Medicine and Health Sciences Commons^™

Predicting Avascular Necrosis After Unstable Slipped Capital Femoral Epiphysis, Jonathan Warren, Alexander Metoxen, Michael Held, Brant Ansley, Berglund Lisa

Research Days

Background: There is no consensus in the literature on the risk of developing avascular necrosis (AVN) after unstable slipped capital femoral epiphysis (SCFE). In recent years, a number of studies have sought to better characterize risk factors for AVN in this population. However, to the best of our knowledge, there is no study that uses predictive modeling to assess the chance of developing AVN based on different patient-centric factors.

Objectives/Goal: Our goal is to assess whether or not previously-published risk factors for AVN in unstable SCFE such as duration of symptoms, reduction type, type of surgery, timing of surgery, and …

Laparoscopic Versus Open Inguinal Hernia Repair: A Single Institution Comparison Of 1200 Patients, Shai Stewart Md, Wendy Jo Svetanoff, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: : Laparoscopy has become the standard of care for many pediatric surgical procedures; however, there is no consensus regarding the optimal approach for inguinal hernia repair (IHR). We report our experience over an 8-year period with open and laparoscopic inguinal hernia repair (LIHR).

Objectives/Goal: We aim to describe our experience within a free-standing tertiary care pediatric institution and compare outcomes between open and laparoscopic repair of pediatric inguinal hernias.

Methods/Design: A retrospective review of patients under 18 years who underwent IHR between June 2010 and June 2017 was performed. The open technique utilizes high ligation of the internal ring, …

“There’S A Difference In Practice When You Have To Make The Decision”: Autonomy In Pediatric Emergency Medicine Fellowship, Katherine Dunne, Vivek Dubey, Sarkan Toy, Camryn Martinez, Kelsey Gavin, Christopher S. Kennedy

Research Days

Background: The Accreditation Council for Graduate Medical Education allows individual training programs to define appropriate supervision and autonomy commensurate with the trainees’ knowledge, clinical competence, and patient complexity and acuity. In pediatric emergency medicine (PEM), supervision is not standardized and subject to supervisor discretion, creating variability in trainee autonomy.

Objectives/Goal: To explore the concept of autonomy from the perspectives of PEM fellows and faculty.

Methods/Design: We conducted a qualitative study consisting of semi-structured interviews of PEM fellows and faculty from a large, single-center pediatric emergency medicine fellowship program. A trained interviewer conducted the interviews over an electronic interview platform. Audio …

A Novel Approach For Laparoscopic Direct Inguinal Hernia Repair In Children, Shai Stewart Md, Charlene Dekonenko, Nelimar Cruz-Centeno, Derek Marlor, Jason D. Fraser

Research Days

Background: Inguinal hernia repair is one of the most common operations performed by pediatric surgeons, and the frequency of laparoscopy for repair is increasing. The vast majority of these are indirect hernias and therefore how to best repair a direct defect when seen during laparoscopy is still unknown. Simple high ligation of the hernia sac (as is done in an indirect hernia) does not repair the inguinal floor weakness/defect seen in a direct hernia.

Objectives/Goal: We therefore present a case of laparoscopic bilateral indirect and direct inguinal hernia repair, commonly known as pantaloon hernia, repaired without mesh and utilizing the …

Institutional Use Of Ultrasound In The Evaluation Of Cryptorchidism, Shai Stewart Md, Dae H. Kim, Nelimar Cruz-Centeno, Derek Marlor, James Fraser, Tolulope A. Oyetunji Md Mph, Shawn D. St.Peter

Research Days

Background, Objectives/Goal, Methods/Design, Results, Conclusions limited to 500 words Background: In 2014, the American Urological Association guidelines recommended against the performance of ultrasound and other imaging modalities in the evaluation of patients with cryptorchidism prior to expert consultation. We hypothesized that ultrasound remains overused by referring physicians.

Objectives/Goal: We aimed to examine our institutional experience and measure adherence to currently available guidelines.

Methods/Design: An institutional review board (IRB) approved retrospective review of ultrasound utilization in the evaluation of patients with cryptorchidism was performed from June 1, 2016, to June 30, 2018, at a single tertiary level pediatric hospital.

Results: We …

Antibiotic Monotherapy Vs Dual-Drug Therapy In Perforated Appendicitis: Single Center Retrospective Review, Shai Stewart Md, Nelimar Cruz-Centeno, Derek Marlor, Dae H. Kim, Shawn D. St Peter, Tolulope A. Oyetunji Md Mph

Research Days

Background: The optimal antibiotic regimen in perforated appendicitis to reduce intraabdominal abscess (IAA) formation has not yet been agreed upon in the pediatric surgery community. We aimed to evaluate the outcomes of patients with perforated appendicitis when intravenous antibiotic monotherapy with Piperacillin-Tazobactam (PT) versus dual-drug therapy with Ceftriaxone and Metronidazole (CM) are administered. We hypothesized there is no difference in the rate of IAA formation with antibiotic monotherapy, as opposed to our once-daily dosed, institutional standard dual-drug therapy.

Objectives/Goal: The goal was to determine if our current management protocols for acute appendicitis were delivering the best possible results for our …

Two Adolescent Idiopathic Scoliosis (Ais) Cases, Two Surgeons, One Operating Room, One Day. Faster And Safer Than One Case In A Day., Jonathan Warren, Robert C. Link, Sean Bonanni, John T. Anderson, Richard M. Schwend

Research Days

Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).

Objectives/Goal: Our purpose is to describe the results of this initiative and compare operative times and outcomes to single cases completed by a single surgeon during the same period.

Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution (Group …

Peritoneal Amyloidosis As A Presenting Manifestation Of Al Amyloid, Indira Acharya, Gifty A. Dominah, Dongmei Xing, Elizabeth Allen, Jeffrey S. Iding, Christopher J. Haas

Journal of Community Hospital Internal Medicine Perspectives

Amyloid is a systemic disease characterized by extracellular deposition of misfolded protein. Gastrointestinal and peritoneal deposition of light chain (AL) amyloid is an under-recognized manifestation of this systemic disease, usually as a late sequela. Here we present a case of recently diagnosed AL peritoneal amyloid that presented in the context of recurrent, acute onset abdominal discomfort and was found to have bowel obstruction complicated by perforation in the setting of AL-mediated gastrointestinal tract infiltration and dysmotility.

Gastrointestinal Bleeding As Initial Manifestation Of Injection Drug Use-Associated Amyloidosis, Mohammed Rifat Shaik, Nishat Anjum Shaikh, Elvina Yunasan, Erika Wheeler, Robert T Chow

Journal of Community Hospital Internal Medicine Perspectives

Systemic amyloidosis has been reported in the context of injection drug use, usually related to ongoing chronic inflammation and persistent cutaneous infections. The kidneys are almost always the first organs affected in that setting. Involvement of the gastrointestinal tract is less common and rarely the initial site of presentation. We present a case of systemic amyloidosis that primarily manifested in the gastrointestinal tract, occurring in the setting of chronic injection drug use. The patient's hemoglobin level dropped progressively over time due to ongoing, slow gastrointestinal bleeding, prompting an endoscopic examination that ultimately confirmed the presence of gastrointestinal amyloidosis. As the …

Recurrent Psychosis In Non-Celiac Gluten Sensitivity, Scarlet Louis-Jean, Shire Chaudhry

Journal of Community Hospital Internal Medicine Perspectives

Neuropsychological manifestations following food exposures in patients with food sensitivities are increasingly being identified in the literature, as understanding of the gut-brain axis is further improved. Non-celiac gluten sensitivity (NCGS) has been shown to occur in individuals without serological or biopsied evidence of celiac disease (CD), who manifest psychotic or mood disorders that resolve following elimination of gluten. In this case history, we discuss a similar manifestation in a 31-year-old woman without serological evidence of CD, whose psychiatric symptoms improve with gluten elimination.

Prevalence And Impact Of Gastrointestinal Manifestations In Covid-19 Patients: A Systematic Review, Bassam Hossain, Shoreh Qazi, Sumair Ahmad, Atif Saleem, Amanke Oranu, Fahad Malik

Journal of Community Hospital Internal Medicine Perspectives

Background and Objective: The aim of this study is to systematically analyze and summarize the implications of COVID-19 on the digestive system by quantitatively evaluating the prevalence of gastrointestinal symptoms such as nausea, vomiting, abdominal pain, constipation, diarrhea, anorexia. reported in COVID-19 cases. We simultaneously investigated other variables to determine the association of such symptoms in COVID-19 patients which can potentially influence the disease prognosis and outcome. This systematic review presents an updated literature on the issue as it requires more scientific discussion in order to better inform the medical community and authorities so that appropriate measures can be taken …

Home Oxygen And Monitoring For Covid-19 Patients: A Multidisciplinary Team Approach, Mahta Salehi, Shehrose Chaudry, Rebecca B. Newman, Josette Hartnett, Suzanne J. Rose, Forugh Homayounrooz

Journal of Community Hospital Internal Medicine Perspectives

Introduction: During the initial COVID-19 pandemic peak, Stamford Hospital implemented a home oxygen program (HOP) to create a comprehensive, multi-disciplinary outpatient initiative without sacrificing a safe discharge. Primary care physicians monitored program participants, whose only indication for remaining admitted was an oxygen requirement. We retrospectively examined participant co-morbidities and outcomes, including death and readmission rates to evaluate HOP safety.

Methods: A retrospective analysis of program participants discharged between April 2020-Janurary 2021 was performed. Variables included demographics, oxygen requirement, days enrolled in the HOP, and major comorbidities such as cardiovascular disease (CVD), diabetes (DM), hypertension (HTN), obesity, chronic kidney disease, malignancies …

Prehospital Management Of Pediatric Behavioral Health Emergencies: A Scoping Review, Elizabeth V. Zorovich, Kathryn Kothari, Kathleen Adelgais, Rachael Alter, Lia Mojica, Aaron Salinas, Marc Auerbach, Carrie Adams, Jennifer Fishe

School of Nursing Faculty Publications

Pediatric behavioral health emergencies (BHE) are increasing in prevalence, yet there are no evidence-based guidelines or protocols for prehospital management. The primary objective of this scoping review is to identify prehospital-specific pediatric BHE research and publicly available emergency medical services (EMS) protocols for pediatric BHE. Secondary objectives include identifying the next priorities for research and EMS protocol considerations for children with neurodevelopmental conditions.

This is a scoping review comprised of a research literature search for publications from 2012-2022 and an internet search for publicly available EMS protocols from the United States. Included publications contain data on the epidemiology of pediatric …

All Clear: A Workbook For Sexually Active Accutane Users Who Can Become Pregnant, Taylor Petersen

Honors Projects

Accutane is a pill-based derivative of Vitamin A used to treat cystic acne. The process to start and continue the medication each month is tedious and full of potential for error. This is especially true for female patients who are able to become pregnant as they have the additional step of monitoring and updating their birth control through an online portal. Patients are treated like numbers and there is little to no customization within Accutane treatment from patient to patient. To make this worse, reliable information about the drug is scarce and many turn to social media platforms or other …

Sleep Problems In Old Age: Metabotropic Glutamate Receptor To The Rescue, Sho Inami, Dinis J.S. Afonso, Kyunghee Koh

Farber Institute for Neuroscience Faculty Papers

No abstract provided.

Factors Associated With Referral To Genetic Testing Among Patients At High Risk Of Cancer, Garrett C. Havican

Health Science Doctoral Thesis

There is mounting evidence that genetic testing can help inform individuals about their breast, ovarian, pancreatic, colorectal, and prostate cancer risk. With this information, a mutation carrier can determine the right procedural path to reduce their cancer or recurrence risk. Further guidance with the decision comes from national evidence-based guidelines and discussions with genetic counselors or trained healthcare providers. This study aimed to identify the factors associated with whether a patient at high risk of cancer undergoes a referral to genetic testing and the factors that influence that decision. A secondary analysis was conducted of local source data from a …

Du Undergraduate Showcase: Research, Scholarship, And Creative Works, Caitlyn Aldersea, Justin Bravo, Sam Allen, Anna Block, Connor Block, Emma Buechler, Maria De Los Angeles Bustillos, Arianna Carlson, William Christensen, Olivia Kachulis, Noah Craver, Kate Dillon, Muskan Fatima, Angel Fernandes, Emma Finch, Colleen Cassidy, Amy Fishman, Andrea Francis, Stacia Fritz, Simran Gill, Emma Gries, Rylie Hansen, Shannon Powers, Jacqueline Martinez, Zachary Harker, Ashley Hasty, Mykaela Tanino-Springsteen, Kathleen Hopps, Adelaide Kerenick, Colin Kleckner, Ci Koehring, Elijah Kruger, Braden Krumholz, Maddie Leake, Lyneé Alves, Seraphina Loukas, Yatzari Lozano Vazquez, Haley Maki, Emily Martinez, Sierra Mckinney, Audrey Mitchell, Kipling Newman, Audrey Ng, Megan Lucyshyn, Andrew Nguyen, Stevie Ostman, Casandra Pearson, Alexandra Penney, Julia Gielczynski, Tyler Ball, Anna Rini, Christina Rorres, Simon Ruland, Helayna Schafer, Emma Sellers, Sarah Schuller, Claire Shaver, Kevin Summers, Isabella Shaw, Madison Sinar, Claudia Pena, Apshara Siwakoti, Carter Sorensen, Madi Sousa, Anna Sparling, Alexandra Revier, Brandon Thierry, Dylan Tyree, Maggie Williams, Lauren Wols

DU Undergraduate Research Journal Archive

DU Undergraduate Showcase: Research, Scholarship, and Creative Works

Single-Nucleus Rna Sequencing Of Pre-Malignant Liver Reveals Disease-Associated Hepatocyte State With Hcc Prognostic Potential, Rodrigo Carlessi, Elena Denisenko, Ebru Boslem, Julia Köhn-Gaone, Nathan Main, N. Dianah B. Abu Bakar, Gayatri D. Shirolkar, Matthew Jones, Aaron B. Beasley, Daniel Poppe, Benjamin J. Dwyer, Connie Jackaman, M. Christian Tjiam, Ryan Lister, Michael Karin, Jonathan A. Fallowfield, Timothy J. Kendall, Stuart J. Forbes, Elin S. Gray, John K. Olynyk, George Yeoh, Alistair R.R. Forrest, Grant A. Ramm, Mark A. Febbraio, Janina E.E. Tirnitz-Parker

Research outputs 2022 to 2026

Current approaches to staging chronic liver diseases have limited utility for predicting liver cancer risk. Here, we employed single-nucleus RNA sequencing (snRNA-seq) to characterize the cellular microenvironment of healthy and pre-malignant livers using two distinct mouse models. Downstream analyses unraveled a previously uncharacterized disease-associated hepatocyte (daHep) transcriptional state. These cells were absent in healthy livers but increasingly prevalent as chronic liver disease progressed. Copy number variation (CNV) analysis of microdissected tissue demonstrated that daHep-enriched regions are riddled with structural variants, suggesting these cells represent a pre-malignant intermediary. Integrated analysis of three recent human snRNA-seq datasets confirmed the presence of a …

Study Design And Protocol Of A Stepped Wedge Cluster Randomized Trial Using A Practical Implementation Strategy As A Model For Hypertension-Hiv Integration - The Map-It Trial, Angela A Aifah, Daphne Lew, Et Al.

2020-Current year OA Pubs

BACKGROUND: As people living with HIV (PLWH) experience earlier and more pronounced onset of noncommunicable diseases (NCDs), advancing integrated care networks and models in low-resource-high-need settings is critical. Leveraging current health system initiatives and addressing gaps in treatment for PLWH, we report our approach using a late-stage (T4) implementation research study to test the adoption and sustainability of a proven-effective implementation strategy which has been minimally applied in low-resource settings for the integration of hypertension control into HIV treatment. We detail our protocol for the Managing Hypertension Among People Living with HIV: an Integrated Model (MAP-IT) trial, which uses a …

Diagnosis And Treatment Of Fungal Infections In Lung Transplant Recipients, Jesus E Escamilla, Spenser E January, Rodrigo Vazquez Guillamet

2020-Current year OA Pubs

Fungal infections are a significant source of morbidity in the lung transplant population via direct allograft damage and predisposing patients to the development of chronic lung allograft dysfunction. Prompt diagnosis and treatment are imperative to limit allograft damage. This review article discusses incidence, risk factors, and symptoms with a specific focus on diagnostic and treatment strategies in the lung transplant population for fungal infections caused by

Dynamic Frailty Risk Assessment Among Older Adults With Multiple Myeloma: A Population-Based Cohort Study, Hira Mian, Tanya M Wildes, Ravi Vij, Matthew J Pianko, Ajay Major, Mark A Fiala

2020-Current year OA Pubs

Multiple myeloma (MM) is a cancer of older adults and those who are more frail are at high risk of poor outcomes. Current tools for identifying and categorizing frail patients are often static and measured only at the time of diagnosis. The concept of dynamic frailty (i.e. frailty changing over time) is largely unexplored in MM. In our study, adults with newly-diagnosed MM who received novel drugs between the years 2007-2014 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases. Using a previously published cumulative deficit approach, a frailty index score was calculated at diagnosis and each …

Bronchoscopic Evaluation Of A Steerable Needle For Simulated Tumor Targets In The Lung Periphery: A Feasibility Study (Bullseye), Alexander C. Chen, Michael Machuzak, George Cheng, Momen M. Wahidi

2020-Current year OA Pubs

BACKGROUND: Peripheral bronchoscopy is often performed to biopsy peripheral pulmonary lesions. Despite technological advancements to improve reach and access to the lung periphery, the diagnostic yield of peripheral bronchoscopy has been inconsistent, and challenging, particularly for lesions that are adjacent to peripheral bronchi. Current biopsy instruments are reliant on the catheter or scope to align properly with targeted lesions.

OBJECTIVES: This study evaluates the feasibility of using a steerable biopsy needle to gain access to peripheral tumor targets in a cadaveric model.

METHODS: Simulated tumor targets 10-30 mm in axial diameter were placed into human cadavers. Bronchoscopy was performed using …

A Mindfulness Intervention For Veterans With Post-Traumatic Stress Disorder, Ashley N. Ries, Steven M. Gerardi Phd, Otd, Mss, Otr, Mary Horne Lcsw

Spring 2023 Virtual OTD Capstone Symposium

Every day, many United States veterans are suffering from the effects of post-traumatic stress disorder (PTSD). Responses to trauma may vary from person to person; however, a diagnosis of PTSD includes the individual experiencing clinically significant distress in their social and occupational areas of functioning. The impact of PTSD on a veteran’s life could impact their ability to carry out activities of daily living, decrease the amount of social participation they have, and limit their ability to perform instrumental daily activities, such as grocery shopping. Mindfulness is the practice of paying full attention to the present moment, without judgment, and …

Determining The Effect Of Cuff Deflation On Post-Exercise Arterial Occlusion Pressure, John Benton

Honors Theses

While it is recommended that blood flow restriction be applied relative to pre-exercise arterial occlusion pressure (AOP), no guidelines exist for an initial rest period prior to the measurement. Remeasuring AOP post-exercise can be used to estimate the cardiovascular response. When measuring post-exercise (pre-) AOP, different methods could be used. Some increase the cuff pressure from blood flow restriction exercise pressure (without deflation), or deflate the cuff prior to post-exercise (post-) AOP measurement. It is unknown if pre-AOP is affected by initial rest period, or if post- AOP is affected by cuff deflation. Thus, the purpose of this study was …

Influences Of Post-Fledging Protein Supplementation On Growth And Reactive Stress Response In Zebra Finches (Taeniopygia Castanotis), Gabrielle Morris, Mary Lindley Tharp

Honors Theses

Protein needs of non-poultry birds, like Zebra Finches (ZF) are understudied. ZFs consume proteinaceous half-ripe seeds during breeding and chicken eggs are recommended supplements for captive ZFs; but developmental needs are unclear. Eggs contain essential amino acids that impact the “stress” hormone, corticosterone (CORT). Diet and corticosterone influence avian growth and stress management. Juvenile egg-fed ZFs outgrow seed-fed birds. Juvenile egg-supplementation boosts adult male attractiveness due to cheek patch augmentation compared to seed-only birds. Across studies, timing of diet (nestling Vs. fledgling) varies, both sexes have not been included, and simultaneous measures of growth and corticosterone are lacking. We are …

Prescription Drug Misuse Among Graduate Students: Prevalence And Links To Mental Health And Academic Burnout, Madison De Gruiter

Honors Theses

The aims of this study are to examine the prevalence of prescription drug misuse (PDM) among doctoral students and assess associations between PDM and anxiety and burnout in this population. Additional analyses analyzed differential associations by doctoral degree type (i.e., research versus professional programs). A sample of doctoral students (n=131) affiliated with the University of Mississippi participated in an anonymous survey to assess research aims.

Synthesis Of Tert-Butyl Ester And Ethyl Ester Prodrugs Of L-Gamma-Methyleneglutamic Acid Amides For The Treatment Of Cancer, Tristan D. Tran

Honors Theses

Metabolic pathways differ in cancer cells compared to noncancerous cells. Glutaminolysis is the primary producer of biosynthetic precursors in cancer cells, which allows for the cells to proliferate. In previous publications, the Le lab has established efficient synthetic routes to L-γ-methyleneglutamic acid amides which have shown to be as efficacious as tamoxifen and olaparib in inhibiting the growth of various breast cancer cell lines. These compounds have shown to inhibit the growth of MCF-7, SK-BR-3, and MDA-MB-231 breast cancer cell lines after 24 or 72 h of exposure. Furthermore, these compounds were selective in inhibiting the growth of cancer …

Synthesis Of Salvimadol Analogues For The Studies Of Pain, Anxiety, And Depression, Seth Mccaughan

Honors Theses

From 2001 to 2013, worldwide prescriptions of opioids more than doubled from around 3 billion daily opioid doses per year to 7 billion due to major shifts in pain management culture and attitude.¹ This surge in opioid prescriptions brought quick pain relief to patients, but it also brought new challenges, such as nonmedical opioid use, opioid use disorders, and overdose deaths.² In 2015, 33,091 of the 52,404 drug overdose deaths were contributed to opioids, and in 2013, the cost of opioid overdose and addiction was estimated to be $78 billion in economic burden.^3,4 The social and economic …

Functional And Location Context Effects On Reading Sentences In Healthy Young Adults: Evidence From Eye Tracking Methods, Elizabeth Baird

Honors Theses

Spreading activation theory proves the way our brains are semantically wired to accept outside information and understand it. Previous studies have demonstrated the effects of spreading activation theory in different settings and activities. These effects are important to understand because they can be used in therapy and assessment for communication disorders. This study explores how the context of sentences affects reading time on noun targets in healthy young adults using an eye tracking method. Specifically, we compared functional and location context types and manipulated the context to be incongruent or congruent to the targets. Our research questions were (1) whether …

Confidence-Based Laboratory Test Reduction Recommendation Algorithm, Tongtong Huang, Linda T Li, Elmer V Bernstam, Xiaoqian Jiang

Faculty, Staff and Student Publications

BACKGROUND: We propose a new deep learning model to identify unnecessary hemoglobin (Hgb) tests for patients admitted to the hospital, which can help reduce health risks and healthcare costs.

METHODS: We collected internal patient data from a teaching hospital in Houston and external patient data from the MIMIC III database. The study used a conservative definition of unnecessary laboratory tests, which was defined as stable (i.e., stability) and below the lower normal bound (i.e., normality). Considering that machine learning models may yield less reliable results when trained on noisy inputs containing low-quality information, we estimated prediction confidence to assess the …