Medicine and Health Sciences Commons^™

Atypical Idiopathic Intracranial Hypertension Presenting As Cyclic Vomiting Syndrome: A Case Report, Nafee T Talukder, Amanda H Clorfeine, Moira K Black, Shade B Moody

Faculty, Staff and Student Publications

BACKGROUND: Idiopathic intracranial hypertension is a disorder of increased intracranial pressure in the absence of cerebrospinal outflow obstruction, mass lesion, or other underlying cause. It is a rare phenomenon in prepubertal children and is most typically found in women of childbearing age. The classic presentation consists of headaches, nausea, vomiting, and visual changes; however, children present more atypically. We report a case of idiopathic intracranial hypertension in an otherwise healthy, 4-year-old child with atypical symptoms resembling those of cyclic vomiting syndrome.

CASE PRESENTATION: A 4-year-old Caucasian, otherwise healthy, male child presented to our emergency department with episodic intermittent early-morning vomiting …

Association Between Self-Reported Survey Measures And Biomarkers Of Second-Hand Tobacco Smoke Exposure In Non-Smoking Pregnant Women, Meiman Maggie Chen, Su-Er Guo, Chi-Pin Yuan, Chizimuzo T. C. Okoli, Yen-Chi Liao

Nursing Faculty Publications

Second-hand tobacco smoke (SHS) causes adverse health outcomes in adults. Further studies are needed to evaluate psychosocial SHS exposure measures in comparison to SHS exposure biomarkers, particularly in pregnant women. This study aimed to compare self-reported SHS exposure to urinary cotinine levels in pregnant women. A cross-sectional correlation design was conducted using a convenience sample of 70 non-smoking pregnant women. Measures included self-reported questionnaires and laboratory confirmation of cotinine levels in the urinary samples. Multiple regression analysis was used to assess the correlation after controlling for potential confounding variables. The average level of urinary cotinine among non-smoking pregnant women was …

Poverty And Paternal Education Associated With Infant Safe Sleep Intentions In A Peri-Urban Community In Ecuador, Hartley Feld, Janeth Ceballos Osorio, Marisol Bahamonde, Thomas Young, Pablo Boada, Mary Kay Rayens

Nursing Faculty Publications

Ecuador’s annual mortality rate from SIDS is 0.4 per 100 000 people, 4 times higher than neighboring countries Peru, Bolivia, and Brazil. Modifying the infant sleep environment toward safe practice has been demonstrated to be the most effective risk reduction strategy in reducing mortality from SIDS and little is known about sleep practices in Ecuador. The purpose of this study is to describe baseline infant sleep intentions of pregnant women in a peri-urban, low resource community in Ecuador. We also aim to identify demographic and psychosocial factors associated with suboptimal sleep practices in this context to develop long-term strategies to …

Variation Of Igg N-Linked Glycosylation Profile In Diabetic Retinopathy, Zhiyuan Wu, Huiying Pan, Di Liu, Di Zhou, Lixin Tao, Jie Zhang, Xiaonan Wang, Xia Li, Youxin Wang, Wei Wang, Xiuhua Guo

Research outputs 2014 to 2021

Background: The relationship of immunoglobulin G (IgG) glycosylation with diabetes and diabetic nephropathy has been reported, but its role in diabetic retinopathy (DR) remains unclear. We aimed to investigate and validate the association of IgG glycosylation with DR.

Methods: We analyzed the IgG N-linked glycosylation profile and primarily selected candidate glycans by lasso (least absolute shrinkage and selection operator) regression analysis in the discovery population. The findings were validated in the replication population using a binary logistics model. The association between the significant glycosylation panel and clinical features was illustrated with Spearman's coefficient. The results were confirmed by sensitivity analyses. …

A Susceptible Exposed Infected Recovered Susceptible (Seirs) Model For The Transmission Of Tuberculosis, Latifat M Erinle-Ibrahim, Waheed O Lawal, Olukayode Adebimpe, Gbemisola R Sontan

Tanzania Journal of Science

In this paper, a deterministic mathematical model was proposed and analyzed to understand the dynamics of tuberculosis based on the SEIRS model. The disease-free equilibrium, the endemic equilibrium, and their stabilities were examined. The R0 (basic reproduction number) was derived using the Next Generation Matrix method and its sensitivity analysis showed that the birth rate and infectious rate were the most sensitive parameters of R0. The behaviour of exposed individuals at the latent period with varied treatment rates were examined through numerical simulation. From the analysis carried out, the effect of variations of the treatments of latent TB shows that …

An Age-Structured Model For Transmission Dynamics Of Malaria With Infected Immigrants And Asymptomatic Carriers, Asha S Kalula, Eunice Mureithi, Theresia Marijani, Isambi Mbalawata

Tanzania Journal of Science

Abstract An age-structured (children and adults) model for the transmission dynamics of malaria with asymptomatic carriers and infected immigrants has been analyzed. We first analyze a model without infected immigrants. It shows that the disease-free equilibrium exists and is stable when and unstable for . Also, we compute the sensitivity indices of the basic reproduction number. The basic reproduction number is most sensitive to the mosquito biting rate. Besides, the sensitivity of the basic reproduction number shows that the children's class parameters are more sensitive than those of adults. In the presence of infected immigrants, the model does not admit …

Spatial Modelling For Cholera Incidence Rates In Morogoro Municipality, Tanzania, Caroline Ngereza, Rosalia S. Katapa, Ali R. Mniachi

Tanzania Journal of Science

Spatial modelling was conducted to examine community factors associated with cholera incidence rates in Morogoro Municipality. The study employed both secondary (cholera cases) and primary (geographic coordinates of community risk factors) data. Spatial lag model was applied in examining association between the variables. All wards of Morogoro Municipality were considered in the study to capture their variations because cholera cases have a tendency to be clustered. Results indicated that market density, distance to the market and distance to the dumpster are significant factors associated with cholera incidence rates in the wards (p < 0.05). Geographically weighted Poisson model was used to show the variations of those factors between the wards in Municipality. A statistically significant positive association of cholera incidence rates; and market density was only found in Mazimbu ward (p < 0.05) and distance from the community to the dumpster was found in Kihonda, Kingolwira, Bigwa, Kichangani, Kilakala and Boma wards (p < 0.001) and some wards at the centre of the municipality which are Mji Mkuu and Kingo (p < 0.05). A statistically significant negative association of cholera incidence rates and distance from the centre of the community to the market was found in Kihonda, Kingolwira and Kichangani (p < 0.001) and Bigwa wards (p < 0.05). Therefore, measures taken to control and prevent cholera disease should base on the variations of the risk factors found in the Municipal wards.  Keywords:    Cholera incidence rate, Spatial lag regression model, Community risk factor, Geographically weighted Poisson model

Highlighting A Curricular Need: Uncertainty, Covid-19, And Health Systems Science., Dimitrios Papanagnou, Rebecca Jaffe, Deborah Ziring

Department of Medicine Faculty Papers

No abstract provided.

Mmc Simulation Annual Report 2020

Journal of Maine Medical Center

No abstract provided.

Mmc Wellbeing & Peer Support Program, Christine Hein Md

Journal of Maine Medical Center

No abstract provided.

Healthcare Systems Should Be Leaders In Patient-Centered Sustainability, Katherine T. Liu Md, Facp, Lesley B. Gordon Md, Ms

Journal of Maine Medical Center

No abstract provided.

Qualitative Evaluation Of A Certificate In Health Care Improvement For Interprofessional Teams, Hannah R. Martin, Eilish W. Carpenter, Peter W. Bates, Erin M. Graydon-Baker, Mark G. Parker, Jordan S. Peck, Debra Rothenberg Md, Phd, Isaac Z. Stickney, Ghassan A. Saleh, John E. Wennberg, John Tooker, Robert Trowbridge Jr, Kathleen M. Fairfield

Journal of Maine Medical Center

No abstract provided.

Case Report: Pheochromocytoma Presenting With Cushing’S Syndrome And Hyperglycemia, Elizabeth Garbitelli, Halla Bates, Cheryl Liechty, Robert Bing-You

Journal of Maine Medical Center

Introduction: Pheochromocytomas are catecholamine-producing neuroendocrine tumors that arise from the adrenal medulla. Pheochromocytomas typically present with uncontrollable or paroxysmal hypertension that can be accompanied by other common initial symptoms, including headache, diaphoresis, arrhythmia, and pallor. Given the morbidity and mortality associated with undiagnosed pheochromocytomas, and their potential for treatment, primary care physicians should consider this tumor type, and other endocrinological phenomena, when evaluating new onset hyperglycemia.

Clinical Findings: Patient G was a 76-year-old female who presented in her primary care office with newly uncontrollable hyperglycemia. During initial evaluation, her clinical condition deteriorated rapidly. Her laboratory studies revealed markedly elevated cortisol, …

A Rare Entity: Case Report Of Recurrent Hypertrophic Pyloric Stenosis, Astrid A. Gleaton, Kartikey Pandya

Journal of Maine Medical Center

Introduction: Hypertrophic pyloric stenosis (HPS) is well known in pediatric surgery and has good outcomes after pyloromyotomy.1 Emesis in the immediate postoperative period occurs in 40% of patients with HPS and is attributed to gastroparesis from prolonged gastric distention.2 Emesis presenting weeks to months after pyloromyotomy prompts an evaluation that often yields pathology unrelated to HPS. Because recurrent HPS is rare, making this diagnosis highlighted the importance of practicing broad differential diagnoses, ruling out most common causes, and including obscure etiologies.

Clinical Findings: A 3-week-old male born after full-term gestation with a history of HPS underwent an uncomplicated laparoscopic pyloromyotomy. …

Spouses With Pulmonary Mycobacterium Avium Complex Infections: A Case Report, Gregg Raymond Md, Emily Wood Md

Journal of Maine Medical Center

Introduction: Mycobacterium avium complex (MAC) is the most common cause of pulmonary infections due to nontuberculous mycobacterium in the United States. While there have been reports of geographic variations in incidence as well as disease clusters among genetically related individuals, there have been no published reports describing clusters of co-occurring pulmonary MAC disease among genetically unrelated individuals.

Clinical Findings: Patient 1 was a 56-year-old male with worsening asthma exacerbations associated with recurrent bronchitis. Patient 2 was a 55-year-old female with worsening asthma exacerbations, progressive dyspnea, and recurrent bronchitis. The 2 patients lived together, were immunocompetent, and genetically unrelated. They were …

Building Innovation Capacity In A Learning Health System: The Innovation Cohort Experience, Jennifer Monti, Owen Sanderson

Journal of Maine Medical Center

Introduction: People with ideas about how to improve products and services often benefit from a structured process to test their ideas. The Innovation Cohort was developed to empower staff at MaineHealth to create solutions to unmet needs. This article describes the progress and perspectives gained over 3 years of the program.

Methods: The Innovation Cohort was loosely modeled on the National Science Foundation’s iCorp that emphasizes customer discovery and hypothesis testing early during development. Innovation Cohort applicants proposed a specific problem and answered 5 basic questions related to solving that problem. Selected participants shared readings and attended 5 in-person meetings …

Total Body Photography And Sequential Digital Dermoscopy Imaging For Melanoma Surveillance In Patients Starting Natalizumab For Multiple Sclerosis, Tyler Nussinow Ba, Amanda Robinson Np, Biljana Beretich Md, Kathryn Stevens Np, Elizabeth Seiverling Md

Journal of Maine Medical Center

Introduction: Natalizumab is an integrin receptor antagonist that has been approved by the Food and Drug Administration to treat multiple sclerosis and Crohn’s disease. The drug has been linked to an increased risk of melanoma. This brief report highlights an innovative clinical approach for monitoring the skin of patients prescribed natalizumab.

Methods: We include 2 cases from our skin oncology clinic and a literature review on the incidence of melanoma in patients prescribed natalizumab between 2004 and 2019.

Results: In addition to our 2 cases, we found 193 reports of patients with melanoma who were prescribed natalizumab. We propose an …

Inclusive Language Matters: Recommendations For Health Care Providers To Address Implicit Bias And Equitable Health Care, Crystal R. Herron

Journal of Maine Medical Center

Problem Statement: Stigmatizing language—written and verbal—can fuel implicit bias among health care professionals, leading to unintentional negative effects in how they care for patients. To provide equitable care, health care professionals and systems must become aware of the language they use and learn to replace biased language with inclusive language.

Background: The medical field strives to treat all patients equally, yet disparities in health care persist. These disparities are due, in part, to implicit bias that affects how health care professionals and systems care for patients. Although reports recommend developing education programs that address implicit bias, these programs fail to …

Patient Transport In The Time Of Covid-19: Using Health Care Failure Mode And Effect Analysis With Simulation To Test And Modify A Protocol, John Kwock, Jeffrey Holmes, Shelly Chipman, Erin Siebers, Angela Berry, Sonja Orff, Victoria Boutin, Leah Mallory

Journal of Maine Medical Center

Introduction: In March 2020, in response to the COVID-19 pandemic, an interprofessional, interdisciplinary team at Maine Medical Center used Healthcare Failure Mode and Effect Analysis (HFMEA) and in situ simulation to rapidly identify and mitigate latent safety threats (LST) in patient transport protocols.

Methods: Following HFMEA steps, stakeholders representing a variety of disciplines assembled to address transport of patients with COVID-19. A process map was created to describe the process. With hazard analysis using table-top simulation followed by in situ simulation, we identified, categorized, and scored LSTs. Mitigation strategies were identified during structured debriefing.

Results: Fourteen LSTs were identified in …

Implementing A Clinical Practice Guideline For Pediatric Appendicitis Safely Reduced Health Care Use And Improved Antimicrobial Stewardship, Jack Vernamonti, Robin Cotter, Jennifer Jubulis, Kartikey Pandya

Journal of Maine Medical Center

Introduction: Appendicitis is the most common emergency surgical disease in children. Those with perforated appendicitis have a more complicated and varied course. Through a clinical practice guideline (CPG), we sought to reduce computed tomography scans, laboratory draws, and exposure to broad-spectrum antibiotics without adversely affecting length of stay, hospital readmission, or repeat antibiotic administration.

Methods: Electronic records were retrospectively reviewed before and after CPG implementation, and data was collected in REDCap.

Results were reported as mean or percent incidence, and statistical analysis was done using a Student’s t-test, Mann-Whitney U test, or Pearson’s χ2 with P < .05 considered significant. Results: One hundred patients with a perforated appendix (50 before and 50 after CPG implementation) were included in our analysis. Length of stay (4.98 vs 4.46 days; P = .25), hospital readmission rate (10% vs 14%; P = .54), and additional antibiotic administration (2% vs 4%; P = .56) did not change. We observed no difference in the Pediatric Appendicitis Score (9 vs 9; P = .48) and a trending increase in evaluation at an outside hospital (56% vs 74%; P = .06). Rates of computed tomography scans did not differ overall (50% vs 40%; P = .31), but showed a decreasing trend at our institution (30% vs 12%; P = .06). We also found fewer post-operative laboratory studies (90% vs 38%; P < .01) and patients who received broad-spectrum intravenous antibiotics (92% vs 18%; P < .01).

Discussion: Through implementing the …

Genetic Testing Reveals Germline Mutations Among Patients Undergoing Surgery For Colorectal Carcinoma In A Community Hospital Setting, Alex R. Jones, Dana Greer Rn, Bsn, Ocn, Karin L. Cole Md

Journal of Maine Medical Center

Introduction: Defined germline mutations contribute to 5% to 10% of cases of colorectal carcinoma (CRC). While protocols for universal tumor screening have been adopted to detect mismatch repair (MMR) protein deficiency, widespread multigene panel testing has not been achieved. Barriers to implementing testing protocols may occur in community settings.

Methods: A total of 160 patients presenting for surgical management of CRC between 2011 and 2020 were considered for retrospective analysis in a single-surgeon, single-institution, community-based cohort. The rate of multigene panel testing and prevalence of germline mutations were calculated, and patient characteristics were assessed.

Results: A total of 32/160 (20%) …

Factors That Influence Perception Of Hiv Risk And Willingness To Use Pre-Exposure Prophylaxis In People Who Inject Drugs, Daria Egorova, Anny Fenton, Kinna Thakarar

Journal of Maine Medical Center

Introduction: Sexual and injection behaviors increase the risk of HIV transmission in people who inject drugs (PWID). We aimed to determine the prevalence of sexual and drug behaviors that increase HIV risk in PWID hospitalized for infections related to injection drug use in Maine. We also examined factors that influenced their perception of HIV risk and willingness to take pre-exposure prophylaxis (PrEP).

Methods: We surveyed 101 PWID with infections related to injection drug use who were hospitalized at 4 hospitals in Maine. T-tests assessed differences in means of bacterial infection risk scores and willingness to take PrEP based on different …

Missed Opportunities: Documentation And Referral Rates Among Children And Adults With Obesity, Heidi Walls, Christina Holt, Amy Haskins Phd, Williams Dexter

Journal of Maine Medical Center

Introduction: Our study reports rates of obesity documentation on the problem list (PL) and numbers of referrals to obesity medicine specialists and dietitians among pediatric and adult patients with obesity.

Methods: All pediatric and adult patients with obesity seen at 14 primary care clinics between 7/1/2017 and 6/30/2019 were evaluated for inclusion of obesity on the PL and referrals to obesity medicine specialists or dietitians.

Results: For children with BMI >95% for age, obesity was documented in 31.2%, and 12.5% received a referral. For adults with BMI >30, obesity was documented in 54.2%, and 8.4% received a referral. Significantly more …

Perceptions Of Maine Health Care Providers On Youth Tobacco Use And Prevention Efforts, Titilola Balogun, Toho Soma, Liam O'Brien

Journal of Maine Medical Center

Introduction: Tobacco use causes preventable morbidity and mortality, and leads to high medical costs annually. In Maine, both cigarette and electronic cigarette (e-cigarette) use among high school students are higher than the national average. To what extent Maine health care providers are familiar with tobacco use prevention is unknown. We aimed to describe the knowledge, attitudes, and practices of Maine health care providers regarding youth tobacco use. We also determined what preventive services they provide, and measured their self-efficacy regarding screening and counseling for tobacco use.

Methods: In this cross-sectional study, health care providers were surveyed about their knowledge, attitudes, …

County And Demographic Differences In Drug Arrests And Controlled Substance Use In Maine, Trajan F. Hyde, Amadea D. Bekoe-Tabiri, Amalie K. Kropp Lopez, Luis G. Devia, Belsy D. Gutierrez, Matthew C. Lara, Anthony R. Soto, Daniel E. Kaufman, Matthew T. Moran, Kevin J. Simpson, Dipam T. Shah, Michelle Foster, Clare E. Desrosiers, John Hebert, Stephanie D. Nichols, Kenneth Lee Mccall, Brian J. Piper

Journal of Maine Medical Center

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Introduction: The Diversion Alert Program (DAP) was established to curb misuse of drugs and help identify people who may need treatment for substance use disorder (SUD). Law enforcement compiled arrest data into a database accessible by health care providers. Our objectives were to identify regional and demographic differences in drug use and misuse in Maine.

Methods: All arrests (N = 11 234) reported to the DAP from 2013 to 2018 were examined by county and arrestee demographics, and classified into families (opioids, stimulants, sedatives). The Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) tracks the distribution …

Adopting Inclusive Language As Part Of Patient Centered Care, Ryan Polly

Journal of Maine Medical Center

No abstract provided.

Comparative Study Of Ultrasound Guided Popliteal Fossa Block Versus Ankle Block As Primary Anaesthesia For Forefoot Surgeries., Pavitra S.K.

Kasturba Medical College, Mangalore Theses and Dissertations

No abstract provided.

"Comparison Of Three Scoring Criteria To Assess Recovery From General Anaesthesia In The Post-Anaesthesia Care Unit- A Longitudinal Observational Study ", Shagun Aggarwal

Kasturba Medical College, Mangalore Theses and Dissertations

No abstract provided.

2021-08-30_Michiganoverview_Covidoutbreak, Michigan Department Of Health & Human Services

Michigan COVID-19 Outbreak Reports

The Outbreak Data page was obtained from Michigan's COVID-19 data page: https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173_102057---,00.html.

This report is created by the Michigan Department of Health & Human Services from data self-reported by local health departments. Data is updated every week.

COVID-19 outbreaks are generally defined as two or more cases with a link by place and time indicating a shared exposure outside of a household. Local health departments report the number of new and ongoing outbreaks they are investigating by the setting of the outbreak. New outbreaks are those outbreaks that were first identified during the current reporting week. Ongoing outbreaks are …

The Minimum Effective Training Dose Required For 1rm Strength In Powerlifters, Patroklos Androulakis-Korakakis, Nick Michalopoulos, James P. Fisher, Justin Keogh, Jeremy P. Loenneke, Eric Helms, Milo Wolf, Greg Nuckols, James Steele

Faculty and Student Publications

The aim of this multi-experiment paper was to explore the concept of the minimum effective training dose (METD) required to increase 1-repetition-maximum (1RM) strength in powerlifting (PL) athletes. The METD refers to the least amount of training required to elicit meaningful increases in 1RM strength. A series of five studies utilising mixed methods, were conducted using PL athletes & coaches of all levels in an attempt to better understand the METD for 1RM strength. The studies of this multi-experiment paper are: an interview study with elite PL athletes and highly experienced PL coaches (n = 28), an interview and survey …