Medical Specialties Commons^™

Neighborhood Walkability And Health, Edward F. Ansello

Director's Editorials from Age in Action

The apparent benefit of neighborhood walkability suggests that it may be an important health-related consideration in the lives of everyday people. Most of the elements in the walkability index reflect components in the environment, so these may be relevant across the continuum of impairments, meaning that walkable neighborhoods themselves may have positive impact on the daily lives of people with physical or intellectual disabilities.

Palliative Care Is More Care, Not Less, Rachel Selby-Penczak

Case Studies from Age in Action

Educational Objectives:

1. Discuss the origins of hospice and palliative care.

2. Compare and contrast Curative, Palliative, and Hospice Models of Care.

3. Identify when palliative care is appropriate.

Palette: An Intergenerational Art Program To Improve Health Care Delivery And Health Outcomes Of Older Adults, Sadie Rubin

Case Studies from Age in Action

Educational Objectives:

1. Demonstrate the positive out-comes of the PALETTE model in training and educating health pro-fessional students in gerontological experiences.

2. Describe the partnerships devel-oped and their importance in exe-cuting PALETTE programs.

3. Highlight student experiences in intergenerational visual arts and intergenerational movement arts.

Evaluating Commonwealth Coordinated Care: The Experiences Of Individuals Dually Eligible For Medicare And Medicaid, Gerald Craver, Alison Cuellar, Gilbert Gimm

Case Studies from Age in Action

Objectives

1. To understand Virginia’s rationale for implementing the Commonwealth Coordinated Care Program and its approach to evaluating it.

2. To provide a framework for examining the health care experiences of individuals with behavioral health and/or long-term service and support needs who are enrolled in the Commonwealth Coordinated Care Program.

3. To inform policy on future options for improving the quality and health care experiences of similar groups of individuals in Virginia and other states.

Averting Financial Exploitation And Undue Influence Through Legislation, Kathy Pryor

Case Studies from Age in Action

Objectives

1. Explain what financial exploitation is.

2. Examine the elements of undue influence through case studies.

3. Consider the reasons undue influence is so difficult to address legislatively.

Effects Of Inositol(S) In Women With Pcos: A Systematic Review Of Randomized Controlled Trials, Vittorio Unfer, John E. Nestler, Zdravko A. Kamenov, Nikos Prapas, Fabio Facchinetti

Obstetrics and Gynecology Publications

Polycystic ovary syndrome (PCOS) is a common endocrine disorder, with complex etiology and pathophysiology, which remains poorly understood. It affects about 5–10% of women of reproductive age who typically suffer from obesity, hyperandrogenism, ovarian dysfunction, and menstrual irregularity. Indeed, PCOS is the most common cause of anovulatory infertility in industrialized nations, and it is associated with insulin resistance, type 2 diabetes mellitus, and increased cardiovascular risk. Although insulin resistance is not included as a criterion for diagnosis, it is a critical pathological condition of PCOS. The purpose of this systematic review is the analysis of recent randomized clinical trials of …

Family-Centered Rounds And Medical Student Performance On The Nbme Pediatrics Subject (Shelf) Examination: A Retrospective Cohort Study, Tiffany N. Kimbrough, Victor Heh, N. Romesh Wijesooriya, Michael S. Ryan

Pediatrics Publications

Objective

To determine the association between family-centered rounds (FCR) and medical student knowledge acquisition as assessed by the National Board of Medical Examiners (NBME) pediatric subject (shelf) exam.

Methods

A retrospective cohort study was conducted of third-year medical students who graduated from Virginia Commonwealth University School of Medicine between 2009 and 2014. This timeframe represented the transition from ‘traditional’ rounds to FCR on the pediatric inpatient unit. Data collected included demographics, United States Medical Licensing Examination (USMLE) Step 1 and 2 scores, and NBME subject examinations in pediatrics (PSE), medicine (MSE), and surgery (SSE).

Results

Eight hundred and sixteen participants …

Pharmacological Blockade Of The Calcium Plateau Provides Neuroprotection Following Organophosphate Paraoxon Induced Status Epilepticus In Rats, Laxmikant S. Deshpande, Robert E. Blair, Beverly A. Huang, Kristin F. Phillips, Robert J. Delorenzo

Neurology Publications

Organophosphate (OP) compounds which include nerve agents and pesticides are considered chemical threat agents. Currently approved antidotes are crucial in limiting OP mediated acute mortality. However, survivors of lethal OP exposure exhibit delayed neuronal injury and chronic behavioral morbidities. In this study, we investigated neuroprotective capabilities of dantrolene and carisbamate in a rat survival model of paraoxon (POX) induced status epilepticus (SE). Significant elevations in hippocampal calcium levels were observed 48-h post POX SE survival, and treatment with dantrolene (10 mg/kg, i.m.) and carisbamate (90 mg/kg, i.m.) lowered these protracted calcium elevations. POX SE induced delayed neuronal injury …

Using Platelet-Rich Plasma To Reverse The Effects Of Tendinopathy And Prevent Tendon Re-Rupture After Surgery In Athletes: The Search For A Standardized Protocol, Shiv Patel

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

30-50% of all lesions amateur and professional sports players will experience during activity are related to the tendon. Moreover, the incidence of tendinopathy, a precursor to tendon rupture, is much higher in both of these groups due to excessive loading of tendons during physical activity, insufficient rest afterwards and certain antibiotic use. The tendon anatomically has both a low blood supply and a low cell turnover rate, which contribute to the relative ease by which an athlete can develop tendinopathy. Chronic tendinopathy has very few high-success treatments but in recent years, platelet-rich plasma (PRP), a treatment in which platelets are …

Prenatal Nicotine Exposure As A Teratogen In Neurological Pathways, Monica Grover

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Attention-deficit/hyperactivity disorder (ADHD) is the most heritable and commonly diagnosed childhood psychiatric disorder with 4% of all children being diagnosed with this disorder. Prenatal smoking has been found to be a risk factor for ADHD, a disorder that has been believed to be linked to the fluctuation of dopamine levels. Prenatal nicotine exposure in the second trimester influences dopaminergic neurological pathways by altering dopamine release levels. The altered dopamine levels make the fetus brain more sensitive to the nicotine, causing the nicotine exposure to be more dangerous in causing ADHD symptoms. Prenatal nicotine exposure alters the neurological pathway of the …

Understanding And Targeting The C-Terminal Binding Protein (Ctbp) Substrate-Binding Domain For Cancer Therapeutic Development, Benjamin L. Morris

Theses and Dissertations

Cancer involves the dysregulated proliferation and growth of cells throughout the body. C-terminal binding proteins (CtBP) 1 and 2 are transcriptional co-regulators upregulated in several cancers, including breast, colorectal, and ovarian tumors. CtBPs drive oncogenic properties, including migration, invasion, proliferation, and survival, in part through repression of tumor suppressor genes. CtBPs encode an intrinsic dehydrogenase activity, utilizing intracellular NADH concentrations and the substrate 4-methylthio-2-oxobutyric acid (MTOB), to regulate the recruitment of transcriptional regulatory complexes. High levels of MTOB inhibit CtBP dehydrogenase function and induce cytotoxicity among cancer cells in a CtBP-dependent manner. While encouraging, a good therapeutic would utilize >100-fold …

Characterizing The Oncogenic Properties Of C-Terminal Binding Protein, Evan T. Sumner

Theses and Dissertations

The paralogous C-terminal binding proteins (CtBP) 1 and 2 are evolutionarily conserved transcriptional coregulators that target and disrupt the expression of several genes essential for multiple cellular processes critical to regulating tumor formation. CtBP’s ability to govern the transcription of genes necessary for apoptosis, tumor suppression, invasion/migration and EMT gives rise to its oncogenic activities. Both isoforms of CtBP are found to be overexpressed in cancers including colorectal, pancreatic, ovarian, and breast, with higher levels correlating to lower overall median survival. Although multiple lines of evidence suggest CtBP plays a role in tumorigenesis, it has never been formally characterized as …

Sciatic Peripheral Nerve Blockade For Pain Control Following Hamstring Autograft Harvest In Adolescents: A Comparison Of Two Techniques, James Furstein

Theses and Dissertations

Anterior cruciate ligament reconstruction utilizing a hamstring autograft is a surgical technique that has gained popularity among orthopedic surgeons caring for adolescent patients. While utilization of a hamstring autograft is a revered technique, harvest of the hamstring yields significant pain. Sciatic peripheral nerve blockade has proven to reliably provide analgesia at the hamstring donor site. Single-injection sciatic peripheral nerve blockade is considered a basic and effective technique, making its use following anterior cruciate ligament reconstruction standard practice in many institutions. The duration of action of a single-injection sciatic peripheral nerve blockade may fail to outlast the pain arising from the …

Tumor-Specific Cell Death Induction By Noxa Overexpression For Head And Neck Squamous Cell Carcinoma (Hnscc) Treatment, Nicolas T. Maxim Mr.

Theses and Dissertations

The primary focus of this research is the mechanisms of cell death in head and neck squamous cell carcinoma (HNSCC) treatment. These cancers typically originate in squamous cells that line the moist mucosal surfaces of head and neck. HNSCC is commonly treated with a platinum based agent, cisplatin. While the drug does offer strong antitumor effects, its prolonged use often results in tumor-acquired resistance, which limits treatment effectiveness. We have shown that cisplatin treatment induces the expression of a pro-apoptotic BCL-2 family member Noxa, which then initiates caspase- dependent apoptosis through its binding and sequestration of pro-survival protein MCL-1 for …

Pharmacological Inhibition Of Cyclophilin Ameliorates Experimental Allergic Encephalomyelitis, Zi L. Huang

Theses and Dissertations

A subset of cyclophilins have been implicated in mechanisms of neuroinflammation and neurodegeneration that contributes to the pathogenesis of Multiple Sclerosis. Mitochondrial dysfunction leading to mitochondrial permeability transition plays a pivotal role in axonal damage and disease progression in Multiple Sclerosis. Cyclophilin D (CypD) is a crucial regulatory component of the mitochondrial permeability transition pore and it was demonstrated that the cyclophilin D knockout animals showed reduced experimental allergic encephalomyelitis (EAE) clinical disease severity and axonal injury. We investigated the effect of N-methyl-4-isoleucine-cyclosporin (NIM811), a non-immunosuppressive and non-selective cyclophilin inhibitor, on the course and severity of EAE. EAE mice treated …

Development And Evaluation Of A Peer-To-Peer Intervention To Increase Self-Management Among Adult In-Center Hemodialysis Patients, Jennifer J. St Clair Russell

Theses and Dissertations

Background: Peer-to-peer (P2P) support programs have the potential to assist ESRD patients in managing their disease and improve outcomes. Yet, there is little research examining P2P programs’ impact on psychosocial outcomes and disease management behaviors.

Methods: A 4-month P2P mentoring intervention was designed and piloted in a facility serving 249 in-center hemodialysis patients in Lynchburg, Virginia. Preceded by a social marketing effort, which included a program naming contest and participant recruitment, the intervention included: (1) mentor training, (2) pairing of mentees and mentors, (3) kick-off social mixers, (4) ongoing meetings between mentees and mentors, (5) mentor training booster, and (6) …

Reduction Of Oxidative Stress And Storage Lesions (Rcsl) In Red Blood Cells - Analysis Of Ascorbic Acid (Aa), N-Acetylcysteine Amide (Ad4), And Serotonin (5-Ht), Shanmuka Gadiraju

Undergraduate Research Posters

Oxidative stress is a common occurrence in red blood cell (RBC) storage in blood banks throughout the world. Typically RBC units stored under routine standard protocol (stored in SAGM-CPD additive solution) can only be kept up to 42 days for transfusion usage before being discarded. I am studying the effects of Ascorbic Acid (AA), N-acetylcysteine amide (AD4), and Serotonin (5-HT) as additives in blood bank storage because I want to find out if these additives can reduce storage-induced oxidative stress on red blood cells (RBCs), in order to help my reader understand how potential blood storage additives can affect the …

Healthcare Access In Women’S Prisons: An Intersectional Perspective, Megan R. Bray

Undergraduate Research Posters

This project will be identifying the key factors that contribute to the significant lack of health care in prisons in the U.S., specifically in women’s correctional facilities. I will be lending my focus to disparities in mental health, HIV/AIDs care, reproductive health, trans health, and physical health issues among women who are either currently incarcerated or those who have completed their sentences and are at higher risk for re-entry after attempting re-integration. There is a lack of care, access, and proper treatment for women inmates in U.S. prisons and reform is needed. I foresee the best possible way to accomplish …

Provision Of Hospital-Based Palliative Care And The Impact On Organizational And Patient Outcomes, Marisa L. Roczen

Theses and Dissertations

Hospital-based palliative care services aim to streamline medical care for patients with chronic and potentially life-limiting illnesses by focusing on individual patient needs, efficient use of hospital resources, and providing guidance for patients, patients’ families and clinical providers toward making optimal decisions concerning a patient’s care. This study examined the nature of palliative care provision in U.S. hospitals and its impact on selected organizational and patient outcomes, including hospital costs, length of stay, in-hospital mortality, and transfer to hospice. Hospital costs and length of stay are viewed as important economic indicators. Specifically, lower hospital costs may increase a hospital’s profit …

Perception Of Differences In Lip Profile Between 2-D And 3-D, Andrew Hansen

Theses and Dissertations

Past studies evaluating the esthetics of orthodontic treatment have been done using 2-D images. New 3-D imaging offers an improved, real-life representation of a subject. The purpose of this study was to determine how laypeople perceived differences in lip position (flat versus ideal lip fullness) in 2-D compared to 3-D.

3dMD images of 8 Caucasian subjects were adjusted to an ideal and flat lip position in 3-D and then in 2-D from the profile view. 2 surveys were created with paired ideal and flat images on the screen, either in 2-D or 3-D, and evaluators were asked to choose which …

Genetic And Epigenetic Mechanisms Of Complex Reproductive Disorders, Bhavi P. Modi

Theses and Dissertations

Common, complex disorders are polygenic and multifactorial traits representing interactions between environmental, genetic and epigenetic risk factors. More often than not, contributions of these risk factors have been studied individually and this is especially true for complex reproductive traits where application of genomic technologies has been challenging and slow to progress. This thesis explores the potential of genetic and epigenetic components contributing to a better understanding of the biological pathways underlying disease risk in two specific female complex reproductive traits - polycystic ovary syndrome (PCOS) and preterm premature rupture of membranes (PPROM). The PCOS projects focus on characterization of a …

Eeg Interictal Spike Detection Using Artificial Neural Networks, Howard J. Carey Iii

Theses and Dissertations

Epilepsy is a neurological disease causing seizures in its victims and affects approximately 50 million people worldwide. Successful treatment is dependent upon correct identification of the origin of the seizures within the brain. To achieve this, electroencephalograms (EEGs) are used to measure a patient’s brainwaves. This EEG data must be manually analyzed to identify interictal spikes that emanate from the afflicted region of the brain. This process can take a neurologist more than a week and a half per patient. This thesis presents a method to extract and process the interictal spikes in a patient, and use them to reduce …

Altered Protease And Antiprotease Balance During A Copd Exacerbation Contributes To Mucus Obstruction, Shashi Chillappagari, Jenni Preuss, Sebastian Licht, Christian Müller, Poornima Mahavadi, Gaurav Sarode, Claus Vogelmeier, Andreas Guenther, Lutz Narlich, Bruce K. Rubin, Markus O. Henke

Pediatrics Publications

Background

Proteases have been shown to degrade airway mucin proteins and to damage the epithelium impairing mucociliary clearance. There are increased proteases in the COPD airway but changes in protease-antiprotease balance and mucin degradation have not been investigated during the course of a COPD exacerbation. We hypothesized that increased protease levels would lead to mucin degradation in acute COPD exacerbations.

Methods

We measured neutrophil elastase (NE) and alpha 1 protease inhibitor (A1-PI) levels using immunoblotting, and conducted protease inhibitor studies, zymograms, elastin substrate assays and cigarette smoke condensate experiments to evaluate the stability of the gel-forming mucins, MUC5AC and MUC5B, …

Variability In Splanchnic Tissue Oxygenation During Preterm Red Blood Cell Transfusion Given For Symptomatic Anaemia May Reveal A Potential Mechanism Of Transfusion-Related Acute Gut Injury, Sean M. Bailey, Karen D. Hendricks-Muñoz, Pradeep V. Mally

Pediatrics Publications

Background

There is increasing evidence indicating an association between red blood cell (RBC) transfusions and necrotising enterocolitis (NEC) in preterm infants, especially late-onset NEC. This phenomenon is referred to as transfusion-related acute gut injury (TRAGI). One theory as to a pathophysiological mechanism is that transfusion may result in an ischemia-reperfusion injury to intestinal tissue. We tested the hypothesis that there is significantly greater variability during transfusion in splanchnic tissue oxygen saturation (SrSO2) than in cerebral tissue oxygen saturation (CrSO2).

Materials and methods

This was a prospective, observational study using near-infrared spectroscopy to monitor SrSO2 and CrSO2in preterm neonates undergoing RBC …

Inhibitory Behavioral Control: A Stochastic Dynamic Causal Modeling Study Comparing Cocaine Dependent Subjects And Controls, Liangsuo Ma, Joel L. Steinberg, Kathryn A. Cunningham, Scott D. Lane, James M. Bjork, Harshini Neelakantan, Amanda E. Price, Ponnada A. Narayana, Thomas R. Kosten, Antoine Bechara, F. Gerard Moeller

Radiology Publications

Cocaine dependence is associated with increased impulsivity in humans. Both cocaine dependence and impulsive behavior are under the regulatory control of cortico-striatal networks. One behavioral laboratory measure of impulsivity is response inhibition (ability to withhold a prepotent response) in which altered patterns of regional brain activation during executive tasks in service of normal performance are frequently found in cocaine dependent (CD) subjects studied with functional magnetic resonance imaging (fMRI). However, little is known about aberrations in specific directional neuronal connectivity in CD subjects. The present study employed fMRI-based dynamic causal modeling (DCM) to study the effective (directional) neuronal connectivity associated …

Geriatric Telemedicine: Background And Evidence For Telemedicine As A Way To Address The Challenges Of Geriatrics, Ronald C. Merrell

Surgery Publications

Objectives

The global population of elderly people is increasing at a remarkable rate, which may be expected to continue for some time. Older patients require more care, and with the current model of care delivery, the costs may be expected to rise, although higher cost is unsustainable. For this reason, a new pattern of practice is needed. Telemedicine will be presented as a highly effective and necessary tool in geriatrics.

Methods

This review will present some of the background and evidence for telemedicine as a way to address the challenges of geriatrics through geriatric telemedicine. Some of the evidence for …

Addition Of Interleukin-21 For Expansion Of T-Cells For Adoptive Immunotherapy Of Murine Melanoma, Christine Kathryn Zoon, Wen Wan, Laura Graham, Harry D. Bear

Surgery Publications

We previously demonstrated that interleukin (IL)-7/15 was superior to IL-2 for expansion of T cells in vitro for adoptive immunotherapy. We sought to ascertain whether IL-21 would further improve yield and therapeutic efficacy of T cells in culture. Naïve T cell receptor (TcR) transgenic splenocytes or antigen-sensitized lymph node cells were harvested from PMEL-1 mice and exposed to bryostatin-1 and ionomycin (B/I) for 18 h. Cells were then cultured in IL-2, IL-21, IL-7/15 or IL-7/15/21 for six days. Harvested cells were analyzed by flow cytometry and used to treat C57Bl/6 mice injected intravenously with B16 melanoma. Lungs were harvested and …

An Unusual Case Of Bony Styloid Processes That Extend To The Hyoid Bone, Shekhar K. Gadkaree, Christopher G. Hyppolite, Aisha Harun, Ryan H. Sobel, Young Kim

Surgery Publications

The embryological origin of the hyoid bone is a point of uncertainty, with controversy surrounding the relative contribution of the second pharyngeal arch to hyoid development. We encountered a 52-year-old male with bilateral bony styloid extension to the lesser cornu of the hyoid bone during the workup of a patient with laryngeal cancer. This embryological malformation clearly supports the hypothesis that the second pharyngeal arch gives rise to the lesser cornu and demonstrates an unusual clinical finding that may be encountered by otolaryngologists. We demonstrate the imaging findings and surgical management of this unusual anatomical variant and review the embryological …

Penetrating Cardiac Trauma And The Use Of Emergent Extracorporeal Membrane Oxygenation And Therapeutic Hypothermia: When Cooler Heads Prevail, Nathaniel Lee, Daniel Tang, Sudha Jayaraman

Surgery Publications

This is a case of penetrating chest trauma with traumatic arrest from cardiac tamponade, right and left ventriculotomies, mitral valve injury and ventricular septal defect. Patient underwent resuscitative thoracotomy converted to clamshell thoracotomy for haemorrhage control. Ventriculotomies were repaired on initial damage control operation. Extracorporeal membrane oxygenation cannulation and therapeutic cooling bridged to definitive cardiac repair several days later. Patient was discharged to an inpatient rehabilitation facility in 16 days.

Wses Guidelines For Management Of Clostridium Difficile Infection In Surgical Patients, Massimo Sartelli, Mark A. Malangoni, Fikri M. Abu-Zidan, Ewen A. Griffiths, Stefano Di Bella, Lynne V. Mcfarland, Ian Eltringham, Vishal G. Shelat, George C. Velmahos, Ciarán P. Kelly, Sahil Khanna, Zaid M. Abdelsattar, Layan Alrahmani, Luca Ansaloni, Goran Augustin, Miklosh Bala, Frédéric Barbut, Offir Ben-Ishay, Aneel Bhangu, Walter L. Biffl, Stephen M. Brecher, Adrián Camacho-Ortiz, Miguel A. Caínzos, Laura A. Canterbury, Fausto Catena, Shirley Chan, Jill R. Cherry-Bukowiec, Jesse Clanton, Federico Coccolini, Maria Elena Cocuz, Raul Coimbra, Charles H. Cook, Yunfeng Cui, Jacek Czepiel, Koray Das, Zaza Demetrashvili, Isidoro Di Carlo, Salomone Di Saverio, Irina Magdalena Dumitru, Catherine Eckert, Christian Eckmann, Edward H. Eiland, Mushira Abdulaziz Enani, Mario Faro, Paula Ferrada, Joseph Derek Forrester, Gustavo P. Fraga, Jean Louis Frossard, Rita Galeiras, Wagih Ghnnam, Carlos Augusto Gomes, Venkata Gorrepati, Mohamed Hassan Ahmed, Torsten Herzog, Felicia Humphrey, Jae Il Kim, Arda Isik, Rao Ivatury, Yeong Yeh Lee, Paul Juang, Luis Furuya-Kanamori, Aleksandar Karamarkovic, Peter K. Kim, Yoram Kluger, Wen Chien Ko, Francis D. Labarbera, Jae Gil Lee, Ari Leppaniemi, Varut Lohsiriwat, Sanjay Marwah, John E. Mazuski, Gokhan Metan, Ernest E. Moore, Frederick Alan Moore, Carl Erik Nord, Carlos A. Ordoñez, Gerson Alves Pereira Júnior, Nicola Petrosillo, Francisco Portella, Basant K. Puri, Arnab Ray, Mansoor Raza, Miran Rems, Boris E. Sakakushev, Gabriele Sganga, Patrizia Spigaglia, David B. Stewart, Pierre Tattevin, Jean Francois Timsit, Kathleen B. To, Cristian Tranà, Waldemar Uhl, Libor Urbánek, Harry Van Goor, Angela Vassallo, Jean Ralph Zahar, Emanuele Caproli, Pierluigi Viale

Surgery Publications

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficileinfection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.