• Radiology Reporting Preferences of Non‐Radiologist Ordering Clinicians: Prose? Do you even list?

      Al‐Abbadi, Tabarik; The University of Arizona College of Medicine - Phoenix; Gridley, Daniel (The University of Arizona., 2017-04-20)
      The purpose of this survey was to expand the limited knowledge regarding non-radiologist physician preferences in radiology report styles and content.
    • Reproductive Life Planning in the Refugee Community: Focus on the Role of Men and Religion

      Hussain, Jawad; The University of Arizona College of Medicine - Phoenix; Johnson‐Agbakwu, Crista (The University of Arizona., 2017-05-09)
      Health literacy is the degree to which individuals have the capacity to understand basic health information and services needed to make appropriate health decisions. Women seen at Maricopa Integrated Health System (MIHS) Refugee Women’s Health Clinic (RWHC) are routinely offered education on developing a Reproductive Life Plan (RLP). In order to influence women’s reproductive health and medical decision‐making, there is a need to tailor RLP counseling to engage their male partners in the refugee community. We aimed to assess increased knowledge on preconception care related to the importance of developing a RLP, perspectives on birth spacing, and the influence of men as well as religion in medical decision‐making. We aimed to identify the refugee community’s receptivity to culturally and linguistically appropriate audiovisual modalities. Study participants comprised 120 refugees (39 men and 81 women) including couples, across the respective target languages with pre‐ and post‐Likert scale surveys assessing perspectives on RLP, birth spacing, the role of religion, and readiness for behavior change. Summary statistics examined changes in pre‐ and post‐Likert scale survey responses with responses dichotomized as Strongly agree/Agree compared against all other responses. A higher frequency of male respondents agreed about knowing what RLP means in the posttest relative to pretest (71.8% to 89.7%, P = 0.016) as well as 'Not having children…' (41% to 64.1%, P=0.035). Female respondents were more likely to agree to 'Know what RLP means' (76.5% to 86.4%, P =0.039) and 'Having a baby soon after…' (65.4% to 76.5%, P =0.035) after the training. They also were less likely to agree that 'RLP is about birth control' (71.6% to 59.3%, P =0.021). Amongst Muslim participants, we found improvement in knowing what RLP means (65.5% to 87.9%) and that it is important for men to have a RLP (67.2% to 84.5%). Cronbach’s alpha was used to measure internal inconsistency, with most values less than 0.5 and deemed unacceptable. Only one value, birth spacing, was > 0.6 and deemed questionable. There was the same degree of concordance, yet there also was discordance in the direction of opinions between women and men pre vs post‐test answers. When comparing couples pre and posttest, there was no significant differences observed across genders. This is the first reported U.S. initiative to provide a culturally and linguistically appropriate preconception health education. Project had demonstrated ability to mobilize several ethnic communities around the RLP. Respondents among both genders were more likely to agree about knowing what RLP means. The most challenging aspect of our community mobilization efforts was recruiting a larger sample size. Another limitation was the use of the Likert scale in a population with low literacy as there were some discrepancies in responses to negatively‐worded questions. Future studies could use a visual analog scale of smiley faces to assist those with limited literacy and incorporate a more global feel.
    • Retrospective Analysis of Injuries Sustained In Vehicle Front‐ and Back‐Overs in a Level I Pediatric Trauma Center

      Bendall, William Bryson; The University of Arizona College of Medicine - Phoenix; van Leeuwen, Kathleen (The University of Arizona., 2017-05-26)
      Motor vehicle accidents involving pedestrians are some of the most common and lethal forms of injury for children in the United States. Among younger children, a common mechanism of action for severe trauma is when a vehicle runs over the child in a forward or backward motion at low speed resulting in a blunt crush injury. This typically occurs in non‐traffic settings including driveways, sidewalks, and roadways. Such incidents have been referred to in many different ways in the literature but for the purposes of this paper will be referred to as low speed vehicle run‐overs. This is a retrospective chart review carried out at Phoenix Children’s Hospital in affiliation with the University of Arizona College of Medicine‐Phoenix that categorizes and examines the injuries sustained by patients involved in low speed vehicle runovers occurring between December 2007 and August 2013. Fifty‐five pediatric patients were included with a median age of 24 months and 6 of these patients were fatally injured. Internal injuries were common overall and significantly more common in children ≤24months. Over half of the cohort sustained fractures, with a 24% incidence of skull fractures. All fatalities were the result of traumatic brain injury. Twenty percent of victims required operative intervention. It was concluded that the severity of these types of incidents varies from minimal to life threatening and best care requires close and thorough evaluation by the trauma and emergency department teams.
    • The Role of Gilt in the Cross Presentation of the Melanoma Antigen gp100

      Johnson, Kenneth; The University of Arizona College of Medicine - Phoenix; Hastings, Karen Taraszka (The University of Arizona., 2017-05-10)
      In this study we examine the utility of using CD8+ T cell hybridomas to measure the ability of bone marrow dendritic cells (BMDCs) to internalize cancer proteins and display them to cytotoxic T cells, a process termed cross‐presentation. We test the ability of a newly generated T cell hybridoma called BUSA14 to detect cross‐presentation of the melanoma antigen gp100. BUSA14 produces a dose‐dependent response to human and mouse gp100 peptides. However, cross‐presentation of gp100 by BMDCs using SK‐MEL‐28 human melanoma cell lysates or direct MHC class I‐restricted presentation by B16 murine melanoma cells was not detected. Both SKMEL‐28 and B16 cells express gp100 protein by immunoblot, and gp100 as a membrane bound protein may be concentrated by cell fractionation techniques. We validated our crosspresentation assay with another T cell hybridoma B3Z to detect cross‐presentation of the model antigen ovalbumin. Lastly, we determined that although BUSA14 expresses the coreceptor CD8, BUSA14 lacks CD3 expression, which likely impairs the ability of this hybridoma to respond to engagement of the T cell receptor and contributes to the inability to detect presentation of native gp100 protein. To resolve these issues, we plan to use primary gp100‐specific T cells from pmel mice expressing the same T cell receptor as the BUSA14 hybridoma to detect presentation of gp100 protein. Ultimately, we plan to evaluate the requirements for cross‐presentation of gp100, including a role for gamma‐interferon‐inducible lysosomal thiol reductase (GILT), a disulfide bond reducing enzyme.
    • The Seasonality of Eosinophilic Esophagitis Flares in Children and Adolescents in Arizona

      Manley, Kelsi; The University of Arizona College of Medicine - Phoenix; Williams, Dana (The University of Arizona., 2017-05-11)
      Aeroallergens are implicated in the pathogenesis of eosinophilic esophagitis, which has a recurrent or relapsing nature. We aim to determine the incidence of seasonal disease recurrence, referred to as flares, of eosinophilic esophagitis in patients in Arizona with eosinophilic esophagitis in remission, and to characterize the presence of allergy and other disease co‐morbidities in patients that experience disease flare. A retrospective study was performed by analyzing data from visits of patients aged 5 to 18 years coded for eosinophilic esophagitis in remission seen by the Phoenix Children’s Hospital Pediatric Gastroenterology Department between June 2010 and June 2011. The data included 148 patients and 326 clinical visits. Data identified demographic information, allergy, and other disease co‐morbidities. Arizona seasons were defined as: spring from February 15 to June 15, and fall from September 1 to November 30, according to the typical pattern of allergen pollination. To analyze incidence and season of flares, statistical methods used included the Chi‐square tests and logistic regressions. Ninety‐four of 148 patients (63.5%) flared during the study period. An increased incidence of flares in the fall compared with other seasons was statistically significant (p = 0.041). Flares in the spring also had an increased incidence. Of the 94 patients that flared, 70 patients (74.5%) had environmental allergy, 83 (88.3%) had food allergy, and 66 (70.2%) had both environmental and food allergy. Our findings suggest a role for seasonal environmental allergens in the pathogenesis of eosinophilic esophagitis and disease flares in children in Arizona, particularly those with food allergy, environmental allergy, or both.
    • Study of an Early Wellness Program in Parkinson ’s Disease: Impact On Quality Of Life And Early Intervention Guidance

      Page, Brent Michael; The University of Arizona College of Medicine - Phoenix; Shill, Holly (The University of Arizona., 2017-05-26)
      Previous studies have shown that Parkinson’s disease (PD) patients are at an increased risk for a variety of complications impacting health related quality of life (HRQoL). Additionally, these various complications often lead to increased healthcare utilization. Wellness intervention in PD has shown to be effective in improving HRQoL and objective measures of disease burden such as motor functioning. What has not been demonstrated to date is whether patients who are given the opportunity to participate in regularly administered classes in these modalities will continue to attend and whether benefits will continue to be realized outside the strict confines of a controlled trial. This study examined whether intervening early in PD with a comprehensive Wellness Program is feasible and promotes lasting habits that will continue to provide sustained benefit. It was hypothesized that intervening early in PD with an intensive program involving structured exercise, socialization and PD specific education would serve to maintain or improve subject’s quality of life while decreasing healthcare utilization. Twenty‐one consenting ambulatory adult subjects diagnosed with PD within the last five years completed various screenings at baseline and following a required 6‐month Wellness Program intervention. Subjects were assessed at 12 and 18 months if they continued to participate. Patient demographics, disease specific quality of life, objective mobility, healthcare utilization and falls were assessed. Data were collected at Banner Sun Health Research Institute, located in Sun City, Arizona. All p‐values were 2‐tailed and P<0.05 was considered statistically significant. All data analyses were conducted using STATA‐14. Twenty of twenty‐one subjects completed the required 6‐month intervention. Continued participation was 70% at 12 months and 60% at 18 months. Overall HRQoL was stable at 18 months. Significant improvement was seen in patient reported mobility and emotion sub‐areas at 12 months. Communication specific HRQoL was significantly worsened at 12 months. Subjects demonstrated a stable level of physical activity while fatigue was significantly decreased. All objective measures were significantly improved from baseline. Healthcare utilization was decreased by 18 months. A total of 5 falls were reported by 3 subjects during the 6‐month interventional period. This pilot study demonstrates that comprehensive wellness intervention in early PD is feasible, effective, safe and valuable in establishing long‐term beneficial habits while potentially reducing healthcare utilization. The significant long‐term subject participation observed in this study establishes that wellness intervention may be practical for large scale implementation. The results also highlight the importance of addressing communication specific symptoms early in the course of the disease. Ultimately, this study will aid the design and implementation of future PD wellness interventions.
    • Systematic Review and Meta‐Analysis of Clinical Outcomes of Fractures Fixed with the Surgical Implant Generation Network (SIGN) Intramedullary Nail

      Sonenthal, Nechama; The University of Arizona College of Medicine - Phoenix; McLaren, Alex (The University of Arizona., 2017-05-18)
      The (Surgical Implant Generation Network) SIGN Intramedullary (IM) nail is designed to fix long bone fractures without using a costly C‐arm imaging device. It is distributed for free to countries in need, allowing for elevation of care from the standard, lengthy traction treatment in those countries to clinically superior IM nailing. This paper compares the clinical outcomes of the SIGN IM nail to those of the IM nails used in developed countries with use of a C‐arm. The terms “Surgical Implant Generation Network” and “union” were searched in four databases. Primary studies of SIGN IM nails were included and their outcomes, including union rate, time to union, and complications, were recorded and compared to historical data of IM nails used in developed countries. Overall, there is a similar union rate in bones fixed with SIGN IM nails (94.6%) versus bones fixed with IM nails in developed countries (92.3%) (p = 0.009, OR = 1.67), while some bone types (tibia and femur) demonstrated a lower union rate when individually stratified (p = 0.008, OR = 0.26 and p = 0.002 and OR = 0.15, respectively). Mean time to union for all bone types combined showed no significant difference between SIGN IM nails and IM nails used in developed countries (p = 0.26). Complications rates were similar between SIGN IM nails and IM nails used in developed countries. It is possible for the SIGN IM nail to be used to fix long bone fractures in developing countries with outcomes comparable to the IM nail used in developed countries.
    • A Systematic Review of Hyaluronidase‐Assisted Subcutaneous Fluid Administration in Pediatrics and Geriatrics and Its Potential Application in Low Resource Settings

      Wilhelm, Kelsey; The University of Arizona College of Medicine - Phoenix; Barcellona, Dawn (The University of Arizona., 2017-05-25)
      The role of enzyme‐assisted subcutaneous fluid administration (EASFA) in treating mild to moderate dehydration in pediatrics, geriatrics, and palliative care has been studied in developed countries. However, it has historically been underutilized due to widely available health care and alternative treatments, namely peripheral intravenous (IV) fluid administration. Fluid infusions in the subcutaneous tissue have a low risk of infection, are easy to administer, and have wide potential use. The use of EASFA in low resource settings to treat those with difficult IV access or where skilled healthcare workers are not as readily available could prove to be a live saving measure in many situations, including the care of patients in remote areas of the world, mass casualty events, or other disasters. Our objective was to determine if EASFA is a valid and appropriate technique to utilize in pediatric and elderly patients, and evaluate if it could be a safe and efficient way to provide fluid resuscitation in low resource settings. For this systematic review MEDLINE and Cochrane Library were searched from January 1950 to December 2015 to recover all available literature relevant to this topic. Studies that met the inclusion criteria were analyzed using Cohen’s D. This was calculated using the mean difference between intervention and control divided by the pooled standard deviation. For dichotomous outcome of the placement success rate the odds ratios were calculated with 95% confidence intervals. In reviewing 7 articles using Cohen’s D to compare mean differences to determine effect size, we found that catheter placement success rates and infusion rates were similar between EASFA and peripheral intravenous fluid administration. Additionally, it was found that the odds of correct initial needle placement was 7.19 times higher in EASFA versus intravenous administration. EASFA is a comparable alternative to intravenous fluid administration when delivering fluids to pediatric and elderly patients with mild to moderate dehydration. While infusion rates and total volume of fluids administered were similar, the high rate of success with placement of the subcutaneous catheter proves it to be more useful in some situations. Venous cannulation is difficult, even for a trained healthcare provider, and the ease of placement of subcutaneous catheters makes training lay people to administer subcutaneous fluids a possibility. Additionally, this type of fluid administration may lead to less psychological trauma to a child from multiple needle sticks, while still achieving a similar outcome of effective volume replacement. Based on the results of this study, further research is needed to evaluate the effectiveness of utilizing EASFA in low resource settings.
    • Targeting the Hippo Signaling Pathway in Atypical Teratoid Rhabdoid Tumor

      Norris, Gregory; The University of Arizona College of Medicine - Phoenix; Bhardwaj, Ratan (The University of Arizona., 2017-05-26)
      Atypical teratoid rhabdoid tumor (ATRT) is a highly malignant pediatric central nervous system tumor. The prognosis is often poor, with a 2‐year survival rate estimated at 15%. This dismal prognosis highlights the need to develop new treatment modalities for this devastating pediatric tumor. Recently, a tumor suppressing signaling pathway known as Hippo has emerged as a possible cancer treatment target. The Hippo signaling pathway is involved in organ growth and maintenance, and is dysregulated in many diverse cancers. We used quantitative real‐time PCR to evaluate the mRNA expression profile of Hippo pathway genes. We then used determined the protein expression of various Hippo components using Western blots. The results of this study suggest that Hippo plays a definite role in atypical teratoid rhabdoid tumor.
    • Training of Community Health Workers: Recognition of Maternal, Neonatal and Pediatric Illness

      McCabe, Chris; The University of Arizona College of Medicine - Phoenix; Yoblonski, Lara (The University of Arizona, 2017-05-11)
      This systematic review focuses on improving recognition and treatment of acute medical conditions in pregnant women, infants and children in low and middle income countries by Community Health Workers (CHWs). By examining critically selected articles from different electronic databases, this review seeks to organize and present the important characteristics of a training program aimed at reducing maternal, neonatal and childhood mortality. Data in the form of peer‐reviewed and published articles were collected using three public databases – PubMed, Ovid and EMBASE – using specific search terms. Greater than 300 articles where found using the specific search terms. Those articles were then processed through a series of inclusion and exclusion criteria resulting in a cohort of papers which were then individually analyzed for content. After critical analysis of all 15 publications included in the study, it becomes clear that training programs are incredibly diverse. These four aspects of training programs appear to be the most variable between the studies: size of the training program, length of the training program, training assessment and follow‐up refresher courses. Training programs that are shorter in duration or greater in class number do not seem to be any less effective than longer programs with fewer participants. Future studies should be performed in which one training program with identical training techniques, lengths, and focuses is taught in different regions. The impact that this study has on the literature is as follows: Training programs of shorter duration seem to be as effective as their longer counterparts. Finally, there is a clear need for more robust, standardized and geographically and culturally diverse training programs to more effectively study training methods.
    • Triage of Trauma Patients Injured By Large Animals: Do Urban Doctors Undertriage?

      Stevenson, Justin; The University of Arizona College of Medicine - Phoenix; Katz, Eric (The University of Arizona., 2017-05-19)
      In the United States the responsibility to develop criteria for trauma patient’s triage status rests upon individual hospitals rather than the American College of Surgeons. Traumatic injuries from large animals represent a potential need for expanded hospital resources. Urban emergency departments are less likely to regularly see patients with large‐animal related injuries and might be expected to underestimate the predicted injuries. There is scarce research on the topic of initial triage designation for large‐animal related injuries. The aim of this study is to investigate the adequacy of the initial triage designation given to patients presenting with injuries from animals larger than themselves at an urban, safety net, academic Emergency Department and Trauma Center (ACS Level 1 Adult, Level 2 Pediatric). A retrospective chart review was performed on patients presenting to the emergency department (ED) from Jan 2006 until September 2015 with injuries resulting from animals larger than the patient. A total of 213 patients met the inclusion criteria. Our study found that trauma patients injured by large animals who are triaged as low priority have dispositions that are not statistically different from those with higher initial prioritization.
    • Tumor Associated Antigens Harbor Readily Defined and Universally Immunogenic Regions Relevant For Cancer Immunotherapy

      McCurry, Dustin; The University of Arizona College of Medicine - Phoenix; Cohen, Peter; Gendler, Sandra (The University of Arizona., 2017-05-11)
      Recent advances in cancer immunology, highlighted by immune checkpoint inhibitors, have demonstrated that immunotherapy is a viable option in the oncologist’s armamentarium. Despite these advances, many patients are nonresponders. Preliminary studies have suggested that non-responders lack a de-novo anti-tumor antigen immune response that can be unmasked by checkpoint blockade; thus, strategies to induce anti-tumor immune responses are needed. We hypothesized that many tumor associated antigens (Ag) are readily susceptible to immune attack, but only in the context of identifying the tumor antigen epitopes that can reliably initiate an immune response, regardless of individual patient human leukocyte antigen (HLA) haplotype restrictions. We further hypothesized that epitope prediction strategies which seek to identify pan- or highly promiscuous-HLA binding epitopes would reduce the number of potential candidates and be more likely to accurately identify high-priority tumor Ag epitopes. Utilizing known HLA-serotype frequencies and setting a threshold of ninety percent of population coverage, regardless of race or ethnicity, twenty-nine different HLA-DRB1 haplotypes were chosen for antigen prediction utilizing the open source epitope prediction algorithm netMHCIIpan. Predictions were also performed for HLA-A serotypes utilizing the open source algorithm netMHCpan. Predicted epitopes were synthesized in the form of synthetic long peptides and tested in immune system sensitization assays involving unfractionated peripheral blood mononuclear cells (PBMC). Briefly, PBMC were subjected to a two-step culture, first synchronizing their exposure to the long peptides with aggressive surrogate activation of innate immunity, followed by IL-7-modulated T-cell hyperexpansion. Predictions resulted in identification of highly promiscuous-HLA binding epitopes. Unexpectedly, these epitopes clustered together forming high priority regions: unique “hot spots” with high densities of promiscuous HLA-binding epitopes from the widely expressed oncoproteins MUC1, HER2/neu and CMV-pp65 (p<0.0001, for predicted HLA-DRB1 binding affinities, compared to non-hot spot regions). Added synthetic long peptides (>20aa) derived from “hot spot” regions of MUC1, HER2/neu, and CMVpp65 reliably produced selective and sustained expansion of both CD4+ and CD8+ peptide-specific, interferon-γ (IFNγ)-producing Tcells when synchronized with step 2 exposure to exogenous IL-7 (p<0.0001 and p=0.0048, for CD4+ and CD8+ Ag-specific T-cells, respectively, compared to T-cells directed against peptides from non-hot spot regions). “Hot spot” peptide Ag-specific T-cells preferentially recognized endogenous tumor derived MUC1, either in MUC1 expressing tumor cell killing assays (p=0.038, compared to non-peptide Ag-specific T-cells) or as MUC1 tumor lysate when pulsed onto restimulatory PBMC (p=0.022 and 0.025, for CD4+ and CD8+ T-cells, respectively, compared to T-cells directed against peptides from non-hot spot regions). This mechanistically rational antigen selection sequence, effective even for unvaccinated donors, regardless of HLA-haplotype, enables rapid identification of tumor protein regions relevant for cancer immunology, including adoptive immunotherapy, vaccines, and even identification of tumor neo-antigens unique to each patient.
    • Underreporting of Fatigue in Gynecologic Oncology Patients

      Chavez, Marin; The University of Arizona College of Medicine - Phoenix; Chase, Dana (The University of Arizona., 2017-04-27)
      Cancer‐related fatigue (CRF) is a well‐documented symptom among gynecologic oncology patients. However, there is little known about the etiology, and treatment options are currently suboptimal. While the lack of knowledge surrounding the intricacies of CRF impedes effective care, there is arguably a more serious barrier to delivering adequate treatment. Fatigue symptoms are highly underreported to physicians making it impossible to offer treatment to a large subsection of patients. This study will focus specifically on gynecologic oncology patients, a population with a staggering prevalence of CRF. The purpose of this study is to identify clinical, psychosocial, and lifestyle characteristics that may be associated with the underreporting of fatigue specifically in gynecologic oncology patients. The design of this study is a cross‐sectional survey. 89 subjects were recruited from three outpatient sites. Inclusion criteria included: (a) women age ≥18 years old with a known ovarian, uterine, cervical, vaginal, vulvar, or primary peritoneal cancer; (b) Currently attending physician’s office hours and/or undergoing chemotherapy at one of the above listed centers. This study will focus specifically on the reporting of CRF in gynecologic oncology patients. Results showed that barriers to reporting fatigue were significantly correlated with the chemotherapy cycle a patient was undergoing. Additionally, the date of last treatment, a patient’s weight, and the cancer stage was associated with higher levels of underreporting in this population. The prevalence of cancer related fatigue is staggering; however, there is limited research as to why patients are underreporting such a significant symptom to their health care team. With the knowledge from this study, screening for fatigue can become more efficient by targeting women in specific chemotherapy cycles. Practitioners can also use this data to identify patients with high‐risk characteristics that might contribute to their unwillingness to discuss fatigue symptoms.
    • Understanding Severe Acute Malnutrition in Children Globally: A Systematic Review

      Kellerhals, Sarah; The University of Arizona College of Medicine - Phoenix; Caputo, Grace (The University of Arizona., 2017-06-19)
      Severe acute malnutrition (SAM) affects 13 million children under the age of 5 worldwide, and contributes to 1‐2 million preventable deaths each year. Malnutrition is a significant factor in approximately one third of the nearly 8 million deaths in children who are under 5 years of age worldwide. There have been many revolutions in treatment of SAM over time; however, the exact etiology of this preventable condition is not well understood. This review serves to identify the most common risk factors for the development of SAM in children and to identify the most effective treatment for the disease. There are many factors that contribute to developing and surviving SAM as a child, and this systematic review serves to highlight the most common variables that lead to this cause of mortality. An exhaustive review of PubMed was conducted to complete this review. The literature review demonstrates that the most common risk factor for the development of SAM is low maternal literacy.
    • Understanding the Effect of Morphine on the Accuracy of Nuclear Hepatobiliary Imaging Through a Case Study

      Dhadvai, Sandeep; The University of Arizona College of Medicine - Phoenix; Verma, Nishant (The University of Arizona, 2017-05-08)
      Many patients present with upper abdominal pain and receive some type of pain relieving therapy prior to gallbladder imaging. The physiologic effect of morphine and other analgesics on gallbladder function has been well‐studied. What hasn’t been studied as much are the implications on clinical practice and the decision about whether morphine is the best option to use in suspected chronic gallbladder disease. This case study serves to illustrate the influence of morphine in a patient who underwent both inpatient and outpatient hepatobiliary scintigraphy with dramatically different results. This case study perfectly shows the considerations that must be taken when using morphine because it eliminates many confounding variables; the only difference in the patient at the time of initial and subsequent presentation was the presence of morphine.
    • The Use of Pulmonary Dead Space Fraction to Identify Risk of Prolonged Mechanical Ventilation in Children after Cardiac Surgery

      Siddiqui, Muniza; The University of Arizona College of Medicine - Phoenix; Willis, Brigham (The University of Arizona., 2017-05-18)
      Children with prolonged mechanical ventilation after cardiac surgery have a higher risk for poor outcome due to a variety of ventilator‐associated morbidities. It therefore becomes essential to identify these children at higher risk of prolonged mechanical ventilation as well as find methods to identify children ready to be extubated as early as possible to avoid these complications. One physiological variable, the pulmonary dead space fraction (VD/VT), has been suggested as a possible indicator of prolonged mechanical ventilation. VD/VT essentially measures the amount of ventilated air that is unable to participate in gas exchange. Can VD/VT be used successfully in children undergoing cardiac surgery to identify those at risk for prolonged mechanical ventilation and identify those ready for extubation? Retrospective chart review of 461 patients at Phoenix Children’s Hospital in the Pediatric Cardiac Intensive Care Unit since the initiation of standard application of the Philips NM3 monitors in October 2013 through December 2014. From the 461 patients screened, only 99 patients met all the inclusion criteria. These 99 patients consisted of 29 patients with balanced single ventricle physiology and 61 patients with two ventricle physiology. Initial postoperative and pre‐extubation VD/VT values correlated with length of mechanical ventilation for patients with two ventricle physiology but not for patients with single ventricle physiology. Additionally, pre‐extubation VD/VT values of greater than 0.5 indicated higher rates of extubation failure in two ventricle patients. Conclusion: For children with two ventricle physiology undergoing cardiac surgery, VD/VT should be used clinically to estimate the length of mechanical ventilation for these children. VD/VT should also be checked in these patients before attempting to extubate. If VD/VT is found to be higher than 0.5, extubation should not be attempted since the patient is at a much higher risk for extubation failure.
    • The Vaginal and Gastrointestinal Microbiomes in Gynecologic Cancers: A Review of Applications in Etiology, Symptoms and Treatment

      Goulder, Alison; The University of Arizona College of Medicine - Phoenix; Chase, Dana (The University of Arizona., 2017-05-26)
      The human microbiome is the collection of microorganisms in the body that exist in a mutualistic relationship with the host. Recent studies indicate that perturbations in the microbiome may be implicated in a number of diseases, including cancer. More specifically, changes in the gut and vaginal microbiomes may be associated with a variety of gynecologic cancers, including cervical cancer, uterine cancer, and ovarian cancer. Current research and gaps in knowledge regarding the association between the gut and vaginal microbiomes and the development, progression, and treatment of gynecologic cancers are reviewed here. In addition, the potential use of probiotics to manage symptoms of these gynecologic cancers is discussed. A better understanding of how the microbiome composition is altered at these sites and its interaction with the host may aid in prevention, optimization of current therapies, development of new therapeutic agents and/or dosing regimens, and possibly limit the side effects associated with cancer treatment.