• School-Based Health Centers and Mental Health Access among Minority and Low-Socioeconomic Adolescents

      Barfield, Kailey; Martinelli, LeAnne (2021)
      School-Based Health Centers (SBHCs) are comprehensive health clinics that provide a myriad of services to the students that they serve. SBHCs are meant to overcome barriers students face when it comes to accessing healthcare such as transportation, limited clinic hours, and parent work schedules. However, many of the most vulnerable populations - like those living in poverty and those that identify as racial/ethnic minorities - may still encounter barriers when it comes to accessing mental healthcare. A review of previous studies was done, and suggestions were provided for improved access to mental health services through SBHCs to even the most vulnerable populations.
    • Pen Pal Project to Write Away Isolation: An IRB-approved Project Aimed at Decreasing Isolation During a Global Pandemic

      Barfield, Kailey; de la Cruz, Jennifer; Lepp, Erin F. (2021)
      As the COVID-19 pandemic radically upended the daily lives and routines of many people, those considered vulnerable faced increased physical isolation due to efforts of increased protection. While interventions such as social distancing have been appropriate to maintain physical health, mental health has taken the brunt of the pandemic. To create connections while maintaining safe physical distance, a letter writing project was created between Mercer Physician Assistant Students and volunteers in the community. This project was created for the Paul Ambrose Scholars Program in which students in medical professions are selected to design a community health project focusing on one of the Leading Health Indicators (LHI) of Healthy People 2020. Suicide was the LHI chosen for this project. As depression increases among elderly, isolated individuals during the pandemic, the risk of suicide increases as well. Letter writing is a cheap, easy way to maintain emotional connections with others despite social distancing guidelines. This project has been IRB approved and included nineteen Mercer Physician Assistant (PA) students and nineteen volunteer letter recipients throughout the United States. A screening tool was used to assess depression levels of volunteer letter recipients both prior to and after receiving letters from PA students over the course of 4-5 months. This poster is a summary of the research project.
    • Analysis of Student Roles in COVID-19 Contact Tracing and Case Investigation Efforts

      Hernandez, Arlette; Batten, Ashley; Thomas, Joy (2021)
      In December of 2019, Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China and would be marked as the beginning of the COVID-19 pandemic. COVID-19 is caused by the SARS-CoV-2 virus, and is most commonly transmitted via person to person through exposure to respiratory droplets. The Center for Disease Control and Prevention issued an agency-wide response that involved several guidelines for local Health Departments to implement disease tracking strategies to mitigate the spread of the virus. The practice of contact tracing has been continuously supported as a procedure for the control of low-prevalence infectious diseases by identifying individuals who may have been exposed to a person with suspected or confirmed infection of a pathogen. In the COVID-19 response, the "contacts" of confirmed COVID-19 cases were referred by public health authorities to isolate or quarantine themselves during their possible infectious period. In April of 2020, Mercer University's Department of Public Health informed their Master of Public Health student body of their partnership with the Georgia Department of Public Health. Since then, 18 students have participated in contact tracing across Georgia. Some students have used these opportunities for practicum completion, and some as part-time positions. Students were given the opportunity to highlight their experiences as a Contact Tracer and lend their perspective about its effectiveness in controlling the spread of COVID-19.
    • The Progression From My ePortfolio To My Writing Major

      Cantrell, April (2021)
      Developing an ePortfolio purposefully walks you through the process of understanding and conceptualizing your general education and major courses with your specific path followed to develop and explain your major. Simply knowing that I wanted to write or be a writer wasn't necessarily specific enough. Why did I want to be a writer? Did I have a purpose? The ePortifolio was a light to the path that helped me understand that I want to write to heal others as they read and to self-heal the writers emotional struggles. Narrowing the broad concept of a major in writing to the narrow concept of writing with the intention to heal others and myself through writing is the result of my ePortfolio.
    • Capstone ePortfolios and Synthetic Learning

      Winkler, Andrea (2021)
      ePortfolios are considered the eleventh high-impact practice by the AACU. Done well, they do not merely store artifacts that record a student’s progress. They actively encourage students to reflect on their work and to synthesize it. They focus attention on the process of learning, and make that learning visible to student, faculty, and others alike. The LBST 498 ePortfolio required students to explain their degree to the public in a succinct format. The process of selecting artifacts, explaining them, and using them to make meaning for themselves of their degree helped students actively to synthesize their experiences with the perspectives they had gained through their concentrations and core courses. By demonstrating recent ePortfolios, we intend to document the initial success of the ePortfolio program, and generate discussion about the role of reflection in increasing student success.
    • Assessment of a Best Practice Alert in Managing Patients on Anticoagulation

      Olocha, Queen O.; Patel, Sweta; Elliott, Jennifer (2021)
      Estimated 900,000 patients in the United States and nearly 1 million patients worldwide have Venous Thromboembolism (VTE). Untreated VTE can lead to long-term morbidity and mortality with an increased risk of stroke, heart failure, and death. The use of Best Practice Alerts (BPAs) to encourage prophylaxis will reduce the frequency of VTE among high-risk hospitalized patients as well as educating medical clinicians and adhering to guidelines. BPAs are clinical support tools accessible through EHR to alert the clinicians about a particular element of a patient's care, such as improper dosing, platelet counts, high serum creatinine, infections, blood transfusions, or overuse of testing. The usage of BPAs integrated with the EHR can bring attention to clinicians when prescribing anticoagulants to non-indicated patients and better educate physicians. Single-center, retrospective, chart review study assessed eligible adult patients who were prescribed anticoagulants for VTE prophylaxis. Eligible adult patients were 18 years old and older and were at increased risk for venous thromboembolism. The following were determined: the accuracy of the BPAs firing related to VTE prophylaxis and the providers' acceptance of BPA recommendation. A VTE prophylaxis report was processed through EPIC� at Grady Memorial Hospital between July 27, 2019 � August 26, 2019. One hundred patients were identified, and 207 BPAs were fired during this period. Electronic orders were searched for VTE prophylaxis and mechanical prophylactic measures, including sequential compression devices. Patient notes were screened for past/present medical history, accidents, providers, surgeries/procedures, length of stay, or social history. A list of active and discontinued medications was also screened for the presence of prophylactic pharmacologic measures, including UFH/Lovenox, aspirin, DOACs, or Warfarin. One hundred patients identified and 207 BPAs. The number of BPAs was fired per unique patient weekly and by floor unit. The firing of the BPAs related to VTE prophylaxis was 94.5% accuracy for 36 patients. The provider could not prescribe each unique patient with anticoagulation therapy due to having PCI, dementia, or timing when the BPA fired. During the study period, BPA was accurately fired and assessed. The assessment showed that VTE prophylaxis was not needed due to a specific event that the patient may have had. This specific BPA improved the appropriate management of anticoagulation for VTE prophylaxis in patients.
    • Use of Progressive Neurodynamic Exercises in Conservative Treatment of Acute Lumbar Radiculopathy

      O'Neill, Kathleen; Christ, Tom; Collier, Beth (2021)
      Background: Radiculopathy occurs when there is compression of the nerve at the level of the spinal nerve root. The clinical presentation of radiculopathy depends on the level of spinal compression but involves corresponding diminished reflex, impaired dermatomal sensation, and myotomal weakness. Current research supports conservative physical therapy management of acute low back pain with a symptom modulation approach including manual therapy, directional preference exercises, or traction. The objective of this case report is to explore the effectiveness of incorporating progressive neurodynamic exercises into physical therapy treatment of acute lumbar radiculopathy. Case Description: A 26-year-old female patient presents to an outpatient physical therapy clinic with complaints of right lower extremity weakness, numbness, and pain. Myotomal, dermatomal, and reflex testing revealed signs and symptoms consistent with L5-S1 lumbar radiculopathy. The patient was conservatively treated with progressive neurodynamic exercises in addition to traction and other manual therapy techniques. Patient saw significant improvements in lower extremity neurodynamics, pain, and function following 14 sessions of interventions. Discussion: Further research involving larger, randomized control trials are needed to explore whether utilizing progressive neurodynamic exercises should be more regularly incorporated into existing guidelines for conservative management of acute lumbar radiculopathy.
    • Does the Use of Health Apps to Monitor Hypertension Improve the Knowledge, Attitudes, and Practices of African-Americans towards Hypertension Self- and Active-Management

      Lindsey, Jacquetta; Ramadan, Awatef A. Ben (2021)
      Showcase: Does the Use of Health Apps to Monitor Hypertension Improve the Knowledge, Attitudes, and Practices of African-Americans towards Hypertension Self- and Active-Management First Author: Jacquetta Lindsey Co-author: Awatef Ben Ramadan Background: Despite the many medical advancements available today, cardiovascular disease remains the leading cause of death in the African American community. Hypertension is considered the most modifiable cardiovascular disease, and African Americans are disproportionately affected by this disease � 43% compared to 28% of White Americans. Study Aim: To determine if the knowledge, attitudes, and practices (KAP) of African Americans towards hypertension self-management and active engagement in the healthcare process improved with the use of a mobile health application to monitor their condition. Methods: Study participants were recruited from community-based resources. Participants first completed a pre-survey to determine their baseline KAP. Next, they downloaded the AVAX Blood Pressure Diary to daily monitor their blood pressure. Lastly, participants completed the post-survey and system user satisfaction (SUS) survey on the blood pressure application. Results: Majority of the participants were women (70%) with 50% on medication for their hypertension. Most of the participants (87.5%) believed that their hypertension was better managed after using the health app. The average SUS score for the hypertension mobile health application was 89.75. Conclusion: It appears that the mobile health application assisted participants with monitoring their blood pressure daily and being aware of changes that needed to be made to improve their self-management.
    • Assessment of Mercer University Students' perceptions and Attitudes about the University's Sudden transfer to the Total Online Learning Environment due to COVID-19 Pandemic

      Ramadan, Awatef A. Ben (2021)
      The study investigator constructed a survey tool to assess and evaluate the students' reactions to the sudden and massive transformation of the Mercer learning environment. Study Aims: To assess Atlanta College of Professional Advancement students' perceptions and attitudes about the sudden transfer to the total online learning environment due to the COVID-19 pandemic. The results of this study are expected to: � Collect relevant and robust evidence on the massive and sudden transformation's influence on our students. Therefore, we could help our leaders and policymakers plan, tweak, and issue effective and efficient evidence-based policies and interventions that suit our students' preferences and expectations now and help them prepare and control similar crises in the future. The students' opinions, attitudes, and perceptions are important for us to be sure that we are meeting their expectations, enabling them to attain their courses' learning objectives, and serving them smoothly and efficiently throughout this health crisis. Study design: A cross-sectional descriptive study targeted all undergraduate and graduate students of Atlanta College of Professional Advancement, used an online self-administered survey. Survey: It is a structured questionnaire with closed-ended questions. The study tool composed of 54 structured questions. Data Analysis: The survey link has been disseminated through mercer emails to the participants. The survey has published from March 24, 2021 to the present. In this poster, we present the results that we retrieved from the survey monkey's results link from March 24 to April 1, 2021.
    • Topical and Transdermal Iontophoretic Delivery of Methotrexate in Healthy and Psoriatic Human Skin

      Vora, Deepal; Somayaji, Mahadevabharath R.; German, Carrie; Banga, Ajay K. (2021)
      Psoriasis is a condition of the skin which involves scales, dry patches, and inflammation. Methotrexate (logP: -0.236, MW: 454.44 g/mol) is administered orally or intravenously to treat psoriasis. The first pass metabolism and systemic side effects associated can be avoided by transdermal delivery. We investigated the iontophoretic delivery of methotrexate using healthy and psoriatic human skin to understand the effect of skin�s disease condition on topical and transdermal delivery. In vitro permeation testing using vertical Franz diffusion cell were conducted. Cathodal iontophoresis (0.5 mA/sq.cm for 4 h) delivered a significantly higher total amount of methotrexate into the skin and receptor when compared to that delivered by passive diffusion and anodal iontophoresis. A current density of 0.2 mA/sq.cm using cathodal iontophoresis and 10mg/mL donor concentration was optimized to obtain the target delivery through healthy human skin. There was no significant difference in receptor delivery for psoriatic skin as compared to healthy skin, while significantly higher methotrexate delivery in skin was observed for psoriatic skin as compared to healthy skin. Thus, cathodal iontophoresis delivered a significantly higher total amount of methotrexate as compared to passive diffusion and anodal iontophoresis. Significantly higher delivery in skin and hence significantly higher total delivery was observed for psoriatic skin as compared to healthy skin.
    • A Novel Diagnostic Method for Detection and Quantitation of Paralytic Shellfish Poisoning in Humans

      Vakkalanka, Mani Deepika; Knaack, Jennifer S.; Strom, Grady J. (2021)
      Paralytic shellfish toxins(PSTs) are potent neurotoxins which bind to the voltage gated sodium channels and prevent the conduction of action potentials leading to respiratory paralysis and death. Gonyautoxins(GTXs) 1,2,3,4 are the most potent PSTs and testing them in human matrices is the best approach to quantify the exposures. Here, we describe a solid phase extraction method for extracting GTXs from human plasma using HILIC HPLC-MS/MS analysis. Pooled plasmas were spiked with GTXs and extracted using strong cationic exchange cartridges. These cartridges were conditioned with methanol and acetate buffer and eluted with 5% ammonium hydroxide in methanol. Calibrants were prepared at the following concentration ranges: GTX1 8.13-517.66 ng/mL, GTX2 6.98-473.25 ng/mL, GTX3 2.96-200.68 ng/mL and GTX4 2.56-162.91 ng/mL. Eight plasma specimens were spiked with toxin at a concentration of 173.85ng/ml. All the samples were extracted and injected onto HPLC-MS/MS for analysis. The developed method was validated according to FDA guidance for bioanalytical method validation. The method showed good percent accuracies for all the toxins: GTX1 95-104%, GTX2 92-114%, GTX3 92-117%, GTX4 92-107%. Precision ranged from 3.5 to 10.9% for GTX1, 3.03 to 11.25% for GTX2, 3.01 to 12.72 for GTX3 and 2.08 to 10.49 for GTX4. Recovery of GTXs from specimen plasmas were between 83.27% to 110.55%. We have successfully developed a fast and simple diagnostic method accessible to common clinical laboratories.
    • Usability Study on MyChart Mobile Health Application

      Ahmed, Nasra (2021)
      With technology constantly growing it is important for the gap between patients and their healthcare providers to close. Mobile health applications have made it easier for patients to access their personal health information at the tip of their fingers where and when it is needed. It is important for patients to be able to access this information even when they are not present with their healthcare provider. By doing so, they patients are able to be engaged and make informed decisions about their health. There were many usability problems associated with MyChart that required a usability testing. Some of these problems were that poor navigation, too many steps, and undetected errors. The purpose of this project was to test the user interface of the MyChart mobile health application against its usability issues. Conducting a usability test gave me the opportunity to determine and identify some of the participants issues as it relates to the mobile health application. It was important to observe and conduct this study so that I can gather the results to determine the efficiency and effective on the mobile application with their personal experience. As a result of this project I was able to determine how certain usability issues made a difference in the users overall experience with the mobile health application. I was also able to use the 10 usability heuristics and evaluate them against the MyChart mobile health application.
    • Technology Implementation: How it Reduces the Transmission of HIV/AIDs in Low-income/Rural Communities

      Walker, Brittany (2021)
      Sexuality, race, age, education, and socioeconomic status are all actors in HIV transmission. In a sense, socioeconomic status encompasses all factors which directly affect the quality of life and privileges offered to people. The lack of resources in low-income communities is directly linked to risk behavior; people who lack resources are more likely to participate in drug use and high-risk sexual behaviors. Also, individuals who experience homelessness are more likely to engage in sexual behaviors in exchange for money, housing, and food are also at a higher risk of contracting/transmitting HIV; this is also the case for people who lack nutritional resources. Though it cannot be said that poverty causes HIV, poverty is highly correlated with HIV infection rates. Implementing technology utilization in clinics within impoverished communities can positively impact subjects at a higher risk of contracting and transmitting the disease. By combining technology and education, access to health care and other resources are accessible to at-risk subjects.
    • Coworker Support Amplifies Reactions to the COVID-19 Pandemic for Working Parents

      Donnelly, Lilah; O'Brien, Kimberly; Shepard, Agnieszka (2021)
      The COVID-19 pandemic directly threatened our health and safety, while contradictory scientific and media reports generated uncertainty. Employees likely relied on their coworkers for emotional support and to make sense of the confusion. In this study, we evaluate the role of coworker support, which has been shown in the past to have either ameliorative (as a resource) or exacerbating (as social information) results. We use data, collected from a heterogeneous sample of working parents in May of 2020 (when most states were getting ready to lift their stay-at-home orders), to illustrate the path from resilient personal resources (measured as optimism, generalized self-efficacy, and internal locus of control) to fear of COVID-19 to workplace outcomes in a multiphasic study design. Employees with more optimism, generalized self-efficacy, and internal locus of control reported less fear of COVID-19, and in turn, less decrement to their workplace outcomes. This mediation is moderated by coworker support, such that the indirect effect is amplified by coworker support. This is consistent with previous research, which shows that coworker support can unintentionally corroborate and amplify employee stress perceptions. We therefore recommend that, when faced with significant adversity, organizations provide communication training oriented toward increasing positive coworker interactions and guiding social information.
    • Platelet-Rich Plasma for Chronic Plantar Fasciitis

      Shimada, Yoichiro; Heard, Henry (2021)
      Platelet-rich plasma (PRP), also referred to as autologous platelet gel, has been increasingly used for musculoskeletal injuries, including Achilles tendonitis, shoulder impingement, rotator cuff tear, lateral epicondylitis, patellar tendinopathy, and plantar fasciitis. Chronic plantar fasciitis is defined as degenerative irritation of the plantar fascia that has failed to respond to conservative therapy, and it presents with non-inflammatory, fibroblastic hypertrophy and dysfunctional vasculature. With the chronic degenerative changes of the tissue along with zones of avascularity, chronic plantar fasciitis is difficult to treat, and the recurrence is common even after prolonged rest. Current treatments for chronic plantar fasciitis include corticosteroid injection, extracorporeal shock wave therapy, and surgery. Corticosteroid injections are common treatments for chronic plantar fasciitis; however, there are potential disabling complications associated with corticosteroid injections. PRP has been proposed as an effective, safer alternative treatment option for chronic plantar fasciitis. Due to the hypovascularity and hypocellularity nature of the injury, directly introducing growth factors and cytokines found in PRP to the fascia is believed to promote tissue heal. The purpose of this review is to examine current literature on PRP treatment for chronic plantar fasciitis.
    • Current Treatment for Hepatitis C Patients: A Review

      Purcell, Anna Lydia; Heard, Henry (2021)
      Hepatitis C is an RNA virus that affects millions in the United States and globally, but with recent pharmacological achievements, the cure rate of hepatitis C has increased greatly. Hepatitis C is transmitted by blood, with the main infections in the US being cause by IV drug use and blood transfusions prior to 1992. Hepatitis C has six genotypes, but the overwhelming majority of cases in America are genotypes 1, 2, and 3. Diagnosis of hepatitis C is difficult due to the lack of symptoms on presentation. Screening in high risk populations has shown to be efficacious in diagnosing the disease. Previous treatment norms consisted of interferon, but cure rates were very low. In 2011, direct-acting antivirals were introduced and revolutionized the treatment of hepatitis C. Response rates have increased exponentially to over 95%, and the medications are much more tolerable.
    • Emerging Migraine Treatment Monoclonal Antibodies: Pathophysiology, Efficacy, and Recommendations

      Oliver, Hannah; Salmon, Arlene (2021)
      Migraines cause immobilizing headaches and are amongst the top causes of disability worldwide. In the past, migraines were understood as a vascular disorder, but in recent years researchers have attributed the cause of migraines to be a series of neurovascular events. This cascade of events causes a release of peptides, most notably, calcitonin gene-related peptide (CGRP) which triggers pain signals to be released from the trigeminal neurons in the brain. This development in comprehension has led to the production of a new treatment, monoclonal antibodies targeting CGRP, to treat migraines. Since 2018, four new drugs of monoclonal antibodies have been approved by the FDA and each drug has shown significant decrease in monthly migraine days when compared to placebo in people who suffer from episodic and chronic migraines. Today these medications are recommended in patients with migraines who have failed simple abortive therapy.
    • Catheter Directed Thrombolytics: Best Therapy for Pulmonary Emboli?

      Hill, Jonathan; Baeten, Robert (2021)
      Pulmonary emboli are blood clots in the pulmonary arterial vasculature that can lead to right ventricular strain, obstructive shock, and even death. Current treatment options for pulmonary emboli include anticoagulants, systemic thrombolytics, and/or surgical embolectomy. Although these therapies are usually effective, they are associated with side effects such as increased risk of bleeding, surgical site infections, and intracranial hemorrhages. Additionally, there are contraindications to these treatments that limit which patients are eligible. In the past 10 years, the use of catheter directed thrombolytics has emerged and appears to be a promising alternative to traditional therapies. This therapy has been shown to have similar efficacy to anticoagulation or systemic thrombolytics with a much lower risk of severe complications.
    • Dry needling with electrical stimulation in the post-ACL reconstruction management of a female basketball athlete with persistent quadriceps palsy: A case report

      Pyle, Rebecca; Lucado, Ann (2021)
      Background and Purpose: Anterior Cruciate Ligament (ACL) injury is common in sports.1 Well-developed protocols on post-surgical management do not address all potential complications. Our purpose is to determine the effectiveness of dry needling with electrical stimulation (DNES) to address persistent quadriceps palsy (PQP) post ACL reconstruction (ACLR). Methods: A 16-year-old female basketball athlete post-ACLR with quadriceps tendon graft followed the Baylor ACLR Accelerated Protocol with appropriate modifications. DNES to the quadriceps began at post-op week 15 for PQP. Findings: The Lower Extremity Functional Scale (LEFS), knee ROM, MMTs, and circumferential measurements were tracked. All surpassed significant values. Clinical Relevance: When neuromuscular electrical stimulation (NMES) is ineffective for PQP, DNES offers an alternative intervention strategy for increasing maximal voluntary contraction. Conclusion: Data suggest improvement in outcome measures and may promote voluntary muscle contraction of the quadriceps. Further research is required for optimal protocols. Keywords: Neuromuscular control, voluntary contraction
    • Analyzing propensity of hospital readmissions of diabetic customers to reduce medical expenditure

      Bandi, Ravi; Pokhriyal, Shitanshu; Khan, Shakeel A. (2021)
      Background: A large portion of hospital inpatient management expenditure is due to high readmission rates. Diabetes is one of the leading causes of re admissions for chronically ill patients. Analyzing readmission patterns helps proactively manage and reduce readmission, thus resulting in reduced medical expenditure. Objective of the study is to find factors that lead to readmission of Diabetic patients and identify key influencers impacting readmission rates. Study Design Methods: The data originated from Cerner EMR systems with instances for over 70,000 patients and has information on Inpatient admission, diabetes type, length of stay, Lab tests performed, and medications administered across 130 US hospitals We used Logistic Regression, Na�ve Bayes and Classification tree methods and Data visualization by using key influencers to identify the key factors. Results & Findings: Using the above data mining and visualization techniques, the study had key findings as below: - Outpatient Diabetics above age 40 with HBA1c level more than 8 are more likely to readmit. - Inpatient diabetic patients with higher number of prescribed medications and number of procedures are less likely to get readmitted. - Serum level analysis shows that with High glucose serum levels, the readmission rates are higher. - Higher HbA1c in patients has a direct relationship with re admissions. - Lab Procedures show high correlation with medications, diagnosis, and time in Hospital.