Medicine and Health Sciences Commons^™

New Cwic-Ph Posters In Jefferson Digital Commons, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

Twenty four new College within the College posters have been added to the Jefferson Digital Commons.

College within the College (CwiC) is a four year academic area of concentration designed to enrich the Jefferson Medical College curriculum for those students who seek additional training in Population Health. This program aims to step beyond the individual-level focus of mainstream medicine by addressing a broad range of factors that impact health, such as environment, literacy, ethnicity, social structure, resource distribution, health systems and health education/promotion.

This collection consists of posters and presentations developed by Jefferson CwiC-PH medical students in their exploration …

Appendix: Expand Wikipedia Stub On Supplier - Induced Demand, Robert D. Lieberthal, Phd, Juan Leon, Phd

College of Population Health Faculty Papers

Appendix for article that has been accepted for Journal of Economic Education.

Abstract for article:

The authors describe a Wikipedia-based project designed for a graduate course introducing health economics to experienced healthcare professionals. The project allows such students to successfully write articles on niche topics in rapidly evolving health economics subspecialties. These students are given the opportunity to publish their completed projects in Wikipedia. Despite the lack of conventional classroom incentives, the authors have found that the students generally choose to enter their final projects intoWikipedia. The authors explore the motivators for this behavior from the perspective of human capital …

Effectiveness Of Surgery For Lumbar Stenosis And Degenerative Spondylolisthesis In The Octogenarian Population: Analysis Of The Spine Patient Outcomes Research Trial (Sport) Data., Jeffrey A Rihn, Alan S Hilibrand, Wenyan Zhao, Jon D Lurie, Alexander Vaccaro, Md, Phd, Todd Albert, James Weinstein

Rothman Institute Papers

BACKGROUND: The purpose of this study was to determine whether surgery is an effective option for the treatment of stenosis of the lumbar spine and degenerative spondylolisthesis in the octogenarian population.

METHODS: An as-treated analysis of patients with lumbar stenosis and degenerative spondylolisthesis enrolled in the Spine Patient Outcomes Research Trial (SPORT) was performed. Patients who were at least eighty years of age (n = 105) were compared with those younger than eighty years (n = 1130). Baseline patient and clinical characteristics were noted, and the difference in improvement from baseline between operative and nonoperative treatment was determined for each …

Disrupting Sumoylation Enhances Transcriptional Function And Ameliorates Polyglutamine Androgen Receptor-Mediated Disease., Jason P Chua, Satya L Reddy, Zhigang Yu, Elisa Giorgetti, Heather L Montie, Sarmistha Mukherjee, Jake Higgins, Richard C Mceachin, Diane M Robins, Diane E Merry, Jorge A Iñiguez-Lluhí, Andrew P Lieberman

Department of Biochemistry and Molecular Biology Faculty Papers

Expansion of the polyglutamine (polyQ) tract within the androgen receptor (AR) causes neuromuscular degeneration in individuals with spinobulbar muscular atrophy (SBMA). PolyQ AR has diminished transcriptional function and exhibits ligand-dependent proteotoxicity, features that have both been implicated in SBMA; however, the extent to which altered AR transcriptional function contributes to pathogenesis remains controversial. Here, we sought to dissociate effects of diminished AR function from polyQ-mediated proteotoxicity by enhancing the transcriptional activity of polyQ AR. To accomplish this, we bypassed the inhibitory effect of AR SUMOylation (where SUMO indicates small ubiquitin-like modifier) by mutating conserved lysines in the polyQ AR that …

Healthy Habits, Happy Baby!, Amanda Ocran, Suvidha Polu, Joan I. Gluch, Phd, Rdh, James D. Plumb, Md, Mph, Rickie Brawer, Mph, Phd

CwiC-PH

Cribs for Kids, a component program of the Maternity Care Coalition, provides needy families in Philadelphia with cribs and education on safe sleeping environments.

• Cribs for Kids also provides education on how to reduce the risk of sudden infant death syndrome (SIDS).
• The organization hosts workshops throughout the city and home visits for those who cannot attend the workshops.
• Cribs for Kids also increases awareness about safe sleeping habits and their program by attending community health fairs.
• In the last year Cribs for Kids has provided families the city of Philadelphia with over 2,000 safe sleeping environments.

Care With Dignity: Understanding How To Care For Hiv Positive And Formerly Incarcerated Populations, Caroline Komanecky, Terry Trudeau, Med, James D. Plumb, Md, Mph, Helen Koenig, Md

CwiC-PH

Philadelphia FIGHT is a comprehensive HIV/AIDS service organization providing primary care, consumer education, advocacy, and research on potential treatments and vaccines. FIGHT was formed as a partnership of individuals living with HIV/AIDS and clinicians, who joined together to improve the lives of people living with the disease. Today, FIGHT serves an even broader patient population and recently received designation as a Federally Qualified Health Center. FIGHT strives to address not only HIV-infected patients, but all at-risk populations through education, outreach, and preventative medicine. The annual Bridging the Gaps interns are responsible for several projects, including a client satisfaction survey, a …

Moyamoya Disease And Acute Inpatient Rehabilitation In A 17-Month Old Previously Healthy Male, Cassandra Coleman, Nicole Marcantuono

CwiC-PH

Case Diagnosis

17-month old male with newly diagnosed MoyaMoya after presenting with new onset seizures and right-sided weakness.

Case Description

MoyaMoya is a rare cerebrovascular condition predisposing patients to stroke in association with progressive stenosis of the intracranial internal carotid arteries and their proximal branches.

The patient presented initially after a fall with subsequent inability to bear weight on his right leg along with minimized use of his right arm. Patient was treated for a suspected tibial Salter-Harris II and nursemaid’s elbow. He presented four days later to the ED with new onset seizures. CT of the brain showed loss …

Health Care In Bolivia: A First Hand Experience, Sanchi Malhotra

CwiC-PH

This research project is based on a one month work experience in Cochabamba, Boliva through the NGO Sustainable Bolivia at Hosptial Viedma, a major public hospital and Centre de Salud Pacata, a rural outpatient health clinic. The information presented below is derived from both research and personal experience. This trip was partially funded by Jefferson Office of International Affairs with the goal of gaining experience and knowledge about the Bolivian health care system.

Universal Healthcare: Costa Rica As A Model, Annie J. Ferris

CwiC-PH

What it Looks Like in Costa Rica

• Run by the Costa Rican Social Security Administration
• Financed by employers, employees, and the Ministry of Health. Employer and employee contributions together make up over 90% of contributions.
• Costa Rica is divided into 105 health areas, which are further divided up into primary care units called Basic Provision Units of Integrated Healthcare, or EBAIS. There are 947 of these primary care centers throughout Costa Rica, and everyone is assigned to one.
• The EBAIS clinics provide a wide range of services to cover the general and specific health needs of the community, including primary …

Establishing Roots In West Philadelphia, Nina Millman, James Larosa, Skip Weiner, Rickie Brawer, Mph, Phd, James D. Plumb, Md, Mph

CwiC-PH

Urban Tree Connection

Urban Tree Connection is an organization that utilizes plots of land which have been abandoned. The organization uses the land to create gardens that grow produce which is then sold at markets and to the community. Their goal is to provide access to fresh fruits and vegetables in the food desert areas of West Philadelphia. Members of the community are able to get involved by allowing some of their land to be used as gardens and helping to maintain the sites. The organization also tries to spread information about sustainability including a compost program in the neighborhood.

Regional Disparities In Neurocritical Care Outcomes, Kali Graham

CwiC-PH

BACKGROUND

• Determinants of Neurocritical Care Outcomes: Social as opposed to biological disparities can frequently dictate health outcomes for neurocritically ill patients. Survival rates are determined both by a patient’s access to a NCU (Neurocritical Care Unit) as well as the level of inpatient care he or she receive once admitted to a NCU.
• Regional Inequality in Access to Care¹:
• Only 12.8% of Americans have access to a NCU within 45 min by ground transportation and 36.8% have access to a NCU within 45 minutes by air transportation.
• Racial Disparities in NCU Admissions and Outcomes²:
• Non …

Direct From The Students: Ideas To Improve Diversity Education At Sidney Kimmel Medical College, Elizabeth Sophy, Ms2, Christine Jerback, Md, Natasha Brown, Edd, Ms

CwiC-PH

The Importance of Diversity

Diversity in medical education:

• Enhances students’ educational experience⁸
• Influences perspectives about culture, health, and about social issues³

Diversity in clinical practice:

• Decreases health disparities and improves outcomes³
• Increases patient satisfaction⁵
• Increases access for underserved^4,7

Francis Daniels Moore: One Of The Brightest Minds In The Surgical Field., Sara L. Low, Bs, Charles J. Yeo, Md, Scott W. Cowan, Md, Ashesh P. Shah, Md

Department of Surgery Gibbon Society Historical Profiles

Francis Daniels Moore was a pioneer ahead of his time who made numerous landmark contributions to the field of surgery, including the understanding of metabolic physiology during surgery, liver and kidney transplant, and the famous Study on Surgical Services of the United States (SOSSUS) report of 1975 that served for decades as a guideline for development of surgical residencies. He was the epitome of what a physician should be, a compassionate and dedicated surgeon, innovative scientist, and a medical professional dedicated to quality medical education across all specialties.

Vivien Thomas: Master Craftsman, Gifted Teacher, And Unsung Hero., Alisha Joyner, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

The field of pediatric cardiovascular surgery gained international recognition in 1944 with the first successful correction of a tetralogy of Fallot congenital anomaly in a 15-month-old patient. Dr. Helen Taussig (1898 to 1986), a pediatrician at Johns Hopkins Hospital, recognized the need for the procedure. Dr. Alfred Blalock (1899 to 1964), Chief of Surgery at Johns Hopkins Hospital, is credited with performing the surgery. However, there is an unsung hero who for many years did not receive a single mention in the medical literature. Vivien Thomas (1910 to 1985) was Dr. Blalock’s research assistant who is said to have stood …

Population Health: Where's The Beef?, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

African American Men With Low-Grade Prostate Cancer Have Increased Disease Recurrence After Prostatectomy Compared With Caucasian Men., Kosj Yamoah, Curtiland Deville, Neha Vapiwala, Elaine Spangler, Charnita M. Zeigler-Johnson, Bruce Malkowicz, David I Lee, Michael Kattan, Adam P. Dicker, Timothy R. Rebbeck

Department of Radiation Oncology Faculty Papers

PURPOSE: To explore whether disparities in outcomes exist between African American (AA) and Caucasian (CS) men with low-grade prostate cancer and similar cancer of the prostate risk assessment-postsurgery (CAPRA-S) features following prostatectomy (RP).

METHODS: The overall cohort consisted of 1,265 men (234 AA and 1,031 CS) who met the National comprehensive cancer network criteria for low- to intermediate-risk prostate cancer and underwent RP between 1990 and 2012. We first evaluated whether clinical factors were associated with adverse pathologic outcomes and freedom from biochemical failure (FFbF) using the entire cohort. Next, we studied a subset of 705 men (112 AA and …

The Effect Of Peer Educators On Medication Adherence In Hiv Patients In Cochabamba, Bolivia, George Ru

CwiC-PH

BACKGROUND INFORMATION

• Bolivia is the least developed country in South America, with high levels of poverty, poor access to safe water, and low economic activity. Bolivia’s GDP, in US dollars, in 2013 was $30.60 billion and the gross national income, per capita in US dollars was $2,550, which both rank either at or near the bottom of the list for all South American countries (7).
• The Ministry of Health and Sports (MSD) is the national governing body responsible for formulating the strategy, policies, plans and programs in health. The Department of Health Services (SEDES) is the highest level of technical …

Experiences With Prenatal Care Among Women In A Philadelphia Homeless Shelter, Stephanie Rand, Ms4, Montida Fleming, Ms3, Maria Somohod, Ms3, Caitlin Callaghan, Ms2, Alexandra Strauss, Ms2, Natalie Ziegler, Ms2, Anita Modi, Ms4, Rickie Brawer, Mph, Phd, James D. Plumb, Md, Mph

CwiC-PH

Prenatal care for the underserved is a national concern, with pregnancy rates as high as 22% in homeless women and 75% of these women reporting barriers to care during pregnancy. Inadequate prenatal care confers increased risk for gestational complications and unfavorable postnatal outcomes, including prematurity and low birth weight. Yet while many studies delineate the prevalence and health consequences of inconsistent prenatal care in the homeless population, few address healthcare barriers. To both fill this gap in the literature and design effective interventions increasing consistency of care, we explored prenatal care experiences of pregnant homeless women at Philadelphia’s primary intake …

An Interdisciplinary Approach To Combat Obesity In The Galapagos, Christopher Busack, Bethany Fox

CwiC-PH

Galapagos Background

• Total Population (2010) = 25,124¹
• Largest city = Puerto Ayora (Santa Cruz)
• Average monthly income in Galapagos = $772.03/month²
• Average monthly income in mainland Ecuador = $251.70/month²
• Booming tourism industry contributes to rapid population growth³

4 of 18 main islands (>1km²) open for human residence (Santa Cruz, Isabela, San Cristobal, Floreana)

Bridging The Gaps Chip: Prevention Point, Patrick Prior, Clayton Ruley, Mss, Mlsp, Shp, Rickie Brawer, Mph, Phd, James D. Plumb, Md, Mph

CwiC-PH

Prevention Point Philadelphia aims to reduce the harm associated with injection drug use and sex industry work through an array of harm reduction programs, including syringe exchange, condom distribution, naloxone rescue, social workers, and opioid replacement therapy.

Rural And Urban Medicine In Ecuador, Moira Black

CwiC-PH

Free, Universal Health Care

• Health care is free to all workers and their children with support from the government, employers, and a portion of the workers’ paychecks.¹
• Military personnel do not contribute part of their paychecks to paying for healthcare.¹

Health Needs Assessment For Head Start Children, Gerald Gibbons

CwiC-PH

Background: Head Start Program

• Preschool program for low-income families, providing comprehensive learning and care for children ages birth through 5 years old.¹
• Receives federal funds through the Department of Health & Human Services. However, each Head Start program is a locally designed and implemented model based on local community needs and resources.¹
• One of many government requirements involves yearly health check-ups and up-to-date immunization records for all children enrolled.¹
• NSCA elicited services from Jefferson Center for Urban Health to investigate why some families have a difficult time completing the medical record requirements.

Addiction: A Treatable Disease, Nathaniel Graham

CwiC-PH

Addiction: Definitions and Statistics

Nearly 1 in 7 Americans (~40 million people) are addicted to a chemical substance.

An additional 2 in 7 Americans (~80 million people) qualify as risky substance users; those who use chemical substances in ways that threaten their health and safety.

Underrepresented Minorities And Jefferson Medical System Healthcare: What Can We Do To Diversify The Physician Workforce?, David Halpen

CwiC-PH

Why Diversity?

• An increasingly diverse workforce leads to better levels of care.¹
• Underserved areas need better care and this is currently not being provided by Physicians from non URM backgrounds. ²
• Research shows that physicians from diverse backgrounds are more likely to return to service the communities of underrepresented minorities (URMs). ³
• There will be a decrease in overall healthcare disparities between different groups. ⁴

Lgbt Healthcare And Our Role In Smoking Cessation, Leor Krichilsky, John Covotta, Valerie Canavin, Rickie Brawer, Mph, Phd, Robert Winn, Md, Ms, Aahivs

CwiC-PH

Mazzoni’s goal is comprehensive LGBT care

The interns learned the value of comprehensive care through observing roles of the nurses, transgender intake counselor, case managers, and physicians. Mazzoni’s multi-disciplinary model allows patients’ various needs to be met directly.

The interns also learned the importance of LGBT care through discussions about use of unisex bathrooms, preferred pronouns, and inclusive language. This is demonstrated by Mazzoni’s new patient forms.

Crossmodal Encoding Of Motor Sequence Memories, Brittany Heckel, Marianne Stephan, Sunbin Song, Leonardo G. Cohen

CwiC-PH

Background

• The field of motor rehabilitation is in need of more efficient and effective rehabilitation strategies.
• Each year, almost 2.5 million Americans suffer from traumatic brain injury (TBI) and roughly 800,000 Americans experience a stroke. ^{1, 2}
• The total annual direct and indirect costs of stroke and TBI in the United States are $65.5 billion and between $48 and $56 billion, respectively.^{3, 4}
• A promising new approach may lie in using sound as a neuromodulatory tool to access motor areas of the brain.
• Pianists, for example, can improve their performance of a previously practiced musical piece just by listening …

Comparison Of Breastfeeding Among White And African American Patients Delivering At Thomas Jefferson University Hospital, Rachel Horowitz, Theresa Burcher, Md, Abigail Wolf, Md, Rebecca J. Mercier Md Mph

CwiC-PH

BACKGROUND

• Maternal breastfeeding has been widely accepted as the gold standard for infant nutrition during the first six months of life.¹
• Healthy People 2020 goals:

– 89.1% initiation of breastfeeding

– 60.6% breastfeeding for 6 months

– 32.4% breastfeeding for 1 year¹

• Global promotion of breastfeeding though Baby-Friendly Hospital Initiative

– Started by WHO and UNICEF in 1991 to assist hospitals in facilitating and promoting breastfeeding

– Provides education and skill building for all levels of staff

– Recognizes hospitals providing optimal care for infant nutrition²

• While the rates of breastfeeding have increased nationally since 1990, the …

Globally Minded, Locally Serving: Refugee Health In Philadelphia, Sarah Jamieson, Angelica Montes, Gretchen Shanfeld, Mph, Rickie Brawer, Mph, Phd, Caryn Johnson, Ms, Otr/L, Faota, James D. Plumb, Md, Mph

CwiC-PH

Introduction

A refugee is someone who is forced to leave their country of origin due to war, violence, or persecution. The United States is the world’s top resettlement country. Out of the 50 states, Pennsylvania is 5^th in terms of the number of annually resettled refugees. Each year, Philadelphia resettles approximately 800 refugees. Bhutan, Burma, Iraq, Eritrea, Sudan, and Democratic Republic of Congo are the most frequent countries of origin in Philadelphia.

Cervical Cancer In Guatemala: Using Visual Inspection With Acetic Acid Screening To Reduce Incidence Of And Mortality From Cervical Cancer, Zachary Klock

CwiC-PH

Guatemala is a developing nation of nearly 16 million in Central America. Among the many health problems the nation suffers, cervical cancer remains a leading cause of cancer-related death. Cervical cancer, an easily detectable cancer, predominantly affects women in developing nations. Traditional cytology techniques have been used to screen women in the country for over 25 years, but less than 10% of the Guatemalan population is screened. The Visual Inspection with Acetic Acid (VIA) is a simple produce that uses acetic acid to visualize precancerous cervical lesions and has been proven to be more effective in resource-poor settings. The screening …

Evaluating And Responding To Medical Student Demand For Global Health Education, Angela Ugorets, Bs, Maria Montano, Mph, Michael Cafarchio, Md, Daniel Becchi, Ba, Annie Masterson, Ba, Nithin Paul, Ba, Ellen Plumb, Md

CwiC-PH

Introduction

With the constant interchange of people and diseases across continents, “the separation between domestic and international health problems is no longer useful.” (1) Look no further than the 80,000 refugees currently resettled in the United States for proof that health is a global phenomenon. The medical community needs to respond to the changing global landscape by training future healthcare leaders to think and act globally.

Medical students across the U.S. recognize this need with 68% of U.S. allopathic medical schools having an active student global or international health interest group. (2) Unfortunately, training opportunities lag behind student interest with …