Establishing A Continuum of Care to Improve Follow-Up Rates for Survivors of Sexual Assault

Introduction. In 2011 there were over 1000 reported sexual assaults in Vermont. Current recommendations suggest that survivors of sexual assault (survivors) receive follow- up care within two weeks after an initial Sexual Assault Nurse Examiner (SANE) exam, but fewer than 15% receive documented follow-up. A published report has demonstrated increased follow-up to over 80% when appointments are scheduled prior to discharge from the emergency department (ED).https://scholarworks.uvm.edu/comphp_gallery/1082/thumbnail.jp

Antigenic Complementarity in the Origins of Autoimmunity: A General Theory Illustrated With a Case Study of Idiopathic Thrombocytopenia Purpura

We describe a novel, testable theory of autoimmunity, outline novel predictions made by the theory, and illustrate its application to unravelling the possible causes of idiopathic thrombocytopenia purpura (ITP). Pairs of stereochemically complementary antigens induce complementary immune responses (antibody or T-cell) that create loss of regulation and civil war within the immune system itself. Antibodies attack antibodies creating circulating immune complexes; T-cells attack T-cells creating perivascular cuffing. This immunological civil war abrogates the self-nonself distinction. If at least one of the complementary antigens mimics a self antigen, then this unregulated immune response will target host tissues as well. Data demonstrating that complementary antigens are found in some animal models of autoimmunity and may be present in various human diseases, especially ITP, are reviewed. Specific mechanisms for preventing autoimmunity or suppressing existing autoimmunity are derived from the theory, and critical tests proposed. Finally, we argue that Koch's postulates are inadequate for establishing disease causation for multiple-antigen diseases and discuss the possibility that current research has failed to elucidate the causes of human autoimmune diseases because we are using the wrong criteria

Three-Dimensional Quantum Percolation Studied by Level Statistics

Three-dimensional quantum percolation problems are studied by analyzing energy level statistics of electrons on maximally connected percolating clusters. The quantum percolation threshold \pq, which is larger than the classical percolation threshold \pc, becomes smaller when magnetic fields are applied, i.e., \pq(B=0)>\pq(B\ne 0)>\pc. The critical exponents are found to be consistent with the recently obtained values of the Anderson model, supporting the conjecture that the quantum percolation is classified onto the same universality classes of the Anderson transition. Novel critical level statistics at the percolation threshold is also reported.Comment: to appear in the May issue of J. Phys. Soc. Jp

Prospective assessment of white matter integrity in adult stem cell transplant recipients

Hematopoietic stem cell transplantation (HSCT) is often used in the treatment of hematologic disorders. Although it can be curative, the pre-transplant conditioning regimen can be associated with neurotoxicity. In this prospective study, we examined white matter (WM) integrity with diffusion tensor imaging (DTI) and neuropsychological functioning before and one year after HSCT in twenty-two patients with hematologic disorders and ten healthy controls evaluated at similar intervals. Eighteen patients received conditioning treatment with high-dose (HD) chemotherapy, and four had full dose total body irradiation (fTBI) and HD chemotherapy prior to undergoing an allogeneic or autologous HSCT. The results showed a significant decrease in mean diffusivity (MD) and axial diffusivity (AD) in diffuse WM regions one year after HSCT (p-corrected <0.05) in the patient group compared to healthy controls. At baseline, patients treated with allogeneic HSCT had higher MD and AD in the left hemisphere WM than autologous HSCT patients (p-corrected <0.05). One year post-transplant, patients treated with allogeneic HSCT had lower fractional anisotropy (FA) and higher radial diffusivity (RD) in the right hemisphere and left frontal WM compared to patients treated with autologous HSCT (p-corrected <0.05). There were modest but significant correlations between MD values and cognitive test scores, and these were greatest for timed tests and in projection tracts. Patients showed a trend toward a decline in working memory, and had lower cognitive test scores than healthy controls at the one-year assessment. The findings suggest a relatively diffuse pattern of alterations in WM integrity in adult survivors of HSCT

‘Trial and error…’, ‘…happy patients’ and ‘…an old toy in the cupboard’: a qualitative investigation of factors that influence practitioners in their prescription of foot orthoses

Background: Foot orthoses are used to manage of a plethora of lower limb conditions. However, whilst the theoretical foundations might be relatively consistent, actual practices and therefore the experience of patients is likely to be less so. The factors that affect the prescription decisions that practitioners make about individual patients is unknown and hence the way in which clinical experience interacts with knowledge from training is not understood. Further, other influences on orthotic practice may include the adoption (or not) of technology. Hence the aim of this study was to explore, for the first time, the influences on orthotic practice. Methods: A qualitative approach was adopted utilising two focus groups (16 consenting participants in total; 15 podiatrists and 1 orthotist) in order to collect the data. An opening question “What factors influence your orthotic practice?” was followed with trigger questions, which were used to maintain focus. The dialogue was recorded digitally, transcribed verbatim and a thematic framework was used to analyse the data. Results: There were five themes: (i) influences on current practice, (ii) components of current practice, (iii) barriers to technology being used in clinical practice, (iv) how technology could enhance foot orthoses prescription and measurement of outcomes, and (v) how technology could provide information for practitioners and patients. A final global theme was agreed by the researchers and the participants: ‘Current orthotic practice is variable and does not embrace technology as it is perceived as being not fit for purpose in the clinical environment. However, practitioners do have a desire for technology that is usable and enhances patient focussed assessment, the interventions, the clinical outcomes and the patient’s engagement throughout these processes’. Conclusions: In relation to prescribing foot orthoses, practice varies considerably due to multiple influences. Measurement of outcomes from orthotic practice is a priority but there are no current norms for achieving this. There have been attempts by practitioners to integrate technology into their practice, but with largely negative experiences. The process of technology development needs to improve and have a more practice, rather than technology focus

Systematic 1/N1/N corrections for bosonic and fermionic vector models without auxiliary fields

In this paper, colorless bilocal fields are employed to study the large $N$ limit of both fermionic and bosonic vector models. The Jacobian associated with the change of variables from the original fields to the bilocals is computed exactly, thereby providing an exact effective action. This effective action is shown to reproduce the familiar perturbative expansion for the two and four point functions. In particular, in the case of fermionic vector models, the effective action correctly accounts for the Fermi statistics. The theory is also studied non-perturbatively. The stationary points of the effective action are shown to provide the usual large $N$ gap equations. The homogeneous equation associated with the quadratic (in the bilocals) action is simply the two particle Bethe Salpeter equation. Finally, the leading correction in $1\over N$ is shown to be in agreement with the exact $S$ matrix of the model.Comment: 24 pages, uses REVTEX macros. Replaced with final version to appear in Phys. Rev.

Exact and approximate dynamics of the quantum mechanical O(N) model

We study a quantum dynamical system of N, O(N) symmetric, nonlinear oscillators as a toy model to investigate the systematics of a 1/N expansion. The closed time path (CTP) formalism melded with an expansion in 1/N is used to derive time evolution equations valid to order 1/N (next-to-leading order). The effective potential is also obtained to this order and its properties areelucidated. In order to compare theoretical predictions against numerical solutions of the time-dependent Schrodinger equation, we consider two initial conditions consistent with O(N) symmetry, one of them a quantum roll, the other a wave packet initially to one side of the potential minimum, whose center has all coordinates equal. For the case of the quantum roll we map out the domain of validity of the large-N expansion. We discuss unitarity violation in the 1/N expansion; a well-known problem faced by moment truncation techniques. The 1/N results, both static and dynamic, are also compared to those given by the Hartree variational ansatz at given values of N. We conclude that late-time behavior, where nonlinear effects are significant, is not well-described by either approximation.Comment: 16 pages, 12 figrures, revte