Putting theory into practice - a case study in one U.K. Medical school of the nature and extent of unprofessional behaviour over a 6-year period

Producing a medical profession which is fit for the demands and expectations of society involves ensuring that practitioners learn what it means to behave in a 'professional' way. Codes of professional conduct have been developed for medical students in the UK, but the literature on how medical schools actually apply these is small. More detail is needed to evaluate approaches to assessing professionalism, or to analyse the extent to which students 'fail' this aspect

Orthotopic liver transplantation for fulminant and subacute hepatic failure

Fulminant and subacute hepatitis are conditions characterized by rapid liver failure, which can lead to death in 80 to more than 95% of the cases with medical supportive care only. The etiology can be viral, drug-, or other chemical-induced, metabolic, etc. Orthotopic liver transplantation emerged during the 1980s as a powerful means for dealing with these diseases. The existence of this therapeutic modality has brought about major changes in the diagnosis, patient selection, treatment, and outlook for fulminant/subacute liver failure. The authors present the results of orthotopic liver transplantation for the treatment of 47 cases of acute/subacute hepatic insufficiency at the University of Pittsburgh between March 1980 and July 1987. The results of this series demonstrate that liver transplantation is the most effective means for treating this condition

Identification of transmembrane domains that regulate spatial arrangements and activity of prokineticin receptor 2 dimers

The chemokine prokineticin 2 (PK2) activates its cognate G protein-coupled receptor (GPCR) PKR2 to elicit various downstream signaling pathways involved in diverse biological processes. Many GPCRs undergo dimerization that can modulate a number of functions including membrane delivery and signal transduction. The aim of this study was to elucidate the interface of PKR2 protomers within dimers by analyzing the ability of PKR2 transmembrane (TM) deletion mutants to associate with wild type (WT) PKR2 in yeast using co-immunoprecipitation and mammalian cells using bioluminescence resonance energy transfer. Deletion of TMs 5-7 resulted in a lack of detectable association with WT PKR2, but could associate with a truncated mutant lacking TMs 6-7 (TM1-5). Interestingly, TM1-5 modulated the distance, or organization, between protomers and positively regulated Gαs signaling and surface expression of WT PKR2. We propose that PKR2 protomers form type II dimers involving TMs 4 and 5, with a role for TM5 in modulation of PKR2 function

Cholangiocarcinoma in sclerosing cholangitis. The role of liver transplantation

Our experience with patients who underwent orthotopic liver transplantation for sclerosing cholangitis at the University of Pittsburgh Health Center between March 1980 and March 1988 is reported here. Ten patients had an associated cholangiocarcinoma. Six of these patients died of recurrent, disseminated cancer, usually before one year. One patient died of sepsis, while three are alive and apparently free of tumor four months to almost two years later. Pre-operative identification of a possible cholangiocarcinoma and complete resection are of crucial importance. Adjuvant therapy, especially pre-transplant radiation with a prophylactic purpose is still being evaluated

The role of wind gusts in upper ocean diurnal variability

Upper ocean processes play a key role in air-sea coupling, with variability on both short and long time scales. The diurnal cycle associated with diurnal solar insolation and nighttime cooling, may act, along with stochastic wind variability, on upper ocean temperatures and stratification resulting in a diurnal warm layer and a nonlinear rectified effect on longer time scales. This study describes diurnal changes in upper ocean temperature for a location in the equatorial Indian Ocean, using observations from the Dynamics of the Madden-Julian Oscillation field campaign, a high vertical resolution 1-D process model, and a diurnal cycling scheme. Solar forcing is the main driver of diurnal variability in upper ocean temperature and stratification. Yet except during nighttime convection, winds with variability on the order of hours (here referred to as “wind gusts”) regulate how fast surface water is mixed to greater depths when daily mean winds are weak. Wind gusts are much stronger than diurnal winds. Even using stochastic wind gusts but no diurnal winds as input in a 1-D process model yields an estimate of diurnal temperature that compares well with observations. A new version of the Large and Caron (2015) scheme (LC2015) provides an estimate of upper ocean diurnal temperature that is consistent with observations. LC2015 has the advantage of being suitable for implementation in a climate model, with the goal to improve SST estimates, hence the simulated heat flux at the air-sea interface. Yet LC2015 is not very sensitive to the inclusion or omission of the high-frequency component of the wind

Phonon renormalisation in doped bilayer graphene

We report phonon renormalisation in bilayer graphene as a function of doping. The Raman G peak stiffens and sharpens for both electron and hole doping, as a result of the non-adiabatic Kohn anomaly at the $\Gamma$ point. The bilayer has two conduction and valence subbands, with splitting dependent on the interlayer coupling. This results in a change of slope in the variation of G peak position with doping, which allows a direct measurement of the interlayer coupling strength.Comment: 5 figure

Nitrification amplifies the decreasing trends of atmospheric oxygen and implies a larger land carbon uptake

[1] Atmospheric O-2 trend measurements are used to partition global oceanic and land biotic carbon sinks on a multiannual basis. The underlying principle is that a terrestrial uptake or release of CO₂ is accompanied by an opposite flux of O-2. The molar ratio of the CO₂ and O-2 terrestrial fluxes should be 1, if no other elements are considered. However, reactive nitrogen produced by human activities (e.g., fertilizers, N deposition) is also being incorporated into plant tissues. The various reaction pathways of the terrestrial nitrogen cycle cause fluxes of atmospheric O-2. Thus the cycles of nitrogen, carbon, and oxygen must be linked together. We report here on previously unconsidered anthropogenic nitrogen-related mechanisms which impact atmospheric O-2 trends and thus the derived global carbon sinks. In particular, we speculate that anthropogenic-driven changes are driving the global nitrogen cycle to a more oxidized state, primarily through nitrification, nitrate fertilizer industrial production, and combustion of fossil fuels and anthropogenic biomass burning. The sum of these nitrogen-related processes acts to additionally decrease atmospheric O-2 and slightly increase atmospheric CO₂. We have calculated that the effective land biotic O-2: CO₂ molar ratio ranges between 0.76 and 1.04 rather than 1.10 ( moles of O-2 produced per mole of CO₂ consumed) over the period 1993 - 2003, depending on which of four contrasting nitrogen oxidation and reduction pathway scenarios is used. Using the scenario in which we have most confidence, this implies a 0.23 PgC yr(-1) correction to the global land biotic and oceanic carbon sinks of most recently reported estimates over 1993 - 2003, with the land biotic sink becoming larger and the oceanic sink smaller. We have attributed large uncertainties of 100% to all nitrogen-related O-2 and CO₂ fluxes and this corresponds up to +/- 0.09 PgC yr(-1) increase in global carbon sink uncertainties. Thus accounting for anthropogenic nitrogen-related terrestrial fluxes of O-2 results in a 45% larger land biotic sink of 0.74 +/- 0.78 PgC yr(-1) and a slightly smaller oceanic sink of 2.01 +/- 0.66 PgC yr(-1) for the decade 1993 - 2003. [References: 38

Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial

Objective To determine whether vaccination of care home staff against influenza indirectly protects residents.Design Pair matched cluster randomised controlled trial.Setting Large private chain of UK care homes during the winters of 2003-4 and 2004-5.Participants Nursing home staff (n = 1703) and residents (n = 2604) in 44 care homes (22 intervention homes and 22 matched control homes).Interventions Vaccination offered to staff in intervention homes but not in control homes.Main outcome measures The primary outcome was all cause mortality of residents. Secondary outcomes were influenza-like illness and health service use in residents.Results In 2003-4 vaccine coverage in full time staff was 48.2% (407/884) in intervention homes and 5.9% (51/859) in control homes. In 2004-5 uptake rates were 43.2% (365/844) and 3.5% (28/800). National influenza rates were substaritially below average in 2004-5. In the 2003-4 period of influenza activity significant decreases were found in mortality of residents in intervention homes compared with control homes (rate difference - 5.0 per 100 residents, 95% confidence interval - 7.0 to - 2.0) and in influenza-like illness (P = 0.004), consultations with general practitioners for influenza-like illness (P = 0.008), and admissions to hospital with influenza-like illness (P = 0.009). No significant differences were found in 2004-5 or during periods of no influenza activity in 2003-4.Conclusions Vaccinating care home staff against influenza can prevent deaths, health service use, and influenza-like illness in residents during periods of moderate influenza activity

Quantum spin Hall effect in bound states in continuum

Moving the polarization of the incident wave along a meridian of the Poincaré sphere, experimentally we show that the coupling with the fundamental Bloch's surface waves of the mode, provide a spatially coherent, macroscopic spinmomentum locked propagation along the symmetry axes of the PhCM. This novel mechanism of light-spin manipulation enables a versatile implementation of spin-optical structures that may pave the way to novel strategies for light spin technology and photonic multiplatform implementations