Medicine and Health Sciences Commons^™

Enhancing Discovery Of Genetic Variants For Posttraumatic Stress Disorder Through Integration Of Quantitative Phenotypes And Trauma Exposure Information, Adam X. Maihofer, Andrew C. Heath, Et Al.

2020-Current year OA Pubs

BACKGROUND: Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWASs).

METHODS: A GWAS on PTSD symptoms was performed in 51 cohorts followed by a fixed-effects meta-analysis (N = 182,199 European ancestry participants). A GWAS of LTE burden was performed in the UK Biobank cohort (N = 132,988). Genetic correlations were evaluated with linkage disequilibrium score regression. Multivariate analysis was performed using Multi-Trait Analysis of GWAS. …

Association Between Self-Reported Body Mass Index And Active Life Expectancy In A Large Community-Dwelling Sample Of Older U.S. Adults, Haomiao Jia, Erica I. Lubetkin

Publications and Research

Background: Obesity may have a protective effect (greater survival) in older adults, a finding known as the "obesity paradox." This study examined the association between self-reported body mass index (BMI) and active life expectancy (ALE) among older U.S. adults.

Methods: Using the Medicare Health Outcomes Survey Cohort 15 (2012 baseline, 2014 follow-up), we estimated life expectancy and ALE by participants' baseline BMI and age using multi-state models. A participant was classified as in an active state if this person reported having no difficulty for any of these six activities of daily living (ADLs).

Results: Small differences in life expectancy were …

Duelos Incompletos: La Situación Actual Del Acceso A Servicios De Salud Mental Para Los Sobrevivientes Del Conflicto Armado En Ayacucho, Olivia Frison De Angelis

Independent Study Project (ISP) Collection

La salud mental es un asunto relativamente nuevo en el Perú. En la ciudad andina de Ayacucho en la provincia de Huamanga, el gobierno solamente empezó a financiar proyectos de salud mental accesibles a las comunidades campesinas en los últimos seis años, desde 2016. Considerando que la región de Ayacucho ha sufrido el número más alto de muertes y desaparecidos durante el conflicto armado interno de 1980 hasta 2000, es atroz que estas medidas han empezado tan tarde. Entretanto, mientras que las conversaciones avanzan sobre cómo seguir haciendo reparaciones de salud mental a los sobrevivientes del conflicto, ellos siguen con …

La Política Cultural Del Aborto: Las Percepciones Y El Manejo Del Aborto En Arica, Chile, Eva Strelitz-Block

Independent Study Project (ISP) Collection

Chile has a long history of restricting access to legal abortion. Until 2017, when the government passed the law N° 21.030 decriminalizing abortion on three grounds, abortion was completely illegal. However, despite this movement towards decriminalization, legal abortion access is still very limited and highly restricted. In this criminalized, highly stigmatized environment, self-managed abortion has emerged as a way to transform the landscape of abortion. This qualitative, exploratory study seeks to explore perceptions of abortion and practices of abortion management both within and outside of the official healthcare system among women and people with the capacity to become pregnant and …

Worrying In Cato Manor: A Case Study Analysis On The Influence Of Context, Samantha Garbus

Independent Study Project (ISP) Collection

Social Causation theory states that social and economic circumstances cause people to be at a higher risk of mental illness (Lund 2011, p.1). South Africa has high inequality, with racial disparities prevalent in multiple indicators of socioeconomic status. Moreover, mental health in South Africa has often not been prioritized. This project aimed to assess how context impacts relevant aspects of mental health, such as worrying and the mind/body stress-response in Cato Manor. An additional theme of community beliefs on stress emerged from the interviews which is also presented.

For this project, I used a Mixed Methods-Case Study research design. I …

Healing In The Himalayas: Mustangi Medical Practitioners’ Perspectives On Integrative Approaches To Chronic Illness, Lucia Morey

Independent Study Project (ISP) Collection

The purpose of this Independent Study Project is to capture a snapshot of the opinions and experiences of 13 health practitioners from 7 villages and towns in Mustang. Specifically, I asked independent healers (IH), amchis and health post workers about their practices and perspectives on chronic illness, integrative medicine and the intersection of the two. I found that there is a flow of information in one general direction, with practitioners along a continuum of most to least globally recognized. Understandably, the least well known (independent healers) are aware of Traditional Tibetan Medicine (TTM) and conventional Western medicine (CWM). Subcategories of …

A Comparative Analysis Of Migrant Health Policies And Practices In The Us And Switzerland, Rebecca Mak

Independent Study Project (ISP) Collection

Migrants compose a large proportion of the population in both the US and Switzerland. The social vulnerability of migrants has been well-established in literature, but few studies have attempted to compare healthcare policies and approaches that most effectively support migrant health using multiple measures.

To fill this gap in the literature, this study will comparatively analyze of the efficacy of US and Switzerland migrant health policies and services by assessing access to and quality of care for migrants in each country. Four main features of healthcare systems were analyzed: insurance policy, healthcare utilization, NCD outcomes, and patient perceptions of care. …

The Ethics Of Medical Voluntourism: The Conceptualization And Management Of ‘Doing Harm’ Within The Business, Katelyn Dohler

Independent Study Project (ISP) Collection

Although medical voluntourism programs are rapidly growing in popularity, deep ethical controversies overly the industry. In particular, understanding how the field of medical voluntourism follows a business model sheds insight on the sources of tension and conflicts of interest that can arise within organizations and the sector as a whole. However, understanding the roles of individual motivations and societal pressures in the development of these ethical controversies is relatively unexplored.

Through an inductive thematic analysis of data gathered from literature review and expert interviews, this project investigates these driving factors behind the rapidly growing business, how these driving factors contribute …

The Correlation Between Vaccine Hesitancy And Privilege: Exploring The Degree To Which Education And Income Foster Resistance To Vaccination Efforts, Sophie Goldenberg

Independent Study Project (ISP) Collection

Vaccine hesitancy is a public health issue of growing concern. Extensive pre-existing literature offers several explanations and conflicting viewpoints regarding reluctance toward vaccinations. However, minimal research has been done exploring the upstream social determinants driving vaccine hesitancy. Utilizing academic and gray literature and interviews with experts in the field, this study addresses this gap in knowledge with the research question: To what extent does privilege impact vaccine hesitancy and resistance? Vaccine hesitancy appears globally and is particularly concerning given the re-emergence of vaccine-preventable diseases (VPDs). Additionally, due to inconsistent causes, vaccine hesitancy is difficult to combat. In referencing the history …

Evaluating The Validity Of Restrictions On Blood Donation Eligibility For Men Who Have Sex With Men (Msm) In The United States, France, And Switzerland, Swathi Gorantla

Independent Study Project (ISP) Collection

For the first time in a decade, the number of new human immunodeficiency virus (HIV) diagnoses is higher for heterosexual people compared to gay and bisexual men (Florêncio, 2022). Additionally, in the United States, the American Red Cross has declared a national blood crisis due to the nationwide shortage of donated blood. During this crisis, charged with the new information on HIV diagnosis rates, many advocates for the Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) community question why discriminatory policy surrounding gay and bisexual men donating still exist around the world. These policies are changing worldwide – several European countries have …

Microplastics, The Environment, And Reproductive Health: How Is The Accumulation Of Microplastics In Our Environment And Bodies Impacting Reproductive Health?, Katherine Hayward

Independent Study Project (ISP) Collection

As global trends in both production and consumption of plastics continue to evolve, the bioaccumulation and biomagnification of microplastic particles in our everyday lives follow suit. This increasingly relevant problem has only recently been explored in the context of global health, and more specifically, reproductive health. Along with this steady increase in plastics and our exposure to them, researchers have separately observed adverse patterns in reproductive health. The chemicals involved throughout the microplastic life cycle may be playing a key role in these simultaneous patterns. With the aid of previous studies and publications on microplastics, exposure pathways, endocrine disruptors, and …

Understanding How To Promote Healthy Dietary Habits Among Parents Of Adolescents, Jazmine D. Collins

Electronic Theses and Dissertations

Adolescents in the United States today have record-high prevalence rates for childhood obesity and overweight, which are conditions that have lifelong negative health consequences for individuals, and also carry high financial and social costs for the entire nation. The disproportionate burden of obesity and associated health conditions falls on adolescents of racial and ethnic minority group identities and from lower-income households. The increased risk that adolescents have for developing conditions like childhood obesity is closely associated with youth having diets that are unhealthier than in the past. Parents have a large influence on the eating habits and preferences of their …

How Early Education And Pet Therapy May Help Nurses With Compassion Fatigue, Katie E. Clark

Electronic Theses and Dissertations

Abstract

Although there is a great deal of research on the causes of compassion fatigue, there is little research on prevention techniques or ways to combat compassion fatigue. The purpose of this qualitative phenomenological study was to discover if nurses are prepared to cope with occupational stress and compassion fatigue. A secondary purpose was to examine the perceived benefit that pet therapy can have as a possible stress reduction technique to decrease the effects of compassion fatigue. This research was conducted by gathering data via semistructured interviews. The researcher interviewed nurses who were currently practicing patient care and scored as …

Facilitators To Becoming And Remaining Open Defecation Free In Uganda: Implications For Community-Led Total Sanitation Programming, Danette Lee Cagnet

Electronic Theses and Dissertations

Poor sanitation behaviors, including open defecation, present risks for diarrhea, which is credited with 600,000 deaths a year in children under age five. Although CLTS is a solution to ending open defecation, more than half of the investment in producing open defecation free (ODF) communities is lost during the maintenance phase. The purpose of this qualitative, case study was to understand stakeholder perceptions of the facilitators and hindrances to becoming ODF certified and maintaining ODF status and sanitary behaviors in a small village community located in Uganda, East Africa. The researcher held individual interviews and in-person focus group discussions to …

Effect Of Sensory Neuropathy On The Predictive Value Of Inflammatory Biomarkers For Osteomyelitis In Diabetic And Nondiabetic Patients With Foot Infections, Easton Ryan, Junho Ahn, Dane K. Wukich, Javier La Fontaine, Andrew Crisologo, Matthew Malone, Orhan Oz, Lawrence A. Lavery

School of Podiatric Medicine Publications

Objective: To investigate the predictive value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in persons with and without diabetes with osteomyelitis (OM).

Methods: We evaluated 455 patients in a retrospective cohort study of patients admitted to the hospital with diabetic foot OM (n = 177), diabetic foot soft-tissue infections (STIs) (n = 176), nondiabetic OM (n = 51), and nondiabetic STIs (n = 51). Infection diagnosis was determined through bone culture, histopathologic examination for OM, and/or imaging (magnetic resonance imaging/single-photon emission computed tomography) for STI. The optimal cutoff values of ESR and CRP in predicting OM were determined …

Suppressing Fatty Acid Synthase By Type I Interferon And Chemical Inhibitors As A Broad Spectrum Anti-Viral Strategy Against Sars-Cov-2, Saba R. Aliyari, Xiaochao Wei, Clay F. Semenkovich, Et Al.

2020-Current year OA Pubs

SARS-CoV-2 is an emerging viral pathogen and a major global public health challenge since December of 2019, with limited effective treatments throughout the pandemic. As part of the innate immune response to viral infection, type I interferons (IFN-I) trigger a signaling cascade that culminates in the activation of hundreds of genes, known as interferon stimulated genes (ISGs), that collectively foster an antiviral state. We report here the identification of a group of type I interferon suppressed genes, including fatty acid synthase (FASN), which are involved in lipid metabolism. Overexpression of FASN or the addition of its downstream product, palmitate, increased …

When Reboa Grows Wings: Resuscitative Endovascular Balloon Occlusion Of The Aorta To Facilitate Aeromedical Transport, Jason A Snyder, Douglas J E Schuerer, Grant V Bochicchio, Mark H Hoofnagle

2020-Current year OA Pubs

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a helpful adjunct in the control of non-compressible truncal hemorrhage. Concerns regarding ischemia time limits its applicability in transfer. We describe the first reported case of civilian transfer via aeromedical transport to a higher level of care with a zone 3 REBOA catheter deployed.

CASE REPORT: We present the case of a patient in hemorrhagic shock with a complex pelvic fracture exceeding the capability of a rural level-two trauma center requiring the use of REBOA catheter to permit aeromedical transport to a level-one trauma center for definitive embolization.

CONCLUSION: Deployment …

Better Together: Integrating Biomedical Informatics And Healthcare It Operations To Create A Learning Health System During The Covid-19 Pandemic, Philip R O Payne, Adam B Wilcox, Peter J Embi, Christopher A Longhurst

2020-Current year OA Pubs

The growing availability of multi-scale biomedical data sources that can be used to enable research and improve healthcare delivery has brought about what can be described as a healthcare "data age." This new era is defined by the explosive growth in bio-molecular, clinical, and population-level data that can be readily accessed by researchers, clinicians, and decision-makers, and utilized for systems-level approaches to hypothesis generation and testing as well as operational decision-making. However, taking full advantage of these unprecedented opportunities presents an opportunity to revisit the alignment between traditionally academic biomedical informatics (BMI) and operational healthcare information technology (HIT) personnel and …

Contralateral Control Rate With Unilateral Proton Beam Radiotherapy For Oropharyngeal Scc: A Multi-Institutional Prospective Study From The Proton Collaborative Group, Aleksander Vayntraub, Thomas Quinn, John Chang, Noah Kalman, Sanford Katz, James Urbanic, Arpi Thukral, Jason Molitoris, Craig Stevens, Rohan Deraniyagala

Conference Presentation Abstracts

Introduction: Select patients with oropharyngeal SCC are candidates for unilateral radiation therapy. We sought to investigate if ipsilateral targeting leads to increased contralateral recurrences. Methods: We queried the PCG database for patients treated with unilateral proton RT for head and neck SCC from 2015 – 2020 at 12 institutions. DICOMs were evaluated to ensure dose delivered matched a unilateral proton treatment plan. Demographic, clinical and pathological, toxicity and dosimetry information were compiled. Results: We found 43 cases treated with unilateral proton RT. 94% (n¼16) of recurrent cases received prior radiation. Oropharyngeal sites included tonsillar fossa (n¼32), and base of tongue …

The First Modeling Of The Spot-Scanning Proton Arc(Sparc) Delivery Sequence And Investigating Its Efficiency Improvement, Xuanfeng Ding, Gang Liu, Lewei Zhao, Rohan Deraniyagala, Craig Stevens, Di Yan, Xiaoqiang Li

Conference Presentation Abstracts

Purpose: Introduce an experimental approach to model a precise prototype arc system and quantitatively assess its efficiency improvement in the routine proton clinical operation. Methods: The SPArc delivery sequence model(DSMSPArc) includes two kinds of parameters:(1) mechanical parameters. (2) irradiation parameters. Log files and an independent gantry inclinometer were used to derive the irradiation parameters through a series of test plans. The in-house DSMSPArc was established by fitting both mechanical and irradiation parameters. Eight SPArc plans from different disease sites were used to validate the model’s accuracy. To assess the treatment efficiency improvement, the DSMSPArc was used to simulate the SPArc …

A Direct Machine-Specific Parameters Incorporated Spot-Scanning Proton Arc (Sparc) Algorithm, Gang Liu, Lewei Zhao, Di Yan, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To address the challenges of generating a deliverable and efficient spot-scanning proton arc (SPArc) plan for a proton therapy system. We developed a novel SPArc optimization algorithm (SPArcDMSP) by directly incorporating machinespecific parameters such as mechanical constraints and delivery sequence. Method and Material: A SPArc delivery sequence model (DSMarc) was built based on the machine-specific parameters of the prototype arc delivery system IBA ProteusONEt. The SPArcDMSP resamples and adjusts each control point’s delivery speed based on the DSMarc calculation through the iterative approach (Fig1). Users could set the expected delivery time and gantry max acceleration as a mechanical constraint …

Improved Cotard Delusion And Motor Function In Parkinson’S Disease Following Electroconvulsive Therapy (Ect), Sunihidi Ramesh, Jeffrey Ratliff

Department of Neurology Faculty Papers

No abstract provided.

Immunomodulatory Effects And Clinical Benefits Of Intravenous Immunoglobulin In Myasthenia Gravis., Marinos C Dalakas, Andreas Meisel

Department of Neurology Faculty Papers

Introduction Myasthenia gravis (MG) is an antibody-mediated disease that develops in the majority of patients mainly as a result of acetylcholine receptor (AChR) autoantibodies. This process is mediated by a series of immunoregulatory events. Therapeutic targets for MG include suppression of circulating antibodies or antibody production, suppression of complement activation, and immunomodulation of cytokines or T cells. Intravenous immunoglobulin (IVIg) has an effect on all of these mechanisms. Areas covered This narrative review explores the broad immunomodulatory effects of IVIg in MG and provides an update on IVIg treatment for MG. Expert opinion IVIg has a range of immunomodulatory effects …

The Role Of The Complement System In Chronic Inflammatory Demyelinating Polyneuropathy: Implications For Complement-Targeted Therapies., Luis A Querol, Hans-Peter Hartung, Richard A Lewis, Pieter A Van Doorn, Timothy R Hammond, Nazem Atassi, Miguel Alonso-Alonso, Marinos Dalakas

Department of Neurology Faculty Papers

Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common, heterogeneous, immune-mediated neuropathy, characterized by predominant demyelination of motor and sensory nerves. CIDP follows a relapsing-remitting or a progressive course and causes substantial disability. The pathogenesis of CIDP involves a complex interplay of multiple aberrant immune responses, creating a pro-inflammatory environment, subsequently inflicting damage on the myelin sheath. Though the exact triggers are unclear, diverse immune mechanisms encompassing cellular and humoral pathways are implicated. The complement system appears to play a role in promoting macrophage-mediated demyelination. Complement deposition in sural nerve biopsies, as well as signs of increased complement activation in …

Complement In Autoimmune Inflammatory Myopathies, The Role Of Myositis-Associated Antibodies, Covid-19 Associations, And Muscle Amyloid Deposits., Marinos Dalakas

Department of Neurology Faculty Papers

Introduction

The inflammatory myopathies (IM) have now evolved into distinct subsets requiring clarification about their immunopathogenesis to guide applications of targeted therapies

Areas Covered

Immunohistopathologic criteria of IM with a focus on complement, anti-complement therapeutics, and other biologic immunotherapies. The COVID19-triggered muscle autoimmunity along with the correct interpretation of muscle amyloid deposits is discussed.

Expert Opinion

The IM, unjustifiably referred as idiopathic, comprise Dermatomyositis (DM), Necrotizing Autoimmune Myositis (NAM), Anti-synthetase syndrome-overlap myositis (Anti-SS-OM), and Inclusion-Body-Myositis (IBM). In DM, complement activation with MAC-mediated endomysial microvascular destruction and perifascicular atrophy is the fundamental process, while innate immunity activation factors, INF1 and …

Prognostic And Predictive Value Of Β-Blockers In The Eortc 1325/Keynote-054 Phase Iii Trial Of Pembrolizumab Versus Placebo In Resected High-Risk Stage Iii Melanoma, Oliver J. Kennedy, Michal Kicinski, Sara Valpione, Sara Gandini, Stefan Suciu, Christian U. Blank, Georgina V. Long, Victoria G. Atkinson, Stéphane Dalle, Andrew M. Haydon, Andrey Meshcheryakov, Adnan Khattak, Matteo S. Carlino, Shahneen Sandhu, James Larkin, Susana Puig, Paolo A. Ascierto, Piotr Rutkowski, Dirk Schadendorf, Rutger Koornstra, Leonel Hernandez-Aya, Anna M. Di Giacomo, Alfonsus J.M. Van Den Eertwegh, Jean Jacques Grob, Ralf Gutzmer, Rahima Jamal, Alexander C.J. Van Akkooi, Caroline Robert, Alexander M. M. Eggermont, Paul Lorigan, Mario Mandala

Research outputs 2022 to 2026

Background:

β-adrenergic receptors are upregulated in melanoma cells and contribute to an immunosuppressive, pro-tumorigenic microenvironment. This study investigated the prognostic and predictive value of β-adrenoreceptor blockade by β-blockers in the EORTC1325/KEYNOTE-054 randomised controlled trial.

Methods:

Patients with resected stage IIIA, IIIB or IIIC melanoma and regional lymphadenectomy received 200 mg of adjuvant pembrolizumab (n = 514) or placebo (n = 505) every three weeks for one year or until recurrence or unacceptable toxicity. At a median follow-up of 3 years, pembrolizumab prolonged recurrence-free survival (RFS) compared to placebo (hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.47–0.68). β-blocker use was …

Differential Effects Of Speech And Language Therapy And Rtms In Chronic Versus Subacute Post-Stroke Aphasia: Results Of The Northstar-Ca Trial, Anna Zumbansen, Heike Kneifel, Latifa Lazzouni, Anja Ophey, Sandra E. Black, Joyce L. Chen, Dylan Edwards, Thomas Funck, Alexander Erich Hartmann, Wolf Dieter Heiss, Franziska Hildesheim, Sylvain Lanthier, Paul Lespérance, George Mochizuki, Caroline Paquette, Elizabet Rochon, Ilona Rubi-Fessen, Jennie Valles, Susan Wortman-Jutt, Alexander Thiel

Research outputs 2022 to 2026

Background & objective: Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5–45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (>6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. Methods: Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for …

Identifying The 'Vulnerable Plaque' In Asymptomatic Carotid Artery Disease Patients, Zia Ur Rehman

Department of Surgery Docs

No abstract provided.

Quantifying The Effect Of Monitor Wear Time And Monitor Type On The Estimate Of Sedentary Time In People With Copd: Systematic Review And Meta-Analysis, Fiona Coll, Vinicius Cavalheri, Daniel F. Gucciardi, Sheldon Wulff, Kylie Hill

Research outputs 2022 to 2026

In studies that have reported device-based measures of sedentary time (ST) in people with chronic obstructive pulmonary disease (COPD), we explored if the monitor type and monitor wear time moderated the estimate of this measure. Five electronic databases were searched in January 2021. Studies were included if >70% of participants had stable COPD, and measures of ST (min/day) were collected using wearable technology. Meta-regression was used to examine the influence of moderators on ST, monitor type, and wear time. The studies identified were a total of 1153, and 36 had usable data for meta-analyses. The overall pooled estimate of ST …

Survivorship Research For People With Metastatic Or Advanced Cancer: A Time For Action, Andrea L. Smith, Nicolas H. Hart, Michael Jefford, Raymond J. Chan

Research outputs 2022 to 2026

Over recent decades, survival outcomes for people diagnosed with cancer have changed dramatically, with approximately 20% improvement in five-year relative survival rates in high-income countries including the United States and Australia. Regardless of regions, there is a decrease in overall cancer mortality rate of about 1% per year. Likewise, the cancer disease trajectory has changed. The traditional linear cancer trajectory in which a patient moves from cancer diagnosis through to a binary outcome (cure or death)—is no longer applicable and does not adequately describe the complexity of experience for many people. Indeed, the availability of targeted therapies and immunotherapies has …