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History and Trends in US Medical Education: A Focus on Family Medicine

Medical Bulletin of Shanghai Jiaotong University 2014年第1期26卷 59-67页

作者： Michael A.Sitorius Michael Wadman Bradley Britigan jeffrey d.harrison University of Nebraska Medical Center

The United States medical education system has undergone dramatic changes over the past 350 years. The system has evolved from an individualized apprenticeship format into a standardized, nationally accredited and outcomes based system of training. As residencies in specialty care developed so did the recognized need for a robust primary care system to meet the national healthcare demand; thus leading to the creation of the American Board of Family Practice. Medical education in the US operates on a continuum from college to medical school to residency training to continuing lifelong *** of these components are overseen by nationally recognized accrediting bodies that are designed to ensure the public that physicians are competent and qualified to deliver safe and effective patient care. The most recent trend has been led by the Accreditation Council for Graduate Medical Education(ACGME) through its Next Accreditation System(NAS). The NAS focuses on continuous quality improvement in residency training programs, achievement of observable milestones by individual residents, and sponsoring institutional oversight of the learning environment. These NAS concepts are also expanding into medical school education and continuing medical education areas. These constructs have been incorporated into the newest requirements for Family Medicine training also with a special emphasis on ambulatory care, faculty development, scholarly activity, and defined program outcomes. The evolution of the US medical education system has resulted in a focus on outcomes,national standards, national accreditation, and competent physicians to provide safe and effective are.

关键词： Accreditation Standardization Milestones Outcomes Competency

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New insight into the phylogenetic and biogeographic history of genus Ficus:Vicariance played a relatively minor role compared with ecological opportunity and dispersal

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Journal of Systematics and Evolution 2011年第6期49卷 546-557页

作者： Rhett d.harrison Xishuangbanna Tropical Botanical Garden Chinese Academy of Sciences

Studies on the evolution of tropical taxa emphasize the role of vicariance and the break-up of Gondwana in explaining modern *** studies on figs(Ficus spp.)support this *** the current study,we used an expanded sample(208 spp.)and improved molecular dating techniques to reconstruct the phylogenetic and biogeographic history of *** with previous studies,our biogeographic analysis indicated that the ancestor of Ficus was present in ***,a relaxed clock analysis relying on uncorrelated rates in BEAST suggested that the Neotropical section Pharmacosycea split-off in South America 86.67 Mya,and that other Ficus lineage ancestors originated in *** of the basal lineages appeared to have diverged following KT extinction,then rapidly diversified after India collided with continental *** Afrotropical species most likely evolved initially in the Indian subcontinent then dispersed to Africa,either in the late Cretaceous of Madagascar or even later,following the Eocene collision of India with *** Neotropical section Americana,either islandhopped to South America or took a northern route to the Americas through Europe prior to the terminal Eocene global cooling *** may have arrived in eastern Malesia following the collision of India with Asia,then widely dispersed *** the wide ranges in our date estimates,several other scenarios are ***,contrary to earlier reports,our analyses suggest that vicariance played a relatively minor role compared with ecological opportunity and dispersal in the diversification of genus Ficus.

关键词： biogeographic history evolution Ficus molecular phylogeny vicariance.

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Spatial and seasonal variation in soil respiration along a slope in a rubber plantation and a natural forest in Xishuangbanna, Southwest China

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Journal of Mountain Science 2018年第4期15卷 695-707页

作者： ZHAO Yong-li Stefanie d.GOLdBERG XU Jian-chu Rhett d.harrison Center for Mountain Ecosystem Studies Kunming Institute of Botany Chinese Academy of Sciences Kunming 650201 China University of Chinese Academy of Sciences Beijing 100039 China World Agroforestry Centre East and Central Asia Kunming 650201 China World Agroforestry Centre East & Southern Africa Region 13 Elm Road Woodlands Lusaka Zambia

Soil respiration is a key component of the global carbon cycle, and even small changes in soil respiration rates could result in significant changes in atmospheric CO_2 levels. The conversion of tropical forests to rubber plantations in SE Asia is increasingly common, and there is a need to understand the impacts of this land-use change on soil respiration in order to revise CO_2 budget calculations. This study focused on the spatial variability of soil respiration along a slope in a natural tropical rainforest and a terraced rubber plantation in Xishuangbanna, Southwest(SW) China. In each land-use type, we inserted 105 collars for soil respiration *** was conducted over one year in Xishuangbanna during May, June, July and October 2015(wet season) and January and March 2016(dry season). The mean annual soil respiration rate was 30% higher in natural forest than in rubber plantation and mean fluxes in the wet and dry season were 15.1 and 9.5 Mg C ha^(-1) yr^(-1) in natural forest and 11.7 and 5.7 Mg C ha^(-1) yr^(-1) in rubber plantation. Using a linear mixedeffects model to assess the effect of changes in soil temperature and moisture on soil respiration, we found that soil temperature was the main driver of variation in soil respiration, explaining 48% of its seasonal variation in rubber plantation and 30% in natural forest. After including soil moisture, the model explained 70% of the variation in soil respiration in natural forest and 76% in rubber plantation. In the natural forest slope position had a significant effect on soil respiration, and soil temperature and soil moisture gradients only partly explained this correlation. In contrast, soil respiration in rubber plantation was not affected by slope position, which may be due to the terrace structure that resulted in more homogeneous environmental conditions along the slope. Further research is needed to determine whether or not these findings hold true at a landscape level.

关键词： Soil respiration Tropical rain forest Rubber plantation Land-use change Carbon cycle Transect

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Classifying Cognitive decline in Older drivers from Behavior on Adverse Roads detected Using Computer Vision

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Journal of Transportation Technologies 2025年第1期15卷 135-154页

作者： Md Zahid Hasan Guillermo Basulto-Elias Shauna Hallmark Jun Ha Chang Anuj Sharma jeffrey d. dawson Soumik Sarkar Matthew Rizzo Institute for Transportation Iowa State University Ames Iowa USA department of Neurological Sciences University of Nebraska Medical Center Omaha Nebraska USA

As drivers age, roadway conditions may become more challenging, particularly when normal aging is coupled with cognitive decline. driving during lower visibility conditions, such as inclement weather, is especially challenging for older drivers due to their sensitivity to glare and reduced visibility. As a result, older drivers may adjust their behavior during adverse weather. This paper explores the differential impacts of weather on older drivers with cognitive decline compared to older drivers with normal cognitive function. data were from a naturalistic driving study of older drivers in Omaha, Nebraska. driver speed and weather data were extracted and the correlation between speed compliance, road weather conditions, and the cognitive/neurological status of the drivers was examined. Speed compliance was used as the surrogate safety measure since driving at lower speeds can indicate that the driver is challenged by roadway or environmental conditions and can therefore indicate a risk. The percentage of time during a trip when drivers were 16.1 kph under the speed limit was modeled as the dependent variable using beta regression. The variables that resulted in the best fit model were mild cognitive impairment (MCI), age group, traffic density, and weather. Results indicated that the youngest group of older drivers (young-old) spent less time driving at impeding speeds and had the least variability compared to the other two age groups. The middle group of older drivers (middle-old) had the highest amount of time driving at impeding speeds and had more variability than young-old drivers. The oldest group of older drivers (old-old) were the most likely to drive at impeding speeds and had the most variability. In general, older drivers were more likely to drive at impeding speeds during peak hours than during non-peak hours. Additionally, in most cases, older drivers spent less time below the speed limit when the weather was clear than in adverse conditions. Results i

关键词： Traffic Safety Older driver Cognitive Impairment Machine Learning Speed

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Reduced texaphyrin:A ratiometric optical sensor for heavy metals in aqueous solution

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Frontiers of Chemical Science and Engineering 2020年第1期14卷 19-27页

作者： harrison d.Root Gregory Thiabaud Jonathan L.Sessler department of Chemistry The University of Texas at AustinAustinTX 78712-1224USA

We report here a water-soluble metal cation sensor system based on the as-prepared or reduced form of an expanded porphyrin,*** metal complexation,a change in the redox state of the ligand occurs that is accompanied by a color change from red to *** long employed for synthesis in organic media,we have now found that this complexation-driven redox behavior may be used to achieve the naked eye detectable colorimetric sensing of several number of less-common metal ions in aqueous *** to In(Ⅲ),Hg(Ⅱ),Cd(Ⅱ),Mn(Ⅱ),Bi(Ⅲ),Co(Ⅱ),and Pb(Ⅱ)cations leads to a colorimetric response within 10 *** process is selective for Hg(Ⅱ)under conditions of competitive ***,among the subset of responseproducing cations,In(Ⅲ)proved unique in giving rise to a ratiometric change in the ligand-based fluorescence features,including an overall increase in *** cation selectivity observed in aqueous media stands in contrast to what is seen in organic solvents,where a wide range of texaphyrin metal complexes may be *** formation of metal cation complexes under the present aqueous conditions was confirmed by reversed phase highperformance liquid chromatography,ultra-violet-visible absorption and fluorescence spectroscopies,and highresolution mass spectrometry.

关键词： texaphyrin fluorescent sensor ion-sensing indium mercury

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Hematological changes during androgen deprivation therapy

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Asian Journal of Andrology 2012年第2期14卷 187-192页

作者： Mathis Grossmann jeffrey d Zajac department of Medicine Austin Health/Northern Health University of Melbourne Heidelberg Vic. 3084 Australia

Androgen deprivation therapy （AdT） has been associated with a plethora of adverse effects, consistent with the androgen dependency of multiple reproductive and somatic tissues. One such tissue is the hemopoietic system, and one of the most predictable consequences of AdT is the development of anemia. Although anemia caused by AdT is rarely severe, AdT is often given to frail, elderly men with increased susceptibility to anemia due to multiple other causes. AdT-associated anemia may contribute to fatigue and reduced quality of life （QoL） in such men, although this requires further study. While anemia is an independent risk factor of mortality in men with prostate cancer, it is not known whether treatment of AdT-associated anemia alters clinically important outcomes, or whether treatment affects mortality. Awareness of the phenomenon of AdT-induced anemia should avoid unnecessary work-up in mild cases of normocytic normochromic anemia. However, assessment and treatment of more severe anemia may be required. This should be determined on an individual basis. In contrast to the weli-descrihed actions of AdT on erythropoiesis, its effect on other hemopoietic lineages has been less well elucidated. While preclinical studies have found roles for androgens in maturation and differentiated function of neutrophils, lymphocytes and platelets, the implications of these findings for men with prostate cancer receiving AdT require further studies.

关键词： anemia androgen deprivation therapy (AdT) prostate cancer

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Enhanced Structural Complexity Index:An Improved Index for describing Forest Structural Complexity

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Open Journal of Forestry 2013年第1期3卷 23-29页

作者： Philip Beckschafer Philip Mundhenk Christoph Kleinn Yinqiu Ji douglas W.Yu Rhett d.harrison Chair of Forest Inventory and Remote Sensing Georg-August-Universitat GottingenGottingenGermany State Key Laboratory of Genetic Resources and Evolution Kunming Institute of ZoologyChinese Academy of SciencesKunmingChina School of Biological Sciences University of East AngliaNorwichUK Key Laboratory for Tropical Forest Ecology Xishuangbanna Tropical Botanical GardenChinese Academy of SciencesMenglunChina

The horizontal distribution of stems, stand density and the differentiation of tree dimensions are among the most important aspects of stand structure. An increasing complexity of stand structure is often linked to a higher number of species and to greater ecological stability. For quantification, the Structural Complexity Index (SCI) describes structural complexity by means of an area ratio of the surface that is generated by connecting the tree tops of neighbouring trees to form triangles to the surface that is covered by all triangles if projected on a flat plane. Here, we propose two ecologically relevant modifications of the SCI: The degree of mingling of tree attributes, quantified by a vector ruggedness measure, and a stem density term. We investigate how these two modifications influence index values. data come from forest inventory field plots sampled along a disturbance gradient from heavily disturbed shrub land, through secondary regrowth to mature montane rainforest stands in Mengsong, Xishuangbanna,Yunnan,China. An application is described linking structural complexity, as described by the SCI and its modified versions, to changes in species composition of insect communities. The results of this study show that the Enhanced Structural Complexity Index (ESCI) can serve as a valuable tool for forest managers and ecologists for describing the structural complexity of forest stands and is particularly valuable for natural forests with a high degree of structural complexity.

关键词： Forest Structure Index Structural Complexity Stem Map Species Composition NMdS

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Pressure vessel priming analysis for a regulated liquid propulsion system

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Propulsion and Power Research 2020年第2期9卷 101-115页

作者： jeffrey d.Moore The Pennsylvania State University Altoona CollegeAltoonaPA16601USA

An investigation was performed to determine the pressure transient levels and time required to reach pressure equilibrium in a regulated liquid propulsion system due to the priming of a propellant tank during system *** experimental fluid flow test setup was designed and fabricated using a pressure vessel to house distilled water as a propellant simulant for liquid hydrazine and high-pressure gaseous nitrogen as the pressurant.A snubber orifice was installed downstream of the high-pressure gaseous nitrogen bottles to protect a regulator from high-pressure transients,prior to the regulation of incoming gas to beginning of life propulsion system propellant tank *** were conducted to measure pressure transients and time to pressure equilibrium by varying initial system pressures,snubber orifice diameter,and system ullage volume.A mathematical model was developed and compared against the experimental regulated system priming results to predict the system pressures and time to reach system pressure equilibrium during the pressurization period for regulated propulsion systems given initial conditions.

关键词： Priming event Regulated liquid propulsion system Pressure vessel Pressure transients Snubber orifice

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World Journal of Hepatology 2010年第8期2卷 302-310页

作者： duygu d.harrison-Findik division of Gastroenterology and Hepatology Department of Internal MedicineUniversity of Nebraska Medical Center

The regulation of iron metabolism involves multiple organs including the duodenum,liver and bone *** recent discoveries of novel iron-regulatory proteins have brought the liver to the forefront of iron *** iron overload disorder,genetic hemochromatosis,is one of the most prevalent genetic diseases in individuals of Caucasian ***,patients with non-hemochromatotic liver diseases,such as alcoholic liver disease,chronic hepatitis C or nonalcoholic steatohepatitis,often exhibit elevated serum iron indices(ferritin,transferrin saturation)and mild to moderate hepatic iron *** data indicate significant differences between men and women regarding liver injury in patients with alcoholic liver disease,chronic hepatitis C or nonalcoholic *** penetrance of genetic hemochromatosis also varies between men and *** has been suggested to act as a modifier gene in genetic *** is a circulatory antimicrobial peptide synthesized by the *** plays a pivotal role in the regulation of iron *** has been shown to be regulated by iron,inflammation,oxidative stress,hypoxia,alcohol, hepatitis C and *** and genetic background have also been shown to modulate hepcidin expression in *** role of gender in the regulation of human hepcidin gene expression in the liver is ***,hepcidin may play a role in gender-based differences in iron metabolism and liver *** understanding of the mechanisms associated with gender-related differences in iron metabolism and chronic liver diseases may enable the development of new treatment strategies.

关键词： Alcohol Hepcidin Hepatitis C Hemochromatosis Non-alcoholic steatohepatitis

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Human androgen deficiency： insights gained from androgen receptor knockout mouse models

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Asian Journal of Andrology 2014年第2期16卷 169-177,I0006页

作者： Kesha Rana Rachel A davey jeffrey d Zajac department of Medicine Austin Health University of Melbourne Heidelberg Victoria Australia.

The mechanism of androgen action is complex. Recently, significant advances have been made into our understanding of how androgens act via the androgen receptor （AR） through the use of genetically modified mouse models. A number of global and tissue-specific AR knockout （ARKO） models have been generated using the Cre-loxP system which allows tissue- and/or cell-specific deletion. These ARKO models have examined a number of sites of androgen action including the cardiovascular system, the immune and hemopoetic system, bone, muscle, adipose tissue, the prostate and the brain. This review focuses on the insights that have been gained into human androgen deficiency through the use of ARKO mouse models at each of these sites of action, and highlights the strengths and limitations of these Cre-loxP mouse models that should be considered to ensure accurate interpretation of the phenotype.

关键词： androgen receptor androgen receptor knockout mouse model androgen deficiency

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