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  • Purpose:The purpose of this project was to review palliative care understanding among nurses with a bachelor’s degree enrolled in a doctoral nurse practitioner program during the clinical component of the educational program. Palliative care can be used as part of treatment to ease symptoms related to severe illnesses. Clinicians should have a fundamental understanding of palliative care and provide it as part of treatment plans when appropriate.Methodology:This project collected demographic data from participants. The project used the Palliative Care Quiz for Nursing (PCQN) and a palliative plan of care for a seriously ill patient pre-intervention, post, and a one-month follow up to assess for improvement on the knowledge of palliative care. Results:There was a total of 35 participants that were recruited for the project; 17 participants completed all aspects of the project. The intervention did yield a change in knowledge but there was no statistical significance among the pretest and post-tests. The plan of care showed improvement post the intervention in the treatment plans of a seriously ill patient that required palliative care.Implications for Practice:Palliative care education in the nurse practitioner curriculum is important because the population is aging. The fundamentals of palliative care are required for patients that are seriously ill. Clinicians and healthcare organizations can obtain reimbursement by Medicare and Medicaid if they provide advance care planning to patients. There are laws that have been adopted to encourage clinicians to provide palliative care. The implication for nurse practitioners to be well versed in palliative care is essential if they are responsible to provide a multifactorial treatment plan for all aspects of an illness. Quality of patient care and cost containment improves for the healthcare organization improves with the use of palliative care.
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  • This is a reflection on the engagement of the critical legal studies movement with law school teaching, focused on the teaching of private law.
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  • The dissertation focuses on issues of tax avoidance, base erosion and profit shifting of multinational companies and consists of three essays. First essay studies multinational’s decision making process regarding tax optimization in the global environment with the choice of placing mobile assets in different tax locations and in the presence of possible enforcement from tax authorities. The decision making process is presented as a decision tree, which is used as a tool to evaluate possible payoffs of multinational in regulated environment. Another novelty of the presented approach is inclusion of intermediate destinations (offshores) into existing two ends scheme – home and foreign subsidiary. The model introduces tax authorities in parent and final destinations, which attempt enforce the firm to apply arm-length rules by means of audit and penalties. The results demonstrate that transfer pricing regulations in high tax countries may compel the firm to move the optimal transfer price close to arm-length, especially if efforts of high tax countries are coordinated. Second Essay attempts to study tax motivated profit shifting of US companies by constructing structural equation model based on factors that traditionally believed to be associated with income shifting and to investigate the nature of the relationships. Additional advantage of this technique lays in possibility to evaluate the relationships among factors in the presence of multi-co-linearity. Since all variables used in the model are observable, measurement model issues associated with latent indicators are not a concern. Data is constructed by merging Compustat North America Fundamentals and Compustat Execucomp covering the period of 2000-2016. Initial results illustrates that publicly available information can be used to measure income shifting effects. Particularly, application of the simultaneous equations’ method in the current analysis confirms that US companies face (i) higher domestic tax obligations and lower abroad tax obligations (ii) book-to-tax difference can be a good sign of tax aggressiveness, (iii) US companies prefers debt financing to equity financing to reduce domestic taxes rather than overseas taxes, and (iv) intangibles are shifted to jurisdictions with low tax rates to reduce taxes in US. Third essay discusses Luxembourg tax agreements (LTAs, Agreements initiated by the Government of Luxemburg to boost investments), which became a financial scandal first time leaked to newspapers in November 2014 by the group of journalist from the International Consortium of Investigative Journalists. EU authorities (State Aid) have concerns that those companies involved in LTAs were able to reduce their taxes and these agreements signed by multinationals only for tax avoidance purposes and therefore those taxes to be paid in EU. At the same time multinationals claim that LTA were used by them to pursue other management goals such as expansion of the presence in the EU market and for investment decisions. Current paper evaluates whether US multinational companies from S&P 500, which had been involved in Luxemburg Tax Agreements of 2005-2008, were able to reduce their worldwide tax obligations. By comparing results from various difference-in-difference regressions – traditional, quantile and semiparametric, I have found that these companies may have saved more on taxes then other US companies of the S&P list, what indirectly confirms the arguments of EU authorities about tax aggressiveness of those companies involved in Luxembourg agreements.
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  • Increasing market uncertainty renders traditional marketing efforts less efficient and effective in enhancing firm performance. In today’s ever-changing, chaotic, and unsettled environments, with continuously increasing competition and increasingly diminishing returns to current market offerings, businesses are constantly on the lookout for new market opportunities. Overall, firms are under an increasing burden to be more vigilant, innovative, proactive, risk-tolerant, and agile than ever as they develop and carry out marketing strategies.This dissertation introduces a robust scale for measuring entrepreneurial marketing (EM) as a distinct construct and demonstrates its discriminant validity from the overlapping notions of market orientation (MO) and entrepreneurial orientation (EO). Empirical findings also demonstrate that the positive and significant impact of EM on firm performance becomes even more pronounced under highly uncertain environmental conditions. Additionally, this research finds EM to partially mediate the well-established positive relationships between MO, EO, and firm performance. It reviews the evolution of the domain and conceptualization of EM and synthesizes the literature that is emerging from the marketing-entrepreneurship interface on this fertile research stream. The interrelationships between EM, MO, EO, firm performance, and the moderating effect of network structure (i.e., size, diversity, and strength), environmental variables (i.e., market turbulence, technological turbulence, competitive intensity, supplier power, and market growth), and firm size are examined through several hypotheses.To test the hypotheses articulated by this research, I employed structural equation modeling (SEM) to analyze survey results from 450 U.S. based firms representing a broad spectrum of industries and firm sizes, using a stratified sampling technique. Overall, the analyses provide compelling evidence that EM is a distinct construct that has a positive influence on firm performance, and that it partially mediates the positive effects of MO and EO on firm performance. This dissertation also demonstrates that while the EM-performance relationship is positively moderated by market turbulence, competitive intensity, and supplier power, it is negatively moderated by market growth and network strength. It also finds an inverted U-shaped relationship between the performance efficacy of EM and firm size. Managerial implications, limitations, and future research are also discussed.
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  • Acrylonitrile butadiene styrene (ABS) is a common thermoplastic polymer used in engineering, electrical, textile, and automotive industries. ABS has good impact resistance and toughness but suffers from low flexural modulus and strength. Typically, ABS is mixed with other materials to create a composite with better properties. In this work, graphite was exfoliated into graphene nanoflakes (GNFs) within ABS in concentrations of 1, 5, and 20 wt.% GNFs followed by injection molding to fabricate GNF-ABS specimens for testing. The morphology and structure of the GNF-ABS composites were characterized using scanning electron microscopy (SEM), X-ray diffraction (XRD), Raman spectroscopy. And X-ray photoemission spectroscopy (XPS). The mechanical properties in flexure and electrical conductivity of the GNF-ABS composites were also determined. Results show that GNF particles created within ABS are multilayer graphene, and that increasing GNF concentration increases flexural modulus and strength, as well as impart electrical conductivity.
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  • Although natural bone grafts including autografts and allografts are widely used in the clinics for the reconstruction of large bone defects, the development of bone graft substitutes (BGSs) continues to be an area of intense research. To apply the concept of tissue engineering in the development of BGSs, osteogenic growth factors and/or stem cells are incorporated into engineered scaffolds to mimic the bone tissue microenvironment. In the Kohn lab, BGSs based on E1001(1k), an intrinsically osteoconductive tyrosine-based polycarbonate, and beta-tricalcium phosphate (β-TCP) nanocrystals, were custom-fabricated (abbreviated as E1001(1k)/β-TCP scaffolds) and tested in various critical size calvarial models in combination with recombinant human bone morphogenetic protein 2 (rhBMP-2). To test the in vivo performance of this type of BGSs in long bone defect reconstruction, comparison study was conducted between E1001(1k)/β-TCP scaffolds and a clinically used β-TCP-based BGS (i.e., chronOS®) in a critical size sheep tibia model, with both constructs carrying a low dose of rhBMP-2 (1.1 mg per defect). It was found that E1001(1k)/β-TCP scaffolds have comparable in vivo performance to chronOS®. More importantly, new bone regenerated in E1001(1k)/β-TCP scaffolds demonstrated a more physiological morphology, indicating ongoing bone remodeling into compact bone tissue.A critical component in the bone microenvironment is the osteogenic growth factor (GF) phase. Though rhBMP-2 being one of the most studied GFs in the bone regeneration field, adverse effects associated with supraphysiological dosing is reported. Therefore, it is necessary to establish a reliable in vitro-in vivo correlation to determine the proper rhBMP-2 doses as well as to evaluate the efficacy of rhBMP-2 delivery systems. To date, the various study design in examining rhBMP-2 release profile in vitro has precluded comparative analyses. Due to the aforementioned concerns, a systematic evaluation of the most widely used in vitro rhBMP-2 activity assays is reported in Chapter 3. It was found that each model cell line (i.e., W-20-17, MC3T3 and C2C12) has an optimal dose-response range upon rhBMP-2 induction. In addition, a correlation between protein concentration (as measured by enzyme-linked immunosorbent assay) and protein activity (as measured by alkaline phosphatase induction from W-20-17 cells) was established. It was found that the expression system used to produce the rhBMP-2 had the most significant effect on its activity and stability in vitro.In the previous in vivo studies, E1001(1k)/β-TCP scaffolds have been successfully utilized as carriers of rhBMP-2 to assist the healing process of critical size bone defects. However, the scaffold-only treatments typically demonstrate moderate osteoconductivity in vivo due to the lack of biological cues in synthetic polymers. On the other hand, owning to the unique redox chemistry, chelation capability with metal ions and Michael-type addition from thiols and amines, catechol functionality has triggered great interest in the tissue engineering field. In Chapter 4, E1001(1k) analog polymers were functionalized with catechol side chains for enhanced bioactivity. It was found that the modified polymers were able to support mesenchymal stem cell, human osteoblast and MC3T3 cell growth. In addition, the surface anchoring catechol groups assist nano-sized silver deposition on the polymer surface by immersion-coating in silver nitrate solution, and the Ag-decorated surface has excellent antibacterial properties against Escherichia coli and Staphylococcus aureus. The versatile secondary functionality introduced by catechol modification makes the E1001(1k) analog polymers suitable for multiple bone-related applications.
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  • We consider the problem of private distributed computation. Our main interest in this problem stems from machine learning applications. A master node (referred to as master) possesses a tremendous amount of {em confidential} data (e.g., personal, genomic or medical data) and wants to perform intensive computations on it. The master divides these computations into smaller computational tasks and distribute them to {em untrusted} workers that perform these tasks in parallel. The workers return their results to the master, who processes them to obtain its original task. In large scale systems, the appearance of slow and unresponsive workers, called stragglers, is inevitable. Stragglers incur large delays on the computation if they are not accounted for. Our goal is to construct codes that maintain the privacy of the data and allow flexible straggler mitigation, ie tolerate the presence of a varying number of stragglers.We propose the use of communication efficient secret sharing (CE-SS) in private {em linear} coded computation with straggler mitigation. A CE-SS scheme satisfies the properties of threshold secret sharing. Moreover, it allows the master to reconstruct the secret by reading and communicating the minimum amount of information from a variable number of workers, up to a given threshold. We introduce three explicit constructions of CE-SS codes called {em Staircase codes}. The first construction achieves optimal communication and read costs for a given number of workers $d$. The second construction achieves optimal costs universally for all possible values of $d$ between $k$ and $n$. The third construction, which is the most general, achieves optimal costs universally for all values of $d$ in any given set $Delta subseteq {k,dots,n}$.We analyze the performance of Staircase codes in distributed computation systems where the workers have fixed resources. We model the workers service time by iid shifted exponential random variables. We derive upper and lower bounds on the Master's mean waiting time. We derive the distribution of the Master's waiting time, and its mean, for systems with up to two stragglers. We show that Staircase codes always outperform existing solutions based on classical secret sharing codes. We validate our results with extensive implementation on Amazon EC2.We consider the case where the workers have time-varying resources. We develop a private and rateless adaptive coded computation (PRAC) algorithm for distributed matrix-vector multiplication. PRAC is based on the use of Fountain codes coupled with MDS codes to maintain privacy and to adaptively assign tasks to the workers. The assigned tasks are proportional to the estimated resources at the workers. We provide theoretical guarantees on the performance of PRAC and compare it to baselines. Moreover, we validate our theoretical results through simulations and implementation on Android devices.We go beyond linear coded computation and tackle the problem of distributed gradient descent for general convex loss functions in the presence of stragglers. However, we drop the privacy constraints on the master's data. We propose an approximate gradient coding scheme called em Stochastic Gradient Coding em (SGC), which works when the stragglers are random. SGC distributes data points redundantly to workers according to a pair-wise balanced design, and then simply ignores the stragglers. We prove that the convergence rate of SGC mirrors that of batched Stochastic Gradient Descent (SGD) for the $ell_2$ loss function, and show how the convergence rate can improve with the redundancy. We also provide bounds for more general convex loss functions. We show empirically that SGC requires a small amount of redundancy to handle a large number of stragglers and that it can outperform existing approximate gradient codes when the number of stragglers is large.We study private information retrieval (PIR) which is an extension of private distributed computation. The data is public and stored (replicated) at the workers. The master wants to retrieve a file without revealing its identity to the workers. Robust PIR capacity is the minimum amount of information downloaded by the master to retrieve the file in the presence of a fixed number of stragglers. We show that communication efficient secret sharing achieve robust PIR capacity simultaneously for all number of stragglers, up to a given threshold. As a result, we construct a family of universally robust PIR called Staircase-PIR.
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  • The Keap1-Nrf2-ARE signaling system that regulates the transcription and subsequent expression of cellular cytoprotective proteins and enzymes plays a crucial role in preventing pathological conditions exacerbated by the overproduction of oxidative stress. Thus, a noncovalent inhibitor that directly interrupts the Keap1-Nrf2 protein-protein interaction (PPI) and eventually leads to stimulation of related antioxidant responses has attracted a great deal of attention as a preventive and therapeutic agent for the treatment of oxidative stress-related diseases. Considering that the cellular potency or drug-like properties of direct inhibitors have remained as significant factors to be overcome, we have focused on discovering diverse classes of potent small molecule inhibitors based on known compounds via two different rational approaches. In this study, we found a series of 1,4-diamino phenyl and naphthalene scaffolds containing an oxygen-linked substituent that could be modified, contributing to greater structural diversity of the core moiety. The SAR studies revealed that O-linked derivatives displayed potent inhibitory activity in the submicromolar or nanomolar range. Among them, compound 120 is the most promising noncovalent inhibitor, with 64.5 nM in the fluorescent polarization (FP) assay and 14.2 nM in a time-resolved fluorescence resonance energy transfer (TR-FRET) assay. In addition, we designed three different scaffolds as direct inhibitors of Keap1-Nrf2 PPI via a molecular hybridization strategy, and identified THIQ and N-phenylglycine analogs which exhibited good potency for a preliminary SAR study. As a result, THIQ analog 139c was found to be the most potent with an IC50 value of 0.37 μM among a series of THIQ compounds developed by our group and other groups. Among the N-phenylglycine derivatives, compound 191b is the most active with an IC50 value of 183.4 nM in the FP assay and 107.5 nM in a TR-FRET assay. The optimized new scaffolds may serve as a promising starting point for further biological evaluation and rational optimization as a Nrf2 activator.
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  • Introduction: Abbreviations are often used in clinical documentation to reduce time spent documenting in electronic health records and to save space during documentation. Abbreviations represent a specific challenge in healthcare as they can often contain multiple means. This ambiguous use of abbreviations is a patient safety issue for clinicians who do not properly understand the intended use of the abbreviation and presents a health literacy issue to patients as they try and understand what a provider’s note says about the care provided. Plenty of research has been done on a clinician’s ability to disambiguate abbreviations, but little work has been done to assess how clinicians are using abbreviations or creating tools to assist administrators and clinicians to explore the documentation of their providers.Methods: A semi-supervised approach was taken to identify potential abbreviations within the MIMIC-III database. Over 400 million-word tokens were compared to a list approved abbreviation for Beth Israel Deaconess Hospital. The results of this semi-supervised identification were used to analyze the use of abbreviations and prevalence of abbreviations within the dataset.Results: 463,175,566 raw word tokens were compared to a list of 1,742 approved abbreviations. On average, every document within MIMIC contained almost 14 abbreviation tokens, or roughly 9% of an average note is comprised of potential abbreviations. Some notes contained almost 26% of potential abbreviation tokens. The average count of potential abbreviations for a note created by an RN is 21.87, and the average count of potential abbreviations in a note created by an MD is 11.39. There is a substantial difference in the number of abbreviations used in a note by an RN and MD. MIMIC note events contain a substantial amount of abbreviations >= 5%.Conclusion: Using the MIMIC data set we have shown that clinical abbreviations and complex clinical jargon make up a specific amount of provider documentation. 8.22% of total words within the MIMIC note events table is a term found within the Beth Israel Deaconess approved abbreviation list. We have also shown that there is the capability to replace abbreviations in medical text to provide additional context to patients.
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