Medicine and Health Sciences Commons^™

Hiv-1 Infection Of Macrophages Induces Retention Of Cholesterol Transporter Abca1 In The Endoplasmic Reticulum, Beda Brichacek, Christina Darwish, Anastas Popratiloff, Larisa Dubrovsky, Michael I. Bukrinsky

Microbiology, Immunology, and Tropical Medicine Faculty Publications

No abstract provided.

Neural Transcription Factors: From Embryos To Neural Stem Cells, Hyun-Kyung Lee, Hyun-Shik Lee, Sally Ann Moody

Anatomy and Regenerative Biology Faculty Publications

The early steps of neural development in the vertebrate embryo are regulated by sets of transcription factors that control the induction of proliferative, pluripotent neural precursors, the expansion of neural plate stem cells, and their transition to differentiating neural progenitors. These early events are critical for producing a pool of multipotent cells capable of giving rise to the multitude of neurons and glia that form the central nervous system. In this review we summarize findings from gain- and loss-of-function studies in embryos that detail the gene regulatory network responsible for these early events. We discuss whether this information is likely …

Children's Use Of Dental Care In Medicaid: Federal Fiscal Years 2000-2012, Erika Steinmetz, Brian K. Bruen, Leighton C. Ku

Health Policy and Management Faculty Publications

This report presents with national and state-specific analyses about dental services received by children ages 1 to 20 under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit in federal fiscal years (FFY) 2000-2012. These analyses are based on data reported by state Medicaid agencies using Form CMS-416 (Form 416); all data reflect updates received by CMS as of April 3, 2014. This report focuses on the number of children who received any dental service, any preventive dental service (e.g., dental cleaning or application of dental sealants) and any dental treatment service (e.g., filling a cavity). The national trend …

Tps Mutational Status Is A Potential Marker For Risk Stratification In Wilms Tumour With Diffuse Anaplasia, Mariana Maschietto, Richard D. Williams, Tasnim Chagtai, Sergey D. Popov, Neil J. Sebire, Gordan Vujanic, Elizabeth Perlman, James R. Anderson, Paul Grundy, Jeffrey S. Dome, Kathy Pritchard-Jones

Pediatrics Faculty Publications

Purpose

The presence of diffuse anaplasia in Wilms tumours (DAWT) is associated with TP53 mutations and poor outcome. As patients receive intensified treatment, we sought to identify whetherTP53 mutational status confers additional prognostic information.

Patients and Methods

We studied 40 patients with DAWT with anaplasia in the tissue from which DNA was extracted and analysed for TP53 mutations and 17p loss. The majority of cases were profiled by copy number (n = 32) and gene expression (n = 36) arrays. TP53 mutational status was correlated with patient event-free and overall survival, genomic copy number instability and gene expression profiling. …

Malignant Hyperthermia, Chase Contri

Nursing Student Class Projects (Formerly MSN)

Although very rare, occurring one out of every 100,000 anesthesia cases, malignant hyperthermia is a hypermetabolic disorder that anesthesia providers screen and interrogate patients prior to every case they are administering anesthesia. Many research studies about anesthesia induced malignant hyperthermia have explored new methods of testing for the genetic susceptibility for malignant hyperthermia and into hospital based protocols when a patient starts to show the signs and symptoms of the metabolic disorder. This new knowledge and understanding has decreased patient mortality of anesthesia induced malignant hyperthermia from eighty percent to five percent over the past three decades (Rosenberg et al, …

Malignant Hyperthermia, Devin Poncsak

Nursing Student Class Projects (Formerly MSN)

A crisis of malignant hyperthermia is a medical emergency, and must be treated immediately with a coordinated, multidisciplinary team response in order to give the patient the highest chance for a successful recovery (Dirksen, Van Wicklin, Mashman, Neiderer, & Merritt, 2013). Malignant hyperthermia is defined by Bandschapp & Girard (2012), as “a disturbance of the skeletal muscle calcium homeostasis, triggered by volatile anaesthetics and depolarizing muscle relaxants.” Once a vulnerable patient is exposed to one of these triggering agents, a pathologic hypermetabolic response ensues, and the patient has a rapid increase in oxygen consumption and expired carbon dioxide, hyperthermia, acidosis, …

Acute Respiratory Distress Syndrome, Brian Flowers

Nursing Student Class Projects (Formerly MSN)

In healthcare, there are many interesting and intriguing conditions that are vital to understand from both a clinical and a pathophysiological standpoint. Comprehending and knowing how to treat these conditions effectively, ultimately leads to the best care and patient outcomes. As a current critical care nurse and future advanced practice nurse, it was important to select a research topic of interest to explore that would benefit a high risk group of patients. Based on this precedent, acute respiratory distress syndrome (ARDS) was chosen. As a critical care nurse, exposure to respiratory conditions and mechanical ventilation management is something nurses are …

Management Of A Dka Patient With Severe Metabolic And Ketoacidosis With Chronic Renal Insufficiency, Brian Albany

Nursing Student Class Projects (Formerly MSN)

Diabetic ketoacidosis (DKA) serves as one the leading causes of mortality in diabetic patients [14]. The mortality has decreased over the past several decades due to the rapid recognition of the disease state and the improvement of management of DKA [14]. Despite a decline in mortality rates over the past twenty years from 7.96% to 0.67%, errors in management of the disease state are associated with significant morbidity and mortality [2]. Utilization of DKA protocols in the acute care setting have allowed congruency in care and delivery of effective lifesaving treatment. Despite advances in standardized DKA protocols, there still remains …

The Pathophysiology Of Tumor Lysis Syndrome In Oncology Patients, Jessica Richardson

Nursing Student Class Projects (Formerly MSN)

Patients with oncological conditions are at an increased risk of developing a wide variety of complications from chemotherapy that they would not otherwise be exposed too. One such life threatening complication is tumor lysis syndrome, which is an oncology emergency that frequently lands patients in the intensive care unit. Tumor lysis syndrome (TLS) occurs most frequently after the initiation of chemotherapy or other chemotoxic drugs during the patients’ treatment course [8]. It causes faster than normal tumor cell breakdown and release of intracellular contents into the general circulation. [8]. This leads to a very predictable development of electrolyte imbalances to …

Multimodal Therapy For Postoperative Pain Management, Karen Lynch

Nursing Student Class Projects (Formerly MSN)

Multimodal therapy works best to control postoperative pain safely. Multimodal pain treatment involves the use of two or more classes of analgesics to target different pain mechanisms. Why? Data is present that supports that health care systems are still under treating pain in the postoperative patient. Unrelieved pain has harmful effects to multi ple body systems. There is still a need to provide education to providers, nurses and patients to promote best practice in pain management approaches regarding multimodal therapy. Opiate analgesics still remain the most commonly used treatment for pain following surgery. Using this singular analgesic modality could put …

Necrotizing Fasciitis, Holly Herron

Nursing Student Class Projects (Formerly MSN)

Necrotizing fasciitis also known as necrotizing soft tissue infections (NSTIs) is a rare life-threatening infection that involves the skin and soft tissue. A rapid and accurate diagnosis of NSTIs must be identified by healthcare providers to diminish morbidity and mortality. NSTIs are characterized by progressive necrosis of subcutaneous tissue and fascia involving large areas of tissue (Lin, Chang, Lai, Lin, & Chen, 2013). Hippocrates (500 BC) described necrotizing fasciitis as “diffuse erysipelas caused by trivial accidents [where] flesh, sinews, and bones fell away in large quantities, [leading to] death in many cases” (Lancerotto, Tocco, Salmaso, Vindigni & Bassetto, 2012). In …

Necrotizing Fasciitis: The “Flesh Eating” Disease, John Neukam

Nursing Student Class Projects (Formerly MSN)

Necrotizing fasciitis, often referred to as the “flesh-eating disease”, is a rare bacterial infection with an extremely high mortality rate with symptoms that begin subtle but can quickly ravish the human body.1 While the prevalence of this disease is relatively low, evidence of this disease can be traced back as far as the 5th century BC where it was initially described by Hippocrates.2 It wasn’t until 1952 however that Dr. Bob Wilson termed the disease “necrotizing fasciitis”.3 The rapid progression of this disease and the acute deterioration it causes in a patient is extremely intriguing. This “flesh-eating disease” can present …

Accurate Intervention In Visceral Aneurysms, Megan Hoying

Nursing Student Class Projects (Formerly MSN)

A 30 year old male presented to the ED with a one week history of fever, abdominal pain, and poor PO intake due to nausea and emesis. He was given a GI cocktail and sent home for a presumed diagnosis of gastritis. After having persistent pain the patient returned to the ER the following day and was admitted for further testing. The patient died 3 days later. This is an interesting case presentation, and was in no way straightforward.

Pseudocholinesterase Deficiency, Ross Gerken

Nursing Student Class Projects (Formerly MSN)

Pseudocholinesterase deficiency is a rare genetic or acquired variation in the metabolism of choline esters such as the neuromuscular blockers succinylcholine, mivacurium, and ester local anesthetics. Pseudocholinesterase deficiency genetically is transmitted in an autosomal recessive pattern with the frequency of apnea from a genetic abnormality of pseudocholinesterase between 1:480 and 1:3200 people (Ok et al., 2013). An extended period of neuromuscular blockade results from these medications than what is clinically expected. The signs and symptoms which occur are apnea and paralysis hours longer. This condition is rare but must be known and understood by the clinician in order to provide …

Understanding The Mystery Of Brain Death, Natalie A. Felter

Nursing Student Class Projects (Formerly MSN)

Lack of understanding of brain death has contributed to recent controversial cases (Copnell, 2014). The cases of Jahi McMath and Marlise Munoz were the focus of national news, causing an intense debate among the public and healthcare professionals (Copnell, 2014). The concept of brain death is a mystery to the public (Powell, 2014). Copnell (2014) found that 60% of family members who had been told their loved one was brain dead believed that they were still alive. Health professionals not having a clear grasp of brain death’s definition and assessment can lead to increased confusion in family members (Powell, 2014).

Hypertrophic Obstructive Cardiomyopathy, Tiffany Branson

Nursing Student Class Projects (Formerly MSN)

Hypertrophic obstructive cardiomyopathy or HOCM, is a genetic disease that is described as hypertrophy or enlargement of the left ventricle which obstructs the blood flow to the body (Yue-Cheng et al., 2012). HOCM is a disease that cannot be cure, but can be treated. One of the main goals of treatment is to focus on treating the symptoms. HOCM can be asymptomatic or symptomatic and can cause some major complications. Some of the complications of HOCM are arrhythmias and sudden cardiac death, “which is defined as natural death to due cardiac causes, heralded by abrupt loss of consciousness within one …

Dvt And Economy Class Syndrome, Troy Perkins

Nursing Student Class Projects (Formerly MSN)

Traveling long distances can be very stressful on the body. Deep vein thrombosis (DVT) has often been linked to long air flights or long distance travel in a vehicle. DVT is a blood clot usually formed in the legs. Economy Class Syndrome (ECS) has been referred to as the formation of a DVT occurring during (or just after) a long airplane flight, especially in economy class where there is the least space allotted per passenger and one’s legs especially tend to be immobilized for lack of leg room (MedicineNet, 2012). Developing a DVT can lead to other life-threatening illnesses such …

Effects Of Mindfulness Practices On Perceived Stress Levels, Kendall Ginn

Graduate Research Projects

No abstract provided.

Barriers To Immunizations, Megan England

Graduate Research Projects

No abstract provided.

Designing A Sustainable And Transferable Inventory Management System For Small Healthcare Facilities, Shree Frazier

Open Access Theses

Managing the costs of supplies within healthcare facilities has been a task that has plagued the health industry for many years. Many facilities are accustomed to using a par system approach. This involves bringing an inventory item to an amount sufficient for daily operation. This method often requires daily inspection by a healthcare worker, which reduces his/her time spent performing value added tasks. Employees at small healthcare facilities have multiple responsibilities, therefore they cannot afford to spend much time on inventory management. A proposed approach is the Kanban method, which allows for strict monitoring of inventory items without the need …

Block Scheduling Social Skills Groups: An Intensive And Inclusive Model, Jennifer K. Schoffer Closson, Anisa Goforth

Speech, Language, Hearing, and Occupational Sciences Faculty Publications

This poster was presented at the annual Montana Speech Language and Hearing Convention in Missoula.

Chhs October 2014 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.

Does Your Child Have Reflux Or Could There Be More To It Than That, Cody Elam

Nursing Student Class Projects (Formerly MSN)

Eosinophilic esophagitis (EE) is differentiated from Gastroesophageal Reflux Disease (GERD) by endoscopic and histopathologic examination. The hallmark of EE is eosinophilic infiltration of the esophagus. EE has been defined as “a clinicopathologic entity, combining clinical data on (1) relevant symptoms (distinct in the pediatric or adult populations with mostly food impaction and dysphagia in adults and feeding intolerance, failure to thrive, and GERD symptoms in children); (2) esophageal biopsies with adequate histologic findings in the esophageal biopsies (>15 eosinophils/high power field [HPF]); and (3) exclusion of other diseases with overlapping features, especially GERD” (Genevay, Rubbia-Brandt, & Rougemont, 2010, p.816). …

Protein Losing Enteropathy Following Fontan Palliation In The Single Ventricle Population, Alaina Dunkleberger

Nursing Student Class Projects (Formerly MSN)

Congenital heart defects requiring single ventricle palliation are a rare but life-threatening occurrence. There are multiple defects resulting in single ventricle physiology including defects in which the right or left ventricle within the heart is either undeveloped (hypoplastic left heart syndrome, hypoplastic right heart syndrome), or the valve to the main pulmonary artery did not form (pulmonary atresia). These defects prevent the heart from supplying adequate blood flow to the lungs or body. Single ventricle congenital heart defects are not easily treated surgically due to their complexity in nature. Single ventricle surgical palliation typically involves three open-heart surgeries including the …

Therapeutic Hypothermia Following Cardiac Arrest, Cassandra Patrick

Nursing Student Class Projects (Formerly MSN)

According to the Sudden Cardiac Arrest Foundation (2014), each year, 424,000 people in the U.S. (more than 1,000/day) experience EMS-assessed out-of-hospital non-traumatic sudden cardiac arrest. This is roughly equivalent to the number of people who die from Alzheimers’ disease, assault with firearms, breast cancer, cervical cancer, colorectal cancer, diabetes, HIV, house fires, motor vehicle accidents, prostate cancer and suicides combined (Sudden Cardiac Arrest Foundation, 2014). It is estimated that the likelihood of surviving an out-of-hospital cardiac arrest (OHCA) to hospital discharge can be as low as 6% to 8% (Williams, Calder, Cocchi & Donnino, 2013). Additionally an estimated 200,000 hospitalized …

Effects Of Edmr On Veterans With Ptsd, Beth Abele

Nursing Student Class Projects (Formerly MSN)

Of all the mental health disorders, the most commonly diagnosed among Iraqi and Afghanistan wars is Posttraumatic stress disorder (PTSD) (Hellmuth et al., 2012). Veterans who are suffering the effects of PTSD are treated every day in VA Medical Centers across the country, as well as in private sector hospitals. Many of these men and women are battling with drug addictions and alcohol abuse in attempts to self medicate (Murdoch et al., 2010). According to nationally represented study by Murdoch and colleagues (2010), one fifth of individuals who have been diagnosed with PTSD use drugs, alcohol or both to treat …

Brain Death Determination, Bethani Knipfer

Nursing Student Class Projects (Formerly MSN)

Patient MR was a seventeen year old female involved in a motor vehicle collision which resulted in a traumatic brain injury leading to declaration of brain death. The pathophysiology behind the traumatic brain injury, the concept and use of a brain tissue monitoring device, and the tests used in the declaration of brain death will be explored. When brain death is determined, the patient has the opportunity to become an organ donor. Thousands of people are waiting for organs to become available. This is a huge healthcare concern that may be decreased if the general public is more educated regarding …

Angiotensin Converting Enzyme Related Angioedema, Andrea Sims

Nursing Student Class Projects (Formerly MSN)

A 54 year old female patient arrives to the emergency department (ED) via squad complaining that 2 days ago her lips were tingling and her face felt a little swollen but it subsided. Today she woke up with her tongue protruding out of her mouth, her lips, face and eyes are swollen. She does not present with itching or urticaria. Squad personnel established an IV, gave her intravenous (IV) Benadryl 50 mg, and 0.3 mg subcutaneous epinephrine without any change in her condition. The emergency medical service (EMS) also applied oxygen at 2 liters per minute (lpm). She denies taking …

The Mystery Of Transverse Myelitis: Can It Happen To You?, Jessica Castle

Nursing Student Class Projects (Formerly MSN)

Imagine a day like any other, as a healthy performs daily tasks without any particular difficulty. Then, the first fall happens. After standing and recovering, two more falls occur; however, despite all physical effort, standing proves to be a complete impossibility. Imagine the fear. What is going on? This unexplainable scenario happened to an 81 woman diagnosed with idiopathic transverse myelitis (TM) in May 2011, leaving her permanently paralyzed below the mysteriously appearing T9 lesion. This woman had only a personal history of asthma and breast cancer, and nothing significant in her family history. After 60 days of lumbar punctures, …

Acute Respiratory Distress Syndrome, Jaqueline Yunker

Nursing Student Class Projects (Formerly MSN)

Acute Respiratory Distress Syndrome is an inflammatory response resulting from injury to the alveolar-­‐capillary membrane. This injury is caused by a systemic inflammatory response that involves either direct trauma to the lung cells, such as a pneumonia, or indirect, such as sepsis. The inflammatory response that is triggered results in leaky alveolar-­‐capillary beds and infiltration of the lungs (Villar, 2011). This is very common with approximately 150,000 cases annually in the United States and a very high mortality rate of 60,000 deaths per year (Pipeling & Fan, 2010). Despite the high mortality rate, 15-­‐35%, there is no set of guidelines …