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Showcase Health Sciences Spokane

De-escalation of antibiotic therapy in acute exacerbation of COPD (AECOPD)

De-escalation of antibiotic therapy in acute exacerbation of COPD (AECOPD)

Primary author: Anne Keef
Faculty sponsor: Dr. Megan Undeberg

Primary college/unit: College of Pharmacy and Pharmaceutical Sciences
Campus: Spokane

Abstract:

COPD patients are at increased risk of pulmonary infections secondary to their underlying pathology of the disease: compromised lung function coupled with increased inflammation and mucus production within the lungs provides for a breeding ground for infection. COPD patients are at increased risk of infection by M. catarrhalis, H. influenzae, and S. pneumoniae. Typically, these pathogens induce upper respiratory tract infections. In the COPD patient, however, the compromised lung function and decline in innate respiratory elevator clearing functions results in an increased risk for bacteria to invade the lower respiratory tract and induce inflammation and infection. Additionally, infection with Pseudomonas is not uncommon in COPD patients with more severe symptoms at baseline and especially those with recurrent infections. Regardless of the pathogenic cause, the resultant increase in inflammation in the lungs places the COPD patient at increased risk for further decompensation and increased morbidity. As a result, when a patient presents with cardinal symptoms of an infection inducing an acute exacerbation of COPD (AECOPD), it is not uncommon for a patient to be started on empiric, broad spectrum antibiotic therapy with Pseudomonas coverage, pending sputum culture results. However, once sputum cultures have resulted, antimicrobial therapy is not always refined to correlate with the pathogen present. Our project proposes looking at AECOPD admissions for the first quarter of 2019, initial antibiotic choice, sputum culture results, and subsequent change or no change to antibiotic therapy. Results from this information will guide antimicrobial stewardship and provider education.

Effect of Total Sleep Deprivation on Word Recognition of Previously Studied Words with Different Emotional Valence

Effect of Total Sleep Deprivation on Word Recognition of Previously Studied Words with Different Emotional Valence

Primary author: Amanda Hudson
Co-author(s): Paul Whitney; John Hinson; Devon Hansen; Hans Van Dongen; Kimberly Honn
Faculty sponsor: Kimberly Honn

Primary college/unit: Arts and Sciences
Campus: Spokane

Abstract:

Stimuli with an emotional valence tend to produce better recognition from memory than neutral stimuli. Sleep loss is believed to increase reactivity to negative stimuli, compared to positive stimuli, which may comparatively enhance subsequent recognition from memory for negative stimuli. We investigated the impact of total sleep deprivation (TSD) on recognition accuracy for words with different emotional valence using the Affective Item Source Memory Task (AISM).

Fourteen adults (ages 21-39; 7 females) completed a 4-day/3-night laboratory study with a baseline sleep opportunity, 39h acute TSD, and recovery sleep. The AISM was administered at 16:30 during baseline and after 34h TSD. During a study phase, participants heard a list, twice, of positive, negative, and neutral words spoken with a male or female voice. During an immediately subsequent recognition phase, participants heard and judged whether words were previously presented (item memory). For words judged to have been presented previously, participants indicated whether those were presented by a female or male speaker (source memory).

We found session (p<0.001) and valence (p<0.001) effects on item memory, but no interaction. At baseline, accuracy was higher for neutral and positive words than negative words. During TSD, accuracy declined for all valences as expected. However, there was no comparatively greater impact on item or source memory for negative words nor any differential effect of TSD for different valences. Whether our results would hold with longer time intervals between task phases or an intervening sleep period remains to be determined. This research was supported by Jazz Pharmaceuticals.

Treatment for Injuries Among Washington State Adults: Differences by Rurality

Treatment for Injuries among Washington State Adults: Differences by Rurality

Primary author: Janessa Graves
Co-author(s): Demetrius Abshire

Primary college/unit: College of Nursing
Campus: Spokane

Abstract:

Statement of Purpose: Rural residents face significant barriers in accessing trauma care, with access becoming more challenging in highly rural areas. We examined differences in injury-related medical care among Washington State residents across the rural-urban continuum.

Methods/Approach: Stratified random sampling was used to select 2575 adults from small rural, large rural, suburban, and urban areas who were invited to complete a survey on factors affecting health. Data were obtained from 616 adults (278 from small rural, 100 from large rural, 98 from suburban, and 140 from urban areas). Respondents reported past-year injury experience and barriers to access for medical care. We examined variation in access by rurality using chi-squared and modified Poisson regression models.

Results: Fewer than half (45.1%) of respondents reported any activity-restricting injury in the last year and 32.4% reported seeking care. Injuries were often treated by a primary care provider (59.7%) or walk-in clinic (21.9%) with no significant difference in care location by rurality. Overall, 20.2% of small rural residents sought medical care >30 minutes away, compared to 3.9% of urban, 8.0% of suburban, and 12.1% of large rural residents (p30 minutes away from home (adjusted IRR, p<0.01).

Conclusions: Washington residents face differential access to medical care for injuries across levels of rurality, with small rural residents reporting the most substantial access-related concerns. Health systems and policies must address inequities in access to care for residents along the rural-urban gradient.

Trait Inter-Individual Differences in Deep Sleep

Trait Inter-Individual Differences in Deep Sleep

Primary author: Julie Erwin

Primary college/unit: Elson S. Floyd College of Medicine
Campus: Spokane

Abstract:

Inter-individual differences in the amount of deep sleep, stage N3, in nighttime sleep have been found to be large and trait-like, even during recovery sleep after sleep deprivation. We investigated whether this phenomenon extends to daytime sleep, and whether it is robust to prior caffeine intake.

In an 18-day in-laboratory study, 12 healthy adults underwent three 48-hour periods of total sleep deprivation. In randomized, counterbalanced, double-blind fashion, participants received either placebo, 200 mg caffeine, or 300 mg caffeine every 12 hours during sleep deprivation. Each sleep deprivation period was preceded by three baseline sleep periods (21:00-07:00) and followed by a daytime recovery nap (07:00-12:00). Sleep periods were recorded polysomnographically. Analyses focused on the baseline night immediately preceding and the daytime recovery nap immediately following each sleep deprivation period.

Daytime recovery naps had 44.6±5.1 minutes (mean±SE) more stage N3 sleep than baseline sleep periods (p<0.001). Daytime naps preceded by 200 or 300 mg caffeine intake every 12 hours during sleep deprivation had 15.4±6.2 and 21.6±6.2 minutes less stage N3 sleep, respectively, than daytime naps in the placebo condition (p=0.003). Across the baseline nights and daytime naps, regardless of caffeine condition, there were large inter-individual differences in stage N3 sleep, with a standard deviation over individuals of 23.2 minutes and considerable stability (intraclass correlation coefficient: 0.70). Thus, the amount of deep sleep is a trait characteristic that is robust to sleep deprivation, time of day, and caffeine.

A wake-like state in vitro induced by transmembrane TNF/soluble TNF receptor reverse signaling

A wake-like state in vitro induced by transmembrane TNF/soluble TNF receptor reverse signaling

Primary author: Cheryl Dykstra-Aiello

Primary college/unit: College of Veterinary Medicine
Campus: Spokane

Abstract:

Tumor necrosis factor (TNF) plays a role in regulating sleep. Neuronal activity enhances TNF expression. Co-cultured neuron/glia cells exhibit deeper sleep-like states after TNF administration. Both TNF and TNF receptors (R) are produced as transmembrane ™ proteins that, when cleaved, produce soluble (s) forms. Unlike conventional cell signaling induced by soluble (s) ligands binding to tm receptors, with immunocytes, sTNFR can bind tmTNF and reverse signal within the cell expressing tmTNF. Having previously shown sTNFR sleep inhibition in animals, we hypothesized that tmTNF-sTNFR binding would induce wake-like states in cells through reverse signaling.
Somatosensory cortical neurons/glia from wildtype (WT) mice and mice lacking either TNF (TNF-KO) or both TNFRs (TNFR-KO), were co-cultured and incubated on multi-electrode arrays. Daily one-hour electrophysiological recordings were taken on days 4 – 13 for development analyses. On day 14, a one-hour baseline was recorded prior to sTNFR treatment. Immediately post-treatment, recordings resumed for another hour. Synchronization of electrical activity (SYN), action potentials, slow wave power (SWP), and burstiness index (whole animal sleep defining measures) were used to characterize the emergence of these electrophysiological properties and sTNFR-induced changes.
Relative to WT, development rates were increased in both TNF-KO and TNFR-KO cells. Additionally, a sTNFR dose-dependent wake-like state was suggested by decreased SYN and SWP in TNFR-KO cells, but not in TNF-KO cells.
To our knowledge, this is the first demonstration of reverse TNF signaling in sleep/wake states. This provides a new way of viewing state regulation and associated potential clinical applications.

Planting the Seeds of Health and Resilience

Planting the Seeds of Health and Resilience

Primary author: Shawna Beese
Co-author(s): Teresa Bigand; Marian Wilson
Faculty sponsor: Marian Wilson

Primary college/unit: College of Nursing
Campus: Spokane

Abstract:
PRINCIPAL TOPIC
Food bank recipients suffer a greater risk than adults who do not use food banks for insufficient access to fresh fruits and vegetables and negative health factors such as depression, obesity, and food insecurity. Creating access to gardens for this population may offer a low-cost public health approach to increase access to fresh produce and reduce risk for food insecurity. Additionally, access to gardens may offer secondary health benefits including reduced depressive symptoms and improved cardiovascular well-being.

METHOD
Through secondary survey analysis, baseline garden use of food bank recipients was assessed. The interest level of recipients to learn more about gardening, explore how gardening impacts the food security of food bank recipients, and determine potential differences between garden users and non-garden users across multiple health variables (pain interference, depressive symptoms, and sleep quality) were also analyzed.

RESULTS/IMPLICATIONS
In total, 28% (n=49) of participants identified the use of home or community gardens.

More than half of the self-identified garden users (53%, n=26) reported food insecurity; yet garden users had an 18% relative risk reduction for reporting food insecurity compared to non-garden users (p>0.05).

No statistically significant differences resulted across measured health variables between garden users and non-garden users.

Gardening may be a viable public health intervention to ease food insecurity. Future studies with larger sample sizes to investigate the relative risk between garden use and food insecurity are suggested.