Quality Evaluation Tool for Clinician Online Continuing Medical Education

The purpose of this study was to develop and assess an instrument evaluating the quality of online continuing medical education interventions for clinicians. A review of seminal literature for evaluating health-related websites was conducted to incorporate best practices from health education, health communication, and web-based design principles. After reviewing the literature, 12 preliminary quality indicators were developed. Two independent coders used the preliminary quality indicators to code continuing medical education interventions. Internal reliability of the preliminary indicators was calculated using the Krippendorff’s alpha coefficient. After completing the reliability testing and revising the tool, the quality evaluation framework consisted of six quality indicators: accessibility, content, design, evaluation, interactivity, and theory/models. The indicators are not specifically tied to one content area; therefore, this tool can be utilized to assess the quality of continuing medical education interventions of various content areas. Future research should be conducted to further develop a comprehensive metric to assess indicators’ effect on behavior change and clinician communication with patients. These quality indicators are important as they are a foundation for intervention developers to effectively communicate current medical information and new guidelines from medical organizations and, in turn, impact patient communication and care

A cortical potential reflecting cardiac function

Emotional trauma and psychological stress can precipitate cardiac arrhythmia and sudden death through arrhythmogenic effects of efferent sympathetic drive. Patients with preexisting heart disease are particularly at risk. Moreover, generation of proarrhythmic activity patterns within cerebral autonomic centers may be amplified by afferent feedback from a dysfunctional myocardium. An electrocortical potential reflecting afferent cardiac information has been described, reflecting individual differences in interoceptive sensitivity (awareness of one's own heartbeats). To inform our understanding of mechanisms underlying arrhythmogenesis, we extended this approach, identifying electrocortical potentials corresponding to the cortical expression of afferent information about the integrity of myocardial function during stress. We measured changes in cardiac response simultaneously with electroencephalography in patients with established ventricular dysfunction. Experimentally induced mental stress enhanced cardiovascular indices of sympathetic activity (systolic blood pressure, heart rate, ventricular ejection fraction, and skin conductance) across all patients. However, the functional response of the myocardium varied; some patients increased, whereas others decreased, cardiac output during stress. Across patients, heartbeat-evoked potential amplitude at left temporal and lateral frontal electrode locations correlated with stress-induced changes in cardiac output, consistent with an afferent cortical representation of myocardial function during stress. Moreover, the amplitude of the heartbeat-evoked potential in the left temporal region reflected the proarrhythmic status of the heart (inhomogeneity of left ventricular repolarization). These observations delineate a cortical representation of cardiac function predictive of proarrhythmic abnormalities in cardiac repolarization. Our findings highlight the dynamic interaction of heart and brain in stress-induced cardiovascular morbidity

Variants Within Genes \u3ci\u3eEDIL3\u3c/i\u3e and \u3ci\u3eADGRB3\u3c/i\u3e are Associated With Divergent Fecal Egg Counts in Katahdin Sheep at Weaning

Gastrointestinal nematodes (GIN) pose a severe threat to sheep production worldwide. Anthelmintic drug resistance coupled with growing concern regarding potential environmental effects of drug use have demonstrated the necessity of implementing other methods of GIN control. The aim of this study was to test for genetic variants associated with resistance or susceptibility to GIN in Katahdin sheep to improve the current understanding of the genetic mechanisms responsible for host response to GIN. Linear regression and casecontrol genome-wide association studies were conducted with high-density genotype data and cube-root transformed weaning fecal egg counts (tFEC) of 583 Katahdin sheep. The casecontrol GWAS identified two significant SNPs (P-values 1.49e-08 to 1.01e-08) within introns of the gene adhesion G protein-coupled receptor B3 (ADGRB3) associated with lower fecal egg counts. With linear regression, four significant SNPs (P-values 7.82e-08 to 3.34e-08) were identified within the first intron of the gene EGF-like repeats and discoidin domains 3 (EDIL3). These identified SNPs were in very high linkage disequilibrium (r2 of 0.996–1), and animals with alternate homozygous genotypes had significantly higher median weaning tFEC phenotypes compared to all other genotypes. Significant SNPs were queried through public databases to identify putative transcription factor binding site (TFBS) and potential lncRNA differences between reference and alternate alleles. Changes in TFBS were predicted at two SNPs, and one significant SNPwas found to bewithin a predicted lncRNA sequencewith greater than 90% similarity to a known lncRNA in the bovine genome. The gene EDIL3 has been described in other species for its roles in the inhibition and resolution of inflammation. Potential changes of EDIL3 expression mediated through lncRNA expression and/or transcription factor binding may impact the overall immune response and reduce the ability of Katahdin sheep to control GIN infection. This study lays the foundation for further research of EDIL3 and ADGRB3 towards understanding genetic mechanisms of susceptibility to GIN, and suggests these SNPs may contribute to genetic strategies for improving parasite resistance traits in sheep

Swift-UVOT detection of GRB 050318

We present observations of GRB 050318 by the Ultra-Violet and Optical Telescope (UVOT) on-board the Swift observatory. The data are the first detections of a Gamma Ray Burst (GRB) afterglow decay by the UVOT instrument, launched specifically to open a new window on these transient sources. We showcase UVOTs ability to provide multi-color photometry and the advantages of combining UVOT data with simultaneous and contemporaneous observations from the high-energy detectors on the Swift spacecraft. Multiple filters covering 1,800-6,000 Angstroms reveal a red source with spectral slope steeper than the simultaneous X-ray continuum. Spectral fits indicate that the UVOT colors are consistent with dust extinction by systems at z = 1.2037 and z = 1.4436, redshifts where absorption systems have been pre-identified. However, the data can be most-easily reproduced with models containing a foreground system of neutral gas redshifted by z = 2.8 +/- 0.3. For both of the above scenarios, spectral and decay slopes are, for the most part, consistent with fireball expansion into a uniform medium, provided a cooling break occurs between the energy ranges of the UVOT and Swifts X-ray instrumentation.Comment: 15 pages, 4 figures, ApJ Letters, in pres

Genetic Markers of IgG Influence The Outcome of Infection with Hepatitis C Virus

We examined the role that immunoglobulin GM and KM allotypes—genetic markers of γ and κ chains, respectively—play in the outcome of hepatitis C virus (HCV) infection in white Americans. A total of 119 persons who had cleared HCV and 111 with persistent HCV infection were genotyped for the presence of several GM and KM determinants. Persistent HCV infection was more than three times as likely (odds ratio, 3.50; P = .01) in subjects who were carriers of the GM3 allele than in those who were noncarriers. These results show that particular GM alleles may be important determinants of the outcome of HCV infection

Implications of New Gallex Results for the MSW Solution of the Solar Neutrino Problem

We compare the implications for 7Be and pp neutrinos of the two MSW fits to the new GALLEX solar neutrino measurements . Small mixing angle solutions tend to suppress the former as electron-neutrinos, but not the latter, and large angle solutions tend to reduce both by about a factor of 2. The consequences for BOREXINO and similar solar neutrino--electron scattering experiments are discussed.Comment: 7 pages (plus 3 figures available upon request) UTAPHY-HEP-

Ultraviolet, Optical, and X-Ray Observations of the Type Ia Supernova 2005am with Swift

We present ultraviolet and optical light curves in six broadband filters and grism spectra obtained by Swift's Ultraviolet/Optical Telescope for the Type Ia supernova SN2005am. The data were collected beginning about four days before the B-band maximum, with excellent coverage of the rapid decline phase and later observations extending out to 69 days after the peak. The optical and near UV light curve match well those of SN1992A. The other UV observations constitute the first set of light curves shorter than 2500 Angstroms and allow us to compare the light curve evolution in three UV bands. The UV behavior of this and other low redshift supernovae can be used to constrain theories of progenitor evolution or to interpret optical light curves of high redshift supernovae. Using Swift's X-Ray Telescope, we also report the upper limit to SN2005am's X-ray luminosity to be 1.77 x 10^40 erg s^-1 in the 0.3--10 keV range from 58,117 s of exposure time.Comment: 15 pages, including 3 figures and 2 tables, submitted to Astrophysical Journa