Recording problems and diagnoses in clinical care: developing guidance for healthcare professionals and system designers.

Funder: Professional Record Standards BodyFunder: Royal College of Physicians; FundRef: http://dx.doi.org/10.13039/501100000395BACKGROUND: Accurate recording of problems and diagnoses in health records is key to safe and effective patient care, yet it is often done poorly. Electronic health record systems vary in their functionality and ease of use, and are not optimally designed for easy recording and sharing of clinical information. There is a lack of professional consensus and guidance on how problems and diagnoses should be recorded. METHODS: The Professional Record Standards Body commissioned work led by the Royal College of Physicians Health Informatics Unit to carry out a literature review, draft guidance, carry out an online consultation and round table discussion, and produce a report including recommendations for systems. A patient workshop was held to explore patient preferences for mechanisms for sharing diagnosis information between primary and secondary care. RESULTS: Consensus was reached among medical specialties on key elements of diagnosis recording, and draft guidance was produced ready for piloting in a variety of care settings. Patients were keen for better ways for diagnosis information to be shared. DISCUSSION: Improving the recording of diagnoses and problems will require a major effort of which the new guidance is only a part. The guidance needs to be embedded in training, and clinical systems need to have improved, standardised functionality. Front-line clinicians, specialist societies, clinical informaticians and patients need to be engaged in developing information models for diagnoses to support care and research, accessible via user-friendly interfaces

Microgravity induces proteomics changes involved in endoplasmic reticulum stress and mitochondrial protection

On Earth, biological systems have evolved in response to environmental stressors, interactions dictated by physical forces that include gravity. The absence of gravity is an extreme stressor and the impact of its absence on biological systems is ill-defined. Astronauts who have spent extended time under conditions of minimal gravity (microgravity) experience an array of biological alterations, including perturbations in cardiovascular function. We hypothesized that physiological perturbations in cardiac function in microgravity may be a consequence of alterations in molecular and organellar dynamics within the cellular milieu of cardiomyocytes. We used a combination of mass spectrometry-based approaches to compare the relative abundance and turnover rates of 848 and 196 proteins, respectively, in rat neonatal cardiomyocytes exposed to simulated microgravity or normal gravity. Gene functional enrichment analysis of these data suggested that the protein content and function of the mitochondria, ribosomes, and endoplasmic reticulum were differentially modulated in microgravity. We confirmed experimentally that in microgravity protein synthesis was decreased while apoptosis, cell viability, and protein degradation were largely unaffected. These data support our conclusion that in microgravity cardiomyocytes attempt to maintain mitochondrial homeostasis at the expense of protein synthesis. The overall response to this stress may culminate in cardiac muscle atrophy

Data set of smallholder farm households in banana-coffee-based farming systems containing data on farm households, agricultural production and use of organic farm waste

Open Access Journal; Published online: 16 Feb 2021The data was collected in the Karagwe and Kyerwa districts of the Kagera region in north-west Tanzania. It encompasses 150 smallholder farming households, which were interviewed on the composition of their household, agricultural production and use of organic farm waste. The data covers the two previous rainy seasons and the associated vegetation periods between September 2016 and August 2017. The knowledge of experts from the following institutions was included in the discussion on the selection criteria: two local non-profit organisations, i.e., WOMEDA and the MAVUNO Project; the International Institute of Tropical Agriculture (IITA); and the National Land Use Planning Commission (NLUPC). Households were selected for inclusion if all of the following applied to them: 1) less than 10 acres of land (4.7 ha) registered in the village offices, 2) no agricultural training, and 3) decline in the fertility of their land since they started farming (self-reported). We selected 150 smallholder households out of a pool of 5,000 households known to WOMEDA in six divisions of the Kyerwa and Karagwe districts. The questionnaire contained 54 questions. The original language of the survey was Kiswahili. All interviews were audio recorded. The answers were digitalised and translated into English. The data set contains the raw data with 130 quantitative and qualitative variables. For quantitative variables, the only analysis that was made was the conversion of units, e.g., land area was converted from acres to hectares, harvest from buckets to kilograms and then to tons, and heads of livestock to Tropical Livestock Units (TLU). Qualitative variables were summarised into categories. All data has been anonymised. The data set includes geographical variables, household information, agricultural information, gender-specific responsibilities, economic data, farm waste management, and water, energy and food availability (Water-Energy-Food (WEF) Nexus). Variables are written in italics. The following geographical variables are part of the data set: district, division, ward, village, hamlet, longitude, latitude, and altitude. Household information includes start of farming, household size, gender and age of household members. Agricultural information includes land size, size of homegarden, crops, livestock and livestock keeping, trees, and access to forest. Gender-specific responsibilities includes producing and exchanging seeds, weed control, terracing, distributing organic material to the fields, care of annual and perennial crops, harvesting of crops, decisions about the harvest and animal products, selling and buying products, working on their own farm and off-farm, cooking, storing food, collecting and caring for drinking water, washing, and toilet cleaning. Economic data includes distance to the market, journey time to market, transport methods, labourers employed by the household, working off-farm, and assets such as type of house. Variables relevant to the WEF Nexus are drinking water source and treatment, meals per day, months without food, cooking fuel, and type of toilet. Variables on farm waste management are the use of crop residues, food and kitchen waste, livestock manure, cooking ash, animal bones, and human urine and faeces. The data can be potentially reused and further developed for the purpose of agricultural production analysis, socio-economic analysis, comparison to other regions, conceptualisation of waste and nutrient management, establishment of land use concepts, and further analysis on food security and healthy diets

Dynamics of Endoreplication during Drosophila Posterior Scutellar Macrochaete Development

Endoreplication is a variant type of DNA replication, consisting only of alternating G1 and S phases. Many types of Drosophila tissues undergo endoreplication. However, the timing and the extent to which a single endocycling macrochaete undergoes temporally programmed endoreplication during development are unclear. Here, we focused on the dynamics of endoreplication during posterior scutellar (pSC) macrochaete development. Quantitative analyses of C values in shaft cells and socket cells revealed a gradual rise from 8C and 4C at 8 hours after pupal formation (APF) to 72C and 24C at 29 hours APF, respectively. The validity of the values was further confirmed by the measurement of DNA content with a confocal laser microscope. BrdU incorporation assays demonstrated that shaft cells undergo four rounds of endoreplication from 18 to 29.5 hours APF. In contrast, socket cells undergo two rounds of endoreplication during the same period. Statistical analyses showed that the theoretical C values, based on BrdU assays, nearly coincide with the actually measured C values in socket cells, but not in shaft cells after 22 hours APF. These analyses suggest that socket cells undergo two rounds of endoreplication. However, the mechanism of endoreplication in the shaft cells may change from 22 hours APF, suggesting the possibility that shaft cells undergo two or four rounds of endoreplication during the periods. We also found that the timing of endoreplication differs, depending on the type of macrochaete. Moreover, endocycling in shaft cells of both the left and right sides of pSC bristle lineages occurs in the same pattern, indicating that the process is synchronized for specific types of macrochaete. Our findings suggest that endocycling in macrochaete cell lineages can be a model for understanding mechanisms of endoreplication at the single-cell level

An innovative integral field unit upgrade with 3D-printed micro-lenses for the RHEA at Subaru

In the new era of Extremely Large Telescopes (ELTs) currently under construction, challenging requirements drive spectrograph designs towards techniques that efficiently use a facility's light collection power. Operating in the single-mode (SM) regime, close to the diffraction limit, reduces the footprint of the instrument compared to a conventional high-resolving power spectrograph. The custom built injection fiber system with 3D-printed micro-lenses on top of it for the replicable high-resolution exoplanet and asteroseismology spectrograph at Subaru in combination with extreme adaptive optics of SCExAO, proved its high efficiency in a lab environment, manifesting up to ~77% of the theoretical predicted performance

Self-tolerance in multiple sclerosis

During the last decade, several defects in self-tolerance have been identified in multiple sclerosis. Dysfunction in central tolerance leads to the thymic output of antigen-specific T cells with T cell receptor alterations favouring autoimmune reactions. In addition, premature thymic involution results in a reduced export of naïve regulatory T cells, the fully suppressive clone. Alterations in peripheral tolerance concern costimulatory molecules as well as transcriptional and epigenetic mechanisms. Recent data underline the key role of regulatory T cells that suppress Th1 and Th17 effector cell responses and whose immunosuppressive activity is impaired in patients with multiple sclerosis. Those recent observations suggest that a defect in self-tolerance homeostasis might be the primary mover of multiple sclerosis leading to subsequent immune attacks, inflammation and neurodegeneration. The concept of multiple sclerosis as a consequence of the failure of central and peripheral tolerance mechanisms to maintain a self-tolerance state, particularly of regulatory T cells, may have therapeutic implications. Restoring normal thymic output and suppressive functions of regulatory T cells appears an appealing approach. Regulatory T cells suppress the general local immune response via bystander effects rather than through individual antigen-specific responses. Interestingly, the beneficial effects of currently approved immunomodulators (interferons β and glatiramer acetate) are associated with a restored regulatory T cell homeostasis. However, the feedback regulation between Th1 and Th17 effector cells and regulatory T cells is not so simple and tolerogenic mechanisms also involve other regulatory cells such as B cells, dendritic cells and CD56bright natural killer cells

Correction to: Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain

The original article [1] contained an error in coauthor, Balazs Ruzsics’s name which has since been corrected

Nef-mediated Clathrin-coated Pit Formation

The sequence of events leading to clathrin-coated pit (CCP) nucleation on the cell surface and to the incorporation of receptors into these endocytic structures is still imperfectly understood. In particular, the question remains as to whether receptor tails initiate the assembly of the coat proteins or whether receptors migrate into preformed CCP. This question was approached through a dissection of the mechanisms implemented by Nef, an early protein of human and simian immunodeficiency virus (HIV and SIV, respectively), to accelerate the endocytosis of cluster of differentiation antigen type 4 (CD4), the major receptor for these viruses. Results collected showed that: (a) Nef promotes CD4 internalization via an increased association of CD4 with CCP; (b) the Nef-mediated increase of CD4 association with CCP is related to a doubling of the plasma membrane area occupied by clathrin-coated structures; (c) this increased CCP number at the plasma membrane has functional consequences preferentially on CD4 uptake and does not significantly affect transferrin receptor internalization or fluid-phase endocytosis; (d) the presence of a CD4 cytoplasmic tail including a critical dileucine motif is required to induce CCP formation via Nef; and (e) when directly anchored to the cytoplasmic side of the plasma membrane, Nef itself can promote CCP formation. Taken together, these observations lead us to propose that CD4 can promote CCP generation via the connector molecule Nef. In this model, Nef interacts on one side with CD4 through a dileucine-based motif present on CD4 cytoplasmic tail and on the other side with components of clathrin-coated surface domain (i.e., adaptins). These Nef-generated complexes would then initiate the nucleation of CCP