1st Place: Development of a Feasibility Study of Tele-Education for Ensuring Correct Bronchodilator Use

2018 Research Scholar Winner: 1st Place Mentor: Robert Kruklitis, M

Investing in New Technology in Pulmonary Medicine–Navigating the Tortuous Path to Success.

The introduction of new technologies offer the promise to advance medicine. This occurs alongside improved efforts to control costs of healthcare by hospital administrators, Center for Medicare and Medicaid Services’ (CMS) pivot to value programs, and commercial payers’ efforts to reduce reimbursement. These trends present a challenge for the pulmonologist, among others, who must navigate increasingly complex and highly scrutinized evaluation processes used to secure new technologies. Healthcare providers are turning toward value assessments, while simultaneously tasked with a mission of offering state-of-the art technologies and services. Pulmonologists desiring new technologies are thus faced with increased scrutiny in their evaluation of costs and clinical data to support investments. Consideration of this scrutiny and further evidence to temper the evaluation will improve the likelihood of adoption and patient access to clinically-impactful technology. The identification of this evidence may provide – to both administrators and pulmonary clinicians – a comprehensive view of the clinical and economic benefits of such technologies. It is imperative that all parties involved in the decision process work collaboratively to deploy value-added and clinically-impactful technologies. While a physician group might invest in such new technologies, the capital required often leads such decisions to a larger organization such as a hospital, healthcare system, or privately owned entity. This article aims to provide a framework for pulmonary clinicians to better understand the processes that purchasers use to evaluate new technologies, the pressures that influence their consideration, and what resources may be leveraged towards success

Opposing effects of DNA on proteolysis of a replication initiator

DNA replication initiation proteins (Reps) are subjected to degradation by cellular proteases. We investigated how the formation of nucleoprotein complex, involving Rep and a protease, affects Rep degradation. All known Escherichia coli AAA+ cytosolic proteases and the replication initiation protein TrfA of the broad-host-range plasmid RK2 were used. Our results revealed that DNA influences the degradation process and that the observed effects are opposite and protease specific. In the case of ClpXP and ClpYQ proteases, DNA abolishes proteolysis, while in the case of ClpAP and Lon proteases it stimulates the process. ClpX and ClpY cannot interact with DNA-bound TrfA, while the ClpAP and Lon activities are enhanced by the formation of nucleoprotein complexes involving both the protease and TrfA. Lon has to interact with TrfA before contacting DNA, or this interaction can occur with TrfA already bound to DNA. The TrfA degradation by Lon can be carried out only on DNA. The absence of Lon results with higher stability of TrfA in the cell