• Alaskan Physicians' Knowledge, Attitudes, And Behaviors Related To Fetal Alcohol Spectrum Disorders

      Dewane, Sarah L.; Brems, Christine; Rivkin, Inna; Johnson, Mark E.; Eldridge, Gloria (2010)
      Fetal alcohol spectrum disorders (FASDs), caused by maternal consumption of alcohol during pregnancy, constitute the leading known preventable birth defects in the US. Given high prevalence rates and lifetime costs of FASDs in Alaska, it is imperative that healthcare providers have an adequate foundation of knowledge related to FASDs, as well as a strong sense of self-efficacy vis-a-vis their personal capacity to engage in primary and secondary prevention activities. The purpose of this study was to examine Alaskan physicians' self-reported levels of knowledge, attitudes, and practice behaviors related to FASDs, and identify effective ways to educate and train physicians about primary and secondary FASD prevention. Study goals were accomplished via an explanatory mixed methods research design involving three distinct phases; namely, a quantitative, qualitative, and application phase. Through study participation, Alaskan physicians shared their perceptions and opinions about systemic and professional barriers that affect educational and training needs related to FASD prevention and clinical intervention, as well as challenges that impede access to care for individuals who are affected by FASDs. Results based on surveys from 243 physicians and interviews with 24 key informants revealed that physicians are generally knowledgeable about the risks of alcohol consumption during pregnancy. However, physicians are in need of support to provide effective services related to FASD prevention and intervention. These needs include: 1) specialized education during medical school and residency; 2) easily accessible continuing education opportunities; 3) development and dissemination of best practice protocols related to FASD care; 4) workforce development to increase referral options for patients; and 5) changes to healthcare systems to support primary and secondary prevention practices. Clearly, many challenges and obstacles identified by physicians are beyond their control and need to be addressed not only as independent practice issues but as larger medical education and healthcare systems issues. Given these realities and findings, the study concludes with suggestions and resources for physicians related to needed changes in FASD-related practice behaviors, as well as recommendations about how universities, medical schools, healthcare systems, and State and federal entities can better support physicians' efforts to reduce and treat these entirely preventable birth defects.
    • Resistance To Multi Organ Failure And Metabolic Alterations After Global Ischemia/Reperfusion In The Arctic Ground Squirrel

      Bogren, Lori Kristine; Drew, Kelly; Green, Thomas; Harris, Michael; O'Brien, Kristin (2013)
      Cardiac arrest (CA) and hemorrhagic shock (HS) are two clinically relevant situations where the body undergoes global ischemia/reperfusion (I/R). Hibernating animals such as ground squirrels have been shown to be resistant to I/R injury in various tissues. The present study compared physiological and metabolic changes occurring during global I/R in an I/R-injury prone animal, the rat, to that of I/R injury resistant animals, arctic ground squirrels (AGS). We sought to determine if AGS are protected from multi organ failure after global I/R and if any protection is dependent upon their hibernation season or the ability to maintain a stable metabolic profile during I/R. For CA, rats and euthermic AGS were asphyxiated for 8 min, inducing CA. For HS, rats, euthermic AGS, and interbout arousal AGS were subject to HS by withdrawing blood to achieve a MAP of 35 mm Hg for 20 min before reperfusion. For both I/R models, the animals' temperature was maintained at 36.5-37.5�C. After reperfusion, animals were monitored for 3 hours (HS) or 7 days (CA), then tissues and blood were collected for histopathology, clinical chemistries, cytokine level analysis (HS only), and 1H-NMR metabolomics of hydrophobic and hydrophilic metabolites (HS only). For the HS studies, a group of rats and AGS were monitored for three days after HS to access survival and physiological impairment. Regardless of season AGS showed no physiological deficit 12 hours after HS or CA. Blood chemistries and circulating cytokine levels indicated liver damage and systemic inflammation in the rats while AGS showed no signs of organ damage or inflammation. In addition, rats had a shift in their hydrophilic metabolic fingerprint and alterations in several metabolite concentrations during HS-induced I/R, indicative of metabolic adjustments and organ damage. In contrast, AGS, regardless of season, were able to maintain a 1H-NMR metabolic profile with few changes in quantified metabolites during I/R. These data demonstrate that AGS are resistant to systemic inflammation and organ damage/failure after I/R and this resistance is not dependent on their ability to become hypothermic during insult but may stem from an intrinsic resistance to disruptions in their metabolic processes during I/R.
    • Shudder: Poems And Essays On Cancer, Care, And Healing

      Mohatt, Nathaniel Vincent; Burleson, Derick (2011)
      This book chronicles my journey in understanding and coming to terms with my father's illness and death. In 2005 he was diagnosed with Chronic Lymphocytic Leukemia (CLL), and in 2008 I traveled with him to the MD Anderson Cancer Center in Houston, Texas. In 2010 he died suddenly after his cancer transformed into an aggressive form of large cell lymphoma. The introductory personal essay ties together the trip to MD Anderson with writings from poetry and psychology, chronicling my experience with cancer care. The essay unveils an intimate relationship between art, the creation and experience of beauty, the provision of health care, and the meaning of healing. Like art, health care and healing are experienced in "the attempt," the process of trying to attain (health or beauty) without the ability to realize perfection. The poems weave together visions from the MD Anderson trip, other encounters with cancer, and pieces of my family's life after his death with a wide variety of images, memories, characters, and spirits. The poems begin with scenes and people from MD Anderson, then move to poems about coming into sense, discovery of the internal wild, and preparation for a time of sorrow. The later poems grapple with understanding the disease and my father's relationship with illness and conclude with in a continuation of "the attempt" even after death.