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Establishing an integrated gastroenterology service between a medical center and the community

World Journal of Gastroenterology 2015年第7期21卷 2152-2158页

作者： Yaron Niv Ram Dickman Zohar Levi Gadi Neumann Dorit Ehrlich haim bitterman Jacob Dreiher Arnon Cohen Doron Comaneshter Eyran Halpern Rabin Medical Center Clalit Health Services Tel Aviv University Dan-Petach Tikva District Clalit Health Services General Management Clalit Health Services

AIM:To combine community and hospital services inorder to enable improvements in patient management,an integrated gastroenterology service(IGS)was ***:Referral patterns to specialist clinics were optimized;open access route for endoscopic procedures(including esophago-gastro-duodenoscopy,sigmoidoscopy and colonoscopy)was established;family physicians’knowledge and confidence were enhanced;direct communication lines between experts and primary care physicians were *** education,guidelines and agreed instructions for referral were promoted by the *** quality indicators were developed by the Delphi method,rigorously designed and regularly *** was assessed by comparing 2010,2011 and 2012 ***:An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of *** this paper we describe a new integrated gastroenterology service established in April *** time for procedures decreased:3 mo in April 30th 2010 to 3 wk in April 30th 2011and stayed between 1-3 wk till December 30th *** cost for patient’s visit decreased from 691 to638 NIS(a decrease of 7.6%).Six health indicators were improved significantly comparing 2010 to 2012,2.5%to 67.5%:Bone densitometry for patients with inflammatory bowel disease,preventive medications for high risk patients on aspirin/NSAIDs,colonoscopy following positive fecal occult blood test,gastroscopy in Barrett’s esophagus,documentation of family history of colorectal cancer,and colonoscopy in patients with a family history of colorectal ***:Establishment of an IGS was found to effectively improve quality of care,while being costeffective.

关键词： Gastroenterology Direct referral Endoscopy Communi

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Physiological adaptations of small mammals to desert ecosystems

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Integrative Zoology 2009年第4期4卷 357-366页

作者： Hagit SCHWIMMER Abraham haim Department of Biology The University of HaifaHaifaIsrael

Adaptations of animals to the xeric environment have been studied in various taxonomic groups and across several *** the impressive data that have been accumulated,the focus in most of these studies is mainly on the significance of one variable at a ***,we attempt to integrate between responses of several physiological systems,challenged by increasing diet and water salinity and extreme temperatures,acquired in different studies of thermo and osmo-regulatory adaptations,of small rodents,to the xeric *** have shown differen-tial thermoregulatory responses to increased dietary salinity,which were attributed to habitat and habits of the relevant *** the thermoregulatory studies,a potential adaptive significance of low metabolic rate was *** an evolutionary point of view,the most important adaptation is in the timing of reproduction,as it enables the transfer of genetic properties to the next generation in an unpredictable ecosystem,where repro-duction might not occur every *** in this aspect show that increased dietary salinity,through an increase in vasopressin plasma levels,plays an important role as a regulator of the reproductive *** assume that the amount of food existing in the habitat and the amount of reserves in the animal in the form of white adipose tissue are important for *** affects all studied physiological responses,emphasizing the impor-tance of pre-acclimation to seasonal *** summarize the existing data and suggest neuro-endocrine pathways,which have a central role in these adaptations by affecting thermoregulation,osmoregulation and repro-duction to create the optimal response to xeric *** hypotheses can be used as the basis for future studies.

关键词： adaptation osmoregulation thermoregulation vasopressin xeric environment.

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Bright artificial light at night is associated with increased body mass,poor reproductive success and compromised disease tolerance in Australian budgerigars(Melopsittacus undulatus)

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Integrative Zoology 2019年第6期14卷 589-603页

作者： Itay MALEK Abraham haim Department of Evolutionary and Environmental Biology University of HaifaMount CarmelHaifaIsrael The Israeli Center for Interdisciplinary Research in Chronobiology University of HaifaHaifaIsrael

Artificial light at night(ALAN)can cause circadian disruption and result in adverse behavioral and ecological effects in free-living birds,but studies on captive pet birds as companion animals have been *** studied the effects of exposure to bright ALAN on body mass,melatonin sulfate levels,reproduction and disease severity in Australian budgerigars(Melopsittacus undulatus)kept in *** the experiment,birds were kept under outdoor temperature,humidity and natural photoperiod from September to December.A total of 48 birds were equally split into 4 groups(6 mating pairs each)and concurrently exposed to ALAN of 200 lux with different duration(0,30,60 and 90 min).Monthly observations were recorded for all dependent parame*** exposure increased mass gain and suppressed melatonin levels in a dose-dependent manner,especially during *** addition,ALAN exposure in all duration groups decreased egg production and reduced hatchability from 61%±14%in the ALAN-unexposed control group to 0%in the ALAN-exposed *** severity was also found to increase in line with the duration of ALAN *** captive ***latus,ALAN exposure was demonstrated to affect photoperiodic regulation with subsequent excess mass gain and reproduction impairment,and increased susceptibility to infections plausibly through duration dose-dependent suppression of *** the best of our knowledge,this is the first study to demonstrate a possible association between acute bright ALAN of increasing duration and both natural development of infections as well as reproductive cessation in captive *** findings could be used to improve breeding conditions of captive birds.

关键词： avian model circadian disruption disease susceptibility light pollution stress responses

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Accelerating CFD–DEM simulation of processes with wide particle size distributions

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Particuology 2014年第1期12卷 113-121页

作者： Tamir Brosh haim Kalman Avi Levy Pearlstone Centre for Aeronautical Engineering Studies Department of Mechanical Engineering Ben-Gurion University of the Negev School of Mechanical and Systems Engineering Stephenson Building Claremont Road Newcastle University

Sizereduction systems have been extensively used in industry for many years. Nevertheless, reliable engi neering tools to be used to predict the comminution of particles are scarce. Computational fluid dynamics （CFD）discrete element model （DEM） numerical simulation may be used to predict such a complex phe nomenon and therefore establish a proper design and optimization model for comminution systems, They may also be used to predict attrition in systems where particle attrition is significant. Therefore, empirical comminution functions （which are applicable for any attrition/comminution process）, such as： strength distribution, selection, equivalence, breakage, and fatigue, have been integrated into the three dimensional CFDDEM simulation tool. The main drawback of such a design tool is the long computational time required owing to the large number of particles and the minute timestep required to maintain a steady solution while simulating the flow of particulate materials with very fine particles. The present study developed several methods to accelerate CFDDEM simulations： reducing the num ber of operations carried out at the singleparticle level, constructing a DEM grid detached from the CFD grid enabling a no binary search, generating a subgrid within the DEM grid to enable a no binary search for fine particles, and increasing the computational timestep and eliminating the finest particles in the simulation while still tracking their contribution to the process. The total speedup of the simulation process without the elimination of the finest particles was a factor of about 17. The elimination of the finest particles gave additional speedup of a factor of at least 18. Therefore, the simulation of a grinding process can run at least 300 times faster than the conventional method in which a standard no binary search is employed and the smallest particles are tracked.

关键词： Computational fluid dynamicsDiscrete element modelSearch algorithmIncreased time-step

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Protein kinase A inhibition induces EPAC-dependent acrosomal exocytosis in human sperm

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Asian Journal of Andrology 2019年第4期21卷 337-344页

作者： Diana Itzhakov Yeshayahu Nitzan haim Breitbart The Mina and Everard Faculty of Life Sciences Bar-llan University Ramat-Gan 5290002 Israel Department of Clinical Laboratory Science Zefat Academic College Zefat 1320611 Israel

To in teract with the egg, the spermatozo on must un dergo several biochemical and motility modifications in the female reproductive tract, collectively called capacitation. Only capacitated sperm can undergo acrosomal exocytosis, near or on the egg, a process that allows the sperm to penetrate and fertilize the egg. In the present study, we investigated the invoIvement of cyclic adenosine monophosphate (cAMP)-dependent processes on acrosomal exocytosis. Inhibition of protein kinase A (PKA) at the end of capacitation induced acrosomal exocytosis. This process is cAMP-dependent;however, the addition of relatively high concentration of the membrane-permeable 8-bromo-cAMP (8Br-cAMP, 0.1 mmol l^-1) analog induced significant inhibition of the acrosomal exocytosis. The induction of acrosomal exocytosis by PKA inhibition was significantly inhibited by an exchange protein directly activated by cAMP (EPAC) ESI09 inhibitor. The EPAC selective substrate activated AE at relatively low concentrations (0.02-0.1 μmol l^1), whereas higher concerttrations (>5 pmol l^-1) were inhibitory to the AE induced by PKA inhibition. Inhibition of PKA revealed about 50% increase in intracellular cAMP levels, conditions under which EPAC can be activated to induce the AE. Induction of AE by activating the actin severing?protein, gelsolin, which causes F-actin dispersion, was inhibited by the EPAC inhibitor. The AE induced by PKA inhibition was mediated by phospholipase C activity but not by the Ca^2+-channel, CatSper. Thus, inhibition of PKA at the end of the capacitation process induced EPAC/phospholipase C-dependent acrosomal exocytosis. EPAC mediates F-actin depolymerization an d/or activation of effectors down stream to F-actin breakdown that lead to acrosomal exocytosis.

关键词： acrosomal exocytosis exchange protein directly activated by cyclic adenosine monophosphate protein kinase A sperm

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Mechanism of sperm capacitation and the acrosome reaction： role of protein kinases

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Asian Journal of Andrology 2012年第6期14卷 816-821页

作者： Debby Ickowicz Maya Finkelstein haim Breitbart The Mina & Everard Faculty of Life Sciences Bar-Ilan University Ramat-Gan 52100 Israel

Mammalian sperm must undergo a series of biochemical and physiological modifications, collectively called capacitation, in the female reproductive tract prior to the acrosome reaction （AR）. The mechanisms of these modifications are not well characterized though protein kinases were shown to be involved in the regulation of intracellular Ca2＋ during both capacitation and the AR. In the present review, we summarize some of the signaling events that are involved in capacitation. During the capacitation process, phosphatidyl-inositol-3-kinase （PI3K） is phosphorylated/activated via a protein kinase A （PKA）-dependent cascade, and downregulated by protein kinase C a （PKCa）. PKCa is active at the beginning of capacitation, resulting in PI3K inactivation. During capacitation, PKCa as well as PP172 is degraded by a PKA-dependent mechanism, allowing the activation of PI3K. The activation of PKA during capacitation depends mainly on cyclic adenosine monophosphate （cAMP） produced by the bicarbonate-dependent soluble adenylyl cyclase. This activation of PKA leads to an increase in actin polymerization, an essential process for the development of hyperactivated motility, which is necessary for successful fertilization. Actin polymerization is mediated by PIP2 in two ways： first, PIP2 acts as a cofactor for phospholipase D （PLD） activation, and second, as a molecule that binds and inhibits actin-severing proteins such as gelsolin. Tyrosine phosphorylation of gelsolin during capacitation by Src family kinase （SFK） is also important for its inactivation. Prior to the AR, gelsolin is released from PIP2 and undergoes dephosphorylation/activation, resulting in fast F-actin depolymerization, leading to the AR.

关键词： sperm capacitation acrosome reaction AR PKCα PI3K PKA gelsolin PIP2

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Effect of conspecific and heterospecific urine odors on the foraging behavior of the golden spiny mouse

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Integrative Zoology 2013年第1期8卷 1-8页

作者： Claude BAUDOIN Abraham haim Jean-Luc DURAND Experimental and Comparative Ethology University of Paris 13VilletaneuseFrance Israeli Center for Interdisciplinary Research in Chronobiology University of HaifaHaifaIsrael

The common spiny mouse(Acomys cahirinus)inhibits the foraging activity of the golden spiny mouse(***).These two sympatric species of spiny mice,which are considered habitat competitors,occur in extreme arid *** test this theory of competition,the influence of urinary odors of both conspecific and heterospecific mice on the foraging behavior of *** was studied under controlled laboratory *** adult males,born in captivity and unfamiliar to the odors of the donor mice,were tested in 3 experimental conditions choosing between 2 seed patches that were scented with urine of either heterospecifics(***),conspecifics(***)or controls(odors of the tested individual).Of the 20 males,12 were also tested with urine of unfamiliar gerbils,bushy-tailed jird,considered as competitors in the *** conspecific and heterospecific urine samples from Acomys significantly reduced foraging behavior of *** when compared to the control *** inhibitory effect of the Acomys urine does not result from the novelty of chemical stimuli of the urine because no effect was shown with unfamiliar gerbil *** findings are in accordance with the general theory that *** dominates the foraging activity of *** hypothesize that chemical cues in the urine of Acomys *** induce a negative effect on the foraging behavior of ***.

关键词： Acomys spp. foraging behavior golden spiny mouse Sekeetamys calurus urine odors

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Biliary leaks after laparoscopic cholecystectomy:time to stent or time to drain

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Hepatobiliary & Pancreatic Diseases International 2008年第6期7卷 628-632页

作者： haim Pinkas Patrick G.Brady Division of Digestive Diseases and Nutrition University of South Florida

BACKGROUND:Endoscopic retrograde cholangiopan- creatography(ERCP)with placement of a biliary stent or nasobiliary(NB)drain is the procedure of choice for treatment of post-cholecystectomy bile duct *** aim of this study was to compare the effect of NB drainage versus internal biliary stenting on rates of leak closure, time elapsed until drain or stent removal,length of hospital stay and number of required endoscopic procedures. METHODS:Charts were reviewed on 20 patients who underwent laparoscopic cholecystectomy complicated by Luschka or cystic duct *** patients were treated with NB drains connected to low intermittent suction and repeat NB cholangiograms were performed until leak closure was *** patients were treated with internal biliary *** sphincterotomies were performed for stone extraction or a presumed papillary *** bilomas were drained percutaneously prior to stenting. RESULTS:In all 20 patients,a cholangiogram and successful placement of a NB drain or internal stent was *** patients(20%)were found to have bile duct stones,which were extracted following a sphincterotomy. Sixteen patients required percutaneous drains to evacuate large bilomas prior to biliary *** cystic duct leaks and 5 Luschka duct leaks were reviewed. There were no complications related to *** of the leak was documented within 2 to 11 days(mean 4.7±0.9 days)in patients receiving a NB *** drains were removed non-endoscopically following leak closure. The internal stent group required stenting for 14 to 53 days(mean 29.1±4.4 days).The stent was then removed endoscopically after documentation of leak *** leaks following laparoscopic cholecystectomy closed rapidly after NB drainage and did not require repeat endoscopy for removal of the NB drain,resulting in fewer ERCPs required for treatment of biliary *** biliary stents were in place longer owing to the nature of this intermittent endos

关键词： biliary leak cholecystectomy,laparoscopic endoscopic retrograde cholangiopancreatography nasobiliary drain biliary stent

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DMRT1 at the border between mitosis and meiosis

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Asian Journal of Andrology 2011年第2期13卷 189-190页

作者： Jeremy Don Uri Nir haim Breitbart The Mina and Everard Goodman Faculty of LifeSciences Bar-Ilan University Ramat-Gan 52900 Israel

In males, sperm production begins at puberty and lasts throughout reproduct-ire life. This implies that a population of germ stem cells/progenitors must be main- tained, amplified and differentiate throughout life to enable the continuous supply of sperm. Spermatogenesis is indeed divided into three phases： a proliferative phase, a meiotic phase and a postmeiotic spermio- genic phase. In the proliferative phase, undifferentiated spermatogonia stem cells are divided to maintain the principle undiffer- entiated stern cell population on the one hand, and on the other hand to amplify and differentiate a fraction of the spermatogonia into primary spermatocytes.

关键词： Production Productivity Products Cells Lymphocytes Semen Political systems Stems Gametes Spermatozoa

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Regularized Interpolation Driven by Total Variation

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Analysis in Theory and Applications 2019年第4期35卷 335-354页

作者： haim Brezis Department of Mathematics RutgersThe State University110 Frelinghuysen Rd.PiscatawayNJ 08854-8019USA Departments of Mathematics and Computer Science TechnionIsrael Institute of Technology32.000 HaifaIsrael

We explore minimization problems of the form ■ where u is a function defined on(0, 1),(ai) are k given points in(0, 1), with k ≥ 2,( fi)are k given real numbers, and α≥ 0 is a parameter taken to be 0 or 1 for *** natural functional setting is the Sobolev space W1,1(0, 1). When α = 0 the Inf is achieved in W1,1(0, 1). However, when α = 1, minimizers need not exist in W1,1(0, 1).One is led to introduce a relaxed functional defined on the space BV(0, 1), whose minimizers always exist and can be viewed as generalized solutions of the original ill-posed problem.

关键词： Interpolation minimization problems functions of bounded variation relaxed func tional

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