Medicine and Health Sciences Commons^™

The Role Of Argumentation In Hypothetico-Deductive Reasoning During Problem-Based Learning In Medical Education: A Conceptual Framework, Hyunjung Ju, Ikseon Choi

Interdisciplinary Journal of Problem-Based Learning

One of the important goals of problem-based learning (PBL) in medical education is to enhance medical students’ clinical reasoning—hypothetico-deductive reasoning (HDR) in particular—through small group discussions. However, few studies have focused on explicit strategies for promoting students’ HDR during group discussions in PBL. This paper proposes a novel conceptual framework that integrates Toulmin’s argumentation model (1958) into Barrows’s HDR process (1994). This framework explains the structure of argumentation (a claim, data, and a warrant) contextualized in each phase of HDR during PBL. This paper suggests four instructional strategies—understanding argument structures, questioning, elaborating on structural knowledge, and assessing argumentation—for promoting medical …

2017 November 14 - Medical Student Education Committee Minutes, Medical Student Education Committee, East Tennessee State University

Medical Student Education Committee Minutes

No abstract provided.

Ventilation Inhibits Sympathetic Action Potential Recruitment Even During Severe Chemoreflex Stress, Mark B. Badrov, Otto F. Barak, Tanja Mijacika, Leena N. Shoemaker, Lindsay J. Borrell, Mihajlo Lojpur, Ivan Drvis, Zeljko Dujic, J. Kevin Shoemaker

Bone and Joint Institute

© 2017 the American Physiological Society. This study investigated the influence of ventilation on sympathetic action potential (AP) discharge patterns during varying levels of high chemoreflex stress. In seven trained breath-hold divers (age 33 ± 12 yr), we measured muscle sympathetic nerve activity (MSNA) at baseline, during preparatory rebreathing (RBR), and during 1) functional residual capacity apnea (FRCApnea) and 2) continued RBR. Data from RBR were analyzed at matched (i.e., to FRCApnea) hemoglobin saturation (HbSat) levels (RBRMatched) or more severe levels (RBREnd). A third protocol compared alternating periods (30 s) of FRC and RBR (FRC-RBRALT). Subjects continued each protocol until …

One- Vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy For Pancreatic Carcinoma: Single Institution Retrospective Review, Philip Anthony Sutera, Mark E. Bernard, Beant S. Gill, Kamran K. Harper, Kimmen Quan, Nathan Bahary, Steven A. Burton, Herbert Zeh, Dwight E. Heron

Radiation Medicine Faculty Publications

Background/introduction: Early reports of stereotactic body radiation therapy (SBRT) for pancreatic ductal adenocarcinoma (PDAC) used single fraction, but eventually shifted to multifraction regimens. We conducted a single institution review of our patients treated with single- or multifraction SBRT to determine whether any outcome differences existed.

Methods and materials: Patients treated with SBRT in any setting for PDAC at our facility were included, from 2004 to 2014. Overall survival (OS), local control (LC), regional control (RC), distant metastasis (DM), and late grade 3 or greater radiation toxicities from the time of SBRT were calculated using Kaplan–Meier estimation to either the date …

Aeromedical Transport Of Critically Ill Infants Less Than 3 Months Of Age, Anil P. George, Akshay Sharma, Scottie B. Day

Pediatrics Faculty Publications

No abstract provided.

Examining The Relationship Between Registered Nurses’ Turnover And The Benefits Of An Affirming Climate Of Diversity As Mediated By Workplace Outcomes, James Mark Clardy

Human Resource Development Theses and Dissertations

The Affordable Care Act has created within health care a growing demand for primary care services in both the inpatient and outpatient settings. The anticipated growth in need for registered nurses (RN) of 19% by 2020 is compounded by a current estimated national turnover rate greater than 17%. Human Resource Development (HRD) practitioners in health care are challenged to develop and implement interventions that can influence turnover in RNs despite identifying variables that effect turnover. This research explored how RN turnover can be positively affected by a government mandated requirement that health care create a diverse workforce and cultural competency. …

A Word From The Writing Center (November 2017), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Stylish academic writing
• The Write Stuff

A Comprehensive Patient-Derived Xenograft Collection Representing The Heterogeneity Of Melanoma., Clemens Krepler, Katrin Sproesser, Patricia Brafford, Marilda Beqiri, Bradley Garman, Min Xiao, Batool Shannan, Andrea Watters, Michela Perego, Gao Zhang, Adina Vultur, Xiangfan Yin, Qin Liu, Ioannis N Anastopoulos, Bradley Wubbenhorst, Melissa A. Wilson, Wei Xu, Giorgos Karakousis, Michael Feldman, Xiaowei Xu, Ravi Amaravadi, Tara C. Gangadhar, David E. Elder, Lauren E. Haydu, Jennifer A. Wargo, Michael A. Davies, Yiling Lu, Gordon B. Mills, Dennie T. Frederick, Michal Barzily-Rokni, Keith T. Flaherty, Dave S. Hoon, Michael Guarino, Joseph J. Bennett, Randall W. Ryan, Nicholas J. Petrelli, Carol L. Shields, Mizue Terai, Takami Sato, Andrew E. Aplin, Alexander Roesch, David Darr, Steve Angus, Rakesh Kumar, Ensar Halilovic, Giordano Caponigro, Sebastien Jeay, Jens Wuerthner, Annette Walter, Matthias Ocker, Matthew B. Boxer, Lynn Schuchter, Katherine L Nathanson, Meenhard Herlyn

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Therapy of advanced melanoma is changing dramatically. Following mutational and biological subclassification of this heterogeneous cancer, several targeted and immune therapies were approved and increased survival significantly. To facilitate further advancements through pre-clinical in vivo modeling, we have established 459 patient-derived xenografts (PDX) and live tissue samples from 384 patients representing the full spectrum of clinical, therapeutic, mutational, and biological heterogeneity of melanoma. PDX have been characterized using targeted sequencing and protein arrays and are clinically annotated. This exhaustive live tissue resource includes PDX from 57 samples resistant to targeted therapy, 61 samples from responders and non-responders to immune checkpoint …

Reducing Symptom Distress In Patients With Advanced Cancer Using An E-Alert System For Caregivers: Pooled Analysis Of Two Randomized Clinical Trials, David H. Gustafson, Lori L. Dubenske, Amy K. Atwood, Ming-Yuan Chih, Roberta A. Johnson, Fiona Mctavish, Andrew Quanbeck, Roger L. Brown, James F. Cleary, Dhavan Shah

Health and Clinical Sciences Faculty Publications

Background: Symptom distress in patients toward the end of life can change rapidly. Family caregivers have the potential to help patients manage those symptoms, as well as their own stress, if they are equipped with the proper resources. Electronic health (eHealth) systems may be able to provide those resources. Very sick patients may not be able to use such systems themselves to report their symptoms but family caregivers could.

Objective: The aim of this paper was to assess the effects on cancer patient symptom distress of an eHealth system that alerts clinicians to significant changes in the patient’s symptoms, as …

Treatment Guidelines And Early Loss From Care For People Living With Hiv In Cape Town, South Africa: A Retrospective Cohort Study, Ingrid T. Katz, Richard Kaplan, Garrett Fitzmaurice, Dominick Leone, David R. Bangsberg, Linda-Gail Bekker, Catherine Orrell

OHSU-PSU School of Public Health Faculty Publications and Presentations

South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl.

Genetic And Genomic Characterization Of 462 Melanoma Patient-Derived Xenografts, Tumor Biopsies, And Cell Lines., Bradley Garman, Ioannis N. Anastopoulos, Clemens Krepler, Patricia Brafford, Katrin Sproesser, Yuchao Jiang, Bradley Wubbenhorst, Ravi Amaravadi, Joseph Bennett, Marilda Beqiri, David Elder, Keith T. Flaherty, Dennie T. Frederick, Tara C. Gangadhar, Michael Guarino, David Hoon, Giorgos Karakousis, Qin Liu, Nandita Mitra, Nicholas J. Petrelli, Lynn Schuchter, Batool Shannan, Carol L. Shields, Jennifer Wargo, Brandon Wenz, Melissa A. Wilson, Min Xiao, Wei Xu, Xaiowei Xu, Xiangfan Yin, Nancy R. Zhang, Michael A. Davies, Meenhard Herlyn, Katherine L. Nathanson

Wills Eye Hospital Papers

Tumor-sequencing studies have revealed the widespread genetic diversity of melanoma. Sequencing of 108 genes previously implicated in melanomagenesis was performed on 462 patient-derived xenografts (PDXs), cell lines, and tumors to identify mutational and copy number aberrations. Samples came from 371 unique individuals: 263 were naive to treatment, and 108 were previously treated with targeted therapy (34), immunotherapy (54), or both (20). Models of all previously reported major melanoma subtypes (BRAF, NRAS, NF1, KIT, and WT/WT/WT) were identified. Multiple minor melanoma subtypes were also recapitulated, including melanomas with multiple activating mutations in the MAPK-signaling pathway and chromatin-remodeling gene mutations. These well-characterized …

The Gene Smart Study: Method, Study Design, And Preliminary Findings, Xu Yan, Nir Eynon, Ioannis D. Papadimitriou, Jujiao Kuang, Fiona Munson, Oren Tirosh, Lannie O’Keefe, Lyn R. Griffiths, Kevin J. Ashton, Nuala Byrne, Yannis P. Pitsiladis, David J. Bishop

Research outputs 2014 to 2021

The gene SMART (genes and the Skeletal Muscle Adaptive Response to Training) Study aims to identify genetic variants that predict the response to both a single session of High-Intensity Interval Exercise (HIIE) and to four weeks of High-Intensity Interval Training (HIIT). While the training and testing centre is located at Victoria University, Melbourne, three other centres have been launched at Bond University, Queensland University of Technology, Australia, and the University of Brighton, UK. Currently 39 participants have already completed the study and the overall aim is to recruit 200 moderately-trained, healthy Caucasians participants (all males 18 – 45 y, BMI …

Niemann-Pick Type C Disease, Sameh Morkous Md, Faan

Department of Pediatrics

No abstract provided.

An Empirical Approach To Assessing Pediatric Residents' Attitudes, Knowledge And Skills In Primary Care Behavioral Health, Jeffrey D. Shahidullah Phd, Paul W. Kettlewell Phd, Kathryn Dehart Md, Kris Rooney Md, Ilene Ladd Ma, Tyler Bogaczyk Bs, Amy Signore Phd, Sharon L. Larson Phd

International Journal of Health Sciences Education

This paper describes an empirical approach to assessing pediatric residents' attitudes, knowledge and skills in primary care behavioral health. Outcomes from that assessment approach are presented from two pediatric residency training programs in the northeastern United States. Thirty-six pediatric residents completed attitudes, knowledge and skills surveys. The survey was developed to align with the American Academy of Pediatrics’ Policy Statement in 2009 citing aspirational competencies for pediatricians in primary care behavioral health. This alignment addressed both learner variables (attitudes, knowledge, and skills) as well as clinical presentations (ADHD, anxiety, depression, and suicide) highlighted in the policy statement. The survey specifically …

Using Standardized Patients For Training And Evaluating Medical Trainees In Behavioral Health, Jeffrey D. Shahidullah, Paul W. Kettlewell

International Journal of Health Sciences Education

Training delivered to medical students and residents in behavioral health is widely acknowledged to be inadequate. While the use of standardized patients is common in medical training and education for physical health conditions via the adherence to clinical protocols for evaluation and treatment, this approach is infrequently used for behavioral health conditions. Used under specific circumstances, standardized patient encounters have long been considered a reliable method of training and assessing trainee performance on addressing physical health conditions, and are even comparable to ratings of directly observed encounters with real patients. This paper discusses common issues and challenges that arise in …

Assessment Of Midwifery And Nursing Students’ Nutrition Competence In Ethiopia: A Cross Sectional Study, Endris Mekonnen Yimer, Firew Ayalew Desta, Kefyalew Muleta Akassa, Tadele Bogale Yitaferu, Mesfin Goji Abebe, Mebit Kebede Tariku, Hannah Gibson

International Journal of Health Sciences Education

Background: Malnutrition is a major public health problem in Ethiopia contributing to half of infant and child mortality. The 2014 mini Ethiopian Demographic and Health Survey revealed that four out of ten children under five are stunted, nearly one out of ten are wasted, and a quarter are underweight. One of the factors that contributed to the high stunting rate is the shortage of capable providers who are competent to provide nutrition services. The purpose of this study was to assess graduating midwifery and nursing students’ nutrition competence and explore the factors that influence their competence.

Methods: A cross-sectional survey …

Discourse Changes Following Severe Traumatic Brain Injury: A Longitudinal Study, Elizabeth Young

Speech and Hearing Sciences ETDs

Purpose: There are few longitudinal data charting recovery of discourse skills following severe traumatic brain injury (TBI). Limited knowledge about the trajectory of discourse recovery and the best tools for assessing communication abilities in persons with TBI (PWTBIs) restricts detection of communication impairment and the ability to make informed prognostic judgments following TBI. This study sought to contribute longitudinal data to the research base, using clinically efficient measures that are sensitive to communication deficits associated with TBI and that use nuanced scoring systems to provide detailed characterization of discourse.

Methods: Twenty-three PWTBIs completed picture description tasks at 3 (or 6) …

Durable Near-Complete Response To Anti-Pd-1 Checkpoint Immunotherapy In A Refractory Malignant Solitary Fibrous Tumor Of The Pleura, James T. Boothe, G. Thomas Budd, Matthew B. Smolkin, Patrick C. Ma

Clinical and Translational Science Institute

Solitary fibrous tumor of the pleura is a rare and usually benign primary neoplasm arising from mesenchymal cells of the submesothelial tissue. We present here the case of a patient diagnosed with CD34-positive advanced malignant solitary fibrous tumor of the pleura whose disease failed to respond to combination cytotoxic chemotherapy agents, but demonstrated a prompt near-complete response to checkpoint blockade treatment using the anti-programmed death (PD)-1 monoclonal antibody pembrolizumab, based on tumor molecular profiling revealing tumoral expression positivity for both programmed death-ligand 1 (PD-L1) and PD-1. The patient experienced minimal adverse effects from the treatment with durable favorable response lasting …

What's Happening: November 13, 2017, Maine Medical Center

What's Happening

No abstract provided.

Healthcare And Its Impact On Nurses: The United States Vs. The United Kingdom, Alexandria Colovos

Mahurin Honors College Capstone Experience/Thesis Projects

Currently, in the United States, the topic of healthcare reform is in the back of everyone’s mind. What will come of our healthcare system? Will the cost of healthcare decrease? Will patients have better access to care? With this Capstone Experience/Thesis, I wanted to explore the differences between the current healthcare system that we have in the United States, to the nearly seventy-year-old National Health Service (NHS) in the United Kingdom, which provides healthcare to all. The NHS is free at the point of care and is funded by taxation. To understand if such a system would work in the …

Week Of November 13, 2017, New York Medical College

InTouch

• Mark J. Kittleson, Ph.D., is Named Chair of the Department of Public Health in the School of Health Sciences and Practice
• Renowned Trauma Surgeon to Address 14th Annual Louis R.M. DelGuercio Professorship and Research Day
• NYMC Recognizes Alumnus for 18 Years of Micro Lectures
• M.P.H. Student Adds Global Experience to Public Health Education
• Dental Students Present on First-Ever Research Elective

P2x2 Dominant Deafness Mutations Have No Negative Effect On Wild-Type Isoform: Implications For Functional Rescue And In Deafness Mechanism, Yan Zhu, Juline Beudez, Ning Yu, Thomas Grutter, Hong-Bo Zhao

Otolaryngology--Head & Neck Surgery Faculty Publications

The P2X2 receptor is an ATP-gated ion channel, assembled by three subunits. Recently, it has been found that heterozygous mutations of P2X2 V60L and G353R can cause autosomal dominant nonsyndromic hearing loss. However, the underlying mechanism remains unclear. The fact that heterozygous mutations cause deafness suggests that the mutations may have dominant-negative effect (DNE) on wild-type (WT) P2X2 isoforms and/or other partners leading to hearing loss. In this study, the effect of these dominant deafness P2X2 mutations on WT P2X2 was investigated. We found that sole transfection of both V60L and G353R deafness mutants could efficiently target to the plasma …

Cancer-Associated Fibroblasts Neutralize The Anti-Tumor Effect Of Csf1 Receptor Blockade By Inducing Pmn-Mdsc Infiltration Of Tumors., Vinit Kumar, Laxminarasimha Donthireddy, Douglas Marvel, Thomas Condamine, Fang Wang, Sergio Lavilla-Alonso, Ayumi Hashimoto, Prashanthi Vonteddu, Reeti Behera, Marlee A. Goins, Charles Mulligan, Brian Nam, Neil Hockstein, Fred Denstman, Shanti Shakamuri, David W. Speicher, Ashani T. Weeraratna, Timothy Chao, Robert H. Vonderheide, Lucia R. Languino, Peter Ordentlich, Qin Liu, Xiaowei Xu, Albert Lo, Ellen Puré, Chunsheng Zhang, Andrey Loboda, Manuel A. Sepulveda, Linda A. Snyder, Dmitry I. Gabrilovich

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Tumor-associated macrophages (TAM) contribute to all aspects of tumor progression. Use of CSF1R inhibitors to target TAM is therapeutically appealing, but has had very limited anti-tumor effects. Here, we have identified the mechanism that limited the effect of CSF1R targeted therapy. We demonstrated that carcinoma-associated fibroblasts (CAF) are major sources of chemokines that recruit granulocytes to tumors. CSF1 produced by tumor cells caused HDAC2-mediated downregulation of granulocyte-specific chemokine expression in CAF, which limited migration of these cells to tumors. Treatment with CSF1R inhibitors disrupted this crosstalk and triggered a profound increase in granulocyte recruitment to tumors. Combining CSF1R inhibitor with …

Family Income, Cumulative Risk Exposure, And White Matter Structure In Middle Childhood, Alexander J. Dufford, Pilyoung Kim

Psychology: Faculty Scholarship

Family income is associated with gray matter morphometry in children, but little is known about the relationship between family income and white matter structure. In this paper, using Tract-Based Spatial Statistics, a whole brain, voxel-wise approach, we examined the relationship between family income (assessed by income-to-needs ratio) and white matter organization in middle childhood (N = 27, M = 8.66 years). Results from a non-parametric, voxel-wise, multiple regression (threshold-free cluster enhancement, p < 0.05 FWE corrected) indicated that lower family income was associated with lower white matter organization [assessed by fractional anisotropy (FA)] for several clusters in white matter tracts involved in cognitive and emotional functions including fronto-limbic circuitry (uncinate fasciculus and cingulum bundle), association fibers (inferior longitudinal fasciculus, superior longitudinal fasciculus), and corticospinal tracts. Further, we examined the possibility that cumulative risk (CR) exposure might function as one of the potential pathways by which family income influences neural outcomes. Using multiple regressions, we found lower FA in portions of these tracts, including those found in the left cingulum bundle and left superior longitudinal fasciculus, was significantly related to greater exposure to CR (β = -0.47, p < 0.05 and β = -0.45, p < 0.05).

Small Rna Teg49 Is Derived From A Sara Transcript And Regulates Virulence Genes Independent Of Sara In Staphylococcus Aureus, Adhar Manna, Samin Kim, Liviu Cengher, Anna Corvaglia, Stefano Leo, Patrice Francois, Ambrose L. Cheung

Dartmouth Scholarship

Expression of virulence factors in Staphylococcus aureus is regulated by a wide range of transcriptional regulators, including proteins and small RNAs (sRNAs), at the level of transcription and/or translation. The sarA locus consists of three overlapping transcripts generated from three distinct promoters, all containing the sarA open reading frame (ORF). The 5= untranslated regions (UTRs) of these transcripts contain three separate regions 711, 409, and 146 nucleotides (nt) upstream of the sarA translation start, the functions of which remain unknown. Re- cent transcriptome-sequencing (RNA-Seq) analysis and subsequent characterization indicated that two sRNAs, teg49 and teg48, are processed and likely produced …

Evaluating And Improving The Effectiveness Of Vehicle Inspection And Maintenance Programs: A Cost-Benefit Analysis Framework, Ying Li

ETSU Faculty Works

Motor vehicle inspection and maintenance (I/M) programs are designed to identify high-emitting vehicles and mitigate their impacts on air quality and climate. I/M programs have been traditionally ranked superior among various vehicle emission control measures by the results of cost-benefit analysis, based on the assumption that these programs will achieve the targeted emission reduction outcomes. However, the actual effects of I/M programs may be greatly uncertain and when this uncertainty is taken into account, these programs may become suboptimal. This study develops a new a cost-benefit analysis framework that links various program design consideration, such as program participation rate, identification …

Parafoveolar Retinoblastoma Regression With Foveal Preservation Following Intra-Arterial Chemotherapy Documented On Hand-Held Optical Coherence Tomography In A Newborn., Vera Yarovaya, Kareem Sioufi, Carol L Shields

Wills Eye Hospital Papers

Background: Optical coherence tomography (OCT) has become an invaluable tool in retinoblastoma management, providing submillimeter visualization of tumor control following treatment. Herein, we document OCT-detection of a subtle tumor recurrence, allowing early intervention and achieving foveal microanatomy preservation.

Case presentation: A 3-week-old girl was diagnosed with bilateral familial retinoblastoma, classified as group D in the right eye (OD) and group B in the left eye (OS), and treated with intravenous chemoreduction. At 6-months follow-up, the right eye was under control, but the left eye revealed a subtle juxtafoveal tumor recurrence, documented on handheld OCT (HH-OCT) and measuring 2750 µm in …

The Relationship Between Total Neuropathy Score-Reduced, Neuropathy Symptoms And Function., Ashraf Abulhaija

USF Tampa Graduate Theses and Dissertations

Chemotherapy Induced Peripheral Neuropathy (CIPN) is a common problem among cancer patients who receive a wide range of chemotherapy. This problem causes a decline in quality of life and increased disabilities. CIPN assessment instruments are either subjective, objective, or a combination of both. So far, there is no agreement on the best way for assessment. The goal of this study was to explore the relationships among subjective and objective CIPN assessment instruments. Specifically, this study aimed to 1) evaluate the relationship between the Total Neuropathy Score-reduced (mainly objective) and patients’ function, as measured by the interference scale of the Chemotherapy-Induced …

Menstrupedia: Fighting The Stigma Against Comprehensive Sex Education, Cindy Butor

LIS Student Conference

This poster demonstrates how comics can be used to inform teens about puberty by focusing on the Indian comic Menstrupedia. It has been adapted from a PowerPoint presented at the 2017 Graphic Medicine Conference in Seattle and includes information about graphic medicine, the health-based comics movement.

Medical School Watercooler Newsletter - November 12, 2017, Lindsey Lyle

Watercooler Newsletter

This is the November 12, 2017 edition of the Frederick P. Whiddon College of Medicine's Newsletter - Watercooler.

Contents Include:

USA Medical Students Participate in Light the Night

Dr. John Marymont Appointed to Advisory Roles

Department of Pediatrics Hosts Residents Day

USA Internal Medicine Residency Program Participates in Service Project for Children in Need

Anne Norton Appointed Director of Operations for Surgery at USA Physicians Group

USA Health Names Rickert as Chief Policy Officer