Prong Approach Research Articles

Does biasedness starts with HR? - Analysis and outcomes and suggestions for transparent practices

HR research has shown that HR practitioners are influenced by different biases in their decision making. But do they know they are biased? This study looks at blind spots. These findings contribute to behavioural research in HR and practical tips to address workplace bias, whether deliberate or not Recognising and addressing biases is key to a fair and inclusive work environment across the globe whether international, national or local to identify common biases and their impact on the organisation and employees as well as ways to mitigate the unfair outcome.Cultural stereotypes, personal biases and institutionalised practices that unintentionally favour some groups over others are the main sources of HR bias. Gender, race, age and socio-economic status can for example determine who gets hired, evaluated for performance or promoted by employers. Without diversity considerations the result is uniform teams that stifle creativity as marginalisation excludes certain perspectives from consideration through exclusionary means.The impact of HR bias goes beyond individual employees to the organisation as a whole. Biased HR practices can erode trust in management, reduce employee engagement and increase turnover rates. This in turn can harm the organisation’s reputation making it less attractive to top talent and potentially lead to legal challenges. Biased decision making can also result in suboptimal talent management where the most qualified candidates are overlooked and the organisation’s overall performance is compromised.To address HR bias you need a 3 prong approach, bias awareness training, standardised and transparent HR processes and a culture of inclusion. Organisations need to actively work to identify and mitigate biases in their HR practices to be fair, equitable and utilise human capital optimally.

Abstract 63: A case report of friedreich ataxia (FA) associated with diabetes mellitus and hypertrophic cardiomyopathy “A tri prong approach in the management of insulin autoimmune syndrome”

Introduction: Friedreich ataxia (FA) is a multisystem autosomal recessive disease with progressive involvement of the central and peripheral nervous system, and endocrine system. Diabetes mellitus (DM) is one typical non-neurological manifestation. Diabetes is due to insulin resistance and progressive beta cell dysfunction.Case Report: 11 years old girl was suspected of Friedreich ataxia when presented with difficulty of walking, getting up, and recurrent falls. Examination revealed positive Romberg's test, areflexia with bilateral extensor plantar reflexes. Genetic analysis of the Frataxin gene confirmed the expanded trinucleotide GAA repeats +250. At the age of 16 years, she presented to ER with diabetic ketoacidosis. At18years, follow-up evaluation showed hypertrophic cardiomyopathy. She had progressive neurodegeneration and is wheelchair-bound with severe sensory-motor peripheral neuropathy. Presently, she is 21 years and on the basal-bolus insulin regimen with a TDD of 96 units and beta-blockers for cardiomyopathy.Discussion: Mitochondrial dysfunction at the liver, muscles, adipocytes are associated with insulin resistance. β cell dysfunction with eventual loss of Islets of Langerhans causing diabetes in FA. Mortality in FA is secondary to diabetes or related complications and cardiomyopathy.Conclusion: Currently, no effective treatment is available for FA. Optimal Diabetes and cardiomyopathy management is essential in the management of FA.

Abstract 160: A tri prong approach in the management of insulin autoimmune syndrome

Insulin autoimmune syndrome (IAS) manifests as transient self-limiting endogenous hyperinsulinemic hypoglycemia. It is characterized by the presence of insulin autoantibodies which bind insulin and the unpredictable release of insulin from insulin-autoantibody complexes resulting in spontaneous hypoglycemia. It needs to be considered in patients with hypoglycemia (in non-diabetic individuals) to avoid unnecessary investigations and surgical interventions. Treatment of Insulin autoimmune syndrome has always been an enigma. We suggest a tri-prong approach, with the pharmacological cocktail of alpha glucose inhibitor, steroids, and diazoxide along with dietary modifications after the elimination of the culprit agent. The targeting of the three major pathogenetic mechanisms when initiated early holds the potential of earlier relief of symptoms and accelerated recovery in severe and refractory hypoglycemia.

Genesis of Antibiotic Resistance LXII: Mitigation of Antibiotic Resistant Bacterial Pathogen(s) (ARBP) / Clinical Persisters (cPrs) (ARBP ‐ cPrs) herded Pandemic by Effective Preventive Measures

An inspiration for an analysis of plausible of Pandemic impelled by Antibiotic Resistant (AR) infectious diseases (PARID) was derived from the observations during Covid-19 pandemic from February 2020 on till the time of submission of this work and also from a colloquium on the role of multiple socioeconomic factors impinging on pathophysiological factors (lymphatic system functions) contributing for the plausible sixth mass extinction. We have formulated three prong approach namely, (focusing on reducing the antibiotic footprint, drug resistance index - resistance map DRI-RM, implementation of antibiotic stewardship) I: Prevention, II: Treatment (Clinical care), and III: Rehabilitation of cohort with or without comorbidity. Here, we present a multitude of mitigation strategies as a part of I: Prevention: Non-Pharm. Intervention: i. establishment of internet site/home page for issuing and monitoring a national alert for lockdown /followed by a 48 – 72-hour mandatory preparatory process for stay home / shelter-in order simultaneous call center for guidelines and concerted effort in undertaking the contact tracing of the infected person sustaining quarantine / social isolation, ii. hand washing for 20 seconds before and after work, preparing food, dining, sneezing, coughing, iii. avoid crowds / close contact with sick people, iv. avoid community gathering (not more than 5, no cinemas, conferences, beauty salons), v drink adequate amount of water, vi Wear personal protection equipment while maintaining six feet during the rationing or going to the groceries hospitals or other life demanding event activities then demands demanding activities and see being informed by the local city states national global morbidity and mortality data on a daily basis, vii disinfect the surface of frequent contacts (door knob, toilet seat, dining table, electronic devices namely phone, computers, tv remotes, viii Avoid shaking hands, ix Stay home while taking a short walk in the lawn maintaining 6 feet distance with other person, x Decontaminate arriving from work or unknowingly touching an infected/sick patient by taking shower, washing clothes, xi Avoid touching your face, xii Avoid non-essential travels including the hot zones from where the disease started spreading, xiii Isolate the Footwear before entering the house, xiv No personal handkerchief, xv Decontaminate the personal jewelries, xvi Preferably vegetarian food, if not well cooked meat diet, and xvii Avoid unnecessary trips domestic / aboard / cruses) and well-coordinated pause in stay-home/shelter-in laws. Prophyl. Meas : DDX of the clinically recorded signs and symptoms of infectious diseases, plasma therapy, medically supervised implementation of vaccine campaigns as needed, stock pile of vaccines at each health care centers. Taken together, effective implementation of aforesaid mitigation measures, PARID would be improbable to impart a vile mortality rate. However, the plausibility of a higher morbidity rate of asymptomatic carrier with an array of comorbidity requiring concerted integrative approach for rehabilitation.

Engagement in Practice: Engineering Minority Student Engagement Project (EM-STEP)

The US is in greater need of STEM graduates to keep its competitive edge. Various US government agencies have raised concerns about shortage of STEM graduates for 35 years. It is equally important to keep US in technologically superior position. One way to grow the STEM workforce is to increase enrollment, retention, and graduation rates. It has been reported that incoming students are weak in Mathematics and thereby having great difficulty in engineering courses. As a result, they are dropping out of engineering programs resulting in low retention and graduation rates. It is desired to reinforce mathematical concepts. It is desired to engage, mentor and tutor them to keep them from dropping. There are three objectives in this project. One is to increase recruitment; the second goal is to improvement via engagement and providing help. The third goal of increasing graduation rates will be automatically achieved by enhancing retention rates. To meet this objective, Engineering Minority student Engagement Project (EM-STEP) is using an innovative five prong approach of offering Saturday Academy, peer lead group, professional lecture series, freshman seminar and summer research projects. Four high D, withdrawals, incomplete and F grade rates courses have been identified and they are Fundamentals of Electric Circuit Analysis, Engineering Mechanics: Statics and Dynamics, Introduction to Fluid Mechanics and Introduction to Thermodynamics. Students in these courses are from four engineering disciplines of Chemical, Electrical, Mechanical and Petroleum Engineering. These courses are being taught in the Saturday Academy and twenty students are working as peer group leaders. We are also offering motivating lectures in the professional lecture series. Summer research project for 8-week duration is also offered.

Multimodality of human epidermal growth factor receptor-2 antagonism restores the apoptotic capacity of liver cancer cells

Background: Hepatocellular carcinoma, the most widespread form of liver cancer and one of the most common and lethal malignancies, is characterized by poor prognosis, late onset, and a lack of clear-cut diagnostic markers. Novel therapeutic approaches are desperately required to develop effective treatment regimens. Methods: In this study, we attempted to reverse the proliferative capacity of liver cancer cells through employing a 3 – prong approach. We evaluated the antitumorigenic effects of some medicinal plant extracts that contain bioactive phytochemicals. In addition, we used Imatinib – a tyrosine kinase inhibitor (TKI), with human epidermal growth factor receptor (Her2)-specific small interfering RNA(siRNA) species to counteract the Her2-induced proliferative capacity of cancer cells. In our model, we evaluated the extent of activation of apoptotic mechanisms versus the proliferative and antiapoptotic strategies mounted by cancer cells. Results: Our results showed that HepG2 cells treated with 0.5 mM Imatinib exhibited marked downregulation of Her2 expression, upregulation of the proapoptotic marker, BAX and a downregulation of proliferative markers GPC3 and transforming growth factor (TGF)-β (45, 29, 95, and 115 folds, respectively). In the meantime, there was also significant downregulation of Her2, TGF-β, Mcl1, Spp1, GLUL and GPC3 expression and activation of apoptotic system in the cells treated with a mixture of anti-Her2 siRNA, Imatinib along with some selected extracts where the mixture successfully decreased viability of cancer cells. Conclusion: our study reveals the potential of using TKI along with phytochemical therapy and RNA interference as adjuvant regimen for treatment of liver cancer to augment the efficacy of the current control programs, yet, minimizing the side effects by transition to targeted rather than mass therapies.

Soft tissue tumor diagnosis: A three prong approach utilizing pattern analysis, immunocytochemistry, and molecular diagnostics.

Tissue diagnosis of a soft tissue neoplasm is of paramount importance for the development of an appropriate treatment plan. Biopsy technique including approach and biopsy method is important to the success of diagnosis and subsequent treatment. Histologic and cytologic diagnoses are difficult and complicated by the large number of soft tissue lesions described, distinctly different biopotential for morphologically similar lesions, often small biopsy specimen size, and the generally limited experience many pathologists have in the diagnosis of soft tissue neoplasms. While utilized less frequently than core-needle biopsies, fine-needle aspiration is a valuable initial approach for the classification of soft tissue neoplasms. The combination of pattern based morphologic analysis, immunohistochemistry, and molecular diagnostics represents a utilitarian and generally successful approach for the diagnosis of soft tissue lesions.

Destination Therapy: Standardizing the Role of Palliative Medicine and Delineating the DT-LVAD Journey

ContextDestination therapy (DT) patients face significant challenges as they transition from chronic left ventricular assist device (LVAD) support to comfort-oriented care. Integration of palliative medicine (PM) into the multidisciplinary team is important to facilitate advanced care planning (ACP) and improve quality of life (QoL). ObjectivesWe evaluated the impact of a structured programmatic approach to the end-of-life (EOL) process in DT patients as measured by QoL surveys and the utilization of ACP. MethodsWe instituted a four prong intervention approach: 1) delineated the path from implant to EOL by defining specific stages, including a transitional phase where care limits were agreed upon, 2) standardized the role of PM, 3) held transitional care meetings to support shared decision-making, and 4) held multidisciplinary team debriefings to facilitate communication. Preintervention and postintervention outcomes were measured for patients/caregivers by using the QUAL-E/QUAL-E (family) QoL instrument. Wilcoxon signed-ranks test compared nonparametric variables. ResultsAll patients (n = 41)/caregivers (n = 28) reported improved QoL measures (patient P = 0.035/caregiver P = 0.046). Preparedness plans increased from 52% to 73% after implementation and advance directives increased from 71% to 83%. Fifty-nine percent of the patients completed an outpatient PM clinic visit; 51% completed/scheduled a second visit. Clinician outcomes improved including satisfaction with multidisciplinary team communication/expectations, ACP processes, and EOL management. ConclusionA programmatic approach that standardizes the role of PM and delineates the patient's path from implant to EOL improved quality outcomes and increased implementation of ACP. A defined communication process allowed the multidisciplinary team to have a clear patient management approach.

Overview of progress in European medium sized tokamaks towards an integrated plasma-edge/wall solution a aIn the future we will refer to the author list of the paper as the EUROfusion MST1 Team.

Integrating the plasma core performance with an edge and scrape-off layer (SOL) that leads to tolerable heat and particle loads on the wall is a major challenge. The new European medium size tokamak task force (EU-MST) coordinates research on ASDEX Upgrade (AUG), MAST and TCV. This multi-machine approach within EU-MST, covering a wide parameter range, is instrumental to progress in the field, as ITER and DEMO core/pedestal and SOL parameters are not achievable simultaneously in present day devices. A two prong approach is adopted. On the one hand, scenarios with tolerable transient heat and particle loads, including active edge localised mode (ELM) control are developed. On the other hand, divertor solutions including advanced magnetic configurations are studied. Considerable progress has been made on both approaches, in particular in the fields of: ELM control with resonant magnetic perturbations (RMP), small ELM regimes, detachment onset and control, as well as filamentary scrape-off-layer transport. For example full ELM suppression has now been achieved on AUG at low collisionality with n = 2 RMP maintaining good confinement . Advances have been made with respect to detachment onset and control. Studies in advanced divertor configurations (Snowflake, Super-X and X-point target divertor) shed new light on SOL physics. Cross field filamentary transport has been characterised in a wide parameter regime on AUG, MAST and TCV progressing the theoretical and experimental understanding crucial for predicting first wall loads in ITER and DEMO. Conditions in the SOL also play a crucial role for ELM stability and access to small ELM regimes.

Side stream treatment nitrogen removal: alternatives for New York City

New York City Environmental Protection (NYCEP) is in the process of upgrading its treatment plants for nitrogen removal and is treating centrate, the side stream emanating from the anaerobic digestion process separately (SCT). The City is currently using a multi prong approach to treat centrate. Currently it uses the conventional nitrification/denitrification process with caustic and carbon addition at some of the plants and has the world's largest SHARON® demonstration facility at one site. In addition, the City is exploring the use of the anammox process as a viable alternative to the above two processes. To this effect, a pilot MBBR partial nitritation/anammox (PNA) reactor was operated in conjunction with the City College of New York (CCNY) at the 26th Ward Waste Water Treatment Plant in Brooklyn, NY. PNA is a nitrogen removal process that has a low carbon footprint and fits a low energy framework exceedingly well with low aeration and no external carbon requirements. Conducting a cost comparison of the PNA process to the conventional SCT and the SHARON® process on a cost per pound of nitrogen removed basis, it is found that the operating costs for the PNA process is only 35% of the SCT and 65% of the SHARON®, thus delivering substantial savings to the City when adopted at full-scale for future decades.

Integrating services and education in primary care

When developing integrated services in primary care mental health and wellbeing you also need to skill the workforce to deliver it. This workshop uses a practical case for the audience to work through to illustrate a whole systems model and pathway and the appropriate development and training plus the research from literature reviews that backs this up. Integrated care services need to be intrinsically linked to local needs assessment, national/international policy and drivers. We will compare and contrast a researched and successful integrated primary care mental health and physical wellbeing model against other integrated care models identified through the literature, examining the outputs and outcomes of a horizontal and vertical integrated model of primary care mental health and wellbeing and conclude with key findings and recommendations for future organisational and workforce development. Our work researched and developed a whole system pathway going across the whole life cycle and across all conditions, bringing in Primary Care and the Community. Poor outcomes from treatment of mental illness are frequently attributed to the failure of GPs to follow guidelines, but according to a literature search, GPs do recognise and support their patients when they are in mental distress, but they work in a chaotic environment that has not been defined and where guidelines are difficult, if not impossible, to follow. Borders between mental distress due to adverse life events and true mental illness are hard to distinguish. For an integrated model and developed workforce to be successful it has to align itself with the reality in primary care and is. It is therefore much more likely to succeed if developed according to educational theory, through small group work, sharing, discussing successes and failures and learning from patients lived experiences, to improve and refine skills and attitudes. We will use a real case to demonstrate this with the audience. Leadership and peer education involving acute and secondary care plus patients participating as technical experts will improve relationships and help integration. Mental health in primary care is poorly understood and scarcely researched. Its practice is substantially different from the practice of the specialism of psychiatry, being targeted mainly at the 93% of patients with mental illness who remain in primary care and are not looked after by specialists in secondary care nor are case managed within primary care. Despite this, training for the workforce in all aspects of mental health is performed mainly by psychiatrists, because they are seen as the experts, but they are experts in a systems based approach that uses a classification system (DSM or ICD) which fails to recognise that primary care mental health is a very inexact science, and possibly more of an art, relying on the strength of the relationship between doctor, nurse and patient, an understanding of their social background and the ability to listen, support and empathise. Traditional style didactic education and pathways, using a guidelines approach, therefore fails to support patients and health professionals in primary care. The lack of a common language between primary, acute, social and secondary care does not help and leads to a strained interface with poor communication The developed integrated model and case based training challenged this and was replicated across a number of UK sites with investment made in the development of low intensity interventions consisting of psycho educational courses, wellbeing and self care approaches alongside talking therapies, navigation and social support. These interventions were offered both at a whole population (horizontal) and targeted level (vertical). A stepped approach to primary care mental health is offered, which uses different levels of care to ensure the consistent flow of service users between the steps, resulting in no waiting lists. Steps are graduated from low to high intensity and are non-exclusive and recovery is built into each step. People can be referred back to primary care at any point and step back if needed. People are offered a range of evidence-based approved interventions, to give a choice of services, with different interventions offered at each level. Wellbeing and recovery is built in to all levels. Using a two prong approach of education and an integrated model showed both reliable outcomes and clinical change and that we were hitting the diverse needs of the target group outlined by the needs analysis. Added benefits were reductions in lengths of stay and a reduction in hospital admissions.

A REVIEW OF TECHNIQUES IN OPTIMAL SIZING OF HYBRID RENEWABLE ENERGY SYSTEMS

This paper presents a review of techniques usedin recent published works on optimal sizing of hybrid renewable energy sources. Hybridization of renewable energy sources is an emergent promising trend born out of the need to fully utilize and solve problems associated with the reliability of renewable energy resources such as wind and solar. Exploitation of these resources has been instrumental in tackling or mitigating present day energy problems such as price instability for fossil based fuels, global warming and climate change in addition to being seen as way of meeting future demand for power. This paper targets researchers in the renewable energy space and the general public seeking to inform them on trends in methods applied in optimal sizing of hybrid renewable energy sources as well as to provide a scope into what has been done in this field. In reviewing previous works, a two prong approach has been used focusing attention on the sizing methods used in the reviewed works as well as the performance indices used to check quality by these works. In summary there is a clear indication of increased interest in recent years in optimal sizing of hybrid renewable energy resources with metaheuristic approaches such as Genetic Algorithms and Particle Swarm Optimization coming out as very interesting to researchers. It has also been observed that resources being hybridized are those with complementary regimes on specific sites. Index Terms - Energy storage, hybrid power systems, optimization methods, renewable energy sources, reviews, solar energy, wind energy.

Keynote: Thin Film Magnetic Heads: Break-through of Electroplating into Electronics, Quantum Jump in Magnetic Storage

When IBM announced the random access magnetic disk storage system RAMAC 305 in 1957, it was hailed as a major break-through in data storage. By the early 1960s engineers realized that within a decade or so the system would not be able to achieve the higher areal density needed to meet the ever increasing demand for greater storage capacity. The limitation was that the hand-wound magnetic head could not be made any smaller to further increase the areal density on the discs. Many proposals were made and patents filed for small heads, but the technology to produce the required miniature 3-D structures did not exist.The first break-through came when we demonstrated that it is possible to electroplate the 3 µm thick, precise patterns of copper and permalloy required for a magnetic head through a photoresist mask on a thin, conductive seed layer. This was followed by exploratory investigations to achieve the required magnetic material properties of the metallic alloys and the invention of appropriate plating tools to build the head structures. Working side by side with the design engineers, functional requirements of the head could be balanced against fabrication process capabilities to produce a testable device.Our presentation will describe the structure of the inductive read/write heads, MR read-only heads and integrated MR read/inductive write heads. We will show that viable heads would not have been possible without several studies and inventions relating to plating solution chemistry, processing, materials and very uniform, high intensity, reproducible agitation in plating tools. Furthermore, all the process steps had to be carefully chosen to make sure no process step damaged any of the previously fabricated structure or interfered with subsequent steps. We were learning process integration before that concept even had a formal name. Once the prototype heads were built at the Yorktown Research lab and accepted for IBM’s next generation storage system, the next step was to design and build a pilot line in San Jose, IBM’s manufacturing site for magnetic storage. Electrochemical processes with the precision required for the thin film head had never before been run on a production line. Establishing the line required frequent visits to San Jose and often daily phone contact with their engineers. Furthermore, several of the engineers who were hired to run the San Jose line spent their first year with IBM in Yorktown doing research related to head fabrication, thus facilitating the transfer of this knowledge to San Jose.The five prong approach that prevailed from the first prototype to the final product was to concurrently develop the fabrication tools and to engage in studies related to the materials, the process, process control and process integration. Our preference was to use concrete data wherever possible, but to make the best engineering judgment if such data was not available. Studies were carried just far enough to obtain the information required to control the process and build the head. When time permitted, or if new problems surfaced, we could further pursue these studies. Where problems could be clearly defined and did not need head building capability, we tried to get professors and students interested in working on them.We have demonstrated that even in the absence of a full set of concrete data it is possible to build a relatively complex device by using the available information in combination with the best engineering judgment and then coming back to refine the technology into a full-fledged manufacturing process with all the necessary controls for optimum mass production.When the RAMAC 305 was first introduced, the disk size was 24 inches in diameter and the density of magnetic recording was 2 kilobits/in2. Today the disk size may be as small as two inches in diameter and the density is approaching a trillion bits per square inch – an increase of nearly 6 orders of magnitude in 50 years. In the same time, the cost of storage has dropped by 6 orders of magnitude. The successful use of electrochemistry in building the thin film head has underscored the importance of this field in both science and engineering. Electrochemical technology today is treated as a desirable fabrication approach in silicon chip fabrication, packaging, chip package attachment and MEMS. The thin film head has been a key factor in enabling the computers that now play a vital role in every aspect of our lives.

Poverty impairs cognitive function

Journal of Paediatrics and Child HealthVolume 50, Issue 4 p. 323-323 Heads UpFree Access Poverty impairs cognitive function First published: 03 April 2014 https://doi.org/10.1111/jpc.12533_2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Poor people often make bad decisions that exacerbate their financial and other problems. They use less preventive health care, are tardier and less likely to keep appointments, and comply less well with prescribed medications. They are also less productive workers and manage their finances worse than people who are not so poor. Are these behaviours, which can exacerbate poverty and ill health, the primary cause of the poverty or does poverty cause the problems? A paper from British and American psychology and economics departments adopted a two prong approach.1 Firstly, US shoppers had thoughts about finances induced experimentally (e.g. they were told to imagine their car needed repairs). ‘Poor’ shoppers had reduced cognitive performance compared with ‘rich’ shoppers, particularly for hard compared with easy financial problems (e.g. the repairs would cost $1500 vs. $150) (see Fig. 1). Secondly, Indian sugar cane farmers from Tamil Nadu, India are not paid until harvest; 464 farmers showed diminished cognitive function before harvest (‘poor’) compared with the same farmers after harvest (‘rich’). These important studies suggest that strategies to reduce poverty would be likely to improve cognitive function, coping and productivity. Figure 1Open in figure viewerPowerPoint Performance of US shoppers on easy and hard cognitive control tasks when poor and rich. Reference 1 Mani A et al. Poverty impedes cognitive function. Science 2013; 341: 976– 980. Available from: http://www.sciencemag.org/content/341/6149/976.full.pdf [accessed 18 March 2014]. CrossrefCASPubMedWeb of Science®Google Scholar Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au Volume50, Issue4April 2014Pages 323-323 FiguresReferencesRelatedInformation

Implicitly Unjust: How Defenders Can Affect Systemic Racist Assumptions

This paper discusses the power of implicit racial bias (IRB) in driving unjust, racially disparate outcomes in our criminal justice system and examines the role of the defender committed to racial equality. The paper examines how IRB influences the decision making of every player in the system, including the defense lawyer, and offers strategies for how defense counsel can address IRB while simultaneously living up to his or her obligations to each client. The paper suggests a three prong approach for the defender: 1) working to overcome his or her own biases, 2) developing strategies to educate others in the system about their biases at every stage of the process, and 3) finding ways to sustain him/herself in the face of intolerable injustice in order to help build a more just system.

Abstract 3497: A novel pathway involving Tcf-driven Bcl2 under regulation of Bmi-1 stem cell factor: Role in chemoresistance

Abstract Introduction: Bmi-1 a polycomb group (PcG) protein and stem cell factor is reported to play important roles in cell cycle, cell immortalization and senescence. Bmi-1 is reported to be elevated in several tumor types; however its mechanism of action is not clearly understood. Emerging evidences show that the chemoresistance of tumor cells are in part due to the activation of PcG proteins. Objective: In the current study, we investigated the relevance of Bmi-1 in the proliferation of prostatic tumor cells before and after chemotherapy and investigated the underlying mechanism. Methods: Bmi-1 protein was determined in normal, prostate cancer (CaP) cell lines and human prostatic tissues by employing immunoblot and immunohistochemistry analysis. To understand the mechanism a two prong approach (overexpression and silencing) was adopted by stably transfecting normal and CaP cells with either Bmi-1-overexpressing or Bmi-silencing plasmid. Transfected cells were tested for proliferation and sensitivity to various chemotherapeutic agents (casodex, docetaxel and Cisplatin) by employing MTT, 3[H]thymidine uptake and soft-agar assays. Immunoblot, microarray, luciferase-based reporter, TESS and ChIP analysis were used to identify potential targets of Bmi-1. The significance of Bmi-1 in proliferation and its translational significance as a molecular target (for gene therapy and chemotherapy) was evaluated by measuring the tumorigenic growth and sensitivity of CaP cells (harboring varied Bmi-1 expression) to Docetaxel therapy in xenograft mouse models. Results: Bmi-1 protein levels are highly elevated in CaP, colon cancer cell lines and in prostatic tissues of CaP patients. Bmi-1-overexpression was observed to abolish the senescence of normal epithelial cells and increase proliferation of CaP cells even under the presence of chemotherapeutic agents. A reverse effect was observed in Bmi-1-supressed cells. Bmi-1 was observed to regulate the expression of Cyclin D1 and Bcl-2, pro-survival genes and targets of Sonic Hedgehog (SHH) signaling. We provide compelling evidence that regulation of Bcl-2 by Bmi-1 is independent of SHH and is mainly through the activation and binding of TCF-4 transcriptional factor (Wnt signaling component) to promoter regions of Bcl-2. We identified the binding sites of TCF-4 on promoter region of Bcl-2 gene in tumor cells and in human tissues. Docetaxel therapy did not inhibit growth of Bmi-1 overexpressing tumors, however significantly inhibited the growth of Bmi-1-silenced tumors. Finally, we identified small molecule inhibitors of Bmi-1 by using Blue Gene/L Super Computer. Conclusions: For the first time, we identified a novel Tcf/Bcl-2 pathway driven by Bmi-1 that confers chemoresistance to tumor cells. We suggest that Bmi-1 could be developed as a novel therapeutic target to treat chemoresistant tumors. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3497. doi:1538-7445.AM2012-3497

Abstract 210: Utilization of ACTION Registry® - GWTG™ Report Data to Decrease Gender Disparity in Facility's Time to PCI ≤ 90 Minutes

Door to Percutaneous Coronary Intervention (PCI) time is a standard benchmark that is closely analyzed and reviewed in most PCI centers. Studies have established that gender bias exists in healthcare. The facility utilized the ACTION Registry® - GWTG™ 2009 annual report data to discern that females received a PCI within 90 minutes 92% of the time as compared to males receiving PCI within 90 minutes 97% of the time. The 5% gender difference illustrated a possible disparity in care that was converted into an opportunity for improvement. The hospital’s Acute Coronary Syndrome team reviews ACTION Registry® - GWTG™ data on a quarterly basis and employed a three prong approach to decrease the disparity. The team utilized case reviews, physician education, and staff education. The case reviews illustrated that the females who had not met the PCI within 90 minutes measurement were atypical presentations. The atypical presentations included “flu-like” symptoms, ear pain, hyperglycemia, and other uncommon signs and symptoms. The physician and staff education focused on awareness of the disparity and understanding atypical presentations in females. The nursing staff and physicians received education in the form of case reviews and quarterly tracking and reporting of the measure. The results became evident beginning with the 2010 Quarter 3 data, whereupon females received a PCI within 90 minutes 100% of the time. The case reviews and education have become part of the monthly Acute Coronary Syndrome and the Emergency Department monthly agendas. The female PCI within 90 minutes has been 100% for the last four quarters. The utilization of reliable data from the ACTION Registry® - GWTG™ registry enabled the facility to bring awareness to a disparity but more importantly to employ the data as a basis for a long term quality improvement project. The project has been replicated by various teams to examine several other measures. The project has led to several other process improvement projects that include utilization of the ACTION Registry® - GWTG™ data to improve regional Door to PCI times, Door to ECG times, and discharge medication measurements.

Implementing a holiday cooking-related burn injury prevention program: don't get burned by the bird

Grease burns and other cooking related injuries have an especially high incidence around the November/December holiday season. A study done in 2004 at our Burn Center showed that the incidence...

Donor management: social marketing, maintenance and trust

กระบวนการวางแผนในการรณรงคการบรจาคโลหตในกลม เปาหมาย โดยการนาาแนวคดเกยวกบการตลาดเชงสงคมมาใช ซงเรยกวาการผสมผสานแนวคดทางการตลาด ดงทรจกกนคอ 4 Ps ซงแสดงใหเหนถงทศทางและการตดสนใจในประเดนตางๆ ดงตอไปน Product (สนคา หรอบรการทเสนอใหกบลกคา) คอ การบรจาค โลหต (blood donation) Price (ราคาของสนคา) คอการสอสารใหผบรจาคโลหตรวา จะตองทาาอยางไรเพอใหไดสนคานนมาซงสนคาตามแนวคดการ ตลาดเชงสงคมในทน คอการบรจาคโลหต (give blood) Place (สถานท) คอวธทสนคาหรอบรการจะถงมอผบรโภค คอสถานทรบบรจาคโลหต โดยคาานงถงกจกรรมและนสยของ กลมเปาหมาย เชนเดยวกบทเขามประสบการณและความพง พอใจตอระบบการจดสงสนคาทมอยในปจจบน ธนาคารเลอดจะ บรรลเปาหมายการรกษาผบรจาคโลหตไวไดในอตราทสง Promotion (การประชาสมพนธ) คอการนาาวธการตางๆ มาใช รวมกน คอสอสงพมพ การโฆษณา ประชาสมพนธ การสราง กระแสผานสอตางๆ การเขาถงรายบคคล และการจดกจกรรม บนเทง เพอสรางความคด และภาพลกษณเกยวกบการบรจาค โลหตวาเปนการกระทาาทสรางกศลและเปนประโยชนตอสงคม Publics (สาธารณชน) คอ ประชาชนกลมเปาหมาย เลอก เจาะจง 2 กลม คอ กลมทกาาลงสรางอตลกษณ (identity builder) และกลมกาาลงกอรางสรางตว (career shapers) โดย มวตถประสงคเพอทาาใหกลมเปาหมายเหลาน เปนกลมทมความ ศรทธาในการบรจาคโลหต และเหนวาการบรจาคโลหตเปนสวน หนงของการดาาเนนชวตประจาาวน Partnership (ภาคเครอขาย) คอ องคกรหลกทรบผดชอบงาน บรการโลหตแหงชาตโดยตรง รวมทงการสรางภาคเครอขายในการ ทาางานรวมกบภาคเอกชนและองคกรทางศาสนา เพอใหไดปรมาณ โลหตทเพยงพอตอความตองการของประชาชน Policy (นโยบาย) คอ ใชการตลาดเชงสงคม เปนนโยบายใน การดาาเนนงานรณรงคการบรจาคโลหตในระยะยาว Purse strings คอ งบประมาณทจะใชในโครงการ สภากาชาดสงคโปรมประสบการณในการนาาการตลาดเชง สงคมมาใชสาาหรบการรณรงคผบรจาคโลหตซงประสบผลสาาเรจ ในประเทศสงคโปร โดยมการพดคยกบผบรโภคโดยไมมการพด ถงสนคาแทนการชกชวนบคคลใหบรจาคโลหต แผนงานการบรหาร จดการผบรจาคโลหตใชไดผล โดยการนาาเรองหลกการตลาดเชง สงคมมาทาาใหเกดการเปลยนพฤตกรรมจากทไมยอมบรจาคโลหต มามสวนในการบรจาคโลหตและถอวาการบรจาคโลหตเปนสวนหนง ของชวต นบเปนสงทาทายอยางแทจรง ถงการเผชญหนากบการเกด ขนของโรคตางๆ รวมถงภาวะเศรษฐกจทตกตาา โดยสภากาชาด สงคโปรสามารถมโลหตสาารองอยางเพยงพอถง 6 วน สาาหรบ 326 วนใน พ.ศ. 2551 ซงดขนถงรอยละ 30 เมอเทยบกบ พ.ศ. 2550 ม การเพมขนของผบรจาครายใหมถงรอยละ 34 ในกลมเปาหมายอาย 16-25 ป และเพมขนรอยละ 46 ในกลมเปาหมายอาย 26-35 ป เพอใหเกดความยงยนในขณะทมการพฒนาโปรแกรมจะตองม การคอยตรวจสอบและทบทวนถงองคประกอบสาาคญของการตลาด เชงสงคม 3 ประการและ ‘8Ps’ ของการผสมผสานการตลาดเชง สงคม เพอพฒนาโปรแกรมการรณรงคการบรจาคโลหต ซงตอง อาศยการวจย เพอคนหาโปรแกรมในการบรหารจดการผบรจาค โลหตทมประสทธภาพตอไป

The Mechanism of Absorption of CO2 in Ionic Liquids: a Computational and Raman Spectroscopy Study

Ionic liquids have the ability to solubilize various gases especially CO2, but the interaction that results in the solubility is unknown. In order to study the mechanism of solubility, a two prong approach, experimental and computational, was undertaken. Raman spectroscopy was performed on various CO2 infused ionic liquids to investigate the shift in the Raman bands which relate to the interactions between the gas and ions. In concert, a computational study was conducted to support the Raman data with possible conformations for the ion-CO2 complexes.