2,010 research outputs found

    The accuracy of the Jamaican national physician register: a study of the status of physicians registered and their countries of training

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    <p>Abstract</p> <p>Background</p> <p>The number of physicians per 10,000 population is a basic health indicator used to determine access to health care. Studies from the United States of America and Europe indicate that their physician registration databases may be flawed. Clinical research activities have suggested that the current records of physicians registered to practice in Jamaica may not be accurate. Our objective was to determine whether the Medical Council of Jamaica (MCJ) accurately records and reports the identities, number and specialty designation of physicians in Jamaica. An additional aim was to determine the countries in which these physicians were trained.</p> <p>Methods</p> <p>Data regarding physicians practicing in Jamaica in 2005 were obtained from multiple sources including the MCJ and the telephone directory. Intense efforts at tracing were undertaken in a sub-sample of physicians, internists and paediatricians to further improve the accuracy of the data. Data were analysed using SPSS, version 11.5.</p> <p>Results</p> <p>The MCJ listed 2667 registered physicians of which 118 (4.4%) were no longer practicing in Jamaica. Of the subset of 150 physicians who were more actively traced, an additional 11 were found to be no longer in practice. Thus at least 129 (4.8%) of the physicians on the MCJ list were not actively practising in Jamaica. Twenty-nine qualified physicians who were in practice, but not currently on the Jamaican register, were identified from other data sources. This yielded an estimate of 2567 physicians or 9.68 physicians per 10,000 persons. Seven hundred and twenty six specialists were identified, 118 from the MCJ list only, 452 from other sources, in particular medical associations, and 156 from both the MCJ list and other sources. Sixty-six percent of registered doctors completed medical school at the University of the West Indies (UWI).</p> <p>Conclusion</p> <p>These data suggest that the MCJ list includes some physicians no longer practicing in Jamaica while underestimating the number of specialists. Difficulty in accurately estimating the number of practicing physicians has been reported in studies done in other countries but the under-reporting of the number of specialists is uncommon. Additional consideration should be given to strategies to ensure compliance with the annual registration that is mandated by law and to changing the law to include registration of specialist qualifications.</p

    IL-4Rα Blockade by Dupilumab Decreases Staphylococcus aureus Colonization and Increases Microbial Diversity in Atopic Dermatitis.

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    Dupilumab is a fully human antibody to interleukin-4 receptor α that improves the signs and symptoms of moderate to severe atopic dermatitis (AD). To determine the effects of dupilumab on Staphylococcus aureus colonization and microbial diversity on the skin, bacterial DNA was analyzed from swabs collected from lesional and nonlesional skin in a double-blind, placebo-controlled study of 54 patients with moderate to severe AD randomized (1:1) and treated with either dupilumab (200 mg weekly) or placebo for 16 weeks. Microbial diversity and relative abundance of Staphylococcus were assessed by DNA sequencing of 16S ribosomal RNA, and absolute S.&nbsp;aureus abundance was measured by quantitative PCR. Before treatment, lesional skin had lower microbial diversity and higher overall abundance of S.&nbsp;aureus than nonlesional skin. During dupilumab treatment, microbial diversity increased and the abundance of S.&nbsp;aureus decreased. Pronounced changes were seen in nonlesional and lesional skin. Decreased S.&nbsp;aureus abundance during dupilumab treatment correlated with clinical improvement of AD and biomarkers of type 2 immunity. We conclude that clinical improvement of AD that is mediated by interleukin-4 receptor α inhibition and the subsequent suppression of type 2 inflammation is correlated with increased microbial diversity and reduced abundance of S.&nbsp;aureus

    Real-Time Projection to Verify Plan Success During Execution

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    The Mission Data System provides a framework for modeling complex systems in terms of system behaviors and goals that express intent. Complex activity plans can be represented as goal networks that express the coordination of goals on different state variables of the system. Real-time projection extends the ability of this system to verify plan achievability (all goals can be satisfied over the entire plan) into the execution domain so that the system is able to continuously re-verify a plan as it is executed, and as the states of the system change in response to goals and the environment. Previous versions were able to detect and respond to goal violations when they actually occur during execution. This new capability enables the prediction of future goal failures; specifically, goals that were previously found to be achievable but are no longer achievable due to unanticipated faults or environmental conditions. Early detection of such situations enables operators or an autonomous fault response capability to deal with the problem at a point that maximizes the available options. For example, this system has been applied to the problem of managing battery energy on a lunar rover as it is used to explore the Moon. Astronauts drive the rover to waypoints and conduct science observations according to a plan that is scheduled and verified to be achievable with the energy resources available. As the astronauts execute this plan, the system uses this new capability to continuously re-verify the plan as energy is consumed to ensure that the battery will never be depleted below safe levels across the entire plan

    Tuning graphitic oxide for initiator- and metal-free aerobic epoxidation of linear alkenes

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    Graphitic oxide has potential as a carbocatalyst for a wide range of reactions. Interest in this material has risen enormously due to it being a precursor to graphene via the chemical oxidation of graphite. Despite some studies suggesting that the chosen method of graphite oxidation can influence the physical properties of the graphitic oxide, the preparation method and extent of oxidation remain unresolved for catalytic applications. Here we show that tuning the graphitic oxide surface can be achieved by varying the amount and type of oxidant. The resulting materials differ in level of oxidation, surface oxygen content and functionality. Most importantly, we show that these graphitic oxide materials are active as unique carbocatalysts for low-temperature aerobic epoxidation of linear alkenes in the absence of initiator or metal. An optimum level of oxidation is necessary and materials produced via conventional permanganate-based methods are far from optimal

    Spitzer UltRa Faint SUrvey Program (SURFS UP). II. IRAC-Detected Lyman-Break Galaxies at 6 < z < 10 Behind Strong-Lensing Clusters

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    We study the stellar population properties of the IRAC-detected 6â‰Čzâ‰Č106 \lesssim z \lesssim 10 galaxy candidates from the Spitzer UltRa Faint SUrvey Program (SURFS UP). Using the Lyman Break selection technique, we find a total of 16 new galaxy candidates at 6â‰Čzâ‰Č106 \lesssim z \lesssim 10 with S/N≄3S/N \geq 3 in at least one of the IRAC 3.6ÎŒ3.6\mum and 4.5ÎŒ4.5\mum bands. According to the best mass models available for the surveyed galaxy clusters, these IRAC-detected galaxy candidates are magnified by factors of ∌1.2\sim 1.2--5.55.5. We find that the IRAC-detected 6â‰Čzâ‰Č106 \lesssim z \lesssim 10 sample is likely not a homogeneous galaxy population: some are relatively massive (stellar mass as high as 4×109 M⊙4 \times 10^9\,M_{\odot}) and evolved (age â‰Č500\lesssim 500 Myr) galaxies, while others are less massive (Mstellar∌108 M⊙M_{\text{stellar}}\sim 10^8\,M_{\odot}) and very young (∌10\sim 10 Myr) galaxies with strong nebular emission lines that boost their rest-frame optical fluxes. We identify two Lyα\alpha emitters in our sample from the Keck DEIMOS spectra, one at zLyα=6.76z_{\text{Ly}\alpha}=6.76 (in RXJ1347) and one at zLyα=6.32z_{\text{Ly}\alpha}=6.32 (in MACS0454). We show that IRAC [3.6]−[4.5][3.6]-[4.5] color, when combined with photometric redshift, can be used to identify galaxies likely with strong nebular emission lines within certain redshift windows.Comment: ApJ in pres
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