Mechanoregulation of h2-calponin gene expression and the role of Notch signaling

The essential role of mechanical signals in regulating the function of living cells is universally observed. However, how mechanical signals are transduced in cells to regulate gene expression is largely unknown. We previously demonstrated that the gene encoding h2-calponin (Cnn2) is sensitively regulated by mechanical tension. In the present study, mouse genomic DNA containing the Cnn2 promoter was cloned, and a nested set of 5' truncations was studied. Transcriptional activity of the Cnn2 promoter-reporter constructs was examined in transfected NIH/3T3, HEK293, and C2C12 cells for their responses to the stiffness of culture substrate. The results showed significant transcriptional activities of the -1.00- and -1.24-kb promoter constructs, whereas the -0.61-kb construct was inactive. The -1.38-, -1.57-, and -2.12-kb constructs showed higher transcriptional activity, whereas only the -1.57- and -2.12-kb constructs exhibited repression of expression when the host cells were cultured on low stiffness substrate. Internal deletion of the segment between -1.57 and -1.38 kb in the -2.12-kb promoter construct abolished the low substrate stiffness-induced repression. Site-specific deletion or mutation of an HES-1 transcription factor binding site in this region also abolished this repression effect. The level of HES-1 increased in cells cultured under a low tension condition, corresponding to the down-regulation of h2-calponin. h2-Calponin gene expression is further affected by the treatment of cells with Notch inhibitor and activator, suggesting an upstream signaling mechanism.

JEMS Salary Survey 2001

EMS organizations have made strides in recent years in recruiting women into all employment categories. However, this year's small glimpse of top management pay inequities for women indicates the need for additional research and attention to correcting salary imbalances. On the bright side, as EMS organizations tighten their belts in preparation for potential cutbacks due to the impending Medicare fee schedule, we find it encouraging to see modest salary increases in most provider categories this year.

2000 200-city survey. Operational & clinical EMS trends in large, urban areas

The year's survey illustrated ongoing stability with respect to providers and operational approaches, and explored relationships that could provide opportunities for improvement. The continued use of hot response to every request for service is a high-risk response strategy. Today's EMD protocol systems can enable systems to safely prioritize requests for service. Response time performance reported by measure interval and averaged response time, while appearing to follow a rational model for transportation providers, fell short with respect to first responder response times which appeared to have no correlation with response clock start times. A possible explanation for this difference is the lower percentage of first responder agencies that are subject to external response-time performance review. The medical direction results suggest an investment in a full-time medical director could reduce online medical control requirements. The use of handheld computing technology could serve as a vehicle for building accurate clinical databases, as well as a means to deliver DS technology to the patient's bedside. Use of this technology could also improve reimburesment through more accurate reporting. The future of EMS has enormous challenges that must be overcome, especially in light of reduced health-care insurance reimbursements. However, these challenges also present an opportunity for EMS to reinvent itself. The capture and analysis of operational and clinical data by EMS systems will prove essential to understanding what changes can be made to enable them to meet future demands.

1995 almanac. EMS in the United States. 1995 survey of providers in the 200 most populous cities

In summary, the continued acquisition of technology capable of providing managers with comprehensive analysis of system operations will enable managers to develop EMS configuration models capable of predicting operational and financial performance. Increased involvement of MCOs in the design and funding of EMS, in addition to recent HCFA decisions to reimburse for treatment--not provider training--will result in a move away from funding mechanisms that reward consumption of services to mechanisms that reward conservation (e.g., capitation). Ultimately, we (the authors) predict that the realignment of funding mechanisms, with assurances that quality patient care will not deteriorate, will result in some significant changes in the 200 most populous cities.

Cooperation. An alternative to consolidation or bankruptcy

With all the recent consolidation and doomsaying within the EMS industry, the music from the movie "Jaws" is likely playing a constant refrain in the minds of many smaller EMS providers. The word from the consolidators--those large companies buying up small and midsized ambulance services--is that health maintenance organizations (HMOs) soon will be purchasing EMS and other "out-of-hospital" services and that since HMOs are for-profit institutions, they will be looking for the least expensive EMS delivery system. The consolidators and others with a stake in the new order assert that cost-effective services can only be produced by large national EMS companies; smaller companies will be left out in the cold. But will they?

Avionics and airframe options: current usage and future plans

The 1994 Avionics and Airframe Survey was sent to 178 chief or lead pilots of helicopter emergency medical services (HEMS) programs in October 1993, and 100 (56%) were returned. Sixty-four programs (64%) reported that they operate one helicopter exclusively for EMS, 24 (24%) operate two, and 12 (12%) reported using three or more aircraft. Interestingly, the reported percentage of programs with two or more exclusive helicopters continues to rise, increasing by 5.6% to 36%.