR) oximetry in mice breathing 30% O₂ or carbogen and the tumors were irradiated with 4 Gy/day for 5 consecutive days; a protocol that emulates the clinical application of carbogen. The RIF-1 tumors were hypoxic with a tissue pO₂ of 5–9 mmHg. Carbogen (CB) breathing significantly increased tumor pO₂, …

Protection And Attachment Of Vibrio Cholerae Mediated By The Toxin-Coregulated Pilus In The Infant Mouse Model, Shelly J. Krebs, Ronald K. Taylor

Dartmouth Scholarship

Colonization of the human small intestine by Vibrio cholerae is an essential step in pathogenesis that requires the type IV toxin-coregulated pilus (TCP). To date, three functions of TCP have been characterized: it serves as the CTXΦ receptor, secretes the colonization factor TcpF, and functions in microcolony formation by mediating bacterium-bacterium interactions. Although type IV pili in other pathogenic bacteria have been characterized as playing a major role in attachment to epithelial cells, there are very few studies to suggest that TCP acts as an attachment factor. Taking this into consideration, we investigated the function of TCP in attachment to …

Assessing Medicare Beneficiaries’ Strength‐Of‐Preference Scores For Health Care Options: How Engaging Does The Elicitation Technique Need To Be?, Trafford Crump, Hilary A. Llewellyn-Thomas

Dartmouth Scholarship

The objective was to determine if participants’ strength‐of‐preference scores for elective health care interventions at the end‐of‐life (EOL) elicited using a non‐engaging technique are affected by their prior use of an engaging elicitation technique.

Systematic Analysis Of Diguanylate Cyclases That Promote Biofilm Formation By Pseudomonas Fluorescens Pf0-1, Peter D. Newell, Shiro Yoshioka, Kelli L. Hvorecny, Russell D. Monds, George A. O'Toole

Dartmouth Scholarship

Cyclic di-GMP (c-di-GMP) is a broadly conserved, intracellular second-messenger molecule that regulates biofilm formation by many bacteria. The synthesis of c-di-GMP is catalyzed by diguanylate cyclases (DGCs) containing the GGDEF domain, while its degradation is achieved through the phosphodiesterase activities of EAL and HD-GYP domains. c-di-GMP controls biofilm formation by Pseudomonas fluorescens Pf0-1 by promoting the cell surface localization of a large adhesive protein, LapA. LapA localization is regulated posttranslationally by a c-di-GMP effector system consisting of LapD and LapG, which senses cytoplasmic c-di-GMP and modifies the LapA protein in the outer membrane. Despite the apparent requirement for c-di-GMP for …

Genetic Determinants Of Uv-Susceptibility In Non-Melanoma Skin Cancer, Marleen M. Welsh, Margaret R. Karagas, Jacquelyn K. Kuriger, Andres Houseman, Steven K. Spencer, Ann E. Perry, Heather H. Nelson

Dartmouth Scholarship

A milieu of cytokines and signaling molecules are involved in the induction of UV-induced immune suppression and thus the etiology of non-melanoma skin cancer (NMSC). Targeting the UV-induced immunosuppression pathway, and using a large population based study of NMSC, we have investigated the risk associated with functional variants in 10 genes (IL10, IL4, IL4R, TNF, TNFR2, HTR2A, HRH2, IL12B, PTGS2, and HAL). The most prominent single genetic effect was observed for IL10. There was increasing risk for both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with …

Histone Modifications Influence Mediator Interactions With Chromatin, Xuefeng Zhu, Yongqiang Zhang, Gudrun Bjornsdottir, Zhongle Liu, Amy Quan, Michael Costanzo, Marcela Davila Lopez, Jakub Orzechowski Westholm, Hans Ronne, Charles Boone, Claes M. Gustafsson, Lawrence C. Myers

Dartmouth Scholarship

The Mediator complex transmits activation signals from DNA bound transcription factors to the core transcription machinery. Genome wide localization studies have demonstrated that Mediator occupancy not only correlates with high levels of transcription, but that the complex also is present at transcriptionally silenced locations. We provide evidence that Mediator localization is guided by an interaction with histone tails, and that this interaction is regulated by their post-translational modifications. A quantitative, high-density genetic interaction map revealed links between Mediator components and factors affecting chromatin structure, especially histone deacetylases. Peptide binding assays demonstrated that pure wild-type Mediator forms stable complexes with the …

Decision Quality Instrument For Treatment Of Hip And Knee Osteoarthritis: A Psychometric Evaluation, Karen R. Sepucha, Dawn Stacey, Catharine F. Clay, Yuchiao Chang

Dartmouth Scholarship

A high quality decision requires that patients who meet clinical criteria for surgery are informed about the options (including non-surgical alternatives) and receive treatments that match their goals. The aim of this study was to evaluate the psychometric properties and clinical sensibility of a patient self report instrument, to measure the quality of decisions about total joint replacement for knee or hip osteoarthritis.

Multilaboratory Evaluation Of Real-Time Pcr Tests For Hepatitis B Virus Dna Quantification, Angela M. Caliendo, Alexander Valsamakis, James W. Bremer, Andrea Ferreira-Gonzalez, Suzanne Granger, Linda Sabatini, Gregory J. Tsongalis

Dartmouth Scholarship

The performance characteristics of four different assays for hepatitis B virus (HBV) quantification were assessed: the Abbott RealTime HBV IUO, the Roche Cobas AmpliPrep/Cobas TaqMan HBV test, the Roche Cobas TaqMan HBV test with HighPure system, and the Qiagen artus HBV TM ASR. Limit of detection (LOD), linear range, reproducibility, and agreement were determined using a serially diluted plasma sample from a single chronically infected subject. Each assay was tested by at least three laboratories. The LOD of the RealTime and two TaqMan assays was approximately 1.0 log₁₀ IU/ml; for artus HBV (which used the lowest volume of extracted …

Recognizing Whether Sensors Are On The Same Body, Cory Cornelius, David Kotz

Dartmouth Scholarship

As personal health sensors become ubiquitous, we also expect them to become interoperable. That is, instead of closed, end-to-end personal health sensing systems, we envision standardized sensors wirelessly communicating their data to a device many people already carry today, the cellphone. In an open personal health sensing system, users will be able to seamlessly pair off-the-shelf sensors with their cellphone and expect the system to ıt just work. However, this ubiquity of sensors creates the potential for users to accidentally wear sensors that are not necessarily paired with their own cellphone. A husband, for example, might mistakenly wear a heart-rate …

Remote Positioning Optical Breast Magnetic Resonance Coil For Slice-Selection During Image-Guided Near-Infrared Spectroscopy Of Breast Cancer, Michael A. Mastanduno, Shudong Jiang, Brian W. Pogue, Keith D. Paulsen, Roberta Diflorio-Alexander

Dartmouth Scholarship

The design and testing of a pneumatic optical positioning interface produced with the goal of improving fiber positioning in magnetic resonance (MR)-guided diffuse spectral imaging of breast cancer is presented. The system was created for vertical positioning of optical fibers inside the MR bore during a patient exam to target suspicious lesions with MR scans for reference and collect multiple planes of optical data. The interface includes new fiber plates for mechanical and optical coupling to the breast, and was tested in phantoms and human imaging. Reconstructions with data taken in the new interface show acceptable linearity over different absorber …

Mediator Influences Telomeric Silencing And Cellular Life Span, Xuefeng Zhu, Beidong Liu, Jonas O. P. Carlsten, Jenny Beve, Thomas Nyström, Lawrence C. Myers, Claes M. Gustafsson

Dartmouth Scholarship

The Mediator complex is required for the regulated transcription of nearly all RNA polymerase II-dependent genes. Here we demonstrate a new role for Mediator which appears to be separate from its function as a transcriptional coactivator. Mediator associates directly with heterochromatin at telomeres and influences the exact boundary between active and inactive chromatin. Loss of the Mediator Med5 subunit or mutations in Med7 cause a depletion of the complex from regions located near subtelomeric X elements, which leads to a change in the balance between the Sir2 and Sas2 proteins. These changes in turn result in increased levels of H4K16 …

Variations In Mre11/Rad50/Nbs1 Status And Dna Damage-Induced S-Phase Arrest In The Cell Lines Of The Nci60 Panel, Kristen M. K. Garner, Alan Eastman

Dartmouth Scholarship

The Mre11/Rad50/Nbs1 (MRN) complex is a regulator of cell cycle checkpoints and DNA repair. Defects in MRN can lead to defective S-phase arrest when cells are damaged. Such defects may elicit sensitivity to selected drugs providing a chemical synthetic lethal interaction that could be used to target therapy to tumors with these defects. The goal of this study was to identify these defects in the NCI60 panel of cell lines and identify compounds that might elicit selective cytotoxicity.

Oral Ingestion Of Hexavalent Chromium Through Drinking Water And Cancer Mortality In An Industrial Area Of Greece - An Ecological Study, Athena Linos, Athanassios Petralias, Costas A. Christophi, Eleni Christoforidou, Paraskevi Kouroutou, Melina Stoltidis, Afroditi Veloudaki, Evangelia Tzala, Konstantinos C. Makris, Margaret R. Karagas

Dartmouth Scholarship

Background: Hexavalent chromium is a known carcinogen when inhaled, but its carcinogenic potential when orally ingested remains controversial. Water contaminated with hexavalent chromium is a worldwide problem, making this a question of significant public health importance.

Methods: We conducted an ecological mortality study within the Oinofita region of Greece, where water has been contaminated with hexavalent chromium. We calculated gender, age, and period standardized mortality ratios (SMRs) for all deaths, cancer deaths, and specific cancer types of Oinofita residents over an 11-year period (1999 - 2009), using the greater prefecture of Voiotia as the standard population.

Results: A total of …

Nrt1 And Tna1-Independent Export Of Nad+ Precursor Vitamins Promotes Nad+ Homeostasis And Allows Engineering Of Vitamin Production, Peter Belenky, Rebecca Stebbins, Katrina L. Bogan, Charles R. Evans, Charles Brenner

Dartmouth Scholarship

NAD⁺ is both a co-enzyme for hydride transfer enzymes and a substrate of sirtuins and other NAD⁺ consuming enzymes. NAD⁺ biosynthesis is required for two different regimens that extend lifespan in yeast. NAD⁺ is synthesized from tryptophan and the three vitamin precursors of NAD⁺: nicotinic acid, nicotinamide and nicotinamide riboside. Supplementation of yeast cells with NAD⁺ precursors increases intracellular NAD⁺ levels and extends replicative lifespan. Here we show that both nicotinamide riboside and nicotinic acid are not only vitamins but are also exported metabolites. We found that the deletion of the nicotinamide …

Direct, Physically-Motivated Derivation Of The Contagion Condition For Spreading Processes On Generalized Random Networks, Peter Sheridan Dodds, Kameron Decker Harris, Joshua L. Payne

Dartmouth Scholarship

For a broad range of single-seed contagion processes acting on generalized random networks, we derive a unifying analytic expression for the possibility of global spreading events in a straightforward, physically intuitive fashion. Our reasoning lays bare a direct mechanical understanding of an archetypal spreading phenomena that is not evident in circuitous extant mathematical approaches.

An Evaluation Of The Emerging Interventions Against Respiratory Syncytial Virus (Rsv)-Associated Acute Lower Respiratory Infections In Children, Harish Nair, Vasundhara R. Verma, Evropi Theodoratou, Lina Zgaga, Tanvir Huda, Eric Af Simoes, Peter F. Wright, Igor Rudan, Harry Campbell

Dartmouth Scholarship

Background: Respiratory Syncytial Virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in children. It is estimated to cause approximately 33.8 million new episodes of ALRI in children annually, 96% of these occurring in developing countries. It is also estimated to result in about 53,000 to 199,000 deaths annually in young children. Currently there are several vaccine and immunoprophylaxis candidates against RSV in the developmental phase targeting active and passive immunization.

Methods: We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed …

Autoimmune Melanocyte Destruction Is Required For Robust Cd8+ Memory T Cell Responses To Mouse Melanoma, Katelyn T. Byrne, Anik L. Côté, Peisheng Zhang, Shannon M. Steinberg, Yanxia Guo, Rameeza Allie, Weijun Zhang, Marc S. Ernstoff, Edward J. Usherwood, Mary Jo Turk

Dartmouth Scholarship

A link between autoimmunity and improved antitumor immunity has long been recognized, although the exact mechanistic relationship between these two phenomena remains unclear. In the present study we have found that vitiligo, the autoimmune destruction of melanocytes, generates self antigen required for mounting persistent and protective memory CD8⁺ T cell responses to melanoma. Vitiligo developed in approximately 60% of mice that were depleted of regulatory CD4⁺ T cells and then subjected to surgical excision of large established B16 melanomas. Mice with vitiligo generated 10-fold larger populations of CD8⁺ memory T cells specific for shared melanoma/melanocyte antigens. CD8 …