Liver Transplantation to Provide Low-Density-Lipoprotein Receptors and Lower Plasma Cholesterol in a Child with Homozygous Familial Hypercholesterolemia

A six-year-old girl with severe hypercholesterolemia and atherosclerosis had two defective genes at the low-density-lipoprotein (LDL) receptor locus, as determined by biochemical studies of cultured fibroblasts. One gene, inherited from the mother, produced no LDL receptors; the other gene, inherited from the father, produced a receptor precursor that was not transported to the cell surface and was unable to bind LDL. The patient degraded intravenously administered 125I-LDL at an extremely low rate, indicating that her high plasma LDL-cholesterol level was caused by defective receptor-mediated removal of LDL from plasma. After transplantation of a liver and a heart from a normal donor, the patient's plasma LDL-cholesterol level declined by 81 per cent, from 988 to 184 mg per deciliter. The fractional catabolic rate for intravenously administered 125I-LDL, a measure of functional LDL receptors in vivo, increased by 2.5-fold. Thus, the transplanted liver, with its normal complement of LDL receptors, was able to remove LDL cholesterol from plasma at a nearly normal rate. We conclude that a genetically determined deficiency of LDL receptors can be largely reversed by liver transplantation. These data underscore the importance of hepatic LDL receptors in controlling the plasma level of LDL cholesterol in human beings. (N Engl J Med 1984; 311: 1658–64.). © 1984, Massachusetts Medical Society. All rights reserved

Data Segmentation in Electronic Health Information Exchange: Policy Considerations and Analysis

The issue of whether and, if so, to what extent patients should have control over the sharing or withholding of their health information represents one of the foremost policy challenges related to electronic health information exchange. It is widely acknowledged that patients\u27 health information should flow where and when it is needed to support the provision of appropriate and high-quality care. Equally significant, however, is the notion that patients want their needs and preferences to be considered in the determination of what information is shared with other parties, for what purposes, and under what conditions. Some patients may prefer to withhold or sequester certain elements of health information, often when it is deemed by them (or on their behalf) to be sensitive, whereas others may feel strongly that all of their health information should be shared under any circumstance. This discussion raises the issue of data segmentation, which we define for the purposes of this paper as the process of sequestering from capture, access or view certain data elements that are perceived by a legal entity, institution, organization, or individual as being undesirable to share. This whitepaper explores key components of data segmentation, circumstances for its use, associated benefits and challenges, various applied approaches, and the current legal environment shaping these endeavors

The SAMI Galaxy Survey: energy sources of the turbulent velocity dispersion in spatially-resolved local star-forming galaxies

We investigate the energy sources of random turbulent motions of ionised gas from H$\alpha$ emission in eight local star-forming galaxies from the Sydney-AAO Multi-object Integral field spectrograph (SAMI) Galaxy Survey. These galaxies satisfy strict pure star-forming selection criteria to avoid contamination from active galactic nuclei (AGN) or strong shocks/outflows. Using the relatively high spatial and spectral resolution of SAMI, we find that -- on sub-kpc scales our galaxies display a flat distribution of ionised gas velocity dispersion as a function of star formation rate (SFR) surface density. A major fraction of our SAMI galaxies shows higher velocity dispersion than predictions by feedback-driven models, especially at the low SFR surface density end. Our results suggest that additional sources beyond star formation feedback contribute to driving random motions of the interstellar medium (ISM) in star-forming galaxies. We speculate that gravity, galactic shear, and/or magnetorotational instability (MRI) may be additional driving sources of turbulence in these galaxies.Comment: 11 pages, 5 figures, 3 tables. Accepted by MNRA

Supporting Family Physician Maternity Care Providers

Maternity care access in the United States is in crisis. The American Congress of Obstetrics and Gynecology projects that by 2030 there will be a nationwide shortage of 9,000 obstetrician-gynecologists (OB/GYNs). Midwives and OB/GYNs have been called upon to address this crisis, yet in underserved areas, family physicians are often providing a majority of this care. Family medicine maternity care, a natural fit for the discipline, has been on sharp decline in recent years for many reasons including difficulties cultivating interdisciplinary relationships, navigating privileging, developing and maintaining adequate volume/competency, and preventing burnout. In 2016 and 2017, workshops were held among family medicine educators with resultant recommendations for essential strategies to support family physician maternity care providers. This article summarizes these strategies, provides guidance, and highlights the role family physicians have in addressing maternity care access for the underserved as well as presenting innovative ideas to train and retain rural family physician maternity care providers

The SAMI Galaxy Survey: Asymmetry in Gas Kinematics and its links to Stellar Mass and Star Formation

We study the properties of kinematically disturbed galaxies in the SAMI Galaxy Survey using a quantitative criterion, based on kinemetry (Krajnovic et al.). The approach, similar to the application of kinemetry by Shapiro et al. uses ionised gas kinematics, probed by H{\alpha} emission. By this method 23+/-7% of our 360-galaxy sub-sample of the SAMI Galaxy Survey are kinematically asymmetric. Visual classifications agree with our kinemetric results for 90% of asymmetric and 95% of normal galaxies. We find stellar mass and kinematic asymmetry are inversely correlated and that kinematic asymmetry is both more frequent and stronger in low-mass galaxies. This builds on previous studies that found high fractions of kinematic asymmetry in low mass galaxies using a variety of different methods. Concentration of star forma- tion and kinematic disturbance are found to be correlated, confirming results found in previous work. This effect is stronger for high mass galaxies (log(M*) > 10) and indicates that kinematic disturbance is linked to centrally concentrated star formation. Comparison of the inner (within 0.5Re) and outer H{\alpha} equivalent widths of asymmetric and normal galaxies shows a small but significant increase in inner equivalent width for asymmetric galaxies.Comment: 29 pages, 21 figure

Widespread Detection of Antibodies to Eastern Equine Encephalitis, West Nile, St. Louis Encephalitis, and Turlock Viruses in Various Species of Wild Birds from Across the United States

Wild birds serve as amplifying hosts for many arboviruses, and are thought to be responsible for introducing these viruses into new areas during migration as well as reintroducing them to places where winter temperatures disrupt mosquito-borne transmission. To learn more about four mosquito-borne arboviruses of concern to human or animal health, we tested sera from 997 wild birds of 54 species and 17 families across 44 states of the United States collected from January 1, 2013, through September 30, 2013. Samples were tested for antibody against eastern equine encephalitis, St. Louis encephalitis, West Nile, and Turlock viruses using plaque reduction neutralization tests with an endpoint of 80% or greater. Of the 333 (33.4%) birds that tested positive for antibody to at least one arbovirus, 29.7% were exposed to two or more arboviruses. Exposure to all four arboviruses was detected in Canada geese, double-crested cormorants, mallards, mute swans, laughing gulls, and American coots. Our results suggest that exposure to arboviruses is widespread in the United States across a diversity of wild bird species

Widespread Detection of Antibodies to Eastern Equine Encephalitis, West Nile, St. Louis Encephalitis, and Turlock Viruses in Various Species of Wild Birds from Across the United States

Wild birds serve as amplifying hosts for many arboviruses, and are thought to be responsible for introducing these viruses into new areas during migration as well as reintroducing them to places where winter temperatures disrupt mosquito-borne transmission. To learn more about four mosquito-borne arboviruses of concern to human or animal health, we tested sera from 997 wild birds of 54 species and 17 families across 44 states of the United States collected from January 1, 2013, through September 30, 2013. Samples were tested for antibody against eastern equine encephalitis, St. Louis encephalitis, West Nile, and Turlock viruses using plaque reduction neutralization tests with an endpoint of 80% or greater. Of the 333 (33.4%) birds that tested positive for antibody to at least one arbovirus, 29.7% were exposed to two or more arboviruses. Exposure to all four arboviruses was detected in Canada geese, double-crested cormorants, mallards, mute swans, laughing gulls, and American coots. Our results suggest that exposure to arboviruses is widespread in the United States across a diversity of wild bird species

High resolution CMB power spectrum from the complete ACBAR data set

In this paper, we present results from the complete set of cosmic microwave background (CMB) radiation temperature anisotropy observations made with the Arcminute Cosmology Bolometer Array Receiver (ACBAR) operating at 150 GHz. We include new data from the final 2005 observing season, expanding the number of detector-hours by 210% and the sky coverage by 490% over that used for the previous ACBAR release. As a result, the band-power uncertainties have been reduced by more than a factor of two on angular scales encompassing the third to fifth acoustic peaks as well as the damping tail of the CMB power spectrum. The calibration uncertainty has been reduced from 6% to 2.1% in temperature through a direct comparison of the CMB anisotropy measured by ACBAR with that of the dipole-calibrated WMAP5 experiment. The measured power spectrum is consistent with a spatially flat, LambdaCDM cosmological model. We include the effects of weak lensing in the power spectrum model computations and find that this significantly improves the fits of the models to the combined ACBAR+WMAP5 power spectrum. The preferred strength of the lensing is consistent with theoretical expectations. On fine angular scales, there is weak evidence (1.1 sigma) for excess power above the level expected from primary anisotropies. We expect any excess power to be dominated by the combination of emission from dusty protogalaxies and the Sunyaev-Zel'dovich effect (SZE). However, the excess observed by ACBAR is significantly smaller than the excess power at ell > 2000 reported by the CBI experiment operating at 30 GHz. Therefore, while it is unlikely that the CBI excess has a primordial origin; the combined ACBAR and CBI results are consistent with the source of the CBI excess being either the SZE or radio source contamination.Comment: Submitted to ApJ; Changed to apply a WMAP5-based calibration. The cosmological parameter estimation has been updated to include WMAP