Homo sapiens reached the higher latitudes of Europe by 45,000 years ago.

The Middle to Upper Palaeolithic transition in Europe is associated with the regional disappearance of Neanderthals and the spread of Homo sapiens. Late Neanderthals persisted in western Europe several millennia after the occurrence of H. sapiens in eastern Europe1. Local hybridization between the two groups occurred2, but not on all occasions3. Archaeological evidence also indicates the presence of several technocomplexes during this transition, complicating our understanding and the association of behavioural adaptations with specific hominin groups4. One such technocomplex for which the makers are unknown is the Lincombian-Ranisian-Jerzmanowician (LRJ), which has been described in northwestern and central Europe5-8. Here we present the morphological and proteomic taxonomic identification, mitochondrial DNA analysis and direct radiocarbon dating of human remains directly associated with an LRJ assemblage at the site Ilsenhöhle in Ranis (Germany). These human remains are among the earliest directly dated Upper Palaeolithic H. sapiens remains in Eurasia. We show that early H. sapiens associated with the LRJ were present in central and northwestern Europe long before the extinction of late Neanderthals in southwestern Europe. Our results strengthen the notion of a patchwork of distinct human populations and technocomplexes present in Europe during this transitional period.

Development, synthesis and structure-activity-relationships of inhibitors of the macrophage infectivity potentiator (Mip) proteins of Legionella pneumophila and Burkholderia pseudomallei.

The bacteria Burkholderia pseudomallei and Legionella pneumophila cause severe diseases like melioidosis and Legionnaire's disease with high mortality rates despite antibiotic treatment. Due to increasing antibiotic resistances against these and other Gram-negative bacteria, alternative therapeutical strategies are in urgent demand. As a virulence factor, the macrophage infectivity potentiator (Mip) protein constitutes an attractive target. The Mip proteins of B. pseudomallei and L. pneumophila exhibit peptidyl-prolyl cis/trans isomerase (PPIase) activity and belong to the PPIase superfamily. In previous studies, the pipecolic acid moiety proved to be a valuable scaffold for inhibiting this PPIase activity. Thus, a library of pipecolic acid derivatives was established guided by structural information and computational analyses of the binding site and possible binding modes. Stability and toxicity considerations were taken into account in iterative extensions of the library. Synthesis and evaluation of the compounds in PPIase assays resulted in highly active inhibitors. The activities can be interpreted in terms of a common binding mode obtained by docking calculations.

Team Training for Dynamic Cross-Functional Teams in Aviation: Behavioral, Cognitive, and Performance Outcomes.

OBJECTIVE: This study evaluates the effectiveness of a training program designed to improve cross-functional coordination in airline operations. BACKGROUND: Teamwork across professional specializations is essential for safe and efficient airline operations, but aviation education primarily emphasizes positional knowledge and skill. Although crew resource management training is commonly used to provide some degree of teamwork training, it is generally focused on specific specializations, and little training is provided in coordination across specializations. METHOD: The current study describes and evaluates a multifaceted training program designed to enhance teamwork and team performance of cross-functional teams within a simulated airline flight operations center. The training included a variety of components: orientation training, position-specific declarative knowledge training, position-specific procedural knowledge training, a series of high-fidelity team simulations, and a series of after-action reviews. RESULTS: Following training, participants demonstrated more effective teamwork, development of transactive memory, and more effective team performance. CONCLUSION: Multifaceted team training that incorporates positional training and team interaction in complex realistic situations and followed by after-action reviews can facilitate teamwork and team performance. APPLICATION: Team training programs, such as the one described here, have potential to improve the training of aviation professionals. These techniques can be applied to other contexts where multidisciplinary teams and multiteam systems work to perform highly interdependent activities.

Coexistence of different droplet generating instabilities: new breakup regimes of a liquid filament.

The coexistence of multiple droplet breakup instabilities in a Step-emulsification geometry is studied. A liquid filament, which is confined in one dimension by channel walls and surrounded by a co-flowing immiscible continuous phase, decays into droplets when subject to a sudden release of confinement. Depending on the filament aspect ratio and liquid flow rates, an unexpectedly rich variety of droplet breakup regimes is found. All of these breakup regimes are composed of two basic instabilities, i.e. a step- and a jet-instability, that coexist in various combinations on the same filament. Surprisingly, even an asymmetric breakup regime is found, producing droplet families of significantly different diameters, while the filament is subject to a fully symmetric flow field. We suggest key physical principles explaining the spontaneous symmetry breaking and the transitions between individual droplet breakup regimes. The particular ability to produce distinct droplet families from a single filament is demonstrated to allow for simultaneous concentration and encapsulation of particles into one droplet family while excess bulk liquid is released into another family of droplets.

Flow field induced particle accumulation inside droplets in rectangular channels.

Particle concentration is a basic operation needed to perform washing steps or to improve subsequent analysis in many (bio)-chemical assays. In this article we present field free, hydrodynamic accumulation of particles and cells in droplets flowing within rectangular micro-channels. Depending on droplet velocity, particles either accumulate at the rear of the droplet or are dispersed over the entire droplet cross-section. We show that the observed particle accumulation behavior can be understood by a coupling of particle sedimentation to the internal flow field of the droplet. The changing accumulation patterns are explained by a qualitative change of the internal flow field. The topological change of the internal flow field, however, is explained by the evolution of the droplet shape with increasing droplet velocity altering the friction with the channel walls. In addition, we demonstrate that accumulated particles can be concentrated, removing excess dispersed phase by splitting the droplet at a simple channel junction.

Medical homes require more than an EMR and aligned incentives.

BACKGROUND: The Veterans Health Administration (VHA) is changing its primary care delivery by implementing the patient-centered medical home (PCMH). OBJECTIVES: To evaluate PCMH implementation among 22 newly formed teams working in the VHA. STUDY DESIGN: Longitudinal formative evaluation of team members' role transformation during the first 18 months of implementation. METHODS: We used 3 sequential, semistructured focus groups to gather data from 4 different groups representing the principal team member roles: primary care providers, registered nurse care managers, licensed practical nurses, and clerical associates. RESULTS: Team members identified within-team role and interpersonal conflict, as well as discordant administrative leadership styles, as key implementation challenges. CONCLUSIONS: Our results suggest that, in addition to technological and fiscal infrastructure, healthcare leaders implementing the PCMH model must take into account interprofessional issues associated with changes in leadership and the adoption of team-based structures.

Phytoplankton community composition in nearshore coastal waters of Louisiana.

Phytoplankton community compositions within near-shore coastal and estuarine waters of Louisiana were characterized by group diversity, evenness, relative abundance and biovolume. Sixty-six taxa were identified in addition to eight potentially harmful algal genera including Gymnodinium sp. Phytoplankton group diversity was lowest at Vermillion Bay in February 2008, but otherwise ranged between 2.16 and 3.40. Phytoplankton evenness was also lowest at Vermillion Bay in February 2008, but otherwise ranged between 0.54 and 0.77. Dissolved oxygen increased with increased biovolume (R² = 0.85, p < 0.001) and biovolume decreased with increased light attenuation (R² = 0.34, p = 0.007), which supported the importance of light in regulating oxygen dynamics. Diatoms were dominant in relative abundance and biovolume at almost all stations and all cruises. Brunt-Väisälä frequency was used as a measure of water column stratification and was negatively correlated (p = 0.02) to diatom relative percent total abundance.

Improving outpatient diabetes care.

More than 20% of patients in the Veterans Health Administration (VHA) have diabetes; therefore, disseminating "best practices" in outpatient diabetes care is paramount. The authors' goal was to identify such practices and the factors associated with their development. First, a national VHA diabetes registry with 2008 data identified clinical performance based on the percentage of patients with an A1c >9%. Facilities (n = 140) and community-based outpatient clinics (n = 582) were included and stratified into high, mid, and low performers. Semistructured telephone interviews (31) and site visits (5) were conducted. Low performers cited lack of teamwork between physicians and nurses and inadequate time to prepare. Better performing sites reported supportive clinical teams sharing work, time for non-face-to-face care, and innovative practices to address local needs. A knowledge management model informed our process. Notable differences between performance levels exist. "Best practices" will be disseminated across the VHA as the VHA Patient-Centered Medical Home model is implemented.

The self-talk scale: development, factor analysis, and validation.

Researchers and theorists have argued that self-talk plays an important role in everyday behavior and self-regulation. To facilitate research on this role, we developed a new measure of self-talk for use with nonclinical adult populations. The Self-Talk Scale (STS) measures one's frequency of self-talk. Analysis indicated a factor structure consisting of Social Assessment, Self-Criticism, Self-Reinforcement, and Self-Management factors. In 5 studies, we demonstrated that the STS shows acceptable test-retest reliability and preliminary construct validity. We present implications for the use of the STS.

Acne fulminans: a case report.

Acne Fulminans (AF) is a severe form of cystic acne primarily affecting Caucasian adolescent males. The systemic clinical manifestations of the disease make it likely that the patient will present to his or her primary care provider rather than to a dermatologist. Promptly recognizing this disorder will aid in appropriate management, avoiding costly and invasive diagnostic procedures, multiple consultations, unnecessary pharmacologic treatments, and residual scarring of the skin. We report a case and a brief review of the literature regarding this enigmatic disorder.

Aggressive systemic mastocytosis: a case report and brief review of the literature.

Aggressive Systemic Mastocytosis (ASM), a rare subtype of Systemic Mastocytosis (SM), results from clonal proliferation and invasion of multiple organs by neoplastic mast cells. The clinical presentation varies, dependent on which organ systems are involved, and may take an indolent or rapidly fatal course. Several treatment strategies have been proposed. The most effective treatment, though not curative, is a combination of glucocorticoids and alpha-interferon 2b (IFN-alpha). We present a case report of ASM to demonstrate the clinical presentation, laboratory findings, and therapeutic response to treatment.

Management of hyperglycemia in the hospitalized podiatric medical patient.

With the growing prevalence worldwide of diabetes mellitus and hyperglycemia, hospital-based health-care professionals will encounter patients with these conditions with increasing frequency. It is well known that long-term control of blood glucose reduces the rate and severity of complications in patients with diabetes, but there is also mounting evidence that even short-term glycemic control in hospitalized diabetic patients can significantly lower morbidity and mortality in many areas, from nosocomial infection to postoperative course. The results of traditional approaches to controlling blood glucose in hospitalized patients have been disappointing owing to a variety of factors, including the use of oral agents that are difficult or dangerous to use in inpatients, older insulin preparations with unphysiologic modes of action, and even provider reluctance to accept glycemic control as an essential element of the care of the diabetic hospitalized patient. This article provides guidelines for the effective management of hyperglycemia in these patients throughout the hospital stay, with specific recommendations for the perioperative, operative, and postoperative periods.

Consequences of counterion mutation in sensory rhodopsin II of Natronobacterium pharaonis for photoreaction and receptor activation: an FTIR study.

In many retinal proteins the proton transfer from the Schiff base to the counterion represents a functionally important step of the photoreaction. In the signaling state of sensory rhodopsin II from Natronobacterium pharaonis this transfer has already occurred, but in the counterion mutant Asp75Asn it is blocked during all steps of the photocycle. Therefore, the study of the molecular changes during the photoreaction of this mutant should provide a deeper understanding of the activation mechanism, and for this, we have applied time-resolved step-scan FTIR spectroscopy. The photoreaction is drastically altered; only red-shifted intermediates are formed with a chromophore strongly twisted around the 14-15 single bond. In addition, the photocycle is shortened by 2 orders of magnitude. Nevertheless, a transition involving only protein changes similar to that of the wild type is observed, which has been correlated with the formation of the signaling state. However, whereas in the wild type this transition occurs in the millisecond range, it is shortened to 200 micros in the mutant. The results are discussed with respect to the altered electrostatic interactions, role of proton transfer, the published 3D structure, and physiological activity.

Copper deficiency anemia and nephrosis in zinc-toxicity: a case report.

Zinc is a ubiquitous element that is essential for normal enzymatic function in multiple metabolic pathways. Chronic excessive zinc ingestion causes severe reversible anemia in humans. In animals, zinc toxicity leads to anemia as well as physiologic and morphologic damage to the pancreas, kidneys, and often, multisystem failure and death. In this case, a young female ingested approximately 2000 mg of zinc gluconate daily for 12 months. She subsequently developed anemia consistent with zinc-induced copper deficiency and severe nephrosis. After cessation of zinc ingestion, her anemia and nephrosis resolved. This case study underscores the importance of an accurate and thorough investigation of nutritional supplements during the history and physical examination. Given the promulgation of zinc for the treatment of skin disorders and the common cold, along with the commercialization of nutritional supplements, unimpeded by regulatory guidelines, it is imperative that primary care physicians be attuned to the potentially dangerous consequences of excessive zinc ingestion.

Time-resolved FTIR studies of sensory rhodopsin II (NpSRII) from Natronobacterium pharaonis: implications for proton transport and receptor activation.

The photocycle of the photophobic receptor from Natronobacterium pharaonis, NpSRII, is studied by static and time-resolved step-scan Fourier transform infrared spectroscopy. Both low-temperature static and time-resolved spectra resolve a K-like intermediate, and the corresponding spectra show little difference within the noise of the time-resolved data. As compared to intermediate K of bacteriorhodopsin, relatively large amide I bands indicate correspondingly larger distortions of the protein backbone. The time-resolved spectra identify an intermediate L-like state with surprisingly small additional molecular alterations. With the formation of intermediate M, the Schiff-base proton is transferred to the counterion Asp-75. This state is characterized by larger amide bands indicating larger distortions of the protein. We can identify a second M state that differs only in small-protein bands. Reisomerization of the chromophore to all-trans occurs with the formation of intermediate O. The accelerated decay of intermediate M caused by azide results in another red-shifted intermediate with a protonated Schiff base. The chromophore in this state, however, still has 13-cis geometry. Nevertheless, the reisomerization is still as slow as under the conditions without azide. The results are discussed with respect to mechanisms of the observed proton pumping and the possible roles of the intermediates in receptor activation.