8,297 research outputs found

    The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK

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    This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of ‘knowledge structures’ when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests

    A Time for Courage: The Royal Air Force in the European War, 1939-1945

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    DNMT inhibitors reverse a specific signature of aberrant promoter DNA methylation and associated gene silencing in AML

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    <b>Background</b>. Myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are neoplastic disorders of hematopoietic stem cells. DNA methyltransferase inhibitors (DNMTi), 5-azacytidine (AzaC) and 5-aza-2’-deoxycytidine (Decitabine), benefit some MDS/AML patients. However, the role of DNMTi-induced DNA hypomethylation in regulation of gene expression in AML is unclear.<p></p> <b>Results. </b> We compared the effects of AzaC on DNA methylation and gene expression using whole-genome single-nucleotide bisulfite-sequencing (WGBS) and RNA-sequencing in OCI-AML3 (AML3) cells. For data analysis, we used an approach recently developed for discovery of differential patterns of DNA methylation associated with changes in gene expression, that is tailored to single-nucleotide bisulfite-sequencing data (Washington University Interpolated Methylation Signatures (WIMSi)). By this approach, a subset of genes upregulated by AzaC was found to be characterized by AzaC-induced signature methylation loss flanking the transcription start site. These genes are enriched for genes increased in methylation and decreased in expression in AML3 cells compared to normal hematopoietic stem and progenitor cells. Moreover, these genes are preferentially upregulated by Decitabine in human primary AML blasts, and control cell proliferation, death and development. <p></p> <b>Conclusions.</b> Our WGBS and WIMSi data analysis approach has identified a set of genes whose is methylation and silencing in AML is reversed by DNMTi. These genes are good candidates for direct regulation by DNMTi, and their reactivation by DNMTi may contribute to therapeutic activity. This study also demonstrates the ability of WIMSi to reveal relationships between DNA methylation and gene expression, based on single-nucleotide bisulfite-sequencing and RNA-seq data.<p></p&gt

    The Wood Turtle, Glyptemys insculpta, at River Denys: A Second Population for Cape Breton Island, Nova Scotia

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    The Wood Turtle, Glyptemys insculpta, population at River Denys, Inverness County, Cape Breton Island, Nova Scotia, was unknown except locally until listed in a provincial survey in 1995. Subsequently a hatchling was photographed at McLennan Brook on 17 September 1999, and three adult males were photographed between 14 and 19 September 2000. Two adult females were photographed at South Side River Denys on 18 June 2001. An excavated nest and empty egg shells were located at the same time on a stony-gravel bank at the outflow of McLennan Brook, and one sub-adult male was found at the edge of a hay field on 19 August 2001. Additional observations made of a nesting site and five basking sites, mostly along the main branch of River Denys, provide further evidence that a breeding population of Wood Turtles exists in River Denys watershed

    A Simulation Study Of The Impact Of Forecast Recovery For Control Charts Applied To ARMA Processes

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    Forecast-based schemes are often used to monitor autocorrelated processes, but the resulting forecast recovery has a significant effect on the performance of control charts. This article describes forecast recovery for autocorrelated processes, and the resulting simulation study is used to explain the performance of control charts applied to forecast errors
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