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Editor's Column, Edward Kim, M.D.

Jefferson Journal of Psychiatry

This issue of the Jefferson Journal of Psychiatry impressively reflects current trends in the American Psychiatric Association. Past President Herb Pardes took as his theme "The Research Alliance: Road to Clinical Excellence." Current President Elissa Benedek has adopted the theme "Our Children, Our Future" for the 1991 annual meeting. Adjusting to the responsibilities of chief editorship (under the watchful eye of my predecessor, Dr. Trefzger), I am impressed by the evolution of the Journal and the manuscripts submitted for review.

Editorial Staff

Jefferson Journal of Psychiatry

List of Editorial Staff for Jefferson Journal of Psychiatry, Volume 8, Number 2, 1990.

Prescriptions For Excellence In Health Care Fall 2011 Dowload Full Pdf

Prescriptions for Excellence in Health Care Newsletter Supplement

No abstract provided.

Mis Posterior Cervical Spine Surgery: Five-Level Fusion Through A Novel Cervical Tube, Ashwini Sharan Md, Mitchell A. Hardenbrook, Md, John K. Ratliff Md, James Harrop, Md

JHN Journal

Minimally invasive surgical (MIS) techniques to the spine have focused mainly on the lumbar region. Many reports exist on the ability to decompress the neural structures in the lumbar and thoracic spine both via an anterior and posterior approach. Familiarity with these techniques now allows one or two level interbody and pedicle fusions, and treatment of trauma through MIS approaches. Controversy exists as to the efficacy of these techniques because direct studies comparing MIS approaches with open techniques are lacking. However, proponents of these techniques site smaller incision, less muscle retraction, less blood loss, shorter length of stay and better …

Second Floor Pilot For Group Learning Tools, Aisr, Education Services

Library Posters

Poster promoting collaborative learning tools including whiteboards and Teamspot.

Abca12-Mediated Lipid Transport And Snap29-Dependent Trafficking Of Lamellar Granules Are Crucial For Epidermal Morphogenesis In A Zebrafish Model Of Ichthyosis., Qiaoli Li, Michael Frank, Masashi Akiyama, Shiu-Ying Ho, Hiroshi Shimizu, Christine Thisse, Bernard Thisse, Eli Sprecher, Jouni Uitto

Department of Dermatology and Cutaneous Biology Faculty Papers

Zebrafish (Danio rerio) can serve as a model system to study heritable skin diseases. The skin is rapidly developed during the first 5-6 days of embryonic growth, accompanied by expression of skin-specific genes. Transmission electron microscopy (TEM) of wild-type zebrafish at day 5 reveals a two-cell-layer epidermis separated from the underlying collagenous stroma by a basement membrane with fully developed hemidesmosomes. Scanning electron microscopy (SEM) reveals an ordered surface contour of keratinocytes with discrete microridges. To gain insight into epidermal morphogenesis, we have employed morpholino-mediated knockdown of the abca12 and snap29 genes, which are crucial for secretion of lipids and …

Challenges And Opportunities For Medical Institutional Repositories, Dan Kipnis, Msi, Ann E. Koopman, Am, Lisa Palmer, Msls, Ahip

Academic Commons and Scott Memorial Library Staff Papers and Presentations

Description

Thomas Jefferson University Library and University of Massachusetts Medical School Library have two important things in common: successful institutional repositories and experienced library leaders that developed them.

Please join Dan Kipnis and Ann Koopman of Thomas Jefferson University, and Lisa Palmer of University of Massachusetts Medical School for a free webinar on institutional repositories (IRs) at medical schools.

Speakers will explore how each organization decided to start an IR, how the IRs have evolved, unique IR collections, successful partnerships, challenges and opportunities, and the future of medical IRs.

The Gross Clinic, The Agnew Clinic, And The Listerian Revolution., Caitlyn M. Johnson, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Thomas Eakins was an American artist whose unique and prolific style set him apart from other artists of the late 19th century.1 He chose to portray his subjects with intense objectivity, never deviating from reality. Even during his era when art was expected to be always beautiful, demonstrating Victorian morals of decency and decorum, Eakins chose to paint the naked truth.1 Walt Whitman was noted to have said, ‘‘I never knew of but one artist, and that’s Tom Eakins, who would resist the temptation to see what they ought to be rather than what it is.’’2 It was Eakins’ rigid …

Robert Milton Zollinger, M.D., Teacher, Surgeon, Soldier, And Farmer., Fiona M. Chory, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

From Humble roots, Dr. Robert Milton Zollinger worked his way to a position in history among the giants of American surgery. He was born on September 4, 1903, in the central Ohio town of Millersport, the son of Elmira and William Zollinger. Neither of his parents had a high school education, but they supported education and always expressed a confidence that young Robert would be successful at anything he attempted.1 He had aspirations of attending West Point, a dream that was never fulfilled when he decided to be a surgeon. On being informed of his son’s intentions, Zollinger’s father bestowed …

Functional Recovery Of Untreated Human Immunodeficiency Virus-Associated Guillain-Barré Syndrome: A Case Report, Adam L. Schreiber, John W. Norbury Iii, Eduardo A. De Sousa

Department of Rehabilitation Medicine Faculty Papers

HIV-associated Guillain-Barré Syndrome is a well-documented phenomenon, typically occurring at seroconversion. GBS may result in functional impairment treated with a combination of medications, plasmapheresis, and rehabilitation. The quantified functional recovery of HIV-associated GBS with or without HIV treatment is not well-described. Utilizing serial FIM scoring, we describe a patient’s recovery from HIV-associated GBS after treatment with IVIg and acute inpatient rehabilitation without HIV treatment.

Clinical Care Plan: Interdisciplinary Course (Ccpic), Marcia Levinson, Pt, Phd, Mft, Amy M Egras, Pharm.D, Bcps, E. Adel Herge, Otd, Otr/L, Kathryn Shaffer, Rn, Msn

Department of Physical Therapy Faculty Papers

Background/Rationale:

Interprofessional collaborative practice significantly improves patient outcomes, reduces mortality and enhances quality-of-life.

Person-focused care demands collaboration among professions in a team approach to address multiple issues including illness, prevention, and health promotion activities.

Key elements of successful implementation of interprofessional education supported by Clinical Care Plan, Interprofessional Course (CCPIC):

-Increasing knowledge of the roles, responsibilities, and competencies of multiple health professions.

-Collaborating in teams

-Recognizing the patient as the expert

-Communicating effectively

Course Statistics:

-176 students from various disciplines completed course (2008-2011).

Disciplines include:

-Medicine, Nursing, Occupational Therapy, Physical Therapy, Pharmacy

Health Information Technology (Hit) And Chemotherapy Management, Diane Abisaleh, Rn, Bsn, Msn

Department of Nursing papers and presentations

• Cancer is the 2nd most common cause of death, accounting for 26% of all deaths.
• Chemotherapy errors can potentially lead to significant harm or death
• 1 out of every 50 chemotherapy orders, results in serious death
• Lack of HIT support for workflow increases error

Partnership Between University Clnical Skills/Simulation Center And Nursing Staff Development-New Products, Mary Bent Mangano, Msn, Rn, Cns, John J. Duffy, Rn, Msn, Ccrn, Cnrn

Department of Nursing papers and presentations

There is a growing evidence in the nursing literature about the effectiveness of clinical simulation as a powerful teaching/learning strategy. This wealth of research attributes simulation's effectiveness to its design that creates an environment where "students become active learners, abandoning memorization for accessing knowledge, and thinking and applying learning in context rather than providing answers to fact-based test" (Jeffries, 2007). A simulation suite provides a "safe, supportive environment that allows students to learn a variety of complex skills in a stress-free environment" (Ghiglieri, Ruiz, & Vasudevan, 2007). Creating this environment requires meticulous planning to details. The learner must have a …

What Are The Implications Of Accountable Care Organizations For Physical Medicine And Rehabilitation Practices?, John L. Melvin, Greg Worsowicz

Department of Rehabilitation Medicine Faculty Papers

The goal of delivering quality health care at a lower overall cost through accountable care organizations (ACO) as described as part of the Patient Protection and Affordable Care Act of 2010 (ACA) has gained momentum among payers, providers, and the public. The concept includes developing an organization that provides incentives for quality care while lowering the overall cost of the care. If the goals are met, then both providers and payers would be able to share in the financial savings produced by the lower health care costs achieved while improving the quality of care delivered. The Centers for Medicare and …

Predictors Of Appropriate Defibrillator Therapies- A Single Center Analysis, Rina R. Shah, Ratika Gupta, Carrie Stackhouse, Robin Ward, Behzad B. Pavri

Division of Cardiology Faculty Papers

Discussion:

• Although differences in HR and the JT interval were statistically significant in patients who received appropriate shock vs. those who did not, these differences are not clinically meaningful
• We did not identify any clinical predictors of early vs. late ICD shocks
• These data suggest that we may not be able to improve on current guidelines for patient selection for ICD implantation.

Postoperative Glycemic Variability In Diabetic And Non Diabetic Patients, Boris Mraovic, Md, Brian Hipszer, Md, Zvi Grunwald, Md, David Gratch, Do, Charles J. Yeo, Md, Jennifer Lessin, Rn, Kathleen O'Malley, Rn, Angela Gulino, Md, Peter Simpson, Meng, Jeffrey Joseph

Department of Anesthesiology Faculty Papers

Objectives: Glycemic variability increases oxidative stress and may trigger the inflammation and coagulation cascades. Variability may be associated with increase morbidity and mortality in ICU patients. We analyzed glycemic variability after major surgery in diabetic (DM) and non-diabetic (NDM) patients using an automated intravenous blood glucose monitor (IVBG).

Postenucleation Adjuvant Chemotherapy With Vincristine, Etoposide, And Carboplatin For The Treatment Of High-Risk Retinoblastoma., Swathi Kaliki, Carol L Shields, Sanket U Shah, Ralph C Eagle, Jerry A Shields, Ann Leahey

Wills Eye Hospital Papers

BACKGROUND: Analysis of 52 eyes with high-risk retinoblastoma managed with postenucleation adjuvant chemotherapy using vincristine sulfate, etoposide phosphate, and carboplatin showed no evidence of systemic metastasis in any case during a mean (range) follow-up of 66 (12-202) months.

PURPOSE: To determine the efficacy of postenucleation adjuvant chemotherapy with vincristine, etoposide, and carboplatin in the prevention of metastasis for patients with high-risk retinoblastoma.

METHODS: Retrospective, nonrandomized, interventional case series of 52 eyes in 51 patients with high-risk retinoblastoma consisting of tumor invasion into the anterior segment, posterior uvea 3 mm or greater, postlaminar optic nerve, or any combination of posterior uvea …

Factors Influencing The Implementation Of A Point-Of-Care Screening Tool For Delirium, Beth Ann Swan, Phd, Crnp, Faan, Julie Becker, Phd, Mph, Rickie Brawer, Mph, Phd, Christopher N. Sciamanna, Md, Mph

College of Nursing Faculty Papers & Presentations

Given the ample evidence delirium in hospitalized older adults is under diagnosed and not recognized by nurses up to 85% of the time, interventions are needed at the point of care to assist nurses in recognizing delirium. In this qualitative study, factors that might influence the implementation of a point-of-care screening tool for delirium were examined.

Characterization Of The Drosophila Slowpoke Binding Protein (Slob) Promoter, Amanda L. Sheldon, Lauren Manderfield, Irwin B. Levitan

Farber Institute for Neuroscience Faculty Papers

Drosophila SLOWPOKE (SLO) is a voltage and calcium dependent, large conductance potassium channel important for action potential repolarization, neuronal excitability, neurotransmitter release, and hormone secretion. SLO binding protein (SLOB) binds to and modulates SLO activity. We have shown previously that modulation of SLO by SLOB has profound effects on SLO channel currents, synaptic transmisison, and metabolism. Multiple isoforms of SLOB exist and are encoded by multiple transcripts; the isoforms are named based on their predicted protein molecular weights, in kilodaltons. In the Drosophila brain, SLOB57/51 proteins are expressed especially prominently in insulin producing neurons of the pars intercerebralis, while SLOB71/65 …

The Prevalence Of Cervico-Arterial Dissection In Sub-Arachnoid Hemorrhage In The United States, Ali Seifi, Md, Fred Rincon, Md, Msc, Mitchell Maltenfort, Phd, Pascal Jabbour, Md, Rodney Bell, Md, Michael Moussouttas, Md

Department of Neurology Faculty Papers

Objectives: In this study, we sought to determine the prevalence of cervico-arterial dissection in aubarachnoid hemorrhage (SAH) using a large administrative database.

On The Incidence Of Pulmonary Embolism In Spinal Arthrodesis And The Need For Better Evidence And Prevention Guidelines, Zachary J. Senders, Bs, Benjamin Zussman, Bs, James S. Harrop, Md

JHN Journal

Pulmonary Embolism (PE) is a rare but serious event that may occur after spinal surgery. Vascular endothelial damage during surgery and immobilization of the patient after surgery contribute to a higher risk of thrombosis and subsequent PE. Prophylaxis including intermittent pneumatic compression stockings, heparin, and other interventions is often employed by the treatment team to lower the risk of thromboembolic complications. In orthopedic, trauma, burn and other high-risk surgical patients, the incidence of PE has been thoroughly studied, and this knowledge has been used to establish prophylaxis guidelines specifically for these patients. The incidence of PE in spinal fusion patients, …

Surgical Management Of Fungal Vertebral Osteomyelitis, Benjamin M. Zussman, Bs, David L. Penn, Ms, James S. Harrop, Md

JHN Journal

Fungal vertebral osteomyelitis (FVO) is an uncommon but aggressive disease that may cause spinal instability, neurological insult, and possible death. Little data about treatment strategies and patient outcomes exist. A retrospective review of medical and surgical management with follow-up of this disease was performed.

Bevacizumab: A Controversial Agent Against High-Grade Gliomas, Sussan Salas, Md, Miguel Guzman, Md, Kevin Judy, Md

JHN Journal

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults. Despite the current regimen of surgical resection with subsequent external beam radiotherapy and temozolomide, mean survival is 14.6 months and 2-year survival is 26%. GBM is a highly vascular tumor, a result of its increased expression of vascular endothelial growth factor (VEGF) compared to other brain tumors. VEGF promotes endothelial cell proliferation, and is thought to have a pivotal role during tumor progression. Multiple treatment modalities have targeted VEGF and VEGF receptors (VEGFTs) due to their essential roles in the regulation of angiogenic processes. Bevacizumab is a …

Case Report On Intracranial Hemorrhage Related To Type I Cryoglobulinemia, Richard Dalyai, Md, L. Fernando Gonzalez, Md

JHN Journal

A traumatic intracranial hemorrhage (ICH) is a common neurosurgical pathology that affects about 20 of 100,000 people every year with a mortality of at least 40%. However, a specific etiology, cannot be identified in about 30% of spontaneous ICH. Here, we present a rare case of ICH related to a patient's previously undiagnosed cryoglobinemia.

Childhood Obesity And Blood Pressure: Back To The Future?, Bonita Falkner, Samuel Gidding

Department of Pediatrics Faculty Papers

The prevalence of childhood hypertension is increasing.^{1, 2} Studies that apply the 95^th percentile definition and repeat measurements on three separate visits, report a pediatric hypertension prevalence of approximately 3.5%^{3, 4}, and among obese children and adolescents the prevalence of both hypertension and prehypertension is even greater. The recently documented increase in hypertension among the young is due largely to the childhood obesity epidemic and possibly other secular changes in lifestyles. These publications and others confirm that hypertension is a prevalent child health condition, especially among overweight and obese children. A consistent positive association between body …

The Characteristics Of Borrelia Hermsii Infection In Human Hematopoeitic Stem Cell-Engrafted Mice Mirror Those Of Human Relapsing Fever, Raja Vuyyuru, Hongqi Liu, Tim Manser, Kishore Alugupalli

Department of Microbiology and Immunology Faculty Papers

Rodents are natural reservoirs for a variety of species of Borrelia that cause relapsing fevers in humans. The murine model of this disease recapitulates many of the clinical manifestations of the human disease and has revealed that T cell-independent antibody responses are required to resolve the bacteremic episodes. However, it is not clear whether such protective humoral responses are mounted in humans.

The Role Of Mer In Apoptotic Cell Clearance In The Germinal Center, Tahsin N. Khan, Eric B. Wong, Ziaur S.M. Rahman, Phd

Department of Microbiology and Immunology Faculty Papers

Germinal centers (GCs) are specialized micro-environments that generate high affinity Ab-forming cells (AFCs) and memory B cells. Many B cells undergo apoptosis during clonal selection in GCs. The TAM (Tyro-3, Axl, and Mer) family receptor tyrosine kinases, including Mer, facilitate macrophage clearance of apoptotic cells. We previously showed that tingible body macrophages (TBMφs) in GCs express Mer. We observed that apoptotic cells (ACs) accumulated in GCs of mice deficient in Mer (Mer-/-), after immunization with T-dependent Ag. Accumulation of ACs in GCs of Mer-/- mice resulted in significantly increased AFCs, GCs, and Th1-skewed IgG2c Ab responses. We report here that …

Macrophages And Neutrophils From Humans And Mice Kill Larval Strongyloides Stercoralis During Innate Immunity, Sandra Bonne-Annee, Laura A. Kerepesi, Jessica A. Hess Ligas, David Abraham, Phd

Department of Microbiology and Immunology Faculty Papers

The parasitic nematode Strongyloides stercoralis (Ss) infects 30-100 million people worldwide, yet little is known about the immune response in humans. Previous studies on innate immunity to Ss in mice have demonstrated a role for eosinophils, neutrophils (PMN) and complement activation in the protective immune response.

Innate And Adaptive Immunity To The Nematode Strongyloides Stercoralis In A Mouse Model., Sandra Bonne-Annee, Jessica A. Hess, David Abraham

Department of Microbiology and Immunology Faculty Papers

Mice have been used to the study the mechanisms of protective innate and adaptive immunity to larval Strongyloides stercoralis. During primary infection, neutrophils and eosinophils are attracted by parasite components and kill the larvae by release of granule products. Eosinophils also function as antigen-presenting cells for the induction of a Th2 response. B cells produce both IgM and IgG that collaborate with neutrophils to kill worms in the adaptive immune response. Vaccine studies have identified a recombinant diagnostic antigen that induced high levels of immunity to infection with S. stercoralis in mice. These studies demonstrate that there are redundancies in …

Individual Agency, Community Capacity Building, And Chronic Illness Care: Using Participatory Methods To Implement The Stanford Chronic Disease Self Management Program In A Housing First Program, Lara Carson Weinstein, Md, Mph, Abbie Santana, Msph, Carolyn Armour, Cornelius Crossan, James Lawson, Karen Webb

Department of Family & Community Medicine Presentations and Grand Rounds

Research questions:

Is a standardized chronic disease self management program (CDSMP) experienced as a valuable intervention by Pathways' consumers?

What is the impact of collaborative inquiry into health program development on participant's critical agency?