Assuring Excellence, or Merely Reassuring - Policy and Practice in Promoting Mediator Quality

Mediation practice in the United States has grown substantially over the last two decades, as has the number of people offering to serve as mediators. This growth has led some to argue that competency standards are needed to protect consumers and promote the integrity of mediation processes. While professionals and researchers have tried over the past fifteen years or so to define what mediators do and better understand how to do it well, alternative dispute resolution (ADR) programs, roster administrators, and parties seeking neutrals have had to make day-to-day choices

Congress, the Executive Brand and the Dispute Resolution Process

This rapid, recent expansion in administrative proceedings and related litigation is not, of course, a unique or isolated phenomenon. It is part of a greatly increased reliance on our judiciary to decide all manner of social, political, and economic issues. Much of this litigation may be an inexorable result of complicated social and economic interactions, heightened resort to regulatory schemes to deal with environmental, health and safety, civil rights and welfare concerns, and other historical factors. However, the point has been reached where much of it is unnecessary, unproductive, and less than ideally suited for many of the conflicts involved. More and more administrative, business, regulatory, employment, benefit, and other decisions are being made by judicial officers pursuant to marginally relevant criteria in forums not always conducive to efficient decisionmaking.

Mesophyll diffusion conductance to CO 2: An unappreciated central player in photosynthesis

Mesophyll diffusion conductance to CO 2 is a key photosynthetic trait that has been studied intensively in the past years. The intention of the present review is to update knowledge of g m, and highlight the important unknown and controversial aspects that require future work. The photosynthetic limitation imposed by mesophyll conductance is large, and under certain conditions can be the most significant photosynthetic limitation. New evidence shows that anatomical traits, such as cell wall thickness and chloroplast distribution are amongst the stronger determinants of mesophyll conductance, although rapid variations in response to environmental changes might be regulated by other factors such as aquaporin conductance.Gaps in knowledge that should be research priorities for the near future include: how different is mesophyll conductance among phylogenetically distant groups and how has it evolved? Can mesophyll conductance be uncoupled from regulation of the water path? What are the main drivers of mesophyll conductance? The need for mechanistic and phenomenological models of mesophyll conductance and its incorporation in process-based photosynthesis models is also highlighted.The study was financially supported by the Estonian Ministry of Science and Education (grant SF1090065s07), the Spanish Ministry of Science and Innovation through projects BFU2008-01072 (MEFORE), AGL2009-11310/AGR, BFU2011-23294 (MECOME) and CGL2009-13079-C02-01 (PALEOISOTREE), and the European Commission through European Regional Fund (the Estonian Center of Excellence in Environmental Adaptation), and the Marie Curie project MC-ERG-246725 (FP7). J.P.F. is supported by the Ramón y Cajal program (RYC-2008-02050). A.G. had a Swiss National Science Fellowship (PA00P3_126259). M.M.B. and C.R.W are supported by Future Fellowships from the Australian Research Council (FT0992063 and FT100100024). C.D. was supported by a grant from the French government and by the cooperation project Tranzfor (Transferring Research between EU and Australia–New Zealand on Forestry and Climate Change, PIRSES-GA-2008-230793) funded by the European Union

Age of Child, More than HPV Type, Is Associated with Clinical Course in Recurrent Respiratory Papillomatosis

Background: RRP is a devastating disease in which papillomas in the airway cause hoarseness and breathing difficulty. The disease is caused by human papillomavirus (HPV), 6 or 11 and is very variable. Patients undergo multiple surgeries to maintain a patent airway and in order to communicate vocally. Several small studies have been published in which most have noted that HPV 11 is associated with a more aggressive course. Methodology/Principal Findings: Papilloma biopsies were taken from patients undergoing surgical treatment of RRP and were subjected to HPV typing. 118 patients with juvenile-onset RRP with a least 1 year of clinical data and infected with a single HPV type were analyzed. HPV 11 was encountered in 40% of the patients. By our definition, most of the patients in the sample (81%) had run an aggressive course. The odds of a patient with HPV 11 running an aggressive course were 3.9 times higher that that of patients with HPV 6 (Fisher's exact p=0.017). However, clinical course was more closely associated with age of the patient (at diagnosis and at the time of the current surgery) than with HPV type. Patients with HPV 11 were diagnosed at a younger age (2.4y) than were those with HPV 6 (3.4y) (p=0.014). Both by multiple linear regression and by multiple logistics regression HPV type was only weakly associated with metrics of disease course when simultaneously accounting for age. Conclusions/Significance Abstract: The course of RRP is variable and a quarter of the variability can be accounted for by the age of the patient. HPV 11 is more closely associated with a younger age at diagnosis than it is associated with an aggressive clinical course. These data suggest that there are factors other than HPV type and age of the patient that determine disease course. © 2008 Buchinsky et al

Salinity-mediated transcriptional and post-translational regulation of the Arabidopsis aquaporin PIP2;7.

Salt stress triggers a simultaneous transcriptional repression and aquaporin internalization to modify root cell water conductivity. Plasma membrane intrinsic proteins (PIPs) are involved in the adjustment of plant water balance in response to changing environmental conditions. In this study, Arabidopsis wild-type (Col-0) and transgenic lines overexpressing PIP2;7 were used to investigate and compare their response to salt stress. Hydraulic conductivity measurements using a high-pressure flowmeter (HPFM) revealed that overexpression of PIP2;7 induced a sixfold increase in root hydraulic conductivity of four week-old Arabidopsis thaliana plants compared to WT. Exposure to a high salt stress (150 mM NaCl) triggered a rapid repression of overall aquaporin activity in both genotypes. Response to salt stress was also investigated in 8 day-old seedlings. Exposure to salt led to a repression of PIP2;7 promoter activity and a significant decrease in PIP2;7 mRNA abundance within 2 h. Concomitantly, a rapid internalization of fluorescently-tagged PIP2;7 proteins was observed but removal from the cell membrane was not accompanied by further degradation of the protein within 4 h of exposure to salinity stress. These data suggest that PIP transcriptional repression and channel internalization act in concert during salt stress conditions to modulate aquaporin activity, thereby significantly altering the plant hydraulic parameters in the short term

Exposure to high nitrogen triggered a genotype‐dependent modulation of cell and root hydraulics, which can involve aquaporin regulation

Root nitrogen acquisition has been proposed to be regulated by mass flow, a process by which water flow brings nutrients to the root surface, depending on a concerted regulation of the root hydraulic properties and stomatal conductance. As aquaporins play an important role in regulating transcellular water flow, we aimed at evaluating the short-term effect of high nitrogen (HN)availability on the dynamics of hydraulic parameters at both the root and cell level and the regulation of aquaporins. The effect of short-term HN (8 mM NO3-) treatment was investigatedon 12 diverse 15-day-old maize genotypes. Root exposure to HN triggered a rapid (< 4 h) increasein the root hydraulic conductivity (Lpr) in seven genotypes while no Lpr variation was recorded for the others, allowing the separation of the genotypes into two groups (HN-responsive and HNnon- responsive). A remarkable correlation between Lpr and the cortex cell hydraulic conductivity (Lpc) was observed. However, while differences in gas exchange parameters were also observed, the variations were genotype-specific and not always correlated with the root hydraulic parameters. We then investigated whether HN-induced Lpr variations were linked to the activity and regulation of plasma membrane PIP aquaporins. While some changes in PIP mRNA levels were detected, this was not correlated with the protein levels. On the other hand, the rapid variation in Lpr observed in the B73 genotype was correlated with the PIP protein abundance in the plasma membrane, highlighting PIP posttranslational mechanisms in the short-term regulation of root hydraulic parameters in response to HN treatment

The submental island flap is a viable reconstructive option for a variety of head and neck ablative defects

The submental island flap (SIF) is a pedicled flap based upon the submental artery and vein. Its utility in reconstruction following ablative head and neck procedures has been applied to various subsites including skin, lip, buccal mucosa, retromolar trigone, parotidectomy defects, and tongue. We review our experience using the SIF for reconstruction following tumor ablation.This prospective case series with medical record review includes consecutive patients undergoing SIF reconstruction following ablative surgery for malignancy at a single tertiary care facility between November 2014 and November 2016. We examined preoperative variables, surgical procedures, and postoperative outcomes.Thirty-seven patients met inclusion criteria. Twenty-nine were male; the average age was 64.3 (±12.4) years. Seventeen cancers involved the oral cavity, 11 involved the skin, 8 were in the oropharynx, and 1 was in the paranasal sinus. The average size of the SIF was 38.8 cm(±17.6 cm). Four partial flap losses occurred; none required revision surgery. The average length of stay for these patients was 7.2 (±6.1) days.The SIF is a robust flap that can be reliably used for a variety of head and neck defects following tumor ablation with an acceptable rate of donor- and flap-related complications

Paranasal sinus opacification-to-pneumatization ratio applied as a rapid and validated clinician assessment

The utility of clinician-applied instruments, particularly the Lund-Mackay score, in the assessment of paranasal sinus computed tomography (CT) in chronic rhinosinusitis (CRS) remains incompletely defined. The purpose of this study was to determine if a new approach to the evaluation of sinus CT could accurately predict the extent of opacification while remaining simple for clinician use.Twenty-four sinus CT scans were measured for the percent of sinus opacification using three-dimensional (3D) volumetric analyses. The same scans were also evaluated using the Lund-Mackay score to measure opacification and the Assessment of Pneumatization of the Paranasal Sinuses (APPS) score to measure total sinus volume (TSV). Correlation analysis was performed for the Lund-Mackay to APPS score ratio as a predictor of percent opacification. Validation analysis was also performed to determine the optimal orientation for Lund-Mackay scoring, which has not previously been described.The Lund-Mackay to APPS score ratio was very strongly correlated with the percentage of sinus opacification measured by 3D volumetric analysis (r = 0.862, r2 = 0.743, p < 0.001). Lund-Mackay scoring was not statistically different between axial-only, coronal-only, or triplanar groups for interrater (p = 0.379) and intrarater reliability (p = 0.312).The Lund-Mackay score is validated for rater reliability in multiple orientations. Using the APPS score as a measure of TSV, the Lund-Mackay-to-APPS ratio very strongly correlates with the percentage of sinus opacification by 3D volumetric analysis. Further study will be required to determine if this ratio is predictive of symptom severity