Medicine and Health Sciences Commons^™

Maximizing The Benefit-Cost Ratio Of Anthracyclines In Metastatic Breast Cancer: Case Report Of A Patient With A Complete Response To High-Dose Doxorubicin, Kevin Shee, Alan T. Kono, Susan P. D'Anna, Mark A. Seltzer, Xiaoying Lu, Todd W. Miller, Mary D. Chamberlin

Dartmouth Scholarship

Despite the clinical efficacy of anthracycline agents such as doxorubicin, dose-limiting cardiac toxicities significantly limit their long-term use. Here, we present the case of a 33-year-old female patient with extensive metastatic ER+/PR+/HER2– mucinous adenocarcinoma of the breast, who was started on doxorubicin/cyclophosphamide therapy after progressing on paclitaxel and ovarian suppressor goserelin with aromatase inhibitor exemestane. The patient was comanaged by cardiology, who carefully monitored measures of cardiac function, including EKGs, serial echocardiograms, and profiling of lipids, troponin, and pro-BNP every 2 months. The patient was treated with the cardioprotective agent dexrazoxane, and changes in cardiac markers [e.g. decreases in ejection …

Types Of Persuasive Message Promoting Blood Donation In Hong Kong, Pui Chuen Tam

Bachelor of Social Sciences – Senior Theses

Based on Ferguson, Farrell, & Lawrence (2008)’s study on persuasive messages promoting blood donation, this study has identified a characteristic of persuasive message that could influence Chinese participants’ behavioral intention to donate blood. Participants (N = 66) were randomly assigned to read one of the four messages with different focuses and framings. They then indicated their behavioral intention to donate blood after reading the messages. Two-way ANCOVA, with self-efficacy as covariate indicated that respondents after reading altruistic messages reported a higher intention to donate blood than those who read egoistic messages. Moreover, it is also revealed that within people with …

The Nobel Prize In Chemistry 2015: Exciting Discoveries In Dna Repair By Aziz Sancar, David K. Orren

Toxicology and Cancer Biology Faculty Publications

On October 7, 2015, the Nobel Prize in Chemistry for 2015 was awarded to three deserving scientists for their pioneering research on DNA repair. Tomas Lindahl was recognized for studies that uncovered the inherent instability of DNA as well as the mechanism of the base excision repair pathway, Paul Modrich for characterization of the mismatch repair pathway, and Aziz Sancar for mechanistic elucidation of the nucleotide excision repair (NER) pathway. For me, the announcement of these awards in my area of research was extremely gratifying, particularly so because Aziz was my mentor during my Ph.D. studies that examined the steps …

Two Sudden And Unexpected Deaths Of Patients With Schizophrenia Associated With Intramuscular Injections Of Antipsychotics And Practice Guidelines To Limit The Use Of High Doses Of Intramuscular Antipsychotics, Nasratullah Wahidi, Katie M. Johnson, Allen Brenzel, Jose De Leon

Psychiatry Faculty Publications

Intravenous haloperidol has been associated with torsades de pointes (TdP). These two sudden deaths were probable adverse drug reactions (ADRs) following intramuscular (IM) antipsychotics. The autopsies described lack of heart pathology and were highly compatible with the possibility of TdP in the absence of risk factors other than the accumulation of antipsychotics with a high serum peak after the last injection, leading to death within hours. The first case was a 27-year-old African-American male with schizophrenia but no medical issues. His death was probably caused by repeated IM haloperidol injections of 10 mg (totaling 35 mg in 2 days). The …

A Combination Of Two Rare Coronary Anomalies Makes It Even Rarer: Right Sided Single Coronary Artery With Dual Left Anterior Descending Artery, Aram Barbaryan, Theodore Addai, Monahar Kola, Muhammad Wajih Raqeem, Sergey Barsamyan, Aibek E. Mirrakhimov

Internal Medicine Faculty Publications

An 82-year-old female with history of hyperlipidemia and hypertension presented to the clinic with chief complaint of nonradiating chest tightness accompanied by exertional dyspnea. Cardiac catheterization showed the absence of left coronary system; the entire coronary system originated from the right aortic sinus as a common trunk which then gave off the right coronary artery and the left main coronary artery. Cardiac catheterization demonstrated also another rare coronary anomaly: dual left anterior descending artery. Patient underwent percutaneous coronary intervention and subsequent multidetector computed tomography angiography confirmed the above angiography findings. Patient was subsequently discharged home on double antiplatelet therapy with …

Telomerase Inhibition By Everolimus Suppresses Smooth Muscle Cell Proliferation And Neointima Formation Through Epigenetic Gene Silencing, Jun Aono, Ernesto Ruiz-Rodriguez, Hua Qing, Hannes M. Findeisen, Karrie L. Jones, Elizabeth B. Heywood, Dennis Bruemmer

Internal Medicine Faculty Publications

Proliferation of smooth muscle cells (SMCs) during neointima formation is prevented by drug-eluting stents. The replicative capacity of mammalian cells is enhanced by telomerase expression; however, the contribution of telomerase to the proliferative response underlying neointima formation and its potential role as a pharmacological target are unknown. The present study investigated the mechanisms underlying the mitogenic function of telomerase, and tested the hypothesis that everolimus, which is commonly used on drug-eluting stents, suppresses SMC proliferation by targeting telomerase. Inhibition of neointima formation by everolimus was lost in mice overexpressing telomerase reverse transcriptase (TERT), indicating that repression of telomerase confers the …

Acute Liver And Renal Failure: A Rare Adverse Effect Exclusive To Intravenous Form Of Amiodarone, Robin Paudel, Prerna Dogra, Saurav Suman, Saurav Acharya, Jyoti Matta

Internal Medicine Faculty Publications

Amiodarone is an antiarrhythmic drug which is highly effective against a wide spectrum of ventricular tachyarrhythmias making it irreplaceable in certain group of patients. We report an unusual case of acute liver and renal failure within 24 hours of initiation of intravenous (IV) amiodarone which resolved after stopping the medication. The mechanism of acute liver and renal toxicity is not clearly known but is believed to be secondary to amiodarone induced (relative) hypotension, idiosyncratic reaction to the drug, and toxicity of the vector that carries the medication, polysorbate-80. In this case review, we discuss the hyperacute drug toxicity caused by …

Promoting Culturally Respectful Cancer Education Through Digital Storytelling, Melany Cueva, Regina Kuhnley, Anne Lanier, Mark Dignan, Laura Revels, Nancy E. Schoenberg, Katie Cueva

Internal Medicine Faculty Publications

Cancer is the leading cause of mortality among Alaska Native people. Over half of Alaska Native people live in rural communities where specially trained community members called Community Health Aides/Practitioners (CHA/Ps) provide health care. In response to CHA/Ps’ expressed desire to learn more about cancer, four 5-day cancer education and digital storytelling courses were provided in 2014. Throughout each course, participants explored cancer information, reflected on their personal experiences, and envisioned how they might apply their knowledge within their communities. Each course participant also created a personal and authentic digital story, a methodology increasingly embraced by Indigenous communities as a …

Effect Of Vitamins C And E On Endothelial Function In Type 1 Diabetes Mellitus, Rachel-Marie Cazeau, Hong Huang, John A. Bauer, Robert P. Hoffman

Pediatrics Faculty Publications

Background/Objectives. Endothelial dysfunction due to hyperglycemia-induced oxidative damage is an important predictor of future cardiovascular risk in patients with type 1 diabetes mellitus (T1DM) and is present in adolescent T1DM. We hypothesized that combined treatment with the antioxidant vitamins C and E might improve endothelial function (EF) and other biochemical risk factors in adolescents with T1DM. Subjects/Methods. Open-label antioxidant supplementation was given for six weeks with endpoint measurements collected at baseline and study completion. Endpoints measured included EF and plasma measurements of biochemical endothelial risk. Results. Two males and 7 females were studied. Mean age was 12.9 ± 0.9 yrs; …

Effect Of Metformin On Body Mass Index In Adolescent Females With Polycystic Ovary Syndrome, Alissa Briggs, Mandakini Sadhir, Maya Todd, Hatim A. Omar

Pediatrics Faculty Publications

Polycystic ovary syndrome (PCOS) is often associated with obesity, insulin resistance, irregular menstrual periods and pelvic pain. Treatment involves hormonal methods for regulation of menstrual cycle, lifestyle changes and metformin for improving insulin resistance and weight. The aim of our study was to compare changes in body mass index (BMI) of adolescent female with PCOS treated with metformin as compared to lifestyle modification only. Participants: Adolescent and young adult females aged I0-25 years diagnosed with PCOS seen for at least two visits for at least one year on the same treatment. Based on treatment plan, participants were categorized as metformin …

Chinese Adolescent In Hong Kong, Mandakini Sadhir

Pediatrics Faculty Publications

No abstract provided.

Bone Mineral Density, Preventative Behaviors And Risk Factors In African American And Caucasian Mother-Daughter Pairs, Mary Haskins Haskins

Electronic Theses and Dissertations

It is expected that by 2030, elderly minorities will comprise 20.2 million of the total 72.8 million population of Americans over 65 years (pollard, 2013). For African American women over the age of 50, 5% have osteoporosis and an estimated 35% have low bone mass (nof, n.d.). It is estimated that while over 40% of African American women over 80 years meet criteria for treatment, yet less than 12% are actually treated (Cauley, 2011). Striking disparities exist between African American and Caucasian women's likelihood for dual-energy x-ray absorptiometry (dxa) referral, the measurement tool that is used to diagnosis osteoporosis. (Hamrick, …

A Feasibility Study Of Lqts-Specific Problem-Solving Workshop: Parents' Problem-Solving Skills, Coping, Hope, And Worry, Elizabeth A. Phelps

PCOM Psychology Dissertations

Long-QT Syndrome (LQTS) is an inherited cardiac condition that predisposes individuals to cardiac arrhythmias and is a potentially fatal disorder that affects approximately 1 in 2,000 people. The triggers are difficult to avoid and may cause children and their families to make major life changes to avoid scenarios that can precipitate cardiac events. Parent may become more aware of the risks and may be hypervigilant of their child’s surroundings and exposure to potential triggers. Social problem-solving skills have been shown to enhance the ability to cope with both minor and major daily stressors and minimize psychological problems associated with physical …

The Effects Of A Trauma-Informed Care Training Program On Mental Health Professionals Knowledge, Skills, And Attitudes With The Smi, Angelina Pelletier

PCOM Psychology Dissertations

Trauma has been found to be highly prevalent among individuals diagnosed with SMIs. Mental health professionals have been reported to misdiagnose or avoid addressing trauma in this population. There is a need to provide information about trauma and to foster awareness among mental health professionals who are treating individuals diagnosed with SMIs. With a TIC approach, operating from a recovery-oriented philosophy, there have been interventions created to address trauma and SMIs with the aim of developing awareness about trauma and the impact it may have on someone’s life. With these factors in mind, mental health professionals should be competent in …

Local Health Departments’ Activities To Address Health Disparities And Inequities: Are We Moving In The Right Direction?, Gulzar H. Shah, John P. Sheahan

Health Policy & Management: Faculty Publications (2006-2018)

Context: Health disparities are among the critical public health challenges.

Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with variation in such engagement.

Methods: We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities.

Results: About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four …

Overcoming Treatment Resistance In Heterogeneous Tumors, Nikhil Hebbar

Theses and Dissertations--Toxicology and Cancer Biology

Most primary tumors are heterogeneous and are often composed of therapy-sensitive and emerging therapy-resistant cancer cells. Rather unexpectedly, treatment of therapy-sensitive tumor cells in heterogeneous tumor microenvironments resulted in apoptosis of the therapy-resistant cancer cells. We identified a novel Par-4 amino-terminal fragment (PAF, which includes amino acids 1-131 of Par-4) that is produced and released by therapy-sensitive cancer cells following therapy-induced caspase-dependent cleavage of the tumor suppressor Par-4. PAF caused paracrine apoptosis in therapy-resistant cancer cells. Unlike Par-4-inducible apoptosis, which is dependent on the cell surface GRP78 receptor, PAF produced cancer-selective apoptosis independent of cell surface GRP78 function. Par-4 contains …

Incidence Of Non-Hodgkin's Lymphoma By Residential Proximity To Superfund Sites In Kentucky: A Multivariate Analysis, William Brent Webber

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Non-Hodgkin’s Lymphoma (NHL) is a category of cancers that arise from the lymphocytes of the immune system. The rates of NHL in the United States and Kentucky began to rise in the mid-20th Century, shortly after the manufacture, use, and disposal of numerous chemical substances began to increase during and after the Second World War. While the etiology of NHL is not fully known, there are several chemical substances for which evidence exists of a possible link between exposures and development of NHL and other cancers. Several of these substances are also present in sites within Kentucky designated by the …

Correlates Of Antibiotic Diversion In The Philippines: Misconceptions And Community-Level Access To Nonmedical Sources Of Antibiotics, Daniel Alexander Barber

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: To identify sociodemographic, knowledge, and attitudinal correlates to antibiotic diversion among a community-based sample of adults (age 18 and older) in a low-income setting of the Philippines and to explore community-level data on informal antibiotic distribution in sari-sari stands.

Methods: Participants (n=307) completed self-administered surveys. Correlates to antibiotic diversion were assessed using logistic regression with Firth’s bias-adjusted estimates. Availability and characteristics of antibiotics in the sari-sari stands (n=106) were observed through site visits.

Results: A majority (78%) had shared antibiotics in their lifetime, most often with family members. In multivariable analysis, agreement with the belief that it is safe …

Self-Rated Diet Health: Socioeconomic And Health Related Correlates, Emily B. Bell

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

BACKGROUND: Two-thirds of Americans are overweight or obese, increasing their risk for multiple chronic diseases. Self-rated diet health may be useful in public health efforts to prevent the negative consequences of overweight/obesity. This study aims to identify sociodemographic and health-related correlates of the NHANES self-rated diet health question.

METHODS: The 2009-2010 NHANES data for adults 20 years and older were used. Sociodemographic and health-related variables were investigated with selfrated diet health as the outcome. First, bivariate analyses determined associations of each variable with self-rated diet health. Those associated with pvalues ≤.25 were included in two multiple ordinal logistic regression models. …

Correlates Of Hepatitis C Serostatus Disclosure In Rural Appalachian Kentucky, Megan G. Hofmeister

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: To identify demographic, behavioral, and interpersonal characteristics associated with hepatitis C (HCV) serostatus disclosure among adult, rural, high-risk people who use drugs (PWUD) in Appalachian Kentucky.

Methods: Laboratory confirmed HCV antibody-positive participants (n=243), drawn from the fifth follow-up assessment of a longitudinal study of rural PWUD, completed interviewer-administered questionnaires eliciting demographic and interpersonal characteristics, risk behaviors, and information on HCV disclosure. Correlates of HCV disclosure were assessed using logistic regression.

Results: Most (69.1%) reported disclosing their HCV-positive status to at least one of their social referents (current or past sex partners, current or past injection drug use (IDU) partners, …

Equine Leptospirosis Seroprevealence In The Central And Bluegrass Regions Of Kentucky From 1993 - 2015, Charlene Siza

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

BACKGROUND

Leptospirosis is a worldwide zoonotic bacterial disease of significant importance for both human and animal health. There are many sources of infection and shedding of the bacteria, including horses. There is a known occupational hazard for leptospirosis, especially in occupations that work directly with animals or animal products. This study examined the prevalence of equine leptospirosis in Kentucky in relation to trends over time and geographical distribution.

METHODS

Data was obtained from the University of Kentucky Veterinary Diagnostic Laboratory(UKVDL) on equine leptospirosis from 1993 through September 2015. Overall seropositive prevalence and prevalence stratified by serovar were calculated. Furthermore, distribution …

Impact Of Partner Support On Time To First Treatment For Women With Breast Cancer, Laura Anne Cannon

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Treatment delays have been linked to decreased survival in women with breast cancer. Many women rely on their spouse or partner to provide support following breast cancer diagnosis. To date, little research has explored the effects of partner supportive behaviors on timely receipt of recommended cancer treatment and ultimately cancer survival.

Objective: To determine whether women identified as having lower partner support experience delays in time to first breast cancer treatment relative to women with highly supportive partners.

Methods: Women aged 18-79 who were diagnosed with incident and primary breast cancer within the past 12 months and included in …

Birth Cohort Effects In Risk Factors For Alzheimer’S Disease, Kingsley Uzodinma

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background and Objectives: The purpose of this study was to assess the presence of birth cohort effects by exploring differences in established risk factors of Alzheimer’s disease (AD) and dementia using case-control designs and also estimate the AD risk among women with respect to their number of biological children.

Methods: This is a case control study design of participants born in 1896 – 1955 and were enrolled in one of the designated Alzheimer’s disease centers (ADCs). The uniform Data Set of the National Alzheimer’s Coordinating center (NACC) include those who had Alzheimer’s disease or mild cognitive impairment (cases) and were …

Increasing Colorectal Cancer Screening Rates In Shelby County, Tennessee Through The Implementation Of Flu-Fit In Community Clinics And Pharmacies, Samantha Wang

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The Shelby County Health Department (SCHD) proposes implementing of Flu-FIT in community clinics and pharmacies to increase colorectal cancer screening (CRCS) rates in Shelby County, Tennessee. Flu-FIT is an evidenced-based program that involves health care providers offering patients between 50 and 75 years of age the fecal-immunochemical test at the time the patients receive their annual influenza vaccine along with counseling on colorectal cancer and reminder phone calls. Flu-FIT aligns with the mission of SCHD to “promote, protect, and improve the health and environment of all Shelby County residents.” The project’s short term outcomes include increasing CRCS rates in patients …

The Utilization Of Models Of Care Transition To Reduce Medicare Beneficiaries’ Hospital Readmission Rates In Kentucky: A Case Study, Audra Putt

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Problem: Unsuccessful care transitions for Medicare beneficiaries have resulted in high health expenditures and a diminished quality of care as the 30-day hospital readmission rate has increased. This has prompted the Centers for Medicare and Medicaid Services to require hospitals with high readmission rates to pay penalties. As a result, the Community-based Care Transitions Program was established under Section 3026 of the Affordable Care Act to provide health organizations funding to utilize models of care transition to improve the care transition process. The purpose of this capstone project was to identify whether two community-based organization programs, the Kentucky Appalachian Transition …

Drink Switch Program In South La Schools, Lauren Barker

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Sugary drinks, including sports and energy drinks, are the number one source of added sugar in the American diet.1 Excess sugar consumption can lead to health complications such as overweight and obesity, and obesity-related chronic diseases such as diabetes, high blood pressure, and cardiovascular disease.2 Sugary drink consumption among youth in Los Angeles is particularly high, and teenagers in Service Planning Area (SPA) 6 of Los Angeles have some of the highest consumption rates in the county, with one out of two reporting consuming at least one sugary drink per day.3 Based on the correlation between sugar consumption and health, …

An Analysis Of The Role Of Medicaid Expansion On Mobile Mammography Units And Breast Cancer Screening In The Commonwealth Of Kentucky, Joseph Chiweshe

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction

Breast cancer and adequate screening remains a significant scientific, clinical and societal challenge both in Kentucky and in the U.S. To date, the lack of medical insurance has been implicated as a barrier to the provision of breast cancer screening not only to those within the Commonwealth of Kentucky but amongst the general population of the United States.

Methods

The Kentucky Department of Health provided study data utilized in our analysis. The data requested consisted of Medicaid claims for mammography screens for all counties in the Commonwealth of Kentucky. In addition, data gathering occurred via interviews with four Mobile …

Wnc Healthy Teens: A Multi-Level Teen Pregnancy Prevention Initiative, Katharine Macmillan

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

WNC Healthy Teens is a multi-component, community-based teen pregnancy prevention initiative. The program will be targeted in rural areas of Buncombe and Henderson Counties that have aggregate rates showing that over half the population of women aged 15-19 years are giving birth. Sexual education is necessary, but not sufficient to preventing risky sexual behaviors1. Tying multiple levels of evidence-based school interventions together with standardization of adolescent sexual health care will provide a well-rounded approach to address teenage pregnancy. Starting the initiative at age 14, it is anticipated the majority of teens will have yet to initiate sexual activity. Reducing the …

Risking Connection: A Multi-Level Trauma-Informed Care Approach To Refugee Services In Lexington, Ky, Marie Paige Higginson-Rollins

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

This project proposes to implement a multi-level, trauma-informed care approach to refugee services in Lexington, KY. The intervention will be carried out at three sites, the Bluegrass Community Health Center, the Kentucky Refugee Ministries, and the Lexington Global Engagement Center. These sites were chosen because of their extensive work with the refugee community. The intervention proposed is Risking Connection, a SAMHSA recommended trauma-informed care program, with a cultural-sensitivity training module and marketing campaign, and a group therapy pilot intervention for Congolese women based on the Bashal program at the Center for Torture and Trauma Survivors. The short-term goals of this …

Colorectal Cancer Prevention In The North Slope Borough Of Alaska Utilizing The Flu-Fit Intervention, Jennifer Jenkins

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The intention of the Flu-FIT intervention is to increase colorectal cancer screening rates by combing two annual activities into one visit that doesn’t necessitate a doctors visit. The original study increased colorectal cancer screening rates by 14 percentage points and this program should be able to show similar results in the North Slope Borough of Alaska. The North Slope Borough has the highest incidence rate of colorectal cancer in the United States, and this proposed intervention could lead to a reduction in that rate by increasing screening and knowledge about colorectal cancer in the community.