Digital Commons Network^™

Severe Aortic And Arterial Aneurysms Associated With A Tgfbr2 Mutation, Scott A Lemaire, Hariyadarshi Pannu, Van Tran-Fadulu, Stacey A Carter, Joseph S Coselli, Dianna M Milewicz

Faculty, Staff and Student Publications

BACKGROUND: A 24-year-old man presented with previously diagnosed Marfan's syndrome. Since the age of 9 years, he had undergone eight cardiovascular procedures to treat rapidly progressive aneurysms, dissection and tortuous vascular disease involving the aortic root and arch, the thoracoabdominal aorta, and brachiocephalic, vertebral, internal thoracic and superior mesenteric arteries. Throughout this extensive series of cardiovascular surgical repairs, he recovered without stroke, paraplegia or renal impairment.

INVESTIGATIONS: CT scans, arteriogram, genetic mutation screening of transforming growth factor beta receptors 1 and 2.

DIAGNOSIS: Diffuse and rapidly progressing vascular disease in a patient who met the diagnostic criteria for Marfan's syndrome, …

Lessons Learned: A Pilot Study On Occupational Therapy Effectiveness For Children With Sensory Modulation Disorder., Lucy Jane Miller, Sarah A. Schoen, Katherine James, Roseann C Schaaf

Department of Occupational Therapy Faculty Papers

OBJECTIVE: The purpose of this pilot study was to prepare for a randomized controlled study of the effectiveness of occupational therapy using a sensory integration approach (OT-SI) with children who have sensory processing disorders (SPD).

METHOD: A one-group pretest, posttest design with 30 children was completed with a subset of children with SPD, those with sensory modulation disorder.

RESULTS: Lessons learned relate to (a) identifying a homogeneous sample with quantifiable inclusion criteria, (b) developing an intervention manual for study replication and a fidelity to treatment measure, (c) determining which outcomes are sensitive to change and relate to parents' priorities, and …

Occupational Therapy Using A Sensory Integrative Approach: A Case Study Of Effectiveness., Roseann C. Schaaf, Kathleen Mckeon Nightlinger

Department of Occupational Therapy Faculty Papers

OBJECTIVE: This article presents a case report of a child with poor sensory processing and describes the disorders impact on the child's occupational behavior and the changes in occupational performance during 10 months of occupational therapy using a sensory integrative approach (OT-SI).

METHOD: Retrospective chart review of assessment data and analysis of parent interview data are reviewed. Progress toward goals and objectives is measured using goal attainment scaling. Themes from parent interview regarding past and present occupational challenges are presented.

RESULTS: Notable improvements in occupational performance are noted on goal attainment scales, and these are consistent with improvements in behavior. …

Fidelity In Sensory Integration Intervention Research., L Diane Parham, Ellen S. Cohn, Susan Spitzer, Jane A. Koomar, Lucy Jane Miller, Janice P Burke, Barbara Brett-Green, Zoe Mailloux, Teresa A. May-Benson, Susanne Smith Roley, Roseann C. Schaaf, Sarah A. Schoen, Clare A. Summers

Department of Occupational Therapy Faculty Papers

OBJECTIVE: We sought to assess validity of sensory integration outcomes research in relation to fidelity (faithfulness of intervention to underlying therapeutic principles).

METHOD: We identified core sensory integration intervention elements through expert review and nominal group process. Elements were classified into structural (e.g., equipment used, therapist training) and therapeutic process categories. We analyzed 34 sensory integration intervention studies for consistency of intervention descriptions with these elements.

RESULTS: Most studies described structural elements related to therapeutic equipment and interveners' profession. Of the 10 process elements, only 1 (presentation of sensory opportunities) was addressed in all studies. Most studies described fewer than …

Goal Attainment Scaling As A Measure Of Meaningful Outcomes For Children With Sensory Integration Disorders., Zoe Mailloux, Teresa A. May-Benson, Clare A. Summers, Lucy Jane Miller, Barbara Brett-Green, Janice P. Burke, Ellen S. Cohn, Jane A. Koomar, L Diane Parham, Susanne Smith Roley, Roseann C. Schaaf, Sarah A. Schoen

Department of Occupational Therapy Faculty Papers

Goal attainment scaling (GAS) is a methodology that shows promise for application to intervention effectiveness research and program evaluation in occupational therapy (Dreiling & Bundy, 2003; King et al., 1999; Lannin, 2003; Mitchell & Cusick, 1998). This article identifies the recent and current applications of GAS to occupational therapy for children with sensory integration dysfunction, as well as the process, usefulness, and problems of application of the GAS methodology to this population. The advantages and disadvantages of using GAS in single-site and multisite research with this population is explored, as well as the potential solutions and future programs that will …

Cystic Lymphangioma Of The Pancreas, Madhusudhan R. Sanaka, Thomas E. Kowalski

Department of Medicine Faculty Papers

A case report.

Hepatitis C Risk Assessment, Testing And Referral For Treatment In Urban Primary Care: Role Of Race And Ethnicity., Stacey B. Trooskin, Victor J. Navarro, Robert J. Winn, David J. Axelrod, A. Scott Mcneal, Maricruz Velez, Steven K. Herrine, Simona Rossi

Division of Gastroenterology and Hepatology Faculty Papers

AIM: To determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity.

METHODS: Retrospective chart review from four primary care sites in Philadelphia; two academic primary care practices and two community clinics was performed. Demographics, HCV risk factors, and other risk exposure information were collected.

RESULTS: Four thousand four hundred and seven charts were reviewed. Providers documented histories of injection drug use (IDU) and transfusion for less than 20% and 5% of patients, respectively. Only 55% of patients who admitted IDU were tested …

Teenage Pregnancy: Impact Of The Integral Attention Given To The Pregnant Teenager And Adolescent Mother As A Protective Factor For Repeat Pregnancy, Maria José Carvalho Sant'anna, Kepler Alencar Mendes Carvalho, Amanda Melhado, Verônica Coates, Hatim A. Omar

Pediatrics Faculty Publications

The purpose of this study was to evaluate the impact of the integral attention to the health of pregnant adolescents and adolescent mothers, having follow-up from the Integral Support Program for the Pregnant Teen (ISPPT), with the intention to determine quality of life and prevent repeat pregnancy. A prospective study comprised 85 adolescents attended by the ISPPT between January 2002 and June 2006 who participated in meetings during pregnancy with a multidisciplinary team that provided orientation concerning family planning, self-esteem, pregnancy prevention, motivation to continue education and/or work, and evaluate the postpartum mother-child relationship. The following were analyzed: education level, …

Emotional Expression During Attention-Deficit/Hyperactivity Disorders Treatment: Initial Assessment Of Treatment Effects., Christopher J. Kratochvil, D. Faries, Brigette S. Vaughan, A. Perwien, J. Busner, K. Saylor, S. Kaplan, C. Buermeyer, R. Swindle

Journal Articles: Psychiatry

OBJECTIVE: The purpose of this research was to provide an initial examination of the effects of atomoxetine and stimulants on emotional expression using a newly developed scale for assessing emotional expression in children with attention-deficit/hyperactivity disorder (ADHD).

METHOD: The parent-rated Expression and Emotion Scale for Children (EESC) was collected during two studies. During a cross-sectional validation study, the EESC was completed to assess the child's current treatment and retrospectively for previous medication. In a randomized, placebo-controlled trial of atomoxetine, the EESC was collected at baseline and endpoint.

RESULTS: In the validation study, no statistically significant differences in EESC scores were …

Improving Student Dentist Competencies And Perception Of Difficulty In Delivering Care To Children With Developmental Disabilities Using A Virtual Patient Module, Harold L. Kleinert, Carla Sanders, John Mink, David A. Nash, Jeff Johnson, Sara Boyd, Sandra Challman

Human Development Institute Faculty Publications

An interactive, multimedia, virtual patient module was designed and developed on compact disc (CD-ROM) to address the need for student dentists to increase their competence and decrease their perception of difficulty in caring for children with developmental disabilities. A development team consisting of pediatric dentistry faculty members, parents of children with developmental disabilities, an individual with a developmental disability, and educational specialists developed an interactive virtual patient case. The case involved a ten-year-old child with Down syndrome presenting with a painful tooth. Student dentists were required to make decisions regarding proper interactions with the child, as well as appropriate clinical …

Cephalalgiaphobia: A Possible Specific Phobia Of Illness., Mario F P Peres, Juliane P P Mercante, Vera Z Guendler, Felipe Corchs, Marcio A Bernik, Eliova Zukerman, Stephen Silberstein

Department of Jefferson Headache Center Papers and Presentations

Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild …

Jefferson Scale Of Patient's Perceptions Of Physician Empathy: Preliminary Psychometric Data., Gregory C. Kane, Joanne L. Gotto, Salvatore Mangione, Susan West, Mohammadreza Hojat

Department of Psychiatry and Human Behavior Faculty Papers

AIM: To develop a brief scale for measuring patient's perceptions of their physician's empathic engagement and to provide preliminary evidence in support of aspects of the scale's psychometrics.

METHOD: Study comprised 225 patients, out of 436 patients (52% response rate) seen by 166 residents in the internal medicine residency program at the Jefferson Hospital Ambulatory Clinic as part of their ambulatory training at Thomas Jefferson University Hospital. A 5-item questionnaire entitled the Jefferson Scale of Patient's Perceptions of Physician Empathy was developed and administered to the study participants. Its factor structure, item-total score correlations, and correlations with several relevant criterion …

Toward A Biopsychosocial Understanding Of The Patient-Physician Relationship: An Emerging Dialogue, Herbert M. Adler

Department of Family & Community Medicine Faculty Papers

Complexity theory has been used to view the patient-physician relationship as constituted by complex responsive processes of relating. It describes an emergent, psychosocial relational process through which patients and physicians continually and reciprocally influence each other's behavior and experience. As psychosocial responses are necessarily biopsychosocial responses, patients and physicians must likewise be influencing each other's psychobiology. This mutual influence may be subjectively experienced as empathy, and may be skillfully employed by the clinician to directly improve the patient's psychobiology.

Vancomycin-Resistant Enterococcus Faecalis Endocarditis: Linezolid Failure And Strain Characterization Of Virulence Factors, Constantine Tsigrelis, Kavindra V Singh, Thais D Coutinho, Barbara E Murray, Larry M Baddour

Faculty, Staff and Student Publications

Infective endocarditis due to vancomycin-resistant (VR) Enterococcus faecalis has only rarely been reported. We report a case of VR E. faecalis endocarditis that failed to respond to linezolid therapy, outline the virulence traits of the isolate, and review previously published cases of VR E. faecalis endocarditis.

The Genome-Enabled Electronic Medical Record., M A Hoffman

Manuscripts, Articles, Book Chapters and Other Papers

The integration of patient-specific genomic information into the electronic medical record (EMR) will create many opportunities to improve patient care. Key to the successful incorporation of genomic information into the EMR will be the development of laboratory information systems capable of appropriately formatting molecular diagnostic and cytogenetic findings in the EMR. Due to the lack of granular genomics-related content in existing medical vocabularies, the adoption of new standards for describing clinically significant genomic information will be an important step toward recognizing the genome-enabled EMR. Appropriate capture of patient-specific genomic results in the EMR will generate new opportunities to utilize this …

Phosphorylation Of The Proline-Rich Domain Of Xp95 Modulates Xp95 Interaction With Partner Proteins, Robert E Dejournett, Ryuji Kobayashi, Shujuan Pan, Chuanfen Wu, Laurence D Etkin, Richard B Clark, Oliver Bögler, Jian Kuang

Faculty, Staff and Student Publications

The mammalian adaptor protein Alix [ALG-2 (apoptosis-linked-gene-2 product)-interacting protein X] belongs to a conserved family of proteins that have in common an N-terminal Bro1 domain and a C-terminal PRD (proline-rich domain), both of which mediate partner protein interactions. Following our previous finding that Xp95, the Xenopus orthologue of Alix, undergoes a phosphorylation-dependent gel mobility shift during progesteroneinduced oocyte meiotic maturation, we explored potential regulation of Xp95/Alix by protein phosphorylation in hormone-induced cell cycle re-entry or M-phase induction. By MALDI-TOF (matrix-assisted laser-desorption ionization-time-of-flight) MS analyses and gel mobility-shift assays, Xp95 is phosphorylated at multiple sites within the N-terminal half of the …

Phosphorylation Of The Proline-Rich Domain Of Xp95 Modulates Xp95 Interaction With Partner Proteins, Robert E Dejournett, Ryuji Kobayashi, Shujuan Pan, Chuanfen Wu, Laurence D Etkin, Richard B Clark, Oliver Bögler, Jian Kuang

Faculty, Staff and Student Publications

The mammalian adaptor protein Alix [ALG-2 (apoptosis-linked-gene-2 product)-interacting protein X] belongs to a conserved family of proteins that have in common an N-terminal Bro1 domain and a C-terminal PRD (proline-rich domain), both of which mediate partner protein interactions. Following our previous finding that Xp95, the Xenopus orthologue of Alix, undergoes a phosphorylation-dependent gel mobility shift during progesteroneinduced oocyte meiotic maturation, we explored potential regulation of Xp95/Alix by protein phosphorylation in hormone-induced cell cycle re-entry or M-phase induction. By MALDI-TOF (matrix-assisted laser-desorption ionization-time-of-flight) MS analyses and gel mobility-shift assays, Xp95 is phosphorylated at multiple sites within the N-terminal half of the …

Beta Blocker Specificity: A Building Block Toward Personalized Medicine., Brent R Degeorge, Walter J Koch

Center for Translational Medicine Faculty Papers

Drugs known as beta blockers, which antagonize the beta-adrenergic receptor (beta-AR), are an important component of the treatment regimen for chronic heart failure (HF). However, a significant body of evidence indicates that genetic heterogeneity at the level of the beta(1)-AR may be a factor in explaining the variable responses of HF patients to beta blockade. In this issue of the JCI, Rochais et al. describe how a single amino acid change in beta(1)-AR alters its structural conformation and improves its functional response to carvedilol, a beta blocker currently used in the treatment of HF (see the related article beginning on …

A Non-Pharmacological Intervention To Manage Behavioral And Psychological Symptoms Of Dementia And Reduce Caregiver Distress: Design And Methods Of Project Act3., Laura N Gitlin, Laraine Winter, Marie P Dennis, Walter W Hauck

Center for Applied Research on Aging and Health Research Papers

Project ACT is a randomized controlled trial designed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia (BPSD) and caregiver distress. The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances. All participants are interviewed at baseline, 4-months (main trial endpoint), and 6-months (maintenance). The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers (communication style, environmental clutter) contributing to behaviors, and instruct in strategies to reduce caregiver …

Development Of Tilt Table With Visual Feedback Function For Hemiplegia Patients, J. Cho, J. Choi, T. Nam, J. Park, I. Park-Ko, F. Ibrahim

Research Publications (2006 to 2010)

Due to damaged vertebrae nerves, serious disease and aging, patients who have to lie down for long period of time need to exercise to maintain up-right standing position and recover their muscle power of paralytic leg. This study describes the development of an intelligent tilt table which can provide a patient with visual feedback of exercise to increase the effect of rehabilitation. This could be possible by measuring and displaying the knee bent angle and pressure for each foot during exercise in real time. It is expected that patient's exercising effect can increase by self-monitoring these two values during exercise.

Tooth-Size Discrepancy And Bolton's Ratios: The Reproducibility And Speed Of Two Methods Of Measurement, S.A. Othman, N.W. Harradine

Research Publications (2006 to 2010)

OBJECTIVE: To determine and compare the reproducibility and speed of two methods of performing Bolton's tooth-size analysis. DESIGN: Analysis of randomly selected clinical sample. SETTING: Bristol Dental Hospital, University of Bristol, United Kingdom. MATERIALS AND METHODS: Pre-treatment study casts of 150 patients were selected randomly from 1100 consecutively treated Caucasian orthodontic patients. Bolton tooth-size discrepancies and ratios were measured using two methods; one method employed entirely manual measurement and the Odontorule slide rule, while the other employed digital calipers and the HATS analysis software. Twenty study casts were measured twice, a week apart with both methods. Another three investigators also …

Human Health Risk Assessment For Aluminium, Aluminium Oxide, And Aluminium Hydroxide, Daniel Krewski, Robert A. Yokel, Evert Nieboer, David Borchelt, Joshua Cohen, Jean Harry, Sam Kacew, Joan Lindsay, Amal M. Mahfouz, Virginie Rondeau

Pharmaceutical Sciences Faculty Publications

A compendium is provided of aluminium compounds used in industrial settings, and as pharmaceuticals, food additives, cosmetics and as other household products. Most aluminium compounds are solids exhibiting high melting points. The solubility of aluminium salts is governed by pH, because the aluminium(III)-cation (Al³⁺) has a strong affinity for the hydroxide ion, which promotes precipitation. Like Mg²⁺ and Ca²⁺ ions, Al³⁺ in most situations seeks out complexing agents with oxygen-atom donor sites such as carboxylate and phosphate groups, including in biological systems. Aluminium oxides, hydroxides and oxyhydroxides occur in numerous crystallographic forms, which exhibit different …

The Impact Of Stress Management On Nurse Productivity And Retention, Tammi F. Milliken, Paul T. Clements, Harry J. Tillman

Counseling & Human Services Faculty Publications

Throughout the history of nursing there is a seeming legacy of personnel shortage, lack of funds, and, based on the nature of the role and related services, heightened levels of stress involved in patient care.

The future of the profession and more imminently, patient care and the health of nurses, may be significantly impacted by repeated challenges where current levels of stress and burnout are contributing to organizational problems, burnout, and attrition.

Employee stress and burn out commonly lead to myriad health-related problems that result in significant organizational consequences.

There are many methods of stress management, and sometimes the best …

Silencing Of The Pink1 Gene Expression By Conditional Rnai Does Not Induce Dopaminergic Neuron Death In Mice., Hongxia Zhou, Björn H Falkenburger, Jörg B Schulz, Kim Tieu, Zuoshang Xu, Xu Gang Xia

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Transgenic RNAi, an alternative to the gene knockout approach, can induce hypomorphic phenotypes that resemble those of the gene knockout in mice. Conditional transgenic RNAi is an attractive choice of method for reverse genetics in vivo because it can achieve temporal and spatial silencing of targeted genes. Pol III promoters such as U6 are widely used to drive the expression of RNAi transgenes in animals. Tested in transgenic mice, a Cre-loxP inducible U6 promoter drove the broad expression of an shRNA against the Pink1 gene whose loss-of-functional mutations cause one form of familial Parkinson's disease. The expression of the shRNA …

Does Time Really Slow Down During A Frightening Event?, Chess Stetson, Matthew P Fiesta, David M Eagleman

Faculty, Staff and Student Publications

Observers commonly report that time seems to have moved in slow motion during a life-threatening event. It is unknown whether this is a function of increased time resolution during the event, or instead an illusion of remembering an emotionally salient event. Using a hand-held device to measure speed of visual perception, participants experienced free fall for 31 m before landing safely in a net. We found no evidence of increased temporal resolution, in apparent conflict with the fact that participants retrospectively estimated their own fall to last 36% longer than others' falls. The duration dilation during a frightening event, and …

Association Of Putative Enteroaggregative Escherichia Coli Virulence Genes And Biofilm Production In Isolates From Travelers To Developing Countries, Jamal A Mohamed, David B Huang, Zhi-Dong Jiang, Herbert L Dupont, James P Nataro, Jaime Belkind-Gerson, Pablo C Okhuysen

Faculty, Staff and Student Publications

Enteroaggregative Escherichia coli (EAEC) is an emerging enteric pathogen that causes acute and chronic diarrhea among children, human immunodeficiency virus-infected patients, and travelers to developing regions of the world. The pathogenesis of EAEC strains involves the production of biofilm. In this study, we determined the association between presence of putative EAEC virulence genes and biofilm formation in 57 EAEC isolates (as defined by HEp-2 adherence) from travelers with diarrhea and in 18 EAEC isolates from travelers without diarrhea. Twelve nondiarrheagenic E. coli isolates from healthy travelers were used as controls. Biofilm formation was measured by using a microtiter plate assay …

Mediating Between Qualitative And Quantitative Representations For Task-Orientated Human-Robot Interaction., Michael Brenner, John D. Kelleher, Nick Hawes, Jeremy Wyatt

Conference papers

In human-robot interaction (HRI) it is essential that the robot interprets and reacts to a human’s utterances in a manner that reflects their intended meaning. In this paper we present a collection of novel techniques that allow a robot to interpret and execute spoken commands describing manipulation goals involving qualitative spatial constraints (e.g. “put the red ball near the blue cube”). The resulting implemented system integrates computer vision, potential field models of spatial relationships, and action planning to mediate between the continuous real world, and discrete, qualitative representations used for symbolic reasoning.

Computer Simulation Of Glioma Growth And Morphology, Hermann B. Frieboes, John S Lowengrub, S Wise, X Zheng, Paul Macklin, Elaine L. Bearer, Vittorio Cristini

Faculty, Staff and Student Publications

Despite major advances in the study of glioma, the quantitative links between intra-tumor molecular/cellular properties, clinically observable properties such as morphology, and critical tumor behaviors such as growth and invasiveness remain unclear, hampering more effective coupling of tumor physical characteristics with implications for prognosis and therapy. Although molecular biology, histopathology, and radiological imaging are employed in this endeavor, studies are severely challenged by the multitude of different physical scales involved in tumor growth, i.e., from molecular nanoscale to cell microscale and finally to tissue centimeter scale. Consequently, it is often difficult to determine the underlying dynamics across dimensions. New techniques …

Predictive Oncology: A Review Of Multidisciplinary, Multiscale In Silico Modeling Linking Phenotype, Morphology And Growth, Sandeep Sanga, Hermann B. Frieboes, Xiaoming Zheng, Robert Gatenby, Elaine L. Bearer, Vittorio Cristini

Faculty, Staff and Student Publications

Empirical evidence and theoretical studies suggest that the phenotype, i.e., cellular- and molecular-scale dynamics, including proliferation rate and adhesiveness due to microenvironmental factors and gene expression that govern tumor growth and invasiveness, also determine gross tumor-scale morphology. It has been difficult to quantify the relative effect of these links on disease progression and prognosis using conventional clinical and experimental methods and observables. As a result, successful individualized treatment of highly malignant and invasive cancers, such as glioblastoma, via surgical resection and chemotherapy cannot be offered and outcomes are generally poor. What is needed is a deterministic, quantifiable method to enable …

Exploration Of Computational Methods For Classification Of Movement Intention During Human Voluntary Movement From Single Trial Eeg, Ou Bai, Peter Lin, Sherry Vorbach, Jiang Li, Steve Furlani, Mark Hallett

Electrical & Computer Engineering Faculty Publications

Objective: To explore effective combinations of computational methods for the prediction of movement intention preceding the production of self-paced right and left hand movements from single trial scalp electroencephalogram (EEG).

Methods: Twelve naïve subjects performed self-paced movements consisting of three key strokes with either hand. EEG was recorded from 128 channels. The exploration was performed offline on single trial EEG data. We proposed that a successful computational procedure for classification would consist of spatial filtering, temporal filtering, feature selection, and pattern classification. A systematic investigation was performed with combinations of spatial filtering using principal component analysis (PCA), independent component analysis …