Outcomes of metallic stents for malignant ureteral obstruction.

PURPOSE: Malignant ureteral obstruction often necessitates chronic urinary diversion and is associated with high rates of failure with traditional ureteral stents. We evaluated the outcomes of a metallic stent placed for malignant ureteral obstruction and determined the impact of risk factors previously associated with increased failure rates of traditional stents. MATERIALS AND METHODS: Patients undergoing placement of the metallic Resonance® stent for malignant ureteral obstruction at an academic referral center were identified retrospectively. Stent failure was defined as unplanned stent exchange or nephrostomy tube placement for signs or symptoms of recurrent ureteral obstruction (recurrent hydroureteronephrosis or increasing creatinine). Predictors of time to stent failure were assessed using Cox regression. RESULTS: A total of 37 stents were placed in 25 patients with malignant ureteral obstruction. Of these stents 12 (35%) were identified to fail. Progressive hydroureteronephrosis and increasing creatinine were the most common signs of stent failure. Three failed stents had migrated distally and no stents required removal for recurrent infection. Patients with evidence of prostate cancer invading the bladder at stent placement were found to have a significantly increased risk of failure (HR 6.50, 95% CI 1.45-29.20, p = 0.015). Notably symptomatic subcapsular hematomas were identified in 3 patients after metallic stent placement. CONCLUSIONS: Failure rates with a metallic stent are similar to those historically observed with traditional polyurethane based stents in malignant ureteral obstruction. The invasion of prostate cancer in the bladder significantly increases the risk of failure. Patients should be counseled and observed for subcapsular hematoma formation with this device.

An exploration of future trends in environmental education research

This article describes future trends in environmental education (EE) research based on a mixed-methods study where data were collected through a content analysis of peer-reviewed articles published in EE journals between 2005 and 2010; interviews with experts engaged in EE research and sustainability-related fields; surveys with current EE researchers; and convenings with EE researchers and practitioners. We discuss four core thematic findings: (1) EE researchers are highlighting the importance of collective and community learning and action; (2) EE researchers are placing increased emphasis on the intersection of learning within the context of social-ecological communities (e.g. links between environmental quality and human well-being); (3) a pressing need exists for research conducted with urban and diverse populations; and (4) research around social media and other information technologies is of great interest, yet currently is sparse. © 2013 © 2013 Taylor & Francis.

Encouraging clean energy investment in developing countries: what role for aid?

A large portion of foreign assistance for climate change mitigation in developing countries is directed to clean energy facilities. To support international mitigation goals, however, donors must make investments that have effects beyond individual facilities. They must reduce barriers to private-sector investment by generating information for developers, improving relevant infrastructure, or changing policies. We examine whether donor agencies target financing for commercial-scale wind and solar facilities to countries where private investment in clean energy is limited and whether donor investments lead to more private investments. On average, we find no positive evidence for these patterns of targeting and impact. Coupled with model results that show feed-in tariffs increase private investment, we argue that donor agencies should reallocate resources to improve policies that promote private investment in developing countries, rather than finance individual clean energy facilities.

Mechanobiology of the meniscus.

The meniscus plays a critical biomechanical role in the knee, providing load support, joint stability, and congruity. Importantly, growing evidence indicates that the mechanobiologic response of meniscal cells plays a critical role in the physiologic, pathologic, and repair responses of the meniscus. Here we review experimental and theoretical studies that have begun to directly measure the biomechanical effects of joint loading on the meniscus under physiologic and pathologic conditions, showing that the menisci are exposed to high contact stresses, resulting in a complex and nonuniform stress-strain environment within the tissue. By combining microscale measurements of the mechanical properties of meniscal cells and their pericellular and extracellular matrix regions, theoretical and experimental models indicate that the cells in the meniscus are exposed to a complex and inhomogeneous environment of stress, strain, fluid pressure, fluid flow, and a variety of physicochemical factors. Studies across a range of culture systems from isolated cells to tissues have revealed that the biological response of meniscal cells is directly influenced by physical factors, such as tension, compression, and hydrostatic pressure. In addition, these studies have provided new insights into the mechanotransduction mechanisms by which physical signals are converted into metabolic or pro/anti-inflammatory responses. Taken together, these in vivo and in vitro studies show that mechanical factors play an important role in the health, degeneration, and regeneration of the meniscus. A more thorough understanding of the mechanobiologic responses of the meniscus will hopefully lead to therapeutic approaches to prevent degeneration and enhance repair of the meniscus.

PHILIPPE ROGIER (c.1561-1596): MISSA INCLITA STIRPS JESSE. A CRITICAL AND PERFORMING EDITION WITH PERFORMANCE COMMENTARY

The dissertation comprises two parts: (a) a musical edition and (b) a performance given on 3 July, 2008 of Philippe Rogier’s Missa Inclita stirps Jesse. The dissertation explores some of the editorial decisions required, how the demands of performers and musicologists differ, and whether they can be reconciled in one single edition. The commentary explains the preparation and realization of the edition. A video recording of the concert performance is attached to the dissertation. The Mass: The Missa Inclita stirps Jesse was published in Madrid in 1598 in a collection entitled Missae Sex. The mass setting is for four voices, except the Agnus Dei, which is for five, and is based on musical material in the motet Inclita stirps Jesse by Jacobus Clemens non Papa (c. 1510-15 – c.1556-6). Rogier’s choice and use of musical material from the motet (published in 1549) are discussed in the dissertation. The Edition: The edition is made from a microfilm copy of the Missae Sex held in the Biblioteca del Conservatorio de Musica “Giuseppe Verdi” in Milan. The Missae Sex was originally dedicated to King Philip II of Spain (1527-1598, reg. 1556-1598), whom Rogier had served as chorister and then maestro de capilla. Both Rogier and King Philip died before the volume was ready for publication. One of Rogier’s pupils, Géry de Ghersem, prepared the volume, which was printed in 1598, dedicated to King Philip III. The Performance: The mass was performed at a concert of Spanish Renaissance music in St. Matthew’s Cathedral, Washington, DC, on 3 July 2008, sung by the ensemble Orpheus directed by Philip Cave as part of the Chorworks summer workshop entitled Kings and Conquistadors: Music of Old and New Spain.

Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders

© Cambridge University Press 2014.Background Asian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized. Method We examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs. Results NHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had higher prevalences of DSM-IV diagnoses than AAs (alcohol/drug, mood, adjustment, childhood-onset disruptive or impulse-control disorders), although co-morbidity was common in both groups. AAs and NHs/PIs with an SUD were unlikely to use treatment, especially treatment for alcohol problems, and treatment use tended to be related to involvement with the criminal justice system. Conclusions Although available data are limited by small sample sizes of AAs and NHs/PIs, they demonstrate the need to separate AAs and NHs/PIs in health statistics and increase research into substance use and treatment needs for these fast-growing but understudied population groups.

Hydraulic redistribution of soil water by roots affects whole-stand evapotranspiration and net ecosystem carbon exchange.

*Hydraulic redistribution (HR) of water via roots from moist to drier portions of the soil occurs in many ecosystems, potentially influencing both water use and carbon assimilation. *By measuring soil water content, sap flow and eddy covariance, we investigated the temporal variability of HR in a loblolly pine (Pinus taeda) plantation during months of normal and below-normal precipitation, and examined its effects on tree transpiration, ecosystem water use and carbon exchange. *The occurrence of HR was explained by courses of reverse flow through roots. As the drought progressed, HR maintained soil moisture above 0.15 cm(3) cm(-3) and increased transpiration by 30-50%. HR accounted for 15-25% of measured total site water depletion seasonally, peaking at 1.05 mm d(-1). The understory species depended on water redistributed by the deep-rooted overstory pine trees for their early summer water supply. Modeling carbon flux showed that in the absence of HR, gross ecosystem productivity and net ecosystem exchange could be reduced by 750 and 400 g C m(-2) yr(-1), respectively. *Hydraulic redistribution mitigated the effects of soil drying on understory and stand evapotranspiration and had important implications for net primary productivity by maintaining this whole ecosystem as a carbon sink.

A framework for revising preservice curriculum for nonphysician clinicians: The mozambique experience.

Mozambique, with approximately 0.4 physicians and 4.1 nurses per 10,000 people, has one of the lowest ratios of health care providers to population in the world. To rapidly scale up health care coverage, the Mozambique Ministry of Health has pushed for greater investment in training nonphysician clinicians, Tιcnicos de Medicina (TM). Based on identified gaps in TM clinical performance, the Ministry of Health requested technical assistance from the International Training and Education Center for Health (I-TECH) to revise the two-and-a-half-year preservice curriculum. A six-step process was used to revise the curriculum: (i) Conducting a task analysis, (ii) defining a new curriculum approach and selecting an integrated model of subject and competency-based education, (iii) revising and restructuring the 30-month course schedule to emphasize clinical skills, (iv) developing a detailed syllabus for each course, (v) developing content for each lesson, and (vi) evaluating implementation and integrating feedback for ongoing improvement. In May 2010, the Mozambique Minister of Health approved the revised curriculum, which is currently being implemented in 10 training institutions around the country. Key lessons learned: (i) Detailed assessment of training institutions' strengths and weaknesses should inform curriculum revision. (ii) Establishing a Technical Working Group with respected and motivated clinicians is key to promoting local buy-in and ownership. (iii) Providing ready-to-use didactic material helps to address some challenges commonly found in resource-limited settings. (iv) Comprehensive curriculum revision is an important first step toward improving the quality of training provided to health care providers in developing countries. Other aspects of implementation at training institutions and health care facilities must also be addressed to ensure that providers are adequately trained and equipped to provide quality health care services. This approach to curriculum revision and implementation teaches several key lessons, which may be applicable to preservice training programs in other less developed countries.

NgBR is essential for endothelial cell glycosylation and vascular development.

NgBR is a transmembrane protein identified as a Nogo-B-interacting protein and recently has been shown to be a subunit required for cis-prenyltransferase (cisPTase) activity. To investigate the integrated role of NgBR in vascular development, we have characterized endothelial-specific NgBR knockout embryos. Here, we show that endothelial-specific NgBR knockout results in embryonic lethality due to vascular development defects in yolk sac and embryo proper. Loss of NgBR in endothelial cells reduces proliferation and promotes apoptosis of the cells largely through defects in the glycosylation of key endothelial proteins including VEGFR2, VE-cadherin, and CD31, and defective glycosylation can be rescued by treatment with the end product of cisPTase activity, dolichol phosphate. Moreover, NgBR functions in endothelial cells during embryogenesis are Nogo-B independent. These data uniquely show the importance of NgBR and protein glycosylation during vascular development.

An investigation into regional differences in educational performance in the National Child Development Study

The National Child Development Study (NCDS) is used to investigate factors which affect children's educational performance over time. Multilevel modelling techniques are used on a subset of the NCDS to investigate variation in educational performance in 11 regions in the UK, and in local education authorities within these regions. Social characteristics of the NCDS members are also analysed. Differences between regions and education authorities are found to be negligible, the main source of variation in achievement being due to differences in social background.

Temporal structure and enablement representation for mutual wills: A Petri net approach

Those temporal formalisms that are sporadically found nowadays in the literature of AI & Law are based on temporal logic. We claim a revived role for another major class of temporal representation: Petri nets. This formalism, popular in computing from the 1970s, had its potential recognized on occasion in the literature of legal computing as well, but apparently the discipline has lost sight of it, and its practitioners on average need be tutored into this kind of representation. Asynchronous, concurrent processes—for which the approach is well‐suited—are found in the legal domain, in disparate contexts. We develop an example for Mutual Wills.

Representing temporal knowledge in legal discourse

This paper presents a formalism for representing temporal knowledge in legal discourse that allows an explicit expression of time and event occurrences. The fundamental time structure is characterized as a well‐ordered discrete set of primitive times, i.e. non‐decomposable intervals with positive duration or points with zero duration), from which decomposable intervals can be constructed. The formalism supports a full representation of both absolute and relative temporal knowledge, and a formal mechanism for checking the temporal consistency of a given set of legal statements is provided. The general consistency checking algorithm which addresses both absolute and relative temporal knowledge turns out to be a linear programming problem, while in the special case where only relative temporal relations are involved, it becomes a simple question of searching for cycles in the graphical representation of the corresponding legal text.

Temporal representation of state transitions

This paper describes a knowledge-based temporal representation of state transitions for industrial real-time systems. To allow expression of uncertainty, we shall define fluents as disjuncts of positive/negative time-varying properties. A state of the world is represented as a collection of fluents, which is usually incomplete in the sense that neither the positive form nor the negative form of some properties can be implied from it. The world under consideration is assumed to persist in a given state until an action(s) takes place to effect a transition of it into another state, where actions may either be instantaneous or durative. High-level causal laws are characterized in terms of relationships between actions and the involved world states. An effect completion axiom is imposed on each causal law to guarantee that all the fluents that can be affected by the performance of the corresponding action are governed. This completion requirement is practical for most industrial real-time applications and in fact provides a simple and effective treatment to the so-called frame problem.