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Siegel C.A.,Dartmouth Hitchcock Medical Center | Siegel C.A.,University of Southern New Hampshire
Gastroenterology | Year: 2017

Health care is changing rapidly, so we must change with the times to develop more efficient, practical, cost-effective, and, importantly, high-quality methods to care for patients. We teach medical students that optimal patient care requires face-to-face interaction to collect information on the patient's history and perform the physical examination. However, management of many patients—especially those with chronic diseases—does not always require physical examination. Telemedicine offers an opportunity to take advantage of technology while leveraging the progressive push toward efficiency and value but also requires the belief that excellent patient care is not always provided in person. Telemedicine can include a variety of aspects of patient care adapted to be performed remotely, such as telemonitoring, tele-education, teleconsultation, and telecare. All of these have been evaluated in gastroenterology practice and have demonstrated feasibility and patient preference but have produced mixed results regarding patient outcomes. By combining telemedicine tools and new care models, we can redesign chronic disease management to include fewer in-person visits when patients are well yet increase access for patients who need to be seen. This change could lead to higher-value care by improving the experience of care, decreasing costs, and improving the health of the population. Barriers include reimbursement, licensing, and fear of litigation. However, if we hope to meet the needs of patients within our changing health care system, telemedicine should be incorporated into our strategy. © 2017 AGA Institute

News Article | May 9, 2017
Site: www.prweb.com

Marketing executive search firm MarketPro is proud to announce the selection of Alana Burns as the new Chief Marketing Officer of Southern New Hampshire University working with marketing and brand teams across the university. SNHU is a regionally accredited, nonprofit, private university based in Manchester, NH. With 3,000 students enrolled on campus and more than 80,000 students online, SNHU is one of the fastest growing universities in the country. SNHU continues to transform higher education by providing the best educational opportunity and experience for all students. “It was great to work with SNHU where their mission drives everything they do,” said Bob Van Rossum, President of MarketPro. “The University is at the center of redesigning higher education, allowing greater access at lower cost for a top degree. It comes as no surprise they have been growing; our job was to find them a top marketing leader who could take them to the next level. They wanted not only a top marketing leader, but their new executive had to have an authentic connection to the mission of improving the quality and availability of higher education. In both of those considerations, Alana was an exceptional choice.” “Our search process with MarketPro was great. The search team worked to understand not only our functional requirements but also to deliver candidates that aligned to our mission driven organization. Every candidate presented exceeded our expectations and added value to the overall process.” said Amelia Manning EVP, College of Online and Continuing Education. “That said, we are thrilled to welcome Alana to our team, she is the exact right person to take our marketing to new heights.” Burns is moving into the role from a position at the American Lung Association where she was SVP of Strategic Initiatives, Branding and Marketing. Her previous experience in nonprofit made her especially well-qualified for this nonprofit marketing executive search. “I am honored to join SNHU in this new role and help expand access to higher education,” said Burns. “SNHU is an innovative university focused on the success of students. I look forward to working with everyone in the SNHU community.” “We were able to bring the client multiple great candidate options from across the country to choose from,” said Van Rossum. “They were adamant in not wanting someone from a large, traditional university who was used to wading through bureaucracy and red tape. Our recruiters knocked it out of the park with this slate of talent.” About MarketPro MarketPro Inc. is a woman-owned CMO executive recruitment and marketing staffing firm founded in 1996. Headquartered in Atlanta, the nationwide recruitment agency matches high-performing marketers with clients who need their skills and experience to take their business to the next level. MarketPro has former marketers finding and vetting the talent, so only the best get through to our clients. Learn more at https://marketproinc.com/. About Southern New Hampshire University Southern New Hampshire University (SNHU) is a nonprofit, regionally accredited, private university with an 80-year history of educating traditional-age students and working adults. With more than 80,000 students and more than 200 undergraduate, graduate and certificate programs, available on campus and online, SNHU offers access to high-quality and affordable education. SNHU’s main campus is located in Manchester, NH with locations in Salem, NH, and Brunswick, Maine. Recognized as the “Most Innovative” regional university by U.S. News & World Report, SNHU continues to transform higher education by providing the best educational opportunity and experience for all students. Learn more at http://www.snhu.edu.

Henderson M.B.,University of Southern New Hampshire
Neurosurgical focus | Year: 2010

OBJECT: The authors tested the hypothesis that deep brain stimulation (DBS) in the nucleus accumbens (NAcc) decreases alcohol intake in alcohol-preferring (P) rats after each animal has established a stable, large alcohol intake and after P rats with an established intake have been deprived of alcohol for 4-6 weeks. METHODS: Bipolar stimulating electrodes were bilaterally placed in the NAcc using stereotactic coordinates. In the first study, P rats (9 animals) were allowed to establish a stable pattern of alcohol intake (about 5-7 g/day) over approximately 2 weeks, and the acute effects of DBS in the NAcc (140-150 Hz, 60-microsec pulse width, and 200-microA current intensity) on alcohol intake and alcohol preference were studied. Each animal acted as its own control and received 1 hour of DBS followed by 1 hour of sham-DBS or vice versa on each of 2 sequential days. The order of testing (sham-DBS vs DBS) was randomized. In the second study, each animal was allowed to establish a stable alcohol intake and then the animal was deprived of alcohol for 4-6 weeks. Animals received DBS (6 rats) or sham-DBS (5 rats) in the NAcc for 24 hours starting when alcohol was reintroduced to each animal. RESULTS: Deep brain stimulation in the NAcc, as compared with a period of sham-DBS treatment in the same animals, acutely decreased alcohol preference. Furthermore, alcohol consumption and preference were significantly reduced in the DBS group compared with the sham treatment group during the first 24 hours that alcohol was made available after a period of forced abstinence. CONCLUSIONS: The NAcc plays a key role in the rewarding and subsequent addictive properties of drugs of abuse in general and of alcohol in particular. Deep brain stimulation in the NAcc reduced alcohol consumption in P rats both acutely and after a period of alcohol deprivation. Therefore, DBS in the NAcc coupled with other neurophysiological measurements may be a useful tool in determining the role of the NAcc in the mesocorticolimbic reward circuit. Deep brain stimulation in the NAcc may also be an effective treatment for reducing alcohol consumption in patients who abuse alcohol and have not responded to other forms of therapy.

The development and homeostasis of multicellular animals requires precise coordination of cell division and differentiation. We performed a genome-wide RNA interference screen in Caenorhabditis elegans to reveal the components of a regulatory network that promotes developmentally programmed cell-cycle quiescence. The 107 identified genes are predicted to constitute regulatory networks that are conserved among higher animals because almost half of the genes are represented by clear human orthologs. Using a series of mutant backgrounds to assess their genetic activities, the RNA interference clones displaying similar properties were clustered to establish potential regulatory relationships within the network. This approach uncovered four distinct genetic pathways controlling cell-cycle entry during intestinal organogenesis. The enhanced phenotypes observed for animals carrying compound mutations attest to the collaboration between distinct mechanisms to ensure strict developmental regulation of cell cycles. Moreover, we characterized ubc-25, a gene encoding an E2 ubiquitin-conjugating enzyme whose human ortholog, UBE2Q2, is deregulated in several cancers. Our genetic analyses suggested that ubc-25 acts in a linear pathway with cul-1/Cul1, in parallel to pathways employing cki-1/p27 and lin-35/pRb to promote cell-cycle quiescence. Further investigation of the potential regulatory mechanism demonstrated that ubc-25 activity negatively regulates CYE-1/cyclin E protein abundance in vivo. Together, our results show that the ubc-25-mediated pathway acts within a complex network that integrates the actions of multiple molecular mechanisms to control cell cycles during development. Copyright © 2014 Roy et al.

Interferon β (IFNβ) is an antiviral cytokine secreted in response to pathogenic exposure that creates a restrictive intracellular environment through the action of downstream interferon-stimulated genes (ISG). The objective of this study was to examine the expression of IFNβ and ISG in both human uterine epithelial cells (UEC) and the ECC-1 uterine epithelial cell line and determine if expression changes with TLR stimulation and hormone exposure. Stimulation of primary uterine epithelial cells and ECC-1 cells with the TLR3 agonist poly (I:C) induced the mRNA expression of IFNβ, MxA, OAS2 and PKR. Other TLR agonists including imiquimod and CpG had no effect on either IFNβ or ISG expression. In contrast to ECC-1 cell responses which were slower, maximal IFNβ upregulation in UEC occurred 3 hours post-stimulation and preceded the ISG response which peaked approximately 12 hours after poly (I:C) exposure. Unexpectedly, estradiol, either alone or prior to treatment with poly (I:C), had no effect on IFNβ or ISG expression. Blockade of the IFN receptor abrogated the upregulation of MxA, OAS2 and PKR. Furthermore, neutralizing antibodies against IFNβ partially inhibited the upregulation of all three ISG. Estradiol, directly and in the presence of poly (I:C) had no effect on IFNβ and ISG expression. These results indicate that uterine epithelial cells are important sentinels of the innate immune system and demonstrate that uterine epithelial cells are capable of mounting a rapid IFN-mediated antiviral response that is independent of estradiol and is therefore potentially sustained throughout the menstrual cycle to aid in the defense of the uterus against potential pathogens.

Breast cancer screening holds a prominent place in public health, health care delivery, policy, and women's health care decisions. Several factors are driving shifts in how population-based breast cancer screening is approached, including advanced imaging technologies, health system performance measures, health care reform, concern for "overdiagnosis," and improved understanding of risk. Maximizing benefits while minimizing the harms of screening requires moving from a "1-size-fits-all" guideline paradigm to more personalized strategies. A refined conceptual model for breast cancer screening is needed to align women's risks and preferences with screening regimens. A conceptual model of personalized breast cancer screening is presented herein that emphasizes key domains and transitions throughout the screening process, as well as multilevel perspectives. The key domains of screening awareness, detection, diagnosis, and treatment and survivorship are conceptualized to function at the level of the patient, provider, facility, health care system, and population/policy arena. Personalized breast cancer screening can be assessed across these domains with both process and outcome measures. Identifying, evaluating, and monitoring process measures in screening is a focus of a National Cancer Institute initiative entitled PROSPR (Population-based Research Optimizing Screening through Personalized Regimens), which will provide generalizable evidence for a risk-based model of breast cancer screening, The model presented builds on prior breast cancer screening models and may serve to identify new measures to optimize benefits-to-harms tradeoffs in population-based screening, which is a timely goal in the era of health care reform. © 2014 American Cancer Society.

Pochampally K.K.,University of Southern New Hampshire | Gupta S.M.,Northeastern University
International Journal of Production Research | Year: 2012

Reverse logistics aims at capturing the remaining value in end-of-use products. This also means saving natural resources, energy, clean air and water, landfill space, and money. Strategic planning (also called designing) of a reverse supply chain is a challenging problem due to various crucial issues, such as what end-of-use products to collect, where to collect them, how to reprocess them, where to reprocess them, etc. To this end, this paper addresses the following two crucial issues, and proposes a quantitative decision-making model for each of them: (i) how to select efficient collection centres? and (ii) how to evaluate whether repairing an end-of-use product is more sensible than remanufacturing/recycling the same? For the first problem, we propose a Linear Physical Programming model, and for the second problem, we employ Fuzzy Logic and Bayesian Updating. The models are demonstrated via numerical examples. © 2012 Copyright Taylor and Francis Group, LLC.

Williams A.L.,Dartmouth Hitchcock Medical Center | Williams A.L.,University of Southern New Hampshire
Palliative & supportive care | Year: 2011

Because caregiving to an adult with cancer is a dynamic process, a caregiver's perceived burden and psychosocial concerns may be different at different phases of the patient's disease. There is evidence of escalation in caregiver anxiety, depression, and psychological distress as the patient's functional status declines and as the patient nears death. The purpose of this review was to organize the literature in a meaningful way that can potentially capture the unique needs of caregivers to patients receiving palliative and/or hospice care, and caregivers who are in the post-death bereavement phase. A systematic review was conducted. Major databases were searched for non-intervention descriptive studies that included psychosocial variables of family caregivers to adults with cancer during the palliative, hospice, or bereavement phases. The 19 studies reviewed were conducted in six countries and varied considerably by samples, outcome measures, methodologies, and analytic approaches. Despite limiting to the palliative, hospice, and bereavement phases, inconsistent results were found for key variables, such as age, gender, and relationship to the patient. When patient-caregiver dyad analysis was conducted, with rare exception, there was mutuality between the patient's condition and the caregiver's response. Across the 19 studies, 89 unique instruments were used, almost half of which were study specific with no psychometric testing reported. CONCLUSIONS/SIGNIFICANCE OF RESEARCH: As a direct consequence of assuming the caregiver role, cancer family caregivers in the palliative, hospice, and bereavement phases are at increased risk for physical and mental morbidity. Often, the psychological burden of the caregiver exceeds that of the critically ill patient. It is possible that distressed caregivers have a deleterious influence on patient well-being. This review demonstrates the need to develop research standards, especially regarding measurement instruments, so that caregiver research can mature and interventions can be developed to support family caregivers.

Constantian M.B.,University of Southern New Hampshire
Plastic and Reconstructive Surgery | Year: 2012

Background: There is little evidence-based information on secondary rhinoplasty patient motivations for surgery, satisfaction, or revision rates. Methods: The charts of 150 consecutive patients (121 women and 29 men) who underwent secondary rhinoplasty between July of 2007 and October of 2008 were reviewed; preoperative deformity severity was graded from 1 to 5. The patients primary reasons for surgery, patient and surgeon satisfaction, and postoperative depression or body dysmorphic disorder were tallied. Results: The average number of prior operations was 3.6. The most commonly expressed reason (41 percent) for undergoing revision was the development of a new deformity after the primary rhinoplasty. Those patients also had the most severe preoperative deformities (p < 0.02). Other motivations were failure to correct the original deformity (33 percent), an intolerable perceived loss of personal, familial, or ethnic characteristics (15 percent), the desire for further improvement in an already acceptable result (10 percent), and a new or unrelieved airway obstruction (1 percent). Ninety-seven percent of patients were happy with their outcomes. Forty patients (27 percent) were depressed before surgery and three (2 perent) displayed evidence of body dysmorphic disorder postoperatively. The depressed and dysmorphic patients did not have worse deformities than those who were not depressed postoperatively (p < 0.8695). Conclusions: Most secondary rhinoplasty patients have motivations similar to those of our other reconstructive patients and will be pleased with their surgical outcomes. The most severe preoperative deformities were iatrogenic. The unhappy postoperative patients, including those with body dysmorphic disorder, did not have more severe preoperative deformities than the others (i.e., their deformities alone did not justify their unhappiness). Clinical Question/Level of Evidence: Risk, IV. © 2012 by the American Society of Plastic Surgeons.

Desai K.,Norris Cotton Cancer Center | Desai K.,University of Southern New Hampshire
Nature Genetics | Year: 2016

Sustained expression of the estrogen receptor-α (ESR1) drives two-thirds of breast cancer and defines the ESR1-positive subtype. ESR1 engages enhancers upon estrogen stimulation to establish an oncogenic expression program. Somatic copy number alterations involving the ESR1 gene occur in approximately 1% of ESR1-positive breast cancers, suggesting that other mechanisms underlie the persistent expression of ESR1. We report significant enrichment of somatic mutations within the set of regulatory elements (SRE) regulating ESR1 in 7% of ESR1-positive breast cancers. These mutations regulate ESR1 expression by modulating transcription factor binding to the DNA. The SRE includes a recurrently mutated enhancer whose activity is also affected by rs9383590, a functional inherited single-nucleotide variant (SNV) that accounts for several breast cancer risk–associated loci. Our work highlights the importance of considering the combinatorial activity of regulatory elements as a single unit to delineate the impact of noncoding genetic alterations on single genes in cancer. © 2016 Nature Publishing Group, a division of Macmillan Publishers Limited. All Rights Reserved.

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