Patient safety indicators for England from hospital administrative data: case-control analysis and comparison with US data

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.The Healthcare Commission received a small grant from the Health and Social Care Information Centre to support the initial recoding work

Enhancing Student Learning Outcomes Through Increased Predeparture Preparation for Study Abroad

Numerous studies have shown that each year, more students in the United States choose to study abroad. Some universities have even taken steps to make international study a requirement. Similar to the increased competitiveness for students to attend and thereafter, to stand out in college, making the most of one’s overseas experience, going to more exotic locations and delving deeper into the local culture, will follow in this pattern as a means to be more competitive upon graduation. Increased awareness of the needs of students studying abroad will need to be addressed and students across the spectrum of both mental and physical ability will need to be more greatly accounted for. How can the negative effects of international study be mitigated through increased predeparture planning and mentorship? Will increased predeparture preparation limit the challenges students who study abroad face? Using the fall 2013 voyage of Semester at Sea (SAS) as my focus, I investigated the challenges students faced during their international experience. This case study was conducted through a survey exhibiting the students’ perspectives and predeparture support, as well as faculty and staff interviews demonstrating professional observations of students’ adjustment and behaviors abroad. This study demonstrated that overall, students had little predeparture support at their home institutions prior to their international programs. Little was known about culture shock, though faculty and staff reported that universally it was experienced. At risk behaviors abroad, students’ overall mental health, and academic accountability also proved to be factors influencing students’ overall experience and success

The Role of DNA Methylation in Regulation of the Murine Lhx3 Gene

LHX3 is a LIM-homeodomain transcription factor with critical roles in pituitary and nervous system development. Mutations in the LHX3 gene are associated with pediatric diseases featuring severe hormone deficiencies, hearing loss, developmental delay, and other symptoms. The mechanisms that govern LHX3/Lhx3 transcription are poorly understood. In this study, we examined the role of DNA methylation in the expression status of the mouse Lhx3 gene. Pituitary cells that do not normally express Lhx3 (Pit-1/0 cells) were treated with 5-aza-2’-deoxycytidine, a demethylating reagent. This treatment lead to activation of Lhx3 gene expression suggesting that methylation contributes to Lhx3 regulation. Treatment of Pit-1/0 pituitary cells with a combination of a demethylating reagent and a histone deacetylase inhibitor led to rapid activation of Lhx3 expression, suggesting possible crosstalk between DNA methylation and histone modification processes. To assess DNA methylation levels, treated and untreated Pit-1/0 genomic DNA was subjected to bisulfite conversion and sequencing. Treated Pit-1/0 cells had decreased methylation at specific sites in the Lhx3 locus compared to untreated cells. Chromatin immunoprecipitation assays demonstrated interactions between the MeCp2 methyl binding protein and Lhx3 promoter regions in the Pit-1/0 cell line. Overall, this study demonstrates that DNA methylation patterns of the Lhx3 gene are associated with its expression status

Predicting the Effects of Cerulean Warbler, Dendroica cerulea Management on Eastern Ontario Bird Species

Single-species habitat management strategies are often undertaken without explicit consideration of their effects on the larger community. Here we explore the potential effects of managing eastern Ontario deciduous forests for the Cerulean Warbler (Dendroica cerulea) by examining its potential as a biodiversity indicator species and as an umbrella species. Our results indicate that the Cerulean Warbler would not be an effective biodiversity indicator, as its distribution across the studied landscape did not coincide with areas of high avian species richness. However, the Cerulean Warbler may be effective as an umbrella species for the maintenance of populations of other canopy-nesting species that require mature deciduous forest habitats. It is hoped that the conclusions reached in Ontario, while perhaps not directly transferable to all parts of the breeding range, encourage other Cerulean Warbler researchers to ask similar questions in their study areas

Origin of Hysteresis in Bed Form Response to Unsteady Flows

Field and laboratory studies indicate that changes in riverbed morphology often lag changes in water discharge. This lagged response produces hysteresis in the relationship between water discharge and bed form geometry. To understand these phenomena, we performed flume experiments to observe the response of a sand bed to step increases and decreases in water discharge. For an abrupt rise in discharge, we observed that bed forms grew rapidly by collision and merger of bed forms migrating with different celerities. Growth rate slowed as bed forms approached equilibrium with the higher discharge regime. After an abrupt discharge drop, bed form decay occurred through formation of smaller secondary bed forms, in equilibrium with the lower discharge, which cannibalized the original, relict features. We present a simple model framework to quantitatively predict time scales of bed form adjustment to flow changes, based on equilibrium bed form heights, lengths, and celerities at low and high flows. For rising discharge, the model assumes that all bed form collisions result in irreversible merger, due to a dispersion of initial celerities. For falling discharge, we derive a diffusion model for the decay of relict high-stage features. Our models predict the form and time scale of experimental bed form adjustments. Additional experiments applying slow and fast triangular flood waves show that bed form hysteresis occurs only when the time scale of flow change is faster than the modeled (and measured) bed form adjustment time. We show that our predicted adjustment time scales can also be used to predict the occurrence of bed form hysteresis in natural floods

Effectiveness of highly active antiretroviral therapy in HIV-positive children: evaluation at 12 months in a routine program in Cambodia.

OBJECTIVE: Increasing access to highly active antiretroviral therapy to reach all those in need in developing countries (scale up) is slowly expanding to HIV-positive children, but documented experience remains limited. We aimed to describe the clinical, immunologic, and virologic outcomes of pediatric patients with >12 months of highly active antiretroviral therapy in 2 routine programs in Cambodia. METHODS: Between June 2003 and March 2005, 212 children who were younger than 13 years started highly active antiretroviral therapy. Most patients started a standard first-line regimen of lamivudine, stavudine, and nevirapine, using split adult fixed-dosage combinations. CD4 percentage and body weight were monitored routinely. A cross-sectional virologic analysis was conducted in January 2006; genotype resistance testing was performed for patients with a detectable viral load. RESULTS: Mean age of the subjects was 6 years. Median CD4 percentage at baseline was 6. Survival was 92% at 12 months and 91% at 24 months; 13 patients died, and 4 were lost to follow-up. A total of 81% of all patients had an undetectable viral load. Among the patients with a detectable viral load, most mutations were associated with resistance to lamivudine and non-nucleoside reverse-transcriptase inhibitor drugs. Five patients had developed extensive antiretroviral resistance. Being an orphan was found to be a predictor of virologic failure. CONCLUSIONS: This study provides additional evidence of the effectiveness of integrating HIV/AIDS care with highly active antiretroviral therapy for children in a routine setting, with good virologic suppression and immunologic recovery achieved by using split adult fixed-dosage combinations. Viral load monitoring and HIV genotyping are valuable tools for the clinical follow-up of the patients. Orphans should receive careful follow-up and extra support

Variants within the MMP3 gene are associated with achilles tendinopathy: possible interaction with the COL5A1 gene

Objectives: Sequence variation within the COL5A1 and TNC genes are known to associate with Achilles tendinopathy. The primary aim of this case-control genetic association study was to investigate whether variants within the matrix metalloproteinase 3 (MMP3) gene also contributed to both Achilles tendinopathy and Achilles tendon rupture in a Caucasian population. A secondary aim was to establish whether variants within the MMP3 gene interacted with the COL5A1 rs12722 variant to raise risk of these pathologies. Methods: 114 subjects with symptoms of Achilles tendon pathology and 98 healthy controls were genotyped for MMP3 variants rs679620, rs591058 and rs650108. Results: As single markers, significant associations were found between the GG genotype of rs679620 (OR = 2.5, 95% CI 1.2 to 4.90, p = 0.010), the CC genotype of rs591058 (OR = 2.3, 95% CI 1.1 to 4.50, p = 0.023) and the AA genotype of rs650108 (OR = 4.9, 95% CI 1.0 to 24.1, p = 0.043) and risk of Achilles tendinopathy. The ATG haplotype (rs679620, rs591058, and rs650108) was under-represented in the tendinopathy group when compared to the control group (41% vs 53%, p = 0.038). Finally, the G allele of rs679620 and the T allele of COL5A1 rs12722 significantly interacted to raise risk of AT (p = 0.006). No associations were found between any of the MMP3 markers and Achilles tendon rupture. Conclusion: Variants within the MMP3 gene are associated with Achilles tendinopathy. Furthermore, the MMP3 gene variant rs679620 and the COL5A1 marker rs12722 interact to modify the risk of tendinopathy. These data further support a genetic contribution to a common sports related injur

The Physical Basis for Anomalous Diffusion in Bed Load Transport

Recent studies have observed deviation from normal (Fickian) diffusion in sediment tracer dispersion that violates the assumption of statistical convergence to a Gaussian. Nikora et al. (2002) hypothesized that particle motion at short time scales is superdiffusive because of inertia, while long-time subdiffusion results from heavy-tailed rest durations between particle motions. Here we test this hypothesis with laboratory experiments that trace the motion of individual gravels under near-threshold intermittent bed load transport (0.027 \u3c τ* \u3c 0.087). Particle behavior consists of two independent states: a mobile phase, in which indeed we find superdiffusive behavior, and an immobile phase, in which gravels distrained from the fluid remain stationary for long durations. Correlated grain motion can account for some but not all of the superdiffusive behavior for the mobile phase; invoking heterogeneity of grain size provides a plausible explanation for the rest. Grains that become immobile appear to stay at rest until the bed scours down to an elevation that exposes them to the flow. The return time distribution for bed scour is similar to the distribution of rest durations, and both have power law tails. Results provide a physical basis for scaling regimes of anomalous dispersion and the time scales that separate these regimes