Implementation and Outcomes of the New York State YMCA Diabetes Prevention Program: A Multisite Community-Based Translation, 20102012

Weight loss and physical activity achieved through the Diabetes Prevention Program (DPP) have been shown to reduce type 2 diabetes risk among individuals with prediabetes. The New York State Young Men's Christian Association (YMCA) delivered the 16-week evidence-based model at 14 YMCAs. A mixed methods process and outcomes evaluation was conducted

T cells reactive to an inducible heat shock protein induce disease in toxin-induced interstitial nephritis.

T cells reactive against immunodominant regions of inducible heat shock proteins (HSPs) have been identified in the chronic inflammatory lesions of several experimental autoimmune diseases. Since HSPs are known to be induced by a number of renal tubular epithelial cell toxins associated with chronic interstitial nephritis, we investigated the relevance of HSP expression and T cell reactivity to HSP70 in a model of progressive inflammatory interstitial nephritis. Chronic administration of cadmium chloride (CdCl2) to SJL/J mice induces HSP70 expression in renal tubular cells 4-5 wk before the development of interstitial mononuclear cell infiltrates. CdCl2 also induces HSP70 expression in cultured tubular epithelial cells from SJL/J mice. CD4+, TCR-alpha/beta+ T cell lines specific for an immunodominant HSP peptide are cytotoxic to heat stressed or CdCl2-treated renal tubular cells. Such HSP-reactive T cells mediate an inflammatory interstitial nephritis after adoptive transfer to CdCl2-treated mice at a time when immunoreactive HSP70 is detectable in the kidneys, but before the development of interstitial mononuclear cell infiltrates. T cells isolated from the nephritic kidneys of mice treated with CdCl2 for 13 wk are also cytotoxic to heat shocked or cadmium-treated tubular cells. These kidney-derived T cells additionally induced interstitial nephritis after passive transfer, indicating their pathogenic significance. Our studies strongly support a role for HSP-reactive T cells in CdCl2-induced interstitial nephritis and suggest that the induction of HSPs in the kidney by a multitude of "non-immune" events may initiate or facilitate inflammatory damage by HSP-reactive lymphocytes

A REVERSIBLE ERLANG LOSS SYSTEM WITH MULTITYPE CUSTOMERS AND MULTITYPE SERVERS

We consider a memoryless Erlang loss system with servers S = {1, …, J}, and with customer types C = {1, …, I}. Servers are multitype, so that server j can serve a subset of customer types C(j). We show that the probabilities of assigning arriving customers to idle servers can be chosen in such a way that the Markov process describing the system is reversible, with a simple product form stationary distribution. Furthermore, the system is insensitive; these properties are preserved for general service time distributions

Patient Portals in Pharmacist-run Ambulatory Care Clinics: Is There “Meaningful Use”?

Objective The purpose of this study is to describe patient portal utilization within pharmacist-managed clinics at an academic medical center from the perspectives of the institution, healthcare team, and patient. This study measures the progress toward meeting requirements for meaningful use per the Centers for Medicare and Medicaid Services (CMS). Methods The study included patients in pharmacist-managed clinics and consisted of a retrospective chart review and patient survey. Primary endpoints consisted of: 1) report progress toward meeting CMS criteria for meaningful use in subset of patients seen in the pharmacy-managed clinics, 2) describe utilization of patient portal across the healthcare team in patients of the pharmacist-managed clinics and 3) describe the usefulness of the patient portal from the patient’s perspective. Results The pharmacist-managed clinics met and exceeded meaningful use requirements. Seventy one percent of patients had been offered portal access and more than 10% of unique patients initiated a message. The healthcare team utilized the patient portal for a variety of clinical and non-clinical purposes. Per patient survey, of those who used the patient portal, 80% reported at least monthly use and 96% reported that the portal was either somewhat or very useful. Conclusions Pharmacist-managed clinics met and exceeded CMS meaningful use criteria. Patients reported that the patient portal is a useful tool that improves access to healthcare providers and increases efficiency. Pharmacists play a valuable role in assuring hospitals meet required CMS meaningful use objectives in order to qualify for the financial incentives

Bússola Ágil : portal de avaliação de maturidade em equipes de desenvolvimento ágil de software

Orientadora: Rafaela Mantovani FontanaMonografia (Graduação) - Universidade Federal do Paraná, Setor de Educação Profissional e Tecnológica, Curso de Graduação em Análise e Desenvolvimento de SistemasQualidade é, ou deveria ser, o princípio básico para desenvolvimento de software, principalmente as adeptas de mqueatolqduoelor geiaqsu ipáeg edise. Desta forma, a busca por maturidade no desenvolvimento torna-se natural ao longo da caminhada de cada uma delas rumo a obtenção de tal adjetivo. Em equipes de desenvolvimento tradicional a forma de conquistar a certificação de maturidade é por meio de modelos de referência internacionais, baseados primariamente em processos institucionalizados. Já quando se trata de equipes ágeis, não há como definir e avaliar sua maturidade desta mesma forma, afinal não possuem processos definidos. Baseando-se nisso, o presente projeto propõe a criação de uma ferramenta capaz de auxiliar na avaliação da maturidade no desenvolvimento de equipes ágeis, de uma forma eficiente e adaptável a realidade de cada equipe, sem afetar a agilidade presente nas suas técnicas e práticas do dia a dia. metodoPloagraia oá gdiel sSecnruvomlv, imreesnutlota nddoo permoje utom foproarmta l uwtielibza pdaarsa tqéucen icaass ebqausipeeasd aásg enias possam realizar avaliações de maturidad

Local electronic structural effects and measurements on the adsorption of benzene on Ag(110)

The adsorption of benzene on the Ag(110) surface has been investigated using low-temperature scanning tunneling microscopy (STM). We found that benzene molecules preferentially adsorb above step edges at 66 K, leaving the terraces free of molecules. The preference for the step edge adsorption is attributed to the Smoluchowski effect enhancing the empty states to which charge is donated from the π orbitals of the benzene. However, only the [11̅0] step edges are decorated. We attribute this to the presence of the band gap that exists at the [001] step edge, reducing the Smoluchowski effect - the charge transfer across step edges - and thus the adsorption on these steps. We have also explored the deposition of additional benzene onto this surface at 4 K, where benzene populates a weak adsorbed state. A saturated monolayer of these species arranges hexagonally, commensurate along one direction with the Ag surface. These overlayers present interesting transparency effects in the STM images. The transparency is highly dependent upon changes in the tip-sample distance and is believed to be due to dielectric screening of the Ag orbitals by the benzene

Association of antiretroviral therapy with high-risk human papillomavirus, cervical intraepithelial neoplasia, and invasive cervical cancer in women living with HIV: a systematic review and meta-analysis

Background The interactions between antiretroviral therapy (ART) and high-risk human papillomavirus (HPV) and cervical lesions in women living with HIV are poorly understood. We reviewed the association of ART with these outcomes. Methods We did a systematic review and meta-analysis by searching MEDLINE and Embase databases for cross-sectional or cohort studies published in English between Jan 1, 1996, and May 6, 2017, which reported the association of ART with prevalence of high-risk HPV or prevalence, incidence, progression, or regression of histological or cytological cervical abnormalities, or incidence of invasive cervcal cancer. Studies were eligible if they reported the association of combination ART or highly active ART use with the following outcomes: high-risk HPV prevalence; squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia (CIN) prevalence, incidence, progression, or regression; and invasive cervical cancer incidence among women living with HIV. We did random-effects meta-analyses to estimate summary statistics. We examined heterogeneity with the I (2) statistic. This review is registered on the PROSPERO database at the Centre of Reviews and Dissemination, University of York, York, UK (registration number CRD42016039546). Findings We identified 31 studies of the association of ART with prevalence of high-risk HPV (6537 women living with HIV) and high grade cervical lesions (HSIL-CIN2+; 9288 women living with HIV). Women living with HIV on ART had lower prevalence of high-risk HPV than did those not on ART (adjusted odds ratio [aOR] 0.83, 95% CI 0.70-0.99; I-2= 51%, adjusted for CD4 cell count and ART duration), and there was some evidence of association with HSIL-CIN2+ (0.65, 0 .40-1.06; I-2=30%). 17 studies reported the association of ART with longitudinal cervical lesion outcomes. ART was associated with a decreased risk of HSIL-CIN2+ incidence among 1830 women living with HIV (0 .59, 0.40-0.87; I-2=0%), SIL progression among 6212 women living with HIV (adjusted hazard ratio [aHR] 0. 64, 95% CI 0.54-0.75; I-2= 18%), and increased likelihood of SIL or CIN regression among 5261 women living with HIV (1.54, 1.30-1.82; I-2= 0%). In three studies among 15 846 women living with HIV, ART was associated with a reduction in invasive cervical cancer incidence (crude HR 0.40, 95% CI 0.18-0.87, I-2= 33%). Interpretation Early ART initiation and sustained adherence is likely to reduce incidence and progression of SIL and CIN and ultimately incidence of invasive cervical cancer. Future cohort studies should aim to confirm this possible effect. Copyright (c) The Author(s). Published by Elsevier Ltd

Time-Varying Potassium in High-Resolution Spectra of the Type Ia Supernova 2014J

We present a time series of the highest resolution spectra yet published for the nearby Type Ia supernova (SN) 2014J in M82. They were obtained at 11 epochs over 33 days around peak brightness with the Levy Spectrograph (resolution R~110,000) on the 2.4m Automated Planet Finder telescope at Lick Observatory. We identify multiple Na I D and K I absorption features, as well as absorption by Ca I H & K and several of the more common diffuse interstellar bands (DIBs). We see no evolution in any component of Na I D, Ca I, or in the DIBs, but do establish the dissipation/weakening of the two most blueshifted components of K I. We present several potential physical explanations, finding the most plausible to be photoionization of circumstellar material, and discuss the implications of our results with respect to the progenitor scenario of SN 2014J.Comment: 11 pages, 8 figures, 3 tables, submitted to Ap