Translational Medical Research Commons^™

N-Of-1 Trials: The Epitome Of Personalized Medicine?, Joyce P Samuel, Susan H Wootton, Jon E Tyson

Faculty, Staff and Student Publications

Observational studies are notoriously susceptible to bias, and parallel-group randomized trials are important to identify the best overall treatment for eligible patients. Yet, such trials can be expected to be a misleading indicator of the best treatment for some subgroups or individual patients. In selected circumstances, patients can be treated in n-of-1 trials to address the inherent heterogeneity of treatment response in clinical populations. Such trials help to accomplish the ultimate goal of all biomedical research, to optimize the care of individual patients.

An Exploration Of The Link Between Vertebral Endplate Fracture, Velocity, And Health Of The Intervertebral Disc., John Mcmorran

Theses and Dissertations (Comprehensive)

The capacity for fractures to manifest in the growth cartilage of the adolescent human spine is well documented, but much of the knowledge available regarding such fractures remains retrospective and is largely composed of small case series made up of relatively few participants. In-vitro tissue testing has demonstrated that pressurization of the intervertebral disc’s nucleus pulposus significantly contributes to the generation of growth plate fractures. However, a comprehensive biomechanical investigation of the mechanical consequences for the intervertebral disc when exposed to ring apophyseal (growth plate) fractures at different velocities remains to be demonstrated.

The first two experiments of the present …

Use Of Bioheat Modeling To Characterize And Optimize Implantable Medical Devices And Neuromodulation Technologies, Adantchede Louis Zannou

Dissertations and Theses

Medical device development includes prototyping, benchtop characterization, preclinical studies, and clinical trials. Understanding the limitations and potential adverse effects of medical devices prior to their administration in humans is a crucial first step. Optimizing medical devices is essential to employing technology and improving patients care. Computational modeling is widely adopted as a powerful tool to predict stimulation/recording parameter optimization, rapid electrode/device prototyping, investigating novel mechanism of action, and testing working principles of any medical devices. Many implantable neuromodulation technologies including Spinal Cord Stimulation (SCS), which provide substantial therapeutic benefit for patient population with lower back pain, produces heat via the …

Leveraging Cell-Substrate Adhesion And Cell Migratory Properties In Skeletal Muscle Constructs And Cancer Metastasis Assays, Lauren E. Mehanna

Theses and Dissertations--Chemical and Materials Engineering

Volumetric muscle loss (VML) remains one of the few skeletal muscle injuries without a reliable and repeatable treatment. In large volume muscle injuries, muscle fibers as well as the surrounding connective tissue are damaged, preventing therapeutic muscle stem cells, called myogenic progenitor cells (MPCs), from reaching the injury site and initiating repair. There is a clinical need to rapidly fabricate in vitro muscle tissue constructs that mimic the native tissue organization, with aligned myotubes, for insertion and integration at the patient’s injury site. In this dissertation, we utilize the MPC’s natural propensity to close gaps across an injury site to …

Role Of Histone Deacetylase (Hdac) In Epithelial To Mesenchymal Transition (Emt) In A Human Cholangiocyte Model Of Ischemic Cholangiopathy, Priyanshi Pragnesh Parikh

Theses and Dissertations

Organ transplants are a vital intervention for many diseases that result in end stage organ failure. Currently, the donation pool is not meeting the demands of the transplant list. Expanding this pool to include donation after cardiac death (DCD) is highly sought-after. However, the use of DCD livers can lead to increased odds of graft failure and ischemic cholangiopathy. The loss of epithelialization and fibrosis that occurs during ischemic cholangiopathy is characteristic of these cells undergoing epithelial-to-mesenchymal transition (EMT). The biological changes the cell experiences enhance migratory capacity, invasiveness, and increased resistance to apoptosis. Our earlier studies have shown differential …

Physical Activity Promotion, Assessment, And Engagement In Clinical Settings In The United States, Kristin A. Grogg

Graduate Theses, Dissertations, and Problem Reports (ETD)

Physical inactivity is an important contributor to morbidity and all-cause mortality and the 2018 Physical Activity Guidelines Advisory Committee recommended that physicians increase their role in physical activity assessment and promotion to combat physical inactivity and related comorbidities. Healthcare providers are increasingly called upon to initiate physical activity promotion with their patients to manage conditions like obesity, diabetes, and cardiovascular diseases. Still, recent reports indicate that less than half of primary care visits include some type of physical activity promotion. Although the National Physical Activity Plan includes some recommendations for clinicians and the healthcare sector on physical activity promotion, it …

Cocaine Sensitizes The Cd4+ T Cells For Hiv Infection By Co-Stimulating Nfat And Ap-1, Adhikarimayum Lakhikumar Sharma, Dylan Shafer, Daniel Netting, Mudit Tyagi

Center for Translational Medicine Faculty Papers

The productive infection of HIV, which generates new viral progeny, depends on the activation status of the cell. In this study, we found cocaine exposure sensitizes partially active CD4+ T cells and makes them poised for productive HIV infection. We discovered that cocaine treatment enhances the metabolic state of the cells by co-stimulating several transcription factors, mainly NFAT and AP-1, the two transcription factors, which specifically play a crucial role in enhancing both HIV and the overall cellular gene expression in T cells. We found that cocaine-induced AP-1 works in tandem with NFAT to boost HIV transcription. The enhanced HIV …

Campaigners, Capitalizers, And Cooperators: A Typology Of Professional Identities Of Physician-Researchers Who Care For Patients While Recruiting Them To Industry-Sponsored Clinical Trials, Romiya Felecia Glover Barry

Doctor of Philosophy in Translational Health Sciences Dissertations

The critical phase for a successful clinical trial is timely accrual of research participants. Interventions to improve the outcome of recruiting activities have been developed to address the research structure of clinical trials, the administrative and design burdens of study protocols, the lack of awareness and acceptance of trials from patients and clinicians, and the insufficient research training for trial investigators. Engagement with potential clinical trial participants is lower than expected with a contributing factor being that investigators do not identify and approach all potential participants. The behaviors of physician-researchers responsible for recruiting and enrolling their patients into clinical trials …

Understanding The Contributions Of Hormonal Contraceptives And Cortisol Levels To Fear Learning In Women, Sahil Bardai

Symposium of Student Scholars

Women are twice as likely to be diagnosed with an anxiety disorder than men. Eighty-five percent of women in the US will use hormonal contraceptives at some point in their lifetime. Women who use hormonal contraceptives show heightened startle reactivity to a threatening stimulus. Previous results from our lab showed a significant increase in fear-potentiated startle (FPS) in women who were on hormonal contraceptives compared to women who were naturally cycling. These results stayed consistent throughout three acquisition trials. Others have shown that the use of OCPs (oral contraceptive pills) is related to the dysregulation of the HPA-axis and elevated …

Bioprosthetic Reoperative Aortic Valve Replacement In Patients Under 50, Aisha Kazeem

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Chan V, Lam BK, Rubens FD, et al. Long-term evaluation of biological versus mechanical prosthesis use at reoperative aortic valve replacement. J Thorac Cardiovasc Surg. 2012;144(1):146-151. https://doi.org/10.1016/j.jtcvs.2011.08.041

for a patient considering reoperative aortic valve replacement.

Renal Replacement Therapy Could Be Initiated In Patients With Severe Aki, Regardless Of Age And Critical Condition, El Hussain Shamsa

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Meersch M, Küllmar M, Schmidt C, et al. Long-Term Clinical Outcomes after Early Initiation of RRT in Critically Ill Patients with AKI. J Am Soc Nephrol. Mar 2018;29(3):1011-1019. https://doi.org/10.1681/asn.2017060694

for a critically ill elderly patient with severe acute kidney injury.

The Effect Of Medical Respite Services On Hospital Readmissions For Those Experiencing Homelessness, Kendrick Belardo

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Kertesz SG, Posner MA, O’Connell JJ, et al. Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons. J Prev Interv Community. 2009;37(2):129-142. https://doi.org/10.1080/10852350902735734

for a patient experiencing homelessness.

The Use Of Cold Dialysis Solution In Reducing Fatigue In An End-Stage Renal Disease Patient, Justin Pawloski

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Sajadi M, Gholami Z, Hekmatpour D, Soltani P, Haghverdi F. Cold dialysis solution for hemodialysis patients with fatigue ‐ a cross‐over study. Iranian Journal of Kidney Diseases. 2016;10(5):319‐24.

for a patient with sickle cell disease.

Self-Administered Opat (S-Opat) Is A Potential Cost-Effective Equivalent Option For Uninsured Patients Requiring Opat, Joshua Brady

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Bhavan KP, Brown LS, Haley RW. Self-Administered Outpatient Antimicrobial Infusion by Uninsured Patients Discharged from a Safety-Net Hospital: A Propensity-Score-Balanced Retrospective Cohort Study. PLoS Med. 2015;12(12): e1001922. https://doi.org/10.1371/journal.pmed.1001922

for a patient with fungal peritonitis requiring OPAT.

Cystic Fibrosis Transmembrane Conductance Regulator Modulation May Improve Intestinal Inflammation In Adults With Cystic Fibrosis, Lauren G. Culver

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Ooi CY, Syed SA, Rossi L, Garg M, Needham B, Avolio J, Young K, Surette MG, Gonska T. Impact of CFTR modulation with Ivacaftor on Gut Microbiota and Intestinal Inflammation. Sci Rep. 2018 Dec 13;8(1):17834. https://doi.org/10.1038/s41598-018-36364-6

for a patient with cystic fibrosis experiencing small bowel obstruction.

Partial Outpatient Oral Antibiotic Treatment Of Infective Endocarditis Is Non-Inferior To Inpatient Intravenous Antibiotic Therapy, Nicholas J. Murphy

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Iversen K, Ihlemann N, Gill SU, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med. 2019; 380:415-424. https://doi.org/10.1056/NEJMoa1808312

for a patient with infective endocarditis and intravenous drug use with desire to leave the hospital.

Baclofen As A Helpful Alternative In Treatment Of Painful Paroxysmal Attacks From Trigeminal Neuralgia, Samantha Ryan

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Fromm GH, Terrance CF, Chattha AS. Baclofen in the treatment of trigeminal neuralgia: double-blind study and long-term follow-up. Ann Neurol. 1984;15(3):240. https://doi.org/10.1002/ana.410150306

for a patient with paroxysmal attacks from trigeminal neuralgia who is unable to take carbamazepine.

Indwelling Pleural Catheterization Maximizes Functionality And Quality Of Life In Management Of Recurrent Malignant Pleural Effusions, Avinash Ramkissoon

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Davies HE, Mishra EK, Kahan BC, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: The TIME2 randomized controlled trial. J Am Med Assoc. 2012;307(22):2383-2389. https://doi.org/10.1001/jama.2012.5535

for the management of recurrent malignant pleural effusions in a patient with metastatic renal cell carcinoma.

Exploring Alternative Treatment Options For A Patient With Heavy Menstrual Bleeding And Mistrust Of The Healthcare System, Rachel A. O'Dell

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Tinelli A, Gustapane S, D’Oria O, Licchelli M, Panese G. Nutraceuticals in fibroid management after ulipristal acetate administration: An observational study on patients’ compliance. International Journal of Gynecology and Obstetrics; 2022;156(1):133-138. https://doi.org/10.1002/ijgo.13692

for a patient with chronic, symptomatic anemia with menorrhagia and uterine fibroid.

The Importance Of Stigma Theory For Clinical Decisions Related To Diabetic Foot Amputations, Rachael Garcia, Callie Bartkowiak, Alison Nesbitt Do

Clinical Research in Practice: The Journal of Team Hippocrates

The authors examine the unconsidered impact of social stigma theory on the shared clinical decision-making process for a patient with foot osteomyelitis and MRSA bacteremia facing the prospect of an amputation.