The Social Contract: Duty and Discrimination in Public Service

What do citizens owe the government? And conversely, what does the government owe its people, particularly those who volunteer for military or public service? The works in this portfolio attempt to answer these questions and delve into the social contract between the American government and its citizens, often through the lens of sexual orientation. Using original correspondence from the Center for War Letters at Chapman University as well as existing works concerning Don’t Ask, Don’t Tell and the Lavender Scare, the collected essays aim to tell the story of everyday Americans who answered the call to public service only to find indifferent or even hostile treatment by government they sought to serve. Through poor planning or discrimination, the U.S. government routinely violated its oath to its people at key points throughout the nation’s history, but this portfolio demonstrates how dedicated citizens strove to update and improve the social contract in order to produce the more perfect union promised in the nation’s constitution

Dance Your Way to Communication: Dance Movement Therapy to Increase Self-Esteem, Poor Body Image, and Communication Skills in High School Females

A study with the use of dance movement therapy as a counseling approach in a suburban high school setting was presented. The objective of this study was to determine if Dance Movement Therapy (DMT) with females struggling with relational issues with their paternal figure contributed to improved self esteem, body image, and communication skills. The literature review describes dance movement therapy, aspects of self-esteem, body image, dance movement therapy used with specific populations, fundamentals of group work, and movement therapy techniques used with adolescents. Methods of the study were presented with the use of eight movement therapy interventions. The instrument and participants were also described. The results were evaluated qualitatively and quantitatively through pre and post test results and observations. Results indicated that DMT was an effective therapeutic technique in a school setting. The discussion also describes areas for additional research and implications for future research

Effects of Radio-Transmitters on Body Condition, Harvest Rate, and Survival of Bobwhites

Numerous studies of northern bobwhite (Colinus virginianus) population and habitat ecology employ use of radio-telemetry techniques to relocate and monitor individuals. Radio-telemetry enables estimation of reproductive success, survival, movements, and home range at levels of resolution not otherwise possible. Unbiased estimation of these parameters via radio-telemetry assumes that survival, reproduction, and behavior of radio-marked individuals are not affected by carrying the radio-transmitter. These assumptions have not been rigorously tested for bobwhites. In 1993, we initiated a study at Divide Section Wildlife Management Area in Mississippi and at Tall Timbers Research Station to test the effects of radio-transmitters on survival, harvest rate, and body condition of bobwhites. From 1993 to 1996 we banded 221 and radio-marked 259 bobwhites on Tall Timbers Research Station. Harvest rate for radio-marked bobwhites was 18.5% and banded birds 12.7%. In 2 of 3 years, radio-marked birds experienced greater mean weight loss between capture and harvest than banded birds. From 1994 to 1995 we radio marked 188 and banded 210 birds on Divide Section Wildlife Management Area. Harvest rate for radio-marked birds was 40% and banded birds 30%. In the 1995-1996 hunting season radiomarked birds had lower mean weight gain from capture to harvest than banded birds. Based on our sample of marked birds, 34% of the fall population on this area was harvested. We have established a captive breeding colony of wild bobwhites at the Blackjack Captive Animal Research Facility at Mississippi State University. During the summer of 1996, genetically wild progeny are being produced to be used in a pen study to evaluate the effects of radio-transmitters on bobwhite body weight and lipid levels under abundant and scarce food resources. This study will provide the first harvest rate estimates for bobwhites on a public hunting area in Mississippi. Additionally, this study will evaluate the effects of radio-transmitters on bobwhite body condition, survival, and harvest rate. It will either validate the assumption of no radio effects and aid interpretation of previous and future radio studies or elucidate critical violations of fundamental assumptions of this methodology. If radio effects are detected, this study will identify the specific mechanisms creating bias in estimation of population parameters. This information will enable researchers to target radio design problems and develop new radio technology with reduced effects. Preliminary results suggest that radio-marking may marginally increase bobwhite vulnerability to harvest and potentially predation

Optimization of the measurement sequence used for functional Fourier Decomposition Magnetic Resonance Imaging of the human lung at 1.5 Tesla

Fourier Decomposition (FD) magnetic resonance imaging is a non-invasive method for assessing ventilation and perfusion in the lungs. However, the technique struggles with a low signal to noise ratio (SNR). This work analyzed and optimized the standard balanced steady-state free precession (bSSFP) sequence used in the FD framework. The biggest drawbacks of the standard sequence were the long echo time compared to the short T2* of the lung parenchyma and the restriction of the utilized flip angles, due to specific absorption rate (SAR) limitations. To achieve the necessary improvements, advanced techniques were used, specifically, (utra-)fast bSSFP, two speed variablerate selective excitation (VERSE) pulses and variable flip angle (VFA) patterns. All steps of the optimization process were tested in both simulations and phantom measurements. The finished sequence was tested in two human studies, one featuring healthy volunteers and the other featuring patients with different types of lung cancer. In both studies the average SNR of the morphological images was increased by 47%, while the SNR of the functional images was increased by 53%. Furthermore, due to the higher SNR of the morphological images, both the effective resolution and the robustness of the functional images were increased. None of the employed techniques introduced any transient artifacts and possible blurring was minimized. Due to these improvements, this work reinforces both the position of FD MRI as a research tool and brings the technique closer towards a clinical application

Chirurgie als pluripotentes Instrument gegen eine metabolische Erkrankung

Die bariatrische/metabolische Chirurgie stellt derzeit die effektivste Therapie zur dauerhaften Gewichtsreduktion und Verbesserung der mit Adipositas assoziierten metabolischen Begleiterkrankungen wie Diabetes mellitus Typ 2, arterielle Hypertonie, Lipidstoffwechselstörungen und kardiovaskuläre Erkrankungen dar. Trotz kontinuierlich steigender Operationszahlen in Deutschland und weltweit sowie belegter Effektivität sind die genauen Wirkmechanismen der Operationsverfahren jedoch nicht vollständig geklärt. Einer der am häufigsten durchgeführten und am besten untersuchten Eingriffe ist der Roux-en-Y-Magenbypass (RYGB), dessen Wirksamkeit traditionell durch mechanische Nahrungsrestriktion und kalorische Malabsorption begründet wurde. Inzwischen hat sich allerdings gezeigt, dass die zugrunde liegenden Mechanismen weitaus komplexer sind und dass physiologische Prozesse wie beispielsweise veränderte Spiegel verschiedener gastrointestinaler Hormone, ein gesteigerter Energieumsatz und eine modifizierte Zusammensetzung des intestinalen Mikrobioms eine wichtigere Rolle spielen. Nachdem die Verbesserung der metabolischen Begleiterkrankungen lange Zeit als Folgeeffekt der Gewichtsreduktion nach RYGB interpretiert wurde, hat sich inzwischen gezeigt, dass dies zumindest teilweise gewichtsunabhängig zu sein scheint und direkt durch physiologische Veränderungen vermittelt wird. Dieser Artikel soll eine Übersicht zu den potenziellen und aktuell wichtigsten Wirkmechanismen der RYGB-Operation liefern, die sowohl an der Therapie des Übergewichts als auch der adipositasassoziierten metabolischen Begleiterkrankungen beteiligt sind

Chirurgie als pluripotentes Instrument gegen eine metabolische Erkrankung: Was sind die Mechanismen?

Zusammenfassung: Die bariatrische/metabolische Chirurgie stellt derzeit die effektivste Therapie zur dauerhaften Gewichtsreduktion und Verbesserung der mit Adipositas assoziierten metabolischen Begleiterkrankungen wie Diabetes mellitus Typ 2, arterielle Hypertonie, Lipidstoffwechselstörungen und kardiovaskuläre Erkrankungen dar. Trotz kontinuierlich steigender Operationszahlen in Deutschland und weltweit sowie belegter Effektivität sind die genauen Wirkmechanismen der Operationsverfahren jedoch nicht vollständig geklärt. Einer der am häufigsten durchgeführten und am besten untersuchten Eingriffe ist der Roux-en-Y-Magenbypass (RYGB), dessen Wirksamkeit traditionell durch mechanische Nahrungsrestriktion und kalorische Malabsorption begründet wurde. Inzwischen hat sich allerdings gezeigt, dass die zugrunde liegenden Mechanismen weitaus komplexer sind und dass physiologische Prozesse wie beispielsweise veränderte Spiegel verschiedener gastrointestinaler Hormone, ein gesteigerter Energieumsatz und eine modifizierte Zusammensetzung des intestinalen Mikrobioms eine wichtigere Rolle spielen. Nachdem die Verbesserung der metabolischen Begleiterkrankungen lange Zeit als Folgeeffekt der Gewichtsreduktion nach RYGB interpretiert wurde, hat sich inzwischen gezeigt, dass dies zumindest teilweise gewichtsunabhängig zu sein scheint und direkt durch physiologische Veränderungen vermittelt wird. Dieser Artikel soll eine Übersicht zu den potenziellen und aktuell wichtigsten Wirkmechanismen der RYGB-Operation liefern, die sowohl an der Therapie des Übergewichts als auch der adipositasassoziierten metabolischen Begleiterkrankungen beteiligt sind

The Prevalence and Impact of Obesity on the Outcomes of Patients Undergoing Transcatheter Mitral Valve Repair using MitraClip - A National Inpatient Sample Analysis 2016 to 2020.

Background: Low Body Mass Index (BMI) is associated with poor outcomes in patients who undergo various cardiac interventions. Studies on patients with elevated BMI have produced mixed results. Our study aims to evaluate the impact of obesity on the in-hospital outcomes of patients undergoing transcatheter mitral valve repair using MitraClip in the United States. Methods: The National Inpatient Sample (NIS) database (2016-2020) was analyzed to identify patients who underwent transcatheter mitral valve repair using MitraClip. Patients less than 18 years, with protein-energy malnutrition and rapid weight loss, were excluded. Our final study population was classified into Obese (BMI ≥ 30 Kg/m2) and Non-obese (Normal/Overweight) (BMI 0f 18.5 -29.9 Kg/m2) cohorts based on their Body Mass Index (BMI). The primary outcomes were the prevalence of obesity and in-hospital mortality. Secondary outcomes were the rate of periprocedural complications, including cardiogenic shock, cardiac arrest, myocardial infarction, and acute kidney injury. Result: 40,950 patients underwent transcatheter mitral valve repair (MitraClip) during our study period. 7.8% were identified as obese. Obese patients were more likely to be female (50.6% vs. 43.9%, p Conclusions: Our study suggests obesity does not influence short-term in-hospital outcomes in patients undergoing transcatheter mitral valve repair using MitraClip

Teprasiran, a Small Interfering RNA, for the Prevention of Acute Kidney Injury in High-Risk Patients Undergoing Cardiac Surgery

Background: Acute kidney injury (AKI) affects up to 30% of patients undergoing cardiac surgery, leading to increased in-hospital and long-term morbidity and mortality. Teprasiran is a novel small interfering RNA that temporarily inhibits p53-mediated cell death that underlies AKI. Methods: This prospective, multicenter, double-blind, randomized, controlled phase 2 trial evaluated the efficacy and safety of a single 10 mg/kg dose of teprasiran versus placebo (1:1), in reducing the incidence, severity, and duration of AKI after cardiac surgery in high-risk patients. The primary end point was the proportion of patients who developed AKI determined by serum creatinine by postoperative day 5. Other end points included AKI severity and duration using various prespecified criteria. To inform future clinical development, a composite end point of major adverse kidney events at day 90, including death, renal replacement therapy, and ≥25% reduction of estimated glomerular filtration rate was assessed. Both serum creatinine and serum cystatin-C were used for estimated glomerular filtration rate assessments. Results: A total of 360 patients were randomly assigned in 41 centers; 341 dosed patients were 73±7.5 years of age (mean±SD), 72% were men, and median European System for Cardiac Operative Risk Evaluation score was 2.6%. Demographics and surgical parameters were similar between groups. AKI incidence was 37% for teprasiran- versus 50% for placebo-treated patients, a 12.8% absolute risk reduction, P=0.02; odds ratio, 0.58 (95% CI, 0.37-0.92). AKI severity and duration were also improved with teprasiran: 2.5% of teprasiran- versus 6.7% of placebo-treated patients had grade 3 AKI; 7% teprasiran- versus 13% placebo-treated patients had AKI lasting for 5 days. No significant difference was observed for the major adverse kidney events at day 90 composite in the overall population. No safety issues were identified with teprasiran treatment. Conclusions: The incidence, severity, and duration of early AKI in high-risk patients undergoing cardiac surgery were significantly reduced after teprasiran administration. A phase 3 study with a major adverse kidney event at day 90 primary outcome that has recently completed enrollment was designed on the basis of these findings (NCT03510897)