Medicine and Health Sciences Commons^™

Trna Methylation Is A Global Determinant Of Bacterial Multi-Drug Resistance., Isao Masuda, Ryuma Matsubara, Thomas Christian, Enrique R. Rojas, Srujana S. Yadavalli, Lisheng Zhang, Mark Goulian, Leonard J. Foster, Kerwyn Casey Huang, Ya-Ming Hou

Department of Biochemistry and Molecular Biology Faculty Papers

Gram-negative bacteria are intrinsically resistant to drugs because of their double-membrane envelope structure that acts as a permeability barrier and as an anchor for efflux pumps. Antibiotics are blocked and expelled from cells and cannot reach high-enough intracellular concentrations to exert a therapeutic effect. Efforts to target one membrane protein at a time have been ineffective. Here, we show that m ¹ G37-tRNA methylation determines the synthesis of a multitude of membrane proteins via its control of translation at proline codons near the start of open reading frames. Decreases in m ¹ G37 levels in Escherichia coli and Salmonella impair …

Split Tolerance Permits Safe Ad5-Gucy2c-Padre Vaccine-Induced T-Cell Responses In Colon Cancer Patients., Adam E. Snook, Trevor R. Baybutt, Bo Xiang, Tara S. Abraham, John C. Flickinger, Terry Hyslop, Tingting Zhan, Walter K. Kraft, Takami Sato, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Background: The colorectal cancer antigen GUCY2C exhibits unique split tolerance, evoking antigen-specific CD8+, but not CD4+, T-cell responses that deliver anti-tumor immunity without autoimmunity in mice. Here, the cancer vaccine Ad5-GUCY2C-PADRE was evaluated in a first-in-man phase I clinical study of patients with early-stage colorectal cancer to assess its safety and immunological efficacy.

Methods: Ten patients with surgically-resected stage I or stage II (pN0) colon cancer received a single intramuscular injection of 1011 viral particles (vp) of Ad5-GUCY2C-PADRE. Safety assessment and immunomonitoring were carried out for 6 months following immunization. This trial employed continual monitoring of both efficacy and toxicity …

Management Of Cancer-Associated Anemia With Erythropoiesis-Stimulating Agents: Asco/Ash Clinical Practice Guideline Update., Julia Bohlius, Kari Bohlke, Roberto Castelli, Benjamin Djulbegovic, Maryam B Lustberg, Massimo Martino, Giannis Mountzios, Namrata Peswani, Laura Porter, Tiffany N. Tanaka, Gianluca Trifirò, Hushan Yang, Alejandro Lazo-Langner

Department of Medical Oncology Faculty Papers

PURPOSE: To update the American Society of Clinical Oncology (ASCO)/American Society of Hematology (ASH) recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer.

METHODS: PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs in patients with cancer published from January 31, 2010, through May 14, 2018. For biosimilar ESAs, the literature search was expanded to include meta-analyses and RCTs in patients with cancer or chronic kidney disease and cohort studies in patients with cancer due to limited RCT evidence in the cancer setting. ASCO and ASH convened an Expert Panel to …

Understanding And Impact Of Negative Direct-To-Consumer Brca Test Results: A Pilot Study, Kristen Pauley, Zohra Ali-Khancatts, Rachael Brandt, Cristina Nixon, Robert Sterling

Department of Biochemistry and Molecular Biology Posters

Many people pursue direct-to-consumer (DTC) DNA testing to learn about health risks. While DTC testing for breast cancer genes BRCA1 and BRCA2 may provide vital information to those testing positive, it is unclear whether individuals testing negative understand the implications of these results. Furthermore, it is unknown how such findings may influence future cancer risk management. Ninety-six individuals who underwent BRCA testing through the DTC service, 23andMe, completed a survey designed to assess their understanding of a negative result and how this result may impact cancer risk management. Respondents were recruited via social media sources Reddit and Facebook. All participants …

Single-Cell Gene Expression Analysis Identifies Chronic Alcohol-Mediated Shift In Hepatocyte Molecular States After Partial Hepatectomy., Sirisha Achanta, Aalap Verma, Ankita Srivastava, Harshavardhan Nilakantan, Jan B. Hoek, Rajanikanth Vadigepalli

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The analysis of molecular states of individual cells, as defined by their mRNA expression profiles and protein composition, has gained widespread interest in studying biological phenomena ranging from embryonic development to homeostatic tissue function and genesis and evolution of cancers. Although the molecular content of individual cells in a tissue can vary widely, their molecular states tend to be constrained within a transcriptional landscape partly described by the canonical archetypes of a population of cells. In this study, we sought to characterize the effects of an acute (partial hepatectomy) and chronic (alcohol consumption) perturbation on the molecular states of individual …

Increasing Upstream Chromatin Long-Range Interactions May Favor Induction Of Circular Rnas In Lysopc-Activated Human Aortic Endothelial Cells., Angus Li, Yu Sun, Charles Drummer, Yifan Lu, Daohai Yu, Yan Zhou, Xinyuan Li, Simone J. Pearson, Candice Johnson, Catherine Yu, William Y. Yang, Kevin Mastascusa, Xiaohua Jiang, Jianxin Sun, Thomas Rogers, Wenhui Hu, Hong Wang, Xiaofeng Yang

Center for Translational Medicine Faculty Papers

Circular RNAs (circRNAs) are non-coding RNAs that form covalently closed continuous loops, and act as gene regulators in physiological and disease conditions. To test our hypothesis that proatherogenic lipid lysophosphatidylcholine (LPC) induce a set of circRNAs in human aortic endothelial cell (HAEC) activation, we performed circRNA analysis by searching our RNA-Seq data from LPC-activated HAECs, and found: (1) LPC induces significant modulation of 77 newly characterized cirRNAs, among which 47 circRNAs (61%) are upregulated; (2) 34 (72%) out of 47 upregulated circRNAs are upregulated when the corresponding mRNAs are downregulated, suggesting that the majority of circRNAs are upregulated presumably via …

Bova Is Superior To Spesi In Identification Of High Risk Pulmonary Embolism Patients, Joseph Dibello

Sigma Xi Student Research Day

No abstract provided.

Innovator - Spring 2019

Innovator

8 - A MESSAGE FROM THE PRESIDENT

10 - WHAT’S HAPPENING AT JEFFERSON?

16 - OUR STRATEGIC ACADEMIC FRAMEWORK Jefferson is dedicated to improving lives by redefining humanly possible.

18 - THE BOY FROM BROOKLYN Noted alumnus Harold Ronson leaves his mark on Jefferson.

24 - WE DESIGN THINKING The University has developed a world-class reputation for graduating designers with a demonstrated capacity for developing robust solutions for real-world problems.

30 - UNLEASHING CREATIVITY Provost Mark L. Tykocinski, MD, describes the exciting and productive intersections explored at Jefferson.

32 - AN EVOLUTION ROOTED IN EMPATHY Two industry experts and educators …

Inside Out, Spring 2018

Inside Out

Contents:

Untitled, Jane Jacob - Cover

Guy, Tariro Mupaso - Inside Cover

IM Rounds, Michelle Chen - 1

Histology of the Cerebellum at the Level of the Medulla, Caroline Dunne - 3

Summer Fruit, Kanika Ramchandan 2

Serenity, Chen Zhou - 4

Stage IV, Jordyn Tumas - 5

Pitting Anitha, Ahmed - 6

The Other Hand, Sophia Dang - 6

Dust, Victoria Stevenson - 7

Conflagration, Anitha Ahmed - 8

Sweet Shop - Tangail, Bangladesh, Micaela Langille Collins - 8

Newborn Exam, Jordyn Tumas - 9

The Descent, Jeffrey Lee …

Rabies-Based Vaccine Induces Potent Immune Responses Against Nipah Virus., Rohan Keshwara, Thomas Shiels, Elena Postnikova, Drishya Kurup, Christoph Wirblich, Reed F. Johnson, Matthias J. Schnell

Department of Microbiology and Immunology Faculty Papers

Nipah Virus (NiV) is a re-emerging zoonotic pathogen in the genus Henipavirus of the Paramyxoviridae family of viruses. NiV is endemic to Bangladesh and Malaysia and is highly fatal to both livestock and humans (human case fatality rate = 74.5%). Currently, there is no approved vaccine against NiV on the market. The goal of this study was to use a recombinant RABV vector expressing NiV glycoprotein (NiV G) to develop a bivalent candidate vaccine against NiV disease and rabies virus (RABV) disease, which is also a significant health burden in the regions where NiV is endemic. The rabies vector is …

Hotspotting Student Initiatives: Lessons Learned From A Patient-Centered Approach, Brianna Gomez, Mirna Rezkalla, Daisy Yan, Krystal Park, Amy Lachewitz, Md

JCIPE Posters

• Hotspotting is a program focusing on providing interprofessional care to patients with complex medical and social needs using a patient-centered approach.
• Hotspotting program provides an opportunity for students from various healthcare programs to coordinate and offer individualized interventions to reduce ED admissions in “high-utilizers.”
• Our team consisted of students from: physical therapy, medicine, pharmacy, and occupational therapy programs.

An Evaluation Of Risk Attitudes And Risk Tolerance In Emergency Medicine Residents., Carlos Rodriguez, Nishad A Rahman, Kory London, Robin Naples, Simran Buttar, Xiao Chi Zhang, Hyunjoo Lee, Joshua Rudner, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Introduction Previous studies have shown that risk attitudes and tolerance for uncertainty are significant factors in clinical decision-making, particularly in the practice of defensive medicine. These attributes have also been linked with rates of physician burnout. To date, the risk profile of emergency medicine (EM) physicians has not yet been described. Our goal was to examine the risk profile of EM residents using a widely available risk tolerance and attitude assessment tool. Methods First-, second-, and third-year residents of Thomas Jefferson University Hospital's EM residency program completed the commercially available, unmodified Risk Type Compass, a validated instrument offered by Multi-Health …

Use Of Jejunostomy Tubes With Esophagectomy And Inpatient Healthcare Utilization In The National Readmissions Database, R. Zheng, Md, A. R. Rios-Diaz, Md, S. Liem, Bs, C. L. Devin, Md, N. R. Evans, Iii, Md, E. L. Rosato, Md, F. Palazzo, Md, A. C. Berger, Md

Department of Surgery Posters

Objectives

Evaluate the readmission rates and mortality associated with j-tubes post-esophagectomy nationally.

Trust The Process: A Templated, Centralized, And Protocolized Patient Safety Pilot Project To Improve Outside Admissions, Alan A. Kubey, Md, Jeffrey M. Riggio, Md

Department of Medicine Posters

Transfers are high-risk. Intra-hospital transfer processes research has improved protocols used nationally.1 Outside-hospital admissions remain without standards ensuring the transfer of the right information to the right clinician at the right time; presently, patients can arrive at a new hospital with limited-to-no information.2We trialed a novel process for outside (hospital, provider, or skilled nursing facility) admissions to a single academic medical center’s resident and- hospital-medicine-attending-based (“teaching”) medicine services.

Health Insurance Coverage Of Recommended Gender-Affirming Health Care Services For Transgender Youth: Shopping Online For Coverage Information, Nadia L. Dowshen, Julie Christensen, Siobhan Gruschow

Student Papers, Posters & Projects

We assessed online health insurance plan indication of coverage and accessibility of information for recommended services for transgender youth (TY). Content analysis was performed for plans used at a pediatric Gender Clinic by reviewing information about coverage of puberty blockers, hormones, masculinizing chest surgery, and counseling. Transgender-specific exclusions and the time required for the research assistant to review each plan's online information were noted. No plan (0%; n=36) indicated coverage of all four categories of recommended services online. Forty-nine percent indicated ≥1 transgender-specific exclusion. The median time required for a research assistant to review online coverage information for each insurance …

Coronary Angiography After Cardiac Arrest - The Right Timing Or The Right Patients?, Benjamin S. Abella, David F. Gaieski

Department of Emergency Medicine Faculty Papers

No abstract provided.

Gasdermin Pores Permeabilize Mitochondria To Augment Caspase-3 Activation During Apoptosis And Inflammasome Activation., Corey Rogers, Dan A. Erkes, Alexandria Nardone, Andrew E. Aplin, Teresa Fernandes-Alnemri, Emad S. Alnemri

Department of Biochemistry and Molecular Biology Faculty Papers

Gasdermin E (GSDME/DFNA5) cleavage by caspase-3 liberates the GSDME-N domain, which mediates pyroptosis by forming pores in the plasma membrane. Here we show that GSDME-N also permeabilizes the mitochondrial membrane, releasing cytochrome c and activating the apoptosome. Cytochrome c release and caspase-3 activation in response to intrinsic and extrinsic apoptotic stimuli are significantly reduced in GSDME-deficient cells comparing with wild type cells. GSDME deficiency also accelerates cell growth in culture and in a mouse model of melanoma. Phosphomimetic mutation of the highly conserved phosphorylatable Thr6 residue of GSDME, inhibits its pore-forming activity, thus uncovering a potential mechanism by which GSDME …

Histological Chorioamnionitis Induces Differential Gene Expression In Human Cord Blood Mononuclear Leukocytes From Term Neonates., Suhita Gayen Nee’ Betal, Swati Murthy, Michael Favara, Gina Fong, Joanna Chan, Sankar Addya, Thomas H. Shaffer, Jay S. Greenspan, Vineet Bhandari, Irfan Rahman, Zubair H. Aghai

Department of Pediatrics Faculty Papers

Histological chorioamnionitis (HCA) is an infection of fetal membranes and complicates 5.2% to 28.5% of all live births. HCA is associated with increased mortality and morbidity in both premature and term neonates. Exposure to HCA may have long-term consequences, including an increased risk for allergic disorders and asthma later in childhood, the mechanism(s) of which are still not yet well understood. The objective of this study was to determine the mRNA transcriptome of cord blood mononuclear leukocytes from term neonates to identify key genes and pathways involved in HCA. We found 366 differentially expressed probe IDs with exposure to HCA …

Role Of Ribosome Recycling Factor As A Ribosome Releasing Factor, Yoshio Inokuchi, Fabio Quaglia, Akikazu Hirashima, Yoshihiro Yamamoto, Hideko Kaji, A. Kaji

Department of Biochemistry and Molecular Biology Posters

The objective of this presentation is to study the in vivo actions of ribosome recycling factor (RRF) and compare them with those found in vitro. RRF is known to catalyze three separate reactions: release of tRNA and mRNA from the post-termination complex (PoTC), and splitting of the ribosome of the PoTC. To study the mechanism of RRF reaction in vivo, we used E. coli harboring temperature sensitive (ts) RRF and assayed by following downstream reading of translationally coupled ORF. At the non-permissive temperature, ribosomes remain on the termination codon of the junction sequence of coupled ORFs and translate downstream ORF …

A Horseshoe Kidney With A Unique Constellation Of Renal Vasculature - A Case Report, Guiyan Zhang, Richard Schmidt

Department of Pathology, Anatomy, and Cell Biology Posters

Horseshoe kidney with variable vascular supply is of interest to clinicians and anatomists due to its immense surgical significance. A horseshoe kidney encountered during cadaveric dissection is reported here. The left kidney is vertical and the right kidney is slightly horizontal. The isthmus is narrow and 1.5cm inferior to the inferior mesenteric artery. The hilum of the right kidney opens anteriorly and the left opens anteromedially. The ureters lie on the anterior surfaces of both kidneys. In addition to renal arteries arising from the aorta described in previous reports, a unique renal artery (Renal Artery 3) was found supplying the …

Telemedicine Training In Undergraduate Medical Education: Mixed-Methods Review., Shayan Waseh, Mph, Adam P. Dicker, Md, Phd, Fastro

Student Papers, Posters & Projects

BACKGROUND: Telemedicine has grown exponentially in the United States over the past few decades, and contemporary trends in the health care environment are serving to fuel this growth into the future. Therefore, medical schools are learning to incorporate telemedicine competencies into the undergraduate medical education of future physicians so that they can more effectively leverage telemedicine technologies for improving the quality of care, increasing patient access, and reducing health care expense. This review articulates the efforts of allopathic-degree-granting medical schools in the United States to characterize and systematize the learnings that have been generated thus far in the domain of …

Vision Rehabilitation Impacting Return To Occupation After Post-Concussion Syndrome, Joe Kardine, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Vision rehabilitation is an emerging use of efficient occupation-based intervention in occupational therapy for vision impairment after concussion. Public awareness of untreated concussions has led to more patients seeking treatment for symptom remediation. Efficient interpretations of comprehensive vision evaluations followed by incorporation of vision therapy to treatment improve performance outcomes, increase patient quality of life and ensure compliance of intervention.

From Prison To The Community: The Pivotal Role Of Ot In Facilitating A Healthy Transition, Pari Kumar, Bs, Jennifer A. Merz, Bs, Audrey L. Zapletal, Otd, Otr/L, Cla, Susan E. Connor, Otd, Otr/L, Cchp

Department of Occupational Therapy Posters and Presentations

Background

• Approximately 630,000 prisoners are released into the community each year.1
• First Step Act (2018) reduces minimum sentencing for populations such as nonviolent drug offenders.2
• Majority released to unsafe areas due to shortage of affordable housing. 3
• Insecure housing and homelessness are related to increased:
• Recidivism4; Emergency room use5; Substance use 6; Unstable family relationships7; Mental health (MH) problems.7
• Post-release is a high-risk time due to poor care continuity and lack of support.8 •Individuals report difficulty: Obtaining employment and stable housing, accessing relevant treatment services, reintegrating with their families and communities.9
• Stable housing provides a secure place to seek employment, …

The Student Hotspotting Program: Facilitating Interprofessional Community Learning, Tracey Vause-Earland, Phd, Otr/L, Sara Cohen, Ots

Department of Occupational Therapy Posters and Presentations

Student Hotspotting teams work together to identify and engage super-utilizing individuals to establish healing relationships and identify barriers to their care. With support from faculty and clinician advisors, students guide these individuals through achieving personalized health goals, navigating the complex healthcare system and connect them to community resources.

In addition to hands-on work, students are guided through this program with a supplemental online curriculum consisting of webinars and monthly case conferences with professionals in the field.

• Core Principles: Harm reduction, motivational interviewing, trauma informed care and accompaniment
• Webinars cover topics such as client recruitment and enrollment, the power of empathy, …

Critically Appraised Paper: A Multicenter, Randomized Controlled Trial Of Individualized Occupational Therapy For Patients With Schizophrenia In Japan, Pari Kumar, Bs, Mary Muhlenhaupt, Otd, Otr/L, Faota

Department of Occupational Therapy Posters and Presentations

• Based on the article "A multicenter, randomized controlled trial of individualized OT for patients with schizophrenia in Japan," by Shimada, et al.
• Results suggest that combining individual OT with group OT can improve cognition, intrinsic motivation, medication adherence, and treabnent satisfaction for individuals with schizophrenia and schizoaffective disorder.
• These findings have implications for OTs working in psychiatric settings.

The Power To Transform Development: Benefits Of Power Mobility Devices For Children 0-3 Years, Madeleine Clements, Ots, Chalia Bellis, Ots, Audrey Zapletal, Otd, Otr/L, Cla

Department of Occupational Therapy Posters and Presentations

The purpose of this poster is to describe the benefits of PMD for children 0-3 years old and to provide evidence-based recommendations for prescription and usage.

The Vitamin C, Thiamine And Steroids In Sepsis (Victas) Protocol: A Prospective, Multi-Center, Double-Blind, Adaptive Sample Size, Randomized, Placebo-Controlled, Clinical Trial., David N. Hager, Michael H. Hooper, Gordon R. Bernard, Laurence W. Busse, E. Wesley Ely, Alpha A. Fowler, David F. Gaieski, Alex Hall, Jeremiah S. Hinson, James C. Jackson, Gabor D. Kelen, Mark Levine, Christopher J. Lindsell, Richard E. Malone, Anna Mcglothlin, Richard E. Rothman, Kert Viele, David W. Wright, Jonathan E. Sevransky, Greg S. Martin

Department of Emergency Medicine Faculty Papers

BACKGROUND: Sepsis accounts for 30% to 50% of all in-hospital deaths in the United States. Other than antibiotics and source control, management strategies are largely supportive with fluid resuscitation and respiratory, renal, and circulatory support. Intravenous vitamin C in conjunction with thiamine and hydrocortisone has recently been suggested to improve outcomes in patients with sepsis in a single-center before-and-after study. However, before this therapeutic strategy is adopted, a rigorous assessment of its efficacy is needed.

METHODS: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled trial. It will enroll …

Addressing Chronic Homelessness & Mental/Behavioral Health Needs In The Community: Collaborative Level Ii Fieldwork And Doctoral Experiential Programming, Tina M. Deangelis, Edd, Otr/L, Josephine Beker, Ots, Eliza Brooks, Ots, Rebecca Brown, Ots, Jonette Ishmael, Ots, Alex Manwaring, Ots, Jennifer Merz, Ots, Erin Schifferdecker, Ots, Cerissa Zenor Clark, Ots

Department of Occupational Therapy Posters and Presentations

OT students worked with a diverse population in a variety of living environments including permanent supportive housing, and safe havens.

Trends In Rates Of Asia Impairment Scale Conversion In Traumatic Complete Spinal Cord Injury, R. Marino, M. Leff, D. Cardenas, D. Chen, S. Kirshblum, B. Leiby

Department of Rehabilitation Medicine Posters

Objective: Recent studies on conversion of ASIA Impairment Scale (AIS) grades report higher rates of conversion than older studies. The purpose of this study is to examine the rate of conversion over time in persons with ASIA Impairment Scale (AIS) grade A spinal cord injury (SCI), accounting for level of injury.

Methods: Subjects were injured between 1995 and 2015, enrolled in the National SCI Database as Day-1 admissions, at least 16 years old at the time of injury, classified as AIS A, and had an initial examination within 2 weeks of injury. Change in AIS grade was determined for …

The Effect Of A Didactic Educational Program With Practical Application On Nursing Knowledge And Empowerment In Antibiotic Stewardship, Eleanor Fitzpatrick, Rn, Msn, Ag-Cns, Acnp, Ccrn

College of Nursing Posters

• Antimicrobial use is a crucial element of patient care but their overuse and misuse have detrimental effects including the growing problem of antimicrobial resistance (AMR).
• Nurse empowerment and engagement has resulted in improvements in many quality initiatives including enhanced patient safety in the areas of Central Line Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infections (CAUTI) and pressure injuries (Carter, 2016).
• Enhancing nurse empowerment in AS may be effective in reducing antibiotic misuse.
• The purpose of this study is to implement an educational program engaging nurses in AS activities and determining the effect of this educational intervention on the knowledge …