Post-laminectomy pain syndrome refers to persistent leg and/or lumbar back pain after a surgical procedure. The pathophysiology of this syndrome is complex, as often the operation was technically successful. Evaluation with MRI plays a crucial role in the assessment of post- laminectomy pain syndrome, as it provides soft tissue resolution for evaluation for common post- surgical pain generators, including recurrent posterior disc disease and associated narrowing of the spinal canal, lateral recess or neural foramina.
Massage therapy in the NICU appears to be safe, feasible, and improves patient pain self-assessment without vital sign instability.
Past studies suggest that patients who leave without being seen by a physician (LWBS) from a hospital’s emergency department (ED) represent a quality and safety concern, and thus LWBS rates have often been used as an ED performance metric. There are few recent studies, however, that have examined the characteristics of the LWBS population at hospitals in the United States.
After 18 years of service in the same location, the UCSD Free Clinic Project (Free Clinic) had to close one its four clinic sites. Several hundred patients were faced with the challenge of commuting long distances to another clinic, and even losing access to car. Although unfortunate, this became an opportunity for the Free Clinic to examine where its patients live, the distances they travel to clinic, and determine new locations for a clinic. To complete this examination, the Free Clinic performed a spatial analysis--mapping patients and clinic locations--using specialized Geographic Information Systems (GIS) software.
Enrichment activities are known to enhance youth development, and are especially beneficial for at-risk youth who have not consistently had the social capital to receive such enrichment throughout the critical periods of their development. The National Institute of Justice has published many studies demonstrating the benefit of enrichment activities for disadvantaged youth. Enrichment activities promote self-esteem and sense of discipline and well-being, which impacts mental health and risk taking behaviors such as substance abuse. With the goal of achieving the aforementioned impact, juvenile detention centers offer enrichment programs as part of the rehabilitation process. My goal for this project was to further investigate the availability, equity and impact of such programs on mental health outcomes for at risk youth, I completed a needs assessment. The following needs assessment report summarizes my findings.
Multiple theories about the association between Post Traumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) have been proposed, but there is yet to be a common consensus on their exact relationship. Regardless of the etiology of their association, it is reasonable to suggest that the interaction between SUD and comorbid PTSD is complex. The intention of this project was not to dive deeper into the suggested theoretical models, but rather to focus on understanding how these conditions affect patients and on a pragmatic approach to treatment. This was based largely in principle on two observations from prior studies. One of which was the fact that patients with the SUD/PTSD are more likley to struggle with treatment for substance use disorder in regards to retention and periods of abstinence. Second was the realization that patients with comorbid disease have higher rates of homelessness, physical health problems, psychiatric cormorbities, and psychosocial impairment when compared to individuals with a single disorder. As such, the goal of this project was to gain a better understanding of the challenges associated with treating these patients and to also develop a greater understanding of the "best" practice approach to treatment.
To explore the topic of gender micro‐inequities, both on a personal level and on a professional level. To evaluate literature on the topic. This includes evaluating the different ways to study this topic (survey, focus group, longitudinal interviews, etc), as well as the specific populations studied and critically consider the positives and negatives of the different methods. To plan and give a professional lecture/webinar, including seeking feedback and evaluation.
Danon disease is a congenital X-linked hypertrophic cardiomyopathy that results from mutations in LAMP2, a transmembrane lysosomal protein necessary for autophagy. The disease presents in childhood or adolescence, and life expectancy is 19 for men and 34 for women. Although Danon disease is rare, no specific therapy based on its biology is currently known. Recent in vitro studies using mouse by the Cherqui Lab have shown evidence supporting hematopoetic stem cell transplant as a novel treatment option for cystinosis. Cystinosis is a metabolic disease that arises from mutations in a transmembrane lysosomal protein - cystinosin (CTNS gene). Detailed in vitro and in vivo studies have shown that rescue of the phenotype occurs because wildtype macrophages derived from the transplanted wildtype hematopoietic stem cells can transfer lysosomes containing wildtype cystinosin directly to Ctns-deficient cells in multiple organs of the host Ctns -/- mice. Because Danon disease also arises from mutations in a transmembrane lysosomal protein, LAMP2, a similar approach could be effective in rescuing the phenotype of LAMP2 mutant mice. The Adler Lab has recently developed an in vitro cell model for Danon disease using skin fibroblasts expanded from skin biopsies from two identified patients diagnosed with Danon disease, confirmed by RT-PCR. These in vitro and in vivo models can be used show efficacy of hematopoietic stem cell transplant for Danon disease.
Military members are required to carry heavy loads frequently during training and active duty combat. We investigated if operationally relevant axial loads affect lumbar disc kinematics in forty-one male active duty Marines with no previous clinically diagnosed pathology. Marines were imaged standing upright with and without load. From T2-weighted magnetic resonance images, IVD health and kinematic changes between loading conditions and across lumbar levels were evaluated using two-way repeated measures analysis of variance tests. IVD kinematics with loading were compared between individuals with and without signs of degeneration on imaging. Linear regression analyses were performed to determine associations between IVD position and kinematic changes with loading. Fifty-eight percent (118/205) of IVDs showed evidence of degeneration and 3% (7/205) demonstrated a disc bulge. IVD degeneration was not related to posterior annular position (p>0.205). Changes in sagittal intervertebral angle were not associated with changes in posterior annular position between baseline and loaded conditions at any lumbar level (r<0.267; p=.091-0.746). Intervertebral angles were significantly larger in the lower regions of the spine (p<0.001), indicating increased local lordosis when moving in the caudal direction Disc height at the L5/S1 level was significantly smaller (6.3mm, mean difference =1.20) than all other levels (p<0.001) and baseline posterior disc heights tended to be larger at baseline (7.43mm ± 1.46) than after loading (7.18 ±1.57, p=0.071). Individuals with a larger baseline posterior annular position demonstrated greater reduction with load at all levels (p<0.002), with the largest reductions at L5/S1 level. Overall, while this population demonstrated some signs of disc degeneration, operationally relevant loading did not significantly affect disc kinematics.
As information technology continues to improve, patients are given access to increasing amounts of their health data. Health applications such as Epic MyChart provide an easily accessible archive of information for both patients and, in the case of pediatrics, parents. With increasing amounts of available information there is a concurrent need to provide education about interpretation. This study aimed to create a short, parent-focused, educational video to convey high-yield information regarding growth chart data. A pre- and post-survey were administered in conjunction with the educational video using QR codes at pediatric offices in La Jolla. We found, in general, parents felt well-equipped to be active participants in their child’s health, but identified some areas for improvement regarding perceptions of health.
