Contrasting responses to catchment modification among a range of functional and structural indicators of river ecosystem health

1. The value of measuring ecosystem functions in regular monitoring programs is increasingly being recognised as a potent tool for assessing river health. We measured the response of ecosystem metabolism, organic matter decomposition and strength loss, and invertebrate community composition across a gradient of catchment impairment defined by upstream landuse stress in two New Zealand streams. This was performed to determine if there were consistent responses among contrasting functional and structural indicators. 2. Rates of gross primary production (GPP) and ecosystem respiration (ER) ranged from 0.1 to 7.0 gO2 m−2 day−1 and from 0.34 to 16.5 gO2 m−2 day−1 respectively. Rates of GPP were variable across the landuse stress gradient, whereas ER increased linearly with the highest rates at the most impacted sites. Production/respiration (P/R) and net ecosystem metabolism (NEM) indicated that sites at the low and high ends of the stress gradient were heterotrophic with respiration rates presumably relying on organic matter from upstream sources, adjacent land or point sources. Sites with moderate impairment were predominantly autotrophic. 3. Declines in the tensile strength of the cotton strips showed no response across part of the gradient, but a strong response among the most impaired sites. The rate of mass loss of wooden sticks (Betula platyphylla Sukaczev) changed from a linear response to a U-shaped response across the impairment gradient after water temperature compensation, whereas leaf breakdown at a subset of sites suggested a linear loss in mass per degree-day. Three macroinvertebrate metrics describing the composition of the invertebrate community and its sensitivity to pollution showed similar linear inverse responses to the landuse stress gradient. 4. The first axis of a redundancy analysis indicated an association between landuse stress and various measures of water quality, and wooden stick mass loss, the invertebrate metric % EPT [percentage of macroinvertebrate taxa belonging to the Ephemeroptera, Plecoptera and Trichoptera (excluding Hydroptilidae] taxa, P/R and NEM, supporting the utility of these structural and functional metrics for assessing degree of landuse stress. The second axis was more strongly associated with catchment size, ER and GPP which suggests that these indicators were responding to differences in stream size. 5. Our results suggest that nonlinear responses to catchment impairment need to be considered when interpreting measurements of ecosystem function. Functional indicators could be useful for detecting relatively subtle changes where the slope of the response curve is maximised and measurements at the low and high ends of the impairment gradient are roughly equivalent. Such responses may be particularly valuable for detecting early signs of degradation at high quality sites, allowing management responses to be initiated before the degradation becomes too advanced, or for detecting initial moves away from degraded states during the early stages of restoration. Close links between structural and functional indices of river health across an impairment gradient are not necessarily expected or desirable if the aim is to minimise redundancy among ecological indicators

Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the diagnosis of dementia within community dwelling populations

<b>Background</b><p></p> Various tools exist for initial assessment of possible dementia with no consensus on the optimal assessment method. Instruments that use collateral sources to assess change in cognitive function over time may have particular utility. The most commonly used informant dementia assessment is the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).<p></p> A synthesis of the available data regarding IQCODE accuracy will help inform cognitive assessment strategies for clinical practice, research and policy.<p></p> <b>Objectives</b><p></p> Our primary objective was to determine the diagnostic accuracy of the informant based questionnaire IQCODE, for detection of all cause (undifferentiated) dementia in community-dwelling adults with no previous cognitive assessment. We sought to describe the accuracy of IQCODE (the index test) against a clinical diagnosis of dementia (the reference standard).<p></p> Our secondary objective was to describe the effect of heterogeneity on the summary estimates. We were particularly interested in the traditional 26-item scale versus the 16-item short form; and language of administration. We explored the effect of varying the threshold IQCODE score used to define 'test positivity'.<p></p> <b>Search methods</b><p></p> We searched the following sources on 28 January 2013: ALOIS (Cochrane Dementia and Cognitive Improvement Group), MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), BIOSIS Previews (ISI Web of Knowledge), Web of Science with Conference Proceedings (ISI Web of Knowledge), LILACS (BIREME). We also searched sources relevant or specific to diagnostic test accuracy: MEDION (Universities of Maastrict and Leuven); DARE (York University); ARIF (Birmingham University). We used sensitive search terms based on MeSH terms and other controlled vocabulary.<p></p> <b>Selection criteria</b><p></p> We selected those studies performed in community settings that used (not necessarily exclusively) the IQCODE to assess for presence of dementia and, where dementia diagnosis was confirmed, with clinical assessment. Our intention with limiting the search to a 'community' setting was to include those studies closest to population level assessment. Within our predefined community inclusion criteria, there were relevant papers that fulfilled our definition of community dwelling but represented a selected population, for example stroke survivors. We included these studies but performed sensitivity analyses to assess the effects of these less representative populations on the summary results.<p></p> <b>Data collection and analysis</b><p></p> We screened all titles generated by the electronic database searches and abstracts of all potentially relevant studies were reviewed. Full papers were assessed for eligibility and data extracted by two independent assessors. For quality assessment (risk of bias and applicability) we used the QUADAS 2 tool. We included test accuracy data on the IQCODE used at predefined diagnostic thresholds. Where data allowed, we performed meta-analyses to calculate summary values of sensitivity and specificity with corresponding 95% confidence intervals (CIs). We pre-specified analyses to describe the effect of IQCODE format (traditional or short form) and language of administration for the IQCODE.<p></p> <b>Main results</b><p></p> From 16,144 citations, 71 papers described IQCODE test accuracy. We included 10 papers (11 independent datasets) representing data from 2644 individuals (n = 379 (14%) with dementia). Using IQCODE cut-offs commonly employed in clinical practice (3.3, 3.4, 3.5, 3.6) the sensitivity and specificity of IQCODE for diagnosis of dementia across the studies were generally above 75%.<p></p> Taking an IQCODE threshold of 3.3 (or closest available) the sensitivity was 0.80 (95% CI 0.75 to 0.85); specificity was 0.84 (95% CI 0.78 to 0.90); positive likelihood ratio was 5.2 (95% CI 3.7 to 7.5) and the negative likelihood ratio was 0.23 (95% CI 0.19 to 0.29).<p></p> Comparative analysis suggested no significant difference in the test accuracy of the 16 and 26-item IQCODE tests and no significant difference in test accuracy by language of administration. There was little difference in sensitivity across our predefined diagnostic cut-points.<p></p> There was substantial heterogeneity in the included studies. Sensitivity analyses removing potentially unrepresentative populations in these studies made little difference to the pooled data estimates. The majority of included papers had potential for bias, particularly around participant selection and sampling. The quality of reporting was suboptimal particularly regarding timing of assessments and descriptors of reproducibility and inter-observer variability.<p></p> <b>Authors' conclusions</b><p></p> Published data suggest that if using the IQCODE for community dwelling older adults, the 16 item IQCODE may be preferable to the traditional scale due to lesser test burden and no obvious difference in accuracy. Although IQCODE test accuracy is in a range that many would consider 'reasonable', in the context of community or population settings the use of the IQCODE alone would result in substantial misdiagnosis and false reassurance. Across the included studies there were issues with heterogeneity, several potential biases and suboptimal reporting quality

The Relationship of Continuum Scaling Scores and Certainty Scaling Scores on the Outdoor Situational Fear Inventory

This study examined the reliability and relationship of two methods of scaling the Outdoor Situational Fear Inventory-continuum scaling and the more easily scored certainty method of scaling. With either scaling method, the OSFI and its subscales were reliable as measured by Cronbach\u27s alpha. The relation­ships of the two instruments\u27 overall and subscale scores were strong

Curated Collections for Educators: Five Key Papers on Clinical Teaching

The ability to teach in the clinical setting is of paramount importance. Clinical teaching is at the heart of medical education, irrespective of the learner’s level of training. Learners desire and need effective, competent, and thoughtful clinical teaching from their instructors. However, many clinician-educators lack formal training on this important skill and thus may provide a variable experience to their learners. Although formal training of clinician-educators is standard and required in many other countries, the United States has yet to follow suit, leaving many faculty members to fend for themselves to learn these important skills. In September 2018, the Academic Life in Emergency Medicine (ALiEM) 2018-2019 Faculty Incubator program discussed the topic of clinical teaching techniques. We gathered the titles of papers that were cited, shared, and recommended within our online discussion forum and compiled the articles pertaining to the topic of clinical teaching techniques. To augment the list, the authors did a formal literature search using the search terms “teaching techniques", "clinical teaching", "medical education", "medical students", and "residents” on Google Scholar and PubMed. Finally, we posted a call for important papers on the topic of clinical teaching techniques on Twitter. Through this process, we identified 48 core articles on the topic of clinical teaching. We conducted a modified Delphi methodology to identify the key papers on the topic. In this paper, we present the five highest-rated articles based on the relevance to junior faculty and faculty developers. This article will review and summarize the articles we found to be the most impactful to improve one’s clinical teaching skills

How does iron interact with sporopollenin exine capsules? An X-ray absorption study including microfocus XANES and XRF imaging

Sporopollenin exine capsules (SECs) derived from plant spores and pollen grains have been proposed as adsorption, remediation and drug delivery agents. Despite many studies there is scant structural data available. This X-ray absorption investigation represents the first direct structural data on the interaction of metals with SECs and allows elucidation of their structure–property relationships. Fe K-edge XANES and EXAFS data have shown that the iron local environment in SECs (derived from Lycopodium clavatum) reacted with aqueous ferric chloride solutions is similar to that of ferrihydrite (FeOOH) and by implication ferritin. Fe Kα XRF micro-focus experiments show that there is a poor correlation between the iron distribution and the underlying SEC structure indicating that the SEC is coated in the FeOOH material. In contrast, the Fe Kα XRF micro-focus experiments on SECs reacted with aqueous ferrous chloride solutions show that there is a very high correlation between the iron distribution and the SEC structure, indicating a much more specific form of interaction of the iron with the SEC surface functional groups. Fe K-edge XANES and EXAFS data show that the FeII can be easily oxidised to give a structure similar to, but not identical to that in the FeIII case, and that even if anaerobic conditions are used there is still partial oxidation to FeIII

Auditory cueing in Parkinson's patients with freezing of gait. What matters most: action-relevance or cue-continuity?

Gait disturbances are a common feature of Parkinson’s disease, one of the most severe being freezing of gait. Sensory cueing is a common method used to facilitate stepping in people with Parkinson’s. Recent work has shown that, compared to walking to a metronome, Parkinson’s patients without freezing of gait (nFOG) showed reduced gait variability when imitating recorded sounds of footsteps made on gravel. However, it is not known if these benefits are realised through the continuity of the acoustic information or the action-relevance. Furthermore, no study has examined if these benefits extend to PD with freezing of gait. We prepared four different auditory cues (varying in action-relevance and acoustic continuity) and asked 19 Parkinson’s patients (10 nFOG, 9 with freezing of gait (FOG)) to step in place to each cue. Results showed a superiority of action-relevant cues (regardless of cue-continuity) for inducing reductions in Step coefficient of variation (CV). Acoustic continuity was associated with a significant reduction in Swing CV. Neither cue-continuity nor action-relevance was independently sufficient to increase the time spent stepping before freezing. However, combining both attributes in the same cue did yield significant improvements. This study demonstrates the potential of using action-sounds as sensory cues for Parkinson’s patients with freezing of gait. We suggest that the improvements shown might be considered audio-motor ‘priming’ (i.e., listening to the sounds of footsteps will engage sensorimotor circuitry relevant to the production of that same action, thus effectively bypassing the defective basal ganglia).This research was supported by a European Research Council grant (TEMPUS_G; 210007 StIG)

JNK activation is responsible for mucus overproduction in smoke inhalation injury

<p>Abstract</p> <p>Background</p> <p>Increased mucus secretion is one of the important characteristics of the response to smoke inhalation injuries. We hypothesized that gel-forming mucins may contribute to the increased mucus production in a smoke inhalation injury. We investigated the role of c-Jun N-terminal kinase (JNK) in modulating smoke-induced mucus secretion.</p> <p>Methods</p> <p>We intubated mice and exposed them to smoke from burning cotton for 15 min. Their lungs were then isolated 4 and 24 h after inhalation injury. Three groups of mice were subjected to the smoke inhalation injury: (1) wild-type (WT) mice, (2) mice lacking JNK1 (JNK1-/- mice), and (3) WT mice administered a JNK inhibitor. The JNK inhibitor (SP-600125) was injected into the mice 1 h after injury.</p> <p>Results</p> <p>Smoke exposure caused an increase in the production of mucus in the airway epithelium of the mice along with an increase in MUC5AC gene and protein expression, while the expression of MUC5B was not increased compared with control. We found increased MUC5AC protein expression in the airway epithelium of the WT mice groups both 4 and 24 h after smoke inhalation injury. However, overproduction of mucus and increased MUC5AC protein expression induced by smoke inhalation was suppressed in the JNK inhibitor-treated mice and the JNK1 knockout mice. Smoke exposure did not alter the expression of MUC1 and MUC4 proteins in all 3 groups compared with control.</p> <p>Conclusion</p> <p>An increase in epithelial MUC5AC protein expression is associated with the overproduction of mucus in smoke inhalation injury, and that its expression is related on JNK1 signaling.</p

Atelectasis Induced by Thoracotomy Causes Lung Injury during Mechanical Ventilation in Endotoxemic Rats

Atelectasis can impair arterial oxygenation and decrease lung compliance. However, the effects of atelectasis on endotoxemic lungs during ventilation have not been well studied. We hypothesized that ventilation at low volumes below functional residual capacity (FRC) would accentuate lung injury in lipopolysaccharide (LPS)-pretreated rats. LPS-pretreated rats were ventilated with room air at 85 breaths/min for 2 hr at a tidal volume of 10 mL/kg with or without thoracotomy. Positive end-expiratory pressure (PEEP) was applied to restore FRC in the thoracotomy group. While LPS or thoracotomy alone did not cause significant injury, the combination of endotoxemia and thoracotomy caused significant hypoxemia and hypercapnia. The injury was observed along with a marked accumulation of inflammatory cells in the interstitium of the lungs, predominantly comprising neutrophils and mononuclear cells. Immunohistochemistry showed increased inducible nitric oxide synthase (iNOS) expression in mononuclear cells accumulated in the interstitium in the injury group. Pretreatment with PEEP or an iNOS inhibitor (1400 W) attenuated hypoxemia, hypercapnia, and the accumulation of inflammatory cells in the lung. In conclusion, the data suggest that atelectasis induced by thoracotomy causes lung injury during mechanical ventilation in endotoxemic rats through iNOS expression

Acantholytic Anaplastic Extramammary Paget's Disease: A Case Report and Review of the Literature

Extramammary Paget's disease (EMPD) is an uncommon intraepithelial neoplasm that most commonly arises on the vulva and perianal region. Very few cases of EMPD revealing a histological Bowenoid appearance have been reported. This study describes scrotal EMPD presenting with histological features of Bowen's disease in a 79-year-old man. He presented with a 5-year history of a pruritic erythematous plaque and a verrucous papule on the scrotum. The verrucous papule histopathologically showed Bowenoid features, and the erythematous plaque demonstrated acantholytic EMPD. Immunohistochemical findings revealed strong expression for carcinoembryonic antigen, Cam 5.2, epithelial membrane antigen, cytokeratin (CK) 7, and pancytokeratin (AE1/AE3) in both areas, but negative CK20 staining, supporting the overall diagnosis of primary acantholytic anaplastic EMPD. This is the first reported case of acantholytic anaplastic EMPD in the Korean literature