A Genetic Locus Regulates the Expression of Tissue-Specific mRNAs from Multiple Transcription Units

129 GIX- mice, unlike animals of the congeneic partner strain GIX+, do not express significant amounts of the retroviral antigens gp70 and p30. Evidence is presented indicating that the GIX phenotype is specified by a distinct regulatory gene acting on multiple transcription units to control the levels of accumulation of specific mRNA species. The steady-state levels of retroviral-homologous mRNA from the tissues of GIX+ and GIX- mice were examined by blot hybridization using as probes DNA fragments from cloned murine leukemia viruses. RNA potentially encoding viral antigens was reduced or absent in GIX- mice, even though no differences in integrated viral genomes were detected between these congeneic strains by DNA blotting. Tissue-specific patterns of accumulation of these RNA species were detected in brain, epididymis, liver, spleen, and thymus, and several distinct RNA species were found to be coordinately regulated with the GIX phenotype. Measurements of RNA synthesis suggest a major role for transcriptional control in the regulation of some retroviral messages

Combining Historical Research and Narrative Inquiry to Create Chronicles and Narratives

Stories about the Idaho State Library, chronicles and narratives, are reported in my doctoral dissertation (Wilson, 2005). The chronicles, reconstructed from documents and records, provided a presentation of the people, events, and activities to frame the stories. The narratives, excerpted from interviews, provided the rich description and unique perspectives of the two living State Librarians who directed the agency between 1962 and 2005. The focus of this paper is a presentation and discussion of the use of historical research and narrative inquiry to create chronicles and narratives

Inciting Genocide with Words

During the 1994 genocide in Rwanda, observers emphasized the role of media propaganda in inciting Rwandan Hutus to attack the Tutsi minority group, with one claiming that the primary tools of genocide were “the radio and the machete.” As a steady stream of commentators referred to “radio genocide” and “death by radio” and “the soundtrack to genocide,” a widespread consensus emerged that key responsibility for the genocide lay with the Rwandan media. Mathias Ruzindana, prosecution expert witness at the ICTR, supports this notion, writing, “In the case of the 1994 genocide in Rwanda, the effect of language was lethal . . . hate media . . . played a key role in the instigation of genocide.” Legal precedents from the International Criminal Tribunal for Rwanda (ICTR) solidified this view as doctrine, finding that certain public statements by Hutu political leaders and RTLM radio broadcasts constituted direct and public incitement to commit genocide against ethnic Tutsis

Prioritising pre-hospital outcome measures with a multi-stakeholder group: a consensus methods study

Context: A consensus event to discuss and prioritise ambulance service care outcome measures was held with 43 participants from a range of professional backgrounds including Commissioners; Policy makers; clinicians; managers; academics and patient and public representatives. Problem: Ambulance services in England manage 8 million emergency calls per years and treat 6.5 million people. Services are currently unable to ascertain whether the care they provide is safe, effective and of good quality as they receive no information about patients once they have been discharged from their care. The lack of robust patient focussed outcome measures for ambulance care means there is no opportunity for identifying and sharing good practice, identifying problems and measuring the impact of service developments and innovations. Assessment of problem and analysis of its causes: Historically ambulance service performance has been measured using response time as a proxy measure for quality. Although the limitations of this measure are recognised there is a lack of consensus on which outcome measures are important and little opportunity to measure alternatives due to poor information on what happens to patients after their ambulance service contact. The PhOEBE NIHR research programme aims to develop a linked ambulance service and secondary care dataset and to assess quality of care in this patient group using outcome measures identified from the literature and in consultation with different stakeholder groups. This means that for the first time the ambulance service will be able to assess the quality of care they provide to patients, rather than just how quickly the ambulance arrived. Intervention: Potential outcome measures identified from 2 systematic reviews were categorised into 1 of 3 headings (Service/operational, patient management and patient outcomes) and participants were pre-allocated to a discussion group. All discussion groups contained participants representing a range of stakeholder view points. Participants took part in small group themed discussions relating to a number of pre-specified outcome measures. They were also able to add to the list of measures. Directly following the discussion participants voted on the importance of the outcome measures in relation to ambulance service care quality. This was done using Turning Point software. Participants rated each outcome measure as either ‘Essential’, ‘Desirable’ or ‘Irrelevant’ using individual key pads. The voting was done independently and anonymously. Real time results were displayed following each vote. Study design: We used an interactive voting system coupled with a modified nominal group technique for the prioritisation of potential ambulance service outcome measures. Strategy for change: Following on from this study the top ranking outcome measures will be further refined as part of a Delphi study, before using the outcome measures to assess ambulance service quality of care in our linked data sample. The methods for linking the ambulance service data to other health care information and the identified outcome measures will enable all UK ambulance services to assess the quality of care they provide to patients and the impact of any service changes on care quality and patient outcomes. Measurement of improvement: The results from the outcome prioritisation voting exercise were ranked based on the highest proportion of ‘Essential’ rated measures. Where over 50% of participants rated a measure as ‘Essential’ these were taken forward and considered in further consensus studies. Effects of changes: From undertaking the consensus event we have prioritised potential ambulance service outcome measures. Lessons learnt: We have established that it is possible to incorporate voting technology into consensus methodologies and provide real time results to participants. Message for others: This research prioritised ambulance service outcome measures. Out of the 40 number of measures considered, the top 5 measures were Accuracy of dispatch decisions; Completeness and accuracy of patient records; Accuracy of call taker identification of different conditions; pain measurement and symptom relief and Patient experience

Developing new ways of measuring the impact of ambulance service care

Background Pre-hospital care in England is provided by ambulance services who deliver a diverse range of services to over 9 million patients a year but there is limited evidence about the effectiveness of this care. Historically ambulance performance has been measured by response times rather than clinical need or effectiveness. Progress on developing more appropriate performance measures is constrained by a lack of information about what happens to patients and their outcome after the pre-hospital component of care. If ambulance service information about patients could be linked to process and outcome data further along the care pathway then relevant measurement tools could be developed that allow a better assessment of the impact of pre-hospital care. The Pre-hospital Outcomes for Evidence Based Evaluation (PhOEBE) project is a 5 year programme of research funded by the UK National Institute of Health Research. Aims & objectives The aim of the programme is to develop new ways of measuring the impact of care provided by the ambulance service to support quality improvement through monitoring, audit and service evaluation. The objectives are to: 1) Review and synthesise the research literature on pre-hospital care outcome measures and identify measures relevant to the NHS and patients for further development; 2) Create a dataset linking routinely collected pre-hospital data, hospital data and mortality data to provide outcome information; 3) Develop new ways of measuring process and outcome indicators including building risk adjustment models that predict the outcomes using the linked data; 4) Explore the practical use of the linked dataset and the risk adjustment models to measure the effectiveness and quality of ambulance service care. Research plans The programme has 4 linked stages; 1. Synthesis of evidence on outcome measures and identification of measures for further development - review and assessment of the evidence base on outcome measurement for pre-hospital care and a consensus studies to identify measures relevant to patients and NHS staff. 2: Linking pre-hospital data with other patient data sources – creating a single dataset that links ambulance service electronic care records with routinely collected Hospital Episode Statistics (HES) and national mortality data. 3. Development of risk adjustment models for outcomes in patients attended by the ambulance service – using the linked data to develop risk adjustment tools that will allow patient differences to be taken into account and differences between expected and actual outcomes to be detected. Particular emphasis will be made to include the broad EMS population and not specific conditions as has been the case in the past. 4. Testing the risk adjustment models to assess if they can be used to measure effectiveness and quality – exploring the practical application of the measures by using them to assess if different ways of providing ambulance service care result in different consequences for patients. Outputs, outcomes and impact The programme will: • Provide a summary of relevant evidence on pre-hospital care outcome measurement • Develop a method for linking healthcare information into a format that can be used to support quality improvement, is acceptable to patients and complies with information legislation • Develop population based models for measuring the impact of pre-hospital care that can be used to monitor quality and safety, evaluate new service innovations and support quality improvement • Provide added value by using routine information and NHS infrastructure to operationalise the process and outcome models so that they will be of use across the NHS Progress to date The programme commenced in June 2011 and ends in May 2016. Two systematic reviews of measures used to measure the impact of ambulance service care (one policy literature and one research literature based) have been completed as has a qualitative study of recent service users to identify aspects of service they value. Potential measures identified by these studies were presented at a consensus conference and then further refined in a Delphi study to prioritise and identify measures for further development. Linked data is currently being created and the next stage will be the development of risk adjusted predictive models for the final identified measures

Incitement in an Era of Populism: Updating Brandenburg After Charlottesville

We live in an era of populism, characterized by political polarization, inciting speech on social media, and an escalation in hate crimes. The regulatory framework for direct incitement to imminent lawless action established fifty years ago in Brandenburg is showing signs of severe strain. One of the central frailties of Brandenburg’s three-part test is the lack of guidance on how courts should evaluate the probability that an inciting speech act will cause an imminent offense. In the absence of clear direction on analyzing risk, judges often rely on outdated heuristics and misleading metaphors. This article is the first to draw on behavioral research to construct a systematic evidence-based framework for assessing the likelihood that inciting speech will result in imminent lawless action. This matrix is then applied to the fact pattern in Sines v. Kessler, a civil suit arising from the events in Charlottesville, Virginia in 2017