Digital Commons Network^™

Nurse-Led Advocacy For Hiv And Hepatitis C: A Socioecological Approach Across Israel And The Philippines, Wedad M. Ashkar, James Montegrico

Global Advocacy

Background: HIV and Hepatitis C Virus (HCV) remain global public health challenges, with millions of people still undiagnosed or untreated. Nurses play a critical role in combating stigma and leading advocacy interventions in diverse cultural contexts. In Israel and the Philippines, nurses are addressing infectious disease care using multi-level strategies informed by local epidemiology and global health goals.

Purpose: This project aimed to identify, implement, and evaluate nurse-led advocacy strategies to reduce stigma and improve education, community engagement, and policy development around HIV and HCV in both Israel and the Philippines.

Methods: A socioecological model guided the development of …

The Role Of The Global Nursing Workforce In Health System Resilience During Disasters, Katherine Kruger

Global Advocacy

Background: Climate change and resulting impacts will be the largest global health threats of the 21st century. The global nursing workforce is critical to the resilience of health systems, especially in the face of climate-induced disasters. Nurses are the largest health workforce globally, representing more than 50% of the healthcare workforce, and are most frequently on the front lines of disaster events as clinicians, leaders, and advocates. Despite this, there remains a lack of objective evidence surrounding the unique contributions nurses make in preserving population health during disasters.

Objectives: This presentation will demonstrate the relationship between the global nursing workforce …

An Action Plan For Global Advocacy: First Aid And Cardiopulmonary Resuscitation As A Pillar In Disaster Health Preparedness, Nurul'ain Ahayalimudin

Global Advocacy

Despite increasing global investments in disaster risk reduction, the integration of First Aid and Cardiopulmonary Resuscitation (CPR) training into national and community disaster preparedness strategies remains inadequate. This presentation outlines an urgent call to action for inclusive, culturally responsive, and community-accessible First Aid and CPR training—particularly targeting underserved, linguistically diverse, and geographically isolated populations. Systemic barriers such as cost, lack of trained instructors, cultural mismatches, and policy gaps limit equitable access to lifesaving skills.

This advocacy initiative aligns with the Sustainable Development Goals (SDGs), specifically SDG 3 (Good Health and Well-Being), SDG 11 (Sustainable Cities and Communities), and SDG 13 …

Global Advocacy For Alzheimer’S Disease And Related Dementias, Modupe F. Akintomide, Amy Reid

Global Advocacy

Background: Alzheimer's disease and related dementias represent a growing public health challenge, significantly impacting individuals, families, and healthcare systems worldwide. The increasing prevalence highlights the urgent need for effective strategies to improve care and support for those affected, in alignment with key United Nations Sustainable Development Goals (SDGs), particularly SDG 3 on health and well-being, SDG 10 on reducing inequalities, SDG 11 on sustainable cities and communities, and SDG 17 on partnerships for sustainable development.

Aim: To improve the quality of life for individuals with Alzheimer's disease and related dementias and their care partners through a multifaceted advocacy approach.

Methods: …

Message In A Bottle, Saptarshi Biswas

HCA Healthcare Journal of Medicine

The title of the image is inspired by a famous old song by the British rock band The Police. The song featured Sting’s evocative lyrics and captures a profound sense of isolation and longing. The song tells the story of a castaway who sends out a distress signal, only to discover that he is not alone in his feelings of loneliness. Through its haunting melody and rhythmic pulse, the track conveys themes of connection and the human experience, illustrating how, despite physical separation, people share similar struggles and emotions. The metaphor of the bottle serves as a poignant reminder of …

Multi-Center Survey Of Medicine Residents And Self-Assessment On Cardiac Complications In Obstetric Patients, Kevyn Niu, Christie A. Tran, Robert J. Subbiondo Md, Olubenga Oyesanmi

HCA Healthcare Journal of Medicine

Background

Internal medicine (IM) residents receive significant cardiology training, and previous surveys have evaluated IM resident competency on obstetric (OB)-related subjects. However, there is minimal literature on self-reported competence of cardiac-specific complications in OB patients. Our study assessed self-reported comfort and competency regarding cardiovascular complications in OB patients with medical residents across several specialties.

Methods

We surveyed 207 residents across 3 specialties and 3 teaching hospitals on 10 questions regarding their self-reported confidence in managing cardiovascular complications in OB patients, including practice setting, specific cardiac issues, and stages of labor. We received 42 responses. Results were obtained using Google Sheets …

“Good Enough Mother”: Accepting The Imperfections Of Motherhood In Medicine, France M. Leandre

HCA Healthcare Journal of Medicine

This article draws attention to Winnicott's concept of the “good enough mother” and how it can be applied to those in medicine. It emphasizes that no one is perfect, and our children learn best from our imperfections. I was reminded of that while kayaking on the Lost Spring Lake in Ocala, FL, and took this picture. If we can find beauty in nature’s imperfections, we can also find it within our own imperfections.

Nondominant Right Coronary Artery Occlusion Leading To An Anterior St-Segment Elevation Myocardial Infarction, Taha Ahmed, Taylor Wood, Austin Harris, Rajan Desai, Garima Handa, Naoki Misumida, Amartya Kundu

HCA Healthcare Journal of Medicine

Background

A nondominant right coronary artery supplies a small portion of the myocardium. Albeit rare, an acute occlusion of a nondominant right coronary artery is believed to be inconsequential with minimal clinical relevance.

Case Presentation

We present a case of a middle-aged man who presented with chest pain and an electrocardiogram demonstrating anterior ST-segment elevation. An emergent coronary angiogram revealed acute thrombotic occlusion of the proximal nondominant right coronary artery with no significant obstructive atherosclerotic disease in the dominant left coronary circulation. Balloon angioplasty of the occluded vessel followed by implantation of a drug-eluting stent resulted in the resolution of …

Ovarian Dysgerminoma With Tubo-Ovarian Torsion In An 11-Year-Old Child: A Rare Occurrence But A Significant Differential Diagnosis In Acute Abdomen, Charu Chandra, Keeranmayee Mishra, Rahul Mangal, Chirag Doshi, Apurba Anshuman Mishra

HCA Healthcare Journal of Medicine

Background

Ovarian tumors are quite uncommon in the premenarchal age group, with the majority being functional cysts. Malignant tumors are unusual in this age group, making the diagnosis of ovarian malignancy in children quite challenging. Dysgerminoma is the most common malignant ovarian germ cell tumor in females. The clinical symptoms often include abdominal pain, distension, a palpable mass, reduced appetite, nausea, and vomiting.

Case Presentation

We discuss the case of an 11-year-old premenarchal girl who was brought to the emergency department with abdominal pain persisting for 3-4 days, which had intensified over the 24 hours before she arrived at the …

Brown Umbilical Nodule: A Case Of Primary Cutaneous Endometriosis, Richard G. Bindernagel Jr., Aleia Boccardi, Taylor C. Jindia, Parth Patel, Jaimie Bryan, Addie Walker, Summer Moon, Richard Miller

HCA Healthcare Journal of Medicine

Background

Endometriosis is a common condition in which endometrial glands and stroma are implanted outside the uterine cavity. Rarely, the skin can be involved.

Case Presentation

We describe a case of a 41-year-old woman who presented to the dermatology clinic complaining of a brown umbilical nodule with slight erythema. It was occasionally painful and hemorrhagic. She denied a history of endometriosis and abdominal surgeries. A shave biopsy of the nodule was consistent with a diagnosis of cutaneous endometriosis. The patient was referred to her gynecologist for further evaluation and treatment.

Conclusion

This unique case demonstrates primary cutaneous endometriosis in the …

Sevoflurane In Status Asthmaticus: A Case Report And Literature Review, Amelia L. Gurley, Thomas W. Church, Sana Hadyah, Brandon Abrajan, Julia Cheree Glavinic

HCA Healthcare Journal of Medicine

Background

Sevoflurane and other inhaled anesthetics are gradually entering provider awareness as rescue therapies for patients in refractory status asthmaticus. This paper documents a case report and a literature review involving the use of sevoflurane to treat status asthmaticus.

Case Presentation

A 27-year-old man presented to the emergency room in acute hypoxic respiratory failure due to status asthmaticus, refractory to multiple therapies and requiring intubation. He was successfully extubated following sevoflurane administration in the operating room, and his care was complicated by transient hypotension. A multidisciplinary effort was critical in ensuring successful and timely therapy.

Methods

We performed a literature …

Educational Point-Of-Care Ultrasound Discovers Adrenal Cortical Carcinoma, A Case Report: Clinical Implications And Review Of The Literature, Minh Q. Nguyen, Moshe Bengio, Vu H. Tran

HCA Healthcare Journal of Medicine

Introduction

Point-of-care ultrasound (POCUS) has become an indispensable tool for emergency physicians in assessing intra-abdominal pathology due to its real-time visualization, portability, and cost-effectiveness. While POCUS is not traditionally focused on adrenal gland assessment, incidental findings of adrenal masses during examinations have been reported. Our patient presented with a chronic obstructive pulmonary disease (COPD) exacerbation and was found to have a large adrenal mass, discovered incidentally, during thoracic ultrasound.

Case Presentation

This case report presents the discovery of an adrenal mass in a patient with respiratory distress due to a COPD exacerbation, emphasizing the importance of sonographers’ ability to identify …

A Complex Case Of A Large Fibroid Uterus Compressing The Inferior Vena Cava Causing Recurrent Deep Vein Thrombosis And Pulmonary Embolisms, Jessica Gil, Jessica Klingensmith, Lauren Hendrix, Patrick J. Stocker, Olugbenga Oyesanmi

HCA Healthcare Journal of Medicine

Background

Uterine fibroids have been found to increase the risk for venous thromboembolism. There have been other case reports linking large uterine fibroids, pulmonary embolisms, and deep vein thrombosis (DVT) together due to compression of blood vessels and increased venous stasis. This case report will discuss a case of a large fibroid uterus compressing the inferior vena cava causing a patient with few risk factors to have recurrent DVTs and pulmonary embolisms.

Case Presentation

The patient was a 35-year-old woman who presented with repeated unprovoked thrombosis episodes. The patient had a full workup after the first episode of DVT and …

Using Dexcom G7 In Critically Ill Infant With Hyperinsulinemia On High Frequency Oscillatory Ventilation Support, Chad E. Ward, Timothy Clark, Eric Velezquez

HCA Healthcare Journal of Medicine

Introduction

Life threatening hypoglycemia can occur during critical illness in infants with underlying hyperinsulinemia or metabolic conditions, such as glycogen storage diseases. Using a continuous glucose monitor (CGM) can provide insight into glycemic trends with this high-risk patient population in the intensive care setting. Barriers to usage of CGMs in the intensive care unit include familiarity with CGMs devices among staff, safety, and cost.

Case Presentation

We describe the first reported case of safely utilizing the newest Dexcom G7 continuous glucose monitor in an infant with hyperinsulinemia undergoing high frequency oscillatory ventilator (HFOV) support for acute respiratory distress syndrome (ARDS) …

A Case Report And Evaluation Of Intrauterine Gas Of Unknown Origin, Chrystal Stallworth, Diane Gilbertson, Michele L. Mccarroll, Timothy Kremer

HCA Healthcare Journal of Medicine

Introduction

Most reports of intrauterine or endometrial gas have been reported in the setting of underlying gynecologic malignancy or infection. The significance of this case report is to give a presentation of a patient presenting with intrauterine gas who subsequently was identified as having neither an infectious nor malignant cause for such a finding.

Case Presentation

The patient is a 56-year-old postmenopausal woman who presented with “hip pain” and was found to have incidental intrauterine gas on a pelvic computed tomography. She underwent in-office and outpatient hysteroscopies with resection of a submucosal fibroid. Her final pathology was returned as benign, …

Recurrent, Acute Limb Ischemia Secondary To Arterial Thrombosis: A Devastating Complication In The Setting Of Severe Covid-19 Infection, Shaikh Afaq, Kyle S. Strouse, Sini Saju, Olugbenga Oyesanmi, Mohamad Eid, Salman Muddassir

HCA Healthcare Journal of Medicine

Background

COVID-19 infection, particularly with the Delta variant, has been associated with a heightened risk of thromboembolic events due to a profound hypercoagulable state. While venous thrombosis is more commonly reported, arterial thrombosis—including acute limb ischemia—has emerged as a serious complication with significant morbidity and mortality.

Case Presentation

We report the case of a 53-year-old man with severe COVID-19 pneumonia who developed recurrent acute limb ischemia secondary to an aortic mural thrombus. Despite therapeutic anticoagulation and multiple surgical interventions—including thrombectomy, angioplasty, and stenting—the patient experienced repeated episodes of arterial thrombosis. His clinical course was further complicated by pneumothorax and hemothorax, …

Understanding Challenges Faced By Female Graduate Medical Education Trainees: A Qualitative Content Analysis Of Physician Coaching Requests, Nathalie Dieujuste, Adrienne Mann, Kimiko Dunbar, Pari Shah Thibodeau, Tyra Fainstad, Brooke Dorsey Holliman

HCA Healthcare Journal of Medicine

Background

Physician burnout, particularly among female graduate medical education (GME) trainees, is a growing concern that affects physician wellness and patient safety. Professional coaching has shown promise in improving physician wellness. The Better Together Physician Coaching program (BT) is a web-based, group-coaching program, piloted using female GME trainees, aimed at improving key indicators of well-being, including burnout and impostor syndrome. In this qualitative study, we aimed to understand the challenges faced by female physician trainees shared in the pilot of the BT coaching intervention.

Methods

A total of 101 female physician trainees participated in the BT pilot. A sample of …

Converting Usmle Step 1 To Pass Or Fail: The Potential Impact On Applicants Who Are Female Or From Underrepresented Groups, Haris Ahmed, Peter Yu, Brendan Rosamond, Jonathan Lall, Scott Zimmerle, Said Maldonado, Nicole Lyons, Ashlynn N. Mills, Yoolim Alex Seo, Angelica C. Rodriquez, Jacqueline E. Levesque, Oluwatunmininu A. Anwoju, Zuhair Ali, Rajeev Raghavan, Mike Liang

HCA Healthcare Journal of Medicine

Background

In January 2022, the United States Medical Licensing Examination (USMLE) Step 1 exam became pass/fail and the transition to using USMLE Step 2 scores for residency interview screening appeared imminent. While this change was intended to result in holistic reviews of residency applicants, the impact remains unclear. In this study, we aimed to determine how USMLE scoring changes might affect female candidates and applicants from underrepresented groups (URM).

Methods

We performed a retrospective cross-sectional study of all applicants to a single institution. Data for applicants were extracted from their 2021-2022 residency applications and included age, race, sex, medical school, …

A Hard Problem: Managing Constipation In The Geriatric Population, William G. Jones, Veeraen Jonnalagadda, Alexandra E. Thomson, Victoria Grumbles, Chase Cottle, Christian Robertson, Maulikkumar Patel

HCA Healthcare Journal of Medicine

Constipation is a common condition among geriatric patients with different presenting symptoms and potential serious complications. Additionally, the condition causes a significant burden on our healthcare system. Here, we summarized recommendations from several societies, including the American College of Gastroenterology, American Geriatrics Society, and American Academy of Family Physicians to provide guidance on managing constipation with geriatric patients. Our aim was to emphasize the importance of prevention of constipation in this population and methods to do so. We also give recommendations on how to manage constipation when it does develop and how to manage it across different healthcare settings. These …

An Acknowledgement To The Hca Healthcare Journal Of Medicine's Reviewers And Editors For The First Half Of 2025, Juan A. Sanchez, Graig Donini

HCA Healthcare Journal of Medicine

The HCA Healthcare Journal of Medicine would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our peer reviewers, authors, and board members.

Automated Log Analysis And Incident Response, N/A

Defensive Publications Series

This technology described herein relates to automated, intelligent analysis of log data from complex software systems. The technology employs a two-tiered Large Language Model (LLM) architecture to detect anomalies and generate context-rich incident reports. The first tier LLM performs a rapid, broad analysis of all incoming log streams to flag potential issues. Flagged events are escalated to a second tier LLM with a long context window, which performs deep, multi-modal analysis by correlating log strings across services with time-series data and deployment events. The output is a high-confidence alert and a human-readable summary that explains the anomaly, its likely impact, …

Optical Circuit Switch With Ultra Low Return Loss, N/A

Defensive Publications Series

Optical circuit switch (OCS) collimator devices can be utilized in communication networks to transfer large amounts of data quickly and efficiently. The OCS collimator devices provide for low-return loss capabilities across a wide range of wavelengths. Specifically, the OCS collimator devices may have a faceted spacer-epoxy interface surface and a relatively close refractive index between the fiber, spacer, and epoxy such that return loss is greater than 55dB. The low return loss allows for the use of bidirectional ports without the creation of excessive noise signals that degrade communication performance therefore allowing for the operation of communication equipment that may …

Intermediate Representation Randomization For Unique Software Builds, Joshua Mason

Defensive Publications Series

Software applications distributed as identical copies may present a vulnerability because an exploit discovered in one instance could be replicated across others due to shared internal structures. This publication describes a method to address this vulnerability by generating unique software builds, and which in instances could be used for each download request. The method operates by compiling an application into an intermediate representation, such as a low level virtual machine intermediate representation (LLVM IR) bytecode. Upon receiving a download request, the method performs randomized transformations on the LLVM IR elements, thereby changing the locations of functions, basic block ordering, instruction …

Process For The Preparation Of Crystalline Form Of 2-[[[4-(3-Methoxypropoxy)-3-Methyl-2-Pyridinyl]-Methyl]Sulfinyl]-1h–Benzimidazole Sodium Salt Thereof, Msn Laboratories Private Limited, R&D Center, Hyderabad, India, Srinivasan Thirumalai Rajan, Seetharama Sarma Peri, Thirupathi Tatikonda.

Defensive Publications Series

The present invention relates to crystalline form of 2-[[[4-(3-methoxypropoxy)-3-methyl-2-pyridinyl]-methyl]sulfinyl]-1H–benzimidazole sodium salt represented by the following structural formula-1a, which is referred to as Rabeprazole sodium.

Formula-1a

The present invention also relates to a process for the preparation of crystalline form of Rabeprazole sodium.

Deferred Texture Decoding With Filtering, Seokhoon Kim, Eric Young, Elaine Poon

Defensive Publications Series

A method may include (1) performing, by an integrated circuit, decoding and filtering using a combined texture decoding and filtering equation and (2) providing, by the integrated circuit, a decoded filter output to a next stage in a graphics pipeline. Various other methods and systems are disclosed.

Measurement Of Rotary Bit Inertia By Trifilar Pendulum Method, Baker Hughes Company

Defensive Publications Series

The invention can be used to measure the rotational moment of inertia of drill bits around their center of rotation. The knowledge of the rotational moment of inertia of the bit is significantly important for the accurate prediction of the torsional eigenfrequencies (e.g. High-Frequency Torsional Oscillation (HFTO)) and mode shapes of the bottom hole assembly (BHA) and/or the drill string by simulation. Precise prediction of the torsional eigenfrequencies is for example required for optimal placement of HFTO-damper tools to efficiently mitigate HFTO. In addition, it is required for the estimation of critical torsional loads within the BHA (dynamic torque, tangential …

Integrated Wiper For Optical Module Cage, N/A

Defensive Publications Series

An integrated wiper for a pluggable optical module is described herein. The integrated wiper is a modification to a pluggable optical module cage that addresses surface damage caused by particulate debris. Metal features are removed from a leading edge of an upper surface of the optical module cage and replaced with the integrated wiper. The integrated wiper, which can be overmolded, adhered, or fastened to the leading edge of the cage, cleans an upper surface of an optical module during insertion. The integrated wiper removes any debris before it can be trapped between the module and internal components, such as …

Network And Device Management Based On Commercial Mobile Alert System (Cmas) And Location Aware Solutions, Thirupathi Reddy Katam, Hari Pillai, Aumen Lee, Vignesh Rajendran

Defensive Publications Series

Proposed herein are techniques to facilitate secure, reliable communication and emergency management utilizing a software-defined wide area network (SDWAN) controller that can manage a wide area network upon detection of emergency events, such as earthquakes, floods, wildfires, severe weather conditions, etc. by one or more endpoints that can interface with a Commercial Mobile Alert System (CMAS) via wireless (e.g., 4G/5G) or wired networks.

Nanosensor Communication Via Localized Cnt Resonance And Central Controller Coordination, Suma Mallapragada, Vaishnavi Sankepally

Defensive Publications Series

A system and method are disclosed for delivering information from a central controller to nanoscale sensors embedded within plant tissues and receiving information back from these sensors. The approach uses localized nanoparticles to encode binary or discrete signals, enabling remote monitoring and control of plant-associated nanoscale devices. The method preserves selective targeting of individual sensors without relying on long-range electromagnetic propagation, diffusion across large distances, or microcontrollers attached to each nanosensor. The disclosed methods cover the flow of information between the controller and nanosensors, while specific designs of proboscis-inspired delivery mechanisms or controller hardware remain open for further innovation. This …

Airflow Regulation System With Pliant Membrane, Mark Wessel, Umesh Nandanan, David (Hong) Huynh

Defensive Publications Series

An airflow regulation system is proposed herein that includes a variable or pliant membrane device that can be utilized to control the airflow in electronics enclosures in a manner that is effective, repeatable, and comprehensive. The membrane device of the airflow regulation system provides an adaptable solution for a problem (airflow management) that is inherently variable. Traditional methods for airflow management often fall short in terms of scope, complexity, effectiveness, and robustness. In contrast, the membrane device proposed herein can include variable/pliant properties such that the proposed airflow regulation system addresses the shortcomings of traditional airflow management solutions with a …