Search

Local and regional governments in the U.S. rely increasingly on voter-approved local option sales taxes (LOSTs) to fund transportation capital investments, maintenance, and operations. LOSTs typically present voters with lists of local transportation projects and programs to be funded by a ¼ to 1 percent sales tax increase. Most research on LOSTs are case studies, which make generalizations about LOSTs difficult. We conducted a comprehensive, multi-jurisdictional analysis of LOST measures in California, the U.S. state with the greatest number of LOST measures. We examined 76 LOST measures put to voters between 1976 and 2016 to assess factors associated with voter support. LOSTs in California are enacted by counties, which we examined in addition to smaller intra-county geographies using both regression models and case studies. We tested several explanatory variables for association with voter support including macroeconomic and political context, planned measure expenditures, voter characteristics, and spatial distribution of proposed projects. We found that funding dedicated to public transit and returned to local jurisdictions predicts support at the county level, and that LOSTs that create new taxes—as opposed to extending or renewing existing taxes—are less popular with voters, all else equal. Our analyses of sub-county geographies revealed that political party affiliation is the strongest predictor of local voter support for LOSTs and that voters living adjacent to funded projects tended to be more supportive of LOSTs.

Understandings of the nature of scientific inquiry (NOSI), as opposed to engaging students in inquiry learning experiences, are included in science education reform documents around the world. However, little is known about what students have learned about NOSI during their pre-college school years. The purpose of this large-scale follow-up international project (i.e. 32 countries and regions, spanning six continents and including 3917 students for the high school sample) was to collect data on what exiting high school students have learned about NOSI. Additionally, the study investigated changes in 12th grade students' NOSI understandings compared to seventh grade (i.e. 20 countries and regions) students' understandings from a prior investigation [Lederman et al. (2019). An international collaborative investigation of beginning seventh grade students' understandings of scientific inquiry: Establishing a baseline. "Journal of Research in Science Teaching," 56(4), 486-515. https://doi.org/10.1002/tea.21512]. This study documents and discusses graduating high school students' understandings and compares their understandings to seventh grade students' understandings of the same aspects of scientific inquiry for each country. It is important to note that collecting data from each of the 130+ countries globally was not feasible. Similarly, it was not possible to collect data from every region of each country. A concerted effort was made, however, to provide a relatively representative picture of each country and the world.

Jurisdictions across the United States have increasingly turned to local option sales taxes, or LOSTs, to fund transportation projects and programs. California is an enthusiastic adopter of these measures; since 1976, residents in over half of the state’s 58 counties have voted on 76 LOST measures. As of 2017, 24 counties, home to 88% of the state’s population, have LOST measures in place. Many counties have enacted multiple measures, with passage rates especially high among renewal and follow-on measures. This research is the first comprehensive analysis of LOST measures; drawing on measure expenditure plans to determine the range and frequency of transportation projects and services funded. This detailed review of expenditure plans across dozens of urban, suburban, and rural California counties offers insight on these measures and the projects and programs they fund. Overall, this study finds that LOSTs are heterogeneous, often including something for nearly every interest group. Almost all of the measures studied dedicate funding to a mix of transportation modes, including highways, public transit, local road maintenance, and active transportation. Expenditures on particular modes vary, reflecting transportation geography across counties. On average, 60% of LOST expenditures in California fund road projects and over 30% are allocated to public transit. Measures often dedicate a substantially larger share of revenue to transit relative to transit’s mode share. Finally, LOSTs typically appeal to diverse local interests by returning a portion of revenues to local jurisdictions to address local priority projects.

The algae Dunaliella bardawil and Dunaliella salina naturally contain large concentrations of all-trans and 9-cis beta-carotene (betaC). The purpose of this study was to compare the relative serum and tissue accumulation of all-trans and 9-cis betaC in ferrets fed different ratios of all-trans/9-cis betaC derived from two commercial sources, D. bardawil or D. salina (Betatene). Male ferrets (7 wk old) were fed carotene-free, pelleted diets for 27 d. Beginning on d 18, groups of ferrets (n = 6 or 7) received daily, one of six oral supplements varying in ratios of 9-cis and all-trans betaC mixed with approximately 1.0mL of Ensure. Four supplements containing 5.2-8.3 micromol total betaC were prepared from a 20% Betatene preparation, D. bardawil, a high-cis Betatene preparation, and Betatene further enriched in 9-cis betaC with all-trans betaC/9-cis betaC ratios of 2.2, 1.5, 0.6 and 0.4, respectively. Two control supplements, high and low betaC, were prepared from commercial betaC beadlets. The high control supplement had an all-trans/9-cis ratio of 19.0, whereas 9-cis betaC was not detected in the low supplement. On d 27, serum and tissues were obtained for HPLC analysis of betaC and its isomers. Analysis of livers showed that all-trans betaC was the primary isomer present, but 9-cis and other isomers were also detected in all groups. The hepatic all-trans/9-cis ratios were 5.9, 4.9, 2.5, 1.4, 52.2 and47.5, respectively, for the groups listed above. Lower amounts of all-trans and 9-cis betaC were found in kidneys compared with the liver, but ratios of all-trans/9-cis were not different among groups. Only trace amounts of 9-cis betaC were found in serum. These results demonstrate that the algae D. bardawil and D. salina provide a bioavailable source of betaC isomers, but, as in humans, absorption of 9-cis betaC is poor and any 9-cis betaC absorbed is apparently cleared by the liver. [ABSTRACT FROM AUTHOR]

Vitamin A (VA) deficiency is the leading cause of blindness in children in developing countries. Dietary intervention with foods rich in provitamin A carotenoids, such as beta-carotene (betaC), has been suggested as one solution to this problem. The objective of the two studies described in this paper was to examine the utilization of betaC as a source of VA at different stages of VA depletion using the Mongolian gerbil as a model. Male 4- to 5-wk-old Mongolian gerbils were fed powdered betaC-free semipurified diets either with or without VA for 26 d (Study 1), or without VA for 8-10 wk (Study 2). Gerbils were then fed diets with or without VA (20.9 nmol/g diet) and/or betaC [(67.0 micromol/g diet (Study 1) and 145.9 micromol/g diet (Study 2)] for variable periods. Two (Study 1) or three (Study 2) days before termination of the study, 3-4 gerbils per group were dosed orally with 14C-betaC. Tissues were evaluated for VA and betaC content by HPLC. Liver was extracted with and without saponification to evaluate 14C-betaC and 14C-VA content. The results demonstrate the following: 1) the gerbil is an appropriate animal model to study betaC utilization; 2) 20.9 nmol VA/g diet is more than sufficient for this species; 3) the daily VA utilization rate for this species is calculated to be 3.1 microg/100 g body weight; 4) a highly bioavailable source of betaC at a 6:1 weight ratio of betaC:VA is sufficient to reverse marginal VA status in this model; and 5) a highly bioavailable source of betaC fed between a 6:1 and 13:1 weight ratio to VA provides equivalent VA status as preformed VA in Mongolian gerbils. [ABSTRACT FROM AUTHOR]

The ferret has recently been used as a model to evaluate the absorption and metabolism of several carotenoids; however, little is known about the vitamin A (VA) requirements of this species or the ability of ferrets to convert dietary beta-carotene (betaC) to VA. Three studies were conducted to estimate the daily utilization of VA in ferrets and to determine the effect of prior VA status on the ability of ferrets to utilize betaC as a source of VA. Weanling male ferrets were fed a pelleted, low carotenoid, semipurified diet either with (+VA) or without VA (-VA) for 21- to 35-d prefeeding periods. Upon initiation of the experiments, several ferrets were killed to determine base-line VA status. The remaining ferrets were fed VA, betaC, or VA and betaC in pelleted feed (Studies 1-3) or liquid carrier (Study 3) for 16-21 additional days. Hepatic VA and betaC concentrations were used as the primary indicators of VA status, although serum and adrenal VA and betaC also were measured. The results showed the following: 1) provision of betaC at up to a 15:1 weight ratio of betaC to VA in pelleted feed or liquid carrier was not sufficient to maintain hepatic VA stores after a -VA prefeeding period; 2) the daily utilization rate of VA by ferrets ranged from 80 to 171 microg in the three studies; 3) the ferret was confirmed to be a species that has the majority of its serum VA in ester form; and 4) feeding -VA diets significantly reduced serum retinyl esters but had less effect on serum retinol. We conclude that although ferrets can convert betaC to VA, the process is inefficient. The ferret model can be most appropriately used when studying the biological effect of tissue betaC stores on VA status and is less appropriate for the evaluation of dietary betaC conversion to VA. [ABSTRACT FROM AUTHOR]

Objective: Despite the prevalence of emergency medical service assignments related to chest discomfort, limited research delves into nurses' experiences of caring for such patients. This study aimed to illuminate prehospital emergency nurses' (PENs') experiences of caring for patients with suspected acute myocardial infarction (AMI)., Design: A qualitative interview study., Setting: Two Swedish emergency medical service organisations in two different regions., Participants: Consecutive inclusion of 12 PENs., Data Analysis: An inductive content analysis according to Elo and Kyngäs., Results: The results underline the active role of PENs in providing care for patients with AMI in the emergency medical service. They emphasise the ability to identify classic symptoms and the need for an open-minded approach to diffuse presentations. Ensuring patient security, projecting knowledge and composure are decisive for instilling a sense of safety. Healthcare providers feel profound responsibility and a fear of errors, especially in critical situations with potential patient deterioration. Prioritisation in time-sensitive cases leans towards medical interventions and immediate transportation. Continuing education is essential to enhance patient management and safety. Effective communication and trust are vital for urgent patient care, and prompt activation of the ST-elevation myocardial infarction pathway is recognised as imperative. Malfunctions result in frustration, underlining the importance of pathway functionality., Conclusions: PENs have immense responsibility for the swift and knowledgeable management of patients with suspected AMI. Balancing patient involvement and urgent medical measures is challenging, emphasising the critical role of mental preparedness and comprehensive education. The study underlines the significance of effective communication and trust between healthcare providers, particularly in time-sensitive scenarios. Establishing feedback mechanisms for prehospital staff is important for advancing prehospital emergency care in this patient category., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: An increasing number of patients receive ambulance care without being conveyed to a definitive care provider. This process has been described as complex, challenging, and lacking in guideline support by EMS clinicians. The use of quality- and outcome measures among non-conveyed patients is an understudied phenomenon., Aim: To identify current quality- and outcome measures for the general population of non-conveyed patients in order to describe major trends and knowledge gaps., Methods: A scoping review of peer-reviewed original articles was conducted to identify quality- and outcome measures for non-conveyance within emergency medical services. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement (PRISMA-ScR) was followed. The PROSPERO and OSF database were checked for pending reviews or protocols. PubMed, CINAHL, Scopus, Web of Science and the Cochrane Library database were searched for relevant articles. Searches were performed in November 2023., Results: Thirty-six studies fulfilled the inclusion criteria and were included in the review. Mortality was the most used outcome measure, reported in 24 (67%) of the articles. Emergency department attendance and hospital admission were the following most used outcome measures. Follow-up durations varied substantially between both measures and studies. Mortality rates were found to have the longest follow-up times, with a median follow-up duration a little bit over one week., Conclusions: This scoping review shows that studies report a wide range of quality and outcome measures in the ambulance setting to measure non-conveyance. Reported quality and outcome measures were also heterogeneous with regard to their follow-up timeframe. The variety of approaches to evaluate non-conveyance poses challenges for future research and quality improvement. A more uniform approach to reporting and measuring non-conveyance is needed to enable comparisons between contexts and formal meta-analysis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Höglund et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Non-conveyed patients (i.e. patients who are not transported to a hospital after being assessed by ambulance clinicians) represent a significantly increasing proportion of all patients seeking ambulance care. Scientific knowledge about patients' non-conveyance experiences is sparse. This study describes the lived experiences of non-conveyed patients in an ambulance care context., Methods: A reflective lifeworld research (RLR) approach founded on phenomenology is used. Data is derived from nine in-depth interviews with patients not conveyed by the ambulance service in a major Swedish region., Results: Patients' lived experiences of becoming acutely ill or injured and not conveyed by ambulance to a hospital are characterised by several dynamic movements: losing and regaining situational and bodily control, dependence and autonomy, external competence and inner knowledge, handing over and regaining responsibility, and fear and security., Conclusions: Patients' lived experiences of non-conveyance are complex and versatile. Although non-conveyed patients initially experience strong fear and the loss of situational and bodily control, they gradually feel more secure when experiencing confirmation and trust, which evolves into insecurity and uncertainty. The non-conveyance situation's complexity from a patient's perspective implies the need for ambulance organisations to take measures to prevent further suffering. Non-conveyed patients must be taken seriously in their unique situations, requiring ambulance clinicians to reflect and act with a conscious ethical perspective before, during and after their visit., (© 2023. The Author(s).)

Feeling a sense of belonging is a central human motivation that has consequences for mental health and well-being, yet surprisingly little research has examined how belonging shapes mental health among young adults. In three data sets from two universities (exploratory study: N = 157; Confirmatory Study 1: N = 121; Confirmatory Study 2: n = 188 in winter term, n = 172 in spring term), we found that lower levels of daily-assessed feelings of belonging early and across the academic term predicted higher depressive symptoms at the end of the term. Furthermore, these relationships held when models controlled for baseline depressive symptoms, sense of social fit, and other social factors (loneliness and frequency of social interactions). These results highlight the relationship between feelings of belonging and depressive symptoms over and above other social factors. This work underscores the importance of daily-assessed feelings of belonging in predicting subsequent depressive symptoms and has implications for early detection and mental health interventions among young adults.

Background: Older adults (age ≥ 65 years) represent a significant proportion of all patients who are not transported to hospital after assessment by ambulance clinicians (non-conveyed patients). This study aimed to fill the knowledge gap in the understanding of the prevalence of older adult non-conveyed patients and investigate their characteristics and risk factors for subsequent and adverse events with those of younger non-conveyed patients comparatively., Methods: This population-based retrospective cohort study included all adult non-conveyed patients who availed the ambulance service of Region Stockholm, Sweden in 2015; they were age-stratified into two groups: 18-64 and ≥ 65 years. Inter-group differences in short-term outcomes (i.e. emergency department visits, hospitalisations, and mortality within 7 days following non-conveyance) were assessed using multivariate regression analyses., Results: Older adult patients comprised 48% of the 17,809 non-conveyed patients. Dispatch priority levels were generally lower among older non-conveyed patients than among younger patients. Non-conveyance among older patients occurred more often during daytime, and they were more frequently assessed by ambulance clinicians with nonspecific presenting symptoms. Approximately one in five older adults was hospitalised within 7 days following non-conveyance. Patients presenting with infectious symptoms had the highest mortality risk following non-conveyance. Oxygen saturation level < 95% or systolic blood pressure > 160 mmHg had significantly higher associations with hospitalisation within 7 days following non-conveyance in older adult patients., Conclusions: Older adult patients have an increased risk for adverse events following non-conveyance. In combination with a complex and variating presentation of symptoms and vital signs proved difficult for dispatch operators and ambulance clinicians to identify and assess, the identified risks raise questions on the patient safety of older adult non-conveyed patients. The results indicate a system failure that need to be managed within the ambulance service organisation to achieve higher levels of patient safety for older non-conveyed patients., (© 2021. The Author(s).)

The ventral pallidum (VP) is the major downstream nucleus of the nucleus accumbens (NAc). Both VP and NAc neurons are responsive to reward-predictive stimuli and are critical drivers of reward-seeking behavior. The cue-evoked excitations and inhibitions of NAc neurons predict the vigor (latency and speed) of the cue-elicited locomotor approach response and encode the animal's proximity to the movement target, but do not encode more specific movement features such as turn direction. VP neurons also encode certain vigor parameters, but it remains unknown whether they also encode more specific movement features, and whether such encoding could account for vigor encoding. To address these questions, we recorded the firing of neurons in the VP of freely moving male rats performing a discriminative stimulus (DS) task. Similar to NAc neurons, VP neurons' cue-evoked excitations were correlated with the speed of the upcoming approach movement and the animal's proximity to the movement target at cue onset. Unlike NAc neurons, VP neurons' firing reflected the efficiency of the approach movement path but not the latency to initiate locomotion. VP cue-evoked excitations are unlikely to be directly influenced by NAc cue-evoked excitations because unilateral treatment of the NAc with a dopamine D1 receptor antagonist, a manipulation that reduces NAc neurons' cue-evoked excitations, did not alter ipsilateral VP cue-evoked excitations. These observations suggest that the two structures receive simultaneous activation by inputs conveying similar but not identical information, and work in parallel to set the vigor of the behavioral response., (Copyright © 2021 Lederman et al.)

Objectives: Non-conveyed patients represent a significant proportion of all patients cared for by ambulance services in the western world. However, scientific knowledge on non-conveyance is sparse. Therefore, the aim of this study was to describe the prevalence of non-conveyance, investigate associations and compare patients' characteristics, drug administration, initial problems and vital signs between non-conveyed and conveyed patients., Design: A population-based retrospective cohort study., Setting: The study setting area, Stockholm, Sweden, has a population of 2.3 million inhabitants, with seven emergency hospitals. Annually, approximately 210 000 assignments are performed by 73 ambulances. All ambulance assignments performed from 1 January to 31 December 2015 were included., Results: In total, 23 603 ambulance assignments ended in non-conveyance-13.8% of all ambulance assignments performed in 2015. Compared with conveyed patients, non-conveyed patients were younger and more often female (median age 50.1 years for non-conveyed vs 61.7 years for conveyed; female=52 %, both p values <0.001). Approximately half of all ambulance assignments ending in non-conveyance were initially prioritised and dispatched as the highest priority. Non-conveyed patients were more often assessed by ambulance clinicians as presenting non-specific symptoms or symptoms related to psychiatric problems. Low blood glucose levels were highly associated with non-conveyance (adjusted OR (AOR): 15; 95 % CI 11.18 to 20.13), although non-conveyed patients presented abnormal vital signs across all categories of vital signs. Moreover, drugs were more often administered to younger non-conveyed patients. Older patients were more often conveyed and administered drugs once conveyed (AOR: 1.29; 95 % CI 1.07 to 1.56)., Conclusions: This study shows that non-conveyed patients represent a non-negligible proportion of all patients in contact with ambulance services. In general, most cases of non-conveyance occur at the highest dispatch level, to a large extent involve younger patients, and features problems assessed by ambulance clinicians as non-specific or related to psychiatric symptoms., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Recently, the use of bottom-TJ geometry in LEDs, which achieves N-polar-like alignment of polarization fields in conventional metal-polar orientations, has enabled enhancements in LED performance due to improved injection efficiency. Here, we elucidate the root causes behind the enhanced injection efficiency by employing mature laser diode structures with optimized heterojunction GaN/In 0.17 Ga 0.83 N/GaN TJs and UID GaN spacers to separate the optical mode from the heavily doped absorbing p-cladding regions. In such laser structures, polarization offsets at the electron blocking layer, spacer, and quantum barrier interfaces play discernable roles in carrier transport. By comparing a top-TJ structure to a bottom-TJ structure, and correlating features in the electroluminescence, capacitance-voltage, and current-voltage characteristics to unique signatures of the N- and Ga-polar polarization heterointerfaces in energy band diagram simulations, we identify that improved hole injection at low currents, and improved electron blocking at high currents, leads to higher injection efficiency and higher output power for the bottom-TJ device throughout 5 orders of current density (0.015-1000 A/cm 2 ). Moreover, even with the addition of a UID GaN spacer, differential resistances are state-of-the-art, below 7 × 10 -4 Ωcm 2 . These results highlight the virtues of the bottom-TJ geometry for use in high-efficiency laser diodes.

Objectives: To combat overcrowding in emergency departments, ambulance clinicians (ACs) are being encouraged to make on-site assessments regarding patients' need for conveyance to hospital, and this is creating new and challenging demands for ACs. This study aimed to describe ACs' experiences of assessing non-conveyed patients., Design: A phenomenological interview study based on a reflective lifeworld research approach., Setting: The target area for the study was Stockholm, Sweden, which has a population of approximately 2.3 million inhabitants. In this area, 73 ambulances perform approximately just over 200 000 ambulance assignments annually, and approximately 25 000 patients are non-conveyed each year., Informants: 11 ACs., Methods: In-depth open-ended interviews., Results: ACs experience uncertainty regarding the accuracy of their assessments of non-conveyed patients. In particular, they fear conducting erroneous assessments that could harm patients. Avoiding hasty decisions is important for conducting safe patient assessments. Several challenging paradoxes were identified that complicate the non-conveyance situation, namely; responsibility, education and feedback paradoxes. The core of the responsibility paradox is that the increased responsibility associated with non-conveyance assessments is not accompanied with appropriate organisational support. Thus, frustration is experienced. The education paradox involves limited and inadequate non-conveyance education. This, in combination with limited support from non-conveyance guidelines, causes the clinical reality to be perceived as challenging and problematic. Finally, the feedback paradox relates to the obstruction of professional development as a result of an absence of learning possibilities after assessments. Additionally, ACs also described loneliness during non-conveyance situations., Conclusions: This study suggests that, for ACs, performing non-conveyance assessments means experiencing a paradoxical professional existence. Despite these aggravating paradoxes, however, complex non-conveyance assessments continue to be performed and accompanied with limited organisational support. To create more favourable circumstances and, hopefully, safer assessments, further studies that focus on these paradoxes and non-conveyance are needed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

An 83-year-old female patient with rheumatoid arthritis and hypertension presented to the emergency department with fever and chills of 1 day duration. On examination, temperature was 100.9 F, heart rate 111/min and she had orthostatic hypotension. Laboratory tests showed elevated blood urea nitrogen and white cell count. The patient underwent treatment for symptomatic urinary tract infection and while her fever and leucocytosis resolved, tachycardia persisted. An EKG done showed T inversions in leads II, III, arteriovenous fistula, V2 and V3. Troponin-I was elevated. Nuclear stress test revealed apical wall motion abnormality confirming myocardial infarction. Ewing's tests were carried out at bedside and these diagnosed severe autonomic neuropathy. Rheumatoid arthritis can cause cardiac autonomic neuropathy from chronic inflammation. This case entails the importance of assessing and detecting cardiac autonomic neuropathy in chronic inflammatory conditions, and the need to be cautious of acute coronary events in these patients, even for minimal or no symptoms., (2016 BMJ Publishing Group Ltd.)

Invasive pulmonary aspergillosis (IPA) is a severe fungal infection with a high mortality rate. The incidence of IPA is on the rise due to an increase in the number of patients undergoing transplants and receiving chemotherapy and immunosuppressive therapy. Diagnosis is challenging due to the non-specific nature of symptoms. Voriconazole is the mainstay of therapy. We present a case of an elderly woman presenting with acute bronchitis and asthma exacerbation, who succumbed to overwhelming IPA. It is uncommon for IPA to develop in patients on short-term steroid therapy for asthma exacerbation. The possibility of aspergillosis in immunocompetent patients should be considered in those on systemic steroids and deteriorating pulmonary functions.

Molecular manipulations and targeted pharmacological studies provide a compelling picture of which nicotinic receptor subtypes are where in the central nervous system (CNS) and what happens if one activates or deletes them. However, understanding the physiological contribution of nicotinic receptors to endogenous acetylcholine (ACh) signaling in the CNS has proven a more difficult problem to solve. In this review, we provide a synopsis of the literature on the use of optogenetic approaches to control the excitability of cholinergic neurons and to examine the role of CNS nicotinic ACh receptors (nAChRs). As is often the case, this relatively new technology has answered some questions and raised others. Overall, we believe that optogenetic manipulation of cholinergic excitability in combination with some rigorous pharmacology will ultimately advance our understanding of the many functions of nAChRs in the brain.

The nematode sperm cell crawls by recycling major sperm protein (MSP) from dimers into subfilaments, filaments, and filament complexes, as a result of thermal writhing in the presence of hydrophobic patches. Polymerization near leading edges of the cell intercolates MSP dimers onto the tips of growing filament complexes, forcing them against the cell boundary, and extending the cytoskeleton in the direction of motion. Strong adhesive forces attach the cell to the substrate in the forward part of the lamellipod, while depolymerization in the rearward part of the cell breaks down the cytoskeleton, contracting the lamellipod and pulling the cell body forward. The movement of these cells, then, is caused by coordinated protrusive, adhesive and contractile forces, spatially separated across the lamellipod. This paper considers a phenomenological model that tracks discrete elements of the cytoskeleton in curvilinear coordinates. The pseudo-two dimensional model primarily considers protrusion and rotation of the cell, along with the evolution of the cell boundary. General assumptions are that pH levels within the lamellipod regulate protrusion, contraction and adhesion, and that growth of the cytoskeleton, over time, is perpendicular to the evolving cell boundary. The model follows the growth and contraction of a discrete number of MSP fiber complexes, since they appear to be the principle contributors for force generation in cell boundary protrusion and contraction, and the backbone for the dynamic geometry and motion.

Objective: To determine the utility of routine perioperative bilateral internal jugular venous sampling of parathyroid hormone (BIJ PTH) for localization during parathyroid surgery., Summary Background Data: Venous sampling for PTH is a useful tool for parathyroid localization in patients undergoing reoperative surgery for hyperparathyroidism (HPT). With the development of intraoperative rapid PTH (ioPTH) testing, internal jugular PTH sampling with ioPTH testing to guide operative localization has been shown to be possible in select, difficult cases. However, the value of BIJ PTH for patients with HPT is unclear., Methods: Between May 2004 and February 2006, 216 consecutive patients underwent neck exploration for HPT by one surgeon. Of these, 168 patients had BIJ PTH. Internal jugular venous blood was drawn from both left and right sides and analyzed for PTH using a rapid PTH assay. BIJ PTH levels were defined as lateralizing if >5% differences were observed between the right and left internal jugular vein samples., Results: Of the 168 patients, 120 (71.4%) had a single parathyroid adenoma, 15 (8.9%) had double adenoma, and 33 (19.6%) had hyperplasia. The cure rate after parathyroidectomy was 98.2%. There were no complications related to BIJ PTH sampling. Sensitivity and positive predictive value of BIJ PTH for primary hyperparathyroidism were 80% and 71%, respectively. BIJ PTH was diagnostic in 95 cases (62.9%) in primary HPT. BIJ PTH successfully localized an abnormal gland in 26 of 45 (57.8%) in patients with negative sestamibi scanning. BIJ PTH was especially helpful in 18 of 168 (10.7%) cases when intraoperative peripheral parathyroid hormone did not fall by 50% and BIJ PTH successfully localized the hyperfunctioning glands., Conclusions: In patients with HPT, BIJ PTH is safe and effective, providing additional localization information in the majority of cases. BIJ PTH is particularly useful in the setting of negative sestamibi scanning and in complex multigland disease cases.

Objective: Cardiovascular disease (CVD) is largely preventable through appropriate risk-factor modification. We sought to compare effects of comprehensive cardiac risk factor screening with and without computed tomography (CT) imaging of the coronary arteries on behavior change related to cardiac risk in postmenopausal women., Study Design and Setting: 56 postmenopausal women were randomized to alternative screening programs and followed for 1 year., Results: Subjects randomized (n=26) to the CT imaging group were shown images of their coronary arteries and received an interpretation from a radiologist. Most subjects in the CT group had a very low-risk (73.1%) coronary calcification score at baseline. Systolic blood pressure, total cholesterol, triglyceride, LDL, and cholesterol/HDL ratio declined significantly in the conventional screening group, but not in the CT imaging group (P<0.05). As compared to baseline values, study participation lead to significant reductions in total cholesterol, HDL, LDL, and blood pressure at 6 months (P<0.05) and triglyceride (P<0.05) at 12 months., Conclusions: CVD risk-screening programs can facilitate cardiac risk reduction in women, but these data do not support an independent benefit of coronary CT imaging in a low-to-moderate risk group. The possibility of a deleterious effect of imaging on patient commitment to lifestyle changes is suggested.

Background: Minimally invasive parathyroidectomy (MIP) under local/cervical block anesthesia (LA) is safe and effective for patients with primary hyperparathyroidism (HPT). Advantages of LA versus general anesthesia (GA) for these focused procedures have not been clearly demonstrated., Methods: Between 3/01 and 6/04, 177 consecutive patients with primary HPT and positive localization studies underwent MIP. Seventy-three (41%) had surgery under LA while 104 (59%) had GA. Primary endpoints were IV narcotic use, anti-emetic use, nausea, vomiting, and post-operative pain., Results: Patients who had parathyroidectomy under LA were older (64 +/- 2 vs. 57 +/- 2 years, P = 0.001). Cure and complication rates were identical between the two groups. Patients who had parathyroidectomy under LA required less IV narcotic pain mediation (mean morphine equivalents 11.4 +/- 1.3 mg vs. 22.5 +/- 1.1 mg; P < 0.001) compared to GA patients. The LA patients had better pain control as shown by lower post-operative peak pain scores (2.9 +/- 0.3 vs. 5.0 +/- 0.4; P < 0.001) and lower overall pain scores (mean 1.9 +/- 0.2 vs. 3.1 +/- 0.2; P < 0.001). The LA group required fewer anti-emetic medications compared to the GA patients (mean 0.4 +/- 0.1 vs. 1.7 +/- 0.1 doses; P < 0.001). Fewer LA patients experienced post-operative nausea (16% vs. 49%; P < 0.001), and vomiting (7% vs. 24%; P = 0.002). Length of stay was similar between the groups (0.4 +/- 0 vs. 0.3 +/- 0; P = 0.22)., Conclusions: In this study the choice of anesthesia did not affect surgical cure rate, morbidity, or length of stay. LA was associated with significantly lower post-operative pain, nausea, and vomiting. LA appears to offer specific advantages more than GA for patients undergoing MIP.

Purpose: Liver resection improves survival in selected patients with colorectal liver metastases. However, the majority of patients with colorectal liver metastases have inoperable disease at presentation. Neo-adjuvant therapy (systemic or regional chemotherapy and interstitial laser therapy) used singly or in combination may convert a selected group of patients with irresectable liver metastases into an operable state., Patients and Methods: We report a series of patients with initially inoperable multiple colorectal liver metastases who became operable after neo-adjuvant therapy. Operability was defined as unilateral disease limited to the liver. Twelve patients (7 female, 5 male, median age 57 years, range 38-69 years) with multiple inoperable colorectal liver metastases (8 synchronous, 4 metachronous) were initially treated with systemic chemotherapy (n = 7), hepatic arterial chemotherapy (n = 2) and chemotherapy plus interstitial laser therapy (n = 3)., Results: In all cases, a significant response was achieved which enabled subsequent liver resection to be undertaken. There was only one postoperative complication (8%) and no peri-operative deaths. 3 patients were operated on within the last 12 months and are still alive. Of the remainder, 1 died within 1 year with recurrent disease. The remaining patients have a median survival of 2.5 years, range 1.39-4 years., Conclusions: These results are similar to those reported for patients undergoing resection for operable metastases without neo-adjuvant therapy. Aggressive multimodality treatment of colorectal liver metastases in specialised centres may improve the resectability rates and survival in a selected group of patients.