bluuebunny/crossref_metadata_2025 huggingface dataset:
Update on Midlevel Provider Utilization in U.S. Emergency Departments, 2006 to 2009
Authors: Wiler Jennifer L. , Rooks Sean P. , Ginde Adit A.
Published: August 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:986–989 © 2012 by the Society for Academic Emergency Medicine

Objectives:  Previous studies have noted a sharp increase in utilization of physician assistants (PAs) and nurse practitioners (NPs), up to 13% of all U.S. emergency department (ED) visits in 2005. The authors sought to reevaluate utilization and visit acuity for these midlevel providers (MLPs) in U.S. EDs from 2006 to 2009.

Methods:  This was a secondary analysis of the 2006–2009 National Hospital Ambulatory Medical Care Surveys (NHAMCS), using the “providers seen” fields to categorize visits. Demographic, visit, and hospital characteristics of visits seen by MLPs only were compared to those seen by MLPs with physician involvement and by physicians only.

Results:  Of the estimated 496 million U.S. ED visits from 2006 to 2009, 5.8% (95% confidence interval [CI] = 4.7% to 7.1%) were seen by MLPs only and 7.4% (95% CI = 6.3% to 8.5%) by MLPs with physician involvement. The annual proportions of visits seen by MLPs only for 2006 to 2009 ranged from 5.4% to 6.0% without an obvious trend. Acuity of MLP‐only visits in 2006–2009 was similar to prior 1993–2005 data for arrival by ambulance (6.5% vs. 6.0%), urgent/emergent triage acuity (33% vs. 37%), and hospital admission (3.3% vs. 3.0%). From 2006 through 2009, 64% of EDs utilized MLPs, with higher utilization in urban (72%, 95% CI = 64% to 78%) compared to nonurban EDs (51%, 95% CI = 39% to 63%). However, among EDs that did utilize MLPs, nonurban EDs had MLPs without physician involvement see a median 27% of all ED visits, compared to 7.5% for urban EDs.

Conclusions:  Despite a rapid expansion of MLP utilization in U.S. EDs, recent growth appears to have plateaued. The scope of practice of MLPs in EDs does not appear to be rapidly expanding. Urban EDs use MLPs more than nonurban EDs, but among EDs that use MLPs, nonurban EDs had MLPs see a larger proportion of overall ED visits.
Effect of γ‐aminobutyric acid on growth performance and immune function in chicks under beak trimming stress
Authors: XIE Wan‐ying , HOU Xin‐yan , YAN Feng‐bin , SUN Gui‐rong , HAN Rui‐li , KANG Xiang‐tao
Published: August 2012

This experiment was undertaken to examine the effect of beak trimming stress on the growth performance and immune system, and to consider possible roles of γ‐aminobutyric acid (GABA) in this stress response. Results showed that body weight, feed intake and relative spleen weight were significantly increased by GABA at 80 mg/kg (P < 0.05) under beak trimming stress, whereas the relative organ weights of the bursa of fabricius and thymus were not significantly affected (P > 0.05). Adrenocorticotropic hormone concentration in serum was highest for chicks fed the GABA‐deficient water and was significantly decreased by the supplement of GABA at days 1, 3 and 5 after beak trimming (P < 0.05). The supplement of GABA significantly increased the proportions of CD4+ and CD8+ lymphocytes, especially at the dose of 60 mg/kg (P < 0.05). The levels of interleukin (IL)‐1β, lipopolysaccharide‐induced tumor necrosis factor‐α and IL‐6 in serum were significantly decreased by GABA at 80 mg/kg (P < 0.05). All the three cytokines expressed in the spleen were significantly decreased by GABA at 80 mg/kg when birds were under beak trimming stress (P < 0.05). It is concluded that beak trimming suppressed the immune response of chicks, whereas the immune response of chicks could be improved by GABA supplementation.
Predictors of Body Appearance Cognitive Distraction During Sexual Activity in Men and Women
Authors: Pascoal Patrícia , Narciso Isabel , Pereira Nuno Monteiro
Published: August 2012

Introduction

Cognitive distraction is a core concept in cognitive models of sexual dysfunction. Body appearance cognitive distraction during sexual activity (BACDSA) has been mainly studied among female college samples. However, the relative contribution of different indicators of body dissatisfaction among men and women from community samples, including the contribution of relationship variables to BACDSA, has yet to be examined.

Aim

The aim of this study was to examine the extent to which aspects of body dissatisfaction and relationship variables predict BACDSA.

Methods

A total of 669 cohabitating, heterosexual, Portuguese participants (390 women and 279 men) with no sexual problems completed an anonymous online survey. The survey included a sociodemographic questionnaire and a set of questionnaires assessing body- and relationship-related variables.

Main Outcome Measures

We used a single item measure of the participant’s satisfaction with the opinion that they perceive their partner has about the participant’s body (PPO); the Global Body Dissatisfaction Subscale of the Body Attitudes Test (GBD); a version of the Contour Drawing Rating Scale; the Global Measure of Relationship Satisfaction; and the Inclusion of Other in Self Scale. Focus on specific body parts during sexual activity (FBP) and relationship length were assessed with an open-ended question.

Results

Hierarchical multiple regression indicated that GBD and FBP were the only body dissatisfaction variables that significantly predicted BACDSA in both men and women. The relationship variables significantly increased the amount of variance explained in BACDSA for both men and women. However, PPO was the only significant relationship variable that predicted BACDSA and only in women.

Conclusions

Body and relationship variables are significant factors in body appearance cognitive distraction. They require further research and assessment, particularly for clinical intervention.
In vitro and in vivo application of RNA interference for targeting genes involved in peritrophic matrix synthesis in a lepidopteran system
Authors: Toprak Umut , Baldwin Doug , Erlandson Martin , Gillott Cedric , Harris Stephanie , Hegedus Dwayne D.
Published: August 2012

Abstract  The midgut of most insects is lined with a semipermeable acellular tube, the peritrophic matrix (PM), composed of chitin and proteins. Although various genes encoding PM proteins have been characterized, our understanding of their roles in PM structure and function is very limited. One promising approach for obtaining functional information is RNA interference, which has been used to reduce the levels of specific mRNAs using double‐stranded RNAs administered to larvae by either injection or feeding. Although this method is well documented in dipterans and coleopterans, reports of its success in lepidopterans are varied. In the current study, the silencing midgut genes encoding PM proteins (insect intestinal mucin 1, insect intestinal mucin 4, PM protein 1) and the chitin biosynthetic or modifying enzymes (chitin synthase‐B and chitin deacetylase 1) in a noctuid lepidopteran, Mamestra configurata, was examined in vitro and in vivo. In vitro studies in primary midgut epithelial cell preparations revealed an acute and rapid silencing (by 24 h) for the gene encoding chitin deacetylase 1 and a slower rate of silencing (by 72 h) for the gene encoding PM protein 1. Genes encoding insect intestinal mucins were slightly silenced by 72 h, whereas no silencing was detected for the gene encoding chitin synthase‐B. In vivo experiments focused on chitin deacetylase 1, as the gene was silenced to the greatest extent in vitro. Continuous feeding of neonates and fourth instar larvae with double‐stranded RNA resulted in silencing of chitin deacetylase 1 by 24 and 36 h, respectively. Feeding a single dose to neonates also resulted in silencing by 24 h. The current study demonstrates that genes encoding PM proteins can be silenced and outlines conditions for RNA interference by per os feeding in lepidopterans.
Effect of Allopurinol on Blood Pressure: A Systematic Review and Meta‐Analysis
Authors: Agarwal Vikram , Hans Nidhi , Messerli Franz H.
Published: August 2012

J Clin Hypertens (Greenwich). 2013; 15:435–442 ©2012 Wiley Periodicals, Inc.

Allopurinol is a potent xanthine oxidase inhibitor that is used in hyperuricemic patients to prevent gout. It has also been shown to decrease cardiovascular complications in a myriad of cardiovascular conditions. However, studies have reported conflicting evidence on its effects on blood pressure (BP). A systematic review was conducted using Medline, PubMed, Embase, and the Cochrane Library for all the longitudinal studies that assessed the efficacy of allopurinol on systolic and diastolic BP. A total of 10 clinical studies with 738 participants were included in the analysis. Compared with the control group, systolic BP decreased by 3.3 mm Hg (95% confidence interval [CI], 1.4–5.3 mm Hg; P=.001) and diastolic BP decreased by 1.3 mm Hg (95% CI, 0.1–2.5 mm Hg; P=.03) in patients treated with allopurinol. When analysis was restricted to the higher‐quality randomized controlled trials, similar changes in systolic and diastolic BPs were found: 3.3 mm Hg (95% CI, 0.8–5.8 mm Hg; P<.001) and 1.4 mm Hg (95% CI, 0.1–2.7 mm Hg; P=.04), respectively. Allopurinol is associated with a small but significant reduction in BP. This effect can be potentially exploited to aid in controlling BP in hypertensive patients with hyperuricemia.
Cross‐Language Identification of Spanish Consonants in English
Authors: Rose Marda
Published: August 2012

Previous research has shown that first language (L1) American English speakers discriminate the Spanish /ɾ/‐/r/ and /ɾ/‐/t/ contrasts significantly better than the /ɾ/‐/d/ contrast, regardless of their proficiency level in Spanish (Rose, 2010a). Therefore, the current study follows the framework of the Perceptual Assimilation Model (e.g., Best, 1995) and its application to the L2 context (PAM‐L2; Best & Tyler, 2007) to ascertain why L1 English speakers discriminate certain L2 Spanish contrasts before others. Thirteen L1 English speakers with little (n = 6) or no Spanish experience (n = 7) completed a cross‐language mapping task. Results indicate that native English speakers experience difficulty discriminating the /ɾ/‐/d/ contrast because they categorize the Spanish /ɾ/ and /d/ to similar phonemic categories in English. Results further suggest that both L2 Spanish experience and lexical context affect how L2 consonants are categorized in an L1.
Is Thinking Aloud Reactive When Writing in the Heritage Language?
Authors: Yanguas Iñigo , Lado Beatriz
Published: August 2012

Critics argue that requiring subjects to verbalize their thoughts while completing certain language tasks increases the participants’ cognitive load and impairs their final performance (e.g., Jourdenais, 2001). Despite the importance of this claim for language instructors, few studies have produced contradicting evidence after an empirical study (e.g., Goo, 2010).

This study investigates whether thinking aloud in either English or Spanish hindered performance during a semi‐guided writing task completed by 37 college students whose heritage language (HL) is Spanish. This study also explores the validity of implementing think‐alouds to investigate HL writing, an area which requires more research. Results indicate that thinking aloud while writing in the HL benefits fluency and accuracy. These results support studies that found positive reactivity and those concluding that concurrent verbalizations should be employed with caution.
The Design and Development of a New Light-Weight Portable Oxygen System
Authors: Bruton Anne , Sinclair Ian , Arnold Elizabeth , Hepples Warren , Kay Francis , Maisey Graeme , Norwood Andy , Clinch Mike
Published: August 2012

Background: Patients with respiratory disorders such as chronic obstructive pulmonary disease (COPD) are prescribed oxygen therapy, but frequently fail to use it as intended and therefore do not receive the associated health benefits. Many of the reasons for this non adherence to therapy relate to the design of the equipment currently provided. We have designed and developed a novel system for portable oxygen delivery to overcome this problem. Method of Approach: There were five complementary workpackages (user involvement and exploratory work; ultra lightweight cylinder technology; embedded valve regulator technology; patient-driven system design; regulatory design & manufacturing review). Each had specific deliverables supporting the end point of the program, i.e., to have a fully functioning prototype oxygen delivery system that had been designed and evaluated with maximum input from end users. Results: Patients primarily wanted a lightweight, long lasting, reliable, unobtrusive and ergonomically designed system with simple controls. To provide this, we have developed a new full wrap composite cylinder that has achieved weight savings of ∼12% over a comparative composite cylinder, or a doubling in cylinder design life. We have developed a totally new concept in valve regulator technology, conferring significant reductions in weight and space envelope. We have addressed form factor, flow dial design and flow setting indicator design to improve the ergonomics and esthetics of the system. The developed prototype system weighs 1.7 kg when full, is 34.2 cm in height and 8.5–8.7 cm in diameter, and is capable of 8 h operation at a flow rate of 2 liters per minute, using a standard conserver. Conclusions: Throughout this project, a significant amount of time was invested in establishing the views and perceptions of potential end-users of the new system. This has ensured that their views informed the design and development process. By combining novel cylinder technology with revolutionary valve technology (SmartFlow) we have been able to design an ultra-light cylinder oxygen system (IOS®) with accurate, reliable and stable flow. The weight reduction combined with the new easy-to-read gauge and user-friendly controls should improve patient confidence in the system and result in increased adherence to therapy.
Formation and morphological evolution of InAs quantum dots grown by chemical beam epitaxy
Authors: Zribi Jihene , Morris Denis , Arès Richard
Published: August 2012

In this work, we study the formation and the morphological evolution of InAs quantum dots (QDs) grown by chemical beam epitaxy on GaAs (001) substrate. A series of samples having different nominal InAs thicknesses has been investigated using atomic force microscopy (AFM) and low-temperature photoluminescence (PL) experiments. AFM results show that large two-dimensional (2D) clusters evolve into three-dimensional (3D) islands that change in size and density as the quantity of deposited InAs material increases. The 2D–3D growth mode transition occurs at an InAs thickness of 1.6 monolayer (ML). The QD density reaches a maximum value of about 8 × 1010 cm−2 at 2.4 ML and dot coalescence is observed for larger InAs thicknesses. These results are consistent with PL measurements performed on samples having an additional GaAs cap layer. A broad QD PL band appears when the InAs thickness reaches 1.6 ML and this emission band is redshifted for thicknesses above 2.4 ML.
History Trials: Can Law Decide History?
Authors: Douzinas Costas
Published: August 2012

This article examines the relationship between law and historiography. Law played a central role in the creation of the nation-state. Historiography also narrates the victories and sacrifices of the nation and constructs its “imagined community.” Recently, court hearings are increasingly used for history authentication. Developing Hannah Arendt's argument in Eichmann in Jerusalem, the article argues that legal proceedings are not suitable for clarifying the historical record.
Intracellular pH in the Resistance Vasculature: Regulation and Functional Implications
Authors: Boedtkjer Ebbe , Aalkjaer Christian
Published: August 2012

Net acid extrusion from vascular smooth muscle (VSMCs) and endothelial cells (ECs) in the wall of resistance arteries is mediated by the Na+,HCO3– cotransporter NBCn1 (SLC4A7) and the Na+/H+ exchanger NHE1 (SLC9A1) and is essential for intracellular pH (pHi) control. Experimental evidence suggests that the pHi of VSMCs and ECs modulates both vasocontractile and vasodilatory functions in resistance arteries with implications for blood pressure regulation. The connection between disturbed pHi and altered cardiovascular function has been substantiated by a genome-wide association study showing a link between NBCn1 and human hypertension. On this basis, we here review the current evidence regarding (a) molecular mechanisms involved in pHi control in VSMCs and ECs of resistance arteries at rest and during contractions, (b) implications of disturbed pHi for resistance artery function, and (c) involvement of disturbed pHi in the pathogenesis of vascular disease. The current evidence clearly implies that pHi of VSMCs and ECs modulates vascular function and suggests that disturbed pHi either consequent to disturbed regulation or due to metabolic challenges needs to be taken into consideration as a mechanistic component of artery dysfunction and disturbed blood pressure regulation.
High Dynamics of rDNA Cluster Location in Kissing Bug Holocentric Chromosomes (Triatominae, Heteroptera)
Authors: Panzera Y. , Pita S. , Ferreiro M.J. , Ferrandis I. , Lages C. , Pérez R. , Silva A.E. , Guerra M. , Panzera F.
Published: August 2012

In this paper, we determine by fluorescent in situ hybridization the variability in the chromosomal location of 45S rDNA clusters in 38 species belonging to 7 genera of the Triatominae subfamily, using a triatomine-specific 18S rDNA probe. Our results show a striking variability at the inter- and intraspecific level, never reported so far in holocentric chromosomes, revealing the extraordinary genomic dynamics that occurred during the evolution in this group of insects. Our results also demonstrate that the chromosomal position of rDNA clusters is an important marker to disclose chromosomal differentiation in species karyotypically homogenous in their chromosome number.
What H.M. Taught Us
Authors: Eichenbaum Howard
Published: August 2012

Studies on H.M. generated five main findings: that memory is a distinct psychological function, that amnesia spares short-term and working memory, that amnesia is an impairment of declarative and episodic memory, that the hippocampus is a core brain structure supporting memory, and that the hippocampus supports the permanent consolidation of memories. Each of these basic findings has recently been challenged, but a consideration of these studies suggests the new observations serve to support the original findings on H.M. and improve our understanding of the memory functions of the hippocampal system.
On the Absence of X-within-X Recursion in Human Grammar
Authors: Arsenijević Boban , Hinzen Wolfram
Published: August 2012

We make these observations: (a) The direct embedding of a syntactic category X in itself (X-within-X) is surprisingly rare in human language, if it exists at all. (b) Indirect self-embedding (mediated by a sequence of other categories, and usually a phase boundary) systematically goes along with intensionality effects; the embedding and the embedded XP exhibit different behavior at the semantic interface. We argue that these constraints on recursion follow from the way in which single-cycle derivations organize semantic information in grammar.
Complementizer Agreement and the Relation between C0and T0
Authors: Haegeman Liliane , van Koppen Marjo
Published: August 2012

Several proposals suggest a φ-feature dependency between C0and T0(see, e.g., Zwart 1993 , Chomsky 2008 ). In most (if not all) of these proposals, the core piece of empirical evidence is complementizer agreement (CA). On the basis of two sets of CA data, CA with coordinated subjects and CA with external possessors, we conclude that there is no φ-feature dependency between C0and T0; instead, C0and T0must each be endowed with a discrete set of φ-features.
Musical imagination: Perception and production, beauty and creativity
Authors: Hargreaves David J.
Published: August 2012

In our recently-published book Musical Imaginations (Hargreaves, Miell, & MacDonald, 2012), I suggest that the creative aspects of music listening have been neglected, and that putting these at the centre of musical creativity (which is usually seen as being manifested in the activities of composition, improvisation and performance) can lead to a more fundamental view of imagination as the cognitive basis of musical activity. I consider different approaches to the concept of musical beauty in experimental aesthetics and neuroscience, and also different views of the concept of imagination, which declined in psychology in favour of studies of creativity. I propose that we should redress this balance by orienting the study of musical activity around the musical imagination, such that the concept of musical creativity can be seen to be much more restricted in scope. I suggest that musical imagination involves different networks of association, and consider the existence of a creative general executive function for music. This leads to a revised and simplified reciprocal-feedback model of music processing, which exists at the core of both musical perception and musical production.
The reciprocal relationship between jazz musicians and audiences in live performances: A pilot qualitative study
Authors: Brand Gail , Sloboda John , Saul Ben , Hathaway Martin
Published: August 2012

Despite the centrality of live musical performance to jazz, there has been little scholarly attention placed on the performer–audience relationship. This pilot study explored the factors that assisted and hindered this relationship among players and audience members attending live performances at a London jazz club. Semi-structured interviews were held with seven jazz musicians and ten audience members who had been present at one of their performances in a London jazz club. The central question was ‘what makes a successful jazz gig?’. Content analysis of responses identified that responses clustered in three major themes: the power of the audience, as experienced by both parties in positive and negative ways; the critical importance of venue size in moderating the quality of the performer-audience interaction; and the relative accuracy of each group’s beliefs about what the other group sought from this relationship. A major finding was that performers set clear limits on the degree to which they are willing to take audience views or behaviour into consideration, whilst acknowledging the very considerable power of the audience to influence events for better or for worse.
Market Integration for Inclusive Growth
Authors: Pellissery Sony , Raja Karthik , James Anupama
Published: August 2012

The issue of market integration has been primarily examined in the disciplines of international business, development economics, finance strategy and managerial economics. Sociological views about market have been largely mute on integration issues. In this article, we examine the honey market in south India to make this conceptual contribution. Honey as a natural product, through interaction of complex botanical and zoological species, generates a unique market. It is ethnic communities, living closely with the nature, which depend on honey for their livelihood. Because of this reason, market integration is a challenging factor from the sociological point of view. Further, different policies by the state on forest products make market integration more difficult. In this study we empirically examine the honey market in the Nilgiri Biosphere Reserve (NBR) which is spread in three south Indian states. We examine how honey hunters overcome the barriers to market access. We examine the impact of different types of traders on the income for honey hunters. We present three value chains in the local communities, data that was collected in 2008 through fieldwork.
Transient Myeloproliferative Disease
Authors: King Michelle Elizabeth , Hueckel Remi
Published: August 2012

Transient myeloproliferative disorder (TMD) can be found in well or ill newborns with Down syndrome. Although it is a relatively harmless process for most, in some children, TMD can present as a life-threatening state requiring critical care. As the disease is seemingly uncommon, some providers may lack a sense of urgency in the dissemination of TMD awareness; however, one can never know on whose door this patient may knock tomorrow. Advanced practice professionals should be prepared for the TMD patient that may present without warning. The goals of this article are to discuss common presentations, diagnosis, and management; and to bring attention to this often de-emphasized disease.
The French Department of Underwater Archaeology: A Brief Overview
Authors: L'Hour Michel
Published: August 2012

Underwater archaeology took off from 1950 following the invention of the aqualung by two Frenchmen. In 1966, France became the first country with a specialized organization for underwater archaeology (DRASSM (Département des Recherches Archéologiques Subaquatiques et Sous-Marines)). The evolution of French law has provided strong protection for this heritage. Over the last 40 years, DRASSM has identified several thousands of wrecks and has managed the excavation of many of them. Currently, DRASSM has been given a new lease of life, with a service enhanced by young recruits, new buildings, and a technologically advanced research vessel.
Genetic polymorphisms associated with anti-malarial antibody levels in a low and unstable malaria transmission area in southern Sri Lanka
Authors: Dewasurendra Rajika L , Suriyaphol Prapat , Fernando Sumadhya D , Carter Richard , Rockett Kirk , Corran Patrick , Kwiatkowski Dominic , Karunaweera Nadira D ,   in collaboration with the 7 MalariaGEN Consortium
Published: August 2012

Background

The incidence of malaria in Sri Lanka has significantly declined in recent years. Similar trends were seen in Kataragama, a known malaria endemic location within the southern province of the country, over the past five years. This is a descriptive study of anti-malarial antibody levels and selected host genetic mutations in residents of Kataragama, under low malaria transmission conditions.

Methods

Sera were collected from 1,011 individuals residing in Kataragama and anti-malarial antibodies and total IgE levels were measured by a standardized ELISA technique. Host DNA was extracted and used for genotyping of selected SNPs in known genes associated with malaria. The antibody levels were analysed in relation to the past history of malaria (during past 10 years), age, sex, the location of residence within Kataragama and selected host genetic markers.

Results

A significant increase in antibodies against Plasmodium falciparum antigens AMA1, MSP2, NANP and Plasmodium vivax antigen MSP1 in individuals with past history of malaria were observed when compared to those who did not. A marked increase of anti-MSP1(Pf) and anti-AMA1(Pv) was also evident in individuals between 45–59 years (when compared to other age groups). Allele frequencies for two SNPs in genes that code for IL-13 and TRIM-5 were found to be significantly different between those who have experienced one or more malaria attacks within past 10 years and those who did not. When antibody levels were classified into a low-high binary trait, significant associations were found with four SNPs for anti-AMA1(Pf); two SNPs for anti-MSP1(Pf); eight SNPs for anti-NANP(Pf); three SNPs for anti-AMA1(Pv); seven SNPs for anti-MSP1(Pv); and nine SNPs for total IgE. Eleven of these SNPs with significant associations with anti-malarial antibody levels were found to be non–synonymous.

Conclusions

Evidence is suggestive of an age–acquired immunity in this study population in spite of low malaria transmission levels. Several SNPs were in linkage disequilibrium and had a significant association with elevated antibody levels, suggesting that these host genetic mutations might have an individual or collective effect on inducing or/and maintaining high anti–malarial antibody levels.
Development of an interactive model for planning the care workforce for Alberta: case study
Authors: Bloom Judy , Duckett Stephen , Robertson Andrea
Published: August 2012

Introduction

In common with other jurisdictions, Alberta faces challenges in ensuring a balance in health worker supply and demand. As the provider organization with province-wide responsibility, Alberta Health Services needed to develop a forecasting tool to inform its position on key workforce parameters, in the first instance focused on modeling the situation for Registered Nurses, Licensed Practical Nurses and health care aides. This case study describes the development of the model, highlighting the choices involved in model development.

Case description

A workforce planning model was developed to test the effect of different assumptions (for instance about vacancy rates or retirement) and different policy choices (for example about the size of intakes into universities and colleges, different composition of the workforce). This case study describes the choices involved in designing the model. The workforce planning model was used as part of a consultation process and to develop six scenarios (based on different policy choices).

Discussion and evaluation

The model outputs highlighted the problems with continuation of current workforce strategies and the impact of key policy choices on workforce parameters.

Conclusions

Models which allow for transparency of the underlying assumptions, and the ability to assess the sensitivity of assumptions and the impact of policy choices are required for effective workforce planning.
Chemoattraction of macrophages by secretory molecules derived from cells expressing the signal peptide of eosinophil cationic protein
Authors: Liu Yu-Shu , Tsai Pei-Wen , Wang Yong , Fan Tan-chi , Hsieh Chia-Hung , Chang Margaret Dah-Tsyr , Pai Tun-Wen , Huang Chien-Fu , Lan Chung-Yu , Chang Hao-Teng
Published: August 2012

Background

Eosinophil cationic protein is a clinical asthma biomarker that would be released into blood, especially gathered in bronchia. The signal peptide of eosinophil cationic protein (ECPsp) plays an important role in translocating ECP to the extracellular space. We previously reported that ECPsp inhibits microbial growth and regulates the expression of mammalian genes encoding tumor growth factor-α (TGF-α) and epidermal growth factor receptor (EGFR).

Results

In the present study, we first generated a DNA microarray dataset, which showed that ECPsp upregulated proinflammatory molecules, including chemokines, interferon-induced molecules, and Toll-like receptors. The levels of mRNAs encoding CCL5, CXCL10, CXCL11, CXCL16, STAT1, and STAT2 were increased in the presence of ECPsp by 2.07-, 4.21-, 7.52-, 2.6-, 3.58-, and 1.67-fold, respectively. We then constructed a functional linkage network by integrating the microarray dataset with the pathway database of Kyoto Encyclopedia of Genes and Genomes (KEGG). Follow-up analysis revealed that STAT1 and STAT2, important transcriptional factors that regulate cytokine expression and release, served as hubs to connect the pathways of cytokine stimulation (TGF-α and EGFR pathways) and inflammatory responses. Furthermore, integrating TGF-α and EGFR with the functional linkage network indicated that STAT1 and STAT2 served as hubs that connect two functional clusters, including (1) cell proliferation and survival, and (2) inflammation. Finally, we found that conditioned medium in which cells that express ECPsp had been cultured could chemoattract macrophages. Experimentally, we also demonstrated that the migration of macrophage could be inhibited by the individual treatment of siRNAs of STAT1 or STAT2. Therefore, we hypothesize that ECPsp may function as a regulator for enhancing the migration of macrophages through the upregualtion of the transcriptional factors STAT1 and STAT2.

Conclusion

The increased expression and release of various cytokines triggered by ECPsp may attract macrophages to bronchia to purge damaged cells. Our approach, involving experimental and computational systems biology, predicts pathways and potential biological functions for further characterization of this novel function of ECPsp under inflammatory conditions.
Phenomics of rice early vigour and drought response: Are sugar related and morphogenetic traits relevant?
Authors: Rebolledo Maria-Camila , Dingkuhn Michael , Clément-Vidal Anne , Rouan Lauriane , Luquet Delphine
Published: August 2012

Background

Early vigour (biomass accumulation) is a useful but complex trait in rainfed rice (Oryza sativa L). Little is known on trade-offs with drought tolerance. This study explored the relevance of (sugar) metabolic and morphogenetic traits to describe the genetic diversity of rice early vigour and its phenotypic plasticity under drought conditions. A greenhouse experiment was conducted to characterize on a panel of 43 rice genotypes plant morphogenesis and sugar concentration in expanded (source) and expanding (sink) leaves.

Results

Across genotypes in control treatment, leaf starch concentration was negatively correlated with organogenetic development rate (DR, defined as leaf appearance rate on main stem). Genotypes with small leaves had high DR and tiller number but low leaf starch concentration. Under drought, vigorous genotypes showed stronger growth reduction. Starch concentration decreased in source leaves, by contrast with soluble sugars and with that observed in sink leaves. Accordingly, genotypes were grouped in three clusters differing in constitutive vigour, starch storage and growth maintenance under drought showing a trade off between constitutive vigour and drought tolerance.

Conclusions

It was therefore suggested that non structural carbohydrates, particularly starch, were relevant markers of early vigour. Their relevance as markers of growth maintenance under drought needs to be further explored. Results are discussed regarding novel process based traits to be introduced in the GRiSP (Global Rice Science Partnership) phenotyping network.
Curcumin inhibition of JNKs prevents dopaminergic neuronal loss in a mouse model of Parkinson’s disease through suppressing mitochondria dysfunction
Authors: Pan Jing , Li Hui , Ma Jian-Fang , Tan Yu-Yan , Xiao Qin , Ding Jian-Qing , Chen Sheng-Di
Published: August 2012

Curcumin,a natural polyphenol obtained from turmeric,has been implicated to be neuroprotective in a variety of neurodegenerative disorders although the mechanism remains poorly understood. The results of our recent experiments indicated that curcumin could protect dopaminergic neurons from apoptosis in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of Parkinson’s disease (PD). The death of dopaminergic neurons and the loss of dopaminergic axon in the striatum were significantly suppressed by curcumin in MPTP mouse model. Further studies showed that curcumin inhibited JNKs hyperphosphorylation induced by MPTP treatment. JNKs phosphorylation can cause translocation of Bax to mitochondria and the release of cytochrome c which both ultimately contribute to mitochondria-mediated apoptosis. These pro-apoptosis effect can be diminished by curcumin. Our experiments demonstrated that curcumin can prevent nigrostriatal degeneration by inhibiting the dysfunction of mitochondrial through suppressing hyperphosphorylation of JNKs induced by MPTP. Our results suggested that JNKs/mitochondria pathway may be a novel target in the treatment of PD patients.
Household Behavior and the Tax Reform Act of 1986
Authors: Hausman Jerry A , Poterba James M
Published: August 2012

President Reagan's May 1985 letter to Congress, accompanying his tax reform proposal, argued that the existing tax system hindered economic growth because “most Americans labor under excessively high tax rates that discourage work and cut drastically into savings.” This paper analyzes how the Tax Reform Act of 1986 affects these aspects of household behavior.
Choice Under Uncertainty: Problems Solved and Unsolved
Authors: Machina Mark J
Published: August 2012

Fifteen years ago, the theory of choice under uncertainty could be considered one of the “success stories” of economic analysis: it rested on solid axiomatic foundations, it had seen important breakthroughs in the analytics of risk, risk aversion, and their applications to economic issues, and it stood ready to provide the theoretical underpinnings for the newly emerging “information revolution” in economics. Today choice under uncertainty is a field in flux: the standard theory is being challenged on several grounds from both within and outside economics. The nature of these challenges, and of our profession's responses to them, is the topic of this paper.
Horizontal Mergers: Triage and Treatment
Authors: Fisher Franklin M
Published: August 2012

The pursuit of any sort of structural policy towards oligopoly presupposes that we can recognize anticompetitive structures when we see them. Unfortunately, that requisite is not easy to meet, and there is a temptation to avoid difficult analysis in favor of standards that are apparently precise but in fact very approximate. When considering merger standards, it is important to bear in mind that policy takes place in stages. There is a difference between deciding on guidelines for triage -- guidelines as to what cases to investigate or oppose& -- and for treatment, the judicial standard to be used. I believe merger policy should be explicitly conducted as a twostage process. In the first stage, fairly simple tests should be used to decide what cases should be further investigated. I would use concentration measures heavily (but not exclusively) here and would consider a variety of reasonable market definitions. In the second stage, prospective mergers that fail such tests would be investigated in considerably more detail. This investigation will require a more sophisticated approach to market definition and concentration than is needed at the first stage.
‘I just love these sessions’. Should physician satisfaction matter in clinical ethics consultations?
Authors: Delany Clare , Hall Georgina
Published: August 2012

Clinical ethics committees aim to resolve conflict, facilitate communication and ease moral distress in health care. Dialogue in committee discussions is complex and involves a balance between implicitly and explicitly expressed values of patients, families and professionals. Evaluating effectiveness and concrete outcomes is challenging and most studies focus on broad benefits such as quality of care and reduction of unnecessary or unwanted treatments. In this paper we propose ‘physician satisfaction’ as a valuable outcome. We refer to the clinical ethics approach followed at one large paediatric hospital in Australia, propose reasons for the often-expressed feeling of satisfaction and discuss why this feeling matters. We conclude that physician satisfaction is a valid measure of an effective ethics consultation because it implies the person has been listened to and respected by others, and has perhaps developed greater understanding of and insights into their own work and values, and those of others.
Gate-keeping or free choice in crisis resolution and home treatment teams
Authors: Hubbeling Dieneke
Published: August 2012

Crisis resolution and home treatment (CRHT) teams have been introduced into mental health care in the UK because, in general, patients do not want to be admitted to hospital, treatment at home is cheaper and in the only randomized controlled trial conducted so far there was no difference in symptomatic outcome. However, because of compulsory gate-keeping by CRHT teams, some patients no longer have the option of going to hospital if they want to. This aspect of the introduction of CRHT teams has not been discussed so far, but it certainly warrants further examination. Intervention through CRHT teams may in fact increase compulsory admissions and serious and untoward incidents, although this is not certain. Sufferers from psychosis are the patient group most likely to be compulsorily admitted to hospital and they are generally considered less responsible for serious and untoward incidents. Therefore, a possible solution could be to offer a choice to some patients, namely those with a psychotic disorder, on whether they want to be admitted or not. At least one should investigate what the consequences of this policy would be, if it were to be adopted in a test region. This example shows that in developing policies for rationing health care, it can be important to look at subgroups and not just at average results when determining the best course of action.
Presumed consent and organ donation
Authors: Upton Hugh
Published: August 2012

This article explores the meaning and moral significance of presumed consent with particular reference to an opt-out policy for postmortem organ donation. It does so under two general categories: circumstances where we believe consent to have been given and those where we have no reason to believe that it has either been given or been refused. In the context of an opt-out policy, the first category would relate to the idea of tacit consent. It is argued both that substituting the term ‘presumed consent’ would be misleading and that it is unlikely that the conditions for tacit consent would be met in practice. Regarding the second category, where the claim would be one regarding counterfactual consent, two main points are made: that claims about consent are unwarranted, and also that they are unnecessary to moral argument, given that the moral work is done by reasons other than any supposedly provided by a presumption of consent.
Rethinking WHO guidance: review of evidence for misoprostol use in the prevention of postpartum haemorrhage
Authors: Chu Christina S , Brhlikova Petra , Pollock Allyson M
Published: August 2012

This article describes and critically appraises clinical trials assessing misoprostol effectiveness in preventing primary postpartum haemorrhage (PPH) in home and community settings in low- and middle-income countries. Of 172 identified studies of misoprostol use in labour only six fulfilled the inclusion criteria. All trials used 600μg misoprostol in the intervention arm; three assessed misoprostol alongside components of active management of the third-stage labour (AMTSL), two used expectant management of labour and one allowed birth attendants to choose management practice. The three AMTSL studies showed no significant differences in PPH incidence or referral to higher centres and only one study showed significant decrease in severe PPH using misoprostol. One expectant management study and the choice of management by birth attendants study found significant decreases in PPH incidence with misoprostol. All studies showed significantly increased risk of shivering with misoprostol. Studies were biased by use of alternative uterotonics in the control arm, confounding management practices, and subjective assessment and, with one exception, exclusion of high-risk women. PPH incidence fell in both the control and intervention groups in both the landmark papers that informed the World Health Organization (WHO) decision to admit misoprostol to the Essential Medicines List. This suggests factors other than misoprostol use are crucial. Current evidence does not support misoprostol use in home and community settings in low- and middle-income countries for PPH prevention. WHO should rethink its recent decision to include misoprostol on the Essential Medicines List.
A novel two-stage surgical approach for the treatment of symptomatic supra-aortic artery aneurysms
Authors: Ullery Brant W , Foley Paul J , Brinster Clay J , Pochettino Alberto , Fairman Ronald M
Published: August 2012

We describe the case of a 45-year-old man with a unique constellation of supra-aortic artery aneurysms detected by chest X-ray during work-up for chronic cough. During his diagnostic work-up, the patient suffered an embolic stroke likely secondary to disrupted plaque originating in an aneurysmal right vertebral artery. Endovascular repair was not a viable option due to the diffuse and bilateral nature of aneurysmal disease, including involvement of the innominate and right carotid and vertebral arteries. The patient was successfully treated with a two-stage open surgical approach involving an initial right carotid artery to vertebral artery bypass and subsequent in situ reconstruction utilizing a bifurcated Dacron graft sewn to the proximal aortic arch with distal extension to the right common carotid and axillary arteries.
Endovascular repair of abdominal aortic aneurysm with pelvic transplant kidney with antegrade deployment of iliac limb
Authors: Harrington David M , Forbes Thomas L
Published: August 2012

A 63-year-old woman presented with a symptomatic aneurysm and a pelvic transplant kidney on the side of an external iliac artery occlusion. A commercially available bifurcated endograft was introduced through the common iliac artery contralateral to the kidney. The external iliac artery occlusion required antegrade delivery of an iliac limb through the contralateral endograft gate and cannulation of the common iliac artery to allow for deployment proximal to the transplant kidney artery. This technique was successful and remains so six months postoperatively. Endovascular repair of aneurysms proximal to pelvic transplant kidneys remains the preferred method of repair. However, inadequate access vessels may require antegrade delivery of endograft components which is facilitated by advances in endograft design.
Silent stroke and cognitive decline in asymptomatic carotid stenosis revascularization
Authors: Capoccia Laura , Sbarigia Enrico , Rizzo Annarita , Mansour Wassim , Speziale Francesco
Published: August 2012

The aim of this study was to assess the relationship between serum levels of S100 β and neuron-specific enolase (NSE), postoperative diffusion-weighted magnetic resonance imaging (DW-MRI) and Mini-Mental State Examination (MMSE) score in asymptomatic patients affected by ≥70% carotid stenosis submitted to carotid endarterectomy (CEA) or carotid artery stenting (CAS), and to compare MMSE scores and DW-MRI findings at follow-up evaluations. Between April 2008 and April 2009, 60 patients were submitted to carotid intervention. All patients underwent DW-MRI and MMSE preoperatively, at 24 hours postoperatively, at 6 months and at 12 months. Neurobiomarkers were assessed for each patient at six time-points. Thirty-two patients were submitted to CEA and 28 to CAS. No mortality was observed. One CAS patient presented with an ischemic stroke. In six CAS patients and one CEA patient, new subclinical ischemic lesions were detected at postoperative DW-MRI (21.4% versus 3%, P = 0.03). In CAS patients, new DW-MRI lesions were significantly associated with MMSE score decline ( P = 0.001). At 12 months, patients presenting with new postoperative ischemic lesions showed lower MMSE scores ( P = 0.08). CAS patients showed increasing neurobiomarker levels compared with CEA patients ( P = 0.02). In conclusion, microembolization effects may persist over time, so it should be avoided whenever possible. Carotid revascularization procedures should be evaluated and compared not only with respect to death/stroke but also to microembolism rates.
Embolisation of Angio-Seal device: an unusual case of post-cardiac catheterisation limb ischaemia
Authors: Khakha RS , Ali T , Chong P , Gerrard D , Leopold P
Published: August 2012

We present the case of a 67-year-old male presenting with critical limb ischaemia following cardiac catheterisation. Immediately after deployment of an arterial closure device, the patient reported severe lower limb pain with impalpable pulses. Magnetic resonance angiography revealed an abrupt disruption of flow in the tibioperoneal trunk. Subsequent surgery revealed embolisation of the arterial closure device. The patient went on to make an unremarkable recovery.
The plague of obsolescence
Authors: Jakobsen Kiersten
Published: August 2012

In The Cage, youth brings decay home, yet once it convinces the patriarch to embrace the possibility of recuperation, the mechanism the impotent father adopts becomes obsolete. This article analyzes The Cage's allegorical and political nuance by way of a passively perched camera that
fails to zoom, track or pan.