Medical Specialties Commons^™

Pediatric Spasticity, Kavita Parikh, Olga Morozova, Melanie Anspacher, Neha Shah

E-Learning Modules

Children with special health care needs (CSHCN) are increasingly prevalent in US hospitals. The pediatric hospitalist is often the primary provider of inpatient care for these patients. However, exposure to this patient population during training varies from provider to provider. No published educational curricula are specific to the inpatient care of this population. The purpose of this project is to build a multi-modal educational curriculum for providers with the overall goal of improving inpatient care for this at-risk population.

This curriculum is primarily composed of a series of topic-specific learning modules. Asynchronous learning modules, utilized appropriately, can augment learning by …

Extreme Measures: Field Amputation On The Living And Dismemberment Of The Deceased To Extricate Individuals Entrapped In Collapsed Structures, Anthony Macintyre, Efraim B. Kramer, Bruno P. Petinaux, Trevor Glass, Charmaine M. Tate

Emergency Medicine Faculty Publications

No abstract provided.

Coccygeal Fracture Pain Cured By Sacral Neuromodulation: A Case Report, Erica R. Hope, Daniel Gruber

Obstetrics and Gynecology Faculty Publications

No abstract provided.

Prevalence Of Obesity Among Young Asian-American Children, Anjali Jain, Stephanie Mitchell, Radha Chirumamilla, Jin Zhang, Ivor B. Horn, Amy Lewin, Z. Jennifer Huang

Pediatrics Faculty Publications

BACKGROUND:

Asian-American children are considered to be at low risk of obesity, but previous estimates have not distinguished between children from different Asian countries. We estimate the prevalence of obesity among Asian-American children by mother's country of origin, generational status, and family socioeconomic factors using a secondary analysis of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) wave III (children ∼4 years old) dataset.

METHODS:

The ECLS-B is a nationally representative study of children born in 2001 that oversampled births to Asian mothers. Asian ethnic categories included Chinese, Japanese, Filipino, Asian Indian, Korean, Vietnamese, and Other Asian/Pacific Islander. The primary outcome …

Radiation Therapy Quality In Ccg/Pog Intergroup 9961: Implications For Craniospinal Irradiation And The Posterior Fossa Boost In Future Medulloblastoma Trials, Bernadine Donahue, Mary A.H. Marymont, Sandra Kessel, Matthew K. Iandoli, Thomas Fitzgerald, Emiko Holmes, Mehmet Kocak, James M. Boyett, Amar Gajjar, Roger J. Packer

Neurology Faculty Publications

Purpose: Associations of radiation therapy (RT) deviations and outcomes in medulloblastoma have not been defined well, particularly in the era of reduced-dose craniospinal irradiation and chemotherapy. The aim of this study is to evaluate the quality of RT on Children’s Cancer Group/Pediatric Oncology Group 9961 and analyze associations of RT deviations with outcome.

Materials and Methods: Major volume deviations were assessed based on the distance from specified anatomical region to field edge. We investigated associations of RT deviations with progression-free survival (PFS), overall survival (OS), and explored associations with demographics and clinical variables.

Results: Of the 308 patients who were …

Neuropsychological Outcomes In Adults Commencing Highly Active Anti-Retroviral Treatment In South Africa: A Prospective Study, John Joska, John Joska, Jennifer Westgarth-Taylor, Jacqueline Hoare, Kevin Thomas, Robert Paul, Landon Myer, Dan Stein

Psychology Faculty Works

BackgroundInfection with HIV may result in significant neuropsychological impairment, especially in late stage disease. To date, there have been no cohort studies of the impact of highly active anti-retroviral treatment (HAART) in South Africa where clade C HIV is predominant.MethodsParticipants in the current study were recruited from a larger study of HIV-associated neurocognitive disorders (HAND) and included a group of individuals commencing HAART (n = 82). Baseline and one-year neuropsychological function was assessed using a detailed battery, and summary global deficit scores (GDS) obtained. Associations with change in GDS were calculated.ResultsParticipants had a median CD4 cell count of 166 at …

Fundamentals Of Sonographic Wave Propagation And New Technologies, Michael Hartman

Faculty Works: AHS (2004-2023)

Presented at Society of Diagnostic Medical Sonography in a webinar/professional series.

Blended Learning In Anesthesia Education: Current State And Future Model, Jaya Kannan, Viji Kurup

Jandrisevits Faculty Publications

Purpose of review: Educators in anesthesia residency programs across the country are facing a number of challenges as they attempt to integrate blended learning techniques in their curriculum. Compared with the rest of higher education, which has made advances to varying degrees in the adoption of online learning anesthesiology education has been sporadic in the active integration of blended learning. The purpose of this review is to discuss the challenges in anesthesiology education and relevance of the Universal Design for Learning framework in addressing them.

Recent findings: There is a wide chasm between student demand for online education and the …

Mechanical Contributors To Sex Differences In Idiopathic Knee Osteoarthritis, Daniel P. Nicolella, Mary I. O'Connor, Roger M. Enoka, Barbara D. Boyan, David A. Hart, Eileen Resnick, Karen J. Berkeley, Kathleen A. Sluka, C. Kent Kwoh, Laura L. Tosi, Richard D. Coutts, Wendy M. Kohrt

Orthopaedic Surgery Faculty Publications

The occurrence of knee osteoarthritis (OA) increases with age and is more common in women compared with men, especially after the age of 50 years. Recent work suggests that contact stress in the knee cartilage is a significant predictor of the risk for developing knee OA. Significant gaps in knowledge remain, however, as to how changes in musculoskeletal traits disturb the normal mechanical environment of the knee and contribute to sex differences in the initiation and progression of idiopathic knee OA. To illustrate this knowledge deficit, we summarize what is known about the influence of limb alignment, muscle function, and …

Twice-Daily Application Of Hiv Microbicides Alters The Vaginal Microbiota, Jacques Ravel, Pawel Gajer, Li Fu, Christine K. Mauck, Sara S.K. Koenig, Joyce Sakamoto, Alison A. Motsinger-Reif, Gustavo F. Doncel, Steven L. Zeichner

Pediatrics Faculty Publications

Vaginal HIV microbicides offer great promise in preventing HIV transmission, but failures of phase 3 clinical trials, in which microbicide-treated subjects had an increased risk of HIV transmission, raised concerns about endpoints used to evaluate microbicide safety. A possible explanation for the increased transmission risk is that the agents shifted the vaginal bacterial community, resulting in loss of natural protection and enhanced HIV transmission susceptibility. We characterized vaginal microbiota, using pyrosequencing of bar-coded 16S rRNA gene fragments, in samples from 35 healthy, sexually abstinent female volunteer subjects (ages 18 to 50 years) with regular menses in a repeat phase 1 …

Predicting Risk For Adverse Outcomes Following Distal Radius Fracture, Saurabh Mehta Phd

Physical Therapy Faculty Research

Some individuals remain at risk for adverse outcomes such as chronic wrist/hand pain, falls, and fall-related osteoporotic fractures after distal radius fracture (DRF) remain. This thesis includes five studies that were conducted to establish prediction rules or assessing the risk of these adverse outcomes following DRF.

The first manuscript outlines a theoretical framework (RACE - Reducing pain, Activating, Cognitive reshaping, Empowering) for managing the risk of adverse outcomes, mainly chronic pain, in individuals with DRF. The RACE is one of the first frameworks to suggest a risk-based management approach for individuals with DRF.

The Patient-Rated Wrist Evaluation (PRWE) is a …

Fak Is A Critical Regulator Of Neuroblastoma Liver Metastasis, Sora Lee, Jingbo Qiao, Pritha Paul, Kathleen L. O'Connor, B. Mark Evers, Dai H. Chung

Surgery Faculty Publications

Neuroblastomas express increased levels of gastrin-releasing peptide receptor (GRP-R). However, the exact molecular mechanisms involved in GRP-R-mediated cell signaling in neuroblastoma growth and metastasis are unknown. Here, we report that focal adhesion kinase (FAK), as a critical downstream target of GRP-R, is an important regulator of neuroblastoma tumorigenicity. We found that FAK expression correlates with GRP-R expression in human neuroblastoma sections and cell lines. GRP-R overexpression in SK-N-SH cells increased FAK, integrin α3 and β1 expressions and cell migration. These cells demonstrated flatter cell morphology with broad lamellae, in which intense FAK expression was localized to the leading edges of …

The Association Between Acrochorda (Skin Tags), Metabolic Syndrome, And Adenomatous Polyps, Brendan O'Hare, Md, Anastasia Shnitser, Md, Jason Korenblit, Md, Mba, Ali Siddiqui, Md

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND

Acrochorda (skin tags) are benign skin tumors that form primarily at skin creases, generally on the neck, armpit, and groin areas. There have been a small number of published studies in 1980s in patients who were found to have increased number of skin tags and colonic polyps, with a direct correlation described between the two. In addition, metabolic syndrome has been linked to adenomatous polyps, but a link between skin tags and metabolic syndrome has not been established.

Emil Theodor Kocher, M.D., And His Nobel Prize (1841-1917)., Zhi Ven Fong, B.S., Ernest L. Rosato, Md, Harish Lavu, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

Major contributions to the advancement of surgery occurred at the turn of the 20th century. Theodor Billroth was in the midst of revolutionizing abdominal surgery, whereas Louis Pasteur and Joseph Lister were making landmark strides in antisepsis, forever changing the foundations of surgical thinking. Undoubtedly, Theodor Kocher’s (Fig. 1) exposure to these and other giants had a major influence on his career and contributed to his success and ascent as the first, and one of only 10, surgeons ever to be awarded the Nobel Prize in Medicine.

Gsk3Β Inhibition Blocks Melanoma Cell/Host Interactions By Downregulating N-Cadherin Expression And Decreasing Fak Phosphorylation., Jobin K John, Kim H T Paraiso, Vito W Rebecca, Liliana P Cantini, Ethan V Abel, Nicholas Pagano, Eric Meggers, Rahel Mathew, Clemens Krepler, Victoria Izumi, Bin Fang, John M Koomen, Jane L Messina, Meenhard Herlyn, Keiran S M Smalley

Department of Cancer Biology Faculty Papers

This study addresses the role of glycogen synthase kinase (GSK)-3β signaling in the tumorigenic behavior of melanoma. Immunohistochemical staining revealed GSK3β to be focally expressed in the invasive portions of 12 and 33% of primary and metastatic melanomas, respectively. GSK3 inhibitors and small interfering RNA (siRNA) knockdown of GSK3β were found to inhibit the motile behavior of melanoma cells in scratch wound, three-dimensional collagen-implanted spheroid, and modified Boyden chamber assays. Functionally, inhibition of GSK3β signaling was found to suppress N-cadherin expression at the messenger RNA and protein levels, and was associated with decreased expression of the transcription factor Slug. Pharmacological …

Evaluation Of Very High- And Very Low-Dose Intravitreal Aflibercept In Patients With Neovascular Age-Related Macular Degeneration., Quan Dong Nguyen, Peter A. Campochiaro, Syed Mahmood Shah, David J. Browning, Henry L. Hudson, Peter L. Sonkin, Seenu M. Hariprasad, Peter K. Kaiser, Jason Slakter, Julia A. Haller, Diana V. Do, William Mieler, Karen Chu, Avner Ingerman, Robert Vitti, Alyson J. Berliner, Jesse Cedarbaum, Clear-It 1 Investigators

Journal Articles: Ophthalmology

PURPOSE: To determine bioactivity and duration of effect of intravitreal aflibercept injection (also known as vascular endothelial growth factor Trap-Eye) for neovascular age-related macular degeneration (AMD).

METHODS: In this double-masked, phase 1 study, 28 patients with lesions ≤12 disc areas, ≥50% active choroidal neovascularization (CNV), and best corrected visual acuity (BCVA) ≤20/40 were randomized 1:1 to a single intravitreal injection of aflibercept 0.15 or 4 mg. The primary end point was the change from baseline in central retinal/lesion thickness (CR/LT) at week-8. Secondary outcomes were the change from baseline BCVA, the change in CNV lesion size and area of leakage, …

Prevelacne Of Pressure Ulcers In Patients With Spinal Cord Injury; A Retrospective Study, Aatik Arsh, Haider Darain, Syed Muhammad Ilyas, Amir Zeb

Pakistan Journal of Neurological Sciences (PJNS)

Pressure ulcers in patients with spinal cord injury (SCI) are associated with incredible financial cost and human sufferings. The aim of this retrospective study was to determine prevalence of pressure ulcers amongst patients with different levels of SCI.

Uchunguzi (Journal Watch/Montre De Journal) December 2012, Benjamin Wachira

Family Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent.

Limiting The Caesarean Section Rate In Low Risk Pregnancies Is Key To Lowering The Trend Of Increased Abdominal Deliveries: An Observational Study, Ilse Delbaere, Hendrik Cammu, Evelyne Martens, Inge Tency, Guy Martens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: As the rate of Caesarean sections (CS) continues to rise in Western countries, it is important to analyze the reasons for this trend and to unravel the underlying motives to perform CS. This research aims to assess the incidence and trend of CS in a population-based birth register in order to identify patient groups with an increasing risk for CS.

Methods: Data from the Flemish birth register ‘Study Centre for Perinatal Epidemiology’ (SPE) were used for this historic control comparison. Caesarean sections (CS) from the year 2000 (N = 10540) were compared with those from the year 2008 (N …

Antiseptics And Disinfectants For The Treatment Of Bacterial Vaginosis: A Systematic Review, Hans Verstraelen Verstraelen, Rita Verhelst, Kristien Roelens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV).

Methods: A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin …

Labrad : Vol 38, Issue 2 - December 2012, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Automation in Microbiology Specimen Processing and Inoculation
• Use of Automated Urine Analyzer for Urinanalysis
• Automation in Blood Culture
• Vitek 2 System: An Automated System for Antimicrobial Susceptibility Testing
• TB Diagnosis-A New Horizon
• Serological and Molecular Diagnosis of Malaria
• Diagnosis of Leishmaniasis
• Rapid Detection of Dengue NS1 Antigen by ELISA in Suspected Dengue Patients
• Saline Infusion Hysterosonography to Evaluate Abnormal Uterine Bleeding
• Workshop on “Diagnosis of Fungal Infections in Clinical Laboratory”

On The Importance Of Modeling Stent Procedure For Predicting Arterial Mechanics, Shijia Zhao, Linxia Gu, Stacey R. Froemming

Department of Mechanical and Materials Engineering: Faculty Publications

The stent-artery interactions have been increasingly studied using the finite element method for better understanding of the biomechanical environment changes on the artery and its implications. However, the deployment of balloon-expandable stents was generally simplified without considering the balloon-stent interactions, the initial crimping process of the stent, its overexpansion routinely used in the clinical practice, or its recoil process. In this work, the stenting procedure was mimicked by incorporating all the above-mentioned simplifications. The impact of various simplifications on the stent-induced arterial stresses was systematically investigated. The plastic strain history of stent and its resulted geometrical variations, as well as …

The Role Of Misoprostol In The Reduction Of Maternal Deaths In Low Resource Settings: A Systematic Review With Recommendations For Action, Melissa Anne Mcmillian

Master of Public Health Program Student Publications

Objective: The purpose of this systematic review is to determine the role misoprostol currently plays in the reduction of maternal deaths and implications for the future reduction of maternal deaths in low resource settings.

Methods: A comprehensive review of the literature was performed using the following databases: The Cochrane Database, Ebsco, MEDLINE, PubMed, and Electronic Journal Center (EJC). Articles were excluded based upon date published, overt data changes since publication, and setting of misoprostol interventions in tertiary or referral centers that have access to oxytocin. A total of 61 articles were included from 2002-2012 and demonstrated several methodologies and study …

Root Causes Of Intraoperative Hypoglycemia: A Case Series., Eric S. Schwenk, Boris Mraovic, Ryan P. Maxwell, Gina S. Kim, Jesse M. Ehrenfeld, Richard H. Epstein

Department of Anesthesiology Faculty Papers

STUDY OBJECTIVE: To describe the root causes of intraoperative hypoglycemic events.

DESIGN: Retrospective analysis.

SETTING: Large academic teaching hospital.

MEASUREMENTS: Data from 80,379 ASA physical status 1, 2, 3, 4, and 5 surgical patients were reviewed. Blood glucose values, insulin, oral hypoglycemic medication doses, and doses of glucose or other medications for hypoglycemia treatment were recorded.

MAIN RESULTS: Hypoglycemia in many patients had multiple etiologies, with many cases (8 of 17) involving preventable errors. The most common root causes of hypoglycemia were ineffective communication, circulatory shock, failure to monitor, and excessive insulin administration.

CONCLUSION: Intraoperative hypoglycemia was rare, but often …

Influence Of Body Mass Index And Antibiotic Dose On The Risk Of Surgical Site Infections In Pediatric Clean Orthopedic Surgery., Jeffrey J Cies, Shannon Chan, Jobayer Hossain, B Randall Brenn, M Cecilia Di Pentima

Department of Anesthesiology Faculty Papers

OBJECTIVE: To evaluate body mass index (BMI) and antimicrobial dose as risk factors for surgical site infections in pediatric patients.

PATIENTS AND METHODS: Children between 2 and 19 years of age undergoing clean orthopedic procedures and receiving at least one dose of perioperative antibiotics (cefazolin, vancomycin, or clindamycin) were studied. The retrospective case-controlled study was conducted at the Alfred I. duPont Hospital for Children, a 180-bed tertiary-care academic pediatric hospital in Wilmington, DE. Data were collected from January 1, 2002, to December 31, 2005.

RESULTS: Underweight children had a higher risk for SSIs than overweight and normal-weight children. American Society …

Frequency Of Carpal Tunnel Syndrome In Patients Of Diabetic Peripheral Neuropathy, Ahmad Furqan Dr., Naeem Kasuri, Athar Javed, Javed Iqbal, Haroon Khan, Mohsin Zaheer

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Aging And Religious Participation In Late Life, Kuan-Yuan Wang

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Objective: The aim of the study is to evaluate the relationship between two dimensions of religiosity, religious service attendance and religious beliefs, and the process of aging, controlling for the effects of covariates known to affect religious development among older adults.

Methods: Secondary analysis of longitudinal data from the Florida Retirement Study was used to assess the trajectories of religious development over time as modeled with two growth processes: religious service attendance and religious beliefs. We analyzed data from six interview waves (Waves 1 and 5 - 9) with 1000 older adults age 72 or over. Covariates included demographic factors …

Differentiating Lymphovascular Invasion From Retraction Artifact On Histological Specimen Of Breast Carcinoma And Their Implications On Prognosis., Nicholas George Zaorsky, Ninad Patil, Gary Mitchel Freedman, Madalina Tuluc

Department of Radiation Oncology Faculty Papers

On a pathological specimen of breast cancer cells, retraction artifact during histological processing mimics true lymphovascular invasion (LVI). The accurate determination of the presence or absence of LVI is a factor in determining risk of having a positive sentinel node, or having additional positive axillary nodes after a positive sentinel node biopsy in women with early-stage breast cancer. The determination of nodal risk influences the decision of the treating physicians as to whether a sentinel node biopsy or completion axillary dissection is necessary. On slide preparation, ideal factors favoring true LVI include: a definite endothelial lining, with endothelial nuclei that …

Effect Of Iron Chelators On Methemoglobin And Thrombin Preconditioning., Jing Chen-Roetling, Jesse Sinanan, Raymond F. Regan

Department of Emergency Medicine Faculty Papers

Cell loss immediately adjacent to an intracerebral hemorrhage may be mediated in part by the toxicities of extracellular hemoglobin (Hb) and thrombin. However, at low concentrations, these proteins induce tolerance to hemin and iron that may limit further peri-hematomal injury as erythrocyte lysis progresses. The mechanisms mediating these preconditioning effects have not been completely defined, but increased expression of both heme oxygenase (HO)-1 and iron binding proteins likely contributes. In the present study, we hypothesized that iron chelator therapy would attenuate this protective response. Pretreatment of cortical glial cultures (> 90 % GFAP+) with 3 μM methemoglobin (metHb) or 5 …

Limited Sampling Estimates Of Epigallocatechin Gallate Exposures In Cirrhotic And Noncirrhotic Patients With Hepatitis C After Single Oral Doses Of Green Tea Extract., Dina Halegoua-De Marzio, Walter K. Kraft, Constantine Daskalakis, Xie Ying, Roy L Hawke, Victor J. Navarro

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Epigallocatechin-3-gallate (EGCG) has antiangiogenic, antioxidant, and antifibrotic properties that may have therapeutic potential for the treatment of cirrhosis induced by hepatitis C virus (HCV). However, cirrhosis might affect EGCG disposition and augment its reported dose-dependent hepatotoxic potential.

OBJECTIVE: The safety, tolerability, and disposition of a single oral dose of EGCG in cirrhotic patients with HCV were examined in an exploratory fashion.

METHODS: Eleven patients with hepatitis C and detectable viremia were enrolled. Four had Child-Pugh (CP) class A cirrhosis, 4 had Child-Pugh class B cirrhosis, and 3 were noncirrhotic. After a single oral dose of green tea extract 400 …