Early Palliative Care in Patients with Chronic Obstructive Pulmonary Disease

Background: There are over 300 million people living with COPD and over 2.9 million people die annually from the disease. Palliative care is an underused resource for this population as it can help establish goals of care, manage disease symptoms, and improve patient’s quality of life. Unfortunately, patients diagnosed with COPD have many effective treatments for their illness but none of them are curative. Therefore, the concept of early use of palliative care is urgently needed to be more widely utilized and understood Purpose: The purpose of this project was to generate a tool to identify patients appropriate for a palliative care consult based on a COPD diagnosis, risk scores, demographics, and hospital admissions. Methods: This quality improvement project examined provider practices to determine if palliative care consults had been made in the past 18 months before project initiation. A tool was developed to identify patients diagnosed with COPD who were appropriate for palliative care consults based on inclusion criteria. The medical assistants were educated on how to identify patients through the tool. Providers ordered consults based on tool results. Results: The chart audit revealed a 100% increase in providers ordering palliative care consults for patients with COPD who were identified by the tool as appropriate. Implications for Practice: Research shows encouraging results with palliative care introduction early in the COPD. This project’s findings further reinforce and support the importance and impact palliative care and COPD have on each other through evidence-based practices, research, and theory; which will hopefully improve patient’s lives now and in the future.D.N.P

The dynamics of proximity : Hitchcock\u27s cinema of claustrophobia

The implication of space in film is worth exploring in detail particularly with regard to the films of Alfred Hitchcock, since he is, perhaps more than any other filmmaker, concerned with the dynamics of proximity. Possibly because of his experience as a set designer on Graham Cutt’s silent films Woman to Woman (1922), The White Shadow (1923), The Passionate Adventure (1924), The Blackguard, and The Prude’s Fall (both 1925), Hitchcock very early in his career was faced with the task of expressing himself - without words - through setting, set shape, and room size. In Francois Truffaut\u27s book, Hitchcock, the Master relates an important (since he remembers his) childhood episode in which his father arranged for the chief of police to lock him in a jail cell for five or ten minutes, admonishing that, “This is what we do to naughty boys.” Consequently, we see in Hitchcock’s films (which were all visually designed by him in the storyboard process) a persuasive aura of claustrophobia which involves a certain amount of connotes guilt and fear. As I intend to explain, this claustrophobia has far-reaching implications in five hermeneutic contexts, proving to be an important key to his moral-aesthetic universe

LAW ENFORCEMENT AND OTHER AGENCIES Georgia Bureau of Investigation: Expunge Criminal Records When Arrested But Not Charged or Charges Dismissed; Allow Prosecutor Discretion in Expungement; Provide for Judicial Review of Prosecutor or Agency Decision Against Expunging Record; Provide for Fees for Expungement

The Act allows individuals arrested but not charged, or who have had charges brought against them but dismissed by the prosecuting attorney, to have their criminal records relating to the incident expunged. The Act requires the individual to submit a written request to have his or her record expunged from the arresting agency\u27s files. The Act allows the individual to appeal a refusal to expunge the record. The Act also allows the prosecuting attorney to appeal a decision by the agency to expunge the record. The Act provides criteria which must be met for the record to be expunged. The Act allows the prosecuting attorney discretion in deciding whether to allow expungement. The Act further provides for a fee to cover the costs of expungement. The Act provides that it shall not apply to destruction or expungement of incident reports or jail records

LAW ENFORCEMENT AND OTHER AGENCIES Georgia Bureau of Investigation: Expunge Criminal Records When Arrested But Not Charged or Charges Dismissed; Allow Prosecutor Discretion in Expungement; Provide for Judicial Review of Prosecutor or Agency Decision Against Expunging Record; Provide for Fees for Expungement

The Act allows individuals arrested but not charged, or who have had charges brought against them but dismissed by the prosecuting attorney, to have their criminal records relating to the incident expunged. The Act requires the individual to submit a written request to have his or her record expunged from the arresting agency\u27s files. The Act allows the individual to appeal a refusal to expunge the record. The Act also allows the prosecuting attorney to appeal a decision by the agency to expunge the record. The Act provides criteria which must be met for the record to be expunged. The Act allows the prosecuting attorney discretion in deciding whether to allow expungement. The Act further provides for a fee to cover the costs of expungement. The Act provides that it shall not apply to destruction or expungement of incident reports or jail records

Isopeptide and Ester Bond Ubiquitination Regulate Degradation of the Human Dopamine Receptor 4

The human dopamine receptor 4 (hD4R) is a seven-transmembrane helical G protein-coupled receptor (GPCR) found in neural synaptic membranes. The neurotransmitter dopamine binds to and activates the hD4R, which is involved in central nervous system pathways that modulate cognition and circadian rhythms. The hD4R is the primary dopaminergic receptor for the atypical anti-psychotic drug clozapine, which is used to treat schizophrenia and other cognitive disorders. The hD4R gene is unique among the superfamily of GPCR-encoding genes because within the human population, it contains a variable number of tandem repeat (VNTR) exon polymorphism. Because of the VNTRs, the length of the primary structure of one of the intracellular loops of the hD4R can vary dramatically among individuals. Attempts have been made to correlate different VNTR structures with different behavioral traits – for example, a specific variant of hD4R is robustly correlated with attention deficit hyperactivity disorder. Like other GPCRs, hD4R functions at the plasma membrane by binding an extracellular ligand, in this case dopamine, to regulate an intracellular signaling cascade. The density of hD4R at the plasma membrane and its distribution within the neuron/synapse dictate the cellular response to dopamine. Despite the importance of hD4R in neuronal signaling, the molecular mechanisms regulating its cellular expression and degradation are unclear. Isopeptide ubiquitination of lysine residues on the cytoplasmic surface of various GPCRs regulates receptor abundance at the membrane by promoting protein degradation. I have studied the role of the ubiquitin-proteasome system in the cellular degradation of hD4R, and show here that hD4R protein levels are regulated through both a canonical and a non-canonical ubiquitination pathway. Site-directed mutagenesis of lysine residues, as well as mutagenesis of the atypical ubiquitin acceptors serine and threonine, led to an additive increase in mutant hD4R protein abundance in a cellular expression model. Chemical inhibition of the proteasome increased levels of the wild-type hD4R, but not the lysine, serine, and threonine null mutant. Both isopeptide ubiquitination of lysine and ester bond ubiquitination of serine and threonine were detected on hD4R in a model protein expression system using immunoprecipitation techniques. A proximity ligation assay was used to quantify isopeptide and ester bond ubiquitination in this protein expression system and to detect ubiquitination of hD4R in mouse primary cortical neurons. Together, these data support the hypothesis that hD4R is proteasomally degraded after isopeptide ubiquitination of lysine residues and ester ubiquitination of serine and threonine residues. The ubiquitination and subsequent degradation of hD4R represents a mechanism for cellular control over hD4R protein levels. While the low abundance of hD4R protein produced in heterologous expression systems has previously been limiting for biochemical and structural biology techniques, the degradation-resistant hD4R mutants presented here overcomes this limitation and may facilitate future research, including the identification of dopamine receptor interacting proteins (DRIPs). hD4R joins a small number of proteins that are known to be modified by ubiquitination via ester bonds. This work also describes novel techniques to confirm and quantify ester-bond ubiquitination for a given membrane protein within a cell

The action of Digitalis on the cardiac inhibitory centre

Typescript.Illustrations pasted in.Tables and illustrations are folded to fit inside the text block.So long has digitalis been in use as a clinical drug and so long has its action been the subject of experimentation that it would seem that there is little hope of presenting anything new on the subject. Yet so long as every detail of such a subject is not fully understood, and so long as there is diversity of opinion as to the action there is room for work whether entirely new or confirmatory. It is in the hope of confirming some older theories by newer methods that the present work is undertaken. It is the purpose of this work to carry out a direct investigation of the exclusive action of Digitalin upon the cardiac inhibitory centre in the medulla, accomplishing this by making a perfusion of the brain when isolated from the body except for its connections through the vagus trunk