Leadership in Design and Construction Education and Practice

It has been conveyed that inspiration and creativity are the greatest strengths of architects. Those who possess them often demonstrate innovation and ability to transform diverse, often contradictory, information into a cohesive design. Yet, having architectural and design talent may suggest to some that they also have a broader skill set. Among the competencies that do not necessarily co-exist with inspiration and creativity are those associated with managing or leading a complex project or organization. Leadership and many of the administrative and project management competencies needed to operate in the modern complex environment of the Architecture profession are largely absent from educational programs which specialize in producing architects and designers. Therefore, if architects must possess both talent and leadership competencies, what is to be done to support the growth, development and sustainability of the profession? This challenge was presented to the College of Architecture and the Built Environment (CABE) by their Advancement Council, a community of working professionals who offered advice and support to the College. Specifically, CABE was asked to find a way to add to their academic curriculum new and appropriate education that would prepare their graduates for the leadership and management responsibilities which existed and were increasing within the professional environment of architecture and design. The premise of this challenge was that the current curriculum failed to adequately prepare students with the confidence and competence needed to be successful. In response to this, the approach taken by the Doctor of Management in Strategic Leadership (DSL) Team in this phase of our project was to focus on identifying the characteristics within the architecture industry/ professional that people should possess in terms of competencies, i.e., knowledge and skills that could be learned/developed, and in terms of traits that could be identified and supported in order to emerge as a “true leader.” Using participant interview methods from established professionals in the industry, we identified leadership themes that impact emergent behavior for CABE graduates. At the time of this project, Philadelphia University was beginning the process of integrating with Thomas Jefferson University

Accès Aux Soins Et Recouvrement Des Couts Dans Les Formations Sanitaires Publiques (FSP) De Parakou (Benin)

RESUME : L’accès aux soins et services de santé rencontre de nombreuses difficultés dans les pays à revenu faible. Le système de santé béninois connaît de ce fait, des lacunes organisationnelles par rapport à l’accès de tous aux soins et services de santé. Les dysfonctionnements du système de santé associés au faible budget alloué au secteur de la santé ainsi que la faible couverture du système de protection sociale sont à la base de l’automédication dont les conséquences ne sont pas à négliger. Le présent article vise à analyser les influences de la politique de recouvrement des coûts dans les formations sanitaires publiques sur l’accès de la population aux soins et services de santé dans la Commune de Parakou (Bénin). L’approche méthodologique a été essentiellement basée sur la collecte des informations sur le terrain à l’aide d’un questionnaire et d’un guide d’entretien auprès de 422 ménages et avec 69 personnes ressources. Ces informations ont été appuyées par les données démographiques et socio-sanitaires. Cette étude montre que 62,9% des enquêtées se réfèrent aux FSP. Ce taux élevé est lié au niveau d’instruction (77%). Le taux de recouvrement des coûts dans les FSP a varié de 1,03 en 2017 à 1,08 en 2021. La viabilité des FSP interpelle les acteurs responsables du système qui peuvent aussi s’inspirer des limites de cette étude.Mots clés : Recouvrement des coûts, Influences, Soins de qualité, Parakou. AbstractAccess to health care and services encounters many difficulties in low-income countries. The Beninese health system therefore has organizational shortcomings with regard to access for all to health care and services. The dysfunctions of the health system associated with the low budget allocated to the health sector as well as the low coverage of the social protection system are the basis of self-medication, the consequences of which should not be overlooked. This article aims to analyze the influences of the cost recovery policy in public health facilities on the population's access to health care and services in the Commune of Parakou (Benin). The methodological approach was essentially based on the collection of information in the field using a questionnaire and an interview guide from 422 households and with 69 resource persons. This information was supported by demographic and socio-health data. This study shows that 62.9% of respondents refer to FSPs. This high rate is linked to the level of education (77%). The cost recovery rate in the PSPs varied from 1.03 in 2017 to 1.08 in 2021. The viability of the PSPs challenges the actors responsible for the system who can also draw inspiration from the limits of this study.Keywords: Cost recovery, Influences, Quality care, Parakou

Identification of hydroxyapatite spherules provides new insight into sub-retinal pigment epithelial deposit formation in the aging eye

Identification of hydroxyapatite spherules provides new insight into subretinal pigment epithelial deposit formation in the aging eye. Proc Natl Acad Sci U S A , 112 Keywords: Hydroxyapatite, calcium, drusen, macula, retinal pigment epithelium, RPE, age-related macular degeneration, AMD, cholesterol, complement factor H, CFH, amyloid-beta, vitronectin Significance Statement Proteins and lipids accumulating in deposits external to the RPE represent a barrier to metabolic exchange between the retina and the choroidal capillaries. With time, these deposits can lead to age-related macular degeneration (AMD), the most common cause of blindness in the elderly in the developed world. It remains unclear how sub-RPE deposits are initiated and grow to clinically relevant features. Using a combination of high resolution analytical techniques we found that tiny hydroxyapatite (bone mineral) spherules with cholesterol-containing cores are present in all examined sub-RPE deposits, providing a scaffold to which proteins adhere. If the spherules are important in initiating sub-RPE deposit formation this may provide attractive new approaches for early identification and treatment of AMD

Identification of candidate Parkinson disease genes by integrating genome-wide association study, expression, and epigenetic data sets

Importance Substantial genome-wide association study (GWAS) work in Parkinson disease (PD) has led to the discovery of an increasing number of loci shown reliably to be associated with increased risk of disease. Improved understanding of the underlying genes and mechanisms at these loci will be key to understanding the pathogenesis of PD. Objective To investigate what genes and genomic processes underlie the risk of sporadic PD. Design and Setting This genetic association study used the bioinformatic tools Coloc and transcriptome-wide association study (TWAS) to integrate PD case-control GWAS data published in 2017 with expression data (from Braineac, the Genotype-Tissue Expression [GTEx], and CommonMind) and methylation data (derived from UK Parkinson brain samples) to uncover putative gene expression and splicing mechanisms associated with PD GWAS signals. Candidate genes were further characterized using cell-type specificity, weighted gene coexpression networks, and weighted protein-protein interaction networks. Main Outcomes and Measures It was hypothesized a priori that some genes underlying PD loci would alter PD risk through changes to expression, splicing, or methylation. Candidate genes are presented whose change in expression, splicing, or methylation are associated with risk of PD as well as the functional pathways and cell types in which these genes have an important role. Results Gene-level analysis of expression revealed 5 genes (WDR6 [OMIM 606031], CD38 [OMIM 107270], GPNMB [OMIM 604368], RAB29 [OMIM 603949], and TMEM163 [OMIM 618978]) that replicated using both Coloc and TWAS analyses in both the GTEx and Braineac expression data sets. A further 6 genes (ZRANB3 [OMIM 615655], PCGF3 [OMIM 617543], NEK1 [OMIM 604588], NUPL2 [NCBI 11097], GALC [OMIM 606890], and CTSB [OMIM 116810]) showed evidence of disease-associated splicing effects. Cell-type specificity analysis revealed that gene expression was overall more prevalent in glial cell types compared with neurons. The weighted gene coexpression performed on the GTEx data set showed that NUPL2 is a key gene in 3 modules implicated in catabolic processes associated with protein ubiquitination and in the ubiquitin-dependent protein catabolic process in the nucleus accumbens, caudate, and putamen. TMEM163 and ZRANB3 were both important in modules in the frontal cortex and caudate, respectively, indicating regulation of signaling and cell communication. Protein interactor analysis and simulations using random networks demonstrated that the candidate genes interact significantly more with known mendelian PD and parkinsonism proteins than would be expected by chance. Conclusions and Relevance Together, these results suggest that several candidate genes and pathways are associated with the findings observed in PD GWAS studies

Children’s Health Insurance Program Expansions: What Works for Families?

We examine the impact of Children’s Health Insurance Program (CHIP) eligibility expansions 1999 to 2012 on child and joint parent/child insurance coverage. We use changes in state CHIP income eligibility levels and data from the Current Population Survey Annual Social and Economic Supplement to create child/parent dyads. We use logistic regression to estimate marginal effects of eligibility expansions on coverage in families with incomes below 300% federal poverty level (FPL) and, in turn, 150% to 300% FPL. The latter is the income range most expansions targeted. We find CHIP expansions increased public coverage among children in families 150% to 300% FPL by 2.5 percentage points (pp). We find increased joint parent/child coverage of 2.3 pp ( P = .055) but only in states where the public eligibility levels for parent and child are within 50 pp. In these states, the CHIP expansion increased the probability that both parent/child are publicly insured (2.5 pp) among insured dyads, but where the eligibility levels are further apart (51-150 pp; >150 pp), CHIP expansions increase the probability of mixed coverage—one public, one private—by 0.9 to 1.5 pp. Overall, families made decisions regarding coverage that put the child first but parents took advantage of joint parent/child coverage when eligibility levels were close. Joint public parent/child coverage can have positive care-seeking effects as well as reduced financial burdens for low-income families

Radiopharmaceuticals: Recent Developments and Trends 247 15 Radiopharmaceuticals: Recent Developments and Trends 15.1 Production of Radiopharmaceuticals, Quality Control and Availability

Radionuclides used in nuclear medicine are mostly artificial ones. They are primarily produced in a reactor or cyclotron and supplied by commercial companies to individual nuclear medicine departments and institutions. On the other hand, some radionuclides, in particular short-lived ones, are available at any time due to the availability of appropriate radionuclide generators. By far the most important generator in nuclear medicine is the 99 Mo/ 99m Tc generator, which has led to the almost unlimited availability of 99m Tc. Together with the excellent radiation characteristics of 99m Tc and the commercial availability of efficient and licensed labeling kits, this generator lies at the base of contemporary nuclear medicine practice. The very short-lived positron-emitting radionuclides used in clinical PET [ 11 C (t ½ = 20.38 min), 13 N (t ½ = 9.96 min) and 15 O (t ½ = 122.2 s)] are only available at or near institutions which have cyclotron facilities and can not be supplied to remote institutions or hospitals due to their rapid decay. Since facilities with a cyclotron and radiochemistry laboratory are expensive, they are not evenly spread worldwide, although their number has increased significantly in recent years. A steadily growing number of PET centers performs clinical imaging but does not have a cyclotron. These sites are mostly limited to the use of radiotracers labeled with fluorine-18 (t ½ = 109.8 min), provided by nearby facilities. Currently, mainly 18 Ffluorodeoxyglucose ( 18 FDG) is produced in these facilities, increasingly under 'good manufacturing practice' (GMP) conditions, and dispensed to PET imaging facilities in the area. It can be foreseen that soon other fluorine-18 labeled PET radiopharmaceuticals will be distributed through the logistic channels that have been set up for 18 FDG distribution. There is a growing interest in using PET radiopharmaceuticals labeled with gallium-68, a radio-CONTENT

Tympanic, Infrared Skin, and Temporal Artery Scan Thermometers Compared with Rectal Measurement in Children: A Real-Life Assessment

Introduction: Body temperature measurement in children is of clinical relevance. Although rectal measurement is the gold standard, less invasive tools have become available. We aimed to describe the accuracy of tympanic, infrared skin, or temporal artery scan thermometers compared with rectal measurement to reflect core temperature. Methods: Rectal (Filac 3000; Covidien, Mechelen, Belgium), tympanic (AccuSystem Genius2 Typmanic Infrared Ear Thermometer, Covidien, Mechelen, Belgium), temporal artery scan (Exergen, Exergen Corp, Watertown, Massachusetts), and infrared (ThermoFlash Contactless Medical Electronic Thermometer, Visiomedlab, Paris, France) body temperature measurements were randomly performed and readings were collected once. Temperature readings were described as median and range, and observations were compared with rectal temperature readings (using Wilcoxon, Bland-Altman, sensitivity, and specificity tests). The child’s comfort was assessed by the child, parent, and nurse (using Likert scales) and ease of use was assessed by nurses (using visual analog scale). Results: Based on observations in 294 (median age = 3.2 years, range = 0.02–17 years) children, the mean difference was 0.49°C (tympanic scan; P < 0.0001), 0.34°C (infrared skin scan; P < 0.0001), and 0°C (temporal artery scan; P = 0.9288), respectively, when compared with rectal temperature readings. Based on visual inspection of Bland-Altman plots, all tools overestimated the temperature at lower body temperature and underestimated the temperature at higher body temperature, resulting in a sensitivity of 22% to 41% and a specificity of 98% to 100% for rectal temperatures above 38°C. The Likert scale scores and the visual analog scale scores for rectal measurement were only slightly higher when compared with the other methods. Conclusions: All noninvasive techniques underperformed compared with rectal measurement. The temporal artery scan deviations were smallest, but all noninvasive techniques overestimate lower temperatures and underestimate higher temperatures compared with rectal measurement. In our hands, temporal artery scan measurement seems to be second best, but not yet ideal

Is Type 1 Diabetes Mellitus More Prevalent Than Expected in Transgender Persons? A Local Observation

The International Diabetes Federation estimates that approximately 0.4% of the Belgian population is diagnosed with type 1 diabetes mellitus, which is similar to other industrialized countries. The prevalence of transgenderism is estimated at 0.6% to 0.7% of all adults in Western populations. In this study, we evaluated whether there was an increased prevalence of type 1 diabetes mellitus in transgender people in the local cohort. Medical records of transgender patients were analyzed retrospectively. From January 1, 2007 until October 10, 2016, 1,081 transgender patients presented at a tertiary reference center to start hormonal treatment. Nine of these 1,081 patients were previously diagnosed with type 1 diabetes mellitus and 1 was diagnosed with latent autoimmune diabetes in adults. A 2.3-fold higher prevalence of type 1 diabetes mellitus was observed in transgender patients. We concluded that type 1 diabetes mellitus was more prevalent in transgender patients than one would expect from population prevalences. This could be a spurious result in a local cohort, because a causal relation seems unlikely, but our finding might encourage other centers to investigate this putative association. Defreyne J, De Bacquer D, Shadid S, et al. Is Type 1 Diabetes Mellitus More Prevalent Than Expected in Transgender Persons? A Local Observation. Sex Med 2017;5:e215–e218