Journey to Internal Medicine

My name is Dr. Williams, or as most people call me Dr. Luke. Currently, I work in South Georgia as an ED physician. The road to where I’m currently sitting and to where I started has been long, trying but mostly fun! I started my undergraduate at Valdosta State University; to say the least I was completely lost. My hometown has about 5000 people in the entire county so being at a bigger city seemed overwhelming. I had no friends really and my social life was subpar. I started out as a premed major but quickly realized that these college professors were in the businesses of “weeding” out students. My first bio class I made a C! Devastated but not out, I realized that if my dreams were to become reality it was going to take more dedication, time, and discipline. The first tool I can give you in regards to discipline is found in the book The Road Less Traveled. There is a chapter in the book that talks about “Delaying Gratification” or as in movie I watched a few years ago when the father told his son, “we do what we have to so we can do what we want to”. Just think about this for a while. Are you willing to say no to going out in order to study, miss family functions and events, and basically willing to accumulate more debt that most people make in their lifetime of working? I was. After undergraduate, I applied to many “state” medical schools. My GPA was really good but MCAT was not so good. I did all of the Kaplan courses but just could not get my MCAT score up. I got wait listed but decided I did not want to take off an entire year. I applied to St. Matthews School of Medicine. This school is located in Grand Cayman! (small island located southwest of Cuba). My medical school changed my life. I had the opportunity to meet all types of people. We all came here with one goal and that was to become a medical doctor. While studying was strenuous and classes were grueling, I had the best time of my life. After graduating medical school, I applied to internal medicine residency. Being from Georgia, I wanted to stay close to home. I was accepted into Mercer IM, located in Macon, GA. I spent the next 3 years of my life in the hospital. Hours were strenuous in the hospital but as I grew in my residency, I realized there is no short cut to medicine. There is always something to learn; whether this pertains directly to the patient and their diagnosis and treatment plans to breaking difficult news to family members. Each step along the way was a building block to where I am now. My goal for us, is for you to ask as many questions as possible and we can learn from each other. I look forward to speaking to you soon

Exploration of Hospital Inpatients' Use of the Verbal Rating Scale of Pain

Background: Assessment of pain largely relies on self-report. Hospitals routinely use pain scales, such as the Verbal Rating Scale (VRS), to record patients' pain, but such scales are unidimensional, concatenating pain intensity and other dimensions of pain with significant loss of clinical information. This study explored how inpatients understand and use the VRS in a hospital setting. Methods: Forty five participants were interviewed, with data analysed by thematic analysis, and completed a task concerned with the VRS and communication of other dimensions of pain. Results: Participants anchored their pain experience in the physical properties of pain, its tolerability, and its impact on functioning. Their relationship to analgesic medication, personal coping styles, and experiences of staff all influenced how they used the VRS to communicate their pain. Conclusion: Participants grounded and explained their pain in semantically similar but idiosyncratic ways. The VRS was used to combine pain intensity with multiple other elements of pain and often as a way to request analgesic medication. Pain scores need to be explored and elaborated by patient and staff, content of which will imply access to non-pharmacological resources to manage pain

Biomass Compositional Analysis for Conversion to Renewable Fuels and Chemicals

As the world continues to deplete its nonrenewable resources, there has begun a shift toward using renewable materials for the production of fuels and chemicals. Terrestrial biomass, as well as municipal solid wastes, provides renewable feedstocks for fuel and chemical production. However, one of the major challenges to using biomass as a feedstock for fuel and chemical production is the great amount of innate variability between different biomass types and within individual biomass species. This inconsistency arises from varied growth and harvesting conditions and presents challenges for conversion processes, which frequently require physically and chemically uniform materials. This chapter will examine intrinsic biomass compositional characteristics including cellulose, hemicellulose, lignin, extractives/volatiles, and ash for a wide array of biomass types. Additionally, extrinsic properties, such as moisture content and particle grind size, will be examined for their effect on biomass conversion to fuels using four major conversion processes: direct combustion, pyrolysis, hydrothermal liquefaction, and fermentation. A brief discussion on recent research for the production of building block chemicals from biomass will also be presented

Selective incorporation of proteinaceous over nonproteinaceous cationic amino acids in model prebiotic oligomerization reactions.

Numerous long-standing questions in origins-of-life research center on the history of biopolymers. For example, how and why did nature select the polypeptide backbone and proteinaceous side chains? Depsipeptides, containing both ester and amide linkages, have been proposed as ancestors of polypeptides. In this paper, we investigate cationic depsipeptides that form under mild dry-down reactions. We compare the oligomerization of various cationic amino acids, including the cationic proteinaceous amino acids (lysine, Lys; arginine, Arg; and histidine, His), along with nonproteinaceous analogs of Lys harboring fewer methylene groups in their side chains. These analogs, which have been discussed as potential prebiotic alternatives to Lys, are ornithine, 2,4-diaminobutyric acid, and 2,3-diaminopropionic acid (Orn, Dab, and Dpr). We observe that the proteinaceous amino acids condense more extensively than these nonproteinaceous amino acids. Orn and Dab readily cyclize into lactams, while Dab and Dpr condense less efficiently. Furthermore, the proteinaceous amino acids exhibit more selective oligomerization through their α-amines relative to their side-chain groups. This selectivity results in predominantly linear depsipeptides in which the amino acids are α-amine-linked, analogous to today's proteins. These results suggest a chemical basis for the selection of Lys, Arg, and His over other cationic amino acids for incorporation into proto-proteins on the early Earth. Given that electrostatics are key elements of protein-RNA and protein-DNA interactions in extant life, we hypothesize that cationic side chains incorporated into proto-peptides, as reported in this study, served in a variety of functions with ancestral nucleic acid polymers in the early stages of life

Gapped Excitations in the High-Pressure Antiferromagnetic Phase of URu2_2Si2_2

We report a neutron scattering study of the magnetic excitation spectrum in each of the three temperature and pressure driven phases of URu$_2$Si$_2$. We find qualitatively similar excitations throughout the (H0L) scattering plane in the hidden order and large moment phases, with no changes in the $\hbar\omega$-widths of the excitations at the $\Sigma$ = (1.407,0,0) and $Z$ = (1,0,0) points, within our experimental resolution. There is, however, an increase in the gap at the $\Sigma$ point from 4.2(2) meV to 5.5(3) meV, consistent with other indicators of enhanced antiferromagnetism under pressure.Comment: 5 pages, 3 figures, 1 tabl

Enhanced neutralising antibody response to bovine viral diarrhoea virus (BVDV) induced by DNA vaccination in calves

DNA vaccination is effective in inducing potent immunity in mice; however it appears to be less so in large animals. Increasing the dose of DNA plasmid to activate innate immunity has been shown to improve DNA vaccine adaptive immunity. Retinoic acid-inducible gene I (RIG-I) is a critical cytoplasmic double-stranded RNA pattern receptor required for innate immune activation in response to viral infection. RIG-I recognise viral RNA and trigger antiviral response, resulting in type I interferon (IFN) and inflammatory cytokine production. In an attempt to enhance the antibody response induced by BVDV DNA in cattle, we expressed BVDV truncated E2 (E2t) and NS3 codon optimised antigens from antibiotic free-plasmid vectors expressing a RIG-I agonist and designated either NTC E2t(co) and NTC NS3(co). To evaluate vaccine efficacy, groups of five BVDV-free calves were intramuscularly injected three times with NTC E2t(co) and NTC NS3(co) vaccine plasmids individually or in combination. Animals vaccinated with our (previously published) conventional DNA vaccines pSecTag/E2 and pTriExNS3 and plasmids expressing RIG-I agonist only presented both the positive and mock-vaccine groups. Our results showed that vaccines coexpressing E2t with a RIG-I agonist induced significantly higher E2 antigen specific antibody response (p < 0.05). Additionally, E2t augmented the immune response to NS3 when the two vaccines were delivered in combination. Despite the lack of complete protection, on challenge day 4/5 calves vaccinated with NTC E2t(co) alone or NTC E2t(co) plus NTC NS3(co) had neutralising antibody titres exceeding 1/240 compared to 1/5 in the mock vaccine control group. Based on our results we conclude that co-expression of a RIG-I agonist with viral antigen could enhance DNA vaccine potency in cattle