Medicine and Health Sciences Commons^™

Integrating Telehealth Emergency Department Follow-Up Visits Into Residency Training., Dimitrios Papanagnou, Danica Stone, Shruti Chandra, Phillip Watts, Anna Marie Chang, Judd E. Hollander

Department of Emergency Medicine Faculty Papers

Introduction: Given the rapid expansion of telehealth (TH), there is an emerging need for trained professionals who can effectively deliver TH services. As there is no formal TH training program for residents, the Department of Emergency Medicine (DEM) at Thomas Jefferson University (TJU) developed a pilot training program for senior post-graduate-year three (PGY-3) residents that exposed them to TH practices. The objective of the study was to determine the feasibility of developing a resident-led, post-Emergency-Department (ED) visit TH follow-up program as an educational opportunity to 1) address patient satisfaction; and 2) expose senior residents to TH delivery.

Methods: During …

"My Bitterness Is Deeper Than The Ocean": Understanding Internalized Stigma From The Perspectives Of Persons With Schizophrenia And Their Family Caregivers., Yin-Ling Irene Wong, Dexia Kong, Lufei Tu, Rosemary Frasso Phd, Msc, Cph

College of Population Health Faculty Papers

Background: It is estimated that 8 million of the Chinese adult population had a diagnosis of schizophrenia. Stigma associated with mental illness, which is pervasive in the Chinese cultural context, impacts both persons with schizophrenia and their family caregivers. However, a review of the literature found a dearth of research that explored internalized stigma from the perspectives of both patients and their caregivers.

Methods: We integrated data from standardized scales and narratives from semi-structured interviews obtained from eight family-dyads. Interview narratives about stigma were analyzed using directed content analysis and compared with responses from Chinese versions of the Internalized Stigma …

Jefferson Digital Commons Quarterly Report: January-March 2018, Kelsey Duinkerken, Msi, James Copeland, Libt

Jefferson Digital Commons Reports

This quarterly report includes:

• Articles
• Conference materials
• From the Archives - Yearbooks
• Grand Rounds
• Journals
• MPH Capstones
• Newsletters
• Podcasts
• Posters
• Reports
• Symposiums
• What People are Saying About the Jefferson Digital Commons

Ot Department News- Issue #3

Department of Occupational Therapy Newsletter

In this Issue:

• Alumni Spotlight
• Alumni Highlights
• Faculty Spotlight
• International Experiences
• Advanced Practice Certificate
• New Faculty Spotlight
• Research Highlights
• Student Volunteers
• CREATE Day
• Department Chair Update
• Faculty News

A Word From The Writing Team (April 2018), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Our New Name
• Now Offering Group Consultations
• Writing Café

An Expert Consensus For The Management Of Chronic Hepatitis B In Asian Americans., M. J. Tong, C. Q. Pan, S.-H. B. Han, D. S.-K. Lu, S. Raman, K.-Q. Hu, J. K. Lim, H.W. Hann, A. D. Min

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Hepatitis B virus (HBV) infection is common with major clinical consequences. In Asian Americans, the HBsAg carrier rate ranges from 2% to 16% which approximates the rates from their countries of origin. Similarly, HBV is the most important cause of cirrhosis, hepatocellular carcinoma (HCC) and liver related deaths in HBsAg positive Asians worldwide.

AIM: To generate recommendations for the management of Asian Americans infected with HBV.

METHODS: These guidelines are based on relevant data derived from medical reports on HBV from Asian countries as well as from studies in the HBsAg positive Asian Americans. The guidelines herein differ from …

A Sub-Type Of Familial Pancreatic Cancer: Evidence And Implications Of Loss-Of-Function Polymorphisms In Indoleamine-2,3-Dioxygenase-2., Avinoam Nevler, Alexander J. Muller, Joseph A. Cozzitorto, Austin Goetz, Jordan M. Winter, Theresa P. Yeo, Harish Lavu, Charles Yeo, George C. Prendergast, Jonathan Brody

Department of Surgery Faculty Papers

BACKGROUND: Variation in an individual's genetic status can impact the development of pancreatic ductal adenocarcinoma; however, the majority of familial pancreatic cancers (FPC) cannot yet be attributed to a specific inherited mutation. We present data suggesting a correlation between loss-of-function single nucleotide polymorphisms (SNPs) in an immune regulator gene, indoleamine-2,3-dioxygenase-2 (IDO2), and an increased risk of FPC.

STUDY DESIGN: Germline DNA from patients who underwent resection for pancreatic ductal adenocarcinoma (n = 79) was sequenced for the IDO2 SNPs R248W and Y359Stop. Genotypes resulting in inactivation of IDO2 (Y325X homozygous, R248W homozygous) were labeled as homozygous, and the other genotypes …

What Are Biofilms?, Noreen J. Hickok

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Mud-Splattered Fundus, Roger Joel Welch, Xintong Li, Carol L. Shields

Wills Eye Hospital Papers

No abstract provided.

Pim-1 Kinase Phosphorylates Cardiac Troponin I And Regulates Cardiac Myofilament Function., Ni Zhu, Bing Yi, Zhifu Guo, Guanxin Zhang, Shengdong Huang, Yongwen Qin, Xianxian Zhao, Jianxin Sun

Center for Translational Medicine Faculty Papers

BACKGROUND/AIMS: Pim-1 is a serine/threonine kinase that is highly expressed in the heart, and exerts potent cardiac protective effects through enhancing survival, proliferation, and regeneration of cardiomyocytes. Its myocardial specific substrates, however, remain unknown. In the present study, we aim to investigate whether Pim-1 modulates myofilament activity through phosphorylation of cardiac troponin I (cTnI), a key component in regulating myofilament function in the heart.

METHODS: Coimmunoprecipitation and immunofluorescent assays were employed to investigate the interaction of Pim-1 with cTnI in cardiomyocytes. Biochemical, site directed mutagenesis, and mass spectrometric analyses were utilized to identify the phosphorylation sites of Pim1 in cTnI. …

Prenatal Exposure To Methadone Or Buprenorphine: Early Childhood Developmental Outcomes., Karol Kaltenbach, Kevin E O'Grady, Sarah H. Heil, Amy L. Salisbury, Mara G. Coyle, Gabriele Fischer, Peter R. Martin, Susan Stine, Hendrée E. Jones

Department of Pediatrics Faculty Papers

BACKGROUND: Methadone and buprenorphine are recommended to treat opioid use disorders during pregnancy. However, the literature on the relationship between longer-term effects of prenatal exposure to these medications and childhood development is both spare and inconsistent.

METHODS: Participants were 96 children and their mothers who participated in MOTHER, a randomized controlled trial of opioid-agonist pharmacotherapy during pregnancy. The present study examined child growth parameters, cognition, language abilities, sensory processing, and temperament from 0 to 36 months of the child's life. Maternal perceptions of parenting stress, home environment, and addiction severity were also examined.

RESULTS: Tests of mean differences between children …

Differences In Work Environment For Staff As An Explanation For Variation In Central Line Bundle Compliance In Intensive Care Units., Yuna S.H. Lee, Patricia W. Stone, Monika Pogorzelska-Maziarz, Ingrid M. Nembhard

College of Nursing Faculty Papers & Presentations

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals.

PURPOSE: The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs).

METHODOLOGY/APPROACH: A cross-sectional study of hospital medical-surgical ICUs in the United States was done. …

Limited Immune Surveillance In Lymphoid Tissue By Cytolytic Cd4+ T Cells During Health And Hiv Disease., Marcus Buggert, Son Nguyen, Laura M. Mclane, Maria Steblyanko, Nadia Anikeeva, Dominic Paquin-Proulx, Perla M Del Rio Estrada, Yuria Ablanedo-Terrazas, Kajsa Noyan, Morgan A. Reuter, Korey Demers, Johan K. Sandberg, Michael A. Eller, Hendrik Streeck, Marianne Jansson, Piotr Nowak, Anders Sönnerborg, David H. Canaday, Ali Naji, E. John Wherry, Merlin L. Robb, Steven G Deeks, Gustavo Reyes-Teran, Yuri Sykulev, Annika C. Karlsson, Michael R. Betts

Department of Medical Oncology Faculty Papers

CD4+ T cells subsets have a wide range of important helper and regulatory functions in the immune system. Several studies have specifically suggested that circulating effector CD4+ T cells may play a direct role in control of HIV replication through cytolytic activity or autocrine β-chemokine production. However, it remains unclear whether effector CD4+ T cells expressing cytolytic molecules and β-chemokines are present within lymph nodes (LNs), a major site of HIV replication. Here, we report that expression of β-chemokines and cytolytic molecules are enriched within a CD4+ T cell population with high levels of the T-box transcription factors T-bet and …

Ketamine And Remote Hyperalgesia, Steven B. Porter, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

No abstract provided.

Plasma Inflammatory Cytokines And Survival Of Pancreatic Cancer Patients., A. Babic, N. Schnure, N. P. Neupane, M. M. Zaman, N. Rifai, M. W. Welch, L. K. Brais, D. A. Rubinson, V. Morales-Oyarvide, C. Yuan, S. Zhang, E. M. Poole, B. M. Wolpin, M. H. Kulke, D. A. Barbie, K. Wong, C. S. Fuchs, K. Ng

Department of Medical Oncology Faculty Papers

OBJECTIVES: Inflammation and inflammatory conditions have been associated with pancreatic cancer risk and progression in a number of clinical, epidemiological, and animal model studies. The goal of the present study is to identify plasma markers of inflammation associated with survival of pancreatic cancer patients, and assess their joint contribution to patient outcome.

METHODS: We measured circulating levels of four established markers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6), soluble tumor necrosis factor receptor type II (sTNF-RII), and macrophage inhibitory cytokine-1 (MIC-1)) in 446 patients enrolled in an ongoing prospective clinic-based study. Hazard ratios (HRs) and 95% confidence intervals (CI) for …

Inhibition Of Dna Methyltransferase Leads To Increased Genomic 5-Hydroxymethylcytosine Levels In Hematopoietic Cells., Borbála Vető, Pál Szabó, Caroline Bacquet, Anna Apró, Edit Hathy, Judit Kiss, János M. Réthelyi, Flóra Szeri, Dávid Szüts, Tamás Arányi

Department of Dermatology and Cutaneous Biology Faculty Papers

5-Hydroxymethylcytosine (5hmC) is produced from 5-methylcytosine (5mC) by Ten-eleven translocation (TET) dioxygenases. The epigenetic modification 5hmC has crucial roles in both cellular development and differentiation. The 5hmC level is particularly high in the brain. While 5mC is generally associated with gene silencing/reduced expression, 5hmC is a more permissive epigenetic mark. To understand its physiological function, an easy and accurate quantification method is required. Here, we have developed a novel LC-MS/MS-based approach to quantify both genomic 5mC and 5hmC contents. The method is based on the liberation of nucleobases by formic acid. Applying this method, we characterized the levels of DNA …

Validation Of An Icd Code For Accurately Identifying Emergency Department Patients Who Suffer An Out-Of-Hospital Cardiac Arrest., Shelby K. Shelton, Steve B. Chukwulebe, David F. Gaieski, Benjamin S. Abella, Brendan G. Carr, Sarah M. Perman

Department of Emergency Medicine Faculty Papers

AIM: International classification of disease (ICD-9) code 427.5 (cardiac arrest) is utilized to identify cohorts of patients who suffer out-of-hospital cardiac arrest (OHCA), though the use of ICD codes for this purpose has never been formally validated. We sought to validate the utility of ICD-9 code 427.5 by identifying patients admitted from the emergency department (ED) after OHCA.

METHODS: Adult visits to a single ED between January 2007 and July 2012 were retrospectively examined and a keyword search of the electronic medical record (EMR) was used to identify patients. Cardiac arrest was confirmed; and ICD-9 information and location of return …

Comorbidities In Aging Patients With Sickle Cell Disease., Samir K. Ballas

Cardeza Foundation for Hematologic Research

Sickle cell disease (SCD) in general and sickle cell anemia in particular is a highly complex disorder both at the molecular and clinical levels. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of the disease. Moreover, despite the fact that SCD is a chronic malady, its manifestations are both acute and chronic. The former include, among other things, the recurrent vaso-occlusive crises (its hallmark) and acute chest syndrome. The chronic complications include most commonly avascular necrosis and leg ulcers. Currently, survival of patients with …

Electrophysiological Signatures Of Spatial Boundaries In The Human Subiculum., Sang Ah Lee, Jonathan F. Miller, Andrew J. Watrous, Michael R. Sperling, Ashwini Sharan, Gregory A. Worrell, Brent M. Berry, Joshua P. Aronson, Kathryn A. Davis, Robert E. Gross, Bradley Lega, Sameer Sheth, Sandhitsu R. Das, Joel M. Stein, Richard Gorniak, Daniel S. Rizzuto, Joshua Jacobs

Department of Radiology Faculty Papers

Environmental boundaries play a crucial role in spatial navigation and memory across a wide range of distantly related species. In rodents, boundary representations have been identified at the single-cell level in the subiculum and entorhinal cortex of the hippocampal formation. Although studies of hippocampal function and spatial behavior suggest that similar representations might exist in humans, boundary-related neural activity has not been identified electrophysiologically in humans until now. To address this gap in the literature, we analyzed intracranial recordings from the hippocampal formation of surgical epilepsy patients (of both sexes) while they performed a virtual spatial navigation task and compared …

Sickle Cell Disease: Classification Of Clinical Complications And Approaches To Preventive And Therapeutic Management., Samir K. Ballas

Department of Medicine Faculty Papers

Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure that has no established cure in adult patients. Cure has been achieved in selected children with sickle cell anemia (SCA) using allogeneic bone marrow transplantation or cord blood transplantation. SCD is essentially a triumvirate of (1) pain syndromes, (2) anemia and its sequelae and (3) organ failure, including infection. Pain, however, is the hallmark of SCD and dominates its clinical picture throughout the life of the patients. The prevalence of these complications varies with age from infancy through adult life. However, pain, infections and anemia requiring blood transfusion occur …

Blood Rheological Abnormalities In Sickle Cell Anemia., Philippe Connes, Céline Renoux, Marc Romana, Manouk Abkarian, Philippe Joly, Cyril Martin, Marie-Dominique Hardy-Dessources, Samir K. Ballas

Department of Medicine Faculty Papers

This review focuses on the contribution of abnormal blood rheology in the pathophysiology of sickle cell anemia (SCA). SCA is characterized by a reduction of red blood cell (RBC) deformability but this reduction is very heterogeneous among patients. Recent works have shown that patients with the lowest RBC deformability (measured by ektacytometry) have enhanced hemolysis and would be more prone to develop several complications such as priapism, leg ulcers and glomerulopathy. In contrast, patients with the highest deformability, and not under hydroxyurea therapy, seem to develop more frequently vaso-occlusive like events. Although less studied, RBC aggregation properties are very different …

Self-Directed Learning Modules Enhance Mastery Of Diagnostic Imaging In Dissection-Based Anatomy Course For Physician Assistant Students, Guiyan Zhang, Bruce Fenderson, Xuan Zuo

Department of Pathology, Anatomy, and Cell Biology Posters

Abstract

The virtues of using computer-based learning modules as an alternative to traditional didactic lectures were tested in a human anatomy course for Physician Assistant (PA) students. Self-directed learning modules on diagnostic imaging were created using ArticulateTM software and provided online as homework assignments for PA students taking a human anatomy lecture and dissection laboratory course. These interactive self-learning modules replaced the content of traditional didactic lectures on the same topics that had been given in previous years. For the PA class of 2016 (n=103), diagnostic imaging was taught via traditional lectures, whereas for the PA class of 2017 (n=100), …

Allometry And Ecology Of The Bilaterian Gut Microbiome., Scott Sherrill-Mix, Kevin Mccormick, Abigail Lauder, Aubrey Bailey, Laurie Zimmerman, Yingying Li, Jean-Bosco N Django, Paco Bertolani, Christelle Colin, John A Hart, Terese B Hart, Alexander V Georgiev, Crickette M Sanz, David B Morgan, Rebeca Atencia, Debby Cox, Martin N Muller, Volker Sommer, Alexander K Piel, Fiona A Stewart, Sheri Speede, Joe Roman, Gary Wu, Josh Taylor, Rudolf Bohm, Heather M Rose, John Carlson, Deus Mjungu, Paul Schmidt, Celeste Gaughan, Joyslin I Bushman, Ella Schmidt, Kyle Bittinger, Ronald G Collman, Beatrice H Hahn, Frederic D Bushman

Department of Medicine Faculty Papers

Classical ecology provides principles for construction and function of biological communities, but to what extent these apply to the animal-associated microbiota is just beginning to be assessed. Here, we investigated the influence of several well-known ecological principles on animal-associated microbiota by characterizing gut microbial specimens from bilaterally symmetrical animals (

Perceptions About Authentic Leadership Development: South African Occupational Therapy Students' Camp Experience, Fatima Hendricks, Susan Toth-Cohen

Department of Occupational Therapy Faculty Papers

Background. Twenty-three years into democracy, concern is deepening regarding the slow progress of Occupational Therapy (OT) in South Africa, especially with regard to diversity and inclusion within OT. Methods. This study explores authentic leadership development primarily among Black OT students attending a pilot Occupational Therapy Association of South Africa (OTASA) National Student Leadership Camp. It seeks to ascertain their perceptions on leadership and leadership development. This descriptive pilot study employs in-depth interviews and subsequent content analysis, with 12 OT students from six university OT programs in South Africa. Findings. Four categories of participant perceptions on authentic leadership development emerged from …

A New Mini-Navigation Tool Allows Accurate Component Placement During Anterior Total Hip Arthroplasty., Javad Parvizi Md, Jessica R. Benson, Jeffrey M. Muir

Department of Orthopaedic Surgery Faculty Papers

Introduction: Computer-assisted navigation systems have been explored in total hip arthroplasty (THA) to improve component positioning. While these systems traditionally rely on anterior pelvic plane registration, variances in soft tissue thickness overlying anatomical landmarks can lead to registration error, and the supine coronal plane has instead been proposed. The purpose of this study was to evaluate the accuracy of a novel navigation tool, using registration of the anterior pelvic plane or supine coronal plane during simulated anterior THA.

Methods: Measurements regarding the acetabular component position, and changes in leg length and offset were recorded. Benchtop phantoms and target measurement values …

Implementation Of An Iv Workflow System To Reduce Iv Preparation Errors, Craig Senholzi, Rph, Mba, Jeremy Lawton, Pharmd, Gary Bea, Bs, Brian G. Swift, Pharm.D., Mba

Pharmacy Presentations, Posters, and Grand Rounds

The goals of our IV workflow implementation project were to:

• Promote safety by reducing the number of preparation errors involving IV products that could subsequently lead to patient harm.
• Promote efficiency and standardization in our IV workflow process.
• Minimize waste of compounded IV products.
• Assist in our journey toward high reliability.

Expression Of Carbonic Anhydrase Iii, A Nucleus Pulposus Phenotypic Marker, Is Hypoxia-Responsive And Confers Protection From Oxidative Stress-Induced Cell Death., Elizabeth S. Silagi, Philip Batista, Irving Shapiro, Makarand V. Risbud

Department of Stem Cell Biology and Regenerative Medicine Faculty Papers & Presentations

The integrity of the avascular nucleus pulposus (NP) phenotype plays a crucial role in the maintenance of intervertebral disc health. While advances have been made to define the molecular phenotype of healthy NP cells, the functional relevance of several of these markers remains unknown. In this study, we test the hypothesis that expression of Carbonic Anhydrase III (CAIII), a marker of the notochordal NP, is hypoxia-responsive and functions as a potent antioxidant without a significant contribution to pH homeostasis. NP, but not annulus fibrosus or end-plate cells, robustly expressed CAIII protein in skeletally mature animals. Although CAIII expression was hypoxia-inducible, …

Spsnet: Subpopulation-Sensitive Network-Based Analysis Of Heterogeneous Gene Expression Data., Abha Belorkar, Rajanikanth Vadigepalli, Limsoon Wong

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Transcriptomic datasets often contain undeclared heterogeneity arising from biological variation such as diversity of disease subtypes, treatment subgroups, time-series gene expression, nested experimental conditions, as well as technical variation due to batch effects, platform differences in integrated meta-analyses, etc. However, current analysis approaches are primarily designed to handle comparisons between experimental conditions represented by homogeneous samples, thus precluding the discovery of underlying subphenotypes. Unsupervised methods for subtype identification are typically based on individual gene level analysis, which often result in irreproducible gene signatures for potential subtypes. Emerging methods to study heterogeneity have been largely developed in the context of …

The Rna Binding Protein Sorbs2 Suppresses Metastatic Colonization Of Ovarian Cancer By Stabilizing Tumor-Suppressive Immunomodulatory Transcripts., Linjie Zhao, Wei Wang, Shuang Huang, Zhengnan Yang, Lian Xu, Qilian Yang, Xiu Zhou, Jinjin Wang, Qiuhong Shen, Chenlu Wang, Xiaobing Le, Min Feng, Nianxin Zhou, Wayne Bond Lau, Bonnie Lau, Shaohua Yao, Tao Yi, Xin Wang, Xia Zhao, Yuquan Wei, Shengtao Zhou

Department of Emergency Medicine Faculty Papers

BACKGROUND: Ovarian cancer constitutes one of the most lethal gynecologic malignancies for females. Currently, early detection strategies and therapeutic options for ovarian cancer are far from satisfactory, leading to high diagnosis rates at late stages and disease relapses. New avenues of therapy are needed that target key processes in ovarian cancer progression. While a variety of non-coding RNAs have been proven to regulate ovarian cancer metastatic progression, the functional roles of RNA-binding proteins (RBPs) in this process are less well defined.

RESULTS: In this study, we identify that the RBP sorbin and SH3 domain containing 2 (SORBS2) is a potent …

Sex-Dependent Effects Of Developmental Lead Exposure On The Brain, Garima Singh, Vikrant Singh, Marissa Sobolewski, Deborah A. Cory-Slechta, Jay S. Schneider

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The role of sex as an effect modifier of developmental lead (Pb) exposure has until recently received little attention. Lead exposure in early life can affect brain development with persisting influences on cognitive and behavioral functioning, as well as, elevated risks for developing a variety of diseases and disorders in later life. Although both sexes are affected by Pb exposure, the incidence, manifestation, and severity of outcomes appears to differ in males and females. Results from epidemiologic and animal studies indicate significant effect modification by sex, however, the results are not consistent across studies. Unfortunately, only a limited number of …