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Engineering Considerations for Treatment of Prosthetic Joint Infections Using Alternating Magnetic Fields (AMF)
Get PDFTreatment of infected orthopedic implants presents a major medical challenge, involving prolonged antibiotic therapy and revision surgery. This contributes to >1 billion USD in annual healthcare costs in the US alone. Exposure of metallic implants to alternating magnetic fields (AMF) generates heat that can provide a non-invasive means to target biofilm adhered to the surface. In this thesis, first an AMF system with a solenoid coil was constructed for targeting a metal plate surgically implanted in a sheep model. The system produced magnetic field strengths up to 12 mT and achieved plate temperatures of 65-80°C within 10-14 seconds. A tissue-mimicking phantom of the sheep leg was developed to evaluate heating with the system and to compare these results with numerical simulations. Single and intermittent AMF exposures of a tissue-mimicking phantom agreed with numerical simulations within ± 5%. Similar agreement between experimental measurements and simulations was also observed in the live sheep metal implant model. The simulations also predicted 2-3 mm of tissue damage using a CEM43 thermal dose model for 1-h AMF exposures targeting 65°C for pulse delays of 2.5 and 5 mins. This study confirmed that AMF technology can be scaled up to treat implants in a large animal model with the same rates of heating and peak temperature as observed in prior in vitro studies. After this, the thesis focused on designing a working prototype to target a clinical knee implant with AMF. For initial optimizations numerical simulations approximate interaction between AMF and metal implants were used to design AMF coils windings for heating clinical knee implant on horseshoe surface. These winding patters were engineered into a prototype, capable of running a total current upwards of 400 A, producing a magnetic field of 4 - 5 mT at 2000 W of input power. This coil was further characterized and calibrated to optimal AMF parameters. The AMF system was able cycle through this power for 60 s at each instance, producing uniform surface temperature on complex geometry of knee implant. This heating rate was equivalent of producing 70 - 80 °C on implant surface inside a simulated homogeneous tissue model. Equivalent simple Helmholtz coil was also designed to show its inability of producing a narrow temperature distribution on complex knee implant surface. This work will be further enhanced for the final design for clinical trials based on the findings presented in this thesis
Hidden Opportunity: The Advantages of Synchronizing Multiple Knowledge Bases
No full textThis paper was presented at the Camp ER&L (Electronic Resources & Libraries) 2024, which was held March 3-6, 2024, in Austin, Texas.Authors are Emily Gross, ILS Specialist, Western Michigan University; Soley Somma, Senior Product Manager, OCLC; and Jon Crossno, Collection Management Librarian, UT Southwestern Medical Center.There are many advantages to synchronizing your knowledge bases that benefit your library. However, with reduced staff, the rapid changes across e-Resources, and working with multiple vendors, synching knowledge bases can seem daunting. Panelists will share why and how they chose to synchronize knowledge bases to support their library's strategy
Surgical and Conservative Treatment Approaches in Cases of Central Cord Syndrome: A Systematic Review and Meta-Analysis
Get PDFThe 62nd Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 30, 2024, 3-6 p.m., D1.700 Lecture Hall)INTRODUCTION: Management of central cord syndrome (CCS) is still controversial. This study aimed to examine the roles and timing of conservative and surgical management in CCS.
METHODS: A systematic review was conducted according to the PRISMA guidelines to identify articles describing the use of conservative and/or surgical methods in the management of CCS. Data extracted was subsequently meta-analyzed.
RESULTS: A total of 37 articles detailing 99 cases of adult CCS were identified with 79 males and 20 females. Patients receiving surgery were all female patients (100% vs. 0%, p24 hours after injury (p<0.001, OR: 17.18, 95% CI: 3.00-182.81) and spondylosis on diagnostic imaging (p<0.01, OR: 8.84, 95% CI: 1.82-86.09). Additionally, surgical intervention was found to be less likely with increased patient age (p<0.01, OR: 0.96, 95% CI: 0.93-0.98). Meanwhile, sports trauma was a predictor of conservative management (p<0.001, OR: 0.03, 95% CI: 0.00-0.29). There was no statistically significant difference in symptomatic improvements between the two management strategies (87.7% vs 100%, p=0.2765).
CONCLUSION: Understanding these predictors and outcomes can aid in personalized treatment decisions for CCS cases. Early surgical intervention within 24 hours of injury does not appear to be superior to conservative management with possible deferred operation.Southwestern Medical Foundatio
Examining Academic Health Sciences Library Directors in 2009 and 2024
No full textThis presentation was recognized at the SCC/MLA Annual Business Meeting on October 29, 2024, as the recipient of the First Place Award for Contributed Papers in the 2024 Elizabeth K. Eaton, Ph.D. Research Awards.OBJECTIVES: The objective is to develop a 2024 profile of an AHSL director based on sex distribution, professional titles, membership in the Academy of Health Information Professionals (AHIP), elected positions within MLA, and publication record and compare the findings from 2009 and 2024. METHODS: The 2024 Membership Directory of the Association of Academic Health Sciences Libraries was used to identify AHSL directors in the United States and Canada. The academic health sciences libraries' websites and MLANET were examined to collect information about the AHSL directors. The publications of the directors were identified using Library Literature and Information Science Source (EBSCO database). The collected data was analyzed using descriptive statistics. RESULTS: In 2009, the majority (73%) of the 146 AHSL directors were female, and in 2024, 76% of the 167 directors were female. The most commonly used term in the professional titles was director (84%) in 2009, and the same term was used by 78% in 2024. Less than half of the directors' were members of AHIP in 2009 (49%) and 2024 (45%). Most of the directors did not hold MLA elected positions in both 2009 (71%) and 2024 (82%). Lastly, the majority of directors had at least one publication in 2009 (75%) and 2024 (80%), and the median number of publications was 2 in 2009 and 3 in 2024. CONCLUSIONS: Results indicate that the profile of an AHSL director has not significantly changed over the last 15 years
Let's Talk About Leadership!
Get PDFIn this round table session, a panel of recent NNLM Region 3 Leadership Pathways and Emerging Leader awardees will share their interest in pursuing leadership training and answer questions of those who are interested in applying for these awards in the future. Executive Director of NNLM Region 3, Brian Leaf, will moderate the panel and present information on the awards and application process. The session aims to encourage and inform potential applicants, and to promote the importance of strong leadership in our libraries and region
The Impacts of Information Factors on Diabetes Self-Management Behaviors
Get PDFOBJECTIVES: The purpose of the project is to examine the relationship between online information seeking, eHealth literacy, health literacy, self-efficacy, and diabetes-related health behaviors, including four types of diabetes self-management behaviors, among diabetic patients. METHODS: An online survey was distributed to patients with diabetes who are 18-44 years old in the U.S. Participants were recruited through a third-party survey company. A total of 300 valid responses were collected. In addition to descriptive analyses, linear regression models were utilized to analyze the data. All data analyses were conducted in R. RESULTS: Results suggested that key elements including two types of online information seeking behaviors, eHealth literacy, three types of health literacy, and diabetes self-efficacy have different impacts on various diabetes self-management behaviors including glucose management, dietary control, physical activity, and health-care use. CONCLUSION: By examining the unique roles of each key information elements on major diabetes self-management behaviors, this study provides insights on potential adjustments and strategies for information professionals and public health practitioners to improve the effectiveness of health communication regarding diabetes. Health sciences librarians could be invaluable during the course of health communication enhancement and contribute to better health of communities
From Dream to Reality: How One Medical Library Regrew After Organizational Shake-Ups
No full textBACKGROUND: After considerable organizational shake-up in 2022, the Library has been rebuilding and moving forward. The loss of 7 librarians gave room to create a new service model and team identity. With the funding to rehire, we began to see opportunities to evolve our structure and culture. In the last 1.5 years a department has grown from 1 librarian to a team of 10 spread over 3 regional campuses and our main campus. It was important to us to align with the values of the university, while meeting our mission to further the research, education and clinical goals of the health science community. OUTCOME: By reviewing our structure before the shakeup and what we wanted it to be after, we were able to identify areas within the Library that already worked well, minor changes we could make, and areas for complete redesign. This paper will describe the valuable skills and strategies used to re-establish our unique identity within the larger library system and identify the individual roles needed to support a new service model for the Library. We will outline specific efforts to build a cohesive culture and organize our team to serve programs and patrons spread throughout Texas. DISCUSSION: Each campus library plays a unique role in services and resources offered to our user populations. It is up to the librarians to foster independence while working in tandem with the team. We have been able to build an environment of collaboration and set purposeful goals to establish long-term success
Modifying an Institutional Animal Care and Use Committee Protocol Form for Better Animal Use Alternative and Duplication Search Submissions
Get PDFOBJECTIVE: Improve Animal Use Duplication and Alternative IACUC protocol search submissions by modifying the protocol form sections for searches and instructions because submissions often lack required searches and information. METHODS: Instructions for Duplication and Animal Use Alternative searches were modified to clarify requirements: full search strategy with proper syntax, number of search results, and that all results must be reviewed. Search examples that fulfill all requirements were added to instructions. Alternative Search instructions were also modified to include 3Rs (Replacement, Refinement, Reduction) search requirements and the requirement to search two databases. The search submission form sections were modified from a free-text entry field to a table with the fields: Search String (using AND, OR, NOT), Database Searched, and Number of Results. RESULTS: Some improvements have been observed after the modifications to the protocol instructions and form were made. More investigators include a complete search strategy, number of results, and database searched. However, many investigators continue to not include all required 3Rs searches or provide searches from two databases for Animal Use Alternative searches. CONCLUSIONS: While search submissions have improved there still seems to be a lack of understanding of requirements. Other interventions such as search training modules or searching workshops may need to be employed for further search submission improvements
A Molecular Basis for Macrophage Control of Enteric Nervous System Function
Get PDFPeristaltic movement of the intestine propels food down the length of the gastrointestinal tract to promote nutrient absorption. Interactions between intestinal macrophages and the enteric nervous system regulate gastrointestinal motility, yet we have an incomplete understanding of the molecular mediators of this crosstalk. Here we identify complement component 1q (C1q) as a macrophage product that regulates gut motility. Macrophages were the predominant source of C1q in the mouse intestine and most extraintestinal tissues. Although C1q mediates complement-mediated killing of bacteria in the bloodstream, we found that C1q was not essential for immune defense of the intestine. Instead, C1q-expressing macrophages were localized to the intestinal submucosal plexus where they closely associated with enteric neurons and expressed surface markers characteristic of nerve-adjacent macrophages in other tissues. Mice with a macrophage-specific deletion of C1qa showed changes in enteric neuronal gene expression, increased peristaltic activity, and accelerated intestinal transit. Our findings identify C1q as a key regulator of gastrointestinal motility and provide enhanced insight into the crosstalk between macrophages and the enteric nervous system
The 18-Month Curriculum: The Impact of Mixed Learning Clerkships
No full textBACKGROUND: UT Southwestern implemented a new, 18-month, shortened pre-clerkship curriculum in the Fall of 2015 in order to increase the clerkship phase from 1 year to 18 months, beginning mid-second year. In keeping with this new curriculum schedule, it was necessary to combine MS2 and MS3 students on clerkships from January to June; during that time, both MS2 and MS3 students are on the same clerkship simultaneously, creating opportunities for informal near-peer learning. Each clerkship handles this mixing differently: some create mixed-year teams, others group students together with their peers, while still others do not create teams at all.
OBJECTIVE: We are interested in determining the impact of mixing students on team dynamics, narrative assessments, and grades.
HYPOTHESIS: Upperclassmen and underclassmen participating on the same clerkships in a mixed learning environment will report predominantly positive experiences but will have significant differences in their grades and narrative assessments compared to each other.
METHODS: A tri-pronged approach was taken, looking at qualitative student perspectives, qualitative attending perspectives, and quantitative scores on de-identified student evaluations. In the first arm of the study, students in the classes of 2020 and 2021 were sent a voluntary survey seeking comments regarding their experiences on mixed clerkships and to indicate their interest in participating in a follow-up 30-minute focus group interview. Four purposeful focus groups of 4-5 students, two groups from each class, were interviewed to learn more about perceived advantages and disadvantages of mixed clerkships. Interviews were audio-recorded, transcribed, and coded for themes. Transcripts were validated by the interviewees and de-identified prior to analysis. In the second and third arms of the study, student evaluations from 2019 in the Internal Medicine, Pediatrics, and Psychiatry clerkships were gathered and de-identified. From these, 120 narrative assessments were randomly selected for qualitative analysis. Final grades and four scored skills were selected for quantitative analysis. Finally, de-identified quantitative data from 2015-2016, prior to the implementation of the 18-month curriculum, were analyzed for additional insights.
RESULTS: In the first arm of the study, interviewees reported overall positive experiences with mixed clerkships. Common perceived advantages as an MS2 paired with MS3s included being able to ask "dumb" questions without being judged; being taught "practical" skills such as how to use the electronic medical record (EMR) and how to write a note; having fears allayed through candid discussions; and having a sense of camaraderie. Common advantages as an MS3 paired with MS2s included satisfaction in teaching MS2s and being motivated by MS2 enthusiasm. Perceived disadvantages were less commonly mentioned but still present, and mostly centered around fears of being compared by evaluators. In the second and third arms of the study, the mixed clerkships of Pediatrics and Psychiatry tended to show more significant differences in MS2 and MS3 evaluations than the non-mixed clerkship of Internal Medicine. However, this was highly nuanced, and there was some, but not consistent, division between differences observed in "learned" skills such as history-taking or note-writing and "inherent" skills such as professionalism or confidence. Comparison with students on the old curriculum also revealed significant differences with different MS2 and MS3 cohorts suggesting both positive and negative effects of the mixed learning environment on student evaluations.
CONCLUSION: Overall, students reported more positive experiences and perceived advantages on mixed clerkships than negative experiences and disadvantages. However, attendings reported a higher proportion of significant differences between less and more experienced students on mixed clerkships. Despite this, the impact of cross-class comparison versus other factors, such as natural student improvement, contributing to these differences is unclear, and therefore mixed clerkships resulting from the 18-month curriculum have had a generally positive impact despite some negative effects. Further research, including research into other assessments of educational outcomes such as shelf exam scores as well as research into cross-clerkship comparisons, is needed to provide a fuller picture of the impact of these mixed clerkships