• 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.
    • 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.
    • Chemotherapy Induced Cardiotoxicity

      Proto, Gabrielle Elizabeth; Salmon, Arlene (2021)
      Cancer affects approximately 38.4% of the population and is the second leading cause of death in America. Treatment for cancer has improved and the number of cancer survivors is expected to increase from about 11.7 million in 2007 to 18 million by 2020. However, chemotherapy and radiation therapies for cancer can have long lasting effects for patients. One notable side effect is cardiotoxicity, most commonly caused by anthracycline chemotherapeutic agents. There are several detection methods for anthracycline induced cardiotoxicity and treatment options to manage and prevent heart failure. The most promising diagnostic procedure has been tracking the decline of Left Ventricular Ejection Fraction (LVEF). The only approved treatment by the FDA is Dexrazoxane, though it is only approved for patients under 16. Adult patients are treated prophylactically with organic heart failure medications. Efficient detection and rapid treatment have become a high priority due to the increasing number of cancer survivors and therefore increased number of patients who will experience cardiotoxicity from their treatments.
    • Clinical Reasoning in the Management of a Patient with Low Back Pain in Multiple Classification Categories: A Case Report

      Orton, Nicholas; Moran, Kristen Doolittle; Lucado, Ann (2021)
      Low back pain is one of the most common reasons for individuals to seek physical therapy. While prevalent, low back pain can be difficult to classify and treat. Multiple evidence-based classification systems exist with varying approaches to treatment. Case Description: This case report explores the clinical reasoning in the treatment of a patient falling into multiple low back pain classification categories based on the impairment/functional-based classification system. The patient is an otherwise healthy female presenting to physical therapy with a chief complaint of an acute flare-up of persistent low back pain. The rationale behind the sequence in which classification categories were addressed, the decisions behind when to change categories based on emerging data, and the intervention strategies implemented to successfully manage this patient are illustrated. Outcomes: The patient was seen for a total of 13 visits over a span of two months. At discharge, the Revised Oswestry Disability Index for low back pain and the numeric pain rating scale demonstrated improvement with achievement of all patient goals, return of function, and ability to manage symptoms independently. Conclusion: Use of the impairment/functional-based classification system approach to low back pain management proved beneficial and effective. This classification-based approach may assist in clinical decision making when treating individuals with acute flare-ups of persistent low back pain.
    • Contraception in Adolescent Women: Helping Your Patient Choose and Use

      Cook, Ivy; Dickerson, Lisa (2021)
      There are numerous contraceptive methods on the market, yet rates of unplanned pregnancy continue to be problematic among adolescent female patients in the United States. This reality poses the question “What are we missing?” It is imperative that clinicians have a good understanding of the unique social, economic, physical, and psychologic factors that influence adolescent females’ contraceptive choices. This poster outlines some of those variables and influences, including attributes of contraceptive methods, economic considerations, cultural influences, relationship with both sexual partners and parents, sexual education, confidentiality concerns, and social media influences. It is important that providers are able to incorporate this knowledge into their conversations about reproductive health, so this poster also lists effective interview questions and strategies for discussing contraceptive options and expectations with adolescent patients.
    • COVID-19 Subunit Vaccine: A novel microparticulate microneedle vaccine using spike S1 protein

      Patil, Smital Rajan; Vijayanand, Sharon; Joshi, Devyani; Gomes, Keegan Braz; Menon, Ipshita, J; D'Souza, Martin J. (2021)
      COVID-19 has affected around 118 million people and caused more than 2 million deaths worldwide. Currently, the Food Drug Administration (FDA) authorized vaccines such as Pfizer for COVID-19 require cold chain storage, thus their availability in developing countries is challenging. Microparticles (MPs) are suitable delivery vehicles for vaccine antigens as they are better taken up by antigen-presenting cells, and they eliminate the need for cold chain storage. The spike S1 protein is a suitable antigen candidate due to its ability to produce a robust immune response. For this study, the spike protein was loaded into poly (lactic-co-glycolic acid) (PLGA) MPs and then incorporated into dissolving microneedles, a promising delivery system for large molecules such as proteins. The microparticles were characterized and assessed for innate and adaptive immune response in vitro. The vaccine particles induced a significantly higher nitrite production in mammalian cells compared to control groups. They also exhibited significantly higher expression of antigen-presenting molecules: major histocompatibility complex (MHC) I, CD80, MHC II, and CD40 on the surface of the dendritic cells. This formulated vaccine thus shows high immunogenicity in vitro and has the potential to produce a robust immune response in a murine model, conferring long-lasting protection against coronavirus. This has the potential to be a promising vaccine in the ongoing COVID-19 pandemic the world is facing currently.
    • 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.
    • Cultural Responsiveness in Counseling and Counselor Education

      McDonald, C. Peeper; Burch, Shakenya; Davis, Dazzmen (2021)
      Given the continued and steady growth of diversity within the United States population (Tran et al., 2016; Vespa et al., 2020) and the discourse around social injustice in all it's forms, it is more important than ever that the strengths-based approaches to counseling be infused with cultural responsiveness. As a result, cultural responsive approaches will be discussed as it relates to counseling and teaching to create social change. In this way, this presentation will not only educate the general public about how professional counselors and educators are utilizing best practices for serving traditionally minoritized and under-represented groups, it will illuminate advocacy action efforts perpetuated through cultural responsiveness.
    • 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.
    • Direct regulation of cerebral artery contractility by simvastatin and rosuvastatin

      Zerin, Farzana; Pandey, A.; Hasan, A.; Menon, S.; Hasan, R. (2021)
      Statins are amongst the most widely prescribed drugs in the world with a range of vascular effects that have been primarily attributed to the inhibition of cholesterol and mevalonate biosynthesis, and the inhibition of mevalonate-dependent Rho/ROCK signaling upon long-term treatment. However, no studies have investigated the direct effects of acute statin application on fresh isolated resistance cerebral arteries using therapeutic concentrations of statins. Here, we examined acute vascular effects of therapeutically relevant concentrations of statins on male and female Sprague Dawley rat cerebral arteries and underlying molecular mechanisms using pressurized arterial myography as well as Ca2+ fluorescence and diameter measurement. Our data showed that the application of 1nM rosuvastatin and simvastatin constricted cerebral arteries within 2-3 minutes of drug application. The removal of extracellular Ca2+ with EGTA or the application of nimodipine, a selective blocker of smooth muscle cell voltage-gated Ca2+ channel, CaV1.2, each abolished cerebral artery vasoconstriction by statins, indicating that the Ca2+ entry through CaV1.2 plays a critical role here. Since Ca2+ entry into smooth muscle cells induces Ca2+ release from intracellular Ca2+ stores such as sarcoplasmic reticulum and endoplasmic reticulum. Altogether, our data suggests that smooth muscle cell CaV1.2 opening and Ca2+ influx is the primary mechanism underlying statin-induced constriction of cerebral arteries.
    • 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.
    • Drug Use In The LGBT Community

      Cleary, Drew (2021)
      Drug use in the LGBT community is a large problem. Rates of drug use in the community is higher than in the heterosexual community. There are several factors that contribute to the high rates that are unique to the LGBT community. One way to conceptualize these unique factors is to use the minority stress model. There are a few therapeutic options as well as directions for future research.
    • 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
    • ED Treatment of Acute Ischemic Strokes: The Future of the Brain Cath Lab

      Crider, Allie; Bedoya, Damien (2021)
      Acute ischemic strokes are defined as a sudden cessation of blood flow to an area of the brain, resulting in hypoxic death of brain tissue and subsequent loss of neurologic function. They are a leading cause of serious disability worldwide and cost the US healthcare system roughly $3.2 billion per year.1 Historically, first-line treatment for acute ischemic strokes has been thrombolytic therapy with Tissue-Type Plasminogen Activation (tPA), which works by systemically altering the blood�s clotting cascade. tPA is a very effective therapy, however, it carries with it a significant risk of life-threatening bleeding events. Because of the wide array of contraindications to tPA, many patients with prior history of bleeding, anticoagulation use, or prolonged presentation of symptoms are ineligible for this therapy. Mechanical thrombectomy (MT) is an alternative treatment which involves placing catheter-guided stents directly at the site of intravascular blockages in the brain. This method has primarily been reserved for patients in which systemic anticoagulation is contraindicated and was considered a second-line treatment for years. During the early 2010�s, several studies supported the consideration of mechanical thrombectomy as an additional first-line treatment choice in certain patient populations, rather than strictly as an alternative to tPA. This research is essential in determining the safest, most effective treatment for stroke patients on an individual level. It may also lead to expedited triage protocols in the emergency department and faster time to treatment.
    • Effect of barrier integrity on topical/transdermal delivery of diclofenac sodium via iontophoresis

      Dandekar, Amruta; Kale, Madhura S.; Mahadevabharath, R. Somayaji; Garimella, Harsha T.; Banga, Ajay K. (2021)
      Introduction: Application of a drug product on compromised skin may result in altered drug delivery leading to potential systemic toxicity. In this study, we investigated the effect of barrier integrity on the topical and transdermal delivery of brand: generic pair of diclofenac sodium (model anti-inflammatory drug) via iontophoresis. Methods: In vitro drug permeation studies were performed on normal and compromised skin using vertical Franz diffusion cells. A compromised skin model was created using ten tape strips on dermatomed human skin. We compared marketed brand and generic formulations of diclofenac sodium (Voltaren� and 1% diclofenac sodium topical gel by Amneal) via cathodal iontophoresis (0.5 mA/cm2; 2h followed by passive delivery till 6h) using 700 �L of formulation. Results/Conclusion: No significant difference observed between brand and generic formulations for delivery of diclofenac sodium via normal (149.78�18.43�g/cm2(brand);145.53�12.61�g/cm2(generic)) and compromised skin (233.13�8.32 �g/cm2(brand); 242.07�11.17 �g/cm2(generic)). The total delivery of diclofenac was significantly higher for the brand-generic pair into and across compromised skin as compared to normal skin indicating the effect of barrier integrity on delivery of diclofenac sodium. However, there was no significant difference in skin delivery of diclofenac sodium for normal (94.18�15.08 �g/cm2 (brand); 76.97�14.15 �g/cm2 (generic)) and compromised skin (76.74�8.75 �g/cm2 (brand); 72.36�5.18 �g/cm2 (generic)).
    • 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.
    • Evaluating and comparing release profiles of four different non-prescription niacin formulations

      Shah, Sarthak; Uddin, Mohammad N. (2021)
      Niacin, nicotinic acid or vitamin B3 is critical portion of a balanced nutritional diet. None of the niacin's dissolution profiles were evaluated and compared in literature. Niacin, a supplement, is not subjected to Federal Drug Administration (FDA) monitoring. The study compared several different formulations such as immediate release (IR) powder, IR tablet, timed release (TR) capsule, extended release (ER) capsule, and controlled release (CR) tablet to validate the claims for each formulation provided by the manufacturer. In our in vitro study, dissolution apparatus was used. Two different media were prepared, simulated gastric fluid (SGF) at pH 1 and simulated intestinal fluid (SIF) at pH 7. UV/VIS Spectrophotometry for analysis was used. In IR form, maximum concentration was 80% concentration of the label's claim. In ER, in pH 7, drug remained constant at about 50% niacin concentration over 24-hour period. In TR, in both pH conditions, the maximal niacin release concentration was about 65-70%. In Slo-Niacin tablets, release rates were consistent in both pH 1 and pH 7. Our findings illustrate that the four release forms (IR, ER, TR, CR) and their modified drug formulations are aligned with their release definitions. Further research is encouraged and should evaluate other non-FDA formulations.
    • Evaluation of Hypoglycemia Causes and Treatment at a Community Hospital

      Carbone, Kristina; Murphy, Sarah (2021)
      Hypoglycemia is defined as dangerously low blood glucose levels of less than 70 mg/dL where action, such as administration of glucose, is required to raise the blood glucose levels to the target range. This review seeks to analyze hypoglycemic episodes to determine the cause of hypoglycemia, assess treatment, and identify areas for improvement to enhance patient outcomes and prevent hypoglycemia. This is a retrospective chart review of patients who experienced a hypoglycemic event during their stay between 1/2020 to 12/2020. Patients who experienced a blood glucose level less than 70 mg/dL were identified and randomly selected for review. Patients under 18 years of age and obstetrical patients were excluded. 120 patients were reviewed, with a median blood glucose of 59 mg/dL. 19.2% of patients experienced a severe blood glucose less than 50 mg/dL. Basal insulin was the most common cause of hypoglycemia along with low feeding status. Average time between last basal insulin dose and hypoglycemia was approximately 10 hours with a majority of basal insulin given in the evening and hypoglycemia occurring in the morning. 95.8% of patients had the institutional standard hypoglycemic treatment protocol orders available for use prior to the hypoglycemic event, and 62.5% of patients were treated per protocol. The treatment protocol should always be used to treat hypoglycemia to ensure standardization, and education to nurses on how to use the protocol appropriately is necessary.
    • Finding Clarity Through My ePortfolio (Capstone ePortfolios and Synthetic Learning)

      Adams, Brooke (2021)
      This presentation showcases some of the ePortfolios created by senior Liberal Studies majors. To improve students’ reflective skills and increase their chances of creating effective syntheses of their work to date, the Liberal Studies Department began using ePortfolios in the major. These student ePortfolios represent the results of the first time seniors in LBST 498 (Senior Capstone) used the ePortfolios. 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. This presentation showcases some of the ePortfolios created by senior Liberal Studies majors. To improve students’ reflective skills and increase their chances of creating effective syntheses of their work to date, the Liberal Studies Department began using ePortfolios in the major. These student ePortfolios represent the results of the first time seniors in LBST 498 (Senior Capstone) used the ePortfolios. 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.
    • FoxM1 upregulation correlates with worse recurrence-free survival in breast cancer

      Nguyen, Tro; Nahta, Rita (2021)
      Breast cancer is the second most deadly malignancy among women in the US. Breast cancers harbor intrinsic heterogeneity, allowing stratification into molecular subtypes. Basal-like breast cancer (BLBC) is an aggressive subtype with a high rate of metastasis and poor overall survival. Due to poor understanding of the molecular drivers, few therapeutic options exist for BLBC. Studies suggest that the forkhead box M1 (FoxM1) transcription factor is upregulated in breast cancer. However, the clinical implications of FoxM1 upregulation, including in BLBC, remain unclear. The aims of this study were to (1) compare FoxM1 expression in breast cancer vs normal breast, and (2) correlate FoxM1 expression with clinical outcome using publicly accessible databases. First, we searched breast cancer datasets in Oncomine using FoxM1 as a query term. FoxM1 expression was significantly (p<0.001) higher in invasive ductal breast carcinoma vs normal breast. Next, we searched the KM Plotter breast cancer database using FoxM1 as a query. Among 4,929 patients with breast cancer, median recurrence-free survival (RFS) was significantly (p<0.001) lower in patients with high (upper quartile, 34.13 months) vs low (upper quartile, 80 months) FoxM1 expression. A sub-analysis for BLBC (n=846) demonstrated that median RFS did not significantly (p<0.053) differ in patients with high (upper quartile, 25.2 months) vs low (upper quartile, 26 months) FoxM1. These results suggest that FoxM1 is upregulated in breast cancer in association with worse clinical outcome. Future studies will examine the mechanisms through which FoxM1 is upregulated and strategies for targeting FoxM1 in breast cancer.