IgE-mediated hypersensitivity: patients with complex regional pain syndrome type 1 (CRPS1) vs the Dutch population. A retrospective study.
To investigate whether hypersensitivity is more common in Complex Regional Pain Syndrome type 1 (CRPS1) patients than in the general population. In a recent study, the level of tryptase, a specific marker for mast cells, was significantly higher in blister fluid from the involved extremity of CRPS1 patients. This suggested that mast cells may play a role in the pathophysiology of CRPS1. Mast cells are major effectors in allergic reactions, and are also involved in a variety of noninfectious inflammatory diseases. Patients. Sixty-six Dutch patients with CRPS1 in one extremity were included. Allergy information was obtained from the medical history and a modified questionnaire based on the Europees Luchtweg Onderzoek Nederland 1 study. Total IgE and allergen-specific IgE were measured from blood samples. Also tryptase, as a marker for mast cells, was measured. The data from the questionnaire were compared with that of the general Dutch population, and the plasma levels were compared with reference values and data in the literature. The medical history did not differ from information provided in the questionnaire by the CRPS1 group. There was no significant difference between the answers to the questionnaire between the CRPS1 patients and the general population. The total IgE levels were elevated in 30% of the CRPS1 patients compared with 15-24% of the general population, and allergen-specific IgE and tryptase levels were comparable with the reference values. Based on the medical history, an allergy questionnaire, and objective laboratory findings we conclude that IgE-mediated hypersensitivity is not more common in CRPS1 patients than in the general population.


The importance of coherence length in laser phototherapy of gingival inflammation: a pilot study.
The aim of this study was to investigate if coherence length is of importance in laser phototherapy. Twenty patients with moderate periodontitis were selected. After oral hygiene instructions, scaling and root planing (SRP), one side of the upper jaw was randomly selected for HeNe (632.8 nm, 3 mW) or InGaAlP (650 nm, 3 mW) laser irradiation. One week after SRP, the following parameters were measured: pocket depth, gingival index, plaque index, gingival crevicular fluid volume, matrix metalloproteinase (MMP-8), interleukin (IL-8) and subgingival microflora. The irradiation (180 s per point, energy 0.54 J) was then performed once a week for 6 weeks. At the follow up examination, all clinical parameters had improved significantly in both groups. A more pronounced decrease of clinical inflammation was observed after HeNe treatment. MMP-8 levels were considerably reduced on the HeNe side, while there was no difference for IL-8 or microflora. Coherence length appears to be an important factor in laser phototherapy.


Bioconvection flow in accelerated couple stress nanoparticles with activation energy: bio-fuel applications.
On the account of significance of bioconvection in biotechnology and several biological systems, valuable contributions have been performed by scientists in current decade. In current framework, a theoretical bioconvection model is constituted to examine the analyzed the thermally developed magnetized couple stress nanoparticles flow by involving narrative flow characteristics namely activation energy, chemical reaction and radiation features. The accelerated flow is organized on the periodically porous stretched configuration. The heat performances are evaluated via famous Buongiorno's model which successfully reflects the important features of thermophoretic and Brownian motion. The composed fluid model is based on the governing equations of momentum, energy, nanoparticles concentration and motile microorganisms. The dimensionless problem has been solved analytically via homotopic procedure where the convergence of results is carefully examined. The interesting graphical description for the distribution of velocity, heat transfer of nanoparticles, concentration pattern and gyrotactic microorganism significance are presented with relevant physical significance. The variation in wall shear stress is also graphically underlined which shows an interesting periodic oscillation near the flow domain. The numerical interpretation for examining the heat mass and motile density transfer rate is presented in tubular form.


HBV, HIV co-infection at Kisumu District Hospital, Kenya.
Patients with dual infection of HBV and HIV are increasingly being recognised. The two viruses, HBV and HIV share the same route of transmission and HBV is more efficiently transmitted than HIV. There is evidence that HBV will contribute significantly to continuing morbidity and mortality within the HIV infected population over the coming years. This is due to the widespread use/accessibility of the highly active anti-retroviral (HAART) drugs hence patients live longer. There are few published data in the tropical region on these patients especially in regions where HBV and HIV are endemic. To determine the prevalence of HBV, HIV co-infection in patients who presented with jaundice and the pattern of CD4 cell counts in these patients. A prospective, cross-sectional, descriptive study of all consecutive patients included in the study. Medical wards, medical outpatient clinic and liver clinic, Kisumu District Hospital, Western Kenya. Five hundred and nineteen (261 females and 258 males) patients who had jaundice were screened for the study. One hundred and eighty five (110 males and 75 females) patients were excluded. Three hundred and thirty four patients 151 (45.2%) males and 183 (54.8%) females were included and completed the study between August 2002 and October 2003. Socio-demographic data, HBsAg positive, HIV serology (positive or negative), CD4 cell counts, ALT and AST, IgG anti-HBc and IgM anti-HBc. The age range was 7-76 years with a mean of 36 (+/-13) years. The mean age for males and females was 37 (+/-13) years and 35 (+/-12) years respectively. One hundred and seventy seven (53%) had co-infection and 157 (47%) had HBV mono-infection. IgG anti-HBc and IgM anti-HBc were detected in 17 (5%) and 317 (95%) patients respectively. Of the 317 patients with IgM anti-HBc, 177 (55.8%) had co-infection while 140 (44.2%) had HBV mono-infection (p=0.05). The overall mean CD4 cell count for the whole population was 391 (+/-314) cells/mm3. The mean CD4 cell count for patients with co-infection was lower, (120 (+/-112) cells/mm3) than for patients with HBV mono-infection, 694 (+/-140) cells/mm3. The transaminases were uniformly elevated in both groups with mean AST of 207 (+/-147) U/L and ALT of 356 (+/-177) U/L. In the co-infection and mono-infection groups, AST was 286 (+/-117) U/L and 306 (+/-175) U/L (p=0.23) and is not statistically significant, and the ALT was 338 (+/-135) U/L and 375 (+/-213) U/L respectively p=0.05 and the difference is statistically significant. HBV and HIV co-infection is recognised in this region, which is endemic for both viral infections. The patients with dual infection had very low CD4 cell counts. This will influence the choice of highly active anti-retroviral therapy (HAART) in favour of Lamivudine containing combinations to cover the HBV infection.


Species-Deconvolved Proteomics for In Situ Investigation of Tumor-Stroma Interactions after Treatment of Pancreatic Cancer Patient-Derived Xenografts with Combined Gemcitabine and Paclitaxel.
Tumor-stroma interactions are critical in pancreatic ductal adenocarcinoma (PDAC) progression and therapeutics. Patient-derived xenograft (PDX) models recapitulate tumor-stroma interactions, but the conventional antibody-based immunoassay is inadequate to discriminate tumor and stromal proteins. Here, we describe a species-deconvolved proteomics approach embedded in IonStar that can unambiguously quantify the tumor (human-derived) and stromal (mouse-derived) proteins in PDX samples, enabling unbiased investigation of tumor and stromal proteomes with excellent quantitative reproducibility. With this strategy, we studied tumor-stroma interactions in PDAC PDXs that responded differently to Gemcitabine combined with nab-Paclitaxel (GEM+PTX) treatment. By analyzing 48 PDX animals 24 h/192 h after treatment with/without GEM+PTX, we quantified 7262 species-specific proteins under stringent cutoff criteria, with high reproducibility. For the PDX sensitive to GEM+PTX, the drug-dysregulated proteins in tumor cells were involved in suppressed oxidative phosphorylation and the TCA cycle, and in the stroma, inhibition of glycolytic activity was predominant, suggesting a relieved reverse Warburg effect by the treatment. In GEM+PTX-resistant PDXs, protein changes suggested extracellular matrix deposition and activation of tumor cell proliferation. Key findings were validated by immunohistochemistry (IHC). Overall, this approach provides a species-deconvolved proteomic platform that could advance cancer therapeutic studies by enabling unbiased exploration of tumor-stroma interactions in the large number of PDX samples required for such investigations.


A novel role for the pineal gland: Regulating seasonal shifts in the gut microbiota of Siberian hamsters.
The gut microbiota plays a significant role in a variety of host behavioral and physiological processes. The mechanisms by which the gut microbiota and the host communicate are not fully resolved but include both humoral and direct neural signals. The composition of the microbiota is affected by internal (host) factors and external (environmental) factors. One such signal is photoperiod, which is represented endogenously by nocturnal pineal melatonin (MEL) secretion. Removal of the MEL signal via pinealectomy abolishes many seasonal responses to photoperiod. In Siberian hamsters (Phodopus sungorus), MEL drives robust seasonal shifts in physiology and behavior, such as immunity, stress, body mass, and aggression. While the profile of the gut microbiota also changes by season, it is unclear whether these changes are driven by pineal signals. We hypothesized that the pineal gland mediates seasonal alterations in the composition of the gut microbiota. To test this, we placed pinealectomized and intact hamsters into long or short photoperiods for 8 weeks, collected weekly fecal samples, and measured weekly food intake, testis volume, and body mass. We determined microbiota composition using 16S rRNA sequencing (Illumina MiSeq). We found significant effects of treatment and time on the abundances of numerous bacterial genera. We also found significant associations between individual OTU abundances and body mass, testis mass, and food intake, respectively. Finally, results indicate a relationship between overall community structure, and body and testis masses. These results firmly establish a role for the pineal gland in mediating seasonal alterations in the gut microbiota. Further, these results identify a novel neuroendocrine pathway by which a host regulates seasonal shifts in gut community composition, and indicates a relationship between seasonal changes in the gut microbiota and seasonal physiological adjustments.


DELAYED APPEARANCE OF LABELED PROTEIN IN ISOLATED NERVE ENDINGS AND AXOPLASMIC FLOW.
Subcellular fractions of mouse brain were prepared by differential and sucrose density-gradient centrifugation at intervals up to 130 hours after intracerebral injection of C(14)- labeled leucine. The specific activity of the nerve ending fraction continued to rise during this period. Between 2 and 130 hours after injection there was a fivefold rise in the specific activity of the soluble protein prepared by lysing the nerve ending particles with water while the specific activity of the soluble protein from the whole homogenate concomitantly fell almost by a factor of three. The data are interpreted as being consistent with the appearance of protein in nerve endings by axoplasmic flow.


Force Required to Cinch the Tricuspid Annulus: An Ex-Vivo Study.
Tricuspid annuloplasty is the most preferred technique for the treatment of functional tricuspid regurgitation (FTR). However, high incidences of recurrent regurgitation and risky reoperation demands a deeper insight into the technique. The cinching force required to bring a dilated annulus back to the original size is unknown. The study aim was to quantify the cinching force in the tricuspid annulus which can contribute to the long-term durability of tricuspid annuloplasty and percutaneous device design. In ten ovine hearts, a suture was anchored around the free wall of the tricuspid annulus with the free end attached to a force transducer. The force transducer was mounted on a slider system which pulled the suture at regular intervals. Closure of the tricuspid valve was achieved by pressurizing the right ventricle at 30 mmHg through the pulmonary valve. The suture was pulled to cinch the tricuspid annulus. The tricuspid annulus area was measured from images taken at each increment, and the corresponding force was recorded. The hearts were tested for three conditions: (i) non-pressurized (NP); (ii) pressurized (P; normal), and (iii) dilated-pressurized (DP; diseased). Leakage data were also collected for pressurized and dilated pressurized conditions. Annulus dilation was created by injecting phenol into the annulus. The maximum annulus dilation obtained was 8.82%, and the maximum cinching force was 0.38 +/- 0.09 N. Leakage was increased by 81.73% from the pressurized to dilated condition. The minimal force required to cinch a tricuspid annulus with severe FTR (23.98% dilation) can be approximated to 0.25 N. The required cinching force can play a major role in the long-term durability of the tricuspid annuloplasty.


Gender differences in plasma levels of lipoprotein (a) in patients with angiographically proven coronary artery disease.
The objective of the study was to assess the association between plasma levels of lipoprotein(a) [Lp(a)] and the presence of angiographically defined coronary artery disease (aCAD). Patients (346 men and 184 women) undergoing selective coronary angiography (SCA) were classified into groups with positive [aCAD(+)] and negative [aCAD(-)] findings and their age, body mass index (BMI), waist circumference, blood pressure, smoking, plasma total, LDL-, HDL-cholesterol (TC, LDL-C, HDL-C), triglycerides (TG), apolipoprotein B (apoB), Log(TG/HDL-C) and TC/HDL-C were determined. Concentration of plasma Lp(a) was estimated using the commercial solid phase two-side immunoradiometric assay of apolipoprotein apo(a). The plasma Lp(a) was significantly higher in both women and men with aCAD(+) compared to those with aCAD(-). While there was no significant difference in the Lp(a) level between men and women with aCAD(-) (median 138 vs. 145 units/l), the women with aCAD(+) had almost twice as high Lp(a) levels as men (median 442 vs. 274 units/l, p<0.001). Women with aCAD(+) had also significantly lower HDL cholesterol levels (1.09 vs. 1.20 mmol/l, p<0.05), higher triglycerides (1.82 vs. 1.46 mmol/l, p<0.05) and Log(TG/HDL-C) than women with aCAD(-). The differences in Lp(a) between positive and negative findings remained highly significant (p<0.001 in women, p<0.05 in men) after the adjustment for age, plasma HDL- and LDL-cholesterol and triglycerides in logistic regression analyses. In logistic regression model the Lp(a) and Log(TG/HDL-C) and smoking in women but smoking and age in men were the most powerful predictors of positive aCAD findings. Our findings suggest that Lp(a) is more strongly associated with aCAD+ in women than in men.


Atmospheric Pressure and Abdominal Aortic Aneurysm Rupture: Results From a Time Series Analysis and Case-Crossover Study.
Associations between atmospheric pressure and abdominal aortic aneurysm (AAA) rupture risk have been reported, but empirical evidence is inconclusive and largely derived from studies that did not account for possible nonlinearity, seasonality, and confounding by temperature. Associations between atmospheric pressure and AAA rupture risk were investigated using local meteorological data and a case series of 358 patients admitted to hospital for ruptured AAA during the study period, January 2002 to December 2012. Two analyses were performed-a time series analysis and a case-crossover study. Results from the 2 analyses were similar; neither the time series analysis nor the case-crossover study showed a significant association between atmospheric pressure ( P = .627 and P = .625, respectively, for mean daily atmospheric pressure) or atmospheric pressure variation ( P = .464 and P = .816, respectively, for 24-hour change in mean daily atmospheric pressure) and AAA rupture risk. This study failed to support claims that atmospheric pressure causally affects AAA rupture risk. In interpreting our results, one should be aware that the range of atmospheric pressure observed in this study is not representative of the atmospheric pressure to which patients with AAA may be exposed, for example, during air travel or travel to high altitudes in the mountains. Making firm claims regarding these conditions in relation to AAA rupture risk is difficult at best. Furthermore, despite the fact that we used one of the largest case series to date to investigate the effect of atmospheric pressure on AAA rupture risk, it is possible that this study is simply too small to demonstrate a causal link.


Phage-Based Fluorescent Biosensor Prototypes to Specifically Detect Enteric Bacteria Such as E. coli and Salmonella enterica Typhimurium.
Water safety is a major concern for public health and for natural environment preservation. We propose to use bacteriophages to develop biosensor tools able to detect human and animal pathogens present in water. For this purpose, we take advantage of the highly discriminating properties of the bacteriophages, which specifically infect their bacterial hosts. The challenge is to use a fluorescent reporter protein that will be synthesized, and thus detected, only once the specific recognition step between a genetically modified temperate bacteriophage and its bacterial host has occurred. To ensure the accuracy and the execution speed of our system, we developed a test that does not require bacterial growth, since a simple 1-hour infection step is required. To ensure a high sensitivity of our tool and in order to detect up to a single bacterium, fluorescence is measured using a portable flow cytometer, also allowing on-site detection. In this study, we have constructed and characterized several "phagosensor" prototypes using the HK620 bacteriophage and its host Escherichia coli TD2158 and we successfully adapted this method to Salmonella detection. We show that the method is fast, robust and sensitive, allowing the detection of as few as 10 bacteria per ml with no concentration nor enrichment step. Moreover, the test is functional in sea water and allows the detection of alive bacteria. Further development will aim to develop phagosensors adapted on demand to the detection of any human or animal pathogen that may be present in water.


Intestinal injury and endotoxemia in children undergoing surgery for congenital heart disease.
Children with congenital heart disease are at risk of gut barrier dysfunction and translocation of gut bacterial antigens into the bloodstream. This may contribute to inflammatory activation and organ dysfunction postoperatively. To investigate the role of intestinal injury and endotoxemia in the pathogenesis of organ dysfunction after surgery for congenital heart disease. We analyzed blood levels of intestinal fatty acid binding protein and endotoxin (endotoxin activity assay) alongside global transcriptomic profiling and assays of monocyte endotoxin receptor expression in children undergoing surgery for congenital heart disease. Levels of intestinal fatty acid binding protein and endotoxin were greater in children with duct-dependent cardiac lesions. Endotoxemia was associated with severity of vital organ dysfunction and intensive care stay. We identified activation of pathogen-sensing, antigen-processing, and immune-suppressing pathways at the genomic level postoperatively and down-regulation of pathogen-sensing receptors on circulating immune cells. Children undergoing surgery for congenital heart disease are at increased risk of intestinal mucosal injury and endotoxemia. Endotoxin activity correlates with a number of outcome variables in this population, and may be used to guide the use of gut-protective strategies.


Effects of the interleukin-1β-511 C/T gene polymorphism on the risk of gastric cancer in the context of the relationship between race and H. pylori infection: a meta-analysis of 20,000 subjects.
The interleukin (IL)-1β-511 C/T polymorphism has been shown to be functional and to contribute to the risk of gastric cancer. However, the relationship between the IL-1β-511 C/T polymorphism and gastric carcinogenesis remains inconclusive. A systematical electronic search was conducted of the MEDLINE, EMBASE, and CENTRAL databases. A random and a fixed effects model were exploited to estimate summary odds ratios and 95 % confidence intervals. Subgroup and sensitivity analyses were carried out with respect to ethnicity, quality assessment scores, control sources, genotyping methods, cancer histopathology and location, and Helicobacter pylori (H. pylori) infection. A total of 45 studies containing 9,066 cases of gastric cancer and 11,192 control subjects satisfied the inclusion criteria. The IL-1β-511 C/T polymorphism was found to enhance the risk of stomach cancer for overall and HWE-satisfying studies. Asians showed a positive relationship in both the overall and HWE-satisfying groups, whereas Caucasians did not. Based on subgroup analysis, H. pylori infection and genotype analysis using PCR-RFLP methods increase the association between IL-1β-511 T allele carrier and risk of stomach cancer. A positive relationship was found between the IL-1β-511 C/T SNP and stomach carcinoma susceptibility, and the results suggest that Asian ethnicity, H. pylori infection and methodologically, PCR-RFLP genotyping strengthen this relationship. Reflecting on prevalence of H. pylori in Asian countries, additional studies on the IL-1β-511 C/T SNP in the context of ethnicity and H. pylori infection may provide key insights into the mechanism underlying gastric cancer carcinogenesis. It was found PCR-RFLP is the most reliable genotyping method, and thus, it is recommendable to adopt it to determine the presence of the IL-1β-511 C/T SNP.


Carbon-14 in low-level radioactive waste from two nuclear power plants.
The amount of 14C in low-level radioactive wastes is important for determining the future impacts of their disposal. New regulations in the Code of Federal Regulations, Title 10, Part 61 (10 CFR 61) require quantitation of 14C and other radionuclides in such wastes not amenable to measurement by gamma spectroscopy. Sampling was done of major waste streams at the Palisades pressurized water reactor (PWR) and the Big Rock Point boiling water reactor (BWR) to determine quantities of 14C in the waste streams for comparison with other reported studies. Analyses were performed by releasing all 14C constituents in the waste samples in the form of 14CO2 by chemical processing or by heating the samples in a tube furnace containing CuO2 catalyst and trapping the evolved gas in a liquid scintillator for counting. The largest amounts of 14C were found in the resins and filters used for reactor water cleanup, a result which is similar to those of the available studies. From these data, the annual amounts of 14C in wastes from nominal PWRs and BWRs were estimated to be 4.7 and 0.5 Ci/GW(e)-yr, respectively.


Split-thickness skin graft of a pedal oil burn in an adolescent female.
Split-thickness skin grafting of the foot following a burn injury provides excellent coverage to promote early rehabilitation and to facilitate healing. When compared to a more slowly healing, cosmetically unacceptable secondary granulation process, grafting is especially important for the young, active patient for whom hospitalization and immobilization are difficult to maintain. Cosmetic results are also a great concern, especially in the female sector of this age group. The case presentation shows grafting as a successful means of treatment in consideration of these primary goals.


Insight into host cell carbohydrate-recognition by human and porcine rotavirus from crystal structures of the virion spike associated carbohydrate-binding domain (VP8*).
Rotavirus infection leads to the death of half a million children annually. The exact specifics of interaction between rotavirus particles and host cells enabling invasion and infection have remained elusive. Host cell oligosaccharides are critical components, and their involvement aids the virus in cell-recognition and attachment, as well as dictation of the remarkable host-specificity that rotaviruses demonstrate. Interaction between the rotavirus spike-protein carbohydrate-binding domain (VP8*) and cell surface oligosaccharides facilitate virus recognition of host cells and attachment. Rotaviruses are considered, controversially, to recognise vastly different carbohydrate structures and either with incorporation of terminal sialic acid or without, as assessed by their ability to infect cells that have been pre-treated with sialidases. Herein, the X-ray crystallographic structures of VP8* from the sialidase insensitive Wa and the sialidase sensitive CRW-8 rotavirus strains that cause debilitating gastroenteritis in human and pig are reported. Striking differences are apparent regarding recognition of the sialic acid derivative methyl alpha-D-N-acetylneuraminide, presenting the first experimental evidence of the inability of the human rotavirus strain to bind this monosaccharide, that correlates with Wa and CRW-8 recognising sialidase-resistant and sialidase-sensitive receptors, respectively. Identified are structural features that provide insight in attainment of substrate specificity exhibited by porcine strains as compared to rhesus rotavirus. Revealed in the CRW-8 VP8* structure is an additional bound ligand that intriguingly, is within a cleft located equivalent to the carbohydrate-binding region of galectins, and is suggestive of a new region for interaction with cell-surface carbohydrates. This novel result and detailed comparison of our representative sialidase-sensitive CRW-8 and insensitive Wa VP8* structures with those reported leads to our hypothesis that this groove is used for binding carbohydrates, and that for the human strains, as for other sialidase-insensitive strains could represent a major oligosaccharide-binding region.


Function of vitamin A in vertebrate embryonic development.
Advances in molecular biology and retinoic acid receptor research have significantly contributed to the understanding of the role of vitamin A during vertebrate development. Examination of the function of this vitamin during very early developmental stages using the completely vitamin A-depleted avian embryo has revealed that the vitamin A requirement begins at the time of formation of the primitive heart, circulation and specification of hindbrain. The lack of vitamin A at this critical time results in gross abnormalities and early embryonic death. In rodent models, vitamin A deficiency can be targeted to later gestational windows and documents the need for vitamin A for more advanced stages of development. Major target tissues of vitamin A deficiency include the heart, central nervous system and structures derived from it, the circulatory, urogenital and respiratory systems, and the development of skull, skeleton and limbs. These abnormalities are also evident in mice mutants from retinoid receptor knockouts; they have revealed both morphological and molecular aspects of vitamin A function during development. Retinoic acid receptors (RAR) in partnership with retinoid X receptor (RXR)alpha appear to be the important retinoid receptor transcription factors regulating vitamin A function at the gene level during development via the physiologic ligand all-trans-retinoic acid. Homeostasis of retinoic acid is maintained by developmentally regulated vitamin A metabolism enzyme systems. Inadequate vitamin A nutrition during early pregnancy may account for some pediatric congenital abnormalities.


Travel of pregnant women in emergency situations to hospital and maternal mortality in Lagos, Nigeria: a retrospective cohort study.
Prompt access to emergency obstetrical care (EmOC) reduces the risk of maternal mortality. We assessed institutional maternal mortality by distance and travel time for pregnant women with obstetrical emergencies in Lagos State, Nigeria. We conducted a facility-based retrospective cohort study across 24 public hospitals in Lagos. Reviewing case notes of the pregnant women presenting between 1 November 2018 and 30 October 2019, we extracted socio-demographic, travel and obstetrical data. The extracted travel data were exported to Google Maps, where driving distance and travel time data were extracted. Multivariable logistic regression was conducted to determine the relative influence of distance and travel time on maternal death. Of 4181 pregnant women with obstetrical emergencies, 182 (4.4%) resulted in maternal deaths. Among those who died, 60.3% travelled ≤10 km directly from home, and 61.9% arrived at the hospital ≤30 mins. The median distance and travel time to EmOC was 7.6 km (IQR 3.4-18.0) and 26 mins (IQR 12-50). For all women, travelling 10-15 km (2.53, 95% CI 1.27 to 5.03) was significantly associated with maternal death. Stratified by referral, odds remained statistically significant for those travelling 10-15 km in the non-referred group (2.48, 95% CI 1.18 to 5.23) and for travel ≥120 min (7.05, 95% CI 1.10 to 45.32). For those referred, odds became statistically significant at 25-35 km (21.40, 95% CI 1.24 to 36.72) and for journeys requiring travel time from as little as 10-29 min (184.23, 95% CI 5.14 to 608.51). Odds were also significantly higher for women travelling to hospitals in suburban (3.60, 95% CI 1.59 to 8.18) or rural (2.51, 95% CI 1.01 to 6.29) areas. Our evidence shows that distance and travel time influence maternal mortality differently for referred women and those who are not. Larger scale research that uses closer-to-reality travel time and distance estimates as we have done, rethinking of global guidelines, and bold actions addressing access gaps, including within the suburbs, will be critical in reducing maternal mortality by 2030.


Long-term treatment with antidepressants increases glucocorticoid receptor binding and gene expression in cultured rat hippocampal neurones.
Since the glucocorticoid receptor (GR) and/or mineralocorticoid receptor (MR) in the hippocampus have been implicated in cortisol feedback of the hypothalamus-pituitary-adrenal (HPA) axis, abnormalities in those receptors might underlie the hyperactivity of the HPA axis described in patients with major depression. Animal studies have shown that long-term in-vivo treatment with antidepressants up-regulates hippocampal GR and/or MR, but it is not clear whether this up-regulation is evoked through a direct action of antidepressants on these receptors. We therefore examined the direct effects of long-term antidepressant treatment on GR binding and the levels of GR messenger RNA (mRNA) in primary cultures of rat hippocampal neurones. The time course of the effects of the tricyclic antidepressants desipramine and amitriptyline on GR binding, as assessed by [3H]dexamethasone binding using RU 28362, a specific agonist for GR, showed a biphasic mode of stimulation: desipramine significantly increased the GR binding with 2-day exposure by 36% over that in controls and by 99% and 60% with 10- and 14-day exposures, respectively. Amitriptyline also led to a significant increase in GR binding, with peaks at 2 (by 60%) and 14 days of exposure (by 60%). The effects of 14-day treatment with desipramine required at least the first 4-day exposure, and the first 10-day exposure was required for the full effect. Northern blot analysis demonstrated that the GR mRNA level was significantly increased by 14-day treatment with desipramine (+142% over control), amitriptyline (+108%), mianserin (+124%), paroxetine (+42%) and sulpiride (+92%), but not with haloperidol. Immunocytochemistry for GR revealed that 2- or 14-day treatment with desipramine significantly increased the number of GR-positive cells with dominant immunoreactivity in the nuclei of granule cell-like neurones or in perikarya of pyramidal cell- and granule cell-like neurones. These findings suggest that tricyclic antidepressants directly increase hippocampal GR by short-term (2-day) and long-term (14-day) exposure, and that the increase by long-term exposure is evoked commonly with different classes of antidepressants through transcriptional up-regulation of GR expression.


Infants admitted to neonatal units--interventions to improve breastfeeding outcomes: a systematic review 1990-2007.
This review aimed to identify interventions to promote breastfeeding or breast milk feeding for infants admitted to the neonatal unit. The medical electronic databases were searched for papers listed between 1990 and June 2005 which had breastfeeding or breast milk as an outcome and which targeted infants who had been admitted to a neonatal unit, thus including the infant and/or their parents and/or neonatal unit staff. Only papers culturally relevant to the UK were included resulting in studies from the USA, Canada, Europe, Australia and New Zealand. This search was updated in December 2007 to include publications up to this date. We assessed 86 papers in full, of which 27 ultimately fulfilled the inclusion criteria. The studies employed a range of methods and targeted different aspects of breastfeeding in the neonatal unit. Variations in study type and outcomes meant that there was no clear message of what works best but skin-to-skin contact and additional postnatal support seemed to offer greater advantage for the infant in terms of breastfeeding outcome. Galactogogues for mothers who are unable to meet their infants' needs may also help to increase milk supply. Evidence of an effect from other practices, such as cup-feeding on breastfeeding was limited; mainly because of a lack of research but also because few studies followed up the population beyond discharge from the unit. Further research is required to explore the barriers to breastfeeding in this vulnerable population and to identify appropriate interventions to improve breastfeeding outcomes.


The Genetics of Endophenotypes of Neurofunction to Understand Schizophrenia (GENUS) consortium: A collaborative cognitive and neuroimaging genetics project.
Schizophrenia has a large genetic component, and the pathways from genes to illness manifestation are beginning to be identified. The Genetics of Endophenotypes of Neurofunction to Understand Schizophrenia (GENUS) Consortium aims to clarify the role of genetic variation in brain abnormalities underlying schizophrenia. This article describes the GENUS Consortium sample collection. We identified existing samples collected for schizophrenia studies consisting of patients, controls, and/or individuals at familial high-risk (FHR) for schizophrenia. Samples had single nucleotide polymorphism (SNP) array data or genomic DNA, clinical and demographic data, and neuropsychological and/or brain magnetic resonance imaging (MRI) data. Data were subjected to quality control procedures at a central site. Sixteen research groups contributed data from 5199 psychosis patients, 4877 controls, and 725 FHR individuals. All participants have relevant demographic data and all patients have relevant clinical data. The sex ratio is 56.5% male and 43.5% female. Significant differences exist between diagnostic groups for premorbid and current IQ (both p<1×10-10). Data from a diversity of neuropsychological tests are available for 92% of participants, and 30% have structural MRI scans (half also have diffusion-weighted MRI scans). SNP data are available for 76% of participants. The ancestry composition is 70% European, 20% East Asian, 7% African, and 3% other. The Consortium is investigating the genetic contribution to brain phenotypes in a schizophrenia sample collection of >10,000 participants. The breadth of data across clinical, genetic, neuropsychological, and MRI modalities provides an important opportunity for elucidating the genetic basis of neural processes underlying schizophrenia.


Multi-level regulation of even-skipped stripes by the ubiquitous factor Zelda.
The zinc-finger protein Zelda (Zld) is a key activator of zygotic transcription in early Drosophila embryos. Here, we study Zld-dependent regulation of the seven-striped pattern of the pair-rule gene even-skipped (eve). Individual stripes are regulated by discrete enhancers that respond to broadly distributed activators; stripe boundaries are formed by localized repressors encoded by the gap genes. The strongest effects of Zld are on stripes 2, 3 and 7, which are regulated by two enhancers in a 3.8 kb genomic fragment that includes the eve basal promoter. We show that Zld facilitates binding of the activator Bicoid and the gap repressors to this fragment, consistent with its proposed role as a pioneer protein. To test whether the effects of Zld are direct, we mutated all canonical Zld sites in the 3.8 kb fragment, which reduced expression but failed to phenocopy the abolishment of stripes caused by removing Zld in trans. We show that Zld also indirectly regulates the eve stripes by establishing specific gap gene expression boundaries, which provides the embryonic spacing required for proper stripe activation.


Death Scene Investigation and Autopsy Practices in Sudden Unexpected Infant Deaths.
To describe and compare sudden unexpected infant death (SUID) investigations among states participating in the SUID Case Registry from 2010 through 2012. We analyzed observational data from 770 SUID cases identified and entered into the National Child Death Review Case Reporting System. We examined data on autopsy and death scene investigation (DSI) components, including key information about the infant sleep environment. We calculated the percentage of components that were complete, incomplete, and missing/unknown. Most cases (98%) had a DSI. The DSI components most frequently reported as done were the narrative description of the circumstances (90%; range, 85%-99%), and witness interviews (88%, range, 85%-98%). Critical information about 10 infant sleep environment components was available for 85% of cases for all states combined. All 770 cases had an autopsy performed. The autopsy components most frequently reported as done were histology, microbiology, and other pathology (98%; range, 94%-100%) and toxicology (97%; range, 94%-100%). This study serves as a baseline to understand the scope of infant death investigations in selected states. Standardized and comprehensive DSI and autopsy practices across jurisdictions and states may increase knowledge about SUID etiology and also lead to an improved understanding of the cause-specific SUID risk and protective factors. Additionally, these results demonstrate practices in the field showing what is feasible in these select states. We encourage pediatricians, forensic pathologists, and other medicolegal experts to use these findings to inform system changes and improvements in DSI and autopsy practices and SUID prevention efforts.


Retinal vein occlusion in Armenia.
To determine the demographic characteristics, associated ophthalmic and systemic conditions of retinal vein occlusion (RVO) and associations of central retinal vein occlusion among Armenian patients. A retrospective study of 460 patients aged 30 years and older with a clinical diagnosis of RVO who were seen in the five-year period between January 1, 1993, and December 31, 1997 at the Eye Hospital. Signs of central RVO were found in 297 eyes (64.5%), branch RVO in 163 eyes (35.5%). Among the 460 patients occlusion was hemispheric in 4 eyes (2.4%), hemicentral in 5 eyes (3%). CRVO was more common among the younger patients (odds ratio [OR] = 2.42, 95% confidence interval [CI]: 1.06-5.65). Hypercoagulability was noted in the majority of RVO cases. Glaucoma was an associated condition (12.6%). Systemic hypertension was the most frequent association. In CRVO a significant association was found with hypertension (OR = 1.89, 95% CI: 1.23-2.70). Our results suggest RVO is associated with glaucoma and hypertension. RVO was more closely associated with hypertension than BRVO. There were no differences in the distribution for the site of occlusion with regard to sex in patients with CRVO and BRVO. No seasonal pattern was found in the onset of any type of RVO. Hypercoagulability may be a contributing factor in the pathogenesis. The findings reinforce recommendations to carefully evaluate patients with RVO for open-angle glaucoma, and to diagnose and treat systemic hypertension.


Clinical results of Intraductal Meibomian gland probing combined with intense pulsed light in treating patients with refractory obstructive Meibomian gland dysfunction: a randomized controlled trial.
This study aims to optimize the therapeutic regimen for refractory obstructive meibomian gland dysfunction (o-MGD) patients by combining intraductal meibomian gland probing (MGP) and intense pulsed light (IPL) to enhance their positive effects and reduce their limitations. This randomized, assessor blind study includes 45 patients (90 eyes) with refractory o-MGD who were divided into 3 groups via allocation concealment: IPL (group I, received an IPL treatment course: 3 times at 3-week intervals), MGP (group II, received MGP one time), and combined MGP-IPL (group III, MGP first followed by an IPL treatment course). Standard Patient Evaluation of Eye Dryness score (SPEED), tear break-up time (TBUT), corneal fluorescein staining (CFS), meibum grade, and lid margin finding results were assessed at baseline, 3 weeks after final treatment for groups I and III, 3 and 12 weeks after MGP for group II. Six months after final treatment, the SPEED and willingness to receive any treatment again were also collected for all groups. Paired Wilcoxon, Mann-Whitney U with Bonferroni correction, and Kruskal-Wallis tests were used for data analysis. For all 3 groups, all previously mentioned indexes improved significantly following treatment (P<0.01). MGP-IPL was better than IPL and MGP in terms of post-treatment SPEED, TBUT, meibum grade, and lid telangiectasia (P<0.05/3). Furthermore, the MGP-IPL was better than IPL in terms of lid tenderness and better than MGP in terms of orifice abnormality (P< 0.05/3). Six months later, the SPEED for the MGP-IPL was also significantly lower than other groups (P<0.05/3). Moreover, no patients in the MGP-IPL group expressed the need to be treated again compared to 35.7% or 20% of patients in the IPL or MGP groups, respectively. Compared with IPL or MGP alone, the combination MGP-IPL produced best results in relieving all signs and symptoms and helping patients attain long-lasting symptom relief. http://clinicaltrials.gov , ChiCTR1900021273 (retrospectively registered February 9, 2019).


Antibiotics for persistent cough or wheeze following acute bronchiolitis in children.
Bronchiolitis is a common acute respiratory infectious condition, with a high prevalence worldwide. It is a clinically diagnosed syndrome, manifested by tachypnoea (rapid breathing), with crackles or wheeze in young children. In the acute phase of bronchiolitis (< 14 days), antibiotics have only been recommended when a secondary bacterial infection is suspected. Although bronchiolitis is usually a self-limiting condition, a number of children have persistent respiratory symptoms such as cough and wheezing in post-acute bronchiolitis, and they present or re-present to secondary care. To determine the effectiveness of antibiotics compared to a control (no treatment or placebo) for persistent respiratory symptoms (within six months), following acute bronchiolitis. The following databases were searched, The Cochrane Airways Group Register of Trials, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), EMBASE (Ovid) and ClinicalTrials.gov. We searched all databases from their inception to the present, and did not impose restriction on language of publication. The search was performed in October 2012. All randomised controlled trials (RCTs) comparing antibiotics with controls (placebo or no treatment) given in the post-acute phase of bronchiolitis (> 14 days) for children younger than two years of age diagnosed with bronchiolitis were included. Two review authors independently assessed studies against pre-defined criteria; and selected, extracted and assessed the data for inclusion. Several subgroup analyses were planned and this included when antibiotics commenced (early commencement classified as preventing; later commencement as treatment for post-bronchiolitis symptoms). A single study met the inclusion criteria but had a high attrition rate. Thirty infants with respiratory syncytial virus (RSV)-confirmed bronchiolitis were randomised to receive either a daily dose of oral clarithromycin 15 mg/kg or placebo for three weeks. Using an intention-to-treat (ITT) analysis, there was no significant difference between groups for the proportion of children who had persistent symptoms (odds ratio (OR) 0.20; 95% confidence interval (CI) 0.02 to 2.02) or re-hospitalisation within six months (OR 0.11; 95% CI 0.01 to 1.29). There were no treatment studies of later commencement of antibiotics. There is currently insufficient evidence to inform whether antibiotics should be used to treat or prevent persistent respiratory symptoms in the post-acute bronchiolitis phase. Future RCTs that evaluate the efficacy of antibiotics to reduce persistent respiratory symptoms are required, especially in areas where both acute and post-bronchiolitis morbidity is high such as in Indigenous communities in the US, New Zealand and Australia.


The Barcelona Sleepiness Index: A New Instrument to Assess Excessive Daytime Sleepiness in Sleep Disordered Breathing.
To develop the Barcelona Sleepiness Index (BSI), an interviewer-administered instrument for assessing excessive daytime sleepiness (EDS) in sleep-disordered breathing (SDB) that correlates well with objective measures of EDS and which is sensitive to change with treatment. (1) Generation of a preliminary item list: Fifty-three consecutive SDB patients complaining of EDS and their bed partners were interviewed using a focus group methodology to generate a list of situations prone to cause sleepiness. Sixty different consecutive SDB patients were then evaluated using cognitive interviews to refine this list. (2) Construct validity: The maintenance of wakefulness test (MWT), the multiple sleep latency test (MSLT) and the sustained attention to response task (SART) test were used in an additional 98 consecutive SDB patients with and without EDS. The item combination that best correlated with the objective tests constituted the BSI. Cutoff values were determined to differentiate between patients with and without EDS. (3) Sensitivity to change: Thirty patients requiring continuous positive airway pressure (CPAP) were evaluated after satisfactory treatment. A combination of two items, "in the morning, when relaxing" and "in the afternoon, standing inactive, in a public place," presented the highest correlations with the MWT (r: -0.50, p < 0.001), the MSLT (r: -0.21, p = 0.07), and the SART (r: 0.27, p < 0.02) and constituted the BSI. The BSI significantly correlated with oxyhemoglobin saturation measures (nadir SpO2: r: -0.28, p = 0.01; CT 85: r: 0.23, p = 0.04) and showed a high sensitivity to change with CPAP treatment (t: 3.4, p = 0.002). A score of 2 or more identified patients with objective EDS (sensitivity = 64.9%, specificity = 72.1%). The Barcelona Sleepiness Index is a simple, brief instrument for measuring subjective EDS in SDB.


Knowledge and healthcare-seeking behavior of family caregivers of children with pneumonia: A qualitative study in an urban community in Indonesia.
Childhood pneumonia is the leading cause of death. Family caregivers may have a poor understanding of pneumonia, especially related to prevention and treatment. It is crucial to understand country-specific knowledge and healthcare-seeking behaviors of caregivers of children with pneumonia before planning programmatic responses, particularly in an urban community where the culture-social economic status is diverse. This study aimed to describe the knowledge and healthcare-seeking behavior of family caregivers of children with pneumonia in Indonesia's urban community. A descriptive qualitative study was conducted at a public hospital in Jakarta, Indonesia, from 10 December 2019 to 28 January 2020. Ten family caregivers of children with pneumonia were included, and a semi-structured interview was conducted for data collection. The audio recording was transcribed verbatim, and the data were analyzed using content analysis. The emerged data indicated low knowledge of the family caregivers, especially mothers, which considered pneumonia a common cold only, and they failed to understand the risk of its transmission. Using traditional medicines was the first stage of healthcare-seeking behavior. If the symptoms worsened, the caregivers brought their children to the nearest health center. If there was no change in the symptoms, they headed to the hospital. The health center's location, condition, services, and staff attitude were considered factors to choose the services. Living in an urban area does not guarantee the family caregivers have better knowledge and good healthcare-seeking behavior. Therefore, nurses should provide comprehensive education about pneumonia, its symptoms, and treatment management to improve family care and prevent pneumonia-related deaths. Integrated management of children with illness is recommended to help the family caregivers of children with pneumonia receive treatment as quickly as possible.


Design of clinical trials for new drugs in animals.
Consideration of the intended purpose, an effort to ask specific questions that can be answered by specific data, selection of the correct values to be measured, and investigators who are able to conduct the study, will make it possible to design clinical studies properly. The ethical need to avoid unnecessary suffering of experimental animals and rules and regulations in effect at the time of clinical trials will dictate certain aspects of the design. The type of product to be evaluated, its mode of administration, the type of animal in which the drug will be used, the type of investigator who will collect the data, and the individual who will use the drug, will determine the mechanical part of the protocol. All of these factors need to be considered and discussed with all participants, which may include biostatisticians, regulatory authorities, investigators, and other individuals, to ensure that a rational design is chosen.


In-vitro comparison of the effect of different bonding strategies on the micro-shear bond strength of a silorane-based composite resin to dentin.
The current study evaluated the micro-shear bond strengths of a new low-shrinkage composite resin to dentin. In this in-vitro study, 70 extracted premolars were assigned to one of seven groups (n = 10): Group 1: OptiBond Solo Plus (Opt; Kerr); Group 2: SE Bond (SE; Kuraray); Group 3: Silorane System Adhesive (SSA; 3M ESPE); Group 4: OptiBond Solo Plus + LS Bond (Opt LS); Group 5: SE Bond + LS Bond (SE LS); Group 6: OptiBond Solo Plus (Opt Po); and Group 7: SE Bond (SE Po). Occlusal dentin was exposed and restored with Filtek LS (3M ESPE) in groups 1 to 5 and Point 4 (Kerr) in groups 6 and 7. After thermocycling (1000 cycles at 5/55΀C), micro-shear bond test was carried out to measure the bond strengths. The results were submitted to analysis of variance and post hoc Tukeytests (P < 0.05). Two-way ANOVA showed no significant differences between the two types of composite resin (P = 0.187), between bonding agents (P = 0.06) and between composite resin and bonding agents (P = 0.894). Because P value of bonding agents was near the significance level, one-way ANOVA was used separately between the two composite groups. This analysis showed significant differences between silorane composite resin groups (P = 0.045) and Tukey test showed a significant difference between Groups 4 and 5 (P = 0.03). The application of total-etch and self-etch methacrylate-based adhesives with and without use of a hydrophobic resin coating resulted in acceptable bond strengths.


Antagonistic effects of adrenalectomy and ether/surgical stress on light-induced photoreceptor damage.
Light-induced damage to retinal photoreceptors in influenced by the endocrine status of the animal during the period of exposure. Experimental manipulation of the pituitary gland and of prolactin levels has been shown to affect retinal damage in rats exposed to visible light. When rats are experimentally stressed, prolactin secretion from the pituitary gland occurs as does secretion of adrenocorticotropic hormone (ACTH), which stimulates the release of adrenal cortical hormones. Since prolactin appears to influence retinal damage and since stressed animals have increased serum levels of prolactin, a comparison of photoreceptor damage in animals in which the adrenal glands were removed or which had been experimentally stressed was undertaken in this study. Adrenalectomized rats had thicker outer nuclear layer (ONL) measurements than those found in sham-operated animals. Stressed rats had severely damaged retinas with cystic degeneration and significantly reduced ONL thickness measurements as compared to retinas of unstressed and adrenalectomized rats. Therefore hormones of the pituitary-adrenal system appear to be involved in the damage to the retina by light, and this response may be related to an interaction or synergism between the adrenal gland, stress, and prolactin secretion.


Measuring social support in pregnancy: can it be simple and meaningful?
It is important to determine the level of a woman's social support at the booking-in interview for prenatal care, but measurement tends to be ad hoc and nonquantifiable. The purpose of this study was to describe the Maternity Social Support Scale and the relationship between support scale ratings and the Edinburgh Postnatal Depression Scale and other health and service use outcomes. Women (n = 901) who attended the antenatal clinic at the Royal Women's Hospital in Brisbane, Australia, were asked to complete a support scale as part of their booking-in interview. Participants were contacted at 16 weeks postpartum and invited to complete a follow-up questionnaire. Relationships between the scale and study outcomes were explored using analysis of variance and chi-square tests. Women with low social support in pregnancy were more likely than well-supported women to report poorer health during pregnancy (p = 0.006) and postnatally (p < 0.001), to book later for prenatal care (p = 0.000), to seek medical help more frequently (p = 0.004), and to be more depressed postnatally (p = 0.0001). Social support during pregnancy can be measured in a meaningful and simple way through the use of a short questionnaire administered at the prenatal booking-in visit.


Abbreviation definition identification based on automatic precision estimates.
The rapid growth of biomedical literature presents challenges for automatic text processing, and one of the challenges is abbreviation identification. The presence of unrecognized abbreviations in text hinders indexing algorithms and adversely affects information retrieval and extraction. Automatic abbreviation definition identification can help resolve these issues. However, abbreviations and their definitions identified by an automatic process are of uncertain validity. Due to the size of databases such as MEDLINE only a small fraction of abbreviation-definition pairs can be examined manually. An automatic way to estimate the accuracy of abbreviation-definition pairs extracted from text is needed. In this paper we propose an abbreviation definition identification algorithm that employs a variety of strategies to identify the most probable abbreviation definition. In addition our algorithm produces an accuracy estimate, pseudo-precision, for each strategy without using a human-judged gold standard. The pseudo-precisions determine the order in which the algorithm applies the strategies in seeking to identify the definition of an abbreviation. On the Medstract corpus our algorithm produced 97% precision and 85% recall which is higher than previously reported results. We also annotated 1250 randomly selected MEDLINE records as a gold standard. On this set we achieved 96.5% precision and 83.2% recall. This compares favourably with the well known Schwartz and Hearst algorithm. We developed an algorithm for abbreviation identification that uses a variety of strategies to identify the most probable definition for an abbreviation and also produces an estimated accuracy of the result. This process is purely automatic.


New methods for sex estimation using sternum and rib morphology.
Sex estimation of skeletal remains is of great importance in the fields of physical and forensic anthropology. Since skeletons are often incomplete, it is essential to estimate sex from as many skeletal remains as possible. The aim of this study was to establish new methods for estimating sex using the morphology of the sternum and the fifth to ninth ribs. We considered two conditions of skeletal preservation: All skeletal elements measured are available, or only a single element is available. Traditional or virtual measurements were carried out on three samples: (1) A skeletal sample from the Hamann-Todd Human osteological collection, Cleveland Museum of Natural History, USA (N = 413), was used to create prediction equations for sex estimation. (2) A recent, CT-based sample from Israel (N = 33) was used to cross-validate the accuracy of the prediction equations. (3) A skeletal sample from the Anthropological Collection at Tel Aviv University (N = 15) was used to test the validity of the virtual measurements. Reliability and validity analyses were carried out via intraclass correlation coefficient analysis. Prediction equations for sex were created using logistic regression. The measurements were found to be highly reliable and valid. Success rates for sex estimation were high (> 80%) and correspond well between the skeletal and recent samples, especially for the left sixth, left eigth, and left ninth ribs. To conclude, measurements of the sternum and ribs are valuable for estimating sex and can be carried out using either traditional or virtual tools. Of all the skeletal elements examined in this study, the sternum, left sixth, left eighth, and left ninth ribs were found to be the most reliable skeletal elements for estimating the sex of an individual.


Microstructure and Mechanical Properties of an Ultrasonic Spot Welded Aluminum Alloy: The Effect of Welding Energy.
The aim of this study is to evaluate the microstructures, tensile lap shear strength, and fatigue resistance of 6022-T43 aluminum alloy joints welded via a solid-state welding technique-ultrasonic spot welding (USW)-at different energy levels. An ultra-fine necklace-like equiaxed grain structure is observed along the weld line due to the occurrence of dynamic crystallization, with smaller grain sizes at lower levels of welding energy. The tensile lap shear strength, failure energy, and critical stress intensity of the welded joints first increase, reach their maximum values, and then decrease with increasing welding energy. The tensile lap shear failure mode changes from interfacial fracture at lower energy levels, to nugget pull-out at intermediate optimal energy levels, and to transverse through-thickness (TTT) crack growth at higher energy levels. The fatigue life is longer for the joints welded at an energy of 1400 J than 2000 J at higher cyclic loading levels. The fatigue failure mode changes from nugget pull-out to TTT crack growth with decreasing cyclic loading for the joints welded at 1400 J, while TTT crack growth mode remains at all cyclic loading levels for the joints welded at 2000 J. Fatigue crack basically initiates from the nugget edge, and propagates with "river-flow" patterns and characteristic fatigue striations.


Cross-Cultural Chronotypes: Educating Medical Students in America, Malaysia and the UAE.
This article was migrated. The article was marked as recommended. Background: Ample data demonstrates that sleep deprivation leads to impaired functioning including cognitive performance, memory and fine motor skills. Medical students represent a professional sector in which optimizing cognitive performance and functioning is critical from a personal, public health and safety perspective. Aims: To characterize chronotypes of an international cohort of medical students and determine if chronotype is affected by demographics or latitude. Samples: 328 students from medical schools in the United States (US), Malaysia and United Arab Emirates (UAE) were assessed for differences in chronotype and sleep habits. Methods: A cross-sectional, questionnaire-based study from medical schools in the US, Malaysia and UAE between 2013 and 2015. Results: There was a significant difference in mean waking times for Malaysian students who reported awakening earlier than US or UAE students. Malaysian students were most likely to feel their best earlier in the day and consider themselves a "morning type." UAE students were more likely to do "hard physical work" later in the day, followed by US and Malaysian. On average, US students were less likely to shift their bedtime later if they had no commitments the next day. Overall, mean chronotype score was "neither" type for all three groups however the Malaysian group showed a significant preference for morning hours in some individual questions. Conclusion: Medical student sleep patterns vary internationally but chronotype may not. Improving sleep education globally, with awareness of the effects of chronotype, could ultimately result in improved sleep awareness, potentially influencing physician wellbeing, patient care and safety.


Influence of Iron Deficiency on Olfactory Behavior in Weanling Rats.
Chronically high occupational exposure to airborne metals like iron can impair olfactory function, but little is known about how low iron status modifies olfactory behavior. To investigate the influence of body iron status, weanling rats were fed a diet with low iron content (4 - 7 ppm) to induce iron deficiency anemia and olfactory behavior was compared to control rats fed an isocaloric diet sufficient in iron (210 - 220 ppm). Iron-deficient rats had prolonged exploratory time for attractive odorants in behavioral olfactory habituation/dis-habituation tests, olfactory preference tests and olfactory sensitivity tests compared with control rats. No significant differences were observed for aversive odorants between the two groups. These findings suggest that iron-dependent functions may be involved in controlling and processing of olfactory signal transduction via self and lateral inhibition such that odorant signal remains stronger for longer times prolonging exploratory activity on attractive odorants in the behavioral tests. These findings establish that iron deficiency can modify olfactory behavior.


Characterizing salt substitution in beef meat processing by vibrational spectroscopy and sensory analysis.
In this investigation, the effect of NaCl, KCl and MgSO4 on bovine meat was studied, where the salts were used in standard marinades in 5.5% concentration. The effect of salts on secondary structure of the myofibrillar proteins, protein-water interactions, WHC, and sensory properties of the meat was followed by carrying out FTIR and NIR measurements, cooking loss and sensory analysis. The information obtained by spectroscopic analysis was integrated by using CPCA. This revealed that MgSO4 increased ratio of α-helices and CO and NH groups (followed by FTIR) that are involved in H-bonding with surrounding water molecules (followed by NIR). This was also supported by increased WHC. Conversely, KCl reduced WHC of meat and was correlated to non-hydrogenated CO and NH groups. Furthermore, the sensory analysis confirmed that MgSO4 was acceptable only when the share of this salt in the mixture was one third.


Rapid cognitive decline in a patient with chronic lymphocytic leukaemia: a case report.
The use of monoclonal antibodies in various settings has been linked to the development of progressive multifocal leukoencephalopathy (PML). Whilst this association is well-described with agents such as rituximab and natalizumab, the literature describing the occurrence of PML with ofatumumab therapy (especially in a haematology setting) is sparse. This case aims to draw attention to the above association with a particular focus on the mechanisms by which B-cell-depleting therapy can precipitate PML during the treatment of haematological malignancy. A 68-year-old Caucasian man presented with acute-on-subacute confusion and reduced mobility. He had a history of chronic lymphocytic leukaemia for which he had completed six cycles of ofatumumab and chlorambucil 2 months prior to presentation. Biochemistry, physical examination and imaging were unremarkable on admission. Subsequent neurological examination demonstrated diminished reflexes and an extensor right plantar, while magnetic resonance imaging (MRI) assessment revealed white matter hyperintensities in the frontal lobes with restricted diffusion surrounding these areas. Cerebrospinal fluid (CSF) analysis demonstrated normal cell counts and chemistry but detected John Cunningham virus (JCV) via polymerase chain reaction (PCR), with a quantitative value of 41,850 gEg/ml. CSF immunophenotyping excluded malignant processes. A diagnosis of PML was confirmed, and with the support of palliative care, the patient was discharged to a hospice for ongoing care with the family's agreement. PML remains a rare complication of ofatumumab treatment. Nevertheless, clinicians should maintain a certain level of suspicion for this risk, especially in the context of patients presenting with clinical syndromes of encephalopathy and focal neurologic deficits. Furthermore, research to better our understanding of the manifold links between B-cell function and JCV regulation could provide valuable information for use in the future prevention and treatment of PML.


Conditioned taste aversion learning in leptin-receptor-deficient db/db mice.
The db/db mouse has defective leptin receptors. The defects lead to impairments of leptin regulation of food intake and body weight, and result in the expression of diabetic symptoms such as hyperinsulinemia, hyperglicemia, and extreme obesity. Recent studies have proposed that leptin may also affect memory and learning processes. To examine this possibility, we compared the ability of leptin-receptor-deficient db/db mice and their normal lean litter mates to form and extinguish a conditioned taste aversion (CTA) for saccharin. We used a short-term (10 s) lick test and a long-term (48 h) two bottle preference test for measurement of consumption of test solutions. On the first day after conditioning to avoid saccharin, the db/db mice showed preference scores for saccharin as low, and aversion thresholds for sucrose lower than that of the lean mice. During the extinction test trials beginning from the second up to the 30th day after conditioning, numbers of licks and preference scores for aversive saccharin and sucrose appeared to be larger, and recovered faster to the control levels in db/db mice. These results indicate that db/db mice with leptin-receptor-deficiency may show equal capacity to form CTAs for saccharin, greater generalization from saccharin to sucrose, and a faster rate of extinction. This suggests that disruption of leptin signalling does not inhibit acquisition of CTA learning, but impairs its extinction. This differential contribution of the leptin system on CTA processes may be due to differential distribution of leptin receptors in the CTA-related brain areas.


Error analysis on parameter estimates in the ligand-receptor model: application to parameter imaging using PET data.
Positron emission tomography and compartmental models allow the in vivo analysis of radioligand binding to receptor sites in the human brain. Benzodiazepine receptor binding was studied using a three-compartmental model and [11C]flumazenil. Four and five parameters were estimated from a single kinetic curve obtained with a multi-injection protocol, and parametric maps of receptor density and of the individual kinetic parameters were created with four-pixel sampling of the experimental images. The coefficient of variation on each estimated model parameter was calculated using the diagonal elements of the covariance matrix. However, these estimates are valid only under some statistical hypotheses which are not always verified with PET data. Thus, in order to verify the validity of the coefficient of variation of each parameter calculated with the covariance matrix, these results have been compared with the more rigorous statistical results provided by a Monte Carlo simulation. The study showed a negligible difference between the results obtained by the two methods for a low noise level in time-concentration curves encountered using large ROIs. However, this bias becomes less negligible when the noise level is high and some estimations of the coefficients of variation were unacceptable (> 100%) with the five-parameter model. Such difficulties did not occur with the four-parameter model which led to parametric images with good quality and acceptable estimates of coefficients of variation (less than 20% in about 75% of the ROIs).


Exploiting Joint Base Station Equipped Multiple Antenna and Full-Duplex D2D Users in Power Domain Division Based Multiple Access Networks.
In this paper, we investigate power domain division-based multiple access (PDMA) to support the base stations (BS) equipped with multiple antennas to serve mobile users. Such a system deploys multiple input single output (MISO)-based wireless transmission and a full-duplex (FD) scheme. Furthermore, such MISO PDMA system consists of BS employing transmit antenna selection to reduce complexity in signal processing at the receivers. We distinguish two kinds of mobile users, device-to-device (D2D) users and traditional users. In such MISO PDMA, there exists a trade-off between outage performance of each PDMA user and power allocation factors. Since the implementation of the FD scheme at PDMA users, bandwidth efficiency will be enhanced despite the existence of self-interference related to such FD. In particular, exact expressions of outage probability are derived to exhibit system performance with respect to D2D users. Finally, valuable results from the simulated parameters together with the analytical results show that MISO PDMA can improve its performance by increasing the number of transmit antennas at the BS.


Epigenetic control of mammalian centromere protein binding: does DNA methylation have a role?
Chromosome 1 of the inbred mouse strain DBA/2 has a polymorphism associated with the minor satellite DNA at its centromere. The more terminal block of satellite DNA sequences on this chromosome acts as the centromere as shown by the binding of CREST ACA serum, anti-CENP-B and anti-CENP-E polyclonal sera. Demethylation of the minor satellite DNA sequences accomplished by growing cells in the presence of the drug 5-aza-2'-deoxycytidine results in a redistribution of the CENP-B protein. This protein now binds to an enlarged area on the more terminal block and in addition it now binds to the more internal block of minor satellite DNA sequences on chromosome 1. The binding of the CENP-E protein does not appear to be affected by demethylation of the minor satellite sequences. We present a model to explain these observations. This model may also indicate the mechanism by which the CENP-B protein recognises specific sites within the arrays of minor satellite DNA on mouse chromosomes.


Interhemispheric Inhibition Between Primary Motor Cortices is Not Altered in Individuals With Chronic Lateral Epicondylalgia.
Lateral epicondylalgia (LE), commonly referred to as tennis elbow, is a musculoskeletal condition characterized by pain and sensorimotor dysfunction. In some individuals with chronic unilateral LE, sensorimotor symptoms develop on the unaffected side despite no evidence of tissue damage. Altered interhemispheric inhibition (IHI) is one mechanism that could underpin this phenomenon. The aim of this cross-sectional study was to examine IHI between the primary motor cortices (M1) in individuals with chronic LE and healthy controls. In 20 individuals with chronic LE and 20 healthy participants, transcranial magnetic stimulation was used to assess 1) short and long-latency IHI from the affected (corresponding to the injured side) to the unaffected M1 and 2) corticomotor excitability of the affected and unaffected M1. Sensorimotor function was evaluated bilaterally at the extensor carpi radialis brevis muscle using pressure pain threshold, grip strength, 2-point discrimination, and temporal summation tests. Short- and long-latency IHI from the affected to the unaffected M1 and corticomotor excitability of the affected and unaffected M1 were not altered in individuals with LE compared with healthy participants. No differences in sensorimotor function were observed for the affected or unaffected extensor carpi radialis brevis muscles when individuals with LE were compared with healthy participants. IHI is not altered in individuals with chronic LE. Further studies are required to determine the mechanisms that underpin the development of bilateral sensorimotor symptoms in unilateral LE. PERSPECTIVE: IHI is unaltered from the affected M1 (corresponding to the painful muscle) to unaffected M1 in individuals with LE compared to healthy controls. The absence of bilateral sensorimotor dysfunction and low pain severity in this cohort of individuals with LE may explain this finding.


Chemical Stability of Bioglass in Simulated Oral Environment.
Bioglasses are a series of biocompatible dental materials, which are considered as light conducting inserts in resin composite restorations. Consequently, their chemical stability is more essential when they are used in conjunction with resin composite. The aim of this study was to evaluate and compare the chemical stability of Bioglass with dental porcelain and resin composite by determining the amount of released K+, Na+, Ca2+ ions and silicone elements from these materials as a result of exposure to tested solutions with different pH levels including: Sodium Bicarbonate [SB, (pH=9.2)], Sodium Buffer Lactate [SBL, (pH=2.4)], Acetic Acid [AA, (pH=2.4)], and Distilled Water [DW, (pH=6.2)]. In this experimental study, forty 2.0 × 4.0 cylindrical rods for each tested material group (Dental porcelain, Resin composite and Bioglass) were prepared. They were divided into four subgroups of 10 rods each, which immersed in one of the four testing solutions in a designated container. The containers were stored at 50°C and 100% humidity for one week. The released ions were measured by using a spectrophotometer (µg/cm2/ml). The data were statistically analyzed by nonparametric Kruskal-Wallis H test. It was observed that the tested materials released ions at different levels of concentration. The significant amounts of Sodium, Calcium, and Silicon ions release were measured in Bioglass subgroups in all the tested solutions (p < 0.001). Potassium ion release from dental porcelain was the largest in all solutions except for AA in which Bioglass had the greatest potassium ion release (p < 0.001). A greater structural instability was observed for Biogalss group than dental porcelain and resin composite in testing solutions with different pH levels.


Selective blood sampling in adrenal hypertension.
Selective venous blood sampling was performed in 89 patients with hypertension (14 pheochromocytoma, 10 Conn's syndrome, 8 Cushing's disease, 57 essential hypertension). We looked for diagnostic criteria and the valuability of blood sampling from the adrenal veins in such diseases. Defining a norepinephrine concentration of more than 8,000 ng/l as pathological, we had an accuracy of 94.6%. Defining an aldosterone concentration of more than 1,400 pg/ml as pathological, we had an accuracy of 97.4%. In Cushing's disease this method was not very helpful due to overlapping results.


America's Liberal Social Climate and Trends: Change in 283 General Social Survey Variables between and within US Birth Cohorts, 1972-2018.
The late James A. Davis characterized American public opinion in the Reagan era as "conservative weather" amidst a liberalizing "climate." By climate, he meant differences between cohorts, while the weather referred to trends within cohorts. Thirty years later, the public opinion climate continues to get more liberal, as each successive cohort continues to be more liberal, on balance, than the ones that came before them. Recent weather complements that by being quite liberal, too. Specifically, 62 percent of variables analyzed were more liberal in recent birth cohorts than they were in the oldest ones, but just 5 percent were more conservative (some did not differ among cohorts, and some were neither liberal nor conservative). Within cohorts, recent measurements were more liberal than early measurements for 51 percent of the variables and more conservative for 11 percent.


Etiology of acute diarrhoea among children in developing countries: a multicentre study in five countries.
A 2-year etiological survey of acute diarrhoea in children aged 0-35 months who were attending treatment facilities was carried out using a standardized protocol in five hospitals in China, India, Mexico, Myanmar, and Pakistan. A total of 3640 cases of diarrhoea and 3279 age- and sex-matched controls were studied; about 60% of the patients were aged less than 1 year and 60% were male. An enteric pathogen was detected in 68% of the cases and in 30% of the controls. In all the study centres, the pathogens most strongly associated with disease were rotavirus (16% of cases, 2% of controls), Shigella spp. (11% of cases, 1% of controls) and enterotoxigenic Escherichia coli (16% of cases, 5% of controls). Rotavirus was commonest among 6-11-month-olds, accounting for 20% of all cases in this age group; 71% of all rotavirus episodes occurred during the first year of life. Shigella spp. were commonest among those aged 12-23 months and 24-35 months, accounting for 22% and 27% of the cases, respectively. The proportion of cases that yielded no pathogen was inversely related to age, being highest (41%) among infants below 6 months of age and lowest (19%) among those aged 24-35 months. These results suggest that microbe-specific intervention strategies for the control of childhood diarrhoeal diseases in developing countries should focus on rotavirus, Shigella spp. and enterotoxigenic E. coli.


Dmrt2 and Pax3 double-knockout mice show severe defects in embryonic myogenesis.
Myogenesis is one of the critical developmental processes in mammals. Several transcription factors from the dermomyotome affect embryonic myogenesis. Among these, Dmrt2 and Pax3 were tested for genetic and functional interactions during embryonic myogenesis by evaluating myogenin and desmin expression patterns in Dmrt2-Pax3 mutant mouse embryos. In doubly homozygous mutant embryos, myogenin expression was reduced, and the expression pattern was altered dramatically. In Pax3-knockout mouse embryos, the pattern of Dmrt2 expression was altered, suggesting that Pax3 is important in maintaining the epaxial dermomyotome. Even though Pax3 and Dmrt2 are expressed in similar tissue- and developmental-stage-specific manners during dermomyotomal development, they appear to have independent roles in mammalian myogenesis. The processes characteristic of embryonic myogenesis are similar to those occurring during muscle regeneration in adults. Therefore, these results may provide insight into the pathogenesis of innate muscular dystrophy and may lead to the development of drugs to promote muscle repair after injury.


Phosphate regulation of gene expression in Vibrio parahaemolyticus.
The synthesis of a major outer membrane protein, OmpP, in Vibrio parahaemolyticus was induced by growth in media deficient in phosphate. The gene, ompP, encoding this protein was cloned. Synthesis of OmpP in Escherichia coli was regulated by the availability of phosphate, and this control required the function of pho regulatory genes of E. coli. Analysis of gene fusion strains constructed by mutagenesis with transposon mini-Mulux revealed that ompP was transcriptionally regulated in V. parahaemolyticus. Impaired growth of a strain with an ompP defect was observed in media which contained large linear polyphosphates as the phosphate source. This and other evidence suggested that OmpP functions as a porin channel for the entry of phosphate into the cell. A number of other proteins or activities were induced by phosphate limitation including hemolysin, phospholipase C, and phosphatase activities. A regulatory locus controlling expression of phosphate-regulated genes was identified and cloned. This regulatory locus cloned from V. parahaemolyticus was shown to complement E. coli strains with defects in pho regulatory genes.


Averting a public health crisis in England's coastal communities: a call for public health research and policy.
Coastal communities have received little attention in the public health literature, perhaps because our mental maps tend to associate socio-economic deprivation and health inequalities with inner cities. Mapping a range of key health indicators at small area level, this paper reveals a distinct core-periphery pattern in disease prevalence, with coastal communities experiencing a high burden of ill health across almost all conditions included in the Quality and Outcomes Framework dataset. Other sources suggest poor outcomes for children and young people living in coastal areas. Low rates of participation in higher education contrast with high rates of hospitalisation for self-harm, alcohol and substance use. Reflecting a shift in the distribution of children living in poverty since the 1990s, this may be an early indicator of a future public health crisis in these communities. Exploring reasons for the health challenges facing the periphery, this perspective piece calls for more public health research that can accommodate the complex and interlinked problems facing coastal communities and a more concerted effort to align public health with economic, education, local government and transport policies at the national level.


Relationships between clinical signs, pathological changes and tissue distribution of Mycobacterium avium subspecies paratuberculosis in 21 cows from herds affected by Johne's disease.
Twenty-one cows from eight herds affected by Johne's disease were assigned to four groups: seven were not thriving and had persistent diarrhoea, six were not thriving and had intermittent diarrhoea, four were not thriving but did not have diarrhoea, and four were clinically normal. Postmortem, macroscopic lesions consistent with Johne's disease were identified in 17 of the cows and Mycobacterium avium subspecies paratuberculosis (MAP) was isolated from all of them. However, except for the fact that diarrhoea was correlated with the presence of lesions in the large intestine there was little correlation between the presence or absence of clinical signs and the lesions associated with Johne's disease. The tissue distribution of MAP was also poorly correlated with either the clinical signs or the lesions. The organism was widely distributed in 17 of the 21 cows, including three of the clinically normal animals, and was present in the mammary tissues of seven cows including two of the clinically normal animals. Three distinct histopathological patterns were observed in the affected intestines: infiltration of the lamina propria with giant cells, tuberculoid lesions, and lepromatous lesions; the lepromatous lesions were associated with extensive pathological changes.


Optimum Refractive Target in Patients with Bilateral Implantation of Extended Depth of Focus Intraocular Lenses.
To determine the refractive target of extended depth of focus (EDOF) intraocular lenses in dominant and non-dominant eyes which provides the best binocular vision at all ranges after cataract surgery. This retrospective, single-center, non-comparative study included 47 patients who had undergone bilateral cataract surgery with implantation of EDOF IOLs (Tecnis Symfony or Tecnis Symfony Toric) targeting emmetropia in both eyes. Binocular uncorrected visual acuity at distance (UDVA), near (UNVA), intermediate (UIVA), and manifest refraction spherical equivalent (MRSE) were recorded between 1 and 3 months after the second-eye cataract surgery. Scattergrams for combined binocular UDVA, UIVA, UNVA and postoperative MRSE were plotted and the points of minima of the quadratic regression curve for the dominant and non-dominant eyes were considered as the optimum MRSE corresponding to the best overall visual acuity. Subgroup analysis of patients who achieved UDVA and UIVA ≥20/20 and UNVA ≥20/30 was also performed. For the overall group, the optimum MRSE was -0.08 D for dominant and -0.63 D for non-dominant eyes. In a subset of 17 patients who achieved excellent acuity at all distances, the mean MRSE for the dominant and non-dominant eyes was -0.07 ± 0.14 D and -0.21 ± 0.24 D, respectively. Excellent visual acuity at all ranges can be achieved with bilateral EDOF intraocular lenses implanted after cataract surgery. Our results indicate the best results when the dominant eye is targeted at emmetropia and the nondominant eye is targeted between -0.21D and -0.63D, with excellent results shown with mild myopia of -0.21 in the non-dominant eyes. Future studies with larger sample sizes and subjective patient-reported outcomes may validate current study outcomes.


'None of my ancestors ever discussed this disease before!' How disease information shapes adaptive capacity of marginalised rural populations in India.
Smallholder farmer and tribal communities are often characterised as marginalised and highly vulnerable to emerging zoonotic diseases due to their relatively poor access to healthcare, worse-off health outcomes, proximity to sources of disease risks, and their social and livelihood organisation. Yet, access to relevant and timely disease information that could strengthen their adaptive capacity remain challenging and poorly characterised in the empirical literature. This paper addresses this gap by exploring the role of disease information in shaping the adaptive capacity of smallholder farmer and tribal groups to Kyasanur Forest Disease (KFD), a tick-borne viral haemorrhagic fever. We carried out household surveys (n = 229) and in-depth interviews (n = 25) in two affected districts-Shimoga and Wayanad-in the Western Ghats region. Our findings suggest that, despite the generally limited awareness about KFD, access to disease information improved households' propensity to implement adaptation strategies relative to households that had no access to it. Of the variety of adaptation strategies implemented, vaccination, avoiding forest visits, wearing of protective clothing and footwear, application of dimethyl phthalate (DMP) oil and income diversification were identified by respondents as important adaptive measures during the outbreak seasons. Even so, we identified significant differences between individuals in exposure to disease information and its contribution to substantive adaptive action. Households reported several barriers to implement adaptation strategies including, lack of disease information, low efficacy of existing vaccine, distrust, religio-cultural sentiments, and livelihood concerns. We also found that informal information sharing presented a promising avenue from a health extension perspective albeit with trade-offs with potential distortion of the messages through misinformation and/or reporting bias. Altogether, our findings stress the importance of contextualising disease information and implementing interventions in a participatory way that sufficiently addresses the social determinants of health in order to bolster households' adaptive capacity to KFD and other neglected endemic zoonoses.


Misunderstanding the behavior priming controversy: Comment on Payne, Brown-Iannuzzi, and Loersch (2016).
There has been considerable controversy around the limits and reproducibility of so-called "behavior" priming effects. Payne, Brown-Iannuzzi, and Loersch (2016) reported a series of 6 experiments on the effects of primes on participants' bets in a simulated blackjack game, and claimed that their findings not only establish the reality of behavior priming beyond dispute, but also demonstrate that this form of priming has the crucial hallmark of occurring outside participants' awareness and control. I describe a statistical model that does not distinguish automatic and controlled processes, but which nonetheless reproduces Payne et al.'s (2016) results and hence shows that their conclusions are unwarranted. Payne et al.'s (2016) experimental task and within-subjects design provide little insight into why some behavior priming studies have proven difficult to replicate. (PsycINFO Database Record


Physical exercise for patients undergoing hematopoietic stem cell transplantation: systematic review and meta-analyses of randomized controlled trials.
The treatment-related burden for patients undergoing hematopoietic stem cell transplantation (HSCT) may be relieved by physical exercises. The purpose of this study was to summarize and analyze the evidence provided by randomized controlled trials (RCTs) on physical exercise interventions among patients with cancer undergoing HSCT. PubMed, CINAHL, EMBASE, the Cochrane Library, and PEDro were searched for relevant RCTs up to October 1, 2011. Two reviewers screened articles on inclusion criteria and indentified relevant RCTs. Two authors assessed the selected articles for risk of bias. Data extraction was performed by 1 reviewer. Meta-analyses were undertaken to estimate the outcomes quality of life (QOL), psychological well-being and distress, and fatigue. Eleven studies were included, with study populations consisting of recipients undergoing either an allogeneic or autologous HSCT (n=734). Four studies had low risk of bias. The exercise interventions were performed before, during, and after hospitalization for the HSCT. Different exercise programs on endurance, resistance and/or activities of daily living training, progressive relaxation, and stretching were used. Meta-analyses showed that exercise during hospitalization led to a higher QOL (weighted mean difference=8.72, 95% confidence interval=3.13, 14.31) and less fatigue (standardized mean difference=0.53, 95% confidence interval=0.16, 0.91) in patients with an allogeneic HSCT at the moment of discharge from the hospital. No marked effects were found for psychological well-being and distress. Individual study results suggested significant positive effects on QOL, fatigue, psychological well-being and distress, and physical functioning. Prevalent shortcomings in the included studies were the heterogeneity among studies and the lack of blinding of participants, personnel, and outcome assessment. The results suggest that recipients of HSCT may benefit from physical exercise.


Information chaos in primary care: implications for physician performance and patient safety.
The purpose of this article is to explore the concept of information chaos as it applies to the issues of patient safety and physician workload in primary care and to propose a research agenda. We use a human factors engineering perspective to discuss the concept of information chaos in primary care and explore implications for its impact on physician performance and patient safety. Information chaos is comprised of various combinations of information overload, information underload, information scatter, information conflict, and erroneous information. We provide a framework for understanding information chaos, its impact on physician mental workload and situation awareness, and its consequences, and we discuss possible solutions and suggest a research agenda that may lead to methods to reduce the problem. Information chaos is experienced routinely by primary care physicians. This is not just inconvenient, annoying, and frustrating; it has implications for physician performance and patient safety. Additional research is needed to define methods to measure and eventually reduce information chaos.


Transcriptional network analysis of human astrocytic endfoot genes reveals region-specific associations with dementia status and tau pathology.
The deposition of misfolded proteins, including amyloid beta plaques and neurofibrillary tangles is the histopathological hallmark of Alzheimer's disease (AD). The glymphatic system, a brain-wide network of perivascular pathways that supports interstitial solute clearance, is dependent upon expression of the perivascular astroglial water channel aquaporin-4 (AQP4). Impairment of glymphatic function in the aging rodent brain is associated with reduced perivascular AQP4 localization, and in human subjects, reduced perivascular AQP4 localization is associated with AD diagnosis and pathology. Using human transcriptomic data, we demonstrate that expression of perivascular astroglial gene products dystroglycan (DAG1), dystrobrevin (DTNA) and alpha-syntrophin (SNTA1), are associated with dementia status and phosphorylated tau (P-tau) levels in temporal cortex. Gene correlation analysis reveals altered expression of a cluster of potential astrocytic endfoot components in human subjects with dementia, with increased expression associated with temporal cortical P-tau levels. The association between perivascular astroglial gene products, including DTNA and megalencephalic leukoencephalopathy with subcortical cysts 1 (MLC1) with AD status was confirmed in a second human transcriptomic dataset and in human autopsy tissue by Western blot. This suggests changes in the astroglial endfoot domain may underlie vulnerability to protein aggregation in AD.


Negative Emotionality Interacts with Trauma Exposure to Prospectively Predict Posttraumatic Stress Disorder Symptoms During Firefighters' First 3 Years of Service.
Firefighters (FFs) protect the public despite significant risks to their health and well-being stemming from frequent trauma exposure and other occupational stressors. A minority of FFs develop posttraumatic stress disorder (PTSD) or related mental health problems, whereas most remain remarkably resilient despite enormous stress. This points toward substantial variability in responses to traumatic stress among FFs. Personality, particularly negative emotionality (NEM), has been shown to predict the development of PTSD in other trauma-exposed populations, yet has not been prospectively studied in relation to PTSD in FFs. The aim of this secondary analysis from a broader study of mental health in FFs was to test whether preemployment NEM predicted PTSD symptom severity over time by influencing how FFs respond to traumatic experiences. In this first prospective study of the development of PTSD symptoms in professional FFs, 322 FFs were recruited from seven urban fire academies across the United States and followed over their first 3 years of fire service. We assessed NEM during the fire academy as well as trauma exposure and both self-reported and clinician-rated PTSD symptoms at 1-, 2-, and 3-year follow-ups. Level of trauma exposure and NEM predicted PTSD symptoms over time, and NEM moderated the effect of trauma exposure on clinician-rated PTSD symptoms across both trauma exposure measures at 1- and 3-year follow-ups, f2 = .03-.10, but not at 2-year follow-up nor for self-reported PTSD symptoms. These findings indicate that NEM, assessed upon entry into a high-risk occupation, is useful in predicting PTSD symptom development.


Large Microsphere Structure of a Co/C Composite Derived from Co-MOF with Excellent Wideband Electromagnetic Microwave Absorption Performance.
In the field of electromagnetic wave (EMW) absorption, carbon matrix materials based on metal-organic frameworks (MOFs) have drawn more interest as a result of their outstanding advantages, such as porous structure, lightweight, controlled morphology, etc. However, how to broaden the effective absorption bandwidth [EAB; reflection loss (RL) ≤ -10 dB] is still a challenge. In this paper, large microsphere structures of a Co/C composite composed of small particle clusters were successfully prepared by the solvothermal method and annealing treatment. At a filling ratio of 40 wt %, the Co/C composite shows attractive microwave absorption (MA) performance after being annealed at 600 °C in an atmosphere of argon. With an EAB of 6.32 GHz (9.92-16.24 GHz) and a thickness of just 2.57 mm, the minimum RL can be attained at -54.55 dB. Most importantly, the EAB can attain 7.12 GHz (10.88-18.0 GHz) when the thickness is 2.38 mm, which is larger than that of the majority of MOF-derived composites. The superior MA performance is strongly related to excellent impedance matching and a higher attenuation constant. This study provides a simple strategy for synthesizing a MOF-derived Co/C composite with a wide EAB.