The Balm Framework Of Clinical Excellence: An Adoptable Model For Sub-Saharan Africa., Taoreed Adegoke Azeez

Digital Journal of Clinical Medicine

Clinical excellence is the ability to provide rigorous, evidence-based, and rewarding care to the right patients. The BALM (brilliance, attitude, leadership, and materials) framework is a novel model for adjudicating clinical excellence. There are a few models and frameworks for evaluating clinical excellence, but each has its flaws and does not consider the peculiarities of economically-challenged regions such as sub-Saharan Africa. Coincidentally, such low-resource areas have an urgent need for a framework to assess clinical excellence because of their low health-related indices. The five-step mode of professional excellence is a well-recognised tool and was the model upon which the BALM …

Alkaptonuria Presenting With Back Pain: A Diagnostic Dilemma, Arnav Salar, Dyuksha Arora, Mahabaleshwar Mamadapur

Digital Journal of Clinical Medicine

Alkaptonuria is a rare inborn error of metabolism due to a deficiency of homogentisate 1,2 dioxygenase, resulting in homogentisic acid accumulation in tissues. It is characterised by homogentisic aciduria, ochronosis, and arthritis. We hereby discuss a 46-year-old male who presented with progressive lower back pain and polyarthralgia for ten years, initially diagnosed as ankylosing spondylitis. Characteristic skin pigmentation, ochronosis, and radiological findings led to the correct diagnosis of alkaptonuria. This case highlights the importance of considering alkaptonuria as a differential diagnosis for chronic back pain and arthritis, mainly when sacroiliac joints are spared, and ochronosis is present. While no cure …

Knowledge, Attitudes, And Practices Among Health Care Professionals In A Tertiary Care Teaching Hospital, Mysuru, Rakesh M, Dr Sunil Kumar D, Dr Shwethashree M, Kodeeswaran M, Aradhya M. Gowda

Digital Journal of Clinical Medicine

ABSTRACT

Background: Biomedical waste (BMW) refers to waste generated during the diagnosis, treatment, or immunization of humans or animals, posing risks to health and the environment if not managed properly. Proper knowledge, attitudes, and practices (KAP) among healthcare professionals are essential for effective BMW management. This study assessed the KAP of healthcare workers regarding BMW in a tertiary care teaching hospital.

Methods: A cross-sectional study was conducted among 149 healthcare professionals at a private medical college from April 10 to May 10, 2023. Participants were selected using simple random sampling, including consultants, postgraduates, interns, nursing staff, laboratory technicians, and housekeeping …

Psychiatric Morbidity In Perinatal Women And Its Outcome In A Tertiary Care Hospital, Lakshmi Velayudam, Prathap Talwar, Kishor M, Harshitha Padmanabha

Digital Journal of Clinical Medicine

Background: Pregnancy and postpartum are a period of vulnerability in a women’s life for developing mental health problems. Perinatal psychiatric illness has various adverse outcome on maternal, neonatal and child health.

Objective: To study the prevalence of psychiatric disorders and its outcome among women in the perinatal period.

Method: It is a prospective study conducted at a tertiary care hospital where antenatal and postnatal women were screened for psychiatric disorder using patient health questionnaire-9 (PHQ-9) and Edinburgh Post Natal Depression Scale (EPDS) respectively. Total of 140 women diagnosed with psychiatric disorder were followed up for a year and outcome …

The Pros And Cons Of Systematic Review And Meta-Analysis: Methodological Insights And Future Directions, Malik Maaz Ahmad, Imran Ahmed Khan, Harish Chandra Tiwari

Digital Journal of Clinical Medicine

Systematic reviews (SR) and meta-analyses (MA) are the highest level of evidence in the hierarchy of scientific evidence which aggregate data from various studies, offering a comprehensive overview of a particular topic. This approach reduces the influence of isolated studies that may have small sample sizes or unique biases, leading to more robust conclusions. By combining data from multiple studies, the overall sample size is increased enhancing the statistical power and precision of the results. The value of SR and MA is often compromised by the poor quality of the primary studies they include, which can lead to misleading conclusions. …

Exploring The Elective Experience: A Review Of The "Adult Psychiatry" Elective At A Medical College, Dyuksha Arora, Kishor M

Digital Journal of Clinical Medicine

This review delves into the motivations, experiences, and perceived advantages and disadvantages of undertaking the 'Adult Psychiatry' as an elective at JSS Medical College. Experiences from four students, two from the 2019 batch and two from the 2020 batch, provide a comprehensive overview of their elective.

A Rare Case Of Early Onset Vitamin B6 Dependent Epilepsy, Rohit Thorat, Qudsiya Ansari, Kailas Randad, Vinaya Singh, Akash Sarkate

Digital Journal of Clinical Medicine

Pyridoxine dependent epilepsy (PDE) is a rare seizure disorder which manifests in neonatal period, but can be manifested in early infancy also. Seizures are seen in the first month of life in the classical form, but in the atypical form they don't show up until later in life, sometimes as late as three years old. It has an autosomal recessive inheritance caused by mutation in ALDH7A1 gene, causing deficiency of alpha-aminoadepic semialdehyde dehydrogenase commonly known as antiquitin (ATQ). Its deficiency leads to accumulation of metabolites, which causes deficiency of functional form of pyridoxine. The seizures are non-responding to antiepileptic medications, …

Clozapine And Modified Electroconvulsive Therapy (M-Ect) In Treatment Resistant Schizophrenia (Trs) – A Case Report, Kareena Arora, Kishor M, Murali M R, Suhas K Mr

Digital Journal of Clinical Medicine

Schizophrenia is psychiatric disorder affecting less than 1% of population that can be devastating, characterized by positive, negative and cognitive symptoms. This can lead to significant functional impairment. Despite intensive and ongoing research, outcomes from best-practice treatment are often suboptimal. Unfortunately, not all the patients respond to antipsychotic medications. Overall estimates suggest that one-fifth to one-half of patients have treatment resistant schizophrenia (TRS).

TRS include failure sequential trial of two different antipsychotics with sufficient dose, duration and adherence as a minimum criterion. TRS represents major clinical challenge.

Clozapine is the only drug approved for TRS as it is the drug …

Osteochondroma At Unusual Location Causing Deformity (Metacarpal): A Rare Case Report, Pranshu S. Panwar, Prakash M, Purushothama Sastry, Gurumurthy B, Punith N, Ravi H. S

Digital Journal of Clinical Medicine

INTRODUCTION: Osteochondroma is benign tumors of bone which usually occurs in long bones. Common locations proximal tibia, distal femur and proximal humerus. Metacarpals are rarely affected.

Case Report: Patient, 10 years old/boy came to JSS hospital with complaint of swelling and deformity over left hand for 2 years. After relevant clinical examination and radiological investigation, patient was diagnosed with synostoses of 5^th metacarpal with 4^th metacarpal. Patient was taken up deformity correction and intra-op patient was diagnosed as exostoses of 5^th metacarpal. Post-op radiograph was taken. After 1-month ex-fix was removed. After 4 months follow up, deformity …

Internet Gaming Disorders Amongst Medical Undergraduates In Tamil Nadu, India - A Cross Sectional Study, Rejee Sneha Ebanezer, Sumedha K, Murugan V

Digital Journal of Clinical Medicine

Abstract

Background: Internet Gaming Disorder (IGD) or internet-related gaming addictions are characterized by severely impaired control over gaming affecting routine activities, followed by several psychological, physical and social issues. Budding medical undergraduates who are future health professionals might have positive effects on their studies and career goals when saved from internet gaming addictions. Hence, this study aimed to identify the proportion of medical undergraduate students and interns with internet gaming disorders studying in a private medical college and tertiary care hospital.

Setting: A tertiary care Hospital and Medical College, Tamil Nadu, India

Study design: Cross – sectional study.

Participants: Medical …

High Stakes And Hidden Risks: A Case Series On Pathological Gambling In Context With Affective Disorders And Substance Abuse, Avni Gupta, Namita Deka, Mahesh Kumar

Digital Journal of Clinical Medicine

Background: Pathological gambling is a non–substance-related addictive disorder, characterized by persistent preoccupation with gambling, impaired control, and continuation despite negative consequences. It is associated with financial losses, social and occupational dysfunction, and psychiatric comorbidities, including affective and substance use disorders. Although international prevalence estimates range from 1–2%, research in India remains limited, particularly with the rise of online gambling.

Methods: We report a case series of three individuals presenting to a tertiary-care psychiatry outpatient department with pathological gambling. Clinical assessments included detailed psychiatric evaluation, mental status examination, and psychometric assessments using the Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory …

Investigating Black Emerging Adult Health And Model Of Care Choices, Alexandra Wynn

Theses and Dissertations

This mixed methods study aimed to analyze the health profiles of Black emerging adults (who do not seek medical care for chronic condition management) college students to identify factors influencing their use of preventive services and their choices in healthcare plans. The study revealed distinct profiles of Black emerging adults based on patterns of factors related to their engagement with healthcare, such as barriers to care, insurance access, usual source of care, self-rated health, intention to seek care, discrimination, trust in physician, medical mistrust, and sex-assigned at birth. Interviews were conducted to investigate the similarities and differences among all participants …

Transforming Children's Oral Health: The Impact Of Oral Healthcare Policies On Virginia Medicaid Dental Health Outcomes., Anita M. Kumar

Theses and Dissertations

Abstract: Transforming Children's Oral Health: The Impact of Oral Healthcare Policies on Virginia Medicaid Dental Health Outcomes.

Objectives: This dissertation uses Department of Medical Assistance Services (DMAS) administrative files at the individual and provider level from fiscal years (FY) 2011 to 2021 to systematically study the effect of recently implemented oral health policies (EBD guidelines on sealants, CMS updated quality measures, expansion of Medicaid oral healthcare for qualifying pregnant women) on oral health outcomes of Virginia Medicaid-enrolled children.

Methods: The studies employ a difference in differences regression methods (negative binomial, Poisson, and logistic) to examine the effects of oral health …

Longitudinal Analysis Of Maternal Depression, Physical Work Demand, And Working Hours Before, During, And After Pregnancy On Offspring Blood Pressure Trajectories, Medhin Tsegaye Haile

Theses and Dissertations

Overall Abstract

Background: Pediatric high blood pressure (BP) is a growing global concern, with 1 in 7 adolescents in the U.S. experiencing elevated BP or hypertension. Maternal lifestyle factors, including depressive symptoms, physically demanding work, and work hours during pregnancy, may influence offspring BP trajectories. However, prior studies often focus on single time points or specific age groups, limiting understanding of long-term effects. This study investigates the associations between maternal depressive symptoms, physically demanding work-related factors, and work hours before, during, and after pregnancy with offspring systolic blood pressure (SBP) trajectories from early childhood to adolescence.

Methods: We utilized …

The Genetic Architecture Of Cervical Change During Pregnancy: From Modeling To Mechanism — Does The Cervix Mediate Maternal Risk For Spontaneous Preterm Birth?, Hope M. Wolf

Theses and Dissertations

This project leverages clinical data and biospecimens from a prospective longitudinal cohort of pregnant women to study the genetic and phenotypic relationships between cervical shortening and the duration of pregnancy. Sonographic cervical length (CL) was measured throughout pregnancy in a cohort of 5,160 Black/African American women in Detroit, Michigan. Maternal DNA samples were sequenced with a next-generation low-pass whole genome platform. The heritability of cervical change during pregnancy and its genetic correlation with gestational age at delivery (GAD) were estimated using Genome-Wide Complex Trait Analysis. These estimates suggest that cervical change is heritable (h²CL = 51%) and highly polygenic trait. …

Overcoming The Unseen: Understanding Diverse Canadian Workers’ Well-Being During The Beginning Of The Coronavirus Pandemic, Tyler M. Pacheco

Theses and Dissertations (Comprehensive)

Canadian workers were severely affected by the onset of the coronavirus (COVID-19) pandemic. The rapid spread of the pathogen across Canada resulted in several work-related consequences (e.g., temporary/indefinite layoffs and business closures, mandatory working-from-home) that could have impacted workers’ well-being during this turbulent period. Research available at the start of this dissertation process, and even more recently published studies, primarily explored general trends in workers’ negative well-being during COVID-19, not examining the distinct realities that diverse workers, including more marginalized ones, may have experienced. Across three manuscripts, several theories from diverse disciplines (positive, developmental, community, and industrial-organizational psychology, public health) …

"Why Does This Have To Be So Hard?": Perinatal Experiences From An Ecological Systems Approach, Caitlin Senk

Antioch University Dissertations & Theses

This study examines the lived experience of the perinatal population to understand how they can be supported from the lens of different ecological systems and what counselors can do to better serve people with uteruses during their perinatal experience. Furthermore, this study aims to utilize an inclusive framework for capturing the perinatal experience of people with uteruses and to explore barriers and facilitators to care through an ecological systems framework. Fifteen participants who have experienced infertility, conception, pregnancy, miscarriage, childbirth, stillbirth, and postpartum were recruited through various means throughout the United States. Thematic analysis was used, with semi-structured interviews and …

Lead Poisoning In Children: A Preventable Disease, Heather Aaron

Antioch University Dissertations & Theses

Children lead poisoning disease causes irreversible neurological damage in children (Centers for Disease Control and Prevention [CDC], 2022). The effects are lifelong for the children poisoned and their families. A major cause of childhood lead poisoning is the ingestion of peeling paint in old homes. Leaded paint was banned by the federal government in 1978 (Mayo Clinic, 2022). Leaded paint is mostly found in dwellings constructed before 1978. The purpose of this study is to identify barriers, social justice parameters, and solutions to and for the eradication of childhood lead poisoning in Connecticut. The methodology used was a qualitative interview …

The Anatomy Of Physician Fulfillment: Strategies Beyond Burnout, Brook Hale

Antioch University Dissertations & Theses

The persistent tension and power struggle between healthcare executives and physicians is a prevalent issue in healthcare organizations, often leading to a culture of organizational mistrust. This dynamic stems from perceived conflicting goals: executives are frequently seen as primarily focused on financial outcomes, while physicians are viewed as resistant to change. This study explored how physician fulfillment is experienced at work, with the ultimate goal of identifying potential interventions to bridge the gap between these groups. There is vast research and literature available regarding burnout in healthcare; this research focused on understanding what physicians find fulfilling in their work and …

Exploring Angiotensin Ii And Oxidative Stress In Radiation-Induced Cataract Formation: Potential For Therapeutic Intervention, Vidya P. Kumar, Yali Kong, Riana Dolland, Sandra R. Brown, Kan Wang, Damian Dolland, David Mu, Milton L. Brown

Department of Biomedical and Translational Sciences Faculty Publications

Radiation-induced cataracts (RICs) represent a significant public health challenge, particularly impacting individuals exposed to ionizing radiation (IR) through medical treatments, occupational settings, and environmental factors. Effective therapeutic strategies require a deep understanding of the mechanisms underlying RIC formation (RICF). This study investigates the roles of angiotensin II (Ang II) and oxidative stress in RIC development, with a focus on their combined effects on lens transparency and cellular function. Key mechanisms include the generation of reactive oxygen species (ROS) and oxidative damage to lens proteins and lipids, as well as the impact of Ang II on inflammatory responses and cellular apoptosis. …

From Pollution To Resource: Advancing Swine Waste Treatment In The Usa, Viney P. Aneja, Ryke Longest, Matias B. Vanotti, Ariel A. Szogi, Gudigopuram B. Reddy

Faculty Scholarship

Concentrated animal feeding operations (CAFOs) have led to environmental challenges, specifically waste management. Swine CAFOs generate large amounts of waste, requiring proper treatment to avoid air and water pollution. Conventional waste management technologies, such as lagoon and spray field systems, do not prevent air and water pollution impacts. Research for the past few decades led to recommendations for waste treatment technologies superior to lagoons and spray fields. Private environmental sustainability initiatives focused on reducing greenhouse gas emissions in the food supply chain have implemented biogas digester projects for capturing methane in covered swine lagoons to reduce greenhouse gas emissions. However, …

Modeling The Effect Of Observational Social Learning On Parental Decision-Making For Childhood Vaccination And Diseases Spread Over Household Networks, Tamer Oraby, Andras Balogh

School of Mathematical & Statistical Sciences Faculty Publications

In this paper, we introduce a novel model for parental decision-making about vaccinations against a childhood disease that spreads through a contact network. This model considers a bilayer network comprising two overlapping networks, which are either Erdős–Rényi (random) networks or Barabási–Albert networks. The model also employs a Bayesian aggregation rule for observational social learning on a social network. This new model encompasses other decision models, such as voting and DeGroot models, as special cases. Using our model, we demonstrate how certain levels of social learning about vaccination preferences can converge opinions, influencing vaccine uptake and ultimately disease spread. In addition, …

Use Of Hydroxychloroquine In Multidrug Protocols For Sars-Cov-2, Eleftherios Gkioulekas, Peter A. Mccullough

School of Mathematical & Statistical Sciences Faculty Publications

We review the available evidence supporting the use of hydroxychloroquine-based multidrug protocols in the treatment of COVID-19, in response to a recently published editorial in the Tasman Medical Journal.

Vulnerable, Recalcitrant And Resilient: A Foucauldian Discourse Analysis Of Risk And Older People Within The Context Of Covid-19 News Media, Marjorie Skoss, Rachel Batten, Patricia Cain, Mandy Stanley

Research outputs 2022 to 2026

Risk is an innate and integral part of everyday life and is present in simple, everyday occupations and complex actions. Age-related stereotypes can mean older people have little opportunity to engage in activities that present some degree of risk. The present study explores the discourse around risk and older people in the context of the COVID-19 pandemic. We investigated news media as a reflection of the dominant public discourse around older people's behaviour to identify how risk is represented in relation to occupational engagement. Texts relating to older people and COVID-19 were sourced from the West Australian newspaper for a …

Incorporating Variable Rbe In Impt Optimization For Ependymoma, Hadis Moazami Goudarzi, Gino Lim, David Grosshans, Radhe Mohan, Wenhua Cao

Faculty, Staff and Student Publications

PURPOSE: To study the dosimetric impact of incorporating variable relative biological effectiveness (RBE) of protons in optimizing intensity-modulated proton therapy (IMPT) treatment plans and to compare it with conventional constant RBE optimization and linear energy transfer (LET)-based optimization.

METHODS: This study included 10 pediatric ependymoma patients with challenging anatomical features for treatment planning. Four plans were generated for each patient according to different optimization strategies: (1) constant RBE optimization (ConstRBEopt) considering standard-of-care dose requirements; (2) LET optimization (LETopt) using a composite cost function simultaneously optimizing dose-averaged LET (LET

RESULTS: We found that the LETopt plans consistently achieved increased LET in …

Association Of Perceived Neighborhood Air Quality Problems With Attempt To Quit Cigarette Smoking: A Cross-Sectional Study In Texas, Monalisa Chandra, Joel Fokom Domgue, Robert Yu, Sanjay Shete

Faculty, Staff and Student Publications

Background: Cigarette smoking is the major preventable cause of premature deaths in the United States. Attempting to quit smoking is an important step toward smoking cessation. Although it has been studied extensively, limited information on the association between attempts to quit smoking and neighborhood air quality problems is available. Therefore, we examined the association between attempts to quit smoking in the past year and perceived neighborhood air quality problems among adult Texans who smoke.

Methods: In 2018, a cross-sectional multistage area probability design-based survey was administered to collect sociodemographic, behavioral, and health-related information from a representative sample of 2050 Texas …

Body-Map Storytelling: A Qualitative Exploration Of The Lived Experiences Of Hospital Care Amongst Street Involved Youth, Chelsey Fedchenko

Theses and Dissertations (Comprehensive)

This social work study explores the experiences of hospital care amongst street-involved (SI) youth. Given that SI youth are at a higher risk for health-related harms and experience significant barriers to health care services, they are at an increased likelihood of hospitalization. Yet, inadequate health care support for SI youth remains a critical problem in Canada. While hospital care amongst adult homeless populations has been well studied interdisciplinary, there is a scarcity of research investigating the hospital care experiences amongst SI youth. The aim of this qualitative, arts-based study was to explore how street-life contributes to hospitalization, how SI youth …

Hospital Surge Capacity In Co-Occurring Mass Casualty Incidents, Carolyn Solimine

Electronic Theses & Dissertations (2024 - present)

The COVID-19 pandemic has brought sweeping disruption and changes across healthcare systems. Examining how these changes have impacted surge capacity and capabilities is necessary to plan for future co-occurring surge-creating events in hospital Emergency Departments (EDs) and Intensive Care Units (ICUs). While there is extensive research on patient surge management, no study has looked at how the presence of a prolonged surge would impact the healthcare system’s ability to handle a concurrent acute patient surge. This study seeks to demonstrate the need for comprehensive planning for co-occurring patient surges in New York State using hospital capacity data from Health and …

Assessing Associations Between Emergency Room Visits For Respiratory And Cardiovascular Diseases And Criteria Air Pollutants Exposure In New York State, Tamba Solomon Lebbie

Electronic Theses & Dissertations (2024 - present)

Abstract

Air pollution is a major environmental health hazard for the general population. Approximately 90% of the global population is at risk of both indoor and outdoor air pollution, and it accounts for an estimated 7 million premature deaths every year according to the World Health Organization (WHO). Multiple studies including epidemiological and molecular analyses have confirmed the negative effects of air pollutants on human health even at levels within the WHO guidelines. This study examines the health impacts of releases of criteria air pollution from point sources in New York State (NYS). There is evidence from population studies that …

Optimizing The Community Health Worker (Chw) Program In Belize And Understanding Its Unique Intermediary Position Within The Health System: Perspective From The World Health Organization (Who) Health Systems Approach, Andrei R. Chell

Electronic Theses & Dissertations (2024 - present)

Human resources for health (HRH) are the backbone of a well-functioning and resilient health system. Issues related to HRH recruitment, retention, planning, leadership and governance have been amplified by the coronavirus disease 2019 (COVID-19) pandemic and have posed additional and unprecedented challenges in many countries. Community health workers (CHWs) in particular, are uniquely positioned to be frontline health care workers (HCWs) that are considered a vital link between communities and the formal health system. Globally, the benefits of CHW programs have been well documented, and there is substantial evidence of the efficacy and effectiveness of these programs. However, countries are …