University Of Pennsylvania Research Articles

FRANCES HESSELBEIN: A STUDY IN COURAGE AND GRACE

AbstractThe author, an executive coach, and Adjunct Full Professor at the University of Pennsylvania knew and collaborated with Frances Hesselbein for many years. She discusses the qualities that made Frances stand out as a person and as a leader: “Frances stood up for honor, for responsibility, and for choosing the right path. More, Frances called on us to see the truth, maybe especially when it hurt, and to optimistically choose that right path even when the forces that be were insidiously pushing us to choose the easier, quieter, and yes, the cowardly path.” Along with courage, “I believe that what enabled Frances to overcome people’s natural resistance was grace. What is grace? Grace is compassion and dignity and eloquence and serenity in the face of opposition. Grace is optimism even when things look bleak. Grace is good humor and playfulness. Grace is joy.”

Comparison of Anatomical and Diffusion MRI for detecting Parkinson's Disease using Deep Convolutional Neural Network.

Parkinson's disease (PD) is a progressive neurodegenerative disease that affects over 10 million people worldwide. Brain atrophy and microstructural abnormalities tend to be more subtle in PD than in other age-related conditions such as Alzheimer's disease, so there is interest in how well machine learning methods can detect PD in radiological scans. Deep learning models based on convolutional neural networks (CNNs) can automatically distil diagnostically useful features from raw MRI scans, but most CNN-based deep learning models have only been tested on T1-weighted brain MRI. Here we examine the added value of diffusion-weighted MRI (dMRI) - a variant of MRI, sensitive to microstructural tissue properties - as an additional input in CNN-based models for PD classification. Our evaluations used data from 3 separate cohorts - from Chang Gung University, the University of Pennsylvania, and the PPMI dataset. We trained CNNs on various combinations of these cohorts to find the best predictive model. Although tests on more diverse data are warranted, deep-learned models from dMRI show promise for PD classification.Clinical Relevance- This study supports the use of diffusion-weighted images as an alternative to anatomical images for AI-based detection of Parkinson's disease.

Did court dismiss student's Title IX retaliation claim?

A student at the University of Pennsylvania was granted leaves of absence for medical reasons.

Design of Off-Grid Lighting Business Models to Serve the Poor: Field Experiments and Structural Analysis

A significant proportion of the world’s population has no access to grid-based electricity and so relies on off-grid lighting solutions. Rechargeable lamp technology is gaining popularity as an alternative off-grid lighting model in developing countries. In this paper, we explore consumer behavior and the operational inefficiencies that result under this model. Specifically, we are interested in (i) measuring the impact of inconvenience (of traveling to recharge the lamp) along with the impact of liquidity constraints (because of poverty) on lamp usage and (ii) evaluating the efficacy of strategies that address these factors. We build a structural model of consumers’ recharge decisions that incorporates several operational features of the low-income regions. We conducted large-scale field experiments in Rwanda in partnership with a local rechargeable lamp operator and use the resultant data to estimate and test our model. We find that the complete removal of inconvenience and liquidity constraints from the current business model results in 73% and 126% increases in both recharges and revenue, thereby suggesting that these constraints are major sources of inefficiency. By implementing simple operations-based strategies—such as starting more recharge centers, visiting consumers periodically to collect their lamps for recharge, and allowing consumers to partially recharge their lamps and pay flexibly for the recharge—more than half the benefit of completely eliminating the inefficiencies can be attained. By contrast, the price- and capacity-based strategies that vary the economic variables (i.e., the amount paid per recharge and the amount of light obtained in return) but not the operational model perform far worse than the aforementioned strategies. Overall, our analysis emphasizes the importance of managing operations effectively even in markets with cash-constrained consumers, in which firms may have a natural tendency to focus more on reducing prices. This paper was accepted by Vishal Gaur, operations management. Funding: This work was supported by the International Growth Centre; Wharton School, University of Pennsylvania; and Institut Européen d’Administration des Affaires; The Environment and Energy Partnership; Grand Challenges Canada (Stars in Global Health); INSEAD’s Emerging Markets Institute; INSEAD’s Randomized Controlled Trials Laboratory; the INSEAD–Wharton Alliance, and International Growth Centre. Supplemental Material: The online appendix and data are available at https://doi.org/10.1287/mnsc.2023.4844 .

Incorporation and Utilization of an Additional Needs Screener by Surgical Trainees for Comprehensive Care of Underserved and Underinsured Surgical Patients

Comprehensive, socially-minded healthcare has historically been delivered in the primary care setting. For underserved patient populations, however, a surgical care episode may serve as the health care access point. To maximize patient wellbeing during the perioperative period, our surgical center developed the Additional Needs Screener (ANS). Operationalized into practice by GME and UME trainees, this tool screens surgical patients across 3 domains (social, emotional, and immigration needs) and connects patients to partner organizations if appropriate. This study describes the pilot utilization of the ANS among underserved and underinsured surgical patients. Clinical quality improvement and retrospective cohort study of patients completing the ANS from implementation in September 2021 to September 2022. The Hospital of the University of Pennsylvania, PA-a tertiary care center. One hundred and 10 underinsured and/or underserved patients completed at least 1 ANS domain. Patients were majority female (55F, 53M, 2 other) and Hispanic/Latinx (72%) with a median age of 38 (IQR = 34-48). Most patients spoke a primary language other than English (77%), and nearly all were either uninsured (82%) or received emergency medical assistance or Medicaid (14%) at referral. Patients demonstrated significant needs; 39% endorsed difficulty affording housing, 32% endorsed difficulty paying for food, 29% endorsed experiencing current life-interfering distress, and 75% had undocumented immigration status. Ultimately, 57% of screened patients accepted referrals to our needs response teams. Underserved and underinsured patients presenting for surgical care face significant challenges relating to social, emotional, and immigration needs. Through adoption of the ANS, trainees gained competency identifying and addressing these barriers in the perioperative period. Future works will focus on categorizing referral outcomes, developing interventions to increase patient trust, and improving screener dissemination.

Determinants of Wheat Production in Nigeria (1981 – 2019): A Bounds Testing Approach

The study examined the analysis of trends and determinants of wheat production in Nigeria between 1981 and 2019. The data for this study are time series data at macro level spanning from 1981 to 2019. All the data were largely sourced from Food and Agriculture Organization (FAO) statistical data base, Penn world data of the university of Pennsylvania and Central Bank of Nigeria (CBN) statistical bulletin. The data include output of wheat in Nigeria, local and international price of wheat, real exchange rate, and external reserve. The data were analyzed using autoregressive distributed lags to access the relationship between wheat output and factors affecting wheat production in Nigeria. Results showed that external reserve, per capita income, market reforms and technological advancement significantly increased wheat production in Nigeria. Consistency of government policies and policy actions geared towards reducing wheat imports should especially pursued by the government.

Host Inflammatory Response in Viral Lower Respiratory Tract Infections: Friend or Foe?

Viral lower respiratory tract infections (LRTI) are a leading cause of hospitalizations and death worldwide, placing significant pressure on healthcare systems. In this article, two pulmonary critical care specialists explored the prevalence and global burden of viral LRTIs, focusing on recent advancements in understanding the role of dysregulated host immune response and hyper-inflammation. Specifically, they focused on the relevance of alarmin cytokines and their association with adverse patient outcomes. This article reviews the presentations delivered during an industry theater session that took place at the American Thoracic Society (ATS) 2023 International Conference, held in person in Washington, D.C., USA, in May 2023. The primary objective of this session was to provide a comprehensive overview of the impact and burden imposed by severe viral LRTIs. Pratik Sinha, an Assistant Professor in Anesthesiology at Washington University in St. Louis, Missouri, USA, provided valuable insights into the drivers behind the progression of viral LRTIs, which result in significant mortality and morbidity, imposing a considerable clinical burden with unmet needs. Nuala Meyer, an Associate Professor of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, USA, shed light on the dysregulated host immune response and hyper-inflammation triggered by viral infections, which serve as key drivers of disease progression and severe patient outcomes. Sinha also discussed the potential role of alarmin cytokines, particularly IL-33, in influencing the severity and progression of respiratory viral infection. These cytokines may also serve as pleiotropic regulators of the host immune response to viral LRTIs.

Histological and immunohistochemical guide to tendon tissue.

Tendons are unique dense connective tissues with discrete zones having specific structure and function. They are juxtaposed with other tissues (e.g., bone, muscle, and fat) with different compositional, structural, and mechanical properties. Additionally, tendon properties change drastically with growth and development, disease, aging, and injury. Consequently, there are unique challenges to performing high quality histological assessment of this tissue. To address this need, histological assessment was one of the breakout session topics at the 2022 Orthopaedic Research Society (ORS) Tendon Conference hosted at the University of Pennsylvania. The purpose of the breakout session was to discuss needs from members of the ORS Tendon Section related to histological procedures, data presentation, knowledge dissemination, and guidelines for future work. Therefore, this review provides a brief overview of the outcomes of this discussion and provides a set of guidelines, based on the perspectives from our laboratories, for histological assessment to assist researchers in their quest to utilize these techniques to enhance the outcomes and interpretations of their studies.

First person – Kevin Zhang

ABSTRACT First Person is a series of interviews with the first authors of a selection of papers published in Disease Models & Mechanisms, helping researchers promote themselves alongside their papers. Kevin Zhang is first author on ‘ Oxidative stress induces lysosomal membrane permeabilization and ceramide accumulation in retinal pigment epithelial cells’, published in DMM. Kevin is an MD/PhD student in the lab of Dr Joshua Dunaief at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA, investigating the cell biology and metabolism of the eye.

Your Best Life: Real Change Occurs Within.

1Professor of Clinical Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA J. D. Kelly IV, Perelman School of Medicine at the University of Pennsylvania, 34th and Spruce Street, Philadelphia, PA 19104, USA, Email: [email protected] A note from the Editor-in-Chief: I am pleased to present the next installment of “Your Best Life,” a quarterly column written by John D. Kelly IV MD. Dr. Kelly is a Professor of Clinical Orthopaedic Surgery at the University of Pennsylvania. His column explores the many ways that busy professionals—surgeons and scientists—might find peace, happiness, and balance both at work and in their personal lives. We welcome reader feedback on all of our columns and articles; please send your comments to[email protected]. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Michael J. Brown. Hope and Scorn: Eggheads, Experts, and Elites in American Politics.

Journal Article Michael J. Brown. Hope and Scorn: Eggheads, Experts, and Elites in American Politics. Get access Michael J. Brown. Hope and Scorn: Eggheads, Experts, and Elites in American Politics. Chicago: The University of Chicago Press, 2020. Pp. 368. Cloth $27.50. Bruce Kuklick Bruce Kuklick University of Pennsylvania, US Email: bkuklick@sas.upenn.edu Search for other works by this author on: Oxford Academic Google Scholar The American Historical Review, Volume 128, Issue 2, June 2023, Pages 995–996, https://doi.org/10.1093/ahr/rhad158 Published: 22 June 2023

Communications

Journal Article Communications Get access Robert Shaffer Robert Shaffer Shippensburg University of Pennsylvania, US Email: ahrproduction@historians.org Search for other works by this author on: Oxford Academic Google Scholar The American Historical Review, Volume 128, Issue 2, June 2023, Pages 1072–1073, https://doi.org/10.1093/ahr/rhad232 Published: 22 June 2023

CORR Insights®: Can Artificial Intelligence Pass the American Board of Orthopaedic Surgery Examination? Orthopaedic Residents Versus ChatGPT.

1Resident Physician, Hospital of the University of Pennsylvania, Philadelphia, PA, USA J. M. Karnuta, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA, Email: [email protected] This CORR Insights® is a commentary on the article “Can Artificial Intelligence Pass the American Board of Orthopaedic Surgery Examination? Orthopaedic Residents Versus ChatGPT” by Lum available at: DOI: 10.1097/CORR.0000000000002704. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

From film to philanthropy

From film to philanthropy

Did court dismiss student's Title IX retaliation claim?

A student at the University of Pennsylvania was granted leaves of absence for medical reasons.

Addressing Food Insecurity in the Postpartum Period

The lack of availability or access to nutritionally adequate and safe food, known as food insecurity, affects approximately one in five Philadelphians. Potential for health complications and chronic illness increases for affected individuals. Food deserts, low income, and lack of transportation are contributing factors that lead to food insecurity. The Hospital of the University of Pennsylvania largely serves Philadelphia, making the need to address this disparity an essential aspect of providing equitable patient care. The need for an intervention that provides food directly to food-insecure postpartum patients was identified.

William H. Nichols Medal to Karen Goldberg

The 2023 William H. Nichols Medal has been awarded to Karen I. Goldberg , the Vagelos Professor of Energy Research at the University of Pennsylvania. This award is presented by the American Chemical Society New York Local Section for outstanding contributions in the field of chemistry. Goldberg is recognized for her leading work in organometallic reaction mechanisms. She received her medal during the William H. Nichols Symposium and Awards Ceremony on April 14. The ceremony was preceded by a symposium titled “Catalysis for a Sustainable Future,” which featured presentations from Goldberg, Melanie Sanford from the University of Michigan, Rachel Narehood Austin from Barnard College, William Jones from the University of Rochester, and Alan Goldman from Rutgers University.

Target Aortic Stenosis: A National Initiative to Improve Quality of Care and Outcomes for Patients With Aortic Stenosis.

Target Aortic Stenosis: A National Initiative to Improve Quality of Care and Outcomes for Patients With Aortic Stenosis.

Five-year survival outcomes in patients with melanoma with complete response to immunotherapy who discontinue therapy.

e21503 Background: Immune checkpoint inhibitor (ICI) therapy for advanced melanoma in the first-line setting often results in durable responses and prolonged overall survival (OS) after achieving a complete response (CR). While generally well-tolerated, there are financial toxicities and treatment related adverse events (TRAEs) associated with ICI use. There are limited data to inform the optimal duration of therapy after CR, and how specific patient factors may lead to variable OS in patients (pts) with CR. Methods: Pts with locally advanced stage III or stage IV melanoma who started first-line ICI therapy with pembrolizumab, nivolumab, or ipilimumab/nivolumab (ipi/nivo) and achieved CR were identified at a single institution under an Institutional Review Board approved protocol. Pts were only included in the sample if they had initiated treatment by 2013 and discontinued therapy by February of 2021 and had documented follow-up at least 1 year after discontinuing ICI therapy. Recurrence rates were determined by the presence of any recurrence after CR. Pts were analyzed by baseline stage (III vs IV), BRAF status, use of steroids for TRAEs, time from treatment start to CR, and total duration of therapy. OS was determined by time from treatment start to death or date of last follow-up. Results: 78 Pts with CRs from ICI therapy who discontinued treatment were identified at the University of Pennsylvania. Median follow-up time was 63 months from ICI treatment start. Median age at treatment start was 65 years (range 33-94). 51 Pts (68%) had an ECOG performance status (PS) of 0 vs 24 (32%) with ECOG PS of 1-2. 21 Pts (27%) had locally advanced stage III and 57 (73%) had stage IV disease. Of stage IV pts, 8 were M1a, 16 M1b, 22 M1c, and 11 M1d. 61 (78%) pts were treated with pembrolizumab, 5 (6%) nivolumab, 12 (15%) ipi/nivo. 34 pts (44%) were treated with steroids for TRAEs. Of the 78 total pts, 13 (16.7%) developed a recurrence after stopping treatment. The median time to recurrence was 57 months (range 9-110). Melanoma specific survival was 96%. Of the pts with recurrence, 3 died of melanoma, 9 are disease free after additional local and/or systemic treatment and one patient is alive with disease. There was no significant difference ( p < 0.05) in OS based on baseline stage, BRAF status, or use of steroids for TRAEs. Pts were treated for a median of 6 months (range 1 day to 24 months). Conclusions: With over 5 years median follow-up time, the majority of pts with advanced melanoma who attain a CR from first-line ICI therapy remain disease free after treatment discontinuation. Patient factors including stage at treatment initiation, BRAF status, and steroid usage during treatment were not associated with significant variation in OS in this cohort. Most pts with recurrences remain disease free after additional local and/or systemic treatment. Few melanoma specific deaths occurred in pts with a CR to ICI who discontinued treatment.

Hospital Anxiety and Depression Scale (HADS) score trends among testicular cancer survivors: A longitudinal study.

5042 Background: The rarity of testicular germ cell tumors, in conjunction with the young age of its patients, makes it challenging to study its long-term adverse effects. We sought to investigate the changes in Hospital Anxiety and Depression Scale (HADS) scores over time in our institutional cohort of testicular cancer (TC) survivors, hypothesizing that anxiety and depression indices will improve over time, and specifically after treatment completion. Methods: A longitudinal analysis of TC survivors at the University of Pennsylvania between 2013 and 2020, quality of life metrics were measured annually during routine clinic visits. A validated HADS score was utilized to calculate indices of anxiety and depression. Multivariable linear mixed-effects regression models adjusted for pathology type, stage, treatment type, age, marital status, education, income, insurance, employment status, living situation, and time from diagnosis to first survey administration were used to calculate the mean predicted HADS, HADS-Anxiety, and HADS-Depression scores. ANOVA was used to test for parallelism and changes between survey scores. Each item is rated on a 4-point scale (ranging from 0 = no not at all, to 3 = yes definitely), for a total score ranging from 0-21 for each sub-scale with a cut-off point of 8/21 for anxiety or depression. Results: A total of 353 patients were included in the study. Baseline mean scores were 7.3, 4.9, and 2.4 for HADS overall, HADS-Anxiety, and HADS-Depression, respectively. Mean scores did not change over time, ANOVA testing of p=0.84, p=0.78, and p=0.0.65 for overall HADS, HADS-Anxiety, and HADS-Depression, respectively. Stratification by pathology, stage, or treatment did not show any significant interaction. Conclusions: Our data demonstrates that there was no significant change over time in HADS scores, thus considering the risks associated with depression and anxiety, such as suicide, it is essential to consider early referrals to psychiatric services. Our results are from a single institution, limited by a small sample size, and data lacks granularity, including mental health history. Nonetheless, our findings serve as a framework for future prospective studies of TC survivors.