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Protecting The Protectors: Supporting Emergency Department Security Officer Wellness: A Brief Conceptual Review And Research Agenda, James A. Espinosa Md, Paul Sarnese, Alan Lucerna

Rowan-Virtua Research Day

Background: Workplace violence in emergency departments (EDs) has been widely studied, yet the occupational wellness of ED security officers has received comparatively limited focused attention in emergency medicine literature.

Objective: To conceptually examine the role of ED security personnel within the emergency care environment and outline a research agenda addressing their wellness.

Discussion: Security officers frequently respond to behavioral crises, assist with restraint events, and help maintain safety for patients, visitors, and staff. These duties include vigilance between events, sudden physical exertion, and exposure to aggression. ED security work often follows a recognizable rhythm: baseline vigilance, rapid escalation response, physical …

Light Therapy Vs. Pharmacotherapy In Improving Quality Of Life In Seasonal Affective Disorder, Hitanshi Patel

Rowan-Virtua Research Day

Seasonal Affective Disorder (SAD) is a pattern of depressive episodes triggered by seasonal changes. Light therapy involves exposure to artificial bright light by stimulating the production of serotonin. Pharmacotherapy primarily requires careful consideration of side effects and patient response times. Findings indicate that light therapy not only leads to significant improvements in depressive symptoms but also long-term enhancement in quality of life. Pharmacotherapy, while effective for some, often involves delays in response and potential adverse effects that can diminish overall satisfaction.

A Conceptual Framework That Supports The Transition From Supervised Training To Independent Clinical Practice, Aligned With Acgme Milestones, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: The transition from residency to independent attending practice represents a critical developmental inflection point. Although residents achieve competency-based milestones, many graduates report challenges related to decision ownership, uncertainty tolerance, and the assumption of final clinical authority. Traditional training emphasizes competence under supervision, while independent practice requires performance without supervision. Objective: To propose a conceptual framework that supports the transition from supervised training to independent clinical practice, aligned with ACGME Milestones. Methods: Conceptual synthesis of literature on preparedness for practice, entrustment, and professional identity formation, integrated with practical observations from graduate medical education. Results (Conceptual): Six domains central to transition …

Atomoxetine Enhances Specific Dimensions Of Cognitive Performance In A Rodent Strategy Shifting Assay, Jessica Ivanov

Rowan-Virtua Research Day

Title: Atomoxetine enhances specific dimensions of cognitive performance in a rodent strategy shifting assay

Authors: Jessica Ivanov, Christopher P. Knapp, Barry D. Waterhouse, Rachel L. Navarra

Objective: Cognitive flexibility, a domain of executive function, supports adaptive shifts in behavior in response to changing environmental demands and task contingencies. Deficits in this capacity are common to neuropsychiatric disorders such as Attention Deficit Hyperactivity Disorder (ADHD), where improper regulation of the catecholamine transmitters dopamine (DA) and norepinephrine (NE) within the prefrontal cortex (PFC) has been implicated. Atomoxetine (ATX), a selective NE transporter (NET) inhibitor, elevates levels of NE and DA in the …

Schizophrenia And Multiple Dka Episodes Leading To Neurocognitive Deficits In A 37yo Patient, Andrew Harmon D.O.

Rowan-Virtua Research Day

Patient is a 37 year old female with a PPHx of schizoaffective disorder and PMH of type 1 Diabetes who has had numerous admissions to the ICU due to uncontrolled blood sugars in the setting of continued delusions and medication noncompliance. With continued episodes of DKA, patient continued to psychiatrically decline over the course of multiple years. Studies have shown that anti-psychotic treatment in schizophrenia can help improve cognitive functioning.

Mental Health Comorbidities And Ibd Outcomes In Patients Treated With Anti–Il-23 Therapy, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Om Patel, Yecheskel Schneider, Jason Hyman, Abdallah Hussein

Rowan-Virtua Research Day

Background: Depression and anxiety are prevalent in inflammatory bowel disease (IBD) and may adversely influence outcomes. We evaluated the impact of comorbid mood disorders on clinical outcomes among IBD patients treated with anti–IL-23 agents.

Methods: Using a global de-identified electronic health record network, adults with Crohn's disease or ulcerative colitis initiating an anti–IL-23 agent were identified. Cohort 1 included patients with a documented mood disorder (depression and/or anxiety) at or prior to treatment initiation; Cohort 2 included those without mood disorders. Propensity score matching (1:1) on demographics and comorbidities yielded 3,546 patients per cohort. Primary outcomes included inpatient/ED encounters, abscess/fistula, …

When Biomarkers Disagree: Diagnostic Challenges In Alzheimer’S Disease, Hayya Ali, Omar C. Chishti

Rowan-Virtua Research Day

Alzheimer’s disease (AD) is commonly diagnosed using a combination of clinical evaluation and biomarkers, including amyloid positron emission tomography (PET) imaging and tau protein levels. However, discordant biomarker findings can complicate diagnosis and clinical decision-making. We present a case study of a patient with progressive cognitive decline who demonstrated positive amyloid PET imaging but negative tau biomarkers. The objective of this case report is to demonstrate key diagnostic challenges in Alzheimer’s disease and highlight the need for a comprehensive, multimodal diagnostic approach. This case underscores the limitations of relying on a single biomarker modality and highlights the potential for overlap …

Cannabis Use Disorder And Executive Function - A Literature Review, Jonathan Perumpail

Rowan-Virtua Research Day

Cannabis use disorder (CUD) is recognized as a psychiatric condition characterized by persistent and problematic cannabis consumption that leads to marked functional impairment. Growing evidence suggests that chronic CUD exerts significant effects on executive functions such as inhibitory control, cognitive flexibility, goal-directed behavior, and decision-making. This literature review integrates findings from 25 studies focusing specifically on individuals with objectively diagnosed CUD to explore the effects on cognition in this patient population. Across studies, deficits in executive function are consistently observed, with adolescents and early-onset users demonstrating increased vulnerability. Neuroimaging studies reveal structural and functional alterations in the prefrontal cortex and …

When Flashbacks Don’T Return: Lasting Ptsd Remission After Utilization Of Alpha-1 Adrenergic Antagonists, Priyal Pritesh Shah, Tara Young, Danah Atassi, Afshan Khan, Christie Richardson, Martin Forsberg

Rowan-Virtua Research Day

Introduction

Research has indicated that potentially 90% of older adults have undergone at least one potentially traumatic event in their lifetime. Post-traumatic stress disorder (PTSD) is a psychiatric illness that follows a traumatic life event where the person is exposed to death, threatened death, actual or threatened serious injury, or actual/threatened sexual violence. This event triggers symptoms including flashbacks, recurrent nightmares, hypervigilance, dissociative reactions, and physiologic reactions to traumatic cues. Some recent reports in PTSD treatment have indicated the potential for the use of centrally-acting alpha-1 antagonists, such as prazosin and doxazosin, as effective treatments for PTSD-associated flashbacks and nightmares. …

When Malingering Is Suspected: A Structured Clinical Framework For Assessment And Documentation, Thomas Sim, Timothy Wong

Rowan-Virtua Research Day

When Malingering is Suspected: A Structured Clinical Framework for Assessment and Documentation

BACKGROUND:

Distinguishing malingering from primary psychosis remains a common challenge across all psychiatric settings from emergency, consult-liaison, and to inpatient units. According to DSM-5-TR, malingering is defined as the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Despite its prevalence, many clinicians receive limited formal training in its systematic assessment. Misidentification carries a bidirectional risk, as falsely labeling a genuinely psychotic patient as malingering may deny treatment whereas failure to detect malingering may result in misallocation of resources. Reliance on …

“This Wasn’T You”: Mania, Agency, And Moral Responsibility In Psychiatric Practice​, Phillip Mastoridis, Justin Scarano, Timothy Wong

Rowan-Virtua Research Day

A manic episode is a state of abnormally elevated or irritable mood with increased energy, impaired judgment, and risky or uncharacteristic behavior. This poster examines a case in which a woman, during a manic episode, placed doxylamine succinate, an over‑the‑counter sedating antihistamine, into her husband’s drink. After stabilization, she expressed shame and confusion about the act. In the clinical encounter, the treating psychiatrist responded, “It wasn’t you,” intending to reduce self‑blame and facilitate engagement in treatment. This reassurance was therapeutically effective but raises a deeper philosophical question: in what sense, if any, is it true?

Refractory Catatonia In Schizoaffective Disorder (Bipolar Type) Successfully Treated With Electroconvulsive Therapy, Shreya Kadi, Victoria Coles

Rowan-Virtua Research Day

Background: Catatonia is a neuropsychiatric syndrome

associated with mood and psychotic disorders and may

become life-threatening if untreated. While benzodiazepines

are first-line therapy, some cases are refractory and require

electroconvulsive therapy (ECT).

Hypothesis: Early use of ECT in refractory catatonia leads to

improved clinical and functional outcomes.

Methods: We present a retrospective case analysis of a 62-

year-old female with schizoaffective disorder, bipolar type,

who developed severe catatonia during inpatient psychiatric

hospitalization. Clinical course, Bush–Francis Catatonia Rating

Scale scores, and response to treatment were reviewed.

Results: The patient presented with severe catatonia (Bush–

Francis score 19) and elevated creatine kinase …

The Ramifications Of German Ostpolitik: How Germany’S Foreign Policy Influenced The Russia-Ukraine Conflict, John Aton

Senior Theses

German Ostpolitik, established during the Cold War, was the main foreign policy of Germany emphasizing international cooperation and diplomatic engagement with Russia. As the Russia-Ukraine conflict remains active, the challenges of this particular foreign policy’s adoption are evident within certain actions and decisions Germany made in the pursuit of mutual cooperation with Russia. By conducting a thorough analysis of the historical events in German Ostpolitik’s formation and its security policy, while assessing Germany’s leap for economic interdependence alongside Russia, this paper reveals a troubling dynamic where certain actions taken under the doctrine of German Ostpolitik influenced Germany to misjudge and …

Might Ite And Board Preparation Be Both Informative And Neurobiologically Formative? A Plausibility Argument Linking Study Processes To Hippocampal–Cortical Memory Consolidation, Pattern Recognition Networks, And Cognitive Efficiency, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:  The in-service training exam ( ITE ) and board preparation are traditionally framed as processes of information acquisition and evaluation. Educational discussions typically focus on knowledge transfer, study strategies, and examination performance. However, modern neuroscience suggests that sustained, emotionally salient, and repetitive cognitive challenge in adulthood can produce durable neuroplastic adaptations. Might such residency training be not only informative but also formative?

Objective: To propose a conceptual framework in which board preparation may be both informative and neurobiologically formative, functioning as a training environment that promotes integration of neural systems involved in memory retrieval, pattern recognition, and decision-making under …

The Use Of Prazosin In Individuals With Post-Traumatic Stress Disorder: A Scoping Review Protocol, Priyal Pritesh Shah, Marisa Riebesell, Afshan Khan, Amanda M. Carey, Emily Balog, Martin Forsberg

Rowan-Virtua Research Day

Background: Post-Traumatic Stress Disorder (PTSD) is a prevalent and debilitating condition, and is most often associated with sleep disturbances such as nightmares, flashbacks, and heightened arousal. Prazosin, an alpha-1 adrenergic antagonist, has been widely used for PTSD symptoms, however findings across studies are variable and limited, and the scope of existing evidence is not well established.

Objective: This scoping review aims to systematically map the literature on the use of prazosin in individuals with PTSD across diverse populations, settings, and study designs.

Methods: The scoping review will be conducted in accordance with JBI methodology and reported following PRISMA-ScR guidelines. A …

The Effects Of Misinformation And Source Credibility On False Recall In College Students, Ashlee Smolenski

Honors Capstones

Eyewitness testimony if often treated as strong evidence in legal systems, yet psychological research consistently shows that memory is not a perfect recording of events. Instead, memory is reconstructive and vulnerable to distortion. The present study examined whether exposure to misleading post-event information and differences in perceived source credibility would influence false recall in college students. Using a 2 x 2 factorial design, participants watched a brief video of a car accident and later received either misleading or neutral questions presented by a high credibility (police officer) or low credibility (elderly man) source. It was predicted that misinformation would decrease …

Invisible Shipwrecks And Neurological Endangerment: The Trade-Off In Seeking Asylum - Reframing The Neurobiological Cost Of Forced Migration, Eisha Giran

CISLA Senior Integrative Projects

Forced migration along the Spain–Morocco route represents one of the most visible humanitarian crises of the twenty-first century, yet its neurological dimensions remain insufficiently examined. This paper investigates how prolonged displacement and trauma reshape neural systems involved in stress regulation, memory, and emotional processing. It introduces the concept of neurological endangerment, defined as a condition of prolonged and inescapable threat exposure during forced migration in which stress-response systems remain chronically activated, opportunities for recovery are structurally constrained, and cumulative neurobiological risk persists beyond the period of immediate danger.

To address the gap between biological measurement and lived experience, this paper …

Assessing Medical Trainees Knowledge Of Secondary Traumatic Stress Before And After Clinical Experiences At The Cares Institute: A Literature Review, Anastasiya Matveyenko, Sarah Kleinle, Paul Furtaw, Rachel Silliman Cohen

Rowan-Virtua Research Day

Secondary Traumatic Stress (STS) has been positively correlated with burnout in healthcare professionals through numerous studies. It is defined as the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by another individual. Medical students experience high level of STS due to exposure to trauma during multiple clinical rotations. Child Abuse Research Education and Service (CARES) Institute treats children who have experiences of abuse, neglect, and other forms of trauma. As part of the current curriculum, Rowan SOM students rotate at the CARES Institute for at least a day for up to a month and might …

Phenomenological Philosophy Of Psychedelics: Psychedelic Experience In The Modes Of Saturation And Flesh, Michael V. Kramer

Electronic Theses and Dissertations

This work seeks to develop the nascent sub-field of the phenomenological philosophy of psychedelics. Beginning with a general overview of key aspects pertinent to psychedelic studies, the focus then turns to a general disciplinary discussion of current approaches within the philosophy of psychedelics, as well as psychedelic philosophy—a distinction which is technically deployed. Special consideration is given to the specific approach known as the “natural philosophy of psychedelics,” which is taken as the philosophical foil to the preferred approach of phenomenological philosophy. A survey of the extant literature regarding the implementation of phenomenology within psychedelic discourse is then provided …

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Examining A Positive Variation Of The Good Behavior Game With Head Start Children At Risk For Child Adversity And Externalizing Behavior Problems., Alexandra Gibson, Courtney P D Goldenberg, Malinda J. Colwell, Amelia E. Talley, Joaquín Borrego, Adam T. Schmidt

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Children participating in the Head Start program in the United States are predominantly from underserved groups, have increased rates of child adversity, and are at risk for externalizing behavior problems in the classroom. The Good Behavior Game (GBG) is an effective classroom management strategy for reducing disruptive and off-task classroom behaviors. However, previous research has not examined the GBG within the Head Start context.

METHODS: The current case-controlled study evaluated the effectiveness of the GBG in six Head Start children aged 3-5. Researchers conducted daily classroom behavioral observations of disruptive behaviors, and teachers completed pre- and post-treatment assessments of …

Reframing Emergency Medicine (And Healthcare) Wellness Measures: The Case For Adding Measures Of Physiological Sustainability, Exercise, Restoration, And Meaning, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Physician wellness measurement in Emergency Medicine (EM) in particular and in healthcare in general has largely focused on identifying distress states such as emotional exhaustion and depersonalization. Instruments such as the Maslach Burnout Inventory and related derivative surveys have been well-validated and  have played a central role in identifying the scope of burnout across healthcare systems.

Conceptual Framing

While current measures of distress are essential, they may not fully characterize the spectrum of clinician health. In many fields outside healthcare—including occupational health, resilience research, and positive psychology—assessment of well-being includes behaviors and experiences associated with sustained health, such as …

Worsening Obsessive Compulsive Disorder (Ocd) With New Onset Dementia, Melvin D. Ways Jr

Rowan-Virtua Research Day

Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition typically characterized by intrusive thoughts and repetitive behaviors with preserved insight. Dementia, a progressive neurocognitive disorder, is frequently associated with behavioral and psychiatric symptoms; however, its impact on pre-existing OCD is less well understood.

Subject of study includes evaluation of neurodegenerative processes to exacerbate pre-existing OCD symptoms. Evidence suggests that dysfunction in shared fronto-striatal circuits—particularly involving the orbitofrontal cortex and basal ganglia—may underlie this relationship. Additionally, cognitive impairment may reduce the ability to inhibit intrusive thoughts, further reinforcing compulsive behaviors. Emerging research also indicates a bidirectional association, with OCD linked to an …

Physician Bedside Communication Posture (Sitting Versus Standing) In Relation To Patient Satisfaction: A Focused Literature Review And Areas For Potential Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:

Sitting during patient encounters is commonly recommended in communication training, with the assumption that it improves patient satisfaction. However, the empirical evidence supporting this recommendation in Emergency Department (ED) settings appears limited.

Objective:

To review the existing literature examining physician posture (sitting versus standing) and its association with patient satisfaction and perceived communication quality.

Methods:

Narrative review of ED and non-ED studies evaluating posture during clinical encounters, with attention to study design, sample size, setting, and outcome measures.

Results:

ED-specific evidence remains heterogeneous. Some studies demonstrate that sitting increases patients’ perception of time spent at bedside without increasing actual …

Case Study: 46-Year-Old Female With Auditory Hallucinations, Ahmed Aly, Tayeb Ahamed, Chien Y. Cepeda, Apn

Rowan-Virtua Research Day

The case study discusses a patient seen at a voluntary psychiatric unit. Patient has been prescribed benzodiazepine and bupropion; she became dependent on the benzodiazepine due to social difficulties that have not been addressed by her prescriber. The study highlights the dependency of benzodiazepine while being offered bupropion (which lowers seizure threshold), which can be deadly if accompanied with benzodiazepine withdrawal

Comparative Efficacy Of Cognitive Behavioral Therapy And Intranasal Oxytocin In Adolescent Anorexia Nervosa, Nikhila P. Archakam, Akhila P. Archakam, Wesley A. Kim, Harshal Parmar, Iram Fatima

Rowan-Virtua Research Day

Anorexia nervosa (AN) is a severe and potentially life-threatening psychiatric disorder with the highest mortality rate among psychiatric illnesses affecting adolescents.¹ It is characterized by extreme restriction of caloric intake driven by an intense fear of weight gain or negative body image perception.¹ Mortality results from medical complications of starvation and an increased prevalence of suicide risk.¹ Although AN can occur at any point across the lifespan, it most commonly first presents during adolescence.¹ This developmental period is marked by significant hormonal, biological, and psychosocial changes. Early-onset AN is associated with stunted growth, pubertal delay, and long-term cognitive and emotional …

Impostor Phenomenon In Healthcare: Prevalence, Implications, And Educational Responses, James Espinosa, Robin Lahr, Sergey Medlenov, Swet Patel, Nicholas Tomasello, James Lee, Neel Parikh, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

The impostor phenomenon describes persistent self-doubt and fear of being exposed as a fraud despite objective evidence of competence. The term 'impostor phenomenon' is preferred over the term "imposter syndrome" because it is not a psychiatric diagnosis and avoids pathologizing normal developmental uncertainty. The original authors used the term 'phenomenon' (Clance & Imes, 1978), and contemporary scholarship increasingly adopts this terminology.

First described by Clance and Imes (1978), the construct has since been studied across diverse professional domains, including medicine, nursing, and academic leadership. Subsequent research demonstrates that impostor experiences occur across genders, training levels, and healthcare roles (Bravata et …

From Lists To Landscapes And Locations: Spatial Memory And Schema Formation (Memory Palace Adaptation) As A Neurobiologically Informed Strategy For Teaching Environmental And Toxicology Emergencies Ite And Board Review In Emergency Medicine Residency, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:

Most emergency medicine board domains inherit spatial scaffolding from foundational anatomy education (e.g., neuroanatomy, gastrointestinal tract, cardiopulmonary structures). Environmental emergencies lack an inherent anatomic anchor and are frequently taught as disconnected lists, increasing cognitive load and impairing schema formation. Similarly, toxicology crosses age, and specialty without an inherent anatomic structural anchor.

Objective:

To describe a scene-based, learner-generated landscape model designed to reintroduce spatial structure into environmental emergency education and to situate the model within contemporary neurobiology and learning science.

Educational Innovation:

Residents construct a large-format landscape diagram (sun–water–mountain schema) during live instruction. Environmental conditions are spatially anchored in ecologically …

The Ones That Got Away:Shared Misses, Shared Mastery — A Proposal For Leveraging Spaced Retrieval, Variable Reinforcement, And Collective Learning In Emergency Medicine Residency, James Espinosa D, Robin Lahr, James Lee, Swet M. Patel, Alan Lucerna

Rowan-Virtua Research Day

Background

Residents frequently engage in individual question-bank study for board preparation; however, missed questions are typically processed in isolation. Educational psychology demonstrates that spaced retrieval and variable reinforcement enhance durable learning. Psychological safety further supports collective sense-making in professional education . The addition of a periodic, structured, collective shared-review process model may leverage these principles within residency training.

Objective

To propose a resident-driven educational initiative that transforms individually missed board-style questions into a shared, psychologically safe learning stream that promotes durable knowledge retention and community-based mastery.  The movement of this stream could be a chief resident responsibility, or could be …

When Individual Implicit Bias Meets Ed System Turbulence: Expanding The Implicit Bias And Cultural Bias Conceptual Frame To Support Reflective Decision Making Through Both Individual Bias Reduction Strategies As Well As System-Level Design Approaches, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Cultural and implicit bias have been widely studied as contributors to disparities in healthcare delivery. Prior literature has largely conceptualized bias as an individual-level cognitive phenomenon occurring within clinician–patient interactions. However, emergency departments (EDs) function as complex adaptive systems (CAS), characterized by time pressure, uncertainty, cognitive load, and environmental noise. These conditions may contribute to the expression of implicit bias in clinical care.

Objective

To reframe cultural and implicit bias in the ED as both an individual cognitive property as well as a system-dependent and modulated  phenomenon and to propose that the operational state of the ED influences the …