Hepatitis A Vaccination Program in Jefferson Emergency Departments

Aims for Improvement Increase the rate of hepatitis A vaccination in high-risk patients (homeless and drug users) who present to Thomas Jefferson University Hospital and Jefferson Methodist emergency departments over a 5 month period starting on 9/4/2019

Imposter Phenomenon and Dunning-Kruger Effect: Leveraging Internal Conflicts for Professional Growth and Wellness

Working together as a team, we all came to realize that addressing uncomfortable topics such as imposter phenomenon is important to build resilience among faculty and students

Informing Policy on Built Environments to Safeguard Children in Environmental Justice Communities: Case Study of Five AAP Climate Advocates

Climate change’s health effects are most strongly felt in Environmental Justice (EJ) communities which are predominantly people of color. This results in a disproportionate burden of climate change health effects on EJ communities. Climate change is a public health crisis, and more importantly to pediatricians – it is a pediatric public health crisis. We are five pediatricians who are part of the American Academy of Pediatrics (AAP) Climate Advocate Program representing four diverse regions; Colorado, California, Puerto Rico, and North Carolina. We are applied research practitioners, as we live in the world between academic research and clinical practice. We are natural advocates to ensure that the future world is rebuilt with children’s health, especially children of EJ communities, at the center. Each of us has seen the direct effects of climate change adversely impact EJ Communities. In this article, we will briefly review the literature on the dangers that children face in the air they breathe, the lack of natural green spaces, and the increasingly hostile built environments, especially to children in EJ communities. We will review opportunities in our local areas to change the built environment that will work toward reducing carbon emissions and increase overall pediatric health. We will illustrate the commonalities that helped us succeed as Climate Advocates including collaboration, working locally, and purposefully choosing to identify ourselves as climate advocates and child-advocates. The intersection between public health, policy, and medicine will now become increasingly important as we head into this new decade and approach the point of no return on climate change

The Job Opportunity Investment Network Education on Diabetes in Urban Populations (JOINED-UP) Project

Work in Progress (36 PowerPoint Slides) Diabetes and obesity are inter-related health issues that impact many aspects of daily living, including workplace productivity and efficiency. Obese individuals are less likely to be employed and more often absent from work. Nearly one billion dollars per year is attributed to lost productivity for reasons relating to diabetes including early retirement, increased sick days, disability and premature mortality. Utilizing an interdisciplinary team of a physician, public health staff, nursing and health educators, the Job Opportunity Investment Network Education on Diabetes in Urban Populations (JOINED-UP) is a diabetes and obesity healthy lifestyle education program that is embedded in a Green Jobs training program targeting low skilled, low resourced residents inPhiladelphia. Participants in the program are required to attend six Healthy Lifestyle workshops that use a “patient” case study (whose attributes are created by program participants) as a means to encourage sharing of real life experiences related to incorporating healthier behaviors onto daily life. Participants meet individually with the health educator to review screening/survey results, discuss personal health concerns, and create a personal action plan. Motivational interviewing techniques guide this discussion. A Certified Diabetes Educator meets with individuals whose screening results indicate pre-diabetes and provides information about diabetes, and suggestions for risk reduction. The CDE counsels diagnosed diabetics about managing diabetes and preventing complications. A post-program screening was conducted. To date– 56% of the participants were obese, 11% overweight, 11% diabetic, 63% pre-diabetic/diabetic, 19% hypertensive, and 26% pre-hypertensive. Process measure and outcome measures on 50 participants will be presented. Learning Objectives: Participants attending this session will be able to: 1. Organize an approach to providing obesity and diabetes prevention in a workforce development program utilizing an interdisciplinary team 2. Apply a methodology of engaging community organizations to address obesity and diabetes prevention 3. Identify the challenges of incorporating obesity and diabetes prevention in a workforce development progra

Response function analysis of excited-state kinetic energy functional constructed by splitting k-space

Over the past decade, fundamentals of time independent density functional theory for excited state have been established. However, construction of the corresponding energy functionals for excited states remains a challenging problem. We have developed a method for constructing functionals for excited states by splitting k-space according to the occupation of orbitals. In this paper we first show the accuracy of kinetic energy functional thus obtained. We then perform a response function analysis of the kinetic energy functional proposed by us and show why method of splitting the k-space could be the method of choice for construction of energy functionals for excited states.Comment: 11 page

Functional Outcomes after Lumbar Fusion in Opioid-Tolerant Patients

Introduction: Prolonged opioid use after lumbar fusion surgery is implicated with increased hospital readmissions, higher postoperative pain scores, and longer return to work time. There are several non-modifiable risk factors for postoperative opioid use including socioeconomic status and gender. The purpose of this study was to determine the effects of opioid-tolerance on PROMs and to determine risk factors for prolonged opioid use after lumbar spine surgery. Method: Using retrospective cohort analysis, patients who underwent lumbar spinal fusion at TJUH were identified and determined to be either opioid-naïve or opioid-tolerant using the Pennsylvania PDMP. Outcomes included number of opioid tablets consumed, duration of time using opioids, and patient-reported outcome measures (ODI, PCS-12, MCS-12, VAS Back, VAS Leg). Univariate and multivariate analysis were used to compare outcomes between the two groups. Logistic regression was used to determine independent predictors for prolonged opioid use which was defined as greater than one postoperative opioid prescription script filled. Results: A total of 260 patients were included in the final cohort, of which, 138 were opioid-tolerant and 122 were opioid naïve. Opioid-tolerant patients showed decreased improvement in PROMs compared to the opioid-naïve patients (p=0.043). The number of preoperative pills prescribed was a significant predictor for prolonged opioid use after lumbar fusion. Conclusion: The number of pills prescribed preoperatively was found to be a predictor for prolonged opioid use after lumbar fusion surgery. Overall, our results demonstrated that naïve patients have improved health-related quality of life outcome scores compared to opioid-tolerant patients after lumbar fusion

Effects of Cocaine and/or Heroin Use on Resting Cardiovascular Function

Background: Regular cocaine and/or heroin use is associated with major health risks, especially cardiovascular disease (CVD), but confounded by other factors. Objectives: We examined effects of chronic (years of regular use) and recent (past-month) use of cocaine and heroin, controlling for other factors, on resting cardiovascular function. Methods: In a sample of cocaine and/or heroin users (N=292), we obtained data on demographics, body mass index (BMI), history of substance use, and electrocardiogram, heart rate (HR) and blood pressure (BP). Following bivariate correlations, three-block (1: demographics, BMI; 2: tobacco, alcohol, marijuana; 3: cocaine, heroin) regression analyses were conducted to predict cardiovascular measures. Results: Higher BMI predicted increased systolic and diastolic BP (as did older age), increased supine HR, and longer QRS duration, QTc interval, PR interval, and P-wave duration. Recent substance use had more reliable effects than chronic use on cardiovascular measures. Past-month marijuana-use days predicted higher systolic BP, lower supine HR, and greater likelihood of early repolarization and ST elevation, whereas average daily marijuana use predicted shorter QTc interval. Average daily alcohol use predicted higher diastolic BP, higher supine HR and lower likelihood of sinus bradycardia (HRbpm). Past-month tobacco-use days predicted shorter QTc interval and increased likelihood of profound bradycardia (HRbpm). Past-month heroin-use days predicted lower seated HR, greater likelihood of sinus bradycardia and lower likelihood of left ventricular hypertrophy. More years of regular cocaine use and past-month cocaine-use days predicted longer QTc interval. Conclusions: Cocaine and heroin incrementally predicted modest variance in resting bradycardia and QTc interval. Clinicians should first consider demographics and recent use of tobacco, alcohol and marijuana before assuming cocaine and heroin affect these measures

FPGA Processor In Memory Architectures (PIMs): Overlay or Overhaul ?

The dominance of machine learning and the ending of Moore's law have renewed interests in Processor in Memory (PIM) architectures. This interest has produced several recent proposals to modify an FPGA's BRAM architecture to form a next-generation PIM reconfigurable fabric. PIM architectures can also be realized within today's FPGAs as overlays without the need to modify the underlying FPGA architecture. To date, there has been no study to understand the comparative advantages of the two approaches. In this paper, we present a study that explores the comparative advantages between two proposed custom architectures and a PIM overlay running on a commodity FPGA. We created PiCaSO, a Processor in/near Memory Scalable and Fast Overlay architecture as a representative PIM overlay. The results of this study show that the PiCaSO overlay achieves up to 80% of the peak throughput of the custom designs with 2.56x shorter latency and 25% - 43% better BRAM memory utilization efficiency. We then show how several key features of the PiCaSO overlay can be integrated into the custom PIM designs to further improve their throughput by 18%, latency by 19.5%, and memory efficiency by 6.2%.Comment: Accepted in 2023 33rd International Conference on Field-Programmable Logic and Applications (FPL

Routine Dental Extractions Routinely Produce Cavitations

ABSTRACT: Cavitations (CVs) are persistent holes found at the extraction sites of permanent teeth after apparent healing has taken place. Current den-talliterature considers this common phenomenon to be rare. In the scientific literature, CVs have a plethora of synonyms. They have been variably labeled as Ratner, Roberts, or trigger point bone cavities, interference fields, neuralgia-inducing cavitational osteonecrosis (NICO), and alveolar cavitational osteopathosis. Evidence suggests that the incidence of CVs is presently grossly underestimated. Therefore, we reviewed the charts of 112 randomly chosen patients treated at the Huggins Diagnostic Center (HDC) from 1991 through 1995 to determine the incidence of CVs in old extraction sites. We believe this problem to be important to the general health of patients who are being treated for a wide range of diseases where such a dental condition may be the ultimate cause or a significant contributing factor. This manuscript is clearly one written for dental surgeons. It describes, however, a little known phenomenon that is extremely important in the general ill health of many patients with a number of different diseases that are not usually associated with dental problems. Since there is more and mor