Digital Commons Network^™

Delay In Care Due To High Number Of Provider Evaluations In Hip Arthroscopy, Kaylin Knapsack, Wynn Bastianelli, Alexander Cabrera, Stewart Meridian, Sean Mcmillan

Rowan-Virtua Research Day

Background: Diagnosing hip pain in young and middle-aged adults remains challenging due to overlapping intra- and extra-articular pathology. Femoroacetabular impingement syndrome (FAIS) and acetabular labral tears are increasingly recognized as major contributors to pain, mechanical symptoms, and functional limitation. Despite growing awareness of hip preservation surgery, delays in referral to arthroscopy-trained specialists persist and may contribute to disease progression and inferior outcomes.

Purpose: To evaluate delays in surgical management among patients undergoing hip arthroscopy for labral pathology and identify factors contributing to delayed referral to hip preservation specialists.

Methods: A retrospective cohort study was conducted on patients undergoing hip arthroscopy …

The Impact Of Diet Modification And Physical Exercise On Chronic Htn Outcomes Compared To Typical Prescription Treatment Regimen, Artem Duda, Aishwarya Muppoor, Ahson Haider, Meshva Patel, Katherine Xie, Faiqa Ali

Rowan-Virtua Research Day

Hypertension remains a leading global cause of cardiovascular morbidity and mortality, affecting over one billion individuals worldwide. While pharmacologic therapy remains the standard of care, growing evidence supports the role of lifestyle modification as an effective strategy for hypertension control. This literature review evaluates the effectiveness of dietary interventions and physical exercise versus standard antihypertensive medication regimens in adults with chronic hypertension. Following PRISMA guidelines, a comprehensive search of PubMed and Embase (2015–2025) identified 5,178 citations, with 12 systematic reviews and meta-analyses meeting inclusion criteria. Across studies, structured exercise and dietary interventions consistently reduced systolic blood pressure by approximately 3–12 …

The Comparative Efficacy Of Perioperative Pharmacological And Non-Pharmacological Strategies In Reducing Post-Anesthesia Cognitive Impairment Among Elderly Patients: A Literature Review, Mehnaz Islam Khan, Natalie Santos De La Torre, Christine Cherian, Shreya Shah

Rowan-Virtua Research Day

Older adults (≥65 years) are at increased risk for postoperative cognitive impairment, including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), which contribute to prolonged recovery, increased morbidity, and mortality. Preventive strategies include pharmacological interventions and non-pharmacological approaches such as cognitive training; however, these approaches are typically studied in isolation. The purpose of this literature review was to compare the effectiveness of perioperative pharmacological and non-pharmacological interventions in reducing postoperative cognitive impairment in elderly surgical patients. A review of six studies, including randomized controlled trials and cohort studies, was conducted in patients undergoing cardiac, spinal, and noncardiac surgeries. Cognitive outcomes, …

A Comprehensive Review Of Photothermal Therapy: Tumor Responses, Safety, And Clinical Translation, Taniya Sood

Rowan-Virtua Research Day

Background: Cancer affects 1 in 2 men and 1 in 3 women in the United States. Traditional treatments such as chemotherapy, radiation, and surgery often lack selectivity, resulting in significant systemic side effects. Photothermal therapy (PTT) is an emerging modality that utilizes light-activated nanoparticles to generate localized heat, selectively destroying cancer cells while minimizing damage to surrounding healthy tissue.

Methods: A comprehensive literature review was conducted utilizing PubMed, Embase, and Web of Science (2009–2024). Inclusion criteria included randomized controlled, cohort, and controlled trials involving adults (18+) with a confirmed cancer diagnosis. Studies were required to evaluate PTT using gold nanomaterials …

Barriers To Accessing Mental Healthcare Among Refugee Populations In Southern New Jersey, Paul Cardillo, Hijab Zaidi, Jacob Trainer, Alison Mancuso Do, Facofp

Rowan-Virtua Research Day

This project examines barriers to accessing mental healthcare among refugee populations in Southern New Jersey, with a focus on individuals with limited English proficiency (LEP). Using a narrative review of peer reviewed studies and government reports, key challenges were identified, including language barriers, cultural stigma, and limited familiarity with the U.S. healthcare system. Findings show that refugee populations experience significantly higher rates of mental health disorders, including PTSD and depression, driven by trauma, structural inequities, and social disadvantage. Effective interventions emphasize culturally competent care, integration of bicultural staff, and community based approaches. Addressing these barriers is essential to improving equitable …

Cultural Influences In Psychiatry, Kavita Bhavsar, Mayuri Patel

Rowan-Virtua Research Day

The patient is a 26-year-old female presenting with unspecified hallucinations, delusional thinking, concerns for catatonia and potential sex-trafficking. This case study highlights the importance of approaching each patient through their unique cultural lens while examining and minimizing our own biases while navigating each patient holistically and individually.

Assessing The Utilization Of Emergency Departments For Primary Care Services In Southern New Jersey, Joshua James Novello, Sheila Joazile, Mohammad Isa

Rowan-Virtua Research Day

Background: Primary care (PC) is essential to proactive, comprehensive, and preventative care that can improve patient outcomes. One-third of emergency department (ED) visits are for non-emergency care that can be appropriately treated by a PC provider. In New Jersey, more than $400 million is spent annually on avoidable ED visits. Decreasing the total PC treatable ED visits per year will improve the quality of care and decrease costs. New Jersey’s PC spending, based on total health spending, is one of the lowest in the country. Demographic and socioeconomic factors in the Social Vulnerability Index (SVI) examine potentially preventable ED …

A Quasi-Experimental Study To Examine The Food Bucks Rx Program For Food Insecure Patients With Chronic Conditions In A Hospital Outpatient Setting, Nicole A. Vaughn, Robert E. Post, Charlampos Papachristou, Maikel Mansour, April Schetler, Gwen Ockenlaender, Julia Koprak, Elise Mitchell, Benjamin Topiel, Melanie Ernest, Nadine Nugent, Carmen Byker Shanks

Rowan-Virtua Research Day

Objective: Primary purpose of this study was to determine the potential impact of FBRx versus standard of care (SoC) on dietary intake and health outcomes. Design: Quasi-experimental 2-group design, with pre- and post- data using the EHR to capture biometrics, food insecurity, and dietary behavior from participants over the intervention. Setting: Hospital-based food pantry program connected community resources Participants: 587 enrolled participants, 304 in intervention group and 283 in SoC group. Inclusion criteria: screened positive for food insecurity and at least 1 documented chronic condition.  Intervention: FBRx participants received $30 per month in produce vouchers for …

De-Epithelialization Versus Pedicle De-Skinning In Reduction Mammoplasty: Comparative Outcomes From The Literature, Samantha Fry, Karina Vizzoni

Rowan-Virtua Research Day

Background- Reduction mammoplasty treats symptomatic macromastia. A key step involves pedicle preparation before breast mound reconstruction. Two main techniques include: De-epithelialization: Removes epidermis, preserves dermis, De-skinning: Excises both epidermal and dermal layers. Evidence comparing surgical outcomes between these techniques is limited.

Hypothesis- De-epithelialization will result in fewer vascular complications but longer operative times than de-skinning; thus, superiority depends on case selection.

Methods- A literature review identified studies on skin removal techniques in breast reduction mammoplasty.

Results- De-skinning was faster than de-epithelialization, though energy-assisted modalities were fastest. Nipple–areola complex (NAC) ischemia and necrosis rates were low across all methods. Superficial de-epithelialization …

Adolescent Opioid Use And Prefrontal Cortex Development - A Systematic Review, Jonathan Perumpail, Liam Kerrick, Shreya Kadi

Rowan-Virtua Research Day

Adolescence represents a critical period of neurodevelopment characterized by ongoing maturation of the prefrontal cortex (PFC), a brain region essential for executive function, impulse control, and behavioral regulation. Exposure to opioids during this vulnerable window may disrupt neural development and lead to long-term consequences. This review synthesizes current preclinical and human evidence examining the effects of adolescent opioid exposure on PFC development. Across rodent models, opioid exposure is associated with impaired synaptogenesis, altered dopaminergic signaling, and dysregulation of the prefrontal-mesolimbic circuits involved in decision making. Human studies showed reduced functional connectivity and white matter changes in those with opioid use …

Challenges Of Weight Management In A Transgender Woman Veteran, Emily Sarett, Wilmington Va Medical Center

Rowan-Virtua Research Day

Case Report

Title: Challenges of Weight Management in a Transgender Woman Veteran

Authors/Institutions: Emily Sarett, OMS-II1; Heather Dixon, PharmD2

Abstract:

Introduction: Obesity is a growing concern among transgender individuals, influenced by hormone therapy and social determinants of health. Bariatric surgery is effective, but weight regain is common and understudied in this population. Case: A transgender woman with prior sleeve gastrectomy presented with weight regain despite multiple pharmacologic trials. Her Gender-affirming hormone therapy included estrogen and androgen suppression. Results: Following the initiation of tirzepatide, the patient achieved clinically meaningful weight loss (8.4% total body weight reduction) with normalization of hemoglobin A1c …

Feasibility Of 90-Day Follow Up For Patients With Intracerebral Hemorrhage: Early Data From A Neuro Icu Sleep Quality And Delirium Study, Sierra Triolo, Bethany C. Young, Mikel Shea Ehntholt, Anuoluwapo Fadare, Jamie R. Feinour, Jennifer A. Jond, Jonathan Perumpail, Kevin Eaise, Lily Roessler, Shay Lynn Greco, Vanessa Salasky

Rowan-Virtua Research Day

Background. Neuro intensive care unit (ICU) patients often experience sleep deprivation due to serial neurologic assessments, among other factors. Subjective sleep disturbance has been associated with increased delirium risk in patients with intracerebral hemorrhage (ICH).¹ However, relationships between specific sleep features, delirium and subsequent outcomes in neurocritically ill patients have not been studied.¹ Additionally, ICH-related clinical research has not historically been conducted at Virtua Our Lady of Lourdes (VOLOL) Hospital. This study aimed to assess feasibility of obtaining quantitative sleep data, delirium assessments, and 90-day functional outcomes in neurocritical care patients with ICH.

Hypothesis. We hypothesized that 90-day …

Hormonal Contraceptives And Menstrual Symptom Severity Among Women With Elevated Cardiovascular Disease Risk: Global And Daily Assessment, Maria Cox, Danielle Arigo, Gabrielle M. Salvatore

Rowan-Virtua Research Day

Hormonal contraceptive (HC) use is primarily for pregnancy prevention and may reduce menstrual symptoms in some individuals, though evidence is inconsistent. The aim of the study was to examine differences in symptom presence and severity among 64 menstruating women with ≥1 CVD risk factor (e.g., hypertension), including HC users (20.63%) and non-users (79.37%; sample M_age= 31.88 ± 9.89, M_bmi= 31.79 ± 7.6). Participants completed the global Premenstrual Screening Tool at baseline and then reported the presence and severity of 16 menstrual symptoms (1=Not Present to 4 = Severe) in end-of-day surveys over 45 days. In a …

Coal Ash-Derived Aluminosilicate Precursors: A Chemical Engineering Approach To Geopolymer Characterization, Hafiz Abdul Basit, Abdullah Bashir, Abdur Raafey

World of Coal Ash Proceedings

The chemical and microstructural evaluation of coal-derived aluminosilicate precursors is critical for understanding their suitability in advanced construction material systems. In this study, a characterization of Class F fly ash, ground granulated blast furnace slag (GGBFS), and Silica Fumes (SF) was conducted to elucidate their morphological and elemental features. Scanning Electron Microscopy (SEM) was used to assess particle morphology and surface characteristics (porosity, particle diameter, particle geometry), and Energy-Dispersive X-ray Spectroscopy (EDS) to determine elemental composition and distribution. The analysis revealed distinct morphological and compositional differences among the precursors, including spherical fly ash particles, calcium-rich slag phases, and ultra-fine silica …

State Permitting Program Update, Jessica Reiss

World of Coal Ash Proceedings

State Permitting Program Update Jessica L. Reiss, Barnes & Thornburg LLP, 11 South Meridian Street, Indianapolis, IN 46204 KEYWORDS: states, permitting, permit program, rulemaking ABSTRACT At the end of 2016, the United States Congress authorized states to establish permit programs for coal combustion residuals (CCR) surface impoundments and landfills.[1] Since then, several states have established such programs, and the United States Environmental Protection Agency (U.S. EPA) has approved programs for Oklahoma,[2] Georgia,[3] Texas,[4] and North Dakota,[5] proposed approval for Wyoming,[6] and denied approval for Alabama.[7] Other states, such as Indiana,[8] are actively working through the state rulemaking process and plan …

Zero-Waste And High-Value Valorization Of Coal Combustion Residues Via Critical Minerals Recovery And Cementitious Materials Production, Hongyan Ma

World of Coal Ash Proceedings

Coal combustion residues (CCRs) pose significant environmental and disposal challenges, yet they also represent an untapped resource rich in aluminosilicates and critical minerals. This work presents a zero-waste, high-value valorization pathway that integrates critical mineral recovery with the production of cementitious materials. Advanced separation and extraction techniques are employed to recover strategically important elements such as gallium and rare earths, while the mineral-rich residues are simultaneously processed into supplementary cementitious materials (SCMs) for blended cements and concretes. This integrated approach not only offsets the environmental burden of CCR disposal but also supports domestic supply chains of critical minerals and reduces …

Revolutionizing Closure Systems: The Performance Advantages Of Structured Geomembranes, Scott Perugia

World of Coal Ash Proceedings

Coal combustion residual (CCR) containment facilities have traditionally been closed using methods that have changed little over several decades, but structured geomembranes are now reshaping closure design by improving slope stability, increasing interface friction, enhancing drainage, and providing long-term durability. Two systems are emerging as leading solutions: a structured geomembrane paired with a geotextile and vegetative cover, and a structured geomembrane paired with engineered turf. This presentation compares these approaches using field performance data, laboratory testing, and lessons learned, with emphasis on key factors such as infiltration control, drainage efficiency, slope stability, constructability, and regulatory compliance. The engineered turf system …

Developing Concentrated Brines / Salt Slurries For Disposal Of Coal Ash Wastewaters., Lance Edling

World of Coal Ash Proceedings

If coal ash wastewater is not fully concentrated to the greatest extent possible, then this results in greater disposal volumes and costs. However, concentrating a wastewater stream high in scaling compounds can be difficult. Membranes are prone to scale and Vacom thermal systems are higher in operating cost. This presentation will discuss the need to minimize disposal volumes by concentrating wastewater that is readily prone to scale and foul. The discussion will present past project examples of waste streams that were concentrated until salt crystals formed and the method used to minimize fouling and scaling during the concentration process. In …

Recinis™ Wet Beneficiation Process For Landfilled Coal Ash, Tim Sambrook

World of Coal Ash Proceedings

The decline of coal-fired power generation has reduced fresh “Run-of-Station” ash availability, increasing reliance on reclaimed ash from landfills to meet supplementary cementitious material (SCM) demand. This shift has lowered OPC replacement rates and raised concrete costs due to inconsistent ash quality. ReCinis™ offers a low-capex wet beneficiation solution for landfill-aged, saturated, and variable-quality coal ash. With over 5 billion tons of ash impounded in the U.S., this process enables long-term supply security where dry beneficiation is unsuitable. Combining proven mineral processing techniques with coal ash expertise, ReCinis™ can be deployed as a 150,000 tpa skid-mounted plant or scaled to …

Lessons Learned From A Full-Scale Discrete In-Situ Stabilization Project For Ccr Impoundment Closure, Tony Moran, Paul Jennings, Jacob Susser, Tim Silar

World of Coal Ash Proceedings

ENTACT, in collaboration with Silar Services, Inc., the patent holder of Discrete In-Situ Solidification (DISS) technology, has successfully performed a full-scale implementation of DISS in a Coal Combustion Residual (CCR) impoundment. DISS hydraulically isolates ash from surrounding groundwater by constructing a low-permeability barrier at the impoundment bottom to treat a layer of ash and tying into underlying natural soil layers. DISS enables targeted stabilization within a designated treatment zone, minimizing the disturbance of overburden compared to traditional excavation methods and reducing the use of costly cementitious reagents. The process starts with Reagentless Drilling of the overburden CCR utilizing a specialized …

From Clogs To Compliance: Overcoming Persistent Leachate Head Issues In Ccr Landfills, Breanne Kahnk, Zachary Bauman

World of Coal Ash Proceedings

State and federal regulations require that landfills, including coal combustion residual (CCR) landfills, be designed and operated to maintain leachate head levels of less than 30 centimeters (approximately 1 foot). While proper leachate collection system design and routine maintenance are critical for meeting this requirement, challenges such as clogging of drainage media, pipes, fittings and/or pipeline perforations, settlement of collection pipes, and breaks in the piping system can lead to elevated leachate levels, posing risks to compliance and long-term system performance. TRC will provide an overview of leachate collection system regulatory requirements along with design, operation, and maintenance strategies that …

Plasma Coal Ash Processing For Enhanced Recovery Of Rare Earth Elements & Precious Metals: Proven From R&D To Commercial Plants, George Paskalov, Victoria Campbell, Jason Honigberg

World of Coal Ash Proceedings

Our Radio-frequency Plasma System is an ash pretreatment before the application of extractive metallurgy and addresses current elemental, methodological, and technological limitations of complex and refractory coal ash. Our system data shows from 10-20% improved recovery, to 9x-100x. RFP can access all metals contained in coal ash. Our focus is not on the alteration of established methodologies, such as cyanidation for non-refractory ore, which has a proven return and capacity to achieve target revenue at-scale. Using the RFP systems, no waste is created, overburden can be more easily dealt with, and no metal content will be left behind. We assert …

Probing The Critical Element Chemistry Of Coal-Combustion Fly Ash: Electron Microbeam Investigations Of The Spent Ash From The Pilot-Scale Acid Extraction Of Rare Earth Elements From A Beneficiated Kentucky Fly Ash, James Hower

World of Coal Ash Proceedings

Fly ash derived from the combustion of an eastern Kentucky high volatile bituminous coal blend was beneficiated to yield a <75-μm product with a reduction in the carbon and spinels and reacted with a strong acid in a pilot-scale unit to extract rare earth elements. Electron microscopy showed a wide range of rare earth-bearing minerals. The acid-extracted fly ash had a rim that was depleted in REE and in most other elements except silicon.

Providing Perspective On Arsenic Risks In The Human Health Risk Evaluation Of Coal Combustion Products (Ccps), Ari Lewis

World of Coal Ash Proceedings

Arsenic has been a key risk factor in the evaluations for the 2015 Coal Combustion Residuals (CCR) Rule and the recent “Legacy Rule”, which addresses areas of historical CCP placement not covered by the 2015 rule. These risk assessments concluded that cancer risks from arsenic in various waste management scenarios exceeded the U.S. Environmental Protection Agency's (USEPA) target of 1 in 100,000 excess lifetime cancer cases, forming part of the basis for national CCP regulations. However, background exposure to naturally occurring arsenic in food, water, and soil also exceeds permissible levels, complicating risk conclusions. The USEPA's recent revision of arsenic …

Standardization Of Coal Ash Testing, Classification, And Harvesting, Benjamin Gallagher, Chris Frishcosy, Eric Hageman

World of Coal Ash Proceedings

Standards such as product specifications, test methods, practices and guides play a crucial role in supporting both commerce and science. Standardization helps build consistency and reliability whether it pertains to the performance of an ingredient in a product or in the measurement of a material characteristic. Coal combustion products, such as coal ash and synthetic gypsum, exhibit unique characteristics and many standard have been developed to characterize these materials and support their beneficial use. ASTM is a voluntary, consensus-based organization, and publishes many standards related to coal combustion products. Currently, there are seven ASTM standards related to chemical analysis of …

Leachate Quantification And Reduction – One Facility’S Path To Zld, Cedric Ruhl

World of Coal Ash Proceedings

The Environmental Protection Agency (EPA) promulgated Effluent Limitation Guidelines (ELG) that govern liquids discharged from energy production facilities. According to the ELG, energy production facilities that burn coal beyond December 31, 2034 must convert to a Zero Liquid Discharge (ZLD) system by December 31, 2029*. This presentation focuses on one coal-burning facility’s strategy to meet ZLD requirements. The predominant source of liquid that will be treated by the proposed ZLD system is leachate from an active coal combustion residual (CCR) landfill. Is the ZLD’s design capacity suitable for average leachate flow conditions? Is there enough leachate storage volume to manage …

Ai-Guided Upcycling Of Coal Combustion Residues In Blended Cement And Concrete, Hongyan Ma

World of Coal Ash Proceedings

Coal combustion residues (CCRs), including fly ash, bottom ash, desulfurization gypsum, etc., on specification or off-specification, remain an abundant yet underutilized byproduct of power generation. While these materials have long been considered as supplementary cementitious materials (SCMs), their variable chemical and physical characteristics limit broader adoption in blended cement and concrete. This study introduces an AI-guided framework to accelerate the upcycling of CCRs into high-performance construction materials. By integrating materials informatics, machine learning models, and experimental validation, the framework enables rapid property prediction and performance-based preprocessing recommendation or mix design optimization for diverse CCR sources. Preliminary results demonstrate the ability …

Comparison Of Residuals From Neighboring Power Stations With Different Coal Combustion Technologies, Allan Kolker, Denise Levitan, Brett Valentine

World of Coal Ash Proceedings

Due to the ongoing need for critical minerals, coal combustion residuals (CCR), like fly ash, have been evaluated as a potential source of critical minerals, particularly rare earth elements (REEs). Previous studies have found that REEs in fly ash are largely contained within aluminosilicate glass from which they are difficult to extract. However, these studies have predominantly studied CCR from conventional pulverized coal fired (PCF) plants. PCF plants use higher temperatures (≥1300°C) than do circulating fluidized-bed (CFB) plants (~900-950°C). Samples of feed coal, fly ash, and bottom ash were collected from two adjacent Vietnamese coal-fired power stations, one with a …

Impacts Of Updating Background Groundwater Statistics For Ccr Compliance, May Raad, Molly Reeves

World of Coal Ash Proceedings

In 2017, many power utilities adopted statistical methods to comply with the EPA’s Coal Combustion Residuals (CCR) Rule under the Hazardous and Solid Waste Management System. By 2017–2018, most owners completed initial statistical evaluations for detection and assessment monitoring to meet CCR deadlines. Groundwater sampling and analysis requirements in Parts 257.95, 257.98, and 257.102 are critical for compliance, yet implementation is complex. Subsections 257.93(f) and (g) lack clarity on which statistical tests to apply or how to address distributions and outliers. Additionally, the Rule does not specify when or how to update background threshold values (BTVs), though EPA’s Unified Guidance …

Advancing Ccr Site Management With Rapidly Deployable Gccm Technology For Runoff And Drainage Control, Nathan Ivy

World of Coal Ash Proceedings

GCCM’s were first invented over 20 years ago. These products combine both a concrete – hard armor – top surface for protection and durability and a geomembrane bottom surface for lower permeability. Originally used for erosion control, smaller drainage channel and remediation projects, this presentation discusses the newest iteration in GCCM technology. This product incorporates a 12 mil LLDPE backing which allows for thermal bonding and significant reduction in seepage at the joints. It can be used in a wide variety of applications from drainage ditches and swales to water and wastewater conveyance along with slope protection and erosion control …