What Is the Relationship between Vitamin D Status, Pregnancy Symptoms and Quality of Life?

Purpose and Background/Significance: The main purpose of the study is to determine: (1) to determine if there is a relationship between vitamin D status, pregnancy symptoms, health promoting behaviors, and quality of life and (2) to determine if differences exist in pregnancy symptoms, health promoting behaviors and quality of life between African American and Hispanic women. There is evidence to show that vitamin D deficiency has been associated with numerous symptoms such as musculoskeletal pain, poor sleep, and depression. However, whether low levels of vitamin D is associated with these and other symptoms during pregnancy is unknown. What is known is that vitamin D deficiency disproportionately affects pregnant minority women, therefore, this study will help to understand the impact that vitamin D deficiency has on pregnancy symptoms and potential impact on quality of life. Theoretical/ conceptual framework: Using Wilson & Cleary\u27s Health Related Quality of Life model, that the characteristics of the individual (e.g. age, ethnicity) and the environment (e.g. social support) has an important impact on biological factors (e.g. vitamin D status), symptom status (pregnancy symptoms and depression), functional status (health promoting behaviors), all of which ultimately effect the overall health related quality of life. Method: A descriptive, cross sectional design examining women at 24 to 32 weeks gestation. The variables of study include the following: biologic (vitamin D status), symptoms (Edinburgh Postnatal Depression Scale and Pregnancy Symptom Inventory and Pittsburgh Sleep Quality Index), functional status (Health Promoting Lifestyles Profilev.2), and quality of life (SF-12). A convenience sample of 125 women from an underserved, low income health center serving a predominantly African American and Hispanic patient population will be recruited. Results: With vitamin D measured on a binary scale as sufficient (vitamin D level \u3e30 ng/ml) versus deficient (vitamin D level/ml), both univariable and multivariable binary logistic regression models will be used to assess the association between these risk factors and vitamin D status. As a measure of effect size, univariable odds ratios along with their 95% confidence intervals will be reported, and a single multivariable model will report adjusted odds ratios for each factor after controlling for the influence of other significant predictors of vitamin D deficiency

Life Course Health Effects of Early Life Trauma

The experience of trauma and psychosocial stress over the life course can have lasting impacts on health. Childhood and adolescence may serve as a particularly sensitive period during which trauma may become biologically embedded and affect adult health. Evaluating the pathways through which early life trauma can affect biological mechanisms of disease development provides insight into the early origins and etiology of adverse health outcomes in adulthood and provides potential targets to help mitigate their effects. Using data from the Sister Study, a large prospective cohort study of women residing in the U.S. or Puerto Rico aged 35 to 74 with a sister previously diagnosed with breast cancer, we examined the relationship between early life trauma and three indicators of adult health—1) incident breast cancer risk, 2) DNA methylation of the glucocorticoid receptor gene (NR3C1), and 3) leukocyte telomere length. Much of the previous literature has depended upon summative trauma scores, traditional trauma domains (e.g., sexual trauma, physical trauma, household dysfunction), or single traumatic events to represent early life adversity. However, early life traumatic experiences rarely occur in isolation and the experience of trauma in early life is a risk factor for future revictimization. This dissertation utilizes a latent class approach to evaluate the effect of specific profiles of early profiles on the three measures of adult health and biological embedding of trauma, as well as uses a sensitive period life course model to examine whether early life trauma impacts 1) NR3C1 methylation and 2) leukocyte telomere length in adulthood independent of later life trauma or if adult trauma mediates these associations. The findings from this dissertation suggest that the relationship between early life trauma and these three indicators of adult health are complex. There were no associations between traditional measures of early life trauma (e.g., summative scores or trauma domains) and incident breast cancer risk; however, compared to women who were classified in the latent class of early life trauma consisting of low early life trauma (i.e., the average probability of reporting any type of early life trauma was less than 2% across all possible traumatic events), the rate of incident breast cancer overall, as well as pre- and post- menopausal breast cancer, appeared higher among women belonging to the latent class of early life trauma consisting of both sexual trauma and family drug, alcohol, and/or mental health issues. This latent class of early life trauma was also associated with hypomethylation of cytosine-phosphate-guanine (CpG) sites located in the gene body of NR3C1. This association was also observed in a sensitive period life course model whereby the direct effect of early life trauma on decreased methylation was independent of trauma in adulthood. Finally, leukocyte telomere length was statistically significantly shorter in women classified in the latent class consisting of high early life trauma experience (i.e., the average probability of reporting each early life traumatic event was approximately 32%) compared to women classified in the latent class of low early life trauma experience independent of any indirect effect through trauma in adulthood. The findings from this dissertation emphasize that the effect of early life trauma on incident breast cancer risk, NR3C1 methylation, and leukocyte telomere length in adulthood may be more nuanced than what is captured via a cumulative trauma score, assessment of a single traumatic event, or traditional trauma domains can capture. Traumatic experiences differ in duration and intensity and various traumatic experiences tend to cluster and cooccur, likely contributing to unique patterns of biological embedding, behavioral responses, and socioenvironmental trajectories that may further differentiate how early life trauma affects adult health. Measures that capture the unique combinations of concomitant early life trauma profiles are needed to fully elucidate the effects of different experiences of early life trauma on adult health. Doing so can assist in designing programs and early life interventions to address those trauma profiles that are most detrimental to future health. Furthermore, the experience of trauma can occur across the life course. Utilizing life course models can help to better understand the relationship between the experience of early life trauma and adult manifestations of the biological embedding of stress and trauma. The findings from this dissertation contribute to a more robust understanding of the relationship between early life trauma and incident breast cancer risk, adult circulating NR3C1 methylation, and leukocyte telomere length in adulthood and support the need to identify opportunistic windows for interventions over the life course in order to minimize these negative health outcomes and their impacts. Future research will need to continue to utilize complex measures of early life trauma and a life course framework before a unified picture of the association between the nuanced roles of early life trauma in shaping these health outcomes can be fully elucidated

Two Cases of Lyme Arthritis in Winter In New England: A Case Series

Case Diagnosis: Lyme Arthritis Case Description: Patient 1 is a 26 year old male who presented in March with severe right knee pain and swelling for two weeks. He had a similar episode a month prior, but it resolved. The second episode progressed with pain from knee to foot and numbness on top of the foot. He had no known history of tick bites, travel, or trauma, but endorsed contact with a dog. On physical exam, he had a right knee effusion with limited ROM, diffuse joint line tenderness, positive McMurray’s, and pain with ligamentous testing. Synovial fluid of the joint showed WBC count 44,467 and was positive for Lyme. He was treated with doxycycline. MRI findings were limited to ACL laxity and inflammation. Patient 2 is a 24 year old male who presented in December with progressive right knee and calf pain for one week. He had been fishing in the woods a few weeks prior with no trauma. Joint aspiration showed a positive Lyme PCR and WBC count 37,520, and he was treated with doxycycline. Aspiration was repeated for recurrent effusion, and an MRI was done due to persistent pain. MRI showed bone contusion, ACL laxity, and inflammation. Discussions: Lyme disease is transmitted by Ixodes scapularis ticks, which appear in late spring and early summer; however,Lyme arthritis may occur during any season. Ticks infected with the spirochete B. burgdorferi are primarily found in the Northeastern and upper Midwestern US. B. burgdorferi strains of Lyme often disseminate to joints, tendons, or bursae early in infection.Lyme arthritis presents later, with an adaptive immune response that results in spirochetal killing. Conclusions: Lyme arthritis can present at any time of year, and clinical suspicion in endemic regions should remain high even without a known history of tick exposure or erythema migrans rash

An Investigation of Socially Responsible Consumers’ Behavior in Thrift Stores

The annual revenue of U.S. thrift stores is estimated to be $12 billion (First Research, 2014). Apparel products represent the majority of the products sold in these stores (Shim, 2010). While sales of apparel at thrift stores increased steadily during the economic downturn that began in 2008 (Tully, 2012), sales are expected to decrease as the economy improves (IBISWorld, 2012). To remain viable, thrift store managers need to have a solid understanding of their core apparel consumers in order to satisfy their needs (Carrigan & De Pelsmacker, 2009)

Systematic assessment of HER2/neu in gynecologic neoplasms, an institutional experience.

BackgroundHER2/neu overexpression and/or amplification has been widely studied in a number of solid tumors, primarily in the breast. In gynecologic neoplasms, determination of HER2/neu status has not been well studied as a predictive biomarker in anti-HER2/neu treatment.MethodsWe systematically evaluated the HER2/neu reactions by immunohistochemistry and fluorescent in situ hybridization in malignant gynecologic neoplasms as experienced in our institution.ResultsThe HER2/neu overexpression or amplification occurred in 8 % of the cancers of the gynecological organs in our series. Majority of the HER2/neu overexpression and/or amplification occurred in clear cell (27 %) and serous (11 %) carcinomas. HER2/neu positivity was also seen in undifferentiated as well as in mixed clear cell and serous carcinomas. Discordant IHC and FISH results (positive by FISH but not IHC) was seen in 2 cases. Majority of the HER2/neu overexpression and/or amplification occurs in the endometrium rather than the ovary. Heterogeneity of the HER2/neu by IHC staining was in < 2 % of the tumors in our series.ConclusionsWe recommend the HER2/neu studies on Müllerian carcinomas of clear cell, serous, and undifferentiated types, particularly when they arise in the endometrium. Since there are some discordant IHC/FISH results, we also propose performing the HER2/neu testing by FISH when the IHC score is less than 3 + 

Shape and Stereoselective Cyclopropanation of Alkenes Catalyzed by Iron Porphyrins

Iron porphryin complexes are active catalysts for the cyclopropanation of alkenes by ethyl diazoacetate. Fe(TIP) (TIP = meso-tetra-p-tolylporphyrin), an isolated iron(II) porphyrin complex, can be used as the catalyst, or the iron(III) complexes of several porphyrins can be reduced in situ. The reactions produce synthetically useful excesses of the trans cyclopropyl ester products. This stereoselectivity exhibits a modest solvent dependence, with donor solvents giving higher ratios of the trans cyclopropane products. The diastereoselectivity exhibits only a modest dependence on the steric bulk of the porphyrin. The reactions are selective for 1-alkenes and 1, 1-disubstituted alkenes. Conjugated substrates and enol ethers react more rapidly than simple aliphatic alkenes. A mechanistic model for the iron-mediated reactions is proposed which is consistent with the data presented herein

Prevalence and Predictors of Low Serum 25-Hydroxyvitamin D among Female African-American Breast Cancer Survivors

Background: African-American breast cancer survivors commonly demonstrate low serum 25-hydroxyvitamin D (25(OH)D). Decreased cutaneous conversion, high levels of adiposity, and even breast cancer treatment may influence vitamin D status. Previous investigations have analyzed African-American women in aggregate with other breast cancer survivors and have not comprehensively addressed these influential factors

Brain putamen volume changes in newly-diagnosed patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is accompanied by cognitive, motor, autonomic, learning, and affective abnormalities. The putamen serves several of these functions, especially motor and autonomic behaviors, but whether global and specific sub-regions of that structure are damaged is unclear. We assessed global and regional putamen volumes in 43 recently-diagnosed, treatment-naïve OSA (age, 46.4 ± 8.8 years; 31 male) and 61 control subjects (47.6 ± 8.8 years; 39 male) using high-resolution T1-weighted images collected with a 3.0-Tesla MRI scanner. Global putamen volumes were calculated, and group differences evaluated with independent samples t-tests, as well as with analysis of covariance (covariates; age, gender, and total intracranial volume). Regional differences between groups were visualized with 3D surface morphometry-based group ratio maps. OSA subjects showed significantly higher global putamen volumes, relative to controls. Regional analyses showed putamen areas with increased and decreased tissue volumes in OSA relative to control subjects, including increases in caudal, mid-dorsal, mid-ventral portions, and ventral regions, while areas with decreased volumes appeared in rostral, mid-dorsal, medial-caudal, and mid-ventral sites. Global putamen volumes were significantly higher in the OSA subjects, but local sites showed both higher and lower volumes. The appearance of localized volume alterations points to differential hypoxic or perfusion action on glia and other tissues within the structure, and may reflect a stage in progression of injury in these newly-diagnosed patients toward the overall volume loss found in patients with chronic OSA. The regional changes may underlie some of the specific deficits in motor, autonomic, and neuropsychologic functions in OSA

Reduced regional brain cortical thickness in patients with heart failure.

AimsAutonomic, cognitive, and neuropsychologic deficits appear in heart failure (HF) subjects, and these compromised functions depend on cerebral cortex integrity in addition to that of subcortical and brainstem sites. Impaired autoregulation, low cardiac output, sleep-disordered-breathing, hypertension, and diabetic conditions in HF offer considerable potential to affect cortical areas by loss of neurons and glia, which would be expressed as reduced cortical thicknesses. However, except for gross descriptions of cortical volume loss/injury, regional cortical thickness integrity in HF is unknown. Our goal was to assess regional cortical thicknesses across the brain in HF, compared to control subjects.Methods and resultsWe examined localized cortical thicknesses in 35 HF and 61 control subjects with high-resolution T1-weighted images (3.0-Tesla MRI) using FreeSurfer software, and assessed group differences with analysis-of-covariance (covariates; age, gender; p<0.05; FDR). Significantly-reduced cortical thicknesses appeared in HF over controls in multiple areas, including the frontal, parietal, temporal, and occipital lobes, more markedly on the left side, within areas that control autonomic, cognitive, affective, language, and visual functions.ConclusionHeart failure subjects show reduced regional cortical thicknesses in sites that control autonomic, cognitive, affective, language, and visual functions that are deficient in the condition. The findings suggest chronic tissue alterations, with regional changes reflecting loss of neurons and glia, and presumably are related to earlier-described axonal changes. The pathological mechanisms contributing to reduced cortical thicknesses likely include hypoxia/ischemia, accompanying impaired cerebral perfusion from reduced cardiac output and sleep-disordered-breathing and other comorbidities in HF