• Salvage Hyperthermic Gemcitabine and Docetaxel Combination Chemotherapy After BCG Failure in Non-Muscle Invasive Bladder Cancer Patients

      Rao, Mounica; The University of Arizona College of Medicine – Phoenix; Lamm, Donald L. (The University of Arizona., 2019)
      In patients with non-muscle invasive bladder cancer (NMIBC), intravesical BCG has been shown to reduce the rate of disease recurrence and disease progression, as well as improve disease-specific survival. While Bacillus Calmette-Guerin (BCG) has become the gold-standard therapy for NMIBC, there are still patients who fail this therapy or are not good candidates for it. Although a radical cystectomy is recommended when BCG is failed, some patients either desire bladder preservation or are not surgical candidates. Thus, further exploration into salvage chemo therapy treatments should be done to provide these patients with an alternative treatment option. The purpose of this study is to analyze if combination Gemcitabine and Docetaxel chemotherapy (GEM/DOCE) is a successful salvage option in adults who have failed or cannot tolerate BCG therapy for NMIBC, and are poor surgical candidates for a radical cystectomy (RC) or desire bladder preservation. In this retrospective study, 60 patients were included. Overall treatment success was 83% (50/60) at first surveillance, 69% at 1-year, and 55% at 2-years after induction of GEM/DOCE in the entire cohort, and 90%(53/51) at first surveillance, 74% at 1-year, and 56% at 2-years in the BCG-failure patients. These success rates are quite favorable and warrant further investigation in a prospective manner to further optimize this salvage protocol for patients who remain a challenge to treat.
    • Surgery Night Float Team: Should Medical Students Have a Spot on the Roster?

      Richter, Madeline; The University of Arizona College of Medicine – Phoenix; Keric, Natasha (The University of Arizona., 2019)
      Following the trend of residency programs, more medical schools are offering night float (NF) schedules for clerkships and sub-internship rotations. The efficacy of this structure to educate students and prepare them for residency was evaluated. This study investigates the question: Is a night float surgical rotation an effective educational experience for 4th year medical students to prepare for internship in that it matches or exceeds day-shift rotations in operative and procedural opportunities, autonomy, and instructive interactions with attending physicians and residents? Twenty individuals were surveyed after a month-long 4th year NF rotation in Trauma and Emergency Surgery. Thirteen participants responded (65%), reporting more bedside procedures (84.7%) and one-on-one teaching with residents (84.7%), when compared to daytime shifts. All participants (100%) reported: increased autonomy; that this elective better prepared them for their surgical residencies; and that they would recommend this type of program to other students considering a career in surgery. Overall the NF surgical sub-internship effective and well-received, with increased autonomy, more frequent procedures, and added resident-led education, when compared to a traditional daytime surgical clerkship/sub-internship. A NF schedule can be a valuable learning experience that prepares medical students for surgical residency.
    • Systematic Review of Quality of Life for Family Members of Children with Autism Spectrum Disorder in Asia and Mindfulness Based Interventions for Children with Autism Spectrum Disorder and Their Parents: Mechanism, Evidence, and Feasibility

      Vincent, Kathleen; The University of Arizona College of Medicine – Phoenix; Melmed, Raun (The University of Arizona., 2019)
      Autism Spectrum Disorder (ASD) is a lifetime neurodevelopmental disorder with presence of symptoms early in development. About 1 in 68 children have been identified with ASD globally. Parents of children with ASD face diverse hurdles that can have a significant impact on their quality of life (QOL), and interventions may be able to improve these outcomes. A systematic review was conducted to assess the QOL for family members of children with ASD in Asia and to elucidate interventions that can impact QOL outcome measures. This study sought to synthesize QOL outcomes for parents of children with ASD across Asia by drawing from currently available primary research. It also sought to examine interventions that have been used in this population to investigate their impact on QOL outcomes in order to unveil the most efficacious interventions for impacting a given outcome. A total of 34 studies were included for review; 17 were used for quantitative analysis and 17 used for qualitative review. Parents of children with ASD in Asia were found to have lower QOL in the areas of general health, role physical, social, vitality, mental health, stress, and overall well-being than parents of typically developing (TD) children. High sense of coherence was shown to be associated with higher parental QOL and lower parental stress. Certain factors were found to be associated with higher sense of coherence including: male gender, parent age greater than 45, and child age greater than seven. Mothers were broadly found to have lower QOL than fathers. Mothers had a lower sense of coherence, lower health-related QOL, poorer overall well-being, and higher stress levels. Coping strategies that parents of children with ASD were found to use most often were religion and a focus on positive growth to create meaning. Not all interventions resulted in positive outcomes. A Mindfulness Based Intervention in Jordan positively impacted QOL outcomes. A Multidisciplinary Parent Education program in China had a significant positive impact on family functioning, while a Cognitive Behavioral Therapy (CBT) intervention for children with ASD decreased parental stress. Additionally, parents having and maintaining contact with parents in a similar situation helped improve well-being, parental stress and family functioning, following an intervention. This preliminary work investigating QOL for family members of children with ASD emphasizes the importance of discovering QOL outcome targets and pairing these with efficacious interventions that are specific to the needs of the population.
    • Systematic Review of Stigmas Present against Disabled Children Globally and How These Stigmas Vary across Regions and Population and Comprehensive Review of the Perceptions and Attitudes that Disabled Children Face Globally

      Pusapati, Nithin; The University of Arizona College of Medicine – Phoenix; Beyda, David (The University of Arizona., 2019)
      Current literature shows that disabled individuals are vulnerable compared to their abled body counterparts in a variety of measures, disability varies across regions and cultures and that attitudes toward these disabilities may also vary globally. Literature searches using keyword searches were done based on search strings of “childhood disability” with other phrases. Outcome variables included region, population studied, a general description of the attitudes, a broader category into which the type of attitude falls and whether or not there were persistent negative attitudes toward disability. Meta analyses were done for outcomes. An initial 114 articles were screened to be relevant to the topic. 15 articles had data extracted. Descriptive results demonstrated that cultural and religious norms are associated with negative attitudes toward disability. Meta analyses did not demonstrate any statistical significance between the cultural, religious or regional factors in the likelihood of having negative attitudes toward disability. The association between religion, culture and region and the likelihood of having negative attitudes was not statistically significant. The presence of negative attitudes on the basis of culturally or religiously held beliefs, globally, does appear to exist on review of the literature.
    • 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.
    • The Long Term Efficacy of a Behavioral Based Diabetes Prevention Program for High Risk Hispanic Youth

      Wright, Mia; The University of Arizona College of Medicine – Phoenix; Lee, Maurice (The University of Arizona., 2019)
      There is little known about the long term efficacy of diabetes prevention programs in adolescents targeting high risk youth. In this study a chart review was performed to recruit 21 adolescents from the intervention arm and 9 from the control. The HbA1c, BMI% and BP were measured and they all took a health behavior questionnaire. The results varied but the data suggest that there is not an overall decrease in diabetes risk as there was no statistically significant difference in the A1c or BMI.
    • Tumor Infiltrating Lymphocytes as a Predictive Biomarker for Response to CTLA-4 and PDL-1 Therapies

      Mousa, Abeer; The University of Arizona College of Medicine – Phoenix; Chang, John (The University of Arizona., 2019)
      Recently approved immunotherapies capitalize on antitumor mechanisms of the patient’s immune system by inhibiting CTLA-4 and PD-1 pathways. Studies have shown better overall survival with increased tumor infiltrating lymphocyte (TIL) across multiple cancer. Recent trials with anti-PDL-1 has shown better response with high PDL-1 expression. However, studies have not evaluated whether TIL level would correlate with anti-PDL-1 or anti-CTLA-4 responses. The aim of this study is to determine if the level of TIL in metastatic melanoma and lung cancer correlates with patient response to modern immunotherapies. We identified 10 patients with melanoma or lung cancer treated with an immune checkpoint inhibitor. The biopsy samples were stratified according to level of TIL. The TIL categories ranged from 0 to 3, with 0 indicating no TIL detected and 3 indicating 67-100% TIL infiltration. Survival analysis was achieved with Kaplan-Meier curve, and tumor size change was evaluated with linear mixed model analysis. Overall survival was significantly longer in patients who had TIL (TIL0-0.3 yr; TIL1-2-2.4 yr; TIL3-1.6 yr, p=0.024). Tumor size also dramatically decreased at first follow up based on TIL level (TIL 1-2: 371% greater decrease than TIL 0, p < 0.01; TIL 3: 406%; p<0.01). Decrease in tumor size for TIL0 was 0.12cm2 at first follow-up. Baseline tumor size for TIL0 was 41.9cm2; TIL1-2 0.4 cm2; TIL3 1.4cm2. Our study shows that TIL level may serve as a biomarker to predict tumor response to immunotherapy, without specific histochemical staining. This study is limited by the low number; a larger review is currently taking place.
    • 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.
    • What are the physical characteristics of the distal tibiofibular syndesmotic joint in uninjured patients?

      Rahman, Qasim; The University of Arizona College of Medicine – Phoenix; Gridley, Daniel G. (The University of Arizona., 2019)
      The syndesmosis is a crucial component for the ankle joint as any injury to it can immobilize a person. The ultimate goal of treatment is to restore the syndesmosis and ankle joint to their respective pre-injury, anatomic alignments. Few studies have attempted to characterize normal syndesmotic joints. Many of these studies have had certain limitations: small population size, minimal diversity in subject demographics, and very few raters taking part in data collection. The purpose of this study is to review a normal distal tibiofibular syndesmosis and characterize the parameters of an uninjured joint using both computed tomography (CT) and magnetic resonance imaging (MRI).
    • 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.