Effect of physician reminders on preventive care: meta-analysis of randomized clinical trials

pre-printThe objective of this study was to assess the clinical value of the physician reminder, an information intervention, in increasing compliance for selected preventive health care measures. Meta-analysis was used to combine the quantitative evidence from randomized controlled clinical trials meeting the eligibility criteria. The trials included in this meta-analysis were conducted in a family or internal medicine clinic. Physician reminders were used in the trials to influence utilization and compliance of preventive health care activities. The use of physician reminders for preventive health care activities resulted in a homogeneous effect for the subcategories of cervical cancer screening (test for heterogeneity X22 = 4.122, non significant) and tetanus immunization (test for heterogeneity X22 = 3.139, non-significant). Similarly, the odds ratio from the combination of evidence from the three cervical cancer screening trials was significant (1.180, 95 percent CI: 1.020 to 1.339). The resulting odds ratio from the combination of evidence from the three tetanus immunization trials was significant (2.819, 95 percent CI: 2.664 to 2.975). The results of the meta-analyses for cervical cancer screening and tetanus immunizations indicate that physician reminders are an effective information intervention and can improve compliance for these two preventive health care procedures. Based on the results of this meta-analysis, further trials testing the effect of physician reminders on tetanus immunization would be unnecessary and probably unethical

Mendelian inheritance in man: diagnoses in the UMLS

pre-printBecause they deal with many distinct but rare inheritance diseases, geneticists have difficulty translating from their codes to other biomedical coding schemes. The objective ofthis research was to investigate the potential uses and difficulties of using the UMLS Metathesaurus for genetic diagnoses and to make recommendations to UMLS developers for improvements in UMLS for common genetic disorders. The 110 most common Mendelian Inheritance in Man disorders from the Missouri Genetic Disease Program over the period of one year were translated into MeSH, ICD and SNOMED. The more common diseases are more likely to be mapped than the rarer ones. Diseases with a proven genetic inheritance pattern are more likely to be mapped than those with speculated inheritance patterns. Approximately one third of all diagnoses were not mapped across all three coding schemes in Meta-1. 2. The ICD coding scheme was found to be too broad to be meaningful for genetic diagnosis or epidemiological purposes. MeSH and SNOMED need to be made more specific and complete, and all of the new version of SNOMED needs to be included in the Metathesaurus

Drugs and Criminal Responsibility

This Special Project has carried out three broad purposes.First, it has synthesized and organized materials concerning drugs and criminal responsibility into a useful guide for legal practitioners and others interested in the problems of the drug dependent defendant. Second, it has identified serious analytical flaws in many of the defenses available to the criminal defendant. Finally,it has responded to these deficiencies with proposals intended to protect not only the legal rights of the drug dependent defendant but also the rights of society pertaining to criminal justice. While these societal interests include the swift imposition of criminal penalties when warranted, they should not be allowed to diminish the concomitant rights of the criminal defendant. In fact, societal rights would be better served by a reexamination and reinterpretation of several traditional legal theories concerning drugs and criminal defendants. A recognition by courts and legislatures of the existing analytical flaws should lead to the development of more equitable theories and a search for alternative forms of treatment and rehabilitation for the drug dependent defendant. Rather than hiding behind the guise of legal history and moral judgment, courts and legislatures should respond to illogical and insufficient theories that fail to deal with the drug dependent defendant in an equitable and just manner

The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease

Background. Nutrition is important for the management of chronic diseases. While practice nurses have numerous roles in primary care, the expectations on practice nurses to provide nutrition care for chronic disease management are increasing. The self-perceived knowledge, skills and attitudes of practice nurses in providing nutrition care has not been widely investigated

Small, Low-energy, Dispersive Solar Energetic Particle Events Observed by Parker Solar Probe

The Energetic Particle Instrument–Low Energy (EPI-Lo) experiment has detected several weak, low-energy (~30–300 keV nucleon⁻¹) solar energetic particle (SEP) events during its first two closest approaches to the Sun, providing a unique opportunity to explore the sources of low-energy particle acceleration. As part of the Parker Solar Probe (PSP) Integrated Science Investigation of the Sun (IS⊙IS) suite, EPI-Lo was designed to investigate the physics of energetic particles; however, in the special lowest-energy "time-of-flight only" product used in this study, it also responds to solar photons in a subset of approximately sunward-looking apertures lacking special light-attenuating foils. During the first three perihelia, in a frame rotating with the Sun, PSP undergoes retrograde motion, covering a 17° heliographic longitudinal range three times during the course of the ~11-day perihelion passes, permitting a unique spatial and temporal study into the location, correlation, and persistence of previously unmeasurable SEPs. We examine the signatures of these SEPs (during the first PSP perihelion pass only) and the connection to possible solar sources using remote observations from the Solar Dynamics Observatory (SDO), the Solar TErrestrial RElations Observatory (STEREO), and the ground-based Global Oscillation Network Group (GONG). The orientation of the Sun relative to STEREO, SDO, and GONG makes such identifications challenging, but we do have several candidates, including an equatorial coronal hole at a Carrington longitude of ~335°. To analyze observations from EPI-Lo, which is a new type of particle instrument, we examine instrumental effects and provide a preliminary separation of the ion signal from the photon background

Banking from Leeds, not London: regional strategy and structure at the Yorkshire Bank, 1859–1952

Industrial philanthropist Edward Akroyd created the Yorkshire Penny Savings Bank in 1859. Despite competition from the Post Office Savings Bank after 1861 and a serious reserve problem in 1911, it sustained his overall strategy to become a successful regional bank. Using archival and contemporary sources to build on recent scholarship illustrating how savings banks were integrated into local economies and the complementary roles of philanthropy and paternalism, we analyse an English regional bank's strategy, including an assessment of strategic innovation, ownership changes and management structure. This will demonstrate that the founder's vision continued, even though the 1911 crisis radically altered both strategy and structure

Novel missense mutations of the Deleted-in-AZoospermia-Like (DAZL) gene in infertile women and men

BACKGROUND: The Deleted-in-AZoospermia-Like (DAZL) gene has homologs required for germ cell development in many organisms. Recently, we showed that there are several common polymorphisms within the DAZL gene that are associated with age at ovarian failure/menopause and sperm count. METHODS: Here we sought to identify rare mutations in DAZL and examine their phenotypes in men and women. We sequenced the DAZL gene in 519 individuals; sequences spanned the entire coding region of the gene. RESULTS: We report the identification of four putative missense mutations in DAZL. Three individuals that were heterozygous for a DAZL mutation reported having children, while two individuals that were homozygous reported no children. These mutations were found only in infertile men and women. CONCLUSION: Given the strong data associating DAZL polymorphisms and deletions with fertility in humans and model organisms, we suggest that these mutations may be associated with age at menopause and/or sperm count and warrant further biochemical and genetic investigation

Neotropical Anacardiaceae (cashew family)

Anacardiaceae is an ecologically and economically important plant family of about 200 species in 32 genera in the Neotropics. The family is particularly diverse in leaf architecture and fruit morphology, making it a model family to study the evolution of structural diversity as it correlates with lineage diversification. This fruit diversity is the primary reason 11 of the Neotropical genera are monotypic and that so many genera are recognized in the Anacardiaceae. The economic value of the family is driven by the global markets for cashews, mangoes, and pistachios, but there is great potential value in its medicinal properties. At least 10 Neotropical genera cause contact dermatitis, which is a rich area for research in the family. Here presented is a review of the systematics and structural diversity of the family. Particular attention is given to the morphology, economic botany, paleobotany, ecology, and taxonomy of native and naturalized genera. Keys to Neotropical Anacardiaceae subfamilies and genera are provided along with descriptions of native genera

Observations of Energetic-particle Population Enhancements along Intermittent Structures near the Sun from the Parker Solar Probe

Observations at 1 au have confirmed that enhancements in measured energetic-particle (EP) fluxes are statistically associated with "rough" magnetic fields, i.e., fields with atypically large spatial derivatives or increments, as measured by the Partial Variance of Increments (PVI) method. One way to interpret this observation is as an association of the EPs with trapping or channeling within magnetic flux tubes, possibly near their boundaries. However, it remains unclear whether this association is a transport or local effect; i.e., the particles might have been energized at a distant location, perhaps by shocks or reconnection, or they might experience local energization or re-acceleration. The Parker Solar Probe (PSP), even in its first two orbits, offers a unique opportunity to study this statistical correlation closer to the corona. As a first step, we analyze the separate correlation properties of the EPs measured by the Integrated Science Investigation of the Sun (IS⊙IS) instruments during the first solar encounter. The distribution of time intervals between a specific type of event, i.e., the waiting time, can indicate the nature of the underlying process. We find that the IS⊙IS observations show a power-law distribution of waiting times, indicating a correlated (non-Poisson) distribution. Analysis of low-energy (~15 – 200 keV/nuc) IS⊙IS data suggests that the results are consistent with the 1 au studies, although we find hints of some unexpected behavior. A more complete understanding of these statistical distributions will provide valuable insights into the origin and propagation of solar EPs, a picture that should become clear with future PSP orbits

Solar Energetic Particles Produced by a Slow Coronal Mass Ejection at ∼0.25 au

We present an analysis of Parker Solar Probe (PSP) IS⊙IS observations of ~30–300 keV n⁻¹ ions on 2018 November 11 when PSP was about 0.25 au from the Sun. Five hours before the onset of a solar energetic particle (SEP) event, a coronal mass ejection (CME) was observed by STEREO-A/COR2, which crossed PSP about a day later. No shock was observed locally at PSP, but the CME may have driven a weak shock earlier. The SEP event was dispersive, with higher energy ions arriving before the lower energy ones. Timing suggests the particles originated at the CME when it was at ~7.4R_⊙. SEP intensities increased gradually from their onset over a few hours, reaching a peak, and then decreased gradually before the CME arrived at PSP. The event was weak, having a very soft energy spectrum (−4 to −5 spectral index). The earliest arriving particles were anisotropic, moving outward from the Sun, but later, the distribution was observed to be more isotropic. We present numerical solutions of the Parker transport equation for the transport of 30–300 keV n⁻¹ ions assuming a source comoving with the CME. Our model agrees well with the observations. The SEP event is consistent with ion acceleration at a weak shock driven briefly by the CME close to the Sun, which later dissipated before arriving at PSP, followed by the transport of ions in the interplanetary magnetic field