bluuebunny/crossref_metadata_2025 huggingface dataset:
Poor health knowledge and behaviour is a risk for the spread of antibiotic resistance: survey of higher secondary school students in Goa, India
Authors: Almeida Santimano Nerissa ML , Foxcroft David R
Published: June 2016

Aims:

We assessed antibiotic knowledge and practice among youth in India, where antibiotics are widely available without prescription.

Methods:

Randomly selected school questionnaire survey representing four regions in Goa, India, with students ( n = 773) aged 16–17.

Results:

Most students (67%) were unaware of the problem of antibiotic resistance, with around half (49%) mistakenly thinking that bacteria cause cold or flu. Around one-fifth (19%) said they frequently self-medicate with antibiotics, 57% would discontinue antibiotics when symptoms alleviated and 24% stored unused antibiotics at home. Generalised linear mixed models (GLMM) showed that females consistently had poorer antibiotic knowledge than males. Especially notable were the higher odds in females for reporting incorrectly that antibiotics kill harmful viruses (odds ratio (OR) = 1.93; 99.5% confidence interval (CI) = 1.09–3.41) and for reporting incorrectly that antibiotics do not kill harmless bacteria (OR = 2.02; 99.5% CI = 1.16–3.51). Poor antibiotic practice was not clearly differentiated between males and females. In terms of poor antibiotic practice, one model showed notable results for educational stream: both arts and commerce students were more likely than science students to say they would discontinue antibiotics when symptoms alleviated and before the antibiotic course of treatment was finished (arts: OR = 2.76; 99.5% CI = 1.58–4.82 and commerce: OR = 1.79; 99.5% CI = 1.06–3.04).

Conclusion:

Young adults in India had poor antibiotic knowledge and practice. Efforts to improve antibiotic health knowledge and safe practice are required to help prevent the spread of antibiotic resistance.
Dimethyl fumarate in multiple sclerosis: latest developments, evidence and place in therapy
Authors: Linker Ralf A. , Haghikia Aiden
Published: June 2016

Dimethyl fumarate (DMF) is one of the newer additions to the armamentarium of potent immunomodulators for the treatment of relapsing-remitting multiple sclerosis (RRMS). After more than 2 years of real-world experience and more than 190,000 patients currently treated with DMF worldwide, it is a good timepoint to review the experience gathered so far and to re-evaluate the potential of this first-line oral multiple sclerosis (MS) drug. Post-hoc analyses of clinical and magnetic resonance imaging (MRI) data, some comprising more than 6 years of drug exposure including patients from the clinical trials, and the overall notion in clinical practice widely confirm the good efficacy of DMF in RRMS. Despite an overall good safety profile, it became also clear that the necessary clinical vigilance while using DMF may not be neglected. So far, four reported cases of progressive multifocal leukoencephalopathy (PML), a towering shadow over many MS therapies, warrant proper attention in newly-updated risk management plans. This review recapitulates efficacy and safety aspects of DMF therapy in relation to reported data from the pivotal clinical trials. In addition, we summarize recent insights into DMF mechanisms of action drawn from the field of basic research which may have important implications for clinical practice.
Innovation through interactive crowdsourcing: The role of boundary objects
Authors: Djelassi Souad , Decoopman Isabelle
Published: June 2016

The aim of this study is to explore company–consumer collaboration in the innovation process through the practice of interactive crowdsourcing. This type of crowdsourcing lies within the co-creation process and is characterized by close interactions between the two categories of actors. To pursue our aim, we draw on the concept of “boundary object,” developed within sociology. This concept can help understand the dynamics of interactions and collective action among disparate actors. The study’s findings show that boundary objects and boundary negotiating artifacts facilitate the exchange of knowledge and expertise between the world of companies and the world of consumers. They also highlight the role of these objects in revealing influence and power games liable to generate disappointment and tensions between actors. The study sheds new light on the advantages, limitations, and challenges of a co-creation process.
Learning by Doing—Promoting Access to Justice to the Marginalized and Vulnerable Groups in India
Authors: Bajpai Asha
Published: June 2016

This article discusses about the LLM programme of the Tata Institute of Social Sciences (TISS) in the area of access to justice, and how it has promoted access to justice to the marginalized and vulnerable groups in India. The article also discusses the access to justice clinic of TISS—its functioning, supervision, achievements and challenges.
The Influence of Wait Time on Patient Satisfaction in the Orthopedic Clinic
Authors: Kreitz Tyler M , Winters Brian S , Pedowitz David I
Published: June 2016

Introduction:

Patient satisfaction is of increasing importance in the delivery of quality healthcare and may influence provider reimbursement. The purpose of this study is to examine how patient wait time relates to their level of satisfaction and likelihood to recommend an orthopedic clinic to others.

Methods:

A retrospective analysis was performed on standardized new patient survey data collected at a single orthopedic clinic from June 2011 through October 2014.

Results:

A total of 3125 and 3151 responses were collected for satisfaction and likelihood to recommend the practice. The mean wait time was 27.3 ± 11.3 minutes. The likelihood of obtaining an “excellent” (odds ratio [OR]: 0.86, P = .01081) or “excellent/very good” (OR: 0.82, P = .0199) satisfaction demonstrated significant correlation with wait time in 15-minute intervals. The likelihood of obtaining an “agree” (OR: 0.9, P = .10575) and “strongly agree/agree” (OR: 0.85, P = .139) response to recommend the practice demonstrated no correlation during the same interval.

Conclusion:

Minimizing wait times in the orthopedic clinic may improve patient satisfaction but may not affect their likelihood of recommending the practice to others.
Situs Inversus With Liver Metastases
Authors: Turner Ellyn N. , Fisher Kelsy Loren
Published: June 2016

Situs inversus totalis is a rare condition of the organs being transposed within the abdominal and chest cavities. The cause of situs inversus is unknown, but it is a recessive trait. Complete situs inversus may be associated with other malformations, such as levocardia, dextrocardia, and Kartagener syndrome; congenital heart disease may be present in some cases. The case presented describes a patient with situs inversus totalis with detection of liver metastases diagnosed by 2D sonography, computed tomography, and biopsy.
JAK2 exon 12 mutant mice display isolated erythrocytosis and changes in iron metabolism favoring increased erythropoiesis
Authors: Grisouard Jean , Li Sai , Kubovcakova Lucia , Rao Tata Nageswara , Meyer Sara C. , Lundberg Pontus , Hao-Shen Hui , Romanet Vincent , Murakami Masato , Radimerski Thomas , Dirnhofer Stephan , Skoda Radek C.
Published: June 2016

Key Points

Mice expressing a JAK2 exon 12 mutation display isolated erythrocytosis similar to the majority of patients with JAK2 exon 12 mutations. JAK2 exon 12 mutation induces changes in iron metabolism that increase iron availability to allow maximal production of red cells.
Research priorities in bronchiectasis: a consensus statement from the EMBARC Clinical Research Collaboration
Authors: Aliberti Stefano , Masefield Sarah , Polverino Eva , De Soyza Anthony , Loebinger Michael R. , Menendez Rosario , Ringshausen Felix C. , Vendrell Montserrat , Powell Pippa , Chalmers James D.
Published: June 2016

Bronchiectasis is a disease of renewed interest in light of an increase in prevalence and increasing burden on international healthcare systems. There are no licensed therapies, and large gaps in knowledge in terms of epidemiology, pathophysiology and therapy. The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) is a European Respiratory Society (ERS) Clinical Research Collaboration, funded by ERS to promote high-quality research in bronchiectasis. The objective of this consensus statement was to define research priorities in bronchiectasis. From 2014 to 2015, EMBARC used a modified Delphi process among European bronchiectasis experts to reach a consensus on 55 key research priorities in this field. During the same period, the European Lung Foundation collected 711 questionnaires from adult patients with bronchiectasis and their carers from 22 European countries reporting important research priorities from their perspective. This consensus statement reports recommendations for bronchiectasis research after integrating both physicians and patients priorities, as well as those uniquely identified by the two groups. Priorities identified in this consensus statement provide the clearest possible roadmap towards improving our understanding of the disease and the quality of care for patients with bronchiectasis.
Classification of polyhedral shapes from individual anisotropically resolved cryo-electron tomography reconstructions
Authors: Bag Sukantadev , Prentice Michael B , Liang Mingzhi , Warren Martin J , Roy Choudhury Kingshuk
Published: June 2016

Background

Cryo-electron tomography (cryo-ET) enables 3D imaging of macromolecular structures. Reconstructed cryo-ET images have a “missing wedge” of data loss due to limitations in rotation of the mounting stage. Most current approaches for structure determination improve cryo-ET resolution either by some form of sub-tomogram averaging or template matching, respectively precluding detection of shapes that vary across objects or are a priori unknown. Various macromolecular structures possess polyhedral structure. We propose a classification method for polyhedral shapes from incomplete individual cryo-ET reconstructions, based on topological features of an extracted polyhedral graph (PG).

Results

We outline a pipeline for extracting PG from 3-D cryo-ET reconstructions. For classification, we construct a reference library of regular polyhedra. Using geometric simulation, we construct a non-parametric estimate of the distribution of possible incomplete PGs. In studies with simulated data, a Bayes classifier constructed using these distributions has an average test set misclassification error of < 5 % with upto 30 % of the object missing, suggesting accurate polyhedral shape classification is possible from individual incomplete cryo-ET reconstructions. We also demonstrate how the method can be made robust to mis-specification of the PG using an SVM based classifier. The methodology is applied to cryo-ET reconstructions of 30 micro-compartments isolated from E. coli bacteria.

Conclusions

The predicted shapes aren’t unique, but all belong to the non-symmetric Johnson solid family, illustrating the potential of this approach to study variation in polyhedral macromolecular structures.
Donor age and long-term culture do not negatively influence the stem potential of limbal fibroblast-like stem cells
Authors: Tomasello Laura , Musso Rosa , Cillino Giovanni , Pitrone Maria , Pizzolanti Giuseppe , Coppola Antonina , Arancio Walter , Di Cara Gianluca , Pucci-Minafra Ida , Cillino Salvatore , Giordano Carla
Published: June 2016

Background

In regenerative medicine the maintenance of stem cell properties is of crucial importance. Ageing is considered a cause of reduced stemness capability. The limbus is a stem niche of easy access and harbors two stem cell populations: epithelial stem cells and fibroblast-like stem cells. Our aim was to investigate whether donor age and/or long-term culture have any influence on stem cell marker expression and the profiles in the fibroblast-like stem cell population.

Methods

Fibroblast-like stem cells were isolated and digested from 25 limbus samples of normal human corneo-scleral rings and long-term cultures were obtained. SSEA4 expression and sphere-forming capability were evaluated; cytofluorimetric assay was performed to detect the immunophenotypes HLA-DR, CD45, and CD34 and the principle stem cell markers ABCG2, OCT3/4, and NANOG. Molecular expression of the principal mesenchymal stem cell genes was investigated by real-time PCR. Two-dimensional gel electrophoresis and mass spectrometric sequencing were performed and a stable proteomic profile was identified. The proteins detected were explored by gene ontology and STRING analysis. The data were reported as means ± SD, compared by Student’s unpairedttest and consideringp < 0.05 as statistically significant.

Results

The isolated cells did not display any hematopoietic surface marker (CD34 and CD45) and HLA-DR and they maintained these features in long-term culture. The expression of the stemness genes and the multilineage differentiation under in-vitro culture conditions proved to be well maintained. Proteomic analysis revealed a fibroblast-like stem cell profile of 164 proteins with higher expression levels. Eighty of these showed stable expression levels and were involved in maintenance of “the stem gene profile”; 84 were differentially expressed and were involved in structural activity.

Conclusions

The fibroblast-like limbal stem cells confirmed that they are a robust source of adult stem cells and that they have good plasticity, good proliferative capability, and long-term maintenance of stem cell properties, independently of donor age and long-term culture conditions. Our findings confirm that limbal fibroblast-like stem cells are highly promising for application in regenerative medicine and that in-vitro culture steps do not influence their stem cell properties. Moreover, the proteomic data enrich our knowledge of fibroblast-like stem cells.
CXCL1, but not IL-6, significantly impacts intraocular inflammation during infection
Authors: Parkunan Salai Madhumathi , Randall C Blake , Astley Roger A , Furtado Glaucia C , Lira Sergio A , Callegan Michelle C
Published: June 2016

During intraocular bacterial infections, the primary innate responders are neutrophils, which may cause bystander damage to the retina or perturb the clarity of the visual axis. We hypothesized that cytokine IL-6 and chemokine CXCL1 contributed to rapid neutrophil recruitment during Bacillus cereus endophthalmitis, a severe form of intraocular infection that is characterized by explosive inflammation and retinal damage that often leads to rapid vision loss. To test this hypothesis, we compared endophthalmitis pathogenesis in C57BL/6J, IL-6−/−, and CXCL1−/− mice. Bacterial growth in eyes of CXCL1−/−, IL-6−/−, and C67BL/6J mice was similar. Retinal function retention was greater in eyes of IL-6−/− and CXCL1−/− mice compared with that of C57BL/6J, despite these eyes having similar bacterial burdens. Neutrophil influx into eyes of CXCL1−/− mice was reduced to a greater degree compared with that of eyes of IL6−/− mice. Histology confirmed significantly less inflammation in eyes of CXCL1−/− mice, but similar degrees of inflammation in IL6−/− and C57BL/6J eyes. Because inflammation was reduced in eyes of infected CXCL1−/− mice, we tested the efficacy of anti-CXCL1 in B. cereus endophthalmitis. Retinal function was retained to a greater degree and there was less overall inflammation in eyes treated with anti-CXCL1, which suggested that anti-CXCL1 may have therapeutic efficacy in limiting inflammation during B. cereus endophthalmitis. Taken together, our results indicate that absence of IL-6 did not affect overall pathogenesis of endophthalmitis. In contrast, absence of CXCL1, in CXCL1−/− mice or after anti-CXCL1 treatment, led to an improved clinical outcome. Our findings suggest a potential benefit in targeting CXCL1 to control inflammation during B. cereus and perhaps other types of intraocular infections.
Role for phospholipid acyl chains and cholesterol in pulmonary infections and inflammation
Authors: Shaikh Saame Raza , Fessler Michael B , Gowdy Kymberly M
Published: June 2016

Bacterial and viral respiratory tract infections result in millions of deaths worldwide and are currently the leading cause of death from infection. Acute inflammation is an essential element of host defense against infection, but can be damaging to the host when left unchecked. Effective host defense requires multiple lipid mediators, which collectively have proinflammatory and/or proresolving effects on the lung. During pulmonary infections, phospholipid acyl chains and cholesterol can be chemically and enzymatically oxidized, as well as truncated and modified, producing complex mixtures of bioactive lipids. We review recent evidence that phospholipids and cholesterol and their derivatives regulate pulmonary innate and adaptive immunity during infection. We first highlight data that oxidized phospholipids generated in the lung during infection stimulate pattern recognition receptors, such as TLRs and scavenger receptors, thereby amplifying the pulmonary inflammatory response. Next, we discuss evidence that oxidation of endogenous pools of cholesterol during pulmonary infections produces oxysterols that also modify the function of both innate and adaptive immune cells. Last, we conclude with data that n-3 polyunsaturated fatty acids, both in the form of phospholipid acyl chains and through enzymatic processing into endogenous proresolving lipid mediators, aid in the resolution of lung inflammation through distinct mechanisms. Unraveling the complex mechanisms of induction and function of distinct classes of bioactive lipids, both native and modified, may hold promise for developing new therapeutic strategies for improving pulmonary outcomes in response to infection.
Key seismic exploration techniques for foreland thrust belt: A case from the complex deep subsalt structure of Kuqa, Tarim Basin, Western China
Authors: Ping Yang , Longde Sun , Jiafu Qi
Published: June 2016

The Kuqa area of the Tarim Basin is a typical foreland thrust belt. Abundant petroleum resources are stored in the complex subsalt structures at depths greater than 6500 m. The extremely rugged surface, the severely deformed gypsum-salt cap above the reservoir, and the large burial depth of the overthrust target make it difficult to accurately delineate the target structures. Those geologic challenges translate into geophysical difficulties of complex seismic wavefields, low signal-to-noise ratio (S/N), and poor imaging accuracy, which compound the exploration challenge in the Kuqa area. To meet the exploration challenge, a research campaign has been conducted since 2005 to integrate seismic acquisition, processing, and interpretation. After almost a decade of research effort and pilot applications, a set of techniques, comprised of wide-line large-array acquisition, anisotropic prestack depth migration under rugged topography, complex structure modeling, and structure mapping with varying velocities, was developed. The use of these techniques has much improved the S/N, imaging accuracy, subsequent interpretation, and well placement. As a result, the success ratio of exploration drilling has increased from less than 25% to more than 64% in the Kuqa area of the Tarim Basin.
Patient Navigation As a Model to Increase Participation of African Americans in Cancer Clinical Trials
Authors: Fouad Mona N. , Acemgil Aras , Bae Sejong , Forero Andres , Lisovicz Nedra , Martin Michelle Y. , Oates Gabriela R. , Partridge Edward E. , Vickers Selwyn M.
Published: June 2016

Purpose:

Less than 10% of patients enrolled in clinical trials are minorities. The patient navigation model has been used to improve access to medical care but has not been evaluated as a tool to increase the participation of minorities in clinical trials. The Increasing Minority Participation in Clinical Trials project used patient navigators (PNs) to enhance the recruitment of African Americans for and their retention in therapeutic cancer clinical trials in a National Cancer Institute–designated comprehensive cancer center.

Methods:

Lay individuals were hired and trained to serve as PNs for clinical trials. African American patients potentially eligible for clinical trials were identified through chart review or referrals by clinic nurses, physicians, and social workers. PNs provided two levels of services: education about clinical trials and tailored support for patients who enrolled in clinical trials.

Results:

Between 2007 and 2014, 424 African American patients with cancer were referred to the Increasing Minority Participation in Clinical Trials project. Of those eligible for a clinical trial (N = 378), 304 (80.4%) enrolled in a trial and 272 (72%) consented to receive patient navigation support. Of those receiving patient navigation support, 74.5% completed the trial, compared with 37.5% of those not receiving patient navigation support. The difference in retention rates between the two groups was statistically significant (P < .001). Participation of African Americans in therapeutic cancer clinical trials increased from 9% to 16%.

Conclusion:

Patient navigation for clinical trials successfully retained African Americans in therapeutic trials compared with non–patient navigation trial participation. The model holds promise as a strategy to reduce disparities in cancer clinical trial participation. Future studies should evaluate it with racial/ethnic minorities across cancer centers.
Typical Time to Treatment of Patients With Lung Cancer in a Multisite, US-Based Study
Authors: Vidaver Regina M. , Shershneva Marianna B. , Hetzel Scott J. , Holden Timothy R. , Campbell Toby C.
Published: June 2016

Introduction:

The importance of high-quality, timely lung cancer care and the need to have indicators to measure timeliness are increasingly discussed in the United States. This study explored when and why delays occur in lung cancer care and compared timeliness between two states with divergent disease incidence.

Methods:

Patients with small-cell or non–small-cell lung cancer were recruited through cancer centers, outpatient clinics, and community approaches, and interviewed over the phone. Statistical analysis of patient-reported dates included descriptive statistics and comparing time intervals between states and across the sites with Mann-Whitney U tests. Additionally, data from patients with longer timelines were qualitatively analyzed to identify possible reasons for delays.

Results:

On the basis of the dates reported by 275 patients, the median time from first presentation to a clinician to treatment was 52 days; 29% of patients experienced a wait of 90 days or more. Median times for key intervals were 36.5 days from abnormal radiograph to treatment, 9.5 days from initial presentation to specialist referral, 15 days from patient informed of diagnosis to first therapy, and 16 days from referral to treatment to first therapy. More than one quarter of patients perceived delays in care. No significant differences in length of time intervals were identified between states. Monitoring of small nodules, missed diagnosis, and other reasons for longer timelines were documented.

Conclusion:

Results defined typical time to treatment of patients with lung cancer across a variety of health systems and should facilitate establishing metrics for determining timeliness of lung cancer care.
Effectiveness of a Survivorship Program: An Assessment of Patients With Breast Cancer in a Community Setting
Authors: Dietrich Leah , Smith Angela L. , Watral Alexandra , Borgert Andrew J. , Al-Hamadani Mohammed , Van Oosbree Marie , Meyer Christine M.
Published: June 2016

Purpose:

This study assesses the effectiveness of a single institution’s breast cancer survivorship program on patient perceptions, quality of life (QOL), and compliance with National Comprehensive Cancer Network (NCCN) guidelines for follow-up.

Methods:

Sampled patients completed all their breast cancer treatment at a single tertiary center. Surveys designed to evaluate QOL were obtained, and retrospective medical record review was conducted to assess NCCN compliance. Survivorship clinic (SC) attendees and nonattendees were matched for age and disease stage for comparison of the outcomes (QOL, NCCN compliance, and overall effectiveness).

Results:

SC patients (n = 63) tended to perceive their concerns in various categories to be addressed more adequately than did nonattendees (n = 54), with significant differences in the areas of practical concerns (P = .03) and late-term adverse effects (P = .03). There was a significant difference in compliance with three NCCN guidelines (history and physical every 3 to 6 months, annual mammography, and a pelvic examination if on tamoxifen) between survivorship attendees and nonattendees (P < .001, P = .02, and P < .001, respectively). Women who attended an SC used other survivorship support resources more often.

Conclusion:

Survivorship programs can be time and resource consuming, but our study is one of the first to show that a survivorship program effectively changes patient behavior in important ways. Patients who attended an SC were more likely to be compliant with NCCN-recommended follow-up and to use other survivorship resources and felt their concerns were better addressed. These measures can be used to help us improve our survivorship services and by other institutions to measure the quality and effectiveness of their programs.
Cross-Sectional Data That Explore the Relationship Between Outpatients’ Quality of Life and Preferences for Quality Improvement in Oncology Settings
Authors: Fradgley Elizabeth A. , Bryant Jamie , Paul Christine L. , Hall Alix E. , Sanson-Fisher Robert W. , Oldmeadow Christopher
Published: June 2016

Purpose:

This cross-sectional study assessed the association between oncology outpatients' quality improvement preferences and health-related quality of life (HRQoL). Implementation of specific initiatives preferred by patients with lower HRQoL may be a strategic approach to enhancing care for potentially vulnerable patients.

Methods:

English-speaking adults were recruited from five outpatient chemotherapy clinics located in New South Wales, Australia. Using touch screen devices, participants selected up to 25 initiatives that would improve their experiences and completed the Functional Assessment of Cancer Therapy-General (FACT-G) survey. The logistic odds of selecting an initiative according to FACT-G scores were calculated to determine whether preferences were associated with HRQoL after controlling for potential confounders.

Results:

Of the 411 eligible outpatients approached to participate, 263 (64%) completed surveys. Commonly selected initiatives were up-to-date information on treatment and condition progress (19.8%), access to or information on financial assistance (18.3%), and reduced clinic wait times (17.5%). For those with relatively lower FACT-G scores, the adjusted odds of selecting five initiatives illustrated an increasing trend: convenient appointment scheduling systems (+23% [P = .002]), reduced wait times (+15% [P = .01]), information on medical emergencies (+14% [P = .04]), access to or information on financial assistance (+15% [P = .009]), help to maintain daily living activities (+18% [P = .007]).

Conclusion:

Two areas of improvement were commonly selected: easily accessible health services and information and support for self-management. Although the results suggest an association between a few quality improvement preferences and HRQoL, a wider spectrum of patient characteristics must be considered when targeting quality improvement to patient subgroups.
The Rhetorics and Realities of Community Health Care: The Limits of Countervailing Powers to Meet the Health Care Needs of the Twenty-First Century
Authors: Light Donald W.
Published: June 2016

As the paradox of medical success leaves behind more chronicity, policy makers around the world increasingly focus on community-based programs both to address chronic health problems and to prevent major disorders. This essay presents my comparative sociological framework of ideal-type models for understanding the countervailing powers that underlie and shape different kinds of health care systems and their limitations in addressing the health care needs of the twenty-first century. In this context, I then analyze the revival of community heath care rhetoric in the United States and compare it to the realities in which it operates. The realities of institutional power, fragmentation in funding, illness as a private condition and health care as a private good, the lack of societal commitment, competition, and the waning of community cohesion all suggest that communal democracy will be difficult to achieve. Current successes require further investigation. Examples from abroad suggest, ironically, that community health care develops best if the state and health professionals make a deep commitment to it, against their own immediate interests but for their enlightened self-interest.
Doctors and Corporatist Politics: The Case of the Mexican Medical Profession
Authors: Nigenda Gustavo , Solórzano Armando
Published: June 2016

This study advances our understanding of the relationship between the state and the medical profession in countries where health care services are used as instruments of economic and political control. As a general argument, we maintain that the corporatist nature of the Mexican state impedes the medical profession from achieving autonomy and control over its professional activities. In contraposition to medical professions in developed societies, the nature of the Mexican profession is shaped by state policies and by its reiterated efforts to act independently of the state’s tutelage. We analyze this dynamic interaction through three different historical epochs that reflect the complexity and uniqueness of the Mexican medical profession. Whatever attempts the profession has made to control the medical curriculum, the licensing process, the market, or the specific laws that affect its own field, the Mexican state has responded with measures that systematically divide and antagonize the different factions of medical associations. The result is a highly fragmented and disenfranchised medical profession with dissimilar political, professional, personal, and academic aims. In the final analysis, the interests of the corporatist Mexican state prevail over the interests of other groups, including doctors. The evisceration of the medical corps by the Mexican state results in a profession with low salaries, higher rates of unemployment, atomization in terms of political representation, and heavily co-opted medical organizations that seem to neglect the overwhelming health care needs of the Mexican people.
The Health System in Transition: Care, Cost, and Coverage
Authors: Thorpe Kenneth E.
Published: June 2016

The growth in market-based contracting and the ascendency of managed care have generated substantial change in the health care delivery system. These reforms were spurred largely by private health care purchasers seeking a means for controlling the relentless growth in medical care costs. Following the private sector’s lead, the two large public programs, Medicaid and Medicare, have also looked to managed care for solving their mounting expenditure problems. Increased reliance on competition, and the growing rejection of rate regulation, have fundamentally re-shaped the health care delivery system and raise several important policy issues. Market-based contracting places a premium on the ability of health plans to control the growth in prices and use of services, resulting in continued merger and consolidation among health plans. At the same time, providers have recognized the competitive bargaining advantages in negotiating with health plans through their own consolidation and mergers. Unanswered in the managed care revolution is the means for financing care for the 41 million uninsured Americans. Moreover, whether the private and public sector are willing, or need, to finance the training of young physicians also hangs in the balance.
Can Markets Give Us the Health System We Want?
Authors: Rice Thomas
Published: June 2016

The purpose of this article is to reconsider the foundations of health economics as applied to the study of competition. It shows that conclusions concerning the purported desirability of competitive markets are based on a number of assumptions—many of which have heretofore been ignored—that typically are not fulfilled in the health care area. Once this is recognized, market mechanisms no longer necessarily provide the best way to improve social welfare.

The article is divided into two parts: competition and demand. Each of these sections presents and then critiques key assumptions of the conventional economic model, and then provides a number of health applications. It concludes that by not considering the validity of these assumptions in health care applications, researchers and policy analysts will blind themselves to policy options that may be most effective in improving social welfare.
The Technocratic Wish: Making Sense and Finding Power in the “Managed” Medical Marketplace
Authors: Belkin Gary S.
Published: June 2016

Enormous changes have recently swept through the organization and delivery of medical care. Scholars and students of the health care system and its politics try to make sense of the shift in power to identify and allocate needed resources away from physicians and toward corporate firms. I suggest that we cannot understand managed care unless we understand its power as at least substantially due to its reliance on a claim to be better science. In this way, managed care needs to be placed within an analytic historical tradition that is concerned with how accounts of scientific objectivity become convincing and support (and are confirmed as scientific by) social and political objectives. In this way, managed care reflects what I call the technocratic wish: an appeal to objective measures to resolve contentious issues and/or clothe their resolution as scientifically logical and natural.
The Limits of Social Learning: Translating Analysis into Action
Authors: Peterson Mark A.
Published: June 2016

In what respects does public-policy making reflect social learning, drawing lessons from previous experiences and from the experiences of governments in other settings? Starting with an examination of the effect of policy legacies on current policy making, I present a process model of social learning embedded within the larger policy-making process resting at the intersection of the nation’s constitutional context, technological change, and political influences exogenous to social learning. The model first distinguishes between the structural and the social learning effects of policy legacies. I then conceptually divide social learning into separate streams of substantive learning and situational learning. The effect that each of these has on policy making depends on the relative position of three categories of participants in the policy-making process (experts, organized interests, and politicians), as well as on the scope of the policy issue being considered (ranging from routine change to major reform). This analysis, with reference to recent health care policy making, reveals the full extent to which social learning is often a decidedly political struggle over ideas and information in which advocates promote lessons that serve their specific interests within a given institutional context and political setting. I consider the implications of social learning for understanding likely policy responses to the rise of market forces in health care.
Enemies of the People: The Moral Dimension to Public Health
Authors: Morone James A.
Published: June 2016

This essay explores the effects of morality on health policy. Moral images and stereotypes, I argue, have powerful political consequences. They are the difference between fighting poverty and fearing the poor, between expanding social welfare programs and cracking down on crime, between public health campaigns and drug wars. I begin by locating morality within traditional paradigms of American politics (which are designed to overlook the issue); I then suggest how moral stigmas are constructed; show how they are deployed in debates over public health issues, such as alcohol abuse and drug addiction; and briefly sketch an alternative approach to defining community and seeking public health.
Learning from Others: Shall the Last Be the First?
Authors: Klein Rudolf
Published: June 2016

The cross-national exchange of ideas and experience in health care reform has, in recent years, reached epidemic proportions. Taking stock of this suggests the need for critical caution. The various participants in the process have different motives; models may be exported before they have been fully tested; information may be sought chiefly as political ammunition; and selective perception often distorts the evidence. A more helpful approach might be to concentrate on evaluating the experience of countries over time, rather than concentrating on the latest fashionable panacea, and to focus more on the process of introducing change.
Early development ofDrosophilaembryos requires Smc5/6 function during oogenesis
Authors: Tran Martin , Tsarouhas Vasilios , Kegel Andreas
Published: June 2016

Mutations in structural maintenance of chromosomes (Smc) proteins are frequently associated with chromosomal abnormalities commonly observed in developmental disorders. However, the role of Smc proteins in development still remains elusive. To investigate Smc5/6 function during early embryogenesis we examined smc5 and smc6 mutants of the fruit fly Drosophila melanogaster using a combination of reverse genetics and microscopy approaches. Smc5/6 exhibited a maternally contributed function in maintaining chromosome stability during early embryo development, which manifested as female subfertility in its absence. Loss of Smc5/6 caused an arrest and a considerable delay in embryo development accompanied by fragmented nuclei and increased anaphase-bridge formation, respectively. Surprisingly, early embryonic arrest was attributable to the absence of Smc5/6 during oogenesis, which resulted in insufficient repair of pre-meiotic and meiotic DNA double-strand breaks. Thus, our findings contribute to the understanding of Smc proteins in higher eukaryotic development by highlighting a maternal function in chromosome maintenance and a link between oogenesis and early embryogenesis.
Lmx1a functions in intestinal serotonin-producing enterochromaffin cells downstream of Nkx2.2
Authors: Gross Stefanie , Garofalo Diana C. , Balderes Dina A. , Mastracci Teresa L. , Dias José M. , Perlmann Thomas , Ericson Johan , Sussel Lori
Published: June 2016

The intestinal hormone-producing cells represent the largest endocrine system in the body; however, there is still remarkably little known about enteroendocrine cell type specification in the embryo and adult. We analyzed stage and cell-type specific deletions of Nkx2.2 and its functional domains to characterize its precise role in the development and maintenance of enteroendocrine cell lineages in the duodenum and colon. Although Nkx2.2 regulates enteroendocrine cell specification in the duodenum at all stages examined, Nkx2.2 controls the differentiation of progressively fewer enteroendocrine cell populations when deleted from Neurogenin 3 (Ngn3)+ progenitor cells or in the adult duodenum. During embryonic development Nkx2.2 regulates all enteroendocrine cell types, except gastrin and preproglucagon. In the developing Ngn3-expressing enteroendocrine progenitor cells, Nkx2.2 is also not required for the specification of neuropeptide Y and vasoactive intestinal polypeptide, indicating that a subset of these cell populations derive from an Nkx2.2-independent lineage. In the adult duodenum, Nkx2.2 also becomes dispensable for cholecystokinin and secretin production. In all stages and Nkx2.2 mutant conditions, serotonin-producing enterochromaffin cells were the most severely reduced enteroendocrine lineage in the duodenum and the colon. We determined that the transcription factor Lmx1a is expressed in enterochromaffin cells and functions downstream of Nkx2.2. Consistently, Lmx1a-deficient mice have reduced expression of Tph1, the rate-limiting enzyme for serotonin biosynthesis. These data clarify the function of Nkx2.2 in the specification and homeostatic maintenance of enteroendocrine populations, and identify Lmx1a as a novel enterochromaffin cell marker that is also essential for the production of the serotonin biosynthetic enzyme Tph1.
Endosperm turgor pressure decreases during early Arabidopsis seed development
Authors: Beauzamy Léna , Fourquin Chloé , Dubrulle Nelly , Boursiac Yann , Boudaoud Arezki , Ingram Gwyneth
Published: June 2016

In Arabidopsis, rapid expansion of the coenocytic endosperm after fertilization has been proposed to drive early seed growth, which is in turn constrained by the seed coat. This hypothesis implies physical heterogeneity between the endosperm and seed coat compartments during early seed development, which to date has not been demonstrated. Here we combine tissue indentation with modelling to show that the physical properties of the developing seed are consistent with the hypothesis that elevated endosperm-derived turgor pressure drives early seed expansion. We provide evidence that whole-seed turgor is generated by the endosperm at early developmental stages. Furthermore, we show that endosperm cellularization and seed growth arrest are associated with a drop in endosperm turgor pressure. Finally we demonstrated that this decrease is perturbed when the function of POLYCOMB REPRESSIVE COMPLEX2 is lost, suggesting that turgor pressure changes could be a target of genomic imprinting. Our results indicate a developmental role for changes in endosperm turgor-pressure in the Arabidopsis seed.
Structural basis for the antagonistic roles of RNP-8 and GLD-3 in GLD-2 poly(A)-polymerase activity
Authors: Nakel Katharina , Bonneau Fabien , Basquin Claire , Habermann Bianca , Eckmann Christian R. , Conti Elena
Published: June 2016

Cytoplasmic polyadenylation drives the translational activation of specific mRNAs in early metazoan development and is performed by distinct complexes that share the same catalytic poly(A)-polymerase subunit, GLD-2. The activity and specificity of GLD-2 depend on its binding partners. In Caenorhabditis elegans, GLD-2 promotes spermatogenesis when bound to GLD-3 and oogenesis when bound to RNP-8. GLD-3 and RNP-8 antagonize each other and compete for GLD-2 binding. Following up on our previous mechanistic studies of GLD-2–GLD-3, we report here the 2.5 Å resolution structure and biochemical characterization of a GLD-2–RNP-8 core complex. In the structure, RNP-8 embraces the poly(A)-polymerase, docking onto several conserved hydrophobic hotspots present on the GLD-2 surface. RNP-8 stabilizes GLD-2 and indirectly stimulates polyadenylation. RNP-8 has a different amino-acid sequence and structure as compared to GLD-3. Yet, it binds the same surfaces of GLD-2 by forming alternative interactions, rationalizing the remarkable versatility of GLD-2 complexes.
Decrease in rate of multiple sclerosis-related hospitalizations in Portugal
Authors: Pereira Marta , Lambrelli Dimitra , Ramagopalan Sreeram V.
Published: June 2016

We sought to investigate the rate of multiple sclerosis (MS)-related hospitalizations in Portugal and assess whether there have been temporal changes as described in other countries. Using data from the Portuguese National Discharge Registry, we observed that between 2008 and 2013 the rate of MS-related hospitalizations decreased by 44%, from 15.9/100 person-years (95% confidence interval (CI: 14.9-16.9) in 2008 to 8.9/100 person-years (95% CI: 8.2-9.6) in 2013. The change in hospitalization rates is in accordance with what has been observed in other countries, and coincides with the release of new therapies for MS in Portugal.
Bone mineralization disorders as a complication of anorexia nervosa - etiology, prevalence, course and treatment
Authors: Jagielska Gabriela , Przedlacki Jerzy , Bartoszewicz Zbigniew , Racicka Ewa
Published: June 2016

Początek jadłowstrętu psychicznego ( j.p.) przypada najczęściej na okres adolescencji, który jest kluczowy dla osiągnięcia szczytowej masy kostnej. Zaburzenia hormonalne (hipoestrogenizm, hiperkortyzolemia, obniżone wydzielanie dehydroepiandrosteronu, testosteronu, insulinopodobnego czynnika wzrostu) i niedożywienie związane są z głębokimi zaburzeniami metabolizmu kości. Densytometryczne wartości gęstości mineralnej kości (BMD) dla osteopenii i osteoporozy stwierdzano odpowiednio u 35-98% i 13-50% kobiet z j.p. Badania prospektywne wskazują na dalszy spadek BMD na początku realimentacji oraz kluczowe znaczenie wzrostu masy ciała i powrotu samoistnych miesiączek dla jej wzrostu. W związku z często występującym przewlekłym lub nawrotowym przebiegiem j.p. zaleca się wykonanie badania densytometrycznego u wszystkich kobiet chorujących na j.p. z zatrzymaniem miesiączki trwającym ok. 12 mies. Podejmowane są badania dotyczące leczenia farmakologicznego, zmierzające do ustalenia standardów postępowania w osteoporozie w j.p. Obiecujące wyniki, wskazujące na wzrost BMD, uzyskano w badaniach z zastosowaniem terapii fizjologicznymi dawkami estrogenów z sekwencyjnym podawaniem medroksyprogesteronu u nastolatek i terapii bisfosfonianami u dorosłych kobiet. Zalecane jest suplementowanie witaminy D oraz odpowiednia podaż wapnia w diecie. Konieczne są dalsze badania długoterminowe dotyczące skuteczności leczenia osteoporozy w zakresie możliwości wzrostu BMD i zmniejszenia ryzyka złamań osteoporotycznych.
Polish project of a Sex Offenders Registry – a mental health professionals’ perspective
Authors: Szumski Filip , Kasparek Krzysztof , Gierowski Józef
Published: June 2016

W pracy poddano dyskusji rządowy projekt ustawy przeciwdziałaniu zagrożeniom przestępczością na tle seksualnym. Zakłada on stworzenie Rejestru Sprawców Przestępstw na Tle Seksualnym; w wersji o ograniczonym dostępie oraz w wersji dostępnej publicznie. Uzupełniającym go produktem ma być publicznie dostępna mapa zagrożeń przestępczością seksualną, obejmująca miejsca popełnienia przestępstw seksualnych oraz miejsca zamieszkania sprawców tego rodzaju przestępstw. Krytykując zaproponowane rozwiązania autorzy wskazują m.in. na brak zintegrowania z pozostałymi oddziaływaniami prowadzonymi w Polsce wobec sprawców przestępstw seksualnych, niezgodność z zaleceniami najważniejszych w dziedzinie środowisk eksperckich, a także wyniki badań wskazujących na brak skuteczności planowanych działań w zakresie redukcji przestępczości seksualnej. Podkreślono też liczne negatywne następstwa upublicznienia danych sprawców przestępstw seksualnych w postaci wyraźnego pogorszenia rokowań na resocjalizację, dodatkową stygmatyzację i wykluczenie społeczne sprawców, ich rodzin oraz samych ofiar przemocy seksualnej. W podsumowaniu podkreślono konieczność przeciwdziałania problemowi przestępczości seksualnej w sposób systemowy oraz potrzebę zróżnicowania podejmowanych oddziaływań w zależności od poziomu ryzyka recydywy seksualnej.
A History of ‘The Mysteries’
Authors: Solberg Emma Maggie
Published: June 2016

This study explores the history of the term ‘mystery’ in its theatrical sense. Victorian scholar (and forger) J.P. Collier was the first to question the term’s legitimacy, accusing the eighteenth-century publisher Robert Dodsley of having invented it. Collier’s condemnation has held sway ever since; ‘mystery’ is nearly bankrupt in the field of early English drama studies. I reconsider the authenticity, utility, etymology, and history of ‘mystery’, fact-checking the arguments made for and against it by Collier, E.K. Chambers, J.M. Salter, and Meg Twycross (amongst others) to show that reports of the term’s illegitimacy have been greatly exaggerated.

 