• An ecological snapshot of Clostridioides difficile: characterizing genetic diversity of C. difficile within Banner-University Medical Center Phoenix

      Brussels, Aaron; Vedantam, Gayatri (The University of Arizona., 2020)
      RATIONALE: The genetic diversity of Clostridioides difficile within hospitals is known to vary geographically: the C. difficile ecology within Banner-University Medical Center Phoenix (BUMCP) is uncharacterized. METHODS: A laboratory-based surveillance study design was used unique to-be-discarded stool samples testing positive for C. difficile infection (CDI) at BUMCP per their existing testing protocol were collected and banked over a 16 month period. Each deidentified sample underwent selection and culture before being prepared for and subjected to capillary PCR in order to determine genetic type (ribotype) of each offending strain of C. difficile. RESULTS: A total of 267 samples met inclusion criteria for this study; 225 were successfully genetically typed, and 83 unique ribotypes were identified. 17 ribotypes (20.5%) are responsible for 60.5% of all typeable cases of CDI during the study period, while 43 strains (51.8%) were each represented by only one case (15.1% of typeable cases) and another 23 strains (27.7%) were represented by two cases (20.4% of typable cases). CONCLUSIONS: There is an uneven distribution of disease burden relative to ribotype. This finding is consistent with similar investigations in other geographies. The highest burdens of disease are attributable to ribotypes 027, 106 and 176 – all well-documented hypervirulent outbreak associated strains.
    • 10-Year Epidemiology of Ankle Injuries in Men’s and Women’s Collegiate Soccer Players

      Gulbrandsen, Matt; Chhabra, Anikar (The University of Arizona., 2020)
      Background: Data from the National Collegiate Athletic Associ-ation (NCAA) Injury Surveillance Program (ISP) has indicated that ankle injuries are the most common injuries among NCAA soccer players. Objective:To review 10 years of NCAA-ISP data for soccer players’ ankle injuries to understand how the time period (2004-2005 through 2008-2009 versus 2009-2010 through 2013-2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognoses. Design:Descriptive epidemiology study. Setting: Online injury surveillance. Main Outcome Measure(s): The NCAA-ISP was queriedfor men’s and women’s soccer ankle data from 2004 to 2014. Ankle injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics. Results: When compared with the 2004-2005 through 2008-2009 seasons, the 2009-2010 through 2013-2014 seasons showed a similar rate of injuries (RR¼0.94, 95% confidence interval [CI]¼0.85, 1.04) but fewer days missed (P,.001) and fewer recurrent injuries (IPR¼0.55, 95% CI¼0.41,0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears(65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss 30þdays (IPR¼1.9, 95% CI¼1.24, 2.90). Men and women had similar injury rates (RR¼1.02, 95% CI¼0.94, 1.11). Men had more contact injuries (IPR¼1.28, 95% CI¼1.16, 1.41) and contusion injuries (IPR¼1.34, CI¼1.03, 1.73) but fewer noncontact injuries (IPR¼0.86, 95% CI¼0.78, 0.95) and lateral ligamentous complex injuries (IPR¼0.92, 95% CI¼0.86, 0.98). Conclusions: Although the rate of ankle injuries did not change between the 2004-2005 through 2008-2009 seasons and the 2009-2010 through 2013-2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high anklesprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.
    • Trend Analysis of the Incidence of Certain Aesthetic Surgical Procedures in the United States within the Last 19 Years and the Influence of Changing Demographics

      Meza-Rochin, Ana; Bernard, Robert (The University of Arizona., 2020)
      Over the years, there has been an increase in the overall incidence of surgical cosmetic procedures performed in the United States and in some instances, a seemingly disproportionate increase in the incidence of certain procedures12. We believe that several factors, including, but not limited to changes in the U.S. demographics such as race, socioeconomic status and education level in minorities have influenced certain types of procedures performed. The procedures that we analyzed for this study were ethnic rhinoplasties, blepharoplasties, and buttock augmentations. To conduct this study, statistics for surgical aesthetic procedures were evaluated from 1997 to 2016. The total number of rhinoplasties, blepharoplasties and buttock augmentations per year were recorded on an excel table for all 19 years (1997-2016). Trend analysis was performed to assess possible reasons for changes overtime of the yearly incidence for each of the procedures studied. Various literature sources aided in deciphering the relationship between the incidence of certain aesthetic surgical procedures relating to changing demographics such as ethnicity, income, age, and other demographic factors.
    • Endoscopically Assisted Targeted Keyhole Retrosigmoid Approaches for Microvascular Decompression: Quantitative Anatomic Study

      Onaka, Naomi; Preul, Mark C. (The University of Arizona., 2020)
      OBJECTIVE: We describe and quantitatively assess minimally invasive keyhole retrosigmoid approaches targeted to the upper, middle, and lower cranial nerve (CN) complexes of the cerebellopontine angle (CPA). METHODS: Anatomic dissections were performed on 10 sides of 5 fixed, silicone-injected cadaver heads. Surgical views through various trajectories were assessed in endoscopic videos and 3-dimensional (3D) interactive virtual reality microscope views. Surgical freedom and angles of attack to the proximal and distal areas of CN complexes of the CPA were compared among upper and lower keyholes and conventional retrosigmoid craniotomy using neuronavigation. RESULTS: Compared with keyholes, the conventional approach had superior surgical freedom to most areas except for the distal CN V, the root of CN VII, and the root of CN IX, where differences were not significant. The conventional retrosigmoid approach provided a larger horizontal angle of attack than either the upper or lower keyholes for all selected areas; however, the vertical angles of attack were not different. Splitting the petrosal fissure resulted in a significant increase in the vertical angle of attack to the root zones of CNs V and VII but not to the distal areas of these nerves or CN IX. Illustrative cases of endoscope-assisted keyhole retrosigmoid approaches for the treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia are presented. - CONCLUSIONS: Targeted keyhole retrosigmoid approaches require detailed understanding of the 3D anatomy of the CPA to create appropriate locations of corridors, including skin incisions and keyholes. Endoscope assistance complements the standard microsurgical technique by maximizing the visualization and identification of the delicate neurovascular structures.
    • Cefazolin Monotherapy Versus Cefazolin Plus Aminoglycoside for Antimicrobial Prophylaxis of Type III Open Fractures

      Meshay, Ian; Culver, Mark (The University of Arizona., 2020)
      Background: There are conflicting recommendations between organizations regarding aminoglycoside use for the prophylaxis of type III open fractures. Study Question: To compare cefazolin monotherapy versus cefazolin plus aminoglycoside therapy for prophylaxis of type III open fractures in trauma patients. Study Design: This was a multicenter retrospective cohort study conducted in three academic medical centers in the United States. Consecutive adult trauma patients with type III open fractures between January 2014 and September 2016 were included. Patients were divided into two groups: 1) cefazolin monotherapy versus 2) cefazolin plus aminoglycoside. Measures and Outcomes: The primary outcome measure was occurrence of infection at the open fracture site. The secondary outcome measure was occurrence of acute kidney injury. Results: There were 134 patients included in the study cohort. Of these, 39 received cefazolin monotherapy and 95 received cefazolin plus aminoglycoside. Overall, the mean age was 39 ± 15 years, 105 (78%) were male, and the most common fracture location was tibia/fibula (n=74, 56%). Infection at the open fracture site occurred in 6/39 (15%) in the cefazolin monotherapy group and 15/95 (16%) in the cefazolin plus aminoglycoside group (p=1.000). Acute kidney injury occurred in 0/39 (0%) in the cefazolin monotherapy group and 1/95 (1%) in the cefazolin plus aminoglycoside group (p=1.000). Conclusion: Cefazolin monotherapy may be appropriate for antimicrobial prophylaxis of type III open fractures in trauma patients.
    • Ethical Guidelines for Human Subjects Research in Least Developed Countries: How do they compare to the Council for International Organizations of Medical Sciences International Ethical Guidelines?

      Reed, Melissa; Beyda, David (The University of Arizona., 2020)
      Background: The most vulnerable populations for human subjects research are those living in the most resource poor settings. As technology has progressed to support convenient long-distance travel, international communication, and data sharing via the internet, international research has become a more manageable task. While some dismiss the ethical guidelines for human subjects research as necessary only for the most barbaric researchers, history demonstrates the need for ethical guidelines as well as oversight of adherence to such guidelines. Methods: Forty-eight countries designated as least developed countries (LDCs) were identified and selected for analysis. An internet search was utilized to identify research guidelines for LDCs available online or primary research studies conducted in such countries to determine to what extent authors noted ethical considerations. Council for the International Organizations of Medical Sciences (CIOMS) guidelines were distilled into keywords by the authors and compared to guidelines for LDCs. Frequencies and percentages of comparison to CIOMS guidelines were tabulated across the 48 LDCs. Findings: Of the 48 LDCs identified, 22 did not have published research guidelines or mention of a Research Ethics Committee (REC). An additional 10 countries had documentation of some sort of REC, 3 countries had at least one ethical guideline in addition to a REC, and 13 countries had no mention of a REC but did have established ethical guidelines available online. Overall, the average number of guidelines per country was 5 with a SD of 4.11. Conclusion: Over half of countries had online documentation of limited ethics oversight for research, indicating a clear lack of thoroughness in the available guidelines as compared to the international gold standard guidelines from CIOMS. The majority of primary research articles reviewed showed no mention of ethical considerations despite some of the articles using chart review or engaging in patient care interventions. Based on the findings of this study, authors recommend the adoption of existing ethical guidelines by countries still lacking individualized guidelines, as well as a movement toward journals requiring documentation of ethical approval or ethical considerations as a requirement prior to approving articles for publication.
    • Prevalence of Sexually Transmitted Infections (STI’s) among Incoming Refugees in Maricopa County, Arizona

      Osman, Fawsia; Khurana, Renuka (The University of Arizona., 2020)
      Objective: The aim for this study was to determine the prevalence rate of Sexually Transmitted Infections (STI’S) among incoming refugees in Maricopa County in the state of Arizona. Design: A retrospective study Setting: Maricopa County Public Health Department Participants: 1,471 refugees from the Maricopa County Main outcome measures: Prevalence of Chlamydia, Gonorrhea, HIV and syphilis among incoming refugees compared to the Maricopa County prevalence. Results: The overall prevalence rates among those tested were 1.12% (90 of 8,055) for Chlamydia, 0.19% (15 of 8,055) for Gonorrhea, 0.73% (80 of 11,018) for HIV, and 55.5% (71of 138) for Syphilis (+TPPA+RPR). The prevalence rates of Chlamydia(p<0.001), HIV (p<0.001) and Syphilis (p<0.001) were statistically significant when compared to the Maricopa County rates while the rate of Gonorrhea (p<0.84) did not show statistical difference. There was no statistically significant difference noted in the all the STI’s tested among males and females. Between the various age groups, Chlamydia was statistically higher among the age group of 15- 25 p<0.04 while HIV was statistically significant among the age group of 36-45 p<0.04. Among the different regions, syphilis, the seroprevalence rate was highest among those from the Caribbean (73.7%) p<0.02 than among persons from the other three region (South/southeast Asia, Sub-Saharan Africa, Middle East and North Africa). Chlamydia had the highest prevalence among those from the Middle East/ North Africa (2.0%) p<0.04. There was no statistically significant among the prevalence of Chlamydia, Gonorrhea, HIV and Syphilis and HIV over the years from 2013-2017. Conclusion: Overall, the higher prevalence rates of Chlamydia, HIV and Syphilis when compared to the population they immigrate into indicate the importance of routine screening of incoming refuges and utility of CDC refugee post-arrival screening and evaluation recommendations.
    • Effects of a workplace sedentary behavior intervention on sleep in office workers with sleep complaints: Results from the Stand and Move at Work Trial

      Schaeffler, Kelby; Buman, Matthew (The University of Arizona., 2020)
      Background: Chronic inadequate sleep is associated with increased risk for cardiovascular disease, hypertension, obesity, immunosuppression and overall mortality. There is an abundance of research on the effects of exercise on sleep, but there is currently no data on the impact of sedentary interventions in the workplace on acute and long-term sleep quality/quantity. Purpose: The purpose of this study is to determine if increased standing and/or light-intensity physical activity (LPA) at work will improve sleep quality and duration in sedentary office-workers with mild to moderate sleep complaints. Methods: For this group randomized trial, 51 participants with mild-to-moderate sleep complaints were selected from the Stand and Move at Work Trial. Participants were randomized into two groups: MOVE+ (a multilevel individual, social, environmental, and organizational intervention targeting increases in LPA in the workplace) and STAND+ (MOVE+ intervention with the addition of the installation of sit-stand workstations). Sedentary behavior/LPA and sleep were measured objectively at baseline, 3 and 12 months with the activPAL3 micro accelerometer (PAL Technologies, Glasgow, United Kingdom) and the GeneActiv (GeneActiv, Activinsight, Wimbolton, UK) wrist-worn actigraphy sensor. Results: The sit-stand workstation intervention was effective, with the STAND+ participants sitting on average 70 minutes/day less than the MOVE+ participants at 12 months (p<0.05). There were no statistically significant differences between intervention groups in objectively or subjectively measured time in bed, total sleep time, sleep onset latency, wake after sleep onset, or sleep efficiency at the 3 or 12-month timepoints. On the individual level, adjusting for group assignment, there was no correlation between change in sedentary behavior and sleep measures, objective or subjective. Conclusion: This study found no correlation between a decrease in sedentary behavior at work and changes in objective or subjective measures of sleep. Limitations of this study include underpowering due to small sample size, potential significance of difference in baseline demographics and sleep/sedentary behavior between in groups, and the nature of the intervention being low-dose.
    • Lesion Size as a Predictor of Non-Operative Therapy Failure in Juvenile Osteochondritis Dissecans of the Knee

      Roehr, Mark; Kelly, Brian (The University of Arizona., 2020)
      Background: The primary challenge in juvenile osteochondritis dissecans of the knee management lies in the lack of definitive non-operative treatment criteria. The purpose of this study was to evaluate the predictive nature of the lesion size and to determine a lesion size cutoff point beyond which a patient’s likelihood of successful 3 month non-operative therapy significantly declines. Methods: 36 knees were retrospectively identified that met the inclusion criteria of stable JOCD lesions that received a 3 month non-operative therapy treatment consisting of either unloader bracing and/or activity restriction. The primary outcome of interest was improved clinical status at three months with accompanying MRI evidence of reossification. Continuous and categorical variables including lesion size were analyzed using logistic regression to ascertain the likelihood of a surgical intervention following a non-operative treatment regimen. Results: Following three months of non-operative treatment, 23 of the 36 knees (64%) had progression toward healing. The mean starting age of the patients with lesions that progressed toward healing was 10.4 years +/- 2.10 years and the mean age that required surgical referral was 12.4 years +/- 1.18 years (p = 0.002). The mean surface area of the lesions that demonstrated progression toward healing was 185.0mm2 +/- 103.7mm2, and the mean surface area of the lesions that did not progress toward healing and were referred for surgical management was 266.6mm2 +/- 95.5mm2 (p = 0.01). The mean lesion surface area cut point >250mm2 contained 13 knees. Of these 13 knees, 4 progressed toward healing (17.4% of the healing group), while 9 required surgical referral (69.2% of the surgery group) (OR = 6.84, 95% CI [1.17,39.8], p = 0.032). Conclusion: Increased lesion size and increased age were the strongest predictors of JOCD non-operative therapy failure. Stable lesions with a mean surface area that is > 250mm2 are at an increased risk for non-opperative failure and should be considered for direct surgical referral on a case by case basis.
    • Evaluating Narrative Operative Reports for Endoscopic Sinus Surgery in a Residency Training Program

      Wheeler, Shannon; Lal, Devyani (The University of Arizona., 2020)
      Methods: The quality of NRs for endoscopic sinus surgery (ESS) was evaluated by studying 90 NRs for ESS written between 2014-2017. Thirty-three elements that the attending surgeon regards as “critical” variables, or quality indicators (QIs), that should be documented in the NR, were studied to evaluate quality. “NR efficiency” (average percent of QIs dictated / total word count) was studied. Subgroup analysis by the level of training was additionally performed. Results: Surgical indications, procedural steps and immediate postoperative findings were accurately documented in 71%, 84%, and 82% of patients, respectively. The attending surgeon had the highest quality (proportion of included key elements) of NR (89% +/- 6.2%) followed by junior residents (87% +/- 5.7%) and then senior residents (80% +/- 14%) [p=0.008]. The attending surgeon also demonstrated the highest degree of “NR efficiency”, followed by senior and then junior residents (p<0.0001). Conclusions: The quality of NRs was found to be high overall, but not “perfect” for either the attending or trainee surgeon. NR efficiency amongst residents was expectedly lower than the attending surgeon. We propose that a synoptic reporting system that ensures inclusion of key elements may be helpful in training residents (and attendings) in creating comprehensive and efficient NRs.
    • Pediatric Primary Headache Sensitivity to Weather Variables

      Sabb, Dylan; Hickman, Carolyn (The University of Arizona., 2020)
      Objective: To determine the relationship between weather patterns and pediatric Emergency Department visits for primary headache. Methods: A retrospective descriptive correlational design was used. Chart reviews were done on 351 medical records of children less than 18 years of age. Study setting was visits to an Emergency Department at an academic pediatric hospital in the Southwest region of the United States. One calendar year of assessments of weather variables to include temperature, relative humidity, precipitation, and barometric pressure were obtained at multiple time points prior to presentation to identify weather-sensitive subsets. In addition, assessments of demographic (date of birth, sex, race, zip code) and clinical variables (chief complaint, diagnoses codes, imaging, medication, and disposition) were collected. Results: Findings indicate that there is a correlation between weather variables and Emergency Department visits in pediatric patients, especially in forecasts of two to five days. Conclusion: A subset of pediatric patients with primary headaches are sensitive to temperature changes within the 5 days preceding the presentation of the headache.
    • Methylene Blue Use in Pediatric Patients in the Cardiovascular Intensive Care Unit

      Patel, Sarah; Willis, Brigham C. (The University of Arizona., 2020)
      Objective: 1) Compare trends in mean arterial blood pressures and vasoactive-inotropic scores of pediatric patients after treatment of hypotension with methylene blue compared to controls; 2) Describe the dose administered and the pathologies of hypotension cited for methylene blue use; 3) Compare the morbidity and mortality of pediatric patients treated with methylene blue versus controls. Design: A retrospective chart review. Setting: Cardiac ICU in a quaternary care free-standing children’s hospital. Patients: Thirty-two patients with congenital heart disease who received methylene blue as treatment for hypotension, fifty patients with congenital heart disease identified as controls. Interventions: None. Measurements and Main Results: Demographic and vital sign data was collected for all pediatric patients treated with methylene blue during a three year period. Linear regression models examined trends in mean arterial blood pressures twelve hours post methylene blue treatment and vasoactive-inotropic scores for twenty-four hours post treatment. Methylene blue treatment correlated with an increase in mean arterial blood pressure of 10.8mm Hg over a twelve hour period (p< 0.001). Mean arterial blood pressure trends of patients older than one year did not differ significantly from controls (p=0.79), but patients less than or equal to one year of age had increasing mean arterial blood pressures that trended toward significance compared to controls (p=0.07). Similarly, a statistically significant decrease in vasoactive-inotropic scores was observed over a twenty-four hour period (?= -0.62, p< 0.001, ECMO ?= -6.07, p= 0.029). This difference remained significant compared to controls (p=0.001). Survival estimates did not detect survival differences between the groups (p=0.5). Conclusion: Methylene blue may be associated with a decreased need for vasoactive-inotropic support and may correlate with an increase in mean arterial blood pressure in patients who are less than or equal to one year of age.
    • 3D Volumetric Measurement of Normal Pediatric Livers: Creating a Reference Database and Predictive Model

      Sandoval, Amber; Bardo, Dianna M. E. (The University of Arizona., 2020)
      Background: Accurate and reproducible measurements of pediatric organs are necessary for defining normal organ volume, size, growth rates, and patterns of development, which aids in determining pathological variants. Currently, no modern reliable database exists for normal liver volume (LV) in children, and although predictive equations have been proposed, many are based on adult data, ethnically homogenous populations, or are derived from smaller samples and have not utilized advanced imaging technology in determining LV in vivo. Objective: To establish normal LV measurements in children, using a three-dimensional (3D) volumetric approach, with additional consideration for height, weight, body surface area (BSA), and body mass index (BMI), and to develop a predictive model using these parameters. Materials and methods: A retrospective review of normal contrast enhanced abdomen and pelvis CT images of 184 patients from 1 month to 18 years, identified within the Phoenix Children’s Hospital picture archive communications system (PACS) was performed. Gender, age, height and weight were recorded for each patient; BSA and BMI were calculated. LV measurements were obtained using segmentation images software (IntelliSpace, Phillips Healthcare, Haifa, Israel). Results: Univariate analysis of LV was most strongly correlated with and predicted by BSA (R2 = 0.90, p < 0.0001), which could be defined by: LV = -115.5 + 941.7*BSA. In multivariate analysis, BSA (p < 0.0001), gender (p = 0.01), and height (p = 0.001) were the covariates that best predicted LV with an adjusted R2 value of 0.90. 3 Stratifying the model by age did not modify the predictive capabilities of the covariates. Further stratifying by gender revealed inconsistent effect modification in some age groups. Conclusion: Univariate analysis of LV was most strongly correlated with and predicted by BSA, which can be defined by: LV = -115.5 + 941.7*BSA.
    • Optimization of a Novel Hepatobiliary Scintigraphy Protocol

      Peterson, Juliana; Singer Pressman, Melissa (The University of Arizona., 2020)
      Strategic use of medical imaging can improve healthcare quality and reinforce the practice of precision medicine by providing specific, individualized diagnostic information. Unfortunately, excessive radiologic scan duration times limit imaging center efficiency, leading to decreased patient satisfaction and heightened facility costs. A novel hepatobiliary scintigraphy protocol outlined by Verma et al. can be utilized with equivalent diagnostic ability to maximize scanner operation. The current study demonstrated multiple ways in which the new scintigraphy protocol can be optimized to increase imaging facility productivity. The models presented allow for customization based on facility preference and capability in order to decrease costs and generate revenue, while improving patient satisfaction.
    • Does exposure to chronic stress in rodents alter the level of SIRT1 in the nucleus accumbens?

      Peoples, Sandy; Ferguson, Deveroux (The University of Arizona., 2020)
      In this study we show that chronic social defeat stress, an ethologically validated model of depression in mice, stably induces SIRT1 levels in the nucleus accumbens, an area of the brain that is associated with motivation and reward. We exposed rodents to chronic social defeat stress for a period of ten days and then assessed the rodents on a social interaction test to determine stress response. Rodents were then classified as susceptible or resilient to chronic stress. SIRT1 mRNA and protein levels were then measured in the nucleus accumbens. Results showed that SIRT1 mRNA and protein levels were increased in susceptible rodents but not control or resilient rodents. This supports our hypothesis that SIRT1 levels are associated with depression and anxiety-like behaviors induced by chronic stress and may identify a novel signaling pathway for the treatment of major depressive disorders.
    • Assessing the Surveillance and Treatment of Perinatal Hepatitis C Transmission among Different Specialties in Arizona

      Immel, Shanan; Kim, Elizabeth (The University of Arizona., 2020)
      Hepatitis C is the most common chronic bloodborne infection in the United States as well as a leading cause of chronic liver disease. Recently, there has been increasing infections in younger people and women of childbearing age due mostly to the opioid epidemic. Among the many diseases that can pass vertically during pregnancy, hepatitis C is able to establish perinatal infections in approximately 5% of HCV-positive mothers. There is increasing evidence that many of these infections go undiagnosed and are lost to follow-up, putting children at risk of complications of hepatitis C at a young age. This study was designed to examine the knowledge, attitudes, and practices (KAP) of Arizona providers surrounding perinatal HCV infections through a Qualtrics survey. A difference was found between specialty guidelines, knowledge, and practices as it related to perinatal HCV. 6/30 (20%) FM providers, 5/10 (50%) Pediatric providers, and 14/23 (61%) OB/GYN providers correctly stated the vertical transmission rate of HCV. For antibody-based testing FM scored 4/30 correct, Pediatrics scored 8/10 correct, and Pediatric Infectious Disease scored 1/2 correct. 73.2% support universal prenatal screening for HCV as opposed to risk-based screening. 31% said they rarely or never ask about these risk factors for HCV. For OB/GYN providers 45% always counsel HCV-positive women about postpartum follow up for their child, 32% said they rarely or never do. In conclusion this survey showed a statewide deficiency in knowledge of screening and transmission of perinatal hepatitis C among certain specialties as well as a majority of respondents in favor of routine screening prenatally.
    • The Effect of Type of Antenatal and Delivery Care Providers on Breastfeeding in South and Southeast Asia Countries

      Ahmed, Zoha; Mercer, Laura (The University of Arizona., 2020)
      Countries in the South and Southeast Asian region vary tremendously in their rates of breastfeeding and the region has both some of the lowest and highest rates of breastfeeding reported worldwide. For example, breastfeeding rates are 23% in Thailand, 65% in Cambodia and 82% in Sri Lanka6. These countries also vary in the type of antenatal and delivery care provider9. The objective of this study was to determine what association, if any, exists between a woman's type of antenatal care or delivery provider and her duration of breastfeeding. A secondary objective was to look at the association between type of provider and time after birth before breastfeeding was initiated. We hypothesized that having a skilled provider as the antenatal or delivery care provider will be associated with an increased duration of breastfeeding and shorter time after birth before initiation of breastfeeding. A cross-sectional analysis was performed on data from Demographic Health Surveys conducted from 2015 and 2018 in ten South and Southeast Asian countries. This included Afghanistan, Bangladesh, India, Indonesia, Cambodia, Myanmar, Maldives, Nepal, Pakistan and Timor Leste.The analysis revealed that having a doctor as an antenatal or delivery care provider was associated with statistically significant decrease in duration of breastfeeding when compared with nurse/midwife and traditional birth attendant in Bangladesh and Afghanistan. Having a nurse/midwife in Afghanistan was also associated with decreased duration of breastfeeding. In contrast, having a nurse/midwife was associated with statistically significant increase in duration of breastfeeding in Cambodia, Myanmar and Timor Leste. There was also a significant increase with use of a traditional birth attendant in Cambodia, Indonesia, Myanmar and Timor Leste. Our secondary objective analysis showed a statistically significant increase in time before initiation of breastfeeding with use of a doctor as the provider in Bangladesh and Nepal and with use of a traditional birth attendant as the provider in Afghanistan and Nepal. These findings suggest that there is a negative association in duration of breastfeeding with use of a doctor and a positive association with use of nurse/midwife or traditional birth attendant in some, but not all, countries in this region. Further investigation would be necessary to confirm these findings and determine why this negative association may exist.
    • Pulmonary Computed Tomography Findings of Coccidioidomycosis Infection in Patients with HIV/AIDS: A Retrospective Case Series of 14 Patients in a Vulnerable Population

      Casper, David; Connell, Mary; Roh, Albert; McAferty, Kenyon (The University of Arizona., 2020)
      Background: Coccidioidomycosis (Valley Fever) is a fungal infection endemic to the Southwestern United States. Approximately 150,000 cases occur each year but are often subclinical in those with a robust immune system. However, in patients with HIV/AIDS, pulmonary symptoms and complications are far more prevalent. This study aims to elucidate common radiologic findings on Computed Tomography to better characterize trends seen in pulmonary Coccidioidomycosis infection at varying CD4 levels. This will not only assist in characterizing disease progression, but we seek to also provide educational findings that may benefit physicians where Coccidioidomycosis infection may be less prevalent. Methods: A retrospective review of 14 patients with confirmed HIV/AIDS, Coccidioidomycosis infection, and CT scan within 8 weeks of principal diagnosis was performed. Radiologists were blinded to CD4 level. Radiologists evaluated the CT scans for the following findings: nodules, tree-in-bud pattern, alveolar infiltrates, ground glass opacifications, adenopathy, cavitary lesions, pleural effusions, and hypodense splenic lesions. Results: 14/14 cases had a CD4 level less than 200. In total, the frequency of findings was pathologic adenopathy (size >10mm short axis) 57% (8/14), Tree in Bud 100% (14/14), Alveolar Infiltrates 57% (8/14), Nodules 100% (14/14), Pulmonary Cavities 21% (3/14), Ground Glass Opacifications 50% (7/14), Pleural Effusions 29% (4/14), and Splenic Lesions 14% (2/14). Adenopathy was present only in cases with CD4 levels below 100 at a prevalence of 80% (8/10). Alveolar infiltrates were present at all CD4 ranges. Ground glass opacification was present only in cases with CD4 levels below 50 with a prevalence of 88% (7/8). Pulmonary cavities were present only in cases with CD4 levels below 50 with a prevalence of 38% (3/8). Conclusion: Patient sample size significantly limited statistical analysis with no statistical significance proven. Despite this, we may begin to appreciate the severity of disease burden. Findings such as ground glass opacification and pulmonary cavities become more frequent as CD4 levels continue to fall. While not unexpected with increasing immunosuppression, these images serve as a leading point for further exploration where prior imaging was limited and provide an educational benefit through varying imaging findings within a vulnerable population.
    • Retrospective review of the four-year trend of immunization coverage and personal belief exemption among Maricopa County kindergarten and sixth grade students

      DiNolfi, Jocelyn; Sunenshine, Rebecca (The University of Arizona., 2020)
      Introduction: In recent years, there has been an increase in personal belief exemption and a corresponding decrease in vaccination coverage for school-required vaccines among children in Maricopa County. Trends in personal belief exemption (PBE) as well as documented immunity to measles, mumps, rubella (MMR) was reviewed retrospectively for four consecutive academic years among Maricopa County kindergarten and sixth grade students. Methods: Data of immunization coverage was obtained online via the publicly available Arizona Reporting Schools Coverage Report for the represented years. Data from 1,280 schools was available for analysis from 2015-2016, 1,298 schools from 2016-2017, 1,281 schools from 2017- 2018, and 1,280 schools from 2018-2019. This data was stratified based on school type (public, charter, private) and free and reduced lunch subsidy was used as a surrogate of socioeconomic status for each participating school. Results: Overall, for every increase in academic year, there was an increase in PBE to at least one required immunization and an increase in PBE to all required immunizations by 0.43% and 0.5%, respectively. For each increase in academic year, there was a decrease in documented MMR immunity by 0.26%. Higher rates of exemption were seen in charter and private schools when compared to public schools. Additionally, parents of children attending schools utilizing less free and reduced lunch subsidy have a higher tendency to exempt their children from schoolrequired vaccinations. Conclusion: These results demonstrate a growing need to limit personal belief exemptions as the lack of vaccination coverage continues to threaten the health of Maricopa County children.
    • The influence of physician guided social media on patient information gathering

      Lin, Carrie; Anderson, Karen (The University of Arizona., 2020)
      Social media is ubiquitous in everyday life and more people find themselves utilizing these resources to interact with others and receive information. Among these users are breast cancer patients looking to find reliable information about their illness. As healthcare professionals, it is our duty to educate patients and provide relevant and accessible information. This prospective study will assess the influence of a physician mediated social media account on patient’s information gathering and understanding of their disease. We evaluated the number of interactions made on the social media pages and measured patient comprehension of information that is presented through social media and how this will impact their lifestyle choices. We provided patients at Mayo Clinic Phoenix’s Breast Cancer Clinic with links to a physician approved Facebook page that posts new findings, articles, clinical trials, and other relevant information We believe that providing patients with a source to find reputable information will allow them to be more engaged and knowledgeable about their health. Long term, this can help identify how to better reach and connect with patients and how to present information in a readily digestible manner. Our results indicate that patients who utilize patient oriented physician mediated social media accounts believe that these sites are more reliable than other information they find on social media (52.6%, p < .001), have a better understanding of their medical condition (p < .001), and 90.9% are more likely to develop healthy lifestyle habits.