bluuebunny/crossref_metadata_2025 huggingface dataset:
Sounding out the future of ultrasound education
Authors: Bowra J , Dawson M , Goudie A , Mallin M
Published: December 2014

As in so many other fields, the internet has revolutionised medical education. It has done this by circumventing the traditional constraints of medical education, in particular the availability of local resources such as teachers and textbooks. This “education revolution” has been most successful in the areas of theoretical knowledge. This article explores the available resources, and the challenges that arise when attempting to teach point-of-care ultrasound via the internet, such as the visuomotor and visuospatial skills required to create a diagnostic image. This article also describes the progress to date in this field.
Renal replacement therapy in Scottish critical care units: A national audit of practices
Authors: Black Euan , Chalmers James , Wallis Charles , Cole Stephen ,   on behalf of the SICS Trainees Audit Share Group
Published: December 2014

Large randomised controlled trials show no benefit of high intensity renal replacement therapy compared to lower intensity regimens. Previous data suggest large variation in practice. This audit evaluated practices in relation to intensity of replacement therapy in critical care units across the Scottish National Health Service over a 28-day period. The mean delivered weight-adjusted effluent flow rates for continuous veno-venous haemofiltration were 29.1 (8.1 SD) ml kg−1 h−1 which was 89% of that prescribed. For continuous veno-venous haemodiafiltration, the mean delivered dose was 41.3 (7.9) ml kg−1 h−1 which was 88.4% of that prescribed. Of the eight patients undergoing intermittent haemodialysis, seven had daily treatments, whilst the eighth had four treatments in five days. The prescription and delivery of renal replacement therapy within Scottish critical care units are routinely performed at an intensity that is higher than necessary. Avoidance of excessive dose could provide important cost savings.
A case of chronic anorexia nervosa with child-bearing by in vitro fertilization necessitating comprehensive team support
Authors: Toki Shigeru , Hashimoto Eri , Masuda Masayuki , Machino Akihiko , Yamawaki Shigeto
Published: December 2014

Lesson

Generalists should be aware of the issues surrounding pregnancy in patients with anorexia nervosa and discuss well with patients and their families before in vitro fertilization.
Yes, no, possibly, maybe: Community sanctions, consent and cooperation
Authors: Canton Rob
Published: December 2014

This article explores the significance of consent to community sanctions and measures. The value of consent derives from the principle of autonomy and rights to freedom and dignity. While normally these are rights that should be upheld and defended, the question is complicated in the case of penal sanctions. The account goes on to discuss the necessary conditions for meaningful informed consent and to inquire into the extent to which these conditions apply to community sentences. The origin of consent to the probation order and other community penalties in England and Wales is outlined – the reason why it was originally expected and why it was eventually abolished. Yet even if consent is not formally required, there is reason to think that England and Wales is an example of a country where in practice consent is actively sought. The relationship between consent and compliance – and the distinct concept of active cooperation – is discussed. It is concluded that a formal expression of consent in Court has symbolic value, but does not resolve the challenge of trying to secure consent and cooperation that must persist throughout the duration of the community order.
Informed consent as a requirement for probation work with (in)voluntary clients: Probationers’ and probation officers’ perspectives
Authors: Sučić Ines , Ricijaš Neven , Glavak-Tkalić Renata
Published: December 2014

Offenders’ consent is incorporated in Croatian legislation as a necessary element for the execution of probation measures and sanctions. However, legal provisions, which are in accordance with contemporary European recommendations, provide only a basic framework for the implementation of such measures and sanctions. In this article, we argue that some elements of consent may be questionable and that changes to related practices are possible. After describing legal documents on this topic, we present the results of focus groups with probation officers and probationers with regard to the implementation of consent. Their perceptions and personal experiences provided us with valuable insights about and for practice and served as additional support for future recommendations.
Consent to probation in England and Wales: How it was abolished, and why it matters
Authors: Raynor Peter
Published: December 2014

Much of probation theory and probation training in Britain during the 1980s emphasised the importance of ‘contracts’ or negotiated agreements between probation officers, probationers and the sentencing Court – for example, joint decision-making was central to the influential ‘non-treatment paradigm’ and its variants. However, the legal requirement of consent to a probation order was abolished in 1997, partly because it was seen as diminishing the authority of the Court. This article discusses the arguments and attitudes that lay behind abolition, and considers how far the absence of formal consent should be seen as making a difference in practice. Recent studies of supervision skills, therapeutic alliance, compliance with probation, sentencer involvement in supervision, and the role of individual choice in desistance from offending all point to the continuing importance of co-operation and joint ownership of the supervision agenda. Although these can exist in the absence of a formal requirement for consent, they have greater support and legitimacy when such a requirement is present. Finally, the article explores how official thinking and political gestures lead to decisions that are detached from the realities of practice, and discusses some of the current dangers that arise from this.
Aspects of Connected Speech Processes in Nigerian English
Authors: Oladipupo Rotimi Olanrele
Published: December 2014

Nigerian English (NigE), like other new Englishes, possesses its unique features at various domains of phonology. This article examined aspects of connected speech processes (CSPs), the phenomena that account for sound modifications and simplifications in speech, with a view to establishing features that characterize Standard NigE connected speech. Natural phonology (NP), which provides explanations for substitutions, alternations, and variations in the speech of second language speakers, was adopted as theoretical framework. The subjects of the study were 360 educated NigE speakers, accidentally sampled from different language groups in Nigeria. The CSPs found in their semi-spontaneous speeches were transcribed perceptually and analyzed statistically, by allotting marks to instances of occurrence and converting such to percentages. Three categories of CSPs were identified in the data: dominant, minor, and idiosyncratic processes. The study affirms that only the dominant CSPs, typical of NigE speakers, are acceptable as Standard Nigerian spoken English.
Information Technology Managerial Capabilities and Customer Service Performance Among Insurance Firms in Nigeria
Authors: Aduloju Sunday Adekunle
Published: December 2014

The potential of information technology (IT) as an enabler of customer service process continues to generate interest, which is reflected in the large number of IT-related studies. In spite of the significant progress made in this area, research findings have been mixed and inconsistent. Also, the underlying mechanisms by which IT can affect customer service process remain underexamined. The aim of this study was to find out whether IT investments and IT managerial capabilities can account for variations in customer service performance among insurance companies in Nigeria. Using survey research design, the three formulated hypotheses were tested with data gathered from 402 staff at the managerial level drawn from the selected insurance companies in Nigeria, which have been among the largest investors in IT, and where customer service is widely perceived as strategically important. Responses were analyzed using linear regression. A major finding of this study is that IT is a necessary, but not sufficient, condition for sustainable competitive advantage in customer service. Results show that the interaction of IT investments and tacit, path-dependent, and firm-specific IT managerial capabilities significantly explains variations in customer service performance. Consequently, this study recommends that to realize IT-business value, investments in IT should be accompanied by building and developing IT managerial capabilities.
The BJP’s Fragile Mandate: Modi and Vote Mobilizers in the 2014 General Elections
Authors: Chhibber Pradeep K. , Ostermann Susan L.
Published: December 2014

It has become commonplace to attribute the BJP’s victory in the 2014 Indian general elections to Narendra Modi. In this article we unravel the Modi effect and argue that Modi’s success is tied to his ability to attract ‘vote mobilizers’—individuals who campaign for the party—to the BJP. In 2014, the BJP had more mobilizers than any other party. The BJP also had more vote mobilizers in 2014 than in 2004, while the Congress had fewer. However, these mobilizers, while capable of increasing both turnout and vote share for their chosen party, display little party loyalty or partisanship. Instead, they are drawn to a winning candidate or party. Since it is ‘winnability’ that motivates mobilizers, their support for a party is shallow and, potentially, fleeting. We conclude by claiming that the BJP’s victory is more fragile than many assume.
Understanding the Defeat of the BSP in Uttar Pradesh: National Election 2014
Authors: Pai Sudha
Published: December 2014

The failure of the Bahujan Samaj Party to win a single Lok Sabha seat from Uttar Pradesh in the 2014 general elections, the only state in India, where the party had earlier secured power, came as a shocking surprise to many. Most analyses of the results claimed that the party lost because its core support base among the Dalits, and particularly, among the Jatav community, had drifted away from it. The article argues that while it is true that support to the Bahujan Samaj Party from its core constituency has shrunk in the 2014 elections, the party has managed to secure the allegiance of a majority of the Jatavs, as also the Dalits. It further points out that the defeat of the Bahujan Samaj Party was largely due to its failure to retain the support of those communities, other than the Dalits, who had extended substantial support to it in the past, as well as due to the Bharatiya Janata Party’s campaign strategy.
Affirmative Action for Muslims? Arguments, Contentions and Alternatives
Authors: Alam Mohd. Sanjeer
Published: December 2014

India is one of the most unequal societies of the world. At the same time, it has the distinction of having the longest history of affirmative action programmes for alleviating socio-economic inequalities. Currently, three social groups—the Scheduled Castes (SCs), the Scheduled Tribes (STs) and the Other Backward Classes (OBCs)—enjoy the benefits of affirmative action programmes, of reservation in particular. However, the demands to get acknowledged as ‘disadvantaged’ and for inclusion in the system of affirmative action have not stopped. Of late, the demands for reservation for disadvantaged minorities, Muslims in particular, have ignited intense and polarized debates. All this has not only complicated the politics of ‘recognition’ and ‘redistribution’ but also affected the discourse on and capacity of existing affirmative measures to tackle the issue of group-based disadvantages. Against this backdrop, the objective of this article is two-fold: ( a) to get into the complexities underlying the idea of affirmative action for Muslims; and ( b) to move the debates on affirmative action beyond ‘one policy fits all’ perspective.
Book Review: David N. Gellner, ed., Borderland Lives in Northern South Asia
Authors: Chowdhory Nasreen
Published: December 2014

David N. Gellner, ed., Borderland Lives in Northern South Asia. New Delhi: Orient BlackSwan. 2014. 322 pages. ₹ 875.
Book Review: Maya Tudor, The Promise of Power: The Origins of Democracy in India and Autocracy in Pakistan
Authors: Gilmartin David
Published: December 2014

Maya Tudor, The Promise of Power: The Origins of Democracy in India and Autocracy in Pakistan. New Delhi: Cambridge University Press. 2013. xvi + 239 pages. ₹ 595.
Book Review: Dayabati Roy, Rural Politics in India: Political Stratification and Governance in West Bengal
Authors: Sircar Neelanjan
Published: December 2014

Dayabati Roy, Rural Politics in India: Political Stratification and Governance in West Bengal. New Delhi: Cambridge University Press. 2014. 279 pages. ₹ 895.
Characterizing heterogeneity in leukemic cells using single-cell gene expression analysis
Authors: Saadatpour Assieh , Guo Guoji , Orkin Stuart H , Yuan Guo-Cheng
Published: December 2014

Background

A fundamental challenge for cancer therapy is that each tumor contains a highly heterogeneous cell population whose structure and mechanistic underpinnings remain incompletely understood. Recent advances in single-cell gene expression profiling have created new possibilities to characterize this heterogeneity and to dissect the potential intra-cancer cellular hierarchy.

Results

Here, we apply single-cell analysis to systematically characterize the heterogeneity within leukemic cells using the MLL-AF9 driven mouse model of acute myeloid leukemia. We start with fluorescence-activated cell sorting analysis with seven surface markers, and extend by using a multiplexing quantitative polymerase chain reaction approach to assay the transcriptional profile of a panel of 175 carefully selected genes in leukemic cells at the single-cell level. By employing a set of computational tools we find striking heterogeneity within leukemic cells. Mapping to the normal hematopoietic cellular hierarchy identifies two distinct subtypes of leukemic cells; one similar to granulocyte/monocyte progenitors and the other to macrophage and dendritic cells. Further functional experiments suggest that these subtypes differ in proliferation rates and clonal phenotypes. Finally, co-expression network analysis reveals similarities as well as organizational differences between leukemia and normal granulocyte/monocyte progenitor networks.

Conclusions

Overall, our single-cell analysis pinpoints previously uncharacterized heterogeneity within leukemic cells and provides new insights into the molecular signatures of acute myeloid leukemia.
Dragging scientific publishing into the 21st century
Authors: Khan Razib , Goodman Laurie , Mittelman David
Published: December 2014

Scientific publishers must shake off three centuries of publishing on paper and embrace 21st century technology to make scientific communication more intelligible, reproducible, engaging and rapidly available.
Transcriptome-wide signatures of tumor stage in kidney renal clear cell carcinoma: connecting copy number variation, methylation and transcription factor activity
Authors: Liu Qi , Su Pei-Fang , Zhao Shilin , Shyr Yu
Published: December 2014

Background

Comparative analysis of expression profiles between early and late stage cancers can help to understand cancer progression and metastasis mechanisms and to predict the clinical aggressiveness of cancer. The observed stage-dependent expression changes can be explained by genetic and epigenetic alterations as well as transcription dysregulation. Unlike genetic and epigenetic alterations, however, activity changes of transcription factors, generally occurring at the post-transcriptional or post-translational level, are hard to detect and quantify.

Methods

Here we developed a statistical framework to infer the activity changes of transcription factors by simultaneously taking into account the contributions of genetic and epigenetic alterations to mRNA expression variations.

Results

Applied to kidney renal clear cell carcinoma (KIRC), the model underscored the role of methylation as a significant contributor to stage-dependent expression alterations and identified key transcription factors as potential drivers of cancer progression.

Conclusions

Integrating copy number, methylation, and transcription factor activity signatures to explain stage-dependent expression alterations presented a precise and comprehensive view on the underlying mechanisms during KIRC progression.
Computational investigation of inhibitory mechanism of flavonoids as bovine serum albumin anti-glycation agents
Authors: Johari Anahita , Moosavi-Movahedi Ali Akbar , Amanlou Massoud
Published: December 2014

Background

Glycation of serum albumin and its consequence products were considered as an important factor in drug distribution and diabetic complications, therefore finding the glycation inhibitors and their inhibitory mechanisms became a valuable field of study. In this work, bovine serum albumin (BSA) became a subject as a model protein for analyzing the inhibitory mechanism of flavonoids, known as natural BSA glycation inhibitors in the early stage of glycation.

Methods

Firstly, for theoretical study, the three-dimensional model of BSA structure was generated by homology modeling and refined through molecular dynamic simulation. Secondly, several validation methods (statistical assessment methods and also neural network methods) by simultaneous docking study were employed for insurance about accuracy of our simulation. Then docking studies were performed for visualizing the relation between flavonoids’ binding sites and BSA glycation sites besides, the correlation analyzes between calculated binding energy and reported experimental inhibitory IC50 values of the flavonoids set, was considered to explore their molecular inhibitory mechanism.

Results

The quality assessment methods and simultaneous docking studies on interaction of quercetin (as the most studied flavonoids) with BSA and Human serum albumin (HAS), confirm the accuracy of simulation and the second stage of docking results which were in close agreement with experimental observations, suggest that the potential residues in flavonoids binding sites (which were place neighbor of tryptophan 212 within 5Ǻ) cannot be considered as one of glycation sites.

Conclusions

Based on the results, flavonoids don’t participate in inhibitory interference mechanism, and also, the differentiation between complexes of flavonoids with BSA and HSA could destroy the speculation of using them as an exchangeable model protein in study of serum albumin and flavonoids interactions.
Hydroxylation index of omeprazole in relation to CYP2C19 polymorphism and sex in a healthy Iranian population
Authors: Payan Maryam , Rouini Mohammad Reza , Tajik Nader , Ghahremani Mohammad Hossein , Tahvilian Reza
Published: December 2014

Background

Polymorphism ofCYP2C19gene is one of the important factors in pharmacokinetics of CYP2C19 substrates. Omeprazole is a proton pump inhibitor which is mainly metabolized by cytochrome P450 2C19 (CYP2C19). The aim of present study was to assess omeprazole hydroxylation index as a measure of CYP2C19 activity considering new variant allele (CYP2C19*17) in Iranian population and also to see if this activity is sex dependent.

Methods

One hundred and eighty healthy unrelated Iranian individuals attended in this study. Blood samples for genotyping and phenotyping were collected 3 hours after administration of 20 mg omeprazole orally. Genotyping of2C19variant alleles*2,*3and*17was performed by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and semi-nested PCR methods. Plasma concentrations of omeprazole and hydroxyomeprazole were determined by high performance liquid chromatography (HPLC) technique and hydxroxylation index (HI) (omeprazole/ hydroxyomeprazole) was calculated.

Results

TheCYP2C19*17was the most common variant allele in the studied population (21.6%). Genotype frequencies ofCYP2C19*17*17,*1*17, and*2*17were 5.5%, 28.8% and 3.3% respectively. The lowest and the highest median omeprazole HI was observed in*17*17and*2*2genotypes respectively (0.36 vs. 13.09). The median HI of omeprazole in subjects homozygous forCYP2C19*1was 2.16-fold higher than individuals homozygous forCYP2C19*17(P < 0.001) and the median HI ofCYP2C19*1*17genotype was 1.98-fold higher thanCYP2C19 *17*17subjects (P < 0.001). However, subjects withCYP2C19*2*17(median HI: 1.74) andCYP2C19*1*2(median HI: 1.98) genotypes and alsoCYP2C19*1*17(median HI: 0.71) andCYP2C19*1*1(mean HI: 0.78) did not show any significantly different enzyme activity. In addition, no statistically significant difference was found between women and men in distribution ofCYP2C19genotypes. Furthermore, the hydroxylation index of Omeprazole was not different between women and men in the studied population.

Conclusion

Our data point out the importance ofCYP2C19*2andCYP2C19*17variant alleles in metabolism of omeprazole and therefore CYP2C19 activity. Regarding the high frequency ofCYP2C19*17in Iranian population, the importance of this new variant allele in metabolism of CYP2C19 substrates shall be considered.
Impaired T cell function in argininosuccinate synthetase deficiency
Authors: Tarasenko Tatyana N , Gomez-Rodriguez Julio , McGuire Peter J
Published: December 2014

ASS1 is a cytosolic enzyme that plays a role in the conversion of citrulline to arginine. In human and mouse tissues, ASS1 protein is found in several components of the immune system, including the thymus and T cells. However, the role of ASS1 in these tissues remains to be defined. Considerable attention has been focused recently on the role of metabolism in T cell differentiation and function. Based on the expression of ASS1 in the immune system, we hypothesized that ASS1 deficiency would result in T cell defects. To evaluate this question, we characterized immune function in hypomorphic fold/fold mice. Analysis of splenic T cells by flow cytometry showed a marked reduction in T cell numbers with normal expression of activation surface markers. Gene therapy correction of liver ASS1 to enhance survival resulted in a partial recovery of splenic T cells for characterization. In vitro and in vivo studies demonstrated the persistence of the ASS1 enzyme defect in T cells and abnormal T cell differentiation and function. Overall, our work suggests that ASS1 plays a role in T cell function, and deficiency produces primary immune dysfunction. In addition, these data suggest that patients with ASS1 deficiency (citrullinemia type I) may have T cell dysfunction.
Pore-scale modeling of elastic wave propagation in carbonate rocks
Authors: Wang Zizhen , Wang Ruihe , Weger Ralf J. , Li Tianyang , Wang Feifei
Published: December 2014

The relationship between P-wave velocity and porosity in carbonate rocks shows a high degree of variability due to the complexity of the pore structure. This variability introduces high uncertainties to seismic inversion, amplitude variation with offset analysis, porosity estimation, and pore-pressure prediction based on velocity data. Elastic wave propagation in porous media is numerically modeled on the pore scale to investigate the effects of pore structure on P-wave velocities in carbonate rocks. We built 2D models of porous media using pore structure information and the similarity principle. Then, we simulated normal incidence wave propagation using finite element analysis. Finally, the velocity was determined from received modeled signals by means of crosscorrelation. The repeatability and accuracy of this modeling process was verified carefully. Based on the modeling results, a simple formulation of Sun’s frame flexibility factor ([Formula: see text]), aspect ratio (AR, the ratio of the major axis to the minor axis), and pore density was developed. The numerical simulation results indicated that the P-wave velocity increases as a power function as the AR increases. Pores with small AR ([Formula: see text]) or large [Formula: see text] created softening effects that decrease P-wave velocity significantly. The P-wave velocity of carbonate rocks was dispersive; it depends on the ratio of the wavelength to pore size ([Formula: see text]). Such scale-dependent dispersion was more evident for carbonate rocks with higher porosity, lower AR, and/or lower P-wave impedance of pore fluids. The P-wave velocity of carbonate rocks with complicated pore geometries (low AR, high [Formula: see text], small [Formula: see text]) was much lower than that of rocks with simple pore geometries (high AR, small [Formula: see text], large [Formula: see text]) at low and high [Formula: see text]. The pore-scale modeling of elastic wave properties of porous rocks may explain the poor velocity-porosity correlation in carbonate rocks.
Assessing Biochar Stability Indices Using near Infrared Spectroscopy
Authors: Kusumo Bambang Hari , Arbestain Marta Camps , Mahmud Ainul Faizah , Hedley Mike James , Hedley Carolyn Betty , Pereira Roberto Calvelo , Wang Tao , Singh Bhupinder Pal
Published: December 2014

New and rapid techniques for estimating the stable fraction of organic carbon (Corg) in biochar are needed for carbon (C) sequestration accounting. In this study, 25 biochar samples produced from different feedstocks and pyrolysis temperatures were scanned using visible near infrared (NIR) spectroscopy and analysed using standard laboratory methods for reference data. Principal component analysis and linear discriminant analysis of preprocessed spectral data were used to extract relevant information and discriminate among biochars, respectively. Partial least squares regression was used to build calibration models between preprocessed spectral data and reference data, and the accuracy of calibration models in predicting biochar properties was then tested using a cross-validation procedure. Biochar indices related to C stability, such as aromatic C, fixed C, atomic H/Corg ratio and the fraction of total C that is aromatic(fa) were successfully predicted ( R2CV 0.92–0.94, RPDCV 3.26–4.22) using the NIR spectroscopy technique (NIR bands, 780–2500 nm). Aromatic C and fixed C could be predicted independently from fa. Other biochar properties, such as Corg, H and O content, and atomic O/Corg ratio, were predicted with an accuracy ranging from moderate to very high ( R2CV 0.80–0.96, RPDCV 2.24–4.66). The study illustrates the potential of this rapid and low-cost technique for measuring biochar stability indices in routine analysis if accurate calibration models for each index are available.
Splicing of designer exons informs a biophysical model for exon definition
Authors: Arias Mauricio A. , Lubkin Ashira , Chasin Lawrence A.
Published: December 2014

Pre-mRNA molecules in humans contain mostly short internal exons flanked by longer introns. To explain the removal of such introns, exon recognition instead of intron recognition has been proposed. We studied this exon definition using designer exons (DEs) made up of three prototype modules of our own design: an exonic splicing enhancer (ESE), an exonic splicing silencer (ESS), and a Reference Sequence (R) predicted to be neither. Each DE was examined as the central exon in a three-exon minigene. DEs made of R modules showed a sharp size dependence, with exons shorter than 14 nt and longer than 174 nt splicing poorly. Changing the strengths of the splice sites improved longer exon splicing but worsened shorter exon splicing, effectively displacing the curve to the right. For the ESE we found, unexpectedly, that its enhancement efficiency was independent of its position within the exon. For the ESS we found a step-wise positional increase in its effects; it was most effective at the 3′ end of the exon. To apply these results quantitatively, we developed a biophysical model for exon definition of internal exons undergoing cotranscriptional splicing. This model features commitment to inclusion before the downstream exon is synthesized and competition between skipping and inclusion fates afterward. Collision of both exon ends to form an exon definition complex was incorporated to account for the effect of size; ESE/ESS effects were modeled on the basis of stabilization/destabilization. This model accurately predicted the outcome of independent experiments on more complex DEs that combined ESEs and ESSs.
Student perception about working in rural United States/Canada after graduation: a study in an offshore Caribbean medical school
Authors: Shankar P Ravi , Dubey Arun K , Nandy Atanu , Herz Burton L , Little Brian W
Published: December 2014

Introduction: Rural residents of the United States (US) and Canada face problems in accessing healthcare. International medical graduates (IMGs) play an important role in delivering rural healthcare. IMGs from Caribbean medical schools have the highest proportion of physicians in primary care.  Xavier University School of Medicines admits students from the US, Canada and other countries to the undergraduate medical (MD) course and also offers a premedical program. The present study was conducted to obtain student perception about working in rural US/Canada after graduation.  

Methods: The study was conducted among premedical and preclinical undergraduate medical (MD) students during October 2014. The questionnaire used was modified from a previous study. Semester of study, gender, nationality, place of residence and occupation of parents were noted. Information about whether students plan to work in rural US/Canada after graduation, possible reasons why doctors are reluctant to work in rural areas, how the government can encourage rural practice, possible problems respondents anticipate while working in rural areas were among the topics studied.

Results: Ninety nine of the 108 students (91.7%) participated. Forty respondents were in favor of working in rural US/Canada after graduation. Respondents mentioned good housing, regular electricity, water supply, telecommunication facilities, and schools for education of children as important conditions to be fulfilled. The government should provide higher salaries to rural doctors, help with loan repayment, and provide opportunities for professional growth.  Potential problems mentioned were difficulty in being accepted by the rural community, problems in convincing patients to follow medical advice, lack of exposure to rural life among the respondents, and cultural issues.

Conclusions: About 40% of respondents would consider working in rural US/Canada. Conditions required to be fulfilled have been mentioned above. Graduates from Caribbean medical schools have a role in addressing rural physician shortage. Similar studies in other offshore Caribbean medical schools are required as Caribbean IMGs make an important contribution to the rural US and Canadian health workforce.
On a Unified Framework for Approachability with Full or Partial Monitoring
Authors: Perchet Vianney , Quincampoix Marc
Published: December 2014

We represent any repeated game with partial monitoring as an abstract repeated game with full monitoring where outcomes are probability measures, to be interpreted as the “maximal information” the players can obtain in the original game. One of our objectives is to define and generalize Blackwell’s approachability theory in this space of probability measures. We characterize approachable sets with, as usual, a simple and complete formulation for convex sets. Translated back into the original games with partial monitoring, these results provide the first necessary and sufficient approachability condition. As there is not a unique way to define averages of probability measures, we also investigate the case of displacement interpolation. We obtain similar results along with rates of convergence.
A proven pathway for stoma care: the value of stoma care services
Authors: Davenport Rebecca
Published: December 2014

The role of the stoma nurse is often misunderstood by those who have little or no understanding of the complexities of their role. Stoma nurses face challenges when communicating the valuable role they provide in relation to quality, value and cost. The implementation of an accredited pathway designed specifically for stoma patients would not only promote excellence in nursing practice, but would also assist the stoma nurse in building the profile of the specialty. The accredited pathway should outline the sequence and timings of actions necessary to achieve expected patient outcomes and organisational goals regarding quality of care, costs, patient experience and efficiency.
Service-user involvement in nurse education: partnership or tokenism?
Authors: McCutcheon Karen , Gormley Kevin
Published: December 2014

Following on from the Keogh Report, the need for a framework of service-user involvement exists not just in the health service, but also in higher education. There are wide variances globally in the levels of service-user interaction and involvement in healthcare education. Health policy internationally has indicated a move towards developing partnerships with service users, but to date this remains elusive, with the majority of user involvement consultative in approach. This article aims to discuss the health policy background and the current approaches taken in the involvement of service users in healthcare education.
Do psychological interventions reduce preoperative anxiety?
Authors: Renouf Tessa , Leary Alison , Wiseman Theresa
Published: December 2014

The systematic review investigates whether, during preoperative assessments, nurse-delivered psychological interventions reduce anxiety levels preoperatively for patients undergoing elective surgery. Seventeen studies met the inclusion criteria for data extraction and in-depth critiquing. Of these, two were discarded due to lack of validity, while the remaining studies were organised thematically in a narrative synthesis, generating two principal results: patients' preoperative anxieties were lowered by nurse-delivered general preoperative psychological interventions; and patients valued individualised preoperative interventions delivered by nurses. However, the single oncology study in the review showed an elevation in preoperative anxiety, regardless of intervention, and highlights the need for more research in this under-reviewed area. In the meantime, the authors believe that service improvements should be implemented to ensure that, where possible, psychological preoperative interventions are individualised.
Improving pressure ulcer risk assessment and management using the Waterlow scale at a London teaching hospital
Authors: Mahalingam S. , Gao L. , Nageshwaran S. , Vickers C. , Bottomley T. , Grewal P.
Published: December 2014

Objective:

Pressure ulcers (PUs) cost the National Health Service (NHS) up to 4% of its health care expenditure. Arising from this are also clinical negligence claims, where inadequate risk assessment has been cited as one of the principal drawbacks in the prevention of PUs. This two-cycle audit aims to examine the consistency and accuracy of risk assessment of patients, and demonstrates how simple focused interventions can improve the quality of care provided.

Method:

The Waterlow pressure ulcer risk assessment tool was employed to assess inpatients during a 6-month period at a London teaching hospital. Patients were risk assessed, and examined to detect PUs and to determine the type of mattress. We compared our findings with clinical (nursing and medical) documentation. Interventions were made through questionnaires given to staff, educational sessions, presentations and posters addressing where improvements could be made in risk stratifying patients. A repeat audit was carried out 24 months later and the results from both cycles were compared. Statistical analysis was carried out using Fisher's exact and the Student's T-test.

Results:

In total 100 in-patients were assessed in each cycle with a mean age of 71.4 years in cycle 1 and 70.1 years in cycle 2. A nursing Waterlow score was recorded for 81% of patients in cycle 1 and 100% in cycle 2 (p<0.05). In cycle 1, the average nursing score was significantly lower than that from the study (mean 13.7 versus 17.1, median 14.0 versus 18.0; p<0.05), but after intervention this had reduced to a minimal difference (mean 8.5 versus 9.0, median 8.0 versus 9.0, p=0.08).

Conclusion:

Nursing scores recorded in the notes were lower than the study scores in cycle 1, primarily from a failure to appropriately assess certain categories of the Waterlow scale. These differences reduced after focused education of staff. Our results suggest that targeted interventions tailored towards nursing and medical staff can result in improvements in the risk assessment for prevention and subsequent management of PUs. However, it also highlights the need for increased input from the entire multidisciplinary team in order to reduce the morbidity caused by PUs.

Declaration of interest:

The authors have no conflict of interest. No funding was received for this study.
Failed MitraClip-procedure with pull out of the anterior leaflet
Authors: Gross Michael , Wilkenshoff Ursula , Rutschow Susanne
Published: December 2014

Abstract:
MitraClip is an attractive and less invasive alternative to mitral valve surgery in serve mitral regurgitation in patients with moderate or severe risk for operation. It has been described to be effective and safe in functional as well as in degenerative mitral regurgitation. We report a case of MitraClip procedure with the pull out of the anterior leaflet during the intervention. The patient underwent cardiopulmonary support and surgical intervention with a good outcome. With this report we illustrated the etiology and management of this complication.
Preictal Activity of Subicular, CA1, and Dentate Gyrus Principal Neurons in the Dorsal Hippocampus before Spontaneous Seizures in a Rat Model of Temporal Lobe Epilepsy
Authors: Fujita Satoshi , Toyoda Izumi , Thamattoor Ajoy K. , Buckmaster Paul S.
Published: December 2014

Previous studies suggest that spontaneous seizures in patients with temporal lobe epilepsy might be preceded by increased action potential firing of hippocampal neurons. Preictal activity is potentially important because it might provide new opportunities for predicting when a seizure is about to occur and insight into how spontaneous seizures are generated. We evaluated local field potentials and unit activity of single, putative excitatory neurons in the subiculum, CA1, CA3, and dentate gyrus of the dorsal hippocampus in epileptic pilocarpine-treated rats as they experienced spontaneous seizures. Average action potential firing rates of neurons in the subiculum, CA1, and dentate gyrus, but not CA3, increased significantly and progressively beginning 2–4 min before locally recorded spontaneous seizures. In the subiculum, CA1, and dentate gyrus, but not CA3, 41–57% of neurons displayed increased preictal activity with significant consistency across multiple seizures. Much of the increased preictal firing of neurons in the subiculum and CA1 correlated with preictal theta activity, whereas preictal firing of neurons in the dentate gyrus was independent of theta. In addition, some CA1 and dentate gyrus neurons displayed reduced firing rates preictally. These results reveal that different hippocampal subregions exhibit differences in the extent and potential underlying mechanisms of preictal activity. The finding of robust and significantly consistent preictal activity of subicular, CA1, and dentate neurons in the dorsal hippocampus, despite the likelihood that many seizures initiated in other brain regions, suggests the existence of a broader neuronal network whose activity changes minutes before spontaneous seizures initiate.
GABAergic Projections from the Medial Septum Selectively Inhibit Interneurons in the Medial Entorhinal Cortex
Authors: Gonzalez-Sulser Alfredo , Parthier Daniel , Candela Antonio , McClure Christina , Pastoll Hugh , Garden Derek , Sürmeli Gülşen , Nolan Matthew F.
Published: December 2014

The medial septum (MS) is required for theta rhythmic oscillations and grid cell firing in the medial entorhinal cortex (MEC). While GABAergic, glutamatergic, and cholinergic neurons project from the MS to the MEC, their synaptic targets are unknown. To investigate whether MS neurons innervate specific layers and cell types in the MEC, we expressed channelrhodopsin-2 in mouse MS neurons and used patch-clamp recording in brain slices to determine the response to light activation of identified cells in the MEC. Following activation of MS axons, we observed fast monosynaptic GABAergic IPSPs in the majority (>60%) of fast-spiking (FS) and low-threshold-spiking (LTS) interneurons in all layers of the MEC, but in only 1.5% of nonstellate principal cells (NSPCs) and in no stellate cells. We also observed fast glutamatergic responses to MS activation in a minority (<5%) of NSPCs, FS, and LTS interneurons. During stimulation of MS inputs at theta frequency (10 Hz), the amplitude of GABAergic IPSPs was maintained, and spike output from LTS and FS interneurons was entrained at low (25–60 Hz) and high (60–180 Hz) gamma frequencies, respectively. By demonstrating cell type-specific targeting of the GABAergic projection from the MS to the MEC, our results support the idea that the MS controls theta frequency activity in the MEC through coordination of inhibitory circuits.
An RNA Binding Protein Promotes Axonal Integrity in Peripheral Neurons by Destabilizing REST
Authors: Cargnin Francesca , Nechiporuk Tamilla , Müllendorff Karin , Stumpo Deborah J. , Blackshear Perry J. , Ballas Nurit , Mandel Gail
Published: December 2014

The RE1 Silencing Transcription Factor (REST) acts as a governor of the mature neuronal phenotype by repressing a large consortium of neuronal genes in non-neuronal cells. In the developing nervous system, REST is present in progenitors and downregulated at terminal differentiation to promote acquisition of mature neuronal phenotypes. Paradoxically, REST is still detected in some regions of the adult nervous system, but how REST levels are regulated, and whether REST can still repress neuronal genes, is not known. Here, we report that homeostatic levels of REST are maintained in mature peripheral neurons by a constitutive post-transcriptional mechanism. Specifically, using a three-hybrid genetic screen, we identify the RNA binding protein, ZFP36L2, associated previously only with female fertility and hematopoiesis, and show that it regulates REST mRNA stability. Dorsal root ganglia inZfp36l2knock-out mice, or wild-type ganglia expressing ZFP36L2 shRNA, show higher steady-state levels ofRestmRNA and protein, and extend thin and disintegrating axons. This phenotype is due, at least in part, to abnormally elevated REST levels in the ganglia because the axonal phenotype is attenuated by acute knockdown of REST inZfp36l2KO DRG explants. The higher REST levels result in lower levels of target genes, indicating that REST can still fine-tune gene expression through repression. Thus, REST levels are titrated in mature peripheral neurons, in part through a ZFP36L2-mediated post-transcriptional mechanism, with consequences for axonal integrity.
Activity-Dependent Upregulation of Presynaptic Kainate Receptors at Immature CA3–CA1 Synapses
Authors: Clarke Vernon R.J. , Molchanova Svetlana M. , Hirvonen Teemu , Taira Tomi , Lauri Sari E.
Published: December 2014

Presynaptic kainate-type glutamate receptors (KARs) regulate glutamate release probability and short-term plasticity in various areas of the brain. Here we show that long-term depression (LTD) in the area CA1 of neonatal rodent hippocampus is associated with an upregulation of tonic inhibitory KAR activity, which contributes to synaptic depression and causes a pronounced increase in short-term facilitation of transmission. This increased KAR function was mediated by high-affinity receptors and required activation of NMDA receptors, nitric oxide (NO) synthetase, and postsynaptic calcium signaling. In contrast, KAR activity was irreversibly downregulated in response to induction of long-term potentiation in a manner that depended on activation of the TrkB–receptor of BDNF. Both tonic KAR activity and its plasticity were restricted to early stages of synapse development and were lost in parallel with maturation of the network due to ongoing BDNF–TrkB signaling. These data show that presynaptic KARs are targets for activity-dependent modulation via diffusible messengers NO and BDNF, which enhance and depress tonic KAR activity at immature synapses, respectively. The plasticity of presynaptic KARs in the developing network allows nascent synapses to shape their response to incoming activity. In particular, upregulation of KAR function after LTD allows the synapse to preferentially pass high-frequency afferent activity. This can provide a potential rescue from synapse elimination by uncorrelated activity and also increase the computational dynamics of the developing CA3–CA1 circuitry.
Slow Oscillations during Sleep Coordinate Interregional Communication in Cortical Networks
Authors: Cox Roy , van Driel Joram , de Boer Marieke , Talamini Lucia M.
Published: December 2014

Large-amplitude sleep slow oscillations group faster neuronal oscillations and are of functional relevance for memory performance. However, relatively little is known about the impact of slow oscillations on functionally coupled networks. Here, we provide a comprehensive view on how human slow oscillatory dynamics influence various measures of brain processing. We demonstrate that slow oscillations coordinate interregional cortical communication, as assessed by phase synchrony in the sleep spindle frequency range and cross-frequency coupling between spindle and beta activity. Furthermore, we show that the organizing role of slow oscillations is restricted to circumscribed topographical areas. These findings add importantly to our basic understanding of the orchestrating role of slow oscillations. In addition, they are of considerable relevance for accounts of sleep-dependent memory reprocessing and consolidation.
Unraveling Mechanisms Underlying Partial Agonism in 5-HT3A Receptors
Authors: Corradi Jeremías , Bouzat Cecilia
Published: December 2014

Partial agonists have emerged as attractive therapeutic molecules. 2-Me-5HT and tryptamine have been defined as partial agonists of 5-HT3receptors on the basis of macroscopic measurements. Because several mechanisms may limit maximal responses, we took advantage of the high-conductance form of the mouse serotonin type 3A (5-HT3A) receptor to understand their molecular actions. Individual 5-HT-bound receptors activate in long episodes of high open probability, consisting of groups of openings in quick succession. The activation pattern is similar for 2-Me-5HT only at very low concentrations since profound channel blockade takes place within the activating concentration range. In contrast, activation episodes are significantly briefer in the presence of tryptamine. Generation of a full activation scheme reveals that the fully occupied receptor overcomes transitions to closed preopen states (primed states) before opening. Reduced priming explains the partial agonism of tryptamine. In contrast, 2-Me-5HT is not a genuine partial agonist since priming is not dramatically affected and its low apparent efficacy is mainly due to channel blockade. The analysis also shows that the first priming step is the rate-limiting step and partial agonists require an increased number of priming steps for activation. Molecular docking suggests that interactions are similar for 5-HT and 2-Me-5HT but slightly different for tryptamine. Our study contributes to understanding 5-HT3A receptor activation, extends the novel concept of partial agonism within the Cys-loop family, reveals novel aspects of partial agonism, and unmasks molecular actions of classically defined partial agonists. Unraveling mechanisms underlying partial responses has implications in the design of therapeutic compounds.