Shoulder Arthroplasty in Patients with Inflammatory Arthritis: Preoperative and Perioperative Management of Disease Modifying Anti-Rheumatic Drug Therapy

Introduction Inflammatory arthritis is a debilitating systemic autoimmune and inflammatory disease that leads to joint damage, resulting in significant pain and disability. Rheumatoid arthritis (RA) is the most common inflammatory arthritis typically associated with advanced arthritic changes of the glenohumeral joint as well as with rotator cuff tears.20 Since the introduction of disease modifying anti-rheumatic drug (DMARD) therapy, patients diagnosed with inflammatory rheumatic diseases have observed improvements in pain management and functional outcomes, alongside a reduction in the occurrence of upper limb arthroplasties.16 Nonetheless, total joint arthroplasty still remains common in the treatment of RA.8,14 One recognized challenge in shoulder arthroplasty in the context of inflammatory arthritis is the perioperative management of anti-inflammatory medications. Approximately 75-84% of patients undergoing arthroplasty take traditional DMARDs or biologics.14 Management of these medications currently varies across rheumatology organizations. For instance, the American College of Rheumatology recommends withholding tumor necrosis factor (TNF)-α inhibitors for more than a week prior to surgery, British Society recommends withholding for 3-5 times the half-life of the drug, and Canadian Rheumatology Association propose withholding for 2 half-lives of the drug.14,22,31 Understanding the appropriate timing for discontinuing or continuing these medications is a critical element of perioperative management in shoulder arthroplasty, as it involves balancing the potential risks of post-operative disease flares with concerns for poor wound healing and infection

Inappropriate electrolyte repletion for patients undergoing endoscopic procedures

At Thomas Jefferson University Hospital (TJUH), there has been a perceived necessity among housestaff and fellows to routinely check and replete serum potassium and magnesium for inpatients prior to endoscopic procedures In addition, there was an unwritten policy that these electrolytes needed to be aggressively repleted, with a goal potassium above 4.0 and magnesium above 2.0 Contributing factors include absence of clear policy, fear of adverse outcomes during procedures, and fear of delay of procedures leading to increased hospital stay This practice has led to unwarranted lab draws, costs of lab tests and electrolyte riders, and possible delayed procedures Goals Clarify policies regarding electrolyte repletion Determine frequency of inappropriate electrolyte checking and repletion Determine monetary cost of this action Decrease frequency of inappropriate electrolyte lab check and repletionhttps://jdc.jefferson.edu/patientsafetyposters/1023/thumbnail.jp

Counting homomorphisms onto finite solvable groups

We present a method for computing the number of epimorphisms from a finitely-presented group G to a finite solvable group \Gamma, which generalizes a formula of G\"aschutz. Key to this approach are the degree 1 and 2 cohomology groups of G, with certain twisted coefficients. As an application, we count low-index subgroups of G. We also investigate the finite solvable quotients of the Baumslag-Solitar groups, the Baumslag parafree groups, and the Artin braid groups.Comment: 30 pages; accepted for publication in the Journal of Algebr

MICROBIAL GENOME MINING IN UNDERSTANDING HUMAN BACTERIAL PATHOGENESIS AND CYANOBACTERIAL NATURAL PRODUCTS BIOSYNTHESIS

Recent accessibility of microbial genome sequencing data has enabled broad investigations into the nature of microbial physiology and their consequences on humans and their environment. Through an approach known as genome mining, an in silico technique that enables the identification of uncharacterized gene clusters based on sequence homology, the investigations described herein provide new insight into two important groups of microbes, namely human bacterial pathogens and cyanobacteria. In Part I of this dissertation, genome mining techniques have identified two evolutionarily-conserved cryptic biosynthetic operons in the human pathogens Acinetobacter baumannii and Pseudomonas aeruginosa. Interestingly, the findings demonstrate the significance of these gene clusters and their small molecule products to be important contributors to the pathogenesis of these organisms. As a result, the proteins encoded by these gene clusters are expected to be important targets in the development of next-generation antibiotics. In Part II, a novel platform for the investigation of natural products biosynthesis from cyanobacteria is described. Cyanobacteria have proven to be important yet relatively unexplored sources of bioactive compounds. Recent genome sequencing has indicated the substantial potential of these microbes to synthesize compounds that can be developed into new medicines. The collective findings in this dissertation demonstrate the considerable utility of emerging microbial genome sequencing information and its future impact on human health and disease

Political Rumor Communication on Instant Messaging Platforms:Relationships With Political Participation and Knowledge

Modern communication technologies have vastly increased the reach and influence of political rumors, with negative consequences for democratic political systems globally. Rumor communication can be theorized as a form of political talk that helps citizens grapple with the uncertainty inherent in politics, form opinions, and build solidarity with others. The present study examines how one type of communication technology—instant messaging platforms—might facilitate forms of rumor communication that can influence participation in and knowledge about politics. Using original panel survey data from the 2017 South Korean election, we find that rumor communication on the popular instant messaging platform KakaoTalk predicts increased campaign participation, but not campaign knowledge. Further, political rumor communication on instant messaging platforms appears to exacerbate participatory inequality between those with weak and those with strong political interest and ideology

Political Rumor Communication on Instant Messaging Platforms:Relationships With Political Participation and Knowledge

Modern communication technologies have vastly increased the reach and influence of political rumors, with negative consequences for democratic political systems globally. Rumor communication can be theorized as a form of political talk that helps citizens grapple with the uncertainty inherent in politics, form opinions, and build solidarity with others. The present study examines how one type of communication technology—instant messaging platforms—might facilitate forms of rumor communication that can influence participation in and knowledge about politics. Using original panel survey data from the 2017 South Korean election, we find that rumor communication on the popular instant messaging platform KakaoTalk predicts increased campaign participation, but not campaign knowledge. Further, political rumor communication on instant messaging platforms appears to exacerbate participatory inequality between those with weak and those with strong political interest and ideology

Dopamine overdose hypothesis: Evidence and clinical implications

About a half a century has passed since dopamine was identified as a neurotransmitter, and it has been several decades since it was established that people with Parkinson's disease receive motor symptom relief from oral levodopa. Despite the evidence that levodopa can reduce motor symptoms, there has been a developing body of literature that dopaminergic therapy can improve cognitive functions in some patients but make them worse in others. Over the past two decades, several laboratories have shown that dopaminergic medications can impair the action of intact neural structures and impair the behaviors associated with these structures. In this review, we consider the evidence that has accumulated in the areas of reversal learning, motor sequence learning, and other cognitive tasks. The purported inverted‐U shaped relationship between dopamine levels and performance is complex and includes many contributory factors. The regional striatal topography of nigrostriatal denervation is a critical factor, as supported by multimodal neuroimaging studies. A patient's individual genotype will determine the relative baseline position on this inverted‐U curve. Dopaminergic pharmacotherapy and individual gene polymorphisms can affect the mesolimbic and prefrontal cortical dopaminergic functions in a comparable, inverted‐U dose‐response relationship. Depending on these factors, a patient can respond positively or negatively to levodopa when performing reversal learning and motor sequence learning tasks. These tasks may continue to be relevant as our society moves to increased technological demands of a digital world that requires newly learned motor sequences and adaptive behaviors to manage daily life activities. © 2013 International Parkinson and Movement Disorder SocietyPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102168/1/mds25687.pd