CELLPHONE, EMAIL, AND TEXT-MESSAGING AND PATIENT-PHYSICIAN COMMUNICATION IN PRIMARY CARE

Patient-provider communication is an important aspect of quality of care and poor communication is a frequent problem. Evolving communication technologies can create new problems as well as offer opportunities for addressing them. It is not known how providers choose among available technologies, decide who of their patients to communicate using such technology, or how use influences patient satisfaction. This thesis addresses these questions in three aims, incorporating a survey of primary care providers on their communication patterns, the linkage of survey results with existing patient-reported data, and qualitative interviews with primary care physicians on their experiences with favorite patients. In Aim 1, I found that while more providers had used their cellphones than email to communicate to patients (54% vs. 38%, p=0.03), they were more inclined to give their email addresses than cellphone numbers (56% vs. 37%, p<0.001). Academic providers and providers who gave patients their email addresses were more likely to communicate with their patients electronically than community providers and those who did not give email addresses, respectively. In Aim 2, multivariable regression analyses revealed that making email addresses available to patients by non-pediatric providers was associated with a 19-point difference in overall satisfaction but not individual satisfaction domains. The offering of a provider email address is a signifier of a strong patient-provider relationship. The use of cellphone, email, and text-messaging was not associated with satisfaction. In Aim 3, I found that favorite patients are often not like their physicians in socio-demographic and personality characteristics. Cellphone numbers were privileged by physicians and when given, only to a few patients whose illnesses warranted having direct access; email addresses were given more often, especially when the patient was a fellow physician or employee of the same medical institution. Some favorite patients fell into these categories; others did not. These findings suggest the need for institutional guidelines that establish expectations and boundaries in communicating with patients outside of the office

Benefit Assessment of the Integrated Demand Management Concept for Multiple New York Metroplex Airports

Benefits of the Integrated Demand Management (IDM) concept were assessed utilizing a newly developed automated simulation capability called Traffic Management Initiative Automated Simulation (TMIAutoSim). The IDM concept focuses on improving traffic flow management (TFM) by coordinating the FAAs strategic Traffic Flow Management System (TFMS) with its more tactical Time-Based Flow Management (TBFM) system. The IDM concept leverages a new TFMS capability called Collaborative Trajectory Options Program (CTOP) to strategically pre-condition traffic demand flowing into a TBFM-managed arrival environment, where TBFM is responsible for tactically managing traffic by generating precise arrival schedules. The IDM concept was developed over a multi-year effort, focusing on solving New York metroplex airport arrival problems. TMIAutoSim closely mimics NASAs high-fidelity simulation capabilities while enabling more data to be collected at higher speed. Using this new capability, the IDM concept was evaluated using realistic traffic across various weather scenarios. Six representative weather days were selected after clustering three months of historical data. For those selected six days, Newark Liberty International Airport (EWR) and LaGuardia Airport (LGA) arrival traffic scenarios were developed. For each selected day, the historical data were analyzed to accurately simulate actual operations and the weather impact of the day. The current day operations and the IDM concept operations were simulated for the same weather scenarios and the results were compared. The selected six days were categorized into two groups: clear weather for days without Ground Delay Programs (GDP) and convective weather for days with GDP and significant weather around New York metroplex airports. For the clear weather scenarios, IDM operations reduced last minute, unanticipated departure delays for short-haul flights within TBFM control boundaries with minimal to no impact on throughput and total delay. For the convective weather scenarios, IDM significantly reduced delays and increased throughput to the destination airports

The Influences of Personality and Motivation on Exercise Participation and Quality of Life

[[abstract]]The major purpose of this study was to identify the effects of personality on individual exercise motivation and exercise participation, which then influences quality of life. A comprehensive model was developed, based on an extensive literature review, and empirically tested using members of fitness centers from Taiwan, Europe and the United States as respondents. The results indicate that individuals with a positive personality tend to have higher levels of exercise motivation and exercise participation. Personality and exercise participation then impacted on individuals’ quality of life, in terms of physical health improvement, psychological health improvement, and sexual satisfaction. The study results offer valuable suggestions not only to marketing managers of fitness centers but also to government officers to promote health and quality of life through stimulating exercise motivation and exercise participation

Trends and predictors of changes in pulmonary function after treatment for pulmonary tuberculosis

OBJECTIVES: The present study aimed to investigate the trends in changes in pulmonary function and the risk factors for pulmonary function deterioration in patients with pulmonary tuberculosis after completing treatment. INTRODUCTION: Patients usually have pulmonary function abnormalities after completing treatment for pulmonary tuberculosis. The time course for changes in pulmonary function and the risk factors for deterioration have not been well studied. METHODS: A total of 115 patients with 162 pulmonary function results were analyzed. We retrieved demographic and clinical data, radiographic scores, bacteriological data, and pulmonary function data. A generalized additive model with a locally weighted scatterplot smoothing technique was used to evaluate the trends in changes in pulmonary function. A generalized estimating equation model was used to determine the risk factors associated with deterioration of pulmonary function. RESULTS: The median interval between the end of anti-tuberculosis treatment and the pulmonary function test was 16 months (range: 0 to 112 months). The nadir of pulmonary function occurred approximately 18 months after the completion of the treatment. The risk factors associated with pulmonary function deterioration included smear-positive disease, extensive pulmonary involvement prior to anti-tuberculosis treatment, prolonged anti-tuberculosis treatment, and reduced radiographic improvement after treatment. CONCLUSIONS: After the completion of anti-tuberculosis TB treatment, several risk factors predicted pulmonary function deterioration. For patients with significant respiratory symptoms and multiple risk factors, the pulmonary function test should be followed up to monitor the progression of functional impairment, especially within the first 18 months after the completion of anti-tuberculosis treatment

Synthesis and structure-activity relationship studies of novel 3,9-substituted α-carboline derivatives with high cytotoxic activity against colorectal cancer cells

In our continued focus on 1-benzyl-3-(5-hydroxymethyl-2-furyl)indazole (YC-1) analogs, we synthesized a novel series of 3,9-substituted α-carboline derivatives and evaluated the new compounds for antiproliferactive effects. Structure activity relationships revealed that a COOCH or CHOH group at position-3 and substituted benzyl group at position-9 of the α-carboline nucleus were crucial for maximal activity. The most active compound, , showed high levels of cytotoxicity against HL-60, COLO 205, Hep 3B, and H460 cells with IC values of 0.3, 0.49, 0.7, and 0.8 μM, respectively. The effect of compound on the cell cycle distribution demonstrated G2/M arrest in COLO 205 cells. Furthermore, mechanistic studies indicated that compound induced apoptosis by activating death receptor and mitochondria dependent apoptotic signaling pathways in COLO 205 cells. The new 3,9-substituted α-carboline derivatives exhibited excellent anti-proliferative activities, and compound can be used as a promising pro-apoptotic agent for future development of new antitumor agents

Efficient Detection of Preparing Quantum Remote States Using Coherence Quantum Benefits

A sender can prepare a quantum state for a remote receiver using preshared entangled pairs, only the sender's single-qubit measurement, and the receiver's simple correction informed by the sender. It provides resource-efficient advantages over quantum teleportation for quantum information. Here, we propose the most efficient approach to detect the remote state preparation (RSP) based on the quantum benefits powered by quantum coherence's static resources of the shared pairs and the dynamic resources both the RSP participants input. It requires only the receiver's minimum of one additional coherence creation operation to verify RSP. Experimentally, we implement the introduced RSP assessment using different photon pair states generated from a high-quality polarization Sagnac interferometer, confirming the necessary and sufficient role played by the static and dynamic quantum coherence resources and demonstrating efficient RSP verification. Our results provide a route to efficiently assess RSP in practical scenarios such as quantum information in quantum networks

The design of a prospective, randomized, open-labeled study to compare the efficacy of lercanidipine with amlodipine on renal function in hypertensive patients aged at least 55 years (LEADER study)

AbstractBackgroundAlthough all classes of antihypertensive treatment can successfully reduce morbidity and mortality of cardiac pathology, prevention of target organ damages is of great importance beyond blood pressure lowering. Unlike most dihydropyridines, lercanidipine dilates both afferent and the efferent arterioles of nephrons, so it may provide renoprotective effects, which other CCBs may not have. The main purpose of this study is to compare the renoprotective effect of lercanidipine and amlodipine among hypertensive people aged 55years and older with newly diagnosed hypertension or those who were treatment-naïve for one month.MethodsThe study is a prospective, open-labelled, randomized, controlled trial to enrol 232 hypertensive patients aged ≥55 years. Subjects will be randomized into lercanidipine arm (10–20mg/day) and amlodipine arm (5–10mg/day) by 1:1 ratio. The dosage can be up-titrated to 20mg/day (lercanidipine group) and 10mg/day (amlodipine group), respectively, at week 4 or any following visit thereafter. Efficacy and safety data will be collected at week 4, 12 and 24 by evaluating the blood pressure lowering, estimated glomerular filtration rate, creatinine clearance, and urine albumin-creatinine ratio.ConclusionsThe reno-protective effects of new generation of CCBs such as lercanidipine administered to patients with hypertension are not investigated well. After all, this study will bring benefit to older patients who need drugs with both excellent anti-hypertensive and reno-protective efficacy. And the results will be provided for future treatment guideline of elder population in Taiwan

High Glucose Induces VEGF-C Expression via the LPA1/3-Akt-ROS-LEDGF Signaling Axis in Human Prostate Cancer PC-3 Cells

Background/Aims: Hyperglycemia has been shown to increase the incidence and metastasis in various types of cancers. However, the correlation between hyperglycemia and lymphatic metastasis in prostate cancer (PCa) remains unclear. Our previous study demonstrated that lysophosphatidic acid (LPA) enhances vascular endothelial growth factor-C (VEGF-C) expression, a lymphangiogenic factor, through activating it receptors LPA1/3 in prostate cancer (PCa) cells. Moreover, hyperglycemia up-regulates autotaxin (ATX) expression, a LPA-generating enzyme. Therefore, we propose that high glucose promotes VEGF-C expression through LPA signaling in PCa cells. Methods: Pharmacological inhibitors and siRNAs were utilized to investigate the molecular mechanism of high glucose-induced VEGF-C expression. Real-time PCR and Western blot were used to determine the mRNA and protein expressions, respectively. Cellular bioenergetics analysis was performed to determine the glycolysis levels. Results: We demonstrated that the expressions of VEGF-C, ATX, and calreticulin were increased upon high glucose treatments in PC-3 cells. Moreover, high glucose-induced VEGF-C expression was mediated through the LPA1/3, PLC, Akt, ROS and LEDGF-dependent pathways. Additionally, high glucose enhanced the aerobic glycolysis via LPA1/3. Conclusion: These results indicated that hyperglycemia leads to LPA synthesis, and subsequent promoting pathological consequence of PCa. These novel findings could potentially provide new strategies for PCa treatments

The novel synthetic compound 6-acetyl-9-(3,4,5-trimethoxybenzyl)-9H-pyrido[2,3-b]indole induces mitotic arrest and apoptosis in human COLO 205 cells

A novel synthetic compound 6-acetyl-9-(3,4,5-trimetho-xybenzyl)-9H-pyrido[2,3-b]indole (HAC-Y6) demonstrated selective anticancer activity. In the present study, COLO 205 cells were treated with HAC-Y6 to investigate the molecular mechanisms underlying its effects. HAC-Y6 induced growth inhibition, G2/M arrest and apoptosis in COLO 205 cells with an IC50 of 0.52±0.035 µM. Annexin V/PI double staining demonstrated the presence of apoptotic cells. JC-1 staining analysis showed that HAC-Y6 decreased mitochondrial membrane potential in support of apoptosis. An immunostaining assay revealed that HAC-Y6 depolymerized microtubules. Treatment of COLO 205 cells with HAC-Y6 resulted in increased expression of BubR1 and cyclin B1 and decreased expression of aurora A, phospho-aurora A, aurora B, phospho-aurora B and phospho-H3. HAC-Y6 treatment increased protein levels of active caspase-3, caspase-9, Endo G, AIF, Apaf-1, cytochrome c and Bax, but treatment with the compound caused reduced levels of procaspase-3, procaspase-9, Bcl-xL and Bcl-2. Overall, our results suggest that HAC-Y6 exerts anticancer effects by disrupting microtubule assembly and inducing G2/M arrest, polyploidy and apoptosis via mitochondrial pathways in COLO 205 cells