Decision for reconstructive interventions of the upper limb in individuals with tetraplegia: the effect of treatment characteristics

Objective: To determine the effect of treatment characteristics on the\ud decision for reconstructive interventions for the upper extremities (UE) in\ud subjects with tetraplegia. - \ud Setting: Seven specialized spinal cord injury centres in the Netherlands. - \ud Method: Treatment characteristics for UE reconstructive interventions were\ud determined. Conjoint analysis (CA) was used to determine the contribution\ud and the relative importance of the treatment characteristics on the decision\ud for therapy. Therefore, a number of different treatment scenarios using these\ud characteristics were established. Different pairs of scenarios were presented\ud to subjects who were asked to choose the preferred scenario of each set. - \ud Results: forty nine subjects with tetraplegia with a stable C5, C6 or C7\ud lesion were selected. All treatment characteristics significantly influenced\ud the choice for treatment. Relative importance of treatment characteristics\ud were: intervention type (surgery or surgery with FES implant) 13%, number\ud of operations 15%, in patient rehabilitation period 22%, ambulant\ud rehabilitation period 9%, complication rate 15%, improvement of elbow\ud function 10%, improvement of hand function 15%. In deciding for therapy\ud 40% of the subjects focused on one characteristic. - \ud Conclusion: CA is applicable in Spinal Cord Injury medicine to study the\ud effect of health outcomes and non-health outcomes on the decision for\ud treatment. Non-health outcomes which relate to the intensity of treatment\ud are equally important or even more important than functional outcome in the\ud decision for reconstructive UE surgery in subjects with tetraplegia

Sex-Specific Differences in Shoaling Affect Parasite Transmission in Guppies

Background: Individuals have to trade-off the costs and benefits of group membership during shoaling behaviour. Shoaling can increase the risk of parasite transmission, but this cost has rarely been quantified experimentally. Guppies (Poecilia reticulata) are a model system for behavioural studies, and they are commonly infected by gyrodactylid parasites, notorious fish pathogens that are directly transmitted between guppy hosts. Methodology/Principal Findings:Parasite transmission in single sex shoals of male and female guppies were observed using an experimental infection of Gyrodactylus turnbulli. Parasite transmission was affected by sex-specific differences in host behaviour, and significantly more parasites were transmitted when fish had more frequent and more prolonged contact with each other. Females shoaled significantly more than males and had a four times higher risk to contract an infection. Conclusions/Significance: Intersexual differences in host behaviours such as shoaling are driven by differences in natural and sexual selection experienced by both sexes. Here we show that the potential benefits of an increased shoaling tendency are traded off against increased risks of contracting an infectious parasite in a group-living species

What cost components are relevant for economic evaluations of palliative care, and what approaches are used to measure these costs? A systematic review

BACKGROUND: It is important to understand the costs of palliative and end-of-life care in order to inform decisions regarding cost allocation. However, economic research in palliative care is very limited and little is known about the range and extent of the costs that are involved in palliative care provision. AIM: To undertake a systematic review of the health and social care literature to determine the range of financial costs related to a palliative care approach and explore approaches used to measure these costs. DESIGN: A systematic review of empirical literature with thematic synthesis. Study quality was evaluated using the Weight of Evidence Framework. DATA SOURCES: The databases CINAHL, Cochrane, PsycINFO and Medline were searched from 1995 to November 2015 for empirical studies which presented data on the financial costs associated with palliative care. RESULTS: A total of 38 papers met our inclusion criteria. Components of palliative care costs were incurred within four broad domains: hospital care, community or home-based care, hospice care and informal care. These costs could be considered from the economic viewpoint of three providers: state or government, insurers/third-party/not-for-profit organisations and patient and family and/or society. A wide variety of costing approaches were used to derive costs. CONCLUSION: The evidence base regarding the economics of palliative care is sparse, particularly relating to the full economic costs of palliative care. Our review provides a framework for considering these costs from a variety of economic viewpoints; however, further research is required to develop and refine methodologies

SUBTIPE HIV-1 DI BEBERAPA DAERAH DI INDONESIA DAN PERANNYA SEBAGAI PETUNJUK DINAMIKA EPIDEMI HIV

Subtipe HIV-1 dapat ditentukan dengan melakukan analisis sekuens nukleotida dari gen selubung luar HIV-1, dengan mengekstrak DNA proviral dari sampel pasien, dan memakainya dalam PCR khusus untuk envelope HIV-1. Kemudian ini di sekuens dan dianalisis dengan memakai rujukan sekuens dari bank gen LANL (Los Alamos National Library) untuk menentukan subtipe. Distribusi geografi subtipe HIV-1 bersifat dinamis. Sampai sekarang terdapat 9 subtipe HIV dan 34 circulating recombinant forms (CRFs). Penelitian terdahulu mendapatkan ada dua subtipe HIV-1 yang beredar di Indonesia, Subtipe B dan CRF01_AE. Dengan mengetahui subtipe HIV-1 dapat membantu penelusuran arah epidemi dan memberikan informasi untuk merencanakan pencegahan HIV demikian juga memberikan informasi yang diperlukan dalam pembuatan vaksin. Oleh karena itu sangat penting dilakukan penelitian mengenai subtipe HIV di Indonesia.Rancangan penelitian adalah cross-sectional analytic yang dilakukan di Klinik Pelayanan AIDS di Denpasar, Bali dan Panti Rehabilitasi Narkoba di Bogor, Jawa Barat. Responden adalah odha dewasa yang memenuhi kriteria inklusi (odha dewasa dan bersedia ikut dalam penelitian) dan responden dipilih secara non probability sampling sampai memenuhi jumlah sampel yang dibutuhkan. Dengan memakai rumus 16.4 Sastroasmoro S. and Ismael S. (2002), jumlah sampel minimal dihitung sebesar 65. Untuk hipotesis 1, melihat perbedaan Subtipe HIV-1 dengan cara transmisi virus, analisis data menggunakan uji statistik Chi-Square. Untuk hipotesis 2, membandingkan Subtipe HIV-1 dengan derajat penyakit, analisis data menggunakan uji statistik Fisher’s Exact test, sedangkan untuk analisis data epidemiologi kasus dikerjakan secara deskriptif. Hasil disajikan dalam bentuk tabel, gambar pohon phylogenetic dan narasi.Dari penelitian ini didapatkan empat jenis subtipe di Indonesia, yaitu Subtipe B, CRF01_AE, C dan G (A/G). Semua pengguna narkotika suntik (penasun) terinfeksi oleh Subtipe CRF01_AE, dan hubungan ini terbukti secara statistic bermakna (Chi-square test with continuity correction value 7,951 p = 0,005) (Tabel 5.3.1). Subtipe HIV-1 tidak berhubungan secara bermakna dengan derajat penyakit, akan tetapi terdapat kecenderungan CRF01_AE mempunyai lebih banyak kasus dengan derajat penyakit berat dibandingkan dengan NonCRF01_AE. Prevalensi kasus dengan performance yang terganggu pada CRF01_AE adalah 30,3% sedangkan pada Non CRF01_AE 14,3%. Perbedaan ini secara statistic tidak bermakna (Fisher’s-Exact test p = 0,3445 (Tabel 5.11). Dari analisis Phylogenetic didapatkan bahwa transmisi HIV pada populasi risiko tinggi di Indonesia bersifat dinamis, dan epidemi yang terjadi tidak terpisah diantara populasi dengan faktor risiko yang berbeda.Kesimpulan dari penelitian adalah: CRF01_AE merupakan subtipe yang paling banyak didapatkan dan tersebar disebagian besar wilayah. CRF01_AE didapatkan pada populasi penasun, heteroseksual, penjaja seks komersial dan pelanggannya. Karena prevalensi HIV pada penasun sangat tinggi, baik di Bali maupun daerah lainnya di Indonesia (50%), maka ada kemungkinan penasun merupakan episentrum epidemi HIV di Bali dan beberapa daerah di Indonesia, yang akan menyebar ke populasi umum melalui kelompok heteroseksual risiko tinggi yaitu PSK dan pelanggannya. Sedangkan Subtipe B, C dan G (AG) terdapat baik pada homoseks dan heteroseks, namun tidak ada penasun. Data tersebut didukung oleh gambaran pohon phylogenetic (Gambar 5.3). Pemakaian DBS dalam penelitian ini cukup praktis dan aman, walaupun keberhasilannya masih rendah (44,9%). Sekarang sudah ada kertas saring yang lebih baik dan sesuai untuk dipakai pada penelitian yang akan datang.Saran dari penelitian ini adalah, dalam program harm reduction bagi penasun hendaknya juga menekankan pemakaian kondom secara konsisten dengan pasangan seksualnya. Disamping itu disarankan perlunya melakukan pemeriksaan subtipe HIV secara periodik karena distribusi subtipe HIV bersifat dinamis.</p

Non-Fermi-liquid d-wave metal phase of strongly interacting electrons

Developing a theoretical framework for conducting electronic fluids qualitatively distinct from those described by Landau's Fermi-liquid theory is of central importance to many outstanding problems in condensed matter physics. One such problem is that, above the transition temperature and near optimal doping, high-transition-temperature copper-oxide superconductors exhibit `strange metal' behaviour that is inconsistent with being a traditional Landau Fermi liquid. Indeed, a microscopic theory of a strange-metal quantum phase could shed new light on the interesting low-temperature behaviour in the pseudogap regime and on the d-wave superconductor itself. Here we present a theory for a specific example of a strange metal---the 'd-wave metal'. Using variational wavefunctions, gauge theoretic arguments, and ultimately large-scale density matrix renormalization group calculations, we show that this remarkable quantum phase is the ground state of a reasonable microscopic Hamiltonian---the usual t-J model with electron kinetic energy $t$ and two-spin exchange $J$ supplemented with a frustrated electron `ring-exchange' term, which we here examine extensively on the square lattice two-leg ladder. These findings constitute an explicit theoretical example of a genuine non-Fermi-liquid metal existing as the ground state of a realistic model.Comment: 22 pages, 12 figures: 6 pages, 7 figures of main text + 16 pages, 5 figures of Supplementary Information; this is approximately the version published in Nature, minus various subedits in the main tex

In vivo tau pathology is associated with synaptic loss and altered synaptic function

BACKGROUND: The mechanism of synaptic loss in Alzheimer’s disease is poorly understood and may be associated with tau pathology. In this combined positron emission tomography (PET) and magnetoencephalography (MEG) study, we aimed to investigate spatial associations between regional tau pathology ([{18}^F]flortaucipir PET), synaptic density (synaptic vesicle 2A [11C]UCB-J PET) and synaptic function (MEG) in Alzheimer’s disease. METHODS: Seven amyloid-positive Alzheimer’s disease subjects from the Amsterdam Dementia Cohort underwent dynamic 130-minV [{18}^F]flortaucipir PET, dynamic 60-min [{11}^C]UCB-J PET with arterial sampling and 2 × 5-min resting-state MEG measurement. [{18^}F]flortaucipir- and [{11}^C]UCB-J-specific binding (binding potential, BPND) and MEG spectral measures (relative delta, theta and alpha power; broadband power; and peak frequency) were assessed in cortical brain regions of interest. Associations between regional [{18}^F]flortaucipir BPND, [{11}^C]UCB-J BP_{ND} and MEG spectral measures were assessed using Spearman correlations and generalized estimating equation models. RESULTS: Across subjects, higher regional [{18}^F]flortaucipir uptake was associated with lower [{11}^C]UCB-J uptake. Within subjects, the association between [{11}^C]UCB-J and [{18}^F]flortaucipir depended on within-subject neocortical tau load; negative associations were observed when neocortical tau load was high, gradually changing into opposite patterns with decreasing neocortical tau burden. Both higher [{18}^F]flortaucipir and lower [{11}^C]UCB-J uptake were associated with altered synaptic function, indicative of slowing of oscillatory activity, most pronounced in the occipital lobe. CONCLUSIONS: These results indicate that in Alzheimer’s disease, tau pathology is closely associated with reduced synaptic density and synaptic dysfunction

Exploring the Universe with Metal-Poor Stars

The early chemical evolution of the Galaxy and the Universe is vital to our understanding of a host of astrophysical phenomena. Since the most metal-poor Galactic stars (with metallicities down to [Fe/H]\sim-5.5) are relics from the high-redshift Universe, they probe the chemical and dynamical conditions of the Milky Way and the origin and evolution of the elements through nucleosynthesis. They also provide constraints on the nature of the first stars, their associated supernovae and initial mass function, and early star and galaxy formation. The Milky Way's dwarf satellites contain a large fraction (~30%) of the known most metal-poor stars that have chemical abundances that closely resemble those of equivalent halo stars. This suggests that chemical evolution may be universal, at least at early times, and that it is driven by massive, energetic SNe. Some of these surviving, ultra-faint systems may show the signature of just one such PopIII star; they may even be surviving first galaxies. Early analogs of the surviving dwarfs may thus have played an important role in the assembly of the old Galactic halo whose formation can now be studied with stellar chemistry. Following the cosmic evolution of small halos in simulations of structure formation enables tracing the cosmological origin of the most metal-poor stars in the halo and dwarf galaxies. Together with future observations and additional modeling, many of these issues, including the reionization history of the Milky Way, may be constrained this way. The chapter concludes with an outlook about upcoming observational challenges and ways forward is to use metal-poor stars to constrain theoretical studies.Comment: 34 pages, 11 figures. Book chapter to appear in "The First Galaxies - Theoretical Predictions and Observational Clues", 2012 by Springer, eds. V. Bromm, B. Mobasher, T. Wiklin

Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic diseases. International evidence suggests that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA

Adaptive remodeling of the bacterial proteome by specific ribosomal modification regulates Pseudomonas infection and niche colonisation

Post-transcriptional control of protein abundance is a highly important, underexplored regulatory process by which organisms respond to their environments. Here we describe an important and previously unidentified regulatory pathway involving the ribosomal modification protein RimK, its regulator proteins RimA and RimB, and the widespread bacterial second messenger cyclic-di-GMP (cdG). Disruption of rimK affects motility and surface attachment in pathogenic and commensal Pseudomonas species, with rimK deletion significantly compromising rhizosphere colonisation by the commensal soil bacterium P. fluorescens, and plant infection by the pathogens P. syringae and P. aeruginosa. RimK functions as an ATP-dependent glutamyl ligase, adding glutamate residues to the C-terminus of ribosomal protein RpsF and inducing specific effects on both ribosome protein complement and function. Deletion of rimK in P. fluorescens leads to markedly reduced levels of multiple ribosomal proteins, and also of the key translational regulator Hfq. In turn, reduced Hfq levels induce specific downstream proteomic changes, with significant increases in multiple ABC transporters, stress response proteins and non-ribosomal peptide synthetases seen for both ΔrimK and Δhfq mutants. The activity of RimK is itself controlled by interactions with RimA, RimB and cdG. We propose that control of RimK activity represents a novel regulatory mechanism that dynamically influences interactions between bacteria and their hosts; translating environmental pressures into dynamic ribosomal changes, and consequently to an adaptive remodeling of the bacterial proteome