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Background: History and health humanities instruction offers a framework for professional students to examine the arc and development of their profession as well as develop cultural competencies. Exploring ideas, themes, and health care practices and approaches through historical instruction can show students how culture influences health care and practice, therefore providing a context for further development of cultural competence skills. Case Presentation: This case report describes a collaboration among a dentistry course instructor, a liaison librarian, and curators of a rare book collection. Working together, this team offers an active learning class that examines the historical arc of the dental profession. We aim to have students use primary source materials to examine the experiences, research, and narratives of their profession. Discussion: Using a World Cafe with thematic tables allows students to safely examine rare materials and artifacts and have meaningful conversations about themes that are critical to dentistry’s past, present, and future. Students reported that engaging with artifacts and historical materials provided a different way to understand history and enhanced their learning experience. Engaging students in this work builds critical thinking skills that are essential to evidence-based practice.

The ketone bodies, sodium and lithium salts of acetoacetate (AcAc) and sodium 3-hydroxybutyrate (3-HB; commonly called beta-hydroxybutyrate) have been found to inhibit the proliferation of cancer cells. Previous studies have suggested that lithium itself may be an inhibiting agent but may be additive or synergistic with the effect of AcAc. We previously found that sodium acetoacetate (NaAcAc) inhibits the growth of human colon cancer cell line SW480. We report here similar results for several other cancer cell lines including ovarian, cervical and breast cancers. We found that NaAcAc does not kill cancer cells but rather blocks their proliferation. Similar inhibition of growth was seen in the effect of lithium ion alone (as LiCl). The effect of LiAcAc appears to be due to the combined effects of acetoacetate and the lithium ion. The ketone bodies, when given together with chemotherapeutic agents, rapamycin, methotrexate and the new peptide anti-cancer agent, PNC-27, substantially lowers their IC 50 values for cancer cell, killing suggesting that ketone bodies and ketogenic diets may be powerful adjunct agents in treating human cancers.

The authors' objective was to quantify the relationship between type II muscle fiber composition and recovery latency from controlled perturbations. Thirty healthy adults performed a Thorstensson test to indirectly determine muscle fiber composition of the knee extensors. On a subsequent day, reactive balance was measured by assessing latency time required to accommodate three controlled perturbations via computerized dynamic posturography. The proportion of type II fibers had a negative correlation with latency caused by a large backward perturbation (r = -.62, p = .001). These data may indicate a higher percentage of type II fibers in the knee extensors are associated with better reactive balance. Further investigation is warranted, in particular as it pertains to populations at risk for balance impairment.

Although aquatic exercise is considered a potentially effective treatment intervention for people with osteoarthritis (OA), previous research has focused primarily on calisthenics in a shallow pool with the inherent limitations on regulating exercise intensity. The purpose of this study was to quantify the efficacy of a 6-week aquatic treadmill exercise program on measures of pain, balance, function, and mobility. Eighteen participants (age = 64.5 ± 10.2 years) with knee OA completed a non-exercise control period followed by a 6-week exercise period. Outcome measures included visual analog scales for pain, posturography for balance, sit-to-stand test for function, and a 10-m walk test for mobility. The exercise protocol included balance training and high-intensity interval training (HIT) in an aquatic treadmill using water jets to destabilize while standing and achieve high ratings of perceived exertion (14-19) while walking. In comparison with pretests, participants displayed reduced joint pain (pre = 50.3 ± 24.8 mm vs. post = 15.8 ± 10.6 mm), improved balance (equilibrium pre = 66.6 ± 11.0 vs. post = 73.5 ± 7.1), function (rising index pre = 0.49 ± 0.19% vs. post = 0.33 ± 0.11%), and mobility (walk pre = 8.6 ± 1.4 s vs. post = 7.8 ± 1.1 s) after participating in the exercise protocol (p = 0.03-0.001). The same benefits were not observed after the non-exercise control period. Adherence to the exercise protocol was exceptional and no participants reported adverse effects, suggesting that aquatic treadmill exercise that incorporates balance and HIT training was well tolerated by patients with OA and may be effective at managing symptoms of OA.

For present-day biotas, close relationships have been documented between the number of species in a given region and the area of the region. To date, however, there have been only limited studies of these relationships in the geologic record, particularly for ancient marine biotas. The recent development of large-scale marine paleontological databases, in conjunction with enhanced geographical mapping tools, now allow for their investigation. At the same time, there has been renewed interest in comparing the environmental and paleobiological properties of two broad-scale marine settings: epicontinental seas, broad expanses of shallow water covering continental areas, and open-ocean-facing settings, shallow shelves and coastlines that rim ocean basins. Recent studies indicate that spatial distributions of taxa and the kinetics of taxon origination and extinction may have differed in these two settings. Against this backdrop, we analyze regional Genus-Area Relationships (GARs) of Late Cretaceous marine invertebrates in epicontinental sea and open-ocean settings using data from the Paleobiology Database. We present a new method for assessing GARs that is particularly appropriate for fossil data when the geographic distribution of these data is patchy and uneven. Results demonstrate clear relationships between genus richness and area for regions worldwide, but indicate that as area increases, genus richness increases more per unit area in epicontinental seas than in open-ocean settings. This difference implies a greater degree of compositional heterogeneity as a function of geographic area in epicontinental sea settings, a finding that is consistent with the emerging understanding of physical differences in the nature of water masses between the two marine settings.

Environmental perturbations during mass extinctions were likely manifested differently in epicontinental seas than in open-ocean-facing habitats of comparable depth. Here, we present a dissection of origination and extinction in epicontinental seas versus open-ocean-facing coastal regions in the Permian through Cretaceous periods, an interval through which both settings are well represented in the fossil record. Results demonstrate that extinction rates were significantly higher in open-ocean settings than in epicontinental seas during major mass extinctions but not at other times and that origination rates were significantly higher in open-ocean settings for a protracted interval from the Late Jurassic through the Late Cretaceous. These patterns are manifested even when other paleogeographic and environmental variables are held fixed, indicating that epicontinental seas and open-ocean-facing coastlines carry distinct macroevolutionary signatures.

It has previously been thought that there was a steep Cretaceous and Cenozoic radiation of marine invertebrates. This pattern can be replicated with a new data set of fossil occurrences representing 3.5 million specimens, but only when older analytical protocols are used. Moreover, analyses that employ sampling standardization and more robust counting methods show a modest rise in diversity with no clear trend after the mid-Cretaceous. Globally, locally, and at both high and low latitudes, diversity was less than twice as high in the Neogene as in the mid-Paleozoic. The ratio of global to local richness has changed little, and a latitudinal diversity gradient was present in the early Paleozoic.

Therapeutic radiation is widely used in cancer treatments. The success of radiation therapy depends not only on the radiosensitivity of tumor cells but also on the radiosensitivity of endothelial cells lining the tumor vasculature. Vascular endothelial growth factor (VEGF) plays a critical role in protecting endothelial cells against a number of antitumor agents including ionizing radiation. Strategies designed to overcome the survival advantage afforded to endothelial cells by VEGF might aid in enhancing the efficacy of radiation therapy. In this report we examined the signaling cascade(s) involved in VEGF-mediated protection of endothelial cells against gamma-irradiation. gamma-Irradiation-induced apoptosis of human dermal microvascular endothelial cells (HDMECs) was predominantly mediated through the p38 MAPK pathway as an inhibitor of p38 MAPK (PD169316), and dominant negative mutants of p38 MAPK could significantly enhance HDMEC survival against gamma-irradiation. Inhibition of the PI3K and MAPK pathways markedly up-regulated gamma-irradiation-mediated p38 MAPK activation resulting in enhanced HDMEC apoptosis. In contrast, VEGF-treated HDMECs were protected from gamma-irradiation-induced apoptosis predominantly through the PI3K/Akt pathway. Bcl-2 expression was markedly elevated in VEGF-treated HDMECs, and it was significantly inhibited by the PI3K inhibitor LY294002. HDMECs exposed to irradiation showed a significant decrease in Bcl-2 expression. In contrast, VEGF-stimulated HDMECs, when irradiated, maintained higher levels of Bcl-2 expression. Taken together our results suggest that gamma-irradiation induces endothelial cell apoptosis predominantly via the activation of p38 MAPK, and VEGF protects endothelial cells against gamma-irradiation predominantly via the PI3K-Akt-Bcl-2 signaling pathway.

Cohorts of marine taxa that originated during recoveries from mass extinctions were commonly more widespread spatially than those originating at other times. Coupled with the recognition of a correlation between the geographic ranges and temporal longevities of marine taxa, this observation predicts that recovery taxa were unusually long-lived geologically. We analyzed this possibility by assessing the longevities of marine genus cohorts that originated in successive substages throughout the Phanerozoic. Results confirm that several mass extinction recovery cohorts were significantly longer lived than other cohorts, but this effect was limited to the post-Paleozoic, suggesting differences in the dynamics of Paleozoic versus post-Paleozoic diversification.

Objective: Hepatitis C virus (HCV) infection is more prevalent in U.S. veterans attending Veterans Affairs Medical Centers than in the general population. The purpose of this study was to examine the risk factors, psychiatric and substance abuse conditions, and severity of liver disease in veterans with HCV., Methods: The medical records and liver biopsies of 206 consecutive patients with HCV attending a multidisciplinary medical/psychiatric chronic hepatitis clinic and who met eligibility criteria for interferon alpha-2b therapy were reviewed., Results: The mean age was 46.5+/-6.8 yr and 77% were Vietnam-era veterans. Risk factors included i.v. drug use (64%), blood transfusion (15%), and cocaine use (9%), and were unknown in 12%. The average estimated duration of disease was 24+/-7.6 yr. A history of alcohol abuse or dependence was identified in 80% of patients. Psychiatric illnesses were present in 60%, the most common being depression and posttraumatic stress disorder. Overall, 89% of patients had documented psychiatric and/or substance abuse diagnoses. Severe fibrosis (stages 3-4) was present in 32% and severe inflammation (grades 2-3) was present in 71% of biopsies. Psychiatric and substance abuse diagnoses did not correlate with severity of liver disease. A total of 145 patients (71%) were prescribed interferon-based treatment. The overall virological sustained response rates were 16% after interferon monotherapy and 28% after interferon/ribavirin therapy. Reasons for not receiving interferon therapy included minimal fibrosis on liver biopsy (37 patients [18%]), worsening medical conditions (nine [4%]), and worsening psychiatric and substance abuse problems (14 [7%])., Conclusions: Advanced fibrosis is common in this cohort of veteran patients with chronic hepatitis C, and the overwhelming majority of these patients have psychiatric and/or substance abuse diagnoses. Despite these comorbidities, the majority received interferon therapies in the context of a multidisciplinary clinic. These data emphasize the importance of hepatitis C care that includes linkage of medical care and psychiatric services.

Global diversity curves reflect more than just the number of taxa that have existed through time: they also mirror variation in the nature of the fossil record and the way the record is reported. These sampling effects are best quantified by assembling and analyzing large numbers of locality-specific biotic inventories. Here, we introduce a new database of this kind for the Phanerozoic fossil record of marine invertebrates. We apply four substantially distinct analytical methods that estimate taxonomic diversity by quantifying and correcting for variation through time in the number and nature of inventories. Variation introduced by the use of two dramatically different counting protocols also is explored. We present sampling-standardized diversity estimates for two long intervals that sum to 300 Myr (Middle Ordovician-Carboniferous; Late Jurassic-Paleogene). Our new curves differ considerably from traditional, synoptic curves. For example, some of them imply unexpectedly low late Cretaceous and early Tertiary diversity levels. However, such factors as the current emphasis in the database on North America and Europe still obscure our view of the global history of marine biodiversity. These limitations will be addressed as the database and methods are refined.

Short stratigraphic sections in apparently monotonous strata pose several challenges to high-resolution (

Long-term transitions in the composition of Earth's marine biota during the Phanerozoic have historically been explained in two different ways. One view is that they were mediated through biotic interactions among organisms played out over geologic time. The other is that mass extinctions transcended any such interactions and governed diversity over the long term by resetting the relative diversities of higher taxa. However, a growing body of evidence suggests that macroevolutionary processes effecting biotic transitions during background times were not fundamentally different from those operating during mass extinctions. Physical perturbations at many geographic scales combined to produce the long-term trajectory of Phanerozoic diversity.

Although parasequence and sequence are scale-independent terms, they are frequently applied only to specific scales of cycles. For example, meter-scale cycles are commonly assumed to be parasequences or PACs. In the Upper Ordovician Kope and Fairview Formations of northern Kentucky, we examined a succession of 50 meter-scale cycles that have been variously interpreted as deepening-upward, shallowing-upward, or showing no relationship with water depth. Our analysis shows that these cycles, characterized by shifts in storm-bed proximality, are highly variable in their thickness and internal construction. Most cycles are best considered high-frequency sequences, because deepening-upward intervals are common, and many cycles contain evidence of abrupt basinward shifts in facies as expected at sequence boundaries. A minority fit the parasequence model of shallowing-upward cycles bounded by flooding surfaces. Larger, 20 m scale cycles are defined by systematic thickening and thinning trends of meter-scale cycles. However, meter-scale cycles do not display any systematic trends in cycle anatomy as a function of position within the 20 m cycles or position within the Kope and Fairview Formations. The high cycle variability and the lack of systematic stratigraphic organization with respect to longer-term cyclicity reflect either the irregularity of relative sea-level changes, the poor recording of sea-level changes in this deep-water setting, or the generation of these cycles by climate-induced cyclicity in storm intensity. These three mechanisms would generate similar patterns at the outcrop scale, so it is not possible at the present to distinguish between them.

Although the history of life has been characterized by intermittent episodes of radiation that can be recognized in global compilations of biodiversity, it does not necessarily follow that these episodes are caused by processes that occurred uniformly around the world. Major diversity increases could be generated by the cumulative effects of different mechanisms operating simultaneously at several geographic or environmental scales. The purpose of this review is to describe ongoing research on the manifestations, at several scales, of the Ordovician Radiation, which was among the most extensive intervals of diversification in the history of life. Through much of the period, diversity was concentrated most heavily near regions of active mountain building and volcanism; differences in diversity patterns from continent to continent, and among regions within continents, reflect this overprint. While this suggests a linkage of the Radiation and tectonic activity, this is by no means the only mediating agent. Outcrop-based research in North America has demonstrated that tectonic activity was detrimental to some biotic elements, in contrast to its effects on other organisms. Moreover, in the Great Basin of North America where the local stratigraphic record is of particularly high quality, biotic transitions characteristic of the period occurred far more rapidly than observed in global compilations of diversity, suggesting that the global rate of transition may represent the aggregate sum of transitions that occurred abruptly, but at different times, around the world. Finally, it has been demonstrated that, in concert with an increase in average age, the environmental and geographic ranges of Ordovician genera both increased significantly through the period, indicating a role for intrinsic factors in producing Ordovician biotic patterns.

Although available paleobiological data indicate that the geographic ranges of marine species are maintained throughout their entire observable durations, other evidence suggests, by contrast, that the ranges of higher taxa expand as they age, perhaps in association with increased species richness. Here, I utilize a database of Ordovician genus occurrences collected from the literature for several paleocontinents to demonstrate that a significant aging of the global biota during the Ordovician Radiation was accompanied by a geographic and environmental expansion of genus ranges. The proportion of genera occurring in two or more paleocontinents in the database, and two or more environmental zones within a six-zone onshore-offshore framework, increased significantly in the Caradocian and Ashgillian. Moreover, widespread genera tended to be significantly older than their endemic counterparts, suggesting a direct link between their ages and their environmental and geographic extents. Expansion in association with aging was corroborated further by demonstrating this pattern directly among genera that ranged from the Tremadocian through the Ashgillian. Taken together, these results are significant not only for what they reveal about the kinetics of a major, global-scale diversification, but also for what they suggest about the interpretation of relationships between diversity trends at the alpha (within-community) and beta (between-community) levels.

The Ordovician Radiation was among the most extensive intervals of diversification in the history of life. However, a delineation of the proximal cause(s) of the Radiation remains elusive. Any such determination should involve an analysis of geographic overprints on diversification: did the Radiation occur randomly around the world or, alternatively, was it focused in particular geographic or depositional regimes? Here, I present a comparative evaluation of Ordovician diversification among several palaeocontinents to determine whether biotas associated with certain palaeocontinents exhibited different diversification patterns than others; in part, this involves a numerical "correction" to raw diversity trajectories. Clear disparities among palaeocontinents are indicated by the data, which appear to reflect differences in the extent of siliciclastic input partly in association with tectonic activity. Further testing will be required to fully substantiate the implication that siliciclastic influx was a predominant factor in the Ordovician Radiation, affecting a variety of higher taxa among all three Phanerozoic evolutionary faunas.

It has long been suspected that trends in global marine biodiversity calibrated for the Phanerozoic may be affected by sampling problems. However, this possibility has not been evaluated definitively, and raw diversity trends are generally accepted at face value in macroevolutionary investigations. Here, we analyze a global-scale sample of fossil occurrences that allows us to determine directly the effects of sample size on the calibration of what is generally thought to be among the most significant global biodiversity increases in the history of life: the Ordovician Radiation. Utilizing a composite database that includes trilobites, brachiopods, and three classes of molluscs, we conduct rarefaction analyses to demonstrate that the diversification trajectory for the Radiation was considerably different than suggested by raw diversity time-series. Our analyses suggest that a substantial portion of the increase recognized in raw diversity depictions for the last three Ordovician epochs (the Llandeilian, Caradocian, and Ashgillian) is a consequence of increased sample size of the preserved and catalogued fossil record. We also use biometric data for a global sample of Ordovician trilobites, along with methods of measuring morphological diversity that are not biased by sample size, to show that morphological diversification in this major clade had leveled off by the Llanvirnian. The discordance between raw diversity depictions and more robust taxonomic and morphological diversity metrics suggests that sampling effects may strongly influence our perception of biodiversity trends throughout the Phanerozoic.

The Ordovician radiation of marine life was among the most substantial pulses of diversification in Earth history and coincided in time with a major increase in the global level of orogenic activity. To investigate a possible causal link between these two patterns, the geographic distributions of 6576 individual appearances of Ordovician vician genera around the world were evaluated with respect to their proximity to probable centers of orogeny (foreland basins). Results indicate that these genera, which belonged to an array of higher taxa that diversified in the Middle and Late Ordovician (trilobites, brachiopods, bivalves, gastropods, monoplacophorans), were far more diverse in, and adjacent to, foreland basins than they were in areas farther removed from orogenic activity (carbonate platforms). This suggests an association of orogeny with diversification at that time.

The global diversification of the class Bivalvia has historically received two conflicting interpretations. One is that a major upturn in diversification was associated with, and a consequence of, the Lake Permian mass extinction. The other is that mass extinctions have had little influence and that bivalves have experienced slow but nearly steady exponential diversification through most of their history, unaffected by interactions with other clades. We find that the most likely explanation lies between these two interpretations. Through most of the Phanerozoic, the diversity of bivalves did indeed exhibit slow growth, which was not substantially altered by mass extinctions. However, the presence of "hyperexponential bursts" in diversification during the initial Ordovician radiation and following the Late Permian and Late Cretaceous mass extinctions suggests a more complex history in which a higher characteristic diversification rate was dampened through most of the Phanerozoic. The observed pattern can be accounted for with a two-phase coupled (i.e., interactive) logistic model, where one phase is treated as the "bivalves" and the other phase is treated as a hypothetical group of clades with which the "bivalves" might have interacted. Results of this analysis suggest that interactions with other taxa have substantially affected bivalve global diversity through the Phanerozoic.

A case of SLE with the unique association of gastric polyps and vasculitis is reported. Gastrointestinal symptoms, surgical indications, and complications of SLE with gastrointestinal involvement are reviewed. The unusual patterns of ileus or lupus peritonitis secondary to mesenteric vasculitis must be differentiated from a true surgical emergency. Corticosteroids may be expected to produce rapid clinical improvement in the two former instances. Surgical exploration is reserved for those cases with clinical or radiologic evidence of uncontrollable hemorrhage, bowel perforation, or mesenteric infarction.

We have reviewed 23 documented cases of phlegmonous gastritis reported since 1945 in the American literature, and have added 2 of our own. A small series of cases makes it somewhat difficult to draw any definite conclusions regarding the modes of presentation; nonetheless, some clinical trends are discernible. In a patient with a history of large ethanol intake, a recent bout of "gastritis," or recent upper respiratory infection, who presents with acute upper abdominal pain, peritonitis, purulent ascitic fluid, and fever, the diagnosis of phlegmonous gastritis must be considered in differential diagnosis. With normal serum amylase, no historical evidence of ulcer or gallbladder disease, the diagnosis becomes even more probable. Preoperative diagnosis is rare, but gastroscopy with or without biopsy, and culture of gastric contents may establish the diagnosis. The definitive treatment would appear to be resection or drainage of the stomach, combined with large doses of systemic antibiotics, usually penicillin. The surgical mortality in cases reviewed was 18.2%, while the medical mortality was 100%. The overall mortality was 67%. It is hoped that more frequent recognition of this disease entity will lead to earlier diagnosis and a resulting lower morbidity and mortality.

A synthetic polypeptide, copolymer I (COP I), composed of alanine, glutamic acid, lysine, and tyrosine, has been demonstrated to be nonencephalitogenic and nontoxic in laboratory animals, yet it is capable of suppressing experimental allergic encephalomyelitis. A preliminary open trial examined the ability of COP I to alter the course of disease in 12 patients with chronic progressive and 4 with exacerbating-remitting multiple sclerosis (MS). After therapy for as long as two years or more, no undesirable side reaction was noted in any patient. Three patients with chronic progressive MS and 2 with exacerbating-remitting disease are better. These results, which may represent simply a placebo effect or may be a significant response, are now being examined in randomized, placebo-controlled, double-blind pilot trials.

Alpha-Fetoprotein was detected in a patient with alcoholic hepatitis during the acute phase of the illness. The alpha-fetoprotein was no longer detected as clinical improvement developed. No evidence of malignant disease was found after an extensive evaluation. This case represents another example of a non-neoplastic disease associated with the presence of increased serum levels of alpha-fetoprotein.