Indiana University-Purdue University Indianapolis (IUPUI) / Hospital readmission is of growing importance in the healthcare industry because of associated patient and system costs, impact to the quality of patient care, and hospital Medicare payment penalties. The increasing interest in sepsis readmission prevention has highlighted the uniqueness of severe sepsis or septic shock survivors. The results of this study provide insight into the relationship between index hospital length of stay (LOS) and 30-day readmissions for older adults (> 65 years) who discharged home from an index hospital with a principle or secondary discharge diagnosis of severe sepsis or septic shock. The purpose of this study was to investigate the relationship between index hospital LOS and 30-day readmissions in older adults (> 65 years) whose expected primary payer was Medicare and who discharged home with a principle or secondary diagnosis of severe sepsis or septic shock. Data used to answer the proposed research questions consisted of older adult discharge records from the 2014 Nationwide Readmissions Database (NRD), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Differences in 30-day readmissions between older adult age groups, gender, and older adult location were examined. The number of days to readmission since discharge was evaluated for the subset of older adults with a readmission. Approximately 15.6% of older adults were readmitted within 30 days of their discharge. Readmissions were statistically different based on the older adult’s age, gender, and LOS. Location did not have a significant effect on readmissions. Mean LOS among readmitted older adults was 10.1 days. Analysis indicates that an older adult’s LOS had a significant effect on readmissions, although models performed poorly. Findings suggest that there are certain factors that can predict older adults who are at risk for being readmitted after being discharged with a principle or secondary discharge diagnosis of severe sepsis or septic shock.

京都大学 / 0048 / 新制・課程博士 / 博士(理学) / 甲第18640号 / 理博第4019号 / 新制||理||1579(附属図書館) / 31554 / 京都大学大学院理学研究科地球惑星科学専攻 / (主査)教授 石川 裕彦, 准教授 林 泰一, 教授 余田 成男 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DGAM

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiological agent responsible for the coronavirus disease of 2019 (COVID-19) pandemic, which has infected millions of people worldwide. To date, several vaccines and antivirals have been developed against SARS-CoV-2; however, its tendency to mutate rapidly poses a continued threat to human health. As such, the development of better pan-coronavirus therapeutics is still required. Recently, the SARS-CoV-2 non-structural protein 13 (Nsp13) helicase has been shown to be an attractive therapeutic target given its high conservation rate among coronaviruses and indispensable role in viral replication. Based on this, we sought to further study the biochemical mechanisms behind Nsp13's binding and unwinding activities, along with its interactions with host cells, to provide further insight for future therapeutic development. To study the binding and unwinding activity of Nsp13, we site-specifically incorporated the non-canonical amino acid (ncAA) p-azido-L-phenylalanine (AzF) into Nsp13 to act as a bioorthogonal handle for fluorescent labelling. We identified five potential sites for AzF incorporation in Nsp13 and assessed their reactivities towards a conjugated Cy5 fluorophore through strain-promoted alkyne-azide cycloaddition (SPAAC). Further experiments were also performed to ensure that the unwinding activity was not adversely affected before these Nsp13-AzF constructs were utilized in fluorescence resonance energy transfer (FRET)-based binding assays. Ultimately, the F81AzF construct was identified to be the most suitable for monitoring the binding of Nsp13 to a series of nucleic acid substrates in a distance-dependent manner by FRET. The next steps of this project would be to implement F81AzF in single-molecule FRET (smFRET) experiments to directly monitor the positioning and dynamics of this helicase on its substrate. In addition, interactions between Nsp13 and host cellular and biological processes were investigated to provide further insight into potential mechanisms that can be exploited for novel therapeutic development. From transcriptomic profiling analyses of A549 cells, we uncovered that Nsp13 influences microRNA (miRNA) expression and signalling pathways; in particular, miR-146a, a potent mediator of inflammation and immune responses, was found to be induced upon Nsp13-overexpression. Further experiments revealed that this may lead to the inhibition of NF-κB signalling, through the repression of the upstream targets TRAF6 and IRAK1, to suppress the production of proinflammatory cytokines and facilitate viral infection. Collectively, from this work, we propose that further exploration of these miR-146a-mediated signalling pathways may present alternative strategies for antiviral investigations.

Severe weather outbreaks are fairly common events that occur multiple times a year. Many studies have attempted to define and quantify these outbreaks, however, no work has been done to directly relate synoptic-scale processes to outbreak intensity using the N15 ranking index. It is believed that a statistically significantly strong relationship between outbreak severity and quantified synoptic-scale parameters exists and can be utilized to predict the severity of an upcoming outbreak using the N15 ranking index. Utilizing the NCEP-NCAR Reanalysis dataset, synoptic-scale variables were chosen and standardized into domains created from areal coverages. A series of tests were completed, including stepwise regression, principal component analysis, and a bootstrap cross-validation method to find the most significant variables and best domain size. The findings from this study suggest that synoptic-scale processes do not have a strong relationship to severe weather outbreak intensity and that future work would be necessary.

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An alien who commits a crime with imprisonment in the penalty scale can be expelled from Sweden. In order for deportation to be relevant, the alien must be sentenced to a more severe punishment than a fine. In examining the issue of deportation, the court must also take into account the alien's connection to Swedish society and make an overall assessment where the reasons for and against deportation are weighed against each other. If the alien has resided in Sweden for a longer period of time, special reasons for deportation are required, which provides a very strong protection for the alien.  The legislation on deportation due to crime is sparsely worded and entails ambiguities in many respects. Examples of ambiguities are which factors get into a recidivism risk assessment when there is no previously documented crime and how the factors in the assessment of an alien's connection to Sweden are to be evaluated. The problem with these ambiguities entails difficulties in predicting the outcome of the overall assessment that the court makes when the reasons for and against deportation are weighed against each other. It is reasonable to assume that the ambiguities can also lead to equal cases not being treated equally as the court is given a great deal of room for interpretation in its overall assessment. From a legal security perspective, these circumstances are problematic as legal security is largely based on the law being predictable. In order to remedy the problem, the legislator must take a clearer position and dare to legislate on the issues. Keywords: Alien, crime, deportation, severe punishment, legislation.

The development of posttraumatic stress disorder (PTSD) and severe weather phobia (SWP) symptoms in relation to weather-related trauma was examined. Participants were college students (N = 815) enrolled at Mississippi State University. Findings suggest that distinct factors (specifically, disorder-specific cognitions and anxiety sensitivity) contribute to the development of PTSD and in the onset of SWP symptoms following exposure to weather-related trauma. A weather trauma model taking into account disorder-specific cognitive vulnerabilities, previous exposure to weather-related trauma, and levels of anxiety sensitivity is suggested to provide an explanation for these differences. The results suggest that prevention and treatment efforts should address learned fear response, aim at reducing anxiety sensitivity, and target disorder-specific cognitions.

The current study examined the prevalence of severe weather phobia in high school students who had experienced a traumatic weather event and considered possible predictor variables to distinguish between students who did and did not develop severe weather phobia after experiencing the traumatic weather event. Participants (N = 17) completed a diagnostic interview and various questionnaires. Severe weather phobia symptoms (e.g., excessive fear, avoidance, anticipatory anxiety, realization that fear is excessive, distress or dysfunction) were common in the sample. Higher levels of PTSD symptoms and certain coping styles distinguished between those with phobia or subclinical phobia and those without, indicating that traumatic responses to severe weather and coping with severe weather by using social support or restraint predicts the development of severe weather phobia.

No description available.

No description available.