A People's History Of Recent Urban Transportation Innovation

Who are the people leading the charge in urban transportation? As our report explains, the short answer is that it takes leaders from three different sectors of urban society to make change happen quickly.First, there needs to be a robust civic vanguard, the more diverse their range of skills and participation, the better. Second, mayors, commissioners and other city leaders need to create the mandate and champion the change. The third sector is the agency staff. When these three sectors align, relatively quick transformation is possible. Several cities, including New York and Pittsburgh, recently experienced this alignment of a healthy civic community, a visionary and bold mayor and transportation head, and internal agency champions. Our report also highlighted the potential of other cities, such as Charlotte, where the civic sector continues to build on and widen their base

Procalcitonin as a marker of bacterial infection in the emergency department: an observational study

INTRODUCTION: Procalcitonin (PCT) has been proposed as a marker of infection in critically ill patients; its level is related to the severity of infection. We evaluated the value of PCT as a marker of bacterial infection for emergency department patients. METHODS: This prospective observational study consecutively enrolled 120 adult atraumatic patients admitted through the emergency department of a 3000-bed tertiary university hospital in May 2001. Fifty-eight patients were infected and 49 patients were not infected. The white blood cell counts, the serum C-reactive protein (CRP) level (mg/l), and the PCT level (ng/ml) were compared between the infected and noninfected groups of patients. RESULTS: A white blood cell count >12,000/mm(3 )or <4000/mm(3 )was present in 36.2% of the infected patients and in 18.4% of the noninfected patients. The best cut-off serum levels for PCT and CRP, identified using the Youden's Index, were 0.6 ng/ml and 60 mg/l, respectively. Compared with CRP, PCT had a comparable sensitivity (69.5% versus 67.2%), a lower specificity (64.6% versus 93.9%), and a lower area under the receiver operating characteristic curve (0.689 versus 0.879). PCT levels, but not CRP levels, were significantly higher in bacteremic and septic shock patients. Multivariate logistic regression identified that a PCT level ≥ 2.6 ng/ml was independently associated with the development of septic shock (odds ratio, 38.3; 95% confidence interval, 5.6–263.5; P < 0.001). CONCLUSIONS: PCT is not a better marker of bacterial infection than CRP for adult emergency department patients, but it is a useful marker of the severity of infection

Nonalcoholic Fatty Liver Disease Manifesting Esophageal Variceal Bleeding

Nonalcoholic fatty liver disease (NAFLD) is a fatty liver disease occurring in patients without alcohol consumption. It includes a broad spectrum of liver disease, from fatty infiltration, inflammation and fibrosis, to cirrhosis, usually having obesity, hyperlipidemia, and diabetes mellitus as its etiology. NAFLD-related cirrhosis has rarely been reported in Taiwan. We herein report a 41-year-old male patient with nonalcoholic fatty liver cirrhosis (NAFLC), with the first clinical manifestation being bleeding esophageal varices (EV). The patient was obese with diabetes mellitus, but without hyperlipidemia or any history of drinking alcohol. The laboratory tests, abdominal sonography, and computed tomography revealed a typical case of liver cirrhosis. The pan-endoscopy disclosed EV with red-color sign. EV ligation was performed successfully to stop the bleeding. When the patient was in a stabilized clinical condition, a liver biopsy showed a typical histologic finding of NAFLD. Most of the cases of NAFLC reported in the literature have silent signs and symptoms. Sudden onset of the EV as the first clinical manifestation, as in this case, is rare. This case reminds us that NAFLD may indeed induce severe liver impairment, such as liver cirrhosis. Liver biochemical tests and abdominal sonography should be considered in patients with overt obesity and diabetes

Ethylene is involved in nitrate-dependent root growth and branching in Arabidopsis thaliana

production, lateral root development, nitrat