Body Size of the Endosymbiotic Pea Crab Tumidotheres maculatus: Larger Hosts Hold Larger Crabs

The endosymbiotic pea crab, Tumidotheres maculatus, uses a broad range of host taxa, including several bivalve species, in the northern Gulf of Mexico. Because shelter size affects the size of other, free-living crab species, we hypothesized that pea crabs living in larger bivalve hosts should attain larger sizes. Crabs and hosts collected from 3 field sites in northern Florida show this trend. We examined crabs living in a large host, the pen shell Atrina rigida, and found them to be larger than pea crabs living in a small host, the bay scallop Argopecten irradians. Moreover, this trend was only apparent among female pea crabs, which are lifelong endosymbionts, but not among males, which are free-ranging and move among hosts. Our data support the broader conclusion that shelter size influences adult crab size in brachyuran crabs

A Team Project that Improves Student Engagement in Large Classes

Our university has grown dramatically over the past several years. Although there is much that is good about this growth, it has also generated growing pains. The increase in student enrollment has outpaced the addition of new faculty and classroom space, and this is reflected in the enrollment doubling in one of our department’s junior-level courses. We share an innovative team project assignment that has successfully improved the level of engagement of students in this large-class format. Readers will find a thoughtfully designed and thoroughly tested model for improving student engagement in their own large classes

Suspected Methicillin-resistant Staphylococcus aureus infections at sea

Background: Methicillin-resistant Staphylococcus aureues (MRSA) has been increasingly reported as the cause of community acquired skin infections in individuals without established risk factors. MRSA infections have been reported in multiple settings, but not yet in the commercial maritime industry. Objective: To evaluate the incidence of skin and soft tissue infections at sea over the past 5 years, and to see if there are trends in reported clinical features that suggest MRSA as the pathogen. Methods: A retrospective chart review was undertaken of all cases reported from 2002 until 2006 to a single tele-medical advice service for ships at sea. Since microbiologic diagnosis is not feasible at sea, cases were evaluated for the following features which may suggest MRSA: the presence of pus, small abscess or furuncle, or suspected spider bite. Results: From 2002 to 2006 the percentage of cases that were skin infections rose from 5.5 to 8.8%. In 2002, 36% had features consistent with MRSA infection and 74 % had them in 2006 (

Evaluating the effects of a multi-component support service for people recently diagnosed with dementia and their carers: A qualitative study

Abstract Introduction Although prior research has provided an understanding of the needs of people living with dementia (PLWD) and their carers, less is known about how tailored multicomponent interventions impact their lives. This study explored the effect of providing ongoing support to people who had been recently diagnosed with dementia and to their carers. Methods We conducted interviews with a convenience sample of key stakeholders: 11 interviews with people who had dementia and their familial carers (n = 14) and six interviews with staff and other practitioners involved with the service (n = 13). Inductive thematic analysis was performed on the data. Results Four themes were developed: the service as a source of respite, peer support, activities as facilitators of emotional wellbeing, and social support. The service was well‐respected, credible, and trusted and was highly valued by practitioners, clients, and carers. It had a clear role in supporting PLWD and their carers. Peer support provided through the service contributed to greatly reducing self‐reported carer burden. Conclusion Recommendations arising from this study include offering holistic services to PLWD and their carers, developing activities for men, raising awareness of services among practitioners working with PLWD, and improving partnerships between services and agencies working with older people. Patient or Public Contribution Service users were consulted on the themes generated from the data and were asked to provide feedback to help guide the interpretation of the data and ensure this reflected their views and experiences

Three patients with homozygous familial hypercholesterolemia: Genomic sequencing and kindred analysis.

BackgroundHomozygous Familial Hypercholesterolemia (HoFH) is an inherited recessive condition associated with extremely high levels of low-density lipoprotein (LDL) cholesterol in affected individuals. It is usually caused by homozygous or compound heterozygous functional mutations in the LDL receptor (LDLR). A number of mutations causing FH have been reported in literature and such genetic heterogeneity presents great challenges for disease diagnosis.ObjectiveWe aim to determine the likely genetic defects responsible for three cases of pediatric HoFH in two kindreds.MethodsWe applied whole exome sequencing (WES) on the two probands to determine the likely functional variants among candidate FH genes. We additionally applied 10x Genomics (10xG) Linked-Reads whole genome sequencing (WGS) on one of the kindreds to identify potentially deleterious structural variants (SVs) underlying HoFH. A PCR-based screening assay was also established to detect the LDLR structural variant in a cohort of 641 patients with elevated LDL.ResultsIn the Caucasian kindred, the FH homozygosity can be attributed to two compound heterozygous LDLR damaging variants, an exon 12 p.G592E missense mutation and a novel 3kb exon 1 deletion. By analyzing the 10xG phased data, we ascertained that this deletion allele was most likely to have originated from a Russian ancestor. In the Mexican kindred, the strikingly elevated LDL cholesterol level can be attributed to a homozygous frameshift LDLR variant p.E113fs.ConclusionsWhile the application of WES can provide a cost-effective way of identifying the genetic causes of FH, it often lacks sensitivity for detecting structural variants. Our finding of the LDLR exon 1 deletion highlights the broader utility of Linked-Read WGS in detecting SVs in the clinical setting, especially when HoFH patients remain undiagnosed after WES

Positive Surgical Margins in the 10 Most Common Solid Cancers.

A positive surgical margin (PSM) following cancer resection oftentimes necessitates adjuvant treatments and carries significant financial and prognostic implications. We sought to compare PSM rates for the ten most common solid cancers in the United States, and to assess trends over time. Over 10 million patients were identified in the National Cancer Data Base from 1998-2012, and 6.5 million had surgical margin data. PSM rates were compared between two time periods, 1998-2002 and 2008-2012. PSM was positively correlated with tumor category and grade. Ovarian and prostate cancers had the highest PSM prevalence in women and men, respectively. The highest PSM rates for cancers affecting both genders were seen for oral cavity tumors. PSM rates for breast cancer and lung and bronchus cancer in both men and women declined over the study period. PSM increases were seen for bladder, colon and rectum, and kidney and renal pelvis cancers. This large-scale analysis appraises the magnitude of PSM in the United States in order to focus future efforts on improving oncologic surgical care with the goal of optimizing value and improving patient outcomes

Using Cerebrospinal Fluid Biomarker Testing to Target Treatment to Patients with Mild Cognitive Impairment: A Cost-Effectiveness Analysis

Objective Cerebrospinal fluid (CSF) biomarkers are shown to facilitate a risk identification of patients with mild cognitive impairment (MCI) into different risk levels of progression to Alzheimer’s disease (AD). Knowing a patient’s risk level provides an opportunity for earlier interventions, which could result in potential greater benefits. We assessed the cost effectiveness of the use of CSF biomarkers in MCI patients where the treatment decision was based on patients’ risk level. Methods We developed a state-transition model to project lifetime quality-adjusted life-years (QALYs) and costs for a cohort of 65-year-old MCI patients from a US societal perspective. We compared four test-and-treat strategies where the decision to treat was based on a patient’s risk level (low, intermediate, high) of progressing to AD with two strategies without testing, one where no patients were treated during the MCI phase and in the other all patients were treated. We performed deterministic and probabilistic sensitivity analyses to evaluate parameter uncertainty. Results Testing and treating low-risk MCI patients was the most cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of US$37,700 per QALY. Our results were most sensitive to the level of treatment effectiveness for patients with mild AD and for MCI patients. Moreover, the ICERs for this strategy at the 2.5th and 97.5th percentiles were US$18,900 and US$50,100 per QALY, respectively. Conclusion Based on the best available evidence regarding the treatment effectiveness for MCI, this study suggests the potential value of performing CSF biomarker testing for early targeted treatments among MCI patients with a narrow range for the ICER

The ‘‘ICE’’ Study: Feasibility of Inexpensive Commercial Coolers on Mobile EMS Units

Introduction: Prehospital postresuscitation induced hypothermia (IH) has been shown to reduce neurological complications in comatose cardiac-arrest survivors. Retrofitting ambulances to include equipment appropriate to initiate hypothermia, such as refrigeration units for cooled saline, is expensive. The objective of this nonhuman subject research study was to determine if inexpensive, commercially available coolers could, in conjunction with five reusable ice packs, keep two 1 L bags of precooled 0.9% normal saline solution (NSS) at or below 48C for an average shift of eight to 12 hours in a real-world environment, on board in-service Emergency Medical Service (EMS) units, over varying weather conditions in all seasons. Methods: The coolers were chosen based on availability and affordability from two nationally available brands: The Igloo MaxxCold (Igloo Products Corp., Katy, Texas USA) and Coleman (The Coleman Company, Wichita, Kansas USA). Both are 8.5 liter (nine-quart) coolers that were chosen because they adequately held two 1 L bags of saline solution, along with the reusable ice packs designated in the study design, and were small enough for ease of placement on ambulances. Initial testing of the coolers was conducted in a controlled environment. Thereafter, each EMS unit was responsible to cool the saline to less than 48C prior to shift. Data were collected by emergency medical technicians, paramedics, and resident physicians working in seven different ambulance squads. Data analysis was performed using repeated measurements recorded over a 12-hour period from 19 individual coolers and were summarized by individual time points using descriptive statistics. Results: Initial testing determined that the coolers maintained temperatures of 48C for 12 hours in a controlled environment. On the ambulances, results based on the repeated measurements over time revealed that the saline solution samples as defined in the protocol, remained consistently below 48C for 12 hours. Utilizing the lower bound of the 2- sided 95% exact binomial confidence intervals, there was less than a five percent chance that saline samples could not be maintained below 48C for 12 hours, even during the summer months. Conclusions: Simple, commercially available coolers can maintain two 1 L bags of 0.9% NSS at 48C for 12 hours in ambulances in varying environmental conditions. This suggests that EMS agencies could inexpensively initiate prehospital IH in appropriate cases

Residual Impact of Previous Injury on Musculoskeletal Characteristics in Special Forces Operators

Background: Musculoskeletal injuries are a significant burden to United States Army Special Operations Forces. The advanced tactical skill level and physical training required of Army Special Operators highlights the need to optimize musculoskeletal characteristics to reduce the likelihood of suffering a recurrent injury. Purpose: To identify the residual impact of previous injury on musculoskeletal characteristics. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Isokinetic strength of the knee, shoulder, and back and flexibility of the shoulder and hamstrings were assessed as part of a comprehensive human performance protocol, and self-reported musculoskeletal injury history was obtained. Subjects were stratified based on previous history of low back, knee, or shoulder injury, and within-group and between-group comparisons were made for musculoskeletal variables. Results: Knee injury analysis showed no significant strength or flexibility differences. Shoulder injury analysis found internal rotation strength of the healthy subjects (H) was significantly higher compared with injured (I) and uninjured (U) limbs of the injured group (H, 60.8 ± 11.5 percent body weight [%BW]; I, 54.5 ± 10.5 %BW; U, 55.5 ± 11.3 %BW) (P = .014 [H vs I] and P = .05 [H vs U]). The external rotation/internal rotation strength ratio was significantly lower in the healthy subjects compared with injured and uninjured limbs of the injured group (H, 0.653 ± 0.122; I, 0.724 ± 0.121; U, 0.724 ± 0.124) (P = .026 [H vs I] and P = .018 [H vs U]). Posterior shoulder tightness was significantly different between the injured and uninjured limb of the injured group (I, 111.6° ± 9.4°; U, 114.4° ± 9.3°; P = .008). The back injury analysis found no significant strength differences between the healthy and injured groups. Conclusion: Few physical differences existed between operators with prior knee or back injury. However, operators with a previous history of shoulder injury demonstrated significantly less shoulder strength than uninjured operators as well as decreased shoulder flexibility on the injured side. All operators, regardless of prior injury, must perform the same tasks; therefore, a targeted injury rehabilitation/human performance training specifically focused on internal rotation strength and tightness of the posterior capsule may help reduce the risk for recurrence of injury. Operators presenting with musculoskeletal asymmetries and/or insufficient strength ratios may be predisposed to musculoskeletal injury. Clinical Relevance: Specific fitness programs to compensate for deficiencies in strength and flexibility need to be designed that may reduce the risk of injuries in Special Forces Operators

Hole dynamics in generalized spin backgrounds in infinite dimensions

We calculate the dynamical behaviour of a hole in various spin backgrounds in infinite dimensions, where it can be determined exactly. We consider hypercubic lattices with two different types of spin backgrounds. On one hand we study an ensemble of spin configurations with an arbitrary spin probability on each sublattice. This model corresponds to a thermal average over all spin configurations in the presence of staggered or uniform magnetic fields. On the other hand we consider a definite spin state characterized by the angle between the spins on different sublattices, i.e a classical spin system in an external magnetic field. When spin fluctuations are considered, this model describes the physics of unpaired particles in strong coupling superconductors.Comment: Accepted in Phys. Rev. B. 18 pages of text (1 fig. included) in Latex + 2 figures in uuencoded form containing the 2 postscripts (mailed separately