The Effect of Radiated vs Non-Irradiated Blood Transfusions on Extracellular Potassium Levels in Infants Undergoing Craniosynostosis Repair

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Transfusion Associated Graft Versus Host Disease (TA-GVHD), a risk of blood transfusions, has a mortality rate > 90%. This results when viable donor T-lymphocytes within the transfused product proliferate and attack host tissue. The risk is reduced with irradiation of blood prior to transfusion. The downside to irradiating cellular blood products is that irradiation also affects other cellular components in the blood product causing the level of extracellular potassium to rise due to hemolysis of the red blood cells. The rapid infusion of high potassium blood products has been associated with fatal cardiac arrhythmias. This study evaluated the effect of irradiated versus non-irradiated blood transfusions on extracellular potassium levels if washing irradiated blood prior to transfusion results in less of a change in extracellular potassium.This item is part of the College of Medicine - Phoenix Scholarly Projects 2019 collection. For more information, contact the Phoenix Biomedical Campus Library at [email protected]

The Association Between Medication Adherence in Mental Illness and Substance Use Disorder Relapse in Patients with Dual Diagnosis

Objectives: The aims of the study were to (1) identify personal, social, and clinical history for patients with substance use disorder (SUD) and mental illness, (2) measure agreeance between patient self-report versus facility record history for mental illness, substance abuse, and psychotropic medication, (3) investigate the specific role of medication adherence and barriers to use for psychotropic medications upon SUD relapse, and (4) assess follow-up changes in mental illness severity and medication adherence in dual diagnosis patients enrolled in a substance abuse rehabilitation program. Methods: The pilot study utilized a mixed methodology. Inclusion criteria included male patients at least 18 years of age who were newly admitted at a 90-day residential rehabilitation program with a self-reported diagnosis of SUD, and either major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD) or schizophrenia. Patients were evaluated within their first week of treatment and follow-up interviews were conducted at 1 and 2 months. Facility records were accessed to cross-reference patient reported data, using Cohen’s kappa coefficient to determine agreement. Patient demographic characteristics, substance abuse characteristics, health-related characteristics, and attitude towards medications stratified by adherence rates and relapse rates utilizing ANOVA and t-tests. Pearson’s correlation coefficient was utilized to analyze the relationship between medication adherence and SUD relapse. A multivariable logistic regression model was created to assess the impact of adherence on relapse frequency. Patient and clinical characteristics were stratified according to follow-up interviews completed utilizing ANOVA and t-tests. Lastly, changes in patients’ self reported adherence from interview to interview were analyzed using mean difference. SPSS Statistics (IBM Corp; Armonk, NY) was utilized for all analyses, with a two-tailed level of significance at 0.05. Results: The final sample consisted of 38 patients. The majority of patients were white (n=27, 71.1%), unemployed (n=32, 84.2%), and homeless (n=30, 78.9%). Heroin was the most common primary drug of use (n=19, 50%), followed by alcohol (n=12, 31.6%), and crack cocaine (n=4, 10.5%). The average length of substance use was 20.3 years. Half of the patients (n=19, 50%) had two or more mental illness diagnoses and the most common was the combination of MDD and GAD (n=9, 23.7%), followed by MDD alone (n=7, 18.4%), and bipolar disorder (n=6, 15.8%). Significant agreeance was found between patient self-reported data to facility records for primary substance of use (κ=0.753, p Conclusions: The study provided valuable insight into the relationship between psychotropic medication adherence and SUD relapse in patients with dual diagnosis which can be used by healthcare professionals and drug abuse rehabilitation programs

Going Green – The Relationship Between Medical Marijuana Policy Implementation and Opioid Prescribing Patterns

Objectives The objectives of this dissertation are: 1) To measure the prevalence of medical marijuana use in the U.S. and to identify predictors of medical marijuana use; 2) To measure opioid prescribing patterns among Medicare beneficiaries within states following the implementation of medical marijuana policies and to compare opioid prescribing patterns among Medicare beneficiaries residing within these states compared to individuals within states without medical marijuana policies in place; and 3) To determine if racial disparities exist in the effect of medical marijuana policy implementation on opioid prescribing patterns among Medicare beneficiaries. Methods A retrospective secondary database analysis was conducted utilizing five years of the National Survey on Drug Use and Health (NSUDH). A multivariable logistic regression model assessed the association between prescription pain reliever use and medical marijuana in the adult U.S. population while adjusting for substance use factors, psychiatric factors, and demographic characteristics. A difference-in-difference fixed effects linear regression model assessed the impact of medical marijuana policy implementation on opioid prescribing rates among Medicare enrollees by comparing changes in prescribing levels in the year following a state-level medical marijuana policy implementation versus states with no medical marijuana laws and states with existing laws. Lastly, an additional difference-in-difference analysis was conducted, stratified by race, to determine racial disparities. Results Within the U.S. adult population from 2015 to 2019, medical marijuana use prevalence increased from 1.6% to 2.4%, while appropriate prescription pain reliever use decreased from 33.4% to 27.5%, and misuse decreased from 4.7% to 3.7%. Past-year medical marijuana users were significantly more likely to use prescription pain relievers appropriately (OR=1.99, p\u3c.001) and misuse (OR=1.94, p\u3c.001). Among Medicare enrollees in the year following a medical marijuana policy implementation, opioid prescribing levels per patient increased by 98.3 MME. However, the increase in opioid prescribing levels observed in the comparator states was significantly greater, with an increase of 198.2 MME per enrollee among non-medical marijuana policy states and an increase of 131.1 MME per enrollee among existing medical marijuana policy states. When stratified by race, the difference-in-difference regression model found no within-state racial disparities in changes in opioid prescribing levels between minorities and white individuals within implementation states, nor any between-state racial disparities compared to enrollees residing in non-medical marijuana states or existing medical marijuana states. Conclusions The study results show an increase in patients’ willingness to use medical marijuana to treat pain in place of prescription opioids, along with the need for policy expansions in states with no medical marijuana availability. Medical marijuana is a potential solution to combating increases in opioid prescribing rates but should be initiated with other long-term strategies. No racial disparities were found within states that implement a new medical marijuana policy, nor were there any racial disparities found when making comparisons between states with new medical marijuana policies versus states without medical marijuana laws and states with existing laws. However, government entities must move forward with medical marijuana policies with mindfulness regarding how previous marijuana policies negatively impacted the minority population

Estimation of body mass index from the metrics of the first metatarsal

Estimation of the biological profile from as many skeletal elements as possible is a necessity in both forensic and bioarchaeological contexts; this includes non-standard aspects of the biological profile, such as body mass index (BMI). BMI is a measure that allows for understanding of the composition of an individual and is traditionally divided into four groups: underweight, normal weight, overweight, and obese. BMI estimation incorporates both estimation of stature and body mass. The estimation of stature from skeletal elements is commonly included into the standard biological profile but the estimation of body mass needs to be further statistically validated to be consistently included. The bones of the foot, specifically the first metatarsal, may have the ability to estimate BMI given an allometric relationship to stature and the mechanical relationship to body mass. There are two commonly used methods for stature estimation, the anatomical method and the regression method. The anatomical method takes into account all of the skeletal elements that contribute to stature while the regression method relies on the allometric relationship between a skeletal element and living stature. A correlation between the metrics of the first metatarsal and living stature has been observed, and proposed as a method for valid stature estimation from the boney foot (Byers et al., 1989). Body mass estimation from skeletal elements relies on two theoretical frameworks: the morphometric and the mechanical approaches. The morphometric approach relies on the size relationship of the individual to body mass; the basic relationship between volume, density, and weight allows for body mass estimation. The body is thought of as a cylinder, and in order to understand the volume of this cylinder the diameter is needed. A commonly used proxy for this in the human body is skeletal bi-iliac breadth from rearticulated pelvic girdle. The mechanical method of body mass estimation relies on the ideas of biomechanical bone remodeling; the elements of the skeleton that are under higher forces, including weight, will remodel to minimize stress. A commonly used metric for the mechanical method of body mass estimation is the diameter of the head of the femur. The foot experiences nearly the entire weight force of the individual at any point in the gait cycle and is subject to the biomechanical remodeling that this force would induce. Therefore, the application of the mechanical framework for body mass estimation could stand true for the elements of the foot. The morphometric and mechanical approaches have been validated against one another on a large, geographically disparate population (Auerbach and Ruff, 2004), but have yet to be validated on a sample of known body mass. DeGroote and Humphrey (2011) test the ability of the first metatarsal to estimate femoral head diameter, body mass, and femoral length. The estimated femoral head diameter from the first metatarsal is used to estimate body mass via the morphometric approach and the femoral length is used to estimate living stature. The authors find that body mass and stature estimation methods from more commonly used skeletal elements compared well with the methods developed from the first metatarsal. This study examines 388 `White' individuals from the William M. Bass donated skeletal collection to test the reliability of the body mass estimates from femoral head diameter and bi-iliac breadth, stature from maximum femoral length, and body mass and stature from the metrics of the first metatarsal. This sample included individuals from all four of the BMI classes. This study finds that all of the skeletal indicators compare well with one another; there is no statistical difference in the stature estimates from the first metatarsal and the maximum length of the femur, and there is no statistical between all three of the body mass estimation methods. When compared to the forensic estimates of stature neither of the tested methods had statistical difference. Conversely, when the body mass estimates are compared to forensic body mass there was a statistical difference and when further investigated the most difference in the body mass estimates was in the extremes of body mass (the underweight and obese categories). These findings indicate that the estimation of stature from both the maximum femoral length and the metrics of the metatarsal are accurate methods. Furthermore, the estimation of body mass is accurate when the individual is in the middle range of the BMI spectrum while these methods for outlying individuals are inaccurate. These findings have implications for the application of stature and body mass estimation in the fields of bioarchaeology, forensic anthropology, and paleoanthropology

White certificates and white certificate trading schemes as greenhouse gas mitigation policy options for South Africa

A white certificate, which is also referred to as an Energy Saving Certificate (ESC), or an Energy Efficiency Credit (EEC), is an instrument awarded by an authorisation body to guarantee that a specific amount of energy savings has been achieved. Each certificate is a unique and traceable commodity carrying a property right over a certain amount of additional energy savings and certifying that the benefit of these savings has not been accounted for elsewhere (EuroWhiteCert Project, 2006)

Emissions trading as a policy option for greenhouse gas mitigation in South Africa

An emissions trading scheme (ETS) is based on the allocation of allowances to emit pollutants, which in the case of climate change are greenhouse gases. Allowances are allocated to a defined set of emitters, who are required to hold sufficient allowances to cover their emissions at the end of a compliance period, or face penalties. Scarcity is created in the scheme through the allocation of fewer allowances than emissions, resulting in emitters having to choose between reducing their emissions in line with their allowance allocations, or purchasing additional allowances to cover their excess emissions levels

Noise color and asymmetry in stochastic resonance with silicon nanomechanical resonators

Stochastic resonance with white noise has been well established as a potential signal amplification mechanism in nanomechanical two-state systems. While white noise represents the archetypal stimulus for stochastic resonance, typical operating environments for nanomechanical devices often contain different classes of noise, particularly colored noise with a 1/f spectrum. As a result, improved understanding of the effects of noise color will be helpful in maximizing device performance. Here we report measurements of stochastic resonance in a silicon nanomechanical resonator using 1/f noise and Ornstein-Uhlenbeck noise types. Power spectral densities and residence time distributions provide insight into asymmetry of the bistable amplitude states, and the data sets suggest that 1/f^alpha noise spectra with increasing noise color (i.e. alpha) may lead to increasing asymmetry in the system, reducing the achievable amplification. Furthermore, we explore the effects of correlation time tau on stochastic resonance with the use of exponentially correlated noise. We find monotonic suppression of the spectral amplification as the correlation time increases.Comment: 7 pages, 6 figures, To be published in Eur. Phys. J. B (2009). Related papers can be found at http://nano.bu.edu

Implicit Strategies within Environmental Context of Same-Sex Parents

Introduction: • LGBT populations are understudied • 2014: >170,000 children live in the US with a same-sex couple • Sexual orientation found to influence occupational selection and experience • Same-sex families vulnerable to judgment, pressure to conform, and need to guard kids from homophobia • Unique stressors might affect public engagement of occupations. Research Question: • How do same-sex parented families experience public occupations

Genetic variation in eggshell crystal size and orientation is large and these traits are correlated with shell thickness and are associated with eggshell matrix protein markers

The size and orientation of calcium carbonate crystals influence the structure and strength of the eggshells of chickens. In this study, estimates of heritability were found to be high (0.6) for crystal size and moderate (0.3) for crystal orientation. There was a strong positive correlation (0.65) for crystal size and orientation with the thickness of the shell and, in particular, with the thickness of the mammillary layer. Correlations with shell breaking strength were positive but with a high standard error. This was contrary to expectations, as in man-made materials smaller crystals would be stronger. We believe the results of this study support the hypothesis that the structural organization of shell, and in particular the mammillary layer, is influenced by crystal size and orientation, especially during the initial phase of calcification. Genetic associations for crystal measurements were observed between haplotype blocks or individual markers for a number of eggshell matrix proteins. Ovalbumin and ovotransferrin (LTF) markers for example were associated with crystal size, while ovocleidin-116 and ovocalyxin-32 (RARRES1) markers were associated with crystal orientation. The location of these proteins in the eggshell is consistent with different phases of the shell-formation process. In conclusion, the variability of crystal size, and to a lesser extent orientation, appears to have a large genetic component, and the formation of calcite crystals are intimately related to the ultrastructure of the eggshell. Moreover, this study also provides evidence that proteins in the shell influence the variability of crystal traits and, in turn, the shell’s thickness profile. The crystal measurements and/or the associated genetic markers may therefore prove to be useful in selection programs to improve eggshell quality