Honoring Veterans’ Wishes: Efficacy Of An Evidence-Based Shared Decision-Making Tool In Va Icu Goals-Of-Care Discussions, Stephanie Alexander, Anna Astashchanka Md, Venktesh Ramnath Md

Doctor of Nursing Practice Final Manuscripts

Abstract

Introduction: This Doctor of Nursing Practice project aimed to enhance the knowledge and confidence of the San Diego Veterans Health Administration’s (VASD) Intensive Care Unit (ICU) medical providers in goals-of-care discussions (GOCD). Additionally, this project aimed to improve the documentation of these discussions.

Background: Delays in GOCD can lead to futile medical and surgical interventions, inappropriate antibiotic use, and higher rates of mental health conditions in patients and their loved ones. Earlier GOCD are associated with lower ventilation and resuscitation rates, earlier hospice enrollment, reduced ICU admissions, lower financial costs, and better patient and caregiver quality of life. However, …

The Enzymatic Regulation Of Contraction-Induced Toll-Like Receptor 4 Shedding From C2c12 Myotubes, Rebekah C. Gridley

Health, Exercise, and Sports Sciences ETDs

Stimulated contractions are shown to increase toll-like receptor 4 (TLR4) release from C2C12 myotubes in vitro. The purpose of this study was to determine if the release of TLR4 from myotubes is controlled by proteolytic membrane cleavage. A broad-spectrum metalloprotease inhibitor was used to test this hypothesis in a C2C12 cell culture model, and TLR4 concentrations in the cell culture supernatant were measured via enzyme-linked immunosorbent assay (ELISA) following stimulated myotube contractions.

ELISA analysis revealed TLR4 concentrations below the sensitivity threshold of the ELISA kit for all experimental conditions. In confirming the effectiveness of the electrical pulse stimulation (EPS) treatment, …

Keratin 17 Modulates The Immune Topography Of Pancreatic Cancer, Lyanne Delgado-Coka, Michael Horowitz, Mariana Torrente-Goncalves, Lucia Roa-Peña, Cindy Leiton, Mahmudul Hasan, Sruthi Babu, Danielle Fassler, Jaymie Oentoro, Ji-Dong Bai, Emanuel Petricoin, Lynn Matrisian, Edik Matthew Blais, Natalia Marchenko, Felicia Allard, Wei Jiang, Brent Larson, Andrew Hendifar, Chao Chen, Shahira Abousamra, Dimitris Samaras, Tahsin Kurc, Joel Saltz, Luisa Escobar-Hoyos, Kenneth Shroyer

Kimmel Cancer Center Faculty Papers

BACKGROUND: The immune microenvironment impacts tumor growth, invasion, metastasis, and patient survival and may provide opportunities for therapeutic intervention in pancreatic ductal adenocarcinoma (PDAC). Although never studied as a potential modulator of the immune response in most cancers, Keratin 17 (K17), a biomarker of the most aggressive (basal) molecular subtype of PDAC, is intimately involved in the histogenesis of the immune response in psoriasis, basal cell carcinoma, and cervical squamous cell carcinoma. Thus, we hypothesized that K17 expression could also impact the immune cell response in PDAC, and that uncovering this relationship could provide insight to guide the development of …

Systematic Comparison Of Propensity Score Matching And Structural Causal Modeling For Clinical Applications, With A Case Study Of Albumin Treatment For Acute Kidney Injury (Aki) Patients: Propensity Score Matching Vs. Structural Causal Models, Layaal Khellah

Student Research Symposium

Introduction:

Propensity Score Matching (PSM) and Structural Causal Models (SCMs) are key approaches in causal inference for treatment evaluation and clinical decisions, both rooted in the potential outcome framework but differing in their foundations—PSM follows Rubin's Causal Model, while SCMs adhere to the Structural Theory of Causation.

Methods:

Our study compares PSM and SCMs in clinical contexts, focusing on albumin as an AKI treatment. We examine each method's steps, highlighting differences. Using data from AKI patients with cirrhosis, we assess albumin’s treatment efficacy with both PSM and SCMs, offering insights into their performance in estimating causal effects..

Results:

PSM and …

Perinuclear Damage From Nuclear Envelope Deterioration Elicits Stress Responses That Contribute To Lmna Cardiomyopathy, Kunal Sikder, Elizabeth Phillips, Zhijiu Zhong, Nadan Wang, Jasmine Saunders, David Mothy, Andrew Kossenkov, Timothy Schneider, Zuzana Nichtova, György Csordás, Kenneth B. Margulies, Jason C. Choi

Center for Translational Medicine Faculty Papers

Mutations in the LMNA gene encoding lamins A/C cause an array of tissue-selective diseases, with the heart being the most commonly affected organ. Despite progress in understanding the perturbations emanating from LMNA mutations, an integrative understanding of the pathogenesis underlying cardiac dysfunction remains elusive. Using a novel conditional deletion model capable of translatome profiling, we observed that cardiomyocyte-specific Lmna deletion in adult mice led to rapid cardiomyopathy with pathological remodeling. Before cardiac dysfunction, Lmna-deleted cardiomyocytes displayed nuclear abnormalities, Golgi dilation/fragmentation, and CREB3-mediated stress activation. Translatome profiling identified MED25 activation, a transcriptional cofactor that regulates Golgi stress. Autophagy is disrupted …

Molecular Therapy And Nucleic Acid Adeno-Associated Virus-Based Gene Therapy Delivering Combinations Of Two Growth-Associated Genes To Mps Iva Mice, Estera Rintz, Betul Celik, Nidhi Fnu, Angélica María Herreño-Pachón, Shaukat Khan, Shunji Tomatsu, Eliana Benincore-Flórez

Department of Medicine Faculty Papers

Mucopolysaccharidosis type IVA (MPS IVA) is caused by a deficiency of the galactosamine (N-acetyl)-6-sulfatase (GALNS) enzyme responsible for the degradation of specific glycosaminoglycans (GAGs). The progressive accumulation of GAGs leads to various skeletal abnormalities (short stature, hypoplasia, tracheal obstruction) and several symptoms in other organs. To date, no treatment is effective for patients with bone abnormalities. To improve bone pathology, we propose a novel combination treatment with the adeno-associated virus (AAV) vectors expressing GALNS enzyme and a natriuretic peptide C (CNP; NPPC gene) as a growth-promoting agent for MPS IVA. In this study, an MPS IVA mouse model was treated …

Identifying The Molecular Determinants Of Lung Metastatic Adaptation In Prostate Cancer, Grace M. Waldron

Theses & Dissertations

Prostate cancer (PC) stands as the primary diagnosed cancer in men in the US at approximately 299,010 cases in 2024 and ranks second globally, posing a significant public health challenge. Clinical presentations vary widely, from indolent to aggressive forms, necessitating stage-specific treatment regimens. Understanding its metastatic nature is critical due to the impact of cancer cell dissemination on disease morbidity, with bone and visceral organs serving as key sites of metastasis. Despite bone metastasis being the most common site for metastasis, visceral metastases at sites such as the liver and lungs correlate with poorer survival, emphasizing the role of microenvironmental …

Assessment Of In-Vitro And In-Vivo Pre-Clinical Pharmacokinetics Of Epz015666; A Novel Small Molecule For Medulloblastoma Treatment, Pratiksha U. Kshirsagar

Theses & Dissertations

Group 3 medulloblastoma (MB) has the worst prognosis of the MB subgroups associated with elevated MYC expression and a 5-year survival rate of

Quantitation of EPZ was performed on a Shimadzu LC-MS/MS system utilizing electrospray ionization operated in positive mode. The validated assay was linear from 0.2 to 500 ng/mL. Metabolic stability studies demonstrated slow intrinsic clearance of EPZ in mouse and human liver microsomes, suggesting no CYP-mediated metabolism. Additionally, EPZ exhibited low binding affinity to plasma and brain proteins and high apparent permeability across artificial membranes, indicating efficient membrane penetration. Drug transporter studies identified EPZ as a substrate of …

Therapeutic Effects Of Bet Protein Inhibition In B-Cell Malignancies And Beyond, Audrey L. Smith

Theses & Dissertations

Chronic lymphocytic leukemia (CLL) develops through a combination of intrinsic genetic defects, constitutively active survival/proliferation signaling pathways, and complex microenvironment interactions. Redundant tumor microenvironment (TME) immuno-suppressive mechanisms and epigenetic maintenance of terminal T-cell dysfunction also greatly hinder anti-tumor T-cell responses in CLL. Small-molecule agents targeting the B-cell receptor (BCR) pathway and anti-apoptotic proteins alone or in combination with chemo-immunotherapy have revolutionized the management of CLL, yet there is still a significant need for novel therapeutic strategies to yield durable tumor elimination. Bromodomain and extra-terminal domain (BET) proteins are epigenetic readers that bind to acetyl-lysine residues on histones to regulate gene …

Novel Spirocyclic Dimer (Spid3) Displays Potent Preclinical Effects In Hematological Malignancies, Alexandria Eiken

Theses & Dissertations

Chronic lymphocytic leukemia (CLL) is a heterogeneous disease characterized by the accumulation of mature CD5⁺ B-cells in the peripheral blood, bone marrow, and secondary lymphoid tissues (e.g., spleen and lymph nodes).Despite the efficacy of front-line therapies, CLL is still an incurable disease, highlighting the need for development of novel therapeutics and further study of resistance mechanisms. Within the lymph node CLL tumor microenvironment (TME), there is an upregulation of gene signatures associated with B-cell receptor (BCR) and downstream nuclear factor kappa B (NF-κB) signaling compared to CLL cells found within the blood or bone marrow niches. Additionally, BCR signaling …

Moonlighting: A Pilot Project To Assess Impact Of Extracurricular Activities On Career Satisfaction And Quality-Of-Life In Graduate Medical Education, Charlotte O'Sullivan, David Lee, Karen Childers, Justine Nasr

Conference Presentation Abstracts

Background: Moonlighting is the delivery of healthcare outside of training programs in exchange for compensation. The Accreditation Council on Graduate Medical Education allows individual training programs to permit or restrict moonlighting, which leads to variation in prevalence and practice. Guidelines and regulations for moonlighting vary greatly across graduate medical education programs. Yet, limited research has been done to determine resident and fellow physician attitudes towards moonlighting and its impact on quality-of-life. Objective: This pilot study investigates how participating in moonlighting and extracurricular activities may impact resident and fellow physicians’ self-perceptions of quality-of-life and career satisfaction. Methods: 442 residents and fellow …

Applications Of Deep Learning With Detecting Intracranial Aneurysms On Ct Angiograms: A Literature Review, Christian Fang, Emily Wang

Rowan-Virtua Research Day

INTRODUCTION

Deep learning is a method of artificial intelligence involving progressively layered neural networks to extrapolate patterns from data to provide predictions. Moreover, given the arduous nature required for examining CT scans for intracranial aneurysms, discovering ways to expedite this process is beneficial. The use of deep learning to evaluate CT angiograms for intracranial aneurysms has been sparsely studied. This literature review aims to determine the accuracy and reliability of deep learning to analyze CT angiograms in patients suspected to have intracranial aneurysms.

METHODS

A qualitative review of literature using PubMed, SCOPUS, and EMBASE was conducted. Inclusion criteria comprised articles …

Evaluating C-Reactive Protein Associated Risk Of Cardiovascular Disease In Patients With Autism Spectrum Disorder, Brandon Cunha, Andrea Iannuzzelli, Rohan Mehra

Rowan-Virtua Research Day

This study examines the relationship between C-reactive protein (CRP) levels and cardiovascular disease (CVD) risk in 293 patients with Autism Spectrum Disorder (ASD) from the Rowan-Virtua Regional Integrated Special Needs Center (RISN Center). Baseline CRP values were gathered from EMR and evaluated for CVD risk. ASD patients have increased prevalence of CVD risk factors, and the literature demonstrates a strong relationship between CRP and CVD risk in this population. Patients were stratified by severity of ASD to investigate potential differences. Severe limitations in EMR data and overall sample size limited the generalizability and significance of this study. Larger scale studies …

Exploring Illness Beyond Disease: Development Of A Sense Of Identity In Patients With Inflammatory Bowel Disease (Ibd), Nicholas Totah, Jason Adam Wasserman

Posters

• Inflammatory bowel disease (IBD) poses significant challenges to an individual’s physical and emotional well-being, often reshaping their sense of self and life trajectories.
• Patient narrative can illuminate the illness experience in ways that are often unaddressed in the literature.

A Comparison Of Post-Operative Pain Management Following Lumbar Laminectomy Fusions Utilizing Tlip Or Intra-Operative Local Anesthesia Block, Lauren Eberhardt, Philip Zakko, Karen Childers, Daniel Park

Conference Presentation Abstracts

Background/Introduction: Spinal fusion patients suffer significant acute post-operative pain, potentially leading to chronic pain. Opioids are commonly used for peri-operative pain management despite significant side effects. The thoracolumbar interfascial plane (TLIP) and erector spinae plane (ESP) block, alternative analgesic options with rare side effects, have proven to reduce pain and opioid consumption compared to standard non-block care. This study aimed to determine if a significant difference exists between block groups with multi- and single level laminectomy fusions in post-operative and discharge opioid consumption and length of stay. Materials/Methods: A retrospective review was performed via data query for lumbar laminectomy fusion …

Summary Of: Feasibility Of Continuous Home Monitoring Of Particulate Matter And Lung Function In Patients With Chronic Obstructive Lung Disease Who Are Exposed To Wood Smoke, S Wayne, K Cowan, L.M. Paulin, J Emery, D.A. Kaminsky

Northern New England Clinical & Translational Research

Particulate matter (PM) contains microscopic solids or liquids that are so small they can be inhaled and cause serious health problems. Examples include smoke, dust, soot, and fumes.

There is increasing evidence that small particles have harmful effects on people’s breathing. Wood stoves are a source of indoor PM.

Smoking And Covid-19: An Analysis Of Demographics, Risk Factors, And Outcomes, Andrew Vrtar, Luca Cucullo, Richard H. Kennedy

Posters

• Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a respiratory pathogen that first emerged in late 20191 and was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020.
• Cigarette use is a significant public health concern throughout the world. Despite reductions in prevalence in recent years, tobacco smoking remains one of the main preventable causes of ill-health and premature death.
• Both tobacco smoking and vaping are phenomena that may increase the vulnerability of these individuals to COVID19 infection.4 Therefore, it is crucial to explore the medical consequences of and …

Analysis Of Ed Visitors For Dermatological Disorders Prior To And During The Covid Pandemic, Faris Alkhouri, Jacob Keeley, Ramin Homayouni

Posters

Dermatology-related Emergency Department (ED) visits make up more than 3% of total ED visits1; however, only around 2% of these visits can be considered true emergencies.2 To our knowledge, there are no studies that examined demographic influences on ED visits in regards to skin disorders in the adult population.

The sudden onset of the COVID-19 pandemic had significant effects on healthcare systems and policies, which resulted in a nationwide decline of 20-43% in ED visits.3 However, no studies have examined the impact of the pandemic on the presentation of skin disorders in the ED.

Use Of Early Enteral Nutrition In Mechanically Ventilated Covid-19 Patients, Vivian Chang, Ramin Homayouni, Virginia Uhley

Posters

Malnutrition in critically ill patients has been associated with a greater length of hospital stay, incidence of complications, and risk of death. Up to 37% of critically ill patients in the intensive care unit (ICU) are either moderately or severely malnourished1. Optimizing enteral nutrition delivery is key to maximizing the benefits of nutrition support for critically ill patients. At the onset of the COVID-19 pandemic in March 2020, the role of nutrition support for COVID-19 patients was poorly understood. In May 2020, the American Society of Parenteral and Enteral Nutrition (ASPEN) approved nutrition guidelines for COVID-19 patients that state that …

Association Between Primary Care And Emergency Department Utilization, Donna Kayal, Jacob Keeley, Ramin Homayouni

Posters

Emergency departments have been designed to provide rapid and accessible care for emergent and acute needs for a broad scope of illnesses and injuries.1-2 However, the emergency department (ED) has been facing an overwhelming increase in demand, leading to an increase in wait time and significant overcrowding, which decreases the effectiveness of the ED.1-4 A common explanation that has been noted over the years is utilization of ED services for non-emergent care, which professionals have often labeled as “inappropriate use.”2,5 Such encounters take away time from ED physicians and health care workers, compromising the care for true emergencies and leading …