Medicine and Health Sciences Commons^™

Evaluation Of Unplanned Reattendances To The Pediatric Emergency Department: A Five-Year Study, Liying Toh, Jin Wee Lee, Siok Hoon Ang, Sashikumar Ganapathy, Janani D/O Nadarajan, Shu-Ling Chong

Research Collection School Of Economics

Background: Unplanned reattendances (UR) are an important quality indicator in the emergency department (ED). Understanding the risk factors associated with UR can aid clinicians in optimizing the allocation of time and resources, as well as targeted counselling for this specific group of patients. In this study, we aimed to compare patient characteristics between children who attended a pediatric emergency department (ED) with unplanned reattendances (UR) and those without UR. We also aimed to study the association between healthcare delivery factors such as timing of the attendance, patient load, changeover months for rotating junior doctors, presence of supervision, and rate of …

Genomic Biomarkers To Predict Response To Atezolizumab Plus Bevacizumab Immunotherapy In Hepatocellular Carcinoma: Insights From The Imbrave150 Trial, Sun Young Yim, Sung Hwan Lee, Seung-Woo Baek, Bohwa Sohn, Yun Seong Jeong, Sang-Hee Kang, Kena Park, Hyewon Park, Sunyoung S Lee, Ahmed O Kaseb, Young Nyun Park, Sun-Hee Leem, Michael A Curran, Ji Hoon Kim, Ju-Seog Lee

Faculty, Staff and Student Publications

Background/aims: Combination immunotherapy, exemplified by atezolizumab plus bevacizumab, has become the standard of care for inoperable hepatocellular carcinoma (HCC). However, the lack of predictive biomarkers and limited understanding of response mechanisms remain a challenge.

Methods: Using data from the IMbrave150plus cohort, we applied an immune signature score (ISS) predictor to stratify HCC patients treated with atezolizumab plus bevacizumab or with sorafenib alone into potential high and low response groups. By applying multiple statistical approaches including a Bayesian covariate prediction algorithm, we refined the signature to 10 key genes (ISS10) for clinical use while maintaining similar predictive power to the full …

Feasibility Of Quantitative Relaxometry For Prostate Target Localization And Response Assessment In Magnetic Resonance-Guided Online Adaptive Stereotactic Body Radiotherapy, Ergys Subashi, Eve Locastro, Sarah Burleson, Aditya Apte, Michael Zelefsky, Neelam Tyagi

Faculty, Staff and Student Publications

Purpose: Multiparametric magnetic resonance imaging (MRI) is known to provide predictors for malignancy and treatment outcome. The inclusion of these datasets in workflows for online adaptive planning remains under investigation. We demonstrate the feasibility of longitudinal relaxometry in online MR-guided adaptive stereotactic body radiotherapy (SBRT) to the prostate and dominant intra-prostatic lesion (DIL).

Methods: Fifty patients with intermediate-risk prostate cancer were included in the study. The clinical target volume (CTV) was defined as the prostate gland plus 1 cm of seminal vesicles. The gross tumor volume (GTV) was defined as the DIL identified on multiparametric MRI. Online adaptive radiotherapy was …

Small-Molecule Ccr4 Antagonists In Cutaneous T-Cell Lymphoma, José S Enriquez, Xiaohong Wang, Loka Reddy Velatooru, Wei Han, Pedram Bijani, Xiao Ni

Faculty, Staff and Student Publications

Mycosis fungoides (MF) and Sézary syndrome (SS) are two most common types of cutaneous T-cell lymphoma (CTCL). Despite advances in understanding the pathogenesis of MF and SS, effective treatments remain limited. CC chemokine receptor-4 (CCR4) is highly expressed on CTCL cells and serves as a great therapeutic target. Mogamulizumab, an FDA-approved anti-CCR4 antibody, has shown efficacy in treating MF/SS; however, its side effects have raised concerns, underscoring the need for more effective and less toxic CCR4-targeted therapies. Although small-molecule CCR4 antagonists have been studied in other diseases involving CCR4⁺ Th2 cells and regulatory T cells, their effects in CTCL …

Evaluating Dynamic And Predictive Discrimination For Recurrent Event Models: Use Of A Time-Dependent C-Index, Jian Wang, Xinyang Jiang, Jing Ning

Faculty, Staff and Student Publications

Interest in analyzing recurrent event data has increased over the past few decades. One essential aspect of a risk prediction model for recurrent event data is to accurately distinguish individuals with different risks of developing a recurrent event. Although the concordance index (C-index) effectively evaluates the overall discriminative ability of a regression model for recurrent event data, a local measure is also desirable to capture dynamic performance of the regression model over time. Therefore, in this study, we propose a time-dependent C-index measure for inferring the model's discriminative ability locally. We formulated the C-index as a function of time using …

Mhc Hammer Reveals Genetic And Non-Genetic Hla Disruption In Cancer Evolution, Clare Puttick, Thomas P Jones, Michelle M Leung, Felipe Galvez-Cancino, Jiali Liu, Manuel Varas-Godoy, Andrew Rowan, Oriol Pich, Carlos Martinez-Ruiz, Robert Bentham, Krijn K Dijkstra, James R M Black, Rachel Rosenthal, Nnennaya Kanu, Kevin Litchfield, Roberto Salgado, David A Moore, Peter Van Loo, Mariam Jamal-Hanjani, Sergio A Quezada, Tracerx Consortium, Charles Swanton, Nicholas Mcgranahan

Faculty, Staff and Student Publications

Disruption of the class I human leukocyte antigen (HLA) molecules has important implications for immune evasion and tumor evolution. We developed major histocompatibility complex loss of heterozygosity (LOH), allele-specific mutation and measurement of expression and repression (MHC Hammer). We identified extensive variability in HLA allelic expression and pervasive HLA alternative splicing in normal lung and breast tissue. In lung TRACERx and lung and breast TCGA cohorts, 61% of lung adenocarcinoma (LUAD), 76% of lung squamous cell carcinoma (LUSC) and 35% of estrogen receptor-positive (ER+) cancers harbored class I HLA transcriptional repression, while HLA tumor-enriched alternative splicing occurred in 31%, 11% …

Biomarker Trajectory For Earlier Detection Of Lung Cancer, Ehsan Irajizad, Johannes F Fahrmann, Iakovos Toumazis, Jody Vykoukal, Jennifer B Dennison, Yu Shen, Kim-Anh Do, Edwin J Ostrin, Ziding Feng, Samir Hanash

Faculty, Staff and Student Publications

Background: To determine whether an algorithm based on repeated measurements of a panel of four circulating protein biomarkers (4 MP) for lung cancer risk assessment results in improved performance over a single time measurement.

Methods: We conducted data analysis of the 4 MP consisting of the precursor form of surfactant protein B, cancer antigen 125, carcinoembryonic antigen, and cytokeratin-19 fragment in pre-diagnostic sera from 2483 ever-smoker participants (389 cases and 2094 randomly selected non-cases) in the Prostate, Lung, Colorectal, Ovarian (PLCO) Study who had at least two sequential blood collections over 6 years. A parametric empirical Bayes (PEB) algorithm, which …

Meta-Analysis Of Censored Adverse Events, Xinyue Qi, Shouhao Zhou, Christine B Peterson, Yucai Wang, Xinying Fang, Michael L Wang, Chan Shen

Faculty, Staff and Student Publications

Meta-analysis is a powerful tool for assessing drug safety by combining treatment-related toxicological findings across multiple studies, as clinical trials are typically underpowered for detecting adverse drug effects. However, incomplete reporting of adverse events (AEs) in published clinical studies is frequently encountered, especially if the observed number of AEs is below a pre-specified study-dependent threshold. Ignoring the censored AE information, often found in lower frequency, can significantly bias the estimated incidence rate of AEs. Despite its importance, this prevalent issue in meta-analysis has received little statistical or analytic attention in the literature. To address this challenge, we propose a Bayesian …

Precision Imaging For Prostate Cancer Localization: How Multiparametric Ultrasound Stands Against Multiparametric Mri, Amr Mohammed, Priscilla Machado, Tania Siu Xiao, Aylin Tahmasebi, Mostafa Alnoury, Edouard Trabulsi, Ethan J. Halpern, John R. Eisenbrey, Flemming Forsberg

Department of Radiology Faculty Papers

Multiparametric MRI (mpMRI) is currently the standard imaging modality for the diagnosis of prostate cancer; however, studies have reported that targeted biopsy based on mpMRI may miss approximately 30% of clinically significant cases. Recent advances in ultrasound imaging have improved its accuracy for detection of prostate cancer. Newer techniques such as MicroUS, elastography, contrast-enhanced ultrasound (CEUS), and contrast ultrasound dispersion imaging (CUDI) have enabled a comprehensive, real-time, and relatively inexpensive approach to evaluate the prostate gland. Multiparametric ultrasound (mpUS) integrates multiple parameters from these techniques to generate multiparametric maps akin to those produced by mpMRI, to localize prostate cancer. This …

Evaluation Of Liver Fibrosis On Grayscale Ultrasound In A Pediatric Population Using A Cloud-Based Transfer Learning Artificial Intelligence Platform, Amr Mohammed, Aylin Tahmasebi, Sooji Kim, Mostafa Alnoury, Corinne E. Wessner, Tania Siu Xiao, Sharon W. Gould, Lauren A. May, Heidi Kecskemethy, David T. Saul, John R. Eisenbrey

Department of Radiology Faculty Papers

Objectives: The incidence of chronic liver diseases in children is increasing worldwide due to congenital, metabolic, autoimmune and viral diseases. Currently, liver biopsy for fibrosis assessment is considered the gold standard. However, this procedure is invasive, may result in unavoidable complications and is prone to sampling errors. These limitations have led to an increasing demand for noninvasive methods for fibrosis screening. Artificial intelligence integration in ultrasound diagnosis of liver fibrosis has gained interest in clinical research. In the current study we used a cloud-based artificial intelligence platform utilizing transfer learning to evaluate the accuracy of B-mode ultrasound based AI model …

A Guideline For Open-Source Tools To Make Medical Imaging Data Ready For Artificial Intelligence Applications: A Society Of Imaging Informatics In Medicine (Siim) Survey, Sanaz Vahdati, Bardia Khosravi, Elham Mahmoudi, Kuan Zhang, Pouria Rouzrokh, Shahriar Faghani, Mana Moassefi, Aylin Tahmasebi, Katherine Andriole, Peter Chang, Keyvan Farahani, Mona Flores, Les Folio, Sina Houshmand, Maryellen Giger, Judy Gichoya, Bradley Erickson

Department of Radiology Faculty Papers

In recent years, the role of Artificial Intelligence (AI) in medical imaging has become increasingly prominent, with the majority of AI applications approved by the FDA being in imaging and radiology in 2023. The surge in AI model development to tackle clinical challenges underscores the necessity for preparing high-quality medical imaging data. Proper data preparation is crucial as it fosters the creation of standardized and reproducible AI models while minimizing biases. Data curation transforms raw data into a valuable, organized, and dependable resource and is a fundamental process to the success of machine learning and analytical projects. Considering the plethora …

A Scoping Review Of Patient Safety Checklists In Dentistry, K. Zouaidi, T. W. Miner, M. F. Walji, E. Kalenderian, D. B. Rindal, K. J. Suda

School of Dentistry Faculty Research and Publications

Objectives

Not much is known about safety checklists use in dentistry. We aim to examine, assess, and provide a comprehensive understanding of the current knowledge concerning the use of checklists to improve patient safety in dentistry.

Methods

We conducted a comprehensive literature search using Medline and Embase for studies that use or describe the development of dental patient safety checklists. All study designs were included for citations published through December 2023.

Results

Following abstract and full-text screening, 27 studies remained for data extraction and analysis. Oral surgery emerged as the main dental specialty where the utilization and evaluation of checklists …

The Role Of The Basolateral Nuclear Complex & Central Nucleus Of The Amygdala In Fear-Conditioned Responses To External Stimuli And Anxiety Responses, Oluwaseyi A. Adelakun

Senior Theses

This thesis reviews the role of the amygdala, particularly the basolateral nuclear complex (BLA) and central nucleus (CeA), in fear-conditioned responses and generalized anxiety disorder (GAD). By investigating the neurological and physiological mechanisms that influence the amygdala’s fear and anxiety responses, further connections can be made between this region and other notable brain regions, like the prefrontal cortex (PFC). We review both human and rodent models to explore the overlap between the two and explore various therapeutic interventions that regulate amygdalar activity and therefore mitigate anxiety symptoms. Key research into the patient SM, who lacks fear responses due to bilateral …

Perceptions Of Virtual Reality In Cardiac Pharmacy Education, Morgan E. Mendes

Senior Theses

Background: The reformation of how educational content is portrayed is not a new phenomenon. However, the world of pharmacy has been slow to adapt, particularly considering higher education’s declining attendance rates and less engaging lectures. XR can be a great addition to learners’ curriculum, particularly VR, with various applications including adjunctive pharmacotherapy, patient counseling, pharmacist training, and pharmacological modeling. Despite the various barriers VR integration faces, the benefits of VR necessitate its future implementation into our COP curriculum as an augmentative form of learning.

Methods: An independent study of 11 students at the UofSC COP was conducted in the Spring …

Stop Sucking Us Dry: Decreasing Unnecessary Blood Draws In The Intensive Care Unit, Danielle A Sultan Do, Danny Le Do, Robert P Briggs Do, Shawn M. Quinn Do, Jessica Boehmler Md, Bryan G. Kane Md, Amy Slenker Md

Department of Emergency Medicine

No abstract provided.

Psychological Distress Among Ethnically Diverse Participants From Eastern And Southern Africa, Kester Tindi, Allan Kalungi, Eugene Kinyanda, Bizu Gelaye, Alicia Martin, Ronald Galiwango, Wilber Ssembajjwe, Fred Kirumira, Adele Pretorius, Lukoye Atwoli

Internal Medicine, East Africa

Importance: Psychological distress is characterized by anxiety and depressive symptoms. Although prior research has investigated the occurrence and factors associated with psychological distress in low- and middle-income countries, including those in Africa, these studies’ findings are not very generalizable and have focused on different kinds of population groups.

Objective: To investigate the prevalence and characteristics (sociodemographic, psychosocial, and clinical) associated with psychological distress among African participants.

Design, setting and participants: This case-control study analyzed data of participants in the Neuropsychiatric Genetics in African Populations-Psychosis (NeuroGAP-Psychosis) study, which recruited from general outpatient clinics in Eastern (Uganda, Kenya, and Ethiopia) and Southern …

Application Of A Mepilex Border Dressing To Prevent Heel Pressure Injury, Melissa Sterlin

All Doctor of Nursing Practice (DNP) Scholarly Projects

• Problem:

Heel pressure injuries (HPIs) are preventable, yet they can easily occur when policies specifically targeting heel protection are lacking. A quality improvement methodology was implemented on two intensive care units (ICUs) within an organization which involved revising existing policies to standardize practices and mitigate occurrences.

Aim of the Project:

To evaluate the effectiveness of an evidence-based protocol that utilizes Mepilex border dressings to prevent hospital-acquired HPIs in ICUs.

• Review of the Evidence:

Across various studies, common themes emerged, notably the utilization of prophylactic Mepilex foam dressings as effective interventions specifically targeted in the ICU.

• Project Design:

A protocol …

Reducing Patient Falls In A Behavioral Health Unit: Improvement Through Audit Implementation, Kristin Gardner

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Fall-related events are a significant source of harm, with more than 700,000 patients falling every year in U.S. hospitals. The project was implemented in a 41-bed acute inpatient adult behavioral health unit (BHU). Over the last eight quarters, the BHU experienced an average of 3.16 falls per 1,000 days, exceeding the benchmark's median of 2.53 total falls.

Aim of the Project: The primary aim of this project was to decrease overall falls in an acute inpatient behavioral health unit.

Review of the Evidence: A comprehensive literature review identified intervention prevention bundles, compliance auditing, and staff education as effective ways …

Reducing Falls Through Enhanced Staff Compliance With The Fall Bundle, Lester Lubuguin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

Patient falls represent a critical issue that incurs significant health and economic burdens for both individuals and healthcare organizations. Annually, falls and fall-related injuries are responsible for nearly 3 million emergency room visits and 1 million hospitalizations, costing an estimated $50 billion. Evidence suggests that a multi-factorial approach—often referred to as a "fall bundle"—is effective in reducing the incidence of falls. However, staff non-compliance with this bundle can undermine its effectiveness.

Aim of the Project:

The project aimed to reduce the incidence of falls by enhancing staff compliance with fall prevention measures through audits and feedback conducted by designated …

Participant Engagement And Preference Study For Clinical Outcomes Associated With Atrial Fibrillation: The Pearl-Af Study, Shelby D. Reed, Josephine L. Harrington, Daniel P. Morin, Samir F. Saba, Jay Alan Montgomery, Robert W. Harrison, Daniel R. Frisch, Thomas Viethen, Miriam Tamm, Jessica Xiao, Hardi Mundl, Rosa Coppolecchia, Jui-Chen Yang, Matthew J. Wallace, Juan Marcos Gonzalez, Manesh R. Patel

Division of Cardiology Faculty Papers

Background: Quantifying patients’ preferences for health outcomes associated with atrial fibrillation (AF) and its treatments offers a replicable approach to considering the patient perspective in regulatory decision-making. Objective: The authors conducted a preference survey to estimate the relative importance of AF-related events for use in clinical trial analyses to estimate net health benefits with anticoagulants. Methods: The survey included nontechnical descriptions of three severities of stroke, systemic embolism, myocardial infarction (MI) with or without subsequent heart failure (HF), major bleeding, clinically relevant nonmajor bleeding, and death. A best-worst scaling question format was used in which patients were shown 10 sets …

Law Library Blog (October 2024): Legal Beagle's Blog Archive, Roger Williams University School Of Law

Law Library Newsletters/Blog

No abstract provided.

Sex Differences In Active Avoidance And Neural Circuit Mechanisms In Contextual Fear Generalization, Carly Vincent

Theses and Dissertations

The current studies were aimed to investigate two behavioral hallmarks of anxiety and stress-related disorders, avoidance responses and the over-generalization of fear. In the first set of studies, active avoidance and extinction learning, that parallels exposure therapy in preclinical rodent models, were used. It is known that stress can influence aversive learning and extinction training, which can result in poor extinction retention. However, it is not well understood how the stress response is facilitating extinction resistance in active avoidance learning across sexes. Therefore, the first set of studies aimed to investigate the role of biological sex and glucocorticoid receptor (GR) …

Discovering Therapeutic Strategies In Colorectal Cancer Via Synthetic Lethal Genetic Screens On Patient-Derived Organoid Models, Sana Khalili

Theses and Dissertations

Precision medicine is a revolutionary approach of targeting genetic alterations that are present only in tumor cells to find vulnerabilities that can be targeted with therapy. Identifying genetic dependencies in human colon cancer could help identify effective treatment strategies. Genome-wide CRISPR-Cas9 dropout screens can reveal all genetic dependencies, some of which could be exploited as therapeutic targets using existing drugs.

In this dissertation, I comprehensively characterized genetic dependencies present in a colon cancer organoid avatar, and validated tumor-specific selectivity of select pharmacologic agents. I identified all somatic mutations, all expressed genes, and conducted a genome-wide CRISPR dropout screen to elucidate …

Mitochondrial Function In The Maternal Brain: A New Perspective On Gestational Stress And Pathology Of Postpartum Depression, Erin Rene Gorman-Sandler

Theses and Dissertations

Postpartum depression (PPD) is a major psychiatric complication of childbirth, affecting up to 20% of mothers, yet remains understudied. Mitochondria, dynamic organelles crucial for cell homeostasis and energy production, share links with many of the proposed mechanisms underlying PPD pathology. Brain mitochondrial function is affected by stress, a major risk factor for development of PPD, and is linked to avoidance and social behaviors. Considering the importance of mitochondria in regulating brain function and behavior, we hypothesized that mitochondrial dysfunction is associated with behavioral alterations in a chronic stress-induced rat model of PPD. Chronic mild unpredictable (CMUS) stress during late gestation …

Beyond The Mirage: Confronting Historic Inequities In Maternal Care Deserts., Chynna Smith

Women’s Health Articles

No abstract provided.

Pelvic Floor Physical Therapy In Pregnant And Postpartum Women, Madison G. Kaup

Senior Theses

This project had three main goals: 1) Explore how pregnancy and childbirth affect the female pelvic floor anatomy and physiology, 2) Examine current practices through a literature review and interviews conducted with pelvic floor physical therapists currently practicing in various clinical settings across the United States, and 3) Develop suggestions to mitigate the challenges currently faced in the field by patients and therapists.

The female pelvic floor undergoes extensive changes throughout pregnancy as its structures are targeted by laxity-inducing hormones and mechanical stress from the growing fetus. During childbirth, the system is stretched beyond its physiological limit, causing damage to …

The Dengue Vaccine Initiative: A Bibliometric Analysis Of Research Publications, Festus Mulakoli, Abednego Ongeso, Horatius Musembi

School of Nursing & Midwifery, East Africa

Dengue fever has become a significant public health problem in tropical and subtropical regions and affects millions of people annually. Approximately 390 million people worldwide are estimated to be infected with dengue every year, of which 96 million develop dengue fever. Recently, there has been a noticeable increase in dengue cases, primarily in areas with tropical and subtropical climates. Vaccines have been developed to prevent or reduce the severity of the disease. This study reviews the number of publications on dengue vaccines and related topics worldwide. We aimed to evaluate the research output and create a narrative on global vaccine …

Technical Pitfalls For Fenestrated-Branched Endovascular Aortic Repair Following Petticoat, Aidin Baghbani-Oskouei, Emanuel R Tenorio, Marina Dias-Neto, Andrea Vacirca, Aleem K Mirza, Naveed Saqib, Bernardo C Mendes, Laura Ocasio, Thanila A Macedo, Gustavo S Oderich

Faculty, Staff and Student Publications

Purpose: The Provisional Extension to Induce Complete Attachment Technique (PETTICOAT) uses a bare-metal stent to scaffold the true lumen in patients with acute or subacute aortic dissections. While it is designed to facilitate remodeling, some patients with chronic post-dissection thoracoabdominal aortic aneurysms (TAAAs) require repair. This study describes the technical pitfalls of fenestrated-branched endovascular aortic repair (FB-EVAR) in patients who underwent prior PETTICOAT repair.

Technique: We report 3 patients with extent II TAAAs who had prior bare-metal dissection stents treated by FB-EVAR. Two patients required maneuvers to reroute the aortic guidewire, which was initially placed in-between stent struts. This was …

Cross-Silo Federated Learning With Record-Level Personalized Differential Privacy, Junxu Liu, Jian Lou, Li Xiong, Jinfei Liu, Xiaofeng Meng

Faculty, Staff and Student Publications

Federated learning (FL) enhanced by differential privacy has emerged as a popular approach to better safeguard the privacy of client-side data by protecting clients’ contributions during the training process. Existing solutions typically assume a uniform privacy budget for all records and provide one-size-fits-all solutions that may not be adequate to meet each record’s privacy requirement. In this paper, we explore the uncharted territory of cross-silo FL with record-level personalized differential privacy. We devise a novel framework named rPDP-FL, employing a two-stage hybrid sampling scheme with both uniform client-level sampling and non-uniform record-level sampling to accommodate varying privacy requirements.

A …

Enhanced Privacy Bound For Shuffle Model With Personalized Privacy, Yixuan Liu, Yuhan Liu, Li Xiong, Yujie Gu, Hong Chen

Faculty, Staff and Student Publications

The shuffle model of Differential Privacy (DP) is an enhanced privacy protocol which significantly amplifies the central DP guarantee by anonymizing and shuffling the local randomized data. Yet, deriving a tight privacy bound is challenging due to its complicated randomization protocol. While most existing works focused on uniform local privacy settings, this work focuses on a more practical personalized privacy setting. To bound the privacy after shuffling, we need to capture the probability of each user generating clones of the neighboring data points and quantify the indistinguishability between two distributions of the number of clones on neighboring datasets. Existing works …