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Search Results: 1 - 10 of 405927 matches for " Kristen M. Johnson "
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The Effects of Vestibular Rehabilitation after Bilateral Superior Semicircular Canal Dehiscence: A Case Report  [PDF]
Connor L. Naccarato, Kristen M. Johnson
International Journal of Clinical Medicine (IJCM) , 2017, DOI: 10.4236/ijcm.2017.86042
Abstract: Background and Purpose: Despite the strong body of evidence for vestibular rehabilitation, research is lacking for effective clinical management of patients with superior semicircular canal dehiscence (SSCD) and endolymphatic hydrops (EH). The purpose of this case report is to describe the effects of physical therapy in the treatment of a patient diagnosed with bilateral SSCD. Case Description: The patient was a 56-year-old woman with a long-standing otologic history involving bilateral SSCD and EH. The patient’s body structure and function impairments include constant headaches, dizziness with head rotation and eye movements, sensitivity to sounds and lights, and instability during gait. Her activity limitations include lower extremity dressing, driving, and playing her flute. Her participation restrictions include taking part in social gatherings, going to church, driving longer than 30 minutes, playing with her dogs, and teaching flute lessons. Interventions: Specific interventions included vestibular habituation and adaptation exercises, balance and gait training, and patient education. Physical therapy services were provided for approximately 11 weeks with a frequency of two times per week. Outcomes: After eleven weeks of physical therapy, the patient made improvements on the Lower Extremity Functional Scale (43/80 to 52/80), the Dynamic Gait Index (19/24 to 24/24), the Dizziness Handicap Inventory (86/100 to 68/100), and the Sharpened Romberg (2 seconds to >30 seconds). The patient improved in all her activity limitations and participation restrictions. She was able to play her flute for 20-minute intervals, play with her dogs, partake in social gatherings, and drive for 5 hours without symptoms. The patient had plans to pursue surgical intervention within the next year. Discussion: For a patient with a complex otologic history and a current diagnosis of bilateral SSCD, vestibular rehabilitation was an effective management option. The information from this case can be used to guide the effective treatment of similar patients diagnosed with vestibular dysfunction.
Improving Balance through Virtual Reality and Physical Therapy Integration  [PDF]
Ben Joseph S. Esguerra, Kristen Johnson
International Journal of Clinical Medicine (IJCM) , 2017, DOI: 10.4236/ijcm.2017.85030
Abstract: Background and Purpose: Virtual reality (VR) is an innovative technology that shows promise in the assistance of physical therapy (PT). This case report explores the use of virtual reality with a patient suffering from unilateral vestibular hypofunction (UVH). Case Description: The patient is a 50-year-old male who was referred to physical therapy following a motor vehicle accident. The patient was diagnosed with having an acute left UVH, accompanied by reports of dizziness, imbalance and gait disturbances which impaired him from his work in construction. Intervention: The patient was seen two to three times a week for 40-minute sessions along with an individualized home exercise program. Interventions included vestibular rehabilitation exercises, balance training, gait training, and VR. The goals of VR were to provide task-specific simulations to improve postural balance, decrease anxiety through exposure therapy, and improve smooth eye pursuits to improve static balance. Outcomes: Outcomes used included subjective questionnaires such as the Activities-Specific Balance Confidence survey and the Dizziness Handicap Inventory (DHI) as well as functional tests like the Sensory Organization Test, Motor Control Test, and the Functional Gait Assessment (FGA). Outcome measures were performed at initial evaluation, at the 10th visit, and again at discharge. Notable improvements were seen on DHI and FGA scores. Conclusion: Dizziness, confidence, balance, and gait improved following vestibular rehabilitation combined with VR. Outcomes of this case suggest that virtual reality in conjunction with vestibular rehabilitation therapy is effective in improving deficits of unilateral vestibular hypofunction. Additionally, the use of VR in this case report suggests this can be an effective tool for intervention to facilitate patient-specific goals.
Prions Adhere to Soil Minerals and Remain Infectious
Christopher J Johnson,Kristen E Phillips,Peter T Schramm,Debbie McKenzie,Judd M Aiken,Joel A Pedersen
PLOS Pathogens , 2006, DOI: 10.1371/journal.ppat.0020032
Abstract: An unidentified environmental reservoir of infectivity contributes to the natural transmission of prion diseases (transmissible spongiform encephalopathies [TSEs]) in sheep, deer, and elk. Prion infectivity may enter soil environments via shedding from diseased animals and decomposition of infected carcasses. Burial of TSE-infected cattle, sheep, and deer as a means of disposal has resulted in unintentional introduction of prions into subsurface environments. We examined the potential for soil to serve as a TSE reservoir by studying the interaction of the disease-associated prion protein (PrPSc) with common soil minerals. In this study, we demonstrated substantial PrPSc adsorption to two clay minerals, quartz, and four whole soil samples. We quantified the PrPSc-binding capacities of each mineral. Furthermore, we observed that PrPSc desorbed from montmorillonite clay was cleaved at an N-terminal site and the interaction between PrPSc and Mte was strong, making desorption of the protein difficult. Despite cleavage and avid binding, PrPSc bound to Mte remained infectious. Results from our study suggest that PrPSc released into soil environments may be preserved in a bioavailable form, perpetuating prion disease epizootics and exposing other species to the infectious agent.
Functional Substitution by TAT-Utrophin in Dystrophin-Deficient Mice
Kevin J. Sonnemann,Hanke Heun-Johnson,Amy J. Turner,Kristen A. Baltgalvis,Dawn A. Lowe,James M. Ervasti
PLOS Medicine , 2009, DOI: 10.1371/journal.pmed.1000083
Abstract: Background The loss of dystrophin compromises muscle cell membrane stability and causes Duchenne muscular dystrophy and/or various forms of cardiomyopathy. Increased expression of the dystrophin homolog utrophin by gene delivery or pharmacologic up-regulation has been demonstrated to restore membrane integrity and improve the phenotype in the dystrophin-deficient mdx mouse. However, the lack of a viable therapy in humans predicates the need to explore alternative methods to combat dystrophin deficiency. We investigated whether systemic administration of recombinant full-length utrophin (Utr) or ΔR4-21 “micro” utrophin (μUtr) protein modified with the cell-penetrating TAT protein transduction domain could attenuate the phenotype of mdx mice. Methods and Findings Recombinant TAT-Utr and TAT-μUtr proteins were expressed using the baculovirus system and purified using FLAG-affinity chromatography. Age-matched mdx mice received six twice-weekly intraperitoneal injections of either recombinant protein or PBS. Three days after the final injection, mice were analyzed for several phenotypic parameters of dystrophin deficiency. Injected TAT-μUtr transduced all tissues examined, integrated with members of the dystrophin complex, reduced serum levels of creatine kinase (11,290±920 U versus 5,950±1,120 U; PBS versus TAT), the prevalence of muscle degeneration/regeneration (54%±5% versus 37%±4% of centrally nucleated fibers; PBS versus TAT), the susceptibility to eccentric contraction-induced force drop (72%±5% versus 40%±8% drop; PBS versus TAT), and increased specific force production (9.7±1.1 N/cm2 versus 12.8±0.9 N/cm2; PBS versus TAT). Conclusions These results are, to our knowledge, the first to establish the efficacy and feasibility of TAT-utrophin-based constructs as a novel direct protein-replacement therapy for the treatment of skeletal and cardiac muscle diseases caused by loss of dystrophin.
Human eosinophil–airway smooth muscle cell interactions
J. Margaret Hughes,Craig A. Arthur,Shane Baracho,Stephen M. Carlin,Kristen M. Hawker,Peter R.A. Johnson,Carol L. Armour
Mediators of Inflammation , 2000, DOI: 10.1080/096293500411550
Abstract: Eosinophils are present throughout the airway wall of asthmatics. The nature of the interaction between human airway smooth muscle cells (ASMC) and eosinophils was investigated in this study. We demonstrated, using light microscopy, that freshly isolated eosinophils from healthy donors rapidly attach to ASMC in vitro. Numbers of attached eosinophils were highest at 2 h, falling to 50% of maximum by 20 h. Eosinophil attachment at 2 h was reduced to 72% of control by anti-VCAM-1, and to 74% at 20 h by anti-ICAM-1. Pre-treatment of ASMC for 24 h with TNF-α, 10 nM, significantly increased eosinophil adhesion to 149 and 157% of control after 2 and 20 h. These results provide evidence that eosinophil interactions with ASMC involve VCAM-1 and ICAM-1 and are modulated by TNF-α.
Osteopontin Is Required for the Early Onset of High Fat Diet-Induced Insulin Resistance in Mice
Justin Chapman,Philip D. Miles,Jachelle M. Ofrecio,Jaap G. Neels,Joseph G. Yu,Jamie L. Resnik,Jason Wilkes,Saswata Talukdar,Divya Thapar,Kristen Johnson,Dorothy D. Sears
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0013959
Abstract: Insulin resistance is manifested in muscle, adipose tissue, and liver and is associated with adipose tissue inflammation. The cellular components and mechanisms that regulate the onset of diet-induced insulin resistance are not clearly defined.
Low pH immobilizes and kills human leukocytes and prevents transmission of cell-associated HIV in a mouse model
Stuart S Olmsted, Kristen V Khanna, Erina M Ng, Steven T Whitten, Owen N Johnson, Richard B Markham, Richard A Cone, Thomas R Moench
BMC Infectious Diseases , 2005, DOI: 10.1186/1471-2334-5-79
Abstract: Human lymphocyte, monocyte, and macrophage motilities were measured as a function of time and pH using various acidifying agents. Lymphocyte and macrophage motilities were measured using video microscopy. Monocyte motility was measured using video microscopy and chemotactic chambers. Peripheral blood mononuclear cell (PBMC) viability and intracellular pH were determined as a function of time and pH using fluorescent dyes. HuPBL-SCID mice were pretreated with BufferGel, saline, or a control gel and challenged with HIV-1-infected human PBMCs.Progressive motility was completely abolished in all cell types between pH 5.5 and 6.0. Concomitantly, at and below pH 5.5, the intracellular pH of PBMCs dropped precipitously to match the extracellular medium and did not recover. After acidification with hydrochloric acid to pH 4.5 for 60 min, although completely immotile, 58% of PBMCs excluded ethidium homodimer-1 (dead-cell dye). In contrast, when acidified to this pH with BufferGel, a microbicide designed to maintain vaginal acidity in the presence of semen, only 4% excluded dye at 10 min and none excluded dye after 30 min. BufferGel significantly reduced transmission of HIV-1 in HuPBL-SCID mice (1 of 12 infected) compared to saline (12 of 12 infected) and a control gel (5 of 7 infected).These results suggest that physiologic or microbicide-induced acid immobilization and killing of infected white blood cells may be effective in preventing sexual transmission of cell-associated HIV.Most HIV transmission occurs sexually [1,2], and semen [3-6] and cervicovaginal secretions [7] contain free HIV virions as well as HIV-infected leukocytes. Whether cell-free virus or infected cells are the primary means of transmission, or whether both are important remains unknown.Free virus transmits infection in monkey [8], chimpanzee [9], and cat [10] vaginal-challenge models, although the amount of virus used [8] has generally been greater than the amount of infectious virus found in semen of H
Evaluation of extended and continuous use oral contraceptives
Kristen Page Wright,Julia V Johnson
Therapeutics and Clinical Risk Management , 2008,
Abstract: Kristen Page Wright, Julia V JohnsonUniversity of Vermont College of Medicine and Reproductive Endocrinology and Infertility, Women’s Health Care Services, Fletcher Allen Health Care, Burlington, VT USAAbstract: Oral contraceptives are classically given in a cyclic manner with 21 days of active pills followed by 7 days of placebo. In the past 4 years, new oral contraceptives have been introduced which either shorten the placebo time, lengthen the active pills (extended cycle), or provide active pills every day (continuous). These concepts are not new; extended and continuous pills were first studied in the 1960s and 1970s and have been provided in an off-label manner by gynecologists to treat menstrual disorders, such as menorrhagia and dysmenorrhea, and gynecologic disorders, such as endometriosis. Now that extended and continuous combined oral contraceptives are available for all patients, it is critical for providers to understand the physiology, dosing, side effects, and benefits of this form of oral contraceptive. This article reviews the history and the potential uses of the new continuous combined oral contraceptive.Keywords: oral contraceptives, administration, dosage, adverse effects, menstrual disturbances
The Current Status of Exenatide Once Weekly
Kristen M. Kulasa
Clinical Medicine Insights: Therapeutics , 2012, DOI: 10.4137/CMT.S3083
Abstract: Type 2 diabetes mellitus (T2DM) is a chronic, progressive metabolic disorder that is associated with long-term microvascular (retinopathy, neuropathy and nephropathy) and macrovascular (myocardial infarction, stroke, peripheral arterial disease) complications. Both the prevalence of T2DM and the cost of its long-term complications have driven the focus and emphasis on treatments aimed at reducing hyperglycemia and controlling hypertension and dyslipidemia while minimizing hypoglycemia and weight gain. Exenatide twice daily, the first GLP-1R agonist approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMEA), has been shown to reduce hemoglobin A1C, lower fasting and postprandial plasma blood glucose concentrations as well as reduce body weight without causing significant hypoglycemia. However, its current formulation requires twice daily subcutaneous injections and does not provide continuous GLP-1R activation. Therefore, a long-acting release form of exenatide has been developed for use as a once-weekly injection, providing for convenient administration and continuous GLP-1R activation. This review covers the currently published data on this new formulation including mechanism of action, pharmacokinetics, efficacy and comparison trials to other commonly used anti-diabetic agents.
Sulfamethoxazole-Trimethoprim-Induced Rhabdomyolysis in an Immunocompetent Patient: A Case Report  [PDF]
Pamela M. Moye, Sara Manasen, Kristen O’Brien
Case Reports in Clinical Medicine (CRCM) , 2017, DOI: 10.4236/crcm.2017.612037
Abstract: Sulfamethoxazole-trimethoprim (TMP-SMX)-induced rhabdomyolysis is a rare complication of a commonly used antibiotic. This is a case report of a 43-year old immunocompetent African American woman with a history of depression and chronic alcohol consumption who presented to the emergency department (ED) with worsening bilateral leg pain. Before presentation, the patient was prescribed a twice daily dose of TMP-SMX for a urinary tract infection. The patient reported the development of intensifying leg pain after taking five doses of TMP-SMX. On presentation to the ED she was hemodynamically stable, afebrile, and leg pain intensity 10 out of 10. The patient admitted to daily alcohol consumption and taking vortioxetine 10 mg per day for treatment of depression. Initial labs drawn in the ED showed an elevated creatine kinase (CK) of 26,231 U/L and a normal serum creatinine (SCr) of 1 mg/dL. Through patient history and laboratory tests, common causes of rhabdomyolysis were ruled out. Treatment was initiated with IV fluids plus thiamine and folic acid supplementation, TMP-SMX was discontinued, and vortioxetine 10 mg per day was continued until hospital day five. The patient began to show improvement in lower extremity pain and tenderness and was discharged on hospital day eight with minimal residual leg pain and a CK of 2809 U/L. This case report presents only the third incidence of an immunocompetent patient developing TMP-SMX-induced rhabdomyolysis. This case highlights an opportunity for a pharmacist’s intervention and the need for future research to determine risk factors of TMP-SMX-induced rhabdomyolysis in immunocompetent patients.
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