Medicine and Health Sciences Commons^™

The Role Of An Auditory Cue In Generating Anticipatory Postural Adjustments In Response To An External Perturbation, Huaqing Liang, Tippawan Kaewmanee, Alexander S. Aruin

Physical Therapy Faculty Research

Anticipatory postural adjustments (APAs) are usually generated to minimize the potential postural disturbance induced by predictable external perturbations. Visual information about a perturbation is important for the generation of APAs, but whether people can rely on auditory information to generate APAs is unknown. The aim of this study was to investigate the role of an auditory cue in generating APAs when visual information is not available. Fifteen young adults participated in the study. They received external perturbations a) with visual information but no auditory information available, b) without neither visual nor auditory information, c) with both visual and auditory information …

Himmelfarb Library Liaison Letter - February 2020, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

Integrating Interactive, Adaptive Technology To Teach First Year Physician Assistant Students, Zilola Khashimova

Physician Assistant Studies | Faculty Conference Presentations

Idea: Integrate adaptive technology into Anatomy curriculum. Need: Physician assistant departments do not have the extensive resources and instruction time to teach anatomy like medical schools. With faster computers and large data storage on the cloud, interactive technology has become quite useful and affordable. Interactive technology is algorithm-based systems that take advantage of advanced mathematical formulas and machine learning concepts to adapt specifically to individual learners. At its core, such systems are intended to identify what a student does and doesn’t understand, identify and provide content that will help the student learn it, assess again, help again, etc., until some …

A Comprehensive Basic Understanding Of Pelvis And Acetabular Fractures After High-Energy Trauma With Associated Injuries: Narrative Review Of Targeted Literature, Muhammad Atif, Obada Hussein Hasan, Naveed Baloch, Masood Umer

Section of Orthopaedic Surgery

Acetabular fractures are caused by energy trauma which is high enough to cause such a fracture with incidence of 3 patients / 100000. In older individuals, most commonmechanism of injury is fall and, in younger individuals, road traffic accidents. Acetabular fractures are usually associated with visceral injuries and other musculoskeletal injuries (about 50% of patient). In this narrative review of targeted English literature from all level of evidences, which is written and supervised by experienced specialized orthopedic and trauma surgeons who were among the pioneers of conducting pelvis fracture management workshops in the country, we aim to describe the mechanism …

Functional And Clinical Outcomes Of Open Versus Closed Radius And Ulna Shaft Fractures In Adults: A Prospective Cohort Study, Tashfeen Ahmad, Zehra Abdul Muhammad, Pervaiz Hashmi

Section of Orthopaedic Surgery

Objective: To compare functional and clinical outcomes of open versus closed radius ulna shaft fractures in adults treated by internal fixation.
Methods: A prospective cohort study was conducted on patients presenting with traumatic radius and ulna shaft fractures to Aga Khan University and undergoing internal fixation between July 2015 to June 2019. Data was extracted from an ongoing orthopaedic trauma registry. Functional and clinical outcomes were assessed by Price et al. criteria at 6 weeks, 3, 6 and 12 months follow-up. Outcome scores of open versus closed fractures were compared.
Results: Twenty-nine adult patients with isolated radius and ulna shaft …

In The Cost-Conscious Era: Ilizarov Circular Frame Or Uniplanar External Fixator For Management Of Complex Open Tibia Shaft Fracture, Retrospective Cohort Study From A Level-1 Trauma Center, Muhammad Atif, Yasir Mohib, Obada Hussein Hasan, Haroon Rashid

Section of Orthopaedic Surgery

Objective: External fixation is the most commonly used method for temporary management of open fractures of the Tibial shaft followed by internal fixation. This can also be used as a definitive method of fixation. Ilizarov is more superior and can be the primary and definite option where expertise is available. This study was conducted todetermine the outcome of open tibia shaft fracture treated with either Ilizarov or AO External Fixator.
Methods: Anon-commercial retrospective cohort was conducted at Aga Khan University Hospital Karachi on patients operated for isolated open tibia fractures Gustillo type III (A, B, C) stabilized with external fixation …

Comparison Of Intraarticular Distal Humerus Fracture Outcomes Treated With Or Without Olecranon Osteotomy - A Case Series, Naveed Baloch, Tashfeen Ahmad, Zehra Abdul Muhammad

Section of Orthopaedic Surgery

A case series was extracted from the trauma registry at Aga Khan University Hospital from the period June 2015 to June 2019. Included were 16 adult patients who presented with intra-articular distal humerus fracture type C2. The functional, clinical and radiological outcomes of fractures treated with or without olecranon osteotomy up to 12 months follow-up were compared. Outcomes were assessed at 6 weeks, 3, 6 and 12 months re-visits. Among the 16 studied patients, 9 (56%) were males and 7 (44%) were females. In the group without osteotomy, there was a good functional and clinical outcome with a mean Quick …

Patient Outcomes Association With Patient Factors And Care Provided: Trauma Registry Derived Cohort Study, Tashfeen Ahmad, Zehra Abdul Muhammad

Section of Orthopaedic Surgery

Objective: To determine the association of delay in treatment with injury-specific patient outcomes.
Methods: This was a single-center, longitudinal cohort study on orthopaedic trauma registry. Data on patients enrolled between June 2015 and June 2018 were analyzed. Data was collected from admitted consenting patients' medical records. Definitive surgical care provided after 24 hours was considered as 'delayed surgical treatment'. Outcomes of patients were serially assessed on follow-up visits up to 12 months using injury-specific scoring system.
Results: A total of 789 patients, were enrolled with 856 upper or lower extremity injuries altogether; in 67 cases both extremities were involved. Surgery …

Successful Recovery In A Paediatric Patient With Polytrauma Following Multiple Gunshot Wounds: Case Report And Review Of Literature, Areej Saleem, Rida Ahmed, Abeer Aziz, Sohail Asghar Dogar

Section of Paediatric Surgery

Our case report evaluates a 2½ year old boy who presented to emergency care, following multiple gunshot injuries and was managed emergently using a multidisciplinary surgical approach at our center. The patient was unresponsive, had poor perfusion, bilaterally decreased air entry, a distended abdomen, and multiple entry and exit wounds. A multidisciplinary team including Paediatric Surgery, Cardiothoracic Surgery, Paediatric anaesthesiology team and Orthopaedic surgery were taken on board. Following effective immediate management and stabilization, the patient was admitted to the ward under careful observation. He was discharged on post-operative day 28 after a successful recovery and on his 6 month …

Isolated Gallbladder Injury From Blunt Abdominal Trauma: A Rare Co-Incidence, Muhammad Rizwan Khan, Saleema Begum

Section of General Surgery

Gallbladder injury resulting from blunt abdominal trauma is a rare entity and generally associated with other intra-abdominal injuries. Incidence of isolated gallbladder injury has not been reported yet. The most common mechanism of injury reported is road traffic accident. Diagnosis is usually made on imaging as clinical presentation may vary from no symptoms to peritonitis due to extravasation of bile in the abdominal cavity. Cholecystectomy is the treatment of choice and minimally invasive approach can be considered in haemodynamically stable patients.

Rare Disease Week - Cooper Library Display, Jenessa Mcelfresh, Laura Stanley

Presentations

The Rare Disease Week book display in Cooper Library aims to highlight the history, stories, and impact of rare diseases. This display seeks to demonstrate the many types of rare diseases in the world, the foundational research texts behind disease identification and epidemiology, and the ways that communities can help support individuals living with a rare disease.

Delay Between Onset Of Indication And Definitive Surgery For Tracheal Trauma, Mohammad Bin Pervez, Hassan Mushtaq, Shahmir Chauhan, Ali Aahil Noorali, Yasir Bilal Khan, Muhammad Saad Yousuf, Saulat Fatimi

Section of Cardiothoracic Surgery

Tracheal stenosis is rare but a recognized complication after traumatic injury or prolonged intubation. We assessed the time lag between onset of indication for tracheal reconstruction surgery following trauma and actual surgical intervention. We reviewed our operative records for all patients undergoing tracheal reconstruction over the past 10 years. Files were reviewed retrospectively to collect all the relevant data. Surgically all patients were operated via cervical approach. Series 12 cases were identified with an equal split between external trauma and iatrogenic tracheal trauma from prolonged intubation. On, an average patients presented 185 days after initial indication of surgery however there …

Interview With Dr. Geoffrey Krampitz, Colin Yost

Gibbon Surgical Review

Geoffrey Krampitz, MD, PhD is a hepatopancreaticobiliary surgeon with an extensive background in surgical oncology, stem cell science, and cancer immunotherapy research who recently joined the faculty here at Thomas Jefferson University as an Assistant Professor of Surgery. After earning his BSE in biomedical engineering at Johns Hopkins University and before starting medical training, Dr. Krampitz worked in consulting in the San Francisco Bay Area and eventually helped launch two internet startup companies in Silicon Valley. He then went to UC San Francisco for his Master’s degree, where he investigated the role of HIF1-alpha in stem cell differentiation. Dr. Krampitz …

Primum Non Nocere: Surgeons And The Politics Of Firearm Trauma, Kaushal Desai

Gibbon Surgical Review

The crisis of firearm violence in America continues to worsen and the call to action cannot be ignored. If we are to make a real impact, we must be just as skilled policy makers as proceduralists. We must wield the pen as well as we wield the scalpel. All the clinical knowledge and surgical skills in the world will make no difference if we do not reduce the number of firearm injuries. The skillset we need is policy analysis and lobbying, which can only be developed through political activism and engagement, not more practice questions and Online MedEd.

General Surgery 101: Nissen Fundoplication, Kelley Yuan, Tyler Bauer

Gibbon Surgical Review

The first time that medical students enter the OR can be a jarring experience. Successfully maintaining sterility is hard enough, but remembering relevant patient history, answering “pimp” questions, and performing basic suturing skills can make the third year medical student experience difficult. In this article we describe a common surgery performed by both general and thoracic surgeons with a specific focus on “medical student level” understanding. This piece is the product of a collaboration between an MS1 and MS4, both of whom are interested in a career in surgery. We hope you find it helpful!

Interview With Dr. Dawn Salvatore, Preeyal Patel

Gibbon Surgical Review

A medical student’s path to surgery is notoriously long and arduous. Traditionally, students who are interested in the field begin to prepare their qualifications from day one, especially given the competitive nature of acceptance into surgical programs. For students who develop an interest in surgery during their later years of medical school, it can be a daunting task to pursue a track in which they already feel behind. Often times, these students are discouraged from applying to surgical residencies, worrying that their non-traditional path may hinder their success. However, Dr. Dawn Salvatore can reassure students that a non-traditional path to …

The Utility Of Surgical Simulation In Student Education, Jared Raikin

Gibbon Surgical Review

The use of simulation in the field of surgery has become a heavily researched topic over the last few decades, but it is by no means a new concept. The first recorded use of surgical simulation dates back 2,500 years with evidence of nasal models for flap reconstruction made of leaf and clay.1 But simulation as we know it today did not take shape until the 1980s with the invention of the Comprehensive Anesthesia Simulation Environment (CASE) mannequins. The use of nonorganic simulation tools revolutionized the field and continues to play a large role in medical education. These modalities have …

Bedside To Bench: Basic Science Research During General Surgery Residency, Signe Caksa

Gibbon Surgical Review

Clinical, basic science, and quality improvement research is becoming increasingly integrated into general surgery residency programs, providing aspiring surgeons with an avenue to engage with academia and improve patient care early on in their careers. For example, as an essential part of their training, general surgery residents at Thomas Jefferson University Hospital (TJUH) complete one to two years of research, usually between their PGY3 and PGY4 years. The goal of this protected research time is for residents to gain hands-on surgical research skills and work on translational research projects that correlate with clinical cases, while also becoming more competitive for …

Longevity In Surgery: A Conversation With Two Temple Surgeons About How They Continually Find Joy In Their Careers, Kelsey Muir

Gibbon Surgical Review

Both Dr. Daly and Dr. Pontari describe the stress and pressure that comes with a long career in patient care, however intertwined with the stress is their overwhelming gratitude and joy for surgery. Maintaining that perspective for medicine and patient care has required two things: community and an outlet. Dr. Daly and Dr. Pontari expressed the need to be able to share their anxieties and struggles with someone to process the stress, the difficulties, and the demands of a surgical career.

Surgery Myths And Facts, Heli Patel

Gibbon Surgical Review

Throughout social media, television shows, movies, and “public perception”, surgical residents and attendings are often stereotyped into a personality that is most often incorrect. Unless you are a surgeon, it is often hard to understand what exactly the life entails. Add in some Hollywood drama and social media, and what you get is a wildly disproportionate picture of what surgeons’ personalities are like. As a medical student, it is often difficult to separate fact from fiction, so here are some of the most common myths debunked.

John H. Gibbon, Jr., Md

Gibbon Surgical Review

Dr. John Heysham Gibbon, Jr. graduated from Jefferson Medical College in 1927, and in a brief series of events, he was named Fellow at Massachusetts General Hospital. In 1930, he found himself assisting Dr. Edward Churchill in an emergency pulmonary embolectomy. At that time the procedure was one of desperation, as no patient in the U.S. had survived the removal of blood clots in open-heart surgery. As Dr. Gibbon recorded the patient’s waning vital signs prior to the procedure he thought, “If only we could remove the blood from her body by bypassing her lungs, and oxygenate it, then return …

Gibbon Surgical Review, Volume 3, Issue 1, 2020

Gibbon Surgical Review

Table of Contents

4 - Interview with Dr. Geoffrey Krampitz

8 - Primum Non Nocere: Surgeons and the Politics of Firearm Trauma

10 - General Surgery 101: Nissen Fundoplication

14 - Interview with Dr. Dawn Salvatore

16 - The Utility of Surgical Simulation in Student Education

18 - Bedside to Bench: Basic Science Research During General Surgery Residency

20 - Longevity in Surgery: A Conversation with Two Temple Surgeons About How They Continually Find Joy in Their Careers

22 - Surgery Myths and Facts

24 - Gibbon Surgical Society

25 - John H. Gibbon Jr., MD

26 - Editorial Board …

Circrnas Expressed In Human Peripheral Blood Are Associated With Human Aging Phenotypes, Cellular Senescence And Mouse Lifespan., Shahnaz Haque, Ryan M Ames, Karen Moore, Luke C Pilling, Luanne L. Peters, Stefania Bandinelli, Luigi Ferrucci, Lorna W Harries

Faculty Research 2020

Circular RNAs (circRNAs) are an emerging class of non-coding RNA molecules that are thought to regulate gene expression and human disease. Despite the observation that circRNAs are known to accumulate in older organisms and have been reported in cellular senescence, their role in aging remains relatively unexplored. Here, we have assessed circRNA expression in aging human blood and followed up age-associated circRNA in relation to human aging phenotypes, mammalian longevity as measured by mouse median strain lifespan and cellular senescence in four different primary human cell types. We found that circRNAs circDEF6, circEP300, circFOXO3 and circFNDC3B demonstrate associations with parental …

Non-Traditional And Non-Invasive Approaches In Facial Rejuvenation: A Brief Review, Abigail M. Smith, Taylor Ferris, Vinayak K. Nahar, Manoj Sharma

Walden Faculty and Staff Publications

While injectables, lasers, and surgical interventions have traditionally been used to reverse the changes associated with facial aging, other alternative therapies such as facial acupuncture and facial exercises are now being studied for facial rejuvenation. In this paper, we both summarize the concepts of facial acupuncture and facial exercises, and review seven studies that evaluate the efficacy of these modalities. Data from these studies suggest that both facial acupuncture and facial exercises have the potential to improve the skin laxity, wrinkle length, muscle thickness, and pigmentary changes associated with aging. Patients frequently reported improvement and experienced very few side effects. …

The Impact Of Human Papillomavirus Educational Intervention Study On The Knowledge, Health Beliefs, Health Behaviors And Increasing The Use Of Gardasil In Women Of Color, Charlotte Hurst, Michael Hagensee, Syed Adeel Ahmed, Geornique M. Hayes

The Journal of the Research Association of Minority Professors

Lack of human papillomavirus (HPV) knowledge and cervical cancer awareness are factors contributing to a disproportion in African American (AA) women with cervical cancer. The purpose of this intervention study was to use gender specific and culturally appropriate HPV educational materials to increase HPV knowledge and cervical cancer awareness, to increase health beliefs, and the intent for AA women to use the HPV vaccine. Convenience sampling was used to describe a sample of 98 AA women recruited from an Ambulatory Women’s health clinic between 2015 and 2017. HPV educational videos and pamphlets materials were used to collect baseline and post …

Tumor Slice Culture As A Biologic Surrogate Of Human Cancer., Heidi L Kenerson, Kevin M Sullivan, Yongwoo D Seo, Kathryn M Stadeli, Cigdem Ussakli, Xiaowei Yan, Christopher G Lausted, Venu G Pillarisetty, James O Park, Kimberly J Riehle, Matthew Yeh, Qiang Tian, Raymond S Yeung

Articles, Abstracts, and Reports

Background: The tumor microenvironment (TME) is critical to every aspect of cancer biology. Organotypic tumor slice cultures (TSCs) preserve the original TME and have demonstrated utility in predicting drug sensitivity, but the association between clinicopathologic parameters and

Methods: One hundred and eight fresh tumor specimens from liver resections at a tertiary academic center were procured and precisely cut with a Vibratome to create 250 μm × 6 mm slices. These fixed-dimension TSCs were grown on polytetrafluoroethylene inserts, and their metabolic activities were determined by a colorimetric assay. Correlation between baseline activities and clinicopathologic parameters was assessed. Tissue CEA mRNA expression …

Methylation Signatures In Peripheral Blood Are Associated With Marked Age Acceleration And Disease Progression In Patients With Primary Sclerosing Cholangitis., Michael Trauner, Yevgeniy Gindin, Zhaoshi Jiang, Chuhan Chung, G Mani Subramanian, Robert P Myers, Aliya Gulamhusein, Kris V Kowdley, Cynthia Levy, Zachary Goodman, Michael P Manns, Andrew J Muir, Christopher L Bowlus

Articles, Abstracts, and Reports

Background & Aims: A DNA methylation (DNAm) signature derived from 353 CpG sites (the Horvath clock) has been proposed as an epigenetic measure of chronological and biological age. This epigenetic signature is accelerated in diverse tissue types in various disorders, including non-alcoholic steatohepatitis, and is associated with mortality. Here, we assayed whole blood DNAm to explore age acceleration in patients with primary sclerosing cholangitis (PSC).

Methods: Using the MethylationEPIC BeadChip (850K) array, DNAm signatures in whole blood were analyzed in 36 patients with PSC enrolled in a 96-week trial of simtuzumab (Ishak F0-1, n = 13; F5-6, n = 23). …

Editorial., Jeffrey C Wang, Jens R Chapman, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Safety And Immunogenicity Of The Oral, Inactivated, Enterotoxigenic Escherichia Coli Vaccine Etvax In Bangladeshi Children And Infants: A Double-Blind, Randomised, Placebo-Controlled Phase 1/2 Trial, Firdausi Qadri, Marjahan Akhtar, Taufiqur R Bhuiyan, Mohiul I Chowdhury, Tasnuva Ahmed, Tanzeem A Rafique, Arifuzzaman Khan, Sadia I A Rahman, Farhana Khanam, Anna Lundgren, Gudrun Wiklund, Joanna Kaim, Madeleine Löfstrand, Nils Carlin, A Louis Bourgeois, Nicole Maier, Alan Fix, Thomas Wierzba, Richard I Walker, Ann-Mari Svennerholm

Faculty and Staff Publications

Background: Enterotoxigenic Escherichia coli causes diarrhoea, leading to substantial mortality and morbidity in children, but no specific vaccine exists. This trial tested an oral, inactivated, enterotoxigenic E coli vaccine (ETVAX), which has been previously shown to be safe and highly immuongenic in Swedish and Bangladeshi adults. We tested the safety and immunogenicity of ETVAX, consisting of four E coli strains overexpressing the most prevalent colonisation factors (CFA/I, CS3, CS5, and CS6) and a toxoid (LCTBA) administered with or without a double-mutant heat-labile enterotoxin (dmLT) as an adjuvant, in Bangladeshi children.

Methods: We did a randomised, double-blind, placebo-controlled, dose-escalation, age-descending, phase …

Implementation Of A Cardiogenic Shock Protocol And Data Review Process Is Associated With Improved In-Hospital Survival, Adrienne Jones, Renee Swanson, Kateri Spinelli, Joshua Remick, Daniel Westerdahl, Jill M Gelow, David Hotchkin, Jason Wells, Tim Lewis, Robert Kim, Jeff Robinson, Roxanna Barr, Sarah Ramelli, Jacob Abraham

Articles, Abstracts, and Reports

Background: Despite increasing use of mechanical circulatory support devices (MCS), cardiogenic shock (CS) mortality is persistently high, with worsening outcomes in later stages of CS. Delays in diagnosis and practice variation may contribute to in-hospital mortality.

Methods: In June 2018, we devised and implemented a CS protocol at two hospitals from one health system in Portland, OR. The CS protocol was designed to promote early CS recognition, rapid notification of a multi-disciplinary specialty team lead by a heart failure cardiologist, invasive hemodynamic evaluation, and institution of MCS as appropriate. CS was defined by widely accepted clinical and hemodynamic criteria. Patient …