Medicine and Health Sciences Commons^™

Healing The Health Care System: Summaries From The Department Of Health Policy Summer Seminar, David B. Nash, Nora Dowd Eisenhower, Rosemarie Greco, Deborah C. Meiris

College of Population Health Faculty Papers

Editorial Introduction:
The disease management field continues to evolve. The range of chronic diseases treated has expanded to include such conditions as obesity and pain management, and the care continuum now encompasses wellness, prevention, and population health. One population that is an ideal candidate for our collective efforts is that of older adults. Global and national population projections reveal the impending staggering increase in the age 65+ cohort, which will cause a sharp increase in the demand for health care and other services due to such age-related issues as multiple chronic conditions, falls, and depression.

To begin to address these …

Report On The U.S. Summit: "Chronic Care At The Crossroads: Exploring Solutions For Chronic Care Management", Janice L. Clarke

College of Population Health Faculty Papers

On Tuesday, July 17, 2007 in Washington, DC, Intel Corporation assembled a group of the nation’s most respected health leaders to discuss the issues surrounding chronic care and an aging population and explore solutions to these highly complex and increasingly urgent challenges for the US health care system. The highlevel summit, hosted by Intel Chairman Craig Barrett, was held in the auditorium of the National Museum for Women in the Arts and attended, either in person or via the simultaneous webcast, by presidents, chairmen, and executive directors of influential organizations including the National Business Coalition on Health, the National Medical …

Rehabilitation Of Transtibial Amputation Caused By Necrotizing Soft Tissue Infections: A Casereport, Shih-Kun Chang, Wai-Keung Lee, Huei-Yu Lo, Yau-Wai Wai, Won-Jean Lin, Kien-Jung Wang

Rehabilitation Practice and Science

Necrotizing soft tissue infections is an infrequent disease. Although many studies and casereports have been presented in recent years, none have described the impact of this disease on prosthetic fitting, ambulation training, and rehabilitation for patients with transtibial amputation.A 50 year-old man suffered from left transtibial amputation and received operation of split thickness skin grafts due to necrotizing soft tissue infections. He was trained to overcome the following problems: 1. Poor endurance, cardiopulmonary function and muscle strength of bilateral lower limbs. 2. The loss of dorsiflexion in the right ankle that resulted from excision of the anterior tibialis muscle. 3. …

Bilateral Putaminal Hemorrhage In A Young Female: A Casereport, Ke-Vin Chang, Wen-Shiang Chen, Huey-Wen Liang

Rehabilitation Practice and Science

Background: The etiology of spontaneous intracerebral hemorrhage (ICH) in young adults may include causative factors such as vascular abnormality, hypertension, anticoagulant therapy, brain tumor, and others. Hypertension is the most common cause of ICH in young adults in Taiwan. Simultaneous or multiple intracerebral hemorrhages are uncommon, and symmetrical distribution is even rarer. Most cases reported in the literature are in the elderly.Case: We report the case of a 29 years old female with a history of hypertension and elevated blood pressure, who presented with an acute onset of right side limb weakness. Results: Brain computed tomography (CT) showed hemorrhage in …

Exercise Training May Enhance Functional Capacity And Improve Heart Rate Impairment In Coronary Artery Disease Patients With Chronotropic Incompetence, Chen-Jung Hsu, Ssu-Yuan Chen, Ching Lan, Der-Sheng Han, Jin-Shin Lai

Rehabilitation Practice and Science

This study investigated whether coronary artery disease patients with chronotropic incompetence (CI) can significantly improve their functional capacity after exercise training. Forty-two men (mean age: 55.3±9.3yr) underwent coronary revascularization and without beta-blockade participated in a threemonth outpatient exercise training program. Patients were separated into a CI group (n=18) and a non-CI group (n=24) based on whether they could reach 85% of the age-predicted peak heart rate (HR). Chronotropic incompetence was defined as failure to achieve 85% of the age-predicted maximal HR. Bicycle exercise workouts were conducted three times weekly. The exercise duration was 30 minutes per session included 5 minutes …

A Psuedo-Mass Of Shoulder Girdle Due To Spinal Accessory Nerve Injury After Neck Lymph Node Biopsy: A Casereport, Yen-Nung Lin, Jing-Hwa Wey, Mei-Chun Huang, Kwang-Hwa Chang, Chun-Chieh Chiu

Rehabilitation Practice and Science

Shoulder problems such as pain, weakness, limited range of motion and palpable mass are common complaints in PM&R clinic. This casereport describes a less common but not rare condition: iatrogenic accessory nerve injury after neck lymph node biopsy. The patient in this study presented symptoms of shoulder girdle pain and weakness and also complained of a ”hard palpated mass” over her shoulder girdle.A 49-year-old female complained of gradually worsening left shoulder pain accompanied by weakness and limited range of motion in her left shoulder for many months. She had sought medical advice for many times and rotator cuff pathology was …

Argininosuccinic Acidemia: A Casereport, Chih-Wei Lin, Huey-Jen Lay, I-Ju Chen

Rehabilitation Practice and Science

Urea cycle disorder (UCD) is one of inborn error diseases. Citrullinemia is the most common disease (1/57000) among them, followed by argininosuccinic acidemia (ASA) (1/70000). The common characteristic of UCD is hyperammonemia induced by the abnormal liver function. Common symptoms at the onset of diseases include altered consciousness, respiratory insufficiency and seizures. Developmental delay, mental retardation, cerebral palsy, and learning disability are common findings in long-term follow-ups. In this report, we give an account of a patient with ASA. Besides the aforementioned symptoms and long-term sequelae, this patient also has the problem of ataxia. However, the patient's conditions and developments …

A Novel Runx2 Missense Mutation Predicted To Disrupt Dna Binding Causes Cleidocranial Dysplasia In A Large Chinese Family With Hyperplastic Nails, Shaohua Tang, Qiyu Xu, Xueqin Xu, Jicheng Du, Xuemei Yang, Yusheng Jiang, Xiaoqin Wang, Nancy Speck, Taosheng Huang

Dartmouth Scholarship

Background: Cleidocranial dysplasia (CCD) is a dominantly inherited disease characterized by hypoplastic or absent clavicles, large fontanels, dental dysplasia, and delayed skeletal development. The purpose of this study is to investigate the genetic basis of Chinese family with CCD.

Methods: Here, a large Chinese family with CCD and hyperplastic nails was recruited. The clinical features displayed a significant intrafamilial variation. We sequenced the coding region of the RUNX2 gene for the mutation and phenotype analysis.

Results: The family carries a c.T407C (p.L136P) mutation in the DNA- and CBFβ-binding Runt domain of RUNX2. Based on the crystal structure, we predict this …

Botulinum Toxin Type A Treatment For Drooling In Taiwanese Children With Cerebral Palsy: Three Casereports, Yu-Ching Lin, I-Ling Lin, Yu-Te Chiu, Jeng-Yi Shieh

Rehabilitation Practice and Science

Botulinum toxin is a promising treatment option for the management of drooling in patients with cerebral palsy. However, the effect of botulinum toxin type A in treating drooling of Taiwanese children with cerebral palsy has not been reported thus far. We injected single dose botulinum toxin into bilateral parotid glands of three children with cerebral palsy, and followed the results over a 9-month period. Drooling improved in all three patients without significant adverse effects during follow up. There were individual differences in terms of efficacy and duration of effect. Two patients had longer duration of effect than that reported in …

Mice Deficient In Involucrin, Envoplakin, And Periplakin Have A Defective Epidermal Barrier., Lisa M Sevilla, Rachida Nachat, Karen R Groot, John F Klement, Jouni Uitto, Philippe Djian, Arto Määttä, Fiona M Watt

Department of Dermatology and Cutaneous Biology Faculty Papers

The cornified envelope is assembled from transglutaminase cross-linked proteins and lipids in the outermost epidermal layers and is essential for skin barrier function. Involucrin, envoplakin, and periplakin form the protein scaffold on which the envelope assembles. To examine their combined function, we generated mice deficient in all three genes. The triple knockouts have delayed embryonic barrier formation and postnatal hyperkeratosis (abnormal accumulation of cornified cells) resulting from impaired desquamation. Cornified envelopes form but are ultrastructurally abnormal, with reduced lipid content and decreased mechanical integrity. Expression of proteases is reduced and the protease inhibitor, serpina1b, is highly upregulated, resulting in defective …

Periodontal Disease And Diabetes: Knowledge And Attitudes Assessment Project

Florida Public Health Review

There is a growing body of evidence showing that periodontal disease is more prevalent among diabetic patients than among non-diabetic patients. This same evidence also shows that the more poorly controlled the diabetes, the more severe the periodontal disease. However, it is unclear if the increased risk of periodontal disease is known by the diabetes community. Two hundred diabetic patients voluntarily participated in an intervention to increase the diabetic patient’s knowledge of and attitudes toward periodontal disease. The study was conducted at the University of Miami-Jackson Memorial Hospital’s Diabetes Research Institute (DRI) during the month of May 2005. The purpose …

Stem Cells: The Dawn Of A New Era For Huntington’S Disease Research, Kenneth P. Serbin

At Risk for Huntington's Disease

No abstract provided.

Acetylation In Nuclear Receptor Signaling And The Role Of Sirtuins, Chenguang Wang, Michael J. Powell, Vladimir M. Popov, Richard G. Pestell

Department of Cancer Biology Faculty Papers

It has been known since the early 1970s that nuclear receptor complexes bind DNA in association with co-regulatory proteins. Characterization of these nuclear receptor coregulators has revealed diverse enzymatic activities which temporally and spatially coordinate nuclear receptor activity within the context of local chromatin in response to diverse hormone signals. Chromatin modifying proteins, which dictate the higher order chromatin structure in which DNA is packaged, in turn orchestrate orderly recruitment of nuclear receptor complexes. Modifications of histones include acetylation, methylation, phosphorylation, ubiquitylation, sumoylation, ADP ribosylation, deimination and proline isomerization (1). At this time, we understand how a subset of these …

How Does Quality Enter Into Health Care Purchasing Decisions?, Neil I. Goldfarb, Vittorio Maio, Chureen T. Carter, Laura Pizzi, David B. Nash

College of Population Health Faculty Papers

A number of employers, business consortia, and public purchasers are promoting "value-based purchasing" as a way to improve the quality of patient care. Some purchasers are using publicly available information on health plan and provider performance to make their health plan and provider choices, while others are using their market power to drive improvements in patient care and safety. This article examines six key strategies used by purchasers.

Editorial Board

Jefferson Journal of Psychiatry

No abstract provided.

Use Of Parthenolide Derivatives As Antileukemic And Cytotoxic Agents, Peter A. Crooks, Craig T. Jordan, Xiaochen Wei

Pharmaceutical Sciences Faculty Patents

Compounds of the formula having anti-tumor activity, wherein R₁ and R₂ are as described herein

Determinan Kematian Neonatal Dini Di Rsud Dr. Achmad Mochtar Bukittinggi, Efriza Efriza

Kesmas

Berdasarkan data SDKI 2002-2003 angka kematian neonatal di Indonesia adalah 20 per 1000 kelahiran hidup. Sebagian besar kematian neonatal terjadi pada saat neonatal dini ketika bayi berumur 0-7 hari. Penelitian ini bertujuan untuk mengetahui berbagai faktor yang mempengaruhi kematian neonatal dini di RSUD Dr. Achmad Mochtar Bukittinggi tahun 2001-2005. Penelitian yang dilakukan pada sumber data sekunder rekam medik ibu dan bayi ini menggunakan disain studi kasus kontrol. Sampel dihitung dengan rumus ukursan sampel minimal kasus kontrol. Kasus. adalah bayi yang lahir hidup dan meninggal pada periode neonatal dini (0-7 hari) dan kontrol adalah bayi yang lahir hidup dan bertahan hidup …

Faktor Risiko Tuberculosis Paru Di Kabupaten Rejang Lebong, Demsa Simbolon

Kesmas

Di Kabupaten Rejang Lebong, sejak tahun 1995 telah dilaksanakan kegiatan pemberantasan TB Paru dengan strategi DOTS, tetapi penderita baru tetap di temukan dan memperlihatkan trend yang meningkat dari tahun ke tahun. Penelitian ini bertujuan untuk mengetahui faktor risiko yang berhubungan dengan kejadian TB paru BTA (+) di Kabupaten Rejang Lebong. Desain penelitian yang digunakan adalah disain kasus kontrol. Kelompok kasus adalah penderita TB Paru BTA (+) berumur >15 tahun yang berobat pada Oktober 2005 sampai Mei 2006. Kontrol adalah tetangga kasus yang tidak mempunyai tanda-tanda gejala klinis TB paru dengan golongan umur >15 tahun. Jumlah sampel sebanyak 50 kasus dan …

Ketahanan Hidup Setahun Pasien Stroke Di Rs Cipto Mangunkusumo Jakarta, Sri Mulyani

Kesmas

Di Indonesia, penyebab utama kematian di rumah sakit adalah stroke. Penelitian ini bertujuan untuk mengetahui ketahanan hidup 1 tahun pasien stroke yang dirawat di RS Cipto Mangunkusumo Jakarta tahun 2003 dan faktor yang mempengaruhinya. Rancangan penelitian ini adalah kohort retrospektif. Sampelnya adalah total populasi, yaitu 275 pasien yang didiagnosa mengalami serangan stroke pertama dan dirawat di RS Cipto Mangunkusumo Jakarta, yang masuk tanggal 1 Januari sampai 31 Desember 2003. Hasil penelitian menunjukkan bahwa probabilitas ketahanan hidup pasien stroke berbeda beda, tergantung pada tipe stroke, ruang rawat, dan penyakit jantung. Masing-masing probabilitas ketahanan hidup setahun pasien stroke adalah sebagai berikut: 63,7% …

Repeated N-Acetylcysteine Administration Alters Plasticity-Dependent Effects Of Cocaine, Aric Madayag, Doug Lobner, Kristen S. Kau, John R. Mantsch, Omer Abdulhameed, Matthew Hearing, Mark D. Grier, David A. Baker

Biomedical Sciences Faculty Research and Publications

Cocaine produces a persistent reduction in cystine–glutamate exchange via system x_c− in the nucleus accumbens that may contribute to pathological glutamate signaling linked to addiction. System x_c− influences glutamate neurotransmission by maintaining basal, extracellular glutamate in the nucleus accumbens, which, in turn, shapes synaptic activity by stimulating group II metabotropic glutamate autoreceptors. In the present study, we tested the hypothesis that a long-term reduction in system x_c− activity is part of the plasticity produced by repeated cocaine that results in the establishment of compulsive drug seeking. To test this, the cysteine prodrug N-acetylcysteine …

Towards An Understanding Of Salient Neighborhood Boundaries: Adolescent Reports Of An Easy Walking Distance And Convenient Driving Distance, Natalie Colabianchi, Marsha Dowda, Karin A. Pfeiffer, Dwayne E. Porter, Maria João C. A. Almeida, Russell R. Pate

Faculty Publications

Numerous studies have examined the association between the surrounding neighborhood environment and physical activity levels in adolescents. Many of these studies use a road network buffer of Euclidean distance buffer around an adolescent's home to represent the appropriate geographic area for study (i.e., neighborhood). However, little empirical research has examined the appropriate buffer size to use when defining this area and there is little consistency across published research as to the buffer size used. In this study, 909 12^th grade adolescent girls of diverse racial and geographic backgrounds were asked to report their perceptions of an easy walking distance …

Common And Distinct Mechanisms Of Different Redox-Active Carcinogens Involved In The Transformation Of Mouse Jb6p+ Cells, Sun Yang, Bobbye J. Misner, Rita Chiu, Frank L. Meyskens Jr.

Pharmacy Faculty Articles and Research

We transformed JB6P+ cells with prolonged intermittent low-dose UVB radiation or prolonged exposure to low-dose H2O2 or CdCl2. Stable transformation was confirmed by an anchorage-independence assay. The JB6P+ transformants formed more colonies (∼six folds) in soft agar as compared to their JB6P+ parent cells and were associated with increased intracellular reactive oxygen species (ROS) levels. Activating protein-1 (AP-1) is a family of transcription factors that are rapidly activated by elevated intracellular ROS levels, and their composition is important in the process of cellular transformation and/or tumor progression. To investigate if carcinogenesis induced by distinct carcinogens was via similar molecular mechanisms …

Short-Wavelength Light Sensitivity Of Circadian, Pupillary, And Visual Awareness In Humans Lacking An Outer Retina, Farhan H. Zaidi, Joseph T. Hull, Stuart N. Peirson, Katharina Wulff, Daniel Aeschbach, Joshua J. Gooley, George C. Brainard, Kevin Gregory-Evans, Joseph F. Rizzo Iii, Charles A. Czeisler, Russell G. Foster, Merrick J. Moseley, Steven W. Lockley

Department of Neurology Faculty Papers

As the ear has dual functions for audition and balance, the eye has a dual role in detecting light for a wide range of behavioral and physiological functions separate from sight. These responses are driven primarily by stimulation of photosensitive retinal ganglion cells (pRGCs) that are most sensitive to short-wavelength ( approximately 480 nm) blue light and remain functional in the absence of rods and cones. We examined the spectral sensitivity of non-image-forming responses in two profoundly blind subjects lacking functional rods and cones (one male, 56 yr old; one female, 87 yr old). In the male subject, we found …

Evidence-B(I)Ased Medicine: Limitations And Non-Superstition-Based Alternatives, Joshua S. Green M.D., Ph.D. (Pgy4)

Jefferson Journal of Psychiatry

The Evidence-Based Medicine (EBM) movement crystallized in the early 1990's at McMaster University in Canada. The movement originally challenged practitioners to validate their treatments based on reasoning and clinical studies rather than personal authority. In this essay, I will argue that, contrary to this wholesome intention, EBM is authoritarian in spirit and actually constricts discourse about how to make clinical decisions.

Diphenhydramine-Dependence Resulting From Self-Medication Of Antipsychotic- Induced Extrapyramidal Symptoms, Faisal S. Shaikh M.B.B.S., Ann M. Mortimer M.D.

Jefferson Journal of Psychiatry

Antipsychotic-induced extrapyramidal symptoms should be recognised and adequately treated. We report an unusual complication of not doing so: a patient’s self-medicating to control these symptoms, which produced diphenhydramine-dependence.

Dissociative-Like Spells In A Child With Neurofibromatosis (Type 1), Gregory M. Singleton M.D. (Pgy2), Ann M. Lagges Ph.D., Karen G. Meighen M.D.

Jefferson Journal of Psychiatry

Neurofibromatosis, type 1, (NF1) is a common neurocutaneous disorder of childhood. Little is known about the psychiatric aspects of the condition. We present the case of a 10-year-old male with NF1 and complex spells. For two years he had been experiencing self-limited paroxysms of auditory and visual hallucination, assaultiveness, excited undressing, and amnesia. The spells have been refractory to multiple treatments, including antipsychotic medication. The question remains whether this episodic amnestic disorder is comorbid with NF1 or is caused by it.

A Major Event Of Self-Mutilation In A Patient With Fetal Alcohol Syndrome, Joel P. Johnson M.D. (Pgy4), Steven Sugden M.D., James A. Bourgeois O.D., M.D.

Jefferson Journal of Psychiatry

We describe a young adult male with fetal alcohol syndrome (FAS) who presented with a non-repetitive, major, genital self-mutilation necessitating urological intervention. On formal psychiatric evaluation, he did not have psychosis or suicidality. Most commonly, self-injury in developmental disability is less severe and more stereotypic; major-class self-mutilation is confined, generally, to psychosis. It is this discrepancy that is the unusual feature of our case.

Autocastration And Autoamputation Of The Penis In A Patient With Delusions Of Sexual Guilt, Craig B. Franke M.D. (Pgy4), James A. Rush M.D. (Pgy3)

Jefferson Journal of Psychiatry

Genital self-mutilation (GSM) is a rare event that is commonly associated with psychotic disorders; we report an occurrence in the context of psychosis and drug use. We also review the etiologies of this phenomenon and how these etiologies differ across gender.

Clozapine, Fluoxetine, And Benztropine- Associated Ileus: Case Report, Pegah Pajouhi M.D. (Pgy1), James A. Bourgeois O.D., M.D.

Jefferson Journal of Psychiatry

Gastrointestinal complications of anticholinergic medications are prevalent, potentially life-threatening, and could be more actively prevented. We present a case report of an ileus that required surgical intervention and developed in the context of clozapine, benztropine, and fluoxetine use. The case exemplifies the potential anticholinergic toxicities of clozapine and benztropine as well as possible pharmacokinetic interactions between fluoxetine, clozapine, and benztropine. We discuss ways to minimize the likelihood of anticholinergic complications with these medications.

Oral Immunization Of Rhesus Macaques With Adenoviral Hiv Vaccines Using Enteric-Coated Capsules, George T. Mercier, Pramod N. Nehete, Marco F. Passeri, Bharti N. Nehete, Eric A. Weaver, Nancy Smyth Templeton, Kimberly Schluns, Stephanie S. Buchl, K. Buchl, Michael A. Barry

Nebraska Center for Virology: Faculty Publications

Targeted delivery of vaccine candidates to the gastrointestinal (GI) tract holds potential for mucosal immunization, particularly against mucosal pathogens like the human immunodeficiency virus (HIV). Among the different strategies for achieving targeted release in the GI tract, namely the small intestine, pH sensitive enteric coating polymers have been shown to protect solid oral dosage forms from the harsh digestive environment of the stomach and dissolve relatively rapidly in the small intestine by taking advantage of the luminal pH gradient. We developed an enteric polymethacrylate formulation for coating hydroxy-propyl-methyl-cellulose (HPMC) capsules containing lyophilized Adenoviral type 5 (Ad5) vectors expressing HIV-1 gag …