Digital Commons Network^™

Reversible Cerebral Vasoconstriction Disorder In A Patient With A Chief Complaint Of Headache., Simran Buttar, Anuja Trivedi, Dimitrios Papanagnou, Md

Department of Emergency Medicine Faculty Papers

As emergency medicine physicians, we have formulated an approach to managing patients with a chief complaint of headache that starts with considering the story the patient relays in the context of a wide differential. Here we will describe a case that presented to our emergency department in hopes to broaden your differential. Reversible cerebral vasoconstriction syndrome (RCVS), well described in the neurology literature, is characterized by severe headaches that may or may not be accompanied by neurological symptoms and is definitively diagnosed by diffuse constriction of cerebral arteries on cerebral angiogram. Here we present a case of a patient who …

Credibility, Replicability, And Reproducibility In Simulation For Biomedicine And Clinical Applications In Neuroscience., Lealem Mulugeta, Andrew Drach, Ahmet Erdemir, C A Hunt, Marc Horner, Joy P. Ku, Jerry G Myers, Rajanikanth Vadigepalli, William W. Lytton

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Modeling and simulation in computational neuroscience is currently a research enterprise to better understand neural systems. It is not yet directly applicable to the problems of patients with brain disease. To be used for clinical applications, there must not only be considerable progress in the field but also a concerted effort to use best practices in order to demonstrate model credibility to regulatory bodies, to clinics and hospitals, to doctors, and to patients. In doing this for neuroscience, we can learn lessons from long-standing practices in other areas of simulation (aircraft, computer chips), from software engineering, and from other biomedical …

Optimizing Visiting Clerkships In Dermatology: A Dual Perspective Approach., Jordan V. Wang, Kathleen P. Mcguinn, Matthew Keller

Department of Dermatology and Cutaneous Biology Faculty Papers

Matching into a dermatology residency program has become increasingly more challenging for medical students. As students continue to explore various methods to help them standout to programs, recent medical literature has continued to show evidence of the important role that visiting clerkships play. Visiting clerkships offer several benefits to both students and programs. In order to optimize visiting clerkships, the perspectives of both students and programs are each examined with recommendations provided to help maximize its benefits.

Layout And Flow Of Dermatology Clinics: Principles From Operations Management., Jordan V. Wang

Department of Dermatology and Cutaneous Biology Faculty Papers

Dermatology is a medical specialty that experiences high patient demand and long patient wait times. Dermatology clinics should look for ways to improve efficiency through the incorporation of principles from operations management. Addressing the layout and flow of a clinic can lead to operational efficiency. An ideal layout may lead to increased patient volume, satisfaction, and retention.

An Inpatient Patient Safety Curriculum For Pediatric Residents., John Szymusiak, Michael D Fox, Catherine Polak, Kwonho Jeong, Doris Rubio, Stephanie Dewar, Andrew Urbach, Alda Maria Gonzaga

Department of Pediatrics Faculty Papers

Introduction: Patient safety is recognized as an important part of pediatric resident education. There is a lack of published safety curricula targeting pediatric residents. A local needs assessment showed that while residents felt safety was an important part of their current and future jobs, they did not feel prepared to apply safety principles to their future careers or participate in a root cause analysis (RCA).

Methods: This curriculum was delivered to senior-level pediatric and multiple-board residents during five monthly, hour-long, multidisciplinary sessions. Sessions covered systems-based thinking, terminology, the second victim phenomenon, RCA, and medication errors, while providing feedback on recent …

Regulation Of Nociceptive Glutamatergic Signaling By Presynaptic Kv3.4 Channels In The Rat Spinal Dorsal Horn., Tanziyah Muqeem, Biswarup Ghosh, Vitor Pinto, Angelo C. Lepore, Manuel Covarrubias

Farber Institute for Neuroscience Faculty Papers

Presynaptic voltage-gated K⁺ (Kv) channels in dorsal root ganglion (DRG) neurons are thought to regulate nociceptive synaptic transmission in the spinal dorsal horn. However, the Kv channel subtypes responsible for this critical role have not been identified. The Kv3.4 channel is particularly important because it is robustly expressed in DRG nociceptors, where it regulates action potential (AP) duration. Furthermore, Kv3.4 dysfunction is implicated in the pathophysiology of neuropathic pain in multiple pain models. We hypothesized that, through their ability to modulate AP repolarization, Kv3.4 channels in DRG nociceptors help to regulate nociceptive synaptic transmission. To test this hypothesis, we …

Changing Characteristics Of The Surface P Wave With Aging, And Insights Into Inter-Atrial Conduction - A Study Of 2,156 Patients Over 9 Decades Of Life, Chamaka Kalutota, Bs, Gregory Troutman, Bs, Goutham Ravipati, Bs, Anna Carleen, Ba, Matthew Decaro, Md, Behzad B. Pavri, Md

Sigma Xi Student Research Day

Objective

To define changes in surface ECG P-wave morphology, vector, and duration with advancing age, and make inferences about IAC and risk of atrial fibrillation

Puma Amplifies Necroptosis Signaling By Activating Cytosolic Dna Sensors., Dongshi Chen, Jingshan Tong, Liheng Yang, Liang Wei, Donna B. Stolz, Jian Yu, Jianke Zhang, Lin Zhang

Department of Microbiology and Immunology Faculty Papers

Necroptosis, a form of regulated necrotic cell death, is governed by RIP1/RIP3-mediated activation of MLKL. However, the signaling process leading to necroptotic death remains to be elucidated. In this study, we found that PUMA, a proapoptotic BH3-only Bcl-2 family member, is transcriptionally activated in an RIP3/MLKL-dependent manner following induction of necroptosis. The induction of PUMA, which is mediated by autocrine TNF-α and enhanced NF-κB activity, contributes to necroptotic death in RIP3-expressing cells with caspases inhibited. On induction, PUMA promotes the cytosolic release of mitochondrial DNA and activation of the DNA sensors DAI/Zbp1 and STING, leading to enhanced RIP3 and MLKL …

Optimizing Vaccine Immunotherapy For Prostate Cancer, G. Hattier, E. K. Bongiorno, C. Portocarrero, Trevor R. Baybutt, Adam E. Snook, U. Rodeck

Sigma Xi Student Research Day

Introduction: Treatment options for metastatic prostate cancer are limited and cures are rare. In other cancers immunotherapy has shown remarkable efficacy in certain patient subsets particularly when combined with other treatment modalities. Our previous work showed that combining radiation and vaccine therapy slows the growth of syngeneic prostate cancer in mice more effectively than single modality treatment arms. Here we tested the hypothesis that addition of immune checkpoint inhibitors targeting the PD1/PD-L1 axis further improves efficacy of the dual radiation/vaccine treatment.

Methods: Mice were injected with tumor cells expressing human prostate specific antigen (TPSA-23). The mice were divided into six …

Near-Infrared Spectroscopy’S Predictive Ability Of Neurological Injury In Ecmo Patients, Spencer Liem, Bs, Nicholas Cavarocchi, Md, Hitoshi Hirose, Md, Phd

Sigma Xi Student Research Day

Objectives

• Elucidate sensitivity and specificity of NIRS in detecting neurological injury
• Determine magnitude of NIRS decline in ECMO patients with neurologic injury
• Explore how effective cerebral O2 monitoring is regionally and globally

Incidence Of Ocular Hypertension After Intravitreal Injection Of 2 Mg Triamcinolone Acetonide (Ivt), Jake Goodman, Bs, Maitri Pancholy, Bs, Philip Storey, Md, Mph, Anthony Obeid, Md, Durga Borkar, Md, Carl Regillo, Md, Daniel Su, Md

Sigma Xi Student Research Day

Purpose

To report the incidence of OHT following injection of 2mg IVT

Radiomic Features From Muti-Institutional Glioblastoma Mri Offers Additive Prognostic Value To Clinical And Genomic Markers, Spencer Liem, Bs, Gaurav Shukla, Md, Phd, Spyridon Bakas, Phd, Sung Min Ha, Ms, Saima Rathore, Phd, Christos Davatzikos, Phd

Sigma Xi Student Research Day

Objective

Synergies between clinical, genomic, and radiomic features should improve the predictive value of each group of features and their combinations through a prognostic classifier based on machine learning in patients with glioblastoma.

Long-Term Visual Outcomes In Optic Nerve Sheath Meningiomas Following Fractionated Stereotactic Radiotherapy, Sana Dastgheyb, Christian Fernandez, Md, Maria Werner-Wasik, Md, Voichita Bar-Ad, Md, David Andrews Md, James Evans, Md, Kevin Judy, Md, Sara Lally, Md, Carol Shields, Md, Arman Mashayekhi, Md, Wenyin Shi, Md, Phd, Christopher Farrell, Md

Sigma Xi Student Research Day

Introduction

Radiation therapy is often used for tumors of the optic nerve. The challenge with irradiating tumors surrounding structures associated with the eye is the risk of exposing the optic nerve, or other structures important to maintaining vision to potentially damaging radiation.

Fractionated stereotactic radiotherapy (FSRT) is commonly used for the treatment of optic nerve sheath meningiomas (ONSMs) for vision preservation. However, long term visual data in the literature is limited. We investigated visual outcomes in 27 patients with ONSMs after FSRT.

Visualization Of Fibronectin Assembly Using Crispr And Fluorescence Imaging, Brenda French, Sophie Astrof

Sigma Xi Student Research Day

Objectives

Surprisingly, the mechanisms of fibronectin assembly remain largely unknown. This project aims to elucidate the process by which fibronectin assembles through fluorescent labeling. Fluorescent tags allow for the visualization of fibronectin to clarify how this extracellular matrix protein may influence migration and signaling.

Dealing With Deans And Academic Medical Center Leadership: Advice From Leaders., Fred Sanfilippo, Deborah Powell, Robert Folberg, Mark Tykocinski

Department of Medicine Faculty Papers

The 2017 Association of Pathology Chairs Annual Meeting included a session for department chairs and other department leaders on "how to deal with deans and academic medical center leadership." The session was focused on discussing ways to foster positive relationships with university, medical school, and health system leaders, and productively address issues and opportunities with them. Presentations and a panel discussion were provided by 4 former pathology chairs who subsequently have served as medical deans and in other leadership positions including university provost, medical center CEO, and health system board chair. There was a strong consensus among the participants on …

Integrating Telehealth Emergency Department Follow-Up Visits Into Residency Training., Dimitrios Papanagnou, Danica Stone, Shruti Chandra, Phillip Watts, Anna Marie Chang, Judd E. Hollander

Department of Emergency Medicine Faculty Papers

Introduction: Given the rapid expansion of telehealth (TH), there is an emerging need for trained professionals who can effectively deliver TH services. As there is no formal TH training program for residents, the Department of Emergency Medicine (DEM) at Thomas Jefferson University (TJU) developed a pilot training program for senior post-graduate-year three (PGY-3) residents that exposed them to TH practices. The objective of the study was to determine the feasibility of developing a resident-led, post-Emergency-Department (ED) visit TH follow-up program as an educational opportunity to 1) address patient satisfaction; and 2) expose senior residents to TH delivery.

Methods: During …

"My Bitterness Is Deeper Than The Ocean": Understanding Internalized Stigma From The Perspectives Of Persons With Schizophrenia And Their Family Caregivers., Yin-Ling Irene Wong, Dexia Kong, Lufei Tu, Rosemary Frasso Phd, Msc, Cph

College of Population Health Faculty Papers

Background: It is estimated that 8 million of the Chinese adult population had a diagnosis of schizophrenia. Stigma associated with mental illness, which is pervasive in the Chinese cultural context, impacts both persons with schizophrenia and their family caregivers. However, a review of the literature found a dearth of research that explored internalized stigma from the perspectives of both patients and their caregivers.

Methods: We integrated data from standardized scales and narratives from semi-structured interviews obtained from eight family-dyads. Interview narratives about stigma were analyzed using directed content analysis and compared with responses from Chinese versions of the Internalized Stigma …

Jefferson Digital Commons Quarterly Report: January-March 2018, Kelsey Duinkerken, Msi, James Copeland, Libt

Jefferson Digital Commons Reports

This quarterly report includes:

• Articles
• Conference materials
• From the Archives - Yearbooks
• Grand Rounds
• Journals
• MPH Capstones
• Newsletters
• Podcasts
• Posters
• Reports
• Symposiums
• What People are Saying About the Jefferson Digital Commons

Ot Department News- Issue #3

Department of Occupational Therapy Newsletter

In this Issue:

• Alumni Spotlight
• Alumni Highlights
• Faculty Spotlight
• International Experiences
• Advanced Practice Certificate
• New Faculty Spotlight
• Research Highlights
• Student Volunteers
• CREATE Day
• Department Chair Update
• Faculty News

Inhibition Of Dna Methyltransferase Leads To Increased Genomic 5-Hydroxymethylcytosine Levels In Hematopoietic Cells., Borbála Vető, Pál Szabó, Caroline Bacquet, Anna Apró, Edit Hathy, Judit Kiss, János M. Réthelyi, Flóra Szeri, Dávid Szüts, Tamás Arányi

Department of Dermatology and Cutaneous Biology Faculty Papers

5-Hydroxymethylcytosine (5hmC) is produced from 5-methylcytosine (5mC) by Ten-eleven translocation (TET) dioxygenases. The epigenetic modification 5hmC has crucial roles in both cellular development and differentiation. The 5hmC level is particularly high in the brain. While 5mC is generally associated with gene silencing/reduced expression, 5hmC is a more permissive epigenetic mark. To understand its physiological function, an easy and accurate quantification method is required. Here, we have developed a novel LC-MS/MS-based approach to quantify both genomic 5mC and 5hmC contents. The method is based on the liberation of nucleobases by formic acid. Applying this method, we characterized the levels of DNA …

A Word From The Writing Team (April 2018), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Our New Name
• Now Offering Group Consultations
• Writing Café

What Are Biofilms?, Noreen J. Hickok

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

An Expert Consensus For The Management Of Chronic Hepatitis B In Asian Americans., M. J. Tong, C. Q. Pan, S.-H. B. Han, D. S.-K. Lu, S. Raman, K.-Q. Hu, J. K. Lim, H.W. Hann, A. D. Min

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Hepatitis B virus (HBV) infection is common with major clinical consequences. In Asian Americans, the HBsAg carrier rate ranges from 2% to 16% which approximates the rates from their countries of origin. Similarly, HBV is the most important cause of cirrhosis, hepatocellular carcinoma (HCC) and liver related deaths in HBsAg positive Asians worldwide.

AIM: To generate recommendations for the management of Asian Americans infected with HBV.

METHODS: These guidelines are based on relevant data derived from medical reports on HBV from Asian countries as well as from studies in the HBsAg positive Asian Americans. The guidelines herein differ from …

Mud-Splattered Fundus, Roger Joel Welch, Xintong Li, Carol L. Shields

Wills Eye Hospital Papers

No abstract provided.

Pim-1 Kinase Phosphorylates Cardiac Troponin I And Regulates Cardiac Myofilament Function., Ni Zhu, Bing Yi, Zhifu Guo, Guanxin Zhang, Shengdong Huang, Yongwen Qin, Xianxian Zhao, Jianxin Sun

Center for Translational Medicine Faculty Papers

BACKGROUND/AIMS: Pim-1 is a serine/threonine kinase that is highly expressed in the heart, and exerts potent cardiac protective effects through enhancing survival, proliferation, and regeneration of cardiomyocytes. Its myocardial specific substrates, however, remain unknown. In the present study, we aim to investigate whether Pim-1 modulates myofilament activity through phosphorylation of cardiac troponin I (cTnI), a key component in regulating myofilament function in the heart.

METHODS: Coimmunoprecipitation and immunofluorescent assays were employed to investigate the interaction of Pim-1 with cTnI in cardiomyocytes. Biochemical, site directed mutagenesis, and mass spectrometric analyses were utilized to identify the phosphorylation sites of Pim1 in cTnI. …

Validation Of An Icd Code For Accurately Identifying Emergency Department Patients Who Suffer An Out-Of-Hospital Cardiac Arrest., Shelby K. Shelton, Steve B. Chukwulebe, David F. Gaieski, Benjamin S. Abella, Brendan G. Carr, Sarah M. Perman

Department of Emergency Medicine Faculty Papers

AIM: International classification of disease (ICD-9) code 427.5 (cardiac arrest) is utilized to identify cohorts of patients who suffer out-of-hospital cardiac arrest (OHCA), though the use of ICD codes for this purpose has never been formally validated. We sought to validate the utility of ICD-9 code 427.5 by identifying patients admitted from the emergency department (ED) after OHCA.

METHODS: Adult visits to a single ED between January 2007 and July 2012 were retrospectively examined and a keyword search of the electronic medical record (EMR) was used to identify patients. Cardiac arrest was confirmed; and ICD-9 information and location of return …

Prenatal Exposure To Methadone Or Buprenorphine: Early Childhood Developmental Outcomes., Karol Kaltenbach, Kevin E O'Grady, Sarah H. Heil, Amy L. Salisbury, Mara G. Coyle, Gabriele Fischer, Peter R. Martin, Susan Stine, Hendrée E. Jones

Department of Pediatrics Faculty Papers

BACKGROUND: Methadone and buprenorphine are recommended to treat opioid use disorders during pregnancy. However, the literature on the relationship between longer-term effects of prenatal exposure to these medications and childhood development is both spare and inconsistent.

METHODS: Participants were 96 children and their mothers who participated in MOTHER, a randomized controlled trial of opioid-agonist pharmacotherapy during pregnancy. The present study examined child growth parameters, cognition, language abilities, sensory processing, and temperament from 0 to 36 months of the child's life. Maternal perceptions of parenting stress, home environment, and addiction severity were also examined.

RESULTS: Tests of mean differences between children …

Differences In Work Environment For Staff As An Explanation For Variation In Central Line Bundle Compliance In Intensive Care Units., Yuna S.H. Lee, Patricia W. Stone, Monika Pogorzelska-Maziarz, Ingrid M. Nembhard

College of Nursing Faculty Papers & Presentations

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals.

PURPOSE: The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs).

METHODOLOGY/APPROACH: A cross-sectional study of hospital medical-surgical ICUs in the United States was done. …

Ketamine And Remote Hyperalgesia, Steven B. Porter, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

No abstract provided.

A Sub-Type Of Familial Pancreatic Cancer: Evidence And Implications Of Loss-Of-Function Polymorphisms In Indoleamine-2,3-Dioxygenase-2., Avinoam Nevler, Alexander J. Muller, Joseph A. Cozzitorto, Austin Goetz, Jordan M. Winter, Theresa P. Yeo, Harish Lavu, Charles Yeo, George C. Prendergast, Jonathan Brody

Department of Surgery Faculty Papers

BACKGROUND: Variation in an individual's genetic status can impact the development of pancreatic ductal adenocarcinoma; however, the majority of familial pancreatic cancers (FPC) cannot yet be attributed to a specific inherited mutation. We present data suggesting a correlation between loss-of-function single nucleotide polymorphisms (SNPs) in an immune regulator gene, indoleamine-2,3-dioxygenase-2 (IDO2), and an increased risk of FPC.

STUDY DESIGN: Germline DNA from patients who underwent resection for pancreatic ductal adenocarcinoma (n = 79) was sequenced for the IDO2 SNPs R248W and Y359Stop. Genotypes resulting in inactivation of IDO2 (Y325X homozygous, R248W homozygous) were labeled as homozygous, and the other genotypes …