Clinicopathological Characteristics And Mutation Profile Of Braf And Nras Mutation Incutaneous Melanomas In The Western Turkish Population, Mustafa Kürşat Evrenos, Peyker Temi̇z, Fethi̇ Sirri Çam, Murat Yaman, Levent Yoleri̇, Ayli̇n Türel Ermertcan

Turkish Journal of Medical Sciences

Background/aim: Malignant melanoma is the most common cause of death due to skin cancers. The most common mutations in RAFRAS pathway from tumor oncogenes are BRAF and NRAS. In this study, we analyzed the frequency of BRAF and NRAS gene mutations and investigated their association with clinicopathological features of melanomas in the Turkish population. Materials and methods: 65 primary cutaneous melanoma were included in the study. The mutations were evaluated with real-time PCRbased PCR-array through allele-specific amplification, and the results were correlated with various clinicopathological characteristics. Results: 52.3% of the patients were female and 47.7% were male. The mean age …

Effects Of Tourniquet Usage In Lower Extremity Surgery On Optic Nerve Sheath Diameter, Ahmet Beşi̇r, Ersagun Tuğcugi̇l

Turkish Journal of Medical Sciences

Background/aim: The aim of this study was to evaluate changes in intracranial pressure following tourniquet deflation using noninvasive ultrasonographic optic nerve sheath diameter (ONSD) measurements. Materials and methods: Our study included 59 adult patients between the ages of 18 and 65 years from the American Society of Anesthesiologists (ASA) I/II risk groups who were scheduled to undergo elective orthopedic surgery of the lower extremities using a tourniquet under general anesthesia. ONSD and end-tidal CO2 (ETCO2) were measured 5 times: 15 min prior to the anesthesia induction; just prior to the deflation of the tourniquet; and at 5, 10, and 15 …

Determining The Effect Of Long-Term Dexamethasone And Prednisolone Treatment Onsugammadex, Ebru Bi̇ri̇ci̇k, Ersel Güleç, Işil Öcal, Mehmet Bertan Yilmaz, Feri̇de Karacaer, Di̇lek Özcengi̇z

Turkish Journal of Medical Sciences

Background/aim: We aimed to investigate the effect of long-term use of dexamethasone and prednisolone on the reversal effect of sugammadex. Materials and methods: TTwenty-four male Wistar albino rats were divided into three groups. Dexamethasone (600 µg/kg) was given to group D, prednisolone (10 mg/kg) was given to group P, and an equivalent volume of saline per day was administered intraperitoneally to group S for 14 days, respectively. The left hemidiaphragm with attached phrenic nerve was maintained in Krebs solution. Sugammadex (30 µmol/L) was applied while rocuronium (10 µmol/L) was present in an organ bath and a single twitch was obtained. …

Serum Adma, Endothelial Dysfunction, And Atherosclerosis In Hypervolemichemodialysis Patients, İbrahi̇m Doğan, Bariş Eser, Sultan Özkurt, Özlem Yayar, Bülent Özgür, Hüseyi̇n Kayadi̇bi̇, Tolga Doğan, Ahmet Musmul, Mehmet Soydan

Turkish Journal of Medical Sciences

Background/aim: Asymmetric dimethyl arginine (ADMA) is a strong predictor of cardiovascular disease and mortality in patients under hemodialysis treatment. We aimed to investigate the relationship among volume status, endothelial dysfunction, and ADMA in hemodialysis patients. Materials and methods: A total of 120 patients with a history of hemodialysis treatment were included. ADMA and CRP were measured. Echocardiographic evaluation and carotid artery intima-media thickness (CIMT) measurements were performed. Patients were divided into two groups according to clinical evaluation, ultrafiltration rate, vena cava inferior diameter (VCI), and cardiothoracic index (CTI); the two groups were hypervolemic and normovolemic. Results: The hypervolemic group included …

Considerations Regarding The Digestive Development Of The Premature Neonate, Gretchen Clavey

A with Honors Projects

For most parents, adjusting to life with a typical newborn revolves around two main priorities: getting the baby sufficiently fed and watching for tell-tale signs of adequate digestion. Usually this does not involve much consideration for what is going on between the two ends of the digestive system. However, if the infant is born prematurely or needs to spend the start of life in the Neonatal Intensive Care Unit (NICU), they find themselves thrust into a foreign world where life revolves around the baby’s fluid intake & output, oxygen saturations and heart rate. At this point, a conversation about the …

Nanopulse Stimulation (Nps) Induces Tumor Ablation And Immunity In Orthotopic 4t1 Mouse Breast Cancer: A Review, Stephen J. Beebe, Brittany P. Lassiter, Siqi Guo

Bioelectrics Publications

Nanopulse Stimulation (NPS) eliminates mouse and rat tumor types in several different animal models. NPS induces protective, vaccine-like effects after ablation of orthotopic rat N1-S1 hepatocellular carcinoma. Here we review some general concepts of NPS in the context of studies with mouse metastatic 4T1 mammary cancer showing that the postablation, vaccine-like effect is initiated by dynamic, multilayered immune mechanisms. NPS eliminates primary 4T1 tumors by inducing immunogenic, caspase-independent programmed cell death (PCD). With lower electric fields, like those peripheral to the primary treatment zone, NPS can activate dendritic cells (DCs). The activation of DCs by dead/dying cells leads to increases …

Examination Of Athletic Trainer’S Perceptions On Mentoring Relationships, Nicole Anne Wilkins

Student Dissertations

No abstract provided.

Whether, When, And How: Fertility Intentions And Age In The U.S., Andrea Melnikas

Dissertations and Theses

Thinking about, planning for, and having children is a deeply personal experience influenced by myriad factors at individual, intrapersonal, community and larger social levels. Examining fertility intentions is of interest to researchers from numerous social science disciplines in part because these intentions are potentially tied to larger demographic and economic shifts. In recent years in the U.S. the mean age at first birth has been increasing, with more women of older ages (age 35 and older) giving birth, due to both delays in childbearing that accompanied larger social trends such as increased educational and career opportunities and a decrease in …

Enriching Clinical Learning Environments Through Partnerships: Academic And Practice Partnerships To Strengthen Care For Older Adults In Residential And Assisted Living Settings, Juliana Cartwright, Diana L. White

Institute on Aging Publications

This report was prepared by Oregon Health & Science University (OHSU) School of Nursing and the Institute on Aging at Portland State University to describe an academic-community partnership using the Enriching Clinical Learning Environments through Partnerships (ECLEPs) model. This two-year project was conducted with 34 students in the RN-BSN program in eight assisted living (AL) communities and ElderPlace, a PACE program serving residents in assisted living and other residential settings. Quality improvement was the focus of the project. Features of the ECLEPs model include:

• An intentional partnership between academic and clinical organizations
• Relationship-based; shared decision making
• Long-term commitment between partners …

Identifying Rates, Barriers And Facilitators For Hpv Vaccines In Children Ages 11-14 In A Kentucky Primary Care Clinic, Sarah J. King

DNP Projects

Background: Among all of the pediatric vaccinations recommended by the CDC, the HPV vaccination has consistently had lower adherence rates than the goal set by Healthy People 2020. The CDC recommends that adolescents start receiving the human papillomavirus (HPV) vaccine at the ages 9-11 to provide protection against certain strains of HPV that can cause cancer. The goal is to administer the HPV vaccine before the adolescent would be exposed to the virus. However, there has been much resistance and non-adherence to the HPV vaccination. Purpose: The purpose of this study was to identify the current rates of HPV vaccination …

Evaluation Of Education Implementation In The Adult Palliative Care Population, Amber Nicole Folske

DNP Projects

Abstract

PURPOSE: The purpose of this study is to determine if staff nurses are knowledgeable concerning palliative care consults and to assess the effectiveness/outcomes of the education intervention that had been implemented in the emergency department and 4W surgical/oncology units at Norton Audubon Hospital.

METHODS: This descriptive, interventional study was done in two phases at Norton Audubon Hospital. The first phase of this study included educational intervention for 24 nurses on 4W and 22 nurses in the emergency department concerning palliative care in July 2018. The second phase of the study was a chart review on consults placed on 69 …

Reducing Depression And Suicide Ideation Among College Students, Andrew Ritzel

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

Suicide rates have been on the rise for the past 30 years; 42,773 Americans dying every year by suicide. Suicide is the tenth leading cause of death among all ages, but the second leading cause of death among Americans ages 15-24. College students traditionally fall within this age group, and are especially at risk for suicide due to stressful life conditions. The University of Kentucky, located centrally within Kentucky in the city of Lexington, is an ideal location for a suicide prevention intervention. Students demonstrated an increased rate of depression compared to the national population (15.13% of students surveyed reported …

Environmental Exposure To Atrazine And Birth Defects: An Ecological Study In Kentucky, 2005-2014, Maria Dimitrios Politis

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

Atrazine is one of the most widely used pesticides in the United States. Studies have shown that pesticides, in particular herbicides such as atrazine, may be associated with birth defects. The purpose of this study is to evaluate the association between potential environmental exposures to atrazine in water systems and prevalence rates of birth defects for the state of Kentucky. An ecological study using the Kentucky Birth Defects Registry Surveillance and the Kentucky Geological Survey databases from 2005 to 2014 was conducted. Poisson regression was used to estimate crude and adjusted rate ratios of the association between agricultural exposure metrics …

Chinese Herbal Medicine Therapy And The Risk Of Mortality For Chronic Hepatitis B Patients With Concurrent Liver Cirrhosis: A Nationwide Population-Based Cohort Study, Tzung-Yi Tsai, Tsung-Hsing Hung, Hanoch Livneh, I-Hsin Lin, Ming-Chi Lu, Chia-Chou Yeh

Counselor Education Faculty Publications and Presentations

Chronic hepatitis B (CHB) is increasingly recognized as a public health problem in Taiwan. After affected patients are diagnosed with contaminant liver cirrhosis (LC), adverse clinical outcomes, especially death, are common. This study aimed to investigate the effect of Chinese herbal medicine (CHM), an essential branch of Traditional Chinese medicine (TCM), on the mortality risk among CHB patients with contaminant LC. This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 1522 patients 20–70 years of age with newly diagnosed CHB with LC during 1998–2007. Among them, 508 (33.37%) had received CHM products after the onset …

Applying Lean Methodology To Improve The Response And Management Of Postpartum Hemorrhage, Caroline Siefken

DNP Scholarly Projects

Postpartum Hemorrhage is an obstetric emergency that can lead to substantial maternal morbidity and mortality. Lean methodology is an improvement framework that addresses processes and identifies opportunities to eliminate waste and introduce efficiencies. The North Shore Medical Center uses an improvement framework modeled after the Toyota Production System that uses lean methodology to assess processes. This framework is called the North Shore Production System. This quality improvement project used the lean methodology tools from the North Shore Production System and applied them to interdisciplinary, simulated drills at the North Shore Medical Center Birthplace. After analysis of the tools, a postpartum …

Preventing Emergency Department Overutilization For Florida’S Seasonal Resident Population, Amanda Garcia

DNP Scholarly Projects

Background/Local Problem: Seasonal migration of elderly patients to Lee County, Florida result in overcrowding and prolonged wait times in emergency departments. Many of these seasonal residents dissociate the management of their chronic health conditions with a local provider, therefore utilizing the emergency department for non-urgent needs. Purpose: The Seasonal Resident Navigator Program was intended to enhance the coordination of primary care services for elderly seasonal residents by establishing appointments with local primary care providers (PCP) in order to reduce the overutilization of emergency services and improve patient throughput. Methods: A residency and provider assessment tool was incorporated into the Healthpark …

University Of Nebraska At Omaha 2018-2019 Course Catalog, University Of Nebraska At Omaha

Undergraduate Catalogs

Located in one of America’s best cities to live, work and learn, the University of Nebraska at Omaha (UNO) is Nebraska’s premier metropolitan university. With more than 15,000 students enrolled in 200-plus programs of study, UNO is recognized nationally for its online education, graduate education, military friendliness, and community engagement efforts.Founded in 1908, UNO has served learners of all backgrounds for more than 100 years and is dedicated to another century of excellence both in the classroom and in the community.

Incredible Years (Iy) Parents & Babies Well-Baby Program: Expanding The Reach Through Cultural Adaptation, Ayanda Chakawa, Briana Woods-Jaeger

Posters

No abstract provided.

Partnering With Inpatient Situation Awareness Screening To Improve Early Sepsis Recognition, Leslie Hueschen, Stephanie Burrus, Andrea Raymond, Charity Thompson, Lisa Carney, Jay Rilinger

Posters

Background

Early recognition of sepsis and designing a huddle process are key drivers of the Improving Pediatric Sepsis Outcomes (IPSO) collaborative. Our tertiary care, free-standing, pediatric hospital joined the IPSO collaboration in 2016. Our hospital began piloting Situation Awareness (SA) Escalation Huddles in 2016, to improve recognition of patients with clinical deterioration. The tool triggers if a patient has a high PEWS(> 5), requires initiation of hi-flow nasal cannula, or for staff/parental concern. The SA paper tool guides the communication process and steps of the huddle. Huddles include a nurse, provider, and respiratory therapist. One of the goals of the …

Significant Loss Of Blood Amino Acids And Free Carnitine In Newborns Receiving Continuous Renal Replacement Therapy (Crrt), Uttam Garg, Marita Thompson, Bradley A. Warady, Vimal Chadha

Posters

Background

•Newborns with acute kidney injury (AKI) or end-stage kidney disease (ESKD) often receive prolonged CRRT when the early initiation of peritoneal dialysis is either contraindicated or unable to be performed. •These patients often receive total parenteral nutrition (TPN) to meet their nutritional goals. •Little to no information exists on the loss of blood amino acids (AA) and carnitine during CRRT in these patients. •The objective of this study was to determine the amino acids and carnitine losses in newborns receiving prolonged CRRT and TPN. Material and Methods

•Three newborns who received prolonged (> 2 weeks) CRRT and TPN were …

Depression, Thanu Abraham

Senior Honors Theses and Projects

Depression is one of the most prevalent mental health disorders in the United States. Anyone can be diagnosed with depression at any point in life. The objective of this paper is to explore depression within special populations. This paper will be sectioned into five different chapters. Chapter I will discuss what depression is. Chapter II will examine depression in adolescents. Chapter III will explore postpartum depression. Chapter IV will discuss geriatric depression. Chapter V will explore the relationship between depression and cardiovascular disease. Each section will contain extensive research within its topic. Although depression drastically impacts one's life, only half …

"I Viewed Them Sick": Photography And Addiction Medicine As Activism During The "Speed Freak" Crisis Of The Long 1960s, Hannah Zornow Alter

Yale Medicine Thesis Digital Library

“Speed freak” was a pejorative term that emerged in the late 1960s to describe young people who binged on amphetamines, often by injection. The accessibility of amphetamines during the 1960s and early 1970s coupled with the emergence of a radical youth movement produced this distinctive subculture. This thesis will address responses to this drug crisis in two parts, from the perspective of two activists working in very different fields. In 1971, Larry Clark, a photographer, and David Smith, a physician, each published their seminal works on “speed freak” culture. Separated by half a country, they had enmeshed themselves in communities …

Measuring The Burden Of Childhood Cancer Treatment: Decrements In Bone Health And Financial Toxicity, Hadley Bloomhardt

Yale Medicine Thesis Digital Library

With research and clinical advances over the past several decades, survival rates for childhood cancer have improved to greater than 80%. However, the path to survivorship poses a substantial burden to patients and families, with lengthy treatment courses requiring frequent hospital visits, and with late complications of treatment that can present years after therapy ends. This thesis explores each of these areas: one study investigating bone health and morbidity in leukemia and lymphoma survivors, and another study examining the cost burden to families of children during treatment for average-risk acute lymphoblastic leukemia (ALL). We aimed to determine the utility of …

A Novel Staining Method For Detecting Bloodborne Bacteria After Their Dielectrophoretic Isolation, John Gaudet

Yale Medicine Thesis Digital Library

Current methods to diagnose bacteremia typically require 18 to 36 hours to detect positive samples and five days to identify negative ones. This delay stems in part from the incubation time necessary for bacteria to multiply and achieve detectable concentrations. In recent years, microfluidic chips have been developed that isolate and concentrate bacteria from the blood on a time scale of minutes to hours (1). This research seeks to stain and visualize these bacteria after their microfluidic processing thereby significantly shortening the time required to diagnose bacteremia.

The traditional Gram stain is not sufficiently sensitive to detect bacteria in this …

Implementation Of New Definitions Of Labor Arrest Disorders And Failed Induction Can Decrease The Cesarean Rate, Jessica Tanzer Wright Greenberg

Yale Medicine Thesis Digital Library

Cesarean delivery for labor arrest currently makes up the largest proportion of

primary cesarean delivery in the United States. Because cesarean delivery is associated

with significant morbidity, it is important to limit its use to ensure the benefits outweigh

the risks. New diagnostic criteria to limit the diagnosis of labor arrest have the potential

to decrease the cesarean delivery rate. To investigate how cesarean delivery for arrest of

dilation or descent and failed induction contributed to the primary cesarean delivery rate,

we analyzed rates of primary cesarean for these indications among 17,864 live births at

our institution from 2010 through …

Adherence To Prospective Registration Policy And Implications For Clinical Trial Endpoint Integrity, Anand Gopal

Yale Medicine Thesis Digital Library

Since implementation of the International Committee of Medical Journal Editors’ (ICMJE) prospective registration policy in 2005, trial registration has increased significantly. Registering clinical trials is critical in promoting transparency and integrity in medical research, however trials must be registered in an appropriate manner to deter unaccounted protocol modifications or selection of alternate endpoints that may enhance favorability of reported results. This thesis provides relevant background on clinical trial registration and appropriate reporting in addition to evaluating adherence with the ICMJE’s prospective trial registration policy and the implications of inappropriate adherence for the integrity of reported results. In a cross-sectional, retrospective …

Simulation-Based Nurse Mentoring To Promote Preeclampsia Care: What Is The Impact In Bihar, India?, Julia Haven Raney

Yale Medicine Thesis Digital Library

Background:

Inadequately treated, severe preeclampsia and eclampsia (PE/E) may rapidly lead to severe complications in both mothers and neonates and are estimated to cause 60,000 maternal deaths globally each year. Simulation-based training where health providers review basic emergency obstetric and newborn care through highly realistic cases have demonstrated promising results in low- and middle-income countries (LMIC). Two international simulation training programs, Helping Mothers Survive and PRONTO International, have demonstrated improved overall use of evidence-based practices (EBPs) in active management of third stage of labor and hemorrhage management, though individual skills varied. However, the impact of simulation training on use of …

Role Of The Rna Modification N6-Methyladenosine In Normal Hematopoiesis & Disease, Radovan Vasic

Yale Medicine Thesis Digital Library

N6-methyladenosine (m6A) is the most abundant modified nucleotide occurring in mRNA, with key roles in RNA metabolism and regulation of gene expression. Proposed effects of m6A modification of RNA transcripts include effects on transcript half-life, translation efficiency, splicing and miRNA biogenesis. Importantly, m6A is the only known dynamic RNA modification, with deposition mediated by the “writer” METTL3, and demethylation carried out by the “erasers” ALKBH5 and FTO. We hypothesized a role for m6A in hematopoiesis, with potential disease relevance in myeloid malignancies.

To gain an understanding of the effects of m6A on normal hematopoiesis and myeloid malignancies such as the …

Photodynamic Therapy For Cutaneous Squamous Cell Carcinoma In-Situ & Mutation Burden Analysis, Yuemei Zhang

Yale Medicine Thesis Digital Library

PHOTODYNAMIC THERAPY FOR CUTANEOUS SQUAMOUS CELL CARCINOMA IN-SITU & MUTATION BURDEN ANALYSIS. Yuemei (Amy) Zhang, Mei Zhong, Haifan Lin, and Sean Christensen. Department of Dermatology, Yale University School of Medicine, New Haven, CT.

SCC in-situ (SCCIS), or Bowen’s disease, is a precursor to invasive squamous cell carcinoma (SCC) of the skin. Compared to other available treatment modalities, photodynamic therapy (PDT) may offer comparable efficacy with decreased morbidity and better cosmetic and functional outcomes. This retrospective study analyzes the effectiveness and outcomes of photodynamic therapy with aminolevulinic acid (ALA-PDT) treatment of cutaneous squamous cell carcinoma in-situ (SCCIS) with blue light. Data …

Orally-Dosed Citalopram Stimulates Small Intestinal Mucosal Growth, Lucy Zhang

Yale Medicine Thesis Digital Library

Parenterally-administered selective serotonin reuptake inhibitors (SSRI), such as citalopram, increase intestinal mucosal absorptive surface by day 7 of treatment. We hypothesized that enteral citalopram would also induce intestinal mucosal growth, thus allowing for therapy with an oral agent. In the study’s first phase, C57BL/6 mice received peanut butter (PB) pellets containing 10, 50, or 100 mg/kg/day citalopram for 7 days; or 25 mg/kg/day citalopram for 14 or 21 days; or plain PB pellets for 7, 14, or 21 days. In the second phase, C57BL/6 mice received 0, 10, 25, or 50 mg/kg/day citalopram in drinking water for 2, 3, 6, …