Resident Physicians' Preparedness to Provide Cross-Cultural Care: Implications for Clinical Care and Medical Education Policy

Recommends integrating cross-cultural training into medical school curricula, training faculty to ensure useful instruction and mentoring, and mandatory and formal evaluation of residents' cross-cultural communication skills

Exploring a Method to Quantitatively Measure Design Flexibility Early in the Defense Acquisition Life Cycle

The purpose of this research was to demonstrate a methodology using an Epoch-Era Analysis to quantify and estimate the value of design flexibility early in the Department of Defense\u27s (DOD) acquisition life cycle. This method was implemented using a possible replacement to the Air Force\u27s fighter-trainer aircraft as a baseline and a set of future requirements that would change the baseline. An existing Cost Estimating Relationship tool was utilized in conjunction with a decision tree modeling approach to accommodate uncertain future needs. Sensitivity analysis was performed to identify model parameters with dominant effects on the recommended design strategies. The results indicated that this methodology can quantitatively measure design flexibility using existing tools when key assumptions are made. The methodology exists as a proof of concept within the domain of aircraft to quantitatively measure design flexibility early in the acquisition life cycle. Further research is required to characterize the assumptions of this study and to test this methodology in other domains to validate its broader applicability

Expression of Heterologous OsDHAR Gene Improves Glutathione (GSH)-Dependent Antioxidant System and Maintenance of Cellular Redox Status in Synechococcus elongatus PCC 7942.

An excess of reactive oxygen species (ROS) can cause severe oxidative damage to cellular components in photosynthetic cells. Antioxidant systems, such as the glutathione (GSH) pools, regulate redox status in cells to guard against such damage. Dehydroascorbate reductase (DHAR, EC 1.8.5.1) catalyzes the glutathione-dependent reduction of oxidized ascorbate (dehydroascorbate) and contains a redox active site and glutathione binding-site. The DHAR gene is important in biological and abiotic stress responses involving reduction of the oxidative damage caused by ROS. In this study, transgenic Synechococcus elongatus PCC 7942 (TA) was constructed by cloning the Oryza sativa L. japonica DHAR (OsDHAR) gene controlled by an isopropyl β-D-1-thiogalactopyranoside (IPTG)-inducible promoter (Ptrc) into the cyanobacterium to study the functional activities of OsDHAR under oxidative stress caused by hydrogen peroxide exposure. OsDHAR expression increased the growth of S. elongatus PCC 7942 under oxidative stress by reducing the levels of hydroperoxides and malondialdehyde (MDA) and mitigating the loss of chlorophyll. DHAR and glutathione S-transferase activity were higher than in the wild-type S. elongatus PCC 7942 (WT). Additionally, overexpression of OsDHAR in S. elongatus PCC 7942 greatly increased the glutathione (GSH)/glutathione disulfide (GSSG) ratio in the presence or absence of hydrogen peroxide. These results strongly suggest that DHAR attenuates deleterious oxidative effects via the glutathione (GSH)-dependent antioxidant system in cyanobacterial cells. The expression of heterologous OsDHAR in S. elongatus PCC 7942 protected cells from oxidative damage through a GSH-dependent antioxidant system via GSH-dependent reactions at the redox active site and GSH binding site residues during oxidative stress

Minimum-Cost Coverage of Point Sets by Disks

We consider a class of geometric facility location problems in which the goal is to determine a set X of disks given by their centers (t_j) and radii (r_j) that cover a given set of demand points Y in the plane at the smallest possible cost. We consider cost functions of the form sum_j f(r_j), where f(r)=r^alpha is the cost of transmission to radius r. Special cases arise for alpha=1 (sum of radii) and alpha=2 (total area); power consumption models in wireless network design often use an exponent alpha>2. Different scenarios arise according to possible restrictions on the transmission centers t_j, which may be constrained to belong to a given discrete set or to lie on a line, etc. We obtain several new results, including (a) exact and approximation algorithms for selecting transmission points t_j on a given line in order to cover demand points Y in the plane; (b) approximation algorithms (and an algebraic intractability result) for selecting an optimal line on which to place transmission points to cover Y; (c) a proof of NP-hardness for a discrete set of transmission points in the plane and any fixed alpha>1; and (d) a polynomial-time approximation scheme for the problem of computing a minimum cost covering tour (MCCT), in which the total cost is a linear combination of the transmission cost for the set of disks and the length of a tour/path that connects the centers of the disks.Comment: 10 pages, 4 figures, Latex, to appear in ACM Symposium on Computational Geometry 200

An extended global Earth system data record on daily landscape freeze–thaw status determined from satellite passive microwave remote sensing

The landscape freeze–thaw (FT) signal determined from satellite microwave brightness temperature (Tb) observations has been widely used to define frozen temperature controls on land surface water mobility and ecological processes. Calibrated 37 GHz Tb retrievals from the Scanning Multichannel Microwave Radiometer (SMMR), Special Sensor Microwave Imager (SSM/I), and SSM/I Sounder (SSMIS) were used to produce a consistent and continuous global daily data record of landscape FT status at 25 km grid cell resolution. The resulting FT Earth system data record (FT-ESDR) is derived from a refined classification algorithm and extends over a larger domain and longer period (1979–2014) than prior FT-ESDR releases. The global domain encompasses all land areas affected by seasonal frozen temperatures, including urban, snow- and ice-dominant and barren land, which were not represented by prior FT-ESDR versions. The FT retrieval is obtained using a modified seasonal threshold algorithm (MSTA) that classifies daily Tb variations in relation to grid-cell-wise FT thresholds calibrated using surface air temperature data from model reanalysis. The resulting FT record shows respective mean annual spatial classification accuracies of 90.3 and 84.3 % for evening (PM) and morning (AM) overpass retrievals relative to global weather station measurements. Detailed data quality metrics are derived characterizing the effects of sub-grid-scale open water and terrain heterogeneity, as well as algorithm uncertainties on FT classification accuracy. The FT-ESDR results are also verified against other independent cryospheric data, including in situ lake and river ice phenology, and satellite observations of Greenland surface melt. The expanded FT-ESDR enables new investigations encompassing snow- and ice-dominant land areas, while the longer record and favorable accuracy allow for refined global change assessments that can better distinguish transient weather extremes, landscape phenological shifts, and climate anomalies from longer-term trends extending over multiple decades. The dataset is freely available online (doi:10.5067/MEASURES/CRYOSPHERE/nsidc-0477.003)

Loss of the tumor suppressor, Tp53, enhances the androgen receptor-mediated oncogenic transformation and tumor development in the mouse prostate.

Recent genome analysis of human prostate cancers demonstrated that both AR gene amplification and TP53 mutation are among the most frequently observed alterations in advanced prostate cancer. However, the biological role of these dual genetic alterations in prostate tumorigenesis is largely unknown. In addition, there are no biologically relevant models that can be used to assess the molecular mechanisms for these genetic abnormalities. Here, we report a novel mouse model, in which elevated transgenic AR expression and Trp53 deletion occur simultaneously in mouse prostatic epithelium to mimic human prostate cancer cells. These compound mice developed an earlier onset of high-grade prostatic intraepithelial neoplasia and accelerated prostate tumors in comparison with mice harboring only the AR transgene. Histological analysis showed prostatic sarcomatoid and basaloid carcinomas with massive squamous differentiation in the above compound mice. RNA-sequencing analyses identified a robust enrichment of the signature genes for human prostatic basal cell carcinomas in the above prostate tumors. Master regulator analysis revealed SOX2 as a transcriptional regulator in prostatic basal cell tumors. Elevated expression of SOX2 and its downstream target genes were detected in prostatic tumors of the compound mice. Chromatin immunoprecipitation analyses implicate a coregulatory role of AR and SOX2 in the expression of prostatic basal cell signature genes. Our data demonstrate a critical role of SOX2 in prostate tumorigenesis and provide mechanistic insight into prostate tumor aggressiveness and progression mediated by aberrant AR and p53 signaling pathways

Mechanisms of airfoil noise near stall conditions

The focus of this paper is on investigating the noise produced by an airfoil at high angles of attack over a range of Reynolds number Re≈2×10⁵–4×10⁵. The objective is not modeling this source of noise but rather understanding the mechanisms of generation for surface pressure fluctuations, due to a separated boundary layer, that are then scattered by the trailing edge. To this aim, we use simultaneous noise and surface pressure measurement in addition to velocimetric measurements by means of hot wire anemometry and time-resolved particle image velocimetry. Three possible mechanisms for the so-called “separation-stall noise” have been identified in addition to a clear link between far-field noise, surface pressure, and velocity fields in the noise generation