Medicine and Health Sciences Commons^™

Impact Of Esophageal Motility On Microbiome Alterations In Symptomatic Gastroesophageal Reflux Disease Patients With Negative Endoscopy: Exploring The Role Of Ineffective Esophageal Motility And Contraction Reserve, Ming-Wun Wong, I-Hsuan Lo, Wei-Kai Wu, Po-Yu Liu, Yu-Tang Yang, Chun-Yao Chen, Ming-Shiang Wu, Sunny H Wong, Wei-Yi Lei, Chih-Hsun Yi, Tso-Tsai Liu, Jui-Sheng Hung, Shu-Wei Liang, C Prakash Gyawali, Chien-Lin Chen

2020-Current year OA Pubs

BACKGROUND/AIMS: Ineffective esophageal motility (IEM) is common in patients with gastroesophageal reflux disease (GERD) and can be associated with poor esophageal contraction reserve on multiple rapid swallows. Alterations in the esophageal microbiome have been reported in GERD, but the relationship to presence or absence of contraction reserve in IEM patients has not been evaluated. We aim to investigate whether contraction reserve influences esophageal microbiome alterations in patients with GERD and IEM.

METHODS: We prospectively enrolled GERD patients with normal endoscopy and evaluated esophageal motility and contraction reserve with multiple rapid swallows during high-resolution manometry. The esophageal mucosa was biopsied for …

Computer Simulation Of Catheter Cryoablation For Pulmonary Vein Isolation, Solange I. Rivera, Clara P. Bernal, Rafael Martínez-Peláez, Rogelio Robledo-Nolasco, Gerardo De León-Larios, Vanessa G. Félix, Rodolfo Ostos, Gladys Maestre, Jesus Melgarejo, Luis J. Mena

School of Medicine Publications

Cryoablation is a well-established medical procedure for surgically treating atrial fibrillation. Cryothermal catheter therapy induces cellular necrosis by freezing the insides of pulmonary veins, with the goal of disrupting abnormal electrical heart signals. Nevertheless, tissue damage induced by cold temperatures may also lead to other complications after cardiac surgery. In this sense, the simulation of catheter ablation can provide safer environments for training and the performance of cryotherapy interventions. Therefore, in this paper, we propose a novel approach to help better understand how temperature rates can affect this procedure by using computer tools to develop a simulation framework to predict …

Lipidomic Risk Score To Enhance Cardiovascular Risk Stratification For Primary Prevention, Jingqin Wu, Corey Giles, Aleksandar Dakic, Habtamu B. Beyene, Kevin Huynh, Tingting Wang, Thomas Meikle, Gavriel Olshansky, Agus Salim, John Blangero

School of Medicine Publications

Background

Accurate risk stratification is vital for primary prevention of cardiovascular disease (CVD). However, traditional tools such as the Framingham Risk Score(FRS) may underperform within the diverse intermediate-risk group, which includes individuals requiring distinct management strategies.

Objectives

This study aimed to develop a lipidomic-enhanced risk score (LRS), specifically targeting risk prediction and reclassification within the intermediate group, benchmarked against the FRS.

Methods

The LRS was developed via a machine learning workflow using ridge regression on the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab; n = 10,339). It was externally validated with the Busselton Health Study (n = 4,492), and …

A Rare Case Of Cardiac Angiosarcoma Presenting As Recurrent Atrial Flutter/Fibrillation, Muhammad Umer Riaz Gondal, Luke Rovenstine, Muhammad Asad Hanif, Nayab Mirza, Arjun Basnet, Fawwad Ansari, Muhammad Ibraiz Bilal, Zainab Kiyani, Rohail Azhar, Arun Kundra

Transformative Medicine

Introduction

Cardiac angiosarcomas are extremely rare, with an incidence of only 0.056%. They can have various presentations, including arrhythmias.

Case

A 65-year-old male presented to an outside hospital one year ago with palpitations. Heart rates were 130 bpm, and EKG revealed new-onset atrial flutter with 2-1 block. Apixaban and metoprolol tartrate were started, with plans for a TEE and cardioversion in 4 weeks. He went to the emergency department twice the following month with rapid atrial fibrillation and had TEE and cardioversion twice one week apart. A 2.5 cm mass in the right atrium was noted on the TEE.

The …

The Intersection Of Interprofessional Education And One Health: A Qualitative Study In Human And Veterinary Medical Institutions, Claire Tucker, Jake Keyel, Amy Blue, Ruthanne Chun, Amara Estrada, Hossein Khalili, Anuja Riles, Rohini Roopnarine, Brian Sick, Sue Vandewoude, Brittany Watson, Lauren Wisnieski, Tracy Webb

College of Humanities and Social Sciences Departmental Research

Interprofessional Education (IPE) and One Health are two common and overlapping frameworks for teaching collaborative practice. IPE is common at human medical institutions, while One Health is more common in graduate and veterinary programs. The connection between IPE and One Health is still being explored both in scholarship and in real-world professional settings. This prospective, qualitative research study examines the intersection of IPE and One Health at institutions that are members of the Clinical and Translational Science Award (CTSA) One Health Alliance (COHA). COHA consists of veterinary schools partnered with medical institutions through the National Institutes of Health CTSA funding …

Developing A Fair And Interpretable Representation Of The Clock Drawing Test For Mitigating Low Education And Racial Bias., Jiaqing Zhang, Sabyasachi Bandyopadhyay, Faith Kimmet, Jack Wittmayer, Kia Khezeli, David J. Libon, Catherine C Price, Parisa Rashidi

Rowan-Virtua School of Osteopathic Medicine Departmental Research

The clock drawing test (CDT) is a neuropsychological assessment tool to screen an individual's cognitive ability. In this study, we developed a Fair and Interpretable Representation of Clock drawing test (FaIRClocks) to evaluate and mitigate classification bias against people with less than 8 years of education, while screening their cognitive function using an array of neuropsychological measures. In this study, we represented clock drawings by a priorly published 10-dimensional deep learning feature set trained on publicly available data from the National Health and Aging Trends Study (NHATS). These embeddings were further fine-tuned with clocks from a preoperative cognitive screening program …

Perceived Effects Of Kinesiotaping On Muscle Performance Of The Elderly Amongst Physical Therapists From Select Provinces Of Central Visayas, Alkiah Belle B. Cielo, Chiara Vivan C. Cudal, Elijah Emil Angelo C. De Leon, Khristine F. Dimagiba

Student Dissertations

Kinesiology Taping (KT) is a therapeutic intervention used to improve muscle performance in older adults. Its effectiveness, however, is subject to varying perceptions influenced by clinical exposure and outcomes. This study explored Filipino physical therapists’ agreement on KT’s physiological and therapeutic effects for the elderly in Central Visayas, aiming to address gaps between research and practice.

Healthcare Barriers And Supports To Healthcare Participation Within The Lgbtqia+ Community: A Systematic Review, Jordan Bradley

Department of Occupational Therapy Entry-Level Capstone Projects

Background: Historically the LGBTQIA+ community has faced many barriers to healthcare participation resulting in significant disparities.

Objective: The purpose of this review is to highlight the barriers and supports that affect the LGBTQIA+ communities’ participation in healthcare and highlight the inclusive practices and policy reforms needed to advance healthcare equity for this population.

Methods: ProQuest Central was utilized, identifying thirty-seven peer reviewed articles for synthesis. Included articles were written within the last 3 years and addressed LGBTQIA+ individuals’ participation in healthcare within the United States.

Results: The most prevalent barrier identified was discrimination appearing in overt and implicit forms. Environmental …

Evanescent - Issue 5

Evanescent

Evanescent: A Journal of Literary Medicine is the journal of the Eakins Writing Project, which also sponsors the Drs. Theresa and Charles Yeo Writing Prize. The Eakins Writing Project is supported by the Jefferson Center for Injury Research and Prevention, located in the Department of Surgery of Thomas Jefferson University, Philadelphia.

Contents:

5 - Editorial Statement
6 - A Note On Poetry
7 - Mutually Exclusive Identities by Anonymous
9 - If You Can Read This by Anonymous

The Drs. Theresa and Charles Yeo Writing Prize: Honorable Mention:
11 - Happy T-Day by Brittany MacDonald

13 - Watching (R)evolution. …

Quality Improvement Project Integrating Telemedicine To Reduce Patient No-Shows, Ferdinand Akoko

Doctor of Nursing Practice Projects

No-show among psychiatric outpatient clinic patients is a major problem due to disrupted clinical flow, reduced productivity, and financial losses. This quality improvement project implemented telehealth services to decrease the no-show rates in an outpatient psychiatric clinic in Texas. This project employed quantitative methods to compare the no-show rates pre- and post-intervention for 90 days. The quantitative data were analyzed by paired t-tests. A total of 1,790 appointments were sampled during the implementation period. The obtained results are statistically significant in decreasing the rates of no-shows for all adult appointments from 18% to 13% (p ≈ 0.0067). New appointment no-shows …

Long Covid Is Not A Functional Neurologic Disorder, Todd E. Davenport, Svetlana Blitshteyn, Nicola Clague-Baker, David Davies-Payne, Glenn J. Treisman, Sarah F. Tyson

Pacific Faculty Work

Long COVID is a common sequela of SARS-CoV-2 infection. Data from numerous scientific studies indicate that long COVID involves a complex interaction between pathophysiological processes. Long COVID may involve the development of new diagnosable health conditions and exacerbation of pre-existing health conditions. However, despite this rapidly accumulating body of evidence regarding the pathobiology of long COVID, psychogenic and functional interpretations of the illness presentation continue to be endorsed by some healthcare professionals, creating confusion and inappropriate diagnostic and therapeutic pathways for people living with long COVID. The purpose of this perspective is to present a clinical and scientific rationale for …

More Resilience, More Green Berets: A Quantitative Analysis Of The Effects Of Functional Imagery Training During British Army Commando Training, Emma S. J. Yates

The Plymouth Student Scientist

This study investigates the low completion rates of the British Army commando training course in 2018-2019, recorded at 20%, following concerns raised by course Directing Staff. It examines the relationship between resilience and performance in military contexts and evaluates whether resilience-building interventions can improve completion rates. To establish how completion rates could be improved, sixty-two candidates from three commando training cohorts were recruited and assigned to either a Functional Imagery Training (FIT) intervention or a control group. Interventions were delivered in week one of training with a booster in week five. FIT, a goal-centred imagery intervention, has previously improved resilience-related …

Veritac-2: A Phase Iii Study Of Vepdegestrant, A Protac Er Degrader, Versus Fulvestrant In Er+/Her2- Advanced Breast Cancer, Erika P Hamilton, Cynthia Ma, Michelino De Laurentiis, Hiroji Iwata, Sara A Hurvitz, Seth A Wander, Michael Danso, Dongrui R Lu, Julia Perkins Smith, Yuan Liu, Lana Tran, Sibyl Anderson, Mario Campone

2020-Current year OA Pubs

Vepdegestrant (ARV-471) is an oral PROTAC ER degrader that binds an E3 ubiquitin ligase and ER to directly trigger ubiquitination of ER and its subsequent proteasomal degradation. In a first-in-human Phase I/II study, vepdegestrant monotherapy was well tolerated with clinical activity in pretreated patients with ER+/HER2- advanced breast cancer. The global, randomized Phase III VERITAC-2 study compares efficacy and safety of vepdegestrant versus fulvestrant in adults with ER+/HER2- advanced breast cancer after treatment with a CDK4/6 inhibitor plus endocrine therapy. Progression-free survival by blinded independent central review (primary end point) will be assessed in the intention-to-treat population and

Antimicrobial Resistance In Equines: A Growing Threat To Horse Health And Beyond-A Comprehensive Review., Ajran Kabir, Bibek Lamichhane, Tasmia Habib, Alexis Adams, Hossam El-Sheikh Ali, Nathan M Slovis, Mats H. T. Troedsson, Yosra A. Helmy

Veterinary Science Faculty Publications

The equine industry holds substantial economic importance not only in the USA but worldwide. The occurrence of various infectious bacterial diseases in horses can lead to severe health issues, economic losses, and restrictions on horse movement and trade. Effective management and control of these diseases are therefore crucial for the growth and sustainability of the equine industry. While antibiotics constitute the primary treatment strategy for any bacterial infections in horses, developing resistance to clinically important antibiotics poses significant challenges to equine health and welfare. The adverse effects of antimicrobial overuse and the escalating threat of resistance underscore the critical importance …

Application Of An Opioid Risk Assessment Tool For Patients With Pain Presenting To The Emergency Department With Drug-Seeking Behaviors, Darian L. Stephens

Doctor of Nursing Practice Final Project Abstract

PURPOSE The purpose of this quality improvement project was to introduce the Screener and Opioid Assessment for Patients with Pain- Revised (SOAPP-R) tool to identify patients in the emergency department (ED) at risk for opioid abuse.

BACKGROUND The project was implemented in a 13-bed freestanding ED that can treat medical emergencies as well as provide substance abuse detoxification services.

METHODOLOGY A systematic approach that combined quantitative and qualitative data was used during the pre-implementation and implementation periods. The clinical staff was educated on the process of implementing the SOAPP-R tool. Those who were identified as at risk for opioid abuse …

Frailty Explains Variation In Emergency Department Use For Older Veterans During The Covid-19 Pandemic, Justine Seidenfeld, Karen M. Stechuchak, Valerie A. Smith, Catherine Stanwyck, Chelsea Perfect, Courtney Van Houtven, Susan Nicole Hastings

Journal of Geriatric Emergency Medicine

Background: Older adults were critically vulnerable to disruptions in health care during the COVID-19 pandemic, but it is not known if changes in ED utilization varied based on patient characteristics. Using a cohort of older Veterans, we examined changes in ED visit rates based on four characteristics of interest: age, race, area deprivation index, and frailty

Methods: Participants were aged ≥65, with ≥2 visits in primary or geriatric clinics between 02/02/2018-05/07/2019. An adjusted negative binomial regression model was constructed for each characteristic. We report mean counts of all ED visits by quarter for subgroups separately, and report rate …

The Significant Role Of Amino Acid Metabolic Reprogramming In Cancer, Xiaohong Liu, Bo Ren, Jie Ren, Minzhi Gu, Lei You, Yupei Zhao

Faculty, Staff and Student Publications

Amino acid metabolism plays a pivotal role in tumor microenvironment, influencing various aspects of cancer progression. The metabolic reprogramming of amino acids in tumor cells is intricately linked to protein synthesis, nucleotide synthesis, modulation of signaling pathways, regulation of tumor cell metabolism, maintenance of oxidative stress homeostasis, and epigenetic modifications. Furthermore, the dysregulation of amino acid metabolism also impacts tumor microenvironment and tumor immunity. Amino acids can act as signaling molecules that modulate immune cell function and immune tolerance within the tumor microenvironment, reshaping the anti-tumor immune response and promoting immune evasion by cancer cells. Moreover, amino acid metabolism can …

Empirical Algorithms For Estimating Downwelling Light Attenuation At Λ=490 Nm From Sentinel-2 In A Narrow Optically Complex Bay, Plymouth Sound, United Kingdom, Louis J. Thornton

The Plymouth Student Scientist

This study investigates the potential of reflectance band ratios, modelled on Sentinel-2’s MultiSpectral Instrument (MSI) bands 10m resolution to estimate the downwelling attenuation coefficient for planar irradiance, Kd(λ), at 490nm (Kd(490)) in Plymouth Sound. Kd(λ) is vital for characterising subsurface light climate, strongly influencing physical and biogeochemical processes in coastal and oceanic waters. In temperate shelf seas, human activities have led to loss in vitality and spatial extent of structurally complex seabed, emphasizing the need for enhanced monitoring. Satellite-based remote sensing (RS) offers spatial and temporal advantages to conventional in situ methods. There are, however two main inadequacies that persist …

The Wellbeing Benefits Of Exposure To Nature: The Difference Between Environment Types On Different Wellbeing Types, Lily-Mae Petherick

The Plymouth Student Scientist

The world is facing a mental health crisis, thus implementing measures to improve wellbeing is a global priority. One way of combating this worldwide issue is through the well-known wellbeing benefits of nature. However, natural environments include more than just the well-known green spaces, and wellbeing encompasses multiple components. Consequently, this study compares the wellbeing outcomes of virtual exposure to a green space, blue space, and urban environment on both hedonic (pleasure) and eudaimonic wellbeing (meaningfulness). A factorial design was employed in which 96 University of Plymouth students watched one stressor video and then one of three environment videos (green, …

"It Shouldn't Be Just Hush-Hush": A Qualitative Community-Based Study Of Menstrual Health Communication Among Women In Philadelphia, Allison R. Casola, Lynette Medley, Brianna C. Kunes, Nya Mcglone, Alexis Silverio

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community.

METHODOLOGY: In partnership with No More Secrets (NMS), a Philadelphia menstrual health non-profit, we conducted a community-based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18-45 recruited from NMS' catchment in Philadelphia participated in semi-structured interviews about their menstrual experiences and communication (N …

Impacts Of Social Media Use On The Wellbeing Of Older Adults : Evidence From China During The Covid-19 Pandemic, Xuying Dong

Lingnan Theses (Doctoral degree)

Given the trend of increasing use of information and communication technologies among Chinese elder population, more attention should be drawn on the relationship between social media use and wellbeing of older adults. This research explores the social media use situation among older adults in mainland China as well as its influences on their wellbeing, and employs a mixed approach including quantitative questionnaire distributed via WeChat social media platform and qualitative interview among Chinese older adults who are over 60 years of age in Jingzhou, Hubei Province. Generally speaking, social media use can improve the wellbeing of Chinese older adults, more …

The Association Between Prolonged Sars-Cov-2 Symptoms And Work Outcomes, Arjun K Venkatesh, Huihui Yu, Caitlin Malicki, Michael Gottlieb, Joann G Elmore, Mandy J Hill, Ahamed H Idris, Juan Carlos C Montoy, Kelli N O'Laughlin, Kristin L. Rising, Kari A Stephens, Erica S Spatz, Robert A Weinstein

Department of Emergency Medicine Faculty Papers

While the early effects of the COVID-19 pandemic on the United States labor market are well-established, less is known about the long-term impact of SARS-CoV-2 infection and Long COVID on employment. To address this gap, we analyzed self-reported data from a prospective, national cohort study to estimate the effects of SARS-CoV-2 symptoms at three months post-infection on missed workdays and return to work. The analysis included 2,939 adults in the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) study who tested positive for their initial SARS-CoV-2 infection at the time of enrollment, were employed before the pandemic, and completed …

Analyzing The Relationship Between Dose And Geometric Agreement Metrics For Auto-Contouring In Head And Neck Normal Tissues, Barbara Marquez, Zachary T Wooten, Ramon M Salazar, Christine B Peterson, David T Fuentes, T J Whitaker, Anuja Jhingran, Julianne Pollard-Larkin, Surendra Prajapati, Beth Beadle, Carlos E Cardenas, Tucker J Netherton, Laurence E Court

Faculty, Staff and Student Publications

This study aimed to determine the relationship between geometric and dosimetric agreement metrics in head and neck (H&N) cancer radiotherapy plans. A total 287 plans were retrospectively analyzed, comparing auto-contoured and clinically used contours using a Dice similarity coefficient (DSC), surface DSC (sDSC), and Hausdorff distance (HD). Organs-at-risk (OARs) with ≥200 cGy dose differences from the clinical contour in terms of Dmax (D0.01cc) and Dmean were further examined against proximity to the planning target volume (PTV). A secondary set of 91 plans from multiple institutions validated these findings. For 4995 contour pairs across 19 OARs, 90% had a DSC, sDSC, …

Quantitative Proteomics Reveals Serum Proteome Alterations During Metastatic Disease Progression In Breast Cancer Patients, Jaspreet Kaur, Sung Yun Jung, Marie Austdal, Aaditya Krishna Arun, Thomas Helland, Gunnar Mellgren, Tone Hoel Lende, Emiel A M Janssen, Håvard Søiland, Ritu Aneja

Faculty, Staff and Students Publications

BACKGROUND: Tumor recurrence and metastatic progression remains the leading cause for breast cancer related mortalities. However, the proteomes of patient- matched primary breast cancer (BC) and metastatic lesions have not yet been identified, due to the lack of clinically annotated longitudinal samples. In this study, we evaluated the global-proteomic landscape of BC patients with and without distant metastasis as well as compared the proteome of distant metastatic disease with its corresponding primary BC, within the same patient.

METHODS: We performed mass spectrometry-based proteome profiling of 73 serum samples from 51 BC patients. Among the 51 patients with BC, 29 remained …

Cerebellar Nuclei Cells Produce Distinct Pathogenic Spike Signatures In Mouse Models Of Ataxia, Dystonia, And Tremor, Meike E Van Der Heijden, Amanda M Brown, Dominic J Kizek, Roy V Sillitoe

Duncan NRI Faculty and Staff Publications

The cerebellum contributes to a diverse array of motor conditions, including ataxia, dystonia, and tremor. The neural substrates that encode this diversity are unclear. Here, we tested whether the neural spike activity of cerebellar output neurons is distinct between movement disorders with different impairments, generalizable across movement disorders with similar impairments, and capable of causing distinct movement impairments. Using in vivo awake recordings as input data, we trained a supervised classifier model to differentiate the spike parameters between mouse models for ataxia, dystonia, and tremor. The classifier model correctly assigned mouse phenotypes based on single-neuron signatures. Spike signatures were shared …

Iron And Cardiovascular Health: A Review, Diana Othon, Osiris Fernandez, Barbara Malaga-Espinoza, Maria E. Torres, Everardo Cobos, Cesar Gutierrez

School of Medicine Publications

Iron is an essential element for the biological processes of living organisms, including the production of crucial oxygen-carrying proteins, formation of heme enzymes, and playing roles in electron transfer and oxidation–reduction reactions. It plays a significant role in various cardiovascular functions, including bioenergetics, electrical activity, and programmed cell death. Minor deficiencies of iron have been found to have negative impact on cardiovascular function in patients with heart failure (HF). The contractility of human cardiomyocytes is impaired by iron deficiency (ID), which results in reduced mitochondrial function and lower energy production, ultimately leading to cardiac function impairment, contributing to significant morbidity …

Epigenetic Age Acceleration And Disparities In Posttraumatic Stress In Women In Southeast Louisiana: Nimhd Social Epigenomics Program, Alicia K. Smith, Seyma Katrinli, Dawayland O. Cobb, Evan G. Goff, Michael Simmond, Grace M. Christensen, Tyler Prusisz, Sierra N. Garth, Meghan Brashear, Anke Hüls, Erika J. Wolf, Edward J. Trapido, Ariane L. Rung, Nicole R. Nugent, Edward S. Peters

School of Medicine Faculty Publications

IMPORTANCE: Disasters experienced by an entire community provide opportunities to understand individual differences in risk for adverse health outcomes over time. DNA methylation (DNAm) differences may help to distinguish individuals at increased risk following large-scale disasters. OBJECTIVE: To examine the association of epigenetic age acceleration with probable posttraumatic stress disorder (PTSD) and PTSD symptom severity in women. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study examined data from participants in the Women and Their Children's Health cohort, who were characterized longitudinally following the Deepwater Horizon oil spill (DHOS) in 2010 and through numerous hurricanes in the Gulf Coast region of …

Chromium And Cobalt In Leather: A Danish Market Survey, Mikkel Bak Jensen, Farzad Seyed-Alinaghi, Ivan Chen, Jonas F. Hedberg, Yolanda S. Hedberg, Claus Zachariae, Jeanne Duus Johansen

Chemistry Publications

Introduction

Leather has been a significant source of chromium (Cr) allergy in Denmark since the 1990s. More recently, cobalt (Co) allergy has been identified in leather as a source of allergic contact dermatitis.

Objectives

To measure Cr and Co levels in Danish leather goods.

Methods

A total of 87 leather samples were collected, all tanned in Europe. Handheld X-ray fluorescence (XRF) device was used to screen for the presence of Cr and Co. The 20 leather samples with the highest concentrations of Co and Co were tested using International Organization for Standardization (ISO)-standards.

Results

XRF analysis showed Cr in 78/87 …

A Comparison Between Inverse-Planning Imrt Versus Forward-Planning Imrt For Left-Sided Breast Cancer With Breath Hold Technique, Dien Tran

Masters Projects

Abstract

Introduction:

Radiation therapy using tangential fields is a common treatment for breast cancer, targeting the tumor while reducing radiation exposure to surrounding healthy tissues such as the heart and lungs. Forward-planned "field-in-field" IMRT (FP-IMRT) is widely used for its ability to provide uniform dose distribution and spare normal tissue, despite requiring high planning skill and time. Inverse-planning IMRT (IP-IMRT) offers better conformal dose to targets with reduced planning variability and time. This study compares FP-IMRT and IP-IMRT in left-sided breast cancer patients using the deep inspiration breath hold (DIBH) technique.

Method:

A retrospective analysis was conducted on 10 patients …

Development And Implementation Of An Emergency Preparedness Policy And Procedure, Educational Intervention, And In-Situ Simulation In A Pediatric Primary Care Office: A Quality Improvement Project, Kaitlin Patel

Doctor of Nursing Practice Scholarly Projects

Background. Pediatric primary care offices are frequently unprepared to respond to clinical emergencies that may present to or occur at their site. The purpose of this project was to improve office emergency preparedness at a pediatric primary care office to align with the American Academy of Pediatrics policy statement for pediatric office emergency preparedness.

Methods. A PRISMA-guided literature review found support for both educational interventions and in-situ simulation to improve aspects of emergency preparedness. The aim of this project was to develop a practice-specific emergency preparedness policy and procedure and implement a training and in-situ simulation to increase medical and …