Medicine and Health Sciences Commons^™

Occupational Therapy’S Role In Self-Determination And Transition To Adulthood For High School Students In Special Education Programming, Kylee A. Read

OT Student Capstones

The Individuals with Disabilities Education Act Amendments of 1997 list occupational therapists (OT) as transition service providers in schools under the related services category (PL 105-117, 1997) able to provide interventions to help students develop skills to access the school curriculum and transition-related activities (Cleary, Persh, & Spencer, 2015). However, OTs are currently not fully participating in providing appropriate services in the areas of secondary education, vocational training, employment, community participation, and independent living to the extent allowed by the law (PL 108-446, 2004). Self-determination is the best predictor of successful transition to adulthood in students with disabilities. Self-determination can …

Mohs Micrographic Surgery In A Pediatric Patient With Squamous Cell Carcinoma, Cameron Nichols, Shields W. Callahan Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

An 11-year old boy presented with biopsy proven squamous cell carcinoma (SCC) of the left cheek. Pathology demonstrated moderate to well-differentiated SCC with positive deep and peripheral margins and no signs of definitive perineural invasion. Past medical history was significant for radiation therapy, chemotherapy, and stem cell transplant seven years prior for the treatment of a spinal embryonal tumor with multilayered rosettes with no signs of recurrence. He never had any direct radiation therapy to the site of his SCC. Mohs micrographic surgery (MMS) was ultimately selected as the treatment of choice for his SCC.

The main concern with MMS …

Hip Labral Injury Worsens After Platelet Rich Plasma Injections: A Case Report, Brennan M. Wright, Carmen Wong

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Case Description

A 47-year-old active male presented with 2.5 years of right hip pain suggestive of labral pathology. Ice, heat, celecoxib, ibuprofen, diclofenac gel, and physical therapy provided minimal relief. A diagnostic intra-articular bupivacaine injection resolved the pain. A subsequent MR arthrogram revealed a non-displaced tear of the right anterior superior acetabular labrum.

In pursuit of conservative treatment, the patient agreed to a series of 3 right hip intra-articular PRP (platelet rich plasma) injections. When he presented for the second injection, he reported his pain had decreased by 20% and he was tolerating light running. Due to improvement in symptoms, …

Reduced Length Of Stay In Major Hepatectomy Surgery After Implementation Of An Enhanced Recovery Pathway In The United States Veteran Population, Yvonne Nguyen Md, Marilyn Mcnulty Np, Leopoldo Fernandez Md, Michael R. Kazior Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction

Enhanced recovery after surgery (ERAS) pathways are associated with better postoperative recovery, however, evidence is lacking in major liver surgery, .This study aimed to evaluate the impact of an ERAS pathway in U.S. veterans undergoing major hepatectomy surgery. We hypothesized that the adoption of an ERAS pathway reduces decreased length of stay (LOS).

Methods

After approval from the Hunter Holmes McGuire VA Medical Center IRB, we compared data from consecutive patients undergoing elective open hepatectomy within an ERAS pathway (January 2019-December 2019) to a previous cohort of patients before introduction of ERAS (July 2016-December 2017). One surgeon performed all …

Budd-Chiari Syndrome As The Initial Manifestation Of Behcet’S Disease​, Yashswee Kc, Abhishek Nandan, Nishant Desai

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Telemedicine Hcv Treatment In Department Of Corrections Results In High Svr In Era Of Direct-Acting Antivirals (Daa), Taseen A. Syed, Reena Cherian, Lewis Shawn, Richard K. Sterling

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Energy Compensation With Exercise Is Not Dependent On Dose, H. Michael Hays

Theses and Dissertations--Nutrition and Food Systems

Background: Exercise induced weight loss is often less than expected due to a coordinated set of compensatory mechanisms that serve to maintain energy homeostasis. The extent to which exercise frequency, duration, intensity and exercise energy expenditure (ExEE) influences the compensatory response to an exercise-induced energy deficit (energy compensation) is controversial. Determining how these variables impact energy compensation would help health care providers prescribe exercise with greater probability of creating a sustained negative energy balance and subsequent weight loss.

Methods: 44 Overweight/obese men and women (BMI=25-35kg/m²) aged 18 to 40 years were randomized to perform aerobic exercise 2 or 6 days/week …

Severe Drug-Induced Gingival Enlargement And Periodontitis: A Case Series With Clinical Presentation And Management, Janina Golob Deeb, Denver J. Lyons, Daniel M. Laskin, George R. Deeb

Periodontics Publications

Gingival enlargement (GE) is a condition in which the size of the gingiva increases in response to inflammation, systemic disease, or certain medications including anticonvulsants, calcium-channel blockers, and immunosuppressants. This report describes the management of two cases involving severe gingival enlargement related to the use of an anti-hypertensive calcium-channel blocker and an immunosuppressant. Besides taking amlodipine, one patient had undergone a heart transplantation seven years prior and has been taking two immunosuppressant drugs, mycophenolate and tacrolimus. The extent of the destruction of periodontal support, aggravated by gingival enlargement, resulted in extensive tooth loss. Periodontitis and gingival enlargement exacerbate and accelerate …

The Role Of Dental Hygienist In Hpv Prevention And Education In Parents Of Adolescents, Kelsey Dore, Sari Sweet

Dental Hygiene Student Scholarship

Objectives/Aims: Today the Human Papillomavirus (HPV) infects nearly 14 million people each year in the United States alone. HPV is responsible for several cancers, including oropharyngeal, which is currently on the rise. Each year an estimated 53,000 cases of oropharyngeal cancers are diagnosed, with 70% of the cases related to HPV. The significance of educating dental providers and patients of the correlations between HPV and oropharyngeal cancers involves increased prevention strategies in dental practices. The aim is to begin offering multi-level education to adolescents’ parent’s in routine dental care visits, in order to provide an innovative approach to reduce HPV-related …

The Role Of Rassf5 On Cell Growth And Hippo Signaling In Rhabdomyosarcoma, Megan Garver, Lee Helman, Md, Katrina Slemmons, Phd

Phase 1

Introduction: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood. Dysregulation of the Hippo pathway, a signaling cascade that regulates many biological processes, is associated with many human cancers. The goal of my project was to delete RASSF5, a regulator of the Hippo pathway, in RMS cells utilizing CRISPR/Cas9 and then to evaluate how the absence of RASSF5 affects RMS cell growth and Hippo signaling, with and without DNMTi Tx.

Methods: A lipofectamine transfection was performed in two different RMS cell lines, Rh30 & RD, in which two different CRIPSR/Cas9 vectors with RASSF5 guide RNA were introduced. …

Characteristics And Outcomes Of Patients Discharged Directly Home From A Medical Intensive Care Unit, Michele Fiorella, Ms, Preeyal M. Patel, Ann Zheng, Lauren Mcdonnell, Msn, Acnp, Mina Yasuoka, Msn, Erika J. Yoo, Md

Phase 1

RATIONALE: Discharging patients directly from ICUs is an increasingly common practice, largely due to decreased availability of ward beds. The purpose of this study was to describe the population and evaluate the outcomes of patients discharged directly from the MICU.

METHODS: We conducted a retrospective chart review of direct discharges to home from June 2018 to June 2019 from two MICUs. Patients were separated into two groups based on wait time (<24 hours or ≥ 24 hours) between ward transfer order and actual discharge. The primary outcome was 30-day hospital readmission. Risk was adjusted using Mortality Probability Model (MPM-III); ICU workload at admission and discharge was estimated using the nine equivalents of nursing manpower use score (NEMS). Patient characteristics were compared using t-test and Fisher exact or X².

RESULTS: There was no difference in severity-of-illness or admission NEMS between the two groups. Patients who waited <24 hours for discharge were more likely to be admitted from home. Patients who waited ≥24 hours prior to discharge had significantly longer mean hospital LOS compared to those who waited <24 hours (4.63 days vs. 2.65 days, p<0.001). There was no significant difference in 30-day readmission between patients who were discharged after waiting <24 hours vs. waiting ≥24 hours (p=0.70).

CONCLUSION: Patients who returned directly home from the MICU …

Helping Continuing Care Retirement Communities Determine The Best Level Of Care For Each Patient, Austin Klein, Nicholas Safian, Grant Schultheis, Sopuru Ezeonu, Danielle Snyderman, Md

Phase 1

Background: The vast majority of healthcare costs are spent on the last decade of life. Older patients often have complex medical histories complicated further by physical, mental and social limitations. High levels of hospital readmittance and nonadherence further complicate care for senior adult patients. Continuing Care Retirement Communities (CCRCs) are long term care facilities that attempt to support this diverse array of problematic patients. Residents can live in several different groupings called “Levels of Care” (LOC). To maximize safety, quality of care, and patient satisfaction, it is important to place residents in the right context. This project seeks to drive …

Treatment Of Persistent Air Leaks Using Endobronchial Valves, Michael Zimmerman, Cole Zingas, Achala Donuru, Scott W. Cowan, Nathaniel Evans Iii, Boyd Hehn

Phase 1

Introduction: Persistent air leaks (PAL) are from bronchopleural fistula resulting from communication between the bronchial tree and pleural space. Endobronchial valves (EBVs) are unidirectional valves placed bronchoscopically preventing airflow to the diseased lung lobe. For non-operable patients with PALs, EBVs offer a potential non-invasive treatment approach to stop air leak and allow lung healing. The purpose of this study is to retrospectively analyze EBV placement to treat non-operable adult patients with PALs.

Methods: We retrospectively analyzed all adult patients that underwent EBV placement for PAL treatment at our institution from January 2016 to June 2019. All patients failed conservative …

Late Complications Of Free Flaps In Head And Neck Microvascular Reconstruction, Swapna Vasudevan, Cory Bovenzi, Md

Phase 1

Introduction: Late free flap complications (LFFC) in head and neck reconstructive surgery occur over 72 hours postoperatively and result in flap loss in 97% of cases. Due to the rarity of LFFC, there is minimal research regarding risk factors for their development. Identifying risk factors for LFFC will result in improved monitoring of patients to prevent flap loss. This study aims to identify risk factors for the development of LFFC.

Methods: The target population of this retrospective cohort study was 116 patients who had undergone an Orbital Exenteration at Thomas Jefferson University Hospital (TJUH) and had LFFC. Data was …

Effects Of Corneal Transplant On Rates Of Retinal Detachment, Daniel S. Mackinnon, Zeba A. Syed, Md, Durga Borkar, Hannah Levin

Phase 1

Introduction: Corneal transplant remains the gold standard treatment for irreversible corneal damage. The purpose of this study is to evaluate retinal detachment rates and clinical outcomes after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). We hypothesized that corneal transplants would increase the rate of RD.

Methods: This retrospective cohort study utilized corneal transplant data from all surgical visits from PK or EK between April 1, 2012 and August 31, 2018. Individual charts were reviewed from patients who had a subsequent retinal detachment. Incidence of retinal detachment following PK or EK was the main outcome measured.

Results: A total of …

Simulation Of Status Epilepticus Is Effective Teaching For Junior Neurology Residents, Pankhuri Jha, Navya George, Jeffrey Ratliff

Phase 1

Purpose: Status Epilepticus (SE) represents a potentially fatal neurologic emergency. At Jefferson, acute management of SE falls to the inpatient neurologist, requiring early competency.

Methods: During a 2 week educational “bootcamp”, 9 PGY2 residents participated in a 2 hour simulation of acute SE with two clinical scenarios. Scenarios included a patient with SE requiring adequate benzodiazepine dosing and another with seizures requiring IV anticonvulsant therapy. Prior to and following the simulation, residents took a survey to gauge their knowledge and confidence in managing SE.

Results and Conclusions: There was an increase in the number of residents expressing confidence in their …

A Module Based Method Of Teaching A Novel Approach To Electrocardiogram Interpretation, Emily Fishbein, Alexandra Koutsoubis, Jennifer White, Md, Dimitrios Papanagnou, Md

Phase 1

Purpose: The traditional approach to 12-lead electrocardiogram interpretation has limitations in the ED setting because it is tedious and does not emphasize pattern recognition for potentially fatal conditions that ED physicians must recognize. Additionally, while lecture-based learning is necessary, learning modules can help learners gain a better understanding of the material. The purpose of this study was to create and implement a self-paced learning module that teaches a novel way of ECG interpretation through the following steps: is it sinus? is it wide? is there ischemia? and does this herald sudden death?

Methods: The objective endpoint of this study was …

Medical Student Knowledge Of Narcolepsy, Alyssa Sinko, Karl Doghramji, Md

Phase 1

Background: Narcolepsy is a sleep disorder, whose main symptoms include daytime sleepiness, cataplexy, sleep paralysis, disturbed sleep, and hypnagogic hallucinations. The disorder is poorly identified in medical settings. We hypothesized that lack of knowledge of narcolepsy and its hallmark symptoms are a cause for the low levels of identification of this disorder. This was a pilot study into medical student knowledge of narcolepsy at Sidney Kimmel Medical College of Thomas Jefferson University (SKMC).

Methods: Two groups of SKMC students, years 1 and 2 (before sleep medicine education) and years 3 and 4 (after sleep medicine education) were the subjects of …

Examining Israeli Emergency Medical Preparedness In The Context Of Jefferson And Affiliates Practices, Jamie D. Garden, Amit S. Padaki

Phase 1

Introduction: Recent domestic disasters have demonstrated the challenges and vulnerabilities in the US health care disaster preparedness framework, challenges that extend to Thomas Jefferson University Hospital System (TJUH), in Philadelphia, PA. As Israel serves as a global leader in civilian defense and disaster preparedness, this study examines best practices in response to a mass casualty event at Hadassah Hospital in Jerusalem, Israel, and compares them with existing protocol at TJUH. The list of best practices generated from this research allows for a greater understanding of standards that are feasibly employable at TJUH.

Methods: This study examined hospital staff response practices …

Systems Analysis Of The Community Elder Caregiver Program At The Spirit Lake Nation, Morgan Ferrell, Robert Motley, Md, Mhcds, Christine Burd, Phd, Rn

Phase 1

Native Americans (NA) disproportionately reside in areas with significantly more social, economic, and health disparities than any other population, and have the lowest employment rates nationally. Additionally, the NA Baby Boomer generation is aging, with senior citizen services largely unavailable on reservations. The Community Elder Caregiver (CEC) Program at Spirit Lake was developed with two aims: 1) to meet the needs of unemployed natives and 2) to develop a competent workforce to help elders safely “age in place”. In the initial pilot, seventeen individuals started the initial (NECC) training, with three completing the Qualified Service Provider (QSP) training. We analyzed …

College Women's Knowledge And Understanding Of Women Health Issues: A Descriptive Study, Dana Brown

Mahurin Honors College Capstone Experience/Thesis Projects

Breast self-examinations, pap smears, Obstetrician and Gynecologist (OBGYN) visits, mammograms, and other preventative measures are all vital pieces of women’s health that can help determine a variety of issues and illnesses (U.S. National Library of Medicine, 2020). Women are presumed to have acquired information on these issues through certain sources to guide them through their adult lives. Not every woman is familiar with, or follows, the recommended guidelines for breast self-examination or gynecological visits. According to the Centers for Disease Control and Prevention (CDC), about 94,000 U.S. women are diagnosed each year with some form of gynecologic cancer, which disproportionately …

Automated Generation Of Gene Summaries At The Alliance Of Genome Resources., Ranjana Kishore, Valerio Arnaboldi, Ceri E Van Slyke, Juancarlos Chan, Robert S Nash, Jose M Urbano, Mary E. Dolan, Stacia R Engel, Mary Shimoyama, Paul W Sternberg, The Alliance Of Genome Resources

Faculty Research 2020

Short paragraphs that describe gene function, referred to as gene summaries, are valued by users of biological knowledgebases for the ease with which they convey key aspects of gene function. Manual curation of gene summaries, while desirable, is difficult for knowledgebases to sustain. We developed an algorithm that uses curated, structured gene data at the Alliance of Genome Resources (Alliance; www.alliancegenome.org) to automatically generate gene summaries that simulate natural language. The gene data used for this purpose include curated associations (annotations) to ontology terms from the Gene Ontology, Disease Ontology, model organism knowledgebase (MOK)-specific anatomy ontologies and Alliance orthology data. …

Methods For Comparative Chia-Pet And Hi-C Data Analysis., Dan Capurso, Zhonghui Tang, Yijun Ruan

Faculty Research 2020

The three-dimensional architecture of chromatin in the nucleus is important for genome regulation and function. Advanced high-throughput sequencing-based methods have been developed for capturing chromatin interactions (Hi-C, genome-wide chromosome conformation capture) or enriching for those involving a specific protein (ChIA-PET, chromatin interaction analysis with paired-end tag sequencing). There is widespread interest in utilizing and interpreting ChIA-PET and Hi-C. We review methods for comparative ChIA-PET and Hi-C data analysis and visualization. The topics reviewed include: downloading ChIA-PET and Hi-C data from the ENCODE and 4DN portals; processing ChIA-PET data using ChIA-PIPE; processing Hi-C data using Juicer or distiller and cooler; viewing …

Updated Poster Presentation Abstract (N = 58) From 2020 Combined Sections Meeting Of The American Physical Therapy Association: How Well Do Clinical Walking Measures Predict Natural Walking Behavior In Parkinson Disease?, James T. Cavanaugh, Cristina Colon-Semenza, Tammy Deangelis, Ryan P. Duncan, Daniel Fulford, Martha Hessler, Michael Lavalley, Timothy Nordahl, Lisa Quintiliani, Kerri S. Rawson, Marie Saint-Hilaire, Cathi A. Thomas, Jenna A. Zajac, Gammon M. Earhart, Terry D. Ellis

Physical Therapy Faculty Publications

Declines in the amount and intensity of natural walking behavior in people with Parkinson disease (PD) may precede declines in motor behavior, gait, and balance. Physical interventions targeting walking behavior in PD may have the greatest impact on slowing the progression of disability. Despite a lack of supporting evidence, however, clinicians may be more likely to rely on quick performance measures of walking speed, capacity, and balance to make inferences about a patient’s walking health, rather than direct measures of natural walking behavior. Our primary purpose, therefore, was to examine the extent to which clinical walking measures might predict natural …

The Impact Of Body Mass Index On Functional Rehabilitation Outcomes Of Working-Age Inpatients With Stroke, Alejandro Garcia-Rudolph, John D. Kelleher, Blanca Cegarra, Joan Sauri Ruiz, Vasudevan Nedumpozhimana, Eloy Opissso, Jose M. Tormos, Montserrat Bernabeu

Articles

BACKGROUND: Stroke is the most relevant cause of acquired persistent disability in adulthood. The relationship between patient’s weight during rehabilitation and stroke functional outcome is controversial, previous research reported positive, negative and no effects, with scarce studies specifically addressing working-age patients.
AIM: To evaluate the association between Body Mass Index (BMI) and the functional progress of adult (<65 >years) patients with stroke admitted to a rehabilitation hospital.
DESIGN: Retrospective observational cohort study.
SETTING: Inpatient rehabilitation center.
POPULATION: 178 stroke patients (ischemic or hemorrhagic).
METHODS: Point-biserial and Spearman’s correlations, multivariate linear regressions and analysis of covariance were used to describe differences …

Sport In The Face Of The Covid-19 Pandemic: Towards An Agenda For Research In The Sociology Of Sport, Adam B. Evans, Joanna Blackwell, Paddy Dolan, Josef Fahlén, Remco Hoekma, Verena Lenneis, Gareth Mcnarry

Articles

These are extraordinary times. Less because we are currently in the midst of a global pandemic; humanity has been here multiple times in the past, sometimes with even more devastating results (the ‘Black Death’ of 1346–1353, or Cocolitzli Epidemics in the 16th Century, for example). Rather, these are extraordinary times due to both the huge shutting down of industry, travel and borders, and the enormous level of coverage and discussion of the crisis through both traditional and social media formats (Stevens & Prins, 2020). Moreover, global, regional and national comparisons and discussions have become commonplace with regards to everything …

Achieving Access Parity For Inpatient Psychiatric Care Requires Repealing The Medicaid Institutions For Mental Disease Exclusion Rule, Briony Marie Dubose Mhi, Rn, Lss Bb, Eileen K. Fry-Bowers Phd, Jd, Rn, Cpnp, Faan

School of Nursing and Health Science: Faculty Scholarship

Approximately 3.4% of Americans have a mental health condition and suicide is the 10th leading cause of death. While the rate of mental health conditions has slightly increased for adult populations, America’s youth has experienced a significant rise in depression. From 2008 to 2017, occurrence of depression in the adolescent population increased from 8.3% to 13.3%. As adolescents mature into adults; it is likely the rate of mental health conditions for the adult population will rise as well as it is the common thread that binds the “diseases of despair”: drug abuse, alcoholism and suicide.

Arising out of the deinstitutionalization …

Differences In Evaluating Fall Risk By Primary Care Provider Type, Janice Mark, Yara K. Haddad, Elizabeth R. Burns

Nursing and Health Professions Faculty Research and Publications

This study assessed differences in clinical fall risk assessment of older adults (65+) and clinical resources used by primary care providers (PCP). We used Porter Novelli's 2016 DocStyles survey to examine clinical behavior data from PCPs (n=1128). Compared to other practitioners, nurse practitioners (NP) reported a higher percentage of their patients were older adults. The majority of NPs reported screening for falls risk routinely, but most did not use standardized fall-risk assessments to assess risk factors. There were also differences in the types of clinical resources used by NPs and other PCPs to evaluate the safety profile of medications.

Stochastic Expression Of Sae-Dependent Virulence Genes During Staphylococcus Aureus Biofilm Development Is Dependent On Saes, Elizabeth A. Delmain, Derek E. Moormeier, Jennifer L. Endres, Rebecca E. Hodges, Marat R. Sadykov, Alexander R. Horswill, Kenneth W. Bayles

Journal Articles: Pathology and Microbiology

The intricate process of biofilm formation in the human pathogen Staphylococcus aureus involves distinct stages during which a complex mixture of matrix molecules is produced and modified throughout the developmental cycle. Early in biofilm development, a subpopulation of cells detaches from its substrate in an event termed “exodus” that is mediated by SaePQRS-dependent stochastic expression of a secreted staphylococcal nuclease, which degrades extracellular DNA within the matrix, causing the release of cells and subsequently allowing for the formation of metabolically heterogenous microcolonies. Since the SaePQRS regulatory system is involved in the transcriptional control of multiple S. aureus virulence factors, the …

Tolle Lege Works Published In 2020, Mcquade Library

Bibliographies

Compiled Tolle Lege bibliography of works published by members of the Merrimack College Community in 2020. Works include journal articles, books, book chapters, conference presentations and posters, and more.