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Home-Based Stroke Rehabilitation: Virtual Reality for the Elderly?
Full text linkStroke remains the leading cause of long-term disability, especially within the elderly population. Nearly 50 percent of stroke survivors never achieve full independence post-stroke. This literature review examines the capability of virtual reality (VR), as home-based continuation of stroke rehabilitation for elderly patients. VR has the potential to improve motor recovery, increase independence, and reduce healthcare costs for stroke survivors. A comprehensive literature review has been conducted following the PRISMA guidelines to evaluate VR therapy compared to conventional post-stroke therapy. VR rehabilitation demonstrated improvements in motor ability, however it did not demonstrate significantly superior improvements when compared to conventional therapy. Prolonged therapy post-stroke would lead to greater functional recovery and reduced disability. VR offers potential cost advantages compared to conventional therapy, which may be further reduced with telehealth and do it yourself programs. Given these comparable outcomes and potential benefits, home-based VR represents a promising, cost-effective continuation of hospital-based stroke therapy. Implementation of home-based VR could markedly reduce the burden of stroke by decreasing long-term disability, as well as healthcare costs. Future research should focus on refining the VR protocols to yield the highest motor recovery, while increasing accessibility through tablet-compatible programs in order to reach more stroke survivors
Case Report: A Case of Tracheal Perforation
Full text linkHere we present the case of a 93-year-old female with a past medical history of arthritis and dementia who came to the hospital for a change in mental status and decreased responsiveness at home. The patient was intubated at home by EMS secondary to continued respiratory distress. The patient had a history of a productive cough over the past three days. The patient arrived at the emergency department with continued respiratory failure. During the ED evaluation, the patient was noted to have tracheal rupture. The patient was admitted to the ICU for severe sepsis and continued on broad spectrum IV antibiotics, before being ultimately consulted to palliative care for end-of-life management
Takotsubo Syndrome: A Case of Acute Altered Mental Status, Aphasia, and Weakness
Full text linkBackground: Stress-induced cardiomyopathy (SICM), also known as Takotsubo syndrome, can mimic acute coronary syndrome despite the absence of obstructive coronary artery disease. This case report explores the diagnostic workup and management of a patient with potential SICM presenting with sudden onset altered mental status, aphasia, and weakness.
Case: A 46-year-old woman with no past medical history presented with acute altered mental status, aphasia, and weakness requiring intubation. Blood glucose level was 123 mg/dL. Initial workup for stroke was negative. Extensive neurological workup, including cranial imaging and electroencephalography, revealed no abnormalities.
Initial ECG was unremarkable, but elevated troponin levels and a reduced left ventricular ejection fraction (LVEF) of 40% on echocardiogram suggested probable cardiac involvement. Subsequent coronary angiography demonstrated normal coronary arteries. Repeat echocardiogram showed improvement in LVEF to 45-50%.
The patient remained hemodynamically stable throughout hospitalization. Stress-induced cardiomyopathy was suspected as the underlying cause of her presentation due to her family and social history. The patient was discharged home on a regimen of metoprolol, valsartan, and aspirin with close follow-up with cardiology and primary care physician.
Conclusion: This case highlights a possible atypical presentation of SICM with neurological symptoms and the importance of considering it in the differential diagnosis of patients with unexplained altered mental status and elevated cardiac biomarkers, even in the absence of abnormal ECG findings.
Keyword: aphasia; stress; cardiomyopathy; altered mental status; stress-induced cardiomyopathy; Takotsubo syndrome; encephalopathy
The Impact of Obesity on the Risk of Venous Thromboembolism in Users of Combined Oral Contraceptives: A Comprehensive Literature Review
Full text linkBackground: Combined oral contraceptives (COCs) are a widely used method of birth control in the U.S., particularly among women aged 15–44. COCs are known to increase the risk of venous thromboembolism (VTE). Obesity, which affects over 40% of adult women in the U.S., is also a recognized independent risk factor for VTE. However, the compounded risk posed by the simultaneous presence of obesity and COC use has not been thoroughly explored.
Hypothesis: Obesity significantly elevates the risk of VTE in women using COCs, demonstrating a synergistic interaction between these two factors.
Methods: A systematic literature review was conducted using PubMed, Embase, and Scopus. The search included clinical trials, cohort studies, and peer-reviewed articles from the last 25 years examining the relationship between COC use, obesity, and VTE.
Results: Findings indicate a strong positive correlation between BMI and VTE risk in COC users. One meta-analysis reported a baseline VTE incidence of 39.4 per 100,000 woman-years among COC users, with progressively increasing odds ratios (ORs) for higher BMI categories. Women with a BMI ≥35 had an OR of 3.1 compared to those with a BMI of 20–24.9. Another study showed VTE risk increasing up to 24-fold in obese COC users compared to non-obese non-users.
Conclusion: Obesity amplifies the thrombotic risk associated with COC use. These findings underscore the importance of personalized contraceptive counseling and targeted preventive strategies for obese women to reduce VTE risk
Impact of the ACGME Merger on Ophthalmology Match Success: A Pre- and Post-Merger Comparative Analysis
Full text linkBackground
In 2020, the ACGME merger unified the residency match process for MD and DO applicants into a single, standardized system. The merger aimed to promote equity in graduate medical education by streamlining training pathways and matching processes across applicant backgrounds.
Hypothesis
Despite the merger’s goal of standardization and equity, disparities in ophthalmology match outcomes between MD and DO applicants may persist.
Methods
Data from the SF Match and AUPO were collected for ophthalmology applicants from 2016 to 2024. Applicants were divided into pre-merger (2016–2019) and post-merger (2020–2024) cohorts. Match rates for MD and DO applicants were calculated and compared between these periods using chi-square analysis.
Results
Results showed a statistically significant decline in match rates for MD applicants, from 85.32% pre-merger to 78.26% post-merger (p \u3c 0.05). DO match rates also declined, from 45.07% to 38.62%, but this change was not statistically significant (p ≥ 0.05). In both time periods, MD applicants had significantly higher match rates than DO applicants (p \u3c 0.05).
Conclusion
Although the ACGME merger was intended to promote equity, disparities in ophthalmology match outcomes between MD and DO applicants remain. The non-significant downward trend in DO match rates may reflect persistent challenges such as fewer rotation opportunities, limited advising, and reduced program familiarity. These findings highlight the need for continued research into structural barriers affecting DO applicants in competitive specialties like ophthalmology
Vaccine Booster Hesitancy and Factors Associated Amongst Minority Students in South Jersey
Full text linkIn October 2022, COVID-19 vaccine coverage for two doses in NJ was 77.4%. This exceeded the US national average of 67.8%. However, initial booster uptake remained low at only 50% statewide, and bivalent booster uptake was just 16.8% by March 2023. South Jersey, including Gloucester County and Glassboro, contains large marginalized populations that have experienced barriers to vaccination access, misinformation, and skepticism regarding government and pharmaceutical intentions. This health equity service project was to provide clear, factual, and relatable information to increase vaccine confidence and uptake among minority students at Rowan University and the broader South Jersey community. By addressing safety, effectiveness, and access, this poster aims to empower informed health decisions. We conducted a community-centered content analysis and health education initiative focused on COVID-19 booster hesitancy. Vaccine hesitancy among minority students is influenced by a combination of historical mistrust, misinformation, and access gaps. However, confidence can be improved through peer stories, culturally tailored messaging, and trusted local providers. The development of our student-focused infographic offers a model for academic institutions to educate and empower students, while addressing vaccine inequities at the campus and community level
Social comparison target selections as health information preferences: Exploring contextual influences among women in midlife with elevated risk for cardiovascular disease
No full textInsufficient physical activity (PA) heightens the risk of chronic illnesses including cardiovascular disease (CVD), particularly among women in midlife with conditions such as hypertension. Behavioral interventions often use psychoeducation and skills training to increase PA, but how individuals interact with health-relevant information and how this relates to daily PA behavior is unclear. Health information preferences vary between individuals, but whether they vary for the same individual across contexts has been understudied. In particular, the role of contextual factors in predicting social comparison (i.e., evaluating oneself relative to others to obtain information about oneself) are not well understood. The purpose of this thesis was to explore social comparison target selections as indicators of health information preferences, using data from a PA promotion tool for women in midlife with elevated CVD risk (N = 88). Women showed considerable daily variability in PA, satisfaction, and comparison target selections (ICCs \u3c 0.634). Comparison target selections were predicted by women’s satisfaction with their step count from the previous day (ORs \u3c 0.777 and ORs \u3e 1.251, ps \u3c 0.03). Satisfaction did not predict affect immediately after viewing the comparison target (srs \u3c 0.011, ps \u3e 0.80). Findings highlighted meaningful daily fluctuations and indicated the promise of tailoring digital interventions based on momentary information preferences
STRUCTURAL DESIGN AND CONSTRUCTION OF FULL-DEPTH POROUS ASPHALT PAVEMENT FOR HIGH-TRAFFIC VOLUME ROADWAYS
No full textPorous asphalt (PA) mixtures, characterized by their high interconnected air voids, offer stormwater management alongside reductions in splash, road spray, improved skid resistance, and pollutant capture/ filtration in low-traffic applications. Although most research on PA focuses on hydrological aspects, recent advancements make porous asphalt pavements (PAPs) viable under heavy traffic by proper structural design. This study develops a design framework for durable PAPs by laboratory testing, AASHTO 93 and Pavement ME methods, and full-scale construction and instrumentation. Three lab-mixed PA mixtures were tested for air voids, moisture susceptibility, draindown, permeability, and durability. Dynamic modulus (|E*|) tests showed 16–21% stiffness increase under 20 psi confinement. Fatigue tests (Overlay Test and IDEAL-CT) were satisfactory, and rut depths were within the limit (\u3c 5mm) for two of the mixes. Similar performance in-plant-mixed samples confirmed the lab findings. Designing a full-depth PAP for high-traffic demonstrated the design framework, starting from hydrological design and followed by structural design. Two full-scale PAP test sections for medium and high-traffic loading (1 million and 13 million ESALs) were constructed and instrumented to facilitate accelerated pavement testing. This work outlines the laboratory evaluation, quality assurance procedures, and challenges unique to full-depth PAP design and construction for high-traffic roadways
ARTIFICIAL INTELLIGENCE-POWERED DRUG DISCOVERY: PREDICTIVE MODELS FOR THE BIOACTIVITY AND TOXICITY OF SMALL MOLECULES AND NANOMATERIALS
No full textThe pharmacological activity and toxicity of chemical entities are critical factors influencing their success in drug discovery and development. Traditionally, in vivo animal studies have been employed to evaluate their efficacy and safety profiles. However, these studies are often costly and time-consuming. Artificial intelligence (AI)-powered assessments have emerged as promising alternatives for evaluating the bioactivity and toxicity of both new drugs and drug candidates. This dissertation presents novel AI-driven modeling approaches that leverage machine learning (ML) to predict the bioactivity and toxicity of small molecules and nanomaterials (NMs). First, we constructed a virtual graphene library using a nanostructure annotation technique and computed novel geometrical descriptors from the annotated nanostructures for ML modeling. The resulting models showed good performance in predicting graphene toxicities. Next, we developed an online nanoinformatics platform that provides annotated nanostructure databases and modeling toolkits for bioactivity and toxicity prediction. This platform serves as a data-driven computational resource, facilitating the rational design of NMs. Lastly, we proposed a new ML framework integrating drug pharmacokinetic (PK) data to predict placental drug permeability and assess fetal exposure risks. Key transporters identified by the model reveal critical routes of drug transfer across the placental barrier
Leveraging AI to Democratize the Hidden Curriculum in Medical Education: An Implementation Framework
No full textThe “hidden curriculum” in medical education—comprising unwritten rules, values, and expectations—significantly impacts student success, yet remains inaccessible to students from underrepresented backgrounds. This paper presents a theoretical framework and practical implementation strategy for using artificial intelligence (AI) to democratize access to this hidden curriculum. We analyze how cognitive load theory and the Fast/Slow Thinking paradigm explain inequities in professional integration, then propose a comprehensive implementation approach to guide equitable AI integration. This model demonstrates how AI tools, when thoughtfully implemented, can reduce cognitive burdens on disadvantaged students, accelerate professional acculturation, and contribute to building an inclusive medical workforce