• A Comparison of 3 Methods of Neonatal Intensive Care Unit (NICU) Mortality and Morbidity Risk Scoring Assessments (CRIB, SNAPPE-II, NTISS): A Systemic Analysis

      Ul-Haque, Anum; Baskaran, Vikraman (2021)
      The NICU aims to provide real-time updates on the medical status of its infant patients. Along with medical techniques, the use of mortality risk scoring systems is necessary in enabling the medical team to make better predictions about the conditions of its patients. Currently, there are many scoring systems used in the NICU, each of which focus on different characteristics to assist the physicians and determine the best course of action and treatment plans. A few common NICU mortality scoring systems are CRIB, SNAPPE-II, and NTISS. CRIB and SNAPPE-II assess infant morbidity at different timepoints post-birth in a cross-sectional methodology. NTISS conducts continuous observations in a longitudinal methodology to record patient healthcare outcomes after different treatments are applied. To conduct thorough research on these NICU patient mortality and morbidity scoring systems, literature searches will be conducted to determine the prevalence of these NICU scoring systems. Specific keywords will be utilized to search multiple databases related to the NICU by focusing on patient categorizations, successful variables, and ineffective scoring systems. After this preliminary research, the evolution of these systems over the past 20 years will also be studied, to learn how the scoring techniques were modified for different clinical scenarios. Finally, a new NICU scoring system will be proposed for future implementation, and a systematic analysis will be written with these results.
    • A Knee Blowout Complicated by Fibular Nerve Damage and the COVID-19 Pandemic: A Case Report

      Dieckmann, Ansley; Ebert, Jeffrey (2021)
      While an anterior cruciate ligament (ACL) injury is the most common knee injury, it typically does not occur in isolation. Increased age and contact injuries have been associated with a higher incidence of concomitant damage. The impact of traumatic nerve injury on rehabilitation of the knee is not widely discussed in current literature and optimal timing of ACL reconstruction surgery is not largely agreed upon. Prehabilitation and rehabilitation are provided for patients who undergo knee reconstructive surgery. The purpose of this study is to examine the rehabilitation of a patient status post knee reconstruction when complicated by COVID-19 and fibular nerve damage. This study examines the rehabilitation of a 23-year-old male s/p ACL and LCL reconstruction. The patient presented to a physical therapy (PT) clinic following surgery and revealed that the initial injury occurred 3 months prior, but intervention was delayed due to the COVID-19 pandemic. The nerve damage and delay in intervention altered his rehabilitation and current functional ability. Outcome measures used include the Lower Extremity Functional Scale, ranges of motion of involved joints, and manual muscle testing. This report details a case complicated by fibular nerve damage and delayed intervention after a severe knee injury. The complications led to impaired safety and function prior to surgery and interfered with PT. The patient may have had minimal difficulties when recovering without these complications.
    • A Microparticulate Vaccine Microneedle patch for pain-free Immunization against Coronavirus Disease

      Vijayanand, Sharon; Patil, Smital R.; Joshi, Devyani; D'Souza, Martin J. (2021)
      Microneedle (MN) patches for vaccine delivery is an effective immunization strategy suitable for mass immunization. Here, we test the level of immunity provided by a microparticulate (MP) heat-inactivated coronavirus vaccine when administered via the skin as pain-free dissolving MN patches. The vaccine formulation utilizes an MP matrix that provides protection of the antigen and improved antigen uptake by antigen-presenting cells (APCs). The microparticles (MPs) were formulated using a double emulsion method, lyophilized, characterized, and assessed for their in vitro immunogenicity. The in vivo efficacy of the MP vaccine was tested in mice. The immunization was done in 3 doses. ELISA was done to assess the IgG level in mice sera. The animals were sacrificed at week 10 and their organs were harvested for further analysis and expression of immune markers. The results show that the MPs were less than 1 microns in size and the MP vaccine induced a strong innate immune response in vitro. Serum analysis showed higher IgG levels of the vaccine groups. The vaccine groups showed a higher expression of antigen-presenting molecules. Based on the results, we summarize that the MP vaccine can produce an effective immune response when administered as an MN patch via the skin. Moreover, MN patches allow self-administration, which greatly increases patient compliance in addition to decreasing the need for trained pharmacists for immunization.
    • 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.
    • A Pain in the Face: When Insurers Sucker Punch Their Subscriber's Teeth In

      Lancaster, Kimberly D. (2021)
      There is a crisis in American healthcare. This very crisis involves insurers whether those insurers be medical, dental, or property and casualty insurers not covering surgical and non-surgical treatments for craniomandibular and temporomandibular disorders that include accompanying commodities that become multi-system overall health dysfunctions. In many jurisdictions, these subscriber denials are in direct violation of state statue. The states that experience some of the highest denial rates leaving patients receiving shocking sucker punches to their oral health, joint health, multi-system health, wallets, and functional capacities including performing daily ADLs (activities of daily leaving) are the biggest offenders. These disorders, thanks to the insurance carriers' relentless arguments whether this is dental or medical has left many patients between the ages of thirty and forty chronically disabled with many being forced to live in poverty on social security and receive further sub-par medical management on state plans. Thus, to shed light on the necessity for legislative and healthcare overalls that address this forgotten medical population, I have followed the personal stories of two patients and their families from Tennessee and Illinois that have laws mandating coverage (Tmjjoints.org, n.d.). The aim of this research is being used to become a national and global catalyst for permanent and effective access to coverage and care change. The goal is academic and personal.
    • A Prophylactic Gonorrhea Vaccine: Evaluation of In vivo Immune Response

      Bagwe, Priyal; Bajaj, Lotika; Gala, Rikhav; Zughaier, Susu; D'Souza, Martin (2021)
      Neisseria gonorrhoeae is the bacteria causing gonorrhea and has gradually developed antimicrobial resistance. Currently, there is no vaccine for gonorrhea. This study aims to investigate the immunogenicity of novel whole-cell inactivated gonococcal microparticulate vaccine formulation loaded in dissolving microneedles for skin delivery. The efficacy of vaccine formulation was assessed in vivo using female mice. The mice were immunized with a prime dose at week 0 followed by two boosters at weeks 2 and 4. Enzyme linked immunosorbent assay (ELISA) was used to measure immunoglobulin levels in collected mice sera. Formalin-fixed gonococci were intact as observed by SEM. The average length of microneedles as observed by SEM was 350 �m. ELISA demonstrated significantly higher serum immunoglobulin levels in groups receiving adjuvanted gonorrhea particulate vaccine when compared to untreated group (p<0.001). The particulate vaccine allows better uptake of antigen facilitated by the APCs causing improved antigen presentation and subsequent immune response by activation of T cells. Skin delivery of the inactivated whole-cell gonococcal microparticulate vaccine formulation loaded in dissolving microneedles is therefore an effective strategy.
    • A Study on the Performance of Airbnb Listings in New York City

      Candace Walton; Tiffany Williams
      This paper aims to better understand what factors are considered when an individual chooses to book an Airbnb and what features contribute most to their experience. With this understanding, it is the goal to be able to effectively market Airbnb to potential customers to increase the number of bookings and generate more revenue.
    • Acute Pancreatitis: Evaluation and Management Recommendations in a Critical Care Setting

      Adeyeye, Yomi; Martinelli, LeAnne (2021)
      Acute pancreatitis (AP) is the most common cause of gastrointestinal hospitalizations in the United States. Gallstones and alcohol abuse are its most common underlying etiologies. With AP consistently adding to the hospital burden across America every year, initial management and prompt recognition of a severe AP presentation have become cornerstones for decreasing morbidity and mortality in AP patients. The introduction of severity scoring to the evaluation of AP patients has been essential for drastically decreasing morbidity and mortality. However, with so many severity scores to choose from, along with the controversies with management, how can we ensure that we are providing the best care for AP patients? It is crucial to understand the principles of evaluating and managing AP in order to provide excellent care for patients with this common disease. My capstone project looks to compare and contrast severity scoring systems while also providing evidence for the best diagnostic and management modalities for AP patients.
    • Addressing Fear-Avoidance Beliefs in a Veteran with Sub-Acute Low Back Pain Who Is Non-Ambulatory

      Ferrari, Sofia; Taylor, Leslie F. (2021)
      Purpose: The aim of this case report is to discuss physical therapy management of a 59-year-old male veteran with sub-acute low back pain and elevated fear-avoidance beliefs about walking. Case Description: The patient is a 59-year-old male who was referred to physical therapy for evaluation and treatment of "Sciatica, right side." The patient was non-ambulatory for one month preceding his first physical therapy visit. His primary impairments on initial evaluation were elevated fear-avoidance beliefs, lower quarter weakness, and impaired gait mechanics. Interventions: Physical therapy management included strategies to address fear-avoidance beliefs in combination with gait training and lower quarter strengthening. Strategies used to manage fear-avoidance beliefs included patient education with cognitive restructuring, graded exposure in vivo, one-on-one patient care, and development of a therapeutic relationship. Outcomes: Fear-avoidance beliefs, disability, and gait were assessed at initial evaluation, 5 weeks, and 8 weeks (discharge). All outcome measures exceeded a minimal clinically important difference from initial evaluation to discharge. Conclusions: The patient demonstrated improvements in all functional outcome measures and was ambulating independently after eight weeks of physical therapy interventions aimed at reducing fear-avoidance behaviors.
    • Administration of a microparticulate Zika vaccine using dissolving microneedle patches

      Kale, Akanksha; D'Souza, Martin (2021)
      Zika is an infectious disease transmitted to humans through mosquito bites. It can lead to Guillain-Barré Syndrome. If transferred from mother to fetus, Zika can cause microcephaly. However, there is no approved treatment or vaccine available for Zika. Hence, we aim to develop a microparticulate vaccine for Zika and to investigate transdermal route for administration using microneedle patches to provide pain-free and needle-free immunization. PLGA microparticles (MP) encapsulating antigen (Zika PRVABC59) and adjuvants were formulated using double emulsion solvent evaporation. The size and zeta potential of MP were 573.4±10.18nm and -22.6±0.503mV. The encapsulation efficiency was 55-70%. Scanning electron microscopy showed that the MP were spherical. SDS-PAGE confirmed that the process did not affect antigen integrity. In vitro release study showed sustained release of antigen. MP were immunogenic and non-cytotoxic in vitro in dendritic cells. Subsequently, the vaccine MP with or without adjuvant MP were either injected IM or using microneedle patches via transdermal route to mice. Mice immunized with particulate vaccine produced significantly higher IgG, IgG1 and IgG2a antibody titers than the control group a robust humoral response as well as a balanced Th1/Th2 response. Antibody titers after transdermal immunization were comparable with titers after intramuscular immunization. Thus, this study established the feasibility of transdermal microneedle-based vaccine for Zika.
    • Advocacy and Leadership Development through Honor Society Membership: Implications for Counseling Professional Identity

      C. Peeper McDonald; Yvonne Varner-Kirkland; Caroline Fernandes
      Chi Sigma Iota (CSI), the International Counseling Honor Society for professional counselors, counselor educators, and students was established in 1985 in recognition for outstanding achievement as well as outstanding service within the counseling profession. This poster exemplifies the exceptional advocacy and leadership developmental work being implemented by the Mercer University (MU) Upsilon Alpha Chi Sigma Iota (CSI) Chapter.
    • An Examination of Commonly Used Fourth-Grade Textbooks Using a LatCrit Lens

      Jami Friedrich
      This is a poster presenting the findings of a qualitative critical discourse and content analysis dissertation study.
    • An Update on Nonalcoholic Fatty Liver Disease (NAFLD)

      Kang, Anna; Dickerson, Lisa (2021)
      Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease with a prevalence of 25% worldwide. NAFLD is categorized into nonalcoholic fatty liver (NAFL), or simple steatosis, and the more severe form, nonalcoholic steatohepatitis (NASH), a combination of fatty liver plus liver inflammation and injury. Up to 30% of Americans have NAFLD, 20% of whom have NASH. NASH can progress to life-threatening cirrhosis and is a risk factor for developing hepatocellular carcinoma. Considering NAFLD and understanding risk factors is paramount to helping at-risk patients receive timely screening and diagnosis before liver damage is irreversible. The gold standard for diagnosis is liver biopsy, but emerging studies show that noninvasive serum biomarkers and scores as well as novel imaging techniques are acceptable alternatives for the diagnosis and staging of fatty liver. In the absence of approved drug therapy, the gold standard treatment for NAFLD is lifestyle intervention, namely weight loss as a result of diet and exercise. This article will review the epidemiology, pathophysiology, clinical features, diagnostic approach, and treatment recommendations for patients with NAFLD.
    • Analysis of electronic health record (EHR) tracking and computing system for Breast Imaging Reporting and Data System (BIRADS 3) Probably Benign breast lesions

      Harris, Julie M. (2021)
      The purpose of this study is to determine if the EHR is beneficial in tracking and monitoring patients with BIRADS 3. The study will determine if the follow up imaging intervals are necessary. The current tracking system does not have an algorithm that is able to monitor patient outcome statuses.
    • 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.
    • 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.
    • Are Virtual Visits A Viable Alternative to In-Person Visits from a Healthcare Professional Perspective?

      Scott, Tashaleta M. (2021)
      The COVID Pandemic has changed the way that various parts of healthcare perform interactions and business with patients. This is very true for Orthopaedics. It seemed to be a difficult process to think of when stating a virtual visit for Orthopaedic injuries. It is important that wounds are evaluated, radiographs are taken, etc. to ensure that the correct care is given. It is also important to ensure that the virtual information and process can be easily understood by patient, staff, and physicians. Virtual visits require the use of an application that can call and/or provide video. There must also be access to an EMR/EHR to document the visit and provide the necessary information to setup the virtual visit. The most important issue to determine when looking at the implementation of virtual visits is to understand how the physicians and staff feel about the procedural change. The users are an important aspect of understanding the issues, concerns, as well as the favorable aspects of a system. If the users are not satisfied with the virtual visits, the system could be less used which would result in a decrease in revenue. These factors will allow organizations to focus on reducing and/or eliminating issues that could cause the virtual visit to be unsuccessful and/or misuse of valuable resources. The best way to assess this is to pose various questions that will look at productivity, time management, satisfaction, advantages, and disadvantages of the virtual program. The results from polling and providing questionnaires to physicians and staff can assist with choosing a system or process that better serves the patients and those who utilize the system. Virtual visits are about convenience as well as providing an alternative of care that can be as beneficial as in person visits. Overall, the opinions and insight from the physicians and staff who utilize the virtual visit program will be beneficial to ensuring that virtual visits are a viable alternative to in-person visits, user friendly, and accomplishes the goal of providing superb patient care.
    • Assessing Expression and Function of Serotonin Receptors and Transporter in Fmr1 Knockout Mice

      Saraf, Tanishka Satyajit; Chen, Yiming; Armstrong, Jessica; Prophitt, Jennifer; Canal, Clinton (2021)
      The serotonin receptors (5-HTRs) and transporter (SERT) modulate excitation-inhibition altered in autism and its leading monogenic cause, fragile X syndrome (FXS). Here, we assessed their expression and function in adult Fmr1 knockout (KO) mice, a model of FXS, compared to wild type (WT) mice. We performed autoradiography on brain sections using [3H]5-CT for 5-HT1ARs, [3H]Ketanserin for 5-HT2ARs, [3H]Mesulergine for 5-HT2CRs, [3H]Citalopram for SERT. Regions of interest were analyzed using ImageJ. Saturation binding assay was performed for 5-HT1ARs with [3H]5-CT. Behavioral effects of 1,2mg/kg (R)-8-OH-DPAT, 1 mg/kg (�)-DOI, 1,3,10mg/kg lorcaserin and 10mg/kg escitalopram were used to probe in vivo functional activity of 5-HT1A, 5-HT2A, 5-HT2CRs, and SERT, respectively. KO males have higher 5-HT1AR expression in lateral septum and frontal cortex, lower 5-HT2AR expression in isocortex layer V and lower 5-HT2CR expression in anterior olfactory nucleus and nucleus accumbens, than WT males. Saturation binding analysis confirmed the increased 5-HT1AR expression. WT and KO males had lower 5-HT2CR expression in choroid plexus and caudate putamen than females. KO mice showed more pronounced responses to (R)-8-OH-DPAT, decreased DOI-elicited head twitches, and similar lorcaserin-induced hypolocomotion compared to WT mice. SERT expression and function are being evaluated. This shows perturbations in key 5-HTRs in Fmr1 KO mice, suggesting dysfunctions in the central 5-HT system in FXS.
    • 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.
    • Assessment of Current Opioid Stewardship Activities and Evaluation of Health Informatics Tools to Reduce Opioid Prescribing

      Parker, Julie; Baskaran, Vikraman (2021)
      Background: Overprescribing opioids has become a public health emergency in which 128 people in the United States die every day after overdosing on opioids. This also poses a problem in the acute care setting, as many institutions do not continually monitor daily opioid administrations. Currently, opioid use in the hospital setting can be tracked using morphine milligram equivalents (MME) calculators. Several studies have shown that monitoring MMEs can help identify patients at risk for overdose death. In particular the CDC recommends using caution when increasing to >50 MME per day, and to avoid or carefully justify increasing doses to >90 MME per day. The CDC has also outlined high risk conditions for opioid related harm including patients >65 years, pre-disposing conditions such as mental health or substance abuse disorders, and previous naloxone use. Through this research project, we will be able to assess our current opioid stewardship activities through a survey presented to pharmacy staff and then discussing health informatics-based options for the monitoring of MMEs in an acute care hospital system. Objective: The primary objective of this study is to assess the current opioid stewardship activities and to discuss the need to implement clinical decision support tools to provide EHR-based opioid prescribing guidelines. Methods: A voluntary survey will be administered to pharmacy staff to assess how pharmacists current screen patients� profiles for pain medication administration and how they currently approach avoiding pain duplication and overprescribing of opioids. Through this survey, we will be able to address: � PDMP review � MEDD calculator use � Long-acting opioid appropriateness � Interdisciplinary communication with provider � Chart review for naloxone use or respiratory depression � PRN opioid order monitoring This survey will provide information for how pharmacists are performing opioid stewardship activities. This information will also be used to discuss current health informatics tools that could be utilized to provide an EHR-based approach to this real-time monitoring for the development of a process to integrate into workflow. Results & Conclusions: In progress