Anaphylaxis is a systemic life-threatening allergic reaction that presents unique challenges for emergency care practitioners. Allergists and emergency physicians have a history of collaborating to ...promote an evidence-based, multidisciplinary approach to improve the emergency management and follow-up of patients with or at risk of anaphylaxis.
To review recent scientific literature about anaphylaxis, discuss barriers to care, and recommend strategies to support improvement in emergency anaphylaxis care.
An expert panel of allergists and emergency physicians was convened by the American College of Allergy, Asthma and Immunology in November 2014 to discuss current knowledge about anaphylaxis, identify opportunities for emergency practitioners and allergists to partner to address barriers to care, and recommend strategies to improve medical management of anaphylaxis along the continuum of care: from emergency medical systems and emergency department practitioners for acute management through appropriate outpatient follow-up with allergists to confirm diagnosis, identify triggers, and plan long-term care.
The panel identified key barriers to anaphylaxis care, including difficulties in making an accurate diagnosis, low rates of epinephrine administration during acute management, and inadequate follow-up. Strategies to overcome these barriers were discussed and recommendations made for future allergist/emergency physician collaborations, and key messages to be communicated to emergency practitioners were proposed.
The panel recommended that allergists and emergency physicians continue to work in partnership, that allergists be proactive in outreach to emergency care practitioners, and that easy-to-access educational programs and materials be developed for use by emergency medical systems and emergency department practitioners in the training environment and in practice.
To evaluate in a preliminary manner the feasibility, safety, and efficacy of Constraint-Induced Movement therapy (CIMT) of persons with impaired lower extremity use from multiple sclerosis (MS).
...Clinical trial with periodic follow-up for up to 4 years.
University-based rehabilitation research laboratory.
A referred sample of ambulatory adults with chronic MS (N=4) with at least moderate loss of lower extremity use (average item score ≤6.5/10 on the functional performance measure of the Lower Extremity Motor Activity Log LE-MAL).
CIMT was administered for 52.5 hours over 3 consecutive weeks (15 consecutive weekdays) to each patient.
The primary outcome was the LE-MAL score at posttreatment. Secondary outcomes were posttreatment scores on laboratory assessments of maximal lower extremity movement ability.
All the patients improved substantially at posttreatment on the LE-MAL, with smaller improvements on the laboratory motor measures. Scores on the LE-MAL continued to improve for 6 months afterward. By 1 year, patients remained on average at posttreatment levels. At 4 years, half of the patients remained above pretreatment levels. There were no adverse events, and fatigue ratings were not significantly changed by the end of treatment.
This initial trial of lower extremity CIMT for MS indicates that the treatment can be safely administered, is well tolerated, and produces substantially improved real-world lower extremity use for as long as 4 years afterward. Further trials are needed to determine the consistency of these findings.
Decision makers crave insightful assessments and timely warnings of the anticipated actions, reactions, and behaviors of others, principally adversaries, in order to gird against threats and seize ...opportunities. In intelligence, warning is a core element of prediction. Thus, the task laid before intelligence -- to see what is coming, as far in advance of its arrival as possible -- is formidable, if not impossible.
The initial version of Constraint-Induced Aphasia Therapy (CIAT I) consisted of a single exercise. This study sought to evaluate the feasibility for future trials of an expanded and restructured ...protocol designed to increase the efficacy of CIAT I.
The subjects were 4 native English speakers with chronic stroke who exhibited characteristics of moderate Broca's aphasia. Treatment was carried out for 3.5 hr/day for 15 consecutive weekdays. It consisted of 3 components: (a) intensive training by a behavioral method termed shaping using a number of expressive language exercises in addition to the single original language card game, (b) strong discouragement of attempts to use gesture or other nonverbal means of communication, and (c) a transfer package of behavioral techniques to promote transfer of treatment gains from the laboratory to real-life situations.
Participation in speech in the life situation improved significantly after treatment. The effect sizes (i.e., d') in this domain were ≥ 2.2; d' values ≥ 0.8 are considered large. Improvement in language ability on a laboratory test, the Western Aphasia Battery-Revised (Kertesz, 2006), did not achieve statistical significance, although the effect size was large--that is, 1.3 (13.1 points).
These pilot results suggest in preliminary fashion that CIAT II may produce significant improvements in everyday speech.
From WMD to WME Miller, Bowman H.
Journal of strategic security,
10/2015, Letnik:
8, Številka:
3
Journal Article
Recenzirano
Odprti dostop
One of the challenges the United States and its intelligence community confronts today, if not the foremost challenge, is the girth of its national security problem set. The array of threat types, as ...well as the potential sources of those threats, is unprecedented and growing. The burdensome task for intelligence at all times, but especially given the present rate of change and the increasing porosity of borders, is to try to cope with an escalating mix of challenges and rising expectations of what intelligence can provide. Existing tasks persist; they are not replaced. The number and types of potentially threatening actors have exploded. Nation-states are now joined by countless ethno-religious groupings, terrorists, criminals of all stripes, drug cartels, transnational movements and issue groups, and malevolent and delinquent individuals. Threats come from all quarters and in all sizes these days, and the mission of intelligence, i.e., to track indicators to provide warning and to reduce uncertainty for decision-makers, is monumental.
Summary
RNA silencing is a conserved eukaryotic pathway in which double‐stranded RNA (dsRNA) triggers destruction of homologous target RNA via production of short‐interfering RNA (siRNA). In plants, ...at least some cases of RNA silencing can spread systemically. The signal responsible for systemic spread is expected to include an RNA component to account for the sequence specificity of the process, and transient silencing assays have shown that the capacity for systemic silencing correlates with the accumulation of a particular class of small RNA. Here, we report the results of grafting experiments to study transmission of silencing from stably transformed tobacco lines in the presence or absence of helper component‐proteinase (HC‐Pro), a viral suppressor of silencing. The studied lines carry either a tail‐to‐tail inverted repeat, the T4‐IR transgene locus, or one of two different amplicon transgene loci encoding replication‐competent viral RNA. We find that the T4‐IR locus, like many sense‐transgene‐silenced loci, can send a systemic silencing signal, and this ability is not detectably altered by HC‐Pro. Paradoxically, neither amplicon locus effectively triggers systemic silencing except when suppressed for silencing by HC‐Pro. In contrast to results from transient assays, these grafting experiments reveal no consistent correlation between capacity for systemic silencing and accumulation of any particular class of small RNA. In addition, although all transgenic lines used to transmit systemic silencing signals were methylated at specific sites within the transgene locus, silencing in grafted scions occurred without detectable methylation at those sites in the target locus of the scion.
Helper component-protease (HC-Pro) is a plant viral suppressor of RNA silencing, and transgenic tobacco expressing HC-Pro has increased susceptibility to a broad range of viral pathogens. Here we ...report that these plants also exhibit enhanced resistance to unrelated heterologous pathogens. Tobacco mosaic virus (TMV) infection of HC-Pro-expressing plants carrying the
N resistance gene results in fewer and smaller lesions compared to controls without HC-Pro. The resistance to TMV is compromised but not eliminated by expression of
nahG, which prevents accumulation of salicylic acid (SA), an important defense signaling molecule. HC-Pro-expressing plants are also more resistant to tomato black ring nepovirus (TBRV) and to the oomycete
Peronospora tabacina. Enhanced TBRV resistance is SA-independent, whereas the response to
P. tabacina is associated with early induction of markers characteristic of SA-dependent defense. Thus, a plant viral suppressor of RNA silencing enhances resistance to multiple pathogens via both SA-dependent and SA-independent mechanisms.
Costly proton pump inhibitors have been widely prescribed since the 1990s for prevention and treatment of ulcers and gastroesophageal reflux disease. Evidence published since 2012 demonstrates risks ...associated with taking proton pump inhibitors for longer than 8 weeks. Primary care providers mostly deprescribe proton pump inhibitors for persons not meeting criteria for long-term use. Many patients resist discontinuation.A 3-month evidence-based practice education project was conducted by a nurse practitioner to improve primary care provider peer deprescribing successes with appropriate patients in an outpatient California-based veteran primary care clinic. Fifteen primary care providers were pretested about usual care practices between 2 comparable clinics. Five primary care providers at the smaller clinic location were educated about long-term proton pump inhibitor use risks and introduced to 3 evidence-based practice guidelines using tapering techniques with follow-up care.A Canadian 2017 evidence-based practice proton pump inhibitor deprescribing guideline was proposed for translation into practice. Primary care providers voted to pilot this guideline, dependent upon nursing support. Primary care providers denied frustration with usual care practices, even as all were willing to try an evidence-based practice change between pre- and post-test surveys. Support for peer-led evidence-based practice on-site coaching increased from 87% to 100%. Tapering behavior increased from 67% to 100%, expediting improved long-term medication cessation.
Does corporate strategy matter? Bowman, Edward H.; Helfat, Constance E.
Strategic management journal,
01/2001, Letnik:
22, Številka:
1
Journal Article
Recenzirano
A revisionist view that corporate strategy does not matter has gained considerable influence in recent years. This view largely stems from empirical results of early variance decomposition studies ...that found negligible corporate effects associated with profitability differences between businesses. Our analysis of the variance decomposition literature shows this view to be incorrect. Not only do the studies as a group show that factors at the corporate level of organizations contribute to profitability differences, but also evidence suggests that factors specifically associated with corporate strategy contribute to corporate effects. Corporate strategy in fact does matter.
Summary Flagellar type III secretion systems (T3SS) contain an essential cytoplasmic-ring (C-ring) largely composed of two proteins FliM and FliN, whereas an analogous substructure for the closely ...related non-flagellar (NF) T3SS has not been observed in situ. We show that the spa33 gene encoding the putative NF-T3SS C-ring component in Shigella flexneri is alternatively translated to produce both full-length (Spa33-FL) and a short variant (Spa33-C), with both required for secretion. They associate in a 1:2 complex (Spa33-FL/C2) that further oligomerises into elongated arrays in vitro. The structure of Spa33-C2 and identification of an unexpected intramolecular pseudodimer in Spa33-FL reveal a molecular model for their higher order assembly within NF-T3SS. Spa33-FL and Spa33-C are identified as functional counterparts of a FliM-FliN fusion and free FliN respectively. Furthermore, we show that Thermotoga maritimaFliM and FliN form a 1:3 complex structurally equivalent to Spa33-FL/C2, allowing us to propose a unified model for C-ring assembly by NF-T3SS and flagellar-T3SS.
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