Medicine and Health Sciences Commons^™

Pathophysiology And Treatment Of Life-Threatening Angioedema, Stephen J. Hoffman

Nursing Student Class Projects (Formerly MSN)

Angioedema is a potentially lethal swelling of the interstitial space from extravasation of intravascular plasma (Wood, Choromanski, & Orlewicz, 2013). Angioedema may present in any medical setting with a broad range of severity. Angioedema is commonly seen in emergency departments and intensive care units. According to Barbara, Ronan, Maddox, & Warner (2013), “angioedema is of particular importance to anesthesiologists, as it may present at any point in the perioperative period and it may rapidly become life-threatening if it involves airway compromise” (p. 335). Anesthesia professionals may also respond to airway management emergencies throughout the hospital setting and may treat angioedema …

Preparedness Of Nurses For Malignant Hyperthermia, Melissa Flemming

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia (MH) is a potentially life threatening disorder that occurs following exposure to certain inhaled anesthetics such as halothane, isoflurane, sevoflurane, desflurane, enflurane, ether, and methoxyflurane alone or in combination with the depolarizing muscle relaxant, succinylcholine (Seifert,, Wahr, Pace, Cochrane, & Bagnola, 2014, p. 189). Patients experiencing malignant hyperthermia may progress to death if it is not recognized and treated early. Patient outcomes improve the earlier an intervention is given. Malignant hyperthermia is not a common condition and, therefore, nurses are frequently unfamiliar with the common signs, symptoms, and treatments. Malignant hyperthermia can occur in a variety of settings …

The Importance Of Evaluation And Management Of Sepsis, Severe Sepsis, And Septic Shock, Katherine Herda

Nursing Student Class Projects (Formerly MSN)

Sepsis is a life-threatening and complicated host response to the presence of infection that is affecting millions of individuals around the world each year (Dellinger et al., 2013, p. 583). According to Gray et al. (2013), sepsis is not only one of the primary causes of hospital admission but it is also a leading cause of morbidity and mortality worldwide (p. 397). Severe sepsis and septic shock are the more advanced and detrimental stages of sepsis, which are starting to increase in incidence and are killing one in four (and sometimes more) individuals infected (Dellinger et al., 2013, p. 583). …

Methylene Chloride Exposure Evaluation During Active Pharmaceutical Ingredient Manufacturing, Janet Rullman

Graduate Theses & Non-Theses

A manufacturer utilizes methylene chloride (CH2Cl2) (CAS 75-09-2), also known as dichloromethane, to manufacture active pharmaceutical ingredients. Methylene chloride is specifically regulated by the Occupational Safety and Health Administration (OSHA) under 29 Code of Federal Regulation (CFR) 1910.1052. Evaluation and documentation of employee exposure to methylene chloride is required to comply with OSHA regulations. In addition to OSHA compliance, it is also important to evaluate employee exposure levels to determine if respiratory protection, regulation of the work area, and medical monitoring are necessary.

This industrial hygiene report describes an investigation into the risks of exposure to methylene chloride. This report …

Shame, Relational Aggression, And Sexual Satisfaction: A Longitudinal Study, Austin Ray Beck

Student Works

This longitudinal study examined the relationship between husband and wife shame and husband and wife sexual satisfaction one year later with husband and wife relational aggression as mediating variables. The sample included 353 heterosexual married couples who participated in the Flourishing Families Research Project, a longitudinal study of daily family life. Results showed that husband and wife shame was negatively related with husband and wife sexual satisfaction, respectively. Husband love withdrawal was negatively related with both husband and wife sexual satisfaction, while wife love withdrawal was negatively related with only husband sexual satisfaction. Each partner's use of social sabotage was …

Hiv Risk Perception And Risk Behaviors Among Men Who Have Sex With Men In Nigeria, George I. Eluwa, Adebajo Sylvia, Stanley Luchters, Babatunde Ahonsi

Population Health, East Africa

Background: Some studies have shown that greater perceived vulnerability to HIV is associated with less involvement in risk taking. We evaluated prevalence and correlates of HIV risk perception among men who have sex with men (MSM) in Nigeria.

Methods: A cross sectional study using respondent driven sampling (RDS) was conducted in six Nigerian states in 2010. Weighted HIV risk perceptions were calculated using an RDS analytic tool. Logistic regression was used to determine correlates of HIV risk perception, stratified by state.

Results: The total number of MSM ranged from 217 in Abuja to 314 in Cross River state. Median age …

Changes In Serum Strongylus Vulgaris-Specific Antibody Concentrations In Response To Anthelmintic Treatment Of Experimentally Infected Foals, Martin Krarup Nielsen, Jessica Scare, Holli Sullivan Gravatte, Jennifer Lynn Bellaw, Julio C. Prado, Craig Robert Reinemeyer

Maxwell H. Gluck Equine Research Center Faculty Publications

Strongylus vulgaris is the most pathogenic nematode parasite of horses. Its extensive migration in the mesenteric blood vessels can lead to life-threatening intestinal infarctions. Recent work has shown that this parasite is still identified among managed horse populations. A serum enzyme-linked immunosorbent assay (ELISA) has been developed for the detection of migrating larvae of S. vulgaris. Previous work has documented an increase in ELISA values following larvicidal treatment with ivermectin and suggested that the target parasite antigen is primarily produced by the later larval stages. The aim of this study was to experimentally inoculate cohorts of foals with S. …

The Effects Of Antiepileptic Inducers In Neuropsychopharmacology, A Neglected Issue. Part Ii: Pharmacological Issues And Further Understanding, Jose De Leon

Psychiatry Faculty Publications

The literature on inducers in epilepsy and bipolar disorder is seriously contaminated by false negative findings. Part II of this comprehensive review on antiepileptic drug (AED) inducers provides clinicians with further educational material about the complexity of interpreting AED drug-drug interactions.

The basic pharmacology of induction is reviewed including the cytochrome P450 (CYP) isoenzymes, the Uridine Diphosphate Glucuronosyltransferases (UGTs), and P-glycoprotein (P-gp). CYP2B6 and CYP3A4 are very sensitive to induction. CYP1A2 is moderately sensitive while CYP2C9 and CYP2C19 are only mildly sensitive. CYP2D6 cannot be induced by medications. Induction of UGT and P-gp are poorly understood. The induction of metabolic …

Role Of Mitochondria In Regulating Microrna Activity And Its Relevance To The Central Nervous System, Wang-Xia Wang, Joe E. Springer

Physical Medicine and Rehabilitation Faculty Publications

No abstract provided.

A Step By Step Methodological Approach To Appraise The Quality Of Written Feedback Using Comment Analysis, Lubna Ghazal, Raisa B. Gul, Amina Aijaz Khowaja

School of Nursing & Midwifery

Several studies have been conducted to analyze the quality of written feedback given by teachers on students’ written assignments. However, it has been observed that there is no clear existing method or tool to facilitate the analysis of teachers’ written feedback. This paper aims to document a step by step methodological approach to analyze teachers’ comments and appraise the quality of feedback on students’ written assignments. A self-initiated tool was developed from the comment analysis process which revealed the use of various formats and modes employed to provide written feedback to the students. In addition, this tool helped to determine …

Some Comments On Cavenagh, Costelloe, Davis, And Howell (2015), Manish Rami

Communication Sciences & Disorders Faculty Publications

This letter addresses some concern in Cavenagh, Costelloe, Davis, and Howell (2015) titled “Characteristics of Young Children Close to the Onset of Stuttering.” Concerns include incomplete report of collected data from speech samples and the Wechsler Preschool and Primary Scale of Intelligence, interpretation of some data from the Child Health Questionnaire, and other issues.

Placental Dna Methylation Related To Both Infant Toenail Mercury And Adverse Neurobehavioral Outcomes, Jennifer Zeynab Joukhadar Maccani, Devin C. Koestler, Barry Lester, E Andres Houseman, David A. Armstrong, Karl T. Kelsey, Carmen J. Marsit

Dartmouth Scholarship

Background:

Prenatal mercury (Hg) exposure is associated with adverse child neurobehavioral outcomes. Because Hg can interfere with placental functioning and cross the placenta to target the fetal brain, prenatal Hg exposure can inhibit fetal growth and development directly and indirectly.

Objectives:

We examined potential associations between prenatal Hg exposure assessed through infant toenail Hg, placental DNA methylation changes, and newborn neurobehavioral outcomes.

Methods:

The methylation status of > 485,000 CpG loci was interrogated in 192 placental samples using Illumina’s Infinium HumanMethylation450 BeadArray. Hg concentrations were analyzed in toenail clippings from a subset of 41 infants; neurobehavior was assessed using the NICU …

Nitrous Oxide For Pain Management During In-Office Hysteroscopic Sterilization, Emily N. Schneider

Biomedical Sciences ETDs

Objectives: To determine if inhaled nitrous oxide with oxygen (NOS) is superior to oral sedation for pain management during in-office hysteroscopic sterilization. Methods: This double blinded randomized controlled trial enrolled women undergoing in-office hysteroscopic sterilization. The intervention group received NOS titrated to a maximum 70%:30% NO:O2 mixture and placebo pills 30 minutes prior to the procedure. The control group received inhaled O2 during the procedure and 5/325mg hydrocodone/acetaminophen and 1mg lorazepam 30 minutes prior to the procedure. The primary outcome was maximum procedural pain, assessed on a 100mm Visual Analogue Scale (VAS) 3 minutes post procedure. A sample size of …

Immediate Postpartum Versus Interval Intrauterine Devices And Implant: A Cost Utility Analysis, Michelle R. Chungtuyco

Biomedical Sciences ETDs

Objectives: To compare the cost per quality of life (QALY) between immediate postpartum and interval initiation of intrauterine devices (IUDs) and contraceptive implants from the societal perspective. Cost per unintended pregnancy prevented between timing strategies was also compared. Methods: Two decision analytic models were created using TreeAge Pro 2015 software for TCu380A IUD and levonorgestrel IUD and for the contraceptive implant. Each model compared immediate postpartum versus interval contraceptive provision to determine the occurrence of pregnancy events over time and their impact on costs and QALYs, using a time horizon of 1 to 5 years. The probabilities of insertion, expulsion/removal, …

Beyond The Basics: Providing Continuing Education Workshops For Preceptors; A Commentary, Sara Nottingham, Michelle A. Cleary, Jason Bennett

Education Faculty Articles and Research

Current Commission on Accreditation of Athletic Training Education (CAATE) standards allow education programs to determine the most appropriate format and content of preceptor workshops. Clinicians, including preceptors, have noted challenges trying to keep their knowledge updated with current standards of care and educational competencies. Clinicians and preceptors in our program and the literature have described challenges trying to keep knowledge current with changing standards of care, research evidence, and athletic training educational competencies. Preceptors also value applicable and easily accessible continuing education opportunities. In order to address these challenges and provide accessible continuing education opportunities for preceptors, the faculty in …

Today - July 2015, Loma Linda University Health

TODAY

Inside this issue:

-- Thousands experience Loma Linda University Health at 60th General Conference Session
-- Empowering teachers: EXSEED trains K-12 educators in the art of teaching STEM
-- LLUMC Murrieta named 'Most Wired' by American Hospital Association for second consecutive year
-- Twins overcome insurmountable odds to celebrate first berthday
-- Worldwide delegates from General Conference session tour Loma Linda University Health campus
-- The importance of child health care spans across continents
-- Memory of Cancer Center patients lives on
-- Why go on a mission trip?
-- President's Award recipients represent that University's best
-- Ralph Lee …

Dualism And Doctrine, Dov Fox, Alex Stein

Indiana Law Journal

What kinds of harm among those that tortfeasors inflict are worthy of compensation? Which forms of self-incriminating evidence are privileged against government compulsion? What sorts of facts constitute a criminal defendant’s intent? Existing doctrine pins the answer to all of these questions on whether the injury, facts, or evidence at stake are “mental” or “physical.” The assumption that operations of the mind are meaningfully distinct from those of the body animates fundamental rules in our law.

A tort victim cannot recover for mental harm on its own because the law presumes that he is able to unfeel any suffering arising …

Intractable Delay And The Need To Amend The Petition Provisions Of The Fdca, Diana R. H. Winters

Indiana Law Journal

Private party oversight has proven to be ineffective at countering inaction by the Food and Drug Administration (FDA). Inaction when regulation is warranted can put the public at continued and increasing risk of harm, but the failure of private enforcement to compel action reverberates beyond this harm to the interests of individuals. It also diminishes the transparency of agency decision making, lessens the opportunity for public participation, and reduces the interaction between the institutions that oversee agencies. Moreover, the benefits afforded to the administrative process by judicial review are weakened.

This Article analyzes two examples of FDA inertia and compares …

New Approach To Develop Ultra-High Inhibitory Drug Using The Power Function Of The Stoichiometry Of The Targeted Nanomachine Or Biocomplex, Dan Shu, Fengmei Pi, Chi Wang, Peng Zhang, Peixuan Guo

Pharmaceutical Sciences Faculty Publications

AIMS: To find methods for potent drug development by targeting to biocomplex with high copy number.

METHODS: Phi29 DNA packaging motor components with different stoichiometries were used as model to assay virion assembly with Yang Hui's Triangle [Formula: see text], where Z = stoichiometry, M = drugged subunits per biocomplex, p and q are the fraction of drugged and undrugged subunits in the population.

RESULTS: Inhibition efficiency follows a power function. When number of drugged subunits to block the function of the complex K = 1, the uninhibited biocomplex equals q(z), demonstrating the multiplicative effect of stoichiometry on inhibition with …

Influence Of Linker Length And Composition On Enzymatic Activity And Ribosomal Binding Of Neomycin Dimers, Derrick Watkins, Sunil Kumar, Keith D. Green, Dev P. Arya, Sylvie Garneau-Tsodikova

Pharmaceutical Sciences Faculty Publications

The human and bacterial A site rRNA binding as well as the aminoglycoside-modifying enzyme (AME) activity against a series of neomycin B (NEO) dimers is presented. The data indicate that by simple modifications of linker length and composition, substantial differences in rRNA selectivity and AME activity can be obtained. We tested five different AMEs with dimeric NEO dimers that were tethered via triazole, urea, and thiourea linkages. We show that triazole-linked dimers were the worst substrates for most AMEs, with those containing the longer linkers showing the largest decrease in activity. Thiourea-linked dimers that showed a decrease in activity by …

Inhibition Of Aminoglycoside Acetyltransferase Resistance Enzymes By Metal Salts, Yijia Li, Keith D. Green, Brooke R. Johnson, Sylvie Garneau-Tsodikova

Pharmaceutical Sciences Faculty Publications

Aminoglycosides (AGs) are clinically relevant antibiotics used to treat infections caused by both Gram-negative and Gram-positive bacteria, as well as Mycobacteria. As with all current antibacterial agents, resistance to AGs is an increasing problem. The most common mechanism of resistance to AGs is the presence of AG-modifying enzymes (AMEs) in bacterial cells, with AG acetyltransferases (AACs) being the most prevalent. Recently, it was discovered that Zn²⁺ metal ions displayed an inhibitory effect on the resistance enzyme AAC(6')-Ib in Acinetobacter baumannii and Escherichia coli. In this study, we explore a wide array of metal salts (Mg²⁺, …

Language Barriers Impact Prehospital Care, Ramsey Tate

Biomedical Sciences ETDs

Emergency medical services (EMS) rely on accurate and efficient communication. The impact of language discordance between EMS providers and their patients on EMS decision-making has not been well-studied, nor have the strategies that EMS providers use to overcome language barriers. This thesis presents a body of scholarly work investigating the prior research on language barriers in the prehospital setting, the application of mixed methods to prehospital research, and the results of an international, multi-site, mixed methods study of the impact of language barriers on prehospital care. EMS providers struggle with a lack of language assistance resources that are appropriate for …

Effects Of Low-Dose Gamma Radiation In A Murine Model Of Benzo[A]Pyrene-Induced Lung Cancer, Veronica R. Bruce

Biomedical Sciences ETDs

Lung cancer is the leading cause of cancer related mortality in the United States and in the world. One of the carcinogenic compounds found in cigarette smoke, Benzo[a]pyrene (B[a]P), at high levels elicits a number of inflammatory events consistent with those found in lung cancer patients. In our studies, the effects of low-dose gamma radiation (LDR) on carcinogenesis and tumor progression in a murine model of B[a]P-induced lung cancer were investigated. Two studies (46 weeks in duration) were conducted to assess the effects of fractionated doses of low-dose gamma rays on whole body irradiated A/J mice either before or following …

Glanzmann's Thrombasthenia: Pathogenesis, Diagnosis, And Current And Emerging Treatment Options, Tia Solh, Ashley Botsford, Melhem Solh

PCOM Scholarly Works

Glanzmann’s thrombasthenia (GT) is a genetic platelet surface receptor disorder of GPIIb/IIIa (ITG αIIbβ3), either qualitative or quantitative, which results in faulty platelet aggregation and diminished clot retraction. Spontaneous mucocutaneous bleeding is common and can lead to fatal bleeding episodes. Control and prevention of bleeding among patients with GT is imperative, and remains challenging. Local measures, including anti-fibrinolytic therapy, with or without platelet transfusions, used to be the mainstay of therapy. However, in recent years the use of recombinant factor VIIa (rFVIIa) has increased significantly, with excellent response rates in treating and preventing hemorrhage among GT patients. Gene therapy and …

A Genetic Porcine Model Of Cancer, Lawrence B. Schook, Tiago V. Collares, Wenping Hu, Ying Liang, Fernanda M. Rodrigues, Laurie A. Rund, Kyle M. Schachtschneider, Fabiana K. Seixas, Kuldeep Singh, Kevin D. Wells, Eric M. Walters, Randall S. Prather, Christopher M. Counter

Toxicology and Cancer Biology Faculty Publications

The large size of the pig and its similarity in anatomy, physiology, metabolism, and genetics to humans make it an ideal platform to develop a genetically defined, large animal model of cancer. To this end, we created a transgenic "oncopig" line encoding Cre recombinase inducible porcine transgenes encoding KRAS^G12D and TP^53R167H, which represent a commonly mutated oncogene and tumor suppressor in human cancers, respectively. Treatment of cells derived from these oncopigs with the adenovirus encoding Cre (AdCre) led to KRAS^G12D and TP^53R167H expression, which rendered the cells transformed in culture and tumorigenic when engrafted into …

Oncolog, Volume 60, Number 07, July 2015, Kathryn L. Hale, Bryan Tutt, K. Stuyck

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Emergency Care for Cancer Patients: Medical problems that may seem routine in patients without cancer often mean something different or have a different cause in cancer patients and may be much more serious, requiring urgent treatment. Managing these problems promptly and effectively is a challenge faced by all cancer centers.
• Immunotherapy Trials Offer Hope to Patients with High-Risk or Metastatic Cancer: Although the cure rate for the breast cancer has risen steadily in recent decades, recurrent or metastatic disease remains difficult to control. To fight metastatic breast cancer and forestall the recurrence of high-risk primary disease, researchers at The University …

Mobile Health-Care Information For All: A Global Challenge, Geoff Royston, Christine Hagar, Lesley-Anne Long, Dennis Mcmahon, Neil Pakenham-Walsh, Nand Wadhwani

Faculty Publications

Access to health-care information for citizens is a key determinant to reach both the Millennium Development Goals (MDGs) and the emerging post-2015 Sustainable Development Goals, but this challenge has repeatedly been relegated to the sidelines.1 What might kickstart progress? An obvious candidate is the mobile phone, which is becoming ubiquitous in low-income and middle-income countries.

Shiga Toxin-Producing Escherichia Coli (Stec) Detection Strategies With Formalin-Fixed Stec Cells, Christopher Adam Baker

Graduate Theses and Dissertations

Certain pathogenic Escherichia coli known as Shiga toxin (Stx)-producing Escherichia coli (STEC) are commensals in cattle, and typically cause bloody diarrhea in humans once the Stx toxin is secreted in invaded intestinal epithelial cells. Infections with STEC cells can lead to hemolytic uremic syndrome, which is commonly associated with kidney failure. Several STEC serogroups have been declared adulterants in raw, non-intact ground meat, and future regulations could potentially lead to a higher number of STEC serogroup detection strategies for these pathogenic microorganisms. Microbiological research laboratories may benefit from formalin-fixed STEC cells for periodic (daily, weekly, monthly, among others) instrument validation/calibration …

A Survey Of Concerns In End-Of-Life Care: Perspective From Pakistan, Ariba Khan, Maharaj Singh, Sarah Saeed, Arif Siddiqui, Zeba Aziz, Michael Malone

College of Nursing Faculty Research and Publications

Personalized health care that incorporates advance care planning and aligns treatment with patient-centered goals can improve the quality of life of dying individuals and reduce stress, anxiety, and depression in surviving relatives. Although several prognostication indices that address all-cause mortality have been developed for use in elderly inpatients, none have been integrated into the electronic health record (EHR) to automatically identify high-risk individuals and used during interdisciplinary team rounds to identify vulnerable hospitalized adults.3 At Aurora Health Care in Milwaukee, Wisconsin, an automated alert for serious medical illnesses has been programmed into the EHR. Built on previous findings,the alert …

A Needs Assessment Of Occupation Based Services In A West Michigan Homeless Shelter From A Staff Perspective, Stephanie A. Ballard, Katie M. Deveneau, April D. Hemlock

Community Based

In this qualitative study, student researchers conducted one-on-one semi-structured interviews of individuals employed by a homeless shelter in West Michigan, posing questions related to the perceived need of occupation-based services for shelter recipients, and the efficacy of current services. Narratives were interpreted using thematic analysis, yielding themes related to the barriers faced by the shelter population, life skills of the shelter population, and services in place to provide for the needs of the shelter recipients. Authors concluded that shelter staff perceived a need for occupation-based services to engage the shelter population in meaningful occupations, particularly relating to leisure, education and …