ND-Track: Tractography utilising parametric models of white matter fibre orientation dispersion

This work develops a tractography algorithm to leverage fibre dispersion estimates derived from fitting parametric models of orientation dispersion to diffusion data. Tractography techniques are powerful tools to probe white matter (WM) connectivity non-invasively. Most current techniques follow a small number of discrete directions per voxel to identify WM connections. This approach addresses the limitation of traditional DTI-based tractography for regions with crossing fibres. However, it remains an oversimplification for regions with fanning and bending configurations, where the underlying fibre orientation distributions are continuous rather than discrete [2]. Following only a discrete set of directions in this case misrepresents the underlying anatomy and is likely to result in false negative connectivity estimates. Recent parameterized models of fibre dispersion represent such sub-voxel fibre architecture more realistically and provide more accurate estimates of dispersion than non-parametric techniques such as spherical deconvolution, which are vulnerable to noise [3]. Here, we present a new tractography algorithm, hereby referred to as ND-Track (Neurite Dispersion Tracking), that leverages directional information gathered from parametric models of dispersion. We investigate the advantages of tracking with dispersion measures on a simple phantom and in in-vivo data, tracking through the coronal radiata, a region known to exhibit a significant degree of fibre dispersion. We further demonstrate that this approach does not compromise the tracking of the WM pathways for which the standard technique works well

Carboxyhaemoglobin levels and their determinants in older British men

Background: Although there has been concern about the levels of carbon monoxide exposure, particularly among older people, little is known about COHb levels and their determinants in the general population. We examined these issues in a study of older British men.Methods: Cross-sectional study of 4252 men aged 60-79 years selected from one socially representative general practice in each of 24 British towns and who attended for examination between 1998 and 2000. Blood samples were measured for COHb and information on social, household and individual factors assessed by questionnaire. Analyses were based on 3603 men measured in or close to (< 10 miles) their place of residence.Results: The COHb distribution was positively skewed. Geometric mean COHb level was 0.46% and the median 0.50%; 9.2% of men had a COHb level of 2.5% or more and 0.1% of subjects had a level of 7.5% or more. Factors which were independently related to mean COHb level included season (highest in autumn and winter), region (highest in Northern England), gas cooking (slight increase) and central heating (slight decrease) and active smoking, the strongest determinant. Mean COHb levels were more than ten times greater in men smoking more than 20 cigarettes a day (3.29%) compared with non-smokers (0.32%); almost all subjects with COHb levels of 2.5% and above were smokers (93%). Pipe and cigar smoking was associated with more modest increases in COHb level. Passive cigarette smoking exposure had no independent association with COHb after adjustment for other factors. Active smoking accounted for 41% of variance in COHb level and all factors together for 47%.Conclusion: An appreciable proportion of men have COHb levels of 2.5% or more at which symptomatic effects may occur, though very high levels are uncommon. The results confirm that smoking (particularly cigarette smoking) is the dominant influence on COHb levels

Stage-Specific Inhibition of MHC Class I Presentation by the Epstein-Barr Virus BNLF2a Protein during Virus Lytic Cycle

gamma-herpesvirus Epstein-Barr virus (EBV) persists for life in infected individuals despite the presence of a strong immune response. During the lytic cycle of EBV many viral proteins are expressed, potentially allowing virally infected cells to be recognized and eliminated by CD8+ T cells. We have recently identified an immune evasion protein encoded by EBV, BNLF2a, which is expressed in early phase lytic replication and inhibits peptide- and ATP-binding functions of the transporter associated with antigen processing. Ectopic expression of BNLF2a causes decreased surface MHC class I expression and inhibits the presentation of indicator antigens to CD8+ T cells. Here we sought to examine the influence of BNLF2a when expressed naturally during EBV lytic replication. We generated a BNLF2a-deleted recombinant EBV (ΔBNLF2a) and compared the ability of ΔBNLF2a and wild-type EBV-transformed B cell lines to be recognized by CD8+ T cell clones specific for EBV-encoded immediate early, early and late lytic antigens. Epitopes derived from immediate early and early expressed proteins were better recognized when presented by ΔBNLF2a transformed cells compared to wild-type virus transformants. However, recognition of late antigens by CD8+ T cells remained equally poor when presented by both wild-type and ΔBNLF2a cell targets. Analysis of BNLF2a and target protein expression kinetics showed that although BNLF2a is expressed during early phase replication, it is expressed at a time when there is an upregulation of immediate early proteins and initiation of early protein synthesis. Interestingly, BNLF2a protein expression was found to be lost by late lytic cycle yet ΔBNLF2a-transformed cells in late stage replication downregulated surface MHC class I to a similar extent as wild-type EBV-transformed cells. These data show that BNLF2a-mediated expression is stage-specific, affecting presentation of immediate early and early proteins, and that other evasion mechanisms operate later in the lytic cycle

Severe childhood malaria syndromes defined by plasma proteome profiles

BACKGROUND Cerebral malaria (CM) and severe malarial anemia (SMA) are the most serious life-threatening clinical syndromes of Plasmodium falciparum infection in childhood. Therefore it is important to understand the pathology underlying the development of CM and SMA, as opposed to uncomplicated malaria (UM). Different host responses to infection are likely to be reflected in plasma proteome-patterns that associate with clinical status and therefore provide indicators of the pathogenesis of these syndromes. METHODS AND FINDINGS Plasma and comprehensive clinical data for discovery and validation cohorts were obtained as part of a prospective case-control study of severe childhood malaria at the main tertiary hospital of the city of Ibadan, an urban and densely populated holoendemic malaria area in Nigeria. A total of 946 children participated in this study. Plasma was subjected to high-throughput proteomic profiling. Statistical pattern-recognition methods were used to find proteome-patterns that defined disease groups. Plasma proteome-patterns accurately distinguished children with CM and with SMA from those with UM, and from healthy or severely ill malaria-negative children. CONCLUSIONS We report that an accurate definition of the major childhood malaria syndromes can be achieved using plasma proteome-patterns. Our proteomic data can be exploited to understand the pathogenesis of the different childhood severe malaria syndromes

Why do women not use antenatal services in low and middle income countries? A metasynthesis of qualitative studies

Background: Almost 50% of women in low & middle income countries (LMIC’s) don’t receive adequate antenatal care. Women’s views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the findings are not easily transferable. We aimed to inform the development of future antenatal care programmes through a synthesis of findings in all relevant qualitative studies. Methods and Findings: Using a pre-determined search strategy, we identified robust qualitative studies reporting on the views and experiences of women in LMIC’s who received inadequate antenatal care. We used meta-ethnographic techniques to generate themes and a line of argument synthesis. We derived policy relevant hypotheses from the findings. We included 21 papers representing the views of more than 1230 women from 15 countries. Three key themes were identified: ‘Pregnancy as socially risky and physiologically healthy’; ‘Resource use and survival in conditions of extreme poverty’and ‘Not getting it right first time’. The line of argument synthesis describes a dissonance between programme design and cultural contexts that may restrict access and discourage return visits. We hypothesize that centralized, risk-focused antenatal care programmes may be at odds with the resources, beliefs and experiences of pregnant women who underuse antenatal services. Conclusions: Our findings suggest that there may be a mis-alignment between current antenatal provision and the social and cultural context of some women in LMIC’s. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences are likely to be underused, especially when attendance generates increased personal risks of lost family resource or physical danger during travel; when the promised care is not delivered due to resource constraints; and when women experience covert or overt abuse in care settings

New tractography methods based on parametric models of white matter fibre dispersion

Diffusion weighted magnetic resonance imaging (DW-MRI) is a powerful imaging technique that can probe the complex structure of the body, revealing structural trends which exist at scales far below the voxel resolution. Tractography utilises the information derived from DW-MRI to examine the structure of white matter. Using information derived from DW-MRI, tractography can estimate connectivity between distinct, functional cortical and sub-cortical regions of grey matter. Understanding how seperate functional regions of the brain are connected as part of a network is key to understanding how the brain works. Tractography has been used to deliniate many known white matter structures and has also revealed structures not fully understood from anatomy due to limitations of histological examination. However, there still remain many shortcomings of tractography, many anatomical features for which tractography algorithms are known to fail, which leads to discrepancies between known anatomy and tractography results. With the aim of approaching a complete picture of the human connectome via tractography, we seek to address the shortcomings in current tractography techniques by exploiting new advances in modelling techniques used in DW-MRI, which provide more accurate representation of underlying white matter anatomy. This thesis introduces a methodology for fully utilising new tissue models in DWMRI to improve tractography. It is known from histology that there are regions of white matter where fibres disperse or curve rapidly at length scales below the DW-MRI voxel resolution. One area where dispersion is particularly prominent is the corona radiata. New DW-MRI models capture dispersion utilising specialised parametric probability distributions. We present novel tractography algorithms utilising these parametric models of dispersion in tractography to improve connectivity estimation in areas of dispersing fibres. We first present an algorithm utilising the the new parametric models of dispersion for tractography in a simple Bayesian framework. We then present an extension to this algorithm which introduces a framework to pool neighbourhood information from multiple voxels in the neighbournhood surrounding the tract in order to better estimate connectivity, introducing the new concept of the neighbourhood-informed orientation distribution function (NI-ODF). Specifically, using neighbourhood exploration we address the ambiguity arising in ’fanning polarity’. In regions of dispersing fibres, the antipodal symmetry inherent in DW-MRI makes it impossible to resolve the polarity of a dispersing fibre configuration from a local voxel-wise model in isolation, by pooling information from neighbouring voxels, we show that this issue can be addressed. We evaluate the newly proposed tractography methods using synthetic phantoms simulating canonical fibre configurations and validate the ability to effectively navigate regions of dispersing fibres and resolve fanning polarity. We then validate that the algorithms perform effectively in real in vivo data, using DW-MRI data from 5 healthy subjects. We show that by utilising models of dispersion, we recover a wider range of connectivity compared to other standard algorithms when tracking through an area of the brain known to have significant white fibre dispersion - the corona radiata. We then examine the impact of the new algorithm on global connectivity estimates in the brain. We find that whole brain connectivity networks derived using the new tractography method feature strong connectivity between frontal lobe regions. This is in contrast to networks derived using competing tractography methods which do not account for sub-voxel fibre dispersion. We also compare thalamo-cortical connectivity estimated using the newly proposed tractography method and compare with a compteing tractography method, finding that the recovered connectivity profiles are largely similar, with some differences in thalamo-cortical connections to regions of the frontal lobe. The results suggest that fibre dispersion is an important structural feature to model in the basis of a tractography algorithm, as it has a strong effect on connectivity estimation

Defending the genome from the enemy within:mechanisms of retrotransposon suppression in the mouse germline

The viability of any species requires that the genome is kept stable as it is transmitted from generation to generation by the germ cells. One of the challenges to transgenerational genome stability is the potential mutagenic activity of transposable genetic elements, particularly retrotransposons. There are many different types of retrotransposon in mammalian genomes, and these target different points in germline development to amplify and integrate into new genomic locations. Germ cells, and their pluripotent developmental precursors, have evolved a variety of genome defence mechanisms that suppress retrotransposon activity and maintain genome stability across the generations. Here, we review recent advances in understanding how retrotransposon activity is suppressed in the mammalian germline, how genes involved in germline genome defence mechanisms are regulated, and the consequences of mutating these genome defence genes for the developing germline

How to Escape Local Optima in Black Box Optimisation: When Non-elitism Outperforms Elitism

Escaping local optima is one of the major obstacles to function optimisation. Using the metaphor of a fitness landscape, local optima correspond to hills separated by fitness valleys that have to be overcome. We define a class of fitness valleys of tunable difficulty by considering their length, representing the Hamming path between the two optima and their depth, the drop in fitness. For this function class we present a runtime comparison between stochastic search algorithms using different search strategies. The ((Formula presented.)) EA is a simple and well-studied evolutionary algorithm that has to jump across the valley to a point of higher fitness because it does not accept worsening moves (elitism). In contrast, the Metropolis algorithm and the Strong Selection Weak Mutation (SSWM) algorithm, a famous process in population genetics, are both able to cross the fitness valley by accepting worsening moves. We show that the runtime of the ((Formula presented.)) EA depends critically on the length of the valley while the runtimes of the non-elitist algorithms depend crucially on the depth of the valley. Moreover, we show that both SSWM and Metropolis can also efficiently optimise a rugged function consisting of consecutive valleys

IMCI and ETAT Integration at a Primary Healthcare Facility in Malawi:A Human Factors Approach

Abstract Background Integrated Management of Childhood Illness (IMCI) and Emergency Triage, Assessment and Treatment (ETAT) are guidelines developed by the World Health Organization to reach targets for reducing under-5 mortality. They were set out in the Millennium Development Goals. Each guideline was established separately so the purpose of this study was to understand how these systems have been integrated in a primary care setting and identify barriers and facilitators to this integration using a systems approach. Method Interviews were carried out with members of staff of different levels within a primary healthcare clinic in Malawi. Along with observations from the clinic this provided a well-rounded view of the running of the clinic. This data was then analysed using the SEIPS 2.0 work systems framework. The work system elements specified in this model were used to identify and categorise themes that influenced the clinic’s efficiency. Results A process map of the flow of patients through the clinic was created, showing the tasks undertaken and the interactions between staff and patients. In their interviews, staff identified several organisational elements that served as barriers to the implementation of care. They included workload, available resources, ineffective time management, delegation of roles and adaptation of care. In terms of the external environment there was a lack of clarity over the two sets of guidelines and how they were to be integrated which was a key barrier to the process. Under the heading of tools and technology a lack of guideline copies was identified as a barrier. However, the health passport system and other forms of recording were highlighted as being important facilitators. Other issues highlighted were the lack of transport provided, challenges regarding teamwork and attitudes of members of staff, patient factors such as their beliefs and regard for the care and education provided by the clinic. Conclusions This study provides the first information on the challenges and issues involved in combining IMCI and ETAT and identified a number of barriers. These barriers included a lack of resources, staff training and heavy workload. This provided areas to work on in order to improve implementation