Philadelphia College of Osteopathic Medicine
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Supervision needs of novice behavioral health clinicians in integrated primary care settings.
No full textINTRODUCTION: Clinical supervision is a foundational experience for novice behavioral health clinicians (BHCs), with the provision of high-quality supervision in the integrated primary care (IPC) context being imperative. While the literature highlights skills, knowledge, and considerations for supervisors in these settings, less is known about the supervision needs of novice BHCs.
METHOD: This article presents the findings of a classical Delphi study with a panel of 12 novice BHCs who have received supervision in an IPC setting.
RESULTS: The Delphi panelists achieved statistical consensus on 68 statements across nine themes, highlighting a wide range of supervisory needs of novice BHCs in IPC settings.
DISCUSSION: This study expands upon the existing literature on supervision in IPC settings by indicating the various needs of novice BHCs receiving supervision in IPC. Implications for the planning, implementation, and evaluation of supervision in IPC settings are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
A Middle Eocene Haplorhine Frontal Bone From the Tornillo Basin of Texas, and Its Implications for the Phylogenetic Relationships of Rooneyia and Other Paleogene Primates.
No full textOBJECTIVES: Here we describe a well-preserved primate frontal bone (TMM 46513-1) recovered from Middle Eocene exposures of the Devil\u27s Graveyard Formation in the Tornillo Basin of Texas. We also discuss the significance of frontal bone morphology for understanding early haplorhine phylogeny.
MATERIALS AND METHODS: TMM 46513-1 was mechanically prepared, μCT scanned, and compared with a broad array of extant and fossil crown primates. Revised dates for the specimen were provided using 40Ar/39Ar geochronology. Dice-CT scans of Saguinus were used to investigate the contents of bony canals found within the frontal bones of many euarchontans.
RESULTS: TMM 46513-1 resembles Rooneyia viejaensis in several key features, including: (1) the presence of a ventral flange on the lateral process of the frontal that intervenes between the posterosuperior orbit and temporal fossa, (2) the presence of a bony canal system ( orbitofrontal canal ) within the frontal that connects a foramen on the posterior aspect of the lateral process ( lateral process foramen ) with the superomedial orbit and the anterior cranial fossa, (3) a metopic suture that is unfused at its rostral end but obliterated at its caudal end, and (4) an anterior cranial fossa that overlaps the posteromedial portions of the orbits.
CONCLUSIONS: The lateral segment of the orbitofrontal canal and substantial ventral expansion of the lateral process are features restricted to the Haplorhini among crown primates. The morphological features shared by TMM 46513-1 and Rooneyia suggest that they may be stem haplorhines, but are less consistent with the hypothesis that Rooneyia is a stem anthropoid
Examination of cardiovascular function in mice with epicardial-specific deletions of Crk-CrkL adaptor proteins
No full textINTRODUCTION: Crk and CrkL are intracellular cytoplasmic adaptor proteins that contribute to the development of the cardiovascular system. They mediate signaling pathways involved in biological processes such as cell migration, proliferation, apoptosis, adhesion, survival, and differentiation. Both Crk and CrkL share functions in the endocardial lineage for atrioventricular valve development. Our lab has observed Crk and CrkL expression throughout the developing mouse heart including the epicardium and epicardium-derived cells (EPDCs), which give rise to the coronary vascular cells and cardiac fibroblasts. Investigators have demonstrated that deletion of Crk-CrkL genes causes various cardiovascular structural defects. We observed embryonic lethality due to septal defects in mice at mid-to-late gestation with global deletion of Crk and Crk. To determine the impact of Crk and CrkL on cardiovascular function, we devised a strategy to achieve tissue-specific conditional deletion of these proteins that enable these mice to survive to adulthood for analysis of physiological parameters.
OBJECTIVE: The goal of our study was to determine the impact of Crk and CrkL in the epicardium and its derivatives to control and maintain cardiovascular function in the adult mouse heart.
METHODS: We developed a tissue-specific strategy to conditionally delete one or both Crk and CrkL alleles from the epicardium and EPDCs of the mouse heart with Wilms’ tumor 1 (Wt1) Cre-driven recombinase. The mice obtained from this breeding strategy included Crklox/lox/CrkLlox/lox control mice, 2 allele knockouts (Crklox/+/CrkLlox/+; Wt1-Cre), 3 allele knockouts (Crklox/+/CrkLlox/lox ;Wt1-Cre or Crklox/lox/CrkLlox/+ ;Wt1-Cre), and 4 allele knockouts (Crklox/lox/CrkLlox/lox;Wt1-Cre). Cardiovascular structure and functional parameters were examined in anesthetized mice via a series of cardiac micro-ultrasounds performed at 4, 8, and 12 months of age. We used the Vevo1100 Ultrasound imager to capture parasternal long and short axis views of heart wall motion and coronary blood flow in these mice. These cardiovascular functional parameters were compared between control and Crk-CrkL epicardial-deletion mice. Various measurements were obtained from the images and loops captured at each timepoint including stroke volume, ejection fraction, cardiac output, end-systolic volume, and end-diastolic volume. Analysis was performed using Vevo Lab analysis software.
RESULTS: Echocardiogram analysis of 4-month-old mice revealed slight increases in contractility of Crk-CrkL epicardial-deletion mice compared to control hearts. In addition, we observed a mild increase in coronary velocity time integral in Crk/CrkLdel/+ mouse hearts compared to the control mice. This parameter indicates the distance blood travels within the coronary arteries.
CONCLUSION: Our data demonstrates the importance of Crk and CrkL expression in the epicardium and its derivatives. We speculate Crk-CrkL deletions may impact contractility and coronary blood flow of the heart as a result of the increased demands placed on the systemic circulation to maintain adequate blood flow. In future studies, we will explore the molecular and physiologic mechanisms that contribute to the increased systemic demands in Crk-CrkL epicardial-deletion mice
Optogenetic deactivation of amygdalo-auditory cortex circuit
Full text linkIntroduction: While the functions of many amygdalar circuits have been widely studied, the role of the direct amygdalo-auditory cortex (AM-AC) circuit is unknown.
Objective: Understand the function of the direct projection from the amygdala to the auditory cortex.
Methods: Two experiments were performed. In Experiment 1:Electrophysiology was utilized to record single and multi-unit responses from the auditory cortex. Optogenetic activation or deactivation of the amygdalo-auditory cortex circuit was then utilized to examine changes to auditory neuron firing rate during normal and deactivation scenarios. In Experiment 2, the protocols for experiment 1 were tested in animals with a sound-induced tinnitus to determine whether deactivation of the amygdalo-auditory cortex circuit would influence the tinnitus perception. In both experiments, fluorescent labeling from the optogenetic injection was examined in the amygdala and auditory cortex.
Results: The optogenetic vector construct provided both anterograde and retrograde labeling. The injection site was isolated to the lateral and basal nuclei of the amygdala. Labeled neurons included pyramidal and multipolar cells. Within the auditory cortex, a few pyramidal neurons were observed bilaterally throughout both primary and secondary areas of the auditory cortex. In addition, a large number of en-passant and terminal boutons were observed throughout layers 1-6 but predominantly in layers 5 and 6. Recording of neurons in the auditory cortex were characterized by best frequency. Deactivation of the amygdala projection to auditory cortex caused a significant inhibition of cortical firing rates in both multiunit and single-unit recordings. This inhibition occurred only during the time of the amygdala projection deactivation. In our tinnitus animals, the tinnitus was eliminated during the amygdala projection deactivation. However, the tinnitus immediately recovered when the pathway was released from deactivation.
Conclusion: While most of the amygdalar projection neurons to the auditory cortex are pyramidal (i.e., glutamatergic), the overall influence of the pathway was inhibitory. Therefore, this pathway is likely to contact inhibitory circuits within the cortex. The timing of inhibition and release from inhibition occurred within a manner of milliseconds. No long-term effects were observed. Therefore, we hypothesize that the amygdalo-auditory cortex circuit may provide quick modulatory influences on cortex that may help to prime cortical circuits for subsequent inputs from the nucleus basalis (a projection that has longer-lasting influences on cortical function)
Social determinants of health in patients with Diabetes Mellitus II
Full text linkIntroduction: More than 37 million people in the United States have diabetes, the majority 90-95% with type 2 diabetes. The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems. The SDH have an important influence on health inequities - the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health. Research has demonstrated that diabetes affects racial and ethnic minority and low-income adult populations in the U.S. disproportionately. Clinical observations in a free medical clinic suggested the hypothesis that diabetic patients have social determinants that affect their ability to control their diabetes.
Methods: A random sample of patients seen at Grace Village Medical Clinic (DeKalb County, GA) with previously diagnosed diabetes, were asked a survey of questions in regard to the five domains of social determinants of health. Each patient was asked questions in their native tongue through an interpreter; regarding their income, education, access to health care and grocery stores, mental wellbeing, compliance with medication, and their understanding of diabetes. The averages of the results were looked at to determine the prevalence of the social determinants domains in these patients.
Results: 29 patients were assessed, 16 female and 13 male. Ages ranged from 27 to 87. 15 patients (51.7%) had an education less than high school and 10 (34.5%) had an education level of high school. 9 patients (31%) had a monthly income of 0, 10 (34.5%) had a monthly income of 1-1000 or 2001-3000.
23 patients (79.3%) were unemployed. A majority did have access to healthier foods and grocery stores being 17 (58.6%) and 20 (69%). Only two patient’s primary language was English with 21 (72.4%) of patients not understanding or speaking English. 31% of patients did not feel supported in their community and 65.5% of patients felt a stressor at home. Only 55.2% of patients had adequate transportation to healthcare and grocery stores. 29.6% of patients were not compliant with medication. 44.4% of patients were not properly informed about diabetes by a healthcare professional.
Conclusions: This discussion illustrates the importance of understanding the different factors that can contribute to a patient’s diagnosis of diabetes. In the different fields of medicine, it is important to recognize how a patient’s wellbeing, lifestyle, and education can contribute to the persistence of diabetes and its potential long-term complications such as neuropathy, retinopathy and nephropathy. This highlights the significance of resources and education necessary to provide that patients can be treated with adequate care and help
Confocal Microscopy Visualizing Hyperphosphorylated Tau Preparation of Coverslip for Confocal Microscopy
No full textEmbryonic hippocampal rat astrocytes were cultured in T75 Poly-D-Lysine flasks for 13 days before trypsinizing. The incubator for cell cultures were maintained at 37 C, 95% humidity, and 5% CO2. The media was exchanged with fresh media every other day for 10 days. This media exchange procedure was altered when it was discovered that exchanging the media with fresh media every day for another four days, increased the number of cells by over 50 percent (Komiskey, unpublished results).
A 12-well plate will be pre-warmed at 37° C. Forceps will be sterilized using 70% ethanol and a flame under the sterile hood. Using sterile forceps, a 22mm poly-D-lysine coated coverslip will be placed into four separate wells of the 12-well plate to allow for cellular adherence. Two 50ml conical tubes with glucose and non-glucose media and cells, will be reserved from glucose deprivation. Three ml of media and cells will be pipetted onto four or more coverslips in the 12 well plate. The prepared plate will be wrapped in tin foil to prevent media evaporation. Media will be changed after two days to allow cells to adhere. Media will be removed from all four wells and washed with 500µ1 of PBS will be added to each well and removed. This wash will be repeated two more times. Final wash will be removed, and 500ul of 4% formaldehyde added to each well, and incubated for 30 minutes at room temperature. Formaldehyde will be removed, followed by a 10-minute incubation in 0.1 % Triton-X for 10 minutes to allow the cell membrane to be more permeable. Following the incubation, Triton-X will be removed, and 500µ1 of 1% BSA added to each well and blocking will be performed for 30 minutes at room temperature. BSA will be removed, and a 1ml of a 1ug/ml dilution of primary antibody in PBS was added to each well. Primary antibody will be incubated for 1 hour at room temperature, after which it will be removed, and the coverslips will be washed 3 times for 3 minutes per wash. Goat anti-rabbit secondary antibody was prepared (1ml per well at lµg/ml dilution), added and incubated for 1 hour at room temperature in the dark. Washes were performed 3x with 500µ1 of IX PBS at 3 minutes per wash DAPI (4\u27,6-diamidino-2-phenylindole) was prepared at a 1: 1000 dilution, 1ml will be added to each well, and allowed to incubate for 10 minutes in the dark at room temperature. Again, three washes were performed with 500µ1 of PBS at 3 minutes per wash. Finally, 500µ1 of PBS will be added to all wells, and the well plate will be Para filmed to prevent evaporation of PBS while placed in 4C refrigerator before imaging. Mitochondria in the astrocytes were also stained using Mitochondrial Membrane assay kit to determine the dose-dependent ability of sulforaphane and/or new compounds as potential inhibitor of mitochondrial damage in astrocytes. Researchers have reported that phosphorylated Tau can change from fibers to liquid droplets and later released
Retear, Repair, Repeat: A Rotator Cuff Case Report
Full text linkThe following case report demonstrates a common yet educational case of a rotator cuff retear. The patient was a 64-year-old R-hand dominant female with a PMH significant for T2DM, a prior R RCR with subacromial decompression, and distal clavicle excision. She presented for evaluation of R shoulder pain s/p ground-level fall on an outstretched hand. XR was negative for any acute fractures but did reveal a small subacromial osteophyte. MRI findings demonstrate a full-thickness tear of the supraspinatus tendon with evidence of underlying tendinosis. Given the patient’s active lifestyle and pain impacting her functional mobility, subacromial decompression and arthroscopic repeat RCR were pursued. The patient’s PMH, in addition to its traumatic nature, predisposed her to reinjury. However, this report also raises room for discussion regarding the benefits of subacromial decompression and distal clavicle excision in preventing further rotator cuff pathology
Bilateral Anatomical Variation of the Extensor Hallucis Longus: Dual Attachments to the Hallux
Full text linkIntroduction:
The extensor hallucis longus (EHL) is a crucial muscle in the lower limb, responsible for the extension of the hallux and dorsiflexion of the ankle. While anatomical variation of the EHL has been documented, the extensor hallucis longus muscle typically has a single attachment on the dorsal aspect of the base of the distal phalanx of the hallux. Variations in its attachment sites can provide clinical significance for reconstructive procedures.
Methods:
Medical students at Philadelphia College of Osteopathic Medicine (PCOM) in South Georgia conducted a cadaveric dissection on a 69-year-old male. During a routine cadaver dissection, a bilateral observation was made regarding the lower limb of a cadaver. A detailed examination was performed to assess the muscle structure, attachment sites, and any variation present.
Results:
The extensor hallucis longus muscle was found to have two distinct attachments on the anterior surface of the hallux, observed bilaterally. The belly of the extensor hallucis longus bifurcates before extending toward the attachment sites. The primary attachment followed the common arrangement, inserting on the dorsal aspect of the base of the distal phalanx of the hallux. However, an additional attachment was identified, anchoring onto the medial aspect of the hallux.
Conclusion:
There were no signs of surgical procedures performed to the muscle indicating a congenital anomaly. The presence of the dual attachments may influence the functional strength of the extensor hallucis longus. The dual attachments of the extensor hallucis longus may influence the stability and control of the movement of the great toe. However, this variation could create an imbalance by altering the muscle’s line of pull, potentially reducing strength. The dual attachment may also impact biomechanics, such as walking and running. An increase in strength and stability could be advantageous, whereas any inefficiencies may require compensatory movement from other muscles
Case Study Research Project: Anatomical and Pathophysiological Findings in a Cadaver with a Spinal Cord Stimulator and Chronic PASH Syndrome, Critical Illness Myopathy, and Reflex Sympathetic Dystrophy.
Full text linkIntroduction:
Spinal cord stimulators (SCS) are commonly used for neuropathic pain management, particularly in conditions such as reflex sympathetic dystrophy (RSD)/complex regional pain syndrome (CRPS). However, the long-term anatomical and histopathological changes in patients with SCS and multiple comorbidities remain poorly understood. This case study investigates the postmortem findings of a cadaver with a documented history of chronic PASH syndrome (pyoderma gangrenosum, acne, hidradenitis suppurativa), critical illness myopathy (CIM), and RSD/CRPS, all of which contributed to the patient’s cause of death.
Methods:
A comprehensive cadaveric examination was performed in the anatomy laboratory at Philadelphia College of Osteopathic Medicine - South Georgia on an 81-year-old male cadaver , including gross anatomical dissection, histopathological analysis of muscle, nerve, and skin tissues, and evaluation of the SCS placement and its surrounding tissue response. Special attention was given to muscle atrophy and fibrosis (CIM-related), peripheral nerve degeneration (RSD/CRPS-related), and chronic inflammatory skin lesions (PASH-related).
Results:
Preliminary findings suggest fibrotic encapsulation of the SCS leads, indicative of chronic inflammatory response. A reduction in muscle size and mass, likely due to prolonged illness or disuse, which is common in critical illness myopathy (CIM). The replacement of muscle tissue with fat, a hallmark of CIM, indicating chronic muscle degeneration.Structural damage or deterioration of nerves, which is commonly associated with reflex sympathetic dystrophy (RSD)/complex regional pain syndrome (CRPS) and can contribute to chronic pain and sensory abnormalities.
Discussion:
This cadaveric case study provides rare and valuable insights into the complex interplay between chronic inflammatory conditions, neuromuscular pathology, and pain management interventions. The fibrotic encapsulation of the spinal cord stimulator suggests that long-term neuromodulation devices may trigger persistent inflammatory responses that could potentially alter their therapeutic efficacy over time. Furthermore, the coexistence of critical illness myopathy, reflex sympathetic dystrophy, and PASH syndrome in this patient illustrates how systemic inflammatory processes can simultaneously affect multiple organ systems, creating a challenging clinical picture where neuromuscular deterioration, pain sensitization, and impaired wound healing form a self-perpetuating cycle. These findings highlight the need for comprehensive, multidisciplinary approaches to complex pain syndromes that address not only symptom management but also the underlying inflammatory and degenerative processes across neural, muscular, and cutaneous systems
The effectiveness of teledermatology and artificial intelligence across diverse skin tones: a systematic review
Full text linkINTRODUCTION: Teledermatology has become a vital tool in dermatologic care since its introduction, improving accessibility and efficiency, particularly in underserved communities. However, concerns persist regarding its diagnostic accuracy across diverse skin tones. Dermatologic conditions often present differently in patients with darker skin, and teledermatology’s reliance on image-based diagnosis may amplify disparities in detection and management. Additionally, artificial intelligence (AI) systems used in teledermatology may inherit biases due to underrepresentation of darker skin tones in training datasets. This systematic review examines current evidence on the diagnostic accuracy of teledermatology across diverse skin tones, identifies gaps in research, and explores the potential of AI to mitigate diagnostic disparities.
METHODS: This systematic review conducted a comprehensive search across PubMed, Google Scholar, and OneSearch+. Keywords included teledermatology, diagnostic accuracy, skin of color, race, and artificial intelligence in dermatology. Inclusion criteria encompassed studies published between 2012 and 2025 that assessed the diagnostic performance of teledermatology compared to in-person dermatology across varying skin tones. Articles were screened for quality assessment, and data were extracted regarding diagnostic concordance rates, differences in performance across skin types, and AI applications in teledermatology.
RESULTS: A recent meta-analysis of 44 studies found a pooled teledermatology vs. in-person diagnostic concordance of ~69% (κ ≈0.67). Specialist involvement significantly boosted accuracy: when a dermatologist evaluated patients both via telemedicine and in-person, diagnostic agreement was about 71% compared to only 44% when non-specialists were involved. Individual studies likewise report substantial agreement; a large clinic study observed 76.4% concordance between remote and in-person diagnosis (κ=0.636). Teledermatology’s diagnostic accuracy was slightly lower than in-person examination. Qualitatively, common factors influencing performance included image quality and the availability of clinical context. Incorporating high-resolution photography, patient history, or teledermoscopy was noted to further improve diagnostic accuracy, particularly for skin cancer detection (9% higher than traditional methods). AI-assisted diagnostic tools exhibited up to 15% lower accuracy on darker skin tones compared to lighter skin.
DISCUSSION: Teledermatology is a useful tool with diagnostic accuracy comparable to in-person dermatology. This indicates teledermatology is viable for timely triage and diagnosis in many settings, including areas limited in resources. However, its effectiveness across diverse skin tones remains understudied. This review found no study that explicitly stratified diagnostic accuracy by skin type, highlighting a critical gap. This absence of data on darker skin tones leaves uncertainty about teledermatology’s efficacy across diverse populations. AI integration shows potential to enhance accuracy but risks perpetuating bias if datasets lack proper representation. Future research should focus on ensuring diverse representation in teledermatology studies, optimizing AI training methods, and standardizing imaging protocols for all skin tones. Addressing these disparities is crucial to ensuring equitable access to high-quality dermatologic care as teledermatology continues to expand