Medicine and Health Sciences Commons^™

Department Integration Of A Community Hospital With A Large Urban Teaching Hospital: A Case Report, Jessica Shank, Pt

Jefferson Hospital Staff Papers and Presentations

Purpose/Background

Healthcare is rapidly changing and community hospitals are no longer able to keep up. Accountable Care Organizations (ACOs) are absorbing many of these hospitals. Rehab departments within these facilities are afforded the opportunity to impact the financial bottom line by removing inefficiencies and promoting higher quality patient care. The purpose of this quality improvement initiative was to develop a process to integrate departments focusing on efficiency, patient care, and employee engagement.

Telemedicine Coverage For Post-Operative Icu Patients., Tara Ann Collins, Matthew P. Robertson, Corinna P. Sicoutris, Michael A. Pisa, Daniel N. Holena, Patrick M. Reilly, Benjamin A. Kohl

Department of Anesthesiology Faculty Papers

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical …

Prospects And Limitations Of Improving Skeletal Growth In A Mouse Model Of Spondyloepiphyseal Dysplasia Caused By R992c (P.R1192c) Substitution In Collagen Ii., Machiko Arita, Jolanta Fertala, Cheryl Hou, James Kostas, Andrzej Steplewski, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Skeletal dysplasias form a group of skeletal disorders caused by mutations in macromolecules of cartilage and bone. The severity of skeletal dysplasias ranges from precocious arthropathy to perinatal lethality. Although the pathomechanisms of these disorders are generally well defined, the feasibility of repairing established aberrant skeletal tissues that developed in the presence of mutant molecules is currently unknown. Here, we employed a validated mouse model of spondyloepiphyseal dysplasia (SED) that enables temporal control of the production of the R992C (p.R1192C) collagen II mutant that causes this disease. Although in our earlier studies we determined that blocking the expression of this …

Academic Primer Series: Five Key Papers For Consulting Clinician Educators., Teresa M. Chan, Michael Gottlieb, Antonia Quinn, Kory S. London, Lauren W. Conlon, Felix Ankel

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Clinician educators are often asked to perform consultations for colleagues. Invitations to consult and advise others on local problems can help foster great collaborations between centers, and allows for an exchange of ideas between programs. In this article, the authors identify and summarize several key papers to assist emerging clinician educators with the consultation process.

METHODS: A consensus-building process was used to generate a list of key papers that describe the importance and significance of educational consulting, informed by social media sources. A three-round voting methodology, akin to a Delphi study, determined the most impactful papers from the larger …

A Comparison Of Usage And Outcomes Between Nurse Practitioner And Resident-Staffed Medical Icus., Rachel Scherzer, Marie P Dennis, Beth Ann Swan, Mani Kavuru, David A. Oxman

College of Nursing Faculty Papers & Presentations

OBJECTIVE: To compare usage patterns and outcomes of a nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU.

DESIGN: Retrospective chart review of 1,157 medical ICU admissions from March 2012 to February 2013.

SETTING: Large urban academic university hospital.

SUBJECTS: One thousand one hundred fifty-seven consecutive medical ICU admissions including 221 nurse practitioner-staffed medical ICU admissions (19.1%) and 936 resident-staffed medical ICU admissions (80.9%).

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Data obtained included age, gender, race, medical ICU admitting diagnosis, location at time of ICU transfer, code status at ICU admission, and severity of illness using both Acute Physiology …

Management Of Forehead Scars, Ryan N. Heffelfinger, Akshay Sanan, Lucas M. Bryant

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

This article provides an overview of scar management within the forehead region. It addresses the unique challenges specific to the treatment of forehead wounds. A logical, stepwise approach is used. A subsite based treatment algorithm is provided along with a review of current best practices. Pertinent case examples are included for demonstration purposes.

Prone Position: Does It Help With Acute Respiratory Distress Syndrome (Ards) Requiring Extracorporeal Membrane Oxygenation (Ecmo)?, Nava Azimzadeh, Michael Baram, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

Introduction: Lung protective ventilation therapy with low tidal volume-high PEEP is the standard treatment for the patients with acute respiratory distress syndrome (ARDS). Oscillators are occasionally used for salvage ventilation in cases where poor compliance restricts the use of traditional ventilation with ARDS. In addition to ventilator therapy, prone positioning has been used to improve oxygenation. We presented a challenging case of ARDS, which failed medical management extracorporeal membrane oxygenation (ECMO) support and oscillatory ventilation. Prone positioning was initiated which improved oxygenation, respiratory compliance and posterior atelectasis. Case presentation: A 41-year-old morbid obese female developed ARDS due to influenza pneumonia. …

Associations Of Emergency Department Length Of Stay With Publicly Reported Quality-Of-Care Measures., Anna Marie Chang, Amber Lin, Rongwei Fu, K. John Mcconnell, Benjamin Sun

Department of Emergency Medicine Faculty Papers

OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals.

METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of …

5'-Terminal Nucleotide Variations In Human Cytoplasmic Trnahisgug And Its 5'-Halves., Megumi Shigematsu, Yohei Kirino

Computational Medicine Center Faculty Papers

Transfer RNAs (tRNAs) are fundamental adapter components of translational machinery. tRNAs can further serve as a source of tRNA-derived noncoding RNAs that play important roles in various biological processes beyond translation. Among all species of tRNAs, tRNA(HisGUG) has been known to uniquely contain an additional guanosine residue at the -1 position (G-1) of its 5'-end. To analyze this -1 nucleotide in detail, we developed a TaqMan qRT-PCR method that can distinctively quantify human mature cytoplasmic tRNA(HisGUG) containing G-1, U-1, A-1, or C-1 or lacking the -1 nucleotide (starting from G1). Application of this method to the mature tRNA fraction of …

A Word From The Writing Center (February 2017), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Writing tip
• Publishing news
• Writing Café

Challenges To Smartphone Applications For Melanoma Detection, Jordan V. Wang, Lance W. Chapman, Matthew S. Keller

Department of Dermatology and Cutaneous Biology Faculty Papers

This commentary addresses the emerging market for health-related smartphone applications. Specific to dermatology, there has been a significant increase not only in applications that promote skin cancer awareness and education but also in those meant for detection. With evidence showing that 365 dermatology-related applications were available in 2014--up from 230 in 2012--and that 1 in 5 patients under the age of 50 have used a smartphone to help diagnose a skin problem, there is clearly a large subset of patients participating in this growing trend. Therefore, we are obligated to take a closer look into this phenomenon. Studies have shown …

Holocaust Remembrance Day Presentation Available In The Jefferson Digital Commons, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

A commemoration of the Holocaust was held at Thomas Jefferson University on January 27, the anniversary of the day that prisoners were liberated from the Auschwitz-Birkenau concentration camp in 1945. The program “Nazi Medicine, the Holocaust, and the Problem of Collective Evil”, featured a presentation by Salvatore Mangione, MD, Associate Professor of Medicine, Sidney Kimmel Medical College. Mangione discussed why study of the horrors of the Holocaust is especially important for medicine. A recording of the presentation, Group Thinking and the Roots of Collective Evil Implications for Health Care, is available in the Jefferson Digital Commons.

Portal Protein Functions Akin To A Dna-Sensor That Couples Genome-Packaging To Icosahedral Capsid Maturation., Ravi K. Lokareddy, Rajeshwer S. Sankhala, Ankoor Roy, Pavel V. Afonine, Tina Motwani, Carolyn M M. Teschke, Kristin N. Parent, Gino Cingolani

Department of Biochemistry and Molecular Biology Faculty Papers

Tailed bacteriophages and herpesviruses assemble infectious particles via an empty precursor capsid (or 'procapsid') built by multiple copies of coat and scaffolding protein and by one dodecameric portal protein. Genome packaging triggers rearrangement of the coat protein and release of scaffolding protein, resulting in dramatic procapsid lattice expansion. Here, we provide structural evidence that the portal protein of the bacteriophage P22 exists in two distinct dodecameric conformations: an asymmetric assembly in the procapsid (PC-portal) that is competent for high affinity binding to the large terminase packaging protein, and a symmetric ring in the mature virion (MV-portal) that has negligible affinity …

Improving Medication Use For Project Home Residents In An Urban Setting, Toni Campanella, Pharmd Candidate, Ashley Maister, Pharmd Candidate, Roshni S. Patel, Pharmd, Bcps

College of Pharmacy Posters

Partners:

Project HOME is a non-profit organization in Philadelphia that provides housing, employment opportunities, medical care, and education to those who are homeless or at risk of becoming homeless, including those with a history of serious mental health or substance misuse disorders.

Jefferson College of Pharmacy students are dedicated to transforming the health and well-being of the community. By engaging in innovative opportunities, students are well-positioned to deliver patient-centered care.

APhA-ASP serves as the collective voice of student pharmacists to provide opportunities for professional growth, to improve patient care, and to envision and advance the future of pharmacy.

From Emt To Hsc To Aml: Zeb2 Is A Cell Fate Switch., Sara E. Meyer

Department of Cancer Biology Faculty Papers

In this issue of Blood, complimentary studies by J. Li et al¹ and H. Li et al² identify the transcription factor ZEB2 as a critical regulator of multilineage differentiation in both normal and malignant hematopoiesis. In particular, these studies show that ZEB2 is an inhibitor of normal granulocyte production, and in acute myeloid leukemia (AML), antagonizing ZEB2 function releases the granulocytic differentiation block, creating an antileukemic therapeutic effect.

Grand Rounds In The Jefferson Digital Commons, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

The Jefferson Digital Commons has a collection of grand rounds presentations archived from various departments, including: 

• Surgery
• Otolaryngology
• Kimmel Cancer Center
• Family and Community Medicine
• Integrative Medicine

T Cell Migration From Inflamed Skin To Draining Lymph Nodes Requires Intralymphatic Crawling Supported By Icam-1/Lfa-1 Interactions., Alvaro Teijeira, Morgan C. Hunter, Erica Russo, Steven T Proulx, Thomas Frei, Gudrun F. Debes, Marc Coles, Ignacio Melero, Michael Detmar, Ana Rouzaut, Cornelia Halin

Department of Microbiology and Immunology Faculty Papers

T cells are the most abundant cell type found in afferent lymph, but their migration through lymphatic vessels (LVs) remains poorly understood. Performing intravital microscopy in the murine skin, we imaged T cell migration through afferent LVs in vivo. T cells entered into and actively migrated within lymphatic capillaries but were passively transported in contractile collecting vessels. Intralymphatic T cell number and motility were increased during contact-hypersensitivity-induced inflammation and dependent on ICAM-1/LFA-1 interactions. In vitro, blockade of endothelial cell-expressed ICAM-1 reduced T cell adhesion, crawling, and transmigration across lymphatic endothelium and decreased T cell advancement from capillaries into lymphatic collectors …

Ladarixin, A Dual Cxcr1/2 Inhibitor, Attenuates Experimental Melanomas Harboring Different Molecular Defects By Affecting Malignant Cells And Tumor Microenvironment., Daria Marley Kemp, Alyson Pidich, Mary Larijani, Rebecca Jonas, Elizabeth Lash, Takami Sato, Mizue Terai, Maria De Pizzol, Marcello Allegretti, Olga Igoucheva, Vitali Alexeev

Department of Dermatology and Cutaneous Biology Faculty Papers

CXCR1 and CXCR2 chemokine receptors and their ligands (CXCL1/2/3/7/8) play an important role in tumor progression. Tested to date CXCR1/2 antagonists and chemokine-targeted antibodies were reported to affect malignant cells in vitro and in animal models. Yet, redundancy of chemotactic signals and toxicity hinder further clinical development of these approaches. In this pre-clinical study we investigated the capacity of a novel small molecule dual CXCR1/2 inhibitor, Ladarixin (LDX), to attenuate progression of experimental human melanomas. Our data showed that LDX-mediated inhibition of CXCR1/2 abrogated motility and induced apoptosis in cultured cutaneous and uveal melanoma cells and xenografts independently of the …

Fsd-C10, A Fasudil Derivative, Promotes Neuroregeneration Through Indirect And Direct Mechanisms., Yan-Hua Li, Chong Xie, Yuan Zhang, Xing Li, Hai-Fei Zhang, Qing Wang, Zhi Chai, Bao-Guo Xiao, Rodolfo Thome, Guang-Xian Zhang, Cun-Gen Ma

Department of Neurology Faculty Papers

FSD-C10, a Fasudil derivative, was shown to reduce severity of experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS), through the modulation of the immune response and induction of neuroprotective molecules in the central nervous system (CNS). However, whether FSD-C10 can promote neuroregeneration remains unknown. In this study, we further analyzed the effect of FSD-C10 on neuroprotection and remyelination. FSD-C10-treated mice showed a longer, thicker and more intense MAP2 and synaptophysin positive signal in the CNS, with significantly fewer CD4(+) T cells, macrophages and microglia. Importantly, the CNS of FSD-C10-treated mice showed a shift of activated macrophages/microglia from …

Maternal And Newborn Health In Karnataka State, India: The Community Level Interventions For Pre-Eclampsia (Clip) Trial's Baseline Study Results., Mrutynjaya B. Bellad, Marianne Vidler, Narayan V. Honnungar, Ashalata Mallapur, Umesh Ramadurg, Umesh Charanthimath, Geetanjali Katageri, Shashidhar Bannale, Avinash Kavi, Chandrashekhar Karadiguddi, Sumedha Sharma, Tang Lee, Jing Li, Beth Payne, Laura Magee, Peter Von Dadelszen, Richard Derman, Shivaprasad S. Goudar

Department of Obstetrics and Gynecology Faculty Papers

Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)-Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in …

T-Cadherin Deficiency Increases Vascular Vulnerability In T2dm Through Impaired No Bioactivity., Han Wang, Ling Tao, Anastasia Ambrosio, Wenjun Yan, Ross Summer, Wayne Bond Lau, Yajing Wang, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

BACKGROUND: Endothelial dysfunction plays a critical role in the development of type 2 diabetes (T2DM). T-cadherin (T-cad) has gained recognition as a regulator of endothelial cell (EC) function. The present study examined whether T-cad deficiency increases vascular vulnerability in T2DM.

METHODS: Vascular segments were isolated from WT or T-cad knockout mice. Endothelial function, total NO accumulation, and the expression of T-cad related proteins were determined.

RESULTS: Ach and acidified NaNO2 induced similar vasorelaxation in WT groups. T-cad KO mice exhibited normal response to acidified NaNO2, but manifested markedly reduced response to Ach. NO accumulation was also decreased in T-cad KO …

Endothelium In The Pharyngeal Arches 3, 4 And 6 Is Derived From The Second Heart Field., Xia Wang, Dongying Chen, Kelley Chen, Ali Jubran, Annjosette Ramirez, Sophie Astrof

Center for Translational Medicine Faculty Papers

Oxygenated blood from the heart is directed into the systemic circulation through the aortic arch arteries (AAAs). The AAAs arise by remodeling of three symmetrical pairs of pharyngeal arch arteries (PAAs), which connect the heart with the paired dorsal aortae at mid-gestation. Aberrant PAA formation results in defects frequently observed in patients with lethal congenital heart disease. How the PAAs form in mammals is not understood. The work presented in this manuscript shows that the second heart field (SHF) is the major source of progenitors giving rise to the endothelium of the pharyngeal arches 3 - 6, while the endothelium …

Regulation Of Sleep Plasticity By A Thermo-Sensitive Circuit In Drosophila., Angelique Lamaze, Arzu Öztürk-Çolak, Robin Fischer, Nicolai Peschel, Kyunghee Koh, James E.C. Jepson

Department of Neuroscience Faculty Papers

Sleep is a highly conserved and essential behaviour in many species, including the fruit fly Drosophila melanogaster. In the wild, sensory signalling encoding environmental information must be integrated with sleep drive to ensure that sleep is not initiated during detrimental conditions. However, the molecular and circuit mechanisms by which sleep timing is modulated by the environment are unclear. Here we introduce a novel behavioural paradigm to study this issue. We show that in male fruit flies, onset of the daytime siesta is delayed by ambient temperatures above 29 °C. We term this effect Prolonged Morning Wakefulness (PMW). We show that …

Sports Medicine Potpourri, Marc I. Harwood, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

At the conclusion of this talk, the learner will be:

• Thoroughly confused by the whirlwind of information presented
• But...able to delve into any of the topics at greater length when time permits.

Presentation: 52:03

Audio for PowerPoint slides.

Androgen Receptor-Dependent And -Independent Mechanisms Driving Prostate Cancer Progression: Opportunities For Therapeutic Targeting From Multiple Angles., David T. Hoang, Kenneth A. Iczkowski, Deepak Kilari, William See, Marja T. Nevalainen

Student Papers, Posters & Projects

Despite aggressive treatment for localized cancer, prostate cancer (PC) remains a leading cause of cancer-related death for American men due to a subset of patients progressing to lethal and incurable metastatic castrate-resistant prostate cancer (CRPC). Organ-confined PC is treated by surgery or radiation with or without androgen deprivation therapy (ADT), while options for locally advanced and disseminated PC include radiation combined with ADT, or systemic treatments including chemotherapy. Progression to CRPC results from failure of ADT, which targets the androgen receptor (AR) signaling axis and inhibits AR-driven proliferation and survival pathways. The exact mechanisms underlying the transition from androgen-dependent PC …

Urokinase Plasminogen Activator Expression Is Regulated By P53 Harboring The Lung Cancer-Specific Mutation V157f, Julie Barta, Md, Kristen Pauley, Steven B. Mcmahon, Phd

Department of Biochemistry and Molecular Biology Posters

OBJECTIVES

• To define the mutant p53-regulated transcriptome of lung cancer cells with alterations at V157 and R158 in the p53 tumor suppressor.
• To determine the biological effects of lung-enriched p53 mutations in lung cancer cells.

Diversity And Plasticity In Signaling Pathways That Regulate Smooth Muscle Responsiveness: Paradigms And Paradoxes For The Myosin Phosphatase, The Master Regulator Of Smooth Muscle Contraction., Masumi Eto, Toshio Kitazawa

Department of Molecular Physiology and Biophysics Faculty Papers

A hallmark of smooth muscle cells is their ability to adapt their functions to meet temporal and chronic fluctuations in their demands. These functions include force development and growth. Understanding the mechanisms underlying the functional plasticity of smooth muscles, the major constituent of organ walls, is fundamental to elucidating pathophysiological rationales of failures of organ functions. Also, the knowledge is expected to facilitate devising innovative strategies that more precisely monitor and normalize organ functions by targeting individual smooth muscles. Evidence has established a current paradigm that the myosin light chain phosphatase (MLCP) is a master regulator of smooth muscle responsiveness …

Biological Functions Of Cdk5 And Potential Cdk5 Targeted Clinical Treatments., Alison Shupp, Mathew C. Casimiro, Richard G. Pestell

Department of Cancer Biology Faculty Papers

Cyclin dependent kinases are proline-directed serine/threonine protein kinases that are traditionally activated upon association with a regulatory subunit. For most CDKs, activation by a cyclin occurs through association and phosphorylation of the CDK's T-loop. CDK5 is unusual because it is not typically activated upon binding with a cyclin and does not require T-loop phosphorylation for activation, even though it has high amino acid sequence homology with other CDKs. While it was previously thought that CDK5 only interacted with p35 or p39 and their cleaved counterparts, Recent evidence suggests that CDK5 can interact with certain cylins, amongst other proteins, which modulate …

Transgender Care, Nyasha George, Md, Pgy 3

Department of Family & Community Medicine Presentations and Grand Rounds

Outline:

Objectives

Review of trans epidemiology

Healthcare and the Transcommunity

Cases 1&2

• Taking a transgender history
• CSH indications

Case 3

• Mental Health and Transpersons

Case 4

• Cardiovascular Risks and Estrogen in Transwomen
• Provider Resources

Objectives

My goals for you at the end of this lecture:

Comfort in determining which transgender patients meet criteria for initiating CSH

Appreciation of the overlap between transgender identity and psychiatric disease as mediated primarily by trauma

Improved self efficacy in weighing risks/benefits of CSH therapy

Familiarity with resources available to help support primary care providers take care of transgender patients.

Presentation: 58:36

Promoting Family Resilience As A Population Health Strategy, Barry J. Jacobs, Psy.D.

Department of Family & Community Medicine Presentations and Grand Rounds

Today's Talk:

• Why family matters to population health
• Research from two movements
• Steps toward patient and family resilience
• Barriers to integrating family caregivers into healthcare
• Healthcare-based family caregiver support programs: Baylor Scott & White, Concord Hospital

No audio, just PowerPoint slides