Abstracts on published experiments and unpublished theses written at Boston University, School of Education on written composition in the elementary schools

Thesis (Ed.M.)--Boston Universit

Giving formulary and drug cost information to providers and impact on medication cost and use: a longitudinal non-randomized study

BackgroundProviders wish to help patients with prescription costs but often lack drug cost information. We examined whether giving providers formulary and drug cost information was associated with changes in their diabetes patients' drug costs and use. We conducted a longitudinal non-randomized evaluation of the web-based Prescribing Guide ( www.PrescribingGuide.com ), a free resource available to Hawaii's providers since 2006, which summarizes the formularies and copayments of six health plans for drugs to treat 16 common health conditions. All adult primary care physicians in Hawaii were offered the Prescribing Guide, and providers who enrolled received a link to the website and regular hardcopy updates.MethodsWe analyzed prescription claims from a large health plan in Hawaii for 5,883 members with diabetes from 2007 (baseline) to 2009 (follow-up). Patients were linked to 299 "main prescribing" providers, who on average, accounted for >88 % of patients' prescriptions and drug costs. We compared changes in drug costs and use for "study" patients whose main provider enrolled to receive the Prescribing Guide, versus "control" patients whose main provider did not enroll to receive the Prescribing Guide.ResultsIn multivariate analyses controlling for provider specialty and clustering of patients by providers, both patient groups experienced similar increases in number of prescriptions (+3.2 vs. +2.7 increase, p = 0.24), and days supply of medications (+141 vs. +129 increase, p = 0.40) averaged across all drugs. Total and out-of-pocket drug costs also increased for both control and study patients. However, control patients showed higher increases in yearly total drug costs of $208 per patient (+$792 vs. +$584 increase, p = 0.02) and in 30-day supply costs (+$9.40 vs. +$6.08 increase, p = 0.03). Both groups experienced similar changes in yearly out-of-pocket costs (+$41 vs + $31 increase, p = 0.36) and per 30-day supply (-$0.23 vs. -$0.19 decrease, p = 0.996).ConclusionGiving formulary and drug cost information to providers was associated with lower increases in total drug costs but not with lower out-of-pocket costs or greater medication use. Insurers and health information technology businesses should continue to increase providers' access to formulary and drug cost information at the point of care

Giant Molecular Outflows Powered by Protostars in L1448

We present sensitive, large-scale maps of the CO J=1-0 emission of the L1448 dark cloud. These maps were acquired using the On-The-Fly capability of the NRAO 12-meter telescope. CO outflow activity is seen in L1448 on parsec-scales for the first time. Careful comparison of the spatial and velocity distribution of our high-velocity CO maps with previously published optical and near-infrared images and spectra has led to the identification of six distinct CO outflows. We show the direct link between the heretofore unknown, giant, highly-collimated, protostellar molecular outflows and their previously discovered, distant optical manifestations. The outflows traced by our CO mapping generally reach the projected cloud boundaries. Integrated intensity maps over narrow velocity intervals indicate there is significant overlap of blue- and red-shifted gas, suggesting the outflows are highly inclined with respect to the line-of-sight, although the individual outflow position angles are significantly different. The velocity channel maps also show that the outflows dominate the CO line cores as well as the high-velocity wings. The magnitude of the combined flow momenta, as well as the combined kinetic energy of the flows, are sufficient to disperse the 50 solar mass NH3 cores in which the protostars are currently forming, although some question remains as to the exact processes involved in redirecting the directionality of the outflow momenta to effect the complete dispersal of the parent cloud.Comment: 11 pages, 9 figures, to be published in the Astronomical Journa

The medical student

The Medical Student was published from 1888-1921 by the students of Boston University School of Medicine

The Effect of the 2009 USPSTF breast cancer screening recommendations on breast cancer in Michigan: A longitudinal study

In 2009, the revised United States Preventive Services Task Force (USPSTF) guidelines recommended against routine screening mammography for women age 40â 49 years and against teaching selfâ breast examinations (SBE). The aim of this study was to analyze whether breast cancer method of presentation changed following the 2009 USPSTF screening recommendations in a large Michigan cohort. Data were collected on women with newly diagnosed stage 0â III breast cancer participating in the Michigan Breast Oncology Quality Initiative (MiBOQI) registry at 25 statewide institutions from 2006 to 2015. Data included method of detection, cancer stage, treatment type, and patient demographics. In all, 30 008 women with breast cancer detected via mammogram or palpation with an average age of 60.1 years were included. 38% of invasive cancers were identified by palpation. Presentation with palpable findings decreased slightly over time, from 34.6% in 2006 to 28.9% in 2015 (P < .001). Over the 9â year period, there was no statistically significant change in rate of palpationâ detected tumors for women age <50 years or â ¥50 years (P = .27, .30, respectively). Younger women were more likely to present with palpable tumors compared to older women in a statewide registry. This rate did not increase following publication of the 2009 USPSTF breast cancer screening recommendations.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146414/1/tbj13034.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146414/2/tbj13034_am.pd

The TcEG1 beetle (Tribolium castaneum) cellulase produced in transgenic switchgrass is active at alkaline pH and auto-hydrolyzes biomass for increased cellobiose release

Background Genetically engineered biofuel crops, such as switchgrass (Panicum virgatum L.), that produce their own cell wall-digesting cellulase enzymes would reduce costs of cellulosic biofuel production. To date, non-bioenergy plant models have been used in nearly all studies assessing the synthesis and activity of plant-produced fungal and bacterial cellulases. One potential source for cellulolytic enzyme genes is herbivorous insects adapted to digest plant cell walls. Here we examine the potential of transgenic switchgrass-produced TcEG1 cellulase from Tribolium castaneum (red flour beetle). This enzyme, when overproduced in Escherichia coliand Saccharomyces cerevisiae, efficiently digests cellulose at optima of 50 °C and pH 12.0. Results TcEG1 that was produced in green transgenic switchgrass tissue had a range of endoglucanase activity of 0.16–0.05 units (µM glucose release/min/mg) at 50 °C and pH 12.0. TcEG1 activity from air-dried leaves was unchanged from that from green tissue, but when tissue was dried in a desiccant oven (46 °C), specific enzyme activity decreased by 60%. When transgenic biomass was “dropped-in” into an alkaline buffer (pH 12.0) and allowed to incubate at 50 °C, cellobiose release was increased up to 77% over non-transgenic biomass. Saccharification was increased in one transgenic event by 28%, which had a concurrent decrease in lignin content of 9%. Histological analysis revealed an increase in cell wall thickness with no change to cell area or perimeter. Transgenic plants produced more, albeit narrower, tillers with equivalent dry biomass as the control. Conclusions This work describes the first study in which an insect cellulase has been produced in transgenic plants; in this case, the dedicated bioenergy crop switchgrass. Switchgrass overexpressing the TcEG1 gene appeared to be morphologically similar to its non-transgenic control and produced equivalent dry biomass. Therefore, we propose TcEG1 transgenics could be bred with other transgenic germplasm (e.g., low-lignin lines) to yield new switchgrass with synergistically reduced recalcitrance to biofuel production. In addition, transgenes for other cell wall degrading enzymes may be stacked with TcEG1 in switchgrass to yield complementary cell wall digestion features and complete auto-hydrolysis

Rapid adaptive radiation of Darwin's finches depends on ancestral genetic modules

Recent adaptive radiations are models for investigating mechanisms contributing to the evolution of biodiversity. An unresolved question is the relative importance of new mutations, ancestral variants, and introgressive hybridization for phenotypic evolution and speciation. Here, we address this issue using Darwin's finches and investigate the genomic architecture underlying their phenotypic diversity. Admixture mapping for beak and body size in the small, medium, and large ground finches revealed 28 loci showing strong genetic differentiation. These loci represent ancestral haplotype blocks with origins predating speciation events during the Darwin's finch radiation. Genes expressed in the developing beak are overrepresented in these genomic regions. Ancestral haplotypes constitute genetic modules for selection and act as key determinants of the unusual phenotypic diversity of Darwin's finches. Such ancestral haplotype blocks can be critical for how species adapt to environmental variability and change

Knowledge and exposure to complementary and alternative medicine in paediatric doctors: a questionnaire survey

<p>Abstract</p> <p>Background</p> <p>Complementary and alternative medicines are increasingly used by the general population. A survey was conducted to ascertain the knowledge of Complementary and Alternative Medicines (CAMs) amongst paediatric physicians, and whether seniority increases the likelihood of its use being considered in consultations, or of families discussing it.</p> <p>Methods</p> <p>Anonymous survey of general paediatric doctors in a large inner-city district general hospital (DGH) and tertiary children's centre (TC) using a questionnaire. Statistical analysis was calculated using Minitab.</p> <p>Results</p> <p>43/49 (88%) questionnaires were returned correctly. 13 (30%, CI 17 – 46%) doctors had personally used CAMs. 24 (56%, CI 40 – 71%) of their families had used CAMs. 13 (30%, CI 17 – 46%) had received formal CAMs education. 21 (49%, CI 40 – 71%) could name a total of 5 types of CAMs. Consultants were significantly more likely to ask about CAM use than middle-grades and juniors (p < 0.05, CI 48 – 93%, 35 – 90%, 8 – 33% respectively) and have had a clinical encounter where they felt it was significant. 32 (74%, CI 59 – 86%) of the clinicians had been asked about CAMs. 33 (77%, CI 61 – 88%) of doctors had successful CAM use reported to them, and 20 (47%, CI 31 – 62%) had failure of CAMs reported to them.</p> <p>Conclusion</p> <p>CAM use is relatively common in paediatric doctors and their families. They have received little formal CAMs education. Consultants were more likely than juniors to ask about CAM use and have had a clinical encounter where it played a significant part. Around half of all doctors irrespective of grade have been asked about CAMs in a clinical encounter.</p

Treatment outcomes of new tuberculosis patients hospitalized in Kampala, Uganda: a prospective cohort study.

BACKGROUND: In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda. METHODS AND FINDINGS: Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045). CONCLUSION: Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART