Medicine and Health Sciences Commons^™

A Systematic Review And Meta-Regression Analysis Of Lung Cancer Risk And Inorganic Arsenic In Drinking Water., Steven H. Lamm, Hamid Ferdosi, Elisabeth K. Dissen, Ji Li, Jaeil Ahn

Epidemiology Faculty Publications

High levels (> 200 µg/L) of inorganic arsenic in drinking water are known to be a cause of human lung cancer, but the evidence at lower levels is uncertain. We have sought the epidemiological studies that have examined the dose-response relationship between arsenic levels in drinking water and the risk of lung cancer over a range that includes both high and low levels of arsenic. Regression analysis, based on six studies identified from an electronic search, examined the relationship between the log of the relative risk and the log of the arsenic exposure over a range of 1-1000 µg/L. The …

Patient Centered Medical Home: Creating A Blueprint For Quality Healthcare Through Illustrative Simulation, Brenda Helen Sheingold, Deborah W. Chapa, Esther Emard

Nursing Faculty Publications

The advent of healthcare reform in the U.S. presents an unprecedented challenge to academic institutions that are striving to prepare a workforce to interact with individuals needing care in a variety of new practice settings. Patient-centered care is a core objective of these evolving settings which enhance access to a variety professionals and services in one location. This study was conducted over a period of three years and describes how illustrative simulation can be employed as a learning intervention to prepare graduate students for the expanded scope of practice necessary to function in the Patient Centered Medical Home healthcare delivery …

Leadership In Learning And Teaching In Higher Education: Perspectives Of Academics In Non-Formal Leadership Roles, Anne Hofmeyer, Brenda Helen Sheingold, Hester C. Klopper, Jane Warland

Nursing Faculty Publications

Developing leaders and leadership are key factors to improve learning and teaching in higher education. Despite the abundance of literature concerning developing formal leadership, fewer studies have been conducted with academics in non-formal leadership roles that focus on how they develop their leadership in learning and teaching. Publication and funding metrics are evidence of leadership and success in research. Metrics in learning and teaching exist, but are less well accepted and valued. We undertook a qualitative descriptive study to examine how academics in non-formal leadership roles at an Australian university understood leadership and described their leadership in teaching. Following ethical …

St Segment Depression After Norwood/Systemic-Pulmonary Artery Shunt, Ashraf Harahsheh, Craig A. Sable, Pranava Sinha, Richard A. Jonas

Pediatrics Faculty Publications

A three-month-old girl with double inlet left ventricle (S;D;D), hypoplastic outlet ventricle, restrictive bulboventricular foramen, d-transposition of great arteries and interrupted aortic arch underwent Norwood stage 1 operation, systemic to pulmonary artery (PA) shunt and atrial septectomy, and developed ectopic atrial tachycardia that responded to digoxin therapy. She developed fussiness lasting two hours, not associated with cyanosis, and not relieved by feeding. Her pulse oximetry was 88% while breathing room air, and she had no differential blood pressure gradient.

An Exploratory Study Of Dog Park Visits As A Risk Factor For Exposure To Drug-Resistant Extra-Intestinal Pathogenic E. Coli (Expec)., Lubna N. Ahmed, Lance B. Price, Jay P. Graham

Environmental and Occupational Health Faculty Publications

Background

Extraintestinal pathogenic E. coli (ExPEC) are common causative agents of urinary tract infections in humans. Dogs have been found to harbor ExPEC. This study tested stool samples from dogs (n = 16), the shoes of dog park visitors (n = 16) and the shoes of controls (n = 16) for ExPEC. Phenotypic resistance of isolates was characterized.

Findings

ExPEC were present in one-third of the dog stool samples, 9% of the samples from the shoes of dog park visitors and 6% of control samples. Half of the ExPEC isolates were multi-drug resistant.

Discussion

The findings suggest that dogs may …

Staphylococcus Aureus And The Ecology Of The Nasal Microbiome, Cindy M. Liu, Lance B. Price, Bruce A. Hungate, Alison G. Abraham, Lisbeth A. Larsen, Kaare Christensen, Marc Stegger, Robert Skov, Paal Skytt Andersen

Environmental and Occupational Health Faculty Publications

The human microbiome can play a key role in host susceptibility to pathogens, including in the nasal cavity, a site favored by Staphylococcus aureus. However, what determines our resident nasal microbiota—the host or the environment—and can interactions among nasal bacteria determine S. aureus colonization? Our study of 46 monozygotic and 43 dizygotic twin pairs revealed that nasal microbiota is an environmentally derived trait, but the host’s sex and genetics significantly influence nasal bacterial density. Although specific taxa, including lactic acid bacteria, can determine S. aureus colonization, their negative interactions depend on thresholds of absolute abundance. These findings demonstrate that …

Dose-Response Effects Of The Text4baby Mobile Health Program: Randomized Controlled Trial, William Douglas Evans, Peter E. Nielsen, Daniel R. Szekely, Jasmine W. Bihm, Elizabeth A. Murray, Jeremy Snider, Lorien C. Abroms

Prevention and Community Health Faculty Publications

BACKGROUND:

Mobile health (mHealth) is growing rapidly, but more studies are needed on how to optimize programs, including optimal timing of messaging, dose of exposure, and value of interactive features. This study evaluates final outcomes of text4baby (a text message service for pregnant and postpartum women) from a randomized trial performed in a population of pregnant female soldiers and family members.

OBJECTIVE:

The study aims were to evaluate (1) treatment effects and (2) dose-response effects of text4baby on behavioral outcomes compared to control (no text4baby) condition.

METHODS:

The study was a randomized trial of text4baby at Madigan Army Medical Center. …

Cost Effectiveness Of A Mail-Delivered Individually Tailored Physical Activity Intervention For Latinas Vs. A Mailed Contact Control, Britta Larsen, Todd Gilmer, Dori Pekmezi, Melissa A. Napolitano, Bess H. Marcus

Prevention and Community Health Faculty Publications

Background

Physical inactivity is high in Latinas, as are chronic health conditions. There is a need for physical activity (PA) interventions that are not only effective but have potential for cost-effective widespread dissemination. The purpose of this paper was to assess the costs and cost effectiveness of a Spanish-language print-based mail-delivered PA intervention that was linguistically and culturally adapted for Latinas.

Methods

Adult Latinas (N = 266) were randomly assigned to receive mail-delivered individually tailored intervention materials or wellness information mailed on the same schedule (control). PA was assessed at baseline, six months (post-intervention) and 12 months (maintenance phase) …

Interpersonal Communication As An Agent Of Normative Influence: A Mixed Method Study Among The Urban Poor In India, Rajiv N. Rimal, Pooja Sripad, Ilene S. Speizer, Lisa M. Calhoun

Prevention and Community Health Faculty Publications

Background

Although social norms are thought to play an important role in couples’ reproductive decisions, only limited theoretical or empirical guidance exists on how the underlying process works. Using the theory of normative social behavior (TNSB), through a mixed-method design, we investigated the role played by injunctive norms and interpersonal discussion in the relationship between descriptive norms and use of modern contraceptive methods among the urban poor in India.

Methods

Data from a household survey (N = 11,811) were used to test the underlying theoretical propositions, and focus group interviews among men and women were then conducted to obtain …

Assessing Seasonality Of Travel Distance To Harm Reduction Service Providers Among Persons Who Inject Drugs., Sean T. Allen, Monica S. Ruiz, Amira Roess, Jeff Jones

Prevention and Community Health Faculty Publications

BACKGROUND: Prior research has examined access to syringe exchange program (SEP) services among persons who inject drugs (PWID), but no research has been conducted to evaluate variations in SEP access based on season. This is an important gap in the literature given that seasonal weather patterns and inclement weather may affect SEP service utilization. The purpose of this research is to examine differences in access to SEPs by season among PWID in the District of Columbia (DC).

FINDINGS: A geometric point distance estimation technique was applied to records from a DC SEP that operated from 1996 to 2011. We calculated …

The Core Competencies For Mental, Neurological, And Substance Use Disorder Care In Sub-Saharan Africa, Pamela Y. Collins, Seggane Musisi, Seble Frehywot, Vikram Patel

Health Policy and Management Faculty Publications

The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated …

Should We Put Our Feet In The Water? Use Of A Survey To Assess Recreational Exposures To Contaminants In The Anacostia River., Rianna Murray, Sacoby Wilson, Laura Dalemarre, Victoria Chanse, Janet Phoenix, Lori Baranoff

Health Policy and Management Faculty Publications

The Anacostia River, a tributary of the Potomac River that flows into the Chesapeake Bay, is highly contaminated with raw sewage, heavy metals, oil and grease, trash, pathogens, excessive sediments, and organic chemicals. Despite this contamination, recreation on the river is very popular, including kayaking, canoeing, rowing, and sport fishing. There is currently no information available on the potential health risks faced by recreational users from exposure to the river’s pollutants. A total of 197 recreational users of the Anacostia River were surveyed regarding general demographic information and their recreational behavior over the previous year, including frequency and duration of …

Health Care Access Dimensions And Cervical Cancer Screening In South Africa: Analysis Of The World Health Survey., Tomi F. Akinyemiju, Jasmine A. Mcdonald, Paula M. Lantz

Health Policy and Management Faculty Publications

Background

Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services.

Methods

Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple …

Transforming Health Professions' Education Through In-Country Collaboration: Examining The Consortia Among African Medical Schools Catalyzed By The Medical Education Partnership Initiative., Zohray M. Talib, Elsie Kiguli-Malwadde, Hannah Wohltjen, Miliard Derbew, Yakub Mulla, David Olaleye, Nelson Sewankambo

Health Policy and Management Faculty Publications

BACKGROUND: African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning.

METHODS: Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These …

Expert Consensus Document: Mind The Gaps—Advancing Research Into Short-Term And Long-Term Neuropsychological Outcomes Of Youth Sports-Related Concussions, Aaron J. Carman, Rennie Ferguson, Robert Cantu, R. Dawn Comstock, Penny A. Dacks, Gerard A. Gioia, +20 Additional Authors

Psychiatry and Behavioral Sciences Faculty Publications

Sports-related concussions and repetitive subconcussive exposure are increasingly recognized as potential dangers to paediatric populations, but much remains unknown about the short-term and long-term consequences of these events, including potential cognitive impairment and risk of later-life dementia. This Expert Consensus Document is the result of a 1-day meeting convened by Safe Kids Worldwide, the Alzheimer's Drug Discovery Foundation, and the Andrews Institute for Orthopaedics and Sports Medicine. The goal is to highlight knowledge gaps and areas of critically needed research in the areas of concussion science, dementia, genetics, diagnostic and prognostic biomarkers, neuroimaging, sports injury surveillance, and information sharing. For …

Voltage-Gated Na+ Channel Activity Increases Colon Cancer Transcriptional Activity And Invasion Via Persistent Mapk Signaling, Carrie D. House, Bi-Dar Wang, Kristin Ceniccola, Russell Williams, May Simaan, Norman H. Lee, +7 Additional Authors

Pharmacology and Physiology Faculty Publications

Functional expression of voltage-gated Na⁺ channels (VGSCs) has been demonstrated in multiple cancer cell types where channel activity induces invasive activity. The signaling mechanisms by which VGSCs promote oncogenesis remain poorly understood. We explored the signal transduction process critical to VGSC-mediated invasion on the basis of reports linking channel activity to gene expression changes in excitable cells. Coincidentally, many genes transcriptionally regulated by the SCN5A isoform in colon cancer have an over-representation of cis-acting sites for transcription factors phosphorylated by ERK1/2 MAPK. We hypothesized that VGSC activity promotes MAPK activation to induce transcriptional changes in invasion-related genes. Using …

How Can We Better Evaluate Complex Global Health Initiatives? Reflections From The January 2014 Institute Of Medicine Workshop., Sangeeta Mookherji, Kate Meck

Global Health Faculty Publications

An IOM workshop on evaluation design drew on recent evaluations of 4 complex initiatives (PEPFAR; the Global Fund to Fight AIDS, TB and Malaria; the President’s Malaria Initiative; and the Affordable Medicines Facility-malaria). Key components for good evaluations: (1) a robust theory of change to understand how and why programs should work; (2) use of multiple analytic methods; and (3) triangulation of evidence to validate and deepen understanding of results as well as synthesis of findings to identify lessons for scale-up or broader application.

Adapting Pharmaceutical Reimbursement Policies To Manage Spending On High-Priced Drugs, Elizabeth Docteur, Ruth Lopert

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

A Family Perspective On Hippotherapy: A Case Study, Lisa Boelter Lapka

Theses and Graduate Projects

Hippotherapy, or equine-assisted therapy, is a developmental tool for children and young adults with disabilities, conducted by trained physical, occupational, and speech therapists and assistants in areas focusing on motor skills including balance, agility, strengthening and coordination. Within its framework across the nation, hippotherapy is a specialized therapy for neuromotor challenges such as cerebral palsy. As hippotherapy is one of many complex developmental interuention strategies within both non-profit and clinical services, it is being explored more in recent years through academic research to better define its place as a clinical and educational tool. To better understand hippotherapy as a clinical …

A Collaborative Approach To An Advanced Nursing Practice, Elizabeth R. Janeczko

Theses and Graduate Projects

Collaboration within multiple disciplines is fundamental to the success of any health care practitioner. For the Advanced Practice Registered Nurse (APRN), collaboration as well as the use of a mentor during a detailed, organized orientation leads to success in the chosen field of the APRN. A good orientation requires the current staff to work together in a harmonious way to mentor the new orientee and ultimately produces a confident staff member. An unorganized orientation lacking in collaboration may force the orientee to struggle, never knowing if they are on the right path, can lead to disruption of the unit, dissatisfaction, …

Developing A Healthy Work Environment For Radiology Nurses Through Metaphor, Anne Cords

Theses and Graduate Projects

A healthy work environment is an essential part of a nurse's professional practice. Providing nurses access to resources to understand the importance of a healthy work environment should be present in healthcare organizations. After evaluating a Radiology Department at a large hospital in the Midwest, the themes of communication, collaboration, and authentic leadership were revealed as areas to be improved upon for this work environment. Not only will these themes contribute to the workplace as well as providing effective patient care. The American Association of Critical-Care Nurses (AACN) Standards for Establishing and Sustaining Healthy Work Environments (Barden, 2005:2016) and Martha …

Improving Patient Safety In The Operating Room: Utilizing A Safety Checklist And Briefings, Lori R. Schacht

Theses and Graduate Projects

The perioperative care setting can be a hazardous environment for patients undergoing surgery. Surgical teams caring for patients undergoing complex surgical procedures may create an opportunity for surgical errors impacting patient safety. The purpose of this project is to improve consistent standardized Surgical Safety Checklist (SSC) use and briefings in the orthopedic perioperative care setting in a large Midwestern hospital, thereby supporting a culture of safety through staff engagement and a team-based communication approach. Watson’s Theory of Human Caring guided this project through the theoretical concepts of presence and faith. An initial implementation of the SSC and briefings revealed a …

Nurse Burnout: When The Flame Goes Dim, Brittany M. Barden

Theses and Graduate Projects

Anticipating and responding to the needs of others is the forefront of the nursing profession. Nurses all too often place the needs of patients, patient's families, and organizations ahead of their own. The constant care of others without proper attention to one's own needs can lead to nurse burnout. There is little education being provided to nurses regarding the danger and effects of nurse burnout and how one can create a healthy balance between meeting their own needs as well as those of others. The purpose of this project is to develop an educational module that will raise awareness of …

Expanding The Practice Of Caring In The Peri-Anesthesia Unit, Jacqueline J. Meyer-Rostad

Theses and Graduate Projects

Caring is a central theme of the nursing profession; the essence of nursing. The preoperative and postoperative surgical settings at a large Midwestern Hospital are extremely busy and very demanding, which can affect patient care. It is essential for Patient Care Assistants (PCAs) to identify caring actions and to provide authentic caring for patients and families. Themes of witnessed uncaring behavior include: rough handling, loud and inappropriate conversations, ignoring the patient or family, abrupt answers to questions, and negative non-verbal body language. Conversations with several patient care assistants (PCAs) revealed they feel 'too busy' during their work day or are …

Quest For Health: An Early Beginning To A Lifelong Journey, Kerry P. Appleton

Theses and Graduate Projects

Childhood obesity has been cited as a modern day public health crisis. Despite the creation of many health education programs and interventions, the prevalence of childhood obesity remains largely unchanged. In response to this growing epidemic, nurses have been called to action to help mitigate health education disparities. The purpose of this project is to pool existing community resources to impact the general health of school-age children while influencing the health norms of their surrounding communities. A partnership between local school districts and a non-profit children's hospital has been created to provide health education to school age children in the …

Isolated Cardiac Amyloidosis: An Enigma Unravelled, Umair Khalid, Omar Awar, Gordana Verstovsek, Benjamin Cheong, Sarvari Venkata Yellapragada, Hani Jneid, Anita Deswal, Salim S. Virani

Office of the Provost

Amyloidosis is a rare, multisystem disease characterized by deposition of fibrils in extracellular tissue involving kidney, liver, heart, autonomic nervous system, and several other organs. This report discusses a 75-year-old male who presented with worsening dyspnea on exertion, orthopnea, and lower-extremity edema. On physical exam, he had elevated jugular venous pressure and lower-extremity edema. Electrocardiogram depicted low voltage in limb leads and a prolonged PR interval. Echocardiogram revealed left ventricular hypertrophy, severe biatrial dilatation, and restrictive filling physiology. Coronary angiography showed absence of significant epicardial coronary artery disease. On right heart catheterization, a "dip-and-plateau sign" was noted on right ventricular …

Vacuum Assisted Closure-Utilization As Home Based Therapy In The Management Of Complex Diabetic Extremity Wounds, Kamran Hafeez, Haroon Ur Rashid, Ghulam Mustafa Karim Khani, Darshan Kumar, Sunil Kumar

Section of Orthopaedic Surgery

Objective: Vacuum assisted closure is a reported technique to manage complex wounds. We have utilized this technique by using simple locally available material in the management of our patients on outpatient basis. The objective of this study is to present our experience.
Methods: This study was conducted from June 2011 to June 2013 at Dow University Hospital and Aga Khan University Hospital, Karachi. There were 38 patients managed with vacuum assisted closure. Mean age was 56±7.8 years. Twenty three patients presented with necrotizing fasciitis and 15 patients with gangrene. Lower limbs were involved in majority of the patients. Debridement or …

Impacts Of Signal Free Corridors On The Incidence Of Road Traffic Accidents In Karachi, Salman Zubair, Jamil H. Kazm, Syed Shahid Ali, Rashid Jooma, Zeeshan Akhtar

Section of Neurosurgery

Increase in road Traffic Accidents is a global phenomenon and Pakistan is no exception. In Karachi, this problem becomes severe due to rapid growth of population. This menace is ruining the lives of thousands of people and making Karachi a worrisome place to live. Recent road geometrical transitions in the city with insufficient accessories have been reducing the problem of traffic congestion to a limited extent. On the contrary, this has erupted as a problem of Road Traffic Accidents which is reaching out of proportions. Recently, induction of a unique feature named, Signal Free Corridor in Karachi has cost many …

The Patterns Of Health Seeking Behavior Among Patients With Hepatitis C In Karachi, Pakistan, Shahina Sabz Ali Pirani, Tazeen S. Ali, Saleema Allana, Faisal Wasim Ismail

School of Nursing & Midwifery

Background: The study aimed to assess the patterns of health seeking behavior and the level satisfaction with the health care providers among hepatitis C patients in Karachi, Pakistan.
Methodology: A descriptive, cross-sectional study was conducted among 250 hepatitis C patients, who were recruited from the Aga Khan University Hospital and the Civil Hospital Karachi, Pakistan, between March and May 2013.
Results: The patterns of health seeking behavior showed that a majority of the study participants approached a medical doctor (n=359), followed by spiritual healers (n=103), and a few participants approached traditional healers (n=38) and homeopaths (n=11). The pattern …

Prevalence And Predictors Of Pap Smear Cervical Epithelial Cell Abnormality Among Hiv-Positive And Negative Women Attending Gynecological Examination In Cervical Cancer Screening Center At Debre Markos Referral Hospital, East Gojjam, Northwest Ethiopia, Melkamu Getinet, Baye Gelaw, Abinet Sisay, Eiman Mahmoud, Abate Assefa

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Background: Cervical cancer is the leading cause of cancer related death among women in developing countries. Cervical cancer is preceded by cervical surface epithelial cell abnormalities (ECA) which can be detected by Pap smear test. Simultaneous human papillomavirus and human immunodeficiency virus (HIV) infection increases cervical cancer. Data on the prevalence and predictors of ECA among women in Ethiopia is limited. Hence, we aimed to determine the prevalence and associated factors of ECA among women.

Methods: A comparative cross-sectional study was conducted among HIV+ and HIV- women attending gynecological examination in cervical cancer screening center at the Debre …