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Abstract Background Patient registries provide long-term, real-world evidence that aids the understanding of the natural history and progression of disease, and the effects of treatment on large patient populations with rare diseases. The year 2021 marks the 20th anniversary of the Fabry Outcome Survey (FOS), an international, multicenter, observational registry (NCT03289065). The primary aims of FOS are to broaden the understanding of Fabry disease (FD), an X-linked lysosomal storage disorder, and to improve the clinical management of affected patients. Here, we review the history of FOS and the analyses and publications disseminated from the registry, and we discuss the contributions FOS studies have made in understanding FD. Results FOS was initiated in April 2001 and, as of January 2021, 4484 patients with a confirmed diagnosis and patient informed consent have been enrolled from 144 centers across 26 countries. Data from FOS have been published in nearly 60 manuscripts on a wide variety of topics relevant to FD. Analyses of FOS data have investigated the long-term effectiveness and safety of enzyme replacement therapy (ERT) with agalsidase alfa and its effects on morbidity and mortality, as well as the benefits of prompt and early treatment with agalsidase alfa on the progression of cardiomyopathy and the decline in renal function associated with FD. Based on analyses of FOS data, ERT with agalsidase alfa has also been shown to improve additional signs and symptoms of FD experienced by patients. FOS data analyses have provided a better understanding of the natural history of FD and the specific populations of women, children, and the elderly, and have provided practical tools for the study of FD. FOS has also provided methodology and criteria for assessing disease severity which contributed to the continuous development of medical practice in FD and has largely improved our understanding of the challenges and needs of long-term data collection in rare diseases, aiding in future rare disease real-world evidence studies. Conclusion FOS over the last 20 years has substantially increased the scientific knowledge around improved patient management of FD and continues to expand our understanding of this rare disease.

Abstract Inborn errors of metabolism are predominantly autosomal-recessive disorders, but several follow an X-linked pattern of inheritance. They are called X-linked recessive, if the female carriers are asymptomatic, and are called X-linked dominant disorders, if almost all females are affected. Conditions, in which some females have symptoms while others are asymptomatic lifelong are simply referred to as X-linked. The aim of this review is to point out the variability in clinical manifestation of affected females in some X-linked metabolic disorders and to discuss on the basis of these examples possible mechanisms that may explain the broad phenotypic spectrum, such as the type of the underlying mutation, the issue of autonomous versus non-autonomous gene expression and the degree of skewing of X-inactivation. The use of the terms “X-linked dominant” and “X-linked recessive” will be discussed.

Farmers and consultants face an unmanageable amount of diverse knowledge and information for crop management decisions. To determine optimal actions, decision makers require knowledge-based support. In this way, decisions can be improved and heuristics can be replaced over time. The study presents a digital knowledge base with an integrated decision support system (DSS), using the example of nutrient supply, specifically nitrogen (N), fertilization. Therefore, the requirements of farmers and crop consultants for DSS to inform fertilization decisions for winter wheat (Triticum aestivum L.) were elaborated using surveys, expert interviews, and a prototype test. Semantic knowledge was enriched by expert knowledge and combined in a web application, the Crop Portal. To map regional and personal decision making patterns and experiences, the tacit knowledge on the complex advisory problem of N fertilization is made digitally usable. For this purpose, 16 fuzzy variables were specified and formalized. Individual decision trees and their interactions with an integrative knowledge base were used to multiply the consulting reach of experts. Using three consultants and nine model farms from different soil–climate areas in Germany, the Crop Portal was tested under practical conditions and the perceived pragmatic and hedonic quality of the system was evaluated using a standardized questionnaire. The field test showed that the variation in fertilizer recommendations from the ‘digital advisor twin’ ranged from 5 kg N ha−1 to 16 kg N ha−1 when compared with the decisions of the experts in the field. The study presents the participatory development and evaluation of a rule-based DSS prototype in agricultural practice.

This is a retrospective analysis of Fabry Outcome Survey data from children/adults (n = 677) receiving agalsidase alfa enzyme replacement therapy for a median of 3 years, examining cerebrovascular, cardiac, and renal morbidity endpoints separately. Cardiac events occurred at younger ages than cerebrovascular or renal events, cerebrovascular events were more frequent in females than males, and males were more likely to experience cardiac and renal events at a younger age than females.

Abstract Background Many of the genetic childhood disorders leading to death in the pre- or neonatal period or during early childhood follow autosomal recessive modes of inheritance and bear specific challenges for genetic counseling and prenatal diagnostics. Parents are carriers but clinically unaffected, and diseases are rare but have recurrence risks of 25% in the same family. Often, affected children (or fetuses) die before a genetic diagnosis can be established, post-mortem analysis and phenotypic descriptions are insufficient and DNA from affected fetuses or children is not available for later analysis. A genetic diagnosis showing biallelic causative mutations is, however, the requirement for targeted carrier testing in parents and prenatal and preimplantation genetic diagnosis in further pregnancies. Methods We undertook targeted next-generation sequencing (NGS) for carrier screening of autosomal recessive lethal disorders in 8 consanguineous and 5 non-consanguineous couples with one or more affected children. We searched for heterozygous variants (non-synonymous coding or splice variants) in parents’ DNA, using a set of 430 genes known to be causative for rare autosomal recessive diseases with poor prognosis, and then filtering for variants present in genes overlapping in both partners. Putative pathogenic variants were tested for cosegregation in affected fetuses or children where material was available. Results The diagnosis for the premature death in children was established in 5 of the 13 couples. Out of the 8 couples in which no causative diagnosis could be established 4 consented to undergo further analysis, in two of those a potentially causative variant in a novel candidate gene was identified. Conclusions For the families in whom causative variants could be identified, these may now be used for prenatal and preimplantation genetic diagnostics. Our data show that NGS based gene panel sequencing of selected genes involved in lethal autosomal recessive disorders is an effective tool for carrier screening in parents and for the identification of recessive gene defects and offers the possibility of prenatal and preimplantation genetic diagnosis in further pregnancies in families that have experienced deaths in early childhood and /or multiple abortions.

Abstract Background Mucopolysaccharidosis type II (MPS II; Hunter syndrome) is a rare, X-linked disorder caused by deficient activity of the enzyme iduronate-2-sulfatase (I2S). Treatment is available in the form of enzyme replacement therapy (ERT) with recombinant I2S. Clinical outcomes following ≥3 years of ERT with idursulfase were investigated in a broad population of patients with MPS II enrolled in the Hunter Outcome Survey (HOS). Methods As of January 2016, 639 patients (excluding female patients, individuals who had received a bone marrow transplant and those enrolled in the phase 1/2 [TKT018] or phase 2/3 [TKT024] clinical trial) followed prospectively in the registry had received idursulfase for ≥6 months. These individuals all had data available for ≥1 clinical parameter at baseline and ≥1 additional time point following treatment initiation. Changes in clinical parameters were assessed in the subcohorts of patients with a measurement at baseline and at year 1, 2 or 3 of treatment. Safety data from patients who started treatment at or after enrollment in HOS (n = 233) were also assessed. Results Median (10th, 90th percentiles) age at first treatment was 6.2 (2.1, 18.2) years and median treatment duration was 56.3 (18.2, 97.6) months. Urinary glycosaminoglycan (uGAG) levels decreased from baseline to year 3 in patients with data available at this time point (median change from baseline: −201.0 [−591.4, −21.9] μg/mg creatinine [n = 121]). Improvements in the following parameters were observed at year 3 in the subcohorts: 6-min walking test (6MWT) distance, 10.6 (−33.6, 50.8)% (n = 26); left ventricular mass index (LVMI), −9.3 (−31.5, 19.7)% (n = 52); absolute forced vital capacity (FVC), 29.7 (−13.4, 66.7)% (n = 23); absolute forced expiratory volume in 1 s (FEV1), 22.8 (−15.2, 62.1) % (n = 22); palpable liver size, −54.5 (−85.7, 50.0)% (n = 53); palpable spleen size, −33.3 (−80.0, 33.3)% (n = 17). No new or unexpected safety concerns were identified in this analysis. Conclusions These findings suggest that idursulfase has a positive effect on uGAG levels, 6MWT results, LVMI, FVC, FEV1 and hepatosplenomegaly after 1, 2 and 3 years treatment.

Abstract Mucopolysaccharidosis type II (MPS II; Hunter syndrome; OMIM 309900) is a rare lysosomal storage disease with progressive multisystem manifestations caused by deficient activity of the enzyme iduronate-2-sulfatase. Disease-specific treatment is available in the form of enzyme replacement therapy with intravenous idursulfase (Elaprase®, Shire). Since 2005, the Hunter Outcome Survey (HOS) has collected real-world, long-term data on the safety and effectiveness of this therapy, as well as the natural history of MPS II. Individuals with a confirmed diagnosis of MPS II who are untreated or who are receiving/have received treatment with idursulfase or bone marrow transplant can be enrolled in HOS. A broad range of disease- and treatment-related information is captured in the registry and, over the past decade, data from more than 1000 patients from 124 clinics in 29 countries have been collected. Evidence generated from HOS has helped to improve our understanding of disease progression in both treated and untreated patients and has extended findings from the formal clinical trials of idursulfase. As a long-term, global, observational registry, various challenges relating to data collection, entry, and analysis have been encountered. These have resulted in changes to the HOS database platform, and novel approaches to maximize the value of the information collected will also be needed in the future. The continued evolution of the registry should help to ensure that HOS provides further insights into the burden of the disease and patient care and management in the coming years.

Measuring of the center of pressure (CoP) is one of the most frequently used quantitative methods for quantifying postural performance. The aim of the study is to describe differentiation criteria in the CoP-track for the clinical picture of chronic unspecific back pain. In this study, dynamic models loaded with multi-variable controls are used to determine whether biomechanical questions for upright posture can be answered. These models are particularly well suited for investigating the kinematics and the influence of the influencing disturbance variables. These investigations are extended by power density spectrum (PSD) analyses of CoP measurements on 590 subjects with and without chronic non-specific back pain. Pain patients show an average of 0.5 Nm2 more area under the spectrum than the pain-free reference group. In the power density spectrum different frequency ranges can be assigned to specific body oscillation. Among others, the frequency range between 0.5–0.8 Hz corresponds to the hip movement. In the range around 0.2 Hz, the movements are reflected in the upper body. Patients with back pain experience less activity in certain, individual areas.

ABSTRACT Human-associated archaea remain understudied in the field of microbiome research, although in particular methanogenic archaea were found to be regular commensals of the human gut, where they represent keystone species in metabolic processes. Knowledge on the abundance and diversity of human-associated archaea is extremely limited, and little is known about their function(s), their overall role in human health, or their association with parts of the human body other than the gastrointestinal tract and oral cavity. Currently, methodological issues impede the full assessment of the human archaeome, as bacteria-targeting protocols are unsuitable for characterization of the full spectrum of Archaea. The goal of this study was to establish conservative protocols based on specifically archaea-targeting, PCR-based methods to retrieve first insights into the archaeomes of the human gastrointestinal tract, lung, nose, and skin. Detection of Archaea was highly dependent on primer selection and the sequence processing pipeline used. Our results enabled us to retrieve a novel picture of the human archaeome, as we found for the first time Methanobacterium and Woesearchaeota (DPANN superphylum) to be associated with the human gastrointestinal tract and the human lung, respectively. Similar to bacteria, human-associated archaeal communities were found to group biogeographically, forming (i) the thaumarchaeal skin landscape, (ii) the (methano)euryarchaeal gastrointestinal tract, (iii) a mixed skin-gastrointestinal tract landscape for the nose, and (iv) a woesearchaeal lung landscape. On the basis of the protocols we used, we were able to detect unexpectedly high diversity of archaea associated with different body parts. IMPORTANCE In summary, our study highlights the importance of the primers and data processing pipeline used to study the human archaeome. We were able to establish protocols that revealed the presence of previously undetected Archaea in all of the tissue samples investigated and to detect biogeographic patterns of the human archaeome in the gastrointestinal tract and on the skin and for the first time in the respiratory tract, i.e., the nose and lungs. Our results are a solid basis for further investigation of the human archaeome and, in the long term, discovery of the potential role of archaea in human health and disease.

Metastases to the skeletal system are commonly observed in cancer patients, highly affecting the patients' quality of life. Imaging plays a major role in detection, follow-up, and molecular characterisation of metastatic disease. Thus, imaging techniques have been optimised and combined in a multimodal and multiparametric manner for assessment of complementary aspects in osseous metastases. This review summarises both application of the most relevant imaging techniques for bone metastasis in preclinical models and the clinical setting.

Outcomes from 5 years of treatment with agalsidase alfa enzyme replacement therapy (ERT) for Fabry disease in patients enrolled in the Fabry Outcome Survey (FOS) were compared with published findings for untreated patients with Fabry disease. Data were extracted from FOS, a Shire-sponsored database, for comparison with data from three published studies. Outcomes evaluated were the annualized rate of change in estimated glomerular filtration rate (eGFR) and left ventricular mass indexed to height (LVMI) as well as time to and ages at a composite morbidity endpoint and at death. FOS data were extracted for 740 treated patients who were followed for a median of ~ 5 years. Compared with no treatment, patients treated with agalsidase alfa demonstrated slower decline in renal function and slower progression of left ventricular hypertrophy. Treated male patients with baseline eGFR

In the last decades, it has become more and more evident that lysosomal storage disorders and common neurodegenerative diseases such as Alzheimer and Parkinson diseases have clinical, neuropathological, and genetic features in common, including lysosomal dysfunction and impaired autophagy. Patients with Gaucher and even carriers of Gaucher disease have an increased risk to develop Parkinson disease. Likewise, individuals who are heterozygous for a mutation of a gene that causes an adult form of neuronal ceroid lipofuscinosis are more likely to be affected by a form of frontotemporal dementia in their later life. A further example is the gene NAGLU encoding the enzyme α- N -acetylglucosaminidase, which is deficient in patients with mucopolysaccharidosis type IIIB. Mutations of the NAGLU gene have been observed in patients affected by an axonal neuropathy. An interesting unexpected finding was the link between stuttering and genes that are essential for the function of all lysosomal enzymes. This review will present some example of the association of lysosomal storage disorders and neurodegenerative disease and discuss possible pathogenic mechanisms that are common to both conditions. The understanding of the pathophysiology of the endosomal–lysosomal–autophagic system may help to develop drugs, which might provide benefit not only for patients with rare lysosomal storage disorders but also for individuals affected by more common diseases.

The measurement of the center of pressure (CoP) is one of the most frequently used quantitative methods for quantifying postural performance. Due to the complexity and the high biological variability of the postural control loop, a large number of different methods and parameters have been established to describe the CoP process. Furthermore, the methodological conditions such as the foot position, visual condition, sampling duration, and the data processing also have a relevant influence on the measurement results. In addition, there are various methods for recording the pressure curve, which differ in particular with regard to the filters used, the frequencies, and measurement times. The aim of the present study was the methodical comparison between different digital filters, measurement frequencies and times, and their effects on the CoP process based on a healthy reference group. The data acquisition was done with LabVIEW and the data storage was organized in a subject oriented data structure. Based on the presented results it could be seen that with a different dominant frequency in the spectrum of the group of test persons, certain filter types are required for the processing of CoP data. In the sampling range from 300 Hz to 1 kHz in the bipedal stand and 600 Hz to 1 kHz in the monopedal stand, the choice of measurement frequency had no influence on the filter result.

Next-generation sequencing (NGS) panels are used widely in clinical diagnostics to identify genetic causes of various monogenic disease groups including neurometabolic disorders and, more recently, lysosomal storage disorders (LSDs). Many new challenges have been introduced through these new technologies, both at the laboratory level and at the bioinformatics level, with consequences including new requirements for interpretation of results, and for genetic counseling. We review some recent examples of the application of NGS technologies, with purely diagnostic and with both diagnostic and research aims, for establishing a rapid genetic diagnosis in LSDs. Given that NGS can be applied in a way that takes into account the many issues raised by international consensus guidelines, it can have a significant role even early in the course of the diagnostic process, in combination with biochemical and clinical data. Besides decreasing the delay in diagnosis for many patients, a precise molecular diagnosis is extremely important as new therapies are becoming available within the LSD spectrum for patients who share specific types of mutations. A genetic diagnosis is also the prerequisite for genetic counseling, family planning, and the individual choice of reproductive options in affected families.

The Fabry Outcome Survey (FOS) is an international long-term observational registry sponsored by Shire for patients diagnosed with Fabry disease who are receiving or are candidates for therapy with agalsidase alfa (agalα). Established in 2001, FOS provides long-term data on agalα safety/efficacy and collects data on the natural history of Fabry disease, with the aim of improving clinical management. The FOS publications have helped establish prognostic and severity scores, defined the incidence of specific disease variants and implications for clinical management, described clinical manifestations in special populations, confirmed the high prevalence of cardiac morbidity, and demonstrated correlations between ocular changes and Fabry disease severity. These FOS data represent a rich resource with utility not only for description of natural history/therapeutic effects but also for exploratory hypothesis testing and generation of tools for diagnosis/management, with the potential to improve future patient outcomes.

The center of pressure (CoP) is one of the most utilized quantitative measurements describing postural competency. Due to the complexity and biological variability of postural regulatory systems, a myriad of different methods and parameters have been established describing the CoP trajectory. Besides procedural variables, such as foot position, visual condition, and sampling duration, the method of data collection itself has a relevant effect on the result of the measurement. Furthermore, different methods for recording the measured data have been developed, which differ regarding the filters, frequencies, and test durations used. The goal of this study was the methodical comparison of various filters, measurement frequencies, and measurement duration, with respect to their effects on the CoP trajectory. Based on the results presented, we demonstrate that the Butterworth and Bessel filters can be recommended for analysis of CoP data, and at the very least, a second-order filter should be chosen for the process. For assessment of the cutoff frequency, a technical pendulum was used to show that a cutoff frequency of 13 Hz provided reliable data and it can be inferred that a 100 Hz sampling rate would be the minimum requirement.

Michael BeckChildren’s Hospital, University of Mainz, Mainz, GermanyAbstract: Pompe disease is a lysosomal storage disorder characterized by muscle weakness and cardiomyopathy. It shows a broad variability regarding the clinical severity as well as the age of onset. In the past, two different recombinant enzyme preparations have been developed for the treatment of Pompe patients: α-glucosidase, produced in rabbit milk, and α-glucosidase, produced in Chinese hamster ovary (CHO) cell lines. The CHO enzyme received marketing approval in 2006 after it was proven to be effective in ameliorating muscle strength and improving heart function. The other has not been approved. The clinical efficacy of this enzyme preparation could be confirmed by several clinical trials in patients with different age of onset and disease severity. Enzyme replacement therapy, however, has its limitations due to unsatisfactory access of recombinant α-glucosidase to the muscle cells and due to the formation of antibodies. To overcome these therapeutic restraints, the development of a more effective enzyme preparation may become necessary.Keywords: alglucosidase alfa, alpha glucosidase, Pompe disease, enzyme replacement therapy, glycogen storage disorder type II, acid maltase deficiency

Ocular signs in Fabry disease have generally been regarded to be primarily of diagnostic value. We explored whether ocular findings, alone or in particular in combination with the α-galactosidase A gene mutation, have predictive value for disease severity. Data from the Fabry Outcome Survey (FOS), a large, global database sponsored by Shire, were selected for adult patients who had undergone ophthalmological examination. Three ocular signs were assessed: cornea verticillata, tortuous conjunctival and/or retinal vessels, and cataract. Fabry disease severity was measured using FOS Mainz Severity Score Index and modifications thereof. Ophthalmological data were available for 1203 (699 female, 504 male) adult patients with eye findings characteristic of Fabry disease in 55.1%. Cornea verticillata had a similar distribution in women (51.1%) and men (50.8%), whereas tortuous vessels and Fabry cataract were somewhat more frequent in men than in women. Patients with cornea verticillata, selected as the principal ocular sign for this study, had more severe disease (median score, 20.0) versus those without ocular signs (11.0; P

Brain structural alterations and neuropsychiatric symptoms have been described repeatedly in Fabry disease, yet cognitive deficits have been shown to be only mild. Here, we aimed to investigate neuropsychiatric symptoms and brain structure longitudinally. We expected no clinically relevant increase of neuropsychiatric symptoms in parallel to increased brain structural alterations. We assessed 14 Fabry patients (46.1 ± 10.8 years) who had participated in our investigation eight years ago. Patients engaged in neuropsychiatric testing, as well as structural magnetic resonance imaging and angiography to determine white matter lesions, hippocampal volume, and the diameter of the larger intracranial arteries. While Fabry patients did not differ on cognitive performance, they showed progressive and significant hippocampal volume loss over the 8-year observation period. White matter lesions were associated with older age and higher white matter lesion load at baseline, but did not reach statistical significance when comparing baseline to follow-up. Likewise, intracranial artery diameters did not increase significantly. None of the imaging parameters were associated with the neuropsychiatric parameters. Depression frequency reduced from 50% at baseline to 21% at follow-up, but it did not reach significance. This investigation demonstrates clinical stability in cognitive function, while pronounced hippocampal atrophy is apparent throughout the 8 years. Our middle-aged Fabry patients appeared to compensate successfully for progressive hippocampal volume loss. The hippocampal volume decline indicates brain regional neuronal involvement in Fabry disease.

In recent years, there has been intensified development of cost-effective alternatives to conventional force plates, such as those of Kistler and AMTI, in clinical and scientific research. To our knowledge, the evidence for existing validity and reliability of the HUMAC Balance System has so far been lacking. Over the course of the study, the HUMAC Balance System, which is based on the WII Balance Board technology, was tested. 26 HUMAC Balance Systems in conjunction with 2 force plates, each from the manufacturers Kistler and AMTI, were examined and their properties under static and dynamic conditions were evaluated. Under static conditions, the HUMAC Balance System revealed a relatively constant and comparatively small margin of displacement error. However, tests of the force plates under dynamic conditions revealed contrasting results. The conventional force plates, with a margin of error of 2.5%, proved to have a smaller margin of error compared to the HUMAC Balance System, which had margins of error of 8.6% and 6.1% in x and y directions, respectively. A calibration method was developed to overcome these systematic deviations. After applying the calibration, the Balance Board margin of error was reduced to an acceptable maximum of 0.18%.

Mucopolysaccharidosis type II (MPS II or Hunter syndrome) is a rare, inherited disorder caused by deficiency of the lysosomal enzyme iduronate-2-sulfatase. As a result of this deficiency, glycosaminoglycans accumulate in lysosomes in many tissues, leading to progressive multisystemic disease. The cardiopulmonary and neurological problems associated with MPS II have received considerable attention. Orthopedic manifestations are common but not as well characterized. This study aimed to characterize the prevalence and severity of orthopedic manifestations of MPS II and to determine the relationship of these signs and symptoms with cardiovascular, pulmonary and central nervous system involvement. Orthopedic manifestations of MPS II were studied using cross-sectional data from the Hunter Outcome Survey (HOS). The HOS is a global, physician-led, multicenter observational database that collects information on the natural history of MPS II and the long-term safety and effectiveness of enzyme replacement therapy. As of January 2009, the HOS contained baseline data on joint range of motion in 124 males with MPS II. In total, 79% of patients had skeletal manifestations (median onset, 3.5 years) and 25% had abnormal gait (median onset, 5.4 years). Joint range of motion was restricted for all joints assessed (elbow, shoulder, hip, knee and ankle). Extension was the most severely affected movement: the exception to this was the shoulder. Surgery for orthopedic problems was rare. The presence of orthopedic manifestations was associated with the presence of central nervous system and pulmonary involvement, but not so clearly with cardiovascular involvement. Orthopedic interventions should be considered on an individual-patient basis. Although some orthopedic manifestations associated with MPS II may be managed routinely, a good knowledge of other concurrent organ system involvement is essential. A multidisciplinary approach is required.

Abstract Recent advances in imaging suggested that spatial organization of hematopoietic cells in their bone marrow microenvironment (niche) regulates cell expansion, governing progression, and leukemic transformation of hematological clonal disorders. However, our ability to interrogate the niche in pre-malignant conditions has been limited, as standard murine models of these diseases rely largely on transplantation of the mutant clones into conditioned mice where the marrow microenvironment is compromised. Here, we leveraged live-animal microscopy and ultralow dose whole body or focal irradiation to capture single cells and early expansion of benign/pre-malignant clones in the functionally preserved microenvironment. 0.5 Gy whole body irradiation (WBI) allowed steady engraftment of cells beyond 30 weeks compared to non-conditioned controls. In-vivo tracking and functional analyses of the microenvironment showed no change in vessel integrity, cell viability, and HSC-supportive functions of the stromal cells, suggesting minimal inflammation after the radiation insult. The approach enabled in vivo imaging of Tet2 +/− and its healthy counterpart, showing preferential localization within a shared microenvironment while forming discrete micro-niches. Notably, stationary association with the niche only occurred in a subset of cells and would not be identified without live imaging. This strategy may be broadly applied to study clonal disorders in a spatial context.

Abstract Background This study was conducted to estimate the additional objective and perceived workload of nurses resulting from the use of webcams. The successful implementation of webcam technology into routine care requires an analysis to prevent adverse events of increased nursing workload. Methods The study took place on three neonatal wards in two University Hospitals in Germany. In the first Hospital, the study was conducted from February to July 2021; in the second one it was conducted between June and November 2021. Data were collected using a combined approach of a standardised diary questionnaire study and passive observations. The participants were accompanied in their daily work and their activities were recorded 65 nurses participated. Results 2,031 h were observed in 1,630 observation blocks. In 14.74% of the observation blocks webcam activities were detected. The extent to which the nurses had webcam-related additional workloads was rated as no additional workload in 82.16% of the daily questionnaires (n = 1,026). Conclusion The observed low workload due to the webcams is in line with the nurses’ perception. The observational data revealed, on a number of different analysis levels, that a limited additional workload was generated. There was no decrease in activity performance observed and no clear indication for interruptions due to the webcam-related activities for the nurses. However, it is important to raise awareness about the individual workload levels for the successful implementation. Additional education programs can be provided for nurses. Trial registration The Neo-CamCare study is registered at the German Clinical Trials Register. DRKS-ID: DRKS00017755 .

Hydrangea serrata, also knowen as the Japanese tea hortensia, is known for its sweet taste and health properties of bevarages produced from this plant. The H. serrata 3,4-dihydroisocoumarins, hydrangenol and phyllodulcin harbour a variety of biological activities and pharmacological properties. Therefore, a detailed understanding of dihydroisocoumarin biosynthesis in H. serrata is of major interest. Their biosynthesis is assumed to be enhanced by elicitors and mediated by polyketide synthases like in cases of phenylpropanoid derived phytoalexins. A de-novo transcriptome assembly of leaves and roots from the aluminium chloride treatment group versus the control group alongside with annotation was generated. Secondary plant metabolites were analysed by LC-MS. It revealed that a terpene synthase and a triterpenoid synthase gene as well as lignin biosynthesis encoding genes were upregulated in roots. Many genes for transporters, glycosyl, and other transferases as well as glycosylases were found to be differentially expressed in both organs. As no differentially expressed polyketide synthase gene homolog was found, the relative leaf and root 3,4-dihydroisocoumarin content was analysed by LC-MS measurement. Although Hydrangea species are known for their aluminium detoxification using phenylpropanoid-derived compounds, the levels of 3,4- dihydroisocoumarins were not enhanced. In this metabolite analysis, an organ- specific accumulation profile of hydrangenol, phyllodulcin, hydrangeic acid and their mono- and di-glycosides was figured out.

Abstract The United Nations has declared 2021–2030 the decade on ecosystem restoration with the aim of preventing, stopping and reversing the degradation of the ecosystems of the world, often caused by the fragmentation of natural landscapes. Human activities separate and surround habitats, making them too small to sustain viable animal populations or too far apart to enable foraging and gene flow. Despite the need for strategies to solve fragmentation, it remains unclear how to efficiently reconnect nature. In this paper, we illustrate the potential of deep reinforcement learning (DRL) to tackle the spatial optimisation aspect of connectivity conservation planning. The propensity of spatial optimisation problems to explode in complexity depending on the number of input variables and their states is and will continue to be one of its most serious obstacles. DRL is an emerging class of methods focused on training deep neural networks to solve decision‐making tasks and has been used to learn good heuristics for complex optimisation problems. While the potential of DRL to optimise conservation decisions seems huge, only few examples of its application exist. We applied DRL to two real‐world raster datasets in a connectivity planning setting, targeting graph‐based connectivity indices for optimisation. We show that DRL converges to the known optimums in a small example where the objective is the overall improvement of the Integral Index of Connectivity and the only constraint is the budget. We also show that DRL approximates high‐quality solutions on a large example with additional cost and spatial configuration constraints where the more complex Probability of Connectivity Index is targeted. To the best of our knowledge, there is no software that can target this index for optimisation on raster data of this size. DRL can be used to approximate good solutions in complex spatial optimisation problems even when the conservation feature is non‐linear like graph‐based indices. Furthermore, our methodology decouples the optimisation process and the index calculation, so it can potentially target any other conservation feature implemented in current or future software.

Abstract Background Perinatal women are highly vulnerable to developing mental health issues and particularly susceptible to a recurrence of psychiatric illness. Poor mental health during the perinatal period can have long-term impacts on the physical and psychiatric health of both mother and child. A potentially useful strategy to improve women’s mental health is through a mobile application teaching mindfulness, an evidence-based technique helping individuals focus on the present moment. Methods A mixed method, prospective randomised controlled trial. The study group comprise women aged 18 years and over, who are attending the public and private maternity clinics at Mater Mothers’ Hospital. A sample of 360 prenatal women will be randomised into the intervention group (with the use of the mindfulness app) or usual care. Participants will remain in the study for 11 months and will be assessed at four timepoints for changes in postnatal depression, mother-infant bonding, and quality of life. A cost-effectiveness evaluation will also be conducted using quality-adjusted life year (QALY) calculations. A random selection of intervention participants will be invited to attend focus groups to give feedback on the mindfulness app. Discussion Previous studies have found mindfulness interventions can reduce stress, anxiety, depression, and sleep disturbances in a prenatal population. The risks of the intervention are low, but could be of significant benefit for women who are unable to attend face-to-face appointments due to geographical, financial, or time barriers; during endemic or pandemic scenarios; or due to health or mobility issues. Trial registration This study was approved by the Mater Misericordiae Human Research Ethics Committee (83,589). Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622001581752 ( https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385107&isReview=true ). Registered on 22 Dec. 2022.

Abstract Electrodes are used to measure a potential difference between two points. In geophysical and geotechnical applications they are often in the form of non‐polarizable porous‐pot electrodes. Here we describe the design, construction, and testing of modular and refillable electrodes, which facilitates repair as the electrodes degrade over time. We use a chemical composition based on a metal in contact with an over‐saturated electrolyte that consists of a salt of that metal and an auxiliary salt. We compare characteristics when the electrolyte is stabilized in a clay or not, and with various states of ceramic porous plugs and two types of wood plugs. Next, we assess the long‐term stability (more than 1 month), noise (periods of 1 s to 1 hr), and temperature sensitivity of different types of electrodes. Electrodes with an electrolyte and clay formula showed lower noise (0.2–0.4 μV at periods of 1–120 s), greater long‐term stability (0.05–0.5 mV/month of smooth drift), and greater consistency between samples measured than those with no clay (noise and drift values up to four times larger). The effects from different porous plugs were negligible, with similar results for ceramic and wood types. The temperature sensitivity of the electric potential was assessed, from −3 to 35°C. All electrodes showed a temperature sensitivity of about −30 μV/°C. This is considered very low compared to some commercially available electrodes. Finally, continuous long‐term laboratory and field measurements of the potential highlight the application of the new electrodes.

Abstract In Europe and elsewhere, agri‐environmental schemes (AES) are designed to reduce agriculture's impacts on the environment. Designing effective schemes requires an understanding of the reasons that drive farmers' decisions whether to adopt AES. Currently, most insights come from individual case studies or structured surveys based on predefined questions. There is a paucity of studies that do not rely on rigid preconceptions about relevant behavioural factors while also offering a geographically and socio‐culturally broad perspective that can address the cultural and institutional context‐specificity of behavioural studies. Also, most studies focus on the adoption decision, while implementation decisions and their consequences for the ecological effectiveness of AES remain understudied. In this article, we present the results from semi‐structured farmer interviews conducted in five agricultural landscapes across Europe. The results are used to uncover reasons for AES adoption as well as the implications of AES implementation decisions for their ecological effectiveness. The main reason for AES adoption that was common across case study regions is the interplay of opportunity costs and payment levels, which has negative implications for the ecological effectiveness of AES as farmers prioritized marginal land or adopted non‐additional AES. Among reasons that vary across regions, tenure relations and the role of ecological reasoning stand out. We find that AES are unlikely to trigger broader shifts towards sustainable management but there is some potential for improvement, mainly by increasing the flexibility, spatial targeting and ecological ambition of the schemes. Read the free Plain Language Summary for this article on the Journal blog.

Abstract This study presents a novel standardized rating instrument for observing and measuring effective classroom management (ECM) as part of the teaching and learning environments in primary school. The instrument comprises eight high-inferent items on organizational aspects (lack of disruptions/discipline problems, withitness, effective time use, clear rules, clear routines, appreciation) and instructional aspects (structuring, goal clarity). It was applied in second grade classrooms of German primary school teachers (n = 35) providing early reading and writing instruction. Pairs of trained raters (student teachers) observed one to three lessons in each classroom over 3–4 months, reaching acceptable interrater agreement. The instrument showed acceptable internal consistency. Factor analyses revealed structures with good to acceptable fit indices, with confirming the differentiation into organizational and instructional ECM aspects. Correlations between observed ECM and facets of teacher knowledge (that were directly assessed by using paper–pencil tests) provide divergent and convergent validity evidence: Whereas no significant correlations could be found between pedagogical content knowledge for early reading and writing instruction and ECM, findings show significant correlations between general pedagogical knowledge and the ECM. The added value of the study is therefore to provide a novel instrument that can be applied in future empirical research on primary school classroom management.

Abstract A better understanding of the genetic regulation of the biosynthesis of microbial compounds could accelerate the discovery of new biologically active molecules and facilitate their production. To this end, we have investigated the time course of genome‐wide transcription in the myxobacterium Sorangium sp. So ce836 in relation to its production of natural compounds. Time‐resolved RNA sequencing revealed that core biosynthesis genes from 48 biosynthetic gene clusters (BGCs; 92% of all BGCs encoded in the genome) were actively transcribed at specific time points in a batch culture. The majority (80%) of polyketide synthase and non‐ribosomal peptide synthetase genes displayed distinct peaks of transcription during exponential bacterial growth. Strikingly, these bursts in BGC transcriptional activity were associated with surges in the net production rates of known natural compounds, indicating that their biosynthesis was critically regulated at the transcriptional level. In contrast, BGC read counts from single time points had limited predictive value about biosynthetic activity, since transcription levels varied >100‐fold among BGCs with detected natural products. Taken together, our time‐course data provide unique insights into the dynamics of natural compound biosynthesis and its regulation in a wild‐type myxobacterium, challenging the commonly cited notion of preferential BGC expression under nutrient‐limited conditions. The close association observed between BGC transcription and compound production warrants additional efforts to develop genetic engineering tools for boosting compound yields from myxobacterial producer strains.

We here present a database of evidence on the impact of agricultural management practices on biodiversity and yield. This database is the result of a systematic literature review, that aimed to identify meta-analyses that use as their response variables any measure of biodiversity and yield. After screening more than 1,086 titles and abstracts, we identified 33 relevant meta-analyses, from which we extracted the overall estimates, the subgroup estimates as well as all information related to them (effect size metric, taxonomic group, crop type etc.). We also extracted information relative to the empirical studies used for each meta-analysis and recorded the countries in which they took place and assessed the quality of each meta-analysis. Our dataset is publicly accessible and can be used for conducting second-order meta-analyses on the effect of management measures on species richness, taxon abundance, biomass and yields. It can also be used to create evidence maps on agriculture-related questions.

Measurement(s) plant trait Technology Type(s) various Factor Type(s) none Sample Characteristic - Organism Tracheophyta Sample Characteristic - Environment natural environment Sample Characteristic - Location global

Lymph nodes in various locations of the body differ in their cell composition and gene expression signatures. Here authors show that the rapid postnatal expansion of lymph nodes is governed by CD34 + stromal cells and fibroblastic reticular stromal cell progenitors, distinguished by intrinsic, microbiome-independent core epigenetic blueprints.

Abstract In this article, the binding forms of two lignite samples are determined by thermal desorption using a high-temperature furnace. Each mercury compound, such as HgCl2, has a specific binding strength whose decomposition requires a certain thermal energy. Hence, the release of mercury from pure substances and lignite samples was analyzed in a high-temperature furnace. The released mercury is determined with a Mercury Vapor Monitor. The obtained characteristic temperature range and peak of the mercury release were compared between lignite samples and mercury pure substances. For the lignite samples investigated, the binding form of mercury was then identified as Humic Acid. These organic compounds vaporize at lower temperatures. About half of the mercury bound in the lignite was already released at 350 °C. Furthermore, the question arises whether mercury is already released during the grinding-drying process in the coal mill of a power plant. At two power plants, lignite samples were taken simultaneously at the feeder before entering the coal mill and at the dust line afterwards. The samples were analyzed for mercury concentration. The results show that up to one third of the mercury was already released in the coal mill. The vaporized mercury enters the combustion chamber detached from the lignite. The stated analysis methods and the results presented in this article contribute to the understanding of the mercury binding forms in lignite. It also shows the potential of thermal coal pretreatment as a favorable alternative mercury separation technology to others such as activated carbon dosing.

The adoption of agri-environment practices (AEPs) is crucial for safeguarding the long-term sustainability of ecosystem services within European agricultural landscapes. However, the tailoring of agri-environment policies to the unique characteristics of farming systems is a challenging task, often neglecting local farm parameters or requiring extensive farm survey data. Here, we develop a simplified typology of farming system archetypes (FSAs), using field-level data on farms’ economic size and specialisation derived from the Integrated Administration and Control System in three case studies in Germany, Czechia and the United Kingdom. Our typology identifies groups of farms that are assumed to react similarly to agricultural policy measures, bridging the gap between efforts to understand individual farm behaviour and broad agri-environmental typologies. We assess the usefulness of our approach by quantifying the spatial association of identified archetypes of farming systems with ecologically relevant AEPs (cover crops, fallow, organic farming, grassland maintenance, vegetation buffers, conversion of cropland to grassland and forest) to understand the rates of AEP adoption by different types of farms. Our results show that of the 20 archetypes, economically large farms specialised in general cropping dominate the agricultural land in all case studies, covering 56% to 85% of the total agricultural area. Despite regional differences, we found consistent trends in AEP adoption across diverse contexts. Economically large farms and those specialising in grazing livestock were more likely to adopt AEPs, with economically larger farms demonstrating a proclivity for a wider range of measures. In contrast, economically smaller farms usually focused on a narrower spectrum of AEPs and, together with farms with an economic value

Glioblastoma (GBM) heterogeneity, aggressiveness and infiltrative growth drastically limit success of current standard of care drugs and efficacy of various new therapeutic approaches. There is a need for new therapies and models reflecting the complex biology of these tumors to analyze the molecular mechanisms of tumor formation and resistance, as well as to identify new therapeutic targets. We established and screened a panel of 26 patient-derived subcutaneous (s.c.) xenograft (PDX) GBM models on immunodeficient mice, of which 15 were also established as orthotopic models. Sensitivity toward a drug panel, selected for their different modes of action, was determined. Best treatment responses were observed for standard of care temozolomide, irinotecan and bevacizumab. Matching orthotopic models frequently show reduced sensitivity, as the blood-brain barrier limits crossing of the drugs to the GBM. Molecular characterization of 23 PDX identified all of them as IDH-wt (R132) with frequent mutations in EGFR, TP53, FAT1, and within the PI3K/Akt/mTOR pathway. Their expression profiles resemble proposed molecular GBM subtypes mesenchymal, proneural and classical, with pronounced clustering for gene sets related to angiogenesis and MAPK signaling. Subsequent gene set enrichment analysis identified hallmark gene sets of hypoxia and mTORC1 signaling as enriched in temozolomide resistant PDX. In models sensitive for mTOR inhibitor everolimus, hypoxia-related gene sets reactive oxygen species pathway and angiogenesis were enriched. Our results highlight how our platform of s.c. GBM PDX can reflect the complex, heterogeneous biology of GBM. Combined with transcriptome analyses, it is a valuable tool in identification of molecular signatures correlating with monitored responses. Available matching orthotopic PDX models can be used to assess the impact of the tumor microenvironment and blood-brain barrier on efficacy. Our GBM PDX panel therefore represents a valuable platform for screening regarding molecular markers and pharmacologically active drugs, as well as optimizing delivery of active drugs to the tumor.

Algorithms and procedures to fully automate retuning of synchrotron radiation beamlines over wide energy ranges are discussed. The discussion is based on the implementation at the National Institute of General Medical Sciences and the National Cancer Institute Structural Biology Facility at the Advanced Photon Source. When a user selects a new beamline energy, software synchronously controls the beamline monochromator and undulator to maintain the X-ray beam flux after the monochromator, preserves beam attenuation by determining a new set of attenuator foils, changes, as needed, mirror reflecting stripes and the undulator harmonic, preserves beam focal distance of compound refractive lens focusing by changing the In/Out combination of lenses in the transfocator, and, finally, restores beam position at the sample by on-the-fly scanning of either the Kirkpatrick–Baez mirror angles or the transfocator up/down and inboard/outboard positions. The sample is protected from radiation damage by automatically moving it out of the beam during the energy change and optimization.

Abstract Background & Aims Thymic conventional dendritic cells (t‑DCs) are crucial for the development of T cells. A substantial fraction of t‑DCs originates extrathymically and migrates to the thymus. Here, these cells contribute to key processes of central tolerance like the clonal deletion of self‑reactive thymocytes and the generation of regulatory T (Treg) cells. So far, it is only incompletely understood which impact the thymic microenvironment has on thymus‑homing conventional DCs (cDCs), which phenotypic changes occur after the entry of peripheral cDCs into the thymus and which functional properties these modulated cells acquire. Materials & Methods In the present study, we mimicked the thymus‑homing of peripheral cDCs by introducing ex vivo isolated splenic cDCs (sp‑DCs) into reaggregated thymic organ cultures (RTOCs). Results Already after two days of culture, the transcriptomic profile of sp‑DCs was modulated and had acquired certain key signatures of t‑DCs. The regulated genes included immunomodulatory cytokines and chemokines as well as costimulatory molecules. After four days of culture, sp‑DCs appeared to have at least partially acquired the peculiar Treg cell‐inducing capacity characteristic of t‑DCs. Discussion & Conclusion Taken together, our findings indicate that peripheral cDCs possess a high degree of plasticity enabling them to quickly adapt to the thymus‐specific microenvironment. We further provide indirect evidence that thymus‐specific properties such as the efficient induction of Treg cells under homeostatic conditions can be partially transferred to thymus‑homing peripheral cDC subsets.

The current focus on renewable energy in global policy highlights the importance of methane production from biomass through anaerobic digestion (AD). To improve biomass digestion while ensuring overall process stability, microbiome-based management strategies become more important. In this study, metagenomes and metaproteomes were used for metagenomically assembled genome (MAG)-centric analyses to investigate a full-scale biogas plant consisting of three differentially operated digesters. Microbial communities were analyzed regarding their taxonomic composition, functional potential, as well as functions expressed on the proteome level. Different abundances of genes and enzymes related to the biogas process could be mostly attributed to different process parameters. Individual MAGs exhibiting different abundances in the digesters were studied in detail, and their roles in the hydrolysis, acidogenesis and acetogenesis steps of anaerobic digestion could be assigned. Methanoculleus thermohydrogenotrophicum was an active hydrogenotrophic methanogen in all three digesters, whereas Methanothermobacter wolfeii was more prevalent at higher process temperatures. Further analysis focused on MAGs, which were abundant in all digesters, indicating their potential to ensure biogas process stability. The most prevalent MAG belonged to the class Limnochordia; this MAG was ubiquitous in all three digesters and exhibited activity in numerous pathways related to different steps of AD.

The identification of novel therapeutic strategies for advanced non-small cell lung cancer (NSCLC) is essential as the outcome of most of these patients is poor. Here the authors provide a proof-of concept that specific low-dose drug combinations can disrupt intercellular crosstalk to overcome drug resistance in NSCLC patient-derived xenografts.

Joern Pezoldt et al. analyze mouse spleen fibroblasts using single cell RNA sequencing, revealing 11 distinct clusters of fibroblastic cells or subtypes. Their results collectively provide further insight into the transcriptional identities of splenic fibroblasts and innate immune signatures of distinct stromal compartments.

Abstract Background Bluetongue virus (BTV) and epizootic hemorrhagic disease virus (EHDV) are orbiviruses that can cause fatal vector-borne diseases in white-tailed deer (Odocoileus virginianus). Trapping methods for collecting potential Culicoides vectors of orbiviruses were compared to optimize surveillance studies. Methods The number of captured midges and the virus infection rates of midge pools were compared for dry ice-baited Centers for Disease Control and Prevention (CDC) traps with or without black light. The number of individual midges of different Culicoides species captured at different crepuscular and nocturnal periods using rotator traps also was determined. The number of species/specimens of Culicoides was measured using five different trap methods including three animal-baited methods, a CDC trap with black light, and a CDC trap with no light. Results In trial one, there was no significant difference (P = 0.37) in the proportion of BTV-infected flies caught in traps with light compared to traps without light. However, there was a significant difference (P = 0.026) for EHDV-infected flies, and 89% were captured in traps with light. In trial two, more specimens of C. debilipalpis were captured in the morning hours (06:00–08:00) than in the evening hours (18:00–20:00). For trial three, the animal-baited traps did not capture any species of Culicoides that were not captured in the CDC light traps. There was no significant difference (P = 0.22) in total specimens captured among all five trap types. Conclusions Specimens of Culicoides infected with BTV were not repelled by light traps in the first trial, while the majority of the specimens positive for EHDV were caught in traps with light. For the second trial, specimens of C. debilipalpis were most abundant during early morning hours, and thus spray applications of insecticides for control of that species may be more effective at sunrise rather than sunset. For objective three, no animal-baited trapping method collected different species of midges when compared to the CDC traps with light, which is unlike certain studies conducted in other geographical regions. Graphical abstract

Abstract Background Implementation science aims to embed evidence-based practice as ‘usual care’ using theoretical underpinnings to guide these processes. Conceptualising the complementary purpose and application of theoretical approaches through all stages of an implementation project is not well understood and is not routinely reported in implementation research, despite call for this. This paper presents the synthesis and a collective approach to application of a co-design model, a model for understanding need, theories of behaviour change with frameworks and tools to guide implementation and evaluation brought together with the Consolidated Framework for Implementation Research (CFIR). Method Using a determinant framework such as the CFIR provides a lens for understanding, influencing, and explaining the complex and multidimensional variables at play within a health service that contribute to planning for and delivering effective patient care. Complementary theories, models, frameworks, and tools support the research process by providing a theoretical and practical structure to understanding the local context and guiding successful local implementation. Results This paper provides a rationale for conceptualising the multidimensional approach for implementation using the worked example of a pregnancy, birth, postnatal and early parenting education intervention for expectant and new parents at a large maternity hospital. Conclusion This multidimensional theoretical approach provides useful, practical guidance to health service researchers and clinicians to develop project specific rationale for their theoretical approach to implementation projects.

Die Erzeugung und Nutzung (digitaler) Daten gewinnt nicht nur im unterrichtlichen Kontext zunehmend an Relevanz, sondern Daten beeinflussen auch das Handeln pädagogischer Akteurinnen und Akteure und stellen diese vor (neue) Herausforderungen. Der Beitrag fokussiert hieran anknüpfend das Verständnis von Datenhandeln pädagogischen Personals in dessen Alltag. Unter der Prämisse, dass Metaphern Denk- und Handlungsorientierungen sichtbar und damit auch Un-Sagbares sowie handlungsleitende Sinnstrukturen zum Ausdruck bringen können, rekonstruieren wir die in diesem Zusammenhang gebrauchte Verwendung metaphorischer Konzepte in Interviews mit Schulleitungen. Nach einer kurzen theoretischen und methodischen Rahmung des Artikels werden im empirischen Ergebnisteil vier rekonstruierte metaphorische Konzepte (Datenhandeln ist verwalten, Datenhandeln ist schützen, Datenhandeln ist sichtbarmachen sowie Datenhandeln ist Waren austauschen) vorgestellt und diskutiert. Diese unterscheiden sich zwar hinsichtlich ihrer Funktionen, weisen aber als Common Sense auf ein weitestgehend vergegenständlichtes Verständnis von Daten in Schule hin.

Potassium ion (K+) plays a critical role as an essential electrolyte in all biological systems. Genetically-encoded fluorescent K+ biosensors are promising tools to further improve our understanding of K+-dependent processes under normal and pathological conditions. Here, we report the crystal structure of a previously reported genetically-encoded fluorescent K+ biosensor, GINKO1, in the K+-bound state. Using structure-guided optimization and directed evolution, we have engineered an improved K+ biosensor, designated GINKO2, with higher sensitivity and specificity. We have demonstrated the utility of GINKO2 for in vivo detection and imaging of K+ dynamics in multiple model organisms, including bacteria, plants, and mice.