Orthopedic procedures represent a large expense to the Medicare program, and costs of implantable medical devices account for a large proportion of those procedures' costs. Physicians have been ...encouraged to consider cost in the selection of devices, but several factors make acquiring cost information difficult. To assess physicians' levels of knowledge about costs, we asked orthopedic attending physicians and residents at seven academic medical centers to estimate the costs of thirteen commonly used orthopedic devices between December 2012 and March 2013. The actual cost of each device was determined at each institution; estimates within 20 percent of the actual cost were considered correct. Among the 503 physicians who completed our survey, attending physicians correctly estimated the cost of the device 21 percent of the time, and residents did so 17 percent of the time. Thirty-six percent of physicians and 75 percent of residents rated their knowledge of device costs "below average" or "poor." However, more than 80 percent of all respondents indicated that cost should be "moderately," "very," or "extremely" important in the device selection process. Surgeons need increased access to information on the relative prices of devices and should be incentivized to participate in cost containment efforts.
Mathematics learning in early childhood Schweingruber, Heidi; Woods, Taniesha A; Cross, Christopher T
National Academies Press,
2009, 20091110, 2009-00-00, 2009-01-30, 2009-11-13
eBook, Book
Odprti dostop
Early childhood mathematics is vitally important for young children's present and future educational success. Research demonstrates that virtually all young children have the capability to learn and ...become competent in mathematics. Furthermore, young children enjoy their early informal experiences with mathematics. Unfortunately, many children's potential in mathematics is not fully realized, especially those children who are economically disadvantaged. This is due, in part, to a lack of opportunities to learn mathematics in early childhood settings or through everyday experiences in the home and in their communities. Improvements in early childhood mathematics education can provide young children with the foundation for school success.
Relying on a comprehensive review of the research, Mathematics Learning in Early Childhood lays out the critical areas that should be the focus of young children's early mathematics education, explores the extent to which they are currently being incorporated in early childhood settings, and identifies the changes needed to improve the quality of mathematics experiences for young children. This book serves as a call to action to improve the state of early childhood mathematics. It will be especially useful for policy makers and practitioners-those who work directly with children and their families in shaping the policies that affect the education of young children.
The structure of proline prevents it from adopting an optimal position for rapid protein synthesis. Poly-proline-tract (PPT) associated ribosomal stalling is resolved by highly conserved eIF5A, the ...only protein to contain the amino acid hypusine. We show that de novo heterozygous EIF5A variants cause a disorder characterized by variable combinations of developmental delay, microcephaly, micrognathia and dysmorphism. Yeast growth assays, polysome profiling, total/hypusinated eIF5A levels and PPT-reporters studies reveal that the variants impair eIF5A function, reduce eIF5A-ribosome interactions and impair the synthesis of PPT-containing proteins. Supplementation with 1 mM spermidine partially corrects the yeast growth defects, improves the polysome profiles and restores expression of PPT reporters. In zebrafish, knockdown eif5a partly recapitulates the human phenotype that can be rescued with 1 µM spermidine supplementation. In summary, we uncover the role of eIF5A in human development and disease, demonstrate the mechanistic complexity of EIF5A-related disorder and raise possibilities for its treatment.
As the average age of agricultural producers continues to rise, farm succession planning and the large number of anticipated land transfers are expected to transform rural American agricultural ...production and landscapes. Policy tools like conservation easements (CEs) can facilitate agricultural land preservation through “dead hand control” by restricting the development through binding legal contracts that can be transferred across generations. We examine whether agricultural landowners seek CE agreements to keep the land in agriculture for intergenerational bequest, rather than selling the land for financial gains that could be enjoyed immediately or passed to heirs. We assess whether this may be influenced by landowner conservation ethic or perceived threat to sense of place. We analyze the survey data collected from 2,270 agricultural landowners in Colorado and Wyoming utilizing a random utility model estimation. We find that landowners are less likely to reject a CE agreement when there is a desire to bequest agricultural land to the next generation or a perceived threat to sense of place; however, conservation ethic mitigates intergenerational bequest effects. This indicates that conservation ethic encompasses a desire to pass land to the next generation. Our findings contribute to the conservation literature by advocating for the regenerative approach to land conservation rather than the theory of planned behavior.
Targeting epigenetic mechanisms has shown promise against several cancers but has so far been unsuccessful against glioblastoma (GBM). Altered histone 3 lysine 4 methylation and increased ...lysine‐specific histone demethylase 1A (LSD1) expression in GBM tumours nonetheless suggest that epigenetic mechanisms are involved in GBM. We engineered a dual‐action prodrug, which is activated by the high hydrogen peroxide levels associated with GBM cells. This quinone methide phenylaminecyclopropane prodrug releases the LSD1 inhibitor 2‐phenylcyclopropylamine with the glutathione scavenger para‐quinone methide to trigger apoptosis in GBM cells. Quinone methide phenylaminocyclopropane impaired GBM cell behaviours in two‐dimensional and three‐dimensional assays, and triggered cell apoptosis in several primary and immortal GBM cell cultures. These results support our double‐hit hypothesis of potentially targeting LSD1 and quenching glutathione, in order to impair and kill GBM cells but not healthy astrocytes. Our data suggest this strategy is effective at selectively targeting GBM and potentially other types of cancers.
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Glioblastoma (GBM) is the most common primary and malignant brain tumour in adults. We report here a prodrug that releases the LSD1 inhibitor trans‐2‐phenylcyclopropylamine (2‐PCPA) and quinone methide simultaneously through oxidation of a boronate trigger by hydrogen peroxide. This quinone methide phenylaminecyclopropane (Q‐PAC) prodrug impaired GBM cell behaviours in two‐dimensional and three‐dimensional assays, and triggered cell apoptosis in several primary and immortal GBM cell cultures, but not healthy cells.
Open Science: This manuscript was awarded with the Open Materials Badge
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Recent clinical trials have established B cell depletion by the anti-CD20 chimeric antibody Rituximab as a beneficial therapy for patients with relapsing-remitting multiple sclerosis (MS). The impact ...of Rituximab on T cell responses remains largely unexplored. In the experimental autoimmune encephalomyelitis (EAE) model of MS in mice that express human CD20, Rituximab administration rapidly depleted peripheral B cells and strongly reduced EAE severity. B cell depletion was also associated with diminished Delayed Type Hypersensitivity (DTH) and a reduction in T cell proliferation and IL-17 production during recall immune response experiments. While Rituximab is not considered a broad immunosuppressant, our results indicate a role for B cells as a therapeutic cellular target in regulating encephalitogenic T cell responses in specific tissues.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
► Economic dependence is one dimensions of sense of place. ► Economic dependence is negatively related to holding a conservation easement. ► Trust of land trusts increases likelihood of holding a ...conservation easement. ► Intake questionnaires should screen landowners for sense of place dimensions.
The inter-mountain west is one of the most highly urbanized and rapidly growing regions in the United States. Conservation easements are one common tool used to protect rural and agricultural land from urban development. This paper examines the attitudinal and demographic characteristics of agricultural landowners to predict adoption of conservation easements. The study has two primary objectives: (1) to broaden the literature on sense of place and place attachment by including a measure of economic dependence as one dimension, and (2) to examine the relation of this dimension with attitudes towards land trusts and participation in conservation easements. Agricultural landowners (
N
=
2266) in Colorado and Wyoming were surveyed about their sense of place for their land, their attitudes towards land trusts, and perceived need for land conservation. Factor analysis of 12 measures of sense of place indicated that place identity, conservation ethic, and economic dependence ere distinct dimensions of sense of place among agricultural landowners. Logistic regression analyses revealed that economic dependence had a significant and negative relation with landowner's trust of and trusts and placement of a conservation easement on agricultural land, whereas a conservation ethic and spiritual attachment are positively related. Two main implications for land trusts are that time spent contacting landowners is time well spent and intake questionnaires could be used to screen and owners for both a conservation ethic and a sense of economic dependence providing information hat might improve the possibility of reaching an easement agreement.
This abstract provides an evidence-based approach to the detection of post-HSCT BOS in children. The background discusses the high occurrence of pulmonary complications post-HSCT, particularly BOS, ...and the conflicting recommendations for surveillance. A multinational panel of experts conducted a systematic review of the literature to answer six questions regarding surveillance and evaluation of post-HSCT BOS in children. The panel used the Grading of Recommendations, Assessment, Development, and Evaluation approach to rate the quality of evidence and strength of recommendations. The recommendations address the role of screening pulmonary function testing and diagnostic tests in children with suspected post-HSCT BOS, and propose new diagnostic criteria. The document also highlights considerations for implementing each recommendation and identifies areas for future research.
The Intermountain West's rapid changes in population growth and land use may be welcome to some, but others perceive such changes as threats to sense of place. The objective of this study is to ...assess whether New West and Old West contextual variables predict how agricultural landowners view threats to agricultural lifestyles and sense of place. We analyze survey data collected from 2,270 agricultural landowners in Colorado and Wyoming utilizing a multilevel regression model (MLM). We posit that this analytical approach is effective for evaluating hierarchal New West or Old West economic configurations that may otherwise be difficult to observe. Our study specifically examines whether population pressures threaten agricultural lifestyles in the amenity‐based New West or in Old West economic regimes with proclivity toward large‐scale agricultural production. Our results show that landowners in farming‐dependent counties and in high‐amenity areas express greater concern than other landowners surveyed about increases in population growth that could threaten an agricultural way of life. Furthermore, we demonstrate that these perceptions relate to whether individuals reside in New West or Old West counties. In summary, some of the contextual variables of New West and Old West economic structures predict whether individuals perceive population growth and land use changes as threats to sense of place.
Since 2002 the Neuroform stent has expanded endovascular treatment of wide-necked intracranial aneurysms. A study was undertaken to assess the technical success rates and angiographic and clinical ...outcomes in stent-assisted coiling with Neuroform 1, 2, 2 Treo and 3.
Patients undergoing Neuroform stent-assisted coiling were enrolled in a prospective registry that included 156 stent deployment attempts in 113 consecutive patients (mean age 53, range 25-78). Deployment success and difficulty, stent movement, procedural complications, immediate/delayed aneurysm occlusion and in-stent stenosis on angiographic follow-up were compared among Neuroform 1, 2, 2 Treo and 3 stents using a log likelihood ratio χ2 test.
Of 156 stent attempts, 123 (79%) were deployed (Neuroform 1: 8/9 (89%), Neuroform 2: 50/66 (76%), Neuroform 2 Treo: 9/11 (82%), Neuroform 3: 56/70 (80%)) with a symptomatic complication rate of 1.9% (3/156; 2 transient ischemic attacks, 1 stroke, no deaths). Non-target stent placement (1/8 (13%), 6/50 (12%), 2/9 (22%), 3/56 (5%)), difficult placement (2/8 (25%), 10/50 (20%), 5/9 (56%), 6/56 (11%)), stent movement (1/8 (13%), 4/50 (8%), 0/9 (0%), 4/56 (7%)), procedural complications (1/9 (11%), 7/66 (11%), 2/11 (18%), 2/70 (3%)) and immediate near complete aneurysm occlusion (6/6 (100%), 24/37 (65%), 5/7 (71%), 40/45 (89%)) trended towards improvement with each generation. Improvements in difficult stent placement and immediate aneurysm occlusion were significant (p=0.01 and 0.03, respectively).
Neuroform stent-assisted coiling has evolved through four generations as a safe and effective means of treating wide-necked intracranial aneurysms.
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