Digital Commons Network^™

“Ecmo Anticoagulation: Should We Consider Bivalirudin Over Heparin?”, Confidence Paul

The PA Department Journal of Medical Science

Introduction: Extracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to prevent thrombotic events within the circuit. The use of unfractionated heparin has been the traditional anticoagulant of choice. Bivalirudin, a direct thrombin inhibitor, offers an alternative that has theoretical and observed benefits. The purpose of this clinical review is to evaluate whether bivalirudin provides superior safety and efficacy compared to UFH in ECMO patients.

Methods: PubMed was searched with a specific search strategy using key terms “Extracorporeal membrane oxygenation” AND “indirect anticoagulants” AND “deep vein thrombosis”. Operators and filters narrowed the results to four relevant, quality articles for review.

Results: In …

Effects Of Angiotensin-Converting Enzyme Inhibitors And Angiotensin Receptor Blockers On Covid-19 Outcomes In Severely Ill Patients, Madison L. Edwards

The PA Department Journal of Medical Science

Introduction: Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the virus SARS-CoV-2 and can cause debilitating illness in vulnerable patient populations. The purpose of this clinical review is to analyze the effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the clinical course and severity in COVID-19 adult patients.

Methods: PubMed was searched with a specific search strategy using key terms “adult,” “COVID-19,” and “RAAS inhibiting medications.” Specific operators and filters narrowed the results to a total of five relevant, quality articles for review.

Results: Two articles were randomized controlled trials that directly compared the continuation of …

Comparison Of Vagal Maneuvers And Antiarrhythmics On Adult Patients Presenting With Supraventricular Tachycardias (Svt), James S. Ng

The PA Department Journal of Medical Science

INTRODUCTION: SVT is a well-known and potentially life-threatening arrhythmia, with vagal maneuvers and/or antiarrhythmic drugs often attempted for first-line conversion. The purpose of this clinical review is to analyze the relative effectiveness and success rates of these specific maneuvers and medications.

METHODS: The following PubMed database search was performed:“((vagal maneuver*) OR (valsalva)) AND (pharmacologic) ((medication) OR (medical therapy) OR (adenosine) OR (beta blocker*) OR (calcium channel blocker*) OR (anti-arrhythmic*) OR (anti arrhythmic*) OR (antiarrhythmic)) AND ((SVT) OR (supraventricular tachycardia))”. Filters were then applied and article titles/abstracts reviewed, resulting in a final selection of five articles for review.

RESULTS:. The most …

The Effects Of A Gluten-Free Diet On Patients With Hashimoto’S Thyroiditis, Chandler Blackburn

The PA Department Journal of Medical Science

Introduction: Hashimoto’s thyroiditis is a chronic autoimmune inflammatory condition of the thyroid gland. Hashimoto’s occurs in five percent of the American population and is the most common cause of hypothyroidism in the US. There are various comorbidities associated with Hashimoto’s, which treatment can help mitigate some of those risks. The purpose of this paper is to evaluate if a gluten-free diet, as an adjunct treatment, can lower autoimmune related antibodies while improving thyroid labs levels.

Methods: PubMed was searched for clinical reviews using key terms “Hashimoto’s disease”, “hypothyroidism”, “gluten”, and “anti-TPO antibodies”. Operators and additional filters narrowed down search results …

Monotherapy Versus Combination Levothyroxine And Liothyronine In The Treatment Of Hypothyroidism, Anne F. Thomas

The PA Department Journal of Medical Science

Introduction: Primary hypothyroidism is a common condition where the thyroid gland cannot produce free thyroxine (T4), leading to low serum levels of it. For this reason, it is often treated directly with monotherapy synthetic T4 or as a combined synthetic T4/T3. The purpose of this clinical review is to analyze the effectiveness of T4 monotherapy versus T4/T3 combination therapy in normalizing TSH values and improving symptoms in adults with hypothyroidism.

Methods: A specific search strategy in PubMed was used to conduct the research, incorporating key terms such as “hypothyroidism,” “levothyroxine,” “liothyronine,” and “TSH.” Four quality articles were left for final …

Modern Approaches To Mental Health: App-Based Cbt Versus Traditional Psychotherapy, Samira Shende

The PA Department Journal of Medical Science

Background: Digital mental health tools are becoming widely used as flexible alternatives to in-person therapy. A key question is how effective they are compared to traditional therapy for people with depression and anxiety.

Objective: To compare how effective digital interventions, like app-based CBT or telehealth, are compared to in-person psychotherapy in reducing symptoms of depression and anxiety in adults.

Methods: A structured PubMed search was conducted using specific search terms, limited to English-language randomized controlled trials, systematic reviews, and meta-analyses published between 2020 and 2025. After screening 116 articles, four high-quality studies were selected for review.

Results: Of the four …

Epinephrine In Cardiac Arrest: Is It Enough?, Zachary Gusler

The PA Department Journal of Medical Science

Introduction: Epinephrine has long been the clinical mainstay of pharmacologic treatment for cardiac arrest management. It provides both α- and β-adrenergic receptor activation. However, at higher dosages, it may lead to sympathetic overload, oxidative stress, and cardiac myocyte apoptosis. The purpose of this paper is to evaluate the rates of ROSC (return of spontaneous circulation) with in-hospital cardiac arrest between epinephrine monotherapy and VSE (vasopressin, steroid, and epinephrine).

Methods: A search via PubMed database using the keywords “Cardiac arrest” AND “VSE” AND “Vasopressor monotherapy” with additional specifiers resulted in 30 articles. 26 articles were removed due to study type and …

Efficacy Of Catheter Ablation Compared To Antiarrhythmic Drug Therapy In Atrial Fibrillation, Sarah Mckinney

The PA Department Journal of Medical Science

Introduction: A-fib occurs when the electrical signals in the heart become unorganized and unsynchronized, resulting in an irregularly irregular heart rate. This can increase the risk of blood clots and stroke. The purpose of this paper is to explore two of the most common treatment options, comparing the efficacy of catheter ablation to AAD (antiarrhythmic drug) therapy in adults diagnosed with atrial fibrillation.

Methods: PubMed was searched using the keywords “atrial fibrillation,” “catheter ablation,” and “antiarrhythmic.” Operators and filters yielded a final result of 159 articles; four articles that most closely aligned with the focus of this research were reviewed. …

Hyaluronic Acid Versus Corticosteroids In Osteoarthritis Of The Knee, Victoria B. Short

The PA Department Journal of Medical Science

Introduction: Osteoarthritis is a very common degenerative disease seen in older adults that is typically due to repetitive movements of the joints over time. Without treatment, osteoarthritis can progress and cause individuals to have decreased function and quality of life. The purpose of this review is to evaluate the effectiveness of hyaluronic acid injections compared to corticosteroid injections in treating osteoarthritis of the knee.

Methods: PubMed was searched with a specific search strategy using key terms “knee osteoarthritis”, “hyaluronic acid”, and “corticosteroids”. Operators and filters were applied to narrow 572 results down to 40. 15 articles were reviewed and 4 …

Injection Or Ingestion: A Comparative Review Of Antipsychotic Delivery Methods And Patient Outcomes In Schizophrenia, Jeffrey K. Fear

The PA Department Journal of Medical Science

Introduction: Schizophrenia is a chronic psychiatric disorder that causes significant functional impairment and decreased quality of life for those who suffer from it. The purpose of this review is to compare the use of long-acting injectable (LAIs) antipsychotics with oral antipsychotic medications and to evaluate which treatment modality provides more favorable outcomes in terms of symptom control, adherence, and relapse prevention.

Methods: PubMed was searched to find articles examining the efficacy of both long-acting injectables and oral antipsychotics, and why long-acting injectables are becoming the preferred method of delivering treatment to patients suffering from schizophrenia. Four articles were selected for …

Glp-1 Agonists For Pediatric Obesity: A Clinical Review, Grace Burgin

The PA Department Journal of Medical Science

Introduction: Pediatric obesity is a chronic disease with multiple complex causes and many potential consequences if carried into adulthood. Lifestyle modifications alone have not been effective for all patients in the treatment of pediatric obesity. GLP-1 RAs already being prescribed in the adult population were also recently approved for pediatric patients. The purpose of this clinical review is to analyze the efficacy of GLP-1 RAs in decreasing markers associated with obesity, such as BMI, cholesterol, etc. in pediatric patients diagnosed with obesity.

Methods: PubMed was first searched using synonyms of the keywords “pediatric obesity,” “GLP-1 agonists,” “lifestyle modifications,” and “biomarkers …

The Gut Microbiome’S Effect On Metabolic Syndrome, Kayla Turner

The PA Department Journal of Medical Science

Introduction: Metabolic Syndrome (MetS) is a chronic condition characterized by insulin resistance and low-grade inflammation. The purpose of this review is to focus on pre-/pro/symbiotic supplementation as a means of improving MetS parameters in place of pharmacological intervention.

Methods: PubMed was searched with the terms “metabolic syndrome”, “obese”, “obesity”, “overweight”, “insulin resistance”, “insulin sensitivity”, “probiotic”, “symbiotic”, and “bifidobacter*”. Operators and filters narrowed the results down to 55 results, 4 of which were picked due to their relevance and quality.

Results: The 4 articles chosen were RCT and a systematic review that explored the Bifidobacterium genus in relationship to the MetS …

Pharmacological Management Of A Spinal Cord Injury: A Review, Victoria A. Sumner

The PA Department Journal of Medical Science

Introduction

A spinal cord injury results from damage to the cord itself. People who experience such an injury often live with pain for the rest of their lives. This review aims to compare the effectiveness of gabapentin versus tramadol in managing post-spinal cord injury pain.

Methods

A search using the key terms “spinal cord injury,” “gabapentin,” and “tramadol” was conducted on PubMed. Five relevant results were identified after applying operators and filters to narrow down the articles. Of those five articles, four were reviewed in this analysis.

Results

All four articles directly compare gabapentin to a test substance. Three of …

Understanding The Efficacy Of Photodynamic Therapy In Comparison To Topical Therapies In Treating Actinic Keratosis In Those At Increased Sun Exposure Risk, Tatum R. Mcbride

The PA Department Journal of Medical Science

Introduction: Actinic keratoses are precancerous skin lesions that arise secondary to increased sun exposure. These lesions have a propensity to transform into non-melanoma skin cancers, mainly squamous cell carcinoma, if left untreated. There are a multitude of different treatment options for the prevention and clearance of these lesions. Among these options is photodynamic therapy (PDT). The purpose of this paper is to investigate the effectiveness of PDT when compared to other options for AK treatment.

Methods: A search was conducted using PubMed for studies to analyze the efficacy of PDT when compared to other treatment options. 3 articles were selected …

Psilocybin Treatment For Refractory Depression: A Clinical Review, Hailey A. Jensen

The PA Department Journal of Medical Science

Introduction:

Depression is a widespread mental illness that affects a large portion of the world population and many of those who suffer from depression are resistant to treatment currently available. The purpose of this review is to compare the efficacy of psilocybin to the current available methods for the treatment of refractory depression.

Methods:

PubMed was searched with the key search terms: resistant depression, psilocybin therapy, and adults. Operators and filters narrowed down the search to 43 results. Four articles were then chosen based on quality and specificity with this review.

Results:

The articles included in this review compare the …

Hyaluronic Acid For The Treatment Of Knee Osteoarthritis: A Clinical Review, Victoria G. Morrison Cerda

The PA Department Journal of Medical Science

Introduction: Osteoarthritis of the knee (KOA) is a progressive degenerative disease of the knee joint characterized by knee pain and limited knee function which negatively impacts activities of daily living. Effective and safe IA treatments are needed to meet the needs of an ever-increasing population of those living with KOA. This clinical review aims to assess the effectiveness of IA hyaluronic acid compared to corticosteroids for pain management in KOA.

Methods: PubMed was searched using the key terms “hyaluronic acid injection”, “knee osteoarthritis”, “corticosteroid injection”, and “pain relief”. Modifiers and operators were applied, and results were narrowed to four relevant …

Beyond Steroids: A Head-To-Head Review Of Hyaluronic Acid And Prp In Knee Osteoarthritis, Phillip A. Sekander

The PA Department Journal of Medical Science

Introduction: Osteoarthritis of the knee is one of the most common primary complaints in the US. Newer injectable therapies that target specific cartilage degeneration are being developed. The purpose of this review is to compare the efficacy of PRP and HA injections for the management of knee osteoarthritis.

Methods: PubMed was searched using the key terms “osteoarthritis of the knee,” “hyaluronic acid,” “platelet-rich plasma,” and “management of pain.” This search was refined using MeSH terms, Boolean operators, and applied filters (English, free full-text, publication date between 2020-2025). Four articles were selected for in-depth review of the efficacy of platelet-rich plasma …

Gluten-Free Diet For Patients With Hashimoto's Thyroiditis: A Clinical Review, Sallie Young

The PA Department Journal of Medical Science

Introduction: Hashimoto’s thyroiditis (HT) is the most common cause of hypothyroidism worldwide. Although levothyroxine remains the standard treatment for hypothyroidism caused by HT, interest has grown in dietary interventions, particularly gluten-free diets (GFDs), as a means of reducing thyroid autoimmunity and improving clinical outcomes. The purpose of this clinical review is to analyze the effectiveness of GFD on improving thyroid autoantibodies in patients with HT.

Methods: PubMed was search with a specific search strategy using key terms “Hashimoto’s thyroiditis”, “autoimmune hypothyroidism”, “Hashimoto’s” and “diet”. Operators and filters narrowed results to sixteen. Four studies met the inclusion criteria, including …

“I Don’T Always See A Future For Me Here”: Oppressive Political Pressures On Lgbtq+ College Students’ Well-Being, Jodi Linley, Olivia M. Copeland, Kathleen J. Buell, Cindy Ann Kilgo, Megan Pendleton, Alex C. Lange, N F. Tennessen

Journal of Queer and Trans Studies in Education

In recent decades, colleges have broadly supported LGBTQ+ students. Now, institutions have shuttered LGBTQ+ initiatives in response to political pressures, with little consideration for the effects on students. This study answers the question, what current policy factors do LGBTQ+ college students describe as affecting their well-being, and in what ways? We analyzed 426 responses from a multi-institution study of LGBTQ+ students. By and large, students feel anxious and fearful as they navigate the current climate. Our analysis illustrated numerous factors, from the President and his administration to states and general emboldened violence, and the real and potential consequences of those …

Facts, Policy, And Discretion, F. Andrew Hessick, Carissa Byrne Hessick

Faculty Publications

Presidents, prosecutors, and judges often announce policies on how they will make discretionary decisions. These policies have met the criticism that discretion must be the product of an assessment of the particular facts of a case. Decisionmakers cannot base discretionary decisions on policy considerations, nor can they adopt policies stating how they intend to exercise their discretion. To do so, the argument goes, does not constitute an exercise of discretion, but rather an abdication of it.

This Article argues that this criticism misunderstands discretion. Discretionary decisions must rest on reasons, and reasons necessarily appeal to principles and policies that are …

Civil Death By A Thousand Cuts, Eisha Jain

Faculty Publications

Commentators have leveled trenchant critiques of collateral consequences of criminal conviction, analogizing them to a form of “civil death.” This Essay develops the related concept of “civil death by a thousand cuts” in two senses. First, penalties such as voting bans or deportation after a conviction are often just the tip of the iceberg. Second, a system of far-flung, intertwined civil and criminal penalties portends the death of a civil society capable of recognizing and mediating excessive penalties. Recognizing how these penalties operate—and how difficult they can be to address—is a critical step toward creating a more proportionate criminal legal …

A New 17 U.S.C. § 108a: Restoring The Intellectual Property Clause's Balance In Copyright Consideration Of Digital Disruption And The Prevalence Of Onerous Licensing Practices, Caroline L. Osborne

Faculty Publications

Accessibility of knowledge and control over information is key to an informed public and democracy. The founding fathers recognized the benefits of an informed citizenry, enshrining this concept in the Intellectual Property Clause of the Constitution. Such a clause created a delicate balance between creator and consumer, incentivizing creation for the benefit of society. The beauty of the Clause is the concept of balance. Balance resting delicately on the fulcrum with the dual requirements of reward for creation and benefit to society. The evolution of the means and formats in which information is delivered to the consumer in the creation …

Government Religious Speech And The Establishment Clause, Mark Storslee, Michael Helfand

Faculty Publications

The government says religious things. From monuments and holiday displays to legislative prayers, religion saturates the government’s public voice. But how can that be permissible when the Establishment Clause, at least in theory, indicates the government should be religiously neutral?

So far, the Supreme Court’s attempts to address the puzzle have come up short. Early on, the Court suggested that seemingly all government speech must be secular, or that it refrain from “endorsing” religion. But the Court never consistently enforced those limits, struggling to reconcile them with America’s historical experience. And in recent years, the Court has rejected those approaches …

Forum Shopping, Statutes Of Limitations, And Borrowing Statutes, John F. Coyle

Faculty Publications

When a claim is stale in one state but timely in another, a rational plaintiff will always file a lawsuit in the latter jurisdiction. To discourage plaintiffs from shopping around for the longest statute of limitations, thirty-six states have enacted laws known as borrowing statutes. A borrowing statute directs the state’s courts to apply the shorter statute of limitations of another state—typically the one where the cause of action arose—to bar the plaintiff’s claim.

The conventional wisdom holds that borrowing statutes merely restrain plaintiffs from filing lawsuits in out-of-the-way jurisdictions with no connection to the lawsuit. This Article reveals that, …

Clinical Informatics Education To Advance Learning Health Systems: A Scoping Review, Alexandra Zingg, L Ida Tovar, Laura Witte, Kelsey L Koym, Kyler Godwin

Library Staff Publications

Introduction: Learning health systems leverage clinical data and knowledge to advance healthcare quality. Effective training in informatics concepts and tools is essential for medical trainees to become health system experts and contributors to positive organizational change. The objective of this study is to summarize characteristics of existing clinical informatics training programs and map these to recommended Learning Health System informatics competencies. We aim to answer the following research questions: (1) How are academic medical institutions implementing informatics education initiatives for medical trainees? (2) Are these initiatives implementing recommended informatics competencies? and (3) How effective are these initiatives according to established …

Spatial Evolution In Temporal Dynamics Of Hemodynamic Response Function In Human Superior Colliculi With Ultra-High-Resolution Mri At 9.4t, Nooshin J Fesharaki, Artemy Vinogradov, David Ress, Jung Hwan Kim

Faculty, Staff and Student Publications

The superior colliculus (SC) plays a crucial role in multisensory integration, visual information processing, saccadic target selection, visual selective attention, and decision making. In particular, the SC has a key role in oculomotor coordination, following a rostro-caudal organization. The rostral SC, which corresponds to foveal representation, is linked to fixation, microsaccades, smooth pursuit, and vergence adjustments. In contrast, the caudal SC, representing more peripheral visual field, is associated with the large gaze shifts (saccades). However, evidence regarding whether this functional gradient is preserved in the human SC remains limited. In this study, we employed a sequence-following visual-motor task to specifically …

Polyfluoroalkyl Substances And Altered Glucose Homeostasis In Adolescents Following Bariatric Surgery, Elizabeth Costello, Brittney O Baumert, Zhenjiang Li, Vishal Midya, Shudi Pan, Justin R Ryder, Thomas H Inge, Todd M Jenkins, Stephanie Sisley, Stavra A Xanthakos, Anita Courcoulas, Douglas I Walker, Nikos Stratakis, Damaskini Valvi, Scott M Bartell, Angela L Slitt, Rohit Kohli, Sarah Rock, Michele A La Merrill, Sandrah P Eckel, Max T Aung, Rob Mcconnell, David V Conti, Lida Chatzi

Children’s Nutrition Research Center Staff Publications

Objectives: Bariatric surgery is an effective treatment for severe obesity and associated metabolic comorbidities. Exposure to polyfluoroalkyl substance (PFAS) before bariatric surgery may attenuate improvements in glucose metabolism and explain some of the heterogeneity in post-surgery outcomes.

Design: This is an observational cohort study.

Methods: Adolescents (n = 186) enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery study were included. Eight-PFAS congeners were measured in plasma before surgery. Linear and logistic regressions were used to examine cross-sectional associations between log2-transformed PFAS (ng/mL) and fasting glucose, insulin, hemoglobin A1c (HbA1c), and homeostatic model assessment for insulin resistance (HOMA-IR). Linear mixed …

Alternative Polyadenylation Signatures Distinguish Maladaptive Right Ventricular Remodeling In Pulmonary Hypertension: Implications For Rna-Based Diagnostics And Therapeutics, Janani Subramaniam, Venkata Jonnakuti, Scott D Collum, Sandra Martineau, Kai-Lieh Huang, Sandra Breuils-Bonnet, Andrea L Frump, Bindu H Akkanti, Jayeshkumar A Patel, Manish K Patel, Ismael Salas De Armas, Isabella N Lefebvre, Rajko Radovancevic, Elvin Blanco, Eric J Wagner, Igor Gregoric, Sriram Nathan, Biswajit Kar, Steeve Provencher, Sebastien Bonnet, François Potus, Hari Krishna Yalamanchili, Harry Karmouty-Quintana

Faculty, Staff and Student Publications

Increased pulmonary vascular pressures due to vascular remodeling, elevated vascular resistance, and vasoconstriction characterize Pulmonary Arterial Hypertension (PAH). The narrowing of the pulmonary arteries and obstruction of blood flow increase the Right Ventricular (RV) afterload, forcing the RV to undergo structural and functional changes. While adaptive remodeling leads to RV compensation by maintaining function, maladaptive remodeling leads to RV decompensation, characterized by worsening function and eventual failure. At present, there is no effective treatment for these patients as therapies for left ventricular failure are ineffectual, and there are no therapies specifically targeting the RV. Therefore, there is a clear need …

Test-Retest Apparent Diffusion Coefficient Reproducibility In Head And Neck Cancer Using A 15-T Mr-Linac, Brigid A Mcdonald, Dina El-Habashy, Renjie He, Sam Mulder, Sarah Mirbahaeddin, Abdallah S R Mohamed, Sara Ahmed, Yao Ding, Jihong Wang, Stephen Y Lai, Alex Dresner, John Christodouleas, Clifton D Fuller

Faculty, Staff and Student Publications

Purpose

To evaluate the reproducibility of apparent diffusion coefficient (ADC) measurements in head and neck squamous cell carcinoma (HNSCC) using a 1.5-T MR-linac (MRI-guided linear accelerator) system.

Materials and Methods

In this retrospective study, conducted between February 2021 and January 2024, patients with HNSCC lesions underwent echo-planar imaging diffusion-weighted MRI on a 1.5-T MR-linac system at two time points before the start of radiation therapy. Mean and median ADC values and volumes were measured for each lesion. Absolute and percent reproducibility coefficients (RCs) were calculated. Linear regression analyses and F tests were performed to determine whether the lesion volume or …

Teacher Perceptions Of Best Teaching Practices For Improved Student Outcomes In An Alternative School Setting, Chasity Clark

Doctor of Education Dissertations

This dissertation explores the experiences and professional perspectives of educators working in urban alternative school settings and examines how they foster positive outcomes for marginalized youth. Although alternative education is frequently characterized as a punitive “last resort,” this study highlights its potential as a setting for transformative resilience, student empowerment, and innovative teaching practices. Guided by social constructivism, transformative learning theory, and critical pedagogy, the study employed a qualitative design involving two rounds of semi-structured interviews and a focus group with 11 educators. Analysis of the data resulted in six integrated themes: psychological safety as a prerequisite for agency, self-efficacy …