Medicine and Health Sciences Commons^™

Mental Health Problems Of The Youngest Generation Of American Veterans (Problemy Zdrowia Psychicznego Najmłodszego Pokolenia Weteranów Amerykańskich), Jaroslaw Richard Romaniuk

Faculty Scholarship

Wartime activities determine the threats to a soldier’s life and health. To prepare soldiers for a new forms of warfare, one should know the challenges the soldier faces in the midst of battle and after returning home. From 2001 to 2015, 1.2 million American soldiers returning from Iraq and Afghanistan used the health care services of the Department of Veterans’ Affairs. An analysis of the resulting medical interventions makes possible a long term evaluation of the effects of war, some of which appear only after the soldier returns to civilian life. This study analyzes the research on the mental health …

The Use Of Videoconferencing For Qualitative Interviewing: Opportunities, Challenges, And Considerations, Elliane Irani

Faculty Scholarship

No abstract provided.

Adenosine Signaling Through A1 Receptors Inhibits Chemosensitive Neurons In The Retrotrapezoid Nucleus, S. D. James, V. E. Hawkins, B. Falquetto, D. N. Ruskin, S. A. Masino, T. S. Moreira, M. L. Olsen, D. K. Mulkey

Faculty Scholarship

© 2018 James et al. A subset of neurons in the retrotrapezoid nucleus (RTN) function as respiratory chemoreceptors by regulating depth and frequency of breathing in response to changes in tissue CO 2 /H + . The activity of chemosensitive RTN neurons is also subject to modulation by CO 2 /H + -dependent purinergic signaling. However, mechanisms contributing to purinergic regulation of RTN chemoreceptors are not entirely clear. Recent evidence suggests adenosine inhibits RTN chemoreception in vivo by activation of A1 receptors. The goal of this study was to characterize effects of adenosine on chemosensitive RTN neurons and identify intrinsic …

Ultrastructural Changes In Peripheral Blood Leukocytes In Α-Synuclein Knockout Mice, Hammad Tashkandi, Afshin Shameli, Clifford V. Harding, Robert W. Maitta

Faculty Scholarship

Effects of α-synuclein deficiency on cellular blood components have not been extensively investigated. This study evaluated ultrastructural changes of leukocytes in α-synuclein knockout (KO) mice using electron microscopy (EM). The following ultrastructural characteristics were quantified in leukocytes: mitochondria, primary granules, specific granules (SG), Golgi apparatus (GA), inclusions, rough-endoplasmic reticulum (RER), smooth-endoplasmic reticulum (SER), and cellular projections (CP). EM showed increased numbers or amounts of SG, inclusions, and SER in KO group (5.3 ± 4.5 in WT vs. 14.1 ± 10.3 in KO, p = 0.02; 0.4 ± 0.9 in WT vs. 3.2 ± 2.8 in KO, p = 0.007; and …

Patient Safety And The Ageing Physician: A Qualitative Study Of Key Stakeholder Attitudes And Experiences, Andrew A. White, William M. Sage, Paulina H. Osinska, Monica J. Salgaonkar, Thomas H. Gallagher

Faculty Scholarship

Background Unprecedented numbers of physicians are practicing past age 65. Unlike other safety-conscious industries, such as aviation, medicine lacks robust systems to ensure late-career physician (LCP) competence while promoting career longevity.

Objective To describe the attitudes of key stakeholders about the oversight of LCPs and principles that might shape policy development.

Design Thematic content analysis of interviews and focus groups.

Participants 40 representatives of stakeholder groups including state medical board leaders, institutional chief medical officers, senior physicians (>65 years old), patient advocates (patients or family members in advocacy roles), nurses and junior physicians. Participants represented a balanced sample from …

Ketogenic Diet Modulates Nad+-Dependent Enzymes And Reduces Dna Damage In Hippocampus, Marwa Elamin, David N. Ruskin, Susan A. Masino, Paola Sacchetti

Faculty Scholarship

© 2018 Elamin, Ruskin, Masino and Sacchetti. The ketogenic diet’s (KD) anti-seizure effects have long been documented. Recently, its therapeutic potential in multiple neurodegenerative and neurodevelopmental disorders has emerged. Yet experimental evidence for a fundamental mechanism underlying beneficial effects across numerous diseases remains lacking. We previously showed that feeding rats a KD produced an early (within 2 days) and persistent elevation of hippocampal nicotinamide adenine dinucleotide+ (NAD+), an essential metabolic coenzyme and signaling molecule. NAD+ is a marker of cellular health and a substrate for enzymes implicated in longevity and DNA damage repair such as sirtuins and poly-ADP ribose polymerase-1 …

Multidomain Architecture Of Estrogen Receptor Reveals Interfacial Cross-Talk Between Its Dna-Binding And Ligand-Binding Domains, Wei Huang, Yi Peng, Janna G. Kiselar, Xuan Zhao, Aljawharah Albaqami, Daniel Mendez, Yinghua Chen, Hung-Ying Kao, Mark R. Chance, Sichun Yang

Faculty Scholarship

Human estrogen receptor alpha (hERα) is a hormone-responsive nuclear receptor (NR) involved in cell growth and survival that contains both a DNA-binding domain (DBD) and a ligand-binding domain (LBD). Functionally relevant inter-domain interactions between the DBD and LBD have been observed in several other NRs, but for hERα, the detailed structural architecture of the complex is unknown. By utilizing integrated complementary techniques of small-angle X-ray scattering, hydroxyl radical protein footprinting and computational modeling, here we report an asymmetric L-shaped “boot” structure of the multidomain hERα and identify the specific sites on each domain at the domain interface involved in DBD–LBD …

Influence Of Built Environment And Social Capital On Mental Health Of Residents Of Assisted Living Communities In Louisville, Ky., Sarah E. Walsh, A. Scott Lajoie

Faculty Scholarship

Objectives: Prior research has shown social capital and built environment quality are associated with overall health status and the incidence of mental illness. This study explores the relationship between social capital, built environment, and quality of life specifically for assisted living residents, currently a gap in the literature. Method: A total of 76 assisted living residents were interviewed for the study using researcher-administered questionnaires. In addition, site audits were conducted to quantitatively evaluate the built environment surrounding 12 assisted living communities in the Louisville Metro region. Results: There was a moderate, positive correlation between social capital and mental health, r …

Α-Synuclein Concentration Increases Over Time In Plasma Supernatant Of Single Donor Platelets, Catherine M. Stefaniuk, Clifford V. Harding, Robert W. Maitta

Faculty Scholarship

OBJECTIVES: In platelets, α-synuclein is important in calcium-dependent granule release. Notably, cells release α-synuclein in setting of cell damage or death. Therefore, we investigated α-synuclein levels in plasma of single donor platelet (SDP) units during storage. METHODS: Aliquots were obtained from same SDP units for 7 days from day of donation. Additionally, randomly sampled SDP units at same storage time points were also assayed by enzyme-linked immunosorbent assay. RESULTS: α-Synuclein in SDP plasma increased continuously over time at each assayed time point. Significant increases were measured on day 3 (11.7 ± 9.6 ng/mL, P = 0.025), day 5 (15.3 ± …

How Home Health Nurses Plan Their Work Schedules: A Qualitative Descriptive Study, Elliane Irani

Faculty Scholarship

Aims and objectives: To describe how home health nurses plan their daily work schedules and what challenges they face during the planning process. Background: Home health nurses are viewed as independent providers and value the nature of their work because of the flexibility and autonomy they hold in developing their work schedules. However, there is limited empirical evidence about how home health nurses plan their work schedules, including the factors they consider during the process and the challenges they face within the dynamic home health setting. Design: Qualitative descriptive design. Methods: Semi-structured interviews were conducted with 20 registered nurses who …

Global Phosphoproteomics Of Ccr5-Tropic Hiv-1 Signaling Reveals Reprogramming Of Cellular Protein Production Pathways And Identifies P70-S6k1 And Mk2 As Hiv-Responsive Kinases Required For Optimal Infection Of Cd4+ T Cells, Danica D. Wiredja, Caroline O. Tabler, Daniela M. Schlatzer, Ming Li, Mark R. Chance, John C. Tilton

Faculty Scholarship

Background: Viral reprogramming of host cells enhances replication and is initiated by viral interaction with the cell surface. Upon human immunodeficiency virus (HIV) binding to CD4+ T cells, a signal transduction cascade is initiated that reorganizes the actin cytoskeleton, activates transcription factors, and alters mRNA splicing pathways. Methods: We used a quantitative mass spectrometry-based phosphoproteomic approach to investigate signal transduction cascades initiated by CCR5-tropic HIV, which accounts for virtually all transmitted viruses and the vast majority of viruses worldwide. Results: CCR5-HIV signaling induced significant reprogramming of the actin cytoskeleton and mRNA splicing pathways, as previously described. In addition, CCR5-HIV signaling …

Perspectives And Best Practices For Artificial Intelligence And Continuously Learning Systems In Healthcare, Berkman Sahiner, Bruce Friedman, Cindi Linville, Cindy Ipach, Edna Montgomery, Eileen Steinle Alexander, Et Al.

Faculty Scholarship

Goals of this paper Healthcare is often a late adopter when it comes to new techniques and technologies; this works to our advantage in the development of this paper as we relied on lessons learned from CLS in other industries to help guide the content of this paper. Appendix V includes a number of example use cases of AI in Healthcare and other industries. This paper focuses on identifying unique attributes, constraints and potential best practices towards what might represent “good” development for Continuously Learning Systems (CLS) AI systems with applications ranging from pharmaceutical applications for new drug development and …

Trends Of Child Undernutrition In Rural Ecuadorian Communities With Differential Access To Roads, 2004–2013, Velma K. Lopez, Carolyn Dombecki, James Trostle, Patricia Mogrovejo, Nancy Castro Morillo, William Cevallos, Jason Goldstick, Andrew D. Jones, Joseph N.S. Eisenberg

Faculty Scholarship

© 2018 John Wiley & Sons Ltd Road access can influence protective and risk factors associated with nutrition by affecting various social and biological processes. In northern coastal Ecuador, the construction of new roads created a remoteness gradient among villages, providing a unique opportunity to examine the impact of roads on child nutritional outcomes 10 years after the road was built. Anthropometric and haemoglobin measurements were collected from 2,350 children Esmeraldas, Ecuador, from 2004 to 2013 across 28 villages with differing road access. Logistic generalized estimating equation models assessed the longitudinal association between village remoteness and prevalence of stunting, wasting, …

Alternative Financial Services As A Social Determinant Of Health In U.S. Metropolitan Statistical Areas, Courtney Hundley, Richard W. Wilson, John Chenault

Faculty Scholarship

Alternative financial services (AFS) such as payday lenders, pawn brokers, tax refund loans, and check cashers are more prevalent in minority and lower income neighborhoods. These are neighborhoods also found to have disparities in health, compared to more affluent neighborhoods and communities. The focus of this paper is to determine if any relationship exists between use of AFS and health disparities. Using data from a survey performed by the Federal Deposit Insurance Corporation (FDIC), we compared four banking variables to several measures of health for 85 metropolitan statistical areas (MSA) across the nation. The four banking variables all related to …

Biomimetic Post-Capillary Venule Expansions For Leukocyte Adhesion Studies, Bryan L. Benson, Lucy Li, Jay T. Myers, R. Dixon Dorand, Umut A. Gurkan, Alex Y. Huang

Faculty Scholarship

Leukocyte adhesion and extravasation are maximal near the transition from capillary to post-capillary venule, and are strongly influenced by a confluence of scale-dependent physical effects. Mimicking the scale of physiological vessels using in vitro microfluidic systems allows the capture of these effects on leukocyte adhesion assays, but imposes practical limits on reproducibility and reliable quantification. Here we present a microfluidic platform that provides multiple (54–512) technical replicates within a 15-minute sample collection time, coupled with an automated computer vision analysis pipeline that captures leukocyte adhesion probabilities as a function of shear and extensional stresses. We report that in post-capillary channels …

Prospective Memory In Clinical Populations [Post-Print], Sarah Raskin

Faculty Scholarship

Objective: Prospective memory (PM) has emerged as a form of episodic memory that is frequently impaired in a variety of clinical populations. Neuropsychologists who routinely evaluate these populations are often unaware of the possibility of PM deficits or the impact these deficits may have on everyday functioning. The objective of this special issue is to provide an overview of the nature of prospective deficits in a range of clinical populations, to discuss neuropsychological assessment techniques, and to critically evaluate management strategies. Method: We solicited papers from established researchers and issued a general call for papers for the special …

Home Health Nurse Decision-Making Regarding Visit Intensity Planning For Newly Admitted Patients: A Qualitative Descriptive Study, Elliane Irani

Faculty Scholarship

Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency’s protocols to develop the personalized visit plan. They revised the plan based on changes in the patient’s clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients.

Research Support Infrastructure: Implementing A Clinical Research Coordinating Center, Julio A. Ramirez, Paula Peyrani, William A. Mattingly, Forest W. Arnold, Timothy L. Wiemken, Robert R. Kelley, Leslie A. Wolf, Ruth M. Carrico, Andrea Reyes-Vega

Faculty Scholarship

Insufficient infrastructure is one of the challenges facing investigators in the field of clinical research. At the University of Louisville (UofL) Division of Infectious Diseases, we developed a multidisciplinary coordinating center with the aim to support investigators in all aspects of the clinical research process. The objective of this article is to describe the composition and the role of the different units of the UofL Clinical Research Coordinating Center. The different components of the Center can serve as a template for institutions interested in developing a clinical research support infrastructure.

The Role Of Mobile Genetic Elements In The Spread Of Antimicrobial-Resistant Escherichia Coli From Chickens To Humans In Small-Scale Production Poultry Operations In Rural Ecuador, Kara A. Moser, Lixin Zhang, Ian Spicknall, Nikolay P. Braykov, Karen Levy, Carl F. Marrs, Betsy Foxman, Gabriel Trueba, William Cevallos, Jason Goldstick, James Trostle, Joseph N.S. Eisenberg

Faculty Scholarship

© The Author(s) 2018. Small-scale production poultry operations are increasingly common worldwide. To investigate how these operations influence antimicrobial resistance and mobile genetic elements (MGEs), Escherichia coli isolates were sampled from small-scale production birds (raised in confined spaces with antibiotics in feed), household birds (no movement constraints; fed on scraps), and humans associated with these birds in rural Ecuador (2010-2012). Isolates were screened for genes associated with MGEs as well as phenotypic resistance to 12 antibiotics. Isolates from small-scale production birds had significantly elevated odds of resistance to 7 antibiotics and presence of MGE genes compared with household birds (adjusted …

Caffeine Consumption Disrupts Hippocampal Long-Term Potentiation In Freely Behaving Rats., J Harry Blaise, Jee Eun Park, Nicholas J Bellas, Thomas M Gitchell, Vy Phan

Faculty Scholarship

Caffeine, one of the most commonly consumed psychoactive substances in the world, has long been known to alter neurological functions, such as alertness, attention, and memory. Despite caffeine's popularity, systematic investigations of its effects on synaptic plasticity in the brain are still lacking. Here we used a freely behaving rodent model of long-term potentiation (LTP), a frequently studied form of synaptic plasticity, to assess the effects of caffeine consumption on hippocampal plasticity. LTP, which is a persistent increase in the strength of synaptic connections between neurons, is a cellular mechanism widely considered to underlie the processes of learning and memory. …

Factor Xii And Upar Upregulate Neutrophil Functions To Influence Wound Healing, Evi X. Stavrou, Chao Fang, Kara L. Bane, Erdem Kucukal, Agharnan Gandhi, Adina Brett-Morris, Michele M. Mumaw, Alona Merkulova, Cindy C. Reynolds, Omar Alhalabi, Lalitha Nayak, Wen-Mei Yu, Cheng-Kui Qu, Howard J. Meyerson, George R. Dubyak, Umut A. Gurkan, Marvin T. Nieman, Anirban Sen Gupta, Alvin H. Schmaier

Faculty Scholarship

Coagulation factor XII (FXII) deficiency is associated with decreased neutrophil migration, but the mechanisms remain uncharacterized. Here, we examine how FXII contributes to the inflammatory response. In 2 models of sterile inflammation, FXII-deficient mice (F12–/–) had fewer neutrophils recruited than WT mice. We discovered that neutrophils produced a pool of FXII that is functionally distinct from hepatic-derived FXII and contributes to neutrophil trafficking at sites of inflammation. FXII signals in neutrophils through urokinase plasminogen activator receptor–mediated (uPAR-mediated) Akt2 phosphorylation at S474 (pAktS474). Downstream of pAkt2S474, FXII stimulation of neutrophils upregulated surface expression of αMβ2 integrin, increased intracellular calcium, and promoted …

Understanding Diabetes-Related Distress Characteristics And Psychosocial Support Preferences Of Urban African American Adults Living With Type 2 Diabetes: A Mixed-Methods Study, Sula Marie Hood, Amy Irby-Shasanmi, Mary De Groot, Elissabeth Martin, Andrew S. Lajoie

Faculty Scholarship

Purpose

Methods

A Mixed Methods Study Of Symptom Perception In Patients With Chronic Heart Failure, Elliane Irani

Faculty Scholarship

Background: Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF. Methods: We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months. Results: In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In …

If We Pay Football Players, Why Not Kidney Donors, Philip J. Cook, Kimberly D. Krawiec

Faculty Scholarship

Ethicists who oppose compensating kidney donors claim they do so because kidney donation is risky for the donor’s health, donors may not appreciate the risks and may be cognitively biased in other ways, and donors may come from disadvantaged groups and thus could be exploited. However, few ethical qualms are raised about professional football players, who face much greater health risks than kidney donors, have much less counseling and screening concerning that risk, and who often come from racial and economic groups deemed disadvantaged. It thus seems that either ethicists—and the law—should ban both professional football and compensated organ donation, …

Trauma, Depression, And Burnout In The Human Rights Field: Identifying Barriers And Pathways To Resilient Advocacy, Sarah Knuckey, Margaret Satterthwaite, Adam Brown

Faculty Scholarship

Human rights advocates often confront trauma and stress in their work. They are exposed to testimony about heinous abuses; work in insecure locations; visit physical sites of abuse; review forensic, photographic, and video evidence; directly witness abuses; experience threats; and can also suffer detention, be attacked, or be tortured themselves. Such exposure risks adversely impacting the wellbeing and mental health of advocates. While the human rights field is diverse and work varies widely, most – if not all – advocates are likely directly or indirectly exposed to potentially traumatic events or material in the course of their work. The degree …