Synthesis and Analysis of Three-Dimensional Molecular Architectures

The use of resorcinarenes in the study of biologically significant phenomena has been the focus of much attention, due to the versatility of these macrocyclic compounds. In this thesis, two applications of resorcinarenes are explored. First, the search for the mechanism by which tetraarylboronic acid resorcinarenes lead to colorimetric detection and quantization of saccharide analyte concentration in solution is described. Second, the extension of the lower rim conjugation of the resorcinarene macrocycle by the fourfold addition of various length oligo(p-phenylene) rods is discussed. The synthesis of these tubular materials, with potential uses as artificial ion channels and for binding and transportation of large molecular guests, is the primary focus of this work

THE IMPACT OF A MEDICATION PROFILE RELEASE PROGRAM ON OUTPATIENT DRUG USE: AN EVALUATION OF SASKATCHEWAN'S PATIENT PROFILE RELEASE PROGRAM

The Patient Profile Release Program was designed to promote optimal drug use in Saskatchewan by identifying individuals who are at risk for drug-related problems and communicating these drug use concerns to the physicians and pharmacists responsible for their care. During 1992, the PPRP had three components — the Extreme User, Polypharmacy and Polyprescriber Programs — which monitored for the use of high dosages of mood- modifying drugs and asthma medications, the use of multiple different drugs and the use of multiple prescribers, respectively. Similar programs have been implemented elsewhere; however, there is little objective evidence that these programs effectively influence physician prescribing practices and improve patient drug use. The objectives of the present investigation were to describe the individuals who were identified by the PPRP in 1992, evaluate the impact of the PPRP on drug use by these patients and describe the use of mood-modifying drugs and asthma medications in the province of Saskatchewan. An historical cohort study with a 3.5 month follow-up period was used to evaluate the impact of the PPRP. The study population included all individuals who had a profile released under the Program during 1992. Profiles for the intervention group subjects were released at the time that they were identified whereas profile release for the comparison group subjects was delayed for at least two months after the index identification. Re-identification by the PPRP was the primary outcome of interest. During 1992, 3124 individuals were identified by the PPRP, of which 2542 (81%) were eligible for inclusion in this study. 58.7%, 25.1% and 15.3% of the subjects were identified under the ExU, PPh and PPr Programs, respectively. The ExU and PPh subjects tended to be female and elderly. Women were also more likely than men to be identified under the PPr Program. For all three Program components, the intervention group subjects were significantly less likely than comparison group subjects to be re-identified by the PPRP. This reduction in the likelihood of re-identification persisted even after controlling for differences between the study groups with respect to age, sex, residence, coverage type, the numbers of pharmacies and prescribers during the pre-identification period, hospitalization during the follow-up period, the level of extreme use and the number of different drugs. A long-term descriptive analysis of the intervention group subjects demonstrated that re-identification continued during the 9 month post-intervention period. This finding highlights the need for ongoing feedback. The findings of the present investigation indicate that the release of patient medication profiles under Saskatchewan's PPRP was associated with a reduction in the risk of re-identification during a short-term follow-up period. Since re-identification is a marker of changes in drug utilization, the findings indicate that profile release was associated with a decreases in the level of drug use, the number of different drugs and the number of different prescribers for individuals identified under the ExU, PPh and PPr Programs, respectively. Given the high threshold criteria for identification under the PPRP, the observed decreases in drug utilization reflect an improvement in the quality of patient drug use

Acrodermatitis continua of Hallopeau: clinical perspectives.

Acrodermatitis continua of Hallopeau (ACH) is a rare, sterile pustular eruption of one or more digits. The condition presents with tender pustules and underlying erythema on the tip of a digit, more frequently arising on a finger than a toe. As far as classification, ACH is considered a localized form of pustular psoriasis. The eruption typically occurs after local trauma or infection, but such a history is not always present and various other etiologies have been described including infectious, neural, inflammatory, and genetic causes. The natural progression of ACH is chronic and progressive, often resulting in irreversible complications such as onychodystrophy that can result in anonychia, as well as osteitis that can result in osteolysis of the distal phalanges. Because of the rarity of ACH, there have been no randomized controlled studies to evaluate therapies, resulting in an absence of standardized treatment guidelines. In clinical practice, a wide variety of treatments have been attempted, with outcomes ranging from recalcitrance to complete resolution. In recent years, the introduction of biologics has provided a new class of therapy that has revolutionized the treatment of ACH. Specifically, rapid and sustained responses have been reported with the use of anti-tumor necrosis factor agents like infliximab, adalimumab, and etanercept; IL-17 inhibitors like secukinumab; IL-12/23 inhibitors like ustekinumab; and IL-1 inhibitors like anakinra. Nevertheless, there remains a considerable need for more research into treatment for the benefit of individual patients with ACH as well as for the clinical knowledge gained by such efforts. The purpose of this review is to provide a comprehensive overview of the key features of ACH as well as a discussion of clinical management strategies for this unique and debilitating condition

Effects of Hydrogen on InP Light-Emitting Devices Etched in a Methane-Hydrogen Environment

Research has been conducted on the physical damage and hydrogenation effects during RF plasma exposure and epitaxial growth in the III-V material system. Device consequences of this damage or chemical alteration have received less attention, particularly in active light emitting devices. This paper discusses these effects for lasers and edge emitting light-emitting diodes (EELEDs) which use a ridge waveguide structure. By using analysis techniques such as SIMS we have concluded that methane-hydrogen reactive ion etching of InP induces hydrogen levels in an active device which are high enough to significantly alter the device properties. The decrease in light output is substantial, but subsequent annealing times as short as 1 min. at 430°C can restore power dramatically

Laminin 332 processing impacts cellular behavior

Laminin 332, composed of the α3, β3 and γ2 chains, is an epithelial-basement membrane specific laminin variant. Its main role in normal tissues is the maintenance of epithelial-mesenchymal cohesion in tissues exposed to external forces, including skin and stratified squamous mucosa. After being secreted and deposited in the extracellular matrix, laminin 332 undergoes physiological maturation processes consisting in the proteolytic processing of domains located within the α3 and the γ2 chains. These maturation events are essential for laminin 332 integration into the basement membrane where it plays an important function in the nucleation and maintenance of anchoring structures. Studies in normal and pathological situations have revealed that laminin 332 can trigger distinct cellular events depending on the level of its proteolytic cleavages. In this review, the biological and structural characteristics of laminin 332 domains are presented and we discuss whether they trigger specific functions

“Disadvantaged patient populations”: A theory-informed education needs assessment in an urban teaching hospital

Recent calls in medical education and health care emphasize equitable care for disadvantaged patient populations (DPP), with education  highlighted as a key mechanism to move toward this goal. However, in order to develop effective education strategies we must first better understand the DPP concept. We conducted a theory-informed needs assessment to explore the concept of DPP as understood in our hospital.  Using an interpretive qualitative approach informed by principles of critical discourse analysis we conducted focus groups with trainees and staff across professions and groups, as identified in the hospital’s strategic plan, representing “patients experiencing disadvantage.” We identified three main perceptions about DPP:  1) disadvantaged patients require care above and beyond what is normal; 2) the system is to blame for failures in serving disadvantaged patients; and 3) labelling patients is problematic and stigmatizing. In response, patients wanted to be first seen as valuable human beings rather than as a burden or category. Patients appreciated that the DPP concept opened up better access to care, but also felt ‘othered’ by the concept. As a result, patients felt they were not accessing the same level of care in terms of compassion and respect.  Our findings suggest potential for three, theory-informed educational approaches to help improve care for patients experiencing disadvantage: 1) sharing authentic and varied stories; 2) fostering dialogue; and 3) aligning assessment approaches with educational approaches. Additionally, we suggest a need to define access beyond the ability to receive services; according to our participants, access must also engender a sense of common humanity and respect.&nbsp

mHealth intervention development to support patients with active tuberculosis

Background: Mobile Health (mHealth) based interventions have been increasingly used to improve a broad range of health outcomes. However, few researchers have reported on the process or the application of theory to guide the development of mHealth based interventions, or specifically for tuberculosis (TB) treatment management. Aims: To describe the steps, process, and considerations in developing a text messaging-based intervention to promote treatment adherence and provide support to patients with active TB. Methods: Traditional qualitative techniques, including semi-structured interviews, field notes, content analysis, iterative coding, and thematic analysis, were used to design and document the intervention development with a multidisciplinary team of researchers, clinicians, administrators, and patients who were in active TB treatment. The Information-Motivation-Behavioral Skills (IMB) model was used to guide the coding scheme for content analysis of patient-directed TB educational material and intervention development. Results: The development steps included: a) establishing intervention components, including justifications, considerations, timing and frequency of components; b) developing educational messages, including cultural adaption, text or short message service (SMS) formatting, and prioritizing message delivery order; and c) determining implementation protocol. A set of 16 IMB-based messages were developed for the educational component. Final intervention development was achieved in 3 months. Conclusion: A collaborative approach and application of a theory to guide the intervention design and development is supported. Although a collaborative approach was more time consuming, it resulted in a more responsive, culturally appropriate, and comprehensive intervention. Considerations for developing a text messaging based intervention are provided and may serve as a guide for similar interventions. Further empirical evidence is needed for applying the IMB model for adherence-promotion in TB efforts

Organisational and staff-related effects on cultural competence in the hospital setting: a cross-sectional online survey of nursing and medical staff

Background: Cultural competence is considered a core qualification for dealing with socio-cultural diversity and balancing disparities in health care. Objectives: To explore features supporting and inhibiting cultural competence in the hospital at both organisational and staff levels. Design: Cross-sectional online survey in the form of a full census from May to November 2018. Setting: Two organisations that run a total of 22 hospitals in Germany. Participants: Eight hundred nursing and medical professionals [nurses: n = 557; doctors: n = 243]. Methods: Using the Short Form Cultural Intelligence SCALE (SFCQ), cultural competence was measured and its relation to potential influencing factors at staff level and organisational level examined, using bivariate (t-Test, one-way ANOVA, Pearson and Spearman correlations) and multivariate (multiple linear regression) approaches. Model 1 examined features at organisational level, Model 2 at individual level and Model 3 included organisational and individual features. Results: The mean cultural competence measured was 3.49 [min.: 1.3; max.: 5.0]. In the bivariate and isolated multivariate models [Models 1 and 2], factors on both organisational and individual levels were significantly related to the hospital staff's cultural competence. The multivariate overview [Model 3], however, revealed that individual features at staff level were the statistically relevant predictors. Positive influencing features included staff's assessment of the importance of cultural competence in their professional context [B: 0.368, 95% confidence interval 0.307; 0.429], participation in competence training [B: 0.193; 95% confidence interval 0.112; 0.276] and having a migration background [B: 0.175; 95% confidence interval 0.074; 0.278], while negative features included length of medical service [B: -0.004; 95% confidence interval -0.007; -0.001]. Conclusions: The development and practice of cultural competence appear to be determined less by organisational features and more on the level of individual actors. In addition to staff development, adequate organisational structures and an economic incentive system are required to promote sociocultural diversity in hospitals

The dendritic and T cell responses to herpes simplex virus-1 are modulated by dietary vitamin E

Previous studies from our laboratory have shown that dietary α-tocopherol (vitamin EVE) is essential for regulating the cytokine and chemokine response in the brain to herpes simplex virus-1 (HSV-1) infection. The timing of T cell infiltration is critical to the resolution of central nervous system HSV-1 infections. Specifically, the appearance of “neuroprotective” CD8+IFN-γ+ T cells is crucial. During CNS infection, CD8+ T cell priming and expansion in the draining lymph node, followed by recruitment and expansion occurs in the spleen with subsequent accumulation in the brain. Weanling male BALB/cByJ mice were placed on VE deficient (Def) or adequate (Adq) diets for 4 weeks followed by intranasal infection with HSV-1. VE Def mice had fewer CD8+IFN-γ+ T cells trafficking to the brain despite increased CD8+IFN-γ+ T cells and activated dendritic cells in the periphery. VE Def mice had increased T regulatory cells in the periphery and brain and the increase in Tregs decreases CD8+ T cell numbers in the brain. Our results demonstrate that adequate levels of VE are important for trafficking antigen-specific T cells to the brain and dietary VE levels modulate T regulatory and dendritic cells in the periphery

Employee Satisfaction with Onsite Clinic and Collaborative Care Pharmacy

Background: On-job-productivity loss (presenteeism), voluntary non-attendance at work (absenteeism), work-related injuries, and the wage replacement cost of disability are major factors promoting the need for employer-based onsite health clinics. Objective: To determine employee satisfaction with an employer-based clinic and pharmacy. Design: One-group pre-test-post-test research design. Setting: One utility company in South Eastern United States. Participants: A convenience sample of employees (n = 20) working for the utility company. Methods: Company employees were emailed an informational letter announcing the study, including instructions on how to participate. Consent was sought by a research assistant, not associated with patient care, to avoid perceptions of coercion. Participants were given a pre- and post-care survey to complete privately before and after their scheduled appointment. Results: Ten participants showed no change in perception of quality of care and service; Ten participants gave higher quality of care and service ratings following use of the on-site clinic and pharmacy. The median change score was +0.50, which was statistically significant with the sign text (p = .002, two-tailed). Results reflected a higher degree of patient satisfaction and more positive perceptions of care based on the use of the employer-sponsored onsite clinic with pharmacy. Conclusions: Results suggest participants’ satisfaction and positive perceptions of care increased once participant experienced the services of the onsite clinic and pharmacy. As a result, employees are more likely to seek treatment. Companies may benefit from increased attendance and higher productivity when accessibility to a health care provider and medications to treat an acute illness exist