Fighting Novel Diseases amidst Humanitarian Crises

Humanitarian crises are becoming more prevalent and, frequently, more complex, in zones of mis-governance, lack of government presence, and even active conflict, marked by public mistrust and insecurity. The WHO and other health emergency responders lack the capacities and mandate to adequately respond. The current Ebola outbreak in an area of an active insurgency in the Democratic Republic of the Congo is just such a crisis. The State Department has banned U.S. personnel from the outbreak zone due to safety concerns, leaving the population feeling abandoned, potentially increasing the threat to the few brave health workers who remain. We need is to rethink health emergency response during complex crises and devise new strategies. We offer a blueprint for responding to health emergencies amidst complex humanitarian crises. This blueprint includes peacekeepers who have the mandate and modalities fit for the purpose of quelling a health emergency; “smart” diplomacy to negotiate with belligerents and community members to ensure health and humanitarian worker safety; and deploying all needed health, security, and diplomatic assets. We also call for international development assistance for health, including to support states in developing core public health capacities, creating inclusive health systems, and meeting other need like clean water and nutritious food. Political actors will need to assume their responsibilities if humanitarians and health workers are to carry out theirs

Relationship of blood monocytes with chronic lymphocytic leukemia aggressiveness and outcomes: a multi‐institutional study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134120/1/ajh24376.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134120/2/ajh24376_am.pd

Relationship of blood monocytes with chronic lymphocytic leukemia aggressiveness and outcomes: a multi‐institutional study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134120/1/ajh24376.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134120/2/ajh24376_am.pd

A multi-layer extension of the stochastic heat equation

Motivated by recent developments on solvable directed polymer models, we define a 'multi-layer' extension of the stochastic heat equation involving non-intersecting Brownian motions.Comment: v4: substantially extended and revised versio

The role of guidelines and the patient's life-style in GPs' management of hypercholesterolaemia

BACKGROUND: Recent Swedish and joint European guidelines on hyperlipidaemia stress the high coronary risk for patients with already established arterio-sclerotic disease (secondary prevention) or diabetes. For the remaining group, calculation of the ten-year risk for coronary events using the Framingham equation is suggested. There is evidence that use of and adherence to guidelines is incomplete and that tools for risk estimations are seldom used. Intuitive risk estimates are difficult and systematically biased. The purpose of the study was to examine how GPs use knowledge of guidelines in their decisions to recommend or not recommend a cholesterol-lowering drug and the reasons for their decisions. METHODS: Twenty GPs were exposed to six case vignettes presented on a computer. In the course of six screens, successively more information was added to the case. The doctors were instructed to think aloud while processing the cases (Think-Aloud Protocols) and finally to decide for or against drug treatment. After the six cases they were asked to describe how they usually reason when they meet patients with high cholesterol values (Free-Report Protocols). The two sets of protocols were coded for cause-effect relations that were supposed to reflect the doctors' knowledge of guidelines. The Think-Aloud Protocols were also searched for reasons for the decisions to prescribe or not to prescribe. RESULTS: According to the protocols, the GPs were well aware of the importance of previous coronary heart disease and diabetes in their decisions. On the other hand, only a few doctors mentioned other arterio-sclerotic diseases like stroke and peripheral artery disease as variables affecting their decisions. There were several instances when the doctors' decisions apparently deviated from their knowledge of the guidelines. The arguments for the decisions in these cases often concerned aspects of the patient's life-style like smoking or overweight- either as risk-increasing factors or as alternative strategies for intervention. CONCLUSIONS: Coding verbal protocols for knowledge and for decision arguments seems to be a valuable tool for increasing our understanding of how guidelines are used in the on treatment of hypercholesterolaemia. By analysing arguments for treatment decisions it was often possible to understand why departures from the guidelines were made. While the need for decision support is obvious, the current guidelines may be too simple in some respects

Epidermal growth factor receptor downregulation by small heterodimeric binding proteins

No single engineered protein has been shown previously to robustly downregulate epidermal growth factor receptor (EGFR), a validated cancer target. A panel of fibronectin-based domains was engineered to bind with picomolar to nanomolar affinity to multiple epitopes of EGFR. Monovalent and homo- and hetero-bivalent dimers of these domains were tested for EGFR downregulation. Selected orientations of non-competitive heterodimers decrease EGFR levels by up to 80% in multiple cell types, without activating receptor signaling. These heterodimers inhibit autophosphorylation, proliferation and migration, and are synergistic with the monoclonal antibody cetuximab in these activities. These small (25 kDa) heterodimers represent a novel modality for modulating surface receptor levels.National Institutes of Health (U.S.) (NIH grant CA96504)National Institutes of Health (U.S.) (NIH grant CA118705)National Science Foundation (U.S.) (Graduate Research Fellowship Program

New Insights into X-ray Binaries

X-ray binaries are excellent laboratories to study collapsed objects. On the one hand, transient X-ray binaries contain the best examples of stellar-mass black holes while persistent X-ray binaries mostly harbour accreting neutron stars. The determination of stellar masses in persistent X-ray binaries is usually hampered by the overwhelming luminosity of the X-ray heated accretion disc. However, the discovery of high-excitation emission lines from the irradiated companion star has opened new routes in the study of compact objects. This paper presents novel techniques which exploits these irradiated lines and summarises the dynamical masses obtained for the two populations of collapsed stars: neutron stars and black holes.Comment: 12 pages, 5 figures, 2 tables, Invited review to plenary session in "Highlights of Spanish Astrophysics V", Proceedings of the VIII Scientific Meeting of the Spanish Astronomical Society (SEA) held in Santander, 7-11 July, 2008. Edited by J. Gorgas, L. J. Goicoechea, J. I. Gonzalez-Serrano, J. M. Dieg