Medicine and Health Sciences Commons^™

Intraoperative Liposomal Bupivacaine Is Associated With Reduced Opioid Use And Enhanced Recovery After Total Knee Arthroplasty: A Multicenter Registry Study, Mitchell Ng, Jennifer Lin, Andrew Spitzer, Vinod Dasa, Adam Rivadeneyra, David Rogenmoser, Andrew Concoff, Mary Digiorgi, Joshua Urban, William Mihalko, Michael Mont

Rothman Institute Papers

BACKGROUND: With an annual volume of total knee arthroplasties (TKAs) in the United States projected to exceed 1.5 million by 2050, optimizing perioperative pain control and facilitating early discharge remain clinical priorities. This study evaluated the effectiveness of liposomal bupivacaine (LB) vs conventional bupivacaine/ropivacaine in opioid-naïve patients undergoing primary TKA, comparing/contrasting: (1) pain score improvements, (2) opioid usages, (3) functional recoveries, and (4) hospital lengths of stay.

METHODS:  Data from the Innovations in Genicular Outcomes Research (iGOR) registry were used to identify patients undergoing unilateral primary TKA between September 2021 and December 2024. Two hundred twenty-five patients were analyzed, 42 …

Powering Up Clinical Scholarship In Santa Fe Family Medicine, Evelyn Wang

HSLIC Faculty and Staff Instructional Resources

This presentation introduces family medicine residents and faculty in Santa Fe to clinical scholarship pathways, highlighting research question formulation, literature search strategies, full-text access tools, and HSLIC services that support evidence-based practice, quality improvement, and publication.

Functional And Spatially Specialized Inhibition And Neuromodulation During Learning In The Hippocampus, Gerardo Enrique Molina

McKelvey School of Engineering Graduate Student Theses & Dissertations

The hippocampus relies on a diverse network of regulatory components for memory formation. Neuromodulators and inhibitory interneurons act in concert with excitatory neurons to control learning. Even within one of these components there is a vast diversity of genetic or chemical composition that may come from unique sources at uniquely timed intervals or events. The goal of this dissertation is to identify specific functional-behavioral attributes of two such examples: parvalbumin (PV)-expressing interneurons and the neuromodulator dopamine, in hippocampal CA1. In separate experiments, I used two-photon microscopy of the calcium sensor, GCaMP, which measures neuronal activity, and GRAB-DA, which reports levels …

Use Of The Casper Test As An Admissions Test For Predicting Academic And Clinical Performance In Student Registered Nurse Anesthetists: A Predictive Correlational Study, Barbara A. Acord

Doctoral Dissertations and Projects

This quantitative, non-experimental, predictive correlational study examined the extent to which CASPer test scores predict academic and clinical performance among student registered nurse anesthetists (SRNAs). Certified registered nurse anesthetists (CRNAs) provide over 80% of anesthesia services in the United States, showing the importance of effective admissions processes to identify candidates most likely to succeed academically and clinically. Traditional admissions criteria in nurse anesthesia programs largely prioritize grades and may underrepresent non-cognitive attributes associated with student success. A convenience sample used a medium effect size, power of .8, and alpha level of .05, with G*Power calculated to be 85 participants 2nd …

Indicators Of Fontan Circulatory Failure In Pediatric Patients: A Scoping Review Of Early Clinical And Hemodynamic Factors, Marina Mcmahon

Student Works

Structured Summary

a. Background/Introduction:

For patients with single ventricle congenital heart disease, the Fontan procedure is the definitive palliative procedure. Although advancements have been made in the surgical technique and management, the Fontan circulation is inefficient and prone to progressive dysfunction. Elevated central venous pressure, non-pulsatile pulmonary blood flow, and reduced cardiac output can lead to many complications, and eventual failure. These conditions can lead to protein losing enteropathy, plastic bronchitis, and hepatic fibrosis which often indicate advanced decline. Though a known problem, there is a lack of standardized criteria to guide optimal intervention timing of Fontan revision prior to …

A Case Of Sweet Syndrome In A Patient With Myelodysplastic Syndrome, Malia’Ka Hall, Do, Elizabeth Hutshinson, Md

Books, Presentations, Posters, Etc.

Introduction: Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is a rare inflammatory disorder characterized by the abrupt onset of high fevers and exquisitely tender, erythematous skin lesions that may appear on virtually any area of the body. These lesions typically manifest as papules, nodules, or plaques and often evolve rapidly, contributing to the dramatic clinical presentation. Although uncommon—with only several hundred cases documented in the literature—Sweet syndrome remains an important diagnostic consideration due to its distinctive combination of cutaneous findings and systemic symptoms, as well as its potential association with underlying malignancy, infection, or medication exposure. Presentation: A …

Individuals Deemed Low Risk For Cardiotoxicity With Her2-Directed Antibody Therapy Developed Modest Incidences Of Treatment-Related Lvef Decline And Heart Failure Across A Large Western Us Hospital System, Cameron Smith1, David Page1, Michael Layoun, Li Hsin-Fang

Books, Presentations, Posters, Etc.

Background: Incidence of anti-HER2 cardiotoxicity varies widely from 3-30%. Baseline cardiac risk factors can drastically affect an individual's risk of cardiotoxicity while on anti-HER2 therapies. Risk stratification calculators like the HFA-ICOS tool can estimate relative risk of cardiotoxicity based on preceding risk factors. High risk factors: Heart failure (HF), CAD, severe valvular heart disease. Mild-moderate risk factors: HTN, DM, CKD, age 65-79, anthracycline use, arrhythmia, smoking history, BMI>30. De-intensified surveillance has been proposed for low-risk patients. Objective: Characterize incidence and predictors of cardiotoxicity in a real world population of early-stage breast cancer patients receiving anti-HER2 therapies. Evaluate incidence of …

Postpartum Spontaneous Coronary Artery Dissection With Multivessel Arteriopathy, Devon Schaefer, Do, Cody Paiva, Do

Books, Presentations, Posters, Etc.

Case Presentation: Hospital Day 0 – Presentation: 43-year-old postpartum female (s/p C-section 4-months prior) presenting with recurrent central chest pressure after several days of intermittent symptoms. She was hemodynamically stable but had diffuse T‑wave inversions and a marked troponin rise. Treated with aspirin, nitroglycerin, and heparin for presumed NSTEMI. Coronary angiography planned. Hospital Day 1 -- Initial Angiography: TTE showed mildly reduced EF with apical akinesis. Angiogram read as mild diffuse mid-distal LAD disease (Figure 1), but no evidence of obstructive disease or culprit lesion. Working diagnosis was MINOCA, stress cardiomyopathy, or an occult SCAD. Hospital Day 2 -- Diagnostic …

Expanding The Mutation Spectrum Of Non-Syndromic Retinitis Pigmentosa In Consanguineous Pakistani Families: Unraveling Novel Pathogenic Variants In Rp1, Pde6b, And Prcd Genes For Precision Diagnosis, Tayyaba Shan, Nimra Mukhtar, Sayyed Hammad Ullah, Asad Ullah, Asfandyar Ahmad Khan, Yumei Li, Meng Wang, Raeesa Tehreem, Amtul Aziz, Kiran Afshan, Rui Chen, Sabika Firasat

Faculty, Staff and Students Publications

No abstract provided.

Culturally Tailored Materials For Smoking Cessation And Hiv Care Adherence Among Hispanic Adults: Protocol For Content Development And Formative Evaluation, Lorra Garey, Jacqueline J Charles, Ashley L Ruiz, Rodrigo Castillo-Avilés, Virmarie Correa-Fernández, Marshall K Cheney, Thomas P Giordano, Michael J Zvolensky

Faculty, Staff and Students Publications

Background: Hispanic people with HIV who smoke cigarettes experience unique stressors (eg, stigma), which contribute to health disparities. Anxiety sensitivity (AS) may worsen mood management problems, which are a leading barrier to smoking cessation. Interventions targeting AS can improve HIV-specific outcomes and smoking cessation. However, no prior research has culturally tailored an AS reduction program to improve quality of life among Hispanic people with HIV who smoke. The research team previously developed a mobile health (mHealth) intervention addressing AS reduction, smoking cessation, and HIV care management for Black people with HIV who smoke. Building on this work, this study represents …

Diagnostic Overlap In Hus: An Atypical Case, Ryan Daily, Med, Do, Andrea Roast, Md

Books, Presentations, Posters, Etc.

Introduction: Atypical HUS (aHUS) is a rare type of Thrombotic Microangiopathy distinguished by complement dysregulation and overall clinical progression. We present a diagnostically ambiguous case with early intervention that preserved end-organ function with discussion of future pregnancy implications. Case Presentation: A 36yo F (G2P1) with hypothyroidism, Small Intestinal Bacterial Overgrowth (SIBO), and intermittent urticarial rashes presented with fever, abdominal pain, and 3 days of bloody diarrhea. Discussion: This case highlights an atypical presentation of aHUS with diarrheal prodrome and normal complement function, features that typically suggest Shiga toxin–mediated HUS. We saw clinical change after admission, allowing real-time monitoring. Maintaining a …

Optimizing Behavioral Health Integration In Primary Care Through A Targeted Didactic, Ravneet Dhaliwal, M.A., Behavioral Health Intern, Joshua Morris

Books, Presentations, Posters, Etc.

Background: The integration of behavioral health into primary care settings is an essential strategy for improving patient outcomes, increasing access to mental health services, and achieving the Triple Aim of healthcare.1, 2 To maximize this integration and bridge the gap for primary care providers (PCPs), targeted didactic training and continued education are pivotal. National surveys indicate that PCPs often report low comfort levels in managing psychological concerns due to a lack of formal training, despite the high prevalence of these issues in primary care. 3, 4 Brief didactics facilitated by embedded behavioral health psychologists offer an accessible, adaptable method for …

Inhibition Of Epac1 Prevents Neuronal Death Mediated By Diesel Exhaust Particles In Ferroptotic Cell Death Conditions, Hong Yan, Leshan Zhang, Ana L Manzano-Covarrubias, Phoeja S Gadjdjoe, Anja Land, Christina H J T M Van Der Veen, Teresa Mitchell-Garcia, Heba A Fayyaz, Marco Venema, Christoffer Åberg, Marieke Van Der Hart, Frank Lezoualc'h, Xiaodong Cheng, Amalia M Dolga, Martina Schmidt

The Brown Foundation: Institute of Molecular Medicine

Air pollution is a growing hazard to global health. Epidemiological studies have reported a potential role of air pollutant exposure in the development or aggravation of neurodegenerative diseases. However, the underlying mechanisms are ill-defined. Ferroptosis is an iron- and reactive oxygen species (ROS)-dependent form of cell death that drives neuronal loss in neurodegenerative diseases. Our previous studies reported the involvement of adenosine 3',5'-cyclic monophosphate (cAMP) and EPAC (exchange protein directly activated by cAMP) in ferroptotic cell death. Here, we investigated the effects of diesel exhaust particles (DEP) in mouse hippocampal (HT22) neuronal cells. Our data showed that toxicity induced by …

Revolutionizing Hematology/Oncology Education With Visual Storytelling And “Gamification” For Internal Medicine Residents, N Smith1, A Patel1, J Dechet, C Powell

Books, Presentations, Posters, Etc.

Introduction: Hematology/oncology ranks among the lowest scoring sections on in-training exams for internal medicine residents. Prior resident feedback expressed a need for an improved didactic curriculum that was applicable to internal medicine residents and board examinations Aim: To enhance curriculum through multimodal education by integrating traditional didactic presentations along with specific lectures utilizing visual storytelling, memory palaces, and gamification. Methods: Trainees completed a 5-point Likert scale survey on their perceptions of hematology and oncology with a 16-question quiz before and after the curriculum. Multimodal lecture series created using "murder mystery" and "jewel heist" to teach hemolytic anemia, team-based Jeopardy-style format …

Breakthroughs In Cervical Cancer Screening: Hpv Self-Collection At Pmg Milwaukie Family Medicine Clinic, Brandon Bartlett, Sataj Johnson, Emily Miyasako, Rachel Gallagher, Daniel Ruegg

Books, Presentations, Posters, Etc.

Background: Cervical cancer screening is a cornerstone of preventative healthcare and cancer screening in primary care. Based on data from the CDC, in the US alone, the rate of new cervical cancers each year is ~13,000, accounts for ~4,000 deaths annually, and disproportionally effects people of color and people of low SES (CDC, 2025). In our clinic (PMG Milwaukie), the rate of cervical cancer screening has remained around 70% for years, which is below the national average of ~75% (Healthy People, 2021). Primary HPV screening with self-collected swabs has been used successfully for years outside of the US, improving screening …

Improving Post-Hospital Medication Reconciliation In A Rural Primary Care Clinic Through An Rn-Led Workflow, Jack Kennady

Books, Presentations, Posters, Etc.

Context/background: Adverse events after hospital discharge are common and represent a major patient safety concern. Approximately 1 in 5 patients experience a safety event after discharge, and 39% of these events are adverse drug events (ADEs), with 26% considered preventable. Medication discrepancies during transitions of care contribute significantly to these events, with an estimated 40% of medication errors resulting from inadequate medication reconciliation. Rural primary care clinics face additional challenges, including limited communication between inpatient and outpatient systems and inconsistent reconciliation workflows. Improving medication reconciliation during the transition from hospital discharge to outpatient follow-up represents an important opportunity for family …

Improving Recognition Of Chronic Kidney Disease In A Federally Qualified Health Center Through A Quality Improvement Initiative, Rachel Monroe, Evan Saulino, Kathleen Mckenna

Books, Presentations, Posters, Etc.

Context/background: Chronic kidney disease (CKD) affects approximately 15% of adults in the United States, yet nearly 90% of affected individuals are unaware of their diagnosis. Early identification in primary care enables interventions such as blood pressure optimization, renin –angiotensin system blockade, and kidney -protective medications that can significantly delay disease progression and postpone dialysis. Screening and diagnosis gaps disproportionately affect high -risk populations, including Latinx patients and immigrant agricultural workers commonly served in federally qualified health centers (FQHCs). National CKD screening rates among patients with diabetes or hypertension remain low, leaving many high -risk individuals unscreened for kidney disease. Improving …

Mechanisms Of Binding And Immune Escape Resistance For Broadly Neutralizing Antibodies Targeting Distinct Conserved Sars-Cov-2 Spike Epitopes: A Hierarchical Approach Integrating Mutational Profiling And Energy Landscape Analysis, Mohammed Alshahrani, Will Gatlin, Max Ludwick, Lucas Turano, Brandon Foley, Gennady M. Verkhivker

Mathematics, Physics, and Computer Science Faculty Articles and Research

The continued evolution of SARS-CoV-2 has enabled an escape from most monoclonal antibodies, yet a subset of broadly neutralizing antibodies targeting three newly identified super-conserved RBD epitopes—SCORE-A, SCORE-B, and SCORE-C—retains remarkable activity against even the most recent JN.1-derived sublineages. Here, we employed an integrated computational framework combining conformational dynamics, mutational scanning, MM-GBSA binding energetics, and frustration profiling to dissect the molecular mechanisms by which XGI antibodies achieve broad neutralization and resistance to immune escape. Structural analysis revealed that all three SCORE epitopes share a common architecture: a highly conserved, minimally frustrated core that provides stable anchoring, flanked by peripheral regions …

All-Inside Endoscopic Zone 1 Flexor Hallucis Longus Transfer: A Cadaveric Feasibility Study., Kevin D Martin, Yi Wei, Adam G F Smith, Franco Piscitani, Luke M Martin, Brian Steginsky, Brian Tscholl, Nathaniel A Bates

Surgery Articles

BACKGROUND: Endoscopic flexor hallucis longus (FHL) tendon transfer addresses chronic Achilles tendon ruptures. Traditional percutaneous plantar incisions gain FHL length but risk neurovascular injury. This study evaluated the feasibility of an all-inside endoscopic FHL zone 1 tenotomy and transfer technique, which avoids plantar incisions by using zone 1 of the FHL tendon. We hypothesized that this technique would (1) provide sufficient tendon length, (2) avoid neurovascular damage, and (3) securely anchor the FHL tendon without tunnel blowout.

METHODS: Ten cadaveric all-inside endoscopic zone 1 FHL tendon transfers were performed without fluoroscopic guidance. Specimens were independently assessed post hoc by 2 …

The Right Time For A Synapse To Change: Windows And Mechanisms Of Multiday Training Trials, Rong-Yu Liu, Yili Zhang, Roberta Calvo, Paul Smolen, John H Byrne

Faculty, Staff and Student Publications

Although learning over multiple days is more effective than a single day of training, the underlying cellular mechanisms of repeated training trials remain poorly understood. With a combination of empirical and computational approaches, we determined a critical time window for a second stimulus block of a multiday training protocol to augment long-term synaptic facilitation (LTF) of the Aplysia sensorimotor synapse and long-term enhancement of neuronal excitability (LTEE), two cellular correlates of learning and memory. A second stimulus block delivered 24 h after the first block significantly enhanced LTF and LTEE, but was without effect at 18 or 32 h. This …

Rosai-Dorfman Disease In A Rare Cardiac Presentation: Left Ventricular Mass Causing Ventricular Tachycardia, Motaz Al Yafi, Swetha Pasala, Valentina Robila, Cory Trankle, Bharadhwaj Kolipakkam, Patricia Nicolato

Faculty, Staff and Student Publications

Background: Rosai-Dorfman disease (RDD) is a rare, benign histiocytic disorder that most often presents with nodal involvement. Cardiac involvement is exceedingly uncommon and poses significant diagnostic and therapeutic challenges.

Case summary: A 51-year-old woman presented with shortness of breath and palpitations and was found to have monomorphic ventricular tachycardia. Imaging revealed a left ventricular mass, and biopsy confirmed RDD. The lesion was surgically excised with cryoablation and CorMatrix reinforcement. The patient recovered uneventfully and remains disease free 25 months postoperatively.

Discussion: RDD with cardiac involvement has been reported in only approximately 25 cases, with very few affecting the left ventricle. …

Increasing Structured Inpatient Teaching In A Family Medicine Residency, Eric Waelbroeck, Mh Choe

Books, Presentations, Posters, Etc.

Background: What is not measured cannot be improved. Residents at Providence Milwaukie Family Medicine Residency identified a need to increase structured teaching on inpatient rotations. Other projects aimed at increasing structured teaching during family medicine training have demonstrated improvements in resident confidence in key areas of practice, licensing exam performance, and resident satisfaction with their training. However, without a system of measurement, the number of teaching opportunities cannot be reliably improved. Objectives: Develop a method of documenting structured inpatient teaching that occurs at Providence Milwaukie Hospital. Then, implement interventions using a quality improvement model to increase structured teaching over time. …

Addressing Food Insecurity Through Partnering With The Community Teaching Kitchen On Lifestyle Medicine Hypertension Class, Emily Miyasako, Jill Christensen

Books, Presentations, Posters, Etc.

Background: Food insecurity is defined as limited or unreliable access to adequate and nutritious food. In Oregon, approximately 1 in 8 residents experience food insecurity, with rates disproportionately affecting low-income individuals, racial and ethnic minorities, and households with children or elderly individuals. Food insecurity remains a significant threat to our patients’ health and is associated with obesity, malnutrition, and poor mental health. As a primary care provider, I have seen the effects of food insecurity on my patients, but I am thankful for the presence of our Community Teaching Kitchen. The Community Teaching Kitchen (CTK) at Providence Milwaukie provides nutritional …

A Phenomenological Study On The Lived Experiences Of Military Spouses With Secondary Traumatic Stress Who Are Married To Veterans Diagnosed With Ptsd, Trisha R. Perry

Doctoral Dissertations and Projects

The purpose of this hermeneutical phenomenological study was to understand the lived experiences of Secondary Traumatic Stress (STS) in military spouses whose partners have Post-Traumatic Stress Disorder (PTSD). The theory guiding this study was Lazarus and Folkman’s Transactional Model of Stress and Coping (TMSC). The central research question was: What are the lived experiences of STS in spouses married to a service member with PTSD? Additional sub-questions addressed changes in worldview, marital satisfaction, and daily functioning. Criterion and snowball sampling were used to select participants who were married to service members with PTSD for the study. Following the hermeneutical phenomenological …

Impact Of The Menstrual Cycle On Female Endurance Athletes' Performance, Julia M. Monk

Doctoral Dissertations and Projects

Background: During different phases of the menstrual cycle, a female endurance athlete will experience some physiological and fatigue variables. This study aims to analyze whether the differences in variables, specifically an increase in heart rate and fatigue, impacts endurance performance. Method: 20 endurance-trained, runners performed a maximal treadmill test in each of the phases of the menstrual cycle: early follicular phase (days 2–3, ± 1 day), mid-follicular phase (days 10–12, ± 1 day), and luteal phase (days 21–22, ± 1 day). Heart rate was measured before, during, and immediately after the test as well as time to exhaustion and the …

A Qualitative Case Study Exploring The Relationship Between Nutritional Awareness, Behavioral Outcomes, And The Prevention Of Early Risk Factors Of Hypertension And Cardiovascular Disease In Elementary School Students: Perceptions Of Parents And Educators In Hull-Daisetta Independent School District, Shante Monique Espree

Doctoral Dissertations and Projects

The purpose of this case study was to explore the relationship between nutritional awareness and observed behavioral outcomes among elementary school students, with a secondary focus on how these factors may contribute to early risk indicators for hypertension and cardiovascular disease. This study was situated within Hull-Daisetta Independent School District (ISD), Texas and centered on the perspectives of both parents and educators. The theory guiding the study was the Social Cognitive Theory (Bandura, 1986) as it emphasizes the role of observational learning, social influence, and behavior change in health-related interventions. This framework supported the exploration of how nutritional awareness shapes …

Acute Effects Of Olympic Lifting Post-Activation Potentiation On Baseball Pitching Velocity And Ball Flight: A Crossover Study, Brent Hauser Pourciau

Doctoral Dissertations and Projects

This quantitative study evaluated the acute effect of an Olympic lifting-based post-activation potentiation (PAP) warm-up on fastball performance in collegiate baseball pitchers. Using a randomized, counterbalanced within-subjects crossover design (N = 13), each participant completed two warm-up conditions in a single indoor session: (a) a standard dynamic baseball warm-up and (b) the same standard warm-up followed by a brief Olympic-lifting PAP sequence (1 x 3 clean pulls at 80% predicted one-repetition maximum [1RM], 1 x 3 power cleans at 80% predicted 1RM, and 1 x 3 power jerks at 60% predicted 1RM, with 2-minute rests between sets) and a 3-minute …

The Impact Of Cognitive Behavioral Therapy In Enhancing Employee Well-Being And Performance In The Workplace, Chris M. Garcia

Doctoral Dissertations and Projects

This study investigates the lived experiences of clinical administrative professionals in healthcare settings who have undergone Cognitive Behavioral Therapy (CBT) training. The importance of this study lies in addressing significant gaps in existing literature, particularly the long-term outcomes of CBT training in healthcare workplace settings and the necessity of tailoring these training to diverse work environments. The purpose of the study is to explore how CBT training influences the mental health, job performance, and overall well-being of these professionals.

Employing a Transcendental Phenomenology approach, the study will conduct in-depth interviews with clinical administrative professionals in various healthcare settings. The sample …

Associate Degree Program Administrator Perceptions Of Clinical Dishonesty, Cynthia Moore Swineford

Doctoral Dissertations and Projects

The purpose of this hermeneutic phenomenological study was to explore the perceptions of associate degree nursing program administrators regarding faculty reporting of dishonest clinical behaviors by pre-licensure nursing students. Aristotle’s theory of virtue ethics guided this examination of how administrators interpret ethical responsibility, leadership influence, and professional accountability related to clinical dishonesty. The central research question asked, “What are the perceptions of associate degree program administrators regarding faculty reporting of dishonest student behaviors in clinical settings?” The sample included 11 associate degree nursing program administrators from programmatically accredited nursing programs in three mid-Atlantic states. Data were collected through semi-structured interviews, …

The Impact Of Nutritional Education On Hemoglobin Levels In Adolescent Cross-Country Runners, Phillip L. Hardy

Doctoral Dissertations and Projects

Iron deficiency and anemia have been documented in adolescent endurance athletes, particularly female runners, due to increased physiological demands during growth and sustained training stress. However, limited research has examined seasonal hemoglobin progression in high school cross-country athletes while simultaneously examining outcomes during participation in structured nutrition education. Therefore, the purpose of this longitudinal quantitative study was to examine hemoglobin levels, dietary iron intake, and nutrition knowledge among adolescent cross-country runners across a competitive season during participation in a four-session, nutrition education program delivered from August 2025 through November 2025. Participants included 44 high school runners from northwest Georgia who …