Interim Position Research Articles

Incretin-based Therapies (Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase - 4 Inhibitors) for the Treatment of Type 2 Diabetes

Since the publication of the 2008 guidelines, a number of new agents have been approved in Canada, all in the incretin class. Because our next set of guidelines will not be published until 2013, it was felt that an interim position statement should be developed. Glucose-dependent insulinotropic polypeptide (GIP) and glucagon like peptide-1 (GLP-1) are incretin hormones secreted by cells of the gastrointestinal (GI) tract in response to food ingestion (1). GIP is secreted from K-cells, located primarily in the duodenum. GLP-1 is secreted from the L-cells, located primarily in the distal ileum but also found in the rest of the small and large intestine, pancreatic alpha-cells and central nervous system (2). Secretion of the incretin hormones results in glucose-dependent stimulation of insulin secretion. GLP-1 also inhibits glucagon secretion by stimulating insulin release from beta-cells and via somatostatin secretion from the D-cells (3e6). Other actions of GLP-1 include inhibition of gastric emptying, and reduction in appetite and food intake (6). Incretin hormones are secreted within minutes of nutrient intake, suggesting a mechanism controlled by a combination of neural and endocrine stimulatory factors (1). Subsequent direct nutrient contact with GLP-1esecreting L cells in the distal small bowel and colon also stimulates GLP-1 secretion (3). The circulating levels of intact GLP-1 decrease rapidly by enzymatic inactivation mediated by dipeptidyl peptidase-4 (DPP-4), and by renal clearance (7e9). DPP-4 is found on endothelial and epithelial cells throughout the vascular beds, and is widely distributed. DPP-4 enzymatic removal of the N-terminal dipeptides results in a very short circulating half-life of 2 minutes for native GLP-1 (5,10). The incretin effect is significantly reduced in type 2 diabetes. Recent studies suggest that the defective incretin action in type 2 diabetes results from loss or decreased responsiveness of beta-cells to insulinotropic action of GIP, even though GLP-1 secretion and activity is maintained (11e14). The lack of responsiveness to GIP is mainly related to a decrease in beta-cell mass (15). To overcome the rapid degradation of native GLP-1, DPP-4degradation-resistant GLP-1 receptor agonists (GLP-1RA) have

Downsizing Expands Career Opportunities for Women

Downsizing Expands Career Opportunities for Women

Internal Medicine Department Chairs: Where They Come From, Why They Leave, Where They Go

Internal Medicine Department Chairs: Where They Come From, Why They Leave, Where They Go

Choosing or Becoming an Interim Administrator

Filling an administrative position on an interim basis requires careful deliberation even when the decision has to be made quickly. A poor fit, even for a short-term position, can lead to problems for the interim administrator, the subsequent permanent administrator, faculty, staff, students, and the nursing program. This article poses questions for decision makers who are contemplating filling a position with an interim appointee. These decision makers must determine the need for an interim administrator, his or her role, the anticipated length of an interim appointment, and whether the interim appointee can apply for the permanent position. In addition, relevant questions are presented for those persons who are considering accepting an interim position, including questions about the position itself and their preparation and personal goals and considerations for leaving the temporary position.

Leading in a Time of Change: Assuming Interim Academic Administrator Positions

This article is about interim leadership in academic settings, specifically at the level of dean of an educational program in nursing. The interim administrator is often an invisible actor in the history of a school or department. However, they are key players in maintaining stability, facilitating change, and providing a transitional pathway for the new, permanent leader. An essential theme is that interim administrators do real work that has consequences, and make real contributions to institutional history and continuity. This article provides guidance to those considering or serving in interim positions. Guidelines are suggested for the stages of evaluating and serving in interim positions: assessing the request to serve, making a decision about accepting an interim position, negotiating an interim position, and acting out the interim position, using the analogy of a theatrical play and guideposts for actors.

Revised U.S. Surveillance Case Definition for Severe Acute Respiratory Syndrome (SARS) and Update on SARS Cases—United States and Worldwide, December 2003

During the 2003 epidemic of severe acute respiratory syndrome (SARS), CDC and the Council of State and Territorial Epidemiologists (CSTE) developed surveillance criteria to identify persons with SARS. The surveillance case definition changed throughout the epidemic as understanding of the clinical, laboratory, and transmission characteristics of SARS-associated coronavirus (SARS-CoV) increased. On June 26, CSTE adopted a position statement to add SARS-CoV disease to the National Notifiable Disease Surveillance System (NNDSS). The position statement included criteria for defining a SARS case for national reporting. On November 3, CSTE issued a new interim position statement with a revised SARS case definition. This report summarizes the new U.S. surveillance case definition for SARS and updates reported cases of SARS worldwide and in the United States.

Interim position statement on intensive care nursing staffing

This is the interim position statement as of December 2000. A full review will be made following membership feedback in June 2001.

Environmental endocrine disruption: an effects assessment and analysis.

This report is an overview of the current state of the science relative to environmental endocrine disruption in humans, laboratory testing, and wildlife species. Background information is presented on the field of endocrinology, the nature of hormones, and potential sites for endocrine disruption, with specific examples of chemicals affecting these sites. An attempt is made to present objectively the issue of endocrine disruption, consider working hypotheses, offer opposing viewpoints, analyze the available information, and provide a reasonable assessment of the problem. Emphasis is placed on disruption of central nervous system--pituitary integration of hormonal and sexual behavioral activity, female and male reproductive system development and function, and thyroid function. In addition, the potential role of environmental endocrine disruption in the induction of breast, testicular, and prostate cancers, as well as endometriosis, is evaluated. The interrelationship of the endocrine and immune system is documented. With respect to endocrine-related ecological effects, specific case examples from the peer-reviewed literature of marine invertebrates and representatives of the five classes of vertebrates are presented and discussed. The report identifies some data gaps in our understanding of the environmental endocrine disruption issue and recommends a few research needs. Finally, the report states the U.S. Environmental Protection Agency Science Policy Council's interim position on endocrine disruption and lists some of the ongoing activities to deal with this matter.

INTRODUCTION

One of Saul Krugman's favorite photographs recalls the day in 1965 when he handed his predecessor at New York University, L. Emmett Holt, Jr., a copy of the Festschrift in his honor. Some 25 years later, it is our privilege to similarly honor Saul. It continues a long tradition at Bellevue Hospital. A Festschrift was dedicated to Abraham Jacobi, the first Director of Pediatrics, some 100 years ago. Tradition plays an important role in Saul Krugman's life and in the history of medicine in New York City. New York hospitals have long been involved with the sequestration and care of patients with infectious diseases. In fact, many municipal hospitals were established because of epidemics of smallpox, measles, typhus, yellow fever, cholera, and typhoid fever. To protect the general population from infections arriving on ships, quarantine sites were established on islands in New York Harbor and the East River. These quarantine hospitals became the pest houses. The word "pest" derives from the first of the three great scourges of mankind: pestilence, famine, and war. As New York's municipal hospital system became better established, the pest houses evolved into infectious disease hospitals. The most famous of these was Willard Parker Hospital located on the East River on Manhattan's lower East side. Saul was discharged from the Air Force in 1946 and joined an army of veterans seeking hospital training. Because of a delay in procuring a Pediatric residency at NYU-Bellevue, he took an interim position as resident physician at Willard Parker for six months. At the time all patients with infectious diseases in New York were funnelled into three specialty hospitals. Waves of children arrived at Willard Parker with scarlet fever, measles, pertussis, croup, and polio, filling wards to overflowing. Saul became an expert in infectious disease even before he began his pediatric residency! He maintained his affiliation with Willard Parker until it was closed 10 years later, signaling the end of an epoch as the result of medical advances. During those momentous years, Saul sharpened his clinical skills to an extraordinary degree, laying the groundwork for his future career in research and accumulating the experience that made the Krugman and Ward text, Infectious Diseases of Children, now in its 9th edition, an international success. The past 100 years has seen the conquest in this country of most of the dreaded infections that concerned us at the opening of the century. Saul Krugman participated in many of those advances. It is part of the irony of medical progress that, as we congratulate ourselves on our success, a new threat has emerged which will tax our energies and resources for many years to come. The frightening dimensions of AIDS will stalk the 21st century.

A Theory of Signalling During Job Search, Employment Efficiency, and "Stigmatised" Jobs

This paper discusses why redundant skilled workers may be reluctant to accept interim unskilled jobs. If skilled work is more satisfying or less arduous for highly productive workers, then such workers invest more in moving quickly between skilled jobs. Thus, high productivity workers tend to search on-the-job, and if unemployed will specialise in job search, rather than take an interim position. If individual differences in productivity are known to the worker but not the potential employer, then search strategy may be used as a productivity signal, with more than the efficient proportion of workers searching on-the-job and too few accepting interim unskilled jobs. Optimal policy requires a subsidy on interim unskilled jobs.

The acting or interim leadership position: Expectations, perceptions, realities

The acting or interim leadership position has been neglected in terms of selection, role identification, and status. Individuals, programs, and organizations are paying a price for this inattention.

The acting or interim leadership position

Health Care Management Review (HCMR) disseminates state-of-the-art knowledge about management, leadership, and administration of health care systems, organizations, and agencies. Multidisciplinary and international in scope, articles present completed research relevant to health care management, leadership, and administration, as well report on rigorous evaluations of health care management innovations, or provide a synthesis of prior research that results in evidence-based health care management practice recommendations. Articles are theory-driven and translate findings into implications and recommendations for health care administrators, researchers, and faculty. Annually, HCMR publishes the Best Theory to Practice paper chosen by the Health Care Administration Division of the Academy of Management.