Penn Medicine News Blog

Can sleeping actually make you MORE tired? For many patients with obstructive sleep apnea (OSA), they awake each morning thinking they had a full night’s rest, only to feel exhausted and unfocused day after day. This counterintuitive situation occurs because OSA sufferers may wake up dozens of times an hour or more each night without even realizing it due to pauses in breathing that can jolt a person out of sleep. The staggered breathing is the direct result of the airway collapsing or becoming blocked during sleep.

That was the case for Penn Medicine patient Daniel Sheiner. At 32, his exhaustion was starting to become an issue while he was at work. He would wake up each morning believing he had slept through the night, but never actually felt any of the restorative benefits. After seeking medical help and undergoing a sleep exam, doctors determined that he had a very severe case of OSA. After many failed attempts with standard front line therapies such as lifestyle changes, mouthpieces, and breathing devices, Daniel learned about a new surgical approach for OSA being pioneered at Penn Medicine.

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The recent events in Boston remind us how important it is to help people, children and families affected by such tragedies get the most effective mental health treatments out there.

The good news is, over the years, evidence-based therapies (EBT), like prolonged exposure therapy, where patients with posttraumatic stress disorder (PTSD) face the situations, places, and people they have been avoiding, have been shown to successfully ameliorate PTSD severity.  The bad news is, though, the majority of these patients haven’t been getting them. But researchers are trying to change that.

“The recent tragic events will leave a host of lingering health and mental health problems, like PTSD, in its wake,” said Edna B. Foa, PhD, a professor of Clinical Psychology in the department of Psychiatry. “And it highlights how important it is to identify and overcome the barriers to dissemination and implementation of effective treatment, such as prolonged exposure, among mental health providers, so that people affected by such tragedies can benefit from those short-term treatments.”

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In a previous post, I noted that most of my work as Digital Communications Editor takes place online, rarely expanding beyond the reaches of my keyboard. But that was five months ago, and six months since I got my first in-depth view of the whole Penn Medicine enterprise while shooting photographs across campus for the Day in the Life photo project. Since then, I've taken on an additional role as “in-house photographer.” Now, I find myself getting out from behind the keyboard pretty frequently, accompanying press officers to various events and happenings around Penn Medicine's facilities to turn my camera’s lens toward a wide variety of happenings in the patient care and research world. It has been wonderful — a welcome development.

In what will hopefully be a regular series on the Penn Medicine News Blog, I'd like to share some of the photos I've taken over the past month or so, giving readers a glimpse behind the scenes of events – both the everyday and the extraordinary – that happen here. Some of these photos you may already have seen floating around in an online slideshow or accompanying an article on various Penn sites, others have not previously seen the light of day. All of them represent another experience I'm thankful to have had here at Penn Medicine.

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The Philadelphia Science Festival, from April 19 – 28 this week, celebrates the region’s strengths in science and technology, bringing together more than 100 partners from academia to museums to restaurants.The Festival will include an extensive line-up of programs and exhibitions designed to inspire the next generation of scientists and spark discussion among young and old. 

This year the Center for Brain Injury and Repair (CBIR) is reaching audiences of all stripes with their message of how to mind your brain from concussions with such demos as eggs in Styrofoam to mimic a human head in a helmet.

On Saturday, April 20 CBIR was part of the “Penn village” at the Science Carnival on Ben Franklin Parkway. They and many other Penn groups of exhibitors shared their knowledge and enthusiasm of science and technology:

• Laboratory for the Research of the Structure of Matter
• Netter Center for Community Partnerships
• School of Veterinary Medicine
• Upward Bound Math and Science 
• Biomedical Graduate Studies
• GRASP Lab

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• A trauma nurse faces the tragic loss of a young patient close to his own son’s age.
• A transporter must bring an infant who died in the Neo-ICU down to the morgue.
• A pharmacist hears that his patient had an anaphylactic reaction to a medication.  He discovers the medication allergy was documented but not acknowledged during the patient’s admission.
• A housekeeper learns that a long-time patient she has grown close to has coded and is now in an intensive care unit.

 

What do all these hospital employees have in common?  They are ‘second victims’ of a tragic patient outcome.  For years, many have suffered in silence, trying to retain the expected stoic façade. 

But, now, at the Hospital of the University of Pennsylvania, a new program launching this summer will pro-actively provide immediate ‘emotional’ first aid to those who need it.

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It was a book that was excerpted in The Saturday Evening Post, featured in Time magazine, reviewed enthusiastically in Annals of the American Academy of Political and Social Science, and recommended by Archives of Neurology and Psychiatry. It earned mixed reviews in The Journal of the American Medical Association and The American Journal of Psychiatry and was panned in The Saturday Review. It has also been described as a best-seller. The book, Their Mothers’ Sons: The Psychiatrist Examines an American Problem, which first appeared in 1946, was even reviewed in the journal Military Affairs. It appears to have drawn the attention of both the general reading public of the post-World War II era and the professional specialists.

In part, this shared interest was because of its author, Edward A. Strecker, MD, then chair of the Department of Psychiatry at the University of Pennsylvania, a position he held for more than 20 years. He also served as chief medical officer of The Institute of Pennsylvania Hospital from 1920 to 1928 and continued his association with the Institute until his death in 1959. Strecker figures in Part 2 of “Benjamin Rush and 200 Years of Penn Psychiatry,” which will soon appear in the Spring 2013 issue of Penn Medicine. In his article, Marshall Ledger, Ph.D., notes that Strecker was called “one of the first, if not the first” psychiatrists to treat the disorders of everyday life. He helped revive the dilapidated outpatient clinics at Pennsylvania Hospital, which had been built in 1885, and he later started an outpatient clinic at the Hospital of the University of Pennsylvania.

But Strecker had also been a major in World War I and served as a special consultant in World War II to the Secretary of War and to the Surgeon General of the Army and the Navy, which partially explains why Military Affairs would review Their Mothers’ Sons. Given his connection to the war effort in the Second World War, Strecker has been cited as the primary source of some startling figures: a reported 1,825,000 men were rejected for military service during the war because of psychiatric disorders and another 600,000 were discharged for similar reasons. In Their Mothers’ Sons, Strecker argued that overprotective and oversolicitous mothers bore much of the blame. Borrowing the concept of “Momism” from Philip Wylie, author of the provocative screed Generation of Vipers (1942), Strecker pointed the finger at “Mom” –- “the woman who has failed in the elementary mother function of weaning her offspring emotionally as well as physically.”

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Never in a million years would I have thought that I’d be writing about blues musician Blind Boy Fuller, cartoonist R. Crumb, and molecular motors in the same blog post. The Popular Science blog and sci-fi future blog io9 took notice first. The cover of last month’s Biophysical Journal likens movement of the molecular motor Myosin-V to the exaggerated, wobbly gait of R. Crumb’s “Mr. Natural” on the cover of Blind Boy Fuller's record album "Truckin' My Blues Away."

There’s even a link to a 1930s Fuller recording on the io9 post. The Pop-Sci post has a great 22 second animation of a kinesin molecule “walking” along a microtubule while dragging its large cargo and another video of Myosin-V’s tilt and wobble on an actin filament.

These all refer to papers recently published by researchers from the Pennsylvania Muscle Institute. The Biophysical Journal cover is an adaption by sci-artist Patrick Lane submitted by Penn scientists.

The labs of senior authors Yale E. Goldman, and Erika L.F. Holzbaur, both in the Physiology department, have been studying molecular motors for close to a combined five decades. Colleagues Henry Shuman, Phillip C. Nelson in Physics, Haim Bau in Mechanical Engineering, Russel J. Composto in Materials Science, and PMI director Mike Ostap round out the team.

They investigate molecular motors -- proteins that function as tiny molecular machines to move cargos within a cell – to get a better handle on what happens when the transport of cellular cargo goes off track and how that may be the start of developmental and neurodegenerative diseases.  

The Biophysical Journal paper details how Myosin-V works in the “harsh” environment of the cell on a nano scale. Myosin-V must function in a sea of water molecules that bombard it 10¹² times every second. And what’s most spectacular is that myosin uses this seemingly chaotic environment to adjust its short-lived sub-steps to search for the next binding site on its actin track to keep efficiently moving onward. Literally, myosin V uses its fluctuating environment to extend its reach to take each new step.

 

Goldman, Nelson, and company conduct their observations into this micro world with single purified molecules using custom a fluorescence microscope that Goldman and junior colleagues designed and built to see the detailed tilts and wobbles of molecular motors. He calls this the “bottom up” approach.

The researchers also use super-high resolution cell bioimaging, the “top-down approach.” A related paper recently published in the Proceedings of the National Academy of Sciences uses both approaches to understand how components of cell motility like the cytoskeleton and molecular motors work together. Using optical trapping technology in live cells, they found that different types of molecular motors work as a team to get to their target destination. In the center of cell, dynein and kinesin work on microtubule tracks and switch to myosin on actin tracks at the periphery of the cell. Using immune cells called macrophages, they asked, how the microtubule motors operate together. They found that cargoes simultaneously engage with many microtubules and generate high forces to move back and forth in the macrophages.

These papers illustrate how scientific collaborations across multiple disciplines coupled with development of new biophysical technology facilitate discriminating measurements on complex biological networks, notes Goldman. Both of the papers, he adds, show that molecular motors have also evolved sophisticated collaborative adaptations to conduct their essential transport functions. 

 

In early April, Penn Medicine hosted a fast-paced lightning round of presentations highlighting new and emerging technology being used inside and outside the Health System that may help patients and medical professionals alike. “Connected health” is about continuous sensing and monitoring to enable early detection, diagnosis and intervention, and improving outcomes at lower cost.  Alternating between internal and external projects, the presenters brought their best ideas and applications to share, explaining how these new devices fit within the existing health care system and, in some cases, how they stretch the boundaries and may change the way healthcare is delivered.

"We wanted a chance to bring some of the best innovations from industry and from within Penn Medicine together, to share ideas, connect like-minded groups, and explore new ways we can use technology now and in the future to improve patient care and convenience and lower costs," said Bill Hanson, MD, Chief Medical Information Officer for the University of Pennsylvania Health System and professor of Anesthesiology in the Perelman School of Medicine at the University of Pennsyvania. The event was organized by the Penn Medicine Center for Innovation and moderated by David Asch, MD, MBA, Professor of Health Care Management and Executive Director of Penn Medicine's Center for Innovation, as well as Roy Rosin, MBA, Chief Innovation Officer at Penn Medicine's Center for Innovation and former Vice President for Innovation at the software company Intuit.

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Penn’s signature event at the 3^rd annual Philadelphia Science Festival next week is a sure sign of the times. “Big Ideas: Funding and Innovation” draws on current themes and reminders of where the bright ideas really come from. Fundamental research at such government agencies as the National Institutes of Health and the National Science Foundation spur today’s most successful businesses and healthcare innovations. Federal funds from taxpayer dollars drive the development of nearly all of the top technologies that permeate our lives.

 

On Tuesday, April 23, 2013 at 6:30pm at the historic Iron Gate Theater, 3700 Chestnut Street, NSF Director and 2013 Franklin Medal awardee Subra Suresh will open a discussion on the importance of federally funded research at laboratories in research universities.

 

In TED-talk style, a group of Penn and Drexel innovators will share their real-life examples of how federal funds have contributed to their Big Ideas:

Garret FitzGerald, MD, FRS, Chair of the Department of Pharmacology, and Director, Institute for Translational Medicine & Therapeutics, Perelman School of Medicine, studies how drugs work in the body. His lab leads the way, with many firsts, to help people lead healthier lives -- discovering how low-dose aspirin is important for heart health, showing which anti-inflammatory drugs might be harmful, and finding an internal body clock important to the circulatory system and when best to take medications.

Chris Hunter, PhD, Chair of the Penn Vet Department of Pathobiology, uncovers ways in which certain proteins cause or prevent inflammatory diseases to create more accurate models of immune-system function, to combat diseases from cancer and arthritis to HIV/AIDS.

Adam Fontecchio, PhD, Professor of Electrical and Computer Engineering and the Associate Dean of Undergraduate Affairs in the College of Engineering, co-directs Drexel’s Expressive and Creative Interaction Technologies (ExCITe) Center, a hub for enabling teams of faculty, students, and entrepreneurs to pursue multi-disciplinary collaborative projects. He investigates liquid crystal interactions to develop novel devices.

Jordan Miller, post-doctoral fellow in the Tissue Microfabrication Laboratory in the School of Engineering and Applied Sciences, combines chemistry and rapid prototyping to direct cultured human cells to form complex organizations of living vessels and tissues. He is one of the founding members of the 3D maker community, using 3D printing in his regenerative medicine research.

Tickets can be purchased here and the full calendar of PSF programs is available here.

Women who develop breast cancer while they’re young are often searching for answers about the cause for their disease or what they can do to improve their chances of being cured. While an increasing number of large genetic testing panels promise to scrutinize their DNA to uncover clues, a team of researchers from the Perelman School of Medicine and the Abramson Cancer Center has found that those powerful tests tend to produce more questions than they answer. The group presented their findings earlier this month during the American Association for Cancer Research Annual Meeting 2013 in Washington, D.C.

Sometimes, these tests reveal deleterious – clearly bad – mutations in genes that are associated with an increased risk in developing cancer. When women test positive for mutations of the BRCA 1 and BRCA 2 genes, they may opt for mastectomies and ovary removal surgery – which research shows slashes their risk of developing those cancers. However, there is not yet guidance for clinicians on how to care for patients who exhibit these other types of mutations. The new study also uncovered many of what are known as variants of unknown significance (VUS) – genetic wrinkles that experts don’t yet know how to interpret.

“We’re in a time where the testing technology has outpaced what we know from a clinical standpoint. There’s going to be a lot of unknown variants that we’re going to have to deal with as more patients undergo large genetic testing panels,” said the new study’s lead author Kara Maxwell, MD, PhD, a fellow in the division of Hematology-Oncology in Penn’s Abramson Cancer Center. “It’s crucial that we figure out the right way to counsel women on these issues, because it can really provoke a lot of anxiety for a patient when you tell them, ‘We found a change in your DNA and we don’t know what it means.’”

Researchers will gather to delve further into these topics tomorrow at the first Basser Research Center for BRCA Symposium.

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When news broke last July of the American Society for Clinical Oncology’s recommendation against PSA screening in many groups of men, Alan J. Wein, MD, professor and chief director, Division of Urology, shared his insight for the Penn Medicine News Blog. Wein noted that the test is worthwhile for some groups and not for others. 

Now, almost a year later, new prostate cancer screening methods are garnering national attention, and a Reuters article earlier this week discusses the cautious approach towards PSA testing taken by the American College of Physicians. A recent New York Times article suggests that these new tests can decrease the number of “false alarms” from elevated PSA readings and prevent thousands of men from receiving unnecessary biopsies, surgeries, and radiation treatments. Some of the new tests look at the genetic workings of a cancer to identify dangerous tumors that need treatment, rather than slow-growing ones that may be best to monitor only.

Considering these new discoveries, I checked in with David Lee, MD, FACS, assistant professor of Surgery in Urology, to see if any of these new tests influences the treatment he provides for patients.

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On Tuesday, April 9, local residents, sponsors, and 16 of Philadelphia’s best-known restaurants joined forces in the city’s first ever Wine and Dine for Women’s Health event, hosted by Penn Medicine’s Women’s Health Leadership Council. Proceeds from the event will support patient programs at the Helen O. Dickens Center for Women’s Health and the Hospital of the University of Pennsylvania that are critical to the health and well being of underserved women in the West Philadelphia community.

For over 40 years the Center has served generations of women living in the West Philadelphia community. In 1999, the Center was named for Dr. Helen O. Dickens, a remarkable woman and a pioneer who spent her career in academic medicine seeking to find ways to improve the lives of low-income women and their families. Dr. Dickens practiced obstetrics and gynecology in Philadelphia for over 50 years, joining the faculty at the University of Pennsylvania in the late 1960s. In 1967 she established one of the first multidisciplinary Obstetrical Programs in the United States for teen mothers. She was a life-long advocate for women’s health especially among the underserved, the youth, the vulnerable, and minorities in Philadelphia.

“Low income women often believe they must choose between feeding their families and paying for medical care that they personally need to help prevent and/or address health issues,” said C. Neill Epperson, MD, director of the Penn Center for Women's Behavioral Wellness. “Recognizing the unique balance between the physical and psychosocial well being of underserved women, the Helen O. Dickens Center for Women’s Health is providing access to comprehensive healthcare for these women throughout their lifespan. This Center is a great example of Penn Medicine’s dedication to helping improve the lives of women and their families who live within the local community.”

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Back in December, when the chatter about budget cuts to the National Institutes of Health started getting louder, Penn PhD students Michael Allegrezza and Shaun O’Brien decided it was time to join the conversation and advocate. They wanted to bring that on-the-ground scientist voice into the mix but knew it had to be something their research is not: clear and simple.

“You need to personalize the work so people can relate to it,” says O’Brien, a fifth year Immunology doctoral candidate. “Researchers need to communicate their findings and talk about the impacts… to get people, the taxpayers, to see why biomedical research is so important.”

So the two started the Penn Science Policy Group, a coalition that now has about 90 science graduate and postdoctoral students out there, explaining their science and advocating to restore and even increase funds to the NIH.

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A scientist's life is a busy one, and sometimes it can include interacting with the news media to share the findings of their research. But talking to reporters is not something most scientists learn in school. The first Penn Media Training Workshop, aimed at science and medical faculty from across the entire University, was designed to fill that gap.

Held on April 5^th and organized by the Office of University Communications and the Penn Medicine Department of Communications with funding sponsorship from the Burroughs Wellcome Fund, the program provided training for 30 researchers from the schools of Medicine, Arts and Sciences, Engineering and Applied Science, Veterinary Medicine, Dental Medicine and Nursing.

 

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Nurses make up the single largest segment of the health-care work force, providing 95 percent of direct care to hospitalized patients.  So it’s not surprising that the higher the quality of a hospital’s nursing staff, the better the patient care.  

But how does a consumer determine how good a nursing staff is? Magnet® accreditation --  one of the most respected recognitions of nursing excellence -- is a good place to start. Created by the American Nurses Credentialing Center, the Magnet Recognition Program closely examines a hospital’s nursing practices. Only those hospitals that meet its high standards – currently less than seven percent of U.S. hospitals – receive the recognition of excellence. The Hospital of the University of Pennsylvania is among that elite group. It received Magnet accreditation in 2008 and was recently re-accredited.

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Penn Medicine will play a starring role in the Philadelphia Science Festival again this year. The Festival is a citywide collaboration showcasing science and technology every April. 

This year it runs from April 19 - 28, 10 days to celebrate the region’s strengths in science and technology, bringing together more than 100 partners from academia to museums to restaurants. The Festival will include an extensive line-up of programs and exhibitions designed to inspire the next generation of scientists and spark discussion among young and old. 

Take a look at who will be representing Penn Med at the 2013 Philadelphia Science Festival. Penn Med participants are in bold. Click on the links to each event to learn more. Watch this space for more about individual events and for coverage of the festival.

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Officially our nation’s first hospital, Pennsylvania Hospital has been a stalwart pillar of its surrounding Philadelphia community since its founding in 1751. No wonder than, with over two and a half centuries of history and continuous service behind it, the hospital inspires its employees to “give back” to the community.

“When I was still in school I was very involved in community outreach,” said Alyssa Vaysman, PharmD, Outpatient Pharmacy supervisor at Pennsylvania Hospital. “It’s something that I’ve really been missing. At the end of the day, I got into health care to help people and I got into community and outpatient pharmacy because I love interacting with patients.”

Alyssa Vaysman, PharmD, Outpatient Pharmacy supervisor and Carmela Bynum, Pharmacy technician at Pennsylvania Hospital

It was through her interacting with patients that Alyssa recognized a very real, very specific need in the older adult population. “Prior to working at Pennsylvania Hospital I worked for CVS, participating in annual flu shot clinics at various assisted living facilities and nursing homes. We were there to talk with residents about the importance of getting a flu vaccine but they always had other questions about their medications – how to take them, side effects, etc.,” said Alyssa.  “But we were so busy giving out flu shots that we weren’t able to answer all of their questions.” With her current position at the Hospital, Alyssa realized she now has the opportunity to work with the community as she’s always wanted. “This gave me the idea to contact a local facility and set up a venue to address the needs of our older adult community and apply for grant funding.”

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Know the traits of HIV-1 strains capable of establishing new infections could be important for AIDS vaccine development.

After developing methods for their accurate identification, George Shaw, Beatrice Hahn, and Nicholas Parrish, from the Department of Microbiology at the Perelman School of Medicine, and their colleagues, generated infectious clones of transmitted founder and chronic control HIV-1 strains and compared their traits to probe the earliest stages of HIV-1 infection.

Transmitted founder (TF) viruses from acutely infected patients have all the genetic tools to start a new infection, while chronic control (CC) viruses from long-term HIV patients have the genetic tools to sustain an infection for years.

After a transmitted founder strain of HIV-1 infects mucosal tissues, it spreads to nearby and distant tissues, including the gut-associated lymphoid tissue. There, the virus expands exponentially, triggering a systemic cytokine storm, preceding peak viral load in the blood.

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This week’s TIME magazine makes an eye-catching, bold proclamation. HOW TO CURE CANCER, the cover reads, with a subhead previewing the story contained inside: “Yes, it’s now possible – thanks to new cancer dream teams that are delivering better results faster.”

Much of that team science is happening right here at Penn Medicine, as part of Stand Up to Cancer’s pancreatic cancer “dream team.” As detailed in a News Blog post last fall before the third Stand Up to Cancer telethon, a Penn-led tumor tissue banking study is one of that dream team’s marquee achievements thus far. Since that trial began here, pieces of tumor from more than 60 patients with pancreatic cancer have kick-started a nationwide scavenger hunt that, bit by bit, is yielding new information that stands to shape a new, hopeful generation of treatments.

Under the direction of Jeffrey Drebin, MD, PhD, chairman of the department of Surgery in the Perelman School of Medicine, each patient’s tumor tissue is divided following their surgery and sent out to the other dream team institutions who study a variety of traits found within these tumors. Together, the team’s findings – essentially, the “secrets” of how pancreatic cancer cells use fuel inside the body, says Dr. Chi Dang, director of the Abramson Cancer Center -- are pooled and used to map out new treatment strategies.

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Last week, a fleet of community health workers fanned out to help patients in need of some extra support, as part of an ambitious new Penn Medicine program that brings relatable neighbors and peers on board to help vulnerable Penn Medicine patients navigate the medical system and address underlying causes of illness.

Poor health is only one reason why vulnerable patients bounce back to the hospital shortly after being discharged, or have a hard time managing chronic conditions, and the IMPaCT program - Individualized Management for Patient-Centered Targets - hopes to change that. IMPaCT Partners are specially-trained community health workers who share life experiences with the patients they serve. These "natural helpers," who have shared [language, ethnic and geographical] backgrounds as many of the patients they will serve, were selected for characteristics including good listening skills, non-judgmental nature, reliability, availability and knowledge of their communities.

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