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The Impact Of Four Common Lumbar Spine Diagnoses Upon Overall Health Status, Michael A. Pahl, Brian Brislin, Scott Boden, Alan S. Hilibrand, Alexander Vaccaro, Brett Hanscom, Todd J. Albert

Department of Orthopaedic Surgery Faculty Papers

Background Context: The SF-36 health survey has been shown to be a valid instrument when used to measure the self-reported physical and mental health of patients. The impact of lumbar spinal disorders can be assessed as the difference between the SF-36 scale scores and age-and-gender specific population norms.

Purpose: To establish the impact upon the self-reported health status of patients with one of four common lumbar spinal diagnoses.

Study Design: A cross-sectional, observational assessment of the health status of spine patients.

Methods: Data from patients presenting to the participating centers of the National Spine Network with low back pain and/or …

Zonisamide For Migraine Prophylaxis In Refractory Patients, Avi Ashkenazi, Adam Benlifer, Jason Korenblit, Stephen D. Silberstein

Department of Neurology Faculty Papers

Zonisamide, a new antiepileptic drug, has been approved in the US as adjunctive therapy for the treatment of partial seizures in adults.^1,2 Chemically a sulfonamide analogue, zonisamide is thought to have several mechanisms of action, including a rate-dependent blockade of voltage-gated sodium channels and reduction of ion flow through T-type calcium channels.^3-5 It is also a weak carbonic anhydrase inhibitor. Zonisamide has a favorable pharmacokinetic profile that includes high oral bioavailability and a long half life (63 hours), permitting a once- or twice-daily dosing regimen.⁶

There are only a limited number of current migraine preventive medications that …

Cell-Signalling Dynamics In Time And Space, Boris N. Kholodenko Phd, Dsci

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The specificity of cellular responses to receptor stimulation is encoded by the spatial and temporal dynamics of downstream signalling networks. Computational models provide insights into the intricate relationships between stimuli and responses and reveal mechanisms that enable networks to amplify signals, reduce noise and generate discontinuous bistable dynamics or oscillations. These temporal dynamics are coupled to precipitous spatial gradients of signalling activities, which guide pivotal intracellular processes, but also necessitate mechanisms to facilitate signal propagation across a cell.

Trading The Micro-World Of Combinatorial Complexity For The Macro-World Of Protein Interaction Domains, Nikolay M. Borisov, Nick I. Markevitch, Jan B. Hoek, Boris N. Kholodenko

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Membrane receptors and proteins involved in signal transduction display numerous binding domains and operate as molecular scaffolds generating a variety of parallel reactions and protein complexes. The resulting combinatorial explosion of the number of feasible chemical species and, hence, different states of a network greatly impedes mechanistic modeling of signaling systems. Here we present novel general principles and identify kinetic requirements that allow us to replace a mechanistic picture of all possible micro-states and transitions by a macro-description of states of separate binding sites of network proteins. This domain-oriented approach dramatically reduces computational models of cellular signaling networks by dissecting …

Causes And Mechanisms, An Interview With Dr. Jeremiah Stamler, Samuel S. Gidding

Department of Pediatrics Faculty Papers

Dr. Jeremiah Stamler began his career in New York City and moved to Chicago in 1947 with his wife Rose, to accept a basic research position with Dr. Louis N. Katz. Early animal studies convinced him of the role of dietary factors, particularly cholesterol and salt, in the etiology of atherosclerotic vascular disease. Because of a strong interest in public health, he began the first of many population based cohort studies in the 1950s that subsequently defined the role of health behaviors (adverse nutrition choices, tobacco use, low physical activity) and associated measurable biologic traits, now called risk factors, in …

The Ribosome-Recycling Step: Consensus Or Controversy?, Go Hirokawa, Natalia Demeshkina, Nobuhiro Iwakura, Hideko Kaji, Akira Kaji

Department of Biochemistry and Molecular Biology Faculty Papers

Ribosome recycling, the last step in translation, is now accepted as an essential process for prokaryotes. In 2005, three laboratories showed that ribosome-recycling factor (RRF) and elongation factor G (EF-G) cause dissociation of ribosomes into subunits, solving the long-standing problem of how this essential step of translation occurs. However, there remains ongoing controversy regarding the other actions of RRF and EF-G during ribosome recycling. We propose that the available data are consistent with the notion that RRF and EF-G not only split ribosomes into subunits but also participate directly in the release of deacylated tRNA and mRNA for the next …

Lung Development In Laminin Γ2 Deficiency: Abnormal Tracheal Hemidesmosomes With Normal Branching Morphogenesis And Epithelial Differentiation, Nguyet M. Nguyen, Leena Pulkkinen, Jessica A. Schlueter, Guerrino Meneguzzi, Jouni Uitto, Robert M. Senior

Department of Dermatology and Cutaneous Biology Faculty Papers

Background

Laminin γ2 (Lamc2), one of the polypeptides in laminin-332 (laminin-5), is prominent in the basement membrane of alveolar walls and airways of developing and adult lung. Laminins are important for lung morphogenesis and based on its localization, a function for laminin γ2 in lung development has been hypothesized. Targeted deletion of the laminin γ2 gene in mice results in skin blistering and neonatal death at 3–5 days after birth due to failure to thrive.

Methods

Examination of lung development in Lamc2-/- mice through 1–2 days postnatal was accomplished by morphometric analysis, lung bud culture, electron microscopy, immunohistochemical …

Alterations In Vasodilator-Stimulated Phosphoprotein (Vasp) Phosphorylation: Associations With Asthmatic Phenotype, Airway Inflammation And Β2-Agonist Use, Annette T. Hastie, Min Wu, Gayle C. Foster, Gregory A. Hawkins, Vikas Batra, Katherine A. Rybinski, Rosemary Cirelli, James G. Zangrilli, Stephen P. Peters

Department of Medicine Faculty Papers

Background

Vasodilator-stimulated phosphoprotein (VASP) mediates focal adhesion, actin filament binding and polymerization in a variety of cells, thereby inhibiting cell movement. Phosphorylation of VASP via cAMP and cGMP dependent protein kinases releases this "brake" on cell motility. Thus, phosphorylation of VASP may be necessary for epithelial cell repair of damage from allergen-induced inflammation. Two hypotheses were examined: (1) injury from segmental allergen challenge increases VASP phosphorylation in airway epithelium in asthmatic but not nonasthmatic normal subjects, (2) regular in vivo β₂-agonist use increases VASP phosphorylation in asthmatic epithelium, altering cell adhesion.

Methods

Bronchial epithelium was obtained from asthmatic …

Surgical Decision Making For Unstable Thoracolumbar Spine Injuries: Results Of A Consensus Panel Review By The Spine Trauma Study Group, Alexander R. Vaccaro, Moe R. Lim, R. John Hurlbert, Ronald A. Lehman, James Harrop, D. Charles Fisher, Marcel Dvorak, D. Greg Anderson, Steven C. Zeiller, Joon Y. Lee, Michael G. Fehlings, F. C. Oner, Spine Trauma Study Group

Department of Orthopaedic Surgery Faculty Papers

Objectives: The optimal surgical approach and treatment of unstable thoracolumbar spine injuries are poorly defined owing to a lack of widely accepted level I clinical literature. This lack of evidence based standards has led to varied practice patterns based on individual surgeon preferences. The purpose of this study was to survey the leaders in the field of spine trauma to define the major characteristics of thoracolumbar injuries that influence their surgical decision making. In the absence of good scientific data, expert consensus opinions may provide surgeons with a practical framework to guide therapy and to conduct future research.

Methods: A …

Increasing Illness Severity In Very Low Birth Weight Infants Over A 9-Year Period, David A. Paul, Kathleen H. Leef, Robert G. Locke, Louis Bartoshesky, Judy Walrath, John L. Stefano

Department of Pediatrics Faculty Papers

Background: Recent reports have documented a leveling-off of survival rates in preterm infants through the 1990's. The objective of this study was to determine temporal changes in illness severity in very low birth weight (VLBW) infants in relationship to the outcomes of death and/or severe IVH.

Methods: Cohort study of 1414 VLBW infants cared for in a single level III neonatal intensive care unit in Delaware from 1993-2002. Infants were divided into consecutive 3-year cohorts. Illness severity was measured by two objective methods: the Score for Neonatal Acute Physiology (SNAP), based on data from the 1st day of …

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Value-Based Purchasing Newsletter

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Program Schedule

Value-Based Purchasing Newsletter

No abstract available.

Literature Review, Joshua J. Gagne

Value-Based Purchasing Newsletter

Each issue of Value-Based Purchasing will provide a summary of recent articles from the published VBP literature. In this issue, we spotlight several recent publications regarding pay-for-performance programs and financial incentives for quality care.

News Briefs

Value-Based Purchasing Newsletter

No abstract available.

Improving Health Care Quality Through Value-Based Purchasing: What Can The Pioneers Teach Us?, Christine W. Hartmann, Neil I. Goldfarb, Vittorio Maio, Adam R. Roumm, David B. Nash

Value-Based Purchasing Newsletter

The Department of Health Policy of Jefferson Medical College has been engaged in research on value-based purchasing (VBP) for the past five years. With support from The Commonwealth Fund, the Department’s research team has examined the potential of VBP to improve quality and cost-effectiveness of health care. This article summarizes this work.

Clinical Performance Measurements And Incentives Enable Value Based Purchasing, Jerry Reeves

Value-Based Purchasing Newsletter

No abstract available.

Welcome To Value-Based Purchasing, Neil I. Goldfarb, Dale Shaller

Value-Based Purchasing Newsletter

No abstract available.

Download Full Pdf Issue Volume 2, Issue 1 - Msph Newsletter 2006

Public Health Link

This is the first issue of 2006 and it highlights upcoming events and an accreditation update.

Description Of Twelve Cases Of Nephrogenic Fibrosing Dermopathy And Review Of The Literature, Fabian A. Mendoza, Carol M. Artlett, Nora Sandorfi, Kevin Latinis, Sonoles Piera-Velazquez, Sergio A. Jimenez

Selected Works of Sergio Jiménez, MD, MACR

ABSTRACT

Objectives: To review the clinical and laboratory features of twelve cases of nephrogenic fibrosing dermopathy (NFD) studied at our institution and of 70 previously described cases in the literature.

Methods: Clinical evaluation and laboratory studies of twelve patients with NFD associated with chronic hemodialysis or peritoneal dialysis for end-stage renal disease and a review of 23 previous publications describing 70 patients with this disease.

Results: Eleven patients undergoing chronic hemodialysis and one patient undergoing chronic peritoneal dialysis for end-stage renal failure developed a severe and progressive cutaneous fibrotic process with woody induration of legs, thighs, hands and forearms, and …

American College Of Obstetricians And Gynecologists Practice Bulletins: An Overview, Suneet P. Chauhan, Vincenzo Berghella, Maureen Sanderson, Everett F. Magann, John C. Morrison

Department of Obstetrics and Gynecology Faculty Papers

Objective The purpose of this study was to review the American College of Obstetricians and Gynecologists practices bulletins to quantify the type of recommendations and references and determining whether there are any differences between obstetric and gynecologic bulletins. Study design All practice bulletins published from June 1998 to December 2004 were reviewed. Odds ratios and 95% confidence intervals were calculated. Results The 55 practice bulletins contained 438 recommendations of which 29% are level A, 33% level B, and 38% level C. The 55 bulletins cite 3953 references of which 17% are level I, 46% level II, 34% level III, and …

Dopamine-D1 And Δ-Opioid Receptors Co-Exist In Rat Striatal Neurons, L. M. Ambrose-Lanci, S. M. Gallagher, E. M. Unterwald, E. J. Van Bockstaele

Department of Neurosurgery Faculty Papers

Cocaine’s enhancement of dopaminergic neurotransmission in the mesolimbic pathway plays a critical role in the initial reinforcing properties of this drug. However, other neurotransmitter systems are also integral to the addiction process. A large body of data indicates that opioids and dopamine together mediate emotional and reinforced behaviors. In support of this, cocaine-mediated increases in activation of dopamine D1 receptors (D1R) results in a desensitization of δ-opioid receptor (DOR) signaling through adenylyl cyclase (AC) in striatal neurons. To further define cellular mechanisms underlying this effect, the subcellular distribution of DOR and D1R was examined in the rat dorsolateral striatum. Dual …

The Use Of Contract Licensed Nursing Staff In U.S. Nursing Homes., Meg Bourbonniere, Zhanlian Feng, Orna Intrator, Joseph Angelelli, Vincent Mor, Jacqueline S. Zinn

College of Nursing Faculty Papers & Presentations

The extent to which nursing homes rely on the use of contracted licensed staff, factors associated with this staffing practice, and the resultant effect on the quality of resident care has received little public attention. Merging the On-line Survey Certification and Reporting System database with the Area Resource File from 1992 through 2002, the authors regressed organizational and market-level variables on the use of 5 percent or more contract full-time equivalent registered nurses and licensed practical nurses. Since 1997, the proportion of facilities using 5 percent or more contract licensed staff more than tripled. Use of contract nurses was associated …

Antisense Inhibition Of Cyclin D1 Expression Is Equivalent To Flavopiridol For Radiosensitization Of Zebrafish Embryos, Mary Frances Mcaleer, Kevin T. Duffy, William R. Davidson, Gabor Kari, Adam P. Dicker, Ulrich Rodeck, Eric Wickstrom

Department of Biochemistry and Molecular Biology Faculty Papers

Purpose: Flavopiridol, a small molecule pan-cyclin inhibitor, has been shown to enhance the radiation response of tumor cells both in vitro and in vivo. The clinical utility of flavopiridol, however, is limited by toxicity, previously attributed to pleiotropic inhibitory effects on several targets affecting multiple signal transduction pathways. Here we utilized zebrafish embryos to investigate radiosensitizing effects of flavopiridol in normal tissues.

Methods and Materials: Zebrafish embryos at the 1-4 cell stage were treated with 500 nM flavopiridol or injected with 0.5 pmol antisense hydroxylprolyl-phosphono nucleic acid oligomers to reduce cyclin D1 expression, then subjected to ionizing radiation (IR) or …

A Domain-Oriented Approach To The Reduction Of Combinatorial Complexity In Signal Transduction Networks, Holger Conzelmann, Julio Saez-Rodriguez, Thomas Sauter, Boris N. Kholodenko Phd, Dsci, Ernst D. Gilles

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background:

Receptors and scaffold proteins possess a number of distinct domains and bind multiple partners. A common problem in modeling signaling systems arises from a combinatorial explosion of different states generated by feasible molecular species. The number of possible species grows exponentially with the number of different docking sites and can easily reach several millions. Models accounting for this combinatorial variety become impractical for many applications.

Results:

Our results show that under realistic assumptions on domain interactions, the dynamics of signaling pathways can be exactly described by reduced, hierarchically structured models. The method presented here provides a rigorous way to …

Clinical Perspectives Of Emerging Pathogens In Bleeding Disorders, Jamie Siegel

Department of Medicine Faculty Papers

As a result of immunological and nucleic-acid screening of plasma donations for transfusion-transmissible viruses, and the incorporation of viral reduction processes during plasma fractionation, coagulation-factor concentrates (CFC) are now judged safe in terms of many known infectious agents, including hepatitis B and C viruses, HIV, and human T-cell lymphotropic virus. However, emerging pathogens could pose future threats, particularly those with blood-borne stages that are resistant to viral-inactivation steps in the manufacturing process, such as non-lipid-coated viruses. As outlined in this Review, better understanding of infectious diseases allows challenges from newly described agents of potential concern in the future to be …

Measuring Sustained Attention After Traumatic Brain Injury: Differences In Key Findings From The Sustained Attention To Response Task (Sart), John Whyte, Patricia Grieb-Neff, Christopher Gantz, Marcia Polansky

Department of Rehabilitation Medicine Faculty Papers

Clinical reports after traumatic brain injury (TBI) suggest frequent difficulties with sustained attention, but their objective measurement has proved difficult. In 1997, Robertson and colleagues reported on a new sustained attention assessment tool, the sustained attention to response task (SART). Individuals with TBI were reported to produce more errors of commission on the SART than control participants, and both groups showed a relationship between SART errors and everyday lapses of attention as measured by the cognitive failures questionnaire (CFQ). Although few direct replications of these findings have been reported, the SART has been used widely as a measure of sustained …

The Inflammatory And Normal Transcriptome Of Mouse Bladder Detrusor And Mucosa, Marcia R. Saban, Helen L. Hellmich, Mary Turner, Ngoc-Bich Nguyen, Rajanikanth Vadigepalli, David W. Dyer, Robert E. Hurst, Michael Centola, Ricardo Saban

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background

An organ such as the bladder consists of complex, interacting set of tissues and cells. Inflammation has been implicated in every major disease of the bladder, including cancer, interstitial cystitis, and infection. However, scanty is the information about individual detrusor and urothelium transcriptomes in response to inflammation. Here, we used suppression subtractive hybridizations (SSH) to determine bladder tissue- and disease-specific genes and transcriptional regulatory elements (TRE)s. Unique TREs and genes were assembled into putative networks.

Results

It was found that the control bladder mucosa presented regulatory elements driving genes such as myosin light chain phosphatase and calponin 1 that …

Counseling Patients Exposed To Ionizing Radiation During Pregnancy, Robert L. Brent

The Selected Works of Robert Brent

Health physicists and knowledgeable clinicians have the responsibility to counsel women of reproductive age about the reproductive risks of ionizing radiation exposure before conception or during pregnancy. It is important to realize that lay individuals have many misconceptions about the reproductive risks of ionizing radiation. Many patients who have already had or will undergo some type of radiological test are apprehensive about the reproductive and developmental risks of diagnostic radiological procedures. Epidemiological studies and animal studies indicate that high exposures of ionizing radiation can cause miscarriage, congenital malformations, growth retardation, stillbirth, and cancer. With the exception of cancer, there are …

Department Of Radiology-Annual Executive Summary Report-July 1, 2005 To June 30, 2006, Vijay M. Rao M.D.

Department of Radiology Administrative Documents and Reports

98 page Department of Radiology Annual Executive Summary Report, July 1, 2005 to June 30, 2006, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.

Effects Of Dorsiflexor Endurance Exercises On Foot Drop Secondary To Multiple Sclerosis: A Pilot Study, Julie Mount, Stan Dacko

Department of Physical Therapy Faculty Papers

PURPOSE: This is a pilot study to determine if endurance exercises for dorsiflexors will improve walking for people with foot drop secondary to MS, and if improvement in muscle endurance for persons with MS can be predicted based on the amount of central fatigue (CF) in the muscle.

SUBJECTS: Five individuals with foot drop secondary to MS and five age-matched controls.

METHODS: The intervention was 4 sets of 10 isometric contractions, at 60% of MVC, 3X/week, 8 weeks. Pretests-posttests included a dorsiflexor endurance test with superimposed electrical stimulation to measure CF, and a gait assessment including measurement of dorsiflexion at …