Medicine and Health Sciences Commons^™

Pediatric Experience And Outcomes From The First Single-Vault Compact Proton Therapy Center, Stephanie M Perkins, Sabrina Prime, Michael Watts, Jiayi Huang, Tianyu Zhao

2020-Current year OA Pubs

The first single-vault compact proton therapy center opened in 2013, utilizing a gantry-mounted synchrocylotron. The center was placed within a large academic radiation oncology department with a high priority for pediatric cancer care. Here we performed a retrospective study of pediatric (≤21 years) patients treated with proton therapy at our institution between 2013-2022. Patient, tumor, and treatment characteristics were obtained including race, socioeconomic status, insurance type, distance travelled, need for anesthesia, and outside referrals for proton therapy. In total, 250 pediatric patients were treated with proton therapy comprising 18% of our proton patient volume. Median follow-up was 3.1 years, 38.4% …

Mutation-Induced Changes In The Stability, B-Cell Epitope, And Antigenicity Of The Sars-Cov-2 Variant Spike Protein: A Comparative Computational Stud, Nira Meirita Wijayanti, Muhammad Hermawan Widyananda, Lailil Muflikhah, Nashi Widodo

Karbala International Journal of Modern Science

The spike (S) protein is a major antigenicity site that targets neutralizing antibodies and drugs. The growing number of S protein mutations has become a severe problem for developing effective vaccines. Here, we investigated four severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants that were the most infectious and widespread during the COVID-19 pandemic to determine the trends and patterns of mutation-induced changes in the stability, B-cell epitope, and antigenicity of the SARS-CoV-2 S protein. The data showed that the Beta and Gamma variants had three mutations on the receptor-binding domain (RBD), which is the specific site on the S …

The Devil You Know And The Devil You Don’T: Current Status And Challenges Of Bovine Tuberculosis Eradication In The United States, Daniel J. O'Brien, Tyler C. Thacker, Liliana C.M. Salvador, Anthony G. Duffiney, Suelee Robbe‑Austerman, Mark S. Camacho, Jason E. Lombard, Mitchell V. Palmer

United States Department of Agriculture Wildlife Services: Staff Publications

Having entered into its second century, the eradication program for bovine tuberculosis (bTB, caused by Mycobacterium bovis) in the United States of America occupies a position both enviable and daunting. Excepting four counties in Michigan comprising only 6109 km2 (0.06% of US land area) classified as Modified Accredited, as of April 2022 the entire country was considered Accredited Free of bTB by the US Department of Agriculture for cattle and bison. On the surface, the now well-described circumstances of endemic bTB in Michigan, where white-tailed deer (Odocoileus virginianus) serve as a free-ranging wildlife maintenance host, may appear to be …

Medical Muse Volume 7, Issue 2 - Fall/Winter 2002

Medical Muse

No abstract provided.

Medical Muse Volume 19 Issue 1 - Spring 2014

Medical Muse

No abstract provided.

Medical Muse Volume 19, Issue 2 - Fall 2014

Medical Muse

No abstract provided.

New Onset, Refractory Hyperglycemia With Diabetic Ketoacidosis After Enfortumab Vedotin Treatment: A Case Report, Ross E. Heinrich, Marie Caldwell

Journal of Maine Medical Center

Introduction: A patient with no prior diagnosis of diabetes presented with diabetic ketoacidosis (DKA) and severe insulin resistance after being treated with enfortumab vedotin (EV). EV-associated DKA is uncommon—described in only a few case reports—and has unknown pathophysiology. This case characterizes the unique features of DKA in this patient and an unusual amount of insulin resistance not typically seen in patients with diabetes.

Clinical Findings: A 71-year-old male presented with fatigue, xerostomia, and increased thirst. He had a history of obesity, hypertension, and invasive, high-grade papillary urothelial carcinoma. His laboratory results were consistent with DKA.

Clinical Course: The patient was …

Medical School Watercooler Newsletter - August 11, 2023, Lindsey Lyle

Watercooler Newsletter

This is the August 11, 2023 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents include:

• Register now: Tools for teaching in medical education
• Meet a Med Student: Ben Loftis
• Basic medical sciences student presents research at international conference
• Pre-orientation course prepares medical students for academic success

Developing A Game (Inner Dragon) Within A Leading Smartphone App For Smoking Cessation: Design And Feasibility Evaluation Study., Justin S White, Marie K Salem, Séverine Toussaert, J Lee Westmaas, Bethany Raiff, David Crane, Edward Warrender, Courtney Lyles, Lorien Abroms, Johannes Thrul

College of Science & Mathematics Departmental Research

BACKGROUND: Several stand-alone smartphone apps have used serious games to provide an engaging approach to quitting smoking. So far, the uptake of these games has been modest, and the evidence base for their efficacy in promoting smoking cessation is still evolving. The feasibility of integrating a game into a popular smoking cessation app is unclear.

OBJECTIVE: The aim of this paper was to describe the design and iterative development of the Inner Dragon game within Smoke Free, a smartphone app with proven efficacy, and the results of a single-arm feasibility trial as part of a broad program that seeks to …

A Review Of Chronic Pectoralis Major Tears: What Options Are Available?, Joshua R Giordano, Brandon Klein, Benjamin Hershfeld, Joshua Gruber, Robert Trasolini, Randy M Cohn

HPD Articles

Rupture of the pectoralis major muscle typically occurs in the young, active male. Acute management of these injuries is recommended; however, what if the patient presents with a chronic tear of the pectoralis major? Physical exams and magnetic resonance imaging can help identify the injury and guide the physician with a plan for management. Nonoperative management is feasible, but is recommended for elderly, low-demand patients whose functional goals are minimal. Repair of chronic tears should be reserved for younger, healthier patients with high functional demands. Although operative management provides better functional outcomes, operative treatment of chronic pectoralis tears can be …

Acceptability, Appropriateness, And Feasibility Of Rural School Support Strategies For Behavioral Interventions: A Mixed Methods Evaluation Over Two Years Of A Hybrid Type 3 Implementation-Effectiveness Trial, Hannah G. Calvert, Michaela Mcquilkin, Ashley Havlicak, Teri Lewis, Lindsey Turner

Public and Population Health Faculty Publications and Presentations

Background: Positive Behavioral Interventions and Supports (PBIS) is a framework for implementing evidence-based interventions for preventing behavioral issues and improving climate in schools. The implementation of school-wide PBIS with fidelity is complex, requiring leadership commitment, teaming, and coordination of systems for tracking behaviors and consequences. Putting these components in place while ensuring alignment with the values and needs of the school community can be difficult for schools with fewer resources, such as rural schools. Implementation supports are needed, including strategies such as technical assistance, but it is unclear whether lower-cost modalities such as virtual support are acceptable, appropriate, and feasible …

Prevalence Of Symptoms ≤12 Months After Acute Illness, By Covid-19 Testing Status Among Adults — United States, December 2020–March 2023, Juan Carlos C Montoy, James Ford, Huihui Yu, Michael Gottlieb, Dana Morse, Michelle Santangelo, Kelli N O'Laughlin, Kevin Schaeffer, Pamela Logan, Kristin Rising, Mandy J Hill, Lauren E Wisk, Wafah Salah, Ahamed H Idris, Ryan M Huebinger, Erica S Spatz, Robert M Rodriguez, Robin E Klabbers, Kristyn Gatling, Ralph C Wang, Joann G Elmore, Samuel A Mcdonald, Kari A Stephens, Robert A Weinstein, Arjun K Venkatesh, Sharon Saydah, Innovative Support For Patients With Sars-Cov-2 Infections Registry (Inspire) Group

Faculty, Staff and Student Publications

To further the understanding of post-COVID conditions, and provide a more nuanced description of symptom progression, resolution, emergence, and reemergence after SARS-CoV-2 infection or COVID-like illness, analysts examined data from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a prospective multicenter cohort study. This report includes analysis of data on self-reported symptoms collected from 1,296 adults with COVID-like illness who were tested for SARS-CoV-2 using a Food and Drug Administration-approved polymerase chain reaction or antigen test at the time of enrollment and reported symptoms at 3-month intervals for 12 months. Prevalence of any symptom decreased substantially between baseline …

Improving Health Outcomes Among Patients With Chf Through Implementation Of Telehealth Depression Screening And Chf Symptom Management, Akudo Udodiri Unanwa

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Comorbid congestive heart failure (CHF) and depressive disorder is a leading cause of mortality globally. Despite effective detection and therapeutic options, 30-day hospital readmission rates for CHF patients remain high, with patients experiencing adverse clinical outcomes and poorer quality of life. Depression is identified as a common comorbidity among CHF patients that may negatively impact patient self-care and adherence to a CHF treatment plan.

Problem: Telehealth applications are an increasingly utilized approach to healthcare delivery that enhances timely access to healthcare services by reducing physical proximity and transportation barriers to care. Currently, telehealth screening for CHF in the …

Increasing Pediatric Hearing Aid Use: Considerations For Clinical Practice, Karen Muñoz, Kali Markle, Guadalupe G. San Miguel, Michael P. Twohig

Communicative Disorders and Deaf Education Faculty Publications

Purpose: Hearing aid use can be variable for young children, and inconsistent wear time can undermine spoken language development. This study explored the effectiveness of hearing aid data logging (DL) awareness and coaching sessions on increasing hours of hearing aid use. We also collected qualitative data on challenges participants experienced managing hearing aid use.

Method: We used a single-subject design that included three conditions, during a 6-week period, in the same order for each participant. Condition A was baseline, Condition B was DL monitoring alone, and Condition C was remote coaching calls plus DL monitoring.

Results: Hours of hearing aid …

An Implementation Of Combined Fecal/Gastric Occult Blood Testing In The Emergency Department, Desiree Long

Master's Projects and Capstones

Problem: The gastrointestinal occult blood test is a point-of-care (POC) test used to detect the presence of occult (hidden) gastrointestinal bleeding via stool or gastric contents. Existing fecal and gastric occult blood point-of-care (POC) testing requires separate and unique sampling cards and developer, respectively. Separate fecal/gastric tests are less definitive and take longer than a combined test. Fecal/gastric testing can be improved and more effective using a combined testing mechanism.

Context: This project includes the microsystem of the emergency department, which involves groups of medical professionals, such as groups of clinicians and staff working together with a shared clinical goal …

Design And Synthesis Of Small Molecule Drugs For Cns Disorders, Kirsten T. Tolentino

Theses & Dissertations

Dopamine (DA) is an important neurotransmitter for the regulation and long-term function of the central nervous system (CNS). DA binds to Dopamine Receptors (DR) to stimulate or inhibit adenyl cyclase production to further elicit a pharmacological response. DRs were cloned, and it was determined that there are two families separated by their function and five total subtypes distinguished by their amino acid structure. The Dopamine 4 receptor (D4R) is the second least studied subtype but has high expression in the frontal cortex, amygdala, hippocampus, hypothalamus, globus pallidus, substantia nigra pars reticula, and thalamus. Dopamine signaling and transmission, especially in the …

Understanding And Quantifying Bioaerosol Fate Within The Aerobiological Pathway: Physical Transport, Environmental Decay, And Mitigation, Sean Kinahan

Theses & Dissertations

The recent COVID-19 pandemic has highlighted the need for better tools to understand and characterize phases of the aerobiological pathway, a model for understanding how infectious bioaerosols are sourced, generated, transported, deposit, and affect human health. This dissertation presents validation of methodologies for studying transport of airborne biological agents and variations on their consequences, especially focusing on their physical and chemical fate. Chapter 1 focuses on a parallel comparison of two methods of aging bioaerosols in real-world outdoor environments with complex sunlight, atmospheric chemistry, and pollutants. Both capture on microfibers and the use of Goldberg rotating drums to keep a …

A Pilot Randomized Controlled Trial Evaluating Peer Recovery Coaches For Addiction Recovery Among Indigenous Americans, Nicholas Guenzel

Theses & Dissertations

Addiction is a common and devastating problem among many Indigenous American (IA) groups around the United States. Too few IA health care providers are available to deliver care in a way that leverages IA values and traditions to support addiction recovery. Peer recovery coaches (PRCs) are individuals who have lived experience of addiction and have received specialized training in helping others in recovery. IA PRCs hold significant potential in helping to fill the gap of culturally-specific support in addiction. In this feasibility trial, we recruited a total of 120 adult (≥19 years) IAs with a substance use disorder through Facebook …

Genome-Scale Methylation Analysis In Blood And Tumor Identifies Immune Profile, Age Acceleration, And Dna Methylation Alterations Associated With Bladder Cancer Outcomes, Ji-Qing Chen

Dartmouth College Ph.D Dissertations

Bladder cancer patients receive frequent screening due to the high tumor recurrence rate (more than 60%). Nowadays, the conventional monitoring method relies on cystoscopy which is highly invasive and increases patient morbidity and burden to the health care system with frequent follow-up. As a result, it is urgent to explore novel markers related to the outcomes of bladder cancer. Immune profiles have been associated with cancer outcomes and may have the potential to be biomarkers for outcomes management. However, little work has been conducted to investigate the associations of immune cell profiles with bladder cancer outcomes. Here, I utilized the …

Identification Of Immune Biomarkers In Thyroid Cancer, Anupam Kotwal

Theses & Dissertations

Thyroid cancer is the most common endocrine malignancy, estimated to be the second most common cancer in women by 2030. The frequency of differentiated thyroid cancer (DTC), the most common subtype of thyroid cancer, is higher in patients with autoimmune thyroid disease but the influence of the immune milieu on thyroid carcinogenesis remains unclear. To address this gap in knowledge, we performed clinical and translational experiments to identify immune biomarkers for the occurrence and prognosis of DTC. Multiparameter flow cytometry of peripheral blood from 32 adults found advanced thyroid cancer either at presentation or during the disease-course to be associated …

Factors Affecting The Healthcare Of Adults With Communication Difficulties Due To Autism Spectrum Disorder And/Or Intellectual And Developmental Disability, Kathryn L. Shady

MUSC Theses and Dissertations

Purpose: This dissertation explores the healthcare barriers and facilitators experienced by autistic adults and adults with intellectual and developmental disabilities (IDD) who have communication difficulties (CD).

Problem: Approximately 5-10% of Americans have CD, including difficulties such as stuttering, aphasia, apraxia, and other forms of language impairment(1,2). Communication difficulties are present in about 25-30% of autistic individuals and 57.9% of those with IDD, which accounts for a large and poorly studied portion of those with CD(3,4). Individuals with CD report negative healthcare experiences and decreased levels of satisfaction with healthcare providers secondary to practices such as communication solely with a …

Association Of Inflammatory Markers And Growth Factors With Radiographically Assessed Wound Healing Of Extraction Sockets, Sasha Mohammadi

Theses & Dissertations

The purpose of this prospective cohort pilot study was to investigate the association of the periodontal status and inflammatory markers from the gingival crevicular and wound fluid with the healing outcomes following tooth extraction. The central research hypothesis is that extraction sites and the adjacent teeth that exhibit increased markers of inflammation, or decreased growth factors, at baseline or 2 weeks will be associated with reduced healing outcomes observed radiographically 3 months following surgery. Nine patients at the UNMC College of Dentistry who were seeking care to extract a posterior tooth due to advanced periodontal bone loss, non-restorable caries or …

Overcoming Resistance Mechanisms To Cdk4/6 Inhibitor Treatment Using Cdk6-Selective Protac, Sarah Truong

Theses & Dissertations

Hormone receptor-positive (HR+) breast cancer (BC) constitutes approximately 75% of all breast cancer patients. These tumors rely on hormones, estrogen and progesterone, for their proliferation. The interaction between the hormones and their respective receptors enhances cyclin D expression, which results in the persistent activation of CDK4 and CDK6. The CDK4/6-cyclin D complex engages in a phosphorylation cascade that ultimately allows the cells to proceed past the G1/S checkpoint of the cell cycle. Inhibition of CDK4/6 has been shown to trigger cell cycle arrest, inhibit tumor growth, and induce apoptosis. Currently, there are three FDA-approved CDK4/6 inhibitors (CDK4/6i). A limitation of …

Factors Associated With The Difficulty Of Computerized Tasks Among Office-Based Physicians In The United States, Khalid Alshehri

Theses & Dissertations

Computerized tasks represent an essential component of the modern health care services. A substantial part of these computerized tasks performed by physicians are made for documenting clinical care through Electronic Health Records (EHRs) and using Prescription Drug Monitoring Programs (PDMPs). While these computerized tasks have positively impacted the care provided by physicians, difficulty-based barriers to using these electronic tools were identified. Given the potential unfavorable roles that difficulty-based barriers can play in the provision for health care, it is important to examine factors associated with these barriers. Thus, the core objective of this study is to examine factors associated with …

Exploiting Vulnerabilities In The Ras-Rac Signaling Pathway For The Selective Targeting Of Pancreatic Cancer Cells, Neha Chaudhary

Theses & Dissertations

Deregulation of the KRas (Kirsten rat sarcoma virus) GTPase is one of the early hallmarks of Pancreatic Cancer (PC). The most common genetic alteration found in PC are mutations in the KRas protein that block its ability to hydrolyze GTP to GDP and resulting in higher levels of GTP-bound KRas, its active form. Pancreatic tumors driven by oncogenic mutants of KRas tend to be addicted to the oncogene, to the extent that its repression leads to the induction of cell death. This addiction to the KRAS oncogene makes the KRas protein an ideal target for cancer therapy. However, the globular …

An Exploration Of Policies, Equity, And Emerging Threats To The Traffic Safety Environment In The U.S., Sachi Verma

Theses & Dissertations

Road traffic crashes are among one of the leading causes of death around the globe. Additionally, it also causes long-term physical disabilities, mental trauma, and financial pressure. By implementing road safety guidelines such as speed limits, drug and alcohol checkpoints, restraints, and penalties, motor vehicle crashes can be reduced. Road traffic crash survival primarily depends on emergency medical service's timely triaging. Rapid triaging and reduced response times can help road traffic crash morbidities and mortalities. However, several factors can be responsible for EMS delays in responding to a fatal crash. This dissertation aims to observe multiple factors related to EMS …

The Co-Oncogenic Function Of Ecdysoneless Protein With Erbb2 In Mammary Epithelial Cells, Benjamin B. Kennedy

Theses & Dissertations

The Ecdysoneless (ECD) protein is highly evolutionarily conserved and ubiquitously expressed across human tissues. ECD has established roles in cell cycle regulation, embryogenesis, cell survival, and RNA biogenesis. ECD mRNA and protein are overexpressed in breast cancer, and its overexpression correlates with poor patient survival, especially in ErbB2/HER2-positive breast cancer. This thesis work investigates the co-oncogenic role of ECD in ErbB2-driven oncogenesis using immortalized mammary epithelial cells. Here, we show that ECD and ErbB2 overexpression in immortalized human mammary epithelial cells increases cancer traits, such as invasion, migration, and anchorage independent growth. Significantly, ECD+ErbB2 co-overexpression further enhanced all oncogenic traits. …

Design, Synthesis, And Evaluation Of Novel Peptidomimetics As Neurolysin Activators For The Treatment Of Ischemic Stroke., Md. Shafikur Rahman

Theses & Dissertations

Stroke is the world's second-leading cause of death and disability. Ischemic stroke (IS), a primary subtype of stroke, has ineffective and limited treatment options, resulting in a significant unmet medical need for novel therapies. Tissue plasminogen activator (tPA) is the sole FDA-approved medication now in use; however, it has a narrow therapeutic window (3 to 4.5 h). Unfortunately, few individuals have this opportunity to be diagnosed with stroke in time to begin therapy with tPA. Additionally, treatment with tPA can have major adverse effects, such as bleeding, which can exacerbate the consequences of a stroke on the brain. To overcome …

Understanding Healthcare Worker Experiences And Personal Protective Equipment (Ppe)-Related Skin Reactions/Injuries During The Covid-19 Pandemic: A Mixed Methods Approach, Susan Solmos

Theses & Dissertations

Personal protective equipment (PPE)-related facial skin reactions/injuries occurred in 75.13% of healthcare workers during the COVID-19 pandemic. Critical appraisal of cross-sectional studies identified methodological gaps as the majority of survey questions were not content-validated and those that were lacked descriptions of methods and psychometrics for the survey questions/tool. The aims of this dissertation study were to describe the nature, severity, and distribution of selfie captured PPE-related facial injuries using a validated tool (quantitative) and describe the contextual factors associated with PPE-related facial injuries and what factors influence nurses and Health Care Workers (HCWs) to share their experiences (qualitative). The setting …

Inclusive Education Is Power: Revising Sexual Health Education For People With Disabilities, Carly M. Tsuruda

Master's Projects and Capstones

For people with disabilities in the United States, comprehensive sexual health education is not always available. There are a number of reasons for the lack of comprehensive sexual health education, including excessive censorship and curriculum that is not representative of people with disabilities. Sexual health education and disability are both topics that have several preconceived notions attached to them, yet there is a dearth in resources that could provide accurate information to those both with and without disabilities. These preconceived notions that have been associated with these identity labels lead to negative health outcomes for people with disabilities such as …