Overproduction of Tumor Necrosis Factor-α, a Direct Result of a Mutation of the CARD15/NOD2 Gene, May be Significant in the Etiology of Inflammatory Bowel Disease. Albert Antonio, Tanuj Banker, Bridget Brogan, Kelly Croglio and Allan Angerio Ph.D. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Inflammatory Bowel Disease (IBD) is a chronic disorder of the lower gastrointestinal tract. Crohn s Disease (CD) and Ulcerative Colitis (UC), the two major types of IBD, affect the lumen of the small intestine and large intestine, respectively. With a primary focus on CD, recent research suggests that pro-inflammatory pathways are mistakenly turned on by the CARD15, or NOD2 gene. The CARD15 gene is found in the intestinal macrophages within the GI mucosa. In healthy individuals, the gene functions by maintaining a proper balance in the production of pro and anti-inflammatory cytokines. However, if the gene is mutated, an overproduction of Tumor Necrosis Factor-alpha (TNF-α;) occurs. TNF-α; is a ligand that draws white blood cells to an area, thus promoting an inflammatory response. The subsequent imbalance created by the active CARD15/NOD2 gene, prevents the proper inhibition of TNF-α; by anti-TNF, causing chronic inflammation and decomposition of the intestinal lumen. This possible correlation, which may further explain the pathogenesis of CD, suggests a whole new area of concentration for exploration that might help find a treatment to replace infliximab. RemicadeR, the marketed form of infliximab, is currently only FDA approved for moderate to severe Crohn’s Disease. RemicadeR functions by promoting the production of anti-TNF, which prevents TNF-α from functioning, thus limiting the inflammatory response.
Tetracycline Delivery Effectivenes in Drinking Water versus Food. Jaclyn A. Artuso. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
To date, optimal delivery of tetracycline to mouse models has been through drinking water. Because tetracycline is light sensitive, it must be changed twice a week. However, food-containing tetracycline has recently become available. The problem with this is that it has not yet been determined whether or not gene expression control is as good with delivery through food as with delivery through the drinking water. This time-course study looks at three mouse models that have tetracycline responsive gene expression. The first is a mouse model in which expression of the viral oncogene Simian virus 40 T Antigen is regulated by administration or withdrawal of tetracycline. The other two mouse models, MMTV-rtTA and Tetop tTA, have expression of Estrogen receptor alpha is regulated in different tissue compartments by administration or withdrawal of tetracycline. What will be determined through this study is if the same control of transgene expression can be obtained through the delivery of tetracycline in water, as compared to delivery in the food.
Dexamethasone and the Treatment of Bronchiolitis in Children. Heather M. Avedissian. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
I have been participating as a research assistant in a national, double-blind study on the effectiveness of using oral dexamethasone to treat bronchiolitis in children. Bronchiolitis is generally defined as a first time episode of wheezing in young children, and this disease is responsible for the most infant hospitalizations each year during winter outbreaks. The study is being conducted to help establish a standard of treatment for this disease. This current study is meant to expand upon a past study conducted by Schuh, et al in Canada from 1997 until 2000. I am participating at Children s National Medical Center. This internship is for my major in the health studies Science department of the School of Nursing and Health Studies.
My job for this study has been to screen children in the emergency room, to obtain informed consent, to complete randomization of subjects, to monitor subjects after the drug or placebo has been administered, to ensure that vital signs and respiratory scores are taken at the appropriate times, and to conduct follow-up telephone interviews. For my project, I plan to discuss the results of this study as it progresses, as well as to incorporate my own research on the subject of bronchiolitis in children. I have been researching the drug dexamethasone, how it works, and how it has been used in clinical settings so far. I have also gathered information on bronchiolitis, current treatments of this disease, and how dexamethasone may improve upon these current treatment options. My purpose is to develop a project that discusses the outcomes of the study that I have been working on, as well as past studies on different ways of treating bronchiolitis. I will discuss my results and conclusions regarding the most beneficial treatment options for this disease that affects so many young children.
Mental, Spiritual, and Physical Well-being: Are they positively related? Angel M. Barber and Carlota Ocampo, Trinity College; Dominicus So, Howard University.
Spirituality and religious practice have been shown to be positively associated with healthy lifestyle practices and good health outcomes. Few research studies have investigated this relationship among culturally diverse groups. Our study explored relationships between spirituality, health lifestyle practices, and wellness in a predominantly African American sample. METHOD: Forty-nine participants accessed a password protected website and responded to a survey about level of spiritual practice and spiritual beliefs, health behaviors, and health outcomes. Pearson’s correlations were performed to determine the extent to which scores on the spirituality and health subscales were associated. RESULTS: Results indicated a moderate positive correlation between scores on the Mental and Spiritual Wellness subscales of the Mental, Physical and Spiritual Well-being Scale (r=.42, p=.013), but no correlations emerged with physical well-being. Thus, while it appears that spirituality and mental wellness co-occur in this sample, this relationship does not necessarily translate into physical health benefits. Clearly, future research is in order to explore variables that moderate mental and spiritual wellness and health in diverse groups.
Improve Health Care for All Americans. Amy M. Bonitatibus. Department of Government, Georgetown College, Georgetown University.
Senator Hillary Rodham Clinton has introduced a bill (SR2003) that would create an electronic healthcare system. This system aims to make individuals aware of various health risks within a sufficient period of time, allow researchers to discover cures for different viruses, and reduce the number of years from the time a disease arises to the time awareness and possible cures for it reach the public.
Senator Clinton s legislation is outlined in a five-point plan. The first point includes increasing research on the quality of care. The second provision is a standardized reporting system that enables patients to dependably compare the quality of care delivered by varying facilities. This consists of an electronic system that will create report cards on quality of healthcare performances between health facilities in each state.
Thirdly, the senator s legislation will build an information technology infrastructure that enables information sharing. This includes converting records and documents from paper to an electronic form. An electronic system will better enable healthcare professionals to transfer records, but also find information on a patient or a particular disease in a timely
manner. The fourth aspect of this legislation utilizes technology and health information to deliver valuable facts and statistics in real time. This includes giving patients and providers access to guidelines, the latest research and records to engage people in the process. Lastly, this bill provides financial incentives for studies to improve healthcare performance.
As a member of Senator Clinton s staff, I have closely tracked the progress of this bill and the attention it has received, both within Congress and by the public. I have compiled extensive information from articles, letters and reports on this issue. My findings, which will be presented, support the conclusion that this new health quality proposal will improve, update, and enhance the system currently in place.
The Effect Of Body Mass On Observed Physiological Adaptations Associated With Hypothermic Environments Using The Georgetown University Simulator. Brittany Braga, Maureen Egan, Chaz Huber, Earl Johnson. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
There are many environments where hypothermia is a major concerning factor. Mountain climbing, polar exploration, and deep sea diving are only a few instances where the body undergoes adaptation to maintain a state of homeostasis. In moderate to severe cases of hypothermia, peripheral pulses are often difficult to detect as the body shifts its circulation of blood flow from the periphery to the core.
We chose to simulate a hypothermic response to an extremely cold water environment. Submersion in cold water can decrease core body temperature more rapidly than exposure to air, because the thermal conductivity of water is 32 times greater than air. The simulated environment was water exposure at 0 degrees Celsius for 15 minutes. This is the amount of time it would take a 70 kg man to drop core body temperature from 38 to 32 C. Therefore, the length of time exposed, and the temperature of the environment are the two factors we controlled.
Our primary question of interest was to determine how long the human body can withstand exposure to an extremely cold environment before showing signs of severe hypothermia, as indicated by changes in ECG waves. We tested the effects of the simulated environment on two subjects with different masses, evaluating changes in baseline measurements (RR, HR, BP, %O2) and alterations in cardiac rhythm. We hypothesized that the individual with less body mass would exhibit ECG patterns indicative of severe hypothermia in a shorter period of exposure to the environment than the individual with greater body mass.
We found our hypothesis substantiated by the data, with the more massive individual (70 kg.) indicating atrial fibrillation after 15 minutes at 0 deg. C (core temperature 32C), while the less massive individual (54 kg.) displayed fibrillation after only 12 minutes at 0 deg. C (core temperature 32C).
Maternal Depression in a Sample of Adolescent and Adult First-Time Mothers: The Relationship Between Religion and Depression. Melissa G. Bresnick, Dominick V. Bufalino, and Robin L. Lanzi, Ph.D. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Research has shown that about 1 out of every 10 people in the United States suffer from depression, with women being affected at about twice the rate of men (Blehar & Oren, 1997). Depressive symptomatology rates among indigent mothers of young children are consistently in the range of 40-50 percent (Lanzi, Pacoe, Keltner, & Ramey, 1999: Ore, James, Burns, & Thompson, 1992). Maternal depression symptoms reverberate throughout the family and adversely affect children as well as their mothers. The purpose of this study was to examine the extent to which religious association is correlated with maternal depression among adolescents. It is hypothesized that religious
To address this question, the proposed presentation utilizes data from a 4-site National Institute of Child Health and Human Development study of first-time mothers, including 383 low-income adolescent mothers, 161 adult low resource mothers, and 120 adult high resource mothers. Approximately half of the moms screened positive for mild depression using the Beck Depression Inventory. The moms were asked a number of questions about their religiosity, including the extent of their religious involvement and to the degree in which religion and faith played a significant role in their lives. Results indicate that 68% of adolescent mothers are part of a particular religion, and similarly, 61% of the participants indicated that religion was very important to them. Significant differences were found between those who were depressed and those who were not depressed in terms of: how important religion is in their life (F(2) = 3.007, p< .99), how often they attended church/mosque/meetings (F(5) = 3.073, p<.01), and to the extent that they perceived faith as an important part of their lives (F(5) = .587, p< .710).The implications of these findings will be discussed.
Role of Tumor Necrosis Factor in Iron Deficiency Anemia Associated with Rheumatoid Arthritis. Carmen S. Cofield, Mariah Marshall, Siobhan McCarthy, Jackie
Morano, and Allan Angerio, Ph.D. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
TNF has a direct effect on the iron-concentration within red blood cells by inhibiting the erythropoietin production. Through this effect it has the ability to cause iron-deficiency anemia in patients with RA. The inflammation produced in the synovial fluid in the joints of RA patients causes the TNF alpha to be secreted in higher concentrations. These recent observations have been made based upon the research uncovered from scientific experiments in which the roles of immune factors were determined in RA patients as well as healthy individuals. Blood concentrations of TNF
and other gamma globulins were monitored over a prolonged period of time to show the relationship between auto-immune responses to debilitating ailments. Based on the findings of the relationships that exist between TNF and RA, and TNF and iron-deficiency anemia, the link between RA and iron-deficiency anemia becomes concrete. Through the usage of certain NSAIDs in distinct concentrations, TNF is reduced in RA patients thereby limiting the susceptibility to iron deficiency anemia and providing effective pain management.
Key words: Tumor Necrosis Factor, Erythropoiesis, Cycloxygenase, Rheumatoid Arthritis, Iron-deficiency anemia, NSAID, Gastrointestinal bleeding, hyferramia, Erythropoietic regulator, Inflammation
Understanding Bioterrorism. Kristen E. Colello. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
The probability of a bioterrorist attack against US civilian and military personnel overseas or in the United States also is likely to grow as more states and groups develop a biological warfare capability. Although there is no evidence that the recent West Nile virus outbreak in New York City was caused by foreign state or nonstate actors, the scare and several earlier instances of suspected bioterrorism showed the confusion and fear they can sow regardless of whether or not they are validated. There are over twenty identified pathogens that can be used as a biological weapons, along with radiological and chemical agents that can strike SLIENTLY at any moment. I spent last semester working for CT Senator Joseph Lieberman and took an indepth look at current legislation and biotech advances relating to bioterrorism. Throughout my research it was discovered that there is an increase in concern for counterterrorism measures and funds to help support the research. I have been able to identify the major pathogens that can be used an attack and certain countermeasures that are in labs. My independent study was overseen by Professor Meier.
HIV/AIDS, Food Security, And Malnutrition: Bridging The Intervention Gap. Rita/Xin Deng. Department: International Health Systems, School of Nursing and Health Studies, Georgetown University.
Purpose: As HIV/AIDS quickly ravages many parts of Africa and the rest of the world, the agricultural aspects of the African community have been overlooked until recent years. A great deal has been written since 2000 in regard to the intricate yet deadly relationship between HIV/AIDS, food security, and malnutrition. This paper critically reviews existing clinical research, intervention methodologies and policy trends in areas of HIV/AIDS, food security, and malnutrition.
Findings/Results: The progression of HIV/AIDS force impoverished individuals in famine-prone areas to struggle to survive, as available infrastructure and coping mechanism quickly collapses. Such new variant famines will need to build on existing programs that focus on food aid, behavior change, and nutrition supplementation. Presentation of current research should be made available and translated into intervention strategies. Many new findings regarding micronutrients such as vitamins in relation to HIV/AIDS demonstrate the need to educate health care workers on-site regarding the
interaction between the disease, cultural practices, habitual behaviors, and the deteriorating social environment.
Conclusion: Future educational interventions must be context-specific and community based to ensure sustainability. A general outline of nutritional therapy in caring for the HIV-infected patient is included.
Interaction of Tobacco Smoke Condensate with Estrogen Receptor-a in Lung Cancer.Tuisha Desai*, Annabell Oh*, Kelsey Smith*, Mary Beth Martin, Ph.D.**, Adriana Stoica, Ph.D.*. Department of Human Science, School of Nursing and Health Studies* and Department of Oncology**, Georgetown University.
Previous studies demonstrated that low doses of tobacco smoke condensate (TSC) (40mg/ml) exert estrogen-like effects in breast cancer cells and in animals by a mechanism involving the hormone-binding domain of the estrogen receptor a (ER-a). TSC may also interact with ER-a in the lung and lead to receptor activation and cell proliferation, increasing the risk to lung cancer. To demonstrate this hypothesis, we used two human lung cancer cell lines, A 549 and NCI596. In these cells, TSC competes with estradiol for binding to ER (Kd = 2-3 x10-9M), leading to a ~50% decrease in receptor concentration. Transient co-transfection of ER-a, but not ER-b with an estrogen response element-luciferase reporter gene into NCI596 cells leads to a ~2-fold increase in luciferase activity. We will further test the induction of the endogenous estrogen-regulated gene, progesterone receptor (PR) upon TSC treatment. We will use a ligand-binding assay to measure PR protein and real-time RT-PCR to determine ER mRNA and PR mRNA. Dose-effect curves will be established for receptor proteins and mRNA. To determine which region of ER-a is involved in the interaction with TSC, we will use a chimeric receptor containing the hormone-binding domain of ER fused to the DNA binding domain of the transcription factor GAL-4 and ER-a mutants. Cell proliferation will be measured performing growth curves. To determine whether ER-a mediates estrogenic effects of TSC, an antiestrogen will be used. If lung cancers are responsive to estrogens, then hormonal therapies analogous to those used for breast cancer might be designed for selected lung cancer patients. Improved survival of some lung cancer patients who have a bad prognosis and relatively few therapy options may be a significant gain.
Childhood Obesity. Stephanie A. Deutsch. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Overweight and obesity in America have reached epidemic proportions. According to the CDC, over 61% of adults in the U.S. are either overweight or obese, and over 13% of children ages 6-11 and 14% of adolescents aged 12 to 19 are overweight. Over the past 30 years the population of children either overweight or obese has tripled, making children and adolescents the fastest-growing obese population. Obesity has
been linked to the development of chronic diseases, including diabetes, hypertension, cardiovascular disease, and even depression, anxiety and low-self esteem, all of which are detrimental to health and overall quality of life. Kids with obesity are at greater risk for developing these problems earlier, with more serious consequences. The purpose of this project is to analyze the myriad factors – genetic/biological, ethnic and cultural, social, psychological, economic and environmental characteristics that have contributed to the obesity epidemic, and identify particular points of entry for intervention. Focus areas for change include the family, school and community environments. For example, by changing the community/physical environment – creating an environment safer and more hospitable to biking and walking, by increasing funding for physical education programs in schools, and by developing healthier restaurant menus, the behaviors of overweight and obesity could be curtailed. Another area of research is the role of stigmatization of obese children in curtailing the behavior. Independent research studies from the scientific community and government public health agencies were synthesized and reviewed. The findings to be presented support the hypothesis that obesity is the result of a complex equation that surrounds the social and physical environment of the child, including parents, peers, and community. Modifications of these three environments can reduce the burden of overweight and obesity, decrease the prevalence of chronic disease and improve the overall quality of life of Americans.
Role of Calcium in Activation of Estrogen Receptor – alpha. Shailaja D. Divekar*; Earl M. Johnson, Jr.**; and Mary Beth Martin, Ph.D.* Department of Biochemistry and Molecular Biology* and Department of Human Science**, School of Nursing and Health Studies, Georgetown University
Estrogen receptors (ER) are expressed in about two-thirds of human breast cancer, indicating that estrogen plays an important role in breast cancer cell proliferation. However, breast cancer progresses from hormone dependent phenotype to hormone independent phenotype. The mechanisms responsible for acquisition of a hormone independent phenotype are not well understood but hormone independent activation of estrogen receptor by growth factor signaling pathways is thought to play a role in mlignant progression of the disease. Growth factors like epidermal growth factor (EGF) and insulin like growth factor (IGF-1) have been shown to enhance ERα; transcriptional
activity. In addition, bivalent cations like cadmium, nickel, copper, and anions like selenite and arsenite have shown to activate ERα; in a hormone independent manner. Preliminary results from our lab suggest that EGF might activate ERα; through a calcium-mediated pathway. Treatment of COS-1 cells, transiently cotransfected with the wild-type estrogen receptor and an estrogen-responsive chloramphenicol aetyltransferase reporter gene, with calcium led to an increase in chloramphenicol acetyltransferase reporter gene. The ability of calcium to alter the gene expression was blocked by an anitestrogen, suggesting that the effect of calcium is mediated by ERα. Preliminary results from the binding assays suggest that calcium blocks the binding of estradiol to the receptor. Future experiments will determine whether calcium activates the receptor by directly binding to the hormone-binding domain of the ERα; or through an indirect mechanism mediated by growth factor signaling pathways. It is also possible that calcium might activate the receptor through both direct and indirect mechanisms. Calcium fnctions as a second messenger to regulate a variety of cellular processes including contraction, metabolism, neuronal excitability, cell proliferation and cell death. Dietary sources of calcium and other divalent cations have shown to influence the risk of breast cancer. This risk may be due to their ability to activate ERα.
The Economics of Health: The Impact of Intellectual Property. Cullen A. Drescher. Department of Political Economy, Georgetown College, Georgetown University.
The purpose of my research is to assess the role of intellectual property regulations in providing health systems worldwide with access to affordable medicines. The debate over patents and affordable access to health care is a timely issue. Some of the discussion involving the relation between intellectual property rights and access to health care has been based on misunderstanding of the patent system. This project discusses economic issues relating to access to drugs and healthcare and endeavors to elucidate the impact of the patent system on availability and pricing of medicines in developing countries.
Patents perform a central, measurable role in stimulating drug development by offering incentives for investing in research and development. Each new drug requires an estimated $800 million to cover R&D and approval costs. These costs are borne by private investors who expect to recoup their investments during the life of the patent. Alternative means of financing have been proposed, but no workable system has been devised. Without the investment stimulated by patents, there would be no debate about the price of drugs the drugs would not exist.
The patent system also requires full disclosure of information leading to invention of drugs. Thus, technical knowledge is made available to researchers and corporate developers who innovate by building on previous discoveries. In short, patent protection lends transparency to the Science of drug development, and allows it to be used to benefit populations that need affordable treatments.
Conclusion: Data to be presented indicates that patent protection is not culpable for increases in drug prices. International agreements such as TRIPS attempt to standardize regulations on patents so more advanced medicines may be produced based on previous knowledge. Patents are not barriers to drug accessibility, but incentives for innovation that will surely improve the lives of populations everywhere.
Akt and ErbB2 Can Modulate the Growth of MCF-7 Cells in Vivo. Jessica A. Duncan*, Keven Lehnes*, Elisha Morgan*, Mary C. Iann*, Abigail D. Winder*, Gerald E. Stoica, Ph.D**., Mary Beth Martin, Ph.D**., and Andrianna Sstoica, Ph.D.** Department of Human Science, School of Nursing and Health Studies* and Department of Oncology**, Georgetown University.
The hormone-dependent breast cancer cell line, MCF-7, stably transfected with constitutively active Akt (myr-Akt) demonstrated hormone-independent cell growth that was blocked by the selective ErbB2 inhibitor, AG825, and was partially inhibited by tamoxifen. In contrast, cells stably transfected with dominant negative Akt (K179M-Akt) or with a pleckstrin homology domain mutant (R25C-Akt) required estradiol for growth.
The growth effects of estradiol were reduced and blocked by AG825. To determine if Akt altered the in vivo growth of MCF-7 cells, the xenograft model was used. Parental, K179M-Akt and R25C-Akt cells were implanted in both sides of the backs of ovariectomized BALB c nu+/nu+ mice. The animals were randomly placed in several treatment groups: vehicle; continued estrogen supplementation (0.25 mg pellet), in the presence or absence of tamoxifen (500 mg/day, 5 times/week, s.c. injection) or AG825 (50 µg/kg/day, i.p. injection); tamoxifen; and AG825. Tumor growth was monitored for 70-90 days. Parental MCF-7 cells inoculated in mice formed palpable tumors upon estradiol supplementation after four weeks. A ~30-35-fold increase in tumor volume and weight was observed at the end of the experiment. The effect of estradiol on tumor growth was blocked by tamoxifen and AG825 by 95 and 82% respectively, suggesting a role for ErbB2 in the estradiol response. For K179M-Akt or the R25C-Akt cells, no tumor growth was observed upon estradiol treatment, supporting a role for Akt in mediating the growth of MCF-7 cells in vivo. Taken together, our results suggest that interruption of the ErbB2 and/or Akt signaling pathways may enhance the inhibitory effects of antiestrogens in breast cancer treatment strategies.
How to React to Health Risks Worldwide. Patrick T. Durbin. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
The expanding global economy has resulted in companies seeking new markets for their products and services in international locations. Therefore, it is imperative that corporations and their employees become familiar with the health conditions in foreign locales in order to minimize their risks. Corporate Risk International s Worldwide Advisory Intelligence Service (WAIS) provides valuable intelligence, analysis and insight into all types of health risks around the globe as well as those related to crime, social unrest, and political instability. WAIS aims to minimize companies, their employees and families vulnerability domestically and while abroad. This paper explores the ways in which the WAIS analyzes SARS, bird flu, malaria, tuberculosis, and other health risks that are present in many countries American corporations operate. This paper provides the scientific basis behind the transmission, incubation, signs and symptoms of a disease. This scientific explanation of what makes a disease serious allows corporate executives to understand why the WAIS assigns a country a particular threat level. This unique project will help executives make better decisions regarding employee deployment to a particular part of the country or world based on research of past and current risks that have appeared or continue to appear in a certain location. There are also many potential threats that have not appeared on a global level yet. Such things as smallpox, ricin, botulism, and anthrax are all severe threats to the health of individuals and must have a planned response if such an agent were to appear any where in the world. Here, we provide the scientific data of both current and future threats to explain risk level assessments that is imperative to have in a world of where biological and chemical terrorism attacks are becoming increasingly realistic and where the virulence of infectious diseases are increasing.
A Comparison between Three Different HIV Tests for use in Universal Screening Methods. Elizabeth M. Duvall. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
There are 300,000 people currently infected with HIV in the United States who are unaware that they are infected. Because the spread of HIV is increasing at an exponential rate, with 40,000 new cases occurring in the U.S. every year, there needs to be more efficient methods of testing a larger number of at-risk individuals. An at-risk individual is one who has been exposed to HIV, has multiple sex partners, or is an intravenous drug user. In order to increase the number of individuals tested for the disease, universal screening programs should be implemented in communities around the country. Universal screening is a method of testing a large number of individuals in an at-risk community for the presence of HIV in an efficient manner with accurate testing procedures. In my report I will discuss three major HIV tests that are possible candidates for universal screening: a urine-based antibody test, an Orasure test, and an Oraquick test. A urine-based test is a very convenient test because urine is able to retain activity under normal conditions and it is easy to transport and store. The Orasure method uses an oral mucosa sample and tests for the presence of HIV using an ELISA and a Western Blot test. It takes one week to get the results back and it is a highly accurate alternative to serum testing. The Oraquick method also uses an oral mucosa sample. This test is more convenient than the Orasure method because it only takes 30 minutes to get the results back, but it is not as accurate as Orasure. The urine test, Orasure, and Oraquick tests would work best for universal screening because they are all noninvasive and require minimal medical training to perform, and they are therefore more cost efficient and more convenient.
Relationship between Iron Deficiency Anemia and Congestive Heart Failure. Matt Egan, Mike Hall, Matt J. DeBole, and Allan Angerio, Ph.D. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Iron Deficiency Anemia (IDA) and Congestive Heart Failure (CHF) are adversely related to one another. Among the elderly, risk for both of these conditions increase as nutritional content in the diet becomes more crucial. CHF is a serious medical condition when the heart does not pump enough blood to meet the demands of the body. The heart will overcompensate by pumping a greater volume at an increased rate, but less efficiently. IDA is caused by the body s inability to absorb and utilize iron for the production of hemoglobin in red blood cells. A patient who is iron deficient may not be anemic, but can be at greater risk of developing IDA when they have CHF. Non-anemic iron deficiency can be caused by bleeding ulcers, hemorrhoids, gastrointestinal bleeding or lack of dietary iron. Treatments for CHF such as ACE Inhibitors, lower the blood
pressure and may cause Anemia as erythropoietin production is limited. IDA develops when the decrease of erythropoietin production is coupled with the patient s existing iron deficiency. Similarly, IDA can cause and increase symptoms associated with CHF. The heart tries to combat the decreased flow of blood caused by IDA while maintaining the oxygen supply to the cells by working harder but less efficiently. Ultimately, nutritional needs, especially in the elderly can either intensify or reduce the risk associated with both Congestive Heart Failure and Iron Deficiency Anemia and are important in the treatment of both.
The Role of Nitric Oxide in the Exercise Response. David C. Fajgenbaum, Sarah Fricke, Kate Fredrikson, Tricia Dougherty, and Allan Angerio, Ph.D. Department of Humans Science, School of Nursing and Health Studies, Georgetown University.
The primary aim of this research article is to determine a more mechanistic understanding of nitric oxide s role in the exercise response. Nitric oxide (NO) is a small hydrophobic gas that modulates cellular function in a wide variety of tissues. NO mediates an array of physiological functions, including gas exchange in the lungs, cell signaling which increases regional blood flow, skeletal muscle contraction, and nutrient transport. Results: We examined the role of NO in the lungs and found that high intensity exercise acutely enhances the ability of NO to diffuse between the airway tissues. NO exerts its biological effects on the cells through two mechanisms. The first is by activating cellular guanylate cyclase; the second is by directly modifying and affecting the function of various cellular proteins. We found NO to be a vasoactive substance, which, when released, decreases intracellular calcium levels, leading to smooth muscle relaxation. Therefore, an increase in blood flow and a decrease in blood pressure results. Recently, NO biosynthesis has been found to occur in skeletal muscle, where it exerts an effect on both the metabolic and contractile processes. The greatest effect of NO on cellular metabolism is to increase the delivery and uptake of fuel substrates such as glucose, amino acids, and oxygen. Conclusion: Thus, we conclude that, through various physiological processes, nitric oxide has profound effects on the enhancement of the body s adaptation to exercise. Key Words: nitric oxide, gas exchange, vasodilation, blood flow, oxygen transport, arginine, cellular guanylate cyclase, skeletal muscle.
Community-Building to Promote Biomedical Health Careers. Amy L. French, Maria I. Klopf, and Charles H. Evans, Jr., M.D., Ph.D. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
The Biomedical Health Careers Promotion Program introduces rural and otherwise educationally-underserved high school students to the wide variety of available health Science careers and aids them in their personal pursuit of a career in this area. The program increases student awareness of the wide spectrum of biomedical careers through various exercises, virtual experiments and laboratories, and other educational and informative activities. These exercises, in the form of a Virtual Laboratory, are posted online at the BHC website, and are a continuation of the students learning, which begins here, at Georgetown, in a three-week summer Science program.
The Biomedical Virtual Laboratory exercises are designed by Georgetown University students with the help of faculty at the School of Nursing and Health Studies. Each exercise is coordinated around a particular theme, such as a body system or particular biomedical career, and various activities, websites, and readings are posted on the Virtual Laboratory that correspond to the chosen theme. These are selected with the hopes of expanding the students horizons and cultural awareness. Along with these activities, several critical thinking questions are posted to stimulate the students to think independently and make decisions based on the things they learned in the exercise and on their own knowledge and common sense, rather than to have them simply reiterate facts. The students email their responses to the coordinators of the program, who evaluate them accordingly and give them positive, personalized feedback.
Data is collected to mark the students intellectual progress, and it is hoped that eventually these students, due at least in part to their experiences with this program, will go on to college and choose a career in a biomedical field.
Oral Health and Access to Dental Care for Children. Katrina E. Hernandez. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Oral Health in America: A Report of the Surgeon General, established the importance of oral health to general health and well-being. Oral health can be achieved by all Americans but there are certain vulnerable populations who do not experience an acceptable level of oral health. Children are among those at risk for suffering from poor oral health. Very young children, children with high levels of caries and children covered by Medicaid are especially at risk. Children s access to dental care has been found to have an impact on their oral health status. Lack of access to dental care, in turn, has been found to be related to provider participation, the family s income level and ethnicity, and dental insurance coverage or lack of coverage. Because poor oral health can lead to serious general health problems, interfere with proper nutrition, discourage social interaction and disrupt learning, lack of access to dental care is a major pediatric health care problem. The Surgeon General’s Report has paved the way for research on this important health care issue. This paper will focus on the latest studies regarding different barriers preventing children from getting access to dental care, particularly disparities in dental disease due to income and ethnicity, low provider participation and Medicaid coverage. These barriers have a negative impact on the well-being of children and subsequently threaten our nation’s youth.
Spatial Differences in Health Status and Investment in Health, An Economic Approach.Matthew A. Ingham, Department of Economics, Georgetown College, Georgetown University.
This paper uses the National Health Interview Survey, the chief empirical instrument for assessing the health of the U.S. population, to determine whether rural residents are in poorer health as compared their urban counterparts, and, if so, to identify factors that may account for the differential. Few studies of these spatial variations exist at the national level. Following the work of economist Michael Grossman, health status is treated as a capital good which depreciates over time, but can be invested in by consumers.
Health status is assessed using several indicators: prevalence of a representative set of medical conditions in the population, degree of limitation in activities of daily living, and number of days lost from work due to sickness. The results of the health status assessment are equivocal rural residents are in substantially poorer health than their urban counterparts. Moreover, the independent effect of living in a rural area, as distinguished from other socioeconomic influences by logistical regression, raises the odds of having several conditions (hypertension, 2.49:1; emphysema, 4.00:1; heart attacks, 2.67:1, and so on.) as well as the likelihood of being limited in daily activities. Although rural residents report fewer missed workdays due to sickness, this can be explained by differing attitudes towards work and economic conditions. Mental health differentials across space are less significant than physical ones.
Health investment is measured by exercise, medical care, diet, and lifestylistic habits, with broad results indicating lower investment rates by rural residents, particularly in exercise, smoking, and nutrition. While rural residents were more likely to report inability to pay for medical inputs, and were less likely to have seen medical specialists, they visited general doctors at about the same rates as urban residents. This may, however, be an empirical artifact of poorer rural health a priori and of aggregation bias.
Effects Of Arsenite On Mammary Tumorigenesis. MiJin Kang*, Galam Khan**, Amina Fakhro**, Leena Hilakiri Clarke**, Mary Beth Martin**, & Adriana Stoica.* Department of Human Science, School of Nursing and Health Studies* and Department of Oncology,** Georgetown University.
Environmental arsenite is a known carcinogen in animals and humans. Although the mechanism of the arsenite-mediated oncogenesis is not fully understood, arsenite may not directly cause tumor by DNA damage, but may act at the level of tumor promotion by modulating cell growth. Arsenite may promote tumor formation by mimicking estradiol and interacting with the hormone-binding domain of the ER. Previously, we have demonstrated that in the human breast cancer cell line, MCF-7, arsenite increases cell growth, induces two estrogen-regulated genes, progesterone receptor and pS2, and competes with estradiol for the binding to the ER. In this study, we want to see whether the in vitro effects of arsenite can be reproduced in animals. We will examine the effects of arsenite on mammary tumorigenesis and immunohistochemical markers of proliferation, apoptosis, ER and progesterone receptor of mammary glands of animals fed arsenite or a control diet for 25 days. Female Sprague-Dawley rats were randomly divided into ovariectomized and intact groups and/or given DMBA treatment at 49 days. In the intact animals, tumors formed after 11-14 weeks of DMBA treatment in 50% of the control group and 100% of the arsenite treated group, respectively. After tumor formation, samples from mammary glands and tumors were taken from each study group, which was then subjected to immunohistochemistry. In the intact rats, PCNA and apoptosis staining was higher in tumors from arsenite-fed animals than in the tumors from control-fed animals and ER- α; staining did not seem to be statically different in the two animal groups. The data from ovariectomized rats will be compared with results obtained in intact animals. Elucidation of the carcinogenic mechanisms of arsenite may lead to better treatment and prevention strategies.
The Effects of Pharmacy Counseling on Health Care Costs and Outcomes. Kathryn M. Koren. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Pharmacy counseling has the potential to decrease growing health care costs and improve patients quality and length of life. One study estimated that in the United States drug-related illness and death cost $76.6 billion dollars annually in the ambulatory health care setting alone. Most drug-related morbidity and mortality may be attributed to inappropriate use of medication and thus may be preventable. Three variables lead to inappropriate medication use. First the medication may not be properly prescribed resulting in underdosing or drug-drug interactions. Second the patient may not understand how to correctly monitor herself while on a prescription drug or may not attend appointments with health care professionals. Third the drug may be administered improperly which includes taking the medication at the incorrect time and skipping doses. Pharmacist directed patient education and management can reduce inappropriate medication use leading to the decrease in overall medical costs. For example, a study found that pharmacy counseling reduced medical costs of patients with hypertension, diabetes, asthma, and/ or hypercholesterolemia by $293.39 per patient per month after controlling for variables such as age and disease severity.
This paper reviews the effectiveness of various pharmacist interventions for patients with diabetes, asthma, and hyperlipidemia. Research studies have demonstrated that pharmacy counseling of diabetic patients resulted in a 66% reduction in emergency room visits, 48% decline in hospitalizations, 54% decrease in the length of stay in hospitals, and an increase in quality of life. Asthma patients who received pharmacist interventions experienced similar results. In another study when patients with hyperlipidemia received pharmacy counseling, adherence to lipid lowering medications was 84%. If insurance companies, pharmacists, patients, and the government become more aware of the drastic benefits of pharmacy counseling, they can help cut unnecessary health care costs while providing patients with a better quality of care.
The Role of Cytokines in the Wasting Syndrome. Jennifer Landon, Katie Maroon, Diane Mauro, Allan Angerio, Ph.D. Departments of Nursing and Human Science, School of Nursing and Health Studies, Georgetown University.
The wasting syndrome is a condition that affects many patients today suffering from numerous inflammatory diseases, such as cancer, chronic congestive heart failure, and HIV/AIDS. Cytokines play an important role in the wasting syndrome associated with these inflammatory diseases. Although cytokines are usually helpful in the inflammatory response, it has been shown that when overproduced they will cause a break down of lean muscle mass and reduce the weight of an individual significantly, thus causing wasting or cachexia. It has been shown that cytokines, tumor necrosis factor-α, interleukin-1, and interleukin-6 play the greatest role in the wasting syndrome. Cytokines have also been shown to decrease appetite in those infected with inflammatory diseases and HIV/AIDS. The decrease in appetite is caused by several factors including the overproduction of TNF-α and interleukin-1, as well as the hormone leptin. Cytokines will mimic the leptin action of the hypothalamic negative feed back loop, which ultimately decreases the appetite of an individual thus decreasing food intake. Like cytokines, when leptin is overproduced it causes wasting in the body. There have been many treatments that have been used to attempt to reduce the wasting that takes place in these inflammatory disease, however, their success has been limited. It seems that the most successful appetite-stimulating drugs have been megestrol acetate, dronabinol and growth hormone. All of these have had some positive affect on preventing wasting, however, they also have many side affects. Although there has been some success in decreasing wasting among patients, further studies need to be done to lower the morbidity rate of individuals affected by inflammatory diseases and HIV/AIDS.
Total Knee Replacement. Kara A. Langhamer. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
This paper will discuss the surgery and process of a total knee replacement, focusing mainly on the post-operative care and rehabilitation. Total knee replacements are one of the two most successful surgeries in the history of orthopedics, meaning it is very safe, low-risk, and cost-effective in alleviating pain and restoring physical function in the patient, with very few contraindications, no matter what the variables may be (orthopedic surgeon, surgical facility, patient characteristics and health status, type of prosthesis implanted, etc.). Approximately 300,000 of these surgeries are performed each year due to many different causes, such as decreased function of the knee, knee pain that has failed to respond to treatment, and most importantly and commonly, arthritis. Because of the high need for total knee replacements, it is no wonder that improvements are continually being developed, in order to decrease recovery time, determine the best method/procedure for a particular age group, increase the length of time the prosthesis lasts, etc. Some of the current controversial literature regarding total knee replacements will be discussed, starting with whether pre-operative exercise is truly beneficial, following through to the actual knee closure technique, and ending with treatment and rehabilitation. Rehabilitation includes post-operative continuous passive motion and most importantly, physical therapy consisting of iontophoresis, ultrasound, hydrotherapy, aquatic therapy, manual therapy, electrical stimulation, and many strengthening/ stretching programs. It can be seen that there are many aspects to an individual s treatment after having a total knee replacement in order to have a full recovery and regain optimal function of their new knee, which is why constant research is being performed and critiqued.
How Does Cadmium Interact with the Androgen Receptor to Increase the Risk of Prostate Cancer? Gregory H. Lehnes, Daniel Gamett*, and Mary Beth Martin**
*Department of Human Science, School of Nursing and Health Studies; **Department of Oncology, Lombardi Cancer Center, Georgetown University.
Epidemiological evidence suggests that the heavy metal Cadmium (Cd) may play a role in the promotion of prostate cancer. Furthermore, in vitro studies have proposed that Cd may activate the androgen receptor (AR) in a way similar to the mechanism in which Cd interacts with the estrogen receptor (ER). Cd has a high affinity to the hormone-binding domain of ER-alpha and activates the receptor. The studies on how Cd interacts AR were initiated on the following premises. 1. Coactivators (AIB-1, AIB-1 Delta3, SRC-1, and ARA-70) should enhance the transcriptional activity of the AR in response to DHT, similar to their known coactivation of the ER. 2. If Cd interacts with AR in a manner similar to that of DHT, coactivators would also be expected to enhance Cd responses. In order to define the role of cadmium as a promoter in the development of prostate cancer, determine the mechanism by which cadmium activates the androgen receptor, and determine whether cadmium induces an active conformation of the androgen receptor, CV-1 cells were transfected with expression plasmids for the AR, a luciferase reporter gene, and varying amounts of expression plasmids for coactivators of the androgen receptor. The transfected, cells were then challenged with a known activator of the androgen receptor (DHT) or cadmium. The induced gene expression was then compared using luciferase assays. The results of several trials indicated that none of the coactivators showed a reproducible, dose-dependent activation of AR transcriptional activity. Because of this, the significance of transcriptional activation by Cd in the presence or absence of coactivator was difficult to evaluate. Thus, the results are inconclusive and further studies will be needed.
Prevention of Childhood Obesity. Lara C. Madonia. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Obesity in children and adolescents is becoming an epidemic in the United States. It is a serious issue that is causing many negative health and social consequences that often continue into adulthood. Implementing prevention programs and acquiring a better understanding of treatment for affected children are vital in controlling this obesity epidemic. A review of prevention and intervention programs will be presented especially programs aimed at increasing physical activity in children and programs aimed at increasing their knowledge on the subject matter. It will illustrate what was effective in fighting such a disease and what was not effective.
Furthermore, this presentation will demonstrate how this evidence base is being incorporated into the Healthy Kids program initiated by the Joy of Sports Foundation in Alexandria, VA. The mission of the Joy of Sports Foundation is to use sports and education to teach at-risk children critical life success skills that will enable them to grow strong in body, mind, and spirit. The Joy of Sports Foundation offers sports program including Tennis, Basketball, Soccer, and a Star Power (physical play and games for younger children). It specifically focuses on at risk children between the ages of 3-14. This foundation has served more than 30,000 children nationwide and in June 2000 the White House honored the Joy of Sports Foundation for their service to underprivileged children. The Healthy Kids initiative will provide children with the knowledge and opportunity they need to live a healthy and active lifestyle. This program was started at the Joy of Sports Foundation in San Diego in 2002 and will be launched next year in Washington, DC. It is a comprehensive program that will integrate different types of evidence-based research in order to stop the obesity epidemic in children.
Sickle Cell Disease and the Possibilities of Nitric Oxide Therapy. Jessica O’Hara, Jonathan Olbrych, Crystal Olguin, Briele Reynolds, and Allan Angerio, Ph.D. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Many different treatments have been administered to patients of the painful attacks associated with sickle cell disease. Blood transfusions and bone marrow transplants have supplemented the most common treatment hydroxyurea, to manage the symptoms of vaso-occulation, and other vascular complications due to the structure of the sickled erythrocytes. Nitric oxide has always been known to have an effect on blood circulation, but recent studies have suddenly emerged that illustrate the potential of the gas as a treatment of sickle cell disease. Inhaled nitric oxide is now being used as a vasodilator lowering the total peripheral resistance of the circulatory system. It has been seen that this will reduce the agglutination of the sickled cells and adherence along vessel walls. It has also been proposed that NO can serve to increase the oxygen affinity of sickle cell patients, whether genetically or by remodeling the hemoglobin of the erythrocytes. Investigation of these tests and case studies will prove inhaled nitric oxide can serve as a effective treatment of sickle cell patients, even in their most common form of death acute chest syndrome.
Key Words: Sickle cell disease, Nitric oxide, Vaso-occulation, acute chest syndrome, Erythrocyte, agglutination, Hydroxyurea .
Evaluating the Quality of Data obtained from Short versus Long Cellular Phone Interviews. Katherine E. O’Leary and Robin D. Lanzi, Ph.D., Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Child neglect is a leading indicator of child abuse; a major problem in today’s society. Early predictors of child neglect have been found among adolescent teen mothers. Some good predictors the study seeks to use are degree of stimulation, care, and stability in the child s life. By examining all these different predictors, appropriate prevention strategies can be evaluated. In order to gain knowledge on the parent-child relationship and daily activities, the study sets out to collect data through the use of
frequent cell-phone interviews. The study relies heavily on the truthfulness and quality of information provided by the mothers so the question being posed is which type of interview would gather more useful information; short or long. Would mothers be more receptive to shorter interviews? Would the questions posed during a shorter interview gather the same amount and quality of information? The study found that mothers were much more receptive to the shorter interviews. This resulted in a much more open conversation and better relationship between the interviewer and mother which ultimately lead to a better quality of information. Although fewer questions were asked in the shorter interview than in the long, the same essential components of parenting were addressed. The study suggests that a better method for collecting data of this sort would be frequent short cell phone interviews that allow the mother’s experience to be more enjoyable while supplying the researcher with a greater amount of useful, truthful information.
Simulation in Health Science Education. Julee R. Pulverenti. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
The purpose of this project is to integrate simulation as a learning tool into the Pathophysiology and Pharmacology course taught in the School of Nursing and Health Studies. The research project being conducted will focus on theories of adult learning and how simulation can be a useful instructional strategy. Theories about adult learning support the use of simulation technology to aide the adult learner through the learning process. These theories will be highlighted and provide insight into the creation of the project.
Project: The project is to create a course session using a human patient simulator to reinforce learning and retention. The topic of the session will be a presentation of the nervous system in healthy and diseased individuals and how it affects other systems, namely the cardiovascular system.
Methods/Implementation: Prior to designing the project, appropriate research was conducted. The research was two-fold. The first part focused on the simulation and adult learning theories. These theories guide the project so that it is created according to standards that are proven to be beneficial for students. The second part focused on the recipients, or class members and faculty who may benefit from this project. The class and specific faculty were surveyed in order to determine which topic should be the focus of the session. A simulation session will be developed to meet these goals and offered to the students.
Evaluation: The students and faculty will then evaluate the experience. The evaluation will be helpful in determining how effective the project was. The evaluations will lead students to reflect on their experience and provide their opinions. The session will be modified based on the evaluations and the course will be integrated into the Pathophysiology and Pharmacology course. The results and conclusions will be analyzed and presented in a formal paper.
The Role of the Inflammatory Response in Macular Disease. Kristin E. Quinlan. Department of Nursing, School of Nursing and Health Studies, Georgetown University.
Age-related macular degeneration (AMD) is the leading cause of legal blindness in the United States. It is more prevalent in the Caucasian population than in any other ethnic group. Drusen, a metabolic byproduct, initially appear in the macula at the onset of AMD. Choroidal neovascularization (CNV) and atrophy soon follow as the AMD progresses from its dry to more severe wet form. This paper presents a new perspective on the pathophysiology of this disease, one which considers inflammation and the vascular system as primary sources of macular degradation. Additionally, this paper investigates and underscores the promise in nontraditional methods of AMD prevention such as steroid therapy which could directly diffuse into the blood stream to inhibit the inflammation of the macular vasculature.
The advent of alternative treatment approaches for the prophylactic treatment of AMD proves significant since preventing the progression of dry AMD to wet AMD in even a small percent of patients could result in a substantial effect on lowering the incidence of vision loss from AMD in the United States. The disease currently lacks definitive causes, means of prevention, or cures; however, age, genetic predisposition, and smoking are known risk factors for AMD. This paper considers the role of diet, vascular occlusions, inflammatory responses, and collateral circulation in predisposing a patient to AMD. An understanding of these predisposing factors may aid in the development of more specific and effective preventions and treatments for macular degeneration.
Succinic Semialdehyde Dehydrogenase Deficiency. Emily Robbins. Department of Human Science, School of Nursing and Health Stduies, Georgetown University.
Succinic semialdehyde dehydrogenase (SSADH) deficiency, a rare autosomal recessive disorder, is caused by an enzyme deficiency in the degradation of gaba-aminobutyric acid (GABA), the major inhibitory neurotransmitter. Normally, GABA is converted to succinic semialdehyde, which is then, via succinic semialdehyde dehydrogenase, oxidized to succinic acid. In the absence of succinic semialdehyde dehydrogenase, succinic acid is reduced to gaba-hydroxybutyrate (GHB), the neurotoxic agent that accumulates in the cerebrospinal fluid (CSF), urine, and serum of patients with SSADH deficiency, and is believed to cause the clinical manifestations of the disorder. About half of the SSADH deficiency patients suffer from seizures. GHB, which is an addictive drug of abuse, has a wide range of uses. Researching SSADH deficiency will not allow us to treat the disorder, but will also, in providing a better understanding of GHB, increase our understanding of many neuropsychiatric disorders. I work at the National Institute of Health in the National Institute of Neurological Disorders and Stroke s epilepsy lab with a murine model of this disorder, in which the gene encoding SSADH is disrupted. I, along with others, plan to administer anti-epileptic drugs in order to prolong the lives of these knockout mice by controlling their seizures, and then use the treatment to control patients seizures. We are experiencing difficulties, and are in the process of revising the experimental design. I have co-authored two reviews of SSADH deficiency with Dr. Phillip Pearl and Dr. Michael Gibson that are in press at Genetests and Medlink. I would like to present a poster describing SSADH deficiency not only as an interesting disease but also as a way to better understand and treat generalized neurological disorders. I will describe the research, the problems that we are experiencing, and future plans, but I will have very few conclusive results on the research itself.
The Effect Of Chronic Illnesses On The Transition Through The Early School Years Of Head Start Children. Michael F. Saulle, Gregory Strait, and Robin D. Lanzi, Ph.D. Deparyment of Human Science, School of Nursing and Health Studies, Georgetown University.
The health status of a child is essential in their ability to learn (Novello, DeGraw & Kleinman, 1992). Children with sub par health can ultimately result in reduced school attendance, ability to concentrate, energy levels, and other aspects of behavior (Zigler, Piotrkowski & Collins, 1994). Head Start has incorporated the importance of participants health status through health promotion efforts as one the four major components of the program (Zigler & Meunchow, 1992). Little is known about how poor health in kindergarten children reflects on their potential for future academic success. This analysis seeks to determine how chronic illnesses could effect the transition through the early school years in Head Start children. This proposed presentation analyzes data from over 7500 former Head Start children in over 450 public schools who participate in the 31-site National Head Start-Public School Early Childhood Transition Demonstration study (NTDS), conducted from 1992-1998 by Sharon L. Ramey and Craig T. Ramey and colleagues (Ramey, Ramey & Phillips, 1996; Ramey, Ramey, Phillips, Lanzi, Brezausek, Katholi & Snyder, 2000). The most commonly reported health conditions: asthma (13%), health injury (6 %), hyperactivity (6 %), with 10 % of children having been seen by a professional about emotional and behavioral problems (3 % were prescribed drugs for behavior problems). About 15% had a speech problem, 14% were anemic, 6 % were in poor/fair health, 7 % had major health limitations, and 2 % could not attend school regularly due to their health. Various child health conditions will be examined for their effect on children’ cognitive and social performance as well as emotional status. Comparisons will be drawn between parent and teacher ratings on children s academic and social outcomes as a function of their health status. These findings will have major implications for how programs, policy makers, and funders frame the programs for Head Start children and their families.
References: Novello, A.C., DeGraw, C. & Kleinman, D.V. (1992). Healthy children ready to learn: An essential collaboration between health and education. Public
Health Reports, 107, 3-15. Ramey, S., Ramey, C., Phillips, M.M., Lanzi, R.G., Brezausek, C., Katholi & C. Snyder, S. (2000). Report on the National Head Start/Public School Early Childhood Transition Demonstration Study. Head Start Children s Entry into Public School. Washington, DC: U.S. Department of Health and Human Services.
Zigler, E. & Muenchow, S. (1992). Head Start: The inside story of America’s most successful education experiment. New York: Basic Books. Zigler, E., Piotrkowski, C.S. & Collins, R. (1994). Health services in Head Start. Annual Review of Public Health, 15, 511-534.
Stigma and HIV/AIDS. Mansi S. Shah, Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Stigma exists in many forms and undermines individual and community health.
Stigma related to HIV/AIDS involves the prejudice, discounting, discrediting, and discrimination that are directed towards individuals with HIV/AIDS. There are many factors that lead to stigmatization such as fear or lack of understanding and education. Stigma that an HIV/AIDS individual faces from oneself and the community could lead to reduced quality of life, acceptance of their HIV/AIDS status, and efforts to stop the growing pandemic. In contrast, understanding and open-mindedness about HIV/AIDS could promote better access to treatment for HIV/AIDS individuals and can lead to better prevention methods, HIV testing, and harm reduction efforts. Therefore, interventions to combat stigma are essential to prevent the spread of HIV/AIDS. Strategies to reduce stigma for individuals and their communities would involve a comprehensive approach to HIV/AIDS prevention and treatment. Individuals, both HIV positive and negative, would be empowered and informed so to decrease their chances of stigmatizing others and being stigmatized against. HIV/AIDS stigmatization on individuals and communities has been the subject of intensive research and intervention efforts. This presentation will summarize the current knowledge of HIV/AIDS stigmatization, discuss the causes and effects of stigma on those infected and affected by HIV/AIDS, and propose various methods that can be implemented to reduce stigma for individual and public health.
The Role of Nitric Oxide in the Lung: A look at Lung Therapy in Neonates. Jonathon Slade, Ali Starling, Anna Staudenmeyer, Lisa Trepper, and Allan Angerio, Ph.D. Departments of Nursing and Human Science, School of Nursing and Health Studies, Georgetown University.
ARDS, Pulmonary hypertension, ventilation-perfusion mismatching, and other pulmonary diseases are commonly seen in neonatology. Inhaled Nitric Oxide can selectively reduce pulmonary hypertension and improve oxygenation without having profound effects on the systemic circulation. Hence, Nitric Oxide therapy clearly reduces the need for extracorporeal membrane oxygenation therapy. Inhaled NO in neonates with pulmonary diseases should reduce pulmonary vascular resistance and selectively increase blood flow to areas of lung that are being adequately ventilated, thereby improving oxygenation and reducing ventilation requirements and the risk of oxygen toxicity.
These possible benefits would need to be weighed against the possible adverse effects of Nitric Oxide therapy resulting in internal bleeding, possible interactions with surfactant and increased pulmonary inflammation. Further research need be conducted before inhaled Nitric Oxide can be considered a standard treatment for neonates with pulmonary diseases. In neonates, severe respiratory failure is in large part the result of surfactant deficiency. Conversely, treatment with exogenous surfactant can cause dramatic improvements in oxygenation, but only up to 50% of neonates have “suboptimal responses.” No large randomized clinical trials have been yet reported on neonates testing the effectiveness of Nitric Oxide therapies. On the contrary, Nitric Oxide can prevent lung disease and death among neonates. Low doses of inhaled Nitric Oxide can decrease the risk of chronic lung disease and death by nearly one-fourth in neonates who have respiratory distress syndrome. Nitric Oxide does not cause bronchodilation but improves gas exchange, and as for whether Nitric Oxide therapy influences long-term outcomes will require clinical and field testing. Finally, the cost effectiveness of Nitric Oxide therapy is very high in comparison to the use of a mechanical ventilator, economically and practically. At present, a “multicentre collaborative controlled trial” is underway in the United Kingdom: a randomized controlled trial of ventilatory support with inhaled Nitric Oxide compared to ventilatory support without inhaled Nitric Oxide for neonates with severe respiratory failure and pulmonary disease. This trial may be able provide more data that would determine whether inhaled Nitric Oxide should be used as a treatment of choice in the effort to reduce neonatal casualties to respiratory diseases.
Gender Differences On Verbal And Visual Neuropsychological Tests Among African Americans. LaKeisha G. Thomas and Carlota Ocampo, Department of Psychology, Trinity College; Alfonso Campbell and Amira Brown, Department of Psychology, Howard University.
Gender differences in cognitive processing have been reported in many research studies. Typically, women out-perform men on verbal tasks, while men out-perform women on visuo-spatial tasks. A previous study by Campbell et al. (2003) found low predictive validity of neuropsychological tests among African Americans. The present study sought to determine whether a measurable difference would emerge in the performances of African-American men and women on verbal and visuo-spatial tasks. METHOD: Archival verbal and visual test scores of African American men and women (mean age =51.35, SD=15.24) , mean level of education = 11.19, SD=3.33) who served as non-brain injured controls in a previous study of cortical functions after stroke were compared using the independent samples t-test. RESULTS: Results revealed no significant differences between men’s and women’s performances on Hooper s Visual Organization Test (VOT) and the Peabody Picture Vocabulary Test (PPVT). Results support earlier findings that patterns of cognitive test performance among African Americans differ from traditional normative data, possibly due to cultural differences between these groups. Diagnostic neuropsychological tests should be utilized with caution when clients differ in cultural background from the normative groups for the tests.
Human Simulator Evaluation of Physiological Adaptation to Extreme Exercise.Samantha Tryon, Julee Pulverenti, Mi Jin Kang, Jaclyn Artuso. School of Nursing and Health Studies, Georgetown University.
Purpose: This experiment is designed to use simulation to study the physiologic response of the body to the stress of exercise in a diseased individual and a healthy individual. Hypothesis: In doing this experiment it is hypothesized that the healthy individual will be able to adapt to the stress of the exercise test. The diseased individual will only be able to adapt for a limited amount of time before he is unable to tolerate the stress of exercise.
Methods: The simulator was programmed to increase to specific heart rates at
three-minute intervals. Heart rate, blood pressure, respiratory rate, percent oxygen, and ECG changes were recorded at each interval. The test continued until the maximum predicted heart rate was successfully surpassed or until all ECG changes and data indicated an inability to adapt.
Conclusion: The results of this experiment indicate that health of an individual has an effect of their ability to overcome external stress.
Health Care Disparities: Analysis of Quality and Patient Satisfaction of the Uninsured.Christina F. Wong. Department of Human Science, School of Nursing and Health Studies, Georgetown University.
Health care inequality is a very broad concept as many things can lead to inequality such as race, gender, socioeconomic status, and demographics. More than 60 million Americans are uninsured and unable to afford adequate medical attention to fulfill their health needs, a sign of evident health care inequality. My work focuses on insurance status as a determinant of quality of care and patient safety, specifically no insurance and its effects on quality and patient satisfaction. From the literature available
It seems as if one of the biggest issues for uninsured individuals when receiving care is the amount of wait time before they see a health care provider or receive their medicine. The results from the patient satisfaction surveys that I conducted at Bread for the City medical clinic concur with these findings. This issue is of great importance as it puts the
Individuals are at even greater risk of having their health care needs unmet.
A potential solution would be to provide health care for everybody, or universal health care. Although universal health care looks like the optimal solution superficially, when looking deeper one might question it. Universal health care must include managed care to effectively serve the entire population; one of the underlying components of managed care is the long wait time. Through addressing recent findings concerning the effect of no insurance on poor quality and patient dissatisfaction I hope to give some
Insight as to whether the main cause of patient dissatisfaction is a result of not having insurance or a result of the manner that the health care was delivered, mainly managed care. This issue is of great importance as it affects many lives and it will affect even more in the future.