Healthcare Cost Savings Through Telemedicine Use At Correctional State Facilities

Telemedicine offers both soft and hard return on investment, including cost savings avoidance and convenience of access to care. Incarcerated individuals represent a patient population that uniquely benefit from receiving care via telemedicine. They lack access to subspecialty care as prison facilities are located outside of urban areas, which is compounded by security risks, risk to individuals around inmates, and transportation cost to tertiary care facilities. To attend a brief in-office medical visit, an inmate requires hours of administrative support and logistical coordination, including appointment scheduling, transport arrangement and related fuel expense, and guard accompaniment - all at a financial cost to taxpayers. Telemedicine stands as a proven solution to decrease these costs and improve access to the care of inmates. The Virginia Commonwealth University (VCU) Office of Telemedicine has provided telemedicine visits to more than 45,000 patients over 22 years and encompasses over 15 subspecialties, which have facilitated care to incarcerated patients at 30 Department of Corrections (DOC) sites in Virginia. Cost savings analysis was performed by the VCU Office of Telemedicine for the 2016 fiscal year. The amount saved per telemedicine visit was estimated by calculating officer costs and transportation costs associated with transporting an inmate to an on-site visit. It was found that each telemedicine visit represents a cost avoidance of $800 per visit. There were 2,850 Virginia DOC telemedicine visits in the fiscal year 2016, resulting in over 2 million dollars in estimated cost savings.https://scholarscompass.vcu.edu/gradposters/1034/thumbnail.jp

The Rhetoric of Christianization in Thessaloniki: Saint Demetrios

The origins of Saint Demetrios, the patron saint of Thessaloniki, Greece, are contentious, however the effects of growing following of the saint during the city's transition to Christianity can be examined. Considering how Byzantine history and rhetoric shaped the fabric of Saint Demetrios' cult, we explored the Christianization of Thessaloniki through the transition from late antique cults, the establishment of Hagios Demetrios, the changing depictions of the Saint, and the relics of Saint Demetrios. The martyr saint legitimizes Thessaloniki as a Christian city, conferring power on the city within the religion and develops a rhetoric that further solidifies the city's position.No embargoAcademic Major: History of Ar

Terrestrial and marine risks for leach's storm-petrels during the breeding season

Globally, seabirds are in decline, so comprehensive efforts are needed to understand risks facing these species. Leach’s Storm-Petrels are globally identified as ‘Threatened’, and my thesis addresses two factors which pose risk during the breeding season for the population breeding at Gull Island, Newfoundland: predation and light attraction. Chapter 2 investigates activity associations between breeding storm-petrels and nearby predatory Herring Gulls to gauge predation risk. Herring Gull activity was negatively associated with, and was the most important predictor of, Leach’s Storm-Petrel activity, suggesting that storm-petrels modify their colony activity in response to their top predator. Chapter 3 examines foraging tracks of parental storm-petrels to assess risk from light attraction to offshore oil platforms. This population of storm-petrels was consistent in foraging trip duration, distance, behaviour, and location. They transited past oil platforms during the day, thereby minimising risk. Breeding season risks from predation and light attraction are minimised by existing constraints on behaviour, so future research should focus on other risks to adults along with the juvenile and immature phases of the life cycle. Overall, I demonstrate that a comprehensive examination of risks facing seabirds throughout their life cycle is vital for informing effective mitigation efforts

Gibberellin Application on Dwarf Strains of Millets

Gibberellin is a plant hormone that stimulates cell growth. This hormone was added to three types of dwarf and normal millets, Setaria Viridis, in a 1,000-ppm gibberellic acid form. Dwarf millets are plants that grow at an abnormally shorter stature than the rest of their species. After this was added the dwarf height rate was taken and observed for any change in height. If the dwarf plants had an increase in growth, it is plausible that the dwarf mutation is due to its inability to produce gibberellin. While if there was no difference in plant growth it\u27s plausible that the plant produces gibberellin, however it\u27s not able to process it. This experiment is important in understanding the role gibberellin has in mutated dwarf plants

Rotation of planet-harbouring stars

The rotation rate of a star has important implications for the detectability, characterisation and stability of any planets that may be orbiting it. This chapter gives a brief overview of stellar rotation before describing the methods used to measure the rotation periods of planet host stars, the factors affecting the evolution of a star's rotation rate, stellar age estimates based on rotation, and an overview of the observed trends in the rotation properties of stars with planets.Comment: 16 pages, 4 figures: Invited review to appear in 'Handbook of Exoplanets', Springer Reference Works, edited by Hans J. Deeg and Juan Antonio Belmont

The molecular basis of breast cancer pathological phenotypes

The histopathological evaluation of morphological features in breast tumours provides prognostic information to guide therapy. Adjunct molecular analyses provide further diagnostic, prognostic and predictive information. However, there is limited knowledge of the molecular basis of morphological phenotypes in invasive breast cancer. This study integrated genomic, transcriptomic and protein data to provide a comprehensive molecular profiling of morphological features in breast cancer. Fifteen pathologists assessed 850 invasive breast cancer cases from The Cancer Genome Atlas (TCGA). Morphological features were significantly associated with genomic alteration, DNA methylation subtype, PAM50 and microRNA subtypes, proliferation scores, gene expression and/or RPPA subtype. Marked nuclear pleomorphism, necrosis, inflammation and high mitotic count were associated with Basal-like subtype and have similar molecular basis. Omics-based signatures were constructed to predict morphological features. The association of morphology transcriptome signatures with overall survival in oestrogen receptor (ER)-positive and ER-negative breast cancer was first assessed using the METABRIC dataset; signatures that remained prognostic in the METABRIC multivariate analysis were further evaluated in five additional datasets. The transcriptomic signature of epithelial tubule formation was prognostic in ER-positive breast cancer. No signature was prognostic in ER-negative. This study provided new insights into the molecular basis of breast cancer morphological phenotypes. The integration of morphological with molecular data has potential to refine breast cancer classification, predict response to therapy, enhance our understanding of breast cancer biology and improve clinical management. This work is publicly accessible at www.dx.ai/tcga_breast

Genome Sequencing of SHH Medulloblastoma Predicts Genotype-Related Response to Smoothened Inhibition

SummarySmoothened (SMO) inhibitors recently entered clinical trials for sonic-hedgehog-driven medulloblastoma (SHH-MB). Clinical response is highly variable. To understand the mechanism(s) of primary resistance and identify pathways cooperating with aberrant SHH signaling, we sequenced and profiled a large cohort of SHH-MBs (n = 133). SHH pathway mutations involved PTCH1 (across all age groups), SUFU (infants, including germline), and SMO (adults). Children >3 years old harbored an excess of downstream MYCN and GLI2 amplifications and frequent TP53 mutations, often in the germline, all of which were rare in infants and adults. Functional assays in different SHH-MB xenograft models demonstrated that SHH-MBs harboring a PTCH1 mutation were responsive to SMO inhibition, whereas tumors harboring an SUFU mutation or MYCN amplification were primarily resistant

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Maria Cosway’s Hours: Cosmopolitan and Classical Visual Culture in Thomas Macklin’s Poets Gallery

Thomas Macklin’s Gallery of Poets opened at the Mitre Tavern in Fleet Street in 1788 with the aim to ‘display British Genius’ through ‘Prints Illustrative of the Most Celebrated British Poets’. Early newspaper coverage promised ‘a monument of the powers of the pencil in England, as the Vatican is at Rome’. The incongruous juxtaposition between Fleet Street and the Vatican spells out the cosmopolitan ambition of the literary gallery phenomenon through its real and imagined geographies of display. Through the format of the paper gallery of prints, Macklin’s Poets offered the inventions of British Poets as a repository of painting. This chapter examines how the cosmopolitan idiom of the paper gallery is negotiated in the first number of Macklin’s Poets. This essay examines the extent to which this ambition was achieved in the first Number of Macklin’s Poets which carried an engraving of Maria Cosway’s The Hours, originally a painting with an impressively European iconographic heritage. The painting was first exhibited at the Royal Academy in 1783, and was retroactively associated by Macklin with Thomas Gray’s ‘Ode on the Spring’. The trope of the Hours brought with it a weighty provenance derived from classical marble bas-relief, through the antiquarian pages of Pietro Santi Bartoli and Bernard de Montfaucon to Flaxman’s designs for Wedgwood plaques and vases. Cosway’s name also imported into Gray’s poem her reputation as a cosmopolitan, cultured woman who had completed the Grand Tour and who moved in elite circles including those of the Prince of Wales in London and the Duke of Orleans, Pierre d’Hancarville and Thomas Jefferson in Paris. The iconographies of the painting, the print, and the poem articulate a European cosmopolitan tradition for British Art