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Lactobacillus Bacteremia: A Tell-Tale Sign For Diabetes?, Kriti Lnu, Ahmed Abdelsalam, William Bambach

Journal of Community Hospital Internal Medicine Perspectives

Background: Lactobacillus is a commensal that can be found as normal flora in the oropharynx, gastrointestinal and genitourinary tracts. Lactobacillus sepsis and bacteremia is usually found in immunocompromised individuals. In patients with no known underlying disease presenting with lactobacillus bacteremia, an extensive workup should be done before dismissing the organism as a contaminant.

Case: A 35-year-old man with no known past medical history presented with a perianal abscess associated with Lactobacillus bacteremia. There was no known history of human immunodeficiency virus, diabetes mellitus, carcinomas or chemotherapy, intravenous drug abuse, and/or commercial probiotic use. Laboratory testing revealed an HA1c of 15%, …

Where Is The Thrombus ? Mural Ascending Aortic Thrombus With Embolic Events In A Patient With Recent Covid 19 Infection, Hardik Fichadiya, Melvin Santana, Sarah Ayad, Iman El-Feki, Edmund Appiah-Kubi, Nirmal Guragai, Raja Pullatt

Journal of Community Hospital Internal Medicine Perspectives

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a global health pandemic that led to substantial morbidity and mortality worldwide.  The virus has been known to  predominantly cause severe hypoxemic respiratory failure but there have been multiple reports of extra-pulmonary manifestations.  Additionally, there has been increasing evidence of COVID-19 hyper-coagulability. Herein, we present a case of a  49-year-old male with a past medical history of diet controlled type II diabetes mellitus and recently diagnosed COVID-19  who presented to the emergency department with a chief complaint of nausea and vomiting. Our patient was found to have a …

Angiotensin Receptor Blockers Associated Enteropathy- Brief Report, Falgun Gosai, Neha Gosai

Journal of Community Hospital Internal Medicine Perspectives

The current literature has shown equivocal results regarding the association of Olmesartan and other angiotensin receptor blockers (ARBs) use and the presence of Celiac sprue-like enteropathy (CSLE). Various factors affecting the association are- patient population under study, geographic area, and duration of use of medication. Various case reports/ case series and observational studies have shown the mixed results regarding an association. We have tried to answer a question what exists in the literature regarding the angiotensin receptor blockers related sprue like enteropathy.

Atypical Takotsubo Cardiomyopathy Presentation In An Adult Patient, Jasmin Martin, Allison Wallingford, Dana Dhami, Aseem Sood

Journal of Community Hospital Internal Medicine Perspectives

Takotsubo cardiomyopathy (TSC) is a transient cardiac condition brought on by physical and emotional distress causing left ventricular akinesis. Typically, patients are older females that present with substernal chest pain radiating to the left arm, presenting similarly to acute coronary syndrome. In addition, the elevated troponins and EKG changes such as ST elevations and T wave inversions seen in acute coronary syndrome may also be appreciated in TSC. While there have been many reports of TSC presenting in a similar manner to acute coronary syndrome, this case report will describe an atypical presentation of Takotsubo cardiomyopathy. The patient we are …

Drug-Induced Erythema Multiforme Major In An Elderly Female, Roshniben Patel, Akhila Mohan, Noha Omar, Maria Pardi

Journal of Community Hospital Internal Medicine Perspectives

Erythema multiforme (EM) is an acute, immune-mediated condition which affects the skin and mucous membranes. EM is a type 4 hypersensitivity reaction typically mediated by cytotoxic T lymphocytes. It is usually a self limiting, transient, inflammatory disease that spontaneously resolves within weeks without major sequelae. However, occasionally patients might have frequent recurrences, persistent disease or serious complications like fluid and electrolyte abnormalities.The most common triggers are infection followed by medications. Here we present the case of an 81-year-old female who came in with worsening lip and tongue swelling associated with a rash and was diagnosed with EM major due to …

The Racial Divide: A Follow Up Study On Racial Disparity Amongst Covid-19 Survivors In An Urban Community, Christopher Millet, Emily Racoosin, Spandana Narvaneni, George Horani, Sherif Roman, Alisa Farokhian, Arslan Chaudhry, Sohail Chaudhry, Yezin Shamoon, Humberto Jimenez, Patrick Michael, Jin Suh

Journal of Community Hospital Internal Medicine Perspectives

Background Studies have shown that COVID-19 has had a disproportionate effect on minority groups in both the clinical and social settings in America. We conducted a follow up study on patients previously diagnosed with COVID-19 one year ago in an urban community in New Jersey. The purpose of the study was to evaluate the socioeconomic impact of COVID-19 as well as assess for receptiveness towards COVID-19 vaccination amongst various ethnic groups.

Methods This was a prospective cohort study consisting of patients who had recovered from COVID-19 one year prior. The patients included in the study had a confirmed COVID-19 diagnosis …

Successful Utilization Of Life-Saving Extra-Corporeal Co2 Removal In Catastrophic Status Asthmaticus: A Case Report, Mahsa Mohammadian, Ahmed Mowafy, Anthony Dikhtyar

Journal of Community Hospital Internal Medicine Perspectives

Acute asthma exacerbations can be severe and life-threatening. In some cases, standard interventions and management do not result in reversal of bronchoconstriction. It is crucial to detect patients with impending respiratory failure and escalate management to invasive mechanical ventilatory support and, in refractory cases, interventions like extracorporeal membrane oxygenation (ECMO). This technique is not frequently utilized but has proven to be effective in settings of resistant status asthmaticus.

We describe a case of respiratory distress secondary to asthma exacerbation, which rapidly devolved into status asthmaticus. It was resistant to all standard and off-label management modalities, which necessitated the use of …

Neurosyphilis: A Monkey Among Men, Cameron Rowe Do, Nathan Buckley Do, Bhaskar Chhetri Md, Suresh Paudel Md

Journal of Community Hospital Internal Medicine Perspectives

Neurosyphilis is the progression of the untreated sexually transmitted infection caused by Treponema pallidum. When the initial infection is not adequately treated, progression of primary syphilis can lead to a wide variety of serious health sequelae. While neurosyphilis can appear up to 10-30 years after the initial infection, syphilis can invade the nervous system at any stage of infection and can imitate symptoms of many other diseases. This variety of symptoms is why syphilis has been called “The Great Pretender” or “The monkey among diseases” (12). This is a case report of an 83-year-old female with a history of multiple …

2-Deoxy-D-Glucose As India’S Response To Covid-19: A Commitment Or Conceit?, Ritwik Ghosh, Dipayan Roy, Subhankar Chatterjee, Julián Benito-León

Journal of Community Hospital Internal Medicine Perspectives

2-deoxy-D-glucose (2-DG) has recently been approved to treat moderate to severe COVID-19 patients in India. Here we discuss whether this is a well-thought-out step towards the long-term management of COVID-19 or a decision taken at the spur of the moment. 2-DG, an anticancer drug, also has immunomodulatory functions. Several studies have shown 2-DG to inhibit viral replication and cytokine storm. However, these findings are mostly on cells and animal models. The clinical trial that has become the basis of the approval of this drug in India is yet to be peer-reviewed and has not explicitly addressed several concerns, nor has …

The Utility Of Brain Natriuretic Peptide In Patients Undergoing An Initial Evaluation For Pulmonary Hypertension, Sanjana Rao, Benjamin Daines, Omid Hosseini, Victor Test, Kenneth Nugent

Journal of Community Hospital Internal Medicine Perspectives

Introduction: Brain natriuretic peptide (BNP) is a polypeptide released from the cardiac ventricles and has been used as a diagnostic marker in cardiovascular diseases. Some patients with pulmonary hypertension have significant increases in BNP levels. This study wanted to determine whether the BNP levels in patients referred for evaluation of possible pulmonary hypertension were associated with a particular functional class or diagnostic group. Methods: Data were collected on patients from the Pulmonary Vascular Disease clinic undergoing right heart catheterization between 1/1/2019 and 5/20/2020. Clinical information, laboratory results including BNP, and hemodynamic parameters were recorded. Results: This study included 117 patients …

Restrictive Versus Liberal Blood Transfusion Strategy In Patients With Acute Myocardial Infarction: A Meta-Analysis Of Randomized Clinical Trials, Basel Abdelazeem, Bilal Malik, Emad Kandah, Sandi Banour, Abdul Rafae, Arvind Kunadi, Mustafa Hassan

Journal of Community Hospital Internal Medicine Perspectives

Background: A meta-analysis of observational studies comparing differences in outcomes between restrictive blood transfusion (RBT) and liberal blood transfusion (LBT) in patients with acute myocardial infarction (AMI) reported that LBT is associated with higher all-cause mortality. Few randomized clinical trials (RCTs) have compared RBT to LBT in patients with AMI and anemia, but no meta-analysis of RCTs was performed to date.

Aim: To assess the clinical effect of RBT compared to LBT in patients with AMI and anemia regarding was all-cause mortality, recurrent MI, revascularization, and heart failure exacerbation. Methods: The electronic databases Ovid MEDLINE, EMBASE, Cochrane Central, Scopus, and …

A Scoping Review Of Vaping, E-Cigarettes And Mental Health Impact: Depression And Suicidality, Sana Javed, Sadia Usmani, Zouina Sarfraz, Azza Sarfraz, Aunsa Hanif, Amena Firoz, Rusab Baig, Medha Sharath, Namrata Walia, Ivan Chérrez-Ojeda, Saeed Ahmed

Journal of Community Hospital Internal Medicine Perspectives

Electronic cigarettes have grown in popularity due to natural curiosity, novel flavors, and advertising as both a means to aid smoking cessation and a “safe” smoking option. There is a substantial body of research on the harmful physical health effects of vaping, but there are relatively few studies on its mental health effects, particularly in adolescents 10e21 years of age. The purpose of this review is to examine the negative effects of vaping on mental health, in particular depression and suicidality. focused on observational studies looking into association between vaping, depression and suicidality. We found 7255 studies; after removing duplicates …

Perspectives On Consumer And Clinical Genetic Testing Education Among Medical Students In West Texas, Jonathan Kopel, Gregory L. Brower

Journal of Community Hospital Internal Medicine Perspectives

There is a popular trend for genetic test companies to market genetic screenings to identify detrimental mutations directly to consumers. As a result, there has been an increase in the number of patients wanting to discuss the results of their personal genetic tests with their physician. In turn, the medical education community has recognized a need to provide medical staff and patients with resources to interpret and act on personal genetic data. Most medical students and residents lack the requisite knowledge to interpret and manage patient-provided individualized genetic testing. This has prompted a growing interest among medical students in learning …

Cases From A Community Hospital… Jchimp Series #1: 55-Year-Old Male With Acute Pe Who Developed Persistent Epistaxis., Jerrica N. Mueller, Bobby Mathew, Douglas D. Reh, Joseph Fuscaldo

Journal of Community Hospital Internal Medicine Perspectives

This is the first in a new series of case reports that will present real scenarios from our community hospital. The cases are chosen to highlight clinical dilemmas and offer review and perspective on what is currently known about the topic. We present the case of a 55-year-old Caucasian male who presented to the emergency department of our community hospital for worsening dyspnea. Evaluation in the Emergency department revealed a diagnosis of extensive pulmonary emboli in the pulmonary vasculature. The patient was admitted to the ICU. A clinical decision was made to initiate treatment with low-dose tissue plasminogen activator (tpa) …

Simulation Of Inpatient Medical Critical Events For Physicians At A Community Hospital, Michael S. Yoo, Derek J. Ochi, Susan J. Doolittle, Carrie M. Griffith

Journal of Community Hospital Internal Medicine Perspectives

Background: Critical events are common at community hospitals, yet physicians who lead them have had varying levels of training and involvement during their residency and professional development. Little is known about the impact of simulation to improve performance during inpatient critical events among community hospitalist physicians. Objectives: To determine if hospitalist physicians reported sustained performance improvement regarding critical events as a result of simulation. Methods: Physicians at a community hospital in Northern California participated in critical event simulation over one year. Self-assessment surveys (scale 1 through 5) were collected before, after, and at 1-month post-simulation. Differences in survey scores and …

Development Of A Community Hospital Medicine Affiliated Inpatient Rotation For Family Medicine Residents - A Collaborative Success, David M. Gallagher, Anthony J. Viera, William E. Bynum, Poonam Sharma, John W. Ragsdale, Jeffrey Eschbach, Lalit Verma

Journal of Community Hospital Internal Medicine Perspectives

Background: Hospitalists perform key roles as inpatient educators for family medicine residents. For the past decade, Duke University Family Medicine Residency Program had its inpatient family medicine resident rotation at non-Duke facilities.

Objective: The authors describe the steps taken in 2020 to develop an inpatient Duke family medicine rotation at a North Carolina community hospital, Duke Regional Hospital, and provide outcomes data.

Methods: Duke Family Medicine Residency and Duke Regional Hospital Medicine collaborated in addressing key issues to develop an inpatient rotation for family medicine residents. Performance metrics of patients cared for by both the family medicine inpatient resident team …

11th Anniversary Of Jchimp, Robert Ferguson, Richard Alweis, Gillian Junker

Journal of Community Hospital Internal Medicine Perspectives

No abstract provided.

Leverage Topology Optimization To Maximize Structure Design Efficiency, Teng Li, Saad Aqerrout

ME 4233/6233 Fundamentals of FEA

This paper presents the topology optimization method to improve the efficiency of mechanical structure design.

Computational Mechanics Implementation Of Performance Based Testing In Massive Concrete Structures, Gabriel Y. Riveros

ME 4233/6233 Fundamentals of FEA

Most of the nation’s critical water resource infrastructures are near or have exceeded their design lives. Consequently, there is a huge need for the development of assessment procedures that will change the way dams are maintained and operated with the intent of extending the service life. This is crucial for ensuring the safety and security of our nation’s public services. The combination of advanced computational mechanics and performance based testing (PBT) methods can be used to investigate the existing conditions of large concrete structures.

Performance based testing (PBT) is a new and innovative non-destructive testing technique that we are implementing …

Comparison Of Johnson-Cook And Linear Elastic-Perfectly Plastic Material Models For Ballistic Impact Case, Logan J. Callahan, Marella Failla, Harrison Williams

ME 4233/6233 Fundamentals of FEA

In an effort to characterize the linear elastic-perfect plastic (J2) and Johnson-Cook (JC) Strengthening and Damage material models for an Aluminum target material being struck by a steel penetrator, finite element analysis (FEA) will be used to simulate the residual velocities from ballistic impacts, using various velocities of the penetrator. The object is to define the point at which the J2 material model is no longer accurate and therefore requires the use of the JC material models.

Numerical Analysis Of Taylor Impact With Various Nose Shapes, Jean C. Santiago Padilla, Erik M. Chappell

ME 4233/6233 Fundamentals of FEA

The Taylor impact test is an experimental technique used to determine dynamic material response and to validate constitutive models used in numerical simulations. It generally consists of shooting a cylinder rod of a select material against a rigid target at different velocities. After impact, the plastic deformation of the cylinder is recorded and is directly compared to numerical predictions. Another application for Taylor impact was proposed by Li et al. (2021) where the nose shape of the cylinder is modified to create different loading environments that can test electronic equipment in penetration weapons. FEA models where designed in ABAQUS/Explicit to …

Improving Feedforward Controls To Improve Npd Portfolio Performance – An Empirical Study, Mark H. Baker, Mike Bourne

Engaged Management ReView

Managers making crucial project selections in large, fast-changing project portfolios face the challenge of balancing the tension between control (performance) and creativity (experimentation/innovation). To better manage this challenge and to improve performance, some practitioners and scholars have considered the application of more sophisticated feedforward controls in new product development portfolio project selections. However, empirical studies of changes in the sophistication of such controls and of their influence on performance are lacking. We use an engaged scholarship approach and an action research methodology in a large international organization with multiple business units to study the post-intervention changes in applied controls and …

The Influence Of Regulatory Oversight On Environmental, Social, And Governance Ratings, John F. Torpey

Engaged Management ReView

Firm performance in the specific areas of environmental stewardship, social responsibility, and corporate governance (ESG) has become an important criterion that investors use in determining a firm’s value. This empirical investigation, based on stakeholder theory examines the relationship between regulatory oversight and third-party ESG ratings. Our research methodology involved quantitative, observational, and retrospective analyses. The study population consisted of 471 firms from two heavily regulated industry sectors—the utility and financial sectors—and from two less regulated sectors—the information technology and consumer discretionary sectors. We compiled the ESG ratings for the firms from two independent rating services. The quantitative evaluation included multiple …

Journal Of South Carolina Water Resources

Journal of South Carolina Water Resources

The Journal of South Carolina Water Resources (JSCWR) is dedicated to scientific research and policy to meet the growing challenge of providing water resources for the sustainable growth of South Carolina’s economy while preserving its natural resources. This special issue focuses on Water Quality and Public Health and is sponsored by the federally funded Center for Oceans and Human Health and Climate Change Interactions (COHHC² I) at the University of South Carolina (UofSC). In addition to UofSC researchers, the COHHC² I involves researchers, students, and other participants from Baylor University, The Citadel, College of Charleston, Rutgers University, University …

A Model For Equity In Arts Education For Youth In Greater Portland, Maine, Catherine Scheirer

Thinking Matters Student Research Symposium

Time and time again, by providing an outlet that allows innate human creativity to roam free, participation in arts activities such as dance, music, theatre, and visual arts is proven to have significant positive impacts on participants, regardless of age, experience, or background. Even though the arts have been acknowledged as critical for mental, physical, and emotional health, especially for children and adolescents, research has found that providing arts education in an equitable and culturally appropriate way is fraught with barriers. In addition, certain areas of the arts have seen a downward trend in educational priority and availability. My project …

Analysis Of Preload In Bolted Joints Under Impulse, Albert Dusseault

Thinking Matters Student Research Symposium

From transportation to storage to construction, bolted joints are utilized everywhere. Bolted joints in closures such as pressure vessels/tanks require a preload, or a specific amount of tightening of the bolts to seal the vessel when pressurized to avoid leaking. Low preload can result in joint loosening whereas high preload can result in yielding. Therefore, finding feasible and even better optimal values of preload is of great practical importance. In an earlier work in 1996, this problem was tackled with an exponentially decaying pressure applied on a pressure vessel closure. In the present analysis, however, the pressure variation is considered …

A Review Of The Effect Of Hla Genotype On Covid-19 Severity, Natalie Chalfant

Thinking Matters Student Research Symposium

No abstract provided.

Identifying The Support Women Entrepreneurs In Rural Maine Need From Each Other And Their Communities To Thrive, Lisa Luken

Thinking Matters Student Research Symposium

Rural women entrepreneurs have the power to positively impact the sustainability of their communities, yet they are faced with internal and external challenges in their pursuits to grow successful businesses and create sustainable livelihoods. While a number of scholars in the past 10 years investigated these challenges and suggested some solutions, more research is needed to identify additional solutions, including those specifically relevant to rural Maine communities. This qualitative study explored the support women entrepreneurs in rural Maine need from each other and their communities to thrive. Data gathered through semi-structured interviews with eleven women entrepreneurs from rural Maine revealed …

3d Printing Of Piezoelectric Materials And Devices, Dominic Polletta, Zack Myrtle

Thinking Matters Student Research Symposium

The design goal of the project is to use a stock 3D printer to 3D print materials with piezoelectric properties by adding Barium Titanate nanoparticles to the UV resin. The result of the printed material will be a device that will produce a charge when subjected to vibrations or stress. These printed devices can be used as microphones and other vibration sensors in a variety of applications. This process will be achieved by modifying the 3D printer by changing the film in the resin vat of the printer with a conductive film. This will allow for applied voltage to create …

Transgender Experiences In Healthcare, Paige Grover

Thinking Matters Student Research Symposium

No abstract provided.