Improving Primary Care Follow-Up After Pediatric Hospitalization

BACKGROUND: Transitioning patient care to primary care physicians after pediatric hospitalization plays a critical role in children’s health. Follow-up appointments are an ideal time to provide education, address concerns, and arrange for continuity of care. This quality improvement (QI) study aimed to improve the percentages of primary care clinic follow-up within 7 days of hospital discharge. METHODS: Using the Plan-Do-Study-Act (PDSA) Model for Improvement, a multidisciplinary team examined pre-implementation data for patients discharged from the children’s hospital in February 2018. Electronic medical record (EMR) review was performed to determine if follow-up appointments were scheduled and attended within 7 days of discharge. Four week PDSA cycles were then completed by the medical residents, pediatric hospitalists and a care transition coordinator. Cycle 1 (n=25) involved developing an EMR-based shared patient list to identify all patients needing follow-up. In Cycle 2 (n=69), monthly standardized resident education was implemented to optimize use of the shared patient list. In Cycle 3 (n=81), a discharge appointment template was used to schedule appointments for patients discharged on weekends. RESULTS: Percent of appointments scheduled increased throughout the PDSA cycles from baseline (baseline - 60%; cycle 1 - 72%; cycle 2 - 74%; cycle 3 - 85%), as well as percent of appointments attended (baseline - 56%; cycle 1 - 56%; cycle 2 - 61%; cycle 3 - 70%) with p<0.001. Clinic follow-up was lower for patients with chronic illnesses but did improve from cycle 1 (42%) to cycle 3 (67%). The percentage of appointments scheduled for weekend discharges was not significantly different from weekday discharges, and increased from baseline over the course of the PDSA cycles. CONCLUSION: The number of follow-up appointments both scheduled and attended increased throughout the study, suggesting that the QI measures implemented were effective. Further interventions will focus on patient and system barriers to appointment attendance.N

Volume 07

Introduction from Interim Dean Dr. Jennifer Apperson Spatial Analysis of Potential Risk Factors Associated with Addition of Atlantic Coast Pipeline Through Virginia by Rachel C. Lombardi Delicate Matters with No Speaking, Hope and Nothing, Mono Duality by Ben Osterhout Connect Graphic Design Senior Project by Lindsay Graybill Phenolic Acids in Brassicaceae Plants: Ovipositional Stimulants or Deterrents for Cabbage White Butterfly, Pieris Rapae? by Rebecca E. Dey And Skyler T. Carpenter Abecedarian Cards by Emma Beckett, Jason Ware, And Mollie Andrews Helvetica: A Type Specimen Book by James Bates, Landon Cooper, Tiffani Jeffries, And Maria Wheaton “Things Left Behind” by Dallas Price Heretic Adornment by Laura Kahler Photography by Sarah Charlton Revisiting Longfellow: Expressing Universality through Accessibility by Anna Bultrowicz Magazine Spreads from “What Dreams May Come: Marriage Across Cultures” by Emily Spittle Magazine Spreads From “Live on The Street: A Naked Look at Human Sex Trafficking” by Erin Godwin Lasting Light by Eamon Brokenbroug

Volume 06

Introduction from Dean Dr. Charles Ross Caught Between Folklore and the Cold War: The Americanization of Russian Children\u27s Literature by Kristen Gains Graphic Design by Amanda Willis Graphic Design by Holly Backer Prejudices in Swiss German Accents by Monika Gutierrez Photography by Cara O\u27Neal Photography by Sara Nelson Edmund Tyrone\u27s Long Journey through Night by Sasha Silberman Photography by Jessica Beardsley Photography by Jamie Gardner and Edward Peeples The Republican Razor: The Guillotine as a Symbol of Equality by Jamie Clift Graphic Design by Matthew Sakach Genocide: The Lasting Effects of Gender Stratification in Rwanda By Tess Lione and Emily Wilkins Photography by Kelsey Holt and Jessica Page Morocco and the 20 February Movement by Charles Vancampen, Gilbert Hall, Jenny Nehrt, Kasey Dye, Amanda Tharp, Jamie Leeawrik, & Ashley McGee Photography by Emily Poulin Photography by Michael Kropf Improving Performance of Arbitrary Precision Arithmetic Using SIMD Assembly Code Instructions by Nick Pastore Art by Austin Polasky and Morgan Glasco Art by Laura L. Kahler The Effects of the Neutral Response Option on the Extremeness of Participant Responses by Melinda L. Edwards and Brandon C. Smith Graphic Design by Mariah Asbell Graphic Design by Cabell Edmunds College Bullying: An Exploratory Analysis by Amelia D. Perry Photography by Alyssa Hayes Death-Related Crime: Applying Bryant\u27s Conceptual Paradigm of Thanatological Crime to Military Settings by Irina Boothe Graphic Design by Perry Bason Graphic Design by James Earl

Groucho binds two conserved regions of LEF-1 for HDAC-dependent repression

<p>Abstract</p> <p>Background</p> <p><it>Drosophila </it>Groucho and its human Transducin-like-Enhancer of Split orthologs (TLEs) function as transcription co-repressors within the context of Wnt signaling, a pathway with strong links to cancer. The current model for how Groucho/TLE's modify Wnt signaling is by direct competition with β-catenin for LEF/TCF binding. The molecular events involved in this competitive interaction are not defined and the actions of Groucho/TLEs within the context of Wnt-linked cancer are unknown.</p> <p>Methods</p> <p>We used <it>in vitro </it>protein interaction assays with the LEF/TCF family member LEF-1, and <it>in vivo </it>assays with Wnt reporter plasmids to define Groucho/TLE interaction and repressor function.</p> <p>Results</p> <p>Mapping studies reveal that Groucho/TLE binds two regions in LEF-1. The primary site of recognition is a 20 amino acid region in the Context Dependent Regulatory domain. An auxiliary site is in the High Mobility Group DNA binding domain. Mutation of an eight amino acid sequence within the primary region (RFSHHMIP) results in a loss of Groucho action in a transient reporter assay. <it>Drosophila </it>Groucho, human TLE-1, and a truncated human TLE isoform Amino-enhancer-of-split (AES), work equivalently to repress LEF-1•β-catenin transcription in transient reporter assays, and these actions are sensitive to the HDAC inhibitor Trichostatin A. A survey of Groucho/TLE action in a panel of six colon cancer cell lines with elevated β-catenin shows that Groucho is not able to repress transcription in a subset of these cell lines.</p> <p>Conclusion</p> <p>Our data shows that Groucho/TLE repression requires two sites of interaction in LEF-1 and that a central, conserved amino acid sequence within the primary region (F S/T/P/xx y I/L/V) is critical. Our data also reveals that AES opposes LEF-1 transcription activation and that both Groucho and AES repression require histone deacetylase activity suggesting multiple steps in Groucho competition with β-catenin. The variable ability of Groucho/TLE to oppose Wnt signaling in colon cancer cells suggests there may be defects in one or more of these steps.</p

Impulsivity as a vulnerability factor for poor addiction treatment outcomes: A review of neurocognitive findings among individuals with substance use disorders

The support of the Special Research Fund of Ghent University (Belgium) is gratefully acknowledged.With the current review, we explore the hypothesis that individual differences in neurocognitive aspects of impulsivity (i.e., cognitive and motor disinhibition, delay discounting and impulsive decision-making) among individuals with a substance use disorder are linked to unfavorable addiction treatment outcomes, including high drop-out rates and difficulties in achieving and maintaining abstinence. A systematic review of the literature was carried out using PubMed, PsycINFO and Web of Knowledge searches. Twenty-five unique empirical papers were identified and findings were considered in relation to the different impulsivity dimensions. Although conceptual/methodological heterogeneity and lack of replication are key limitations of studies in this area, findings speak for a prominent role of cognitive disinhibition, delay discounting and impulsive decision-making in the ability to successfully achieve and maintain abstinence during and following addiction treatment. In contrast, indices of motor disinhibition appear to be unrelated to abstinence levels. Whereas the relationship between impulsivity and treatment retention needs to be examined more extensively, preliminary evidence suggests that impulsive/risky decision-making is unrelated to premature treatment drop-out among individuals with a substance use disorder. The reviewed findings are discussed in terms of their clinical implications.Special Research Fund of Ghent University (Belgium

Gene expression imputation across multiple brain regions provides insights into schizophrenia risk

Transcriptomic imputation approaches combine eQTL reference panels with large-scale genotype data in order to test associations between disease and gene expression. These genic associations could elucidate signals in complex genome-wide association study (GWAS) loci and may disentangle the role of different tissues in disease development. We used the largest eQTL reference panel for the dorso-lateral prefrontal cortex (DLPFC) to create a set of gene expression predictors and demonstrate their utility. We applied DLPFC and 12 GTEx-brain predictors to 40,299 schizophrenia cases and 65,264 matched controls for a large transcriptomic imputation study of schizophrenia. We identified 413 genic associations across 13 brain regions. Stepwise conditioning identified 67 non-MHC genes, of which 14 did not fall within previous GWAS loci. We identified 36 significantly enriched pathways, including hexosaminidase-A deficiency, and multiple porphyric disorder pathways. We investigated developmental expression patterns among the 67 non-MHC genes and identified specific groups of pre- and postnatal expression

Genomic Dissection of Bipolar Disorder and Schizophrenia, Including 28 Subphenotypes

publisher: Elsevier articletitle: Genomic Dissection of Bipolar Disorder and Schizophrenia, Including 28 Subphenotypes journaltitle: Cell articlelink: https://doi.org/10.1016/j.cell.2018.05.046 content_type: article copyright: © 2018 Elsevier Inc