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Small area ecological studies are commonly used in epidemiology to assess the impact of area level risk factors on health outcomes when data are only available in an aggregated form. However, the resulting estimates are often biased due to unmeasured confounders, which typically are not available from the standard administrative registries used for these studies. Extra information on confounders can be provided through external data sets such as surveys or cohorts, where the data are available at the individual level rather than at the area level; however, such data typically lack the geographical coverage of administrative registries. We develop a framework of analysis which combines ecological and individual level data from different sources to provide an adjusted estimate of area level risk factors which is less biased. Our method (i) summarizes all available individual level confounders into an area level scalar variable, which we call ecological propensity score (EPS), (ii) implements a hierarchical structured approach to impute the values of EPS whenever they are missing, and (iii) includes the estimated and imputed EPS into the ecological regression linking the risk factors to the health outcome. Through a simulation study, we show that integrating individual level data into small area analyses via EPS is a promising method to reduce the bias intrinsic in ecological studies due to unmeasured confounders; we also apply the method to a real case study to evaluate the effect of air pollution on coronary heart disease hospital admissions in Greater London. [ABSTRACT FROM AUTHOR]

Many research studies aim to draw causal inferences using data from large, nationally representative survey samples, and many of these studies use propensity score matching to make those causal inferences as rigorous as possible given the non-experimental nature of the data. However, very few applied studies are careful about incorporating the survey design with the propensity score analysis, which may mean that the results do not generate population inferences. This may be because few methodological studies examine how to best combine these methods. Furthermore, even fewer of them investigate different non-response mechanisms. This study examines methods for handling survey weights in propensity score matching analyses of survey data under different non-response mechanisms. Our main conclusions are: (i) whether the survey weights are incorporated in the estimation of the propensity score does not impact estimation of the population treatment effect, as long as good population treated-comparison balance is achieved on confounders, (ii) survey weights must be used in the outcome analysis, and (iii) the transferring of survey weights (i.e., assigning the weights of the treated units to the comparison units matched to them) can be beneficial under certain non-response mechanisms. [ABSTRACT FROM AUTHOR]

Instrumental variable (IV) analysis is an increasingly popular tool for inferring the effect of an exposure on an outcome, as witnessed by the growing number of IV applications in epidemiology, for instance. The majority of IV analyses of time-to-event endpoints are, however, dominated by heuristic approaches. More rigorous proposals have either sidestepped the Cox model, or considered it within a restrictive context with dichotomous exposure and instrument, amongst other limitations. The aim of this article is to reconsider IV estimation under a structural Cox model, allowing for arbitrary exposure and instruments. We propose a novel class of estimators and derive their asymptotic properties. The methodology is illustrated using two real data applications, and using simulated data. [ABSTRACT FROM AUTHOR]

Autoimmune diseases are characterized by highly specific immune responses against molecules in self-tissues. Different autoimmune diseases are characterized by distinct immune responses, making autoantibodies useful for diagnosis and prediction. In many diseases, the targets of autoantibodies are incompletely defined. Although the technologies for autoantibody discovery have advanced dramatically over the past decade, each of these techniques generates hundreds of possibilities, which are onerous and expensive to validate. We set out to establish a method to greatly simplify autoantibody discovery, using a pre-filtering step to define subgroups with similar specificities based on migration of radiolabeled, immunoprecipitated proteins on sodium dodecyl sulfate (SDS) gels and autoradiography [Gel Electrophoresis and band detection on Autoradiograms (GEA)]. Human recognition of patterns is not optimal when the patterns are complex or scattered across many samples. Multiple sources of errors-including irrelevant intensity differences and warping of gels-have challenged automation of pattern discovery from autoradiograms.In this article, we address these limitations using a Bayesian hierarchical model with shrinkage priors for pattern alignment and spatial dewarping. The Bayesian model combines information from multiple gel sets and corrects spatial warping for coherent estimation of autoantibody signatures defined by presence or absence of a grid of landmark proteins. We show the pre-processing creates more clearly separated clusters and improves the accuracy of autoantibody subset detection via hierarchical clustering. Finally, we demonstrate the utility of the proposed methods with GEA data from scleroderma patients. [ABSTRACT FROM AUTHOR]

Numerous tectonic scenarios have been proposed for terrane growth and accretion within the Archean Dharwar Craton, southern Peninsular India. Previously accepted interpretations involving a two-terrane model—comprising a Western Dharwar Craton (WDC) and Eastern Dharwar Craton (EDC) block—have invoked west-dipping subduction and ocean closure, leading to arc magmatism and accretionary orogeny in the WDC, followed by metamorphic overprinting and collisional orogeny in the EDC. However, recent field investigations have revealed the existence of a previously unrecognized 'central' block (Central Dharwar Craton; CDC) within the craton, which requires revision of this model and reinterpretation of metamorphic and magmatic age data. Five samples of high-pressure, upper amphibolite- and granulite-facies meta-igneous and metasedimentary rocks from the southern portion of the Chitradurga Suture Zone, which divides the WDC and CDC, record minimum peak metamorphic conditions of ∼820–875°C at ∼10 kbar, indicating equilibration at the base of thickened continental crust. U–Pb zircon and Pb–Pb monazite geochronology indicates crystallization of parent mafic magmas at c. 2·61–2·51 Ga and subsequent regional metamorphism of these intrusions to garnet-amphibolite and garnet-granulite facies at c. 2·48–2·44 Ga, bracketing the timing of microblock accretion to the Archean–Proterozoic boundary. Light rare earth element enrichment within these zircon grains indicates magma generation in a suprasubduction-zone environment. In addition, detrital magmatic zircon grains with ages of c. 3·10–3·03 Ga and c. 2·97–2·86 Ga imply contamination of these magmas with Mesoarchean material sourced from the Western Dharwar Craton continental nucleus. Comparison of these metamorphic and magmatic age data with those recorded in the EDC shows that westward-directed subduction is implausible, and that all three terranes (the WDC, CDC, and EDC) must have accreted synchronously, driven by two separate eastward-dipping ocean–continent convergent plate margins. These data further support a recent abundance of observations from the geological record supporting the hypothesis that subduction-driven plate tectonics had initiated on Earth before c. 2·5 Ga, as opposed to a Neoproterozoic onset (c. 0·8–0·9 Ga) reported by numerous studies. [ABSTRACT FROM AUTHOR]

La transmission d'infections au cabinet du pédiatre est une source de préoccupation croissante. Le présent document traite des voies de transmission des infections et des principes de contrôle des infections actuellement en vigueur. La prévention englobe un aménagement du cabinet et des politiques administratives appropriés, le triage, les pratiques de soins habituelles pour tous les patients (p. ex. hygiène des mains; port de gants, de masques, d'un dispositif de protection oculaire et de blouses pour certaines interventions; nettoyage, désinfection et stérilisation des surfaces et de l'équipement, y compris les jouets; technique d'asepsie pour les interventions invasives), ainsi que les précautions additionnelles en cas d'infections particulières. Les membres du personnel doivent avoir reçu les vaccins nécessaires, et ceux qui sont atteints d'une infection doivent respecter les politiques de restriction au travail. [ABSTRACT FROM AUTHOR]

This statement provides guidance for health care providers to ensure the safe discharge of healthy term infants who are born in hospital and who are ≥37 weeks' gestational age. Hospital care for mothers and infants should be family-centred, with healthy mothers and infants remaining together and going home at the same time. The specific length of stay for newborn infants depends on the health of their mother, infant health and stability, the mother's ability to care for her infant, support at home, and access to follow-up care. Many mother–infant dyads are ready to go home 24 h after birth. Parent or guardian education and assessment of discharge readiness are important components of discharge planning. Each infant must have an appropriate discharge plan, including identification of the infant's primary health care provider and assessment by a health care provider 24 h to 72 h after discharge. [ABSTRACT FROM AUTHOR]

Aim Although socioeconomic background is known to impact on the incidence and progression of chronic kidney disease, its influence of on the presentation and outcome for acute kidney injury is not known and is the subject of this study. Design The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients >18 years of age between March 2015 and November 2017. Methods Socioeconomic classification of patients was derived from the Welsh Index Multiple Deprivation score (WIMD). Patients were grouped according to the WIMD score by their postcode, and the ranked data were categorized into percentiles and correlated with incidence and measures of AKI severity and outcome. Results Date was collected on a total of 57 654 patients. Increased deprivation was associated with higher AKI incidence rates, more episodes of AKI per patient and more severe AKI at presentation. In contrast 90-day mortality was highest in the most affluent areas. Mortality in affluent areas was driven by increased patient age. Corrected for age 90-day mortality was higher in areas of increased deprivation. Conclusion This study highlights that AKI incidence presentation and outcomes are adversely affected by social deprivation. Further studies are required to understand the extent to which these differences reflect patient related factors or regional differences in provision and access to care. [ABSTRACT FROM AUTHOR]

Background: A survivorship care plan (SCP), that is, individualized treatment summary and schedule of off-therapy surveillance, will be mandated by January 2019. It is unclear whether SCPs improve adherence to recommended follow-up care in the community. In this trial, we evaluated the impact of randomly assigning childhood cancer survivors to 1) SCPs to be taken to their primary care physician (PCP) to implement or 2) survivorship clinic (SC) on health care quality measures.Methods: Eligibility included cancer diagnosis younger than age 18 years (2000-2012), cancer free, one or more years off therapy, and no prior survivorship clinic attendance. At 12 months, the random assignment groups were compared (SCP+PCP vs SC) by intent-to-treat analysis with two-sided statistical tests in terms of patient adherence to guideline-recommended surveillance tests (eg, echocardiogram) and number of newly identified late complications of therapy.Results: From 2011 to 2013, 96 participants (46.9% female, mean age = 15.9 ± 6.1 years) were randomly assigned. Adherence to 14 evaluated guideline-recommended surveillance tests ranged from 0% to 46.9% in the SCP+PCP group (n = 47) and from 50.0% to 86.4% in the SC group (n = 47). Adherence to 10 tests was statistically significantly different between the groups (all P < .05). One mild new late complication was identified in the SCP+PCP group compared with 21 late complications, ranging from mild to severe, identified in 11 patients in the SC group (2.1% vs 23.4% of patients, respectively, P = .003).Conclusions: Our randomized trial suggests that empowering childhood cancer survivors with SCPs to be implemented by their PCPs is not sufficient to meet consensus follow-up recommendations. [ABSTRACT FROM AUTHOR]

The National Cancer Policy Forum of the National Academies of Sciences, Engineering and Medicine sponsored a workshop on July 24 and 25, 2017 on Long-Term Survivorship after Cancer Treatment. The workshop brought together diverse stakeholders (patients, advocates, academicians, clinicians, research funders, and policymakers) to review progress and ongoing challenges since the Institute of Medicine (IOM)'s seminal report on the subject of adult cancer survivors published in 2006. This commentary profiles the content of the meeting sessions and concludes with recommendations that stem from the workshop discussions. Although there has been progress over the past decade, many of the recommendations from the 2006 report have not been fully implemented. Obstacles related to the routine delivery of standardized physical and psychosocial care services to cancer survivors are substantial, with important gaps in care for patients and caregivers. Innovative care models for cancer survivors have emerged, and changes in accreditation requirements such as the Commission on Cancer's (CoC) requirement for survivorship care planning have put cancer survivorship on the radar. The Center for Medicare & Medicaid Innovation's Oncology Care Model (OCM), which requires psychosocial services and the creation of survivorship care plans for its beneficiary participants, has placed increased emphasis on this service. The OCM, in conjunction with the CoC requirement, is encouraging electronic health record vendors to incorporate survivorship care planning functionality into updated versions of their products. As new models of care emerge, coordination and communication among survivors and their clinicians will be required to implement patient- and community-centered strategies. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy after breast conservation has become the standard of care. Prior meta-analyses on effects of radiotherapy predated availability of gene expression profiling (GEP) to assess recurrence risk and/or did not include all relevant outcomes. This analysis used GEP information with pooled individual-level data to evaluate the impact of omitting radiotherapy on recurrence and mortality.Methods: We considered trials that evaluated or administered radiotherapy after lumpectomy in women with low-risk breast cancer. Women included had undergone lumpectomy and were treated with hormonal therapy for stage I, ER+ and/or PR+, HER2- breast cancer with Oncotype scores no greater than 18. Recurrence-free interval (RFI), type of RFI (locoregional or distant), and breast cancer-specific and overall survival were compared between no radiotherapy and radiotherapy using adjusted Cox models. All statistical tests were two-sided.Results: The final sample included 1778 women from seven trials. Omission of radiotherapy was associated with an overall adjusted hazard ratio of 2.59 (95% confidence interval [CI] = 1.38 to 4.89, P = .003) for RFI. There was a statistically significant increase in any first locoregional recurrence (P = .001), but not distant recurrence events (P = .90), or breast cancer-specific (P = .85) or overall survival (P = .61). Five-year RFI rate was high (93.5% for no radiotherapy vs 97.9% for radiotherapy; absolute reduction = 4.4%, 95% CI = 0.7% to 8.1%, P = .03). The effects of radiotherapy varied across subgroups, with lower RFI rates for those with Oncotype scores of less than 11 (vs 11-18), older (vs younger), and ER+/PR+ status (vs other).Conclusions: Omission of radiotherapy in hormone-sensitive patients with low recurrence risk may lead to a modest increase in locoregional recurrence event rates, but does not appear to increase the rate of distant recurrence or death. [ABSTRACT FROM AUTHOR]

Background: We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer.Methods: Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias.Results: Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status.Conclusions: There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations. [ABSTRACT FROM AUTHOR]

Buckwheat (Fagopyrum esculentum Moench) shows high tolerance to aluminum (Al) toxicity, but the molecular mechanisms underlying its high Al tolerance are poorly understood. Here, we functionally characterized two genes (FeSTAR1 and FeSTAR2), which encode a nucleotide-binding domain and a membrane domain, respectively, of a bacterial-type ATP-binding cassette (ABC) transporter. The expression of FeSTAR1 and FeSTAR2 was induced by Al in both roots and leaves with higher expression in the roots. Spatial and tissue-specific expression analysis showed that the Al-induced expression of these two genes was found in both the root tips and basal root regions with higher expression in the root outer cell layers. The expression was neither induced by other metals including Cd and La nor by low pH and phosphorus-deficiency. FeSTAR1 and FeSTAR2 were present in a single copy in the genome, but the Al-induced transcript copy number of FeSTAR1 and FeSTAR2 was much higher than their homologous genes in rice and Arabidopsis. FeSTAR1 and FeSTAR2 form a complex when co-expressed in onion epidermal cells. Introduction of FeSTAR1 and FeSTAR2 into Arabidopsis mutants atstar1 and als3 / atstar2, respectively, rescued the sensitivity of the mutants to Al. Taken together, our results indicate that FeSTAR1 and FeSTAR2 are involved in Al tolerance and that their high expression level may contribute to high Al tolerance in buckwheat. [ABSTRACT FROM AUTHOR]

The responses of pepper (Capsicum annuum) plants to inoculation with the pathogenic bacterium Ralstonia solanacearum and to high-temperature-high-humidity (HTHH) conditions were previously found to be coordinated by the transcription factors CaWRKY6 and CaWRKY40 ; however, the underlying molecular mechanism was unclear. Herein, we identified and functionally characterized CaHsfB2a, a nuclear-localized heat shock factor involved in pepper immunity to R. solanacearum inoculation (RSI) and tolerance to HTHH. CaHsfB2a is transcriptionally induced in pepper plants by RSI or HTHH and by exogenous application of salicylic acid (SA), methyl jasmonate (MeJA), ethylene (ETH), or abscisic acid (ABA). Virus-induced gene silencing (VIGS) of CaHsfB2a significantly impaired pepper immunity to RSI, hampered HTHH tolerance, and curtailed expression of immunity- and thermotolerance-associated marker genes such as CaHIR1, CaNPR1, CaABR1, and CaHSP24. Likewise, transient overexpression of CaHsfB2a in pepper leaves induced hypersensitive response (HR)-like cell death and H2O2 accumulation and upregulated the above-mentioned marker genes as well as CaWRKY6 and CaWRKY40. Chromatin immunoprecipitation (ChIP) and microscale thermophoresis (MST) analysis revealed that CaHsfB2a bound the promoters of both CaWRKY6 and CaWRKY40. In a parallel experiment, we determined by ChIP-PCR and MST that CaHsfB2a was regulated directly by CaWRKY40 but indirectly by CaWRKY6. Cumulatively, our results suggest that CaHsfB2a positively regulates plant immunity against RSI and tolerance to HTHH, via transcriptional cascades and positive feedback loops involving CaWRKY6 and CaWRKY40. [ABSTRACT FROM AUTHOR]

Uncertainty in the estimation of daytime ecosystem carbon cycling due to the light inhibition of leaf respiration and photorespiration, and how these small fluxes vary through the growing season in the field, remains a confounding element in calculations of gross primary productivity and ecosystem respiration. Our study focuses on how phenology, short-term temperature changes and canopy position influence leaf-level carbon exchange in Quercus rubra L. (red oak) at Harvard Forest in central Massachusetts, USA. Using leaf measurements and eddy covariance, we also quantify the effect of light inhibition on estimates of daytime respiration at leaf and ecosystem scales. Measured rates of leaf respiration in the light and dark were highest in the early growing season and declined in response to 10-day prior air temperatures (P < 0.01), evidence of within-season thermal acclimation. Leaf respiration was significantly inhibited by light (27.1 ± 2.82% inhibited across all measurements), and this inhibition varied with the month of measurement; greater inhibition was observed in mid-summer leaves compared with early- and late-season leaves. Increases in measurement temperature led to higher rates of respiration and photorespiration, though with a less pronounced positive effect on photosynthesis; as a result, carbon-use efficiency declined with increasing leaf temperature. Over the growing season when we account for seasonally variable light inhibition and basal respiration rates, our modeling approaches found a cumulative 12.9% reduction of leaf-level respiration and a 12.8% reduction of canopy leaf respiration, resulting in a 3.7% decrease in total ecosystem respiration compared with estimates that do not account for light inhibition in leaves. Our study sheds light on the environmental controls of the light inhibition of daytime leaf respiration and how integrating this phenomenon and other small fluxes can reduce uncertainty in current and future projections of terrestrial carbon cycling. [ABSTRACT FROM AUTHOR]

Background With >1.4 million cases in the United States reported to the Centers for Disease Control and Prevention in 2012, Chlamydia trachomatis infection is a major public health concern. We examined the impact of a C trachomatis vaccination program using a decision-analysis model to estimate the effects of vaccination on C trachomatis –associated costs and morbidity. Methods We developed a Markov model considering a cohort of 2158117 US females aged 9 to 26 years. Morbidity, death, and healthcare–associated costs associated with chlamydial infection of mothers and fetuses/neonates were calculated over a 17-year time frame. We developed 2 major comparison arms, namely, a C trachomatis vaccination program and no C trachomatis vaccination program. Base-case efficacy and coverage were set to those of human papillomavirus in the United States with all variables, including efficacy and coverage, ranged in sensitivity analyses. Results On the basis of a base-case analysis, a vaccination program would cost an estimated $710 million for a cohort of 2158117 women over a 17-year period, an increase of $41 million over having no vaccination program. A vaccination program would prevent 34000 cases of C trachomatis infection and 5976 cases of pelvic inflammatory disease. Conclusions A C trachomatis vaccination program results in increased cost to the healthcare system but averts significant morbidity and death. [ABSTRACT FROM AUTHOR]

Northern oceans are in a state of rapid transition. Still, our knowledge of the likely effects of climate change and ocean acidification on key species in the food web, functionally important habitats and the structure of Arctic and sub-Arctic ecosystems is limited and based mainly on short-term laboratory studies on single species. This review discusses how tropical and temperate natural analogues of carbonate chemistry drivers, such as CO2 vents, have been used to further our knowledge of the sensitivity of biological systems to predicted climate change, and thus assess the capacity of different species to show long-term acclimation and adaptation to elevated levels of p CO2. Natural analogues have also provided the means to scale-up from single-species responses to community and ecosystem level responses. However, to date the application of such approaches is limited in high latitude systems. A range of Arctic and sub-Arctic sites, including CO2 vents, methane cold seeps, estuaries, up-welling areas, and polar fronts, that encompass gradients of pH, carbonate saturation state, and alkalinity, are suggested for future high latitude, in-situ ocean acidification research. It is recommended that combinations of monitoring of the chemical oceanography, observational, and experimental (in situ and laboratory) studies of organisms around these natural analogues be used to attain better predictions of the impacts of ocean acidification and climate change on high latitude species and ecosystems. [ABSTRACT FROM AUTHOR]

Climate change drives fish and plankton species ranges toward the poles, often related to warmer waters mediating geographic distributions via changes in vital rates. Yet, the distribution of fish may also be governed by less acknowledged mechanisms. Ice limits access to air for physostomous fish filling their swimbladders at the surface. We hypothesize that release of ice constraints may facilitate northward expansion of physostomes, with implied impact on their zooplankton prey. On the other hand, even in a changing Arctic, the extreme high-latitude photoperiod will persist. The abundance of mesopelagic fish is low in the Arctic Ocean. Feeding conditions may be inferior during the darkness of winter and in light summer nights. If the photoperiod is constraining distributions, biogeographic boundaries of mesopelagic fish may be relatively unaffected by climate change. Alternatively, if low temperatures are their main constraint, we hypothesize that northward extensions in a warmer ocean may be detrimental to key Arctic copepods as we argue that their current success relates to low mortality during overwintering in the absence of mesopelagic fish. It is therefore essential to discriminate the role of the light climate at high latitudes from those related to temperatures for assessing future biogeographic boundaries. [ABSTRACT FROM AUTHOR]

The Arctic marine environment is rapidly changing with rising sea surface temperatures, declining sea ice habitat and projected increases in boreal species invasions. The success of resident Arctic fish will depend on both their thermal tolerance and their ability to cope with changing trophic interactions. Larval fish energetic condition is closely associated with mortality rates and therefore provides an indicator of overall well-being or fitness. In this study, we experimentally determined larval morphometric and lipid-based condition in an Arctic gadid (Arctic cod, Boreogadus saida) and a boreal gadid (walleye pollock, Gadus chalcogrammus) in response to different temperatures and food rations. Our results suggest that larval condition is highly sensitive to both factors but varies in a species- and ontogenetic-dependent manner. Results indicated that condition metrics based on length–weight relationships were not as sensitive as those based on lipid storage. Further, condition metrics changed with ontogeny and were best used within a developmental stage rather than across developmental stages. As expected, larval condition in first-feeding Arctic cod was higher at colder temperatures (2–5°C) than in the boreal gadid (5–12°C). However, at more developed larval stages the peak condition for Arctic cod was at warmer temperatures (7°C), while walleye pollock had the same thermal optimum as during earlier stages. Arctic cod were more sensitive to food ration at first feeding than walleye pollock, however; at later larval stages both species had a negative condition response to low food ration, especially at elevated temperatures (5 vs. 7°C). The lower thermal tolerance of Arctic cod, coupled with a higher sensitivity to food availability indicates that Arctic cod are particularly vulnerable to on-going environmental change. Arctic cod is a lipid-rich keystone species and therefore a reduction in their energetic condition during summer has the potential to affect the health of higher trophic levels throughout the Alaskan Arctic. [ABSTRACT FROM AUTHOR]

Arctic cod (Boreogadus saida) is an ecologically significant species that is uniquely adapted to occupy ice edges, but warming and loss of sea ice are hypothesized to favour more facultative gadids, such as walleye pollock (Gadus chalcogrammus). To test this hypothesis, we experimentally measured the growth and survival of Arctic cod and walleye pollock at two larval stages across a range of temperature and food conditions in the laboratory. Results indicated early and late-stage Arctic cod larvae have a competitive growth and survival advantage over walleye pollock at low temperatures. However, these advantages are lost under warmer, food-productive conditions where walleye pollock larvae survived and experienced accelerated growth rates. Growth models developed from this study emphasize the need to account for both species- and stage-specific differences in the thermal response of closely related marine fish larvae. More broadly, these new vital rate data provide a mechanistic framework to forecast spatial-temporal shifts of gadids at the Arctic-boreal interface resulting from climatic warming and altered productivity regimes. [ABSTRACT FROM AUTHOR]

Background In accordance with the policy actions that address childhood overweight and obesity at European level and as a contribution to the EU Action Plan on Childhood Obesity 2014–20, a Joint Action on Nutrition and Physical Activity (JANPA) was established. As part of JANPA work package 6, an evaluation framework to identify good practices, targeting childhood obesity prevention in kindergartens and schools, was developed. This article describes the WP 6 JANPA framework of good practice criteria and its development, compares it to other frameworks and discusses its potential for future use. Methods Based on the analysis of scientific literature, a set of 47 potential good practice criteria was drafted, that was then revised and complemented through a series of online Delphi consultations. Results A final list of 48 good practice criteria (9 of which were rated as core criteria) was developed and grouped into three categories: intervention characteristics (n = 17), implementation (n = 17) and monitoring and evaluation (n = 14). Conclusion The identified JANPA framework of good practice criteria complements the existing frameworks by focussing on kindergarten- and school-based initiatives and provides guidance for evaluators, programme planners and decision makers bearing in mind that a one-size-fits-all approach is inadequate. To ensure the effectiveness of future practices, programme planners should endeavour to meet at least the nine JANPA core criteria. [ABSTRACT FROM AUTHOR]

Background The current economic context calls for rationalizing health resources that can be pursued through disinvestment from low value health technologies to invest in the best performing ones, ensuring high healthcare quality. Oncology is a field where, because of high costs of health technologies and rapid innovation, disinvestment is crucial. Methods On this basis, the research team investigated through a survey, based on a questionnaire, opinions and views of representatives of European countries about disinvestment, in terms of fields of application, potential advocates and barriers, specifically focusing on cancer care. Results A total of 17 questionnaires were filled in (response rate: 32.1%). The survey showed disinvestment is applied in several countries as a tool for containing health care expenditures and identifying obsolete technologies/ineffective interventions. Clinicians' resistance to change and industries' opposition are recognized as the most important barriers to the implementation of disinvestment policies. Potential targets of disinvestment in cancer are seen in diagnostic and therapeutic areas. Conclusion Despite the agreement on fields of waste and of disinvestment policies, operational methods to put disinvestment in place are lacking. Since they should rely on an inclusive assessment of the technology, Health Technology Assessment may represent a good approach. [ABSTRACT FROM AUTHOR]

Background Schizophrenia is a chronic disease associated with significant and long-lasting effects on health, and it is also a social and financial burden, not only for patients but also for families, other caregivers, and the wider society. It is essential to conduct the assessment of indirect costs, to understand all the effects of the disease on society. Our aim is to gain a better understanding of the indirect costs of schizophrenia in Europe. Methods We conducted a comprehensive systematic literature review covering EMBASE, Medline, and PsycINFO as well as reviewing Health Technology Assessment databases from different countries. We used a qualitative research synthesis for presenting information, as most of the studies were methodologically diverse, a quantitative analysis would have been impractical. Results Indirect cost adjusted to inflation ranged vastly between studies included in the review from 119 Euros to 62, 034 Euros annually. The average proportion of indirect costs of total costs was 44%. Studies highlighted important cost drivers as age, gender, and disease severity, explaining the variation in costs between treatment and patient groups. Conclusions Regardless of the methodological heterogeneity of the reviewed studies, there was an agreement about the significance of indirect costs of schizophrenia on the society. Considering the relatively high prevalence of schizophrenia in Europe, a need for more cost of illness studies especially from Central Eastern and Southern Europe is suggested. [ABSTRACT FROM AUTHOR]

Background There is still significant uncertainty as to whether market competition raises or lowers clinical quality in publicly funded healthcare systems. We attempted to assess the effects of market competition on inpatient care quality of stroke patients in a retrospective study of the universal single-payer health insurance system in Taiwan. Methods In this 11-year population-based study, we conducted a pooled time-series cross-sectional analysis with a fixed-effects model and the Hausman test approach by utilizing two nationwide datasets: the National Health Insurance Research Database and the National Hospital and Services Survey in Taiwan. Patients who were admitted to a hospital for ischemic or hemorrhagic stroke were enrolled. After excluding patients with a previous history of stroke and those with different types of stroke, 247 379 ischemic and 79 741 hemorrhagic stroke patients were included in our analysis. Four outcome indicators were applied: the in-hospital mortality rate, 30-day post-operative complication rate, 14-day re-admission rate and 30-day re-admission rate. Results Market competition exerted a negative or negligible effect on the medical care quality of stroke patients. Compared to hospitals located in a highly competitive market, in-hospital mortality rates for hemorrhagic stroke patients were significantly lower in moderately (β = –0.05, P < 0.01) and less competitive markets (β = –0.05, P < 0.01). Conversely, the impact of market competition on the quality of care of ischemic stroke patients was insignificant. Conclusions Simply fostering market competition might not achieve the objective of improving the quality of health care. Other health policy actions need to be contemplated. [ABSTRACT FROM AUTHOR]

Background Socioeconomically disadvantaged children often have psychosocial problems. This study examined the mediating role of maternal depressive symptoms during pregnancy, infancy and early childhood in the association between maternal education, as indicator of socioeconomic status (SES), and child's psychosocial problems. Methods Included were 3410 children from the Amsterdam Born Children and their Development (ABCD) study. To assess the child's psychosocial problems at age 5–6 years, mothers and teachers completed the Strengths and Difficulties Questionnaire (SDQ). Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale and the Depressive Anxiety and Stress Scale 21. Mediation analysis was performed to calculate the direct effect of maternal education on SDQ score and indirect effects through maternal depressive symptoms. Results The mean mother-reported SDQ total score was significantly higher (P < 0.001) for children of low-educated mothers (6.74 ± 4.41) compared with children of highly educated mothers (4.47 ± 3.73). Levels of maternal depressive symptoms were also higher in low-educated mothers during pregnancy, infancy and early childhood. Maternal depressive symptoms explained 27.5% of the association between maternal education and mother-reported SDQ scores and 22.9% for combined mother/teacher SDQ scores. Maternal depressive symptoms during pregnancy had the strongest indirect effect. Conclusion Maternal depressive symptoms during pregnancy mediate the association between low maternal education and child's psychosocial problems. Early recognition and treatment of maternal depressive symptoms is important to prevent psychosocial problems in children, especially in those with low education. [ABSTRACT FROM AUTHOR]

Background Determinants of hypertension diagnosis and/or awareness and control among older adults are understudied in Albania, a former communist country in South Eastern Europe, which is experiencing rapid demographic, socioeconomic and epidemiological transition. This paper examines the association of individual, interpersonal, organizational and community factors with hypertension awareness and control among older adults in Tirana, the Albanian capital. Methods Using 2012 International Mobility in Aging Study data on older adults from Albania's capital city (n = 393) and the socioecological model as a conceptual framework, multinomial regression models identified factors associated with controlled, uncontrolled and undiagnosed hypertension. Results For hypertension, 17.3% participants had none, 23.4% were controlled, 48.4% were uncontrolled and 10.9% were undiagnosed/unaware. Compared to those with controlled hypertension, in multivariable models, a high level of friend support was negatively associated with uncontrolled (OR: 0.4; 95% CI: 0.2–0.9) and undiagnosed (OR: 0.2; 95% CI: 0.1–0.6) hypertension. A high level of perceived neighbourhood safety was negatively associated with uncontrolled (OR: 0.6; 95% CI: 0.3–1.0) and undiagnosed (OR: 0.4; 95% CI: 0.2–1.0) hypertension. Compared to those with no hypertension, children's social support was positively associated with uncontrolled (OR: 2.2; 95% CI: 1.1–4.3) and undiagnosed (OR: 3.6; 95% CI: 1.3–9.6) hypertension. Conclusion This study provides new insights about distinct risk factors for inadequate hypertension management in Albania. It highlights the importance of community-level factors (safety) and interpersonal factors (family and friend ties) to hypertension diagnosis/awareness and control, which may provide novel intervention opportunities for hypertension programs. [ABSTRACT FROM AUTHOR]

Aim The aim was to analyze (i) the prevalence of online unwanted sexual solicitation (USS) victimization, (ii) predictors of online USS and (iii) the associations between online USS and depressive symptoms in Swedish pupils in grades 7–9. Methods An electronic questionnaire was disseminated in 2011 in schools in a municipality in the northern part of Sweden. Total n = 1193 (boys n = 566; girls n = 627). Logistic regression models were fitted to test the cross-sectional associations between predictors of online USS and depressive symptoms, respectively. Results One third of girls and every fifth boy reported online USS victimization. In boys, predictors associated with online USS were offline bullying and sexual harassment victimization. Only offline sexual harassment victimization was associated with online USS in girls. Girls victimized by online USS had about twice the likelihood to report depressive symptoms compared to non-victimized girls. There were no associations between online USS and depressive symptoms in boys. While offline bullying was associated with depressive symptoms in both genders, offline sexual harassment victimization increased the likelihood to report depressive symptoms in girls only. Conclusions Online USS was common among Swedish youth, particularly among girls. Schools, parents and internet safety educators should look at co-occurrence of different forms of victimization as offline victimization was a predictor of online USS. Online USS was associated with depressive symptoms in girls and may hence be a factor driving gender inequity in mental health in youth. [ABSTRACT FROM AUTHOR]

Background Starting in 2008 recession affected many European countries and especially Greece. Previous studies have reported increases in low birth weight, preterm birth and stillbirth rates in Greece during early crisis. In our study we used data on births from 1980 to 2014 that allowed us to distinguish recent changes, which could possibly be attributed to the financial crisis, from long term trends, and controlled for maternal age and country of origin as potential confounders. Our study covered a longer period (up to 2014) than what has been studied before and looked separately at the effect of early and established crisis. Methods We used national vital statistics data from 1980 to 2014. We performed age standardization and calculated age standardized rates and standardized rate ratios (SRRs) for perinatal factors for three time periods (pre-crisis, early crisis and established crisis) for Greek and non-Greek women. Results We found an increase in low birth weight deliveries independent of maternal age and origin and an increased stillbirth rate in Greek women younger than 25 in early (RR = 1.42 95%CI: 1.12–1.80) and established crisis periods (RR = 1.36 95%CI: 1.07–1.72) compared with pre-crisis. Non-Greek women have also been affected, with their advantage regarding birth outcomes becoming less profound in the established crisis period (low birth weight: established crisis SRR = 0.84 95%CI: 0.82–0.87, pre-crisis SRR = 0.79 95% CI: 0.76– 0.81). Conclusions The financial crisis has possibly adversely affected perinatal factors in Greece. Our results highlight the need of appropriate public health interventions and family support policies, especially for younger people, unemployed and immigrants. [ABSTRACT FROM AUTHOR]

Background Three main explanations of the relationship between income and population health have been identified: the absolute, the contextual and the relative income hypotheses. The evidence about their relevance particularly in egalitarian societies is, however, inconsistent. This study aimed to test the three hypotheses in relation to psychological distress in northern Sweden. Methods Data come from the 2014 cross-sectional survey from the four northern-most counties in Sweden, and included people aged 25–84 years (n = 21 004). Psychological distress was measured by the General Health Questionnaire-12 and income information came from population registers. Absolute income was operationalized by individual disposable income, contextual income as the municipal-level Gini coefficient and relative income by the Yitzhaki index. Prevalence ratios (PR) were calculated from log-binomial regression analyses. Results A gradient in poor mental health was observed across quintiles of individual income, with the poorest substantially more likely to report poor health compared with the highest quintile (PR = 1.56; 95% CI = 1.19, 2.04). Second, municipalities in the quintiles 2–3 of the Gini coefficient had a better mental health compared with those in the most equal municipalities. Third, a gradient in poor mental health across quintiles of relative deprivation was also found, with the most deprived quintile the most likely to report poor health (PR = 1.37; 95% CI = 1.06, 1.76). Conclusion This study suggests a strong, moderate and lack of support for the absolute, relative and contextual income effect hypotheses, respectively. Interventions targeting a reduction in the individual income gap may be necessary in order to reduce psychosocial distress differences in northern Sweden. [ABSTRACT FROM AUTHOR]

Circulating insulin-like growth factor-1 (IGF-1) is consistently associated with prostate cancer risk. IGF-1 binds to IGF-1 receptor (IGF1R) and insulin receptor (IR), activating cancer hallmark pathways. Experimental evidence suggests that TMPRSS2:ERG may interact with IGF/insulin signaling to influence progression. We investigated IGF1R and IR expression and its association with lethal prostate cancer among 769 men. Protein expression of IGF1R, IR and ERG (i.e. a surrogate of ERG fusion genes) were assayed by immunohistochemistry. Cox models estimated hazard ratios (HR) and 95% confidence intervals (CI) adjusted for clinical characteristics. Among patients, 29% had strong tumor IGF1R expression and 10% had strong IR expression. During a mean follow-up of 13.2 years through 2012, 80 men (11%) developed lethal disease. Tumors with strong IGF1R or IR expression showed increased cell proliferation, decreased apoptosis and a higher prevalence of ERG. In multivariable models, strong IGF1R was associated with a borderline increased risk of lethal prostate cancer (HR 1.7; 95% CI 0.9–3.1). The association appeared greater in ERG-positive tumors (HR 2.8; 95% CI 0.9–8.4) than in ERG-negative tumors (HR 1.3; 95% CI 0.6–3.0, p-heterogeneity 0.08). There was no association between IR and lethal prostate cancer (HR 0.8; 95% CI 0.4–1.9). These results suggest that tumor IGF1R expression may play a role in prostate cancer progression to a lethal phenotype and that ERG-positive tumors may be more sensitive to IGF signaling. These data may improve our understanding of IGF signaling in prostate cancer and suggest therapeutic options for disease subtypes. [ABSTRACT FROM AUTHOR]

Accumulating evidence suggests that long non-coding RNA (lncRNA) plays important roles in some malignant tumors. However, the mechanism underlying how lncRNA regulates hepatocellular carcinoma (HCC) process remains largely unknown. In this study, we explored the potential role of lncRNA 00607 as a novel tumor suppressor in HCC. In this study, we examined the regulation of lncRNA 00607 by the important inflammatory cytokine tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). We also determined the expression of LINC000607 in 159 HCC tumors and paired adjacent tissues. Effects of LINC000607 in HCC proliferation and apoptosis were examined in vitro in HCC cell lines and in vivo tumor xenografts. Furthermore, we also examine underlying mechanism by which lncRNA 00607 regulates NF-κB p65 and how LIN00607 exerts its tumor suppressor role in HCC. We found that lncRNA 00607 expression level is lower in HCC tumors compared with matched normal liver tissue, and its low expression predicts worse prognosis in HCC. Functionally, lncRNA 00607 overexpression leads to decreased HCC cell proliferation in vitro and in vivo, enhanced apoptosis and chemotherapeutic drug sensitivity. Mechanistically, lncRNA 00607 inhibits the p65 transcription by binding to the p65 promoter region, therefore contributing to increased p53 levels in HCC. Taken together, the findings of this study show that the TNF-α/IL-6-lncRNA 00607-NF-κB p65/p53 signaling axis represents a novel therapeutic avenue in cancer chemotherapy. [ABSTRACT FROM AUTHOR]

The dysregulation of micro RNAs (miRNAs) is a crucial characteristic of human cancers. Herein, we observed frequent amplification of the MIR191/425 locus in breast cancer, which is correlated with poor survival outcome. We demonstrated that the miR-191/425 cluster binds the 3′ untranslated region of the DICER1 transcript and posttranscriptionally represses DICER1 expression, thereby impairing global miRNAs biogenesis. Functionally, the forced expression of miR-191 or miR-425 stimulated the proliferation, survival, migration and invasion of breast cancer cells, whereas the inhibition of miR-191 or miR-425 suppressed these oncogenic behaviors of breast cancer cells, in a manner dependent on miR-191/425-mediated downregulation of DICER1. Furthermore, the miR-191/425 cluster promoted breast tumor growth, invasion and metastasis in vivo. The let-7 family of miRNAs was downregulated upon forced expression of miR-191 or miR-425, with a corresponding increase in the levels of let-7 target, high-mobility group AT-hook 2 (HMGA2). The forced expression of let-7 partially abrogated the miR-191/425-mediated oncogenic effects in breast cancer cells, suggestive of let-7 as a downstream effector of the miR-191/425–DICER1 axis. Collectively, we proposed that the inhibition of global miRNA processing, through miR-191/425-mediated downregulation of DICER1, promotes breast cancer progression. [ABSTRACT FROM AUTHOR]

Despite the promise of abundant renewable energy resources in the world, the poultry sector is still dominated by traditional energy sources. In this study, results of a field trial of an innovative and cost-effective HVAC system design applied to a poultry house have been presented. This system comprises of two integrated novel components; a polyethylene heat exchanger (PHE) based a photovoltaic thermal (PVt) array and an efficient and innovative ground pipe array coupled to a heat pump driven HVAC system. The analysis included the daily PV electrical output and heat pump performance. The results of the experimental study reveal that 3733 kWh and 2432 kWh heat energy have been supplied in the 7-week growth cycle of chickens condition, respectively. The COP of the HP has been calculated for the winter period and observed between 2.3 and 2.43. The PV system was able to generate 1876 kWh electrical energy with potential to meet HP's energy needs in the most energy needing period. [ABSTRACT FROM AUTHOR]

With the development of China's economy, the marine economy has been an important way of increasing national economic output value. However, the marine economy is still at the initial development stage. The theory and management of marine economy and resulting economic output value has not been able to satisfy the requirements of the overall economy. To increase the impact of the marine industry on the overall economic increase, the economic benefits in marine environment needs to be investigated and discussed. Using a Data Envelopment Analysis model, this study conducted data analysis for regional marine environments, noted relatively optimal aspects of marine economy based on the analysis results, analyzed an aspect of marine economy which is urgent to be improved, and suggests other solutions. Finally, the development prospects of marine economy were evaluated. This work aims at maximizing the economic output of marine environment and provides guidance for the development of marine economy. Some problems existing in the development of marine economy in coastal provinces were discovered, and suggestions, and counter measures were proposed to solve those problems. [ABSTRACT FROM AUTHOR]

The energy consumption and economic performance of the solar PV cooling system, the solar absorption cooling system and the conventional vapor compression cooling system located in Hefei, Chengdu and Haikou have been analyzed. The annual cost method is used to compare the economic performance of the three kinds of cooling systems. For the PV cooling system, 'full power to grid' PV grid-connected mode and 'self-generated, left power to grid' PV grid-connected mode are discussed. And for the solar absorption cooling system, the single-effect absorption chiller and the double-effect absorption chiller are both discussed. Meanwhile, the economic performances of three kinds of cooling systems are also analyzed when PV subsidies are ignored and energy prices are variable. The results indicate that the economic performance of the PV cooling system is better than that of the solar absorption cooling system and the conventional vapor compression cooling system. Furthermore, even when PV subsidies are ignored or the energy prices change a lot, the economic performance of PV cooling is better than that of solar absorption cooling and conventional vapor compression cooling. [ABSTRACT FROM AUTHOR]

Microencapsulated phase change materials (MEPCMs) have been recognized as potential energy storage materials for applications such as balancing of heating and cooling loads in buildings. However, current MEPCMs do suffer from low thermal conductivity and low mechanical strength thus limiting their full potential. Past investigations have shown that nanomaterials could be used as a surfactant for the preparation of O/W emulsion and for thermal enhancement in encapsulation processes of phase change materials. For that reason nanosilicon dioxide hydrosol was selected as a surfactant for the encapsulation of samples of n -octadecane due to its excellent thermal stability and good combination properties with both organic and inorganic phase change materials. To this end, the focus of the study was on the synthesis and characterization of the fabricated MEPCM samples. Analysis of the results did show good particle dispersion and shell integrity with the best fabricated sample (MF-2) achieving a significant increase in thermal stability temperature by approximately 78°C (i.e. from 133°C to 211°C) and also higher core material content ranging from 8% to 25% in comparison with other samples. However, there was a reduction of about 17% in the energy storage capacity and a slight reduction of 0.57°C in its melting temperature when compared with the original sample of n -octadecane. The results also revealed that the nucleating agent (ammonium chloride) did affect the morphology, particle size distribution and the content of the base materials. Further enhancement studies are therefore encouraged. [ABSTRACT FROM AUTHOR]

Due to environmental problems related to using fossil fuels and limitations in the sources of these types of fuels, renewable energies have sharply developed in recent decades. Renewable energy systems are applicable in various fields to provide clean energy. In the current study, medical and dental applications of renewable energies are reviewed. Based on the literature review, technologies based on renewable energy sources can be utilized in medical buildings and instruments. For instance, solar-based technologies can be applied in heating and cooling of hospitals and other healthcare facilities. In addition, the thermal energy of the sun is applicable in autoclaves and medical dryers. Although utilizing renewable energy systems for these applications requires more investment cost and probably more complicated structures, it would result in lower carbon dioxide emission which leads to sustainable development. [ABSTRACT FROM AUTHOR]

We constrain the oxygen fugacity (⁠ f O 2 ⁠) of strongly peraluminous granites [SPGs; i.e. granites (sensu lato) generated through the partial melting of sediments] across the Archean–Proterozoic boundary, which coincides roughly with the Great Oxygenation Event (GOE), to understand whether secular changes in atmospheric O2 levels may be imprinted on the f O 2 of igneous rocks. SPGs were chosen to maximize the potential effects of sediments in their sources on the f O 2 of the magmas. We studied 28 Archean (2685–2547 Ma) and 31 Meso- to Paleoproterozoic (1885–1420 Ma) geographically distributed samples from North America, spanning two cratons (Superior and Wyoming) and both orogenic and anorogenic Proterozoic provinces (Trans-Hudson Orogen, Wopmay Orogen, and SW USA). We present an analysis of both new and previously published whole-rock major and trace element data and mineral major element chemistry from the samples. All the studied samples are peraluminous high-silica plutonic rocks (all contain >67 wt % SiO2, and 92% are true granites with >69 wt % SiO2), and biotite + muscovite ± garnet ± tourmaline ± sillimanite are the primary aluminous minerals in all samples. Whole-rock major element and trace element abundances of all samples are consistent with derivation by partial melting of aluminous sediments. To constrain the f O 2 of crystallization of the SPGs, we developed an alphaMELTS-based method that takes advantage of the sensitivity of biotite FeT/(FeT + Mg) ratios to f O 2 ⁠. This method is able to reproduce experimental and empirical data where biotite compositions and whole-rock compositions, pressures and temperatures of crystallization and f O 2 are known. For the SPGs in this study, alphaMELTS modeling indicates that 68% of Proterozoic samples crystallized at an f O 2 between NNO –1 and NNO +1·1 (where NNO is nickel–nickel oxide buffer), whereas the remaining Proterozoic samples (32%) and most of the Archean samples (75%) crystallized at ≤NNO –2. The simplest explanation of these results is that the Proterozoic SPGs were derived from metasedimentary source rocks that on average had more oxidized bulk redox states relative to their Archean counterparts. The bulk redox state of the metasedimentary source rocks of SPGs of all ages is defined by the relative abundances of oxidized (e.g. Fe3+ and S6+) and reduced (e.g. organic matter) material. The crystallization of both Archean and Proterozoic samples at f O 2 values of ≤NNO –2 is consistent with them having their f O 2 buffered by graphite (formed from organic carbon) in their source regions. However, the dominantly low f O 2 (≤NNO –2) values of the Archean SPGs plausibly reflects the presence of organic material and relatively reduced metasedimentary rocks in their source region prior to the GOE. In contrast, the elevated f O 2 values of the majority of the Proterozoic SPGs may reflect enhanced sulfate contents or increased Fe3+/FeT in sediments after the GOE, which, in terms of the bulk redox state of their metasedimentary source region, would have offset the reducing nature of organic matter present there. [ABSTRACT FROM AUTHOR]

Aurelia aurita (Linneaus, 1758) is a cosmopolitan scyphozoan, probably the most investigated jellyfish in temperate and highly productive coastal ecosystems. Despite a prominent top-down control in plankton food webs, a mechanistic understanding of A. aurita population dynamics and trophic interactions has been barely addressed. Here we develop a food web dynamic model to assess A. aurita role in the seasonal plankton dynamics of the Kiel Fjord, southwestern Baltic Sea. The model couples low trophic level dynamics, based on a classical Nutrient Phytoplankton Zooplankton Detritus (NPZD) model, to a stage-resolved copepod model (referencing Pseudocalanus sp.) and a jellyfish model (A. aurita ephyra and medusa) as consumers and predators, respectively. Simulations showed the relevance of high abundances of A. aurita, which appear related with warm winter temperatures, promoting a shift from a copepod-dominated food web to a ciliate and medusa dominated one. The model captured the intraspecific competition triggered by the medusae abundance and characterized by a negative relationship between population density and individual size/weight. Our results provide a mechanistic understanding of an emergent trait such as size shaping the food web functioning, driving predation rates and population dynamics of A. aurita, driving its sexual reproductive strategy at the end of the pelagic phase. [ABSTRACT FROM AUTHOR]

Harmful bloom-forming algae include some of the most prolific microbial producers of extracellular reactive oxygen species (ROS). However, the taxonomic diversity of ROS production, the underlying physiological mechanisms and ecophysiological roles of ROS cycling are not completely characterized among phytoplankton taxa that form harmful algal blooms (HABs). This study examines the extracellular production of the ROS superoxide and hydrogen peroxide by five marine HAB species: Chattonella marina, Heterosigma akashiwo, Karenia brevis, Pseudo-nitzschia sp. and Aureococcus anophagefferens. All species produced extracellular superoxide and hydrogen peroxide. Rates of ROS production per cell spanned several orders of magnitude and varied inversely with cell density, suggesting a potential signaling role for extracellular ROS. ROS production was also detected in the spent media of all cultures except K. brevis, indicating the presence of cell-free ROS-generating constituents, such as enzymes or metabolites, which could be further investigated as molecular targets for tracking ROS production in laboratory and field settings. Finally, ratios of superoxide to hydrogen peroxide production could not be accounted for by superoxide dismutation alone, except in the case of K. brevis, indicating a diversity of ROS production and degradation pathways that may ultimately help illuminate the functions of HAB-derived ROS. [ABSTRACT FROM AUTHOR]

Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Three position statements have been developed by the Canadian Paediatric Society, following systematic literature reviews. Statement objectives are to: 1) Summarize the current clinical evidence regarding ADHD, 2) Establish a standard for ADHD care, and 3) Assist Canadian clinicians in making well-informed, evidence-based decisions to enhance care of children and youth with this condition. Specific topics reviewed in Part 3, which focuses on associated autism spectrum disorder, intellectual disability, and prematurity, include the challenges of diagnostic assessment, common presentations, the role of genetics, and treatment, including the benefits of physical activity. Recommendations are based on current guidelines, evidence from the literature, and expert consensus. [ABSTRACT FROM AUTHOR]

Background Tumor-associated macrophages (TAMs) are important determinants of intratumoral immune evasion, neoangiogenesis, extracellular matrix remodeling and dysregulated tumor cell proliferation. Our prior studies revealed that macrophage-derived, but not tumor cell-derived, macrophage migration inhibitory factor (MIF), is an important determinant of TAM alternative activation and M2 polarization. Aim Because MIF is historically thought to initiate signaling via a receptor-dependent, outside-in mode of action, we wished to investigate the specific contributions of tumor-derived vs. macrophage-derived MIF to M2 marker expression during macrophage polarization. Design Murine oral squamous cell-carcinoma cells (SCCVII) were co-cultured with either the RAW 264.7 mouse macrophage cell line or mouse primary bone marrow-derived macrophages in the context of MIF genetic loss/inhibition individually or in combination each cell type. Methods Twelve well Transwell plates were used to co-culture SCCVII cells and RAW 264.7, MIF+/+or MIF−/−macrophages treated with/without the small molecule MIF inhibitor, 4-iodo-6-phenylpyrimidine and incubated in the presence or absence of interleukin (IL-4) for 48 h. Macrophages were analyzed by quantitative real-time polymerase chain reaction and/or immunoblotting for relative macrophage polarization marker expression. Results IL-4 treatment synergizes with SCCVII co-culture in inducing the expression of macrophage M2 markers and loss or inhibition of macrophage-derived MIF significantly reduces both IL-4 alone and IL-4/SCCVII co-culture-induced macrophage M2 marker expression. Conclusion These studies identify an important and dominant requirement for macrophage MIF in maximal Th2-cytokine and oral squamous carcinoma cell-induced macrophage polarization and M2 marker expression. [ABSTRACT FROM AUTHOR]

Background Although increasing frailty is predictive of increased mortality and length of stay for hospitalized older adults, this approach ignores health assets that individuals can utilize to recover following hospital admission. Aim To examine whether health assets mitigate the effect of frailty on outcomes for older adults admitted to hospital. Design Patients of 1418 aged ≥ 70 years admitted to 11 hospitals in Australia were evaluated at admission using the interRAI assessment system for Acute Care, which surveys a large number of domains, including cognition, communication, mood and behaviour, activities of daily living, continence, nutrition, skin condition, falls and medical diagnosis. Methods The data set was interrogated for potential health assets and a multiple logistic regression adjusted for frailty index, age and gender as covariates was performed for the outcomes mortality, length of stay, re-admission and new need for residential care. Results Inpatient mortality was 3% and 4.5% of patients died within 28 days of discharge. Median length of stay was 7 days (IQR 4–11). In multivariate analysis that includes frailty, being able to walk further [OR 0.08 (0.01–0.63)], ability to leave the house [OR 0.35 (0.17–0.74)] and living alone [OR 0.28 (0.10–0.79)] were protective against mortality. The presence of a support person was associated with a decreased length of stay [OR 0.14 (0.08–0.25)]. Conclusion The inclusion of health assets in predictive models can improve prognostication and highlights potential interventions to improve outcomes for hospitalized older adults. [ABSTRACT FROM AUTHOR]

Background Viper envenomation contributes to nearly 50% of snake-bite deaths in India, chiefly due to circulatory shock. The mechanisms leading to circulatory shock include bleeding, capillary leak syndrome (CLS) and myocardial depression. Pituitary-adrenal axis involvement in circulatory shock, though described, has not been fully elucidated. Aim To identify predictors of circulatory shock and mortality in viper envenomation and explore the role of pituitary-adrenal axis in circulatory shock. Design Prospective hospital-based observational study. Methods Once a syndromic diagnosis of viper envenomation was made, relevant clinical and laboratory data were collected. Serum cortisol was estimated in those with circulatory shock. Post-mortem examination of pituitary, kidneys and adrenals was performed. Adjusted odds-ratios were calculated for respective risk-factors for shock and mortality using multivariable logistic regression with backward elimination strategy. Results Of 248 patients of viper envenomation treated at our hospital, circulatory shock was present in 19% and in-hospital mortality was 23%. CLS, circulatory shock, bleeding and requirement of > 20 vials of antivenom predicted mortality. Ischaemic and haemorrhagic necrosis of pituitary or adrenals was present in 51% of post-mortem specimens. Disseminated intravascular coagulation (DIC) and CLS were strong predictors of pituitary haemorrhage. Conclusion Predictors of mortality - bleeding, CLS and requirement of high antivenom doses are warning signs which can alert clinicians to patients who may have poor outcomes. Our study points to a definite role of pituitary-adrenal axis in circulatory shock supports the hypothesis that pituitary involvement in viper envenomation closely resembles Sheehan syndrome. The mechanism of pituitary involvement appears to be a result of increased susceptibility of the swollen gland secondary to CLS and micro thrombi deposition in DIC. [ABSTRACT FROM AUTHOR]

Background Chronic Q fever is accompanied by high mortality and morbidity, and requires prolonged antibiotic treatment. Little is known on long-term quality of life (LQOL) in chronic Q fever patients treated with antibiotics. Aim To identify patient and treatment-related factors associated with impaired LQOL in chronic Q fever patients treated with antibiotics, and to assess patients' perception on treatment. Design Cross-sectional study. Methods LQOL was assessed with a validated questionnaire from the Nijmegen Clinical Screening Instrument. Patients' perception on treatment was measured with three newly developed questions. Results We included 64 patients: LQOL was impaired in 55% (n = 35) after a median follow-up of 5 years. Median treatment duration was 27 months. In multivariable analysis, treatment duration was significantly associated with impaired LQOL (OR 1.07; 95%CI 1.02–1.12, P < 0.01 per month increase). Age, gender, number of antibiotic regimens, surgical intervention, complications, diagnostic classification, focus of infection or registration of side effects during treatment were not associated with impaired LQOL. After start of treatment, 17 patients (27%) perceived improvement of their condition. Disadvantages of treatment were experienced on a daily basis by 24 patients (69%) with impaired LQOL and 13 patients (46%) without impaired LQOL (P = 0.04). Conclusions LQOL in chronic Q fever patients treated with antibiotics is impaired in more than half of patients 5 years after diagnosis. Antibiotic treatment duration was the only variable associated with impaired LQOL. The majority of patients experienced disadvantages on a daily basis, highlighting the high burden of disease and treatment. [ABSTRACT FROM AUTHOR]

Non-structural carbohydrates (NSC) play a central role in plant functioning as energy carriers and building blocks for primary and secondary metabolism. Many studies have investigated how environmental and anthropogenic changes, like increasingly frequent and severe drought episodes, elevated CO2and atmospheric nitrogen (N) deposition, influence NSC concentrations in individual trees. However, this wealth of data has not been analyzed yet to identify general trends using a common statistical framework. A thorough understanding of tree responses to global change is required for making realistic predictions of vegetation dynamics. Here we compiled data from 57 experimental studies on 71 tree species and conducted a meta-analysis to evaluate general responses of stored soluble sugars, starch and total NSC (soluble sugars + starch) concentrations in different tree organs (foliage, above-ground wood and roots) to drought, elevated CO2and N deposition. We found that drought significantly decreased total NSC in roots (−17.3%), but not in foliage and above-ground woody tissues (bole, branch, stem and/or twig). Elevated CO2significantly increased total NSC in foliage (+26.2%) and roots (+12.8%), but not in above-ground wood. By contrast, total NSC significantly decreased in roots (−17.9%), increased in above-ground wood (+6.1%), but was unaffected in foliage from N fertilization. In addition, the response of NSC to three global change drivers was strongly affected by tree taxonomic type, leaf habit, tree age and treatment intensity. Our results pave the way for a better understanding of general tree function responses to drought, elevated CO2and N fertilization. The existing data also reveal that more long-term studies on mature trees that allow testing interactions between these factors are urgently needed to provide a basis for forecasting tree responses to environmental change at the global scale. [ABSTRACT FROM AUTHOR]

In the past three decades the European eel Anguilla anguilla experienced up to 99% decline in recruitment in some parts of its distribution range. In addition to this long-term trend, glass eel recruitment exhibits significant inter-annual variability partially explained by large-scale oceanographic processes as well as local-scale meteorological and hydrological variables. A 40-year long time series of glass eel fishery catch in the Minho estuary, Portugal, was used to assess (a) whether local recruitment followed the general pattern of decline of A. anguilla observed elsewhere, and (b) whether environmental variables may explain inter-annual fluctuations in glass eel recruitment in the Minho estuary. The analysis shows that, in contrast to the majority of coastal systems in northern Europe and the Mediterranean, CPUE of glass eel in the Minho estuary did not exhibit a marked decline between 1974–2015 and never dropped below 20% of the 10-year mean (1974–1983), taken as baseline. The difference between the recruitment trend observed in the Minho river and that reported by WGEEL for wider European geographical scales highlights the need to calculate recruitment indices with a higher geographic resolution to better support the assessment of the status of the European eel population. [ABSTRACT FROM AUTHOR]