Medicine and Health Sciences Commons^™

Immature Platelet Dynamics In Immune-Mediated Thrombocytopenic States, Hollie M. Reeves, Robert W. Maitta

Faculty Scholarship

A major challenge encountered by clinicians is differentiating presentations characterized by significant thrombocytopenia due to overlapping clinical symptoms and signs in the setting of ambiguous laboratory results. Immature platelets represent the youngest platelets that can be measured in peripheral blood by current hematology analyzers. These young platelets are larger, with higher RNA content recently released from the bone marrow. Thrombocytopenic presentations caused directly or indirectly by immune responses can lead to compensatory bone marrow responses seeking to normalize the platelet count; thus obtaining absolute immature platelet counts may be informative while triaging patients. Over the last decade, their use has …

A One Health Framework To Estimate The Cost Of Antimicrobial Resistance, Chantal Morel, Richard Alm, Christine Årdal, Alessandra Bandera, Giacomo Bruno, Elena Carrara, Giorgio Colombo, Marlieke De Kraker, Sabiha Essack, Isabel Frost, Bruno Gonzalez-Zorn, Herman Goossens, Luca Guardabassi, Stephan Harbarth, Peter Jørgensen, Souha Kanj, Tomislav Kostyanev, Ramanan Laxminarayan, Finola Leonard, Gabriel Levy Hara, Marc Mendelson, Malgorzata Mikulska, Nico Mutters, Kevin Outterson, Jesus Rodriguez Baňo, Evelina Tacconelli, Luigia Scudeller

Faculty Scholarship

Objectives/purpose

The costs attributable to antimicrobial resistance (AMR) remain theoretical and largely unspecified. Current figures fail to capture the full health and economic burden caused by AMR across human, animal, and environmental health; historically many studies have considered only direct costs associated with human infection from a hospital perspective, primarily from high-income countries. The Global Antimicrobial Resistance Platform for ONE-Burden Estimates (GAP-ON€) network has developed a framework to help guide AMR costing exercises in any part of the world as a first step towards more comprehensive analyses for comparing AMR interventions at the local level as well as more harmonized …

Resilience, Moral Distress, And Workplace Engagement In Emergency Department Nurses, Paul Clark, Timothy Crawford, Brandonn Hulse, Barbara Polivka

Faculty Scholarship

This cross-sectional, correlational study’s purpose was to evaluate the effects of resilience and moral distress on workplace engagement in emergency department nurses providing direct patient care. Data were collected from 175 emergency department nurses using a Web-based survey. The higher the nurses’ resilience and the lower their moral distress, the greater their workplace engagement. Resilience and moral distress were not correlated; furthermore, moral distress did not mediate a relationship between resilience and workplace engagement. Resilience was higher with greater job satisfaction, increased age, and longer tenure as a nurse. Workplace engagement increased with higher job satisfaction and less time seeking …

Red Blood Cell Adhesion To Icam-1 Is Mediated By Fibrinogen And Is Associated With Right-To-Left Shunts In Sickle Cell Disease, Erdem Kucukal, Yuncheng Man, Erina Quinn, Neil Tewari, Ran An, Jane A. Little, Umut A. Gurkan

Faculty Scholarship

Sickle cell disease (SCD), which afflicts 100 000 Americans, as well as millions worldwide, is associated with anemia, lifelong morbidity, and early mortality. Abnormal adhesion of sickle red blood cells (RBCs) to activated vascular endothelium may contribute acutely to the initiation of painful vaso-occlusive crises and chronically to endothelial damage in SCD. Sickle RBCs adhere to activated endothelium through several adhesion mechanisms. In this study, using whole blood from 17 people with heterozygous SCD (HbS variant) and 55 people with homozygous SCD (HbSS) analyzed in an in vitro microfluidic assay, we present evidence for the adhesion of sickle RBCs to …

Whole Blood Viscosity And Red Blood Cell Adhesion: Potential Biomarkers For Targeted And Curative Therapies In Sickle Cell Disease, Erdem Kucukal, Yuncheng Man, Ailis Hill, Shichen Liu, Allison Bode, Ran An, Jaikrishnan Kadambi, Jane A. Little, Umut A. Gurkan

Faculty Scholarship

Sickle cell disease (SCD) is a recessive genetic blood disorder exhibiting abnormal blood rheology. Polymerization of sickle hemoglobin, due to a point mutation in the β-globin gene of hemoglobin, results in aberrantly adhesive and stiff red blood cells (RBCs). Hemolysis, abnormal RBC adhesion, and abnormal blood rheology together impair endothelial health in people with SCD, which leads to cumulative systemic complications. Here, we describe a microfluidic assay combined with a micro particle image velocimetry technique for the integrated in vitro assessment of whole blood viscosity (WBV) and RBC adhesion. We examined WBV and RBC adhesion to laminin (LN) in microscale …

Inflammatory Pathway Analytes Predicting Rapid Cognitive Decline In Mci Stage Of Alzheimer’S Disease, Jagan A. Pillai, Gurkan Bebek, Lynn M. Bekris, Aaron Bonner-Jackson, Stephen M. Rao, Mark R. Chance, James B. Leverenz

Faculty Scholarship

Objective: To determine the inflammatory analytes that predict clinical progression and evaluate their performance against biomarkers of neurodegeneration. Methods: A longitudinal study of MCI-AD patients in a Discovery cohort over 15 months, with replication in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) MCI cohort over 36 months. Fifty-three inflammatory analytes were measured in the CSF and plasma with a RBM multiplex analyte platform. Inflammatory analytes that predict clinical progression on Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB) and Mini Mental State Exam scores were assessed in multivariate regression models. To provide context, key analyte results in ADNI were compared against biomarkers …

The Role Of Social Work In Health Care For Veterans In The United States Of America (Praca Socjalna W Lecznictwie Weteranów Służby Wojskowej W Usa), Jaroslaw Richard Romaniuk

Faculty Scholarship

Clinical social work in the American system of health care and its specific features in the Veterans Affairs (VA) of veterans are described in this paper. VA hospitals are the largest employers of social work worldwide. Because health care for veterans is paid for from government funds, VA hospitals are subject to regulations developed on the basis of research into the system’s effectiveness and efficiency. Clinical social workers cooperate with physicians and nurses to comprise an integral part of the health care team. Social workers fulfill the usual tasks related to social well‑being but also act as health educators and …

L’Utilizzo Del Tourniquet Nelle Emorragie Da Trauma In Ambito Civile: Una Revisione Narrativa Della Letteratura (Tourniquet In Traumatic Haemorrhage In Civilian Settings: A Narrative Literature Review), Celeste Marie Alfes

Faculty Scholarship

Introduzione: L’emorragia arteriosa è una delle principali cause di morte in ambito civile e militare. Nonostante la pressione manual diretta del sito emorragico sia ancora lo standard di riferimento per il controllo del sanguinamento, l’applicazione precoce, in ambito extra-ospedaliero di tourniquet si è dimostrata capace di ridurre le morti con bassi rischi di complicanze. L’obiettivo dello studio è quello di sintetizzare i metodi di utilizzo, le condizioni dei pazienti, gli esiti e le complicazioni relative alle applicazioni del tourniquet. Materiali e Metodi: È stata condotta una revisione narrativa della letteratura tramite PubMed. Risultati: Dieci articoli inclusi hanno fornito informazioni su …

Proteins Inform Survival-Based Differences In Patients With Glioblastoma, L. C. Stetson, Daniela M. Schlatzer, Peter Liao, Karen Devine, Kristin Waite, Marta E. Couce, Andrew E. Sloan, Mark R. Chance, Jill S. Barnholtz-Sloan

Faculty Scholarship

Background: Improving the care of patients with glioblastoma (GB) requires accurate and reliable predictors of patient prognosis. Unfortunately, while protein markers are an effective readout of cellular function, proteomics has been underutilized in GB prognostic marker discovery. Methods: For this study, GB patients were prospectively recruited and proteomics discovery using liquid chromatography-mass spectrometry analysis (LC-MS/MS) was performed for 27 patients including 13 short-term survivors (STS) (≤10 months) and 14 long-term survivors (LTS) (≥18 months). Results: Proteomics discovery identified 11 941 peptides in 2495 unique proteins, with 469 proteins exhibiting significant dysregulation when comparing STS to LTS. We verified the differential …

The Elevated Systemic Cytokine Levels In Hiv Patients Are Not Associated With An Elevated Pulmonary Cytokine Environment., Rafael Fernandez-Botran, Andrea Reyes-Vega, Yasmany García, Chanakya Charan Tirumala, Praneet Kumar Srisailam, Anupama Raghuram, Paula Peyrani, Stephen P. Furmanek, Mahder A. Tella, Jeffrey D. Ritzenthaler, Jesse Roman, Julio A. Ramirez

Faculty Scholarship

Background

HIV-positive patients on anti-retroviral therapy (ART) are at higher risk of developing many non-AIDS related chronic diseases, including chronic obstructive pulmonary disease (COPD), compared to HIV-negative individuals. While the mechanisms are not clear, a persistent pro-inflammatory state appears to be a key contributing factor. The aims of this study were to investigate whether HIV-positive patients without COPD present evidence of potentially predisposing abnormal pulmonary cytokine/chemokine environment and to explore the relationship between pulmonary and systemic cytokine levels.

Methods

This study included 39 HIV-seropositive and 34 HIV-seronegative subjects without COPD. All were subjected to outpatient bronchoscopy with bronchoalveolar lavage fluid …

Systematic Review Of Technology-Based Interventions Targeting Chronically Ill Adults And Their Caregivers, Elliane Irani, Atsadaporn Niyomyart, Ronald L. Hickman Jr.

Faculty Scholarship

The purpose of this systematic review is to synthesize the study design features as well as the attributes and outcomes of technology-based health interventions targeting chronically ill adults and their family caregivers. Twenty papers representing 19 studies met the inclusion criteria. Various theoretical foundations or approaches guided the interventions in 11 studies. Interventions either aimed to support patient self-management and improve patient outcomes or enhance shared illness management and improve patient and caregiver outcomes. The interventions included educational, behavioral, and support components and were delivered using various technologies ranging from text messaging to using the Internet. Overall, patients and caregivers …

Older Adults Hospitalized For Pneumonia In The United States: Incidence, Epidemiology, And Outcomes., Forest W. Arnold, Andrea Reyes-Vega, Vidyulata Salunkhe, Stephen P. Furmanek, Christian Furman, Laura Morton, Anna Johan Faul, Pam Yankeelov, Julio A. Ramirez

Faculty Scholarship

OBJECTIVES: To define the current incidence, epidemiology, and mortality of older adult patients hospitalized with community-acquired pneumonia (CAP) in Louisville, KY and thus estimate the burden of CAP in the older adult population of the United States. To define risk factors associated with early and late outcomes. DESIGN: This was a secondary analysis of older adults (aged ≥65 years) from the University of Louisville Pneumonia Study, a prospective population-based cohort study of all hospitalized adults with CAP between June 1, 2014, and May 31, 2016. SETTING: The study took place in all nine acute care hospitals for adults in Louisville, …

The Enhanced Danger Of Physicians’ Off-Label Prescribing, Doriane Lambelet Coleman, Philip M. Rosoff

Faculty Scholarship

The COVID-19 pandemic represents a major challenge to both technologically advanced and resource-poor countries. There are currently no effective treatments for severe disease other than supportive care and advanced life support measures, including the use of mechanical ventilators. With the urgency and necessity bred from desperation, there have been many calls to utilize unproven therapies, such as hydroxychloroquine, for which little evidence of efficacy exists. We have previously argued that such off-label use, while legal, is problematic (and even dangerous) and have suggested several regulatory remedies that could protect patients and advance their interests while preserving the reasonable authority of …

Reconciling Environmental Justice With Climate Change Mitigation: A Case Study Of Nc Swine Cafos, D. Lee Miller, Ryke Longest

Faculty Scholarship

For thirty years, the swine industry has externalized severe environmental and health harms onto poor communities of color in Eastern North Carolina. This “Big Pig” problem is caused by the confinement, consolidation, and concentration of industrial hog operations within the low, flat, and economically marginalized Coastal Plain. Big Pig’s rise was not inevitable. As recently as 1982, more than 11,000 small swine farms freckled nearly all of North Carolina’s 100 counties. Then came the “boom” of consolidation and industrialization that transformed hog production into a highly consolidated and vertically integrated industry.

Kidney Donation And The Consent Of The Poor, Philip J. Cook, Kimberly D. Krawiec

Faculty Scholarship

In "Consentability," Nancy Kim tackles an important and current topic—in an age of increasing options about how to live, die, and procreate, what limits, if any, should the law place on those choices? "Consentability" is a valuable resource for scholars and policymakers alike, summarizing the arguments for and against government intrusion on the choices of consenting adults with encyclopedic thoroughness. After weighing the arguments, Kim proposes that “bodily integrity exchanges” be permitted, subject to limitations. Although we agree with the general conclusion that bodily integrity exchanges should be permitted, we disagree with the specific limitations that treat the decisions of …

Words Have A Weight: Language As A Source Of Inner Grounding And Flexibility In Abstract Concepts, Guy Dove, Laura Barca, Luca Tummolini, Anna M. Borghi

Faculty Scholarship

The role played by language in our cognitive lives is a topic at the centre of contemporary debates in cognitive (neuro)science. In this paper we illustrate and compare two theories that offer embodied explanations of this role: the WAT (Words As social Tools) and the LENS (Language is an Embodied Neuroenhancement and Scaffold) theories. WAT and LENS differ from other current proposals because they connect the impact of the neurologically realized language system on our cognition to the ways in which language shapes our interaction with the physical and social environment. Examining these theories together, their tenets and supporting evidence, …