3336 E Chandler Heights Rd Bldg. 1, Ste 107
Gilbert AZ 85298
Medical School: Other - Unknown
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License #: D008998
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Active Tracing and Monitoring of Contacts Associated With the First Cluster of Ebola in the United States. - Annals of internal medicine
Following hospitalization of the first patient with Ebola diagnosed in the United States on 28 September 2014, contact tracing methods for Ebola were implemented.To identify, risk-stratify, and monitor contacts of patients with Ebola.Descriptive investigation.Dallas County, Texas, September to November 2014.Contacts of symptomatic patients with Ebola.Contact identification, exposure risk classification, symptom development, and Ebola.The investigation identified 179 contacts, 139 of whom were contacts of the index patient. Of 112 health care personnel (HCP) contacts of the index case, 22 (20%) had known unprotected exposures and 37 (30%) did not have known unprotected exposures but interacted with a patient or contaminated environment on multiple days. Transmission was confirmed in 2 HCP who had substantial interaction with the patient while wearing personal protective equipment. These HCP had 40 additional contacts. Of 20 community contacts of the index patient or the 2 HCP, 4 had high risk exposures. Movement restrictions were extended to all 179 contacts; 7 contacts were quarantined. Seven percent (14 of 179) of contacts (1 community contact and 13 health care contacts) were evaluated for Ebola during the monitoring period.Data cannot be used to infer whether in-person direct active monitoring is superior to active monitoring alone for early detection of symptomatic contacts.Contact tracing and monitoring approaches for Ebola were adapted to account for the evolving understanding of risks for unrecognized HCP transmission. HCP contacts in the United States without known unprotected exposures should be considered as having a low (but not zero) risk for Ebola and should be actively monitored for development of symptoms. Core challenges of contact tracing for high-consequence communicable diseases included rapid comprehensive contact identification, large-scale direct active monitoring of contacts, large-scale application of movement restrictions, and necessity of humanitarian support services to meet nonclinical needs of contacts.None.
Addressing needs of contacts of Ebola patients during an investigation of an Ebola cluster in the United States - Dallas, Texas, 2014. - MMWR. Morbidity and mortality weekly report
The first imported case of Ebola virus disease (Ebola) diagnosed in the United States was confirmed on September 30, 2014; two health care workers who cared for this patient subsequently developed Ebola. Since then, local, state, and federal health officials have continued to prepare for future imported cases, including developing strategies to identify and monitor persons who have had contact with an Ebola patient. This report describes some of the needs of persons who were contacts of Ebola patients in Texas. It is based on requests received from contacts in the course of daily contact tracing interactions and on how those needs were met through community partnerships. Meeting the needs of contacts of the Ebola patients was essential to successful contact tracing, which is critical to interrupting transmission. Although a formal needs assessment of contacts was not conducted, this report provides important information for preparing for an importation of Ebola. Anticipating the nonclinical needs of persons under public health surveillance includes addressing potential concerns about housing, transportation, education, employment, food, and other household needs. Ensuring necessary supports are in place for persons who are asked to refrain from entering public venues can impact their willingness to comply with voluntary and mandated quarantine orders. Engagement with a wide range of community partners, including businesses, schools, charitable foundations, community and faith-based organizations, and mental health resources would enhance public health emergency preparedness for Ebola by readying resources to meet these potential needs.
Prevalence of chronic ankle instability and associated symptoms in university dance majors: an exploratory study. - Journal of dance medicine & science : official publication of the International Association for Dance Medicine & Science
Previous investigations have established that dancers suffer a large number of injuries to the lower leg, foot, and ankle, with a portion of these being significant time loss injuries or in some cases career ending. Lateral ankle sprain is a common injury in dancers and can often lead to recurrent instability and repetitive injuries. Research in other active populations has linked ankle sprains to the development of chronic ankle instability (CAI). Therefore, the purpose of this study was to identify the prevalence of CAI and related symptoms of ankle sprain in a student dance population. Individuals were included if they were currently a modern or ballet dance major at the investigators' university (exclusion criterion: a history of fracture or surgery in the lower extremities). A self-reported demographic questionnaire and the Identification of Functional Ankle Instability survey were used to identify the presence and characteristics of CAI. A total of 83 questionnaires were collected, and after exclusions, 77 participants remained: 43 modern dancers and 34 ballet dancers (10 males and 67 females, mean age 19.61 Â± 2.53 years, mean dance experience 13.61 Â± 3.16 years). Of all dancers surveyed, 41 (53.2%) had CAI, and of those 24 (58.5%) were modern dancers, and 17 (41.5%) were ballet dancers. When looking only at those dancers who had a previous lateral ankle sprain, 75.9% were identified as having CAI. Chronic Ankle Instability can create long-term problems for anyone but especially female dancers, who place extreme stress on their feet and ankles from being en pointe or demi-pointe. It is important to educate dancers, instructors, and medical staff of the importance of recognizing CAI and seeking medical care for ankle sprains and their residual symptoms.
Ebola virus disease cluster in the United States--Dallas County, Texas, 2014. - MMWR. Morbidity and mortality weekly report
Since March 10, 2014, Guinea, Liberia, and Sierra Leone have experienced the largest known Ebola virus disease (Ebola) epidemic with approximately 13,000 persons infected as of October 28, 2014. Before September 25, 2014, only four patients with Ebola had been treated in the United States; all of these patients had been diagnosed in West Africa and medically evacuated to the United States for care.
Loss of BRMS1 promotes a mesenchymal phenotype through NF-ÎºB-dependent regulation of Twist1. - Molecular and cellular biology
Breast cancer metastasis suppressor 1 (BRMS1) is downregulated in non-small cell lung cancer (NSCLC), and its reduction correlates with disease progression. Herein, we investigate the mechanisms through which loss of the BRMS1 gene contributes to epithelial-to-mesenchymal transition (EMT). Using a short hairpin RNA (shRNA) system, we show that loss of BRMS1 promotes basal and transforming growth factor beta-induced EMT in NSCLC cells. NSCLC cells expressing BRMS1 shRNAs (BRMS1 knockdown [BRMS1(KD)]) display mesenchymal characteristics, including enhanced cell migration and differential regulation of the EMT markers. Mesenchymal phenotypes observed in BRMS1(KD) cells are dependent on RelA/p65, the transcriptionally active subunit of nuclear factor kappa B (NF-ÎºB). In addition, chromatin immunoprecipitation analysis demonstrates that loss of BRMS1 increases Twist1 promoter occupancy of RelA/p65 K310-a key histone modification associated with increased transcription. Knockdown of Twist1 results in reversal of BRMS1(KD)-mediated EMT phenotypic changes. Moreover, in our animal model, BRMS1(KD)/Twist1(KD) double knockdown cells were less efficient in establishing lung tumors than BRMS1(KD) cells. Collectively, this study demonstrates that loss of BRMS1 promotes malignant phenotypes that are dependent on NF-ÎºB-dependent regulation of Twist1. These observations offer fresh insight into the mechanisms through which BRMS1 regulates the development of metastases in NSCLC.Copyright Â© 2015, American Society for Microbiology. All Rights Reserved.
Strength-training protocols to improve deficits in participants with chronic ankle instability: a randomized controlled trial. - Journal of athletic training
Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability (CAI), strength-training rehabilitation protocols may improve the deficits often associated with CAI.To determine whether strength-training protocols affect strength, dynamic balance, functional performance, and perceived instability in individuals with CAI.Randomized controlled trial.Athletic training research laboratory.A total of 39 individuals with CAI (17 men [44%], 22 women [56%]) participated in this study. Chronic ankle instability was determined by the Identification of Functional Ankle Instability Questionnaire, and participants were randomly assigned to a resistance-band-protocol group (n = 13 [33%] age = 19.7 Â± 2.2 years, height = 172.9 Â± 12.8 cm, weight = 69.1 Â± 13.5 kg), a proprioceptive neuromuscular facilitation strength-protocol group (n = 13 [33%], age = 18.9 Â± 1.3 years, height = 172.5 Â± 5.9 cm, weight = 72.7 Â± 14.6 kg), or a control group (n = 13 [33%], age = 20.5 Â± 2.1 years, height = 175.2 Â± 8.1 cm, weight = 70.2 Â± 11.1 kg).Both rehabilitation groups completed their protocols 3 times/wk for 6 weeks. The control group did not attend rehabilitation sessions.Before the interventions, participants were pretested by completing the figure-8 hop test for time, the triple-crossover hop test for distance, isometric strength tests (dorsiflexion, plantar flexion, inversion, and eversion), the Y-Balance test, and the visual analog scale for perceived ankle instability. Participants were again tested 6 weeks later. We conducted 2 separate, multivariate, repeated-measures analyses of variance, followed by univariate analyses on any significant findings.The resistance-band protocol group improved in strength (dorsiflexion, inversion, and eversion) and on the visual analog scale (P < .05); the proprioceptive neuromuscular facilitation group improved in strength (inversion and eversion) and on the visual analog scale (P < .05) as well. No improvements were seen in the triple-crossover hop or the Y-Balance tests for either intervention group or in the control group for any dependent variable (P > .05).Although the resistance-band protocol is common in rehabilitation, the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI. Both protocols showed clinical benefits in strength and perceived instability. To improve functional outcomes, clinicians should consider using additional multiplanar and multijoint exercises.
Inhibition of breast cancer metastasis suppressor 1 promotes a mesenchymal phenotype in lung epithelial cells that express oncogenic K-RasV12 and loss of p53. - PloS one
Expression of the breast cancer metastasis suppressor 1 (BRMS1) protein is dramatically reduced in non-small cell lung cancer (NSCLC) cells and in primary human tumors. Although BRMS1 is a known suppressor of metastasis, the mechanisms through which BRMS1 functions to regulate cell migration and invasion in response to specific NSCLC driver mutations are poorly understood. To experimentally address this, we utilized immortalized human bronchial epithelial cells in which p53 was knocked down in the presence of oncogenic K-RasV12 (HBEC3-p53KD-K-RasV12). These genetic alterations are commonly found in NSCLC and are associated with a poor prognosis. To determine the importance of BRMS1 for cytoskeletal function, cell migration and invasion in our model system we stably knocked down BRMS1. Here, we report that loss of BRMS1 in HBEC3-p53KD-K-RasV12 cells results in a dramatic increase in cell migration and invasion compared to controls that expressed BRMS1. Moreover, the loss of BRMS1 resulted in additional morphological changes including F-actin re-distribution, paxillin accumulation at the leading edge of the lamellapodium, and cellular shape changes resembling mesenchymal phenotypes. Importantly, re-expression of BRMS1 restores, in part, cell migration and invasion; however it does not fully reestablish the epithelial phenotype. These finding suggests that loss of BRMS1 results in a permanent, largely irreversible, mesenchymal phenotype associated with increased cell migration and invasion. Collectively, in NSCLC cells without p53 and expression of oncogenic K-Ras our study identifies BRMS1 as a key regulator required to maintain a cellular morphology and cytoskeletal architecture consistent with an epithelial phenotype.
A new type of DNA "light-switch": a dual photochemical sensor and metalating agent for duplex and G-quadruplex DNA. - Chemical communications (Cambridge, England)
Ru(bpy)2dppz, a well studied "light-switch" metal complex, transforms into a photochemical "light-switch" and DNA damaging agent by incorporating structural strain. This distorted compound is photoreactive and ejects a ligand upon binding duplex and G-quadruplex DNA, producing a reactive metal center that metalates the DNA.
Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study. - BMC pregnancy and childbirth
Women who are diagnosed with gestational diabetes mellitus (GDM) are at increased risk for developing prediabetes and type 2 diabetes mellitus (T2DM). To date, there have been few interdisciplinary interventions that target predominantly ethnic minority low-income women diagnosed with GDM. This paper describes the rationale, design and methodology of a 2-year, randomized, controlled study being conducted in North Carolina.Using a two-group, repeated measures, experimental design, we will test a 14- week intensive intervention on the benefits of breastfeeding, understanding gestational diabetes and risk of progression to prediabetes and T2DM, nutrition and exercise education, coping skills training, physical activity (Phase I), educational and motivational text messaging and 3Â months of continued monthly contact (Phase II). A total of 100 African American, non-Hispanic white, and bilingual Hispanic women between 22-36Â weeks of pregnancy who are diagnosed with GDM and their infants will be randomized to either the experimental group or the wait-listed control group. The first aim of the study is to determine the feasibility of the intervention. The second aim of study is to test the effects of the intervention on maternal outcomes from baseline (22-36Â weeks pregnant) to 10Â months postpartum. Primary maternal outcomes will include fasting blood glucose and weight (BMI) from baseline to 10Â months postpartum. Secondary maternal outcomes will include clinical, adiposity, health behaviors and self-efficacy outcomes from baseline to 10Â months postpartum. The third aim of the study is to quantify the effects of the intervention on infant feeding and growth. Infant outcomes will include weight status and breastfeeding from birth through 10Â months of age. Data analysis will include general linear mixed-effects models. Safety endpoints include adverse event reporting.Findings from this trial may lead to an effective intervention to assist women diagnosed with GDM to improve maternal glucose homeostasis and weight as well as stabilize infant growth trajectory, reducing the burden of metabolic disease across two generations.NCT01809431.
How do medical students navigate the interplay of explicit curricula, implicit curricula, and extracurricula to learn curricular objectives? - Academic medicine : journal of the Association of American Medical Colleges
Current focus in medical education on competencies and curricular objectives draws attention to boundaries rather than the openness inherent in the learning process. This qualitative study explored the tension between boundedness (mandated curricular objectives) and openness (variability in learning experience as students traverse the explicit, implicit, and extracurriculum) in the curriculum.Following the revision and implementation of 10 curricular objectives for Columbia University College of Physicians and Surgeons, the authors interviewed 18 fourth-year medical students in spring 2011. For each objective, students indicated the relative influence of the explicit curriculum, implicit curriculum, and extracurriculum on their learning. Students were asked to think aloud and assign points as they made these judgments. Quantitative and qualitative data were analyzed to understand students' perceptions of learning across curricula and for each curricular objective.There was marked variability in students' learning experience. For two objectives, students perceived that learning occurred mainly in the explicit curriculum and consumed a disproportionate amount of study time. For two other objectives, students perceived that learning occurred mainly in the extracurriculum because opportunities to learn these objectives in the implicit and explicit curricula were sparse. For six objectives, students perceived that learning occurred mostly in the implicit curriculum, often through "watching" or interacting with peers.The findings can inform discussions about how to balance the boundedness of curricular mandates with the inherent openness of students' learning experiences.
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3336 E Chandler Heights Rd Bldg. 1, Ste 107 Gilbert, AZ 85298
3076 E. Chandler Heights Rd. Suite 107
2181 E Coconino Dr
3336 E Chandler Heights Rd Bldg 2 Suite 111
3336 E Chandler Heights Rd Bldg. A, Suite 101
3076 E Chandler Heights Rd Ste 107 Chandler Heights Village