Medicine and Health Sciences Commons^™

Understanding An Inflammatory Pathway In Diabetic Retinopathy, Reanna Raye Rodriguez

Theses and Dissertations

Diabetic Retinopathy (DR) is the leading cause of blindness in the U.S. However, not much is known of its molecular pathway and how it attributes to increases in inflammatory response in the eye. One avenue we will investigate is the transforming growth factor beta (TGFB) signaling pathway and its effect of vascular endothelial growth factor (VEGF) secretion and cell viability. VEGF is the hallmark that exacerbates DR progression in prolonged diabetes. Some major concern that have arisen are the underlying effects of oxidants and antioxidants in elevating VEGF secretion in diabetes. In attempt to learn more, we evaluated how an …

Vertical Transmission Of Zika Virus In An Opossum Model, Dionn Carlo Silva

Theses and Dissertations

This study will identify Brazilian ZIKV infection in the offsprings of mated, inoculated Monodelphis domestica females. Unlike non-human primates (NHP) and transgenic mice, M. domestica provides an opportunity to study ZIKV infection in a novel animal model possibly useful for in-utero studies. M. domestica has also been used in cancer and dietary research with varying degrees of success. ZIKV infection will be identified using antibody staining and in situ hybridization. The expected result of this study is that ZIKV will be identified in various tissues and reveal that ZIKV is transmitted vertically in this animal model. The significance of this …

Blood Flow Through An Artery In The Presence Of A Stenosis, Martin Carrillo

Theses and Dissertations

We consider blood flow through an artery in the form of a cylindrical pipe in the presence of a stenosis. Here blood is treated as an incompressible, viscous and non-Newtonian Bingham plastic fluid. We derive the equation of continuity and the momentum equation which are obtained using mass conservation law and momentum conservation law, respectively. Assuming that the flow is due to the pressure drop and wall shear stress, we derive the expressions for the velocity component in the axial direction and the volumetric flow rate in an artery. Computational results for the axial velocity and flow rate are obtained …

System For Hiv-1 Treatment To The Brain, Caroline Rose Garcia

Theses and Dissertations

While HIV-1 treatment has been revolutionized by combination antiretroviral therapy in the past two decades, HIV-1 remains persistent in organs that don’t allow easy penetration of anti-HIV drugs (e.g., brain) and cause persistent HIV-1 infections and inflammation. Researchers have turned towards nanotechnology-based drug carriers to combat this challenge, such as nanodiscoidal bicelles (ND) and liposomes. Bicelles entrap the drug in their interior hydrophobic core until metabolized by the body, and the payload can be released at the desired location in a controlled, long-lasting dosage. This study investigated the toxicity and extended-release of an anti-HIV drug-loaded within ND and liposomes for …

Inoculation Of Juvenile Monodelphis Domestica With Zika Virus Using Various Routes Of Infection, Juan Garcia Jr.

Theses and Dissertations

Monodelphis domestica is a small marsupial from South America that has been previously been used in human metabolism research. However, their suitability as models for Zika virus (ZIKV) research, is currently unknown. Preliminary studies have shown M. domestica susceptible to ZIKV through the intracerebral route. We utilized immunohistochemistry, and analyzation of serological responses to show that juvenile Monodelphis domestica can be infected with ZIKV by using various routes of infection that include subcutaneous, intraperitoneal, and intramuscular. ELISAs performed on sera confirmed that juveniles injected with ZIKV by all three routes generated anti-ZIKV antibodies. Additionally, ZIKV nonstructural protein 1 was detected …

Transitioning To Housing First: Perceptions Of The Role Of The Rehabilitation Counselor In Serving Homeless Individuals With Disabilities In Puerto Rico, Ana Vanessa Serrano Garcia

Theses and Dissertations

Since the 1980s, the federal government has developed strategies to eradicate homelessness in the US and its territories. The introduction of evidence-based practices like the Housing First Model helped decrease the number of people living homeless. Still, it continues to be a public health problem, especially among chronically homeless individuals, defined broadly as people with disabilities and substance abuse problems experiencing homelessness. Rehabilitation counselors are professionals specialized in serving individuals with disabilities. However, their role in programs identified as Housing First was unclear.

Thus, the study aimed to identify service providers' views, opinions, knowledge, and experiences about the role of …

Agreement Level Of Running Temporal Measurements, Kinetics, And Force-Time Curves Calculated From Inertial Measurement Units, Austin Smith

Electronic Theses and Dissertations

Inertial measurement units (IMUs) and wearable sensors have enabled athlete monitoring and research to become more ecologically valid due to their small size and low cost. IMUs and accelerometers that are placed on the body close to the point of impact and that record at sufficiently high frequencies have demonstrated the highest validity when measuring temporal gait event moments such as ground contact time (GCT) and flight time (FT) as well as peak forces (PF) during upright running. While the use of IMUs has increased in the sport performance and athlete monitoring realm, the potential of the technology’s ability to …

A Cross-Content Validation: Sosi-M & Bot-Sf, Eleanor Brewer, Emily Yuen, Alyssa Asuncion, Taylor Hanson, Mariella Villanueva

Occupational Therapy | MSOT Capstone Projects

This thesis paper examines a new assessment, Structured Observations of Sensory Integration- Motor (SOSI-M), and it’s concurrent validity against the well-validated Bruininks- Oseretsky Test of Motor Proficiency Second Edition (BOT-2). This research study answers the question of “Do the scores from SOSI-M correlate with scores from the BOT-2 in a sample of children 5 to 14 years of age?”. The participants for this study are school-aged children between the ages of five to fourteen years old, all genders, English-speaking, ambulate without assistance or use of orthotic devices, and have motor and sensory abilities sufficient in order to complete both motor …

Supporting Dining Occupations For Dementia Residents In Skilled Nursing Facilities, Esther Yu, Nooshin Moslehi, Vickie Nguyen, Aileen Quach, Cierra Passey, Julia Lee

Occupational Therapy | MSOT Capstone Projects

Dementia Friendly Dining provides skilled nursing facilities (SNFs) with a practice guideline and training resources for caregivers. The program is informed by existing research on environmental modifications, both physical and social, to enhance the occupations of feeding, eating, and dining for individuals with dementia (IwD) in SNF settings. The physical and social environment has a significant effect in supporting the dining experience for IwD and their caregivers (Keller et al., 2015; Hung et al, 2016; Palese et al., 2018), but many facilities have not integrated physical and social modifications, creating a gap in practice. Therefore, an evidence-based dining program that …

Relationship Between Sensory Integration And Occupational Participation For School-Aged Children, Natalie Piwinski, Jordan Hoss, Rebecca Velasco, Victoria Jess

Occupational Therapy | MSOT Capstone Projects

Given the wide-spread use of sensory integration intervention for the pediatric population in occupational therapy practice, it is necessary to explore the connection between sensory integration and children’s participation in daily occupations. Although there is a wide breadth of knowledge examining the impact of sensory integration intervention, there is currently a gap in the literature establishing the underlying relationship between sensory integration and children’s occupational participation. This study recruited 22 children, ages 5-12 to examine the relationship between sensory integration and occupational participation by utilizing two parent report measures: Sensory Processing Measure (SPM) and Participation & Environment Measure- Children and …

Adaptive Video Gaming In The Classroom, Lauren Ferrell, Daniela Mari Recinto, Desarae Finck-Fugazi, Christine Angela Manalang, Noémie Von Kaenel

Occupational Therapy | MSOT Capstone Projects

Background: Limited resources exist to support adaptive gaming in school programming using Microsoft® Xbox Adaptive Controller for children. On the other hand, there is abundant evidence supporting motor, cognitive, and social benefits to gaming in rehabilitation.

Objectives: The goal of this program development project was to create a virtual gaming toolkit to support the interdisciplinary team’s use of adaptive gaming during school programming.

Methods: Through our needs assessment and collaboration with our community partner, we discussed the parent and caregiver need for guidance in order to use the Microsoft® Xbox Adaptive Controller and facilitate gameplay with peers. Through an extensive …

Imposter Phenomenon: The Occupational Experiences Of First-Generation College Students, Jamie Zabat, Jacqueline Salas, Yashi Severson, Kevin Chavez, Krysta Gastelum, Javier Gomez

Occupational Therapy | MSOT Capstone Projects

Background: First-generation college students (FGCS) represent an underserved population navigating through higher education and therefore receive less support. There is a current gap in the literature that overlooks the interactions of occupational experiences, imposter phenomenon (IP), and first-generation college students. The purpose of this study is to use grounded theory to observe the impact of IP among FGCS enrolled in a four-year university in California.

Method: This research is a qualitative study using thematic analysis grounded theory. Data was collected through a screening survey and follow-up interview via video chats and in-person sessions, and a live transcription software …

Adaptive Gaming As An Occupation: Motor Phenomena And Lived Experiences, Christina Floyd, Melanie Blaisdell, Madeleine Pope, Audrey Metzger, Donna Chen Tubig, Lauren Andaya, Christine Vincent

Occupational Therapy | MSOT Capstone Projects

Purpose: This qualitative study examined the lived experience and motor phenomena that occur in people with disabilities during the occupation of video gaming. Historically, the occupation of video gaming, also referred to as gaming, has not been inclusive of individuals with disabilities due to the design of traditional video gaming controllers. Typical gaming controllers require fine motor control, finger dexterity, and in-hand manipulation to grasp and use the controls on the device. Although, many people with disabilities do not have the fine motor skills required to access these devices, creating a barrier for this population to engage in …

Exploring Communication Processes During Transitions From Acute Care To Skilled Nursing Facilities And Perceived Barriers To Communication, Marrizzia Oxford

Seton Hall University Dissertations and Theses (ETDs)

Background and Purpose of the Study: The need for skilled care and long-term care services often becomes necessary as the older adult transitions into the golden years. In the United States, more than 1.5 million adults live in long-term care facilities, with this number expected to double by 2050 (Johnson, Pope joy & Radina, 2010). Effective communication between the healthcare professionals who refer individuals from an acute care setting to a skilled nursing facility can be challenging and ultimately impact their transfer status and Plan of Care (POC) or plan of action implementation for meeting healthcare goals of the patient …

The Effect Of Egcg-P Containing Formulations On Bacillus Spp., Sabrina A. Lopez

Seton Hall University Dissertations and Theses (ETDs)

The Gram-positive Bacillus species is known for their spore-forming abilities. These spores are highly resistant to a multitude of factors such as heat, UV radiation, and chemical solvents, which can be attributed to the location of its DNA, and other components that make up the spore as a whole. Bacillus spp. can be detrimental to the food & beverage industry and the medical field due to their production of enterotoxins, which can manifest as bacterial infections. Antibiotic-resistant bacteria towards current treatments are of major concern, and thus the need for alternative therapeutic agents is urgent. The beneficial health properties of …

Evaluation Of Specialty Pharmacy Productivity Metrics To Create An Updated Standardized Productivity Tool, Linda Huynh, Adam Saulles, Amber Franck

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• The number of specialty pharmacy medications has increased and is only projected to grow as more medications are approved for complex, chronic disease states 1,2 • Specialty medications are associated with high costs, high risks, and high complexity requiring extensive time and efforts to make medications safe and affordable for patients. • Much of this health system based specialty pharmacy’s productivity has been measured using a weighted scoring system for new vs. refill prescriptions. • With updated specialty pharmacy accreditation standards, stricter payer requirements, and shifting limited distribution medication complexities, there is a substantial focus on quality, clinical …

Evaluation Of Surgical Antibiotic Prophylaxis Compliance At A Large, Tertiary Medical Center, Meagan Greckel, Brent Footer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Surgical site infections (SSIs) are a significant cause of morbidity, prolonged hospitalization, and mortality. •Studies estimate SSIs contribute to nearly one million additional inpatient days per year and SSI mortality rate has been estimated to be 3%. •Additionally, SSIs in the US alone have an annual cost of approximately $3.5 billion. •A prior quality improvement project performed at a large, tertiary medical center in 2018-2019 identified that consistent adherence to the system surgical antibiotic prophylaxis (SAP) guideline and institutional antibiogram for antibiotic selection was an area for improvement. •This was particularly evident in hysterectomy and colorectal surgeries; therefore, …

Evaluate Opioid Prescribing Trends For Elderplace, A Program For All-Inclusive Care For The Elderly (Pace), Jacqueline Figueras, Loann Wong, Sharon Leigh

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Providence ElderPlace in Oregon is the fifth-largest PACE program in the country that offers wraparound nursing home-eligible medical and social services to over 1600 community-dwelling seniors who are medically frail with complex medication regimens. • Many elderly patients suffer from chronic nonmalignant pain which may affect their function and quality of life. • The Centers for Disease Control and Prevention (CDC) reports a 7.7% increase in drug overdoses and opioid deaths in the aging population from 2013 to 2014. • In 2015-2016 elderly adults obtained an annual average of 774 Morphine Milligram Equivalents (MME) of outpatient prescriptions for …

Critical Conversations: Improving Goals Of Care Conversations At Southeast Family Medicine, Elizabeth Deyo, Michael Dirks, Tyler Nelson, Katherine Cobb, Nicholas Wolfgang, Hannah Kadavy, Ben Pederson

Milwaukie Family Medicine 2021

Quality Improvement Project - Background

Introduction Goals of care (GOC) conversations are an essential element of high quality patient care across care contexts. At our residency clinic site, Southeast Family Medicine, there currently is not a standardized workflow that encourages and reminds providers to complete and document GOC discussions with their patients. Currently, end of life planning is tracked and monitored primarily through two tools: patient completion of advanced directives and POLST forms. Although these two documents are important, their use and application is at times to general or specific to truly reflect a patient’s perspective on their goals of …

Impact Of The Geriatric Mini-Fellowship On Prescribing Patterns Of The Primary Care Providers, Amy Zahn, Sharon Leigh

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2021

Background

• Geriatric patients are likely to experience adverse drug events related to high-risk medication use. Polypharmacy is also common and has a significant impact on the health of older adults. •The American Geriatric Society Beers Criteria lists potentially inappropriate medications for older adults.1 •Current literature suggests that Implementing interventions and deprescribing practices have a role in reducing costly hospitalizations. •STOPP (Screening Tool of Older People’s Prescriptions) was designed to address polypharmacy.2 •Medication review and follow-up services for older, polypharmacy patients lowered medication-related costs.3 •Projections suggest there is an insufficient supply of geriatrician services.4 •Per person personal health care spending …

Assessing The Effect Of An Electronic Health Record Order Entry Guideline On Duration Of Outpatientantimicrobial Therapy Prescribed For Uncomplicated Urinary Tract Infections, Kasey Rubin, Chelsea Houshour, Christine Doran

Providence Pharmacy PGY2 Program at Providence Medical Group 2021

Background

• Fifty percent of antibiotics prescribed in the outpatient setting are unnecessary1. •Outside of unnecessary prescribing, the antibiotics chosen can be incorrect with an inappropriate duration of therapy1. •It has been estimated that resistant infections affect nearly 3 million Americans annually and are the cause of 35,000 deaths each year with added costs up to $33.2 billion dollars1. •The Centers for Disease Control (CDC) recommends that outpatient antimicrobial stewardship programs identify “high priority conditions.” •Examples of high priority conditions include acute respiratory infections, urinary tract infections (UTI)and skin and soft tissue infections (SSTI).2 •Antibiotics are not associated with a …

Navigating Uncertainty In A Critically Ill Patient, Brandon Tempte, Amy Dechet

Providence Portland Medical Center Internal Medicine 2021

Introduction Aspergillus spores are routinely inhaled.Innate immune defenses prevent fungal growth and disease in immunocompetent individuals.However, immunocompromised patients are at risk of developing invasive aspergillosis. Diagnosis of invasive aspergillus is often difficult as biopsy is not always feasible and relies on the interpretation of non-invasive testing. Early recognition and initiation of therapy is paramount as the mortality rate is high.

Case Presentation Patient is a 59 year oldfemale with a history of alcohol abuse admitted with acute encephalopathy and new onset seizure. History: -Initially presented 3 weeks earlier for jaundice, found to have acute alcoholic hepatitis, started and discharged on …

Hormone Wars: The Thyroid Strikes Back! A Case Of Hashimoto Encephalopathy Manifesting As Diffuse Extremity Weakness And Confusion, Cody Paiva, Brinton Clark

Providence Portland Medical Center Internal Medicine 2021

Case Presentation

A 42-year-old female with a past medical history of schizoaffective disorder recently discontinued on multiple psychiatric medications, stable HIV, and hypothyroidism presented with a chief complaint of diffuse extremity weakness and Parkinsonism-like symptoms. History of Present Illness •4-month history of jerking leg movements bilaterally •2-week history of ”feeling paralyzed” with difficulty ambulating •Recent long-term hospitalization at a psychiatric facility as a ward of the state •Multiple changes to psychiatric medication regimen, including abrupt discontinuation of clozapine and risperidone •Abrupt onset confusion at facility and decreased level of interaction at facility prior to admission Exam •T 98.8F, BP 114/66, …

A Case Of Vaccine-Preventable Back Pain, Gerald Hutfles, Tricia James

Providence Portland Medical Center Internal Medicine 2021

The Case 55-year-old male with minimal medical history who presented multiple times over 9 months with progressive and severe gluteal & back pain, ultimately found to be from anal cancer.

HPV - The Bad, Insidious Bug

What is it? •Human Papillomavirus (HPV) is a double-stranded DNA virus of the Papillomaviridaefamily. Its lifecycle is tied to epithelial tissue. Why do we care? •HPV is associated with warts (including condyloma acuminatum) and cancer •Approximately 45,000 HPV-associated cancers occur in the US each year •7,083 -anal cancer •12,143 -cervical cancer •19,975 -oropharyngeal cancer What About Anal Cancer? •Affects ~1.6/100,000 women, and 1.0/100,000 men …

Cryptococcoma From Disseminated Cryptococcus Neoformans Infection In An Immunocompetent Patient, Megan Block, David Hotchkin, Amy Dechet

Providence Portland Medical Center Internal Medicine 2021

Background Cryptococcal infection is an infection caused by encapsulated yeasts of the Cryptococcusfungi that primarily manifests in the CNS or lungs in immunocompromised hosts. Our case describes disseminated Cryptococcus neoformansinfection and cerebral cryptococcomain an immunocompetent individual.

Case History •A 64 year-oldmale with no pertinent medical history presented to his PCP for worsening headaches for the past 2 months. •MRI: new ring enhancing lesion of the left thalamus •CT chest: bilateral upper lobe tree-in-bud nodules and a right upper lobe nodule with stippled calcification. •Lung biopsy, complicated by pneumothorax, was unremarkable. •2 days later developed headaches and nausea, became non-verbal, and …

The Peculiar Case Of Purulent Pericarditis, Laura Bennetts, Meera Jain

Providence Portland Medical Center Internal Medicine 2021

Introduction

Purulent pericarditis is a localized purulent infection in the pericardial space •Before the era of antibiotics, purulent pericarditis was related to complications of pneumococcal pneumonia. Now more frequently associated with thoracic surgeries, immunocompromised hosts and nosocomial blood infections.1 •This case is an unusual presentation of acute methicillin-resistant staphylococcus aureus (MRSA) purulent pericarditis with a course complicated by cardiac tamponade, opiate withdrawal, and a right ventricle (RV) laceration.

Case Presentation

History of Present Illness •Patient is a 30-year-old M active intravenous drug use (IDU) with a recent history of MRSA bacteremia, endocarditis, parasternal abscess s/p I&D, and sternal osteomyelitis with …

The Role Of Src In Nsclc Cell And Lung Fibroblast Migration On 3d Cell-Derived Matrix., Austin M Krueger

Electronic Theses and Dissertations

Lung cancer is responsible for the most cancer deaths between males and females, with a 6% five-year survival rate. Cancer metastasis is one of the leading causes of lung cancer lethality. Our lab has developed a method to culture cells on cell-derived matrix (CDM) and study cell-ECM interactions. This study utilized multiple cell migration methods to investigate the migration of NSCLC cells and IMR90 lung fibroblasts, both together and independently, on 2D plastic and 3D CDM. Our results showed that inhibiting Src, a significant influencer of cell migration and member of integrin activation, blocked cancer cell migration on 2D and …

Bmi And Associated Variables In A Pediatric Gender Clinic Sample, Mirae J. Fornander, Christine Moser, Anna Egan, Timothy A. Roberts

Presentations

Background: Studies of transgender/gender diverse (TGD) youth indicate a high prevalence of overweight/obesity and concern for unhealthy weight control behavior.

Objective: Describe BMI and the association of medication use, well-being, and recreational activities in treatment-naïve pediatric TGD patients.

Design/Methods: Chart review of 302 patients (age 3-19, 73.5% sex assigned at birth (SAB) female; 85.8% white) from 2017-2020. BMI was calculated by age and SAB using CDC growth charts. Parents reported medication use; parent and self-reported Pediatric Quality of Life (PEDS-QL) Well-Being and activities were surveyed electronically.

Results: By BMI category, 3.3% were underweight (BMI<5%); 49.4% were >85% and 29.5% fell >95%. Overweight …

Utility Of Diagnostic Testing In Patients Who Present With Brief Resolved Unexplained Event, Allayne Stephans, Kathryn Westphal, Erin Sullivan, Matt Hall, Risa Bochner, Adam Cohen, Jennifer Y. Colgan, Atima C. Delaney, Amy Delaroche, Thomas Graf, Beth Harper, Ron L. Kaplan, Hannah C. Neubauer, Mark I. Neuman, Nirav Shastri, Victoria Wilkins, Joel S. Tieder, Manoj Mittal

Presentations

Background: Well appearing infants commonly present with a history of a brief event characterized by changes in color, breathing, muscle tone, or level of alertness. In 1986 the National Institutes of Health coined the term ALTE (Apparent Life-Threatening Event) to describe these events. In 2016 the American Academcy of Pediatrics (AAP) published a guideline that updated the term ALTE to BRUE (Brief Resolved Unexplained Event). This guideline includes a more precise definition and limited recommendations for the evaluation of patients who are designated as lower risk for serious underlying diagnoses. A few small studies have examined the diagnostic yield of …

Use Of Clinical Criteria For Prediction Of Invasive Bacterial Infection In Febrile Infants: Evaluation Of The Pros Criteria, Lyubina Yankova, Mark Neuman, Marie Wang, Adrienne G. Deporre, Sanyukta Desai, Laura Sartori, Richard Marble, Lise Nigrovic, Rianna Leazer, Christopher Pruitt, Christopher Woll, Sahar Rooholamini, Frances Balamuth, Paul Aronson

Presentations

Background: In a 2004 study, the American Academy of Pediatrics Pediatric Research in Office Settings (PROS) network developed clinical criteria that had a sensitivity of 93.6% for identification of febrile infants at low-risk for invasive bacterial infection (IBI). Although application of the PROS criteria would reduce routine testing and emergency department (ED) evaluation for febrile infants in outpatient settings without readily available access to laboratory testing, these criteria have not been externally validated in a contemporary cohort.

Objective: To evaluate the sensitivity of the PROS criteria for IBI in febrile infants ≤60 days old.

Design/Methods: We performed a secondary analysis …