Manufacturing Ceramics: Ceramic Ecology and Technological Choice in the Upper Cumberland River Valley

Ceramic material culture recovered from archaeological sites has more to offer the researcher than placing the site or strata into a cultural historic timeline. By examining the characteristics of ceramics manufactured during the Woodland Period in southern Kentucky, this thesis answers questions related to the behavior of the potters who lived and worked there. Using the theoretical basis of ceramic ecology and technological choice, this thesis examines the choices made by the potters of two sites, the Long (15Ru17) and Rowena (15Ru10) sites, located along the Cumberland River in Russell County, Kentucky. The two sites are also compared to one another and similar assemblages in the Upper Cumberland River Valley, in terms of temporal occupation and utilization of tempering resources. Ultimately, the potters who occupied the Long and Rowena sites during the Woodland Period used locally available materials to temper their clay, even as they emulated other ceramic types. In terms of the two sites themselves, it appears that while they were not occupied by the same population of potters, they did employ similar tempering agents and stylistic types. Examining the behavior of potters who occupied these two sites informs the researcher about the behavior of the larger region of the Upper Cumberland Valley

Read Me: The Emergence of Female Voice in American Epistolary Fiction

The objective of the thesis was to study how the letter, as a narrative device provided by the epistolary genre, supplies unheard female characters with an avenue to “speak” when their worlds do not allow it. In the novels, the letters not only permit a female character to practice building a voice, but also provide a self-reflection and identification experience, which enables the woman to see where she is, rewrite her role, and control where she wants to go. Through reading Hannah Webster Foster’s The Coquette, Alice Walker’s The Color Purple, Lee Smith’s Fair and Tender Ladies, and Maria Semple’s Where’d You Go, Bernadette, I argue that the letter grants female characters with the authority to discuss topics of desire, power, and gender expectations without restriction. Focusing on Walker’s Celie and Smith’s Ivy, the thesis explores how the epistle fundamentally nurtures their narrative voices, while Foster’s Eliza sets up the history of genre and Semple’s Bernadette challenges its future

Identification and cost of adverse events in metastatic breast cancer in taxane and capecitabine based regimens.

PurposeWe sought to compare the economic impact of treatment-related adverse events (AEs) in patients with metastatic breast cancer (mBC) using taxane- or capecitabine-based treatment regimens as either first- or second-line (FL or SL) therapy in the US.MethodsWe used healthcare claims data from the Truven Health Analytics MarketScan® Commercial Databases to conduct a retrospective cohort study comparing the economic impact of AEs amongst taxane- and capecitabine-treated mBC patients in the US. We selected women diagnosed with mBC between 2008-2010 who received a taxane or capecitabine as first- or second-line (FL or SL) chemotherapy. Costs related to hospitalization, outpatient services, emergency department visits, chemotherapy and other medications were tabulated and combined to determine total healthcare costs. The incremental monthly costs associated with the presence of AEs compared to no AEs were estimated using generalized linear models, controlling for age and Charlson Comorbidity Index.ResultsWe identified 15,443 mBC patients meeting inclusion criteria. Adjusted total monthly costs were significantly higher in those who experienced AEs than in those without AEs in both lines of treatment (FL incremental cost: taxanes $1,142, capecitabine$1,817; SL incremental cost: taxanes $1,448, capecitabine$4,437). Total costs increased with the number of AEs and were primarily driven by increased hospitalization amongst those with AEs.ConclusionsAdverse events in taxane- or capecitabine-treated mBC patients are associated with significant increases in costs. Selecting treatment options associated with fewer AEs may reduce costs and improve outcomes in these patients

Dual Use of a Patient Portal and Clinical Video Telehealth by Veterans with Mental Health Diagnoses: Retrospective, Cross-Sectional Analysis

BACKGROUND: Access to mental health care is challenging. The Veterans Health Administration (VHA) has been addressing these challenges through technological innovations including the implementation of Clinical Video Telehealth, two-way interactive and synchronous videoconferencing between a provider and a patient, and an electronic patient portal and personal health record, My HealtheVet. OBJECTIVE: This study aimed to describe early adoption and use of My HealtheVet and Clinical Video Telehealth among VHA users with mental health diagnoses. METHODS: We conducted a retrospective, cross-sectional analysis of early My HealtheVet adoption and Clinical Video Telehealth engagement among veterans with one or more mental health diagnoses who were VHA users from 2007 to 2012. We categorized veterans into four electronic health (eHealth) technology use groups: My HealtheVet only, Clinical Video Telehealth only, dual users who used both, and nonusers of either. We examined demographic characteristics and mental health diagnoses by group. We explored My HealtheVet feature use among My HealtheVet adopters. We then explored predictors of My HealtheVet adoption, Clinical Video Telehealth engagement, and dual use using multivariate logistic regression. RESULTS: Among 2.17 million veterans with one or more mental health diagnoses, 1.51% (32,723/2,171,325) were dual users, and 71.72% (1,557,218/2,171,325) were nonusers of both My HealtheVet and Clinical Video Telehealth. African American and Latino patients were significantly less likely to engage in Clinical Video Telehealth or use My HealtheVet compared with white patients. Low-income patients who met the criteria for free care were significantly less likely to be My HealtheVet or dual users than those who did not. The odds of Clinical Video Telehealth engagement and dual use decreased with increasing age. Women were more likely than men to be My HealtheVet or dual users but less likely than men to be Clinical Video Telehealth users. Patients with schizophrenia or schizoaffective disorder were significantly less likely to be My HealtheVet or dual users than those with other mental health diagnoses (odds ratio, OR 0.50, CI 0.47-0.53 and OR 0.75, CI 0.69-0.80, respectively). Dual users were younger (53.08 years, SD 13.7, vs 60.11 years, SD 15.83), more likely to be white, and less likely to be low-income than the overall cohort. Although rural patients had 17% lower odds of My HealtheVet adoption compared with urban patients (OR 0.83, 95% CI 0.80-0.87), they were substantially more likely than their urban counterparts to engage in Clinical Video Telehealth and dual use (OR 2.45, 95% CI 1.95-3.09 for Clinical Video Telehealth and OR 2.11, 95% CI 1.81-2.47 for dual use). CONCLUSIONS: During this study (2007-2012), use of these technologies was low, leaving much potential for growth. There were sociodemographic disparities in access to My HealtheVet and Clinical Video Telehealth and in dual use of these technologies. There was also variation based on types of mental health diagnosis. More research is needed to ensure that these and other patient-facing eHealth technologies are accessible and effectively used by all vulnerable patients

Policy Feedback and the Politics of the Affordable Care Act

There is a large body of literature devoted to how “policies create politics” and how feedback effects from existing policy legacies shape potential reforms in a particular area. Although much of this literature focuses on self‐reinforcing feedback effects that increase support for existing policies over time, Kent Weaver and his colleagues have recently drawn our attention to self‐undermining effects that can gradually weaken support for such policies. The following contribution explores both self‐reinforcing and self‐undermining policy feedback in relationship to the Affordable Care Act, the most important health‐care reform enacted in the United States since the mid‐1960s. More specifically, the paper draws on the concept of policy feedback to reflect on the political fate of the ACA since its adoption in 2010. We argue that, due in part to its sheer complexity and fragmentation, the ACA generates both self‐reinforcing and self‐undermining feedback effects that, depending of the aspect of the legislation at hand, can either facilitate or impede conservative retrenchment and restructuring. Simultaneously, through a discussion of partisan effects that shape Republican behavior in Congress, we acknowledge the limits of policy feedback in the explanation of policy stability and change

Genome-wide analysis of signaling networks regulating fatty acid–induced gene expression and organelle biogenesis

Reversible phosphorylation is the most common posttranslational modification used in the regulation of cellular processes. This study of phosphatases and kinases required for peroxisome biogenesis is the first genome-wide analysis of phosphorylation events controlling organelle biogenesis. We evaluate signaling molecule deletion strains of the yeast Saccharomyces cerevisiae for presence of a green fluorescent protein chimera of peroxisomal thiolase, formation of peroxisomes, and peroxisome functionality. We find that distinct signaling networks involving glucose-mediated gene repression, derepression, oleate-mediated induction, and peroxisome formation promote stages of the biogenesis pathway. Additionally, separate classes of signaling proteins are responsible for the regulation of peroxisome number and size. These signaling networks specify the requirements of early and late events of peroxisome biogenesis. Among the numerous signaling proteins involved, Pho85p is exceptional, with functional involvements in both gene expression and peroxisome formation. Our study represents the first global study of signaling networks regulating the biogenesis of an organelle

Effects of metformin on retinoblastoma growth in vitro and in vivo

Recent studies suggest that the anti-diabetic drug metformin may reduce the risk of cancer and have anti-proliferative effects for some but not all cancers. In this study, we examined the effects of metformin on human retinoblastoma cell proliferation in vitro and in vivo. Two different human retinoblastoma cell lines (Y79, WERI) were treated with metformin in vitro and xenografts of Y79 cells were established in nu/nu immune-deficient mice and used to assess the effects of pharmacological levels of metformin in vivo. Metformin inhibited proliferation of the retinoblastoma cells in vitro. Similar to other studies, high concentrations of metformin (mM) blocked the cell cycle in G0–G1, indicated by a strong decrease of G1 cyclins, especially cyclin D, cyclin-dependent kinases (4 and 6), and flow cytometry assessment of the cell cycle. This was associated with activation of AMPK, inhibition of the mTOR pathways and autophagy marker LC3B. However, metformin failed to suppress growth of xenografted tumors of Y79 human retinoblastoma cells in nu/nu mice, even when treated with a maximally tolerated dose level achieved in human patients. In conclusion, suprapharmacological levels (mM) of metformin, well above those tolerated in vivo, inhibited the proliferation of retinoblastoma cells in vitro. However, physiological levels of metformin, such as seen in the clinical setting, did not affect the growth of retinoblastoma cells in vitro or in vivo. This suggests that the potential beneficial effects of metformin seen in epidemiological studies may be limited to specific tumor types or be related to indirect effects/mechanisms not observed under acute laboratory conditions

Using multiple chronometers to establish a long, directly-dated lacustrine record:Constraining >600,000 years of environmental change at Chew Bahir, Ethiopia

Despite eastern Africa being a key location in the emergence of Homo sapiens and their subsequent dispersal out of Africa, there is a paucity of long, well-dated climate records in the region to contextualize this history. To address this issue, we dated a ∼293 m long composite sediment core from Chew Bahir, south Ethiopia, using three independent chronometers (radiocarbon, 40Ar/39Ar, and optically stimulated luminescence) combined with geochemical correlation to a known-age tephra. The site is located in a climatically sensitive region, and is close to Omo Kibish, the earliest documented Homo sapiens fossil site in eastern Africa, and to the proposed dispersal routes for H. sapiens out of Africa. The 30 ages generated by the various techniques are internally consistent, stratigraphically coherent, and span the full range of the core depth. A Bayesian age-depth model developed using these ages results in a chronology that forms one of the longest independently dated, high-resolution lacustrine sediment records from eastern Africa. The chronology illustrates that any record of environmental change preserved in the composite sediment core from Chew Bahir would span the entire timescale of modern human evolution and dispersal, encompassing the time period of the transition from Acheulean to Middle Stone Age (MSA), and subsequently to Later Stone Age (LSA) technology, making the core well-placed to address questions regarding environmental change and hominin evolutionary adaptation. The benefits to such studies of direct dating and the use of multiple independent chronometers are discussed. Highlights • Four independent dating methods applied to ∼293 m lake core from southern Ethiopia. • Reveals 620 ka high-resolution sedimentary record near key fossil hominin sites. • Mean accumulation rate of 0.47 mm/a comparable to other African lacustrine sediments. • Accumulation rate fell to 0.1 mm/a during MIS 2, likely due to reduced sediment supply. • Use of multiple independent chronometers is a powerful approach in lake settings

High Energy Replicated Optics to Explore the Sun: Hard X-Ray Balloon-Borne Telescope

Set to fly in the Fall of 2013 from Ft. Sumner, NM, the High Energy Replicated Optics to Explore the Sun (HEROES) mission is a collaborative effort between the NASA Marshall Space Flight Center and the Goddard Space Flight Center to upgrade an existing payload, the High Energy Replicated Optics (HERO) balloon-borne telescope, to make unique scientific measurements of the Sun and astrophysical targets during the same flight. The HEROES science payload consists of 8 mirror modules, housing a total of 109 grazing-incidence optics. These modules are mounted on a carbon-fiber - and Aluminum optical bench 6 m from a matching array of high pressure xenon gas scintillation proportional counters, which serve as the focal-plane detectors. The HERO gondola utilizes a differential GPS system (backed by a magnetometer) for coarse pointing in the azimuth and a shaft angle encoder plus inclinometer provides the coarse elevation. The HEROES payload will incorporate a new solar aspect system to supplement the existing star camera, for fine pointing during both the day and night. A mechanical shutter will be added to the star camera to protect it during solar observations. HEROES will also implement two novel alignment monitoring system that will measure the alignment between the optical bench and the star camera and between the optics and detectors for improved pointing and post-flight data reconstruction. The overall payload will also be discussed. This mission is funded by the NASA HOPE (Hands On Project Experience) Training Opportunity awarded by the NASA Academy of Program/Project and Engineering Leadership, in partnership with NASA's Science Mission Directorate, Office of the Chief Engineer and Office of the Chief Technologis

Escitalopram in Adolescents with Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled Study

Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat pediatric anxiety disorders, including generalized anxiety disorder (GAD); however, their efficacy and tolerability are difficult to predict. This study evaluated the efficacy and tolerability of escitalopram in adolescents with GAD (DSM-IV-TR) and the impact of variants in HTR2A and serotonin transporter (SLC6A4) genes and cytochrome P450 2C19 (CYP2C19) phenotypes on response as well as CYP2C19 phenotype on escitalopram pharmacokinetics from February 2015 through November 2018. Methods: Patients were treated with escitalopram (forced titration to 15 mg/d, then flexible titration to 20 mg/d) (n = 26, mean ± SD age: 14.8 ± 1.7 years) or placebo (n = 25, mean ± SD age: 14.9 ± 1.6 years) for 8 weeks. Outcomes were the change in scores on the Pediatric Anxiety Rating Scale (PARS) and Clinical Global Impressions (CGI) scales as well as vital signs and adverse events. Plasma escitalopram and desmethylcitalopram area under the curve during 24 hours (AUC0-24) and maximum concentration (Cmax) were determined and compared across CYP2C19 phenotypes. Results: Escitalopram was superior to placebo for mean ± SD baseline-to-endpoint change in PARS (-8.65 ± 1.3 vs -3.52 ± 1.1, P = .005) and CGI scores, and increasing CYP2C19 metabolism was associated with decreases in escitalopram Cmax (P = .07) and AUC0-24 (P < .05). Vital signs, corrected QT interval, and adverse events were similar in patients who received escitalopram and placebo. Conclusions: Escitalopram reduces anxiety symptoms, and pharmacogenetics variables influence the trajectory and magnitude of improvement. Variation in CYP2C19 metabolism accounts for significant differences in escitalopram pharmacokinetics, raising the possibility that CYP2C19 phenotype should be considered when prescribing escitalopram