Locating Art Worlds

This paper uses a varied literature to define “art” as literary, musical, or visual creations, and theatrical, dance, or musical performances that: are not motivated by utility; play some role in interpreting a culture or place; and are recognized as art by some number of audiences, vendors, producers, and critics. Thus, art benefits cultures and places through its interpretive value. The production and dissemination of artistic creations requires a constellation of materials, standards, techniques, producers, and vendors that is called an “art world” relevant to that type of art. Though the impulse to create art is universal, art worlds are manifested unevenly across cities within a country and across districts within a metropolitan area. These distributions differ for different types of arts and artists, but have some dependence on the division of labor and on economies of scale. Therefore it is not surprising that New York and Los Angeles dominate (different types of) art worlds and art creation in North America. However, some much smaller metropolitan areas exhibit proportional concentration in specific art fields. In addition, large metropolitan areas contain quite-separate districts of art production and dissemination. This paper concludes with a brief case study of visual-arts districts in New Orleans

Amyotrophic Lateral Sclerosis in a Patient with a Family History of Huntington Disease: Genetic Counseling Challenges

Amyotrophic lateral sclerosis (ALS) and Huntington disease (HD) are generally considered to be distinct and easily differentiated neurologic conditions. However, there are case reports of the co‐occurrence of ALS with HD. We present a 57‐year‐old male with a clinical diagnosis of sporadic ALS in the context of a family history of HD. This case adds to the limited literature regarding individuals with a family history of HD who present with features of ALS. There were several genetic counseling challenges in counseling this patient including the diagnostic consideration of two fatal conditions, complex risk information, the personal and familial implications, and the patient’s inability to communicate verbally or through writing due to disease progression. DNA banking effectively preserved the right of our patient and his wife not to learn his HD genetic status during a stressful time of disease progression while providing the option for family members to learn this information in the future if desired. We present lessons learned and considerations for other clinical genetics professionals who are presented with similar challenging issues.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147074/1/jgc40725.pd

In Vitro Gene Expression Dissected: Chemostat Surgery for Mycobacterium Tuberculosis

A unique approach, combining defined and reproducible in vitro models with DNA microarrays, has been developed to study environmental modulation of mycobacterial gene expression. The gene expression profiles of samples of Mycobacterium tuberculosis, from independent chemostat cultures grown under defined and reproducible conditions, were found to be highly correlated. This approach is now being used to study the effect of relevant stimuli, such as limited oxygen availability, on mycobacterial gene expression. A modification of the chemostat culture system, enabling largevolume controlled batch culture, has been developed to study starvation survival. Cultures of M. tuberculosis have been maintained under nutrient-starved conditions for extended periods, with 106 – 107 bacilli surviving in a culturable state after 100 days. The design of the culture system has made it possible to control the environment and collect multiple time-course samples to study patterns of gene expression. These studies demonstrate that it is possible to perform long-term studies and obtain reproducible expression data using controlled and defined in vitro models

Swell Sleeves for Testing Explosive Devices

A method of testing explosive and pyrotechnic devices involves exploding the devices inside swell sleeves. Swell sleeves have been used previously for measuring forces. In the present method, they are used to obtain quantitative indications of the energy released in explosions of the devices under test. A swell sleeve is basically a thick-walled, hollow metal cylinder threaded at one end to accept a threaded surface on a device to be tested (see Figure 1). Once the device has been tightly threaded in place in the swell sleeve, the device-and-swell-sleeve assembly is placed in a test fixture, then the device is detonated. After the explosion, the assembly is removed from the test fixture and placed in a coordinate-measuring machine for measurement of the diameter of the swell sleeve as a function of axial position. For each axial position, the original diameter of the sleeve is subtracted from the diameter of the sleeve as swollen by the explosion to obtain the diametral swelling as a function of axial position (see Figure 2). The amount of swelling is taken as a measure of the energy released in the explosion. The amount of swelling can be compared to a standard amount of swelling to determine whether the pyrotechnic device functioned as specified

Patients’ Attitudes Toward Deprescribing and Their Experiences Communicating with Clinicians and Pharmacists

Purpose: Developing effective deprescribing interventions relies on understanding attitudes, beliefs, and communication challenges of those involved in the deprescribing decision-making process, including the patient, the primary care clinician, and the pharmacist. The objective of this study was to assess patients’ beliefs and attitudes and identify facilitators of and barriers to deprescribing. Methods: As part of a larger study, we recruited patients ⩾18years of age taking ⩾3 chronic medications. Participants were recruited from retail pharmacies associated with the University of Kentucky HealthCare system. They completed an electronic survey that included demographic information, questions about communication with their primary care clinician and pharmacists, and the revised Patients’ Attitudes Toward Deprescribing (rPATD) questionnaire. Results: Our analyses included 103 participants (n=65 identified as female and n=74 as White/Caucasian) with a mean age of 50.4years [standard deviation (SD)=15.5]. Participants reported taking an average of 8.4 daily medications (SD=6.1). Most participants reported effective communication with clinicians and pharmacists (66.9%) and expressed willingness to stop one of their medications if their clinician said it was possible (83.5%). Predictors of willingness to accept deprescribing were older age [odds ratio (OR)=2.99, 95% confidence interval (CI)=1.45–6.2], college/graduate degree (OR=55.25, 95% CI=5.74–531.4), perceiving medications as less appropriate (OR=8.99, 95% CI=1.1–73.62), and perceived effectiveness of communication with the clinician or pharmacist (OR=4.56, 95% CI=0.85–24.35). Conclusion: Adults taking ⩾3 chronic medications expressed high willingness to accept deprescribing of medications when their doctor said it was possible. Targeted strategies to facilitate communication within the patient–primary care clinician–pharmacist triad that consider patient characteristics such as age and education level may be necessary ingredients for developing successful deprescribing interventions

Bordetella holmesii-like organisms isolated from Massachusetts patients with pertussis-like symptoms.

We isolated Bordetella holmesii, generally associated with septicemia in patients with underlying conditions, from nasopharyngeal specimens of otherwise healthy young persons with a cough. The proportion of B. holmesii-positive specimens submitted to the Massachusetts State Laboratory Institute increased from 1995 to 1998

Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention

AbstractObjectives. We examined the relations of elevated creatine kinase (CK) and its myocardial band isoenzyme (CK-MB) to clinical outcomes after percutaneous coronary intervention (PCI) in patients enrolled in Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II (trial) (IMPACT-II), a trial of the platelet glycoprotein IIb/IIIa inhibitor eptifibatide.Background. Elevation of cardiac enzymes often occurs after PCI, but its clinical implications are uncertain.Methods. Patients undergoing elective, scheduled PCI for any indication were analyzed. Parallel analyses investigated CK (n = 3,535) and CK-MB (n = 2,341) levels after PCI (within 4 to 20 h). Clinical outcomes at 30 days and 6 months were stratified by postprocedure CK and CK-MB (multiple of the site’s upper normal limit).Results. Overall, 1,779 patients (76%) had no CK-MB elevation; CK-MB levels were elevated to 1 to 3 times the upper normal limit in 323 patients (13.8%), to 3 to 5 times normal in 84 (3.6%), to 5 to 10 times normal in 86 (3.7%), and to >10 times normal in 69 patients (2.9%). Elevated CK-MB was associated with an increased risk of death, reinfarction, or emergency revascularization at 30 days, and of death, reinfarction, or surgical revascularization at 6 months. Elevated total CK to above three times normal was less frequent, but its prognostic significance paralleled that seen for CK-MB. The degree of risk correlated with the rise in CK or CK-MB, even for patients with successful procedures not complicated by abrupt closure.Conclusions. Elevations in cardiac enzymes, including small increases (between one and three times normal) often not considered an infarction, are associated with an increased risk for short-term adverse clinical outcomes after successful or unsuccessful PCI