How does study quality affect the results of a diagnostic meta-analysis?

Background: The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods: This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results: Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. Conclusion: Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited

Comparative Gene Expression Profiling of P. falciparum Malaria Parasites Exposed to Three Different Histone Deacetylase Inhibitors

Histone deacetylase (HDAC) inhibitors are being intensively pursued as potential new drugs for a range of diseases, including malaria. HDAC inhibitors are also important tools for the study of epigenetic mechanisms, transcriptional control, and other important cellular processes. In this study the effects of three structurally related antimalarial HDAC inhibitors on P. falciparum malaria parasite gene expression were compared. The three hydroxamate-based compounds, trichostatin A (TSA), suberoylanilide hydroxamic acid (SAHA; Vorinostat®) and a 2-aminosuberic acid derivative (2-ASA-9), all caused profound transcriptional effects, with ∼2–21% of genes having >2-fold altered expression following 2 h exposure to the compounds. Only two genes, alpha tubulin II and a hydrolase, were up-regulated by all three compounds after 2 h exposure in all biological replicates examined. The transcriptional changes observed after 2 h exposure to HDAC inhibitors were found to be largely transitory, with only 1–5% of genes being regulated after removing the compounds and culturing for a further 2 h. Despite some structural similarity, the three inhibitors caused quite diverse transcriptional effects, possibly reflecting subtle differences in mode of action or cellular distribution. This dataset represents an important contribution to our understanding of how HDAC inhibitors act on malaria parasites and identifies alpha tubulin II as a potential transcriptional marker of HDAC inhibition in malaria parasites that may be able to be exploited for future development of HDAC inhibitors as new antimalarial agents

Impact of pulmonary exposure to gold core silver nanoparticles of different size and capping agents on cardiovascular injury

Background:The uses of engineered nanomaterials have expanded in biomedical technology and consumer manufacturing. Furthermore, pulmonary exposure to various engineered nanomaterials has, likewise, demonstrated the ability to exacerbate cardiac ischemia reperfusion (I/R) injury. However, the influence of particle size or capping agent remains unclear. In an effort to address these influences we explored response to 2 different size gold core nanosilver particles (AgNP) with two different capping agents at 2 different time points. We hypothesized that a pulmonary exposure to AgNP induces cardiovascular toxicity influenced by inflammation and vascular dysfunction resulting in expansion of cardiac I/R Injury that is sensitive to particle size and the capping agent. Methods: Male Sprague–Dawley rats were exposed to 200 μg of 20 or 110 nm polyvinylprryolidone (PVP) or citrate capped AgNP. One and 7 days following intratracheal instillation serum was analyzed for concentrations of selected cytokines; cardiac I/R injury and isolated coronary artery and aorta segment were assessed for constrictor responses and endothelial dependent relaxation and endothelial independent nitric oxide dependent relaxation. Results: AgNP instillation resulted in modest increase in selected serum cytokines with elevations in IL-2, IL-18, and IL-6. Instillation resulted in a derangement of vascular responses to constrictors serotonin or phenylephrine, as well as endothelial dependent relaxations with acetylcholine or endothelial independent relaxations by sodium nitroprusside in a capping and size dependent manner. Exposure to both 20 and 110 nm AgNP resulted in exacerbation cardiac I/R injury 1 day following IT instillation independent of capping agent with 20 nm AgNP inducing marginally greater injury. Seven days following IT instillation the expansion of I/R injury persisted but the greatest injury was associated with exposure to 110 nm PVP capped AgNP resulted in nearly a two-fold larger infarct size compared to naïve. Conclusions: Exposure to AgNP may result in vascular dysfunction, a potentially maladaptive sensitization of the immune system to respond to a secondary insult (e.g., cardiac I/R) which may drive expansion of I/R injury at 1 and 7 days following IT instillation where the extent of injury could be correlated with capping agents and AgNP size.This work was supported by the National Institute of Environmental Health Sciences U19ES019525, U01ES020127, U19ES019544 and East Carolina Universit

Formation of Sclerotia and Production of Indoloterpenes by Aspergillus niger and Other Species in Section Nigri

Several species in Aspergillus section Nigri have been reported to produce sclerotia on well-known growth media, such as Czapek yeast autolysate (CYA) agar, with sclerotia considered to be an important prerequisite for sexual development. However Aspergillus niger sensu stricto has not been reported to produce sclerotia, and is thought to be a purely asexual organism. Here we report, for the first time, the production of sclerotia by certain strains of Aspergillus niger when grown on CYA agar with raisins, or on other fruits or on rice. Up to 11 apolar indoloterpenes of the aflavinine type were detected by liquid chromatography and diode array and mass spectrometric detection where sclerotia were formed, including 10,23-dihydro-24,25-dehydroaflavinine. Sclerotium induction can thus be a way of inducing the production of new secondary metabolites from previously silent gene clusters. Cultivation of other species of the black aspergilli showed that raisins induced sclerotium formation by A. brasiliensis, A. floridensis A. ibericus, A. luchuensis, A. neoniger, A. trinidadensis and A. saccharolyticus for the first time

Source and seed populations for relativistic electrons: Their roles in radiation belt changes

Strong enhancements of outer Van Allen belt electrons have been shown to have a clear dependence on solar wind speed and on the duration of southward interplanetary magnetic field. However, individual case study analyses also have demonstrated that many geomagnetic storms produce little in the way of outer belt enhancements and, in fact, may produce substantial losses of relativistic electrons. In this study, focused upon a key period in August-September 2014, we use GOES geostationary orbit electron flux data and Van Allen Probes particle and fields data to study the process of radiation belt electron acceleration. One particular interval, 13-22 September, initiated by a short-lived geomagnetic storm and characterized by a long period of primarily northward interplanetary magnetic field (IMF), showed strong depletion of relativistic electrons (including an unprecedented observation of long-lasting depletion at geostationary orbit) while an immediately preceding, and another immediately subsequent, storm showed strong radiation belt enhancement. We demonstrate with these data that two distinct electron populations resulting from magnetospheric substorm activity are crucial elements in the ultimate acceleration of highly relativistic electrons in the outer belt: the source population (tens of keV) that give rise to VLF wave growth and the seed population (hundreds of keV) that are, in turn, accelerated through VLF wave interactions to much higher energies. ULF waves may also play a role by either inhibiting or enhancing this process through radial diffusion effects. If any components of the inner magnetospheric accelerator happen to be absent, the relativistic radiation belt enhancement fails to materialize. Key Points Source/seed energy electrons required to produce MeV radiation belt energization Substorm injections lead to VLF wave growth, producing MeV acceleration ULF waves may enhance loss/acceleration due to increased outward/inward diffusio

Enhancing Students` Speaking Skill through Task-Based Language Teaching (TBLT) at English Tadris Department of STAIN Kerinci

This paper reports a classroom action research which conducted in an EFL classroom. The problem of this study is that teaching and learning process tends to be monotonous due to the single method used by English teachers. The learners` speaking course is familiarized with English structures. It requires a communicative and constructive method such as TBLT. The purpose of this study is to describe the effectiveness of TBLT in enhancing students` speaking skill. 30 EFL learners at the seventh semester at STAIN Kerinci took a part in this study. The instruments used to collect the data were speaking test, observation, and field-note. The results of the study showed that there were 2 cycles needed to implement the method. The process of teaching and learning in the first cycle indicates that TBLT improved learners` speaking skill, though some problems were needed to be solved. Unlike the cycle I, the process in the cycle II was improved in term of learners` speaking score and their motivation to attend the course if compared with those in cycle I. So, it is concluded that TBLT is an appropriate method to improve learners` speaking skill

Source and seed populations for relativistic electrons: Their roles in radiation belt changes

© 2015. American Geophysical Union. All Rights Reserved. Strong enhancements of outer Van Allen belt electrons have been shown to have a clear dependence on solar wind speed and on the duration of southward interplanetary magnetic field. However, individual case study analyses also have demonstrated that many geomagnetic storms produce little in the way of outer belt enhancements and, in fact, may produce substantial losses of relativistic electrons. In this study, focused upon a key period in August-September 2014, we use GOES geostationary orbit electron flux data and Van Allen Probes particle and fields data to study the process of radiation belt electron acceleration. One particular interval, 13-22 September, initiated by a short-lived geomagnetic storm and characterized by a long period of primarily northward interplanetary magnetic field (IMF), showed strong depletion of relativistic electrons (including an unprecedented observation of long-lasting depletion at geostationary orbit) while an immediately preceding, and another immediately subsequent, storm showed strong radiation belt enhancement. We demonstrate with these data that two distinct electron populations resulting from magnetospheric substorm activity are crucial elements in the ultimate acceleration of highly relativistic electrons in the outer belt: the source population (tens of keV) that give rise to VLF wave growth and the seed population (hundreds of keV) that are, in turn, accelerated through VLF wave interactions to much higher energies. ULF waves may also play a role by either inhibiting or enhancing this process through radial diffusion effects. If any components of the inner magnetospheric accelerator happen to be absent, the relativistic radiation belt enhancement fails to materialize

A good death – can the concept be applied to anatomy?

The importance of patient‐centered decisions is embedded throughout clinical practice. The principle that the patient is at the center of all decisions has helped form the contemporary approach to death and dying. The concept of a ‘good death’ will naturally mean different things to different individuals, but is based on the foundation of being pain free, comfortable and able to make informed decisions. Potential donors are faced with many personal, ethical and often spiritual considerations when they come to think about their wishes after death. One consideration is that of a ‘good death’. This article explores how the concept of a ‘good death’ may be applied to anatomy. Where first person consent is in place, the motivating factors frequently include the wish for others to learn from the donation, and this notion may form part of the ‘good death’ for the donor. Such motivations may impact positively on how students feel about dissecting and may provide comfort, assuaging feelings of discomfort and allowing students to focus on anatomical learning. For donors where second person consent is in place, the concept of a ‘good death’ must depend on whether the individual wanted to donate their body in the first instance. The notion of a ‘bad death’ may also be considered with body donation where no consent for donation is in place. This article proposes that there is ultimately a place for the concept that a ‘good death’ may involve an individual donating their body to medical education