Medical Specialties Commons^™

Slicing Through Innovation: Assessing The Durability And Effectiveness Of 3d Printed Scalpel Handles, Christopher Root, Chad Clark, Stephen Mcnichol, Natalie Freeman

DO Research Day

Advancements in 3D printing technology have revolutionized the manufacturing of medical instruments, offering new possibilities for creating customized and cost-effective tools. This study investigates the mechanical properties and breaking points of 3D printed scalpel handles using three different thermoplastic materials: Polyethylene Terephthalate Glycol (PETG), Polylactic Acid (PLA), and Acrylonitrile Butadiene Styrene (ABS). The handles were designed to replicate standard surgical scalpel dimensions and were printed using identical parameters across all samples to ensure consistency. Mechanical testing, including tensile and flexural strength tests, was conducted on all specimens to determine their breaking points under stress typically encountered during surgical procedures. Results …

Prolonged Hormonal Contraceptive Use And Reproductive Recovery: A Narrative Review Of Fertility Outcomes, Hannah Himsl, Beverly Hamilton Ph.D

DO Research Day

Background: Hormonal contraceptives are widely used for pregnancy prevention and management of gynecologic conditions. Because these methods alter endocrine function, many women worry that prolonged use may make it harder to become pregnant after stopping. This review examines current evidence on fertility recovery following long-term hormonal contraceptive use.

Objective: To evaluate evidence regarding:

• Return to fertility after discontinuation
• Differences among contraceptive methods
• Effects on ovarian reserve markers (AMH and AFC)
• Long-term reproductive outcomes
• Clinical implications for patient counseling

Methods:

• Design: Narrative literature review
• Databases: PubMed/MEDLINE, Embase, Web of Science, Google Scholar, hand search of Fertility and Sterility
• Search Period: December …

Association Between Subendocardial Viability Ratio And Body Anthropometrics, Brayden Eftink, Mikaela K. Brown, Nicholas A. Carlini, Bradley Fleenor, Matthew P. Harber

DO Research Day

Lower myocardial perfusion, assessed non-invasively as the subendocardial viability ratio (SEVR), is associated with greater cardiovascular disease (CVD) risk. Waist circumference (WC) and body mass index (BMI) are two metrics associated with CVD risk, yet less is known if these factors are associated with SEVR. We hypothesized a higher WC and BMI will be correlated with a lower SEVR.

Investigating The Effects Of Semaglutide On Hepatic Cytochrome P450 Enzyme Expression, Maanasi Bulusu, Kavya Vasudevan, Mir S. Adil Phd

DO Research Day

Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist widely used to treat type 2 diabetes and obesity. Because many patients taking semaglutide also use other medications, understanding its potential effects on drug metabolism is important. Hepatic cytochrome P450 (CYP450) enzymes metabolize many commonly used medications, and changes in their expression may alter drug levels and treatment response. However, the effects of semaglutide on hepatic CYP450 expression remain poorly understood.: To determine whether semaglutide alters hepatic CYP450 enzyme expression and establish a human liver cell model for studying its potential effects on drug metabolism. Publicly available mouse gene expression data (GEO …

Investigating Monocyte–Endothelial Interactions: Development Of An In Vitro Model Of Doxorubicin-Associated Endothelial Dysfunction, Kiley Moore, Mikah Chandler, Trinity Soto, Samyuktha Athreya, Andrea Linares, Kavya Vasudevan, Mir S. Adil Phd

DO Research Day

Doxorubicin (DOX) is an effective chemotherapeutic agent whose clinical use is limited by cardiovascular toxicity. In addition to direct cardiomyocyte injury, vascular endothelial dysfunction may contribute to chemotherapy-associated cardiovascular injury. Our broader research investigates whether DOX-induced monocyte changes influence endothelial cells through secreted factors and potentially extracellular-vesicle-associated signaling. Preliminary data demonstrated that DOX increases human endogenous retrovirus-K (HERV-K) mRNA expression in THP-1 monocytes. We sought to establish an in vitro monocyte–endothelial conditioned-medium transfer model and identify appropriate controls for evaluating monocyte-derived effects on endothelial cells. THP-1 monocytes and EA.hy926 endothelial cells were cultured under optimized conditions. As an initial model-development …

Diabetes Mellitus And Wound Care Gaps Among Unhoused And Temporarily Housed Individuals In Knoxville, Tn, Andrew Tenaglia, Emily C. Wyatt, Danielle Darter

DO Research Day

Background: Individuals experiencing homelessness face disproportionately high rates of chronic disease and wound-related complications due to limited access to preventive healthcare, hygiene resources, and longitudinal medical management. Street medicine programs provide an opportunity to identify and treat wounds before progression to severe infection or operative intervention.

Objectives: To characterize the prevalence and distribution of diabetes mellitus and wound related conditions among patients receiving care through Knoxville Street Medicine Outreach (KSMO).

Method: A retrospective chart review was performed using de-identified electronic medical records from 604 patients treated by KSMO between June 12, 2024, and July 10, 2026. Patients with documented diabetes …

Prevalence Of Hypertension Among Unhoused And Temporarily Housed Individuals Receiving Street Medicine In Knoxville, Tennessee, Emily Wyatt, Andrew Tenaglia, Danielle Darter

DO Research Day

Background: Individuals experiencing housing instability are disproportionately affected by chronic diseases, including hypertension, yet often face significant barriers to preventive healthcare and longitudinal disease management. Street medicine programs provide healthcare directly to medically underserved populations, but limited data exist describing the prevalence of hypertension among patients receiving these services.

Objectives: To characterize the prevalence of hypertension among patients receiving care through Knoxville Street Medicine Outreach (KSMO) and describe the demographic characteristics and housing status of this population.

Method: A retrospective observational study was conducted using de-identified electronic medical records from KSMO. Patient encounters between June 2024 and July 2026 were …

Improving Medical Student Confidence And Preparedness: The Role Of Simulation-Based Education In Substance Use Disorder Care, Patricia Archambault, David Crabtree

DO Research Day

Substance use disorders (SUDs) remain a major public-health concern. In 2024, approximately 48.4 million Americans aged 12 years or older met criteria for a past-year SUD, yet only 12.3% received substance-use treatment.¹ Although addiction medicine education has expanded, undergraduate medical curricula remain variable, and medical students frequently report limited confidence in screening, counseling, and treating patients with SUDs. Traditional didactic instruction provides foundational knowledge but may offer insufficient opportunities to practice patient centered communication, trauma-informed care, and evidence-based treatment. Simulation-based education (including standardized patients) may help bridge this knowledge-to-practice gap by allowing students to apply clinical knowledge, practice communication, and …

Effect Of Three Nutraceutical Agents On The Metastatic Ability Of Prostate Cancer Cells: Quantitative Evaluation Of Scratch Wound Assay Findings, Michelle Nguyen, Mariam Bushra, Hunter Cole, Caden Cantrill, Debasis Mondal

DO Research Day

Background: Prostate Cancer (PCa) is a leading cause of morbidity and mortality in elderly men in the United States (US). Despite the availability of approved anticancer strategies, treatment related side effects and the recurrence of aggressive and metastatic cancer cells remain a formidable challenge. Therefore, the possible use of safety-tested nutraceuticals that can suppress PCa metastasis would be of great translational value. We have investigated the anti-metastatic effects of dimethyl sulfoxide (DMSO), methyl sulfonyl methane (MSM), and ethyl pyruvate (EP), three clinically tested natural compounds. Here, we document their ability, both alone and in combinations, to suppress PCa cell migration …

Beyond Anesthesia-Attributed Mortality: Access, Capability, And Reliability In Obstetric Anesthesia For Rural And Socioeconomically Disadvantaged Patients, Abdullah Salim, Tiffany Iheanacho, Sarah Kable

DO Research Day

Background & Objective

Anesthesia-related maternal mortality has declined substantially, yet cause-of-death attribution captures only a small part of the specialty’s contribution to maternal outcomes. Access barriers, low-volume care, workforce shortages, overstated facility readiness, and unreliable follow-up may shape risk before, during, and after delivery.

Objective: synthesize U.S. evidence using an Access → Capability → Reliability framework and ask: Can patients reach appropriate care? Can facilities deliver it? Is care delivered consistently and equitably?

Methods & Limitations

Methods: SANRA-informed narrative review of PubMed, Embase, Scopus, and Web of Science through June 2026. Search concepts included obstetric anesthesia, maternal mortality and morbidity, …

Effects Of Warm And Cold Ischemia On The Human Myocardium Over Time, Shawnaleh Cada, Kenneth Bedi, Eliot Peyster, Yoshikazu Suzuki, Surendra Dasari, Kenneth B. Margulies

DO Research Day

Background: Myocardial protection strategies employed in cardiac surgery and transplantation have centered around in situ cardioplegic arrest combined with hypothermic cooling to mitigate myocardial damage and reperfusion injury. The cardioplegic solution is delivered directly to the myocardium at 4°C, producing electromechanical silencing and reduced metabolic demand, while the patient is typically cooled systemically to ~33°C. In transplantation static cold storage at ~4°C has been the standard method for preserving donor hearts for the past 60 years. A handful of cardiac surgical reports have examined warm-ischemic myocardium, but the molecular trajectory of myocardium receiving neither protection (mimicking infarction or the warm …

Enhancing Brachial Plexus Education Through An Interactive, Coded Three-Dimensional Learning Model, Ambika Siddabathula, Erick Moberg, Ph.D

DO Research Day

The brachial plexus presents a persistent instructional challenge in anatomy education because students must integrate its branching organization with its three-dimensional relationships to surrounding structures.[1,2] Understanding the plexus requires learners to trace neural contributions through roots, trunks, divisions, cords, and terminal branches while recognizing their spatial relationships to the axillary artery.[2] Conventional diagrams can clarify connections between named structures, but translating these schematics into an anatomically coherent spatial representation remains a recognized teaching challenge.[1,2] These difficulties occur within a broader pattern of challenges in learning neuroanatomy. In a national survey of 2,877 medical students across 25 UK medical schools, respondents …

Immune Hallmarks Of Recurrent Immune Checkpoint Inhibitor-Mediated Inflammatory Arthritis, Synat Keam, Yuanteng Jeff Li, Yanshuo Chu, Jean H Tayar, Huifang Lu, Michael Wu, Sandeep K Agarwal, Nitin Jain, Pavlos Msaouel, Adi Diab, Linghua Wang, Cara Haymaker, Roza Nurieva, Sang T Kim

Faculty, Staff and Students Publications

Immune checkpoint inhibitor (ICI) therapy is often associated with immune-related adverse events including inflammatory arthritis (IA). However, the mechanisms underlying ICI-mediated IA (ICI-IA), especially its recurrence, are not well understood. In this study, we sought to elucidate mechanisms of recurrent ICI-IA by analyzing longitudinal synovial fluid (SF) samples from patients with ICI-IA. SF samples were collected from six patients with ICI-IA at the first and second occurrences of ICI-IA and analyzed with single-cell RNA sequencing (n = 3), single-cell T-cell receptor sequencing (n = 3), single-cell B-cell receptor sequencing (n = 3), and flow cytometry (n = 6). SF samples …

Mechanisms Of Cd4+T Tolerance To A Corneal Epithelial Neoantigen, Jeremias G Galletti, Kaitlin K Scholand, Jianming Shao, Eric P Fujisaki, Prashant Kumar, Elizaveta A Demianova, Elle Joy J San Juan, Laura Schaefer, Cintia S De Paiva

Faculty, Staff and Students Publications

Tissue-specific peripheral tolerance mechanisms are essential to prevent autoimmunity. The cornea is immune privileged, and anterior chamber-associated immune deviation (ACAID) governs its inner surface. However, the mechanisms governing corneal epithelial (outer surface) antigens remain unknown. Using an inducible, cornea-restricted neoantigen mouse model, we found that tolerance of corneal epithelial antigens is associated with antigen-specific regulatory T cell (Treg) induction. Although the cornea is both avascular and alymphatic, its epithelial antigens are still efficiently presented by ocular surface-derived antigen-presenting cells to T cells in draining lymph nodes under homeostatic conditions, leading to conventional antigen-specific Treg expansion without ocular pathology. This tolerance …

Human Norovirus Infection Does Not Induce Serotonin Secretion In Human Intestinal Organoids, Hephzibah Nwanosike, Vijayalakshmi B Ayyar, Michael J Bolt, Aaya Boussattach, Yi-Ting Shen, Sarah E Blutt, Mary K Estes, Robert L Atmar, Sasirekha Ramani

Faculty, Staff and Students Publications

Human noroviruses (HuNoVs) are a leading cause of acute gastroenteritis worldwide. The primary symptoms of HuNoV-associated disease are vomiting and diarrhea; yet the mechanisms underlying these symptoms are poorly understood. Neuroactive hormones such as serotonin (5-hydroxytryptamine; 5-HT) secreted by intestinal enteroendocrine cells (EECs) can activate vomiting centers in the brain and play a critical role in regulating emetic signaling. Serotonin release from infected EECs has been implicated in vomiting during other enteric infections. Recent studies have reported the detection of HuNoV RNA and antigen in EECs in jejunal biopsies from immunocompromised patients with chronic HuNoV infection and rhesus macaques. We …

Core Stability Training And Sports Performance: A Bibliometric Mapping (2000–2025), Mimi Guo, Muhamad Hafiz Bin Ismail, Diyana Z. Abdul Ghani, Qi Liang, Yifei Gao

Baltic Journal of Health and Physical Activity

Background: Core stability training has become an important topic in sports science because of its proposed role in athletic performance enhancement, injury prevention, and neuromuscular control. This study aimed to map the knowledge structure, research trends, and collaboration patterns in this field. Materials and Methods: A bibliometric analysis was conducted using the Web of Science Core Collection. Articles and reviews published between 2000 and 2025 were screened according to predefined eligibility criteria. A total of 559 publications were included and analyzed using Bibliometrix and Biblioshiny. Results: Scientific output increased markedly over time, particularly after 2020. The USA and China were …

Effect Of Head Coverings On Directional Microphone Performance In Modern Hearing Aids: A Kemar-Based Laboratory Evaluation, Zahra Fekri, Mariam Mohamad, Ayasakanta Rout

Faculty Scholarship

Background/Objectives: Directional microphones are an established hearing aid technology for improving speech understanding in background noise. Although researchers have examined the influence of hair, spectacles, and earmold venting on directional performance, no systematic work has addressed head coverings, which people wear worldwide for cultural, religious, occupational, and personal reasons. This study determined whether a cotton head covering alters the directivity index (DI) of highest-level receiver-in-canal (RIC) hearing aids. Methods: A Knowles Electronics Manikin for Acoustic Research (KEMAR) was positioned in a double-walled, sound-treated booth, and DI was measured for omnidirectional and fixed directional microphone settings, with and without a two-layer …

Effects Of Eight-Week High Interval Training On The Distance Covered During Small-Sided Games Versus League Match In Youth Soccer Players, Dorota Lewandowska, Zbigniew Jastrzebski

Baltic Journal of Health and Physical Activity

Background: The aim of the study was to demonstrate the effectiveness of an 8-week high-intensity interval training (HIIT) program on the distance covered by young soccer players during small-sided games (SSG) and a league match. Materials and Methods: The study involved 39 players aged 17–18 years old, divided into two groups, each performing SSG on a pitch with a surface of 90 m² per player (G-90, n = 19) and 180 m² per player (G-180, n = 20). Players (5 × 5) in both groups completed four games, once a week on Tuesdays. Each game lasted 5 minutes with a …

Giant Cell Arteritis: A Case Study And Review Of Treatment, Andrew Di Mattina Od, Jeffrey Sterling Od, Heather Whyte Od

Optometric Clinical Practice

Background: Giant cell arteritis (GCA) is the most common vasculitis affecting individuals over 50, and frequently leads to severe ischemic complications, most notably irreversible vision loss. Early diagnosis and prompt, aggressive treatment with corticosteroids is paramount to protect the fellow eye. The multifaceted clinical presentation of GCA, sometimes with atypical or sequential ocular involvement, can pose significant diagnostic challenges. This paper reviews current understanding of GCA pathophysiology, diagnosis, and current management strategies.

Case Report: A 70‑year‑old man presented with “cracked glass” vision in his right eye and was diagnosed with a branch retinal artery occlusion (BRAO). Two weeks later he …

Pentosan Polysulfate Sodium (Pps, Elmiron) Maculopathy Demonstrates The Importance Of Coordinated Care From A Low Vision Perspective, Charlotte I. Spada Od, Stephanie Schmiedecke Barbieri Od, Patricia Sanchez Diaz Dvm, Phd, Jeffrey Rabin Od, Phd

Optometric Clinical Practice

Background: Pentosan polysulfate sodium (PPS, Elmiron®) is a widely used medication to reduce pain caused by interstitial cystitis, a bladder disorder most often affecting females. PPS maculopathy is a novel form of toxic retinal disease often not recognized or mistaken for other retinal conditions such as macular degeneration due to the initial similarities on fundus exam. However, when visualized using fundus autofluorescence, affected eyes show characteristic hyper/hypo-autofluorescent patterns.

Case report: A patient taking PPS for 10 years presented with macular changes and complaints of blurry vision and nyctalopia. Clinical, electrodiagnostic, and genetic testing were performed including fundus autofluorescence and …

The Other Visual Acuity, Paul B. Freeman Od

Optometric Clinical Practice

Editorial

Collective High-Intensity Physical Load And Team Performance In The Fifa U-20 World Cup Chile: Match-By-Match Analysis Of Finalists, Khalid El Mouahid, Salim Khairi, Paweł Chmura, Amine Arfaoui

Baltic Journal of Health and Physical Activity

Background: This study aimed to compare the physical and technical-tactical performance profiles of the two finalist teams (Argentina and Morocco) at the FIFA U-20 World Cup 2025 and to examine the relationships between individual physical loads and collective match performance. Materials and Methods: An observational comparative design was applied using official FIFA match reports. Seven matches per team were analyzed. Physical variables included total distance, distances covered in speed zones (Z3–Z5), high-speed running, sprint distance, and maximal speed, while technical-tactical variables described offensive, defensive, and collective behaviors. Between-team comparisons and correlation analyses were conducted using appropriate parametric and non-parametric procedures. …

Benign Jaw Bone Lesions In Athletes Exposed To Craniofacial Trauma: Surgical Treatment And Bone Regeneration Using Biphasic Calcium Sulfate, Damian M. Dudek, Agata Chwarścianek, Izabela Pabin, Łukasz Jaworski, Oliwia Warmusz, Grzegorz Wyrobiec, Ewa Kłodzińska

Baltic Journal of Health and Physical Activity

Benign cystic and tumor lesions of the jaw bones represent relatively frequent pathological conditions encountered in oral and maxillofacial surgery. Although these lesions are often asymptomatic and slow-growing, they may lead to progressive weakening of bone structure. In individuals exposed to repetitive mechanical forces, such as athletes participating in contact sports, the presence of such lesions may significantly increase the risk of pathological fractures of the facial skeleton. The aim of the present study was to present a clinical case series of a benign jaw bone lesion treated surgically using a biphasic calcium sulfate biomaterial and to discuss the potential …

Selected Determinants Of The Health Quality Of The Diet Of Women Practicing Aerobic Sports, Maria Gacek, Paulina Mazur-Kurach

Baltic Journal of Health and Physical Activity

Background: In the context of the importance of nutrition for health and exercise capacity, this study was conducted to assess selected determinants of the health quality of the diet of female athletes training in one of the gymnastics disciplines—aerobic gymnastics. Materials and methods: The study was conducted among 112 women aged 19 to 30 using several research tools, including the Beliefs and Eating Habits Questionnaire KomPAN, the Generalised Self-Efficacy Scale (GSES), and the Satisfaction with Life Scale (SWLS). Statistical analyses were performed using Spearman's correlation coefficients, at a significance level of α = 0.05. Results: The median score for the …

Early Prediction Of The Breast Cancer Response To Neoadjuvant Chemotherapy Based On Intratumoral Interstitial Fluid Pressure Using 3-D Subharmonic-Aided Pressure Estimation, Sung In Choi, Basak Dogan, Corinne E. Wessner, Jessica H. Porembka, Priscilla Machado, B. Bersu Ozcan, Nisha Unni, Maysa Abu-Khalaf, Kenneth Hoyt, Flemming Forsberg, Kibo Nam

Department of Radiology Faculty Papers

Elevated intratumoral interstitial fluid pressure (IFP) may negatively impact the efficacy of neoadjuvant chemotherapy (NAC). This study aimed to predict the breast cancer response to NAC based on intratumoral IFP using 3D contrast-enhanced ultrasound (CEUS) with subharmonic-aided pressure estimation (SHAPE). This prospective study enrolled breast cancer patients undergoing NAC from two clinical sites. 3D CEUS was performed at 0%, 10%, and 30% of NAC completion using a GE Logiq E9 with Definity. The pressure gradients between the tumor and adjacent normal tissue were estimated by SHAPE, utilizing the inverse linear relationship between the ultrasound contrast agent’s subharmonic signal amplitude and …

Peritoneal Dialysis Catheter Complications In Neonates With Kidney Failure., Shannon Reinert, Maanasa Yarlagadda, Alexander Bondoc, Donna Claes, Stefanie Riddle, Meredith P. Schuh

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Neonates with kidney failure require placement of a peritoneal dialysis catheter (PD-C) shortly after birth. PD-C malfunction and peritonitis, both common in this population, are associated with PD failure. The aim of this study was to describe our center's PD-C-related practices and outcomes in neonates with kidney failure.

METHODS: We performed a retrospective chart review of neonates who required kidney replacement therapy (KRT) within the first 30 days of life from 01/2018-12/2023. We evaluated for PD-C duration, PD-C replacement or revision, and peritonitis.

RESULTS: Twenty-four neonates had PD-C placed for chronic dialysis at a median of 9.7 days and …

Clinical Presentations, Treatments, And Outcomes Of Pediatric Lupus Nephritis: A Prospective Cohort Study From The Pediatric Nephrology Research Consortium., Melonie Phillips, Mahmoud Kallash, Chloe Tang, Steve Rust, Kia Jubert-Bacon, Scott Wenderfer, Smriti Mohan, Neal Blatt, Don Batisky, Alejandro Quiroga, Tetyana L. Vasylyeva, Nilka Dejesus, Jerome C. Lane

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: There are few prospective studies of mycophenolate mofetil (MMF) versus cyclophosphamide (CYC) for pediatric lupus nephritis (pLN) and none evaluating rituximab (RTX).

METHODS: The Prospective Pediatric Lupus Nephritis Registry (ProPeL-R) enrolled patients <  21 years within 4 weeks of an initial kidney biopsy diagnostic of pLN. Demographic, clinical, and laboratory data were collected prospectively at enrollment, 3 months, 6 months, and then every 6 months thereafter for up to 5 years of follow-up. For this study, we compared patients receiving initial therapy with corticosteroids (CS) and either MMF (n = 33) vs. CYC (n = 18), and those treated with CS, either MMF or CYC, with RTX (n = 20) vs. without RTX (n = 51).

RESULTS: Histology consisted of 18% class III; 35% class IV; 25% mixed class; and 22% pure class V. Eighty-two percent were female. No significant differences in response or infection rates were identified between those receiving MMF or CYC. There was a significant increase in combined complete (CR) and partial response (PR) at 24 months with RTX use. Overall CR rates at 6 and 24 months were 35% …

Bile Acid Metabolites And Carotid Intima Media Thickness In The Chronic Kidney Disease In Children (Ckid) Study., Arthur M. Lee, Mark M. Mitsnefes, Jennifer Roem, Bradley A. Warady, Susan L. Furth, Michelle R. Denburg, Ckid Study Investigators

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Building A Mini Medical School: An Evidence-Based Framework For Health Science Education Outreach, Alexandra S. Hausmann, Shirley F. Delair, Liliana P. Bronner

Medical Student Summer Research Program

No abstract provided.

Holding Hope: Maternal Experiences Of Kangaroo Mother Care Within Sociocultural Contexts In Ethiopia., Miraj Fuad Alemar, Betelehem B. Kassa, Mahlet Abayneh, Hanan N. Mohammed, Stephanie Kukora

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Kangaroo mother care (KMC) is a crucial method for improving the health outcomes of preterm and low birth weight (LBW) infants, particularly in resource-limited settings. However, barriers hinder mothers from effectively practicing KMC. This study aims to explore mothers' perceptions, hopes, and buy-in regarding KMC in a tertiary care center in Ethiopia.

METHODS: A semistructured interview guide was developed on the basis of a literature review. In-depth interviews were conducted with a purposive sample of mothers who had practiced KMC within the past two years at Saint Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia. The interviews, which …