Baptist Student Ministry: Object Lessons in the New Reality for Denominational Ministries

The world in which we live is a world filled with opportunity. It is an exciting time to be alive and involved in ministry. This is especially true for those who minister to the more than 14 million university students on campuses across America today. To work on a university campus is to experience the quickening of the Spirit. There is a very real sense that one is ministering on the cusp of the postmodem world. In contrast with earlier generations of students, the beginning years of the 21st century are times in which students are characterized by an optimism very different from the cynicism and hopelessness of their Gen X older brothers and sisters. Indeed, instead of a countercultural rejection of society\u27s institutions, there is almost a heroic desire to improve these institutions and make society better. Neil Howe and William Strauss, characterize this generation as the next great generation, a reference to the World War II generation of Americans? Or, as Ann Quindlen of Newsweek put it as quoted in Millennials Rising, Meet the Millennials and rejoice

Online clinical tools to support the use of new plasma biomarker diagnostic technology in the assessment of Alzheimer's disease: a narrative review

Recent advances in new diagnostic technologies for Alzheimer's disease have improved the speed and precision of diagnosis. However, accessing the potential benefits of this technology poses challenges for clinicians, such as deciding whether it is clinically appropriate to order a diagnostic test, which specific test or tests to order and how to interpret test results and communicate these to the patient and their caregiver. Tools to support decision-making could provide additional structure and information to the clinical assessment process. These tools could be accessed online, and such 'e-tools' can provide an interactive interface to support patients and clinicians in the use of new diagnostic technologies for Alzheimer's disease. We performed a narrative review of the literature to synthesize information available on this research topic. Relevant studies that provide an understanding of how these online tools could be used to optimize the clinical utility of diagnostic technology were identified. Based on these, we discuss the ways in which e-tools have been used to assist in the diagnosis of Alzheimer's disease and propose recommendations for future research to aid further development

Building analytic skills to drive improvements in patient care and organisational decision making: an information analysts’ development programme

Purpose This paper briefly outlines a development programme designed to improve the skills of NHS Information Analysts and assesses the extent these skills have been developed. There are significant opportunities for the NHS to utilise information more effectively, and Analysts have a key role. However, training opportunities prior to the development of this programme have been limited for this professional group. The purpose of this paper is to explore the potential benefits to the organisations, patients and the NHS as a whole,that improvements in the quality of analysis can deliver. Design/methodology/approach The authors compared pre-course and post-course self-assessment of skill levels of Analysts who attended the programme. The authors also considered general feedback and comments from participants. Findings All of the 40 skills areas assessed demonstrated an increase in mean competency score. In cohorts 1 and 2, 38 of these were statistically significant (p < 0.001-0.041, mean increase in score 1.0). For cohorts 3-5, 37 were statistically significant (p < 0.001-0.012; mean increase 1.2). These findings were supported by the positive feedback from participants. Practical implication The programme develops skills for NHS Information Analysts which can improve the quality of analysis in the NHS, offering significant potential to improve the effectiveness and efficiency of healthcare. Originality/value The Information Analysts’ Development Programme provides the only training programme available for NHS Information Analysts, contributing to the development of data driven service improvement within the NHS. This may harness the power contained within data to drive improvement and ensure patients receive the highest quality of care

Investigating the prevalence and causes of prescribing errors in general practice : the PRACtICe Study

Report prepared by the University of Nottingham, University of Reading and University of Hertfordshir

Altered protein dynamics of disease-associated lamin A mutants

BACKGROUND: Recent interest in the function of the nuclear lamina has been provoked by the discovery of lamin A/C mutations in the laminopathy diseases. However, it is not understood why mutations in lamin A give such a range of tissue-specific phenotypes. Part of the problem in rationalising genotype-phenotype correlations in the laminopathies is our lack of understanding of the function of normal and mutant lamin A. To investigate this we have used photobleaching in human cells to analyse the dynamics of wild-type and mutant lamin A protein at the nuclear periphery. RESULTS: We have found that a large proportion of wild-type lamin A at the nuclear periphery is immobile, but that there is some slow movement of lamin A within the nuclear lamina. The mobility of an R482W mutant lamin A was indistinguishable from wild-type, but increased mobility of L85R and L530P mutant proteins within the nuclear lamina was found. However, the N195K mutant shows the most enhanced protein mobility, both within the nucleoplasm and within the lamina. CONCLUSION: The slow kinetics of lamin A movement is compatible with its incorporation into a stable polymer that only exchanges subunits very slowly. All of the myopathy-associated lamin A mutants that we have studied show increased protein movement compared with wild-type. In contrast, the dynamic behaviour of the lipodystrophy-associated lamin A mutant was indistinguishable from wild-type. This supports the hypothesis that the underlying defect in lamin A function is quite distinct in the laminopathies that affect striated muscle, compared to the diseases that affect adipose tissue. Our data are consistent with an alteration in the stability of the lamin A molecules within the higher-order polymer at the nuclear lamina in myopathies

Respondent Understanding in Discrete Choice Experiments : A Scoping Review

Acknowledgements The authors would like to acknowledge the contributions of Brendan Mulhern, who gave feedback on the initial project proposal and helped with the full-text reviews, and Bernadette Carr, the librarian who gave assistance developing and implementing the search strategy. Funding During part of this project, Alison Pearce was supported by a University of Technology Sydney Chancellor’s Postdoctoral Research Fellowship and the University of Technology Sydney International Researcher Development Scheme. Mark Harrison is supported by a Michael Smith Foundation for Health Research Scholar Award 2017 (#16813), and holds the UBC Professorship in Sustainable Health Care, which, between 2014 and 2017, was funded by Amgen Canada, AstraZeneca Canada, Eli Lilly Canada, GlaxoSmithKline, Merck Canada, Novartis Pharmaceuticals Canada, Pfizer Canada, Boehringer Ingelheim (Canada), Hoffman-La Roche, LifeScan Canada, and Lundbeck Canada. The Health Economics Research Unit (HERU) receives funding from the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD

An Analysis of Differential Delayed Mortality Experienced by Stream-type Chinook Salmon of the Snake River

In the Anadromous Fish Appendix of the US Army Corp of Engineers (USACE) Environmental Impact Statement on the Lower Snake River Hydrosystem Alternatives for recovery of Snake River salmon and steelhead (hereafter referred to as A-Fish ), the National Marine Fisheries Service (NMFS) suggested that transportation effectiveness of spring/summer chinook may have improved markedly in recent years. The NMFS conclusion was based on estimates of \u27D\u27-values (the differential delayed survival rate between transported fish and fish that migrated in-river) for 1994-1995 (NMFS, 1999). NMFS suggested, if \u27D\u27 is high (estimated in A-Fish at 0.8) and extra mortality of in-river and transported smolts is unrelated to the hydropower system, transportation options may meet recovery standards as well or better than natural river options. NMFS also suggested that further studies could reduce the uncertainty about true values of \u27D\u27 and provide greater confidence to make a decision on the alternative management action needed to recover listed Snake River salmon and steelhead. In this analysis, we demonstrate that the evidence is compatible with a wide range of ‘D’ values, but only a small portion of this distribution is as high as the A-Fish estimate. We also present evidence that the extra mortality of in-river fish is related to the hydrosystem. We analyzed a suite of plausible assumptions used in the calculation of \u27D\u27. Based on our analysis of the 1994-1996 PIT-tag data, there is a wide range of possible \u27D\u27-values. The NMFS\u27 estimate falls at the upper end of this distribution (90th – 95th percentiles). Alternative \u27D\u27-values, based on what we believe to be more reasonable assumptions, were closer to 0.48. Because \u27D\u27 is a modeled value (and not a measurement, as implied in the A-Fish), it is very sensitive to the suite of assumptions made and how the data are grouped. \u27D\u27 estimates were most sensitive to: (1) whether or not fish that were transported from downstream collection/transport sites (Lower Monumental (LMO) and McNary (MCN) dams) were included in the group of fish used to estimate transport smolt to adult return rates (SAR); and (2) how reach survival rate estimates were extrapolated down to Bonneville Dam (BON). In 1994 the ‘D’-value estimated using four collection projects was much lower than two collection projects. However, in 1995 and 1996 the difference in ‘D’ using two and four collection projects was not as dramatic as in 1994. Therefore, the estimated high ‘D’-values are mainly driven by this single assumption for one year. Based on past and proposed future transportation operations, it is unclear why fish transported at the lower two projects were excluded from the NMFS analysis. Transported fish are subjected to stress, injury, and crowding at the collection projects. In addition, the physiological state of fish may be poorly synchronized with the time of saltwater entry for transported fish. These factors could explain the higher delayed mortality experienced by transported fish as suggested by a consistently estimated ‘D’ value that is less than 1. We disagree with the NMFS assertion that “ongoing direct experiments that contrast the return rates of tagged fish that pass through the hydrosystem versus the return rates of transported fish can resolve this question in a clear and unambiguous manner”. While a few components of the \u27D\u27-value estimate are measurable, the sensitivity analysis highlights differences in assumptionsand uncertainties that are not likely resolvable in the near term. In addition, low numbers of returning adults and small numbers of smolts for wild spring/summer chinook salmon may hamper reducing the uncertainty in estimates for reach survival rates and SARs for a non-detected group. Therefore, data are unlikely to perfect our understanding of \u27D\u27 or eliminate the uncertainty in the most influential assumptions. The hypothesis of extra or delayed mortality due to hydrosystem passage has an empirical basis, as well as biological rationale. Based on recent PIT tag data we also found evidence that delayed mortality of both in-river and transported smolts was related to hydropower. More specifically, the evidence suggests that, at least for collected and bypassed smolts, there is a difference between the patterns of direct passage survival rates and SARs. Smolts first detected and transported from the downstream projects (LMO and MCN) had lower SARs than smolts collected and transported from higher up in the system. Similarly (as reported in the A-Fish), SARs of in-river smolts decreased as the number of times the fish were collected and bypassed increased. These pieces of information provide evidence that the Snake River spring summer chinook extra mortality is related to the juvenile migration hydrosystem experience. Based on results from life-cycle modeling (Marmorek and Peters 1998b), transport based management options lead to a high likelihood of recovery only when ‘D’ is high and the source of extra mortality is not related to the experience during hydrosystem passage. However, when extra mortality is hydrosystem related (which our analysis supports), the natural river options are still the most likely management action to recover these stocks, even if ‘D’ is high (which our analysis does not support). Simply studying ‘D’, if that were possible, without determining the source of extra mortality, yields little additional insight into effects of the different management actions on Snake River spring/summer chinook recovery. Given the dangerously low level ofthese populations, we do not believe it is prudent to make management decision on the configuration and operation of the Snake and Columbia hydrosystem for the next 5-20 years (i.e. delaying a decision preserves status quo configuration), based solely on one optimistic assumption about the effectiveness of past and current hydrosystem operations

Our Space: Being a Responsible Citizen of the Digital World

Our Space is a set of curricular materials designed to encourage high school students to reflect on the ethical dimensions of their participation in new media environments. Through role-playing activities and reflective exercises, students are asked to consider the ethical responsibilities of other people, and whether and how they behave ethically themselves online. These issues are raised in relation to five core themes that are highly relevant online: identity, privacy, authorship and ownership, credibility, and participation.Our Space was co-developed by The Good Play Project and Project New Media Literacies (established at MIT and now housed at University of Southern California's Annenberg School for Communications and Journalism). The Our Space collaboration grew out of a shared interest in fostering ethical thinking and conduct among young people when exercising new media skills

Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and Multivessel Disease

BACKGROUND: The optimal management of patients found to have multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction is uncertain.   OBJECTIVES: CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a U.K. open-label randomized study comparing complete revascularization at index admission with treatment of the infarct-related artery (IRA) only.   METHODS: After they provided verbal assent and underwent coronary angiography, 296 patients in 7 U.K. centers were randomized through an interactive voice-response program to either in-hospital complete revascularization (n = 150) or IRA-only revascularization (n = 146). Complete revascularization was performed either at the time of P-PCI or before hospital discharge. Randomization was stratified by infarct location (anterior/nonanterior) and symptom onset (≤3 h or >3 h). The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 12 months.   RESULTS: Patient groups were well matched for baseline clinical characteristics. The primary endpoint occurred in 10.0% of the complete revascularization group versus 21.2% in the IRA-only revascularization group (hazard ratio: 0.45; 95% confidence interval: 0.24 to 0.84; p = 0.009). A trend toward benefit was seen early after complete revascularization (p = 0.055 at 30 days). Although there was no significant reduction in death or MI, a nonsignificant reduction in all primary endpoint components was seen. There was no reduction in ischemic burden on myocardial perfusion scintigraphy or in the safety endpoints of major bleeding, contrast-induced nephropathy, or stroke between the groups.   CONCLUSIONS: In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the IRA. In such patients, inpatient total revascularization may be considered, but larger clinical trials are required to confirm this result and specifically address whether this strategy is associated with improved survival. (Complete Versus Lesion-only Primary PCI Pilot Study [CvLPRIT]; ISRCTN70913605)