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Abstract. There has been an increase in the number of Level I and II trauma centers across the United States in the past few decades. However, data suggest that access to trauma care remains poor in rural areas of the country, while in many urban areas, trauma center density may be too high. Excessive trauma center proliferation in urban areas has the potential for negative effects on patient care and increased trauma system costs. The efficiency and competency of each trauma center may be decreased by having less access to patients, with research, surgeon experience, and training programs for residents, fellows, medical students, and other allied health providers all affected. Because of these concerns, the Orthopaedic Trauma Association (OTA) Health Policy Committee reviewed trauma center trends and trauma system needs and considered the potential effect of the increase in the number of centers on patient care as well as surgeon experience and training. This article reviews the different types of trauma centers and their designation process, as well as the growth in trauma centers during the past few decades. The committee identified and explored each of these issues and provides suggestions for improvement. Potential solutions identified include developing and applying strict criteria for determining the number of trauma centers needed within a given region, considering the needs of the local population, cost containment, and impact on adjacent trauma centers and their educational and research missions. There is opportunity for the OTA to work even more collaboratively with the American College of Surgeons to develop such criteria and to be involved with the orthopaedic accreditation and orthopaedic requirements. Collaboration between professional medical societies such as the OTA and American College of Surgeons and state and federal agencies is needed to help optimize the distribution of trauma centers.

Abstract. Objectives:. This systematic review examined the literature regarding management of fracture patients who take direct oral anticoagulant (DOAC) medications, with a focus on delay in surgical treatment, and need for transfusions. In addition, a survey of orthopaedic trauma surgeons was conducted to gain insight on current practices. Data Sources:. A review of PubMed, Cochrane, Embase, and Scopus databases was performed from inception through March 2024, including English language publications. Study Selection:. Studies were included if they reported time to surgery and transfusion rates among fracture patents who were taking DOAC medications. Additional data points were collected on an “if-reported” basis, including mortality, venous thromboembolism, and bleeding complications. Data Extraction:. In all, 4546 abstracts were screened. Full-text review was conducted on 86 publications, and 25 articles were included in the final analysis. Each article was independently screened by 2 reviewers, with disputes settled by a third reviewer. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool. Data Synthesis:. Descriptive statistics are reported for overall study findings. Meta-analysis was performed for the variables “time to surgery” and “transfusion rate.” Conclusions:. Our findings indicate that fracture patients taking DOACs experience longer delays before surgery but have equivalent transfusion rates compared with nonanticoagulated patients. Survey results indicate that surgeons do not delay operating on emergent or percutaneous cases, regardless of anticoagulant medications. In circumstances when they do delay, they are more likely to do so for patients taking DOAC medications. Level of Evidence:. Level III, systematic review and meta-analysis of Level II and III articles.

Background: Individuals living in initial asylum accommodation are at increased risk of vaccine-preventable disease, yet confidence in vaccination may be low in these settings. Our aim was to understand the influence of experiences within the UK asylum system on vaccine confidence and decision-making from a sociological perspective. Methods: In-depth semi-structured interviews were carried out on views and experiences around vaccination (09/2020-08/2021) with individuals seeking asylum or having recently been granted asylum (

Most Escherichia coli isolates from humans do not utilize D-sucrose as a substrate for fermentation or growth. Previous work has shown that the Csc pathway allows some E. coli to utilize sucrose for slow growth, and this pathway has been engineered in E. coli W strains to enhance use of sucrose as a feedstock for industrial applications. An alternative sucrose utilization pathway, Scr, was first identified in Klebsiella pneumoniae and has been reported in some E. coli and Salmonella enterica isolates. We show here that the Scr pathway is native to an important subset of E. coli phylogroup B2 lineages that lack the Csc pathway but grow rapidly on sucrose. Laboratory E. coli strains derived from MG1655 (phylogroup A, ST10) are unable to utilize sucrose and lack the scr and csc genes, but a recombinant plasmid-borne scr locus enables rapid growth on and fermentation of sucrose. Genome analyses of Enterobacteriaceae indicate that the scr locus is widespread in other Enterobacteriaceae; including Enterobacter and Klebsiella species, and some Citrobacter and Proteus species. In contrast, the Csc pathway is limited mostly to E. coli, some Shigella species (in which csc loci are rendered non-functional by various mutations), and Citrobacter freundii. The more efficient Scr pathway likely has greater potential than the Csc pathway for bioindustrial applications of E. coli and other Enterobacteriaceae using sucrose as a feedstock.

Objectives Fracture is a common injury after a traumatic event. The efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) to treat acute pain related to fractures is not well established.Methods Clinically relevant questions were determined regarding NSAID use in the setting of trauma-induced fractures with clearly defined patient populations, interventions, comparisons and appropriately selected outcomes (PICO). These questions centered around efficacy (pain control, reduction in opioid use) and safety (non-union, kidney injury). A systematic review including literature search and meta-analysis was performed, and the quality of evidence was graded per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group reached consensus on the final evidence-based recommendations.Results A total of 19 studies were identified for analysis. Not all outcomes identified as critically important were reported in all studies, and the outcome of pain control was too heterogenous to perform a meta-analysis. Nine studies reported on non-union (three randomized control trials), six of which reported no association with NSAIDs. The overall incidence of non-union in patients receiving NSAIDs compared with patients not receiving NSAIDs was 2.99% and 2.19% (p=0.04), respectively. Of studies reporting on pain control and reduction of opioids, the use of NSAIDs reduced pain and the need for opioids after traumatic fracture. One study reported on the outcome of acute kidney injury and found no association with NSAID use.Conclusions In patients with traumatic fractures, NSAIDs appear to reduce post-trauma pain, reduce the need for opioids and have a small effect on non-union. We conditionally recommend the use of NSAIDs in patients suffering from traumatic fractures as the benefit appears to outweigh the small potential risks.

Maritime Autonomous Surface Ships (MASS) perfectly fit into the future vision of merchant fleet. MASS autonomous navigation system combines automatic trajectory tracking and supervisor safe trajectory generation subsystems. Automatic trajectory tracking method, using line-of-sight (LOS) reference course generation algorithm, is combined with model predictive control (MPC). Algorithm for MASS trajectory tracking, including cooperation with the dynamic system of safe trajectory generation is described. It allows for better ship control with steady state cross-track error limitation to the ship hull breadth and limited overshoot after turns. In real MASS ships path is defined as set of straight line segments, so transition between trajectory sections when passing waypoint is unavoidable. In the proposed control algorithm LOS trajectory reference course is mapped to the rotational speed reference value, which is dynamically constrained in MPC controller due to dynamically changing reference trajectory in real MASS system. Also maneuver path advance dependent on the path tangential angle difference, to ensure trajectory tracking for turns from 0 to 90 degrees, without overshoot is used. All results were obtained with the use of training ship in real–time conditions.

Background: Health literacy research and practice are constantly evolving. Recent inquiry has highlighted the burdensome literacy demands faced by people with serious mental illness (SMI). Systems, organizational operations, and structures can play a role in decreasing literacy demand, thereby reducing unnecessary challenges for people with SMI. Brief Description of Activity: An organizational health literacy assessment was conducted to explore literacy demands in one mental health shelter and revealed best practice action steps for improving the literacy environment. Implementation: The assessment included an exploration of the shelter environment using The Health Literacy Environment Activity Packet, First Impressions & Walking Interview, and a commonly used shelter document using the Simple Measure of Gobbledygook (SMOG), Suitability Assessment of Materials (SAM), and Centers for Disease Control and Prevention (CDC) Index. Results: The literacy demands of the shelter environment and a frequently used document exceeded the literacy skills of people with SMI. Environment assessment revealed environmental facilitators (e.g., welcoming atmosphere) and barriers (e.g., unclear signage). Document assessment also revealed facilitating factors and barriers. SMOG scores ranged from 11.25 to 11.80 (median: 11.38), meaning 11th to 12th grade-level reading skills are required to understand, use, and take action on the document's content. A SAM score of 50% (adequate) and a CDC Index score of 42.1 (revise and improve) reveal materials contain both facilitating factors (e.g., chunked sections) and barriers (e.g., jargon, mismatched graphics) to use. Lessons Learned: The mismatch between system demands and the literacy skills of people with SMI is more profound than that of the general United States population. Organizational health literacy assessments are achievable and useful for both immediate and long-term action aimed at understanding and improving the organizational health literacy of mental health spaces. Further work is needed to explore the role of behavioral health services in addressing the institutional and programmatic literacy demands that inhibit treatment and recovery. [HLRP: Health Literacy Research and Practice. 2022;6(3):e167–e174.] Plain Language Summary: An organizational health literacy assessment reveals how system demands can be changed to better serve intended users. Engaging in mental health, recovery, and treatment services requires complex literacy skills. Generally, the U.S. adult population does not have the skills to meet such demands, and this is especially true among public mental health service users.

The paper presents one of the modern control methods used for steering of the ship motion. The different automatic systems used to navigate the vessels are described at the beginning. Next, prediction control methodology is presented and multidimensional MPC regulator applied to steering of the training ship is shown as a technical product. Tests results from the real-time experiments with the mentioned controller are presented at the end of the article.

In the process of ship motion control system design, it is necessary to take into account the impact of environmental disturbances such as winds, waves and sea currents. The commonly used representatives of wave influences in this area are the unidirectional wave power spectral density functions describing sea waves of different form: long-crested, fully developed waves, developing wind waves or multi-modal waves (e.g., with swell). The existing standard PSD models describe the surge of open sea or ocean. However, they are inadequate in the case of control system testing of scale ship models for sailing in open water areas such as lakes or test pools. This paper presents a study of wind-generated wave PSD estimations for a small lake used as a test area for free-running scale ships. The publication provides a brief overview of the wave spectral density functions commonly used for control system design. A measurement instrument using the idea of a water-induced variable capacitance that works synchronously with the wind sensors is also described. The process of collected data analysis is presented. As a result of the study, a series of empirical spectral density functions of lake waves for different wind speeds are obtained. They correspond to the rescaled, two-parametric ITTC model.

Objectives: This rapid health needs assessment was undertaken to urgently identify the needs of socially vulnerable groups arising during the first wave of cases of the COVID-19 pandemic in England. The objective was to develop recommendations for policy makers and stakeholders to mitigate adverse impacts on socially vulnerable groups throughout the COVID-19 response and recovery period. Study design: Rapid health needs assessment. Methods: The needs assessment employed qualitative methods to systematically collect data about the knowledge and views of key informants through semi-structured interviews and focus groups. Participants were either topic experts providing services to socially vulnerable groups who routinely face barriers to healthcare access or experts by experience. Participants included people experiencing homelessness, sex workers, people from Gypsy, Roma and Traveller communities and people facing challenges due to their immigration status. Data was collected over a week period in April/May 2020 and followed by thematic analysis to examine interview transcripts. Results: Forty-two participants were included in the study, half of whom were experts by experience. Challenges with accessing and following COVID-19 information and government guidance were described as affecting all groups, due to exclusion from digital technology, translated resources, tailored support and adequate housing. Altered delivery of healthcare services, such as the closure of outreach and drop-in services, remote consultations, and online patient registration, were noted by interviewees as worsening existing barriers to accessing healthcare. Being charged for NHS care remained a key fear for migrants. All groups’ access to income, education and social support were reported as being impacted by service closures and job losses, putting them at higher risk of destitution. Isolation, loneliness and deteriorating mental health were frequently reported. Conclusions: This assessment has highlighted the disproportionate impact of the COVID-19 pandemic on socially vulnerable groups and demonstrated a plethora of unmet needs. As the effects of COVID-19 continue, it is imperative that the needs of these groups are urgently and explicitly addressed and prioritised. This is essential to promote engagement with test and trace services, enable isolation adherence, and achieve high vaccine uptake in socially vulnerable populations.

The forces and moments acting on a marine vessel caused by the wind are most often modeled based on its speed measured at a standard 10 m above the sea level. There exist numerous well-known methods for modeling wind speed in such conditions. These models, by nature, are inadequate for simulating wind disturbances for free-running scale ship models sailing on lakes. Such scale models are being used increasingly for design and testing modern ship motion control systems. The paper describes the hardware and methodology used in measuring wind speed at low altitudes above the lake level. The system consists of two ultrasonic anemometers supplemented with wave sensor acting as a capacitor immersed partially in the water. Obtained measurement results show clear similarity to the values gathered during full-scale experiments. Analysis of the power spectral density functions of turbulence measured for different mean wind speeds over the lake, indicates that, at the present stage of research, the best model of wind turbulence at low altitude above the lake level can be obtained by assembling four of the known, standard turbulence models.

Introduction: Early evidence confirms lower COVID-19 vaccine uptake in established ethnic minority populations, yet there has been little focus on understanding vaccine hesitancy and barriers to vaccination in migrants. Growing populations of precarious migrants (including undocumented migrants, asylum seekers and refugees) in the UK and Europe are considered to be under-immunised groups and may be excluded from health systems, yet little is known about their views on COVID-19 vaccines specifically, which are essential to identify key solutions and action points to strengthen vaccine roll-out. Methods: We did an in-depth semi-structured qualitative interview study of recently arrived migrants (foreign-born, >18 years old;

This article describes the study protocol for an evaluation of an innovative model of care that supports home health nurses (HHN) who serve children with medical complexity (CMC). CMC constitute a small proportion of children, but have very high need for health services, are hospitalized frequently, and account for significant proportion of pediatric healthcare expenditures. High-quality home health nursing services are important for CMC, but models of care of home healthcare, after discharge of CMC from the hospital, have not been tested. Our project aims are to develop, implement, and test a model of care, called ICollab, to improve home healthcare delivery for CMC. The ICollab model consists of collaboration between HHN, primary-care physicians and clinicians of the complex care program of a tertiary-care children's hospital in the care of CMC. In this randomized clinical trial, we will recruit 110 CMC discharged home on home health nursing services. The intervention group (n = 55) will receive the ICollab intervention for 6 months post-discharge from the hospital, in addition to usual care. Children in the control group (n = 55) will receive only usual care. Outcome measures will include healthcare utilization metrics (hospitalization rates, emergency room visit rates, and days to readmission), caregiver burden and caregiver satisfaction with home healthcare, HHN retention, and HHN collaboration with other healthcare providers. We hypothesize that ICollab will reduce healthcare utilization and caregiver burden, and improve caregiver satisfaction with home healthcare, increase HHN retention, and increase HHN collaboration with other healthcare providers. Results of this study have the potential to provide a critically needed evidence-base for interventions to improve the quality of healthcare delivery for CMC. This study is registered on clinicaltrials.gov (NCT03978468) and is ongoing.

Abstract Background Glucocorticoids act on the glucocorticoid receptor (GR; NR3C1) to resolve inflammation and, as inhaled corticosteroids (ICS), are the cornerstone of treatment for asthma. However, reduced efficacy in severe disease or exacerbations indicates a need to improve ICS actions. Methods Glucocorticoid-driven transcriptomes were compared using PrimeView microarrays between primary human bronchial epithelial (HBE) cells and the model cell lines, pulmonary type II A549 and bronchial epithelial BEAS-2B cells. Results In BEAS-2B cells, budesonide induced (≥2-fold, P ≤ 0.05) or, in a more delayed fashion, repressed (≤0.5-fold, P ≤ 0.05) the expression of 63, 133, 240, and 257 or 15, 56, 236, and 344 mRNAs at 1, 2, 6, and 18 h, respectively. Within the early-induced mRNAs were multiple transcriptional activators and repressors, thereby providing mechanisms for the subsequent modulation of gene expression. Using the above criteria, 17 (BCL6, BIRC3, CEBPD, ERRFI1, FBXL16, FKBP5, GADD45B, IRS2, KLF9, PDK4, PER1, RGCC, RGS2, SEC14L2, SLC16A12, TFCP2L1, TSC22D3) induced and 8 (ARL4C, FLRT2, IER3, IL11, PLAUR, SEMA3A, SLC4A7, SOX9) repressed mRNAs were common between A549, BEAS-2B and HBE cells at 6 h. As absolute gene expression change showed greater commonality, lowering the cut-off (≥1.25 or ≤ 0.8-fold) within these groups produced 93 induced and 82 repressed genes in common. Since large changes in few mRNAs and/or small changes in many mRNAs may drive function, gene ontology (GO)/pathway analyses were performed using both stringency criteria. Budesonide-induced genes showed GO term enrichment for positive and negative regulation of transcription, signaling, proliferation, apoptosis, and movement, as well as FOXO and PI3K-Akt signaling pathways. Repressed genes were enriched for inflammatory signaling pathways (TNF, NF-κB) and GO terms for cytokine activity, chemotaxis and cell signaling. Reduced growth factor expression and effects on proliferation and apoptosis were highlighted. Conclusions While glucocorticoids repress mRNAs associated with inflammation, prior induction of transcriptional activators and repressors may explain longer-term responses to these agents. Furthermore, positive and negative effects on signaling, proliferation, migration and apoptosis were revealed. Since many such gene expression changes occurred in human airways post-ICS inhalation, the effects observed in cell lines and primary HBE cells in vitro may be relevant to ICS in vivo.

Recenzja książki Agaty Hołobut i Moniki Woźniak Historia na ekranie. Gatunek filmowy a przekład audiowizualny (2018). Autorki badają w niej wpływ filmu historycznego na specyfikę przekładu audiowizualnego, analizując anglojęzyczne (brytyjskie i amerykańskie) listy dialogowe wybranych filmów fabularnych i seriali historycznych oraz ich dostępne polskie oraz włoskie przekłady (opracowania dubbingowe, lektorskie i napisowe). Recenzentka zwraca uwagę, że książka udatnie łączy narzędzia analizy językoznawczej, filmoznawczej i stylometrycznej.

Background: Recent UK ‘hostile environment’ immigration policies, including obligatory charging and sharing of confidential data between NHS Digital and the Home Office, have created an atmosphere of fear and exposed already highly marginalised and vulnerable groups to significant health risks by increasing barriers to accessing NHS care. Methods: This is a cross-sectional observational study of patients accessing healthcare at Doctors of the World (DOTW) in the UK. DOTW is a humanitarian organisation, providing care to those excluded from NHS healthcare. We aimed to describe population characteristics of individuals using DOTW services and identify groups at greatest risk of facing ‘hostile environment’-related barriers to NHS care, specifically being denied healthcare or fear of arrest. Results: A total of 1474 adults were seen in 2016. Nearly all were non-EU/EEA nationals (97.8%; 1441/1474), living in poverty (68.6%; 1011/1474). DOTW saw a large number of undocumented migrants (57.1%; 841/1474) and asylum seekers (18.2%; 268/1474). 10.2% (151/1474) of adults seen had been denied NHS healthcare and 7.7% (114/1474) were afraid to access NHS services. Asylum seeker status was associated with the highest risk (adjusted odds ratio (OR): 2.48; 95% confidence interval (CI): 1.48-4.14) of being denied NHS healthcare and being undocumented was associated with the highest risk of fearing arrest (adjusted OR: 3.03; 95% CI: 1.70-5.40). Conclusions: Our findings make visible the multiple and intersecting vulnerabilities of individuals forced to seek care outside of the NHS, underlining the public health imperative for the government to urgently withdraw its ‘hostile environment’ policies and address their negative health impacts.

Modeling is the most important component in predictive controller design. It should predict outputs precisely and fast. Thus, it must be adequate for the ship dynamics while having as simple a structure as possible. In a good ship model the standard deviation of a particular coefficient should not exceed 10% of its value. Fitting the validation data to 80% for short-term prediction and 65% for long-term prediction is treated as a declared benchmark for model usage in ship course predictive controller. Regularization was proposed to ensure better state-space models to fit the real ship dynamics and more accurate standard deviation value control. Usage of the simulation results and real-time trials, as model estimation and validation data, respectively, during the identification procedure is proposed. In the first step a predictive linear model is identified conventionally, and then coefficients are regularized, based on the validation data, using a genetic algorithm. Particular linearized model coefficient standard deviations were decreased from more than 100% of their values to approximately 5% of them using genetic algorithm tuning. Moreover, the proposed method eliminated model output signal oscillations, which were observed during the validation process based on experimental data, gained during ship trials. Improved mapping of ship dynamics was achieved. Fit to validation data increased from 71% and 54% to 89% and 76%, respectively, for short-term and long-term prediction. The proposed method, which may be applied to real applications, is easily applicable and reliable. The tuned model is sufficiently suited to plant dynamics and may be used for future predictive control purposes.

The concept of the Marine Autonomous Surface Ship (MASS) requires new solutions in many areas: from law, through economics, social sciences, environmental issues to the technology and even ethics. It also plays a central role in the work of numerous research teams dealing with the ship motion control systems. This article presents the results of the experiments with application of the selected control methods in automatic steering of the movement of an autonomous ship in the two regimes: during the maneuvers at low speed (in a harbor confined waters) and during the lake trials in open water conditions. In the first case, multidimensional state controller synthesized with Linear Matrix Inequalities (LMI) algorithms was used, while, in the second case, Model Predictive Control (MPC) control was adopted. The object for which the experiments were carried out was 1:24 scale model of the Liquefied Natural Gas (LNG) carrier. The paper presents also the design of the measurement and control system and the user interface. The experiments were conducted in the natural conditions on the lake. The results of the experiments indicate the fundamental role of the measurement system in the process of controlling an autonomous ship.

The purpose of the study was to examine whether monolingual adults can identify the bilingual children with LI on the basis of children’s response speed to the examiner. Participants were 37 monolingual English-speaking young adults. Stimuli were 48 audio clips from six sequential bilingual children (48 months) who were predominately exposed to Cantonese (L1) at home from birth and started to learn English (L2) in preschool settings. The audio clips for each child were selected from an interactive story-retell task in both Cantonese and English. Three of the children were typically developing, and three were identified as having a language impairment. The monolingual adult participants were asked to judge children’s response times for each clip. Interrater reliability was high (Kalpha = 0.82 for L1; Kalpha = 0.75 for L2). Logistic regression and receiver operating characteristic curves were used to examine the diagnostic accuracy of the task. Results showed that monolingual participants were able to identify bilingual children with LI based on children’s response speed. Sensitivity and specificity were higher in Cantonese conditions compared to English conditions. The results added to the literature that children’s response speed can potentially be used, along with other measures, to identify bilingual children who are at risk for language impairment.

RATIONALE:Patients with COPD have an increased risk for community-acquired pneumonia, which is further increased by inhaled corticosteroids. OBJECTIVE:To assess effects of the corticosteroids, budesonide and fluticasone propionate, on macrophage bacterial responses in COPD. METHODS:Monocyte-derived macrophages (MDMs) generated from blood monocytes from 10 non-smoker controls (NoS), 20 smokers without COPD (Sm), and 40 subjects with moderate to severe COPD (21 ex-smokers (COPD-ES) and 19 current smokers (COPD-S)) were pre-treated with budesonide or fluticasone (10 nM-1 μM) and challenged with live non-typeable Haemophilus influenzae (NTHI) or Streptococcus pneumoniae (SP). Cell surface bacterial recognition receptor expression (flow cytometry) and cytokine release (bead array) were analyzed. RESULTS:NTHI and SP reduced bacterial recognition receptor expression on MDMs from COPD and Sm, but not NoS (except TLR4). SR-AI and MARCO were reduced by both NTHI and SP, whereas other receptors by either NTHI or SP. Among COPD subjects, COPD-ES demonstrated a greater number of reductions as compared to COPD-S. NTHI reduced SR-AI, MARCO, CD11b, CD35 and CD206 in COPD-ES while only SR-AI and CD11b in COPD-S. SP reduced SRA-1, CD1d, TLR2 and TLR4 in both COPD-ES and COPD-S, and reduced MARCO and CD93 only in COPD-ES. All receptors reduced in COPD by NTHI and most by SP, were also reduced in Sm. Budesonide counteracted the receptor reductions induced by both NTHI (CD206 p = 0.03, MARCO p = 0.08) and SP (SR-AI p = 0.02) in COPD-ES. Fluticasone counteracted only SP-induced reductions in TLR2 (p = 0.008 COPD-ES and p = 0.04 COPD-S) and TLR4 (p = 0.02 COPD-ES). Cytokine release was equivalently reduced by both corticosteroids. CONCLUSIONS:Reduction in macrophage bacterial recognition receptors during bacterial exposure could provide a mechanism for the increased pneumonia risk in COPD. Differential effects of budesonide and fluticasone propionate on macrophage bacterial recognition receptor expression may contribute to the higher pneumonia incidence reported with fluticasone propionate.

For the Research Topic Data Assimilation and Control: Theory and Applications in Life Sciences we first review the formulation of statistical data assimilation (SDA) and discuss algorithms for exploring variational approximations to the conditional expected values of biophysical aspects of functional neural circuits. Then we report on the application of SDA to (1) the exploration of properties of individual neurons in the HVC nucleus of the avian song system, and (2) characterizing individual neurons formulated as very large scale integration (VLSI) analog circuits with a goal of building functional, biophysically realistic, VLSI representations of functional nervous systems. Networks of neurons pose a substantially greater challenge, and we comment on formulating experiments to probe the properties, especially the functional connectivity, in song command circuits within HVC.

Autorka skupia się na pełnometrażowych filmach opartych na Quo vadis Henryka Sienkiewicz – powieści o starożytnym Rzymie, za którą – między innymi – pisarz otrzymał Nagrodę Nobla w dziedzinie literatury i która została przetłumaczona na ponad czterdzieści języków. Te filmy z gwiazdorską obsadą (Quo Vadis? reż. E. Guazzoni /1913/, Quo Vadis? reż. G. D’Annunzio, G. Jacoby /1925/, Quo Vadis, reż. M. LeRoy /1951/, Quo Vadis, reż. J. Kawalerowicz /2001/) zazwyczaj wykorzystywały typowe wzorce melodramatu historycznego: historia miłosna między rzymskim patrycjuszem a młodą chrześcijanką Ligią została osadzona w szerszym kontekście historycznym, w czasach wczesnego chrześcijaństwa i prześladowań Nerona wymierzonych w wyznawców Jezusa. Bez względu na datę i kraj produkcji każdy z tych filmów zawiera kulminacyjną scenę krwawych igrzysk ukazującą męczenników chrześcijańskich ginących na arenie. Miller-Klejsa zwraca uwagę na różnorodność filmowych przestawień tego krwawego spektaklu, a ponadto podkreśla wielowarstwowe konteksty wiążące się z ukazywaniem kluczowych postaci historycznych (zwłaszcza Nerona i św. Piotra).

OBJECTIVE: To assess the impact of routine antenatal HIV testing for preventing mother-to-child transmission of HIV (PMTCT) in urban Zimbabwe. METHODS: Community counsellors were trained in routine HIV testing policy using a specific training module from June 2005 through November 2005. Key outcomes during the first 6 months of routine testing were compared with the prior 6-month "opt-in" period, and clients were interviewed. FINDINGS: Of the 4551 women presenting for antenatal care during the first 6 months of routine HIV testing, 4547 (99.9%) were tested for HIV compared with 3058 (65%) of 4700 women during the last 6 months of the opt-in testing (P < 0.001), with a corresponding increase in the numbers of HIV-infected women identified antenatally (926 compared with 513, P < 0.001). During routine testing, more HIV-infected women collected results compared to the opt-in testing (908 compared with 487, P < 0.001) resulting in a significant increase in deliveries by HIV-infected women (256 compared with 186, P = 0.001); more mother/infant pairs received antiretroviral prophylaxis (n = 256) compared to the opt-in testing (n = 185); and more mother/infant pairs followed up at clinics (105 compared with 49, P = 0.002). Women were satisfied with counselling services and most (89%) stated that offering routine testing is helpful. HIV-infected women reported low levels of spousal abuse and other adverse social consequences. CONCLUSION: Routine antenatal HIV testing should be implemented at all sites in Zimbabwe to maximize the public health impact of PMTCT.

Acting on the glucocorticoid receptor (NR3C1), glucocorticoids are widely used to treat inflammatory diseases. However, glucocorticoid resistance often leads to suboptimal asthma control. Since glucocorticoid-induced gene expression contributes to glucocorticoid activity, the aim of this study was to use a 2 × glucocorticoid response element (GRE) reporter and glucocorticoid-induced gene expression to investigate approaches to combat cytokine-induced glucocorticoid resistance. Pre-treatment with tumor necrosis factor-α (TNF) or interleukin-1β inhibited dexamethasone-induced mRNA expression of the putative anti-inflammatory genes RGS2 and TSC22D3, or just TSC22D3, in primary human airway epithelial and smooth muscle cells, respectively. Dexamethasone-induced DUSP1 mRNA was unaffected. In human bronchial epithelial BEAS-2B cells, dexamethasone-induced TSC22D3 and CDKN1C expression (at 6 h) was reduced by TNF pre-treatment, whereas DUSP1 and RGS2 mRNAs were unaffected. TNF pre-treatment also reduced dexamethasone-dependent 2×GRE reporter activation. This was partially reversed by PS-1145 and c-jun N-terminal kinase (JNK) inhibitor VIII, inhibitors of IKK2 and JNK, respectively. However, neither inhibitor affected TNF-dependent loss of dexamethasone-induced CDKN1C or TSC22D3 mRNA. Similarly, inhibitors of the extracellular signal-regulated kinase, p38, phosphoinositide 3-kinase or protein kinase C pathways failed to attenuate TNF-dependent repression of the 2×GRE reporter. Fluticasone furoate, fluticasone propionate and budesonide were full agonists relative to dexamethasone, while GSK9027, RU24858, des-ciclesonide and GW870086X were partial agonists on the 2×GRE reporter. TNF reduced reporter activity in proportion with agonist efficacy. Full and partial agonists showed various degrees of agonism on RGS2 and TSC22D3 expression, but were equally effective at inducing CDKN1C and DUSP1, and did not affect the repression of CDKN1C or TSC22D3 expression by TNF. Finally, formoterol-enhanced 2×GRE reporter activity was also proportional to agonist efficacy and functionally reversed repression by TNF. As similar effects were apparent on glucocorticoid-induced gene expression, the most effective strategy to overcome glucocorticoid resistance in this model was addition of formoterol to high efficacy NR3C1 agonists.

Autorka analizuje Noc świętego Wawrzyńca (Notte di San Lorenzo, reż. P. i V. Taviani, 1982), umieszczając film w kontekście innych włoskich produkcji łączących problematykę wojennych doświadczeń Włochów oraz perspektywę dziecka. Autorka wskazuje na obecne w filmie wątki religijne i mitologiczne, a także podejmuje próbę interpretacji dziecięcej perspektywy przyjętej w filmie – zabieg ten wpływa bowiem nie tylko na oniryczno-baśniową tonację filmu, ale niesie zarazem istotne konsekwencje dla jego wymowy. Przefiltrowanie wydarzeń z czasów II wojny światowej przez pryzmat świadomości dziecka prowadzi w istocie do wizji odkonkretnionej. Czyżby Taviani sugerowali w ten sposób, że w Italii lat 80. II wojna światowa była dla Włochów historią równie odległą, co starożytne mity i tylko w takiej formule mogła być zrozumiana? A może wręcz przeciwnie – charakter legendy nadany wojennym wydarzeniom ma wskazywać na trwałość tego konfliktu w zbiorowej pamięci i jej istotność dla włoskiego dziedzictwa kulturowego?

Anna Miller analizuje film Marco Bellocchia Witaj, nocy, który podejmuje temat najbardziej wstrząsającej zbrodni politycznej w dziejach powojennej Republiki Włoskiej: dokonanego w 1978 r. przez Czerwone Brygady porwania oraz zabójstwa Aldo Moro, wielokrotnego premiera Italii i ówczesnego lidera Partii Chrześcijańsko-Demokratycznej. Dzieło Bellocchia, okrzykniętego w pierwszej połowie lat 60. za sprawą swego debiutu Pięści w kieszeni (I pugni nel tasca, 1965) prekursorem „kina kontestacji”, będąc medialną rekonstrukcją oraz fabularyzacją tragicznego epizodu z 1978 r., stanowi jednocześnie swoistą refleksję nad „klęską utopii” oraz próbę rozliczenia się reżysera z bliskimi mu niegdyś lewackimi poglądami. Światopoglądowy aspekt filmu – głos sprzeciwu wobec wszelkiego fanatyzmu politycznego – współistnieje tu z tonem osobistym, który podkreśla zamieszczona dedykacja „mojemu ojcu” otwierająca film. Ów swoisty „dwugłos” jest – zdaniem Miller – podkreślany przez poetykę filmu, nieustannie oscylującą między realizmem a oniryzmem.