Teaching Internal Medicine Residents about Genetics: One topic at a Time - Breast Cancer

Background: Currently, the field of medicine is experiencing rapid changes in genetics and genomics information. While medical school curricula all include some genetics education, the content may vary from one school to another, leaving Internal Medicine (IM) residents with different skills and knowledge. In an IM residency where residents come from different medical schools, presenting an organized genetics curriculum may have value. Patients expect their physicians to be knowledgeable and current about their specific disease, including the genetic components and expect that they can inform them about terminology, inheritance, diagnostic testing, risks and benefits of testing. Physicians will need education about how to find current information about genetics factors in many diseases, and how to inform and counsel their patients using web-based tools. Purpose: The purpose of this project was to identify baseline genetics knowledge of Internal Medicine (IM) Residents at The George Washington University, and to determine if a 1-hour presentation can be used to improve their knowledge. Methods: We performed a literature review of currently available information on genetics curriculum for IM residents and residency programs in other specialties. Although there is no standardized curriculum in genetics for IM residents, we did identify a proposed curriculum in genetics for IM1.There has also been research in education about genetics in other residencies including Pediatrics, Obstetrics and Gynecology, Psychiatry and Surgery2,3,4,5,6,7,8,9. We propose to deliver a one-hour presentation about genetics and breast cancer to IM residents and medical students at GWU during Grand Rounds. The presentation will include concepts in genetics, as well as specific information about breast cancer and guidelines for testing. We plan a pre-test to assess knowledge about genetics and breast cancer, a one-hour presentation and a post-test. Pre-test and post-test scores will be compared using student’s t-test. Conclusion: We plan to evaluate the efficacy of a one-hour presentation for teaching genetics and use it as a possible model for other genetics education for IM residents. Possible topics for monthly presentations could include: colon cancer, ovarian cancer, emphysema, cardiology – long and short QT, among others

Social/energy policy: an inquiry into the intersection of two policy domains with Australia’s national electricity market

The introduction of competition to electricity markets has been a priority of energy policy in Australia for over 20 years. Throughout this process, economic efficiency objectives have had explicit primacy over social or environmental objectives. Neoliberalism, or economic rationalism as it is often referred to in Australia, not only radically changed the provision of electricity from the 1990s but recast the provision of welfare services by transferring many services from provision by government to provision by ‘private welfare agencies’. Energy policy and social policy can therefore be seen to have been placed on similar paths towards market-based provision of service to households. Importantly this has shifted many frontline responsibilities away from governments to energy retailers and community sector organisations. The electricity market’s consumer safety net has been described as a shared responsibility between industry, governments and community sector organisations. This shared responsibility represents the intersection of energy policy and social policy in Australia akin to fuel poverty policies internationally. However, this intersection is ill-defined and not systemically governed. The key role of community sector organisations in particular is rarely formalised. This research represents the first attempt to develop a coordinated national policy framework for the consumer safety net of Australia’s National Electricity Market. The research question that this thesis seeks to answer is: • When considering a consumer safety net for consumers in a liberalised electricity market, what is an appropriate analytical framework for policy and practice that can be used by stakeholders to improve governance and consumer outcomes? • Subsequently, what priorities emerge from this framework that could be advanced through the policy cycle? In response, this thesis provides a comprehensive, structured review and analysis of the relationship between energy policy and social policy at a time when electricity pricing is undergoing significant changes in terms of structures (tariff reform) and upward pressure as a result of climate change policies and the development of a natural gas export industry. - 4 - The theory and practice of public policy analysis is summarised and guides the structure of the thesis. The research argues for a systematic approach based on the pursuit of 5 public policy outcomes that reflect the interaction between household energy bills and energy, climate and social policies: ● Stable and Efficient Pricing AND ● Informed and engaged consumers AND ● Energy consumed efficiently and productively AND ● Robust consumer protections AND ● All households have a capacity to pay their energy bills This thesis provides context in Chapters 1 and 2 then a chapter is dedicated to each of the five policy outcomes. In each case, the research and analysis is presented in four parts that represent key stages of a policy cycle, the way in which public policy evolves over time: a review of the current arrangements; analysis to identify key issues; empirical analysis and; policy formulation. Consequently, priority policy issues are identified, and recommendations made in the concluding chapter

What’s All the Fizz About? A Teaching Case Study on the Use of Coca-Cola® Freestyle® Machines in Quick-Service Restaurants

This case focuses on the issues surrounding whether the Coca-Cola® Freestyle® machine should be installed at specific quick-service restaurants (QSR). The case explores how to quantify the service performance of the Freestyle® compared to traditional fountain drink dispensers. Also, the nature of specific QSR processes (ordering, food preparation and delivery) could impact whether a Freestyle® is appropriate. The case is designed for use in upper-division undergraduate courses in operations, consumer behavior and strategy. As part of the case, a link to a simulation has been provide: HERE or visit https://drive.google.com/open?id=0B9gWLxcVUszrYmFjd3JQTW9tRFU. Students will use the simulation to answer case question

Reducing the Effect of Transducer Mount Induced Noise on Aeroacoustic Wind Tunnel Testing Data with a New Transducer Mount Design

Flight vehicle aeroacoustic environments induced during transonic and supersonic flight are usually predicted by subscale wind tunnel testing utilizing high frequency miniature pressure transducers. In order to minimize noise induced by the measurement itself, transducer flush mounting with the model surface is very important. The National Aeronautics and Space Administration (NASA) has accomplished flushness in recent testing campaigns via use of a transducer holder that can be machined and sanded. A single hole in the holder allows the flow medium to interact with the transducer diaphragm. Noise is induced by the resulting cavity however, and is a challenge to remove in post-processing. A new holder design has been developed that minimizes the effects of this transducer mount induced noise (XMIN) by reducing the resonance amplitude or increasing its resonance frequency beyond the range of interest. This paper describes a test conducted at the NASA/George C. Marshall Space Flight Center Trisonic Wind Tunnel intended to verify the effectiveness of this design. The results from this test show that this new transducer holder design does significantly reduce the influence of XMIN on measured fluctuating pressure levels without degrading a transducer's ability to accurately measure the noise external to the model

Variscan sourcing of Westphalian (Pennsylvanian) sandstones in the Canobie Coalfield, UK

The zircon age spectrum in a sample from the Canonbie Bridge Sandstone Formation (Asturian) of southern Scotland contains two main peaks. One is Early Carboniferous in age (348– 318 Ma), and corresponds to the age of igneous activity during the Variscan Orogeny. The other is of late Neoproterozoic to early Cambrian age (693–523 Ma), corresponding to the Cadomian. Together, these two groups comprise 70 % of the zircon population. The presence of these two peaks shows unequivocally that a significant proportion of the sediment was derived from the Variscides of western or central Europe. The zircon population also contains a range of older Proterozoic zircons and a small Devonian component. These could have been derived from the Variscides, but it is possible that some were locally derived through recycling of northerly derived sandstones of Devonian–Carboniferous age. The zircon age data confirm previous suggestions of Variscide sourcing to the Canonbie area, made on the basis of petrographical, heavy mineral and palaeocurrent evidence, and extend the known northward distribution of Variscan-derived Westphalian sediment in the UK

Reducing the Effect of Transducer Mount Induced Noise (XMIN) on Aeroacoustic Wind Tunnel Testing Data with a New Transducer Mount Design

Characterization of flight vehicle unsteady aerodynamics is often studied via large scale wind tunnel testing. Boundary layer noise is measured by miniature pressure transducers installed in a model. Noise levels (2-5 dB ref. 20 Pa) can be induced when transducer is mounted out of flush with model outer surface. This effect must be minimized to accurately determine aerodynamically induced acoustic environments

Applying the causal roadmap to longitudinal national Danish registry data: a case study of second-line diabetes medication and dementia

The causal roadmap is a formal framework for causal and statistical inference that supports clear specification of the causal question, interpretable and transparent statement of required causal assumptions, robust inference, and optimal precision. The roadmap is thus particularly well-suited to evaluating longitudinal causal effects using large scale registries; however, application of the roadmap to registry data also introduces particular challenges. In this paper we provide a detailed case study of the longitudinal causal roadmap applied to the Danish National Registry to evaluate the comparative effectiveness of second-line diabetes drugs on dementia risk. Specifically, we evaluate the difference in counterfactual five-year cumulative risk of dementia if a target population of adults with type 2 diabetes had initiated and remained on GLP-1 receptor agonists (a second-line diabetes drug) compared to a range of active comparator protocols. Time-dependent confounding is accounted for through use of the iterated conditional expectation representation of the longitudinal g-formula as a statistical estimand. Statistical estimation uses longitudinal targeted maximum likelihood, incorporating machine learning. We provide practical guidance on the implementation of the roadmap using registry data, and highlight how rare exposures and outcomes over long-term follow up can raise challenges for flexible and robust estimators, even in the context of the large sample sizes provided by the registry. We demonstrate how simulations can be used to help address these challenges by supporting careful estimator pre-specification. We find a protective effect of GLP-1RAs compared to some but not all other second-line treatments

Atmospheric Acetaldehyde: Importance of Air-Sea Exchange and a Missing Source in the Remote Troposphere.

We report airborne measurements of acetaldehyde (CH3CHO) during the first and second deployments of the National Aeronautics and Space Administration (NASA) Atmospheric Tomography Mission (ATom). The budget of CH3CHO is examined using the Community Atmospheric Model with chemistry (CAM-chem), with a newly-developed online air-sea exchange module. The upper limit of the global ocean net emission of CH3CHO is estimated to be 34 Tg a-1 (42 Tg a-1 if considering bubble-mediated transfer), and the ocean impacts on tropospheric CH3CHO are mostly confined to the marine boundary layer. Our analysis suggests that there is an unaccounted CH3CHO source in the remote troposphere and that organic aerosols can only provide a fraction of this missing source. We propose that peroxyacetic acid (PAA) is an ideal indicator of the rapid CH3CHO production in the remote troposphere. The higher-than-expected CH3CHO measurements represent a missing sink of hydroxyl radicals (and halogen radical) in current chemistry-climate models

A Framework for Multifunctional Green Infrastructure Investment in Camden, NJ

This study demonstrates a decision-support framework for planning Green Infrastructure (GI) systems that maximize urban ecosystem services in Camden, NJ. Seven key ecosystem services are evaluated (urban agriculture expansion, combined sewer overflow reduction, heat island reduction, flooding reduction, capacity building/green jobs expansion, fitness expansion, and stress reduction), to produce a normalized value for each service for each drainage sub-basin within the city. Gaps in ecosystem services are then mapped and utilized to geographically prioritize different kinds of multifunctional GI. Conceptual designs are developed for four site typologies: parks, schools, vacant lots, and brownfield sites. For one demonstration site, additional analysis is presented on urban engagement, life cycle cost reduction, and new sources of funding. What results is an integrated, long-term vision where multifunctional GI systems can be readily customized to meet multiple needs within urban communities. This study provides a portable and replicable framework for leveraging the regulatory requirement to manage stormwater to meet broader urban revitalization goals, all through a decentralized network of green infrastructure assets

Evidence of Differential Allelic Effects between Adolescents and Adults for Plasma High-Density Lipoprotein

A recent meta-analysis of genome-wide association (GWA) studies identified 95 loci that influence lipid traits in the adult population and found that collectively these explained about 25–30% of heritability for each trait. Little is known about how these loci affect lipid levels in early life, but there is evidence that genetic effects on HDL- and LDL-cholesterol (HDL-C, LDL-C) and triglycerides vary with age. We studied Australian adults (N = 10,151) and adolescents (N = 2,363) who participated in twin and family studies and for whom we have lipid phenotypes and genotype information for 91 of the 95 genetic variants. Heterogeneity tests between effect sizes in adult and adolescent cohorts showed an excess of heterogeneity for HDL-C (pHet<0.05 at 5 out of 37 loci), but no more than expected by chance for LDL-C (1 out of 14 loci), or trigycerides (0 out 24). There were 2 (out of 5) with opposite direction of effect in adolescents compared to adults for HDL-C, but none for LDL-C. The biggest difference in effect size was for LDL-C at rs6511720 near LDLR, adolescents (0.021±0.033 mmol/L) and adults (0.157±0.023 mmol/L), pHet = 0.013; followed by ZNF664 (pHet = 0.018) and PABPC4 (pHet = 0.034) for HDL-C. Our findings suggest that some of the previously identified variants associate differently with lipid traits in adolescents compared to adults, either because of developmental changes or because of greater interactions with environmental differences in adults