Mathematical models of gonorrhoea and chlamydia: Biology, behaviour and interactions

Gonorrhoea and chlamydia are curable, bacterial, sexually transmitted infections (STIs) of humans, with important long term consequences for health. Their epidemiology and biology are reviewed in chapter one. The way the biology of the organisms and the behaviour of human hosts interact to influence the patterns of infection and the potential impact of interventions is the subject of the main body of the thesis. Mathematical models are presented, together with empirical data, to gain a better understanding of the epidemiology of gonorrhoea and chlamydia. New approaches are applied, using more complex measures of disease occurrence including reinfection (subsequent infection by the same organism) or coinfection (infection with both organisms simultaneously). Coinfection with gonorrhoea and chlamydia is investigated in chapter two. The third chapter investigates the importance of heterogeneity in human behaviour (i.e. level of sexual activity, mixing patterns within and between populations) on the spread of disease in subpopulations, using a model incorporating race, gender and sexual activity level. This was parameterised and validated using data collected in South East London. In chapter four, models of reinfection are used to investigate the interaction of population level parameters such as degree of assortative mixing and rates of reinfection. In chapter five, the characteristics of individuals coinfected with both organisms are shown to provide additional information useful in determining how infection is distributed across a population. The biology of the organism is demonstrated, in the fifth chapter, to play an important role in the prevalence and incidence of disease within the host population. The impact of the emergence of resistant or asymptomatic phenotypes under selective pressure by different treatment regimens is quantified using a two strain model, including asymptomatic and symptomatic infections. The final chapter considers the contribution of the research and discusses the implications of the results for STI intervention strategies

Caregiver Burden in Dementia: An Occupational Therapy Perspective

Caregiver burden impacts over 16 million caregivers of people with dementia in the United States (Alzheimer’s Association, 2020). Education for caregivers of people with dementia is a critical area of need in occupational therapy. The purpose of this knowledge translation doctoral project was to increase occupational therapy practitioner’s awareness of the importance of utilizing evidence-based tools to address the growing need of caregiver education in community-based application models. The three knowledge translation projects focused on current literature, bridging the research to practice gap, and empowering occupational therapists to forge a larger role in the important area of caregiver education for caregivers of people with dementia. The first knowledge translation project was a continuing education session presented through the Minnesota Occupational Therapy Association targeting occupational therapy students, occupational therapy practitioners, and occupational therapy educators. The second knowledge translation project was a guest lecture at the University of Minnesota for entry-level doctoral students. The third knowledge translation project was a virtual poster delivered at an interdisciplinary conference at the Minnesota Gerontological Society annual conference. The goal of these three knowledge translation projects was to inform, inspire, and lead occupational therapy practitioners, students, educators, caregivers, and professionals from aging related fields in evidence-based research in the area of caregiver education for caregivers of people with dementia

Medicaid\u27s Postpartum Tubal Sterilization Policy\u27s Effect on Vulnerable Populations

After the forced sterilizations of low-income and minority women were exposed in the 1970’s, new Medicaid policies were put into place in order to protect vulnerable populations. The revised policy included a mandatory consent form and a waiting period of 30 days between consent and procedure, as well as a presentation of the form at time of procedure. Although these policies were enacted to protect vulnerable populations, research has shown they are ineffective and act as barrier to women receiving the post-partum tubal sterilization that they desire. The policy has been shown to have a disproportionate detrimental impact on minority populations, and it has created a two-tiered health care system in terms of sterilization. The unfulfilled requests lead to many inadvertent consequences, including higher rates of unintended pregnancies, abortions, loss of self-efficacy, and higher costs for the Medicaid system. In order to ensure equitable treatment of Medicaid patients in regards to tubal sterilization, the 30-day waiting period should be rescinded. Additionally, to confirm that patients are fully knowledgeable of the implications of the tubal sterilization, the form and any ensuing consent should be rewritten to meet literacy standards for the target demographic. This analysis will include a history of the issue, an examination of relevant research, a policy analysis and recommendations to enhance healthcare equity

Cleaning Up the Nuclear Weapons Complex: Exploring New Approaches

In recent years, policy experts have increasingly decried the "piecemeal" approach to environmental protection embodied in existing laws and regulations. This paper analyzes one aspect of the call for more integration: the feasibility and advisability of developing an integrated approach to regulating the cleanup of the nation's nuclear weapons complex. The Cold War has left an unprecedented set of difficulties at sites across the country where vast quantities of hazardous and radioactive materials must be properly managed. Regulatory fragmentation�particularly the phenomenon of multiple regulators and regulations driving the allocation of resources in an uncoordinated fashion�is nowhere more evident than in the current statutory and regulatory framework governing environmental management activities at this array of sites�the nuclear weapons complex. The objective of an integrated approach is to give regulators and the regulated community incentives to look holistically at environmental hazards, both existing and future, and to develop creative ways of setting priorities such that risk, cost effectiveness, and public concerns are taken into account. This paper describes recent efforts to achieve integration in the environmental arena, surveys the unique technical, regulatory, and political circumstances surrounding cleanup of the weapons complex, and offers some preliminary thoughts on how integration might be attained in this vital area. While administrative and regulatory changes could achieve some important steps in this direction, the authors conclude that legislative change is necessary for implementation of a truly integrated approach.

Intensive Areal Survey with Deep Mechanical Testing: For the City of Ballinger Waste Water Treatment Plant Expansion, Runnels County, Texas

Archaeologists from Central Texas Archaeological Resources (CTAR), on behalf of the City of Ballinger, Runnels County, Texas, conducted an intensive areal archaeological survey with deep mechanical testing within the boundaries of a proposed Waste Water Treatment Plant (WWTP) Expansion, located in Ballinger, Runnels County, Texas on August 24-25, 2014. The proposed WWTP expansion was funded by a Texas Community Development Block Grant (TxCDBG) and therefore, subject to the Antiquities Code of Texas. The city’s current treatment plant in Ballinger was nearing it capacity and was required by the Texas Commission on Environmental Quality (TCEQ) to expand its capabilities in order to meet its future needs. The project design would increase the overall size of the treatment plant, meeting the TCEQ mandate. The survey area was on public property currently owned by the City of Ballinger, Texas. The location of the proposed new retention ponds were the Area of Potential Effects (APE) for the survey. The APE contained approximately 8.21 hectares (20.3 acres). All field work was conducted in accordance with the Texas Historical Commission (THC) and the Council of Texas Archaeologists’ (CTA) survey standards as outlined in 13 TAC 26.5(35), 13 TAC 26.20(1), and 13 TAC 26,20(2). The archaeological survey was conducted by Principal Investigator, Katherine Turner-Pearson, MA, RPA on August 24-25, 2014. A total of seven shovel tests were excavated to depths of 42-60 centimeters below the surface (cmbs). Archaeologists placed five backhoe trenches within the APE of approximately 6.5 meters (m) x 2.15 m in surface size and 2.0 m in depth. No archaeological sites or cultural remains were revealed during the shovel tests or mechanical testing; however, one archaeological site was discovered during the pedestrian survey. The site, 41RN277, was a surface lithic scatter believed to be archaic in age. The site was disturbed with no diagnostic artifacts, and did not meet the National Register of Historic Places’ eligibility requirements. Archaeologists recommended that the project proceed as planned. Project and site documentation will be curated at the Texas Archaeological Research Laboratory (TARL) in Austin, Texas, and a copy of this report will be filed with the THC in Austin and the CTAR offices in Woodway, Texas

Therapeutic Potential of rhTRAIL for Malignant Melanoma

The application of recombinant human Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand (rhTRAIL) for the treatment of cancer holds great promise due to its ability to selectively induce apoptosis in cancer cells while not harming normal healthy cells. This is evident by the robust levels of apoptosis induced in malignant melanoma cells while no event of apoptosis was observed in the non-transformed counterpart of melanomas, melanocytes. However, the clinical utility of rhTRAIL is limited due to the heterogeneity seen in rhTRAIL-sensitivity among cancers. rhTRAIL-resistance is especially prevalent in cases of malignant melanoma. Melanoma rhTRAIL-resistance can be attributed to a number of different causations including low expression of rhTRAIL-binding receptors (death receptors (DRs)) and overexpression of anti-apoptotic proteins. Most noteworthy is the correlation between rhTRAIL-sensitivity and the membrane expression of rhTRAIL receptors DR4 and DR5. The membrane expression of DR4 and DR5 may be potential markers for predicting a patient’s sensitivity to rhTRAIL. We propose the development of an in vitro assay to measure the membrane expression of DR4 and DR5 to determine a patient’s suitability for rhTRAIL-treatment. Additionally, rhTRAIL-resistance can be circumvented by combining rhTRAIL with the “Mother Nature”-derived compound quercetin. Quercetin possesses the ability to modulate some of the cellular components that confer rhTRAIL-resistance. Resistant malignant melanomas are sensitized to the effects of rhTRAIL by the quercetin-mediated upregulation of DR4 and DR5 and the downregulation of the anti-apoptotic protein FLIP. Overall, these data show the potential of rhTRAIL to act as a potent anti-cancer therapeutic and methods to overcome rhTRAIL-resistance

No More Secrets: Under Ballard v. Commissioner, Special Trial Judge Reports Must be Revealed

This case note evaluates Ballard v. Commissioner, its roots, and its impact on the Tax Court and administrative agencies. First, the history of the United States Tax Court is provided with a focus on the special trial judges and the structure of Tax Court Rule that was the central focus of Ballard. Second, there is a brief comparison of other positions, such as a magistrate, to the special trial judge. Third, this article simplifies the complicated, prior history of Ballard that includes three different petitioners, weeks of trial, and numerous courts proceedings and opinions. Fourth, the Ballard opinion is analyzed in detail, separately describing the majority opinion authored by Justice Ginsberg, the concurring opinion authored by Justice Kennedy, and the dissenting opinion authored by the late Chief Justice Rehnquist. Finally, there is an explanation of Ballard\u27s effect on the taxpayers involved, the effect on the Tax Court rules and practices, and the impact it will have on “the whole administrative array of the federal government.

Mortgage Interest Deduction

Reviews the mortgage interest deduction's fiscal costs, its limitations in subsidizing homeownership, and alternatives. Analyzes the estimated effects of eliminating it, replacing it with alternative tax credits, and limiting the deduction to 28 percent

Failure of an Educational Intervention to Improve Consultation and Implications for Healthcare Consultation.

INTRODUCTION: Consultation of another physician for his or her specialized expertise regarding a patient's care is a common occurrence in most physicians' daily practice, especially in the emergency department (ED). Therefore, the ability to communicate effectively with another physician during a patient consultation is an essential skill. However, there has been limited research on a standardized method for a physician to physician consultation with little guidance on teaching consultations to physicians in training. The objective of our study was to measure the effect of a structured consultation intervention on both content standardization and quality of medical student consultations. METHODS: Senior medical students were assessed on a required emergency medicine rotation with a physician phone consultation during a standardized, simulated chest pain case. The intervention groups received a standard consult checklist as part of their orientation to the rotation, followed by a video recording of a good consult call and a bad consult call with commentary from an emergency physician. The intervention was given to students every other month, alternating with a control group who received no additional education. Recordings were reviewed by three second-year internal medicine residents pursuing a fellowship in cardiology. Each recording was evaluated by two of the three reviewers and scored using a standardized checklist. RESULTS: Providing a standardized consultation intervention did not improve students' ability to communicate with consultants. In addition, there was variability between evaluators in regards to how they received the same information and how they perceived the quality of the same recorded consultation calls. Evaluator inter-rater reliability (IRR) was poor on the questions of 1) would you have any other questions of the student calling the consult and 2) did the student calling the consult provide an accurate account of information and case detail. The IRR was also poor on objective data such as whether the student stated their name. CONCLUSIONS: A brief intervention may not be enough to change complex behavior such as a physician to physician consultant communication. Importantly, despite consultants listening to the same audio recordings, the information was processed differently. Future investigations should focus on both those delivering as well as those receiving a consultation