Medicine and Health Sciences Commons^™

Reducing Ambulance Diversion At Hospital And Regional Levels: Systematic Review Of Insights From Simulation Models, M. Kit Delgado, Lesley J. Meng, Mary P. Mercer, Jesse M. Pines, Douglas K. Owens, Gregory S. Zaric

Emergency Medicine Faculty Publications

Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion.

Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent …

Chhs March 2013 E-Newsletter, Dr. John Bonaguro, Dean, Vashon S. Wells, Editor, Wku College Of Health & Human Services

College of Health & Human Services Publications

No abstract provided.

Foodborne Urinary Tract Infections: A New Paradigm For Antimicrobial-Resistant Foodborne Illness, Lora Nordstrom, Cindy M. Liu, Lance B. Price

Environmental and Occupational Health Faculty Publications

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide. Disproportionately affecting women, UTIs exact a substantial public burden each year in terms of direct medical expenses, decreased quality of life, and lost productivity. Increasing antimicrobial resistance among strains of extraintestinal pathogenic Escherichia colichallenges successful treatment of UTIs. Community-acquired UTIs were long considered sporadic infections, typically caused by the patients’ native gastrointestinal microbiota; however, the recent recognition of UTI outbreaks with probable foodborne origins has shifted our understanding of UTI epidemiology. Along with this paradigm shift come new opportunities to disrupt the infection process and possibly quell …

Agent-Based Modeling Of Physical Activity Behavior And Environmental Correlations: An Introduction And Illustration, Yong Gao

Kinesiology Faculty Publications and Presentations

Purpose: To introduce Agent-Based Model (ABM) to physical activity (PA) research and, using data from a study of neighborhood walkability and walking behavior, to illustrate parameters for an ABM of walking behavior. Method: The concept, brief history, mechanism, major components, key steps, advantages, and limitations of ABM were first introduced. For illustration, 10 participants (age in years: mean = 68, SD = 8) were recruited from a walkable and a nonwalkable neighborhood. They wore AMP 331 triaxial accelerometers and GeoLogger GPA tracking devices for 21 days. Data were analyzed using conventional statistics and highresolution geographic image analysis, which …

Supporting Rebuilding Efforts In Afghanistan

Data and Test Instruments

The Royal College has been quietly assisting in thereconstruction of Afghanistan’s residency education system,devastated by years of war, by supplying members of theNATO Training Mission-Afghanistan (NTM-A) with educationalmaterials and advice to appropriately modernize the country’straining programs.“These efforts are essential for the training of Afghanphysicians in medical and surgical specialties, to ensure ahealthy future for the people of Afghanistan,” says Major Vivian McAlister, MD, FRCSC, member ofRoyal College Council and NTM-A participant.The capacity-building initiative is supported on the ground by the NTM-A team, which includesnumerous Fellows of the Royal College, who advise their Afghan counterparts on ways they can leadadvances in …

Supporting Rebuilding Efforts In Afghanistan, Dialogue

Data and Test Instruments

The Royal College has been quietly assisting in the reconstruction of Afghanistan’s residency education system, devastated by years of war, by supplying members of the NATO Training Mission-Afghanistan (NTM-A) with educational materials and advice to appropriately modernize the country’s training programs.“These efforts are essential for the training of Afghan physicians in medical and surgical specialties, to ensure a healthy future for the people of Afghanistan,” says Major Vivian McAlister, MD, FRCSC, member of Royal College Council and NTM-A participant.The capacity-building initiative is supported on the ground by the NTM-A team, which includes numerous Fellows of the Royal College, who advise …

Nursing Student Voices: Reflections On An International Service Learning Experience, Molly Kerby, Eve Main

Gender & Women's Studies Faculty Publications

For the past decade participation in service and experiential learning in higher education has increased. The purpose of this study was to explore the lived experience of BSN and MSN students participating in a multidisciplinary service-learning course in a rural, underserved village in Belize. Researchers analyzed student journals utilizing qualitative data analysis techniques. There were eight consistent themes found in the student journals. The findings indicate that international service learning opportunities increase students' awareness of their place in a global society and the potential contribution they can make in society. For the past decade, service and experiential learning in higher …

New Dentist News (March 2013), Ada Committee On The New Dentist

New Dentist News

New Dentist News offers timely information on scientific, social, educational, political and economic developments affecting new dentists. This collection is historical and items may not reflect current standards. For up-to-date information contact the ADA. The New Dentist News was alternately titled ADA Lifeline, 1997-June 2001.

Messengers Without Borders: Mediators Of Systemic Inflammatory Response In Aki, Brian B. Ratliff, May M. Rabadi, Radovan Vasko, Kaoru Yasuda, Michael S. Goligorsky

NYMC Faculty Publications

The list of signals sent by an injured organ to systemic circulation, so-called danger signals, is growing to include multiple metabolites and secreted moieties, thus revealing a highly complex and integrated network of interlinked systemic proinflammatory and proregenerative messages. Emerging new data indicate that, apart from the well established local inflammatory response to AKI, danger signaling unleashes a cascade of precisely timed, interdependent, and intensity-gradated mediators responsible for development of the systemic inflammatory response. This fledgling realization of the importance of the systemic inflammatory response to the localized injury and inflammation is at the core of this brief overview. It …

Differences And Similarities Between Culture-Confirmed Human Granulocytic Anaplasmosis And Early Lyme Disease, Gary P. Wormser, Maria E. Aguero-Rosenfeld, Mary E. Cox, John Nowakowski, Robert B. Nadelman, Diane Holmgren, Donna Mckenna, Susan Bittker, Lois Zentmaier, Denise Cooper, Dionysios Liveris, Ira Schwartz, Harold W. Horowitz

NYMC Faculty Publications

Lyme disease is transmitted by the bite of certain Ixodes ticks, which can also transmit Anaplasma phagocytophilum, the cause of human granulocytic anaplasmosis (HGA). Although culture can be used to identify patients infected with A. phagocytophilum and is the microbiologic gold standard, few studies have evaluated culture-confirmed patients with HGA. We conducted a prospective study in which blood culture was used to detect HGA infection in patients with a compatible clinical illness. Early Lyme disease was defined by the presence of erythema migrans. The epidemiologic, clinical, and laboratory features of 44 patients with culture-confirmed HGA were compared with those of …

Improving Access To Children's Mental Health Care: Lessons From A Study Of Eleven States, Donna Behrens, Julia Graham Lear, Olga Acosta Price

Center for Health and Health Care in Schools

Implementation of the Patient Protection and Affordable Care Act (ACA) is well underway, creating long-overdue opportunities for growing the capacity of child and adolescent mental health systems and meeting children’s pressing needs. The good news is that as of January 1, 2014, coverage of mental health conditions and substance use disorders will be required as part of the broad Essential Benefits package of services under the ACA. While states will determine specific benefits, it is widely accepted that mental health and substance abuse coverage will substantially increase, though the details remain to be determined.1 Additionally, as a result of this …

Journey Of A Peace Journalist, Robert Koehler

Center for the Study of Ethics in Society Papers

Presented October 15, 2012. 2012 Winnie Veenstra Peace Lecture.

Molecular Imaging To Target Transplanted Muscle Progenitor Cells, Kelly Gutpell, Rebecca Mcgirr, Lisa Hoffman

Anatomy and Cell Biology Publications

Duchenne muscular dystrophy (DMD) is a severe genetic neuromuscular disorder that affects 1 in 3,500 boys, and is characterized by progressive muscle degeneration(1, 2). In patients, the ability of resident muscle satellite cells (SCs) to regenerate damaged myofibers becomes increasingly inefficient(4). Therefore, transplantation of muscle progenitor cells (MPCs)/myoblasts from healthy subjects is a promising therapeutic approach to DMD. A major limitation to the use of stem cell therapy, however, is a lack of reliable imaging technologies for long-term monitoring of implanted cells, and for evaluating its effectiveness. Here, we describe a non-invasive, real-time approach to evaluate the success of myoblast …

Large Area Periodic, Systematically Changing, Multishape Nanostructures By Laser Interference Lithography And Cell Response To These Topographies, Erden Ertorer, Fartash Vasefi, Joel Keshwah, Mohamadreza Najiminaini, Christopher Halfpap, Uwe Langbein, Jeffrey J. L. Carson, Douglas W. Hamilton, Silvia Mittler

Anatomy and Cell Biology Publications

The fabrication details to form large area systematically changing multishape nanoscale structures on a chip by laser interference lithography (LIL) are described. The feasibility of fabricating different geometries including dots, ellipses, holes, and elliptical holes in both x- and y- directions on a single substrate is shown by implementing a Lloyd's interferometer. The fabricated structures at different substrate positions with respect to exposure time, exposure angle and associated light intensity profile are analyzed. Experimental details related to the fabrication of symmetric and biaxial periodic nanostructures on photoresist, silicon surfaces, and ion milled glass substrates are presented. Primary rat calvarial osteoblasts …

Microglia-Derived Tnfα Induces Apoptosis In Neural Precursor Cells Via Transcriptional Activation Of The Bcl-2 Family Member Puma, J. Guadagno, X. Xu, M. Karajgikar, A. Brown, S.P. Cregan

Paediatrics Publications

Neuroinflammation is a common feature of acute neurological conditions such as stroke and spinal cord injury, as well as neurodegenerative conditions such as Parkinson’s disease, Alzheimer’s disease, and amyotrophic lateral sclerosis. Previous studies have demonstrated that acute neuroinflammation can adversely affect the survival of neural precursor cells (NPCs) and thereby limit the capacity for regeneration and repair. However, the mechanisms by which neuroinflammatory processes induce NPC death remain unclear. Microglia are key mediators of neuroinflammation and when activated to induce a pro-inflammatory state produce a number of factors that could affect NPC survival. Importantly, in the present study we demonstrate …

Chronic Obstructive Pulmonary Disease: More Imaging, More Phenotyping...Better Care?, Damien Pike, Grace Parraga

Medical Biophysics Publications

No abstract provided.

Himmelfarb Library Liaison Letter - March 2013, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

Dynamics Of Vocalization-Induced Modulation Of Auditory Cortical Activity At Mid-Utterance, Zhaocong Chen, Jeffery A. Jones, Peng Liu, Weifeng Li, Dongfeng Huang, Hanjun Liu

Psychology Faculty Publications

Background: Recent research has addressed the suppression of cortical sensory responses to altered auditory feedback that occurs at utterance onset regarding speech. However, there is reason to assume that the mechanisms underlying sensorimotor processing at mid-utterance are different than those involved in sensorimotor control at utterance onset. The present study attempted to examine the dynamics of event-related potentials (ERPs) to different acoustic versions of auditory feedback at mid-utterance.

Methodology/Principal findings: Subjects produced a vowel sound while hearing their pitch-shifted voice (100 cents), a sum of their vocalization and pure tones, or a sum of their vocalization and white noise at …

Auditory-Motor Adaptation To Frequency-Altered Auditory Feedback Occurs When Participants Ignore Feedback, Dwayne Nicholas Keough, Colin Hawco, Jeffery A. Jones

Psychology Faculty Publications

Background

Auditory feedback is important for accurate control of voice fundamental frequency (F0). The purpose of this study was to address whether task instructions could influence the compensatory responding and sensorimotor adaptation that has been previously found when participants are presented with a series of frequency-altered feedback (FAF) trials. Trained singers and musically untrained participants (nonsingers) were informed that their auditory feedback would be manipulated in pitch while they sang the target vowel [/ɑ /]. Participants were instructed to either ‘compensate’ for, or ‘ignore’ the changes in auditory feedback. Whole utterance auditory feedback manipulations were either gradually presented …

Organizational And Cultural Readiness For Integration Of Evidence-Based Practice Into Graduate Nursing Education, Tracy L. Brewer, Barbara A. Fowler, Pam S. Stephenson, Mary Beth Kaylor

Nursing Faculty Publications

The adoption of EBP is fundamental to the reform of healthcare outcomes.

First Steps Phase I Initiative: Improving Immunizations For Children And Adolescents, Kimberley S. Fox Mpa, Carolyn E. Gray Mph

Population Health & Health Policy

This evalution report, authored by research staff at the USM Muskie School, assesses the change in immunization rates in participating pediatric and family practices that serve a high volume of children insured by MaineCare (Maine's Medicaid system). The authors also summarize lessons learned in implementing changes in practices and challenges in using the immunization measures at the practice-level to inform quality improvement.

Ropivacaine Decreases Tissue Oxygen Saturation Following Peripheral Nerve Block In Children, Nina Deutsch, Mamta Singh, Sophie R. Pestieau, Sean P. Alexander, Domiciano Santos, Richard J. Levy

Anesthesiology and Critical Care Medicine Faculty Publications

Background: Local anesthetics can cause vasoconstriction and disrupt neuronal impulses, reducing regional blood flow and increasing tissue oxygen consumption. This could alter regional oxygen supply and demand. Because microcirculation modifies during development and oxygen consumption kinetics differ between children and adults, we aimed to assess effects of ropivacaine Peripheral Nerve Block (PNB) on regional tissue saturation in children and young adults using Near-Infrared Spectroscopy (NIRS).

Methods: Following Institutional Review Board approval and informed consent, 20 patients undergoing PNB for various orthopedic surgeries were studied. NIRS sensors were placed on the operative limb, contralateral limb, and forehead. Tissue saturations (rSO2) were …

Locus Coeruleus And Hippocampal Tyrosine Hydroxylase Levels In A Pressure-Overload Model Of Heart Disease, Luke A. Johnson

Undergraduate Honors Theses

Studies have indicated that approximately 30% of people with heart disease experience major depressive disorder (MDD). Despite strong clinical evidence of a link between the two diseases, the neurobiological processes involved in the relationship are poorly understood. A growing number of studies are revealing similar neuroanatomical and neurochemical abnormalities resulting from both depression and heart disease. The locus coeruleus (LC) is a group of neurons in the pons that synthesize and release norepinephrine, and that is known to play a significant role in depression pathobiology. For example, there is evidence that tyrosine hydroxylase (TH) is elevated in the LC in …

Improving Access To Children's Mental Health Care: Lessons From A Study Of Eleven States, Donna Behrens, Julia Graham Lear, Olga Acosta Price

Prevention and Community Health Faculty Publications

No abstract provided.

Focused Abdominal Sonography For Trauma (Fast) In Blunt Paediatric Abdominal Trauma, Ahmad Vaqas Faruque, Saqib Hamid Qazi, Muhammad Arif Mateen Khan, Wassem Akhtar, Amina Majeed

Section of Paediatric Surgery

Objective: To evaluate the role of focussed abdominal sonography for trauma in blunt paediatric abdominal trauma patients, and to see if the role of computed tomography scan could be limited to only those cases in which sonography was positive.
Methods: The retrospective study covered 10 years, from January 1,2000 to December 31,2009, and was conducted at the Department of Radiology and Department of Emergency Medicine, Aga Khan University Hospital, Karachi. It comprised cases of 174 children from birth to 14 years who had presented with blunt abdominal trauma and had focussed abdominal sonography for trauma done at the hospital. The …

J Am Coll Dent 2013 80 1

Journal of the American College of Dentists

The Journal of the American College of Dentists (JACD) publishes scholarly articles, editorials, essays, and reflections addressing the ethical, professional, and social dimensions of dentistry. The Journal serves as a forum for advancing ethics, professionalism, leadership, and excellence within the dental community. By fostering dialogue across disciplines and perspectives, JACD provides readers with insights that encourage ethical, professional practice, lifelong learning, and service to the public, reinforcing dentistry’s commitment to advancing oral healthcare and the common good.

John Chalmers Dacosta (1863-1933): Restoration Of The Old Operating Table., Madalyn G. Peters, Md, Adam C. Berger, Md, Gordon Schwartz, Md, Mba, Facs, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

John Chalmers DaCosta was an influential chairman and the first Samuel D. Gross Professor of Surgery at Jefferson Medical College in Philadelphia. He was well known throughout the field as a skilled surgeon, passionate speaker, and exceptional writer. In addition to countless accomplishments during his career, DaCosta was deeply dedicated to the preservation and commemoration of surgical history. This ideology was exemplified when he set out on a mission to recover the old wooden operating table used by many of his iconic mentors including Samuel D. Gross, Joseph Pancoast, and William W. Keen. This table was originally used for surgical …

Intubation In Emergency Department Of A Tertiary Care Hospital In A Low-Income, Nadeem Ullah Khan, Uzma R. Khan, Kiran Ejaz, Humaid Ahmad, Nukhba Zia, Junaid Abdul Razzak

Department of Emergency Medicine

Objective: To study the indications, method, success rate and complications of intubation at the Emergency Department of a private, tertiary care hospital in Karachi, Pakistan.
Methods: The case series involved 278 patients above 14 years of age who underwent emergency intubation at the Emergency Department of Aga Khan University Hospital, Karachi between 1998 and 2003. Descriptive statistics were used to compare rapid sequence intubation with crash intubation. The level of significance was p<0.05.
Results: Of the total 278 intubations performed, 37 (13.3%) had to be left out for incomplete information. The study population remaining for inferential analysis comprised of 241 …

Experience Of Nurses With Using Ehealth In Gilgit-Baltistan, Pakistan: A Qualitative Study In Primary And Secondary Healthcare, Saleema A. Gulzar, Shariq Khoja, Afroz Sajwani

School of Nursing & Midwifery

Background: To improve the quality of health care in remote parts of Pakistan, a research project was initiated in the mountainous region of Gilgit-Baltistan using information and communication technology to improve patient care and support continuing education of health providers (eHealth). This paper describes the experience of nurses in using eHealth in their routine practices.
Methods: All health centres of Gilgit-Baltistan, Pakistan using eHealth as part of this study, were taken as a single case. These include four primary healthcare centres, three secondary care centres and one medical centre. In-depth interviews were conducted using semi-structured interview guide to study nurses' …

Nitric Oxide And Its Metabolites In The Critical Phase Of Illness: Rapid Biomarkers In The Making, Asad Mian, Mayank Aranke, Nathan S. Bryan

Department of Emergency Medicine

The potential of nitric oxide (NO) as a rapid assay biomarker, one that could provide a quantum leap in acute care, remains largely untapped. NO plays a crucial role as bronchodilator, vasodilator and inflammatory mediator. The main objective of this review is to demonstrate how NO is a molecule of heavy interest in various acute disease states along the emergency department and critical care spectrum: respiratory infections, central nervous system infections, asthma, acute kidney injury, sepsis, septic shock, and myocardial ischemia, to name just a few. We discuss how NO and its oxidative metabolites, nitrite and nitrate, are readily detectable …