Medicine and Health Sciences Commons^™

Do Emergency Department Patients Receive A Pathological Diagnosis? A Nationally Representative Sample., Leana S. Wen, Janice A. Espinola, Joshua M. Kosowsky, Carlos A. Camargo Jr

Emergency Medicine Faculty Publications

No abstract provided.

Fusion, 2014, George Washington University, William H. Beaumont Medical Research Honor Society

Fusion

No abstract provided.

Cuentos - 2014, George Washington University, Medical Faculty Associates

Cuentos

Cuentos is the humanities magazine of the George Washington University Medical Faculty Associates Department of Internal Medicine.

Thiamine Pyrophosphokinase Deficiency Causes A Leigh Disease Like Phenotype In A Sibling Pair: Identification Through Whole Exome Sequencing And Management Strategies, Jamie L. Fraser, Adeline Vanderver, Sandra Yang, Taeun Chang, Laura Cramp, Gilbert Vezina, Uta Lichter-Konecki, Kristina Cusmano-Ozog, Patroula Smpokou, Kimberly A. Chapman, Dina Zand

Neurology Faculty Publications

We present a sibling pair with Leigh-like disease, progressive hypotonia, regression, and chronic encephalopathy. Whole exome sequencing in the younger sibling demonstrated a homozygous thiamine pyrophosphokinase (TPK) mutation. Initiation of high dose thiamine, niacin, biotin, α-lipoic acid and ketogenic diet in this child demonstrated improvement in neurologic function and re-attainment of previously lost milestones. The diagnosis of TPK deficiency was difficult due to inconsistent biochemical and diagnostic parameters, rapidity of clinical demise and would not have been made in a timely manner without the use of whole exome sequencing. Molecular diagnosis allowed for attempt at dietary modification with cofactor supplementation …

A Case Control Study Of Environmental And Occupational Exposures Associated With Methicillin Resistant Staphylococcus Aureus Nasal Carriage In Patients Admitted To A Rural Tertiary Care Hospital In A High Density Swine Region, Leah Schinasi, Steve Wing, Kerri L. Augustino, Keith M. Ramsey, Delores L. Nobles, David B. Richardson, Lance B. Price, Maliha Aziz, Pia Macdonald, Jill R. Stewart

Environmental and Occupational Health Faculty Publications

Background

Distinct strains of methicillin resistant Staphylococcus aureus (MRSA) have been identified on livestock and livestock workers. Industrial food animal production may be an important environmental reservoir for human carriage of these pathogenic bacteria. The objective of this study was to investigate environmental and occupational exposures associated with nasal carriage of MRSA in patients hospitalized at Vidant Medical Center, a tertiary hospital serving a region with intensive livestock production in eastern North Carolina.

Methods

MRSA nasal carriage was identified via nasal swabs collected within 24 hours of hospital admission. MRSA carriers (cases) were gender and age matched to non-carriers (controls). …

Ending Open Defecation In Rural Tanzania: Which Factors Facilitate Latrine Adoption?, Stephen Sara, Jay P. Graham

Environmental and Occupational Health Faculty Publications

Diarrheal diseases account for 7% of deaths in children under five years of age in Tanzania. Improving sanitation is an essential step towards reducing these deaths. This secondary analysis examined rural Tanzanian households’ sanitation behaviors and attitudes in order to identify barriers and drivers to latrine adoption. The analysis was conducted using results from a cross-sectional study of 1000 households in five rural districts of Tanzania. Motivating factors, perceptions, and constraints surrounding open defecation and latrine adoption were assessed using behavioral change theory. Results showed a significant association between use of improved sanitation and satisfaction with current sanitation facility (OR: …

Minor Gynecologic Surgery: A Review Of The Training Experience And Skill Building Opportunities For Providers In Low And Middle Income Countries, Rachel Marie Clark, Leslie Siriya Bradford, Jessica Opoku-Anane, Joseph Ngonzi, Ferdous Islam, Mithila Faruque, Annekathryn Goodman

Obstetrics and Gynecology Faculty Publications

Purpose: Minor gynecologic surgery is the cornerstone of gynecologic evaluation and intervention in countries with a well-established medical infrastructure. Surgical training and exposure to minor procedures are not available in low and middle-income countries due to the complex challenges of patient delay and lack of access to healthcare, physician shortages, and the lack of ancillary services such as pathology and radiology. This paper reviews current training statistics, the international literature on minor gynecologic surgery and training strategies.

Methods: PubMed searches using MESH terms cone biopsy, dilation and curettage, and loop electrosurgical excision procedure were performed. Statistics of minor …

Mucopolysaccharidosis Iva (Morquio A Syndrome) And Vi (Maroteaux-Lamy Syndrome): Under-Recognized And Challenging To Diagnose, Ralph S. Lachman, Barbara K. Burton, Lorne A. Clarke, Scott Hoffinger, Shiro Ikegawa, Dong-Kyu Jin, Hiroki Kano, Ok-Hwa Kim, Christina Lampe, Nancy J. Mendelsohn, Renee Shediac, Pranoot Tanpaiboon, Klane K. White

Pediatrics Faculty Publications

OBJECTIVE:

Mucopolysaccharidosis IVA (MPS IVA, or Morquio A syndrome) and VI (MPS VI, or Maroteaux-Lamy syndrome) are autosomal recessive lysosomal storage disorders. Skeletal abnormalities are common initial presenting symptoms and, when recognized early, may facilitate timely diagnosis and intervention, leading to improved patient outcomes. Patients with slowly progressing disease and nonclassic phenotypes can be particularly challenging to diagnose. The objective was to describe the radiographic features of patients with a delayed diagnosis of MPS IVA or VI.

MATERIALS AND METHODS:

This was a retrospective study. The records of 5 MPS IVA and 3 MPS VI patients with delayed diagnosis were …

Gauging Regional Differences In The Hiv Prevalence Rate Among Injection Drug Users In The U.S., Jichuan Wang, Brian Kelly

Pediatrics Faculty Publications

This article aims to introduce and demonstrate the application of the standardization and decomposition analysis (SDA) method to gauge differences in HIV prevalence rates among injection drug users (IDUs) across regions (Northeast, South, Midwest, and West) in the U.S. Using the SDA, the regional HIV prevalence rates were standardized and a rate difference between regions was decomposed into component effects, such as the “real” rate difference, and component effects attributed to differences in specific compositions of confounding factors. A total of 9,824 injection drug users (IDUs) retrieved from the national database of the National Institute on Drug Abuse’s Cooperative Agreement …

Superresolution Imaging Of Human Cytomegalovirus Vmia Localization In Sub-Mitochondrial Compartments, Shivaprasad Bhuvanendran, Kyle Salka, Kristen Rainey, Sen Chandra Sreetama, Elizabeth Williams, Margretha Leeker, Vidhya Prasad, Jonathan Boyd, George H. Patterson, Jyoti K. Jaiswal, Anamaris M. Colberg-Poley

Pediatrics Faculty Publications

The human cytomegalovirus (HCMV) viral mitochondria-localized inhibitor of apoptosis (vMIA) protein, traffics to mitochondria-associated membranes (MAM), where the endoplasmic reticulum (ER) contacts the outer mitochondrial membrane (OMM). vMIA association with the MAM has not been visualized by imaging. Here, we have visualized this by using a combination of confocal and superresolution imaging. Deconvolution of confocal microscopy images shows vMIA localizes away from mitochondrial matrix at the Mitochondria-ER interface. By gated stimulated emission depletion (GSTED) imaging, we show that along this interface vMIA is distributed in clusters. Through multicolor, multifocal structured illumination microscopy (MSIM), we find vMIA clusters localize away from …

Perinatal Pharmacology, Karel M. Allegaert, V. Fanos, John N. Van Den Anker, Stephanie L. Läer

Pediatrics Faculty Publications

No abstract provided.

Rheumatic Heart Disease In Uganda: The Association Between Mhc Class Ii Hla Dr Alleles And Disease: A Case Control Study, Emmy Okello, Andrea Z. Beaton, Charles Mondo, Paul Kruszka, Noah Kiwanuka, Richard Odoi-Adome, Juergen Freers

Pediatrics Faculty Publications

Background

Rheumatic heart disease (RHD), the only long term consequence of acute rheumatic fever, remains a leading cause of morbidity and mortality among young adults in Uganda. An inherited susceptibility to acute rheumatic fever centers around the major histocompatibility class II human leucocyte antigens. However, there is paucity of data from sub-Saharan Africa. This study compares the frequency of HLA class II DR alleles between RHD cases and normal controls in Uganda.

Methods

One hundred ninety-nine participants including 96 established RHD cases aged 5–60 years and 103 age and sex matched normal controls were recruited for participation. DNA was manually …

Preface Of The Special Issue: “Recent Cmv Research”, Kayla Dufrene, Roberta L. Debiasi, Anamaris M. Colberg-Poley

Pediatrics Faculty Publications

No abstract provided.

Expression Of A Secreted Fibroblast Growth Factor Binding Protein-1 (Fgfbp1) In Angioproliferative Kaposi Sarcoma, Patricio E. Ray, Ali Al-Attar, Xue-Hui Liu, Jharna R. Das, Elena Tassi, Anton Wellstein

Pediatrics Faculty Publications

Objective: Kaposi’s sarcoma (KS) is an angioproliferative disease frequently seen in patients with the acquired immunodeficiency syndrome (AIDS). Previous studies suggest that the HIV-1 protein Tat and Fibroblast Growth Factor 2 (FGF-2) have synergistic angiogenic effects in AIDS-KS tumors. However, the mechanisms by which FGF-2 is released and activated in KS tumors are not clearly defined. We carried out this study to determine whether an FGFbinding protein (FGFBP1 or BP1) that enhances the angiogenic activity of FGF-2 is expressed in AIDS-KS tumors, and to define whether BP1, FGF-2, and HIV-Tat protein-protein interactions could play a potential clinically role in the …

Children's Hospital Association Consensus Statements For Comorbidities Of Childhood Obesity, Elizabeth Estrada, Ihuoma Eneli, Sarah Hampl, Michele L. Mietus-Snyder, Nazrat Mirza, Erinn Rhodes, Brooke Sweeney, Lydia Tinjaero-Deck, Susan J. Woolford, Stephen J. Pont

Pediatrics Faculty Publications

Background: Childhood obesity and overweight affect approximately 30% of US children. Many of these children have obesity-related comorbidities, such as hypertension, dyslipidemia, fatty liver disease, diabetes, polycystic ovary syndrome (PCOS), sleep apnea, psychosocial problems, and others. These children need routine screening and, in many cases, treatment for these conditions. However, because primary care pediatric providers (PCPs) often are underequipped to deal with these comorbidities, they frequently refer these patients to subspecialists. However, as a result of the US pediatric subspecialist shortage and considering that 12.5 million children are obese, access to care by subspecialists is limited. The aim of this …

Working Together For Global Health Goals: The United States Agency For International Development And Faith-Based Organizations, Clydette L. Powell

Pediatrics Faculty Publications

For many years, and before the term “FBO” was used for faith-based organizations, the United States Agency for International Development (USAID) has supported the work of FBOs in global health and development. The Agency has long recognized the impact of FBOs within that development space, because these organizations are often well positioned to reach the hard-to-reach and to go the last mile because of their strong ties to the community. Moreover, FBOs deliver a substantial percentage of the health services in some developing countries. Faith partners, whether Catholic, Protestant, Buddhist, Hindu, Muslim, or other, have an important role to play …

Proposed Guidelines For The Diagnosis And Management Of Methylmalonic And Propionic Acidemia., Matthias R Baumgartner, Friederike Hörster, Carlo Dionisi-Vici, Goknur Haliloglu, Daniela Karall, Kimberly A. Chapman, +19 Additional Authors

Pediatrics Faculty Publications

Methylmalonic and propionic acidemia (MMA/PA) are inborn errors of metabolism characterized by accumulation of propionic acid and/or methylmalonic acid due to deficiency of methylmalonyl-CoA mutase (MUT) or propionyl-CoA carboxylase (PCC). MMA has an estimated incidence of ~ 1: 50,000 and PA of ~ 1:100'000 -150,000. Patients present either shortly after birth with acute deterioration, metabolic acidosis and hyperammonemia or later at any age with a more heterogeneous clinical picture, leading to early death or to severe neurological handicap in many survivors. Mental outcome tends to be worse in PA and late complications include chronic kidney disease almost exclusively in MMA …

Aspirin Use And Knowledge In The Community: A Population- And Health Facility Based Survey For Measuring Local Health System Performance., Gregory A Roth, Catherine W. Gillespie, Ali A Mokdad, Danny D Shen, David W Fleming, Andy Stergachis, Christopher J L Murray, Ali H Mokdad

Pediatrics Faculty Publications

BACKGROUND: Little is known about the relationship between cardiovascular risk, disease and actual use of aspirin in the community.

METHODS: The Measuring Disparities in Chronic Conditions (MDCC) study is a community and health facility-based survey designed to track disparities in the delivery of health interventions for common chronic diseases. MDCC includes a survey instrument designed to collect detailed information about aspirin use. In King County, WA between 2011 and 2012, we surveyed 4633 white, African American, or Hispanic adults (45% home address-based sample, 55% health facility sample). We examined self-reported counseling on, frequency of use and risks of aspirin for …

Immunologic Special Forces: Anti-Pathogen Cytotoxic T-Lymphocyte Immunotherapy Following Hematopoietic Stem Cell Transplantation, Michael Keller, Catherine M. Bollard

Pediatrics Faculty Publications

Anti-pathogen adoptive T-cell immunotherapy has been proven to be highly effective in preventing or controlling viral infections following hematopoietic stem cell transplantation. Recent advances in manufacturing protocols allow an increased number of targeted pathogens, eliminate the need for viral transduction, broaden the potential donor pool to include pathogen-naïve sources, and reduce the time requirement for production. Early studies suggest that anti-fungal immunotherapy may also have clinical benefit. Future advances include further broadening of the pathogens that can be targeted and development of T-cells with resistance to pharmacologic immunosuppression.

Intermittent Acute Angle Closure Glaucoma And Chronic Angle Closure Following Topiramate Use With Plateau Iris Configuration, Lamise Z. Rajjoub, Nisha Chadha, David A. Belyea

Ophthalmology Faculty Publications

This is a case report describing recurrent intermittent acute angle closure episodes in the setting of topiramate use in a female suffering from migraines. Despite laser peripheral iridotomy placement for the pupillary block component, and the discontinuation of topiramate, the acute angle closure did not resolve in the left eye with chronic angle closure and the patient required urgent trabeculectomy. The right eye responded to laser peripheral iridotomy immediately and further improved after the cessation of topiramate. While secondary angle closure glaucoma due to topiramate use has been widely reported, its effects in patients with underlying primary angle closure glaucoma …

Creating Opportunities For Personal Empowerment For Adolescent Students In A Rural High School, Sharon A. Edwards

Doctor of Nursing Practice Projects

BACKGROUND: With the incidence of 3% of children and 6% of adolescents diagnosed with depression, treatment appropriate for this population is needed. Provision of mental health care is limited due to barriers of access such as transportation, parental consent, and availability of services in the adolescent’s environment such as the school setting. OBJECTIVES: To decrease the depressive symptoms and increase the self-confidence perceptions of adolescents in a high school setting utilizing a cognitive-behavioral skills enhancing, seven-session intervention called COPE (Creating Opportunities for Personal Empowerment).

STUDY DESIGN: The project was an evidence-based nurse practitioner project utilizing pre- and …

Efficacy Of A Carbon Fiber Orthotic Toe-Off Brace In Adults With Cerebral Palsy, June Kume, John R. Magel, Erin Dicandia, Justine Hoffman, Robert Issing, Joshua Little, Tyler Roden

The School of Health Sciences Publications and Research

Purpose/Hypothesis : This pilot study evaluated the effects of a unique carbon fiber ankle/foot orthosis for individuals diagnosed with foot drop (“Toe-Off” design, Allard USA, Inc). We hypothesized that use of this brace would be useful for adults with cerebral palsy (CP) as evidenced by improved gait characteristics including gait endurance and balance.

Number of Subjects : A convenience sample of 4 patients, between the ages of 29 and 55, with diagnoses of cerebral palsy, was successfully recruited from United Cerebral Palsy (UCP) of Suffolk (Central Islip, NY). All individuals received regular physical therapy at UCP prior to and throughout …

Cognitive Impairment In Patients With Type 2 Diabetes Mellitus: Perspectives And Challenges, Okezie I. Aruoma, Darshini Narrain, Joseph Indelicato, Emmanuel Bourdon, Fatima Murad, Theeshan Bahorun

The School of Health Sciences Publications and Research

Type 2 Diabetes Mellitus is associated with elevated blood glucose level, abnormal abdominal fat deposition, insulin resistance and a number of complications including embryopathy, cardiovascular diseases, nephropathy, neuropathy, microangiopathy and retinopathy. Complications extending to the central nervous system may have a deteriorating effect on mental health including a decline in cognitive functioning. This could be a reason for depression, lack of compliance towards medication/treatment, and the inability of patients to meet the day-to-day management demands of the disease. Due to the high metabolic demand for energy in the brain, perturbations in glucose metabolism can noticeably impact cognitive performance. This review …

The Interplay Of Diabetes, And Health Self Efficacy, Cognition And Compliance, Joseph Indelicato, Vanessa Gilchriest

The School of Health Sciences Publications and Research

The authors argue that screening tools for health self efficacy and cognitive impairment in patients with diabetes should be created to help implement interventions which would be most useful to those patients.

Metabolic Factor: A New Clinical Tool In Obesity Diagnosis And Weight Management, Brandon Davis, Joseph Indelicato, Nicholas Kuiper

The School of Health Sciences Publications and Research

Obtaining resting metabolic rates (RMR) via indirect calorimetry is a critical component of weight management that is used to calculate a new concept, metabolic factor. This calculation allows for the standardized expression of RMR to make it possible to compare metabolism between people and over time. This study found an inverse relationship between weight and metabolic factor, statistically significant, r = -­‐.63, p < 0.001, effect size = .46, suggesting that people who weigh more tend to have lower metabolic factors. Furthermore, statistically significant differences were found in the metabolic factors between people who were normal weight, overweight, and obese, p < 0.001. There was also an inverse relationship between metabolic factor and age, r = -­‐0.21, p < .05, effect size = .03, suggesting that age has a small but significant effect of metabolic factor. This variable has the potential to play a key role in treatment planning as it can be used to set realistic weight goals, determine caloric needs for a given weight, and to make decisions as to surgical intervention. More importantly, metabolic factor can be a key instrument in clinical work used to educate people regarding unique differences in metabolism to lower prejudice against the obese and to reduce the devastating shame that often accompanies weight issues.

Using The Integrated Behavioral Model To Predict High-Risk Drinking Among College Students, Robert E. Braun Mph, Ches, Tavis Glassman Ph.D.,Mph, Jiunn-Jye Sheu Ph.D.,Msph, Tim Jordan Med, Faith Yingling Ph.D.,Med

Health and Sport Sciences Faculty Scholarship

This study assessed the Integrated Behavioral Model’s (IBM) utility in explaining high-risk drinking among college students. A total of 356 participants completed a four-page questionnaire based on the (IBM) theory and their drinking behavior. The results from a path analysis revealed three significant constructs (p<0.05) which predicted intentions to engage in high-risk drinking: experiential attitude (0.34), injunctive norms (0.23), and self-efficacy (-0.28). The IBM explained approximately 45% and 26% of variance in intentions and high-risk drinking, respectively. Although limited in its use thus far, the IBM shows promise in its application r

Development Of An Attribution Of Racial/Ethnic Health Disparities Scale, Robert E. Braun Phd., James H. Price, Jagdish Khubchandani, Erica Payton, Prasum Bhattacharjee

Health and Sport Sciences Faculty Scholarship

The purpose of this study was to develop an Attribution of Racial/Ethnic Health Disparities (AREHD) scale. A convenience sample of undergraduate college students (n = 423) at four Midwestern universities was recruited to respond to the survey. A pilot test with undergraduate students (n = 23) found the survey had good acceptability and readability level (SMOG = 11th grade). Using exploratory factor analysis we found the two a priori subscales were confirmed: individual responsibility and social determinants. Internal reliabilities of the subscales were: individual responsibility (alpha = 0.87) and social determinants (alpha = 0.90). Test–retest stability reliabilities were: individual responsibility …

Adult-Acquired Flatfoot Deformity And Age-Related Differences In Foot And Ankle Kinematics During The Single-Limb Heel-Rise Test, Ruth L. Chimenti, Joshua Tome, Cody D. Hillin, Adolph S. Flemister, Jeff Houck

Faculty Publications - College of Physical Therapy

STUDY DESIGN: Cross-sectional laboratory study.

OBJECTIVE: To compare single-limb heel-rise performance and foot-ankle kinematics between persons with stage 2 adult-acquired flatfoot deformity (AAFD) and healthy controls.

BACKGROUND: The inability to perform a single-limb heel rise is considered a positive functional diagnostic test for AAFD. However, which foot motions contribute to poor performance of this task are not known.

METHODS: Fifty individuals participated in this study, 20 with stage 2 AAFD (mean +/- SD age, 57.6 +/- 11.3 years), and 15 older participants (age, 56.8 +/- 5.3 years) and 15 younger participants (age, 22.2 +/- 2.4 years) without AAFD as control …

Governance Models For Collaborations Involving Assessment, Australian Medical Assessment Collaboration (Amac), Ben Canny, Hamish Coates

Higher education research

This paper is driven by a desire to improve assessment in higher education to yield better outcomes for communities, professions and individuals. The analysis unfolds within the field of medicine but is conceptualised to be of much broader relevance to other professional fields and academic disciplines. The focus is on assessment during the course as opposed to assessment for admissions or licensing purposes. The interest in assessment is not simply to produce practitioners, but to develop better practitioners. As well, the remarks are bounded by the context of universities in Australia and hence the complex but important assumption of academic …

Conservative Treatment Of De Quervain’S Tenosynovitis In Occupational Therapy: A Retrospective Outcome Study, Kevin R. Lang, Brittney S. Gibson, Kayleigh M. Oppenhuizen

Hand and Upper Extremity

Objective: De Quervain’s tenosynovitis (DQ) is a painful condition characterized by pain and inflammation at the first dorsal compartment of the wrist. This condition affects the wrist and thumb, and generally decreases an individual’s performance and engagement in daily occupations. Conservative management with occupational therapy (OT) can assist to diminish the associated symptoms and facilitate recovery of function; however, it is unclear what interventions are the most effective. The purpose of this study was to determine the effectiveness of conservative OT interventions for individuals diagnosed with DQ.

Study Design: An exploratory retrospective review of 148 de­‐identified electronic medical records provided …