Measurement of the proton-air cross section at root s=57 TeV with the Pierre Auger Observatory

We report a measurement of the proton-air cross section for particle production at the center-of-mass energy per nucleon of 57 TeV. This is derived from the distribution of the depths of shower maxima observed with the Pierre Auger Observatory: systematic uncertainties are studied in detail. Analyzing the tail of the distribution of the shower maxima, a proton-air cross section of [505 +/- 22(stat)(-36)(+28)(syst)] mb is found.

Differential dynamic properties of scleroderma fibroblasts in response to perturbation of environmental stimuli.

Diseases are believed to arise from dysregulation of biological systems (pathways) perturbed by environmental triggers. Biological systems as a whole are not just the sum of their components, rather ever-changing, complex and dynamic systems over time in response to internal and external perturbation. In the past, biologists have mainly focused on studying either functions of isolated genes or steady-states of small biological pathways. However, it is systems dynamics that play an essential role in giving rise to cellular function/dysfunction which cause diseases, such as growth, differentiation, division and apoptosis. Biological phenomena of the entire organism are not only determined by steady-state characteristics of the biological systems, but also by intrinsic dynamic properties of biological systems, including stability, transient-response, and controllability, which determine how the systems maintain their functions and performance under a broad range of random internal and external perturbations. As a proof of principle, we examine signal transduction pathways and genetic regulatory pathways as biological systems. We employ widely used state-space equations in systems science to model biological systems, and use expectation-maximization (EM) algorithms and Kalman filter to estimate the parameters in the models. We apply the developed state-space models to human fibroblasts obtained from the autoimmune fibrosing disease, scleroderma, and then perform dynamic analysis of partial TGF-beta pathway in both normal and scleroderma fibroblasts stimulated by silica. We find that TGF-beta pathway under perturbation of silica shows significant differences in dynamic properties between normal and scleroderma fibroblasts. Our findings may open a new avenue in exploring the functions of cells and mechanism operative in disease development.

Differential dynamic properties of scleroderma fibroblasts in response to perturbation of environmental stimuli.

Diseases are believed to arise from dysregulation of biological systems (pathways) perturbed by environmental triggers. Biological systems as a whole are not just the sum of their components, rather ever-changing, complex and dynamic systems over time in response to internal and external perturbation. In the past, biologists have mainly focused on studying either functions of isolated genes or steady-states of small biological pathways. However, it is systems dynamics that play an essential role in giving rise to cellular function/dysfunction which cause diseases, such as growth, differentiation, division and apoptosis. Biological phenomena of the entire organism are not only determined by steady-state characteristics of the biological systems, but also by intrinsic dynamic properties of biological systems, including stability, transient-response, and controllability, which determine how the systems maintain their functions and performance under a broad range of random internal and external perturbations. As a proof of principle, we examine signal transduction pathways and genetic regulatory pathways as biological systems. We employ widely used state-space equations in systems science to model biological systems, and use expectation-maximization (EM) algorithms and Kalman filter to estimate the parameters in the models. We apply the developed state-space models to human fibroblasts obtained from the autoimmune fibrosing disease, scleroderma, and then perform dynamic analysis of partial TGF-beta pathway in both normal and scleroderma fibroblasts stimulated by silica. We find that TGF-beta pathway under perturbation of silica shows significant differences in dynamic properties between normal and scleroderma fibroblasts. Our findings may open a new avenue in exploring the functions of cells and mechanism operative in disease development.

Consumer satisfaction with primary care provider choice and associated trust

Trust is important in medical relationships and for the achievement of better health outcomes. Developments in managed care in the recent years are believed to affect the quality of healthcare services delivery and to undermine trust in the healthcare provider. Physician choice has been identified as a strong predictor of provider trust but has not been studied in detail. Consumer satisfaction with primary care provider (PCP) choice includes having or not having physician choice. This dissertation developed a conceptual framework that guided the study of consumer satisfaction with PCP choice as a predictor of provider trust, and conducted secondary data analyses examining the association between PCP choice and trust, by identifying factors related to PCP choice satisfaction, and their relative importance in predicting provider trust. The study specific aims were: (1) to determine variables related to the factors: consumer characteristics and health status, information and consumer decision-making, consumer trust in providers in general and trust in the insurer, health plan financing and plan characteristics, and provider characteristics that may relate to PCP choice satisfaction; (2) to determine if the factors in aim one are related to PCP choice satisfaction; and (3) to analyze the association between PCP choice satisfaction and provider trust, controlling for potential confounders. Analyses were based on secondary data from a random national telephone survey in 1999, of residential households in the United States which included respondents aged over 20 and who had at least two visits with a health professional in the past two years. Among 1,117 eligible households interviewed (response rate 51.4%), 564 randomly selected to respond to insurer related questions made up the study sample. Analyses using descriptive statistics, and linear and logistic regressions found continual effective care and interaction with the PCP beyond the medical setting most predictive of PCP choice satisfaction. Four PCP choice satisfaction factors were also predictive of provider trust. Findings highlighted the importance of the PCP's professional and interpersonal competencies for the development of sustainable provider trust. Future research on the access, utilization, cognition, and helpfulness of provider specific information will further our understanding of consumer choice and trust. ^

Assessing residents' readiness to screen for domestic violence: Utilizing the transtheoretical model - stages of change, decisional balance and self-efficacy

Domestic violence is a major public health problem, yet most physicians do not effectively identify patients at risk. Medical students and residents are not routinely educated on this topic and little is known about the factors that influence their decisions to include screening for domestic violence in their subsequent practice. In order to assess the readiness of primary care residents to screen all patients for domestic violence, this study utilized a survey incorporating constructs from the Transtheoretical Model, including Stages of Change, Decisional Balance (Pros and Cons) and Self-Efficacy. The survey was distributed to residents at the University of Texas Health Science Center Medical School in Houston in: Internal Medicine, Medicine/Pediatrics, Pediatrics, Family Medicine, and Obstetrics and Gynecology. Data from the survey was analyzed to test the hypothesis that residents in the earlier Stages of Change report more costs and fewer benefits with regards to screening for domestic violence, and that those in the later stages exhibit higher Self-Efficacy scores. The findings from this study were consistent with the model in that benefits to screening (Pros) and Self-Efficacy were correlated with later Stages of Change, however reporting fewer costs (Cons) was not. Very few residents were ready to screen all of their patients.^

US medical students' knowledge of obstetric fistula in developing countries

Obstetric fistula is a devastating child birth injury affecting millions of women worldwide. This paper explores the knowledge and understanding of medical students at the University of Texas Health Science Center at San Antonio regarding this global public health issue. Obstetric fistula has been eradicated in most industrialized nations, and has therefore faded from view of many modern medical organizations. The United Nations Population Fund has launched a “Campaign to End Fistula” in an attempt to bring global awareness to this preventable and treatable condition. Based on a survey administered to medical students at UTHSCSA, a baseline understanding of this disorder based on current curriculum is reviewed, with the objective of improving future physicians’ awareness of obstetric fistula. Despite a low survey response rate, there was a significant association between greater knowledge about causes, treatment, and complications of obstetric fistula and advanced years in medical school. However, the fourth year medical students averaged only a 70.5 percent of correct responses on the survey, indicating room for improvement in addressing this topic during medical school. ^

The association of allergies and attention deficit hyperactivity disorder in children

To investigate the association between allergies and attention deficit hyperactivity disorder (ADHD), a case-control study was conducted using the National Longitudinal Survey of Youth population. Cases were between the ages of 4 and 11 years and were classified either by a maternal-reported diagnosis or by the Behavior Problems Index Hyperactivity Scale. Controls were chosen from the same age group but had a score of less than 14 on the overall Behavior Problems Index. A history of allergies was considered positive if any of the following conditions were reported as requiring treatment by a doctor or other health professional: asthma, allergic conditions, or food allergies. A strong association was observed between allergies and a maternal-reported diagnosis while controlling for demographic, socioeconomic, perinatal, and environmental factors (adjusted odds ratio = 2.85 (95% CI = 1.49-5.42)). Other risk factors found to be important risk factors for a diagnosis of ADHD were gender (male), gestational age ($<$36 weeks), and maternal education ($\leq$high school). No association between allergies and cases classified as ADHD based on the hyperactivity symptom scale was observed. This study confirms other studies that reported an allergy/ADHD association in diagnoses populations. Further investigation confirming the association and explanation of the reasons and underlying mechanisms of the observed association is warranted. These studies should use validated diagnostic criteria for the diagnosis of ADHD symptoms and allergies, adequate sample sizes, and control for confounding. ^

THE RELATIONSHIP BETWEEN SERUM CHOLESTEROL AND CANCER INCIDENCE IN THE POPULATION OF THE HYPERTENSION DETECTION AND FOLLOW-UP PROGRAM

The relationship between serum cholesterol and cancer incidence was investigated in the population of the Hypertension Detection and Follow-up Program (HDFP). The HDFP was a multi-center trial designed to test the effectiveness of a stepped program of medication in reducing mortality associated with hypertension. Over 10,000 participants, ages 30-69, were followed with clinic and home visits for a minimum of five years. Cancer incidence was ascertained from existing study documents, which included hospitalization records, autopsy reports and death certificates. During the five years of follow-up, 286 new cancer cases were documented. The distribution of sites and total number of cases were similar to those predicted using rates from the Third National Cancer Survey. A non-fasting baseline serum cholesterol level was available for most participants. Age, sex, and race specific five-year cancer incidence rates were computed for each cholesterol quartile. Rates were also computed by smoking status, education status, and percent ideal weight quartiles. In addition, these and other factors were investigated with the use of the multiple logistic model.^ For all cancers combined, a significant inverse relationship existed between baseline serum cholesterol levels and cancer incidence. Previously documented associations between smoking, education and cancer were also demonstrated but did not account for the relationship between serum cholesterol and cancer. The relationship was more evident in males than females but this was felt to represent the different distribution of occurrence of specific cancer sites in the two sexes. The inverse relationship existed for all specific sites investigated (except breast) although a level of statistical significance was reached only for prostate carcinoma. Analyses after exclusion of cases diagnosed during the first two years of follow-up still yielded an inverse relationship. Life table analysis indicated that competing risks during the period of follow-up did not account for the existence of an inverse relationship. It is concluded that a weak inverse relationship does exist between serum cholesterol for many but not all cancer sites. This relationship is not due to confounding by other known cancer risk factors, competing risks or persons entering the study with undiagnosed cancer. Not enough information is available at the present time to determine whether this relationship is causal and further research is suggested. ^

2005 ACIP recommendations effect on newborn hepatitis B vaccination rates and the factors affecting the successful implementation of the recommendations in the US

Background. Hepatitis B virus infection is one of major causes of acute and chronic hepatitis, cirrhosis of the liver, and primary hepatocellular carcinoma. Hepatitis B and its long term consequences are major health problems in the United States. Hepatitis B virus can be vertically transmitted from mother to infant during birth. Hepatitis B vaccination at birth is the most effective measure to prevent the newborn from HBV infection and its consequences, and is part of any robust perinatal hepatitis B prevention program following ACIP recommendations. Universal vaccination of the new born will prevent HBV infection during early childhood and, assuming that children receive the three dosages of the vaccine, it will also prevent adolescent and adult infections. Hepatitis B vaccination is now recommended as part of a comprehensive strategy to eliminate HBV transmission in the United States. ^ Objective. (1)To assess if the hepatitis B vaccination rates of newborn babies have improved after the 2005 ACIP recommendations. (2) To identify factors that affects the implementation of ACIP recommendation for hepatitis B vaccination in newborn babies. These factors will encourage ongoing improvement by identifying successful efforts and pinpointing areas that fall short and need attention. Additional focus areas may be identified to accelerate progress in eliminating perinatal HBV transmission.^ Methods. This review includes information from all pertinent articles, reviews, National immunization survey (NIS) surveys, reports, peer reviewed literature and web sources that were published after 1991.The key words to be used for selecting the articles are: "Perinatal Hepatitis B Prevention program", "Universal Hepatitis B vaccination of newborn babies", "ACIP Recommendations." The data gathered will be supplemented with an analysis of vaccination rates using the National Immunization Survey (NIS) birth dose coverage data.^ Results. The data collected in the NIS of 2009 reveals that the national coverage for birth dose of HepB increased to 60.8% from 50.1% in 2006. The largest increase observed for the birth dose in the past 5 years is from 2008 which increased from 55.3 % to 60.8% in 2009. By state, coverage ranged from 22.8% in Vermont to 80.7% in Michigan. %. Overall, in 2009 the estimated vaccination rates are in higher ranges for most states compared to the estimated vaccination rates in 2006. States vary widely in hepatitis B vaccination rates and in their compliance with the 2005 ACIP recommendation. There are many factors at various stages that might affect the successful implementation of the new ACIP recommendation as revealed in literature review. ^ Conclusions. HBV perinatal transmission can be eliminated, but it requires identifying the gaps and measures taken to increase the current vaccination coverage, ensuring timely administration of post exposure immunoprophylaxis and continued evaluations of the impact of immunization recommendations.^

Epidemiology of perinatal mortality: Birthweight, crown -heel length, gestational age, and weight -for -height

Studies suggest that slim infants (low weight-for-height) experienced higher mortality rates than average or high weight-for-height infants (Miller and Hassanein, 1973; Hoffman, Meirik, and Bakketeig, 1984). In this study, the 1980 National Natality Survey and the National Fetal Mortality Survey were used to examine the association of weight, height and perinatal mortality. All singleton births to white married mothers, between 18 and 34 years of age and of parity less than 4, for whom both mother's and hospital questionnaires were completed in those two surveys (3796 live births and 2043 fetal deaths) were selected for analysis. Overall, low weight and height infants had excess mortality rates. However, after adjustment for low birthweight and preterm birth status, low weight and height infants had only slightly higher mortality rates than their medium or high weight and height counterparts. The current study consists of relatively well-educated white married mothers of optimal reproductive age and low parity. Therefore, lower than expected mortality rates for slim infants may be attributed to these favorable demographic factors in this sample as compared with previous studies, or because of advances in perinatal medicine, slim infants may be prevented from achieving the high mortality seen in earlier studies. ^

El acceso a la información como meta ¿realizable? Imaginarios y prácticas de aplicación tecnológica en bibliotecas

El acceso a la información para la comunidad usuaria de bibliotecas y centros de documentación, que ha estado siempre presente en el ideario del campo de la bibliotecología, se ha afianzado en los últimos tiempos en los discursos de la sociedad de la información, especialmente a través de la incorporación de nuevas tecnologías capaces de mediar-que median en las vinculaciones entre bibliotecarios y usuarios. En ese sentido, este trabajo indaga por un lado la cuestión de la incorporación y el uso de las tecnologías de la información y la comunicación en los procesos bibliotecarios llevados a cabo en las bibliotecas que están bajo la dirección de egresados y egresadas de la carrera de Bibliotecología de la Facultad de Humanidades y Ciencias de la Educación de la Universidad Nacional de La Plata (FAHCE-UNLP), Argentina. Por otro, rastrea los imaginarios tecnológicos que poseen planteando una proyección a 10 años sobre estas mismas unidades de información. Para ello, la búsqueda de quiénes están ejerciendo cargos o funciones de dirección en distintas unidades de información dio como resultado una lista de 34 personas. A ellas se les envió vía e.mail un cuestionario de tipo semiestructurado que indagaba sobre 1- sus datos personales y de pertenencia institucional; 2- el estado de situación de los procesos de automatización de las bibliotecas en las que trabajan; 3- la aplicación de tecnologías en los distintos procesos; 4- la formación de grado obtenida en temas vinculados al uso de tecnologías, así como también los cursos y los seminarios realizados sobre estos tópicos en los últimos cinco años; 5- las perspectivas de desarrollo futuro que imagina este conjunto de profesionales para las bibliotecas que dirigen. Este último aspecto se retomó con entrevistas semi estructuradas en profundidad que pretendían situarlos-las dentro de 10 años para pensar aspectos relacionados con los posibles cambios en la comunicación con los usuarios y las instalaciones, la composición de la colección bibliográfica, los servicios documentales a prestar y otros aspectos vinculados a la gestión de las bibliotecas y el acceso a la información de la comunidad usuaria. El análisis de la información obtenida a través tanto de las encuestas como de las entrevistas plantea dilucidar la posibilidad de concreción del acceso a la información de la comunidad usuaria en el presente o en el futuro cercano en-a través de esas bibliotecas

El acceso a la información como meta ¿realizable? Imaginarios y prácticas de aplicación tecnológica en bibliotecas

El acceso a la información para la comunidad usuaria de bibliotecas y centros de documentación, que ha estado siempre presente en el ideario del campo de la bibliotecología, se ha afianzado en los últimos tiempos en los discursos de la sociedad de la información, especialmente a través de la incorporación de nuevas tecnologías capaces de mediar-que median en las vinculaciones entre bibliotecarios y usuarios. En ese sentido, este trabajo indaga por un lado la cuestión de la incorporación y el uso de las tecnologías de la información y la comunicación en los procesos bibliotecarios llevados a cabo en las bibliotecas que están bajo la dirección de egresados y egresadas de la carrera de Bibliotecología de la Facultad de Humanidades y Ciencias de la Educación de la Universidad Nacional de La Plata (FAHCE-UNLP), Argentina. Por otro, rastrea los imaginarios tecnológicos que poseen planteando una proyección a 10 años sobre estas mismas unidades de información. Para ello, la búsqueda de quiénes están ejerciendo cargos o funciones de dirección en distintas unidades de información dio como resultado una lista de 34 personas. A ellas se les envió vía e.mail un cuestionario de tipo semiestructurado que indagaba sobre 1- sus datos personales y de pertenencia institucional; 2- el estado de situación de los procesos de automatización de las bibliotecas en las que trabajan; 3- la aplicación de tecnologías en los distintos procesos; 4- la formación de grado obtenida en temas vinculados al uso de tecnologías, así como también los cursos y los seminarios realizados sobre estos tópicos en los últimos cinco años; 5- las perspectivas de desarrollo futuro que imagina este conjunto de profesionales para las bibliotecas que dirigen. Este último aspecto se retomó con entrevistas semi estructuradas en profundidad que pretendían situarlos-las dentro de 10 años para pensar aspectos relacionados con los posibles cambios en la comunicación con los usuarios y las instalaciones, la composición de la colección bibliográfica, los servicios documentales a prestar y otros aspectos vinculados a la gestión de las bibliotecas y el acceso a la información de la comunidad usuaria. El análisis de la información obtenida a través tanto de las encuestas como de las entrevistas plantea dilucidar la posibilidad de concreción del acceso a la información de la comunidad usuaria en el presente o en el futuro cercano en-a través de esas bibliotecas

El acceso a la información como meta ¿realizable? Imaginarios y prácticas de aplicación tecnológica en bibliotecas

El acceso a la información para la comunidad usuaria de bibliotecas y centros de documentación, que ha estado siempre presente en el ideario del campo de la bibliotecología, se ha afianzado en los últimos tiempos en los discursos de la sociedad de la información, especialmente a través de la incorporación de nuevas tecnologías capaces de mediar-que median en las vinculaciones entre bibliotecarios y usuarios. En ese sentido, este trabajo indaga por un lado la cuestión de la incorporación y el uso de las tecnologías de la información y la comunicación en los procesos bibliotecarios llevados a cabo en las bibliotecas que están bajo la dirección de egresados y egresadas de la carrera de Bibliotecología de la Facultad de Humanidades y Ciencias de la Educación de la Universidad Nacional de La Plata (FAHCE-UNLP), Argentina. Por otro, rastrea los imaginarios tecnológicos que poseen planteando una proyección a 10 años sobre estas mismas unidades de información. Para ello, la búsqueda de quiénes están ejerciendo cargos o funciones de dirección en distintas unidades de información dio como resultado una lista de 34 personas. A ellas se les envió vía e.mail un cuestionario de tipo semiestructurado que indagaba sobre 1- sus datos personales y de pertenencia institucional; 2- el estado de situación de los procesos de automatización de las bibliotecas en las que trabajan; 3- la aplicación de tecnologías en los distintos procesos; 4- la formación de grado obtenida en temas vinculados al uso de tecnologías, así como también los cursos y los seminarios realizados sobre estos tópicos en los últimos cinco años; 5- las perspectivas de desarrollo futuro que imagina este conjunto de profesionales para las bibliotecas que dirigen. Este último aspecto se retomó con entrevistas semi estructuradas en profundidad que pretendían situarlos-las dentro de 10 años para pensar aspectos relacionados con los posibles cambios en la comunicación con los usuarios y las instalaciones, la composición de la colección bibliográfica, los servicios documentales a prestar y otros aspectos vinculados a la gestión de las bibliotecas y el acceso a la información de la comunidad usuaria. El análisis de la información obtenida a través tanto de las encuestas como de las entrevistas plantea dilucidar la posibilidad de concreción del acceso a la información de la comunidad usuaria en el presente o en el futuro cercano en-a través de esas bibliotecas