Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Total Joint Implant Alloy Oxide Layer Cell-Induced Damage, Chandler K. Sears

Longitudinal Scholar's Project

Cobalt-Chromium alloy is commonly used in total joint arthroplasty (TJA). Several studies have investigated evidence of inflammatory-cell-induced-corrosion (ICIC) causing pitting in TJA retrieved implants. Others have determined that placing orthopedic alloys into lower pH solutions will increase the rate of corrosion. We have determined that electrochemical potential and corrosion rates of human knee synovial fluid show a variation greater than an order of magnitude. This means there is going to be a significant variation between a patient’s local environment of the TJA implant and may affect how macrophages interact with alloy oxide layers. Knee disability can be quantified by using …

Artificial Intelligence In The Radiomic Analysis Of Glioblastomas: A Review, Taxonomy, And Perspective, Ming Zhu, Sijia Li, Yu Kuang, Virigina B. Hill, Amy B. Heimberger, Lijie Zhai, Shenjie Zhai

Electrical & Computer Engineering Faculty Research

Radiological imaging techniques, including magnetic resonance imaging (MRI) and positron emission tomography (PET), are the standard-of-care non-invasive diagnostic approaches widely applied in neuro-oncology. Unfortunately, accurate interpretation of radiological imaging data is constantly challenged by the indistinguishable radiological image features shared by different pathological changes associated with tumor progression and/or various therapeutic interventions. In recent years, machine learning (ML)-based artificial intelligence (AI) technology has been widely applied in medical image processing and bioinformatics due to its advantages in implicit image feature extraction and integrative data analysis. Despite its recent rapid development, ML technology still faces many hurdles for its broader applications …

Ribonucleotide Reductase Subunit Switching In Hepatoblastoma Drug Response And Relapse, Anthony Brown

Theses and Dissertations (ETD)

Hepatoblastoma is the most common primary liver cancer in infants and young children. Despite being a very rare cancer that accounts for only 0.5-2% if all childhood cancer cases, HB has the largest increase in incidence among childhood cancers in the United States and worldwide. The five-year survival rate of children with the aggressive forms of HB, including those that have developed metastatic or recurrent diseases, is less than 40% due to the lack of effective treatment. We aim to identify targetable mechanisms underlying the progression and drug resistance of high-risk HB. Our recent work on HB mouse and organoid …

Associations Between Postpartum Depression And Child Overweight And Obesity: Mediating Effect Of Maternal Feeding Behaviors And Beliefs, Michelle Harrison

Theses and Dissertations (ETD)

Purpose. Postpartum depression (PPD) is a mental condition that significantly affects 10% to 25% of women within the first year after the birth of their child. The mother-infant relationship is key to child growth. Previous studies have shown that PPD has a detrimental effect on children’s physical and psychological well-being as it affects the child through the mother’s parenting behavior. Depressed mothers show a lack of engagement with their children, which could extend to feeding practices influencing weight gain. The prevalence and severity of childhood overweight and obesity is a global public health problem. An increase in weight gain in …

Cell-Free Dna Sequencing In Multiple Myeloma, Russell Irwin

Dissertations and Theses (Open Access)

Multiple myeloma (MM) is an incurable plasma cell dyscrasia. Recent advances in MM therapy, including CAR-T therapy, have increased survival and shown the value of assessing treatment response with great sensitivity, both in acute and long-term settings. Cell-free DNA, DNA fragments which are released into circulation as a part of normal cellular turnover, is a useful and dynamic biomarker in cancer patients due to the presence of circulating tumor DNA (ctDNA), which is readily identified using next generation sequencing. Here we report the analytical sensitivity, applicability, consistency, and prognostic ability of M5Seq, a novel hybrid capture panel designed for MM …

Development Of Advanced Mr-Guided Adaptive Radiation Therapy Methods For Head & Neck Cancers On The 1.5t Mr-Linac, Brigid Mcdonald

Dissertations and Theses (Open Access)

The 1.5T hybrid MRI/linear accelerator (MR-linac) has recently been introduced into clinical practice and used for the treatment of head and neck cancers (HNC). This device enables on-line adaptive radiation therapy (ART) based on anatomical changes throughout treatment and variations in patient position. This novel technology also has the potential for advanced ART strategies such as dose-optimized ART, in which the treatment plan is optimized based on the accumulated dose over previous fractions, or biological image-guided ART, in which the plan is adapted based on individual tumor response as measured through quantitative imaging techniques such as diffusion-weighted imaging (DWI). The …

Can Variables From The Electronic Health Record Identify Delirium At Bedside?, Ariba Khan, Kayla Heslin, Michelle Simpson, Michael L. Malone

Journal of Patient-Centered Research and Reviews

Delirium, a common and serious disorder in older hospitalized patients, remains underrecognized. While several delirium predictive models have been developed, only a handful have focused on electronic health record (EHR) data. This prospective cohort study of older inpatients (≥ 65 years old) aimed to determine if variables within our health system’s EHR could be used to identify delirium among hospitalized patients at the bedside. Trained researchers screened daily for delirium using the 3-minute diagnostic Confusion Assessment Method (3D-CAM). Patient demographic and clinical variables were extracted from the EHR. Among 408 participants, mean age was 75 years, 60.8% were female, and …

Heart To Heart, Mom To Mom, Karis L. Tekwani

Journal of Patient-Centered Research and Reviews

This essay describes the human connection forged between two young moms, one the physician and one the patient, when their paths collided one night in the emergency department of a busy hospital. It describes a challenging and most memorable care experience in the career of a young emergency physician, the clinical outcome, and the patient’s appreciative follow-up message years later.

Cardiac Metastasis After Curative Treatment Of Hepatocellular Carcinoma: Risk Factors, Treatment Options, And Prognosis, Gaurav Jain, Mathew Otto, Mubeen Khan Mohammed Abdul, Manpreet Chadha, Ajay Sahajpal

Journal of Patient-Centered Research and Reviews

Hepatocellular carcinoma (HCC) is primary hepatic malignancy with a high incidence of recurrence. The risk of recurrence directly correlates to patient’s overall prognosis. Management of advanced HCC involves a combination of surgical resection, locoregional therapy, and systemic treatment. Distant metastases are rare, and intraventricular cardiac metastases are even more infrequent. This brief review details an illustrative case of cardiac metastasis after curative treatment of primary HCC and then summarizes the literature on risk factors, treatment options, and patient prognosis in the setting of distant metastases from HCC. Prognosis of metastasis to the heart is generally poor, and available evidence emphasizes …

Is Home Blood Pressure Monitoring Effective At Controlling Hypertension In African American Patients? A Clin-Iq, Rebecca Nye, Wilhelm Lehmann, Deborah Simpson

Journal of Patient-Centered Research and Reviews

African Americans are disproportionately affected by hypertension, a modifiable contributor to multiple chronic diseases and premature death. Primary care physicians play an important role in hypertension control. Home blood pressure monitoring (HBPM) is an evidence-based method for confirming diagnosis and monitoring hypertension over time. Some studies have found that HBPM may lead to clinically relevant reductions in blood pressure when combined with additional interventions, but few studies have focused specifically on African American populations. Evidence of effectiveness could increase clinical recommendation of HBPM. This clinical inquiry examined whether HBPM improves blood pressure control in African Americans with uncontrolled hypertension. Reviewed …

Partnering To Advance Health Equity And A Welcome Opportunity To Gather: Proceedings From The 28th Annual Conference Of The Health Care Systems Research Network, Robert T. Greenlee

Journal of Patient-Centered Research and Reviews

In April 2022, the Health Care Systems Research Network (HCSRN) — a consortium of 20 research institutions affiliated with large health systems spread across the United States (and one in Israel) — held its 28th annual conference in Pasadena, California, with 275 researchers, health care colleagues, and external academic partners in attendance. With a conference theme of “Promoting Collaboration and Partnerships to Advance Health Equity,” the scientific program was assembled by a multisite planning committee with input from representatives of informal local host Kaiser Permanente Southern California. Objectives of the annual conference are to showcase scientific findings from HCSRN projects …

Successful Treatment Of Radiation-Induced Colitis And Enteritis With Hyperbaric Oxygen Therapy, Mark D. Ringle, Jeffrey S. Cooper

Graduate Medical Education Research Journal

Introduction

Previously irradiated tissue is characterized by changes including decreased vascularity, impaired cellular proliferation, and local hypoxia consistent with fibroblastic atrophy which can persist long after radiation therapy. Hyperbaric oxygen therapy has been shown to be beneficial in the treatment of complications arising from these late effects of radiation on normal tissue through enhancing fibroblast proliferation, collagen maturation, stem cell recruitment, and angiogenesis.

Methods

We report on three patients with debilitating radiation enterocolitis causing issues including recurrent bowel obstruction, anorexia requiring total parenteral nutrition, pain, diarrhea, fecal incontinence, dehydration, and malnutrition.

Results

In all three cases marked improvement was the …

Utility Of Av Nodal Characteristics In Identification Of Atrioventricular Nodal Reentrant Tachycardia And Risk Of Recurrence, Kimberly M. Decarr

Longitudinal Scholar's Project

Background: Catheter ablation of the slow atrioventricular (AV) nodal pathway is a safe and effective treatment for atrioventricular nodal reentrant tachycardia (AVNRT). While AVNRT occurs frequently in both children and adults, pediatric patients experience higher rates of AVNRT recurrence.

Objective: The purpose of this study was to characterize changes in AV nodal conduction properties following catheter ablation and correlate these properties with AVNRT recurrence in pediatric patients.

Methods: This was a retrospective review of patients aged(AVRT) at a single tertiary care center between January 01, 2010 and September 01, 2021. Demographics, pre- and post-ablation ECG intervals, and AV nodal conduction …

Screening And Assessment Of Cancer-Related Fatigue: A Clinical Practice Guideline For Health Care Providers, Mary I. Fisher, Joy C. Cohn, Shana Harrington, Jeannette Lee, Daniel Malone

Physical Therapy Faculty Publications

Cancer-related fatigue (CRF) is the most common side effect of cancer treatment. Regular surveillance is recommended, but few clinical practice guidelines transparently assess study bias, quality, and clinical utility in deriving recommendations of screening and assessment methods. The purpose of this clinical practice guideline (CPG) is to provide recommendations for the screening and assessment of CRF for health care professions treating individuals with cancer. Following best practices for development of a CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) Statement and Emergency Care Research Institute (ECRI) Guidelines Trust Scorecard, this CPG included a systematic search of the …

Trustworthiness And Quality In Research For Clinical Application, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Review: Conventional Thrombectomy With Intraoperative Fluoroscopy In Acute Limb Ischemia Rutherford Iib, Heru Angkoso, Dedy Pratama

The New Ropanasuri Journal of Surgery

Introduction. Acute limb ischemia (ALI) is a severe condition affecting the extremities and the patient’s survival that requires immediate treatment. It can be treated with either surgical or endovascular revascularization or both (hybrid procedure). It is crucial to evaluate the defect using intraoperative fluoroscopy or angiography in each case. The review aimed to find out the outcomes of the thrombectomy with intraoperative fluoroscopy for ALI Rutherford IIb.

Method. According to the PRISMA protocol, the literature search proceeded in online databases, i.e., Cochrane, Scopus, PubMed, and EBSCOhost, with no year limitation on the publication. All articles were screened and critically appraised. …

Complications Of Pediatric Cochlear Implant Surgery, Andrew Stefan, Sabrina Bernardo, William Azkoul Ii, Bianca Siegel

Medical Student Research Symposium

Background:

Cochlear implantation (CI) surgery is the standard of care treatment for pediatric patients diagnosed with severe to profound sensorineural hearing loss. While considered a relatively safe operation, any invasive procedure involving the cranium has risks. However, there are few recent studies in the United States that have analyzed complication rates among children who have received CI. Furthermore, existing studies fail to discuss specific risk factors that led to post-operative complications, nor offer solutions to reduce their incidence. This study aims to 1) determine the incidence of specific complications in pediatric CI patients and 2) identify evidence-based risk factors for …

Endoscopic Cricoid Split As A Treatment For Subglottic Stenosis: A Systematic Review, Silvia Aluia, Katherine Akers, Michael Chung Md

Medical Student Research Symposium

Introduction: Subglottic stenosis, a fibrotic narrowing of the airway below the vocal cords extending to the lower border of the cricoid cartilage, can be classified as congenital, idiopathic, or acquired in neonates from prolonged intubation. Treatment has more recently expanded from open surgical intervention to include endoscopic procedures. This systematic review aims to evaluate existing literature on anterior and posterior endoscopic cricoid split procedures as a treatment for congenital and acquired subglottic stenosis in order to explore the efficacy of these techniques.

Methods: Literature searches were conducted in PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, and Google scholar, which produced …

The Short-Term Effects Of Fine Airborne Particulate Matter And Climate On Covid-19 Disease Dynamics, El Hussain Shamsa, Kezhong Zhang

Medical Student Research Symposium

Background: Despite more than 60% of the United States population being fully vaccinated, COVID-19 cases continue to spike in a temporal pattern. These patterns in COVID-19 incidence and mortality may be linked to short-term changes in environmental factors.

Methods: Nationwide, county-wise measurements for COVID-19 cases and deaths, fine-airborne particulate matter (PM_2.5), and maximum temperature were obtained from March 20, 2020 to March 20, 2021. Multivariate Linear Regression was used to analyze the association between environmental factors and COVID-19 incidence and mortality rates in each season. Negative Binomial Regression was used to analyze daily fluctuations of COVID-19 cases …

An Updated Patient-Centered Sialadenitis Instrument: The Obstructive Salivary Problem Impact Test (Spit), Arushi Gulati, David M. Cognetti, David S. Cohen, M. Allison Ogden, Barry M. Schaitkin, Rohan R. Walvekar, William R. Ryan, Jolie L. Chang

School of Medicine Faculty Publications

Objective: The Chronic Obstructive Sialadenitis Symptoms questionnaire (COSS) was created to assess chronic sialadenitis symptoms and treatment response, but its development lacked patient input and validation. We analyzed COSS responses and feedback from sialadenitis patients and physician experts to create the novel obstructive Salivary Problem Impact Test (SPIT), a new standardized measure of sialadenitis-associated symptoms. Methods: We analyzed COSS responses via exploratory factor analysis (EFA) to identify essential symptom domains and reduce overlap in questions. Sialadenitis patients evaluated the significance of index symptoms identified from the literature review. Expert physicians rated symptom relevance in clinical assessment. An updated questionnaire (SPIT) …

Group Therapy For Adults With Hip Replacements, Riley Burford Mot/S, Hillary Talley Mot/S, Elizabeth Seals Mot/S, Alishah Pirwani Mot/S, Tylan Wakefield Mot/S

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of our critically appraised topic is to synthesize the best current evidence regarding the feasibility of group occupational therapy and outcomes related to ADL performance. The final portfolio contains a total of four research articles. Study designs include two randomized control trials, one cohort design, and one systematic review. All studies related directly to the PICO question and were used to determine best evidence for the feasibility of group therapy of the older adult population who have hip replacements in a rehabilitation setting.

Imaging Of Transmetallation And Chelation Phenomena Involving Radiological Contrast Agents In Mineral-Rich Fruits, Subhendra Sarkar, Zoya Vinokur, Bleidis Buitrago, Lin Mousa, Hayley Sanchez, Analia Basilicata, Jodi-Ann Douglas, Seanetta Reddock

Publications and Research

Exogenous heavy metals or non-metallic waste products, for example lanthanide or iodinated contrast media for radiological procedures, may interfere with the biochemical pools in patients and in common food sources, creating an excess buildup of exogenous compounds which may reach toxic levels. Although the mechanisms are unknown, our experiments were designed to test if this toxicity can be attributed to “transmetallation” or “chelation” reactions freeing up lanthanides or chelated transition metals in acidic fruits used as phantoms representing the biologically active and mineral-rich carbohydrate matrix. The rapid breakdown of stable contrast agents have been reported at a lower pH. The …

Treatment Of Gravitational Pulling Sensation In Patients With Mal De Debarquement Syndrome (Mdds): A Model-Based Approach, Sergei B. Yakushin, Theodore Raphan, Catherine Cho

Publications and Research

Perception of the spatial vertical is important for maintaining and stabilizing vertical posture during body motion. The velocity storage pathway of vestibulo-ocular reflex (VOR), which integrates vestibular, optokinetic, and proprioception in the vestibular nuclei vestibular-only (VO) neurons, has spatio-temporal properties that are defined by eigenvalues and eigenvectors of its system matrix. The yaw, pitch and roll eigenvectors are normally aligned with the spatial vertical and corresponding head axes. Misalignment of the roll eigenvector with the head axes was hypothesized to be an important contributor to the oscillating vertigo during MdDS. Based on this, a treatment protocol was developed using simultaneous …

Utilizing Training And Educational Materials To Increase Hand Hygiene Compliance Of Healthcare Providers Participating In Cesarean Sections, Christopher Natividad

Master's Projects and Capstones

Surgical site infections (SSIs) are one of the most common complications of Cesarean section (C-section) procedures. The incidence of SSIs after C-section procedures at Hospital X has increased in each of the past three years. The Labor and Delivery (L&D) unit at Hospital X performs approximately 4,500 C-sections each year. Observation of these procedures illustrated a lack of adhesion to hand hygiene policies and protocols. This quality improvement project involved informing staff members of the poor hand hygiene compliance rates, and re-educating them regarding proper hand hygiene behavior using flyers, emails, and addressing them at shift change. Data collection focused …

Save Lives And Sanitize: Prevention Of Surgical Site Infections Post-Cesarean Section Through Increased Hand Hygiene Compliance, Lindsay N. Nance

Master's Projects and Capstones

Problem: Surgical site infections (SSIs) occur in 3-15% of cesarean sections, making SSIs one of the most common hospital-acquired infections (HAIs). Surgical site infections (SSIs) have increased within a Labor & Delivery (L&D) unit in a large California teaching hospital for the past three years, affecting reimbursement and creating a range of adverse outcomes for patients. Performance of consistent and thorough hand hygiene practices is key to preventing infection, yet the unit’s hand hygiene compliance of 66.7% is well below the facility’s target goal of 90%. Based on recommendations from the organization’s Infection Prevention & Control (IPC) specialist, the …

Counting Every Drop: Preventing Maternal Mortality With Quantifying Blood Loss Through Triton Scale, Summer Le

Master's Projects and Capstones

Postpartum (PP) hemorrhage is one of the leading causes of maternal mortality (AWHONN, 2021). In each of the past three years, the percentage of PP hemorrhage has increased at Hospital X. The PP unit at Hospital X performs around 4,500 total deliveries each year. While the standard of care for PP blood loss is to specifically measure blood in milliliters as Quantifying Blood Loss (QBL) for Labor and Delivery (L&D), it is not yet the standard of care in the 24 hours postpartum after delivery (ACOG, 2019). This quality improvement project involved educating nurses about measuring blood loss – specifically …

Dexmedetomidine To Reduce Ponv, Amanda Johnson Srna, Joshua Lawrence Srna, Staci Martinez Srna, Taylor Mayberry Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative nausea and vomiting (PONV) contribute to patient dissatisfaction, discomfort, adverse outcomes, and increased healthcare costs. Despite current protocols that aim to reduce PONV by prevention/antiemetic administration, PONV continues to be a common manifestation in many postoperative patients (Elvir-Lazo et al., 2020). This scoping review aimed to analyze available research on the efficacy of dexmedetomidine to reduce perioperative opioid requirements and PONV.

Methods Synthesis of this scoping review began with a systematic approach to search databases and identify eligibility criteria articles. Of the 21 articles that met criteria, a synthesis table was formed to visualize the qualitative (smoking status, …

Is Blood Flow Restriction Training Superior For The Limitation Of Hamstring And Quadriceps Atrophy After Anterior Cruciate Ligament Reconstruction? A Review Of Randomized Controlled Trials, Joshua M. Spada, Ryan W. Paul, Bradford S. Tucker

Rowan-Virtua Research Day

Post operative recovery from Anterior Cruciate Ligament Reconstruction (ACLR) includes extensive rehabilitation of 6-9 months with return to sport/activity at 12 months

Rehabilitation is initiated shortly following surgery to limit quadriceps and hamstring atrophy, maximizing long term tibiofemoral joint stability and functional outcomes

The best way to achieve improved muscle strength and prevent atrophy is progressive overload training, however, these activities cannot be performed post operatively without risk to the reconstructed knee

Blood Flow Restriction Training (BFR) involves impairing the blood supply for short periods through the application of an air-filled bladder or cuff to restrict the venous drainage of …

Latarjet Surgery Leads To Decreased Rates Of Subjective Instability Compared To Bankart Repair With Concomitant Remplissage, Joshua Spada, Ryan W. Paul, Manoj Reddy, Gabriel Onor, John Hayden Sonnier, Ari Clements, Meghan E. Bishop, Brandon J. Erickson

Rowan-Virtua Research Day

Background: Predictive factors for performing remplissage concomitantly with arthroscopic Bankart repair include the presence of humeral or glenoid defects >11% and/or revision surgery. International and societal consensus statements support these findings, as surgeons recommend the Latarjet procedure for patients with significant glenoid bone loss (>15-20%) while remplissage is recommended for patients with off-track or engaging Hill-Sachs lesions without significant glenoid bone loss. While several studies have compared outcomes between Latarjet surgery and remplissage, these studies have only evaluated patients with engaging Hill-Sachs lesions, not consecutive patient cohorts indicated for each surgery.

Purpose: To compare rates of recurrent instability, re-operation, …

A Puzzling Case Of Normal Pressure Hydrocephalus In The Outpatient Setting, Shadi Shams, Asim Shafique, Marym Khan, James Bailey

Rowan-Virtua Research Day

Normal Pressure Hydrocephalus (NPH) is a disease of adulthood characterized by the triad of gait disturbance, dementia, and urinary incontinence. Since NPH shares a lot of characteristics with other disorders including neurodegenerative disorders and degenerative-dystrophic spine, it is usually underdiagnosed and undertreated. Combination of ventriculomegaly seen on a computerized tomography (CT) scan or magnetic resonance imaging (MRI) with clinical findings could be used in diagnosis of NPH. However, improvement of symptoms post spinal tap procedure would be a better indication of diagnosis. Currently, shunt placement is the best available modality of treatment for NPH. Here we present a case of …