Medical Specialties Commons^™

Hoarding Behavior In The Elderly, Henriette Kellum

Case Studies from Age in Action

Educational Objectives

1. Identify the medical and mental health factors that contribute to hoarding behavior.

2. Describe the unique aspects of hoarding in the elderly.

3. Examine intervention and treatment strategies.

Arthritis And Physical Activity In Mid- And Later-Life, Nicholas Turkas

Case Studies from Age in Action

Educational Objectives

1. Describe some of the more common types of arthritic conditions.

2. Discuss co-morbidities or coexisting conditions often occurring with arthritis.

3. Describe the Arthritis Foundation as a relevant resource when dealing with arthritic conditions.

Mouse Rc/Btb2, A Member Of The Rcc1 Superfamily, Localizes To Spermatid Acrosomal Vesicles, Jiannan Wang, Maria E. Teves, Xuening Shen, David R. Nagarkatti-Gude, Rex A. Hess, Scott C. Henderson, Jerome F. Strauss Iii, Zhibing Zhang

Obstetrics and Gynecology Publications

Mouse RC/BTB2 is an unstudied protein of the RCC1 (Regulator of Chromosome Condensation) superfamily. Because of the significant remodeling of chromatin that occurs during spermiogenesis, we characterized the expression and localization of mouse RC/BTB2 in the testis and male germ cells. The Rc/btb2 gene yields two major transcripts: 2.3 kb Rc/btb2-s, present in most somatic tissues examined; and 2.5 kb Rc/btb2-t, which contains a unique non-translated exon in its 5′-UTR that is only detected in the testis. During the first wave of spermatogenesis, Rc/btb2-t mRNA is expressed from day 8 after birth, reaching highest levels of expression at day …

Preserved Ex Vivo Inflammatory Status In Decidual Cells From Women With Preterm Labor And Subclinical Intrauterine Infection, Violeta Castro-Leyva, Aurora Espejel-Nunez, Gerardo Barroso, Veronica Zaga-Clavellina, Arturo Flores-Pliego, Iyari Morales-Mendez, Silvia Giono-Cerezo, Scott W. Walsh, Guadalupe Estrada-Gutierrez

Obstetrics and Gynecology Publications

Objective

To compare the inflammatory response preserved ex vivo by decidual cells isolated from women who experienced preterm labor with and without subclinical intrauterine infection.

Methods

Fetal membranes were obtained after cesarean section from 35 women who delivered before 37 weeks of gestation following spontaneous preterm labor, with no clinical evidence of intrauterine infection. Decidua was microbiologically tested and cultured. Concentrations of anti-inflammatory cytokines (IL-2, IL-4, IL-10), pro-inflammatory cytokines (IL-6, IL-8, IL-1β and TNF-α), and matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9) were measured in the supernatants using Bio-Plex, and prostaglandin E2 (PGE2) was measured by enzyme immunoassay.

Results …

Patient- And Population-Level Health Consequences Of Discontinuing Antiretroviral Therapy In Settings With Inadequate Hiv Treatment Availability, April D. Kimmel, Stephen C. Resch, Xavier Anglaret, Norman Daniels, Sue J. Goldie, Christine Daniel, Angela Y. Wong, Kenneth A. Freedberg, Milton C. Weinstein

Health Policy Publications

Background

In resource-limited settings, HIV budgets are flattening or decreasing. A policy of discontinuing antiretroviral therapy (ART) after HIV treatment failure was modeled to highlight trade-offs among competing policy goals of optimizing individual and population health outcomes.

Methods

In settings with two available ART regimens, we assessed two strategies: (1) continue ART after second-line failure (Status Quo) and (2) discontinue ART after second-line failure (Alternative). A computer model simulated outcomes for a single cohort of newly detected, HIV-infected individuals. Projections were fed into a population-level model allowing multiple cohorts to compete for ART with constraints on treatment capacity. In the …

Genetic Analysis Of The Neurosteroid Deoxycorticosterone And Its Relation To Alcohol Phenotypes: Identification Of Qtls And Downstream Gene Regulation, Patrizia Porcu, Todd K. O'Buckley, Soomin C. Song, Jo Lynne Harenza, Lu Lu, Xusheng Wang, Michael F. Miles, A. Leslie Morrow

Neurology Publications

Background

Deoxycorticosterone (DOC) is an endogenous neurosteroid found in brain and serum, precursor of the GABAergic neuroactive steroid (3α,5α)-3,21-dihydroxypregnan-20-one (tetrahydrodeoxycorticosterone, THDOC) and the glucocorticoid corticosterone. These steroids are elevated following stress or ethanol administration, contribute to ethanol sensitivity, and their elevation is blunted in ethanol dependence.

Methodology/Principal Findings

To systematically define the genetic basis, regulation, and behavioral significance of DOC levels in plasma and cerebral cortex we examined such levels across 47 young adult males from C57BL/6J (B6)×DBA/2J (D2) (BXD) mouse strains for quantitative trait loci (QTL) and bioinformatics analyses of behavior and gene regulation. Mice were injected with saline …

Fto And Mc4r Gene Variants Are Associated With Obesity In Polycystic Ovary Syndrome, Kathryn G. Ewens, Michelle R. Jones, Wendy Ankener, Douglas R. Stewart, Margrit Urbanek, Andrea Dunaif, Richard S. Legro, Angela Chua, Ricardo Azziz, Richard S. Spielman, Mark O. Goodarzi, Jerome F. Strauss Iii

Obstetrics and Gynecology Publications

Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility in women. It is also associated with metabolic disturbances that place women at increased risk for obesity and type 2 diabetes. There is strong evidence for familial clustering of PCOS and a genetic predisposition. However, the gene(s) responsible for the PCOS phenotypes have not been elucidated. This two-phase family-based and case-control genetic study was designed to address the question of whether SNPs identified as susceptibility loci for obesity in genome-wide association studies (GWAS) are also associated with PCOS and elevated BMI. Members of 439 families having at least one …

The Living Textbook Project For Affordable Higher Education, Dayanjan S. Wijesinghe

Surgery Presentations

A blue print for ensuring that community college education remains affordable to the future generations via elimination of the cost of textbooks.

Ventricular Tachyarrhythmias After Cardiac Arrest In Public Versus At Home, Myron L. Weisfeldt, Siobahn Everson-Stewart, Colleen Sitlani, Thomas Rea, Tom P. Aufderheide, Diane L. Atkins, Blair Bigham, Steven C. Brooks, Christopher Foerster, Randal Gray, Joseph P. Ornato, Judy Powell, Peter J. Kudenchuk, Laurie J. Morrison

Emergency Medicine Publications

Background

The incidence of ventricular fibrillation or pulseless ventricular tachycardia as the first recorded rhythm after out-of-hospital cardiac arrest has unexpectedly declined. The success of bystander-deployed automated external defibrillators (AEDs) in public settings suggests that this may be the more common initial rhythm when outof-hospital cardiac arrest occurs in public. We conducted a study to determine whether the location of the arrest, the type of arrhythmia, and the probability of survival are associated.

Methods

Between 2005 and 2007, we conducted a prospective cohort study of out-of-hospital cardiac arrest in adults in 10 North American communities. We assessed the frequencies of …

Early Versus Later Rhythm Analysis In Patients With Out-Of-Hospital Cardiac Arrest, Ian G. Stiell, Graham Nichol, Brian G. Leroux, Thomas D. Rea, Joseph P. Ornato, Judy Powell, James Christenson, Clifton W. Callaway, Peter J. Kudenchuk, Tom P. Aufderheide, Ahamed H. Idris, Mohamud R. Daya, Henry E. Wang, Laurie J. Morrison, Daniel Davis, Douglas Andrusiek, Shannon Stephens, Sheldon Cheskes, Robert H. Schmicker, Ray Fowler, Christian Vaillancourt, David Hostler, Dana Zive, Ronald G. Pirrallo, Gary M. Vilke, George Sopko, Myron Weisfeldt

Emergency Medicine Publications

Background

In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association–International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm.

Methods

We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients …

A Trial Of An Impedance Threshold Device In Out-Of-Hospital Cardiac Arrest, Tom P. Aufderheide, Graham Nichol, Thomas D. Rea, Siobhan P. Brown, Brian G. Leroux, Paul E. Pepe, Peter J. Kudenchuk, Jim Christenson, Mohamud R. Daya, Paul Dorian, Clifton W. Callaway, Ahamed H. Idris, Douglas Andrusiek, Shannon W. Stephens, David Hostler, Daniel Davis, James V. Dunford, Ronald G. Pirrallo, Ian G. Stiell, Catherine M. Clement, Alan Craig, Lois Van Ottingham, Terri A. Schmidt, Henry E. Wang, Myron L. Weistfeldt, Joseph P. Ornato, George Sopko

Emergency Medicine Publications

Background

The impedance threshold device (ITD) is designed to enhance venous return and cardiac output during cardiopulmonary resuscitation (CPR) by increasing the degree of negative intrathoracic pressure. Previous studies have suggested that the use of an ITD during CPR may improve survival rates after cardiac arrest.

Methods

We compared the use of an active ITD with that of a sham ITD in patients with out-ofhospital cardiac arrest who underwent standard CPR at 10 sites in the United States and Canada. Patients, investigators, study coordinators, and all care providers were unaware of the treatment assignments. The primary outcome was survival to …

Forever Young, Edward F. Ansello

Director's Editorials from Age in Action

Gerontologists theorize that each of us is shaped by the influences of cohort and historical time. If there's a oneness of who we were and who we are, then Bob Dylan's music is in many of us. Forever Young is not a paean to age denial. Rather, it seems to invoke virtues or characteristics that never grow old: charity to others, acceptance of kindness, hope, righteousness, courage, fortitude, industriousness, and joy.

Falls, Edward F. Ansello

Director's Editorials from Age in Action

Falls are common, affecting about one third of community-dwelling adults over age 65 and about half over age 80. The risk factors for falling are complex, and falls may themselves be a signal for other troubling conditions. When fear of falling emerges as an issue for some elders, they are likely to reduce their activities, thinking that this will reduce their risk, and isolation and depression can ensue. There are teaching roles for nurses, physicians, and physical therapists in sharing with other professions how to assess gait, vision, or dizziness.

Baby Boomers And Stereotypes, Edward F. Ansello

Director's Editorials from Age in Action

With age we become more and more like ourselves. This would mean millions and millions of individual Baby Boomers, each with his or her own characteristics and life trajectory. Stereotyping would, therefore, be wrong, but it is happening.

The Most Terrible Poverty, Edward F. Ansello

Director's Editorials from Age in Action

Caring, private individuals and agency employees and volunteers in "direct" or "human" services regularly deliver what can be called love, the antidote to the poverty of loneliness. Let's acknowledge the essential importance of people in various forms of human services who reach out to others who are alone.

The Impact Of Providing Rehab Mobility Equipment To Those In Need, Bruce Stelmack, Brian Leitten

Case Studies from Age in Action

Educational Objectives

1. Discuss the need to provide rehabilitation mobility equipment at no cost to those who have no other means to obtain it.

2. Assess the impact on a community when mobility equipment for underinsured impaired persons (“at risk”) cannot be secured.

3. Describe a successful recycling program that provides free rehabilitation mobility equipment.

4. Explain the importance of a community- based model to provide rehabilitation equipment.

Universal Design In Housing, Steve Hansler, Beth Glas

Case Studies from Age in Action

Educational Objectives

1. Show how an aging population increases the need for housing that is accessible and adaptable.

2. Define visitability, universal design, and accessible design.

3. Explain ways to approach universal design including key factors.

4. Illustrate how universal design can be used in both renovation and new construction.

Alcohol, Medications, And Older Adults, Mailtreyee Mohanty, Patricia Slattum

Case Studies from Age in Action

Educational Objectives

1. Describe patterns of simultaneous use of alcohol and Central Nervous System (CNS) - acting medications among older adults.

2. Understand the mechanisms of interaction between alcohol and CNS-acting medications and their consequences.

3. Identify strategies to prevent alcohol-medication interactions among older adults.

4. Recommend resources for older adults and service providers for identifying and managing problematic alcohol and medication use.

Habilitation Therapy In Dementia Care, Paul Raia

Case Studies from Age in Action

Educational Objectives

1. To describe the goal of Habilitation Therapy and how it differs from other methods of dementia care, including rehabilitation.

2. To identify areas or domains in which we have opportunities to bring about and sustain positive emotions.

3. To discuss four communication strategies to use with mid- to laterstage Alzheimer’s patients.

Epistasis Between Comt And Mthfr In Maternal-Fetal Dyads Increases Risk For Preeclampsia, Lori D. Hill, Timothy P. York, Juan P. Kusanovic, Ricardo Gomez, Lindon J. Eaves, Roberto Romero, Jerome F. Strauss Iii

Obstetrics and Gynecology Publications

Preeclampsia is a leading cause of perinatal morbidity and mortality. This disorder is thought to be multifactorial in origin, with multiple genes, environmental and social factors, contributing to disease. One proposed mechanism is placental hypoxia-driven imbalances in angiogenic and anti-angiogenic factors, causing endothelial cell dysfunction. Catechol-O-methyltransferase (Comt)-deficient pregnant mice have a preeclampsia phenotype that is reversed by exogenous 2-methoxyestradiol (2-ME), an estrogen metabolite generated by COMT. 2-ME inhibits Hypoxia Inducible Factor 1α, a transcription factor mediating hypoxic responses. COMT has been shown to interact with methylenetetrahydrofolate reductase (MTHFR), which modulates the availability of S-adenosylmethionine (SAM), a COMT …

The Cultural Context Of Alzheimer’S Disease: The Impact Of Perception And Knowledge On Willingness To Seek Medcial [I.E., Medical] Help Among Ghanaian Immigrants In The United States., Olivia Owusu-Boakyewaah

Theses and Dissertations

This correlational study explored the knowledge, perceived seriousness, and willingness to seek medical help for Alzheimer’s Disease (AD) among Ghanaian Immigrants currently residing in the Unites States. Study participants were 163 Ghanaian Immigrants between the ages of 45 and 90, attending Ghanaian community churches in Virginia and Maryland. Significant results include a positive correlation between knowledge and perceived seriousness of the disease, perceived seriousness of the disease was negatively correlated with caregiving experience. These results as well as several seemingly counterintuitive findings are discussed in terms of the Health Disparities and Psychometric challenges. Specifically, these results points to the necessity …

Nuclear Expression Of Klf6 Tumor Suppressor Factor Is Highly Associated With Overexpression Of Erbb2 Oncoprotein In Ductal Breast Carcinomas, Ricardo C. Gehrau, Diego S. D'Astolfo, Catherine I. Dumur, Jose L. Bocco, Nicolas P. Koritschoner

Pathology Publications

Background

Krüppel-like factor 6 (KLF6) is an evolutionarily conserved and ubiquitously expressed protein that belongs to the mammalian Sp1/KLF family of transcriptional regulators. Though KLF6 is a transcription factor and harbors a nuclear localization signal it is not systematically located in the nucleus but it was detected in the cytoplasm of several tissues and cell lines. Hence, it is still not fully settled whether the tumor suppressor function of KLF6 is directly associated with its ability to regulate target genes.

Methodology/Principal Findings

In this study we analyzed KLF6 expression and sub-cellular distribution by immunohistochemistry in several normal and tumor tissues …

On Becoming Invisible, Edward F. Ansello

Director's Editorials from Age in Action

Age or impairment tends to render us less likely to be noticed. We can readjust how we see those becoming invisible.

Filling The Gap, Edward F. Ansello

Director's Editorials from Age in Action

There is need for multiple initiatives focusing on the pipeline from professional undergraduate education through the continuing education of current practitioners, in order to make some dent in the looming shortfall of geriatric health care providers. It is particularly gratifying to announce that Virginia has been awarded federal funding of a Geriatric Education Center (VGEC). The overall goal of the VGEC is to improve the training of health professionals in geriatrics.

The Blank Tablet Of Aging, Edward F. Ansello

Director's Editorials from Age in Action

The 16th annual conference of the Virginia Coalition for the Prevention of Elder Abuse (VCPEA) will include the basics of geriatric crisis assessment, depression and suicide among older adults; alcohol and medication misuse; older prisoners; training faith and community-based leaders to respond to domestic violence in later life; and brain injury in later life as a precipitant or a consequence of mistreatment. The Area Planning and Services Committee (APSC) conference will recognize the values, opportunities, and challenges associated with growing older with lifelong disabilities. These two conferences symbolize how we as a people can celebrate the good and confront the …

Aging As An Option, Edward F. Ansello

Director's Editorials from Age in Action

Sometimes people treat aging as if it were an option or a discretionary exercise. Aging is neither a fad nor an option but a bedrock reality that should be constantly under consideration, especially by those charged with protecting the common good. We need to remember that we should not treat aging and aging-related research, training, and services as an option.

Aging And The Behavioral Problems Of Brain Injury, Paul F. Aravich, Marylin Copeland

Case Studies from Age in Action

Educational Objectives

1. List the various classes of brain injury.

2. Identify cognitive and emotional problems as among the most common and disabling complications of brain injury.

3. Assess challenges to successful aging with a brain injury.

4. Examine the consequences of inadequate systems of care for the challenging behaviors produced by brain injury.

Senior Meal Programs: Feeding A Crowd With Local Foods, Gordon Walker, Elyse Thierry

Case Studies from Age in Action

Educational Objectives

1. Examine reasons for an institutional meal program to consider incorporating local food.

2. Identify potential community partners who might assist in moving such a program forward and the mutual benefits.

3. Describe the possible changes that an institution’s local food program can foster in the community at large.

Cpr And Dnr Decision Making, Viki Kind

Case Studies from Age in Action

Educational Objectives

1. Examine the complexities of end-of-life care and obstacles to good DNR decision making.

2. Discuss CPR and its perceived vs. actual chances for success.

3. Demonstrate best practices for communicating about CPR.

4. Consider how the signing of the DNR is just one component of endof- life care.

Reverse Mortgages, Bruce Desimone

Case Studies from Age in Action

Educational Objectives

1. Describe mobility rates among older adults.

2. Define a reverse mortgage and Home Equity Conversion Mortgage (HECM), and their origins in Virginia.

3. Explain key HECM loan and counseling features.

4. Illustrate how these features may improve the lives of older Virginians.