Medicine and Health Sciences Commons^™

Virtual Primary Care In A Large Delaware-Based Independent Academic Medical Center: Impact And Opportunity, Darrell C. Dow, Sarah E. Schenck, Tracy L. Bell, Stephanie C. Roth, Omar Khan

Department of Family & Community Medicine Faculty Papers

COVID-19 and related challenges to patient access necessitated the development of new models of care to ensure a healthy patient population. This paper describes the outcomes of a pilot virtual primary care program at a large independent academic health center in Delaware. The preliminary results are encouraging from the perspective of provider and patient satisfaction, as well as the utility of the operational model. A complete cost-benefit analysis was beyond the scope of the paper; thus, future operational research should focus on the metrics of cost and quality as key indicators of model sustainability.

30- And 90-Day Readmission Rates Following Traumatic Spinal Cord Injury: A Systematic Review And Meta-Analyses, Marjan Hesari, Seyed Danial Alizadeh, Hamid Malekzadeh, Reza Tabrizi, Mohammad-Rasoul Jalalifar, Alireza Shahmohammadi, Zahra Eskandari, Zahra Ghodsi, James Harrop, Vafa Rahimi-Movaghar

Department of Neurosurgery Faculty Papers

Study Design

Systematic Review and Meta-Analyses.

Objective

To assess the 30- and 90-day readmission rates after a traumatic spinal cord injury (SCI).

Methods

A systematic search of MEDLINE and Embase was performed. The period was from inception to June 2022, with no language restrictions. All studies investigating the 30- and/or 90-day readmission rate following traumatic SCI were included. A random-effects model to combine effect sizes in our meta-analysis was applied.

Results

Seven out of 2959 reports met eligibility. The mean age of the patients was 50.2 ± 19.9, with a male-to-female ratio of 2.4:1. The most common traumatic SCI was …

Educating Staff To Use The Teach-Back Method Towards Improving Adherence To Antipsychotic Medication, Elizabeth Adebayo

Walden Dissertations and Doctoral Studies

My goal for this staff education doctoral project was to improve adherence to antipsychotic medication among patients in a mental health facility through an education initiative for psychiatric intensive care unit staff focused on the teach-back method. The facility had reported a 20% increase in medication noncompliance among post-discharge patients within the past year, primarily attributed to nurses’ lack of adequate patient teaching strategies. I addressed the issue of effective patient education using the teach-back method in improving medication adherence in an inpatient mental health setting. Teaching objectives, content, and test questions were developed based on a substantial body of …

Clinical Utility Of Opencap Motion Analysis In Lower Limb Prosthesis Users, Sarahi Fernandez Leon

Honors Program Theses and Research Projects

The use of prosthetics has gradually increased due to various diseases, and it is estimated that 35-40 million people are prosthetic/orthotic users, with the number estimated to increase to two billion by 2050. Mobility has been determined to be a strong predictor of quality of life. There are various ways to measure mobility and predict outcomes in lower-limb amputees (LLA), such as self-report and performance-based measures. However, these come with many limitations, showcasing the need for quantitative measures of gait parameters to allow for better development of prosthetic components. Motion analysis tools are expensive and time consuming, but an inexpensive, …

Functional Connectivity Biomarker Extraction For Schizophrenia Based On Energy Landscape Machine Learning Techniques, Janerra D Allen, Sravani Varanasi, Fei Han, L Elliot Hong, Fow-Sen Choa

Faculty, Staff and Student Publications

Brain connectivity represents the functional organization of the brain, which is an important indicator for evaluating neuropsychiatric disorders and treatment effects. Schizophrenia is associated with impaired functional connectivity but characterizing the complex abnormality patterns has been challenging. In this work, we used resting-state functional magnetic resonance imaging (fMRI) data to measure functional connectivity between 55 schizophrenia patients and 63 healthy controls across 246 regions of interest (ROIs) and extracted the disease-related connectivity patterns using energy landscape (EL) analysis. EL analysis captures the complexity of brain function in schizophrenia by focusing on functional brain state stability and region-specific dynamics. Age, sex, …

Trajectory, Interactions, And Predictors Of Higher Symptom Burden During Induction Therapy For Multiple Myeloma, Mona Kamal, Qiuling Shi, Shu-En Shen, Charles Cleeland, Xin Shelley Wang

Faculty, Staff and Student Publications

Background: Patients with multiple myeloma (MM) experience disabling symptoms that are difficult to manage and may persist after induction therapy. Monitoring disease-related and induction therapy-induced symptoms and identifying patients at greater risk for high symptom burden are unmet clinical needs. The objective of this study was to examine the trajectories of symptom severity over time and identify predictors of high symptom burden during MM induction therapy.

Methodology: Eligible patients with MM rated their symptoms by completing the MD Anderson Symptom Inventory MM module repeatedly during 16 weeks of induction therapy. Group-based trajectory modeling identified patient groups with persistently high-severity (versus …

A Retrospective Validation Of The Hear Score., Jordan Luli, Andrew Scheidemantel, Katelyn Bennett, Jessalyn Schafer, Andrew Costa, Marie Lockhart, Kevin Stiver

Heart and Vascular Articles

Studies have proposed the history, electrocardiogram, age, risk factors (HEAR) score to risk-stratify patients with chest pain in the emergency department. This paper assessed the utility of the HEAR score for ambulatory patients with chest pain. The findings demonstrate patients with low and high HEAR scores can be safely managed in the outpatient setting.

Diet And Immune Effects Trial (Diet)- A Randomized, Double-Blinded Dietary Intervention Study In Patients With Melanoma Receiving Immunotherapy, Rachel M Farias, Yan Jiang, Erma J Levy, Cindy Hwang, Jian Wang, Elizabeth M Burton, Lorenzo Cohen, Nadim Ajami, Jennifer A Wargo, Carrie R Daniel, Jennifer L Mcquade

Faculty, Staff and Student Publications

Background: Gut microbiome modulation is a promising strategy for enhancing the response to immune checkpoint blockade (ICB). Fecal microbiota transplant studies have shown positive signals of improved outcomes in both ICB-naïve and refractory melanoma patients; however, this strategy is challenging to scale. Diet is a key determinant of the gut microbiota, and we have previously shown that (a) habitual high dietary fiber intake is associated with an improved response to ICB and (b) fiber manipulation in mice impacts antitumor immunity. We recently demonstrated the feasibility of a controlled high-fiber dietary intervention (HFDI) conducted in melanoma survivors with excellent compliance and …

Alzheimer's Disease-Linked Risk Alleles Elevate Microglial Cgas-Associated Senescence And Neurodegeneration In A Tauopathy Model, Gillian K Carling, Xiaoying Chen, David M Holtzman, Et Al.

2020-Current year OA Pubs

The strongest risk factors for late-onset sporadic Alzheimer's disease (AD) include the ε4 allele of apolipoprotein E (APOE), the R47H variant of triggering receptor expressed on myeloid cells 2 (TREM2), and female sex. Here, we combine APOE4 and TREM2

X-Chromosome-Wide Association Study For Alzheimer's Disease, Julie Le Borgne, Carlos Cruchaga, John Morris, Et Al.

2020-Current year OA Pubs

No abstract provided.

Trend And Awareness Of E-Cigarettes Among Students In A Private College In Sabah Malaysia, Vitalis Ronald Eden, Hazrina Hamid, Sreemoy Das, Regidor Iii Dioso

AUIQ Complementary Biological System

Objective: This study aims to investigate the trend and awareness of e-cigarette use among students in a private college located in Sabah, Malaysia. Research Methods: The cross-sectional study was conducted in a private college in Sabah. A self-administered questionnaire was adapted and distributed to 300 randomly selected students regardless of their e-cigarettes vaping status. IBM SPSS Statistic 27 was utilized to analysed accumulated data. Results: A-245 students participated in the study with a response rate of 81.6%. Majority of the respondent were female (69.8%), Bumiputera Sabah (72.2%), Diploma students (90%) aged 22-25 years’ old. The study revealed that almost all …

Review Of The Diagnosis, Pathophysiology, And Treatment Of Naegleria Fowleri-Induced Primary Amoebic Meningoencephalitis, Terrance Zhang

MCB Articles

Naegleria fowleri is a thermophilic, ubiquitous, free-living amoeba, but is also known as the “brain-eating” amoeba. This is the etiological agent of a rare and fulminant waterborne disease known as Primary Amoebic Meningoencephalitis (PAM) that is acutely fatal in 90-99% of reported cases. Those who come into contact with infested waters are at risk of introducing the amoeba into their upper nasal canal, whence the trophozoite form is known to migrate along the olfactory nerve, through the cribriform plate, and enter the central nervous system. Although the exact pathogenesis of N. fowleri is not known, studies have demonstrated contact-dependent and …

Caffeine And Arrhythmias: A Critical Analysis Of Cardiovascular Responses And Arrhythmia Susceptibility, Adel Khalifa Sultan Hamad

Journal of the Saudi Heart Association

Caffeine is a frequently consumed stimulant in different foods and beverages: coffee, tea, chocolate, sodas, and energy drinks. While its effects on the cardiovascular system have been extensively studied, there remains controversy surrounding its potential risks, particularly in patients with heart disease. This review provides a complete overview of caffeine's pharmacological properties, sources, and cardiovascular effects, particularly emphasizing its arrhythmogenic potential. The proarrhythmic potential of caffeine, particularly on atrial fibrillation and ventricular arrhythmias, is conducted. It explains the mechanism of action, including adenosine receptor antagonism, phosphodiesterase inhibition, calcium mobilization, and catecholamine release of caffeine. Epidemiological evidence and mechanistic insights are …

Breaking The Yoke: A Systematic Unmasking Of Challenges To Sustainable Rural Development In South Sudan, Gai Chol Paul

Journal of Sustainable Social Impact

South Sudan, a young nation grappling with the legacy of protracted conflict, faces significant challenges in fostering sustainable rural development. While the immense potential of its vast agricultural lands remains largely untapped, the persistent triple threat of insecurity, deficient infrastructure, and the absence of robust government policy actively hinders progress. The ongoing armed conflict, characterized by inter-communal violence and sporadic attacks, casts a long shadow over rural areas in South Sudan. Thus, I developed this mixed-method multiple-case study, grounded in the sustainable livelihoods framework, to explore challenges that hinder sustainable rural development in South Sudan. I collected data through document …

The Challenge Of Regulating Pharmaceutical Clinical Trials In The 21st Century With A Focus On Guatemala, Alejandro Cerón, Antonio Ricafort, Carter Saccocio, Maria Delmonte, Jordan Vasquez, Amarri Bishop, Julia Atwood, Addison Bucsko, Jordan Lewis, Alexandra Welch, Itzael Garcia, Ella Wald, Selena Johnson, Crystal Jin, Talya Riciputi, Lindsey Speer, Vanessa Udo-Obong, Soren Engberg, Tessa Lindstrom

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students and instructor of the "Right to Health in Theory and Practice" class taught in the fall of 2024 at the University of Denver. The report was prepared for the Vice Ministry of Health Regulation, Surveillance and Control of the Ministry of Public Health and Social Assistance of Guatemala. The work used the following guiding question: What can a country like Guatemala do to regulate international pharmaceutical clinical trials in the context of research commercialization? In other words, the work was guided by three important elements. First, the regulatory aspect of clinical trials. Second, …

Rings Of Power: Controlling Sod Mimic Activity By The Addition Of Pyridine Rings Within The Pyridinophane Scaffold, Katherine J. Smith, Timothy M. Schwartz, David M. Freire, Cameron Bowers, Sarah K. Dunn, Jackson F. Bonnell, Magy A. Mekhail, Giridhar Akkaraju, Kayla N. Green

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Superoxide dismutase enzymes are a major defense against superoxide, which is a potent reactive oxygen species. Misregulation of reactive oxygen species and subsequent neuronal damage are etiological hallmarks of neurodegenerative disease. Macrocyclic small molecules have offered inroads toward functional SOD1 mimics. Herein, we report a series of five tetra-aza macrocyclic ^RPy₂N₂ ligands, varied by 4-position substitution of the pyridine ring with both electron-donating (R = OMe) and withdrawing groups (R = Cl, I, and CF₃) to offer the first comparison to well-studied ^RPyN₃ congeners and other mimics in the literature. New ligands …

Sibling Relationships Through The Lens Of Culture And Inclusion Of Other In The Self, Laura Aguilar

Honors Thesis

Sibling relationships are formative for identity development and well-being. These relationships vary in closeness due to factors such as age, gender, family dynamics, parenting style and cultural context. Existing literature has shown that siblings from interdependent cultures have closer relationships than those from independent cultures. This thesis proposes that sibling relationships can be examined through the lens of the self-expansion model, focusing on the Inclusion of Other in the Self (IOS) scale. It hypothesizes that those from interdependent cultures will have more inclusion of other in the self than those from independent cultures. Participants from Japan representing the interdependent culture …

Differential Infiltration Of Key Immune T-Cell Populations Across Malignancies Varying By Immunogenic Potential And The Likelihood Of Response To Immunotherapy., Islam Eljilany, Sam Coleman, Aik Choon Tan, Martin D. Mccarter, John Carpten, Howard Colman, Abdul Rafeh Naqash, Igor Puzanov, Susanne Arnold, Michelle L. Churchman, Daniel Spakowicz, Bodour Salhia, Julian Marin, Shridar Ganesan, Aakrosh Ratan, Craig Shriver, Patrick Hwu, William S. Dalton, George J. Weiner, Jose R. Conejo-Garcia, Paulo Rodriguez, Ahmad A. Tarhini

Markey Cancer Center Faculty Publications

Background: Solid tumors vary by the immunogenic potential of the tumor microenvironment (TME) and the likelihood of response to immunotherapy. The emerging literature has identified key immune cell populations that significantly impact immune activation or suppression within the TME. This study investigated candidate T-cell populations and their differential infiltration within different tumor types as estimated from mRNA co-expression levels of the corresponding cellular markers.

Methods: We analyzed the mRNA co-expression levels of cellular biomarkers that define stem-like tumor-infiltrating lymphocytes (TILs), tissue-resident memory T-cells (TRM), early dysfunctional T-cells, late dysfunctional T-cells, activated-potentially anti-tumor (APA) T-cells and Butyrophilin 3A (BTN3A) isoforms, utilizing …

Evolving Treatment Strategies For Systemic Lupus Erythematosus In Clinical Practice: A Narrative Review, Alan D. Kaye, Joseph P. Tassin, William C. Upshaw, Chandni R. Patel, Alison M. Hawkins, Caroline R. Burroughs, Kristin Nicole Bembenick, Chizoba N. Mosieri, Shahab Ahmadzadeh, Adam M. Kaye, Sahar Shekoohi, Giustino Varrassi

School of Dentistry Faculty Publications

Systemic lupus erythematosus (SLE) is an autoimmune disease that more commonly affects African American people, although it is seen in people of all racial backgrounds. This condition is characterized by a dysregulated immune response resulting in widespread inflammation. Clinical manifestations caused by this inflammation include arthritis, anemia, cutaneous rashes, pleuritis, and nephritis. Treatment for SLE aims to reduce disease activity and maintain a state of low inflammation. In this regard, numerous treatments are used, such as hydroxychloroquine, glucocorticoids, and non-glucocorticoid immunosuppressants such as methotrexate. Related to these drugs resulting in significant adverse effects and being ineffective in controlling SLE symptoms …

Nt-Probnp And Cardiac Troponin I, But Not Cardiac Troponin T, Are Associated With 7-Year Changes In Cardiac Structure And Function In Older Adults: The Aric Study, Peder L Myhre, Brian Claggett, Christie M Ballantyne, Ron C Hoogeveen, Elizabeth Selvin, Kunihiro Matsushita, Dalane Kitzman, Suma Konety, Thomas Mosley, Amil M Shah

Faculty, Staff and Students Publications

Background: Higher circulating concentrations of NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) are associated with left ventricular remodeling and with incident heart failure. The associations of these cardiac biomarkers with changes in cardiac structure and function over time are uncharacterized.

Methods: Among 2006 participants in the ARIC prospective cohort study (Atherosclerosis Risk in Communities) who were free of overt cardiovascular disease and underwent echocardiography at study visits 5 (2011- 2013) and 7 (2018-2019), we assessed the associations of NT-proBNP, hs-cTnT, and hs-cTnI concentrations at visit 5 with changes in left ventricular structure and …

Simulation Education To Improve Confidence Levels In Using Alternative Methods Of Restraint With Children On An Inpatient Psychiatric Unit, Roshni Patel

Walden Dissertations and Doctoral Studies

Summary Seclusion and restraints, while sometimes necessary for patient and staff safety, can result in negative outcomes, including physical and psychological harm to patients. This doctoral project addressed the critical issue of improving inpatient nurses’ confidence in applying alternative methods to seclusion and restraints. These alternatives are essential in psychiatric and acute care settings to promote patient safety, reduce the use of coercive interventions, and support a more humane approach to patient care. The practice problem identified was a notable lack of confidence and knowledge among inpatient nurses regarding using these alternative methods, which led to overreliance on seclusion and …

An Educational Intervention To Increase Nurse Practitioners’ Knowledge And Awareness Of Polypharmacy, Kiana Piedrahita

Walden Dissertations and Doctoral Studies

The presence of multiple health problems can contribute to the simultaneous use of multiple medications by an individual, also known as polypharmacy. While polypharmacy can be necessary, it has the potential risk of adverse drug reactions and possible hospitalization. In the local organization, leadership noted that 47% of patients seen are elderly individuals who have multiple comorbidities, indicating the probable use of multiple medications. Thus, purpose of this Doctor of Nursing Practice project was to determine if an educational intervention focused on polypharmacy and the use of the electronic medical record to manage polypharmacy increased knowledge and awareness among nurse …

The Impacts Of Co-Occurring Developmental Language Disorder On The Academic, Interpersonal, And Behavioral Profiles Of Children With Adhd, Kirsten M. Hannig Russell, Sean M. Redmond

Faculty Publications

Purpose: Attention-deficit/hyperactivity disorder (ADHD) is a multifactorial disorder that has been linked to increased risk for behavioral, academic, and interpersonal problems. Developmental language disorder (DLD) has also been linked to poor outcomes in these areas. The presence of co-occurring disorders in children’s profiles is generally associated with poorer outcomes relative to profiles consisting of only one disorder. This study investigated the extent to which co-occurring DLD in children already identified with ADHD presented increased risk for severity of their primary ADHD symptoms, the presence of secondary behavioral problems, and/or increased problems in the tertiary areas of academic performance and interpersonal …

Advancements And Emerging Insights In Thoracolumbar Spine Trauma, Jonathan Neuhoff, Alex R. Vaccaro, Cumhur Oner, Klaus Schnake, Frank Kandziora

Department of Orthopaedic Surgery Faculty Papers

Thoracolumbar spine trauma represents a complex and evolving field within spinal surgery, with a continuous shift in treatment paradigms as research refines optimal approaches for specific patient populations. This special issue, with contributions from 20 peer-reviewed articles, brings together recent advancements in thoracolumbar trauma care, offering insight into improved diagnostic protocols, emerging surgical techniques, patient-centred outcomes, and the integration of new technologies.

Neuroprotective Care And Painful Procedures, Jelda Frank

Walden Dissertations and Doctoral Studies

An inconsistent application of neuroprotective care provided by clinical staff, based on my observations, to minimize the negative effects of painful procedures that can negatively impact the neurodevelopment of neonates in the neonatal intensive care unit (NICU), was the identified practice problem for my Doctor of Nursing Practice (DNP) staff education project. Implementation of evidence-based neuroprotective and neuropromotive strategies aim to optimize outcomes for premature infants and minimize risk of potential negative effects to the neonate’s short and long term neurodevelopment. The DNP project practice-focused question addressed whether a presentation of an evidence-based educational program for NICU clinical staff would …

Correction: Nepali Oral Microbiomes Reflect A Gradient Of Lifestyles From Traditional To Industrialized, Erica P Ryu, Yoshina Gautam, Diana M Proctor, Dinesh Bhandari, Sarmila Tandukar, Meera Gupta, Guru Prasad Gautam, David A Relman, Ahmed A Shibl, Jeevan Bahadur Sherchand, Aashish R Jha, Emily R Davenport

Faculty, Staff and Student Publications

No abstract provided.

Epigenetic Modifiers: Exploring The Roles Of Histone Methyltransferases And Demethylases In Cancer And Neurodegeneration, Lauren Reed, Janak Abraham, Shay Patel, Shilpa S Dhar

Faculty, Staff and Student Publications

Histone methyltransferases (HMTs) and histone demethylases (HDMs) are critical enzymes that regulate chromatin dynamics and gene expression through the addition and removal of methyl groups on histone proteins. HMTs, such as PRC2 and SETD2, are involved in the trimethylation of histone H3 at lysine 27 and lysine 36, influencing gene silencing and activation. Dysregulation of these enzymes often leads to abnormal gene expression and contributes to tumorigenesis. In contrast, HDMs including KDM7A and KDM2A reverse these methylation marks, and their dysfunction can drive disease progression. In cancer, the aberrant activity of specific HMTs and HDMs can lead to the silencing …

Ethics Of Ai In The Classroom, Kyle Kos

Honors Theses

Artificial intelligence (AI) is rapidly evolving and is increasingly being used in classrooms. Several different forms of artificial intelligence have gained popularity within the past, one form of AI with widespread use in the classroom is Generative Pre-Trained Transformer (ChatGPT). This paper explores how the recent surge of popularity of ChatGPT has caused concerns of ethical use in the classroom. Additionally, this paper explores the capabilities and strategies for students to use AI, specifically in nursing.

ChatGPT can offer extraordinary resources to students through capabilities such as essay writing and editing, generation of answers to questions instantly from a vast …

Using Multiplexed Functional Data To Reduce Variant Classification Inequities In Underrepresented Populations, Moez Dawood, Shawn Fayer, Sriram Pendyala, Mason Post, Divya Kalra, Karynne Patterson, Eric Venner, Lara A Muffley, Douglas M Fowler, Alan F Rubin, Jennifer E Posey, Sharon E Plon, James R Lupski, Richard A Gibbs, Lea M Starita, Carla Daniela Robles-Espinoza, Willow Coyote-Maestas, Irene Gallego Romero

Faculty, Staff and Students Publications

BACKGROUND: Multiplexed Assays of Variant Effects (MAVEs) can test all possible single variants in a gene of interest. The resulting saturation-style functional data may help resolve variant classification disparities between populations, especially for Variants of Uncertain Significance (VUS).

METHODS: We analyzed clinical significance classifications in 213,663 individuals of European-like genetic ancestry versus 206,975 individuals of non-European-like genetic ancestry from All of Us and the Genome Aggregation Database. Then, we incorporated clinically calibrated MAVE data into the Clinical Genome Resource's Variant Curation Expert Panel rules to automate VUS reclassification for BRCA1, TP53, and PTEN.

RESULTS: Using two orthogonal statistical approaches, we …

The Use Of Cloud Based Machine Learning To Predict Outcome In Intracerebral Haemorrhage Without Explicit Programming Expertise, Ajay Hegde, Deepu Vijaysenan, Pitchaiah Mandava, Girish Menon

Faculty, Staff and Students Publications

Machine Learning (ML) techniques require novel computer programming skills along with clinical domain knowledge to produce a useful model. We demonstrate the use of a cloud-based ML tool that does not require any programming expertise to develop, validate and deploy a prognostic model for Intracerebral Haemorrhage (ICH). The data of patients admitted with Spontaneous Intracerebral haemorrhage from January 2015 to December 2019 was accessed from our prospectively maintained hospital stroke registry. 80% of the dataset was used for training, 10% for validation, and 10% for testing. Seventeen input variables were used to predict the dichotomized outcomes (Good outcome mRS 0-3/ …