Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography

The Chicago Classification of esophageal motility was developed to facilitate the interpretation of clinical high resolution esophageal pressure topography (EPT) studies, concurrent with the widespread adoption of this technology into clinical practice. The Chicago Classification has been an evolutionary process, molded first by published evidence pertinent to the clinical interpretation of high resolution manometry (HRM) studies and secondarily by group experience when suitable evidence is lacking.

The Role of the Family in Shaping Self-Concept and Cognitive Styles in Hungary

The project studied the perception of parenting styles and their relation to self-development, cognitive styles, and individualisation in adolescence. Typical parenting styles of mothers and fathers were studied in five different maternal and paternal parenting backgrounds: warm authoritarian, warm democratic, cold neglectful, cold authoritarian, and neutral. Perception of different styles of parenting (for fathers: authority, 'maintaining distance' behaviour, reciprocity, enhancing self-reliance; for mothers: authority, unpredictable behaviour, mutual trust, achievement orientation, and enhancing self-reliance) were analysed in each group using the newly developed Hungarian Parenting Questionnaire (Sallay & Munnich, 1999). This questionnaire has a theoretical basis in the ideas of Harvey (1966, 1967), where the socialisation process is combined with self-development. This categorisation of paternal and maternal parenting backgrounds enabled Sallay to explore and describe in detail how diverse parenting styles contribute to self-development, the development of cognitive complexity, and individualisation. The results show that diverse parenting by mothers and fathers produces differing impacts in nuclear and divorced families and for males and females, taking into consideration such self-components as physical, active, psychological (capabilities, personality, emotions, roles, preferences), social and reflective selves. Cognitive self-complexity varied according to parenting styles and genders: maternal and paternal parenting proved to have the most significant impact on self-complexity in a warm, democratic family. With respect to individualistic tendencies, adolescent boys were most individualistic in a cold, neglectful paternal background in nuclear families as compared to other paternal and maternal family backgrounds and to females.

Learning styles vary among general surgery residents: analysis of 12 years of data

PURPOSE: Understanding the learning styles of individuals may assist in the tailoring of an educational program to optimize learning. General surgery faculty and residents have been characterized previously as having a tendency toward particular learning styles. We seek to understand better the learning styles of general surgery residents and differences that may exist within the population. METHODS: The Kolb Learning Style Inventory was administered yearly to general surgery residents at the University of Cincinnati from 1994 to 2006. This tool allows characterization of learning styles into 4 groups: converging, accommodating, assimilating, and diverging. The converging learning style involves education by actively solving problems. The accommodating learning style uses emotion and interpersonal relationships. The assimilating learning style learns by abstract logic. The diverging learning style learns best by observation. Chi-square analysis and analysis of variance were performed to determine significance. RESULTS: Surveys from 1994 to 2006 (91 residents, 325 responses) were analyzed. The prevalent learning style was converging (185, 57%), followed by assimilating (58, 18%), accommodating (44, 14%), and diverging (38, 12%). At the PGY 1 and 2 levels, male and female residents differed in learning style, with the accommodating learning style being relatively more frequent in women and assimilating learning style more frequent in men (Table 1, p < or = 0.001, chi-square test). Interestingly, learning style did not seem to change with advancing PGY level within the program, which suggests that individual learning styles may be constant throughout residency training. If a resident's learning style changed, it tended to be to converging. In addition, no relation exists between learning style and participation in dedicated basic science training or performance on the ABSIT/SBSE. CONCLUSIONS: Our data suggests that learning style differs between male and female general surgery residents but not with PGY level or ABSIT/SBSE performance. A greater understanding of individual learning styles may allow more refinement and tailoring of surgical programs.

High-resolution morphological and biochemical imaging of articular cartilage of the ankle joint at 3.0 T using a new dedicated phased array coil: in vivo reproducibility study

OBJECTIVE: The objective of this study was to evaluate the feasibility and reproducibility of high-resolution magnetic resonance imaging (MRI) and quantitative T2 mapping of the talocrural cartilage within a clinically applicable scan time using a new dedicated ankle coil and high-field MRI. MATERIALS AND METHODS: Ten healthy volunteers (mean age 32.4 years) underwent MRI of the ankle. As morphological sequences, proton density fat-suppressed turbo spin echo (PD-FS-TSE), as a reference, was compared with 3D true fast imaging with steady-state precession (TrueFISP). Furthermore, biochemical quantitative T2 imaging was prepared using a multi-echo spin-echo T2 approach. Data analysis was performed three times each by three different observers on sagittal slices, planned on the isotropic 3D-TrueFISP; as a morphological parameter, cartilage thickness was assessed and for T2 relaxation times, region-of-interest (ROI) evaluation was done. Reproducibility was determined as a coefficient of variation (CV) for each volunteer; averaged as root mean square (RMSA) given as a percentage; statistical evaluation was done using analysis of variance. RESULTS: Cartilage thickness of the talocrural joint showed significantly higher values for the 3D-TrueFISP (ranging from 1.07 to 1.14 mm) compared with the PD-FS-TSE (ranging from 0.74 to 0.99 mm); however, both morphological sequences showed comparable good results with RMSA of 7.1 to 8.5%. Regarding quantitative T2 mapping, measurements showed T2 relaxation times of about 54 ms with an excellent reproducibility (RMSA) ranging from 3.2 to 4.7%. CONCLUSION: In our study the assessment of cartilage thickness and T2 relaxation times could be performed with high reproducibility in a clinically realizable scan time, demonstrating new possibilities for further investigations into patient groups.

Problem Solving Policing: Views of Citizens and Citizens Expectations in Germany

For the last two decades American police experts developed new police philosophies in order to tackle more successful the increasing crime problems. Community Policing tries to improve the cooperation between the population and the police and to increase the trust in the police. A crucial factor is a meaningful cooperation between the police and the citizens. Problem Oriented Policing aims at structural changes in the organisation and the procedures of the police in public. The police have to investigate the hidden problems and conflicts of an individual offence and to create proactive and long term concepts for the social area of conflicts beyond the specific case. It is doubtful whether these philosophies can be implemented in Germany since the legality principle prohibits meaningful, trustworthy relationships between citizens and police officers. However, if one examines the results of surveys on citizens views and expectations towards the police one finds that the majority of the German citizens favour the postulates of community and problem oriented policing. They expect through these measures an improvement of their life situation in the community and the feelings of safety. If one takes these results seriously one has to question if the legality principle is still appropriate. It seems to hamper new, more promising policing styles which seem to improve life of it's citizens and reflect what the citizens want and expect from their police force.

Quantification of coronary artery stenosis with high-resolution CT in comparison with histopathology in an ex vivo study

PURPOSE To investigate the ex vivo performance of high-resolution computed tomography (CT) for quantitative assessment of percentage diameter stenosis in coronary arteries compared to histopathology. MATERIALS AND METHODS High-resolution CT was performed in 26 human heart specimens after the injection of iodinated contrast media into the coronary arteries. Coronary artery plaques were visually identified on CT images and the grade of stenosis for each plaque was measured with electronic calipers. All coronary plaques were characterized by histopathology according to the Stary classification, and the percentage of stenosis was measured. RESULTS CT depicted 84% (274/326) of all coronary plaques identified by histology. Missed plaques by CT were of Stary type I (n=31), type II (n=16), and type III (n=5). The stenosis degree significantly correlated between CT and histology (r=0.81, p<0.001). CT systematically overestimated the stenosis of calcified plaques (mean difference - 11.0 ± 9.5%, p<0.01) and systematically underestimated the stenosis of non-calcified plaques (mean difference -6.8 ± 10.4%, p<0.05), while there was no significant difference for mixed-type plaques (mean difference -0.4 ± 11.7%, p=0.85). There was a significant underestimation of stenosis degree as measured by CT for Stary II plaques (mean difference -14 ± 9%, p<0.01) and a significant overestimation for Stary VII plaques (mean difference 9 ± 10%, p<0.05), but there was no significant difference in stenosis degree between both modalities for other plaque types. CONCLUSIONS High-resolution CT reliably depicts advanced stage coronary plaques with an overall good correlation of stenosis degree compared to histology, however, the degree of stenosis is systematically overestimated in calcified and underestimated in non-calcified plaques.

Southern Hemisphere high-resolution palaeoclimate records of the last 2000 years

This study presents a comprehensive assessment of high-resolution Southern Hemisphere (SH) paleoarchives covering the last 2000 years. We identified 174 monthly to annually resolved climate proxy (tree ring, coral, ice core, documentary, speleothem and sedimentary) records from the Hemisphere. We assess the interannual and decadal sensitivity of each proxy record to large-scale circulation indices from the Pacific, Indian and Southern Ocean regions over the twentieth century. We then analyse the potential of this newly expanded palaeoclimate network to collectively represent predictands (sea surface temperature, sea level pressure, surface air temperature and precipitation) commonly used in climate reconstructions. The key dynamical centres-of-action of the equatorial Indo-Pacific are well captured by the palaeoclimate network, indicating that there is considerable reconstruction potential in this region, particularly in the post AD 1600 period when a number of long coral records are available. Current spatiotemporal gaps in data coverage and regions where significant potential for future proxy collection exists are discussed. We then highlight the need for new and extended records from key dynamical regions of the Southern Hemisphere. Although large-scale climate field reconstructions for the SH are in their infancy, we report that excellent progress in the development of regional proxies now makes plausible estimates of continental- to hemispheric-scale climate variations possible.

A qualitative analysis of leadership styles and the selection of quality improvement in primary care practice

In the Practice Change Model, physicians act as key stakeholders, people who have both an investment in the practice and the capacity to influence how the practice performs. This leadership role is critical to the development and change of the practice. Leadership roles and effectiveness are an important factor in quality improvement in primary care practices.^ The study conducted involved a comparative case study analysis to identify leadership roles and the relationship between leadership roles and the number and type of quality improvement strategies adopted during a Practice Change Model-based intervention study. The research utilized secondary data from four primary care practices with various leadership styles. The practices are located in the San Antonio region and serve a large Hispanic population. The data was collected by two ABC Project Facilitators from each practice during a 12-month period including Key Informant Interviews (all staff members), MAP (Multi-method Assessment Process), and Practice Facilitation field notes. This data was used to evaluate leadership styles, management within the practice, and intervention tools that were implemented. The chief steps will be (1) to analyze if the leader-member relations contribute to the type of quality improvement strategy or strategies selected (2) to investigate if leader-position power contributes to the number of strategies selected and the type of strategy selected (3) and to explore whether the task structure varies across the four primary care practices.^ The research found that involving more members of the clinic staff in decision-making, building bridges between organizational staff and clinical staff, and task structure are all associated with the direct influence on the number and type of quality improvement strategies implemented in primary care practice.^ Although this research only investigated leadership styles of four different practices, it will offer future guidance on how to establish the priorities and implementation of quality improvement strategies that will have the greatest impact on patient care improvement. ^

Delayed Thrombus Resolution and Fibroproliferative Vascular Wound Healing From Deficiency of Type III Collagen: a Paradoxical Mechanism for Tissue Fragility

Vascular Ehlers-Danlos syndrome is a heritable disease of connective tissue caused by mutations in COL3A1, conferring a tissue deficiency of type III collagen. Cutaneous wounds heal poorly in these patients, and they are susceptible to spontaneous and catastrophic rupture of expansible hollow organs like the gut, uterus, and medium-sized to large arteries, which leads to premature death. Although the predisposition for organ rupture is often attributed to inherent tissue fragility, investigation of arteries from a haploinsufficient Col3a1 mouse model (Col3a1+/-) demonstrates that mutant arteries withstand even supraphysiologic pressures comparably to wild-type vessels. We hypothesize that injury that elicits occlusive thrombi instead unmasks defective thrombus resolution resulting from impaired production of type III collagen, which causes deranged remodeling of matrix, persistent inflammation, and dysregulated behavior by resident myofibroblasts, culminating in the development of penetrating neovascular channels that disrupt the mechanical integrity of the arterial wall. Vascular injury and thrombus formation following ligation of the carotid artery reveals an abnormal persistence and elevated burden of occlusive thrombi at 21 post-operative days in vessels from Col3a1+/- mice, as opposed to near complete resolution and formation of a patent and mature neointima in wild-type mice. At only 14 days, both groups harbor comparable burdens of resolving thrombi, but wild-type mice increase production of type III collagen in actively resolving tissues, while mutant mice do not. Rather, thrombi in mutant mice contain higher burdens of macrophages and proliferative myofibroblasts, which persist through 21 days while wild-type thrombi, inflammatory cells, and proliferation all regress. At the same time that increased macrophage burdens were observed at 14 and 21 days post ligation, the medial layer of mutant arterial walls concurrently harbored a significantly higher incidence of penetrating neovessels compared with those in wild-type mice. To assess whether limited type III collagen production alters myofibroblast behavior, fibroblasts from vEDS patients with COL3A1 missense mutations were seeded into three-dimensional fibrin gel constructs and stimulated with transforming growth factor-β1 to initiate myofibroblast differentiation. Although early signaling events occur similarly in all cell lines, late extracellular matrix- and mechanically-regulated events like transcriptional upregulation of type I and type III collagen secretion are delayed in mutant cultures, while transcription of genes encoding intracellular contractile machinery is increased. Sophisticated imaging of collagen synthesized de novo by resident myofibroblasts visualizes complex matrix reorganization by control cells but only meager remodeling by COL3A1 mutant cells, concordant with their compensatory contraction to maintain tension in the matrix. Finally, administration of immunosuppressive rapamycin to mice following carotid ligation sufficiently halts the initial inflammatory phase of thrombus resolution and fully prevents both myofibroblast migration into the thrombus and the differential development of neovessels between mutant and wild-type mice, suggesting that pathological defects in mutant arteries develop secondarily to myofibroblast dysfunction and chronic inflammatory stimulation, rather than as a manifestation of tissue fragility. Together these data establish evidence that pathological defects in the vessel wall architecture develop in mutant arteries as sequelae to abnormal healing and remodeling responses activated by arterial injury. Thus, these data support the hypothesis that events threatening the integrity of type III collagen-deficient vessels develop not as a result of inherent tissue weakness and fragility at baseline but instead as an episodic byproduct of abnormally persistent granulation tissue and fibroproliferative intravascular remodeling.

Middle Miocene to recent sedimentological record of ODP sites 177-1088 and 177-1092

During Leg 177 of the Ocean Drilling Program (ODP), well-preserved Middle Miocene to Pleistocene carbonate-rich sediment records were recovered on a north-south transect through the south-eastern Atlantic sector of the Southern Ocean at Site 1088 on the Agulhas Ridge and Site 1092 on Meteor Rise. Both sites were dominated by the deposition of calcareous nannofossil oozes through the Miocene, indicating low biological productivity in warm to temperate surface waters. A continuous increase in the proportions of foraminifera since the latest Miocene (6.5 Ma) points to enhanced nutrient supply, possibly related to the global 'biogenic bloom' event across the Miocene-Pliocene boundary. Since the Late Pliocene, different styles of biological productivity developed between the sites. Enhanced deposition of biosiliceous constituents at the southern Site 1092, particularly in the Early Pleistocene, is consistent with the formation of the Circum-Antarctic Opal Belt since 2.5 Ma in a setting near the Polar Front, whereas carbonate deposition still prevailed at the northern Site 1088 situated near the Subtropical Front. Clay-mineral tracers of water-mass advection together with the pattern of sedimentation rates and hiatuses reflect distinct pulses in the development of regional ocean circulation between 14 and 12 Ma, around 8 Ma and since 2.8 Ma. These pulses can be related to Antarctic ice-sheet extension that mediates the production and flow of southern source water, and stepwise increases in North Atlantic Deep Water production that drives global conveyor circulation. At Site 1088, illite chemistry and silt/clay ratios of the terrigenous sediment fraction reflect the history of terrestrial climate in southern Africa, with humid conditions prior to the Early Late Miocene (9.7 Ma), followed by a dry episode until 7.7 Ma. The latest Miocene and Early Pliocene were characterized by a humid episode until modern aridity was established in the Late Pliocene between 4.0 and 2.8 Ma. These climate changes were related to the latitudinal migration of climate belts in response to tectonically caused reorganizations in atmospheric and ocean circulation.

Calcareous nannofossil range-distribution and zonation of sediments from three ODP Leg 205 holes

Ocean Drilling Program Leg 205 of the research vessel JOIDES Resolution was a return expedition to the Leg 170 sites located on the Costa Rica subduction zone. Here the entire sediment cover on the incoming Cocos plate, including significantly large sections of calcareous nannofossil ooze and chalk, is underthrust beneath the overriding Caribbean plate. The large amount of subducted carbonate produces characteristic styles of volcanic and seismic activity that differ from those found farther along strike in Nicaragua and elsewhere. An understanding of the fate of subducted carbonate sediment sections is an essential component to our understanding of the global biogeochemical cycling of carbon dioxide. Because Leg 205 drilling operations were performed within meters of the Leg 170 drill sites occupied during October-December 1996, minimal coring was done during Leg 205. Although the biostratigraphy of the Leg 170 sites has since been documented in detail, questions remained regarding the age and nature of a gabbro sill that was only partially penetrated by coring during Leg 170. Coring operations during Leg 205 fully penetrated the gabbro sill, followed by an additional 12 m of sediments below the sill, and then ~160 m of gabbro. Coring halted at 600 meters below seafloor (mbsf). Calcareous nannofossil age dating of the sediments immediately above the igneous sill, as well as the sediment between the sill and the lower igneous unit, indicates a minimum age of 15.6 Ma and a maximum age of 18.2 Ma for the sediments. This implies that the sill was emplaced more recently than 18.2 Ma. The calcareous nannofossil assemblage in baked sediments in contact with the top of the lower igneous unit also suggests that the maximum age for emplacement is 18.2 Ma. At Site 1254, coring was accomplished between 150 and 230 mbsf (prism section), and from 300 to 367.5 mbsf (prism and through the décollement into the underthrust section). In the interval from 150 to 322 mbsf, the biostratigraphic analysis of calcareous nannofossils suggests that the sediments are early Pleistocene age between 150 and 161 mbsf, late Pliocene age from 161 to 219 mbsf, and early Pliocene age from 219 to 222 mbsf (no younger than 3.75 Ma). The lack of marker fossils in the interval of sediments cored from 300 to 350.6 mbsf does not allow for any age determinations; however, sediments from 351.6 to 359.81 mbsf could be age dated and are also early Pliocene age, but no younger than 3.75 Ma.

High-resolution isotope stratigraphy of ODP Site 184-1144

Narrow-spaced oxygen and carbon stable isotope records of the planktonic foraminifer Globigerinoides ruber (white) were obtained at Ocean Drilling Program Leg 184 Site 1144 to establish a first record of high-resolution Pleistocene monsoon variability on orbital to centennial timescales in the northern South China Sea. The new records extend from the Holocene back to marine isotope Stage (MIS) 34 (1.1 Ma). Sedimentation rates average 0.56 m/k.y. for the upper Matuyama and Brunhes Chrons and increase to 1.8 m/k.y. over the last 100 k.y. Stable isotope records thus reach an average time resolution of 270-500 yr for the last 375 k.y. and 570 yr further back to 700 ka. On the other hand, major stratigraphic gaps were identified for peak warm Stages 5.5, 7.5 (down to 8.4), 11.3, and 15.5. These gaps probably resulted from short-lasting events of contour current erosion induced by short-term enhanced incursions of Upper Pacific Deep Water near the end of glacial terminations. A further major hiatus extends from MIS 34 to MIS 73(?). The long-term variations in monsoon climate were largely dominated by the 100-k.y. eccentricity cycle. Planktonic delta13C values culminated near 30, 480, and 1035 ka and reflect an overlying 450-k.y. eccentricity cycle of minimum nutrient concentrations in the surface ocean. Superimposed on the orbital variations, millennial-scale cycles were prominent throughout the last 700 k.y., mainly controlled by short-term changes in monsoon-driven precipitation and freshwater input from mainland China. During the last 110 k.y. these short-lasting oscillations closely match the record of 1500-yr Dansgaard-Oeschger climate cycles in the Greenland ice core record.

Conflict and cognitive control during sentence comprehension: recruitment of a frontal network during the processing of Spanish object-first sentences.

During sentence processing there is a preference to treat the first noun phrase found as the subject and agent, unless marked the other way. This preference would lead to a conflict in thematic role assignment when the syntactic structure conforms to a non-canonical object-before-subject pattern. Left perisylvian and fronto-parietal brain networks have been found to be engaged by increased computational demands during sentence comprehension, while event-reated brain potentials have been used to study the on-line manifestation of these demands. However, evidence regarding the spatiotemporal organization of brain networks in this domain is scarce. In the current study we used Magnetoencephalography to track spatio-temporally brain activity while Spanish speakers were reading subject- and object-first cleft sentences. Both kinds of sentences remained ambiguous between a subject-first or an object-first interpretation up to the appearance of the second argument. Results show the time-modulation of a frontal network at the disambiguation point of object-first sentences. Moreover, the time windows where these effects took place have been previously related to thematic role integration (300–500 ms) and to sentence reanalysis and resolution of conflicts during processing (beyond 500 ms post-stimulus). These results point to frontal cognitive control as a putative key mechanism which may operate when a revision of the sentence structure and meaning is necessary

High-resolution physical mapping by combined Alu-hybridization/PCR screening: construction of a yeast artificial chromosome map covering 31 centimorgans in 3p21-p14.

We describe an integrated approach to large-scale physical mapping using an Alu-PCR hybridization screening strategy in conjunction with direct PCR-based screening to construct a continuous yeast artificial chromosome map covering >20 mb in human chromosome 3, bands p14-p21, composed of 205 loci, connected by 480 yeast artificial chromosomes, with average interlocus distance of approximately equal to 100 kb. We observe an inverse distribution of Alu-PCR and (CA)n markers. These results suggest that the two screening methods may be complementary and demonstrate the utility of Alu-PCR hybridization screening in the closure of high-resolution human physical maps.

Resolution of Holliday junctions by eukaryotic DNA topoisomerase I.

The Holliday junction, a key intermediate in both homologous and site-specific recombination, is generated by the reciprocal exchange of single strands between two DNA duplexes. Resolution of the junctions can occur in two directions with respect to flanking markers, either restoring the parental DNA configuration or generating a genetic crossover. Recombination can be regulated, in principle, by factors that influence the directionality of the resolution step. We demonstrate that the vaccinia virus DNA topoisomerase, a eukaryotic type I enzyme, catalyzes resolution of synthetic Holliday junctions in vitro. The mechanism entails concerted transesterifications at two recognition sites, 5'-CCCTT decreases, that are opposed within a partially mobile four-way junction. Cruciforms are resolved unidirectionally and with high efficiency into two linear duplexes. These findings suggest a model whereby type I topoisomerases may either promote or suppress genetic recombination in vivo.