bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaginal Pessary in Women With Symptomatic Pelvic Organ Prolapse
Authors: Cheung Rachel Y. K. , Lee Jacqueline H. S. , Lee L. L. , Chung Tony K. H. , Chan Symphorosa S. C.
Published: June 2016

OBJECTIVE:

To compare pelvic floor symptoms, quality of life, and complications in women with symptomatic pelvic organ prolapse (POP) with or without vaginal pessaries in addition to those who do pelvic floor exercises for 12 months.

METHODS:

This was a parallel-group, single-blind, randomized controlled trial with 12 months of follow-up. Women with symptomatic stage I to stage III POP were randomized to either pelvic floor exercises training (control group) or pelvic floor exercises training and insertion of a vaginal pessary (pessary group). The primary outcome was the change of prolapse symptoms and quality of life by using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaires. Secondary outcomes included bothersome of prolapse symptoms, desired treatment, and any complications.

RESULTS:

From December 2011 through November 2014, 311 women were screened and 276 were randomized as follows: 137 to the control and 139 to the pessary group. One hundred thirty-two (95.0%) women in the pessary group and 128 (93.4%) in the control group completed the study. The Pelvic Organ Prolapse Distress Inventory of Pelvic Floor Distress Inventory and the Pelvic Organ Prolapse Impact Questionnaire of Pelvic Floor Impact Questionnaire scores decreased in both groups after 12 months, but the mean score differences were higher in the pessary group (Pelvic Organ Prolapse Distress Inventory: −29.7 compared with −4.7, P<.01; Pelvic Organ Prolapse Impact Questionnaire: −29.0 compared with 3.5, P<.01). Complication rates were low and similar in both groups.

CONCLUSION:

We provided further evidence in nonsurgical treatment for POP. Prolapse symptoms and quality of life were improved in women using a vaginal pessary in addition to pelvic floor exercises.

CLINICAL TRIAL REGISTRATION:

Centre for Clinical Research and Biostatistics–Clinical Trials Registry, https://www2.ccrb.cuhk.edu.hk/web/?page_id=746, ChiCTR-TRC-11001796.
Ensuring Access to Safe, Legal Abortion in an Increasingly Complex Regulatory Environment
Authors: Paul Maureen , Norton Mary E.
Published: June 2016

Restrictions on access to abortion in the United States have reached proportions unprecedented since the nationwide legalization of abortion in 1973. Although some restrictions aim to discourage women from having abortions, many others impede access by affecting the timeliness, affordability, or availability of services. Evidence indicates that these restrictions do not increase abortion safety; rather, they create logistic barriers for women seeking abortion, and they have the greatest effect on women with the fewest resources. In this commentary, we recall the important role that obstetrician–gynecologists (ob-gyns) have played, both before and after Roe v. Wade, in facilitating access to safe abortion care. Using the literature on abortion safety and access as a foundation, we propose several practical ideas about what we as ob-gyns can do to address the current threat to abortion access, whether or not we provide abortion services in practice. We hope that this commentary will encourage discourse within our profession and prompt other suggestions. As ob-gyns who are dedicated to addressing health disparities and promoting the health and well-being of our patients, we can make a difference.
Osteochondral alteration in a child treated with levetiracetam: a rare case of juvenile osteochondritis dissecans of the talar head
Authors: Turati Marco , Glard Yann , Afonso David , Griffet Jacques , Bigoni Marco
Published: June 2016

Levetiracetam is a relatively novel antiepileptic drug used for the treatment of partial and generalized seizures in adult and children. Several animal studies describe a possible drug adverse effect on skeletal growth and metabolism. We present a case report of a 10-year-old female child who underwent a prolonged 7-year treatment with levetiracetam for sporadic secondary convulsions secondary to enterovirus encephalitis at the age of 15 months. This patient developed an osteochondritis dissecans lesion (OCD) of the talar head well treated conservatively. Only a few cases have been described of this rare type of OCD. We hypothesize a possible association between levetiracetam therapy and OCD development, suggesting the importance of long-term control of bone growth in levetiracetam-treated pediatric populations.
Use of Porcine Xenografts in Dermatology Surgery: The Mayo Clinic Experience
Authors: Yang Yul W. , Ochoa Shari A.
Published: June 2016

BACKGROUND

Knowledge regarding the use of xenografts in cutaneous surgery is limited.

OBJECTIVE

We sought to better understand the utility, outcomes, and complications of porcine xenograft applications in cutaneous surgery.

METHODS AND MATERIALS

A single center, retrospective study of patients with porcine xenograft applications was completed. Characteristics of tumors, surgical procedures, resulting wound beds, follow-up care, and final length of follow-up were determined, and statistical analysis was conducted.

RESULTS

Of 225 porcine xenograft placements in 220 patients, the majority of tumors were nonmelanoma skin cancers (89%) and similarly divided between the head (excepting nose/ear), nose, ear, and extremities. Both Mohs and standard excision resulted in a 5.7 cm2 mean area of surgical defect, with the majority closed by porcine xenograft only (84.1%), and healing by secondary intention (97.3%). The area of surgical defect and topical antibiotics contributed to increased length of time to final follow-up.

CONCLUSION

The data represent the largest series of biologic dressings in cutaneous surgery and demonstrate the applicability and safety of porcine xenografts. We recommend consideration of porcine xenografts in the appropriate clinical context, to augment secondary intention.
Surgical Management of Hidradenitis Suppurativa: Outcomes of 590 Consecutive Patients
Authors: Kohorst John J. , Baum Christian L. , Otley Clark C. , Roenigk Randall K. , Schenck Louis A. , Pemberton John H. , Dozois Eric J. , Tran Nho V. , Senchenkov Alex , Davis Mark D. P.
Published: June 2016

BACKGROUND

Hidradenitis suppurativa is a progressive, recurrent inflammatory disease. Surgical management is potentially curative with limited efficacy data.

OBJECTIVE

To evaluate hidradenitis surgical patients.

METHODS

Retrospective review of outcomes of 590 consecutive surgically treated patients.

RESULTS

Most patients were white (91.0% [435/478]), men (337 [57.1%]), smokers (57.7% [297/515]) with Hurley Stage III disease (476 [80.7%]). Procedure types were excision (405 [68.6%]), unroofing (168 [28.5%]), and drainage (17 [2.9%]) treating disease of perianal/perineum (294 [49.8%]), axilla (124 [21.0%]), gluteal cleft (76 [12.9%]), inframammary (12 [2.0%]), and multiple surgical sites (84 [14.2%]). Postoperative complications occurred in 15 patients (2.5%) and one-fourth (144 [24.4%]) suffered postoperative recurrence, which necessitated reoperation in one-tenth (69 [11.7%]) of patients. Recurrence risk was increased by younger age (hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.7–0.9), multiple surgical sites (HR, 1.6; 95% CI, 1.1–2.5), and drainage-type procedures (HR, 3.5; 95% CI, 1.2–10.7). Operative location, disease severity, gender, and operative extent did not influence recurrence rate.

CONCLUSION

Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates. Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.
Basosquamous Carcinoma: Controversy, Advances, and Future Directions
Authors: Tan Caroline Z. , Rieger Kerri E. , Sarin Kavita Y.
Published: June 2016

BACKGROUND

Basosquamous carcinoma is a rare cutaneous neoplasm that has caused considerable controversy as to its classification, pathogenesis, and management.

OBJECTIVE

To review and summarize current literature on the definition, pathogenesis, incidence, and management of basosquamous carcinoma.

MATERIALS AND METHODS

Through December 2015, an electronic search of the Pubmed database was performed using combinations of basosquamous carcinoma and metatypical basal cell carcinoma as search terms.

RESULTS

A selection of 39 publications including case reports and series, retrospective studies, and systematic reviews of the literature were included. Descriptions of the definition of basosquamous carcinoma, clinical behavior, histopathological characteristics, current treatment therapies, and future advances are summarized.

CONCLUSION

This systematic review provides a comprehensive overview of the current understanding of basosquamous carcinoma. Further study is required to elucidate the mechanisms driving the formation of this aggressive tumor.
Recruitment and Deoxygenation of Selected Respiratory and Skeletal Muscles During Incremental Loading in Stable COPD Patients
Authors: Reid W. Darlene , Sheel A. William , Shadgan Babak , Garland S. Jayne , Road Jeremy D.
Published: June 2016

PURPOSE:

To evaluate changes in oxygenated (O2Hb), deoxygenated (HHb), and total hemoglobin (tHb) of the sternocleidomastoid (SCM), parasternal (PS), biceps (BC), and tibialis anterior (TA) using near-infrared spectroscopy during incremental loading of the inspiratory muscles and the elbow flexors in people with stable chronic obstructive pulmonary disease.

METHODS:

Fifteen participants with obstructive pulmonary disease were recruited in a repeated-measures crossover design. Near-infrared spectroscopy optodes were applied over the SCM, PS, BC, and TA to measure O2Hb, HHb, and tHb. Participants were randomly assigned to perform incremental inspiratory threshold loading or elbow flexor loading that imposed higher loads every 2 minutes until task failure. At least 1 week later, participants performed the other test. Arterial oxygen saturation (Spo
2) was monitored continuously.

RESULTS:

O2Hb of the main agonist muscles, SCM and BC, decreased compared with the other muscles during inspiratory threshold loading and elbow flexor loading, respectively. SCM O2Hb and BC O2Hb decreased at higher loads compared with baseline. SCM tHb and HHb increased, whereas TA tHb decreased during inspiratory threshold loading. tHb did not change among any muscles during elbow flexor loading. Spo
2 did not change from baseline to task failure.

CONCLUSIONS:

Our data suggest that the SCM was recruited progressively during incremental inspiratory threshold loading; however, O2Hb was not maintained in this muscle. Similarly, O2Hb was not maintained in the biceps during elbow flexor loading. This regional deoxygenation in SCM and BC during incremental loading protocols was not reflected by a decrease in Spo
2.
Employment status, difficulties at work and quality of life in inflammatory bowel disease patients
Authors: De Boer Angela G.E.M. , Bennebroek Evertsz’ Floor , Stokkers Pieter C. , Bockting Claudia L. , Sanderman Robert , Hommes Daniel W. , Sprangers Mirjam A.G. , Frings-Dresen Monique H.W.
Published: June 2016

Objectives

To assess employment status, difficulties at work and sick leave in inflammatory bowel disease (IBD) patients and their relation with sociodemographic and clinical factors, quality of life (QoL), and anxiety and depression.

Materials and methods

IBD patients attending an IBD outpatients’ clinic received self-report questionnaires on employment status, IBD-related difficulties at work and sick leave (Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness), sociodemographic factors, QoL (Inflammatory Bowel Disease Questionnaire and 12-item Short-form Health Survey) and anxiety and depression (Hospital Anxiety and Depression Scale). Disease activity was assessed by their gastroenterologist. Associations between paid employment and sick leave with sociodemographic and clinical factors, QoL and anxiety and depression were assessed by regression analyses.

Results

In total, 202 IBD patients of working age, with a mean age of 41 years, participated; 63% had Crohn’s disease and 37% had ulcerative colitis, and 57% were women and 19% had active disease. In all, 123 (61%) patients were in paid employment, of whom 31 (25%) were on sick leave, whereas 46 (23%) received a disability pension. Concentration problems (72%), low working pace (78%) and delayed work production (50%) were the most prevalent IBD-related work difficulties. IBD patients without paid employment were older and more often women, with active disease, lower QoL and higher anxiety and depression rates. Sick leave was associated with lower QoL and higher anxiety and depression rates.

Conclusion

More than half of IBD patients were in paid employment, whereas almost a quarter was receiving a disability pension. A large majority experienced work difficulties. Having no paid employment was associated with poorer QoL and more anxiety and depression symptomatology.
Reliability and applicability of two-dimensional shear-wave elastography for the evaluation of liver stiffness
Authors: Varbobitis Ioannis C. , Siakavellas Spyros I. , Koutsounas Ioannis S. , Karagiannakis Dimitrios S. , Ioannidou Panagiota , Papageorgiou Maria-Vasiliki , Pavlopoulou Ioanna D. , Schizas Dimitrios , Bamias Giorgos , Vlachogiannakos Ioannis , Ladas Spyros D. , Papatheodoridis George V.
Published: June 2016

Background/aim

Two-dimensional shear-wave elastography (2D-SWE) is a new elastographic technique that is increasingly being used across several indications. We assessed the reliability and applicability of 2D-SWE in patients with various chronic liver diseases and attempted to identify parameters potentially affecting liver stiffness.

Methods

We included all patients with chronic liver disease who underwent 2D-SWE examination over a 15-month period. Patients with acute hepatitis, active cholestatic disease, or severe heart failure were excluded. The procedures were performed by three adequately trained operators. Standard operating procedures for liver ultrasonography and elastography were followed.

Results

2D-SWE was reliable in 98% of 605 patients. SD to mean liver stiffness value ratio greater than 9.14%, which was considered an indicator of reliability, was associated independently with age more than 50 years, obesity, or overweight, and use of statins for hyperlipidemia. 2D-SWE was applicable, requiring a median time of 7 min per examination and exceeding 15 min in only 5.5% of patients. Worse applicability expressed as duration more than 0.7 min per reliable measurement was associated independently with age more than 50 years and obesity. The mean and median liver stiffness values were 11.6 and 7.7 kPa, respectively. Liver stiffness more than 7.7 kPa was associated independently with age more than 50 years and increased waist circumference.

Conclusion

2D-SWE represents an applicable method of assessment of liver fibrosis that can provide reliable results in the vast majority of patients with chronic liver diseases. Older age and obesity may affect the reliability and applicability of the method as well as the severity of liver fibrosis.
Temporomandibular joint reconstruction
Authors: Imola Mario J. , Liddell Aaron
Published: June 2016

Purpose of review

Temporomandibular joint (TMJ) reconstruction represents one of the more challenging clinical problems that a head and neck surgeon encounters. Fortunately, the problem is fairly uncommon; however, at the same time, clear clinical guidelines have not been formulated. The goal of this review is to present the established solutions to this difficult reconstructive challenge and highlight key developments that have been recently published.

Recent findings

Modern-day approaches to TMJ reconstruction include a handful of surgical modalities: costochondral grafting, revascularized tissue transfer, distraction osteogenesis, and alloplastic temporomandibular joint replacement (APTMJR). Over the past several years, publications have focused primarily on distraction osteogenesis and APTMJR. In particular, APTMJR is emerging as a highly successful and versatile surgical modality when faced with TMJ defects.

With long-term follow-up after APTMJR approaching 20 years at several of the pioneering centers, alloplastic total joint replacement is emerging as the clinical standard when faced with TMJ defects in a variety of clinical situations. Unfortunately, the dogma of serious complications that occurred during early development may still be stalling widespread acceptance of APTMJR. Due to the complexity of the surgery, its relative infrequency and the lack of exposure in the majority of residency training programs, this surgery is currently best performed by tertiary referral centers.
Contemporary mandibular reconstruction
Authors: Divi Vasu , Schoppy David W. , Williams Ryan A. , Sirjani Davud B.
Published: June 2016

Purpose of review

Multiple disease processes, including neoplasia, trauma, and medication side-effects, necessitate segmental resection and subsequent reconstruction of the mandible. As surgical techniques have advanced, several technologies have been developed with the potential to significantly transform a surgeon's approach to the restoration of mandibular continuity. The purpose of this review is to highlight many of these relatively newer tools and discuss their evolving role in mandibular reconstruction.

Recent findings

Several contemporary studies have documented the application of different approaches and modifications to mandibular reconstruction – including computer-aided design or computer-aided modeling, contemporary plating systems, osseointegrated implants, and various modifications to existing osseocutaneous free tissue transfer options – and have reported relatively high success rates.

In discussing these reports, we present a survey of current and developing technologies in the field of mandibular reconstruction and aim to provide sufficient context for the gradual integration of these techniques into practice.
Current concepts in the management of idiopathic sudden sensorineural hearing loss
Authors: O’Connell Brendan P. , Hunter Jacob B. , Haynes David S.
Published: June 2016

Purpose of review

The purpose of this manuscript is to review the initial management strategies for idiopathic sudden sensorineural hearing loss, with an emphasis on the role that steroids play in treatment of this condition, and discuss options for auditory rehabilitation of persistent unilateral hearing loss.

Recent findings

Recent data suggest that hearing improvement may be greater for patients initially treated with both systemic and intratympanic steroid when compared with those treated with systemic steroids alone. Salvage intratympanic steroids have been shown to confer hearing benefit if initial management fails. The ideal dosing regimen for intratympanic steroids has not been established, but evidence supports that higher dosing strategies are advantageous. Cochlear implantation has emerged as a strategy for auditory rehabilitation of persistent unilateral hearing loss. Recent studies have demonstrated high patient satisfaction, subjective improvement in tinnitus, and objective performance benefit after cochlear implantation for single-sided deafness.

Patients can be offered steroid therapy in the initial management of idiopathic sudden sensorineural hearing loss, but should be counseled that the efficacy of steroids remains unclear. If patients fail to improve with initial management, salvage intratympanic steroid administration should be considered. If hearing loss persists long term, options for auditory rehabilitation should be discussed.
Translating Pressure Ulcer Prevention Into Intensive Care Nursing Practice
Authors: Tayyib Nahla , Coyer Fiona
Published: June 2016

This article reports on the development and implementation process used to integrate a care bundle approach (a pressure ulcer [PU] prevention bundle to improve patients' skin integrity in intensive care) and the Ottawa Model of Research Use (OMRU). The PU prevention care bundle demonstrated significant reduction in PU incidence, with the OMRU model providing a consolidated framework for the implementation of bundled evidence in an effective and consistent manner into daily clinical nursing practice.
Clearance of Hepatic Sphingomyelin by Olipudase Alfa Is Associated With Improvement in Lipid Profiles in Acid Sphingomyelinase Deficiency
Authors: Thurberg Beth L. , Wasserstein Melissa P. , Jones Simon A. , Schiano Thomas D. , Cox Gerald F. , Puga Ana Cristina
Published: June 2016

Acid sphingomyelinase deficiency (ASMD; Niemann-Pick disease type A and B) is a lysosomal storage disorder characterized by abnormal intracellular sphingomyelin (SM) accumulation. Prominent liver involvement results in hepatomegaly, fibrosis/cirrhosis, abnormal liver chemistries, and a proatherogenic lipid profile. Olipudase alfa (recombinant human ASM) is in clinical development as an investigational enzyme replacement therapy for the non-neurological manifestations of ASMD. In a phase 1b study conducted to evaluate the safety and tolerability of within-patient dose escalation with olipudase alfa, measurement of SM levels in liver biopsies was used as a pharmacodynamic biomarker of substrate burden. Five adult patients with non neuronopathic ASMD received escalating doses of olipudase alfa every 2 weeks for 26 weeks. Liver biopsies obtained at baseline and 26 weeks after treatment were evaluated for SM storage by histomorphometric analysis, biochemistry, and electron microscopy. Biopsies were also assessed for inflammation and fibrosis, and for the association of SM levels with liver volume, liver function tests, and lipid profiles. At baseline, SM storage present in Kupffer cells and hepatocytes ranged from 9.8% to 53.8% of the microscopic field. After 26 weeks of treatment, statistically significant reductions in SM (P<0.0001) measured by morphometry were seen in 4 patients with evaluable liver biopsies. The 26-week biopsy of the fifth patient was insufficient for morphometric quantitation. Posttreatment SM levels ranged from 1.2% to 9.5% of the microscopic field, corresponding to an 84% to 92% relative reduction from baseline. Improvements in liver volume, liver function tests, and lipid profiles were also observed. This study illustrates the utility of SM assessment by liver biopsy as a pharmacodynamic biomarker of disease burden in these patients.
Pathologic Findings in Prophylactic and Nonprophylactic Hysterectomy Specimens of Patients With Lynch Syndrome
Authors: Bartosch Carla , Pires-Luís Ana S. , Meireles Catarina , Baptista Manuela , Gouveia Alfredo , Pinto Carla , Shannon Kristen M. , Jerónimo Carmen , Teixeira Manuel R. , Lopes José M. , Oliva Esther
Published: June 2016

Women with Lynch syndrome (LS) have a high risk of developing endometrial carcinoma (EC) and, less frequently, ovarian carcinoma. As EC not uncommonly is the first malignancy, prophylactic hysterectomy (PH) has been increasingly implemented. In this study, we report the clinicopathologic features of a series of 70 LS patients who underwent either PH (n=39) or nonprophylactic hysterectomy (NPH) (n=31) at 3 tertiary referral centers. Among the 39 patients with PH, 2 had endometrial tumors seen grossly, whereas 37 showed no macroscopic lesions. Total inclusion of the endometrium was performed in 24/39 (61.5%). Abnormal histologic findings were identified in 9/39 (23.1%) PHs: 3 endometrial endometrioid carcinomas (EECs), including the 2 macroscopic and 1 microscopic (0.6 cm), and 4 atypical and 6 nonatypical hyperplasias. NPH included those performed for endometrial and ovarian cancer treatment. Tumor sampling followed standard protocols. ECs comprised 26 EECs and 1 clear cell carcinoma, with a median size of 3.7 cm. Hyperplasia was observed in 10 (33.3%) as background in EC, in 4 showing atypia. Eight (29.6%) tumors were centered in the lower uterine segment (all EECs). EECs were predominantly well differentiated (53.8%) and FIGO stage I (77.8%). A papillary architecture was common (51.9%) and associated with microcystic elongated and fragmented foci in 4. Mucinous differentiation was observed in 25.9% of endometrial tumors, typically representing <10%. Most endometrial tumors (81.5%) showed tumor-infiltrating lymphocyte counts ≥42/10 high-power fields. Four tumors showed extensive necrosis. Eight patients had ovarian tumors (4 synchronous), including 2 endometrioid carcinomas, 2 clear cell carcinomas, 1 borderline clear cell adenofibroma, 1 Müllerian carcinoma of mixed cell types, 1 primitive neuroectodermal tumor, and 1 metastatic melanoma. Total inclusion of the endometrium should be done in all LS patients’ surgical specimens without macroscopic lesions as some of these patients harbor preneoplastic or neoplastic conditions treatable at an early stage. The phenotype of LS-associated endometrial and ovarian tumors is variable and frequently includes features not commonly observed in sporadic cancers, but in our experience carcinomas were in general low grade and low stage.
Histiocytosis With Raisinoid Nuclei: A Unifying Concept for Lesions Reported Under Different Names as Nodular Mesothelial/Histiocytic Hyperplasia, Mesothelial/Monocytic Incidental Cardiac Excrescences, Intralymphatic Histiocytosis, and Others
Authors: Michal Michael , Kazakov Dmitry V. , Dundr Pavel , Peckova Kvetoslava , Agaimy Abbas , Kutzner Heinz , Havlicek Frantisek , Daum Ondřej , Dubova Magdalena , Michal Michal
Published: June 2016

We report 50 cases of peculiar histiocytic proliferations occurring in diverse body sites that currently bear various names, including nodular mesothelial/histiocytic hyperplasia, nodular histiocytic aggregates, mesothelial/monocytic incidental cardiac excrescences, reactive eosinophilic pleuritis, histioeosinophilic granuloma of the thymus, and intralymphatic histiocytosis. They can sometimes cause considerable differential diagnostic difficulties by resembling a metastatic carcinoma or Langerhans cell histiocytosis. Several previous publications have established a link between some of these conditions, suggesting that these are merely variations within a histopathologic spectrum, affecting different organs and bearing different names based on a particular location. However, no publication has ever comprehensively addressed all of these lesions together in one study in an attempt to explain and discuss their striking analogy. Having studied a large series of cases we provide evidence that all these lesions share the same morphologic, immunohistochemical, and pathogenetic properties, thus they all represent the same pathologic process and should be referred to as such. Taking into account their typical nuclear features we propose a collective term “histiocytosis with raisinoid nuclei” for this spectrum of conditions.
Student Outcomes of School-Based Physical Therapy as Measured by Goal Attainment Scaling
Authors: Chiarello Lisa A. , Effgen Susan K. , Jeffries Lynn , McCoy Sarah Westcott , Bush Heather
Published: June 2016

Purpose:

The main purposes were to describe individualized outcomes of students receiving school-based physical therapy and determine if goal attainment differed by gross motor ability and age.

Methods:

One hundred nine physical therapists and 296 students participated. At the beginning of the school year, therapists translated students' Individualized Education Program goals into subgoals using Goal Attainment Scaling and determined students' Gross Motor Functional Classification System level. Researchers categorized goals (posture/mobility, recreation/fitness, self-care, or academics), and therapists identified students' primary goal. At the end of the school year, therapists scored the goals. Descriptive statistics and 2-way analyses of variance were conducted.

Results:

Students exceeded their expected goal level for primary goals and goals categorized as posture/mobility, recreation/fitness, and self-care and made progress on academic goals. No differences were found by gross motor ability. Younger students had higher goal attainment for primary and recreation goals.

Conclusion:

Students achieve individualized outcomes addressed by school-based physical therapy.
Feasibility and Effectiveness of a Novel Exoskeleton for an Infant With Arm Movement Impairments
Authors: Babik Iryna , Kokkoni Elena , Cunha Andrea B. , Galloway James Cole , Rahman Tariq , Lobo Michele A.
Published: June 2016

Purpose:

To determine whether a novel exoskeletal device (Pediatric-Wilmington Robotic Exoskeleton [P-WREX]) is feasible and effective for intervention to improve reaching and object interaction for an infant with arm movement impairments.

Methods:

An 8-month old infant with arthrogryposis was followed up every 2 weeks during a 1-month baseline, 3-month intervention, and 1-month postintervention. At each visit, reaching and looking behaviors were assessed.

Results:

Within sessions, the infant spent more time contacting objects across a larger space, contacting objects with both hands, and looking at objects when wearing the P-WREX. Throughout intervention, the infant increased time contacting objects both with and without the device and increased bilateral active shoulder flexion.

Conclusions:

(1) It may be feasible for families to use exoskeletons for daily intervention, (2) exoskeletons facilitate immediate improvements in function for infants with impaired upper extremity mobility, and (3) interventions using exoskeletons can improve independent upper extremity function across time.
Effect of Segmental Trunk Support on Posture and Reaching in Children With Cerebral Palsy
Authors: Santamaria Victor , Rachwani Jaya , Saavedra Sandra , Woollacott Marjorie
Published: June 2016

Purpose:

To test the effects of segmental trunk support on seated postural and reaching control in children with cerebral palsy.

Methods:

Seventeen children (age range 2-15 y, Gross Motor Function Classification System levels III-V) were classified with the Segmental Assessment of Trunk Control into mild (complete trunk control/lower lumbar deficits), moderate (thoracic/upper lumbar deficits), and severe (cervical/upper thoracic deficits). Postural and arm kinematics were measured while reaching with trunk support at axillae, mid-ribs, or pelvis.

Results:

Children in the mild group did not display changes in posture or reaching across conditions. The moderately involved group showed decrements in postural and reaching performance with pelvic compared with higher supports (P < .01). Children in the severe group were unable to maintain posture with pelvic support and showed postural deficiencies with mid-ribs compared with axillae support (P < .01).

Conclusions:

Children with cerebral palsy and trunk dysfunction demonstrate improved motor performance when the external assistance matches their intrinsic level of trunk control.
Thromboembolic disease and breathlessness
Authors: Noble Simon
Published: June 2016

Purpose of review

Venous thromboembolism (VTE) comprising deep vein thrombosis and pulmonary embolus, confers a significant symptom burden in the supportive care setting, and yet is often unrecognized. Its management remains challenging because the clinical trials informing practice recruited patients that are largely unrepresentative of the advanced disease populations.

Recent findings

Recent years have seen several developments in the management of VTE including new oral anticoagulants, an appreciation of the patient's experience of VTE, and the importance of considering other comorbidities in ensuring an individualized approach to VTE treatment.

This study reviews the challenges of VTE management within supportive and palliative care, the new oral anticoagulants and the management of VTE in cases in which the evidence is lacking.
Dynamic changes in Sox2 spatio-temporal expression direct the second cell fate decision throughFgf4/Fgfr2signaling in preimplantation mouse embryos
Authors: Mistri Tapan Kumar , Arindrarto Wibowo , Ng Wei Ping , Wang Choayang , Hiong Lim Leng , Sun Lili , Chambers Ian , Wohland Thorsten , Robson Paul
Published: June 2016

Oct4 and Sox2 regulate the expression of target genes such asNanog, Fgf4andUtf1, by binding to their respective regulatory motifs. Their functional cooperation is reflected in their ability to heterodimerise on adjacentcisregulatory elements, the composite Sox/Oct motif. Given that Oct4 and Sox2 regulate many developmental genes, a quantitative analysis of their synergistic action on different Sox/Oct motifs would yield valuable insights into the mechanisms of early embryonic development. In this study, we measured binding affinities of Oct4 and Sox2 to different Sox/Oct motifs using fluorescence correlation spectroscopy (FCS). We found that the synergistic binding interaction is driven mainly by the level of Sox2 in the case of theFgf4Sox/Oct motif. Taking into accountSox2expression levels fluctuate more thanOct4, our finding provides an explanation on how Sox2 controls the segregation of the epiblast (EPI) and primitive endoderm (PE) populations within the inner cell mass (ICM) of the developing rodent blastocyst.
Numerical and Spatial Patterning of Yeast Meiotic DNA Breaks by Tel1
Authors: Mohibullah Neeman , Keeney Scott
Published: June 2016

The Spo11-generated double-strand breaks (DSBs) that initiate meiotic recombination are dangerous lesions that can disrupt genome integrity, so meiotic cells regulate their number, timing, and distribution. Here, we use Spo11-oligonucleotide complexes, a byproduct of DSB formation, to examine the contribution of the DNA damage-responsive kinase Tel1 (ortholog of mammalian ATM) to this regulation inSaccharomyces cerevisiae. Atel1Δmutant had globally increased amounts of Spo11-oligonucleotide complexes and altered Spo11-oligonucleotide lengths, consistent with conserved roles for Tel1 in control of DSB number and processing. A kinase-deadtellmutation also increased Spo11-oligonucleotide levels, but mutating known Tel1 phosphotargets on Hop1 and Rec114 did not. Deep sequencing of Spo11 oligonucleotides fromtel1Δmutants demonstrated that Tel1 shapes the nonrandom DSB distribution in ways that are distinct but partially overlapping with previously described contributions of the recombination regulator Zip3. Finally, we uncover a context-dependent role for Tel1 in hotspot competition, in which an artificial DSB hotspot inhibits nearby hotspots. Evidence for Tel1-dependent competition involving strong natural hotspots is also provided.
Disordered clusters of Bak dimers rupture mitochondria during apoptosis
Authors: Uren Rachel T. , O’Hely Martin , Iyer Sweta , Bartolo Ray , Brouwer Jason M. , Alsop Amber E. , Dewson Grant , Kluck Ruth M.
Published: June 2016

During apoptosis, Bak and Bax undergo major conformational change and form symmetric dimers that coalesce to perforate the mitochondrial outer membrane via an unknown mechanism. We have employed cysteine labelling and linkage analysis to the full length of Bak in mitochondria. This comprehensive survey showed that in each Bak dimer the N-termini are fully solvent-exposed and mobile, the core is highly structured, and the C-termini are flexible but restrained by their contact with the membrane. Dimer-dimer interactions were more labile than the BH3:groove interaction within dimers, suggesting there is no extensive protein interface between dimers. In addition, linkage in the mobile Bak N-terminus (V61C) specifically quantified association between dimers, allowing mathematical simulations of dimer arrangement. Together, our data show that Bak dimers form disordered, compact clusters to generate lipidic pores. These findings provide a molecular explanation for the observed structural heterogeneity of the apoptotic pore.
Decontextualizing Big Data for a Better Perception of Macroecology
Authors: Mulder Christian , Mancinelli Giorgi
Published: June 2016

ABSTRACT

Fish species are charismatic subjects widely used for ecological assessment and modelling. We investigated the influence of electrofishing in an attempt to illuminate the extent to which datasets might be merged together. Three American Midwestern regions in Ohio were chosen as study area and the changes in the size-biomass spectra of more than 2000 fish assemblages were analysed. These communities behaved differently according to the sampling method in conjunction to the morphology of the investigated streams and rivers, as shown by decreasing predatory species and lowering of allometric slopes. There are here several lines of evidence indicating that the chosen sampling method, as determined by different habitats, acts as a pitfall and strongly influences the allometry of fish spectra. In the ongoing data-rich era, our results highlight that macroecological investigations, often performed by machine-learning systems without considering the different procedures adopted to collect original data, can easily produce artefactual allometric scalings.
High virulence does not necessarily impede viral adaptation to a new host: A case study using a plant RNA virus
Authors: Willemsen Anouk , Zwart Mark P. , Elena Santiago F.
Published: June 2016

Background

When between-host selection pressures predominate, theory suggests that high virulence could hinder between-host transmission of microparasites, and that virulence therefore will evolve to lower levels that optimize between-host transmission. Highly virulent microparasites could also curtail host development, thereby limiting both the host resources available to them and their own within-host effective population size. High virulence might therefore curtail the mutation supply rate and increase the strength with which genetic drift acts on microparasite populations, thereby limiting the potential to adapt to the host and ultimately perhaps the ability to evolve lower virulence. As a first exploration of this hypothesis, we evolvedTobacco etch viruscarrying an eGFP fluorescent marker in two semi-permissive host species,Nicotiana benthamianaandDatura stramonium, for which it has a large difference in virulence. We compared the results to those previously obtained in the typical host,Nicotiana tabacum, where we have shown that carriage ofeGFPhas a high fitness cost and its loss serves as a real-time indicator of adaptation.

Results

After over half a year of evolution, we sequenced the genomes of the evolved lineages and measured their fitness. During the evolution experiment, marker loss leading to viable virus variants was only observed in one lineage of the host for which the virus has low virulence,D. stramonium. This result was consistent with the observation that there was a fitness cost ofeGFPin this host, while surprisingly no fitness cost was observed in the host for which the virus has high virulence,N. benthamiana. Furthermore, in both hosts we observed few lineages with increases in viral fitness, and host-specific convergent evolution at the genomic level was only found inN. benthamiana.

Conclusions

The results of this study do not lend support to the hypothesis that high virulence impedes microparasites’ evolution. Rather, they exemplify that jumps between host species can be game changers for evolutionary dynamics. When considering the evolution of genome architecture, host species jumps might play a very important role, by allowing evolutionary intermediates to be competitive.
How are age-related difference in sleep quality associated with health outcomes? An epidemiological investigation in a UK cohort of 2406 adults
Authors: Gadie Andrew , Shafto Meredith , Leng Yue ,   Cam-CAN, Kievit Rogier A.
Published: June 2016

Objectives

To examine age related differences in self-reported sleep quality and their associations with health outcomes across four domains: Physical Health, Cognitive Health, Mental Health and Neural Health.

Setting

Cam-CAN is a cohort study in East Anglia/England, which collected self-reported health and lifestyle questions as well as a range of objective measures from healthy adults.

Participants

2406 healthy adults (age 18-98) answered questions about their sleep quality (Pittsburgh Sleep Quality Index) and measures of Physical, Cognitive, Mental, and Neural Health. A subset of 641 individuals provided measures of brain structure.

Main outcome measures

Pittsburgh Sleep Quality Index scores (PSQI) of sleep, and scores across tests within the four domains of health. Latent Class Analysis (LCA) is used to identify sleep types across the lifespan. Bayesian regressions quantify the presence, and absence, of relationships between sleep quality and health measures.

Results

Better sleep is generally associated with better health outcomes, strongly so for mental health, moderately for cognitive and physical health, but not for sleep quality and neural health. Latent Class Analysis identified four sleep types: ‘Good sleepers’ (68.6%, most frequent in middle age), ‘inefficient sleepers’ (13.05%, most frequent in old age), ‘Delayed sleepers’ (9.76%, most frequent in young adults) and ‘poor sleepers’ (8.6%, most frequent in old age). There is little evidence for interactions between sleep quality and age on health outcomes. Finally, we observe u-shaped associations between sleep duration and mental health (depression and anxiety) as well as self-reported general health, such that both short and long sleep were associated with poorer outcomes.

Conclusions

Lifespan changes in sleep quality are multifaceted and not captured well by summary measures, but instead as partially independent symptoms that vary in prevalence across the lifespan. Better self-reported sleep is associated with better health outcomes, and the strength of these associations differs across health domains. Notably, we do observed associations between self-reported sleep quality and white matter.

Funding

Biotechnology and Biological Sciences Research Council (grant number BB/H008217/1). RAK is supported by the Wellcome Trust (grant number 107392/Z/15/Z and the UK Medical Research Council (MC-A060-5PR61).

Strengths and limitations of this study

Broad phenotypic assessment of healthy ageing across multiple health domains

Advanced analytic techniques (i.e. Latent Class Analysis regression) allows new insights

A uniquely large neuroimaging sample combined with Bayesian inference allows for quantification of evidence for the null hypothesis

Subjective sleep measures may have drawbacks in older samples

Cross-sectional data precludes modelling of within subject changes
Natural DEET substitutes that are strong olfactory repellents of mosquitoes and flies
Authors: Boyle Sean Michael , Guda Tom , Pham Christine Krause , Tharadra Sana Khalid , Dahanukar Anupama , Ray Anandasankar
Published: June 2016

Despite shortcomings, N,N-Diethyl-3-methylbenzamide (DEET) has remained the gold-standard of insect repellents for >60 years. There are significant impediments to finding improved substitutes because the molecular targets causing repellency are unclear, new chemistries will require significant human-safety testing, and predicted costs for development are exorbitant. Here we identify shared structural features important for repellency and using a supervised chemical-informatics method screeninsilico>400,000 compounds to identify >100 natural compounds as candidate repellents. We select 4 candidates that are affordable, 3 approved as safe for human food use, and demonstrate that they are strong olfactory and gustatory repellents to both mosquitoes andDrosophila. The chemicals do not dissolve plastic and have a mild and pleasant odor. These repellents are representative of a new generation of affordable substitutes for DEET that can be rapidly deployed globally because of excellent human-safety profiles, and have great potential in reducing deadly diseases by reducing mosquito-human contact.
Suboptimality in Perceptual Decision Making
Authors: Rahnev Dobromir , Denison Rachel N.
Published: June 2016

Short Abstract

Human perceptual decisions are often described as optimal, but this view remains controversial. To elucidate the issue, we review the vast literature on suboptimalities in perceptual tasks and compile the proposed hypotheses about the origins of suboptimal behavior. Further, we argue that general claims about optimality are virtually meaningless and result in a false sense of progress. Instead, real progress can be achieved by building observer models that account for both optimal and suboptimal behavior. To achieve such progress, the field should focus on assessing the hypotheses about suboptimal behavior compiled here and stop chasing optimality.

Long Abstract

Human perceptual decisions are often described as optimal. Critics of this view have argued that claims of optimality are overly flexible and lack explanatory power. Meanwhile, advocates for optimality have countered that such criticisms single out a few selected papers. To elucidate the issue of optimality in perceptual decision making, we review the extensive literature on suboptimal performance in perceptual tasks. We discuss eight different classes of suboptimal perceptual decisions, including improper placement, maintenance, and adjustment of perceptual criteria, inadequate tradeoff between speed and accuracy, inappropriate confidence ratings, misweightings in cue combination, and findings related to various perceptual illusions and biases. In addition, we discuss conceptual shortcomings of a focus on optimality, such as definitional difficulties and the limited value of optimality claims in and of themselves. We therefore advocate that the field drop its emphasis on whether observed behavior is optimal and instead concentrate on building and testing detailed observer models that explain behavior across a wide range of tasks. To facilitate this transition, we compile the proposed hypotheses regarding the origins of suboptimal perceptual decisions reviewed here. We argue that verifying, rejecting, and expanding these explanations for suboptimal behavior – rather than assessing optimality per se – should be among the major goals of the science of perceptual decision making.
A wireless centrifuge force microscope (CFM) enables multiplexed single-molecule experiments in a commercial centrifuge
Authors: Hoang Tony , Patel Dhruv S. , Halvorsen Ken
Published: June 2016

The centrifuge force microscope (CFM) was recently introduced as a platform for massively parallel single-molecule manipulation and analysis. Here we developed a low-cost and selfcontained CFM module that works directly within a commercial centrifuge, greatly improving accessibility and ease of use. Our instrument incorporates research grade video microscopy, a power source, a computer, and wireless transmission capability to simultaneously monitor many individually tethered microspheres. We validated the instrument by performing single-molecule force shearing of short DNA duplexes. For a 7 bp duplex, we collected over 1000 statistics of force dependent shearing kinetics from 2 pN to 12 pN with dissociation times in the range of 10-100 seconds. We extended the measurement to a 10 bp duplex, applying a 12 pN force clamp and directly observing single-molecule dissociation over an 85 minute experiment. Our new CFM module facilitates simple and inexpensive experiments that dramatically improve access to singlemolecule analysis.