Not So Rare: Errors of Metabolism during the Neonatal Period

During the neonatal period, the diagnosis of an error of metabolism (EM) was once thought to portend a poor prognosis or lethality. Over the past two decades, the prognosis of many EMs has changed. The critical aspect of the metabolic evaluation in a sick newborn is to rapidly identify whether there may be a metabolic problem. If there is a metabolic problem, the goal is to minimize the sequelae of the specific disorder. This review will explore how to approach and evaluate a newborn suspected of having an EM. A discussion of clinical and laboratory findings that often accompany EM will be included

Improving engineer reconnaissance in First Marine Division

This thesis explores alternative organizational designs to improve 1st Marine Division's engineer reconnaissance capability. It defines engineer reconnaissance as a complementary component of the divisions decentralized reconnaissance function, and addresses the evolution of engineer reconnaissance and its relevence to current and future maneuver commanders. This thesis expands on current deficiencies in training, organization, and coordination to define the engineer reconnaissance deficiency in terms of an organizational design problem. Four alternative solutions are proposed to develop and maintain an improved engineer reconnaissance core competency involving both structural and training changes. This thesis evaluates each alternative by three cost criteria (personnel, training, and lateral coordination requirements), and four benefit criteria (quality, acceptability, applicability, and maintainability) using an additive weighting and ranking method of analysis to determine an optimal course of action. Results of this analysis suggest that creating an engineer reconnaissance section at 1st Combat Engineer Battalion will provide the greatest engineer reconnaissance benefit to the division at the lowest costhttp://archive.org/details/improvingenginee00bantMajor, United States Marine CorpsApproved for public release; distribution is unlimited

Genome-Wide Patterns of Arabidopsis Gene Expression in Nature

Organisms in the wild are subject to multiple, fluctuating environmental factors, and it is in complex natural environments that genetic regulatory networks actually function and evolve. We assessed genome-wide gene expression patterns in the wild in two natural accessions of the model plant Arabidopsis thaliana and examined the nature of transcriptional variation throughout its life cycle and gene expression correlations with natural environmental fluctuations. We grew plants in a natural field environment and measured genome-wide time-series gene expression from the plant shoot every three days, spanning the seedling to reproductive stages. We find that 15,352 genes were expressed in the A. thaliana shoot in the field, and accession and flowering status (vegetative versus flowering) were strong components of transcriptional variation in this plant. We identified between ∼110 and 190 time-varying gene expression clusters in the field, many of which were significantly overrepresented by genes regulated by abiotic and biotic environmental stresses. The two main principal components of vegetative shoot gene expression (PCveg) correlate to temperature and precipitation occurrence in the field. The largest PCveg axes included thermoregulatory genes while the second major PCveg was associated with precipitation and contained drought-responsive genes. By exposing A. thaliana to natural environments in an open field, we provide a framework for further understanding the genetic networks that are deployed in natural environments, and we connect plant molecular genetics in the laboratory to plant organismal ecology in the wild

Midnight Song

Photograph of Van EPS-Banta Trio against Masquerade party backgroundhttps://scholarsjunction.msstate.edu/cht-sheet-music/13351/thumbnail.jp

Remote mining for in-situ waste containment. Final report

This document presents the findings of a study conducted at West Virginia University to determine the feasibility of using a combination of longwall mining and standard landfill lining technologies to mitigate contamination of groundwater supplies by leachates from hazardous waste sites

System-Agnostic Clinical Decision Support Services: Benefits and Challenges for Scalable Decision Support

System-agnostic clinical decision support (CDS) services provide patient evaluation capabilities that are independent of specific CDS systems and system implementation contexts. While such system-agnostic CDS services hold great potential for facilitating the widespread implementation of CDS systems, little has been described regarding the benefits and challenges of their use. In this manuscript, the authors address this need by describing potential benefits and challenges of using a system-agnostic CDS service. This analysis is based on the authors’ formal assessments of, and practical experiences with, various approaches to developing, implementing, and maintaining CDS capabilities. In particular, the analysis draws on the authors’ experience developing and leveraging a system-agnostic CDS Web service known as SEBASTIAN. A primary potential benefit of using a system-agnostic CDS service is the relative ease and flexibility with which the service can be leveraged to implement CDS capabilities across applications and care settings. Other important potential benefits include facilitation of centralized knowledge management and knowledge sharing; the potential to support multiple underlying knowledge representations and knowledge resources through a common service interface; improved simplicity and componentization; easier testing and validation; and the enabling of distributed CDS system development. Conversely, important potential challenges include the increased effort required to develop knowledge resources capable of being used in many contexts and the critical need to standardize the service interface. Despite these challenges, our experiences to date indicate that the benefits of using a system-agnostic CDS service generally outweigh the challenges of using this approach to implementing and maintaining CDS systems

Commitment to Breastfeeding in the Context of Phenylketonuria

Objective: To describe the meaning and importance of breastfeeding to mothers of infants with phenylketonuria (PKU). Design: Qualitative description. Setting: Mothers from the United States and Canada were recruited from the PKU Listserv and interviewed by telephone. Participants: Ten breastfeeding mothers with infants who had PKU and were younger than age 36 months. Methods: Mothers’ thoughts, decisions, and experiences of breastfeeding their infants with PKU were collected through telephone interviews. Interviews were transcribed verbatim, and data were analyzed using thematic descriptive analysis in the context of PKU. Results: Participants felt that that breastfeeding an infant with PKU was the healthiest choice and was therefore worth the labor. These women believed that this was what a loving mother would choose. As they continued to breastfeed their infants after diagnosis, the views of the participants changed. Initially they saw PKU as a disorder and felt that their infants were ill; later they felt that their infants were healthy in spite of PKU. Normal could mean a breastfeeding infant with PKU. Conclusion: Findings demonstrate the importance mothers attribute to breastfeeding and their willingness to invest considerable effort to breastfeed. Health care providers working with these mothers should help them strategize for success