Digital Commons Network^™

A New Note In Fiction, Earl Clement Davis

Manuscripts, 1933-1953

This writing is an analysis of fiction's role in showing the human struggle with the changing forces of history, particularly the move away from authoritarianism. Authors mentioned include, Hervey Allen's Anthony Adverse, Honoré de Balzac, Victor Hugo, Alexandre Dumas, Leo Tolstoy, Knut Hamsun's Growth of the Soil, John Galsworthy's The Forsyte Saga, Mazo de la Roche's Jalna series, and Sinclair Lewis' Main Street and Babbitt.

While this manuscript does not have a date, the fact that it mentions Hervey Allen’s novel Anthony Adverse, published in 1933, and does not mention the award-winning movie of Anthony Adverse that premiered in 1936, …

Aspects Of Distribution, Abundance, Habitat, And Life History Of The Caddo Madtom (Noturus Taylori), A Narrow Endemic Of The Ouachita Highlands, Brittany L. Mccall, Brook L. Fluker

Southeastern Fishes Council Proceedings

The Caddo Madtom, Noturus taylori, is a small catfish endemic to the Ouachita Mountain ecoregion in Arkansas, with habitat altered by land use practices and reservoir dams. We examined aspects of distribution, abundance, habitat, and life history of N. taylori during seasonal sampling from winter 2016 through fall 2017. Our sampling data were concordant with previous studies that suggested N. taylori is more widespread and has higher catch per unit effort in the Caddo River drainage when compared to the upper Ouachita River drainage. We did not detect N. taylori in the Little Missouri River drainage, where it is …

Type A Aortic Dissection And Non-Contrast Computed Tomography, Amelie Spangenberg, Shiavax J. Rao, John Mackrell, Sarah Rimm, Christopher James Haas

Journal of Community Hospital Internal Medicine Perspectives

Non-contrast enhanced chest computed tomography (CT) carries a low sensitivity for acute aortic dissection; CT Angiography remains the gold standard. We highlight the potential utility of non-contrast CT for detection of aortic dissection in a case of a young, immunocompromised man presenting with acute abdominal pain and renal injury. Given elevated creatinine, an initial non-contrast chest CT demonstrated subtle findings suggestive of aortic dissection (aneurysmal dilation of the proximal ascending aorta as well as displaced calcified intimal flap/ intraluminal high linear density in the thoracic descending and distal abdominal aorta). Subsequent CT angiography confirmed the presence of an extensive type …

A Case Of Ischemic Monomelic Neuropathy After Arteriovenous Fistula Placement, Vikram Sangani, Mytri Pokal, Edva Noel, Narsimha Rao Keetha, Sasmit Roy, Indrajeet Mahata

Journal of Community Hospital Internal Medicine Perspectives

Ischemic monomelic neuropathy (IMN) is a relatively uncommon and under-recognized complication of vascular access creation for arteriovenous (AV) fistula in hemodialysis patients. They usually develop distal muscle weakness, sensation loss, and severe acute pain without muscle necrosis soon after AV fistula creation. Physicians should be aware of this condition as prompt diagnosis and timely vascular interventions are necessary to save the limbs and prevent permanent functional disability. Once the diagnosis of IMN is made, the patients will need emergent ligation of the fistula to restore the distal perfusion. We report a case of a 59-year-old male patient with End-stage Renal …

Topical Diclofenac-Induced Hepatotoxicity, Thilini Delungahawatta, Ashik Pokharel, Robert Paz, Christopher J Haas

Journal of Community Hospital Internal Medicine Perspectives

The hepatotoxic potential of diclofenac, a commonly used non-steroidal antiinflammatory agent, is well established in literature. However, cases of diclofenacinduced liver disease have occurred almost exclusively with the oral formulation of this medication. We report the case of an elderly man with Paget’s disease and osteoarthritis who developed acute hepatotoxicity, as evidenced by laboratory diagnostics, four months after use of topical diclofenac 1% gel. Once diclofenac gel was discontinued, repeat blood work three weeks after discharge demonstrated return of liver function tests to baseline. Given the temporal relationship between the initiation and escalation of topical diclofenac and the changes in …

A Case Of Granulomatosis With Polyangiitis Masquerading As Community Acquired Pneumonia, Brianna Probasco, Veniamin Melnychuk, Angelina Hong, Abanoub Gabra, Scott Lieberman

Journal of Community Hospital Internal Medicine Perspectives

Granulomatosis with polyangiitis (GPA) has a multitude of presentations, including appearing as a refractory community-acquired pneumonia (CAP) or an isolated localized pulmonary disease. This case describes a patient suspected to have a CAP before further workup and lung biopsy revealed his diagnosis of GPA. This case report demonstrates GPA’s diverse presentations, critical complications such as diffuse alveolar hemorrhage (DAH) and cardiac tamponade, and nuanced management options.

Peritoneal Amyloidosis As A Presenting Manifestation Of Al Amyloid, Indira Acharya, Gifty A. Dominah, Dongmei Xing, Elizabeth Allen, Jeffrey S. Iding, Christopher J. Haas

Journal of Community Hospital Internal Medicine Perspectives

Amyloid is a systemic disease characterized by extracellular deposition of misfolded protein. Gastrointestinal and peritoneal deposition of light chain (AL) amyloid is an under-recognized manifestation of this systemic disease, usually as a late sequela. Here we present a case of recently diagnosed AL peritoneal amyloid that presented in the context of recurrent, acute onset abdominal discomfort and was found to have bowel obstruction complicated by perforation in the setting of AL-mediated gastrointestinal tract infiltration and dysmotility.

Acute Pancreatitis Following Percutaneous Mechanical Thrombectomy Of Left Common Iliac Vein, Ashik Pokharel, Xinhang Tu, Haider A. Naqvi, Rafi Raza, Christopher J. Haas

Journal of Community Hospital Internal Medicine Perspectives

While parental or oral anticoagulation remains a mainstay of therapy for thrombosis, in sporadic clinical situations, percutaneous mechanical thrombectomy is favored. Percutaneous mechanical thrombectomy is a well-tolerated subtype of catheterdirected intervention resulting in thrombus breakdown and removal. This procedure combines endovascular mechanical thrombectomy in combination with pharmacologic thrombolysis allowing for a significant reduction in procedure time. Similar to other catheter-based procedures, common complications include hemorrhage, dissection, pseudoaneurysm, and perforations. Acute pancreatitis, in contrast, is a rare complication of percutaneous mechanical thrombectomy with only limited cases reported and is hypothesized to occur secondary to release of heme byproducts. Here, we present …

Pembrolizumab-Induced Broken Heart Syndrome, Pneumonitis, And Hypophysitis Occurring Concurrently; A Deadly Triad, Wahab J Khan, Muhammad Asif, Hammad S Chaudhry, Sadia Aslam, Ifrah Nadeem

Journal of Community Hospital Internal Medicine Perspectives

Immune checkpoint inhibitors or novel medications are used to treat a wide range of solid organ tumors and work by stimulating the cellular immune response. With their increasing use, more and more multiorgan side effects are reported in the literature. Prompt recognition of these findings is vital for the safe clinical use of these agents. Most side effects are immune-mediated injury, and the treatment involves stopping the ICI drug and systemic steroids. We report a case of a 72-year-old female treated with pembrolizumab monotherapy for non-small cell lung cancer. She presented after the second session of pembrolizumab for dyspnea and …

Thyrotoxicosis In The Setting Of Hydatidiform Mole With Subsequent Development Of Takotsubo Cardiomyopathy Complicated By Covid-19, Kara E. Hensley, Christopher W. Fiechter, Henry J Weiss, Md, Alysson Klein, Md, Rhabia Hussein, Md, Mihail Zilbermint, Md, Mba, Face

Journal of Community Hospital Internal Medicine Perspectives

We present a rare case of hydatidiform molar pregnancy, which led to the development of thyroid storm, followed by a rare complication of Takotsubo cardiomyopathy in the setting of a COVID-19 infection. A 21-year-old female of 22 weeks gestational age presented with heavy vaginal blood loss, brown emesis, tachycardia, and lethargy. Through clinical presentation and ultrasound confirmation, a molar pregnancy was diagnosed. Laboratory data and clinical presentation of thyrotoxicosis supported a diagnosis of thyroid storm. Test for COVID-19 was positive. The patient was treated with dilation and curettage, antithyroid medication, and blood transfusions, resulting in symptom resolution. Thereafter, echocardiography confirmed …

A Rare Case Of Refractory Catastrophic Antiphospholipid Syndrome Successfully Treated With Rituximab And Plasma Exchange, Ayrton Bangolo, Sowmya Sagireddy, Sarah Mahamadeen, Felicia Hasta, Sadhu A. Reddy, Afshan Naz, Ravishankar Ranganatha, Cleveland Ricketts, Padmavathi Muppalla, Swathi Veliginti, Georgemar Arana, Dily T. Sathyarajan, Sachin Singhal, Tanvi Shetty, Kshitij Bhardwaj, Sayed Hashemy, Roberto L. Duran, Sung H. Kim, Candice M. Hipolito, Kibo Yoon, Vrusha Patel, Aseel Alshimari, Pugazhendi Inban, Saaniya Yasmeen, Simcha Weissman

Journal of Community Hospital Internal Medicine Perspectives

A small subset of patients with antiphospholipid syndrome (APS) may develop widespread thrombotic disease with organ damage, referred to as catastrophic APS (CAPS) that is associated with a high mortality. Medical therapy typically involves a combination of anticoagulation, systemic glucocorticoids, plasmapheresis, and intravenous immune globulin (IVIG). There is currently no consensus for the management of refractory cases of CAPS. However, monoclonal antibodies such as rituximab and eculizumab have shown some benefits. Herein, we present a 29-year-old female with previous pulmonary embolism who presented with necrotic left toes and was eventually diagnosed with refractory CAPS, successfully treated with Plasmapheresis and Rituximab. …

Overlapping Hepatotoxicity And Colitis Associated With Immune Checkpoint Inhibitors, Alexander Malik, Muhammad Nadeem Yousaf, Sami Samiullah, Veysel Tahan, Amin Mahdi

Journal of Community Hospital Internal Medicine Perspectives

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that are widely used for the management of many solid-organ and hematologic cancers. These agents work by inhibition of cytotoxic T-lymphocyte–associated antigen-4 (CTLA-4), programmed cell death-1 (PD-1), and PD ligand 1 (PD-L1). Hyperactivation of immune system results in ICI-associated adverse events. Simultaneous hepatotoxicity and colitis associated with ICIs is rare and potentially overlooked, as clinical symptoms are often nonspecific. A 73-year-old man with metastatic squamous cell carcinoma presented six weeks after starting pembrolizumab with abdominal discomfort and diarrhea. Pembrolizumab therapy was held, and supportive therapy with antidiarrheals provided partial relief. After initial workup, …

Classic Iga-Vasculitis With Nephrotic Range Proteinuria - Rare Presentation In An Adult, Ella Teplitsky, Maryam Zafar, Abubakar Tauseef, Marissa Varghese, Joseph Thirumalareddy, Sunil Nair, Akshat Sood, Mohsin Mirza

Journal of Community Hospital Internal Medicine Perspectives

IgA vasculitis formerly known as Henoch-Schonlein Purpura is characterized by leukocytoclastic vasculitis and IgA immune complex in small vessels of the affected organ. IgA vasculitis can involve any organ system depending upon the deposition of the IgA immune complex. IgA vasculitis is a clinical diagnosis which manifest with abdominal pain, arthralgia/arthritis, palpable purpura, and kidney involvement. Occasionally, serum IgA levels or skin or kidney biopsy can help in confirming the diagnosis. Treatment is usually supportive, but studies have proved that prednisone or immunosuppressive agents can help in the prevention or progression of the disease. Hereby we present a case of …

Left Ventricular Non-Compaction Cardiomyopathy: A Case Report And Literature Review, Sherif Elkattawy, Jesus Romero, Kalpesh Shah, Paul Fanous, Muhammad Atif Masood Noori, Nikita Sachdeva, Asnia Latif, Neil Williams, Ana L. Romero

Journal of Community Hospital Internal Medicine Perspectives

Left Ventricular Non-Compaction Cardiomyopathy (LVNC) is a rare myocardial disorder characterized by abnormal myocardial tissue formation in which the left ventricular wall appears to be trabecular with prominent intertrabecular recesses. The diagnosis of LVNC is predominantly reliant on cardiac imaging, namely thoracic echocardiography, however, cardiac MRI is indicated in conditions in which echocardiography is inconclusive. Diagnostic criteria for both echocardiography and cardiac MRI differ, however, the general principle of diagnosis is a comparison of the thickness of non-compacted to compacted myocardial tissue. The management of LVNC is nearly identical to that of Heart Failure with reduced Ejection Fraction (HFrEF), however, …

Gastrointestinal Bleeding As Initial Manifestation Of Injection Drug Use-Associated Amyloidosis, Mohammed Rifat Shaik, Nishat Anjum Shaikh, Elvina Yunasan, Erika Wheeler, Robert T Chow

Journal of Community Hospital Internal Medicine Perspectives

Systemic amyloidosis has been reported in the context of injection drug use, usually related to ongoing chronic inflammation and persistent cutaneous infections. The kidneys are almost always the first organs affected in that setting. Involvement of the gastrointestinal tract is less common and rarely the initial site of presentation. We present a case of systemic amyloidosis that primarily manifested in the gastrointestinal tract, occurring in the setting of chronic injection drug use. The patient's hemoglobin level dropped progressively over time due to ongoing, slow gastrointestinal bleeding, prompting an endoscopic examination that ultimately confirmed the presence of gastrointestinal amyloidosis. As the …

Spontaneous Hemorrhage Of Thoracic Cavernous Malformation Leading To Bilateral Lower Extremity Paralysis, Alex Ashkin, Joshua Parmenter, Keegan Plowman, Ricardo Franco-Sadud

Journal of Community Hospital Internal Medicine Perspectives

Cavernous malformations (CMs) are abnormal clusters of thin-walled blood vessels located in the central nervous system. An 87-year-old male with a history of heart failure with reduced ejection fraction, coronary artery disease, and atrial fibrillation on rivaroxaban was admitted for acute onset, bilateral lower extremity weakness. He was found to have hemorrhagic transformation of a pre-existing spinal cord cavernous malformation located at the level of T9 of the thoracic column worsened by his use of anticoagulation. Surgical resection remains the only definitive management. Patients at high risk for surgical intervention are managed with supportive care and physical therapy.

Recurrent Psychosis In Non-Celiac Gluten Sensitivity, Scarlet Louis-Jean, Shire Chaudhry

Journal of Community Hospital Internal Medicine Perspectives

Neuropsychological manifestations following food exposures in patients with food sensitivities are increasingly being identified in the literature, as understanding of the gut-brain axis is further improved. Non-celiac gluten sensitivity (NCGS) has been shown to occur in individuals without serological or biopsied evidence of celiac disease (CD), who manifest psychotic or mood disorders that resolve following elimination of gluten. In this case history, we discuss a similar manifestation in a 31-year-old woman without serological evidence of CD, whose psychiatric symptoms improve with gluten elimination.

Heart Failure Associated With Mycoplasma Pneumoniae Infection, A Case And Review Of Literature, Muhammad Asif, Hammad S. Chaudhry, Sadia Aslam, Ifrah Nadeem, Sunia S. Chaudhry, Wahab Khan

Journal of Community Hospital Internal Medicine Perspectives

Mycoplasma pneumoniae is well known to cause pulmonary infection. However, it often has extrapulmonary manifestations as well. We diagnosed and treated a 41-year-old female who presented with symptoms of pneumonia along with multisystem involvement, including rash, acute hepatitis, and new onset heart failure that improved with steroids and doxycycline. Subsequent goal-directed medical therapy for non-ischemic cardiomyopathy (NICM) coincided with the complete recovery of the left ventricular function in three months. We also did a brief literature review with similar prior reported cases.

Prevalence And Impact Of Gastrointestinal Manifestations In Covid-19 Patients: A Systematic Review, Bassam Hossain, Shoreh Qazi, Sumair Ahmad, Atif Saleem, Amanke Oranu, Fahad Malik

Journal of Community Hospital Internal Medicine Perspectives

Background and Objective: The aim of this study is to systematically analyze and summarize the implications of COVID-19 on the digestive system by quantitatively evaluating the prevalence of gastrointestinal symptoms such as nausea, vomiting, abdominal pain, constipation, diarrhea, anorexia. reported in COVID-19 cases. We simultaneously investigated other variables to determine the association of such symptoms in COVID-19 patients which can potentially influence the disease prognosis and outcome. This systematic review presents an updated literature on the issue as it requires more scientific discussion in order to better inform the medical community and authorities so that appropriate measures can be taken …

Analyzing And Improving The Utilization Of Statin Drugs In Family Medicine Patients With Type Ii Diabetes, Keegan Dunn, Jonathan Kopel, Mousab Diab, Franklyn Babb

Journal of Community Hospital Internal Medicine Perspectives

Background: Statins are the primary drug used to reduce morbidity and mortality for cardiovascular disease. However, many type II diabetes mellitus (T2DM) patients who are currently not on a statin would otherwise qualify. Therefore, we investigated the proportion of T2DM patients on a statin compared to the total number of T2DM patients eligible to be on a statin. We also examined potential barriers that prevent T2DM patients from being prescribed statins by physicians. Methods: A retrospective chart study on family medicine patients collected data on age, race, cholesterol readings, blood pressure, and whether the patient was on blood pressure medications, …

Lifestyle And Dietary Habits Change Before And During Quarantine And Subsequent Weight Gain, Adnan Gulzar, Anosh Javed, Amna Liaquat, Daniyal Javed, Maham Zahid, Hassan Mumtaz

Journal of Community Hospital Internal Medicine Perspectives

Background: Pandemics greatly affected human health due to changes in dietary habits and lifestyle Methods: A multi-centric comparative cross-sectional study was conducted online using a structured questionnaire with 323 respondents from two medical colleges of Lahore, Pakistan. The collected data was analyzed including various variables of dietary habits, lifestyle changes and were compared by using paired sample t-test. Chi-square test was applied to measure the relation of weight gain with lifestyle and dietary habits changes. Result: Out of 323 participants, 64.5% of them observed an increase in their weights and 64.1% of respondents noticed an increase in caloric intake. An …

Home Oxygen And Monitoring For Covid-19 Patients: A Multidisciplinary Team Approach, Mahta Salehi, Shehrose Chaudry, Rebecca B. Newman, Josette Hartnett, Suzanne J. Rose, Forugh Homayounrooz

Journal of Community Hospital Internal Medicine Perspectives

Introduction: During the initial COVID-19 pandemic peak, Stamford Hospital implemented a home oxygen program (HOP) to create a comprehensive, multi-disciplinary outpatient initiative without sacrificing a safe discharge. Primary care physicians monitored program participants, whose only indication for remaining admitted was an oxygen requirement. We retrospectively examined participant co-morbidities and outcomes, including death and readmission rates to evaluate HOP safety.

Methods: A retrospective analysis of program participants discharged between April 2020-Janurary 2021 was performed. Variables included demographics, oxygen requirement, days enrolled in the HOP, and major comorbidities such as cardiovascular disease (CVD), diabetes (DM), hypertension (HTN), obesity, chronic kidney disease, malignancies …

The Watchman Device Review: A New Era For Stroke Prophylaxis, Samiullah Khan, Hifza Naz, Muhammad Saad Qadeer Khan, Asif Ullah, Danish Iltaf Satti, Jahanzeb Malik, Amin Mehmoodi

Journal of Community Hospital Internal Medicine Perspectives

Atrial fibrillation (AF) is a major risk factor for ischemic stroke, accounting for more than 37 million cases worldwide. In AF, the left atrial appendage (LAA) is the most common site of thrombus formation, and its ligation/closure with the WATCHMAN device is a good alternative to long-term oral anticoagulation, especially in patients with contraindications to warfarin. However, the implantation procedure is associated with various risks and complications. A short-term anticoagulant and antithrombotic administration are essential after implantation. However, no consensus has been reached on the optimal regimen. The WATCHMAN device is non-inferior to warfarin and is a safe alternative for …

Pyramid Of Discharge Needs: A Simple Framework On Discharge Planning For Medical Students And Residents, Ho-Man Yeung

Journal of Community Hospital Internal Medicine Perspectives

Medical students and residents often have difficulty with discharge planning and determining appropriate post-hospitalization level of care. As the discharge planning process can be complex, physicians in-training often do not engage until late into the hospitalization or near day of discharge. This paper offers a simple pyramid construct that categorizes common discharge needs into 4 areas or tiers. As the topic of discharge planning is not formally taught in medical education, most trainees learn through experience and by trial and error. Using a simple pyramid and a basic flow chart to guide students and residents, the discharge planning process can …

Prevalence Of Workplace Violence And Effects Of De-Escalation Training Among Hospitalists: A Pilot Study, Ishaan Gupta, Shaker M. Eid, Che Matthew Harris, Regina Kauffman, Catherine Washburn, Amteshwar Singh, Venkat P. Gundareddy, Flora Kisuule

Journal of Community Hospital Internal Medicine Perspectives

Introduction: Workplace violence (WPV) is increasing in healthcare and negatively impacts healthcare worker outcomes. De-escalation training for healthcare workers is recommended to reduce WPV from patients and visitors. Hospitalists may be at high risk for WPV, but the magnitude of WPV and the impact of de-escalation training among hospitalists is not known. Methods: We investigated the baseline prevalence of WPV experienced by 37 hospitalists at a single center. After an in-person de-escalation training, we measured hospitalists' self-reported "Confidence in Coping with Patient Aggression" using a validated scale (score range 10-110). Results: In the 12 months before de-escalation training, 86.5% of …

The Next Step For Our Unitarian Churches, Earl Clement Davis

Manuscripts, 1933-1953

This was a talk that Earl Davis gave at a conference. We have yet to identify the conference or its exact date, but internal evidence – referencing the past “Hoover Administration” and the Roosevelt Administration “brain trust” -- suggests this was presented in 1934 or shortly thereafter.

This writing is a good representation of Davis' core views, drawing from the history of Congregationalism into a discussion of new problems. He ends with a a poem by Jean Untermeyer.

Date refers to Date Given

The primary downloadable document contains the original document followed by the transcription. The bottom of each item …

Examining The Effects Of Student Loan Forgiveness And The Christian Perspective, Sarah Rogers

Helm's School of Government Conference - 2021-2024

On August 24, 2022, President Joe Biden announced his plan for federal student loan forgiveness. The program allows individuals who make less than $125,000 a year and families under $250,000 relieve up to $10,000 of their loan debt. Those who fall under the Pell Grant program are able to relieve up to $20,000 of their debt. The reactions to this “revolutionary” program were mixed. Typically, those who the program would directly affect were very enthusiastic about this idea while those, most notably Republicans, were less than thrilled. While the idea is good in theory, the execution of debt forgiveness will …

Unequal Democracies: Economic Sanctions' Impact On Human Rights In Democratic Systems, Daniel Partin

Helm's School of Government Conference - 2021-2024

In the past, research into the field of human rights has treated regime as a dichotomous variable and divided the type of governmental structure into either autocracies or democracies. By lumping all democracies into one category, all variation between different categories of governmental composition is discarded and it is difficult to examine the differences between types of democratic governments and their human rights capacities. Due to their tendency to accrete power centrally, presidential democracies are thought to repress the rights of citizens more often and severely than parliamentary systems. Further, an exogenous shock to the political system, such as the …

The American Debate Between Toleration And Liberty Of Conscience, Zachary Federico

Helm's School of Government Conference - 2021-2024

No abstract provided.

The Unethical Use Of Children In War, Mariana Davis

Helm's School of Government Conference - 2021-2024

This paper examines the role the nature of children has in the immorality of their use in warfare. The exploitation of children in war is a long, pervasive issue that is primarily documented in third-world countries with ongoing conflicts. This paper details the developments in the legality of the use of children in war. It expounds upon the current and historical use of child soldiers and the horrors that come with it. Evidence was taken from the consequences to the children and the nations that use them to demonstrate why this practice is unethical and immoral. This paper studies why …