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2012

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Articles 391 - 420 of 1992

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Aetc-Nmc E-News Issue 6, Aetc Staff Aug 2012

Aetc-Nmc E-News Issue 6, Aetc Staff

AETC-NMC e-News

No abstract provided.


2012-2013 Farquhar Forum, Farquhar College Of Arts And Sciences Aug 2012

2012-2013 Farquhar Forum, Farquhar College Of Arts And Sciences

The Farquhar Forum College Magazine

No abstract provided.


Radiosynthesis And Bioimaging Of Antibacterial Agents, Li Liu Aug 2012

Radiosynthesis And Bioimaging Of Antibacterial Agents, Li Liu

Stony Brook Theses and Dissertations Collection, 2006-2020 (closed to submissions)

The dose and duration of treatment of antibacterial agents is normally established using plasma pharmacokinetic (PK) data together with information on drug efficacy once treatment has been initiated. Although plasma drug concentration is an important guide for establishing treatment protocols, recent studies indicate that the distribution of antibiotics in tissues is a more critical determinant and predictive factor for their activity. This is because most drugs exert their bactericidal effects at the site of infection rather than in the plasma, and because drug equilibration between plasma and infection site cannot always be achieved Therefore the tissue distribution of front-line TB …


Lead Optimization And Slow-Onset Inhibition Of The Enoyl-Acp Reductase (Inha) From Mycobacterium Tuberculosis, Pan Pan Aug 2012

Lead Optimization And Slow-Onset Inhibition Of The Enoyl-Acp Reductase (Inha) From Mycobacterium Tuberculosis, Pan Pan

Stony Brook Theses and Dissertations Collection, 2006-2020 (closed to submissions)

The enoyl-ACP reductase (InhA) catalyzes the last step of fatty acid biosynthesis in Mycobacterium tuberculosis, and is a validated target for antitubercular drugs. Our group previously reported diaryl ether InhA inhibitors that are highly active against M. tuberculosis (MIC = 3.15 ??g/mL). Further studies showed that introducing an ortho methyl group on the inhibitor B-ring resulted in a 430-fold increase in binding affinity. To understand the role of this methyl group, and design more potent inhibitors, analogs with various ortho groups on the B-ring were synthesized and evaluated. Enzyme inhibition was found to be highly sensitive to the size of …


Inhibitors Of 3&Beta-Hydroxysteroid? Dehydrogenase And Metabolic? And Enzymatic Characterization Of The Cholesterol? ? Metabolizing Intracellular Growth? Operon? Of? Mycobacterium Tuberculosis, Suzanne T. Thomas Aug 2012

Inhibitors Of 3&Beta-Hydroxysteroid? Dehydrogenase And Metabolic? And Enzymatic Characterization Of The Cholesterol? ? Metabolizing Intracellular Growth? Operon? Of? Mycobacterium Tuberculosis, Suzanne T. Thomas

Stony Brook Theses and Dissertations Collection, 2006-2020 (closed to submissions)

New drugs with novel mechanisms of action are required to meet the severe threat to human health posed by the emergence of multidrug and extensively drug resistant strains of Mycobacterium tuberculosis (M. tuberculosis). The cholesterol metabolism pathway in M. tuberculosis is a potential source of energy as well as secondary metabolite production that is important for survival of M. tuberculosis in the host macrophage. Oxidation and isomerization of 3Β-hydroxysterols to 4-en-3-ones by M. tuberculosis 3Β-hydroxysteroid dehydrogenase (3Β-HSD) is required for sterol metabolism, and inhibitors of 3Β-HSD are important for targeting the cholesterol metabolic pathway. In this work, we evaluated a …


Checkup, Lehigh Valley Health Network Aug 2012

Checkup, Lehigh Valley Health Network

Checkup

No abstract provided.


An Examination Of White-Nose Syndrome Occurrence And Dispersal Patterns: Utilizing Global And Local Moran's I Analysis To Evaluate An Emerging Pathogen, Celia M. Davis Aug 2012

An Examination Of White-Nose Syndrome Occurrence And Dispersal Patterns: Utilizing Global And Local Moran's I Analysis To Evaluate An Emerging Pathogen, Celia M. Davis

Masters Theses & Specialist Projects

In this research, a novel approach that utilizes Moran’s I statistical analyses to examine the spatio-temporal dispersal patterns of the White-Nose Syndrome currently affecting North American bat species is undertaken to further understand the disease transmission mechanism(s) of this emerging wildlife epidemic. White-Nose Syndrome has been responsible for in excess of five million bat deaths to date and has the potential to alter the ecological landscape significantly; however, due to a variety of factors, little research has been conducted into the patterns of infection on a national scale. Global and Local Moran’s I analyses were performed on the spatial-temporal variable …


Microbial Degradation Of 2,4-Dichlorophenoxyacetic Acid On The Greenland Ice Sheet, Marek Stibal, Jacob Baelum, William E. Holben, Sebastian R. Sørensen, Anders Jensen, Carsten S. Jacobsen Aug 2012

Microbial Degradation Of 2,4-Dichlorophenoxyacetic Acid On The Greenland Ice Sheet, Marek Stibal, Jacob Baelum, William E. Holben, Sebastian R. Sørensen, Anders Jensen, Carsten S. Jacobsen

Biological Sciences Faculty Publications

The Greenland ice sheet (GrIS) receives organic carbon (OC) of anthropogenic origin, including pesticides, from the atmosphere and/or local sources, and the fate of these compounds in the ice is currently unknown. The ability of supraglacial heterotrophic microbes to mineralize different types of OC is likely a significant factor determining the fate of anthropogenic OC on the ice sheet. Here we determine the potential of the microbial community from the surface of the GrIS to mineralize the widely used herbicide 2,4-dichlorophenoxyacetic acid (2,4-D). Surface ice cores were collected and incubated for up to 529 days in microcosms simulating in situ …


A Genome-Wide Over-Expression Screen Identifies Genes Involved In Phagocytosis In The Human Protozoan Parasite, Entamoeba Histolytica, Ada V. King, Brenda H. Welter, Amrita B. Koushik, Lindsay N. Gordon, Lesly A. Temesvari Aug 2012

A Genome-Wide Over-Expression Screen Identifies Genes Involved In Phagocytosis In The Human Protozoan Parasite, Entamoeba Histolytica, Ada V. King, Brenda H. Welter, Amrita B. Koushik, Lindsay N. Gordon, Lesly A. Temesvari

Publications

Functional genomics and forward genetics seek to assign function to all known genes in a genome. Entamoeba histolytica is a protozoan parasite for which forward genetics approaches have not been extensively applied. It is the causative agent of amoebic dysentery and liver abscess, and infection is prevalent in developing countries that cannot prevent its fecal-oral spread. It is responsible for considerable global morbidity and mortality. Given that the E. histolytica genome has been sequenced, it should be possible to apply genomic approaches to discover gene function. We used a genome-wide over-expression screen to uncover genes regulating an important virulence function …


The Development And Testing Of The Continuity Assessment Record And Evaluation (Care) Item Set, Volume 1 Of 3, Barbara Gage, Roberta Constantine, Jyoti Aggarwal, Melissa Morley, Vera Kurlantzick, Shulamit Bernard, Dianne Munevar, Megan Garrity, Laura Smith, Dan Barch, Anne Deutsch, Trudy Mallinson, Linda Ehrlich-Jones Aug 2012

The Development And Testing Of The Continuity Assessment Record And Evaluation (Care) Item Set, Volume 1 Of 3, Barbara Gage, Roberta Constantine, Jyoti Aggarwal, Melissa Morley, Vera Kurlantzick, Shulamit Bernard, Dianne Munevar, Megan Garrity, Laura Smith, Dan Barch, Anne Deutsch, Trudy Mallinson, Linda Ehrlich-Jones

Clinical Research and Leadership Faculty Publications

No abstract provided.


Fall In C-Peptide During First 2 Years From Diagnosis: Evidence Of At Least Two Distinct Phases From Composite Type 1 Diabetes Trialnet Data., Carla J. Greenbaum, Craig A. Beam, David Boulware, Stephen E. Gitelman, Peter A. Gottlieb, Kevan C. Herold, John M. Lachin, Paula L. Mcgee, Jerry P. Palmer, Mark D. Pescovitz, Heidi Krause-Steinrauf, Jay S. Skyler, Jay M. Sosenko Aug 2012

Fall In C-Peptide During First 2 Years From Diagnosis: Evidence Of At Least Two Distinct Phases From Composite Type 1 Diabetes Trialnet Data., Carla J. Greenbaum, Craig A. Beam, David Boulware, Stephen E. Gitelman, Peter A. Gottlieb, Kevan C. Herold, John M. Lachin, Paula L. Mcgee, Jerry P. Palmer, Mark D. Pescovitz, Heidi Krause-Steinrauf, Jay S. Skyler, Jay M. Sosenko

Epidemiology Faculty Publications

Interpretation of clinical trials to alter the decline in β-cell function after diagnosis of type 1 diabetes depends on a robust understanding of the natural history of disease. Combining data from the Type 1 Diabetes TrialNet studies, we describe the natural history of β-cell function from shortly after diagnosis through 2 years post study randomization, assess the degree of variability between patients, and investigate factors that may be related to C-peptide preservation or loss. We found that 93% of individuals have detectable C-peptide 2 years from diagnosis. In 11% of subjects, there was no significant fall from baseline by 2 …


Nursing Attitudes Toward The Use Of Reprocessed Single-Use Medical Devices, Laura Maben-Tenney Aug 2012

Nursing Attitudes Toward The Use Of Reprocessed Single-Use Medical Devices, Laura Maben-Tenney

HIM 1990-2015

Background: Before the implementation of single-use devices (SUD) in health care, medical equipment was sterilized and reused. Now many medical devices are used once and then thrown away, contributing to the 5.9 million tons of medical waste produced yearly. This project explores nursing attitudes toward single-use medical devices, evaluates current recycling practices and examines whether student nurses would be likely to use reprocessed SUDs in their practice if given the option. Methodology: After obtaining IRB approval, students enrolled in nursing research courses were invited to participate in this exploratory study. 157 undergraduate nursing students completed the 46-question survey. Descriptive statistics …


Blockade Of Cxcr4 Inhibits Porphyromonas Gingivalis Colonization In Vivo And Subsequent Periodontal Bone Loss., Megan L. Mc Intosh Aug 2012

Blockade Of Cxcr4 Inhibits Porphyromonas Gingivalis Colonization In Vivo And Subsequent Periodontal Bone Loss., Megan L. Mc Intosh

Electronic Theses and Dissertations

Chronic periodontitis is strongly associated with composition of the oral biofilm occupying the gingival crevicular aspect of the tooth and its associated root. Some gram-negative, "red complex" bacteria instigate periodontal bone loss in patients, principal among these Porphyromonas gingivalis. P. gingivalis is a "late colonizer", indicating not only its physical location within the oral biofilm, but also the pathogenic dynamic of the interaction between P. gingivalis and the host innate immunity. Among several other subversive tactics, P. gingivalis has been shown to compel receptors vital to the orchestration of an appropriate immune response to co-associate and consequently signal in a …


Investigation Into Pathological Responses Of Two Phenotypes Of The Scleractinian Coral, Montastraea Faveolata, To Putative Marine Vibrio Pathogens, Angela Michele Richards Donì Aug 2012

Investigation Into Pathological Responses Of Two Phenotypes Of The Scleractinian Coral, Montastraea Faveolata, To Putative Marine Vibrio Pathogens, Angela Michele Richards Donì

Stony Brook Theses and Dissertations Collection, 2006-2020 (closed to submissions)

Corals of the genus Montastraea in the Caribbean are highly susceptible to disease, although not all neighboring colonies appear to be affected on the same time scales. Stressed corals are unable to function optimally and are less likely to be reproductively successful than those that are not stressed. Montastraea spp. corals, like all corals from the order Scleractinia, are adapted to the narrow ranges in temperature and irradiance found in tropical waters. These environmental factors play an important role in a coral colony's ability to maintain homeostasis and excursions from their normal ranges for extended periods of time can trigger …


Design, Synthesis And Evaluation Of Inhibitors Of The Enoyl-Acp Reductase From Staphylococcus Aureus And Yesinia Pestis, Sonam Shah Aug 2012

Design, Synthesis And Evaluation Of Inhibitors Of The Enoyl-Acp Reductase From Staphylococcus Aureus And Yesinia Pestis, Sonam Shah

Stony Brook Theses and Dissertations Collection, 2006-2020 (closed to submissions)

Infectious diseases, caused by pathogenic biological agents, are the leading causes of death worldwide, especially in low-income countries. Two such pathogenic bacteria that are our centers of interest are Staphylococcus aureus, the most common cause of hospital acquired infection and Yesinia pestis, the priority pathogen that causes plague. In order to develop drugs against these pathogens, we focus on the fatty acid biosynthesis (FASII) pathway, a validated target for drug discovery due to structural differences between eukaryotic and prokaryotic fatty acid synthesis machinery. Previously, a library of diphenyl ethers synthesized by our lab exhibited potent inhibition of the enzyme enoyl-ACP …


Journal Publications: A Need For International Collaboration, W.Y. Low, K.H. Ng, A.P. Koh, J. Sinnasamy Aug 2012

Journal Publications: A Need For International Collaboration, W.Y. Low, K.H. Ng, A.P. Koh, J. Sinnasamy

Research Publications (2011 to 2015)

No abstract provided.


Association Between Nutrition And Cognitive Function In Costa Rican Older Adults, Maria Aragon Aug 2012

Association Between Nutrition And Cognitive Function In Costa Rican Older Adults, Maria Aragon

All Theses

Older adults are among the fastest-growing segment of the world's population. In Costa Rica, life expectancy is comparable to developed countries, such as the United States and Western European countries. The loss of cognitive capacity is one of the most significant issues affecting the quality of life of older adults and their families. Although the causes of cognitive decline remain uncertain, it has been linked to cardiovascular risk factors such as diabetes mellitus and high blood pressure. Dietary fatty acids have an important role in these conditions, making it is plausible that they could play a role in cognitive deterioration …


The Effects Of Drought On The Abundance Of The Blue Crab, Callinectes Sapidus, In The Ace Basin Nerr In South Carolina, Kirk Parmenter Aug 2012

The Effects Of Drought On The Abundance Of The Blue Crab, Callinectes Sapidus, In The Ace Basin Nerr In South Carolina, Kirk Parmenter

All Dissertations

Blue crabs make up one of the most important commercial fisheries in the U.S. but there has been some concern over the health of blue crab populations due to large declines in landings seen in recent years. There is a significant positive correlation between river discharge and commercial landings suggesting that drought may be to blame for the recent decline in crab numbers. The work I completed for my dissertation tested multiple hypotheses examining the link between decreasing freshwater discharge, the subsequent rise in salinity, and the abundance of blue crabs in the ACE Basin National Estuarine Research Reserve.
To …


Speleo Spiel, No. 391, July-August 2012, Alan Jackson Aug 2012

Speleo Spiel, No. 391, July-August 2012, Alan Jackson

Speleo Spiel

Contents: Regular Bits -- Trip Reports -- Other Exciting Stuff -- Surveys


Nitric Oxide Regulation Of C-Di-Gmp Metabolism And Biofilm Formation In Shewanella Woodyi, Niu Liu Aug 2012

Nitric Oxide Regulation Of C-Di-Gmp Metabolism And Biofilm Formation In Shewanella Woodyi, Niu Liu

Stony Brook Theses and Dissertations Collection, 2006-2020 (closed to submissions)

Biofilms, multi-cellular sessile communities of bacteria, are known to account for bacterial persistence and antibiotic resistance. Nitric oxide (NO) has been shown to induce biofilm dispersal at sub-lethal concentrations in many species. For example, in the cystic-fibrosis associated bacterium, Pseudomonas aeruginosa, NO is reported to regulate biofilm dispersal through cyclic di-GMP signaling. In this thesis work, I demonstrate that Swoo_2750 from Shewanella woodyi encodes a Heme-Nitric oxide/OXygen binding domain (H-NOX), a protein that binds NO with approximately picomolar sensitivity. I demonstrate further that SwH-NOX is co-cistronic and directly interacts with Swoo_2751, a bi-functional diguanylate cyclase (DGC), which exhibits both c-di-GMP …


Application Of Multivariate Statistical Methodology To Model Factors Influencing Fate And Transport Of Fecal Pollution In Surface Waters, Kimberlee K. Hall Aug 2012

Application Of Multivariate Statistical Methodology To Model Factors Influencing Fate And Transport Of Fecal Pollution In Surface Waters, Kimberlee K. Hall

Electronic Theses and Dissertations

Degraded surface water quality is a growing public health concern. While indicator organisms are frequently used as a surrogate measure of pathogen contamination, poor correlation is often observed between indicators and pathogens. Because of adverse health effects associated with poor water quality, an assessment of the factors influencing the fate and transport of fecal pollution is necessary to identify sources and effectively design and implement Best Management Practices (BMPs) to protect and restore surface water quality. Sinking Creek is listed on the State of Tennessee’s 303D list as impaired due to pathogen contamination. The need to address the listing of …


Prolonged Intermediate Syndrome Pue To Prganophosphate Poisoning, Nadeem Ullah Khan, Muhammad Junaid Patel, M. N.M. Hifath, Saima Kamal, Syed Ather Hussain Aug 2012

Prolonged Intermediate Syndrome Pue To Prganophosphate Poisoning, Nadeem Ullah Khan, Muhammad Junaid Patel, M. N.M. Hifath, Saima Kamal, Syed Ather Hussain

Department of Emergency Medicine

Organophosphate poisoning can present as acute cholinergic syndrome, Intermediate syndrome and delayed neuropathy. Intermediate syndrome secondary to organophosphate poisoning is a serious health problem leading to increased morbidity and mortality. The incidence of problem varies and range from 8%-84% of organophosphate poisoning cases. The factors account for this difference is nature of organophosphate compound, severity of poisoning and inadequate Oxime therapy. The recognition of this syndrome is important as organophosphate poisoning is common in our country. We presented this case of organophosphate poisoning leading to prolonged intermediate syndrome. The muscle weakness associated with this syndrome generally resolves in 5-18 days …


Did Mineral Surface Chemistry And Toxicity Contribute To Evolution Of Microbial Extracellular Polymeric Substances?, Jie Xu, Jay M. Campbell, Nianli Zhang, William J. Hickey, Nita Sahai Aug 2012

Did Mineral Surface Chemistry And Toxicity Contribute To Evolution Of Microbial Extracellular Polymeric Substances?, Jie Xu, Jay M. Campbell, Nianli Zhang, William J. Hickey, Nita Sahai

College of Polymer Science and Polymer Engineering

Modern ecological niches are teeming with an astonishing diversity of microbial life in biofilms closely associated with mineral surfaces, which highlights the remarkable success of microorganisms in conquering the challenges and capitalizing on the benefits presented by the mineral-water interface. Biofilm formation capability likely evolved on early Earth because biofilms provide crucial cell survival functions. The potential toxicity of mineral surfaces toward cells and the complexities of the mineral-water-cell interface in determining the toxicity mechanisms, however, have not been fully appreciated. Here, we report a previously unrecognized role for extracellular polymeric substances (EPS), which form biofilms in shielding cells against …


Locating And Protecting Facilities Subject To Random Disruptions And Attacks, Hugh Medal Aug 2012

Locating And Protecting Facilities Subject To Random Disruptions And Attacks, Hugh Medal

Graduate Theses and Dissertations

Recent events such as the 2011 Tohoku earthquake and tsunami in Japan have revealed the vulnerability of networks such as supply chains to disruptive events. In particular, it has become apparent that the failure of a few elements of an infrastructure system can cause a system-wide disruption. Thus, it is important to learn more about which elements of infrastructure systems are most critical and how to protect an infrastructure system from the effects of a disruption. This dissertation seeks to enhance the understanding of how to design and protect networked infrastructure systems from disruptions by developing new mathematical models and …


Predicting Occupancy Of Wintering Migratory Birds: Is Microhabitat Information Necessary?, Christopher J. W. Mcclure, Brian W. Rolek, Geoffrey E. Hill Aug 2012

Predicting Occupancy Of Wintering Migratory Birds: Is Microhabitat Information Necessary?, Christopher J. W. Mcclure, Brian W. Rolek, Geoffrey E. Hill

Biology Faculty Publications and Presentations

Information regarding microhabitat, here defined as small-scale vegetation structure, is often useful in predicting use of habitat by birds. Quantifying microhabitat, however, is expensive and labor intensive compared to assessment of habitat at a larger scale, possibly from remotely sensed imagery. To assess the importance of microhabitat information in constructing predictive models of habitat occupancy, we compared occupancy models built on the basis of macro- and microhabitat together and separately. We based our models on counts of wintering migratory bird species and vegetation surveys within Tuskegee National Forest, Alabama, completed during winter 2009. Models built from macrohabitat data only outperformed …


Undergraduate And Graduate Course Descriptions, 2012 Fall, Wright State University Aug 2012

Undergraduate And Graduate Course Descriptions, 2012 Fall, Wright State University

Course Descriptions

Wright State University undergraduate and graduate course descriptions from Fall 2012.


Understanding The Pathoecological Relationship Between Ancient Diet And Modern Diabetes Through Coprolite Analysis: A Case Example From Antelope Cave, Mojave County, Arizona, Karl J. Reinhard, Keith L. Johnson, Sara Leroy-Toren, Kyle Wieseman, Isabel Teixeira-Santos, Mônica Vieira Aug 2012

Understanding The Pathoecological Relationship Between Ancient Diet And Modern Diabetes Through Coprolite Analysis: A Case Example From Antelope Cave, Mojave County, Arizona, Karl J. Reinhard, Keith L. Johnson, Sara Leroy-Toren, Kyle Wieseman, Isabel Teixeira-Santos, Mônica Vieira

School of Natural Resources: Faculty Publications

The elevated prevalence of non-insulin-dependent diabetes mellitus (NIDDM) in Native Americans of the Southwest has been explained by several authors in terms of a dietary change from preindustrial traditional foods to modern foods. Physiology adapted to traditional foods became deleterious during the process of modernization. Although several versions of this hypothesis exist, they all relate to the rise in modern NIDDM with change from prehistoric subsistence practices to modern dietary practices. This is especially true for the Southwestern desert tribes of Arizona and New Mexico. Coprolite analysts have been recovering the sort of data needed by diabetes researchers to explore …


The Real-Time Measurements Of Blood Nitric Oxide (No) And Hydrogen Peroxide (H2o2) Levels Under Acute Hyperglycemia, Michael Minni Aug 2012

The Real-Time Measurements Of Blood Nitric Oxide (No) And Hydrogen Peroxide (H2o2) Levels Under Acute Hyperglycemia, Michael Minni

PCOM Biomedical Studies Student Scholarship

Vascular endothelial dysfunction is one of the earliest recognizable events under hyperglycemic conditions. It is characterized by decreased endothelium-derived nitric oxide (NO) bioavailability and increased oxidative stress, such as superoxide and hydrogen peroxide (H2O2) overproduction. However, the real-time changes in blood NO and H2O2 levels under acute hyperglycemia have not been evaluated. In this study, acute hyperglycemia (200 mg/dl, 400 mg/dL, and 600 mg/dL) was induced by intravenous infusion of 20%, 30%, and 50% D-glucose respectively for 180 min. Infusion of saline or 30% L-glucose serve as controls. Blood NO or H2 …


Were Equatorial Regions Less Affected By The 2009 Influenza Pandemic? The Brazilian Experience, Cynthia Schuck-Paim, Cecile Viboud, Lone Simonsen, Mark A. Miller, Fernanda E.A. Moura, Roberto M. Fernandes, Marcia L. Carvalho, Wladimir J. Alonso Aug 2012

Were Equatorial Regions Less Affected By The 2009 Influenza Pandemic? The Brazilian Experience, Cynthia Schuck-Paim, Cecile Viboud, Lone Simonsen, Mark A. Miller, Fernanda E.A. Moura, Roberto M. Fernandes, Marcia L. Carvalho, Wladimir J. Alonso

Global Health Faculty Publications

Although it is in the Tropics where nearly half of the world population lives and infectious disease burden is highest, little is known about the impact of influenza pandemics in this area. We investigated the mortality impact of the 2009 influenza pandemic relative to mortality rates from various outcomes in pre-pandemic years throughout a wide range of latitudes encompassing the entire tropical, and part of the subtropical, zone of the Southern Hemisphere (+5°N to −35°S) by focusing on a country with relatively uniform health care, disease surveillance, immunization and mitigation policies: Brazil. To this end, we analyzed laboratory-confirmed deaths and …


Integrating Care: Improving Overall Health By Integrating Behavioral/Mental Health Care Into Primary Care, Macaran A. Baird Aug 2012

Integrating Care: Improving Overall Health By Integrating Behavioral/Mental Health Care Into Primary Care, Macaran A. Baird

Center for Policy Research

Hippocrates noted that the patient must be attended in light of “his” diet, work, home, and community setting. Since that time, we have struggled with the dilemma of how to put the patient’s presenting problems in the context of the patient’s life circumstances. That goal has proven elusive. So how do we sort out where to put the emphasis with our healing arts?