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EXPLORING NEW JERSEY COUNTY COLLEGE TEXTBOOK AFFORDABILITY PLANNING
No full textThis dissertation reports on a qualitative case study of community colleges’ planning processes to meet the requirement of a state law to develop textbook affordability plans. Since no single solution works for all institutions, the research addresses a variety of affordable adoptions reported by 12 open access, Associate’s degree granting institutions in New Jersey. Study findings describe how these colleges characterize textbook affordability and share the planning process and considerations involved in formulating their plans. These textbook affordability plans are found to be a student-centered decision that focuses on highest-enrolled general education courses. Using a hybrid approach of free, low cost, and commercial course materials, collaborative planning teams crafted affordability approaches that met the demands of their faculty and students by considering content characteristics including access, affordability, quality, and ancillaries. Institutional funding for faculty and technology are also considered. This dissertation includes an academic article and practitioner article that will be used to disseminate the research and offer administrators planning considerations with their implications
Clinical Outcomes for Patients Who Have Hyperlipidemia Who Underwent Mechanical Directed Thrombolysis for Pulmonary Embolism: An Analysis of the National Inpatient Sample
Get PDFMechanical-directed thrombolysis for PE is a recently established therapy option for patients with sub-massive PE with hemodynamic instability. With limited availability on the impact of superimposed anemia on patients that undergo MDT treatment we sought to look more closely at the inpatient population
Investigating Sleep Quality in Post-Stroke Delirium: A Scoping Review
Get PDFBackground: Delirium affects approximately 59% of hospitalized patients with intracerebral hemorrhage and is associated with poor outcomes. Sleep-wake cycle disturbances are hypothesized to contribute to delirium development, particularly in neurointensive care settings where frequent sleep interruptions occur.
Methods: We conducted a scoping review of literature published between 2014-2024 using PubMed, CINAHL, Embase, and Cochrane databases. Studies were included if they observed sleep in adult stroke populations.
Results: Four observational studies (2018-2023) met inclusion criteria, with sample sizes ranging from 20-112 participants. All studies included patients with ICH. All studies reported associations between poor sleep in patients with ICH and delirium prevalence, but with inconsistent findings. Sleep measurement methods varied among all studies and lacked direct quantification of sleep.
Conclusion: Few studies have evaluated sleep-delirium relationships after acute stroke. Measurement inconsistencies and small sample sizes limit conclusions. Future research should standardize methodologies of delirium assessment, quantify sleep architecture in post-stroke delirium to understand this relationship, and evaluate interventions aimed at improving sleep quality to potentially reduce delirium incidence
The Role of ECT in OCD: A 10-Year Review (2014-2024)
Get PDFBackground: Obsessive-compulsive disorder (OCD) affects up to 2.5% of the population with significant impacts on everyday functioning and relationships. First-line treatment includes selective serotonin reuptake inhibitors (SSRI) and cognitive behavioral therapy; however, studies have found that up to 40-60% of patients do not respond to SSRIs. ECT is an alternative approach that has demonstrated limited efficacy in OCD.
Objective: The current review aims to summarize the results of published work between 2014-2024 to assess the efficacy of ECT in the treatment of OCD.
Methods: A literature review was conducted using eight studies from 2014-2024 to assess the effectiveness of ECT in the treatment of OCD as measured by the Yale-Brown Obsessive–Compulsive Scale (Y‐BOCS). ECT was administered adjunctively with medications, not as a standalone treatment.
Results: Y-BOCS scores decreased by an average of 16.75 after ECT treatment. 77.7% participants reported a positive response immediately after ECT. 13.3% reported side effects including headaches, memory disturbances, emesis and post-treatment agitation. 20% reported recurrence of symptoms or a deteriorating disease course after ECT at different time periods and to varying magnitudes.
Conclusion: Although decreased Y-BOCS scores were statistically significant and 77.7% of participants reported a positive response to ECT, limited long-term efficacy and adverse effects limit the effectiveness of ECT. Variable long-term effects were reported across all studies, highlighting the importance of assessing individual benefit-to-risk ratios. ECT may have greater benefit in those with comorbid psychiatric diagnoses, possibly due to more severe courses and resistance to medications
Personalizing Intermittent Fasting: The Role of Microbiome Diversity and Fiber Intake in Shaping Health Outcomes
Get PDFBACKGROUND: Intermittent fasting (IF) has been linked to improved metabolic health, reduced inflammation, and increased longevity in animal models. These effects are thought to be mediated through changes in the gut microbiome. Murine studies consistently show that IF enhances microbial diversity and promotes beneficial species like Lactobacillus and Bifidobacterium, improving metabolic profiles and gut barrier function. However, human studies reveal inconsistent results, suggesting that individual-level factors such as baseline microbiome composition and fiber intake may influence response to IF.
HYPOTHESIS: Baseline gut microbiome diversity and habitual dietary fiber intake modulate the metabolic and inflammatory benefits of intermittent fasting in humans.
METHODS: A systematic literature review was conducted to identify peer-reviewed research articles and clinical trials involving intermittent fasting, gut microbiome outcomes, and metabolic parameters in murine and human models.
RESULTS:
•Murine models: Consistent increase in microbial diversity and improvement in metabolic markers •Human studies: Highly variable outcomes; benefits more likely in individuals with diverse microbiomes and higher fiber intake •Few human trials stratify participants by microbiome composition or diet, limiting interpretation
CONCLUSIONS: Individual variability in human IF outcomes may stem from differences in gut microbiome diversity and dietary fiber intake. A threshold model is proposed, in which individuals with favorable gut conditions are more responsive to IF. This supports the need for personalized dietary interventions
A Rare Case of Cardioversion-Induced Ventricular Fibrillation in a 62 Year Old Male Due to Inappropriate Timing: A Case Report
Get PDF•Atrial fibrillation (AF) is a common arrythmia of the heart due to the atria beating irregularly. AF has a national burden of over 30 million. AF is commonly managed in the outpatient clinic with pharmaceutical interventions. In a minority of cases, medications are unable to restore normal sinus rhythm of the heart, requiring further interventions such as cardiac ablation or trans-esophageal echocardiogram(TEE)/ cardioversion. This arrythmia can frequently leads to blood clots, stroke, and other cardiac complications. •This patient has recurrent paroxysmal AF for 3 years with resistance to multiple medication trials and presents for an outpatient TEE/cardioversion to restore normal sinus rhythm. Synchronized electrical cardioversion is a cardiac procedure to shock the heart to resolve arrythmias, but carries risks including skin irritation, stroke, heart damage, arrythmias such as ventricular fibrillation, and heart failure. This patient experienced an unsuccessful cardioversion, resulting in a new arrythmia of ventricular fibrillation following inappropriate timing of synchronized cardioversion. The purpose of this case report is to encourage awareness and further research on the complications of electric cardioversion. It is intended for others to learn the potential complications of a commonly performed procedure with a very low complication rate
Mapping Fat Embolism as a Complication of Liposuction and Fat Grafting: A Systematic Review of Anatomical and Technical Risk Factors
Get PDFFat grafting (FG) and liposuction are widely performed aesthetic procedures with associated fat embolism risks. However, no comprehensive review has specifically mapped the anatomical distribution and technical causes of fat embolism events across these procedures. This review aims to characterize regional and procedural frequencies of fat embolism to inform safer surgical practices. A review was conducted using PubMed, Embase, Scopus, and Cochrane. Included studies were English-language case reports/series, retrospective reviews, and systematic analyses reporting fat embolism following liposuction or FG. Among 227 FG cases, the most frequent regions were the face (n=120), gluteal region (n=91), genitalia (n=9), and chest (n=7). Embolic locations included ocular (27.0%), pulmonary (26.3%), and cerebral (18.2%) arteries. All 16 reported deaths occurred following intramuscular gluteal injection; none occurred in non-gluteal cases, (X² = 14.13, p = 0.0002) or subcutaneous-only injection. 35 cases of liposuction-associated fat embolism were reviewed. The abdomen was the most frequent site (n=19), followed by the thigh (n=3), with remaining cases involving axilla/back, buttocks, waist/xiphoid, lower-leg, and flanks. 68.6% of these cases involved large-volume or high-force techniques. Across both procedural categories, 76% of patients developed symptoms within 24 hours, and overall mortality-rate was 9.54%, all occurring within 5 days post-op. Fat embolism risk is strongly influenced by anatomical site and technique. All deaths occurred after intramuscular gluteal FG, while subcutaneous injection and non-gluteal sites were not associated with mortality. Abdominal liposuction was most frequently implicated, especially after high-force techniques
Patient Perspectives on the Role of Healthcare Providers in Addressing Food Insecurity in a NJ Primary Care Setting
Get PDFBackground:
Food insecurity is a critical social determinant of health, yet is rarely discussed with patients in primary care settings. The objective of this project is to explore patient perspectives on the physician role in addressing food insecurity as well as to identify factors associated with food insecurity among patients in family medicine clinics.
Methods:
A cross-sectional survey was distributed to patients (n=250) across two academic family medicine clinics in South New Jersey between May 2023 and December 2024. Demographics, self-reported health status, and comfort with discussing food insecurity were collected. Additionally, food insecurity status was determined based on the standard 2 question screen, the Hunger Vital Screen. Results were analyzed through ANOVA and probit regression.
Results:
17.2% of all respondents (n=43) were identified as food insecure. Despite 83% of respondents (n=186) feeling ‘very comfortable’ or ‘somewhat comfortable’ discussing food insecurity with their PCP, only 3 had ever done so. Interestingly, only 10.5% of respondents who felt it was ‘very important’ to discuss food insecurity with their PCP were themselves food insecure, compared to 89.5% who were food secure.
Conclusion:
While most respondents support family physicians addressing food insecurity, discussions around the topic remain limited, especially among those most impacted. These findings highlight a disconnect between patient openness and physician engagement, underscoring the need for more systematic screening and clearer physician roles
The Presence of Cardiac Arrhythmias Impacts Hospitalized Patients With Celiac Disease
Get PDFBackground
Celiac disease has links to inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and sarcoidosis. The latter 3 also have cardiovascular manifestations associated with them. However, there are limited studies on the in-hospital outcomes of Celiac disease with cardiac manifestations. Therefore, the aim of this study was to evaluate the hospital outcomes of Celiac disease with concomitant arrhythmias.
Methods
Patients aged 18 years with Celiac disease and arrhythmias (atrial fibrillation, atrial flutter, ventricular tachycardia, and supraventricular tachycardia) versus Celiac Disease alone were identified from the US Nationwide Inpatient Sample (NIS), from the years 2019-2020. ICD 10 codes were utilized. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, average length of hospital stays, and hospital charges, after adjusting for age, gender, race, primary insurance payer status, hospital type and size (number of beds), hospital region, hospital teaching status, and other demographic characteristics. Weighted analysis utilizing Stata 17 MP was performed.
Results
This study identified approximately 82304 patients with Celiac Disease from the years 2019 to 2020. Of these patients, 15% had concomitant arrhythmia. Mean age of patients with Celiac disease was 56.27. The mean age of Celiac disease patients with arrhythmias was 73.79. The mean length of stay for Celiac disease patient was 4.5 days. The analysis revealed that mortality (OR 1.625, pand total hospital charges (THC) were increased ($19,504.09, pThe rate of total hospitalization death was 4%. The rate of death of Celiac disease patient with no arrhythmias was 1.42% while Celiac disease patients with arrhythmias was 3.42%.
Discussion
Celiac disease is a systemic immune-mediated disorder that is triggered by an abnormal immune response to gliadin, a component of gluten1. Hallmark inflammatory response to gluten could further augment atherosclerosis, a major contributor to cardiovascular diseases1,2. Evidence shows an increased risk of atrial fibrillation in Celiac disease patients2. Gluten free diet has also shown to notably improve arrhythmias2. However, the association of arrhythmias and Celiac disease remain understudied and further research in this area could yield better patient outcomes.
Conclusion
Our study shows that patients with Celiac disease with arrhythmias when hospitalized had increased mortality, hospital LOS, and THC. Based on our study results, patients with cardiac arrhythmias need closer monitoring and there needs to be a focus on improved treatment and management approaches through further research. Future studies should explore the impact of each type of cardiac arrhythmia on outcomes and then there can be further risk stratification based on type of cardiac arrhythmias present for Celiac disease patient
Early Celiac Plexus Block in Metastatic Pancreatic Cancer
Get PDFBoth Early and Delayed Celiac Plexus Blocks (CPBs) have been used in pancreatic cancer. Early CPB is completed when criteria for CPB is initially met, whereas Delayed CPB is implemented only after recalcitrant pain persists. We describe the benefit of early CPB in pancreatic cancer management