Medicine and Health Sciences Commons^™

Total Body Skin Exams: Sensitivity, Specificity, And Number Needed To Screen, Shayan Waseh, Michael Bui, Audra Hugo, Alexander Sherban, Elizabeth Jones, Md

Phase 1

Introduction: Skin cancer, the most common form of cancer worldwide, has one of the highest cure rates among cancers if diagnosed and treated early in its course. The Total Body Skin Exam (TBSE) is the primary modality used to screen for skin cancers. Currently, few studies have characterized the effectiveness of the TBSE in contemporary populations.

Objective: Characterizing the number-needed-to-screen (NNS) to diagnose a case of skin cancer through TBSEs will make it possible to better understand its effectiveness as a screening modality and its utility in an increasingly population health-based healthcare system.

Methods: A retrospective chart review of 3155 …

Economic Impact And Health Disparities Of Firearm Injuries Treated Within The Thomas Jefferson University Health System, Christina Wohler, Stanton Miller, Md

Phase 1

Introduction:

Firearms are a significant cause of morbidity and mortality in the United States. In 2015, firearms killed over 36,000 Americans (CDC, 2017), and in 2013 were responsible for $229 billion in healthcare and other costs (Cerdá 2016). On an average day in Philadelphia, 4 people are injured or killed by firearms (Beard 2017). This purpose of this project is to further investigate these trends in the context of the Thomas Jefferson University Health System.

Objective:

To date, no research exists to examine firearm violence within the Thomas Jefferson University Hospital (TJUH) System. The purpose of this study is to …

Mining For Voices: Reframing Hydraulic Fracturing As A Public Health Issue, Benjamin Chipkin, Ms, Pouné Saberi, Md, Mph

Phase 1

Introduction: Hydraulic fracturing extracts fossil fuels from rock formations by injecting chemicals underground. While 80% of studies demonstrate risks or actual harms to health from fracking, Pennsylvania does not require chemical disclosures. Fracking accelerates climate change, a phenomenon linked to increases in health emergencies. With 1.6 million Pennsylvanians living within 1 mile of active oil or gas development sites, there is considerable risk. In 2012, Pennsylvania banned physicians from discussing health impacts of fracking, an order struck down in 2016. Following the gag order, deficits in physician knowledge and urgency may remain around fracking. Outlining a precautionary approach to fracking …

Pediatric Nasogastric Tube Placement And Verification: Best Practice Recommendations From The Novel Project., Sharon Y. Irving, Gina Rempel, Beth Lyman, Wednesday Marie A Sevilla, Ladonna Northington, Peggi Guenter, American Society For Parenteral And Enteral Nutrition

Manuscripts, Articles, Book Chapters and Other Papers

The placement of a nasogastric tube (NGT) in a pediatric patient is a common practice that is generally perceived as a benign bedside procedure. There is potential risk for NGT misplacement with each insertion. A misplaced NGT compromises patient safety, increasing the risk for serious and even fatal complications. There is no standardized method for verification of the initial NGT placement or reverification assessment of NGT location prior to use. Measurement of the acidity or pH of the gastric aspirate is the most frequently used evidence-based method to verify NGT placement. The radiograph, when properly obtained and interpreted, is considered …

Risk Stratification Of Febrile Infants ≤60 Days Old Without Routine Lumbar Puncture., Paul L. Aronson, Marie E. Wang, Eugene D. Shapiro, Samir S. Shah, Adrienne G. Deporre, Russell J Mcculloh, Christopher M. Pruitt, Sanyukta Desai, Lise E. Nigrovic, Richard D. Marble, Rianna C. Leazer, Sahar N. Rooholamini, Laura F. Sartori, Fran Balamuth, Christopher Woll, Mark I. Neuman, Febrile Young Infant Research Collaborative

Manuscripts, Articles, Book Chapters and Other Papers

Video Abstract: media-1vid110.1542/5840460609001PEDS-VA_2018-1879

OBJECTIVES: To evaluate the Rochester and modified Philadelphia criteria for the risk stratification of febrile infants with invasive bacterial infection (IBI) who do not appear ill without routine cerebrospinal fluid (CSF) testing.

METHODS: We performed a case-control study of febrile infants ≤60 days old presenting to 1 of 9 emergency departments from 2011 to 2016. For each infant with IBI (defined as a blood [bacteremia] and/or CSF [bacterial meningitis] culture with growth of a pathogen), controls without IBI were matched by site and date of visit. Infants were excluded if they appeared ill or had a …

Medial Temporal Lobe Functional Connectivity Predicts Stimulation-Induced Theta Power., E. A. Solomon, J. E. Kragel, R. Gross, B. Lega, M. R. Sperling, G. Worrell, S. A. Sheth, K. A. Zaghloul, B. C. Jobst, J. M. Stein, S. Das, R. Gorniak, C. S. Inman, S. Seger, D. S. Rizzuto, M. J. Kahana

Department of Neurology Faculty Papers

Focal electrical stimulation of the brain incites a cascade of neural activity that propagates from the stimulated region to both nearby and remote areas, offering the potential to control the activity of brain networks. Understanding how exogenous electrical signals perturb such networks in humans is key to its clinical translation. To investigate this, we applied electrical stimulation to subregions of the medial temporal lobe in 26 neurosurgical patients fitted with indwelling electrodes. Networks of low-frequency (5-13 Hz) spectral coherence predicted stimulation-evoked increases in theta (5-8 Hz) power, particularly when stimulation was applied in or adjacent to white matter. Stimulation tended …

Patient Safety Incentives For Residents: A Slippery Slope Or Reinforcement Of Desirable Behavior?, Kathryn Rapala

College of Nursing Faculty Research and Publications

In a study of error reporting in the care of Medicare beneficiaries, the US Department of Health and Human Services Office of Inspector General found that only 14% of patient safety events were reported.¹ A multicenter study found that 44.6% of residents were uncomfortable reporting diagnostic errors, possibly related to fear of repercussions and issues with the reporting system, among other factors.² A key question at the intersection of graduate medical education and patient safety is how to encourage resident and fellow error reporting.

The intervention described in the article, “Improving Resident and Fellow Engagement in Patient Safety …

Depression, Positive Thinking, Personal And Social Resourcefulness Among Caregivers Of Persons With Autism Spectrum Disorders, Abir K. Bekhet, Mauricio Garnier-Villarreal

College of Nursing Faculty Research and Publications

No abstract provided.

Promoting Team-Based Exercise Among African American Breast Cancer Survivors, Linda B. Piacentine, Karen Marie Robinson, Leslie J. Waltke, Judy A. Tjoe, Alexander V. Ng

College of Nursing Faculty Research and Publications

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants (n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, …

Comprehensive Evaluation Of Interventions: Eight Vital Parameters, Jaclene A. Zauszniewski, Abir K. Bekhet, Kayla Herbell

College of Nursing Faculty Research and Publications

Background It is critically important to determine the effectiveness of an intervention before it can be translated into clinical practice. However, the future implementation and sustainability of the intervention may be diminished if other intervention parameters are not assessed. This requires obtaining feedback from intervention recipients so interventions will be perceived as appealing, relevant, meaningful and beneficial to them; otherwise recipients may be unlikely to perform them over time, resulting in unsuccessful health outcomes.

Aim To propose the addition of two intervention parameters to the existing six-parameter model and provide examples from recent research of how each parameter can be …

December 2018 Issue

OCCUPATION: A Medium of Inquiry about Health through Occupation

No abstract provided.

Characterizing The Gut Microbiota During Plasmodium Infection And Antimalarial Treatment., Joshua E. Denny

Electronic Theses and Dissertations

Plasmodium, the parasitic cause of malaria, is a global pathogen, annually causing 216 million infections and 445,000 deaths. As drug resistance continues develop and no effective vaccine is available, it is critical to understand the factors underlying the severity of this disease. Plasmodium is an extra-gastrointestinal tract infection where the parasite infects red blood cells causing clinical malaria. However, recent publications have pointed to interactions between the gut microbiota and malaria. With this in mind, the role of the gut microbiota in malaria infection was studied. C57BL/6 mice from different vendors displayed differential resistance and susceptibility to severe malaria, …

Effects Of Hydrogen Sulfide In Hyperhomocysteinemia-Mediated Skeletal Muscle Myopathy., Avisek Majumder

Electronic Theses and Dissertations

Although hyperhomocysteinemia (HHcy) occurs due to a deficiency in cystathionine-β-synthase (CBS), causing skeletal muscle myopathy, it is still unclear whether this effect is mediated through oxidative, endoplasmic reticulum (ER) stress, both or something else. Cystathionine γ-lyase (CSE) and CBS are the main H₂S producing enzymes, which produce Hydrogen sulfide (H₂S) from Hcy in the transsulfuration reaction. H₂S is an anti-oxidant compound and patients with a CBS deficiency cannot produce enough H₂S, thus rendering them vulnerable to excess Hcy-mediated damage. Both in-vitro (C2C12 cells) and in-vivo (CBS+/- mice) models were used to …

Lead And Crime: An Ecological Study Between Lead Contaminated Topsoil And Violent Crime., Brian Guinn

Electronic Theses and Dissertations

Lead is a known neurotoxicant. Human exposure to lead comes primarily through environmental exposures, including remnant lead paint, lead contaminated topsoil and lead contaminated water. Prenatal and early life lead exposure has been associated with numerous neurocognitive and neuropsychiatric disorders. This dissertation presents findings from an ecological study which evaluated the geospatial association between topsoil lead content and the incidence of FBI designated violent crime in Jefferson County, Kentucky. A total of 412 topsoil samples were collected along roadways (n=300) and from Louisville Metro Parks (n=112). Jefferson County crime data was obtained from the Louisville Metro Police Department – Crime …

Association Between Cigarette Smoking And Ovarian Reserve Among Women Seeking Fertility Treatment With Effect Modification By Race And Nat2 Genotype., Islamiat A. Oladipupo

Electronic Theses and Dissertations

Cigarette smoking in women has been associated with adverse reproductive outcomes such as reduced ovarian reserve, poorer in vitro fertilization (IVF) outcomes and increased adverse pregnancy outcomes. This study examined the association of smoking with ovarian reserve in a cross-sectional study of women seeking fertility treatment, and potential effect modification by race and NAT2 acetylator phenotype. Data from 265 women from the Louisville Tobacco Smoke, Genetic Susceptibility, and Infertility (LOUSSI) Study were analyzed. A total of 265 women were recruited through a single infertility clinic between September 2016 and June 2018. Information on current smoking status was assessed using a …

Assessing The Role Of Arsenite In Disrupting The Egfr Signaling Axis., Christine Kim

Electronic Theses and Dissertations

The epidermal growth factor receptor (EGFR) is a receptor tyrosine kinase localized on the cell surface. Overexpression of EGFR has been used as biomarkers for many different types of cancers, including lung cancer. There is a strong association between arsenic and lung cancer development, although the mechanism is unclear. We hypothesize that chronic exposure of “a physiologically relevant” level of arsenite disrupts the EGFR endocytic trafficking. The goal of this project is to identify molecular mechanisms and roles of chronic arsenite-induced EGFR overexpression in lung cancer development. A non-malignant human bronchial epithelial cell line, Beas-2B cells were exposed to 100 …

The Migration And Developmental Remodeling Of Intrinsic Interneurons In Visual Thalamus And The Role Of Retinal Signaling., Naomi E. Charalambakis

Electronic Theses and Dissertations

The dorsal lateral geniculate nucleus (dLGN) of the mouse is a model system to study the development of thalamic circuitry. While most studies focus on relay neurons of dLGN, little is known about the factors regulating the development of the other principal cell type, intrinsic interneurons. To date, the targeting and migratory path of dLGN interneurons as well as their morphological development remains unclear. Here we examined whether the migration, structure, and function of interneurons relies on retinal signaling. We took a loss-of-function approach and crossed GAD67-GFP mice, which express green fluorescent protein (GFP) in dLGN interneurons, with math5 nulls …

Is Macrolide And Beta-Lactam Combination Therapy Associated With Early Clinical Stability Or 30 Day Mortality In Hospitalized Patients With Pneumonia? An Assessment Of Confounding By Indication., Evangeline Pierce

Electronic Theses and Dissertations

Pneumonia and influenza are one of the leading causes of infectious disease-related deaths worldwide. Current guidelines for the treatment of hospitalized patients with community acquired pneumonia (CAP) include empiric antimicrobial therapy with a macrolide and a beta-lactam. There is little consensus among studies as to which antimicrobial regimen is best. The confusing results seen may very well be due to lack of assessment of confounding by indication (CBI). This analysis was a secondary analysis from Hospitalized Adults with Pneumococcal Pneumonia: Incidence Study (HAPPI). The study participants were those in HAPPI who had received either macrolide and beta-lactam combination therapy or …

Influence Of Bilberry-Derived Anthocyanidins On Key Regulators Of Colorectal Cancer Development., Ashley M. Mudd

Electronic Theses and Dissertations

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths within the United States. A variety of factors including exposure to environmental carcinogens, such as benzo[a]pyrene (B[a]P), dysbiosis of the gut microbiome and hereditary influences, including APC mutations, have been shown to lead to an increased risk of developing colorectal cancer. Given the recent alarming rise in cases of colorectal cancer diagnosed in individuals under the age of 40, further insight into developing novel and effective prevention and treatment strategies are warranted. The family of plant pigments known as the anthocyanins has been identified with …

Changing Culture One Pdsa At A Time: The Creation Of An Innovation Unit, Jennifer Hoople, Gale Arnold, Jennifer Bletscher, Shawna Bolgen, Andy Branca, Tana Case, Matthew Dietz, Jennifer Ferenczy, Heather Haake, Janine Holbrook, Ingrid Jonely, Liga Mezaraups, Jessica Osantowski, Jessica Sehorn, Linda Severs, Dina Shepelyuk

Books, Presentations, Posters, Etc.

An inpatient unit in an acute care hospital was designated as an Innovation Unit. This unit was challenged with the creation of culture change in regards to process improvement. The team learned to use Improvement Science to facilitate rapid and innovative process improvements. These changes have enhanced the quality of healthcare provided while decreasing cost. The poster highlights some of the Improvement Science processes, forms, and roles of the team as well as some of the projects and successes.

What Health Care Leaders Can Learn From Amazon, Amy Compton-Phillips, Goran Henricks

Books, Presentations, Posters, Etc.

Leading change in the internet economy takes different thinking and skills then those that got us the healthcare miracles we have today. Tech companies learned they needed to perfect the product, get serious about costs, remove friction, control the last mile, and accelerate careers to disrupt their industry. Healthcare leaders, and the systems they run, can use the same concepts to re-think our entrenched care models of today. Design thinking coupled with a scrupulous focus on value can help create the nimble systems we all want to work (and receive care) in. Learn how to go from idea to action …

Service Operations Center Improves Hospital Flow And Reduces Ed Boarding!, Jeanne Rhynsburger, Patty Palmer, Michelle Hansen

Books, Presentations, Posters, Etc.

Swedish Edmonds 3 year journey to optimize hospital flow by opening a Service Operations Center – flow management hub.

Notable improvements included:

1. Patient visit times decreased 27 minutes per patient
2. Emergency department (ED) admit times decreased 68 minutes per patient
3. Boarding hours decreased 20%.

Knowledge Management & Data Literacy, Sony Shah

Books, Presentations, Posters, Etc.

Using Knowledge Management and Data Literacy to enable caregivers to have ready access to Organizations’ documented base of facts, source of information and solutions.

The Relationship Between Neuroticism, Self-Esteem, And Disordered Eating Attitudes: Examining The Health At Every Size Theory, Liana Cho

Masters Theses

Background. In the modern day treatment of overweight/obesity, conflicting recommendations regarding treatment have been released by the Academy of Nutrition and Dietetics (AND) and advocates of the Health at Every Size (HAES) movement. While the AND have indicated their support for self-monitoring practices, such as keeping a food diary or tracking calories, HAES advocates have claimed that these restrictive practices may result in increased disordered eating tendencies and poor self-esteem.

Subjects. The participants for this study included 410 students at Grand Valley State University. Almost 80% of participants were female, and just over 85% of participants identified as white. …

Is Tpmt Testing A Predictor Of Duration Of Use Or Long-Term Benefit Of Thiopurine Agents?, Shatoya R. Wilson

Masters Theses

Background: Inflammatory Bowel Disease (IBD) affects as many as 1.3 million Americans and includes both ulcerative colitis (UC) and Crohn’s disease (CD). Recent practices have moved towards using immunomodulators early in the course of disease to prevent disease progression. Patients have shown improved outcomes on immunomodulators compared to aminosalicylates, and reduced risk for tachyphylaxis compared to corticosteroid treatment. Thiopurine agents such as azathioprine and 6-mercaptopurine are immunomodulators often used to treat IBD. Unfortunately, many patients experience cytotoxicity from thiopurine use. Recent studies have shown that patients deficient in thiopurine-S-methyltransferase (TMPT), produce an overabundance of the therapeutic end product, 6-thioguanine nucleotide …

The Relationship Between Feeding Type And Temporomandibular Joint Morphology In Superfamily Musteloidea, Travis L. Garvin

Masters Theses

Many studies have focused on the soft tissue analysis of carnivores and have demonstrated a relationship between feeding biomechanics and feeding types. Herbivores and omnivores rely heavily on anteroposterior and helical movement of the mandible and teeth for the breakdown of fibrous foods resulting in a flat mandibular fossa while the function of the carnivore TMJ is different, as they need a much stable joint for ripping and tearing of the flesh. I aim to look at whether the bony morphology of the temporomandibular joint (TMJ) can be directly related to feeding type, specifically in the superfamily Musteloidea. I sampled …

Analysis Of Growth And Prevalence Of Malnutrition During Total Parenteral Nutrition Weaning: A Methodological Demonstration, Lauren Ashley Kane

Masters Theses

Background: Total Parenteral Nutrition (TPN) is a life-saving intervention which provides nutrition to premature infants with immature gut functioning. Though essential for nutrition provision in the first days of life, TPN is not without risk. Therefore, it is important to introduce feedings into the gut and to wean off TPN when able. During this weaning phase, calorie and protein deficits have been observed to occur. Very few studies have investigated TPN weaning periods, and there are no studies on malnutrition associated with the TPN weaning period in premature infants.

Methods: This study employed a retrospective chart review, with medical …

Reducing Thirty-Day Hospital Readmissions In Drug And Medication Poisoning: An Observational Study, Jenna M. Evans

Seton Hall University Dissertations and Theses (ETDs)

A common and costly occurrence in the United States is thirty-day hospital readmissions. Awareness of 30-day hospital readmissions is currently a national priority. To reduce avoidable readmissions, the Patient Protection and Affordable Care Act of 2010 established a “Hospital Readmission Reduction Program” implemented to provide possible solutions for preventable thirty-day readmissions. Part of this policy states that hospitals with higher than expected adjusted re-hospitalization rates have lower reimbursement rates. One specific area known to be a cause of thirty-day hospital readmissions is drug and medication poisoning. An observational study of data from the Nationwide Readmissions Database is being used to …

Increasing Registered Nurse Retention Using A Mentorship Program, Krystle Lynette Forlines

Doctoral Dissertations and Projects

To address the nursing shortage, it is imperative that healthcare organizations understand the reasons for nurse turnover and develop programs to retain high quality nurses. A program that has been utilized by healthcare organizations is mentoring. Mentor programs have been found to improve job satisfaction thus improving nurse retention. In addition to focusing on orientation programs for new graduate nurses, mentorship programs can be utilized to assist with experienced nurse retention. The purpose of this evidence-based practice project was to pilot a three-month mentorship program with registered nurses with one to three years of experience.

Health And Wellness Factors Affecting The Wholistic Lifestyle Of National And International Christian Missionaries, Angela C. Williams

Doctoral Dissertations and Projects

This thesis will focus on the health and wellness of missionaries and will develop a wholistic framework for healthier living. This framework will be used as a guide to help sustain missionaries living in various cultural contexts by connecting and integrating the mind, body, and spirit in harmony for wholistic lifestyle. God intended for His people to live a healthy lifestyle and to take care of their temples. Missionaries are the backbone of cross-cultural evangelism, but they often find themselves living unhealthy lifestyles. These unhealthy lifestyles can have a negative impact on missionaries’ overall health, wellness, and fruitfulness in serving …