bluuebunny/crossref_metadata_2025 huggingface dataset:
Agent-based modelling in synthetic biology
Authors: Gorochowski Thomas E.
Published: November 2016

Biological systems exhibit complex behaviours that emerge at many different levels of organization. These span the regulation of gene expression within single cells to the use of quorum sensing to co-ordinate the action of entire bacterial colonies. Synthetic biology aims to make the engineering of biology easier, offering an opportunity to control natural systems and develop new synthetic systems with useful prescribed behaviours. However, in many cases, it is not understood how individual cells should be programmed to ensure the emergence of a required collective behaviour. Agent-based modelling aims to tackle this problem, offering a framework in which to simulate such systems and explore cellular design rules. In this article, I review the use of agent-based models in synthetic biology, outline the available computational tools, and provide details on recently engineered biological systems that are amenable to this approach. I further highlight the challenges facing this methodology and some of the potential future directions.
Synthetic biology and the prospects for responsible innovation
Authors: Macnaghten Phil , Owen Richard , Jackson Roland
Published: November 2016

In this article we provide a short review of the debate on responsible innovation and its intersection with synthetic biology, focusing on initiatives we have witnessed and been involved with in the UK. First, we describe the ways in which responsibility in science has been reconfigured institutionally, from an internal focus on the provision of objective and reliable knowledge, to a more external view that embraces the ways in which it has an impact on society. Secondly, we introduce a framework for responsible innovation as a (partial) response to this shift, highlighting its constituent dimensions and the capacities and competencies that are needed to put it into practice. Thirdly, we chart the development of social science research on synthetic biology, addressing its evolution from an ‘ethical, legal and social implications’ (ELSI) frame to a responsible innovation frame. Fourthly, we review findings from UK social science research with the synthetic biology community setting out challenges for productive collaboration. And finally, we conclude with suggestions on the need for changes in institutional governance.
A Single-Center Prospective Observational Study of Ultrasonography for 6 Months after Surgical Decompression of the Median Nerve at the Carpal Tunnel
Authors: Tas Suleyman , Staub Frank , Dombert Thomas , Marquardt Gerhard , Senft Christian , Seifert Volker , Duetzmann Stephan
Published: November 2016

Objective To determine the natural history of the morphology of the median nerve after carpal tunnel decompression.

Methods Between October and December 2014, patients with suspected carpal tunnel were prospectively enrolled and underwent pre- and postoperative (3 and 6 months) high-definition ultrasonography, electrophysiology, and clinical testing.

Results A total of 81 patients were enrolled in the study; 75 (93%) could be reached for the 6-month follow-up, and 100% were clinically better at the 6-month follow-up. The mean cross-sectional area decreased from 14.3 ± 4.4 mm2 to 9.6 ± 2.3 mm2 (mean ± standard deviation [SD]). The mean distal motor latency decreased from 6.5 ± 2.2 msec to 4.4 ± 0.8 msec (mean ± SD). Distal motor latency improved statistically significantly after surgical decompression as well, but sooner.

Conclusion We present the second largest series of patients with sonographic follow-up after surgical decompression of the carpal tunnel.
Neurosurgical Resident Training in Germany
Authors: Gempt Jens , Gautschi Oliver , Demetriades Andreas , Netuka David , Kuhlen Dominique , Schaller Karl , Ringel Florian , Stienen Martin
Published: November 2016

Introduction Efficient neurosurgical training is of paramount importance to provide continuing high-quality medical care to patients. In this era of law-enforced working hour restrictions, however, maintaining high-quality training can be a challenge and requires some restructuring. We evaluated the current status of resident training in Germany.

Methods An electronic survey was sent to European neurosurgical trainees between June 2014 and March 2015. The responses of German trainees were compared with those of trainees from other European countries. Logistic regression analysis was performed to assess the effect size of the relationship between a trainee being from Germany and the outcome (e.g., satisfaction, working time).

Results Of 532 responses, 95 were from German trainees (17.8%). In a multivariate analysis corrected for baseline group differences, German trainees were 29% as likely as non-German trainees to be satisfied with clinical lectures given at their teaching facility (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.18–0.49; p < 0.0001). The satisfaction rate with hands-on operating room exposure was 73.9% and equal to the rate in Europe (OR: 0.94; 95% CI, 0.56–1.59; p = 0.834). German trainees were 2.3 times as likely to perform a lumbar spine intervention as the primary surgeon within the first year of training (OR: 2.27; 95% CI, 1.42–3.64; p = 0.001). However, they were less likely to perform a cervical spine procedure within 24 months of training (OR: 0.38; 95% CI, 0.17–0.82; p = 0.014) and less likely to perform a craniotomy within 36 months of training (OR: 0.49; 95% CI, 0.31–0.79; p = 0.003). Only 25.6% of German trainees currently adhere to the weekly limit of 48 hours as requested from the European Working Time Directive 2003/88/EC, and in an international comparison, German trainees were twice as likely to work > 50 hours per week (OR: 2.13; 95% CI, 1.25–3.61; p = 0.005). This working time, however, is less spent in the operating suite (OR: 0.26; 95% CI, 0.11–0.59; p = 0.001) and more doing administrative work (OR: 1.83; 95% CI, 1.13–2.96; p = 0.015).

Conclusion Some theoretical and practical aspects of neurosurgical training are superior, but a considerable proportion of relevant aspects are inferior in Germany compared with other European countries. The present analyses provide the opportunity for a critical review of the local conditions in German training facilities.
Extending the rigidity of general relativity
Authors: Gomes Henrique , Shyam Vasudev
Published: November 2016

We give the most general conditions to date which lead to uniqueness of the general relativistic Hamiltonian. Namely, we show that all spatially covariant generalizations of the scalar constraint which extend the standard one while remaining quadratic in the momenta are second class. Unlike previous investigations along these lines, we do not require a specific Poisson bracket algebra, and the quadratic dependence on the momenta is completely general, with an arbitrary local operator as the kinetic term.
In situ analysis of post-annealing effect on Sn-doped indium oxide films
Authors: Lim Hojoon , Yang Hyeok-Jun , Kim Ji Woong , Bae Jong-Seung , Kim Jin-Woo , Jeong Beomgyun , Crumlin Ethan , Park Sungkyun , Mun Bongjin Simon
Published: November 2016

Oxygen post-annealing effects on tin (Sn) doped indium oxide (ITO) film are investigated with various analytical tools as a function of temperature, including in situ XRD, ambient pressure XPS (AP-XPS), and Hall measurement. As the annealing temperature increases up to 200 °C under the oxygen pressure of 100 mTorr, the in situ XRD shows the evidence of crystallization of the film while the AP-XPS reveals the formation of oxygen vacancy and Sn4+ states on surface. In addition, the mobility of ITO thin film is increased as the post-annealing temperature increases, supporting the results of both in situ XRD and AP-XPS. The results of angle-resolved XPS reveal that the degree of Sn segregation changes little after post-annealing procedure.
Focused-based multifractal analysis of the wake in a wind turbine array utilizing proper orthogonal decomposition
Authors: Ali Naseem , Kadum Hawwa Falih , Cal Raúl Bayoán
Published: November 2016

Hot-wire anemometry measurements have been performed in a 3 × 3 wind turbine array to study the multifractality of the turbulent kinetic energy dissipation. A multifractal spectrum and Hurst exponents are determined at nine locations downstream of the hub height, bottom and top tips. Higher multifractality is found at 0.5D and 1D downstream of the bottom tip and hub height. The second order of the Hurst exponent and combination factor shows the ability to predict the flow state in terms of its development. Snapshot proper orthogonal decomposition (POD) is used to identify the coherent and incoherent structures and to reconstruct the stochastic velocity signal using a specific number of the POD eigenfunctions. The accumulation of the turbulence kinetic energy in the top tip location exhibits fast convergence compared with the bottom tip and hub height. The dissipation of the large and small scales is determined using the reconstructed stochastic velocities. The higher multifractality is shown in the dissipation of the large scale compared with small scale dissipation showing consistency with the behavior of the original signals. Multifractality of turbulent kinetic energy dissipation in the wind farm is examined and the effect of the reconstructed flow field via proper orthogonal decomposition on the multifractality behavior is investigated. Findings are relevant in wind energy as multifractal parameters identify the variation between the near- and far-wake regions.
Investigating ecosystem processes using targeted fisheries closures: can small-bodied invertivore fish be used as indicators for the effects of western rock lobster fishing?
Authors: Langlois T. J. , Bellchambers L. M. , Fisher R. , Shiell G. R. , Goetze J. , Fullwood L. , Evans S. N. , Konzewitsch N. , Harvey E. S. , Pember M. B.
Published: November 2016

Ecosystem modelling has predicted that fishing for western rock lobster Panulirus cygnus in deep water (50–80m) habitats will result in increased abundance of their macroinvertebrate prey, which would, in turn, support greater production of small-bodied invertivore fish species. To investigate the potential ecosystem effects of rock lobster fishing, a targeted fisheries closure was proposed in deep water habitats along the coast of Western Australia. Data on small-bodied invertivore fish abundance, from baited video, were used to investigate differences across habitats and simulate the likely power of any study to detect change. In general, small-bodied invertivore fish were more abundant at shallower macroalgae-dominated sites, whereas the most abundant single species, the western king wrasse Coris auricularis, was abundant across all habitats and sites. Power simulation of a mixed-model before–after–control–impact (BACI) design found that a 40–50% decrease in either Coris auricularis or small-bodied invertivore fish in general would be very likely to be detected (power ~0.8). Based on the power simulation, we suggest a general sampling design to investigate change before and after the establishment of the fishery closure and make suggestions for further ecological studies to investigate the predicted ecosystem effects of rock lobster fishing.
Motivators and barriers for paediatricians discharging patients
Authors: Turbitt Erin , Kunin Marina , Gafforini Sarah , Freed Gary L.
Published: November 2016

The aim of this study was to identify motivators and barriers that paediatricians face when discharging patients from outpatient specialty care. A questionnaire was administered to outpatient care paediatricians in Victoria working in one of five speciality public hospital clinics. Questions focused on how important various motivators and barriers were in respondents’ decision to discharge a patient from their clinic. Nearly all (91%, n=74) paediatricians invited to participate provided responses. The factor influencing the greatest proportion of paediatricians in their decision to discharge patients back to primary care was the potential that patients may not receive the required care from a GP. The next most highly rated barrier was that it is too complicated to arrange discharge; rated as a very important influence by one-third of paediatricians (33%, n=24). Improvements to the discharge process may encourage more paediatricians to discharge patients back to their GP, therefore freeing up appointment slots. This in turn could reduce waiting times for paediatric outpatient clinics in Victoria. The concern from paediatricians that patients may not receive the required care from a GP warrants attention and should be further investigated.
Exploration of joint redundancy but not task space variability facilitates supervised motor learning
Authors: Singh Puneet , Jana Sumitash , Ghosal Ashitava , Murthy Aditya
Published: November 2016

Significance

Theories of reinforcement learning claim that motor variability helps in motor learning and are supported by recent experimental work. In contrast, theories of motor control propose that variability is noise that needs to be suppressed. We attempt to reconcile these apparent contradictory positions. Using the formulation of the unconstrained manifold hypothesis, we show that motor variability has two components—a part arising out of the redundancy that does not affect task-space and another component related to task-space variability. We show that the motor variability component resulting from the redundancy determines both dynamic and kinematic learning ability across subjects without affecting task-space variability.
Should we embed careers education in STEM lessons?
Authors: Reiss Michael J. , Mujtaba Tamjid
Published: November 2016

Schools have a particular responsibility to introduce young people to the range of possible options for them after they leave education as few families can provide this. However, in the United Kingdom, careers education is currently not strong in most schools for a number of reasons but principally due to its low status and shifts in government policy and funding. As a result, too many young people make subject choices for post‐16 study that they subsequently regret. In particular, fewer young people in the United Kingdom choose post‐16 STEM subjects than might do. Yet, STEM (science, technology, engineering and mathematics) graduates are especially valued by employers. We draw on the findings of two research projects, ASPIRES and UPMAP, and argue that one way forward may be to embed careers education in STEM lessons. This can be done in ways that are respectful of and helpful to students. We recommend that an England‐ or UK‐based project to investigate the consequences of embedding careers education in STEM lessons be undertaken.
Conspicuous Consumption of Time: When Busyness and Lack of Leisure Time Become a Status Symbol
Authors: Bellezza Silvia , Paharia Neeru , Keinan Anat
Published: November 2016

While research on conspicuous consumption has typically analyzed how people spend money on products that signal status, this article investigates conspicuous consumption in relation to time. The authors argue that a busy and overworked lifestyle, rather than a leisurely lifestyle, has become an aspirational status symbol. A series of studies shows that the positive inferences of status in response to busyness and lack of leisure time are driven by the perceptions that a busy person possesses desired human capital characteristics (e.g., competence and ambition) and is scarce and in demand in the job market. This research uncovers an alternative kind of conspicuous consumption that operates by shifting the focus from the preciousness and scarcity of goods to the preciousness and scarcity of individuals. Furthermore, the authors examine cultural values (perceived social mobility) and differences among cultures (North America vs. Europe) to demonstrate moderators and boundary conditions of the positive associations derived from signals of busyness.
Medical therapy, refractory chronic rhinosinusitis, and productivity costs
Authors: Smith Kristine A. , Rudmik Luke
Published: November 2016

Purpose of review

The purpose of this review is to address the most recent advances in the medical therapy for chronic rhinosinusitis (CRS), define recalcitrant and refractory CRS, and discuss the productivity costs associated with CRS.

Recent findings

Recent studies evaluating anti-IL-4 receptor α antibodies and calcium channel blockers have demonstrated promising early results during management of CRS. Recent appropriateness criteria have been developed to assist clinicians with defining which patients have ‘refractory’ CRS and may be considered candidates for endoscopic sinus surgery. Productivity costs appear to be associated with disease severity and can be reduced with appropriate interventions.

Topical corticosteroid therapy and high volume saline irrigation continue to be the cornerstone to medical therapy, whereas use of systemic corticosteroids and antibiotics depends on CRS phenotype and presence of acute exacerbation. More research is needed before routine use of novel immunomodulatory therapies such as anti-IL5, anti-IgE, anti-IL4, and calcium channel blockers. Clinicians should apply an appropriate definition for refractory CRS when discussing role of sinus surgery. Assessing the degree of work productivity impairment can assist in treatment decision-making and may help predict treatment outcomes.
Problems, difficulties, and surgical complications of cubitus varus
Authors: Dhar Shabir Ahmed , Dar Tahir Ahmed , Mir Naseer Ahmed
Published: November 2016

Cubitus varus is a frequent sequela to supracondylar fractures of the humerus in the pediatric population. Often is it viewed as a cosmetic complication only, which may be an oversimplification and underestimation of the problem. We reviewed the literature to find the reported preoperative problems, intraoperative difficulties, and complications encountered by the patient and the surgeon in cubitus varus. Our review shows that there are a surprisingly large number of challenges, problems, and complications associated with this deformity. The surgeon should be aware of the problems a patient with cubitus varus faces as well as the potential difficulties in operative intervention.
Applying Advanced Analytical Approaches to Characterize the Impact of Specific Clinical Gaps and Profiles on the Management of Rheumatoid Arthritis
Authors: Ruiz-Cordell Karyn D. , Joubin Kathy , Haimowitz Steven
Published: November 2016

Introduction:

The goal of this study was to add a predictive modeling approach to the meta-analysis of continuing medical education curricula to determine whether this technique can be used to better understand clinical decision making. Using the education of rheumatologists on rheumatoid arthritis management as a model, this study demonstrates how the combined methodology has the ability to not only characterize learning gaps but also identify those proficiency areas that have the greatest impact on clinical behavior.

Methods:

The meta-analysis included seven curricula with 25 activities. Learners who identified as rheumatologists were evaluated across multiple learning domains, using a uniform methodology to characterize learning gains and gaps. A performance composite variable (called the treatment individualization and optimization score) was then established as a target upon which predictive analytics were conducted.

Results:

Significant predictors of the target included items related to the knowledge of rheumatologists and confidence concerning 1) treatment guidelines and 2) tests that measure disease activity. In addition, a striking demographic predictor related to geographic practice setting was also identified.

Discussion:

The results demonstrate the power of advanced analytics to identify key predictors that influence clinical behaviors. Furthermore, the ability to provide an expected magnitude of change if these predictors are addressed has the potential to substantially refine educational priorities to those drivers that, if targeted, will most effectively overcome clinical barriers and lead to the greatest success in achieving treatment goals.
Impact of Mental Health Comorbidities on the Community-Based Pediatric Treatment and Outcomes of Children with Attention Deficit Hyperactivity Disorder
Authors: Al Ghriwati Nour , Langberg Joshua M. , Gardner William , Peugh James , Kelleher Kelly J. , Baum Rebecca , Brinkman William B. , Lichtenstein Phil , Epstein Jeffery N.
Published: November 2016

Objective:

Children with attention deficit hyperactivity disorder (ADHD) often exhibit psychiatric comorbidities, which may impact illness presentation, diagnosis, and treatment outcomes. Guidelines exist for dealing with these complex cases but little is known about how comorbidities are being handled in community pediatric settings. The purpose of this study was to evaluate how mental health comorbidities affect community physicians' ADHD care practices and patients' symptom trajectories.

Method:

Medical charts of 319 children presenting at primary care clinics for ADHD-related concerns were reviewed. Physician assessment and treatment behaviors were extracted and parents rated ADHD symptoms at the time of diagnosis and at 3, 6, and 12 months. Baseline ratings were used to group children, as no comorbid mental health condition, internalizing, or externalizing comorbid condition. Multilevel analyses compared community physician care behaviors and ADHD symptom trajectories across groups.

Results:

Approximately, 50 percent of the sample met screening criteria for a comorbid mental health condition. For children diagnosed with ADHD and treated with medication, community physician care largely did not differ across groups, but children with internalizing comorbidities made significantly smaller improvements in inattentive and hyperactive/impulsive symptoms compared with children with no comorbidities.

Conclusion:

Children with ADHD and mental health comorbidities, particularly internalizing disorders, exhibit less robust response to ADHD medication and may require additional testing before starting medication and/or alternative treatment approaches. Potential barriers to conducting comprehensive assessments and to providing multi-modal treatment are discussed.
Nursing Practices and Policies Related to Family Presence During Resuscitation
Authors: Powers Kelly A. , Candela Lori
Published: November 2016

Background:

Despite its shown benefits, family presence during resuscitation (FPDR) is a controversial topic among critical care nurses and is not routinely implemented.

Objectives:

The objective of this study was to describe FPDR practices among critical care nurses, as well as the prevalence of FPDR policies and education.

Methods:

The study used a descriptive survey design. Data were collected from a convenience sample of critical care nurses obtained at a national level. A 25-item demographic and professional attribute survey was administered to all participants.

Results:

There were 124 critical care nurses who participated. Results indicated critical care nurses have vast resuscitative care experience; however, FPDR is not a routine component. In the past year, 23% (n = 29) had never experienced FPDR, and only 17% (n = 21) had experienced it more than 5 times. Furthermore, 48% (n = 59) had never invited FPDR, and 45% (n = 56) had invited it only 1 to 5 times. A lack of FPDR policy was noted, with 73% (n = 91) indicating their facility or unit did not have a policy or they were unsure if one existed. Only 38% (n = 47) had ever received education on FPDR.

Discussion:

Despite the shown benefits of FPDR, it is not a routine component of resuscitation in critical care settings. Nurse managers and educators should focus on policy creation and education to help guide nurses at the bedside. The impact of policy and education on critical care nurses’ support for and implementation of FPDR requires further study.
Preventing Long-term Poor Outcomes in the Bariatric Patient Postoperatively
Authors: Cooley Melissa
Published: November 2016

The obesity epidemic in America continues to rise. People are desperately trying to find ways to lose weight successfully and keep the weight off, and many people are turning to bariatric surgery as the only remaining option for morbid obesity. Bariatric surgery is considered to be a viable treatment option for morbid obesity. However, long-term data are revealing that many postsurgical bariatric patients are regaining the weight after 5 years. The purpose of lifelong follow-up appointments in the bariatric patient is to prevent weight regain and poor outcomes. A case study is used as an example for a poor outcome in a postsurgical bariatric patient. The author of this article provides definitions related to postsurgical bariatric patients, explains the value of early detection and prevention, provides an example of a poor outcome, and concludes with a discussion of evidence-based practice changes that prevent poor outcomes.
Paecilomyces lilacinus Keratitis in a Soft Contact Lens Wearer
Authors: Monno Rosa , Alessio Giovanni , Guerriero Silvana , Capolongo Carmen , Calia Carla , Fumarola Luciana , Pazzani Carlo , Di Taranto Anna , Miragliotta Giuseppe
Published: November 2016

We describe a case of keratitis caused by Paecilomyces lilacinus in a contact lens wearer with a history of diabetes.
Primary Care Nurse Practitioner Practice Characteristics
Authors: Poghosyan Lusine , Norful Allison A. , Martsolf Grant R.
Published: November 2016

Developing team-based care models and expanding nurse practitioner (NP) workforce in primary care are recommended by policy makers to meet demand. Little is known how to promote interprofessional teamwork. Using a mixed-methods design, we analyzed qualitative interview and quantitative survey data from primary care NPs to explore practice characteristics important for teamwork. The Interprofessional Teamwork for Health and Social Care Framework guided the study. We identified NP-physician and NP-administration relationships; organizational support and governance; time and space for teamwork; and regulations and economic impact as important. Practice and policy change addressing these factors is needed for effective interprofessional teamwork.
Factors Associated With Electronic Health Record Use Among Nurse Practitioners in the United States
Authors: Jones Emily B.
Published: November 2016

Widespread use of electronic health records (EHRs) among all provider types is foundational to delivery system transformation. Three in 4 nurse practitioners used EHRs in 2012 (76.0%), and 60.3% of nonusers planned to adopt within 18 months. Practice setting, younger age, and colocation with physicians were associated with EHR use. In hospitals and in settings without on-site physicians, EHR use lagged in rural areas. Implementation assistance should be targeted to nonadopters, particularly those who never or infrequently work alongside physicians and those in rural hospitals. Sustained technical assistance with using EHRs for performance improvement and care coordination is also needed.
Increased Brain Lactate During Depressive Episodes and Reversal Effects by Lithium Monotherapy in Drug-Naive Bipolar Disorder
Authors: Machado-Vieira Rodrigo , Zanetti Marcus V. , Otaduy Maria C. , De Sousa Rafael T. , Soeiro-de-Souza Marcio G. , Costa Alana C. , Carvalho Andre F. , Leite Claudia C. , Busatto Geraldo F. , Zarate Carlos A. , Gattaz Wagner F.
Published: November 2016

Objective

Mitochondrial dysfunction and energy metabolism impairment are key components in the pathophysiology of bipolar disorder (BD) and may involve a shift from aerobic to anaerobic metabolism. Measurement of brain lactate in vivo using proton magnetic resonance spectroscopy (1H-MRS) represents an important tool to evaluate mitochondrial and metabolic dysfunction during mood episodes, as well as to monitor treatment response. To date, very few studies have quantified brain lactate in BD. In addition, no study has longitudinally evaluated lactate using 1H-MRS during depressive episodes or its association with mood stabilizer therapy. This study aimed to evaluate cingulate cortex (CC) lactate using 3-T 1H-MRS during acute depressive episodes in BD and the possible effects induced by lithium monotherapy.

Methods

Twenty medication-free outpatients with short length of BD (80% drug-naive) in a current major depressive episode were matched with control subjects. Patients were treated for 6 weeks with lithium monotherapy at therapeutic doses in an open-label trial (blood level, 0.48 ± 0.19 mmol/L). Cingulate cortex lactate was measured before (week 0) and after lithium therapy (week 6) using 1H-MRS. Antidepressant efficacy was assessed with the 21-item Hamilton Depression Rating Scale as the primary outcome.

Results

Subjects with BD depression showed a significantly higher CC lactate in comparison to control subjects. Furthermore, a significant decrease in CC lactate was observed after 6 weeks of lithium treatment compared with baseline (P = 0.002). CC Lactate levels was associated with family history of mood disorders and plasma lithium levels.

Conclusions

This is the first report of increased CC lactate in patients with bipolar depression and lower levels after lithium monotherapy for 6 weeks. These findings indicate a shift to anaerobic metabolism and a role for lactate as a state marker during mood episodes. Energy and redox dysfunction may represent key targets for lithium’s therapeutic actions.
Development and Pilot Testing of an International Knowledge Assessment of Prosthetic Management for Patients Using Lower-Limb Prostheses
Authors: Goodworth Adam D. , Veneri Diana A. , Burger John , Lee Daniel J.
Published: November 2016

Introduction

Individuals using a lower-limb prosthesis need knowledge about many aspects of management to maximize use and comfort and minimize secondary complications. Knowledge assessments are used in other health fields, yet no assessment has been published in prosthetics. Therefore, a knowledge assessment was developed for international use and pilot tested in the United States and East Africa.

Materials and Methods

The assessment contained 36 questions and was written at a 4.7-grade reading level. Content was based on professional input and literature. The assessment was pilot tested with 16 prosthetic users in the United States, 19 prosthetic users in East Africa, and 24 nonprosthetic users in the United States. Assessment scores were analyzed across questions, between prosthetic users and nonprosthetic users, and correlated with patient demographics.

Results

We found the assessment was understandable among all subject groups. United States prosthesis users scored higher than nonprosthesis users. Prosthetic experience was positively correlated with assessment scores in the United States and negatively correlated with assessment scores in East Africa.

Conclusions

Clinicians can use this knowledge assessment to identify gaps or misunderstanding and track progress in comprehension with their patients. Clinicians can adapt questions to their local context, individual needs and componentry, and time constraints.
Potential for treatment and a Zika virus vaccine
Authors: Quanquin Natalie , Wang Lulan , Cheng Genhong
Published: November 2016

Purpose of review

Zika virus (ZIKV) has only recently been exposed as a significant public health threat, and much of our limited knowledge of its pathogenesis and triggered immune responses were discovered in only the last few years. There are currently no ZIKV-specific therapeutics or vaccines available. This review seeks to bring the reader up-to-date with the latest developments in finding a way to combat this emerging infectious disease.

Recent findings

Current strategies used for developing ZIKV vaccines or treatments follow proven methods used against other flaviviruses. Unfortunately, ZIKV carries many unique challenges, such as the need to target drugs and vaccines towards immunocompromised populations (pregnant mothers and fetuses), the risk of stimulating harmful immune responses (either autoimmune or antibody-dependent enhancement of infection in those with previous flavivirus exposure), frequently silent infection that may delay treatment and increase risk of transmission to others, and multiple routes of transmission (arthropod vector, sexual, bloodborne, and potentially other body fluids).

Current medical recommendations are directed towards resolving symptoms and not the actual infection; however, ZIKV treatments and vaccines are in development. Vector control and travel restrictions to endemic areas may remain our only available interventions for some time.
Prostaglandin E‐major Urinary Metabolite as a Biomarker for Pediatric Ulcerative Colitis Activity
Authors: Hagiwara Shin‐ichiro , Okayasu Isao , Fujiwara Mutsunori , Matsuura Masaaki , Ohnishi Hiromitsu , Ito Satoru , Kishimoto Hiroshi , Nambu Ryusuke , Kagimoto Seiichi
Published: November 2016

Objectives:

Prostaglandin E‐major urinary metabolite (PGE‐MUM) is a useful biomarker for adult ulcerative colitis (UC) activity. In the present study, we evaluated whether PGE‐MUM can also be a biomarker of pediatric UC activity and compared its efficacy in predicting UC activity with that of C‐reactive protein and erythrocyte sedimentation rate.

Methods:

Twenty‐nine pediatric patients with UC (8–18 years) and 29 healthy age‐ and sex‐matched subjects were enrolled. UC activity was evaluated using the Pediatric Ulcerative Colitis Activity Index, highest Mayo endoscopic scoring (Mayo), and Matts grading (Matts) for histologic scoring, and the sum of Mayo (total of 6 segments) and Matts in all patients with UC. PGE‐MUM levels were measured using a radioimmunoassay.

Results:

PGE‐MUM levels were elevated in endoscopically and histologically active UC patients, but not in patients with endoscopic and histologic remission or controls. PGE‐MUM levels positively and significantly correlated with UC activity. PGE‐MUM levels were positively correlated with Pediatric Ulcerative Colitis Activity Index (r = 0.594), highest Mayo (r = 0.462), the sum of Mayo (r = 0.694), and the sum of Matts (r = 0.613), but not with highest Matt (r = 0.352). The sum of Mayo and the sum of Matts, which reflect total colon inflammation, showed highest correlation with PGE‐MUM. C‐reactive protein levels did not correlate with any UC activity scores. Erythrocyte sedimentation rate exhibited correlation (r = 0.490) with the sum of Mayo only.

Conclusions:

PGE‐MUM is a reliable biomarker that reflects both the endoscopic and histologic activity of the entire colon in pediatric UC.
Antitissue Transglutaminase Normalization Postdiagnosis in Children With Celiac Disease
Authors: Isaac Daniela Migliarese , Rajani Seema , Yaskina Maryna , Huynh Hien Q. , Turner Justine M.
Published: November 2016

Objectives:

Limited pediatric data exist examining the trend and predictors of antitissue transglutaminase (atTG) normalization over time in children with celiac disease (CD). We aimed to evaluate time to normalization of atTG in children after CD diagnosis, and to assess for independent predictors affecting this duration.

Methods:

A retrospective chart review was completed in pediatric patients with CD diagnosed from 2007 to 2014 at the Stollery Children's Hospital Celiac Clinic (Edmonton, Alberta, Canada). The clinical predictors assessed for impact on time to atTG normalization were initial atTG, Marsh score at diagnosis, gluten‐free diet compliance (GFDC), age at diagnosis, sex, ethnicity, medical comorbidities, and family history of CD. Kaplan‐Meier survival analysis was completed to assess time to atTG normalization, and Cox regression to assess for independent predictors of this time.

Results:

A total of 487 patients met inclusion criteria. Approximately 80.5% of patients normalized atTG levels. Median normalization time was 407 days for all patients (95% confidence interval [CI: 361–453]), and 364 days for gluten‐free diet compliant patients (95% CI [335–393]). Type 1 diabetes mellitus (T1DM) patients took significantly longer to normalize at 1204 days (95% CI [199–2209], P < 0.001). Cox regression demonstrated T1DM (hazard ratio = 0.36 [0.24–0.55], P < 0.001) and higher baseline atTG (hazard ratio = 0.52 [0.43–0.63], P < 0.001) were significant predictors of longer atTG normalization time. GFDC was a significant predictor of earlier normalization (OR = 13.91 [7.86–24.62], P < 0.001).

Conclusions:

GFDC and lower atTG at diagnosis are predictors of earlier normalization. Patients with T1DM are less likely to normalize atTG levels, with longer normalization time. Additional research and education for higher‐risk populations are needed.
Cardiovascular Risk Factors in Adolescents With Celiac Disease
Authors: Assa Amit , Frenkel‐Nir Yael , Tzur Dorit , Katz Lior H. , Shamir Raanan
Published: November 2016

Background:

Recent data have shown that adults with celiac disease (CD) may have a higher prevalence of risk factors for cardiovascular disease (CVD) compared with the general population. Thus, we aimed to investigate the association of CD with CVD risk factors at late adolescence in a cross‐sectional population‐based study.

Methods:

A total of 2,001,353 Jewish Israeli adolescents who underwent a general health examination at median age of 17.1 years from 1988 to 2015 were included. Covariate data included demographic measures, blood pressure (BP), resting heart rate, and risk factors associated with CVD.

Results:

Overall, 10,566 cases of CD were identified (0.53%). Multivariate analysis showed that mean diastolic BP was significantly lower in subjects with CD (men: 72.0±8.7 vs 70.4 ± 8.5, P < 0.0001; women: 70.0 ± 8.3 vs 69.0 ± 8.2, P < 0.0001), whereas systolic BP did not differ between groups. Resting heart rate was higher in CD cases (an absolute difference of 0.4 beats per minute, P < 0.0001). The proportions of overweight and obese subjects were significantly lower in CD cases. Noninsulin‐dependent diabetes mellitus (relative risk [RR], 4.1; 95% confidence interval [CI] 2.8–5.7), hypercoagulability (RR, 2.6; 95% CI 1.5–4.5), and hyperlipidemia (RR, 1.9; 95% CI 1.2–3) were significantly more common in subjects with CD.

Conclusions:

At the age of 17 years, the prevalence of risk factors for CVD is higher in subjects with CD compared with the general population. There is, however, neither increase in BP nor increase in overweight and obesity rates.
Multimorbidity and Genetic Characteristics of DICER1 Syndrome Based on Systematic Review
Authors: Cai Siyu , Zhao Wen , Nie Xiaolu , Abbas Ali , Fu Libing , Bihi Safaa , Feng Guoshuang , Liu Tianyi , Lv Yaqi , Ma Xiaoli , Peng Xiaoxia
Published: November 2016

It has been reported that germline DICER1 mutations correlate with a distinctive human disease syndrome. Many published studies within this field have been conducted based on rare cases. We systematically searched bibliographic databases, including PubMed, Embase, and COSMIC for articles which are related to diseases covered by DICER1 syndrome. The weighted summary of mutation frequencies among patients with pleuropulmonary blastoma (PPB), cystic nephroma (CN), and Sertoli-Leydig cell tumor (SLCT) were calculated. Forty-nine eligible articles were included. In total, 72 cases with multimorbidity of DICER1 syndrome were identified. More females (n=46, 64%) presented with multimorbidity than males (n=18, 25%) and the remaining 8 patients’ sex were unknown. Nineteen of 72 patients with multimorbidity suffered from another disease that was not yet included in DICER1 syndrome, which would provide potential phenotypes of DICER1 syndrome. The germline DICER1 mutation frequencies in PPB, CN, and SLCT were 66.9%, 73.2%, and 57.1%, respectively. The somatic DICER1 mutation frequencies of PPB, CN, and SLCT were 92.4%, 87.9%, and 43.3%, respectively. Majority of patients with multimorbidity of DICER1 syndrome were mutation positive individuals so that multimorbidity may suggest the possible germline mutation of these patients and their relatives.
Classifying Patients’ Complaints for Regulatory Purposes: A Pilot Study
Authors: Bouwman Renée , Bomhoff Manja , Robben Paul , Friele Roland
Published: November 2016

Objectives

It is assumed that classifying and aggregated reporting of patients’ complaints by regulators helps to identify problem areas, to respond better to patients and increase public accountability. This pilot study addresses what a classification of complaints in a regulatory setting contributes to the various goals.

Methods

A taxonomy with a clinical, management, and relationship domain was used to systematically analyze 364 patients’ complaints received by the Dutch regulator.

Results

Most complaints were about hospital care, mental health care, and elder care. About certain sectors such as emergency care, little numbers of complaints were received. The largest proportion of complaints concerned the clinical domain (51%), followed by the management domain (47%) and the relationship domain (42%).

Clinical domain complaints were more prevalent in elder care (65%) than in hospital care (56%) and mental health care (41%). In complaints about mental health care, the relationship domain was the most important (65%). The management domain was most prevalent in elder care (49%) compared with the other sectors.

Conclusions

Problem areas within different health-care sectors could be identified by classifying the complaints. It provided insight in the regulator’s own practices, which are aimed at public accountability. However, there are several limitations. Aggregated analyses were not possible in sectors with low numbers of complaints. Furthermore, the information remains rather superficial, and a standardized detailed system of reporting among agencies is needed. To assess which complaints need regulatory action, an in-depth analysis, using standardized methodology and criteria, of specific complaints is needed. Improving responses to patients requires more than merely aggregated reporting of complaints.
Microstructure and mechanics of healthy and aneurysmatic abdominal aortas: experimental analysis and modelling
Authors: Niestrawska Justyna A. , Viertler Christian , Regitnig Peter , Cohnert Tina U. , Sommer Gerhard , Holzapfel Gerhard A.
Published: November 2016

Soft biological tissues such as aortic walls can be viewed as fibrous composites assembled by a ground matrix and embedded families of collagen fibres. Changes in the structural components of aortic walls such as the ground matrix and the embedded families of collagen fibres have been shown to play a significant role in the pathogenesis of aortic degeneration. Hence, there is a need to develop a deeper understanding of the microstructure and the related mechanics of aortic walls. In this study, tissue samples from 17 human abdominal aortas (AA) and from 11 abdominal aortic aneurysms (AAA) are systematically analysed and compared with respect to their structural and mechanical differences. The collagen microstructure is examined by analysing data from second-harmonic generation imaging after optical clearing. Samples from the intact AA wall, their individual layers and the AAA wall are mechanically investigated using biaxial stretching tests. A bivariate von Mises distribution was used to represent the continuous fibre dispersion throughout the entire thickness, and to provide two independent dispersion parameters to be used in a recently proposed material model. Remarkable differences were found between healthy and diseased tissues. The out-of-plane dispersion was significantly higher in AAA when compared with AA tissues, and with the exception of one AAA sample, the characteristic wall structure, as visible in healthy AAs with three distinct layers, could not be identified in AAA samples. The collagen fibres in the abluminal layer of AAAs lost their waviness and exhibited rather straight and thick struts of collagen. A novel set of three structural and three material parameters is provided. With the structural parameters fixed, the material model was fitted to the mechanical experimental data, giving a very satisfying fit although there are only three material parameters involved. The results highlight the need to incorporate the structural differences into finite-element simulations as otherwise simulations of AAA tissues might not be good predictors for the actualin vivostress state.
Splitting fracture in bovine bone using a porosity-based spring network model
Authors: Mayya Ashwij , Praveen P. , Banerjee Anuradha , Rajesh R.
Published: November 2016

We examine the specific role of the structure of the network of pores in plexiform bone in its fracture behaviour under compression. Computed tomography scan images of the sample pre- and post-compressive failure show the existence of weak planes formed by aligned thin long pores extending through the length. We show that the physics of the fracture process is captured by a two-dimensional random spring network model that reproduces well the macroscopic response and qualitative features of fracture paths obtained experimentally, as well as avalanche statistics seen in recent experiments on porcine bone.
The miR-125 family is an important regulator of the expression and maintenance of maternal effect genes during preimplantational embryo development
Authors: Kim Kyeoung-Hwa , Seo You-Mi , Kim Eun-Young , Lee Su-Yeon , Kwon Jini , Ko Jung-Jae , Lee Kyung-Ah
Published: November 2016

Previously, we reported that
Sebox
is a new maternal effect gene (MEG) that is required for early embryo development beyond the two-cell (2C) stage because this gene orchestrates the expression of important genes for zygotic genome activation (ZGA). However, regulators of
Sebox
expression remain unknown. Therefore, the objectives of the present study were to use bioinformatics tools to identify such regulatory microRNAs (miRNAs) and to determine the effects of the identified miRNAs on
Sebox
expression. Using computational algorithms, we identified a motif within the 3′UTR of
Sebox
mRNA that is specific to the seed region of the miR-125 family, which includes miR-125a-5p, miR-125b-5p and miR-351-5p. During our search for miRNAs, we found that the
Lin28a
3′UTR also contains the same binding motif for the seed region of the miR-125 family. In addition, we confirmed that Lin28a also plays a role as a MEG and affects ZGA at the 2C stage, without affecting oocyte maturation or fertilization. Thus, we provide the first report indicating that the miR-125 family plays a crucial role in regulating MEGs related to the 2C block and in regulating ZGA through methods such as affecting Sebox and Lin28a in oocytes and embryos.
The plastid genome of some eustigmatophyte algae harbours a bacteria-derived six-gene cluster for biosynthesis of a novel secondary metabolite
Authors: Yurchenko Tatiana , Ševčíková Tereza , Strnad Hynek , Butenko Anzhelika , Eliáš Marek
Published: November 2016

Acquisition of genes by plastid genomes (plastomes) via horizontal gene transfer (HGT) seems to be a rare phenomenon. Here, we report an interesting case of HGT revealed by sequencing the plastomes of the eustigmatophyte algae
Monodopsis
sp. MarTras21 and
Vischeria
sp. CAUP Q 202. These plastomes proved to harbour a unique cluster of six genes, most probably acquired from a bacterium of the phylum Bacteroidetes, with homologues in various bacteria, typically organized in a conserved uncharacterized putative operon. Sequence analyses of the six proteins encoded by the operon yielded the following annotation for them: (i) a novel family without discernible homologues; (ii) a new family within the superfamily of metallo-dependent hydrolases; (iii) a novel subgroup of the UbiA superfamily of prenyl transferases; (iv) a new clade within the sugar phosphate cyclase superfamily; (v) a new family within the xylose isomerase-like superfamily; and (vi) a hydrolase for a phosphate moiety-containing substrate. We suggest that the operon encodes enzymes of a pathway synthesizing an isoprenoid–cyclitol-derived compound, possibly an antimicrobial or other protective substance. To the best of our knowledge, this is the first report of an expansion of the metabolic capacity of a plastid mediated by HGT into the plastid genome.