RESEARCH ROUNDUP

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$10 Million in NIH Funded Research

Dr. Loretta Sweet Jemmott, associate professor in the School of Nursing and Director of the Center for Urban Health Research has received two NIH (National Institute of Health) grants from the National Institute of Mental Health for a total of over $10 million.

The first grant HIV Sexual Risk Reduction for Black Drug Using Women. The purpose of the this project is to identify effective culturally sensitive interventions to reduce the risk of sexually transmitted diseases (STDs), including HIV, among inner-city African American women who abuse substances. Over the course of five years, 869 African American women will be recruited from the inpatient detoxification program at Presbyterian Medical Center to participate in this groundbreaking HIV risk-reduction research. The results of this project will contribute to the development of efficient and effective HIV prevention programs for inner-city African American women who abuse drugs.

The second grant Church-Based Parent-Child Health Promotion Project. The broad objective of this project is to identify effective, theory-driven interventions that involve parents and can be implemented in church settings to reduce inner-city African American adolescents' risk of STDs, including HIV. In this project, 720 African American parents and children 6th and 7th grade will be recruited from10 Black Baptist churches in low-income communities in Philadelphia. The findings from this project will contribute to the development of effective HIV risk reduction programs for inner-city African American adolescents.

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Cure for Atrial Fibrillation

Cardiac Rhythm Specialists for Penn's Health System have documented the effectiveness of a new technique to cure atrial fibrillation (A-Fib). The technique targets and isolates the triggers, or "hot spots," on pulmonary veins leading to the heart, preserving the heart's natural electrical circuitry and eliminating the need for a pacemaker or medication. Dr. Francis E. Marchlinski, director of Cardiac Electrophysiology for UPHS, discussed the findings at the American College of Cardiologists' meeting in Atlanta. "This procedure can eliminate atrial fibrillation completely and patients can resume their lives without relying on mechanical devices or any form of medication, including blood-thinners," Dr. Marchlinski said.

Atrial fibrillation is a serious condition, often associated with aging, which results when electrical discharges in one of the atria (upper chambers of the heart) disrupts the normal, organized electrical activity, or "sinus rhythm," generated by the heart's sinus node. Patients with this arrhythmia often suffer a rapid heartbeat, palpitations, weakness, shortness of breath and fatigue, although sometimes the condition manifests no symptoms. Traditional ablation procedures for this arrhythmia deliver an electrical charge that permanently blocks the electrical connection that transmits the impulse from the atria to the heart's lower ventricles. A pacemaker is then required to maintain an adequate heart rate.

The older procedure does not cure afibrillation but merely prevents the fast heart rate that frequently accompanies atrial fibrillation, and patients still require blood-thinning medication. The Penn procedure is more specific in targeting the triggers for atrial fibrillation, rather than blocking the main electrical road to the heart. During the ablation process, Penn electrophysiologists infuse drugs that promote the firing of so-called "hot spots" in the pulmonary veins. Once those triggers are identified with the use of sophisticated electrical recording techniques, a catheter-based ablation procedure isolates the abnormal fibers that cause them. The Penn team has developed what it believes are the optimal recording strategies and pacing techniques for identifying the affected veins rapidly and confirming the effectiveness of the isolation procedure.

Others who assisted Dr. Marchlinski include Dr. David. J. Callans; Erica S. Zado; Dr. Andrea J. Russo; Dr. Edward P. Gerstenfeld; Dr. Sanjay Dixit; De. Robert W. Rho; Dr. Vickas Patel; Dr. John Veshai; Dr. Joseph W. Poku and Dr. David Lin, all of the Penn Heath System.

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Inequality in Treatment of Disease

When it comes to heart disease, women still face discrimination in the way the illness is diagnosed and treated, as well as in epidemiological studies that form the basis for disease treatment strategies, according to a national expert in womens cardiovascular medicine at Penn's School of Medicine. Dr. Mariell Jessup, Director of Women's Cardiovascular Health, spoke on the status of heart failure in women at the national meeting of the American College of Cardiology in Atlanta. "Women make up half of the 4.7 million Americans with heart failure, but they suffered 62.3 percent of the heart-failure fatalities last year," Dr. Jessup said. "In fact, 20 percent of all women diagnosed with heart failure die within a year, and fewer than 15 percent of women survive more than eight to 12 years after the initial diagnosis. Research also indicates that, in general, women with heart failure have a poorer quality of life than men." Further, in reviewing recent major epidemiological studies, Dr. Jessup found "there are important baseline differences by gender" in patients who were randomly selected to participate in the well-known ‘BEST' heart failure study, which was one of the largest clinical trials ever designed to focus on advanced heart failure. Those gender differences, which included age, race and cigarette smoking histories, "are known to influence mortality in heart failure," Dr. Jessup says. Dr. Jessup has also found the percentage of women participants in numerous other scientific studies was significantly lower than 50 percent, despite the fact that women make up more than half the population.

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Studying Rescue Dogs, Handlers From 9/11

When the World Trade Center and sections of the Pentagon came crashing down September 11, the rubble left for rescuers was laden with asbestos, diesel fuel, PCBs and countless other toxins. Researchers at Penn have now begun a three-year study of the search-and-rescue missions' effects on rescue dogs and their handlers.

Comprised of veterinary researchers and psychologists, the team will focus on the physical and psychological toll, possibly sounding an early alert on ailments to watch for among those who have toiled to clear the wreckage.

"Few dogs at the World Trade Center and Pentagon suffered acute injuries, but during the next three years we expect them to serve as our sentinels on long-term consequences," said lead researcher Dr. Cynthia M. Otto, associate professor of critical care in Penn's School of Veterinary Medicine. "We may see health effects that will follow in humans 10 or 20 years from now."

Because the canine teams put in an average seven to 10 days at sites thick with potentially carcinogenic chemicals, Dr. Otto's team will pay particular attention to the incidence of cancer.

Dr. Melissa Hunt, associate director of clinical training in the Department of Psychology, will lead the associated study of dog handlers. Patterns of depression or post-traumatic stress disorder among this small group of personnel, Dr. Hunt said, would likely be replicated among the thousands of others who have combed the ruins of the World Trade Center and Pentagon.

Dr. Hunt will survey the dog handlers at regular intervals through 2004, focusing on emotional and behavioral health outcomes and factors contributing to risk and resilience, including personality traits and prior history of trauma; external factors such as social support and the stability of marriages; and hints of clinically significant depression and post-traumatic stress disorder. For those showing signs of ongoing difficulties, Dr. Hunt's team will offer assistance in the form of modified exposure therapy, which involves writing about one's experiences to help put the trauma into context.

Support for the study comes from the AKC Canine Health Foundation, the American Kennel Club, Ralston Purina Co., Veterinary Pet Insurance Co. and the Geraldine R. Dodge Foundation. The study also includes researchers at Michigan State University and the Centers for Disease Control in Atlanta.

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Experiment in Sentencing

A high-ranking British judge has approved a Penn-led randomized controlled test comparing different sentencing procedures.

Dr. Lawrence Sherman, director of Penn's Jerry Lee Center of Criminology, the Albert M. Greenfield Professor of Human Relations in Penn's Department of Sociology and director of the Fels Center of Government, said the decision appears to be the first time a chief justice in any nation has specifically approved such testing. The endorsement was revealed in a recent advisory letter to crown court judges from Harry Woolf, the lord Chief Justice of England and Wales, in response to questions raised by a judge planning to participate in the experiment.

"Restorative justice" in the impending London experiment is a procedure in which crime victims, offenders and their friends and families meet under the guidance of a specially trained Scotland Yard police officer after a guilty plea but before a sentencing decision. They discuss the harm the crime has caused and agree on ways the offender may try to repair that harm. The agreement is submitted to the judge, who may decide to impose less prison time in consideration of the voluntary agreement.

Dr. Sherman said that the question put to the chief justice was whether the research design created too much inconsistency in sentencing conditions. The research design calls for half of the eligible cases with consenting victims and offenders to be assigned by a random-numbers formula to undergo the restorative justice procedures.

Dr. Sherman and his colleagues were selected to design and conduct the experiments after their controlled experiments with the Australian Federal Police revealed that restorative justice reduced repeat offenses by 38% among those charged with violent crimes.

The London experiments will conduct separate tests for offenders charged with robbery, burglary, assault and property crime.

The $3.5 million project is funded by the British government.