A Primer on Quality Assurance and Performance Improvement for Interprofessional Chronic Kidney Disease Care: A Path to Joint Commission Certification.

Interprofessional care for chronic kidney disease facilitates the delivery of high quality, comprehensive care to a complex, at-risk population. Interprofessional care is resource intensive and requires a value proposition. Joint Commission certification is a voluntary process that improves patient outcomes, provides external validity to hospital administration and enhances visibility to patients and referring providers. This is a single-center, retrospective study describing quality assurance and performance improvement in chronic kidney disease, Joint Commission certification and quality outcomes. A total of 440 patients were included in the analysis. Thirteen quality indicators consisting of clinical and process of care indicators were developed and measured for a period of two years from 2009-2017. Significant improvements or at least persistently high performance were noted for key quality indicators such as blood pressure control (85%), estimation of cardiovascular risk (100%), measurement of hemoglobin A1c (98%), vaccination (93%), referrals for vascular access and transplantation (100%), placement of permanent dialysis access (61%), discussion of advanced directives (94%), online patient education (71%) and completion of office visit documentation (100%). High patient satisfaction scores (94-96%) are consistent with excellent quality of care provided

Improving Annual Diabetic Foot Examinations at a Rural Primary Care Clinic

The goal of this quality improvement project was to increase the number of adult patients who receive an annual diabetic foot examination through the education and training of clinicians and support staff.https://jagworks.southalabama.edu/scholarsday2023_spring-posters/1007/thumbnail.jp

Targeting of reactive isolevuglandins in mitochondrial dysfunction and inflammation.

Inflammation is a major cause of morbidity and mortality in Western societies. Despite use of multiple drugs, both chronic and acute inflammation still represent major health burdens. Inflammation produces highly reactive dicarbonyl lipid peroxidation products such as isolevuglandins which covalently modify and cross-link proteins via lysine residues. Mitochondrial dysfunction has been associated with inflammation; however, its molecular mechanisms and pathophysiological role are still obscure. We hypothesized that inflammation-induced isolevuglandins contribute to mitochondrial dysfunction and mortality. To test this hypothesis, we have (a) investigated the mitochondrial dysfunction in response to synthetic 15-E2-isolevuglandin (IsoLG) and its adducts; (b) developed a new mitochondria-targeted scavenger of isolevuglandins by conjugating 2-hydroxybenzylamine to the lipophilic cation triphenylphosphonium, (4-(4-aminomethyl)-3-hydroxyphenoxy)butyl)-triphenylphosphonium (mito2HOBA); (c) tested if mito2HOBA protects from mitochondrial dysfunction and mortality using a lipopolysaccharide model of inflammation. Acute exposure to either IsoLG or IsoLG adducts with lysine, ethanolamine or phosphatidylethanolamine inhibits mitochondrial respiration and attenuates Complex I activity. Complex II function was much more resistant to IsoLG. We confirmed that mito2HOBA markedly accumulates in isolated mitochondria and it is highly reactive with IsoLGs. To test the role of mitochondrial IsoLGs, we studied the therapeutic potential of mito2HOBA in lipopolysaccharide mouse model of sepsis. Mito2HOBA supplementation in drinking water (0.1 g/L) to lipopolysaccharide treated mice increased survival by 3-fold, improved complex I-mediated respiration, and histopathological analyses supported mito2HOBA-mediated protection of renal cortex from cell injury. These data support the role of mitochondrial IsoLG in mitochondrial dysfunction and inflammation. We conclude that reducing mitochondrial IsoLGs may be a promising therapeutic target in inflammation and conditions associated with mitochondrial oxidative stress and dysfunction

Cell Wall Mutants in Arabidopsis Thaliana

Plant cell walls are versatile structures, playing important roles in communication, defense, organization and support. The importance of each of these functions varies by cell type, with specialized cells often utilizing one or two functions more than others. Trichomes, or leaf hairs, and hypocotyl cells for instance, exhibit distinct cell wall characteristics. Trichomes have developed very thick cell walls with several raised structures, known as papillae, on their surfaces. It is believed that these cells function in defense against predators, making it difficult to crawl on the leaf surface, and in protection against ultra violet radiation, through refraction of light via the papillae. Hypocotyl cells on the other hand are long and narrow, with cell walls that undergo extensive remodeling to permit rapid oriented cell growth. This enables hypocotyl cells to elongate along the axis of plant development, pushing the developing shoot through the soil. To better understand the molecular processes important for papillae deposition on the cell wall surface, as well as for cell wall building and cell elongation, we focused on the identification and characterization of the GLASSY HAIR (GLH) and SHORT HYPOCOTYL (SH) genes, in which mutants display underdeveloped papillae and small dark-grown hypocotyls, respectively. A candidate gene, MED25, located within the mapping region on chromosome 1, was identified for glh1. The gene was sequenced, revealing a mutation site in the sixth intron. A genetic complementation test was conducted, which showed that MED25 was responsible for the glh1 glassy phenotype. A mutant rescue via transformation with the genomic region including MED25 was also performed, confirming mutation identity. The genetic introduction of markers for trichome development (GL2) and ethylene response (ETR2) into the mutant line demonstrated that the transcription of genes in trichomes is not generally changed in mutants. Î?-glucuronidase fusion with the promoter of the gene was also performed, confirming gene expression in trichomes. The glh2 and glh3 mutations were rough mapped to chromosome 4 and 5, respectively. Genetic fine mapping was conducted to reduce the intervals in which the genes were thought to be located. Markers for trichome development were also introduced into each of these mutant lines to begin preliminary characterization of the nature of the mutations. SH was rough mapped to a 2994kb region on chromosome 5. Known mutants within the mapping region that have sh-like phenotypes (cobra and procuste1/cesa6) were genetically or phenotypically tested to verify that sh was novel. A conditional radial expansion test revealed that sh does not exhibit a cobra phenotype. A confocal microscopy analysis of progeny from a sh x YFP-tagged CESA6 cross indicated that SH is not CESA6 and that CESA6 appears to be sequestered in Golgis of sh plants. In addition, we measured birefringence, an optical property of crystalline cellulose, in mutant and wild type trichomes, revealing a possible cellulose deficiency. We performed a biochemical cellulose assay to quantify the amount of cellulose in dark-grown mutant and wild type plants, confirming this possibility

THE INTRODUCED SABELLID POLYCHAETE TEREBRASABELLA HETEROUNCINATA IN CALIFORNIA: TRANSMISSION, METHODS OF CONTROL AND SURVEY FOR PRESENCE IN NATIVE GASTROPOD POPULATIONS

The sabellid polychaete Terebrasabella heterouncinata (Fitzhugh & Rouse 1999) has a unique life history in which larvae settle on the edge of gastropod shells and rely on shell deposition to create a tube with an opening to the exterior. This worm was accidentally imported to California, USA on abalone from South Africa in the 1980s and spread with abalone shipments to most culture facilities and some public aquaria throughout the state. Its ability to infest California's native gastropods has sparked concern regarding potential establishment in intertidal habitats adjacent to facilities that held sabellid-positive abalone. We examined the ability of T. heterouncinata to transmit between individual turban snails, Tegula funebralis. We found that transmission between T.funebralis did occur, but at a significantly slower rate than that between red abalone Haliotis rufescens. During 2002 to 2006 native gastropods (turban snails and limpets) were collected at most sabellid-exposed sites and no T. heterouncinata were detected; it thus appears that this species has not become established in California. Freshwater exposure was examined as a method to kill T. heterouncinala in shell fragments that may remain after abalone are removed from production or display units. Freshwater immersion for up to 8 hours but not 16 or 32 h resulted in survival of adults and/or larvae resident in brood chambers. In a similar study, motile T. heterouncinata larvae were found to survive up to 32 see of freshwater exposure, whereas none survived a 64-sec exposure. These data can be used by abalone culture and display facilities to establish reliable sanitization procedures to prevent T. heterouncinata transmission or reinfestation

An International Collaboration to Promote Inquiry-based Learning in Undergraduate Engineering Classrooms

Abstract Theorists such as Bransford et al. argue that twenty-first century educators need to teach students to do more than simply remember and repeat information. Engineering educators Prince and Felder critique traditional methods of teaching in which instructors focus on mathematics and theory, but fail to convey practical applications of that knowledge. They advocate moving students to a higher level of learning -past the stage of memorizing and reciting data -to more sophisticated methods of analysis, synthesis, and application of knowledge. To enact such transformations, Prince and Felder recommend "inductive teaching methods," including "inquiry-based learning," in which students learn through engaging with challenges and a series of questions. The purpose of this paper is to describe specific techniques of "inquiry-based learning" employed by three instructors in Engineering schools, one in Europe and two in the USA. The paper provides examples of inquiry-based learning activities from each of the authors. The paper then discusses the cross-pollination of ideas and describes how the authors have shared inquiry-based teaching strategies and collaborated to develop new and relevant assignments and approaches to teaching

Quantifying imperfect detection in an invasive pest fish and the implications for conservation management

In managing non-native species, surveillance programmes aim to minimise the opportunity for invasions to develop from initial introductions through early detection. However, this is dependent on surveillance methods being able to detect species at low levels of abundance to avoid false-negative recordings through imperfect detection. We investigated through field experimentation the ability to detect Pseudorasbora parva, a highly invasive pest fish in Europe, in relation to their known density and sampling method. Secure pond mesocosms of area 100 m2 contained P. parva densities from 0.02 to 5.0 m"122; each density was in triplicate. These were searched using point sampling electric fishing and deployment of fish traps (non-baited and baited). No fish were captured at densities 0.5 m"122, whereas for electric fishing it only exceeded 0.95 at 5.0 m"122 using high searching effort. These data reveal that small pest fishes such as P. parva may be prone to imperfect detection when at low densities and this is consistent with a number of other invasive species. This indicates the importance of designing surveillance programmes using methods of known statistical power to optimise conservation resource expenditure and enhance management outcomes

Loss of the melanocortin-4 receptor in mice causes dilated cardiomyopathy.

Haploinsufficiency of the melanocortin-4 receptor, the most common monogenetic obesity syndrome in humans, is associated with a reduction in autonomic tone, bradycardia, and incidence of obesity-associated hypertension. Thus, it has been assumed that melanocortin obesity syndrome may be protective with respect to obesity-associated cardiovascular disease. We show here that absence of the melanocortin-4 receptor (MC4R) in mice causes dilated cardiomyopathy, characterized by reduced contractility and increased left ventricular diameter. This cardiomyopathy is independent of obesity as weight matched diet induced obese mice do not display systolic dysfunction. Mc4r cardiomyopathy is characterized by ultrastructural changes in mitochondrial morphology and cardiomyocyte disorganization. Remarkably, testing of myocardial tissue from Mc4r-/- mice exhibited increased ADP stimulated respiratory capacity. However, this increase in respiration correlates with increased reactive oxygen species production - a canonical mediator of tissue damage. Together this study identifies MC4R deletion as a novel and potentially clinically important cause of heart failure

Hyalotekite, (Ba,Pb,K)(4)(Ca,Y)(2)Si-8(B,Be)(2)(Si,B)(2)O28F, a Tectosilicate Related to Scapolite: New Structure Refinement, Phase Transitions and a Short-Range Ordered 3B Superstructure

Hyalotekite, a framework silicate of composition (Ba,Pb,K)(4)(Ca,Y)(2)Si-8(B,Be)(2) (Si,B)(2)O28F, is found in relatively high-temperature(greater than or equal to 500 degrees C) Mn skarns at Langban, Sweden, and peralkaline pegmatites at Dara-i-Pioz, Tajikistan. A new paragenesis at Dara-i-Pioz is pegmatite consisting of the Ba borosilicates leucosphenite and tienshanite, as well as caesium kupletskite, aegirine, pyrochlore, microcline and quartz. Hyalotekite has been partially replaced by barylite and danburite. This hyalotekite contains 1.29-1.78 wt.% Y2O3, equivalent to 0.172-0.238 Y pfu or 8-11% Y on the Ca site; its Pb/(Pb+Ba) ratio ranges 0.36-0.44. Electron microprobe F contents of Langban and Dara-i-Pioz hyalotekite range 1.04-1.45 wt.%, consistent with full occupancy of the F site. A new refinement of the structure factor data used in the original structural determination of a Langban hyalotekite resulted in a structural formula, (Pb1.96Ba1.86K0.18)Ca-2(B1.76Be0.24)(Si1.56B0.44)Si8O28F, consistent with chemical data and all cations with positive-definite thermal parameters, although with a slight excess of positive charge (+57.14 as opposed to the ideal +57.00). An unusual feature of the hyalotekite framework is that 4 of 28 oxygens are non-bridging; by merging these 4 oxygens into two, the framework topology of scapolite is obtained. The triclinic symmetry of hyalotekite observed at room temperature is obtained from a hypothetical tetragonal parent structure via a sequence of displacive phase transitions. Some of these transitions are associated with cation ordering, either Pb-Ba ordering in the large cation sites, or B-Be and Si-B ordering on tetrahedral sites. Others are largely displacive but affect the coordination of the large cations (Pb, Ba, K, Ca). High-resolution electron microscopy suggests that the undulatory extinction characteristic of hyalotekite is due to a fine mosaic microstructure. This suggests that at least one of these transitions occurs in nature during cooling, and that it is first order with a large volume change. A diffuse superstructure observed by electron diffraction implies the existence of a further stage of short-range cation ordering which probably involves both (Pb,K)-Ba and (BeSi,BB)-BSi

Historical journey in a linguistic archipelago: Descriptive concepts and case studies

This volume offers a selection of papers presented during the 14th International Conference on the History of the Language Sciences (ICHoLS XIV, Paris, 2017). Part I brings together studies dealing with descriptive concepts. First examined is the notion of “accidens” in Latin grammar and its Greek counterparts. Other papers address questions with a strong echo in today’s linguistics: localism and its revival in recent semantics and syntax, the origin of the term “polysemy” and its adoption through Bréal, and the difficulties attending the description of prefabs, idioms and other “fixed expressions”. This first part also includes studies dealing with representations of linguistic phenomena, whether these concern the treatment of local varieties (so-called patois) in French research, or the import and epistemological function of spatial representations in descriptions of linguistic time. Or again, now taking the word “representation” literally, the visual display of grammatical relations, in the form of the first syntactic diagrams. Part II presents case studies which involve wider concerns, of a social nature: the “from below” approach to the history of Chinese Pidgin English underlines the social roles of speakers and the diversity of speech situations, while the scrutiny of Lhomond’s Latin and French textbooks demonstrates the interplay of pedagogical practice, cross-linguistic comparison and descriptive innovation. An overview of early descriptions of Central Australian languages reveals a whole spectrum of humanist to positivist and antihumanist stances during the colonial age. An overarching framework is also at play in the anthropological perspective championed by Meillet, whose socially and culturally oriented semantics is shown to live on in Benveniste. The volume ends with a paper on Trần Đức Thảo, whose work is an original synthesis between phenomenology and Marxist semiology, wielded against the “idealistic” doctrine of Saussure