• A Systematic Review of Physician-Patient Interactions and the Effect of Health Care Provider Bias and Knowledge on Adolescent Contraception Counseling in Developing Countries and Comprehensive Review: Contraceptive Use and Impact of Physician Counseling for Adolescent Patients of Method Choices and Side Effects in Developing Countries

      Cooke, Alexandra; The University of Arizona College of Medicine – Phoenix; Beyda, David (The University of Arizona., 2019)
      Unmet need for contraceptives in developing countries remains a social and health problem and adolescents are more likely to struggle in starting long-acting contraceptive methods, often due to side effect or other concerns. This study aimed to analyze the biases in the provider-patient relationship and counselling practices for adolescent patients in developing countries. Attention was placed on patient’s preferred method, cultural and moral biases, knowledge gaps of patient and providers, side effect knowledge, and attitudes impacting the relationship upon counseling quality and likelihood of contraceptive use. Systematic review of articles with MeSH terms “developing countries,” “contraception,” “adolescents,” and other search terms yielded 6745 articles; 14 articles were chosen for further review. Findings highlight negative impacts of providers’ ethical concerns and knowledge gaps when addressing method use and side effects. Low knowledge base by providers of varying skill level also highlight a need for improved training on family planning methods.
    • Willingness to Receive HPV Vaccine from Community Pharmacists: Exploring the Perspectives of Rural Caregivers of HPV Vaccine Age Eligible Children

      Dominick, Lauren; The University of Arizona College of Medicine – Phoenix; Koskan, Alexis (The University of Arizona., 2019)
      This study explores the perspectives of caregivers of HPV vaccine age-eligible children living in rural Arizona – in terms of having their child vaccinated by a community retail pharmacist.
    • Confocal Microscopy Provides a Rapid Intraoperative Histological Assessment of Brain Neoplasms: Experience with 106 Cases

      Carotenuto, Alessandro; The University of Arizona College of Medicine – Phoenix; Preul, Mark C. (The University of Arizona., 2019)
      Frozen section histological analysis is the mainstay for intra-procedural tissue diagnosis during resection of intracranial neoplasms and for evaluating tumor margins. However, frozen sections are time-consuming and sometimes inaccurate. This study describes potential advantages of CSM imaging of fresh human brain tumor tissues labeled various fluorophores within the neurosurgical operating room facility.
    • Evaluation of the Effects of the MOVE+ vs STAND+ Interventions in the Workplace on Snacking

      Cook, Arianna; The University of Arizona College of Medicine – Phoenix; Buman, Matthew (The University of Arizona., 2019)
      Snacking has been identified as a dietary pattern that could contribute to the prevalence of overweight and obesity. Snacking patterns can be influenced by the environment such as the workplace. The purpose of this study is to determine the effect of workplace sedentary interventions on diet, more specifically snacking, and to give more information on the nutritional value of snacking.
    • Egr3-­/-­ Mice, a Mouse-Model of Schizophrenia, Show Decreased Levels of Htr2a mRNA in the Anterior Frontal Cortex after Sleep Deprivation Compared to WT Mice

      Elizalde-Rodriguez, Diana; The University of Arizona College of Medicine – Phoenix; Gallitano-Medel, Amelia (The University of Arizona., 2019)
      In the U.S., 1 in 25 adults experience serious mental illness each year. Despite ongoing research efforts, the pathogenesis of schizophrenia remains unknown. The aim of this study is to answer the question “Do Egr3-­/-­ mice, a mouse-­model of schizophrenia, show decreased levels of Htr2a mRNA in the prefrontal cortex (PFC) region of the brain after sleep deprivation (SD) compared to wild type (WT) mice?” Data resulting from the study will shed light on the pathogenesis of such a disabling mental disorder. Our study investigates the interaction between two of the genes linked to increased risk of schizophrenia, the early growth response (Egr) 3 gene and Htr2a, which encodes the serotonin 2a receptor (5HT2AR) in response to SD, a form of stress. We used a cohort of age-­matched pairs of C57BL/6 Egr3-­/-­ and WT male mice. Half of these underwent a SD protocol, while the other half served as a control group. Htr2a mRNA was quantified in four different brain regions via densitometry after it was visualized using in-­situ hybridization. Our findings that Egr3-­/-­ mice show statistically significant decreased expression levels of Htr2a mRNA in the PFC support our proposed biological pathway for schizophrenia risk.
    • Comparison of Occipito-atlanto-axial Parameters on Computed Tomography in Pediatric Trauma Patients

      Calhoun, Matthew; The University of Arizona College of Medicine – Phoenix; Connell, Mary (The University of Arizona., 2019)
      Spinal cord injury without radiographic abnormality is a prevalent issue within the pediatric population. Children under the age of 10 are prone to sustaining injury at C1 to C4 because their biomechanical fulcrum exists between C2 and C3. The incidence of spinal cord injury in pediatric population has been estimated to be 4.6 per million per year or 1-2 % of all pediatric trauma cases. There may be subtle findings on computed tomography (CT) that may be able to identify occult cervical spine injury in pediatric trauma patients, which would be evident on magnetic resonance imaging (MRI). This study aims to measure various dimensions of the atlantoaxial and atlantooccipital joints in the pediatric cervical spine in patients with normal spines to detect subtle irregularities on CT scans to warrant further work up with an MRI in trauma patients. Additionally, having an accurate diagnosis will help guide the appropriate type and duration of treatment, which can range from conservative treatment with immobilization to surgery.
    • Does triptolide alter c-Myc expression through regulation of its associated transcriptional factors and coactivators?

      Cao, Thanh; The University of Arizona College of Medicine – Phoenix; Han, Haiyong (The University of Arizona., 2019)
      In this study we investigated whether triptolide regulates c-Myc expression by inhibiting FBP1 protein expression at the transcription and/or protein level. We performed an RNA sequence to determine global regulation of transcriptome in response to triptolide treatment. In addition, we determined the effects of triptolide on c-Myc, FBP1 and FIR protein expression. We found that 100nM of triptolide inhibited gene expression of c-Myc, FBP1, FIR and XBP. This finding is consistent with a decrease in protein expression of c-Myc and FIR. These finding suggest that triptolide may inhibit FBP1 ability to bind with XBP.
    • Does Animal Assisted Therapy (AAT) have an effect on mood in United States Veterans?

      Baumann, Alysa; The University of Arizona College of Medicine – Phoenix; Nelson, Erin (The University of Arizona., 2019)
      Research has shown benefit for United States veterans with service dogs and emotional support animals. However, the literature is lacking in research on the beneficial effects and impact of therapy animals specifically on the disabled veteran population. This pilot study explored the effects of a single therapy dog on various aspects of mood, including depression and anxiety, in disabled veterans by incorporating five weeks of thirty-minute therapy sessions to a group of eight veterans. Although this was a small sample population, we concluded that five weeks of consecutive animal assisted therapy resulted in a general decrease in anxiety and depression, and an overall positive increase in mood as evidenced by Beck Anxiety Inventory, Beck Depression Inventory, and Trauma Symptom Inventory scores. Further large-scale studies will need to be conducted with a greater number of participants to help support the data in this study.
    • The Effect of Radiated vs Non-Irradiated Blood Transfusions on Extracellular Potassium Levels in Infants Undergoing Craniosynostosis Repair

      Dunn, Tyler; The University of Arizona College of Medicine – Phoenix; Singhal, Raj (The University of Arizona., 2019)
      Transfusion Associated Graft Versus Host Disease (TA-GVHD), a risk of blood transfusions, has a mortality rate > 90%. This results when viable donor T-lymphocytes within the transfused product proliferate and attack host tissue. The risk is reduced with irradiation of blood prior to transfusion. The downside to irradiating cellular blood products is that irradiation also affects other cellular components in the blood product causing the level of extracellular potassium to rise due to hemolysis of the red blood cells. The rapid infusion of high potassium blood products has been associated with fatal cardiac arrhythmias. This study evaluated the effect of irradiated versus non-irradiated blood transfusions on extracellular potassium levels if washing irradiated blood prior to transfusion results in less of a change in extracellular potassium.
    • Comparison of Autografts vs. Allografts in the Surgical Repair of Pediatric Obstetrical Brachial Plexus Injuries

      Hamant, Laura; The University of Arizona College of Medicine – Phoenix; Adelson, P. David (The University of Arizona., 2019)
      Obstetrical Brachial Plexus Injuries(OBPI) occur during delivery with a global incidence ranging from 0.2- 4% of live births, and generally, prognosis is excellent with spontaneous recovery in up to 95% of patients. For patients with OBPI that do not obtain a functional recovery by 4-6 months of life, treatment is primarily surgical in nature. Surgical treatment involves testing of the nerves to determine whether they remain connected distally and proximaly, removal of scar tissue/ neurolysis, and then bridging the nerve discontinuity or block with a nerve graft. Nerve grafting provide a three-dimensional extracellular matrix that promotes Schwann cell migration and axon regeneration. Historically, nerve graft was autograft using sural nerve. More recently, a decellularized processed cadaveric nerve allograft (Axogen) has been utilized in numerous peripheral nerve injury repairs, mostly in adults, but has not been reportedly used in pediatric OBPI. The aim of this study is to determine if using nerve allografts (Axogen) will have similar functional outcomes as compared to sural nerve autografts in reconstruction of the brachial plexus after OBPI.
    • Use of Uterine Electromyography (EMG) for Estimation of Uterine Contractility and Cervical Dilation During the 1st Stage Labor in Pregnant Women

      Ford, Brandon; The University of Arizona College of Medicine – Phoenix; Garfield, Robert (The University of Arizona., 2019)
      Labor and delivery in pregnant women occurs in three stages: The 1st stage begins with the onset of uterine contractility and progressive cervical dilation. The onset and development of labor are commonly monitored with crude and inaccurate instruments and methods: a force transducer (tocodynamometer or TOCO) strapped to the abdominal surface to measure uterine contractility and digital exams to estimate effacement and cervical dilation. Electrical activity is the underlying basis for uterine contractility as it is in all muscles including the heart, skeletal and smooth muscles and electrical activity can be accurately estimated with electromyography (EMG, electrophysiological methods). In the uterus, electrical activity consists of bursts of spikes and the characteristics of the bursts are responsible for the frequency, duration and force of contractions. The goals of this study were to assess: 1) The potential for measuring uterine electrical activity during the 1st stage of labor as the basis for contractility of the uterus; 2) The causal relationship of contractility to and changes in cervical effacement and dilation in pregnant patients , and 3) Define how predicted values of cervical dilation can be obtained from electrical signals and how predicted values of electrical signal characteristics can be obtained from cervical dilation.
    • A Systematic Review of the Effectiveness of HIV Intervention Programs on HIV Rates, Condom Use, and Abstinence in Adolescents in Low Resource Countries and The Pathophysiology, Role, Prevention, and Treatment of HIV in Low Resource Countries

      Keerthi, Svadharma; The University of Arizona College of Medicine – Phoenix; Yoblonski, Lara (The University of Arizona., 2019)
      There are high rates of HIV in adolescent girls in low resource countries due to the high incidence and prevalence of sexual violence. The purpose of this project is to collect the data of educational programs that aim to decrease rates of HIV and describe their characteristics, specifically, the rates of HIV, the rate of sexual violence, condom use, and sexual practices before and after intervention by education programs. The data shows that none of the studied measures changed after educational programs.
    • Is Ketamine an Effective Sedative in the Acutely Agitated Patient in the Prehospital Setting?

      Hawk, Katie; The University of Arizona College of Medicine – Phoenix; Gallagher, John (The University of Arizona., 2019)
      Excited Delirium Syndrome: disorder characterized by hallucinations, aggressive and peculiar behaviors, a catecholaminergic surge and secondary risk for sudden cardiac death (Gerold, 2015). The development of sedatives and antipsychotics lead to a decreased incidence until the 1980s. With increasing use of stimulants such as cocaine and methamphetamines, the rates of “undetermined cause of death” has increased in patients exhibiting acute agitated delirium who were in police custody. Patients in this state may be in danger of avoidable death. Emergent medical treatment may prevent death in these patients as suggested by a retrospective review of deceased patients; indicating a need for sedation that minimizes the use of physical restraint and sedates the patient chemically. Ketamine, which functions as a noncompetitive antagonist to NMDA receptors and releases of glutamate, is an option for chemical sedation. The safety profile is ideal as it has a wide therapeutic index and does not act on opioid or GABA receptors. This study asks if Phoenix Fire Department paramedics assessments indicate that IV/IM ketamine administration to patients with Excited Delirium Syndrome is more effective at sedation than Midazolam alone for prehospital transport to an acute care facility?
    • A Systematic Review on the Effect of Misoprostol in the Prevention of Postpartum Hemorrhage in Sub-Saharan African Women of Reproductive Age

      Kassi, Luce Auriane; The University of Arizona College of Medicine – Phoenix; Brady, Michael (The University of Arizona., 2019)
      Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. Oxytocin is the uterotonic drug of choice to prevent PPH. This systematic review was performed to evaluate the use of misoprostol as a possible alternative in resource-poor settings. Articles were selected on PubMed and the International Journal of Obstetrics and Gynecology based on their primary outcomes (estimated blood loss (EBL) in mL), region (Sub-Saharan Africa) and purpose (comparing (1) misoprostol with oxytocin or with a controlled placebo (2) and different doses of misoprostol). All meta-analyses used a Cohen’s D scale. There was no difference between the use of oxytocin over misoprostol and meta-analysis shows that when used separately, both medications decreased total EBL. Misoprostol at 400 and 600 mcg did not show any difference on EBL compared to oxytocin. In combination with oxytocin, there was no difference on EBL compared to misoprostol alone. When oxytocin was not added to misoprostol, there also was no difference on EBL compared to misoprostol alone. This study suggests that misoprostol may be a sustainable alternative to prevent PPH in resource-poor areas where oxytocin is unavailable.
    • Evaluation of Rural Pediatric Patients with Intractable Epilepsy for Vagal Nerve Stimulation: A Telehealth Education Based Model

      Hussain, Omar; The University of Arizona College of Medicine – Phoenix; Adelson, P. David (The University of Arizona., 2019)
      Vagal Nerve Stimulation (VNS) has turned into the treatment of choice for pediatric patients with medically refractory epilepsy. It is non-invasive, has few complications, and has a significant impact on the frequency, severity, and duration of seizures. This project sought to answer three main questions. What are the epidemiologic factors that are significant (if any) for pediatric medically refractory epilepsy? What are the best outcome predictors for VNS implantation? And finally, is there a way to improve rural physicians’ decision making abilities when referring patients for evaluation of VNS implantation?
    • Patient Activation Through Community Paramedicine – Initial Assessment and Future Directions

      Goff, Nathan; The University of Arizona College of Medicine – Phoenix; Clever, M. Todd (The University of Arizona., 2019)
      Community paramedicine (CP) is an evolving concept that promises to expand the role of emergency medical services to support patients beyond the conventional emergency activation. Community paramedics engage in a variety of activities during visits to patient homes including post hospital discharge follow up, medication reconciliation and monitoring of health parameters such as body weight and blood pressure. As CP programs develop, it is important to have a mechanism by which to measure their success. Patient activation is a holistic concept that describes a patient’s ownership of his or her health and healthcare. The survey based Patient Activation Measure (PAM) is a quantitative means to assess a patient’s level of activation. Is it possible that participation in a CP program could increase patient activation, which in turn could act to describe the success of the CP intervention? This study analyzed data derived from a PAM survey used in association with a CP program at Buckeye Fire Department in Buckeye, Arizona. It was expected that patient activation would increase among patients participating in the program. A clear correlation was not found however several insights were gained which hold promise to better define a future study.
    • An Analysis of the “Angelina Jolie Effect”: Does the Media Influence Patients’ Contralateral Prophylactic Mastectomy Decisions?

      Gosney, Jayme; The University of Arizona College of Medicine – Phoenix; Bernard, Robert (The University of Arizona., 2019)
      Following genetic testing and counseling, many women elect to undergo prophylactic surgery to reduce their risk of developing breast and ovarian cancer. Bilateral prophylactic mastectomy (BPM) can decrease a woman’s risk of developing breast cancer by more than 90%.4 However, contralateral prophylactic mastectomy (CPM) does not increase survival for the majority of women with breast cancer, which is contrary to the increasing incidence of CPM.5,7 Angelina Jolie published an op-ed in The New York Times in May 2013 regarding her decision to undergo BPM. She pursued preventative surgery due to her strong family history of breast cancer and positive test for a BRCA mutation. While Jolie’s situation is not analogous to that of women undergoing CPM, it is possible that in many women’s minds, the situations are similar. This study is a retrospective review that examines the relationship between popular magazine articles written about prophylactic mastectomy and the number of CPM surgeries performed.
    • Comparative Assessment of Severe Pediatric TBI Management between Developed and Developing Country Institutions: A Study Comparing Phoenix, Arizona to Neiva, Columbia

      George, Laeth; The University of Arizona College of Medicine – Phoenix; Adelson, P. David (The University of Arizona., 2019)
      Traumatic Brain Injury (TBI) is an etiologically heterogeneous condition that represents a global public health issue with major socioeconomic impact. Evidence-based guidelines for pediatric TBI management exist, and were last updated by the Brain Trauma Foundation in 2012. There are, however, limitations and barriers to their implementation; one such are the differences in resource utilization and availability in developed versus developing countries. In this study, we performed a retrospective review of pediatric patients with severe TBI in two tertiary, pediatric hospitals in the United States and Colombia, comparing characteristics, management and outcomes.
    • Examining the Safety and Cost of Risk-Reducing Salpingectomies as Prophylactic Treatment for Women Seeking Sterilization Who Are at Low to Moderate Risk for Ovarian Cancer

      Samareh-Jahani, Farmin; The University of Arizona College of Medicine – Phoenix; Kaufmann, Bruce (The University of Arizona., 2019)
      Ovarian cancer ranks fifth among the most common cause of cancer deaths in women. There is evidence that the site of origin for the majority of the most serious form of ovarian cancers is the fallopian tube. There is growing consensus for risk-reducing salpingectomies (RRS) to be performed for women who are at moderate risk for developing ovarian cancer especially at a time of patient desired sterilization. A retrospective chart review to determine the safety and cost of risk-reducing salpingectomies in comparison to tubal ligations was performed using the Healthcare Cost and Utilization Project inpatient database from 2008-2012. Results showed no significant difference between each procedure for length of stay in days (95%CI -0.19, 0.79 p: 0.24) or intraoperative complications (OR 4.84 (95%CI 0.38, 60.9 p: 0.22)). There was a significant difference between the total charges associated with each procedure with tubal ligation having a mean cost of $2,227.21 (95%CI $403.2, $4051.10) and the bilateral salpingectomy procedure having a mean cost of $11,189.80 (95%CI $6,582.70, $15,796.80 p<0.001). The cost difference between the two procedures should shift the conversation towards the question of whether hospital billing and insurance coverage for bilateral salpingectomy without oophorectomy should be examined more closely in order to provide RRS as a prophylactic treatment for women at moderate risk for developing ovarian cancer seeking sterilization.
    • Comparing the Effects of Narrative Nonfiction and Literary Fiction on Empathy Retention in Medical Students

      Shi, Aishan; The University of Arizona College of Medicine – Phoenix; Hartmark-Hill, Jennifer (The University of Arizona., 2019)
      Integration of medical humanities into medical student curricula has been shown to improve medical student empathy and resilience. The purpose of this study is to determine if narrative nonfiction pieces help students retain equal or more empathy skills compared to reading literary fiction. Previous studies show that interventions that utilize medical humanities can vary in medium and genre, and face the challenge of small sample size and confirmation bias due to a lack of randomized trials. In contrast, this study compares the reading of Narrative Nonfiction and Literary Fiction in building empathy in second year medical students randomized to each genre. Participants were asked to read selections from their assigned genre during the intervention period. Baseline, pre-intervention, and post-intervention assessments were measured by the Reading the Mind in the Eyes –Revised. Results demonstrated a statistically significant decrease in empathy across the overall study period, and there was no empathy retention difference between genres. Additionally, female gender identity and increased engagement in the arts and humanities prior to medical school were correlated with higher empathy scores across time. These findings indicate the need for longitudinal and personalised learning in medical humanities for more thorough studies and maximised benefits on empathy retention.