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A growing body of research investigates the factors that enhance the research productivity and creativity of political scientists. This work provides a foundation for future research, but it has not addressed some of the most promising causal hypotheses in the general scientific literature on this topic. This article explicates the latter hypotheses, a typology of scientific career paths that distinguishes how scientific careers vary over time with respect to creative ambitions and achievements, and a research agenda based on the preceding components for investigation of the publication success of political scientists.

Ziel der chirurgischen Stabilisierung proximaler Humerusfrakturen ist die Wiederherstellung der anatomischen Verhaltnisse zwischen Tuberculum majus und minus sowie die Rekonstruktion der gelenkkommunizierenden Kopfanteile unter Erhalt der Gefasversorgung der Fragmente. Rund 80 % der proximalen Humerusfrakturen konnen konservativ behandelt werden. Die Indikation zur operativen Versorgung wird anhand des Frakturmusters, der patientenbezogenen Faktoren sowie des Risikos fur eine avaskulare Kopfnekrose gestellt. Minimal-invasive Stabilisierungsverfahren erlauben in der Mehrheit frischer proximaler Humeruskopffrakturen mit oder ohne proximale Schaftfraktur eine annahernd anatomische Rekonstruktion. Beach-chair-Lagerung, Arm in pneumatisch artikulierender Traktionsvorrichtung gehalten. Evaluation des indirekten Repositionspotenzials durch Ligamentotaxis unter Visualisierung des Alignements der Kopffragmente in Relation zum Schaft durch Traktion, Ab‑/Adduktion, Flexion/Extension und Rotation. Halten der Reposition durch die Traktionsvorrichtung und eine Schaumstoffrolle in der Axilla, um den Zug des M. pectoralis major und M. teres major bei gleichzeitiger Adduktion des Ellenbogens zu neutralisieren. Bei ungenugender Reposition: direkte Repositionsmanover mit Hilfe von Kirschner-Drahten. Einbringen dieser durch einen anterolateralen Zugang. Eroffnen der Bursa subdeltoidale, Anschlingen der Sehnen der Rotatorenmanschette und Einbringen eines 2,5-mm-Krischner-Drahts mit Gewinde ins Kopffragment als Joystick. Vorbereiten des Plattenlagers fur eine winkelstabile 5‑Loch-Platte unter Protektion des N. axillaris. Befestigen der Platte am Zielgerat und Einfuhren dieser entlang des Schafts. Positionierung der Platte proximal 5–8 mm unter dem Tuberculum majus und 2–3 mm lateral des Sulkus der langen Bizepssehne. Ausrichten und temporare Fixation der Platte distal mit anschliesender Kontrolle der Plattenposition im axialen Strahlengang. Reposition des Schafts gegen die Platte mit einer Kortikalisschraube. Mit dem Kirschner-Draht im Kopfbereich Unterstutzung des Kalkars durch Veranderung der Varus- und Valgusausrichtung. Komplettieren der Osteosynthese proximal mit winkelstabilen Schrauben. Fixieren der Haltefaden der Rotatorenmanschette an der Platte. Schichtweiser Wundverschluss. Sofortige aktiv assistierte Bewegung im Schultergelenk mit physiotherapeutischer Begleitung. Ruhigstellung zu Komfortzwecken. Aktive und resistive Mobilisation nach der ersten klinischen und radiologischen Kontrolle 6 Wochen postoperativ. Weitere radiologische Kontrollen nach 3 und 6 Monaten sowie nach einem Jahr. Keine routinemasige Plattenentfernung.

Objective After the successful implementation in trauma patients, damage control surgery (DCS) is being increasingly used in non-traumatic abdominal emergencies, too. However, non-trauma DCS (NT-DCS) is currently a matter of debate and has not yet been comprehensively assessed. The aim of this meta-analysis was to investigate the effect of NT-DCS on mortality in patients with abdominal emergencies. Methods Systematic literature search using PubMed. Original articles addressing mortality in patients undergoing NT-DCS or non-trauma conventional surgery (NT-CS) for abdominal emergencies were included. Descriptive statistics and two meta-analyses were performed. Meta-analysis 1 compared mortality in patients undergoing NT-DCS vs. NT-CS. Meta-analysis 2 assessed the observed vs. expected mortality rate, based on APACHE, POSSUM and SAPS scores, in the NT-DCS group. Continuous and categorical variables were reported as weighted means and proportions. Effect sizes were described as risk differences (RD) with 95% confidence intervals (CI). Results Literature search revealed 1314 articles. Of these, 21 studies published 2004-2019 were included. NT-DCS was performed in 1238 and NT-CS in 936 patients. In the NT-DCS vs. NT-CS group mean age was 61.0 vs. 64.9 years and the proportion of male patients 58.6% vs. 52.9%, respectively. Most frequent indications for NT-DCS were hollow viscus perforation (28.4%), mesenteric ischemia (26.5%), anastomotic leak (19.6%), haemorrhage (18.4%), abdominal compartment syndrome (17.4%), bowel obstruction (15.5%), and pancreatitis (13.1%). In meta-analysis 1, mortality was not significantly different in the NT-DCS vs. NT-CS group (RD 0.09, 95% CI -0.06/0.24). Meta-analysis 2 revealed a significantly lower observed than the expected mortality rate in patients undergoing NT-DCS (RD -0.18, 95 % CI -0.29/-0.06). Heterogeneity of included studies was high in both meta-analyses (I2=89.0% and 79.9%, respectively). Conclusion This meta-analysis revealed no significantly different mortality in patients with abdominal emergencies undergoing NT-DCS vs. NT-CS. However, observed mortality was significantly lower than the expected mortality rate in the NT-DCS group, suggesting a benefit of the DCS approach. Based on these results, the effect of DCS in patients with non-traumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted.

Healthcare providers have been rolling up their sleeves along with other adults age 65 and older to get their Covid-19 vaccines. Currently, there are three vaccines that have been authorized for use by the US Food and Drug Administration (FDA). This Covid-19 update provides information to help healthcare providers allay some of the fears surrounding vaccination and answer the questions patients are asking.

Purpose Preserving and increasing the health care workforce in rural areas has become imperative due to the shortage of health care workers serving rural populations. However, limited data are available on long-term patterns of employment in rural settings among health care workers. Methods We analyzed the National Longitudinal Survey of Youth, which enrolled a nationally representative sample of adolescents in 1979 and tracked their career outcomes through 2016. Using the US Census Bureau occupation codes, we identified participants who worked in health care occupations, and we classified their employment in rural versus urban areas. Findings Of the 1,007 respondents (including 109 doctoral health professionals), 70% worked only in urban locations, 13% worked only in rural locations, and 17% worked in both rural and urban locations during their health care career. Rural upbringing, White race, and female gender were associated with rural employment. Among nondoctoral health professionals, lower educational attainment was associated with increased likelihood of working only in rural settings. Conclusion Our study indicates the rural workforce is split between workers who are only employed in rural settings, and those who are intermittently employed in rural and urban settings. Therefore, retention of health care workers in rural settings and recruitment of workers from urban settings to practice in rural areas are important strategies for addressing the rural health care worker shortage. Rural upbringing, previously described as predictive of physician practice in rural locations, appears the strongest predictor of rural employment for both doctoral health professionals and nondoctoral health professionals.

Cauda equina syndrome is a devastating condition often following an innocent pathology in the form of a disc prolapse. The effect on sufferers, however, can be lifelong. It is necessary to make a diagnosis as expeditiously as possible via adequate history, clinical examination and appropriate imaging to offer treatment, in the form of decompressive surgery within 48 hours. It is extremely important to communicate adequately with the patient and their family recording all the relevant details including those of expected outcome. National guidelines are likely to be of value to clinicians and patients.

The pathogenic strategy of Escherichia coli and many other gram-negative pathogens relies on the translocation of a specific set of proteins, called effectors, into the eukaryotic host cell during infection. These effectors act in concert to modulate host cell processes in favor of the invading pathogen. Injected by the type III secretion system (T3SS), the effector arsenal of enterohemorrhagic E. coli (EHEC) O157:H7 features at least eight individual NleG effectors, which are also found across diverse attaching and effacing pathogens. NleG effectors share a conserved C-terminal U-box E3 ubiquitin ligase domain that engages with host ubiquitination machinery. However, their specific functions and ubiquitination targets have remained uncharacterized. Here, we identify host proteins targeted for ubiquitination-mediated degradation by two EHEC NleG family members, NleG5-1 and NleG2-3. NleG5-1 localizes to the host cell nucleus and targets the MED15 subunit of the Mediator complex, while NleG2-3 resides in the host cytosol and triggers degradation of Hexokinase-2 and SNAP29. Our structural studies of NleG5-1 reveal a distinct N-terminal α/β domain that is responsible for interacting with host protein targets. The core of this domain is conserved across the NleG family, suggesting this domain is present in functionally distinct NleG effectors, which evolved diversified surface residues to interact with specific host proteins. This is a demonstration of the functional diversification and the range of host proteins targeted by the most expanded effector family in the pathogenic arsenal of E. coli .

The galectin family of secreted lectins have emerged as important regulators of immune cell function; however, their role in B-cell responses is poorly understood. Here we identify IgM-BCR as a ligand for galectin-9. Furthermore, we show enhanced BCR microcluster formation and signaling in galectin-9-deficient B cells. Notably, treatment with exogenous recombinant galectin-9 nearly completely abolishes BCR signaling. We investigated the molecular mechanism for galectin-9-mediated inhibition of BCR signaling using super-resolution imaging and single-particle tracking. We show that galectin-9 merges pre-existing nanoclusters of IgM-BCR, immobilizes IgM-BCR, and relocalizes IgM-BCR together with the inhibitory molecules CD45 and CD22. In resting naive cells, we use dual-color super-resolution imaging to demonstrate that galectin-9 mediates the close association of IgM and CD22, and propose that the loss of this association provides a mechanism for enhanced activation of galectin-9-deficient B cells., The galectin family of secreted lectins are important regulators of immune cell function; however, their role in B cell responses is poorly understood. Here, the authors identify IgM-BCR as a ligand for galectin-9. In resting naive cells, they show that galectin-9 mediates a close association between IgM and CD22.

Host colonization by Gram-negative pathogens often involves delivery of bacterial proteins called “effectors” into the host cell. The pneumonia-causing pathogen Legionella pneumophila delivers more than 330 effectors into the host cell via its type IVB Dot/Icm secretion system. The collective functions of these proteins are the establishment of a replicative niche from which Legionella can recruit cellular materials to grow while evading lysosomal fusion inhibiting its growth. Using a combination of structural, biochemical, and in vivo approaches, we show that one of these translocated effector proteins, Ceg4, is a phosphotyrosine phosphatase harboring a haloacid dehalogenase–hydrolase domain. Ceg4 could dephosphorylate a broad range of phosphotyrosine-containing peptides in vitro and attenuated activation of MAPK-controlled pathways in both yeast and human cells. Our findings indicate that L. pneumophila's infectious program includes manipulation of phosphorylation cascades in key host pathways. The structural and functional features of the Ceg4 effector unraveled here provide first insight into its function as a phosphotyrosine phosphatase, paving the way to further studies into L. pneumophila pathogenicity.