Background Drug utilization review (DUR) is a central role of the pharmacist, especially within the community pharmacy setting. Previous literature has shown risk of “alert fatigue”, supporting the necessity of pharmacists to utilize a step-wise approach in evaluation of drug therapy during the verification process. Many students are intimidated by this process, and may lack verification practice or experience until their first day as a licensed pharmacist. Educational Activity and Setting An innovative skills-based laboratory exercise was developed for third-year pharmacy students to develop DUR skills. Through simulation of patient prescriptions, profiles, and drug information resources, students were tasked with completing a DUR for each patient case. Students were expected evaluate the clinical significance of various drug-related problems, determine if they would or would not dispense the prescription, and were required to provide rationale for their decision. Findings This learning activity was well-received by the student population; however, students struggled with the volume of cases along with identifying a solution to the clinical scenario. On average, students required nine minutes per case, which is likely longer than community pharmacists can devote to a single DUR in practice. Discussion In response, to student challenges with the activity, the number of cases was condensed to highlight key concepts and cases that facilitated strong discussion. To improve students’ approach to the DUR process, faculty developed a vodcast to watch prior to the activity explaining a systematic approach to the DUR process as well as considerations a pharmacist should have. Summary Development and integration of an active-learning, simulated dispensing activity allowed students to gain valuable experience completing the DUR process, a foundational community pharmacy practice skill; however, repeated experience should be provided to ensure competency.

Thesis advisor: Marc-Jan Gubbels / The two type I genotype T. gondii strains, RH, a lab-adapted strain, and GT1, a non-lab-adapted strain, have a genetic difference of only 0.002%, but show remarkable phenotypic differences in vitro. For example, it has long been known that RH’s in vitro virulence (i.e. plaquing capacity) and extracellular survival is far superior to that of GT1, likely due to several decades of adaptation to the in vitro environment (i.e. lab-adaptation). The genetic basis of these phenotypes, however, remains largely unknown despite previous allele-swapping experiments, thus inspiring two hypotheses: 1) epistatic interactions between two or more alleles and/or 2) gene regulatory mechanisms are responsible for lab-adaptive phenotypes. Uncovering the molecular basis underlying lab-adaptive phenotypes will support our growing understanding of T. gondii virulence and suggest therapeutic targets that affect the parasites lytic cycle in a host-independent manner. To answer this question, we applied Evolve and Resequencing (E&R) of GT1 during the first 1500 generations of its lab-adaptation in order to chronologically identify emerging genotype-phenotype correlations. Indeed, lab-adaptation augmented GT1’s in vitro virulence by improving its extracellular survival and reinvasion capabilities- both extracellular phenotypes of the lytic cycle. DNA-sequencing of parallel GT1 populations at multiple evolutionary timepoints (i.e. passages) identified a polymorphic phospholipid flippase gene whose gene expression is critical for in vitro virulence but, unfortunately, the evolved mutations could not be functionally characterized due to technical limitations. RNA-seq of both intracellular and extracellular parasites across several passages identified hundreds of “pro-tachyzoite” differentially expressed genes (DEGs), but only in extracellular parasites, paralleling our phenotypic observations. Interestingly, several upregulated DEGs are connected to fatty acid biosynthesis. Lastly, genetic KO of five seemingly non-related DEGs indicates that GT1’s lab-adaptive in vitro virulence is a complex and polygenic phenotype that is largely controlled by mechanisms independent of genomic mutations. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Biology.

L'un des défis majeurs de l'évolution de l'architecture Internet est la définition d'une architecture protocolaire permettant d'améliorer le routage, et en particulier (i) conserver un système de routage gérable avec les technologies actuelles et futures c'est-à-dire, avec quelques millions d'états, (ii) offrir une architecture apte à faciliter la programmabilité du plan de transfert, (iii) proposer un système de routage évolutif pouvant être régulièrement optimisé avec uniquement les informations sur les flux actifs, (iv) fournir une séparation entre localisateurs et identificateurs pour la mobilité IP avancée, (v) faciliter un déploiement incrémental, (vi) mieux servir les services applicatifs "over-the-top". Le protocole LISP (\textit{Locator/Identifier Separation Protocol}) a été identifié comme l'un des protocoles émergents à cet égard. Dans son état actuel, il répond très bien aux besoins susmentionnés. Cependant, il subit des limitations lorsqu'il s'agit de prendre en compte la résilience et la capacité à réagir rapidement aux mises à jour de l'état du réseau. Ces inconvénients peuvent être compensés en améliorant l'architecture du plan de contrôle et ses algorithmes de routage. Dans cette thèse, nous proposons une nouvelle architecture réseau-système et expérimentons de nouvelles primitives de plan de contrôle, ainsi que d'algorithmes de diffusion des états, en testant son passage à l'échelle avec différentes conditions de réseau. Nous concevons et construisons d'abord un nœud de plan de données et de plan de contrôle LISP open source. Nous le comparons avec d'autres implémentations en montrant que notre implémentation atteint des performances adaptées aux vrais déploiements. Nous montrons comment notre implémentation a permis la mise en oeuvre d'une plateforme d'expérimentation à grande échelle, la plate-forme LISP-Lab, en opération aussi bien les fonctions de plan de transfert que les fonctions de plan de contrôle. En suite, nous proposons une nouvelle solution pour les migrations à chaud de machines virtuelles à travers des centres de données géographiquement répartis sur des réseaux IP étendus. Des tests dans un testbed réel connecté nativement à Internet montrent qu'avec notre approche, nous pouvons facilement atteindre des temps d'arrêt inférieurs à la seconde lors de la migration sur une grande échelle, même pour des clients très distants. En outre, nous avons étudié des protocoles d'optimisation de réseau multicouche, en particulier en relation avec le protocole MPTCP (Multipath Transport Control Protocol), auquel LISP peut offrir une diversité de chemins pour l’agrégation de bande passante, ainsi qu’une plus grande confidentialité et fiabilité des connexions. Bien que nous ne puissions bénéficier que de quelques nœuds de réseau superposés, nous avons pu évaluer expérimentalement nos propositions en montrant l'impact positif de notre solution, l'impact négatif des longs temps d'aller-rétour sur certains sous-flux MPTCP, et la forte corrélation entre le temps d'aller-retour différentiel et le débit. Enfin, nous avons travaillé sur une refonte du plan de contrôle de LISP afin d’améliorer son fonctionnement du à l'échelle d’Internet, en facilitant la coopération entre les systèmes de mapping LISP et en introduisant plus d'automatisation dans la procédure de fourniture de services de connectivité LISP. Nous croyons qu'une telle optimisation pourrait sensibiliser la communauté des fournisseurs de services, générant de nouvelles opportunités commerciales liées aux services de cartographie LISP et l'application de politiques d'ingénierie de trafic interdomaines avancées dans le but d'obtenir de meilleures garanties de qualité de service. / One of the major challenges in the evolution of the Internet architecture is the definition of a protocol architecture that allows to solve the following major issues in Internet routing and traffic forwarding capabilities, (i) keeping a routing state that is manageable with current and forthcoming computing infrastructure – i.e., with few millions of states, (ii) offering a scalable pull architecture in support of data-plane programmability, (iii) offering a scalable forwarding plane able to be regularly optimized with only active flows information, (iv) offering locator/identifier separation for advanced IP mobility, (v) is incrementally deployable, (vi) can enhance the support of over-the-top services. The Locator/Identifier Separation Protocol (LISP) has been identified as one of the rising protocols in this respect. In its current status, it supports the above mentioned requirements at a level that is acceptable for basic networking environments. However, it shows too limited capacities when it comes to take into consideration fault resiliency and capability to react fast to network state updates. These shortcomings can be compensated by enhancing the control-plane architecture, and the routing algorithms therein. In this dissertation, we propose new protocol features and experiment novel control-plane primitives, as well as hybrid distributed-centralized routing state dissemination algorithms, to scale with different network conditions. We first design and build own open source LISP data-plane and control plane node, comparing it with other implementations, showing how our implementation can scale for large networks and reach performances suitable for real deployments. We present how our implementation served to operate all network nodes (data-plane and control-plane nodes) of a large scale experimentation testbed, the LISP-Lab testbed. Then we propose a novel LISP-based solution for VM live migrations across geographically separated datacenters over wide area IP networks. Experimenting it at large scale, we show that with our approach we can easily reach sub-second downtimes upon Internet-wide migration, even for very distant clients. Moreover, we investigate cross-layer network optimization protocols, in particular in relation with the Multipath Transport Control Protocol (MPTCP) to which LISP can deliver path diversity in support of bandwidth increase, confidentiality support and connection reliability, also using LISP traffic engineering network overlays. Despite we could benefit from only few overlay network nodes, we could experimentally evaluate our proposals showing the positive impact by using our solution, the negative impact of long round-trip times on some MPTCP subflows, and the strong correlation between the differential round-trip time among subflows and the throughput performance. Finally, we worked on a framework to improve LISP operation at the Internet scale, by facilitating cooperation between LISP Mapping Systems and introducing more automation in the LISP connectivity service delivery procedure. We believe such optimization could raise awareness among the service providers’ community, yielding new business opportunities related to LISP mapping services and the enforcement of advanced inter-domain traffic engineering policies for the sake of better quality of service guarantees.

Les tests « in vitro » permettent d’établir près de 70% des diagnostics et leur développement pour une utilisation au plus près du patient apparaît donc comme un enjeu majeur de santé publique. Dans ce contexte, les critères ASSURED (« Affordable, Sensitive, Specific, User-friendly, Rapid and robust, Equipment-free and Deliverable to end-users ») a été défini par l’organisation mondiale de la santé pour que les chercheurs développent des outils de diagnostic dits « Point of Care » utilisables par le plus grand nombre. Avec l’essor de la microfluidique, la gamme des dispositifs possibles s'est élargie et des biocapteurs intégrés ont été développés, transformant le signal biologique d’une reconnaissance d’un biomarqueur par une sonde biologique en un signal optique, électrochimique, mécanique ou encore magnétique. Comme les milieux biologiques sont en grande majorité amagnétiques, les capteurs magnétiques ne sont pas affectés par l’utilisation de matrices biologiques complexes comme peuvent l’être les mesures optiques ou électrochimiques. De plus ces capteurs sont faciles à produire et intégrables dans les puces microfluidiques. Cette thèse a pour objectifs de concevoir un outil de diagnostic in vitro basé sur des capteurs à magnétorésistance géante et de tester ses performances. Cette étude a été réalisée en utilisant une lignée cellulaire de myélome murin. Les cellules sont marquées spécifiquement par des particules magnétiques fonctionnalisées par des anticorps dirigés contre un de leurs antigènes et sont passées dans le canal microfluidique au-dessus des capteurs. Cette méthode de détection dynamique permet de compter les objets magnétiques un par un. La difficulté réside dans la distinction des signaux spécifiques provenant des cellules marquées des signaux faux positifs induits par les billes restant en solution. Deux types de dispositifs ont été conçus dans cette thèse pour lever ce verrou. Le premier possède une couche inerte de séparation de quelques micromètres entre les capteurs GMR et le canal qui permet de supprimer les signaux des billes isolées. Le second dispositif, qui a des capteurs à la fois au-dessus et au-dessous du canal microfluidique, permet une double détection simultanée de chaque objet magnétique. Il est ainsi possible de connaître le nombre de billes qui les marquent et de déterminer s’il s’agit d’un agrégat de billes ou d’un objet biologique. / The « in vitro » tests are requested for the establishment of nearly 70% of diagnoses and their development for on-site detection therefore appears to be a major public health issue. In this context, the ASSURED criterion (« Affordable, Sensitive, Specific, User-friendly, User-friendly, Rapid and robust, Equipment-free and Deliverable to end-users ») has been defined by the World Health Organization to encourage researchers to develop diagnostic tools called « Point of Care » that can be widely used.With the rise of microfluidics, the range of possible devices has broadened and integrated biosensors have been developed, transforming the biological signal from a biomarker recognition by a biological probe into an optical, electrochemical, mechanical or magnetic signal. As biological environments are largely non-magnetic, magnetic sensors are not affected by the use of complex biological matrices as are optical or electrochemical measurements. In addition, these sensors are easy to produce and can be integrated into microfluidic chips. The objectives of this thesis are to design a diagnostic tool in vitro based on giant magnetoresistance sensors and to test its performance. Its development was carried out using a murine myeloma cell line. The cells are specifically labeled by magnetic particles functionalized by antibodies directed against one of their antigens and flown in the microfluidic channel above the sensors. This dynamic detection method allows magnetic objects to be counted one by one. The challenge is to distinguish the signals coming from the labeled cells from those of the beads remaining in solution. In order to address this problem, two labs on chips are developed in this thesis. In a first device, an inner layer of a few micrometers separates the sensors from the channel which allows to suppress the signals of the isolated beads. The second device has sensors both above and below the microfluidic channel and can measure the number of beads corresponding to each doubly detected object which can thus be identified (aggregates or biological objects).

Employee Engagement in a Cardiac Catheterization Lab by Rhonda J. Smith Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2016 This study adds to the existing body of knowledge on employee engagement and workplace climate in the catheter laboratory setting. The study goals were to discover the current state of workplace satisfaction and then to share the results with the staff to determine what to improve and how to guide them through the Lean process. This study was guided by Kanter's structural empowerment theory, which holds that structural factors inside the workplace have a greater impact on employee work feelings and behaviors than do the employees' own personal tendencies. It was also guided by the Lean model, which aims to transform an organization's culture via a customer-focused method to constantly produce improvement opportunities, remove waste, and create value. This project utilized a descriptive research design. The catheter laboratory staff were e-mailed a link to complete a staff engagement and workplace climate survey. The survey was based off of a prior staff satisfaction survey used by the organization for consistency, but was not validated in the process. This survey provided a means to establish employee attitudes on several aspects analyzed by a 7 point-Likert scale. Of the 19 staff members who received the survey, 11 completed it, yielding a 60% response rate. Overall, the staff indicated that they were satisfied with their job and enjoyed working in their department. The findings from this survey were shared with the catheter laboratory staff and they chose to work on improving teamwork with departments outside of cardiology. The results of this study reinforce existing literature that demonstrates that employees who are engaged in the workplace are happier and more productive. The concept of staff engagement has been linked to higher quality patient outcomes, greater financial viability, increased productivity, and higher employee satisfaction.

Applications for lab-on-a-chip devices have been expanding rapidly in the last decade due to their lower required volume of sample, faster experiments, smaller tools, more control, and ease of parallelization compared to their macroscale counterparts. Moreover, lab-on-a-chip devices provide important capabilities, including isolating rare cells from body fluids, such as isolating circulating tumor cells from blood or peritoneal fluid, which are not feasible or at least extremely difficult with macroscale devices. Particles experience different forces (and/or torques) when they are suspended in a fluid in a microdevice. A dominant force is the drag force on the particle as it flows through the fluid.  External forces such as dielectrophoresis, the motion of a particle due to its polarization in the presence of a non-uniform electric field, may also be applied. For instance, well-specified mixing or separation of particles can be achieved by using the combination of drag and dielectrophoretic forces. Two major mechanisms for manipulating particles in a microdevice include control of forces applied to the particles, such as those due to electric and velocity fields, and the geometry of the device that affects the nature of these fields. The coupling between the geometry of the microdevices and applied fields makes the prediction of associated forces inside the microdevice challenging and increasingly difficult when the applied field is time-dependent. Understanding the interaction of external forces and particles and fluid is critical for engineering novel microsystems. Determining this interaction is even more complicated when dealing with bioparticles, especially cells, due to their complex intrinsic biological properties which influence their electrical and mechanical properties. Particles with non-spherical geometries further increase the complexity, making drag and other shape-dependent forces, such as dielectrophoretic force, less predictable and more complicated. In order to introduce more complexity to the system and maintain precise control over particle movement and fluid flow, it is essential to have a comprehensive understanding about the mechanics of particles-fluid interaction and the dynamics of the particle movement. Although microfluidics has been investigated extensively, unanswered questions about the effect of forces on the particle remain. Answering these questions will facilitate designing novel and more practical microdevices for medical, biological, and chemical applications Microfluidics devices were engineered for differentiation of subpopulations of cells based on their bioelectrical properties. These microdevices were utilized for separating prostate, leukemia, and three different stages of breast cancer cells from hematologic cells with concentrations as low as 1:106 with efficiency of >95%. The microfluidic platform was also utilized to isolate prostate cancer stem cells (CSCs) from normal cancer cells based on their electrical signature. Isolating these cells is the first step towards the development of cancer specific therapies. The signal parameters required to selectively isolate ovarian cancer cells at different cancer stages were also compared with peritoneal cells as the first step in developing an early diagnostic clinical system centered on cell biophysical properties. Moreover, the effect of non-toxic concentrations of two metabolites, with known anti-tumor and pro-tumor properties, on the intrinsic electrical properties of early and late stages of ovarian cancer cells was investigated. This work is the first to show that treatment with non-toxic doses of these metabolites correlate with changes in cells electrical properties. / Ph. D.

No description available.

In the Jefferson Lab E12-16-007 (J/psi-007) experiment we measured the differential J/psi photo-production cross section as a function of photon energy, E_gamma and Mandelstam variable t - the momentum transfer from the initial photon to the produced J/psi - in the energy region where all the charm pentaquark states were discovered by the LHCb (Large Hadron Collider beauty) collaboration. The J/psi-007 experiment was conducted in the experimental Hall C of the Thomas Jefferson National Accelerator Facility using a high-intensity real photon beam generated by a 10.6 GeV incident electron beam traversing a copper radiator upstream of a liquid hydrogen target. Two arm spectrometers of Hall C, HMS (High Momentum Spectrometer), and SHMS (Super High Momentum Spectrometer) were used to detect the e+ e- di-lepton J/psi decay pairs in coincidence. The spectrometers' four momentum and angle settings scanned a photon beam energy range between 9.1 and 10.6 GeV and |t| up to 5 GeV^2. An enhanced sensitivity to the s-channel resonant J/psi photo-production was achieved by optimizing the spectrometer settings at a higher t region where the non-resonant standard t-channel J/psi production cross section is strongly suppressed. No evidence for pentaquarks was observed and, the cross section upper limits for each LHCb pentaquark candidate were determined and are presented in this document. / Physics

Rapid, point-of-care infectious disease diagnostics have the potential to dramatically improve health care provision in low-income world regions. However, the development of technologies such as electrochemical DNA biosensors is hindered by slow turnaround times from design to working prototype. In order to facilitate biosensor development, a rapid prototyping method has been applied to the fabrication of wrinkled nano-/micro-structured electrodes in this work. An electrocatalytic DNA hybridization detection scheme is optimized for use with the wrinkled electrodes by adjusting the concentrations of redox agents FiCN and RuHex. Characterization of the electrodes by electrochemical and fluorescence-based methods showed tunability of important detection-related parameters – namely, the density of DNA probe molecules and the hybridization-induced electrocatalytic signal change – by altering parameters of deposition time, molar fraction of DNA probes relative to diluent molecules, and thickness of the wrinkled gold film. / Thesis / Master of Applied Science (MASc)

No description available.