Technology-Enabled Remote Monitoring and Self-Management - Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol.

BACKGROUND: Tens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complications, and related poor functional status are major problems for substantial numbers of patients during the recovery process. To tackle this problem, we aim to refine and test the effectiveness of an eHealth-enabled service delivery intervention, TecHnology-Enabled remote monitoring and Self-MAnagemenT-VIsion for patient EmpoWerment following Cardiac and VasculaR surgery (THE SMArTVIEW, CoVeRed), which combines remote monitoring, education, and self-management training to optimize recovery outcomes and experience of seniors undergoing CaVS in Canada and the United Kingdom. OBJECTIVE: Our objectives are to (1) refine SMArTVIEW via high-fidelity user testing and (2) examine the effectiveness of SMArTVIEW via a randomized controlled trial (RCT). METHODS: CaVS patients and clinicians will engage in two cycles of focus groups and usability testing at each site; feedback will be elicited about expectations and experience of SMArTVIEW, in context. The data will be used to refine the SMArTVIEW eHealth delivery program. Upon transfer to the surgical ward (ie, post-intensive care unit [ICU]), 256 CaVS patients will be reassessed postoperatively and randomly allocated via an interactive Web randomization system to the intervention group or usual care. The SMArTVIEW intervention will run from surgical ward day 2 until 8 weeks following surgery. Outcome assessments will occur on postoperative day 30; at week 8; and at 3, 6, 9, and 12 months. The primary outcome is worst postop pain intensity upon movement in the previous 24 hours (Brief Pain Inventory-Short Form), averaged across the previous 14 days. Secondary outcomes include a composite of postoperative complications related to hemodynamic compromise-death, myocardial infarction, and nonfatal stroke- all-cause mortality and surgical site infections, functional status (Medical Outcomes Study Short Form-12), depressive symptoms (Geriatric Depression Scale), health service utilization-related costs (health service utilization data from the Institute for Clinical Evaluative Sciences data repository), and patient-level cost of recovery (Ambulatory Home Care Record). A linear mixed model will be used to assess the effects of the intervention on the primary outcome, with an a priori contrast of weekly average worst pain intensity upon movement to evaluate the primary endpoint of pain at 8 weeks postoperation. We will also examine the incremental cost of the intervention compared to usual care using a regression model to estimate the difference in expected health care costs between groups. RESULTS: Study start-up is underway and usability testing is scheduled to begin in the fall of 2016. CONCLUSIONS: Given our experience, dedicated industry partners, and related RCT infrastructure, we are confident we can make a lasting contribution to improving the care of seniors who undergo CaVS

Acetaminophen Modulates the Transcriptional Response to Recombinant Interferon-β

BACKGROUND: Recombinant interferon treatment can result in several common side effects including fever and injection-site pain. Patients are often advised to use acetaminophen or other over-the-counter pain medications as needed. Little is known regarding the transcriptional changes induced by such co-administration. METHODOLOGY/PRINCIPAL FINDINGS: We tested whether the administration of acetaminophen causes a change in the response normally induced by interferon-beta treatment. CD-1 mice were administered acetaminophen (APAP), interferon-beta (IFN-beta) or a combination of IFN-beta+APAP and liver and serum samples were collected for analysis. Differential gene expression was determined using an Agilent 22 k whole mouse genome microarray. Data were analyzed by several methods including Gene Ontology term clustering and Gene Set Enrichment Analysis. We observed a significant change in the transcription profile of hepatic cells when APAP was co-administered with IFN-beta. These transcriptional changes included a marked up-regulation of genes involved in signal transduction and cell differentiation and down-regulation of genes involved in cellular metabolism, trafficking and the IkappaBK/NF-kappaB cascade. Additionally, we observed a large decrease in the expression of several IFN-induced genes including Ifit-3, Isg-15, Oasl1, Zbp1 and predicted gene EG634650 at both early and late time points. CONCLUSIONS/SIGNIFICANCE: A significant change in the transcriptional response was observed following co-administration of IFN-beta+APAP relative to IFN-beta treatment alone. These results suggest that administration of acetaminophen has the potential to modify the efficacy of IFN-beta treatment

Why destination visitor travel planning falls between the cracks

© 2013 Elsevier Ltd. Planning for visitor travel within a destination area presents an obvious opportunity to reduce the environmental impact of tourism, while increasing quality of experience and choice for the tourist and benefiting local residents and businesses. Yet, with a few exceptions, comprehensive planning is rarely undertaken by destination managers and initiatives tend to be isolated and fragmented. Drawing on their extensive knowledge of rural destinations in the UK, the authors discuss the types of scheme which can enhance the visitor experience while bringing local and global environmental benefits. They conclude that the tourism industry's structure, dwindling public funding and the difficulties of aligning multiple agencies to a common purpose prevent the strategic planning necessary for integrated visitor travel planning with a failure to reap the potential environmental, economic and social rewards

Synthesis and structural elucidation of the Bis-3-alkylpyridine alkaloid pyrinodemin A and other monomeric alkaloids

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Gene Complexes and their role in Worker Honeybee (Apis mellifera) Ovary Activation

Honeybees (Apis mellifera) are remarkable creatures with a complex eusocial hive structure. There are two female honeybee castes within a hive; a single queen and thousands of workers. The only reproductively active female is the queen. However, should the hive lose its queen (removing the pheromone she produces, queen mandibular pheromone, which keeps the workers in a reproductively inactive state), the ovaries of worker honeybees differentiate from the quiescent state they are normally in and begin to produce eggs. This remarkable remodelling of adult tissue in response to a changing environment occurs rapidly (within ten days) and is accompanied by changes in the expression of thousands of genes. It was hypothesised that this rapid response may be facilitated by the genome being organised into functional domains, known as gene complexes, containing a number of neighbouring genes which were all upregulated or repressed together to produce the rapid morphological and functional changes observed within the worker honeybee ovary. This study began by investigating whether one of the three known honeybee gene complexes was involved in worker ovary activation. The Enhancer of Split Complex [E(Spl)-C] is expressed in response to Notch signalling and as Notch signalling plays a role in Drosophila oogenesis this complex was chosen for investigation by RT-qPCR. This study found that the canonical E(Spl)-C genes were regulated in the same manner as each other during worker ovary activation, although the Tubulin-Tyrosine Kinase-like gene which is inserted within the canonical E(Spl)-C and which is co-ordinately regulated with these genes in development), is expressed in an opposite manner to the rest of this genomic region during worker ovary activation. The identification of a CCCTC-binding factor (CTCF) binding site within this region implies that changes in the three dimensional structure of the DNA may be responsible for the Tubulin-Tyrosine Kinase evading the co-ordinate gene regulation in this region. To test whether there were other, previously uncharacterised, gene complexes involved in worker ovary activation an RNA-Seq data set which compared the expression of all known honeybee genes between queen ovary, quiescent worker ovary and active worker ovary was analysed using the existing programme REEF (REgionally Enriched Features of genomes). When REEF was found to be limited in its approach, a new programme was written (using the C++ programming language) to identify novel gene complexes expressed within the honeybee ovary. Overall, there was less evidence of association between gene activation and genomic co-localisation than would be expected by chance, however there were some regions identified as having coordinate regulation. Both REEF and the programme written for this project identified a region on chromosome 2 which had seven neighbouring genes all identified as homologues of Drosophila Lethal (2) – Essential For Life [l(2)efl] which were co-ordinately regulated with respect to ovary activation. This Lethal Complex and the neighbouring genes were investigated using RT-qPCR and the experimental findings confirmed that all genes in this region are regulated in the same way with highest expression being in the ovaries of worker bees. Phylogenetic and bioinformatic analysis identified that this grouping of l(2)efl genes is also present in a number of other hymenoptheran species. Nothing is known about the molecular functions of l(2)efl, yet their duplication and presence in a range of species suggests they are functionally important. This is a region of the genome worthy of further, functional investigation. One additional region of the honeybee genome was chosen for analysis as it held a group of genes which had highest expression in queen ovary (according to the RNA-Seq data set) and contained a number of genes involved in cell cycle regulation. Many of the Drosophila homologues of these genes are involved in oogenesis or female meiosis. The Cell Cycle group was also analysed using RT-qPCR, the findings of which were consistent with the RNA-Seq data set. Overall, the honeybee genome is randomly arranged with respect to ovary activation. This makes regions with conserved, coordinated gene expression particularly interesting due to their rarity. Further investigation is required to determine how these coordinated regions are regulated

Selection of genetically superior clones of bigtooth aspen in northern lower Michigan

Master of ScienceForestryUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/115108/1/39015003270686.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/115108/2/39015003270686.pd

Absence of long-term potentiation in the retinotectal synaptic region of the adult rat superior colliculus

To answer whether the mammalian retinotectal pathway is modifiable in the adult, an attempt was made to induce long-term potentiation (LTP) in retinal synapes in the superior colliculus (SC) of the adult rat, in vivo. Extracellular field potentials were recorded in the primary retinotectal afferent zone of the rat superior colliculus while electrically stimulating the optic chiasm. Induction of LTP in this primary visual pathway was attempted using a wide range of stimulus parameters. However, LTP was not observed. Iontophoretic application of bicuculline methiodide, before and during trains of stimuli, did not facilitate LTP in the rat SC. The broad spectrum glutamatergic antagonist, kynurenic acid, greatly reduced the size of the field potentials. This supports suggestions that retinotectal neurotransmission may be mediated by excitatory amino acids. An N-methyl-D-aspartate (NMDA) glutamate receptor mediated contribution to synaptic transmission in the evoked field potential was not evident. Iontophoretic application of the NMDA receptor selective antagonist 2-amino-5-phosphonovaleric acid (APV) had no effect on the field potentials. Even in the presence of bicuculline, there was no evidence for an NMDA component in the field potential response. The non-NMDA glutamate receptor antagonist, 6-cyano-7-nitroquinoxa-line-2,3-dione (CNQX), did not affect the evoked potentials. These data suggest that LTP was not observed in the retinotectal pathway due to several factors that may include: a loss of visual plasticity in the adult rat following the critical period, absence of necessary modulation factors and insufficient NMDA receptor mediated synaptic transmission.Medicine, Faculty ofGraduat