• Academic Medical Centers as Innovation Ecosystems

      Silva, Patrick J.; Ramos, Kenneth S.; Univ Arizona, Biomed Corp Alliances; Univ Arizona, Hlth Sci; Univ Arizona, Precis Hlth Sci; Univ Arizona, Ctr Appl Genet & Genom Med (LIPPINCOTT WILLIAMS & WILKINS, 2018-08)
      Innovation ecosystems tied to academic medical centers (AMCs) are inextricably linked to policy, practices, and infrastructure resulting from the Bayh-Dole Act in 1980. Bayh-Dole smoothed the way to patenting and licensing new drugs and, to some degree, medical devices and diagnostic reagents. Property rights under Bayh-Dole provided significant incentive for industry investments in clinical trials, clinical validation, and industrial scale-up of products that advanced health care. Bayh-Dole amplified private investment in biotechnology drug development and, from the authors' perspective, did not significantly interfere with the ability of AMCs to produce excellent peer-reviewed science. In today's policy environment, it is increasingly difficult to patent and license products based on the laws of natureas the scope of patentability has been narrowed by case law and development of a suitable clinical and business case for the technology is increasingly a gating consideration for licensees. Consequently, fewer academic patents are commercially valuable. The role of technology transfer organizations in engaging industry partners has thus become increasingly complex. The partnering toolbox and organizational mandate for commercialization must evolve toward novel collaborative models that exploit opportunities for future patent creation (early drug discovery), data exchange (precision medicine using big data), cohort assembly (clinical trials), and decision rule validation (clinical trials). These inputs contribute to intellectual property rights, and their clinical exploitation manifests the commercialization of translational science. New collaboration models between AMCs and industry must be established to leverage the assets within AMCs that industry partners deem valuable.
    • Allergic Contact Dermatitis to Mastisol Adhesive Used for Skin Closure in Orthopedic Surgery: A Case Report

      Ezeh, Ugonna E; Price, Harper N; Belthur, Mohan V; Univ Arizona, Dept Child Hlth, Coll Med (LIPPINCOTT WILLIAMS & WILKINS, 2018-09-01)
      We report on a rare case of allergic contact dermatitis (ACD) from Mastisol liquid adhesive. We are aware of a few reports in the medical literature, but none describes an allergic reaction during the third exposure to the offending agent. Our patient was a 20-year-old Caucasian man with a history of cerebral palsy spastic hemiplegia who underwent single-event multilevel soft-tissue surgery to optimize function of his left upper extremity. He developed a severe cutaneous allergic reaction after his third exposure to Mastisol. He was subsequently admitted to the inpatient service and managed without further complications by a multidisciplinary team comprising orthopedics, pediatrics, and dermatology. We discuss the etiology, clinical features, diagnosis, and treatment of this entity, and we also review relevant available literature on the subject. We aim at creating further awareness of allergic reactions because of exposure to available skin-prepping and wound-dressing agents.
    • American Heart Association Council on Cardiovascular and Stroke Nursing Liaison Report From the Development Committee

      Davis, Leslie L; Fink, Anne M; Taylor-Piliae, Ruth E; Univ Arizona, Coll Nursing (LIPPINCOTT WILLIAMS & WILKINS, 2019-09-01)
    • American Indian Reservations and COVID-19: Correlates of Early Infection Rates in the Pandemic

      Rodriguez-Lonebear, Desi; Barceló, Nicolás E; Akee, Randall; Carroll, Stephanie Russo; Univ Arizona, Sch Sociol; Univ Arizona, Community Environm & Policy; Univ Arizona, Native Nat Inst, Udall Ctr Studies Publ Policy (LIPPINCOTT WILLIAMS & WILKINS, 2020-07)
      Objective: To determine the household and community characteristics most closely associated with variation in COVID-19 incidence on American Indian reservations in the lower 48 states. Design: Multivariate analysis with population weights. Setting: Two hundred eighty-seven American Indian Reservations and tribal homelands (in Oklahoma) and, as of April 10, 2020, 861 COVID-19 cases on these reservation lands. Main Outcome Measures: The relationship between rate per 1000 individuals of publicly reported COVID-19 cases at the tribal reservation and/or community level and average household characteristics from the 2018 5-Year American Community Survey records. Results: By April 10, 2020, in regression analysis, COVID-19 cases were more likely by the proportion of homes lacking indoor plumbing (10.83,P= .001) and were less likely according to the percentage of reservation households that were English-only (-2.43,P= .03). Household overcrowding measures were not statistically significant in this analysis (-6.40,P= .326). Conclusions: Failure to account for the lack of complete indoor plumbing and access to potable water in a pandemic may be an important determinant of the increased incidence of COVID-19 cases. Access to relevant information that is communicated in the language spoken by many reservation residents may play a key role in the spread of COVID-19 in some tribal communities. Household overcrowding does not appear to be associated with COVID-19 infections in our data at the current time. Previous studies have identified household plumbing and overcrowding, and language, as potential pandemic and disease infection risk factors. These risk factors persist. Funding investments in tribal public health and household infrastructure, as delineated in treaties and other agreements, are necessary to protect American Indian communities.
    • Angiotensin-(1-7)/Mas receptor as an antinociceptive agent in cancer-induced bone pain

      Forte, Brittany L.; Slosky, Lauren M.; Zhang, Hong; Arnold, Moriah R.; Staatz, William D.; Hay, Meredith; Largent-Milnes, Tally M.; Vanderah, Todd W.; Univ Arizona, Coll Med, Dept Pharmacol; Univ Arizona, Coll Med, Dept Physiol, Evelyn McKnight Brain Inst (LIPPINCOTT WILLIAMS & WILKINS, 2016-12)
      Many cancerous solid tumors metastasize to the bone and induce pain (cancer-induced bone pain [CIBP]). Cancer-induced bone pain is often severe because of enhanced inflammation, rapid bone degradation, and disease progression. Opioids are prescribed to manage this pain, but they may enhance bone loss and increase tumor proliferation, further compromising patient quality of life. Angiotensin-(1-7) (Ang-(1-7)) binds and activates the Mas receptor (MasR). Angiotensin-(1-7)/MasR activation modulates inflammatory signaling after acute tissue insult, yet no studies have investigated whether Ang-(1-7)/MasR play a role in CIBP. We hypothesized that Ang-(1-7) inhibits CIBP by targeting MasR in a murine model of breast CIBP. 66.1 breast cancer cells were implanted into the femur of BALB/cAnNHsd mice as a model of CIBP. Spontaneous and evoked pain behaviors were assessed before and after acute and chronic administration of Ang-(1-7). Tissues were collected from animals for ex vivo analyses of MasR expression, tumor burden, and bone integrity. Cancer inoculation increased spontaneous pain behaviors by day 7 that were significantly reduced after a single injection of Ang-(1-7) and after sustained administration. Preadministration of A-779 a selective MasR antagonist prevented this reduction, whereas pretreatment with the AT(2) antagonist had no effect; an AT(1) antagonist enhanced the antinociceptive activity of Ang-(1-7) in CIBP. Repeated Ang-(1-7) administration did not significantly change tumor burden or bone remodeling. Data here suggest that Ang-(1-7)/MasR activation significantly attenuates CIBP, while lacking many side effects seen with opioids. Thus, Ang-(1-7) may be an alternative therapeutic strategy for the nearly 90% of patients with advanced-stage cancer who experience excruciating pain.
    • Artifactual Hepatic Metastasis on FDG PET/CT Secondary to Cryoablation for Adrenal Metastasis

      Frankl, Joseph; Eshghi, Naghmehossadat; Lundeen, Tamara F.; Kuo, Phillip H.; Univ Arizona, Coll Med; Univ Arizona, Dept Med Imaging (LIPPINCOTT WILLIAMS & WILKINS, 2018-02)
      A 65-year-old woman with metastatic lung cancer was referred for CT-guided cryoablation of a right adrenal metastasis. For cryoablation, probes were placed into the adrenal region. FDG PET/CT 3 months later showed new activity in hepatic segment 6 initially suspected to be metastasis. Proximity of the hepatic lesion to the adrenal metastasis was a strange coincidence and prompted review of imaging from the cryoablation. CT showed the probe entered the liver, and postablation image demonstrated injury to the liver adjacent to the adrenal metastasis. Careful review of treatment history and imaging from ablation procedures are important to avoid this pitfall.
    • Can Sural Fasciocutaneous Flaps Be Effective in Patients Older Than 65?

      Roberts, Haydn J.; DeSilva, Gregory L.; Univ Arizona, Dept Orthopaed (LIPPINCOTT WILLIAMS & WILKINS, 2020-04)
      Background Many studies have evaluated the reverse sural fasciocutaneous flap for coverage of wounds on the distal lower extremity, and many of these have focused on younger, healthy patients. However, to our knowledge, there has been no dedicated study focusing on older patients. We believe there is a generalized concern about performing these procedures in older patients because of microvascular changes associated with aging. Questions/purposes (1) What is the likelihood of flap survival in a small series of patients older than 64 years who underwent reverse sural artery fasciocutaneous flap for coverage of lower extremity wounds? (2) What additional procedures did patients undergo after treatment with this flap? Methods From 2009 to 2018, we identified 16 patients, 64 years or older, who underwent a retrograde sural fasciocutaneous flap. Patients were a mean (range) age of 71.5 years (64 to 87). The average size of the flaps was 30 cm(2) (range 12 to 64 cm(2)). The reverse sural artery flap was indicated when the skin could not be closed primarily and there was not a suitable vascularized bed of tissue for a split-thickness skin graft. All patients underwent a wide-based pedicle (3 cm to 4 cm), reverse sural artery fasciocutaneous flap with all but one completed in a "flap delay" manner, between 2 to 7 days, and without the use of microsurgery or doppler. Thirteen flaps were done to cover wounds that occurred over fractures while three were performed to cover chronic wounds. We performed a retrospective review of the electronic health record to ascertain patient comorbidities, age, timing of coverage, and size of the wound. Results In all, 94% of flaps (15 of 16) survived with 100% viability. One flap had 30% skin necrosis at the distal tip. The flap ultimately healed with in-office wound care, and epithelization occurred over the intact fascia. A total of five additional procedures were performed in five patients. Although the flap ultimately healed, an 87-year-old patient with partial flap necrosis ultimately elected for below-knee amputation for a persistent tibial infected nonunion. Another patient, despite a healed flap, eventually underwent a below-knee amputation 3 years later for a chronic osteomyelitis present before undergoing the reverse sural flap. One patient developed a pseudomonal infection of their Gustillo-Anderson IIIB open tibia fracture, resulting in a surgical procedure for debridement, after which the flap healed. Two patients underwent underlying hardware removal to relieve wound tension and allow for complete flap healing. No patients underwent further coverage procedures. Conclusions In this small series, we found fewer complications than have been observed in prior studies, despite our series consisting solely of higher-risk, older patients. We believe this may have been attributable to the period of delay before placing the flap, which has been previously associated with higher flap survival and which allows for an extra recipient-site debridement. We believe this procedure can be performed by appropriately trained orthopaedic surgeons because it does not need microsurgery.
    • Cardiovascular Health in American Indians and Alaska Natives: A Scientific Statement From the American Heart Association

      Breathett, Khadijah; Sims, Mario; Gross, Marie; Jackson, Elizabeth A; Jones, Emily J; Navas-Acien, Ana; Taylor, Herman; Thomas, Kevin L; Howard, Barbara V; Univ Arizona (LIPPINCOTT WILLIAMS & WILKINS, 2020-06-23)
      Background: Cardiovascular disease (CVD) is the leading cause of death among American Indians and Alaska Natives. Over the past 50 years, the prevalence of CVD has been rising among American Indians and Alaska Natives. The objective of this statement is to summarize population-level risk factors and management techniques tailored for the American Indian and Alaska Native populations. Methods: PubMed/MEDLINE, the Centers for Disease Control and Prevention, and the annual Heart Disease and Stroke Statistics report from the American Heart Association were used to identify risk factors and interventions specific to American Indians and Alaska Natives. Results: Diabetes mellitus is a major contributor to disproportionately higher rates of coronary heart disease among American Indians and Alaska Natives compared with other racial and ethnic groups. Additional risk factors for CVD include low-density lipoprotein cholesterol levels, hypertension, renal disease, age, and sex. Smoking and exposure to toxic metals are risk factors for some subpopulations. A quarter of American Indians live below the federal poverty line, and thus, low socioeconomic status is an important social determinant of cardiovascular health. Community-based interventions have reduced CVD risk in American Indians and Alaska Natives. Underreporting of American Indian and Alaska Native race could underestimate the extent of CVD in this population. Conclusions: Prevention and treatment of CVD in American Indians and Alaska Natives should focus on control of risk factors and community-based interventions that address social determinants of health, particularly among individuals with diabetes mellitus. Accurate reporting of race/ethnicity is encouraged to address race-specific risk factors.
    • Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment

      Wheat, Joseph; Myint, Thein; Guo, Ying; Kemmer, Phebe; Hage, Chadi; Terry, Colin; Azar, Marwan M.; Riddell, James; Ender, Peter; Chen, Sharon; et al. (LIPPINCOTT WILLIAMS & WILKINS, 2018-03)
      Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment. While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.
    • Changes in the ABCD Keratoconus Grade After Intracorneal Ring Segment Implantation

      Sedaghat, Mohammad-Reza; Momeni-Moghaddam, Hamed; Belin, Michael W; Zarei-Ghanavati, Siamak; Akbarzadeh, Reyhaneh; Sabzi, Fatemeh; Yekta, Abbas-Ali; Sadeghi Allahabadi, Javad; Univ Arizona, Dept Ophthalmol & Vis Sci (LIPPINCOTT WILLIAMS & WILKINS, 2018-11-01)
      To assess the changes in the ABCD keratoconus staging system 6 months after intracorneal ring segment implantation. Fifty eyes of 50 patients with keratoconus who were implanted with the Keraring (Mediphacos, Belo Horizonte, Brazil) using the femtosecond laser were assessed. Preoperative and postoperative assessments included determination of distance uncorrected visual acuity and distance corrected visual acuity (DCVA), refraction, and Scheimpflug tomography with the Pentacam HR. In the ABCD keratoconus staging system, the elements A, B, C, and D stand for anterior and posterior radii of curvature in a 3.0-mm zone centered on the thinnest point (TP), corneal thickness at the TP, and DCVA, respectively. Keraring implantation produced significant flattening changes (preoperatively vs. postoperatively) in the anterior (6.60 ± 0.48 vs. 7.22 ± 0.57 mm, P < 0.001) and posterior (4.99 ± 0.47 vs. 5.16 ± 0.53 mm, P = 0.002) radii of curvature of the 3-mm zone centered on the corneal TP associated with a statistically significant improvement in the DCVA (0.56 ± 0.24 vs. 0.70 ± 0.22 in the decimal notation, P = 0.001) with no significant change in the corneal thickness at the TP (P = 0.285). The most changes occurred in element A of the ABCD keratoconus classification. Also, a 1-stage change was observed for element B, whereas elements C and D did not show changes in their postoperative stages after ring implantation. ABCD keratoconus staging before ring implantation was A2B3C2D1 and changed to A1B2C2D1 6 months after surgery. The ABCD staging system provides a more comprehensive guide that better illustrates the structural changes and visual acuity as one aspect of visual function after the implantation of the intrastromal corneal ring segments.
    • Corneal Cross-Linking: Current USA Status: Report From the Cornea Society

      Belin, Michael W; Lim, Li; Rajpal, Rajesh K; Hafezi, Farhad; Gomes, Jose A P; Cochener, Beatrice; Univ Arizona, Dept Ophthalmol & Vis Sci (LIPPINCOTT WILLIAMS & WILKINS, 2018-10-01)
      The initial published clinical report on riboflavin/ultraviolet A corneal cross-linking (CXL) for treatment of progressive keratoconus dates back to 2003. CXL has since then been widely used outside the United States for treatment of progressive keratoconus and post-laser in situ keratomileusis ectasia. The Food and Drug Administration (FDA) approved Avedro Inc.'s corneal cross-linking system (KXL) for treatment of patients with progressive keratoconus and post-laser in situ keratomileusis ectasia in April 2016. The procedure is not currently approved for stable keratoconus. There are 2 FDA-approved topical ophthalmic solutions for use in CXL. Riboflavin 5'-phosphate in 20% dextran ophthalmic solution 0.146% (Photrexa Viscous) and Riboflavin 5'-phosphate ophthalmic solution 0.146% (Photrexa) are intended for use with the KXL system. Photrexa Viscous is used in all CXL procedures, whereas Photrexa is indicated for use when the corneal stroma is thinner than 400 µm after completion of the Photrexa Viscous induction period. The FDA-approved procedure using the Dresden protocol (UV-A, 3 mW/cm for 30 min) induces cytologic and morphologic changes in the anterior 250 to 300 µm of the corneal stroma. It has been believed that a minimum thickness of 400 μm was necessary to protect the corneal endothelium from potential damage. The CXL procedure using the standard Dresden protocol is established as the gold standard for treatment of progressive keratoconus. CXL treatment is indicated for a list of conditions ranging from corneal ectasia to infectious keratitis. Newer protocols, treatment regimens, and expanded indications will require further refinements, investigations, and long-term studies.
    • Council on Cardiovascular and Stroke Nursing Liaison Report: Pediatric Cardiovascular Nursing Committee

      Lambert, Linda M; Pike, Nancy A; Taylor-Piliae, Ruth E; Fink, Anne M; Univ Arizona, Coll Nursing (LIPPINCOTT WILLIAMS & WILKINS, 2020-09)
    • COVID-19 and Avoiding Ibuprofen. How Good Is the Evidence?

      Kutti Sridharan, Gurusaravanan; Kotagiri, Rajesh; Chandiramani, Vijay H; Mohan, Babu P; Vegunta, Rathnamitreyee; Vegunta, Radhakrishna; Rokkam, Venkata R P; Univ Arizona, Banner Univ Med Ctr, Dept Internal Med (LIPPINCOTT WILLIAMS & WILKINS, 2020-07)
      Ibuprofen is an over-the-counter medication that is used widely for the treatment of pain and fever during COVID-19 pandemic. A concern was raised regarding the safety of ibuprofen use because of its role in increasing ACE2 levels within the Renin-Angiotensin-Aldosterone system. ACE2 is the coreceptor for the entry of SARS-CoV-2 into cells, and so, a potential increased risk of contracting COVID-19 disease and/or worsening of COVID-19 infection was feared with ibuprofen use. However, available data from limited studies show administration of recombinant ACE2 improves lung damage caused by respiratory viruses, suggesting ibuprofen use may be beneficial in COVID-19 disease. At this time, there is no supporting evidence to discourage the use of ibuprofen.
    • Daily intermittent fasting in mice enhances morphine-induced antinociception while mitigating reward, tolerance, and constipation

      Duron, David I; Hanak, Filip; Streicher, John M; Univ Arizona, Coll Med, Dept Pharmacol (LIPPINCOTT WILLIAMS & WILKINS, 2020-10)
      The opioid epidemic has plagued the United States with high levels of abuse and poor quality of life for chronic pain patients requiring continuous use of opioids. New drug discovery efforts have been implemented to mitigate this epidemic; however, new medications are still limited by low efficacy and/or high side effect and abuse potential. Intermittent fasting (IF) has recently been shown to improve a variety of pathological states, including stroke and neuroinflammation. Numerous animal and human studies have shown the benefits of IF in these disease states, but not in pain and opioid treatment. We thus subjected male and female CD-1 mice to 18-hour fasting intervals followed by 6-hour feed periods with standard chow for 1 week. Mice that underwent this diet displayed an enhanced antinociceptive response to morphine both in efficacy and duration using thermal tail-flick and postoperative paw incision pain models. While showing enhanced antinociception, IF mice also demonstrated no morphine reward and reduced tolerance and constipation. Seeking a mechanism for these improvements, we found that the mu-opioid receptor showed enhanced efficacy and reduced tolerance in the spinal cord and periaqueductal gray, respectively, from IF mice using a(35)S-GTP gamma S coupling assay. These improvements in receptor function were not due to changes in mu-opioid receptor protein expression. These data suggest that a daily IF diet may improve the therapeutic index of acute and chronic opioid therapies for pain patients in the clinic, providing a novel tool to improve patient therapy and reduce potential abuse.
    • Development of a Plastic Surgery Supply Cart: Patient Outcomes and Quality of Care

      Fahrenkopf, Matthew P; Eichhorn, Mitchell G; Univ Arizona, Coll Med (LIPPINCOTT WILLIAMS & WILKINS, 2019-02-01)
      Background: Plastic surgeons experience unique quality issues related to the specialty nature of patient procedures. Lack of accessibility to specialty supplies is a rate-limiting variable that impacts treatment efficiency and hospital resources. This study had the following goals: (1) to develop a mobile plastic surgery cart and (2) to assess the impact of a plastic surgery cart on time to treatment of consults. Methods: Two plastic carts were developed using preexisting hospital supplies. Cart composition was designed and approved by hospital staff. A prospective study was conducted to assess overall time to treatment of patient consults throughout the hospital comparing a plastics cart versus a traditional hunt and gather methodology. One surgeon recorded time to treatment with and without the plastics cart for each consult during on-call duty hours over a 6-month period. Results: A total of 40 patients were treated for either head or neck (60%) or hand-related (40%) cases. The average time (minutes) to treatment across all procedures with the plastics cart was 3.7 +/- 1.9 versus 46.3 +/- 60.0 without the plastics cart. The maximum time to treatment was 9.5 minutes with the plastics cart and 3 hours without the plastics cart. Usage of the plastics cart resulted in a significant reduction in total time to treatment of 42.5 +/- 60.3 minutes (P < 0.0001). Conclusions: A specialty supplies cart has quality improvement implications for patients, physicians, and hospitals. Increased accessibility of specialty supplies may significantly reduce the time to treatment for plastic surgery patient consults throughout a hospital.
    • The dynamics of stress and fatigue across menopause

      Taylor-Swanson, Lisa; Wong, Alexander E.; Pincus, David; Butner, Jonathan E.; Hahn-Holbrook, Jennifer; Koithan, Mary; Wann, Kathryn; Woods, Nancy F.; Univ Arizona, Coll Nursing (LIPPINCOTT WILLIAMS & WILKINS, 2018-04)
      Objective: The objective of this study was to evaluate the regulatory dynamics between stress and fatigue experienced by women during the menopausal transition (MT) and early postmenopause (EPM). Fatigue and perceived stress are commonly experienced by women during the MT and EPM. We sought to discover relationships between these symptoms and to employ these symptoms as possible markers for resilience. Methods: Participants were drawn from the longitudinal Seattle Midlife Women's Health Study. Eligible women completed questionnaires on 60+ occasions (annual health reports and monthly health diaries) (n = 56 women). The total number of observations across the sample was 4,224. STRAW+10 criteria were used to stage women in either in late reproductive, early or late transition, or EPM stage. Change values were generated for fatigue and stress and analyzed with a multilevel structural equation model; slopes indicate how quickly a person returns to homeostasis after a perturbation. Coupling of stress and fatigue was modeled to evaluate resilience, the notion of maintaining stability during change. Results: Eligible women were on average 35 years old (SD = 4.71), well educated, employed, married or partnered, and white. Fit indices suggested the model depicts the relationships of stress and fatigue (chi(2) (9 df) = 7.638, P = 0.57, correction factor = 4.9244; root mean square error of approximation 90% CI = 0.000 <= 0.000 <= 0.032; comparative fit index = 1.00). A loss in model fit across stages suggests that the four stages differed in their dynamics (chi(2) Delta(12 df) = 21.181, P = .048). All stages showed fixed-point attractor dynamics: fatigue became less stable over time; stress generally became more stable over time. Coupling relationships of stress on fatigue show evidence for shifts in regulatory relationships with one another across the MT. Conclusions: Results are suggestive of general dysregulation via disruptions to coupling relationships of stress and fatigue across the MT. Findings support a holistic approach to understanding symptoms and supporting women during the MT.
    • Early for Everyone: Reconceptualizing Palliative Care in the Neonatal Intensive Care Unit

      Quinn, Megan; Weiss, Alyssa B; Crist, Janice D; Univ Arizona, Coll Nursing (LIPPINCOTT WILLIAMS & WILKINS, 2020-04)
      Background: Palliative care (PC) in the neonatal intensive care unit (NICU) is often provided exclusively to infants expected to die. Standards of care support providing PC early after diagnosis with any condition likely to impact quality of life. Purpose: To determine the state of early PC practice across populations to derive elements of early PC applicable to neonates and their families and demonstrate their application in practice. Search Strategy: Multiple literature searches were conducted from 2016 to 2019. Common keywords used were: palliative care; early PC; end of life, neonate; NICU; perinatal PC; pediatric PC; family-centered care; advanced care planning; palliative care consultant; and shared decision-making. Findings: Early PC is an emerging practice in adult, pediatric, and perinatal populations that has been shown to be helpful for and recommended by families. Three key elements of early PC in the NICU are shared decision-making, care planning, and coping with distress. A hypothetical case of a 24-week infant is presented to illustrate how findings may be applied. Evidence supports expansion of neonatal PC to include infants and families without terminal diagnoses and initiation earlier in care.
    • Esophageal Actinomycosis Presenting as an Obstructive Esophageal Mass

      Alshati, Ali; Appleton, Leslie; Maddux, Jacob T; Almohammedawi, Mays; Dangerfield, Benjamin; Univ Arizona, Coll Med, Dept Internal Med (LIPPINCOTT WILLIAMS & WILKINS, 2019-07-23)
      Esophageal actinomycosis is a rare type of esophageal infection, with only approximately 24 cases previously reported in the United States. Most of these cases were described as erosions or ulcers when examined endoscopically. We present a 47-year-old woman who presented with dysphagia. Endoscopy showed a lower esophageal fungating mass, mimicking a malignant mass. Although there was a high suspicion of esophageal carcinoma, biopsy results showed esophageal actinomyces infection.
    • Evaluating Changes in Caring Behaviors of Caritas Coaches Pre and Post the Caritas Coach Education Program

      Brewer, Barbara B; Anderson, Jan; Watson, Jean; Univ Arizona, Coll Nursing (LIPPINCOTT WILLIAMS & WILKINS, 2020-02)
      OBJECTIVE The aim of this study was to examine program effectiveness in changing Caritas leadership, self-caring behaviors, and perceptions of coworkers of participants who completed the Caritas Coach Education Program (CCEP). BACKGROUND The CCEP has been a highly successful education program for individuals who wish to intellectually and experientially learn to teach, live, and practice human caring theory. METHODS A pretest-posttest descriptive design was used to evaluate changes in perceptions of self-caring, caritas leadership, and coworker behaviors after completion of CCEP. RESULTS The mean scores of all measures improved significantly. CONCLUSIONS After completion of CCEP, participants demonstrated statistically significant changes in 3 caritas measures: leadership, coworker, and self-rating. Caritas Coach participants exhibited the greatest change in their self-caring scores.
    • Evaluation of Interventions to Reduce Firefighter Exposures

      Burgess, Jefferey L; Hoppe-Jones, Christiane; Griffin, Stephanie C; Zhou, Jin J; Gulotta, John J; Wallentine, Darin D; Moore, Paul K; Valliere, Eric A; Weller, Sasha R; Beitel, Shawn C; et al. (LIPPINCOTT WILLIAMS & WILKINS, 2020-04)
      Objective: Evaluate the effectiveness of firefighter exposure reduction interventions. Methods: Fireground interventions included use of self-contained breathing apparatus by engineers, entry team wash down, contaminated equipment isolation, and personnel showering and washing of gear upon return to station. Urinary polycyclic aromatic hydrocarbon metabolites (PAH-OHs) were measured after structural fire responses before and after intervention implementation. Separately, infrared sauna use following live-fire training was compared to standard postfire care in a randomized trial. Results: The fireground interventions significantly reduced mean total urinary postfire PAH-OHs in engineers (-40.4%, 95%CI -63.9%, -2.3%) and firefighters (-36.2%, 95%CI -56.7%, -6.0%) but not captains (-11.3% 95%CI -39.4%, 29.9%). Sauna treatment non-significantly reduced total mean PAH-OHs by -43.5% (95%CI -68.8%, 2.2%). Conclusions: The selected fireground interventions reduced urinary PAH-OHs in engineers and firefighters. Further evaluation of infrared sauna treatment is needed.