A1c Reduction and Weight Loss in a Veteran Population Using GLP-1-RAs

Background: Diabetes mellitus is a metabolic disorder defined by high blood glucose. Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) are a newer class of medications that offer potential 2 to 3 kg weight loss and a 1% to 1.5% decrease in A1c. At the Indianapolis Veterans Affairs Medical Center (VAMC), GLP-1-RAs are non-formulary. Objectives: Primary outcomes included mean change in weight, body mass index (BMI) and A1c in VAMC patients. Secondary outcomes included the comparison to published values, analysis of insulin needs, and analysis of GLP-1-RA discontinuation reasons. Methods: Indianapolis VAMC patients ages 18-80 with type 2 diabetes who started a GLP-1-RA from January 1, 2010 to July 1, 2016 were identified. The following data points were gathered at monthly intervals before spreading out to biannual: specific GLP1-RA and dose; weight; BMI; A1c; other diabetes medications; insulin requirements; and any reason for discontinuation. This report is an analysis of the baseline, 24 week, and 48 week data. Results: With a mean age of 62.2 years and a 90.2% male population, the cohort decreased their weight from baseline by 2.5 kg at 24 weeks of use and 3.6 kg at 48 weeks. A1c decreased by 1.3% in the first 24 weeks and was maintained at 48 weeks. Insulin use decreased during the study. Seven percent of patients discontinued GLP-1- RAs due to GI intolerance. Conclusion: GLP-1-RAs have a similar effect on weight and A1c in the veteran population compared to previous study populations. Based on this and further research, GLP-1-RA use may be expanded in the future

The Hair Dilemma: Conform to Mainstream Expectations or Emphasize Racial Identity

Throughout American history, skin color, eye color, and hair texture have had the power to shape the quality of Black people\u27s lives, and that trend continues today for Black women in the workplace

What You Ignore at Work May Harm You: the Effects of Light, Design, and Nature

This paper looks into the effects of light, design, and nature on employees by incorporating environmental health and environmental design research into useful suggestions for the employee and the employer. The “fit” between a user and their work space has been elaborated on in recent years, and it has been shown that insufficient lighting can cause poor fit and consequential draining of energy and productivity. In the healthcare setting, medication errors have been linked to the amount of lighting within a hospital and to the variable amount of daylight throughout the year. While there is not a quick and easy test to determine an individual’s ideal work environment, there are both small and large changes that can be made to improve health and well-being

A Quantitative Analysis of the Factors Associated with Teacher Attitudes and Perceptions towards Job Satisfaction

The purpose of this study was to identify and examine the factors associated with teacher attitudes and perceptions towards job satisfaction and dissatisfaction. While taking into consideration other reasons for teacher shortages, this study sought to determine if teacher attitudes and perceptions of organizational and workplace conditions influence job satisfaction. Data in this study were gathered using the 2003-2004 Schools and Staffing Survey (SASS), administered through the United States Department of Education’s National Center for Educational Statistics (NCES). The power in using this instrument is that it samples a large number of teachers across the United States, from both public and private schools. This instrument provided a series of Likert-type questions, which gathered information on teacher demand and shortages, teacher and administrative characteristics, school programs, and general conditions in schools. It also collected data on principal and teacher perceptions of school climate, teacher compensation, hiring practices, and basic characteristics of student populations. In this study, the independent variables of salary, administrative support, student discipline, faculty influence/input, and teacher attitude were examined to see their influence on the dependent variable, teacher job satisfaction. Descriptive statistics, including frequencies and percentages, were calculated for the key independent and dependent variables. Finally, hierarchical regression analysis was used. Of the independent variables examined, teacher attitudes and perceptions were the strongest predictors of job satisfaction

Improving Office Workflow to Increase Developmental Screening Using the Ages and Stages Questionnaire (ASQ-3) in a Primary Care Setting

Background: It is estimated that 15% of children in the United States have at least one developmental delay, sadly, less than one-fifth of these children receive early intervention services before the age of three (Vitrikas, Savard, & Bucaj, 2017). Objectives: Design, implement, and evaluate an evidence-based protocol to assist in timely referrals of identified children to intervention services in a pediatric primary care setting through staff education of the developmental screening tool ASQ-3. Methods: Accurate assessment of current practice revealed the need for development and implementation of a protocol. Staff education was evaluated through pre and post-surveys. Data was collected pre and post-protocol implementation through chart reviews. Results: The post-protocol implementation data resulted in an increase in screening and 5 children being referred for early intervention services and 4 are being watched with areas of concern. Conclusions: Through education and the development of a protocol this quality improvement project improved quality of care, referrals, workflow, reimbursement, understanding, and overall developmental screening in this primary care practice. Implications: This developmental screening protocol will provide a foundation to increase overall screening in the practice

Qualitative and Quantitative Analysis of Commercial DNA Swabs and Kits

With the use of DNA becoming increasingly more important in the field of forensics, the analysis of DNA extraction kits and collection swabs is significant. This researches main objective was to find a protocol that extracts the highest quantity and quality amount of DNA from human buccal swabs. Three extraction kits (Zymo Research Quick – gDNA MiniPrep Capped Column DNA Kit, a Bioline Isolate II Genomic DNA Kit, and Invitrogen PureLink Genomic DNA Kit) were tested with three different swabs (standard cotton swabs, Puritan foam swabs, and Isohelix DNA buccal swabs). Following procedures outline by the DNA kits distributors, DNA from buccal cells was extracted. The quality and quantity of the extracted DNA samples was measured by using a NanoDrop 2000 UV – Vis Spectrophotometer. Lastly, the samples were then processed with Rotor – Gene Q Real – Time Polymerase Chain Reaction Cycler to confirm the accuracy of the NanoDrop 2000 UV-Vis spectrophotometer measurements. Modifications were made to the protocol to ensure the aims of the research were satisfied. The experimental results showed that the Invitrogen PureLink Genomic DNA Kit protocol with only half of the PBS (250 μl of PBS) added to the samples extracted the highest quantity and quality amount of DNA with the Puritan foam swabs

Comparison of Oral Glucose Tolerance and Hemoglobin A1c as an Initial Indicator of Type 2 Diabetes

The purpose of this literature review was to evaluate the diagnostic utility of hemoglobin A1c (HbA1c) compared to oral glucose tolerance testing (OGTT) for diagnosis of type 2 diabetes. Databases ClinicalKey, PubMed, Dynamed, and CINAHL withdrew a total of 17 peer-reviewed cross-sectional and retrospective studies, secondary data and pooled data analyses, and meta-analyses. Inclusion criteria included human studies, black, white, Hispanic, and Asian populations, studies \u3c 10 years old, individuals \u3e 15 years of age, fasting plasma glucose in conjunction with OGTT, and subjects without known type 2 diabetes. Exclusion criteria included alternative forms of diabetes, screening and diagnosis of prediabetes, comparisons in relation to specific medical conditions such as heart disease, pregnancy, and gestational diabetes, a prior diabetes diagnosis, and children \u3c15 years old. Discrepancies with sole utilization of HbA1c when used to screen and diagnose type 2 diabetes mellitus were found when compared to OGTT standards. Current literature proposes race, gender, age, and obesity may be related to inaccurately low HbA1c compared to OGTT standards in patients who have not been diagnosed with diabetes. Of those, race and metabolic profiles appear to have the greatest impact in reduction of HbA1c’s sensitivity. An alternative to sole utilization of HbA1c may be increasing utilization of OGTT, especially in those with risk of erroneously low HbA1c and high risk for type 2 diabetes. Longitudinal data is needed to strengthen findings noted in this literature review

Exploring the relationship of MBD1 protein binding CpG sites of methylated DNA

Methylated DNA binding (MBD) proteins control transcriptional regulation by binding methylated DNA at CpG islands to modulate transcriptional activation and silencing of specific genes such as tumor suppressors. The goal is to explore the structure/function relationship between MBD proteins and methylated DNA recognition. By synthesizing the methylated DNA binding region of the MBD1 protein, binding studies test the peptide’s affinity and specificity for methylated DNA. Fluorescence, circular dichroism, and thermal denaturation techniques are utilized to determine the binding affinities and structures of peptides. Studies of peptide mutations can monitor the effectiveness of methylated DNA binding compared to the original peptide. The most structured peptide is expected to have the highest affinity and selectivity, leading to a peptide which can compete with the MBD1 protein for methylated DNA binding. The binding region of the MBD1 protein is composed of a two-stranded β-sheet called a -hairpin connected by a large loop region. This was not observed in the initial peptide sequence. Instead the CD indicated the structure to be random coil. This was expected, the -hairpin portion was synthesized without the full protein limiting favorable interactions to stabilize its structure. However, a fluorescence binding study determined the peptide did bind DNA. Thermal denaturation studies were conducted showing the stability of the peptide. Mutants will be made to increase binding affinity and selectivity in the future. This research could produce a series of peptides which can inhibit methylated DNA binding domains and reduce the silencing of tumor suppressor proteins, providing effective cancer therapeutics

Development Plan for a Multi-Family Residential Building in San Luis Obispo

Real estate development is often regarded as a daunting effort that requires a large sum of time and money. However, a greater supply of multi-family housing will protect cities from this homelessness, lack of availability to education, along with poor mental and physical health conditions. This paper addresses methods in which any new developer can efficiently approach developing small-scale, multi-family housing in San Luis Obispo and see overall profitability. The initial research set forth provides interested parties with a generalized basis of the analysis of value, design considerations, and methods of savings involved in development. The research is then directly applied to a currently vacant, city-owned piece of land in San Luis Obispo which lays out each of the necessary components of development such as the feasibility study, creating a conceptual design for the structure, acquiring necessary approvals and permits, as well as the cost and profit analysis. The case study application identifies the best practices in multi-family development so that the developer can methodically approach their cooperation with the city in supplying affordable housing, while still seeing great return on their investment