ESPRAS Survey on Continuing Education in Plastic, Reconstructive and Aesthetic Surgery in Europe

Background Specialty training in plastic, reconstructive and aesthetic surgery is a prerequisite for safe and effective provision of care. The aim of this study was to assess and portray similarities and differences in the continuing education and specialization in plastic surgery in Europe. Material and Methods A detailed questionnaire was designed and distributed utilizing an online survey administration software. Questions addressed core items regarding continuing education and specialization in plastic surgery in Europe. Participants were addressed directly via the European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). All participants had detailed knowledge of the organization and management of plastic surgical training in their respective country. Results The survey was completed by 29 participants from 23 European countries. During specialization, plastic surgeons in Europe are trained in advanced tissue transfer and repair and aesthetic principles in all parts of the human body and within several subspecialties. Moreover, rotations in intensive as well as emergency care are compulsory in most European countries. Board certification is only provided for surgeons who have had multiple years of training regulated by a national board, who provide evidence of individually performed operative procedures in several anatomical regions and subspecialties, and who pass a final oral and/or written examination. Conclusion Board certified plastic surgeons meet the highest degree of qualification, are trained in all parts of the body and in the management of complications. The standard of continuing education and qualification of European plastic surgeons is high, providing an excellent level of plastic surgical care throughout Europe

Deficient Signaling via Alk2 (Acvr1) Leads to Bicuspid Aortic Valve Development

Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly in humans. Despite recent advances, the molecular basis of BAV development is poorly understood. Previously it has been shown that mutations in the Notch1 gene lead to BAV and valve calcification both in human and mice, and mice deficient in Gata5 or its downstream target Nos3 have been shown to display BAVs. Here we show that tissue-specific deletion of the gene encoding Activin Receptor Type I (Alk2 or Acvr1) in the cushion mesenchyme results in formation of aortic valve defects including BAV. These defects are largely due to a failure of normal development of the embryonic aortic valve leaflet precursor cushions in the outflow tract resulting in either a fused right- and non-coronary leaflet, or the presence of only a very small, rudimentary non-coronary leaflet. The surviving adult mutant mice display aortic stenosis with high frequency and occasional aortic valve insufficiency. The thickened aortic valve leaflets in such animals do not show changes in Bmp signaling activity, while Map kinase pathways are activated. Although dysfunction correlated with some pro-osteogenic differences in gene expression, neither calcification nor inflammation were detected in aortic valves of Alk2 mutants with stenosis. We conclude that signaling via Alk2 is required for appropriate aortic valve development in utero, and that defects in this process lead to indirect secondary complications later in life

The My Active and Healthy Aging (My-AHA) ICT platform to detect and prevent frailty in older adults: Randomized control trial design and protocol

[EN] Introduction Frailty increases the risk of poor health outcomes, disability, hospitalization, and death in older adults and affects 7%¿12% of the aging population. Secondary impacts of frailty on psychological health and socialization are significant negative contributors to poor outcomes for frail older adults. Method The My Active and Healthy Aging (My-AHA) consortium has developed an information and communications technology¿based platform to support active and healthy aging through early detection of prefrailty and provision of individually tailored interventions, targeting multidomain risks for frailty across physical activity, cognitive activity, diet and nutrition, sleep, and psychosocial activities. Six hundred adults aged 60 years and older will be recruited to participate in a multinational, multisite 18-month randomized controlled trial to test the efficacy of the My-AHA platform to detect prefrailty and the efficacy of individually tailored interventions to prevent development of clinical frailty in this cohort. A total of 10 centers from Italy, Germany, Austria, Spain, United Kingdom, Belgium, Sweden, Japan, South Korea, and Australia will participate in the randomized controlled trial. Results Pilot testing (Alpha Wave) of the My-AHA platform and all ancillary systems has been completed with a small group of older adults in Europe with the full randomized controlled trial scheduled to commence in 2018. Discussion The My-AHA study will expand the understanding of antecedent risk factors for clinical frailty so as to deliver targeted interventions to adults with prefrailty. Through the use of an information and communications technology platform that can connect with multiple devices within the older adult's own home, the My-AHA platform is designed to measure an individual's risk factors for frailty across multiple domains and then deliver personalized domain-specific interventions to the individual. The My-AHA platform is technology-agnostic, enabling the integration of new devices and sensor platforms as they emerge.This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 689582 and the Australian National Health and Medical Research Council (NHRMC) European Union grant scheme (1115818). M.J.S. reports personal fees from Eli Lilly (Australia) Pty Ltd and grants from Novotech Pty Ltd, outside the submitted work. All other authors report nothing to disclose.Summers, MJ.; Rainero, I.; Vercelli, AE.; Aumayr, GA.; De Rosario Martínez, H.; Mönter, M.; Kawashima, R. (2018). The My Active and Healthy Aging (My-AHA) ICT platform to detect and prevent frailty in older adults: Randomized control trial design and protocol. Alzheimer's and Dementia: Translational Research and Clinical Interventions. 4:252-262. https://doi.org/10.1016/j.trci.2018.06.004S2522624Blair, S. N. (1995). Changes in Physical Fitness and All-Cause Mortality. JAMA, 273(14), 1093. doi:10.1001/jama.1995.03520380029031Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004). Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications for Improved Targeting and Care. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59(3), M255-M263. doi:10.1093/gerona/59.3.m255Gillick, M. (2001). Guest Editorial: Pinning Down Frailty. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M134-M135. doi:10.1093/gerona/56.3.m134Hamerman, D. (1999). Toward an Understanding of Frailty. Annals of Internal Medicine, 130(11), 945. doi:10.7326/0003-4819-130-11-199906010-00022Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., … McBurnie, M. A. (2001). Frailty in Older Adults: Evidence for a Phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146-M157. doi:10.1093/gerona/56.3.m146Panza, F., Solfrizzi, V., Barulli, M. R., Santamato, A., Seripa, D., Pilotto, A., & Logroscino, G. (2015). Cognitive Frailty: A Systematic Review of Epidemiological and Neurobiological Evidence of an Age-Related Clinical Condition. Rejuvenation Research, 18(5), 389-412. doi:10.1089/rej.2014.1637Soong, J., Poots, A., Scott, S., Donald, K., Woodcock, T., Lovett, D., & Bell, D. (2015). Quantifying the prevalence of frailty in English hospitals. BMJ Open, 5(10), e008456. doi:10.1136/bmjopen-2015-008456Varadhan, R., Walston, J., Cappola, A. R., Carlson, M. C., Wand, G. S., & Fried, L. P. (2008). Higher Levels and Blunted Diurnal Variation of Cortisol in Frail Older Women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63(2), 190-195. doi:10.1093/gerona/63.2.190BROWN, I., RENWICK, R., & RAPHAEL, D. (1995). Frailty. International Journal of Rehabilitation Research, 18(2), 93-102. doi:10.1097/00004356-199506000-00001Buchner, D. M., & Wagner, E. H. (1992). Preventing Frail Health. Clinics in Geriatric Medicine, 8(1), 1-18. doi:10.1016/s0749-0690(18)30494-4Kojima, G., Iliffe, S., Jivraj, S., & Walters, K. (2016). Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis. Journal of Epidemiology and Community Health, 70(7), 716-721. doi:10.1136/jech-2015-206717Ory, M. G., Schechtman, K. B., Miller, J. P., Hadley, E. C., Fiatarone, M. A., … Province, M. A. (1993). Frailty and Injuries in Later Life: The FICSIT Trials. Journal of the American Geriatrics Society, 41(3), 283-296. doi:10.1111/j.1532-5415.1993.tb06707.xShamliyan, T., Talley, K. M. C., Ramakrishnan, R., & Kane, R. L. (2013). Association of frailty with survival: A systematic literature review. Ageing Research Reviews, 12(2), 719-736. doi:10.1016/j.arr.2012.03.001Woodhouse, K. W., & O’Mahony, M. S. (1997). Frailty and ageing. Age and Ageing, 26(4), 245-246. doi:10.1093/ageing/26.4.245CAMPBELL, A. J., & BUCHNER, D. M. (1997). Unstable disability and the fluctuations of frailty. Age and Ageing, 26(4), 315-318. doi:10.1093/ageing/26.4.315Drey, M., Pfeifer, K., Sieber, C. C., & Bauer, J. M. (2011). The Fried Frailty Criteria as Inclusion Criteria for a Randomized Controlled Trial: Personal Experience and Literature Review. Gerontology, 57(1), 11-18. doi:10.1159/000313433Albert, M. S., DeKosky, S. T., Dickson, D., Dubois, B., Feldman, H. H., Fox, N. C., … Phelps, C. H. (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7(3), 270-279. doi:10.1016/j.jalz.2011.03.008Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G., & Kokmen, E. (1999). Mild Cognitive Impairment. Archives of Neurology, 56(3), 303. doi:10.1001/archneur.56.3.303Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L.-O., … Petersen, R. C. (2004). Mild cognitive impairment - beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256(3), 240-246. doi:10.1111/j.1365-2796.2004.01380.xDubois, B., Hampel, H., Feldman, H. H., Scheltens, P., Aisen, P., … Andrieu, S. (2016). Preclinical Alzheimer’s disease: Definition, natural history, and diagnostic criteria. Alzheimer’s & Dementia, 12(3), 292-323. doi:10.1016/j.jalz.2016.02.002Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gotzsche, P. C., Devereaux, P. J., … Altman, D. G. (2010). CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. BMJ, 340(mar23 1), c869-c869. doi:10.1136/bmj.c869Gray, L. C., Bernabei, R., Berg, K., Finne-Soveri, H., Fries, B. E., Hirdes, J. P., … Ariño-Blasco, S. (2008). Standardizing Assessment of Elderly People in Acute Care: The interRAI Acute Care Instrument. Journal of the American Geriatrics Society, 56(3), 536-541. doi:10.1111/j.1532-5415.2007.01590.xRadloff, L. S. (1977). The CES-D Scale. Applied Psychological Measurement, 1(3), 385-401. doi:10.1177/014662167700100306Guralnik, J. M., Simonsick, E. M., Ferrucci, L., Glynn, R. J., Berkman, L. F., Blazer, D. G., … Wallace, R. B. (1994). A Short Physical Performance Battery Assessing Lower Extremity Function: Association With Self-Reported Disability and Prediction of Mortality and Nursing Home Admission. Journal of Gerontology, 49(2), M85-M94. doi:10.1093/geronj/49.2.m85Powell, L. E., & Myers, A. M. (1995). The Activities-specific Balance Confidence (ABC) Scale. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 50A(1), M28-M34. doi:10.1093/gerona/50a.1.m28Kendzierski, D., & DeCarlo, K. J. (1991). Physical Activity Enjoyment Scale: Two Validation Studies. Journal of Sport and Exercise Psychology, 13(1), 50-64. doi:10.1123/jsep.13.1.50Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). «Mini-mental state». Journal of Psychiatric Research, 12(3), 189-198. doi:10.1016/0022-3956(75)90026-6Brandt, J. (1991). The hopkins verbal learning test: Development of a new memory test with six equivalent forms. Clinical Neuropsychologist, 5(2), 125-142. doi:10.1080/13854049108403297Lubben, J. E. (1988). Assessing social networks among elderly populations. Family & Community Health, 11(3), 42-52. doi:10.1097/00003727-198811000-00008Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472-480. doi:10.1037/0022-3514.39.3.472De Vries, O. J., Peeters, G. M. E. E., Lips, P., & Deeg, D. J. H. (2013). Does frailty predict increased risk of falls and fractures? A prospective population-based study. Osteoporosis International, 24(9), 2397-2403. doi:10.1007/s00198-013-2303-zTheou, O., Stathokostas, L., Roland, K. P., Jakobi, J. M., Patterson, C., Vandervoort, A. A., & Jones, G. R. (2011). The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review. Journal of Aging Research, 2011, 1-19. doi:10.4061/2011/569194Cadore, E. (2014). Strength and Endurance Training Prescription in Healthy and Frail Elderly. Aging and Disease, 5(3), 183. doi:10.14336/ad.2014.0500183Cadore, E. L., Rodríguez-Mañas, L., Sinclair, A., & Izquierdo, M. (2013). Effects of Different Exercise Interventions on Risk of Falls, Gait Ability, and Balance in Physically Frail Older Adults: A Systematic Review. Rejuvenation Research, 16(2), 105-114. doi:10.1089/rej.2012.1397Gardner, M. M. (2001). Practical implementation of an exercise-based falls prevention programme. Age and Ageing, 30(1), 77-83. doi:10.1093/ageing/30.1.77Eng, J. J. (2010). Fitness and Mobility Exercise Program for Stroke. Topics in Geriatric Rehabilitation, 26(4), 310-323. doi:10.1097/tgr.0b013e3181fee736Wadlinger, H. A., & Isaacowitz, D. M. (2008). Looking happy: The experimental manipulation of a positive visual attention bias. Emotion, 8(1), 121-126. doi:10.1037/1528-3542.8.1.121MacLeod, C. (2012). Cognitive bias modification procedures in the management of mental disorders. Current Opinion in Psychiatry, 25(2), 114-120. doi:10.1097/yco.0b013e32834fda4aMensink, R. P., & Katan, M. B. (1989). Effect of a Diet Enriched with Monounsaturated or Polyunsaturated Fatty Acids on Levels of Low-Density and High-Density Lipoprotein Cholesterol in Healthy Women and Men. New England Journal of Medicine, 321(7), 436-441. doi:10.1056/nejm19890817321070

The Prevalence and Psychopathological Correlates of Sibling Bullying in Children with and without Autism Spectrum Disorder

Using data from a prospective population based study, the prevalence and psychopathological correlates of sibling bullying in children with and without autism spectrum disorder (ASD) were estimated. There were 475 children with ASD and 13,702 children without ASD aged 11 years. Children with ASD were more likely to be bullied by their siblings compared to those without ASD. They were also more likely than those without ASD to both bully and be bullied by their siblings, which was associated with lower prosocial skills as well as more internalizing and externalizing problems compared to those not involved in any sibling bullying. Interventions to improve social and emotional outcomes in children with ASD should focus on both the affected and the unaffected sibling

Inferentialism as an alternative to socioconstructivism in mathematics education

The purpose of this article is to draw the attention of mathematics education researchers to a relatively new semantic theory called inferentialism, as developed by the philosopher Robert Brandom. Inferentialism is a semantic theory which explains concept formation in terms of the inferences individuals make in the context of an intersubjective practice of acknowledging, attributing, and challenging one another’s commitments. The article argues that inferentialism can help to overcome certain problems that have plagued the various forms of constructivism, and socioconstructivism in particular. Despite the range of socioconstructivist positions on offer, there is reason to think that versions of these problems will continue to haunt socioconstructivism. The problems are that socioconstructivists (i) have not come to a satisfactory resolution of the social-individual dichotomy, (ii) are still threatened by relativism, and (iii) have been vague in their characterization of what construction is. We first present these problems; then we introduce inferentialism, and finally we show how inferentialism can help to overcome the problems. We argue that inferentialism (i) contains a powerful conception of norms that can overcome the social-individual dichotomy, (ii) draws attention to the reality that constrains our inferences, and (iii) develops a clearer conception of learning in terms of the mastering of webs of reasons. Inferentialism therefore represents a powerful alternative theoretical framework to socioconstructivism

Protein disorder-order interplay to guide the growth of hierarchical mineralized structures

A major goal in materials science is to develop bioinspired functional materials based on the precise control of molecular building blocks across length scales. Here we report a protein-mediated mineralization process that takes advantage of disorder–order interplay using elastin-like recombinamers to program organic–inorganic interactions into hierarchically ordered mineralized structures. The materials comprise elongated apatite nanocrystals that are aligned and organized into microscopic prisms, which grow together into spherulite-like structures hundreds of micrometers in diameter that come together to fill macroscopic areas. The structures can be grown over large uneven surfaces and native tissues as acid-resistant membranes or coatings with tuneable hierarchy, stiffness, and hardness. Our study represents a potential strategy for complex materials design that may open opportunities for hard tissue repair and provide insights into the role of molecular disorder in human physiology and pathology

The Laegeren site: an augmented forest laboratory combining 3-D reconstruction and radiative transfer models for trait-based assessment of functional diversity

Given the increased pressure on forests and their diversity in the context of global change, new ways of monitoring diversity are needed. Remote sensing has the potential to inform essential biodiversity variables on the global scale, but validation of data and products, particularly in remote areas, is difficult. We show how radiative transfer (RT) models, parameterized with a detailed 3-D forest reconstruction based on laser scanning, can be used to upscale leaf-level information to canopy scale. The simulation approach is compared with actual remote sensing data, showing very good agreement in both the spectral and spatial domains. In addition, we compute a set of physiological and morphological traits from airborne imaging spectroscopy and laser scanning data and show how these traits can be used to estimate the functional richness of a forest at regional scale. The presented RT modeling framework has the potential to prototype and validate future spaceborne observation concepts aimed at informing variables of biodiversity, while the trait-based mapping of diversity could augment in situ networks of diversity, providing effective spatiotemporal gap filling for a comprehensive assessment of changes to diversity

Transforming growth factor-β and breast cancer: Tumor promoting effects of transforming growth factor-β

The transforming growth factor (TGF)-βs are potent growth inhibitors of normal epithelial cells. In established tumor cell systems, however, the preponderant experimental evidence suggests that TGF-βs can foster tumor-host interactions that indirectly support the viability and/or progression of cancer cells. The timing of this 'TGF-β switch' during the progressive transformation of epithelial cells is not clear. More recent evidence also suggests that autocrine TGF-β signaling is operative in some tumor cells, and can also contribute to tumor invasiveness and metastases independent of an effect on nontumor cells. The dissociation of antiproliferative and matrix associated effects of autocrine TGF-β signaling at a transcriptional level provides for a mechanism(s) by which cancer cells can selectively use this signaling pathway for tumor progression. Data in support of the cellular and molecular mechanisms by which TGF-β signaling can accelerate the natural history of tumors will be reviewed in this section