Serial assessment of pulmonary lesion volume by computed tomography allows survival prediction in invasive pulmonary aspergillosis.

BACKGROUND: Serial chest CT is the standard of care to establish treatment success in invasive pulmonary aspergillosis (IPA). Data are lacking how response should be defined. METHODS: Digital CT images from a clinical trial on treatment of IPA were re-evaluated and compared with available biomarkers. Total volume of pneumonia was added up after manual measurement of each lesion, followed by statistical analysis. RESULTS: One-hundred and ninety CT scans and 309 follow-up datasets from 40 patients were available for analysis. Thirty-one were neutropenic. Baseline galactomannan (OR 4.06, 95%CI: 1.08-15.31) and lesion volume (OR 3.14, 95%CI: 0.73-13.52) were predictive of death. Lesion volume at d7 and trend between d7 and d14 were strong predictors of death (OR 20.01, 95%CI: 1.42-282.00 and OR 15.97, 95%CI: 1.62-157.32) and treatment being rated as unsuccessful (OR 4.75, 95%CI: 0.94-24.05 and OR 40.69, 95%CI: 2.55-649.03), which was confirmed by a Cox proportional hazards model using time-dependent covariates. CONCLUSION: Any increase in CT lesion volume between day 7 and day 14 was a sensitive marker of a lethal outcome (>50%), supporting a CT rescan each one and 2 weeks after initial detection of IPA. The predictive value exceeded all other biomarkers. Further CT follow-up after response at day 14 was of low additional value. KEY POINTS: • CT evaluation offers good prediction of outcome for invasive pulmonary aspergillosis. • Predictive capability exceeds galactomannan, blood counts, and lesion count. • Any progression between day 7 and day 14 constitutes a high-risk scenario.

Neural correlates of ticklishness in the rat somatosensory cortex.

Rats emit ultrasonic vocalizations in response to tickling by humans. Tickling is rewarding through dopaminergic mechanisms, but the function and neural correlates of ticklishness are unknown. We confirmed that tickling of rats evoked vocalizations, approach, and unsolicited jumps (Freudensprünge). Recordings in the trunk region of the rat somatosensory cortex showed intense tickling-evoked activity in most neurons, whereas a minority of cells were suppressed by tickling. Tickling responses predicted nontactile neural responses to play behaviors, which suggests a neuronal link between tickling and play. Anxiogenic conditions suppressed tickling-evoked vocalizations and trunk cortex activity. Deep-layer trunk cortex neurons discharged during vocalizations, and deep-layer microstimulation evoked vocalizations. Our findings provide evidence for deep-layer trunk cortex activity as a neural correlate of ticklishness.

Modelling real-time control of WWTP influent flow under data scarcity.

In order to comply with effluent standards, wastewater operators need to avoid hydraulic overloading of the wastewater treatment plant (WWTP), as this can result in the washout of activated sludge from secondary settling tanks. Hydraulic overloading can occur in a systematic way, for instance when sewer network connections are extended without increasing the WWTP's capacity accordingly. This study demonstrates the use of rule-based real-time control (RTC) to reduce the load to the WWTP while restricting the overall overflow volume of the sewer system to a minimum. Further, it shows the added value of RTC despite the limited availability of monitoring data and information on the catchment through a parsimonious simulation approach, using relocation of spatial system boundaries and creating required input data through reverse modelling. Focus was hereby on the accurate modelling of pump hydraulics and control. Finally, two different methods of global sensitivity analysis were employed to verify the influence of parameters of both the model and the implemented control algorithm. Both methods show the importance of good knowledge of the system properties, but that monitoring errors play a minor role.

[Influence of cognition on treatment outcome in geriatric patients: association between MMSE and gain in activities of daily living]. / Einfluss der Kognition auf die Behandlungsergebnisse in der Geriatrie : Zusammenhang von MMSE und Zugewinn in den Alltagsaktivitäten.

BACKGROUND: Cognitive impairment or dementia influence the results of geriatric treatment. The aim of the study was to quantify this influence. PATIENTS AND METHODS: Data of 2527 patients from the years 2006 to 2009 were analysed in order to quantify the influence of cognition measured with the Mini Mental Status Examination (MMSE) on the improvement of activities of daily living as reflected by the Functional Independence Measure (FIM). RESULTS: Impaired cognition is accompanied by a lower FIM score on admission and on discharge. But the improvement of the FIM of slightly cognitively impaired patients (MMSE 20-26) is the same as in patients without cognitive impairment (MMSE 27-30). Patients with a MMSE below 20 points have smaller improvements in their FIM score but nevertheless 40 % of the patients with a MMSE of 10-19 and still 30 % of the patients with a MMSE of 0-9 points show better improvements than the average of all patients. CONCLUSION: Patients with a MMSE below 20 should not generally be excluded from geriatric treatment, but individual factors should be considered.

Long-wavelength chlorophylls in photosystem I of cyanobacteria: origin, localization, and functions.

The structural organization of photosystem I (PSI) complexes in cyanobacteria and the origin of the PSI antenna long-wavelength chlorophylls and their role in energy migration, charge separation, and dissipation of excess absorbed energy are discussed. The PSI complex in cyanobacterial membranes is organized preferentially as a trimer with the core antenna enriched with long-wavelength chlorophylls. The contents of long-wavelength chlorophylls and their spectral characteristics in PSI trimers and monomers are species-specific. Chlorophyll aggregates in PSI antenna are potential candidates for the role of the long-wavelength chlorophylls. The red-most chlorophylls in PSI trimers of the cyanobacteria Arthrospira platensis and Thermosynechococcus elongatus can be formed as a result of interaction of pigments peripherally localized on different monomeric complexes within the PSI trimers. Long-wavelength chlorophylls affect weakly energy equilibration within the heterogeneous PSI antenna, but they significantly delay energy trapping by P700. When the reaction center is open, energy absorbed by long-wavelength chlorophylls migrates to P700 at physiological temperatures, causing its oxidation. When the PSI reaction center is closed, the P700 cation radical or P700 triplet state (depending on the P700 redox state and the PSI acceptor side cofactors) efficiently quench the fluorescence of the long-wavelength chlorophylls of PSI and thus protect the complex against photodestruction.

Characterizing longitudinal health state transitions among heroin, cocaine, and methamphetamine users.

AIMS: Characterize longitudinal patterns of drug use careers and identify determinants of drug use frequency across cohorts of primary heroin, methamphetamine (MA) and cocaine users. DESIGN: Pooled analysis of prospective cohort studies. SETTINGS: Illicit drug users recruited from community, criminal justice and drug treatment settings in California, USA. PARTICIPANTS: We used longitudinal data on from five observational cohort studies featuring primary users of heroin (N=629), cocaine (N=694) and methamphetamine (N=474). The mean duration of follow-up was 20.9 years. MEASUREMENTS: Monthly longitudinal data was arranged according to five health states (incarceration, drug treatment, abstinence, non-daily and daily use). We fitted proportional hazards (PH) frailty models to determine independent differences in successive episode durations. We then executed multi-state Markov (MSM) models to estimate probabilities of transitioning between health states, and the determinants of these transitions. FINDINGS: Across primary drug use types, PH frailty models demonstrated durations of daily use diminished in successive episodes over time. MSM models revealed primary stimulant users had more erratic longitudinal patterns of drug use, transitioning more rapidly between periods of treatment, abstinence, non-daily and daily use. MA users exhibited relatively longer durations of high-frequency use. Criminal engagement had a destabilizing effect on health state durations across drug types. Longer incarceration histories were associated with delayed transitions toward cessation. CONCLUSIONS: PH frailty and MSM modeling techniques provided complementary information on longitudinal patterns of drug abuse. This information can inform clinical practice and policy, and otherwise be used in health economic simulation models, designed to inform resource allocation decisions.

Cytoarchitecture, areas, and neuron numbers of the Etruscan shrew cortex.

The Etruscan shrew, Suncus etruscus, is one of the smallest mammals. Etruscan shrews can recognize prey shape with amazing speed and accuracy, based on whisker-mediated tactile cues. Because of its small size, quantitative analysis of the Etruscan shrew cortex is more tractable than in other animals. To quantitatively assess the anatomy of the Etruscan shrew's brain, we sectioned brains and applied Nissl staining and NeuN (neuronal nuclei) antibody staining. On the basis of these stains, we estimated the number of neurons of 10 cortical hemispheres by using Stereoinvestigator and Neurolucida (MBF Bioscience) software. On average, the neuron number per hemisphere was found to be ~1 million. We also measured cortical surface area and found an average of 11.1 mm² (n = 7) and an average volume of 5.3 mm³ (n = 10) per hemisphere. We identified 13 cortical regions by cytoarchitectonic boundaries in coronal, sagittal, and tangential sections processed for Nissl substance, myelin, cytochrome oxidase, ionic zinc, neurofilaments, and vesicular glutamate transporter 2 (VGluT2). The Etruscan shrew is a highly tactile animal with a large somatosensory cortex, which contains a barrel field, but the barrels are much less clearly defined than in rodents. The anatomically derived cortical partitioning scheme roughly corresponds to physiologically derived maps of neocortical sensory areas.

Protein dynamics-induced variation of excitation energy transfer pathways.

Strong anticorrelation between the fluorescence emission of different emitters is observed by employing single-molecule fluorescence spectroscopy on photosystem I at cryogenic temperatures. This anticorrelation demonstrates a time-dependent interaction between pigments participating in the exciton transfer chain, implying that uniquely defined energy transfer pathways within the complex do not exist. Fluctuations of the chromophores themselves or their immediate protein surroundings induce changes in their site energy, and, as a consequence, these fluctuations change the coupling within the excitation transfer pathways. The time scales of the site energy fluctuations of the individual emitters do not meet the time scales of the observed correlated emission behavior. Therefore, the emitters must be fed individually by energetically higher lying states, causing the observed intensity variations. This phenomenon is shown for photosystem I pigment-protein complexes from 2 different cyanobacteria (Thermosynechococcus elongatus and Synechocystis sp. PCC 6803) with strongly different spectral properties underlining the general character of the findings. The variability of energy transfer pathways might play a key role in the extreme robustness of light-harvesting systems in general.

A kernel-based method to determine optimal sampling times for the simultaneous estimation of the parameters of rival mathematical models.

When several models are proposed for one and the same process, experimental design techniques are available to design optimal discriminatory experiments. However, because the experimental design techniques are model-based, it is important that the required model predictions are not too uncertain. This uncertainty is determined by the quality of the already available data, since low-quality data will result in poorly estimated parameters, which on their turn result in uncertain model predictions. Therefore, model discrimination may become more efficient and effective if this uncertainty is reduced first. This can be achieved by performing dedicated experiments, designed to increase the accuracy of the parameter estimates. However, performing such an additional experiment for each rival model may undermine the overall goal of optimal experimental design, which is to minimize the experimental effort. In this article, a kernel-based method is presented to determine optimal sampling times to simultaneously estimate the parameters of rival models in a single experiment. The method is applied in a case study where nine rival models are defined to describe the kinetics of an enzymatic reaction (glucokinase). The results clearly show that the presented method performs well, and that a compromise experiment is found which is sufficiently informative to improve the overall accuracy of the parameters of all rival models, thus allowing subsequent design of an optimal discriminatory experiment.

Prevention and treatment of invasive fungal infection in very low birthweight infants.

Invasive fungal infection is an important cause of mortality and morbidity in very low birthweight (VLBW) infants. Extremely preterm and extremely low birthweight infants are at highest risk because of the intensive and invasive nature of the care that these infants receive. Additional specific risk factors include prolonged use of parenteral nutrition and exposure to broad-spectrum antibiotics and histamine type 2 receptor blockers. Diagnosis is difficult and often delayed, and this may contribute to the high levels of deep-organ dissemination and associated mortality and morbidity. The most commonly used antifungal agents are amphotericin B and fluconazole. Recent research has assessed the value of early empirical and prophylactic treatment. However, although systemic antifungal prophylaxis reduces the incidence of invasive fungal infection, there is no evidence of effect on mortality. Concern exists about the impact that widespread use of prophylaxis may have on the emergence of antifungal resistance.

Handwriting difficulties in primary school children: a search for underlying mechanisms.

OBJECTIVE: This study investigated the contribution of perceptual-motor dysfunction and cognitive planning problems to the quality or speed of handwriting in children with handwriting problems (HWP). METHOD: Twenty-nine children with HWP and 20 classroom peers attending regular schools (grade 2 and grade 3) were tested with regard to visual perception, visual-motor integration, fine motor coordination, and cognitive planning abilities. RESULTS: The HWP group scored significantly lower on visual perception, visual-motor integration, fine motor coordination, and cognitive planning in comparison with classroom controls. Regression analyses showed that visual-motor integration was the only significant predictor for quality of handwriting in the HWP group, whereas fine motor coordination (i.e., unimanual dexterity) was the only significant predictor of quality of handwriting in the control group. CONCLUSIONS: Results suggest that two different mechanisms underlie the quality of handwriting in children with and without handwriting problems. Poor quality of handwriting of children with HWP seems particularly related to a deficiency in visual-motor integration.

Treatment of spin-coupled metal-centres in pulsed electron-electron double-resonance experiments.

In applications of ELDOR (electron-electron double-resonance) spectroscopy to metal centres, significant g-anisotropy and spin-coupling within multinuclear clusters have to be considered. We show the difficulties and the advantages arising from these effects.

A Rab-related small GTP binding protein is predominantly expressed in root nodules of Medicago sativa.

Rab-related small GTP-binding proteins are known to be involved in the regulation of the vesicular transport system in eucaryotic cells. In this paper we report the isolation of the cDNA clone MS- rab11f from Medicago sativa (alfalfa) root nodules using a combination of RT-PCR and SSCP analysis. MS- rab11f shows high homology to the Rab-related cDNA clone LJ- rab11f from Lotus japonicus root nodules. The MS-Rab11F protein expressed in Escherichia coli was found to bind GTP, confirming that the isolated cDNA indeed codes for a small GTP-binding protein. Expression analysis by RT-PCR demonstrated that MS- rab11f is preferentially expressed in root nodules of alfalfa. Using the cDNA-sequence of MS-rab11f, a peptide-specific antibody was generated. Western blot analysis with this antibody revealed that two Rab11F isoforms, designated MS-Rab11FA and MS-Rab11FB, are found in M. sativa root nodules.

Influence of Silicon and Chlorothalonil on the Suppression of Gray Leaf Spot and Increase Plant Growth in St. Augustinegrass.

Silicon, applied as calcium silicate slag (20% Si), was evaluated for its potential to suppress gray leaf spot (Magnaporthe grisea) and increase plant growth in newly planted St. Augustinegrass in the summers of 2000 and 2001. Calcium silicate was applied (1,000 kg Si/ha) to three sites that contained Si-deficient Histosols prior to sprigging St. Augustinegrass, cv. Floratam, in southern Florida. This treatment was compared with foliar sprays of chlorothalonil, calcium silicate plus chlorothalonil, and an untreated control. Immediately after planting, applications of chlorothalonil (720 g/liter) were made every 10 days for a total of seven sprays at a rate of 7.6 kg a.i./ha with a commercial sprayer. Based on area under the disease progress curve (AUDPC) values for the treatments calcium silicate alone, chlorothalonil, and calcium silicate plus chlorothalonil, gray leaf spot was reduced by 7, 65, and 68% at site one, 28, 34, and 59% at site two, and 41, 55, and 68% at site three, respectively when compared with the untreated control. The application of calcium silicate alone significantly reduced the final AUDPC of gray leaf spot when compared with the control at site two only. However, when disease severities were analyzed by week, the calcium silicate treatment significantly reduced the percentage of disease at weeks 2, 6, and 8 at site one and weeks 3 to 8 at site three when compared with the control. The final percent bare ground coverage for St. Augustinegrass was increased significantly using calcium silicate by 17 and 34% over the control at sites one and two, respectively (P ≤ 0.05). Silicon was the only element to significantly increase in the leaf tissue for treatments amended with calcium silicate. Levels of Si in leaves for treatments amended with calcium silicate were from 1.2 to 1.3%, while those not receiving calcium silicate had only 0.6 to 0.7%. Amendments with calcium silicate slag for St. Augustinegrass sod production on Si-deficient soils may be an option to reduce gray leaf spot development in newly sprigged fields and promote earlier ground coverage of grass when the environment is favorable for disease.

Barriers to tobacco cessation in clinical practice: report from a National Survey of Oncology Nurses.

This study describes the survey results of a national random sample of members of the Oncology Nursing Society who reported the greatest number of barriers to delivering a tobacco cessation intervention with their patients. Nurses who perceived the greatest number of barriers were more likely to be current smokers and to be young and were less likely to have an advanced degree, to be a nurse practitioner, or to have administrative responsibilities. Those with greater barriers were less likely to deliver tobacco cessation interventions.

Predictors of social support and caregiver outcomes.

PURPOSE: This study identified predictors of caregiver's burden, satisfaction, depression, and social support. Little has been done to identify predictors of social support for caregivers at risk for negative outcomes. DESIGN: Correlational descriptive study. METHODS: A subset of interview data from a larger intervention study was utilized. Independent variables were caregiver/care-recipient characteristics and social support. Dependent variables included caregiver burden, satisfaction, depression, anxiety, and hostility. RESULTS: Eighty-one caregiver/care-recipient dyads from the community participated in this study. Caregivers were women with a mean age of 67.53 years (range 39-86). Difficulty arranging assistance from confidante or friends correlated significantly and positively with caregiver burden (r = .38; p <.001) and depression (r = .34; p = .002), and negatively with satisfaction (r = -.28; p = .013). FINDINGS/IMPLICATIONS: Arranging assistance is more important than frequency of social network contact with respect to burden and depression. The findings indicate a need for further investigation and the consideration of interventions for at risk caregivers.

Quality of life in patients with heart failure: do gender differences exist?

OBJECTIVE: The purpose of this study was to evaluate gender differences in quality of life (QOL) in a large sample of age-matched and ejection fraction (EF)-matched patients with heart failure. DESIGN: Matched comparisons of secondary data were used. SETTING: The setting consisted of multicenter Studies of Left Ventricular Dysfunction trials. SAMPLE: The sample included 1382 patients (691 men and 691 women) who were age-matched and EF-matched. OUTCOME MEASURES: Global QOL and the QOL dimensions of physical function, emotional distress, social health, and general health were measured using the Ladder of Life, items from the Profile of Mood States Inventory, the Functional Status Questionnaire, the beta-Blocker Heart Attack Trial instrument, and an item from the RAND Medical Outcomes Study instrument. RESULTS: Women had significantly worse general life satisfaction, physical function, and social and general health scores than men. There were no significant differences found between gender groups for current life situation or emotional distress. After controlling for New York Heart Association classification, women still had significantly worse ratings for intermediate activities of daily living (a sub-dimension of physical functioning) and social activity. CONCLUSIONS: Despite controlling for age, EF, and New York Heart Association classification, women had worse QOL ratings than did men for intermediate activities of daily living and social activity. Research should focus on identifying why differences exist and developing measures to improve QOL, particularly physical functioning, in women with heart failure.

Synchronization of visual responses in the superior colliculus of awake cats.

Multi-unit responses to moving stimuli were recorded simultaneously from several sites in the superior colliculus of awake cats. Correlation analysis revealed that response synchronization was a prominent feature of visually evoked neural activity in both superficial and deep collicular layers. Responses at about half of the recordings separated by < or = 1 mm showed significant correlations. The synchronized responses oscillated in the gamma frequency range (30-70 Hz) which contrasts to conditions in anaesthetized cats where oscillations predominantly occurred in the alpha and beta frequency range (10-20 Hz). Response synchronization was most pronounced with coherent motion stimuli and broke down with incoherent stimuli. These results agree with previous findings on corticotectal synchronization and support the hypothesis that synchronization in the millisecond range serves to group collicular neurons into functionally coherent assemblies.

Cancer screening among Korean Americans.

PURPOSE: Cancer is a leading cause of death among Korean Americans (KAs), one of the most rapidly growing ethnic minority communities in the United States. An understanding about cancer screening practices among Koreans (Ks) living in Korea can be useful in designing culturally sensitive health promotion programs in the United States. The purpose of this study was to describe the cancer screening knowledge and behaviors of a sample of KAs in Los Angeles, California, compared with a similar sample of Ks in Korea. DESCRIPTION OF STUDY: This descriptive survey used a convenience sample of 140 KAs age 40 and older, living in Los Angeles, California, in 1998. A random sample of 149 Ks from Pusan, Korea, in 1995 to 1996 was used as a comparison group. KAs had lived in the United States for an average of 15 years. A Korean and English language 58-item self-administered questionnaire assessed knowledge of cancer screening tests and personal cancer screening practices. RESULTS: The findings demonstrate that both KAs and Ks had low participation in cancer screening. Breast cancer screening was significantly more likely among KA women than among Ks; screening rates for cervical cancer and gastrointestinal malignancies were not significantly different between the two groups. CLINICAL IMPLICATIONS: These data can be used to assist healthcare professionals in the development of educational tools and strategies for promoting cancer screening programs for KAs. The unique contribution of this study was the opportunity to compare findings from an immigrant Korean population with a similar population in the country of origin.

Tobacco-control attitudes, advocacy, and smoking behaviors of oncology nurses.

PURPOSE/OBJECTIVES: To describe oncology nurses' attitudes, smoking behaviors, and involvement in tobacco-control policy and legislation. DESIGN: Descriptive, cross-sectional survey. SAMPLE: Responses from 1,508 (38% return) of 4,000 randomly selected members of the Oncology Nursing Society (ONS). The typical respondent was female, age 44, a staff nurse, had practiced as an oncology nurse for 12 years, and was certified as an OCN. METHODS: A mailed survey with specific questions about smoking status and the importance of nursing involvement in healthcare policy and legislation for tobacco control. MAIN RESEARCH CONCEPTS: Attitudes about tobacco-control policies and legislation; sociodemographic, professional, and institutional variables; and tobacco use. FINDINGS: The majority (85%) of members stated that nursing involvement in tobacco-control healthcare policy and legislation was important. More than 90% of respondents supported prevention of youth access to tobacco and providing information about health effects of tobacco and cessation. Seven percent (n = 106) were current smokers. Significantly fewer smokers valued involvement in tobacco-control activities. Respondents with personal experience of tobacco-related illnesses were more likely to value involvement in advocacy activities. Educational programs to prevent tobacco use among youth and to help patients stop smoking received the most support (80%). IMPLICATIONS FOR NURSING PRACTICE: This sample of ONS members strongly supported involvement in tobacco-control policies and legislation. Smoking was associated with more negative attitudes about the importance of actively engaging in tobacco control. These oncology nurses recognized the need for additional educational programs to prevent tobacco initiation by youth.