Integrative medicine (IM) is a unique clinical paradigm that may be applied across numerous healthcare professions and diverse settings. With its focus on whole person health and lifestyle medicine, it advocates utilizing complementary and alternative medicine in addition to traditional treatments in order to achieve an individual’s optimal wellness. Literature supports how significantly this distinctive, promising field of practice can help reduce overall healthcare costs, alleviate the heavy burden of chronic disease, bolster efforts focused on preventive measures, and improve both patient outcomes along with practitioner wellbeing. In order to meet a growing demand for easily accessible, ongoing professional education in IM, the Arizona Center for Integrative Medicine launched an innovative curriculum called the Integrative Medicine in Residency (IMR). This online, two hundred hour, integrative course premiered with eight Family Medicine Residencies across the United States. The purpose behind this study was to aid in developing an appropriate compilation of instruments for a long-term follow‐up questionnaire for IMR graduates, distribute the survey to a trial cohort, and present a summary of the pilot survey results. The instrument was developed in order to: provide feedback on the course, aid in future program modification, determine how graduates implement what they learned through IMR, identify barriers to care, and help distinguish areas where physicians may need additional support to better incorporate IM into practice. The final forty‐four‐question survey, with quantitative and qualitative measures, was distributed in 2015 over three months to residents that graduated between 2011‐2014 via their program directors. All candidates were sent an email with an embedded link to Survey Monkey. Through this series of online, self‐reported responses, the questionnaire was filled out in real time and results were auto‐populated into a secure excel file for further statistical analysis. Our trial cohort attained valuable responses from thirty‐one graduates. Results demonstrated that students were largely satisfied with their education and pleased with the personal and professional impacts following their IMR training; however, barriers to care most notably reported were time, cost, and patient receptivity. This study emphasizes the importance of providing easy access to ongoing IM education for physicians, while also highlighting the equal importance of future research into how to better support healthcare providers seeking to provide the comprehensive IM therapy all patients deserve.

The current state of intellectual property law is labyrinthine in every sense: it is difficult to follow, full of blind alleys, and the only people who know the way through it are the ones who designed it in the first place. Pamela Samuelson notes in Towards a New Politics of Intellectual Property, “copyright industry groups have cultivated relationships with policy makers in the executive and legislative branches over a long period of time” (98) and these relationships have been used to maintain control over copyrighted materials far beyond the length of time of commercial success of said materials. James Boyle noted that “the ground rules of the information society are being laid down by lawyers (strike one) employed by the biggest players in the field (strike two) all with little public debate or press scrutiny.” (Boyle, “Sold Out”) My goal in this paper will be to examine the history of copyright, attempt to unite some of the disparate aspects of the open information meme, and finally to consider how this meme is being distributed (or not distributed) by academic librarians. I will also attempt to make prescriptive suggestions that might assist librarians in seeing the strengths of the Open Information memepool.

Glioblastoma multiforme (GBM) is among the most aggressive and lethal of all human cancers. Characteristically, GBM is genetically heterogenous with different tumors portions exhibiting vastly different genetic profiles. Due to this, GBM patients are plagued with poor prognosis and high recurrence rates. Within the last decade there has been an increase in knowledge of the molecular finger print of GBM but improvement in patient outcome has been slow as personalized treatment regimens have not been linked to significant improvement. However, there is hope with feasible multiagent personalized regimens as well as expanding the amount of treatment options with repurposed agents and immunologic modulators improving patient outcomes. One hypothesized gene of interest in tumor development and progression is PTEN. In this study we investigate two repurpose agents Metformin and Chlorpromazine which are thought to depress downstream oncogenic proteins specific to the PTEN pathway using a cell culture model. For this study four Xenograft cell lines with differing PTEN status were treated with titrated concentrations of Metformin and Chlorpromazine. After treatment, results were quantified by SiRNA function using cell-titer glo assay a marker for cell viability.

While being theoretically so widely available, information can be restricted from a more general use by linguistic barriers. The linguistic aspects of the information languages and particularly the chances of an enhanced access to information by means of multilingual access facilities will make the substance of this thesis. The main problem of this research is thus to demonstrate that information retrieval can be improved by using multilingual thesaurus terms based on an intermediate or switching language to search with. Universal classification systems in general can play the role of switching languages for reasons dealt with in the forthcoming pages. The Universal Decimal Classification (UDC) in particular is the classification system used as example of a switching language for our objectives. The question may arise: why a universal classification system and not another thesaurus? Because the UDC like most of the classification systems uses symbols therefore, it is language independent and the problems of compatibility between such a thesaurus and different other thesauri in different languages are avoided. Another question may still arise? Why not then, assign running numbers to the descriptors in a thesaurus and make a switching language out of the resulting enumerative system? Because of some other characteristics of the UDC: hierarchical structure and terminological richness, consistency and control. One big problem to find an answer to is: can a thesaurus be made having as a basis a classification system in any and all its parts? To what extent this question can be given an affirmative answer? This depends much on the attributes of the universal classification system which can be favourably used to this purpose. Examples of different situations will be given and discussed upon beginning with those classes of UDC which are best fitted for building a thesaurus structure out of them (classes which are both hierarchical and faceted)...

Traditional information-processing accounts of the reasoning process in radiology assume that humans process the details of the input image in order to compute judgments. In these accounts, the development of expertise involves the acquisition of increasingly precise and complex internal problem representations that are based on a normal anatomy prototype. Fuzzy-trace theory predicts that accurate judgments rely on the reasoners ability to ignore irrelevant detail, to retrieve relevant gist memories and to accurately instantiate the image information with respect to the internal representation. Fuzzy-trace theory predicts that the development of expertise involves the ability to access and process less precise and complex internal representations (i.e., gist). The purpose of this study was to examine the internal representations used to make judgments in radiology and to quantify the changes in complexity of the internal representations, as well as the differences in time, accuracy and confidence that might be associated with experience. Thirty-five subjects from general and specialized expertise samples participated. Each subject was presented with 32 chest films including normal films, films with precise disease patterns (mass category) and diffuse disease patterns (interstitial and airspace category) . For each film, the participant made a series of judgments (normal/abnormal; category; specific diagnosis) and then sketched the features that were essential to the judgments.

This investigation assessed the diagnostic accuracy of thin-slice (1mm) axial Magnetic Resonance Imaging (MRI) in the detection and classification of meniscal tears. Meniscal injuries are a common reason for knee pain and the use of MRI has become standard in their assessment. However, the classification of tears and not merely the detection of lesions has become increasingly important to surgeons in deciding between surgery and conservative management. There is a growing body of literature examining the utility of axial MR images in aiding radiologists to more accurately describe and classify morphological characteristics of meniscus tears. However, the thick- slice (4-5mm) axial sequences utilized at many institutions typically only produce 1-2 images on which the menisci can be visualized, which does not provide the required detail to accurately describe the morphological characteristics of meniscal lesions. This study adds to the growing body of literature examining the diagnostic capabilities of MRI with TSAi to accurately describe meniscal tear morphologies. Imaging reports from 107 patients with clinically suspected meniscus injuries who underwent MRI with thin-slice axial imaging were compared to arthroscopic findings using receiver operating characteris (ROC) analysis to assess the diagnostic accuracy of MRI with thin- slice axial imaging (TSAi). The sensitivity and specificity of MRI with TSAi for meniscal tear detection were found to be 91% and 37.5% respectively. Furthermore, MRI with TSAi was highly specific for bucket handle (98.5%) and root ligament tears (94.1%). The findings of our investigation indicate that MRI with TSAi may assist surgeons in determining the need for operative versus conservative management. MRI with TSAi may be particularly helpful in the case of root tears, which were not as readily identified with traditional MRI techniques and often require surgical intervention due to morbidity associated with unrepaired root tears.

If the aim of this dissertation had to be summarized in a single sentence, it could be algebraization of graph grammars. An equivalent one would be study of graph dynamics. From the point of view of a computer scientist, graph grammars are a natural generalization of Chomsky grammars for which a purely algebraic approach does not exist up to now. A Chomsky (or string) grammar is, roughly speaking, a precise description of a formal language (which in essence is a set of strings). On a more discrete mathematical style, it can be said that graph grammars â Matrix Graph Grammars in particular â study dynamics of graphs. Ideally, this algebraization would enforce our understanding of grammars in general, providing new analysis techniques and generalizations of concepts, problems and results known so far. In this dissertation we fully develop such theory over the field GF(2) which covers all graph cases, from simple graphs (more attractive for a mathematician) to multidigraphs (more interesting for an applied computer scientist). The theory is presented and its basic properties demonstrated in a first stage, moving to increasingly difficult problems and establishing relations among them.

Significance: Cardiovascular disease represents the single most costly and common cause of hospitalizations in the US. More alarmingly, congestive heart failure (CHF) represents the largest cause of preventable hospitalizations. The 30‐day readmission rate after a hospitalization for CHF is an increasingly important measure of quality in the management of this chronic condition. Interventions targeted at CHF patients after discharge should address access to care and early follow‐up, and should be investigated as a means of decreasing 30‐day readmissions and improving patient outcomes. The Phoenix VAMC created a new early‐follow up clinic in 2011, and this study was the first investigation of outcomes from the intervention. Methods: Patients were selected who were admitted to the Phoenix VAMC with a primary diagnosis of heart failure (ICD‐9: 428.x). Patients referred to the early follow‐up clinic by their primary medicine team were our cohort of interest; patients which underwent standard care and served as our controls. A retrospective chart review was done to assess health status, compliance with the intervention, and 30‐day outcomes, the patient level outcomes. We also compared patients in two time periods, before and after the intervention was implemented, the hospital level outcome. Statistical analysis of this cohort study was done by identifying the relative risk of readmission and death. The RE‐AIM framework was used to determine the hospital‐level impact of the intervention. Results: 275 patients were divided into 116 control patients and 159 intervention patients. The RR of readmission in those referred to the clinic was 1.57 (p=0.09), and mortality was 0.78 (p=0.05). In those patients who were discharged in the post‐intervention time period, the RR of readmission was 0.57 (p=0.036) and 30d mortality was 0.72 (p=0.015). Time to follow‐up was reduced from 15 to 9 days (p<0.01) from the early time period to the late one. Conclusions: The use of care transition interventions have the potential to address issues of rehospitalization, especially in chronic diseases. Establishing a model which improves patient outcomes will have many long‐term benefits for our healthcare system. This intervention decreased mortality and increased readmissions on a patient level, while decreasing both mortality and readmissions on a hospital level, though other factors may be involved.

Epilepsy is the most common neurologic condition seen in children. Focal cortical dysplasia (FCD), a seizure disorder characterized by abnormal cortical laminar development, comprises approximately 75% of medically intractable epilepsies in the pediatric population. A greater appreciation of the pathology and intrinsic properties of the epileptogenic zone may help in understanding why FCD lesions are drug‐resistant, and could potentially lead to more effective treatments in the pediatric population. Neuronal support cells such as microglia and astrocytes have shown to have a role in FCD pathology. These cells are also activated during aging and traumatic brain injury as evidence by morphological change. This study aims to characterize the spatial distribution of microglia and astrocytes using immunohistochemistry in dysplastic tissue of eight male pediatric patients diagnosed with FCD. Cortical specimens from patients who underwent surgical resection of focally dysplastic cortex at Phoenix Children’s Hospital between 2008 and 2014 were examined using immunohistochemistry. Primary antibodies against GFAP and Iba1, as well as structural staining using hematoxylin and eosin (H&E), were incubated on sections and further analyzed using bright‐field microscopy. A pattern of perivascular activated microglia was observed in five patients around at least one blood vessel, while a pattern of non‐localized ramified microglia was observed in the other three patients. No identifiable pattern of astrocytic distribution was found. Thus, distinct patterns of microglia, rather than astrocytes, suggest dual underlying mechanisms of epileptogenesis.

The increase in available ultrasound technology has allowed healthcare professionals to begin learning the skills to use it starting early in their training and careers. The best methods of training to increase proficiency in its use have not been investigated, however. This study compares two different training methods of the Focused Assessment with Sonography in Trauma (FAST). First year medical students were randomized into two groups; one who trained using a conventional live human model and the other who trained using themselves as the model. Both groups were then assessed on a non-self live human model and scored based on time to completion of the FAST and the ability to identify pertinent anatomic landmarks. There was no significant difference in mean scores between both groups. The non-self training group was significantly faster than the self training group. This suggests that the conventional training model remains the best method for increasing proficiency in the FAST exam, although there are significant limitations and further investigations are needed.