Evaluation of a Post Discharge Intervention on 30-Day Re-admission and Emergency Room Use in Patients with Diabetes A Pilot Program

Thesis (Master's)--University of Washington, 2016-06

Hypertension in Pagothenia borchgrevinki caused by X-cell disease

Approximately 15% of a population of the cryopelagic nototheniid fish Pagothenia borchgrevinki, found constantly swimming immediately beneath the annual fast ice, in McMudro Sound. Ross Sea, Antarctica, was affected by X-cell gill disease. This disease affected blood flow through the gill lamellae, and this in turn affected oxygen uptake. Exercise caused increases in heart rate and ventral aortic blood pressure. Heart rate increased from 15.1 +/- 1.55 to 23.1 +/- 0.93 beats min(-1) in healthy fish, with a similar increase from 15.1 +/- 1.55 to 23.1 +/- 0.93 beats min(-1) in healthy fish, with a similar increase (to 24.6 +/- 0.26 beats min(-1)) in X-cell-affected animals. In healthy fish, pressures rose with exercise (from 2.72 +/- 0.11 to 3.75 +/- 0.19 kPa) and then rapidly returned to resting levels during recovery. In X-cell fish pressures rose during exercise, but then continued to rise, to reach a high of 4.18 +/- 0.13 kPa, close to the predicted maximum pressure able to be generated by these hearts. Recovery was rapid in healthy fish, but was prolonged in diseased animals. As they are constantly swimming, there is the potential that X-cell-affected fish suffer from chronic hypertension. (C) 2003 The Fisheries Society of the British Isles.

Prospective study of men's psychological and decision-related adjustment after treatment for localized prostate cancer

Objectives. To undertake a prospective longitudinal study to assess psychological and decision-related distress after the diagnosis of localized prostate cancer. Methods. A total of I 11 men (93% response rate) with localized prostate cancer were recruited from outpatient urology clinics and urologists' private practices. More than one half (56%) elected to undergo radical prostatectomy, 19% underwent external beam radiotherapy, and 25% chose watchful waiting. Men completed self-report measures before treatment and 2 and 12 months after treatment. The measures used included the University of California, Los Angeles, Prostate Cancer Index, International Prostate Symptom Score, Impact of Events Scale, Constructed Meaning Scale, Satisfaction with Life Scale, Health Care Orientation subscale, and Decisional Conflict Scale. Results. No statistically significant differences were found by medical treatment group in the psychological and decision-related adjustment at baseline or with time. Men who were undecided about their treatment choice had greater decisional conflict and a more negative healthcare orientation, but were not more psychologically distressed, compared with men who had decided. At diagnosis, 63% of men had high decision-related distress, and this persisted for 42% of men 12 months after treatment, despite high satisfaction with their treatment choice. At diagnosis, low-to-moderate psychological distress was most common, with distress decreasing after treatment. The overall quality of life was similar to community norms. Conclusions. The results of our study indicated that men who were undecided about what treatment to receive experienced greater decision-related distress. The final treatment choice was not related to psychological distress about prostate cancer. Psychological and decision-related distress decreased with time, independent of treatment modality. Interventions should target decision-related distress for all men and in-depth psychological support for those who experience ongoing difficulties. (C) 2004 Elsevier Inc.

Refinement of a cell line based artificial diet for rearing the parasitoid wasp, Trichogramma pretiosum

An artificial diet incorporating insect cells originally developed for Trichogramma australicum Girault (Hymenoptera: Tricho-grammatidae) was successfully used to rear Trichogramm pretiosum Riley (Hymenoptera: Trichogrammatidae). To refine the diet, individual components were removed. Chicken egg yolk and the insect cells were identified as the most important components for T. pretiosum development. Their removal resulted in few pupae and no adults. Removal of Grace's insect medium, a common component of artificial diets, was found to markedly improve the development of T pretiosum, producing 60% larva to pupa transition and 19% pupa to adult transition. There was no significant difference in T pretiosum development on diets in which milk powder, malt powder or infant formula were interchanged, despite differences in nutrient composition. The use of yeast extract resulted in significantly higher survival to the adult stage when compared with yeast hydrolysate enzymatic and a combination of yeast extract and yeast hydrolysate enzymatic. Comparison of four antimicrobial agents showed the antibacterial agent Gentamycin and the antifungal agent Nystatin had the least detrimental effect on T pretiosum development. The use of insect cell line diets has the potential to simplify artificial diet production and significantly reduce T pretiosum production costs in Australia compared to diets using insect hemolymph or the use of natural or factitious hosts. (c) 2005 Elsevier Inc. All rights reserved.

Survey-gap analysis in expeditionary research: where do we go from here?

Research expeditions into remote areas to collect biological specimens provide vital information for understanding biodiversity. However, major expeditions to little-known areas are expensive and time consuming, time is short, and well-trained people are difficult to find. In addition, processing the collections and obtaining accurate identifications takes time and money. In order to get the maximum return for the investment, we need to determine the location of the collecting expeditions carefully. In this study we used environmental variables and information on existing collecting localities to help determine the sites of future expeditions. Results from other studies were used to aid in the selection of the environmental variables, including variables relating to temperature, rainfall, lithology and distance between sites. A survey gap analysis tool based on 'ED complementarity' was employed to select the sites that would most likely contribute the most new taxa. The tool does not evaluate how well collected a previously visited site survey site might be; however, collecting effort was estimated based on species accumulation curves. We used the number of collections and/or number of species at each collecting site to eliminate those we deemed poorly collected. Plants, birds, and insects from Guyana were examined using the survey gap analysis tool, and sites for future collecting expeditions were determined. The south-east section of Guyana had virtually no collecting information available. It has been inaccessible for many years for political reasons and as a result, eight of the first ten sites selected were in that area. In order to evaluate the remainder of the country, and because there are no immediate plans by the Government of Guyana to open that area to exploration, that section of the country was not included in the remainder of the study. The range of the ED complementarity values dropped sharply after the first ten sites were selected. For plants, the group for which we had the most records, areas selected included several localities in the Pakaraima Mountains, the border with the south-east, and one site in the north-west. For birds, a moderately collected group, the strongest need was in the north-west followed by the east. Insects had the smallest data set and the largest range of ED complementarity values; the results gave strong emphasis to the southern parts of the country, but most of the locations appeared to be equidistant from one another, most likely because of insufficient data. Results demonstrate that the use of a survey gap analysis tool designed to solve a locational problem using continuous environmental data can help maximize our resources for gathering new information on biodiversity. (c) 2005 The Linnean Society of London.

Testosterone secretion and pharmacological spermatozoal recovery in the cane toad (Bufo marinus)

The cane toad (Bufo marinus) was used as a model to study male anuran reproductive endocrinology and to develop a protocol for non-invasive sperm recovery. Circulating testosterone concentrations in 6-hourly samples did not vary significantly (P < 0.05) over a 24 h period although there was a tendency (P = 0.06) for testosterone to be elevated at 19:00 h relative to other times of the day, which may be related to the nocturnal activity pattern of this species. Testosterone secretion after intraperitoneal (IP) injection of either a GnRH agonist (5 mu g IP) or hCG (1000 IU) was also examined. While the GnRH agonist did not produce a significant increase above basal plasma testosterone (0.29, 95% C.I. of 0.05-1.10 ng/ml), injection of hCG resulted in an increase (P < 0.01) of plasma testosterone with peak concentrations at approximately 120 min (4.17, 95% C.I. of 2.69-7.44 ng/ml) after injection. Non-invasive pharmaceutical sperm recovery was attempted following IP injection of graded doses of GnRH agonist, hCG or FSH. Urine was collected at 3, 6 and 12 h after treatment to assess sperm quality and quantity. The optimal protocol for sperm recovery in cane toads was injection of either 1000 or 2000 IU hCG; there was no significant difference in the quality of the spermic urine samples obtained using either dose of hCG or with respect to collection time. The findings indicated that hCG can be used to assess testicular steroidogenic status and also to induce sperm recovery in the cane toad. The hCG protocols developed in this study will have application in studies on the reproductive biology of rare and endangered male anurans. (c) 2005 Elsevier B.V. All rights reserved.

Whole brain irradiation following surgery or radiosurgery for solitary brain metastases: Mature results of a prematurely closed randomized Trans-Tasman Radiation Oncology Group trial (TROG 98.05)

We evaluated the effect of adjuvant whole brain irradiation (WBI) after surgery or radiosurgery for solitary brain metastases in a Phase III multicentre trial with randomization to 30-36 Gy WBI or observation. The study was closed early due to slow accrual after 19 patients (WBI 10, observation 9). There was no difference in CNS failure-free survival or overall survival between the arms. There was a trend to reduced CNS relapse with WBI (30% versus 78%, P = 0.12). Limited analysis of quality of life and neurocognitive function data revealed no evidence of difference between the arms. Our results are not inconsistent with two larger randomized trials and support the use of upfront WBI to decrease brain recurrence in this setting. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

No pain, no gain? Torture and ethics in the war on terror

Is the use of torture ever justified? This article argues that torture cannot be justified, even in so called ticking bomb cases, but that in such extreme situations it may be necessary. In those situations, judgements about whether the use of torture is legitimate must balance the imminence and gravity of the threat with the need to prevent future occurrences of torture and maintain a normative environment that is hostile to its use. The article begins by observing that the use of torture and/or cruel and degrading treatment has become a core component of the global war on terror. It tests the claim that the use of coercive interrogation techniques does not constitute torture, showing that similar arguments were levelled by both the British and French governments in relation to Northern Ireland and Algeria respectively and found wanting. It then evaluates and rejects Dershowitz's claim for the legalization of torture and the more limited claim that torture may be permissible in ticking bomb scenarios. In the final section, the article questions how we might maintain the prohibition on torture while acknowledging that it may be necessary in some hypothetical cases.

Dioon Lindl. (Zamiaceae): Perspectives from phylogeny and a population genetic study of Dioon edule

Dioon Lindl. (Zamiaceae) is a small genus restricted to Mexico (12 species) and Honduras (one species). Previous systematic studies have been unable to fully resolve species relationships within the genus. Phylogenetic analyses were conducted with data from several sources, including Restriction Fragment Length Polymorphisms from the chloroplast genome, morphology, two introns of the low copy nuclear gene S-adenosyl-L-homocysteine hydrolase (SAHH) and the 5.8S/ITS2 regions of the nuclear ribosomal DNA. The goals of the study were to construct a total evidence species level phylogeny and to explore current biogeographical hypotheses. None of the analyses performed produced a fully resolved topology. Dioon is comprised of two main lineages (the Edule and Spinulosum Clades), which represents an ancient divergence within the genus. The two introns of the nuclear gene SAHH offer additional evidence for the split into two lineages. Intron 2 contains a 18 bp deletion in the Spinulosum Clade, providing a synapomorphy for that group. The 5.8S/ITS2 regions were highly polymorphic and subsequently omitted from the combined analyses. In order to visualize congruence between morphology and molecular data, morphological characters were mapped onto the combined molecular tree. Current biogeographical hypotheses of a general northward pattern of migration and speciation are supported here. However, sister relationships within the Edule Clade are not fully resolved. Seven DNA microsatellite markers were developed to investigate patterns of genetic variation of seven populations of D. edule, a species restricted to Eastern Mexico. We found that most of the genetic variation lies within populations (Ho = 0.2166–0.3657) and that levels of population differentiation are low (Fst = 0.088); this finding is congruent with the breeding system of this species, dioicy. Four of the populations deviate from Hardy Weinberg Equilibrium and have a high number of identical genotypes, we suggest that this unexpected pattern is due to the life-history strategy of the species coupled with the few number of polymorphic loci detected in these populations. Our results are not congruent with earlier evidence from morphology and allozyme markers that suggest that the two northernmost populations represent a distinct entity that is recognized by some taxonomists as D. angustifolium.

Combination of 16S rRNA variable regions provides a detailed analysis of bacterial community dynamics in the lungs of cystic fibrosis patients

Chronic bronchopulmonary bacterial infections remain the most common cause of morbidity and mortality among patients with cystic fibrosis (CF). Recent community sequencing work has now shown that the bacterial community in the CF lung is polymicrobial. Identifying bacteria in the CF lung through sequencing can be costly and is not practical for many laboratories. Molecular techniques such as terminal restriction fragment length polymorphism or amplicon length heterogeneity-polymerase chain reaction (LH-PCR) can provide many laboratories with the ability to study CF bacterial communities without costly sequencing. The aim of this study was to determine if the use of LH-PCR with multiple hypervariable regions of the 16S rRNA gene could be used to identify organisms found in sputum DNA. This work also determined if LH-PCR could be used to observe the dynamics of lung infections over a period of time. Nineteen samples were analysed with the V1 and the V1_V2 region of the 16S rRNA gene. Based on the amplicon size present in the V1_V2 region, Pseudomonas aeruginosa was confirmed to be in all 19 samples obtained from the patients. The V1 region provided a higher power of discrimination between bacterial profiles of patients. Both regions were able to identify trends in the bacterial population over a period of time. LH profiles showed that the CF lung community is dynamic and that changes in the community may in part be driven by the patient's antibiotic treatment. LH-PCR is a tool that is well suited for studying bacterial communities and their dynamics.

Ground-based electromagnetic (EM) and drill-hole ice and snow thickness and melt pond depth measurements during Polarstern cruise ARK-IX/4, ARK-XI/1, and ARK-XII

Drillhole-determined sea-ice thickness was compared with values derived remotely using a portable small-offset loop-loop steady state electromagnetic (EM) induction device during expeditions to Fram Strait and the Siberian Arctic, under typical winter and summer conditions. Simple empirical transformation equations are derived to convert measured apparent conductivity into ice thickness. Despite the extreme seasonal differences in sea-ice properties as revealed by ice core analysis, the transformation equations vary little for winter and summer. Thus, the EM induction technique operated on the ice surface in the horizontal dipole mode yields accurate results within 5 to 10% of the drillhole determined thickness over level ice in both seasons. The robustness of the induction method with respect to seasonal extremes is attributed to the low salinity of brine or meltwater filling the extensive pore space in summer. Thus, the average bulk ice conductivity for summer multiyear sea ice derived according to Archie's law amounts to 23 mS/m compared to 3 mS/m for winter conditions. These mean conductivities cause only minor differences in the EM response, as is shown by means of 1-D modeling. However, under summer conditions the range of ice conductivities is wider. Along with the widespread occurrence of surface melt ponds and freshwater lenses underneath the ice, this causes greater scatter in the apparent conductivity/ice thickness relation. This can result in higher deviations between EM-derived and drillhole determined thicknesses in summer than in winter.

Espécies arbóreas nativas ornamentais do Rio Grande do Norte

The Caatinga and Atlantic Forest exhibit great species richness, which can attend requirements for various uses. Considering the current level of degradation of vegetation in Rio Grande do Norte, and the increasing use of exotic species, it is urgent to perform actions for the conservation of these biomes. From this perspective, using native plant species in the urban forestry becomes an instrument for the conservation and enhancement of local biodiversity. In this context, the general objective of this study is to gather and provide information about the ornamental native tree species in the state in order to promote and disseminate their use in urban areas. Specific aims of this work are: (1) evaluate and verify the demand and maintenance costs of native and exotic urban forestry, comparatively, with data obtained in the state (Cap. 1); (2) Provide a ornamental native tree species list in the state, including species already widespread use and suggesting new elements with ornamental potential (Cap. 2); and (3) produce a guide of native tree species as a means of disseminating the results obtained in a way accessible to the society. Analysis of maintenance of urban trees was performed at the UFRN's Central Campus, and the ornamental native tree species survey was carried out through literature survey combined with expeditions to forest fragments in the state. As a result, it was obvious that the maintenance of native vegetation resulted in lower costs and least demand for services highlighting the visible advantage in using a afforestation with regionalized floristic composition. The survey of ornamental native tree species led to the selection of 95 species belonging to 30 families, 17 species (17.35%) occurring exclusively in the Caatinga, 27 species (25.55%) in the Atlantic Forest and more than half (55.10%) occurring in both biomes, which provides a good selection available for the composition of urban forestry, both for cities located in the area of Atlantic Forest (81 spp.) or for those located in the Caatinga (71 spp.). From these results, a guide for the recognition and cultivation of native ornamental trees was prepared, consisting in the initial step in the enhancement of existing floristic potential value with the aim to assist in the development of a regionalized perspective of urban environmental management in the state

Economy of the island of eco-tourism: the role of shark-diving and shark harvesting

Beyond its importance in maintaining ecosystems, sharks provide services that play important socioeconomic roles. The rise in their exploitation as a tourism resource in recent years has highlighted economic potential of non-destructive uses of sharks and the extent of economic losses associated to declines in their population. In this work, we present estimates for use value of sharks in Fernando de Noronha Island - the only ecotouristic site offering shark diving experience in the Atlantic coast of South America. Through the Travel Cost Method we estimate the total touristic use value aggregated to Noronha Island by the travel cost was up to USD 312 million annually, of which USD 91.1 million are transferred to the local economy. Interviewing people from five different economic sectors, we show shark-diving contribute with USD 2.5 million per year to Noronha’s economy, representing 19% of the island’s GDP. Shark-diving provides USD 128.5 thousand of income to employed islanders, USD 72.6 thousand to government in taxes and USD 5.3 thousand to fishers due to the increase in fish consumption demanded by shark divers. We discover, though, that fishers who actually are still involved in shark fishing earn more by catching sharks than selling other fish for consumption by shark divers. We conclude, however, that the non-consumptive use of sharks is most likely to benefit large number of people by generating and money flow if compared to the shark fishing, providing economic arguments to promote the conservation of these species.

Safety in bear country

Safety in Bear Country tells the story of Serena Palmer’s twenty-second year. At a time when she thought she would be making a living in Toronto as an artist and as an independent adult, the economic times and her emotionally fragile state due to the demise of a romantic relationship, prove obstructive. Instead, she lives in the basement of her parents’ home and works for the town’s largest employer, a mental institution. Here she embarks on an internal quest for meaning and a truer understanding of love. Specifically, as the novel’s action shifts through Australia and then to Northern Canada, ending with her near-death and shamanistic spiritual transcendence, Serena explores the contradictions that exist between love and fear: in order to ever fully love, one must make oneself vulnerable at the deepest level. And, in order to ever make oneself vulnerable, one must conquer fear. In this way, fear and love are inextricably connected. Here in lies the irony of the title: Safety in Bear Country.

Pollen and macrofossil profiles from six cores in Illinois, U.S.A

Pollen analysis of Wisconsinan sediments from eleven localities in northern and central Illinois, combined with the results of older studies, allows a first general survey of the vegetational changes in Illinois during the last glaciation. In the late Altonian (after 40,000 B.P.), pine was already the most prevalent tree type in northern Illinois. Probably because of the influence of the last Altonian ice advance to northern Illinois, pine migrated to the south and reached south-central Illinois, which was at that time a region of prairie, with oak and hickory trees in favorable sites. Likewise in the late Altonian, spruce appeared in northern Illinois. Spruce also expanded its area to the south during the Wisconsinan, reaching south-central Illinois only after 21,000 B.P., in the early Woodfordian. Deciduous trees (predominantly oak) were present in south-central Illinois throughout the Wisconsinan. Their prevalence decreased to the north. The vegetation during the different subdivisions of the last glacial period in Illinois was approximately as follows: Late Altonian: Pine/spruce forest with some deciduous trees in northern and central Illinois; prairie and oak/hickory stands in south-central Illinois; immigration of pine. Farmdalian: Pine/spruce forest in central Illinois; deciduous trees and pine in south-central Illinois, with areas of open vegetation, perhaps similar to the present-day transition of prairie to forest in the northern Great Plains. Woodfordian: Northern and central Illinois ice covered; in south central Illinois, spruce and oak as dominant tree types, but also pine and grassland. During the Woodfordian, pine and spruce disappeared again from south-central Illinois, and oak/hickory forest and prairie again prevailed. The ice-free areas of northern Illinois become populated temporarily with spruce, but later there is proof of deciduous forest in this region. Pollen investigations in south-central Illinois have shown convincingly that deciduous trees could survive relatively close (less than 60 km) to the ice margin. Therefore the frequently presented view that arctic climatic conditions prevailed in North America during the last glaciation far south of the ice margin can be refuted for the Illinois area, confirming the opinion of other authors resulting from investigations of fossil mollusks and frost-soil features. The small number of localities investigated still permits no complete reconstruction of the vegetation zones and their possible movements in Illinois. During the Altonian and Farmdalian in Illinois, a vegetational zonation probably existed similar to that of today in North America. As the ice pushed southward as far as 39° 20' N. lat in the early Woodfordian, this zonation was apparently broken up under the influence of a relatively moderate climate. In any case, the Vandalia area, which was only about 60 km south of the ice, was at that time neither in a tundra zone nor in a zone of boreal coniferous forest.