A Bottom-Up Approach in Pediatric Ethics Education: Residents Leading Ethics Curriculum Development - A Pilot Project

Presented as a poster at 2020 IUSM Education Day

Evaluation of Small Bowel Lumen Friction Forces for Applications in In vivo Robotic Capsule Endoscopy

To optimize the design of a robotic capsule endoscope (RCE) capable of exploring and delivering targeted medical therapy to the gastrointestinal tract, it is necessary to quantify the mechanical properties of the aforementioned environment. This research aims to empirically determine a coefficient of friction (COF) between the small bowel lumen and several potential RCE materials and to study how the friction response varies with velocity and contact area along the length of the bowel, specifically when eliminating edge effects from the testing coupon (sled). To obtain friction force measurements, a novel tribometer was designed and experiments were conducted to measure the friction on the small bowel lumen surface as a function of sled speed, material, contact area, presence of a leading edge and in situ versus in vitro conditions. The friction forces ranged from 0.001 N to 0.06 N under these conditions. A dry friction model was used to extract a COF from the measured forces and COF values ranged from 0.0004 to 0.05. The results show that the COF increases with increasing sled velocity. Contact between polydimethylsiloxane (PDMS) and the intestinal lumen yields a larger COF than that of stainless steel or polycarbonate. The COF does not demonstrate significant changes with pressure, but does respond to changes in contact area and weight, although the complexities of that relationship were not thoroughly investigated in this research. The results also indicate that by eliminating edge effects, the friction force between a stainless steel sled and the small bowel lumen surface is decreased. The average COF for in situ testing was found to be slightly lower than in vitro tests. These results can be incorporated into the design and control of an RCE to improve mobility within the gastrointestinal tract

Transaortic gunshot wound through perivisceral segment successfully managed by placement of thoracic stent graft

We describe a 36-year-old woman who presented to our facility after sustaining a gunshot wound to the epigastric region. The gunshot resulted in injury to the left lobe of the liver and the twelfth thoracic vertebral body as well as in a through- and-through injury to the abdominal aorta at the level of the celiac axis. The vascular injury was managed successfully by placement of a thoracic stent graft with coverage of the celiac axis. This case demonstrates the feasibility of managing this uncommon injury with endovascular techniques. (J Vasc Surg Cases and Innovative Techniques 2018;4:24-6.

Sustained adherence to a Mediterranean diet and physical activity on all-cause mortality in the Melbourne Collaborative Cohort Study: application of the g-formula.

BACKGROUND: Adherence to a traditional Mediterranean diet has been associated with lower mortality and cardiovascular disease risk. The relative importance of diet compared to other lifestyle factors and effects of dietary patterns over time remains unknown. METHODS: We used the parametric G-formula to account for time-dependent confounding, in order to assess the relative importance of diet compared to other lifestyle factors and effects of dietary patterns over time. We included healthy Melbourne Collaborative Cohort Study participants attending a visit during 1995-1999. Questionnaires assessed diet and physical activity at each of three study waves. Deaths were identified by linkage to national registries. We estimated mortality risk over approximately 14 years (1995-2011). RESULTS: Of 22,213 participants, 2163 (9.7%) died during 13.6 years median follow-up. Sustained high physical activity and adherence to a Mediterranean-style diet resulted in an estimated reduction in all-cause mortality of 1.82 per 100 people (95% confidence interval (CI): 0.03, 3.6). The population attributable fraction was 13% (95% CI: 4, 23%) for sustained high physical activity, 7% (95% CI: - 3, 17%) for sustained adherence to a Mediterranean-style diet and 18% (95% CI: 0, 36%) for their combination. CONCLUSIONS: A small reduction in mortality may be achieved by sustained elevated physical activity levels in healthy middle-aged adults, but there may be comparatively little gain from increasing adherence to a Mediterranean-style diet

Comparison of different regimens for surgical hand preparation

http://deepblue.lib.umich.edu/bitstream/2027.42/55469/1/Larson EL, Comparison of different regimens for surgical hand prep, 2001.pd

Genome-wide associations of gene expression variation in humans

The exploration of quantitative variation in human populations has become one of the major priorities for medical genetics. The successful identification of variants that contribute to complex traits is highly dependent on reliable assays and genetic maps. We have performed a genome-wide quantitative trait analysis of 630 genes in 60 unrelated Utah residents with ancestry from Northern and Western Europe using the publicly available phase I data of the International HapMap project. The genes are located in regions of the human genome with elevated functional annotation and disease interest including the ENCODE regions spanning 1% of the genome, Chromosome 21 and Chromosome 20q12-13.2. We apply three different methods of multiple test correction, including Bonferroni, false discovery rate, and permutations. For the 374 expressed genes, we find many regions with statistically significant association of single nucleotide polymorphisms (SNPs) with expression variation in lymphoblastoid cell lines after correcting for multiple tests. Based on our analyses, the signal proximal (cis-) to the genes of interest is more abundant and more stable than distal and trans across statistical methodologies. Our results suggest that regulatory polymorphism is widespread in the human genome and show that the 5-kb (phase I) HapMap has sufficient density to enable linkage disequilibrium mapping in humans. Such studies will significantly enhance our ability to annotate the non-coding part of the genome and interpret functional variation. In addition, we demonstrate that the HapMap cell lines themselves may serve as a useful resource for quantitative measurements at the cellular level

Assessment of two hand hygiene regimens for intensive care unit personnel

http://deepblue.lib.umich.edu/bitstream/2027.42/55459/1/Larson EL, Assessment of two hand hygiene regimens for ICU personnel, 2001.pd

Clinician perception of care at the end of life in a quaternary neonatal intensive care unit

IntroductionCare for neonates at the end of life (EOL) is often challenging for families and medical teams alike, performed suboptimally, and requires an experienced and compassionate clinician. Much literature exists on adult and pediatric EOL care, but limited studies examine the neonatal process.MethodsWe aimed to describe clinicians' experiences around EOL care in a single quaternary neonatal intensive care unit as we implemented a standard guideline using the Pediatric Intensive Care Unit-Quality of Dying and Death 20 tool.ResultsSurveys were completed by 205 multidisciplinary clinicians over three time periods and included 18 infants at EOL. While most responses were high, a meaningful minority were below goal (<8 on 0–10 scale) for troubling symptom management, conflict between parents and staff, family access to resources, and parent preparation of symptoms. Comparison between Epochs revealed improvement in one symptom management and four communication categories. Satisfaction scores related to education around EOL were better in later Epochs. Neonatal Pain, Agitation, and Sedation Scale scores were low, with few outliers.DiscussionThese findings can guide those aiming to improve processes around neonatal EOL by identifying areas with the greatest challenges (e.g., conflict management) and areas that need further study (e.g., pain management around death)