Medical Specialties Commons^™

Osteopontin And Cadherin 11 Are Novel Mediators And Drug Targets For Chronic Lung Diseases, Daniel J. Schneider

Dissertations and Theses (Open Access)

Chronic lung diseases (CLDs) are a considerable source of morbidity and mortality and are thought to arise from dysregulation of normal wound healing processes. An aggressive, feature of many CLDs is pulmonary fibrosis (PF) and is characterized by excess deposition of extracellular matrix (ECM) proteins from myofibroblasts in airways. However, factors regulating myofibroblast biology are incompletely understood. Proteins in the cadherin family contribute epithelial to mesenchymal transition (EMT), a suggested source of myofibroblasts. Cadherin 11 (CDH11) contributes to developmental and pathologic processes that parallel those seen in PF and EMT. Utilizing Cdh11 knockout (Cdh11 -/-) mice, the goal of this …

Pregnancy Outcomes In Female Liver Recipients Transplanted Under The Age Of 21, Carlo B. Ramirez, Warren R. Maley, Cataldo Doria, Lisa A. Coscia, Michael J. Moritz, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions: Liver recipients transplanted under the age of 21 are able to maintain pregnancy with 75% resulting in a livebirth. Pregnancy, potential risks for mother and newborn, and long-term maternal survival should be discussed with the recipient and the parents of the recipient. Transplant centers are encouraged to report pregnancy outcomes in these recipients to the NTPR.

Self-Efficacy And Educational Interventions In Heart Failure: A Review Of The Literature, Karen S. Yehle, Kimberly Plake

School of Nursing Faculty Publications

Purpose: The purpose of this study was to conduct a systematic review of the literature to better understand how to structure educational interventions for heart failure patients to improve their self-efficacy for self-care behaviors.

Methods: A computer search of the literature from 1966 through May 2009 was conducted, yielding 84 manuscripts. All manuscripts were reviewed in relation to the search criteria, resulting in 12 articles that were evaluated.

Results: Each of the reviewed studies utilized an intervention plus education to improve self-efficacy. Self-efficacy was a primary outcome for seven of the studies, and a secondary outcome for five on the …

Operative Management Of Unstable Thoracolumbar Burst Fractures, Mujahid Jamil Khattak, Shakir Syed, Riaz Hussain Lakdawala

Department of Surgery Docs

Operative management of unstable burst vertebral fractures is challenging and debatable. This study of such cases was conducted at the Aga Khan Hospital, Karachi from January 1998 to April 2003. All surgically managed spine injuries were reviewed from case notes and operative records. Clinical outcome was assessed by Hanover spine score and correction of kyphosis was measured for radiological assessment. The results were analyzed by Wilcoxon sign rank test for two related samples and p-value < 0.05 was considered significant. Ten patients were identified by inclusion criteria. There was statistically significant difference between mean pre-and postoperative Hanover spine score (p=0.008). Likewise, there was significant difference between mean immediate postoperative and final follow-up kyphosis. (p=0.006). Critical assessment of neurologic and structural extent of injury, proper pre-operative planning and surgical expertise can optimize the outcome of patients

Acute Mesenteric, Portal And Inferior Vena Cava (Ivc) Venous Thrombosis: Optimal Outcome Achieved With Anticoagulation, Abdul Rehman Alvi, Shahida Bibi, Zia Ur Rehman, Sameullah Khan Niazi

Department of Surgery Docs

The prevalence and clinical spectrum of acute mesenteric venous thrombosis (AMVT) in Pakistan is largely unknown. The authors report two patients with acute mesenteric, portal and inferior vena cava venous thrombosis confirmed on CT imaging. The diagnoses were established within 24 hours of presentation and both patients were successfully treated with therapeutic heparin during hospital admission and continued on oral warfarin because of hypercoagulable state. The protocol that we currently use is evidence based and is leading to optimal outcome.

Goal Directed Learning: Early Assessment And Individualized Education Plans For Family Medicine Interns, Glenda Stockwell, Beth Anne Fox, Reid Blackwelder

ETSU Faculty Works

• Articulate rationale for early assessment
• Describe process of assessment and feedback sessions
• List benefits of process based on:
  • Objective data
  • Opinion of interns over past 2 years

Multihospital Outbreak Of Clostridium Difficile Infection, Cleveland, Ohio, Usa, Robin L.P. Jump, Ajay K. Sethi, Curtis J. Donskey

Faculty Scholarship

To determine whether a multihospital Clostridium difficile outbreak was associated with epidemic strains and whether use of particular fl uoroquinolones was associated with increased infection rates, we cultured feces from C. difficile-infected patients. Use of fl uoroquionolones with enhanced antianaerobic activity was not associated with increased infection rates.

Basal Insulin Requirements On Continuous Subcutaneous Insulin Infusion During The First 12 Months After Diagnosis Of Type 1 Diabetes Mellitus., Neesha Ramchandani, Mary Kristine Ellis, Shobhit Jain, Sonal Bhandari, Henry Anhalt, Noel K. Maclaren, Svetlana Ten

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: While the endogenous first-phase insulin response has disappeared by the time of diagnosis of type 1 diabetes mellitus (T1DM), anecdotal evidence suggests that these patients can continue to have a second-phase insulin response during the first 12 months after diagnosis. We hypothesized that patients who are started on continuous subcutaneous insulin infusion (CSII) at the time of diagnosis of T1DM would have a lower basal insulin requirement than the 40-60% usually expected.

METHODS: We analyzed 38 patients with T1DM, age 9.9 +/- 6.4 years, 71% male, who were started on CSII within the first month of diagnosis.

RESULTS: Average …

Oral Cancer In Nevada: A Public Health Perspective, Karl Kingsley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Cancer is the second leading cause of death in the United States, and oral cancer remains the eighth leading cause of cancer death among US males. Although previous epidemiologic studies have found that overall rates of cancer, including oral cancer, have declined in the US in recent decades – these declines are neither uniform nor consistent within this population. Anecdotal evidence has suggested that rates of oral cancer in Nevada are relatively high, although no evidence was available to support these assertions.

Oral Cancer Epidemiology: Based upon this information, a detailed and thorough epidemiologic examination of oral cancer rates in …

Factors Associated With Blood Lead Levels Of Children In Southern Nevada, Mackenzie Suzanne Burns

UNLV Theses, Dissertations, Professional Papers, and Capstones

Exposure to lead continues to be a public health concern, particularly for young children. The Centers for Disease Control and Prevention report that approximately 250,000 children currently have blood lead levels (BLLs) above the level at which adverse health effects are apparent and intervention is recommended (10μg/dL). National surveillance data on childhood lead exposure has been collected for children under the age of 6 years old since 1995. However, not until 2006 did a program begin in Nevada (limited to Clark County); therefore, statewide data about childhood lead exposure in Nevada remains limited. The goal of this study was to …

Evaluating The Impact Of The Guatemalan Nursing Program On Staff, Organizational, And Clinical Outcomes, Sara Williamson Day

Theses and Dissertations (ETD)

There is great disparity between the outcome of childhood cancer in developed and developing countries. Nurses, who comprise the largest group of health care professionals globally, are essential to successful treatment. Pediatric oncology education is generally unavailable for nurses in developing countries. This lack of education is likely to contribute to the disparity in survival rates, as undereducated nurses are unable to meet the demands of pediatric cancer care. A second critical problem in developing countries is the workload of the nurse, with a patient nurse ratio reported as high as 30 patients per one nurse.

In 2006, the quality …

Il-2 Regulation Of Il-24 Expression Leads To Growth Suppression Of Melanoma Cells, Emily Jen

Dissertations and Theses (Open Access)

Melanoma is known to be highly resistant to chemotherapy. Treatment with high dose IL-2 has shown significant clinical benefit in a minority of metastatic melanoma patients and has lead to long term survival in a few cases. However, this treatment is associated with excessive multiorgan toxicities, which severely limits its use. We hypothesize that one mechanism of effective IL-2 therapy is through the direct upregulation of IL-24 production in melanoma tumors and subsequent IL-24 mediated tumor growth suppression.

Five melanoma cell lines were treated with high dose recombinant hIL-2 at 1000U/ml. Three of the cell lines (A375, WM1341, WM793) showed …

Use Of An Animal Model To Explore Prenatal Predictors Of Insulin And Glucose Metabolism In Southwestern Alaskan Yupiit, Julie Jo Kachinski

UNLV Theses, Dissertations, Professional Papers, and Capstones

Compared to other North American indigenous populations, Southwest Alaskan Yupiit exhibit very low rates of type 2 diabetes despite the occurrence of common risk factors. Contemporary Yupiit obtain a substantial portion of their calories from traditional foods, which contain high amounts of omega-3 polyunsaturated fatty acids. Epidemiological and experimental animal research has linked glucose and insulin homeostasis with a diet high in omega-3s. This study used an experimental animal model to explore potential diabetes protective effects (for adult offspring) of prenatal maternal nutrition modeled on traditional locally-obtained Yupiit diets. The results of this study showed that the adult offspring whose …

Effects Of Obesity On The Biomechanics Of Children’S Gait At Different Speeds, Philana-Lee Gouws

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of the study was to investigate the relationship between body mass index (BMI) and spatio-temporal gait characteristics of overweight/obese and non-obese school-aged children (12-14 years) at two different walking speeds. Eighty-four overweight/obese (n=28; age: 13.96 ± 0.79 yrs; mass: 74.8 ± 18.21 kg; height: 159.2 ± 7.1 cm and BMI: 29.28 ± 5.64 kg/m2) and non-obese students (n=56; age: 13.72 ± 0.79 yrs; mass: 51.7 ± 10.2 kg; height: 157.8 ± 8.3 cm and BMI: 20.69 ± 2.74 kg/m2) with no present injuries were recruited. Participants were instructed to walk across an electronic walkway in each of two …

Health Care Access Disparities Among Children Entering Kindergarten In Nevada, Nadia Deashinta

UNLV Theses, Dissertations, Professional Papers, and Capstones

Access to health care is an important factor for the well-being of America's children. The principal goal of this study was examine the 2008-2009 Kindergarten Health Survey data to advance understanding and appreciation of the health status of children in addition to their discrepancies in accessing health care in the state of Nevada (n = 11,073). This dataset serves as a secondary data source to determine whether socio-demographic and medical factors are associated with disparity in accessing health care for children entering kindergarten. This study looked at both independent and combined effects of annual household income, race/ethnicity, primary language spoken …

Improving Sexual Health, P.U.L.S.E., And E.R.O.S. At California Polytechnic State University, San Luis Obispo, Megan (Meg) Rust

Psychology and Child Development

This project is designed to update and refine EROS educators’ knowledge of sexual health and to gain insight into Cal Poly students’ general knowledge of sexual health.  Educators are given extensive training during the entire quarter before they begin their positions, but information is constantly changing. This project intends to initiate up to date informational tools that can be revised as new psychological or medical discoveries are made in the realm of sexuality and sexual health.

First Trimester Screening And Its Impact On Uptake Of Diagnostic Testing, Deanna Darnes

Dissertations and Theses (Open Access)

Introduction: First Trimester Screening (FTS) combines maternal age with fetal nuchal translucency (NT) and maternal analytes to identify pregnancies at an increased risk for Down syndrome and trisomy 18. Though the accuracy of this screening is high, it cannot replace the conclusive accuracy of prenatal diagnostic testing (PDT). Since FTS has been available, a decrease in the number of women who pursue PDT has been observed. This study sought to determine if there has been a significant change in the amount of PDT performed in our clinics, if the type of FTS result affects the patient’s decision regarding PDT, and …

A New Tumor Suppressor Gene Candidate Regulated By The Non-Coding Rna Pca3 In Human Prostate Cancer, Alessandro K. Lee

Dissertations and Theses (Open Access)

Prostate cancer is the second leading cause of cancer-related death and the most common non-skin cancer in men in the USA. Considerable advancements in the practice of medicine have allowed a significant improvement in the diagnosis and treatment of this disease and, in recent years, both incidence and mortality rates have been slightly declining. However, it is still estimated that 1 man in 6 will be diagnosed with prostate cancer during his lifetime, and 1 man in 35 will die of the disease.

In order to identify novel strategies and effective therapeutic approaches in the fight against prostate cancer, it …

Thoracic Radiotherapy Treatment Planning With Cine Pet/Ct, Adam C. Riegel

Dissertations and Theses (Open Access)

Purpose: Respiratory motion causes substantial uncertainty in radiotherapy treatment planning. Four-dimensional computed tomography (4D-CT) is a useful tool to image tumor motion during normal respiration. Treatment margins can be reduced by targeting the motion path of the tumor. The expense and complexity of 4D-CT, however, may be cost-prohibitive at some facilities. We developed an image processing technique to produce images from cine CT that contain significant motion information without 4D-CT. The purpose of this work was to compare cine CT and 4D-CT for the purposes of target delineation and dose calculation, and to explore the role of PET in target …

Decision Analytic Model For Evaluation Of Suspected Coronary Disease With Stress Testing And Coronary Ct Angiography., Ethan J Halpern, David Fischman, Michael P Savage, Anish R Koka, Matthew Decaro, David C Levin

Department of Radiology Faculty Papers

RATIONALE AND OBJECTIVES: The aim of this study was to apply a decision analytic model for the evaluation of coronary artery disease (CAD) to define the optimal utilization of coronary computed tomographic angiography (cCTA) and stress testing.

MATERIALS AND METHODS: The model tested in this study assumes that CAD is evaluated with a stress test and/or cCTA and that a patient with positive evaluation results undergoes cardiac catheterization. On the basis of values of sensitivity, specificity, and radiation dose from the published literature and test costs from the Medicare fee schedule, a decision tree model was constructed as a function …

Reproductive Health Services For Populations At High Risk Of Hiv: Performance Of A Night Clinic In Tete Province, Mozambique, Yves Lafort, Diederike Geelhoed, Luisa Cumba, Carla Das Dores Mosse Lázaro, Wim Delva, Stanley Luchters, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability.

Methods: In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held …

The Assessment Of Disability Related To Vision Performance-Based Measure In Diabetic Retinopathy., Kevin J. Warrian, Luciano L. Lorenzana, Dara Lankaranian, Jyoti Dugar, Sheryl S. Wizov, George L. Spaeth

Wills Eye Hospital Papers

PURPOSE: To validate a third-generation performance-based measure of visual function titled "Assessment of Disability Related to Vision" (ADREV) in a study population of patients with diabetic retinopathy.

DESIGN: Prospective, cross-sectional study.

METHODS: Patients with nonproliferative or proliferative diabetic retinopathy, free from ocular comorbidity, were recruited from a single institute and completed the ADREV, the 25-Item National Eye Institute Visual Functioning Questionnaire (VFQ-25), and a clinical ophthalmic examination. Correlation, regression, and bootstrap analysis were conducted to determine the relationship between ADREV scoring and each of the study's clinical and self-report measures of visual ability, while controlling for potential confounders.

RESULTS: Ninety-one …

Loss Of Stromal Caveolin-1 Independently Predicts Poor Disease-Free Survival And Time To Recurrence In Patients With Prostate Cancer, M. Wagner, A. Dasgupta, F. Sotgia, R. B. West, M. P. Lisanti, A. K. Witkiewicz

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Results:

Of the 167 patients originally included in the study, 43 were either lost to follow up or had insufficient clinical data for comparison. Of the remaining 124 cases, 32 showed loss of stromal Cav-1. Statistical analysis revealed no significant association between stromal Cav-1 loss and the usual markers of disease severity including Gleason grade, stage and presence of metastases. Kaplan-Meier curves showed a significant association between stromal Cav-1 loss and poor disease-free survival and time to recurrence (p<0.05), but no significant association with cancer-specific survival.

Emerging Parasitic Infection Mimicking Functional Bowel Disease, Javed Yakoob, Wasim Jafri, Mohammad Asim Beg, Z Abbas, Shagufta Naz,, Muhammad Islam, A. B. Khalid, Rustam Khan, Zubair Ahmad

Section of Gastroenterology

No abstract provided.

Body Mass Index And Cerclage Success, A. Suhag, Md, N. S. Seligman, Md, V. Berghella, Md

Department of Obstetrics and Gynecology Faculty Papers

Conclusions:

Among women with a cerclage, pre-pregnancy BMI was not a significant predictor of SPTB <35 weeks.

There was a non-significant trend toward increased rates of SPTB at all gestational age cutoffs.

Morbidly obese women consistently had worse outcomes than obese and normal/overweight women.

Compared to normal/overweight, GA at delivery decreases by 1 week for obese and 2 weeks for morbidly obese women.

Duration Of Maternal Human Papilloma Virus Infection And Risk Of Spontaneous Preterm Birth, K. Soin, Ms, N. S. Seligman, Md, A. Nnoli, Md, K. Dysart, Md, J. K. Baxter, Md, Mscp

Department of Obstetrics and Gynecology Faculty Papers

Conclusions:

Duration of HPV infection was not a significant risk factor for spontaneous PTB <37 weeks.

Cervical HPV DNA and HPV serology may further delineate the relationship between HPV infection and SPTB <37 weeks.

A larger sample size may be necessary to show a difference.

The 3.5x higher rate of fetal death > 23 weeks in our study (compared to fetal death > 20 weeks in the U.S.) needs further investigation.

The Use Of The Use Of Negative Pressure Wound Therapy In Vulvar Wounds, E. K. Ricci, Md, J. Brace, Phd, Crn, Bc, Cwocn, Aprn, N. G. Rosenblum, Md, Phd

Department of Obstetrics and Gynecology Faculty Papers

Patients with severe HS or Necrotizing Fasciitis often require extensive surgical debridement.

Traditionally, these wounds have been closed using split-thickness skin grafts with or without the use of the VAC device.

Our case study demonstrates good outcomes using the VAC device alone to achieve complete closure when applied immediately following debridement with frequent VAC changes.

Recent Change In The Incidence Of Cervical Cerclage, Maria Bisulli, Md, Neil S. Seligman, Md, Komal Soin, Ms, Anju Suhag, Md, Vincenzo Berghella, Md

Department of Obstetrics and Gynecology Faculty Papers

Conclusions:

More selective indications for cervical cerclage based on recent randomized studies were associated with decreased cerclage placement.

The decrease in incidence of history-indicated cerclage may be due to the fact that more women with prior PTB are being followed by transvaginal cervical length measurements.

The decrease in incidence of ultrasound-indicated cerclage may be due to the use of 17-hydroxy progesterone caproate in women with PTB.

Cocaine And The Heart., Suraj Maraj, Vincent M. Figueredo, M.D., D Lynn Morris

Division of Cardiology Faculty Papers

The use of cocaine may be associated with either acute or chronic toxicity, and approximately 5% to 10% of emergency department visits in the United States are believed to be secondary to cocaine usage. Chest pain is the most common cocaine-related medical problem, leading to the evaluation of approximately 64,000 patients annually for possible myocardial infarction, of which approximately 57% are admitted to the hospital, resulting in an annual cost greater than $83 million. There is a plethora of cocaine-related cardiovascular complications, including acute myocardial ischemia and infarction, arrhythmias, sudden death, myocarditis, cardiomyopathy, hypertension, aortic ruptures, and endocarditis. There is …

The Interim Window: Women’S Experiences During In Vitro Fertilization Leading To Maternal Embryo Attachment, Tammy Mackinnon Lampley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Infertility affects about 7.3 million women and their partners in the U.S., about 12% of the reproductive-age population. In vitro fertilization (IVF) has been used successfully in the United States since 1981. The number of women seeking artificial reproductive techniques (ART) has increased dramatically and the number of ART cycles performed in the United States has more than doubled, from 64,681 in 1996 to 134,260 in 2005 and 99% of these are IVF. Studies indicated that women rank waiting for the outcome of and IVF treatment and a negative pregnancy result as the most stressful events during their treatment. Although …