Altered Gastrointestinal Motility in Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that causes motor, visual, and sensory symptoms. Patients also experience constipation, which is not yet understood, but could involve dysfunction of the enteric nervous system (ENS). Autoimmune targeting of the ENS occurs in other autoimmune diseases that exhibit gastrointestinal (GI) symptoms, and similar mechanisms could lead to GI dysfunction in MS. Here, we characterize GI dysmotility in the experimental autoimmune encephalomyelitis (EAE) model of MS and test whether autoantibodies targeting the ENS are present in the serum of MS patients. Male SJL or B6 mice were induced with EAE by immunization against PLP139-151, MOG35-55, or mouse spinal cord homogenate, and monitored daily for somatic motor symptoms. EAE mice developed GI symptoms consistent with those observed in MS. In vivo motility analysis demonstrated slower whole GI transit, and decreased colonic propulsive motility. EAE mice had faster rates of gastric emptying, with no changes in small intestinal motility. Consistent with these results, ex vivo evaluation of isolated colons demonstrated that EAE mice have slower colonic migrating myoelectric complexes and slow wave contractions. Immunohistochemistry of EAE colons exhibited a significant reduction in GFAP area of ENS ganglia, with no changes in HuD, S100, or neuron numbers. To test whether antibodies in MS bind to ENS structures, we collected serum samples from MS patients with constipation and without constipation, and healthy control patients without constipation. Immunoreactivity was tested using indirect immunofluorescence by applying serum samples to guinea pig ENS tissue. MS serum exhibited significantly higher immunoreactivity against guinea pig ENS than control patients, which was particularly evident in MS patients who did not experience constipation. There was no significant difference in immunoreactivity between MS patients with and without constipation. Targets of human MS and mouse EAE serum include enteric glia and neurons. Taken together, these data validate EAE as a model for constipation in MS, and support the concept that this symptom involves changes within the neuromuscular system of the colon. EAE mice develop symptoms consistent with constipation that affects functional ENS networks and may result in structural or phenotypic changes at the cellular level. Serum immunoreactivity suggests that autoantibodies could play a role in the development of constipation in MS by targeting the ENS itself

A Novel Psychotropic Risk Assessment To Enhance Medical Management Of Patients With Behavioral And Psychological Symptoms Of Dementia

There is growing evidence and concern documenting the risks of antipsychotic use, and psychotropic medication burden in general, for older adults with behavioral and psychological symptoms of dementia (BPSD). Yet nearly 25 percent of all long term care residents take antipsychotics for behavioral disturbances associated with dementia as “off-label” use, despite their modest efficacy and FDA black box warnings (CMS, 2013). Expert consensus calls for non-pharmacological strategies as the first line treatment, yet some patients with BPSD may require a combination of non-pharmacological interventions and pharmacological treatments for symptom reduction (AGS, 2011). The relief of debilitating symptoms aims to improve quality of life, and reduce patient and caregiver distress. The purpose of this quality improvement project was to implement use of an evidence-based psychotropic risk assessment checklist, that integrates palliative medicine with the dementia disease trajectory, to guide treatment decisions for psychotropic risk reduction, and improve the documentation of outcome measures and person-centered care. The checklist was initially used in four separate skilled nursing facilities over a period of eight weeks. The adoption of the checklist to change practice patterns, and influence the prescribing culture in the nursing homes, was founded on Roger’s Diffusion of Innovation theory (Rogers, 2003). Evaluation methods included qualitative impact results from the interdisciplinary team, and chart review for increased utilization and documentation of non-pharmacological interventions, and shared-decision making on goals of care. Additional future outcomes may include, reduced psychotropic use for public reporting with national benchmarking, and improved survey results from oversight and regulatory organizations. The checklist is simple yet comprehensive, has good feasibility for long-term care, and is projected to expand to the electronic health record for clinician access and utilization in diverse settings

Alison Trego, Mezzo-Soprano

Kemp Recital Hall Saturday Afternoon March 28, 1998 4:30p.m

Magnetic phase diagram of the Hubbard model

The competition between commensurate and incommensurate spin-density-wave phases in the infinite-dimensional single-band Hubbard model is examined with quantum Monte Carlo simulation and strong and weak coupling approximations. Quantum fluctuations modify the weak-coupling phase diagram by factors of order unity and produce remarkable agreement with the quantum Monte Carlo data, but strong-coupling theories (that map onto effective Falicov-Kimball models) display pathological behavior. The single-band model can be used to describe much of the experimental data in Cr and its dilute alloys with V and Mn.Comment: 12 pages plus 3 uuencoded postscript figures, ReVTe

Junior Recital:Alison Trego,Soprano Joyce Landes, Piano

Kemp Recital Hall Sunday Afternoon April 5, 1997 2:00 p.m

MAPPING THE LANDSCAPE OF COLLEGE PRESS CENSORSHIP: A QUANTITATIVE ANALYSIS OF ADMINISTRATIVE PRESSURES ON COLLEGE NEWSPAPERS

This thesis examines the issue of administrative censorship of college newspapers from an interdisciplinary, socio-legal perspective. Using quantitative survey research methods, this thesis first maps the current scope and characteristics of newspaper censorship and compliance therewith at public colleges in the United States. It concludes that while a majority of college newspapers experience at least one instance of administrative censorship each year, few newspapers experience administrative censorship as a chronic, ongoing problem. This thesis also indicates that no single personal, organizational, or institutional characteristic appears to have major and wide-spread effect on prevalence of censorship or compliance therewith. After using survey research to provide a current landscape of college press censorship, this thesis concludes by using the survey data to explore how advocacy efforts within the law and policy fields might best react to censorship currently faced by the college press.Master of Art