Coming Out of Crisis: Patient Experiences in Primary Care in New Orleans, Four Years Post-Katrina

Examines the network of neighborhood clinics funded with federal, state, and local money that emerged after Hurricane Katrina as a model for serving vulnerable populations. Looks at access, communication, chronic illnesses management, and preventive care

Taurek, numbers and probabilities

In his paper, “Should the Numbers Count?" John Taurek imagines that we are in a position such that we can either save a group of five people, or we can save one individual, David. We cannot save David and the five. This is because they each require a life-saving drug. However, David needs all of the drug if he is to survive, while the other five need only a fifth each.Typically, people have argued as if there was a choice to be made: either numbers matter, in which case we should save the greater number, or numbers don't matter, but rather there is moral value in giving each person an equal chance of survival, and therefore we should toss a coin. My claim is that we do not have to make a choice in this way. Rather, numbers do matter, but it doesn't follow that we should always save the greater number. And likewise, there is moral value in giving each person an equal chance of survival, but it doesn't follow that we should always toss a coin.In addition, I argue that a similar approach can be applied to situations in which we can save one person or another, but the chances of success are different

Source/sink interactions underpin crop yield: the case for trehalose 6-phosphate/SnRK1 in improvement of wheat

Considerable interest has been evoked by the analysis of the regulatory pathway in carbohydrate metabolism and cell growth involving the non-reducing disaccharide trehalose (TRE). TRE is at small concentrations in mesophytes such as Arabidopsis thaliana and Triticum aestivum, excluding a role in osmoregulation once suggested for it. Studies of TRE metabolism, and genetic modification of it, have shown a very wide and more important role of the pathway in regulation of many processes in development, growth, and photosynthesis. It has now been established that rather than TRE, it is trehalose 6-phosphate (T6P) which has such profound effects. T6P is the intermediary in TRE synthesis formed from glucose-6-phosphate and UDP-glucose, derived from sucrose, by the action of trehalose phosphate synthase. The concentration of T6P is determined both by the rate of synthesis, which depends on the sucrose concentration, and also by the rate of breakdown by trehalose-6-phosphate phosphatase which produces TRE. Changing T6P concentrations by genetically modifying the enzymes of synthesis and breakdown has altered photosynthesis, sugar metabolism, growth, and development which affect responses to, and recovery from, environmental factors. Many of the effects of T6P on metabolism and growth occur via the interaction of T6P with the SnRK1 protein kinase system. T6P inhibits the activity of SnRK1, which de-represses genes encoding proteins involved in anabolism. Consequently, a large concentration of sucrose increases T6P and thereby inhibits SnRK1, so stimulating growth of cells and their metabolic activity. The T6P/SnRK1 mechanism offers an important new view of how the distribution of assimilates to organs, such as developing grains in cereal plants, is achieved. This review briefly summarizes the factors determining, and limiting, yield of wheat (particularly mass/grain which is highly conserved) and considers how T6P/SnRK1 might function to determine grain yield and might be altered to increase them. Increasing the potential rate of filling and mass/grain are ways in which total crop yield could be increased with good husbandry which maintains crop assimilation Cereal yields globally are not increasing, despite the greater production required to meet human demand. Careful targeting of T6P is showing much promise for optimization of source/sink for yield improvement and offers yet further possibilities for increasing sink demand and grain size in wheat