• 10 kHz Spinal Cord Stimulation for Combined Alleviation of Post-Laminectomy Syndrome and Chronic Abdominal Pain: A Case Report.

      Berger, Amnon A; Hasoon, Jamal; Urits, Ivan; Viswanath, Omar; Gill, Jatinder; Univ Arizona, Coll Med Phoenix, Dept Anesthesiol (DOVE MEDICAL PRESS LTD, 2020-04-30)
      Chronic pain affects roughly 50 million Americans, or 20.4% of the national population, and is a huge economic burden on society. Spinal cord stimulation (SCS) is a cost-effective interventional treatment modality for patients with chronic neuropathic and radicular pain. It is traditionally reserved for patients suffering from post-laminectomy syndrome, complex regional pain syndrome, or chronic back pain that is refractory to other less invasive techniques. There have been a few cases describing the use of SCS at higher levels to successfully obtain coverage of visceral abdominal pain. Here we describe an interesting case of a patient who suffered from chronic back pain and radiculopathy with post-laminectomy syndrome as well as chronic abdominal pain. We describe the use of high-frequency SCS to alleviate the patient's post-laminectomy pain as well as his abdominal pain. Our case describes SCS use with multi-level lead placement targeting both post-laminectomy pain and abdominal pain. We describe a strategy that can be useful to patients with concurrent pain from more than one source. Our case also adds to the growing evidence supporting the use of SCS for treating chronic visceral pain syndromes.
    • Adherence to fingolimod in multiple sclerosis: an investigator-initiated, prospective, observational, single-center cohort study

      Zimmer, Andrea; Coslovsky, Michael; Abraham, Ivo; Décard, Bernhard F; Univ Arizona, Ctr Hlth Outcomes & Pharmacoecon Res (DOVE MEDICAL PRESS LTD, 2017-10)
      Objectives: Adherence to multiple sclerosis (MS) treatment is essential to optimize the likelihood of full treatment effect. This prospective, observational, single-center cohort study investigated adherence to fingolimod over the 2 years following treatment initiation. Two facets of adherence - implementation and persistence - were examined and compared between new and experienced users of disease-modifying treatments (DMTs). Materials and methods: Implementation rates were based on the proportion of days covered and calculated as percentages per half-yearly visits and over 2 years, captured through refill data, pill count, and self-report. Nonadherence was defined as taking less than 85.8% of prescribed pills. Implementation rates were classified as nonadherent (< 85.8%), suboptimally adherent (>= 85.8% but. 96.2%), and optimally adherent (>= 96.2%), including perfectly adherent (100%). Persistence, ie, time until discontinuation, was analyzed by Kaplan-Meier analysis. Reasons for discontinuation were recorded. Results: The cohort included 98 patients with relapsing MS, all of whom received a dedicated education session about their medication. Of these 80% were women, 31.6% had fingolimod as first DMT, and 68.4% had switched from other DMTs. The mean implementation rate over 2 years was 98.6% (IQR(1-3) 98.51%-98.7%) and did not change significantly over time; 89% of measurements were in the optimally adherent category, 45.6% in the perfectly adherent category. There was one single occurrence of nonadherence. New users of DMTs were 1.29 times more likely to be adherent than experienced users (OR 1.29, 95% CI 1.11-1.51; P < 0.001), but not more persistent. Nineteen of 98 patients discontinued fingolimod. Conclusion: The very high implementation rates displayed in this sample of MS patients suggest that facilitation by health care professionals in preserving adherence behavior may be sufficient for the majority of patients. Targeted interventions should focus on patients who are nonadherent or who stop treatment without intention to reinitiate.
    • The association between cognition and dual-tasking among older adults: the effect of motor function type and cognition task difficulty

      Ehsani, Hossein; Mohler, Martha Jane; O’Connor, Kathy; Zamrini, Edward; Tirambulo, Coco; Toosizadeh, Nima; Univ Arizona, Dept Biomed Engn; Univ Arizona, Arizona Ctr Aging, Dept Med; Univ Arizona, Div Geriatr Gen Internal Med & Palliat Med, Dept Med (DOVE MEDICAL PRESS LTD, 2019-04)
      Background: Dual-task actions challenge cognitive processing. The usefulness of objective methods based on dual-task actions to identify the cognitive status of older adults has been previously demonstrated. However, the properties of select motor and cognitive tasks are still debatable. We investigated the effect of cognitive task difficulty and motor task type (walking versus an upper-extremity function [UEF]) in identifying cognitive impairment in older adults. Methods: Older adults (>= 65 years) were recruited, and cognitive ability was measured using the Montreal Cognitive Assessment (MoCA). Participants performed repetitive elbow flexion under three conditions: 1) at maximum pace alone (Single-task); and 2) while counting backward by ones (Dual-task 1); and 3) threes (Dual-task 2). Similar single- and dual-task gait were performed at normal speed. Three-dimensional kinematics were measured for both motor functions using wearable sensors. Results: One-hundred older adults participated in this study. Based on MoCA score,20, 21 (21%) of the participants were considered cognitively impaired (mean age = 86 +/- 10 and 85 +/- 5 for cognitively impaired and intact participants, respectively). Within ANOVA models adjusted with demographic information, UEF dual-task parameters, including speed and range-of-motion variability were significantly higher by 52% on average, among cognitively impaired participant (p<0.01). Logistic models with these UEF parameters plus age predicted cognitive status with sensitivity, specificity, and area under curve (AUC) of 71%, 81% and 0.77 for Dual-task 1. The corresponding values for UEF Dual-task 2 were 91%, 73% and 0.81, respectively. ANOVA results were non-significant for gait parameters within both dual-task conditions (p>0.26). Conclusion: This study demonstrated that counting backward by threes within a UEF dual-task experiment was a pertinent and challenging enough task to detect cognitive impairment in older adults. Additionally, UEF was superior to gait as the motor task component of the dual-task. The UEF dual-task could be applied as a quick memory screen in a clinical setting.
    • Bedside echo for chest pain: an algorithm for education and assessment

      Amini, Richard; Stolz, Lori; Kartchner, Jeffrey; Thompson, Matthew; Stea, Nicolas; Joshi, Raj; Adhikari, Srikar; Hawbaker, Nicolaus; Univ Arizona, Med Ctr, Dept Emergency Med (DOVE MEDICAL PRESS LTD, 2016-05)
      Background: Goal-directed ultrasound protocols have been developed to facilitate efficiency, throughput, and patient care. Hands-on instruction and training workshops have been shown to positively impact ultrasound training. Objectives: We describe a novel undifferentiated chest pain goal-directed ultrasound algorithm-focused education workshop for the purpose of enhancing emergency medicine resident training in ultrasound milestones competencies. Methods: This was a cross-sectional study performed at an academic medical center. A novel goal-directed ultrasound algorithm was developed and implemented as a model for teaching and learning the sonographic approach to a patient with undifferentiated chest pain. This algorithm was incorporated into all components of the 1-day workshop: asynchronous learning, didactic lecture, case-based learning, and hands-on stations. Performance comparisons were made between postgraduate year (PGY) levels. Results: A total of 38 of the 40 (95%) residents who attended the event participated in the chest pain objective standardized clinical exam, and 26 of the 40 (65%) completed the entire questionnaire. The average number of ultrasounds performed by resident class year at the time of our study was as follows: 19 (standard deviation [SD]=19) PGY-1, 238 (SD=37) PGY-2, and 289 (SD=73) PGY-3. Performance on the knowledge-based questions improved between PGY-1 and PGY-3. The application of the novel algorithm was noted to be more prevalent among the PGY-1 class. Conclusion: The 1-day algorithm-based ultrasound educational workshop was an engaging learning technique at our institution.
    • Beneficial effects of natural eggshell membrane versus placebo in exercise-induced joint pain, stiffness, and cartilage turnover in healthy, postmenopausal women

      Ruff, Kevin J; Morrison, Dennis; Duncan, Sarah A; Back, Matthew; Aydogan, Cem; Theodosakis, Jason; Univ Arizona, Coll Med (DOVE MEDICAL PRESS LTD, 2018-02)
      Purpose: Despite its many health benefits, moderate exercise can induce joint discomfort when done infrequently or too intensely even in individuals with healthy joints. This study was designed to evaluate whether NEM (R) (natural eggshell membrane) would reduce exercise-induced cartilage turnover or alleviate joint pain or stiffness, either directly following exercise or 12 hours post exercise, versus placebo. Patients and methods: Sixty healthy, postmenopausal women were randomly assigned to receive either oral NEM 500 mg (n=30) or placebo (n=30) once daily for two consecutive weeks while performing an exercise regimen (50-100 steps per leg) on alternating days. The primary endpoint was any statistically significant reduction in exercise-induced cartilage turnover via the biomarker C-terminal cross-linked telopeptide of type-II collagen (CTX-II) versus placebo, evaluated at 1 and 2 weeks of treatment. Secondary endpoints were any reductions in either exercise-induced joint pain or stiffness versus placebo, evaluated daily via participant questionnaire. The clinical assessment was performed on the per protocol population. Results: NEM produced a significant absolute treatment effect (TEabs) versus placebo for CTX-II after both 1 week (TEabs - 17.2%, P=0.002) and 2 weeks of exercise (TEabs - 9.9%, P=0.042). Immediate pain was not significantly different; however, rapid treatment responses were observed for immediate stiffness (Day 7) and recovery pain (Day 8) and recovery stiffness (Day 4). No serious adverse events occurred and the treatment was reported to be well tolerated by study participants. Conclusion: NEM rapidly improved recovery from exercise-induced joint pain (Day 8) and stiffness (Day 4) and reduced discomfort immediately following exercise (stiffness, Day 7). Moreover, a substantial chondroprotective effect was demonstrated via a decrease in the cartilage degradation biomarker CTX-II.
    • Cadaver-based abscess model for medical training

      Ellis, Michael; Nelson, Joseph; Kartchner, Jeffrey; Yousef, Karl; Adamas-Rappaport, William; Amini, Richard; Univ Arizona, Coll Med; Univ Arizona, Dept Surg (DOVE MEDICAL PRESS LTD, 2017-01)
      Ultrasound imaging is a rapid and noninvasive tool ideal for the imaging of soft tissue infections and is associated with a change of clinician management plans in 50% of cases. We developed a realistic skin abscess diagnostic and therapeutic training model using fresh frozen cadavers and common, affordable materials. Details for construction of the model and suggested variations are presented. This cadaver-based abscess model produces high-quality sonographic images with internal echogenicity similar to a true clinical abscess, and is ideal for teaching sonographic diagnostic skills in addition to the technical skills of incision and drainage or needle aspiration.
    • Comparison and analysis of FDA reported visual outcomes of the three latest platforms for LASIK: wavefront guided Visx iDesign, topography guided WaveLight Allegro Contoura, and topography guided Nidek EC-5000 CATz

      Moshirfar, Majid; Shah, Tirth; Skanchy, David; Linn, Steven; Kang, Paul; Durrie, Daniel; Univ Arizona, Coll Med Phoenix (DOVE MEDICAL PRESS LTD, 2017-01)
      Purpose: To compare and analyze the differences in visual outcomes between Visx iDesign Advanced WaveScan Studio (TM) System, Alcon Wavelight Allegro Topolyzer and Nidek EC-5000 using Final Fit (TM) Custom Ablation Treatment Software from the submitted summary of safety and effectiveness of the US Food and Drug Administration (FDA) data. Methods: In this retrospective comparative study, 334 eyes from Visx iDesign, 212 eyes from Alcon Contour, and 135 eyes from Nidek CATz platforms were analyzed for primary and secondary visual outcomes. These outcomes were compared via side-by-side graphical and tabular representation of the FDA data. Statistical significance was calculated when appropriate to assess differences. A P-value <0.05 was considered statistically significant. Results: The mean postoperative uncorrected distance visual acuity (UDVA) at 12 months was 20/19.25 +/- 8.76, 20/16.59 +/- 5.94, and 20/19.17 +/- 4.46 for Visx iDesign, Alcon Contoura, and Nidek CATz, respectively. In at least 90% of treated eyes at 3 months and 12 months, all three lasers showed either no change or a gain of corrected distance visual acuity (CDVA). Mesopic contrast sensitivity at 6 months showed a clinically significant increase of 41.3%, 25.1%, and 10.6% for eyes using Visx iDesign, Alcon Contoura, and Nidek CATz, respectively. Photopic contrast sensitivity at 6 months showed a clinically significant increase of 19.2%, 31.9%, and 10.6% for eyes using Visx iDesign, Alcon Contoura, and Nidek CATz, respectively. Conclusion: FDA data for the three platforms shows all three were excellent with respect to efficacy, safety, accuracy, and stability. However, there are some differences between the platforms with certain outcome measurements. Overall, patients using all three lasers showed significant improvements in primary and secondary visual outcomes after LASIK surgery.
    • Complex management of a patient with refractory primary erythromelalgia lacking a SCN9A mutation

      Low, Sarah; Robbins, Wendye; Tawfik, Vivianne; Univ Arizona, Coll Med, Dept Internal Med, Banner Univ Med Ctr (DOVE MEDICAL PRESS LTD, 2017-04)
      A 41-year-old woman presented with burning and erythema in her extremities triggered by warmth and activity, which was relieved by applying ice. Extensive workup was consistent with adult-onset primary erythromelalgia (EM). Several pharmacological treatments were tried including local anesthetics, capsaicin, ziconotide, and dantrolene, all providing 24-48 hours of relief followed by symptom flare. Interventional therapies, including peripheral and sympathetic ganglion blocks, also failed. Thus far, clonidine and ketamine have been the only effective agents for our patient. Genetic testing was negative for an EM-associated mutation in the SCN9A gene, encoding the Na(V)1.7 sodium channel, suggesting a mutation in an alternate gene.
    • Development of a novel sports medicine rotation for emergency medicine residents

      Waterbrook, Anna; Pritchard, Gail; Lane, Allison; Stoneking, Lisa; Koch, Bryna; McAtee, Robert; Min, Alice; Prior, Jessica; Farrell, Isaac; McNulty, Holly; et al. (DOVE MEDICAL PRESS LTD, 2016-04)
      Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM) does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC) and University Campus (UC). The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the total number of dislocation reductions performed by each graduating resident at both programs over the last 5 years. While all residents in both programs exceeded the ten dislocation reductions required for graduation, residents on the sports medicine rotation had a statistically significant higher rate of satisfaction of their educational experience when compared to the traditional orthopedics rotation. All SC residents successfully completed their sports medicine rotation, had completed postrotation evaluations by attending physicians, and had no duty hour violations while on sports medicine. In our experience, a sports medicine rotation is an effective alternative to the traditional orthopedics rotation for EM residents.
    • Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial

      Sit, Janet WH; Chair, Sek Ying; Choi, KC; Chan, Carmen WH; Lee, Diana TF; Chan, Aileen WK; Cheung, Jo LK; Tang, Siu Wai; Chan, Po Shan; Taylor-Piliae, Ruth E; et al. (DOVE MEDICAL PRESS LTD, 2016-10)
      Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG = 105, IG = 105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P, 0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.
    • Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

      Stoneking, L R; Waterbrook, A L; Garst Orozco, J; Johnston, D; Bellafiore, A; Davies, C; Nuño, T; Fatás-Cabeza, J; Beita, O; Ng, V; et al. (DOVE MEDICAL PRESS LTD, 2016-08-05)
      After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.
    • Effects of the iron oxide nanoparticle Molday ION Rhodamine B on the viability and regenerative function of neural stem cells: relevance to clinical translation

      Madhavan, Lalitha; Umashankar, Abhishek; Corenblum, Mandi; Ray, Sneha; Yoshimaru, Eriko; Trouard, Theodore; Valdez, Mike; Univ Arizona, Dept Neurol; Univ Arizona, Neurosci & Cognit Sci Undergrad Program, Undergrad Biol Res Program; Univ Arizona, Dept Biomed Engn; et al. (DOVE MEDICAL PRESS LTD, 2016-04)
      An essential component of developing successful neural stem cell (NSC)-based therapies involves the establishment of methodologies to noninvasively monitor grafted NSCs within brain tissues in real time. In this context, ex vivo labeling with ultrasmall superparamagnetic iron oxide (USPIO) particles has been shown to enable efficient tracking of transplanted NSCs via magnetic resonance imaging (MRI). However, whether and how USPIO labeling affects the intrinsic biology of NSCs is not thoroughly understood, and remains an active area of investigation. Here, we perform a comprehensive examination of rat NSC survival and regenerative function upon labeling with the USPIO, Molday ION Rhodamine B (MIRB), which allows for dual magnetic resonance and optical imaging. After optimization of labeling efficiency, two specific doses of MIRB (20 and 50 mu g/mL) were chosen and were followed for the rest of the study. We observed that both MIRB doses supported the robust detection of NSCs, over an extended period of time in vitro and in vivo after transplantation into the striata of host rats, using MRI and post hoc fluorescence imaging. Both in culture and after neural transplantation, the higher 50 mu g/mL MIRB dose significantly reduced the survival, proliferation, and differentiation rate of the NSCs. Interestingly, although the lower 20 mu g/mL MIRB labeling did not produce overtly negative effects, it increased the proliferation and glial differentiation of the NSCs. Additionally, application of this dose also changed the morphological characteristics of neurons and glia produced after NSC differentiation. Importantly, the transplantation of NSCs labeled with either of the two MIRB doses upregulated the immune response in recipient animals. In particular, in animals receiving the 50 mu g/mL MIRB-labeled NSCs, this immune response consisted of an increased number of CD68(+)-activated microglia, which appeared to have phagocytosed MIRB particles and cells contributing to an exaggerated MRI signal dropout in the animals. Overall, these results indicate that although USPIO particles, such as MIRB, may have advantageous labeling and magnetic resonance-sensitive features for NSC tracking, a further examination of their effects might be necessary before they can be used in clinical scenarios of cell-based transplantation.
    • Evolving to a new service-dominant logic for health care

      Joiner, Keith; Lusch, Robert; Univ Arizona, Coll Med, Dept Internal Med; Univ Arizona, Dept Econ, Eller Coll Management; Univ Arizona, Dept Mkt, Eller Coll Management; Univ Arizona, McGuire Ctr Entrepreneurship, Eller Coll Management (DOVE MEDICAL PRESS LTD, 2016-01)
      Consumers value health and a sense of well-being. The health care system cannot supply these values, but only "products" such as hospitalization, ambulatory care, medications, procedures, and preventative care. These components of health care represent neither the value within the system nor the desired final output. Nonetheless, the health care system has focused inordinately on the products, to the point of suggesting that they have intrinsic value. We link this situation to the concept of goods-dominant logic, which has dominated business and managerial thinking since the Industrial Revolution. We then explain why and how moving to service-dominant logic is essential for consumers and providers to better cocreate value from products which are not intrinsically valuable. The challenge of cocreating value is confounded by information asymmetry, and by the myriad factors in the health care ecosystem that contribute to or detract from health and well-being. A new lexicon, emanating from service-dominant logic, is suggested to facilitate the move away from a goods-dominant mindset.
    • Extent and Factors Associated with Adherence to Antidepressant Treatment During Acute and Continuation Phase Depression Treatment Among Older Adults with Dementia and Major Depressive Disorder

      Bhattacharjee, Sandipan; Lee, Jeannie K; Vadiei, Nina; Patanwala, Asad E; Malone, Daniel C; Knapp, Shannon M; Lo-Ciganic, Wei-Hsuan; Burke, William J; Univ Arizona, Coll Pharm, Dept Pharm Practice & Sci; Univ Arizona, Stat Consulting Lab, Bio5 Inst (DOVE MEDICAL PRESS LTD, 2020-06-08)
      Purpose: Little is known about adherence to antidepressant treatment during acute and continuation phase of depression among older adults with dementia and newly diagnosed major depressive disorders (MDD). This study estimated the extent of and factors associated with adherence to acute and continuation phase antidepressant treatment among older adults with dementia and newly diagnosed MDD. Methods: We conducted a retrospective cohort study using the Medicare 5% sample claims data (2012-2013) among older adults (age >= 65 years) with dementia who were newly diagnosed with MDD. Intake period of our study was from 01-May-2012 through 30April-2013. The dependent variables of this study were acute and continuation phase depression treatment adherence. Factors associated with acute and continuation phase antidepressant treatment adherence were identified using multiple logistic regression analyses. Results: The final study sample consisted of 6239 [adherent: N=4644 (74.44%)] and 5617 [adherent: N=3584 (63.81%)] older adults with dementia and MDD during the acute and continuation phase treatment, respectively. During the acute phase, only race/ethnicity was significantly associated with adherence to depression treatment, whereas race/ethnicity and baseline antipsychotic use were significantly associated with adherence to depression treatment during the continuation phase. Conclusion: Approximately, 74% and 64% older adults with dementia and MDD were adherent to acute and continuation phase antidepressant treatment in this nationally representative sample of Medicare beneficiaries, and we identified several modifiable and nonmodifiable factors associated with adherence.
    • Flipped classroom for academic and career advising: an innovative technique for medical student advising

      Amini, Richard; Laughlin, Brady S.; Smith, Kathy W.; Siwik, Violet P.; Adamas-Rappaport, William J.; Fantry, George T.; Univ Arizona, Coll Med, Dept Emergency Med; Univ Arizona, Coll Med; Univ Arizona, Coll Med, Dept Psychiat; Univ Arizona, Coll Med, Dept Family & Community Med; et al. (DOVE MEDICAL PRESS LTD, 2018)
      Introduction: Career advising for medical students can be challenging for both the student and the adviser. Our objective was to design, implement, and evaluate a "flipped classroom" style advising session. Methods: We performed a single-center cross-sectional study at an academic medical center, where a novel flipped classroom style student advising model was implemented and evaluated. In this model, students were provided a document to review and fill out prior to their one-on-one advising session. Results: Ninety-four percent (95% CI, 88%-100%) of the medical students surveyed felt that the advising session was more effective as a result of the outline provided and completed before the session and that the pre-advising document helped them gain a better understanding of the content to be discussed at the session. Conclusion: Utilization of the flipped classroom style advising document was an engaging advising technique that was well received by students at our institution.
    • Goldmann tonometer error correcting prism: clinical evaluation

      McCafferty, Sean; Lim, Garrett; Duncan, William; Enikov, Eniko; Schwiegerling, Jim; Levine, Jason; Kew, Corin; Univ Arizona, Dept Ophthalmol, Coll Opt Sci; Univ Arizona, Coll Engn, Dept Aerosp & Mech (DOVE MEDICAL PRESS LTD, 2017-05)
      Purpose: Clinically evaluate a modified applanating surface Goldmann tonometer prism designed to substantially negate errors due to patient variability in biomechanics. Methods: A modified Goldmann prism with a correcting applanation tonometry surface (CATS) was mathematically optimized to minimize the intraocular pressure (IOP) measurement error due to patient variability in corneal thickness, stiffness, curvature, and tear film adhesion force. A comparative clinical study of 109 eyes measured IOP with CATS and Goldmann prisms. The IOP measurement differences between the CATS and Goldmann prisms were correlated to corneal thickness, hysteresis, and curvature. Results: The CATS tonometer prism in correcting for Goldmann central corneal thickness (CCT) error demonstrated a reduction to <+/- 2 mmHg in 97% of a standard CCT population. This compares to only 54% with CCT error <+/- 2 mmHg using the Goldmann prism. Equal reductions of similar to 50% in errors due to corneal rigidity and curvature were also demonstrated. Conclusion: The results validate the CATS prism's improved accuracy and expected reduced sensitivity to Goldmann errors without IOP bias as predicted by mathematical modeling. The CATS replacement for the Goldmann prism does not change Goldmann measurement technique or interpretation.
    • Goldmann tonometry tear film error and partial correction with a shaped applanation surface

      McCafferty, Sean; Enikov, Eniko; Schwiegerling, Jim; Ashley, Sean; Univ Arizona, Coll Med, Dept Ophthalmol; Univ Arizona, Coll Opt Sci; Univ Arizona, Coll Engn, Dept Mech & Aerosp (DOVE MEDICAL PRESS LTD, 2018-01)
      Purpose: The aim of the study was to quantify the isolated tear film adhesion error in a Goldmann applanation tonometer (GAT) prism and in a correcting applanation tonometry surface (CATS) prism. Methods: The separation force of a tonometer prism adhered by a tear film to a simulated cornea was measured to quantify an isolated tear film adhesion force. Acrylic hemispheres (7.8 mm radius) used as corneas were lathed over the apical 3.06 mm diameter to simulate full applanation contact with the prism surface for both GAT and CATS prisms. Tear film separation measurements were completed with both an artificial tear and fluorescein solutions as a fluid bridge. The applanation mire thicknesses were measured and correlated with the tear film separation measurements. Human cadaver eyes were used to validate simulated cornea tear film separation measurement differences between the GAT and CATS prisms. Results: The CATS prism tear film adhesion error (2.74 +/- 0.21 mmHg) was significantly less than the GAT prism (4.57 +/- 0.18 mmHg, p<0.001). Tear film adhesion error was independent of applanation mire thickness (R-2=0.09, p=0.04). Fluorescein produces more tear film error than artificial tears (+0.51 +/- 0.04 mmHg; p<0.001). Cadaver eye validation indicated the CATS prism's tear film adhesion error (1.40 +/- 0.51 mmHg) was significantly less than that of the GAT prism (3.30 +/- 0.38 mmHg; p=0.002). Conclusion: Measured GAT tear film adhesion error is more than previously predicted. A CATS prism significantly reduced tear film adhesion error by similar to 41%. Fluorescein solution increases the tear film adhesion compared to artificial tears, while mire thickness has a negligible effect.
    • Guidance for using pilot studies to inform the design of intervention trials with continuous outcomes

      Bell, Melanie L; Whitehead, Amy L; Julious, Steven A; Univ Arizona, Mel & Enid Zuckerman Coll Publ Hlth, Dept Epidemiol & Biostat (DOVE MEDICAL PRESS LTD, 2018-01)
      Background: A pilot study can be an important step in the assessment of an intervention by providing information to design the future definitive trial. Pilot studies can be used to estimate the recruitment and retention rates and population variance and to provide preliminary evidence of efficacy potential. However, estimation is poor because pilot studies are small, so sensitivity analyses for the main trial's sample size calculations should be undertaken. Methods: We demonstrate how to carry out easy-to-perform sensitivity analysis for designing trials based on pilot data using an example. Furthermore, we introduce rules of thumb for the size of the pilot study so that the overall sample size, for both pilot and main trials, is minimized. Results: The example illustrates how sample size estimates for the main trial can alter dramatically by plausibly varying assumptions. Required sample size for 90% power varied from 392 to 692 depending on assumptions. Some scenarios were not feasible based on the pilot study recruitment and retention rates. Conclusion: Pilot studies can be used to help design the main trial, but caution should be exercised. We recommend the use of sensitivity analyses to assess the robustness of the design assumptions for a main trial.
    • Hypoxia Suppresses High Fat Diet-Induced Steatosis And Development Of Hepatic Adenomas

      Sweeney, Nathan W; Gomes, Cecil J; De Armond, Richard; Centuori, Sara M; Parthasarathy, Sairam; Martinez, Jesse D; Univ Arizona, Dept Med, Div Pulm Allergy Crit Care & Sleep Med, Hlth Sci Ctr Sleep & Circadian Sci; Univ Arizona, Canc Biol Grad Interdisciplinary Program; Univ Arizona, Canc Ctr; Univ Arizona, Dept Cellular & Mol Med Cell & Mol Med (DOVE MEDICAL PRESS LTD, 2019-10-21)
      Purpose: Nonalcoholic fatty liver disease (NAFLD) is considered the most common form of silent liver disease in the United States and obesity is associated with increased risk of NAFLD. Obstructive sleep apnea (OSA) which is common in obese individuals is associated with a greater incidence of NAFLD, which in turn, increases the risk for hepatocellular carcinoma (HCC). It is unclear how obesity, OSA and NAFLD interrelate nor how they collectively contribute to an increased risk for developing HCC. Patients and methods: Male BALB/c mice were exposed to diethylnitrosamine and phenobarbital followed by 48 weeks of either standard chow diet (chow), chow with hypoxia, high-fat diet, or a combination of hypoxia and high-fat diet. We noninvasively monitored tumor development using micro-CT imaging. We tracked the total weight gained throughout the study. We evaluated liver histology, fat accumulation, carbonic anhydrase 9 (CA9) and hypoxia-inducible factor 1-alpha (HIF-1 alpha) expression, as well as, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Results: A high-fat diet without hypoxia led to the development of obesity that induced hepatic steatosis and promoted tumorigenesis. Animals on a high-fat diet and that were also exposed to hypoxia had lower total weight gain, lower steatosis, lower serum AST and ALT levels, and fewer number of hepatic adenomas than a high-fat diet without hypoxia. Conclusion: These findings suggest that hypoxia abrogates obesity, hepatic steatosis, and hepatic tumorigenesis related to a high-fat diet.
    • Integrated mitochondrial function and cancer-related fatigue in men with prostate cancer undergoing radiation therapy

      Hsiao, Chao-Pin; Chen, Mei-Kuang; Daly, Barbara; Hoppel, Charles; Univ Arizona, Dept Psychol (DOVE MEDICAL PRESS LTD, 2018-01-01)
      Introduction: Fatigue experienced by cancer patients is one of the most common symptoms with the greatest adverse effect on quality of life, but arguably the least understood. The purpose of this study was to explore changes in integrated mitochondrial function and fatigue in non-metastatic prostate cancer patients receiving localized radiation therapy (XRT). Materials and methods: We proposed a mitochondria' bioenergetics mechanism of radiation-induced fatigue linking impaired oxidative phosphorylation (OXPIIOS) through complex III and decreased adenosine triphosphate (ATP) production as consequences of XRT. Integrated mitochondria' function was measured as mitochondria' OXPHOS from patients' peripheral blood mononuclear cells. Fatigue was measured using the revised Piper Fatigue Scale. Data were collected before (day 0) and at day 21 of XRT. Results: At day 21 of XRT, fatigue symptom intensified in 15 prostate cancer patients (P<0.05). Mitochondrial OXPHOS complex III-linked and uncoupled complex III rates were significantly decreased in mononuclear cells at day 21 during XRT compared to that before XRT (P<0.05). Additionally, increased fatigue appeared to be associated with decreased OXPHOS complex Ill-linked respiration in patients undergoing XRT. Conclusion: Fatigue was associated with OXPHOS complex III-linked oxidation and a defect in oxidation starting at complex III in mononuclear cell mitochondria was revealed at day 21 of XRT in 15 prostate cancer patients. Complex III is a potential target for pharmacological and, in particular, nutraceutical interventions, eg, Q10, for design of interventions for CRF.