Nurse teachers' feelings about participating in clinical practice: an exploratory study.
The aim of this small study was to explore nurse teachers' feelings about participating in clinical practice. An exploratory design was used entailing focused interviews with 10 nurse teachers which explored their current participation in clinical practice and their feelings about this. Other areas addressed were the perceived benefits and negative effects of participating in practice, as well as the factors which may inhibit or enable teachers participating in practice. It was found that while half the teachers had some participation in practice, only one participated on a regular basis. The teachers were generally dissatisfied with their current level of clinical practice. The teachers identified a number of potential benefits of practising, including keeping in touch with clinical practice, maintenance of clinical skills, improved relationships with trained staff and the opportunity to use knowledge and skills in practice. Perceived negative effects were that their clinical participation may be misinterpreted, or may impinge on other aspects of the role. Some also felt that the limited time which they would have available, would lead to their clinical practice being ineffective. The two major factors which affected whether nurse teachers were able to participate in practice were time and the college philosophy/culture. Other important factors were support from clinical staff, clinical confidence, and the teacher's role perception and attitude towards practice. As recent publications have inferred the need for nurse teachers to remain involved in clinical practice, teachers need to identify how clinical practice may best be achieved, and clarify their aims for practising. Different models of practice may be appropriate for individual teachers. It seems that a supportive environment and a college culture which values nurse teachers practising would be beneficial if clinical practice is to become part of the teacher's role.


Opportunities for Academic Pathology: The Thoughts and Perspectives of a Legal Observer.
As American health care undergoes great change, academic pathology is uniquely positioned to establish pathologists as key to the new health-care environment. Pathologists are at the forefront of major innovations in health care and are specialists who interact with all other medical specialists and essentially the entire range of health-care services. Academic pathologists benefit from being subspecialist experts who provide care to patients referred from large geographic areas, who can attain high academic stature over the course of their careers, and who serve as mentors for learners across virtually all medical specialties. Academic medical centers, in turn, have excellent credibility in the community, strong information technology infrastructure with the ability for data accrual and analysis not available in community health-care settings, and strong liaisons with civic authorities and policy makers. However, pathologists have to overcome their own tendencies toward modesty and lack of assertiveness, in order to help counter the significant trends in the health-care marketplace that disempower health-care providers and place health industry decision-making in the hands of nonmedical stakeholders. Specifically, academic pathologists need to proactively play a major role in institutional efforts to improve performance in quality, patient safety, efficiency, and coordinated care delivery and become leaders in the delivery of effective and efficient patient care. They need to play an essential role in utilization management, including molecular testing. They need to develop their value propositions for payers and seek to gain access to payers in order to represent these value statements. They should gain visibility directly to patients seeking expertise for second opinions and pursue opportunities for outreach programs in the community well beyond the academic medical center. Absent such efforts by academic pathologists, pathology is at risk of continued commoditization by nonpathologists, with weakening of the value proposition that pathology might bring forward.


Role of orexin receptors within the dentate gyrus of the hippocampus in antinociception induced by chemical stimulation of the lateral hypothalamus in the tail-flick test as a model of acute pain in rats.
The dentate gyrus (DG) as a part of the hippocampal formation is considered one of the brain areas involved in pain perception. The orexin neurons in the lateral hypothalamus (LH) also show connections to regions engaged in the circuitry of pain modulation and many studies have shown their potential to alter pain transmission through the nervous system. However, the role of orexin receptors (OXRs) of the DG in mediation of antinociceptive responses induced by the LH stimulation in rats has not yet been investigated. Hence, the present study was an attempt to examine the role of OXRs located within the DG in the pain modulation induced by chemical stimulation of the LH. Adult male Wistar rats weighing 220-250 g were unilaterally implanted with two separate cannulae into the LH and DG. Intra-DG administration of the orexin-1 receptor (OX1R) antagonist, SB334867 or the orexin-2 receptor (OX2R) antagonist, TCS OX2 29 was performed just 5 min before intra-LH carbachol microinjection. Antinociceptive effects were measured using the tail-flick apparatus. The results showed that OX1R and OX2R antagonists dose-dependently decreased the antinociceptive effect of carbachol. In addition, the effective dose of SB334867 was lesser than that of TCS OX2 29, which indicates the more prominent role of OX1R of the DG in carbachol-induced antinociception. None of the antagonists had any significant effect when administrated without intra-LH carbachol microinjection. It seems to be a neural circuit includes the LH and DG, which plays a major role in the neural basis of pain modulation.


The harms of racial miscategorization: Comparing multiracial individuals' well-being in the continental U.S. versus Hawai'i.
The current work explores the effects of racial miscategorization (incongruence between other people's racial categorization of an individual and that individual's racial self-identification) and subjective well-being of multiracial individuals in Hawai'i versus California. We set out to examine how multiracial individuals experience racial miscategorization in more or less ethnically diverse environments and how this experience shapes the extent to which they feel a sense of belonging and inclusion. The study consisted of interviews with 55 multiracial undergraduate and graduate students conducted in Hawai'i (20 self-identified women and 9 self-identified men, with ages ranging from 18 to 47 years; M = 22.93, SD = 6.40) and California (16 self-identified women, 9 self-identified men, and 1 self-identified gender nonbinary person, with ages ranging from 18 to 31 years; M = 20.96, SD = 2.76). Thematic analysis identified two central themes relevant to subjective well-being: (a) racial miscategorization and its consequences and (b) contextual differences in the experiences of miscategorization. Results suggest that racial miscategorization is a pervasive experience among multiracial people and is associated with negative psychological well-being. We also found that environments with greater representation of multiracial individuals, such as Hawai'i, are associated with less racial miscategorization, more inclusion, and better psychological well-being among multiracial individuals. Racial miscategorization is a prominent and aversive experience among multiracial individuals, but multiracial environments can serve as a psychological buffer. Racial miscategorization has important theoretical and practical implications for racial and ethnic identity research, which we discuss. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Factors that affect the traumatic childbirth perceptions of midwifery and nursing students: The case of Turkey.
Birth is a natural and joyful situation as well as a process that contains surprise situations that do not go well. Caregivers at birth are affected by this process. Especially when faced with difficult births, it can have an intense psychological effect and a perception of traumatic birth can occur. Although there is research about midwives on this subject, there are very few studies about students who are becoming midwives. The aim of this study was to determine the factors that affect the traumatic childbirth perceptions of midwifery and nursing students. The study was carried out with 480 students of midwifery and nursing. The data were collected by using a Personal Information Form, the Rosenberg Self-Esteem Scale, Self-Efficacy Scale, Traumatic Childbirth Perception Scale, and State-Trait Anxiety Inventory. The traumatic childbirth perception levels were very low in 7.3% of the participants, low in 26.9%, moderate in 37.9%, high in 21.5% and very high in 6.9%. The regression analysis revealed a significant relationship between traumatic childbirth perceptions and the parameters of satisfaction with the department studied, fear of childbirth, defining childbirth as a difficult and painful process, and history of complicated birth in the family. There was also a significant relationship between traumatic childbirth perceptions and the parameters of trait anxiety and general self-esteem. Traumatic childbirth perceptions increased as the state and trait anxiety levels and self-esteem levels increased, while they decreased as the self-efficacy levels increased.


Non-abstinent recovery in alcohol use disorder is associated with greater regional cortical volumes than heavy drinking.
Harm-reduction (i.e., non-abstinent recovery) approaches to substance use treatment have garnered increasing attention. Reduced levels of alcohol consumption post-treatment have been associated with better psychosocial functioning and physical health, yet less is known regarding differences in brain structures associated with varying levels of alcohol consumption. This study investigated regional cortical volumes after alcohol use disorder (AUD) treatment among individuals who achieved complete abstinence and those who returned to lower and higher levels of consumption. Data were collected from individuals with AUD (n = 68) approximately 8 months after the initiation of treatment. Using risk drinking levels defined by the World Health Organization, participants were classified as abstaining (AB) or relapsing with low (RL) or higher (RH) levels. Data were also obtained from 34 age-matched light/non-drinking controls (LN). All participants completed a 1.5 T magnetic resonance imaging session and volumes for 34 bilateral cortical regions of interest were quantitated with FreeSurfer. Generalized linear models were used to examine group differences in cortical volume. All group findings are significant at an FDR-corrected value of 0.018. Adjusting for age and intracranial volume, significant group differences were found in 13/34 cortical regions. AB showed greater volumes than RL in 2/13 regions and RH in 6/13 regions. RH demonstrated significantly smaller volumes than LN in 12/13 ROIs, whereas RL differed from LN in 9/13 regions. RH and RL differed in only two cortical regions. Individuals who consumed low-risk levels of alcohol post-treatment exhibited regional cortical volumes more similar to abstainers than individuals who returned to higher-risk levels. This suggests that low-risk levels of alcohol consumption are associated with brain integrity that is comparable to that seen with complete abstinence. Given the previously demonstrated improvement in psychosocial and physical health with reduced levels of alcohol consumption post-treatment, harm reduction may be a beneficial and more attainable goal for some individuals with AUD who are seeking treatment.


[Interleukin-2 reduces calcium handling capacity of rat ventricular myocytes during anoxia/reoxygenation].
To investigate the effect of interleukin-2(IL-2) on the cell contractility and calcium handling in cardiomyocytes during normoxia or anoxia/reoxygenation. Chemical anoxia introduced by Krebs-Henseleit(K-H) solution containing 10(-3) mol/L sodium dithionite was used in the enzymatically isolated rat ventricular myocytes. The video-tracking system and spectrofluorometric method were employed to verify the cell contraction and calcium handling of the single myocyte. During anoxia, the cell contraction, amplitude of calcium transient induced by electrical stimulation and Ca2+ release induced by caffeine were depressed while resting calcium level was elevated, but the activity of the L-type calcium channels were not changed. All the parameters could not return to the pre-anoxia level during reoxygenation. IL-2 at 2 x 10(5) U/L administrated during anoxia aggravated the effect of reoxygenation on cell contraction and the calcium handling. Coexistence of IL-2 during anoxia aggravated the effect of reoxygenation on the cell contraction and calcium handling in the isolated rat ventricular myocytes, in which the reduced calcium release from sarcoplasmic reticulum was involved.


Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants.
The technique of distraction, compression, extension, and reduction (DCER) is effective to reduce, realign, and relieve cranio-spinal compression through posterior only approach. Study included all patients with atlantoaxial dislocation and basilar invagination (BI) with occipitalized C1 arch. Study techniques included Nurick grading, computed tomography scan to study atlanto-dental interval, BI, hyper-lordosis, and neck tilt. Sagittal inclination (SI), coronal inclination (CI), cranio-cervical tilt, presence of pseudo-joints, and anomalous vertebral artery were also noted. Patients underwent DCER with/without joint remodeling or extra-articular distraction (EAD) based on the SI being <100°, 100°-160°, or >160° respectively. In cases with pseudo-joints, joint remodeling was performed in type I and EAD in type II. Customized 'bullet shaped' PSC spacers (n=124) and prototype of the universal craniovertebral junction reducer (UCVJR, n=36) were useful. A total of 148 patients with average age 27.25±17.43 years, ranging from 3 to 71 years (87 males) were operated. Nurick's grading improved from 3.14±1.872 to 1.22±1.17 (p<0.0001). Fifty-two percent of total joints (n=154/296 joints) were either type I (19%)/type II (33%) pseudo-j oints. All traditional indices such as Chamberlein line, McRae line, atlanto-dental interval, and Ranawat line improved (p<at least 0.001). BI, SI, and CI values correlated with type of pseudo-joints (p<0.0001). Side of neck tilt correlated with the type of pseudo-joint (p<0.0001). Cervical hyperlordosis improved significantly (p<0.0001). Occipito-C2 pseudo-joints are important in determining the severity of BI. Asymmetrical pseudo-joint causes coronal/neck tilt. Type of pseudo-joint can strategize by DCER. Customized instruments and implants make technique safe, effective and easier.


[Circumscribed vasculitis with posterior infarct in Hashimoto encephalopathy].
The aetiology of Hashimoto's encephalopathy is still unknown. A 52-year-old woman with so far unspecific thyroid disorder presented with acute onset of right-sided sensory loss and visual disturbances. The neurological examination revealed a right upper quadrant anopsia and subtle right-sided sensory loss and weakness. The cranial MRI showed a left-sided cerebral infarction. MR angiography demonstrated a stenosis of the proximal segment of the left posterior cerebral artery, which was confirmed by conventional catheter angiography. The patient had no cardiovascular risk factors, no signs of systemic vasculitis, and no thromboembolic disorder. Thyroid function tests showed a subclinical hypothyroidism with plasma TSH level of 12.0 mU/ml, and thyroid antibodies were markedly elevated (hTG-AB 3390 U/ml, TPO-AB > 8000 U/ml). Typical features of Hashimoto's disease were demonstrated by ultrasound and scintigraphic examination of the thyroid gland. To the best of our knowledge, this is the first description of Hashimoto encephalopathy with localised vasculitis of the posterior cerebral arteries and left posterior infarction. It could be shown that the MR angiogram is a feasible tool to demonstrate regression of the vasculitis under glucocorticoid therapy.


(Salen)tin complexes: syntheses, characterization, crystal structures, and catalytic activity in the formation of propylene carbonate from CO(2) and propylene oxide.
A series of (salen)tin(II) and (salen)tin(IV) complexes was synthesized. The (salen)tin(IV) complexes, (salen)SnX(2) (X = Br and I), were prepared in good yields via the direct oxidation reaction of (salen)tin(II) complexes with Br(2) or I(2). (Salen)SnX(2) successfully underwent the anion-exchange reaction with AgOTf (OTf = trifluoromethanesulfonate) to form (salen)Sn(OTf)(2) and (salen)Sn(X)(OTf) (X = Br). The (salen)Sn(OTf)(2) complex was easily converted to any of the dihalide (salen)SnX(2) compounds using halide salts. All complexes were fully characterized by (1)H NMR spectroscopy, mass spectrometry, and elemental analysis, while some were characterized by (13)C, (19)F, and (119)Sn NMR spectroscopy. Several crystal structures of (salen)tin(II) and (salen)tin(IV) were also determined. Finally, both (salen)tin(II) and (salen)tin(IV) complexes were shown to efficiently catalyze the formation of propylene carbonate from propylene oxide and CO(2). Of the series, (3,3',5,5'-Br(4)-salen)SnBr(2), 3i, was found to be the most effective catalyst (TOF = 524 h(-)(1)).


The diagnostic value of initial video-EEG monitoring in children--review of 1000 cases.
We retrospectively reviewed the clinical utility of initial video-EEG monitoring in a series of 1000 children suspected of epileptic disorders. The ages of patients (523 boys and 477 girls) ranged from 1 month to 17 years (median age: 7 years). The mean length of stay was 1.5 days (range: 1-10 days). Outcomes were classified as: 'useful-epileptic' (successful classification of epilepsy), 'useful-nonepileptic' (demonstration of nonepileptic habitual events), 'uneventful' (normal EEG without habitual events captured), and 'inconclusive' (inability to clarify the nature of habitual events with abnormal interictal EEG findings). A total of 315 studies were considered 'useful-epileptic'; 219 'useful-nonepileptic'; 224 'uneventful'; 242 'inconclusive'. Longer monitoring was associated with higher rate of a study classified as 'useful-epileptic' in all age groups (Chi square test: p<0.001). In addition, longer monitoring was associated with lower rate of a study classified as 'inconclusive' in adolescences (p<0.001). Approximately half of the children with successful classification of epilepsy were assigned a specific diagnosis of epilepsy syndrome according to the International League Against Epilepsy (ILAE) classification. We found only 22 children with ictal EEG showing a seizure onset purely originating from a unilateral temporal region. Video-EEG monitoring may fail to capture habitual episodes. To maximize the utility of studies in the future, a video-EEG monitoring longer than 3 days should be considered in selected children such as adolescences with habitual events occurring on a less than daily basis. We recognize a reasonable clinical utility of the current ILAE classification in the present study. It may not be common to identify children with pure unilateral temporal lobe epilepsy solely based on video-EEG monitoring.


Loss of introns along the evolutionary diversification pathway of snake venom disintegrins evidenced by sequence analysis of genomic DNA from Macrovipera lebetina transmediterranea and Echis ocellatus.
Analysis of cDNAs from Macrovipera lebetina transmediterranea (Mlt) and Echis ocellatus (Eo) venom gland libraries encoding disintegrins argued strongly for a common ancestry of the messengers of short disintegrins and those for precursors of dimeric disintegrin chains. We now report the sequence analysis of disintegrin-coding genes from these two vipers. Genomic DNAs for dimeric disintegrin subunits Ml_G1 and Ml_G2 (Mlt) and Eo_D3 (Eo) contain single 1-kb introns exhibiting the 5'-GTAAG (donor)/3'-AG (acceptor) consensus intron splicing signature. On the other hand, the short RTS-disintegrins Ml_G3 (Mlt) and Eo_RTS (Eo) and the short RGD-disintegrin ocellatusin (Eo) are transcribed from intronless genomic DNA sequences, indicating that the evolutionary pathway leading to the emergence of short disintegrins involved the removal of all intronic sequences. The insertion position of the intron within Ml_G1, Ml_G2, and Eo_D3 is conserved in the genes for vertebrate ADAM (A disintegrin and metalloproteinase) protein disintegrin-like domains and within the gene for the medium-size snake disintegrins halystatins 2 and 3. However, a comparative analysis of currently available disintegrin(-like) genes outlines the view that a minimization of both the gene organization and the protein structure underlies the evolution of the snake venom disintegrin family.


The adaptation of health care marketing to the digital era.
The purpose of health care marketing is to learn and understand the needs and desires of prospective patients in order to be able to meet those necessities at the highest standards. A big advantage is the targeting capability of the electronic media that has led to its being used by managers of marketing in medical institutions as means of advertisement when they develop the marketing strategies. Regarding social media, it is safe to say that there are communication platforms that can promote certain behaviours thus influencing decision-making. Through social media, people stay in touch with other people and they can provide a mean for medical institutions to permanently communicate with the existing patients or with the potential ones. In addition, social media can be used in advertising and promoting strategies, by posting information about discounts, offers and advantages of accessing the products provided by a certain institution. A study was conducted on 126 patients of a dental clinic in Bucharest. 126 new patients were selected on a period of 22 months from January 2015 until October 2016. The patients never had any treatment in this clinic and were influenced by the Internet to seek for dental care services. The purpose of this study was to evaluate the digital methods of promoting medical services, bringing new patients to a clinic. The results of the study demonstrated the need for digital methods of promoting medical care services in order to expand a business. A strategic way of thinking in this case implied attracting new patients and offering them quality health care services, which ensured their satisfaction and the probability of their recommending the health facility further. This study revealed an important role of social networking sites in promoting. This high response was probably responsible due to targeted promoting services. Almost all the new patients who completed the form will remain patients of this clinic in future.


High-frequency force generation in the constrained cochlear outer hair cell: a model study.
Cochlear outer hair cell (OHC) electromotility is believed to be responsible for the sensitivity and frequency selectivity of the mammalian hearing process. Its contribution to hearing is better understood by examining the force generated by the OHC as a feedback to vibration of the basilar membrane (BM). In this study, we examine the effects of the constraints imposed on the OHC and of the surrounding fluids on the cell's high-frequency active force generated under in vitro and in vivo conditions. The OHC is modeled as a viscoelastic and piezoelectric cylindrical shell coupled with viscous intracellular and extracellular fluids, and the constraint is represented by a spring with adjustable stiffness. The solution is obtained in the form of a Fourier series. The model results are consistent with previously reported experiments under both low- and high-frequency conditions. We find that constrained OHCs achieve a much higher corner frequency than free OHCs, depending on the stiffness of the constraint. We analyze cases in which the stiffness of the constraint is similar to that of the BM, reticular lamina, and tectorial membrane, and find that the force per unit transmembrane potential generated by the OHC can be constant up to several tens of kHz. This model, describing the OHC as a local amplifier, can be incorporated into a global cochlear model that considers cochlear hydrodynamics and frequency modulation of the receptor potential, as well as the graded BM stiffness and OHC length.


Ultrasonography for bowel endometriosis.
Transvaginal ultrasonography (TVS) should be the first-line investigation in patients with suspicion of deep endometriosis and, in particular, of rectosigmoid endometriosis. TVS cannot assess the presence of intestinal nodules located proximally to the sigmoid (such as ileal or cecal endometriotic nodules), because these lesions are beyond the field of the transvaginal probe. The ultrasonographic findings of rectosigmoid endometriosis are the presence of an irregular hypoechoic nodule in the anterior wall of the rectosigmoid colon. The learning curve for diagnosing rectosigmoid endometriosis by TVS is quite short; approximately, 40 scans are required to a sonographer who trained in general gynecologic ultrasonography to become proficient at diagnosing bowel endometriosis. Several meta-analyses confirmed the high diagnostic performance of TVS in diagnosing rectosigmoid endometriosis. The presence of "soft markers" (negative sliding sign and kissing ovaries) facilitates the diagnosis of rectosigmoid endometriosis. Enhanced TVS (rectal water-contrast transvaginal ultrasonography, sonovaginography, and tenderness-guided transvaginal ultrasonography) does not improve the performance of TVS in diagnosing rectosigmoid endometriosis. These investigations, however, may be useful to ascertain the depth of infiltration of endometriosis in the intestinal wall or the presence of rectal stenosis. Magnetic resonance imaging has the same performance of TVS in diagnosing rectosigmoid endometriosis; however, it should be recommended as a second-line technique in the preoperative workup of patients with previous equivocal TVS findings.


Prognostic factors and treatment outcomes of spinal osteosarcoma: Surveillance, epidemiology, and end results database analysis.
Spinal osteosarcoma is a rare osseous neoplasm. The aim of this study is to make a comprehensive analysis of the demographic features, clinicopathologic characteristics and factors affecting prognosis of spinal osteosarcoma using the Surveillance, Epidemiology and End Results (SEER) database. SEER data were reviewed to identify patients diagnosed with spinal osteosarcoma between 1975 and 2016 and determine their overall survival (OS) and disease-specifc survival (DSS). Univariate and multivariate analyses were performed using the Cox-regression proportional hazards model and Kaplan-Meier method. A total of 668 patients (53.1% males) with spinal osteosarcoma were identified. The mean age at diagnosis was 45.2 years, including 67.5% patients younger than 60 years. The median OS of these patients was 15 months, and the 5-year OS was 16.8%. Multivariate analysis showed that age ≥60 year (HR=2.271, p = 0.008), high grade (HR=1.323, p = 0.008), regional stage (HR=1.658, p = 0.017), metastasis stage (HR=3.045, p < 0.001) and no-surgery treatment (HR=1.761, p < 0.001) were adversely associated with OS; gender (HR=0.657, p = 0.044), tumor grade (HR=1.616, p = 0.006), tumor stage (HR=3.329, p = 0.011; HR=7.983, p < 0.001) and radiotherapy (HR=0.606, p = 0.031) were independent prognostic factors affecting DSS. Based on SEER data analysis, male, high tumor grade, regional stage, metastasis stage and radiotherapy are independent predictors of poor survival of patients with spinal osteosarcoma. The clinical treatment of spinal osteosarcoma still faces serious challenges. Future research should focus on the clinical impact and survival outcomes of the emerging targeted and immune therapies for the sake of improving the survival stalemate of spinal osteosarcoma.


Extraovarian Dysgerminoma Involving the Uterine Cervix: A Rare Case Report With Literature Review.
Primary extraovarian dysgerminoma (EOD) is a very rare disease. There is no literature about primary EOD involving the uterine cervix. We herein present details of a unique case of primary EOD involving the uterine cervix. A 46-year-old woman with uterine cervical tumor was referred to our institution with atypical genital bleeding. A polypoid tumor localized to the uterine cervix was found. Cervical biopsy detected malignant components of likely nonepithelial cell origin. Preoperative imaging examinations showed a uterine cervical tumor measuring ~5 cm, suggestive of malignancy without distant or lymph node metastases. The patient underwent abdominal radical hysterectomy with pelvic lymph node dissection according to the standard treatment for stage IB3 cervical cancers. The pathological diagnosis was dysgerminoma involving the uterine cervix and the right fallopian tube. Immunohistochemical results were as follows: SALL4 (+), octamer-binding transcription factor 4 (+), D2-40 (+), and c-Kit (+). She received 3 cycles of adjuvant chemotherapy with bleomycin, etoposide, and cisplatin. The disease did not recur up to 14 months after surgery. This is the first-ever published case of primary EOD involving the uterine cervix among previously reported EOD cases. Reported cases of EOD in female genital tract are also reviewed. Our case provides more extensive insights for pathologists to consider the differential diagnosis of cervical lesions. In our case, combination therapy involving a surgical approach-according to cervical cancers and adjuvant chemotherapy as used for ovarian dysgerminomas-was effective. Future verification is needed regarding the best approach for treating uterine cervical dysgerminomas.


Estimation of neuronal firing rates with the three-state biological point process model.
In the subcortex of the human brain, neuronal firing events are stochastic and the inter-arrival times of action potentials (APs) are highly irregular. It has been shown that stimulation of the subthalamic nucleus (STN), a small subcortical structure located within the basal ganglia, can help ameliorate the motor symptoms associated with Parkinson's disease (PD). However, success of image guided stereotactic surgery is reliant upon the refinement of the anatomic target (in this case the STN) based on micro-electrode recordings (MERs) of background activity and firing rate. In practice MERs must be analysed on-line and in real-time. Currently, the most common method of performing on-line MER analysis is a manual thresholding procedure. However, this is subjective in nature and often complicated by the presence of variable amounts of background noise. Therefore, in this paper, we present an automated adaptive thresholding technique, based on a modified 'top-hat' operator, which detects APs exceeding the local background activity. We then go on to model these inter-arrival times using a coupled Poisson process that provides improved estimates of both inter-burst and intra-burst neuronal firing activity in the STN.


Novel molecular targets for systemic lupus erythematosus.
For a long time the complement cascade has been believed to be the predominant pathway to inflammation and tissue destruction in autoimmune diseases such as systemic lupus erythematosus. Recently, new evidences show that FcRs may share the primacy with complement cascade, playing an equal or greater role in the disease process. The generation of specific mouse strains deficient in individual components has clarified the different role played by complement and Fc receptors in their interaction with ICs, illustrating that complement is essential for innate immunity against microbial pathogens, requiring natural antibodies to mediate its protective effects, whereas FcyRs have evolved as the principal system for coupling antigen-antibody complexes to effector cells and initiate the inflammatory cascade. Validation of FcRs as new therapeutic targets for autoimmune diseases, in particular for Systemic Lupus Erythematosus (SLE), has been provided by a large number of studies where the biological action of soluble forms of FcyRs or of monoclonal antibodies targeting Fc receptors has been assessed. Additional support to the role of FcRs in SLE has been provided by data obtained with compounds derived from combinatorial chemistry, such as TG19320, a tetrameric tripeptide which interferes with IgG/FcgammaR interaction in vitro and prevents glomerulonephritis in vivo in a SLE susceptible mouse strain. These findings might open the way to new therapeutic approaches for disorders where the role of FcRs has been established, including not only autoimmune diseases like systemic lupus erythematosus, rheumatoid arthritis, multiple myeloma, but also acquired immunodeficiency syndrome (AIDS).


Physiological Signaling and Structure of the HGF Receptor MET.
The "hepatocyte growth factor" also known as "scatter factor", is a multifunctional cytokine with the peculiar ability of simultaneously triggering epithelial cell proliferation, movement and survival. The combination of those proprieties results in the induction of an epithelial to mesenchymal transition in target cells, fundamental for embryogenesis but also exploited by tumor cells during metastatization. The hepatocyte growth factor receptor, MET, is a proto-oncogene and a prototypical transmembrane tyrosine kinase receptor. Inhere we discuss the MET molecular structure and the hepatocyte growth factor driven physiological signaling which coordinates epithelial proliferation, motility and morphogenesis.


Skills Vs. Pills: Comparative Effectiveness for Low Sexual Desire in Women.
This study compared the effectiveness of a skill-based bibliotherapy intervention and a placebo pill intervention purported to be efficacious in increasing women's sexual desire. Forty-five participants were randomized into the two groups after completing pretest measures of sexual desire and functioning. After completing their interventions, participants completed 6-week posttest and 12-week follow-up measures. Results demonstrated that when compared to the placebo pill group, the bibliotherapy group made statistically greater gains from pretest to follow-up in sexual desire and satisfaction. Nevertheless, the placebo pill group evidenced short-term improvements in sexual desire over time. Findings have implications for future research and current treatments for low sexual desire in women.


Potential Interaction between Sodium Polystyrene Sulfonate and Prescription Drugs in Artificial Intestinal Juice.
This study evaluated the interaction between sodium polystyrene sulfonate (SPS) and several commonly used concomitant drugs, such as carvedilol, bisoprolol, imidapril, atorvastatin and azilsartan. The residual rate of adsorption 6 h after starting the experiment followed the order carvedilol (0.36%) < bisoprolol (19.7%) < imidapril (81.2%) < atorvastatin (86.5%) < azilsartan (87.9%) in artificial intestinal juice (pH 6.8). In addition, the pKa of carvedilol and bisoprolol was 8.0 and 9.6 and that of atorvastatin, azilsartan, and imidapril was 4.5, 6.1, and 2.4, respectively. These results indicate that the form (ionic or uncharged) of each drug is important to its reaction with SPS. Moreover, we demonstrated the effect of potassium ions (concentration of 1000 or 2000 mg/L) on the adsorption of concomitant drugs onto SPS in artificial intestinal juice. Our results show that the residual rate of adsorption of carvedilol and bisoprolol increases with increasing concentration of potassium ions whereas adsorption of potassium ions onto SPS was unaffected by carvedilol and bisoprolol under our experimental conditions. Finally, the obtained results revealed that interactions between SPS and carvedilol or bisoprolol readily occur in artificial intestinal juice.


[The trend of childhood bacterial meningitis in Japan (2000-2002)].
We surveyed the epidemiology of bacterial meningitis in pediatrics between July 2000 and December 2002 in Japan and obtained the following results.: The number of cases of bacterial meningitis was 316 (182 boys and 134 girls), which was equivalent to 1.1-1.7 children out of 1,000 hospitalized those in pediatrics per year. The age-distribution for the infections was the highest under 1 year of age and it decreased as the age increased. Haemophilus influenzae was the most common pathogen causing the infections, followed by Streptococcus pneumoniae, group B streptococcus, and Escherichia coli. Relationship between causing pathogens and age-distribution was as follows: group B streptococcus and E. coli were major pathogens under 4 months of age and H. influenzae and S. pneumoniae were major pathogens over 4 months of age. Susceptibility tests performed at each facility demonstrated that 53.7% of H. influenzae isolates and 67.7% of S. pneumoniae isolates in 2003 were drug-resistant. As ampicillin and cephem antibiotics are effective against GBS, E. coli and Listeria at present, then the combination of ampicillin and cephem antibiotics was used as first line antibiotics in many facilities under 4 month of age and a combination of carbapenem which showed effective against PRSP and cephem which showed effective against H. influenzae is first choice against childhood bacterial meningitis over 4 month of age.


The role of mesenchymal stem cells derived exosomes as a novel nanobiotechnology target in the diagnosis and treatment of cancer.
Mesenchymal stem cells (MSCs), one of the most common types of stem cells, are involved in the modulation of the tumor microenvironment (TME). With the advancement of nanotechnology, exosomes, especially exosomes secreted by MSCs, have been found to play an important role in the initiation and development of tumors. In recent years, nanobiotechnology and bioengineering technology have been gradually developed to detect and identify exosomes for diagnosis and modify exosomes for tumor treatment. Several novel therapeutic strategies bioengineer exosomes to carry drugs, proteins, and RNAs, and further deliver their encapsulated cargoes to cancer cells through the properties of exosomes. The unique properties of exosomes in cancer treatment include targeting, low immunogenicity, flexibility in modification, and high biological barrier permeability. Nevertheless, the current comprehensive understanding of the roles of MSCs and their secreted exosomes in cancer development remain inadequate. It is necessary to better understand/update the mechanism of action of MSCs-secreted exosomes in cancer development, providing insights for better modification of exosomes through bioengineering technology and nanobiotechnology. Therefore, this review focuses on the role of MSCs-secreted exosomes and bioengineered exosomes in the development, progression, diagnosis, and treatment of cancer.


Primary care management for isolated limb injury: referral to orthopedic surgery in a trauma center.
Musculoskeletal injuries affect up to 13% of adults annually. Despite this high incidence, quality of primary care, including analgesia, may be sub-optimal. The goal of this study is to describe the quality of primary care for ambulatory patients with isolated limb injury and to identify related factors. A cross sectional study was undertaken prospectively on 166 consecutive ambulatory adult patients with isolated limb injury who presented to orthopedics service in a Level one Trauma Centre. Quality of care was assessed by evaluating analgesia, walking aids, immobilization, and quality of referral diagnosis according to actual expert recommendations. This study revealed low quality of primary care for 82 (53.2%) of injured patients. Seventy-three patients (50.3%) had pain level over 5/10 and 45 cases (28.5%) had insufficient/absent analgesia prescriptions. Fifty-one (32.3%) had unacceptable immobilization and 21/59 (35.6%) patients with a lower limb injury did not receive a walking aid prescription. A total of 61 patients (36.7%) had an absent or inadequate referral diagnosis. Factors associated with lower quality depended on the specific quality indicator and included: living further away from the hospital, younger age, initially consulting at another health care center, having a fracture, and being a smoker. The high frequency of low quality of care underlines the necessity for orthopedic surgeons to be involved in primary care education. Identifying factors associated with lower quality of care will orient efforts to improve medical care of patients with isolated traumatic injury.


Simulating memory outcome before right selective amygdalohippocampectomy.
In this paper we present the case of a left-sided speech dominant patient with right medial temporal sclerosis (RMTS) and pharmacoresistant epilepsy who showed improved verbal memory during intracarotid amobarbital test (IAT) at his right hemisphere as compared with his own performance before the drug injection (baseline), as well as after right selective amygdalohippocampectomy. We suggest that the defective verbal memory shown by this patient is due to abnormal activity of his right hippocampus that interfered with the function of his left hippocampus. This hypothesis was demonstrated by the fact that disconnection of the two hippocampi, either by anesthetisation or by resection of the right hippocampus, disengaged the left hippocampus and, consequently improved its function. This paper main objective is twofold: first to contribute to the field of neuropsychology of epilepsy surgery by emphasising on postoperative memory outcomes in right medial temporal lobe epilepsy (RMTLE) patients, particularly those undergoing amygdalohippocampectomy, as the pattern of memory changes after resection of the right temporal lobe is less clear; second, by focusing on memory performance asymmetries during IAT, and comparatively considering them with neuropsychological memory performance, because of their possible prognostic-simulating value.


Emerging drugs for the treatment of L-DOPA-induced dyskinesia: an update.
Prolonged treatment with L-3,4-dihydroxyphenylalanine (L-DOPA) leads to the development of uncontrolled movements (L-DOPA-induced dyskinesias (LID)) in Parkinson's disease (PD). There is currently only a single approved drug for the treatment of LID, a long-acting preparation of the NMDA antagonist, amantadine, that has variable benefits and side-effects. Therefore, new treatments for LID remain an unmet in PD. We review the current strategies for the management of LID; the pathogenic mechanisms underlying the development of LID, which provides the rationale for clinical trials of novel targets for LID and provide a review of phase II/III trials for emerging drugs for LID, with either positive results, or ongoing studies, reported between January 2014 and December 2019. There are several ongoing studies for agents that showed possible benefit at phase Ib/IIa for reducing LID. However, there are no new positive phase III double-blind randomized controlled clinical trials (DBRCT) for emerging treatments for LID. Generating better preclinical models, more precise recruitment tools and better outcome measures remain a priority. The pharmacology of drugs investigated for LID may be too selective; therefore, evaluating combinations of drugs is worthy of consideration as is the repurposing of existing drugs with multiple pharmacological targets.


Evaluation of disintegrants functionality for orodispersible mini tablets.
This work evaluates the functionalities of different superdisintegrants (SD) for manufacturing orodispersible mini tablets (ODMT) by direct compression. Twenty-three formulations varying in SD type, concentration, and lubricant were used to manufacture ODMT. The ODMT were then characterized for the following properties: friability, porosity, tensile strength, in vivo and in vitro disintegration time (DT). The results show that the presence, type, and concentration of SD did not influence friability, porosity, or tablet tensile strength. With regards to in vivo DT, only cross-linked poly (vinyl pyrrolidone) improved DT in all the tested formulations. Results also showed that when using microcrystalline cellulose (MCC) above 20% in the formulation, DT is longer. Cross-linked carboxymethyl cellulose accelerates DT when the MCC content is less than 20%. As for cross-linked carboxymethyl starch and calcium alginate showed no improvement on DT. Results for in vitro DT were all shorter than in vivo results and there was no correlation with the in vivo evaluation. This study shows that there is a need to develop better in vitro testing that precisely simulates in vivo conditions and that are adapted to ODMT. This standardization of the test methods for ODMTs must be accompanied by an improvement in the comprehension of SD mechanisms.


Are adult patients with Laron syndrome osteopenic? A comparison between dual-energy X-ray absorptiometry and volumetric bone densities.
Severe short stature resulting from a deficiency in IGF-I is a prominent feature of Laron syndrome (LS). Although low bone mineral density (BMD) has been noted in LS patients examined by dual energy x-ray absorptiometry (DEXA), this technique does not take volume into account and may therefore underestimate the true bone density in patients with small bones. The aim of the present study was to evaluate the BMD yielded by DEXA in our LS patients using estimated volumetric values. Volumetric density was calculated with the following formulas: bone mineral apparent density (BMAD) = bone mineral content (BMC)/(area)(3/2) for the lumbar spine and BMAD = BMC/area(2) for the femoral neck. The study sample included 12 patients (mean age, 43.9 yr; mean height, 123.7 cm). Findings were compared with 10 osteopenic subjects without developmental abnormalities (mean age, 56 yr; mean height, 164.8 cm) and 10 healthy control subjects matched for sex and age to the LS patients (mean height, 165.5 cm). BMAD in the LS group was 0.201 +/- 0.02 g/cm(3) at the lumbar spine and 0.201 +/- 0.04 g/cm(3) at the femoral neck; corresponding values for the osteopenic group were 0.130 +/- 0.01 and 0.140 +/- 0.01 g/cm(3), and for the controls, 0.178 +/- 0.03 and 0.192 +/- 0.02 g/cm(3). Although areal BMD was significantly lower in the LS and osteopenic subjects compared with controls (P < 0.02) at both the lumbar spine and femoral neck, BMAD was low (P < 0.01) in the osteopenic group only. In conclusion, DEXA does not seem to be a reliable measure of osteoporosis in patients with LS.


Etanercept-induced leukemia: could increased mean corpuscular volume be a predictor of hematologic malignancy?
In rheumatology practice, anti-tumor necrosis factor (TNF) alpha agents are frequently used medications, more so in ankylosing spondylitis (AS). There are case reports, besides their adverse effects, such as infection and injection site reaction, suggesting these agents may cause solid or hematologic malignancies. Acute leukemia secondary to anti-TNF alpha agents has been rarely reported in patients with AS. In this case report, based on a patient who developed acute leukemia while on the treatment with etanercept, we will discuss whether it is possible to predict acute leukemia by monitoring the mean corpuscular volume in light of the literature.


Neonatal and post-neonatal mortality in the Galle district.
To determine some factors associated with infant mortality. Descriptive study. Galle district in Sri Lanka. 350 infant deaths of singleton births. Association between variables. Neonatal:post-neonatal death ratio was 3.2:1, and 62.3% (218) were early neonatal deaths. First day deaths comprised 28.6% (100); 67.8% (237) died at the Teaching Hospital. A high incidence (65.7%) of low birthweight (LBW) was noted. Mean birthweights of neonates and post-neonates were 1925 +/- 729 and 2520 +/- 620 gram respectively, and the difference between means was statistically significant (p < 0.001). LBW and related disorders were the major cause of death in 44% (154) of the total sample, and in 55.8% (149) of neonates. Infections were the commonest cause (55.8%) of death in post-neonates. Pediatric clinical assessment to differentiate small-for-dates (SFD) was not recorded in 90.3%. Statistically significant associations were found between the period of death (neonatal and post-neonatal) and the following variables: period of gestation (p < 0.001); birthweight (p < 0.001) and cause of death (p < 0.001). There was a high incidence of neonatal deaths and a high proportion of early neonatal deaths. About one-third of deaths occurred on the first day of life. Incidence of LBW was high. The major cause of death was LBW and related disorders in the total sample and in neonates. Assessment of SFD was not carried out in the vast majority of infants.


Plasmon-assisted spin transition in gold nanostar@spin crossover heterostructures.
Herein we report the design of core@shell nanoparticles formed by a metallic Au nanostar core and a spin-crossover shell based on the coordination polymer [Fe(Htrz)2(trz)](BF4). This procedure is general and has been extended to other metallic morphologies (nanorods, nanotriangles). Thanks to the photothermal effect arising from the plasmonic properties of the Au nanostar, 60% of iron centers undergo a thermal spin transition inside the thermal hysteresis triggered by a 808 nm laser low intensity irradiation. Compared to other Au morphologies, the great advantage of the nanostar shape arises from the hot spots created at the branches of the nanostar. These hot spots give rise to large NIR absorptions, making them ideal nanostructures for efficiently converting light into heat using low energy light, like that provided by a 808 nm laser.


Synthesis, in Vitro Covalent Binding Evaluation, and Metabolism of (14)C-Labeled Inhibitors of 11β-HSD1.
In this letter, we reported the design and synthesis of three potent, selective, and orally bioavailable 11β-HSD1 inhibitors labeled with (14)C: AMG 456 (1), AM-6949 (2), and AM-7715 (3). We evaluated the covalent protein binding of the labeled inhibitors in human liver microsomes in vitro and assessed their potential bioactivation risk in humans. We then studied the in vitro mechanism of 2 in human hepatocytes and the formation of reactive intermediates. Our study results suggest that 1 and 3 have low potential for metabolic bioactivation in humans, while 2 has relatively high risk.


Associations Between Mean Arterial Pressure and Poor ICU Outcomes in Critically Ill Patients With Cirrhosis: Is 65 The Sweet Spot?
Mean arterial pressure is critically important in patients with cirrhosis in the ICU, however, there is limited data to guide therapies and targets. Retrospective observational study. Tertiary care ICU. Two hundred and seventy-three critically ill patients with cirrhosis. None. We performed a comprehensive time-weighted mean arterial pressure analysis (time-weighted-average-mean arterial pressure and cumulative-time-below various mean arterial pressure-thresholds) during the first 24-hours after ICU admission (median: 25 mean arterial pressure measurements per-patient). Time-weighted-average-mean arterial pressure captures both the severity and duration of hypotension below a mean arterial pressure threshold and cumulative-time-below is the total time spent below a mean arterial pressure threshold. Individual univariable and multivariable logistic regression models were assessed for each time-weighted-average-mean arterial pressure and cumulative-time-below mean arterial pressure threshold (55, 60, 65, 70, and 75 mm Hg) for ICU-mortality. Time-weighted-average-mean arterial pressure: for 1 mm Hg decrease in mean arterial pressure below 75, 70, 65, 60, and 55 mm Hg, the odds for ICU-mortality were 14%, 18%, 26%, 41%, and 74%, respectively (p < 0.01, all thresholds). The association between time-weighted-average-mean arterial pressure and ICU-mortality for each threshold remained significant after adjusting for model for end-stage liver disease-sodium score, mechanical ventilation, vasopressor use, renal replacement therapy, grade 3/4 hepatic encephalopathy, WBC count, and albumin. Cumulative-time-below: odds for ICU-mortality were 4%, 6%, 10%, 12%, and 12% for each-hour spent below 75, 70, 65, 60, and 55 mm Hg, respectively. In the adjusted models, significant associations only remained for mean arterial pressure less than 65 mm Hg (odds ratio, 1.07; 95% CI, 1.00-1.14; p = 0.05) and < 60 mm Hg (odds ratio, 1.10; 95% CI, 1.01-1.18; p = 0.04). These data suggest that maintaining a mean arterial pressure of greater than 65 mm Hg may be a reasonable target in patients with cirrhosis admitted to the ICU. However, further prospective randomized trials are needed to determine the optimal mean arterial pressure-targets in this patient population.


Oxidative killing of Aspergillus fumigatus proceeds by parallel myeloperoxidase-dependent and -independent pathways.
The relative importance of several oxygen intermediates in fungicidal action against opsonized Aspergillus fumigatus conidia was investigated with monocytes from normal volunteers and patients with either chronic granulomatous disease or myeloperoxidase (MPO) deficiency. Results from experiments in which catalase, taurine, mannitol, or glucose-glucose oxidase were added to these phagocytes indicated that the MPO-hydrogen peroxide-halide system and an MPO-independent oxidative system exerted comparable conidiacidal activity. These findings offer a plausible explanation for the susceptibility of patients with chronic granulomatous disease to invasive Aspergillus infections; their phagocytes fail to generate hydrogen peroxide, a substrate necessary for both systems. Patients with MPO deficiency are not known to be predisposed to invasive aspergillosis, suggesting that an MPO-independent oxidative system may provide an alternative mechanism for the oxidative killing of Aspergillus spp.


Preparation and characterization of camptothecin solid lipid nanoparticles.
Camptothecin (CA), an antitumor drug, was incorporated into solid lipid nanoparticles (SLNs) prepared by high-pressure homogenization. A Taguchi orthogonal experimental design was used to study the influence of four different variables, with each variable having three value levels on nanoparticle size. Analysis of variance (ANOVA) has been used to evaluate the preparation of CA-SLNs and perform product optimization. The optimized CA-SLNs suspension was lyophilized using mannitol and glucose as cryoprotectants. The physicochemical characteristics of CA-SLNs were evaluated using transmission electron microscopy (TEM), electrophoresis, and differential scanning calorimetry (DSC). The release of camptothecin from CA-SLNs in various media was evaluated using a high-performance liquid chromatography (HPLC) method. The results showed that the concentration of emulsifier and the homogenization pressure had a significant influence on the particle size. The optimized CA-SLNs had an average diameter of about 200 nm, exhibited monodispersity with Dw/Dn of 1.06, and carried a negative charge. The optimal cryoprotectants consisted of 10% mannitol and 5% glucose in nanoparticle suspension. Lyophilized product was reconstituted in distilled water within 0.5 min without change of nanoparticle size. Camptothecin might exist in an amorphous state in SLNs. In vitro results showed that drug release was achieved for up to one week, and the released camptothecin quickly changed to open carboxylate form in the biological pH phosphate buffer. The results indicate that SLNs might be good potential sustained-release delivery vehicles for camptothecin or other lipophilic drugs.


[Use of crude drugs in "PiWeiLun" in comparison to those used in "NeiWaiShangBianHuoLun".].
PiWeiLun (Hi-i-ron in Japanese) is a traditional Chinese medical formulary written in the 13th century that discusses endogenous disease. For curing endogenous diseases (Naisho) caused by functional deficiency of pi- and wei qi (Hi-I-Ki-Kyo), PiWeiLun was recommended for QingShuYiQi-Tang (Seisho-ekki-to), Ban-XiaBaiZhuTianMaTang (Hange-byakuju-tsu-tenma-to) and BuZhongYiQiTang (Ho-chu-ekki-to), which are described in NeiWaiShangBianHuoLun (Naigaisho-benwa-ku-ron).A characteristic of PiWeiLun is that it discusses combining the use of Phellodendri Cortex with sweet Qi-tonics (Hoki-yaku) as Ginseng and Atractylodis Macrocephalae Rhizome for improving false heat syndrome (Kyo-netsu) due to yin-deficiency (In-kyo). In PiWeiLun Cimicifugae Rhizome, Angelicae Radux and Atractylodes Rhizome are more frequently used than in NeiWaiShangBianHuoLun.The use of drugs presented in PiWeiLun may be useful to devise new crude drug formulations good for modern deficiency syndrome experienced by persons having post-operative complications.


[Rehabilitation of the patients presenting with the operated spine syndrome during the complicated postoperative period after discectomy].
This article presents an analytical review of the literature concerning the problem of rehabilitation of the patients following the surgical treatment of hernias of intervertebral disks. The relevance of this problem and the importance of the related research activities in the context of neurorehabilitation are beyond any doubt. Despite the obvious progress in the modernization of the methods and technologies for medical rehabilitation, the number of re-operations in connection with the recurrences of herniated discs remains too high and the overall success thus far achieved in this field falls short of expectations. The authors discuss in detail the need for and the contemporary approaches to the rehabilitative treatment of the patients undergoing vertebral microdiscectomy including medication therapy, physiotherapy an therapeutic physical exercises. The variants of the application of magnetic stimulation during the early period of the rehabilitative treatment of the patients following the minimally invasive interventions for discogenic radiculopathy are considered.


Social entrepreneurship in religious congregations' efforts to address health needs.
Examine how religious congregations engage in social entrepreneurship as they strive to meet health-related needs in their communities. Multiple case studies. Los Angeles County, California. Purposive sample of 14 congregations representing diverse races/ethnicities (African-American, Latino, and white) and faith traditions (Jewish and various Christian). Congregations were recruited based on screening data and consultation of a community advisory board. In each congregation, researchers conducted interviews with clergy and lay leaders (n = 57); administered a congregational questionnaire; observed health activities, worship services, and neighborhood context; and reviewed archival information. Interviews were analyzed by using a qualitative, code-based approach. Congregations' health-related activities tended to be episodic, small in scale, and local in scope. Trust and social capital played important roles in congregations' health initiatives, providing a safe, confidential environment and leveraging resources from-and for-faith-based and secular organizations in their community networks. Congregations also served as "incubators" for members to engage in social entrepreneurship. Although the small scale of congregations' health initiatives suggest they may not have the capacity to provide the main infrastructure for service provision, congregations can complement the efforts of health and social providers with their unique strengths. Specifically, congregations are distinctive in their ability to identify unmet local needs, and congregations' position in their communities permit them to network in productive ways.


Adsorption and reaction of methanol on clean and oxygen modified rhodium/vanadium surface alloys.
The dehydrogenation of methanol on Rh(111), on a Rh(111)/V subsurface alloy and on Rh(111) with V islands has been studied with and without preadsorbed oxygen using a supersonic molecular beam and temperature programmed desorption. The reactivity is highest for the V islands surface without oxygen. But this surface is deactivated due to CO dissociation. The subsurface alloy is less reactive than the islands, but still more active than the Rh(111) surface. The reaction products are carbon monoxide and hydrogen only. With preadsorbed oxygen Rh(111) is the most active surface, but a strong dependence of the activity on the amount of preadsorbed oxygen is found for all three surfaces. The reaction products with preadsorbed oxygen are water, hydrogen, carbon dioxide and carbon monoxide. The reactions follow the same mechanism on all surfaces, but the activation energy of the individual reaction steps is different leading to significant changes in the thermal desorption spectra and in King and Wells-type experiments.


Use of resting-state fMRI in planning epilepsy surgery.
Epileptic seizures result from abnormal neuronal excitability and synchronization, affecting 0.5-1% of the population worldwide. Although anti-seizure drugs are often effective, a significant number of patients with epilepsy continue to experience refractory seizures and are candidates for surgical resection. Whereas standard presurgical evaluation has relied on intracranial electroencephalography (icEEG) and direct cortical stimulation to identify epileptogenic tissue and areas of cortex for which resection would produce clinical deficits, the invasive nature and limited spatial extent of icEEG has led to the investigation of less invasive imaging modalities as adjunctive tools in the presurgical workup. In the past few decades, functional connectivity MRI has emerged as a promising approach for presurgical mapping, leading to a surge in the number of proposed methods and biomarkers for identifying epileptogenic tissue. This review focuses on recent advances in the use of functional connectivity MRI toward its application for presurgical planning, including epilepsy localization and eloquent cortex mapping.


Evolution of insulin-like growth factor II: characterization of the mouse IGF-II gene and identification of two pseudo-exons.
We have cloned the mouse insulin-like growth factor II (IGF-II) gene as a series of overlapping cosmid and lambda recombinants and have characterized its six exons. The gene extends over approximately 12 kb of mouse chromosome 7 and is located 18 kb 3' to the insulin 2 gene and in the same transcriptional polarity. Exons 1-3 encode distinct 5' untranslated regions and are transcribed by three different promoters, P1, P2, and P3, into three IGF-II mRNAs sharing common coding and 3' untranslated sequences. Promoters P2 and P3 each contain a TATA box and appear to direct transcription from single initiation sites. By contrast, exon 1 has three major transcriptional start sites distributed over 556 nucleotides, and P1 lacks a TATA region and other typical transcriptional control sequences. Exons 4-6 code for the 180-amino-acid IGF-II precursor, and exon 6 also contains a 3,045-nucleotide 3' untranslated region which ends at a single polyadenylation site. In addition to six functional IGF-II exons, we identified two 5' "pseudo-exons," which appear to be evolutionarily retained remnants of an alternative promoter-exon cassette that is active in human IGF-II. Loss of the homolog of this promoter, which directs "adult-specific" expression of the IGF-II gene in some human tissues, may explain the disappearance of this growth factor from most murine tissues in the early postnatal period.


Cardiovascular risk factors in type 2 diabetic Nigerians with clinical diabetic nephropathy.
This study aimed to assess the distribution of cardiovascular risk factors among subjects with type 2 clinical diabetic nephropathy, since in diabetic subjects, the excess mortality in cardiovascular events is primarily related to nephropathy. The study group consisted of 162 subjects with type 2 diabetes mellitus and persistent proteinuria, and the control group was 80 type 2 diabetic subjects without nephropathy. In the study group there were 81 male and 81 female subjects whose mean age was 53.4 +/- 6.3 years. There was no significant consumption of alcohol and cigarette use in the population. The mean waist-hip ratio (WHR) was 0.97 and 0.96 in male and female subjects, respectively. The mean body mass index (BMI) of the subjects was 25.5 +/- 5.2 (males: 24.4 +/- 4.3, females: 27.2 +/- 5.5). A total of 106 subjects, made up of 45 male (27.8%) and 61 female (37.7%) subjects, were hypertensive as compared with 16 controls (20%). There was a significant difference in systolic blood pressure (p < 0.05) between the obese and non-obese subjects. One hundred and thirty three subjects (82.1%) had serum total cholesterol below 200 mg% as compared with 74 (92.5% ) in the control. Seventy-eight subjects (48.1%) had left ventricular hypertrophy. Males had a higher tendency of developing left ventricular hypertrophy (p = 0.04). Stroke and peripheral vascular disease respectively occurred more commonly in type 2 diabetes mellitus subjects with nephropathy [7 (4%) and 44 (27.2%)] compared to type 2 diabetic subjects without nephropathy [0 (0% ) and 9 (11.3% )] (p < 0.05). We found that there is a high prevalence of cardiovascular risk factors among Nigerian subjects with clinical diabetic nephropathy.


Reusable tubular membrane oxygenator for isolated organ hemoperfusion.
A reusable tubular membrane oxygenator is described for hypotraumatic hemoperfusion of isolated organs in physiological studies. The constructed oxygenator was of approximately 0.24-m2 effective surface area and contained 450 silicone rubber capillaries of 0.51-mm nominal ID, 34.9 cm long, fixed by conical-shaped, plastic blood headers at manifolds made from Dow-Corning MDX-4-4210 silicone elastomer. During ex vivo hemoperfusions in dogs at inlet hemoglobin saturations near 67%, oxygen transfer rates of the oxygenator increased serially, from 16.6 +/- 1.7 ml/min per m2 (mean +/- SD) at blood flows of 100 ml/min to 34.1 +/- 3.8 ml/min per m2 at flows of 500 ml/min. The oxygenator was thromboresistant and of much loss priming blood volume and wall compliance than the nonresuable Travenol membrane oxygenator of 0.26-m2 effective surface area. The tubular oxygenator was easily cleaned and reassembled, with reproducible oxygen transfer rates. It should prove useful for hemoperfusion studies in organs of moderate size, such as the isolated canine kidney, stomach, and pancreas.


Ratio of bcl-xshort to bcl-xlong is different in good- and poor-prognosis subsets of acute myeloid leukemia.
Acute myeloid leukemia (AML) is a heterogeneous collection of leukemic disorders ranging from chemotherapy-sensitive subsets [inversion 16 and t(8;21)], which often can be cured with cytosine arabinoside alone, to the most resistant subsets, which can survive even supralethal levels of combination alkylator chemotherapy (cytogenetic subsets monosomy 5 and monosomy 7). To analyze the expression of BCL-2 family genes, which are expressed in these subsets of AML, we used PCR sequence amplification reactions that are dependent on oligonucleotide primers representing the BH1 and BH2 homology domains to generate the unique regions between BH1 and BH2. These primers are conserved among all members of the BCL-2 gene family and are separated by a 150 nucleotide region sequence between the BH1 and BH2 domains. The PCR products unique to each BCL-2 family member were cloned directionally into sequencing vectors. The identity of the insert of each clone was determined by slotblots of the DNA amplified from individual colonies and by hybridization with radioactive probes specific to the bcl-2, bcl-x, or bax genes. We found that bcl-2 is the predominant member expressed in AML samples with a poor prognosis (-5, -7), whereas the transcripts of bcl-x are higher than those of bcl-2 in the AML samples with a good prognosis [inv16, t(8;21)]. No significant difference in bax expression was detected between AML subsets of good and bad prognosis. The ratio of bcl-xlong, which inhibits apoptosis, to bcl-xshort, which promotes apoptosis, was determined by amplification with a pair of primers specific to bcl-x followed by separation of the PCR product on agarose gels. Bcl-xlong and bcl-xshort appeared as bands of different molecular mass on a molecular weight gel and were visualized by ethidium bromide staining or Southern blot analysis with a bcl-x-specific probe. We found that the ratio of bcl-x long to bcl-x short was higher in the AML patients with a poor prognosis. These experiments showed that the levels of BCL-2 family members in the leukemia cells of good- and poor-prognosis subsets are different. In addition, novel members of the BCL-2 family were isolated from the cells of AML patients of either prognosis.


Identity, structure, and function of the mitochondrial permeability transition pore: controversies, consensus, recent advances, and future directions.
The mitochondrial permeability transition (mPT) describes a Ca2+-dependent and cyclophilin D (CypD)-facilitated increase of inner mitochondrial membrane permeability that allows diffusion of molecules up to 1.5 kDa in size. It is mediated by a non-selective channel, the mitochondrial permeability transition pore (mPTP). Sustained mPTP opening causes mitochondrial swelling, which ruptures the outer mitochondrial membrane leading to subsequent apoptotic and necrotic cell death, and is implicated in a range of pathologies. However, transient mPTP opening at various sub-conductance states may contribute several physiological roles such as alterations in mitochondrial bioenergetics and rapid Ca2+ efflux. Since its discovery decades ago, intensive efforts have been made to identify the exact pore-forming structure of the mPT. Both the adenine nucleotide translocase (ANT) and, more recently, the mitochondrial F1FO (F)-ATP synthase dimers, monomers or c-subunit ring alone have been implicated. Here we share the insights of several key investigators with different perspectives who have pioneered mPT research. We critically assess proposed models for the molecular identity of the mPTP and the mechanisms underlying its opposing roles in the life and death of cells. We provide in-depth insights into current controversies, seeking to achieve a degree of consensus that will stimulate future innovative research into the nature and role of the mPTP.


Effects of dietary starch types on early postmortem muscle energy metabolism in finishing pigs.
This study aimed to investigate the effects of different dietary starch types on early postmortem muscle energy metabolism in finishing pigs. Ninety barrows (68.0±2.0kg) were randomly allotted to three experimental diets with five replicates of six pigs, containing pure waxy maize starch (WMS), nonwaxy maize starch (NMS), and pea starch (PS) (amylose/amylopectin were 0.07, 0.19 and 0.28 respectively). Compared with the WMS diet, pigs fed the PS diet exhibited greater creatine kinase activity, higher adenosine triphosphate and adenosine diphosphate contents, lower phosphocreatine (PCr), adenosine monophosphate and glycogen contents, and lower glycolytic potential (P<0.05). Moreover, the PS diet led to reduced percentage of bound hexokinase activity, decreased level of phosphorylated AKT (P<0.05) and increased level of hypoxia-inducible factor-1α (P<0.05). In conclusion, diet with high amylose content might promote PCr degradation and inhibit the rate of glycolysis, followed by attenuation of early postmortem glycolysis in finishing pigs.


Structural and catalytic studies of lithium complexes bearing pendant aminophenolate ligands.
Lithium complexes bearing mono-anionic aminophenolate ligands are described. Reactions of ligand precursors HON(Me)Ph(OMe), HON(Me)Ph(SMe), HON(Me)C(OMe) or HON(Me)C(NMe2) [HON(Me)Ph(OMe) = (2-OMeC6H4CH2)N(Me)(CH2-2-HO-3,5-C6H2((t)Bu)2); HON(Me)Ph(SMe)= (2-SMe-C6H4CH2)N(Me)(CH2-2-HO-3,5-C6H2((t)Bu)2); HON(Me)C(OMe) = (MeOCH(2)CH2)N(Me)(CH2-2-HO-3,5-C6H2((t)Bu)2); HON(Me)C(NMe2) = (Me2NCH2CH2)N(Me)(CH2-2-HO-3,5-C6H2((t)Bu)2)] with 1.1-1.3 molar equivalents of (n)BuLi in diethyl ether solution afford (LiON(Me)Ph(OMe))(2) (3), (LiON(Me)Ph(SMe))2 (4), (LiON(Me)C(OMe))2 (5) and (LiON(Me)C(NMe2))2 (6) as dinuclear lithium complexes. The BnOH adduct of , (BnOH)(LiON(Me)C(OMe)) (7), was prepared from the reaction of and BnOH in diethyl ether solution. The molecular structures are reported for ligand precursor HON(Me)Ph(SMe) and compounds 3-5 and 7. These dinuclear lithium complexes show excellent catalytic activities toward the ring-opening polymerization of L-lactide in the presence of benzyl alcohol.


Coping, affective distress, and psychosocial adjustment among people with traumatic upper limb amputations.
This study investigated the prevalence of symptoms of depression and anxiety in a sample of predominantly elderly males with acquired upper limb amputations (n=138) and examined the contribution of coping strategies to the prediction of psychosocial adjustment. One hundred and thirty-eight men with injury-related upper limb amputations completed self-report questionnaires assessing coping strategies, symptoms of anxiety and depression, and psychosocial adaptation to prosthesis use. Prevalence of significant depressive symptoms was 28.3% [Hospital Anxiety and Depression Scale, Depression subscale (HADS-D) score > or =8]. Prevalence of significant anxiety symptoms was 35.5% [HADS Anxiety subscale (HADS-A) score > or =8]. Coping styles emerged as important predictors of psychosocial adaptation. In particular, avoidance was strongly associated with psychological distress and poor adjustment. These findings suggest the potential benefits of interventions to reduce reliance on avoidant coping and stimulate more problem-focused approaches to coping with difficulties and challenges in order to facilitate adaptation and prevent problems in psychosocial functioning postamputation.


Family medicine education in Brazil: challenges, opportunities, and innovations.
Since 1988, Brazil's public health system has tried to build a national health system that responds to the needs and expectations of Brazil's population. In 1994, the government created the Family Health Program to help carry out that goal. However, the dearth of family physicians in Brazil-the central figures in that program-limits the program's effectiveness. The lack of family physicians can be traced primarily to the medical schools, which at that time were not training such physicians. This, in turn, can be traced to a number of conditions in Brazil (e.g., the bias toward specialization in both medical education and care) that favor specialists and discourage generalists. In 1992, a group of physicians founded an academic society in São Paulo to promote the humanistic dimensions of doctoring and "establish the proper basis and scientific methodology for family medicine." The society's board eventually began teaching humanistic medicine to medical students, who became interested in family medicine. The board realized that its mission should expand to find ways to introduce and integrate family medicine into the medical schools of Brazil, to establish family medicine's academic credentials, help attract students to family medicine as a career, and secure family medicine's credibility in the marketplace. Since that time, the society has developed a variety of initiatives involving students, faculty, and medical schools to pursue these goals. The authors describe these initiatives, the progress made, and the challenges ahead.


The potential of CpG oligodeoxynucleotides as mucosal adjuvants.
The development of mucosal vaccines for humans has been hindered by the lack of safe yet effective mucosal adjuvants. Bacterial toxins are commonly used as adjuvants in animal models, but they are too toxic for use in humans. A novel class of adjuvant is CpG DNA, which contains unmethylated CpG dinucleotides in particular base contexts (CpG motifs). CpG DNA is most often coadministered with antigen in the form of synthetic oligodeoxynucleotides (CpG ODN), which are made with a nuclease-resistant phosphorothioate backbone. The vast majority of studies using CpG DNA as adjuvant have been with parenteral delivery; recently, however, mucosal immunization with CpG DNA as adjuvant has also been shown to induce both systemic (humoral and cellular) and mucosal antigen-specific immune responses. This review will highlight the recent uses of CpG DNA as an adjuvant at mucosal surfaces.


Kinetic Isotope Effects of the Enzymatic Transformation of γ-Hexachlorocyclohexane by the Lindane Dehydrochlorinase Variants LinA1 and LinA2.
Compound-specific isotope analysis (CSIA) can provide insights into the natural attenuation processes of hexachlorocyclohexanes (HCHs), an important class of persistent organic pollutants. However, the interpretation of HCH stable isotope fractionation is conceptually challenging. HCHs exist as different conformers that can be converted into each other, and the enzymes responsible for their transformation discriminate among those HCH conformers. Here, we investigated the enzyme specificity of apparent 13C- and 2H-kinetic isotope effects (AKIEs) associated with the dehydrochlorination of γ-HCH (lindane) by two variants of the lindane dehydrochlorinases LinA1 and LinA2. While LinA1 and LinA2 attack γ-HCH at different trans-1,2-diaxial H-C-C-Cl moieties, the observed C and H isotope fractionation was large, typical for bimolecular eliminations, and was not affected by conformational mobility. 13C-AKIEs for transformation by LinA1 and LinA2 were the same (1.024 ± 0.001 and 1.025 ± 0.001, respectively), whereas 2H-AKIEs showed minor differences (2.4 ± 0.1 and 2.6 ± 0.1). Variations of isotope effects between LinA1 and LinA2 are small and in the range reported for different degrees of C-H bond cleavage in transition states of dehydrochlorination reactions. The large C and H isotope fractionation reported here for experiments with pure enzymes contrasts with previous observations from whole cell experiments and suggests that specific uptake processes by HCH-degrading microorganisms might modulate the observable HCH isotope fractionation at contaminated sites.


Risk factors for back pain in marines; a prospective cohort study.
It is recognised that back pain (BP) is a debilitating medical problem in the soldier community, which limits operational readiness as well as work ability. As such, identification of risk factors is a necessity for effective preventive actions, but also regarded as important from a safety perspective. The aim of this prospective cohort study was therefore to identify risk factors for back pain and BP limiting work ability in active duty marines within a 6 and 12-month period. Demographic characteristics, health-related factors and occupational exposure information, as gathered from questionnaires, as well as clinical test of movement control among 137 Swedish marines were regressed with multivariable logistic regressions, and strength of associations was presented as odds ratio (OR) with 95 % confidence intervals (CI). BP within 6 and 12 months were used as primary outcomes, whereas BP limiting work ability within 6 and 12 months served as secondary outcomes. Previous BP and tall body height (≥1.86 m) emerged as risk factors for back pain within 6 months (OR 2.99, 95 % CI 1.22-7.30; OR 2.81, 95 % CI 1.16- 6.84, respectively), and 12 months (OR 6.75, 95 % CI 2.30-19.80; 2.75, 95 % CI 1.21-6.29, respectively). Previous BP was also identified as risk factor for BP limiting work ability within 12 months (OR 6.64, 95 % CI 1.78-24.78), and tall body height emerged as a risk within both six (OR 4.30, 95 % CI 1.31-14.13) and 12 months (OR 4.55, 95 % CI 1.53-13.57) from baseline. Marines with a history of BP are at risk of further BP episodes, which, thus, emphasise the importance of early BP preventive actions. Tall body height also emerged as an important risk which may reflect that personal equipment and work tasks are not adapted for the tallest marines. While this should be considered when introducing new work equipment, further studies are warranted to clarify the underlying mechanism of this association.


Short communication: Efficacy of parenteral ceftiofur for treatment of systemically mild clinical mastitis in dairy cattle.
The objective of this study was to evaluate the effect of intramuscular (i.m.) ceftiofur (2.2 mg/kg) on important outcomes of systemically mild clinical mastitis episodes in lactating dairy cattle. Cows with clinical mastitis were randomly assigned to a treatment group: pirlimycin intramammary (i.m.m.) (n = 35), pirlimycin i.m.m. and ceftiofur i.m.m. (n = 36), cephapirin i.m.m. (n = 40), cephapirin i.m. and ceftiofur i.m. (n = 33). Sixty-nine, 22, and 9% of initial cultures were gram-negative, gram-positive, and mixed, respectively. Logistic regression analysis showed no significant associations between treatment groups and loss of quarter, recurrence, or culling. Mixed infections, positive milk culture at 7 d after leaving hospital pen, decreased rumen motility, and absence of udder firmness were associated with increased odds of mastitis recurrence. The results suggest that i.m. ceftiofur treatment has no beneficial effects on the outcome of systemically mild clinical mastitis.


Qualitative evaluation of the project P.A.T.H.S.: an integration of findings based on program implementers.
An integration of the qualitative evaluation findings collected from program implementers conducting the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in different years (n = 177 participants in 36 focus groups) was carried out. General qualitative data analyses utilizing intra and interrater reliability techniques were performed. Results showed that the descriptors used to describe the program and the metaphors named by the informants that could stand for the program were generally positive in nature. Program participants also perceived the program to be beneficial to the development of the students in different psychosocial domains. The present study further supports the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong based on the perspective of the program implementers.


Inhibition of pinacidil induced IK(ATP) in heart by changes in extracellular pH.
The aim was to determine whether extracellular protons influence the activation of ATP sensitive potassium channels (KATP) in heart by the drug pinacidil. Single channel and whole cell currents were measured in enzymatically dispersed guinea pig ventricular myocytes with patch clamp procedures. ATP sensitive potassium channel activity was induced by pinacidil in whole cell experiments and either by lowering cytoplasmic ATP or pinacidil in membrane patch experiments. Extracellular acidification inhibited and extracellular alkalisation potentiated ATP sensitive potassium channel currents (IK(ATP)) induced by pinacidil under whole cell conditions. In membrane patches, IK(ATP) induced by low cytoplasmic ATP (1 mM) was not sensitive to changes in extracellular pH, but IK(ATP) induced by cytoplasmic application of pinacidil was inhibited by extracellular acidification. Interactions between protons and pinacidil drug molecules underlie the pH dependent changes in IK(ATP) induced by pinacidil. Based on the kinetics of pH dependent changes in pinacidil induced channel activity in inside-out membrane patches, our data suggest that the important inhibitory site of action of this drug is located on the extracellular side of the cell membrane.


A randomised clinical trial on the influence of splinted and unsplinted oral implants in mandibular overdenture therapy. A 3-year report.
A randomised clinical trial was performed to investigate whether there is a need or advantage to splint two implants in the mandible retaining a hinging overdenture. Furthermore, patient satisfaction was evaluated for different attachment systems retaining the overdenture. Thirty-six edentulous patients were randomised into three groups of equal size and treated with either magnets, ball attachments or straight bars (reference group). After 3 years of observation no implants were lost in any of the groups. Besides, no statistically significant differences were noted for the peri-implant outcome. Although the bar group presented the highest retention force, the general satisfaction of the patients in the three groups did not differ. The patients with bar retentions showed less prosthetic complications of the retention elements but more at the level of the denture-supporting mucosa. Finally, the clinical outcome of all groups confirms that overdenture treatment demands regular controls with limited time intervals.


Psychosocial Clusters and their Associations with Well-Being and Health: An Empirical Strategy for Identifying Psychosocial Predictors Most Relevant to Racially/Ethnically Diverse Women's Health.
Strategies for identifying the most relevant psychosocial predictors in studies of racial/ethnic minority women's health are limited because they largely exclude cultural influences and they assume that psychosocial predictors are independent. This paper proposes and tests an empirical solution. Hierarchical cluster analysis, conducted with data from 140,652 Women's Health Initiative participants, identified clusters among individual psychosocial predictors. Multivariable analyses tested associations between clusters and health outcomes. A Social Cluster and a Stress Cluster were identified. The Social Cluster was positively associated with well-being and inversely associated with chronic disease index, and the Stress Cluster was inversely associated with well-being and positively associated with chronic disease index. As hypothesized, the magnitude of association between clusters and outcomes differed by race/ethnicity. By identifying psychosocial clusters and their associations with health, we have taken an important step toward understanding how individual psychosocial predictors interrelate and how empirically formed Stress and Social clusters relate to health outcomes. This study has also demonstrated important insight about differences in associations between these psychosocial clusters and health among racial/ethnic minorities. These differences could signal the best pathways for intervention modification and tailoring.


Meikirch model: new definition of health as hypothesis to fundamentally improve healthcare delivery.
The unrelenting rise in healthcare costs over the past 50 years has caused policymakers to respond. Their reactions have led to a gradual economic transformation of medicine. As a result, detailed billing, quality controls, financial incentives, savings targets and digitalisation are now putting increasing pressures on the nursing and medical staff. In addition, the humanity of care of the patient-doctor and/or patient-nurse interactions has been cast aside to a great extent. Therefore, the immaterial side of care has been neglected or even removed from these relationships. These changes are now perceived as intolerable by most health workers and patients. Yet healthcare costs are still rising. This paper presents a hypothesis that should enable healthcare systems to respond more effectively. It proposes the introduction of the Meikirch model, a new comprehensive definition of health. The Meikirch model takes human nature fully into account, including health and disease. The inclusion of the individual potentials, the social surroundings and the natural environment leads to the concept of health as a complex adaptive system (CAS). Care for such a definition of health requires medical organisations to change from top-down management to bottom-up leadership. Such innovations are now mature and ready for implementation. They require a long-term investment, a comprehensive approach to patient care and new qualifications for leadership. The Meikirch model reads: 'To be healthy a human individual must be able to satisfy the demands of life. For this purpose, each person disposes of a biologically given and a personally acquired potential, both of which are closely related to the social surroundings and the natural environment. The resulting CAS enables the individual to unfold a personal identity and to develop it further until death. Healthcare has the purpose to empower each individual to fully realize optimal health'. This hypothesis postulates that the new definition of health will further develop healthcare systems in such a way that better health results at lower costs.


The joint effect of surface polarity and concentration on the structure and dynamics of acetonitrile solution: a molecular dynamics simulation study.
The interfacial properties of the acetonitrile (ACN)-water-silica interface have great implications in both liquid chromatography and heterogeneous catalysis. We have performed molecular dynamics (MD) simulations of ACN and water binary solutions to give a comprehensive study of the collective effect of silica surface polarity and ACN concentration on interfacial structures and dynamics by tuning both surface charges and ACN concentration. MD simulation results indicate that many properties in the liquid-solid interface region undergo a monotonic change as the silica surface is tuned from polar to apolar due to the weakening of hydrogen bonding, while their dependence on ACN concentration is presumably governed by the preferential adsorption of water at the silica surface over ACN. However, at apolar surfaces, the interfacial structures of both water and ACN behave like the liquid-vapor interface, and this resemblance leads to an enrichment of ACN at the interface as well as accelerated dynamics, which is very different from that in the bulk solution. The organization of ACN molecules at both polar and apolar surfaces can be attributed to the amphiphilic nature of ACN, by which the micro-heterogeneity domain formed can persist both in the bulk and at the liquid-solid interface. Moreover, extending diffusion analysis to the second layer of the interface shows that the interfacial transport pathways at polar surfaces are likely very different from that of apolar surfaces. These simulation results give a full spectrum description of the ACN/water liquid-solid interface at the microscopic level and will be helpful for explaining related spectroscopic experiments and understanding the microscopic mechanisms of separation protocols in current chromatography applications.


Cross index for improving cloning selectivity by partially filling in 5'-extensions of DNA produced by type II restriction endonucleases.
A cross index is presented for using the improved selectivity offered by the Hung and Wensink (Nucl. Acids Res. 12, 1863-1874, 1984) method of partially filling in 5'-extensions produced by type II restriction endonucleases. After this treatment, DNA fragments which normally cannot be ligated to one another, can be joined providing that complementary cohesive ends have been generated. The uses of this technique, which include the prevention of DNA fragments (both vector and insert) auto-annealing, are discussed.


Constitutive modeling of skeletal muscle tissue with an explicit strain-energy function.
While much work has previously been done in the modeling of skeletal muscle, no model has, to date, been developed that describes the mechanical behavior with an explicit strain-energy function associated with the active response of skeletal muscle tissue. A model is presented herein that has been developed to accommodate this design consideration using a robust dynamical approach. The model shows excellent agreement with a previously published model of both the active and passive length-tension properties of skeletal muscle.


Prediction of glycan structures from gene expression data based on glycosyltransferase reactions.
Glycan chains are synthesized by a combination of several kinds of glycosyltransferases (GTs). Thus, once we know the repertoire of GTs in the genome, in the transcriptome or in the proteome, it should in principle be possible to predict the repertoire of possible glycan structures in an organism or at a specific stage of the cell. Here, we show that a repertoire of glycan structures can be predicted from the set of GTs in the transcriptome. That is, using knowledge about glycan structure characteristics, we can predict glycan structures from incomplete or noisy data such as DNA microarray data. First, we constructed a reaction pattern library consisting of bond-formation patterns of GT reactions and investigated the co-occurrence frequencies of all reaction patterns in the glycan database. This was followed by the prediction of glycan structures using this library and a co-occurrence score. A penalty score was also implemented in the prediction method. Then we examined the performance of prediction by the leave-one-out cross validation method using individual reaction pattern profiles in the KEGG GLYCAN database as virtual expression profiles. The accuracy of prediction was 81%. Finally, we applied the prediction method to real expression data. Using expression profiles from the human carcinoma cell, glycan structures with sialic acid and sialyl Lewis X epitope were predicted, which corresponded well with experimental results.


Psychodynamic Therapy: An Overview for Trainees and Their Teachers: Part 1-The Basics.
This first column in a series on psychodynamic therapy (PDT) offers an overview of the basics required to understand and master the provision of PDT. It offers a way of understanding what patients struggle with when viewed through a psychodynamic lens and then examines evidence-based core elements of psychotherapy and PDT.


Child Death in a Resource-Limited Setting: A Simulation Case for Pediatric Residents to Prepare for Global Health Electives.
Pediatric residents are increasingly pursuing global health electives. Differences in cultural norms and management around pediatric deaths in resource-limited settings can be emotionally overwhelming for residents. Educational resources are needed to better equip them for handling these stressful situations. We developed a predeparture simulation child death case to prepare pediatric residents for their global health elective. The simulation module included a clinical case followed by a multidisciplinary structured debriefing. The case featured a 5-year-old, malnourished child in hypovolemic shock who clinically deteriorates and dies. After obtaining a history and performing a physical examination, residents were expected to diagnose severe malnutrition, treat hypovolemic shock, and decide how far to extend resuscitation with the limited resources. Upon returning from abroad, residents were invited to complete a survey on the utility of the simulation case module in preparing for their elective. Twenty-nine residents participated in the simulation case module, and 18 completed the survey. Seventeen agreed or strongly agreed that the simulation module was a useful tool for preparation (Mdn = 4.5 on a 5-point Likert scale). Residents reflected that the simulation module helped manage expectations and provided them with an understanding of the cross-cultural differences in managing pediatric deaths in a resource-limited setting. Pediatric residents trained in resource-rich countries do not encounter death often. Postgraduate training programs could consider simulations like this one to prepare such residents for cross-cultural differences in managing pediatric deaths and build resiliency to operate in resource-limited settings.


Relationships between hope, optimism, and conservation engagement.
The loss and degradation of nature can lead to hopelessness and despair, which may undermine engagement in conservation actions. Emerging movements, such as that behind the organization Conservation Optimism, aim to avert potential despair of those involved in conservation. Some argue that fostering positive states, such as hope or optimism, can motivate engagement and action; however, others question whether fostering hope or optimism may inadvertently undermine perceived gravity of conservation challenges. We examined this issue by quantifying dispositional hope and optimism with a representative sample of Australians (n = 4285) and assessing their relationship with indicators of conservation engagement. We used the Great Barrier Reef (GBR) in Australia as a case study. We asked participants what they could do to help the GBR, then classified their responses into 2 outcome variables: identifying climate actions (i.e., actions that tackle the main threat to the reef) and identifying plastic actions (i.e., actions that are popular among community members). We also quantified likelihood of performing these actions and appraisals of both threats and actions. One dimension of hope, hope pathways (defined by Snyder's hope theory as knowing different ways to act), was associated with greater capacity to identify climate-related behaviors (odds ratio [OR] = 1.44) and plastic reduction behaviors (OR = 1.22) and greater likelihood of adopting climate-related actions (β = 0.20). Optimism was associated with recognition of plastic reduction behaviors only (OR = 1.22). Neither hope nor optimism undermined appraisal of conservation threats. The effects of optimism were mediated by reduced action futility, and effects of hope pathways were mediated by stronger perceptions of threats to the reef (threat appraisal) and confidence in performing useful actions (coping appraisal). Our findings suggest that dispositional hope can strengthen, rather than undermine, appraisal of conservation challenges and solutions and thereby increase conservation engagement.


Microscopy as a tool for renal research.
Microscopy has always played an important role in renal research as a tool to visualize events occurring at the surface of the kidney and as a method to investigate intracellular ion activity and membrane transport. Thanks to the recent advances in fluorochromes as ionic detector agents and as a means to label antibodies, microscopy will maintain its role at the forefront of renal research in the future. This article presents an overview of fluorescence microscopy and then focuses on some of the present applications of microscopy to exam renal epithelial tissues. Other areas covered are the pros and cons of various techniques and their applications to renal research.