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Abstract Background Dental Patient Reported Outcomes (PROs) relate to a dental patient’s subjective experience of their oral health. How practitioners and patients value PROs influences their successful use in practice. Methods Semi-structured interviews were conducted with 22 practitioners and 32 patients who provided feedback on using a mobile health (mHealth) platform to collect the pain experience after dental procedures. A themes analysis was conducted to identify implementation barriers and facilitators. Results Five themes were uncovered: (1) Sense of Better Care. (2) Tailored Follow-up based on the dental procedure and patient’s pain experience. (3) Effective Messaging and Alerts. (4) Usable Digital Platform. (5) Routine mHealth Integration. Conclusion Frequent automated and preferably tailored follow-up messages using an mHealth platform provided a positive care experience for patients, while providers felt it saved them time and effort. Patients thought that the mHealth questionnaires were well-developed and of appropriate length. The mHealth platform itself was perceived as user-friendly by users, and most would like to continue using it. Practical implications Patients are prepared to use mobile phones to report their pain experience after dental procedures. Practitioners will be able to close the post-operative communication gap with their patients, with little interruption of their workflow.

Abstract Recent scholarship suggests that groups who oppose acting on climate change have shifted their emphasis from attacking the credibility of climate science itself to questioning the policies intended to address it, a position often called ‘response skepticism’. As television is the platform most used by audiences around the world to receive climate information, we examine 30 news programmes on 20 channels in Australia, Brazil, Sweden, the UK and USA which included coverage of the 2021 report by the Intergovernmental Panel on Climate Change (IPCC) on the Physical Science. Using manual quantitative content analysis, we find that skepticism about the science of climate change is still prevalent in channels that we have classified as ‘right-wing’, but largely absent from channels classified as ‘mainstream’. Forms of response skepticism are particularly common in ‘right-wing’ channels, but also present in some ‘mainstream’ coverage. Two of the most prominent discourses question the perceived economic costs of taking action and the personal sacrifices involved. We explore the implications of our findings for future research and climate communication.

Background Colorectal cancer (CRC) is the third most common cancer worldwide. The incidence of CRC is rising in low- and middle-income countries but decreasing in high-income countries due to the widespread use of surveillance colonoscopy. In Africa, the implementation of screening programs remains a challenge, even in countries, such as Ghana that have established CRC screening guidelines. Objective The purpose of this review was to identify the barriers and recommend strategies for implementing CRC screening in African countries. Methods A literature search using PubMed was conducted with the following search terms: colorectal neoplasm, early detection of cancer, mass screening, colonoscopy, faecal occult blood test, faecal immunochemical test (FIT) and Africa. After inclusion and exclusion criteria were applied, a total of 13 articles were reviewed. Results The most common barriers reported were limited endoscopic capacity, poor knowledge of CRC and CRC screening, health care factors, cultural factors and sociodemographic factors. Recommendations to increase the availability of CRC screening tests were to include the use of FITs, to provide more training for health care providers, and to expand educational programs for patients, physicians, and religious/community leaders. Conclusion The primary barrier to screening for CRC in Africa is the limited endoscopic capacity, specifically the lack of infrastructure and trained personnel, which requires systematic changes by governing bodies. In addition, health care professionals should be involved in educating patients about CRC and CRC screening. Further research is needed to clarify the factors related to subtypes of CRC and to explore the feasibility of using FITs in Africa.

Abstract BackgroundPostoperative dental pain is pervasive and can affect a patient’s quality of life. Adopting a patient-centric approach to pain management involves having contemporaneous information about the patient’s experience of pain and using it to personalize care. ObjectiveIn this study, we evaluated the use of a mobile health (mHealth) platform to collect pain-related patient-reported outcomes over 7 days after the patients underwent pain-inducing dental procedures; we then relayed the information to the dentist and determined its impact on the patient’s pain experience. MethodsThe study used a cluster-randomized experimental study design with an intervention arm where patients were prompted to complete a series of questions relating to their pain experience after receiving automated text notifications on their smartphone on days 1, 3, 5, and 7, with the resulting information fed back to dentists, and a control arm where patients received usual care. Providers were randomized, and patients subsequently assumed the enrollment status of their providers. Providers or their staff identified eligible patients and invited them to participate in the study. Provider interviews and surveys were conducted to evaluate acceptance of the mHealth platform. ResultsA total of 42 providers and 1525 patients participated. For the primary outcome (pain intensity on a 1 to 10 scale, with 10 being the most painful), intervention group patients reported an average pain intensity of 4.8 (SD 2.6), while those in the control group reported an average pain intensity of 4.7 (SD 2.8). These differences were not significant. There were also no significant differences in secondary outcomes, including pain interference with activity or sleep, patient satisfaction with pain management, or opioid prescribing. Patient surveys revealed reluctance to use the app was mostly due to technological challenges, data privacy concerns, and a preference for phone calls over texting. Providers had high satisfaction with the app and suggested integrating additional features, such as an in-system camera for patients to upload pictures and videos of the procedural site, and integration with the electronic health record system. ConclusionsWhile the mHealth platform did not have a significant impact on acute postoperative pain experience, patients and providers indicated improvement in patient-provider communication, patient-provider relationship, postoperative complication management, and ability to manage pain medication prescribing. Expanded collaboration between mHealth developers and frontline health care providers can facilitate the applicability of these platforms, further help improve its integration with the normal clinic workflow, and assist in moving toward a more patient-centric approach to pain management.

Abstract Background Patient-reported outcome measures provide an essential perspective on the quality of health care provided. However, how data are collected, how providers value and make sense of the data, and, ultimately, use the data to create meaningful impact all influence the success of using patient-reported outcomes. Objectives The primary objective is to assess post-operative pain experiences by dental procedure type through 21 days post-procedure as reported by patients following dental procedures and assess patients’ satisfaction with pain management following dental surgical procedures. Secondary objectives are to: 1) assess post-operative pain management strategies 1 week following dental surgical procedures, as recommended by practitioners and reported by patients, and 2) evaluate practitioner and patient acceptance of the FollowApp.Care post visit patient monitoring technology (FollowApp.Care). We will evaluate FollowApp.Care usage, perceived usefulness, ease of use, and impact on clinical workload. Design and methods We describe the protocol for an observational study involving the use of the FollowApp.Care platform, an innovative mobile application that collects dental patients’ assessments of their post-operative symptoms (e.g., pain). The study will be conducted in collaboration with the National Dental Practice-based Research Network, a collective Network of dental practices that include private and group practices, public health clinics, community health centers and Federal Qualified Health Centers, academic institutional settings, and special patient populations. We will recruit a minimum of 150 and up to 215 dental providers and up to 3147 patients who will receive push notifications through text messages FollowApp.Care on their mobile phones at designated time intervals following dental procedures. This innovative approach of implementing an existing and tested mobile health system technology into the real-world dental office setting will actively track pain and other complications following dental procedures. Through patients’ use of their mobile phones, we expect to promptly and precisely identify specific pain levels and other issues after surgical dental procedures. The study’s primary outcome will be the patients’ reported pain experiences. Secondary outcomes include pain management strategies and medications implemented by the patient and provider and perceptions of usefulness and ease of use by patients and providers.

Objective: The purpose of this country report is to analyze the state of radiology in Brazil from its origins to its present state. We detail both the country’s advancements in the field and the areas that could stand to be improved, including increased access to radiology in its less populous, more rural regions. We detail the imaging equipment available in the country and seek to stratify this data among different geographic areas. Materials and Methods: The review was completed using the University at Buffalo catalog and database search. A search was conducted for both U.S. and Brazil based journal articles focused on radiology in Brazil. A general Google search for articles was conducted to obtain information regarding the socioeconomic status and history of Brazil. The Brazilian government’s health system database website was used to obtain data regarding the availability of different diagnostic equipment. Results: Brazil is the largest radiology market in Latin America. It has taken great strides over the past few decades to advance its work in the radiology sector. There are two main areas still in need of improvement: first of all, providing diagnostic imaging resources to remote and rural regions, and second of all, expanding the use of PACS software to all hospitals. Conclusion: The state of radiology in Brazil has vastly improved over the past few decades. Continued investment in diagnostic imaging equipment — while prioritizing less populous and poorer areas — will help both the field of Brazilian radiology and the individuals it serves.

Objective: The state of radiology varies among countries. The purpose of this country report is to analyze the state of radiology in Mexico, how it has changed over the past several years, and how it compares to other countries.Materials and Methods: A review was completed using the University at Buffalo (UB) catalog and database search, as well as a general Google search for articles regarding radiology in Mexico.Results: While the state of radiology has improved over the past several years, the system in Mexico still lacks an adequate number of medical imaging units and an adequate number of radiologists. Both of these factors have contributed to the stagnant state of radiology in Mexico.Conclusion: There are many factors contributing to the state of radiology in Mexico, including a high poverty percentage and low expenditure on healthcare. It is important to increase the number of medical imaging units throughout the country and replace the current aging scanners to help all patients.

Summary: Background: Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods: This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings: In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation: Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding: DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

Introduction: Mental illness remains a significant issue in refugees worldwide. Internationally, there continues to be stigma surrounding mental health, mental illness, and mental health treatment. Cultural stigma is just one of many barriers to mental healthcare for refugees. Perceptions of mental health are culture-specific and continue to play a role in refugees. Purpose: The purpose of this review study is to make distinctions between the perceptions of mental health of refugees based on country of origin because knowing these cultural differences has the potential to improve refugee mental healthcare. This knowledge could contribute to treatment approaches and help break some of the barriers to mental healthcare for refugees. Methodology: An extensive literature review of relevant articles published between 2000-2021 was performed using the databases APA PsycInfo, Global Health, MEDLINE via Ovid, CINAHL Plus with Full Text, and Google Scholar. The following search terms, in addition to other related and relevant terms, were used: “mental health, refugees, mental health barriers, perceptions of mental illness, country of origin.” Results: There were both numerous similarities and differences between the perceptions of mental health among refugees from different cultures. There were similarities in terms of mental health stigma, with certain cultures thinking of mental health/illness as taboo, as shameful, or associating it with evil spirits. A few of the cultures studied had similar ideas about the causes of mental illness, believing it was due to traumatic events or possession by evil spirits. The refugee groups had some common treatment options, including informal conversation, religious-based ideas, and community-level solutions. Some differences between refugees from different cultures involved certain symptoms associated with mental health, including physical symptoms, and differing degrees of religiosity. Discussion: Based on studies reviewed about the perceptions of mental health of various refugee cultures, many recommendations are proposed to improve refugee mental healthcare. Suggestions include focusing on cultural competency and community-level solutions, in addition to implementing mobile health clinics and telehealth. Conclusions: This review discusses the perceptions of mental health, mental illness, and mental health treatment of refugees from numerous countries of origin. It is unique in its inclusion of different groups of refugees. Culture seems to play a significant role in the perceptions encountered. Keeping culture in mind, several recommendations are made to improve refugee mental healthcare, such as more integrative treatment methods and telehealth.

Background: Teleradiology has grown tremendously across the globe, providing significant benefits to both patients and physicians. In the late 1990s, South Africa sought to lead teleradiology adoption efforts by creating a national telemedicine system through a structured and phased approach. Although initial reports of the system’s effectiveness were encouraging, the present status of this project, as well as comparable efforts in surrounding developing countries, has remained uncertain. Objective: To explore the status of teleradiology adoption in Africa, identify existing barriers to adoption, and explore potential solutions to the most commonly identified barriers. Methods: A narrative literature review was conducted to find articles that discussed current and past teleradiology systems in Africa. Each item was evaluated for relevance separately based on specified inclusion and exclusion criteria and was used to field further articles if relevant to the topic, even if not found in the initial search. The search began with articles published after January 1995 and included articles through December 2021. Findings: Although teleradiology systems in Africa has shown to have a benefit in improving patient outcomes, current implementation remains limited due to feasibility projects with no singular picture archiving and communication system (PACS) being utilized at the time of writing. Conclusions: Although teleradiology has significant potential and can benefit the developing countries in Africa, further expansion, in terms of both complexity and adoption rates, remains hindered by infrastructure development, clinician and technologist support, and general sociopolitical factors.

Acidihalobacter is a genus of acidophilic, gram-negative bacteria known for its ability to oxidize pyrite minerals in the presence of elevated chloride ions, a capability rare in other iron-sulfur oxidizing acidophiles. Previous research involving Acidihalobacter spp. has focused on their applicability in saline biomining operations and their genetic arsenal that allows them to cope with chloride, metal and oxidative stress. However, an understanding of the molecular adaptations that enable Acidihalobacter spp. to thrive under both acid and chloride stress is needed to provide a more comprehensive understanding of how this genus can thrive in such extreme biomining conditions. Currently, four genomes of the Acidihalobacter genus have been sequenced: Acidihalobacter prosperus DSM 5130T, Acidihalobacter yilgarnensis DSM 105917T, Acidihalobacter aeolianus DSM 14174T, and Acidihalobacter ferrooxydans DSM 14175T. Phylogenetic analysis shows that the Acidihalobacter genus roots to the Chromatiales class consisting of mostly halophilic microorganisms. In this study, we aim to advance our knowledge of the genetic repertoire of the Acidihalobacter genus that has enabled it to cope with acidic stress. We provide evidence of gene gain events that are hypothesized to help the Acidihalobacter genus cope with acid stress. Potential acid tolerance mechanisms that were found in the Acidihalobacter genomes include multiple potassium transporters, chloride/proton antiporters, glutamate decarboxylase system, arginine decarboxylase system, urease system, slp genes, squalene synthesis, and hopanoid synthesis. Some of these genes are hypothesized to have entered the Acidihalobacter via vertical decent from an inferred non-acidophilic ancestor, however, horizontal gene transfer (HGT) from other acidophilic lineages is probably responsible for the introduction of many acid resistance genes.

Objective: To assess the efficacy and safety of oral sodium chloride (Slow Sodium®) as hyponatraemia prophylaxis in patients with World Federation of Neurosurgical Societies (WFNS) Grade 1 and Grade 2 aneurysmal subarachnoid haemorrhage (aSAH). Methods: This prospective cohort study was conducted at Royal Victoria Hospital in Northern Ireland over two separate periods between 2015 and 2017, a total of 60 patients with aneurysmal subarachnoid haemorrhage were recruited. During Phase 1 (Jan 2015–Oct 2015), 32 patients were studied before hospital subarachnoid haemorrhage (SAH) protocol was modified. In Phase 2 (Jul 2016–Jan 2017), 28 patients received prophylactic oral sodium chloride (Slow Sodium®) in addition to standard SAH protocol. Primary outcomes were: incidence of hyponatraemia, length of hospital stay and Glasgow Outcome Scale (GOS) at a median of 4 months post-SAH; secondary outcome was the incidence of vasospasm. Results: Patients in Phase 2 demonstrated significantly lower incidence of hyponatraemia (p = 0.0006), shorter hospital stay (p

Third cranial nerve palsy (3cnP) following traumatic brain injury (TBI) is a worrying neurological sign and is often associated with an expanding mass lesion, such as extradural or acute subdural haematomas. Isolated 3cnP can be found in the absence of posttraumatic space-occupying mass lesion, yet it is often considered as a devastating prognostic factor in the context of diffuse axonal injury (DAI). Through the analysis of five exemplificative cases and a thorough review of the literature, we identified four possible mechanisms leading to 3cnP: (1) a partial rootlet avulsion at the site of exit from the midbrain, representing a direct shearing injury to the nerve; (2) a direct traction injury due to the nerve stretching against the posterior petroclinoid ligament at the base of the oculomotor triangle secondary to the downward displacement of the brainstem at the time of impact; (3) a direct vascular compression as a result of internal carotid artery (ICA) dissection or pseudoaneurysm; (4) an indirect injury caused by impaired blood supply to the third nerve in addition to the detrimental biochemical effects of the underlying brain injury itself. Understanding the exact mechanism underlying the onset of 3cnP is key to provide an informed clinical decision-making to the patients and ensure their best chances of recovery. Our experience corroborates data from the literature showing that, even in Grade III DAI, prompt recognition of isolated 3cnP can guide adequate treatment. Nonetheless, even when an overall good neurological outcome is achieved, recovery of isolated 3cnP is dismal, and only rarely the visual deficit completely resolves.

Background Intracerebral hemorrhage (ICH) risk is higher in elderly patients with atrial fibrillation on antithrombotic therapy as well as those with cerebral amyloid angiopathy (CAA). We investigated if mortality among patients with atrial fibrillation on antithrombotic therapy presenting with non‐traumatic ICH was influenced by underlying CAA. Methods and Results We used the Rochester Epidemiology Project to identify 6045 patients with atrial fibrillation aged >55 years on anticoagulation or antiplatelet therapy from 1995 to 2016. Seventy‐four patients in this cohort presented with non‐traumatic ICH. Medical records including imaging data were reviewed to identify those with CAA and record baseline variables and outcomes of interest; 38 of our 74 patients (51.4%) (mean age 81.5 years) met Modified Boston Criteria for possible or probable CAA. Twenty‐six of 74 patients (35%) died during the first 30 days while 56 of the 74 (76%) patients died by 10 years follow‐up after index ICH. Overall mortality was not significantly different between the CAA and non‐CAA groups at any point of time during follow‐up (P=0.89) even amongst patients restarted on anticoagulation +/− antiplatelet (n=19) (P=0.46) or those patients restarted only on antiplatelet therapy (n=22) (P=0.66). Three of the 41 patients who restarted on antithrombotic therapy had a recurrent ICH; these 3 patients met criteria for possible or probable CAA. Conclusions Although more than half of our patients with atrial fibrillation on antithrombotic therapy and non‐traumatic ICH met Modified Boston Criteria for CAA, CAA did not significantly influence the high mortality seen in this cohort.

Background: Sub-Saharan Africa faces an increasing burden of non-communicable diseases. In particular, hypertension and its therapeutic control present a challenge and opportunity for health practitioners and health systems within the region. Aim: This study sought to assess an initiative conducted by two health clinics to begin treatment of hypertension amongst their patient populations by reviewing medication possession rates and documenting patient-reported barriers to care in the provision of chronic hypertension management. Setting: Two private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives. Methods: A retrospective chart review identified 487 records of patients with diagnosed hypertension and assessed for medication adherence through calculation of medication possession ratios from pharmacy refill data. Surveys were conducted on a convenience sample of 68 patients of the hypertension treatment programme to discern patient-reported barriers of care. Results: Medication possession rates were found to be less than 40% in 82% (399/487) of patients, between 40% and 79% in 12% (60/487) of patients and 80% or greater in 6% (28/487) of patients. In surveys of individuals being treated by the programme, patients were most likely to cite transportation (81%, 55/68), financial burden (69%, 47/68) and schedule conflicts with work or other prior commitments (25%, 17/68) as barriers to care. Conclusions: In this newly instituted outpatient hypertensive management initiative, 82% of patients had medication possession ratios under 40%, which is likely to impact the clinical effectiveness of the initiative. The most frequent patient-reported barriers to care in surveys included transportation, financial burden and schedule conflicts.

Abstract Background The decision to initiate or maintain a healthy habit, such as physical activity involves a trade-off between a short-term cost, such as time and effort, which are commonly identified as barriers to physical activity, and a long-term health benefit. Research suggests that individual time preference may be associated with unhealthy behaviors. However, empirical evidence of this for physical activity is scant. This study investigated the relationship between time preference and physical activity, and how this might influence behavior change. Methods Employees (n = 176; mean age 42.2 years) who participated in a physical activity intervention were invited to take part in a behavioral economic field experiment. Two economic experiments, using multiple price lists and monetary trade-off tables involving real money choices, were conducted face-to-face with participants to measure the two components of time preference, namely present-bias and discount rate. Together with individual risk preferences, these three variables were jointly estimated by maximum likelihood. These three parameters were expressed as a linear function of the levels of physical activity while controlling for socio-demographic variables within the same maximum likelihood framework. Results Those who were present-biased and who had higher discount rates did significantly less physical activity than their patient and non present-biased counterparts. A 3% lower discount rate and 1.14 unit decrement in the present-bias parameter was associated with a 30 min increase of physical activity per week. This negative association was more significant for certain sub-groups, such as younger and married adults and those with higher staff grade and those who have children. Participants who dropped out of the study earlier were more present-biased. Conclusions Results demonstrated that discount rate and present-biasedness have a significant impact on physical activity levels. Such concepts have been largely overlooked and underutilized in physical activity interventions. Promising implications include 1) utilizing individuals’ time preferences to better target interventions; 2) taking account of time preferences in the intervention design; 3) interventions attempting to correct for present-biasedness.

Encoded Library Technology (ELT) has streamlined the identification of chemical ligands for protein targets in drug discovery. Here, the authors optimize the ELT approach to screen multiple proteins in parallel and identify promising targets and antibacterial compounds forS. aureus, A. baumannii and M. tuberculosis.

Kidney stones are a common urologic condition with a high amount of recurrence. Recurrence depends on a multitude of factors the incidence of precursors to kidney stones, plugs, and plaques. One method of characterising the stone precursors is endoscopic assessment, though it is manual and time-consuming. Deep learning has become a popular technique for semantic segmentation because of the high accuracy that has been demonstrated. The present Letter examined the efficacy of deep learning to segment the renal papilla, plaque, and plugs. A U-Net model with ResNet-34 encoder was tested; the Letter examined dropout (to avoid overtraining) and two different loss functions (to address the class imbalance problem. The models were then trained in 1666 images and tested on 185 images. The Jaccard-cross-entropy loss function was more effective than the focal loss function. The model with the dropout rate 0.4 was found to be more effective due to its generalisability. The model was largely successful at delineating the papilla. The model was able to correctly detect the plaques and plugs; however, small plaques were challenging. Deep learning was found to be applicable for segmentation of an endoscopic image for the papilla, plaque, and plug, with room for improvement.

In this paper we study the singularities of the invariant metric of the Poincaré bundle over a family of abelian varieties and their duals over a base of arbitrary dimension. As an application of this study we prove the effectiveness of the height jump divisors for families of pointed abelian varieties. The effectiveness of the height jump divisor was conjectured by Hain in the more general case of variations of polarized Hodge structures of weight $-1$ .

Human pulmonary epithelial cells are protected by two layers of fluid—the outer watery periciliary liquid layer (PCL) and the uppermost non-Newtonian mucus layer (ML). Aerosols and inhaled toxic particles are trapped by the ML which must then be removed swiftly to avoid adverse health implications. Epithelial cells are covered with cilia that beat rapidly within the PCL. Such ciliary motion drives the mucus transport. Although cilia can penetrate slightly inside the mucus to assist mucus movement, the motion of the underlying PCL layer within the airway surface liquid (ASL) is significant in mucus and pathogens transport. As such, a detailed parametric study of the influence of different abnormal cilia characteristics, such as low beating frequency, short length, abnormal beating pattern, reduced ciliary density, and epithelium patchiness due to missing cilia on the PCL transport, is carried out numerically. Such abnormalities are found in various chronic respiratory diseases. In addition, the shear stress at the epithelium is assessed due to the importance of shear stress on the epithelial function. Using the immersed boundary (IB) method combined with the finite-difference projection method, we found that the PCL, under standard healthy conditions, has net forward motion but that different diseased conditions decrease the forward motion of the PCL, as is expected based on clinical understanding.

The function of microtubules relies on their ability to switch between phases of growth and shrinkage. A nucleotide-dependent stabilising cap at microtubule ends is thought to be lost before this switch can occur; however, the nature and size of this protective cap are unknown. Using a microfluidics-assisted multi-colour TIRF microscopy assay with close-to-nm and sub-second precision, we measured the sizes of the stabilizing cap of individual microtubules. We find that the protective caps are formed by the extended binding regions of EB proteins. Cap lengths vary considerably and longer caps are more stable. Nevertheless, the trigger of instability lies in a short region at the end of the cap, as a quantitative model of cap stability demonstrates. Our study establishes the spatial and kinetic characteristics of the protective cap and provides an insight into the molecular mechanism by which its loss leads to the switch from microtubule growth to shrinkage.

Nature Communications 8: Article number: 16081 (2017); Published: 17 July 2017, Updated: 13 July 2018 The original version of this Article omitted the following from the Acknowledgements: ‘We thank Robert Kirkpatrick for implementing the high throughput protein design strategy that enabled screeningand triage of essential A.

Articulated education pathways between the vocational education training sector and universities provide opportunities for students wishing to progress to higher qualifications. Enrolled nurses seeking to advance their career in nursing can choose to enter baccalaureate degree programs through such alternative entry routes. Awarding of credit for prior studies is dependent on accurate assessment of the existing qualification against that which is sought. This study employed a modified Delphi method to inform the development of an evidence-based, structured approach to mapping the pathway from the nationally consistent training package of the Diploma of Nursing to the diversity of baccalaureate nursing programs across Australia. The findings of this study reflect the practical nature of the role of the enrolled nurse, particularly the greater emphasis placed on direct care activities as opposed to those related to professional development and the generation and use of evidence. These findings provide a valuable summative overview of the relationship between the Diploma of Nursing and the expectations of the registered nurse role.

Botrytis cinerea is a filamentous plant pathogen of a wide range of plant species, and its infection may cause enormous damage both during plant growth and in the post-harvest phase. We have constructed a cDNA library from an isolate of B. cinerea and have sequenced 11,482 expressed sequence tags that were assembled into 1,003 contigs sequences and 3,032 singletons. Approximately 81% of the unigenes showed significant similarity to genes coding for proteins with known functions: more than 50% of the sequences code for genes involved in cellular metabolism, 12% for transport of metabolites, and approximately 10% for cellular organization. Other functional categories include responses to biotic and abiotic stimuli, cell communication, cell homeostasis, and cell development. We carried out pair-wise comparisons with fungal databases to determine the B. cinerea unisequence set with relevant similarity to genes in other fungal pathogenic counterparts. Among the 4,035 non-redundant B. cinerea unigenes, 1,338 (23%) have significant homology with Fusarium verticillioides unigenes. Similar values were obtained for Saccharomyces cerevisiae and Aspergillus nidulans (22% and 24%, respectively). The lower percentages of homology were with Magnaporthe grisae and Neurospora crassa (13% and 19%, respectively). Several genes involved in putative and known fungal virulence and general pathogenicity were identified. The results provide important information for future research on this fungal pathogen

The videogame industry is a considerable market: in 2012, the industry was worth over $86 billion USD and about seventy-two percent of American households play videogames. It is unsurprising, then, that commercial and educational developers and/or researchers have sought to capitalise on videogames. Games and simulation technologies have been used for educational purposes for thousands of years prior to the digital era (Gee 2007). Digital games, however, offer many new affordances including increased accessibility, reinforced automation (i.e., fair and consistent application of rules), embedded data-gathering for assessment, dynamic adaptation to student needs, the ability to simulate complex situations for student inquiry in a safe context, and reduced overall costs (Jin and Low 2011). However, it is difficult to assess the process of serious game development and effectiveness of educational play. Many serious games retrofit assessment late into the project, creating a gap between original intents and the game's current uses, limiting effectiveness of measuring and meeting the project's goals. As such, we propose an assessment framework that synthesises work from various fields (educational assessment, game design, usability, project management) that aims to guide researchers and game developers through a project from its inception to the end by presenting specific topics to address and questions to answer throughout the game design phase of the project. By building assessment into the game development from the get-go, original intents and a game's current uses can more closely align, allowing for stronger, purposeful games. L’industrie du jeu vidéo est un marché appréciable. En 2012, elle dépassait 86 milliards de dollars US et environ soixante-douze pour cent des ménages américains jouent aux jeux vidéo. Il n’est pas surprenant alors que des concepteurs et des chercheurs de la sphère commerciale et éducationnelle ont cherché à tirer profit des jeux vidéo. Bien avant l’avènement de l’ère numérique, jeux et technologie de simulation étaient utilisés à des fins pédagogiques (Gee 2007). Le jeu vidéo offre toutefois de nouvelles affordances : accessibilité accrue, automatisation renforcée (c.-à-d. l’application juste et systématique des règles), collecte de données intégrée pour l’évaluation, adaptation dynamique aux besoins des élèves, possibilité de simuler des situations complexes pour l’expérience de recherche de l’élève dans un contexte sécuritaire et, finalement, réduction des coûts globaux (Jin and Low 2011). Il est toutefois difficile d’évaluer le processus de conception de jeux sérieux et l’efficacité du jeu éducationnel. De nombreux jeux sérieux intègrent l’évaluation tard dans le projet, créant un écart entre les intentions originelles et les utilisations actuelles du jeu, limitant ainsi l’efficacité à mesurer et respecter les objectifs du projet. À ce titre, nous proposons un cadre d’évaluation synthétisant les travaux dans divers domaines (évaluation pédagogique, conception de jeu, facilité d’utilisation, gestion de projet) qui guiderait chercheurs et concepteurs de jeux dans un projet, de son lancement à sa fin, en présentant des sujets précis à traiter et des questions à répondre pendant la phase conception du jeu du projet. L’incorporation dès le départ de l’évaluation dans la conception du jeu permettrait un meilleur alignement des intentions premières et des utilisations actuelles du jeu, permettant ainsi une expérience de jeux plus forte et plus significative.

Although bulk changes in red blood cell concentration between vessels have been well characterised, local distributions are generally overlooked. Red blood cells aggregate, deform and migrate within vessels, forming heterogeneous distributions which have considerable effect on local haemodynamics. The present study reports data on the local distribution of human red blood cells in a sequentially bifurcating microchannel, representing the branching geometry of the microvasculature. Imaging methodologies with simple extrapolations are used to infer three dimensional, time-averaged velocity and haematocrit distributions under a range of flow conditions. Strong correlation between the bluntness of the velocity and haematocrit profiles in the parent branch of the geometry is observed and red blood cell aggregation has a notable effect on the observed trends. The two branches of the first bifurcation show similar characteristics in terms of the shapes of the profiles and the extent of plasma skimming, despite the difference in geometric configuration. In the second bifurcation, considerable asymmetry between the branches in the plasma skimming relationship is observed, and elucidated by considering individual haematocrit profiles. The results of the study highlight the importance of considering local haematocrit distributions in the analysis of blood flow and could lead to more accurate computational models of blood flow in microvascular networks. The experimental approaches developed in this work provide a foundation for further examining the characteristics of microhaemodynamics.

Urinary incontinence is a debilitating problem in women with significant effects on quality of life. The tension free vaginal tape (TVT) improves urinary symptoms and achieves a high rate of patient satisfaction. The aim of the study was to evaluate the effect of TVT on vaginal symptoms, pelvic floor function and in turn quality of life. We hypothesize that the TVT is associated with an improvement in pelvic floor function. A prospective questionnaire- based analysis was conducted over a period of ten months in patients undergoing the TVT procedure. The International Consul - tation on Incontinence Modular Questionnaire - Vaginal Symptoms questionnaire was used to evaluate the vaginal symptoms pre-operatively and 6 months post-operatively. The results were compared to assess for any significant differences. A total of 31 patients were recruited for the study. There was a statistically significant improvement in vaginal symptoms score at 6 months in women undergoing TVT along with an improvement in urinary symptoms. This study suggests a positive impact of TVT insertion on vaginal symptomatology, which is an exciting prospect influencing patient counseling for treatment options of urinary stress incontinence. This finding may have an impact on performing concomitant surgeries for stress incontinence and pelvic organ prolapse. There is a need for further large–scale research to explore this aspect of unexpected benefit from the TVT.

Abstract This resource was created to support faculty assessment of dental student performance in the predoctoral comprehensive care clinic. This resource consists of an instructor's guide, the quarterly student evaluation by faculty form, the quarterly student self-evaluation form, and the criteria for the final course grade. At approximately 10 week intervals, each faculty member that has worked with the student in clinical patient contact completes the quarterly evaluation form, noting a subjective assessment of each student's current status with regard to each of the six domains and adding written comments regarding the student's strengths and weaknesses, as well as suggestions for professional growth. At the same point in time, the student will complete the quarterly student self-evaluation form and submit it to the group leader. The group leader compiles all the evaluations of the faculty; student progress is discussed together amongst faculty in faculty conferences each 10 weeks throughout the course. After each faculty conference, the group leader provides students with formal face-to-face individual feedback regarding current grade status, perceived strengths, shortcomings, and suggestions for professional growth. At these meetings, the group leader and the student also review the student's self-evaluation form, with particular focus on how this self-evaluation compares with the faculty assessments. The forms and protocols included here were developed and refined specifically for use in the Family Dentistry program at the University of Iowa College of Dentistry. These assessment tools were created to guide learning, reinforce learning, and to support dental student evaluation in the predoctoral comprehensive care clinic. The forms and protocols presented here have been in use in our clinical program since 2007. They are reviewed and refined annually, and have proven to be effective in achieving our objectives.

Urinary incontinence is a debilitating problem in women with significant effects on quality of life. The tension free vaginal tape (TVT) improves urinary symptoms and achieves a high rate of patient satisfaction. The aim of the study was to evaluate the effect of TVT on vaginal symptoms, pelvic floor function and in turn quality of life. We hypothesise that the TVT is associated with an improvement in pelvic floor function. A prospective questionnaire-based analysis was conducted over a period of ten months in patients undergoing the TVT procedure. The ICIQ-VS questionnaire was used to evaluate the vaginal symptoms pre-operatively and 6 months post-operatively. The results were compared to assess for any significant differences. A total of 31 patients were recruited for the study. There was a statistically significant improvement in vaginal symptoms score at 6 months in women undergoing TVT along with an improvement in urinary symptoms. This study suggests a positive impact of TVT insertion on vaginal symptomatology, which is an exciting prospect influencing patient counseling for treatment options of urinary stress incontinence. This finding may have an impact on performing concomitant surgeries for stress incontinence and pelvic organ prolapse. There is a need for further large–scale research to explore this aspect of unexpected benefit from the TVT.

Background Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH.Methods We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression.Results 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia.Conclusions In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care.