If Physicians “Don’t Ask” and LGBT Patients “Don’t Tell,” Then Who’s Talking ?: Educational Strategies for Addressing Health Care Disparities Facing LGBT Patients

Numerous disparities exist in the provision of health services to LGBT people. The utilization of theoretical-grounded and empirically- tested adult educational strategies (e.g., deliberate practice and concept mapping) within medical education may improve the quality of health services offered to LGBT people

NuRD-dependent DNA methylation prevents ES cells from accessing a trophectoderm fate

Embryonic Stem (ES) cells are able to give rise to the three germ layers of the embryo but are prevented from contributing to the trophoblast. The molecular nature of this barrier between embryonic and trophectodermal cell fates is not clear, but is known to involve DNA methylation. Here we demonstrate that the Nucleosome Remodeling and Deacetylation (NuRD) co-repressor complex maintains the developmental barrier between embryonic and trophectodermal cell fates by maintaining transcriptional silencing of trophectoderm determinant genes in ES cells. We further show that NuRD activity facilitates DNA methylation of several of its target promoters, where it acts non-redundantly with DNA methylation to enforce transcriptional silencing. NuRD-deficient ES cells fail to completely silence expression of the trophectoderm determinant genes Elf5 and Eomes, but this alone is not sufficient to induce transdifferentiation towards the trophectoderm fate. Rather this leaves ES cells capable of activating expression of trophectoderm-specific genes in response to appropriate extracellular signals, enabling them to commit to a trophectodermal cell fate. Our findings clarify the molecular nature of the developmental barrier between the embryonic and trophoblast cell fates, and establish a role for NuRD activity in specifying sites for de novo DNA methylation. (C) 2012. Published by The Company of Biologists Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Share Alike License (http://creativecommons.org/licenses/by-nc-sa/3.0)

Adenine, guanine and pyridine nucleotides in blood during physical exercise and restitution in healthy subjects

Maximal physical exertion is accompanied by increased degradation of purine nucleotides in muscles with the products of purine catabolism accumulating in the plasma. Thanks to membrane transporters, these products remain in an equilibrium between the plasma and red blood cells where they may serve as substrates in salvage reactions, contributing to an increase in the concentrations of purine nucleotides. In this study, we measured the concentrations of adenine nucleotides (ATP, ADP, AMP), inosine nucleotides (IMP), guanine nucleotides (GTP, GDP, GMP), and also pyridine nucleotides (NAD, NADP) in red blood cells immediately after standardized physical effort with increasing intensity, and at the 30th min of rest. We also examined the effect of muscular exercise on adenylate (guanylate) energy charge—AEC (GEC), and on the concentration of nucleosides (guanosine, inosine, adenosine) and hypoxanthine. We have shown in this study that a standardized physical exercise with increasing intensity leads to an increase in IMP concentration in red blood cells immediately after the exercise, which with a significant increase in Hyp concentration in the blood suggests that Hyp was included in the IMP pool. Restitution is accompanied by an increase in the ATP/ADP and ADP/AMP ratios, which indicates an increase in the phosphorylation of AMP and ADP to ATP. Physical effort applied in this study did not lead to changes in the concentrations of guanine and pyridine nucleotides in red blood cells

A pilot study comparing the metabolic profiles of elite-level athletes from different sporting disciplines

Background: The outstanding performance of an elite athlete might be associated with changes in their blood metabolic profile. The aims of this study were to compare the blood metabolic profiles between moderate- and high-power and endurance elite athletes and to identify the potential metabolic pathways underlying these differences. Methods: Metabolic profiling of serum samples from 191 elite athletes from different sports disciplines (121 high- and 70 moderate-endurance athletes, including 44 high- and 144 moderate-power athletes), who participated in national or international sports events and tested negative for doping abuse at anti-doping laboratories, was performed using non-targeted metabolomics-based mass spectroscopy combined with ultrahigh-performance liquid chromatography. Multivariate analysis was conducted using orthogonal partial least squares discriminant analysis. Differences in metabolic levels between high- and moderate-power and endurance sports were assessed by univariate linear models. Results: Out of 743 analyzed metabolites, gamma-glutamyl amino acids were significantly reduced in both high-power and high-endurance athletes compared to moderate counterparts, indicating active glutathione cycle. High-endurance athletes exhibited significant increases in the levels of several sex hormone steroids involved in testosterone and progesterone synthesis, but decreases in diacylglycerols and ecosanoids. High-power athletes had increased levels of phospholipids and xanthine metabolites compared to moderate-power counterparts. Conclusions: This pilot data provides evidence that high-power and high-endurance athletes exhibit a distinct metabolic profile that reflects steroid biosynthesis, fatty acid metabolism, oxidative stress, and energy-related metabolites. Replication studies are warranted to confirm differences in the metabolic profiles associated with athletes’ elite performance in independent data sets, aiming ultimately for deeper understanding of the underlying biochemical processes that could be utilized as biomarkers with potential therapeutic implications

EQ-5D in Central and Eastern Europe : 2000-2015

Objective: Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. Methods: An electronic database search was performed up to July 1, 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. Results: We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n=11), Bulgaria (n=6), Czech Republic (n=18), Hungary (n=47), Poland (n=51), Romania (n=2), Slovakia (n=3) and Slovenia (n=14). Cardiovascular (20%), neurologic (16%), musculoskeletal (15%) and endocrine/nutritional/metabolic diseases (14%) were the most frequently studied clinical areas. Overall 112 (78%) of the studies reported EQ VAS results and 86 (60%) EQ-5D index scores, of which 27 (31%) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. Conclusions: Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened

Empirical equations for predicting merchantable breast height form factors for black alder (Alnus glutinosa (L.) Gaertn.

The aim of the study was to develop empirical equations for predicting breast height form factors for black alder (Alnus glutinosa). Data used to develop these equations were collected from 1496 felled trees from 136 stands. One hundred and 36 stands were located in northern and southern Poland, respectively. Separate equations to predict stand form factors (F5, F18) and tree form factors (f 5, f 18) were developed. These functions estimate form factor according to tree diameter and the average stand diameter or mean height. Equations can be used to estimate stem volume u.b. to top diameter u.b. of 5 cm or 18 cm (merchantable vol.)

Die Bedeutung des Studienaufbaus an der Medizinischen Hochschule Hannover für den Studienerfolg im Medizinstudium

Aim: The classical course structure for medicine in Germany is separated by three sections of the medical state examination. This structure is generally regarded as sensible and unchangeable. Because the special program structure at Hannover Medical School (MHH) has one integrated, rather than two separate study blocks, it is possible to examine the influence of structural modifications on the study success of different admission groups.Methods: The data was obtained from students admitted to the MHH between 2006 and 2008 in different admission quotas. Study success was defined as the successful completion of the entire program, but completion of the first section of the state examination was also analysed.Results: More students from the best "Abitur" (school leaving examinations) quota successfully completed their studies than those accepted via the selection process of the universities. The latter were more successful than students from the waiting list quota. However the successful graduates of this last group completed their studies more often within the prescribed period of study, although they needed more time for completing all parts of the first section of the state examination.Conclusion: The data shows that an integrated course structure can offer, in particular, students from the waiting list quota, the opportunity to compensate for delays in the first years of study. However, they do not provide any evidence which applicants are best suited to meet the social and professional requirements of trained doctors. Due to the complex structure of such longitudinal studies, our results allow more than one plausible interpretation.Zielsetzung: Der klassische, durch Teilprüfungen des medizinischen Staatsexamens unterteilte Aufbau des Medizinstudiums wird in der Regel als sinnvoll und deshalb unveränderbar hingenommen. Der Modellstudiengang der Medizinischen Hochschule Hannover (MHH) weist statt zwei Studienabschnitten nur einen integrierten fünfjährigen Studienabschnitt vor dem Praktischen Jahr (PJ) auf. In ihm kann deshalb der Einfluss struktureller Modifikationen auf den Studienerfolg verschiedener Zulassungsgruppen beispielhaft untersucht werden.Methodik: Betrachtet wurde der Studienerfolg der über die Vorabquoten und die drei Hauptquoten zwischen 2006 und 2008 an der MHH zugelassenen Studierenden. Studienerfolg wurde dabei als erfolgreicher Abschluss des gesamten Studiums definiert, ohne den Abschluss des ersten Abschnitts der ärztlichen Prüfung (M1) auszublenden. Ergebnisse: Die Studierenden aus der Abiturbesten-Quote schlossen ihr Studium an der MHH im Untersuchungszeitraum häufiger erfolgreich ab als die Studierenden, die über das Auswahlverfahren der Hochschulen an die MHH gekommen waren. Diese waren wiederum häufiger erfolgreich als MHH-Studierende aus der Wartezeitquote. Gleichzeitig waren letztere häufiger innerhalb der Regelstudienzeit mit dem Studium fertig, obwohl sie seltener innerhalb der Regelstudienzeit alle Teile der M1-Prüfung bestanden hatten.Schlussfolgerung: Die Daten verdeutlichen, dass ein integrierter Studienabschnitt vor dem PJ insbesondere für Studierende aus der Wartezeitquote die Chance bieten kann, Studienzeitverzögerungen aus den ersten Studienjahren im weiteren Verlauf des Studiums zu kompensieren. Ein einstufiger Studienabschnitt kann also die Möglichkeit erhöhen, zügiger zu studieren. Auch wenn die Komplexität der Daten verschiedene Erklärungsansätze erlaubt