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Routine health monitoring is an integral part of managing SPF rodent colonies. In recent years, rack-level environmental sampling has been introduced as an adjunct method or replacement for exposure of sentinel rodents to soiled bedding. However, rack-level environmental monitoring is not compatible with rodent housing systems that have cage-level filtration. The current study investigated whether exposure of sterile flocked swabs to soiled bedding can be an alternative sampling method for routine health monitoring in mice, thus replacing the use of sentinels in soiled-bedding cages. Flocked swabs were placed in cages containing pooled samples of soiled bedding but no mice; swabs remained there for 90 d, with weekly agitation and biweekly swabbing of the cage floor to mimic the agitation of soiled bedding by sentinel mice and facilitate the collection of dust particles. Fecal samples were collected from both colony and sentinel mice. For environmental samples, exhaust debris was collected from the rack plenum, and dust samples were collected from the exhaust hose. All samples were collected on days 88 through 91 and were tested for multiple pathogens by using real-time PCR assays. To determine the diagnostic agreement of flocked swab sampling with the other methods, we used κ statistics to compare the test results from flocked swabs with those from sentinel feces, exhaust debris, and colony animal feces; we found excellent agreement between the colony feces and the flocked swab methods. The sterile flocked swab method detected all enzootic pathogens in the colonies tested. Results from flocked swab samples had the least agreement with sentinel feces, which also failed to detect the presence of fur mites. This study supports the use of sterile flocked swabs as alternative to using sentinel mice, thus conforming to the guiding principles of replacement and reduction in the use of animals for routine colony health monitoring.

Executive function (EF) impacts behavior associated with health outcomes. EF can be measured using self-report and/or performance measures, but the correlations between these types of measures are mixed in the extant literature. This study examined self-report and performance-based measures of EF using data from 6 studies, including community and clinical populations (410 participants, ages 19–80, 71% female). Partial correlations revealed significant relationships between performance on the Trail-making, Delay Discounting, and Stop Signal tasks with self-reported EF (p

The U.S. correctional system has become the epicenter for public health and mental health crisis. This article discusses literature documenting incarcerated transgender individuals’ mental health t...

Background: Responsibility for health and social care was devolved to Scotland in 1999 with evidence of diverging policy and organisation of care compared to England. This paper provides a comparative overview of major health and social care policies in England and Scotland published between 2011 and 2023 relating to the care of older people. Methods: We searched United Kingdom (UK) and Scotland government websites for macro-level policy documents between 2011 and 2023 relating to the health and social care of older people (aged 65+). Data were extracted and emergent themes were summarised according to Donabedian's structure-process-outcome model. Results: We reviewed 27 policies in England and 28 in Scotland. Four main policy themes emerged that were common to both countries. Two related to the structure of care: integration of care and adult social care reform. Two related to service delivery/processes of care: prevention and supported self-management and improving mental health care. Cross-cutting themes included person-centred care, addressing health inequalities, promoting use of technology, and improving outcomes. Conclusion: Despite differences in the structure of care, including more competition, financial incentivization, and consumer-based care in England compared to Scotland, there are similarities in policy vision around delivery/processes of care (e.g. person-centred care) and performance and patient outcomes. Lack of UK-wide health and social care datasets hinders evaluation of policies and comparison of outcomes between both countries.

The incarceration of a family member often has repercussions in various facets of an individual’s life. In particular, the disruption of the coparenting relationship, by which parents negotiate rol...

International audience; Objective : Recommendations to obtain the best bonding to silica-based ceramics are to prepare its surface by hydrofluoric-acid HF etching and regular application of a silane. This study investigated how the HF-etching following by ultrasonic water bath cleaning (recommended protocol to improve the bonding with a composite resin), modifies the surface chemistry of a lithium disilicate glass-ceramic and impacts the chemical bonding with silane.Methods : Lithium disilicate glass-ceramic discs (IPS Emax Press, Ivoclar Vivadent) were mirror polished, etched with 9% HF for 20 s and rinsed 1 min under water. Two post-etching cleaning were compared: (1) no additional cleaning and (2) immersion in water ultrasonic bath for 4 min. Morphology evolution of the surfaces was carried out by scanning electron microscopy. Chemical changes were studied using X-ray Photoelectron Spectroscopy and Nano Auger Electron Spectroscopy analyses. Identification of the compounds formed with fluorine was based on by High Resolution Transmission Tlectronic Microscopy .Results : Residues left on the surface of the discs after etching, the fluorine salts, were eliminated after the ultrasonic bath cleaning. However, analyses showed presence of fluorine on the lithium disilicate needles associated among others with the lithium. HR-TEM validates the presence of Li2SiF6 crystallized phased. A mechanism to explain silane bonding when Li2SiF6 phase is formed on the Li2Si2O5 needles, is proposed.Significance : HF-etching leads to the formation of lithium and fluorine contain LiSi2F6 nano-precipitates on the Li2Si2O5 needles which helps to improve the bonding with silane.

Background Accuracy of intra-synovial injections can be challenging to assess in a clinical setting in horses. Contrast-enhanced ultrasonography (CEUS) using injectate agitated with air has been utilised to determine the success rates of synovial injections in human rheumatology. Objectives To assess the diagnostic sensitivity and specificity of CEUS and to describe its clinical use. Study designs Cadaveric study followed by a prospective descriptive observational study. Methods Part 1: Contrast-enhanced ultrasonography was performed following injection of agitated methylene-blue solution targeting thirteen different anatomical synovial structures from three equine cadavers. Contrast was seen as hyperechoic dots, patches or lines on ultrasonography. Contrast-enhanced ultrasonography was classified as positive if contrast was considered to be intra-synovial and negative if contrast was considered to be extra-synovial. A second synoviocentesis was performed to determine if the injection was intra-synovial based on the presence or absence of methylene-blue. Estimates of sensitivity and specificity were calculated. Part 2: Contrast-enhanced ultrasonography was performed following injection of agitated solutions targeting synovial structures as part of routine investigation and treatment of clinical cases. Results Part 1: Contrast-enhanced ultrasonography was correctly classified as positive or negative in all intra-synovial and extra-synovial injections respectively. The sensitivity estimate was 100% (CI 93-100%) and the specificity estimates was 100% (CI 16-100%). Part 2: The technique was used safely for 26 injections (14 horses; 19 different synovial structures) administered to localise or treat lameness. Traumatic inter-synovial communications or synovial membrane defects were identified using CEUS in three horses. Main limitations The low number of extra-synovial injections in Part 1 resulted in an imprecise specificity estimate. Conclusions In horses CEUS performed following intended intra-synovial injection can be useful for identifying unsuccessful injections.

The specific detection in clinical samples of analytes with dimensions in the tens to hundreds of nanometers, such as viruses and large proteins, would improve disease diagnosis. Detection of these "mesoscale" analytes (as opposed to their nanoscale components), however, is challenging as it requires the simultaneous binding of multiple recognition sites often spaced over tens of nanometers. In response, we have adapted DNA origami, with its unparalleled customizability to precisely display multiple target-binding sites over the relevant length scale, to an electrochemical biosensor platform. Our proof-of-concept employs triangular origami covalently attached to a gold electrode and functionalized with redox reporters. Electrochemical interrogation of this platform successfully monitors mesoscale, target-binding-induced changes in electron transfer in a manner consistent with coarse-grained molecular dynamics simulations. Our approach enables the specific detection of analytes displaying recognition sites that are separated by ∼40 nm, a spacing significantly greater than that achieved in similar sensor architectures employing either antibodies or aptamers.

Identification and characterization of foreign bodies in the distal limb of horses poses a diagnostic challenge. The aims of this prospective experimental cadaver study were to describe the appearance of five foreign body materials within the equine hoof using CT, MRI, and digital radiography (DR) and to compare interrater agreement among three reviewers. Fifty foreign bodies consisting of five materials were implanted at a solar location or a coronary location in 25 equine cadaver feet. The images were reviewed by three equine veterinarians experienced in advanced imaging interpretation, who were blinded to the material of the foreign body. Foreign bodies were graded on visibility and appearance. Sensitivity and specificity were calculated for accurate identification of the different materials. Interrater agreement was assessed using Fleiss' kappa. Computed tomography had higher visibility score, sensitivity/specificity, and interrater agreement for detection of all materials; particularly slate, glass, and dry wood, compared to the other imaging modalities. Soaked wood and plastic had lower sensitivity (31-33%) on CT with a similar attenuation of the two materials. Foreign bodies were often visible on MRI, although with similar appearance and unclear details. On DR, only slate and glass were visible. The interrater agreement for identifying the correct material was almost perfect for slate, glass, and dry wood (κ = 0.92-1.00) and poor for plastic and soaked wood (κ < 0.20) on CT. Interrater agreement was poor for all materials on MRI and DR (κ < 0.20), with the except for fair (κ = 0.28) for slate on DR and moderate (κ = 0.28) for soaked wood on MRI.

Objective: To describe a surgical technique for rostral mandibulectomy and reconstruction of the mandibular symphysis. Study design: Case report. Animal: One 5-month-old warmblood cross filly. Methods: A preoperative diagnosis of a juvenile ossifying fibroma was made on the basis of clinical appearance and was later confirmed via histology. The tumor was large, rapidly growing and extending to the caudal aspect of the mandibular symphysis. Computed tomography was performed for surgical planning. The tumor was excised by performing a mandibulectomy caudal to the symphysis. The mandibular symphysis was reconstructed with String of Pearls (SOP) plates. Cortex screws placed in lag fashion, a cortical bone graft from one of the mandibles and a cancellous graft harvested from the tuber coxae. Results: At 9 months of age there was no sign of tumor reoccurrence, the implants were removed because of infection and the mandible had formed a new stable symphysis. The horse was able to prehend food and masticate normally. The owner was pleased with the cosmetic and functional outcome. Conclusion: The described surgical technique is a viable option for mandibulectomy and reconstruction of the mandibular symphysis. The technique provided adequate stability for healing to occur in the face of infection. Clinical significance: Neoplasia and other conditions affecting the entire mandibular symphysis can be treated by complete surgical excision and reconstruction.

The ability to measure the levels of diagnostically relevant proteins, such as antibodies, directly at the point of care could significantly impact healthcare. Thus motivated, we explore here the E-DNA “scaffold” sensing platform, a rapid, convenient, single-step means to this end. These sensors comprise a rigid nucleic acid “scaffold” attached via a flexible linker to an electrode and modified on its distal end with a redox reporter and a protein binding “recognition element”. The binding of a targeted protein reduces the efficiency with which the redox reporter approaches the electrode, resulting in an easily measured signal change when the sensor is interrogated voltammetrically. Previously we have demonstrated scaffold sensors employing a range of low molecular weight haptens and linear peptides as their recognition elements. Expanding on this here we have characterized sensors employing much larger recognition elements (up to and including full length proteins) in order to (1) define the range of recognition elements suitable for use in the platform; (2) better characterize the platform’s signaling mechanism to aid its design and optimization; and (3) demonstrate the analytical performance of sensors employing full-length proteins as recognition elements. In doing so we have enlarged the range of molecular targets amenable to this rapid and convenient sensing platform.

PurposeThe purpose of this study is to identify best practices for innovative primary care models and to describe a potential future primary care (PC) model for Texas to address the burden of chronic disease in a population-based approach.Design/methodology/approachA systematic literature review was conducted and identified 1,880 published records through PubMed using 26 search terms. After abstract and full-text review, 70 articles remained as potential models.FindingsAlthough there is already a severe shortage of physicians in Texas, emerging practice patterns and choices among physicians are likely to erode access to primary care services in the state. Health-care leaders are encouraged to consider models such as complex adaptive systems for team-based care, pharmacist hypertension care management program and combined nurse-led care management with group visit structure.Research limitations/implicationsAs with any study, this research has its limitations; for example, models that might work in one state, or under a unique state-funded academic medical center, might not be “do-able” in another state within the nuances of a different funding mechanism.Practical implicationsResults of this research provide a model for implementing IPCM for the state of Texas first and will guide IPCM planning and implementation in other states.Originality/valueThis study is “land grant-centric” and focused on carrying out the mission of a major, top-tier research university with an emerging college of medicine at an academic medical center.

Policy makers at the Federal Reserve must make decisions on less than perfect information. To the extent their forecasts are incorrect, policy decisions will also be incorrect. Unfortunately, economic forecasters have a relatively poor record and have not improved as much as one would hope. The research presented in this paper examines one potential source of forecast improvement, economic policy uncertainty. Modeling emotional responses of economic agents to uncertainty is difficult but the inclusion of a policy uncertainty variable could reduce forecast errors of the FOMC’s consensus forecast by as much as 20%.

The multiplexed, point-of-care measurement of specific antibodies could improve the speed with which diseases are diagnosed and their treatment initiated. To this end, we are developing E-DNA scaffold sensors, which consist of a rigid, nucleic acid “scaffold” attached on one end to an electrode and presenting both a redox reporter and an epitope on the other. In the absence of antibody, the reporter efficiently transfers electrons when interrogated electrochemically. Binding-induced steric hindrance limits movement, reducing electron transfer in a manner that is both easily measured and quantitatively related to target concentration. Previously we have used monoclonal antibodies to explore the analytical performance of E-DNA sensors, showing that they support the rapid, single-step, quantitative detection of multiple antibodies in small volume samples. Here, in contrast, we employ authentic human samples to better explore the platform’s clinical potential. Specifically, we developed E-DNA sensors targeting three HIV-specific antibodies and then compared the analytical and clinical performance of these against those of gold standard serological techniques. Doing so we find that, although the multistep amplification of an ELISA leads to a lower detection limits, the clinical sensitivity of ELISAs, E-DNA sensors and lateral-flow dipsticks are indistinguishable across our test set. It thus appears that, by merging the quantitation and multiplexing of ELISAs with the convenience and speed of dipsticks, E-DNA scaffold sensors could significantly improve on current serological practice.

INTRODUCTION: Internet-delivered behavioral weight control is promising for expanding the reach and availability of weight management, but online programs produce lower weight losses than typically achieved in person. Financial incentives have been shown to increase weight losses. The current study examined whether adding financial incentives for self-monitoring and achieving target weight losses increases weight losses attained in a fully online, group-based behavioral weight management program compared with the same program alone. STUDY DESIGN: RCT. SETTING/PARTICIPANTS: Adults with overweight and obesity (N=418; 91% female; 28% minority) were recruited from two clinical centers. INTERVENTION: The intervention was a 24-session online group-based behavioral weight control program with weekly synchronous chat sessions (Internet-only) or the same program with weekly financial incentives for self-monitoring body weight and dietary intake daily and for achieving target weight losses at 2 and 6 months (Internet + incentives). MAIN OUTCOME MEASURES: This study measured weight loss at 6 months and treatment engagement (attendance, self-monitoring of body weight, dietary intake, physical activity). Data were collected between February 2016 and August 2018, and analyses were completed in 2019. RESULTS: Participants randomized to Internet + incentives lost more weight (–6.4 [SD=5.5] kg) than those in the Internet-only group (–4.7 [SD=6.6] kg; p

The faster a disease can be diagnosed, the sooner effective treatment can be initiated, motivating a drive to replace standard laboratory techniques with point-of-care technologies that return answers in minutes rather than hours. Thus motivated, we describe the development of an E-DNA scaffold sensor for the rapid and convenient measurement of antibodies diagnostic of syphilis. To achieve this (and in contrast to previous sensors of this class, which relied on single, linear epitopes for detection), we utilized a near full-length antigen as the sensor's recognition element, allowing us to simultaneously display multiple epitopes. The resultant sensor is able to detect antibodies against Treponema pallidum pallidum, the causative agent of syphilis, at clinically relevant concentrations in samples in less than 10 min. Preliminary results obtained using sero-positive and sero-negative human samples suggest the clinical sensitivity and specificity of the approach compare well to current gold-standard tests, while being simple and rapid enough to deploy at the point of care.

Comprehension of plausible and implausible object- and subject-relative clause sentences with and without prepositional phrases was examined. Undergraduates read each sentence then evaluated a statement as consistent or inconsistent with the sentence. Higher acceptance of consistent than inconsistent statements indicated reliance on syntactic analysis. Higher acceptance of plausible than implausible statements reflected reliance on semantic plausibility. There was greater reliance on semantic plausibility and lesser reliance on syntactic analysis for more complex object-relatives and sentences with prepositional phrases than for less complex subject-relatives and sentences without prepositional phrases. Comprehension accuracy and confidence were lower when syntactic analysis and semantic plausibility yielded conflicting interpretations. The conflict effect on comprehension was significant for complex sentences but not for less complex sentences. Working memory capacity predicted resolution of the syntax-plausibility conflict in more and less complex items only when sentences and statements were presented sequentially. Fluid intelligence predicted resolution of the conflict in more and less complex items under sequential and simultaneous presentation. Domain-general processes appear to be involved in resolving syntax-plausibility conflicts in sentence comprehension.

The Buchan Rift, in northeastern Victoria, is a north–south-trending basin, which formed in response to east–west crustal extension in the Early Devonian. The rift is filled mostly with Lower Devonian volcanic and volcaniclastic rock of the Snowy River Volcanics. Although the structure and geometry of the Buchan Rift and its major bounding faults are well mapped at the surface, a discrepancy exists between the surface distribution of the thickest rift fill and its expected potential field response. To investigate this variation, two new detailed land-based gravity surveys, which span the rift and surrounding basement rocks in an east–west orientation, have been acquired and integrated with pre-existing government data. Qualitative interpretation of the observed magnetic data suggests the highly magnetic rocks of the Snowy River Volcanics have a wider extent at depth than can be mapped at the surface. Forward modelling of both land-based gravity data and aeromagnetic data supports this interpretati...

The use of cannabis for medical purposes, evident throughout history, has become a topic of increasing interest. Yet on the present medical evidence, cannabis-based treatments will only be appropriate for a small number of people in specific circumstances. Experience with cannabis as a recreational drug, and with use of psychoactive drugs that are prescribed and abused, should inform harm reduction in the context of medical cannabis.

Volcanic eruptions emit rock particulates and gases at high speed and pressure, which change the shape of the surrounding rock. Simplified analytical solutions, field studies, and numerical models suggest that this process plays an important role in the behavior and hazards associated with explosive volcanic eruptions. Here we present results from a newly developed laboratory-scale apparatus designed to study this coupled process. The experiments used compressed air jets expanding into the laboratory through fabricated rock analogue material, which evolves through time during the experiment. The compressed air was injected at approximately 2.5 times atmospheric pressure. We fabricated rock analogues from sand and steel powder samples with a three-dimensional printing process. We studied the fluid development using phase-locked particle image velocimetry, while simultaneously observing the solid development via a video camera. We found that the fluid response was much more rapid than that of the solid, permitting a quasi-steady approximation. In most cases, the solid vent flared out rapidly, increasing its diameter by 20 to 100%. After the initial expansion, the vent and flow field achieved a near-steady condition for a long duration. The new expanded vent shapes permitted lower vent exit pressures and larger jet radii. In one experiment, after an initial vent shape development and establishment of steady flow behavior, rock failure occurred a second time, resulting in a new exit diameter and new steady state. This second failure was not precipitated by changes in the nozzle flow condition, and it radically changed the downstream flow dynamics. This experiment suggests that the brittle nature of volcanic host rock enables sudden vent expansion in the middle of an eruption without requiring a change in the conduit flow.

[1] A fundamental goal of volcano acoustics is to relate observed infrasonic signals to the eruptive processes generating them. A link between acoustic power Π¯ and volcanic gas exit velocity V was proposed by Woulff and McGetchin (1976) based upon the prevailing jet noise theory at the time (acoustic analogy theory). We reexamine this approach in the context of the current understanding of jet noise, using data from a laboratory jet, a full-scale military jet aircraft, and a full-scale rocket motor. Accurate estimates of Π¯ require good spatial sampling of jet noise directionality; this is not usually possible in volcano acoustic field experiments. Typical volcano acoustic data better represent point measurements of acoustic intensity I¯(θ) at a particular angle θ from the jet axis rather than Π¯. For pure air jet flows, velocity-scaling laws currently proposed for acoustic intensity differ from those for acoustic power and are of the form I¯(θ)∼(V/c)nθ, where c is the ambient sound speed and nθ varies nonlinearly from ∼5 to 10 as a function of temperature ratio and angle θ. Volcanic jet flows are more complex than the pure air laboratory case, which suggests that we do not currently know how the exponent nθ varies for a volcanic jet flow. This indicates that the formulation of Woulff and McGetchin (1976) can lead to large errors when inferring eruption parameters from acoustic data and thus requires modification. Quantitative integration of field, numerical, and laboratory studies within a modern aeroacoustics framework will lead to a more accurate relationship between volcanic infrasound and eruption parameters.

Thermal non-catalytic cracking of jojoba oil, a non-triacylglyceride-based wax produced by the desert plant, Simmondsia chinensis, was compared to that of triacylglyceride-based soybean oil. Optimum liquid product yield was produced at a higher temperature for jojoba oil compared to soybean oil but at similar reaction pressure and residence time. At optimum conditions, jojoba oil generated a similar gas phase fraction as soybean oil while the liquid product contained a smaller quantity of undesirable polyaromatic and non-GC-elutable (low volatility high-MW) products, with nearly 90% of the cracking liquid product being GC quantifiable. This product included a mixture of linear saturated short-chain fatty acids whose size distribution peaked at C10. It also included alkanes (predominantly linear) that peaked at C7–C8, and smaller concentrations of alkenes, aromatics, and polyaromatic hydrocarbons. Thus, jojoba oil is an excellent renewable feedstock for the production of replacements for petroleum-derived transportation fuels and chemicals.

China, Japan, and Korea have spent decades developing and amending laws, regulations, and guidelines to address the humane care and use of laboratory animals. This process began in 1983 in China, 1973 in Japan, and 1991 in Korea and has continued to the present. The governmental oversight of research varies between these countries, ranging from regulations by multiple levels of government in China to self-regulation under multiple government guidelines in Japan. Common to all is incorporation of the internationally recognized principles of the 3Rs: replacement, reduction and refinement. This paper reviews how the framework of laws, regulations, and guidelines evolved in each of these countries, their current status, and the expectation that they will continue to evolve.

Background A changing health care environment has created a need for physicians trained in health system improvement. Residency programs have struggled to teach and assess practice-based learning and improvement and systems-based practice competencies, particularly within ambulatory settings. Intervention We describe a resident-created and resident-led quality and practice-improvement council in an internal medicine continuity clinic. We conducted focus groups and report on residents' perspectives on council membership, practice management experiences, quality improvement projects, and resident satisfaction. Method Focus groups were held from May 2009 to March 2010 with internal medicine residents (N = 5/focus group) who participated in the Continuity Clinic Ownership in Resident Education (CCORE) council. Data were analyzed with a grounded theory approach. Results During the focus groups, residents responded to the question: “Do you have any new insights into delivering quality patient care in an outpatient clinic as a result of this experience (CCORE membership)?” The qualitative analysis resulted in 6 themes: systems thinking and systems-based care skills; improving quality of patient care; improved clinic efficiency; ownership of patients; need for improved communication of practice changes; and a springboard for research. Conclusions CCORE residents participated in system changes and acquired leadership skills while working on practice-based and system problems in a clinic microsystem. We believe this model can be implemented by other residency programs to promote the development of systems thinking in residents, increase their ownership of continuity clinic, and empower them to implement system changes.

Medical education about care of the dying is not always conducted systematically at the patient’s bedside. Unfortunately, neither life experience nor lecture style pedagogy is an adequate substitute for teaching medical students and residents about caring for the terminally ill. Obstacles to involving trainees in the bedside care of the dying include a general cultural avoidance of death, discomfort among faculty mentors when dealing with death, and uneven application of established rubrics for conveying the art of bedside care of the dying. Valuable lessons about dying and death can be taught if medical educators will model for trainees the delivery of sensitive, compassionate care of the dying and involve them in active learning by convening the “classroom of the bedside.”

Explosive volcanic jets can transition to buoyant plumes or collapse to form pyroclastic density currents depending on their ability to entrain and heat the ambient air. Recent one-dimensional (1D) analysis shows that fluid acceleration through volcanic vents and craters changes the velocity and pressures within these jets sufficiently enough to be a first order control on plume dimensions and therefore air entrainment and column stability (Koyaguchi et al., 2010). These 1D studies are only applicable to craters and vents with angles of less than about 30° to vertical. Using analytical formulations and numerical simulations, this study describes 2D effects of shallowly dipping vents and craters on volcanic eruptions. The effect of vents on acceleration and expansion of eruptive mixtures of ash and gas is described as a force imparted on the fluid by the vent wall, the wall force (Fw). This force is a measure of the momentum coupling between an eruption and the solid earth that takes place in the vent. Rapid divergence of supersonic eruptive fluid within shallowly dipping vents occurs via Prandtl–Meyer expansion, which results in different pressure and velocity fields than those predicted by 1D analysis. This expansion decreases Fw and the vertical acceleration experienced by the eruptive fluid in the vent. For jets predicted by 1D analysis to exit the vent at supersonic velocities and at atmospheric pressure, this decrease in Fw will cause an increase in the predicted plume area, decreasing column stability. The complex 2D shape of volcanic vents can change jet structure (presence and location of shock waves) and preclude the development of jets that exit the vent supersonically with no internal standing shock waves (i.e., perfectly expanded or pressure balanced jets). These significant complications in jet structure and increase in plume radius may result in changes to air entrainment, plume stability, and tephra distribution.

Background: Since 2001, residencies have struggled with teaching and assessing systems-based practice (SBP). One major obstacle may be that the competency alone is not sufficient to support assessment. We believe the foundational construct underlying SBP is systems thinking, absent from the current Accreditation Council for Graduate Medical Education competency language. Summary: Systems thinking is defined as the ability to analyze systems as a whole. The purpose of this article is to describe psychometric issues that constrain assessment of SBP and elucidate the role of systems thinking in teaching and assessing SBP. Conclusion: Residency programs should incorporate systems thinking models into their curricula. Trainees should be taught to understand systems at an abstract level, in order to analyze their own healthcare systems, and participate in quality and patient safety activities. We suggest that a developmental trajectory for systems thinking be developed, similar to the model described by Dreyfus...

The last several decades have seen a large increase in knowledge of the underlying biological mechanisms that serve learning and memory. The insights gleaned from neurobiological and cognitive neuroscientific experimentation in humans and in animal models have identified many of the processes at the molecular, cellular, and systems levels that occur during learning and the formation, storage, and recall of memories. Moreover, with the advent of noninvasive technologies to monitor patterns of neural activity during various forms of human cognition, the efficacy of different strategies for effective teaching can be compared. Considerable insight has also been developed as to how to most effectively engage these processes to facilitate learning, retention, recall, and effective use and application of the learned information. However, this knowledge has not systematically found its way into the medical education process. Thus, there are considerable opportunities for the integration of current knowledge about the biology of learning with educational strategies and curricular design. By teaching medical students in ways that use this knowledge, there is an opportunity to make medical education easier and more effective. The authors present 10 key aspects of learning that they believe can be incorporated into effective teaching paradigms in multiple ways. They also present recommendations for applying the current knowledge of the neurobiology of learning throughout the medical education continuum.

It is well recognized that animals play a vital role and are indispensable to scientific and medical research. Over the years, a number of non-animal procedures have been developed. However, despite all the advances in science, as yet, no system has been evolved which can completely replace a living system to conduct basic research. There is still a need to test food, drugs, medical devices, treatment regimes etc. on some animals before they can be tested and used (if found suitable) in human beings. Even the most sophisticated technology models have failed to mimic completely the complex cellular interactions occurring in a living system. The search for a complete alternative to animal research is still on and in the mean time we can all help play our part by conducting animal research in a humane and responsible fashion. This chapter discusses the ethical issues in animal research highlighting the need to use animals conscientiously.

European inner city areas are increasingly regaining their residential attractiveness after years of decline. Although the demographic dimensions of such residential shifts are gradually being acknowledged by urban scholars, they still remain under-researched, especially with regard to the role of household-driven processes in the stabilisation of inner-city neighbourhoods and the reshaping of residential perceptions, wants and needs. Given this background, our paper looks at the underlying dynamics of reurbanisation processes in different European cities. Reurbanisation is understood as a process of populating and diversifying the inner city with a variety of residential groups of different ages and socio-economic backgrounds. We discuss why and how reurbanisation is changing inner-city districts, while arguing that the demographic or household-related view can lead to an improved understanding of current urban change. We demonstrate that ??? in contrast to a prevailing tendency to understand reurbanisation as an expression of a ???back-to-the-city??? movement ??? it relates more to city-mindedness as a housing preference rather than to the actual return of suburbanites to the city. A typology of reurbanisation processes (distinguishing between different driving forces, and respective impacts on inner-city area and housing markets) is provided, and the role of both social and demographic factors discussed. In particular, the paper examines overlaps and differences between reurbanisation and the concept of gentrification, arguing that, although they are partly driven by similar dynamics, the two processes are, in a qualitative sense, distinctive. Copyright ?? 2009 John Wiley \& Sons, Ltd.

Purpose In 2007, the Scott & White/Texas A&M HSC College of Medicine began requiring all internal medicine residents to attend quarterly patient panel conferences, during which former Scott & White patients speak frankly about their inpatient and outpatient experiences. The main purpose of this mixed-methods pilot study was to determine whether residents’ competency education could be enhanced via the conferences. Method Of the 54 internal medicine residents in the residency program, 31, 39, and 41 participated in three patient panel conferences, respectively, between December 2007 and August 2008. Each resident completed an assessment that included a reflection on his or her own practice and the identification of competency issues highlighted by patients’ oral narratives. Content analyses of responses to open-ended questions were performed. Consensus on themes was reached. Descriptive statistics were run on quantitative data. Results Six themes were identified: improve communication with patients/families, improve patient care, improve professional behaviors, empathize with patients/families, display sensitivity to patients’/families’ needs/concerns, and recognize system issues. When asked if the conference highlighted competency problems, residents answered “agree” or “strongly agree” as follows: 82% for professionalism, 82.9% for systems-based practice, 85.2% for interpersonal and communication skills, and 84.4% for patient care. The majority were able to provide examples of competency issues. Conclusions The patient panel conference experience was a powerful mechanism for enhancing competency education. The conferences were an effective means of presenting real-life examples of systems issues in the context of a hospital system.