Making migraine easier to stomach: the role of the gut-brain-immune axis in headache disorders

BACKGROUND AND PURPOSE

Headache disorders place a significant burden on the healthcare system, being the leading cause of disability in those under 50 years. Novel studies have interrogated the relationship between headache disorders and gastrointestinal dysfunction, suggesting a link between the gut-brain-immune (GBI) axis and headache pathogenesis. Although the exact mechanisms driving the complex relationship between the GBI axis and headache disorders remain unclear, there is a growing appreciation that a healthy and diverse microbiome is necessary for optimal brain health.

METHODS

A literature search was performed through multiple reputable databases in search of Q1 journals within the field of headache disorders and gut microbiome research and were critically and appropriately evaluated to investigate and explore the following; the role of the GBI axis in dietary triggers of headache disorders and the evidence indicating that diet can be used to alleviate headache severity and frequency. The relationship between the GBI axis and post-traumatic headache is then synthesized. Finally, the scarcity of literature regarding paediatric headache disorders and the role that the GBI axis plays in mediating the relationship between sex hormones and headache disorders are highlighted.

CONCLUSIONS

There is potential for novel therapeutic targets for headache disorders if understanding of the GBI axis in their aetiology, pathogenesis and recovery is increased.

Music medicine to improve the tolerability of onabotulinumtoxinA injections for chronic migraine: an open-label prospective cohort study

Introduction

OnabotulinumtoxinA for migraine involves 31 injected repeated every 12 weeks. Tolerability is a significant factor impacting discontinuation. Music medicine has not been studied previously as an intervention to improve the tolerability of injections.

Methodology

A single-centre prospective cohort study was undertaken. Following baseline, patients had music played during the procedure. Change in Visual Analogue Score (VAS) was assessed as the primary outcome.

Results

Over 6 months, 50 patients were recruited with a median age of 42, and median duration of therapy of 13.5 months. 'Quiet calm classical music' was associated with a significant reduction in VAS (z=-4.7, p<0.001). Duration of therapy, disease state or headache frequency had no correlation with change in VAS.

Conclusion

Music medicine is associated with a significant reduction in the procedural pain of onabotulinumtoxinA injections in prospective study. Further study is required to explore other modifiable factors to improve patient experience.

Parent-child nature visits and young Finnish childreńs nature connectedness

Background

It is well-known that frequent nature visits are associated with health benefits in children. Global climate crisis and environmental challenges emphasize the need for reconnecting children to nature, as well. Young children’s nature connectedness (NC) involves enjoyment of nature, sense of responsibility, empathy, and awareness of nature. The study examines whether there is an association between the frequency of parent-child nature visits and young children’s NC.

Methods

The study uses WEB survey data from the Finnish Empowered by Nature project. Respondents, n = 1463, were parents of children aged 2 to 7 years old. NC was assessed by 11-items derived from the NC questionnaire of Sobko et al (2018). Multinomial logistic regression analysis was used and the lowest tertile of NC was used as reference group. Analysis were adjusted for child’s age and gender, and highest education of parent.

Results

Children with moderate (1-2 times a week in previous month) or high (3 times a week or more) frequency of parent-child nature visits were more likely to have strong than weak NC compared to children with low frequency (less than once a week) of adult-child nature visits. Odds ratios (OR) in adjusted models were: moderate frequency 1.67 (1.21- 2.32), and high frequency 2.31 (1.67-3.18). The odds of having medium NC compared to weak NC were more likely in moderate frequency compared to low frequency of parent-child nature visits in the adjusted model (OR 1.46; 1.07-2.00).

Conclusions

The results highlight the importance of parents visiting nature frequently with their children during early childhood. It promotes young children’s NC and may further contribute to raising environmentally responsible children.

Key messages

• More frequent parent-child visits promote young children’s nature connectedness which involves enjoyment of nature, sense of responsibility, empathy, and awareness of nature.

• A strong nature connectedness among children is highly relevant, as it may contribute to raise environmentally responsible children.

LärMiljö (Learning Environment) - study protocol: movement, outdoor learning and well-being in school

Background

Outdoor education (OE) is a teaching method aiming to promote children’s learning, physical activity (PA) and wellbeing. OE in green areas may further increase positive effects. There is little knowledge on use of OE and its possible effects in a Finnish context. Also, there is a need to evaluate OE from a teacher perspective. The aim of the LärMiljö-study is to: a) survey the use of OE in Swedish-language primary schools and investigate factors related to its use; b) investigate the associations between OE and PA, wellbeing, nature relations and learning among children aged 9-13 years, considering other related factors.

Methods

The self-determination theory (SDT) is used as theoretical framework. Data is collected via electronic surveys in Swedish-language primary schools, including: a) national surveys among principals and teachers; b) surveys among children and guardians. Children’s PA is measured for a 7-day period via accelerometers and a diary is kept. Teachers keep a class diary on OE provided. Academic tests are performed. Data will be analyzed using quantitative methods.

Results

This abstract describes the study protocol. The investigation of associations between OE and outcomes among children is mainly done by comparing classes that regularly use OE with classes that do not. Main outcomes are PA, psychosocial wellbeing, academic performance and nature connectedness; secondary outcomes are school motivation, social relations and sleep. Teachers’ experience and use of OE is explored, as is perceived effects of and barriers to OE use. Based on SDT, associations between OE and need satisfaction at work, competence, motivation and work engagement are studied.

Conclusions

The study represents a unique opportunity to explore OE use in primary schools, its effects among children and teachers, and what the supporting and hindering factors for its use are. The study contributes knowledge that can be used to promote learning and wellbeing in school.

Key messages

• Outdoor education in primary school may promote schoolchildren’s learning, physical activity, wellbeing and nature relation, but more knowledge is needed, including the perspective of teachers.

• The LärMiljö-study will broaden the understanding of the potential effects of OE in primary education and school health promotion, and on factors supporting and hindering its use.

Association of Neurocritical Care Services With Mortality and Functional Outcomes for Adults With Brain Injury: A Systematic Review and Meta-analysis

Importance

Neurocritical care (NCC) aims to improve the outcomes of critically ill patients with brain injury, although the benefits of such subspecialized care are yet to be determined.

Objective

To evaluate the association of NCC with patient-centered outcomes in adults with acute brain injury who were admitted to intensive care units (ICUs). The protocol was preregistered on PROSPERO (CRD42020177190).

Data Sources

Three electronic databases were searched (Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials) from inception through December 15, 2021, and by citation chaining.

Study Selection

Studies were included for interventions of neurocritical care units (NCCUs), neurointensivists, or NCC consulting services compared with general care in populations of neurologically ill adults or adults with acute brain injury in ICUs.

Data Extraction and Synthesis

Data extraction was performed in keeping with PRISMA guidelines and risk of bias assessed through the ROBINS-I Cochrane tool by 2 independent reviewers. Data were pooled using a random-effects model.

Main Outcomes and Measures

The primary outcome was all-cause mortality at longest follow-up until 6 months. Secondary outcomes were ICU length of stay (LOS), hospital LOS, and functional outcomes. Data were measured as risk ratio (RR) if dichotomous or standardized mean difference if continuous. Subgroup analyses were performed for disease and models of NCC delivery.

Results

After 5659 nonduplicated published records were screened, 26 nonrandomized observational studies fulfilled eligibility criteria. A meta-analysis of mortality outcomes for 55 792 patients demonstrated a 17% relative risk reduction (RR, 0.83; 95% CI, 0.75-0.92; P = .001) in those receiving subspecialized care (n = 27 061) compared with general care (n = 27 694). Subgroup analyses did not identify subgroup differences. Eight studies including 4667 patients demonstrated a 17% relative risk reduction (RR, 0.83; 95% CI, 0.70-0.97; P = .03) for an unfavorable functional outcome with subspecialized care compared with general care. There were no differences in LOS outcomes. Heterogeneity was substantial in all analyses.

Conclusions and Relevance

Subspecialized NCC is associated with improved survival and functional outcomes for critically ill adults with brain injury. However, confidence in the evidence is limited by substantial heterogeneity. Further investigations are necessary to determine the specific aspects of NCC that contribute to these improved outcomes and its cost-effectiveness.

Added value of Joint ENT-Rheumatology clinic in the management of ANCA-associated vasculitis: One year's experience

PURPOSE

ANCA-associated vasculitides (AAV) represent a group of diagnoses, including granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA) and microscopic polyangiitis (MPA). Most commonly, they present initially with ENT-associated symptomatology, and therefore they often pose a diagnostic challenge. We aim to present our one-year experience in the joint management of AAV in a multi-disciplinary setting.

METHODS

We performed a retrospective analysis based on the records of 39 patients who were seen in the joint clinic, during a period of one year.

RESULTS

After clinical assessment, 13 patients had changes made to their ENT treatment, 2 had some changes in their immunosuppression, while 11 had changes in both ENT and Rheumatology treatment. Six patients did not require any alterations to their therapeutic scheme. On average three separate appointments were reduced to a single appointment in the joint clinic where definitive treatment decisions were made. This led to significant cost reductions.

CONCLUSIONS

Cost-effectiveness, patient satisfaction, rapid multi-disciplinary evaluation, avoidance of unnecessary immunosuppression, patient education and medical training are only a few of the many advantages of this proposed joint service.

Do neurocritical care units improve outcomes for brain-injured adults: a protocol for a systematic review and meta-analysis

INTRODUCTION

Neurocritical care is a rapidly developing subspecialty within intensive care medicine which aims to improve outcomes of critically ill neurological patients. This has inspired the formation of specialised intensive care units or services to provide dedicated care of brain-injured patients, as well as new training pathways for physicians. However, expansion has been variable worldwide and it is yet to be determined if there are clear benefits in regard to patient outcomes. We are planning a systematic review with meta-analysis to assess whether the introduction of neurocritical care units or services, or neurointensivists have favourable effects on survival.

METHODS AND ANALYSIS

We will include all observational and interventional studies comparing specialised neurocritical care units or services with general or non-specialised units in the care of acutely brain-injured adults. The primary outcome will be all-cause mortality at the longest follow-up, and secondary outcomes will be intensive care unit and hospital length of stay, and functional outcomes. All relevant studies will be identified through database searches. All study selection and data extraction will be conducted by two independent reviewers. We will conduct a random-effects meta-analysis to synthesise evidence for all outcomes. In addition, we will perform a subgroup analysis by disease process. We will assess confidence in the cumulative evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework.

ETHICS AND DISSEMINATION

This systematic review and meta-analysis does not require ethical approval. We will publish findings from this systematic review in a peer-reviewed scientific journal and present these at conferences. It will be included in the primary author's higher degree research thesis.

PROSPERO REGISTRATION NUMBER

CRD42020177190.

Neurological implications of COVID-19: a review of the science and clinical guidance

COVID-19 is a significant global health burden. The pulmonary morbidity and mortality of COVID-19 is well described, however, there is mounting evidence of neurological manifestations of SARS-CoV-2, which may be of prognostic significance. This paper summarises the available evidence in order to provide clinicians with a concise summary of the peripheral and central neurological manifestations of COVID-19, discusses specific issues regarding the management of chronic neurological disease in the context of the pandemic, and provides a summary of the thrombotic implications of the disease for the neurologist.

Generation and Characterization of Anti-Glucosepane Antibodies Enabling Direct Detection of Glucosepane in Retinal Tissue

Although there is ample evidence that the advanced glycation end-product (AGE) glucosepane contributes to age-related morbidities and diabetic complications, the impact of glucosepane modifications on proteins has not been extensively explored due to the lack of sufficient analytical tools. Here, we report the development of the first polyclonal anti-glucosepane antibodies using a synthetic immunogen that contains the core bicyclic ring structure of glucosepane. We investigate the recognition properties of these antibodies through ELISAs involving an array of synthetic AGE derivatives and determine them to be both high-affinity and selective in binding glucosepane. We then employ these antibodies to image glucosepane in aging mouse retinae via immunohistochemistry. Our studies demonstrate for the first time accumulation of glucosepane within the retinal pigment epithelium, Bruch's membrane, and choroid: all regions of the eye impacted by age-related macular degeneration. Co-localization studies further suggest that glucosepane colocalizes with lipofuscin, which has previously been associated with lysosomal dysfunction and has been implicated in the development of age-related macular degeneration, among other diseases. We believe that the anti-glucosepane antibodies described in this study will prove highly useful for examining the role of glycation in human health and disease.

The application of a haemorrhage assessment tool in evaluating control of bleeding in a pilot trauma haemorrhage trial

OBJECTIVES

To determine whether it was feasible to use a haemorrhage assessment tool (HAT) within a trauma trial and whether the data obtained could differentiate patients who had achieved haemostasis.

BACKGROUND

Major haemorrhage is one of the leading causes of death worldwide, affecting 40% of trauma patients. Clinical trials evaluating haemostatic interventions often use transfusion outcomes as a primary endpoint. Transfusion is highly dependent on local practice, limiting its reliability as a robust, transferable endpoint.

METHODS

A five-point HAT questionnaire was applied to participants enrolled into the EFIT-1 trial. This RCT evaluated the feasibility of administering a 6 g fibrinogen concentrate to patients with severe trauma haemorrhage.

RESULTS

Of participants, 98% completed a HAT; 75% participants had 'achieved haemostasis' at the time of tool completion, as determined by clinical acumen alone. HAT scores were able to differentiate which participants required transfusion after 3 h. Of participants, 56% were transfused red blood cells when they scored 0-2, compared to 17% with HAT scores between 3 and 5.

CONCLUSION

This study has confirmed the feasibility of using a HAT during the emergency care of patients suffering trauma haemorrhage, and future studies should be conducted to determine its value as an endpoint in haemostasis studies.

Exploring the association between ingestion of foods with higher potential salicylate content and symptom exacerbation in chronic rhinosinusitis. Data from the National Chronic Rhinosinusitis Epidemiology Study

INTRODUCTION

Pharmacological salicylates are known to trigger respiratory exacerbations in patients with Non-Steroidal Exacerbated Respiratory Disease (N-ERD), a specific phenotype of Chronic Rhinosinusitis (CRS) and asthma. The impact of dietary sources of salicylates across subgroups of CRS is not well understood. The hypothesis is that in patients with nasal polyps present, there is likely to be a higher incidence of symptom exacerbation due to dietary salicylates regardless of any known response to pharmacological salicylate.

METHODS

The Chronic Rhinosinusitis Epidemiology Study (CRES) was a questionnaire-based case-control study which sought to characterise the UK CRS population in terms of sociological, economic and medical factors. Using specific questions to examine participant responses relating to symptom exacerbation from food groups thought to be high in salicylate content, this analysis of the CRES database sought to compare an estimate of the prevalence of dietary sensitivity due to food with higher potential salicylate content across patients with CRS with (CRSwNPs) and without nasal polyposis (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS).

RESULTS

The CRSwNPs group were significantly more likely than controls to report symptom exacerbation due to ingestion of food groups with higher potential dietary salicylate content. The same trend was observed amongst CRSsNPs participants to a lesser degree. Reported response to the individual specific food groups wine, nuts, spicy foods, fruit and vegetables demonstrated that a statistically significant proportion of CRSwNPs and AFRS participants reported sensitivity to wine.

CONCLUSIONS

This analysis suggests that there is an association between symptom exacerbation in response to food products with higher potential salicylate content, specifically wine, in CRS patients both with and without nasal polyposis when compared to controls, but especially in the CRSwNPs and AFRS phenotypes. Further studies are needed to detail if this relationship represents a causal relationship to dietary salicylate. The data present the possibility that a wider group of CRS patients may elicit salicylate sensitivity than those with known N-ERD.

Circulating miRNAs as non-invasive biomarkers to predict aggressive prostate cancer after radical prostatectomy

BACKGROUND

Prostate cancer is an extremely heterogeneous disease. Despite being clinically similar, some tumours are more likely to recur after surgery compared to others. Distinguishing those that need adjuvant or salvage radiotherapy will improve patient outcomes. The goal of this study was to identify circulating microRNA that could independently predict prostate cancer patient risk stratification after radical prostatectomy.

METHODS

Seventy-eight prostate cancer patients were recruited at the Odette Cancer Centre in Sunnybrook Health Sciences Centre. All patients had previously undergone radical prostatectomy. Blood samples were collected simultaneously for PSA testing and miRNA analysis using NanoString nCounter technology. Of the 78 samples, 75 had acceptable miRNA quantity and quality. Patients were stratified into high- and low-risk categories based on Gleason score, pathological T stage, surgical margin status, and diagnostic PSA: patients with Gleason ≥ 8; pT3a and positive margin; pT3b and any margin; or diagnostic PSA > 20 µg/mL were classified as high-risk (n = 44) and all other patients were classified as low-risk (n = 31).

RESULTS

Using our patient dataset, we identified a four-miRNA signature (miR-17, miR-20a, miR-20b, miR-106a) that can distinguish high- and low-risk patients, in addition to their pathological tumour stage. High expression of these miRNAs is associated with shorter time to biochemical recurrence in the TCGA dataset. These miRNAs confer an aggressive phenotype upon overexpression in vitro.

CONCLUSIONS

This proof-of-principle report highlights the potential of circulating miRNAs to independently predict risk stratification of prostate cancer patients after radical prostatectomy.

Unusual Cause of Pediatric Vaginal Bleeding: Infantile Capillary Hemangioma of the Cervix

BACKGROUND

The differential diagnosis for pediatric prepubertal vaginal bleeding is wide. Rare etiologies include vascular malformations and tumors, such as infantile hemangiomas (IHs), which validate the usefulness of exam under anesthesia, vaginoscopy, and tissue diagnosis.

CASE

We report a case of an IH in a 6-year-old girl causing vaginal bleeding requiring transfusion. Vaginoscopy revealed a cervical IH of less than 1 cm. Expectant management and oral propranolol were successful management options.

SUMMARY AND CONCLUSION

Rare, even small soft tissue tumors such as IH can lead to impressive blood loss via vaginal bleeding. Accurate tissue diagnosis and a multidisciplinary approach are essential to planning safe, effective treatment, and follow-up.

Microwave absorption properties of reduced graphene oxide strontium hexaferrite/poly(methyl methacrylate) composites

The key factors to consider when designing microwave absorber materials for eradication of electromagnetic (EM) pollution are absorption of incident EM waves and good impedance matching. By keeping these things in mind, flexible microwave absorber composite films can be fabricated by simple gel casting techniques using reduced graphene oxide (RGO) and strontium ferrite (SF) in a poly(methyl methacrylate) (PMMA) matrix. SF nanoparticles are synthesized by the well known sol-gel method. Subsequently, reduced graphene oxide (RGO) and SF nanocomposite (RGOSF) are prepared through a chemical reduction method using hydrazine. The structure, morphology, chemical composition, thermal stability and magnetic properties of the nanocomposite are characterized in detail by various techniques. The SF particles are found to be nearly 500 nm and decorated on RGO sheets as revealed by field emission scanning electron microscopy and transmission electron microscopy analysis. Fourier transform infrared and and Raman spectroscopy clearly show the presence of SF in the graphene sheet by the lower peak positions. Finally, ternary polymer composites of RGO/SF/PMMA are prepared by an in situ polymerization method. Magnetic and dielectric studies of the composite reveal that the presence of RGO/SF/PMMA lead to polarization effects contributing to dielectric loss. Also, RGO surrounding SF provides a conductive network in the polymer matrix which is in turn responsible for the magnetic loss in the composite. Thus, the permittivity as well as the permeability of the composite can be controlled by an appropriate combination of RGO and SF in PMMA. More than 99% absorption efficiency is achieved by a suitable combination of magneto-dielectric coupling in the X-band frequency range by incorporating 9 wt% of RGO and 1 wt% of SF in the polymer matrix.

From inter-agency to multidisciplinary work in a sector generic mental health team

The effects of establishing a full multidisciplinary community psychiatric team in central London are described. The nature of referrals, and referrers' satisfaction with the service were examined during two comparable six-month periods, before and after the changes. The number and severity of referrals increased, and referrers were more satisfied with the new service. In contrast to the inter-agency model, the new multidisciplinary team was associated with more appropriate referral of those patients with the greatest need for specialist services. Clinical skill mix in the team and referrer education are the two factors most likely to have promoted these important changes. The key role of the psychiatrist in a full multidisciplinary team who can empower multi-professional case managers in their day-to-day management of severely ill patients is highlighted.

Curtailment of Higher Surgical Training in the UK: Likely Effects in Otology

Higher surgical training in the UK faces a cut of two years. We conducted a questionnaire survey to assess the operative experience of current higher surgical trainees in otological surgery and the likely effect of the proposed reduction from six to four years.

91 (65%) of the 142 higher surgical trainees responded with details of major otological procedures performed (independently or assisting) over one year. In the present six-year scheme a typical trainee performs 72 myringoplasties, 79 mastoidectomies, 7 skull base procedures and 28 other procedures. In the first four years, however, his or her experience is only 39 myringoplasties, 44 mastoidectomies, 4 skull base procedures and 7 others.

The large shortfall in experience that might result from shortening of the training programme would need to be met by intensification of the training or institution of accredited otology fellowships. Very similar dilemmas are faced by other surgical specialties.

Risk factors for tick exposure in suburban settings in the Northeastern United States

Prevention of tick-borne diseases requires an understanding of when and where exposure to ticks is most likely. We used an epidemiologic approach to define these parameters for residents of a Lyme-endemic region. Two persons in each of 500 Connecticut households were asked to complete a log each night for one week during June, 2013. Participants recorded their whereabouts in 15min increments (indoors, outdoors in their yard, outdoors on others' private property, or outdoors in public spaces) and noted each day whether they found a tick on themselves. Demographic and household information was also collected. Logs were completed for 934 participants in 471 households yielding 51,895 time-place observations. Median participant age was 49 years (range 2-91 years); 52% were female. Ninety-one participants (9.8%) reported finding a tick during the week, with slightly higher rates among females and minors. Household factors positively associated with finding a tick included having indoor/outdoor pets (odds ratio (OR)=1.7; 95% confidence interval (CI): 1.1-2.9), the presence of a bird feeder in the yard (OR=1.9; CI:1.2-3.2), and presence of an outdoor dining area (OR=2.2; CI:1.1-4.3). Individual factors associated with finding a tick on a given day were bathing or showering (OR=3.7; CI:1.3-10.3) and hours spent in one's own yard (OR=1.2, CI:1.1-1.3). Nineteen participants found ticks on multiple days, more than expected assuming independence (p<0.001). Participants who found ticks on multiple days did not spend more time outdoors but were significantly more likely to be male than those finding ticks on a single day (p<0.03). Our findings suggest that most tick exposures in the study area occurred on private property controlled by the respective homeowner. Interventions that target private yards are a logical focus for prevention efforts.

Subacute Cerebellar Degeneration due to a Paraneoplastic Phenomenon Associated with Metastatic Merkel Cell Carcinoma: A Case Report

Purpose

The aim of this article is to illustrate the diagnostic challenges and management of paraneoplastic neurological syndromes in Merkel cell carcinoma.

Materials and Methods

We describe a previously functionally independent 85-year-old woman who presented with subacute onset of dizziness and gait ataxia in the setting of metastatic Merkel cell carcinoma.

Results

Diagnosis was made on biopsy after positron emission tomography imaging revealed increased metabolic activity in 2 left inguinofemoral lymph nodes. Cerebrospinal fluid analysis was positive for anti-Hu on subsequent admission. Her functional status improved with methylprednisolone treatment and radiotherapy.

Conclusion

The case highlights the challenge of the evaluation of patients who present with progressive cerebellar signs and the need to consider a paraneoplastic syndrome, especially in the setting of previous malignancy.

trans-4,4'-Dihydroxystilbene (DHS) protects PC12 cells from oxidative damage but induces reactive oxygen species-mediated apoptosis in SHSY-5Y cell line

Polyphenols can exert both, antioxidant and pro-oxidant properties, depending on cell types as well as their concentrations. Hence, it was of interest to examine if the naturally occurring resveratrol analog, trans-4,4'-dihydroxystilbene (DHS) also exert both these activities in a biphasic or cell-specific manner. In this study, we established the cytoprotective action of DHS against hydrogen peroxide (H2O2)-induced apoptotic death of the PC12 cells. DHS reduced mitochondrial membrane permeabilization and deactivated reactive oxygen species (ROS)-mediated caspase-3 activation in the H2O2-treated PC12 cells. However, it induced apoptosis in the human neuroblastoma SHSY-5Y cell line by destabilizing mitochondrial membrane, augmenting ROS and activating caspapse-3. DHS showed better activity than resveratrol in both the chosen models.

IMAGEtags: Quantifying mRNA Transcription in Real Time with Multiaptamer Reporters

Cell communications are essential to the organization, development, and maintenance of multicellular organisms. Much of this communication involves changes in RNA transcription and is dynamic. Most methods for studying transcription require interrupting the continuity of cellular function by sacrificing the communicating cells and capturing gene expression information by periodic sampling of individual cells or the population. The IMAGEtag technology to quantify RNA levels in living cells, demonstrated here in yeast, allows individual cells to be tracked over time as they respond to different environmental cues. IMAGEtags are short RNAs consisting of strings of a variable number of tandem aptamers that bind small-molecule ligands. The aptamer strings can vary in length and in configuration of aptamer constituents, such as to contain multiples of the same aptamer or two or more different aptamers that alternate in their occurrence. A minimum effective length is about five aptamers. The maximum length is undefined. The small-molecule ligands are enabled for imaging as fluorophore conjugates. For each IMAGEtag, two fluorophore conjugates are provided, which are FRET pairs. When a cell expresses an RNA containing an IMAGEtag sequence, the aptamers bind their ligands and bring the fluorophores into sufficiently close proximity to allow FRET. The background fluorescence of both fluorophores is minimal in the FRET channel. These features endow IMAGEtags with the sensitivity to report on mRNA expression levels in living cells.

Search for a Higgs boson in the diphoton final state in pp collisions at sqrt[s]=1.96 TeV

A search for a narrow Higgs boson resonance in the diphoton mass spectrum is presented based on data corresponding to 7.0  fb{-1} of integrated luminosity from pp collisions at sqrt[s]=1.96  TeV collected by the CDF experiment. No evidence of such a resonance is observed, and upper limits are set on the cross section times branching ratio of the resonant state as a function of Higgs boson mass. The limits are interpreted in the context of the standard model and one fermiophobic benchmark model where the data exclude fermiophobic Higgs bosons with masses below 114  GeV/c{2} at a 95% Bayesian credibility level.

A Bayesian approach for estimating bioterror attacks from patient data

Terrorist attacks using an aerosolized pathogen have gained credibility as a national security concern after the anthrax attacks of 2001. Inferring some important details of the attack quickly, for example, the number of people infected, the time of infection, and a representative dose received can be crucial to planning a medical response. We use a Bayesian approach, based on a short time series of diagnosed patients, to estimate a joint probability density for these parameters. We first test the formulation with idealized cases and then apply it to realistic scenarios, including the Sverdlovsk anthrax outbreak of 1979. We also use simulated outbreaks to explore the impact of model error, as when the model used for generating simulated epidemic curves does not match the model subsequently used to characterize the attack. We find that in all cases except for the smallest attacks (fewer than 100 infected people), 3-5 days of data are sufficient to characterize the outbreak to a specificity that is useful for directing an emergency response.