Book Review of Neither Plain Nor Simple: New Perspectives on the Canterbury Shakers , by David R. Starbuck, 2004, University Press of New England, Lebanon, New Hampshire, 190 pages, 174 illustrations, $29.95 (paper).

A review of David R. Starbuck\u27s book which details his archaeological work of the Shaker people at Canterbury, near Concord, New Hampshire

Strengthening nursing, midwifery and allied health professional leadership in the UK - a realist evaluation

Purpose: This paper aims to share the findings of a realist evaluation study that set out to identify how to strengthen nursing, midwifery and allied health professions (NMAHP) leadership across all health-care contexts in the UK conducted between 2018 and 2019. The collaborative research team were from the Universities of Bangor, Ulster, the University of the West of Scotland and Canterbury Christ Church University. Design/methodology/approach: Realist evaluation and appreciative inquiry were used across three phases of the study. Phase 1 analysed the literature to generate tentative programme theories about what works, tested out in Phase 2 through a national social media Twitter chat and sense-making workshops to help refine the theories in Phase 3. Cross-cutting themes were synthesised into a leadership framework identifying the strategies that work for practitioners in a range of settings and professions based on the context, mechanism and output configuration of realist evaluation. Stakeholders contributed to the ongoing interrogation, analysis and synthesis of project outcomes. Findings: Five guiding lights of leadership, a metaphor for principles, were generated that enable and strengthen leadership across a range of contexts. – “The Light Between Us as interactions in our relationships”, “Seeing People’s Inner Light”, “Kindling the Spark of light and keeping it glowing”, “Lighting up the known and the yet to be known” and “Constellations of connected stars”. Research limitations/implications: This study has illuminated the a-theoretical nature of the relationships between contexts, mechanisms and outcomes in the existing leadership literature. There is more scope to develop the tentative programme theories developed in this study with NMAHP leaders in a variety of different contexts. The outcomes of leadership research mostly focussed on staff outcomes and intermediate outcomes that are then linked to ultimate outcomes in both staff and patients (supplemental). More consideration needs to be given to the impact of leadership on patients, carers and their families. Practical implications: The study has developed additional important resources to enable NMAHP leaders to demonstrate their leadership impact in a range of contexts through the leadership impact self-assessment framework which can be used for 360 feedback in the workplace using the appreciative assessment and reflection tool. Social implications: Whilst policymakers note the increasing importance of leadership in facilitating the culture change needed to support health and care systems to adopt sustainable change at pace, there is still a prevailing focus on traditional approaches to individual leadership development as opposed to collective leadership across teams, services and systems. If this paper fails to understand how to transform leadership policy and education, then it will be impossible to support the workforce to adapt and flex to the increasingly complex contexts they are working in. This will serve to undermine system integration for health and social care if the capacity and capability for transformation are not attended to. Whilst there are ambitious global plans (WHO, 2015) to enable integrated services to be driven by citizen needs, there is still a considerable void in understanding how to authentically engage with people to ensure the transformation is driven by their needs as opposed to what the authors think they need. There is, therefore, a need for systems leaders with the full skillset required to enable integrated services across place-based systems, particularly clinicians who are able to break down barriers and silo working across boundaries through the credibility, leadership and facilitation expertise they provide. Originality/value: The realist evaluation with additional synthesis from key stakeholders has provided new knowledge about the principles of effective NMAHP leadership in health and social care, presented in such a way that facilitates the use of the five guiding lights to inform further practice, education, research and policy development

Analysis of the yeast arginine methyltransferase Hmt1p/Rmt1p and its in vivo function. Cofactor binding and substrate interactions

Many eukaryotic RNA-binding proteins are modified by methylation of arginine residues. The yeast Saccharomyces cerevisiae contains one major arginine methyltransferase, Hmt1p/Rmt1p, which is not essential for normal cell growth. However, cells missing HMT1 and also bearing mutations in the mRNA-binding proteins Np13p or Cbp80p can no longer survive, providing genetic backgrounds in which to study Hmt1p function. We now demonstrate that the catalytically active form of Hmt1p is required for its activity in vivo. Amino acid changes in the putative Hmt1p S-adenosyl-L-methionine-binding site were generated and shown to be unable to catalyze methylation of Np13p in vitro and in vivo or to restore growth to strains that require HMT1. In addition these mutations affect nucleocytoplasmic transport of Np13p. A cold- sensitive mutant of Hmt1p was generated and showed reduced methylation of Np13p, but not of other substrates, at 14 °C. These results define new aspects of Hmt1 and reveal the importance of its activity in vivo

Typical carcinoid tumor of the larynx in a woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Neuroendocrine tumors are the second most common neoplasms of the larynx. Histopathologically, neuroendocrine tumors can be classified into four types: typical carcinoid tumors, atypical carcinoid tumors, small cell neuroendocrine tumors and paragangliomas. Typical carcinoid tumor of the larynx is a particularly rare occurrence. We present a case of this rare disease, and review and discuss its diagnosis and treatment.</p> <p>Case presentation</p> <p>A 55-year-old Turkish woman presented with a two-year history of persistent hoarseness. Endoscopic laryngeal examination and computed tomography revealed a supraglottic mass. Direct laryngoscopy was performed and a biopsy taken. Results of the histopathologic examination and immunohistochemical analysis were consistent with typical carcinoid tumor of the larynx. A supraglottic laryngectomy was performed. There was no recurrence during a follow-up period of three years.</p> <p>Conclusion</p> <p>Carcinoid tumors require an accurate diagnosis because of their varied clinical behavior and prognosis. A correct pathologic diagnosis is essential, differentiating the tumors from other neuroendocrine neoplasms and medullary cancer of the thyroid gland. Immunohistochemical analysis is supplementary to a standard histopathologic evaluation. Currently, conservative surgical resection without elective neck dissection is the recommended treatment for typical carcinoid tumor of the larynx. Additional cases and case series with long-term follow-up will be useful for understanding the nature of this tumor and should clarify the prognosis.</p

Metformin Compared with Insulin in the Treatment of Pregnant Women with Overt Diabetes: A Randomized Controlled Trial

OBJECTIVE: To compare the safety and tolerability of metformin to insulin for glycemic control among women with preexisting type 2 and early A2 gestational diabetes. STUDY DESIGN: Women with preexisting type 2 diabetes and those diagnosed with gestational diabetes who required medical management prior to 20 weeks were randomly assigned to metformin or insulin. Glycemic control, defined as >50% capillary blood glucose within target range, was compared between groups. Other outcomes included patient tolerance, neonatal and obstetric complications, maternal weight gain, neonatal cord blood C-peptide, and patient satisfaction with therapy. RESULTS: Twenty-eight women completed the study, with 14 in each group. Of the 15 women assigned to metformin, 100% continued to receive metformin until delivery, although 43% required supplemental insulin to achieve glycemic control. Glucose measures did not differ between the groups, and the proportion who met fasting and postprandial glycemic target values did not differ between the groups. Women treated with metformin had significantly fewer subjective episodes of hypoglycemia compared with those using insulin (0% versus 36%; p = 0.04) as well as reported glucose values < 60 mg/dL (7.1% versus 50%; p = 0.03). CONCLUSION: Metformin should be considered for treatment of overt diabetes and early A2 gestational diabetes in pregnancy

Rationale for the Cytogenomics of Cardiovascular Malformations Consortium: A Phenotype Intensive Registry Based Approach

Cardiovascular malformations (CVMs) are the most common birth defect, occurring in 1%-5% of all live births. Although the genetic contribution to CVMs is well recognized, the genetic causes of human CVMs are identified infrequently. In addition, a failure of systematic deep phenotyping of CVMs, resulting from the complexity and heterogeneity of malformations, has obscured genotype-phenotype correlations and contributed to a lack of understanding of disease mechanisms. To address these knowledge gaps, we have developed the Cytogenomics of Cardiovascular Malformations (CCVM) Consortium, a multi-site alliance of geneticists and cardiologists, contributing to a database registry of submicroscopic genetic copy number variants (CNVs) based on clinical chromosome microarray testing in individuals with CVMs using detailed classification schemes. Cardiac classification is performed using a modification to the National Birth Defects Prevention Study approach, and non-cardiac diagnoses are captured through ICD-9 and ICD-10 codes. By combining a comprehensive approach to clinically relevant genetic analyses with precise phenotyping, the Consortium goal is to identify novel genomic regions that cause or increase susceptibility to CVMs and to correlate the findings with clinical phenotype. This registry will provide critical insights into genetic architecture, facilitate genotype-phenotype correlations, and provide a valuable resource for the medical community

Characterization of a spark ignition system for flameholding cavities

This paper presents an experimental investigation of a capacitive-discharge spark ignition system designed to promote ignition in CH- and CH-fuelled supersonic combustors. The purpose of this study is the characterization of the ignition system and the plasma generated in the discharge. Schlieren and luminescence imaging are used to visualize the temporal evolution of the spark plasma. Transient voltages and currents across the primary-side of the ignition coil and input-side of the ignition unit are recorded using a high-speed data acquisition system. Three different ignition coils are tested with two different spark plug gaps in an attempt to increase the performance of the ignition system which is evaluated through spatially and temporally integrated luminescence recordings as well as temporally integrated photo diode signals. The data suggests that an increase in performance of a factor of 4-5 over the baseline setup can be achieved. A capacitive ignition lead is used to assess whether or not any capacitance on the coil secondary side can increase the performance of the ignition system. The experiments have also shown that the ignition system parameters can be set to cause sufficient heating of the electrodes to support ignition from a combined glow-spark plug setup

Familial co-occurrence of congenital heart defects follows distinct patterns

Aims Congenital heart defects (CHD) affect almost 1% of all live born children and the number of adults with CHD is increasing. In families where CHD has occurred previously, estimates of recurrence risk, and the type of recurring malformation are important for counselling and clinical decision-making, but the recurrence patterns in families are poorly understood. We aimed to determine recurrence patterns, by investigating the co-occurrences of CHD in 1163 families with known malformations, comprising 3080 individuals with clinically confirmed diagnosis. Methods and results We calculated rates of concordance and discordance for 41 specific types of malformations, observing a high variability in the rates of concordance and discordance. By calculating odds ratios for each of 1640 pairs of discordant lesions observed between affected family members, we were able to identify 178 pairs of malformations that co-occurred significantly more or less often than expected in families. The data show that distinct groups of cardiac malformations co-occur in families, suggesting influence from underlying developmental mechanisms. Analysis of human and mouse susceptibility genes showed that they were shared in 19% and 20% of pairs of co-occurring discordant malformations, respectively, but none of malformations that rarely co-occur, suggesting that a significant proportion of co-occurring lesions in families is caused by overlapping susceptibility genes. Conclusion Familial CHD follow specific patterns of recurrence, suggesting a strong influence from genetically regulated developmental mechanisms. Co-occurrence of malformations in families is caused by shared susceptibility genes

The clustering of galaxies in the SDSS-III Baryon Oscillation Spectroscopic Survey: cosmological implications of the large-scale two-point correlation function

We obtain constraints on cosmological parameters from the spherically averaged redshift-space correlation function of the CMASS Data Release 9 (DR9) sample of the Baryonic Oscillation Spectroscopic Survey (BOSS). We combine this information with additional data from recent CMB, SN and BAO measurements. Our results show no significant evidence of deviations from the standard flat-Lambda CDM model, whose basic parameters can be specified by Omega_m = 0.285 +- 0.009, 100 Omega_b = 4.59 +- 0.09, n_s = 0.96 +- 0.009, H_0 = 69.4 +- 0.8 km/s/Mpc and sigma_8 = 0.80 +- 0.02. The CMB+CMASS combination sets tight constraints on the curvature of the Universe, with Omega_k = -0.0043 +- 0.0049, and the tensor-to-scalar amplitude ratio, for which we find r < 0.16 at the 95 per cent confidence level (CL). These data show a clear signature of a deviation from scale-invariance also in the presence of tensor modes, with n_s <1 at the 99.7 per cent CL. We derive constraints on the fraction of massive neutrinos of f_nu < 0.049 (95 per cent CL), implying a limit of sum m_nu < 0.51 eV. We find no signature of a deviation from a cosmological constant from the combination of all datasets, with a constraint of w_DE = -1.033 +- 0.073 when this parameter is assumed time-independent, and no evidence of a departure from this value when it is allowed to evolve as w_DE(a) = w_0 + w_a (1 - a). The achieved accuracy on our cosmological constraints is a clear demonstration of the constraining power of current cosmological observations.Comment: 26 pages, 15 figures. Minor changes to match version accepted by MNRA