Paul J. Rainey: Northeast Mississippi\u27s Hidden Legend

Paul J. Rainey was a man of the 20th century who had it all. A fortune, land, ability to travel, and fame. He was a big game hunter who out did all others and a wildlife filmmaker who broke records and helped to finance the beginning of Universal Studios. While all his claims to fame were with hunting and filmmaking, Rainey went on to serve in the Great War as an ambulance driver, spy, and Captain in the British army. Rainey was originally from Ohio, but in 1901 he bought land in Northeast Mississippi. Here, Rainey established his Tippah Lodge and home. While his time in history was well documented in The New York Times, his legacy has been forgotten except in the northeast corner of Mississippi. In Tippah and Union counties, Rainey has become a local legend and mysterious 20th century man. Very little is understood or known about him, but this thesis breaks new ground. With research across the United States and interviews with local historians, Rainey comes to life through the pages of history. His hidden legend in Northeast Mississippi is hidden no more, but now laid out in a way that will encourage modern scholars to learn more about a man who has offered so much to the history of the world, but has been forgotten and covered by time. A literary figure as well as a legend, Rainey shows up in famous works of the Mississippi author, William Faulkner, and in Canadian poet WIlliam Service’s poetry. His legacy lives on and is now presented to the public for the first time in an academic format. Described as the real life great gatsby, Rainey lived a life of influence and fame in the 20th century and impacted the world with his skills, adventurous lifestyle, and northeast Mississippi legacy

Empathy, Acceptance of Responsibility, and Compelled Testimony in Juvenile Transfer Hearings: Legal Context and Empirical Evidence

There are a number of legal decisions in which the court must decide whether juveniles can be rehabilitated. Such decisions include juvenile adjudication/placement, waiver, and reverse waiver.1 The criterion used by courts to consider rehabilitation amenability is typically phrased in a way similar to that described under Pennsylvania state law.2 In deciding whether a child may be decertified (reverse waived from criminal to juvenile court), the court can consider. whether the child is amenable to treatment, supervision, or rehabilitation as a juvenile. The court may consider the following in determining treatment, supervision, or rehabilitation amenability: (a) age, (b) mental capacity, (c) maturity, (d) degree of criminal sophistication, (e) previous records, (f) nature and extent of any prior delinquent history, including the success or failure of any previous attempts by the juvenile court to rehabilitate, (g) whether the child can be rehabilitated prior to the expiration of the juvenile court jurisdiction, (h) probation or institutional reports, (i) any other relevant factors, and (j) whether there are reasonable grounds to believe that the child is not committable to an institution for the mentally retarded or mentally ill.3 Empathy for the victims of the defendant’s offenses, and acceptance of responsibility for such offenses, may be considered by mental health and justice professionals working with post-adjudicated youth. But rendering an expert opinion that describes the youth’s capacity for empathy or acceptance of responsibility, when that opinion is based in part on questions concerning the alleged offense, places the evaluating expert in an awkward position. To what extent can denial of culpability be used to infer limited empathy and acceptance of responsibility? How does the Fifth Amendment right against self-incrimination factor into this consideration

Susceptibility locus on chromosome 1q23-25 for a schizophrenia subtype resembling deficit schizophrenia identified by latent class analysis

Context: Identifying susceptibility genes for schizophrenia may be complicated by phenotypic heterogeneity, with some evidence suggesting that phenotypic heterogeneity reflects genetic heterogeneity. Objective: To evaluate the heritability and conduct genetic linkage analyses of empirically derived, clinically homogeneous schizophrenia subtypes. Design: Latent class and linkage analysis. Setting: Taiwanese field research centers. Participants: The latent class analysis included 1236 Han Chinese individuals with DSM-IV schizophrenia. These individuals were members of a large affected-sibling-pair sample of schizophrenia (606 ascertained families), original linkage analyses of which detected a maximum logarithm of odds (LOD) of 1.8 (z = 2.88) on chromosome 10q22.3. Main Outcome Measures: Multipoint exponential LOD scores by latent class assignment and parametric heterogeneity LOD scores. Results: Latent class analyses identified 4 classes, with 2 demonstrating familial aggregation. The first (LC2) described a group with severe negative symptoms, disorganization, and pronounced functional impairment, resembling "deficit schizophrenia." The second (LC3) described a group with minimal functional impairment, mild or absent negative symptoms, and low disorganization. Using the negative/deficit subtype, we detected genome-wide significant linkage to 1q23-25 (LOD = 3.78, empiric genome-wide P = .01). This region was not detected using the DSM-IV schizophrenia diagnosis, but has been strongly implicated in schizophrenia pathogenesis by previous linkage and association studies.Variants in the 1q region may specifically increase risk for a negative/deficit schizophrenia subtype. Alternatively, these results may reflect increased familiality/heritability of the negative class, the presence of multiple 1q schizophrenia risk genes, or a pleiotropic 1q risk locus or loci, with stronger genotype-phenotype correlation with negative/deficit symptoms. Using the second familial latent class, we identified nominally significant linkage to the original 10q peak region. Conclusion: Genetic analyses of heritable, homogeneous phenotypes may improve the power of linkage and association studies of schizophrenia and thus have relevance to the design and analysis of genome-wide association studies

Short sleep duration is associated with risk of future diabetes but not cardiovascular disease: a prospective study and meta-analysis

Epidemiologic studies have observed association between short sleep duration and both cardiovascular disease (CVD) and type 2 diabetes, although these results may reflect confounding by pre-existing illness. This study aimed to determine whether short sleep duration predicts future CVD or type 2 diabetes after accounting for baseline health. Baseline data for 241,949 adults were collected through the 45 and Up Study, an Australian prospective cohort study, with health outcomes identified via electronic database linkage. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals. Compared to 7h sleep, <6h sleep was associated with incident CVD in participants reporting ill-health at baseline (HR=1.38 [95% CI: 1.12-1.70]), but not after excluding those with baseline illness and adjusting for baseline health status (1.03 [0.88-1.21]). In contrast, the risk of incident type 2 diabetes was significantly increased in those with <6h versus 7h sleep, even after excluding those with baseline illness and adjusting for baseline health (HR=1.29 [1.08-1.53], P=0.004). This suggests the association is valid and does not simply reflect confounding or reverse causation. Meta-analysis of ten prospective studies including 447,124 participants also confirmed an association between short sleep and incident diabetes (1.33 [1.20-1.48]). Obtaining less than 6 hours of sleep each night (compared to 7 hours) may increase type 2 diabetes risk by approximately 30%.The Sax Institute; Cancer Council New South Wales; the National Heart Foundation of Australia (New South Wales Division); The New South Wales Ministry of Health; Beyondblue: the National Depression Initiative; Ageing, Disability and Home Care, New South Wales Family and Community Services; the Australian Red Cross Blood Service; Uniting Care Ageing; the Australian National Health and Medical Research Council

Upregulation of arylsulfatase B in carotid atherosclerosis is associated with symptoms of cerebral embolization

The aim of this study was to identify genes for which the expression within carotid atherosclerosis was reproducibly associated with the symptoms of cerebral embolization. Two publically available microarray datasets E-MEXP-2257 and GSE21545 were analysed using GeneSpring 11.5. The two datasets utilized a total of 22 and 126 carotid atherosclerosis samples, obtained from patients with and without symptoms of cerebral embolization, respectively. To assess whether the findings were reproducible we analysed carotid atherosclerosis samples from another 8 patients with and 7 patients without symptoms of cerebral embolization using real-time PCR. In vitro studies using VSMC were performed to assess the functional relevance of one of the validated genes. We identified 1624 and 135 differentially expressed genes within carotid atherosclerosis samples of symptomatic compared to asymptomatic patients using the E-MEXP-2257 and GSE21545 datasets, respectively (≥1.15-absolute fold-change, P < 0.05). Only 7 differentially expressed genes or 0.4% (7/1,752) were consistent between the datasets. We validated the differential expression of ARSB which was upregulated 1.15-fold (P = 0.029) in atherosclerosis from symptomatic patients. In vitro incubation of VSMCs with the ARSB inhibitor L-ascorbic acid resulted in marked upregulation of SIRT1 and AMPK. This study suggests that ARSB may represent a novel target to limit carotid embolization

What is the effect of interrupting prolonged sitting with frequent bouts of physical activity or standing on first or recurrent stroke risk factors? A scoping review

The objective of this review was to ascertain the scope of the available literature on the effects of interrupting prolonged sitting time with frequent bouts of physical activity or standing on stroke and recurrent stroke risk factors. Databases Medline, Embase, AMED, CINAHL and Cochrane library were comprehensively searched from inception until 21st February 2018. Experimental trials which interrupted sitting time with frequent bouts of physical activity or standing in adults (≥ 18 years) were included. Comparison to a bout of prolonged sitting and a measure of at least one first or recurrent stroke risk factor was required to be included. Overall, 30 trials (35 articles) were identified to meet the inclusion criteria. Fifteen trials were completed in participants at an increased risk of having a first stroke and one trial in participants at risk of a recurrent stroke. Outcomes of hypertension and dysglycemia were found to be more favourable following predominately light- to moderate-intensity bouts of physical activity or standing compared to sitting in the majority of trials in participants at risk of having a first stroke. In the one trial of stroke survivors, only outcomes of hypertension were significantly improved. These findings are of significant importance taking into consideration hypertension is the leading risk factor for first and recurrent stroke. However, trials primarily focused on measuring outcomes of dysglycemia and without assessing a dose-response effect. Additional research is required on the dose-response effect of interrupting sitting with frequent bouts of physical activity or standing on first and recurrent stroke risk factors, in those high risk population groups

General practice registrars’ clinical uncertainty, and in-consultation information- and assistance-seeking

Purpose: To explore the association of Australian general practitioner (GP) registrars’ responses to uncertainty with their in-consultation information-, advice- and assistance-seeking.Design/methodology/approach: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study in four Australian states. In ReCEnT, GP registrars record details of 60 consecutive consultations, six-monthly, three times during training.Outcome factors in logistic regression models included whether the registrar sought in-consultation information or assistance from (i) their supervisor or (ii) an electronic or paper-based source. Independent variables were the four independent subscales of the Physicians’ Reaction to Uncertainty (PRU) instrument, as well as registrar, practice and consultation variables.Findings: 589 registrars contributed details of 70,412 consultations.On multivariable analysis, scores on the two ‘affective’ PRU subscales ‘anxiety regarding diagnosis/management’ (OR 1.03; 95% confidence intervals [CIs] [1.01, 1.05], p = 0.003) and ‘concern about a bad outcome’ (OR 1.03; 95% CIs [1.01, 1.06], p = 0.008) were significantly associated with seeking supervisor assistance. There was no association with ‘behavioural’ subscales ‘reluctance to disclose uncertainty to patients’ and ‘reluctance to disclose mistakes to physicians’.None of the PRU subscales were significantly associated with information-seeking from electronic or hard copy sources.Research implications: Further research is required to explore the role of uncertainty within registrar–supervisor interactions and to define the role of supervisors in registrars’ functional adaptation to clinical uncertainty (including how best to support and train supervisors in this role).Practical implications: GP registrars’ ‘affective’ responses to clinical uncertainty are associated with assistance-seeking from clinical supervisors. While in-consultation assistance-seeking may promote registrars’ tolerance of uncertainty, it may also contribute to supervisor workload.Originality/value: This is the first study to examine trainees’ levels of uncertainty and their seeking of information and assistance.Limitations: We have not investigated whether registrars’ seeking assistance resolved or attenuated, for the index problem, their anxiety or concern

Emergency department referral patterns of Australian general practitioner registrars: A cross-sectional analysis of prevalence, nature and associations

Objective: Limited international evidence suggests general practice registrars' emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap by establishing the prevalence, nature and associations of Australian GP registrar ED referrals. Methods: A cross-sectional analysis was performed of the Registrar Clinical Encounters in Training (ReCEnT) cohort study of GP registrars' consultation experiences, between 2010 and 2015. The outcome factor in logistic regression analysis was referral to an ED. Independent variables included patient-level, registrar-level, practice-level and consultation-level factors. Results: In all, 1161 GP registrars (response rate 95.5%) contributed data from 166 966 consultations, comprising 258 381 individual problems. Based on responses, 0.5% of problems resulted in ED referral, of which nearly 25% comprised chest pain, abdominal pain and fractures. Significant (P 34 years, the patient being new to the registrar, one particular regional training provider (RTP), in-consultation information or assistance being sought and learning goals being generated. Outer regional-, remote-or very remote-based registrars made significantly fewer ED referrals than more urban registrars. Of the problems referred to the ED, 45.5% involved the seeking of in-consultation information or assistance, predominantly from supervisors. Conclusions: Registrars' ED referral rates are nearly twice those of established GPs. The findings of the present study suggest acute illnesses or injuries present registrars with clinical challenges and real learning opportunities, and highlight the importance of continuity of care, even for acute presentations

Identification of target-specific bioisosteric fragments from ligand-protein crystallographic data

Bioisosteres are functional groups or atoms that are structurally different but that can form similar intermolecular interactions. Potential bioisosteres were identified here from analysing the X-ray crystallographic structures for sets of different ligands complexed with a fixed protein. The protein was used to align the ligands with each other, and then pairs of ligands compared to identify substructural features with high volume overlap that occurred in approximately the same region of geometric space. The resulting pairs of substructural features can suggest potential bioisosteric replacements for use in lead-optimisation studies. Experiments with 12 sets of ligand-protein complexes from the Protein Data Bank demonstrate the effectiveness of the procedure

Prevalence and associations of General Practice registrars’ management of Impetigo: a cross-sectional analysis from the registrar clinical encounters in training (ReCEnT) study

Background: Impetigo is a mild bacterial skin infection of childhood that is usually managed empirically in primary care. Objective: To establish the prevalence and associations of impetigo in general practice (GP) registrars’ consultations. Methods: Cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study data. Results: Impetigo was managed in 0.24% of problems and 0.43% of consultations. Patient variables associated with impetigo presentations were younger age and impetigo as a new problem, while patients with non–English-speaking backgrounds were less likely to present with impetigo. Associated registrar variables were being new to the registrar and practicing in outer regional/remote locations. Compared with all other problems/diagnoses, impetigo more often involved information seeking, ordering pathology, and prescription of medication, but less often involved follow-up or referral. Conclusions: Impetigo accounts for 0.43 per 100 GP registrar consultations in Australia. Association with outer regional/remote areas may reflect climate and socioeconomic factors that predispose to impetigo. Associated pathology requests may reflect a lack of confidence in GP registrars’ management of impetigo. Cultural differences may exist regarding health-seeking behavior relating to impetigo