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Microvascular injury, inflammation, and coagulation play critical roles in the pathogenesis of acute lung injury (ALI). Plasma protein C levels are decreased in patients with acute lung injury and are associated with higher mortality and fewer ventilator-free days. To test the efficacy of activated protein C (APC) as a therapy for patients with ALI. Eligible subjects were critically ill patients who met the American/European consensus criteria for ALI. Patients with severe sepsis and an APACHE II score of 25 or more were excluded. Participants were randomized to receive APC (24 microg/kg/h for 96 h) or placebo in a double-blind fashion within 72 hours of the onset of ALI. The primary endpoint was ventilator-free days. APC increased plasma protein C levels (P = 0.002) and decreased pulmonary dead space fraction (P = 0.02). However, there was no statistically significant difference between patients receiving placebo (n = 38) or APC (n = 37) in the number of ventilator-free days (median [25-75% interquartile range]: 19 [0-24] vs. 19 [14-22], respectively; P = 0.78) or in 60-day mortality (5/38 vs. 5/37 patients, respectively; P = 1.0). There were no differences in the number of bleeding events between the two groups. APC did not improve outcomes from ALI. The results of this trial do not support a large clinical trial of APC for ALI in the absence of severe sepsis and high disease severity.

The purpose of this phenomenological study is to understand the impact of a student’s spirituality on the decisions he or she makes during transition. For this study, transition will be defined as the process of moving from high school to post-secondary education and employment. Spirituality will be defined as moments of transcendence that can often provide clarity and guidance (Maslow, 1976). The process of transition can be both stressful and exciting. While supports and preparation can make an impact, it is possible that the student’s spiritual beliefs are a significant factor in the decisions that are made. The following research questions attempt to explain this phenomenon: How much of a spiritual emphasis is placed on a student's decisions regarding post-secondary education and employment? How does a student's level of spiritual development contribute to his or her feelings of academic and life success? and How does a student's level of spiritual development contribute to his or her idea of a career calling? The intended participants will be 10 students, either juniors or seniors, enrolled in a private Christian school. The research methods are based in transcendental phenomenology which chooses to collect individual stories and look at them as separate entities that create a phenomenon. The stories will be revealed through the collection and analysis of interviews, journals, and site documentation. Moustakas’ seven steps for data analysis will be used to analyze each experience to create common themes and develop a textural-structural description of the essence of the phenomenon.

Purpose Deposition of fibrin in the alveolar space is a hallmark of acute lung injury (ALI). Plasminogen activator inhibitor-1 (PAI-1) is an antifibrinolytic agent that is activated during inflammation. Increased plasma and pulmonary edema fluid levels of PAI-1 are associated with increased mortality in adults with ALI. This relationship has not been examined in children. The objective of this study was to test whether increased plasma PAI-1 levels are associated with worse clinical outcomes in pediatric patients with ALI. Design/methods We measured plasma PAI-1 levels on the first day of ALI among 94 pediatric patients enrolled in two separate prospective, multicenter investigations and followed them for clinical outcomes. All patients met American European Consensus Conference criteria for ALI. Results A total of 94 patients were included. The median age was 3.2 years (range 16 days–18 years), the PaO 2 /F i O 2 was 141 ± 72 (mean ± SD), and overall mortality was 14/94 (15%). PAI-1 levels were significantly higher in nonsurvivors compared to survivors ( P  < 0.01). The adjusted odds of mortality doubled for every log increase in the level of plasma PAI-1 after adjustment for age and severity of illness. Conclusions Higher PAI-1 levels are associated with increased mortality and fewer ventilator-free days among pediatric patients with ALI. These findings suggest that impaired fibrinolysis may play a role in the pathogenesis of ALI in pediatric patients and suggest that PAI-1 may serve as a useful biomarker of prognosis in patients with ALI.

This volume discusses the interface between human development and socio-cultural processes by exploring the writings of Gerard Duveen, an internationally renowned figure, whose untimely death left a void in the fields of socio-developmental psychology, cultural psychology, and research into social representations. Duveen's original and comprehensiv

Three distinct endosomal fractions were isolated in high purity from livers of estradiol-treated rats. Each fraction had characteristic physical and ultrastructural properties, but the lipid composition and major proteins of their membranes were similar and differed from those derived from the Golgi apparatus. Injected radioiodinated low density lipoproteins accumulated first in the fraction of intermediate density and later in the low density fraction. The latter was composed almost exclusively of lipoprotein-filled multivesicular bodies, most of which had a single membranous appendage. The fraction of intermediate density was composed of lipoprotein-filled vesicles that were smaller than multivesicular bodies and also had membranous appendages. The high density fraction was composed of membranes resembling the appendages of the two vesicular fractions. All three fractions were enriched in receptors for low density lipoproteins and asialoglycoproteins, but receptor concentrations were considerably reduced in multivesicular bodies. The fraction of intermediate density may represent the compartment of uncoupling of receptor and ligand (CURL) described by Geuze et al. [Geuze, H. J., Slot, J. W., Strous, G. J. A. M., Lodish, H. F. & Schwartz, A. L. (1983) Cell 32, 277-287]. CURL vesicles may lose some of their appendages as multivesicular bodies are formed. The high density fraction then may represent a receptor-recycling compartment.

Highly purified endosomal membranes from rat liver, enriched in receptors for a number of macromolecules taken up into hepatocytes via the coated pit/endosome/lysosome pathway [including the receptor for low density lipoproteins (LDL)], were used to characterize binding sites for lipoproteins containing apolipoprotein E. In endosomal membranes from livers of estradiol-treated rats, in which LDL receptors are induced manyfold, two high-affinity binding sites were found for two apolipoprotein E-rich lipoproteins: very low density β -lipoproteins (β -VLDL) from cholesterol-fed rabbits and rat chylomicron remnants. One of these sites, binding to which is inhibited by 30 mM EDTA, appears identical to the LDL receptor by ligand and immunoblotting and other characteristics. The other site, highly resistant to EDTA, does not bind LDL. Binding to the EDTA-resistant site, however, is readily inhibited by heparin (as is the LDL receptor) and also by antisera prepared against rat or bovine LDL receptor. The distribution of the EDTA-resistant site among early endosomes, late endosomes, and endosome-derived receptor-recycling membranes is similar to that of the LDL receptor and other recycling receptors. The LDL receptor was present in endosomal membranes from livers of untreated rats at about 10% of the level found in membranes from estradiol-treated rats, but the EDTA-resistant site was barely detectable. No saturable binding of β -VLDL that could not be inhibited by antisera to the LDL receptor could be detected in endosomal membranes from livers of either untreated or estradiol-treated rats. The EDTA-resistant site may be a modified form of the LDL receptor that recognizes apolipoprotein E but not the B apolipoprotein of LDL. Alternatively, it may be a distinct receptor sharing immunological determinants with the LDL receptor, specialized for the endocytosis of certain lipoproteins containing apolipoprotein E, including chylomicron remnants.

Editor: I am concerned about the Aug. 6 article in The Sun about the \"Nancy Drew Mystery Series.\" I very much disagree.

The problem investigated in this study was the correlation, if any, between and among mean scores of various dimensions of self-concept and student self earned by 98 sixth grade public school students identified as gifted and nongifted. Findings suggested that dimensions of self-concept are not different in gifted and nongifted children, while dimensions of student self are different in gifted and nongifted children.

It is possible for an organization to recover from a negative quality circle experience. Lake Financial Corp. instituted a quality circle program that experienced problems, bit the firm set out to reinvigorate the program. Basic to the recovery was participation in a series of state-of-the-art training sessions through which supervisors and staff learned how to breathe new life into the quality circle groups. They learned such strategies as creating a culture for productivity, developing reward structures, and selecting group members prudently. It is important that the philosophy and objectives of the quality circle program start at the top of the organization. Also, quality circle participants should join on a voluntary basis. A systematic strategy to introduce an involvement effort is outlined.

Can an organization recover from a negative quality circle experience? Management at a midwestern bank explored a failed quality circle program to find out what went wrong and reinvigorate the process