bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of Meloidogyne Species from the Central Valley of Chile and Interaction with Stone Fruit Rootstocks
Authors: Meza Pablo , Soto Braulio , Rojas Luis , Esmenjaud Daniel
Published: March 2016

Root-knot nematodes (RKN; Meloidogyne spp.) are predominant polyphagous pests of crops in the Central Valley of Chile. Twenty RKN populations from this region were collected from diverse crops and subsequently identified with both sequence-characterized amplified region and isoenzyme markers. Populations included three RKN species: Meloidogyne ethiopica (75%), M. javanica (15%), and M. arenaria (10%). This is the first report of the high prevalence and wide host range of M. ethiopica in Chile. The host status of three Prunus rootstocks for isolates obtained from the Chilean RKN populations was then evaluated. Rootstocks assessed included the peach rootstock Nemaguard and the plum rootstock Marianna 2624, both previously considered resistant, and the peach rootstock Pomona as a susceptible accession. In the first experiment, rootstocks were inoculated individually in pots with 10,000 second-stage juveniles and eggs of each isolate, and reproduction and galling were evaluated 5 months after inoculation. In the second experiment, the six most aggressive RKN isolates were used in a mixture to evaluate the host response of the same three rootstocks. No RKN were detected on Marianna 2624 in both experiments, which confirmed its immune host status to M. arenaria and M. javanica; this is the first report of immunity to M. ethiopica. Even though Pomona was classified overall as susceptible, the response of this rootstock to the RKN isolates was highly variable and ranged from susceptible to resistant, depending on the RKN isolates. Nemaguard ranged from resistant (to each of the most aggressive isolates and to their mixture) to highly resistant (to M. arenaria isolates). Our results illustrate that Prunus rootstocks express different levels of resistance to RKN species. RKN resistance may be active either at the isolate level (as in Pomona), at the species level (as in Nemaguard toward M. javanica and M. arenaria), or at the genus level (as in Marianna 2624).
Suppression of Powdery Mildews by UV-B: Application Frequency and Timing, Dose, Reflectance, and Automation
Authors: Suthaparan A. , Solhaug K. A. , Bjugstad N. , Gislerød H. R. , Gadoury D. M. , Stensvand A.
Published: March 2016

Disease-suppressive effects of nighttime applications of ultraviolet-B (UV-B) were investigated at two irradiance levels (1.6 or 0.8 W/m2) in strawberry and rosemary plants inoculated with Podosphaera aphanis or Golovinomyces biocellatus, respectively. Plants were exposed to each irradiance level every third night for either 9 or 18 min, every night for either 3 or 6 min, or three times every night for either 1 or 2 min. Thus, over time, all plants received the same cumulative dose of UV-B, and severity of powdery mildew was reduced by 90 to 99% compared with untreated controls in both crops. Use of polished aluminum lamp reflectors and UV-B reflective surfaces on greenhouse benches significantly increased treatment efficacy. An automated apparatus consisting of an adjustable boom with directed airflow was used to move UV-B lamps over greenhouse benches at 25 or 50 cm/min. Directed airflow moved leaves on the subtending plants to better expose upper and lower surfaces to UV-B but directed airflow actually decreased the efficacy of UV-B treatments, possibly by dispersing conidia from lesions before they were exposed to a lethal dose of UV-B. Results indicate broad applicability of nighttime applications of UV-B to suppress powdery mildews, and that cumulative UV-B dose is an overriding factor determining efficacy. Finally, enhanced suppression on shaded or obscured tissues is more likely to be affected by reflective bench surfaces than through attempts to physically manipulate the foliage.
Grapevine red blotch-associated virus is Present in Free-Living Vitis spp. Proximal to Cultivated Grapevines
Authors: Perry Keith L. , McLane Heather , Hyder Muhammad Z. , Dangl Gerald S. , Thompson Jeremy R. , Fuchs Marc F.
Published: March 2016

Red blotch is an emerging disease of grapevine associated with grapevine red blotch-associated virus (GRBaV). The virus spreads with infected planting stocks but no vector of epidemiological significance has been conclusively identified. A vineyard block of red-blotch-affected Vitis vinifera ‘Cabernet franc’ clone 214 was observed in California, with a clustering of infected, symptomatic vines focused along one edge of the field proximal to a riparian habitat with free-living Vitis spp. No genetic heterogeneity was observed in a 587-nucleotide region of the GRBaV genome in a population of 44 Cabernet franc clone 214 isolates. By contrast, genetic differences were observed in isolates from other cultivars and clones growing in adjacent blocks. GRBaV was confirmed infecting four free-living vines, two of which were shown to be V. californica × V. vinifera hybrids. The genomes of three free-living GRBaV vine isolates and seven from V. vinifera cultivars were compared; free-living vine isolates were shown to be more similar to each other and a ‘Merlot’ isolate than to the other cultivated vine isolates. The finding that GRBaV is present in free-living Vitis spp. indicates the virus can be spread by natural (nonhuman-mediated) means, and we hypothesize that in-field spread of GRBaV is occurring.
Medical Student Perceptions of the Learning Environment at the End of the First Year: A 28-Medical School Collaborative
Authors: Skochelak Susan E. , Stansfield R. Brent , Dunham Lisette , Dekhtyar Michael , Gruppen Larry D. , Christianson Charles , Filstead William , Quirk Mark
Published: March 2016

Purpose

Accreditation and professional organizations have recognized the importance of measuring medical students’ perceptions of the learning environment, which influences well-being and professional competency development, to optimize professional development. This study was conducted to explore interactions between students’ perceptions of the medical school learning environment, student demographic variables, and students’ professional attributes of empathy, coping, tolerance of ambiguity, and patient-centeredness to provide ideas for improving the learning environment.

Method

Twenty-eight medical schools at 38 campuses recruited 4,664 entering medical students to participate in the two-cohort longitudinal study (2010–2014 or 2011–2015). The authors employed chi-square tests and analysis of variance to examine the relationship between Medical School Learning Environment Survey (MSLES) scores and student characteristics. The authors used mixed-effects models with random school and campus effects to test the overall variances accounted for in MSLES scores at the end of the first year of medical school.

Results

Student attributes and demographic characteristics differed significantly across schools but accounted for only 2.2% of the total variance in MSLES scores. Medical school campus explained 15.6% of the variance in MSLES scores.

Conclusions

At year’s end, students’ perceptions toward the learning environment, as reported on the MSLES, differed significantly according to the medical school campus where they trained. Further studies are needed to identify specific factors, such as grading policies, administrative support, and existence of learning communities, which may influence perceptions of the learning environment at various schools. Identifying such variables would assist schools in developing a positive learning environment.
Reflections From the Intersection of Health Professions Education and Clinical Practice: The State of the Science of Interprofessional Education and Collaborative Practice
Authors: Lutfiyya M. Nawal , Brandt Barbara F. , Cerra Frank
Published: March 2016

This informed reflection, from the intersection of health professions education and clinical practice, takes stock of the state of the field of interprofessional education (IPE) and collaborative practice (CP) (together IPECP) by answering the following three questions: (1) As a field of study, where is IPECP? (2) As a research enterprise, what are the current analytical gaps? (3) Scientifically, what needs to be done going forward? While IPE and CP, as well as IPECP, have been areas of scholarly inquiry for nearly 50 years, they have collectively and individually had a limited sphere of influence. Analytical gaps identified include little research dealing with big picture health-related outcomes; mixed results on the effectiveness of health care teams; increasing recognition that additional IPECP competencies might be needed; a gap between the identification and application of educational best practices; and the need for sound, reliable, and validated tools for measuring IPECP. The authors outline the work of the National Center for Interprofessional Practice and Education at the University of Minnesota, which is focused on filling the identified analytical gaps by way of strategic actions organized around three domains—(1) developing an IPECP research agenda, (2) nurturing IPECP intervention research grounded in comparative effectiveness research study designs and the assumptions of critical realism, and (3) the creation of a sound informatics platform. The authors argue that filling these gaps is important because if the effectiveness of IPE on CP and of CP on health outcomes is ever to be ascertained, generalizable findings are paramount.
Building a Framework of Entrustable Professional Activities, Supported by Competencies and Milestones, to Bridge the Educational Continuum
Authors: Carraccio Carol , Englander Robert , Gilhooly Joseph , Mink Richard , Hofkosh Dena , Barone Michael A. , Holmboe Eric S.
Published: March 2016

The transition to competency-based medical education (CBME) and adoption of the foundational domains of competence by the Accreditation Council for Graduate Medical Education, Association of American Medical Colleges (AAMC), and American Board of Medical Specialties’ certification and maintenance of certification (MOC) programs provided an unprecedented opportunity for the pediatrics community to create a model of learning and assessment across the continuum. Two frameworks for assessment in CBME have been promoted: (1) entrustable professional activities (EPAs) and (2) milestones that define a developmental trajectory for individual competencies. EPAs are observable and measureable units of work that can be mapped to competencies and milestones critical to performing them safely and effectively.

The pediatrics community integrated the two frameworks to create a potential pathway of learning and assessment across the continuum from undergraduate medical education (UME) to graduate medical education (GME) and from GME to practice. The authors briefly describe the evolution of the Pediatrics Milestone Project and the process for identifying EPAs for the specialty and subspecialties of pediatrics. The method of integrating EPAs with competencies and milestones through a mapping process is discussed, and an example is provided. The authors illustrate the alignment of the AAMC’s Core EPAs for Entering Residency with the general pediatrics EPAs and, in turn, the alignment of the latter with the subspecialty EPAs, thus helping build the bridge between UME and GME. The authors propose how assessment in GME, based on EPAs and milestones, can guide MOC to complete the bridge across the education continuum.
Prediction of Large Vessel Occlusions in Acute Stroke: National Institute of Health Stroke Scale Is Hard to Beat*
Authors: Vanacker Peter , Heldner Mirjam R. , Amiguet Michael , Faouzi Mohamed , Cras Patrick , Ntaios George , Arnold Marcel , Mattle Heinrich P. , Gralla Jan , Fischer Urs , Michel Patrik
Published: March 2016

Objectives:

Endovascular treatment for acute ischemic stroke with a large vessel occlusion was recently shown to be effective. We aimed to develop a score capable of predicting large vessel occlusion eligible for endovascular treatment in the early hospital management.

Design:

Retrospective, cohort study.

Setting:

Two tertiary, Swiss stroke centers.

Patients:

Consecutive acute ischemic stroke patients (1,645 patients; Acute STroke Registry and Analysis of Lausanne registry), who had CT angiography within 6 and 12 hours of symptom onset, were categorized according to the occlusion site. Demographic and clinical information was used in logistic regression analysis to derive predictors of large vessel occlusion (defined as intracranial carotid, basilar, and M1 segment of middle cerebral artery occlusions). Based on logistic regression coefficients, an integer score was created and validated internally and externally (848 patients; Bernese Stroke Registry).

Interventions:

None.

Measurements and Main Results:

Large vessel occlusions were present in 316 patients (21%) in the derivation and 566 (28%) in the external validation cohort. Five predictors added significantly to the score: National Institute of Health Stroke Scale at admission, hemineglect, female sex, atrial fibrillation, and no history of stroke and prestroke handicap (modified Rankin Scale score, < 2). Diagnostic accuracy in internal and external validation cohorts was excellent (area under the receiver operating characteristic curve, 0.84 both). The score performed slightly better than National Institute of Health Stroke Scale alone regarding prediction error (Wilcoxon signed rank test, p < 0.001) and regarding discriminatory power in derivation and pooled cohorts (area under the receiver operating characteristic curve, 0.81 vs 0.80; DeLong test, p = 0.02).

Conclusions:

Our score accurately predicts the presence of emergent large vessel occlusions, which are eligible for endovascular treatment. However, incorporation of additional demographic and historical information available on hospital arrival provides minimal incremental predictive value compared with the National Institute of Health Stroke Scale alone.
Prevalence and Characteristics of Chronic Intensive Care–Related Pain: The Role of Severe Sepsis and Septic Shock
Authors: Baumbach Philipp , Götz Theresa , Günther Albrecht , Weiss Thomas , Meissner Winfried
Published: March 2016

Objective:

There is only limited knowledge about chronic pain conditions resulting from critical care. Experimental and clinical data suggest a close relationship between inflammation and pain perception. Since sepsis is the most severe form of systemic inflammation, the primary objective was to evaluate chronic pain states and functional impairment of septic and nonseptic patients 6 months after discharge from ICU. Second, we aimed to obtain the total prevalence and characteristics of chronic ICU-related pain.

Design:

Case-control study.

Setting:

Observational study in long-term survivors of mixed surgical and medical ICUs.

Patients:

Septic and nonseptic survivors of critical care (n = 207) and healthy controls (n = 46).

Interventions:

None.

Measurements and Main Results:

We collected comprehensive information on patients’ past and present pain 6 months after ICU discharge by means of the German pain questionnaire. Pain intensity levels and pain interference ratings were compared between septic and nonseptic patients and healthy controls. We found no differences in prevalence, severity, and interference of pain between septic and nonseptic patients. However, both patient groups differed significantly from controls. In secondary analysis, a third of all patients reported chronic clinically relevant pain associated with the ICU stay 6 months after ICU discharge. Half of these patients experienced chronic pain conditions before ICU admission and reported additional sources of pain. Most important, 16% of all patients had no preexisting pain condition and now experience chronic ICU-related pain. The majority of patients with chronic ICU-related pain reported a high degree of disabling pain, limiting daily activities.

Conclusions:

A high percentage of former ICU patients develop chronic pain conditions associated with critical care. These patients differ significantly from control data in terms of pain intensity and show high levels of interference with pain. The presence of sepsis per se seems to play a marginal role for the development of chronic ICU-related pain.
Demodex Folliculitis of the Scalp: Clinicopathological Study of an Uncommon Entity
Authors: Helou Wissam , Avitan-Hersh Emily , Bergman Reuven
Published: March 2016

Demodex is a saprophytic mite in humans commonly present in the pilosebaceous units, which has been implicated as a pathogen in several skin conditions. The clinical presentation and histopathology of Demodex folliculitis of the scalp have been described in only a few case reports. This study was performed to further elucidate the clinicopathological features of this entity. We have studied 333 consecutively submitted scalp biopsies performed for hair loss and alopecia. All specimens were completely step-sectioned. Biopsies with Demodex mites were further studied histopathologically, and the patients' clinical files were reviewed. There were 17 biopsies (5.1%) with Demodex in at least 1 pilosebaceous unit. Based on the clinical presentation, histopathology, and response to therapy, Demodex was considered to be nonpathogenic in 13 cases. The remaining 4 cases were characterized by hair loss, scalp erythema, scales, and pustules. There were 2 or more pilosebaceous units with Demodex along mononuclear and/or neutrophilic infiltrates around and in the involved follicles and occasionally granulomas. All 4 cases responded completely to metronidazole therapy. In conclusion, Demodex is infrequently found in scalp biopsies for hair loss and alopecia, and, in most cases, it does not seem to be pathogenic. Occasionally, however, it is associated with folliculitis characterized by hair loss, erythema, scales, and pustules clinically; neutrophilic and/or mononuclear-cell folliculitis with occasional granulomas histopathologically; and a prompt response to anti-Demodex therapy.
Strategic Moments
Authors: Fletcher Susan Marilyn , McBurney Helen
Published: March 2016

PURPOSE:

There has been extensive investigation of attendance rates at cardiac rehabilitation (CR) but little attention to client reasoning around attendance. This study explored decision-making drivers for attendance or nonattendance at CR programs in rural Victoria, Australia.

METHODS:

All new patients referred to the CR programs at either the local hospital or community health service over a 6-month period were invited to participate and were interviewed before, after, and at 6 months post-CR. Content analysis was used to identify and group common themes that emerged from the semistructured interviews.

RESULTS:

Eighty-four of the 114 patients referred agreed to participate in the study. Multiple barriers or facilitators affected the decisions of all clients. Three themes were identified that reflected the participant decision-making experience: (1) invitation and information about participation in CR; (2) person-centered approach to CR provision; and (3) ongoing support needs. Significant decision-making points identified were after the cardiac event; before and after hospital-based CR; before and after community-based CR; and at 6 months after the cardiac event. At any time there is a risk that the client can become lost or disengaged in the service system, but providing contact at these points can allow them to reengage.

CONCLUSIONS:

This study provided the opportunity to hear participant voices, describing their decisions around CR attendance after a cardiac event. They highlighted the complexity of issues confronting them and suggested improvements to optimize their attendance and to maintain lifestyle changes.
DIFFUSE PERIPAPILLARY CHOROIDAL MELANOMA THAT EVOLVED FROM A SMALL PRESUMED CHOROIDAL NEVUS SUCCESSFULLY TREATED WITH GAMMA KNIFE RADIOTHERAPY
Authors: Duker Jacob S. , Duker Jay S.
Published: March 2016

Purpose:

To report a case of diffuse peripapillary choroidal melanoma which began as a small choroidal nevus and was successfully treated with gamma knife radiotherapy.

Methods:

Observational case report.

Results:

A 31-year-old visually asymptomatic man presented for a routine eye examination and was noted to have a small choroidal nevus. Six years later, the lesion had become a diffuse juxtapapillary choroidal melanoma with a thickness of 1.9 mm. Given the peripapillary location of the tumor with involvement of about 6 clock hours of the disk, Leksell Gamma Knife radiotherapy was performed. At 5.5 years after radiation therapy, visual acuity remained 20/20. The lesion thickness had decreased to 1.5 mm, and there was no interval growth of any margins.

Conclusion:

Small choroidal nevi carry low malignant potential but still deserve photographic documentation when possible with regular follow intervals. Gamma knife radiotherapy can be considered for tumors abutting the optic nerve, especially when plaque radiotherapy may be technically difficult.
Clinical-Laboratory Prediction Rule Derivation for Pulmonary Tuberculosis Diagnosis in General Hospitals in a High-Burden Country
Authors: Gonçalves Berenice das Dores , Passos Sonia Regina Lambert , do Carmo Cleber Nascimento , Monteiro Mariana Couto , Fukuoka Levy Vilas Boas , Mello Fernanda Carvalho de Queiroz
Published: March 2016

Background

Clinical prediction rules (CPR) for pulmonary tuberculosis (PTB) diagnosis in the hospital setting in countries with high prevalence of PTB are rare.

Methods

With the purpose to derive a CPR for PTB and assess its accuracy in patients 15 years or older admitted to a general hospital in Rio de Janeiro city, Brazil, a diagnostic accuracy study was conducted with hospitalized patients from 2008 to 2013. Reference standard: positive Mycobacterium tuberculosis culture in respiratory specimens. Logistic regression-adjusted odds ratios, receiver operating characteristic curve of the value predicted by the model and its accuracy parameters were calculated.

Results

This study assessed 284 patients, 52 with PTB (18.3%). The score of the derived CPR ranged from 0 to 5, 2 points being attributed to fever and 1 to each of the following predictors: weight loss greater than 10%, alcohol consumption and typical/compatible chest imaging. The cutoff point was 3 or greater, with 0.70 area under the receiver operating characteristic curve, 72.1% sensitivity, 64.5% specificity, 30.1% and 91.6% positive and negative predictive values, respectively, and 2.0 and 0.4 positive and negative likelihood ratios, respectively.

Conclusions

The derived CPR corroborated the result of a recent systematic review of PTB predictors for hospitalized patients, but should be prospectively validated. The high false-positive rate justifies its combination with PTB-specific tests.
Pseudomonas mendocina Bacteremia, A Case Study and Review of Literature
Authors: Ruggiero Nicole A , Chang Mei , Brown Sheldon
Published: March 2016

Infections with Pseudomonas mendocina have rarely been reported. P. mendocina seems to be a less virulent and less resistant organism compared to P. aeruginosa. We present a case of P. mendocina bacteremia likely secondary to cellulitis and a brief review of P. mendocina infections reported in the literature.
Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity
Authors: Vaegter Henrik B. , Graven-Nielsen Thomas
Published: March 2016

Pain biomarkers are warranted for individualized painmanagement. Based on different pain modulatory phenotypes, the objectives of this study were to explore the existence of subgroups within patients with nonmalignant chronic pain and to investigate differences in clinical pain and pain hypersensitivity between subgroups. Cuff algometry was performed on lower legs in 400 patients with chronic pain to assess pressure pain threshold, pressure pain tolerance, temporal summation of pain (TSP: increase in pain scores to 10 repeated stimulations), and conditioned pain modulation (CPM: increase in cuff pressure pain threshold during cuff pain conditioning on the contralateral leg). Heat detection and heat pain thresholds at clinical painful and nonpainful body areas were assessed. Based on TSP and CPM, 4 distinct groups were formed: group 1 (n = 85) had impaired CPM and facilitated TSP; group 2 (n = 148) had impaired CPM and normal TSP; group 3 (n = 45) had normal CPM and facilitated TSP; and group 4 (n = 122) had normal CPM and normal TSP. Group 1 showed more pain regions than the other 3 groups (P< 0.001), indicating that impaired CPM and facilitated TSP play an important role in widespread pain. Groups 1 and 2 compared with group 4 had lower heat pain threshold at nonpainful areas and lower cuff pressure pain tolerance (P< 0.02), indicating that CPM plays a role for widespread hyperalgesia. Moreover, group 1 demonstrated higher clinical pain scores than group 4 (P< 0.05). Although not different between subgroups, patients were profiled on demographics, disability, pain catastrophizing, and fear of movement. Future research should investigate interventions tailored towards these subgroups.
Misuse of Prescribed Pain Medication in a Military Population—A Self-Reported Survey to Assess a Correlation With Age, Deployment, Combat Illnesses, or Injury?
Authors: Ramirez Sasha , Bebarta Vikhyat S. , Varney Shawn M. , Ganem Victoria , Zarzabal Lee A. , Potter Jennifer S.
Published: March 2016

Opioid misuse is a growing epidemic among the civilian and military communities. Five hundred prospective, anonymous surveys were collected in the emergency department waiting room of a military tertiary care hospital over 3 weeks. Demographics, medical and military characteristics were investigated for association with opioid use. Univariate logistic models were used to characterize the probability of misuse in relation to the demographic, medical, and military-specific variables. Traumatic brain injury (TBI) and posttraumatic stress disorder were investigated within different age cohorts with adjustment for deployment. The opioid misuse rate disclosed by the subject was 31%. Subjects with TBI were less likely to misuse opioids. We found a trend among younger cohorts to have a higher likelihood for misusing opioids when diagnosed with TBI or posttraumatic stress disorder with history of deployment in the past 5 years. The most common form of misuse was using a previously prescribed medication for a new pain. Traumatic brain injury and/or enrollment in post-deployment recovery programs maybe protective against opioid misuse. Chronic opioid use among young soldiers maybe viewed as a weakness that could influence opioid misuse. Younger cohorts of active duty service members could be at higher risk for misuse. Efforts to enhance close monitoring of misuse should address these at-risk populations.
Broadening the Reach of Standardized Patients in Nurse Practitioner Education to Include the Distance Learner
Authors: Ballman Kathleen , Garritano Nicole , Beery Theresa
Published: March 2016

Using standardized patients (SP) presenting with a specific complaint has been a mainstay in health care education. Increased use of technology has facilitated the move of instruction from the on-campus classroom to distance learning for many nurse practitioner programs. Using interactive case studies provides distance learners SP encounters. This technologically facilitated encounter gives the distance learner the opportunity for integrative thinking and development of problem solving and clinical reasoning skills.
PICU Volume and Outcome: A Severity-Adjusted Analysis*
Authors: Markovitz Barry P. , Kukuyeva Irina , Soto-Campos Gerardo , Khemani Robinder G.
Published: March 2016

Objectives:

To determine the relationship between PICU volume and severity-adjusted mortality in a large, national dataset.

Design:

Retrospective cohort study.

Setting:

The VPS database (VPS, LLC, Los Angeles, CA), a national multicenter clinical PICU database.

Patients:

All patients with discharge dates between September 2009 and March 2012 and valid Pediatric Index of Mortality 2 and Pediatric Risk of Mortality III scores, who were not transferred to another ICU and were seen in an ICU that collected at least three quarters of data.

Interventions:

None.

Measurements and Main Results:

Anonymized data received included ICU mortality, hospital and patient demographics, and Pediatric Index of Mortality 2 and Pediatric Risk of Mortality III scores. PICU volume/quarter was determined (VPS sites submit data quarterly) per PICU and was divided by 100 to assess the impact per 100 discharges per quarter (volume). A mixed-effects logistic regression model accounting for repeated measures of patients within ICUs was performed to assess the association of volume on severity-adjusted mortality, adjusting for patient and unit characteristics. Multiplicative interactions between volume and severity of illness were also modeled. We analyzed 186,643 patients from 92 PICUs, with an overall ICU mortality rate of 2.6%. Volume ranged from 0.24 to 8.89 per ICU per quarter; the mean volume was 2.61. The mixed-effects logistic regression model found a small but nonlinear relationship between volume and mortality that varied based on the severity of illness. When severity of illness is low, there is no clear relationship between volume and mortality up to a Pediatric Index of Mortality 2 risk of mortality of 10%; for patients with a higher severity of illness, severity of illness-adjusted mortality is directly proportional to a unit’s volume.

Conclusions:

For patients with low severity of illness, ICU volume is not associated with mortality. As patient severity of illness rises, higher volume units have higher severity of illness-adjusted mortality. This may be related to differences in quality of care, issues with unmeasured confounding, or calibration of existing severity of illness scores.
Hot Water Epilepsy Successfully Treated With Daily Clobazam
Authors: Ekici Arzu , Ozdemir Ozlem , Yimenicioglu Sevgi , Oren Ayse , Sen Ismail
Published: March 2016

Hot water epilepsy (HWE) is a rare form of reflex epilepsy precipitated by a bath or shower in hot water. Although the condition is benign and a decreased bath temperature will help, antiepileptic drugs may be needed in some cases. Prophylactic clobazam is currently the first choice treatment option. Here we report the case of a 10-year-old boy with HWE successfully treated with daily doses of clobazam. Daily clobazam was preferred over prophylactic clobazam because of the patient's frequent bathing and parental concern. Daily clobazam is a novel treatment option for HWE and seems to be a good choice where antiepileptic drugs are necessary.
Uncertainty in identifying local extinctions: the distribution of missing data and its effects on biodiversity measures
Authors: Boakes Elizabeth H. , Fuller Richard A. , McGowan Philip J. K. , Mace Georgina M.
Published: March 2016

Identifying local extinctions is integral to estimating species richness and geographic range changes and informing extinction risk assessments. However, the species occurrence records underpinning these estimates are frequently compromised by a lack of recorded species absences making it impossible to distinguish between local extinction and lack of survey effort—for a rigorously compiled database of European and Asian Galliformes, approximately 40% of half-degree cells contain records from before but not after 1980. We investigate the distribution of these cells, finding differences between the Palaearctic (forests, low mean human influence index (HII), outside protected areas (PAs)) and Indo-Malaya (grassland, high mean HII, outside PAs). Such cells also occur more in less peaceful countries. We show that different interpretations of these cells can lead to large over/under-estimations of species richness and extent of occurrences, potentially misleading prioritization and extinction risk assessment schemes. To avoid mistakes, local extinctions inferred from sightings records need to account for the history of survey effort in a locality.
Understanding individual routing behaviour
Authors: Lima Antonio , Stanojevic Rade , Papagiannaki Dina , Rodriguez Pablo , González Marta C.
Published: March 2016

Knowing how individuals move between places is fundamental to advance our understanding of human mobility (González
et al
. 2008
Nature
453, 779–782. (
doi:10.1038/nature06958
)), improve our urban infrastructure (Prato 2009
J. Choice Model.
2, 65–100. (
doi:10.1016/S1755-5345(13)70005-8
)) and drive the development of transportation systems. Current route-choice models that are used in transportation planning are based on the widely accepted assumption that people follow the minimum cost path (Wardrop 1952
Proc. Inst. Civ. Eng.
1, 325–362. (
doi:10.1680/ipeds.1952.11362
)), despite little empirical support. Fine-grained location traces collected by smart devices give us today an unprecedented opportunity to learn how citizens organize their travel plans into a set of routes, and how similar behaviour patterns emerge among distinct individual choices. Here we study 92 419 anonymized GPS trajectories describing the movement of personal cars over an 18-month period. We group user trips by origin–destination and we find that most drivers use a small number of routes for their routine journeys, and tend to have a preferred route for frequent trips. In contrast to the cost minimization assumption, we also find that a significant fraction of drivers' routes are not optimal. We present a spatial probability distribution that bounds the route selection space within an ellipse, having the origin and the destination as focal points, characterized by high eccentricity independent of the scale. While individual routing choices are not captured by path optimization, their spatial bounds are similar, even for trips performed by distinct individuals and at various scales. These basic discoveries can inform realistic route-choice models that are not based on optimization, having an impact on several applications, such as infrastructure planning, routing recommendation systems and new mobility solutions.
A nuclear magnetic resonance study of water in aggrecan solutions
Authors: Foster Richard J. , Damion Robin A. , Baboolal Thomas G. , Smye Stephen W. , Ries Michael E.
Published: March 2016

Aggrecan, a highly charged macromolecule found in articular cartilage, was investigated in aqueous salt solutions with proton nuclear magnetic resonance. The longitudinal and transverse relaxation rates were determined at two different field strengths, 9.4 T and 0.5 T, for a range of temperatures and aggrecan concentrations. The diffusion coefficients of the water molecules were also measured as a function of temperature and aggrecan concentration, using a pulsed field gradient technique at 9.4 T. Assuming an Arrhenius relationship, the activation energies for the various relaxation processes and the translational motion of the water molecules were determined from temperature dependencies as a function of aggrecan concentration in the range 0–5.3% w/w. The longitudinal relaxation rate and inverse diffusion coefficient were approximately equally dependent on concentration and only increased by upto 20% from that of the salt solution. The transverse relaxation rate at high field demonstrated greatest concentration dependence, changing by an order of magnitude across the concentration range examined. We attribute this primarily to chemical exchange. Activation energies appeared to be approximately independent of aggrecan concentration, except for that of the low-field transverse relaxation rate, which decreased with concentration.
A full-field image conversion method for the inverse conductivity problem with internal measurements
Authors: Bellis Cédric , Moulinec Hervé
Published: March 2016

This article investigates a Fourier-based algorithm for computing heterogeneous material parameter distributions from internal measurements of physical fields. Within the framework of the periodic scalar conductivity model, a pair of dual Lippmann–Schwinger integral equations is derived for the sought constitutive parameters based on full intensity or current density field measurements. A numerical method based on the fast Fourier transform and fixed-point iterations is proposed. Convergence, stability and approximation quality of the method are analysed. For materials with small contrast, a first-order Born-like approximation is also obtained. Overall, the proposed reconstruction approach enables a direct conversion of full-field measurement images, possibly noisy, into maps of material conductivity. A set of numerical results is presented to illustrate the performance of the method.
Oceanographic drivers and mistiming processes shape breeding success in a seabird
Authors: Ramírez Francisco , Afán Isabel , Tavecchia Giacomo , Catalán Ignacio A. , Oro Daniel , Sanz-Aguilar Ana
Published: March 2016

Understanding the processes driving seabirds' reproductive performance through trophic interactions requires the identification of seasonal pulses in marine productivity. We investigated the sequence of environmental and biological processes driving the reproductive phenology and performance of the storm petrel (
Hydrobates pelagicus
) in the Western Mediterranean. The enhanced light and nutrient availability at the onset of water stratification (late winter/early spring) resulted in annual consecutive peaks in relative abundance of phytoplankton, zooplankton and ichthyoplankton. The high energy-demanding period of egg production and chick rearing coincided with these successive pulses in food availability, pointing to a phenological adjustment to such seasonal patterns with important fitness consequences. Indeed, delayed reproduction with respect to the onset of water stratification resulted in both hatching and breeding failure. This pattern was observed at the population level, but also when confounding factors such as individuals' age or experience were also accounted for. We provide the first evidence of oceanographic drivers leading to the optimal time-window for reproduction in an inshore seabird at southern European latitudes, along with a suitable framework for assessing the impact of environmentally driven changes in marine productivity patterns in seabird performance.
Matching loci surveyed to questions asked in phylogeography
Authors: Hung Chih-Ming , Drovetski Sergei V. , Zink Robert M.
Published: March 2016

Although mitochondrial DNA (mtDNA) has long been used for assessing genetic variation within and between populations, its workhorse role in phylogeography has been criticized owing to its single-locus nature. The only choice for testing mtDNA results is to survey nuclear loci, which brings into contrast the difference in locus effective size and coalescence times. Thus, it remains unclear how erroneous mtDNA-based estimates of species history might be, especially for evolutionary events in the recent past. To test the robustness of mtDNA and nuclear sequences in phylogeography, we provide one of the largest paired comparisons of summary statistics and demographic parameters estimated from mitochondrial, five Z-linked and 10 autosomal genes of 30 avian species co-distributed in the Caucasus and Europe. The results suggest that mtDNA is robust in estimating inter-population divergence but not in intra-population diversity, which is sensitive to population size change. Here, we provide empirical evidence showing that mtDNA was more likely to detect population divergence than any other single locus owing to its smallerNeand thus faster coalescent time. Therefore, at least in birds, numerous studies that have based their inferences of phylogeographic patterns solely on mtDNA should not be readily dismissed.
One crop breeding cycle from starvation? How engineering crop photosynthesis for rising CO2and temperature could be one important route to alleviation
Authors: Kromdijk Johannes , Long Stephen P.
Published: March 2016

Global climate change is likely to severely impact human food production. This comes at a time when predicted demand for primary foodstuffs by a growing human population and changing global diets is already outpacing a stagnating annual rate of increase in crop productivity. Additionally, the time required by crop breeding and bioengineering to release improved varieties to farmers is substantial, meaning that any crop improvements needed to mitigate food shortages in the 2040s would need to start now. In this perspective, the rationale for improvements in photosynthetic efficiency as a breeding objective for higher yields is outlined. Subsequently, using simple simulation models it is shown how predicted changes in temperature and atmospheric [CO2] affect leaf photosynthetic rates. The chloroplast accounts for the majority of leaf nitrogen in crops. Within the chloroplast about 25% of nitrogen is invested in the carboxylase, Rubisco, which catalyses the first step of CO2assimilation. Most of the remaining nitrogen is invested in the apparatus to drive carbohydrate synthesis and regenerate ribulose-1:5-bisphosphate (RuBP), the CO2-acceptor molecule at Rubisco. At preindustrial [CO2], investment in these two aspects may have been balanced resulting in co-limitation. At today's [CO2], there appears to be over-investment in Rubisco, and despite the counter-active effects of rising temperature and [CO2], this imbalance is predicted to worsen with global climate change. By breeding or engineering restored optimality under future conditions increased productivity could be achieved in both tropical and temperate environments without additional nitrogen fertilizer. Given the magnitude of the potential shortfall, better storage conditions, improved crop management and better crop varieties will all be needed. With the short time-scale at which food demand is expected to outpace supplies, all available technologies to improve crop varieties, from classical crop breeding to crop genetic engineering should be employed. This will require vastly increased public and private investment to support translation of first discovery in laboratories to replicated field trials, and an urgent re-evaluation of regulation of crop genetic engineering.
Selection for brain size impairs innate, but not adaptive immune responses
Authors: Kotrschal Alexander , Kolm Niclas , Penn Dustin J.
Published: March 2016

Both the brain and the immune system are energetically demanding organs, and when natural selection favours increased investment into one, then the size or performance of the other should be reduced. While comparative analyses have attempted to test this potential evolutionary trade-off, the results remain inconclusive. To test this hypothesis, we compared the tissue graft rejection (an assay for measuring innate and acquired immune responses) in guppies (
Poecilia reticulata
) artificially selected for large and small relative brain size. Individual scales were transplanted between pairs of fish, creating reciprocal allografts, and the rejection reaction was scored over 8 days (before acquired immunity develops). Acquired immune responses were tested two weeks later, when the same pairs of fish received a second set of allografts and were scored again. Compared with large-brained animals, small-brained animals of both sexes mounted a significantly stronger rejection response to the first allograft. The rejection response to the second set of allografts did not differ between large- and small-brained fish. Our results show that selection for large brain size reduced innate immune responses to an allograft, which supports the hypothesis that there is a selective trade-off between investing into brain size and innate immunity.
Substituting mouse transcription factor Pou4f2 with a sea urchin orthologue restores retinal ganglion cell development
Authors: Mao Chai-An , Agca Cavit , Mocko-Strand Julie A. , Wang Jing , Ullrich-Lüter Esther , Pan Ping , Wang Steven W. , Arnone Maria Ina , Frishman Laura J. , Klein William H.
Published: March 2016

Pou domain transcription factor Pou4f2 is essential for the development of retinal ganglion cells (RGCs) in the vertebrate retina. A distant orthologue of Pou4f2 exists in the genome of the sea urchin (class Echinoidea)
Strongylocentrotus purpuratus
(
SpPou4f1/2
), yet the photosensory structure of sea urchins is strikingly different from that of the mammalian retina. Sea urchins have no obvious eyes, but have photoreceptors clustered around their tube feet disc. The mechanisms that are associated with the development and function of photoreception in sea urchins are largely unexplored. As an initial approach to better understand the sea urchin photosensory structure and relate it to the mammalian retina, we asked whether
SpPou4f1/2
could support RGC development in the absence of
Pou4f2
. To answer this question, we replaced genomic
Pou4f2
with an
SpPou4f1/2
cDNA. In
Pou4f2
-null mice, retinas expressing
SpPou4f1/2
were outwardly identical to those of wild-type mice.
SpPou4f1/2
retinas exhibited dark-adapted electroretinogram scotopic threshold responses, indicating functionally active RGCs. During retinal development,
SpPou4f1/2
activated RGC-specific genes and in
S. purpuratus
,
SpPou4f2
was expressed in photoreceptor cells of tube feet in a pattern distinct from Opsin4 and Pax6. Our results suggest that
SpPou4f1/2
and
Pou4f2
share conserved components of a gene network for photosensory development and they maintain their conserved intrinsic functions despite vast morphological differences in mouse and sea urchin photosensory structures.
DrosophilaCLAMP is an essential protein with sex-specific roles in males and females
Authors: Urban Jennifer A. , Doherty Caroline A. , Jordan William T. , Bliss Jacob E. , Feng Jessica , Soruco Marcela M. , Rieder Leila E. , Larschan Erica N.
Published: March 2016

Dosage compensation is a fundamental mechanism in many species that corrects for the inherent imbalance in X-chromosome copy number between XY males and XX females. InDrosophila melanogaster, transcriptional output from the single male X-chromosome is equalized to that of XX females by recruitment of the Male Specific Lethal (MSL) complex to specific sequences along the length of the X-chromosome. The initial recruitment of MSL complex to the X-chromosome is dependent on a recently discovered zinc finger protein called Chromatin-Linked Adapter for MSL Proteins (CLAMP). However, further studies on thein vivofunction of CLAMP remained difficult because the location of the gene in pericentric heterochromatin made it challenging to create null mutations or deficiencies. Using the CRISPR/Cas9 genome editing system, we generated the first null mutant in theclampgene that eliminates expression of CLAMP protein. We show that CLAMP is necessary for both male and female viability. While females die at the third instar larval stage, males die earlier, likely due to the essential role of CLAMP in male dosage compensation. Moreover, we demonstrate that CLAMP promotes dosage compensation in males and represses key male-specific transcripts involved in sex-determination in females. Our results reveal that CLAMP is an essential protein with dual roles in males and females, which together assure that dosage compensation is a sex-specific process.