Hebrew University-Hadassah Medical School Research Articles

Sleep education improves knowledge but not sleep quality among medical students.

Poor sleep quality, often resulting from poor sleep hygiene, is common among medical students. Educational interventions aimed at improving sleep knowledge are beneficial for sleep quality in healthy populations. However, sleep education is often given minimal attention in medical school curriculums. The aim of the study was to explore whether a short educational intervention could improve sleep knowledge, and consequently sleep quality, among medical students. We recruited preclinical- and clinical-stage medical students during the 2017-2018 academic year. Students completed a demographic survey, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Assessment of Sleep Knowledge in Medical Education (ASKME) questionnaire. Students then attended a lecture on the physiology and importance of sleep. To assess the efficacy of the intervention, questionnaires were repeated 4 months thereafter. A total of 87 students (31 preclinical) with a mean age of 25.86 years (standard deviation [SD], 3.33), 51 of whom were women, participated in the study. At baseline, students had poor sleep quality with a PSQI mean score of 5.9 (SD, 2.37), without significant sleepiness, and a mean ESS score of 8.86 (SD, 4.32). The mean ASKME scores were consistent with poor sleep knowledge at 11.87 (SD, 4.32). After the intervention, the mean ASKME results improved to 14.15 (SD, 4.5; P < .001), whereas sleep quality did not. The effect was similar in preclinical and clinical medical students. Sleep knowledge was inadequate among medical students, who also experienced poor sleep quality. A short educational intervention improved sleep knowledge but was insufficient at improving sleep quality. Further studies are needed to determine which interventions may provide benefit in both sleep knowledge and sleep quality.

First person – Aryeh Babkoff

ABSTRACT First Person is a series of interviews with the first authors of a selection of papers published in Journal of Cell Science, helping early-career researchers promote themselves alongside their papers. Aryeh Babkoff is first author on ‘A direct interaction between survivin and myosin II is required for cytokinesis’, published in JCS. Aryeh is a MD/PhD candidate in the lab of Prof. Shoshana Ravid at The Institute of Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel, investigating the regulation of the actomyosin contractile ring during mitosis.

In memory of Prof Yehiel (Chilik) Ziv

Yehiel (Chilik) Ziv passed away on December 2014, after approximately 3 months of courageous battle with a malignant disease. Dr. Yehiel Ziv, or as we all called him: ‘‘Chilik,’’ was born in Israel in June 1951, to a family of Holocaust survivors who immigrated to Israel. He earned his medical degree from the Hebrew University—Hadassah Medical School in Jerusalem, in a program of pre-military medical training, and served his country as a physician. Following his service, Dr. Ziv did his residency in general surgery at the Beilinson Medical Center, one of the top training programs in Israel. Following completion of his residency, he showed special interest in colorectal surgery, and had spent, in 1989, approximately 3 months at St. Marks hospital in London, enhancing his knowledge and capabilities in colorectal surgery. Between 1992 and 1994, he completed 2 years of colorectal surgery fellowship at the Department of Colorectal Surgery at the Cleveland Clinic, Ohio, headed by Dr. Victor Fazio. In addition to his clinical training, Dr. Ziv has made a significant effort to enhance the Ileoanal pouch registry of the Cleveland Clinic and published landmark papers on this topic. Upon return from his fellowship, Dr. Ziv served as the colorectal surgeon and head of colorectal surgery at the ‘‘Assaf Harofeh’’ Medical Center in Israel, where he rapidly established himself as a leader in this field. He was a renowned physician, especially known for his humane care of his patients and their families. Dr. Ziv has served as the president of the Israeli Society of Colon and Rectal Surgery for two consecutive terms and was a member of the editorial board of Techniques in Coloproctology and a member of the scientific committee of the ESCP. On November 2013, he was elected as the president of ECTA, a position he had held at the time of his death. Dr. Ziv was a teacher in nature, served as an associate professor at the Tel Aviv University faculty of medicine, and founded the Israeli fellowship program in colorectal surgery. No doubt that his professional achievements are remarkable. But above all, Chilik was a friend. A friend personally to me, and a friend to so many colorectal surgeons in Israel, Europe, Asia and the USA. We grieve his loss. Our minds are with his family and many friends. He will be cherished in our souls forever. Yehiel (Chilik) Ziv—1951–2014

Pathological mechanisms of antiphospholipid antibodies in trophoblastic cell fusion

Pathological mechanisms of antiphospholipid antibodies in trophoblastic cell fusion

Pregnancy recall in decidual NK cells

Pregnancy recall in decidual NK cells

Genetic Counseling Services and Training of Genetic Counselors in Israel: An Overview

Genetic counseling services have existed in Israel since 1964 and are available in almost all the major hospitals. Given the socialized healthcare system and small country size, genetic services are generally accessible and often free. The existence of founder mutations in various communities in Israel makes genetic testing easier to perform. Yet, the ethnic, cultural and religious diversity of the population has major implications on the design of the screening programs and the use of genetic services. The Israeli Association of Genetic Counselors (IAGC) was established in 2008 and had existed informally since 1989. There are two Master level genetic counseling training programs (6 students/class, 2year program): Hebrew University-Hadassah Medical School (established in 1997) and the Technion (established in 2009). Genetic counselors' clinical training is largely observational and 2years of supervised counseling sessions post degree are required for board exam eligibility. Genetic counselors are licensed and lead counseling sessions individually, but currently must work under medical geneticist supervision. This is the first article to summarize the history and training of Master level genetic counselors in Israel. Genetic services, coverage and regulations are also described.

729: Deconstructing trends in perinatal ethnic disparities in Hawaii

ethnic disparities in Hawaii Timothy Dye, Hyeong Jun Ahn, John Chen, Marjorie Mau, Donald Hayes, Dena Towner John A. Burns School of Medicine, University of Hawaii, Obstetrics, Gynecology, and Women’s Health, Honolulu, HI, John A. Burns School of Medicine, University of Hawaii, Biostatistics, Honolulu, HI, John A. Burns School of Medicine, University of Hawaii, Native Hawaiian Health, Honolulu, HI, Hawaii State Department of Health, Family Services Division, Honolulu, HI OBJECTIVE: US OMB Directive 15 (OMB15) outlines requirements for reporting race/ethnicity. Oftentimes a range of distinct ethnicities are aggregated (e.g. “Asians”) in OMB15, perhaps masking important differences. These aggregations are particularly significant in Hawaii, a multiracial/multiethnic state significantly impacted by OMB15. This study’s purpose was to examine perinatal risk trends in Hawaii (HI) and among its ethnicities. STUDY DESIGN: Average Annual Percent Change (AAPC) in neonatal mortality rate (NNMR) and low birthweight (LBW) by state/ethnicity from 1969-2009 was computed using National Center for Health Statistics’ data. Birthweight distribution (BWD) reflecting LBW ( 2500 grams) and VLBW ( 1500 grams), and birthweight-specific mortality rate (BWSM) were generated from HI Department of Health (DOH) published data. RESULTS: HI’s NNMR declined 10 percent faster than did the US NNMR during the 1970s-80s (Table). Similarly, HI’s LBW/VLBW rates declined more rapidly than did US rates. In the 1990s, however, HI’s NNMR declined less rapidly than did the US and HI’s VLBW rate increased faster. These patterns worsened in the 2000s. Three concerning trends emerge. First, the Filipino LBW rate remains highest in Hawaii, 3/4ths higher than the white rate (Figure). Secondly, the Japanese NNMR rapidly increased throughout the 2000s, at a rate almost double that of Hawaiians, for instance (Table). Additionally, the Japanese LBW/VLBW rates increased much faster through the 2000s than they did in other ethnicities. Thirdly, the NNMR among Native Hawaiians remained at 50 percent higher than other ethnicities (Figure). This excess Native Hawaiian mortality is associated with higher BWSM (i.e. higher mortality among LBWs) when compared with other ethnic groups, rather than a skewed BWD. CONCLUSION: OMB15 aggregations mask important perinatal differences among Hawaii’s ethnicities. These patterns suggest that a range of strategies may be required to sufficiently address perinatal-related disparities. (NCRR U54RR026136/ NIMHD U54MD007584). 730 Association of parent smoking during pregnancy with offspring cardio-metabolic risk factors at age 17 Uri Dior, Yechiel Friedlander, Liron Kogan, Shani Shulman, Hagit Hochner Hadassah Medical Center and Hebrew University-Hadassah Medical School, Department of Obstetrics and Gynecology, Jerusalem, Israel, Hebrew University School of Public Health, Epidemiology unit, Jerusalem, Israel OBJECTIVE: Accumulating evidence demonstrates an association of maternal smoking during pregnancy with adverse metabolic neonatal outcomes. However, less is known about the influence of maternal or paternal smoking on cardio-metabolic risk factors in adolescence. Hence, we examined the association of maternal and paternal smoking during pregnancy with offspring weight, height, Body Mass Index (BMI), systolic and diastolic blood pressure (BP) at age 17. STUDY DESIGN: We used a population-based cohort of 11,729 births in Western Jerusalem during 1974-76, with available archival data on maternal, paternal and birth characteristics. Measurements at age 17 were assessed at military induction examinations. Linear regression models were used to evaluate the associations of parental smoking during pregnancy with offspring cardio-metabolic outcomes, after controlling for potential confounders. RESULTS: Maternal smoking during pregnancy, independent of paternal smoking and confounders (including socioeconomic status, maternal prepregnancy BMI and gestational weight gain, and offspring gender and birthweight) was positively associated with offspring’s height, weight and BMI at age 17 (all p-values 0.001, Table). For example, mean weight of offspring of smoking mothers was 1.5kg higher than weight of offspring whose mothers did not smoke. Paternal smoking was independently and positively associated with adolescent weight (p 0.001) and BMI (p 0.002) and negatively associated with systolic BP (p 0.02). An analysis examining whether smoking of at least one parent was associated with offspring outcomes yielded similar results. 3-yr combined low birthweight rate, birthweightspecific mortality rate (<2500 gr), and neonatal mortality rate by ethnicity, Hawaii 2007-2009 (Source: HI DoH) Average annual percent change (AAPC %) for selected perinatal outcomes, 1969-2009, USA, Hawaii, and Hawaii’s largest ethnic groups

A note on the resorption and excretion of riboflavine from aluminium monostearate suspensions in the rat.

Journal Article A Note on the Resorption and Excretion of Riboflavine from Aluminium Monostearate Suspensions in the Rat Get access F G Sulman F G Sulman Department of Applied Pharmacology, The Hebrew University-Hadassah Medical School, Jerusalem, Israel Search for other works by this author on: Oxford Academic Google Scholar Journal of Pharmacy and Pharmacology, Volume 7, Issue 1, August-September 1955, Pages 473–476, https://doi.org/10.1111/j.2042-7158.1955.tb12058.x Published: 12 April 2011 Article history Received: 17 February 1955 Published: 12 April 2011

Editorial Comment

No AccessJournal of UrologyPediatric Urology1 Aug 2010Editorial Comment Ezekiel Landau Ezekiel LandauEzekiel Landau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.03.161AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 184(2), p. 668 References 1 : Posterior lumbotomy in pediatric pyeloplasty. J Urol1987; 137: 468. Link, Google Scholar 2 : The versatility of the posterior lumbotomy approach in infants. J Urol1989; 141: 1148. Link, Google Scholar Pediatric Urology Unit, Hebrew University Hadassah Medical School, Jerusalem, Israel© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 184Issue 2August 2010Page: 668 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ezekiel Landau More articles by this author Expand All Advertisement PDF downloadLoading ...

Mycoplasma hyorhinisupregulates calpastatin and inhibits calpain-dependent proteolysis in SH-SY5Y neuroblastoma cells

Mycoplasmas often contaminate cultured cells, leading to alterations in cellular gene expression, protein synthesis, signal transduction and metabolic pathways. Mycoplasmal contamination is often unnoticed, so that mycoplasma-induced alterations in cell functions may not be appreciated, unless specifically studied. Here, we show for the first time that contamination of SH-SY5Y cells by Mycoplasma hyorhinis leads to increased levels of calpastatin (the endogenous inhibitor of the Ca(2+)-dependent protease calpain), resulting in inhibition of Ca(2+)-induced calpain activation and inhibition of calpain-promoted proteolysis in the mycoplasmal-infected cells. Calpain activity is recovered upon calpastatin removal from extracts of contaminated cells. The calpain-calpastatin system has been implicated in a variety of physiological and pathological processes (signal transduction, motility, cell cycle, cell differentiation, membrane damage and apoptosis). Because the ratio of calpastatin to calpain is an important factor in the control of calpain activity within the cell, the elevated calpastatin may protect the mycoplasma-infected cells against certain types of damage (e.g. caused by high Ca(2+)). Thus, our results are important for studies on the modulation of host cells by mycoplasmas, and relevant to the pathobiology of processes involving mycoplasmal infections. The mycoplasma-infected cells provide a system for identifying factors that participate in the regulation of cellular calpastatin.

Highlights From The Literature

Highlights From The Literature

Comparative study of Hebrew University-Hadassah Medical School participation in education council ofr foreign medical graduates (ECFMG) examination.

The achievements of the 874 (55%) medical graduates of Hebrew University-Hadassah School who took the ECFMG examination from 1962, when it was introduced in Israel, to 1972, were compared with those of candidates from other schools during the same period. The achievement level of candidates was high: usually above the 90th percentile rank position; 80 to 85% of its candidates passed the examination (compared to about 40% from all other schools); and the frequency distribution of ECFMG examination scores of HUHMS candidates in 1965 revelas a similarity to the achievements in American medical schools. The difference between the percentage of candidates passing the ECFMG examination from year to year supports the contention that the level of difficulty of the examinations varies. Candidates taking the examination after several years of clinical experience do not perform better. Since only 19% of all HUHMS graduates have gone abroad for postgraduate training, and only 11% have remained abroad for 4 or more consecutive years, participation in ECFMG has not been reflected in an increase in 'brain drain'.

Does postmenopause actually begin before menopause?

Department of Obstetrics and Gynecology, Hebrew University-Hadassah Medical School, Jerusalem, Israel Financial disclosure: None reported.

A streptococcal protease that degrades CXC chemokines and impairs bacterial clearance from infected tissues

Group A Streptococcus (GAS) causes the life-threatening infection in humans known as necrotizing fasciitis (NF). Infected subcutaneous tissues from an NF patient and mice challenged with the same GAS strain possessed high bacterial loads but a striking paucity of infiltrating polymorphonuclear leukocytes (PMNs). Impaired PMN recruitment was attributed to degradation of the chemokine IL-8 by a GAS serine peptidase. Here, we use bioinformatics approach coupled with target mutagenesis to identify this peptidase as ScpC. We show that SilCR pheromone downregulates scpC transcription via the two-component system-SilA/B. In addition, we demonstrate that in vitro, ScpC degrades the CXC chemokines: IL-8 (human), KC, and MIP-2 (both murine). Furthermore, using a murine model of human NF, we demonstrate that ScpC, but not the C5a peptidase ScpA, is an essential virulence factor. An ScpC-deficient mutant is innocuous for untreated mice but lethal for PMN-depleted mice. ScpC degrades KC and MIP-2 locally in the infected skin tissues, inhibiting PMN recruitment. In conclusion, ScpC represents a novel GAS virulence factor functioning to directly inactivate a key element of the host innate immune response.

Preparation for clinical practice: a survey of medical students’ and graduates’ perceptions of the effectiveness of their medical school curriculum

This paper describes the perceptions of students and graduates of the Hebrew University—Hadassah medical school in Israel regarding the effectiveness of their medical education in preparing them for work in the clinical setting. The six-year curriculum consists of three years of mainly lecture-based Basic Science courses, and three years of clinical education, consisting of clinical clerkship rotations of various lengths. An anonymous questionnaire containing 114 items was distributed to 294 students (in their clinical years) and 500 graduates of the faculty. A total of 371 respondents completed the questionnaire (response rate 49%). Overall 60% of the respondents were generally satisfied with the medical training they received. However, respondents indicated many deficiencies in the curriculum, and in their competences. More than half of the respondents felt that Basic Science courses lacked clinical relevance. Almost 40% of the respondents reported that students were not taught sufficient clinical skills in preparations for clinical practice. At least 50% of the respondents reported that they had not received adequate exposure to 26 out of the 36 important clinical activities and skills during clerkships. Only 33% of the respondents agreed that the fundamental knowledge, skills, attitudes and values that medical students should possess at the time of graduation were made explicitly clear to them. Perspectives of students and graduates were compared. In many questions significantly more graduates tended to rate their learning experience better than students. This study illuminates many aspects of the curriculum the faculty needs to address in order to prepare physicians effectively and efficiently for clinical work. It also stresses the need to integrate better preclinical and clinical studies, and to change to active learning methods. This study demonstrates the necessity of gathering information from students and graduates to evaluate their medical education experience.

Highlights from the Literature

Highlights from the Literature

Glucocorticoids Regulate Transcription of the Gene for Phosphoenolpyruvate Carboxykinase in the Liver via an Extended Glucocorticoid Regulatory Unit

The hepatic transcriptional regulation by glucocorticoids of the cytosolic form of phosphoenolpyruvate carboxykinase (PEPCK-C) gene is coordinated by interactions of specific transcription factors at the glucocorticoid regulatory unit (GRU). We propose an extended GRU that consists of four accessory sites, two proximal AF1 and AF2 sites and their distal counterpart dAF1 (-993) and a new site, dAF2 (-1365); together, these four sites form a palindrome. Sequencing and gel shift binding assays of hepatic nuclear proteins interacting with these sites indicated similarity of dAF1 and dAF2 sites to the GRU proximal AF1 and AF2 sites. Chromatin immunoprecipitation assays demonstrated that glucocorticoids enhanced the binding of FOXO1 and peroxisome proliferator-activated receptor-alpha to AF2 and dAF2 sites and not to dAF1 site but enhanced the binding of hepatic nuclear transcription factor-4alpha only to the dAF1 site. Insulin inhibited the binding of these factors to their respective sites but intensified the binding of phosphorylated FOXO1. Transient transfections in HepG2 human hepatoma cells showed that glucocorticoid receptor interacts with several non-steroid nuclear receptors, yielding a synergistic response of the PEPCK-C gene promoter to glucocorticoids. The synergistic stimulation by glucocorticoid receptor together with peroxisome proliferator-activated receptor-alpha or hepatic nuclear transcription factor-4alpha requires all four accessory sites, i.e. a mutation of each of these markedly affects the synergistic response. Mice with a targeted mutation of the dAF1 site confirmed this requirement. This mutation inhibited the full response of hepatic PEPCK-C gene to diabetes by reducing PEPCK-C mRNA level by 3.5-fold and the level of circulating glucose by 25%.

Neurosurgery at the Hadassah-Hebrew University Medical Center in Jerusalem

Henrietta Szold founded the Hadassah Women's Organization in the United States in 1912 to alleviate widespread disease and poverty in Jerusalem. In 1918, the Rothschild-Hadassah Hospital and the Hadassah School of Nursing opened in central Jerusalem. Chaim Weizmann and Albert Einstein, together with a small group of visionaries, founded the Hebrew University in 1923. After 1933, many physicians and scientists fled from Europe to Jerusalem, where they carried on their tradition of academic research at the university and Hadassah, and British military doctors joined medical rounds and lectures at Hadassah beginning in the 1930s. Young physicians who had graduated from European medical schools were trained in the subspecialties at Hadassah beginning in the 1940s, and the Hebrew University-Hadassah Medical School enrolled its first class in 1949. These were the first academic institutions of their kind in Israel. The Department of Neurosurgery at Hadassah was established in 1941 under the leadership of Dr. Henry Wigderson, who was recruited from the United States. Dr. Aaron Beller became chairman in 1951, Dr. Mordechai Shalit became chairman in 1977, and Dr. Felix Umansky, the current chairman, was appointed in 1993. Today, more than 900 neurosurgical procedures spanning the spectrum of subspecialties and using state-of-the-art techniques and equipment are performed annually.

Highlights from the Literature

Highlights from the Literature

Halloween

Hebrew University Hadassah Medical School, Hadassah University Hospital, Jerusalem, Israel. avidan3@netvision.net.ilTo the Editor:—Recently, some propofol was spilled on the floor (fig. 1) and—Halloween ! I assure you that this white solution is propofol and that no actions were taken by staff to make it look like this. It just happened.