Helping Navigate the Complex Web of Community Medicine: How Dedicated Social Services Support in the ED Can Prevent Unnecessary ED Visits and Hospital Readmissions

A hospital\u27s Emergency Department (ED) serves as its front door to the community. The vast majority of admitted patients present initially to the ED, and even more still begin and end their hospital visit in the ED. A hospital\u27s ED will deal with every societal ill facing that community. However, most hospitals reserve dedicated Social Service resources to admitted patients who have had prolonged inpatient hospital stays. EDs around the country are being overburdened with patients who present to the ED for non-emergent conditions. Access to community based healthcare is daunting even for well-connected individuals. It can be downright impenetrable for large portions of the community. Often the easiest, or only, choice is to return to the hospital\u27s ED. Changes in healthcare have brought a sharp focus on these repeat users of hospital services. The Hospital Readmissions Reduction Program, created by the Affordable Care Act, was designed to make hospitals take an active role in preventing readmissions to their hospital for chronic diseases. In 2015, 2,592 hospitals (almost half of the country) will receive lower payments for every Medicare patient that stays in the hospital - a penalty of $420 million. Having dedicated Social Services support in the ED can help prevent these return visits by connecting individuals to community based health services, helping navigate the mental health maze, and by providing a person of contact for patients to utilize before they decide to present back to the hospital - ultimately matching that patient with the appropriate service provider.https://fuse.franklin.edu/ss2016/1052/thumbnail.jp

A Dynamic System Testbed to Facilitate Controller and Estimator Designs and Its Application to Neoclassical Controllers

This thesis proposes a testbed capable of validating experimental controller designs.Because it is undesirable to implement unvalidated controller designs on physical hardware, the need for an effective testbed arises. For the testbed to be useful, it should be easy to use and contain all the hardware and software necessary to implement a controller and analyze its response. To accomplish these goals, a testbed is created by joining the National Instruments ELVIS III board with the Quanser Controls Board. Three controllers are implemented to evaluate the usefulness of the testbed. The controllers are designed using the neoclassical design technique. The neoclassical technique is an experimental design methodology that, until now, has never been implemented on a physical system. The neoclassical technique uses principles from both modern and classical approaches to control to match the transfer function of a system to an optimal transfer function; thus, simplifying the design process. Neoclassical controllers are designed in continuous time, discrete time, and discrete time with a state estimator. A PID controller is designed and used to evaluate the usefulness of the neoclassical design technique. PID controllers have been around for many years and are a highly common method of control. They have been studied extensively and there are several techniques available for controller design. Because the PID is well-known, it provides a good standard to evaluate the neoclassical technique against. A design and performance analysis is then conducted after all controllers have been implemented. The testbed is evaluated on how well it performed as well as the difficulty required to implement the individual controller designs. The performance of the neoclassical controllers is also considered. A comparison is made between the neoclassical controllers and PID controller to determine if the neoclassical method improves efficiency of controller design. It will be shown that while the testbed analyzed in this thesis may be useful as an instructional aid, it is not particularly useful in validating experimental controllers

AHI-1 interacts with BCR-ABL and modulates BCR-ABL transforming activity and imatinib response of CML stem/progenitor cells

Chronic myeloid leukemia (CML) represents the first human malignancy successfully treated with a tyrosine kinase inhibitor (TKI; imatinib). However, early relapses and the emergence of imatinib-resistant disease are problematic. Evidence suggests that imatinib and other inhibitors may not effectively eradicate leukemic stem/progenitor cells, and that combination therapy directed to complimentary targets may improve treatment. Abelson helper integration site 1 (Ahi-1)/AHI-1 is a novel oncogene that is highly deregulated in CML stem/progenitor cells where levels of BCR-ABL transcripts are also elevated. Here, we demonstrate that overexpression of Ahi-1/AHI-1 in murine and human hematopoietic cells confer growth advantages in vitro and induce leukemia in vivo, enhancing effects of BCR-ABL. Conversely, RNAi-mediated suppression of AHI-1 in BCR-ABL–transduced lin−CD34+ human cord blood cells and primary CML stem/progenitor cells reduces their growth autonomy in vitro. Interestingly, coexpression of Ahi-1 in BCR-ABL–inducible cells reverses growth deficiencies exhibited by BCR-ABL down-regulation and is associated with sustained phosphorylation of BCR-ABL and enhanced activation of JAK2–STAT5. Moreover, we identified an AHI-1–BCR-ABL–JAK2 interaction complex and found that modulation of AHI-1 expression regulates phosphorylation of BCR-ABL and JAK2–STAT5 in CML cells. Importantly, this complex mediates TKI response/resistance of CML stem/progenitor cells. These studies implicate AHI-1 as a potential therapeutic target downstream of BCR-ABL in CML

Cutaneous T‐cell lymphoma: 2014 Update on diagnosis, risk‐stratification, and management

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108042/1/ajh23756.pd

Inhibition of the phosphoinositide 3-kinase pathway in multiple myeloma mediated through-activation of SHIP

Multiple myeloma (MM) is a B-lymphocyte neoplasia that remains incurable due in part to intrinsic and acquired drug resistance, despite the numerous conventional therapies available. The growth, survival and anti-apoptosis signals resulting from adhesion and cytokine-mediated interactions between the malignant clones and the bone marrow microenvironment are transduced chiefly through the elevated phosphoinositide 3-kinase (PI3K) signaling pathway, which has been demonstrated essential for disease progression. Many biologically-based therapeutics are in development for MM, but the therapies aimed at abrogating this cascade have shown modest success and often have problems with toxicity. A novel alternate approach in controlling this signaling is activation of an endogenous negative regulator, the inositol phosphatase SHIP. A benefit of targeting SHIP is its restricted expression to hematopoetic cells, thereby limiting potential toxicity to surrounding tissues. Further, the PI3K pathway is involved in the development of drug resistance, and abrogating the cascade can re-sensitize MM cells to conventional therapeutics. Here we demonstrate activation of SHIP is sufficient to inhibit proliferation and induce apoptosis of MM cells in vitro, while having no significant effects on non-hematopoetic cancer cells or lymphocytes lacking SHIP. We also show that SHIP activators enhance the cytotoxicity of current chemotherapeutic agents and provide preliminary results of efficacy in a murine xenograft model. These results not only provide the basis for the further study of a new therapeutic agent to improve MM patient outcome but also propose a new model for studying signal transduction through activating the endogenous negative regulators of the PI3K pathway.Medicine, Faculty ofMedicine, Department ofExperimental Medicine, Division ofGraduat

The use of ICT in the teaching and learning process in secondary schools : a case study of two Cameroonian schools

Abstract The Use of ICT in the Teaching and Learning Process in Secondary Schools: A Case Study of Two Cameroonian schools. This study examines the use of ICT by teachers Cameroonian secondary schools. This study explores the pedagogical use of ICT in the teaching and the learning process, the impact of its use and the role school principals and the community plays in enhancing ICT in the pedagogy. This is a qualitative case study of two public secondary schools in the South West Region of Cameroon consisting of interviews and observations. A total of 24 participants comprising of 20 teachers, two school principals and two parents responded to semi-structured interview questions. Also, observational study was also carried out to examine the various pedagogical practices of ICT in both schools. All the interview data were all transcribed and interpreted using the participants’ quotes as examples and evidence of the findings. Pictures were used to analyse observational data whereby moments related to the pedagogic use of ICT in the classroom and other areas in the schools under study were captured and described to strengthen the findings. The TPACK model was used to examine the teacher's knowledge in the pedagogic use of ICT Findings in this study indicated that pedagogic use of ICT is still in its preliminary stages as 16 out of the 20 teachers were passively using ICT in their classroom and an additional two teachers were non-users of ICT in their pedagogic activities.Also, there were no significant changes in the teachers’ position as a result of the pedagogic use of ICT in the classrooms. 2 out of the 18 teachers who considered themselves as active pedagogic users of ICT were still using the traditional instructional method of teaching even though ICT tools were present in the classrooms. Inadequate ICT training for teachers in their subject area acted as a major challenge for teachers from both schools to integrate ICT in their subject areas. Therefore ICT was still used as an add-on rather than an integrated tool in the teaching and learning process. The majority of the teachers acknowledge positive changes ICT had left in the teaching and learning process. Also, findings from this study reveal that the school principals and parents had little influence over the use of ICT in the pedagogy. It is evident from this study that for teachers to successfully integrate ICT in their classrooms, the teacher pre-service and in-service courses have to technologically drive to ensure effective use of ICT in the pedagogy

An evaluation of the costs and responses of coat colour mismatch in snowshoe hares

Animals that change colour seasonally to match the presence and absence of snow are becoming increasingly mismatched with their environment in many parts of the world. We evaluated the direct and indirect impacts of coat colour mismatch in snowshoe hares in two contrasting geographies, and further investigated the mechanisms that may be driving these impacts. First, we examined the impact of coat colour mismatch on snowshoe hare mortality risk and foraging behaviour in southwestern Yukon. We found that white mismatched hares survived better than their matched counterparts, presumably due to energetic benefits related to winter white coats that allowed hares to spend less time foraging. Next, we experimentally manipulated coat colour mismatch and perceived predation risk in central-eastern Newfoundland. We found that mismatched hares in risky situations experience increased body mass loss, which they may compensate for by altering their forage selection and intake rate. Our results shine light on the mechanisms that govern coat colour mismatch impacts across populations in different geographies, and how animals may compensate for these impacts

Identification of differentially expressed genes in AHI-1-mediated leukemic transformation in cutaneous t-cell lymphoma

The oncogene Ahi-1 was recently identified through provirus insertional mutagenesis in murine leukemias and lymphomas. Its involvement in human leukemogenesis is demonstrated by gross perturbations in its expression in several leukemic cells lines, particularly in cutaneous T-cell lymphoma (CTCL) cell lines (Hut 78 and Hut 102). Hut 78 is derived from a patient with Sezary syndrome, a common leukemic variant of the human CTCL mycosis fungoides. Aberrant expression of AHI-1 mRNA and protein has been found in CD4⁺CD7⁻ leukemic Sezary cells from patients with Sezary syndrome. Moreover, stable suppression of AHI-1 using retroviral-mediated RNA interference in Hut 78 cells inhibits their transforming activity in vitro and in vivo. In an effort to identify genes involved in AHI-1-mediated leukemic transformation in CTCL, microarray analysis was performed to compare six RNA samples from AHI-1 suppressed Hut 78/sh4 cells to five samples from Hut 78 control cells. Limma and dChip analyses identified 218 and 95 differentially expressed genes, respectively, using a fold change criteria of > or < 2 and a p-value threshold of ≤ 0.01. After evaluation of both analyses, 21 genes were selected based upon interesting structural and functional information, specificity to hematopoietic cells or T-cells, and previous connections to cancer. Expression patterns of these 21 genes were validated by qRT-PCR with p-values < 0.05 ranging from 1.97 x 10⁻¹⁰ to 6.55 x 10⁻³, with the exception of BRDG1 at 5.88 x 10⁻². The observed up-regulation of both BIN1 and HCK in AHI-1 suppressed Hut 78/sh4 cells as compared to control cells further confirmed at the protein level. The tumor suppressor BIN1 is known to physically interact with c-MYC, which also exhibits differential protein expression in these cells. Characterization of BIN1 identified 4 isoforms all of which contain exon 10 and demonstrate alternative splicing of exons 12A and 13. Additionally, qRT-PCR results from primary Sezary samples indicate there is clinical significance in the expression changes detected for BIN1, HCK, REPS2, BRDG1, NKG7 and SPIB. These findings identify several new differentially expressed genes that may play critical roles in AHI-1-mediated leukemic transformation of human CTCL cells.Medicine, Faculty ofMedical Genetics, Department ofGraduat

A denaturation study of human serum transferrin and apotransferrin

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Not availabl

Knowledge Organization in Transmedia Fictional Worlds: A Study of Harry Potter, Lord of the Rings, Marvel Universe, and Star Wars

Currently there is no structured data standard for representing elements commonly found in transmedia fictional universes. There are websites dedicated to individual universes, however, information found on these sites separates the various formats into books, movies, comics, etc.; concentrate on only the bibliographic aspects of the material; and are only full-text searchable. We have created an ontological model that will allow researchers, fans, brand managers, and creators to search for and retrieve the information contained in these worlds based on how they are structured. We conducted a domain analysis and user studies based on the contents of Harry Potter, Lord of the Rings, the Marvel Universe, and Star Wars in order to build a new model using the Ontology Web Language (OWL) and an artificial intelligence reasoning engine. This model can infer connections between characters, elements of power, items, places, events, etc. This model will facilitate better search and retrieval of the information contained within these vast story universes for all users interested in them. The result of this project is and OWL ontology that is intuitive for users; can be used by AI systems; and has been updated to reflect real user needs based on user research