Digital Commons Network^™

Clinical Reasoning Education In The Clerkship Years: A Cross-Disciplinary National Needs Assessment, Jonathan G Gold, Christopher L Knight, Jennifer G Christner, Christopher E Mooney, David E Manthey, Valerie J Lang

Faculty, Staff and Students Publications

BACKGROUND: Improving clinical reasoning education has been identified as an important strategy to reduce diagnostic error-an important cause of adverse patient outcomes. Clinical reasoning is fundamental to each specialty, yet the extent to which explicit instruction in clinical reasoning occurs across specialties in the clerkship years remains unclear.

METHOD: The Alliance for Clinical Education (ACE) Clinical Reasoning Workgroup and the Directors of Clinical Skills Courses (DOCS) Clinical Reasoning Workgroup collaborated to develop a clinical reasoning needs assessment survey. The survey questionnaire covered seven common clinical reasoning topics including illness scripts, semantic qualifiers, cognitive biases and dual process theory. Questionnaires were …

Multi-Antigen-Targeted T-Cell Therapy To Treat Patients With Relapsed/Refractory Breast Cancer, Valentina Hoyos, Spyridoula Vasileiou, Manik Kuvalekar, Ayumi Watanabe, Ifigeneia Tzannou, Yovana Velazquez, Matthew French-Kim, Wingchi Leung, Suhasini Lulla, Catherine Robertson, Claudette Foreman, Tao Wang, Shaun Bulsara, Natalia Lapteva, Bambi Grilley, Matthew Ellis, Charles Kent Osborne, Angela Coscio, Julie Nangia, Helen E Heslop, Cliona M Rooney, Juan F Vera, Premal Lulla, Mothaffar Rimawi, Ann M Leen

Faculty, Staff and Students Publications

PURPOSE: Adoptively transferred, ex vivo expanded multi-antigen-targeted T cells (multiTAA-T) represent a new, potentially effective, and nontoxic therapeutic approach for patients with breast cancer (BC). In this first-in-human trial, we investigated the safety and clinical effects of administering multiTAA T cells targeting the tumor-expressed antigens, Survivin, NY-ESO-1, MAGE-A4, SSX2, and PRAME, to patients with relapsed/refractory/metastatic BC.

MATERIALS AND METHODS: MultiTAA T-cell products were generated from the peripheral blood of heavily pre-treated patients with metastatic or locally recurrent unresectable BC of all subtypes and infused at a fixed dose level of 2 × 107/m2. Patients received two infusions of cells 4 …

Functional Studies Of Genetic Variants Associated With Human Diseases In Notch Signaling-Related Genes Using Drosophila, Sheng-An Yang, Jose L Salazar, David Li-Kroeger, Shinya Yamamoto

Duncan NRI Faculty and Staff Publications

Rare variants in the many genes related to Notch signaling cause diverse Mendelian diseases that affect myriad organ systems. In addition, genome- and exome-wide association studies have linked common and rare variants in Notch-related genes to common diseases and phenotypic traits. Moreover, somatic mutations in these genes have been observed in many types of cancer, some of which are classified as oncogenic and others as tumor suppressive. While functional characterization of some of these variants has been performed through experimental studies, the number of ‘variants of unknown significance’ identified in patients with diverse conditions keeps increasing as high-throughput sequencing technologies …

Safety And Efficacy Of Electrical Stimulation For Lower-Extremity Muscle Weakness In Intensive Care Unit 2019 Novel Coronavirus Patients: A Phase I Double-Blinded Randomized Controlled Trial, Alejandro Zulbaran-Rojas, Ramkinker Mishra, Naima Rodriguez, Rasha O Bara, Myeounggon Lee, Amir Behzad Bagheri, James P Herlihy, Muhammad Siddique, Bijan Najafi

Center on Aging Staff Publications

Background: Intensive care unit (ICU) prolonged immobilization may lead to lower-extremity muscle deconditioning among critically ill patients, particularly more accentuated in those with 2019 Novel Coronavirus (COVID-19) infection. Electrical stimulation (E-Stim) is known to improve musculoskeletal outcomes. This phase I double-blinded randomized controlled trial examined the safety and efficacy of lower-extremity E-Stim to prevent muscle deconditioning.

Methods: Critically ill COVID-19 patients admitted to the ICU were randomly assigned to control (CG) or intervention (IG) groups. Both groups received daily E-Stim (1 h) for up to 14 days on both gastrocnemius muscles (GNMs). The device was functional in the IG and …

Selectively Targeting Disease-Restricted Secretogranin Iii To Alleviate Choroidal Neovascularization, Liyang Ji, Prabuddha Waduge, Lili Hao, Avinash Kaur, Wencui Wan, Yan Wu, Hong Tian, Jinsong Zhang, Keith A Webster, Wei Li

Faculty, Staff and Students Publications

Choroidal neovascularization (CNV), a leading cause of blindness in the elderly, is routinely treated with vascular endothelial growth factor (VEGF) inhibitors that have limited efficacy and potentially adverse side effects. An unmet clinical need is to develop novel therapies against other angiogenic factors for alternative or combination treatment to improve efficacy and safety. We recently described secretogranin III (Scg3) as a disease-selective angiogenic factor, causally linked to diabetic retinopathy and acting independently of the VEGF pathway. An important question is whether such a disease-selective Scg3 pathway contributes to other states of pathological angiogenesis beyond diabetic retinopathy. By applying a novel …

Initial Experiences Using Plasma Rich In Growth Factors To Treat Keratoneuralgia, Margaret Wang, Sowmya Yennam, Stephen Pflugfelder

Faculty, Staff and Students Publications

Keratoneuralgia, a clinical diagnosis of sensitized corneal pain without visible ocular surface damage, generally has minimal response to conventional therapies. Causes include refractive surgery and chronic dry eye. We evaluated the efficacy of Plasma Rich in Growth Factors (PRGF), a novel treatment prepared using a commercially available kit, in patients with keratoneuralgia. A retrospective chart review identified patients who had the clinical diagnosis of keratoneuralgia and were treated with PRGF for at least 3 months from October 2015 to April 2020 at a single academic institution. Both objective eye exam findings and concurrent treatments were obtained at baseline, 3 months, …

Cathepsin S Is A Novel Target For Age-Related Dry Eye, Zhiyuan Yu, Jinmiao Li, Gowthaman Govindarajan, Sarah F Hamm-Alvarez, Jehan Alam, De-Quan Li, Cintia S De Paiva

Faculty, Staff and Students Publications

Cathepsin S (CTSS) is a protease that is proinflammatory on epithelial cells. The purpose of this study was to investigate the role of CTSS in age-related dry eye disease. Ctss−/− mice [in a C57BL/6 (B6) background] of different ages were compared to B6 mice. CTSS activity in tears and lacrimal gland (LG) lysates was measured. The corneal barrier function was investigated in naïve mice or after topical administration of CTSS eye drops 5X/day for two days. Eyes were collected, and conjunctival goblet cell density was measured in PAS-stained sections. Immunoreactivity of the tight junction proteins, ZO-1 and occludin, was …

New, Potent, Small Molecule Agonists Of Tyrosine Kinase Receptors Attenuate Dry Eye Disease, Zhiyuan Yu, Shaon Joy, Tianxiong Mi, Ghasem Yazdanpanah, Kevin Burgess, Cintia S De Paiva

Faculty, Staff and Students Publications

Nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and neurotrophin3 (NT-3) bind to tyrosine kinase (Trk) receptors, TrkA, TrkB, and TrkC, respectively. This study investigated the efficacy of novel molecule agonists of Trk receptors in an in vivo model of dry eye disease (DED). Small molecule TrkC agonist (C1) and a pan-Trk agonist (pan) were synthesized for this. C57BL/6J mice were subjected to desiccating stress (DS) and received bilateral eye drops of C1, pan, or vehicle (2x/day). Dry eye signs, inflammation and expression of corneal barrier function, and conjunctival goblet cell (GC) densities were measured as part of the DED …

Targeting Type I Interferons In Systemic Lupus Erythematous, Sebastian Bruera, Thandiwe Chavula, Riya Madan, Sandeep K Agarwal

Faculty, Staff and Students Publications

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with systemic clinical manifestations including, but not limited to, rash, inflammatory arthritis, serositis, glomerulonephritis, and cerebritis. Treatment options for SLE are expanding and the increase in our understanding of the immune pathogenesis is leading to the development of new therapeutics. Autoantibody formation and immune complex formation are important mediators in lupus pathogenesis, but an important role of the type I interferon (IFN) pathway has been identified in SLE patients and mouse models of lupus. These studies have led to the development of therapeutics targeting type I IFN and related pathways for …

Metabolic Targeting, Immunotherapy And Radiation In Locally Advanced Non-Small Cell Lung Cancer: Where Do We Go From Here?, Annika Dhawan, Phillip M Pifer, Vlad C Sandulache, Heath D Skinner

Faculty, Staff and Students Publications

In the US, there are ~250,000 new lung cancer diagnoses and ~130,000 deaths per year, and worldwide there are an estimated 1.6 million deaths per year from this deadly disease. Lung cancer is the most common cause of cancer death worldwide, and it accounts for roughly a quarter of all cancer deaths in the US. Non-small cell lung cancer (NSCLC) represents 80-85% of these cases. Due to an enormous tobacco cessation effort, NSCLC rates in the US are decreasing, and the implementation of lung cancer screening guidelines and other programs have resulted in a higher percentage of patients presenting with …

Reduced Pro-Inflammatory Dendritic Cell Phenotypes Are A Potential Indicator Of Successful Peanut Oral Immunotherapy, Sara Anvari, Levi B Watkin, Charles G Minard, Kimberly Schuster, Oluwatomi Hassan, Aikaterini Anagnostou, Jordan S Orange, David B Corry, Carla M Davis

Faculty, Staff and Students Publications

Dendritic cells are important mediators in the early presentation of antigen and regulation of the differentiation of T cells. Peanut oral immunotherapy (POIT) results in desensitization in most peanut allergic individuals (responders), but not in others due to allergic reactions (non-responders). Delineation of early immunologic changes contributing to desensitization would help clarify the POIT mechanism of action. We analyzed dendritic cells in 15 pediatric subjects (5-12 years) undergoing a phase 1 single-center POIT study. We examined dendritic cells at baseline, 6-, 12-, 18- and 24-weeks after initiation of POIT and responders of therapy were compared to non-responders and healthy controls. …

The Lives Of Late Soviet Science, 1945-1991, Grégory Dufaud, Ksenia Tatarchenko

Research Collection College of Integrative Studies

This study explores the multifaceted landscape of Soviet science from the end of World War II to the dissolution of the USSR in 1991. It examines the interplay between scientific innovation and political ideology, highlighting how the state shaped research agendas and scientific practices during a period marked by both significant achievements and profound challenges. Through an analysis of key scientific institutions, prominent figures, and pivotal projects, the study illustrates the tensions between ideological constraints and the pursuit of knowledge. Additionally, it addresses the impacts of international collaboration and competition during the Cold War, revealing how these dynamics influenced scientific …

A Tool For Biometric Interpretation Of Forensic Str Dna Profiles, Ahmad Jamal Baroudi

Graduate Theses, Dissertations, and Problem Reports (ETD)

Rapid DNA biometric identification applications are becoming more essential and widely used in human identity validation processes. Despite their powerful identification capabilities, processing a sample to generate a forensic DNA profile still takes longer compared with other rapid biometric technologies. Methods used to speed up the analysis could lead to signal artifacts similar to those arising from low copy or degraded DNA samples, making the electropherogram unsuitable for forensic interpretation and analysis. The goal of this research effort is to apply biometrics and mathematical approaches to forensic STR (Short Tandem Repeat) profiles. To accomplish this goal, a multi-function software tool …

Ecology Of Black-Legged Ticks (Ixodes Scapularis) At Fort Drum Military Installation, New York, Lucas Eli Price

Graduate Theses, Dissertations, and Problem Reports (ETD)

The number of confirmed cases of Lyme disease in the United States of America has risen from 12,801 cases reported in 1997, which is the earliest year these data are available, to 23,453 confirmed cases in 2019. In the eastern United States, black-legged ticks (Ixodes scapularis) are the primary vector of Lyme disease, which is caused by the spirochete bacterium, Borrelia burgdorferi. Tick abundance tends to be highest in dense forest habitats and where wildlife diversity is low. Because wildlife species have varying levels of competency as reservoir hosts, sources of tick bloodmeals influence Lyme disease ecology. …

Survival Rate Of Dental Implants Placed In Alveolar Ridge Preservation Sites - Systematic Review, Sravanthi Papisetti

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: It is not known so far performing Alveolar Ridge Preservation (ARP) in a freshly extracted socket with intact walls would improve clinical outcomes of implants placed in these sites. It is not known whether different biomaterials and techniques would affect the survival of dental implants.

Aim: The current systematic review is undertaken to assess the survival rate of dental implants placed in these sockets and to assess different socket graft materials as well as techniques of ridge preservation with regard to the survival of implants.

Material methods: Search for relevant articles was done in Medline (PubMed). No …

Factors Influencing Brook Trout Population Dynamics And Resilience In Central Appalachian Headwater Streams, Christopher W. Schwinghamer

Graduate Theses, Dissertations, and Problem Reports (ETD)

Central Appalachia has a unique history of human perturbation due largely to its historical economic reliance on extractive industry and timber harvest. Legacy impacts from these historic disturbances along with contemporary stressors in the form of continued industry, changing climates, altered land use, habitat fragmentation, and introduced species can present great threats to the region’s aquatic ecosystems. Brook Trout Salvelinus fontinalis are a species that has recreational and economic importance to the communities of central Appalachia but declines in size and abundance have been observed. Given the disturbances that threaten Brook Trout populations, understanding how their populations will respond to …

Mtdna Heteroplasmy In Hair Shafts Versus Buccal Swabs For Forensic Applications, Sara R. Bodnar

Graduate Theses, Dissertations, and Problem Reports (ETD)

Mitochondrial DNA (mtDNA) analysis has several forensic applications such as criminal investigations, identification of human remains, and missing person investigations. It is also the only type of DNA that is available from certain sample types such as hair shafts. The presence of mtDNA heteroplasmy within and between tissue types can lead to mtDNA sequence differences when comparing samples originating from the same individual. Studies on mtDNA heteroplasmy are increasingly being carried out for their implications in forensic interpretation of mtDNA sequences. Specifically, mtDNA in buccal swabs compared to hair samples from one individual may show differences in sequence due to …

Genetic Assessment Of Lake Sturgeon Stocking Practices In Two Lake Superior Tributaries, Mary E. Akers

Graduate Theses, Dissertations, and Problem Reports (ETD)

Lake sturgeon were extirpated throughout much of their historic range in the early 1900s due to overharvest, habitat degradation, and reduced water quality. Interagency management plans have worked to identify historic locations and remnant populations suitable for stocking and habitat remediation to rebuild self-sustaining populations of lake sturgeon within their historic range. The St. Louis River population was extirpated in the early 1900s until lake sturgeon were stocked from 1983-2000 from two different source populations (Wolf River, Sturgeon River). Natural reproduction was confirmed in 2011 and F1 generation larvae were collected in 2017 (n = 41) and 2019 (n = …

Effects Of Depression And Stress On Oral Self-Care Among Perinatal Women In Appalachia: A Longitudinal Study, Jeongwi An

Graduate Theses, Dissertations, and Problem Reports (ETD)

Oral health during the perinatal period has an impact on the health of women and their offspring. Oral self-care behaviors are preventive methods that can be employed to maintain or improve oral health but may be compromised during the perinatal period. Identifying factors affecting oral self-care behaviors might provide direction on how to intervene in oral health during and after pregnancy. The purpose of this study was to investigate independent and interactive effects of depression and stress on oral self-care behaviors of perinatal women in Appalachia, given the burden of oral disease in this region. A total of 1,172 women …

Feed Conditioning Effects On Enzymes, Amino Acids, And Subsequent Broiler Performance, Elizabeth Ann Lynch

Graduate Theses, Dissertations, and Problem Reports (ETD)

There are many things that can be done to improve broiler performance including, but not limited to, pelleting, proper Lys inclusion, and exogenous enzyme supplementation. Pelleting has the ability to improve feed form, reduce wastage, improve bird performance metrics, and decrease pathogens within the feed. Pathogen reduction can be further reduced by hygienic pelleting practices which include an increase in temperature or retention time within a conditioner or hygieniser. However, hygienic pelleting can degrade valuable AA and enzymes (more specifically for the current thesis research Lys and phytase) and make them unavailable to the animal. Supplementing Lys to account for …

Influence Of Saturation Nonequilibrium And Variable Operation Conditions On The Electromechanical Performance Of Ionic Polymer Metal Composite Actuator Architectures, Allison Maria Arnold

Graduate Theses, Dissertations, and Problem Reports (ETD)

Electroactive polymers (EAPs) continue to gain attention for their potential to offer unique and versatile solutions in the soft robotic and flexible electronic industries. Ionic Polymer-Metal Composites (IPMCs) are a class of ionic-type EAPs which can be configured as capacitor actuators with very low voltage requirements (≤ 5 V AC or DC). Their compact, portable, and lightweight properties, coupled with a biomimetic bending actuation response make them ideal for human-machine integrated technologies such as medical implants, active skins, and artificial muscles. The Nafion-based IPMC can be described as a layered composite capacitor containing an ionic polymer core, sandwiched between chemically …

Characterization Of Two Krab-Containing Zinc Finger Transcription Factors In Bovine Preimplantation Embryonic Development, Mingxiang Zhang

Graduate Theses, Dissertations, and Problem Reports (ETD)

Oocyte developmental competence or oocyte intrinsic quality describes the capability of oocytes to resume meiosis, cleave and develop to blastocyst stage after fertilization, implant and develop to term in a good health. A growing number of evidences indicate that the majority of embryonic mortality occurs during early embryonic development in different species, including human, horse and cattle primarily due to poor oocyte quality. Maternal effect genes are key aspects of oocyte quality, which are transcribed during the process of oogenesis and folliculogenesis. The maternal factors are accumulated in oocytes, orchestrating various early developmental events including fertilization, epigenetic reprogramming and zygotic …

Anthropogenic Disturbance Regimes Impact The Microbial And Chemical Composition Of Soils And Sediments Across Ecosystems, Gregory D. Martin

Graduate Theses, Dissertations, and Problem Reports (ETD)

Human activities have led to profound changes in the climate and environment, fundamentally changing global carbon and nitrogen cycles. Ongoing conversion of wildland for human use and the intensification of agricultural systems have dire consequences for biodiversity and the ecosystem services that support society. While natural disturbance regimes are important for the long-term maintenance of native biodiversity and ecosystem function, many disturbances are becoming increasingly frequent due to anthropogenic activities. Increasing the frequency, intensity, or duration of disturbances can prevent ecosystems from returning to their previous equilibria. Disturbance-induced changes to the local environment shape microbial communities, which in turn govern …

Similitude, Scaling, And Prediction Of Stream Dissolved Oxygen Across The Contiguous U.S., Aron Gebreslase

Graduate Theses, Dissertations, and Problem Reports (ETD)

Dissolved oxygen (DO) is a general indicator of stream water quality and ecosystem health. However, the concentration of in-stream DO is controlled by various climatic, land use/cover, hydrologic, biochemical, and ecological drivers. Observational data for stream DO are often unavailable at the desired temporal and spatial scales. Accurate and reliable prediction of stream DO concentration based on a small set of environmental drivers is important to guide the water managers and policymakers to achieve and maintain healthy streams. This dissertation focused on identifying the dominant controls of stream DO and understanding the mechanisms and environmental regimes by employing machine learning, …

Experience Of Parents Caring For A Child With An Acquired Disability, Brad E. Phillips

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Parents caring for a child with an acquired disability often report a negative impact on physical, psychological, emotional, and spiritual health associated with caregiver burden related to their child’s complex health needs. This is further complicated by additional challenges related to the loss of a previously healthy child. Traditional patterns of loss follow linear, time-bound stages that have been observed to be unrelated to the experiences of these specific parents and their families. Therefore, the concept transforming loss has been developed to better understand how these parents navigate loss and find meaning in spite of their suffering.

Purpose: The …

Critical Perspectives On Produce Prescription Programs & Us Federal Nutrition Policy, Alanna K. Higgins

Graduate Theses, Dissertations, and Problem Reports (ETD)

Produce prescription programs, interventions operating at the intersection of food access and public health, are steadily increasing in number across the United States since 2010. I leverage key informant interviews, participant observations, and event ethnographies to form a four-year institutional ethnography of the implementation of produce prescriptions within West Virginia alongside a legal-policy archaeology methodology to understand how produce prescriptions have been institutionalized and funded within the US Farm Bill. While much of produce prescription program growth is attributed to an expansion of federal funding starting in 2014, this dissertation demonstrates that these programs and the federal legislation which has …

Novel Modes Of Synchronization And Extreme Events In Coupled Chemical Oscillators, David Allen Mersing

Graduate Theses, Dissertations, and Problem Reports (ETD)

We experimentally and computationally investigate dynamical behaviors in coupled chemical oscillators. These networks of chemical oscillators are created using catalytic Ru(bpy)₃²⁺ loaded cation exchange beads submerged in catalyst-free Belousov-Zhabotinsky (BZ) solutions. Various network structures are created by utilizing the photosensitive nature of the Ru(bpy) ₃²⁺ catalyst. The response of the oscillators due to light stimuli can be characterized by constructing a phase response curve (PRC). The PRC quantifies the excitatory and inhibitory responses of BZ oscillators due to applied light perturbations as a function of the oscillators' phase. Different initial concentrations of reactants in the BZ reaction …

A Shock To The System: Analyzing Ethnocentric Populist Support Before And After Crises, Kyu Chul Shin

Graduate Theses, Dissertations, and Problem Reports (ETD)

Using the question of what is driving the support for populists in the mid-late 2010s in Western Europe and the United States as the starting point, this dissertation attempts to answer a number of different questions related to populists: Were the reasons behind support for populists in countries that saw an increase in support for populisms similar to those that saw a decrease in support? Are the reasons for supporting right-wing populists different from more general ethnocentric populists? Are the reasons that Americans supported Donald Trump similar or different from the reasons behind support for Western European populists? Following migration-related …

Sleep And Cardiovascular Reactivity To An Acute Virtual Stressor, Alaina Grace Tiani

Graduate Theses, Dissertations, and Problem Reports (ETD)

Inappropriate response and magnitude of cardiovascular reactivity (CVR) to stress is a proposed mechanism through which environmental stressors are linked with poor cardiovascular health outcomes (Chida & Steptoe, 2010; Krantz & Manuck, 1984). Studies of reactivity to various laboratory tasks commonly control for factors known to influence CVR such as smoking, medication use, caffeine intake, and BMI; however, few have considered the influence of sleep on CVR. In order to determine whether sleep characteristics need to be assessed and considered in studies of CVR, this study aimed to examine the association between indices of sleep quality and the magnitude and …

Modeling, Fabrication, And Characterization Of Rf-Based Passive Wireless Sensors Composed Of Refractory Semiconducting Ceramics For High Temperature Applications, Kavin Sivaneri Varadharajan Idhaiam

Graduate Theses, Dissertations, and Problem Reports (ETD)

Real-time health monitoring of high temperature systems (>500^oC) in harsh environments is necessary to prevent catastrophic events caused by structural failures, varying pressure, and chemical reactions. Conventional solid-state temperature sensors such as resistance temperature detectors (RTDs) and thermocouples are restricted by their operating environments, sensor dimensions and often require external power sources for their operation. The current work presents the research and development of RF-based passive wireless sensing technology targeting high temperatures and harsh environmental conditions. Passive wireless devices are generally classified as near-field and far-field devices based on the interrogation distance. Near-field sensors are placed at …