Medicine and Health Sciences Commons^™

Single Institution Implementation Of Permanent 131cs Interstitial Brachytherapy For Previously Irradiated Patients With Resectable Recurrent Head And Neck Carcinoma, Voichita Bar-Ad, Emily Hubley, Adam Luginbuhl, David Cognetti, Joseph Curry, Amy Harrison, Jennifer Johnson, James Keller, Cheng Peng, David To, Laura Doyle

Department of Radiation Oncology Faculty Papers

Purpose: Permanent interstitial brachytherapy is an appealing treatment modality for patients with locoregional recurrent, resectable head and neck carcinoma (HNC), having previously received radiation. Cesium-131 (131Cs) is a permanent implant brachytherapy isotope, with a low average photon energy of 30 keV and a short half-life of 9.7 days. Exposure to medical staff and family members is low; patient isolation and patient room shielding are not required. This work presents a single institution’s implementation process of utilizing an intraoperative, permanent 131Cs implant for patients with completely resected recurrent HNC.

Materials & Methods: Fifteen patients receiving 131Cs permanent seed brachytherapy were included …

Drug-Induced Acute-On-Chronic Liver Failure In Asian Patients, Harshad Devarbhavi, Saeed Hamid

Section of Gastroenterology

Objectives: Acute insults from viruses, infections, or alcohol are established causes of decompensation leading to acute-on-chronic liver failure (ACLF). Information regarding drugs as triggers of ACLF is lacking. We examined data regarding drugs producing ACLF and analyzed clinical features, laboratory characteristics, outcome, and predictors of mortality in patients with drug-induced ACLF.

Metods: We identified drugs as precipitants of ACLF among prospective cohort of patients with ACLF from the Asian Pacific Association of Study of Liver (APASL) ACLF Research Consortium (AARC) database. Drugs were considered precipitants after exclusion of known causes together with a temporal association between exposure and decompensation. Outcome …

Framework For Collaborative Teaching: Strengths And Challenges For A Different Service Paradigm In Haiti, Patricia Mason, Judith C. James-Burga

Journal of Global Education and Research

Nursing education in Haiti is in transition. This article describes the teaching/learning experiences of participants in a nursing educational project in Haiti. The project was guided by an integrative framework of the educational collaborative model, constructivism and situated learning theory. Reflections on the experiences lead to the realization of these four lessons: (a) the service provided must supplement, not negate the values and strengths of the host community; (b) it is important to provide sustainable service; (c) methods used by international educators must be respectful and relevant; and (d) international educators must be willing to engage in the identification and …

Ethical Considerations For Conducting Sexual And Reproductive Health Research With Female Adolescents Engaged In High-Risk Behaviours In China, Xu-Dong Zhang, Sabrina Ching Yuen Luk, Yue-Hong Han, Gui-Rong Chen, Bao-Sheng Zhu, Stanley Luchters

Population Health, East Africa

Background: Chinese female adolescents engaged in sex trade and substance use are often criminalized and stigmatized. As a result of these cultural, legal and political constraints, ethical concerns can discourage investigators from engaging these adolescents in research. This paper aims to address the ethical tensions between protection and inclusion in conducting sexual and reproductive health (SRH) research with adolescents engaged in high-risk behaviours. Processes of moral reasoning, and examples and practical mechanisms in managing such ethical challenges were presented in the hope of advancing the research ethics policies and practice with adolescents.

Methods: We extracted ethical issues from three previously …

Performance Measures For Small-Bowel Endoscopy: A European Society Of Gastrointestinal Endoscopy (Esge) Quality Improvement Initiative, Cristiano Spada, Deirdre Mcnamara, Edward J Despott, Samuel Adler, Brooks D Cash, Ignacio Fernández-Urién, Hrvoje Ivekovic, Martin Keuchel, Mark Mcalindon, Jean-Christophe Saurin, Simon Panter, Cristina Bellisario, Silvia Minozzi, Carlo Senore, Cathy Bennett, Michael Bretthauer, Mario Dinis-Ribeiro, Dirk Domagk, Cesare Hassan, Michal F Kaminski, Colin J Rees, Roland Valori, Raf Bisschops, Matthew D Rutter

Faculty, Staff and Student Publications

The European Society of Gastrointestinal Endoscopy (ESGE) together with the United European Gastroenterology (UEG) recently developed a short list of performance measures for small-bowel endoscopy (i.e. small-bowel capsule endoscopy and device-assisted enteroscopy) with the final goal of providing endoscopy services across Europe with a tool for quality improvement. Six key performance measures both for small-bowel capsule endoscopy and for device-assisted enteroscopy were selected for inclusion, with the intention being that practice at both a service and endoscopist level should be evaluated against them. Other performance measures were considered to be less relevant, based on an assessment of their overall importance, …

Ibuprofen Does Not Increase Blood Pressure In Preeclampsia, Sofia Costas, Sherry Hutton, Cindy Kenyon

Books, Presentations, Posters, Etc.

Objective: The aim of this IRB approved study was to evaluate the impact of ibuprofen on Mean Arterial Pressure (MAP) in the immediate postpartum period of women with preeclampsia.

Design: A retrospective chart audit of 633 preeclampsia patients who had treated severe hypertension (BP > 160/105) during their hospital stay.

Setting: Metropolitan Level 3 facility in Portland OR.

Patients/Participants: 169 patients met criteria; received magnesium sulfate postpartum and had severe hypertension postpartum. 60 were randomly selected, 30 received ibuprofen, 30 did not.

Methods: Baseline was obtained at 2 hours postpartum. Each patients MAP for each 24 hour interval were …

The Lived Experience Of Healthcare Leadership Dyads: Perceptions Of Agency, Susan Murphy Campanelli

All Theses And Dissertations

Healthcare leadership is evolving in response to recommendations from the Institute of Healthcare Improvement (IHI). Physicians and administrators are partnering to form leadership dyads. These leadership dyads are focusing on improving healthcare quality, decreasing costs, and improving access. Existing literature on healthcare dyads explores leadership training needs for physicians, focuses on the differences between physicians and administrators, and emphasizes the need to develop role clarity for dyad leaders. There is a lack of empirical literature exploring how the physician and the administrator develop into a leadership team and extend shared leadership into their organization.

This phenomenological study applies Bandura’s (1986) …

Field Evaluation Of The Impact Of Sahlbergella Singularis Haglund Infestations On The Productivity Of Different Theobroma Cacao L. Genotypes In The Southern Cameroon, R. J. Mahob, R. Feudjio Thiomela, L. Dibog, R. Babin, Y. G. Fotso Toguem, H. Mahot, L. Baleba, P. A. Owona Dongo, C. F. Bilong Bilong

All Peer-Reviewed Publications

Mirids (Sahbergella singularis and/or Distantiella theobroma) are the major pests of cacao farms in Africa. Cocoa production losses due to these species have been widely documented in West Africa. However, their impact on cocoa production is unknown in Central Africa, especially in Cameroon. Moreover, no data are available on the threshold level of fruits tolerance to mirid attacks. For these reasons, we assessed the effect of S. singularis on the productivity of ten cacao genotypes as well as the threshold number of the lethal feeding punctures to fruits under a randomized experimental design. Observations were made on three categories of …

Chimeric Antigen T Cell Receptor Treatment In Hematological Malignancies, Natasha Ali

Department of Pathology and Laboratory Medicine

No abstract provided.

Blood Film Says It All! Rare Case Of Congenital Ttp Misdiagnosed As Itp, Ayesha Majeed Memon, Natasha Ali

Department of Pathology and Laboratory Medicine

We report a case of a 16-year-old female who presented with bleeding diathesis. Peripheral blood film examination was consistent with microangiopathic hemolytic anemia with 7% fragmented red blood cells. The ADAMTS13 level was 40 ng/ml (reference range: 630-850 ng/ml). She responded to plasma exchange therapy and methylprednisolone and was discharged in a stable condition.

Connected Families: Programs For Families Of Infants/Toddlers At Risk For Autism, Toni Carol Durnal Dunning

Loma Linda University Electronic Theses, Dissertations & Projects

Although children with secure attachment are known to have better outcomes, fostering secure attachment in an infant/toddler at risk for autism spectrum disorder is challenging. Some of the challenges stem from bi-directional, negative and ambiguous interaction sequences between the child and caregiver that cause emotional dysregulation and undermine caregiver confidence setting the stage for perpetual miscuing and misattunement— a pattern that can impact the entire family system leaving the child, caregiver, and family vulnerable to stress, anxiety, depression, and isolation.

Although the etiology of autism is a matter of intensive and ongoing research spanning many disciplines, there is converging agreement …

Experience Of An Infectious Diseases (Id) Travel Medicine Clinic During A National Shortage Of Yellow Fever Vaccine (Yfv), Mark Knouse Md, Terri I. Langham Rn, Marcelo Gareca Md, Jarrod W. Kile Rphd

Department of Medicine

No abstract provided.

The Effect Of Mirror Therapy On Upper Extremity Functioning For Patients Poststroke: A Systematic Review, Caitlin Beach, Halie Finke, Abby Garrity, Amanda Norcini, Lily Postus, Kristen Tekel, Lyn Kaiser, Otd, Otr/L

Student Papers, Posters & Projects

Due to the high incidence of stroke and the detrimental impact it can have on a patient’s independence, several systematic reviews examining the effect of MT on post-stroke rehabilitation for upper extremity functioning have been conducted. However, it is necessary to provide an update to existing systematic reviews to include new clinical studies that have recently been published. Since stroke is a leading cause of disability, this study aims to determine the effectiveness of MT in post-stroke rehabilitation for upper extremity function as compared to conventional therapy.

Randomized Phase 3 Evaluation Of Trifarotene 50 Μg/G Cream Treatment Of Moderate Facial And Truncal Acne., Jerry Tan, Diane Thiboutot, Georg Popp, Melinda Gooderham, Charles Lynde, James Del Rosso, Jonathan Weiss, Ulrike Blume-Peytavi, Jolanta Weglovska, Sandra Johnson, Lawrence Parish, Dagmara Witkowska, Nestor Sanchez Colon, Alessandra Alió Saenz, Faiz Ahmad, Michael Graeber, Linda Stein Gold

Department of Dermatology and Cutaneous Biology Faculty Papers

BACKGROUND: Acne vulgaris often affects the face, shoulders, chest, and back, but treatment of nonfacial acne has not been rigorously studied.

OBJECTIVES: Assess the safety and efficacy of trifarotene 50 μg/g cream, a novel topical retinoid, in moderate facial and truncal acne.

METHODS: Two phase III double-blind, randomized, vehicle-controlled, 12-week studies of once-daily trifarotene cream versus vehicle in subjects aged 9 years or older. The primary end points were rate of success on the face, as determined by the Investigator's Global Assessment (clear or almost clear and ≥2-grade improvement), and absolute change from baseline in inflammatory and noninflammatory counts from …

A Neonate With Upper Gi Bleeding, Suneeta Khemani, Huma Ghulam Qadir, Mumtaz Malik, Faiqa Hassan

Department of Paediatrics and Child Health

Bleeding in the newborn is often a serious problem because of cardiovascular effects associated with a loss of blood and/or the damaging effects of bleeding on neonatal tissues, especially the brain. Gastric polyps are described as abnormal lesions that originate in the gastric epithelium or submucosa and protrude into the stomach lumen. Clinical presentation of gastric polyps in children varies widely, from incidental endoscopic finding to massive gastrointestinal bleeding. However, acute gastrointestinal bleeding in association with hyperplastic gastric polyps has been reported very rarely. We report a case of unusual upper gastrointestinal bleeding in newborn baby on 2nd day of …

Use Of A Communication Tool To Improve The Perception Of Continuity Of Care, Annette Lotz

Electronic Theses and Dissertations

Inadequate or incorrect communication during transfer from skilled nursing facilities leads to misunderstandings about patient care needs, jeopardizes patients’ trust in the health care system, and leads to poor clinical outcomes. Due to gaps in communication from one health care setting to another, it was essential to determine if a patient-centered discharge tool would improve patients’ perception of continuity of care. The purpose of the study was to implement a patient-centered tool that would help improve the information needed at the time of discharge from a skilled nursing facility. Roy’s Adaptation Model supports the relevance of effective communication in the …

Developing Resilience Training For The Healthcare Employee In A Rural Medical Center, Sandra E. Gothard

Electronic Theses and Dissertations

In the clinical setting and in their personal lives, health professionals are confronted with many stressors that impact their time and the clarity of their role. Stressors are emotional, moral, or spiritual in nature as a result of exposure to suffering and death. There are often occupational stressors, such as reduced social support, excessive workload, or a prolonged misalignment among personal needs, individual values, and the work role. As a result of these challenges, health care employees need to create coping skills when stressors and demands become hindrances to personal well-being and their professional ability to care for others. Developing …

Satellite Monitoring Of Harmful Algal Blooms In The Western Basin Of Lake Erie: A 20-Year Time-Series, Michael Sayers, Amanda Grimm, Robert Shuchman, Karl Bosse, Gary L. Fahnenstiel, Steven A. Ruberg, George A. Leshkevich

Michigan Tech Publications, Part 1

Blooms of harmful cyanobacteria (cyanoHABs) have occurred on an annual basis in western Lake Erie for more than a decade. Previously, we developed and validated an algorithm to map the extent of the submerged and surface scum components of cyanoHABs using MODIS ocean-color satellite data. The algorithm maps submerged cyanoHABs by identifying high chlorophyll concentrations (>18 mg/m3) combined with water temperature >20 °C, while cyanoHABs surface scums are mapped using near-infrared reflectance values. Here, we adapted this algorithm for the SeaWiFS sensor to map the annual areal extents of cyanoHABs in the Western Basin of Lake Erie for the …

Targeting Iκappab Kinases For Cancer Therapy, Nikee Awasthee, Vipin Rai, Srinivas Chava, Palanisamy Palanisamy Nallasamy, Ajaikumar B. Kunnumakkara, Anupam Bishayee, Subhash C. Chauhan, Kishore B. Challagundla, Subash C. Gupta

School of Medicine Publications

The inhibitory kappa B kinases (IKKs) and IKK related kinases are crucial regulators of the pro-inflammatory transcription factor, nuclear factor kappa B (NF-κB). The dysregulation in the activities of these kinases has been reported in several cancer types. These kinases are known to regulate survival, proliferation, invasion, angiogenesis, and metastasis of cancer cells. Thus, IKK and IKK related kinases have emerged as an attractive target for the development of cancer therapeutics. Several IKK inhibitors have been developed, few of which have advanced to the clinic. These inhibitors target IKK either directly or indirectly by modulating the activities of other signaling …

The Generation Of Novel Metal-Folate- Phenanthroline Complexes And Phenanthroline-Folate Conjugates With Potential As Chemotherapeutic Agents, Aisling Crowley

Doctoral

The folate receptor (FR) was identified in 1986 and has been established as a ‘molecular Trojan Horse’ target for the uptake of folate-conjugated organic molecules into cells. The FR is overexpressed in many malignancies, including those of the ovary, uterus, breast, cervix, and prostate, yet it is reportedly under-expressed in normal healthy cells. This difference in expression and the high affinity/specificity of folate towards the folate receptor presents a promising drug delivery system. The aim of this research was to utilise folic acid as a targeting moiety and generate simple metal folate and novel folate-phenanthroline complexes with cytotoxic properties. A …

Prevalence Of Ametropia, Amblyopia And Visual Impairment In Schoolchildren In Ireland, Siofra Harrington

Doctoral

Background: Uncorrected refractive error is an avoidable cause of visual impairment (Naidoo et al., 2016). Currently, there is a lack of adequate data on eye and vision disorders in schoolchildren in Ireland. Accurate prevalence estimates of refractive error and vision disorders are necessary to determine their impact on public health and to assess the need for interventions (McCarty and Taylor, 2000). Purpose: This study reports the prevalence of ametropia, presenting visual impairment, amblyopia and provides population norms for ocular biometric measures in schoolchildren in Ireland. Links between refractive error and demographic and lifestyle factors were investigated. The impact of poor …

Nurturing Environments And Nutrient-Rich Diets May Improve Cognitive Development: Analysis Of Cognitive Trajectories From Six To Sixty Months From The Mal-Ed Study (Or10-01-19), Benjamin Mccormick, Laura Caulfield, Stephanie Richard, Laura Pendergast, Laura Murray-Kolb, Mal-Ed Network Investigators

Department of Paediatrics and Child Health

Objectives: To identify clusters of cognitive developmental trajectories and associated differentiating factors of children aged 6 to 60 months old in 5 low to middle-income sites.
Methods: We followed 835 children and assessed anthropometry at enrolment (≤ 17 d old); bi-weekly illness data (0–24 and 60 mo); non-diarrheal and diarrheal stools (0–24 mo) analyzed for a panel of enteropathogens; quantitative complementary food intakes (9–24 and 60 mo); micronutrient status (Fe, Zn, Vit A; 7, 15, and 24 mo); quality of the child's home environment (6, 24, and 60 mo) and maternal reasoning ability and depressive symptoms via questionnaire. Child cognitive …

Association Of Nutritional Status Measures With Self-Efficacy And Experiencing Depressed Mood Among Pakistani Young Women (P10-090-19), Jo-Anna Baxter, Yaqub Wasan, Sajid Bashir Soofi, Imran Ahmed, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Objectives:
We aimed to assess self-efficacy and the experience of depression-related emotions among non-pregnant adolescent and young women (15–23 years) living in rural Pakistan, and determine their association with measures of nutritional status.
Methods:
Outcomes were assessed from the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial baseline data (n = 25,279). Self-efficacy and depression-related emotions were determined and categorized using the general self-efficacy scale (low, moderate, and high) and DASS-21 tool (normal, mild, moderate, severe, and extremely severe), respectively. Nutritional status was evaluated using hemoglobin concentration (HemoCue Hb 301 System) and body mass index (BMI). Associations were assessed using ordinal …

Effect Of Lipid-Based Nutrient Supplement - Medium Quantity On Reduction Of Stunting In Children 6-23 Months Of Age In Sindh, Pakistan: A Cluster Randomized Controlled Trial (Or25-06-19), Sajid Bashir Soofi, Gul Nawaz Khan Nawaz Khan, Cecilia Garzon

Department of Paediatrics and Child Health

Objectives:
We evaluated the effectiveness of a locally produced lipid-based nutrient supplement - medium-quantity (LNS-MQ) known as Wawamum to prevent stunting in children 6–23 months of age in Thatta and Sujawal districts of Sindh province, Pakistan. Methods: A cluster randomized controlled trial was conducted and a total of 870 children between 6–18 months old were enrolled. Children in the intervention group received 50 grams/day of Wawamum for 6 months, while children in the control group received standard government health services, not including Wawamum. The primary outcome was stunting risk reduction among children 6–23 months of age.
Results:
Children who received …

Clinical Screening For Congenital Heart Disease In Newborns At A Tertiary Care Hospital Of A Developing Country, Muhammad Mohsin, Khadija N Humayun, Mehnaz Atiq

Department of Paediatrics and Child Health

Objective:
To screen all newborns admitted to a tertiary care hospital to rule out congenital heart disease before discharge and to find out the utility of pulse oximetry to detect congenital heart disease.
Methodology:
This prospective study was done at Aga Khan University Hospital from January 2014 to December 2014 in 1,650 newborns over a period of 12 months. Pulse oximetry and clinical examination were done. Persistent oxygen saturation less than 95% was considered as positive pulse oximetry. Newborns who had positive pulse oximetry or abnormal clinical examinations findings were subjected to echocardiography.
Result:
Pulse oximetry was performed on 1,650 …

Mutational Landscape Of Head And Neck Squamous Cell Carcinomas In A South Asian Population, Kulsoom Ghias, Sadiq S. Rehmani, Safina Abdul Razzak, Sarosh Madani, M Kamran Azim, Rashida Ahmed, Mumtaz J Khan

Department of Biological & Biomedical Sciences

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer type globally and contributes significantly to burden of disease in South Asia. In Pakistan, HNSCC is anmong the most commonly diagnosed cancer in males and females. The increasing regional burden of HNSCC along with a unique set of risk factors merited a deeper investigation of the disease at the genomic level. Whole exome sequencing of HNSCC samples and matched normal genomic DNA (n=7) was performed. Significant somatic single nucleotide variants (SNVs) were identified and pathway analysis performed to determine frequently affected signaling pathways. We identified significant, novel …

Anomalous Origin Of The Right Coronary Artery From The Pulmonary Artery In A Neonate With Turner Syndrome And Aortic Arch Hypoplasia, Bryan P Stefek, Jason R Imundo, Joseph B Clark

The Texas Heart Institute Journal

Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. …

Osborn Waves: Differential Diagnosis, Akriti G Jain, Hammad Zafar, Sanjay Jain, Jason D'Souza

The Texas Heart Institute Journal

No abstract provided.

Percutaneous Coronary Intervention For Interposed Coronary Graft Stenosis After Modified Bentall Procedure In A Teenaged Boy With Takayasu Arteritis, Hiroki Ikenaga, Satoshi Kurisu, Yasuki Kihara

The Texas Heart Institute Journal

Anastomotic occlusion of an interposed coronary artery graft after a Bentall procedure is rare and catastrophic. It can lead to myocardial infarction or sudden cardiac death. We found several reports of occlusion and stenosis of a coronary-graft anastomosis, but few describe occlusion of the interposed coronary graft itself, as evaluated with use of intracoronary ultrasonography and computed tomography. We report the case of a 17-year-old boy with Takayasu arteritis who had a myocardial infarction caused by severe ostial stenosis in an interposed left coronary graft. The graft occlusion was confirmed by results of electrocardiography, aortography, and intracoronary ultrasonography. The patient …

The Man With 2 Hearts: 25 Years From Heterotopic To Orthotopic Heart Transplantation, Elizabeth L Godfrey, Michael L Kueht, Abbas Rana, O H Frazier

The Texas Heart Institute Journal

Substantial technological advances in mechanical circulatory support have caused a shift in the management of end-stage heart failure. From the 1970s through the 1990s, heterotopic heart transplantation was routinely performed in patients in whom orthotopic transplantation was likely to fail. Heterotopic heart transplantation is now performed less often because modern mechanical circulatory assist devices are routinely used as bridges to orthotopic transplantation; regardless, the operation has helped numerous patients who would not otherwise have received adequate allografts. We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft …