Doctors and nurses benefit from interprofessional online education in dermatology

<p>Abstract</p> <p>Background</p> <p>Benefits of online learning in the health sector have been demonstrated in previous studies. We examined the potential benefits of a joint web-based curriculum on atopic eczema for health personnel.</p> <p>Methods</p> <p>Enrolled doctors and nurses had access to the curriculum for 8 weeks. After the course learners completed a questionnaire. Two dermatologists rated the quality of the submitted homework assignments. Based on data from the project's budget and the Norwegian Medical Association, we estimated the saved travel expenses.</p> <p>Results</p> <p>Eighty-eight learners (46 doctors) registered for the course. We received 55 questionnaires (response rate 63%). Twenty-seven learners (31%; 16 doctors, 11 nurses; χ²= 0.03; P = 0.87) used the discussion forum. We found no significant differences in the total questionnaire scores between doctors and nurses. The homework assignments were given an average score of 3.6 for doctors and 3.5 for nurses (P = 0.8) by rater 1. Rater 2 scored 3.9 and 3.6 for doctors and nurses respectively (P = 0.2). The break-even between travel/hotel expenses and course development costs occurred at 135 saved travel refund applications.</p> <p>Conclusions</p> <p>Doctors and nurses were equally satisfied with a joint web-based course on atopic eczema. The use of an online discussion forum was limited but similar between doctors and nurses. There were no significant differences in the quality of submitted homework assignments. The cost of developing the course was 716 841 NOK and the first 86 learners saved 455 198 NOK in travel expenses.</p

Insulin resistance, adiponectin and adverse outcomes following elective cardiac surgery: a prospective follow-up study

<p>Abstract</p> <p>Background</p> <p>Insulin resistance and adiponectin are markers of cardio-metabolic disease and associated with adverse cardiovascular outcomes. The present study examined whether preoperative insulin resistance or adiponectin were associated with short- and long-term adverse outcomes in non-diabetic patients undergoing elective cardiac surgery.</p> <p>Methods</p> <p>In a prospective study, we assessed insulin resistance and adiponectin levels from preoperative fasting blood samples in 836 patients undergoing cardiac surgery. Population-based medical registries were used for postoperative follow-up. Outcomes included all-cause death, myocardial infarction or percutaneous coronary intervention, stroke, re-exploration, renal failure, and infections. The ability of insulin resistance and adiponectin to predict clinical adverse outcomes was examined using receiver operating characteristics.</p> <p>Results</p> <p>Neither insulin resistance nor adiponectin were statistically significantly associated with 30-day mortality, but adiponectin was associated with an increased 31-365-day mortality (adjusted odds ratio 2.9 [95% confidence interval 1.3-6.4]) comparing the upper quartile with the three lower quartiles. Insulin resistance was a poor predictor of adverse outcomes. In contrast, the predictive accuracy of adiponectin (area under curve 0.75 [95% confidence interval 0.65-0.85]) was similar to that of the EuroSCORE (area under curve 0.75 [95% confidence interval 0.67-0.83]) and a model including adiponectin and the EuroSCORE had an area under curve of 0.78 [95% confidence interval 0.68-0.88] concerning 31-365-day mortality.</p> <p>Conclusions</p> <p>Elevated adiponectin levels, but not insulin resistance, were associated with increased mortality and appear to be a strong predictor of long-term mortality. Additional studies are warranted to further clarify the possible clinical role of adiponectin assessment in cardiac surgery.</p> <p>Trial Registration</p> <p>The Danish Data Protection Agency; reference no. 2007-41-1514.</p

The ASH1 HOMOLOG 2 (ASHH2) Histone H3 Methyltransferase Is Required for Ovule and Anther Development in Arabidopsis

BACKGROUND:SET-domain proteins are histone lysine (K) methyltransferases (HMTase) implicated in defining transcriptionally permissive or repressive chromatin. The Arabidopsis ASH1 HOMOLOG 2 (ASHH2) protein (also called SDG8, EFS and CCR1) has been suggested to methylate H3K4 and/or H3K36 and is similar to Drosophila ASH1, a positive maintainer of gene expression, and yeast Set2, a H3K36 HMTase. Mutation of the ASHH2 gene has pleiotropic developmental effects. Here we focus on the role of ASHH2 in plant reproduction. METHODOLOGY/PRINCIPAL FINDINGS:A slightly reduced transmission of the ashh2 allele in reciprocal crosses implied involvement in gametogenesis or gamete function. However, the main requirement of ASHH2 is sporophytic. On the female side, close to 80% of mature ovules lack embryo sac. On the male side, anthers frequently develop without pollen sacs or with specific defects in the tapetum layer, resulting in reduction in the number of functional pollen per anther by up to approximately 90%. In consistence with the phenotypic findings, an ASHH2 promoter-reporter gene was expressed at the site of megaspore mother cell formation as well as tapetum layers and pollen. ashh2 mutations also result in homeotic changes in floral organ identity. Transcriptional profiling identified more than 300 up-regulated and 600 down-regulated genes in ashh2 mutant inflorescences, whereof the latter included genes involved in determination of floral organ identity, embryo sac and anther/pollen development. This was confirmed by real-time PCR. In the chromatin of such genes (AP1, AtDMC1 and MYB99) we observed a reduction of H3K36 trimethylation (me3), but not H3K4me3 or H3K36me2. CONCLUSIONS/SIGNIFICANCE:The severe distortion of reproductive organ development in ashh2 mutants, argues that ASHH2 is required for the correct expression of genes essential to reproductive development. The reduction in the ashh2 mutant of H3K36me3 on down-regulated genes relevant to the observed defects, implicates ASHH2 in regulation of gene expression via H3K36 trimethylation in chromatin of Arabidopsis inflorescences

Estimation of effective diffusion coefficients of drug delivery devices in a flow-through system

We present a numerical approach to estimating the effective diffusion coefficients of drug diffusion from a device into a container with a source and sink condition due to a fluid flowing through the system at a constant rate. In this approach we first formulate this estimation problem as a continuous, nonlinear, least-squares problem subject to a set of constraints containing a partial differential equation system. The nonlinear optimization problem is then discretized by applying a finite volume scheme in space and an implicit time-stepping scheme to the equation system, yielding a finite-dimensional, nonlinear, least-squares problem. An algorithm is proposed for the resulting finite-dimensional, constrained, nonlinear optimization problem. Numerical results using experimental data are presented to demonstrate the usefulness and accuracy of the method

Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease

Crohn's disease and ulcerative colitis, the two common forms of inflammatory bowel disease (IBD), affect over 2.5 million people of European ancestry, with rising prevalence in other populations. Genome-wide association studies and subsequent meta-analyses of these two diseases as separate phenotypes have implicated previously unsuspected mechanisms, such as autophagy, in their pathogenesis and showed that some IBD loci are shared with other inflammatory diseases. Here we expand on the knowledge of relevant pathways by undertaking a meta-analysis of Crohn's disease and ulcerative colitis genome-wide association scans, followed by extensive validation of significant findings, with a combined total of more than 75,000 cases and controls. We identify 71 new associations, for a total of 163 IBD loci, that meet genome-wide significance thresholds. Most loci contribute to both phenotypes, and both directional (consistently favouring one allele over the course of human history) and balancing (favouring the retention of both alleles within populations) selection effects are evident. Many IBD loci are also implicated in other immune-mediated disorders, most notably with ankylosing spondylitis and psoriasis. We also observe considerable overlap between susceptibility loci for IBD and mycobacterial infection. Gene co-expression network analysis emphasizes this relationship, with pathways shared between host responses to mycobacteria and those predisposing to IBD