Social security in the United States

Thesis (M.B.A.)--Boston University, 1944. This item was digitized by the Internet Archive

Mossy fiber input to CA3 interneurons: Balancing short term plasticity and regulation by presynaptic receptors.

The hippocampus is a brain structure thought to be critically important for the formation and maintenance of memories. In order do this, the region must process information as both a linear sequence and as discrete events or objects such that representations can be recalled even when the stimulus is incomplete. This is thought to be accomplished in the hippocampus through several streams of serial and parallel processing kept separate and intact by inhibition. These streams of processing take the anatomical form of the three major glutamatergic pathways of the hippocampus: the perforant path, the mossy fibers and the Schaffer collaterals. Inhibition is provided by specialized groups of GABAergic interneurons. Though the hippocampus has been the subject of intense study for decades, there remain populations of cells that are not well understood in terms of their role in the network. Within area CA3, one of these populations is a group of interneurons with soma residing in the str. lacunosum moleculare that provide feedforward inhibition onto CA3 pyramidal cells. The goal of this thesis was to understand the synaptic physiology of mossy fiber (MF) input to str. lacunosum moleculare interneurons (L-Mi), a connection that has been largely overlooked due to skepticism that an interneuron population ~ 250 µm away could be interacting with the MF pathway. The data presented here describe the functional anatomy of the connection, and define the short term synaptic physiology of MF input to L-Mi including an estimate of the quantal amplitude. I have also documented the modulation of this connection by a presynaptic metabotropic glutamate receptor not previously thought to have a role in MF physiology, thus expanding the known repertoire of MF target specificity. Most importantly, however, these data provide a mechanism through which feedforward inhibition onto CA3 pyramidal cells is regulated in the short term, under physiologic stimulus patterns, and contribute to our knowledge of the function of the CA3 network

Hydrogen Bonding in Platinum Indolylphosphine Polyfluorido and Fluorido Complexes

The reaction of the Pt complexes cis-[Pt(CH3)(Ar){Ph2P(Ind)}2] (Ind=2-(3-methyl)indolyl, Ar=4-tBuC6H4 (1 a), 4-CH3C6H4 (1 b), Ph (1 c), 4-FC6H4 (1 d), 4-ClC6H4 (1 e), 4-CF3C6H4 (1 f)) with HF afforded the polyfluorido complexes trans-[Pt(F(HF)2)(Ar){Ph2P(Ind)}2] 2 a–f, which can be converted into the fluoride derivatives trans-[Pt(F)(Ar){Ph2P(Ind)}2] (3 a–f) by treatment with CsF. The compounds 2 a–f and 3 a–f were characterised thoroughly by multinuclear NMR spectroscopy. The data reveal hydrogen bonding of the fluorido ligand with HF molecules and the indolylphosphine ligand. Polyfluorido complexes 2 a–f show larger |1J(F,Pt)|, but lower 1J(H,F) coupling constants when compared to the fluorido complexes 3 a–f. Decreasing 1J(P,Pt) coupling constants in 2 a–f and 3 a–f suggest a cis influence of the aryl ligands in the following order: 4-tBuC6H4 (a) ≈4-CH3C6H4 (b)<Ph (c)≪4-FC6H4 (d)<4-ClC6H4 (e)<4-CF3C6H4 (f). In addition, the larger cis influence of aryl ligands bearing electron-withdrawing groups in the para position correlates with decreasing magnitudes of |1J(F,Pt)| coupling constants. The interpretation of the experimental data was supported by quantum-chemical DFT calculations.Deutsche Forschungsgemeinschaft http://dx.doi.org/10.13039/501100001659Peer Reviewe

Development And Usability Testing Of A PHR For Down’s Syndrome (DS) Care Coordination

Development and Usability Testing of a PHR for Down’s Syndrome (DS) Care Coordination Jeffrey Duah1, UROP Fellow, Dept. of Computer Science, with Dr. Elizabeth Baker1, Dept. of Information Systems, Dr. Bethany Cosgrove2, School of Nursing, and ISOSCELES Lab1 1Virginia Commonwealth University 2UNC Chapel Hill Parents of children with Down’s Syndrome typically have many health professionals they have to meet with which leads to the need to efficiently document the development of the child. With this, information management becomes a problem for a number of families. Dr. Bethany Cosgrove drafted 321Connect with the purpose of addressing this problem and allowing for smoother coordination of care. This study aims to, 1) create a mHealth application (321 Connect) for documenting the development of children with Down’s Syndrome and 2) conduct usability testing with the general mobile device users on said app. Development for 321Connect (Android) began on February 2021. It was created with an XML front-end, Java for the logic and functionality, and a SQLite database. Usability testing was done via survey through QuestionPro. Users were asked to follow a script and use the app and then fill out a 10-question survey about the usability of the app. Initial results were favorable with the usability score of 78.8 with just 20 participants. Testing is still ongoing and is expected to increase the score. The primary results showed that users agreed that the app was easy to navigate and the systems were well implemented. Users also saw the importance of the app to the Down’s Syndrome community and believed it would greatly benefit them. This is important as this app will be something that caretakers will interact with daily. Ease of use and well-integrated systems are of upmost importance for the success of the app. Dr. Cosgrove’s testing with actual families proved fruitful as they praised the app for its helpfulness and ease of use. With feedback from testing, changes will be made to the prototype in order to provide the families with the best experience possible.https://scholarscompass.vcu.edu/uresposters/1415/thumbnail.jp

Development and Usability Testing of a PHR for Down’s Syndrome (DS) Care Coordination

321Connect was first drafted by Dr. Bethany Cosgrove to support caregivers of children with Down’s Syndrome in coordinating care. These children often require multiple appointments with various healthcare professionals throughout the course of their life. Caregivers expressed a need for accurate and up-to-date information, providing evidence of the potential benefit of an mHealth application. A mobile health application with a PHR (personal health record) for the child would aid in keeping track of this information. However, there is no existing solution on the market that met this need, prompting the creation of 321Connect. 321Connect aims to provide information and support for families and caregivers of children with Down’s Syndrome, allowing them to focus on what truly matters: their child.https://scholarscompass.vcu.edu/uresposters/1428/thumbnail.jp

Significant regional differences in antibiotic use across 576 US hospitals and 11 701 326 adult admissions, 2016-2017

BACKGROUND: Quantifying the amount and diversity of antibiotic use in United States hospitals assists antibiotic stewardship efforts but is hampered by limited national surveillance. Our study aimed to address this knowledge gap by examining adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016-2017. METHODS: We conducted a retrospective study of patients aged ≥ 18 years discharged from hospitals in the Premier Healthcare Database between 1 January 2016 and 31 December 2017. Using daily antibiotic charge data, we mapped antibiotics to mutually exclusive classes and to spectrum of activity categories. We evaluated relationships between facility and case-mix characteristics and antibiotic use in negative binomial regression models. RESULTS: The study included 11 701 326 admissions, totaling 64 064 632 patient-days, across 576 hospitals. Overall, patients received antibiotics in 65% of hospitalizations, at a crude rate of 870 days of therapy (DOT) per 1000 patient-days. By class, use was highest among β-lactam/β-lactamase inhibitor combinations, third- and fourth-generation cephalosporins, and glycopeptides. Teaching hospitals averaged lower rates of total antibiotic use than nonteaching hospitals (834 vs 957 DOT per 1000 patient-days; P \u3c .001). In adjusted models, teaching hospitals remained associated with lower use of third- and fourth-generation cephalosporins and antipseudomonal agents (adjusted incidence rate ratio [95% confidence interval], 0.92 [.86-.97] and 0.91 [.85-.98], respectively). Significant regional differences in total and class-specific antibiotic use also persisted in adjusted models. CONCLUSIONS: Adult inpatient antibiotic use remains high, driven predominantly by broad-spectrum agents. Better understanding reasons for interhospital usage differences, including by region and teaching status, may inform efforts to reduce inappropriate antibiotic prescribing

Electronically available patient claims data improve models for comparing antibiotic use across hospitals: Results from 576 US facilities

BACKGROUND: The Centers for Disease Control and Prevention (CDC) uses standardized antimicrobial administration ratios (SAARs)-that is, observed-to-predicted ratios-to compare antibiotic use across facilities. CDC models adjust for facility characteristics when predicting antibiotic use but do not include patient diagnoses and comorbidities that may also affect utilization. This study aimed to identify comorbidities causally related to appropriate antibiotic use and to compare models that include these comorbidities and other patient-level claims variables to a facility model for risk-adjusting inpatient antibiotic utilization. METHODS: The study included adults discharged from Premier Database hospitals in 2016-2017. For each admission, we extracted facility, claims, and antibiotic data. We evaluated 7 models to predict an admission\u27s antibiotic days of therapy (DOTs): a CDC facility model, models that added patient clinical constructs in varying layers of complexity, and an external validation of a published patient-variable model. We calculated hospital-specific SAARs to quantify effects on hospital rankings. Separately, we used Delphi Consensus methodology to identify Elixhauser comorbidities associated with appropriate antibiotic use. RESULTS: The study included 11 701 326 admissions across 576 hospitals. Compared to a CDC-facility model, a model that added Delphi-selected comorbidities and a bacterial infection indicator was more accurate for all antibiotic outcomes. For total antibiotic use, it was 24% more accurate (respective mean absolute errors: 3.11 vs 2.35 DOTs), resulting in 31-33% more hospitals moving into bottom or top usage quartiles postadjustment. CONCLUSIONS: Adding electronically available patient claims data to facility models consistently improved antibiotic utilization predictions and yielded substantial movement in hospitals\u27 utilization rankings

The Impact of Climate Change on Virginia\u27s Coastal Areas

As part of HJ47/SJ47 (2020), the Virginia General Assembly directed the Joint Commission on Technology and Science (JCOTS) to study the “safety, quality of life, and economic consequences of weather and climate-related events on coastal areas in Virginia.” In pursuit of this goal, the commission was to “accept any scientific and technical assistance provided by the nonpartisan, volunteer Virginia Academy of Science, Engineering, and Medicine (VASEM). VASEM convened an expert study board with representation from the Office of the Governor, planning district commissions in coastal Virginia, The Port of Virginia, the Virginia Economic Development Partnership, state universities, private industry, and law firms. In producing the report, the board followed methods similar to those used by the National Academies of Science, Engineering, and Medicine by convening an expert committee tasked with studying and reporting on the topic. As a result, the report represents the views and perspectives of the study board members but was not submitted for public review or comment. This report is the product of those efforts. It finds that climate change will have an increasingly disruptive effect on people living in Virginia’s coastal areas during the 21st century — and that these disruptions will have repercussions across the Commonwealth. It includes an explanation of the physical forces driving climate change, an analysis of the current and projected effects of climate change on the Commonwealth, perspectives that legislators might consider as they face these challenges, and recommendations that could help Virginia implement more productive and effective strategies to address them

Interaction of a dengue virus NS1-derived peptide with the inhibitory receptor KIR3DL1 on natural killer cells

Killer immunoglobulin-like receptors (KIRs) interact with human leucocyte antigen (HLA) class I ligands and play a key role in the regulation and activation of NK cells. The functional importance of KIR-HLA interactions has been demonstrated for a number of chronic viral infections, but to date only a few studies have been performed in the context of acute self-limited viral infections. During our investigation of CD8(+) T cell responses to a conserved HLA-B57-restricted epitope derived from dengue virus (DENV) non-structural protein-1 (NS1), we observed substantial binding of the tetrameric complex to non-T/non-B lymphocytes in peripheral blood mononuclear cells (PBMC) from a long-standing clinical cohort in Thailand. We confirmed binding of the NS1 tetramer to CD56(dim) NK cells, which are known to express KIRs. Using depletion studies and KIR-transfected cell lines, we demonstrated further that the NS1 tetramer bound the inhibitory receptor KIR3DL1. Phenotypical analysis of PBMC from HLA-B57(+) subjects with acute DENV infection revealed marked activation of NS1 tetramer-binding natural killer (NK) cells around the time of defervescence in subjects with severe dengue disease. Collectively, our findings indicate that subsets of NK cells are activated relatively late in the course of acute DENV illness and reveal a possible role for specific KIR-HLA interactions in the modulation of disease outcomes