A Strategic Audit of Microsoft

This paper provides an analysis of Microsoft’s current market placement and performance, based off external and internal factors, as well as tools such as SWOT analysis. The goal of this audit is to provide an understanding of Microsoft’s current positioning and strategy, as well as a look into possible paths going forward. Additionally, alternative strategies are discussed, and a recommendation is made to which Microsoft should pursue to continue its success. The recommendation reached is that Microsoft should focus on keeping numbers of active Windows users up, as well as pursue a subscription-based model for Windows updates and pricing. The audit provides an implementation plain for this recommendation as well as contingencies and metrics to judge it by

Agroecology

Contributing institution: Carleton CollegePreviously hosted as part of Mann Library's Locale collection

Substance Abuse, Marginalization, and Homelessness: Bayesian Perspectives on a Persisting Problem

This dissertation study examined what role substance abuse plays in the marginalized status of homeless adults and how the combined effects of marginalization and substance abuse impact service use and housing status changes over time. The concept of marginalization is used to describe how isolated an individual is from basic needs such as supportive social contact, a safe environment, and legal income options. Thus, the specific aims of this project were to 1) describe longitudinal patterns of substance abuse and marginalization in a homeless population, 2) examine the combined effects of substance abuse and marginalization on housing status changes over time, and 3) investigate how marginalization and substance abuse impact service use over time. This dissertation used secondary data collected as part of a NIDA funded longitudinal study of urban homelessness called SUNCODA: DA 10713, PI-Carol North). Four hundred adults in the Saint Louis, Missouri metropolitan area were recruited from shelters and street locations: 1999-2001) and interviewed at baseline, then at 1 and 2 year follow ups. Subject-matched service data: including shelter use and contacts with health, substance abuse, and mental health sectors of care) were collected from regional providers over the same time period. These data provided a unique opportunity to explore longitudinal changes in substance abuse, mental health, social contacts, victimization, criminal activity, housing status, service use, and employment among homeless adults. To understand these complex relationships, a flexible Bayesian framework was adopted to develop Markov transition models of housing state changes and zero inflated Poisson regression models of routine and emergency service counts over two time intervals. Key findings include consistent relationships between living on the streets, alcohol use, and increased marginalization, notably legal problems, shadow work, and victimization. Additionally, at several points, there were distinctions between street based homeless and those who found housing at some point or were episodically in shelters. These results underscore the importance of addressing legal problems and local environments in intervention design, specifically in how we might enhance the most basic aspects of well-being for homeless adults such as safety and housing

Intersections of Poverty, Geography, and Custodial Grandparent Caregiving in Appalachia

The purpose of this study is to compare the incidence of custodial grandparenting in Central Appalachia to other areas in Appalachia and the rest of the U.S., to explore how recent economic changes have affected poverty rates of custodial grandparents in all of these areas, and to explore what influences the probability of custodial grandparenting. We hypothesize that the recent economic upheaval of the Great Recession has pressured many families to rely on grandparents to provide care for their grandchildren and that these trends are particularly evident in the Appalachian region due to longstanding historical trends and unique cultural factors. Three year summary data from the American Community Survey (ACS) was used to compare rates of grandparent caregiving along with poverty, children living in grandparent only households, and other indicators of poverty and economic distress both between regions and across three different time periods (2005-07, 2008-10, and 2011-13). We then developed at logistic regression model using the ACS individual level data (Public Use MicroData) for 2009-13 to estimate the probability of caregiving status among grandparents living with grandchildren in each Appalachian region compared to the entire United States. Grandparents living with grandchildren in Central Appalachia had more than double the odds of being the primary caregiver when compared to the rest of the U.S. when controlling for demographics, poverty, gender, race, age, and education. While grandparents can provide an important resource for these families, advocates and state level policy makers need to be aware of the potential downstream costs to children and older adults over time and consider how to better support these Appalachian grandfamilies

Resolution of sickle cell crisis following administration of amiodarone

Sickle cell disease is a prevalent hematologic condition, but some of the factors that lead to erythrocyte sickling are not fully known. A 58-year-old male patient with a history of sickle cell disease (SCD) and paroxysmal atrial fibrillation was transferred from an outside hospital for further management of refractory sickle cell crisis with acute chest syndrome. Before transfer, the patient received antibiotics and multiple packed red blood cell (pRBC) transfusions, with minimal effect on symptoms or anemia. After transfer, the patient developed rapid supraventricular tachycardia and atrial fibrillation (rates >160) with a drop in blood pressure. He was started on IV amiodarone. His heart rate was subsequently better controlled and converted to sinus rhythm the following day. Three days following initiation of amiodarone, the patient, with a hemoglobin count of 6.4 g/dl, required one additional unit of pRBC. On the fourth day, the patient’s hemoglobin count rose to 9.4 g/dl, and he reported a marked improvement in symptoms. The improvements in symptoms and hemoglobin count were sustained, and the patient was discharged two days later. This remarkable improvement in anemia and symptoms triggered a search for potential causes. Amiodarone is a complex drug shown to have effects on multiple cell types, including erythrocytes. A recent preclinical study demonstrated reduced sickling and improved anemia in a murine model of SCD. This case report raises the possibility that amiodarone may have contributed to the rapid improvement in anemia and should be further explored in clinical trials

Tracheal obstruction secondary to extravasation of intravenous fluids from a central catheter port

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30358/1/0000760.pd

Valsartan Improves Insulin Sensitivity without Altering Vascular Function in Healthy Overweight Adults without the Metabolic Syndrome

Background. We investigated hyperactivity of the renin-angiotensin system (RAS) as a cause of endothelial dysfunction in obese humans. Methods. Thirty five healthy overweight (BMI = 33.6 ± 6.6 kg m −2) adults (33 ± 10 years old) without cardiovascular risk factors received valsartan (160 mg) orally daily or a matching placebo for 6 weeks each. Results. Baseline flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD) were not altered by placebo or valsartan. However, fasting plasma insulin was significantly decreased by valsartan compared to placebo (−4.6 ± 16.0 μUmL−1 versus −0.4 ± 11.6 μUmL−1, P = 0.032) with no changes in glucose. A secondary analysis in patients with elevated waist to hip ratios (ÿ0.85, n = 18) showed an increase in FMD with valsartan. Conclusions. Our findings suggest that angiotensin 2 receptor blockade may aid in the prevention of diabetes even at the earliest stages of risk due solely to uncomplicated obesity. The lack of an improvement in FMD does not support a central role of RAS-hyperactivity in the etiology of the vascular dysfunction due solely to obesity. However, it is possible that obese patients with central adiposity may improve FMD with RAS blockade, and future investigation is warranted in this subgroup.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63259/1/met.2007.0002.pd