Sleep Quality Screening in Primary Care Patients with Chronic Pain

Background: Many patients receive treatment for chronic pain from a primary care provider. There is a known relationship between sleep and pain perception, making sleep an important factor to assess in patients with chronic pain. Unlike in specialist pain management settings, sleep is not routinely assessed in the primary care setting, resulting in missed treatment opportunities and suboptimal chronic pain management. Objective: To assess the sleep quality of patients with chronic pain in the primary care setting through the use of the Pittsburgh Sleep Quality Index (PSQI) questionnaire during the patient intake process. Methods: Patients meeting inclusion criteria received a PSQI while waiting to see a provider at chronic care visits. The primary care provider was alerted to the result, and patients who were identified as having poor sleep quality scoring \u3e 5 on the PSQI had the opportunity to receive further assessment and treatment from the provider. Results: Sample data scores revealed 77.7% (n = 7) of patients with chronic pain had global PSQI greater than 5, which is indicative of impaired sleep quality (M = 13, SD = 5.24). All patients (n = 9) received educational handouts from their providers concerning sleep hygiene. The number of patients with an insomnia diagnosis (n = 7) and the number of patients receiving prescribed medication for insomnia (n = 2) did not change after the screening implementation. Conclusion: Implementation of a sleep assessment tool such as the PSQI did not support the increased identification of an insomnia diagnosis or increased management of insomnia with medication in the primary care setting

Essays on Public Finance and Time Use.

My dissertation focuses on regional economic policy and the utilization of time use data to explore economic behavior. I am interested in how regional economic policy frequently fails to account for unintended consequences, generating impacts at odds with intended goals and how time use data enriches our understanding of economic behavior. In my first paper, “The Effect of Enterprise Community Designation for Rural Areas,” I perform a program evaluation of a federal economic development program for rural areas. For controls, I utilize communities who failed at obtaining designation, census tracts that border designated communities and economically similar areas discovered through a propensity score approach. In the term of evaluation, I find evidence of capitalization of increased services and infrastructure in housing values but little difference between the selected communities and their controls. I conclude that the impact of developing an application for such a program may be more important than the program itself. The next essay, “Pump Pressure: Income, Public Transportation and the Time Use Response to Gas Prices,” investigates the responsiveness of time spent in forms of transportation and for different purposes to real gas price changes, the attractiveness of public transportation in a respondent’s metropolitan area and their interaction. I find the inclusion of an interaction term important in correctly controlling for the effect of gas prices themselves and conclude policy makers should account for dampening behavior impacts gasoline taxes and public transportation expansion can have on each other as well as how these policies differentially affect households of different income. My final essay, “Employment and Intra-household Time Allocation,” also utilizes time use data to examine the impact of spousal unemployment and time use on one’s own time use. My results are consistent with other studies in finding a very small, but statistically significant impact of about an hour per week added worker effect. I also construct estimates of partner spousal time use where data do not exist to calculate marginal impacts, finding strong leisure complementarity between partners and some substitutability of household production.PHDPublic Policy & EconomicsUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/102335/1/nmontgom_1.pd

Large autosomal copy-number differences within unselected monozygotic twin pairs are rare

Monozygotic (MZ) twins form an important system for the study of biological plasticity in humans. While MZ twins are generally considered to be genetically identical, a number of studies have emerged that have demonstrated copy-number differences within a twin pair, particularly in those discordant for disease. The rate of autosomal copy-number variation (CNV) discordance within MZ twin pairs was investigated using a population sample of 376 twin pairs genotyped on Illumina Human610-Quad arrays. After CNV calling using both QuantiSNP and PennCNV followed by manual annotation, only a single CNV difference was observed within the MZ twin pairs, being a 130 KB duplication of chromosome 5. Five other potential discordant CNV were called by the software, but excluded based on manual annotation of the regions. It is concluded that large CNV discordance is rare within MZ twin pairs, indicating that any CNV difference found within phenotypically discordant MZ twin pairs has a high probability of containing the causal gene(s) involved

Mutations in the E2 glycoprotein and the 3\u27 untranslated region enhance chikungunya virus virulence in mice

Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus that causes debilitating musculoskeletal pain and inflammation and can persist for months to years after acute infection. Although studies of humans and experimentally infected animals suggest that CHIKV infection persists in musculoskeletal tissues, the mechanisms for this remain poorly understood. To evaluate this further, we isolated CHIKV from the serum of persistently infected Rag1 -/- mice at day 28. When inoculated into naive wild-type (WT) mice, this persistently circulating CHIKV strain displayed a capacity for earlier dissemination and greater pathogenicity than the parental virus. Sequence analysis revealed a nonsynonymous mutation in the E2 glycoprotein (E2 K200R) and a deletion within the 3' untranslated region (3'-UTR). The introduction of these changes into the parental virus conferred enhanced virulence in mice, although primary tropism for musculoskeletal tissues was maintained. The E2 K200R mutation was largely responsible for enhanced viral dissemination and pathogenicity, although these effects were augmented by the 3'- UTR deletion. Finally, studies with Irf3/Irf7 -/- and Ifnar1 -/- mice suggest that the E2 K200R mutation enhances viral dissemination from the site of inoculation independently of interferon regulatory factor 3 (IRF3)-, IRF7-, and IFNAR1-mediated responses. As our findings reveal viral determinants of CHIKV dissemination and pathogenicity, their further study should help to elucidate host-virus interactions that determine acute and chronic CHIKV infection

Exonerations in the United States 1989 through 2003

On August 14, 1989, the Cook County Circuit Court in Chicago, Illinois, vacated Gary Dotson\u27s 1979 rape conviction and dismissed the charges.1 Mr. Dotson-who had spent ten years in and out of prison and on parole for this conviction-was not the first innocent prisoner to be exonerated and released in America. But his case was a breakthrough nonetheless: he was the first who was cleared by DNA identification technology. It was the beginning of a revolution in the American criminal justice system. Until then, exonerations of falsely convicted defendants were seen as aberrational. Since 1989, these once-rare events have become disturbingly commonplace

Exonerations in the United States 1989 Through 2003

On August 14, 1989, the Cook County Circuit Court in Chicago, Illinois, vacated Gary Dotson\u27s 1979 rape conviction and dismissed the charges.1 Mr. Dotson-who had spent ten years in and out of prison and on parole for this conviction-was not the first innocent prisoner to be exonerated and released in America. But his case was a breakthrough nonetheless: he was the first who was cleared by DNA identification technology. It was the beginning of a revolution in the American criminal justice system. Until then, exonerations of falsely convicted defendants were seen as aberrational. Since 1989, these once-rare events have become disturbingly commonplace

Copper-mediated conversion of complex ethers to esters : enabling biopolymer depolymerisation under mild conditions

Authors acknowledge the China Scholarship Council (G.X. studentship), the University of St Andrews (G.X. and J.R.D.M. studentships) and the EPSRC-funded CRITICAT Centre for Doctoral Training (studentship to I.P.; EP/L016419/1) for PhD funding. C.S.L. thanks the Leverhulme Trust Early Career Fellowship (ECF-2018-480) and the University of St Andrews.Selective processing of the β-O-4 unit in lignin is essential for the efficient depolymerisation of this biopolymer and therefore its successful integration into a biorefinery set-up. An approach is described in which this unit is modified to incorporate a carboxylic ester with the goal of enabling the use of mild depolymerisation conditions. Inspired by preliminary results using a Cu/TEMPO/O2 system, a protocol was developed that gave the desired β-O-4-containing ester in high yield using certain dimeric model compounds. The optimised reaction conditions were then applied to an oligomeric lignin model system. Extensive 2D NMR analysis demonstrated that analogous chemistry could be achieved with the oligomeric substrate. Mild depolymerisation of the ester-containing oligomer delivered the expected aryl acid monomer.Publisher PDFPeer reviewe