Improving Rural Bone Health and Minimizing Fracture Risk in West Virginia: Validation of the World Health Organization FRAX® Assessment Tool as a Phone Survey for Osteoporosis Detection

West Virginia ranks second nationally in population ≥ 65 years old placing our state at greater risk for osteoporosis and fracture. The gold standard for detecting osteoporosis is dual X-ray absorptiometry (DXA), yet over half of West Virginia’s counties do not have this machine. Due to access barriers, a validated phone-administered fracture prediction tool would be beneficial for osteoporosis screening. The World Health Organization’s FRAX® fracture prediction tool was administered as a phone survey to 45 patients; these results were compared to DXA bone mineral density determination. Results confirmed that the FRAX® phone survey is as reliable as DXA in detecting osteoporosis or clinically significant osteopenia: 92% positive predictive value, 100% negative predictive value, 100% sensitivity and 91% specificity when compared to the gold standard. These promising results allow for the development of telephone-based protocols to improve osteoporosis detection, referral and treatment especially in areas with health care access barriers

Clinical Phenotype of Bernard Soulier Syndrome Case Resulting from Compound Heterozygous Inheritance

Background: Bernard Soulier Syndrome (BSS) is a rare, autosomal recessive inheritance disorder of platelet function. Estimated to affect one per one million, there are currently only 200 cases reported worldwide presenting more commonly in families with parental consanguinity. This syndrome occurs when there is a genetic defect in the subunits (GPIb-alpha, GPIB-beta, and GP9) that form the GPIb-IX-V complex. The result is inadequate binding to von Willebrand factor. The clotting cascade is, therefore, unable to begin, causing symptoms of excessive and prolonged bleeding. Objectives: We report a case with multiple episodes of exaggerated bleeding and easy bruising. Methods: We analyzed complete blood count, coagulation studies, platelet aggregation assays, platelet glycoprotein expression by flow cytometry, as well as screened both patient and parents for relevant genes responsible for BSS. Results: 14-month-old Caucasian male born at 38w3d gestational age, non-consanguineous parents with multiple episodes of exaggerated bleeding and easy bruising from minor injuries. His symptoms started early in life with excessive bleeding after circumcision. No history of intramuscular, joint, or intracranial bleeding. Complete blood counts showed macrothrombocytopenia (98 X109 /L MPV 12.3 fl) no leukocyte inclusion bodies on peripheral smear. Coagulation tests (prothrombin time, activated partial thromboplastin time, vWF antigen, and vW-Ristocetin cofactor activity, platelet function assay) were normal. Platelet glycoprotein expression by flow cytometry revealed significantly reduced binding of monoclonal antibodies to platelet GPIb and normal GPIIb/IIIa. Comprehensive platelet disorder panel revealed two clinically significant variants missense mutations in the GP9 gene (P.Cys135 Tyr and P.Asn61Ser) These variants were on opposite alleles and results were consistent with the diagnosis of Bernard Soulier syndrome (BSS). The mother reported heavy menstrual cycles, the father had no significant bleeding symptoms, and both parents had normal platelet counts. Target genetic testing identified these two distinct missense mutations from both Mother and Father of the child. Conclusion: The two rare variants occurring on the gene for GPIX (GP9) increase the number of known genetic defects associated with the manifestation of Bernard Soulier Syndrome

Safer Ambu-Bag Manual Ventilation through Addition of a Second High Efficiency Particulate Air (HEPA) Filter

Experts from the Thomas Jefferson University Health Design Lab met with Emergency Medicine and Anesthesia physicians and local engineers A design was envisioned in which 3-D printed connectors could be created to add an additional HEPA Filter as shown in Figure 1 STL Files for the adapters were created based on standard HEPA filter diameters and 3-D printed The second HEPA filter was easily assembled by novice users using the adapters Ventilation adequacy using the double HEPA filter ambu-bag was similar to single HEPA filtered ambu-bag ventilation based on observed inflation of a test lun

Subcutaneous Sarcoid Nodules: A Dermatologic Presentation of Systemic Sarcoidosis for Primary Care Physicians

Sarcoidosis is a multisystem granulomatous disease primarily characterized by pulmonary manifestations. Extrapulmonary involvement in sarcoidosis is well documented and common, but isolated extrapulmonary involvement is rare at around 10% of cases at the time of diagnosis. Cutaneous presentations vary significantly, with erythema nodosum being the most common. Since extrapulmonary symptoms most likely suggest systemic involvement, any way to identify sarcoidosis early is paramount. We present a case of a 63-year-old Caucasian female with multiple palpable 0.5-3cm nodules under the skin of the bilateral forearms, left hand, and lower extremities. A biopsy of a lesion revealed numerous sarcoidal phenotype granulomas without necrosis surrounded by a mild lymphocytic infiltrate. Imaging confirmed calcified mediastinal, hilar, and sub-carinal lymph nodes, as well as revealed scattered calcified and non-calcified granulomas in the upper lung fields. Treatment is not always required, and this patient’s subcutaneous nodules resolved with a single course of steroids. Therefore, it is vital for primary care providers to maintain a high index of suspicion for sarcoidosis with various dermatological findings, as it may be the presenting symptom for sarcoidosis and allow early recognition, monitoring, and intervention

Time-dependence of SrVO3_3 thermionic electron emission properties

Thermionic electron emission cathodes are critical components of various high power and high frequency vacuum electronic devices, electron microscopes, e-beam lithographic devices, and thermionic energy converters, which all demand an efficient and long-lasting low work function cathode. Single phase, polycrystalline perovskite oxide SrVO$_3$, with its intrinsic low effective work function and facile synthesis process, is a promising cathode candidate, where previous works have shown evidence of an effective work function as low as 2.3 eV. However, assessment of the stability over time under conditions relevant for operation and the related interplay of evolving surface chemistry with emission performance are still missing, and necessary for understanding how to best prepare, process and operate SrVO$_3$ cathodes. In this work, we study the vacuum activation process of SrVO$_3$ and find it has promising emission stability over 15 days of continuous high temperature operation. We find that SrVO$_3$ shows surface Sr and O segregation during operation, which we hypothesize is needed to create a positive surface dipole, leading to low effective work function. Emission repeatability from cyclic heating and cooling suggests the promising stability of the low effective work function surface, and additional observations of drift-free emission during one hour of continuous emission testing at high temperature further demonstrates its excellent performance stability

Systems Analysis of the Community Elder Caregiver Program at the Spirit Lake Nation

Native Americans (NA) disproportionately reside in areas with significantly more social, economic, and health disparities than any other population, and have the lowest employment rates nationally. Additionally, the NA Baby Boomer generation is aging, with senior citizen services largely unavailable on reservations. The Community Elder Caregiver (CEC) Program at Spirit Lake was developed with two aims: 1) to meet the needs of unemployed natives and 2) to develop a competent workforce to help elders safely “age in place”. In the initial pilot, seventeen individuals started the initial (NECC) training, with three completing the Qualified Service Provider (QSP) training. We analyzed the pilot CEC training program using feedback from participants and key stakeholders. We identified components that were successful along with barriers that required alterations to the program design. Market and stakeholder analysis revealed that Certified Nursing Assistant (CNA) training offered broader opportunities for employment than QSP training. In the second iteration, CNA training curriculum was offered in place of QSP. CNA training yielded 8 completions, and 7 additional participants registered for the next session. Key contributors to success included: 1) partnerships with Lake Region State College- TrainND Program, the Spirit Lake Tribal Health Nursing Department, and Next Steps Program social worker; 2) pre-training mentorship of candidates to set goals, expectations, and to help identify and overcome barriers to program completion. Participants also served as a “peer recruitment” strategy. Conclusion: The CEC pilot resulted in the evolution of a more sustainable, culturally-competent caregiver model that can be expanded to additional reservations

Surgical Apgar Score (SAS) Predicts Perioperative Morbidity and Length of Stay in Patients Undergoing Esophagectomy at a High-Volume Center

Background: Esophagectomy is a procedure that carries considerable morbidity. Many studies have evaluated factors to predict patients at risk and improve clinical outcomes. The aim of this study was to determine whether the SAS predicts complications, length of stay, and anastomotic leak for patients undergoing esophagectomy at a high-volume institution.https://jdc.jefferson.edu/surgeryposters/1002/thumbnail.jp

A Strategy for Deploying Large-Scale Volunteer Continuous Bag Valve Tube (BVT) Ventilation

Part 1: Hospital Guide The hospital guide outlines steps and considerations for the healthcare system to successfully implement a manual ventilation strategy Part 2: Online BVT Training Module We created an online articulate evidence based training module for safe and effective Bag-Valve-Tube (BVT) ventilation for medical and nonmedical providers