Medicine and Health Sciences Commons^™

Research Imitates Life: Researching Within Your Lived Experience, Bethany Donaghy, Delane Linkiewich

Patient Experience Journal

This personal narrative article seeks to bring awareness to and provide an overview of the various aspects that come with being a lived experience researcher including the host of benefits and challenges that come with conducting research within one's own area of lived experience. Throughout this narrative, we (Bethany Donaghy, an autistic person, and Delane Linkiewich a person living with chronic pain) share our perspectives on what it is like to be lived experience researchers. Our narratives discuss how the many identities we hold both improve the impact and relevance of our research while also posing challenges for us like …

A Commitment To Experience Must Reach Across The Continuum Of Care, Jason A. Wolf Phd

Patient Experience Journal

A conversation on patient experience is not restricted to one care setting, nor should it be. People's healthcare journeys are not singular instances, but most often a series of encounters that while perhaps separate operationally from the delivery side of care, all weave together to frame one experience for a patient, their family members and care partners. This special issue purposefully takes us outside the traditional conversation space for experience, looking at segments of the care continuum including primary care, ambulatory care, free clinics and even dental care and the use of non-traditional care methods such as telehealth and app-based …

Occupational Therapy’S Role In The Success And Positive Outcomes Of Youth Within The Foster System, Cassidy Solomon

Student Capstone Papers

This capstone paper will discuss the development of an occupational therapy program to support the needs of youth within the foster system and prepare this population to live independently. Background information including statistics, the need for occupational therapy, and the program specifics such as rationale, significance, and objective are discussed. The development of an occupational therapy program to aid in the success of children within the foster care system helps close a gap in research that will contribute to this population's success and positive outcomes. The purpose of this capstone was to develop a program for children in the foster …

Improving The Diagnosis And Treatment Of Obstetric Sepsis, Edwije Joseph

Master's Projects and Capstones

Problem: Maternal mortality affects women during four phases of obstetrics, including triage, antepartum, labor & delivery, and postpartum. In the U.S., sepsis is the third leading cause of maternal death. Inconsistent screening practices and delays in recognizing symptoms can occur in any phase. These factors were identified as root causes in a northern California community hospital with 600 monthly deliveries.

Context: Two maternal sepsis cases cost $90,000 annually. A standardized pathway was initiated nationally in October 2023 through the California Maternal Quality Care Collaborative (CMQCC). One regional hospital system initiated a quality improvement project over 5 months within a community …

Decreasing Incivility Through Improved Communication And Teamwork, Marvin Ernest Tamayo

Master's Projects and Capstones

Problem: Workplace incivility (WI), lateral violence (LV), and bullying in healthcare settings are pervasive issues negatively impacting staff morale, turnover rates, and patient care outcomes. High turnover and low employee satisfaction scores from a September 2023 culture of safety survey signaled a toxic work environment characterized by ineffective communication and unprofessional behavior. Context: A 24-bed telemetry-stroke unit at a 172-bed acute care facility in the North Bay area of San Francisco.

Interventions: The Transtheoretical Model (TTM) of behavior change and the Crucial Conversation frameworks were used to improve staff communication and reduce incivility.

Measures: September 2023 and March …

Preventing Hospitalization-Associated Disability, Elizabeth M. White

Master's Projects and Capstones

Problem: Hospital-associated disability (HAD) affects one-third of hospitalized adults, diminishing post-discharge independence and contributing to high mortality rates. Identifying at-risk patients through early assessment of nutritional and functional status upon admission is critical to personalizing care and improving discharge outcomes.

Context: A 24-bed adult medical-surgical unit in a 173-bed suburban hospital in Northern California is part of a large not-for-profit healthcare organization. Interventions: Nursing staff received education on the Enhanced Recovery Medicine (ERM) pathway designed to prevent HAD. A visual display board, maintained and updated by unit champions, gave staff performance feedback. Nursing leadership reviewed admission assessments and addressed barriers …

Improving Stroke Education Scores At A Primary Stroke Center, Jesse J. Young

Master's Projects and Capstones

Abstract

Problem: The COVID-19 pandemic precipitated a significant departure from the nursing profession, leaving healthcare organizations grappling with critical staffing shortages and compromising patient care standards. In 2023, an advanced Primary Stroke Center in a Northern California hospital’s STK-8 scores fluctuated between 80-100%, with an average annual score of 92.8%, putting the facility's primary stroke certification and long-term patient outcomes at risk.

Context: A 24-bed acute stroke and telemetry unit in a Northern California hospital and designated primary stroke center.

Interventions: The following measures were implemented to improve the quality of stroke care and enhance STK-8 compliance, including …

Educating Nursing Staff On Urinary Tract Infections, Eldarada Rosamay Searcy

Walden Dissertations and Doctoral Studies

The primary objective of this doctor of nursing practice (DNP) project was to educate staff on urinary tract infection (UTI) prevention. A gap in practice was identified among nursing staff at an assisted-living facility who lacked current, evidence-based knowledge. This project was conducted to determine whether educating staff on UTI prevention increased their knowledge. Knowles’s adult learning theory and the analysis, design, development, implementation, and evaluation model were used as the theoretical framework that guided this project. Eighty-eight healthcare workers at the project site voluntarily participated in this project. Before the education session, a 10-question, multiple-choice pretest was administered to …

Anti-Cdk Inhibitors For Cancer Treatment, Venkata M. Yenugonda

Technology Transfer - Patents

No abstract provided.

Enpp1 Enzyme Replacement Therapy Improves Ectopic Calcification But Does Not Rescue Skeletal Phenotype In A Mouse Model For Craniometaphyseal Dysplasia, Ernst Reichenberger, Kevin O'Brien, Ayano Hatori, Thomas Carpenter, Koen Van De Wetering, Lisa Flaman, Jennifer Howe, Daniel Ortiz, Yves Sabbagh, I-Ping Chen

Jefferson Institute of Molecular Medicine Papers and Presentations

Craniometaphyseal dysplasia (CMD) is a rare genetic bone disorder, characterized by progressive thickening of craniofacial bones and flared metaphyses of long bones. Craniofacial hyperostosis leads to the obstruction of neural foramina and neurological symptoms such as facial palsy, blindness, deafness, or severe headache. Mutations in ANKH (mouse ortholog ANK), a transporter of small molecules such as citrate and ATP, are responsible for autosomal dominant CMD. Knock-in (KI) mice carrying an ANK_F377del mutation (Ank^KI/KI) replicate many features of human CMD. Pyrophosphate (PPi) levels in plasma are significantly reduced in Ank^KI/KI mice. PPi is a potent inhibitor of …

"I Just Assumed This Was Already Being Done": Canadian Patient Preferences For Enhanced Data Sharing For Precision Oncology, Samantha Pollard Pollard, Morgan Ehman, Anna Hermansen, Deirdre Weymann, Emanuel Krebs, Cheryl Ho, Howard J. Lim, Steven Jones, Yvonne Bombard, Tania M. Bubela

Office of the Provost

Purpose: In Canada, health data are siloed, slowing bioinnovation and evidence generation for personalized cancer care. Secured data-sharing platforms (SDSPs) can enable data analysis across silos through rapid concatenation across trial and real-world settings and timely researcher access. To motivate patient participation and trust in research, it is critical to ensure that SDSP design and oversight align with patients' values and address their concerns. We sought to qualitatively characterize patient preferences for the design of a pan-Canadian SDSP.
Methods: Between January 2022 and July 2023, we conducted pan-Canadian virtual focus groups with individuals who had a personal history of cancer. …

Sedation For Gi Endoscopy In The Morbidly Obese: Challenges And Possible Solutions, Lalitha Sundararaman, Basavana Goudra

Department of Anesthesiology Faculty Papers

With the increasing prevalence of obesity and morbid obesity, this subgroup's contribution to patients presenting for elective procedures requiring sedation is significant. Gastrointestinal (GI) procedures clearly form the largest group of such procedures. These procedures may be intended to treat obesity such as the insertion of an intragastric balloon or one or more unrelated procedures such as a screening colonoscopy and (or) diagnostic/therapeutic endoscopy. Regardless of the procedure, these patients pose significant challenges in terms of choice of sedatives, dosing, airway management, ventilation, and oxygenation. An understanding of dissimilarity in the handling of different groups of medications used by an …

08-08-2024 Hsc Committee Minutes, Helen Maestas

HSC Committee (A subcommittee of the UNM Board of Regents)

08-08-2024 HSC Committee Minutes

Five A Day, The Rainbow Way: A Nutrition Education Toolkit For Elementary School Aged Children, Sasha Menard

Department of Nutrition Student Projects

Learning Outcome: Develop a nutrition educational toolkit based on Social Cognitive Theory (SCT) for obesity prevention among elementary school-aged children by improving determinants of fruit and vegetable intake.

Background: Poor consumption of fruits and vegetables is a major contributing factor to childhood obesity, increasing the risk for chronic diseases later in life. There is a need for multicomponent nutrition educational tools to influence children to improve their eating behavior by increasing their awareness and self-efficacy. The current project describes the development of a 3-component toolkit for improving participants’ knowledge and values related to fruit and vegetable intake among 6-11-year-olds.

Methods: …

Syphilitic Gumma Presenting As Squamous Cell Carcinoma Of Vulva: A Case Report, R.M. Nuss, A.J. Lazenby, Holly C. Provost, Tara Castellano

School of Medicine Faculty Publications

Introduction: Tertiary syphilis, a late form of the disease with neurologic, cutaneous, and cardiovascular manifestations, is rarely seen in the United States in modern times. Also called the “great imitator,” syphilis tends to mimic other disease processes, which can lead to a delay in proper diagnosis and treatment. Case: We present the case of a 59-year-old woman who presented for evaluation of possible squamous cell carcinoma of the vulva. After multiple inconclusive biopsies and extensive workup with multiple providers, she was instead found to have cutaneous and neurologic tertiary syphilis. A correct diagnosis was delayed in this patient due to …

The Use Of Near-Infrared Angiography In Evaluating Bowel Anastomosis During A Gynecologic Oncology Surgery, Lea A. Moukarzel, Sarah Andres, Oliver Zivanovic

Abington Jefferson Health Papers

Reducing anastomotic leak rates after bowel resection is a priority among patients undergoing gynecologic oncology surgery. While near-infrared (NIR) angiography has been investigated in the colorectal literature, more recent work has demonstrated promising results when used in gynecologic cancer surgery. It has been repeatedly shown to be a safe intervention that can offer real time assessment of bowel perfusion, offering the surgeon the opportunity to act on the results in the hopes of decreasing the risk of complications.

Advocacy And Education For Children With Low Vision: Cortical Visual Impairment, Logan Coleman, Cynthia Haynes

Summer 2024 OTD Capstone Symposium

This project addresses the gap in research and advocacy for children with low vision, particularly those diagnosed with Cortical Visual Impairment (CVI), the leading cause of visual impairment in children. Through a needs assessment and educational intervention, the project aimed to enhance occupational therapy (OT) students' understanding of low vision in children and their role in addressing it. Pre- and post-surveys revealed a significant increase in knowledge among students, highlighting the need for specialized education in OT curricula. The findings underscore the importance of integrating targeted interventions for children with low vision into OT practice.

The Dna Methylome Of Pediatric Brain Tumors Appears Shaped By Structural Variation And Predicts Survival, Fengju Chen, Yiqun Zhang, Lanlan Shen, Chad J Creighton

Faculty, Staff and Students Publications

Structural variation heavily influences the molecular landscape of cancer, in part by impacting DNA methylation-mediated transcriptional regulation. Here, using multi-omic datasets involving >2400 pediatric brain and central nervous system tumors of diverse histologies from the Children's Brain Tumor Network, we report hundreds of genes and associated CpG islands (CGIs) for which the nearby presence of somatic structural variant (SV) breakpoints is recurrently associated with altered expression or DNA methylation, respectively, including tumor suppressor genes ATRX and CDKN2A. Altered DNA methylation near enhancers associates with nearby somatic SV breakpoints, including MYC and MYCN. A subset of genes with SV-CGI methylation associations …

Clinical Trial Research Nurse New Employee Onboarding 30- 60 -90 Day Checklist, Arin Alesia Urban

Master's Projects and Capstones

Problem: The clinical trials research management team was plagued with high nurse turnover and poor clinical documentation due to a lack of seasoned clinical research nurses.

Context: A regional clinical trials team serving 22 hospitals within a Northern California not-for-profit health system.

Interventions: Mixed methods were used to inform the development of new employee onboarding for novice clinical trial nurses utilizing a structured 30-60-90-day checklist, improved communication channels, and continuous mentor support.

Measures: Monthly quality queries and quarterly staff turnover rates were tracked. Employee feedback was collected to assess the interventions' impact.

Results: The number of quality queries was reduced …

Implementing Maternal Fetal Triage Index (Mfti) In A High-Risk Obstetrical Setting, Erica Bordenkircher Luna

Master's Projects and Capstones

Problem: The Maternal Fetal Triage Index (MFTI) for obstetric triage provides a systematic method for assessing and assigning acuity. Data evaluated for February 2024 and March 2024 identified the need for improved response times for triage Priority Two, which averaged 28.75 minutes (goal 15 minutes) for a provider to present to the bedside. The average percentage of patients with documented MFTI scores was 70.65% ( goal >80%).

Context: A high-risk 24-bed obstetrical department in an acute care hospital in Northern California that triages over 600 patients monthly with over 400 deliveries in the same period.

Interventions: Real-time observations and staff …

Process Improvement To Reduce The Incidence Of Delirium In An Overflow Unit, Raquel G. Chong

Master's Projects and Capstones

Abstract

Problem: This quality improvement project aims to reduce the incidence of hospital-acquired delirium in an overflow unit, which serves a diverse patient population from medical-surgical and telemetry microsystems. The unit averages 96 delirium episodes annually, costing approximately $3,456,000. The goal is to reduce delirium incidence by 25%, decreasing monthly cases from 8 to 6 by October 31, 2024, and annual cases to 72 by April 2026.

Context: Delirium is a prevalent and severe neuropsychiatric syndrome that significantly affects older hospitalized patients, characterized by acute disturbances in attention, awareness, and cognition.

Interventions: The project introduced a bundle of four interventions …

Changing Landscape Of Liver Transplant In The United States—Time For A New Innovative Way To Define And Utilize The “Non-Standard Liver Allograft”—A Proposal, Rashmi Seth, Kenneth Andreoni

Department of Surgery Faculty Papers

Since the first liver transplant was performed over six decades ago, the landscape of liver transplantation in the US has seen dramatic evolution. Numerous advancements in perioperative and operative techniques have resulted in major improvements in graft and patient survival rates. Despite the increase in transplants performed over the years, the waitlist mortality rate continues to remain high. The obesity epidemic and the resultant metabolic sequelae continue to result in more marginal donors and challenging recipients. In this review, we aim to highlight the changing characteristics of liver transplant recipients and liver allograft donors. We focus on issues relevant in …

Novel Il-4/Hb-Egf-Dependent Crosstalk Between Eosinophils And Macrophages Controls Liver Regeneration After Ischaemia And Reperfusion Injury, Yang Yang, Long Xu, Constance Atkins, Lily Kuhlman, Jie Zhao, Jong-Min Jeong, Yankai Wen, Nicolas Moreno, Kang Ho Kim, Yu A An, Fenfen Wang, Steve Bynon, Vincenzo Villani, Bin Gao, Frank Brombacher, Raymond Harris, Holger K Eltzschig, Elizabeth Jacobsen, Cynthia Ju

Faculty, Staff and Student Publications

OBJECTIVE: Previous studies indicate that eosinophils are recruited into the allograft following orthotopic liver transplantation and protect from ischaemia reperfusion (IR) injury. In the current studies, we aim to explore whether their protective function could outlast during liver repair.

DESIGN: Eosinophil-deficient mice and adoptive transfer of bone marrow-derived eosinophils (bmEos) were employed to investigate the effects of eosinophils on tissue repair and regeneration after hepatic IR injury. Aside from exogenous cytokine or neutralising antibody treatments, mechanistic studies made use of a panel of mouse models of eosinophil-specific IL-4/IL-13-deletion, cell-specific IL-4rα-deletion in liver macrophages and hepatocytes and macrophage-specific deletion of heparin-binding …

Multi-Omic Analysis Of Huntington's Disease Reveals A Compensatory Astrocyte State, Fahad Paryani, Ji-Sun Kwon, Andrew S Yoo, Et Al.

2020-Current year OA Pubs

The mechanisms underlying the selective regional vulnerability to neurodegeneration in Huntington's disease (HD) have not been fully defined. To explore the role of astrocytes in this phenomenon, we used single-nucleus and bulk RNAseq, lipidomics, HTT gene CAG repeat-length measurements, and multiplexed immunofluorescence on HD and control post-mortem brains. We identified genes that correlated with CAG repeat length, which were enriched in astrocyte genes, and lipidomic signatures that implicated poly-unsaturated fatty acids in sensitizing neurons to cell death. Because astrocytes play essential roles in lipid metabolism, we explored the heterogeneity of astrocytic states in both protoplasmic and fibrous-like (CD44+) astrocytes. Significantly, …

Lysineless Hibit And Nanoluc Tagging Systems As Alternative Tools For Monitoring Targeted Protein Degradation, Hanfeng Lin, Kristin Riching, May Poh Lai, Dong Lu, Ran Cheng, Xiaoli Qi, Jin Wang

Faculty, Staff and Students Publications

Target protein degradation (TPD) has emerged as a revolutionary approach in drug discovery, leveraging the cell’s intrinsic machinery to selectively degrade disease-associated proteins. Nanoluciferase (nLuc) fusion proteins and the NanoBiT technology offer two robust and sensitive screening platforms to monitor the subtle changes in protein abundance induced by TPD molecules. Despite these advantages, concerns have arisen regarding potential degradation artifacts introduced by tagging systems due to the presence of lysine residues on them, prompting the development of alternative tools. In this study, we introduce HiBiT-RR and nLucK0, variants devoid of lysine residues, to mitigate such artifacts. Our findings demonstrate that …

Antibody Therapies For Alzheimer's Disease, Alexandra Zerr

University Honors Theses

Alzheimer's Disease (AD) is the leading cause of dementia worldwide. Patients with this condition first experience mild cognitive impairment, followed by the loss of memory, cognitive skills, identity, and the ability to perform daily tasks unassisted, eventually culminating in death.

The dominant hypothesis for the mechanism of Alzheimer's, the amyloid cascade hypothesis, based on early-onset AD, suggests that amyloid plaques formed by Aβ peptides cause a cascading effect involving an increase in toxic tau protein, which is correlated with the disease progression of Alzheimer's patients. While the mechanism of late sporadic AD is not fully understood, this has been used …

Translational Potential Of Mouse Models Of Human Metabolic Disease, I Sadaf Farooqi, Yong Xu

Children’s Nutrition Research Center Staff Publications

Obesity causes significant morbidity and mortality globally. Research in the last three decades has delivered a step-change in our understanding of the fundamental mechanisms that regulate energy homeostasis, building on foundational discoveries in mouse models of metabolic disease. However, not all findings made in rodents have translated to humans, hampering drug discovery in this field. Here, we review how studies in mice and humans have informed our current framework for understanding energy homeostasis, discuss their challenges and limitations, and offer a perspective on how human studies may play an increasingly important role in the discovery of disease mechanisms and identification …

Loss Of Transient Receptor Potential Channel 5 Causes Obesity And Postpartum Depression, Yongxiang Li, Tessa M Cacciottolo, Na Yin, Yang He, Hesong Liu, Hailan Liu, Yuxue Yang, Elana Henning, Julia M Keogh, Katherine Lawler, Edson Mendes De Oliveira, Eugene J Gardner, Katherine A Kentistou, Panayiotis Laouris, Rebecca Bounds, Ken K Ong, John R B Perry, Inês Barroso, Longlong Tu, Jonathan C Bean, Meng Yu, Kristine M Conde, Mengjie Wang, Olivia Ginnard, Xing Fang, Lydia Tong, Junying Han, Tia Darwich, Kevin W Williams, Yongjie Yang, Chunmei Wang, Shelagh Joss, Helen V Firth, Yong Xu, I Sadaf Farooqi

Duncan NRI Faculty and Staff Publications

Hypothalamic neural circuits regulate instinctive behaviors such as food seeking, the fight/flight response, socialization, and maternal care. Here, we identified microdeletions on chromosome Xq23 disrupting the brain-expressed transient receptor potential (TRP) channel 5 (TRPC5). This family of channels detects sensory stimuli and converts them into electrical signals interpretable by the brain. Male TRPC5 deletion carriers exhibited food seeking, obesity, anxiety, and autism, which were recapitulated in knockin male mice harboring a human loss-of-function TRPC5 mutation. Women carrying TRPC5 deletions had severe postpartum depression. As mothers, female knockin mice exhibited anhedonia and depression-like behavior with impaired care of offspring. Deletion of …

Emerging Role Of Mucins In Antibody Drug Conjugates For Ovarian Cancer Therapy, Shabnam Malik, Mohammed Sikander, Natasha Bell, Daniel Zubieta, Maria C. Bell, Murali Yallapu, Subhash Chauhan

School of Medicine Publications

Ovarian cancer stands as the deadliest gynecologic malignancy, responsible for nearly 65% of all gynecologic cancer-related deaths. The challenges in early detection and diagnosis, coupled with the widespread intraperitoneal spread of cancer cells and resistance to chemotherapy, contribute significantly to the high mortality rate of this disease. Due to the absence of specific symptoms and the lack of effective screening methods, most ovarian cancer cases are diagnosed at advanced stages. While chemotherapy is a common treatment, it often leads to tumor recurrence, necessitating further interventions. In recent years, antibody-drug conjugates (ADCs) have emerged as a valuable tool in targeted cancer …

Postacute Sequelae Of Sars-Cov-2 Infection In The Pre-Delta, Delta, And Omicron Eras, Yan Xie, Taeyoung Choi, Ziyad Al-Aly

2020-Current year OA Pubs

BACKGROUND: Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) can affect many organ systems. However, temporal changes during the coronavirus disease 2019 (Covid-19) pandemic, including the evolution of SARS-CoV-2, may have affected the risk and burden of PASC. Whether the risk and burden of PASC have changed over the course of the pandemic is unclear.

METHODS: We used health records of the Department of Veterans Affairs to build a study population of 441,583 veterans with SARS-CoV-2 infection between March 1, 2020, and January 31, 2022, and 4,748,504 noninfected contemporaneous controls. We estimated the cumulative incidence of …