Medicine and Health Sciences Commons^™

Obsessive-Compulsive Disorder, Elizabeth Collins, Md

Department of Family & Community Medicine Presentations and Grand Rounds

PowerPoint only, no audio.

Presentation includes:

• Definitions
• Epidemiology and Pathology
• Diagnosis
• Dermatologic Manifestations
• Management

Loss Of Vglut3 Produces Circadian-Dependent Hyperdopaminergia And Ameliorates Motor Dysfunction And L-Dopa-Mediated Dyskinesias In A Model Of Parkinson's Disease., Christopher B. Divito, Kathy Steece-Collier, Daniel T. Case, Sean-Paul G. Williams, Jennifer A. Stancati, Lianteng Zhi, Maria E. Rubio, Caryl E. Sortwell, Timothy J. Collier, David Sulzer, Robert H. Edwards, Hui Zhang, Rebecca P. Seal

Department of Neuroscience Faculty Papers

UNLABELLED: The striatum is essential for many aspects of mammalian behavior, including motivation and movement, and is dysfunctional in motor disorders such as Parkinson's disease. The vesicular glutamate transporter 3 (VGLUT3) is expressed by striatal cholinergic interneurons (CINs) and is thus well positioned to regulate dopamine (DA) signaling and locomotor activity, a canonical measure of basal ganglia output. We now report that VGLUT3 knock-out (KO) mice show circadian-dependent hyperlocomotor activity that is restricted to the waking cycle and is due to an increase in striatal DA synthesis, packaging, and release. Using a conditional VGLUT3 KO mouse, we show that deletion …

Virtual Rounds: Improving Family Participation In Multidisciplinary Rounds Via Telehealth, Gerald Durkan

CwiC Posters

Background

What Are Multidisciplinary Care Rounds (MDR’s)?

MDRs are defined by the unique characteristic of incorporating a multitude of both physician and non-physician specialties into the conversation with the patient for the coordination of their care.

What is Discussed During an MDR?

Activities relating to the care of the patient that may be incorporated into the MDR include summarizing the treatment that the patient has undergone, discussing the treatment approach that is planned for the patient, working through potential issues that may arise from the treatments, and discussing the potential future therapy.

What is Telehealth?

Telehealth is the delivery of …

Lost In Legislation: Barriers In Actualization Of Post-Apartheid Healthcare Reform In South Africa And American Analogies, Abbie Marie Bender

CwiC Posters

Introduction

A nation now defined by the intersection of the Western and Non-Western worlds, South Africa’s evolving healthcare system provides an invaluable reference for the perils that segregation and class control can create for large groups of a population. Under apartheid, the system propagated such separation in the availability and delivery of medicine to its peoples in a caste-like manner. To be of Western descent in South Africa was a ticket that admitted one to the amenities of Western medicine; those without the whiteness of such validating paper found themselves trapped in substandard care. As apartheid was dissolved with the …

Improving Rural Community Health Through Care Coordination, Alexander Miller

CwiC Posters

DEMOGRAPHICS OF CRAWFORD COUNTY^1,2

• Population – 87,600
• Population density – 86.5 per mi²
• Ratio of patients to PCPs – 1,685:1
• Number of hospitals – 2
• Population 65 and older – 17.4%
• Overweight – 65% Obesity – 32%
• Population with Diabetes – 12%
• Heart disease death rate – 200 deaths per 100,000 people.

The above percentages and rates of disease are either equal to or higher than the averages for the state of Pennsylvania.

How A Civil War Surgeon’S Population Health Initiatives Helped Save The Union, 2lt Tyler Walker

CwiC Posters

Introduction

Dr. Jonathan Letterman was the medical director for the Army of the Potomac during the American Civil War. Dr. Letterman graduated from Jefferson Medical College in Philadelphia in 1849. With his appointment to the largest portion of the Union Army, Dr. Letterman was tasked with improving what would today be called a population health nightmare. Soldiers lived in filth, ate food devoid of nutrition, were forced to train beyond what was necessary no matter the conditions, and worst of all, were not provided with an organized medical department to treat them if they were wounded or became ill. He …

The Public Health Of Youth And High School Athletics, Michael Haines

CwiC Posters

The Problem

• The number of participants in high school sports has increased since 1989 (National Federation of State HS Association).
• From 2000-2010 7% of public schools cut athletic programs while less than 1% added them (Sharp Center Univ. Michigan).
• Some estimates predict 27% of public high schools will not offer varsity athletics by 2020 (Sharp Center Univ. Michigan).
• School’s are dropping athletic programs (as well as music and theater programs) due to budget cuts.
• Alternative approaches schools are taking include “pay to play” which increases the financial burden on students and families.
• In 2011, 3 out of 4 school districts …

Developing Maternal And Child Health Curriculum In Rural Uganda, Rebecca Newbrander, Md Candidate

CwiC Posters

Maternal and Child Health in Iganga District Uganda

Maternal and child health outcomes in the East Central Region of Uganda are especially poor compared to the rest of Uganda [1]:

• Only 32% of women (50.7% nationally) informed about signs of pregnancy or delivery complications
• Only 12% of women (62% nationally) received malaria prophylaxis during pregnancy

The “Three Delays Model” of barriers to care[3]:

• Knowing when to seek care and making the decision to do so
• Access to care once decision is reached to seek it
• Receiving quality care at a health center or hospital

Maternal and Child Heath Care in …

Murine Cmv Infection Induces The Continuous Production Of Mucosal Resident T Cells., Corinne J Smith, Sofia Caldeira-Dantas, Holly Turula, Christopher M. Snyder

Department of Microbiology and Immunology Faculty Papers

Cytomegalovirus (CMV) is a herpesvirus that persists for life and maintains extremely large numbers of T cells with select specificities in circulation. However, it is unknown how viral persistence impacts T cell populations in mucosal sites. We found that many murine (M)CMV-specific CD8s in mucosal tissues became resident memory T cells (TRM). These cells adopted an intraepithelial localization in the salivary gland that correlated with, but did not depend on, expression of the integrin CD103. MCMV-specific TRM cells formed early after infection, and spleen-localized cells had reduced capacities to become TRM at late times. Surprisingly, however, small numbers of new …

School Wellness Assessment: Creating A Culture Of Health, Kaitlyn Petruccelli, Bs, Rickie Brawer, Mph, Phd

CwiC Posters

Introduction

The Center for Urban Health (CUH) and the Office for Student Life and Engagement at Thomas Jefferson University (TJU) are working with two public elementary schools in Philadelphia – Southwark School and Independence Charter School – to create a culture of health in the schools. Both schools wish to establish an environment that promotes health and safety and assists children in developing life-long healthy habits. The offices at TJU set out a plan to

(1) Assess the current policies and climate at the schools,

(2) Identify priority weaknesses to address,

(3) Connect TJU’s various health professional schools and student …

Jeffhealth Medical Student Exchange In Rwanda, Amanda Nemecz, Alexander Rowan, Talia Stark

CwiC Posters

Teaching Community Health Workers

In rural Rwandan villages, the communities are linked to healthcare through Community Health Workers (CHW). CHW are appointed based on village election and the requirement that they can read and write. The Rwandan Ministry of Health provides general health training to the CHW so that they can educate and advise the village on health related matters. CHW administer educational sessions at village meetings about prevalent health issues, and advise members of the village when they should go to the Health Center. JeffHEALTH’s teaching aims to supplement the Ministry of Health training. Topics are chosen and approved …

Clinical Experience At Pasteur Clinic Đà Lạt, Vietnam, Emma Howard-Young, Jordan Howard-Young, Ma

CwiC Posters

History of the Pasteur Clinic Đà Lạt

The Pasteur Clinic is associated with the Institut Pasteur, part of the international network of research institutes dedicated to the prevention and treatment of infectious diseases. The Đà Lạt branch of Vietnam’s Institut Pasteur was built between 1930 and 1936 under the direction of Dr. Alexandre Yersin, a physician remembered for identifying Yersinia pestis as the causative agent of Plague and a student of the eponymous French chemist and microbiologist Louis Pasteur. While many overt references to the French colonial tradition have been supplanted in Vietnam by nationalist sentiments, the Institut Pasteur …

The Intersection Between Medication Tablets And Electronic Tablets: Determining The Usability And Acceptability Of A Patient-Centered Cardiovascular Risk Assessment (Pccra) Ios App, Nisha Patel, Ms2, Geoffrey Mills, Md, Phd, Marianna Lanoue, Phd, Amy Cunningham, Mph

CwiC Posters

Background

One American dies from cardiovascular disease (CVD) every 40 seconds. Risk factor awareness, assessment, and communication has been shown to improve efficacy of patient treatment and also decline overall risk in the population over time. Traditional cardiac risk assessment tools (e.g. Framingham risk assessment, FRA) generate a risk score in a format that may not appreciated or easily understood by all patients. A new patient-centered approach, in which the patient becomes an active participant in the decision-making process, has shown significant increase in patient-provider communication and diagnosis/management.

Housing First: A Solution To Urban Homelessness, Kelsey L. Capron, Lara C. Weinstein, Md

CwiC Posters

Homelessness in the United States

• 630,000 homeless in the US in 2012, thousands in Philadelphia
• Over 3% of the US population has been homeless during the past 5 years
• Homeless = no stable residence

Temporary shelters, unsheltered locations (the street, transit stations, parked cars), etc.

• High rates of legal issues, substance abuse/dependency, & lack of stable employment

Severe mental illness = overrepresented & linked to severe health disparities

• Higher risk for all-cause mortality (primarily due to injuries, overdose, CV disease)

Mortality rates 3-4x higher than the general population

Chronic & acute mental & physical health conditions

HIV, tuberculosis, hypertension, diabetes …

A Phase I Study Of Ad5-Gucy2c-Padre In Stage I And Ii Colon Cancer Patients, Adam E. Snook, Trevor R. Baybutt, Michael J. Mastrangelo, Nancy L. Lewis, Scott D. Goldstein, Walter K. Kraft, Yaa D. Oppong, Terry Hyslop, Ronald E. Myers, Vitali Alexeev, Laurence C. Eisenlohr, Takami Sato, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Posters

Background

Ad5-GUCY2C-PADRE is a replication-deficient human type 5 recombinant adenovirus (Ad5) vaccine encoding guanylyl cyclase C (GUCY2C) fused to the PAn DR Epitope (PADRE). GUCY2C, a paracrine hormone receptor producing the second messenger cyclic GMP (cGMP), is selectively expressed by intestinal epithelial cells and a subset of hypothalamic neurons, but not other tissues. Importantly, GUCY2C is over-expressed in nearly all primary and metastatic human colorectal tumors. Preclinical studies in mice demonstrated selective tolerance of GUCY2C-specific CD4+ T cells, but not CD8+ T or B cells, necessitating inclusion of the exogenous CD4+ T helper cell epitope PADRE to maximize GUCY2C-specific CD8+ …

Follicular Bronchiolitis In An Adult Male With Common Variable Immune Deficiency, Megan K. Ford, Md, Alana B. Kekevian, Do, Charalambos C. Solomides, Md, John R. Cohn, Md, Facaai

Department of Medicine Posters

BACKGROUND

• Follicular bronchiolitis (FB) in patients with common variable immune deficiency (CVID) is rarely described and knowledge is based on case reports, case series, and studies on the individual disease entities.^1-5
• FB is a granulomatous-lymphocytic interstitial lung disease (GLILD). GLILD is a group of non-infectious lung diseases which also includes lymphocytic interstitial pneumonia, granulomatous disease, and lymphoid hyperplasia.^6,7
• FB is caused by an external stimulus or abnormal immune response that incites lymphoid hyperplasia.⁸
• The etiology of FB is idiopathic or associated with collagen vascular disorders (e.g., Sjogrens, rheumatoid arthritis), hypersensitivity reactions, acquired immunodeficiencies (typically HIV), and less …

Vertebral Body Stapling Versus Bracing For Patients With High-Risk Moderate Idiopathic Scoliosis., Laury Cuddihy, Aina J Danielsson, Patrick J Cahill, Amer F Samdani, Harsh Grewal, John M Richmond, M J Mulcahey, John P Gaughan, M Darryl Antonacci, Randal R Betz

Department of Medicine Faculty Papers

Purpose. We report a comparison study of vertebral body stapling (VBS) versus a matched bracing cohort for immature patients with moderate (25 to 44°) idiopathic scoliosis (IS). Methods. 42 of 49 consecutive patients (86%) with IS were treated with VBS and followed for a minimum of 2 years. They were compared to 121 braced patients meeting identical inclusion criteria. 52 patients (66 curves) were matched according to age at start of treatment (10.6 years versus 11.1 years, resp. [P = 0.07]) and gender. Results. For thoracic curves 25-34°, VBS had a success rate (defined as curve progression

Prevalence And Utilization Of Medical Care Services In Persons With Autism Spectrum Disorder Using Medicare Claims, Henry J. Carretta, Phd, Katelyn Graves, Ms, Teal W. Benevides, Phd, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Objective:

To characterize the prevalence of autism spectrum disorder (ASD) among persons in Medicare claims and contrast with prevalence documented during disability determination in Social Security Administration (SSA) Supplemental Security Income (SSI) files.

Poster presented at APHA in Chicago Illinois.

Prevalence Of Health-Related Quality Of Life (Hrqol) In Asian Americans, Hee-Soon Juon, Phd, Frederic Kim, Ms, Seon Yoon Chung, Msn, Sunmin Lee, Scd

Department of Medical Oncology Posters

Objectives

To report the prevalence of Health Related Quality of Life (HRQOL) in foreign-born Asian Americans (AA) and to compare this with the general AA from 2010 BRFSS data.

To examine the influential factors associated with HRQOL-4 including English proficiency, perceived racial discrimination, smoking, alcohol use, and sociodemographics.

Background

Quality of life (QOL) represents individuals’ subjective perception of multidimensional aspects of life including physical, psychological, social and spiritual aspects.

HRQOL represents the physical and mental health domain of QOL.

Centers for Disease Control and Prevention (CDC) has been measuring HRQOL to capture people’s overall perceptions about their health; HRQOL has …

Interactions Of L-3,5,3′-Triiodothyronine, Allopregnanolone, And Ivermectin With The Gabaa Receptor: Evidence For Overlapping Intersubunit Binding Modes, Thomas Westergard, Reza Salari, Joseph V. Martin, Grace Brannigan

Department of Neuroscience Faculty Papers

No abstract provided.

The Global Health "Interactive Curricula Experience (Ice) Platform & App": Technology That Enables Inter-Professional Innovation, James Plumb, Md, Mph, Nicholas Leon, Pharmd, Louis N. Hunter, Pt, Dpt, Martha Langley Ankeny, M.Ed, Ellen Plumb, Md, Lucille B. Pilling, Edd, Mph, Rn

College of Population Health Lectures, Presentations, Workshops

17 slide PowerPoint presentation.

Presented at APHA in Chicago Illinois.

A Prospective 3-Year Follow-Up Trial Of Implantation Of Two Trabecular Microbypass Stents In Open-Angle Glaucoma, Eric D. Donnenfeld, Kerry D. Solomon, Lilit Voskanyan, David F. Chang, Thomas W. Samuelson, Iqbal Ike K. Ahmed, L. Jay Katz

Wills Eye Hospital Papers

No abstract provided.

Healthy Corner Store Network "Heart Smarts" Program, Nyssa Entrekin, Sandra Sherman, Edd, Rickie Brawer, Mph, Phd, Mches, James D. Plumb, Md, Mph

College of Population Health Lectures, Presentations, Workshops

Objectives:

1. Identify corner stores for nutrition education and health screenings based on criteria presented.

2. Identify education strategies appropriate for a corner store setting when integrating health screenings, nutrition education and food access.

3. List at least two store owner training topics for use in a corner store setting that reinforce nutrition education and disease prevention in the store.

4. Understand methods for evaluating outcomes of an integrated educational effort.

Presented at APHA in Chicago, Illinois.

Notching Early Repolarization Pattern In Inferior Leads Increases Risk Of Ventricular Tachyarrhythmias In Patients With Acute Myocardial Infarction: A Meta-Analysis., Zhiwei Zhang, Konstantinos P Letsas, Yajuan Yang, Panagiotis Korantzopoulos, Guangping Li, Gan-Xin Yan, Tong Liu

Department of Medicine Faculty Papers

The aim of this of this meta-analysis was to examine the potential association between certain early repolarization (ER) characteristics and ventricular tachyarrhythmias (VTAs) in patients with acute myocardial infarction (AMI). We searched PubMed, Embase and Web of Science databases for records published until December 2014. Of the 658 initially identified records, 7 studies with a total of 1,565 patients (299 with ER and 1,266 without ER) were finally analyzed. Overall, patients with ER displayed a higher risk of VTAs following AMI compared to patients without ER [odds ratio (OR): 3.75, 95% CI: 2.62-5.37, p < 0.00001]. Subgroup analyses showed that the diagnosis of ER prior to AMI onset is a better predictor of VTAs (OR: 5.70, p < 0.00001) compared to those diagnosed after AMI onset (OR: 2.60, p = 0.00001). Remarkably, a notching morphology was a significant predictor of VTAs compared to slurring morphology (OR: 3.85, p = 0.002). Finally, an inferior ER location (OR: 8.85, p < 0.00001) was significantly associated with increased risk of VTAs in AMI patients. In conclusion, our meta-analysis suggests that ER pattern is associated with greater risk of VTAs in patients with AMI. A notched ER pattern located in inferior leads confers the highest risk for VTAs in AMI.

Sialylation Of Igg Fc Domain Impairs Complement-Dependent Cytotoxicity., Isaak Quast, Christian W Keller, Michael A Maurer, John P Giddens, Björn Tackenberg, Lai-Xi Wang, Christian Münz, Falk Nimmerjahn, Marinos Dalakas, Jan D Lünemann

Department of Neurology Faculty Papers

IgG molecules exert both pro- and antiinflammatory effector functions based on the composition of the fragment crystallizable (Fc) domain glycan. Sialylated IgG Fc domains have antiinflammatory properties that are attributed to their ability to increase the activation threshold of innate effector cells to immune complexes by stimulating the upregulation of the inhibitory Fcγ receptor IIB (FcγRIIB). Here, we report that IgG Fc sialylation of human monoclonal IgG1 molecules impairs their efficacy to induce complement-mediated cytotoxicity (CDC). Fc sialylation of a CD20-targeting antibody had no impact on antibody-dependent cellular cytotoxicity and did not change the affinity of the antibody for activating …

Detection Of Genetic And Epigenetic Dna Markers In Urine For The Early Detection Of Primary And Recurrent Hepatocellular Carcinoma, Hie-Won Hann, Surbhi Jain, Ting-Tsung Chang, Chi-Tan Hu, Selena Lin, Wei Song, Ying-Hsiu Su

Division of Gastroenterology and Hepatology Posters

Poster presented at American Association of the Study of Liver Diseases (AASLD) meeting in San Francisco California.

Objective:

Develop a urine test using a panel of select genetic and epigenetic markers for the early detection of primary and recurrent HCC.

Introduction:

Hepatocellular carcinoma (HCC) or liver cancer is an aggressive disease and one of the fastest growing cancers by incidence in the United States. Early detection is the key for effective treatment of HCC as the 5-year survival rate is 26% in early stage HCC as compared to only 2% when found after spreading to distant organs. The current marker, …

Positive Allosteric Modulation Of Kv Channels By Sevoflurane: Insights Into The Structural Basis Of Inhaled Anesthetic Action., Qiansheng Liang, Warren D Anderson, Shelly T Jones, Caio S Souza, Juliana M Hosoume, Werner Treptow, Manuel Covarrubias

Department of Neuroscience Faculty Papers

Inhalational general anesthesia results from the poorly understood interactions of haloethers with multiple protein targets, which prominently includes ion channels in the nervous system. Previously, we reported that the commonly used inhaled anesthetic sevoflurane potentiates the activity of voltage-gated K+ (Kv) channels, specifically, several mammalian Kv1 channels and the Drosophila K-Shaw2 channel. Also, previous work suggested that the S4-S5 linker of K-Shaw2 plays a role in the inhibition of this Kv channel by n-alcohols and inhaled anesthetics. Here, we hypothesized that the S4-S5 linker is also a determinant of the potentiation of Kv1.2 and K-Shaw2 by sevoflurane. Following functional expression …

Migrated Avalon Veno-Venous Extracorporeal Membrane Oxygenation Cannula: How To Adjust Without Interruption Of Flow., Daizo Tanaka, Harrsion T. Pitcher, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

The Avalon dual lumen cannula is presently the cannula of choice for veno-venous extracorporeal membrane oxygenation (VV-ECMO) via right internal jugular cannulation. This cannula establishes VV-ECMO with a single cannulation; however, it requires appropriate positioning to gain adequate oxygenation. Malposition of this cannula can cause inadequate ECMO flow, hypoxia, and structural injury. We have experienced two cases of migration: one into the hepatic vein and the other into the right ventricle. The former was repositioned using echocardiographic guidance without using a guidewire. The latter was repositioned using a guidewire from the femoral vein under fluoroscopy, without antegrade wire placement into …

Purchase Of Loose Cigarettes By Adult Smokers In Philadelphia: Individual-Level Correlates And Neighborhood Characteristics, Russell K. Mcintire, Phd, Mph

College of Population Health Posters

Background

• Philadelphia has the highest adult smoking rate1 and the highest rate of tobacco retailers2 among the 10 largest U.S. cities.

• Governmental reports have identified high rates of illegal sale of cigarettes in Philadelphia2.

• Studies have found that a main source of cigarette use in low income communities is single (loose) cigarettes purchased at tobacco retailers or from unregulated street vendors3,4.

• While studies have shown that loose cigarette use is a problem among urban youth who reside in disadvantaged neighborhoods, less research has been performed among adults on this topic5,6, and no studies focus on Philadelphia. …

Right Ventricular Dysfunction After Resuscitation Predicts Poor Outcomes In Cardiac Arrest Patients Independent Of Left Ventricular Function., Vimal Ramjee, Anne V. Grossestreuer, Yuan Yao, Sarah M. Perman, Marion Leary, James N. Kirkpatrick, Paul R. Forfia, Daniel M. Kolansky, Benjamin S. Abella, David F. Gaieski

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction.

METHODS: A single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012.

PATIENTS: 291 in- and out-of-hospital adult cardiac arrest patients at the University of Pennsylvania who had return of spontaneous …