Digital Commons Network^™

Correction: Rebuilding The Health Sector In Gaza: Alternative Humanitarian Voices, Karl Blanchet, Martine Najem, Lina Shadid, Rouba Ali Fehmi, Fawzi Al Hammouri, Ghassan Saed, Khaled J Saleh, Mosab Nasser, Nidal Moukaddam, Jonathan Polonsky, Omar Lattouf

Faculty, Staff and Students Publications

No abstract provided.

Manufacturing Companies’ Strategies To Mitigate Supply Chain Disruptions, Trisha L. George

Walden Dissertations and Doctoral Studies

Supply chain disruption has the potential for adverse business outcomes. In manufacturing facility settings, leaders are concerned that supply chain disruption decreases the quality of productivity and profitability. Grounded in dynamic capability theory, the purpose of this qualitative pragmatic inquiry was to explore strategies leaders used to mitigate supply chain disruptions. The participants were six supply chain leaders from three manufacturing facilities located in Mexico who mitigated supply chain disruption. Data were collected using semistructured interviews and public records. Through thematic analysis, four themes were identified: (a) cultural differences, (b) communication, (c) organizational structures, and (d) disciplines. A key recommendation …

Manufacturing Companies’ Strategies To Mitigate Supply Chain Disruptions, Trisha L. George

Walden Dissertations and Doctoral Studies

Supply chain disruption has the potential for adverse business outcomes. In manufacturing facility settings, leaders are concerned that supply chain disruption decreases the quality of productivity and profitability. Grounded in dynamic capability theory, the purpose of this qualitative pragmatic inquiry was to explore strategies leaders used to mitigate supply chain disruptions. The participants were six supply chain leaders from three manufacturing facilities located in Mexico who mitigated supply chain disruption. Data were collected using semistructured interviews and public records. Through thematic analysis, four themes were identified: (a) cultural differences, (b) communication, (c) organizational structures, and (d) disciplines. A key recommendation …

Quality Improvement: Naloxone Prescribing Practices For Paitent With An Opioid Patient Prescriber Agreement, Moniqueca Helms

Walden Dissertations and Doctoral Studies

The Substance Abuse Mental Health and Human Services Administration (SAMHSA) has set guidelines for opioid prescribing practices. The core principles of SAMHSA are to prevent overdose abuse and to provide appropriate treatment for those with an opioid abuse disorder. The concern addressed by the Doctor of Nursing Practice project was the gap in physician education regarding a Best Practice Alert (BPA) in the Electronic Medical Record that appears when prescribing an opioid to a patient without cancer. The alert indicates best practice is to prescribe naloxone with the opioid prescription. The naloxone BPA education project was implemented using the exploration, …

A Staff Education Program On The Education Of Nurses On Transgender Health Care, Diana Collins

Walden Dissertations and Doctoral Studies

In nursing education, both preregistration and continuing professional development, there is an absence of information about the specific needs of transgender people. The practicum site observed that education on the needs of the transgender community was lacking, discussing a discrepancy in the information offered and the scant attention paid to the unique requirements of transgender individuals. The goal of this project was to create a program that would raise staff members’ understanding of the exceptional health care requirements of the transgender population by providing them with an evidence-based assessment screening tool and training on transgender health care for nurses. The …

Who Helps Tsimane Children And Adults?, Eric Schniter, Daniel K. Cummings, Paul L. Hooper, Jonathan Stieglitz, Benjamin C. Trumble, Hillard S. Kaplan, Michael D. Gurven

ESI Working Papers

We examine various forms of helping behavior among Tsimane Amerindians of Bolivia, focusing on the provision of shelter, childcare, food, sickcare, cultural influence, and traditional story knowledge. Kin selection theory traditionally explains nepotistic nurturing of youth by closely related kin. However, less attention has been given to understanding the help provided by individuals without close genetic relatedness. To explain who provides various forms of help, we evaluate support for several predictions derived from kin selection theory. Our results show that helpers who are most often closely related and from an older generation tend to provide more costly forms of help …

Neuropsychological Profiles Of Deployment-Related Mild Traumatic Brain Injury: A Limbic-Cenc Study, Nicola L De Souza, Hannah M Lindsey, Katherine Dorman, Emily L Dennis, Eamonn Kennedy, Deleene S Menefee, J Scott Parrott, Yuane Jia, Mary Jo V Pugh, William C Walker, David F Tate, David X Cifu, Jason M Bailie, Nicholas D Davenport, Sarah L Martindale, Maya O'Neil, Jared A Rowland, Randall S Scheibel, Scott R Sponheim, Maya Troyanskaya, Elisabeth A Wilde, Carrie Esopenko

Faculty, Staff and Students Publications

Background and objectives: Traumatic brain injury (TBI) is a concern for US service members and veterans (SMV), leading to heterogeneous psychological and cognitive outcomes. We sought to identify neuropsychological profiles of mild TBI (mTBI) and posttraumatic stress disorder (PTSD) among the largest SMV sample to date.

Methods: We analyzed cross-sectional baseline data from SMV with prior combat deployments enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Latent profile analysis identified symptom profiles using 35 indicators, including physical symptoms, depression, quality of life, sleep quality, postconcussive symptoms, and cognitive performance. It …

Dorsal Raphe Neurons Integrate The Values Of Reward Amount, Delay, And Uncertainty In Multi-Attribute Decision-Making, Yang-Yang Feng, Ethan S Bromberg-Martin, Ilya E Monosov

2020-Current year OA Pubs

The dorsal raphe nucleus (DRN) is implicated in psychiatric disorders that feature impaired sensitivity to reward amount, impulsivity when facing reward delays, and risk-seeking when confronting reward uncertainty. However, it has been unclear whether and how DRN neurons signal reward amount, reward delay, and reward uncertainty during multi-attribute value-based decision-making, where subjects consider these attributes to make a choice. We recorded DRN neurons as monkeys chose between offers whose attributes, namely expected reward amount, reward delay, and reward uncertainty, varied independently. Many DRN neurons signaled offer attributes, and this population tended to integrate the attributes in a manner that reflected …

Role Of The Afferent Lymph As An Immunological Conduit To Analyze Tissue Antigenic And Inflammatory Load, Padma P Nanaware, Cheryl F Lichti, Xiaoxiao Wan, Emil R Unanue, Et Al.

2020-Current year OA Pubs

The lymphatic fluid is the conduit by which part of the tissue "omics" is transported to the draining lymph node for immunosurveillance. Following cannulation of the pre-nodal cervical and mesenteric afferent lymphatics, herein we investigate the lymph proteomic composition, uncovering that its composition varies according to the tissue of origin. Tissue specificity is also reflected in the dendritic cell-major histocompatibility complex class II-eluted immunopeptidome harvested from the cervical and mesenteric nodes. Following inflammatory disruption of the gut barrier, the lymph antigenic and inflammatory loads are analyzed in both mice and subjects with inflammatory bowel diseases. Gastrointestinal tissue damage reflects the …

Myeloablative Vs Nonmyeloablative Consolidation For Primary Central Nervous System Lymphoma: Results Of Alliance 51101, Tracy T Batchelor, Brad S Kahl, Nancy L Bartlett, Nina Wagner-Johnston, Et Al.

2020-Current year OA Pubs

Although it is evident that standard-dose whole-brain radiotherapy as consolidation is associated with significant neurotoxicity, the optimal consolidative strategy for primary central nervous system lymphoma (PCNSL) is not defined. We performed a randomized phase 2 clinical trial via the US Alliance cancer cooperative group to compare myeloablative consolidation supported by autologous stem cell transplantation with nonmyeloablative consolidation after induction therapy for PCNSL. To our knowledge, this is the first randomized trial to be initiated that eliminates whole-brain radiotherapy as a consolidative approach in newly diagnosed PCNSL. Patients aged 18 to 75 years were randomly assigned in a 1:1 manner to …

Injury-Induced Foxm1 Expression In The Mouse Kidney Drives Epithelial Proliferation By A Cyclin F-Dependent Mechanism, Megan L. Noonan, Yoshiharu Muto, Yasuhiro Yoshimura, Aidan Leckie-Harre, Haojia Wu, Vladimir V. Kalinichenko, Benjamin D. Humphreys, Monica Chang-Panesso

2020-Current year OA Pubs

Acute kidney injury (AKI) strongly upregulates the transcription factor Foxm1 in the proximal tubule in vivo, and Foxm1 drives epithelial proliferation in vitro. Here, we report that deletion of Foxm1 either with a nephron-specific Cre driver or by inducible global deletion reduced proximal tubule proliferation after ischemic injury in vivo. Foxm1 deletion led to increased AKI to chronic kidney disease transition, with enhanced fibrosis and ongoing tubule injury 6 weeks after injury. We report ERK mediated FOXM1 induction downstream of the EGFR in primary proximal tubule cells. We defined FOXM1 genomic binding sites by cleavage under targets and release using …

Airy-Beam Holographic Sonogenetics For Advancing Neuromodulation Precision And Flexibility, Zhongtao Hu, Yaoheng Yang, Leqi Yang, Yan Gong, Chinwendu Chukwu, Dezhuang Ye, Yimei Yue, Jinyun Yuan, Alexxai V Kravitz, Hong Chen

2020-Current year OA Pubs

Advancing our understanding of brain function and developing treatments for neurological diseases hinge on the ability to modulate neuronal groups in specific brain areas without invasive techniques. Here, we introduce Airy-beam holographic sonogenetics (AhSonogenetics) as an implant-free, cell type-specific, spatially precise, and flexible neuromodulation approach in freely moving mice. AhSonogenetics utilizes wearable ultrasound devices manufactured using 3D-printed Airy-beam holographic metasurfaces. These devices are designed to manipulate neurons genetically engineered to express ultrasound-sensitive ion channels, enabling precise modulation of specific neuronal populations. By dynamically steering the focus of Airy beams through ultrasound frequency tuning, AhSonogenetics is capable of modulating neuronal populations …

A Shared Group Of Bacterial Taxa In The Duodenal Microbiota Of Undernourished Pakistani Children With Environmental Enteric Dysfunction, Najeeha T Iqbal, Robert Y Chen, Nicholas W Griffin, Matthew C Hibberd, Michael J Barratt, Jeffrey I Gordon, Et Al.

2020-Current year OA Pubs

Environmental enteric dysfunction (EED) is a subclinical syndrome of altered small intestinal function postulated to be an important contributor to childhood undernutrition. The role of small intestinal bacterial communities in the pathophysiology of EED is poorly defined due to a paucity of studies where there has been a direct collection of small intestinal samples from undernourished children. Sixty-three members of a Pakistani cohort identified as being acutely malnourished between 3 and 6 months of age and whose wasting (weight-for-length

The Crosstalk Between Amyloid-Β, Retina, And Sleep For The Early Diagnosis Of Alzheimer's Disease: A Narrative Review, Isaiah Lorenzo De Guia, Shaun Eslick, Sharon L. Naismith, Swathi Kanduri, Tejal M. Shah, Ralph N. Martins

Research outputs 2022 to 2026

Alzheimer's disease (AD) is the most common type of dementia, which is characterised by progressive memory loss and accumulation of hallmark markers amyloid-β (Aβ) and neurofibrillary tangles in the diseased brain. The current gold standard diagnostic methods have limitations of being invasive, costly, and not easily accessible. Thus, there is a need for new avenues, such as imaging the retina for early AD diagnosis. Sleep disruption is symptomatically frequent across preclinical and AD subjects. As circadian activity, such as the sleep-wake cycle, is linked to the retina, analysis of their association may be useful additions for achieving predictive AD diagnosis. …

Psycho-Social Determinants Of Employee Green Behavior Among It Professionals, Jovita Sherin George, K.N. Jayakumar, Amal Tom Jose

Makara Human Behavior Studies in Asia

As environmental degradation and hazards caused by the information technology (IT) industry reach critical levels, promoting pro-environmental behaviors within IT firms is crucial. These behaviors not only reduce operational costs but also enhance employee productivity. The primary objective of this study is to assess the roles of consideration of future consequences (CFC), nature relatedness (NR), and organizational commitment (OC) as determinants of employee green behavior (EGB). Results revealed a significant relationship between CFC and EGB. Specifically, CFC-Future has a significant positive relationship with EGB, whereas CFC-Immediate has a significant negative correlation with EGB. Additionally, the relationship between EGB and NR …

Identity After Impairment: Development Of An Athletic Identity Model Of Filipino Para-Athletes, Marian M. Lagundino, Marc Eric S. Reyes, Ryan Francis O. Cayubit

Makara Human Behavior Studies in Asia

Athletic Identity (AthID) is an aspect of the self-concept that refers to how one identifies with the role of an athlete and seeks acknowledgment of that role. This identity is not salient in all individuals, but AthID is activated for those who regard their athletic role as significant. Our objective was to develop a theoretical model to elucidate how Filipino para-athletes can cultivate their distinct athletic identity after acquiring a disability. The present study explored the athletic identities of 12 Filipino para-athletes, aged 24 to 63, who developed physical impairment and continued participating and competing in their chosen sports. Using …

A Case Report Of Acute Idiopathic Hepatitis Requiring Liver Transplant, Nathan Rim, Nevin Varghese, Md, Zachary Pang, Md

The Medicine Forum

Acute liver injury may be very difficult to treat, especially when the etiology is unknown. We describe a case of a patient who presented with signs and symptoms of acute liver injury and went through an extensive work-up that did not reveal a definitive cause. The lack of diagnosis can be distressing for the patient, so it is important to regularly communicate the current plan and potential future necessary steps (such as a transplant surgery) to facilitate smooth, informed decision-making throughout the whole process.

A Rare Case Of Upper Gastrointestinal Bleeding And Esophageal Candidiasis In Severe Achalasia, Nevin Varghese, Md, Bertilia Tavárez, Md, Justin Robbins, Md

The Medicine Forum

Achalasia is an esophageal dysmotility disorder characterized by failure of relaxation of the lower esophageal sphincter (LES), accompanied by aperistalsis of the distal esophagus. Recent data show that the prevalence of achalasia in the United States is 10 per 100,000 individuals.¹ Complications of achalasia include esophagitis, esophageal ulcer, esophagealtracheal fistula, esophageal rupture, aspiration pneumonia, and squamous cell carcinoma. We report a rare case of upper gastrointestinal bleeding associated with esophageal ulcer and candidiasis in a patient with severe achalasia requiring multiple endoscopic interventions.

Bicuspid Aortic Valve With Right Coronary Cusp And Noncoronary Cusp Fusion On Transesophageal Echocardiogram, Kashka Mallari, Md

The Medicine Forum

A 39 year old male with a bicuspid aortic valve (BAV) developed progression of aortic valve regurgitation and enlargement of the ascending aorta, despite showing no symptoms. BAV, affecting approximately 2% of the population, poses risks such as aortic stenosis, aortic regurgitation, endocarditis, and aortic dilation, which can lead to aortic aneurysm and potential rupture. Due to the risk of further progression, he underwent a trans-esophageal echocardiogram (TEE) to facilitate aortic valve repair. While majority of patients with BAV exhibit fusion between the right coronary cusp (RCC) and left coronary cusp (LCC), this patient displayed fusion between the RCC and …

Hypertrophic Cardiomyopathy Illustrated On A Transthoracic Echocardiogram And Cardiac Mri, Youssef Elfatatry, Md, Marina Gonzalez, Md

The Medicine Forum

A 46-year-old woman presented to the hospital with subacute dyspnea on exertion and syncope. She had three syncopal episodes in the months prior, all of which occurred after standing from seated position and were associated with complete loss of consciousness. Echocardiogram showed severe concentric left ventricular hypertrophy (LVH) with preserved systolic function (Panels A and B). Cardiac magnetic resonance (CMR) imaging was performed which confirmed asymmetric septal hypertrophy measuring 28-mm in thickness (Panel C, arrow). Patchy, late gadolinium enhancement was also seen within the myocardium (Panel D, arrows). A diagnosis of hypertrophic cardiomyopathy (HCM) was made. The patient had no …

Wellens' Syndrome On Electrocardiogram, A Highly Specific Indicator Of Critical Stenosis Of The Left Anterior Descending Coronary Artery, Youssef Elfatatry, Md, Ryan Gardner, Md

The Medicine Forum

An 85-year-old male with a past medical history of hyperlipidemia presented to his primary care physician with chest pain. The patient had experienced an acute episode of substernal chest pain that resolved spontaneously three days prior to presentation. An electrocardiogram (ECG) was obtained in the office which showed inverted and biphasic T-waves throughout the precordial chest leads (Panel A, arrows). The patient was sent to the emergency department and underwent an emergent cardiac catheterization which revealed a 99% proximal left anterior descending (LAD) artery occlusion (Panel B, arrow). A drug-eluting stent was placed with successful revascularization (Panel C, arrow). Wellens …

Investigating The Etiology Of Non-Ischemic Cardiomyopathy; A Case Report Of Cardiac Amyloidosis, Zachary Pang, Md, Joshua M. Riley, Md, Yair Lev, Md

The Medicine Forum

Amyloidosis is the result of misfolded protein deposition in organs and tissues, including the heart also known as cardiac amyloidosis. We describe a case of a patient presenting with decompensated heart failure, which highlights the importance of identifying the etiology of the patient’s cardiomyopathy through a thorough history and physical. This led to a diagnosis of cardiac amyloidosis. The patient was subsequently initiated on tafamidis, a medication that is associated with reductions in all-cause mortality and cardiovascular-related hospitalizations, reduced decline in functional capacity, and improved quality of life of the patient.

Laao Device Mass: A Classic Condition Involving A Not - So - Classic Device, Ryan Gardner, Md, Rabia Naheed, Md, Youssef Elfatatry, Md, Irfan Ahsan, Md, Alyson N. Owen, Md

The Medicine Forum

Current evidence suggests Class 2a recommendation for a left atrial appendage occlusion with a closure device in patients with atrial fibrillation who have moderate to high risk of stroke (CHA2DS2-VASc score ≥2) and a contraindication to long-term oral anticoagulation due to a nonreversible cause.¹ Watchman device (WD) related infection is infrequent due to complete endothelialization of the device in a few weeks.² We report a highly challenging case of possible WD-related infection that involved complex decision-making.

Dissecting The Literature: A Systematic Review Of Conservative Therapy Versus Revascularization In Spontaneous Coronary Artery Dissection, Avinash Saraiya, Ms, Brian Schonewald, Md

The Medicine Forum

Spontaneous coronary artery dissection (SCAD) is a rare, but increasingly recognized cause of acute coronary syndrome (ACS). While previously only described in case series, the advent of advanced imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) has increased its prevalence dramatically. Anatomically, SCAD results from the formation of an intramural hematoma with or without intimal tear in a coronary artery, potentially leading to occlusion and ischemia. This phenomenon is especially common in women, accounting for 35% of ACS in women under the age of 50, and representing the leading cause of peripartum myocardial infarct.¹ There …

From The Chief Residents, Michael Dong, Md, Chantel Venkataraman, Md, Tamar Wolinsky Md, Benjamin Claxton, Md

The Medicine Forum

As we introduce the latest edition of The Medicine Forum, the journal of our Internal Medicine residency program, we're thrilled to showcase the diverse talents and perspectives of our resident physicians. Evolving alongside our program, this publication serves as both a platform for scientific inquiry and a canvas for creativity, reflecting the dynamic interests of each resident cohort.

We must extend our heartfelt gratitude to our current editors, Amman Bhasin, Suraj Nyalakonda, Mez Kamanu, and Alex Grivas, for their unwavering dedication and tireless efforts in shepherding this journal to new heights. Their commitment to excellence and their vision for …

From The Editors, Amman Bhasin, Md, Suraj Nyalakonda, Md, Chukwuemezie Kamanu, Md, Alexandros Grivas, Md

The Medicine Forum

We are honored to present the 25th Annual edition of The Medicine Forum, carrying forth a quarter-century tradition of scholarly work produced by faculty, residents, and students -- proudly shared with the Jefferson community and beyond. The Medicine Forum embodies the collective voice and spirit of our residency, serving as a vibrant platform for scholarly and artistic expression, and showcasing the remarkable talents and diverse perspectives of our program’s faculty, residents, and students.

Throughout the years, The Medicine Forum has evolved alongside our program, adapting to the changing interests and passions of each new cohort of residents. It serves …

Foreword From Faculty Advisor, Dagan Coppock, Md, Msce

The Medicine Forum

The latest edition of The Medicine Forum celebrates our community’s efforts toward scholarly inquiry and creativity. Our current editors have approached this project with a true passion. Throughout the academic year, it has been my pleasure to work with Amman, Suraj, Mez, and Alex, not only on this project, but also on the medical wards. They have applied the same thoughtfulness and joy to editing this journal that they do to the care of patients. I am in awe of their efforts.

As a department, we are a productive group of writers, thinkers, scientists, and artists. So much of our …

From The Desk Of The Residency Program Director, Christopher Henry, Md, Facp

The Medicine Forum

As we celebrate the silver jubilee of our beloved Jefferson Forum, it is with great pride and admiration that I extend a warm welcome to each of you. For a quarter-century, this annual publication has stood as a testament to the dedication, passion, and scholarly pursuits of our internal medicine residents.

Within the pages of the Jefferson Forum, you will find the embodiment of our residents' commitment to excellence in patient care, education, and research. As the Program Director, I have had the privilege of witnessing firsthand the remarkable growth and development of our residents. Their journey from eager learners …

Table Of Contents: The Medicine Forum, Volume 25, 2023-2024

The Medicine Forum

Table of Contents: The Medicine Forum, Volume 25, 2023-2024

The Medicine Forum: Volume 25

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 25, 2023-2024

TABLE OF CONTENTS

• Case Reports
• Clinical Images
• Humanities & Reflections