Medicine and Health Sciences Commons^™

Mechanisms Of Immunological Tolerance In Central Nervous System Inflammatory Demyelination., Elisabeth R. Mari, Jason N. Moore, Guang-Xian Zhang, A. M. Rostami

Department of Neurology Faculty Papers

Multiple sclerosis is a complex autoimmune disease of the central nervous system that results in a disruption of the balance between pro-inflammatory and anti-inflammatory signals in the immune system. Given that central nervous system inflammation can be suppressed by various immunological tolerance mechanisms, immune tolerance has become a focus of research in the attempt to induce long-lasting immune suppression of pathogenic T cells. Mechanisms underlying this tolerance induction include induction of regulatory T cell populations, anergy and the induction of tolerogenic antigen-presenting cells. The intravenous administration of encephalitogenic peptides has been shown to suppress experimental autoimmune encephalomyelitis and induce tolerance …

Improving Patient Safety By Decreasing Restraint Use, Francesca R. Pearl

Master's Projects and Capstones

Restraints are among the top 15 most frequently reported sentinel events (Cosper et al., 2013). An improvement project was undertaken to reduce restraint use on a medical/surgical acute care unit within a 200 bed not-for-profit teaching hospital. The project aimed to reduce physical restraint use prevalence by 10%. After conducting a literature review and a microsystem assessment, Multidisciplinary Rounding (MDR) was identified as an evidence-based intervention to address physical restraint use. A reduction in restraint prevalence was noted from 2.4% to 1.6%. This equates to a 33% reduction in restraint prevalence. Other interventions implemented during the same time frame may …

Performing A Correct Surgical Time Out, Natalia E. Mariscal

Master's Projects and Capstones

The ending data reflected what we expected in that we would see a significant incline but

not quite the 100% compliance rate we are looking for. Our highest compliance rate has reached

90% and we have contributed the margin error to new staff that requires the proper teaching and

education. In conclusion I feel that the majority of staff was aware that they were not in

compliance with the time out but would proceed anyways due to the rush of the case or surgeon

or simply that they had become laxed in practice. Once the data was brought to staff …

Adverse Effects Of Asparaginase In Pediatric Patients With Acute Lymphoblastic Leukemia, Chengcheng Liu

Theses and Dissertations (ETD)

Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer. Asparaginase is a critical treatment component for ALL. However, its use is complicated by adverse effects, such as hypersensitivity, osteonecrosis and pancreatitis.

Hypersensitivity to asparaginase typically requires discontinuation of current formulation and substitution with other formulations, but the differential diagnosis can be challenging, and the diagnostic utility of antibody tests is unclear. We comprehensively analyzed anti-Elspar (native E.coli asparaginase) IgG antibodies in 410 pediatric patients treated on an asparaginaseintensive front-line clinical trial. Of 169 patients (41.2%) who exhibited clinical allergy, 147 (87.0%) were positive for anti-Elspar antibody. Of …

The Effect Of Background Music On The Visual Categorization Of Printed Words In Normal Younger And Older Adults, Sukhada Vaidya Mairal

Theses and Dissertations (ETD)

Aim: Research has shown that background music, with and without vocal content, has a detrimental effect on cognitive task performance. Research has also shown a decline in processing speed as age increases. The present study seeks to answer the following questions: 1. Will background vocal music have any detrimental effects on performance of a visual semantic word categorization task? 2. Does age have any effect on performance of visual semantic word categorization in the presence of background music?

Participants: Participants consisted of 36 adult native speakers of English with normal speech and language divided in to two groups based on …

Overcoming Acquired Resistance To Braf Inhibitors By Novel Synergistic Drug Combination And Discovery Of Novel Smac Mimetics As Selective Survivin Inhibitors, Jin Wang

Theses and Dissertations (ETD)

The first part (Chapter 1 and 2) of this dissertation presents a novel combination study of melanoma therapy. Acquired clinical resistance to vemurafenib, a selective BRAFV600E inhibitor, arises frequently after short term chemotherapy. Since the inhibitions of targets in the RAFMEK-ERK pathway result in G0/G1 cell cycle arrest, vemurafenib-resistant cancer cells are expected to escape this cell cycle arrest and progress to subsequent G2/M phase. We hypothesized that a combined therapy using vemurafenib with a G2/M phase blocking agent will trap resistant cells and overcome vemurafenib resistance. To test this hypothesis, we first determined the combination index (CI) values of …

Health-Related Quality Of Life In Children With Cancer, Tha'er Ghandi Almomani

Theses and Dissertations (ETD)

Health-related quality of life is an important phenomenon to measure in children undergoing treatment for cancer. However, the effects of different treatment modalities and cancer related factors over the duration of treatment have not been explored. To assess the effects of different child-, cancer-, and treatment-related factors, we analyzed a large sample of children undergoing curative treatment for 5 different childhood cancer diagnoses. These diagnostic groups were Hodgkin Lymphoma (HL), Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Osteosarcoma (OS), and Melanoma. We analyzed a sample of 710 patients across the five diagnostic groups over four time-points in treatment. These …

New Youth For Health Care: The Affordable Care Act Story, Thomas Nieboer

Honors Projects

No abstract provided.

A Comparison Of Ireland And The United States Health Care System And How My Experiences With Each Have Shaped My Future Goals, Jennifer Jess

Honors Projects

No abstract provided.

Ultrasound Biomicroscopic Imaging For Interleukin-1 Receptor Antagonist-Inhibiting Atherosclerosis And Markers Of Inflammation In Atherosclerotic Development In Apolipoprotein-E Knockout Mice, Rong-Juan Li, Yan Sun, Qin Wang, Jiao Yang, Ya Yang, Li Song, Zheng Wang, Xiang-Hong Luo, Rui-Juan Su

The Texas Heart Institute Journal

We sought to validate the hypothesis that the development of atherosclerosis can be suppressed by the interleukin-1 receptor antagonist (IL-1Ra) in murine models of atherosclerosis in vivo, noninvasively seen by means of high-resolution ultrasound biomicroscopy, and we studied changes in inflammatory markers such as IL-1 and C-reactive protein (CRP) plasma levels in these models of atherosclerosis.

We divided IL-1Ra+/−/apolipoprotein-E (apoE)−/− and IL-1Ra+/+/apoE−/− mice into 2 age groups, used as atherosclerotic models. The control groups were age-matched IL-1Ra+/+/apoE+/+ mice. Plaque thickness was measured in the ascending aorta in short-axis images by means of ultrasound and histology. Plasma levels of IL-1 and …

Degradation Science: Mesoscopic Evolution And Temporal Analytics Of Photovoltaic Energy Materials, Roger H. French, Rudolf Podgornik, Timothy J. Peshek, Laura S. Bruckman, Yifan Xu, Nicholas R. Wheeler, Abdulkerim Gok, Yang Hu, Mohammad A. Hossain, Devin A. Gordon, Pei Zhao, Jiayang Sun, Guo-Qiang Zhang

Faculty Scholarship

Based on recent advances in nanoscience, data science and the availability of massive real-world datastreams, the mesoscopic evolution of mesoscopic energy materials can now be more fully studied. The temporal evolution is vastly complex in time and length scales and is fundamentally challenging to scientific understanding of degradation mechanisms and pathways responsible for energy materials evolution over lifetime. We propose a paradigm shift towards mesoscopic evolution modeling, based on physical and statistical models, that would integrate laboratory studies and real-world massive datastreams into a stress/mechanism/response framework with predictive capabilities. These epidemiological studies encompass the variability in properties that affect performance …

Transcatheter Aortic Valve Replacement: A Physician-Patient's Story, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Modified Maze Procedure For Atrial Fibrillation As An Adjunct To Elective Cardiac Surgery: Predictors Of Mid-Term Recurrence And Echocardiographic Follow-Up, Claudia Loardi, Francesco Alamanni, Fabrizio Veglia, Claudia Galli, Alessandro Parolari, Marco Zanobini

The Texas Heart Institute Journal

The radiofrequency maze procedure achieves sinus rhythm in 45%–95% of patients treated for atrial fibrillation. This retrospective study evaluates mid-term results of the radiofrequency maze—performed concomitant to elective cardiac surgery—to determine sinus-rhythm predictive factors, and describes the evolution of patients' echocardiographic variables.

From 2003 through 2011, 247 patients (mean age, 64 ± 9.5 yr) with structural heart disease (79.3% mitral disease) and atrial fibrillation underwent a concomitant radiofrequency modified maze procedure. Patients were monitored by 24-hour Holter at 3, 6, 12, and 24 months, then annually. Eighty-four mitral-valve patients underwent regular echocardiographic follow-up. Univariate and multivariate analysis for risk factors …

Primary Prevention Of Sudden Cardiac Death In Adults With Transposition Of The Great Arteries: A Review Of Implantable Cardioverter-Defibrillator Placement, Sandeep S Sodhi, Ari M Cedars

The Texas Heart Institute Journal

Transposition of the great arteries encompasses a set of structural congenital cardiac lesions that has in common ventriculoarterial discordance. Primarily because of advances in medical and surgical care, an increasing number of children born with this anomaly are surviving into adulthood. Depending upon the subtype of lesion or the particular corrective surgery that the patient might have undergone, this group of adult congenital heart disease patients constitutes a relatively new population with unique medical sequelae. Among the more common and difficult to manage are cardiac arrhythmias and other sequelae that can lead to sudden cardiac death. To date, the question …

Successful Use Of Therapeutic Hypothermia In A Pregnant Patient, Kevin N Oguayo, Ola O Oyetayo, David Stewart, Steven M Costa, Richard O Jones

The Texas Heart Institute Journal

Out-of-hospital cardiac arrest is a leading cause of death in the United States. Pregnant women are not immune to cardiac arrest, and the treatment of such patients can be difficult. Pregnancy is a relative contraindication to the use of therapeutic hypothermia after cardiac arrest.

A 20-year-old woman who was 18 weeks pregnant had an out-of-hospital cardiac arrest. Upon her arrival at the emergency department, she was resuscitated and her circulation returned spontaneously, but her score on the Glasgow Coma Scale was 3. After adequate family discussion of the risks and benefits of therapeutic hypothermia, a decision was made to initiate …

Impact Of Insulin Resistance On Neointimal Tissue Proliferation After 2nd-Generation Drug-Eluting Stent Implantation, Takaaki Komatsu, Isao Yaguchi, Sachiko Komatsu, Shiro Nakahara, Sayuki Kobayashi, Yoshihiko Sakai, Isao Taguchi

The Texas Heart Institute Journal

Percutaneous coronary intervention is established as an effective treatment for patients with ischemic heart disease; in particular, drug-eluting stent implantation is known to suppress in-stent restenosis. Diabetes mellitus is an independent risk factor for restenosis, so reducing insulin resistance is being studied as a new treatment approach. In this prospective study, we sought to clarify the factors associated with in-stent restenosis after percutaneous coronary intervention, and we evaluated the homeostasis model assessment of insulin resistance (HOMA-IR) index as a predictor of restenosis.

We enrolled 136 consecutive patients who underwent elective percutaneous coronary intervention at our hospital from February 2010 through …

Co-Construction Of Personal Narratives In Supporting Identity And Communication In Adults With Aphasia: The ‘My Story’ Project, Katie A. Strong

Dissertations

Stroke and subsequent aphasia can impact a person’s identity negatively, interfering with quality of life. Co-constructing personal narratives about stroke and other aspects of a person’s life is a promising intervention for addressing identity issues. This series of three dissertation studies explored key aspects related to identity, personal narratives, and the perceived impact of telling one’s story.

Study 1 involved a survey examining whether speech-language pathologists view themselves as having a role in supporting the reconstruction of self-identity in adults with aphasia through the use of personal narratives. Results revealed that, whereas the majority of respondents viewed themselves as having …

Fatty Acids Linked To Cardiovascular Mortality Are Associated With Risk Factors, Sven O. E. Ebbesson, V. Saroja Voruganti, Paul B. Higgins, Richard R. Fabsitz, Lars O. Ebbesson, Sandra Laston, William S. Harris, John Kennish, Benjamin D. Umans, Hong Wang

School of Medicine Publications

Background. Although saturated fatty acids (FAs) have been linked to cardiovascular mortality, it is not clear whether this outcome is attributable solely to their effects on low-density lipoprotein cholesterol (LDL-C) or whether other risk factors are also associated with FAs. The Western Alaskan Native population, with its rapidly changing lifestyles, shift in diet from unsaturated to saturated fatty acids and dramatic increase in cardiovascular disease (CVD), presents an opportunity to elucidate any associations between specific FAs and known CVD risk factors.

Objective. We tested the hypothesis that the specific FAs previously identified as related to CVD mortality are also associated …

Connection Between Education And Relationship With Doctor In Female Clinical Research Participation: A Multi-Center Study Investigating The Factors That Influence Female Participation In Clinical Research, Lauren Crawford, Anita Kurt Phd, Rn

Research Scholars Poster Presentation

Connection Between Education and Relationship with Doctor in Female Clinical Research Participation: A Multi-Center Study Investigating the Factors that Influence Female Participation in Clinical Research

Lauren Crawford; Anita Kurt PhD, RN

Abstract

Women, particularly those in racial and ethnic minorities, have long been underrepresented in clinical research. There are many barriers that prevent women from participating. This study aims to determine some of the less recognized factors and barriers faced in women’s decisions, specifically trust of and relationship with doctors. It is hypothesized that trust of doctors varies by level of education and that female participants in research believe these …

Negative Skeletal Effects Of Locally Produced Adiponectin, Marcia J. Abbott, Theresa M. Roth, Linh Ho, Liping Wang, Dylan O'Carroll, Robert A. Nissenson

Health Sciences and Kinesiology Faculty Articles

Epidemiological studies show that high circulating levels of adiponectin are associated with low bone mineral density. The effect of adiponectin on skeletal homeostasis, on osteoblasts in particular, remains controversial. We investigated this issue using mice with adipocyte-specific over-expression of adiponectin (AdTg). MicroCT and histomorphometric analysis revealed decreases (15%) in fractional bone volume in AdTg mice at the proximal tibia with no changes at the distal femur. Cortical bone thickness at mid-shafts of the tibia and at the tibiofibular junction was reduced (3–4%) in AdTg mice. Dynamic histomorphometry at the proximal tibia in AdTg mice revealed inhibition of bone formation. AdTg …

Robot-Assisted Surgeries: Developing A Database For Future Research On Better Practice, Mack Trexler, Sarah K. Wenrich Pa-C, Kyle M. Langston Pa-C

Research Scholars Poster Presentation

Robot-Assisted Surgeries: Developing a Database for Future Research on Better Practice

Mack Trexler¹
Sarah Wenrich, PA-C^1,2 and Kyle Langston, PA-C^1,2

¹Department of Robotic Surgery, LVHN
²Summer Research Scholar Program Mentor

Abstract

Although the first FDA approved utilization of Intuitive Surgical’s da Vinci® Surgery System dates back to the year 2000, the Lehigh Valley Health Network (LVHN) only began using this emergent technology for minimally invasive surgery in 2007. Since the inception of the Robotic Surgery Department roughly 8 years ago, the LVHN has performed over 4,000 robotic cases—a number seemingly large enough to derive valuable …

Incidence Of Rejection In Renal Transplant Surgery In The Lvhn Population Leading To Graft Failure: 6 Year Review, Jessica Ludolph, Lynsey S. Biondi Md, Michael J. Moritz Md

Research Scholars Poster Presentation

Incidence of Rejection in Renal Transplant Surgery in the LVHN Population Leading to Graft Failure: 6 Year Review

Jessica Ludolph¹

Lynsey Biondi, MD^1,2 and Michael Moritz, MD^1,2

¹Department of Surgery, Lehigh Valley Health Network

²Research Scholar Program Mentor

Abstract

To obtain optimal outcomes, it is vital to continually investigate variables potentially effecting rejection and graft failures. 407 renal transplant recipients who were transplanted at The Transplant Center of the Lehigh Valley from January 2009 to December 2014 were analyzed using descriptive statistics. Variables potentially influencing graft survival, including delayed graft function, and cell mediated and …

The Adaptive Change Of Hla-Drb1 Allele Frequencies Caused By Natural Selection In A Mongolian Population That Migrated To The South Of China, Hao Sun, Zhaoqing Yang, Keqin Lin, Shuyuan Liu, Kai Huang, Xiuyun Wang, Jiayou Chu, Xinyu Huang

Faculty Publications

Pathogen-driven balancing selection determines the richness of human leukocyte antigen (HLA) alleles. Changes in the pathogen spectrum may cause corresponding changes in HLA loci. Approximately 700 years ago, a Mongolian population moved from the north of China to the Yunnan region in the south of China. The pathogen spectrum in the south of China differs from that in the north. In this study, changes in the HLA genes in the Yunnan Mongolian population, as well as the underlying mechanism, were investigated. A sequence-based typing method (SBT) was used to genotype HLA-DRB1 in 470 individuals from two Mongolian populations and another …

Physical Activity Design Guidelines For School Architecture, Jeri Brittin, Dina Sorensen, Matthew Trowbridge, Karen K. Lee, Dieter Breithecker, Leah Frerichs, Terry Huang

Publications and Research

Increasing children’s physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students’ physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 …

Sexual And Reproductive Health Research And Research Capacity Strengthening In Africa: Perspectives From The Region., Richard Adanu, Michael T. Mbizvo, Adama Baguiya, Vincent Adam, Beyene W. Ademe, Augustine Ankomah, Godwin N. Aja, Ademola J. Ajuwon, Olapeju A. Esimai, Taofeek Ibrahim, Dintle K. Mogobe, Özge Tunçalp, Venkatraman Chandra-Mouli, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Developing the capacity to effectively carry out public health research is an integral part of health systems at both the national and global levels and strengthening research capacity is recognized as an approach to better health and development in low- and middle-income countries (LMICs). Especially fields such as sexual and reproductive health (SRH) would require inter-disciplinary teams of researchers equipped with a range of methodologies to achieve this. In November 2013, as part of the International Family Planning Conference in Addis Ababa, Ethiopia, a group of African researchers came together to discuss the gaps and strategies to improve sexual and …

Sweat Gland Density And Response During High-Intensity Exercise In Athletes With Spinal Cord Injuries, Robert C. Pritchett, A. M. Al-Nawaiseh, K. K. Pritchett, V. Nethery, P. A. Bishop, J. M. Green

All Faculty Scholarship for the College of the Sciences

Sweat production is crucial for thermoregulation. However, sweating can be problematic for individuals with spinal cord injuries (SCI), as they display a blunting of sudomotor and vasomotor responses below the level of the injury. Sweat gland density and eccrine gland metabolism in SCI are not well understood. Consequently, this study examined sweat lactate (S-LA) (reflective of sweat gland metabolism), active sweat gland density (SGD), and sweat output per gland (S/G) in 7 SCI athletes and 8 able-bodied (AB) controls matched for arm ergometry VO₂peak. A sweat collection device was positioned on the upper scapular and medial calf of …

The Identification Of Maltreatment In Children With Disabilities: An Education Program, Jessica Leigh Ahmann

Nursing Capstones

No abstract provided.

The Effect Of Aspirin On Bleeding And Transfusion In Contemporary Cardiac Surgery., Jordan E Goldhammer, Gregary D. Marhefka, Constantine Daskalakis, Mark W Berguson, John E Bowen, James Diehl, Jianzhong Sun

Department of Medicine Faculty Papers

OBJECTIVE: Despite evidence that preoperative aspirin improves outcomes in cardiac surgery, recommendations for aspirin use are inconsistent due to aspirin's anti-platelet effect and concern for bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on bleeding and transfusion in cardiac surgery.

METHODS: This retrospective study involved consecutive patients (n=1571) who underwent CABG, valve, or combined CABG and valve surgery at a single center between March 2007 and July 2012. Of all patients, 728 met the inclusion criteria and were divided into two groups: those using (n=603) or not using (n=125) aspirin within 5 days …

Agave Chewing And Dental Wear: Evidence From Quids, Emily E. Hammerl, Melissa A. Baier, Karl Reinhard

Karl Reinhard Publications

Agave quid chewing is examined as a potential contributing behavior to hunter-gatherer dental wear. It has previously been hypothesized that the contribution of Agave quid chewing to dental wear would be observed in communities wherever phytolith-rich desert succulents were part of subsistence. Previous analysis of coprolites from a prehistoric agricultural site, La Cueva de los Muertos Chiquitos in Durango, Mexico, showed that Agave was a consistent part of a diverse diet. Therefore, quids recovered at this site ought to be useful materials to test the hypothesis that dental wear was related to desert succulent consumption. The quids recovered from the …

Atrial Fibrillation In Sub-Saharan Africa: Epidemiology, Unmet Needs, And Treatment Options, Bruce Sheldon Stambler, Mzee Ngunga

Internal Medicine, East Africa

Health care in Sub-Saharan Africa is being challenged by a double burden of disease as lifestyle diseases common in the developed world, such as stroke and atrial fibrillation (AF), increase, while, simultaneously, health issues of the developing world in terms of communicable disease persist. The prevalence of AF is lower in Africa than in the developed world but is expected to increase significantly over the next few decades. Patients with AF in Africa tend to be younger and have a higher prevalence of rheumatic valvular heart disease than patients with AF in other regions. Permanent AF is the most prevalent …