Medicine and Health Sciences Commons^™

Neonatal Shoulder Width Suggests A Semirotational, Oblique Birth Mechanism In Australopithecus Afarensis, Jeremy M. Desilva, Natalie M. Laudicina, Karen R. Rosenberg, Wenda R. Trevathan

Peer Reviewed Articles

Birth mechanics in early hominins are often reconstructed based on cephalopelvic proportions, with little attention paid to neonatal shoulders. Here, we find that neonatal biacromial breadth can be estimated from adult clavicular length (R² = 0.80) in primates. Using this relationship and clavicular length from adult Australopithecus afarensis, we estimate biacromial breadth in neonatal australopiths. Combined with neonatal head dimensions, we reconstruct birth in A. afarensis (A.L. 288-1 or Lucy) and find that the most likely mechanism of birth in this early hominin was a semi-rotational oblique birth in which the head engaged and passed through the inlet …

Christians’ Cut: Popular Religion And The Global Health Campaign For Medical Male Circumcision In Swaziland, Casey Golomski, Sonene Nyawo

Anthropology

Swaziland faces one of the worst HIV epidemics in the world and is a site for the current global health campaign in sub-Saharan Africa to medically circumcise the majority of the male population. Given that Swaziland is also majority Christian, how does the most popular religion influence acceptance, rejection or understandings of medical male circumcision? This article considers interpretive differences by Christians across the Kingdom’s three ecumenical organisations, showing how a diverse group people singly glossed as ‘Christian’ in most public health acceptability studies critically rejected the procedure in unity, but not uniformly. Participants saw medical male circumcision’s promotion and …

Evaluation Of Various Inspiratory Times And Inflation Pressures During Airway Pressure Release Ventilation, Tim Gilmore

Health Sciences Program Student Theses, Dissertations and Capstones

There are few recommendations on how best to apply certain modes of mechanical ventilation. The application of Airway Pressure Release Ventilation (APRV) includes strategic implementation of specific inspiratory times (I-times) and particular mean airway pressures (MAWP) neither of which is standardized. This study utilized a retrospective analysis of archived electronic health record data to evaluate the clinical outcomes of adult patients that had been placed on APRV for at least 8 hours. 68 adult subjects were evaluated as part of a convenient purposive sample. All outcomes of interest (surrogates) for short-term clinical outcomes to include the PaO2/FiO2 (P/F) ratio, Oxygen …

Pneumonia Readmissions In Older Adults With Dementia, Sara Knox

Health Sciences Program Student Theses, Dissertations and Capstones

Objective: The purpose of this study was to investigate pneumonia readmissions of older adults with dementia. Readmission rates and predictive factors of older adults with and without dementia were compared in this study. Subjects: A nationally representative sample of 389,198 discharge records, representing 370,003 patients, was extracted from the 2013 Nationwide Readmission Database. Methods: Descriptive statistics were utilized to describe the demographics of the sample population. Differences between groups were analyzed using chi-square or t test statistics as appropriate. A generalized linear model was used to examine predictive factors for pneumonia readmissions. Results: Older adults with dementia had a readmission …

Medical School Watercooler Newsletter - January 1, 2017, Lindsey Lyle

Watercooler Newsletter

This is the January 1, 2017 edition of the Frederick P. Whiddon College of Medicine's Newsletter - Watercooler.

Contents Include:

Jan. 5 DSS to Feature Dr. Sharon Campbell

Dr. Simmons Recognized by American Association for the Surgery of Trauma

Motivational Interviewing In Primary Care To Improve Lifestyle Choices For School Age Children, Angela D. Wood

Doctor of Nursing Practice Projects

Childhood obesity is an epidemic in the United States placing children at risk for immediate and long-term health problems. Primary care providers are optimally placed to address this high-priority health issue. The purpose of the project was to implement a practice change in the delivery of nutrition and physical activity information during well child visits. The 5-2-1-0 healthy habits message was delivered via motivational interviewing to the parent/guardian of overweight/obese children. A sample of seven parents/guardians participated in the educational program, which included an initial visit, two-week follow-up phone call, and one-month follow up visit. An initial assessment of family …

Internet-Based Cognitive Behavior Therapy For College Students With Symptoms Of Depression, Sandra Robertson

Doctor of Nursing Practice Projects

College students have high rates of depression, but do not always receive appropriate mental health care. Internet-based cognitive behavior therapy (ICBT) has the potential to provide students rapid access to an evidence-based treatment for depression. This project examined the acceptability and effectiveness of the ICBT program MoodGYM for college students with significant symptoms of depression. Nineteen college students with scores of 10 or higher on the Patient Health Questionnaire-9 (PHQ-9) depression scale were enrolled in the project. Attrition, defined as failing to complete any MoodGYM modules, was high at 31.6% (n=6). Only 26.3% of participants (n=5) completed all five modules. …

Perioperative Preceptor Education In An Agency Preceptor Workshop, Kimberly N. Crawford

Doctor of Nursing Practice Projects

There is a critical shortage of perioperative nurses and the demand in the United States (US) is growing steadily by 1% to 2% each year. It is estimated that nearly 20% of registered nurses (RNs) currently working in the perioperative area will retire in the next five years. In the perioperative area, when using the 6 to 12-month orientation time frame, as outlined in the Association of PeriOperative Registered Nurses (AORN) orientation calculator, the cost of orienting a new RN can exceed $100,000. A preceptorship workshop is one strategy that has been shown as an evidence-based intervention to decrease RN …

Development Of A Leadership Program For Hospital Employees:, Diana Marie Beckman

Doctor of Nursing Practice Projects

Healthcare leader’s ability to respond to the dynamic environment of healthcare is essential for positive health care outcomes. Leaders set the strategic direction for healthcare organizations, and this requires that leaders assess themselves and their employees to develop effective education programs needed to meet any knowledge gaps limiting the workforce ready to respond to the new demands. The purpose of this project is to implement and assess a revised curriculum of a leadership development program by measuring gained self-identified development of leadership practices.

Formulation And Evaluation Of Fast Disintegrating Sublingual Atropine Tablets For The Potential Treatment Of Acute Organophosphates Toxicity, Alhussain Aodah

Student Theses, Dissertations and Capstones

Organophosphates (OP) are chemicals found in certain pesticides and in nerve agents such as sarin. Toxicity with these agents can lead to death. On August 2013, 1,300 civilians were killed using sarin gas in Syria by the Assad regimen. The lack of prepared medical facilities, and the availability of appropriate treatmentsignificantly contributed to the high percent of causality. Further, worldwide pesticides toxicity affects 3 million people annually. Therefore, it is imperative that antidote to treat OP toxicity are readily available in a dosage form that is acceptable cost, effective, and user friendly. Atropine sulfate (AS) is the first-line antidote forOP …

Rehabilitation After Glenohumeral Microfracture And Type Ii Slap Repair Surgery: A Case Report, Judson Williams, Eric Chaconas

Physical Therapy Collection

Background and Purpose: There are few rehabilitation protocols for patients who have undergone glenohumeral microfracture procedure. The purpose of this paper is to present a patient case after both glenohumeral microfracture and Type II SLAP repair procedures and present a rehabilitation protocol.

Methods: The patient in this case is a 41-year-old male who had a sudden onset of pain, mechanical catching, and audible popping in his right shoulder, particularly with athletic activities. This patient was seen for 27 treatments and progressed per the presented protocol.

Findings: The overall improvement when combining the sections of the Quick- DASH was 72.96%, the …

Evaluation Of Isokinetic Single-Leg Cycling As A Rehabilitation Exercise Following Anterior Cruciate Ligament Reconstruction Surgery, Randolph Hutchison, Jessica Myers, Nicholas Hayden, Lee Shearer, Kaitlin Bruneau, John D. Desjardins

Health Sciences Publications

The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments, with over 250,000 injuries per year in the United States. Previous studies have found that ACL-deficient individuals avoid use of the quadriceps in the injured limb as a means of limiting anterior movement of the tibia in the absence of a functioning ACL. From these results, a study was designed to investigate the effectiveness of isokinetic single-leg cycling in increasing quadriceps muscle recruitment and activation. Ten control and seven ACL-reconstructed subjects completed a series of 15 s cycling trials in isokinetic mode at 75 rpm, while kinematic, …

Targeting Intrinsic And Extrinsic Vulnerabilities For The Treatment Of Multiple Myeloma, Nagaraju Anreddy, Lori A. Hazlehurst

Clinical and Translational Science Institute

Multiple myeloma (MM) is a malignant plasma cell disorder, clinically characterized by osteolytic lesions, immunodeficiency, and renal disease. Over the past decade, MM therapy is significantly improved by the introduction of novel therapeutics such as immunomodulatory agents (thalidomide, lenalidomide, and pomalidomide), proteasome inhibitors (bortezomib, carfilzomib, and ixazomib), monoclonal antibodies (daratumumab and elotuzumab), histone deacetylase (HDAC) inhibitors (Panobinostat). The clinical success of these agents has clearly identified vulnerabilities intrinsic to the MM cell- as well as targets that emanate from the tumor microenvironment. Despite these significant improvements, MM remains incurable due to the development of drug resistance. This perspective will discuss …

The Association Of Hyperglycemia And Diabetes Mellitus And The Risk Of Chemotherapy-Induced Neutropenia Among Cancer Patients: A Systematic Review With Meta-Analysis, Ebtihag O. Alenzi, George A. Kelley

Clinical and Translational Science Institute

Aim—Conduct a systematic review with meta-analysis to determine the association between incident chemotherapy-induced neutropenia (CIN) and either diabetes mellitus (DM) or hyperglycemia in patients with cancer. Methods—Observational studies in cancer patients of any age receiving chemotherapy and having diabetes or hyperglycemia either during or before chemotherapy induction were included. Studies were retrieved by searching four databases (PubMed, EBSCO, ProQuest, and Cochrane) and cross-referencing. The metric for combining studies was the odds ratio (OR). Results were pooled using a random-effects model, while heterogeneity and inconsistency were assessed using the Q and I 2 statistic, respectively. Potential small-study effects were assessed using …

Cancer Type And Risk Of Newly Diagnosed Depression Among Elderly Medicare Beneficiaries With Incident Breast, Colorectal, And Prostate Cancers, Monira Alwhaibi, Usha Sambamoorthi, Suresh Madhavan, Thomas Bias, Kimberly Kelly, James Walkup

Clinical and Translational Science Institute

Background—Elderly individuals (age >65 years) with cancer are at high risk for newly diagnosed depression after a cancer diagnosis. It is not known whether the risk of newly diagnosed depression varies by cancer type. Purpose—To examine the variations in the risk of newly diagnosed depression by cancer type among elderly individuals with cancer. Methods—This study used a retrospective cohort study design and data from the linked SEERMedicare files. Elderly individuals (age >65 years) with incident breast, colorectal (CRC), and prostate cancers diagnosed between 2007 and 2011 (N=53,821) were followed for 12 months after cancer diagnosis. Depression diagnosis was identified during …

Fibrous Nanocellulose, Crystalline Nanocellulose, Carbon Nanotubes, And Crocidolite Asbestos Elicit Disparate Immune Responses Upon Pharyngeal Aspiration In Mice, Eun-Jung Park, Timur O. Khaliullin, Michael R. Shurin, Elena R. Kisin, Naveena Yanamala, Bengt Fadeel, Jaerak Chang, Anna A. Shvedova

Faculty & Staff Scholarship

With the rapid development of synthetic alternatives to mineral fibers, their possible effects on the environment and human health have become recognized as important issues worldwide. This study investigated effects of four fibrous materials, i.e. nanofibrillar/nanocrystalline celluloses (NCF and CNC), single-walled carbon nanotubes (CNTs), and crocidolite asbestos (ASB), on pulmonary inflammation and immune responses found in the lungs, as well as the effects on spleen and peripheral blood immune cell subsets. BALB/c mice were given NCF, CNC, CNT, and ASB on Day 1 by oropharyngeal aspiration. At 14 days post-exposure, the animals were evaluated. Total cell number, mononuclear phagocytes, polymorphonuclear …

Contemporary Trends In The Use And Outcomes Of Surgical Treatment Of Tricuspid Regurgitation, Fahad Alqahtani, Chalak O. Berzingi, Sami Aljohani, Mohamad Hijazi, Ahmad Al-Hallak, Mohamad Alkhouli

Faculty & Staff Scholarship

Background

Tricuspid regurgitation (TR), if untreated, is associated with an adverse impact on long‐term outcomes. In recent years, there has been an increasing enthusiasm about surgical and transcatheter treatment of patients with severe TR. We aim to evaluate the contemporary trends in the use and outcomes of tricuspid valve (TV) surgery for TR using the National Inpatient Sample.

Methods and Results

Between January 1, 2003 and December 31, 2014, an estimated 45 477 patients underwent TVsurgery for TR in the United States, of whom 15% had isolated TV surgery and 85% had TVsurgery concomitant with other cardiac surgery. There was …

Stroke-Associated Pattern Of Gene Expression Previously Identified By Machine-Learning Is Diagnostically Robust In An Independent Patient Population, Grant C. O'Connell, Paul D. Chantler, Taura L. Barr

Faculty & Staff Scholarship

Our group recently employed genome-wide transcriptional profiling in tandem with machine-learning based analysis to identify a ten-gene pattern of differential expression in peripheral blood which may have utility for detection of stroke. The objective of this study was to assess the diagnostic capacity and temporal stability of this stroke-associated transcriptional signature in an independent patient population. Publicly available whole blood microarray data generated from 23 ischemic stroke patients at 3, 5, and 24 h post-symptom onset, as well from 23 cardiovascular disease controls, were obtained via the National Center for Biotechnology Information Gene Expression Omnibus. Expression levels of the ten …

Efficacy Of Stereotactic Radiosurgery In Patients With Multiple Metastases: Importance Of Volume Rather Than Number Of Lesions, Basem A. Dahshan, Malcolm D. Mattes, Sanjay Bhatia, Mary S. Palek, Christopher P. Cifarelli, Joshua D. Hack, John A. Vargo

Faculty & Staff Scholarship

The role of stereotactic radiosurgery (SRS) in the treatment of multiple brain metastases is controversial. While whole brain radiation therapy (WBRT) has historically been the mainstay of treatment, its value is increasingly being questioned as emerging data supports that SRS alone can provide comparable therapeutic outcomes for limited (one to three) intracranial metastases with fewer adverse effects, including neurocognitive decline. Multiple recent studies have also demonstrated that patients with multiple (> 3) intracranial metastases with a low overall tumor volume have a favorable therapeutic response to SRS, with no significant difference compared to patients with limited metastases. Herein, we present …

Exceptional Eight-Year Response To Stereotactic Radiosurgery Monotherapy For Multiple Brain Metastases, Ronny Kalash, Phillip M. Pifer, Sushil Beriwal, Scott M. Glaser, John A. Vargo, Dwight E. Heron

Faculty & Staff Scholarship

Breast cancer represents the second leading cause of brain metastases in women. Once diagnosed, brain metastases have been associated with a rapidly progressive and universally poor prognosis. Breast cancer patients, particularly those with advantageous disease characteristics, may achieve extended survival. This extended life expectancy highlights the importance of effective intracranial treatments that minimize treatment-related late toxicity.

Whole brain radiation therapy (WBRT) remains a standard of care palliative option; however, concerns remain regarding the late neurocognitive effects. Stereotactic radiosurgery (SRS) provides dose-escalated radiation therapy over a shortened course, maintaining equivalent survival and minimizing normal brain tissue exposure.

Herein, we present a …

Monocyte-Lymphocyte Cross-Communication Via Soluble Cd163 Directly Links Innate Immune System Activation And Adaptive Immune System Suppression Following Ischemic Stroke, Grant C. O'Connell, Connie S. Tennant, Noelle Lucke-Wold, Yasser Kabbani, Abdul R. Tarabishy, Paul D. Chantler, Taura L. Barr

Faculty & Staff Scholarship

CD163 is a scavenger receptor expressed on innate immune cell populations which can be shed from the plasma membrane via the metalloprotease ADAM17 to generate a soluble peptide with lympho-inhibitory properties. The purpose of this study was to investigate CD163 as a possible effector of stroke-induced adaptive immune system suppression. Liquid biopsies were collected from ischemic stroke patients (n = 39), neurologically asymptomatic controls (n = 20), and stroke mimics (n = 20) within 24 hours of symptom onset. Peripheral blood ADAM17 activity and soluble CD163 levels were elevated in stroke patients relative to non-stroke control groups, and negatively associated …

Law-Based Arguments And Messages To Advocate For Later School Start Time Policies In The United States, Clark J. Lee, Dennis M. Nolan, Steven W. Lockley, Brent Pattison

Homeland Security Publications

The increasing scientific evidence that early school start times are harmful to the health and safety of teenagers has generated much recent debate about changing school start times policies for adolescent students. Although efforts to promote and implement such changes have proliferated in the United States in recent years, they have rarely been supported by law-based arguments and messages that leverage the existing legal infrastructure regulating public education and child welfare in the United States. Furthermore, the legal bases to support or resist such changes have not been explored in detail to date. This article provides an overview of how …

Pseudomembranous Tracheitis Caused By Aspergillus Fumigatus In The Setting Of High Grade T-Cell Lymphoma, Prashant Malhotra, Karan Singh, Paul Gill, Sonu Sahni, Mina Makaryus, Arunabh Talwar

Touro College of Osteopathic Medicine (New York) Publications and Research

Pseudomembranous tracheitis (PMT) is a rare condition most commonly caused by fungal or bacterial infection that is characterized by a pseudomembrane that partially or completely covers the tracheobronchial tree. PMT is most commonly found in immunocompromised patient populations, such as post-chemotherapy, AIDS, post-transplant and hematological malignancies. Due to its rarity, PMT is often not included in the differential diagnosis. This case describes a 65 year old male with persistent fever and refractory cough despite high dose empiric antibiotics. Subsequent bronchoscopy with biopsy revealed pseudomembranous tracheitis due to Aspergillus fumigatus in the setting of T-cell lymphoma. PMT should be considered in …

Primary Pulmonary Malt Lymphoma Presenting As Non-Resolving Pneumonia, Asma Iftikhar, Albert Magh, Muhammed Azaz Cheema, Sarah Thappa, Sonu Sahni, Stephen Karbowitz

Touro College of Osteopathic Medicine (New York) Publications and Research

Primary lung lymphoma (PLL) is a rare unilateral or bilateral lung disorder that is challenging to diagnose solely based on clinical and radiological presentation. PLL may be misdiagnosed as pneumonia or a lung tumor due to non-specific findings. PLL is most frequently a mucosa-associated lymphoid tissue (MALT) lymphoma, a type of extranodal low-grade B-cell lymphoma most commonly discovered in the gastrointestinal tract. PLL should be considered in the differential diagnosis of non-resolving pneumonias. Herein we present a case of an 84-year-old patient discovered to have a primary pulmonary MALT lymphoma presenting as a non-resolving pneumonia causing a clinical challenge.

Exercise Tolerance Improves After Pulmonary Rehabilitation In Pulmonary Hypertension Patients, Arunabh Talwar, Sonu Sahni, Sameer Verma, Sara Z. Khan, Sean Dhar, Nina Kohn

Touro College of Osteopathic Medicine (New York) Publications and Research

Pulmonary rehabilitation (PR) is part of the recommended management plan of pulmonary hypertension (PHTN) and is important to better quality of life and exercise tolerance. This study aimed at determining effectiveness of PR on exercise capacity. Retrospective chart analysis was conducted on patients referred to our PHTN clinic for PR. Patients who had PHTN diagnosed on right heart catheterization (defined by mean pulmonary artery pressure>25 mmHg) and completed a standardized 12-week PR program were considered for the study. Patients’ baseline exercise tolerance was recorded as speed attainable on a treadmill and duration of exercise in minutes. Demographics, age, sex, …

Socioeconomic Status And Its Relationship To Chronic Respiratory Disease, Sonu Sahni, Ankoor Talwar, Sameer Khanijo, Arunabh Talwar

Touro College of Osteopathic Medicine (New York) Publications and Research

Socioeconomic status (SES) is defined as an individual’s social or economic standing, and is a measure of an individual’s or family’s social or economic position or rank in a social group. It is a composite of several measures including income, education, occupation, location of residence or housing. Studies have found a lower SES has been linked to disproportionate access to health care in many diseases. There is emerging data in pulmonary diseases such as COPD, asthma, cystic fibrosis, pulmonary hypertension and other chronic respiratory conditions that allude to a similar observation noted in other chronic diseases. In the setting of …

Public Health Measures Derived From The Jewish Tradition: Ii. Washing And Cleaning, Noam Zeffren, Tova Chien, Robert Stern

Touro College of Osteopathic Medicine (New York) Publications and Research

The authors discuss public health measures that are described in the Torah and rabbinic literature, focusing on hand washing and cleaning.

Hyaluronidase: A Potential New Treatment For Acute Respiratory Distress Syndrome, C. Leblanc, Robert Stern

Touro College of Osteopathic Medicine (New York) Publications and Research

Acute respiratory distress syndrome, also known as diffuse alveolar damage, is an acute injury to the lungs. Patients experience severe shortness of breath and require mechanical ventilation. It is not a specific disease, but an acute lung dysfunction associated with a variety of disorders: pneumonia, shock, sepsis, and trauma. A similar lesion occurs in newborn infants, called hyaline disease of the newborn. It occurs in premature babies and has the same pathophysiological mechanism as acute respiratory distress syndrome. Hyaline membranes are a pathologic feature of acute respiratory distress syndrome, consisting of basophilic structures that coat alveolar surfaces. They prevent oxygen …

Nationwide Trends In Inpatient Admissions Of Pulmonary Hypertension In The United States From 2000 To 2013, Rutuja R. Sikachi, Sonu Sahni, Dhruv Mehta, Abhishek Agarwal, Abhinav Agrawal

Touro College of Osteopathic Medicine (New York) Publications and Research

Introduction: Pulmonary Hypertension (PH) is a disorder of the pulmonary vasculature with high mortality and bears a large economic burden on the healthcare system. We conducted a review of the largest inpatient database in the United States and analyzed the trends in hospitalizations due to PH from the turn of the century (2000) to 2013 to evaluate the rate of hospitalizations and determine the cost and mortality associated with PH.

Material and methods: We analyzed the National Inpatient Sample Database (NIS) for all patients in which PH (Primary or Secondary) or cor pulmonale was the primary discharge diagnosis …

Adelante Ambassadors: Using Digital Media To Facilitate Community Engagement And Risk-Prevention For Latino Youth, Nicole Barrett, Ricardo Villalba, Elizabeth L. Andrade, Alison Beltran, W. Douglas Evans

Prevention and Community Health Faculty Publications

Digital and social media are now widely used to promote engagement in health programs and improve health behaviors across a variety of age groups and domains. However, limited research exists on applying culturally relevant, new media interventions specific to Latino immigrant youth. This paper describes the pilot Adelante Youth Ambassador program for Latino immigrant youth, which used digital media and community-based participatory research to build positive youth development (PYD) assets as a prevention mechanism to reduce co-occurring health risks of substance use, sexual risk, and interpersonal violence. We worked collaboratively with adolescents to create video content as a conduit for …