Competent to care. Are all doctors competent in nutrition?

Optimising nutrition is known to improve outcome in a variety of specialities from elderly care to orthopaedics. The National Institute for Health and Clinical Excellence guidelines of 2006 have provided standards to positively influence the profile of nutrition within the National Health Service. However, what role do doctors have in this process? Clearly, not all doctors are competent in nutrition. In a recent US survey only 14% of resident physicians reported feeling adequately trained to provide nutrition counselling. A lack of knowledge has also been demonstrated by general practitioners (GP). The Intercollegiate Group on Nutrition is working to improve nutritional knowledge in British medical graduates. In addition, nutritional care is now a core competency assessed in the UK Foundation Programme curriculum, which can only be a positive step. The assessment process may even influence some of the supervising consultants. What about those doctors currently practising in the UK? Recently, a questionnaire study was undertaken to look at healthcare professionals' knowledge of the benefits and risks of percutaneous endoscopic gastrostomy (PEG) feeding. Important gaps in knowledge were found that were positively correlated with whether respondents had received relevant education. Referral for a PEG was considered to be appropriate for patients with advanced dementia by 31% of the GP compared with 10% of the consultants. Only 4% of these GP had received any training in this ethically-sensitive area at a time when they may be asked to countersign consent forms for patients who lack competence. So, what is the way forward? Positive steps are being taken in the undergraduate curriculum and Foundation Programme. Perhaps it is the responsibility of those doctors with the skills and opportunities to promote good nutritional knowledge in those doctors already practising in the UK

The Validity of Herzberg’s Dual-Factor Theory on Job Satisfaction of Political Marketers

An avalanche of studies has been conducted to determine the level of job satisfaction, and determinants thereof, among political marketers – including political party supporters. Majority of these studies utilized the Maslow theory, which is based on a hierarchy of needs. Maslow’s theory has severally been criticized on philosophical, methodological and hierarchical grounds. The theory argues that human needs are ordered, i.e. they range from lower-order to higher-order needs. As one need is adequately or partially fulfilled, the individual moves to the next higher-order need. By so doing, an individual is said to derive his job satisfaction. But Herzberg’s two-factor theory (also called motivation /Hygiene theory) has been suggested as a more plausible alternative to the Maslow’s Theory for studying job satisfaction, and in evaluating the previous research efforts on political marketers which are mainly rooted in Maslow’s theory. The purpose of this paper is to present the result of an empirical investigation of the validity of the motivation – Hygiene Theory in the Nigerian political environment. The result should prove useful in evaluating the theory as an alternative to Maslow’s theory when studying job satisfaction

Simultaneous release of glutamate and acetylcholine from single magnocellular "cholinergic" basal forebrain neurons

Basal forebrain (BF) neurons provide the principal cholinergic drive to the hippocampus and cortex. Their degeneration is associated with the cognitive defects of Alzheimer's disease. Immunohistochemical studies suggest that some of these neurons contain glutamate, so might also release it. To test this, we made microisland cultures of single BF neurons from 12- to 14-d-old rats. Over 1-8 weeks in culture, neuronal processes made autaptic connections onto the neuron. In 34 of 36 cells tested, a somatically generated action potential was followed by a short-latency EPSC that was blocked by 1 mM kynurenic acid, showing that they released glutamate. To test whether the same neuron also released acetylcholine, we placed a voltage-clamped rat myoball expressing nicotinic receptors in contact with a neurite. In six of six neurons tested, the glutamatergic EPSC was accompanied by a nicotinic (hexamethonium-sensitive) myoball current. Stimulation of the M-2-muscarinic presynaptic receptors ( characterized using tripitramine and pirenzepine) produced a parallel inhibition of autaptic glutamatergic and myoball nicotinic responses; metabotropic glutamate receptor stimulation produced similar but less consistent and weaker effects. Atropine enhanced the glutamatergic EPSCs during repetitive stimulation by 25 +/- 6%; the anti-cholinesterase neostigmine reduced the train EPSCs by 37 +/- 6%. Hence, synaptically released acetylcholine exerted a negative-feedback inhibition of coreleased glutamate. We conclude that most cholinergic basal forebrain neurons are capable of releasing glutamate as a cotransmitter and that the release of both transmitters is subject to simultaneous feedback inhibition by synaptically released acetylcholine. This has implications for BF neuron function and for the use of cholinesterase inhibitors in Alzheimer's disease

Novel fuzzy logic controllers with self-tuning capability

Two controllers which extend the PD+I fuzzy logic controller to deal with the plant having time varying nonlinear dynamics are proposed. The adaptation ability of the first self tuning PD+I fuzzy logic controller (STPD+I_31) is achieved by adjusting the output scaling factor automatically thereby contributing to significant improvement in performance. Second controller (STPD+I_9) is the simplified version of STPD+I_31 which is designed under the imposed constraint that allows only minimum number of rules in the rule bases. The proposed controllers are compared with two classical nonlinear controllers: the pole placement self tuning PID controller and sliding mode controller. All the controllers are applied to the two-links revolute robot for the tracking control. The tracking performance of STPD+I_31 and STPD+I_9 are much better than the pole placement self tuning PID controller during high speed motions while the performance are comparable at low and medium speed. In addition, STPD+I_31 and STPD+I_9 outperform sliding mode controller using same method of comparison study

Clinicopathologic and Histopathologic Renal Abnormalities in Dogs with Coccidioidomycosis.

BackgroundWe observed evidence of protein-losing nephropathy in some dogs with coccidioidomycosis, suggestive of immune complex glomerulonephritis (ICGN). The goal of this study was to understand the prevalence of renal histopathologic lesions and proteinuria in dogs with coccidioidomycosis.HypothesisBiochemical and histopathological evidence of glomerular lesions is present in dogs with coccidioidomycosis.AnimalsHundred and fifty-six dogs with naturally occurring coccidioidomycosis.MethodsRetrospective case series. Clinical information and results of clinicopathologic testing were retrieved from the University of California, Davis Veterinary Medical Teaching Hospital (VMTH). Microscopic sections of renal tissue procured from necropsy of dogs with coccidioidomycosis were examined to evaluate the nature and distribution of lesions.ResultsA total of 156 dogs with coccidioidomycosis were identified; 87 dogs had serum biochemistry and a urinalysis performed, 17 had urine protein:creatinine ratios (UPCs), and 24 had renal tissue available for histopathology. Eleven (13%) of the 87 dogs were azotemic, 55 (63%) were proteinuric (of which 14 [25%] had clinically relevant proteinuria defined as ≥3+ or ≥500 mg/dL), and 14 dogs had UPC ≥0.5 (range, 0.5-21.5, median 4.2). Thirteen (54%) of 24 dogs had renal histopathologic lesions suggestive of ICGN. Seven of these dogs had urinalyses performed; 5 (71%) had clinically relevant proteinuria as described above. Two dogs (33%) with normal glomeruli had granulomatous nephritis, 1 of which had intralesional Coccidioides spherules.Conclusions and clinical importanceCoccidioidomycosis should be considered as a possible contributor to glomerular disease in dogs. Whether similar lesions occur in other mammalian hosts, including humans, warrants further investigation

The major myosin-binding domain of skeletal muscle MyBP-C (C protein) resides in the COOH-terminal, immunoglobulin C2 motif.

A common feature shared by myosin-binding proteins from a wide variety of species is the presence of a variable number of related internal motifs homologous to either the Ig C2 or the fibronectin (Fn) type III repeats. Despite interest in the potential function of these motifs, no group has clearly demonstrated a function for these sequences in muscle, either intra- or extracellularly. We have completed the nucleotide sequence of the fast type isoform of MyBP-C (C protein) from chicken skeletal muscle. The deduced amino acid sequence reveals seven Ig C2 sets and three Fn type III motifs in MyBP-C. alpha-chymotryptic digestion of purified MyBP-C gives rise to four peptides. NH2-terminal sequencing of these peptides allowed us to map the position of each along the primary structure of the protein. The 28-kD peptide contains the NH2-terminal sequence of MyBP-C, including the first C2 repeat. It is followed by two internal peptides, one of 5 kD containing exclusively spacer sequences between the first and second C2 motifs, and a 95-kD fragment containing five C2 domains and three fibronectin type III motifs. The C-terminal sequence of MyBP-C is present in a 14-kD peptide which contains only the last C2 repeat. We examined the binding properties of these fragments to reconstituted (synthetic) myosin filaments. Only the COOH-terminal 14-kD peptide is capable of binding myosin with high affinity. The NH2-terminal 28-kD fragment has no myosin-binding, while the long internal 100-kD peptide shows very weak binding to myosin. We have expressed and purified the 14-kD peptide in Escherichia coli. The recombinant protein exhibits saturable binding to myosin with an affinity comparable to that of the 14-kD fragment obtained by proteolytic digestion (1/2 max binding at approximately 0.5 microM). These results indicate that the binding to myosin filaments is mainly restricted to the last 102 amino acids of MyBP-C. The remainder of the molecule (1,032 amino acids) could interact with titin, MyBP-H (H protein) or thin filament components. A comparison of the highly conserved Ig C2 domains present at the COOH-terminus of five MyBPs thus far sequenced (human slow and fast MyBP-C, human and chicken MyBP-H, and chicken MyBP-C) was used to identify residues unique to these myosin-binding Ig C2 repeats

Titanium versus absorbable tacks comparative study (TACS): a multicenter, non-inferiority prospective evaluation during laparoscopic repair of ventral and incisional hernia: study protocol for randomized controlled trial

BACKGROUND: Laparoscopic repair of ventral and incisional hernias has gained popularity since many studies have reported encouraging results in terms of outcomee and recurrence. Choice of mesh and fixation methods are considered crucial issues in preventing recurrences and complications. Lightweight meshes are considered the first choice due to their biomechanical properties and the ability to integrate into the abdominal wall. Titanium helicoidal tacks still represent the "gold standard" for mesh fixation, even if they have been suggested to be involved in the genesis of post-operative pain and complications. Recently, absorbable tacks have been introduced, under the hypothesis that there will be no need to maintain a permanent fixation device after mesh integration. Nevertheless, there is no evidence that absorbable tacks may guarantee the same results as titanium tacks in terms of strength of fixation and recurrence rates. The primary end point of the present trial is to test the hypothesis that absorbable tacks are non-inferior to titanium tacks in laparoscopic incisional and ventral hernia repair (LIVHR) by lightweight polypropylene mesh, in terms of recurrence rates at 3-year follow-up. Surgical complications, post-operative stay, comfort and pain are secondary end points to be assessed. METHODS/DESIGN: Two hundred and twenty patients with ventral hernia will be randomized into 2 groups: Group A (110) patients will be submitted to LIVHR by lightweight polypropylene mesh fixed by titanium tacks; Group B (110) patients will be submitted to LIVHR by lightweight polypropylene mesh fixed by absorbable tacks. DISCUSSION: A few retrospective studies have reported similar results when comparing absorbable versus non-absorbable tacks in terms of intraoperative and early post-operative outcomes. These studies have the pitfalls to be retrospective evaluation of small series of patients, and the reported results still need to be validated by larger series and prospective studies. The aim of the present trial is to investigate and test the non-inferiority of absorbable versus non-absorbable tacks in terms of hernia recurrence rates, in order to assess whether the use of absorbable tacks may achieve the same results as non-absorbable tacks in mid-term and long-term settings

Parton energy loss at strong coupling and the universal bound

The apparent universality of jet quenching observed in heavy ion collisions at RHIC for light and heavy quarks, as well as for quarks and gluons, is very puzzling and calls for a theoretical explanation. Recently it has been proposed that the synchrotron--like radiation at strong coupling gives rise to a universal bound on the energy of a parton escaping from the medium. Since this bound appears quite low, almost all of the observed particles at high transverse momentum have to originate from the surface of the hot fireball. Here I make a first attempt of checking this scenario against the RHIC data and formulate a "Universal Bound Model" of jet quenching that can be further tested at RHIC and LHC.Comment: 8 pages, 2 figures, invited plenary talk given at "Hard Probes 2008" Conference, 8-14 June 2008, Illa da Toxa, Galicia, Spai

'Marriage had bastilled me for life': Propertied Women as Property in the Legal Fictions of Richardson, Wollstonecraft and Collins

When a woman married during the eighteenth century, according to Blackstone’s 'Commentaries on the Laws of England' (1765-69), her autonomous identity was removed and she was immediately classed as one with her husband. This consolidation into the husband’s own identity means that she is automatically classed as his property, as to incorporate and consolidate implies a taking over of ownership of the item being transferred – and thus, of course, a complete lack of self-governance over mind, body and actions on behalf of the woman. This leads to the perception that the woman has been transformed from a human into a mere thing, whilst still retaining human function. It is this mid-existence of the eighteenth and nineteenth century woman and her entrapment somewhere between human and thing that raises a key question. Is it possible for such a legal phenomenon to own property (thus, another thing) itself without repercussions – essentially, if the propertied woman was herself property? This ‘work in progress’ paper examines the extent to which this may be true, and if so, how it affected her identity as an independent human being in a patriarchal legal system over a specific time period by studying several themes of what are arguably legal fictions. The gendered inheritance of Samuel Richardson’s work and the obstacles this incurs due to the female’s lack of legal recognition in the eighteenth century are referred to, and explorations are made into the questions about inheritance, identity and what constitutes as property raised by the French Revolution of the 1790s, and the representations of this in Gothic and revolutionary literature, specifically Wollstonecraft’s 'Maria' (1798). Moreover, I consider the effects of the Gothic upon the development of sensation fiction, positing the latter as a direct descendant rather than subscribing to the notion of them being related but rigidly disparate, with sensation fiction suddenly emerging in the mid-nineteenth century (Hughes, 1980; Thomas, 1994; Herbert, 2008). Within these two genres, the entity of the married woman is well-established, but, I argue, warrants further examination of its representations of the legal entity of woman in her occupation of the domestic sphere as a wife and the social sphere as a single, propertied, legally existing woman in Wilkie Collins’s 'The Woman in White' (1860-61)