Medicine and Health Sciences Commons^™

Polypharmacy And Potentially Inappropriate Medication Use In Geriatric Oncology., Manvi Sharma, Kah Poh Loh, Ginah Nightingale Pharmd, Bcop, Supriya G. Mohile, Holly M. Holmes

College of Pharmacy Faculty Papers

Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. …

Bone Mineral Density In Mucopolysaccharidosis Ivb, Francyne Kubaski, Heidi H. Kecskemethy, Howard T. Harcke, Shunji Tomatsu

Department of Radiology Faculty Papers

To date, the only published reports of bone mineral density (BMD) in MPS IV involve patients with MPS IVA; no reports exist describing BMD for MPS IVB. In this prospective study of BMD in three patients with MPS IVB, BMD was acquired by dual-energy X-ray absorptiometry (DXA) at whole body (WB), lumbar spine (LS), and lateral distal femur (LDF). Functional abilities, ambulatory status, medical history, and height z-score were evaluated. Three patients with MPS IVB (two females), aged 17.7, 31.4 and 31.7 years, were evaluated. Every patient was ambulatory and one sustained two fractures caused by trauma. Whole body and …

Non-Psychotropic Cannabinoid Based Therapy Modulates Nociceptive Signaling Molecules, Microglia, And Pain Behavior In A Model Of Post-Concussion Headache, Jarred M. Stratton, Lan Cheng, Ashley L. Tyburski, Jessica Perino, Melanie B. Elliott

Department of Neurosurgery Posters

Background & Objectives

Headache is a common symptom of post-concussion syndrome which may persist in a substantial portion of patients contributing to a poor quality of life and disability. There is a pressing need to develop novel treatments for post-traumatic headache as current treatments have a number of side effects, are contraindicated or lack efficacy. The Elliott laboratory first established models of post-traumatic headache demonstrating sensitization of trigeminal neurons in rodent models of post-traumatic headache using well-known nociceptive and behavioral markers in the pain and migraine fields^1-3. Traumatic brain injury in mice increases expression of calcitonin gene related …

Systemic Inflammatory Response Syndrome (Sirs) After Extracorporeal Membrane Oxygenation (Ecmo): Incidence, Risks And Survivals., Karthik Thangappan, Nicholas C. Cavarocchi, Michael Baram, Brandi Thoma, Hitoshi Hirose

Department of Surgery Faculty Papers

INTRODUCTION: Systemic inflammatory response syndrome (SIRS) is frequently observed after extracorporeal membrane oxygenation (ECMO) decannulation; however, these issues have not been investigated well in the past.

METHODS: Retrospective chart review was performed to identify post-ECMO SIRS phenomenon, defined by exhibiting 2/3 of the following criteria: fever, leukocytosis, and escalation of vasopressors. The patients were divided into 2 groups: patients with documented infections (Group I) and patients with true SIRS (Group TS) without any evidence of infection. Survival and pre-, intra- and post-ECMO risk factors were analyzed.

RESULTS: Among 62 ECMO survivors, 37 (60%) patients developed the post-ECMO SIRS phenomenon, including …

Multi-Focal Control Of Mitochondrial Gene Expression By Oncogenic Myc Provides Potential Therapeutic Targets In Cancer., Amanda R. Oran, Clare M. Adams, Xiao-Yong Zhang, Victoria J. Gennaro, Harla K. Pfeiffer, Hestia S. Mellert, Hans E. Seidel, Kirsten Mascioli, Jordan Kaplan, Mahmoud R. Gaballa, Chen Shen, Isidore Rigoutsos, Michael P. King, Justin L Cotney, Jamie J. Arnold, Suresh D. Sharma, Ubaldo E. Martinez-Outshoorn, Christopher R. Vakoc, Lewis A. Chodosh, James E. Thompson, James E. Bradner, Craig E. Cameron, Gerald S. Shadel, Christine M. Eischen, Steven B. Mcmahon

Department of Cancer Biology Faculty Papers

Despite ubiquitous activation in human cancer, essential downstream effector pathways of the MYC transcription factor have been difficult to define and target. Using a structure/function-based approach, we identified the mitochondrial RNA polymerase (POLRMT) locus as a critical downstream target of MYC. The multifunctional POLRMT enzyme controls mitochondrial gene expression, a process required both for mitochondrial function and mitochondrial biogenesis. We further demonstrate that inhibition of this newly defined MYC effector pathway causes robust and selective tumor cell apoptosis, via an acute, checkpoint-like mechanism linked to aberrant electron transport chain complex assembly and mitochondrial reactive oxygen species (ROS) production. Fortuitously, MYC-dependent …

Phase I Dose-Escalation Study Of The Mtor Inhibitor Sirolimus And The Hdac Inhibitor Vorinostat In Patients With Advanced Malignancy., Haeseong Park, Ignacio Garrido-Laguna, Aung Naing, Siqing Fu, Gerald S. Falchook, Sarina A. Piha-Paul, Jennifer J. Wheler, David S. Hong, Apostolia M. Tsimberidou, Vivek Subbiah, Ralph G. Zinner, Ahmed O. Kaseb, Shreyaskumar Patel, Michelle A. Fanale, Vivianne M M. Velez-Bravo, Funda Meric-Bernstam, Razelle Kurzrock, Filip Janku

Department of Medical Oncology Faculty Papers

Preclinical models suggest that histone deacetylase (HDAC) and mammalian target of rapamycin (mTOR) inhibitors have synergistic anticancer activity. We designed a phase I study to determine the safety, maximum tolerated dose (MTD), recommended phase II dose (RP2D), and dose-limiting toxicities (DLTs) of combined mTOR inhibitor sirolimus (1 mg-5 mg PO daily) and HDAC inhibitor vorinostat (100 mg-400 mg PO daily) in patients with advanced cancer. Seventy patients were enrolled and 46 (66%) were evaluable for DLT assessment since they completed cycle 1 without dose modification unless they had DLT. DLTs comprised grade 4 thrombocytopenia (n = 6) and grade 3 …

The Financial And Professional Impact Of Anterior Cruciate Ligament Injuries In National Football League Athletes., Eric S. Secrist, Suneel B. Bhat, Christopher C. Dodson

Rothman Institute Papers

BACKGROUND: Anterior cruciate ligament (ACL) injuries can have negative consequences on the careers of National Football League (NFL) players, however no study has ever analyzed the financial impact of these injuries in this population.

PURPOSE: To quantify the impact of ACL injuries on salary and career length in NFL athletes.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Any player in the NFL suffering an ACL injury from 2010 to 2013 was identified using a comprehensive online search. A database of NFL player salaries was used to conduct a matched cohort analysis comparing ACL-injured players with the rest of …

Therapeutic Interventions For The Treatment Of Infants Exposed To Drugs And Alcohol In Utero, Faigie Bier, Ots, Elizabeth Fenn, Ots, Angela Kochobay, Ots, Katie Moran, Ots, Kavita Naik, Ots

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

Primary Focus (Complete): Children and Youth

Learning Objectives (Provide 3 learning objectives):

At the conclusion of the session, the learner will be able to:

1. Identify areas of occupational performance that are affected when an infant is born with Neonatal Abstinence Syndrome or Fetal Alcohol Spectrum Disorder.
2. Recognize the importance of therapeutic interventions in promoting healthy development and participation of infants within the scope of practice for occupational therapy.
3. Apply evidence-based occupational therapy interventions for infants with Neonatal Abstinence Syndrome (NAS) or Fetal Alcohol Spectrum Disorders (FASD).

Abstract:

In the United States, approximately 0.2-1.5 per 1,000 infants are …

Retrain Your Brain: A Systematic Review Of Functional Electrical Stimulation’S Effect On Adl Participation Post-Stroke, Alyssa Brief, Ots, Jimmy Cassel, Ots, Rachael Kaufman, Ots, Caitlin Knudsen, Ots, Sharon Krause, Ots

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

Primary Focus: Rehab, Disability & Participation Learning Objectives:

Learning Objectives:

● Describe the impact of stroke on ADL performance

● Identify the role of OT in stroke rehabilitation

● Explain how Functional Electrical Stimulation (FES) falls within the scope of OT practice

● Interpret the current evidence on how FES influences ADL participation for individuals poststroke

Abstract:

Stroke is one of the leading causes of long term disability in the United States (Centers for Disease Control and Prevention, 2015). According to HartmanMaeir, Soroker, Ring, Avni, and Katz (2007), 57% of stroke survivors will eventually discontinue their meaningful activities, including activities …

Losing A Limb, Regaining Independence: A Systematic Review Of Occupational Therapy Interventions For Lower Extremity Amputations, Davis Berzins, Ots, Jennifer Cohen, Ots, Jamie A. Frank, Ots, Gabrielle Kirk, Ots, Jennifer Mitchell, Ots

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

Primary Focus:

Rehab, Disability & Participation

Learning Objectives:

1. Describe lower extremity residual limb care interventions within the scope of occupational therapy
2. Explain the prevalence of individuals who sustain a lower extremity amputation and understand the impact on the U.S. health-care system
3. Identify lower extremity residual limb care interventions to maximize occupational performance

Abstract:

The purpose of this presentation is to report findings of a systematic review regarding residual limb care interventions supporting increased occupational performance in adults post lower extremity amputation. A systematic review was completed utilizing PubMed, CINHAL, and OTseeker. Inclusion criteria included articles with a sample of adults …

Aging In Place: Technology And Independence For Community-Dwelling Older Adults, Mikael Avery, Ots, Devon Barber, Ots, Maggie Derstine, Ots, Clarice Licon, Ots

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

Primary Focus: Productive Aging

Learning Objectives:

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

1. Explain the rationale for the use of technology-based interventions for community-dwelling older adults.
2. Describe three current technologies that can be used to positively impact occupational performance for community-dwelling older adults.
3. Describe the barriers to successful implementation of technology-based interventions for community-dwelling older adults.

Abstract:

The population of older adults in the U.S. continues to rise, as does the desire to remain in one’s own home, a concept known as “aging in place” (Piau, Campo, Rumeau, Vellas, & Nourhashémi, 2014; Centers …

Can I Have Your Attention? (And Keep It): Interventions To Improve Executive Function Skills In Children Post-Traumatic Brain Injury, Brianna Clee, Ots, Brianna Fecondo, Ots, Sara Johnson, Ots, Catherine Misczak, Ots

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

Primary Focus: Children and Youth

Secondary Focus: Rehab, Disability, & Participation

Learning Objectives:

*Objective 1: Identify and recognize the clinical need of the pediatric traumatic brain injury population in regards to OT practice.

*Objective 2: Interpret presented findings to identify 2-3 of the most effective interventions for desired outcomes for this population.

*Objective 3: Differentiate opportunities and barriers to implementing effective executive functioning interventions in current occupational therapy practice.

Abstract:

Traumatic brain injuries are a frequent source of disability within the pediatric population with estimates of 500:100,00 children in America experiencing an injury each year (Anderson et al., 2012). …

Occupational Therapy Interventions For Activities Of Daily Living In Adults With Osteoarthritis, Amanda Gilroy, Ots, Anna Guthrie, Ots, Tierney Guido, Ots, Maura Iacobucci, Ots

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

Primary Focus: Productive Aging

Learning Objectives:

At the end of this presentation, participants will be able to:

1. Describe the clinical presentation of osteoarthritis and three ways it impacts Activities of Daily Living (ADL) performance
2. Recognize the value of an Occupational Therapy intervention in addition to surgical and pharmacological interventions for osteoarthritis
3. Identify at least three current evidence based practice interventions for improving ADL performance for people with osteoarthritis

Abstract:

Currently, 30.8 million Americans have diagnoses of osteoarthritis (OA) and the number of individuals with arthritis is projected to increase to 78 million by 2040 (CDC, 2016). Health care costs for …

Fall Prevention Interventions For Community-Dwelling Older Adults, Monica Heacock, Ots, Erin Kelly, Ots, June Park, Ots, Alex Muscella, Ots, Tony Thierolf, Ots

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

Primary Focus: Productive Aging

Learning Objectives:

At the conclusion of the session, the learner will be able to: 1. Recognize the impact of falls on community-dwelling older adults

2. Describe ways to include fall prevention interventions into current clinical practice

3. Discuss benefits of preventative interventions in regards to current healthcare trends

Abstract: According to the Centers for Disease Control and Prevention (CDC), older adults (65+ years) are the largest growing population in the United States which comprises 14.5% of the total population (CDC, 2015). This population is estimated to almost double by 2030 to approximately 71 million Americans over …

Occupational Therapy In Preventative Care: Promoting Cardiovascular Health In Underserved Women, David Goldstein, Ots, Rachel Marlow, Ots, Katherine Nelson, Ots, Megan Smith, Ots, Phoi Truong, Ots

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

Primary Focus:

☝ Health & Wellness

Level of session: intermediate, mixed audience

Learning Objectives:

By the conclusion of this presentation, participants will:

Describe how health disparities affect underserved women

Identify evidence supporting the inclusion of occupational therapy in preventative care practice

Discuss occupational therapy’s role in preventative care as it relates to cardiovascular health and wellness

Abstract:

Heart disease causes one in three deaths each year in women (AHA, 2012). Increasing healthcare costs disproportionately affect women with low incomes and those from diverse backgrounds (CHUW, 2012). For underserved women, lack of insurance, education and variations in culture may compromise …

Not Just A “Touch Of The Sugars”: The Use Of Occupational Therapy Interventions To Promote Independence In Diabetes Self-Management, Eric Bull, Ots, Juliana Sullivan, Ots, Jenna Devaney, Ots, Jillian Fader, Ots, Kathleen Sheppard, Ots

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

Primary Focus: Health & Wellness

Secondary Focus: General & Professional Issues

Learning Objectives:

At the end of this presentation, participants will:

Objective 1: Define the scope of self-management in relation to diabetes care.

Objective 2: Describe how the prevalence of diabetes and complications from mismanagement impact the United States healthcare system.

Objective 3: Identify 2-3 ways in which occupational therapists can facilitate diabetes self-management in clinical practice to promote health and wellness.

Abstract:

In the United States (U.S.), 29.1 million people have diabetes mellitus (DM) (Centers for Disease Control and Prevention [CDC], 2014) and the cost of diabetes care …

You’Ve Got Time: Occupational Therapy’S Role In The Juvenile Justice System, Monica Dasgupta, Ots, Jenna Hannan, Ots, Helena Riekena, Ots, Samantha Susson, Ots

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

Primary Focus: Children and Youth

Learning Objectives:

1. State one economic and two population health implications of juvenile incarceration in the United States.
2. Identify two occupation-based interventions implemented in the juvenile justice system.
3. Recognize two areas of opportunity for occupational therapy intervention in the juvenile justice system to promote occupational justice and reduce recidivism.

Abstract:

This is an introductory level presentation for occupational therapists (OTs), occupational therapy assistants, and students intended to provide insight to areas of opportunity for OT intervention to reduce recidivism in the juvenile justice system. A systematic review of the literature was conducted to answer the …

Catastrophic Femoral Head-Stem Trunnion Dissociation Secondary To Corrosion., Laura Matsen Ko, Antonia F. Chen, Md, Mba, Gregory K Deirmengian, William J. Hozack Md, Peter F. Sharkey

Rothman Institute Papers

BACKGROUND: Modular femoral heads provide procedural enhancement by allowing accurate restoration of hip offset and limb-length equalization. However, corrosion may lead to adverse local tissue reactions. Severe trunnion corrosion can also lead to femoral head dissociation and catastrophic implant failure following primary total hip arthroplasty.

METHODS: We describe 5 cases, from our institution, in which the femoral head became dissociated from the femoral stem trunnion secondary to severe corrosion. Possible causes are evaluated.

RESULTS: Demographic commonalities among the 5 patients included a body mass index (BMI) of ≥30 kg/m(2) and male sex. All femoral heads were made of cobalt-chromium alloy …

The 2015 American-British-Canadian Traveling Fellows Report., Alpesh A. Patel, Robert H. Brophy, Rajiv Gandhi, Hue H. Luu, Kishore Mulpuri, Suken A Shah, Sanjeev Kakar

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Integrated Live Imaging And Molecular Profiling Of Embryoid Bodies Reveals A Synchronized Progression Of Early Differentiation., Jonathan Boxman, Naor Sagy, Sirisha Achanta, Rajanikanth Vadigepalli, Iftach Nachman

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Embryonic stem cells can spontaneously differentiate into cell types of all germ layers within embryoid bodies (EBs) in a highly variable manner. Whether there exists an intrinsic differentiation program common to all EBs is unknown. Here, we present a novel combination of high-throughput live two-photon imaging and gene expression profiling to study early differentiation dynamics spontaneously occurring within developing EBs. Onset timing of Brachyury-GFP was highly variable across EBs, while the spatial patterns as well as the dynamics of mesendodermal progression following onset were remarkably similar. We therefore defined a 'developmental clock' using the Brachyury-GFP signal onset timing. Mapping snapshot …

Planetary Health: Report On The 7th Annual Global Health Conference, Lucille B. Pilling Edd,Mph,Rn

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Triple Aim Forces Drive Academic Health Systems Growth, Richard G. Stefanacci Do,Mgh,Mba,Agsf,Cmd, Terri Schieder Rn, Mba

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Telehealth At Jefferson: The Future Of Medicine, Danica Stone

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Mater: Innovative Programs For Maternal Addiction Education Treatment And Research, Meghan Gannon Phd Msph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Specialized Medical Home For Patients With Spinal Cord Injury, Mendel Kupfer Md, Marci Ruediger Pt, Ms, Norah V. Dixon Ma

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Does Tailoring Instructional Style To A Medical Student's Self-Perceived Learning Style Improve Performance When Teaching Intravenous Catheter Placement? A Randomized Controlled Study., Dimitrios Papanagnou, Antonio Serrano, Kaitlyn Barkley, Shruti Chandra, Nicholas Governatori, Nicole Piela, Gregory K. Wanner, Richard Shin

Department of Emergency Medicine Faculty Papers

BACKGROUND: Students may have different learning styles. It is unclear, however, whether tailoring instructional methods for a student's preferred learning style improves educational outcomes when teaching procedures. The authors sought to examine whether teaching to a student's self-perceived learning style improved the acquisition of intravenous (IV) catheter placement skills. The authors hypothesized that matching a medical student's preferred learning style with the instructor's teaching style would increase the success of placing an IV catheter.

METHODS: Using the VARK model (i.e., visual [V], auditory [A], read/write [R] and kinesthetic [K]), third-year medical students reported their self-perceived learning style and were subsequently …

Tumor-Associated Stromal Cells As Key Contributors To The Tumor Microenvironment., Karen M. Bussard, Lysette Mutkus, Kristina Stumpf, Candelaria Gomez-Manzano, Frank C. Marini

Department of Cancer Biology Faculty Papers

The tumor microenvironment is a heterogeneous population of cells consisting of the tumor bulk plus supporting cells. It is becoming increasingly evident that these supporting cells are recruited by cancer cells from nearby endogenous host stroma and promote events such as tumor angiogenesis, proliferation, invasion, and metastasis, as well as mediate mechanisms of therapeutic resistance. In addition, recruited stromal cells range in type and include vascular endothelial cells, pericytes, adipocytes, fibroblasts, and bone-marrow mesenchymal stromal cells. During normal wound healing and inflammatory processes, local stromal cells change their phenotype to become that of reactive stroma. Under certain conditions, however, tumor …

Closed-State Inactivation Involving An Internal Gate In Kv4.1 Channels Modulates Pore Blockade By Intracellular Quaternary Ammonium Ions., Jeffrey D. Fineberg, Tibor G. Szanto, Gyorgy Panyi, Manuel Covarrubias

Department of Neuroscience Faculty Papers

Voltage-gated K(+) (Kv) channel activation depends on interactions between voltage sensors and an intracellular activation gate that controls access to a central pore cavity. Here, we hypothesize that this gate is additionally responsible for closed-state inactivation (CSI) in Kv4.x channels. These Kv channels undergo CSI by a mechanism that is still poorly understood. To test the hypothesis, we deduced the state of the Kv4.1 channel intracellular gate by exploiting the trap-door paradigm of pore blockade by internally applied quaternary ammonium (QA) ions exhibiting slow blocking kinetics and high-affinity for a blocking site. We found that inactivation gating seemingly traps benzyl-tributylammonium …

Mitochondrial Akt Regulation Of Hypoxic Tumor Reprogramming., Young Chan Chae, Valentina Vaira, M. Cecilia Caino, Hsin-Yao Tang, Jae Ho Seo, Andrew V. Kossenkov, Luisa Ottobrini, Cristina Martelli, Giovanni Lucignani, Irene Bertolini, Marco Locatelli, Kelly G. Bryant, Jagadish C. Ghosh, Sofia Lisanti, Bonsu Ku, Silvano Bosari, Lucia R. Languino, David W. Speicher, Dario C. Altieri

Department of Cancer Biology Faculty Papers

Hypoxia is a universal driver of aggressive tumor behavior, but the underlying mechanisms are not completely understood. Using a phosphoproteomics screen, we now show that active Akt accumulates in the mitochondria during hypoxia and phosphorylates pyruvate dehydrogenase kinase 1 (PDK1) on Thr346 to inactivate the pyruvate dehydrogenase complex. In turn, this pathway switches tumor metabolism toward glycolysis, antagonizes apoptosis and autophagy, dampens oxidative stress, and maintains tumor cell proliferation in the face of severe hypoxia. Mitochondrial Akt-PDK1 signaling correlates with unfavorable prognostic markers and shorter survival in glioma patients and may provide an "actionable" therapeutic target in cancer.

The Airway Microbiome At Birth., Charitharth Vivek Lal, Colm Travers, Zubair H. Aghai, Peter Eipers, Tamas Jilling, Brian Halloran, Waldemar A. Carlo, Jordan Keeley, Gabriel Rezonzew, Ranjit Kumar, Casey Morrow, Vineet Bhandari, Namasivayam Ambalavanan

Department of Pediatrics Faculty Papers

Alterations of pulmonary microbiome have been recognized in multiple respiratory disorders. It is critically important to ascertain if an airway microbiome exists at birth and if so, whether it is associated with subsequent lung disease. We found an established diverse and similar airway microbiome at birth in both preterm and term infants, which was more diverse and different from that of older preterm infants with established chronic lung disease (bronchopulmonary dysplasia). Consistent temporal dysbiotic changes in the airway microbiome were seen from birth to the development of bronchopulmonary dysplasia in extremely preterm infants. Genus Lactobacillus was decreased at birth in …