Medicine and Health Sciences Commons^™

Medical Students Preventing Medical Errors: A Student-Led Approach To Patient Safety In Preclinical Curriculum, Daniel Habenicht, Niti Dharwadkar, Aishwarya Gatiganti, Sahar Panjwani, Daniel Nwoschua, Lauren Muenchow, Jose Campo Maldonado

Research Symposium

Introduction: Preventable medical errors are currently the third leading cause of death in the United States following heart disease and cancer (1). Early exposure to patient safety knowledge may lead to students to deliver safer care in their clerkship and residency years. This study was designed to assess the change in knowledge from earlier exposure and education during pre-clinical years and its impact on interest and knowledge about patient safety.

Methods: For the past four years, a patient safety training has been conducted for interested first and second-year medical students and responses are assessed through a pre-test, immediate …

A Stomach Bug? Not What You May Think: A Case Of Post-Viral Gastroparesis Caused By Sars-Cov-2, Adrienne Anderson, Nina Shyama Appareddy, Jose Ramos, Grecia Dominguez Rivera, Robinson Pena, Jose E. Campo Maldonado

Research Symposium

Gastroparesis has a wide range of etiologies including diabetes, medications, post-surgical, post-viral and idiopathic (1). SARS-CoV-2 can cause gastrointestinal symptoms which typically resolve within the first few weeks of infection (2). However, some sequelae persist beyond the initial infectious period.

Computational Studies Of Novel Thiazolidine-4-One Based Mao Inhibitors As Neuro-Protective Anti-Parkinson Agents, Abhimannu Shome, Pooja Chawla

Research Symposium

Now a day’s Neurodegenerative diseases such as Parkinson disease is a big concern in the field of medical sciences. In Parkinson’s disease, neurodegeneration occurs in several ways. Monoamine oxidase enzyme is one of them. MAO oxidize the dopamine into its precursor 3,4-dihydroxyphenylacetic acid (DOPAC), which leads to increased ROS and decreased dopamine level. Thiazolidine-4-one pharmacophore has been used to design the desired compound for the target. Thiazolidine-4-one derivatives have been reported to possess anti-oxidant property so the thiazolidine-4-one clubbed compounds were designed and studied via Molecular docking via AutoDock vina, drug-likeness profile by swissADME and pharmacophore modelling through Pharmagist …

Does Social Media Matter When It Comes To Rank Lists? A Survey Of Applicants For General Surgery Residency During Covid-19, Justin M. Greco, Alessandra Storino, Priyanka V. Chugh, Tara S. Kent, Donald Hess, Dmitry M. Nepomnayshy, Kimberly M. Ellis, Jonathan S. Abelson

The Lahey Journal

Abstract:

Introduction: The COVID-19 pandemic greatly disrupted traditional social interactions between residency applicants and General Surgery programs. There is no previous research on the influence of social media in General Surgery residency recruiting.

Methods: We performed a multi-institutional survey of General Surgery residency applicants from the Northeast United States about the effect social media had on their decision to interview and rank programs, after the results of the 2021 National Resident Matching Program. The survey was sent to 311 e-mail addresses. The 22-question survey consisted of multiple choice, Likert Scale, and free text responses.

Results: 66 applicants completed the survey …

Patient And Provider Perceptions Of Rapid Telehealth Implementation During The Covid-19 Pandemic, Ryan G. Seibert, Amanda K. Stephenson, Aubrey K. Podell, Yuxiu K. Lei, Sheri K. Keitz

The Lahey Journal

Introduction: Despite unprecedented telehealth adoption during the COVID-19 pandemic, its post-pandemic preservation remains uncertain. Understanding key stakeholders’ perspectives on telehealth during the pandemic can inform evidence-based policies and promote effective, sustainable virtual-based care.

Methods: Patients and providers who completed telehealth visits during the early pandemic in primary care, subspecialty, and surgical outpatient clinics at a large community-based academic medical center in New England were surveyed via telephone interviews or electronic surveys. Thematic analyses of qualitative comments further characterized experiences.

Results: Of 1,729 eligible patients called, 969 were contacted and 778 participated (response rate 80.3% among contacted patients). Among 753 eligible …

Measuring Blood Pressure In Primary Care For Accurate Diagnosis And Decision Making: Implementing Evidence-Based Protocols Across A Health System, Gertrude W. Manchester, Deirdre C. Donahue, Catarina I. Kiefe, Lori Pelletier, Marie A. Sosa, Sheri A. Keitz

The Lahey Journal

Abstract

Background: Evidence-based blood pressure (BP) measurement is required for optimal clinical decision-making while improper measurement risks daily diagnostic and therapeutic errors.

Objective: To implement and sustain an evidence-based BP measurement protocol without extra resources and disseminate the protocol across a primary care network.

Design, Setting, and Participants: A Plan-Do-Study-Act (PDSA) framework for quality improvement was used to design a standardized BP measurement protocol including a 5-minute rest period only for patients with persistently elevated blood pressure. The protocol was developed using Goldratt’s Theory of Constraints and Layers of Resistance to ensure multidisciplinary buy-in and was implemented in 3 groups …

Celebrating A Centennial Of Care And Humanism. Dr. Samuel L. Moschella, Adam D. Lipworth

The Lahey Journal

No abstract provided.

Historical Musings, David J. Schoetz Jr.

The Lahey Journal

No abstract provided.

The Academic Mission At Lahey, David L. Longworth

The Lahey Journal

No abstract provided.

Mixed Method Approach Towards The Life Of University Students During The Covid-19 Pandemic, Raihan Khan, Andrew White, Tony Jehi

Department of Health Sciences - Faculty Scholarship

Background

The COVID-19 pandemic negatively impacted the higher education system. This mixed-methods study aimed to assess COVID-19 fear, anxiety, and stress among Shenandoah Valley college students.

Methods

An online survey was fielded and completed by n=680 students. Qualitative semi-structured interviews were conducted with 20 students.

Results

The mean participant age was 22.14±5.48 years, and primarily White (81.9%), women (80.4%), and undergraduate (78.0%) students. Approximately 41% were enrolled in health-related majors (41.4%). Women students had significantly higher anxiety, depression, and fear of contracting COVID-19 than men. Undergraduate students had significantly higher depression than graduate students. Qualitative analysis revealed several major themes: …

Efficacy Of An Enterotoxigenic Escherichia Coli (Etec) Vaccine On The Incidence And Severity Of Traveler's Diarrhea (Td): Evaluation Of Alternative Endpoints And A Td Severity Score, Nicole Maier, Shannon L Grahek, Jane Halpern, Suzanne Restrepo, Felipe Troncoso, Janet Shimko, Olga Torres, Jaime Belkind-Gerson, David A Sack, Ann-Mari Svennerholm, Björn Gustafsson, Björn Sjöstrand, Nils Carlin, A Louis Bourgeois, Chad K Porter

Faculty and Staff Publications

The efficacy of an Oral Whole Cell ETEC Vaccine (OEV) against Travelers' Diarrhea (TD) was reexamined using novel outcome and immunologic measures. More specifically, a recently developed disease severity score and alternative clinical endpoints were evaluated as part of an initial validation effort to access the efficacy of a vaccine intervention for the first time in travelers to an ETEC endemic area. A randomized, double-blind, placebo-controlled trial followed travelers to Guatemala or Mexico up to 28 days after arrival in the country following vaccination (two doses two weeks apart) with an ETEC vaccine. Fecal samples were collected upon arrival, departure, …

Circulating Endocannabinoids And N-Acylethanolamines In Individuals With Cannabis Use Disorder-Preliminary Findings, Nadia Boachie, Erin Gaudette, Richard P. Bazinet, Lin Lin, Rachel F. Tyndale, Esmaeil Mansouri, Marilyn A. Huestis, Junchao Tong, Bernard Le Foll, Stephen J. Kish, Tony P. George, Isabelle Boileau

Institute of Emerging Health Professions Faculty Papers

BACKGROUND: Endocannabinoids and related N-acylethanolamines (NAEs) are bioactive lipids with important physiological functions and putative roles in mental health and addictions. Although chronic cannabis use is associated with endocannabinoid system changes, the status of circulating endocannabinoids and related NAEs in people with cannabis use disorder (CUD) is uncertain.

METHODS: Eleven individuals with CUD and 54 healthy non-cannabis using control participants (HC) provided plasma for measurement by high-performance liquid chromatography-mass spectrometry of endocannabinoids (2-arachidonoylglycerol (2-AG) and N-arachidonoylethanolamine (AEA)) and related NAE fatty acids (N-docosahexaenoylethanolamine (DHEA) and N-oleoylethanolamine (OEA)). Participants were genotyped for the functional gene variant of FAAH (rs324420, C385A) which …

Synlight: A Bicistronic Strategy For Simultaneous Active Zone And Cell Labeling In The Drosophila Nervous System, Michael A. Aimino, Jesse Humenik, Michael J. Parisi, Juan Carlos Duhart, Timothy J. Mosca

Farber Institute for Neuroscience Faculty Papers

At synapses, chemical neurotransmission mediates the exchange of information between neurons, leading to complex movement, behaviors, and stimulus processing. The immense number and variety of neurons within the nervous system make discerning individual neuron populations difficult, necessitating the development of advanced neuronal labeling techniques. In Drosophila, Bruchpilot-Short and mCD8-GFP, which label presynaptic active zones and neuronal membranes, respectively, have been widely used to study synapse development and organization. This labeling is often achieved via the expression of 2 independent constructs by a single binary expression system, but expression can weaken when multiple transgenes are expressed by a single driver. Recent …

Community Mobility And Depressive Symptoms During The Covid-19 Pandemic In The United States, Roy H. Perlis, Kristin Lunz Trujillo, Alauna Safarpour, Alexi Quintana, Matthew D. Simonson, Jasper Perlis, Mauricio Santillana, Katherine Ognyanova, Matthew A. Baum, James N. Druckman, David Lazer

Political Science Faculty Publications

Importance Marked elevation in levels of depressive symptoms compared with historical norms have been described during the COVID-19 pandemic, and understanding the extent to which these are associated with diminished in-person social interaction could inform public health planning for future pandemics or other disasters.

Objective To describe the association between living in a US county with diminished mobility during the COVID-19 pandemic and self-reported depressive symptoms, while accounting for potential local and state-level confounding factors.

Design, Setting, and Participants This survey study used 18 waves of a nonprobability internet survey conducted in the United States between May 2020 and April …

Impacts Of Skin Color And Hypoxemia On Noninvasive Assessment Of Peripheral Blood Oxygen Saturation: A Scoping Review, Kawaiola C. Aoki, Maya Barrant, Mam Jarra Gai, Marina M. Handal, Vivian Xu, Harvey N. Mayrovitz

HPD Articles

Standard pulse oximeters estimate arterial blood saturation (SaO2 ) non-invasively by emitting and detecting light of a specific wavelength through a cutaneous vascular bed, such as a digit or the ear lobe. The quantity measured at these peripheral sites is designated as oxygen saturation (SpO2 ). Most reliable pulse oximeters are calibrated from measurements of healthy volunteers using some form of oxygen desaturation method. As the degree of inducible hypoxemia is limited, the calibration below achievable desaturation levels is usually extrapolated, leading to potential measurement error at low SaO2 values, especially in highly pigmented skin. Such skin color-related errors (SCRE) …

Principles Of Chemistry Ii, Janet L. Shaw

KSU Distinguished Course Repository

Second course in a two-semester sequence covering the fundamental principles and applications of chemistry designed for science majors.

With a pre-requisite of CHEM 1211: Principles of Chemistry I, this course is part of a two-semester sequence covering principles and applications of chemistry. The course is designed to help students apply simplified models to complex systems to build critical thinking and problem-solving skills. A major goal of this course is to help students become self-directed learners thereby preparing them for whatever career path they choose. Although designed for science majors who typically complete the course during their freshman year, pre-health majors …

Patient Specific Normalized Glandular Dose Range Estimate For Mammography, Lacey Medlock

LSU Master's Theses

Breast cancer is the most common type of cancer among women in the United States. It is also the second leading cause of death by cancer among women in the United States. Early detection is key to preventing fatalities. There are over 39 million mammography screening procedures performed yearly [3]. We know that exposure to radiation, including in routine mammography, may induce secondary cancers [4]. Thus, it is important to be able to accurately estimate the dose delivered to a patient during breast cancer screening. The dose delivered to a patient is regulated in the US and in many other …

Suicide Ideation And Behavior And Atod Use Among Bisexual High School Students, Michael S. Dunn, John F. Yannessa

Public Health

Research has indicated that sexual minorities have higher prevalence rates for ATOD use and suicide ideation and behavior compared to heterosexual youth. Yet, most studies to date have combined gay, lesbian, and bisexuals into one category. This study sought to assess the uniqueness of bisexuality to assess the risk of ATOD use and suicide ideation and behavior among bisexual high school students. Data for this study were derived from the 2019 Centers for Disease Control’s Youth Risk Behavior Survey (YRBS). Chi-square analysis was conducted to determine the prevalence of ATOD use and suicide ideation and behavior. Logistic regression was then …

Antibodies To Coagulase Of Staphylococcus Aureus Crossreact To Efb And Reveal Different Binding Of Shared Fibrinogen Binding Repeats, Federico Bertoglio, Ya-Ping Ko, Sheila Thomas, Liliana Giordano, Francesca Romana Scommegna, Doris Meier, Saskia Polten, Marlies Becker, Srishtee Arora, Michael Hust, Magnus Höök, Livia Visai

Faculty, Staff and Student Publications

Staphylococcus aureus pathology is caused by a plethora of virulence factors able to combat multiple host defence mechanisms. Fibrinogen (Fg), a critical component in the host coagulation cascade, plays an important role in the pathogenesis of this bacterium, as it is the target of numerous staphylococcal virulence proteins. Amongst its secreted virulence factors, coagulase (Coa) and Extracellular fibrinogen-binding protein (Efb) share common Fg binding motives and have been described to form a Fg shield around staphylococcal cells, thereby allowing efficient bacterial spreading, phagocytosis escape and evasion of host immune system responses. Targeting these proteins with monoclonal antibodies thus represents a …

Pca-Clf: A Classifier Of Prostate Cancer Patients Into Patients With Indolent And Aggressive Tumors Using Machine Learning, Yashwanth Karthik Kumar Mamidi, Tarun Karthik Kumar Mamidi, Md Wasi Ul Kabir, Jiande Wu, Md Tamjidul Hoque, Chindo Hicks

School of Medicine Faculty Publications

A critical unmet medical need in prostate cancer (PCa) clinical management centers around distinguishing indolent from aggressive tumors. Traditionally, Gleason grading has been utilized for this purpose. However, tumor classification using Gleason Grade 7 is often ambiguous, as the clinical behavior of these tumors follows a variable clinical course. This study aimed to investigate the application of machine learning techniques (ML) to classify patients into indolent and aggressive PCas. We used gene expression data from The Cancer Genome Atlas and compared gene expression levels between indolent and aggressive tumors to identify features for developing and validating a range of ML …

Repurposing Normal Chromosomal Microarray Data To Harbor Genetic Insights Into Congenital Heart Disease, Nephi Walton, Hoang Nguyen, Sara Procknow, Darren Johnson, Alexander Anzelmi, Patrick Jay

Department of Medicine Faculty Papers

About 15% of congenital heart disease (CHD) patients have a known pathogenic copy number variant. The majority of their chromosomal microarray (CMA) tests are deemed normal. Diagnostic interpretation typically ignores microdeletions smaller than 100 kb. We hypothesized that unreported microdeletions are enriched for CHD genes. We analyzed "normal" CMAs of 1762 patients who were evaluated at a pediatric referral center, of which 319 (18%) had CHD. Using CMAs from monozygotic twins or replicates from the same individual, we established a size threshold based on probe count for the reproducible detection of small microdeletions. Genes in the microdeletions were sequentially filtered …

Exploring Conformational Landscapes And Cryptic Binding Pockets In Distinct Functional States Of The Sars-Cov-2 Omicron Ba.1 And Ba.2 Trimers: Mutation-Induced Modulation Of Protein Dynamics And Network-Guided Prediction Of Variant-Specific Allosteric Binding Sites, Gennady M. Verkhivker, Mohammed Alshahrani, Grace Gupta

Mathematics, Physics, and Computer Science Faculty Articles and Research

A significant body of experimental structures of SARS-CoV-2 spike trimers for the BA.1 and BA.2 variants revealed a considerable plasticity of the spike protein and the emergence of druggable binding pockets. Understanding the interplay of conformational dynamics changes induced by the Omicron variants and the identification of cryptic dynamic binding pockets in the S protein is of paramount importance as exploring broad-spectrum antiviral agents to combat the emerging variants is imperative. In the current study, we explore conformational landscapes and characterize the universe of binding pockets in multiple open and closed functional spike states of the BA.1 and BA.2 Omicron …

Examining Cancer Patients' Perceptions Of The Impact Of Covid-19 On Teleoncology: Findings From 15 Nigerian Outpatient Cancer Clinics, Adedayo Joseph, Abdul R. Shour, Nwamaka N. Lasebikan, Mutiu A. Jimoh, Bolanle C. Adegboyega, Emmanuella Nwachukwu, Opeyemi Awofeso, Azeezat Ajose, Abiola Ibraheem, Omolara Aminat Fatiregun, Musa Ali-Gombe, Usman M. Aliyu, Abdallah Elsaid Kotkat, Olusegun Abayomi Biyi-Olutunde, Evaristus Oseiwe Oboh, Ismail H. Zubairu, Mohammad Rifat Haider, Bankole Olatosi Ph.D., David Puthoff, Adedayo A. Onitilo

Faculty Publications

Purpose

To examine cancer patients' perspectives on the impact of COVID-19 on teleoncology in Nigeria.

Methods

Data from a multicenter survey conducted at 15 outpatient clinics to 1,097 patients with cancer from April and July 2020 were analyzed. The study outcome was telemedicine, defined as patients who reported their routine follow-up visits were converted to virtual visits because of COVID-19 (coded yes/no). Covariates included patient age, ethnicity, marital status, income, cancer treatment, service disruption, and cancer diagnosis/type. Stata/SE.v.17 (StataCorp, College Station, TX) was used to perform chi-square and logistic regression analyses. P values ≤ .05 were considered statistically significant.

Results …

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A Prospective Randomized Clinical Trial To Assess Antibiotic Pocket Irrigation On Tissue Expander Breast Reconstruction, Jennifer N Walker, Blake M Hanson, Tayler Hunter, Shelby R Simar, Jesus M Duran Ramirez, Chloe L P Obernuefemann, Rajiv P Parikh, Marissa M Tenenbaum, Julie A Margenthaler, Scott J Hultgren, Terence M Myckatyn

Faculty, Staff and Student Publications

Bacterial infection is the most common complication following staged post-mastectomy breast reconstruction initiated with a tissue expander (TE). to limit bacterial infection, antibiotic irrigation of the surgical site is commonly performed despite little high-quality data to support this practice. We performed a prospective randomized control trial to compare the impact of saline irrigation alone to a triple antibiotic irrigation regimen (1 g cefazolin, 80 mg gentamicin, and 50,000 units of bacitracin in 500 mL of saline) for breast implant surgery. The microbiome in breasts with cancer (

Adjunctive Diagnostic Studies Completed Following Detection Of Candidemia In Children: Secondary Analysis Of Observed Practice From A Multicenter Cohort Study Conducted By The Pediatric Fungal Network, Rachel L Wattier, Robert F T Bucayu, Craig L K Boge, Rachael K Ross, Inci Yildirim, Theoklis E Zaoutis, Debra L Palazzi, Surabhi B Vora, Elio Castagnola, Martha Avilés-Robles, Lara Danziger-Isakov, Alison C Tribble, Tanvi S Sharma, Antonio C Arrieta, Gabriela Maron, David M Berman, Dwight E Yin, Lillian Sung, Michael Green, Emmanuel Roilides, Kiran Belani, José Romero, Pere Soler-Palacin, Eduardo López-Medina, Dawn Nolt, Ibrahim Zaid Bin Hussain, William J Muller, Sarmistha B Hauger, Natasha Halasa, Daniel Dulek, Alice Pong, Blanca E Gonzalez, Mark J Abzug, Fabianne Carlesse, Anna R Huppler, Sujatha Rajan, Catherine Aftandilian, Monica I Ardura, Arunaloke Chakrabarti, Benjamin Hanisch, Christine M Salvatore, Lena Klingspor, Elizabeth D Knackstedt, Irja Lutsar, Maria E Santolaya, Sydney Shuster, Sarah K Johnson, William J Steinbach, Brian T Fisher

Faculty, Staff and Students Publications

BACKGROUND: Adjunctive diagnostic studies (aDS) are recommended to identify occult dissemination in patients with candidemia. Patterns of evaluation with aDS across pediatric settings are unknown.

METHODS: Candidemia episodes were included in a secondary analysis of a multicenter comparative effectiveness study that prospectively enrolled participants age 120 days to 17 years with invasive candidiasis (predominantly candidemia) from 2014 to 2017. Ophthalmologic examination (OE), abdominal imaging (AbdImg), echocardiogram, neuroimaging, and lumbar puncture (LP) were performed per clinician discretion. Adjunctive diagnostic studies performance and positive results were determined per episode, within 30 days from candidemia onset. Associations of aDS performance with episode characteristics …

Evaluation Of Negative Binomial And Zero-Inflated Negative Binomial Models For The Analysis Of Zero-Inflated Count Data: Application To The Telemedicine For Children With Medical Complexity Trial, Kyung Hyun Lee, Claudia Pedroza, Elenir B C Avritscher, Ricardo A Mosquera, Jon E Tyson

Faculty, Staff and Student Publications

BACKGROUND: Two characteristics of commonly used outcomes in medical research are zero inflation and non-negative integers; examples include the number of hospital admissions or emergency department visits, where the majority of patients will have zero counts. Zero-inflated regression models were devised to analyze this type of data. However, the performance of zero-inflated regression models or the properties of data best suited for these analyses have not been thoroughly investigated.

METHODS: We conducted a simulation study to evaluate the performance of two generalized linear models, negative binomial and zero-inflated negative binomial, for analyzing zero-inflated count data. Simulation scenarios assumed a randomized …

Differential Effects Of Pancreatic Cancer-Derived Extracellular Vesicles Driving A Suppressive Environment, Anurag Purushothaman, Jacqueline Oliva-Ramírez, Warapen Treekitkarnmongkol, Deivendran Sankaran, Mark W Hurd, Nagireddy Putluri, Anirban Maitra, Cara Haymaker, Subrata Sen

Faculty, Staff and Student Publications

Pancreatic ductal adenocarcinoma (PDAC) cells display extensive crosstalk with their surrounding environment to regulate tumor growth, immune evasion, and metastasis. Recent advances have attributed many of these interactions to intercellular communication mediated by small extracellular vesicles (sEVs), involving cancer-associated fibroblasts (CAF). To explore the impact of sEVs on monocyte lineage transition as well as the expression of checkpoint receptors and activation markers, peripheral blood monocytes from healthy subjects were exposed to PDAC-derived sEVs. Additionally, to analyze the role of sEV-associated HA in immune regulation and tissue-resident fibroblasts, monocytes and pancreatic stellate cells were cultured in the presence of PDAC sEVs …

Author Correction: Synthetic Oct-A Blood Vessel Maps Using Fundus Images And Generative Adversarial Networks, Ivan Coronado, Samiksha Pachade, Emanuele Trucco, Rania Abdelkhaleq, Juntao Yan, Sergio Salazar-Marioni, Amanda Jagolino-Cole, Mozhdeh Bahrainian, Roomasa Channa, Sunil A Sheth, Luca Giancardo

Faculty, Staff and Student Publications

No abstract provided.

Author Correction: Histone H2a Lys130 Acetylation Epigenetically Regulates Androgen Production In Prostate Cancer, Thanh Nguyen, Dhivya Sridaran, Surbhi Chouhan, Cody Weimholt, Audrey Wilson, Jingqin Luo, Tiandao Li, John Koomen, Bin Fang, Nagireddy Putluri, Arun Sreekumar, Felix Y Feng, Kiran Mahajan, Nupam P Mahajan

Faculty, Staff and Students Publications

No abstract provided.

A Prospective Randomized Clinical Trial To Assess Antibiotic Pocket Irrigation On Tissue Expander Breast Reconstruction, Jennifer N Walker, Blake M Hanson, Tayler Hunter, Shelby R Simar, Jesus M Duran Ramirez, Chloe L P Obernuefemann, Rajiv P Parikh, Marissa M Tenenbaum, Julie A Margenthaler, Scott J Hultgren, Terence M Myckatyn

2020-Current year OA Pubs

Bacterial infection is the most common complication following staged post-mastectomy breast reconstruction initiated with a tissue expander (TE). To limit bacterial infection, antibiotic irrigation of the surgical site is commonly performed despite little high-quality data to support this practice. We performed a prospective randomized control trial to compare the impact of saline irrigation alone to a triple antibiotic irrigation regimen (1 g cefazolin, 80 mg gentamicin, and 50,000 units of bacitracin in 500 mL of saline) for breast implant surgery. The microbiome in breasts with cancer (