Telling our stories of practice through the genre of the case report

Case reports are very well established in the literature. Despite the fact we live in an evidence-based age, in which the information that can be generated from a single case is positioned rather low on the hierarchy of evidence, case reports continue to be popular. It is the humanity of the accounts and the fact they are centered on the therapeutic encounter between a real patient and a treating clinical team that makes them so engaging and absorbing and that brings events to life and makes case reports such a valuable educational resource. There is quite a strong discourse in the literature around the genre of the case report and its value in capturing the uncertainty that can accompany the treatment of complex and unusual clinical problems, and the challenges that can arise for clinicians when anticipated outcomes do not occur. Case reports provide the means to record all manner of clinical events; including adverse events, rare and unusual clinical problems, and describe our roles and actions within them

Julie Rovner’s Health Care Policy and Politics A to Z: a review

Drawing on her vast experience covering health care policy on Capitol Hill, Julie Rovner has written explanations for over 300 key concepts that demystify the world of United States Government health care policy. In the newest edition of Health Care Policy and Politics A to Z, readers will find updated information on long-term health care spending, abortion, Medicaid and Medicare, health insurance and the uninsured, and the State Children’s Health Insurance Program (SCHIP). New entries reflect important changes in recent years and include the Medicare Modernization Act, abstinence education, electronic health records, health savings accounts, and Project BioShield. The book does have its gaps, especially as it relates to mental health. However, this book should become a standard reference for all health care professionals

Defect-Seeded Atomic Layer Deposition of Metal Oxides on the Basal Plane of 2D Layered Materials

Atomic layer deposition (ALD) on mechanically exfoliated 2D layered materials spontaneously produces network patterns of metal oxide nanoparticles in triangular and linear deposits on the basal surface. The network patterns formed under a range of ALD conditions and were independent of the orientation of the substrate in the ALD reactor. The patterns were produced on MoS2 or HOPG when either tetrakis(dimethylamido)titanium or bis(ethylcyclopentadienyl)manganese were used as precursors, suggesting that the phenomenon is general for 2D materials. Transmission electron microscopy revealed the presence, prior to deposition, of dislocation networks along the basal plane of mechanically exfoliated 2D flakes, indicating that periodical basal plane defects related to disruptions in the van der Waals stacking of layers, such as perfect line dislocations and triangular extended stacking faults networks, introduce a surface reactivity landscape that leads to the emergence of patterned deposition

Desempeño reproductivo de cerdas primerizas suplementadas con riboflavina durante la gestación

To evaluate the effects on litter size and expression of vascular endothelial growth factor (VEGF) and of uteroferrln, crossbreed gilts (n = 24) were supplemented with 0 or 60 mg dally of riboflavin during gestation. Litter size and average weight of piglets were determined at birth and at weaning. Samples of placenta were collected at farrowing to determine the relative expression of VEGF and uteroferrln. Supplemented and not supplemented gilts had 11.2 ± 0.6 and 8.2 ± 0.6 of total piglets born, respectively (P < 0.004). There were also corresponding increases In piglets born alive with 10.5 ± 0.6 versus 8.1 ± 0.6 (P< 0.01) and In total piglets weaned by the gilts supplemented with riboflavin (9.41 ± 0.6 and 7.5 ± 0.6, P < 0.05). A difference between treatments was found for total litter weight at birth, but not at weaning. Relative expression of VEGF was greater (P < 0.07) In the placenta of gilts supplemented with riboflavin than In those not supplemented, but no differences between treatments were observed In the relative expression of uteroferrln. The present results demonstrate that dally supplementation with 60 mg of riboflavin to gilts during gestation may Increase litter size, perhaps by Improving vascularization of the placenta, thus enhancing embryo/fetus survival.Para evaluar los efectos en el tamaño de lechigada y la expresión del factor de crecimiento endotelial vascular (VEGF; por sus siglas en inglés) y de la uteroferrlna, cerdas primerizas cruzadas (n = 24) se suplementaron con 0 o 60 mg de riboflavina diariamente durante toda la gestación. El tamaño de la lechigada y el peso individual de las crías se determinó al nacer y al destete. Se colectaron muestras de placenta al momento del parto para determinar la expresión relativa del VEGF y de la uteroferrina. Las cerdas suplementadas y no suplementadas parieron 11.2 ± 0.6 y 8.2 ± 0.6 cerditos totales, respectivamente (P < 0.004). Hubo diferencias análogas en el número de cerditos nacidos vivos de 10.5 ± 0.6 contra 8.1 ± 0.6 (P < 0.01) y en el número total de cerditos destetados (9.41 ± 0.6 y 7.5 ± 0.6, P < 0.05). Se encontró diferencia entre los tratamientos para el peso total de la lechigada al nacer pero no al destete. La expresión relativa del VEGF fue mayor (P < 0.07) en la placenta de cerdas suplementadas con riboflavina que en las controles, pero los tratamientos no difirieron en la expresión relativa de la uteroferrina. Los resultados presentes indican que la suplementación con 60 mg diarios de riboflavina a cerdas primerizas durante la gestación puede incrementar el tamaño de la lechigada, quizás mediado por una mejor vascularización de la placenta y por consiguiente mejorando la supervivencia del embrión/feto

Correlación del largo y espesor del pelo con el potencial genético de producción en ganado Holstein puertorriqueño.

To demonstrate that the Holstein cow population of Puerto Rico presents differences in hair coat characteristics, hair samples were obtained from the rump, ribs and shoulder of cows visually characterized either as short (SH) or normal haired (NH). Hair length and width were measured and correlated with the genetic potential of cows for these traits: duration of productive life, dairy conformation, pregnancy rate, milk production, milk fat, and somatic cell count (SCC). The cows henotypically identified as SH had shorter but wider hairs than NH cows. Length of hair from the rump and ribs was inversely correlated with productive life duration and directly correlated with SCC. In addition, width of the rump and rib hair was directly correlated with milk production but inversely correlated with productive life. This variability in hair coat length and width of Holstein cattle in Puerto Rico may affect productive traits. Identification of Holstein cattle with SH phenotype should continue, thus to facilitate further genetic evaluation of this trait with the goal of improving efficiency of the local dairy industry.Para evidenciar que en Puerto Rico existe ganado Holstein con diferencias en el largo y el espesor del pelaje, se obtuvieron muestras de pelos de la grupa, costillas y hombro de vacas identificadas visualmente como de pelo corto (SH) o pelo normal (NH). Se midió el largo y el espesor del pelo, y se correlacionaron estas medidas con el potencial genético de las vacas para los rasgos de duración de vida productiva, conformación lechera, tasa de preñez, producción de leche, grasa en la leche y conteo de células somáticas (SCC). Las vacas identificadas como SH presentaron pelo más corto pero más grueso que aquellas identificadas como NH. El largo del pelo en la grupa y costillas se correlacionó inversamente con la vida productiva, y directamente con el SCC. Además, el espesor del pelo en la grupa y costillas se correlacionó directamente con la producción de leche, pero inversamente con la vida productiva de las vacas. En el ganado Holstein de Puerto Rico existe variabilidad en cuanto al largo y espesor del pelaje, lo cual puede impactar su desempeño productivo. Se debe seguir identificando ganado Holstein con el fenotipo SH para realizar investigación genética adicional en busca de mayor eficiencia de la industria lechera local

Optimal Control of Parallel Queues for Managing Volunteer Convergence

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163497/2/poms13224.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163497/1/poms13224_am.pd

Aspectos económicos de la evaluación del daño de incendios

La evaluación de los daños causados por incendios es un problema difícil porque los efectos físicos del incendio sobre el bosque y el flujo de producción de bienes y servicios del bosque, particularmente los productos no comerciales, son prácticamente desconocidos. El daño de los incendios al bosque incluye no sólo el valor de mercado de madera comerciable y el crecimiento joven destruido, sino también pérdidas intangibles directas e indirectas a valores de cuencas hidrográficas, valores económicos y sociales, diversidad biológica, y otros valores no comerciales. Por lo tanto, la tarea de mejorar la evaluación de daño de incendios debe ser multidisciplinaha. Una clave para la medición de daño es comprender los factores que influyen en el flujo de servicios de un activo (recurso) natural. Muchos de los bienes y servicios productos del bosque como el habitat de fauna silvestre, especies amenazadas y en peligro de extinción, la diversidad biológica, o vistas escénica no son vendidas en mercados organizados, por lo tanto no hay un mecanismo para asociar el valor de servicios a el valor de reemplazo del activo perdido. Implantar un sistema de evaluación de daño de incendios requiere identificar los bienes y servicios provistos por el recurso natural afectado; determinar cómo la cantidad y calidad de éstos se afectan; evaluar el valor de la reducción en cada flujo de bienes y servicios por la duración del efecto del incendio usando una tasa de descuento para convertir la reducción en el flujo de cada bien o servicio a precios actuales; y estimar los cambios en el flujo por la vida de los efectos. El valor resultante es una estimación del daño al recurso natural ocasionado por el incendio.Fire management is a difficult problem for managers because the physical effects of fire on the forest and the production stream of goods and senvices from the forest, particularly nonmarket outputs, is largely unknown. Forest fire damage includes not only the value of merchantable timber and young growth destroyed, but also direct indirect, and intangible losses to watershed values, social and economic values, biodiversity and other market and nonmarket values. Therefore, the task of improving fire damage assessment must be multidisciplinary. One key to damage measurement is understanding the factors that influence the flow ofservices from a natural asset Many of the forest stream of goods and services such as wildlife habitat, threatened and endangered species, biodiversity, or scenic vistas are not sold in organizad markets, so there is no mechanism to associate the value of services to replacement values of the assets lost. To implement a damage assessment system requires first, to identify the services provided by the natural resource affected. Second, to determine how the quantity and quality of those services are affected. Next place a value on the reduction in each service flow overthe duration of the fire effect using a discount rate to convert the reduction in each service flow into present dollars. Finally the flow changas are sum overthe life ofthe effects. The resulting value is an estimate of the damage to the natural resource caused by fire

Potential Effects of Climate Change on Fire Behavior, Economic Susceptibility and Suppression Costs in Mediterranean Ecosystems: Córdoba Province, Spain

The potentially large ecological, economic, and societal impacts of climate change makes it a significant problem of the 21st century. These consequences have led to tremendous development in climate change scenarios and new technologies to increase knowledge on the effect and efficiency of mitigation and adaptation measures. Large fires will occur at a higher rate than currently because of lower fuel moisture content resulting in a lower resistance to burning. This is also evidenced by more extreme fire behavior that contributes to higher economic impacts, suppression difficulties and suppression costs. The economic susceptibility concept integrates a set of economic valuation approaches for valuing timber and non-timber resources, considering the fire behavior, and as a consequence, the net value changes for each resource. Flame length increased by 4.6% to 15.69%, according to the different future climate scenarios. Climate change is expected to cause widespread changes to economic susceptibility and suppression costs because of higher flame length and fire intensity. Therefore, our outcomes show an increase in the economic susceptibility of Córdoba Province in the medium and long term (2041–2070) between 6.05% and 25.99%, respectively. In addition, we have found an increase between 65.67% and 86.73% in suppression costs in the last decade. The digital version of the economic susceptibility model using Geographic Information Systems improves its operational capabilities enhancing also its dynamism and simplicity to accept modifications and predictions revisions