Pennsylvania Gardener Selects Plant Evaluation Program

The Pennsylvania Gardener Selects (PGS) program represents a unique educational, evaluation, and marketing program that expands the opportunities for Master Gardener input and activity while benefiting the green industry and gardeners statewide. Through the PGS program, Master Gardeners have learned to evaluate plants, develop educational programs for the general public, and participate directly in the selection and marketing of superior plants for the consumer and commercial marketplace. The PGS program has been warmly received by the industry. Since 1999, the PGS program has grown to include 44 gardens in 39 of the 67 counties of Pennsylvania

Freud'dan Lacan'a Kaygı

Lacan’ın kaygı hakkındaki görüşleri Freud’un “Ketlemeler, Semptom ve Kaygı” adlı çalışması etrafında şekillenmektedir. Bu çalışma Lacan’ın Kaygı adını verdiği onuncu seminerine bağlı kalarak, Freud ve Lacan’ın kaygı hakkındaki görüşleri arasındaki ayrımlara ve ortak noktalara odaklanmıştır. Lacan, Freud’dan farklı olarak kaygının eksiğin eksik olmasıyla ilişkili olduğunu söylemektedir. Bu bağlamda bu çalışmada kaygı, öznenin oluşumunda arzu ve jouissance ilişkisi üzerinden açıklanmıştır. Freud’a göre kaygının sebebi kastre olma korkusu iken, Lacan’a göre kaygının sebebi kastre olamama korkusu, dolayısıyla da anne tarafından yutulma riskidir. Bu anlamda, kaygı Başka’nın arzusu ile doğrudan ilişkilidir. Özne, Başka’nın bakışında nasıl göründüğünü bilmediği bir noktada, “Benden ne istiyor?” sorusunu sorduğu anda kaygılanmaktadır. Bu bağlamda, Lacan “Kaygının nesnesi yok değildir.” diyerek kaygının nesnesinin küçük a nesnesi olduğunu ifade etmektedir. Bu çalışmada hem kaygının nesnesi hem de arzunun nesne nedeni olan küçük a nesnesinin doğası, kaygıyla olan ilişkisi üzerinden ele alınmıştır. Bununla birlikte, fobi, fetişizm, eyleme dökme ve eyleme geçme kavramları kaygı karşısında koruyucu mekanizmalar olmaları üzerinden ele alınmış; Lacanyen klinik yapılar olan nevrozda, perversiyonda ve psikozda kaygının nasıl deneyimlendiği ve bu yapıların kaygıyla başa çıkmak için kullandığı mekanizmalar vaka örnekleri üzerinden incelenmiştir.Publisher's Versio

Fertilizante organomineral na produção de mudas de Eucalyptus benthamii.

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Predictors and Impact of Intensification of Antihyperglycemic Therapy in Type 2 Diabetes: Translating Research into Action for Diabetes (TRIAD)

ObjectiveThe purpose of this study was to examine the predictors of intensification of antihyperglycemic therapy in patients with type 2 diabetes; its impact on A1C, body weight, symptoms of anxiety/depression, and health status; and patient characteristics associated with improvement in A1C.Research design and methodsWe analyzed survey, medical record, and health plan administrative data collected in Translating Research into Action for Diabetes (TRIAD). We examined patients who were using diet/exercise or oral antihyperglycemic medications at baseline, had A1C >7.2%, and stayed with the same therapy or intensified therapy (initiated or increased the number of classes of oral antihyperglycemic medications or began insulin) over 18 months.ResultsOf 1,093 patients, 520 intensified therapy with oral medications or insulin. Patients intensifying therapy were aged 58 +/- 12 years, had diabetes duration of 11 +/- 9 years, and had A1C of 9.1 +/- 1.5%. Younger age and higher A1C were associated with therapy intensification. Compared with patients who did not intensify therapy, those who intensified therapy experienced a 0.49% reduction in A1C (P < 0.0001), a 3-pound increase in weight (P = 0.003), and no change in anxiety/depression (P = 0.5) or health status (P = 0.2). Among those who intensified therapy, improvement in A1C was associated with higher baseline A1C, older age, black race/ethnicity, lower income, and more physician visits.ConclusionsTreatment intensification improved glycemic control with no worsening of anxiety/depression or health status, especially in elderly, lower-income, and minority patients with type 2 diabetes. Interventions are needed to overcome clinical inertia when patients might benefit from treatment intensification and improved glycemic control

Primary Language, Income and the Intensification of Anti-glycemic Medications in Managed Care: the (TRIAD) Study

BACKGROUND Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity. OBJECTIVE To examine the associations between primary language, income, and medication intensification. DESIGN Cohort study with 18-month follow-up. PARTICIPANTS One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care. MEASUREMENTS Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c ≥ 8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan. RESULTS Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes 75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race. CONCLUSIONS Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care

T-cell metagene predicts a favorable prognosis in estrogen receptor-negative and HER2-positive breast cancers

Introduction: Lymphocyte infiltration (LI) is often seen in breast cancer but its importance remains controversial. A positive correlation of human epidermal growth factor receptor 2 (HER2) amplification and LI has been described, which was associated with a more favorable outcome. However, specific lymphocytes might also promote tumor progression by shifting the cytokine milieu in the tumor. Methods: Affymetrix HG-U133A microarray data of 1,781 primary breast cancer samples from 12 datasets were included. The correlation of immune system-related metagenes with different immune cells, clinical parameters, and survival was analyzed. Results: A large cluster of nearly 600 genes with functions in immune cells was consistently obtained in all datasets. Seven robust metagenes from this cluster can act as surrogate markers for the amount of different immune cell types in the breast cancer sample. An IgG metagene as a marker for B cells had no significant prognostic value. In contrast, a strong positive prognostic value for the T-cell surrogate marker (lymphocyte-specific kinase (LCK) metagene) was observed among all estrogen receptor (ER)-negative tumors and those ER-positive tumors with a HER2 overexpression. Moreover ER-negative tumors with high expression of both IgG and LCK metagenes seem to respond better to neoadjuvant chemotherapy. Conclusions: Precise definitions of the specific subtypes of immune cells in the tumor can be accomplished from microarray data. These surrogate markers define subgroups of tumors with different prognosis. Importantly, all known prognostic gene signatures uniformly assign poor prognosis to all ER-negative tumors. In contrast, the LCK metagene actually separates the ER-negative group into better or worse prognosis