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The Impact Of The Current Financial Situation On Public Health Prevention Efforts, Tamar Klaiman Phd, Mph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Hp Newsletter Winter 2012 Download Full Pdf

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Mobile Applications For Primary Care, Daniel G. Kipnis, Msi

Academic Commons and Scott Memorial Library Staff Papers and Presentations

No abstract provided.

Newer Agents In Antiplatelet Therapy: A Review., Jennifer Yeung, Michael Holinstat

Cardeza Foundation for Hematologic Research

Antiplatelet therapy remains the mainstay in preventing aberrant platelet activation in pathophysiological conditions such as myocardial infarction, ischemia, and stroke. Although there has been significant advancement in antiplatelet therapeutic approaches, aspirin still remains the gold standard treatment in the clinical setting. Limitations in safety, efficacy, and tolerability have precluded many of the antiplatelet inhibitors from use in patients. Unforeseen incidences of increased bleeding risk and recurrent arterial thrombosis observed in patients have hampered the development of superior next generation antiplatelet therapies. The pharmacokinetic and pharmacodynamic profiles have also limited the effectiveness of a number of antiplatelet inhibitors currently in use …

Aleuria Aurantia Lectin (Aal)-Reactive Immunoglobulin G Rapidly Appears In Sera Of Animals Following Antigen Exposure., Songming Chen, Chen Lu, Hongbo Gu, Anand Mehta, Jianwei Li, Patrick B Romano, David Horn, D Craig Hooper, Carthene R Bazemore-Walker, Timothy Block

Department of Cancer Biology Faculty Papers

We have discovered an Aleuria Aurantia Lectin (AAL)-reactive immunoglobulin G (IgG) that naturally occurs in the circulation of rabbits and mice, following immune responses induced by various foreign antigens. AAL can specifically bind to fucose moieties on glycoproteins. However, most serum IgGs are poorly bound by AAL unless they are denatured or treated with glycosidase. In this study, using an immunogen-independent AAL-antibody microarray assay that we developed, we detected AAL-reactive IgG in the sera of all animals that had been immunized 1-2 weeks previously with various immunogens with and without adjuvants and developed immunogen-specific responses. All of these animals subsequently …

Aleuria Aurantia Lectin (Aal)-Reactive Immunoglobulin G Rapidly Appears In Sera Of Animals Following Antigen Exposure., Songming Chen, Chen Lu, Hongbo Gu, Anand Mehta, Jianwei Li, Patrick B Romano, David Horn, D Craig Hooper, Carthene R Bazemore-Walker, Timothy Block

Department of Cancer Biology Faculty Papers

We have discovered an Aleuria Aurantia Lectin (AAL)-reactive immunoglobulin G (IgG) that naturally occurs in the circulation of rabbits and mice, following immune responses induced by various foreign antigens. AAL can specifically bind to fucose moieties on glycoproteins. However, most serum IgGs are poorly bound by AAL unless they are denatured or treated with glycosidase. In this study, using an immunogen-independent AAL-antibody microarray assay that we developed, we detected AAL-reactive IgG in the sera of all animals that had been immunized 1-2 weeks previously with various immunogens with and without adjuvants and developed immunogen-specific responses. All of these animals subsequently …

The Burden Of Breast Cancer In Italy: Mastectomies And Quadrantectomies Performed Between 2001 And 2008 Based On Nationwide Hospital Discharge Records., Prisco Piscitelli, Maddalena Barba, Massimo Crespi, Massimo Di Maio, Antonio Santoriello, Massiliamo D'Aiuto, Alfredo Fucito, Arturo Losco, Francesca Pentimalli, Pasquale Maranta, Giovanna Chitano, Alberto Argentiero, Cosimo Neglia, Alessandro Distante, Gian Luca Di Tanna, Maria Luisa Brandi, Alfredo Mazza, Ignazio R Marino, Antonio Giordano

Department of Surgery Faculty Papers

BACKGROUND: Where population coverage is limited, the exclusive use of Cancer Registries might limit ascertainment of incident cancer cases. We explored the potentials of Nationwide hospital discharge records (NHDRs) to capture incident breast cancer cases in Italy.

METHODS: We analyzed NHDRs for mastectomies and quadrantectomies performed between 2001 and 2008. The average annual percentage change (AAPC) and related 95% Confidence Interval (CI) in the actual number of mastectomies and quadrantectomies performed during the study period were computed for the full sample and for subgroups defined by age, surgical procedure, macro-area and singular Region. Re-admissions of the same patients were separately …

Hiv Rna Suppression And Immune Restoration: Can We Do Better?, Marilia Rita Pinzone, Michelino Di Rosa, Bruno Cacopardo, Giuseppe Nunnari

Department of Microbiology and Immunology Faculty Papers

HAART has significantly changed the natural history of HIV infection: patients receiving antiretrovirals are usually able to control viremia, even though not all virological responders adequately recover their CD4+ count. The reasons for poor immune restoration are only partially known and they include genetic, demographic and immunologic factors. A crucial element affecting immune recovery is immune activation, related to residual viremia; indeed, a suboptimal virological control (i.e., low levels of plasma HIV RNA) has been related with higher levels of chronic inflammation and all-cause mortality. The sources of residual viremia are not yet completely known, even though the most important …

Jefferson Alumni Bulletin – Volume 61, Number 1, Winter 2012

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Features:

• The Gift of Time for Patients with Advanced Bile Duct Cancer
• Celiac Disease: Overcoming a Stealth Public Health Menace
• Light Therapy for a Blue Planet and Beyond

Vaccine-Preventable Diseases And Foreign-Born Populations, Marc Altshuler, Md, Giang Nguyen, Md

Department of Family & Community Medicine Faculty Papers

Foreign-born individuals account for over 12% of the U.S. population, according to the most recent census data. Since many vaccine-preventable outbreaks in the U.S. have been correlated with disease importation, Congress has mandated vaccinations for numerous immigrant populations. It is essential for primary care physicians to be knowledgeable on the unique immunization-related needs of foreign-born individuals, to recognize some of the cultural and linguistic challenges that immigrants have accessing healthcare, and remember to use each medical encounter as an opportunity to provide necessary vaccinations.

Epitope Characterization Of Sero-Specific Monoclonal Antibody To Clostridium Botulinum Neurotoxin Type A., Cindi R Corbett, Erin Ballegeer, Kelly A Weedmark, M D Elias, Fetweh H Al-Saleem, Denise M Ancharski, Lance L Simpson, Jody D Berry

Department of Medicine Faculty Papers

Botulinum neurotoxins (BoNTs) are extremely potent toxins that can contaminate foods and are a public health concern. Anti-BoNT antibodies have been described that are capable of detecting BoNTs; however there still exists a need for accurate and sensitive detection capabilities for BoNTs. Herein, we describe the characterization of a panel of eight monoclonal antibodies (MAbs) generated to the non-toxic receptor-binding domain of BoNT/A (H(C)50/A) developed using a high-throughput screening approach. In two independent hybridoma fusions, two groups of four IgG MAbs were developed against recombinant H(C)50/A. Of these eight, only a single MAb, F90G5-3, bound to the whole BoNT/A protein …

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.

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 …

Cervical Cancer Screening Outcomes In A Refugee Population, Sarah Pickle, Md, Marc Altshuler, Md, Kevin Scott, Md, Christina Hillson, Md, R. Patrick Mcmanus, Md, Mazvita Nyamukapa, Michael Walker

Department of Family & Community Medicine Presentations and Grand Rounds

The purpose of our study was to determine the prevalence of abnormal Pap smears and high-risk HPV genotypes within our refugee population.

Psychiatrists' Knowledge And Attitudes About The Acquired Immune Deficiency Syndrome, Carol L. Alter, M.D., Ellen S. Dickinson, M.D., Greg Miller, M.D.

Jefferson Journal of Psychiatry

Since 1981 the Acquired Immune Deficiency Syndrome (AIDS) has become the primary health care issue in this nation. Psychiatrists have had a central role in caring for AIDS patients: they have been asked to evaluate and treat patients with neuropsychiatric manifestations of AIDS and emotional reactions to the illness itself, as well as to treat those who are fearful of acquiring AIDS. Numerous studies in the literature have explored the physician and lay population's knowledge and attitudes about AIDS. To date no study has addressed these issues in psychiatrists in specific (1- 9).

Most studies suggest that individuals who have …

A 2-Step Approach To Myeloablative Haploidentical Stem Cell Transplantation: A Phase 1/2 Trial Performed With Optimized T-Cell Dosing., Dolores Gross, Matthew Carabasi, Joanne Filicko-O'Hara, Margaret Kasner, John L Wagner, Beth Colombe, Patricia Cornett Farley, William O'Hara, Phyllis Flomenberg, Maria Werner-Wasik, Janet Brunner, Bijoyesh Mookerjee, Terry Hyslop, Mark Weiss, Neal Flomenberg

Department of Medical Oncology Faculty Papers

Studies of haploidentical hematopoietic stem cell transplantation (HSCT) have identified threshold doses of T cells below which severe GVHD is usually absent. However, little is known regarding optimal T-cell dosing as it relates to engraftment, immune reconstitution, and relapse. To begin to address this question, we developed a 2-step myeloablative approach to haploidentical HSCT in which 27 patients conditioned with total body irradiation (TBI) were given a fixed dose of donor T cells (HSCT step 1), followed by cyclophosphamide (CY) for T-cell tolerization. A CD34-selected HSC product (HSCT step 2) was infused after CY. A dose of 2 × 10(8)/kg …

Immunization With The Recombinant Antigen Ss-Ir Induces Protective Immunity To Infection With Strongyloides Stercoralis In Mice., David Abraham, Jessica A. Hess, Rojelio Mejia, Thomas J. Nolan, James B. Lok, Sara Lustigman, Thomas B. Nutman

Department of Microbiology and Immunology Faculty Papers

Human intestinal infections with the nematode Strongyloides stercoralis remain a significant problem worldwide and a vaccine would be a useful addition to the tools available to prevent and control this infection. The goal of this study was to test single antigens for their efficacy in a vaccine against S. stercoralis larvae in mice. Alum was used as the adjuvant in these studies and antigens selected for analysis were either recognized by protective human IgG (Ss-TMY-1, Ss-EAT-6, and Ss-LEC-5) or were known to be highly immunogenic in humans (Ss-NIE-1 and Ss-IR). Only mice immunized with the Ss-IR antigen demonstrated a significant …

Proliferating Cell Nuclear Antigen Is Required For Loading Of The Smcx/Kmd5c Histone Demethylase Onto Chromatin., Zhihui Liang, Marc Diamond, Johanna A Smith, Matthias Schnell, René Daniel

Department of Medicine Faculty Papers

UNLABELLED: ABSTRACT:

BACKGROUND: Histone methylation is regulated by a large number of histone methyltransferases and demethylases. The recently discovered SMCX/KMD5C demethylase has been shown to remove methyl residues from lysine 4 of histone H3 (H3K4), and constitutes an important component of the regulatory element-1-silencing transcription factor (REST) protein complex. However, little is known about the cellular mechanisms that control SMCX activity and intracellular trafficking.

RESULTS: In this study, we found that small interfering RNA-mediated knockdown of proliferating cell nuclear antigen (PCNA) resulted in the reduction of the chromatin-bound SMCX fraction. We identified a PCNA-interaction protein motif (PIP box) in the …

Commentary: The Hiv-Positive Resident: Questions And More Questions, Marguerite Blythe, Md

Jefferson Journal of Psychiatry

The resident physician who is infected with the human immunodeficiency virus (HIV) faces unique problems. In addition to the difficulties caused by a chronic and lethal disease, HIV-infected physicians-in-training face ethical, educational and practical problems that are unique to the interplay between residency training and the infection.

To date, physicians who have been found to be infected with HIV have faced public discrimination, many with devastating results. Dr. Hacib Aoun, a Venezulean-born cardiologist who contracted AIDS from a boy with leukemia while he was a resident at Johns Hopkins, overcame rumors about how he had contracted the disease only to …

Human Glial-Restricted Progenitor Transplantation Into Cervical Spinal Cord Of The Sod1 Mouse Model Of Als., Angelo C Lepore, John O'Donnell, Andrew S Kim, Timothy Williams, Alicia Tuteja, Mahendra S Rao, Linda L Kelley, James T Campanelli, Nicholas J Maragakis

Department of Neuroscience Faculty Papers

Cellular abnormalities are not limited to motor neurons in amyotrophic lateral sclerosis (ALS). There are numerous observations of astrocyte dysfunction in both humans with ALS and in SOD1(G93A) rodents, a widely studied ALS model. The present study therapeutically targeted astrocyte replacement in this model via transplantation of human Glial-Restricted Progenitors (hGRPs), lineage-restricted progenitors derived from human fetal neural tissue. Our previous findings demonstrated that transplantation of rodent-derived GRPs into cervical spinal cord ventral gray matter (in order to target therapy to diaphragmatic function) resulted in therapeutic efficacy in the SOD1(G93A) rat. Those findings demonstrated the feasibility and efficacy of transplantation-based …

The Stress Factor: Exploring The Possibility Of A Psychological Component To Cancer, Bernard M. Edelstein, Md

Jefferson Journal of Psychiatry

As dwellers in the same house, it seems only logical that psyche and soma would be interdependent , that well-being in one would promote health in the other, and that illness in one would soon become manifest in its partner. Yet quantifying this intuitive relationship has long been a difficult task. Establishing a mechanism for disease-heart disease, infectious disease, neoplastic disease which can withstand the scrutiny of experimental rigor, is difficult enough. To introduce a seemingly not quantifiable entity such as psychology in the form of stress or anxiety presents such great complexity that for a long time it seemed …

Chapter: The Advanced Practice Nurse In The Community, Kellie Smith, Molly A. Rose

College of Nursing Faculty Papers & Presentations

Objectives

After reading this chapter, the student should be able to do the following:

1. Briefly discuss the historical development of the roles of the advanced public health nurse and the nurse practitioner

2. Describe the educational requirements for population-focused advanced practice nurses

3. Discuss credentialing mechanisms in nursing as they relate to the role of the advanced practice nurse

4. Compare and contrast the various role functions of population-focused advanced practice nurses

5. Identify potential arenas of practice

6. Explore current issues and concerns related to practice

7. Identify five stressors that may affect nurses in expanded roles

Sirolimus-Induced Pneumonitis Complicated By Pentamidine-Induced Phospholipidosis In A Renal Transplant Recipient: A Case Report., E J Filippone, J M Carson, R A Beckford, B C Jaffe, E Newman, B K Awsare, C Doria, J L Farber

Department of Medicine Faculty Papers

The proliferation signal inhibitors (PSIs)-sirolimus, everolimus, and temsirolimus-have been associated with a noninfectious pneumonitis characterized by lymphocytic alveolitis and bronciolitis obliterans with organizing pneumonia (BOOP). This condition usually occurs within the first year. Herein we presented a case of a deceased donor renal transplant with interstitial pneumonitis developing 6 years after a switch from tacrolimus to sirolimus due to chronic graft dysfunction. After the addition of intravenous pentamidine due to the suspicion of Pneumocystis pneumonia, there was marked clinical deterioration requiring intubation. Open lung biopsy revealed sirolimus-induced pulmonary toxicity (BOOP) with the additional finding of a drug-induced phospholipidosis (DIPL) that …

Health-Related Quality Of Life In The Gender, Race, And Clinical Experience Trial., Judith Feinberg, Michael Saag, Kathleen Squires, Judith Currier, Robert Ryan, Bruce Coate, Joseph Mrus

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Background. We report health-related QoL (HRQoL) from GRACE (Gender, Race, And Clinical Experience) study by sex and race over 48 weeks. Methods. 429 treatment-experienced adults (HIV-1 RNA ≥ 1000 copies/mL) received darunavir/ritonavir 600/100 mg twice daily plus an appropriate background regimen. QoL was measured by the Functional Assessment of HIV Infection (FAHI) questionnaire. Results. 67% women and 77% men, including 67.4% black, 76.0% Hispanic, and 73.8% white patients, completed the trial. Baseline total FAHI scores were similar between sexes and races. Total FAHI of the entire population improved by Week 4 (P < .05); near-maximum changes obtained by Week 12 were maintained through Week 48. Women and black patients demonstrated larger improvements in total FAHI versus men, and Hispanic and white patients, respectively. Conclusion. HRQoL improved in all sex and racial/ethnic groups. Sex-based and race-based differences in improvements in FAHI subscales may provide insight into subtle differences of HIV-1 and treatment on HRQoL in different populations.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor to the Jefferson Journal of Psychiatry.

Primary Provider Beliefs And Practice Patterns Contribute To The Lack Of Hiv/Hcv Coinfected Patients Undergoing Liver Transplantation In The United States, Jonathan M. Fenkel, Md, Victor J. Navarro, Md

Division of Gastroenterology and Hepatology Faculty Papers

Conclusions:

1. The majority of primary providers were ambivalent toward or against LT for HIV/HCV coninfected patients.

2. Half of all respondents were unlikely to refer cirrhotic coinfected patients for LT evaluation.

3. HIV specialists were significantly more likely to believe transplant should be offered, but reported no difference in likelihood of LT referral.

4. These findings suggest that primary provider beliefs and self-reported practice patterns may partially explain the paucity of coinfected US liver transplant recipients.

Assessment Of Adherence To Guidelines For Hepatocellular Carcinoma Screening In Hiv/Hcv Coinfected Patients, Jonathan M. Fenkel, Md, Victor J. Navarro, Md

Division of Gastroenterology and Hepatology Faculty Papers

Conclusions:

1. Self-reported adherence with published guidelines for HCC screening is poor among primary providers for HIV/HCV coinfected patients, including HIV specialists and University-based providers.

2. Unnecessary imaging is also frequently ordered on non-cirrhotics, particularly by University-based providers.

3. Improved adherence to guidelines is needed among primary providers as over 50% of HCC's may be missed, and many patients many not be referred for subspecialty GI or Liver care, where screening practices may differ.

Rare Gram-Negative Sepsis In A Non-Ventilated Neutropenic Patient With Aml, Jay Sellers, Md, Paurush Shah, Md

The Medicine Forum

Case Report

A 57-year-old man with history of hypertension, hyperlipidemia,and gout presented for evaluation of both a perioral infection and an infection in his right great toe from an injury on the beach at his shore house. The toe trauma was complicated by a massive hematoma and phlebitis, which required antibiotics. His primary care physician ordered basic laboratory studies thatshowed an anemia and thrombocytopenia. He was sent to a Hematology and Oncology specialist and subsequently directly admitted to Thomas Jefferson University Hospital for blood transfusion and further work-up. Upon further questioning, thepatient admitted to chills starting 2 weeks prior to …

Primary Cutaneous Nocardiosis In A Heart Transplant Patient: A Case Report, Kiran Devaraj, Md, Joanna Rodriguez, Md, Bryan Hess, Md, Paul Mather, Md

The Medicine Forum

Case

A 38-year-old female with history of longstanding non-ischemiccardiomyopathy underwent orthotopic heart transplantation (OHT). Her past medical history was significant for factor V leiden and methylenetetrahydrofolate reductase (MTHFR) heterozygous deficiencies with chronic pulmonary embolism, sickle cell trait, atrial flutter, type 2 diabetes mellitus, and hypertension. The patient had a long and complicated course post-transplantation. Immediately after OHT, she was noted tohave donor- specific human leukocyte antigen (HLA) antibodiestreated with 5 cycles of plasmapheresis. On further biopsies it wasnoted that she had acute cellular rejection requiring pulse-dose parenteral steroids on multiple occasions. Her immunosuppressiontherapy consisted of tacrolimus, mycophenolate and prednisone. Six …

A Rare Case Of Abacavir Hypersensitivity Syndrome, Charles-Lwanga Bennin, Md

The Medicine Forum

Case

A 56-year-old African American male with a history of type II diabetes mellitus complicated by neuropathy, infections with human immunodeficiency virus (HIV), with a known CD4 count of 25 per cubic millimeter, hepatitis B and hepatitis C presented with six months of generalized weakness over his lower extremities, poor balance, nausea and vomiting. The patient had recently started anti-retroviral therapy (ART) and noticed that the onset of his symptoms coincided with the initiation of this therapy. He was taking Trizivir, which consistsof abacavir (300mg each day), lamivudine (150mg each day), and zidovudine (300mg each day), atazanavir (300mg each day)and …