Summary of Dissertation Recitals

The first recital was a combination of four performances with the University of Michigan Symphony Band and Concert Band and one lecture presented to a graduate conducting seminar. Reflections on a Sixteenth-Century Tune by Richard Rodney Bennett was performed in Stamps Auditorium on November 2, 2011 with the Symphony Band Chamber Winds. Aria della battaglia by Andrea Gabrieli, arranged by Mark Scatterday, was performed on December 5, 2011 in Hill Auditorium with the Symphony Band. Carnevale: Eight Miniature Classics Introduced by Stravinsky in Pulcinella by Thomas Stone was performed on February 8, 2012 in Hill Auditorium by the Concert Band in. Konzertmusik, op. 41 by Paul Hindemith was performed on March 8, 2012 in Hill Auditorium by the Symphony Band. A lecture reviewing the repertoire from this recital was presented on September 20, 2012. The second recital was a combination of two performances with the Symphony Band and Concert Band and a lecture recital presented in Stamps Auditorium. Masquerade, op. 102 by Vincent Persichetti was performed with the Concert Band in Hill Auditorium on October 8, 2012. Sea-Blue Circuitry by Mason Bates was performed with the Symphony Band in Hill Auditorium on October 26, 2012. Two suites based on music from the eighteenth-century opera Una Cosa Rara by Vincente Martín y Soler were performed as part of a lecture recital on November 7, 2012 in Stamps Auditorium. The first of these suites was Johann Nepomuk Wendt’s transcription of the opera for harmonie ensemble. The second was comprised of music from Divertimenti nos. 1–6 based on themes from Una Cosa Rara by Martín y Soler. A lecture discussing each work preceded the performance. The third recital was performed on January 21, 2013 in the McIntosh Theatre with ad hoc ensembles of students from the School of Music, Theatre, and Dance. The following repertoire was performed: Musick for the Royal Fireworks by Georg Friedrich Handel, “Lied der Waldtaube,” from Gurre- Lieder by Arnold Schoenberg, and Suite in B-flat, op. 4, by Richard Strauss. A lecture discussing each work preceded the performance.AMUMusic: ConductingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/147620/1/ptcornet_1.pd

Factors of the Geriatric Depression Scale that may Distinguish between Four Cognitive Diagnostic Groups: Normal, Mild Cognitive Impairment, Dementia of the Alzheimer's Type, and Vascular Dementia

The purpose of the current study was to explore the relationship between cognitive status and depression in a sample of geriatric patients. Participants included 282 geriatric patients ranging in age from 65 to 96 years who were classified according to diagnosis as: DAT, VaD, MCI, and Norm. All were referred for neurocognitive testing from the Geriatric Assessment Program (GAP) at the University of North Texas Health Science Center (UNTHSC) in Fort Worth, Texas. This study sought to identify factor structures for two versions of the GDS using a geriatric sample of cognitively impaired and intact patients. It then compared these factors to each other to determine whether the GDS-15 is truly a shorter version of the GDS-30. These were then compared to a previously determined factor structure. This study explored whether the four-factors of the GDS-30 are able to differentiate cognitive diagnostic groups. Further, this study sought to identify whether the severity of cognitive decline impacted GDS factor score for each of the cognitively impaired groups. Results revealed a two-factor model of the GDS - 15 and a four-factor model with the GDS - 30. The GDS-15 factors did not differ from the first two factors of the GDS-30. Comparison between the GDS-30 factor structure and that reported by Hall and Davis (in press) revealed no significant differences despite the inclusion of a normal, non-demented group in the current study. Comparisons of subscale scores revealed that DAT patients tended to score lower than the other groups on all but the cognitive impairment subscale. Severity level analyses indicated that as severity of deficits increases, awareness of deficits decreases. This study found that although the GDS-30 is a good screening tool for depression in geriatric patients, it is not particularly useful in differentiating cognitive status group. Also, the GDS-15 was not found to be a good substitute for the GDS-30

Risk Factors for Vascular Dementia

Dementia is a devastating disorder that commonly affects people over the age of 65. Alzheimer's disease and vascular dementia are the most common forms of dementias. A number of studies have implicated cardiovascular risks as important factors in the development of dementia. These risks include high-risk behaviors such as smoking and risks related at least partially to health behaviors such as diet and exercise. This study examines a group of cardiovascular risk factors, as defined by the Framingham study, to ascertain if they are predictors of dementia. A retrospective chart review of 481consecutive patients seen in a geriatric medicine clinic produced a sample of 177 individuals diagnosed with dementia and 304 individuals without a dementia diagnosis. Relative risk ratio (RRR) results indicate that a history of hypertension (RRR= 1.80, p = .009) and a history of hypercholesterolemia (RRR = 1.85, p = .016) are significant predictors of Alzheimer's disease. A history of tobacco use (RRR = 2.18, p = .01) is a significant predictor of vascular dementia. Stepwise regression analyses indicate that hypercholesterolemia is an independent predictor of dementia (b = -.113, p = .009) and hypercholesterolemia (b = -.104, p = .018) and hypertension (b = -.094, p = .031) clustered together have an additive risk factor effect. These results are discussed in terms of the importance of specific health behaviors in the development and possible prevention of dementia

Counting on Collaboration: A Triangular Approach in the Educator Preparation Program for Teachers of Mathematics

This paper outlines the process of establishing a stronger and more reciprocal partnership for collaboration between an education preparation program and a local education agency. The essential partners identified included the College of Natural Sciences and Mathematics and the College of Education at Lee University and stakeholders in the local school district. First, this paper will discuss a theoretical framework that speaks to the importance of dialogue and a dialogic approach to teaching mathematics. Secondly, the processes and methods of the project involving collaboration through partnerships are described. These partnerships gave rise to the realization that coursework would be more effective if it mirrored the instructional practices of local education agencies. A detailed description of the process of changes to the coursework and initial outcomes of the project are outlined. Included are questions and recommendations for further collaboration

Beyond the Medical Record

Studies before and since the 1999 Institute of Medicine report have noted the limitations of using medical record reporting for reliably quantifying and understanding medical error. Quantitative macro analyses of large datasets should be supplemented by small-scale qualitative studies to provide insight into micro-level daily events in clinical and hospital practice that contribute to errors and adverse events and how they are reported. Design : The study design involved semistructured face-to-face interviews with residents about the medical errors in which they recently had been involved and included questions regarding how those errors were acknowledged. Objective : This paper reports the ways in which medical error is or is not reported and residents' responses to a perceived medical error. Participants : Twenty-six residents were randomly sampled from a total population of 85 residents working in a 600-bed teaching hospital. Measurements : Outcome measures were based on analysis of cases residents described. Using Ethnograph and traditional methods of content analysis, cases were categorized as Documented, Discussed, and Uncertain. Results : Of 73 cases, 30 (41.1%) were formally acknowledged and Documented in the medical record; 24 (32.9%) were addressed through Discussions but not documented; 19 cases (26%) cases were classified as Uncertain. Twelve cases involved medication errors, which were acknowledged in different categories. Conclusions : The supervisory discussion, the informal discussion, and near-miss contain important information for improving clinical care. Our study also shows the need to improve residents' education to prepare them to recognize and address medical errors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72013/1/j.1525-1497.2005.0098.x.pd

A 2-step approach to myeloablative haploidentical stem cell transplantation: a phase 1/2 trial performed with optimized T-cell dosing.

Studies of haploidentical hematopoietic stem cell transplantation (HSCT) have identified threshold doses of T cells below which severe GVHD is usually absent. However, little is known regarding optimal T-cell dosing as it relates to engraftment, immune reconstitution, and relapse. To begin to address this question, we developed a 2-step myeloablative approach to haploidentical HSCT in which 27 patients conditioned with total body irradiation (TBI) were given a fixed dose of donor T cells (HSCT step 1), followed by cyclophosphamide (CY) for T-cell tolerization. A CD34-selected HSC product (HSCT step 2) was infused after CY. A dose of 2 × 10(8)/kg of T cells resulted in consistent engraftment, immune reconstitution, and acceptable rates of GVHD. Cumulative incidences of grade III-IV GVHD, nonrelapse mortality (NRM), and relapse-related mortality were 7.4%, 22.2%, and 29.6%, respectively. With a follow-up of 28-56 months, the 3-year probability of overall survival for the whole cohort is 48% and 75% in patients without disease at HSCT. In the context of CY tolerization, a high, fixed dose of haploidentical T cells was associated with encouraging outcomes, especially in good-risk patients, and can serve as the basis for further exploration and optimization of this 2-step approach. This study is registered at www.clinicaltrials.gov as NCT00429143

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

The Parted Eye: Tragicomic Perception In Shakespeare's Last Plays.

PhDBritish & Irish literatureBritish and Irish literatureUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/180605/2/7529199.pd