Philadelphia, PA, United States


Philadelphia, PA, United States
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Disselkoen K.R.,Calvin College | Alsum J.R.,Caledonia | Thielke T.A.,Philadelphia | Muyskens M.A.,Calvin College
Chemical Physics Letters | Year: 2017

The photochemistry of gas-phase 1,1,1-trifluoroacetylacetone (TFAA) and 1,1,1,5,5,5-hexafluoroacetylacetone (HFAA) excited with ultraviolet light involves a significant photoelimination channel producing HF and difluoromethylfuranone or pentafluoromethylfuranone, respectively. We report collisional self-quenching of the experimentally-determined relative quantum yield, and determine rate constants of 0.27 ± 0.03 and 0.33 ± 0.04 μs−1, for HFAA and TFAA respectively. A strong collision model is consistent with the observed quenching. The data suggest that this elimination is the primary photochemical fate at low pressure in both cases. The TFAA rate constant is larger than that for HFAA, in spite of TFAA having half as many fluorine atoms as HFAA. © 2017 Elsevier B.V.

Rubino F.,King's College London | Nathan D.M.,Harvard University | Eckel R.H.,Aurora University | Schauer P.R.,Cleveland Clinic | And 10 more authors.
Diabetes Care | Year: 2016

BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London,U.K.,28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m2 ) and in those with class II obesity (BMI 35.0-39.9 kg/m2 ) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients withT2D andBMI 30.0-34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m2 for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies. © 2016 by the American Diabetes Association.

Zindel L.R.,Philadelphia | Kranzler H.R.,University of Pennsylvania
Journal of studies on alcohol and drugs. Supplement | Year: 2014

Modern pharmacotherapy for alcohol dependence has its roots in the failure of National Prohibition in the United States and the rise of the disease model of alcoholism (embodied in Alcoholics Anonymous). In 1948, disulfiram was the first medication approved by the U.S. Food and Drug Administration (FDA) to treat alcohol dependence, but its efficacy has not been supported by randomized controlled trials. In the 1960s, benzodiazepines replaced older treatments for alcohol withdrawal, but sedative and dependence-producing effects limit their utility in the postwithdrawal period. In the 1980s, the focus shifted to the treatment of co-occurring psychiatric disorders and medications that modify negative mood states, which contribute to relapse to heavy drinking. In the 1990s, developments in neurobiology implicated specific neurotransmitter systems underlying alcohol's effects, culminating in the 1994 approval by the FDA of the opioid antagonist naltrexone to treat alcohol dependence. In 2006, the FDA approved a long-acting formulation of naltrexone. Recently, nalmefene, another opioid receptor antagonist, was approved in Europe for as-needed use to reduce heavy drinking. Acamprosate, an amino acid derivative, first approved in France in 1989, received FDA approval in 2004. However, the beneficial effects of the approved medications are only modestly greater than those of placebo, and their use is limited. Topiramate, currently under investigation for alcohol dependence, has greater efficacy but a variety of adverse effects. In addition to the identification of novel compounds, the future of alcohol dependence pharmacotherapy will depend on developments in pharmacogenetics, in which genetic variation that moderates treatment efficacy and adverse effects is used to personalize treatment.

Kim S.,University of Pennsylvania | Yu A.,University of Pennsylvania | Filippone L.A.,Philadelphia | Kolansky D.M.,University of Pennsylvania | Raina A.,University of Pennsylvania
Clinical Cardiology | Year: 2010

Takotsubo cardiomyopathy is an increasingly recognized clinical syndrome of transient left ventricular dysfunction, commonly with apical ballooning, in the context of physical or emotional stress. Recently, an inverted-Takotsubo contractile pattern has been described with hypokinesis of the basal and mid-ventricular segments and sparing of the apex. We report a case of a 30-year-old man presenting with transient left ventricular dysfunction in an inverted-Takotsubo contractile pattern, associated with a newly discovered pheochromocytoma, and present a literature review of the inverted-Takotsubo contractile pattern cardiomyopathy. © 2010 Wiley Periodicals, Inc.

Goldstein-Levitas N.,Philadelphia
American Journal of Dance Therapy | Year: 2016

Nearly 135 million people worldwide will be afflicted with dementia by 2050 (Robinson et al., 2015). Dementia is a devastating and progressive illness that results in the loss of one’s sense of self and feelings such as frustration, depression, and anxiety. Dance/movement therapy (DMT) is a useful, non-pharmacologic method for the treatment of dementia, as this discipline enhances quality of life, may attenuate cognitive decline, and is cost-effective; DMT engages the sensory systems and stimulates physical, emotional, and cognitive functioning. This article affirms that sensory stimulation in DMT is a holistic, economical, and fruitful approach for dementia care. © 2016 American Dance Therapy Association

Mao H.,Philadelphia
Plastic and reconstructive surgery | Year: 2014

Several investigators have reported their clinical experience with medial pedis flaps for reconstruction of soft-tissue defects of the distal forefoot. However, they had only a few reports where this flap was used to repair soft-tissue defects of the great toe. Thus, reconstruction of soft-tissue defects of the great toe remains a challenge in reconstructive surgery. The authors describe the use of the medial pedis island flap to cover this region. This study was divided into two parts: an anatomic study and clinical application. In the anatomic study, 48 cadaveric feet were injected with latex, and then the main vessels distributed at the medial aspect of the foot were observed. Clinically, retrograde-flow medial pedis island flaps were harvested to cover the soft-tissue defects of the great toe in eight cases. An anatomic study revealed that the arterial circle under the first metatarsophalangeal joint and the arterial network on the surface of the abductor hallucis were responsible for the blood supply of the medial region of the foot. The diameter of the pedicle was great, and the pedicle was longer than previously reported. In terms of clinical application, all flaps were successful, without any significant complications. Using the arterial circle under the first metatarsophalangeal joint, the medial pedis island flap has a reliable retrograde blood supply. This flap should be considered as a preferential way of reconstructing soft-tissue defects of the great toe. Therapeutic, V.

Acolin J.,Philadelphia
American Journal of Dance Therapy | Year: 2016

Interest from varied academic disciplines regarding the mind–body connection has increased in recent decades. This interest has resulted in a proliferation of empirical research investigating the phenomenon. This growing body of research, coming from the cognitive and behavioral neurosciences and identified under the label of embodiment research, combined with the lively conversation between embodiment researchers, are of great importance to the field of dance/movement therapy (DMT). However, in order for DMT to participate effectively in the conversation, the field first needs a clarification of its own theory regarding the mind–body connection. This article distills a sub-section of existing DMT theory into a set of grounded descriptive statements, and summarizes existing empirical data from cognitive and behavioral neurosciences that substantiate the statements. A modified grounded theory method was used. Implications for future research direction are discussed. © 2016 American Dance Therapy Association

Fischer J.P.,Philadelphia
Plastic and reconstructive surgery | Year: 2014

Death following surgical procedures, although uncommon, represents the most significant and costly postoperative complication. The authors delineate several key independently associated risk factors for 30-day mortality in a large nationwide plastic surgery population and generate a simple risk-assessment tool. Patients who underwent a primary plastic surgery procedure (n=24,778) were identified from the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program databases. Preoperative patient comorbidities and operative variables were analyzed to determine associations with mortality. Multivariate regression modeling and risk stratification were performed to generate a decision-support tool capable of assessing mortality risk. Seventy-eight patients (0.31 percent) experienced 30-day mortality. Age older than 65 years, inpatient surgery, hepatorenal disease, recent chemotherapy, and partial or dependent functional status were perioperative factors associated with 30-day mortality. A composite mortality risk score was used to stratify patients into groups of low (n=18,063) (30-day mortality, 0.06 percent), intermediate (n=1252) (30-day mortality, 0.96 percent), high (n=314) (30-day mortality, 5.10 percent), or extreme (n=126) (30-day mortality, 17.46 percent) risk. The scoring groups accurately separated risk (p<0.001) with a 291-fold variation between low- and extreme-risk patients (C statistic, 0.93). This study defines a 0.31 percent risk of perioperative 30-day mortality in a heterogeneous cohort of plastic surgery patients and identifies risk factors independently associated with 30-day mortality. These data can be used to tailor and improve informed consent, to optimize surgical decision-making, and to implement risk-reduction strategies in high-risk patients. Risk, III.

Mitchell L.A.,Philadelphia
Linacre Quarterly | Year: 2015

Character cannot be separated from the person. To be of good character means that one's habits, actions, and emotional responses all are united and directed toward the moral and the good. In this, public actions cannot be separated from private actions. Both sets of actions affect one's character. For example, a physician believes use of contraceptives to be immoral yet prescribes them in the office because he or she feels a duty to provide what the patient asks for, or a pharmacist who believes abortion to be immoral fills prescriptions for the abortifacient RU-486. These public acts affect one's character even if one's private belief is the opposite of the action. They leave traces on one's character. Not only do actions reflect the goodness or badness of one's character, one's actions also change one's character. The more one does an immoral action or recommends an immoral action for others, the more it becomes part of one's character to be the type of person who condones that immoral action. In order to be of good character one must not only know and desire the good, one must also pursue it in both private and public actions. Virtue is an aid in this; it is the act of good character. Growing in the virtues, especially prudence (knowing what to seek and what to avoid) forms good character. What is at stake is the integrity of the person. The physician who believes that use of contraception is immoral must also act in ways that display that belief and avoid actions that promote contraception use by his or her patients. © 2015 Catholic Medical Association.

Background: In a previously reported split-mouth, randomized controlled trial, Miller Class II gingival recession defects were treated with either a connective tissue graft (CTG) (control) or recombinant human platelet-derived growth factor-BB + β-tricalcium phosphate (test), both in combination with a coronally advanced flap (CAF). At 6 months, multiple outcome measures were examined. The purpose of the current study is to examine the major efficacy parameters at 5 years. Methods: Twenty of the original 30 patients were available for follow-up 5 years after the original surgery. Outcomes examined were recession depth, probing depth, clinical attachment level (CAL), height of keratinized tissue (wKT), and percentage of root coverage. Within- and across-treatment group results at 6 months and 5 years were compared with original baseline values. Results: At 5 years, all quantitative parameters for both treatment protocols showed statistically significant improvements over baseline. The primary outcome parameter, change in recession depth at 5 years, demonstrated statistically significant improvements in recession over baseline, although intergroup comparisons favored the control group at both 6 months and 5 years. At 5 years, intergroup comparisons also favored the test group for percentage root coverage and change in wKT, whereas no statistically significant intergroup differences were seen for 100% root coverage and changes to CAL. Conclusions: In the present 5-year investigation, treatment with either test or control treatments for Miller Class II recession defects appear to lead to stable, clinically effective results, although CTG + CAF resulted in greater reductions in recession, greater percentage of root coverage, and increased wKT.

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