Medicine and Health Sciences Commons^™

An Approach To Faculty Development For Underrepresented Minorities In Medicine., Juan Robles, Tanya Anim, Maria Harsha Wusu, Krys E. Foster, Yury Parra, Octavia Amaechi, Kari-Claudia Allen, Jose E. Rodríguez, Kendall M. Campbell, Dmitry Tumin, Judy Washington

Department of Family & Community Medicine Faculty Papers

OBJECTIVES: The diversity of the US physician workforce lags significantly behind the population, and the disparities in academic medicine are even greater, with underrepresented in medicine (URM) physicians accounting for only 6.8% of all US medical school faculty. We describe a "for URM by URM" pilot approach to faculty development for junior URM Family Medicine physicians that targets unique challenges faced by URM faculty.

METHODS: A year-long fellowship was created for junior URM academic clinician faculty with funding through the Society of Teachers of Family Medicine Project Fund. Seven junior faculty applied and were accepted to participate in the fellowship, …

Efficient Killing Of Tumor Cells By Car-T Cells Requires Greater Number Of Engaged Cars Than Tcrs, Nadia Anikeeva, Sergey Panteleev, Nicholas W Mazzanti, Mizue Terai, Takami Sato, Yuri Sykulev

Department of Microbiology and Immunology Faculty Papers

Although CAR-T cells are widely used to treat cancer, efficiency of CAR-T cell cytolytic responses has not been carefully examined. We engineered CAR specific for HMW-MAA (highmolecular- weight melanoma-associated antigen) and evaluated potency of CD8+ CAR-T cells to release cytolytic granules and to kill tissue-derived melanoma cells, which express different levels of HMW-MAA. CAR-T cells efficiently killed melanoma cells expressing high level of HMW-MAA, but not melanoma cells with lower levels of HMW-MAA. The same melanoma cells presenting significantly lower level of stimulatory peptide- MHC ligand were readily lysed by T cells transduced with genes encoding α,β-TCR specific for the …

The Pnpla3 Rs738409 Variant But Not Mboat7 Rs641738 Is A Risk Factor For Nonalcoholic Fatty Liver Disease In Obese U.S. Children Of Hispanic Ethnicity, Sana Mansoor, Anshu Maheshwari, Matthew D. Di Guglielmo, Katryn Furuya, Makala Wang, Erin Crowgey, Zarela Molle-Rios, Zhaoping He

Department of Pediatrics Faculty Papers

Purpose: The rs641738 C>T in membrane-bound O-acyltransferase domain-containing protein 7 (MBOAT7) is implicated, along with the rs738409 C>G polymorphism in patatin-like phospholipase domain-containing protein 3 (PNPLA3), in nonalcoholic fatty liver disease (NAFLD). The association of these polymorphisms and NAFLD are investigated in Hispanic children with obesity.

Methods: Obese children with and without NAFLD were enrolled at a pediatric tertiary care health system and genotyped for MBOAT7 rs641738 C>T and PNPLA3 rs738409 C>G. NAFLD was characterized by the ultrasonographic presence of hepatic steatosis along with persistently elevated liver enzymes. Genetic variants and demographic and biochemical data were …

Cross-Sectional Analysis Of Baseline Visual Parameters In Subjects Recruited Into The Rescue And Reverse Nd4-Lhon Gene Therapy Studies, Mark Moster, Robert C Sergott, Nancy J Newman, Patrick Yu-Wai-Man, Valerio Carelli, Molly Scannell Bryan, Gerard Smits, Valérie Biousse, Catherine Vignal-Clermont, Thomas Klopstock, Alfredo A Sadun, Adam A. Debusk, Michele Carbonelli, Rabih Hage, Siegfried Priglinger, Rustum Karanjia, Laure Blouin, Magali Taiel, Barrett Katz, José Alain Sahel

Wills Eye Hospital Papers

OBJECTIVE: This report presents a cross-sectional analysis of the baseline characteristics of subjects with Leber hereditary optic neuropathy enrolled in the gene therapy trials RESCUE and REVERSE, to illustrate the evolution of visual parameters over the first year after vision loss.

METHODS: RESCUE and REVERSE were 2 phase III clinical trials designed to assess the efficacy of rAAV2/2-ND4 gene therapy in ND4-LHON subjects. At enrollment, subjects had vision loss for ≤6 months in RESCUE, and between 6 and 12 months in REVERSE. Functional visual parameters (best-corrected visual acuity [BCVA], contrast sensitivity [CS], and Humphrey Visual Field [HVF]) and structural parameters …

Long-Term Follow-Up After Unilateral Intravitreal Gene Therapy For Leber Hereditary Optic Neuropathy: The Restore Study, Valérie Biousse, Nancy J Newman, Patrick Yu-Wai-Man, Valerio Carelli, Mark Moster, Catherine Vignal-Clermont, Thomas Klopstock, Alfredo A Sadun, Robert C Sergott, Rabih Hage, Simona Esposti, Chiara La Morgia, Claudia Priglinger, Rustum Karanja, Laure Blouin, Magali Taiel, José-Alain Sahel

Wills Eye Hospital Papers

BACKGROUND: RESCUE and REVERSE were 2 Phase 3 clinical trials that assessed the efficacy and safety of intravitreal gene therapy with lenadogene nolparvovec (rAAV2/2-ND4) for the treatment of Leber hereditary optic neuropathy (LHON). RESTORE is the long-term follow-up study of subjects treated in the RESCUE and REVERSE trials.

METHODS: In RESCUE and REVERSE, 76 subjects with LHON because of the m.11778 G>A mutation in the mitochondrial gene ND4 received a single unilateral intravitreal injection of lenadogene nolparvovec. After 96 weeks, 61 subjects were enrolled in the long-term follow-up study RESTORE. The best-corrected visual acuity (BCVA) was assessed over a …

Predicting Long-Term Hepatocellular Carcinoma Response To Transarterial Radioembolization Using Contrast-Enhanced Ultrasound: Initial Experiences., Lauren J. Delaney, M. Tantawi, Corinne Wessner, Priscilla Machado, Flemming Forsberg, Andrej Lyshchik, Patrick O'Kane, Ji-Bin Liu, Jesse M. Civan, Alison Tan, Kevin Anton, Colette Shaw, John R. Eisenbrey

Department of Radiology Faculty Papers

Conventional cross-sectional imaging done shortly after radioembolization of hepatocellular carcinoma (HCC) does not reliably predict long-term response to treatment. This study evaluated whether quantitative contrast-enhanced ultrasound (CEUS) can predict the long-term response of HCC to yttrium-90 (Y-90) treatment. Fifteen patients underwent CEUS at three time points: immediately following treatment and 1 and 2 wk post-treatment. Response 3-6 mo after treatment was categorized on contrast-enhanced magnetic resonance imaging by two experienced radiologists using the Modified Response Evaluation Criteria in Solid Tumors. CEUS data were analyzed by quantifying tumor perfusion and residual fractional vascularity using time-intensity curves. Patients with stable disease on …

Aortic Fistulas: Pathophysiologic Features, Imaging Findings, And Diagnostic Pitfalls, Aishwarya Gulati, Md, Harit Kapoor, Md, Achala Donuru, Mbbs, Frcr, Kunal Gala, Mbbs, Dnb, Maansi Parekh, Mbbs, Dnb

Department of Radiology Faculty Papers

Fistulas between the aorta and surrounding organs are extremely rare but can be fatal if they are not identified and treated promptly. Most of these fistulas are associated with a history of trauma or vascular intervention. However, spontaneous aortic fistulas (AoFs) can develop in patients with weakened vasculature, which can be due to advanced atherosclerotic disease, collagen-vascular disease, vasculitides, and/or hematogenous infections. The clinical features of AoFs are often nonspecific, with patients presenting with bleeding manifestations, back or abdominal pain, fever, and shock. Confirmation with invasive endoscopy is often impractical in the acute setting. Imaging plays an important role in …

A Review Of Fixed Drug Eruption With A Special Focus On Generalized Bullous Fixed Drug Eruption., Hannah J. Anderson, Jason B. Lee, Md

Department of Dermatology and Cutaneous Biology Faculty Papers

Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the onset of rash at a fixed location on the body each time a specific medication is ingested. With each recurrence, the eruption can involve additional sites. Lesions can have overlying vesicles and/or bullae, and when they cover a significant percentage of body surface area, the eruption is referred to as generalized bullous fixed drug eruption (GBFDE). Due to the widespread skin denudation that can be seen in this condition, GBFDE may be confused clinically with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). While treatments described for GBFDE include supportive …

Neutrophil-Rich, Noncollagenous 16a Domain-Negative Bullous Pemphigoid Associated With Psoriasis, Morgan E Sussman, Shoshana K Grossman, Sylvia Hsu, Jason B. Lee, Kiran Motaparthi

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Reversing The Effects Of Androgen-Deprivation Therapy In Men With Metastatic Castration-Resistant Prostate Cancer, Catherine H Marshall, Jessa Tunacao, Varun Danda, Hua-Ling Tsai, John Barber, Rakhee Gawande, Clifford R Weiss, Samuel R Denmeade, Corinne Joshu

Department of Medical Oncology Faculty Papers

OBJECTIVE: To investigate whether bipolar androgen therapy (BAT), involving rapid cyclic administration of high-dose testosterone, as a novel treatment for metastatic castration-resistant prostate cancer (mCRPC) promotes improvements in body composition and associated improvements in lipid profiles and quality of life.

PATIENTS AND METHODS: Men from two completed trials with computed tomography imaging at baseline and after three cycles of BAT were included. Cross-sectional areas of psoas muscle, visceral and subcutaneous fat were measured at the L3 vertebral level. Functional Assessment of Chronic Illness Therapy - Fatigue questionnaire and 36-item short-form health survey were used to assess quality of life.

RESULTS: …

Highlighting A Curricular Need: Uncertainty, Covid-19, And Health Systems Science., Dimitrios Papanagnou, Rebecca Jaffe, Deborah Ziring

Department of Medicine Faculty Papers

No abstract provided.

Restrictive Versus Liberal Transfusion Thresholds In Very Low Birth Weight Infants: A Systematic Review With Meta-Analysis, Peng Wang, Xing Wang, Haidong Deng, Linjie Li, Weelic Chong, Yang Hai, Yu Zhang

Department of Medicine Faculty Papers

BACKGROUND: To assess the efficacy and safety of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight infants.

METHODS: We searched MEDLINE, EMBASE, and Cochrane database without any language restrictions. The last search was conducted in August 15, 2020. All randomized controlled trials comparing the use of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight (VLBW) infants were selected. Pooled risk ratio (RR) for dichotomous variable with 95% confidence intervals were assessed by a random-effects model. The primary outcome was all-cause mortality.

RESULTS: Overall, this meta-analysis included 6 randomized controlled trials …

Towards A Medical School Curriculum For Uncertainty In Clinical Practice, Dimitrios Papanagnou, Nethra S. Ankam, David Ebbott, Deborah Ziring

Department of Emergency Medicine Faculty Papers

Uncertainty abounds in the clinical environment. Medical students, however, are not explicitly prepared for situations of uncertainty in clinical practice, which can cause anxiety and impact well-being. To address this gap, we sought to capture how students felt in various clinical scenarios and identify programs they found helpful as they worked through uncertainty in their clerkships to better inform curriculum that prepares them to acknowledge and navigate this uncertainty. This is an observational cross-sectional study of third-year medical students surveyed at the end of core clerkships. The survey consisted of the General Self-Efficacy (GSE) Scale and Intolerance of Uncertainty Scale …

Glycosaminoglycans As Biomarkers For Mucopolysaccharidoses And Other Disorders, Paige Amendum, Shaukat Khan, Seiji Yamaguchi, Hironori Kobayashi, Yasuhiko Ago, Yasuyuki Suzuki, Betul Celik, Estera Rintz, Jobayer Hossain, Wendi Xiao, Shunji Tomatsu

Department of Pediatrics Faculty Papers

Glycosaminoglycans (GAGs) are present in proteoglycans, which play critical physiological roles in various tissues. They are known to be elevated in mucopolysaccharidoses (MPS), a group of rare inherited metabolic diseases in which the lysosomal enzyme required to break down one or more GAG is deficient. In a previous study, we found elevation of GAGs in a subset of patients without MPS. In the current study, we aim to investigate serum GAG levels in patients with conditions beyond MPS. In our investigated samples, the largest group of patients had a clinical diagnosis of viral or non-viral encephalopathy. Clinical diagnoses and conditions …

Potential Immunomodulatory Properties Of Biologically Active Components Of Spices Against Sars-Cov-2 And Pan Β-Coronaviruses, Sourodip Sengupta, Debina Bhattacharyya, Grishma Kasle, Souvik Karmakar, Omkar Sahu, Anirban Ganguly, Sankar Addya, Jayasri Das Sarma

Kimmel Cancer Center Faculty Papers

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced COVID-19 has emerged as a defining global health crisis in current times. Data from the World Health Organization shows demographic variations in COVID-19 severity and lethality. Diet may play a significant role in providing beneficial host cell factors contributing to immunity against deadly SARS-CoV-2 pathogenesis. Spices are essential components of the diet that possess anti-inflammatory, antioxidant, and antiviral properties. Hyperinflammation, an aberrant systemic inflammation associated with pneumonia, acute respiratory failure, and multiorgan dysfunction, is a major clinical outcome in COVID-19. Knowing the beneficial properties of spices, we hypothesize that spice-derived bioactive components …

Multiple Autonomous Cell Death Suppression Strategies Ensure Cytomegalovirus Fitness, Pratyusha Mandal, Lynsey Nagrani, Liliana Hernandez, Anita Louise Mccormick, Christopher Dillon, Heather Koehler, Linda Roback, Emad S Alnemri, Douglas Green, Edward Mocarski

Department of Biochemistry and Molecular Biology Faculty Papers

Programmed cell death pathways eliminate infected cells and regulate infection-associated inflammation during pathogen invasion. Cytomegaloviruses encode several distinct suppressors that block intrinsic apoptosis, extrinsic apoptosis, and necroptosis, pathways that impact pathogenesis of this ubiquitous herpesvirus. Here, we expanded the understanding of three cell autonomous suppression mechanisms on which murine cytomegalovirus relies: (i) M38.5-encoded viral mitochon-drial inhibitor of apoptosis (vMIA), a BAX suppressor that functions in concert with M41.1-encoded viral inhibitor of BAK oligomerization (vIBO), (ii) M36-encoded viral inhibitor of caspase-8 activation (vICA), and (iii) M45-encoded viral inhibitor of RIP/RHIM activation (vIRA). Following infection of bone marrow-derived macrophages, the virus initially …

Management And Diagnosis Of Hypothyroidism, Catherine Guariglia, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Goals

• Recognize the different etiologies of hypothyroidism
• Identify signs and symptoms of hypothyroidism
• Feel comfortable diagnosing and treating primary hypothyroidism
• Define subclinical hypothyroidism and when/if it is necessary to treat
• Recognize how pregnancy influences hypothyroidism management
• Be able to counsel patients on treatment for hypothyroidism

A Cancer Ubiquitome Landscape Identifies Metabolic Reprogramming As Target Of Parkin Tumor Suppression, Ekta Agarwal, Aaron R Goldman, Hsin-Yao Tang, Andrew V Kossenkov, Jagadish C Ghosh, Lucia Languino, Valentina Vaira, David W Speicher, Dario C Altieri

Department of Cancer Biology Faculty Papers

Changes in metabolism that affect mitochondrial and glycolytic networks are hallmarks of cancer, but their impact in disease is still elusive. Using global proteomics and ubiquitome screens, we now show that Parkin, an E3 ubiquitin ligase and key effector of mitophagy altered in Parkinson's disease, shuts off mitochondrial dynamics and inhibits the non-oxidative phase of the pentose phosphate pathway. This blocks tumor cell movements, creates metabolic and oxidative stress, and inhibits primary and metastatic tumor growth. Uniformly down-regulated in cancer patients, Parkin tumor suppression requires its E3 ligase function, is reversed by antioxidants, and is independent of mitophagy. These data …

A Retrospective Cohort Study Of Myosteatosis And Quality Of Life In Head And Neck Cancer Patients., Amy L Shaver, Katia Noyes, Heather M Ochs-Balcom, Gregory Wilding, Andrew D Ray, Sung Jun Ma, Mark Farrugia, Anurag K Singh, Mary E Platek

Department of Medical Oncology Faculty Papers

Head and neck cancer (HNC) treatment-related morbidity can be detrimental to quality of life (QOL). Myosteatosis is associated with poor QOL in multiple cancers. If predictive of poor QOL trajectories, myosteatosis would be a tool for clinicians to determine which patients may require additional support during treatment. The purpose of this study was to determine if pretreatment myosteatosis is associated with a poor QOL trajectory following treatment completion.

METHODS: In a retrospective cohort design, myosteatosis was determined from pretreatment CT scans. Both physical and global QOL score was assessed through patient interview on follow-up appointment. Demographic, cancer-specific, and social covariates …

Intravitreal Dexamethasone Implants For Refractory Macular Edema In Eyes With Noninfectious Uveitis., Eugene Yu-Chuan Kang, Sunir Garg, Hsi-Fu Chen, Wei-Chi Wu, Linda Yi-Hsing Chen, Hung-Da Chou, Laura Liu, Kuan-Jen Chen, Yih-Shiou Hwang

Wills Eye Hospital Papers

Macular edema (ME) is a common cause of visual loss among eyes with uveitis, and its management can be challenging. Steroids are an effective treatment for ME, and intravitreal dexamethasone (DEX) implants provide sustained steroid release. The purpose of this study is to evaluate intravitreal DEX implant on refractory ME in eyes with noninfectious uveitis. A retrospective study including 52 eyes of 37 patients with refractory uveitic ME was conducted from January 2011 through August 2017 at Linkou Chang Gung Memorial Hospital in Taiwan. Patients' demographic characteristics were collected. In addition, clinical information, including corrected visual acuity (VA), intraocular pressure …

Theta-Burst Stimulation Entrains Frequency-Specific Oscillatory Responses., Ethan A. Solomon, Michael R. Sperling, Ashwini D. Sharan, Paul A. Wanda, Deborah F. Levy, Anastasia Lyalenko, Isaac Pedisich, Daniel S. Rizzuto, Michael J. Kahana

Department of Neurology Faculty Papers

BACKGROUND: Brain stimulation has emerged as a powerful tool in human neuroscience, becoming integral to next-generation psychiatric and neurologic therapeutics. Theta-burst stimulation (TBS), in which electrical pulses are delivered in rhythmic bouts of 3-8 Hz, seeks to recapitulate neural activity seen endogenously during cognitive tasks. A growing literature suggests that TBS can be used to alter or enhance cognitive processes, but little is known about how these stimulation events influence underlying neural activity.

OBJECTIVE: Our study sought to investigate the effect of direct electrical TBS on mesoscale neural activity in humans by asking (1) whether TBS evokes persistent theta oscillations …

Meet An Ipe Student Champion From Thomas Jefferson University, Emily Romano

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

I had the opportunity to be involved with JCIPE even before I was a Jefferson student! I spent a year working at the Camden Coalition and got to assist with analyzing Student Hotspotting (SH) surveys. After coming to SKMC, I participated in the Health Mentors program in my first and second years and then went on to join an SH team during my third year. I got to serve as an alumni advisor for an SH team the following year and have since been working on a qualitative study of the SH process with an interprofessional team representing occupational therapy, …

Accelerating Interprofessional Trailblazing, Ivy Felicidad Oandasan, Md, Mhsc, Ccfp, Fcfp

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

After the JCIPE conference, our co-director, Dr. Brooke Salzman, sat down with Dr. Ivy Oandasan to learn more about her and her work. We highlight some of the conversation with Dr. Oandasan, a leader in IPE based in Canada.

Meet An Ipe Faculty Champion From Thomas Jefferson University, Emily Scopelliti, Pharmd, Bcps

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

I proudly work with JCIPE as a facilitator for Introductory and Advanced TeamSAFE programs and as an advisor for the Hotspotting program. In these roles, I work with students to strengthen communication skills and teamwork to promote patient safety as well as provide guidance for an interprofessional student team as they navigate the healthcare system and community resources to assist patients with complex health and social needs.

Meet An Ipe Student Champion From Thomas Jefferson University, Krista Garrison

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

From Fall 2019 - January 2021, I had the opportunity to be a graduate assistant (GA) for JCIPE. This experience gave me the opportunity to be involved in a variety of programs. My main projects included working with Team Care Planning, the TeamSAFE program and mainly Hotspotting. My work with Team Care Planning involved analyzing and preparing data from previous sessions.

The Clarion Case Competition, Jordan Mak, Cat-Trinh Phan, Francesca Girone, Mary Lloyd

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Hosted by the Center for Health Interprofessional Programs, University of Minnesota, the CLARION National Interprofessional Case Competition is designed to give healthcare students an interprofessional teamwork experience. In 2021, JCIPE sent a strong team consisting of two pharmacy students, Jordan Mak & Cat-Trinh Phan, and two nursing students, Francesca Girone & Mary Lloyd, to represent Jefferson. Our team successfully developed an innovative solution proposal to build a better healthcare system by conducting a root-cause analysis of a fictionalized event. Over the course of the project, our team formed a strong relationship, which culminated in a presentation and a …

How Structural Competency Can Help Dismantle Structural Racism, Peter S. Cahn, Phd

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

In the case of Mr. Sinclair, any proponent of interprofessional collaborative practice could identify lapses in team performance. Failures in communication prevented crucial information from reaching the appropriate health professionals. Some members of the hospital staff may not have fully understood the scope of their and their colleagues' roles. Fellow patients exhibited more respect for Mr. Sinclair's dignity than the clinicians who encountered Mr. Sinclair.

Jcipe Update

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

JCIPE Update

From The Editors

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

When last we wrote, we were just beginning to reflect on the global upheaval encapsulated in the COVID-19 pandemic and the new urgency to confront systemic racism. Some areas of the world have emerged from COVID-19 lockdowns while others are battling new variants with catastrophic consequences. The disparities in vaccine distribution continue to be an urgent problem, along with vaccine hesitancy, building trust between patients and the healthcare system, and establishing access to healthcare for underserved populations. So, while we may be nearing the end of the COVID-19 pandemic, there is much work to be done to tackle the complexities …

Collaborative Healthcare: Interprofessional Practice, Education And Evaluation (Jcipe), Volume 12, Number 1, Spring/Summer 2021

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

In this Issue

1 - Letter from the Editors

2 - JCIPE Update

3 - How Structural Competency Can Help Dismantle Structural Racism

5 - The Clarion Case Competition

6 - Meet an IPE Student Champion from Thomas Jefferson University

7 - Teamwork (Really Does) Make the Dream Work! Lessons Learned from Implementing Citywide Infrastructure with Interdisciplinary Teams

8 - Meet an IPE Faculty Champion from Thomas Jefferson University

8 - Accelerating Interprofessional Trailblazing

8 - Meet an IPE Student Champion from Thomas Jefferson University

11 - 2021 James B. Erdmann Award Recipients