Medicine and Health Sciences Commons^™

Hernia Surgery In Rural Ghana, West Africa: Barriers To Health Care And Their Implications, Laura Traub

CwiC-PH

The information presented is a the product of a six week international rotation at Volta Regional Hospital and Royal Hospital through Blue-Med Africa, a non-governmental organization based out of Ho, Ghana. The goal of the rotation was to obtain an understanding of healthcare in Ghana and identify the differences between surgical procedures in West Africa and the U.S.

Alternative Income Generation For Kenyan Women: Preventing Prostitution And The Spread Of Hiv, Megan Elizabeth Lundy

CwiC-PH

HIV/AIDS in Mlolongo, Kenya

Mombasa Highway and Weigh Station

• Truckers spend 3+ days waiting to be processed, providing a costumer base for prostitution
• In Kenya, 27.6% of female sex workers are HIV positive and only 26.8% use condoms with all of their partners (Morris, Morris, and Ferguson, 2009).
• The rampant spread of HIV and lack of contraception has led to rapid growth in the population in an area that has little ability to support any residents
• Development of Slums that now line the highway

Adolescent Pregnancy In Ecuador, Paige Bates

CwiC-PH

Description of the Problem

• Teen pregnancy, commonly defined as pregnancy in a girl less than 18 or 19 years of age, is often a target of public health efforts because of the far-reaching economic, social and health effects.¹
  • A girl who becomes pregnant attends 2.5 less years of school, and each additional child translates into 1 less year of education.²
  • Girls who get pregnant before age 18 are more likely to experience violence within marriage or a partnership than girls who postpone child-bearing.¹
  • Babies born to adolescent mothers have a higher incidence of perinatal complications (like asphyxia …

The Heart Of Healthcare: The Role Of Authentic Relationships In Caring For Patients With Frequent Hospitalizations, Charlotte Weisberg, Ba, Margaret Hawthorne, Mph, Marianna Lanoue, Phd, Jeffrey Brenner, Md, Dawn B Mautner, Md, Ms

CwiC-PH

INTRODUCTION

Frequent hospital utilization is a major contributor to the costs of healthcare. Despite a vast body of literature, there remains great uncertainty about the characteristics and care needs of individuals with frequent hospitalizations.^1,2 In the movement to reduce the need for hospitalizations, care management programs have garnered wide attention and support. Of the many studies that exist on the efficacy of care management interventions, only a handful espouse the benefits of “continuous healing relationships.”^3,4,5 Fewer studies, if any, explain the role of affect between care providers and patients in the healing process and how to achieve a …

On Voxel-By-Voxel Accumulated Dose For Prostate Radiation Therapy Using Deformable Image Registration., Jialu Yu, Nicholas Hardcastle, Kyoungkeun Jeong, Edward T. Bender, Mark A. Ritter, Wolfgang A. Tomé

Department of Radiation Oncology Faculty Papers

Since delivered dose is rarely the same with planned, we calculated the delivered total dose to ten prostate radiotherapy patients treated with rectal balloons using deformable dose accumulation (DDA) and compared it with the planned dose. The patients were treated with TomoTherapy using two rectal balloon designs: five patients had the Radiadyne balloon (balloon A), and five patients had the EZ-EM balloon (balloon B). Prostate and rectal wall contours were outlined on each pre-treatment MVCT for all patients. Delivered fractional doses were calculated using the MVCT taken immediately prior to delivery. Dose grids were accumulated to the last MVCT using …

The Onchocerciasis Vaccine For Africa-Tova-Initiative., Peter J Hotez, Maria Elena Bottazzi, Bin Zhan, Benjamin L Makepeace, Thomas R Klei, David Abraham, David W Taylor, Sara Lustigman

Department of Microbiology and Immunology Faculty Papers

No abstract provided.

Underlying Construct Of Empathy, Optimism, And Burnout In Medical Students., Mohammadreza Hojat, Michael Vergare, Gerald A. Isenberg, Mitchell Cohen, John Spandorfer

Department of Psychiatry and Human Behavior Faculty Papers

OBJECTIVE: This study was designed to explore the underlying construct of measures of empathy, optimism, and burnout in medical students.

METHODS: Three instruments for measuring empathy (Jefferson Scale of Empathy, JSE); Optimism (the Life Orientation Test-Revised, LOT-R); and burnout (the Maslach Burnout Inventory, MBI, which includes three scales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment) were administered to 265 third-year students at Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University. Data were subjected to factor analysis to examine relationships among measures of empathy, optimism, and burnout in a multivariate statistical model.

RESULTS: Factor analysis (principal component with oblique …

Jdc Celebrates 10 Years!, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

Do you remember what you were doing on January 13, 2005? Probably not, but on that date the Scott Memorial Library activated their institutional repository, the Jefferson Digital Commons. Yes, it has been a decade since the JDC hit the internet.

Dysregulation Of Kv3.4 Channels In Dorsal Root Ganglia Following Spinal Cord Injury., David Ritter, Benjamin M Zemel, Tamara J Hala, Michael E O'Leary, Angelo C Lepore, Manuel Covarrubias

Farber Institute for Neuroscience Faculty Papers

Spinal cord injury (SCI) patients develop chronic pain involving poorly understood central and peripheral mechanisms. Because dysregulation of the voltage-gated Kv3.4 channel has been implicated in the hyperexcitable state of dorsal root ganglion (DRG) neurons following direct injury of sensory nerves, we asked whether such a dysregulation also plays a role in SCI. Kv3.4 channels are expressed in DRG neurons, where they help regulate action potential (AP) repolarization in a manner that depends on the modulation of inactivation by protein kinase C (PKC)-dependent phosphorylation of the channel's inactivation domain. Here, we report that, 2 weeks after cervical hemicontusion SCI, injured …

Memory T Cells Specific For Murine Cytomegalovirus Re-Emerge After Multiple Challenges And Recapitulate Immunity In Various Adoptive Transfer Scenarios., Michael Quinn, Holly Turula, Mayank Tandon, Berthony Deslouches, Toktam Moghbeli, Christopher M. Snyder

Department of Microbiology and Immunology Faculty Papers

Reconstitution of CMV-specific immunity after transplant remains a primary clinical objective to prevent CMV disease, and adoptive immunotherapy of CMV-specific T cells can be an effective therapeutic approach. Because of viral persistence, most CMV-specific CD8(+) T cells become terminally differentiated effector phenotype CD8(+) T cells (TEFF). A minor subset retains a memory-like phenotype (memory phenotype CD8(+) T cells [TM]), but it is unknown whether these cells retain memory function or persist over time. Interestingly, recent studies suggest that CMV-specific CD8(+) T cells with different phenotypes have different abilities to reconstitute sustained immunity after transfer. The immunology of human CMV infections …

Mitochondrial Ca(2+) Uptake By The Voltage-Dependent Anion Channel 2 Regulates Cardiac Rhythmicity., Hirohito Shimizu, Johann Schredelseker, Jie Huang, Kui Lu, Shamim Naghdi, Fei Lu, Sarah Franklin, Hannah Dg Fiji, Kevin Wang, Huanqi Zhu, Cheng Tian, Billy Lin, Haruko Nakano, Amy Ehrlich, Junichi Nakai, Adam Z Stieg, James K Gimzewski, Atsushi Nakano, Joshua I. Goldhaber, Thomas M. Vondriska, György Hajnóczky, Ohyun Kwon, Jau-Nian Chen

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Tightly regulated Ca(2+) homeostasis is a prerequisite for proper cardiac function. To dissect the regulatory network of cardiac Ca(2+) handling, we performed a chemical suppressor screen on zebrafish tremblor embryos, which suffer from Ca(2+) extrusion defects. Efsevin was identified based on its potent activity to restore coordinated contractions in tremblor. We show that efsevin binds to VDAC2, potentiates mitochondrial Ca(2+) uptake and accelerates the transfer of Ca(2+) from intracellular stores into mitochondria. In cardiomyocytes, efsevin restricts the temporal and spatial boundaries of Ca(2+) sparks and thereby inhibits Ca(2+) overload-induced erratic Ca(2+) waves and irregular contractions. We further show that overexpression …

Morphine For The Treatment Of Pain In Sickle Cell Disease., Mihir Gupta, Lilian Msambichaka, Samir K. Ballas, Kalpna Gupta

Cardeza Foundation for Hematologic Research

Pain is a hallmark of sickle cell disease (SCD) and its treatment remains challenging. Opioids are the major family of analgesics that are commonly used for treating severe pain. However, these are not always effective and are associated with the liabilities of their own. The pharmacology and multiorgan side effects of opioids are rapidly emerging areas of investigation, but there remains a scarcity of clinical studies. Due to opioid-induced endothelial-, mast cell-, renal mesangial-, and epithelial-cell-specific effects and proinflammatory as well as growth influencing signaling, it is likely that when used for analgesia, opioids may have organ specific pathological effects. …

Low-Density Lipoprotein Cholesterol Lowering Therapies: What Is On The Horizon?, Ramprasad Gadi, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Elevated low-density lipoprotein cholesterol (LDL-C) levels are associated with an increased risk for cardiovascular disease (CVD). Statins have been the cornerstone of lipid therapy to lower LDL-C for the past two decades, but despite significant clinical efficacy in a majority of patients, a large residual risk remains for the development of initial or recurrent atherosclerotic CVD. In addition, owing to the side-effects, a significant percentage of patients cannot tolerate any statin dose or a high enough statin dose. Thus, novel therapeutic agents are currently being developed to lower LDL-C levels further. This review will highlight these novel therapeutic agents including …

Endovascular Stroke Therapy Results Improve Over Time: The ‘Learning Curve’ At A New Comprehensive Stoke Center, Ethan A. Benardete, Anil K. Nair

Department of Neurosurgery Faculty Papers

Background: The requirements for a comprehensive stroke center (CSC) include the capability to perform endovascular stroke therapy (EST). EST is a complex process requiring early identification of appropriate patients and effective delivery of intervention. In order to provide prompt intervention for stroke, CSCs have been established away from large academic centers in community-based hospitals. We hypothesized that quantifiable improvements would occur during the first 2 years of a community-based CSC as the processes and personnel evolved. We report the results over time of EST at a new community-based CSC. Methods: We have retrospectively analyzed demographic data and outcome metrics of …

Adult Tracheal Stenosis Causes And Therapies, Colin Huntley, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Outline:

• History of Tracheotomy
• Tracheal Stenosis-Etiology, Signs/Symptoms, Workup, Treatment Modalities

Note: No audio, only PowerPoint slides.

Management Of Cerebral Cavernous Malformations: From Diagnosis To Treatment, Nikolaos Mouchtouris, Nohra Chalouhi, Md, Ameet Chitale, Robert Starke, Stavropoula Tjoumakaris, Robert H. Rosenwasswer Md, P. M. Jabbour

Department of Neurosurgery Faculty Papers

No abstract provided.

The Predictive Value Of The Proliferation Marker Ki-67 In Patients With Fulminant Hepatic Failure, Ashesh P. Shah, Md, Upasana Joneja, Md, David Walls, Md, John Farber, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

INTRODUCTION

In the United States, acute liver failure (ALF) affects an estimated 2,000 people per year and accounts for 6% of all liver transplants. Without transplantation, however, less than 50% of patients survive with medical management alone. Early identification of patients with survivable AFL is important to guiding their management and early referral to transplantation.

Studies have shown that the current prognostic scoring systems used for FHF, including the King’s College Criteria (KCC) and the Model for End- Stage Liver Disease (MELD), have poor sensitivity and negative predictive value for predicting outcome, highlighting a need for more accurate predictive models. …

Stromal Monocarboxylate Transporter Mct4 Is A Poor Prognostic Factor In Squamous Cell Carcinoma, Mehri Mollaee, Md, P. Cotzia, Patrick Tassone, Md, Adam J. Luginbuhl, Md, Ubaldo E. Martinez-Outshoorn, Md, Tingting Zhan, Joseph M. Curry, Md, Madalina Tuluc, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

ABSTRACT

Introduction:

Monocarboxylate transporter 4 (MCT4) is the main exporter of lactate out of cells. It is also a critical component in the glycolytic metabolism of cancer cells. In this study, stromal MCT4 in oral SCC was correlated with risk of recurrence (ROR), extent of primary tumor (pT) and nodal metastasis (pN), perineural invasion (PNI), lymphovascular invasion (LVI), HPV status, extracapsular extension (ECE) and positive margin.

Methods:

Clinical data were collected for 86 consecutive patients with oral HNSCC. Tissue microarrays (TMA) were constructed from paraffin blocks of resection specimens and stained for MCT4. Immunohistochemistry (IHC) staining was assessed and quantified …

Workflow Modifications And Addition Of Maldi-Tof Technology Significantly Improved Turn-Around-Time To Identification Of Common Urine Pathogens, Dimath Alyemni, Md, Christine M. Lam, Amity L. Roberts, Phd, D(Abmm)

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Background:

In order to improve the identification of common aerobic urine cultures as well as antimicrobial susceptibility testing (AST) setup at an Academic Medical Center, work-flow modifications and MALDI-TOF technology were incorporated. Previously, the majority of species identification was achieved with conventional identification/antimicrobial susceptibility combo panels. All urine cultures, regardless of laboratory receipt time, were previously read once per day on 1st shift.

Methods:

The initial workflow modification involved addition of a 2nd shift urine culture reading. Urine specimens received from 8:00 AM to 4:00 PM were read on 1st shift, while urine specimens received from 4:00 PM to 8:00 …

Is Myeloproliferative Neoplasm With Splanchnic Vein Thrombosis A Distinct Clinical Entity?, Upasana Joneja, Md, Jerald Z. Gong, Md, Guldeep Uppal, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Clinical History:

A 29 year-old previously healthy female presented with sub-acute symptoms of weight loss, right upper quadrant pain and nausea.

CBC results: WBC-11.7, Hb- 12.5, Platelet- 286, MCV- 90, MCV- 26.8, RDW- 18%.

Imaging: Ultrasound and MRI of the abdomen were suggestive of Budd-Chiari syndrome that was supported by a liver biopsy showing features of hepatic outflow obstruction(Figure 1). There was no clinical or radiological evidence of splenomegaly. The hypercoagulable work-up was negative. An underlying Myeloproliferative Neoplasm (MPN) was suspected.

Growing A Sustainable Community, Joseph Fulginiti, Alexander Moxam, Roderick Thompson

CwiC-PH

Poster includes: Summer Goals, Community Barriers, Fruits of Labor, Room for Growth and Community Assets.

Dr. Mary Edwards Walker: Years Ahead Of Her Time., Dre M. Irizarry, Bs, Nicole Salomone, As, Karen A. Chojnacki, Md, Charles J. Yeo, Md, Scott W. Cowan, Md, Linda J. Bogar, Md

Department of Surgery Gibbon Society Historical Profiles

Women phsycians in the United States were virtually nonexistent in the early to mid-1800s. Traditional medical schools still did not accept women, and few secretarian or eclectic medical schools were beginning to open their doors to female students. In 1849 at Geneva College, Elizabeth Blackwell became the first woman to achieve a medical degree in the United States.1 At the time of the Civil War, the few women who had managed to obtain medical degrees mainly served as nurses in the war, because society was not yet ready to accept the female physician.2 Dr. Mary Edwards Walker would help change …

Expression Of Interferon Gamma By A Recombinant Rabies Virus Strongly Attenuates The Pathogenicity Of The Virus Via Induction Of Type I Interferon., Darryll A Barkhouse, Samantha A Garcia, Emily K Bongiorno, Aurore Lebrun, Milosz Faber, D Craig Hooper, Phd

Department of Cancer Biology Faculty Papers

UNLABELLED: Previous animal model experiments have shown a correlation between interferon gamma (IFN-γ) expression and both survival from infection with attenuated rabies virus (RABV) and reduction of neurological sequelae. Therefore, we hypothesized that rapid production of murine IFN-γ by the rabies virus itself would induce a more robust antiviral response than would occur naturally in mice. To test this hypothesis, we used reverse engineering to clone the mouse IFN-γ gene into a pathogenic rabies virus backbone, SPBN, to produce the recombinant rabies virus designated SPBNγ. Morbidity and mortality were monitored in mice infected intranasally with SPBNγ or SPBN(-) control virus …

Diagnostic Value Of Endoscopic Ultrasound-Guided Fine Needle Aspiration Of Intra-Abdominal Lymph Nodes In Patients With Concurrent Biopsy Of Intra-Abdominal Tumors, Allison F. Goldberg, Md, Charalambos C. Solomides, Md, Marluce Bibbo, Md, Rossitza Draganova-Tacheva, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

BACKGROUND

• Diagnostic endoscopic biopsy of intra-abdominal lesions may be performed prior to surgical resections.

• Endoscopic ultrasound-guided fine needle aspiration of intra-abdominal lymph nodes may also be performed to:

• Yield more information

• Allow for more accurate staging

• We evaluate the additional staging information concurrent fine needle aspiration of intra-abdominal lymph nodes provided

DESIGN

• We included all patients at our institution from January 1, 2000 to March 30, 2015 who, during the same endoscopic procedure, had:

• Endoscopic ultrasound guided fine needle aspiration of an intra-abdominal lymph node AND

• Endoscopic ultrasound guided fine needle aspiration …

Improved Accuracy Of Surgical Pathology Accessioning, Coding, And Billing Practices After Self-Evaluation, Allison F. Goldberg, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

INTRODUCTION

Accurate accessioning, coding, and billing of specimens are vital, but often disregarded, aspects of a surgical pathologist’s job. This study had two aims related to those aspects. First, to evaluate the quality of our systems based practices in order to identify areas for improvement. Second, to assess if changes made based on our self-evaluation improved accuracy.

Tumor Metabolism In The Microenvironment Of Nodal Metastasis In Head And Neck Squamous Cell Carcinoma, Mehri Mollaee, Md, Patrick T. Tassone, Md, David Cognetti, Md, Adam J. Luginbuhl, Md, Joanie Johnson, Ubaldo E. Martinez-Outshoorn, Md, Tingting Zhan, Joseph M. Curry, Md, Madalina Tuluc, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

ABSTRACT

Introduction: Monocarboxylate transporter 4 (MCT4) is a cell membrane transporter of lactate. MCT4 is a tumor-specific marker of oxidative stress, glycolysis and hypoxia in tumor stromal cells. We investigated HPV positive and negative tumors with regional metastases to cervical lymph nodes (LN) to study how the metastatic tumor cells interact with their microenvironment. By selecting cancers with extracapsular extension (ECE), we intended to evaluate the interaction between metastases and the surrounding extranodal tissue.

Methods:

Clinical data were collected from 24 advanced stage oropharyngeal squamous cell carcinoma (OPSCC) patients with neck LN metastasis. All patients presented with at least N1 …

Assessment Of Utility Of Daily Patient Results Averages As Adjunct Quality Control In A Weekday-Only Satellite Chemistry Laboratory, Dimath Alyemni, Md, Laura J. Mccloskey, Md, Barbara Goldsmith, Phd, Facb, Aryana Treweek, Robert T. Stapp, Do, Douglas F. Stickle, Phd

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

ABSTRACT

Background:

Our department operates a weekday-only (8AM-5PM) satellite laboratory in an infusion center with a menu of 18 chemistry tests on a Roche c501 analyzer. We examined whether daily patient results averages (PRA) in this setting might be useful as a patient-based quality control (PBQC) adjunct to standard daily liquid quality control (LQC) measurements. First, we evaluated the reproducibility (coefficient of variation, CV) of daily PRAs for each analyte, and compared these to CVs of LQC. Second, for select analytes found to have relatively low PRA CVs, we evaluated the extent to which use of daily PRA measurements could …

Is Hemoglobin Variant Analysis Helpful In The Diagnostic Work-Up Of Patients Revealing Microcytic Erythrocytosis On Complete Blood Count?, Upasana Joneja, Md, Alina Dulau-Florea, Gene Gulati, Ph.D, Jerald Z. Gong, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Introduction:

Microcytic erythrocytosis is an abnormal CBC (complete blood count) finding that is under-recognized, poorly understood, and consequently under-utilized in patient care. It is characterized by decreased MCV and increased RBC count. Its etiology is likely multifactorial and includes thalassemias and hemoglobinopathies. The focus of our study was to determine the relative prevalence of hemoglobin-associated disorders in patients revealing microcytic erythrocytosis on CBC and to demonstrate whether or not hemoglobin variant analysis should be included in the diagnostic work-up of such cases.

Analysis Of Patient Results Distributions To Reevaluate A Reference Range Change For Calcium, After A Change In Assay Reagents On The Roche Cobas C500 Analyzer, Upasana Joneja, Md, Laura J. Mccloskey, Md, Douglas F. Stickle, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Introduction:

A change in reagents for calcium (Ca) on the Roche Cobas c500 used in our laboratory analyzer took place in 2013. The previous reference range (8.5-10.5 mg/dL) was replaced with that from the manufacturer's study (8.6-10.0 mg/dL), based on correlation of results between the new and old assays. As a matter of quality assurance, we undertook a post-assay-change reevaluation of the reference range change, using a method based on that of Bhattacharya [1]. In short, the method relies on the assumption that the reference range is a normal distribution, which assumption enables this distribution to be isolated mathematically from …

Quantification Of Csf Chemokines And Cytokines Allows For Rapid Laboratory Detection Of Cns Infections And Further Discrimination Between Viral And Non-Viral Pathogens, Danielle Fortuna, Md, Am Cardenas, Eh Graf, Amity L. Roberts, Phd, D(Abmm), Larry A. Harshyne, Phd, D. Craig Hooper, Phd, Mark T. Curtis, Md, Phd

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Background:

Prompt diagnosis of central nervous system (CNS) disease is critical to guide intervention and appropriate therapy. Development of novel laboratory approaches to rapidly classify acute-onset CNS disease is in great demand. Serious microbial pathogens, especially viruses, are quickly expanding beyond their historic geographic range and may not even be considered in the clinician’s differential diagnosis. Unlike bacterial cultures, current viral testing targets a limited number of viruses. Additionally, despite diversity in etiology, signs and symptoms of both infectious and non-infectious CNS disorders can be remarkably similar, which can confuse the clinical picture and delay treatment. Bacterial, viral, fungal and …