DISCONNECTED FROM THE FRONT LINES: LACK OF WARFIGHTER EXPERIENCE IN ACQUISITIONS YIELDS UNACCEPTABLE END STATES

Over the past few decades, the Defense Acquisition System (DAS) has been under constant fire by Congress, taxpayers, and warfighters for unacceptable cost, schedule, and performance outcomes. This plague has been well documented, discussed, and many potential corrective measures implemented over the years with futile results. This leaves the warfighter with delivered capabilities not meeting actual operational needs, routinely late to field, yielding them irrelevant, and coming with unrecoverable cost overruns. One significant area of the acquisition process, the focus of this research, has the most impact on a program’s outcome yet had the least amount of change: who represents the warfighter during requirements generation and management throughout the life cycle. A program’s requirements establish the end cost, schedule, and performance thresholds that, once a program matures, are extremely difficult to change without a sizable penalty. This research documents a correlation between troubled programs and poor requirements support due to an operational knowledge gap caused by a lack of proficient end-user warfighter representatives involved and empowered in the process. Related, due to the inherent differences in views, experience, and expectations between a career acquisition professional and a warfighter, data shows a need for a blended professional within the DAS. The research shows failure to bridge this personnel gap will predictably yield the same unacceptable results.Lieutenant Commander, United States NavyCommander, United States NavyChief Warrant Officer Three, United States NavyApproved for public release. Distribution is unlimited

Medical Education Research in the Context of Translational Science

Health care struggles to transfer recent discoveries into high‐quality medical care. Therefore, translational science seeks to improve the health of patients and communities by studying and promoting the translation of findings from bench research into clinical care. Similarly, medical education practice may be slow to adopt proven evidence of better learning and assessment. The Academic Emergency Medicine ( AEM ) consensus conference was designed to promote the dissemination of evidence‐based education research and practice. We will pull from the work developed by the consensus conference as a means to create a roadmap for future medical education research using the framework of translational science.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95639/1/acem12040.pd

Astigmatoma

Parinaud's or dorsal midbrain syndrome is usually accomplished by abnormal eye movement and pupil dysfunction. The classic triad of upgaze paralysis, convergence retraction nystagmus and pupillary light-near dissociation are seen in 65% of patients. The common etiologies are hemorrhage, stroke and neoplasms in midbrain and pineal gland tumors. Germinoma is very rare accountingfor less than 5% of all brain tumors. The tectal tumors may cause high intracranial pressure, obstructive hydrocephalus, up gaze palsy, and diplopia. We present a case of parinaud's syndrome with delayed in diagnosis

Nest of Evil

83-year-old Caucasian female presented with headaches, fatigue and vision loss in the right eye. PMH is significant for HTN, HLD, meningioma, lumpectomy and radiation for breast cancer 1994&1998. No history of smoking. Meds: lisinopril, atorvastatin and metoprolol. ROS: fatigue, dizziness, balance problem and anxiety. Her recent MRI showed a plaque-like homogeneous enhancing dural based mass at the planum sphenoidale with involvement of left cavernous sinus measuring 3.6x 1.8x 3.8 cm only 0.2cm increase in each dimension compare to the imaging 6 months prior. BCVA 20/150, 20/40, 3+ RAPD OD, diffuse optic atrophy OD, sup optic atrophy OS. Visual field showed generalized constriction OD, inferior arcuate defect OS. OCT optic nerve: diffuse RNFL thinning OD, superior thinning OS. MRI orbit revealed involvement of orbital apex on the right side. She underwent surgical resection of tumor. Tumor progression in 3 months caused third N. palsy and vision loss on the left eye. VA 20/250 OD, LP OS. Pathology read as malignant tumor

Combining mapping and arraying: An approach to candidate gene identification

A combination of quantitative trait locus (QTL) mapping and microarray analysis was developed and used to identify 34 candidate genes for ovariole number, a quantitative trait, in Drosophila melanogaster. Ovariole number is related to evolutionary fitness, which has been extensively studied, but for which few a priori candidate genes exist. A set of recombinant inbred lines were assayed for ovariole number, and QTL analyses for this trait identified 5,286 positional candidate loci. Forty deletions spanning the QTL were employed to further refine the map position of genes contributing to variation in this trait between parental lines, with six deficiencies showing significant effects and reducing the number of positional candidates to 548. Parental lines were then assayed for expression differences by using Affymetrix microarray technology, and ANOVA was used to identify differentially expressed genes in these deletions. Thirty-four genes were identified that showed evidence for differential expression between the parental lines, one of which was significant even after a conservative Bonferroni correction. The list of potential candidates includes 5 genes for which previous annotations did not exist, and therefore would have been unlikely choices for follow-up from mapping studies alone. The use of microarray technology in this context allows an efficient, objective, quantitative evaluation of genes in the QTL and has the potential to reduce the overall effort needed in identifying genes causally associated with quantitative traits of interest

ATP-gated P2X3 receptors constitute a positive autocrine signal for insulin release in the human pancreatic β cell

Extracellular ATP has been proposed as a paracrine signal in rodent islets, but it is unclear what role ATP plays in human islets. We now show the presence of an ATP signaling pathway that enhances the human β cell's sensitivity and responsiveness to glucose fluctuations. By using in situ hybridization, RT-PCR, immunohistochemistry, and Western blotting as well as recordings of cytoplasmic-free Ca2+ concentration, [Ca2+]i, and hormone release in vitro, we show that human β cells express ionotropic ATP receptors of the P2X3 type and that activation of these receptors by ATP coreleased with insulin amplifies glucose-induced insulin secretion. Released ATP activates P2X3 receptors in the β-cell plasma membrane, resulting in increased [Ca2+]i and enhanced insulin secretion. Therefore, in human islets, released ATP forms a positive autocrine feedback loop that sensitizes the β cell's secretory machinery. This may explain how the human pancreatic β cell can respond so effectively to relatively modest changes in glucose concentration under physiological conditions in vivo