Validation of the psoriasis epidemiology screening tool (PEST) and the new early arthritis for psoriatic patients (EARP) in pediatric population: pilot study

Clinical Rheumatology - Juvenile psoriatic arthritis (JPsA) is a severe inflammatory arthritis, which is associated with psoriasis in most cases. While there are few validated screening tools for...     

Models for projecting supply and demand for nurses in Israel

Background

Concern is growing over serious shortages in the nursing workforce and imbalance between supply and demand. Projections indicate that the demand for the nursing workforce will increase due to the aging population and an increase of the percentage of elderly people requiring assistance.

Study goals

To examine the expected balance between supply and several demand projections for nurses in Israel in order to contribute to planning the nursing workforce.

Methods

1. Open interviews with key figures in the healthcare and nursing care systems; 2. Examination of supply and demand for nurses; 3. Examination of the balance between supply and demand projections.

Main findings

A considerable gap was found between the supply and demand projections for registered nurses, which will increase over time according to each of the demand projection models up to 2030. All of the models indicate that the projected shortage will be significantly affected by the age at which the nurses retire. Models based on a fixed ratio of nurses or infrastructure (beds, positions) per population show a particularly great gap between demand and supply. However, a more conservative model (based on hospital utilization), that takes the system's infrastructures and limitations, as well as the growing population and changes in its composition into account, without an increase in the direct ratio of the number of nurses, also predict a significant shortage of nurses within 20 years.

Conclusions

The gaps between the demand and supply projections indicate the need to augment the workforce in addition to the steps currently taken to recruit nursing staff and increase the number of training institutions for nurses. The relatively simple supply prediction models, which are based on available sources of information that can be easily revised, will make it possible to monitor and update projections regularly over time. The models developed in this study should help the process of long-term strategic planning for the number of nurses in Israel.

     

A novel laparoscopic approach to lesions related to the posterior aspect of the pancreatic head

The posterior aspect of the pancreatic head has proven to be a technically demanding region to approach laparoscopically. Previously, this region was approached through the gastrocolic ligament with the patient in a left semilateral position. We believe that this makes the laparoscopic approach to the posterior pancreatic head extremely difficult. In the technique presented here, which has been successfully used in 4 patients, the patient was in full left lateral position, and Nathanson retractors were used to retract the liver and right kidney. This allowed full exposure of the second part of the duodenum before any major dissection. The duodenum was then Kocherized, and the posterior aspect of the pancreatic head, along with the inferior vena cava, left renal vein, and aorta, was exposed. We describe here a safe and feasible laparoscopic method for access to and management of lesions related to the posterior aspect of the pancreatic head.     

Interactions between the processing of gaze direction and facial expression

In this article, we explored the relationship between the processing of facial expression and the processing of gaze direction. In Experiment 1, participants were unable to ignore gaze while classifying expression-or to ignore expression while classifying gaze. This suggests that the processing of expression and the processing of gaze are interdependent. In Experiment 2, the faces were inverted to isolate configural from part-based contributions to this interdependence. Inversion had a striking effect on expression judgments, which could now be processed independently of gaze, but not on gaze judgments, which were still influenced by expression, even when photos that contained only the eye region of faces were presented (Experiment 4). In Experiment 3 the processing of expression was found to be sensitive to even small variations in the direction of gaze. These results suggest that the processing underlying judgments of expression is configural and entails an obligatory computation of gaze direction. Judgments of gaze direction, however, are carried out in a part-based manner using local features around the eyes and are insensitive to the configural aspects of facial processing.     

Autoimmune epilepsy: some epilepsy patients harbor autoantibodies to glutamate receptors and dsDNA on both sides of the blood-brain barrier, which may kill neurons and decrease in brain fluids after hemispherotomy

PURPOSE: Elucidating the potential contribution of specific autoantibodies (Ab's) to the etiology and/or pathology of some human epilepsies. METHODS: Six epilepsy patients with Rasmussen's encephalitis (RE) and 71 patients with other epilepsies were tested for Ab's to the "B" peptide (amino acids 372-395) of the glutamate/AMPA subtype 3 receptor (GluR3B peptide), double-stranded DNA (dsDNA), and additional autoimmune disease-associated autoantigens, and for the ability of their serum and cerebrospinal-fluid (CSF) to kill neurons. RESULTS: Elevated anti-GluR3B Ab' s were found in serum and CSF of most RE patients, and in serum of 17/71 (24%) patients with other epilepsies. In two RE patients, anti-GluR3B Ab's decreased drastically in CSF following functional-hemispherotomy, in association with seizure cessation and neurological improvement. Serum and CSF of two RE patients, and serum of 12/71 (17%) patients with other epilepsies, contained elevated anti-dsDNA Ab's, the hallmark of systemic-lupus-erythematosus. The sera (but not the CSF) of some RE patients contained also clinically elevated levels of "classical" autoimmune Ab's to glutamic-acid-decarboxylase, cardiolipin, beta2-glycoprotein-I and nuclear-antigens SS-A and RNP-70. Sera and CSF of some RE patients caused substantial death of hippocampal neurons. CONCLUSIONS: Some epilepsy patients harbor Ab's to GluR3 and dsDNA on both sides of the blood-brain barrier, and additional autoimmune Ab's only in serum. Since all these Ab's may be detrimental to the nervous system and/or peripheral organs, we recommend testing for their presence in epilepsy, and silencing their activity in Ab-positive patients.     

Temporal integration by calcium dynamics in a model neuron

The calculation and memory of position variables by temporal integration of velocity signals is essential for posture, the vestibulo-ocular reflex (VOR) and navigation. Integrator neurons exhibit persistent firing at multiple rates, which represent the values of memorized position variables. A widespread hypothesis is that temporal integration is the outcome of reverberating feedback loops within recurrent networks, but this hypothesis has not been proven experimentally. Here we present a single-cell model of a neural integrator. The nonlinear dynamics of calcium gives rise to propagating calcium wave-fronts along dendritic processes. The wave-front velocity is modulated by synaptic inputs such that the front location covaries with the temporal sum of its previous inputs. Calcium-dependent currents convert this information into concomitant persistent firing. Calcium dynamics in single neurons could thus be the physiological basis of the graded persistent activity and temporal integration observed in neurons during analog memory tasks.     

Myocardial conduction time and antiarrhythmic drugs

Complete a-v block was induced in anesthetized mongrel dogs by direct electrocoagulation of the a-v node. The ventricles were paced by steady stimulation (S₁) at a rate of 100/min. and by test stimuli (S₂) with varying post S₁ delay. Right ventricular myocardial tension was measured from the S₂ stimulation site by a specially designed miniature strain gage and from a different site by a Walton-Brodie strain gage. A reproducible time lag between the two sites could be measured by comparing the differences in mechanical response to S₂ stimuli. This time difference was called ΔIT. ΔIT varied markedly (from 10–60 msec) when measured at different sites but no linear relationship between ΔIT and the inter-gage distance could be observed. Increasing the S₂ current intensity induced shortening of ΔIT from 37±13 msec (mean±S.D.) at the threshold current to 16±10 msec (mean±S.D.) with 10 mA. A strength-ΔIT curve could be constructed and was found to be remarkably reproducible during the experiment. Quinidine and disopyramide induced upward displacement of the curve, lidocaine did not change it while verapamil lowered the ΔIT values.We suggest that ΔIT can be used as a reliable indicator of myocardial conduction rate. The possible reasoning for this suggestion has been discussed.