Perelman School of Medicine
Perelman School of Medicine's mission is to advance knowledge and improve health through research, patient care, and the education of trainees in an inclusive culture that embraces diversity, fosters innovation, stimulates critical thinking, supports lifelong learning, and sustains our legacy of excellence.
- Center for Public Health Initiatives
- Department of Biostatistics, Epidemiology and Informatics
- Department of Family Medicine and Community Health
- Department of Medical Ethics and Health Policy
- Department of Microbiology Papers
- Department of Obstetrics and Gynecology
- Department of Psychiatry
- Department of Systems Pharmacology and Translational Therapeutics
- Botswana-UPenn Partnership
- Center for Cognitive Neuroscience
- Global Health Programs
- Medical Physics Programs
PublicationUse of Mobile Telemedicine for Cervical Cancer Screening(2011-06-01) Quinley, Kelly E; Gormley, Rachel H; Ratcliffe, Sarah; Shih, Ting; Szep, Zsofia; Steiner, Ann; Ramogola-Masire, Doreen; Kovarik, CarrieVisual inspection of the cervix with application of 4% acetic acid (VIA) is an inexpensive alternative to cytology-based screening in areas where resources are limited, such as in many developing countries. We have examined the diagnostic agreement between off-site (remote) expert diagnosis using photographs of the cervix (photographic inspection with acetic acid, PIA) and in-person VIA. The images for remote evaluation were taken with a mobile phone and transmitted by MMS. The study population consisted of 95 HIV-positive women in Gaborone, Botswana. An expert gynaecologist made a definitive positive or negative reading on the PIA results of 64 out of the 95 women whose PIA images were also read by the nurse midwives. The remaining 31 PIA images were deemed insufficient in quality for a reading by the expert gynaecologist. The positive nurse PIA readings were concordant with the positive expert PIA readings in 82% of cases, and the negative PIA readings between the two groups were fully concordant in 89% of cases. These results suggest that mobile telemedicine may be useful to improve access of women in remote areas to cervical cancer screening utilizing the VIA `see-andtreat' method. PublicationEpidemiology of Methicillin‐Resistant Staphylococcus aureus Bacteremia in Gaborone, Botswana(2009-08-01) Wood, Sarah; Shah, Samir S; Bafana, Maragaret; Ratner, Adam J; Meaney, Peter A; Malefho, Kolaatamo C.S; Steenhoff, Andrew PThis cross‐sectional study at a tertiary‐care hospital in Botswana from 2000 to 2007 was performed to determine the epidemiologic characteristics of Staphylococcus aureus bacteremia. We identified a high prevalence (11.2% of bacteremia cases) of methicillin‐resistant S. aureus (MRSA) bacteremia. MRSA isolates had higher proportions of resistance to commonly used antimicrobials than did methicillin‐susceptible isolates, emphasizing the need to revise empiric prescribing practices in Botswana. PublicationOutcomes in HIV-Infected Adults With Tuberculosis at Clinics With and Without Co-Located HIV Clinics in Botswana(2013-10-01) Schwartz, Adam B; Tamuhla, Neo; Steenhoff, Andrew P; Nkakana, Kelebogile; Letlhogile, Rona; Chadborn, Tim R; Kestler, Mary; Zetola, Nicola M; Ravimohan, Shruthi; Bisson, Gregory PSETTING Gaborone, Botswana. OBJECTIVE To determine if starting anti-tuberculosis treatment at clinics in Gaborone without co-located human immunodeficiency virus (HIV) clinics would delay time to highly active antiretroviral therapy (HAART) initiation and be associated with lower survival compared to starting anti-tuberculosis treatment at clinics with on-site HIV clinics. DESIGN Retrospective cohort study. Subjects were HAART-naïve, aged ≥21 years with pulmonary tuberculosis (TB), HIV and CD4 counts ≤250 cells/mm3 initiating anti-tuberculosis treatment between 2005 and 2010. Survival at completion of anti-tuberculosis treatment or at 6 months post-treatment initiation and time to HAART after anti-tuberculosis treatment initiation were compared by clinic type. RESULTS Respectively 259 and 80 patients from clinics without and with on-site HIV facilities qualified for the study. Age, sex, CD4, baseline sputum smears and loss to follow-up rate were similar by clinic type. Mortality did not differ between clinics without or with on-site HIV clinics (20/250, 8.0% vs. 8/79, 10.1%, relative risk 0.79, 95%CI 0.36–1.72), nor did median time to HAART initiation (respectively 63 and 66 days, P = 0.53). CONCLUSION In urban areas where TB and HIV programs are separate, geographic co-location alone without further integration may not reduce mortality or time to HAART initiation among co-infected patients. PublicationGuatemala & the University of Pennsylvania: Meeting in the Middle(2013-01-01) Barg, Frances K; Weiss, Eve; Branas, CharlesThe GUATEMALA-PENN relationship is a partnership that is borne from more than a century of research, service and scholarship. Our goal, with this book and with our programs, is to grow this partnership based upon the reciprocal needs of our Guatemalan stakeholders and the mission of the university. Guatemala is only one country away from the US. Our shared heritage and joint economic and social interests make it critical to foster a strong and mutually beneficial relationship between our two countries. Our connections have evolved over time in response to new knowledge gained about each other. This book is a testament to our collective past, present and future. For more information or to donate visit: http://www.med.upenn.edu/globalhealth/guatemalapartners.shtml PublicationTear Osmolarity and Dry Eye Symptoms in Women Using Oral Contraception and Contact Lenses(2013-01-01) Chen, Sarah P; Massaro-Giordano, Giacomina; Pistilli, Maxwell; Schreiber, Courtney A; Bunya, Vatinee YPurpose—To examine the relationship between oral contraceptive pill (OCP) use, contact lens wear, and dry eye signs and symptoms in healthy young females. Methods—Fifty-two women using OCPs and forty-five women not using any form of hormonal contraception were enrolled. Medical, menstrual, and contact lens histories were obtained and dry eye symptoms were assessed using the Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE) questionnaires. Tear osmolarity testing was performed using the TearLab™ Osmolarity System. Results—Mean age of all subjects was 26.0 ± 3.7 years. There were no significant differences in any of the measurements between the follicular and luteal phases. While SANDE scores were significantly higher in subjects with OCP and recent contact lens use (p<0.01), there were no significant differences in OSDI and tear osmolarity amongst the same subject groups. Subjects who reported both OCP and recent contact lens use had significantly higher OSDI and SANDE scores (p=0.015 and p<0.001, respectively). Conclusions—There were no differences between the phases of the menstrual cycle. Tear osmolarity was not affected by OCP or contact lens use in young females. However, the combination of OCP use and contact lens wear may increase the severity of dry eye symptoms. PublicationEarly Mortality and AIDS Progression Despite High Initial Antiretroviral Therapy Adherence and Virologic Suppression in Botswana(2011-06-15) Steele, Katherine; Steenhoff, Andrew P; Newcomb, Craige W; Rantleru, Tumelo; Nthobatsang, Rudo; Lesetedi, Gloria; Bellamy, Scarlett L; Nachega, Jean B; Gross, Robert; Bisson, Gregory PBackground Adverse outcomes occurring early after antiretroviral therapy (ART) initiation are common in sub-Saharan Africa, despite reports of high levels of ART adherence in this setting. We sought to determine the relationship between very early ART adherence and early adverse outcomes in HIV-infected adults in Botswana. Methods This prospective cohort study of 402 ART-naïve, HIV-infected adults initiating ART at a public HIV clinic in Gaborone, Botswana evaluated the relationship between suboptimal early ART adherence and HIV treatment outcomes in the initial months after ART initiation. Early adherence during the interval between initial ART dispensation and first ART refill was calculated using pill counts. In the primary analysis patients not returning to refill and those with adherence <0.95 were considered to have suboptimal early adherence. The primary outcome was death or loss to follow-up during the first 6 months of ART; a secondary composite outcome included the primary outcome plus incident opportunistic illness (OIs) and virologic failure. We also calculated the percent of early adverse outcomes theoretically attributable to suboptimal early adherence using the population attributable risk percent (PAR%). Results Suboptimal early adherence was independently associated with loss to follow-up and death (adjusted OR 2.3, 95% CI 1.1–4.8) and with the secondary composite outcome including incident OIs and virologic failure (adjusted OR 2.6, 95% CI 1.4–4.7). However, of those with early adverse outcomes, less than one-third had suboptimal adherence and approximately two-thirds achieved virologic suppression. The PAR% relating suboptimal early adherence and primary and secondary outcomes were 14.7% and 17.7%, respectively. Conclusions Suboptimal early adherence was associated with poor outcomes, but most early adverse outcomes occurred in patients with optimal early adherence. Clinical care and research efforts should focus on understanding early adverse outcomes that occur despite optimal adherence. PublicationBeyond Exploratory: A Tailored Framework for Assessing Rigor in Qualitative Health Services Research(2017-08-01) Rendle, Katharine A; Abramson, Corey M; Garrett, Sarah B; Halley, Meghan C; Dohan, DanielObjective: To propose a framework for assessing the rigor of qualitative research that identifies and distinguishes between the diverse objectives of qualitative studies currently used in patient-centered outcomes and health services research (PCOR and HSR). Study Design: Narrative review of published literature discussing qualitative guidelines and standards in peer-reviewed journals and national funding organizations that support PCOR and HSR. Principal Findings: We identify and distinguish three objectives of current qualitative studies in PCOR and HSR: exploratory, descriptive, and comparative. For each objective, we propose methodological standards that can be used to assess and improve rigor across all study phases—from design to reporting. Similar to quantitative studies, we argue that standards for qualitative rigor differ, appropriately, for studies with different objectives and should be evaluated as such. Conclusions: Distinguishing between different objectives of qualitative HSR improves the ability to appreciate variation in qualitative studies as well as appropriately evaluate the rigor and success of studies in meeting their own objectives. Researchers, funders, and journal editors should consider how adopting the criteria for assessing qualitative rigor outlined here may advance the rigor and potential impact of qualitative research in patient-centered outcomes and health services research. PublicationAn Exploratory, Randomized, Crossover MRI Study of Microbicide Delivery with the SILCS Diaphragm Compared to a Vaginal Applicator(2013-01-01) Pentlicky, Sara; Rosen, Mark; Coffey, Patricia S; Kilbourne-Brook, M.; Shaunik, A.; Schreiber, Courtney A; Barnhart, KurtBackground—Microbicide gels studied for HIV prevention often are delivered via a single-use vaginal applicator. Using a contraceptive diaphragm such as the SILCS diaphragm for gel delivery could have advantages, including lower cost and additional pregnancy prevention. Study Design—We performed an exploratory, nonblinded, randomized, crossover study among healthy, sexually active, nonpregnant women. Using BufferGel®, we evaluated three microbicide delivery methods for gel distribution and retention: SILCS single-sided gel delivery, SILCS double-sided gel delivery and a vaginal applicator (without SILCS). Magnetic resonance images were taken at baseline, after gel insertion, and immediately and 6 h after simulated intercourse. Three women completed all gel delivery methods described in this article. Results—Magnetic resonance imaging analysis indicated similar gel spread in the vagina among all three methods. SILCS single-sided gel application resulted in the most consistent longitudinal coverage; SILCS double-sided gel application was the most consistent in the transverse dimension. Conclusions—Gel coverage was similar with all three methods. These results suggest that the SILCS microbicide delivery system is comparable to vaginal applicators for delivery of gel products intravaginally. PublicationPerceived Effectiveness of Acupuncture: Findings From the National Health Interview Survey(2008-12-01) LaRiccia, Patrick J; McMurphy, Suzanne; Gallo, Joseph J; Xie, Daiwei; Branas, CharlesBackground: Knowledge of perceived benefit from acupuncture treatment is important to predict who is using acupuncture, to inform physicians of the possible benefits of acupuncture, to determine where rigorous research should be focused, and to help policy makers predict future demand. Objectives: To determine the proportions of survey respondents who reported perceived effectiveness of acupuncture treatment for specific conditions; and to determine the association of specified demographic variables with perceived effectiveness. Design, Setting, and Participants: Publicly available data from 31,044 noninstitutionalized US adults who participated in the 2002 National Health Interview Survey, a cross-sectional in-home computer-assisted interview. Outcome Measures: The proportions of participants reporting “any help” and “great help” for perceived effectiveness across conditions treated and per condition treated; and the association of the subgroups within age, sex, and body mass index (BMI), along with the subgroups Asian race and Chinese ethnicity, with “any help” of acupuncture treatment across conditions treated. Results: Of the 1,274 respondents who reported having consulted an acupuncturist, 329 had used acupuncture in the last 12 months; 276 had used acupuncture to treat a specific condition. A total of 86% of respondents reported being helped by acupuncture, while 45% reported being greatly helped across conditions treated. In an examination of specific conditions treated, the range for “any help” was 98% to 67%, and 98% to 7% in the “great help” outcome. Older age and obesity were negatively associated with perceived effectiveness statistically but not clinically. Asian race and Chinese ethnicity were not statistically significantly associated with perceived effectiveness. Conclusions: Acupuncture is perceived to be effective by most respondents who used it to treat a specific condition. Older age and obesity are negatively associated with perceived effectiveness, but not at a clinically significant level. A larger sample of Asian and Chinese subgroups is needed to determine if there is an association of these subgroups with perceived benefit. PublicationBaby Schema in Infant Faces Induces Cuteness Perception and Motivation for Caretaking in Adults(2009-03-01) Glocker, Melanie L; Langleben, Daniel D; Ruparel, Kosha; Loughead, James W; Gur, Ruben C; Sachser, NorbertEthologist Konrad Lorenz proposed that baby schema (‘Kindchenschema’) is a set of infantile physical features such as the large head, round face and big eyes that is perceived as cute and motivates caretaking behavior in other individuals, with the evolutionary function of enhancing offspring survival. Previous work on this fundamental concept was restricted to schematic baby representations or correlative approaches. Here, we experimentally tested the effects of baby schema on the perception of cuteness and the motivation for caretaking using photographs of infant faces. Employing quantitative techniques, we parametrically manipulated the baby schema content to produce infant faces with high (e.g. round face and high forehead), and low (e. g. narrow face and low forehead) baby schema features that retained all the characteristics of a photographic portrait. Undergraduate students (n = 122) rated these infants’ cuteness and their motivation to take care of them. The high baby schema infants were rated as more cute and elicited stronger motivation for caretaking than the unmanipulated and the low baby schema infants. This is the first experimental proof of the baby schema effects in actual infant faces. Our findings indicate that the baby schema response is a critical function of human social cognition that may be the basis of caregiving and have implications for infant–caretaker interactions.