• Natural Disaster Recovery: a preliminary analysis of 21st century relief funding in natural disasters and its relation to long-term recovery outcomes

      Molnar, Elise; Beyda, David (The University of Arizona., 2020)
      Natural disasters - earthquakes, floods, drought, and other natural hazards – are globally responsible for tens of thousands of deaths each year. The victims of natural disasters represent an inherently vulnerable population, and it follows that international relief responses should aim to be effective and equitable in these emergencies. This retrospective, preliminary analysis of post-disaster relief funding from 2000-2010 suggests that disaster magnitude (measured by total deaths) is directly correlated to donated funds (p<0.01). Over an approximate six year period, funding was also shown to have a significant, moderate inverse relationship with mortality rate (p=0.0139). No significant relationships were found between funding and infrastructure or workforce in this analysis. Larger natural disasters attract more donations and are more likely to disrupt society for a longer period of time, likely affecting the mortality rate. However, confounders like socioeconomic and political climate, corruption, and geographic vulnerability make it difficult to assess the efficacy of recovery efforts. Ultimately, until tangible metrics (for health and infrastructure outcomes) are reliable, reproducible, and relevant, determining how to best utilize recovery funding and resources remains unclear. This analysis does not seek to criticize post-disaster relief efforts, but rather aims to encourage the development of transparent and efficacious response through the creation of these metrics to better inform future recovery efforts.
    • 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.
    • 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.
    • Intentional Foreign Body Ingestion by Inmates: Demographics, Trends, and Motivations

      Hoebee, Shelby; Alexander, Gretchen (The University of Arizona., 2020)
      Objective: The purpose of this study was to identify and analyze the prevalence of psychiatric disorders among inmates who have intentionally ingested foreign bodies. Methods: A retrospective chart review was done on all inmates seen at Valleywise Health Medical Center for intentional foreign body ingestion between January 2010 and January 2014. Data obtained from these encounters included several variables on patient demographics, psychiatric history, and ingestion history. Analysis of these variables was performedthrough comparison of percentages. Results: 89% of patients had psychiatric diagnoses coded in their medical records with 78% having more than 1 diagnosis. In terms of motivation, 40.7% subjects attributed their ingestion to negative affect, while 22.2% did so as a suicide attempt. Only 3/27 patients (11.1%) claimed secondary gain as their reason for ingestion. Only 4/16 (25%) repeat ingesters received special behavioral plans during their inpatient stay. Conclusions: Psychiatric co-morbidity iscommon among inmates who ingest foreign bodies and may play a larger role in their motivations than previously recognized .
    • Alternative Treatments for Osteoporosis in Postmenopausal Women - A Systematic Review

      McCann, Lelan; Beyda, David (The University of Arizona., 2020)
      Introduction: Many postmenopausal women desire non-pharmaceutical alternatives to bisphosphonates for the treatment of osteoporosis and prevention strategies against osteoporosis. Although highly effective in the treatment of osteoporosis, bisphosphonates have a serious side effect profile. These side effects limit the use and duration of bisphosphonates for the treatment of osteoporosis, thus revealing the need for alternative therapies for osteoporosis. Methods: The systematic review was conducted by searching the electronic database of PubMed/MEDLINE using the MeSH terms “postmenopausal osteoporosis” and “vitamins” from January 1961 to April 2019. The review included randomized controlled trials that studied the effects of vitamin supplementation on bone turnover markers and bone mineral density in postmenopausal women with or without osteoporosis. The articles selected for use in this review were assessed for quality using an assessing instrument developed by Jadad et al (1). Results: Twelve articles were included in the final systematic review. These studies showed that vitamin supplements, soy isoflavones, or probiotics decreased the measured markers of bone turnover in studies with a treatment period ranging from 84 days to 48 months. Discussion: Supplementation with probiotic supplements, folic acid, vitamin K, calcium, and phytochemicals with vitamins D and K are shown to be beneficial to bone health with evidence that bone turnover markers are decreased in these treatment groups, although these findings demonstrate that vitamin or probiotic supplementation are not effective in increasing bone mineral density.
    • Effects of Fascial Stretch Therapy on Pain Index and Activities of Daily Living in Patients with Chronic Non-specific Low Back Pain

      Ayotunde, Oluwatosin; Standley, Paul; Frederick, Chris; Frederick, Ann (The University of Arizona., 2020)
      Numerous fascia-focused therapies are used to treat pain, most relying on direct manipulation and or tool-mediated techniques. FascialStretchTherapy,on the other hand,uses distally applied techniques to yield both local and global desired tissue outcomes and subjective pain improvement, including those related to LBP(Figure1). We hypothesize that subjects receiving FST will have reduced nonspecific LBP and enhanced activities of daily living (ADL) scores. Using healthy adults between the ages of 18 to 55, this prospective study was used to determineifa two week, four session FST program will lead to reduced pain, reduced use of pain medications, improved ADL and quality of life scores, increased sleep, and increase range of motion in individuals with CNSLBP.
    • Telephone cardiopulmonary resuscitation after pediatric out-of-hospital cardiac arrest: An analysis of the process measures, outcomes, and barriers to delivery

      Salevitz, Daniel; Bobrow, Bentley (The University of Arizona., 2020)
      Telephone cardiopulmonary resuscitation (T-CPR) has been associated with improved patient outcomes after out-of-hospital cardiac arrest (OHCA) in studies worldwide, however outcomes are similarly poor for adult and pediatric patients. Additionally, relatively little is known about T-CPR process measures and barriers to delivery of T-CPR in the pediatric population when compared with adult patients. We conducted an observational study of suspected and confirmed OHCAs in Arizona between 1/2011 and 12/2014. Telephone CPR process measures and barriers were extracted from suspected OHCA audio recordings from three 9-1-1 centers and linked to EMS confirmed OHCAs and hospital outcomes. Metrics were compared across four groups: Adults (? 18 years old), and pediatrics (0-1 year old, 2-8 years old, and 9-17 years old). In the study period, 4,533 calls were made to dispatch centers, and after exclusion criteria a total of 3,396 calls were included in the outcomes analysis. There was no difference in survival to hospital discharge (p = 0.6395) or functional neurological outcome (p = 0.1189) when comparing the adult and pediatric patients. A total of 2,007 calls were included in the process measures analysis after exclusions. In the pediatric population, there was a higher rate of call-takers starting CPR instructions (p = 0.0009) and bystanders starting chest compressions (p = 0.0011) and rescue breaths (p < 0.0001). Additionally, time to start of CPR instructions (p < 0.0001), first compressions (p = 0.019), and first rescue breaths (p < 0.0001) were significantly shorter for the pediatric population than for adults. Analysis of barriers to delivery of T-CPR revealed that the inability to get a patient to a hard, flat surface was statistically different in frequency between the adult and pediatric calls. Conclusion: Despite better process measures for the pediatric group, survival and functional neurological outcomes are similarly poor for the adult and pediatric populations after OHCA. The inability to get a patient to a hard, flat surface is a significant barrier in adult patients, and further evaluation of barriers to recognition of need for T-CPR in pediatric 9-1-1 calls is needed.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • Analysis of the Efficacy of Diabetes Self-Management Education among an Underserved Population

      Hoelscher, Tyler; Lee, Maurice (The University of Arizona., 2020)
      Question: Does the St. Vincent de Paul Diabetes Self-Management Education (DSME) program improve diabetic control among adults who have received care or are currently receiving care at the St. Vincent de Paul free clinic? Background: Diabetes Mellitus is a disease that requires substantial lifestyle modification to control and prevent significant complication. Because of this, Diabetes Self-Management Education (DSME) is an important part of treatment. This study is designed to evaluate diabetic control among patients who have attended the program as compared to those who have not. Methods: Subjects will be recruited from St. Vincent de Paul’s electronic health records (EHR). Patients having completed at least four DSME classes will be placed into the experimental group, and patients having completed fewer than four classes and who are not currently enrolled in a DSME program will be recruited into the control group. A combo of chart review, biometrics and survey will assess thirteen dichotomous variables either on-site or from medical records. A subject will be considered “controlled” with a pass in at least 70% of variables. Results: The primary outcome for diabetic control, meeting the criteria for 70% of the quality metrics, was met in 46% of patients on the treatment group and 19% of those in the control (P=0.052). A1c was ?8% in 54% of the treatment group and 14% of the control (P=0.02) and blood pressure was controlled in 96% of the treatment group and 52% of the control group (P=0.04). Conclusions: There was a nonsignificant improvement in overall diabetic control among patients who attended the DSME course, though A1c and blood pressure were significantly impacted. Though limited by sample size, the study shows that there is promise for future research in DSME.
    • Emergency Telemedicine Supported by Onsite Emergency Responder Technicians Reduces EMS Transports, Hospitalizations, and Total Patient Costs from Skilled Nursing Facility

      Hasecic, Elzada; Fisher, Jonathan (The University of Arizona., 2020)
      Background: Skilled nursing facility (SNF) residents tend to be older adults and have increased medical complexity and acuity, making them more likely to access the emergency department (ED) and get hospitalized. Several programs have been created with the intention to increase treatment of medical problems on-site and decrease rates of transfer from SNFs to acute hospitals. An Emergency Telemedicine Service (ETS) is designed through interprofessional collaboration with remote emergency medicine physicians and on-site emergency technicians. This framework allows for multi-provider evaluation, navigation, and treatment of patients within SNFs with potential avoidance of transfer to an ED. Objective: To examine the efficacy of an Emergency Telemedicine Service in reducing unplanned EMS to ED transports from skilled nursing facilities (SNFs) and hospitalizations. Secondarily, we aimed to determine which chief complaints were most commonly to be transferred to the ED compared with those more likely to be treated on-site. Methods : A before and after study design was used to examine the implementation of ETS at a single 202 bed SNF. A six month pre-implementation period from July 1, 2015 to December 31st, 2015 was compared to July 1, 2016 to December 31st, 2016. Data regarding the number of ED transfers, hospital admissions, and cost for patients in the SNF were collected from medicare databases. Medical record demographics including patient age, gender, chief complaint, and disposition, were examined for patients who utilized the ETS. Results: The rate of ED transport per patient was 1.10 before implementation compared to 0.97 after implementation; a decrease of 11.69% (95% CI 8.32 - 15.0). ED costs decreased by 33.6% ($2,708, p=0.016) per patient visit. The rate of hospital admission per patient was 0.77 before implementation compared to 0.65 after implementation; a decrease of 15.37% (95% CI 11.6 - 19.1). Inpatient admission costs decreased by 9% ($2,175, p=0.392) per patient. Additionally, the overall monthly cost per patient at the SNF also decreased by 4.42% ($6,345.51 vs $6,064.83) regardless of whether they required the use of the ETS. The average age of patients who utilized the telemedicine service was 80.78 (SD=11.86). 56.44% (n=57) of patients were female and 43.56% (n=44) were male. The most common chief complaint category was respiratory, with musculoskeletal and general complaints also being frequent. Musculoskeletal related complaints required the most transfer, along with cardiovascular/lymph and respiratory complaints. In contrast, all male reproductive, and most digestive, and mental health-related complaints were successfully managed with on-site resources. Conclusions: Through the use of an advanced Emergency Telemedicine Service in a single SNF, there was a reduction in ED transfers and a significant decrease in the cost for SNF residents transferred to the ED. Keywords: Skilled Nursing Facility, Geriatrics, Emergency Medical Services, ET3, Telemedicine
    • The Accuracy of an EKG for Predicting Left Ventricular Hypertrophy: Correlation with BMI, Systolic Blood Pressure, and Heart Rate, a Retrospective Data Analysis

      Burke, Megan; Rhee, Edward K. (The University of Arizona., 2020)
      Left ventricular hypertrophy (LVH) is a disease that manifests as an increase in the mass of the left ventricle, secondary to an increase in wall and/or cavity size. Hypertrophic cardiomyopathy is a genetic condition that causes LVH with prevalence as high as 1 in 500. Adult EKG criteria are insensitive but highly specific, yet pediatric criteria are neither sensitive nor specific. The purpose of this study was to determine if there is a statistical correlation between commonly used EKG voltage criteria for LVH with 2D echocardiogram measurement of LV diameter and wall thickness. We investigated the relationship between EKG voltage, specifically the R wave in V5 and S wave in V2, and how they correlate with systolic blood pressure, BMI, and heart rate. We analyzed community data from the Anthony Bates Foundation with 1351 people screened using both EKGs and echocardiograms. The study population had an average age of 28, were majority Caucasian (73%), had an average systolic blood pressure of 125 and an average BMI of 24.1. We found that there is no significant correlation between the R wave in V5 and HR (p = 0.79) or LV outflow tract diameter (p = 0.82). There was, however, a significant relationship between the R wave in V5 and septal thickness (p = 0.0002), BMI (p < 0.0001), and systolic blood pressure (p = 0.0172). There was only a significant relationship between the S wave in V2 and heart rate (p = 0.03). With these factors in mind, a better screening system may be developed that takes into account BMI and systolic blood pressure in the EKG screening for LVH.
    • Systematic Review: A Qualitative Analysis of the Influences Affecting Parental Acceptance of Rotavirus Vaccine and Comprehensive Review: Evaluating Anti-Vaccine Attitudes, the Resurgence of Vaccine Preventable Diseases due to Exemptions, and the Necessity for Vaccine Mandate

      Janajreh, Nicknaz; Beyda, David (The University of Arizona., 2020)
      Objective: To evaluate factors contributing to the rotavirus vaccine parental hesitancy. We hypothesize that the greatest cause of hesitancy is the fear of intussusception. Identifying hesitancy factors will enable physicians to address concerns and help parents make informed decisions regarding the vaccine. Study Design: A comprehensive search was done for key words on PubMed and OvidSP. MeSH terms were combined and filters were utilized to find relevant primary articles. Articles were screened based on titles, abstracts, conclusions, and full texts. Last search was completed on August 25, 2016. Three additional articles were found through other resources and searching references. A total of 32 articles supported the background and 4 articles supported the analysis. Results: This Systematic Review identified key barriers that are still causing parental rotavirus vaccine hesitancy: fear of side effects, cost of rotavirus vaccine, vaccine not included in free public programs, not protecting against all diarrhea, given in three doses, child receiving enough vaccines, vaccine is not useful, not wanting to administer a live vaccine, newness of the vaccine, narrow window of age for the vaccine, immunity achieved from acquiring the virus itself, needing to evaluate data, producing a stronger mutated virus, preventing through holistic approaches, and a perceived lack of disease threat. Conclusion: Identifying hesitancy factors enables advancements in parental acceptance of the rotavirus vaccine through increasing parental awareness of disease burden, removing rotavirus vaccine age limits, and educating parents on vaccine myths. Limitations include a narrow number of databases used and filtering for English-only articles.
    • 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.
    • Mental Health in the Arizona Asian Pacific Islander Community

      Nguyen, George; Briney, Stephanie (The University of Arizona., 2020)
      There is a disparity within the Asian community with regards to overcoming the mental health stigma. To understand how we can overcome this health obstacle within the Phoenix Asian American community the question lies: does an educational intervention increase mental health literacy in the Asian American community in Arizona? A cross-sectional study of Asian Americans in the city of Phoenix, AZ was done using subject from the Greater Phoenix Chinese Christian Church and Vietnamese Chinese Association of Arizona between September 14th, 2019 and Dec 21st, 2019. From the study, mental health literacy had significant improvement post intervention using an educational model in the form of understand depression treatments, seeking help, and being more open to mental health discussion with family members.
    • The Need for Standardized Medical Mission Evaluation Criteria: A Systematic Review and Look at Past Missions

      Nelson, Madalyn; Dolan, William (The University of Arizona., 2020)
      Background: Many civilian and military global health missions occur every year. There is not only a scarcity of documentation of medical missions, but there is also a lack of standardized evaluation criteria for these missions. In order to create standardized evaluation criteria, it is first necessary to compile currently used criteria. Objective: The objective of this article is to determine what criteria are currently being used to evaluate global health medical missions. This will provide a starting point from which standardized evaluation criteria can be created. Methods: This article is a systematic review of the literature. Articles were compiled through literature searches completed in 2016, sources were chosen based on inclusion and exclusion criteria, and were evaluated based on their medical mission evaluation criteria. Findings: 24 articles fit within the inclusion and exclusion criteria. Among these 24 articles, there were 17 different evaluation criteria identified. The 2 most commonly used criteria were official mission reports (including the location, size, duration and number of patients treated on the mission) and patient data (including patient risk factors, patient labs, procedures and outcomes). Conclusion: This review demonstrates that there is a need for better documentation and a need for consensus about the most important medical mission evaluation criteria, which in turn can be used to create standardized medical mission evaluation criteria. Based on the criteria compiled in this review, we present the M.D. NELSON standardized medical mission evaluation criteria, which include general medical mission concepts as well as specific evaluation criteria.