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Quality & Patient Safety Gazette : Volume 1, Issue 1 - 2022, The Aga Khan University Hospital, Karachi

Quality and Patient Safety Archives

• Revised AKUH Quality and Patient Safety Program
• Blast from the Past
• Learn with Fun!
• Stay Tuned with Us…..

Acute Generalized Exanthematous Pustulosis: A Painful And Pruritic Presentation Of Pustulosis Following Pharmacotherapy For Pharyngeal Phlegmon., Chase Silvers, John Casey

Ambulatory and Primary Care Articles

Acute generalized exanthematous pustulosis (AGEP) is primarily a drug-induced skin eruption, which typically presents within two days of starting an offending medication; it is often self-limiting with spontaneous resolution within two weeks upon medication cessation. We report the case of a patient who presented with generalized desquamation, characteristic pustules, and several morbilliform rashes on the body surface in association with recent amoxicillin-clavulanic acid exposure. This was associated with significant pruritus, which was the associated chief complaint. A multimodal approach to symptomatic management with topical corticosteroids, barrier ointments, oral antihistamines, and analgesics was required, in addition to the cessation of the …

Bringing Joie De Vivre Back: Workplace Burnout & Black Women In Academia, Kay Coates, Vivian F. Bynoe

University Libraries: Faculty Presentations

Workshop presented at the 10th Faculty Women of Color in the Academy (FWCA) Conference.

Embodied Cognition In The Music Theory And Aural Skills Classrooms, Leslie Thompson

Electronic Theses and Dissertations

Applying concepts of embodied cognition positively impacts pedagogy in the theory and aural skills classrooms. This thesis defines a holistic view of the student and identifies how classroom instruction from that perspective can benefit student learning as well as overall well-being. The opening chapters provide a brief scientific background and connect concepts of embodied cognition with specific music theory and aural skills examples from an interview. A select survey of the music theory pedagogy literature also illustrates principles of embodied cognition. Based on this background, the final chapter presents new sample lesson plans and discusses how to adapt to student …

Development Of A Rating Scale For The Measurement Of Adult Social Skills, Jessica Cuitareo

Electronic Theses and Dissertations

Social skills are a person’s ability to adapt to the environment appropriately utilizing verbal and nonverbal communication (Matson et al., 2007). In accordance with the Diagnostic and Statistical Manual of Mental Disorders – fifth edition (DSM-5), individuals diagnosed with Autism demonstrate social skills deficits (APA, 2013). Such deficits may impact an individual negatively in developing and maintaining relationships, as well as occupational skills. However, assessments for adults are few and far between, as assessment has primarily focused on children. Therefore, the purpose of this dissertation was to create and pilot a measure of adult social skills, with the intention of …

Multisystem Inflammatory Syndrome In Children (Mis-C): Emergency Department, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

The Trio Student Support Services Newsletter, Georgia Southern University-Armstrong Campus

Office of Organizational Effectiveness, Leadership Development & Engagement

• Director's Corner & Special Messages

• MLK Service Project

• A Taste of African Cooking Class

• National TRIO Day

• The History of National TRIO Day

• Workshops

• Events

• Recruiting

• TRIO's Annual Awards & Recognition Brunch

• Class of 2022

• Spotlight On... Recognize. Celebrate. Inspire

• Our Amazing Alumni Where Are They Now

• Student Staff

• A Special Thank You

Second Amendment Realism, Michael Ulrich

Faculty Scholarship

In District of Columbia v. Heller, the Supreme Court declared a constitutionally protected individual right to keep and bear arms. Subsequently, the scope of the right has been hotly debated, resulting in circuit splits and lingering questions about what, exactly, the right entails. Despite these splits, the Court has denied certiorari to the myriad gun cases to land on its doorstep. But the balance of the Court has shifted, and likely, too, its willingness to hear these cases. Among the most pressing questions in Second Amendment jurisprudence is the constitutionality of public carry restrictions. With a constitutional challenge inevitable given …

Measuring Racial Equity In New Hampshire’S Food System, Olivia Saunders, Jennifer Wilhelm

UNH Cooperative Extension

No abstract provided.

Nh 4-H Livestock Show & Auction - Market Beef Project Workbook, Michelle B Robblee

UNH Cooperative Extension

No abstract provided.

Nh 4-H Livestock Show & Auction - Market Goat Project Workbook, Michelle B Robblee

UNH Cooperative Extension

No abstract provided.

Nh 4-H Livestock Show & Auction - Market Lamb Project Workbook, Michelle B Robblee

UNH Cooperative Extension

No abstract provided.

Nh 4-H Livestock Show & Auction - Market Animal Project Record Book, Michelle B Robblee

UNH Cooperative Extension

No abstract provided.

Recently Integrated Alu Elements In Capuchin Monkeys: A Resource For Cebus/Sapajus Genomics, J. M. Storer, J. A. Walker, C. E. Rockwell, G. Mores, T. O. Beckstrom, J. D. Orkin, A. D. Melin, Kimberley A. Phillips, C. Roos, M. A. Batzer

Psychology Faculty Research

Capuchins are platyrrhines (monkeys found in the Americas) within the Cebidae fam-ily. For most of their taxonomic history, the two main morphological types of capuchins, gracile (untufted) and robust (tufted), were assigned to a single genus, Cebus. Further, all tufted capuchins were assigned to a single species, Cebus apella, despite broad geographic ranges spanning Central and northern South America. In 2012, tufted capuchins were assigned to their genus, Sapajus, with eight currently recognized species and five Cebus species, although these numbers are still under debate. Alu retrotransposons are a class of mobile element insertion (MEI) widely used …

Peppermint Oil Effects On The Gut Microbiome In Children With Functional Abdominal Pain, Santosh Thapa, Ruth Ann Luna, Bruno P Chumpitazi, Numan Oezguen, Susan M Abdel-Rahman, Uttam Garg, Salma Musaad, James Versalovic, Gregory L Kearns, Robert J Shulman

Faculty, Staff and Students Publications

Peppermint oil (PMO) is effective in the treatment of functional abdominal pain disorders, but its mechanism of action is unclear. Evidence suggests PMO has microbicidal activity. We investigated the effect of three different doses of PMO on gut microbiome composition. Thirty children (7-12 years of age) with functional abdominal pain provided a baseline stool sample prior to randomization to 180, 360, or 540 mg of enteric coated PMO (10 participants per dose). They took their respective dose of PMO (180 mg once, 180 mg twice, or 180 mg thrice daily) for 1 week, after which the stool collection was repeated. …

The Impact Of Smoking Cessation On Multiple Sclerosis Disease Progression, Jeff Rodgers, Tim Friede, Frederick W. Vonberg, Cris S. Constantinescu, Alasdair Coles, Jeremy Chataway, Martin Duddy, Hedley Emsley, H Ford, Leonora Fisniku, Ian Galea, Timothy Harrower, Jeremy Hobart, Huseyin Huseyin, Christopher M. Kipps, Monica Marta, Gavin V. Mcdonnell, Brendan Mclean, Owen R. Pearson, David Rog, Klaus Schmierer, Basil Sharrack, Agne Straukiene, Heather C. Wilson, Dv Ford, Rod M. Middleton, Richard Nicholas

Peninsula Medical School

Abstract The negative impact of smoking in MS is well established, however, there is much less evidence as to whether smoking cessation is beneficial to progression in MS. Adults with MS registered on the United Kingdom MS Register (2011-2020) formed this retrospective and prospective cohort study. Primary outcomes were changes in 3 patient reported outcomes (PROs): normalised MS Physical Impact Scale (MSIS-29-Phys), normalised MS Walking Scale (MSWS-12) and the Hospital Anxiety and Depression Scale (HADS-Anxiety and HADS-Depression). Time to event outcomes were clinically significant increases in the PROs. 7983 participants were included, 4130 (51.7%) of these had ever smoked; of …

Infection With The Hepatitis C Virus Causes Viral Genotype-Specific Differences In Cholesterol Metabolism And Hepatic Steatosis, David A. Sheridan, Isaac Thom Shawa, E. Louise Thomas, Daniel J. Felmlee, Simon H. Bridge, Dermot Neely, Jeremy F. Cobbold, Elaine Holmes, Margaret F. Bassendine, Simon D. Taylor-Robinson

Peninsula Medical School

Lipids play essential roles in the hepatitis C virus (HCV) life cycle and patients with chronic HCV infection display disordered lipid metabolism which resolves following successful anti-viral therapy. It has been proposed that HCV genotype 3 (HCV-G3) infection is an independent risk factor for hepatocellular carcinoma and evidence suggests lipogenic proteins are involved in hepatocarcinogenesis. We aimed to characterise variation in host lipid metabolism between participants chronically infected with HCV genotype 1 (HCV-G1) and HCV-G3 to identify likely genotype-specific differences in lipid metabolism. We combined several lipidomic approaches: analysis was performed between participants infected with HCV-G1 and HCV-G3, both in …

Examining Parenting Practices And Routines As Possible Mediators Of Parenting Inflexibility And Child Behaviors, Lauren S. Erp

Master's Theses

Due to the high prevalence rates of child behavioral problems, considerable research has focused on factors that contribute to child behavioral problems. Parenting inflexibility has been shown to relate to child internalizing and externalizing behaviors through ineffective parenting practices. However, child routines, another related yet distinct parenting behavior, has yet to be explored in this relationship. The primary purpose of this study was to examine parenting practices and child routines as mediators of the relationship between parenting inflexibility and child behavioral outcomes. Mothers of school-aged children (N = 157) were recruited through Amazon’s Mechanical Turk and completed self-report measures of …

Emotions In Work And War: Comparisons Of Emotional-Cultures Of New Deal Ccc Enrollees And Wwii U.S. Army Enlistees, 1933-1945, Maeve Losen

Master's Theses

Though the Great Depression and Second World War were consecutive eras and overlapped in numerous aspects, scholarship often overlooks the commonalities between these periods. To demonstrate these eras’ shared qualities, this thesis examines the relationship in emotional-cultures—the cultural norms that dictated how individuals felt and demonstrated their emotions—among Civilian Conservation Corps (CCC) enrollees and U.S. Army enlistees during WWII.

The broad intent of this undertaking is to place the cultural history of the Great Depression and WWII in conversation and to show the advantage of inter- and multidisciplinary work by applying anthropological and historical theories of emotion. Though the historical …

Colonic Epithelial Angiotensin-Converting Enzyme 2 (Ace2) Expression In Blacks And Whites: Potential Implications For Pathogenesis Covid-19 Racial Disparities, Mart De La Cruz, David P Nunes, Vaishali Bhardwaj, Deepika Subramanyan, Caroline Zaworski, Priya Roy, Hemant K Roy

Faculty, Staff and Students Publications

BACKGROUND: Covid-19 toll is disproportionate in Blacks although the mechanisms remain incompletely understood. From a biological perspective, several host proteins have received most attention as logical susceptibility targets. Specifically, angiotensin-converting enzyme 2 (ACE2) serves as the epithelial cell receptor and acts in concert with transmembrane protease serine 2 (TMPRSS2). Intriguingly, ACE2 can also suppress the inflammatory response and therefore may impact the severity of Covid-19 infections (from the exuberant immune response a.k.a. "cytokine storm"). We, therefore, assessed expression of ACE2 and TMPRSS2 in Blacks versus Whites.

METHODS: Archived mucosal biopsies from colonoscopic biopsies of visually normal rectal mucosa without concurrent …

Purpose, Subject, And Consumer Comment On "Perceived Burden Due To Registrations For Quality Monitoring And Improvement In Hospitals: A Mixed Methods Study", Sylvia J Hysong, Patrick O'Mahen, Jochen Profit, Laura A Petersen

Faculty, Staff and Students Publications

Zegers and colleagues’ study codifies the perceived burden of quality monitoring and improvement stemming from the work by clinicians of registering (documenting) quality information in the medical record. We agree with Zegers and colleagues’ recommendation that a smaller, more effective and curated set of measures is needed to reduce burden, confusion, and expense. We further note that focusing on validity of clinical evidence behind individual measures is critical, but insufficient. We therefore extend Zegers and colleagues’ work through a pragmatic, tripartite heuristic. To assess the value of and curate a targeted set of performance measures, we propose concentrating on the …

Prevalence And Predictors Of Missed Dysplasia On Index Barrett's Esophagus Diagnosing Endoscopy In A Veteran Population, Theresa H Nguyen, Aaron P Thrift, Rollin George, Daniel G Rosen, Hashem B El-Serag, Gyanprakash A Ketwaroo

Faculty, Staff and Students Publications

BACKGROUND & AIMS: Limitations of endoscopic sampling may result in missed dysplasia at the diagnosis of Barrett's esophagus (BE). However, the role of close follow-up endoscopy is unclear. The aim was to evaluate the proportion of patients diagnosed with "missed" dysplasia within 18 months of their index nondysplastic BE (NDBE) diagnosis.

METHODS: This was a retrospective analysis of a cohort of BE patients diagnosed during 1990-2019 at the Houston VA. Patients with BE on index esophagogastroduodenoscopy (EGD) were classified as NDBE, indefinite dysplasia, or dysplastic (low- or high-grade dysplasia) based on initial biopsies. We identified NDBE patients who had follow-up …

Differences In Covid-19-Related Testing And Healthcare Utilization By Race And Ethnicity In The Veterans Health Administration, Javad Razjouyan, Drew A Helmer, Ang Li, Aanand D Naik, Christopher I Amos, Venkata Bandi, Amir Sharafkhaneh

Faculty, Staff and Students Publications

IMPORTANCE: Recent reports indicate differences in COVID-19-related care and outcomes between Black and White Americans.

OBJECTIVE: We examine the COVID-19-related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA).

DESIGN: A retrospective cohort study.

SETTING: We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020.

PARTICIPANTS: Veterans tested for SARS-CoV-2 virus by VHA.

EXPOSURE(S): Three racial-ethnicity groups of Black, Hispanic, and White (as reference) veterans.

MAIN OUTCOME(S) AND MEASURE(S): Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling …

Generation Of Crispr-Cas9-Mediated Genetic Knockout Human Intestinal Tissue-Derived Enteroid Lines By Lentivirus Transduction And Single-Cell Cloning, Shih-Ching Lin, Kei Haga, Xi-Lei Zeng, Mary K Estes

Faculty, Staff and Students Publications

Human intestinal tissue-derived enteroids (HIEs; also called organoids) are a powerful ex vivo model for gastrointestinal research. Genetic modification of these nontransformed cultures allows new insights into gene function and biological processes involved in intestinal diseases as well as gastrointestinal and donor segment-specific function. Here we provide a detailed technical pipeline and protocol for using the CRISPR-Cas9 genome editing system to knock out a gene of interest specifically in HIEs by lentiviral transduction and single-cell cloning. This protocol differs from a previously published alternative using electroporation of human colonoids to deliver piggyback transposons or CRISPR-Cas9 constructs, as this protocol uses …

Intestinal Deletion Of 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Promotes Expansion Of The Resident Stem Cell Compartment, Alexandria M Doerfler, Jun Han, Kelsey E Jarrett, Li Tang, Antrix Jain, Alexander Saltzman, Marco De Giorgi, Marcel Chuecos, Ayrea E Hurley, Ang Li, Pauline Morand, Claudia Ayala, David R Goodlett, Anna Malovannaya, James F Martin, Thomas Q De Aguiar Vallim, Noah Shroyer, William R Lagor

Faculty, Staff and Students Publications

BACKGROUND: The intestine occupies the critical interface between cholesterol absorption and excretion. Surprisingly little is known about the role of de novo cholesterol synthesis in this organ, and its relationship to whole body cholesterol homeostasis. Here, we investigate the physiological importance of this pathway through genetic deletion of the rate-limiting enzyme.

METHODS: Mice lacking 3-hydroxy-3-methylglutaryl-coenzyme A reductase (Hmgcr) in intestinal villus and crypt epithelial cells were generated using a Villin-Cre transgene. Plasma lipids, intestinal morphology, mevalonate pathway metabolites, and gene expression were analyzed.

RESULTS: Mice with intestine-specific loss of Hmgcr were markedly smaller at birth, but gain …

Measuring The Intensity Of Mymotivators™ / Whole Brain® Communication In Print Advertising, Tanner Schulz

Undergraduate Honors Capstone Projects

Advertising’s purpose is to create a state of mind conducive to purchase (Colley, 1961).

This study seeks to identify, measure, and understand the intrinsic motivators communicated within print advertisements and quantify their intensities. The theory is that ads with more intense motivator content - distributed somewhat evenly across all four quadrants of the Whole Brain ® Model - will be more effective in influencing that state of mind.

This research is the first step in identifying, quantifying, and visualizing motivators communicated within print advertisements. The study analyzed 15 print ads found in contemporary magazines.

The framework for this work is …

Metabolic Inflexibility In Youth With Obesity: Is It A Feature Of Obesity Or Distinctive Of Youth Who Are Metabolically Unhealthy?, Nour Y Gebara, Joon Young Kim, Fida Bacha, Sojung Lee, Silva Arslanian

Faculty, Staff and Students Publications

Individuals with obesity have metabolic inflexibility with diminished fasting fat oxidation and blunted increase in respiratory quotient (RQ) in insulin-stimulated states. However, it is unclear if metabolic inflexibility is a characteristic of obesity per se or is unique to youth who have metabolically unhealthy obesity (MUO) compared with metabolically healthy obesity (MHO). We investigated metabolic flexibility in youth with MUO, MHO and normal weight (NW) and compared their metabolic characteristics. Youth (n = 188) were divided, based on cut-off points for in vivo insulin sensitivity (IS) of adolescents with NW, into 137 with MUO and 51 with MHO. Fasting hepatic …

A Phenomenological Study On Teachers' Lived Experience With Self-Efficacy Teaching Face-To-Face Instruction During The Covid-19 Pandemic, James Scott Phillips

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological study was to describe teachers’ lived experiences with self-efficacy teaching face-to-face instruction during the COVID-19 pandemic in a public school district in South Georgia. The theory guiding this study is Bandura’s (1977) theory of self-efficacy which was used to answer the following central research question: What are teachers’ lived experience with self-efficacy teaching face-to face-instruction during the COVID-19 pandemic? Twelve teachers from two schools provided a description of their lived experiences teaching in-person instruction amid the pandemic. Data was collected through semi-structured interviews, teacher journals, and a focus group. Data analysis followed Moustakas’ (1994) …

Applying Biblical Teaching To Resolve Power Struggles Between The Pastor And Deacons In A Southern Baptist Church, Jason Oneal Sweeton

Doctoral Dissertations and Projects

As the Body of Christ, each person within the church must know their role and responsibility, especially the leadership. The Bible teaches that there are pastors, elders, and bishops referring to one office who have been given the authority to shepherd, or lead as it were, the church. The Bible teaches that deacons are an integral part of the church. They are to be servants in the church and minister to the needs of the congregation. The purpose of this project lies in the misconceptions surrounding the roles and biblical responsibilities of both deacons and pastors. Many churches simply follow …

The Experiences Of Elementary School Teachers Teaching In A Virtual Learning Program Who Have Established Presence In The Classroom: A Phenomenological Study In The Southeastern U.S., Amy Tyler Stevenson

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological study was to understand the shared experiences of teachers who have established presence in online classrooms after transitioning from face-to-face to online elementary classrooms in a virtual program developed during the COVID-19 pandemic. The theory guiding this study was the community of inquiry (CoI) framework, developed by Garrison et al., as it specifically relates to distance and online learning and provides a context for research. In this qualitative study, data was collected through interviews, documentation, and a focus group with 11 online teachers (OT) representing several grade levels in an online program. Data was …