Medicine and Health Sciences Commons^™

Ocular Safety Of Repeated Intravitreal Injections Of Carboplatin And Digoxin: A Preclinical Study On The Healthy Rabbits., Alireza Khodabande, Fariba Ghassemi, Fahimeh Asadi Amoli, Hamid Riazi-Esfahani, Raziyeh Mahmoudzadeh, Mohammad Mehrpour, Niloufar Valipour

Wills Eye Hospital Papers

To evaluate the ocular safety of intravitreal carboplatin and digoxin injections as a new intravitreal chemotherapy option for retinoblastoma tumor vitreous seeds. Eighteen rabbits were divided randomly into three groups to receive intravitreal injection of Digoxin (6 rabbits), Carboplatin (7 rabbits), or Saline (5 rabbits). In every group, one eye randomly treated with 10 µg Digoxin in 0.1 cc or 1 µg Carboplatin or Saline, and the contralateral eye was considered as the control. All groups underwent three consecutive injections of the drugs with 1-week intervals. Baseline electroretinography (ERG) was recorded from both eyes of all the animals prior to …

Data From Emergency Medicine Palliative Care Access (Empalla): A Randomized Controlled Trial Comparing The Effectiveness Of Specialty Outpatient Versus Telephonic Palliative Care Of Older Adults With Advanced Illness Presenting To The Emergency Department., Abigail M. Schmucker, Mara Flannery, Jeanne Cho, Keith S. Goldfeld, Corita Grudzen, Empalla Investigators

Student Papers, Posters & Projects

BACKGROUND: The Emergency Medicine Palliative Care Access (EMPallA) trial is a large, multicenter, parallel, two-arm randomized controlled trial in emergency department (ED) patients comparing two models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. This report aims to: 1) report baseline demographic and quality of life (QOL) data for the EMPallA cohort, 2) identify the association between illness type and baseline QOL while controlling for other factors, and 3) explore baseline relationships between illness type, symptom burden, and loneliness.

METHODS: Patients aged 50+ years with advanced cancer (metastatic solid tumor) or end-stage organ failure (New York …

Erratum To: Characterizing Benefit From Temozolomide In Mgmt Promoter Unmethylated And Methylated Glioblastoma: A Systematic Review And Meta-Analysis, Iyad Alnahhas, Mouaz Alsawas, Appaji Rayi, Joshua D Palmer, Raju Raval, Shirley Ong, Pierre Giglio, Mohammad Hassan Murad, Vinay Puduvalli

Department of Neurology Faculty Papers

[This corrects the article DOI: 10.1093/noajnl/vdaa082.].

The Evolution Of Breast Imaging, Susanna M. Nazarian, Md, Phd, Facs

Department of Family & Community Medicine Presentations and Grand Rounds

Overview

• A brief overview of the evolution of breast imaging
• Screening and Detection versus Intraoperative Guidance
• Emerging technologies
• Local research opportunities

Phase 1 Study Of Safety, Tolerability And Immunogenicity Of The Human Telomerase (Htert)-Encoded Dna Plasmids Ino-1400 And Ino-1401 With Or Without Il-12 Dna Plasmid Ino-9012 In Adult Patients With Solid Tumors, Robert H Vonderheide, Kimberly A Kraynyak, Anthony F Shields, Autumn J Mcree, Jennifer Johnson, Weijing Sun, Ashish V Chintakuntlawar, Jan Pawlicki, Albert J Sylvester, Trevor Mcmullan, Robert Samuels, Joseph J Kim, David Weiner, Jean D Boyer, Matthew P Morrow, Laurent Humeau, Jeffrey M Skolnik

Department of Medical Oncology Faculty Papers

BACKGROUND: Human telomerase reverse transcriptase (hTERT) is frequently classified as a 'universal' tumor associated antigen due to its expression in a vast number of cancers. We evaluated plasmid DNA-encoded hTERT as an immunotherapy across nine cancer types.

METHODS: A phase 1 clinical trial was conducted in adult patients with no evidence of disease following definitive surgery and standard therapy, who were at high risk of relapse. Plasmid DNA encoding one of two hTERT variants (INO-1400 or INO-1401) with or without plasmid DNA encoding interleukin 12 (IL-12) (INO-9012) was delivered intramuscularly concurrent with the application of the CELLECTRA constant-current electroporation device …

Rapidly Progressive Acth-Dependent Cushing’S Disease Masquerading As Ectopic Acth-Producing Cushing’S Syndrome: Illustrative Case, Siyuan Yu, Michael Karsy, Jeffery Miller, Stephanie R. Beldick, Mark T. Curtis, Marc Rosen, James J. Evans

Department of Neurosurgery Faculty Papers

BACKGROUND Cushing’s disease (CD) remains a challenging condition to diagnose and treat. This case study highlights the challenges of diagnosing CDwhen faced with discrepant clinical, biochemical, and radiologicalfindings.

OBSERVATIONS A 62-year-old man presented with rapid evolution of symptoms, including depression, fatigue, and extreme muscle atrophy, whichresulted in the patient being a wheelchair user over the course of a few months. His rapid clinical course in conjunction with hypercortisolemia in thesetting of a pituitary macroadenoma involving the cavernous sinus, two large pulmonary nodules, and urine-free cortisol levels in the thousandssuggested an aggressive ectopic adrenocorticotropic hormone (ACTH) source. After extensive testing ruled …

Comparison Of Lethal And Nonlethal Mouse Models Of Orientia Tsutsugamushi Infection Reveals T-Cell Population-Associated Cytokine Signatures Correlated With Lethality And Protection, Alison Luce-Fedrow, Suchismita Chattopadhyay, Teik-Chye Chan, Gregory Pearson, John B. Patton, Allen L. Richards

Department of Microbiology and Immunology Faculty Papers

The antigenic diversity of Orientia tsutsugamushi as well as the interstrain difference(s) associated with virulence in mice impose the necessity to dissect the host immune response. In this study we compared the host response in lethal and non-lethal murine models of O. tsutsugamushi infection using the two strains, Karp (New Guinea) and Woods (Australia). The models included the lethal model: Karp intraperitoneal (IP) challenge; and the nonlethal models: Karp intradermal (ID), Woods IP, and Woods ID challenges. We monitored bacterial trafficking to the liver, lung, spleen, kidney, heart, and blood, and seroconversion during the 21-day challenge. Bacterial trafficking to all …

Promoting Healthy Transitions: Occupational Therapy Interventions For Health Management Of Homeless Populations Discharging From Health Care Settings, Dominic Carullo, Hana Chamoun, Alison Mcandrew, Brian O'Sullivan, Chelsea Pierce

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives
By the end of this presentation, participants will be able to

• Identify the need for effective interventions to create better connections to health services and facilitate health management skills in individuals experiencing homelessness prior to discharge from a healthcare setting
• Recognize the potential for occupational therapists to increase health literacy and the development of self-directed health management skills for individuals experiencing homelessness prior to hospital discharge
• Apply components of an evidence-based, best practice approach to promote the development of healthy behaviors and health management skills in individuals experiencing homelessness

PICO Question
What interventions within the scope of occupational therapy …

Jefferson Digital Commons Quarterly Report: April-June 2021, Kelsey Duinkerken, Msi, Larissa Gordon, Mslis, Med, Ma

Jefferson Digital Commons Reports

This quarterly report includes:

• Articles
• CREATE Day Capstone Projects
• Department of Surgery Resident Research Day
• Dissertations
• Grand Rounds and Lectures
• House Staff Quality Improvement and Patient Safety Conference
• JCPH Capstone Presentations
• Journals and Newsletters
• Know Diabetes by Heart Meetings
• MPH Course Projects
• Occupational Therapy Doctorate Capstones
• Posters and Conference Presentations:
• Promotional Video
• Scholarly Inquiry Abstracts
• What People are Saying About the Jefferson Digital Commons

Parent-Infant Bond: The Connection Between Parents And Infants In The Nicu, Megan Casselberry, Anita Fagotti, Ava Gambucci, Emma Sardinskas, Carly Scheiner

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives

• Define the challenges of parent-infant relations in the neonatal intensive care unit (NICU) setting
• Discuss the role of occupational therapy in fostering parent-infant bonding in the NICU
• Interpret evidence-based interventions within the scope of occupational therapy practice to promote familial relations and social interactions amongst infants and parents

PICO Question
For infants in the NICU, what are evidence-based interventions within the scope of occupational therapy that increase parent-infant bonding?

Occupational Balance For A Better Mood: Occupational Therapy’S Role In Treating Excessive Technology Use In Youth, Emily Danilak, Jenna Higginbotham, Kara Leaman, Tarryn Slattery, Katie Virostek

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives

• Understand the implications of excessive screen time on mental health and its pertinence to youth’s leisure time spent in the virtual environment.
• Identify the distinct role that occupational therapy has in addressing mental health needs in children.
• Analyze the current evidence for effective occupational therapy interventions targeting improved mental health in youth with unhealthy internet habits.

PICO Question
In children with excessive screen time, what interventions within the scope of occupational therapy practice improve mental health?

Promoting Social Participation For Young Individuals Following Concussion, Umara Iftikhar, Ann Claire Macalintal, Madeline Rea, Allizey Shields

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives

1. Understand the relevance of anxiety and depression amongst young individuals following the onset of a concussion or post-concussive symptoms.
2. Recognize the distinct value of occupational therapy in promoting social skills to enhance relationships and mitigate feelings of isolation for persons with concussive symptoms.
3. Develop evidence-based interventions within the scope of occupational therapy for young individuals experiencing anxiety and depression following diagnosis of a concussion.

PICO Question
Amongst individuals, ages 13-25, experiencing symptoms of anxiety and depression following concussion, what interventions within the scope of Occupational Therapy will increase social participation?

Concussion And Class: Returning To College After A Mild Traumatic Brain Injury (Mtbi), Andrew Friedman, Gabrielle Khalifa, Rebecca Smith, Emily Strickberger

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives

• Identify how concussion management to increase academic function falls within the scope of occupational therapy practice
• Describe effective concussion protocols and timelines as they apply to students’ recovery from mTBI and return to academics.
• Apply evidence based practice to treatment plans for patients post-concussion or mTBI injury returning to academics.

PICO Question
In college-aged adults that experienced a concussion, what are effective interventions within the scope of occupational therapy for return to university?

Delirium In The Acute Care Setting: Occupational Therapy’S Role In Delirium Management And Prevention, Regina Antoni, Grace Gaus, Kathleen Greaney, Marisa Ortiz-Brazak

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives

• Explain delirium and its prevalence in the hospital setting
• Identify the role of occupational therapy in treatment of acute care patients with delirium
• Apply evidence-based interventions that address and prevent delirium in the acute care setting

PICO Question
What is the role of occupational therapy in delirium management for patients in the acute care setting?

Gender Disparity In Evaluation Of Internal Medicine Clerkship Performance., Deborah J. Gorth, Rogan G. Magee, Sarah E. Rosenberg, Nina Mingioni

Department of Medicine Faculty Papers

Importance: Women studying medicine currently equal men in number, but evidence suggests that men and women might not be evaluated equally throughout their education.

Objective: To examine whether there are differences associated with gender in either objective or subjective evaluations of medical students in an internal medicine clerkship.

Design, Setting, and Participants: This single-center retrospective cohort study evaluated data from 277 third-year medical students completing internal medicine clerkships in the 2017 to 2018 academic year at an academic hospital and its affiliates in Pennsylvania. Data were analyzed from September to November 2020.

Exposure: Gender, presumed based on pronouns used in …

Value-Based Focused Global Population Health Management, John F. Gibbs, Ashley Newman, Richard G. Stefanacci Do,Mgh,Mba,Agsf,Cmd

College of Population Health Faculty Papers

In 2018, approximately 18 million people worldwide were diagnosed with cancer and are predicted to double by 2040. The global quality chasm in improving health care worldwide requires “systems thinking” as the key to success. Aligning the goal around person-centered care captures the total needs of care of a population and not just disease categories. The integration of the Institute of Medicine’s (IOM) six aims of quality termed “value-based focused” and population health management (PHM) provides all health care leaders grappling with improving the health care of the populations a framework for the communities they serve. In this context, the …

Value-Based Chronic Care Model Approach For Vulnerable Older Patients With Multiple Chronic Conditions, John F. Gibbs, Ellen Guarnieri, Quyen D. Chu, Kenneth Murdoch, Arif Asif

College of Population Health Faculty Papers

“Old age, itself, is not a disease” (Suborne 2007). The rising rate of the global aging population is predicted to create a health care crisis within the next three decades. Vulnerable older adults suffer from multiple chronic conditions (MCCs) in addition to cognitive and physical decline during the process of aging resulting in an inability to optimally achieve self-management. In terms of resource utilization, complex inpatient, and outpatient care results in higher physician visits, polypharmacy, and higher prescription costs. Health literacy has become known as an important social determinant of health affecting the older population. Both reductions in health literacy …

Image Segmentation For Neuroscience: Lymphatics, Nazia Tabassum, Jie Wang, Michael Ferguson, Jasmin Herz, Michael Dong, Antoine Louveau, Jonathan Kipnis, Scott Thomas Acton

Division of Internal Medicine Faculty Papers & Presentations

A recent discovery in neuroscience prompts the need for innovation in image analysis. Neuroscientists have discovered the existence of meningeal lymphatic vessels in the brain and have shown their importance in preventing cognitive decline in mouse models of Alzheimer s disease. With age, lymphatic vessels narrow and poorly drain cerebrospinal fluid, leading to plaque accumulation, a marker for Alzheimer s disease. The detection of vessel boundaries and width are performed by hand in current practice and thereby suffer from high error rates and potential observer bias. The existing vessel segmentation methods are dependent on user-defined initialization, which is time-consuming and …

An Educational Workshop To Improve Neurology Resident Understanding Of Burnout, Substance Abuse, And Mood Disorders., Ryan Donaghy, Shiori Tomatsu, Patrick Kerns, Courtney White, Jeffrey Ratliff

Department of Neurology Faculty Papers

Introduction: Burnout, substance abuse, and mood disorders are prevalent among neurology residents. Increased recognition of concerning behaviors might encourage more access to mental health resources and reduce burnout.

Methods: We created an educational resource reviewing burnout, substance abuse, and mood disorders for neurology residents. This resource included an online module (control) and a role-play scenario offered only to one cohort (intervention). Online surveys assessed knowledge as well as confidence in the ability to recognize concerning behaviors. A practical assessment using a previously published "Stressed Resident" video was also conducted among resident cohorts.

Results: Of neurology residents, 18 participated in the …

Leveraging Big Data For Pattern Recognition Of Socio-Demographic And Climatic Factors In Correlation With Eye Disorders In Telangana State, India, Amna Alalawi, Les Sztandera, Parth Lalakia, Anthony Vipin Das, Sai Prashanthi Gumpili, Richard Derman

Kanbar College Faculty Papers

Purpose: Big data is the new gold, especially in health care. Advances in collecting and processing electronic medical records (EMR) coupled with increasing computer capabilities have resulted in an increased interest in the use of big data in health care. Ophthalmology has been an area of focus where results have shown to be promising. The objective of this study was to determine whether the EMR at a multi-tier ophthalmology network in India can contribute to the management of patient care, through studying how climatic and socio-demographic factors relate to eye disorders and visual impairment in the State of Telangana.

Methods: …

Preoperative Immunotherapy In The Multidisciplinary Management Of Oral Cavity Cancer., Ramez Philips, Md, Chihun Han, Brian Swendseid, Md, Joseph Curry, Athanassios Argiris, Adam Luginbuhl, Jennifer Johnson, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Despite advances in multimodal treatment for oral cavity squamous cell carcinoma, recurrence rates remain high, providing an opportunity for new therapeutic modalities that may improve oncologic outcomes. Much recent attention has been paid to the molecular interactions between the tumor cells with the adjacent peritumoral microenvironment, in which immunosuppressive molecular changes create a landscape that promotes tumor progression. The rationale for the introduction of immunotherapy is to reverse the balance of these immune interactions in a way that utilizes the host immune system to attack tumor cells. In the preoperative setting, immunotherapy has the advantage of priming the unresected tumor …

Isomirmap-Fast, Deterministic, And Exhaustive Mining Of Isomirs From Short Rna-Seq Datasets., Phillipe Loher, Nestoras Karathanasis, Eric R Londin, Paul Bray, Venetia Pliatsika, Aristeidis G. Telonis, Isidore Rigoutsos

Computational Medicine Center Faculty Papers

MOTIVATION: MicroRNA (miRNA) precursor arms give rise to multiple isoforms simultaneously called "isomiRs." IsomiRs from the same arm typically differ by a few nucleotides at either their 5´ or 3´ termini, or both. In humans, the identities and abundances of isomiRs depend on a person's sex, population of origin, race/ethnicity, and on tissue type, tissue state, and disease type/subtype. Moreover, nearly half of the time the most abundant isomiR differs from the miRNA sequence found in public databases. Accurate mining of isomiRs from deep sequencing data is thus important.

RESULTS: We developed isoMiRmap, a fast, standalone, user-friendly mining tool that …

Ten-Year Outcomes Of Uveal Melanoma Based On The Cancer Genome Atlas (Tcga) Classification In 1001 Cases., Carol L Shields, Eileen Mayro, Zeynep Bas, Philip W Dockery, Antonio Yaghy, Sara E. Lally, Arupa Ganguly, Jerry A Shields

Wills Eye Hospital Papers

Purpose: To understand the prognostic value of The Cancer Genome Atlas (TCGA) for uveal melanoma metastasis, using a simplified 4-category classification, based on tumor DNA.

Methods: A retrospective cohort study of 1001 eyes with uveal melanoma at a single center, categorized according to TCGA as Group A, B, C, or D (by fine-needle aspiration biopsy for DNA analysis), and treated with standard methods, was studied for melanoma-related metastasis at 5 and 10 years.

Results: Of 1001 eyes with uveal melanoma, the TCGA categories included Group A (n = 486, 49%), B (n = 141, 14%), C (n = 260, 26%), …

Analysis Of The Dna-Binding Properties Of Alx1, An Evolutionarily Conserved Regulator Of Skeletogenesis In Echinoderms, Jennifer Guerrero-Santoro, Jian Ming Khor, Ayşe Haruka Açıkbaş, James B. Jaynes, Charles A Ettensohn

Department of Biochemistry and Molecular Biology Faculty Papers

Alx1, a homeodomain-containing transcription factor, is a highly conserved regulator of skeletogenesis in echinoderms. In sea urchins, Alx1 plays a central role in the differentiation of embryonic primary mesenchyme cells (PMCs) and positively regulates the transcription of most biomineralization genes expressed by these cells. The alx1 gene arose via duplication and acquired a skeletogenic function distinct from its paralog (alx4) through the exonization of a 41-amino acid motif (the D2 domain). Alx1 and Alx4 contain glutamine-50 paired-type homeodomains, which interact preferentially with palindromic binding sites in vitro. Chromatin immunoprecipitation sequencing (ChIP-seq) studies have shown, however, that Alx1 binds both to …

A Machine Learning Approach To First Pass Reperfusion In Mechanical Thrombectomy: Prediction And Feature Analysis., Lohit Velagapudi, Nikolaos Mouchtouris, Richard F Schmidt, David Vuong, Omaditya Khanna, Ahmad Sweid, Bryan Sadler, Fadi Al-Saiegh, M Reid Gooch, Pascal Jabbour, Robert H Rosenwasser, Stavropoula Tjoumakaris

Department of Neurosurgery Faculty Papers

INTRODUCTION: Novel machine learning (ML) methods are being investigated across medicine for their predictive capabilities while boasting increased adaptability and generalizability. In our study, we compare logistic regression with machine learning for feature importance analysis and prediction in first-pass reperfusion.

METHODS: We retrospectively identified cases of ischemic stroke treated with mechanical thrombectomy (MT) at our institution from 2012-2018. Significant variables used in predictive modeling were demographic characteristics, medical history, admission NIHSS, and stroke characteristics. Outcome was binarized TICI on first pass (0-2a vs 2b-3). Shapley feature importance plots were used to identify variables that strongly affected outcomes.

RESULTS: Accuracy for …

Discrepancies In Stroke Distribution And Dataset Origin In Machine Learning For Stroke., Lohit Velagapudi, Nikolaos Mouchtouris, Michael P Baldassari, David Nauheim, Omaditya Khanna, Fadi Al Saiegh, Nabeel Herial, M Reid Gooch, Stavropoula Tjoumakaris, Robert H Rosenwasser, Pascal Jabbour

Department of Neurosurgery Faculty Papers

BACKGROUND: Machine learning algorithms depend on accurate and representative datasets for training in order to become valuable clinical tools that are widely generalizable to a varied population. We aim to conduct a review of machine learning uses in stroke literature to assess the geographic distribution of datasets and patient cohorts used to train these models and compare them to stroke distribution to evaluate for disparities.

AIMS: 582 studies were identified on initial searching of the PubMed database. Of these studies, 106 full texts were assessed after title and abstract screening which resulted in 489 papers excluded. Of these 106 studies, …

Closing Gaps In The Care Of Patients With Heart-Kidney Disease: The Time Is Now., Janani Rangaswami

Department of Medicine Faculty Papers

No abstract present.

An Investigation Of A Novel Dural Repair Device For Intraoperative Incidental Durotomy Repair., Kartik Shenoy, Chester J. Donnally, Evan D. Sheha, Krishn Khanna, Srinivas K. Prasad

Rothman Institute Papers

Incidental durotomies, or dural tears, can be very difficult and time consuming to repair properly when they are encountered in confined spaces. A novel dural repair device was developed to address these situations. In this paper, the novel device was assessed against the use of traditional tools and techniques for dural repairs in two independent studies using an intricate clinical simulation model. The aim was to examine the results of the two assessments and link the outcomes to the clinical use of the novel device in the operating room. The novel device outperformed conventional techniques as measured by dural repair …

Autophagy, Apoptosis, The Unfolded Protein Response, And Lung Function In Idiopathic Pulmonary Fibrosis, Pawan Sharma, Javad Alizadeh, Maya Juarez, Afshin Samali, Andrew J Halayko, Nicholas J Kenyon, Saeid Ghavami, Amir A Zeki

Center for Translational Medicine Faculty Papers

Autophagy, apoptosis, and the unfolded protein response (UPR) are fundamental biological processes essential for manifold cellular functions in health and disease. Idiopathic pulmonary fibrosis (IPF) is a progressive and lethal pulmonary disorder associated with aging that has limited therapies, reflecting our incomplete understanding. We conducted an observational study linking molecular markers of cell stress response pathways (UPR: BiP, XBP1; apoptosis: cleaved caspase-3; autophagy: LC3β) in lung tissues from IPF patients and correlated the expression of these protein markers to each subject's lung function measures. We hypothesized that changes in lung tissue expression of apoptosis, autophagy, and UPR markers correlate with …

A Rare Fatal Case Of Adenovirus Serotype 4 Associated Acute Disseminated Encephalomyelitis In An Adult: A Case Report, Zahra Qamar, Catherine Tucker, Lawrence C. Kenyon, Tricia. Royer

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease directed against the myelin sheath of the central nervous system that typically presents 1–4 weeks after an infection or vaccination, most commonly in children. We describe a case of a young female who presented with rapidly progressive mental deterioration and died secondary to ADEM following an adenovirus upper respiratory tract infection.