The Twenty-Fifth Amendment and the Establishment of Medical Impairment Panels: Are the Two Safely Compatible?

At least two proposals have been offered by prominent members of the medical community to establish “Medical Impairment Panels” to monitor the health of Presidents of the United States and to facilitate the implementation of relevant Sections of the Twenty-Fifth Amendment. The first discussed in this Article was made by Dr. Herbert Abrams, a now deceased professor of radiology at Stanford University; the second by Dr. Bert Park, a prominent Missouri neurosurgeon. Dr. Abrams and Dr. Park spoke and wrote about their plans frequently over the years. The objective of each proposal was to ensure that the Vice President, the Cabinet, and Congress are informed as to situations when a President might be seriously impaired in terms of carrying out his or her official responsibilities as President of the United States. This Article assesses each proposal in turn

Notch signaling augments the canonical Wnt pathway to specify the size of the otic placode

The inner ear derives from a patch of ectoderm defined by expression of the transcription factor Pax2. We recently showed that this Pax2^+ ectoderm gives rise not only to the otic placode but also to the surrounding cranial epidermis, and that Wnt signaling mediates this placode-epidermis fate decision. We now present evidence for reciprocal interactions between the Wnt and Notch signaling pathways during inner ear induction. Activation of Notch1 in Pax2+ ectoderm expands the placodal epithelium at the expense of cranial epidermis, whereas loss of Notch1 leads to a reduction in the size of the otic placode. We show that Wnt signaling positively regulates Notch pathway genes such as Jag1, Notch1 and Hes1, and we have used transgenic Wnt reporter mice to show that Notch signaling can modulate the canonical Wnt pathway. Gain- and loss-of-function mutations in the Notch and Wnt pathways reveal that some aspects of otic placode development - such as Pax8 expression and the morphological thickening of the placode - can be regulated independently by either Notch or Wnt signals. Our results suggest that Wnt signaling specifies the size of the otic placode in two ways, by directly upregulating a subset of otic genes, and by positively regulating components of the Notch signaling pathway, which then act to augment Wnt signaling

Revolutionary War and an Amsterdam Privy: The Remarkable Background of a Rhode Island Ship Token

In 2008 the City of Amsterdam Office for Monuments & Archaeology (BMA) excavated a remarkable find from a late 18th-century privy in Amsterdam’s city centre that can be directly linked to the American Revolutionary War, a 1779 Rhode Island Ship Token. Approximately twenty-five examples of this token are known worldwide, but none of them come from an archaeological context. From this Amsterdam find one can examine these tokens from an entirely new aspect, namely the socio-economic context of the owner as well as the period in which the token was used. The Rhode Island Ship Token was a British propaganda piece ridiculing the weakness of the Americans in 1778 and distributed in the Netherlands to create negative views of the American revolutionaries to discourage the Dutch from intervening in the Anglo-American conflict. Whether the artifact from the privy expressed its owner’s political preferences or was simply a curiosity will remain unknown. What we do know is that with the outbreak of the Fourth Anglo-Dutch War in 1780, the tokens had become worthless and that this particular piece ended in a cesspit after a final use as a clothing ornament, a counter for card games, or possibly even as a child’s toy

Refined GIS Mapping to Reinvestigate Groundwater Mining Potential Surrounding the Manmade Reservoirs and Tributaries in the Deduru Oya Basin, Sri Lanka

A hydrogeologic study was carried out to understand the influence of Man-Made Reservoirs (MMR),tributaries and fracture intensity on well yields within the Deduru Oya Basin (DOB), Sri Lanka. A number of cascadedMMRs interconnected by tributaries are distributed throughout the basin. Fracture traces, lineaments and reservoirboundaries were initially demarcated using aerial photographs, however, subsequently re-plotted them on to a GoogleEarth map with corrections to rectify the distortion. The GPS based well locations were regenerated and plotted toobtain accurate dimensions. ArcGIS was used to redraw the buffer zones from 0-200, 200-400 and 400-600 m awayfrom the MMRs and tributaries. After eliminating dry wells, box plots were prepared where lower and upper quartilesindicate yield variations from 18-470; 15.8-165 and 12.8–55 liters/minute respectively. It clearly exhibits decreasingyields with respect to distance away from the MMR. However, wells drilled within the alluvial plains of tributariesafter filtering those controlled by the MMRs and eliminating dry wells indicate different yield variations, viz: 7-36.8;12.8-67.5 and 6.5-142.5 liters/minute. The results assigned higher yields to the wells located away from the tributarieswith steep hydraulic gradients whereas lower yields to the wells closer to the tributaries with gentle hydraulic gradients.Moreover, wells drilled at fracture interconnections indicate a potential for high yields compared with those drilledalong with a single fracture. The study concludes that the potential for groundwater mining can be enhanced byidentifying high recharging areas such as MMRs, zones of steeper hydraulic gradients and high fractureinterconnectivity

A case study of Electronic Bill Presentment and Payment (EBPP) integration using the COIN mediation technology

There is no such monopoly as The World Wide Bank that manages the databases of all possible financial activities. Such a concept makes neither technical nor business sense. Each player in the financial industry, each bank, stock exchange, government agency, or insurance company, operates its own internal financial information systems. By its very nature, financial information, like the money that it represents, changes hands. Therefore the interoperation of financial information systems is the cornerstone of the financial services they support. Naturally the critical economic role and the complexity of financial information led to the development of standards for its management and interchange. Yet standards are not the panacea: different groups of players use different standards or versions of a standard's implementation. In this paper we illustrate the nature of the problem in the Electronic Bill Presentment and Payment industry. In particular, we describe and analyze the difficulty of the integration of services using four different formats: IFX, OFX and SWIFT standards, and an example proprietary format. We then propose an improved way to accomplish this integration using the COntext INterchange (COIN) framework

Obesity and Appetite Control

Obesity is one of the major challenges to human health worldwide; however, there are currently no effective pharmacological interventions for obesity. Recent studies have improved our understanding of energy homeostasis by identifying sophisticated neurohumoral networks which convey signals between the brain and gut in order to control food intake. The hypothalamus is a key region which possesses reciprocal connections between the higher cortical centres such as reward-related limbic pathways, and the brainstem. Furthermore, the hypothalamus integrates a number of peripheral signals which modulate food intake and energy expenditure. Gut hormones, such as peptide YY, pancreatic polypeptide, glucagon-like peptide-1, oxyntomodulin, and ghrelin, are modulated by acute food ingestion. In contrast, adiposity signals such as leptin and insulin are implicated in both short- and long-term energy homeostasis. In this paper, we focus on the role of gut hormones and their related neuronal networks (the gut-brain axis) in appetite control, and their potentials as novel therapies for obesity

Approach to the patient: the evaluation and management of men ≥ 50 years with a low serum testosterone concentration

Although testosterone replacement in men with classic hypogonadism due to an identified pathology of the hypothalamic-pituitary-testicular axis is uncontroversial, the role of testosterone treatment for men with age-related declines in circulating testosterone is unclear. This is due to the lack of large, long-term testosterone therapy trials assessing definitive clinical endpoints. However, men >50 years, particularly those who have a body mass index >25 kg/m2 and multiple co-morbidities, commonly present with clinical features of androgen deficiency and low serum testosterone concentrations. Clinicians are faced with the question whether to initiate testosterone therapy, a difficult dilemma that entails a benefit-risk analysis with limited evidence from clinical trials. Using a case scenario, we present a practical approach to the clinical assessment and management of such men