Patient Protection and Affordable Care Act of 2010: Summary, Analysis, and Opportunities for Advocacy for the Academic Emergency Physician

The Patient Protection and Affordable Care Bill, commonly referred to as the “Health Care Bill” or the “Health Care Reform Bill,” was enacted in March 2010. This article is a review and analysis of the sections of this Act that are relevant to researchers and teachers of emergency care. The purpose of this document is to serve as a citable reference for interested parties and a reference to quickly locate the sections of the Bill relevant to academic emergency physicians. When appropriate, text was copied verbatim from the Bill. The source of the downloaded Act, and the page numbers of the text sections, are provided to help the reader to find the sections described. This review is presented in two parts. Part I presents 11 sections extirpated from the Act, with short interpretations of the significance of each section. Part II presents an analysis of the sections that the authors believe represent opportunities for emergency care researchers and teachers to make the most impact, through active involvement with the various departments and agencies of the federal government that will be charged with interpreting and implementing this Act. The Act contains sections that could lead to new funding opportunities for research in emergency care, especially for comparative clinical trials and clinical studies that focus on integration and efficiency of health care delivery. The Act will establish several new institutes, centers, and committees that will create policies highly relevant to emergency care. The authors conclude that this Act can be expected to have a profound influence on research and training in emergency care

Clinicians\u27 attitudes towards borderline personality disorder and post-traumatic stress disorder : implications of gender and a diagnostic label

The purpose of the current study was to investigate mental health clinicians\u27 diagnostic assessments of individuals who have features associated with both Borderline Personality Disorder (BPD) and Posttraumatic Stress Disorder (PTSD), the effect of gender on their assessments, and associated attitudes. Recruitment resulted in a participant sample of 38 mental health clinicians who completed the survey in its entirety. Most of the participants identified as white (71.2%), were female (61.5%), worked in a community mental health center setting (76.9%) and had their LCSW (25%) or MA/MS in counseling (28.8%). Three surveys were evenly distributed between potential participants and each included a vignette describing an individual with features consistent with BPD and PTSD which differed only in gender; male, female, or no gender pronouns. The vignette was followed by an adapted form of the Attitude Towards Personality Disorder Questionnaire created by Bowers and Allen (2006) to assess participant attitudes to the individual they had diagnosed. Because of the small sample size, significance of the findings for diagnosis provision across vignettes could not be determined, though participants diagnosed the vignettes primarily with BPD or PTSD in similar frequencies. Findings from the APDQ indicated more negative attitudes towards individuals diagnosed with BPD than other diagnoses. Implications for further research include replicating the current study with a larger sample size. Indications for clinical practice are also discussed relating to pervasive negative attitudes towards BPD and the interaction of these attitudes with stigma, gender bias, and within clinical relationships

Association of prenatal alcohol exposure and offspring depression:A negative control analysis of maternal and partner consumption

Background: Previous research has suggested that intrauterine alcohol exposure is associated with a variety of adverse outcomes in offspring. However, few studies have investigated its association with offspring internalizing disorders in late adolescence. Methods: Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated the associations of maternal drinking in pregnancy with offspring depression at age 18 and 24 (n=13,480). We also examined partner drinking as a negative control for intrauterine exposure for comparison. Results: Offspring of mothers that consumed any alcohol at 18weeks gestation were at increased risk of having a diagnosis of depression (fully adjusted model: OR 1.17, 95% CI 1.02 to 1.34), but there was no clear evidence of association between partners’ alcohol consumption at 18weeks gestation during pregnancy and increased risk of offspring depression (fully adjusted model: OR 0.87, 95% CI 0.74 to 1.01). Postestimation tests found a positive difference between the association of maternal and partner alcohol use on offspring depression, showing a stronger association for maternal compared with partner alcohol use (OR 1.41, CI 1.07 to 1.84). Conclusions: Maternal drinking in pregnancy was associated with increased risk of offspring depression at age 18. Residual confounding may explain this association, but the negative control comparison of paternal drinking provides some evidence that it may be causal, and this warrants further investigation

An Ab Initio Approach Towards Engineering Fischer-Tropsch Surface Chemistry

One of the greatest societal challenges over the next decade is the production of cheap, renewable energy for the 10 billion people that inhabit the earth. This will require the development of various different energy sources potentially including fuels derived from methane, coal, and biomass and alternatives sources such as solar, wind and nuclear energy. One approach will be to synthesize gasoline and other fuels from simpler hydrocarbons such as CO derived from methane or other U.S. based sources such as coal. Syngas (CO and H{sub 2}) can be readily converted into higher molecular weight hydrocarbons through Fischer-Tropsch synthesis. Fischer-Tropsch synthesis involves the initiation or activation of CO and H{sub 2} bonds, the subsequent propagation steps including hydrogenation and carbon-carbon coupling, followed by chain termination reactions. Commercially viable catalysts include supported Co and Co-alloys. Over the first two years of this project we have used ab initio methods to determine the adsorption energies for all reactants, intermediates, and products along with the overall reaction energies and their corresponding activation barriers over the Co(0001) surface. Over the third year of the project we developed and advanced an ab initio-based kinetic Monte Carlo simulation code to simulate Fischer Tropsch synthesis. This report details our work over the last year which has focused on the derivation of kinetic parameters for the elementary steps involved in FT synthesis from ab initio density functional theoretical calculations and the application of the kinetic Monte Carlo algorithm to simulate the initial rates of reaction for FT over the ideal Co(0001) surface. The results from our simulations over Co(0001) indicate the importance of stepped surfaces for the activation of adsorbed CO. In addition, they demonstrate that the dominant CH{sub x}* surface intermediate under steady state conditions is CH*. This strongly suggests that hydrocarbon coupling occurs through reaction with the adsorbed CH*

Identificación y evaluación de algunos hongos con actividad celulásica aislados en Ecuador

Fungal samples were collected in the Western and Eastern Andean foothills of Ecuador in the provinces of Pichincha, Sucumbíos, Orellana and Santo Domingo de los Tsáchilas. The fungi were aseptically isolated and increased on Potato Dextrose Agar (PDA) or Malt Agar (MA). Their growth characteristics were recorded, and molecularly identified on the basis of ribosomal RNA internal transcribed spacer (ITS) region. The sequences were compared with other similar sequences on GenBank for phylogenetic analysis and identification. The isolated and identified strains were plated on Carboxymethylcellulose (CMC) to evaluate their enzymatic capabilities to degrade cellulose. Diameters (in mm) of the halos of hydrolysis were continuously monitored during 7-14 days of growth. The halos in strains H23.2 and H24 of the genus Pestalotiopsis and of L4 of the genus Neonothopanus had halo diameters significantly bigger than most of the other fungal samples tested. Increased extracellulolytic activity was recorded in the supernatants extracted from the genera Pestalotiopsis, Neonothopanus, and Gymnopilus after 14 days of culture in the 24-hour interval. This enzyme activity, in some cases, was not proportional to the protein concentration in μg/ml of the supernatants extracted from the different culturesMuestras de hongos fueron recolectadas en las estribaciones occidentales y orientales de Ecuador en las provincias de Pichincha, Sucumbíos, Orellana y Santo Domingo de los Tsáchilas. Los hongos fueron asépticamente aislados y multiplicados en Agar Papa Dextrosa (PDA) o Agar Malta (MA). Se observó su crecimiento y luego fueron identificados molecularmente en base a la secuencia de la región ITS1 e ITS2 del ADN ribosomal. Las secuencias obtenidas fueron comparadas con otras similares en Genbank para su análisis filogenético e identificación. Las cepas aisladas e identificadas fueron sembradas en Carboximetilcelulosa (CMC) para evaluar sus capacidades enzimáticas de degradación celulósica. Diámetros (en mm) de los halos de hidrólisis fueron continuamente monitoreados durante 7 y 14 días de crecimiento, observándose halos más grandes en las cepas H23.2 y H24 del género Pestalotiopsis y la de L4 del género Neonothopanus con medias significativas. Mayor actividad extracelulásica se registró en los sobrenadantes extraídos de los géneros Neonothopanus, Pestalotiopsis y Gymnopilus a los 14 días de cultivo en el intervalo de 24 h. Esta actividad enzimática en algunos casos no guardó una relación proporcional con la concentración proteica en μg/ml de los sobrenadantes extraídos de los diferentes cultivos

Spectroscopic Investigation of the Formation of Radiolysis By-Products By 13/9 MeV Linear Accelerator of Electrons (LAE) in Salt Solutions

In the near-field chemistry of a salt repository, the radiolytically-induced redox reactions in concentrated saline solution are of particular importance because the radiolysis of saline solutions results in oxidizing chlorine-containing species, which may oxidize actinide species to higher oxidation states. If the brines are irradiated, the solutions containing radiolytic species such as hypochlorite, hypochlorous acid or hydrogen peroxide, their pH and Eh may be altered. The oxidation and complexation states of actinides, which might be present in the salt brine, will change thus influencing their speciation and consequently their mobility. Furthermore, radiolytically formed oxidizing species such as ClO- or H2O2 may enhance the corrosion of the canister material. Therefore, radiation effects on salt brines must be integrated into the database, which described the chemical processes near a disposal site. Investigations in that context usually focus on the radiation chemistry of solid NaCl however our focus is on the radiolytic products, which are formed when salt brines are irradiated by a 10 MeV linear accelerator of electrons (LAE). We attempt to quantify the irradiation-induced formation of typical radiolysis by-products such as the hypochlorite ion (OCl-) by using a 13/9 MeV LAE with doses between 120 KGy to 216 KGy while monitoring the pH of the brine solutions

Climate change curricula for adult audiences in agriculture and forestry: A review

Agricultural and forestry advisers and other technical service providers play an important role in supporting farmers and foresters to adapt to climate change. However, not all agricultural and forestry advisers are comfortable talking about climate change with land managers. While there is a demonstrated interest related to climate related professional development, few examples of curricula developed with the express purpose of serving this audience and a systematic review of these curricula has not been conducted. To address this gap, we reviewed 12 curricula which were developed and implemented between 2001 and 2017. The goal of this review is to apply the lessons learned from a range of climate change-focused curricula to new, regionally or sector-specific educational programs targeting both agricultural advisers and innovative farmers. Our findings suggest that developers of future educational programs consider the following: (a) the specific needs of their audience, including topical interests and learning needs; (b) the use of interdisciplinary teams for curricula development; (c) trade-offs associated with inclusivity and depth of course content; and (d) the advantages of project-based education approaches suited for adult learning audiences. By applying these concepts to future curricula, these curricula are likely to have the greatest level of impact

The Role of Acceptance and Commitment Therapy in Cardiovascular and Diabetes Healthcare: A Scoping Review

Acceptance and commitment therapy (ACT) is an adapted form of cognitive behavioural therapy. ACT focuses on how thinking affects behaviour and promotes psychological flexibility. The prevalence of psychological distress among people living with cardiovascular disease (CVD) and/or type 2 diabetes mellitus (T2DM) is high, and ACT may offer an alternative treatment approach. This scoping review explored the use of ACT as an intervention to support adults living with CVD and/or T2DM. A systematic search of the literature resulted in the inclusion of 15 studies. Studies were reviewed using the Joanna Briggs Institute approach to conducting scoping reviews. Most studies (n = 13) related to people living with T2DM, and most (n = 10) used a pre-post design, four studies were randomised controlled trials, and one was a qualitative study. Eight studies reported an improvement in the outcome(s) assessed post-intervention, suggesting that ACT was an acceptable and valid intervention to support people living with CVD or T2DM. However, studies were underpowered and only limited studies involved people living with CVD. ACT was assessed as a valuable approach to improve a range of patient-reported outcomes for those living with CVD or T2DM, and further research involving robust study designs and larger cohorts are warranted

Requirement of Male-Specific Dosage Compensation in Drosophila Females—Implications of Early X Chromosome Gene Expression

Dosage compensation equates between the sexes the gene dose of sex chromosomes that carry substantially different gene content. In Drosophila, the single male X chromosome is hypertranscribed by approximately two-fold to effect this correction. The key genes are male lethal and appear not to be required in females, or affect their viability. Here, we show these male lethals do in fact have a role in females, and they participate in the very process which will eventually shut down their function—female determination. We find the male dosage compensation complex is required for upregulating transcription of the sex determination master switch, Sex-lethal, an X-linked gene which is specifically activated in females in response to their two X chromosomes. The levels of some X-linked genes are also affected, and some of these genes are used in the process of counting the number of X chromosomes early in development. Our data suggest that before the female state is set, the ground state is male and female X chromosome expression is elevated. Females thus utilize the male dosage compensation process to amplify the signal which determines their fate