Combined deficiency of factors V and VIII is an autosomal recessive bleeding disorder resulting from alterations in an unknown gene on chromosome 18q, distinct from the factor V and factor VIII genes. ERGIC-53, a component of the ER-Golgi intermediate compartment, was mapped to a YAC and BAC contig containing the critical region for the combined factors V and VIII deficiency gene. DNA sequence analysis identified two different mutations, accounting for all affected individuals in nine families studied. Immunofluorescence and Western analysis of immortalized lymphocytes from patients homozygous for either of the two mutations demonstrate complete lack of expression of the mutated gene in these cells. These findings suggest that ERGIC-53 may function as a molecular chaperone for the transport from ER to Golgi of a specific subset of secreted proteins, including coagulation factors V and VIII.

Many patients who seek emergency department (ED) treatment are not well enough for immediate discharge but are not clearly sick enough to warrant full inpatient admission. These patients are increasingly treated as outpatients using observation services. Hospitals employ four basic approaches to observation services, which can be categorized by the presence or absence of a dedicated observation unit and of defined protocols. To understand which approach might have the greatest impact, we compared 2010 data from three sources: a case study of observation units in Atlanta, Georgia; statewide discharge data for Georgia; and national survey and discharge data. Compared to patients receiving observation services elsewhere in the hospital, patients cared for in "type 1" observation units-dedicated units with defined protocolshave a 23-38 percent shorter length-of-stay, a 17-44 percent lower probability of subsequent inpatient admission, and $950 million in potential national cost savings each year. Furthermore, we estimate that 11.7 percent of short-stay inpatients nationwide could be treated in a type 1 unit, with possible savings of $5.5-$8.5 billion annually. Policy makers should have hospitals report the setting in which observation services are provided and consider payment incentives for care in a type 1 unit.

Forested buffer strips are left along water bodies after forest harvesting to protect water quality and fish stocks, but little is known about their utility as reserves for forest species in managed landscapes. We report on changes in terrestrial vertebrate communities from pre-to post-harvest in experimentally created buffer strips (20, 100, 200, and 800 m wide) in a boreal mixedwood forest in Alberta, Canada. We trapped anuran amphibians and small mammals and spot-mapped bird territories around 12 lakes (4 treatment levels, 3 replicates) before and after harvesting. Changes in small mammal or amphibian abundance were not detected for any treatment relative to controls; however, these species are habitat generalists that used and even bred in clearcuts. Total bird abundance did not change after harvesting, with the exception of crowding in 20-m buffers 1 year post-harvest. Species composition did not change for amphibians and small mammals after harvest, but forest-dependent bird species declined as buffer width narrowed from 200 to 100 m and narrower. We concluded that 20-100 m buffers would not serve as reserves for forest songbirds in managed landscapes, but that 200 m wide strips conserved the pre-harvest passerine bird community, at least up to 3 years post-harvest.Résumé : Lors de coupes forestières, des lisières boisées sont laissées le long des plans d'eau pour protéger la qualité de l'eau et les stocks de poissons. On sait peu de choses de leur utilité comme réserves pour les espèces forestières dans les paysages aménagés. Nous avons documenté les changements dans les communautés de vertébrés terrestres avant et après coupe, dans des lisières boisées expérimentales (20, 100, 200 et 800 m de largeur), dans une forêt boréale mixte de l'Alberta, au Canada. Nous avons piégé les anoures (amphibiens) et les petits mammifères et inventorié les oiseaux par cartographie des territoires autour de 12 lacs (4 niveaux de traitements, 3 répétitions), avant et après coupe. Aucun changement d'abondance des petits mammifères et des amphibiens n'a été détecté dans les traitements par rapport aux témoins, mais ces espèces sont des généralistes qui utilisent et même nichent dans les coupes à blanc. L'abondance totale d'oiseaux n'a pas changé après coupe, à l'exception d'une concentration dans les lisières de 20 m l'année après coupe. La composition spécifique en amphibiens et petits mammifères n'a pas changé après coupe, mais les espèces d'oiseaux dépendants de la forêt ont décliné en relation avec le rétrécissement des lisières de 200 à 100 m et moins. Nous concluons que les lisières de 20-100 m ne servent pas de réserves pour les oiseaux forestiers dans les paysages aménagés tandis que les lisières de 200 m de largeur conservent les communautés d'oiseaux d'avant coupe au moins durant les 3 années suivant la coupe. [Traduit par la Rédaction]Hannon et al. 1800