Provider Education & Requirements for Opioid Prescriptions

Nationally, there has been a surge in the opioid prescription crisis with associated overdose deaths. Vermont is no exception, with increasing opioid overdose related deaths within the last 10 years. A sample (n=111) of opioid addiction patients at the Community Health Centers of Burlington (CHCB) have demonstrated that 25% have their initial use due to provider prescription. New Vermont regulations to decrease opioid prescriptions are inefficient. The goal of this project is to implement a streamlined intervention to improve provider education and comfort regarding new Vermont state opioid prescribing regulations.https://scholarworks.uvm.edu/fmclerk/1326/thumbnail.jp

TNF-α and neuropathic pain - a review

Tumor necrosis factor alpha (TNF-α) was discovered more than a century ago, and its known roles have extended from within the immune system to include a neuro-inflammatory domain in the nervous system. Neuropathic pain is a recognized type of pathological pain where nociceptive responses persist beyond the resolution of damage to the nerve or its surrounding tissue. Very often, neuropathic pain is disproportionately enhanced in intensity (hyperalgesia) or altered in modality (hyperpathia or allodynia) in relation to the stimuli. At time of this writing, there is as yet no common consensus about the etiology of neuropathic pain - possible mechanisms can be categorized into peripheral sensitization and central sensitization of the nervous system in response to the nociceptive stimuli. Animal models of neuropathic pain based on various types of nerve injuries (peripheral versus spinal nerve, ligation versus chronic constrictive injury) have persistently implicated a pivotal role for TNF-α at both peripheral and central levels of sensitization. Despite a lack of success in clinical trials of anti-TNF-α therapy in alleviating the sciatic type of neuropathic pain, the intricate link of TNF-α with other neuro-inflammatory signaling systems (e.g., chemokines and p38 MAPK) has indeed inspired a systems approach perspective for future drug development in treating neuropathic pain

Inventory Management of Platelets in Hospitals: Optimal Inventory Policy for Perishable Products with Emergency Replenishments

Platelets are short-life blood components used in hospital blood transfusion centers. Excluding time for transportation, testing, and arrangement, clinically transfusable platelets have a mere three-day life-span. This paper analyzes a periodic review inventory system for such perishable products under two replenishment modes. Regular orders are placed at the beginning of a cycle. Within the cycle, the manager has the option of placing an emergency order, characterized by an order-up-to level policy. We prove the existence and uniqueness of an optimal policy that minimizes the expected cost. We then derive the necessary and sufficient conditions for the policy, based on which a heuristic algorithm is developed. A numerical illustration and a sensitivity analysis are provided, along with managerial insights. The numerical results show that, unlike typical inventory problems, the total expected cost is sensitive to the regular order policy. It also shows that the optimal policy is sensitive to changes in the expected demand, suggesting to decision makers the significance of having an accurate demand forecast

Policy and design in urban social housing : a reconciliation

Thesis (M. Arch.)--Massachusetts Institute of Technology, Dept. of Architecture, 1980.MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH.Includes bibliographical references.The objective of this thesis is to understand the term " HOUSING" as a verb. This implies that housing is a process which includes three major stages. First, the planning POLICY stage determines distributions of resources, methods of production, and programs of activities. Second, the architectural DESIGN stage transforms these objectives into physical environments through technological means and spatial articulations. Third, the INHABITATION stage involves management of the resulted environment, and its use by inhabitants. The quality of the end product and the user's satisfaction with the product depend on who is making decisions in the three stages. In modern Western urban centers, the results of two centuries of industrialization and urbanization, housing for low-income groups is subsidized by government at federal and local levels. Urban social housing projects, with few exceptions, are products of a hierarchical structuring of the three stages of housing. This structure is possible only when it is controlled by a centralized authority. The problems of this rigidity in urban social housing are manifested in its financial strain on public resources, management crisis, and rapid obsolescence. Also, these problems reflect a mismatch between the needs define d by public agencies and the actual needs of the people housed. Exceptional cases to this mismatch reveal conflicts and contradictions in the present system of housing production, and suggest alternatives to achieve a dialectic and productive interaction between all three stages (POLICY , DESIGN AND INHABITATION) in the housing process. Two major issues addressed in this thesis are the characteristics of alternative housing processes and the role of the architect in such processes.by Lawrence Kai-Leung Cheng.M.Arch

Metric Building of pp Wave Orbifold Geometries

We study strings on orbifolds of $AdS_{5}\times S^5$ by SU(2) discrete groups in the Penrose limit. We derive the degenerate metrics of pp wave of $AdS_{5}\times S^5/\Gamma$ using ordinary $ADE$ and affine \wildtilde{ADE} singularities of complex surfaces and results on ${\cal N}=4$ CFT$_4$'s. We also give explicit metric moduli depencies for abelian and non abelian orbifolds.Comment: 13 pages, no figure

Brane Constructions, Conifolds and M-Theory

We show that a set of parallel 3-brane probes near a conifold singularity can be mapped onto a configuration of intersecting branes in type IIA string theory. The field theory on the probes can be explicitly derived from this formulation. The intersecting-brane metric for our model is obtained using various dualities and related directly to the conifold metric. The M-theory limit of this model is derived and turns out to be remarkably simple. The global symmetries and counting of moduli are interpreted in the M-theory picture.Comment: 31 pages, harvmac (b), 10 eps figures; Minor clarifications and corrections, final version, to appear in Nuclear Physics

Public Awareness of Medical Imaging as a Source of Ionizing Radiation Exposure

Background. Biological effects of exposure to ionizing radiation (IR) are well known. Literature suggests most patients and physicians lack proficient understanding of risks associated with ionizing radiation. Our study goals were to: assess the extent to which productive, informed conversations regarding ionizing radiation are occurring between patients and providers; characterize public awareness of medical imaging procedures as sources of IR exposure; and investigate best practices in patientprovider communications. Methods. We developed and administered a 17-question survey to 303 adults at five locations across Chittenden County, Vermont, over a 6-week period in fall 2016. Descriptive and statistical analyses were conducted using SPSS. Results. The three age groups of respondents had different knowledge levels about ionizing radiation (p Conclusions/Recommendations. 1. A standard oral presentation for pre-imaging patient-provider communication, along with a written handout, be developed; 2. A section of the electronic medical record (also accessible through the patient portal) containing IR exposure be created for patients and physicians to track individuals\u27 information.https://scholarworks.uvm.edu/comphp_gallery/1249/thumbnail.jp

Perfused human organs versus Mary Shelley's Frankenstein

Novel drugs have to go through mandatory pre-clinical testing before they can be approved for use in clinical trials. In essence, it is a form of bench-to-bedside (N2B) translational medicine, but the wastage rate of target candidates is immensely high. Effects seen in vitro often do not translate to in vivo human settings. The search is on for better models closer to human physiology to be used in pre-clinical drug screening. The Ex Vivo Metrics© system has been introduced where a human organ is harvested and revitalized in a controlled environment suitable for testing of both drug efficacy and potential toxicity. This commentary expresses the author's views regarding this technology of perfused human organs