Post-Translational Nuclear Protein Modification and High Vitamin-D Receptor Levels in Genetic Hypercalciuric Stone-Forming Rats

Studies conducted on Genetic Hypercalciuric-Stone Forming (GHS) rats have shown that their excess calcium urine excretion might be caused by significantly high vitamin D receptor (VDR) levels found in key calcium-transporting tissues, since high VDR raises physiological response to 1,25(OH)2D3, the hormonally active metabolite of vitamin D that regulates calcium levels in the body. We suggest that the high VDR levels in GHS tissue are a result of altered post-translational modification by ubiquitin and Small Ubiquitin-like Modifier (SUMO), which regulate the degradation of nuclear proteins substrates such as VDR. Our inquiry begins by overexpressing ubiquitin, SUMO-1, SUMO-2, and SUMO-3 in rat tissue to perform targeted gene expression of VDR. Western blot will be used to analyze resulting changes in the VDR signaling pathway and the degree to which the GHS rat phenotype is emulated with the added ubiquitin or SUMO. Our proceeding step will be to measure changes in VDR levels after performing an siRNA-facilitated knockdown of the E1, E2, and E3 enzymes that facilitate ubiquitination of nuclear proteins. Our final experiment will consist of isolating proteins from GHS bone marrow, intestinal, and renal cells and recording ubiquitin levels to compare with control tissue. If there is a consistent trend in the ubiquitin levels of GHS cells compared to control cells, and the western blot and enzyme knockdown procedures reveal that altered ubiquitin/SUMO presence affects VDR levels, then there will be evidence to show that the general hypercalciuiric phenotype could be an eventual result of insufficient VDR degradation due to abnormal post-translational protein modification

Contextualising over-engagement in work: towards a more global understanding of workaholism as an addiction

Purpose: Despite increasing empirical research into workaholism, no single definition or conceptualisation has emerged, and current understandings of workaholism are arguably problematic. The primary purpose of this paper is to clarify some of these issues, by defining and contextualising over-engagement in work that leads to severe negative consequences (i.e., workaholism) as a genuine behavioural addiction. Approach: By conceptualising work behaviours as manifestations of behavioural engagement and placing them on a continuum from withdrawal/under-engagement (e.g., persistent absenteeism) to over-engagement (e.g., work conflicting with all other activity), this paper argues that workaholism is an extreme negative aspect of behavioural engagement. It then examines the extent to which workaholism can be viewed as a genuine addiction by using criteria applied to other more traditional behavioural addictions (e.g., gambling addiction, exercise addiction), before briefly outlining an approach towards a more global understanding of workaholism. Findings: The framework presented here helps to contextualise over-engagement to work as a genuine addiction. It presents more comprehensive understanding of workaholism that takes into account the individual factors of the employee, situational factors of the working environment, and structural factors of the work activity itself. It provides theoretically derived links between workaholism and other work behaviours that can be empirically demonstrated. Practical implications: Viewing workaholism as an addiction that comprises extreme and prolonged behavioural over-engagement can be invaluable for promoting healthy work engagement. A clearer understanding of the underpinnings of workaholism can allow for a better assessment and management by practitioners. Originality/value: This paper is one the first to contextualise workaholism in relation to other work behaviours, conceptualise it as a genuine behavioural addiction, and to apply clinical criteria for addiction to under- stand workaholism as prolonged and extreme behavioural engagement

The Serendiptichord: Reflections on the collaborative design process between artist and researcher

The Serendiptichord is a wearable instrument, resulting from a collaboration crossing fashion, technology, music and dance. This paper reflects on the collaborative process and how defining both creative and research roles for each party led to a successful creative partnership built on mutual respect and open communication. After a brief snapshot of the instrument in performance, the instrument is considered within the context of dance-driven interactive music systems followed by a discussion on the nature of the collaboration and its impact upon the design process and final piece

Outcomes of Asthma Quality Improvement in Pediatric Patients

Introduction. The Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ) and Utah Department of Health (UDOH) Asthma Program Learning Collaborative is a quality improvement initiative designed to standardize asthma care in pediatric patients and improve the overall assessment and patient education process for both healthcare providers and patients. The aim of the Asthma QI Project was to improve the diagnosis and management of asthma for patients in the state of Utah by implementing a standardized approach to the identification and treatment of patients with asthma. Methods. Patients scheduled to see a healthcare provider at our pediatric clinic were screened for a history of asthma during chart review and assessed for whether the patient completed a standardized asthma control tool and whether they were provided with an asthma action plan. The initiative applied a quality improvement approach using Plan, Do, Study, Act (PDSA) cycles to implement a change plan and achieve desired project outcomes. Monthly asthma education webinars and QI coaching were provided to clinicians and support staff. Monthly reports showing rates of standardized asthma control tool administration and provision of asthma action plan were generated and utilized to discuss goal progress. Results. A total of 236 patient visits from the years 2020-2022 were included in the analysis. Standardized asthma control test was administered and completed in 79% of patients in 2022, 70% in 2021, and 55% in 2020. Rates of asthma action plan being provided were 40% in 2022, 36% in 2021, and 32% in 2020. Conclusion. The implementation of a standard process to follow for pediatric patients being treated for asthma allowed us to meet the desired goal of providing better comprehensive care, thus improving the quality of care

Evaluating initial spine trauma response: injury time to trauma center in PA, USA.

Historical perceptions regarding the severity of traumatic spinal cord injury has led to considerable disparity in triage to tertiary care centers. This article retrospectively reviews a large regional trauma database to analyze whether the diagnosis of spinal trauma affected patient transfer timing and patterns. The Pennsylvania Trauma database was retrospectively reviewed. All acute trauma patient entries for level I and II centers were categorized for diagnosis, mechanism, and location of injury, analyzing transportation modality and its influence on time of arrival. A total of 1162 trauma patients were identified (1014 blunt injuries, 135 penetrating injuries and 12 other) with a mean transport time of 3.9 hours and a majority of patients arriving within 7 hours (\u3e75%). Spine trauma patients had the longest mean arrival time (5.2 hours) compared to blunt trauma (4.2 hours), cranial neurologic injuries (4.35 hours), and penetrating injuries (2.13 hours,

A Younger Demographic Defines Hepatitis C Patient Profiles in the Recent Direct-Acting Antiviral Era

A Younger Demographic Defines Hepatitis C Patient Profiles in the Recent Direct-Acting Antiviral Era Authors: Minawala, Ria1; Naylor, Paul H.2; Ehrinpreis, Murray N.2; Mutchnick, Milton G.2 Institutions: 1. Wayne State University School of Medicine, Detroit, MI, United States. 2. Wayne State University School of Medicine, Division of Gastroenterology, Detroit, MI, United States. Background: Highly effective and safe direct-acting antivirals (DAAs) against hepatitis C virus (HCV) combined with U.S. Preventive Services Task Force recommendation to screen for HCV in individuals born between 1945 and 1965 (age cohort; 54-79 years of age in 2019) was expected to reduce the number of actively infected patients via identification and treatment. Nevertheless, HCV infections remain a significant health concern. A study of HCV infected patients in our urban internal medicine practice, during the interferon era and prior to the introduction of DAAs, demonstrated a population within the age cohort. The objective of this study was to characterize the current patient population seen in the same practice with respect to age, race, and treatment status to determine the impact of DAA therapy on patient profiles and to test the hypothesis that there would be an increase in younger population among those infected. Methods: Using electronic medical records, we identified patients who presented to our urban GI practice in 2019. Data collected from patient charts included demographics, liver function tests, HCV genotype, viral load, imaging studies, and treatment history. Results: There were 601 patients with HCV seen in 2019 and the majority were African American (AA) (85%) and male (66%). Comparison of age alongside gender and race revealed that non-AA patients (51 years, SEM = 0.9) were significantly younger than AA patients (63 years, SEM = 0.4; p Conclusion: The primary shift in patient demographics as compared to the interferon era has been toward younger, non- AA females. In contrast, the predominant AA patients are still within the age cohort. The emergence of younger patients has important implications for screening, patient outreach, and treatment plans. A more intensive evaluation for risk factors and the role of COVID-19 in treatment is warranted. Many AA and non- AA patients were not started on any treatment in 2019, signifying a need for continued follow-up after initial visit to close the linkage to care gap

FAILURE TO TREAT HCV IN PATIENTS SEEN IN A PREDOMINATELY AFRICAN AMERICAN SOCIOECONOMICALLY CHALLENGED POPULATION

The research objective of this proposal is to investigate the impediment with respect to moving a patient from initial antibody/PCR positive to successful completion of treatment. Secondary objectives include determining the most effective way for patients to progress from initial antibody/PCR positive to treatment and identifying the roadblocks for HCV antibody/PCR positive patients to be treated effectively. Data was collected from 2019 HCV patient EMR charts, including demographics, laboratory studies, and treatment history. Concerning treatment, we evaluated linkage to the care; we defined success as treatment within six months of the initial visit. Thus, data on treatment initiation was collected through the first six months of 2020

Screening for Venous Thromboembolism in Asymptomatic Trauma Patients: Effective in High Risk Patients

Hypothesis: Through data analysis of a large cohort of trauma patients, a clinically applicable protocol can be developed based on various predisposing factors for VTE in asymptomatic patients. By isolating the factors that make these patients high risk for VTE, we can effectively lower the incidence of PE in hospitalized trauma patients.https://jdc.jefferson.edu/patientsafetyposters/1001/thumbnail.jp

How Low Can We Go?: Comparing Long-term Oncologic Outcomes for APR and LAR in Very Low Rectal Cancer

Management of very low rectal cancer is one of the most challenging issues faced by colorectal surgeons. For tumors in the mid and upper rectum, procedures can be done to resect the cancer while maintaining continence, a major determinant of post-operative quality of life. In the low rectum, however, to optimize oncologic outcomes, many surgeons feel compelled to pursue abdominoperineal (APR) over low anterior resection (LAR), a sphincter-preserving procedure. It was hypothesized that after robust adjustment, procedure choice will not be associated with a difference in disease-free survival in the resection of tumors in the low rectum. To analyze this, the US Rectal Cancer Collaborative Database, a comprehensive, multi-center dataset obtained from six institutions between 2010 and 2016, was queried. Patients undergoing TME resection for Stage I-III very low rectal cancers (involvement) were selected for this study. Patients were categorized by procedure- LAR vs APR. Primary outcome was five-year disease-free survival. Secondary outcomes included overall survival, recurrence, length of stay, and complications. An adjusted analysis was performed to account for all known potential confounders. 431 patients with very low rectal cancer treated by either APR or LAR were identified. 154 (35.7%) underwent APR. The overall recurrence rate was 19.6%. Median follow-up time was 42.5 months. An analysis adjusted for age, gender, BMI, ASA class, and pathologic stage observed no difference in disease free survival between operative types (HR=0.90, 95% CI [0.53-1.52], p=0.70). Similarly, secondary outcomes demonstrated no significant difference between operation types, including length of stay (Beta: 0.04, Std. error = 0.25, p = 0.54), overall survival (HR=1.29, 95% CI [0.71-2.32], p=0.39), or complications (OR = 1.53, 95% CI [0.94 - 2.50], p=0.09). In this analysis, no significant difference in disease-free survival or overall survival was observed between patients undergoing APR or LAR for very low rectal cancer. This comprehensive study supports the treatment of very low rectal cancer, less than 5cm from the anorectal ring with no sphincter involvement, by either abdominal perineal or low anterior resection. Further studies may focus on patient-reported and quality of life outcomes which may influence decision-making