The Business Case for Community Paramedicine: Lessons from Commonwealth Care Alliance's Pilot Program

Mobile integrated health care and community paramedicine (MIH-CP) programs expand the role of traditional emergency medical services personnel to address non-emergency needs and bring outpatient primary and urgent care into patients' homes. These programs offer potential for reducing health care costs, eliminating unecessary emergency department use, and shifting service back to community-based and home settings. Between 2014 and 2015, the Massachusetts-based Commonwealth Care Alliance (CCA) piloted a community paramedicine prgoram, Acute Community Care (ACC), to serve its members in the Greater Boston area.This brief summarizes ACC's business case assessment, which showed that increasing patient volume after the pilot period would reuslt in net savings given the progam's success in averting unnecessary emergency care. By illustrating cost considerations for an expansion of MIH-CP services, this brief may inform the design and sustainability planning of other MIH-CP programs. The business case assessment was conducted by Mathematica Policy Research through support from the Center for Health Care Strategies' Complex Care Innovation Lab, a Kaiser Permanente Community Benefit-funded initiative

Utilization of Robotics in Higher Education

The use of technology in the classroom has evolved from the most primitive to the widespread use of personal computers. One of the trends in technological advancements to enter the classroom is the use of robotics. The relationship between robotics and education spans many years. This paper details Papert’s Constructionism theory defining learning as being more effective when students are “constructing” or “doing” activities that are personally meaningful. Research includes assessment of experiences of this method of teaching Information Technology through robotics at such institutions as West Point, Reykjavik University and University of South Florida. Based on the experiences reported at the various institutions, authors conclude with recommendations to Bryant College as the college launches an integration of the utilization of robotic components into the Information Technology curriculum to more effectively introduce students to Information Technology concepts

Hetaireia in Homer

This study addresses the neglected subject of hetaireia (roughly, “warrior-companionship”) in Homer. Although many discussions of Homer mention hetairoi in passing, no study treats semantic, poetic, social, and military aspects comprehensively. The purpose of this dissertation is to fill this gap. To this end I explicate the meaning of the heta(i)r- root, survey the social and military roles of Homeric hetairoi, and expose the way the Iliad and the Odyssey use hetaireia to portray pathos and character. The argument is informed by the etymology of heta(i)r- from the PIE reflexive *swe-, but rests on a catalogue and analysis of all scenes in which hetairoi appear. The four chapters of this dissertation argue that hetaireia is a major axis on which both epics turn. The two chapters on the Iliad show what the world is like when hetaireia dominates and consider how a poem about war focuses on the bond between warriors and their companions. The two chapters on the Odyssey show how the world changes when hetaireia disappears and consider how a poem about homecoming replaces the relationships of the battlefield with the relationship between the oikos and the gods. A brief concluding chapter suggests how the analysis of hetaireia presented in this dissertation might affect Homeric studies, cultural, social, and military history of the archaic period, ancient philosophy, the history of psychology, and aspects of modern military psychology, particularly leadership and motivation in battle.Doctor of Philosoph

Maintaining the boundaries of nomos: phthonotic responses to sociopolitical perturbations in Herodotus' Histories

Herodotus begins the Histories with a series of princess-thefts, each resolved by a straightforward tisis response. This simple quantitative equalization is complicated by the Greek theft of Medea without recompense, and Paris appeals to this imbalanced theft as precedent. This appeal implies common east-west membership in a nomotic system in a way that will contribute significantly to the rest of the narrative. The Candaules logos introduces the inverse proportionality characteristic of the circumstances to which phthonos responds; the Croesus logos extends phthonos to the gods, which describes the nomotic system of the kosmos. The Cambyses logos introduces a political formulation of "unlimited monarchy" that precludes any nomoi whatsoever, and puts the Persian monarch in a potentially phthonotic relation to all others. Darius attempts to avoid phthonos from his subjects by imperial expansion, and Xerxes' coerced submission to nomos in book 9 hearkens back to the Candaules logos in book 1

Evolutionary interpretations of mycobacteriophage biodiversity and host-range through the analysis of codon usage bias

In an genomics course sponsored by the Howard Hughes Medical Institute (HHMI), undergraduate students have isolated and sequenced the genomes of more than 1,150 mycobacteriophages, creating the largest database of sequenced bacteriophages able to infect a single host, Mycobacterium smegmatis, a soil bacterium. Genomic analysis indicates that these mycobacteriophages can be grouped into 26 clusters based on genetic similarity. These clusters span a continuum of genetic diversity, with extensive genomic mosaicism among phages in different clusters. However, little is known regarding the primary hosts of these mycobacteriophages in their natural habitats, nor of their broader host ranges. As such, it is possible that the primary host of many newly isolated mycobacteriophages is not M. smegmatis, but instead a range of closely related bacterial species. However, determining mycobacteriophage host range presents difficulties associated with mycobacterial cultivability, pathogenicity and growth. Another way to gain insight into mycobacteriophage host range and ecology is through bioinformatic analysis of their genomic sequences. To this end, we examined the correlations between the codon usage biases of 199 different mycobacteriophages and those of several fully sequenced mycobacterial species in order to gain insight into the natural host range of these mycobacteriophages. We find that UPGMA clustering tends to match, but not consistently, clustering by shared nucleotide sequence identify. In addition, analysis of GC content, tRNA usage and correlations between mycobacteriophage and mycobacterial codon usage bias suggests that the preferred host of many clustered mycobacteriophages is not M. smegmatis but other, as yet unknown, members of the mycobacteria complex or closely allied bacterial species

Speckle statistics in adaptive optics images at visible wavelengths

Residual speckles in adaptive optics (AO) images represent a well-known limitation on the achievement of the contrast needed for faint source detection. Speckles in AO imagery can be the result of either residual atmospheric aberrations, not corrected by the AO, or slowly evolving aberrations induced by the optical system. We take advantage of the high temporal cadence (1 ms) of the data acquired by the System for Coronagraphy with High-order Adaptive Optics from R to K bands-VIS forerunner experiment at the Large Binocular Telescope to characterize the AO residual speckles at visible wavelengths. An accurate knowledge of the speckle pattern and its dynamics is of paramount importance for the application of methods aimed at their mitigation. By means of both an automatic identification software and information theory, we study the main statistical properties of AO residuals and their dynamics. We therefore provide a speckle characterization that can be incorporated into numerical simulations to increase their realism and to optimize the performances of both real-time and postprocessing techniques aimed at the reduction of the speckle noise

Phytoplankton dynamics in contrasting early stage North Atlantic spring blooms: composition, succession, and potential drivers

The spring bloom is a key annual event in the phenology of pelagic ecosystems, making a major contribution to the oceanic biological carbon pump through the production and export of organic carbon. However, there is little consensus as to the main drivers of spring bloom formation, exacerbated by a lack of in situ observations of the phytoplankton community composition and its evolution during this critical period. We investigated the dynamics of the phytoplankton community structure at two contrasting sites in the Iceland and Norwegian basins during the early stage (25 March–25 April) of the 2012 North Atlantic spring bloom. The plankton composition and characteristics of the initial stages of the bloom were markedly different between the two basins. The Iceland Basin (ICB) appeared well mixed down to >400 m, yet surface chlorophyll a (0.27–2.2 mg m−3) and primary production (0.06–0.66 mmol C m−3 d−1) were elevated in the upper 100 m. Although the Norwegian Basin (NWB) had a persistently shallower mixed layer (<100 m), chlorophyll a (0.58–0.93 mg m−3) and primary production (0.08–0.15 mmol C m−3 d−1) remained lower than in the ICB, with picoplankton (<2 μm) dominating chlorophyll a biomass. The ICB phytoplankton composition appeared primarily driven by the physicochemical environment, with periodic events of increased mixing restricting further increases in biomass. In contrast, the NWB phytoplankton community was potentially limited by physicochemical and/or biological factors such as grazing. Diatoms dominated the ICB, with the genus Chaetoceros (1–166 cells mL−1) being succeeded by Pseudo-nitzschia (0.2–210 cells mL−1). However, large diatoms (>10 μm) were virtually absent (<0.5 cells mL−1) from the NWB, with only small nano-sized (<5 μm) diatoms (i.e. Minidiscus spp.) present (101–600 cells mL−1). We suggest microzooplankton grazing, potentially coupled with the lack of a seed population of bloom-forming diatoms, was restricting diatom growth in the NWB, and that large diatoms may be absent in NWB spring blooms. Despite both phytoplankton communities being in the early stages of bloom formation, different physicochemical and biological factors controlled bloom formation at the two sites. If these differences in phytoplankton composition persist, the subsequent spring blooms are likely to be significantly different in terms of biogeochemistry and trophic interactions throughout the growth season, with important implications for carbon cycling and organic matter export