Life Sciences Commons^™

Conus Medullaris Termination In Adult Females, Vishwant Tatagari, Elizabeth Brehman, Jacob Newman, Deonnie Huang, Kerin M. Claeson

Research Day

Objective: The primary objective of this study was to determine the termination level of the spinal cord in a sample population of adult female cadavers.

Introduction: The conus medullaris represents the tapered, distal-most end of the spinal cord. It tends to be found somewhere between the L1-L2 lumbar vertebrae and can sometimes be higher or lower. Studies report the conus medullaris can be found anywhere from the lower third of T11 to the upper third of L3 with the average termination point around the lower third of L1. We aim to describe the level of conus medullaris termination in a …

Bleeding After Endoscopic Peg-Tube Removal On Patient Taking Clopidogrel, Sahil Patel, Michael Steinbook

Research Day

A 64-year-old man who is taking Clopidogrel was getting his PEG-tube removed endoscopically. Post-procedure, he started profusely coughing up blood clots. As a result, a repeat esophagogastroduodenoscopy had to be performed and revealed no blood in the esophagus or stomach. Upon further evaluation, the source of his blood clots was an ongoing episode of epistaxis which started following his COVID-19 test via nasopharyngeal swab three days prior. With the increasing need for COVID-19 testing, screening for epistaxis prior to performing out-patient procedures can help differentiate epistaxis from other procedurally-related complications

No Pain No Gain: Student Performance Over Time On The Revised Neurophysiology Of Pain Questionnaire, Ruth Maher, Jeanne P. Welch

Research Day

Purpose/Hypothesis: Core competencies in pain management for pre-licensure health professional education have been established. The purpose of this study was to assess the effect of 10-hours of pain neurophysiology education (PNE) on physical therapy students' understanding of pain and retention of key concepts.

Number of Subjects: Thirty-three second-year physical therapy students.

Materials and Methods: Ten hours of PNE was embedded in a clinical neuroscience course which included a 2-hour lab assignment called “The Matrix”. The content was guided by key principles recommended by the International Association for the study of Pain (IASP). The lab assignment included case studies that required …

Measuring The Effect Of A Resuscitation Academy On Out Of Hospital Cardiac Arrest Resuscitation Rates, Matthew Momjian, Jeffrey Kalczynski, Patrick Lombardi, Justin Canakis, Anna Mereminskaya, Thomas Depietro, Josh Baron

Research Day

According to the American Heart Association (AHA), rates of successful resuscitation after out of hospital cardiac arrest (OHCA) vary across the country. Amongst 132 counties in the United States, the rates of CPR survival to hospital discharge ranges between 3.4%-22.0%, and the rates of CPR survival with functional recovery ranges from 0.8%-20.1%. This large degree of variability between regions has been improved through programs that educate Emergency Medical Service (EMS) departments on ways to improve outcomes through an evidence-based lens. The Medic One EMS department in Seattle and King County, Washington developed a resuscitation academy (RA) that improved cardiac arrest …

Utilization, Utility, And Variability In Usage Of Adjunctive Hyperbaric Oxygen Therapy In Spinal Management: A Review Of The Literature, Kurt Knepley, Jennifer Mao, Patrick Laird, Nicholas Imperato, Asham Khan, Justice Agyei, Tim O'Conner, John Pollina, Jeffrey Mullin

Research Day

The objective of this review was to understand the clinical utilization, utility, and variability in the usage of adjunctive hyperbaric oxygen therapy (HBOT). Surgical site infection is associated with high morbidity and mortality, increased health care expenditure, and decreased quality of life. With the increasing prevalence of adult spinal deformity and spinal fusion surgery, it is imperative to understand the potential benefits of adjunctive treatments. HBOT is a safe and common procedure indicated to treat various medical conditions. We conducted a literature search across 3 databases for English articles published between December 1, 2019 and December 1, 2000. Thirteen studies …

Virtually Building A Community Of Experts In The Medication-Assisted Treatment (Mat) Of Opioid Use Using The Project Echo Model, Matthew Momjian, Justin Canakis, Faraz Yousefian, Hayden Pond, Adrienne White, Gregory Mayer, Alison Essary

Research Day

Purpose: Project Extension for Community Healthcare Outcomes (ECHO) utilizes telemedicine to connect a multidisciplinary team of experts with a network of primary care physicians to enable rapid dissemination of evidence-based guidelines and practices at scale. In this study, the Project ECHO model disseminated the Arizona Pain and Addiction Curriculum to providers in rural Arizona with the goal to educate providers on MAT.

Methods: Participants engaged in biweekly, virtual teleECHO sessions and post-session surveys were used to collect data on provider satisfaction, self-efficacy, knowledge, barriers to change and changes in practice behavior. Results: Between February 2020 – November 2020, the MAT-ECHO …

Clinical Relevance Of Quantifying Pelvic Lymph Nodes For Predicting And Treating Genital Lymphedema, Shelley Dicecco

Research Day

Anatomical research on the pelvic lymph nodes (LN) is inadequate. According to previous research there are between 41-154 LNs in the pelvic region (Inguinals-Lumbar) based on reported mean values across several studies. This range should be considered too large for a surgeon to decide how many LN to remove for diagnosing cancer without causing unnecessary harm or for a lymphedema therapist to explain expectations of involvement or improvement to a person with lymphedema. A more precise understanding of numbers and LN removed can help guide a therapist’s treatment with genital lymphedema. Muscles can assist in pumping fluid from an involved …

Bridging The Gap: The Lived Experience Of Women With Diastasis Recti Abdominis, Jennifer Wiley, Ruth Maher

Research Day

Research on Diastasis recti abdominis (DRA) has primarily focused on diagnostic tools, surgical and conservative treatments. Despite the association of significant physical symptoms and impact on quality of life, evidence is absent regarding knowledge or education provided to women about this condition.

Purpose: This study explored the lived experience of women who either self-identified or were medically diagnosed with DRA. A deeper insight into the experience of women with DRA may serve to enhance the patient-provider interaction during this critical time.

Methods: Qualitative methodology with a basic interpretive approach and purposive sampling was used. Participants shared their experiences through a …

A Short Story - The Effect Of Innovo® Shorts On Pelvic Floor Function, Ruth Maher

Research Day

The silent epidemic of urinary incontinence (UI) is described by the World Health Organization (WHO) as one of the last medical taboos and it interferes with the lives of millions of women. Only 25% of those with UI seek care, and of those, less than half receive treatment. The most common type of UI is stress urinary incontinence (SUI) which affects approximately 40% of community-dwelling women. The International Continence Society defines SUI as the complaint of involuntary leakage of urine on effort or exertion or with sneezing or coughing. This occurs in response to sudden increases in intra-abdominal pressure (IAP) …

Strabismus Decompensation As A Possible Neurological Manifestation Of Covid-19: A Case Report, Tyler Stevens

Research Day

A 27-year-old female presents to the emergency room with acute onset horizontal binocular diplopia and a history of COVID-19 infection two weeks prior. She has a history of longstanding intermittent right esotropia. Before her COVID-19 infection she only had diplopia after extended reading and typically sees clearly. After the infection, she has constant double vision which started acutely and worsened over several hours. Her only other symptom at the time was increased fatigue. During examination of eye tracking, there was a left esotropia when looking left and a right esotropia when looking right. She was discharged with a Medrol Dosepak …

Covid Smell Tracker: A Research-Based Mobile Application To Study Smell Loss In Subjects With Covid-19, John Pueringer, Matthew Brennan, Tory Mcknight, Mindy Rabinowitz, Elina Toskala, Gurston Nyquist, Marc Rosen, Aykut Unsal

Research Day

Introduction: Up to 60% of people infected with SARS-CoV-2 report anosmia or ageusia during their disease course. “COVID Smell Tracker” is a smart phone application (app) developed to elucidate the onset, duration and extent of anosmia and ageusia through questionnaires.

Methods: “COVID Smell Tracker” is publicly available on smart phone devices (www.covidsmelltracker.org). Users complete surveys around demographics, medical history, COVID status and symptomology. Deidentified responses were collated and analyzed using descriptive statistics.

Results: Of the 266 users included, the majority were located in Europe (43%) and North America (33%). Male, Caucasian users were most common (54.9% and 61.7% respectively), followed …

Resveratrol's Effect On The Androgen Receptor Pathway As A Target For Decreasing Growth And Invasion Of Melanoma And Methods Of Application, Anthony Concilla, Tala Mourabet, Natalie Silk, Kyla Geary, Dianzheng Zhang

Research Day

Introduction: Melanoma is predicted to be the fifth most common cause of cancer mortality in the U.S. in 2021. Although melanoma affects both sexes, current literature shows it is more prevalent and more deadly in men. Several potential reasons for this difference have been proposed, but most literature describes a gap in male knowledge concerning skin cancer and unwillingness to go to the dermatologist as an explanation. That said, the androgen receptor has been proven to play a role in melanoma growth and metastasis, and may play a part in the difference in incidence and mortality rates between sexes. Resveratrol, …

Development Of Humanized Mouse Model For Organ Transplantation, Daniel D. Horuzsko, Ashwin Ajith, Laura Mulloy, A. Musa, Valia Bravo-Egana, Imran Gani, Anatolij Horuzsko

Research Day

Purpose of Study: Solid organ transplantation has been a life-saving procedure for thousands of patients worldwide. Recent advances on improving donor-screening diagnostics have aimed at identification of the most compatible donor for the transplant recipient to maximize allograft survival. Current standards of donor selection relies on HLA typing and in vitro mixed lymphocyte reaction (MLR) which do not take into account the in vivo environment and recipient’s adaptive immune response. Humanized mouse models are an appealing alternative that permits personalized investigation of the immunocompatibility of potential donor tissues for the recipient human immune system without putting patients at risk. By …

The Sebaceous Gland - Friend Or Foe?, Gelan Shamloul, Frederick Lombard, Marina D'Angelo, Amor Khachemoune

Research Day

Introduction: Sebaceous glands are sebum-secreting components of pilosebaceous units, that play a key role in eccrine emulsification, the impermeability of skin and hair, cytokine, chemokine, interleukin, pheromone, and fatty acid synthesis, acid mantle formation, and hormone production. Although the sebaceous gland has been heavily investigated, many advances in the physiology and pathology of the sebaceous gland have since been identified.

Objective: The primary objective of this publication was to perform an updated literature review of the embryology, evolution, structure and function, and pathophysiological disorders associated with the sebaceous gland.

Methods: We performed a literature search using PubMed database with keywords …

30-90 Day Benefit Of Using Interreality Care To Reduce Unnecessary Hospital Admissions Among High-Risk Patients, Kaelin Demuth, Julio Llanga, Will Brewster, Michael Shen, Marla Golden

Research Day

Background: Reducing unnecessary hospital admission/ER visits on HMO/MSO/ACO patients is very challenging beyond traditional 30-90 day readmission threshold. Our study focused on expanding an Interreality (On-Site & On-Line) Care (IC) model (EHJ 2018;39:S225) in high-risk patients in an HMO setting.

Methods: IC model was created by integrating: 1. On-Site Care: ARNP & testing at patients’ residency; 2. On-Line Care: 24/7 monitoring & specialty cardiology/pulmonary intervention; and 3. A new high-risk care system with telemedicine, device, monitoring, protocols & management. A group of 57 Medicare Advantage patients with multiple admission/ER visits from 3 different healthcare organizations were referred to a MSO …

Family History Of Acl Tears As Non-Modifiable Risk Factor In Acl Injury, Michael Valenzuela, Robert Roundy, Marshall Williams, Mathew Pombo

Research Day

Background: 100,000-200,000 anterior cruciate ligament (ACL) injuries occur each year in the United States. These injuries result in significant burden to the patient, and predisposition to ACL injuries is often multifactorial. Some researchers have looked into the genetic component to ACL injuries, both at the population and molecular level. We aim to study a large orthopaedic population in order to assess the association between personal and family history of an ACL injury.

Hypothesis/Purpose: We hypothesize that patients with a first-degree relative, who have a history of ACL injury, will have increased odds to sustain an ACL injury themselves.

Study Design: …

The Benefits Of Peer-Lead Mock Focused Exam Workshops, Aarushi Kalra, Steve E. Carter, Andrew J. Manhan, Fahad Marmarchi, John Lee, Ali Moradi

Research Day

Context: Mock examinations are commonplace in many academic settings and are offered as a study aid to students with the hope of lowering stress levels and increasing their preparedness for the actual exam. In contrast, mock exams are rarely offered by faculty in clinical training due to their expense and administrative burden (1). Students taking objective structured clinical examinations, (OSCEs), have been proven to benefit from participating in mock exams (2). However, this is something that has not been explored in the context of the Focused Exam Workshop (FEW). While OSCEs focus solely on biomechanical skills, the FEW allows students …

Inhibiting Ror1 Expression In Androgen-Independent Prostate Cancer Reduces Aggressive Cancer Phenotypes By Modulation Of Akt-Gsk3Ꞵ Pathway, Vignesh Sivaganesh, Nazifa Promi, Salma Maher, Bela Peethambaran

Research Day

Prostate cancer is a disease that has a high prevalence and mortality amongst men. The severity of the cancer is stratified by risk, which is based on the Gleason grade, prostate-specific antigen (PSA) level, and clinical staging. Unlike breast cancer which can be classified into subtypes based on molecular heterogeneity, prostate cancer has no such classification and is treated with observation, prostatectomy, or radiation if local, and non-specific chemotherapy and androgen deprivation therapy (ADT) if metastatic. It is of the utmost importance to investigate molecular targets that can specifically eradicate prostate cancer while retaining the functions of normal tissue. Receptor …

The Mind-Body Connection: Exploring The Defining Characteristics Of Two Aging Phenotypes, Kiyana Harris, Xue-Lian Sun, Mei-Ling Ge, Qian-Li Xue

Research Day

Introduction: Built on the theory of mind-body connection, there has been a growing interest in phenotypes combining physical frailty and cognitive decline. Two examples are motoric cognitive risk syndrome (MCR) and cognitive frailty (CF). MCR, defined by co-presentation of slow gait and subjective cognitive complaint without dementia or mobility disability, is considered a “pre-dementia syndrome.” CF, defined as having both physical frailty and cognitive impairment in the absence of dementia, is posited to be caused by physical frailty. Although both MCR and CF have been associated with dementia risk, the relationship between the two is unknown. We aimed to (1) …

Predictive Factors And Outcomes In Patients With Severe Postoperative Anemia Following Total Joint Arthroplasty, Hunter Hayes, Yash Chaudhry, Sandesh Rao, Gregory Toci, Kevin Mekkawy, Julius Oni, Robert Sterling, Harpal Khanuja

Research Day

Background: Perioperative allogenic blood transfusions (ABT) have demonstrated associations with poor outcomes and increased complication rates following total joint arthroplasty (TJA). Recent strides in blood conservation methods have been made, including multimodal blood management, tranexamic acid (TXA) use, and restrictive transfusion strategies in order to reduce risk associated with transfusion. While the literature on transfusions and outcomes is extensive, the consequences of low postoperative hemoglobin is less well defined. This study aimed to identify factors and consequences associated with severe anemia (hemoglobin <8g/dL) following primary TJA.

Methods: A retrospective review was conducted of all the elective primary TJA at a single tertiary care medical …

Stroke Centers Of Excellence In The United States: Certification, Access And Outcomes, Evan Kolesnick, Joshua Weinberg, Shyam Majmundar, Ahmad Sweid, Jane Khalife, Satish Gaddam, Zubin Hussain, Robin D'Ambrosio, Maureen Deprince, Pascal Jabbour, Stavropoula Tjoumakaris, M. Reid Gooch, Robert Rosenwasser, Nabeel Herial

Research Day

Introduction: Stroke is a leading cause of morbidity, mortality and healthcare costs in the United States. Evidence suggests that certified stroke centers have improved patient outcomes relative to non-certified hospitals. Our study explains the process, associated cost, quality and geographic proclivities of different certifying organizations.

Methods: Data was collected from published literature, information on certifying organizations’ websites and through direct communication with representatives of The Joint Commission (TJC), Det Norske Veritas and Germanischer Lloyd (DNV-GL), and Healthcare Facilities Accreditation Program (HFAP). Geographic mapping of thrombectomy capable centers and comprehensive stroke centers was performed with the ArcGIS online tool.

Results: Among …

Comparison Of Estimated Glomerular Filtration Rate Using Five Equations To Predict Acute Kidney Injury Following Hip Fracture Surgery, Efstratios A. Papadelis, Kevin L. Mekkawy, Yash P. Chaudhry, Micheal Raad, Raj M. Amin, Harpal S. Khanuja

Research Day

Introduction: Hip fractures are a common injury and a source of disability and mortality in the aging population. Acute kidney injury (AKI) is a common and potentially serious complication following hip fracture surgery. Estimated glomerular filtration rate (eGFR) is used as an indicator of renal function. Several equations are commonly used to calculate eGFR. The purpose of this study was 1) to evaluate the agreement between five equations in calculating eGFR, and 2) to confirm which equation can best predict AKI in patients undergoing hip fracture surgery.

Methods: 146,702 cases of surgical stabilization of hip fracture were queried from the …

Comparison Of Estimated Glomerular Filtration Rate Using Five Equations To Predict Acute Kidney Injury Following Total Joint Arthroplasty, Hunter Hayes, Kevin Mekkawy, Yash Chaudhry, Michael Raad, Raj Amin, Harpal Khanuja

Research Day

Introduction: Primary total joint arthroplasty (TJA) is one of the most common procedures in the United States, and as the incidence of this surgery increases, identifying methods for improving outcomes and reducing complications is essential. Acute kidney injury (AKI) following TJA is a potential source of morbidity and mortality. Estimated glomerular filtration rate (eGFR) is used as an indicator of renal function. Several equations are commonly used to calculate eGFR. The purpose of this study was 1) to evaluate the agreement between five equations in calculating eGFR, and 2) to confirm which equation can best predict AKI in patients undergoing …

Preoperative International Normalized Ratio Thresholds In Hip Fracture: An Analysis Of The National Surgical Quality Improvement Program, Yash Chaudhry, Kevin Mekkawy, John Mawn, Aoife Macmahon, Julius K. Oni, Robert S. Sterling, Rachel B. Sotsky, Harpal S. Khanuja

Research Day

Background: Hip fractures are one of the most common orthopaedic injuries among the elderly, and as life expectancy continues to rise, the incidence of hip fractures has increased. The international normalized ratio (INR) is routinely obtained preoperatively to assess a patient’s readiness for surgery to evaluate bleeding risk. We aimed to 1) assess the relationship between preoperative INR in hip fracture patients and postoperative complication rates and 2) establish an INR threshold under which patients would be safe to proceed to surgery without INR correction.

Methods: We retrospectively reviewed cases of hip fracture surgical stabilization in the American College of …

Direct Oral Anticoagulants And Prosthetic Heart Valves: A Systematic Review Of Case Reports, Tyler Richie, Steven Carter, Jiehyun Lee

Research Day

Background: Direct oral anticoagulants (DOACs) are indicated to treat and prevent venous thromboembolism and to prevent stroke or systemic embolism in patients with non-valvular atrial fibrillation. The introduction of DOACs has provided an alternative to warfarin for patients in need of oral anticoagulation. It is, however, unclear whether DOACs are safe and effective in patients with heart valve replacement. The RE-ALIGN trial published in 2013 did not support the use of dabigatran in patients with mechanical valve replacements; however, there are ongoing studies, such as the PROACT Xa trial and the ATLANTIS trial, investigating the use of other DOACs in …

A Review Of Applicable Materials For 3d Printing A Biomechanically Accurate Cervical Spine Model For Surgical Education & Case Preparation, Nathaniel Neavling, Mashaal Syed, Adedayo Adetunji, Brandon L. Mariotti, Slah Khan, Jennifer J. Mao, Jeffrey Mullin

Research Day

Objectives: The authors review the literature to compare biomechanical properties of the human cervical spine as determined by cadaveric and finite elemental model (FEM) studies, with commercially available three-dimensional (3D) printing materials to aid in the development of 3D-printed cervical spines that can be used as biomechanically accurate educational tools. Specifically, 3D printing materials for fused deposition modeling (FDM) printers were explored.

Methods: A literature review of biomechanical specifications such as Young’s Modulus and Poisson’s ratio of certain anatomical aspects of the cervical spine was performed by searching the databases PubMed, MEDLINE via Ovid, Wolters Kluwer, ClinicalKey, and EMBASE via …

It's All Fun And Games Until Someone Gets Hurt: An Analysis Of Trampoline Injuries In The Pennsylvania Trauma System, Megan Sullivan, Madison Morgan, Lindsey Perea, Frederick Rogers, Eric Bradburn

Research Day

Introduction: It is well known that trampolines can be a particular source of danger, especially in children. We sought to examine the profile of those patients with trampoline injuries. We hypothesized there would be certain injury patterns predicative of trampoline injuries.

Methods: All patients submitted to Pennsylvania Trauma Outcome Study (PTOS) database from 2016-2018 were analyzed. Trampoline injury was determined by ICD10 activity code. Injury patterns in the form of abbreviated injury scale (AIS) body regions were examined in the trampoline injured patients. Patient demographics and clinical variables were compared between those with trampoline injury versus those without.

Results: There …

Blood Transfusions In Revision Surgery For Prosthetic Hip And Knee Infection, Yash Chaudhry, Kevin Mekkawy, Syed A. Hasan, Sandesh S. Rao, Raj Amin, Julius K. Oni, Robert S. Sterling, Harpal S. Khanuja

Research Day

Background: Surgery for prosthetic joint infection (PJI) can often have significant blood loss necessitating allogeneic blood transfusion (ABT). ABT is associated with higher rates of morbidity and death in revision TJA, particularly in the treatment of PJI. It is important to understand how the rates of ABT differ among the various surgical treatments of PJI. We compared ABT rates by procedure type among patients treated for PJI a multimodal blood conservation protocol.

Methods: We retrospectively reviewed 143 operative cases of revision arthroplasty for hip and knee PJI involving 102 patients at a single institution between 2016 and 2018. Procedures were …

Ensuring Internet Access During A Pandemic: Piloting A Wifi Hotspot Lending Program, Pj Grier, Barbara Wood, Erica Rosalle, Jackie Werner, Matt Mcnelis

Research Day

With the onset of the COVID-19 pandemic in March 2020 many students experienced sudden lifestyle adjustments. These adjustments included not having reliable access to an internet source to complete their coursework. In an effort to soften the pandemic’s blow the library secured a grant to purchase, manage, and circulate mobile wifi hotspots to students in need. For the pilot eleven hotspots were purchased for one campus, and due to the success of the pilot now all three campuses of PCOM are loaning out a total of twenty-eight hotspots.

Designing For Disability: Making Activities Of Daily Living More Manageable Through 3d Printing, Mashaal Syed, Anne Egan, Denah Appelt

Research Day

Introduction: While there have been many innovations developed for those with physical disabilities in recent years, a multitude of unmet needs still remain. With the advent of new and affordable technologies such as 3D printing, it is now more possible than ever before to bring one’s ideas to life; from creating customized prosthetics to wheelchair attachments for water bottles and umbrellas, we are able to quickly realize potentials otherwise unlikely - and in turn, we have the capacity to make the activities of daily living more manageable for those with physical disabilities.

Objectives: By personally hearing from individuals with physical …