The use of fixed appliances in the UK: a survey of specialist orthodontists.
To investigate the use of fixed appliances in the UK. Prospective postal questionnaire. UK. All members of the General Dental Council Specialist List in Orthodontics still in active practice and not in training posts. A preemptive letter of explanation was sent inviting orthodontists to participate in the survey. The questionnaire was subsequently posted to 935 specialists. Data analysis investigated differences in clinical practice related to varying provider groups, level of operator experience and geographical region. The response rate achieved was 66.3%. A majority of orthodontists routinely used the 0.022 inch pre-adjusted edgewise system, standard size Siamese pattern stainless steel brackets, conventionally ligated and bonded using standard etch and light cured composite. Nickel titanium and stainless steel were the most popular archwire materials. Anchorage was supported routinely by palatal and lingual arches in up to 25% and by headgear in over a third of respondents. Newer innovations showed variable popularity. Self-etching primer was used routinely by one-third of respondents with 11% use of self-ligating brackets. Banding of first molars was preferred by over 60% of clinicians. Bone screw implants were used by only 0.2% of respondents. Clinicians with less than 10 years experience used more headgear, light curing, MBT prescription and molar bonding. Operators with over 20 years experience used more chemically cured bonding, Roth prescription, banded first molars, 0.018 inch slot size and Tip-Edge(TM), with less use of headgear. Fixed appliance use differed from that reported in the US with lower use in the UK of standard edgewise and Roth systems, aesthetic, miniaturised and 0.018 inch slot brackets and rapid maxillary expansion. Most UK orthodontic specialists routinely used the 0.022 inch pre-adjusted edgewise system with standard size Siamese steel brackets bonded using standard etch and light cured composite with conventional ligation. Variations were seen between different provider groups, types of treatment funding, levels of operator seniority and geographical regions. Differences were noted particularly in the use of bracket prescription and design, types of molar attachment and anchorage control.


Allelic and non-allelic heterogeneities in pyridoxine dependent seizures revealed by ALDH7A1 mutational analysis.
Pyridoxine dependent seizure (PDS) is a disorder of neonates or infants with autosomal recessive inheritance characterized by seizures, which responds to pharmacological dose of pyridoxine. Recently, mutations have been identified in the ALDH7A1 gene in Caucasian families with PDS. To elucidate further the genetic background of PDS, we screened for ALDH7A1 mutations in five PDS families (patients 1-5) that included four Orientals. Diagnosis as having PDS was confirmed by pyridoxine-withdrawal test. Exon sequencing analysis of patients 1-4 revealed eight ALDH7A1 mutations in compound heterozygous forms: five missense mutations, one nonsense mutation, one point mutation at the splicing donor site in intron 1, and a 1937-bp genomic deletion. The deletion included the entire exon 17, which was flanked by two Alu elements in introns 16 and 17. None of the mutations was found in 100 control chromosomes. In patient 5, no mutation was found by the exon sequencing analysis. Furthermore, expression level or nucleotide sequences of ALDH7A1 mRNA in lymphoblasts were normal. Plasma pipecolic acid concentration was not elevated in patient 5. These observations suggest that ALDH7A1 mutation is unlikely to be responsible for patient 5. Abnormal metabolism of GABA/glutamate in brain has long been suggested as the underlying pathophysiology of PDS. CSF glutamate concentration was elevated during the off-pyridoxine period in patient 3, but not in patient 2 or 5. These results suggest allelic and non-allelic heterogeneities of PDS, and that the CSF glutamate elevation does not directly correlate with the presence of ALDH7A1 mutations.


Comparative analysis of cancer genes in the human and chimpanzee genomes.
Cancer is a major medical problem in modern societies. However, the incidence of this disease in non-human primates is very low. To study whether genetic differences between human and chimpanzee could contribute to their distinct cancer susceptibility, we have examined in the chimpanzee genome the orthologous genes of a set of 333 human cancer genes. This analysis has revealed that all examined human cancer genes are present in chimpanzee, contain intact open reading frames and show a high degree of conservation between both species. However, detailed analysis of this set of genes has shown some differences in genes of special relevance for human cancer. Thus, the chimpanzee gene encoding p53 contains a Pro residue at codon 72, while this codon is polymorphic in humans and can code for Arg or Pro, generating isoforms with different ability to induce apoptosis or interact with p73. Moreover, sequencing of the BRCA1 gene has shown an 8 Kb deletion in the chimpanzee sequence that prematurely truncates the co-regulated NBR2 gene. These data suggest that small differences in cancer genes, as those found in tumor suppressor genes, might influence the differences in cancer susceptibility between human and chimpanzee. Nevertheless, further analysis will be required to determine the exact contribution of the genetic changes identified in this study to the different cancer incidence in non-human primates.


Efficient Ultrasound Image Analysis Models with Sonographer Gaze Assisted Distillation.
Recent automated medical image analysis methods have attained state-of-the-art performance but have relied on memory and compute-intensive deep learning models. Reducing model size without significant loss in performance metrics is crucial for time and memory-efficient automated image-based decision-making. Traditional deep learning based image analysis only uses expert knowledge in the form of manual annotations. Recently, there has been interest in introducing other forms of expert knowledge into deep learning architecture design. This is the approach considered in the paper where we propose to combine ultrasound video with point-of-gaze tracked for expert sonographers as they scan to train memory-efficient ultrasound image analysis models. Specifically we develop teacher-student knowledge transfer models for the exemplar task of frame classification for the fetal abdomen, head, and femur. The best performing memory-efficient models attain performance within 5% of conventional models that are 1000× larger in size.


Quality and quantity of TFH cells are critical for broad antibody development in SHIVAD8 infection.
Broadly neutralizing antibodies (bNAbs) protect against HIV-1 infection, yet how they are generated during chronic infection remains unclear. It is known that T follicular helper (TFH) cells are needed to promote affinity maturation of B cells during an immune response; however, the role of TFH during HIV-1 infection is undefined within lymph node germinal centers (GCs). We use nonhuman primates to investigate the relationship in the early stage of chronic SHIVAD8 (simian-human immunodeficiency virus AD8) infection between envelope (Env)-specific TFH cells, Env-specific B cells, virus, and the generation of bNAbs during later infection. We found that both the frequency and quality of Env-specific TFH cells were associated with an expansion of Env-specific immunoglobulin G-positive GC B cells and broader neutralization across HIV clades. We also found a correlation between breadth of neutralization and the degree of somatic hypermutation in Env-specific memory B cells. Finally, we observed high viral loads and greater diversity of Env sequences in rhesus macaques that developed cross-reactive neutralization as compared to those that did not. These studies highlight the importance of boosting high-quality TFH populations as part of a robust vaccine regimen aimed at eliciting bNabs.


A salamander's flexible spinal network for locomotion, modeled at two levels of abstraction.
Animals have to coordinate a large number of muscles in different ways to efficiently move at various speeds and in different and complex environments. This coordination is in large part based on central pattern generators (CPGs). These neural networks are capable of producing complex rhythmic patterns when activated and modulated by relatively simple control signals. Although the generation of particular gaits by CPGs has been successfully modeled at many levels of abstraction, the principles underlying the generation and selection of a diversity of patterns of coordination in a single neural network are still not well understood. The present work specifically addresses the flexibility of the spinal locomotor networks in salamanders. We compare an abstract oscillator model and a CPG network composed of integrate-and-fire neurons, according to their ability to account for different axial patterns of coordination, and in particular the transition in gait between swimming and stepping modes. The topology of the network is inspired by models of the lamprey CPG, complemented by additions based on experimental data from isolated spinal cords of salamanders. Oscillatory centers of the limbs are included in a way that preserves the flexibility of the axial network. Similarly to the selection of forward and backward swimming in lamprey models via different excitation to the first axial segment, we can account for the modification of the axial coordination pattern between swimming and forward stepping on land in the salamander model, via different uncoupled frequencies in limb versus axial oscillators (for the same level of excitation). These results transfer partially to a more realistic model based on formal spiking neurons, and we discuss the difference between the abstract oscillator model and the model built with formal spiking neurons.


Effects of alfentanil on the pressor and catecholamine responses to tracheal intubation.
The effects of alfentanil (given during induction of anaesthesia) on the haemodynamic and catecholamine responses to tracheal intubation were studied in 44 adult patients who received alfentanil 10 micrograms kg-1 or 40 micrograms kg-1, or saline placebo. Alfentanil 10 micrograms kg-1 and 40 micrograms kg-1 prevented any increase in heart rate and arterial pressure after tracheal intubation. Alfentanil 40 micrograms kg-1 produced profound hypotension and bradycardia. The use of alfentanil in both doses was associated with a decrease in plasma adrenaline concentrations after tracheal intubation.


Novel features for automated cell phenotype image classification.
The most common method of handling automated cell phenotype image classification is to determine a common set of optimal features and then apply standard machine-learning algorithms to classify them. In this chapter, we use advanced methods for determining a set of optimized features for training an ensemble using random subspace with a set of Levenberg-Marquardt neural networks. The process requires that we first run several experiments to determine the individual features that offer the most information. The best performing features are then concatenated and used in the ensemble classification. Applying this approach, we have obtained an average accuracy of 97.4% using the three best benchmarks for this problem: the 2D HeLa dataset and both the endogenous and the transfected LOCATE mouse protein subcellular localization databases.


Hazards to wintering geese and other wildlife from the use of dieldrin, chlorfenvinphos and carbophenothion as wheat seed treatments.
Chemical treatments of cereal seeds are used in the United Kingdom to prevent damage by a number of pests including the wheat bulb fly, which is a serious pest of winter wheat. The persistent organochlorine dieldrin was introduced in the 1950s as a seed treatment but caused the death of large numbers of grain eating birds and gave rise to unacceptable environmental contamination. The withdrawal of dieldrin as a seed treatment was made possible by the introduction of two less persistent organophosphate insecticides, chlorfenvinphos and carbophenothion. Although the introduction of these chemicals has been beneficial in reducing environmental contamination, some side-effects on wildlife have still been discernible and carbophenothion has now been withdrawn from use in Scotland owing to the deaths of wintering geese from carbophenothion poisoning. Subsequent laboratory studies have demonstrated that Anser geese are particularly susceptible to carbophenothion poisoning, and the underlying biochemical mechanism has been investigated. The fundamental problem of species variation in toxicity among the organophosphorus and carbamate pesticides which this investigation illustrates presents difficulties for registration authorities when they are considered for clearance for agricultural use. The implications of the environmental problems encountered with dieldrin, chlorfenvinphos and carbophenothion for the pre-clearance testing of new chemicals are discussed and the critical surveillance of the early years of commercial use of a chemical is recommended to support pre-clearance studies aimed at assessing the potential hazard to the environment.


Plasmon-induced transparency in metal-insulator-metal waveguide side-coupled with multiple cavities.
We have demonstrated the analogue of electromagnetically induced transparency (EIT) in the metal-insulator-metal plasmonic waveguide, which consists of a bus waveguide side-coupled with a series of slot cavities. By finite-difference time-domain simulations, it is found that the resonance wavelength of the slot cavity can be controlled by adjusting the length of the cavity. Moreover, the EIT-like response is strongly dependent on the coupling separation between the corresponding adjacent cavities. Multiple-peak plasmon-induced transparency can be realized by cascading multiple cavities with different lengths and suitable cavity-cavity separations. This ultracompact plasmonic waveguide system may find important applications for multichannel plasmonic filter, nanoscale optical switching, and slow-light devices in highly integrated optical circuits and networks.


Maternal iron intake at mid-pregnancy is associated with reduced fetal growth: results from Mothers and Children's Environmental Health (MOCEH) study.
Iron supplementation is a common recommendation for pregnant women to prevent iron deficiency during pregnancy. There is an increasing concern about excessive iron consumption as a general iron prophylaxis by pregnant women without any due consideration about their dietary iron intake or iron status. Our present study investigated the association between total iron intake from diet and supplements and fetal growth in 337 pregnant women at mid-pregnancy in South Korea. Iron intake from diet and supplements was examined by a 24-hour recall method. Subjects were divided into three groups based on tertiles of total iron intake levels. Fetal biometry was assessed by ultrasonography at mid-pregnancy. About 99% of the non-supplement users had iron intake below the recommended nutrient intake (RNI) for pregnant women (24 mg), whereas 64.9% of supplement users had iron intake above the upper level (UL) (45 mg). In the babies of mothers in the third tertile of iron intake (>17.04 mg), biparietal diameter, abdominal circumference, and femur length were lower by 0.41 cm (P =0.019), 0.41 cm (P = 0.027), and 0.07 cm (P = 0.051), respectively, than the babies of mothers in the second tertile of iron intake (11.49 ~ 17.04 mg). These results suggest that excessive maternal iron intake at mid-pregnancy is associated with reduced fetal growth. Iron supplementation for pregnant women should be individualized according to their iron status. Appropriate diet education is needed for pregnant women so that they can consume adequate amounts of iron from food and supplements.


Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease-a pilot study.
Functional gut symptoms are common in patients with inflammatory bowel disease (IBD). Since poorly absorbed, short-chain carbohydrates (FODMAPs) appear to play an important role in the induction of functional gut symptoms, we aimed to determine the effect of their dietary restriction on abdominal symptoms in patients with stable IBD and to examine factors associated with success of and adherence to the diet. 52 consecutive patients with Crohn's disease and 20 with ulcerative colitis who received dietary advice at least 3 months prior at a gastrointestinal dietetic service in Victoria, Australia, underwent a retrospective telephone questionnaire. Information gathered included patient demographics, recall of dietary advice, dietary adherence, and change in gastrointestinal symptoms. Up to 70% of patients were adherent to the diet. Approximately one in two patients responded (defined as improvement of at least 5 out of 10 in overall symptoms). Overall abdominal symptoms, abdominal pain, bloating, wind and diarrhoea improved in patients with Crohn's disease and ulcerative colitis (p<0.02 for all), but constipation did not. For Crohn's disease, efficacy was associated with dietary adherence (p= 0.033) and inefficacy with non-adherence (p=0.013). Sustained response was associated with post-secondary education and working 35 h per week or less (p<0.03). These data suggest that reduction of FODMAP intake offers an efficacious strategy for patients with IBD who have concurrent functional gut symptoms. A controlled dietary intervention trial is indicated.


Practice of ST-segment elevation myocardial infarction care in the Netherlands during four snapshot weeks with the National Cardiovascular Database Registry for Acute Coronary Syndrome.
Clinical registries provide information on the process of care and patient outcomes, with the potential to improve the quality of patient care. A large Dutch national acute coronary syndrome (ACS) registry is currently lacking. Recently, we initiated the National Cardiovascular Database Registry (NCDR) for ACS in the Netherlands. The purpose of this study was to assess the NCDR ACS registry on feasibility and data completeness during a pilot phase of four snapshot weeks. Between 2013 and 2015, we invited all hospitals in the Netherlands to record a predefined dataset for every patient that was admitted to their hospital with ST-segment elevation myocardial infarction (STEMI). Data were entered in an online case report form. All patient-specific data were encrypted to ensure privacy. A total of 392 patients were registered in 35 centres. The mean age of the patients was 64 years (SD 13); 8% of patients presented with signs of cardiogenic shock and 11% with an out-of-hospital cardiac arrest. The median time from first medical contact to percutaneous coronary intervention (PCI) was 75 min (IQR 51-108) and this was significantly longer for patients who presented at a non-PCI centre or to a primary care physician. In-hospital and 30-day mortality rates were 5.2% and 7.8%, respectively. The amount of completeness varied, with improved completeness over time. This report shows that a Dutch ACS registry is feasible with respect to STEMI patients. Data completeness, however, was suboptimal. Improved data completeness is warranted for the future.


Two rare disease-associated Tyk2 variants are catalytically impaired but signaling competent.
Tyk2 belongs to the Janus protein tyrosine kinase family and is involved in signaling of immunoregulatory cytokines (type I and III IFNs, IL-6, IL-10, and IL-12 families) via its interaction with shared receptor subunits. Depending on the receptor complex, Tyk2 is coactivated with either Jak1 or Jak2, but a detailed molecular characterization of the interplay between the two enzymes is missing. In human populations, the Tyk2 gene presents high levels of genetic diversity with >100 nonsynonymous variants being detected. In this study, we characterized two rare Tyk2 variants, I684S and P1104A, which have been associated with susceptibility to autoimmune disease. Specifically, we measured their in vitro catalytic activity and their ability to mediate Stat activation in fibroblasts and genotyped B cell lines. Both variants were found to be catalytically impaired but rescued signaling in response to IFN-α/β, IL-6, and IL-10. These data, coupled with functional study of an engineered Jak1 P1084A, support a model of nonhierarchical activation of Janus kinases in which one catalytically competent Jak is sufficient for signaling provided that its partner behaves as proper scaffold, even if inactive. Through the analysis of IFN-α and IFN-γ signaling in cells with different Jak1 P1084A levels, we also illustrate a context in which a hypomorphic Jak can hamper signaling in a cytokine-specific manner. Given the multitude of Tyk2-activating cytokines, the cell context-dependent requirement for Tyk2 and the catalytic defect of the two disease-associated variants studied in this paper, we predict that these alleles are functionally significant in complex immune disorders.


The FLACC: a behavioral scale for scoring postoperative pain in young children.
To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability. Eighty-nine children aged 2 months to 7 years, (3.0 +/- 2.0 yrs.) who had undergone a variety of surgical procedures, were observed in the Post Anesthesia Care Unit (PACU). The study consisted of: 1) measuring interrater reliability; 2) testing validity by measuring changes in FLACC scores in response to administration of analgesics; and 3) comparing FLACC scores to other pain ratings. The FLACC tool was found to have high interrater reliability. Preliminary evidence of validity was provided by the significant decrease in FLACC scores related to administration of analgesics. Validity was also supported by the correlation with scores assigned by the Objective Pain Scale (OPS) and nurses' global ratings of pain. The FLACC provides a simple framework for quantifying pain behaviors in children who may not be able to verbalize the presence or severity of pain. Our preliminary data indicates the FLACC pain assessment tool is valid and reliable.


Precise, controlled laser delivery with evanescent optical waves.
Precise laser surgery is possible with laser pulses at wavelengths that are strongly absorbed at the surface of tissue. However, pulses at these wavelengths (far UV, far infrared) are not compatible with fiber-optic transmission, making endoscopic surgical procedures inside the body difficult. We use evanescent optical waves to demonstrate an alternative for confining energy near the tissue surface. Precise, superficial tissue ablation is achieved with evanescent waves generated at a sapphire-tissue interface by a free-electron laser, where the ablation depth may be varied. A new class of precise, controlled laser surgical tools may be achieved in this novel approach for use in endoscopic procedures. Electromagnetic theory governing evanescent-wave tissue ablation is presented.


Simultaneous effect of microemulsions and phase-transfer agents on aminolysis reactions.
The catalytic effect of triethylene glycol dimethyl ether (glyme) on the butylaminolysis of 4-nitrophenylcaprate (NPC) in water/AOT/chlorobenzene microemulsions has been studied. Experimental results show the existence of four simultaneous reaction pathways. One of them takes place at the microemulsion interphase where the rate-determining step of butylaminolysis is the formation of the addition intermediate, T+/-. The locus of the other three pathways is the continuous medium of the microemulsion. These three pathways consist of the decomposition of the addition intermediate catalyzed by butylamine, by glyme, and by both of them. The kinetic model allows us to obtain the value of every rate and distribution constant involved in the overall reaction mechanism. We must emphasize that the reactions located in the continuous medium exhibit a kinetic behavior similar to the corresponding one found in pure chlorobenzene. On the basis of the pseudophase model, the percentage of reaction in each of the microdomains of the microemulsion has been calculated. Likewise, changes in the loci of reaction from the interphase to the continuous medium as a function of catalyst concentration have been proved.


The role of Latin America's land and water resources for global food security: environmental trade-offs of future food production pathways.
One of humanity's major challenges of the 21st century will be meeting future food demands on an increasingly resource constrained-planet. Global food production will have to rise by 70 percent between 2000 and 2050 to meet effective demand which poses major challenges to food production systems. Doing so without compromising environmental integrity is an even greater challenge. This study looks at the interdependencies between land and water resources, agricultural production and environmental outcomes in Latin America and the Caribbean (LAC), an area of growing importance in international agricultural markets. Special emphasis is given to the role of LAC's agriculture for (a) global food security and (b) environmental sustainability. We use the International Model for Policy Analysis of Agricultural Commodities and Trade (IMPACT)-a global dynamic partial equilibrium model of the agricultural sector-to run different future production scenarios, and agricultural trade regimes out to 2050, and assess changes in related environmental indicators. Results indicate that further trade liberalization is crucial for improving food security globally, but that it would also lead to more environmental pressures in some regions across Latin America. Contrasting land expansion versus more intensified agriculture shows that productivity improvements are generally superior to agricultural land expansion, from an economic and environmental point of view. Finally, our analysis shows that there are trade-offs between environmental and food security goals for all agricultural development paths.


fMRI Syntactic and Lexical Repetition Effects Reveal the Initial Stages of Learning a New Language.
When learning a new language, we build brain networks to process and represent the acquired words and syntax and integrate these with existing language representations. It is an open question whether the same or different neural mechanisms are involved in learning and processing a novel language compared with the native language(s). Here we investigated the neural repetition effects of repeating known and novel word orders while human subjects were in the early stages of learning a new language. Combining a miniature language with a syntactic priming paradigm, we examined the neural correlates of language learning on-line using functional magnetic resonance imaging. In left inferior frontal gyrus and posterior temporal cortex, the repetition of novel syntactic structures led to repetition enhancement, whereas repetition of known structures resulted in repetition suppression. Additional verb repetition led to an increase in the syntactic repetition enhancement effect in language-related brain regions. Similarly, the repetition of verbs led to repetition enhancement effects in areas related to lexical and semantic processing, an effect that continued to increase in a subset of these regions. Repetition enhancement might reflect a mechanism to build and strengthen a neural network to process novel syntactic structures and lexical items. By contrast, the observed repetition suppression points to overlapping neural mechanisms for native and new language constructions when these have sufficient structural similarities. Acquiring a second language entails learning how to interpret novel words and relations between words, and to integrate them with existing language knowledge. To investigate the brain mechanisms involved in this particularly human skill, we combined an artificial language learning task with a syntactic repetition paradigm. We show that the repetition of novel syntactic structures, as well as words in contexts, leads to repetition enhancement, whereas repetition of known structures results in repetition suppression. We thus propose that repetition enhancement might reflect a brain mechanism to build and strengthen a neural network to process novel syntactic regularities and novel words. Importantly, the results also indicate an overlap in neural mechanisms for native and new language constructions with sufficient structural similarities.


Defective IFNα/γ-induced STAT3 protein activation in human malignant melanoma cells.
Signal transducer and activator of transcription 3 (STAT3) protein has been documented as a significant mediator of interferon (IFN) signaling. Physiological STAT3 phosphorylation involves tyrosine (Y705) and serine (S727) activation. Impairment of STAT3 protein levels and/or of STAT3 phosphorylation after IFN treatment has been found in many pathological conditions such as cancer, immunopathy and inflammatory disease. To analyze tumor-associated defective STAT3 response to IFNs, the induction of S727 and Y705 STAT3 activation after IFN exposure was evaluated in 18 human malignant melanoma cell lines and 68 primary cell cultures established from the lymph node metastases of melanoma patients. STAT3 expression and STAT3 phosphorylated forms were assayed by Western blot analysis employing specific STAT3 antibodies. All melanoma cell lines as well as samples derived from metastatic melanoma patients expressed STAT3 with variable signal intensities depending on the appropriate cell type. Significantly altered IFNγ-induced S727 STAT3 activation was found in both experimental models, with on average 94.1% of patients detected to be non-responders in lymph node cell cultures and 83.3% in melanoma cell lines. Moreover, a deficiency in IFNα-induced S727 induction was detected in 88.9% of melanoma cell lines. Defects in Y705 STAT3 phosphorylation were determined in clinical material (61.8% after IFNγ exposure) as well as in melanoma cell lines (absence of response to IFNα/γ in 83.3 and 55.5%, respectively). Our data clearly confirm STAT3 pathophysiological perturbances in human malignant melanoma cells. Depending on the induction of STAT3-activated phosphoforms by IFNs, three categories of melanoma cells were identified: a) phosphorylation on both the S727 and Y705 amino acid residues; b) STAT3 activation on Y705 only; c) phosphorylation at neither S727 nor Y705. The significance of in vitro STAT3 activation for predicting patient response to immunotherapy will be examined in a prospective clinical study by our group.


Septo-temporal distribution and lineage progression of hippocampal neurogenesis in a primate (Callithrix jacchus) in comparison to mice.
Adult born neurons in the hippocampus show species-specific differences in their numbers, the pace of their maturation and their spatial distribution. Here, we present quantitative data on adult hippocampal neurogenesis in a New World primate, the common marmoset (Callithrix jacchus) that demonstrate parts of the lineage progression and age-related changes. Proliferation was largely (∼70%) restricted to stem cells or early progenitor cells, whilst the remainder of the cycling pool could be assigned almost exclusively to Tbr2+ intermediate precursor cells in both neonate and adult animals (20-122 months). Proliferating DCX+ neuroblasts were virtually absent in adults, although rare MCM2+/DCX+ co-expression revealed a small, persisting proliferative potential. Co-expression of DCX with calretinin was very limited in marmosets, suggesting that these markers label distinct maturational stages. In adult marmosets, numbers of MCM2+, Ki67+, and significantly Tbr2+, DCX+, and CR+ cells declined with age. The distributions of granule cells, proliferating cells and DCX+ young neurons along the hippocampal longitudinal axis were equal in marmosets and mice. In both species, a gradient along the hippocampal septo-temporal axis was apparent for DCX+ and resident granule cells. Both cell numbers are higher septally than temporally, whilst proliferating cells were evenly distributed along this axis. Relative to resident granule cells, however, the ratio of proliferating cells and DCX+ neurons remained constant in the septal, middle, and temporal hippocampus. In marmosets, the extended phase of the maturation of young neurons that characterizes primate hippocampal neurogenesis was due to the extension in a large CR+/DCX- cell population. This clear dissociation between DCX+ and CR+ young neurons has not been reported for other species and may therefore represent a key primate-specific feature of adult hippocampal neurogenesis.


From {Bi22O26} to chiral ligand-protected {Bi38O45}-based bismuth oxido clusters.
The reaction of [Bi(22)O(26)(OSiMe(2)tBu)(14)] (1) in THF with salicylic acid gave [Bi(22)O(24)(HSal)(14)] (2) first, which was converted into [Bi(38)O(45)(HSal)(22)(OH)(2)(DMSO)(16.5)]·DMSO·H(2)O (3·DMSO·H(2)O) after dissolution and crystallization from DMSO. Single-crystal X-ray diffraction analysis and ESI mass spectrometry associated with infrared multi-photon dissociation (IRMPD) tandem MS experiments confirm the formation of the large and quite stable bismuth oxido cluster 3. The reaction of compound 2 with the butoxycarbonyl(BOC)-protected amino acids phenylalanine and valine (BOC-PheOH and BOC-ValOH), respectively, resulted in the formation of chiral [Bi(38)O(45)(BOC-AA)(22)(OH)(2)] (AA=deprotonated amino acid), as shown by a combination of different analytical techniques such as elemental analysis, dynamic light scattering, circular dichroism spectroscopy, and ESI mass spectrometry.


Development of global health education at Johns Hopkins University School of Medicine: a student-driven initiative.
Global health is increasingly present in the formal educational curricula of medical schools across North America. In 2008, students at Johns Hopkins University School of Medicine (JHUSOM) perceived a lack of structured global health education in the existing curriculum and began working with the administration to enhance global health learning opportunities, particularly in resource-poor settings. Key events in the development of global health education have included the introduction of a global health intersession mandatory for all first-year students; required pre-departure ethics training for students before all international electives; and the development of a clinical global health elective (Global Health Leadership Program, GHLP). The main challenges to improving global health education for medical students have included securing funding, obtaining institutional support, and developing an interprofessional program that benefits from the resources of the Schools of Medicine, Public Health, and Nursing. Strategies used included objectively demonstrating the need for and barriers to more structured global health experiences; obtaining guidance and modifying existing resources from other institutions and relevant educational websites; and harnessing institution-specific strengths including the large Johns Hopkins global research footprint and existing interprofessional collaborations across the three schools. The Johns Hopkins experience demonstrates that with a supportive administration, students can play an important and effective role in improving global health educational opportunities. The strategies we used may be informative for other students and educators looking to implement global health programs at their own institutions.


Neonatal lymphatic flow disorders: impact of lymphatic imaging and interventions on outcomes.
Neonatal chylothorax (NCTx) and central lymphatic flow disorder (CLFD) are historically challenging neonatal disorders with high morbidity and mortality. We conducted a retrospective study of 35 neonates with pulmonary lymphatic abnormalities at our institution who underwent lymphatic evaluation between December 2015 and September 2018. Patients with only pulmonary lymphatic perfusion syndrome were classified as NCTx and those with multiple flow abnormalities were classified as CLFD. Demographics, clinical characteristics, and outcomes were compared using t-tests/Wilcoxon rank sum tests and Fisher's exact tests. All 35 patients had intranodal MR lymphangiography and 14 (40%) also had conventional fluoroscopic lymphangiography. Fifteen (42.8%) patients were diagnosed with NCTx and 20 (57.1%) were diagnosed with CLFD. Thirty-four (97.1%) patients had pleural effusions. None of the NCTx group had ascites, anasarca, or dermal backflow compared to 17 (85%) (p < 0.001), 8 (42.1%) (p: 0.004), and 20 (100%) (p < 0.001) of the CLFD group, respectively. In the NCTx group, 11 (73.3%) had ethiodized oil embolization and 4 (26.7%) received conservative therapy. Ten (50%) of the CLFD patients had an intervention; of those, two (10%) had ethiodized oil-only embolization. Eight had non-ethiodized oil embolizations (two (25%) had embolization with glue, three (37.5%) underwent surgical lymphovenous anastomosis, two (25%) underwent thoracic duct (TD) externalization, and one (12.5%) had a non-TD lymphatic channel drain placed). Complete resolution of pleural effusions was achieved in all 15 NCTx patients, whereas 9 (45%) of 20 CLFD patients had resolution of chylothorax (p: 0.001). Establishing a diagnosis of NCTx or CLFD is paramount in selecting treatment options and providing prognostic information. Development of lymphatic interventions represents a paradigm shift in our understanding of neonatal lymphatic flow disorders and may be associated with improved survival.


Development and Implementation of a Mobile Phone-Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique.
Prevention of mother-to-child HIV transmission (PMTCT) care cascade failures drive pediatric HIV infections in sub-Saharan Africa. As nurses' clinical and management role in PMTCT expand, decision-support tools for nurses are needed to facilitate identification of cascade inefficiencies and solutions. The mobile phone-based PMTCT cascade analysis tool (mPCAT) provides health facility staff a quick summary of the number of patients and percentage drop-off at each step of the PMCTC care cascade, as well as how many women-infant pairs would be retained if a step was optimized. The objective of this study was to understand and improve the mPCAT's core usability factors and assess the health workers' experience with using the mPCAT. Overall, 2 rounds of usability testing were conducted with health workers from 4 clinics and leading experts in maternal and child health in Kenya and Mozambique using videotaped think aloud assessment techniques. Semistructured group interviews gauged the understanding of mPCAT's core usability factors, based on the Nielsen Usability Framework, followed by development of cognitive demand tables describing the needed mPCAT updates. Post adaptation, feasibility was assessed in 3 high volume clinics over 12 weeks. Participants completed a 5-point Likert questionnaire designed to measure ease of use, convenience of integration into work, and future intention to use the mPCAT. Focus group discussions with nurse participants at each facility and in-depth interviews with nurse managers were also conducted to assess the acceptability, use, and recommendations for adaptations of the mPCAT. Usability testing with software engineers enabled real-time feedback to build a tool following empathic design principles. The revised mPCAT had improved navigation and simplified data entry interface, with only 1 data entry field per page. Improvements to the results page included a data visualization feature and the ability to share results through WhatsApp. Coding was simplified to enable future revisions by nontechnical staff-critical for context-specific adaptations for scale-up. Health care workers and facility managers found the tool easy to use (mean=4.3), used the tool very often (mean=4.1), and definitely intended to continue to use the tool (mean=4.8). Ease of use was the most common theme identified, with emphasis on how the tool readily informed system improvement decision making. The mPCAT was well accepted by frontline health workers and facility managers. The collaborative process between software developer and user led to the development of a more user-friendly, context-specific tool that could be easily integrated into routine clinical practice and workflow. The mPCAT gave frontline health workers and facility managers an immediate, direct, and tangible way to use their clinical documentation and routinely reported data for decision making for their own clinical practice and facility-level improvements.


A comparison of the toxicity of synergized and technical formulations of permethrin, sumithrin, and resmethrin to trout.
Synthetic pyrethroids often have synergists added to improve effectiveness, yet decisions regarding the use of these pesticides are often based upon toxicity tests using technical material without the synergist, piperonyl butoxide. We conducted toxicity tests with brook trout (Salvelinus fontinalis) and brown trout (Salmo trutta) to compare the toxicity of synergized and technical formulations of permethrin, sumithrin, and resmethrin. We found a significant increase in toxicity in the synergized permethrin formulation using traditional 24, 48, and 96-h tests, relative to tests with the technical formulation. However, there was little difference in toxicity between synergized and technical sumithrin until 48 h had elapsed. Many test fish were strongly intoxicated by either formulation of permethrin or sumithrin, but the synergized formulations of both chemicals affected fish at lower concentrations. Intoxication was potentially severe enough to reduce the survival of these fish in the wild. Following short (6-h) exposures, we also found a larger difference in the number of fish that died or became intoxicated between the synergized and technical formulations of permethrin and sumithrin. Finally, we tested the ability of exposed fish to swim against a current. Fish exposed for 6 h to synergized permethrin and resmethrin had far less swimming stamina than those exposed to technical formulations. We found no difference in the effect on swimming between the synergized and technical formulation of sumithrin. In general, the synergized formulations of these chemicals appeared to cause a faster response than the technical formulations. This response increases the lethal and sublethal impacts of the insecticides. We also found that sumithrin was the least toxic of the three pyrethroids. Since the maximum application rate of sumithrin is half that of the other two pyrethroids, the potential risk to wild trout in streams may be reduced.


Oxygen Saturation and Heart Rate Ranges in Very Preterm Infants Requiring Respiratory Support at Birth.
To evaluate the changes in preductal oxygen saturation (SpO2) and heart rate in preterm infants receiving continuous positive airway pressure (CPAP) and/or positive-pressure ventilation (PPV) at birth. A prospective observational study at birth of infants aged <32 weeks separated into 2 gestational age (GA) groups: 230/7-276/7 weeks (group 1) and 280/7-316/7 weeks (group 2). Infants received delayed cord clamping (DCC) in accordance with institutional protocol. CPAP and/or PPV was applied at the clinical team's discretion. SpO2 and heart rate were recorded every minute for 10 minutes. Preductal SpO2 was targeted according to published nomograms. For heart rate, the goal was to maintain a stable heart rate >100 bpm. The study cohort comprised 96 group 1 infants (mean GA, 26 ± 1 weeks; mean birth weight, 818 ± 208 g) and 173 group 2 infants (mean GA, 30 ± 1 weeks; mean birth weight, 1438 ± 374 g). In general, infants requiring respiratory support reached target values for heart rate and SpO2 more slowly than the published nomograms for spontaneously breathing preterm infants without respiratory support. Infants receiving CPAP reached SpO2 and heart rate targets faster than infants receiving PPV. In group 1, but not group 2 infants, DCC resulted in higher SpO2 and heart rate. SpO2 and heart rate do not quickly and reliably reach the values achieved by spontaneously breathing preterm infants not requiring respiratory support.


Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life: A Randomized Clinical Trial.
Intimate partner violence (IPV) is a public health problem with significant adverse consequences for women and children. Past evaluations of a nurse home visitation program for pregnant women and first-time mothers experiencing social and economic disadvantage have not consistently shown reductions in IPV. To determine the effect on maternal quality of life of a nurse home visitation program augmented by an IPV intervention, compared with the nurse home visitation program alone. Cluster-based, single-blind, randomized clinical trial at 15 sites in 8 US states (May 2011-May 2015) enrolling 492 socially disadvantaged pregnant women (≥16 years) participating in a 2.5-year nurse home visitation program. In augmented program sites (n = 229 participants across 7 sites), nurses received intensive IPV education and delivered an IPV intervention that included a clinical pathway to guide assessment and tailor care focused on safety planning, violence awareness, self-efficacy, and referral to social supports. The standard program (n = 263 participants across 8 sites) included limited questions about violence exposure and information for abused women but no standardized IPV training for nurses. The primary outcome was quality of life (WHOQOL-BREF; range, 0-400; higher score indicates better quality of life) obtained through interviews at baseline and every 6 months until 24 months after delivery. From 17 prespecified secondary outcomes, 7 secondary end points are reported, including scores on the Composite Abuse Scale, SPAN (Startle, Physiological Arousal, Anger, and Numbness), Prime-MD Patient Health Questionnaire, TWEAK (Tolerance/Worry About Drinking/Eye-Opener/Amnesia/C[K]ut Down on Drinking), Drug Abuse Severity Test, and the 12-Item Short-Form Health Survey (physical and mental health), version 2. Among 492 participants enrolled (mean age, 20.4 years), 421 (86%) completed the trial. Quality of life improved from baseline to 24 months in both groups (change in WHOQOL-BREF scores from 299.5 [SD, 54.4] to 308.2 [SD, 52.6] in the augmented program group vs from 293.6 [SD, 56.4] to 316.4 [SD, 57.5] in the standard program group). Based on multilevel growth curve analysis, there was no statistically significant difference between groups (modeled score difference, -4.9 [95% CI, -16.5 to 6.7]). There were no statistically significant differences between study groups in any of the secondary participant end points. There were no adverse events recorded in either group. Among pregnant women experiencing social and economic disadvantage and preparing to parent for the first time, augmentation of a nurse home visitation program with a comprehensive IPV intervention, compared with the home visitation program alone, did not significantly improve quality of life at 24 months after delivery. These findings do not support the use of this intervention. ClinicalTrials.gov Identifier: NCT01372098.


Correlation of in vitro drug-sensitivity testing results with response to chemotherapy and survival in extensive-stage small cell lung cancer: a prospective clinical trial.
We devised a novel clinical protocol for extensive-stage small cell lung cancer (SCLC), selecting chemotherapy whenever possible on the basis of in vitro drug-sensitivity testing (DST) of individual patients' tumor specimens. Most of the specimens were obtained from metastatic sites during routine staging procedures. Increase of tumor cell number by culture in selective media usually was required before DST could be performed. We used the Weisenthal dye exclusion assay to place the seven drugs in rank order and to select the in vitro best regimen (IVBR), a three-drug combination of proved efficacy in SCLC. After initial staging and specimen acquisition, patients received etoposide and cisplatin (primary therapy) and were restaged after 12 weeks. Patients with partial or no responses and those relapsing after a complete response to primary therapy were switched to the IVBR if DST data were available. If DST data were unavailable, an empiric combination, vincristine-doxorubicin-cyclophosphamide, was administered as secondary therapy. Tumor-containing specimens were collected from 60 of the 80 patients (75%). One or more cell lines were established from 28 patients, and DST data were available from 26 patients (33% of total). Several parameters of in vitro drug sensitivity were significantly associated [two-sided P (P2) less than .05] with clinical response to primary therapy and also with response to the IVBR and were marginally associated with length of survival (.07 less than or equal to P2 less than or equal to .08). Sixteen patients (23%) received their IVBR as secondary therapy, and four of these (25%) attained a complete response, compared with three of 43 (7%) who received an empiric regimen (P2 = .16). We concluded that (a) selection of individualized chemotherapy is labor intensive but feasible in extensive-stage SCLC; (b) DST data are associated with clinical response to primary therapy and to secondary therapy with an IVBR; and (c) further observations will be required if we are to determine whether there is a modest therapeutic benefit to administering the IVBR as a secondary therapy.


Organocatalytic decarboxylative alkylation of N-hydroxy-phthalimide esters enabled by pyridine-boryl radicals.
The decarboxylative alkylation of N-hydroxyphthalimide (NHPI) based reactive esters with olefins has been achieved via an organocatalytic strategy. Control experiments and density functional theory calculations suggest that these reactions involve a boryl-radical mediated decarboxylation pathway, which is different from the single electron transfer involved in decarboxylative alkylation reactions reported previously. This metal-free decarboxylative alkylation reaction features good functional compatibility, and broad substrate scope illustrated by the transformations of both the alkyl and aryl carboxylic acid derivatives.


Addressing health inequities in Ontario, Canada: what solutions do the public support?
As public opinion is an important part of the health equity policy agenda, it is important to assess public opinion around potential policy interventions to address health inequities. We report on public opinion in Ontario about health equity interventions that address the social determinants of health. We also examine Ontarians' support and predictors for targeted health equity interventions versus universal interventions. We surveyed 2,006 adult Ontarians through a telephone survey using random digit dialing. Descriptive statistics assessed Ontarians' support for various health equity solutions, and a multinomial logistic regression model was built to examine predictors of this support across specific targeted and broader health equity interventions focused on nutrition, welfare, and housing. There appears to be mixed opinions among Ontarians regarding the importance of addressing health inequities and related solutions. Nevertheless, Ontarians were willing to support a wide range of interventions to address health inequities. The three most supported interventions were more subsidized nutritious food for children (89%), encouraging more volunteers in the community (89%), and more healthcare treatment programs (85%). Respondents who attributed health inequities to the plight of the poor were generally more likely to support both targeted and broader health equity interventions, than neither type. Political affiliation was a strong predictor of support with expected patterns, with left-leaning voters more likely to support both targeted and broader health equity interventions, and right-leaning voters less likely to support both types of interventions. Findings indicate that the Ontario public is more supportive of targeted health equity interventions, but that attributions of inequities and political affiliation are important predictors of support. The Ontario public may be accepting of messaging around health inequities and the social determinants of health depending on how the message is framed (e.g., plight of the poor vs. privilege of the rich). These findings may be instructive for advocates looking to raise awareness of health inequities.


The Sexual and Reproductive Health Burden Index: Development, Validity, and Community-Level Analyses of a Composite Spatial Measure.
The Sexual and Reproductive Health Burden Index (SRHBI) was developed to provide a composite spatial measure of sexual and reproductive health (SRH) indicators that can be widely adopted by urban public health departments for the planning of SRH services. The index was constructed using eight indicators: teen births, low birthweight, infant mortality, new HIV diagnoses, people living with HIV, and incidences of gonorrhea, chlamydia, and syphilis. Chicago Department of Public Health data (2014-2017) were used to calculate index scores for Chicago community areas; scores were mapped to provide geovisualization and global Moran's I was calculated to assess spatial autocorrelation. Cronbach's alpha was calculated to assess internal reliability of the SRHBI. Pearson correlations were conducted to assess concurrent validity and correlation with community-level factors. Linear regression was conducted to assess community-level predictors of the SRHBI. Application of the SRHBI in Chicago demonstrates substantial variation in SRH burden across Chicago's urban landscape with significant spatial autocorrelation of scores (I = .580, p = .001). Internal reliability of the measure was excellent with α = .937. The SRHBI was significantly correlated with other indicators of SRH including rate of prenatal care initiation in the first trimester, rate of preterm births, reported sexual assault incidence, cervical cancer incidence, prostate cancer incidence, and rate of smoking during pregnancy. This suggests good concurrent validity of the measure. Linear regression revealed that the percent of Black residents, percent of household couples that are same-sex, community violence, economic hardship, and population density were significant predictors of the SRHBI. The SRHBI provides a valid, useful, and replicable measure to assess and communicate community-level SRH burden in urban environments. The SRHBI may be scaled through a multi-city public data dashboard and utilized by urban public health departments to optimally target and tailor SRH interventions to communities.


Myxoma virus M11L prevents apoptosis through constitutive interaction with Bak.
M11L, a 166-amino-acid antiapoptotic protein of myxoma virus, was previously shown to bind to the peripheral benzodiazepine receptor by hydrophobic interactions at the outer mitochondrial membrane. Here we demonstrate that an additional property of M11L is the ability to constitutively form inhibitory complexes with the proapoptotic Bcl-2 family member Bak in human cells. This binding interaction was identified by both FLAG-tagged pull-down assays and tandem affinity purification from transfected and virus-infected human cells. M11L binds constitutively to human Bak and, under some inducible conditions, to human Bax as well, but not to the other Bcl-2 family members (Bad, Bid, Bcl-2). When stably expressed in human embryonic kidney (HEK293) cells, M11L effectively protects these cells from Fas ligand-induced apoptosis, thereby blocking release of cytochrome c, activation of caspase 9, and cleavage of poly(ADP-ribose) polymerase. We also demonstrate in coexpression studies that M11L can interact with Bak independently of any involvement with Bax. Furthermore, cells stably expressing M11L function to prevent apoptosis that is induced by overexpression of Bak. We conclude that M11L inhibits, in a species-independent fashion, apoptotic signals mediated by activation of Bak.


Liquid crystal director dynamics imaged using two-photon fluorescence microscopy with remote focusing.
We introduce a novel imaging technique adopting remote focusing for resolving the axial dynamics in the director field for liquid crystals. The high axial time resolution of our approach is demonstrated by imaging directly the evolution of the director field for an initially splayed nematic layer subject to a sudden voltage pulse. Images of the switching dynamics are presented, revealing transient state director configurations and changes in topology of the liquid crystal layer.


Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis.
Symptoms associated with the primary tooth eruption have been extensively studied but it is still controversial. To assess the occurrence of local and systemic signs and symptoms during primary tooth eruption. Latin American and Caribbean Health Sciences, PubMed, ProQuest, Scopus, and Web of Science were searched. A partial gray literature search was taken by using Google Scholar and the reference lists of the included studies were scanned. Observational studies assessing the association of eruption of primary teeth with local and systemic signs and symptoms in children aged 0 to 36 months were included. Two authors independently collected the information from the selected articles. Information was crosschecked and confirmed for its accuracy. A total of 1179 articles were identified, and after a 2-phase selection, 16 studies were included. Overall prevalence of signs and symptoms occurring during primary tooth eruption in children between 0 and 36 months was 70.5% (total sample = 3506). Gingival irritation (86.81%), irritability (68.19%), and drooling (55.72%) were the most frequent ones. Different general symptoms were considered among studies. Some studies presented lack of confounding factors, no clear definition of the diagnostics methods, use of subjective measures and long intervals between examinations. There is evidence of the occurrence of signs and symptoms during primary tooth eruption. For body temperature analyses, eruption could lead to a rise in temperature, but it was not characterized as fever.


The Central Asian Journal of Global Health to Increase Scientific Productivity.
The WHO Collaborating Center at the University of Pittsburgh, USA partnering with Nazarbayev University, developed the Central Asian Journal of Global Health (CAJGH, cajgh.pitt.edu) in order to increase scientific productivity in Kazakhstan and Central Asia. Scientists in this region often have difficulty publishing in upper tier English language scientific journals due to language barriers, high publication fees, and a lack of access to mentoring services. CAJGH seeks to help scientists overcome these challenges by providing peer-reviewed publication free of change with English and research mentoring services available to selected authors. CAJGH began as a way to expand the Supercourse scientific network (www.pitt.edu/~super1) in the Central Asian region in order to rapidly disseminate educational materials. The network began with approximately 60 individuals in five Central Asian countries and has grown to over 1,300 in a few short years. The CAJGH website receives nearly 900 visits per month. The University of Pittsburgh's "open access publishing system" was utilized to create CAJGH in 2012. There are two branches of the CAJGH editorial board: Astana (at the Center for Life Sciences, Nazarbayev University) and Pittsburgh (WHO Collaborating Center). Both are comprised of leading scientists and expert staff who work together throughout the review and publication process. Two complete issues have been published since 2012 and a third is now underway. Even though CAJGH is a new journal, the editorial board uses a rigorous review process; fewer than 50% of all submitted articles are forwarded to peer review or accepted for publication. Furthermore, in 2014, CAJGH will apply to be cross referenced in PubMed and Scopes. CAJGH is one of the first English language journals in the Central Asian region that reaches a large number of scientists. This journal fills a unique niche that will assist scientists in Kazakhstan and Central Asia publish their research findings and share their knowledge with others around the region and the world.


Health in all policies: the role of the US Department of Housing and Urban Development and present and future challenges.
The link between federal housing policy and public health has been understood since the nineteenth century, when housing activists first sought to abolish slums and create healthful environments. This article describes how the Obama administration-building on these efforts and those that followed, including the Great Society programs of President Lyndon Johnson-has adopted a cross-sector approach that takes health considerations into account when formulating housing and community development policy. The federal Department of Housing and Urban Development fully embraces this "health in all policies" approach. Nonetheless, the administration's strategy faces challenges, including fiscal and political ones. Some of these challenges may be overcome by conducting quality research on how housing and community development policies affect health outcomes, and by developing a federal budget strategy that takes into account how investments in one sector contribute to cost savings in another.


Dawn at Vesta: testing the protoplanetary paradigm.
The Dawn spacecraft targeted 4 Vesta, believed to be a remnant intact protoplanet from the earliest epoch of solar system formation, based on analyses of howardite-eucrite-diogenite (HED) meteorites that indicate a differentiated parent body. Dawn observations reveal a giant basin at Vesta's south pole, whose excavation was sufficient to produce Vesta-family asteroids (Vestoids) and HED meteorites. The spatially resolved mineralogy of the surface reflects the composition of the HED meteorites, confirming the formation of Vesta's crust by melting of a chondritic parent body. Vesta's mass, volume, and gravitational field are consistent with a core having an average radius of 107 to 113 kilometers, indicating sufficient internal melting to segregate iron. Dawn's results confirm predictions that Vesta differentiated and support its identification as the parent body of the HEDs.


KIFCI, a novel putative prognostic biomarker for ovarian adenocarcinomas: delineating protein interaction networks and signaling circuitries.
Amplified centrosomes in cancers are recently garnering a lot of attention as an emerging hub of diagnostic, prognostic and therapeutic targets. Ovarian adenocarcinomas commonly harbor supernumerary centrosomes that drive chromosomal instability. A centrosome clustering molecule, KIFC1, is indispensable for the viability of extra centrosome-bearing cancer cells, and may underlie progression of ovarian cancers. Centrosome amplification in low- and high- grade serous ovarian adenocarcinomas was quantitated employing confocal imaging. KIFC1 expression was analyzed in ovarian tumors using publically-available databases. Associated grade, stage and clinical information from these databases were plotted for KIFC1 gene expression values. Furthermore, interactions and functional annotation of KIFC1 and its highly correlated genes were studied using DAVID and STRING 9.1. Clinical specimens of ovarian cancers display robust centrosome amplification and deploy centrosome clustering to execute an error-prone mitosis to enable karyotypic heterogeneity that fosters tumor progression and aggressiveness. Our in silico analyses showed KIFC1 overexpression in human ovarian tumors (n = 1090) and its upregulation associated with tumor aggressiveness utilizing publically-available gene expression databases. KIFC1 expression correlated with advanced tumor grade and stage. Dichotomization of KIFC1 levels revealed a significantly lower overall survival time for patients in high KIFC1 group. Intriguingly, in a matched-cohort of primary (n = 7) and metastatic (n = 7) ovarian samples, no significant differences in KIFC1 expression were detectable, suggesting that high KIFC1 expression may serve as a marker of metastases onset. Nonetheless, KIFC1 levels in both primary and matched metastatic sites were significantly higher compared to normal tissue . Ingenuity based network prediction algorithms combined with pre-established protein interaction networks uncovered several novel cell-cycle related partner genes on the basis of interconnectivity, illuminating the centrosome clustering independent agenda of KIFC1 in ovarian tumor progression. Ovarian cancers display amplified centrosomes, a feature of aggressive tumors. To cope up with the abnormal centrosomal load, ovarian cancer cells upregulate genes like KIFC1 that are known to induce centrosome clustering. Our data underscore KIFC1 as a putative biomarker that predicts worse prognosis, poor overall survival and may serve as a potential marker of onset of metastatic dissemination in ovarian cancer patients.


Antioxidative and antibacterial activities of aqueous ethanol extracts of berries, leaves, and branches of berry plants.
Phenolic compounds were extracted with food grade solvent of acidified aqueous ethanol from leaves, berries, berry press cakes, and branches of Finnish berry plants and analyzed with HPLC-DAD, UPLC-DAD-ESI-MS and NMR. In addition, press cakes from two berry species and branches from one species were also extracted and analyzed with the same methods. The antioxidant activities of the extracts were evaluated using Folin-Ciocalteau, oxygen radical absorbance capacity (ORAC), DPPH free radical scavenging, and total radical trapping antioxidant parameter (TRAP) assays. The antibacterial activities were investigated against various Gram-negative and Gram-positive foodborne pathogens. The leaf extracts showed higher antioxidative activities (3-20 fold in ORAC assay, 10-20 fold in TRAP) than the berry extracts, in association with the higher contents of phenolic compounds in the leaf extracts; Strongest anti-bacterial effects was observed in the leaf extracts of lingonberry (Vaccinium vitis-idaea), sea buckthorn (Hippophaë rhamnoides ssp. rhamnoides) and saskatoon (Amelanchier alnifolia) on Staphylococcus aureus, Listeria monocytogenes, and Bacillus cereus. However, the antibacterial efficacy varied with bacterial species and strains. The Folin-Ciocalteu, ORAC, and TRAP values was strongly correlated with the total content of flavonoids with less association shown with the content of total phenolics and flavonol glycosides. The results suggest a major contribution of pranthocyanidins and flavan-3-ols to the antioxidative activities of the extracts. The growth inhibition on Staphylococcus aureus and Bacillus cereus was clearly associated with the content of total phenolics and ellagitannins.


Intestinal Ca and phosphate transport: differential responses to vitamin D3 metabolites.
The transport of Ca and inorganic phosphate (Pi) was studied in the absence of electrochemical gradients across rat intestine in vitro. 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) increased the active absorption of both Ca and Pi in all segments of the small intestine, with changes occurring only in absorptive fluxes, whereas secretory fluxes were unaffected. Active Ca absorption was greatest in the duodenum (greater than jejunum greater than ileum) and active Pi absorption was highest in jejunum (greater than duodenum greater than ileum), in agreement with earlier reports. 24R,25-dihydroxy-vitamin2D3 had similar effects on transport but was less potent. The ratios of Pi absorptive fluxes to Ca absorptive fluxes remained remarkably constant during 80-200% increases in absorption produced by 1,25(OH)2D3, suggesting coupled Ca-Pi transport or coordinate stimulation of Ca and Pi absorptive processes by hormonally active metabolites of vitamin D. The results seem most compatible with a differential distribution of vitamin D-responsive Ca and Pi absorptive cells with a predominance of cells with Ca absorptive sites occurring in duodenum, more Pi absorbing cells in jejunum, and a nearly equal ratio of each type in ileum.


Increased frequency of abnormal gamma delta T cells in blood of patients with inflammatory bowel diseases.
We have previously reported a preferential usage of V delta 1/V gamma 8 on TCR-gamma-delta-bearing intraepithelial lymphocytes of the normal human intestine as well as in the inflamed synovial tissue of patients with rheumatoid arthritis. The aim of the present study was to analyze V gene segment usage by gamma delta T cells of the intestine and peripheral blood (PB) from patients with inflammatory bowel disease. Freshly isolated lymphocytes were analyzed by flow cytometry using a panel of V gene subset-specific mAbs. The relative proportion of PB TCR-gamma delta+ cells was increased in patients with Crohn's disease as compared with controls. Interestingly, an increased proportion of PB gamma delta T cells of patients with ulcerative colitis or CrD expressed V delta and V gamma genes typically used by intraepithelial lymphocytes. Thus, increased proportions of V delta 1+ and V gamma 8+ cells were found in the PB of both patient groups. The majority of TCR-gamma delta+ intraepithelial lymphocytes (IEL) in inflamed and noninflamed intestine expressed V delta 1/V gamma 8, and a substantial proportion of V gamma(2,3,4)+ cells were found. These observations suggest a disease-associated appearance of "gut-like" gamma delta T cells in the periphery. Moreover, two patients had a large proportion of gamma delta T cells in their PB of which the majority expressed two distinct V gamma proteins. Both of these patients had a short duration of disease (1 and 10 mo, respectively) and the relative proportion of gamma delta T cells decreased in concert with stabilization of disease. Interestingly, one of the patients had a clonal expansion of a V gamma dual-expressing gamma delta T cell in the PB.


Interpersonal Attraction in Dyads and Groups: Effects of the Hearts of the Beholder and the Beheld.
Dyadic interpersonal attraction (IA) was studied within groups of very highly acquainted family members, friends and co-workers. IA was determined by the perceiver (i.e., the heart of the beholder), the target (i.e., the heart of the beheld), and in specific dyads, by the unique combination of the two. The consistency of one's attraction to others and others' attraction to the person across groups were addressed using the key person design. Attraction to a person in one group was independent of attraction to that person in another, although people predicted that members of different groups were similarly attracted to them. A new model (ARRMA) was specified to simultaneously study assumed reciprocity, actual reciprocity, and metaperception accuracy of attraction (i.e., accurate predictions of others' attraction to oneself). Assumed reciprocity of IA was substantial at the individual and dyadic levels. Reciprocity of attraction at the individual level, a heretofore unconfirmed "plausible hypothesis" (Newcomb, 1979), was supported; dyadic reciprocity was weak. Meta-accuracy of IA was observed among individuals but was weak in dyads. Perceived interpersonal similarity predicted IA among individuals and in specific dyads. Considering dyadic attraction within and between groups, and the use of componential analysis permitted the specification of new IA phenomena and resolved a long standing theoretical problem regarding the reciprocity of attraction.


Observation of the wrapping mechanism in amine carbon dioxide molecular interactions on heterogeneous sorbents.
Liquid, solvated amine based carbon capture is the core of all commercial or planned CO2 capture operations. Despite the intense research, few have looked systematically into the nature of amine molecules and their CO2 interaction. Here, we report a systematic introduction of linear ethylene amines on the walls of highly porous Davankov type network structures through simple bromination intermediates. Surprisingly, isosteric heats of CO2 adsorption show a clear linear trend with the increase in the length of the tethered amine pendant groups, leading to a concerted cooperative binding with additional H-bonding contributions from the unassociated secondary amines. CO2 uptake capacities multiply with the nitrogen content, up to an unprecedented four to eight times of the starting porous network under flue gas conditions. The reported procedure can be generalized to all porous media with the robust hydrocarbon framework in order to convert them into effective CO2 capture adsorbents.


Primary lateral sclerosis natural history study - planning, designing, and early enrollment.
Introduction/Aims. Primary lateral sclerosis (PLS) is exceedingly rare and has been an enigmatic disease. Recent progress has drastically changed this perception, with early biomarkers being investigated and potential medications for PLS emerging at the preclinical stage. The aim of this paper is to describe a study of PLS natural history and discuss the limitations and proposed solutions to the study of a rare and slowly progressive disease. Methods. The PLS Natural History Study is a 30-site, 24-month, prospective study that is supported by multiple funding sources. The study aims to enroll 50 early PLS (disease duration ≤4 years) and 50 definite PLS (disease duration 4 to 15 years) participants using modified PLS Diagnostic Criteria. Smartphone-based assessments including semi-quantitative and quantitative measures and patient-reported outcomes are utilized. In-person quantitative measures are also completed during site visits. The change in the PLS Functional Rating Scale score is the primary outcome. The study utilizes the NeuroBANK® patient-centric data capture and management platform. The biostatistical analysis plan has been developed. Results. In one year, 28 participants have been recruited. Enrollment has been much slower than anticipated due to the COVID-19 pandemic, the rarity of PLS, and potential study competition for internal resources from ALS clinical trials. Discussion. We discuss the need for more innovative methods to enroll and study individuals with such rare diseases and propose a number of mechanisms by which more efficient enrollment could be facilitated.


Socially informed dispersal in a territorial cooperative breeder.
Dispersal is a key process governing the dynamics of socially and spatially structured populations and involves three distinct stages: emigration, transience and settlement. At each stage, individuals have to make movement decisions, which are influenced by social, environmental and individual factors. Yet, a comprehensive understanding of the drivers that influence such decisions is still lacking, particularly for the transient stage during which free-living individuals are inherently difficult to follow. Social circumstances such as the likelihood of encountering conspecifics can be expected to strongly affects decision-making during dispersal, particularly in territorial species where encounters with resident conspecifics are antagonistic. Here, we analysed the movement trajectories of 47 dispersing coalitions of Kalahari meerkats Suricata suricatta through a landscape occupied by constantly monitored resident groups, while simultaneously taking into account environmental and individual characteristics. We used GPS locations collected on resident groups to create a georeferenced social landscape representing the likelihood of encountering resident groups. We used a step-selection function to infer the effect of social, environmental and individual covariates on habitat selection during dispersal. Finally, we created a temporal mismatch between the social landscape and the dispersal event of interest to identify the temporal scale at which dispersers perceive the social landscape. Including information about the social landscape considerably improved our representation of the dispersal trajectory compared to analyses that only accounted for environmental variables. The latter were only marginally selected or avoided by dispersers. Before leaving their natal territory, dispersers selected areas frequently used by their natal group. In contrast, after leaving their natal territory, they selectively used areas where they were less likely to encounter unrelated groups. This pattern was particularly marked in larger dispersing coalitions and when unrelated males were part of the dispersing coalition. Our results suggest that, in socially and spatially structured species, dispersers gather and process social information during dispersal, and that reducing risk of aggression from unrelated resident groups outweighs benefits derived from conspecific attraction. Finally, our work underlines the intimate link between the social structure of a population and dispersal, which affect each other reciprocally.


Tau Oligomers Associate with Inflammation in the Brain and Retina of Tauopathy Mice and in Neurodegenerative Diseases.
It is well-established that inflammation plays an important role in Alzheimer's disease (AD) and frontotemporal lobar dementia (FTLD). Inflammation and synapse loss occur in disease prior to the formation of larger aggregates, but the contribution of tau to inflammation has not yet been thoroughly investigated. Tau pathologically aggregates to form large fibrillar structures known as tangles. However, evidence suggests that smaller soluble aggregates, called oligomers, are the most toxic species and form prior to tangles. Furthermore, tau oligomers can spread to neighboring cells and between anatomically connected brain regions. In addition, recent evidence suggests that inspecting the retina may be a window to brain pathology. We hypothesized that there is a relationship between tau oligomers and inflammation, which are hallmarks of early disease. We conducted immunofluorescence and biochemical analyses on tauopathy mice, FTLD, and AD subjects. We showed that oligomers co-localize with astrocytes, microglia, and HMGB1, a pro-inflammatory cytokine. Additionally, we show that tau oligomers are present in the retina and are associated with inflammatory cells suggesting that the retina may be a valid non-invasive biomarker for brain pathology. These results suggest that there may be a toxic relationship between tau oligomers and inflammation. Therefore, the ability of tau oligomers to spread may initiate a feed-forward cycle in which tau oligomers induce inflammation, leading to neuronal damage, and thus more inflammation. Further mechanistic studies are warranted in order to understand this relationship, which may have critical implications for improving the treatment of tauopathies.


Long-term follow-up of acute and chronic non-A, non-B post-transfusion hepatitis: evidence of progression to liver cirrhosis.
The long-term outcome of non-A, non-B post-transfusion hepatitis was evaluated in 21 patients who developed the illness after open-heart surgery and could be followed thereafter up to five years. Histological chronic sequelae were documented in 13 patients, and consisted of chronic persistent hepatitis in one case, chronic lobular hepatitis in two and chronic active hepatitis in 10, five of whom also developed superimposed cirrhosis. Progression to these chronic states was in most cases symptomless, independently of the severity of liver lesions; one patient, however, died of gastrointestinal bleeding due to cirrhosis of the liver. During follow-up the biochemical pattern of chronic non-A, non-B hepatitis was unique, while striking fluctuations of transaminase levels. Liver histology proved essential to identify the severity of chronic liver lesions, as clinical and biochemical features were uniform and not indicative of it. Our results suggest that cirrhosis may develop, often with an asymptomatic course, in a significant number of patients who do not recover after acute post-transfusion non-A, non-B hepatitis.


Rescue vitrectomy with blocked artery massage and bloodletting for branch retinal artery occlusion.
A 61-year-old male suffered from sudden blurred vision and superior visual field defect oculus dexter. His vision was counting fingers at 20 cm. Fundoscopy demonstrated inferior pale retina and a large embolus located at the proximal inferior retinal artery. Branch retinal artery occlusion (BRAO) was diagnosed. Initial paracentesis, topical brimonidine tartrate, oral pentoxifylline, and hyperbaric oxygen therapy were performed but showed limited improvement. Hence, he received 25-gauge vitrectomy, artificial posterior vitreous detachment, blocked retinal artery massage, and bloodletting 5 days after onset. After the surgery, his vision improved to 20/25. Fundoscopy showed reperfused retina, and optical coherence tomography revealed resolved retinal edema. RAO is an ophthalmological emergency; however, no standard guideline is available. Vitrectomy with blocked retinal artery massage and bloodletting showed favorable results in this case of BRAO with a large embolus. More prospective clinical trials are needed for setting up the standard treatment.


Heritability of Neuropsychological Measures in Schizophrenia and Nonpsychiatric Populations: A Systematic Review and Meta-analysis.
Schizophrenia is characterized by neuropsychological deficits across many cognitive domains. Cognitive phenotypes with high heritability and genetic overlap with schizophrenia liability can help elucidate the mechanisms leading from genes to psychopathology. We performed a meta-analysis of 170 published twin and family heritability studies of >800 000 nonpsychiatric and schizophrenia subjects to accurately estimate heritability across many neuropsychological tests and cognitive domains. The proportion of total variance of each phenotype due to additive genetic effects (A), shared environment (C), and unshared environment and error (E), was calculated by averaging A, C, and E estimates across studies and weighting by sample size. Heritability ranged across phenotypes, likely due to differences in genetic and environmental effects, with the highest heritability for General Cognitive Ability (32%-67%), Verbal Ability (43%-72%), Visuospatial Ability (20%-80%), and Attention/Processing Speed (28%-74%), while the lowest heritability was observed for Executive Function (20%-40%). These results confirm that many cognitive phenotypes are under strong genetic influences. Heritability estimates were comparable in nonpsychiatric and schizophrenia samples, suggesting that environmental factors and illness-related moderators (eg, medication) do not substantially decrease heritability in schizophrenia samples, and that genetic studies in schizophrenia samples are informative for elucidating the genetic basis of cognitive deficits. Substantial genetic overlap between cognitive phenotypes and schizophrenia liability (average rg = -.58) in twin studies supports partially shared genetic etiology. It will be important to conduct comparative studies in well-powered samples to determine whether the same or different genes and genetic variants influence cognition in schizophrenia patients and the general population.


Contributions of body fat and effort in the 5K run: age and body weight handicap.
The 5K handicap (5KH), designed to eliminate the body weight (BW) and age biases inherent in the 5K run time (RT), yields an adjusted RT (RTadj) that can be compared between runners of different BW and age. As hypothesized in a validation study, however, not all BW bias may be removed, because of the influences of body fatness (BF) and effort (run speed; essentially the inverse as measured by rating of perceived exertion (RPE)). This study's purpose was to determine the effects of BF and RPE on BW bias in the 5KH. For 99 male runners in a regional 5K race (age = 43.9 +/- 12.1 years; BW = 83.4 +/- 12.9 kg), BF was determined via sum of three skinfolds just before the race. RPE, on the 20-point Borg scale, was used to assess overall race effort on race completion. Multiple regression analysis was used to develop a new adjusted RT (NRTadj, the RTadj corrected for BF and RPE), which was computed for each runner and then correlated with BW to determine bias. Indicative of slight bias, BW was correlated with RTadj (r = 0.220, p = 0.029). Both BF (p = 0.00002) and RPE (p = 0.0005) were significant, independent predictors of RTadj. NRTadj was not significantly correlated with BW (r = 0.051, p = 0.61), but BF explained 90%, and RPE explained only 6%, of the remaining BW bias evidenced in the 5KH. The previous finding that the 5KH does not remove all BW bias is apparently accounted for by BF and not RPE. Because no handicap should be awarded for higher BF, this finding suggests that the 5KH, for men, appropriately adjusts for the age and BW vs. RT biases previously noted.


Anti-inflammatory effects of essential oils from Mangifera indica.
Mangifera indica is widely found in Brazil, and its leaves are used as an anti-inflammatory agent in folk medicine. The aim of this study is to perform composition analysis of essential oils from the M. indica varieties, espada (EOMIL1) and coração de boi (EOMIL2), and confirm their anti-inflammatory properties. Twenty-three volatile compounds were identified via gas chromatography-mass spectrometry (GC-MS) in two essential oils from the leaves. Paw edema and myeloperoxidase (MPO) activity were evaluated using the carrageenan-induced paw model, while leukocyte migration was analyzed using the pleurisy model. At oral doses of 100 and 300 mg/kg, the essential oils significantly reduced edema formation and the increase in MPO activity induced by carrageenan in rat paws. For a dose of 300 mg/kg EOMIL1, 62 ± 8% inhibition of edema was observed, while EOMIL2 led to 51 ± 7% inhibition of edema. At a dose of 100 mg/kg, the inhibition was 54 ± 9% for EOMIL1 and 37 ± 7% for EOMIL2. EOMIL1 and EOMIL2 significantly reduced MPO activity at doses of 100 mg/kg (47 ± 5 and 23 ± 8%, respectively) and 300 mg/kg (50 ± 9 and 31 ± 7%, respectively). In the pleurisy model, inhibitions were also observed for EOMIL1 and EOMIL2 in the leukocyte migration test. The results of the present study show that essential oils from M. indica differ in chemical composition and anti-inflammatory activity in rats.


Of water and worms: Guinea worm re-emergence in Niger.
This paper aims to provide a better understanding of the re-emergence of Guinea worm into the water bodies of the Tillabéri region of the Niger Sahel. It examines the period of re-emergence and subsequent decline from 2002 until 2006. Using a geographic information system combined with a statistical approach to examine the location data of lakes with Guinea worm-associated cases, it is shown that the locations of population centers with cases of Guinea worm disease, the locations of lakes infected with Guinea worm larva, and features of the built environment are correlated in space.


Adrenal Hormones in Common Bottlenose Dolphins (Tursiops truncatus): Influential Factors and Reference Intervals.
Inshore common bottlenose dolphins (Tursiops truncatus) are exposed to a broad spectrum of natural and anthropogenic stressors. In response to these stressors, the mammalian adrenal gland releases hormones such as cortisol and aldosterone to maintain physiological and biochemical homeostasis. Consequently, adrenal gland dysfunction results in disruption of hormone secretion and an inappropriate stress response. Our objective herein was to develop diagnostic reference intervals (RIs) for adrenal hormones commonly associated with the stress response (i.e., cortisol, aldosterone) that account for the influence of intrinsic (e.g., age, sex) and extrinsic (e.g., time) factors. Ultimately, these reference intervals will be used to gauge an individual's response to chase-capture stress and could indicate adrenal abnormalities. Linear mixed models (LMMs) were used to evaluate demographic and sampling factors contributing to differences in serum cortisol and aldosterone concentrations among bottlenose dolphins sampled in Sarasota Bay, Florida, USA (2000-2012). Serum cortisol concentrations were significantly associated with elapsed time from initial stimulation to sample collection (p<0.05), and RIs were constructed using nonparametric methods based on elapsed sampling time for dolphins sampled in less than 30 minutes following net deployment (95% RI: 0.91-4.21 µg/dL) and following biological sampling aboard a research vessel (95% RI: 2.32-6.68 µg/dL). To examine the applicability of the pre-sampling cortisol RI across multiple estuarine stocks, data from three additional southeast U.S. sites were compared, revealing that all of the dolphins sampled from the other sites (N = 34) had cortisol concentrations within the 95th percentile RI. Significant associations between serum concentrations of aldosterone and variables reported in previous studies (i.e., age, elapsed sampling time) were not observed in the current project (p<0.05). Also, approximately 16% of Sarasota Bay bottlenose dolphin aldosterone concentrations were below the assay's detection limit (11 pg/mL), thus hindering the ability to derive 95th percentile RIs. Serum aldosterone concentrations from animals sampled at the three additional sites were compared to the detection limit, and the proportion of animals with low aldosterone concentrations was not significantly different than an expected prevalence of 16%. Although this study relied upon long-term, free-ranging bottlenose dolphin health data from a single site, the objective RIs can be used for future evaluation of adrenal function among individuals sampled during capture-release health assessments.


Palliative Care Research--A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 2012.
In 2007, a literature review was undertaken of palliative care research from Sweden during the 1970s-2006, paving the way for a follow-up study to explore the recent developments. The aim was to systematically examine palliative care research from Sweden between 2007 and 2012, with special attention to methods, designs and research foci. A literature review was undertaken. The databases Academic search elite, Age line, Ahmed, Cinahl, PsychInfo, PubMed, Scopus, Soc abstracts, Web of science and Libris were reviewed for Swedish palliative care research studies published from 2007 to 2012, applying the search criteria 'palliative care OR palliative medicine OR end-of-life care OR terminal care OR hospice care OR dying OR death'. A total of 263 papers met the inclusion criteria, indicating an increased volume of research compared to the 133 articles identified in the previous review. Common study foci were symptom assessment and management, experiences of illness and care planning. Targeting non-cancer-specific populations and utilisation of population-based register studies were identified as new features. There was continued domination of cross-sectional, qualitative and mono-disciplinary studies, not including ethnic minority groups, nonverbally communicable people or children <18 years of age. The trend is that Swedish palliative care research has expanded in volume from 2007 to 2012 compared to during the 1970s to 2006, with increasing participation of non-cancer-specific populations. A domination of qualitative approaches and small, cross-sectional studies with few interventions is still characteristic. Still more strategies are needed to expand the knowledge development of palliative care to respond to demographical, epidemiological, therapeutic and healthcare structure changes.


Attenuation of morphine physical dependence and blood levels of cortisol by central and systemic administration of ramelteon in rat.
Chronic administration of morphine cause physical dependence but the exact mechanism of this phenomenon remains unclear. The aim of this study is the assessment of systemic and intracerebroventricular (icv) administration of ramelteon (a melatonin receptor agonist) on morphine physical dependence. 88 adult male rats were divided into 2 major groups, namely "systematic" and "central" administration of ramelteon. In the first category, systemic administration of ramelteon at various dosages (10, 20, and 40 mg/kg) was assessed on dependent animals and withdrawal signs were compared with positive (received morphine and saline as systemic administration), negative control (saline) and group under treatment by ramelteon (40 mg/kg) groups. In the second category, central administration of ramelteon at various dosages (25, 50, or 100 μg,) was assessed on dependent animals and withdrawal signs were compared with the positive control (received morphine and saline as icv) and negative control (saline) groups, and the group under treatment by ramelteon (50 μg/5 μl/rat). On the test day, all animals received naloxone (3 mg/kg) and were observed for withdrawal signs. Total withdrawal score (TWS) was also determined. Finally, to evaluate the stress level of dependent rats, blood cortisols were measured. Central administration of ramelteon in all doses and systemic administration in high doses attenuate withdrawal syndrome in comparison with the dependent positive control group (P<0.05). Both central and systemic administrations of ramelteon can attenuate the blood cortisol level in comparison with the dependent positive control group (P<0.05). In conclusion, we found that central administration of ramelteon attenuated morphine withdrawal symptoms and cortisol level as a stress marker.


Enhanced North American carbon uptake associated with El Niño.
Long-term atmospheric CO2 mole fraction and δ13CO2 observations over North America document persistent responses to the El Niño-Southern Oscillation. We estimate these responses corresponded to 0.61 (0.45 to 0.79) PgC year-1 more North American carbon uptake during El Niño than during La Niña between 2007 and 2015, partially offsetting increases of net tropical biosphere-to-atmosphere carbon flux around El Niño. Anomalies in derived North American net ecosystem exchange (NEE) display strong but opposite correlations with surface air temperature between seasons, while their correlation with water availability was more constant throughout the year, such that water availability is the dominant control on annual NEE variability over North America. These results suggest that increased water availability and favorable temperature conditions (warmer spring and cooler summer) caused enhanced carbon uptake over North America near and during El Niño.


Is there a role for low-dose eltrombopag as maintenance therapy in the treatment of immune thrombocytopenia?
Thrombopoietin receptor agonists (romiplostim and eltrombopag) have recently been licensed for the treatment of thrombocytopenia in patients with chronic immune thrombocytopenia (ITP) with an insufficient response to corticosteroids, immunoglobulins or splenectomy. In the present case series, we present 4 nonresponding patients with chronic ITP who achieved maintenance of complete response (CR) for a period of at least 6 months on eltrombopag treatment administered in a modified regimen of 25 mg for 2, 3 or 5 days a week. The present study is a retrospective, nonconsecutive case series of 4 eltrombopag-treated patients with chronic ITP. Secondary ITP had been excluded in each patient, first-line therapy had failed and splenectomy had been refused. Furthermore, each patient was treated with eltrombopag, which resulted in a CR for a mean of 2 months. Consequently, decreased eltrombopag dosages have been able to maintain long-term CR. Despite the low quality of evidence, our study results support the use of reduced-dose eltrombopag as a maintenance therapy after achieving CR. It seems a very promising strategy for the effective maintenance of response, improving health-related quality of life, lowering costs and possibly improving the safety in the treatment of ITP.


Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn's Disease.
We aim to provide guidance for medical treatment of luminal Crohn's disease in children. We performed a systematic search of publication databases to identify studies of medical management of pediatric Crohn's disease. Quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. We developed statements through an iterative online platform and then finalized and voted on them. The consensus includes 25 statements focused on medical treatment options. Consensus was not reached, and no recommendations were made, for 14 additional statements, largely due to lack of evidence. The group suggested corticosteroid therapies (including budesonide for mild to moderate disease). The group suggested exclusive enteral nutrition for induction therapy and biologic tumor necrosis factor antagonists for induction and maintenance therapy at diagnosis or at early stages of severe disease, and for patients failed by steroid and immunosuppressant induction therapies. The group recommended against the use of oral 5-aminosalicylate for induction or maintenance therapy in patients with moderate disease, and recommended against thiopurines for induction therapy, corticosteroids for maintenance therapy, and cannabis in any role. The group was unable to clearly define the role of concomitant immunosuppressants during initiation therapy with a biologic agent, although thiopurine combinations are not recommended for male patients. No consensus was reached on the role of aminosalicylates in treatment of patients with mild disease, antibiotics or vedolizumab for induction or maintenance therapy, or methotrexate for induction therapy. Patients in clinical remission who are receiving immunomodulators should be assessed for mucosal healing within 1 year of treatment initiation. Evidence-based medical treatment of Crohn's disease in children is recommended, with thorough ongoing assessments to define treatment success.