• 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.
    • Emotional Intelligence, Burnout, and Professional Fulfillment among Clinical Year Medical Students

      Cody Blanchard
      Emotional intelligence is correlated with decreased levels of burnout and increased levels of professional fulfillment in a group of clinical year medical students.
    • 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.
    • Exploring 5-HT2 Receptors as Targets for Treating Epilepsy in Fragile X Syndrome: A Preclinical Study of Fmr1 Knock-out Mice

      Tanishka Saraf; Yiming Chen; Jessica Armstrong; Clinton Canal
      This project explores the anticonvulsant potential of lorcaserin in Fragile X Syndrome in which epilepsy prevalence is ~25%. We did a full dose response (1-10 mg/kg) in an audiogenic seizure assay in Fmr1 knock-out mice. Lorcaserin did not affect prevalence at any dose but attenuated seizure severity to some extent.
    • 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.
    • Gut microbiota-derived short chain fatty acids stimulate mesenteric artery vasodilation

      Menon, Sreelakshmi Nandakumar; Zerin, Farzana; Pandey, Ajay K.; Rahman, Taufiq; Hasan, Raquibul (2021)
      Authors: SN Menon, F Zerin, AK Pandey, T Rahman, and R Hasan Accumulating evidence suggests that gut microbiota-derived short-chain fatty acids (SCFA's) such as acetate, propionate and butyrate have beneficial effects on the cardiovascular system. However, whether these SCFAs can directly influence arterial contractility remains unclear. Here, we sought to examine the effects of sodium acetate and propionate on the contractility of resistance mesenteric arteries from Sprague Dawley rats, and characterize their mechanism of action. Our pressurized artery myography data showed that both acetate and propionate produced a concentration-dependent vasodilation in mesenteric arteries. Our data also showed that co-application of L-NNA, a selective inhibitor of endothelial nitric oxide synthase (eNOS), with acetate caused 35% reversal of acetate-evoked vasodilation, suggesting that additional vasodilatory mechanisms, including those of smooth muscle origin may be involved. On the other hand, co-application of L-NNA with propionate caused no reversal of sodium propionate-evoked vasodilation, precluding the role of endothelial nitric oxide production. Altogether, our data unveils a novel role for SCFA's in producing direct systemic mesenteric artery vasodilation, which is likely to be mediated by both endothelium- and smooth muscle-specific vasodilatory signaling. Future studies will be focused on dissecting the detailed mechanisms for SCFA-induced mesenteric artery vasodilation, and its relevance for systemic blood pressure regulation.
    • Head Above Water: A Study of K-12 Teachers' Perspectives on Emergency Remote Learning during the COVID-19 Pandemic

      Friedrich, Jami; Perrotta, Katherine (2021)
      In March of 2020, school districts across the country shifted to emergency remote teaching in response to the COVID-19 pandemic. As a result, school districts that closed for the remainder of the 2019-2020 academic year are indefinitely continuing online instruction or incorporating a hybrid model for the 2020-2021 school year. Although scholarship exists with regard to the impact of school closures due to unexpected events such as natural, there is a need to understand how this pandemic has posed specific challenges and benefits for teachers. The purpose of this research is to examine K-12 teachers' perspectives about their experiences transitioning to emergency remote teaching as a result of the COVID-19 pandemic. The major findings show that teachers experienced greater flexibility with regard to content and elimination of state exams. However, teachers expressed that they faced significant challenges with regard to promoting student engagement, maintaining communication, and ensuring students had access to technology and tools for remote learning.
    • How Covid-19 Has Affected the Healthcare Industry

      Griffin, Aundria; McCray, Justice; Mills, Keyonna; Swain, Shnean; Walthall, Sabrina (2021)
      Coronavirus infectious disease (Covid-19) first took rise in Wuhan city, China, in December 2019. The virus has spread globally to the point that the World Health Organization (WHO) declared a global pandemic on March 11, 2020 . Beyond our day-to-day life being brought to a halt, the pandemic has prompted a closer look at the country's health care system. In this research three categories of the healthcare system are identified as facing challenges during the pandemic. First, healthcare workers are affected by COVID-19 as their physical and mental health is challenged as they provide frontline critical care. Secondly, hospitals, especially those located in hotspot areas of the pandemic are increasingly overwhelmed within their management infrastructure and underprepared with inadequate facilities placing doctors and patients in life or death situations. Lastly, the insurance industry has not escaped the impact of COVID- 19 as enforced self-isolation rules has meant that elective procedures and consultations have been greatly curtailed and subsequently claim volumes have reduced in the short term. However, long-term, the treatment of COVID 19, the severity of the disease, and the length of hospital stays are expected to greatly increase the cost of insurance for individuals as insurance companies reexamine their losses. This research emphasizes the impact Covid-19 is having on sub-groups of the healthcare system.
    • How to save a life: Esketamine as a potential rapid pharmacological suicide intervention

      Montgomery, Kevin; Bedoya, Damian (2021)
      Suicide prevention and intervention efforts have been launched with hopeful results; however, research rarely focuses on pharmacological treatment for the acutely suicidal patient. Correlation between mental health diagnosis and suicide drives recommendations to tailor treatment to the mental health diagnosis rather than the acute life-threatening symptom. This article proposes treatment for the acutely suicidal patient should be intentionally directed at the suicidal ideation instead of the mental health diagnosis. Esketamine has been approved by the FDA, and randomized controlled trials show some evidence that this treatment is worth continued study as a method to rapidly reduce suicidal thoughts in at-risk patients.
    • Implementing Science and Engineering practices in K-12 classrooms : Learnings from a STEM course

      Sharma, Meenakshi (2021)
      The contemporary science education framework (NRC, 2012) advocates for the use of science and engineering practices(S&E) in classrooms because these practices represent an authentic view of inquiry or the “doing” of STEM in K-12 classroom. The current study examines teachers’ understanding and use of such S&E practices within a STEM endorsement course. Research participants were teachers who were enrolled in all courses offered as part of the endorsement. As a requirement for the endorsement, each teacher planned and enacted minimum three lessons in their respective classrooms that showcased their use of S&E practices in a real classroom setting. Primary data for this qualitative study includes video recordings of teachers’ classroom instruction. In addition, we use lesson artifacts, teachers’ written reflections on their teaching enactments, and recordings of feedback meetings with the course instructor (primary presenter) as secondary data. Initial analysis shows that implementation of S&E practices helped teachers to create a rigorous learning discourse in their classrooms. Teachers shared various accounts of active student participation as an outcome of using S&E practices during feedback interviews and written reflections. Teachers revealed varying extent of success in enacting these practices in their classrooms. Research Findings have implications for preparing preservice and in-service teachers to effectively implement S&E practices in the classrooms.
    • Improving Nursing Documentation in Patients With Sudden Cardiac Arrest Requiring Cardiopulmonary Resuscitation (CPR) in Long Term Acute Care

      Abdulkadir, Zeinab; Baskaran, Vikraman (2021)
      Healthcare documentation is a very important required task when working in any healthcare setting. From every patient encounter, prescription refill, and laboratory testing; all healthcare providers are required to document. As a Nurse, accurate documentation is vital in improving patient safety and quality of care. In emergency situations, such as a sudden cardiac arrest requiring cardiopulmonary resuscitation, precise documentation is rarely accomplished, due to the hectic nature of the patient's health status. In many circumstances, healthcare providers have witnessed the designated nurse attempting to document interventions on a napkin, whiteboard, or glove. The patient primary nurse is responsible for documenting a narrative note in the patient chart after the incident. The subjective nature of the nursing narrative note after CPR is often inaccurate, incomplete, or lacks details. Several research studies have highlighted the significance of CPR, the assessment of time keeping roles in cardiac arrests, and the evaluation of nursing documentation. This research study will analyze and provide possible solutions to the challenges faced by Nurses in long term acute settings during the documentation process on patients with sudden cardiac arrest requiring CPR. This study will evaluate, anonymous and randomly extracted, narrative notes from patient�s charts. The analysis will identify a CPR documentation template that can be implemented to reconstruct and improve the documentation process. This effort will promote efficiency and accuracy in capturing, analyzing, and reporting of data in resuscitation science to help improve patient outcomes and workflow.
    • Introducing a Mitigation Strategy into EHR Systems for Drug Shortages

      Nisanian, Meetra T.; Baskaran, Vikraman (2021)
      Nationally, hospitals are feeling the effects of the drug shortages on the quality of patient care. These shortages pose strenuous difficulties on patients, clinicians, and healthcare facilities. These shortages can be caused by many factors including, manufacturing problems lack of raw materials, business decisions, regulatory problems, as well as other external factors. The lack of available medications can cause adverse outcomes due to the need for substitution of commonly used medications that can compromise or delay procedures and lead to medication errors. This also places a burden on the hospital and the hospital staff as well. A mitigation strategy needs to be introduced in order to allow the facility in order to act efficiently in the midst of a crisis. The Rehabilitation Hospital of Southern New Mexico, located in the city of Las Cruces, is a specialized facility that provides rehabilitative services to patients recovering from disabilities causes by illnesses, injuries, or chronic medical conditions. This organization is a member of a large hospital network system known as Ernest Health; However, the hospital is managed locally in order to serve the needs of the community. When a drug shortage occurred, the hospital was not prepared. Therefore, introducing a mitigation strategy was vital for the assurance of continuation of quality patient care.
    • It takes two quad tendons to tango: A case report about dancing to recovery post spontaneous bilateral quad tendon rupture and repair

      Iskhakov, Vladislav; McMahon, Tim J. (2021)
      Abstract: Spontaneous quad tendon ruptures and resulting surgical repairs have shown to be disabling. Instances of bilateral quadriceps tendon ruptures (BQTR), although a rare occurrence, is more debilitating for the patient, making it harder to treat. Despite its rare occurrence, contemporary research shows a steady increase in incidences of all tendon ruptures, including BQTR, hypothesized to stem from more active lifestyles in the adult population as life expectancy increases. Purpose: This case report focuses on ballroom dance specific intervention strategies used to achieve a full return to amateur ballroom dancing. This case features a non-simultaneous instance of BQTR, which required surgery on a 69 year old, relatively healthy male patient with a strong desire to return to ballroom dance activities. Outcomes: Outcomes used to measure patient’s progress includes lower extremity functional scale, patient specific functional scale, and global rating of change scale Discussion: BQTR is an extremely rare occurrence, providing a unique feature to this case. The therapeutic approach used to reach the patient’s goals is also unique in that it allowed for challenges in strength, proprioception, balance, and ROM, with dance specific activities throughout the protected phased approach which considered HOAC model of healing. Dance specific activity, as well as therapeutic alliance, have been shown to have great benefits with regards to functional outcomes as well as fall risk.
    • Knowledge, Attitude, and Practice (KAP) Survey about COVID-19 and Telehealth and Virtual Medicine Services of Atlanta College of Professional Advancement students

      Ramadan, Awatef A. Ben (2021)
      The study investigator constructed a survey tool to estimate the students' reactions to different public health precautions and interventions that may be practiced during the current pandemic. The study aims: To measure the knowledge, attitude, and practice (KAP) regarding COVID-19 among Atlanta College of Professional Advancement students. To evaluate the students' KAP about telehealth and virtual medical services to screen, diagnose, and treat COVID-19 and other current acute and chronic The results of this study are expected to: Assist in better preparation for the campus and the university COVID-19-related awareness interventions Tailor different interventions and campaigns to educate the students about the effectiveness and efficiency of Telemedicine and telehealth information technology and motivate them to use these safe healthcare services during this infectious pandemic to manage COVID-19 and other health issues. Methods: Study Design: A cross-sectional descriptive study will be conducted at Atlanta College of Professional Advancement, targeting all undergraduate and graduate students, all races, all gender, and all nationalities. Study Survey: It is a structured questionnaire with closed-ended questions. The study tool comprises 60 structured questions that assess the students' KAP during the COVID-19 pandemic and assess their KAP towards telemedicine and telehealth services to manage the pandemic and follow-up on their current or future different health problems. The survey constructed into a Survey-Monkey format. A link to the survey was created and has been disseminated to the students' emails from March, 24, 2021 to the present. Data Analysis: In this poster, we present the results that we retrieved from the survey monkey's results link from March 24 to April 1, 2021.
    • Lessons Learned: The Lived Experience of Tribal College & University Students

      Vicki Black
      This is the second part of a large phenomenological study about Tribal College & University students.
    • Management of Crohn's Disease: Early and Aggressive Treatment Using Biologics and Immunomodulators

      Martin, Erin; Sadowski, Catherine (2021)
      Crohn's Disease (CD) is an incurable type of inflammatory bowel disease (IBD), in which the intestines are chronically inflamed, causing intestinal and extra-intestinal symptoms. CD patients experience a cycle of remission and relapse of symptoms as the disease progresses to serious complications, including small bowel obstructions, malnutrition, and decreased quality of life. Since CD is incurable, medical management is the mainstay of treatment to obtain and maintain remission. Traditional treatment relies on anti-inflammatories. New management strategies focuses on early and aggressive therapy with immunomodulators and biologics to reduce the rate of mucosal and intestinal damage early in the disease course.