Medicine and Health Sciences Commons^™

Health Policy Forum: Transformative Technology Applications In Health Care

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

New Global Health Fellowship Links Jefferson And Sierra Leone, Bon S. Ku Md, Harsh P. Sule Md

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Use Of Archival Data To Inform Health Policy, Shana Stites Ma, Ms

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

8th Annual Interclerkship Day: Improving Patient Safety

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

The Jefferson Scale Of Empathy (Jse): An Update, Mohammedreza Hojat Phd, Daniel Z. Louis Ms, Kay Maxwell Bs, Joseph S. Gonnella Md

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Pitfalls And Problems Abound: A Medical Student Shares A Family Experience With The Health Care System, Cole Zanetti

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Amsa's 3rd Annual Patient Safety And Quality Leadership Institute, Boris Rozenfeld, Marina Zeltser

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Health Reform: Will It Improve Our Nation's Health?, Rob Simmons Drph,Mph,Mches,Cph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Health Policy Newsletter Spring 2011 Download Full Text Pdf

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Hydrophobicity As A Driver Of Mhc Class I Antigen Processing., Lan Huang, Matthew C Kuhls, Laurence C. Eisenlohr

Department of Microbiology and Immunology Faculty Papers

The forces that drive conversion of nascent protein to major histocompatibility complex (MHC) class I-restricted peptides remain unknown. We explored the fundamental property of overt hydrophobicity as such a driver. Relocation of a membrane glycoprotein to the cytosol via signal sequence ablation resulted in rapid processing of nascent protein not because of the misfolded luminal domain but because of the unembedded transmembrane (TM) domain, which serves as a dose-dependent degradation motif. Dislocation of the TM domain during the natural process of endoplasmic reticulum-associated degradation (ERAD) similarly accelerated peptide production, but in the context of markedly prolonged processing that included nonnascent …

Promoting Occupational Therapy In Virtual Environments: Project-Based Learning In Second Life®, Susan Toth-Cohen, Phd, Otr/L, Veronica Souter, Ots, Elizabeth Vanderlaan, Ots, Kaitlin Rodriguez, Ots

Department of Occupational Therapy Posters and Presentations

Description of project

Occupational therapy students from Jefferson School of Health Professions in Philadelphia planned and implemented interactive exhibits within the virtual world of Second Life®. The educational exhibits were provided through an ongoing project designed to promote occupational therapy, provide immersive experiences on health and wellness for persons in Second Life® and promote collaboration between project personnel and others with an interest in health and wellness. Exhibits focused on home and playground adaptations, mental health and productive aging and were based on current research evidence and best practices. Students also participated in events in which they promoted occupational therapy …

Hormonal Consequences Of Epilepsy And Its Treatment In Men., Kartik Sivaraaman, Scott Mintzer

Department of Neurology Faculty Papers

PURPOSE OF REVIEW: Epilepsy and anticonvulsant medications may substantially alter endocrine homeostasis, including the male reproductive hormonal system.

RECENT FINDINGS: Seizures in medial temporal lobe structures, through their connectivity to the hypothalamus, alter the secretion of gonadotropins. Levels of circulating bioavailable testosterone are affected by changes in the level of binding proteins, which in turn may be affected by seizure medications. The use of older generation medications that induce the cytochrome P450 system is associated with an increase in sex hormone-binding globulin and lower bioactive testosterone. Sexual dysfunction, including decreased libido and decreased potency, and infertility, is seen commonly in …

Role Of Antiarrhythmic Drugs: Frequent Implantable Cardioverter-Defibrillator Shocks, Risk Of Proarrhythmia, And New Drug Therapy., Christopher Droogan, Chinmay Patel, Gan-Xin Yan, Peter R Kowey

Department of Medicine Faculty Papers

The implantable cardioverter-defibrillator (ICD) is the standard of care in patients with ischemic and nonischemic cardiomyopathy who are at high risk for arrhythmic events and sudden cardiac death. Although an ICD saves life, ICD shocks are emotionally and physically debilitating. Most patients receive adjuvant antiarrhythmic drug therapy to circumvent episodes of recurrent ventricular and supraventricular arrhythmias. Antiarrhythmic drugs including β-blockers, sotalol, amiodarone, and azimilide are effective at reducing the shock burden. This article describes data supporting the need for and potential risks and benefits of adjuvant antiarrhythmic drug therapy and examines the benefits and pitfalls of the same in ICD-implanted …

Bionic Technologies Transforming The Science Of Healthcare Delivery, Scott A. Waldman , M.D., Ph.D, Andre Terzic , M.D., Ph.D

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Individualization of patient care is creating an envisioned future in which practitioners wield a new doctor’s bag deploying individual molecular, genetic, cellular, and systems profiles.  These emerging tools are refining traditional paradigms of disease palliation into nuanced patient management algorithms employing prognostic risk stratification, therapeutic response prediction, and adverse event avoidance. Advancing technologies are enabling a shift to more proximal nodes along the continuum of pathobiology. Innovations in biomarker platforms, genomic profiling, and molecular imaging reveal the earliest stages of pathophysiology, limiting systems disruption to cells and tissues while preserving integrated organ function, enabling risk mitigation and disease prevention.  At …

Oncologic Efficacy Is Not Compromised, And May Be Improved With Minimally Invasive Esophagectomy., Adam C Berger, Aaron Bloomenthal, Benny Weksler, Nathaniel Evans, Karen A Chojnacki, Charles J Yeo, Ernest L Rosato

Department of Surgery Faculty Papers

BACKGROUND: Major morbidity and mortality rates continue to be high in large series of transthoracic esophagectomies. Minimally invasive approaches are being increasingly used. We compare our growing series of minimally invasive (combined thoracoscopic and laparoscopic) esophagectomies (MIEs) with a series of open transthoracic esophagectomies.

STUDY DESIGN: We identified 65 patients who underwent an MIE with thoracoscopy/laparotomy (n = 11), Ivor Lewis (n = 2), or 3-hole approach (n = 52). These patients were compared with 53 patients who underwent open Ivor-Lewis esophagectomy (n = 15) or 3-hole esophagectomy (n = 38) over the past 10 years.

RESULTS: The MIE and …

Potent Inhibition Of Heterotopic Ossification By Nuclear Retinoic Acid Receptor-Γ Agonists., Kengo Shimono, Wei-En Tung, Christine Macolino, Amber Hsu-Tsai Chi, Johanna H Didizian, Christina Mundy, Roshantha A Chandraratna, Yuji Mishina, Motomi Enomoto-Iwamoto, Maurizio Pacifici, Masahiro Iwamoto

Department of Orthopaedic Surgery Faculty Papers

Heterotopic ossification consists of ectopic bone formation within soft tissues after surgery or trauma. It can have debilitating consequences, but there is no definitive cure. Here we show that heterotopic ossification was essentially prevented in mice receiving a nuclear retinoic acid receptor-γ (RAR-γ) agonist. Side effects were minimal, and there was no significant rebound effect. To uncover the mechanisms of these responses, we treated mouse mesenchymal stem cells with an RAR-γ agonist and transplanted them into nude mice. Whereas control cells formed ectopic bone masses, cells that had been pretreated with the RAR-γ agonist did not, suggesting that they had …

Implementing An Msn Nursing Program At A Distance Through An Urban-Rural Partnership, Ksenia Zukowsky, Phd, Aprn, Nnp-Bc, Beth Ann Swan, Phd, Crnp, Faan, Mary Powell, Phd, Crnp, Anthony J. Frisby, Phd, Lori Lauver, Phd, Rn, Margaret Mary West, Phd, Cne, Rn, Alexis Marsella, Ba

College of Nursing Faculty Papers & Presentations

Recruiting, retaining, and educating advanced practice nurses is essential to meet the growing need for advanced practice nurses in rural and urban communities. Through the support of Health Resources and Services Administration funding, the urban school of nursing expanded its MSN program and implemented the graduate curriculum on its rural campus by utilizing emerging online and distance education technologies. The purpose of this manuscript is to provide an overview of expanding an existing MSN program offered in an urban, traditional classroom setting to rural graduate nursing students via an online synchronous format. In addition, the article will describe the rural …

Prognostic Significance Of High-Grade Dysplasia In Colorectal Adenomas., A D Toll, D Fabius, T Hyslop, E Pequignot, A J Dimarino, A Infantolino, J P Palazzo

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Aim  Colonoscopy to detect and remove polyps has contributed to a reduction in colorectal carcinoma. Three-year follow up is recommended for patients considered to be at high risk (at least three adenomas, adenoma ≥ 1 cm, villous or high-grade features). Our study focused on patients diagnosed with high-grade dysplasia with regard to initial management and follow up. Method  A search of patients who had had endoscopic removal of a high-grade adenoma was carried out. Patients with the following were excluded: follow up of < 1 year, polyposis syndromes, prior colon cancer and a diagnosis of adenocarcinoma within 6 months following initial diagnosis. Results  Eighty-three patients treated between 1999 and 2007 for high-grade dysplasia (HGD) in a colorectal adenoma were identified. Over a median follow-up period of 4 years, 53 (64%) developed further adenomatous polyps. Among these, 7% had an adenoma with HGD or an adenocarcinoma. In all these patients, the initial high-grade adenoma was > 1 cm in diameter. Initial follow-up colonoscopy was performed on average 7 months following the initial diagnosis. …

Mir-21 Induced Angiogenesis Through Akt And Erk Activation And Hif-1Α Expression., Ling-Zhi Liu, Chongyong Li, Qi Chen, Yi Jing, Richard Carpenter, Yue Jiang, Hsiang-Fu Kung, Lihui Lai, Bing-Hua Jiang

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

MicroRNAs (miRNAs) are endogenous, small noncoding RNAs that play important roles in various cellular functions and tumor development. Recent studies have indicated that miR-21 is one of the important miRNAs associated with tumor growth and metastasis, but the role and molecular mechanism of miR-21 in regulating tumor angiogenesis remain to be elucidated. In this study, miR-21 was overexpressed by transfecting pre-miR-21 into human prostate cancer cells and tumor angiogenesis was assayed using chicken chorioallantoic membrane (CAM). We found that overexpression of miR-21 in DU145 cells increased the expression of HIF-1α and VEGF, and induced tumor angiogenesis. AKT and extracellular regulated …

The Challenge Of Communicating Cardiovascular Risk Information To Our Patients., Samuel S Gidding

Department of Pediatrics Faculty Papers

Each of the major cardiovascular risk factors presents unique challenges to the clinician caring for children.  Dyslipidemia and hypertension are silent and require measurement; the challenge is first risk classification and then communicating strategies for treatment, with attendant cost, in the absence of perceptible disease morbidity.  Obesity and physical inactivity, while generally obvious to the patient, require change in lifestyle for successful management; the challenge is to convince the patient to make that change.  Diabetes mellitus is a significant disease requiring complex management strategies for the patient to execute; the challenge is to add cardiovascular risk reduction strategies to the …

Evaluation Of The Reproductive And Developmental Risks Of Caffeine., Robert L Brent, Mildred S Christian, Robert M Diener

Department of Pediatrics Faculty Papers

A risk analysis of in utero caffeine exposure is presented utilizing epidemiological studies and animal studies dealing with congenital malformation, pregnancy loss, and weight reduction. These effects are of interest to teratologists, because animal studies are useful in their evaluation. Many of the epidemiology studies did not evaluate the impact of the "pregnancy signal," which identifies healthy pregnancies and permits investigators to identify subjects with low pregnancy risks. The spontaneous abortion epidemiology studies were inconsistent and the majority did not consider the confounding introduced by not considering the pregnancy signal. The animal studies do not support the concept that caffeine …

An Evaluation Of Hospital Breastfeeding Policies In The Philadelphia Metropolitan Area 1994-2009: A Comparison With The Baby-Friendly Hospital Initiative Ten Steps., Andrea Crivelli-Kovach, Esther K Chung

Department of Pediatrics Faculty Papers

OBJECTIVE: The purpose of this study was to describe current breastfeeding policies and practices among Philadelphia, PA metropolitan hospitals and changes in their policies and practices over time.

METHODS: In-person group interviews were conducted to obtain a composite picture of actual breastfeeding policies and practices. One questionnaire per hospital was completed based on responses from group consensus. Twenty-five hospitals providing maternity care were contacted. Information was obtained from personnel representing different areas of maternity services. Hospitals were classified according to the degree to which they were implementing the Ten Steps to Successful Breastfeeding.

RESULTS: Mean breastfeeding rates at suburban hospitals …

In Vitro Migration Of Cytotoxic T Lymphocyte Derived From A Colon Carcinoma Patient Is Dependent On Ccl2 And Ccr2., Klara Berencsi, Pyapalli Rani, Tianqian Zhang, Laura Gross, Michael Mastrangelo, Neal J Meropol, Dorothee Herlyn, Rajasekharan Somasundaram

Department of Medical Oncology Faculty Papers

BACKGROUND: Infiltration of colorectal carcinomas (CRC) with T-cells has been associated with good prognosis. There are some indications that chemokines could be involved in T-cell infiltration of tumors. Selective modulation of chemokine activity at the tumor site could attract immune cells resulting in tumor growth inhibition. In mouse tumor model systems, gene therapy with chemokines or administration of antibody (Ab)-chemokine fusion proteins have provided potent immune mediated tumor rejection which was mediated by infiltrating T cells at the tumor site. To develop such immunotherapeutic strategies for cancer patients, one must identify chemokines and their receptors involved in T-cell migration toward …

Aging Enhances Serum Cytokine Response But Not Task-Induced Grip Strength Declines In A Rat Model Of Work-Related Musculoskeletal Disorders., Dong L Xin, Michelle Y Harris, Christine K Wade, Mamta Amin, Ann E Barr, Mary F Barbe

Department of Physical Therapy Faculty Papers

BACKGROUND: We previously reported early tissue injury, increased serum and tissue inflammatory cytokines and decreased grip in young rats performing a moderate demand repetitive task. The tissue cytokine response was transient, the serum response and decreased grip were still evident by 8 weeks. Thus, here, we examined their levels at 12 weeks in young rats. Since aging is known to enhance serum cytokine levels, we also examined aged rats.

METHODS: Aged and young rats, 14 mo and 2.5 mo of age at onset, respectfully, were trained 15 min/day for 4 weeks, and then performed a high repetition, low force (HRLF) …

Maternal Health Workforce Shortages In Southeast Pennsylvania, Jacqueline E. Kohl

Master of Public Health Capstone Presentations

Since 1997, 19 maternity wards have closed in Southeastern Pennsylvania, leaving only 23 to serve the women and families in the area.  Additionally, there have been reports of maternal health workforce shortages, causing many women difficulty in accessing the care they need.  This aims of this qualitative study were to define the problem of maternal health workforce shortages in the region and to identify potential solutions.  Ten key stakeholders were identified for participation.  A single researcher conducted interviews using a structured interview guide.  Results were analyzed for content and major themes by two researchers.    The eight sections include: 1. preconception …

Price, Access And Education At Philadelphia Farmers' Markets, Anna M. Quinn

Master of Public Health Capstone Presentations

Inadequate intake of fruits and vegetables is linked to chronic disease and obesity.   However, consumption rates of fruits and vegetables in the US and specifically in Philadelphia continue to fall short of recommendations for a healthy diet.  Access and price are two barriers in the food environment that prevent sufficient fruit and vegetable consumption. Farmers’ markets offer increased access to fruit and vegetables, yet continue to be perceived as being more costly than grocery stores. This study’s primary aim was to determine if the price of fruit and vegetables are more expensive at farmers’ markets than grocery stores in Philadelphia. …

Use Of Internet-Based Diabetes Self-Management Education: Emmi Solutions, Esther Pak

Master of Public Health Capstone Presentations

Diabetes is a serious public health problem in the United States and in Philadelphia. A 2007 CDC report stated that 7.8% in the US and 10.4% in Philadelphia had diabetes. While the key to managing one’s diabetes and lowering the risk of its adverse health outcomes is adherence to diabetes management guidelines, the prevalence of these behaviors among adult diabetics in the US remained relatively low. Attendance at a diabetes self-management class was particularly low (55.4%), which is of concern because of the importance of education in a patient’s adherence to diabetes-maintenance behaviors. Emmi Solutions recently developed three Internet-based diabetes …

Proteomic Assessment Of A Cell Model Of Spinal Muscular Atrophy., Chia-Yen Wu, Dosh Whye, Lisa Glazewski, Leila Choe, Douglas Kerr, Kelvin H Lee, Robert W Mason, Wenlan Wang

Department of Pediatrics Faculty Papers

BACKGROUND: Deletion or mutation(s) of the survival motor neuron 1 (SMN1) gene causes spinal muscular atrophy (SMA), a neuromuscular disease characterized by spinal motor neuron death and muscle paralysis. Complete loss of the SMN protein is embryonically lethal, yet reduced levels of this protein result in selective death of motor neurons. Why motor neurons are specifically targeted by SMN deficiency remains to be determined. In this study, embryonic stem (ES) cells derived from a severe SMA mouse model were differentiated into motor neurons in vitro by addition of retinoic acid and sonic hedgehog agonist. Proteomic and western blot analyses were …

Enhanced Neutralization Potency Of Botulinum Neurotoxin Antibodies Using A Red Blood Cell-Targeting Fusion Protein., Sharad P Adekar, Andrew T Segan, Cindy Chen, Rodney Bermudez, M D Elias, Bernard H Selling, B P Kapadnis, Lance L Simpson, Paul M Simon, Scott K Dessain

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Botulinum neurotoxin (BoNT) potently inhibits cholinergic signaling at the neuromuscular junction. The ideal countermeasures for BoNT exposure are monoclonal antibodies or BoNT antisera, which form BoNT-containing immune complexes that are rapidly cleared from the general circulation. Clearance of opsonized toxins may involve complement receptor-mediated immunoadherence to red blood cells (RBC) in primates or to platelets in rodents. Methods of enhancing immunoadherence of BoNT-specific antibodies may increase their potency in vivo. We designed a novel fusion protein (FP) to link biotinylated molecules to glycophorin A (GPA) on the RBC surface. The FP consists of an scFv specific for murine GPA fused …

Revised Dose Schema Of Sublingual Buprenorphine In The Treatment Of The Neonatal Opioid Abstinence Syndrome., Walter K Kraft, Kevin Dysart, Jay S Greenspan, Eric Gibson, Karol Kaltenbach, Michelle E Ehrlich

Department of Pharmacology and Experimental Therapeutics Faculty Papers

AIMS: More than half of infants exposed to opioids in utero develop neonatal abstinence syndrome (NAS) of severity to require pharmacological therapy. Current treatments are associated with prolonged hospitalization. We sought to optimize the dose of sublingual buprenorphine in the treatment of NAS.

DESIGN: Randomized, Phase 1, open-label, active-control clinical trial comparing sublingual buprenorphine to oral morphine.

SETTING: Large, urban, tertiary care hospital.

PARTICIPANTS: Twenty-four term infants requiring pharmacological treatment for NAS.

MEASUREMENTS: Outcomes were neonatal safety, length of treatment and length of hospitalization.

FINDINGS: Sublingual buprenorphine was safe and effective. Infants treated with buprenorphine had a 23-day length of …