Jefferson Digital Commons Copyright (c) 2013 Thomas Jefferson University All rights reserved. http://jdc.jefferson.edu Recent documents in Jefferson Digital Commons en-us Sat, 18 May 2013 01:33:11 PDT 3600 Melanocytoma of the Cerebellopontine Angle http://jdc.jefferson.edu/phsrs/16 http://jdc.jefferson.edu/phsrs/16 Fri, 17 May 2013 11:13:00 PDT Ms. M.G. is a 46-year-old woman with a history of hypertension and prior bilateral laser eye surgery. In 2009, she presented with vertigo, tinnitus, and decreased hearing in the left ear. An MRI scan revealed an enhancing mass in the posterior fossa that was thought to be an acoustic neuroma. In May of 2009, she underwent gamma-knife radiotherapy for the 2.7 cm mass.

In September of 2012, M.G. noted progressive change in her voice quality as well as a swallowing disturbance and left facial spasms. A subsequent MRI showed significant enlargement of the tumor to a maximal size of 3.7 cm with brainstem compression and extension through the jugular foramen. In January of 2013, the patient presented for a neurosurgical consult to discuss treatment options. At this time, a review of systems was also positive for absent hearing in the left ear, vertigo, tinnitus, mild headache, and balance disturbance. On physical exam, the patient was awake, alert, and fully oriented. A cranial nerve exam revealed a hoarse voice, a deviating palate and uvula, absent hearing to finger rubs on the left, mildly decreased sensation of trigeminal nerve in the V3 distribution on the left side, and slight asymmetry in the left trapezius muscle. The remainder of the cranial nerve exam was normal. Motor strength and sensory function were intact in both upper and lower extremities, but she did have a positive Romberg’s sign. At this time, the diagnosis of a left posterior fossa jugular foramen schwannoma was made.

In February of 2013, the patient underwent left retrosigmoidal approach to resection of the posterior fossa jugular foramen schwannoma. Because dissection of the tumor from the facial nerve was unsuccessful, a small portion of the tumor was left adherent to the facial nerve superiorly. The patient had a mild left facial palsy postoperatively and was treated with a Decadron taper, but she was subsequently discharged home in a stable condition.

]]> Pranay Soni, M.D et al. Diagnostic Yield of Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA) in Lung Cancer Staging, Subtyping and Diagnosis of Unexplained Mediastinal Lymphadenopathy http://jdc.jefferson.edu/phsrs/15 http://jdc.jefferson.edu/phsrs/15 Fri, 17 May 2013 11:07:34 PDT INTRODUCTION
  • Lung cancer (LC) is the most commonly diagnosed cancer worldwide and the most frequent cause of cancer death in both men and women in the US (more deaths than the next three most common cancers combined)1
  • Clinical staging of LC is an integral part of patient care because it directs therapy and has prognostic value

Patients are routinely investigated with a conventional workup (medical history, PE, lab tests, bronchoscopy), CT and integrated whole-body PET-CT, followed by mediastinal tissue staging for enlarged or PET-positive intrathoracic nodes2

  • Mediastinal tissue staging has been classically performed by mediastinoscopy, but they can also be sampled under real-time ultrasound control from the airways (endobronchial ultra-sound guided fine needle aspiration [EBUS-FNA]).

Current lung cancer staging guidelines acknowledge endosonography as a minimally invasive alternative to surgical staging to detect nodal disease,3,4 reducing the need for surgical staging in up to two thirds of patients5,6

  • The purpose of this study was to evaluate the diagnostic yield of EBUS-FNA for accurate lung cancer staging, subtyping and assessment of mediastinal lymphadenopathy

]]> Rino Sato et al. Temporal lobe ganglioglioma in an epilepsy patient with worsening seizures: case study and future directions http://jdc.jefferson.edu/phsrs/14 http://jdc.jefferson.edu/phsrs/14 Fri, 17 May 2013 11:03:26 PDT Gangliogliomas are rare brain tumors that have both neuronal and glial components. They hold a better prognosis than other infiltrative glial tumors, but differentiating between them can be challenging. While molecular markers are being studied, it is currently a histologic diagnosis.

In this case, the patient presented with epilepsy and worsening seizures secondary to a medial temporal lobe mass. Radiology report was inconclusive. Surgical resection was achieved and based on histologic examination the lesion was diagnosed as ganglioglioma, WHO grade I.

In this patient, pathological diagnosis of ganglioglioma offers a favorable prognosis and low risk of recurrence. In the future, molecular analysis including determination of IDH-1 and BRAF gene status will allow for more accurate diagnosis in these patients.

]]> Adam M. Olszewski et al. Correlations between Gene Amplification and Protein Expression of Topoisomerase 2A (TOP2A) in Squamous Cell Carcinoma of the Lung http://jdc.jefferson.edu/phsrs/13 http://jdc.jefferson.edu/phsrs/13 Fri, 17 May 2013 10:59:22 PDT Background: While DNA topoisomerase 2A (TOP2A) plays an essential role in maintaining the structural integrity of the double helix during replication and recombination, excessive expression of this enzyme may promote malignant cell transformations. In fact, increased levels of TOP2A have been observed in various cancer cell lines including squamous cell carcinoma of the lung. This study sought to identify correlations between genotypic and phenotypic evidence of TOP2A obtained via in situ hybridization (ISH) and immunohistochemistry (IHC) techniques.

Methods Tissue microarrays created from 29 samples of Stage I Squamous Cell Carcinoma of the lung were stained with VENTANA BenchMark ULTRA platform with dual color ISH molecular probes TOP2A / CEP17 and antiTOP2A antibody (clone JS5B4-rabbit monoclonal antibody). Gene copy numbers were analyzed using bright field microscopy. Gene amplification was considered in cells exhibiting gene copies > 3 or TOP2A:CEP17 ratios > 1.82. IHC stains were quantified using Spectrum software (Apeiro technologies) using the nuclear algorithm. All levels of protein expression (+1 to +3) were considered positive.

Results: A moderate Pearson Correlation (0.4) between TOP2A gene amplification and protein expression was identified.

Conclusion: While gene amplification moderately correlated with protein expression of TOP2A, additional factors influencing protein expression independently of gene amplification should be identified.

]]> Anita Modi, MSII et al. Ocular Manifestations of Rosai-Dorfman Disease http://jdc.jefferson.edu/phsrs/12 http://jdc.jefferson.edu/phsrs/12 Fri, 17 May 2013 10:55:24 PDT History of Rosai-Dorfman Disease

In 1969, Dr. Juan Rosai and Dr. Ronald F. Dorfman reported four cases of an entity that previously had puzzled pathologists and clinicians. The four cases had failed to fit under any diagnosis, but shared a few common characteristics. Each patient presented with painless, massive lymphadenopathy, most commonly of the cervical lymph nodes1. Other locations included the inguinal, intra-parotid, and axillary lymph nodes. The patients all presented with fever and leukocytosis1. The differential diagnosis included malignant lymphoma, malignant histiocytosis, reticuloendotheliosis, and chronic inflammation. However, the histopathological characteristics of the cases did not fit the classical characteristics of these diagnoses. Based on the pathologic findings, Dr. Rosai and Dr. Dorfman created a new entity, which they called “sinus histiocytosis with massive lymphadenopathy (SHML).”1

]]> Phoebe L. Mellen, B.S. et al. Adenoid Cystic Carcinoma in Unusual Locations – Differential Diagnosis Difficulties http://jdc.jefferson.edu/phsrs/11 http://jdc.jefferson.edu/phsrs/11 Fri, 17 May 2013 10:51:21 PDT Adenoid Cystic Carcinoma (ACC) is an uncommon malignant salivary gland tumor, representing 1% of all malignant tumors of the oral and maxillofacial region and 22% of all salivary gland malignancies. Although in the majority of cases ACC manifests in the major salivary glands, in rare instances it can be found in locations such as the esophagus, larynx, trachea, lacrimal gland, breast, prostate, lungs, or auditory canal. These unusual locations of ACC often pose a diagnostic challenge to the clinician and are associated with poorer outcomes for patients as compared to those ACC of a more typical presentation. In this study we examined three cases of ACC, originating in the external auditory canal, larynx, and trachea, highlighting the hallmark features that may aid the clinician in their detection.

]]> Heather A. McMahon, B.S. et al. Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) to Carcinoid: Exploring the Link http://jdc.jefferson.edu/phsrs/10 http://jdc.jefferson.edu/phsrs/10 Fri, 17 May 2013 10:47:02 PDT Neuroendocrine cells (NECs) play important roles in normal lung development, autonomic regulation of lung function, and response to hypoxia or injury. They are located between the respiratory epithelium and the basement membrane of bronchi and bronchioles (below), often as single cells or small clusters.

NEC proliferation is a common pathologic occurrence, well established as a reactive response to chronic lung injury. Much less commonly, NEC proliferation is observed in the absence of apparent inciting factors. This neoplastic phenomenon is termed “diffuse idiopathic pulmonary neuroendocrine cell hyperplasia” (DIPNECH).

DIPNECH is recognized as a precursor lesion for carcinoid tumors. While the progression of DIPNECH to carcinoid is an accepted transformation, little is known about the genetic events that drive the pulmonary neuroendocrine cells to proliferate, penetrate the basement membrane, and sustain growth from the tumorlet stage (NEC mass <5mm) to the carcinoid stage (≥5mm). The best described genetic involvement implicates the MEN1 tumor suppressor gene on chromosome 11 as an important early event in the transformation process, but similar disease models suggest that this will prove to be just one event in the spectrum.

]]> Jacob D. McFadden MSII et al. Prevalence of subclassifications of subclinical hypothyroidism: comparison to reclassifications when using free T4-dependent reference ranges for TSH http://jdc.jefferson.edu/phsrs/9 http://jdc.jefferson.edu/phsrs/9 Fri, 17 May 2013 10:41:53 PDT Background: Subclinical hypothyroidism (SH: normal free T4 (FT4), elevated TSH) is the subject of frequent inquiries to the laboratory. New practice guidelines for hypothyroidism from the American Association of Clinical Endocrinologists and the American Thyroid Association (Endocr Pract 2012;18:988-1028) define subclassifications of SH with respect to whether TSH is less than or greater than 10 mIU/L (here defined as subclassifications A and B, respectively), delineating whether recommendation for T4 replacement therapy is automatic (for subclass B). Our objectives were to determine %A and %B in our patient population, and, because of the log-linear relationship between TSH and FT4, to examine how prevalence of subclasses might change if FT4-dependent TSH reference ranges were used.

Methods: Paired TSH and FT4 results from our institution over a period of 1 year (2012) were obtained from electronic records. A subset database was formed from first-or-only results from individual patients having normal FT4 (0.7-1.7 ng/dL) (n = 4781). Spreadsheet analyses determined classification as subclinical hypothyroidism (SH), from which %A (TSH <=10 mIU/L) and %B (TSH >10 mIU/L) were determined. TSH distributions were analyzed as a function of FT4 as a preliminary step in specifying FT4-dependent TSH reference ranges.

Results: Among paired TSH and FT4 results, 616 patients (12.9% of total) were classified as SH, using TSH reference range = 0.3-5.0 mIU/L. Subclassifications of SH patients were 75.6% A and 24.4% B. TSH distributions were analyzed as a function of FT4. Each distribution was well-characterized as a log-normal distribution (that is, on a log scale, the distributions were individually well characterized by parameters of a median (xm) and a standard deviation (s) such that probabilities of results were a normal distribution according to xm ± s). xm was a linear function of FT4: for FT4 = 0.6-1.6 ng/dL, xm = -0.478 FT4+ 0.850 (r2 = 0.929) (Eqn.1). Standard deviations s for TSH were a parabolic function of FT4 (range: s = 0.35-0.9), with a minimum s = 0.35 centered at FT4 = 1.1 ng/dL. This minimum s was only marginally greater than s associated with the TSH reference range (s = 0.31). The fact that all-patient-inclusive TSH data showed log-normal distributions indicated that any assumed FT4-dependent TSH reference ranges should likewise possess these same FT4-dependent medians. We therefore assumed, very conservatively, FT4-dependent reference ranges having medians according to Eqn.1 and with fixed, FT4-independent widths equal to that of the standard TSH reference range (±2s = ±0.62). Applying these FT4-dependent TSH reference ranges to the paired TSH-FT4 patient data, 245 patients (5.1% of total) were classified as SH, with subclassifications of 43.3% A, 56.7%B.

Conclusions: Comparing to use of a standard, FT4-independent TSH reference range, paired TSH-FT4 measurements classified as SH were reduced by 60% when conservative FT4-dependent TSH reference ranges were applied. Additionally, FT4-dependent TSH reference ranges were also more highly selective for SH subclassification B patients, for whom T4 replacement therapy would be automatically recommended.

]]> Hollie L. Matlin et al. Thoracic Dissecting Aneurysm and the Importance of Genetics http://jdc.jefferson.edu/phsrs/8 http://jdc.jefferson.edu/phsrs/8 Fri, 17 May 2013 10:34:49 PDT Patient Presentation
  • 28 year old white male with a past medical history significant for untreated hypertension
  • Presents with 3 day history of chest discomfort, lower extremity weakness, bowel and bladder dysfunction, near-syncopal episodes
  • Absent pulse in right femoral artery, weak pulse in left femoral artery
  • Echosonography showed acute Type A dissecting aortic aneurysm
  • Treatment

Immediately taken to surgery for repair of aorta with a graft and replacement of the aortic valve

  • Outcome

Unstable after surgery

Biventricular heart failure

Persistent bleeding into mediastinum due to DIC

Required massive transfusion of RBCs, FFP, Cryoprecipitate, and Platelets

Became anuric and acidotic

Became fluid overloaded à Pulmonary edema

Progressive deterioration à Multi-Organ Failure à Death

]]> Dan Kramer, BA et al. A Case of Hemoglobinopathy-Thalassemia Syndrome http://jdc.jefferson.edu/phsrs/7 http://jdc.jefferson.edu/phsrs/7 Fri, 17 May 2013 10:31:00 PDT Patient Presentation
  • 43 year-old African American female presents with left lower extremity pain
  • Physical exam: unremarkable
  • Past medical history:

Anemic since childhood

Avascular necrosis of left hip

DVT

Chronic illnesses: asthma, depression

Surgical history: appendectomy, tubal ligation, splenectomy, cholecystectomy, L hip replacement

  • Family history: mother has lupus

]]> Michele C. Khurana, B.S. et al. The Line between Addiction and Medication: Alcohol, Anesthesia, and Analgesia http://jdc.jefferson.edu/phsrs/6 http://jdc.jefferson.edu/phsrs/6 Fri, 17 May 2013 10:27:51 PDT Alcohol is a particularly dangerous addiction because its consumption is legal even in excess, despite its harmful effects. Because alcohol has a multitude of targets in the central nervous system that are modified during chronic exposure, medications with overlapping targets such as anesthetics and analgesics must be modified when given to alcoholics. Unfortunately, as relatively little is known about the mechanism of addiction, it is difficult to predict how medications will be affected by central adaptation to chronic alcohol exposure. This review summarizes the consequences of alcohol exposure with particular attention to the GABAAreceptor, and discusses the reasons behind necessary adjustments to the doses of volatile anesthetics and analgesics for alcoholics.

]]> Priya Joshi, B.S. et al. Myeloid Sarcoma: Extramedullary Relapse After Allogeneic Bone Marrow Transplant for Chronic Myelogenous Leukemia http://jdc.jefferson.edu/phsrs/5 http://jdc.jefferson.edu/phsrs/5 Fri, 17 May 2013 10:24:04 PDT Myeloid sarcoma (MS) is an extramedullary tumor of myeloid precursor cells, which can precede or occur concomitantly with acute myeloid leukemia, myelodysplastic syndrome, or myeloproliferative neoplasms. Although MS can involve any organ, it is more common in the central nervous system (CNS) and gonads, sites known as “pharmacologic sanctuaries” where leukemic cells can survive despite systemic chemotherapy. Less often, this tumor can be the manner of relapse after allogeneic bone marrow transplantation.

The diagnosis is based on morphology and immunophenotype by either flow cytometry or immunohistochemistry of paraffin-embedded tissue, and confirmed by FISH or molecular studies. Myeloid sarcomas usually express the leukocyte common antigens CD45, CD13, CD33, CD43 and lack T-cell and B-cell antigens.

]]> Maria Gubbiotti et al. An unexpected immunohistochemical profile in an ovarian lesion http://jdc.jefferson.edu/phsrs/4 http://jdc.jefferson.edu/phsrs/4 Fri, 17 May 2013 10:14:47 PDT A 27 year old female presented with pelvic pain and a palpable pelvic mass. Upon histological examination, the cystic mass contained a multi-cellular lining with nuclear grooves. Negative inhibin staining ruled out a follicular cyst and granulosa cell tumor while pan-cytokeratin positivity suggested an epithelial lesion. The lesion stained positive for thrombomodulin, ultimately suggesting a diagnosis of a Brenner cell tumor, although CD56 positivity in the tumor questions the known immunohistochemical profile of Brenner cell tumors. This unusual result opens the door to future research into the role CD56 in the diagnosis of ovarian neoplasms.

]]> Kate Fritton et al. Lumbar Chordoma: A Primary Bone Tumor http://jdc.jefferson.edu/phsrs/3 http://jdc.jefferson.edu/phsrs/3 Fri, 17 May 2013 08:55:29 PDT INTRODUCTION
  • Primary malignant bone tumor of embryonic notochord remnants
  • 1-4% of primary bone tumors, <0.1 per 100,000
  • Location: Sacral (50%), Skull base (35%), Vertebral column (15%)
  • Classic, chondroid (5-15%), and dedifferentiated (5%) variants
  • Most commonly in late middle age (50s to 60s)
  • Low-grade, slow growing tumor
  • But locally aggressive, high rate of local recurrence (20% in 1st year)
  • Local recurrence is most important predictor of mortality
  • Metastasis only occurs very late in disease
  • Median survival of about 6 years, less than 12 months with mets
  • 5 year survival of 70%, 10 year survival of 40%
  • Primary therapy- aggressive surgical resection (if possible)
  • New targeted therapies currently under investigation

]]> Andrew N. Fleischman, BS et al. Morphologic and Endoscopic Evaluation of Collagenous Gastritis http://jdc.jefferson.edu/phsrs/2 http://jdc.jefferson.edu/phsrs/2 Fri, 17 May 2013 08:52:22 PDT Collagenous gastritis (CG) is a rare gastrointestinal condition of unknown etiology and pathogenesis characterized by the presence of a gastric subepithelial collagen band of variable thickness. While little is known about the disease, children and young adults often present with anemia, abdominal pain, and nodular gastric mucosa on endoscopy. In contrast, adults often present with chronic watery diarrhea and normal gastric mucosa on endoscopy. Disease associations (usually in adult cases) include celiac disease, collagenous colitis, collagenous sprue, and lymphocytic colitis. This study aims to further characterize the clinical, endoscopic and morphologic spectrum of CG.

]]> Annie Ashok et al. Transfusion Related Acute Lung Injury http://jdc.jefferson.edu/phsrs/1 http://jdc.jefferson.edu/phsrs/1 Fri, 17 May 2013 08:49:01 PDT A 74 year old woman presented with hematemesis. Her medical history was significant for pulmonary embolism treated with warfarin anticoagulation, fibromyalgia treated with NSAIDs/steroids, and a prior bleeding event from a gastric ulcer. On admission she was stable with a hemoglobin of 8.7 g/dL and a therapeutic INR of 3.19. A type and screen determined a blood type of AB positive. In anticipation of endoscopy, the patient received one unit of red blood cells and four units of type AB plasma. Following transfusion, her INR was 1.83. The patient received an additional four units of type AB plasma to further correct her INR. Endoscopy identified a medium-sized gastric ulcer. Shortly after completion of the endoscopy, the patient became hypoxic and began experiencing dyspnea and frothy oral secretions. A chest x-ray 1 hour after the start of the reaction showed diffuse pulmonary edema without cardiomegaly (image 1). The patient was intubated within 2 hours of the reaction and a chest x-ray showed increasingly diffuse pulmonary edema with small bilateral pulmonary effusions (image 2). Ventilator and pressor support were required for several days, and the patient was extubated five days after the reaction. The clinical team and transfusion service strongly suspected Transfusion Related Acute Lung Injury (TRALI) and contacted the blood supplier. The blood supplier determined the Human Leukocyte Antigen (HLA) Class I/II type of the patient and pursued HLA antibody screening for the donors of the four plasma units transfused most proximal to the reaction. Three of the four donors were parous females and returned for HLA antibody screening, while the fourth male donor could not be contacted. Of the three tested donors, none had Human Neutrophil Antigen (HNA) antibodies. Two of the three tested donors had HLA Class I/II antibodies that were non-cognate with the patient. One of the three tested donors had extensive HLA Class I/ II antibodies which were cognate with 4 of 6 of the patient’s HLA Class I antigens and 4 of 6 of the patient’s Class II antigens. The implicated donor was deferred from further donation.

]]> Nadia Abidi et al. Surgical Palliative Care http://jdc.jefferson.edu/surgerygr/5 http://jdc.jefferson.edu/surgerygr/5 Thu, 16 May 2013 08:21:35 PDT Learning Objectives of presentation:

1. Identify the historical background and salient principles of surgical palliative care.

2. Identify barriers to and indications for surgical palliative care.

3. Identify outcomes measurements for surgical palliative care.

4. Identify opportunities for incorporation of palliative care principles into surgical practice.

Presentation: 46 minutes

]]> Geoffrey Dunn, MD, FACS Mini-Grand Rounds "Health Care 101- My Baker's Dozen List of 2013: Topics and Lessons" http://jdc.jefferson.edu/surgerygr/4 http://jdc.jefferson.edu/surgerygr/4 Thu, 16 May 2013 08:12:34 PDT Health Care 101: Baker's Dozen

1. Healthcare spending is finally flattening out.

2. We (physicians and hospitals) will be paid less for what we do.

3. Employers and payers are getting aggressive on cost and quality.

4. Hospitals will be in the cross hairs for more cut.

5. The most meaningful cost reduction strategies will involve standardization and elimination of variation.

6. Control of "waste" crucial.

7. Current payments systems (but not future) are mal-aligned with quality and wellness improvements.

8. The Hot Topic-ACOs

9. The 5-50 rule reigns

10. Hospital systems will transition to Care systems

11. How to enable physician integration

12. Aspiration items for Hospital corporate leaders

Presentation: 40 minutes

Presentation: 40 minutes

]]> Charles J. Yeo, MD, FACS John H. Gibbon Jr., MD Grand Rounds “The Miracle of Transplantation" http://jdc.jefferson.edu/surgerygr/3 http://jdc.jefferson.edu/surgerygr/3 Thu, 16 May 2013 07:59:30 PDT Advances in Transplantation.

Presentation sponsored by the John H. Gibbon Jr. Surgical Society and the Department of Surgery, Thomas Jefferson University

]]> Nancy L. Ascher, MD, PhD, FACS A Historic Grand Rounds, 60 Years After the First Successful Use of Dr. Gibbon's Heart-Lung Machine on May 6, 1953: "Fond Memories" http://jdc.jefferson.edu/surgerygr/2 http://jdc.jefferson.edu/surgerygr/2 Thu, 16 May 2013 07:53:26 PDT Fond Memories of John H. Gibbon Jr.

Presentation: 55 minutes

]]> Herbert E. Cohn, MD Templeton Grand Rounds: "Tracheal Surgery" http://jdc.jefferson.edu/surgerygr/1 http://jdc.jefferson.edu/surgerygr/1 Thu, 16 May 2013 07:44:49 PDT Agenda of presentation:

Post-intubation stenosis

Idiopathic subglottic stenosis

Tumors

Tracheoesophageal fistulas

Trauma

Presentation: 1 hour, 3 minutes

Presentation presented by: Thomas Jefferson University, Department of Surgery and the Division of Cardiothoracic Surgery

]]> Douglas J. Mathisen, MD Translating the Mysteries of Pulmonary Pre-Malignancy http://jdc.jefferson.edu/pulmcritcaregrandrounds/88 http://jdc.jefferson.edu/pulmcritcaregrandrounds/88 Wed, 15 May 2013 12:52:35 PDT Objectives:

1. To understand the importance of early detection and diagnosis

2. To understand advances in lung cancer pathogenesis

3. To understand the importance of patient selection for targeted therapy.

Presentation: 53 minutes

]]> Steven M. Dubinett, MD Summer/Fall 2007 http://jdc.jefferson.edu/jeffersoncurrents/vol8/iss1/1 http://jdc.jefferson.edu/jeffersoncurrents/vol8/iss1/1 Tue, 14 May 2013 13:56:05 PDT Dr. Watts' Brilliant Savings, steam power and chilled water on campus, 6 degrees of efficiency challenge, and other conservation news. 2 pages.

]]> Winter 2005/6 http://jdc.jefferson.edu/jeffersoncurrents/vol6/iss3/1 http://jdc.jefferson.edu/jeffersoncurrents/vol6/iss3/1 Tue, 14 May 2013 13:55:43 PDT Dr. Watts' Brilliant Savings, Jefferson signs agreements for a new central chilled water plant and steam purchase pricing, and other conservation news. 2 pages.

]]> Winter 2005 http://jdc.jefferson.edu/jeffersoncurrents/vol5/iss4/1 http://jdc.jefferson.edu/jeffersoncurrents/vol5/iss4/1 Tue, 14 May 2013 13:55:11 PDT Dr. Watts' Brilliant Savings, energy myths debunked, savings at work, and other conservation news. 2 pages.

]]> Winter 2003 http://jdc.jefferson.edu/jeffersoncurrents/vol4/iss4/1 http://jdc.jefferson.edu/jeffersoncurrents/vol4/iss4/1 Tue, 14 May 2013 13:54:31 PDT Dr. Watts' Brilliant Savings, campus heating costs soar, energy upgrades at TJUH buildings, and other conservation news. 2 pages.

]]> A primary care-public health partnership addressing homelessness, serious mental illness, and health disparities. http://jdc.jefferson.edu/fmfp/35 http://jdc.jefferson.edu/fmfp/35 Tue, 14 May 2013 12:38:55 PDT BACKGROUND: People with histories of homelessness and serious mental illness experience profound health disparities. Housing First is an evidenced-based practice that is working to end homelessness for these individuals through a combination of permanent housing and community-based supports.

METHODS: The Jefferson Department of Family and Community Medicine and a Housing First agency, Pathways to Housing-PA, has formed a partnership to address multiple levels of health care needs for this group. We present a preliminary program evaluation of this partnership using the framework of the patient-centered medical home and the "10 Essential Public Health Services."

RESULTS: Preliminary program evaluation results suggest that this partnership is evolving to function as an integrated person-centered health home and an effective local public health monitoring system.

CONCLUSION: The Pathways to Housing-PA/Jefferson Department of Family and Community Medicine partnership represents a community of solution, and multiple measures provide preliminary evidence that this model is feasible and can address the "grand challenges" of integrated community health services.

]]> Lara Carson Weinstein, MD, MPH et al. Summer 2005 http://jdc.jefferson.edu/jeffersoncurrents/vol6/iss2/1 http://jdc.jefferson.edu/jeffersoncurrents/vol6/iss2/1 Tue, 14 May 2013 07:16:09 PDT Dr. Watts' Brilliant Savings, electricity bills rising, information on buying air conditioners, and other conservation news. 2 pages.

]]> Summer 2004 http://jdc.jefferson.edu/jeffersoncurrents/vol5/iss2/1 http://jdc.jefferson.edu/jeffersoncurrents/vol5/iss2/1 Tue, 14 May 2013 07:10:38 PDT Dr. Watts' Brilliant Savings, energy costs slashed, energy myths debunked, and other conservation news. 2 pages.

]]> Summer 2003 http://jdc.jefferson.edu/jeffersoncurrents/vol4/iss2/1 http://jdc.jefferson.edu/jeffersoncurrents/vol4/iss2/1 Tue, 14 May 2013 07:05:14 PDT Dr. Watts' Brilliant Savings, Jefferson receives two energy awards, Jefferson's water meter costs cut, and other conservation news. 2 pages.

]]> Spring 2013 http://jdc.jefferson.edu/jeffersoncurrents/vol13/iss1/1 http://jdc.jefferson.edu/jeffersoncurrents/vol13/iss1/1 Tue, 14 May 2013 07:02:32 PDT Dr. Watts' Brilliant Savings, insulation for saving on heating and cooling cost, Earth Day news, and other conservation news. 2 pages.

]]> Spring 2011 http://jdc.jefferson.edu/jeffersoncurrents/vol11/iss1/1 http://jdc.jefferson.edu/jeffersoncurrents/vol11/iss1/1 Tue, 14 May 2013 06:56:12 PDT Dr. Watts' Brilliant Savings, healthy Jeff water Wednesday, investment in energy efficiency yields big savings on campus, and other conservation news. 2 pages.

]]> Spring 2006 http://jdc.jefferson.edu/jeffersoncurrents/vol7/iss1/1 http://jdc.jefferson.edu/jeffersoncurrents/vol7/iss1/1 Tue, 14 May 2013 06:50:47 PDT Dr. Watts' Brilliant Savings, electric rates going up, energy myths debunked, and other conservation news. 2 pages.

]]> Spring 2005 http://jdc.jefferson.edu/jeffersoncurrents/vol6/iss1/1 http://jdc.jefferson.edu/jeffersoncurrents/vol6/iss1/1 Tue, 14 May 2013 06:45:39 PDT Dr. Watts' Brilliant Savings, energy use on campus, energy myths debunked, and other conservation news. 2 pages.

]]> Spring 2004 http://jdc.jefferson.edu/jeffersoncurrents/vol5/iss1/1 http://jdc.jefferson.edu/jeffersoncurrents/vol5/iss1/1 Tue, 14 May 2013 06:40:23 PDT Dr. Watts' Brilliant Savings, free hot water, energy myths debunked, and other conservation news. 2 pages.

]]> Degenerative Joint Disease and Tendinopathy http://jdc.jefferson.edu/jmbcim_lectures/59 http://jdc.jefferson.edu/jmbcim_lectures/59 Tue, 14 May 2013 06:18:48 PDT Overall Goals and Objectives:

1. Identify recent advances in integrative medical care and discuss their application to clinical practice.

2. Describe the latest data on complementary and alternative medical therapies that could improve patient outcomes.

3. Discuss core integrative medicine topics that patients frequently ask physicians about.

Presentation: 59 minutes

]]> Jeremy Close, MD Fall 2012 http://jdc.jefferson.edu/jeffersoncurrents/vol13/iss2/1 http://jdc.jefferson.edu/jeffersoncurrents/vol13/iss2/1 Mon, 13 May 2013 13:15:47 PDT Dr. Watts' Brilliant Savings, on the home front, EnergySense from PGW, and other conservation news. 2 pages.

]]> Fall 2011 http://jdc.jefferson.edu/jeffersoncurrents/vol12/iss2/1 http://jdc.jefferson.edu/jeffersoncurrents/vol12/iss2/1 Mon, 13 May 2013 13:10:38 PDT Dr. Watts' Brilliant Savings, six ways to cut winter energy use, load shedding initiative saves money, work completed on large energy projects, and more conservation news. 2 pages.

]]> Fall 2009 http://jdc.jefferson.edu/jeffersoncurrents/vol10/iss1/1 http://jdc.jefferson.edu/jeffersoncurrents/vol10/iss1/1 Mon, 13 May 2013 13:10:30 PDT Dr. Watts' Brilliant Savings, saving money and healing the environment, trash to cash, and other conservation news. 2 pages.

]]> Fall 2004 http://jdc.jefferson.edu/jeffersoncurrents/vol5/iss3/1 http://jdc.jefferson.edu/jeffersoncurrents/vol5/iss3/1 Mon, 13 May 2013 09:01:22 PDT Dr. Watts' Brilliant Savings, oil prices, energy myths debunked, and other conservation news. 2 pages.

]]> Fall 2003 http://jdc.jefferson.edu/jeffersoncurrents/vol4/iss3/1 http://jdc.jefferson.edu/jeffersoncurrents/vol4/iss3/1 Mon, 13 May 2013 08:50:14 PDT Dr. Watts' Brilliant Savings, Campus Electricity Use Slashed, Christmas shopping tips, and other news. 2 pages.

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