• Calculating Ventilatory Threshold in Patients After Stroke

      Quezon, Irvin; The University of Arizona College of Medicine - Phoenix; Bosch, Pamela (The University of Arizona., 2018-04-06)
      BACKGROUND: Aerobic training intensity is commonly determined from heart rate reserve (HRR) or a percentage of maximal heart rate measured during a graded exercise stress test. This method has limitations in people after stroke, who may not reach maximal heart rate. Ventilatory Threshold (VT) is an alternate method of establishing aerobic training intensity. VT indicates the exercise intensity above which ventilation increases disproportionately compared to whole-body oxygen uptake, theoretically representing the optimal intensity for sustaining aerobic exercise. CONCLUSION: Ventilatory Threshold in stroke patients undergoing treadmill testing can be effectively calculated from gas exchange data using the Venilation Curve and the V-slope methods. More research is needed to assess other factors that may affect VT measurements, such as medications or diseases impacting respiratory and cardiac function in patients with stroke to determine the most optimal and effective means of establishing training intensity after stroke.
    • Comparative Mid-term Outcomes of Pediatric Hematogenous Methicillin-resistant Staphylococcus aureus and Methicillin-susceptible Staphylococcus aureus osteomyelitis

      Blank, Tiana; The University of Arizona College of Medicine - Phoenix; Belthur, Mohan (The University of Arizona., 2018-03-28)
      The bacteria staphylococcus aureus is the most common etiology of acute hematogenous osteomyelitis (AHO) in healthy pediatric patients, accounting for 70-90% of cases. • AHO occurs at a rate of 1/10,000 pediatric patients/year. • Increasing prevalence of community-acquired methicillin resistant staph aureus (MRSA) is leading to a concurrent rise of such invasive pediatric infections in the US. • MRSA AHO on average have longer hospital stays, more febrile days, longer antibiotic therapy, and increase in overall complications vs. methicillin sensitive staph aureus (MSSA). • There is a lack of data on the functional outcome of these patients beyond 2 years post index infection. • Goal of study: compare treatment and midterm (2 years post index infection) functional outcomes between patients with MRSA vs. MSSA infections, and localized vs. disseminated infections. • Hypothesis: treatment and outcomes between MRSA and MSSA, and localized and disseminated, will be different, specifically that MRSA and disseminated will have worse midterm functional outcomes
    • Comparing FAST Proficiency of Self vs Non-Self Models of Training

      Johnson, Keith; The University of Arizona College of Medicine - Phoenix; Grimsman, Jason (The University of Arizona., 2018-03-30)
      The increase in available ultrasound technology has allowed healthcare professionals to begin learning the skills to use it starting early in their training and careers. The best methods of training to increase proficiency in its use have not been investigated, however. This study compares two different training methods of the Focused Assessment with Sonography in Trauma (FAST). First year medical students were randomized into two groups; one who trained using a conventional live human model and the other who trained using themselves as the model. Both groups were then assessed on a non-self live human model and scored based on time to completion of the FAST and the ability to identify pertinent anatomic landmarks. There was no significant difference in mean scores between both groups. The non-self training group was significantly faster than the self training group. This suggests that the conventional training model remains the best method for increasing proficiency in the FAST exam, although there are significant limitations and further investigations are needed.
    • Comparing Optical Coherence Tomography Radial and Cube Scan Patterns for Measuring Bruch’s Membrane Opening Minimum Rim Width (BMO-MRW) in Glaucoma and Healthy Eyes: Cross-sectional and Longitudinal Analysis

      Kabbara, Sami; The University of Arizona College of Medicine - Phoenix; Belghith, Akram (The University of Arizona., 2018-04-03)
      Background and Significance: Spectral Domain-Optical Coherence Tomography (OCT) is one of the most widely used imaging modality in Ophthalmology. It utilizes light waves to visualize the various layers of the retina. The OCT machines offer two different scan patterns, the circular and the cube scan patters. It is important to compare these scan pattern to see if any discrepancy exist in quantifying retinal indices. One of the newer indices is the Bruch’s membrane opening minimum rim width (BMO-MRW), which is the minimum distance between from the BMO to the inner limiting membrane (ILM). The BMO-MRW is being used in the diagnosis of glaucoma. Hypothesis: To compare the cube and radial scan patterns of the SD-OCT for quantifying the BMO-MRW. We hypothesis that there might be some differences between the two scan patterns.
    • Comparing Quality of Life in Global Vitiligo Populations

      Welbourn, Brandon; The University of Arizona College of Medicine - Phoenix; Beyda, David (The University of Arizona., 2018-02-28)
      This comprehensive review will provide an overview of the current literature regarding vitiligo and its skin manifestations, as well as the stigma surrounding skin depigmentation diseases. We will also discuss measurement of quality of life. This comprehensive review will provide the background information necessary to understand the psychological impact of the disease vitiligo on global populations.
    • A Comparison of How Adolescent Patients and Their Parents Rate Communication by Pediatric Resident Physicians.

      Ohmart, Connor; The University of Arizona College of Medicine - Phoenix; Bhavaraju, Vasudha (The University of Arizona., 2018-04-05)
      There are unique challenges in caring for the adolescent population, including communication in a way that is effective for both the adolescents and their parents or caregivers. While we assume that both are seeking similar qualities in their resident doctor, we sought to determine if a difference exists between adolescents and their parents in the judgment of adequate physician communication. This may offer insight into what each population values most in the skill set of their provider and may guide future pediatric resident education.
    • Contributing Factors to Late Second Trimester Ultrasounds

      Mistry, Porus; The University of Arizona College of Medicine - Phoenix; Connell, Mary (The University of Arizona., 2018-02-27)
      Background: The level II ultrasonography (US) is designed to detect fetal anatomy and the presence of any fetal anomalies. Previous studies have revealed that a relatively low percentage of women received appropriate prenatal care in Maricopa County. However, the specific barriers and limitations to receiving prenatal care have not been adequately studied. Thus, we constructed a survey to gain insight on the barriers that limit adequate access to level II US. Research Question: What are the significant factors that contribute to late Prenatal Care Level II Ultrasonography at Maricopa Integrated Health System?
    • Correction, Depression, Cardiac Compression and Haller Indices Fail to Correlate with Cardiopulmonary Impairment in Pectus Excavatum

      Donato, Britton; The University of Arizona College of Medicine - Phoenix; Notrica, David (The University of Arizona., 2018-03-29)
      Background: Pectus excavatum (PE), the most common congenital chest wall deformity in children, is the posterior intrusion of the anterior chest wall. The standard for determining disease severity is the Haller Index (HI), which has been shown to poorly correlate with physiologic impairment. Recently, more novel indices have been introduced in an effort to more accurately reflect burden of disease but limited evidence demonstrates a correlation between the indices and physiologic impairment. Data confirming such a correlation would provide a means to measure both the severity of deformity and changes in functional disability in patients with PE. Methods: This is a retrospective study of 71 children who underwent evaluation for corrective surgery for pectus excavatum with preoperative cardiopulmonary exercise testing and endexpiratory chest computed tomography or magnetic resonance imaging at a regional children’s hospital. Regression models were performed to predict VO2 max or O2 pulse predicted. Results: The regression models were not significant at predicting VO2 max or O2 pulse predicted. Additionally, when evaluating the either VO2 max or O2 pulse predicted along with the indexes independently in the linear regression model, there was no statistically significant relationship identified. Conclusions: We found that when assessing for a correlation between the HI, correction index, depression index, or cardiac compression index at end-expiration together and independently with cardiopulmonary impairment, both the linear and multiple regression models failed to identify a statistically significant relationship. While it would be highly advantageous for a PE severity index to correlate with objective physiologic impairment, our data suggest that the currently defined indices calculated at end-expiration fail to do so.
    • Determinants of LARC Usage in Women in Latin America and the Caribbean

      Jones, Ashley; The University of Arizona College of Medicine - Phoenix; Manriquez, Maria (The University of Arizona., 2018-03-30)
      Research question: What is the difference in prevalence of LARCs between women living in urban and rural areas of Latin America and the Caribbean (LAC)? Background, significance, and rationale: While LARCs have been shown to be effective, approved for long duration of use, and cost-effective there is an unmet need for this type contraception in rural areas. The LAC region has a need for improved family planning services, evidenced by the high percentage of maternal deaths due to unsafe abortions. Methods: Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2015 in LAC countries were reviewed and analyzed to determine difference in prevalence of LARC use between women living in urban versus rural areas. Additionally, a systematic literature review was performed resulting in selection of 11 primary research articles evaluated for LARC prevalence and sociodemographic factors associated with LARC use.
    • Development of a non-invasive biomarker of eosinophilic esophagitis

      Galvin, Katie; The University of Arizona College of Medicine - Phoenix; Wright, Benjamin (The University of Arizona., 2018-03-30)
      Background: Eosinophilic esophagitis (EoE) is a non-IgE mediated, antigen-driven disease characterized by eosinophilic inflammation with resultant tissue remodeling, fibrosis, and esophageal dysfunction. The current standard of care requires multiple esophageal biopsies. Eosinophil peroxidase (EPX) is an eosinophil-specific granule protein that serves as a surrogate for eosinophil activity. We aim to develop a rapid, minimally invasive clinical screening test for EoE. We hypothesize EPX from buccal swabs will be elevated in samples from EoE patients versus non-EoE controls.
    • Discussing the Challenges in Creating an Online Library of 3D Printable Assistive Living Devices

      Kantzos, Andrew; The University of Arizona College of Medicine - Phoenix; Lifshitz, Jonathan (The University of Arizona., 2018-02-26)
      Our goal is to identify the barriers and process of creating a digital library of medical assistive devices that can be personalized and 3D printed for people living with disabilities. In the past, and true today, traditional manufacturing methods make it cost prohibitive to create personalized devices to assist individual patients with their activities of daily living (ADL). Now and in the immediate future, availability and affordability of 3D printing makes it feasible to produce low volumes of devices, on demand, using a distributed manufacturing model. This document discusses three main challenges to originating and creating this library: (1) the validity of using 3D printing for assistive device technology, (2) organizational approaches to optimize the library accessibility, and (3) creating an intuitive search method to navigate the library.
    • The effect of high-intensity interval exercise on doxorubicin-induced TLR4 inflammatory signaling in rat myocardium

      DiLizia, Matthew; The University of Arizona College of Medicine - Phoenix; Angadi, Siddhartha; Dickinson, Jared (The University of Arizona., 2018-02-26)
      Background:Doxorubicin(Dox) is a common anti-cancer agent that causes collateral damage to the heart. Pre-conditioning (exercise prior to Doxtherapy) may attenuateDox-induced cardiomyopathy by modulating inflammatory pathways.The effect of pre-conditioning on TLR4 signaling in Dox-induced cardiomyopathy is uncertain. Conclusion: The impact of TLR4 on Doxinduced cardiac inflammation may not be significantly modulated by pre-conditioning HIIT. However, HIIT pre-conditioning may impact downstream mediators NFkB, pNFkB and pIkB in models of Dox-induced cardiac inflammation.
    • The Effects of Calcium Supplementation on the Incidence of Preeclampsia on Pregnant Women in Developing Countries

      Sobhanian, Nura; The University of Arizona College of Medicine - Phoenix; Coonrod, Dean; Ali, Nyima (The University of Arizona., 2018-02-28)
      Preeclampsia is one of the most common pregnancy complications in lower income countries. It can evolve into eclampsia if not treated, which leads to maternal death. Preeclampsia is a global issue; however, the incidence is seven times higher in lower income countries. Calcium supplementation has been thought to play a role in the reduction of preeclampsia in pregnant women and act as a method of early detection. The purpose of this project was to determine whether this intervention reduces the incidence of preeclampsia in pregnant women in low and middle income countries. In order to do this, we examined existing data on calcium supplementation as well as clinical trials through PubMed searches. Each study examined was performed in a low or mid income country, and compared with women in that area who did not receive the intervention. The results of this project do indicate a decrease in the incidence of preeclampsia with calcium supplementation.
    • "El viaje al otro lado: Relationship between Depression Onset in Latinas and Immigration Experience Coming to the United States”

      Rubin, Arielle; The University of Arizona College of Medicine - Phoenix; Moreno, Francisco (The University of Arizona., 2018-04-06)
      Background: Few studies investigate unique psychosocial hardships and trauma during immigration by mode of travel. This retrospective pilot study explores the trauma and hardship during different types of immigration travel among Latina women and explores its relationship to psychiatric diagnosis in Latina immigrant women with and without psychiatric diagnosis history. Conclusion: In this small pilot study, “coyote” travel significantly correlated with trauma exposure. There was a numerical suggestion that coyote travel is more often associated with depression than non-coyote travel. With only 14 individuals this pilot study had limited power to detect effects. The lack of difference in depressive symptomatology one year after arrival between the group of people previously diagnosed and community volunteers suggest a multifactorial high-risk adjustment period warranting a high-degree of clinical suspicion and screening in all newly immigrated patients.
    • Emergency Department Volunteers: Defining the position and its effect on the Patient Experience

      Heller, Paul; The University of Arizona College of Medicine - Phoenix; Samaddar, Kris (The University of Arizona., 2018-03-30)
      Research Question: Will trained volunteers significantly affect patient experience compared to educational fliers or no intervention? Background: Patient experience continues to be an important issue with our nation’s healthcare system especially with the adoption of Value Based Purchasing for hospital reimbursement. With the use of Honor Health Scottsdale’s large number of volunteers, we hoped to design and develop a program that will improve experience for patients presenting to a community based Emergency Department. Objective: To evaluate the impact of Emergency Department Volunteers on the patient experience.
    • Epidemiology of Post-Traumatic Brain Injury-Induced Hypothalamic Pituitary Dysfunction in Arizona AHCCCS Patients

      Sukhina, Alona; The University of Arizona College of Medicine - Phoenix; Lifshitz, Jonathan (The University of Arizona., 2018-04-09)
      Introduction: Traumatic brain injury (TBI) in children can result in cognitive, emotional and somatic neurological impairments. In adults, post-traumatic hypopituitarism can extend or exacerbate these impairments, likely due to mechanical damage to the pituitary and hypothalamus. The pituitary in the pediatric brain likely suffers similar mechanical damage, inducing endocrinopathies as in adults, but injury-induced endocrinopathies are infrequently reported in children. Unrecognized hypopituitarism may lead to elevated risks of metabolic syndrome, diabetes, delayed or absent puberty, short stature, and other endocrinopathies. However, screening for endocrine deficiencies in susceptible patients and initiating appropriate hormone replacement therapy may prevent these sequelae and improve the prospects for recovery. Results: We determined that TBI victims were 3.18-times higher risk of developing a central endocrinopathy compared with the general population (CI=0.264), pediatric AHCCCS patients with a central endocrinopathy had a 3.2-fold higher odds of a history with TBI than those without a central endocrinopathy (CI=0.266), of the central endocrinopathy in TBI victims is attributable to the TBI, and the number of patients who need to be exposed to a TBI for 1 patient to develop an endocrinopathy was 154.2 (CI=7.11). We also determined that more males than females presented with central endocrinopathies after TBI compared with the general population of TBI victims.
    • Evaluation of TEMS Support Efficacy in Four Representative Tactical Units

      Weidenbach, Kimberly; The University of Arizona College of Medicine - Phoenix; Somal, Jasjeet (The University of Arizona., 2018-02-28)
      Background/Significance: Tactical Emergency Medical Support (TEMS) is a service modified from military tactical medicine to encompass the complex environment and mission set of current law enforcement agencies. Physicians and certified personnel acting as TEMS must be able to provide medical care under stressful and dangerous conditions as well as train police to be able to care for themselves when needed. A physician on-scene during a mission can provide deeper medical knowledge and abilities in the event that injuries or the complications thereof go beyond the training of paramedics. By working closely with the operational team, TEMS also have the opportunity to foresee possible risks and advise the team leader during planning stages. Tactical medicine also allows for preventative medical training, advising on anything from diet, hydration, and exercise plans to treatment of acute hemorrhage in the field.
    • Evaluation of Thin-Slice Axial Magnetic Resonance Imaging on the Diagnostic Accuracy of Meniscus Tears

      Albert, Andrew; The University of Arizona College of Medicine - Phoenix; Leung, Jimmy (The University of Arizona., 2018-03-28)
      This investigation assessed the diagnostic accuracy of thin-slice (1mm) axial Magnetic Resonance Imaging (MRI) in the detection and classification of meniscal tears. Meniscal injuries are a common reason for knee pain and the use of MRI has become standard in their assessment. However, the classification of tears and not merely the detection of lesions has become increasingly important to surgeons in deciding between surgery and conservative management. There is a growing body of literature examining the utility of axial MR images in aiding radiologists to more accurately describe and classify morphological characteristics of meniscus tears. However, the thick- slice (4-5mm) axial sequences utilized at many institutions typically only produce 1-2 images on which the menisci can be visualized, which does not provide the required detail to accurately describe the morphological characteristics of meniscal lesions. This study adds to the growing body of literature examining the diagnostic capabilities of MRI with TSAi to accurately describe meniscal tear morphologies. Imaging reports from 107 patients with clinically suspected meniscus injuries who underwent MRI with thin-slice axial imaging were compared to arthroscopic findings using receiver operating characteris (ROC) analysis to assess the diagnostic accuracy of MRI with thin- slice axial imaging (TSAi). The sensitivity and specificity of MRI with TSAi for meniscal tear detection were found to be 91% and 37.5% respectively. Furthermore, MRI with TSAi was highly specific for bucket handle (98.5%) and root ligament tears (94.1%). The findings of our investigation indicate that MRI with TSAi may assist surgeons in determining the need for operative versus conservative management. MRI with TSAi may be particularly helpful in the case of root tears, which were not as readily identified with traditional MRI techniques and often require surgical intervention due to morbidity associated with unrepaired root tears.
    • Exertional Syncope: A 10 year Retrospective Review

      Pitt, Taylor; The University of Arizona College of Medicine - Phoenix; Cohen, Mitchell (The University of Arizona., 2018-04-06)
      Although the usual faint is common, syncope may be an indication of a more serious underlying condition. Exertional syncope has loosely been defined as syncope occurring during or immediately after activity. The evaluation of exertional syncope is often extensive in order to rule-out a potentially life-threatening conditions. This was a retrospective review of all children presenting to the ambulatory clinics at Phoenix Children’s Hospital over the last 10 years with a syncopal event. This study sought to analyze the most consistent diagnosis for a primary complaint of exertional syncope and the most effective diagnostic tests to rule out serious conditions. Major findings include 1) 25% of patients presenting with exertional syncope were diagnosed with cardiac disease and 2) the association between heart disease and abnormal ECG and heart disease and abnormal electrophysiology (EP) study were both statistically significant with increased Odds Ratios (ORs). Consistent with prior studies, ECG and EP study are appropriate initial tests.
    • Geographic correlation between nonmedical exemption rates in Arizona kindergarten classes and rates of community pertussis infection

      Sun, Sophie; The University of Arizona College of Medicine - Phoenix; Villarroel, Lisa (The University of Arizona., 2018-04-09)
      Background: Every state in the US mandates specific vaccinations for all children prior to school entry. However, many states, such as Arizona, are permit nonmedical exemptions (NMEs), and thus, communities with high levels of NMEs are potentially more vulnerable to outbreaks of vaccine preventable diseases. Objective: The objective of this study was to detect spatial clusters of pertussis cases and kindergarten NMEs of DTaP vaccine in Arizona. Methods: Data detailing kindergarten NMEs for each AZ school in the 2012-13 and 2013-14 school years and pertussis cases with report dates during those time periods were obtained from the Arizona Department of Health Services databases. Addresses for each school and pertussis case were geocoded, and the coordinates were obtained for each corresponding census tract. Using a purely spatial analysis with Poisson probability model, areas with high rates of pertussis or NMEs were identified with SaTScan. Clusters for both the number of NMEs and pertussis cases were detected and presented in maps. Extremely large (>50km radius) clusters extending beyond state boundaries were considered irrelevant and removed. Results: Multiple clusters of NMEs and pertussis cases were identified in two school years. While the clusters were generally in highly populated regions, they were not located at the same region in both years. The NME clusters and case clusters did not always overlap. Conclusions: The current analysis does not support an association between kindergarten NME frequency and pertussis outbreaks within these time periods. Clusters of both NMEs and pertussis cases were located in different regions each year. Since kindergarten NMEs vary from year to year, it is possible that these NME rates are not reflective of those in the community. Further studies with larger datasets will be important in elucidating the spatial distribution of pertussis cases and NMEs.