Volunteerism among hospitalists and non-hospitalists at academic and community medical centers in North Carolina

Volunteerism is common in the United States, though less is known about volunteerism among medical professionals. We aimed to record and compare volunteer activities among hospitalists and non-hospitalists in academic and community centers.Includes bibliographical reference

Analysis of Observed Contamination Through SAGE III's First Year on Orbit

SAGE III is a payload on the International Space Station that conducts measurements of ozone and other atmospheric constituents through the use of a moderate resolution spectrometer with an operating wavelength range of 290 nm to 1550 nm. Because of the optically sensitive nature of the payload, a suite of eight Thermoelectric Quartz Crystal Microbalances (TQCMs) were included to monitor the operating environment. During the rst year of operation, the SAGE III TQCMs were instrumental in detecting several periods of higher contamination and localizing their sources. A clear window made from quartz crystal covers the instrument assembly's aperture. Under nominal operating conditions, this window is only open during science gathering activities. However, if the rates of contamination accumulation are detected to be above the background rate, the window will be kept closed during science gathering to protect the optically sensitive instrument mirror. An analysis of the signal transmissions through the window for the wavelengths of 290 nm to 1550 nm has been conducted to determine any possible degradation of the window and potential in uence on science data collected to date, and established a baseline for future analysis

Nesting Ecology and Interactions between Local and International Priorities for Hawksbill Sea Turtle (Eretmochelys imbricata) Conservation on the Pacific Coast of Central America

Despite human interaction with the biophysical environment since the beginning of human history, traditional research generally studied human and natural systems separately when addressing human–nature interactions. The purpose of my research is to better understand the nesting ecology and interactions between local and international priorities for hawksbill sea turtle (Eretmochelys imbricata) conservation in El Salvador and Nicaragua, where >90% of eastern Pacific hawksbill nesting occurs. In the first study, I explained the realities experienced by coastal residents who share habitat with hawksbills in El Salvador and then identified and clarified implications of discrepancies between these realities and international priorities for hawksbill conservation. The main findings were 1) primary importance of hawksbills is economic value attached to egg sales, but deeper cultural connections exist, 2) egg purchase by hatcheries benefits hawksbills and humans and 3) opportunities for local residents to participate in decision-making are limited and should be increased. In the second study, I characterized the microhabitat preferences and repeatability of nest-site choice by hawksbills, and then clarified the implications of doomed egg relocation programs on gene pools of hawksbills. I found 1) hawksbills preferred nest sites with abundant vegetation on dynamic beaches in mangrove estuaries, 2) female hawksbills exhibited local adaptations to differences in nesting habitat and 3) individual hawksbills consistently placed nests under high percentages of overstory vegetation, but were inconsistent in nest placement related to woody vegetation borders. In the third study, I generated and analyzed thermal profiles of hawksbill nest environments and estimated the sex ratios and physical condition of hatchling hawksbills under natural and artificial conditions. The primary findings were 1) minimal differences in temperature existed between sand depths, 2) adjustment of nest depth is unlikely to compensate for climate change, 3) in situ clutches incubated at higher temperatures and produced less fit offspring and 4) egg relocation can contribute to recovery efforts. The findings of these studies offer insight into interactions between hawksbill population dynamics and local community development on the Pacific coast of Central America, and demonstrate the value of implementing an evidence-based approach to guide public policy and conservation strategies

Conservación y recuperación de la tortuga Carey (eretmochelys imbricata) del pacífico oriental, en el caso de El Salvador.

Las tortugas carey (Eretmochelys imbricata) fueron en una época muy abundantes en el Pacífico Oriental (PO) pero en la actualidad es una de las poblaciones de tortugas marinas más amenazadas a nivel mundial. El Salvador es el país más pequeño de Centroamérica, y posee una alta densidad poblacional lo que ha llevado a la sobreexplotación de muchos de los recursos naturales del país, incluyendo a las especies de tortugas marinas. Donde se considera que aproximadamente el 99% de todos los huevos son extraídos, para el consumo humano a nivel nacional (Hasbún y Vásquez 1992a)

Understanding Differences between CORE and CACREP Counselors-in-Training Perceptions of Self-Efficacy

An examination of differences in perceptions of self-efficacy between students in CORE-accredited rehabilitation counseling programs and students in CACREP -accredited clinical mental health counseling programs enrolled in practicum/internship classes is absent in the literature. Results indicated there was not a significant difference (p = .05) between the total self-efficacy scores between both treatment groups (CORE and CACREP). Further, there was not a significant difference between helping skills, session management, and counseling challenging situations scores for both treatment groups (CORE and CACREP). Predictors of self-efficacy for CACREP participants consisted of prior work experience in a field other than helping. Predictors of self-efficacy for CORE participants were gender

Fas (CD95) induces rapid, TLR4/IRAK4-dependent release of pro-inflammatory HMGB1 from macrophages

Although Fas (CD95) is recognized as a death receptor that induces apoptosis, recent studies indicate that the Fas/FasL system can induce pro-inflammatory cytokine production by macrophages independent of conventional caspase-mediated apoptotic signaling. The precise mechanism(s) by which Fas activates macrophage inflammation is unknown. We hypothesized that Fas stimulates rapid release of high mobility group box 1 (HMGB1) that acts in an autocrine and/or paracrine manner to stimulate pro-inflammatory cytokine production via a Toll-like receptor-4 (TLR4)/Interleukin-1 receptor associated kinase-4 (IRAK4)-dependent mechanism. Following Fas activation, HMGB1 was released within 1 hr from viable RAW267.4 cells and primary murine peritoneal macrophages. HMGB1 release was more rapid following Fas activation compared to LPS stimulation. Neutralization of HMGB1 with an inhibitory anti-HMGB1 monoclonal antibody strongly inhibited Fas-induced production of tumor necrosis factor (TNF) and macrophage inflammatory protein-2 (MIP-2). Both Fas-induced HMGB1 release and associated pro-inflammatory cytokine production were significantly decreased from Tlr4-/- and Irak4-/- macrophages, but not Tlr2-/- macrophages. These findings reveal a novel mechanism underlying Fas-mediated pro-inflammatory physiological responses in macrophages. We conclude that Fas activation induces rapid, TLR4/IRAK4-dependent release of HMGB1 that contributes to Fas-mediated pro-inflammatory cytokine production by viable macrophages

Improvements to the APBS biomolecular solvation software suite

The Adaptive Poisson-Boltzmann Solver (APBS) software was developed to solve the equations of continuum electrostatics for large biomolecular assemblages that has provided impact in the study of a broad range of chemical, biological, and biomedical applications. APBS addresses three key technology challenges for understanding solvation and electrostatics in biomedical applications: accurate and efficient models for biomolecular solvation and electrostatics, robust and scalable software for applying those theories to biomolecular systems, and mechanisms for sharing and analyzing biomolecular electrostatics data in the scientific community. To address new research applications and advancing computational capabilities, we have continually updated APBS and its suite of accompanying software since its release in 2001. In this manuscript, we discuss the models and capabilities that have recently been implemented within the APBS software package including: a Poisson-Boltzmann analytical and a semi-analytical solver, an optimized boundary element solver, a geometry-based geometric flow solvation model, a graph theory based algorithm for determining p$K_a$ values, and an improved web-based visualization tool for viewing electrostatics

The neurotoxin DSP-4 dysregulates the locus coeruleus-norepinephrine system and recapitulates molecular and behavioral aspects of prodromal neurodegenerative disease

The noradrenergic locus coeruleus (LC) is among the earliest sites of tau and α-synuclein pathology in Alzheimer\u27s disease (AD) and Parkinson\u27s disease (PD), respectively. The onset of these pathologies coincides with loss of noradrenergic fibers in LC target regions and the emergence of prodromal symptoms including sleep disturbances and anxiety. Paradoxically, these prodromal symptoms are indicative of a noradrenergic hyperactivity phenotype, rather than the predicted loss of norepinephrine (NE) transmission following LC damage, suggesting the engagement of complex compensatory mechanisms. Because current therapeutic efforts are targeting early disease, interest in the LC has grown, and it is critical to identify the links between pathology and dysfunction. We employed the LC-specific neurotoxin N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4), which preferentially damages LC axons, to model early changes in the LC-NE system pertinent to AD and PD in male and female mice. DSP-4 (two doses of 50 mg/kg, one week apart) induced LC axon degeneration, triggered neuroinflammation and oxidative stress, and reduced tissue NE levels. There was no LC cell death or changes to LC firing, but transcriptomics revealed reduced expression of genes that define noradrenergic identity and other changes relevant to neurodegenerative disease. Despite the dramatic loss of LC fibers, NE turnover and signaling were elevated in terminal regions and were associated with anxiogenic phenotypes in multiple behavioral tests. These results represent a comprehensive analysis of how the LC-NE system responds to axon/terminal damage reminiscent of early AD and PD at the molecular, cellular, systems, and behavioral levels, and provides potential mechanisms underlying prodromal neuropsychiatric symptoms

Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification

BACKGROUND: Clinicians caring for patients seeking alcohol detoxification face many challenges, including lack of evidence-based guidelines for treatment and high recidivism rates. OBJECTIVES: To develop a standardized protocol for determining which alcohol dependent patients seeking detoxification need inpatient versus outpatient treatment, and to study the protocol's implementation. DESIGN: Review of best evidence by ad hoc task force and subsequent creation of standardized protocol. Prospective observational evaluation of initial protocol implementation. PARTICIPANTS: Patients presenting for alcohol detoxification. INTERVENTION: Development and implementation of a protocol for evaluation and treatment of patients requesting alcohol detoxification. MAIN MEASURES: Number of admissions per month with primary alcohol related diagnosis (DRG), 30-day readmission rate, and length of stay, all measured before and after protocol implementation. RESULTS: We identified one randomized clinical trial and three cohort studies to inform the choice of inpatient versus outpatient detoxification, along with one prior protocol in this population, and combined that data with clinical experience to create an institutional protocol. After implementation, the average number of alcohol related admissions was 15.9 per month, compared with 18.9 per month before implementation (p = 0.037). There was no difference in readmission rate or length of stay. CONCLUSIONS: Creation and utilization of a protocol led to standardization of care for patients requesting detoxification from alcohol. Initial evaluation of protocol implementation showed a decrease in number of admissions

Host Biomarkers Are Associated With Response to Therapy and Long-Term Mortality in Pediatric Severe Malaria.

Background. Host responses to infection are critical determinants of disease severity and clinical outcome. The development of tools to risk stratify children with malaria is needed to identify children most likely to benefit from targeted interventions.Methods. This study investigated the kinetics of candidate biomarkers of mortality associated with endothelial activation and dysfunction (angiopoietin-2 [Ang-2], soluble FMS-like tyrosine kinase-1 [sFlt-1], and soluble intercellular adhesion molecule-1 [sICAM-1]) and inflammation (10 kDa interferon γ-induced protein [CXCL10/IP-10] and soluble triggering receptor expressed on myeloid cells-1 [sTREM-1]) in the context of a randomized, double-blind, placebo-controlled, parallel-arm trial evaluating inhaled nitric oxide versus placebo as adjunctive therapy to parenteral artesunate for severe malaria. One hundred eighty children aged 1–10 years were enrolled at Jinja Regional Referral Hospital in Uganda and followed for up to 6 months.Results. There were no differences between the 2 study arms in the rate of biomarker recovery. Median levels of Ang-2, CXCL10, and sFlt-1 were higher at admission in children who died in-hospital (n = 15 of 180; P < .001, P = .027, and P = .004, respectively). Elevated levels of Ang-2, sTREM-1, CXCL10, and sICAM-1 were associated with prolonged clinical recovery times in survivors. The Ang-2 levels were also associated with postdischarge mortality (P < .0001). No biomarkers were associated with neurodisability.Conclusions. Persistent endothelial activation and dysfunction predict survival in children admitted with severe malaria