Matching Items (4)
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As a part of the supply chain alternative thesis project, various research seminars were attended to understand various topics relevant to the supply chain academic community. After attending these seminars, the topic of humanitarian aid logistics and vehicle fleet management was selected for review. In order to understand humanitarian logistics,

As a part of the supply chain alternative thesis project, various research seminars were attended to understand various topics relevant to the supply chain academic community. After attending these seminars, the topic of humanitarian aid logistics and vehicle fleet management was selected for review. In order to understand humanitarian logistics, its relevance, and its path forward, a comprehensive literature review was completed to address its current status. Through research and analysis of ten academic studies, four common themes were addressed. Last mile logistics and procurement management styles were two underlying themes or areas of improvement throughout most academic studies. It was found in the majority of studies, various types of statistical modelling were used to prove hypotheses supporting improvement in last mile logistics and procurement management styles. Lastly, among academic studies, interviews and commentary supplied by actual field employees analyzed the feasibility of real-world implementation of proposed solutions. It was concluded that while focusing on improvements related to successful last mile deliveries and procurement management styles are relevant to bettering commercial supply chains, solutions for humanitarian aid logistics must be more specific, microlevel to address the complex needs of each organization. It was also recommended that academic researchers work to close communication and knowledge gaps between themselves and practitioners, in order to provide better context for the problems they attempt to solve.
ContributorsAgwani, Hibah (Author) / Printezis, Antonios (Thesis director) / Boloori, Alireza (Committee member) / Department of Information Systems (Contributor) / Department of Supply Chain Management (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
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Description

Background: Hyperglycemia following solid organ transplant is common among patients without pre-existing diabetes mellitus (DM). Post-transplant hyperglycemia can occur once or multiple times, which if continued, causes new-onset diabetes after transplantation (NODAT).

Objective: To study if the first and recurrent incidence of hyperglycemia are affected differently by immunosuppressive regimens, demographic and medical-related

Background: Hyperglycemia following solid organ transplant is common among patients without pre-existing diabetes mellitus (DM). Post-transplant hyperglycemia can occur once or multiple times, which if continued, causes new-onset diabetes after transplantation (NODAT).

Objective: To study if the first and recurrent incidence of hyperglycemia are affected differently by immunosuppressive regimens, demographic and medical-related risk factors, and inpatient hyperglycemic conditions (i.e., an emphasis on the time course of post-transplant complications).

Methods: We conducted a retrospective analysis of 407 patients who underwent kidney transplantation at Mayo Clinic Arizona. Among these, there were 292 patients with no signs of DM prior to transplant. For this category of patients, we evaluated the impact of (1) immunosuppressive drugs (e.g., tacrolimus, sirolimus, and steroid), (2) demographic and medical-related risk factors, and (3) inpatient hyperglycemic conditions on the first and recurrent incidence of hyperglycemia in one year post-transplant. We employed two versions of Cox regression analyses: (1) a time-dependent model to analyze the recurrent cases of hyperglycemia and (2) a time-independent model to analyze the first incidence of hyperglycemia.

Results: Age (P = 0.018), HDL cholesterol (P = 0.010), and the average trough level of tacrolimus (P<0.0001) are significant risk factors associated with the first incidence of hyperglycemia, while age (P<0.0001), non-White race (P = 0.002), BMI (P = 0.002), HDL cholesterol (P = 0.003), uric acid (P = 0.012), and using steroid (P = 0.007) are the significant risk factors for the recurrent cases of hyperglycemia.

ContributorsBoloori, Alireza (Author) / Saghafian, Soroush (Author) / Chakkera, Harini A. (Author) / Cook, Curtiss B. (Author) / Ira A. Fulton Schools of Engineering (Contributor)
Created2015-11-09
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Description

Introduction: Decreased insulin sensitivity blunts the normal increase in gene expression from skeletal muscle after exercise. In addition, chronic inflammation decreases insulin sensitivity. Chronic kidney disease (CKD) is an inflammatory state. How CKD and, subsequently, kidney transplantation affects skeletal muscle gene expression after exercise are unknown.

Methods: Study cohort: non-diabetic male/female 4/1, age

Introduction: Decreased insulin sensitivity blunts the normal increase in gene expression from skeletal muscle after exercise. In addition, chronic inflammation decreases insulin sensitivity. Chronic kidney disease (CKD) is an inflammatory state. How CKD and, subsequently, kidney transplantation affects skeletal muscle gene expression after exercise are unknown.

Methods: Study cohort: non-diabetic male/female 4/1, age 52±2 years, with end-stage CKD who underwent successful kidney transplantation. The following were measured both pre-transplant and post-transplant and compared to normals: Inflammatory markers, euglycemic insulin clamp studies determine insulin sensitivity, and skeletal muscle biopsies performed before and within 30 minutes after an acute exercise protocol. Microarray analyses were performed on the skeletal muscle using the 4x44K Whole Human Genome Microarrays. Since nuclear factor of activated T cells (NFAT) plays an important role in T cell activation and calcineurin inhibitors are mainstay immunosuppression, calcineurin/NFAT pathway gene expression was compared at rest and after exercise. Log transformation was performed to prevent skewing of data and regression analyses comparing measures pre- and post-transplant performed.

Result: Markers of inflammation significantly improved post-transplantation. Insulin infusion raised glucose disposal slightly lower post-transplant compared to pre-transplant, but not significantly, thus concluding differences in insulin sensitivity were similar. The overall pattern of gene expression in response to exercise was reduced both pre-and post-transplant compared to healthy volunteers. Although significant changes were observed among NFAT/Calcineurin gene at rest and after exercise in normal cohort, there were no significant differences comparing NFAT/calcineurin pathway gene expression pre- and post-transplant.

Conclusions: Despite an improvement in serum inflammatory markers, no significant differences in glucose disposal were observed post-transplant. The reduced skeletal muscle gene expression, including NFAT/calcineurin gene expression, in response to a single bout of exercise was not improved post-transplant. This study suggests that the improvements in inflammatory mediators post-transplant are unrelated to changes of NFAT/calcineurin gene expression.

ContributorsColetta, Dawn (Author) / Campbell, Latoya (Author) / Well, Jennifer (Author) / Kaplan, Bruce (Author) / Clarkson, Marie (Author) / Finlayson, Jean (Author) / Mandarino, Lawrence (Author) / Chakkera, Harini A. (Author) / College of Liberal Arts and Sciences (Contributor)
Created2016-08-12
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Description
One of the critical issues in the U.S. healthcare sector is attributed to medications management. Mismanagement of medications can not only bring more unfavorable medical outcomes for patients, but also imposes avoidable medical expenditures, which can be partially accounted for the enormous $750 billion that the American healthcare system wastes

One of the critical issues in the U.S. healthcare sector is attributed to medications management. Mismanagement of medications can not only bring more unfavorable medical outcomes for patients, but also imposes avoidable medical expenditures, which can be partially accounted for the enormous $750 billion that the American healthcare system wastes annually. The lack of efficiency in medical outcomes can be due to several reasons. One of them is the problem of drug intensification: a problem associated with more aggressive management of medications and its negative consequences for patients.

To address this and many other challenges in regard to medications mismanagement, I take advantage of data-driven methodologies where a decision-making framework for identifying optimal medications management strategies will be established based on real-world data. This data-driven approach has the advantage of supporting decision-making processes by data analytics, and hence, the decision made can be validated by verifiable data. Thus, compared to merely theoretical methods, my methodology will be more applicable to patients as the ultimate beneficiaries of the healthcare system.

Based on this premise, in this dissertation I attempt to analyze and advance three streams of research that are influenced by issues involving the management of medications/treatments for different medical contexts. In particular, I will discuss (1) management of medications/treatment modalities for new-onset of diabetes after solid organ transplantations and (2) epidemic of opioid prescription and abuse.
ContributorsBoloori, Alireza (Author) / Saghafian, Soroush (Thesis advisor) / Fowler, John (Thesis advisor) / Gel, Esma (Committee member) / Cook, Curtiss B (Committee member) / Montgomery, Douglas C. (Committee member) / Arizona State University (Publisher)
Created2019