Digital Commons Network^™

Comparative Analysis Of Demographic Data For Eligible Lifestyle Medicine Program Participants, Cajetan Ejianreh, Amy Cunningham

Phase 1

Introduction: Obesity is a major comorbidity linked to a myriad of health complications and poor treatment outcomes. Through partnership with the PCORI Institute, a comprehensive lifestyle medicine program is being developed to refer eligible patients within the Jefferson Health System. This comparative analysis aims to identify the demographics of these eligible patients.

Methods: Data was extracted from EPIC electronic health record from patients who had a “qualifying” encounter with one of the following specialties: OB/GYN, Geriatrics, Internal Medicine, and Family Medicine. Qualification of patients in this data collection was based on an encounter with one of the aforementioned specialties within …

Patient Experiences With Provision Of Telehealth Addiction Treatment Services, Kaleigh Spollen, Shane Nieves, Mph, Gregory Jaffe, Md, Msed, Vanessa Short, Phd, Mph

Phase 1

Introduction: Substance use disorder (SUD) is a nationwide public health crisis, and deaths from opioids have risen significantly since 1999. In recent years, telehealth has emerged as a novel modality for SUD treatment. This study aims to evaluate patient experiences with a telehealth program for SUD, identifying barriers and facilitators to participation in the program, as well as opportunities for program improvement.

Methods: This qualitative study comprises an online survey and semi-structured interview. Individuals 18 years of age or older who have attended at least one session of Jefferson’s telemedicine program for SUD treatment were enrolled in the …

Cardiovascular Outcomes Of Youth Female Athletes: Stratifications Of Risk Using Subdivisions In Sports, Jillian D'Souza, Nikta Nair, David Shipon, Md

Phase 1

Introduction: Sudden cardiac death (SCD) in youth athletes is a rare, but devastating event that may proactively be prevented through identification of pathologic structural, functional and electrical cardiac remodeling changes. Pathological changes in female athletes along with the associated risk and protective factors related to SCD are understudied. This study aims to identify pathological cardiac changes in female athletes and inquire whether strength-based versus endurance-based sports carry different levels of risk.

Methods: The HeartBytes database was compiled from cardiac screenings of youth athletes in Southeastern Pennsylvania conducted from 2014 to 2021. Screenings collected information from health questionnaires, physical …

Leveraging Social Media To Disseminate Evidence-Based Messaging About Substance Use To Reduce Stigma And Promote Harm Reduction In Adolescents And Young Adults, Jacob Mihalic, Gregory Jaffe, Md, Msed

Phase 1

Introduction

Substance use disorder (SUD) remains a major contributor to morbidity and mortality in Philadelphia, with adolescents and young adults (AYAs) particularly vulnerable due to peer influence and digital exposure. However, harm reduction messaging rarely targets AYAs directly. This project will explore how AYAs engage with social media, how these platforms shape their perceptions of SUD, and how digital messaging can be leveraged to reduce stigma and support prevention.

Methods

This qualitative project will conduct three focus groups with Philadelphia AYAs aged 13-18, recruited through local Boys and Girls Clubs. Discussions will explore how AYAs engage with SUD-related content online, …

Designing A Multilingual Instructional Language Tool For Patient Communication In Interventional Radiology, Ahlam Houssein, Samuel Almodóvar, Gregg Khodorov, Md, Mba, Sahib Sohal, Md, Robert Pugliese, Pharmd, David Dwyer, Md

Phase 1

Introduction: Language barriers in healthcare contribute to medical errors, reduced patient adherence, and increased procedural risk among patients with limited English proficiency (LEP), particularly in interventional radiology (IR), where real-time verbal instruction is essential for procedural success. Current virtual translation services lack the immediacy, specificity, and workflow integration required for intraprocedural communication. This project asks how a digital platform can enable IR professionals to communicate procedural instructions to LEP patients accurately and efficiently in real time, hypothesizing that a structured, phrase-based translation system will improve procedural efficiency and safety.

Methods: On-site interviews and workflow observations were conducted with IR physicians, …

Improving Options For Prehospital Management Of Hyperthermia, David Azizi, Connor Coyle, Robert Pugliese, Pharmd

Phase 1

Introduction: Hyperthermia, particularly heatstroke, is a life-threatening failure of thermoregulation that requires rapid cooling to prevent serious sequelae. Despite effective hospital-based systems, prehospital and austere environments lack portable solutions capable of achieving timely temperature reduction. This project investigates whether a lightweight, field-ready garment incorporating endothermic salts can improve prehospital hyperthermia management.

Methods: We conducted a literature review and expert interviews with emergency and wilderness medicine clinicians to identify limitations of existing tools and define design requirements. A prototype was designed with a thermally conductive inner layer and insulating outer layer integrating off-the-shelf chemical cold packs. Planned testing includes quantifying heat …

Temperature Control Vest For Use In Acute Hyperthermic Episodes, Connor Coyle, David Azizi, Isaac Kravatz, Robert Pugliese, Pharmd

Phase 1

Introduction: In the acute treatment of acute hyperthermia that is treated in austere conditions, there is a lack of a portable, effective, and inexpensive device that can rapidly lower the temperature of the patient back to baseline levels. With rapidly rising global temperatures, we anticipate an increase in acute heat strokes where correction by cooling can save countless lives. We want to create a medical device that is effective in cooling a patient with hyperthermia to increase survival and recovery outcomes. Our main inquiry is whether it is reasonable to design, produce, and test a cooling device that fits within …

Auravena, Isaac Kravatz, Bassem Fayek, Robert Pugliese, Pharmd

Phase 1

Introduction: Over 200 million peripheral IVs are placed annually, serving as critical access points for medications and therapies, yet up to 40% fail on the first attempt. While heat is often used to support IV placement, current methods are insufficient compared to what the literature suggests. Therefore, we asked: how might heat be applied more efficiently and sustainably to improve first-attempt success rates for patients with difficult IV access?

Methods: We began by interviewing nursing staff at an outpatient infusion center, uncovering a significant gap in care for patients with difficult IV access. These insights drove iterative design cycles focused …

Impact Of Jackson-Pratt Drain Placement Location On Postoperative Pain In Breast Mastectomy And Reconstruction, Spencer Haber, Bs, Elizabeth Simon, Bs, Krishna Koka, Bs, Devin Williams, Bs, Andrew Newman, Md

Phase 1

Introduction: The Jackson-Pratt (JP) drain is routinely used after breast mastectomy and reconstruction. However, postoperative JP drain usage is associated with an increased incidence of surgical site pain (SSP), which negatively impacts quality of life (QOL). We hypothesize that the anatomical site of JP drain placement relative to major nerve densities leads to variation in SSP and QOL.

Methods: This prospective cohort study will enroll 30 adult female patients undergoing breast mastectomy or reconstruction. Drain placement location will be measured intraoperatively using X, Y coordinates based on midline, anterior axillary line, and jugular notch landmarks. Normalized spatial data will be …

The Correlation Between Pain And Placement Of The Jackson-Pratt Drain In Post-Mastectomy Patients, Krishna Koka, Bs, Elizabeth Simon, Bs, Spencer Haber, Bs, Devin Williams, Bs, Andrew Newman, Md

Phase 1

Introduction

The Jackson-Pratt Drain is a frequently used closed-suction, active drain system that prevents seroma and hematoma formation through negative pressure drainage. Prior research has revealed that some patients report increased surgical site pain that negatively impacts quality of life. We hypothesize that interpatient variability in pain may be associated with the location of drain placement relative to local innervation.

Methods

We are targeting 30 biologically female patients >30 years old undergoing bilateral mastectomy, excluding those with factors affecting chest wall innervation. Drain placement was measured bilaterally along an X-Y axis: X from the mid-axillary line (negative medial, positive lateral) …

The Need For Innovative Changes In The Jp Drain, Devin Williams, Bs, Elizabeth Simon, Bs, Krishna Koka, Bs, Spencer Haber, Bs, Andrew Newman, Md

Phase 1

Introduction: The Jackson Pratt (JP) Drain removes surgical site fluid postoperatively. It prevents surgical site complications, however mastectomy and breast reconstruction patients report varying states of pain and quality of life (QOL) during use. The anterior chest wall is densely innervated and drain placement is not precisely controlled. We hypothesize that placement variation contributes to inconsistent patient outcomes. This prospective cohort study aims to understand the impact of drain placement on pain and QOL.

Methods: The drain sites of 30 patients undergoing breast reconstruction or mastectomy and screened for exclusion criteria are measured intraoperatively using anatomical landmarks. A validated pain …

The Need For Innovative Changes In The Jp Drain, Elizabeth Simon, Bs, Spencer Haber, Bs, Devin Williams, Bs, Krishna Koka, Bs, Andrew Newman, Md

Phase 1

Introduction: The Jackson-Pratt (JP) drain has been used post-mastectomy since 1980; however, little research has been done regarding the quality of life (QOL) associated with drains. How might we help JP drain patients following mastectomy have increased QOL during drain use? We hypothesize that specific drain placement locations relative to anatomical body wall landmarks correlate with QOL.

Methods: This is a prospective cohort study of thirty female sex patients undergoing breast mastectomy or reconstruction needing bilateral drains and excludes patients with significant confounding variables that interfere with pain data. The surgeon measures the JP drain location after placement in the …

Designing A Multilingual Instructional Language Tool For Patient Communication In Interventional Radiology, Samuel Almodóvar, Ahlam Houssein, Gregg Khodorov, Md, Mba, Sahib Sohal, Md, Robert Pugliese, Pharmd, David Dwyer, Md

Phase 1

Introduction: Current efforts to provide language-inclusive radiological care fall short, resulting in suboptimal imaging, increased procedural time, and greater radiation exposure. Inadequate language accessibility results in poor communication, suboptimal care, and increased patient dissatisfaction. A digital language tool was developed to provide patient instructions during interventional radiology (IR) procedures, addressing this gap and enhancing patient care.

Methods: Observations were carried out to better understand workflow during IR procedures and identify how to incorporate the tool. We conducted interviews with IR physicians, nurses, and technologists to gather common procedural phrases and patient instructions. Spanish and Mandarin were selected because they are …

Aura Vena, Bassem Fayek, Isaac Kravatz, Robert Pugliese, Pharmd

Phase 1

Introduction: Peripheral intravenous (IV) access remains a common problem faced across healthcare, leading to significant healthcare losses in terms of working hours, resources, as well as patient pain and discomfort. At Thomas Jefferson University Hospital’s (TJUH) infusion center, many healthcare workers utilize hot towels and disposable heat packs to warm patients’ arms if IV access is difficult- a wasteful solution that provides limited heating.

Methods: Nurses at TJUH’s infusion center were interviewed to define the problem and identify optimal product requirements for healthcare workers. In conjunction with market research, a heat-warming sleeve is designed and created. The design of the …

Local Rulemaking, Zachary D. Clopton, Marin K. Levy

Duke Law Journal

Any case heard in a United States federal court must adhere to a set of rules—or rather, a few different sets of rules. Regardless of the subject matter of the suit, the parties (and the judge) must follow the relevant Federal Rules. But that is not all. Parties bringing the case must also comply with local rules—those important rules that govern litigation in the space between and around the Federal Rules. These district- and circuit-specific rules govern highly consequential aspects of federal litigation, such as how cases will be assigned to judges, how those cases will then be managed, and …

The End Of Means-End Scrutiny, Francesca Procaccini

Duke Law Journal

It is black-letter law that courts apply means-end scrutiny to evaluate laws that burden constitutional rights. Not anymore. Discreetly and pervasively, the Supreme Court has ousted means-end scrutiny from constitutional law. It has done so through a series of smaller and seemingly unconnected doctrinal incursions, including the introduction of history and tradition tests, the transformation of equality doctrines, and the embrace of formalist rules to govern constitutional law.

This Article provides a complete and interconnected critique of the numerous doctrinal transformations that together comprise the larger constitutional revolution of ending means-end scrutiny. It tracks how this upheaval now touches nearly …

Supervising The Omnipresent Casino: Evaluating The Role Of State And Local Regulation In Stemming Youth Addiction To Sports Gambling, Matthew Connor Flink

Duke Law Journal

Since 2018, state legalization of sports betting and the industry’s corresponding proliferation has driven an epidemic of youth addiction. Current state legislation and regulations do little to combat youth addiction. Many legal scholars emphasize the value that a federal regulatory regime would provide to reign in youth sports betting. This Note explores the value that state and local government can have in the sports gambling space. To illustrate the unique importance of state and local legislation and regulation of sports betting, this Note analogizes to another addictive product with a history of youth addiction: nicotine.

Nicotine has been a regulatory …

"The Persistent And Muddy Dispute": How The Facial/As-Applied Distinction Creates Problems For Constitutional Litigants, Sean P. Wilson

Duke Law Journal

The distinction between facial and as-applied challenges continues to play a central role in constitutional litigation, including at the Supreme Court. Yet, the distinction and its related rules have long suffered from a lack of doctrinal clarity and consistency. This Note sets out a descriptive taxonomy of three problems facing constitutional litigants because of the murkiness surrounding the facial/as-applied distinction.

First, the “Doctrinal-Test Problem” refers to the fact that many constitutional doctrines appear to require the courts to engage in facial adjudication, even if a litigant wishes to bring an as-applied claim. Thus, as-applied litigants are forced into facial challenges, …

Journal Staff

Duke Law Journal

No abstract provided.

Mapping The Pathology Competencies For Medical Education (Pcme) To The Sidney Kimmel Medical College’S Jeffmd Gi Curriculum, Emma Sanders, Alexander Macnow, Md, Mhpe

Phase 1

Introduction/Purpose: Sidney Kimmel Medical College’s competency-based curriculum, JeffMD, is structured around SMART objectives. However, evaluation of the alignment of these objectives against the PCME, a collection of graduation competencies published by the Association for Academic Pathology, has not yet been performed. This study investigated how comprehensively the GI/Liver block of the JeffMD curriculum addresses the corresponding PCME learning objectives, thereby piloting a pathology curriculum map and allowing evaluation of this curriculum.

Methods: In this study, a curriculum map was created of all learning events covered within the JeffMD GI/Liver block. Each learning event was cross-matched with competencies within the gastrointestinal …

Patient Perceptions Of Medicare Annual Wellness Visits: Findings From A Pilot Survey, Payton Mccready, Amy Cunningham, Susan Parks

Phase 1

Purpose

Medicare Annual Wellness Visits (AWVs) were introduced in 2011 to promote preventive care among Medicare beneficiaries, yet patient satisfaction remains understudied. Participating in the  Age-Friendly Health Systems Initiative, Jefferson Health’s Center for Healthy Aging (CHA) is redesigning its AWVs to align with Age-Friendly principles. This study aimed to obtain baseline data on Medicare patients’ familiarity, experience, and satisfaction with AWVs in a geriatrics practice before implementing the redesigned model.

Methods

This cross-sectional survey was conducted in July 2025 at Jefferson Health’s CHA, a geriatrics practice serving about 2,000 Medicare patients. Eligible participants were Medicare-enrolled CHA patients. An eight-item survey …

Understanding The Benefits Of Sustainable Ir Fellowship To A Large Public Hospital In Kenya, Abigael Gebremariam, Kevin Anton

Phase 1

In 2021, Kenya had 10 interventional radiologists for a population of about 54 million. RAD-AID, a non-profit organization improving global radiology, partnered with the University of Nairobi and Kenyatta National Hospital to establish the first IR fellowship program in Kenya in 2021. Through the program, the number of practicing IRs in Kenya has nearly doubled; however, their practice is limited by capital and supply resources. This study will demonstrate the benefit of the program to the hospital system and the patient population in Kenya.

The project employed a retrospective and comparative analysis of IR services at a large public hospital …

The Evaluation Of Therapeutic Communication In Competency Based Nursing Education, Tracy J. Perron, Chelsea Lebo, Mary Louise Thomas, Romy Zemer

Creating Healthy Work Environments (CHWE)

Therapeutic communication is an essential part of nursing care. Therapeutic communication (TC) is the process of using verbal and nonverbal communication to connect with patients.TC is holistic, patient-centered and involves aspects of the physiological, psychological, environmental and spiritual care of the patient. Poor communication in the healthcare setting can lead to poor patient outcomes such as, decreased adherence to treatment, patient's dissatisfaction, inefficient use of resources and even death. Studies have shown that nurses lack communication skills due to a variety reasons from inadequate training, the lack of understanding of the importance of patient-centered communication, and the increased generational use …

What Is Your Preference? Creating A Healing Culture Through Employee Feedback, Julia W. Millspaugh, Mildred Ortu Kowalski, Sunnie A. Mortimer, Catherine C. Errico

Creating Healthy Work Environments (CHWE)

Stress levels are high for healthcare employees. The negative impact of employee burnout is well-documented within healthcare (Shanafelt et al., 2020; U.S. Department of Health and Human Services Office of the U.S. Surgeon General, 2022). A healthy work environment that optimizes the health and wellbeing of nurses is paramount to providing quality care to patients (Mabona et al., 2022). There is an immediate need for brief, feasible, and rapidly scalable interventions while at work to promote wellbeing for our healthcare workers (Putrino et al., 2020). There is no singular tool or one-size-fits-all approach that holds the answer to wellbeing. Wellbeing …

Responding To Workplace Violence, Penny A. Sauer

Creating Healthy Work Environments (CHWE)

Workplace violence against healthcare workers has increased in the past five years (pre-pandemic) (Brigo et al., 2022; Odes et al., 2023; Sari et al., 2023), with no indication that the violence will return to pre-pandemic levels. In the United States, two nurses are assaulted in the acute care setting every hour (ANA, 2022), but this number is likely much more significant as 40%- 80% of WPVs go unreported.

WPV has been a persistent problem in healthcare for decades. The World Health Organization, Joint Commission, Occupational Safety and Health Administration (OSHA), and many professional practice organizations have statements and recommendations about …

The Escape Room Challenge: Integrating Diversity, Equity, Inclusion Initiatives To Promote A Healthy Work Environment, Teresa D. Welch

Creating Healthy Work Environments (CHWE)

Academic nurse leaders nationally face the constant challenge of incorporating diversity, equity, inclusion, and accessibility (DEIA) initiatives and promoting healthy work environments (HWE) standards with limited resources. This presentation describes a professional development offering for academic nurse leaders via an “escape room” approach.

An escape room is a themed challenge event where players collaborate to find clues, complete tasks, and solve various puzzles. The aim is to achieve a specific, time-bound goal, usually to escape from somewhere. Escape rooms help participants develop the knowledge, experience, and skills to overcome complex challenges (Parker & Welch, 2021; Adams et al, 2018; Brown …

The Politics Of Territorial Resistance To Federal Authority: Distinctiveness, Partisanship, And Outbidding In Texas And Alberta, André Lecours, Alexandre Couture Gagnon, Daniel Béland

School of Political Science, Public Affairs, Legal and Security Studies Faculty Publications

Federalism involves political struggles around the territorial division of powers. Typically, these struggles tend to occur when the federal government seeks to act in areas of constituent unit jurisdiction. Yet, recent political developments in Texas (Operation Lone Star) and Alberta (Alberta Sovereignty in a United Canada Act) have showcased state/provincial governments seeking to reject federal legislation within seemingly federal jurisdictions. This article develops an explanation for these initiatives that emphasizes regionalism as a form of territorial politics, the partisan dynamics between the state/provincial government and its federal counterpart, and the internal competition within the dominant political …

Survivors Of Sexual Trauma: Abortion Experiences Of Black Women In The Southern United States, Katie Grace Geter

Walden Dissertations and Doctoral Studies

Women who experience both sexual trauma and abortion within their lifetime are highly likely to struggle with serious mental health symptoms; however, social work students and practitioners lack education and knowledge on how to serve these women. Recent events, including the uprising of gender and race related movements, COVID-19, heightened political division, and increased governmental control on abortion rights also impact social-work practice. Acknowledging intersectionality, the purpose of this qualitative study was to explore the experiences of abortion for Black women in the Southern United States who have a history of sexual trauma. The experiences of 6 Black women with …

Staff Education On Preventing Benzodiazepines Related Falls In Older Adults, Dafnee Gilles

Walden Dissertations and Doctoral Studies

In geriatric psychiatric setting, falls rates are higher than general wards and could reach up to 13-25 falls per 1000 hospital days. High use of benzodiazepines in older adults is a major cause of increased falls despite recommendations to avoid its prescription to the population. This DNP staff education project focused on training nurses working in an 80 bed capacity geriatric psychiatric facility on best evidence based practice of preventing falls associated with use of BZDs. The identified practice issue was knowledge deficit on evidence based best practices to prevent falls in older adults under BZDs medications. The project aims …

Determinants Of Clinical Supervisor Self-Efficacy In Substance Use Disorder Counseling, Victoria A. Nagel

Walden Dissertations and Doctoral Studies

Substance use disorder counselors face increasing challenges in responding to a growing and more severely affected population, often presenting with co-occurring mental health conditions and complex clinical needs. Clinical supervision plays a critical role in supporting counselor development, yet little is known about the factors that contribute to clinical supervisors’ self-efficacy in providing supervision for alcohol and drug counselors. The purpose of this quantitative correlational study was to examine whether years of counseling experience, years of substance use disorder (SUD) counseling experience, years as a clinical supervisor, professional counseling credentials, and supervisory credentials predicted self-efficacy among clinical supervisors. This study …