Digital Commons Network^™

Re-Visioning Interprofessional Education In Virtual Worlds, Susan Toth-Cohen, Anne C. Smith

Department of Occupational Therapy Faculty Papers

From their inception, virtual worlds have attracted educators from many disciplines, and benefits for both students and educators for networking and immersive experience have been well documented. But, while virtual world education has engaged multiple disciplines to learn with, from, and about each other, the potential for innovation in interprofessional education (IPE) has not been fully realized. This paper outlines ways to re-vision IPE using a flexible learning framework to develop, implement, and enhance virtual world training programs.

The Fibrosis Across Organs Symposium: A Roadmap For Future Research Priorities., Jesse Roman, Teresa R. Barnes, Dolly J. Kervitsky, Gregory P. Cosgrove, Dennis E. Doherty, Andrew M. Tager, Luca Richeldi, Eric S. White, David A. Brenner, Lynn M. Schnapp, Timothy D. Hewitson, Bodh I. Jugdutt, Timothy A. Mckinsey, John D. Tosi, Stephen Crane, Kevin K. Brown

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Letter To The Editor: Ketamine For Pain Management: Let's Not Neglect Practical Concerns, Steven P. Cohen, Eric S. Schwenk, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

We read with interest the recent article on ketamine by Bell and Kalso.1 In recent years, the use of ketamine to treat chronic pain and depression has exploded, and this article represents an easy-to-follow overview of this often misunderstood medication.

Automation, Regulation, And Collaboration: Threats And Opportunities For Clinical Medical Physics Careers In Diagnostic Imaging And Nuclear Medicine., David W. Jordan, Eric L. Gingold, Ehsan Samei

Department of Radiology Faculty Papers

No abstract provided.

Re-Code Dcm (Research Objectives And Common Data Elements For Degenerative Cervical Myelopathy): A Consensus Process To Improve Research Efficiency In Dcm, Through Establishment Of A Standardized Dataset For Clinical Research And The Definition Of The Research Priorities, Benjamin M. Davies, Danyal Z. Khan, Oliver D. Mowforth, Angus G.K. Mcnair, Toto Gronlund, Angelos G. Kolias, Lindsay Tetreault, Michelle L. Starkey, Iwan Sadler, Ellen Sarewitz, Delphine Houlton, Julia Carter, Sukhvinder Kalsi-Ryan, Bizhan Aarabi, Brian K. Kwon, Shekar N. Kurpad, James Harrop, Jefferson R. Wilson, Robert Grossman, Armin Curt, Michael G. Fehlings, Mark R.N. Kotter

Department of Neurosurgery Faculty Papers

Study Design: Mixed-method consensus process.

Objectives: Degenerative cervical myelopathy (DCM) is a common and disabling condition that arises when mechanical stress damages the spinal cord as a result of degenerative changes in the surrounding spinal structures. RECODE-DCM (REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy) aims to improve efficient use of health care resources within the field of DCM by using a multi-stakeholder partnership to define the DCM research priorities, to develop a minimum dataset for DCM clinical studies, and confirm a definition of DCM.

Methods: This requires a multi-stakeholder partnership and multiple parallel consensus development processes. It …

Cervical Posterior Longitudinal Ligament Ossification : Microscopy-Assisted Anterior Corpectomy And Fusion., Wanyi Wang, Tao Ding, James Harrop, Huilin Yang, Xiaofeng Gu, Dehong Feng, Yafeng Zhang, Hao Liu, Fenglin Tang, Yuntao Xue, Miao Lu, Chao Wu

Department of Neurosurgery Faculty Papers

OBJECTIVE: To explore the clinical efficacy and safety of microscopy-assisted anterior corpectomy and fusion for cervical ossification of the posterior longitudinal ligament (OPLL).

METHODS: A retrospective review of 32 cervical OPLL patients who underwent microscopy-assisted anterior corpectomy and fusion from June 2012 to March 2017 was carried out. Patients were evaluated with outcome metrics: Japanese Orthopaedic Association (JOA) scores (17 points method), visual analog scale (VAS), and radiographic parameters of the lordotic angle. The complications during treatment and follow-up were recorded.

RESULTS: This study included 32 patients (15 males and 17 females) with a mean age of 58.3 ± 2.9 …

Cuff-Less Methods For Blood Pressure Telemonitoring., Dylan M. Bard, Jeffrey I. Joseph, Noud Van Helmond

Department of Anesthesiology Faculty Papers

Blood pressure telemonitoring (BPT) is a telemedicine strategy that uses a patient's self-measured blood pressure (BP) and transmits this information to healthcare providers, typically over the internet. BPT has been shown to improve BP control compared to usual care without remote monitoring. Traditionally, a cuff-based monitor with data communication capabilities has been used for BPT; however, cuff-based measurements are inconvenient and cause discomfort, which has prevented the widespread use of cuff-based monitors for BPT. The development of new technologies which allow for remote BP monitoring without the use of a cuff may aid in more extensive adoption of BPT. This …

Tumor-Derived Extracellular Vesicles Require Β1 Integrins To Promote Anchorage-Independent Growth., Rachel M. Derita, Aejaz Sayeed, Vaughn Garcia, Shiv Ram Krishn, Christopher D. Shields, Srawasti Sarker, Andrea Friedman, Peter Mccue, Sudheer Kumar Molugu, Ulrich Rodeck, Adam P. Dicker, Lucia R. Languino

Department of Cancer Biology Faculty Papers

The β1 integrins, known to promote cancer progression, are abundant in extracellular vesicles (EVs). We investigated whether prostate cancer (PrCa) EVs affect anchorage-independent growth and whether β1 integrins are required for this effect. Specifically using a cell-line-based genetic rescue and an in vivo PrCa model, we show that gradient-purified small EVs (sEVs) from either cancer cells or blood from tumor-bearing TRAMP (transgenic adenocarcinoma of the mouse prostate) mice promote anchorage-independent growth of PrCa cells. In contrast, sEVs from cultured PrCa cells harboring a short hairpin RNA to β1, from wild-type mice or from TRAMP mice carrying a β1 conditional ablation …

Patients With Refractory Out-Of-Cardiac Arrest And Sustained Ventricular Fibrillation As Candidates For Extracorporeal Cardiopulmonary Resuscitation - Prospective Multi-Center Observational Study., Takahiro Nakashima, Teruo Noguchi, Yoshio Tahara, Kunihiro Nishimura, Soshiro Ogata, Satoshi Yasuda, Daisuke Onozuka, Naoto Morimura, Ken Nagao, David F. Gaieski, Yasufumi Asai, Hiroyuki Yokota, Satoshi Nara, Mamoru Hase, Takahiro Atsumi, Tetsuya Sakamoto

Department of Emergency Medicine Faculty Papers

BACKGROUND: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) and sustained ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) or conversion to pulseless electrical activity/asystole (PEA/asystole) benefit more from extracorporeal cardiopulmonary resuscitation (ECPR). Methods and Results: We analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, which was a prospective, multicenter, observational study with 22 institutions in the ECPR group and 17 institutions in the conventional CPR (CCPR) group. Patients were divided into 4 groups by cardiac rhythm and CPR group. The primary endpoint was favorable neurological outcome, defined as Cerebral Performance Category 1 …

Process Improvement For Follow-Up Radiology Report Recommendations Of Lung Nodules., Philip S. Lim, Doron Schneider, Jonathan Sternlieb, Michel Taupin, Nicholas Sich, Joan Diaz, Eileen Jameson, Bryan Frambes, Sharon Taylor

Abington Jefferson Health Papers

In the modern healthcare system, there are still wide gaps of communication of imaging results to physician and patient stakeholders and tracking of whether follow-up has occurred. Patients are also unaware of the significance of findings in radiology reports. With the increase in use of cross-sectional imaging such as CT, patients are not only being diagnosed with primary urgent findings but also with incidental findings such as lung nodules; however, they are not being told of their imaging findings nor what actions to take to mitigate their risks. In addition, patients at high risk for developing lung cancer often obtain …

Trna Methylation Is A Global Determinant Of Bacterial Multi-Drug Resistance., Isao Masuda, Ryuma Matsubara, Thomas Christian, Enrique R. Rojas, Srujana S. Yadavalli, Lisheng Zhang, Mark Goulian, Leonard J. Foster, Kerwyn Casey Huang, Ya-Ming Hou

Department of Biochemistry and Molecular Biology Faculty Papers

Gram-negative bacteria are intrinsically resistant to drugs because of their double-membrane envelope structure that acts as a permeability barrier and as an anchor for efflux pumps. Antibiotics are blocked and expelled from cells and cannot reach high-enough intracellular concentrations to exert a therapeutic effect. Efforts to target one membrane protein at a time have been ineffective. Here, we show that m ¹ G37-tRNA methylation determines the synthesis of a multitude of membrane proteins via its control of translation at proline codons near the start of open reading frames. Decreases in m ¹ G37 levels in Escherichia coli and Salmonella impair …

Split Tolerance Permits Safe Ad5-Gucy2c-Padre Vaccine-Induced T-Cell Responses In Colon Cancer Patients., Adam E. Snook, Trevor R. Baybutt, Bo Xiang, Tara S. Abraham, John C. Flickinger, Terry Hyslop, Tingting Zhan, Walter K. Kraft, Takami Sato, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Background: The colorectal cancer antigen GUCY2C exhibits unique split tolerance, evoking antigen-specific CD8+, but not CD4+, T-cell responses that deliver anti-tumor immunity without autoimmunity in mice. Here, the cancer vaccine Ad5-GUCY2C-PADRE was evaluated in a first-in-man phase I clinical study of patients with early-stage colorectal cancer to assess its safety and immunological efficacy.

Methods: Ten patients with surgically-resected stage I or stage II (pN0) colon cancer received a single intramuscular injection of 1011 viral particles (vp) of Ad5-GUCY2C-PADRE. Safety assessment and immunomonitoring were carried out for 6 months following immunization. This trial employed continual monitoring of both efficacy and toxicity …

Management Of Cancer-Associated Anemia With Erythropoiesis-Stimulating Agents: Asco/Ash Clinical Practice Guideline Update., Julia Bohlius, Kari Bohlke, Roberto Castelli, Benjamin Djulbegovic, Maryam B Lustberg, Massimo Martino, Giannis Mountzios, Namrata Peswani, Laura Porter, Tiffany N. Tanaka, Gianluca Trifirò, Hushan Yang, Alejandro Lazo-Langner

Department of Medical Oncology Faculty Papers

PURPOSE: To update the American Society of Clinical Oncology (ASCO)/American Society of Hematology (ASH) recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer.

METHODS: PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs in patients with cancer published from January 31, 2010, through May 14, 2018. For biosimilar ESAs, the literature search was expanded to include meta-analyses and RCTs in patients with cancer or chronic kidney disease and cohort studies in patients with cancer due to limited RCT evidence in the cancer setting. ASCO and ASH convened an Expert Panel to …

Increasing Upstream Chromatin Long-Range Interactions May Favor Induction Of Circular Rnas In Lysopc-Activated Human Aortic Endothelial Cells., Angus Li, Yu Sun, Charles Drummer, Yifan Lu, Daohai Yu, Yan Zhou, Xinyuan Li, Simone J. Pearson, Candice Johnson, Catherine Yu, William Y. Yang, Kevin Mastascusa, Xiaohua Jiang, Jianxin Sun, Thomas Rogers, Wenhui Hu, Hong Wang, Xiaofeng Yang

Center for Translational Medicine Faculty Papers

Circular RNAs (circRNAs) are non-coding RNAs that form covalently closed continuous loops, and act as gene regulators in physiological and disease conditions. To test our hypothesis that proatherogenic lipid lysophosphatidylcholine (LPC) induce a set of circRNAs in human aortic endothelial cell (HAEC) activation, we performed circRNA analysis by searching our RNA-Seq data from LPC-activated HAECs, and found: (1) LPC induces significant modulation of 77 newly characterized cirRNAs, among which 47 circRNAs (61%) are upregulated; (2) 34 (72%) out of 47 upregulated circRNAs are upregulated when the corresponding mRNAs are downregulated, suggesting that the majority of circRNAs are upregulated presumably via …

Bova Is Superior To Spesi In Identification Of High Risk Pulmonary Embolism Patients, Joseph Dibello

Sigma Xi Student Research Day

No abstract provided.

Single-Cell Gene Expression Analysis Identifies Chronic Alcohol-Mediated Shift In Hepatocyte Molecular States After Partial Hepatectomy., Sirisha Achanta, Aalap Verma, Ankita Srivastava, Harshavardhan Nilakantan, Jan B. Hoek, Rajanikanth Vadigepalli

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The analysis of molecular states of individual cells, as defined by their mRNA expression profiles and protein composition, has gained widespread interest in studying biological phenomena ranging from embryonic development to homeostatic tissue function and genesis and evolution of cancers. Although the molecular content of individual cells in a tissue can vary widely, their molecular states tend to be constrained within a transcriptional landscape partly described by the canonical archetypes of a population of cells. In this study, we sought to characterize the effects of an acute (partial hepatectomy) and chronic (alcohol consumption) perturbation on the molecular states of individual …

Rabies-Based Vaccine Induces Potent Immune Responses Against Nipah Virus., Rohan Keshwara, Thomas Shiels, Elena Postnikova, Drishya Kurup, Christoph Wirblich, Reed F. Johnson, Matthias J. Schnell

Department of Microbiology and Immunology Faculty Papers

Nipah Virus (NiV) is a re-emerging zoonotic pathogen in the genus Henipavirus of the Paramyxoviridae family of viruses. NiV is endemic to Bangladesh and Malaysia and is highly fatal to both livestock and humans (human case fatality rate = 74.5%). Currently, there is no approved vaccine against NiV on the market. The goal of this study was to use a recombinant RABV vector expressing NiV glycoprotein (NiV G) to develop a bivalent candidate vaccine against NiV disease and rabies virus (RABV) disease, which is also a significant health burden in the regions where NiV is endemic. The rabies vector is …

An Evaluation Of Risk Attitudes And Risk Tolerance In Emergency Medicine Residents., Carlos Rodriguez, Nishad A Rahman, Kory London, Robin Naples, Simran Buttar, Xiao Chi Zhang, Hyunjoo Lee, Joshua Rudner, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Introduction Previous studies have shown that risk attitudes and tolerance for uncertainty are significant factors in clinical decision-making, particularly in the practice of defensive medicine. These attributes have also been linked with rates of physician burnout. To date, the risk profile of emergency medicine (EM) physicians has not yet been described. Our goal was to examine the risk profile of EM residents using a widely available risk tolerance and attitude assessment tool. Methods First-, second-, and third-year residents of Thomas Jefferson University Hospital's EM residency program completed the commercially available, unmodified Risk Type Compass, a validated instrument offered by Multi-Health …

Health Insurance Coverage Of Recommended Gender-Affirming Health Care Services For Transgender Youth: Shopping Online For Coverage Information, Nadia L. Dowshen, Julie Christensen, Siobhan Gruschow

Student Papers, Posters & Projects

We assessed online health insurance plan indication of coverage and accessibility of information for recommended services for transgender youth (TY). Content analysis was performed for plans used at a pediatric Gender Clinic by reviewing information about coverage of puberty blockers, hormones, masculinizing chest surgery, and counseling. Transgender-specific exclusions and the time required for the research assistant to review each plan's online information were noted. No plan (0%; n=36) indicated coverage of all four categories of recommended services online. Forty-nine percent indicated ≥1 transgender-specific exclusion. The median time required for a research assistant to review online coverage information for each insurance …

Gasdermin Pores Permeabilize Mitochondria To Augment Caspase-3 Activation During Apoptosis And Inflammasome Activation., Corey Rogers, Dan A. Erkes, Alexandria Nardone, Andrew E. Aplin, Teresa Fernandes-Alnemri, Emad S. Alnemri

Department of Biochemistry and Molecular Biology Faculty Papers

Gasdermin E (GSDME/DFNA5) cleavage by caspase-3 liberates the GSDME-N domain, which mediates pyroptosis by forming pores in the plasma membrane. Here we show that GSDME-N also permeabilizes the mitochondrial membrane, releasing cytochrome c and activating the apoptosome. Cytochrome c release and caspase-3 activation in response to intrinsic and extrinsic apoptotic stimuli are significantly reduced in GSDME-deficient cells comparing with wild type cells. GSDME deficiency also accelerates cell growth in culture and in a mouse model of melanoma. Phosphomimetic mutation of the highly conserved phosphorylatable Thr6 residue of GSDME, inhibits its pore-forming activity, thus uncovering a potential mechanism by which GSDME …

Coronary Angiography After Cardiac Arrest - The Right Timing Or The Right Patients?, Benjamin S. Abella, David F. Gaieski

Department of Emergency Medicine Faculty Papers

No abstract provided.

Histological Chorioamnionitis Induces Differential Gene Expression In Human Cord Blood Mononuclear Leukocytes From Term Neonates., Suhita Gayen Nee’ Betal, Swati Murthy, Michael Favara, Gina Fong, Joanna Chan, Sankar Addya, Thomas H. Shaffer, Jay S. Greenspan, Vineet Bhandari, Irfan Rahman, Zubair H. Aghai

Department of Pediatrics Faculty Papers

Histological chorioamnionitis (HCA) is an infection of fetal membranes and complicates 5.2% to 28.5% of all live births. HCA is associated with increased mortality and morbidity in both premature and term neonates. Exposure to HCA may have long-term consequences, including an increased risk for allergic disorders and asthma later in childhood, the mechanism(s) of which are still not yet well understood. The objective of this study was to determine the mRNA transcriptome of cord blood mononuclear leukocytes from term neonates to identify key genes and pathways involved in HCA. We found 366 differentially expressed probe IDs with exposure to HCA …

Telemedicine Training In Undergraduate Medical Education: Mixed-Methods Review., Shayan Waseh, Mph, Adam P. Dicker, Md, Phd, Fastro

Student Papers, Posters & Projects

BACKGROUND: Telemedicine has grown exponentially in the United States over the past few decades, and contemporary trends in the health care environment are serving to fuel this growth into the future. Therefore, medical schools are learning to incorporate telemedicine competencies into the undergraduate medical education of future physicians so that they can more effectively leverage telemedicine technologies for improving the quality of care, increasing patient access, and reducing health care expense. This review articulates the efforts of allopathic-degree-granting medical schools in the United States to characterize and systematize the learnings that have been generated thus far in the domain of …

Vision Rehabilitation Impacting Return To Occupation After Post-Concussion Syndrome, Joe Kardine, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Vision rehabilitation is an emerging use of efficient occupation-based intervention in occupational therapy for vision impairment after concussion. Public awareness of untreated concussions has led to more patients seeking treatment for symptom remediation. Efficient interpretations of comprehensive vision evaluations followed by incorporation of vision therapy to treatment improve performance outcomes, increase patient quality of life and ensure compliance of intervention.

From Prison To The Community: The Pivotal Role Of Ot In Facilitating A Healthy Transition, Pari Kumar, Bs, Jennifer A. Merz, Bs, Audrey L. Zapletal, Otd, Otr/L, Cla, Susan E. Connor, Otd, Otr/L, Cchp

Department of Occupational Therapy Posters and Presentations

Background

• Approximately 630,000 prisoners are released into the community each year.1
• First Step Act (2018) reduces minimum sentencing for populations such as nonviolent drug offenders.2
• Majority released to unsafe areas due to shortage of affordable housing. 3
• Insecure housing and homelessness are related to increased:
• Recidivism4; Emergency room use5; Substance use 6; Unstable family relationships7; Mental health (MH) problems.7
• Post-release is a high-risk time due to poor care continuity and lack of support.8 •Individuals report difficulty: Obtaining employment and stable housing, accessing relevant treatment services, reintegrating with their families and communities.9
• Stable housing provides a secure place to seek employment, …

The Student Hotspotting Program: Facilitating Interprofessional Community Learning, Tracey Vause-Earland, Phd, Otr/L, Sara Cohen, Ots

Department of Occupational Therapy Posters and Presentations

Student Hotspotting teams work together to identify and engage super-utilizing individuals to establish healing relationships and identify barriers to their care. With support from faculty and clinician advisors, students guide these individuals through achieving personalized health goals, navigating the complex healthcare system and connect them to community resources.

In addition to hands-on work, students are guided through this program with a supplemental online curriculum consisting of webinars and monthly case conferences with professionals in the field.

• Core Principles: Harm reduction, motivational interviewing, trauma informed care and accompaniment
• Webinars cover topics such as client recruitment and enrollment, the power of empathy, …

Critically Appraised Paper: A Multicenter, Randomized Controlled Trial Of Individualized Occupational Therapy For Patients With Schizophrenia In Japan, Pari Kumar, Bs, Mary Muhlenhaupt, Otd, Otr/L, Faota

Department of Occupational Therapy Posters and Presentations

• Based on the article "A multicenter, randomized controlled trial of individualized OT for patients with schizophrenia in Japan," by Shimada, et al.
• Results suggest that combining individual OT with group OT can improve cognition, intrinsic motivation, medication adherence, and treabnent satisfaction for individuals with schizophrenia and schizoaffective disorder.
• These findings have implications for OTs working in psychiatric settings.

The Power To Transform Development: Benefits Of Power Mobility Devices For Children 0-3 Years, Madeleine Clements, Ots, Chalia Bellis, Ots, Audrey Zapletal, Otd, Otr/L, Cla

Department of Occupational Therapy Posters and Presentations

The purpose of this poster is to describe the benefits of PMD for children 0-3 years old and to provide evidence-based recommendations for prescription and usage.

The Vitamin C, Thiamine And Steroids In Sepsis (Victas) Protocol: A Prospective, Multi-Center, Double-Blind, Adaptive Sample Size, Randomized, Placebo-Controlled, Clinical Trial., David N. Hager, Michael H. Hooper, Gordon R. Bernard, Laurence W. Busse, E. Wesley Ely, Alpha A. Fowler, David F. Gaieski, Alex Hall, Jeremiah S. Hinson, James C. Jackson, Gabor D. Kelen, Mark Levine, Christopher J. Lindsell, Richard E. Malone, Anna Mcglothlin, Richard E. Rothman, Kert Viele, David W. Wright, Jonathan E. Sevransky, Greg S. Martin

Department of Emergency Medicine Faculty Papers

BACKGROUND: Sepsis accounts for 30% to 50% of all in-hospital deaths in the United States. Other than antibiotics and source control, management strategies are largely supportive with fluid resuscitation and respiratory, renal, and circulatory support. Intravenous vitamin C in conjunction with thiamine and hydrocortisone has recently been suggested to improve outcomes in patients with sepsis in a single-center before-and-after study. However, before this therapeutic strategy is adopted, a rigorous assessment of its efficacy is needed.

METHODS: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled trial. It will enroll …

Addressing Chronic Homelessness & Mental/Behavioral Health Needs In The Community: Collaborative Level Ii Fieldwork And Doctoral Experiential Programming, Tina M. Deangelis, Edd, Otr/L, Josephine Beker, Ots, Eliza Brooks, Ots, Rebecca Brown, Ots, Jonette Ishmael, Ots, Alex Manwaring, Ots, Jennifer Merz, Ots, Erin Schifferdecker, Ots, Cerissa Zenor Clark, Ots

Department of Occupational Therapy Posters and Presentations

OT students worked with a diverse population in a variety of living environments including permanent supportive housing, and safe havens.