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We assessed factors associated with mortality and potential targets for intervention in a large national sample of children with nontraumatic intracerebral hemorrhage. Using Healthcare Cost and Utilization Project Kids’ Inpatient Database ICD-9-CM code 431 identified children aged 1 to 18 years with nontraumatic intracerebral hemorrhage in 2003, 2006 and 2009. Intracerebral hemorrhage was the primary diagnosis for 1172 children (ages 1-18 years) over the 3-year sample. Factors associated with mortality based on multivariable logistic regression included Hispanic ethnicity (odds ratio 1.9, 95% confidence interval 1.1-3.3), older age (11-18 vs 1-10 years, odds ratio 2.5, 95% confidence interval 1.3-5.0), coagulopathy (odds ratio 3.0, 95% confidence interval 1.6-6.0), and coma (odds ratio 9.0, 95% confidence interval 3.2-24.6). From 2003 to 2009, there was a non-significant decrease in mortality with a significant increase in length of stay from 9 to 11 days (P < .003). In children with intracerebral hemorrhage, coma and coagulopathy had the strongest association with mortality; coagulopathy is a potentially modifiable risk factor.

Improved survival after cardiac arrest has placed greater emphasis on neurologic resuscitation. The purpose of this pilot study was to evaluate the relationship between cerebrovascular autoregulation and neurologic outcomes after pediatric cardiac arrest.Children resuscitated from cardiac arrest had autoregulation monitoring during the first 72h after return of circulation with an index derived from near-infrared spectroscopy in a pilot study. The range of mean arterial blood pressure (MAP) with optimal vasoreactivity (MAPOPT) was identified. The area under the curve (AUC) of the time spent with MAP below MAPOPT and MAP deviation below MAPOPT was calculated. Neurologic outcome measures included placement of a new tracheostomy or gastrostomy, death from a primary neurologic etiology (brain death or withdrawal of support for neurologic futility), and change in the Pediatric Cerebral Performance Category score (ΔPCPC).Thirty-six children were monitored. Among children who did not require extracorporeal membrane oxygenation (ECMO), children who received a tracheostomy/gastrostomy had greater AUC during the second 24h after resuscitation than those who did not (P=0.04; n=19). Children without ECMO who died from a neurologic etiology had greater AUC during the first 48h than did those who lived or died from cardiovascular failure (P=0.04; n=19). AUC below MAPOPT was not associated with ΔPCPC when children with or without ECMO were analyzed separately.Deviation from the blood pressure with optimal autoregulatory vasoreactivity may predict poor neurologic outcomes after pediatric cardiac arrest. This experimental autoregulation monitoring technique may help individualize blood pressure management goals after resuscitation.

Given the attention around additive manufacturing (AM), organizations want to know if their products should be fabricated using AM. To facilitate product development decisions, a reference system is shown describing the key attributes of a product from a manufacturability stand-point: complexity, customization, and production volume. Complexity and customization scales enable the grouping of products into regions of the map with common levels of the three attributes. A geometric complexity factor developed for cast parts is modified for a more general application. Parts with varying geometric complexity are then analyzed and mapped into regions of the complexity, customization, and production volume model. A discrete set of customization levels are also introduced. Implications for product development and manufacturing business approaches are discussed.

There has been increasing examination of resilience as a concept applicable to climate adaptation. In this paper, resilience is used to explore the layers of responses to past and present climate stress. It examines the factors and circumstances that may hinder or enhance resilience, providing insights into past and present adaptation processes that may be relevant for adaptation to future climate change. Specifically, this paper tests the value of social capital in influencing resilience to climate stress. While there are many examples where social capital influences resilience to climate stress, this paper aims to determine the relative importance of different types of social capital for enhancing resilience, by exploring how relationships of exchange and reciprocity influence responses to climate stress. This study involved case studies of specific communities in the southwest coastal region of Bangladesh. This case study highlights a complex rather than a uniformly positive relationship between social capital and enhancing resilience to climate stress. Specifically, it identifies four types of social capital-based support (with monetary support as a subset) and the interlinkages among the types (and processes) of social capital with diverse effects on resilience. It emphasizes the moral and ethical importance of reconceptualizing resilience with an emphasis on the most vulnerable, as resilience approaches that fail to recognize the differentiated nature of resilience, risk reinforcing vulnerability. Westernized concepts have important benefits, but crucial limitations when applied to the particular conditions, value sets and modes of community working in the south. The uncritical importation of social capital needs to be treated with caution, especially in the context of climate adaptation. © 2014 © 2014 Taylor & Francis.

Aus den Ergebnissen der Deutschen Wirbelsaulenstudie (DWS1), die die Basis der hier vorgestellten DWS-Richtwertestudie (DWS2) darstellen, ist die grundsatzliche Aussage ableitbar, dass auch unterhalb bestimmter Schwellenwerte des Mainz-Dortmunder Dosismodells (MDD) Risiken fur die Entstehung einer bandscheibenbedingten Erkrankung der Lendenwirbelsaule bestehen. In den verwendeten Dosismodellen der DWS1 wurden die Schwellenwerte der Bandscheibendruckkraft, Rumpfvorneigung und Tagesdosis nicht getrennt voneinander, sondern in Kombination variiert. Daher erlaubten die bisherigen Auswertungen der DWS1 keine Aussagen zu Dosismodellen, die durch definierte Absenkung einzelner Eigenschaften des MDD, z. B. der Druckkraft, bei Beibehaltung der ubrigen Eigenschaften gekennzeichnet sind. Ziel der DWS2 ist die wissenschaftlich fundierte Ableitung eines Dosismodells unter Berucksichtigung geeigneter Schwellenwerte. In der DWS2 werden die Schwellenwerte (Bandscheibendruckkraft, Rumpfvorneigung, Tagesdosis) einzeln und anschliesend auch kombiniert variiert. Dabei wird die Anpassungsgute der resultierenden Dosismodelle zur Beschreibung des Dosis-Wirkung-Zusammenhangs auf der Grundlage der kontinuierlichen Dosiswerte anstelle klassierter Daten in der DWS1 und unter Einsatz verschiedener statistischer Methoden [z. B. Akaike-Informationskriterium (AIC), Multi-Modell-Ansatze, fraktionale Polynome] ermittelt. In die Berechnung der Schwellenwerte gingen die Informationen mehrerer gut anpassender, einen breiten Bereich von Schwellenwerten reprasentierender Dosismodelle ein. Unter Einsatz statistischer Mittelungsverfahren (Multi-Modell-Ansatze) liesen sich daraus folgende Schwellenwerte ableiten: eine Bandscheibendruckkraft von 3,2 kN fur Manner und 2,5 kN fur Frauen, ein Rumpfneigungswinkel von 45°, eine Tagesdosis von 2,0 kNh bei Mannern und 0,5 kNh bei Frauen. Weiterhin lies sich eine Verdopplungsdosis des Bandscheibenerkrankungsrisikos von etwa 7 MNh bei Mannern und etwa 3 MNh bei Frauen ermitteln. Die vertiefende Reanalyse der Daten der DWS1 liefert eine wichtige Grundlage zur Beurteilung der Dosis-Wirkung-Beziehung zwischen korperlichen Belastungen und bandscheibenbedingten Erkrankungen. Zunachst sind statistische Unsicherheiten bei der Ableitung von Schwellenwerten sowie die Vereinbarkeit der Studienergebnisse mit den Anforderungen des Berufskrankheitenrechts zu diskutieren, bevor konkrete Folgerungen fur die Berufskrankheit Nr. 2108 gezogen werden konnen.

Children and parents often rely on the support provided by non-parental adults such as extended family members. Expanding conceptualizations of social support beyond traditional nuclear family paradigms to include non-parental adults may be particularly relevant to identifying family strengths among economically disadvantaged and Latino families. In the present study, we examine the extent to which child reports of parenting support provided by non-parental adults are linked to variations in mother-reported parenting efficacy and depressive symptoms, and whether these associations vary according to maternal marital status and Latino/Hispanic race/ethnicity. The present study considers how child-reported social support specific to parenting is associated with maternal self-reported wellbeing among a community sample of 59 mothers and their 10–12 year-old children. Findings indicate that controlling for maternal perceptions of global social-emotional support, parenting support is inversely related to parenting efficacy among single mother and Latino/Hispanic families. Further, Latino/Hispanic children of mothers with higher levels of depressive symptoms report greater support from non-parental adults. These results suggest that parenting support may in this cross-sectional study be a response to maternal need. Further, the function of support from non-parental adults may vary for single-mother versus two-parent families, and Latino/Hispanic families in comparison to European American families.

This study analyzes the transnational migration of interracial cigar workers from Cuba to Tampa, Florida, from the 1880s to the early 1900s, focusing on the cigar workers' attempt to transplant union movement, La Resistencia, from Cuba to the agrarian, nativist, anti-union, Jim Crow American South. By the turn of the century the Cuban emigre workforce accounted for 20% of Tampa's population. The 6000 Cuban cigar makers, about 15% of them Afro-Cubans, toiled in 147 factories and produced almost 148 million cigars, or 20% of the nation's production. This case study also demonstrates an unusual south-to-north immigrant migration that brought with it a need for scholars to further explore, in David Montgomery's memorable phrase, the “racialized nature” of transnational trade unionism. Ultimately, the study argues that racialized union policies transplanted from the Cuban homeland to Florida subverted racial, class, and ethnic norms on which working-class solidarity was grounded in the new “Cigar-Making Capita...

The present research examined whether children's ability to impute false belief is overridden or impaired by content that activates an early-developing, prepotent motivational system: predator avoidance. In three studies, children aged 3 to 8years completed variants of a false-belief test, including analogous predator-avoidance and playmate-avoidances scenarios, in which passing the test meant having the focal character get caught by the pursuer. The proportion of correct answers in the playmate-avoidance scenario was reliably greater than in the predator-avoidance scenario, though this effect largely dissipated by 7 to 8years of age. Enhanced predatory stimuli significantly increased the frequency of false-belief errors in the predator-avoidance scenario (Study 3). Analysis of children's justifications revealed that predator-avoidance false-belief errors were overwhelming motivated by a desire for the prey to avoid the predator (Study 2). The predator-avoidance effect was not an artifact of children generally performing better in playmate than predator–prey scenarios (Studies 1 and 3), the predator-avoidance scenario simply evoking strong emotions (Study 3), or differences between children in their knowledge of predator–prey relationships (Study 1) or executive-function abilities (Study 2). Findings support the hypothesis that activation of the predator-avoidance system generates prepotent response patterns that impair or override full consideration of the mental states of the prey characters in false-belief stories.

Hintergrund Der vorliegende Beitrag erlautert im Wesentlichen den Hintergrund und die Vorgehensweise einer Reanalyse der Daten der Deutschen Wirbelsaulenstudie (DWS) in der sogenannten DWS-Richtwertestudie (DWS2) und greift ausgewahlte Ergebnisse auf. Zur Prufung der arbeitstechnischen Voraussetzungen in Feststellungsverfahren zur Berufskrankheit (BK) 2108 werden Dosisansatze genutzt, bei denen die Wirbelsaulenbelastungen fur alle relevanten Vorgange mit definierter Korperhaltung oder Lastenhandhabung uber typische Schichten und das Berufsleben aufsummiert werden. In der DWS wurden fur alle 4 Fallgruppen (Manner/Frauen mit Prolaps/Chondrose) erhohte Risiken fur bandscheibenbedingte Erkrankungen bei Anwendung von Dosismodellen gefunden, die Belastungen auch unterhalb der Kriterien des gegenwartig angewendeten Mainz-Dortmunder Dosismodells (MDD) sowie Lastenhandhabungen zusatzlich zum Heben oder Tragen einbeziehen.

Purpose Blood oxygenation level-dependent (BOLD)-weighted and vessel-encoded arterial spin labeling (VE-ASL) MRI provide complementary information and can be used in sequence to gauge hemodynamic contributions to cerebrovascular reactivity. Here, cerebrovascular reactivity is assessed using dual echo VE-ASL MRI to understand how VE labeling preparations influence BOLD and ASL contrast in flow-limited and healthy perfusion territories. Methods Patients (n = 12; age = 55 +/– 14 years; 6F/6M) presenting with ischemic steno-occlusive cerebrovascular disease underwent 3.0T angiographic imaging, T1-weighted structural, and planning-free dual echo hypercarbic hyperoxic (i.e., carbogen) VE-ASL MRI. Vasculopathy extent, timecourses, and cerebrovascular reactivity (signal change and Z-statistic) for different VE-ASL images were contrasted across flow territories and Bonferroni-corrected P-values reported. Results BOLD cerebrovascular reactivity (i.e., long-TE VE-ASL) Z-statistics were similarly sensitive to asymmetric disease (P ≤ 0.002) regardless of labeling scenario. Cerebral blood flow reactivity correlated significantly with BOLD reactivity (Z-statistic). However, BOLD signal changes did not differ significantly between labeling scenarios (P > 0.003) or across territories (P > 0.002), indicating BOLD signal changes in response to carbogen offer low sensitivity to lateralizing disease. Conclusion Dual echo VE-ASL can provide simultaneous cerebral blood flow and qualitative BOLD contrast consistent with lateralizing disease severity in patients with asymmetric steno-occlusive disease. The methodological strengths and limitations of composite BOLD and VE-ASL measurements in the clinic are discussed. Magn Reson Med 73:1579–1592, 2015. © 2014 Wiley Periodicals, Inc.

BACKGROUND: Desensitization with intravenous immune globulin (IVIG) and rituximab improves transplantation rates. It is unclear if desensitization increases the risk of polyomavirus BK (BKV) viremia. Here, BKV viremia in HLA-sensitized patients after desensitization with IVIG and rituximab was analyzed. METHODS: Baseline characteristics and outcomes were compared in the desensitized group (N=187) and the non-desensitized group (N=284). Surveillance for BKV viremia was done at 1, 2, 3, 6, 9, and 12 months posttransplant. Univariable and multivariable analyses were performed. RESULTS: BKV viremia was observed in 20% of the desensitized and 10% of the non-desensitized (P

We have developed an efficient, streamlined, cost-effective approach to obtain Investigational New Drug (IND) approvals from the Food and Drug Administration (FDA) for positron emission tomography (PET) imaging probes (while the FDA uses the terminology PET drugs, we are using “PET imaging probes,” “PET probes,” or “probes” as the descriptive terms). The required application and supporting data for the INDs were collected in a collaborative effort involving appropriate scientific disciplines. This path to INDs was successfully used to translate three [18 F]fluoro-arabinofuranosylcytosine (FAC) analog PET probes to phase 1 clinical trials. In doing this, a mechanism has been established to fulfill the FDA regulatory requirements for translating promising PET imaging probes from preclinical research into human clinical trials in an efficient and cost-effective manner. Electronic supplementary material The online version of this article (doi:10.1007/s11307-014-0735-2) contains supplementary material, which is available to authorized users.

Transplant glomerulopathy (TG) is associated with poor long-term allograft survival and is often accompanied by microcirculation inflammation. Histopathologic scoring may inform prognosis and help guide therapy. We retrospectively assessed 33 patients with biopsy-proven TG. All biopsies were given a glomerulitis (g) and peritubular capillaritis (ptc) score. We determined allograft survival and serum creatinine stability in three different score groups: g < 2 and ≥ 2, ptc < 2 and ≥ 2, and (g + ptc) < 4 and ≥ 4. We assessed the impact of treatment with intravenous immune globulin (IVIG) and rituximab on outcomes. Graft survival and serum creatinine stability did not differ in each of the histopathologic score groups. Higher-score groups were associated with the presence of concomitant antibody-mediated rejection and were more likely to receive IVIG and rituximab. Treatment with IVIG and rituximab resulted in stability of serum creatinine within the higher-score groups, but not in the lower-score groups. Stabilization of serum creatinine was associated with an improvement in donor-specific antibody. Histopathologic scoring in kidney allograft biopsies with TG may help guide treatment. The combination of IVIG and rituximab appears to be beneficial in patients whose biopsies have moderate or severe microvascular injury.

The canonical Wnt/β-catenin pathway is involved in the formation of craniofacial skeleton and oral tissues. Aberrant nuclear localization of β-catenin protein has been described in several human diseases including a subset of odontogenic tumors thereby suggesting an important role in tumor development. Fibro-osseous lesions of the craniofacial skeleton comprise several neoplastic, and reactive mesenchymal proliferations in which β-catenin status is unknown. To study this, we immunostained 171 fibro-osseous lesions for β-catenin protein and, for lesions with nuclear positivity, sequenced exon 3 of the CTNNB1 gene and exon 15 of the APC gene. Nuclear β-catenin immunostaining was detected in 34 (20 %) tumors with no correlation between nuclear positivity and either age, gender, or tissue decalcification status (p = 0.2, 0.17, 0.12, respectively). Absent nuclear β-catenin in fibrous dysplasia was the only diagnostically significant finding (p = 0.0034). A single point mutation at Asp56 of CTNNB1 was identified in one case of ossifying fibroma. A second ossifying fibroma and one desmoplastic fibroma demonstrated point mutations (Glu1317 and Glu1536, respectively [corrected] ) in the APC gene. These findings show that apart from fibrous dysplasia where nuclear β-catenin is rare, nuclear β-catenin staining has limited utility in discriminating among the craniofacial fibro-osseous lesions. The molecular mechanisms underlying nuclear β-catenin accumulation in the positive tumors is unlikely to be mediated by CTNNB1 exon 3 or APC exon 15 mutations in most cases.

This reported study was designed to examine the beliefs and perceptions of adolescents on whether or not viewing violence on television contributes to an increase in adolescents’ abilities to learn aggressive attitudes and behaviors. It also explored the effects humor and satire used in the animated television series The Simpsons has on adolescents’ abilities to learn aggressive attitudes and behaviors. Finally, it examined to what extent the violence portrayed in The Simpsons was believed to be realistic and justified by adolescents viewing the show. Results indicate that adolescents were not affected by the violence they observed in The Simpsons animation: Further, they did not feel that it was acceptable for their favorite characters to use violence to solve problems. Youth did not have reactions to viewing the series that were violent, nor did they report becoming aggressive in response to viewing the violence on the The Simpsons. While the majority of the youth also reported that they did not use violence to solve a problem, 3.3% reported that they did. Overall, the study concluded that adolescents’ exposure to violent content by viewing it in animation in The Simpsons did not affect adolescents’ perceptions of their abilities to learn aggressive attitudes and behaviors. Youth did not perceive that the violence portrayed was realistic.

Clinicians who routinely take patient sexual histories have the opportunity to assess patient risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and make appropriate recommendations for routine HIV/STD screenings. However, less than 40% of providers conduct sexual histories with patients, and many do not receive formal sexual history training in school. After partnering with a national professional organization of physicians, we trained 26 (US and US territory-based) practicing physicians (58% female; median age=48 years) regarding sexual history taking using both in-person and webinar methods. Trainings occurred during either a 6-h onsite or 2-h webinar session. We evaluated their post-training experiences integrating sexual histories during routine medical visits. We assessed use of sexual histories and routine HIV/STD screenings. All participating physicians reported improved sexual history taking and increases in documented sexual histories and routine HIV/STD screenings. Four themes emerged from the qualitative evaluations: (1) the need for more sexual history training; (2) the importance of providing a gender-neutral sexual history tool; (3) the existence of barriers to routine sexual histories/testing; and (4) unintended benefits for providers who were conducting routine sexual histories. These findings were used to develop a brief, gender-neutral sexual history tool for clinical use. This pilot evaluation demonstrates that providers were willing to utilize a sexual history tool in clinical practice in support of HIV/STD prevention efforts.

Manuelles Bewegen von Patienten fuhrt bei Beschaftigten im Gesundheitswesen im Allgemeinen zu einer hohen mechanischen Belastung im unteren Ruckenbereich. Ein langfristiges Forschungsvorhaben, die Dritte Dortmunder Lumbalbelastungsstudie (The Dortmund Lumbar Load Study 3, DOLLY 3), wurde durchgefuhrt, um die Lendenwirbelsaulenbelastung von Pflegepersonen wahrend des manuellen Bewegens von Patienten im Pflegebereich fur Tatigkeiten zu untersuchen, die als sicher gefahrdend im Zusammenhang von Berufskrankheiten-Feststellungsverfahren gelten. Neun verschiedene Tatigkeiten mit Patiententransfer im oder am Bett oder Stuhl wurden analysiert. Die Messung von Aktionskraften mit eigens entwickelten Systemen und die Erfassung der jeweils eingenommenen Korperhaltungen mit optoelektronischen und Videokameras, auf deren Basis mehrere Kenngrosen der Lumbalbelastung quantifiziert wurden, sind in einer fruheren Publikation beschrieben. Im vorliegenden Artikel werden die Ergebnisse der Laboruntersuchungen und der anschliesenden biomechanischen Modellrechnungen vorgestellt, die auf die Belastung der Lendenwirbelsaule und auf Moglichkeiten zur Belastungsverringerung durch biomechanisch optimierte Transfermodi statt konventioneller Arbeitsweise sowie durch die zusatzliche Verwendung Kleiner Hilfsmittel wie Gleitmatte und Rutschbrett fokussieren. Die Druckkraft auf die lumbosakrale Bandscheibe kann je nach durchgefuhrter Tatigkeit, Transfermodus und individueller Ausfuhrung erheblich variieren. Die hochsten Werte wurden bei konventioneller Ausfuhrung der Tatigkeiten erhoben, niedrigere Werte ergaben sich durch eine verbesserte Arbeitsweise. Die niedrigsten Druckkraftwerte wurden bei der Verwendung von Kleinen Hilfsmitteln erreicht. Eine statistische Signifikanz wurde fur 13 von 17 derartigen Vergleichen nachgewiesen. Die Analyse der Kenngrosen fur asymmetrische Belastungsanteile zeigte, dass Seitbeuge- und Torsionsmomente an der lumbosakralen Bandscheibe hohe Werte erreichen konnen, die jedoch durch die Nutzung verbesserter Transfermodi wesentlich reduziert werden konnen. Die Bewertung der biomechanischen Belastungen mithilfe von alters- und geschlechtsspezifischen Richtwerten zur Arbeitsgestaltung ergab fur keine der analysierten Tatigkeiten – ungeachtet der Art der Durchfuhrung – Belastungen in akzeptablem Bereich. Demzufolge wird die Anwendung einer biomechanisch angemessenen Arbeitsweise unter Zuhilfenahme Kleiner Hilfsmittel, um beispielsweise die Reibung zwischen Patient und Bettoberflache zu verringern, dringend empfohlen. Diese Masnahmen gelten insbesondere zur Pravention von Uberlastungen fur altere Beschaftigte im Pflegebereich.

BACKGROUND It was demonstrated that human natural killer (NK) cells, via antibody-dependent cellular cytotoxicity (ADCC)-like mechanism, increase IFNγ production after exposure to alloantigens. This finding was associated with an increased risk for antibody-mediated rejection (ABMR). Although the effects of various immunosuppressive drugs on T cells and B cells have been extensively studied, their effects on NK cells are less clear. This study reports the effect of immunosuppressive agents on antibody-mediated NK cell activation in vitro. METHODS Whole blood from normal individuals was incubated with irradiated peripheral blood mononuclear cells (PBMCs) pretreated with anti-HLA antibody+ sera (in vitro ADCC), with or without immunosuppressive agents. The %IFNγ+ and CD107a+ (degranulation marker) in CD56+ NK cells were enumerated by flow cytometry. RESULTS Cyclosporine A and tacrolimus significantly reduced IFNγ production in a dose-dependent manner (53%-83%), but showed minimal effect on degranulation (20%). Prednisone significantly reduced both IFNγ production and degranulation (50%-66% reduction at maximum therapeutic levels). Calcineurin inhibitors (CNIs) in combination with prednisone additively suppressed IFNγ production and degranulation. The effect of sirolimus or mycophenolate mofetil on NK cells was minimal. CONCLUSIONS These results suggest that potent suppressive effects of CNIs and prednisone on antibody-mediated NK cell activation may contribute to the reduction of ADCC in sensitized patients and possibly reduce the risk for ADCC-mediated ABMR. These further underscore the importance of medication compliance in prevention of ABMR and possibly chronic rejection, and suggest that ADCC-mediated injury may increase in strategies aimed at CNI or steroid minimization or avoidance.

The wheat gene Lr1 imparts resistance to certain races of the leaf rust pathogen Puccinia triticina. However, the biological basis underlying the complex resistance mechanisms remains largely unknown. Gene expression profiling analyses using the Affymetrix GeneChip® Wheat Genome Array were performed with six independent Lr1 transgenic lines sampled before inoculation (0 h) and at 6 and 24 h post-inoculation (HPI) with the avirulent P. triticina race CCDS. For the 6- and 24-HPI time points, 3,384 probe sets corresponding to 2,976 transcripts were expressed differentially compared with the plants before inoculation. Genes involved in defence signalling are triggered as early as 6 HPI and include COI1, the primary component of jasmonic acid signalling. By 24 HPI, a shift in plant cellular metabolism, namely carbon conservation, is notable. The enzymes of glycolysis and gluconeogenesis are down-regulated; however, enzymes linked to alternative carbon sequestration processes such as the glyoxylate cycle are up-regulated. Also at 24 HPI, secondary signalling molecules belonging to the various hormone signalling pathways were triggered. These microarray data suggest that the Lr1-mediated leaf rust resistance is achieved by early onset of defence signalling followed by a coordinated interplay of metabolism alteration and elicitation of defence responses.

Medical grade silicones have been employed for decades in medical applications. The associated long-term complications, such as capsule formation and contraction have, however, not been fully addressed yet. The aim of this study is to elucidate if capsule formation and/or contraction can be mitigated by veiling the surface of the silicone during the critical phase after implantation. Medical grade silicone implants are homogeneously coated with a micrometer thin layer of recombinant spider silk proteins. Biocompatibility analysis in vitro and in vivo focuses on specific physiological reactions. Applying quantitative methods for the determination of marker-specific gene expression and protein concentration, it is detected that the silk coating inhibits fibroblast proliferation, collagen I synthesis, and differentiation of monocytes into CD68-positive histiocytes. It significantly reduces capsule thickness, post-operative inflammation, synthesis and re-modeling of extracellular matrix, and expression of contracture-mediating factors. Therefore, coatings made of recombinant spider silk proteins considerably reduce major post-operative complications associated with implantation of silicone-based alloprosthetics, such as capsular fibrosis and contraction, rendering spider silk coatings a bioshield for such implants.

In this paper, spatial and temporal trajectories of land cover/land use change (LCLUC) derived from Landsat data record are combined with hydrological modeling to explore the implication of vegetation dynamics on soil erosion and total suspended sediment (TSS) loading to surface rivers. The inter-annual coefficient of variation (CoV) of normalized difference vegetation index (NDVI) is used to screen the LCLUC and climate change. The Soil and Water Assessment Tool (SWAT) is employed to identify the monthly TSS for two times interval (1991 to 2001 and 2001 to 2011) at subbasin levels. SWAT model is calibrated from 1991 to 2001 and validated from 2002 to 2011 at three USGS gauging sites located in the study area. The Spearman's rank correlation of annual mean TSS is used to assess the temporal trends of TSS dynamics in the subbasins in the two study periods. The spatial correlation among NDVI, LCLUC, climate change and TSS loading rate changes is quantified by using linear regression model and negative/positive trend analysis. Our results showed that higher rainfall yields contribute to higher TSS loading into surface waters. A higher inter-annual accumulated vegetation index and lower inter-annual CoV distributed over the uplands resulted in a lower TSS loading rate, while a relatively low vegetation index with larger CoV observed over lowlands resulted in a higher TSS loading rate. The TSS loading rate at the basin outlet increased with the decrease of annual NDVI due to expanding urban areas in the watershed. The results also suggested nonlinearity between the trends of TSS loading with any of a specific land cover change because of the fact that the contribution of a factor can be influenced by the effects of other factors. However, dominant factors that shape the relationship between the trend of TSS loading and specific land cover changes were detected. The change of forest showed a negative relationship while agriculture and pasture demonstrated positive relationships with TSS loading change. Our results do not show any significant causal relationship between urbanization and the TSS loading change suggesting that further investigation needs to be carried out to understand the mechanism of the impact of urban sprawl on surface water quality.

Moyamoya is a bilateral, complex cerebrovascular condition characterized by progressive non-atherosclerotic intracranial stenosis and collateral vessel formation. Moyamoya treatment focuses on restoring cerebral blood flow (CBF) through surgical revascularization, however stratifying patients for revascularization requires abilities to quantify how well parenchyma is compensating for arterial steno-occlusion. Globally elevated oxygen extraction fraction (OEF) secondary to CBF reduction may serve as a biomarker for tissue health in moyamoya patients, as suggested in patients with sickle cell anemia (SCA) and reduced oxygen carrying capacity. Here, OEF was measured (TRUST-MRI) to test the hypothesis that OEF is globally elevated in patients with moyamoya (n = 18) and SCA (n = 18) relative to age-matched controls (n = 43). Mechanisms underlying the hypothesized OEF increases were evaluated by performing sequential CBF-weighted, cerebrovascular reactivity (CVR)-weighted, and structural MRI. Patients were stratified by treatment and non-parametric tests applied to compare study variables (significance: two-sided P

Background Preformed donor-specific human leukocyte antigen antibodies (DSAs) in patients undergoing simultaneous liver and kidney transplantation (SLKT) are an independent risk factor for poorer patient and renal allograft survival. The outcomes of patients highly sensitized (HS) against HLA antigens undergoing SLKT and select HS SLKT recipients undergoing desensitization at a high-volume desensitization center were investigated. Methods Seventy-five patients undergoing SLKT at a high-volume desensitization center between January 1, 2001, and December 31, 2015, were retrospectively reviewed. HS patients were defined by panel-reactive antibody (PRA) >30% (n = 17 patients), 11 of whom received pre- or perioperative desensitization with high-dose intravenous immunoglobulin (IVIG) ± rituximab. Results HS patients had significantly higher class I and class II PRA (class I = 41.3% ± 40.0% vs 2.5% ± 6.3%; class II = 45.7% ± 36.4% vs 1.0% ± 2.9%; P P = .05), and more likely to have had a prior transplant ( P = .03). HS patients demonstrated greater susceptibility to renal cell-mediated rejection (CMR) (23.5% vs 5.2%, P = .02) compared to nonsensitized patients. Higher renal antibody-mediated rejection (ABMR) was also observed in HS patients, 11.8% vs 3.4%, but did not reach significance ( P = .18). Desensitization in select HS SLKT patients was well tolerated but did not improve patient and allograft survival or significantly curtail rejection. Conclusion HS SLKT recipients demonstrated increased allograft rejection, particularly CMR, but patient and graft survival were not impacted in the first year post-transplant. Select HS SLKT patients tolerated desensitization with high-dose IVIG ± rituximab and may have received additional immunoprotection against ABMR but survival was not affected.

Phytoalexins are substances produced by plants that act as potent inhibitors of pathogens. Pterocarpans are biologically active isoflavonoids most commonly found in the family Fabaceae that have the ability to act as phytoalexins. It is made up of a tetracyclic ring system possessing benzofuran-benzopyran. A very great number of pterocarpans have been isolated from natural sources and they are proved to have significant biological activities such as anti-microbial, anti-cancerous, anti-inflammatory and anti-malarial activities. Recently, pterocarpans gained lot of attention because of the broad range of anti-cancer activities in various cancer cell lines such as breast, leukemia, cervical, lung, colon and melanoma. Interestingly, pterocarpans exhibited inhibitory potency against many enzymes such as PTP1B, Neuraminidase, and α-glycosidase. In addition, they were shown to have anti-estrogenic and anti-diabetic activities. This review is a comprehensive inventory of the structures and sources of pterocarpans and it emphasizes on the biological evaluations of pterocarpans from various plant sources and their scope as a lead molecule.

Background Previous studies have demonstrated that donor-derived cell-free DNA (dd-cfDNA) found in circulating blood of transplant recipients may serve as a noninvasive biomarker of allograft rejection. To better interpret the clinical meaning of dd-cfDNA, it is essential to understand the biological variation of this biomarker in stable healthy recipients. This report establishes the biological variation and clinical reference intervals of dd-cfDNA in renal transplant recipients by using an analytically validated assay that has a CV of 6.8%. Methods We sampled venous blood at patient surveillance visits (typically at posttransplant months 1–4, 6, 9, and 12) in a 14-center observational study. Patients with stable renal allograft function spanning ≥3 serial visits were selected. We used AlloSure®, a targeted next-generation sequencing-based approach, to measure dd-cfDNA in the plasma and computed the intraindividual CV (CVI) and interindividual CV (CVG), the index of individuality (II), and reference change value (RCV). Results Of 93 patients, 61% were men, 56% were Caucasian, mean age was 49 years, and 63% were deceased donor kidney recipients. Of 380 blood samples, the dd-cfDNA median value was 0.21% (interquartile range 0.12%–0.39%) and the 97.5th percentile was 1.20%. In 18 patients with an average of 4.1 tests, the CVI was 21%, CVG was 37%, II was 0.57, and RCV was 61%. Conclusions In a renal transplant recipient, a dd-cfDNA level above 1.2% is out of range and potentially abnormal. A serial increase of up to 61% in level of dd-cfDNA in a patient may be attributable to biological variation. Clinicaltrials.gov Identifier: NCT02424227

Unit V: My Community The 4-H Citizenship Project offers the opportunity to help 4-H members relate all of their 4-H projects and experiences to the world around them. The 4-H Citizenship manuals will serve as a guide for 4-H Citizenship experiences. To be truly meaningful to the real-life needs and interests of your group, the contribution of volunteer leaders is essential. Each person, neighborhood, and community has individual needs that you can help your group identify. This 22-page major revision of Unit V covers the “My Community” project. Written by John Rutledge, Joy C. Jordan, and Dale Pracht and published by the UF/IFAS Extension 4-H Youth Development program. https://edis.ifas.ufl.edu/4h018

The 4-H Citizenship Project offers the opportunity to help 4-H members relate all of their 4-H projects and experiences to the world around them. The 4-H Citizenship manuals will serve as a guide for 4-H Citizenship experiences. To be truly meaningful to the real-life needs and interests of your group, the contribution of volunteer leaders is essential. Each person, neighborhood, and community has individual needs that you can help your group identify. This 23-page major revision of Unit VI covers the “My Government” project. Written by John Rutledge, Joy C. Jordan, and Dale Pracht and published by the UF/IFAS Extension 4-H Youth Development program. https://edis.ifas.ufl.edu/4h020

The 4-H Citizenship Project offers the opportunity to help 4-H members relate all of their 4-H projects and experiences to the world around them. The 4-H Citizenship manuals will serve as a guide for 4-H Citizenship experiences. To be truly meaningful to the real-life needs and interests of your group, the contribution of volunteer leaders is essential. Each person, neighborhood, and community has individual needs that you can help your group identify. This 6-page Volunteer Guide is a major revision written by John Rutledge, Joy C. Jordan, and Dale Pracht and published by the UF/IFAS Extension 4-H Youth Development program. https://edis.ifas.ufl.edu/4h014 Originally published May 1988.

Aims and Objectives: Knee-luxations are severe and rare injuries. Within the last years there is an incline on low velocity trauma leading to a nee-luxation. The luxated knee should be reduced immediately to minimize collateral damage to soft-tissue structures, nerves, vessels, etc. Materials and Methods: We report about a 87-year old man who was brought to our emergency room after he fell out of his bed. He showed a to the lateral side luxated tibial-head, which could not be reduced in analog sedation. The foot pulses could be measured with the Doppler, the patient was under massive pain so we decided to perform an immediate operative intervention. Even under maximum relaxtion the knee stayed in medial luxation. Results: The open reposition showed the destruction of all medial structures including the subcutaneous fat. The medial condyle was completely uncovered. The sartorious fascia, the ruptured M. vastus medialis and fibres of the medial collateral ligament have been trapped in the medial tibial joint line. The reposition was made possible by incision of the sartorious fascia. The tibially ruptured acl was refixated in a modified canula technique, the medial structures were adapted with sutures and additionally stabilized with ligament bracing for the medial collateral ligament. Postoperatively, the knee was immobilized in an external fixation for two week. Afterward we started with functional rehabilitation. The postoperatively obtained CT-angiography showed now traumatic vascular damage. This case is completely foto-documented. Conclusion: The irreducible knee-luxations are rare complications. So far there are 4 cases published. In all cases there has been an interposition of the musculus vastus medialis an the surrounding structures. An immediate open intervenvtion to reposition the knee has to be performed to avoid severe damage to. Especially the elderly patient benefits from a single-staged procedure to reconstruct the ruptured ligaments. To realize the best outcome early functional rehabilitation under close supervision of the surgeon is necessary.

(1) Background: Bone substitutes are essential in orthopaedic surgery to fill up large bone defects. Thus, the aim of the study was to compare diverse bone fillers biomechanically to each other in a clinical-relevant test set-up and to detect differences in stability and handling for clinical use. (2) Methods: This study combined compressive strength tests and screw pullout-tests with dynamic tests of bone substitutes in a clinical-relevant biomechanical fracture model. Beyond well-established bone fillers (ChronOSTM Inject and Graftys&reg, Quickset), two newly designed bone substitutes, a magnesium phosphate cement (MPC) and a drillable hydrogel reinforced calcium phosphate cement (CPC), were investigated. (3) Results: The drillable CPC revealed a comparable displacement of the fracture and maximum load to its commercial counterpart (Graftys&reg, Quickset) in the clinically relevant biomechanical model, even though compressive strength and screw pullout force were higher using Graftys&reg, (4) Conclusions: The in-house-prepared cement allowed unproblematic drilling after replenishment without a negative influence on the stability. A new, promising bone substitute is the MPC, which showed the best overall results of all four cement types in the pure material tests (highest compressive strength and screw pullout force) as well as in the clinically relevant fracture model (lowest displacement and highest maximum load). The low viscosity enabled a very effective interdigitation to the spongiosa and a complete filling up of the defect, resulting in this demonstrated high stability. In conclusion, the two in-house-developed bone fillers revealed overall good results and are budding new developments for clinical use.

Purpose BCMA, a member of the tumor necrosis factor receptor superfamily (TNFRSF17), is selectively expressed during plasma cell differentiation while being nearly absent on naive and memory B cells. Therefore, BCMA appears as a highly selective antigen for mature B-cell targeting. The current study investigated BCMA expression by peripheral B cells and plasma cells during the development of de novo alloantibody responses. Methods A mouse model of allo-sensitization induced by skin allograft was used to study BCMA expression by B cell subsets and plasma cells. Blood samples were collected weekly for measurement of anti-HLA.A2 IgM and IgG titers. PBMCs and splenic lymphocytes were analyzed in FACS for identification of B cell subsets expressing surface BCMA. Splenic B-cells were isolated using EasySep B-cell isolation kit. mRNA expression of TNFRSF17 was studied in quantitative PCR. Results qPCR demonstrated a significant increase in TNFRSF17 mRNA expression by splenic B-cells isolated from HLA.A2 sensitized mice (p=0.004 vs. naive control). Multi-perimeter FACS analysis of splenic lymphocytic cells showed that cell surface BCMA (CD269) was expressed by the majority of CD38+CD138+ plasma cells (60-80%), and by members of CD19+CD23+sIgD+ mature B-cells. CD269 was scarcely expression by early transitional B-cells (CD93+/CD19+/CD23-). Following skin grafting BCMA was increasingly expressed on mature B cells and plasma cells at Days 14 (p=0.03 vs. naive control mice), 21(p=0.004) and 28(p=0.0001) PTx. Increase in BCMA expression by B cells was associated with high DSA IgG titers in the blood, indicating plasmablast differentiation. Conclusion Our data demonstrate that BCMA are increasingly expressed by B/plasma cells during the development of de novo alloantibody responses. Thus, targeting BCMA may serve as a new treatment strategy for desensitization in HLA highly sensitized transplant patients.

Stroke is a feared complication of major trauma.1 Multiple guidelines exist regarding screening for blunt cerebrovascular injury (BCVI)2–5 though reliable estimates of the incidence of stroke after trauma are limited. In this issue of Neurology® , Fox et al.6 utilize a retrospective cohort within the Kaiser Permanente of Northern California (KPNC) system to assess incidence, timing, and risk factors for stroke after trauma in children and adults

Das Deutsch-Sudafrikanische Fellowship der DGOOC ist fur je zwei Stipendiaten dazu bestimmt, das Gastland fur den fachlichen Austausch zu besuchen. Nachfolgend der Bericht der beiden deutschen Stipendiaten, denen der Aufenthalt im September/Oktober 2018 in Sudafrika ermoglicht wurde.

The 4-H Citizenship Project offers you the opportunity to help 4-H members relate all of their 4-H projects and experiences to the world around them. They will learn to care for and share with others through the skills and talents they’ve developed. The 4-H Citizenship manuals will serve as a guide for 4-H Citizenship experiences. To be truly meaningful to the real life needs and interest of your group, your contribution is essential. Each person, neighborhood, and community has individual needs that you can help your group identify. Your challenge is to make Citizenship a real life experience for your group. This 14-page fact sheet is a minor revision written by John Rutledge, Joy C. Jordan, and Dale Pracht, and pubslished by the 4-H Youth Development Department, July 2018. 4HCIM10/4H015: 4-H Exploring Citizenship, Unit I: Me, My Family, and My Friends (ufl.edu)