Cervical wear pathobiology by robot-simulated 3-year toothbrushing - New methodological approach

OBJECTIVES

An ex-vivo study was aimed at (i) programming clinically validated robot three-year random toothbrushing, (ii) evaluating cervical macro- and microwear patterns on all tooth groups of different functional age, (iii) documenting and codificating wear related morphological features at the cemento-enamel junction in young teeth and on roots in older teeth.

DESIGN

Following ethical approval random toothbrushing (44 strokes per tooth horizontally, rotating, vertically; 2x/d) with manual toothbrushes and low-abrasive dentifrice was performed in an artificial oral cavity with brushing-force 3.5 N on 14 extracted human teeth. Morphological features were examined by SEM at baseline and after simulated 3 years using the replication technique. 3D-SEM analyses were carried out with a four-quadrant back scattered electron detector. Wilcoxon-Mann-Whitney-test was used for statistical analyses.

RESULTS

3-year random toothbrushing with horizontal, rotating and vertical brushing movements revealed morphological features classified as four enamel patterns, one dentin pattern and three cervical patterns. Negative impacts were enamel, cementum and dentin loss. Positive impact on oral health was removing dental calculus and straightening cervical traumatic and iatrogenic damages. The volume loss varied from x̅=34.25nl to x̅=87.75nl. Wear extended apically from 100 to 1500 micrometres.

CONCLUSION

Robot simulated toothbrushing in an artificial oral cavity, with subsequent SEM and 3D-SEM assessment, elucidated both negative and oral health-contributing micromorphology patterns of cervical wear after simulated 3-year random toothbrushing. Cervical macro- and microwear of cementum revealed, for the first time, what we describe as overhanging enamel peninsulas and enamel islands on roots in young teeth, but no enamel islands on roots from older teeth after root cementum loss. In contrast, many older teeth exhibited enamel peninsulas.

Novices cannot fill the examiners' shoes: Evidence of footwear examiners' expertise in shoe comparisons

The value of a footwear examiner's opinion centres on their ability to determine whether a particular shoe made an impression with greater accuracy than a novice. However, there has been limited research on the expertise of footwear examiners and the accuracy and reproducibility of their decisions. In the current study, we measured the accuracy and consensus of 31 footwear examiners versus a comparison group of 29 novices. Participants completed 20 ground truth known mock shoe comparisons. Results demonstrated that footwear examiners were more accurate than novices, regardless of comparison difficulty. Overall, on trials where probative decisions were given, examiners made false identifications and false exclusions on a total of 3% and 2% of trials, while novices made false identifications and false exclusions on a total of 19% and 17% of trials. Examiners also demonstrated better consensus in their opinions than novices, although both groups demonstrated low levels of agreement in their responses and variability in their interpretation of the conclusion scale. In summary, these findings support the proposition that footwear examiners show expert-level performance in matching known and unknown footwear impressions. These performance estimates may help the criminal justice system to appropriately value footwear examination evidence.

Current State of Private Practice and Academic Interventional Radiology: Differences in Practice Structure, Case Mix, and Productivity

PURPOSE

To investigate whether private practice interventional radiology (IR) groups self-report higher overall productivity given differing case mix and more diagnostic radiology interpretation.

MATERIALS AND METHODS

A 60-question survey was distributed to 3,159 self-identified US IR physicians via the Society of Interventional Radiologists member search engine, with 357 responses (11.3% response rate). Of these responses, there were 258 unique practices from 34 US states.

RESULTS

Out of 84 IR group responses, private practice IR (PPIR) physicians reported a minimal trend for higher annual work relative value units (wRVUs) per clinical full-time equivalent compared with academic IR physicians (8,000 versus 7,140, P = .202), but this did not reach statistical significance. PPIR groups reported fewer median weekly hours (50 versus 52), more frequent call (every 6 versus every 5 days), and significantly higher median tenured compensation ($573,000 versus $451,000, P = .000). Out of 179 responses, academic practices reported significantly higher case percentages of interventional oncology and complex hepatobiliary intervention (P <.001), and private practices reported significantly higher percentages of musculoskeletal intervention (P < .001) with a nonsignificant trend for stroke or neurologic intervention (P = .010). Private practices reported more wRVUs from the interpretation of diagnostic imaging, at 26% of total wRVU production compared with 7% of total wRVU production for academic practices (P < .001; n = 131).

CONCLUSIONS

Self-reported data from private and academic IR groups suggest minimally higher wRVUs per clinical full-time equivalent among PPIRs with lower weekly work hours, more frequent call, differing case mix, and significantly higher tenured compensation among PPIR groups.

Synchronized beamline at FLASH2 based on high-order harmonic generation for two-color dynamics studies

We present the design, integration, and operation of the novel vacuum ultraviolet (VUV) beamline installed at the free-electron laser (FEL) FLASH. The VUV source is based on high-order harmonic generation (HHG) in gas and is driven by an optical laser system synchronized with the timing structure of the FEL. Ultrashort pulses in the spectral range from 10 to 40 eV are coupled with the FEL in the beamline FL26, which features a reaction microscope (REMI) permanent endstation for time-resolved studies of ultrafast dynamics in atomic and molecular targets. The connection of the high-pressure gas HHG source to the ultra-high vacuum FEL beamline requires a compact and reliable system, able to encounter the challenging vacuum requirements and coupling conditions. First commissioning results show the successful operation of the beamline, reaching a VUV focused beam size of about 20 µm at the REMI endstation. Proof-of-principle photo-electron momentum measurements in argon indicate the source capabilities for future two-color pump-probe experiments.

Set-up of GoLBeT, a pragmatic clinical trial of podoconiosis management in a low-resource setting

 

Clinical trials are often perceived as being expensive, difficult and beyond the capacity of academic groups and healthcare workers in low-resource settings. However, in order to improve healthcare coverage, the WHO World Health Report 2013 stated that all countries need to become generators as well as recipients of data. This study is a methodological examination of the steps and processes involved in setting up the Gojjam Lymphoedema Best Practice Trial (GoLBeT; ISRCTN67805210), a highly pragmatic clinical trial conducted in northern Ethiopia. Challenges to the trial and strategies used to deal with them were explored, together with reasons for delays. A qualitative approach using the Global Health Research Process Map as a framework was used to analyse emails and reports from the period between trial inception and recruitment. This analysis was complemented by interviews with key informants from the operational team and a group discussion. This study showed that the key areas of difficulty in setting up and planning this trial were: the study design (definition and measurement of the study endpoint, and assuring statistical power); recruitment and appropriate training of staff; planning for data quality; and gaining regulatory approvals. Collaboration was essential to successfully setting up the trial. Other important aspects were a team and process perspective, staff training, community engagement, and data quality e.g., through data management. Lessons learnt from this trial might guide in planning pragmatic trials in settings where research is not common, allowing researchers to anticipate challenges and address them through trial design, planning and operational delivery. We also hope that this example might encourage similar pragmatic studies to be undertaken. Such studies are rarely undertaken or locally led, but are an accessible and efficient way to drive improved outcomes in public health.

Key messages

Pragmatic clinical trials are essential to drive improved outcomes in public health in low-resource settings, but are perceived as challenging to set up and initiate. Our analysis of the Gojjam Lymphoedema Best Practice Trial found that factors for a successful set-up were collaborations, a team perspective, staff training, community engagement and data management.

Research and innovation as a catalyst for food system transformation

BACKGROUND

Food systems are associated with severe and persistent problems worldwide. Governance approaches aiming to foster sustainable transformation of food systems face several challenges due to the complex nature of food systems.

SCOPE AND APPROACH

In this commentary we argue that addressing these governance challenges requires the development and adoption of novel research and innovation (R&I) approaches that will provide evidence to inform food system transformation and will serve as catalysts for change. We first elaborate on the complexity of food systems (transformation) and stress the need to move beyond traditional linear R&I approaches to be able to respond to persistent problems that affect food systems. Though integrated transdisciplinary approaches are promising, current R&I systems do not sufficiently support such endeavors. As such, we argue, we need strategies that trigger a double transformation - of food systems and of their R&I systems.

KEY FINDINGS AND CONCLUSIONS

Seizing the opportunities to transform R&I systems has implications for how research is done - pointing to the need for competence development among researchers, policy makers and society in general - and requires specific governance interventions that stimulate a systemic approach. Such interventions should foster transdisciplinary and transformative research agendas that stimulate portfolios of projects that will reinforce one another, and stimulate innovative experiments to shape conditions for systemic change. In short, a thorough rethinking of the role of R&I as well as how it is funded is a crucial step towards the development of the integrative policies that are necessary to engender systemic change - in the food system and beyond.

The use of Atlantic hagfish (Myxine glutinosa) as a bioindicator species for studies on effects of dumped chemical warfare agents in the Skagerrak. 2. Biochemical biomarkers

The sea bottom of the Skagerrak Strait (North Sea) contains munitions loaded with chemical warfare agents (CWA), mostly stored in shipwrecks scuttled intentionally after the end of the World War II. The munition shells inside the wrecks are in different states of deterioration and corrosion and their environmental risk potential is unknown. The Atlantic hagfish (Myxine glutinosa), a sediment-dwelling chordate, was used as a model organism to study the potential impact of dumped CWA on the local ecosystem by using biochemical biomarkers. The hagfish were collected in 2017 and 2018 at three sampling sites: in the immediate vicinity of a wreck with CWA in the Skagerrak, a few kilometres from the wreck, and a reference site 21 km from the wreck, considered to be free of CWA. Significant differences were observed between the wreck site and the reference sites in the activities of glutathione reductase, superoxide dismutase and glutathione S-transferase, while the activity levels of catalase and acetylcholinesterase were identical at all sites. The recorded differences demonstrated negative biological effects in the hagfish sampled close to the dumped chemical munitions. Due to the limited knowledge of hagfish biology and of the extent of CWA contamination in Skagerrak, the results presented here warrant more research to further elucidate the potential environmental risks of the scuttled wrecks. The usefulness of the species as a bioindicator organism is further discussed.

The use of Atlantic hagfish (Myxine glutinosa) as a bioindicator species for studies on effects of dumped chemical warfare agents in the Skagerrak. 1: Liver histopathology

Within the framework of the international project DAIMON (Decision Aid for Marine Munitions), the impact of dumped chemical munitions on fish health was investigated. The Skagerrak Straight (North Sea, at 600 m depth) contains munitions with chemical warfare agents (CWA), scuttled after the end of World War II. Studies of liver histopathology in Atlantic hagfish (Myxine glutinosa) were carried out at three sampling sites: at a wreck with CWA in the Skagerrak (n = 82), a Skagerrak reference site considered to be free of CWA (n = 14) and at a reference site in the northern North Sea outside the Skagerrak (n = 17). Liver lesions were diagnosed and categorized according to standardized ICES and BEQUALM protocols and OSPAR guidelines. Non-specific liver lesions were found in 87.6% of 113 hagfish examined. The prevalence of pre-neoplastic lesions was 7.1% and of neoplastic lesions 6.2%. There was no statistically significant difference in prevalence between hagfish samples from the wreck site and from the reference site near the wrecks. However, at the reference site in the northern North Sea, the prevalence of non-specific lesions was low and neither pre-neoplastic nor neoplastic lesions were observed.

The AAPRISS Platform: Learning and Taking Action to Reduce Social Inequalities in Health to help PHIR

Key messages

Mixed structures housing spaces for both research and action, which create a dynamic of Population Health Intervention Research, are showing themselves to be effective and seem to meet a need. But the financial stability of this mixed structures is insufficient to sustain their activities and promote sustainable reduction of social inequalities in health.

Resistive exercise in astronauts on prolonged spaceflights provides partial protection against spaceflight-induced bone loss

Bone loss in astronauts during spaceflight may be a risk factor for osteoporosis, fractures and renal stone formation. We previously reported that the bisphosphonate alendronate, combined with exercise that included an Advanced Resistive Exercise Device (ARED), can prevent or attenuate group mean declines in areal bone mineral density (aBMD) measured soon after ~ 6-month spaceflights aboard the International Space Station (ISS). It is unclear however if the beneficial effects on postflight aBMD were due to individual or combined effects of alendronate and ARED. Hence, 10 additional ISS astronauts were recruited who used the ARED (ARED group) without drug administration using similar measurements in the previous study, i.e., densitometry, biochemical assays and analysis of finite element (FE) models. In addition densitometry data (DXA and QCT only) were compared to published data from crewmembers (n = 14-18) flown prior to in-flight access to the ARED (Pre-ARED). Group mean changes from preflight (± SD %) were used to evaluate effects of countermeasures as sequentially modified on the ISS (i.e., Pre-ARED vs. ARED; ARED vs. Bis+ARED). Spaceflight durations were not significantly different between groups. Postflight bone density measurements were significantly reduced from preflight in the Pre-ARED group. As previously reported, combined Bis+ARED prevented declines in all DXA and QCT hip densitometry and in estimates of FE hip strengths; increased the aBMD of lumbar spine; and prevented elevations in urinary markers for bone resorption during spaceflight. ARED without alendronate partially attenuated declines in bone mass but did not suppress biomarkers for bone resorption or prevent trabecular bone loss. Resistive exercise in the ARED group did not prevent declines in hip trabecular vBMD, but prevented reductions in cortical vBMD of the femoral neck, in FE estimate of hip strength for non-linear stance (NLS) and in aBMD of the femoral neck. We conclude that a bisphosphonate, when combined with resistive exercise, enhances the preservation of bone mass because of the added suppression of bone resorption in trabecular bone compartment not evident with ARED alone.

Versatile Control of ^{9}Be^{+} Ions Using a Spectrally Tailored UV Frequency Comb

We demonstrate quantum control of ^{9}Be^{+} ions directly implemented by an optical frequency comb. Based on numerical simulations of the relevant processes in ^{9}Be^{+} for different magnetic field regimes, we demonstrate a wide applicability when controlling the comb's spectral properties. We introduce a novel technique for the selective and efficient generation of a spectrally tailored narrow-bandwidth optical frequency comb near 313 nm. We experimentally demonstrate internal state control and internal-motional state coupling of ^{9}Be^{+} ions implemented by stimulated-Raman manipulation using a spectrally optimized optical frequency comb. Our pulsed laser approach is a key enabling step for the implementation of quantum logic and quantum information experiments in Penning traps.

[Patient advanced directives from the perspective of surgery patients-new aspects and aims : Living wills of patients before planned surgery]

BACKGROUND

Patient advance directives and other forms of precautionary medical provisions have arisen from patients' determination to influence and decide about medical treatment even in extreme situations. Although this topic is very present in the media, clinical experience indicates that the majority of patients are not yet aware of this subject. This current investigation aimed to collect data about the familiarity and degree of distribution of patient medical advance directives. Furthermore, it was examined how a routine question concerning patient's provisions in a preoperative setting is perceived by the patients and from which source information about this topic should be provided.

METHODS

Between April 2017 and October 2017 a total of 200 patients were randomly selected prior to planned surgery and interviewed anonymously using a standardized questionnaire.

RESULTS

Of the patients surveyed 78.8% stated that they knew about the possibility of patient advance directives. Of the patients interviewed 26.3% stated they had drawn up an advance directive, 20.7% had a precautionary power of attorney and 12.3% had signed a care directive. Among the influencing factors in drawing up an advance directive, age, as well as familial and disease-related causes, were identified as significant factors. The overwhelming majority of respondents (77.6%) wished to be approached on the subject of precautionary medical provisions before a planned operation.

CONCLUSION

Despite an increasing proportion of patients who have drawn up an advance directive, there is still a great need for information on the subject. Doctors should address patients on the topic before planned interventions.

Clinical and Micromorphologic 29-year Results of Posterior Composite Restorations

Prospective clinical studies of composite restorations revealed their safety and longevity; however, studies did not elucidate the dynamic mechanisms of deterioration caused by fractures and secondary caries. Therefore, the aims of this 29-y controlled study were 1) to follow up on the clinical behavior of posterior composite restorations annually and 2) to compare clinical outcomes with micromorphologic scanning electron microscopy features. After ethical approval, the single-arm study commenced in 1987 with 194 class I or II primary posterior composite restorations with glass ionomer cement providing pulp protection. Each restoration was evaluated annually for 15 y and then again at 29 y per the US Public Health Service-compatible Clinical, Photographic and Micromorphologic coding index, with clinical and photographic criteria for anatomic form, color matching, surface quality, wear, marginal integrity, secondary caries, and clinical acceptability. Parallel micromorphologic criteria were applied at baseline and after 1, 3, 5, 7, 10, 15, and 29 y to assess surface roughness, texture, marginal integrity, fractures, ledges, and marginal gaps with semiquantitative coding and with quantitative 3-dimensional scanning electron microscopy profilometric measurements of marginal grooves next to the enamel, grooves within the bonding zone, and ledges. Statistical analysis included the calculation of the annual failure rate and the use of Kaplan-Meier methodology and nonparametric tests. The cumulative survival rates were 91.7% (6 y), 81.6% (12 y), and 71.4% (29 y). The mean annual failure rate was 1.92%. Significant changes in the restoration-tooth interface from baseline to 5 y resulted in functional masticatory equilibrium. Clinical deterioration year by year, including micromorphologic microfractures and wear, reflected unique dynamic changes in long-term surviving restorations with very low secondary caries and fracture risks (German Network for Health Care Research VfD 29 99 003924).

Directly observed therapy of chronic hepatitis C with ledipasvir/sofosbuvir in people who inject drugs at risk of nonadherence to direct-acting antivirals

An important subgroup of people who inject drugs (PWID) receiving opioid agonist therapy (OAT) cannot be treated in the setting of a hepatology centre and would not regularly ingest their medication when handed to them for self-administration. Our hypothesis was that chronic hepatitis C in these patients could be ideally managed if modern, interferon-free regimens were administered together with OAT under direct observation of a physician or nurse at a low-threshold facility. In this open-label, noninterventional, proof-of-concept study (ClinicalTrials.gov number, NCT02638233), 40 PWID at risk of nonadherence to direct-acting antivirals (DAA) and previously untreated chronic hepatitis C virus genotype 1 infection without cirrhosis were treated with ledipasvir/sofosbuvir for 8 weeks. Patients received antiviral treatment together with OAT under direct observation of a physician or nurse at a low-threshold facility. By following the concept of directly observed therapy, excellent adherence to antiviral therapy was achieved as follows: only 0.16% (95% CI: 0.03-0.47) of scheduled dates for ingestion of the antiviral therapy in combination with OAT were missed by the 40 patients. The rate of sustained virological response 12 weeks after end of therapy was 100% (95% CI: 91.2-100.0). Between week 12 and week 24 of follow-up reinfections were recorded in 2 of 40 patients (5%). Directly observed therapy of chronic hepatitis C is highly effective in PWID at risk of nonadherence to DAA. By this new concept, a group of difficult-to-treat patients can be cured, who could not have been treated in settings of studies published so far.

Bone density and microarchitecture in hepatitis C and HIV-coinfected postmenopausal minority women

We found that HIV+/HCV+ women had 7-8% lower areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA) at the spine, hip, and radius (p < 0.01) and 5-7% lower volumetric BMD (vBMD) by central quantitative computed tomography (cQCT) at the spine and hip (p < 0.05). These data suggest that true deficits in vBMD may contribute to bone fragility and excess fractures reported in HIV+/HCV+ women.

INTRODUCTION

aBMD by DXA is lower in persons coinfected with HIV and HCV (HIV+/HCV+) than with HIV monoinfection (HIV+). However, weight is often also lower with HCV infection, and measurement of aBMD by DXA can be confounded by adiposity; we aimed to determine whether true vBMD is also lower in HIV+/HCV+ coinfection.

METHODS

We measured aBMD of the lumbar spine (LS), total hip (TH), femoral neck (FN), and ultradistal radius (UDR) by DXA and vBMD of the spine and hip by cQCT and of the distal radius and tibia by high-resolution peripheral QCT (HRpQCT) in 37 HIV+/HCV+ and 119 HIV+ postmenopausal women. Groups were compared using Student's t tests with covariate adjustment by multiple regression analysis.

RESULTS

HIV+/HCV+ and HIV+ women were of similar age and race/ethnicity. HIV+/HCV+ women had lower body mass index (BMI) and trunk fat and were more likely to smoke and less likely to have a history of AIDS. In HIV+/HCV+ women, aBMD by DXA was 7-8% lower at the LS, TH, and UDR (p < 0.01). Similarly, vBMD by cQCT was 5-7% lower at the LS and TH (p < 0.05). Between-group differences in LS aBMD and vBMD remained significant after adjustment for BMI, smoking, and AIDS history. Tibial total vBMD by HRpQCT was 10% lower in HIV+/HCV+ women.

CONCLUSION

HIV+/HCV+ postmenopausal women had significantly lower spine aBMD and vBMD. These deficits in vBMD may contribute to bone fragility and excess fractures reported in HIV+/HCV+ women.

Covalent incorporation of tobacco mosaic virus increases the stiffness of poly(ethylene glycol) diacrylate hydrogels

Hydrogels are versatile materials, finding applications as adsorbers, supports for biosensors and biocatalysts or as scaffolds for tissue engineering. A frequently used building block for chemically cross-linked hydrogels is poly(ethylene glycol) diacrylate (PEG-DA). However, after curing, PEG-DA hydrogels cannot be functionalized easily. In this contribution, the stiff, rod-like tobacco mosaic virus (TMV) is investigated as a functional additive to PEG-DA hydrogels. TMV consists of more than 2000 identical coat proteins and can therefore present more than 2000 functional sites per TMV available for coupling, and thus has been used as a template or building block for nano-scaled hybrid materials for many years. Here, PEG-DA (M n = 700 g mol-1) hydrogels are combined with a thiol-group presenting TMV mutant (TMVCys). By covalent coupling of TMVCys into the hydrogel matrix via the thiol-Michael reaction, the storage modulus of the hydrogels is increased compared to pure PEG-DA hydrogels and to hydrogels containing wildtype TMV (wt-TMV) which is not coupled covalently into the hydrogel matrix. In contrast, the swelling behaviour of the hydrogels is not altered by TMVCys or wt-TMV. Transmission electron microscopy reveals that the TMV particles are well dispersed in the hydrogels without any large aggregates. These findings give rise to the conclusion that well-defined hydrogels were obtained which offer the possibility to use the incorporated TMV as multivalent carrier templates e.g. for enzymes in future studies.

Diagnostische Möglichkeiten und Grenzen der Thrombelastometrie/-graphie

Die Thrombelastometrie/-graphie ermöglicht im Gegensatz zur klassischen Gerinnungsanalytik auch eine Beurteilung der Clotfestigkeit und -stabilität. Durch die Einführung von modifizierten thrombelastometrischen/-graphischen Ansätzen konnte die Standardisierung weitgehend verbessert und die diagnostische Aussagekraft erhöht werden. Durch die Verwendung eines Heparinase-Tests kann so ein Heparineffekt leicht nachgewiesen werden. Der FIBTEM ermöglicht auf dem ROTEM® auch eine weitere Differenzierung zwischen einer thrombozytär oder plasmatisch bedingten Störung der Clotfestigkeit. In diesem Zusammenhang scheint das Fibrinogen eine oft unterschätze Bedeutung für die Clotfestigkeit zu haben. Unsere klinischen Daten zeigen, dass im perioperativen Bereich ein erhöhtes D-Dimer keinen Hinweis auf einer Hyperfibrinolyse liefern kann. Durch die Thrombelastometrie/-graphie können jedoch keine Störungen der so genannten primären Hämostase erfasst werden (z. B. von-Willebrand-Syndrom). Auch die Wirkung von Azetylsalizylsäure und Clopidogrel auf die Thrombozyten kann nicht erfasst werden. Lediglich Thrombozytenaggregationshemmer, welche die Funktionalität der Glykoprotein-IIb/IIIa-Rezeptoren auf den Thrombozyten beeinflussen (z. B. ReoPro®) können in hoher Dosierung zu einer verminderten Clotfestigkeit in der Thrombelastometrie/- graphie führen. Ähnliches gilt auch für einen ausgeprägten Morbus Glanzmann. Aufgrund der Verwendung von unterschiedlichen Aktivatoren ist die Gerinnungszeit in der Thrombelastometrie/-graphie (CT/r-Wert) mit den klassischen Gerinnungsparametern nur bedingt vergleichbar. Durch die Einführung der Rotationsthrombelastometrie steht nun auch ein Bedsite-taugliches System zur Verfügung.

Possibilities and limitations of thromboelastometry/thromboelastography

Thromboelastometry/thromboelastography provides information about clot strength and stability. Modified procedures have improved the standardisation and increased the diagnostic power of these test systems. Heparinase- modified thromboelastometry/thromboelastography allows assessment of the heparin effect. The introduction of FIBTEM on the ROTEM® also makes it possible to differentiate between disorders of the plasma and platelet components of clot strength. This may be of interest in the perioperative setting, as our clinical data show that elevated levels of D-dimer have no predictive value for hyperfibrinolysis.

However, disorders of primary haemostasis such as von Willebrand’s disease cannot be determined with thromboelastometry/ thromboelastography, nor do the effects of acetyl salicylic acid and clopidogrel on platelets influence the results. Only platelet aggregation inhibitors which affect the glycoprotein IIb/IIIa receptors, such as ReoPro®, may reduce clot strength at high doses. A similar effect is to be expected with severe Glanzmann’s thrombasthenia. Coagulation times in thromboelastometry/thromboelastography (measured as CT/r value) show poor correlation with conventional coagulation parameters because of the different activators used.

The introduction of rotation thromboelastometry (ROTEM®) provides a stable system suitable for near patient testing.

ZikaPLAN: Zika Preparedness Latin American Network

The ongoing Zika virus (ZIKV) outbreak in Latin America, the Caribbean, and the Pacific Islands has underlined the need for a coordinated research network across the whole region that can respond rapidly to address the current knowledge gaps in Zika and enhance research preparedness beyond Zika. The European Union under its Horizon 2020 Research and Innovation Programme awarded three research consortia to respond to this need. Here we present the ZikaPLAN (Zika Preparedness Latin American Network) consortium. ZikaPLAN combines the strengths of 25 partners in Latin America, North America, Africa, Asia, and various centers in Europe. We will conduct clinical studies to estimate the risk and further define the full spectrum and risk factors of congenital Zika virus syndrome (including neurodevelopmental milestones in the first 3 years of life), delineate neurological complications associated with ZIKV due to direct neuroinvasion and immune-mediated responses in older children and adults, and strengthen surveillance for birth defects and Guillain-Barré Syndrome. Laboratory-based research to unravel neurotropism and investigate the role of sexual transmission, determinants of severe disease, and viral fitness will underpin the clinical studies. Social messaging and engagement with affected communities, as well as development of wearable repellent technologies against Aedes mosquitoes will enhance the impact. Burden of disease studies, data-driven vector control, and vaccine modeling as well as risk assessments on geographic spread of ZIKV will form the foundation for evidence-informed policies. While addressing the research gaps around ZIKV, we will engage in capacity building in laboratory and clinical research, collaborate with existing and new networks to share knowledge, and work with international organizations to tackle regulatory and other bottlenecks and refine research priorities. In this way, we can leverage the ZIKV response toward building a long-term emerging infectious diseases response capacity in the region to address future challenges.

PAH metabolites in fish bile: From the Seine estuary to Iceland

Polycyclic aromatic hydrocarbons (PAH) are environmental contaminants that pose significant risk to health of fish. The International Workshop on Integrated Assessment of Contaminant Impacts on the North Sea (ICON) provided the framework to investigate biomarker responses as well as contaminant concentrations side by side in marine ecosystems. Concentrations of the main PAH metabolites 1-hydroxypyrene, 1-hydroxyphenanthren and 3-hydroxybenzo(a)pyrene were determined in bile by HPLC with fluorescence detection. Fish species under investigation were dab (Limanda limanda), flounder (Platichthys flesus) and haddock (Melanogrammus aeglefinus). A contamination gradient was demonstrated from the low contaminated waters of Iceland and off-shore regions of the North Sea towards higher concentrations in coastal areas. Concentrations of PAH metabolites differed primarily according to sampling region and secondarily to species.

Association of bone turnover markers with volumetric bone loss, periosteal apposition, and fracture risk in older men and women: the AGES-Reykjavik longitudinal study

Association between serum bone formation and resorption markers and cortical and trabecular bone loss and the concurrent periosteal apposition in a population-based cohort of 1069 older adults was assessed. BTM levels moderately reflect the cellular events at the endosteal and periosteal surfaces but are not associated with fracture risk.

INTRODUCTION

We assessed whether circulating bone formation and resorption markers (BTM) were individual predictors for trabecular and cortical bone loss, periosteal expansion, and fracture risk in older adults aged 66 to 93 years from the AGES-Reykjavik study.

METHODS

The sample for the quantitative computed tomography (QCT)-derived cortical and trabecular BMD and periosteal expansion analysis consisted of 1069 participants (474 men and 595 women) who had complete baseline (2002 to 2006) and follow-up (2007 to 2011) hip QCT scans and serum baseline BTM. During the median follow-up of 11.7 years (range 5.4-12.5), 54 (11.4 %) men and 182 (30.6 %) women sustained at least one fracture of any type.

RESULTS

Increase in BTM levels was associated with faster cortical and trabecular bone loss at the femoral neck and proximal femur in men and women. Higher BTM levels were positively related with periosteal expansion rate at the femoral neck in men. Markers were not associated with fracture risk.

CONCLUSION

This data corroborates the notion from few previous studies that both envelopes are metabolically active and that BTM levels may moderately reflect the cellular events at the endosteal and periosteal surfaces. However, our results do not support the routine use of BTM to assess fracture risk in older men and women. In light of these findings, further studies are justified to examine whether systemic markers of bone turnover might prove useful in monitoring skeletal remodeling events and the effects of current osteoporosis drugs at the periosteum.

[The evaluation of pharmacological drugs, medical devices, and non-pharmacological or public health interventions: Experimental design limitations. Moving towards new methods?]

In the field of health, evidence-based medicine and associated methods like randomised controlled trials (RCTs) have become widely used. RCT has become the gold standard for evaluating causal links between interventions and health results. Originating in pharmacology, this method has been progressively expanded to medical devices, non-pharmacological individual interventions, as well as collective public health interventions. Its use in these domains has led to the formulation of several limits, and it has been called into question as an undisputed gold standard. Some of those limits (e.g. confounding biases and external validity) are common to these four different domains, while others are more specific. This paper describes the different limits, as well as several research avenues. Some are methodological reflections aiming at adapting RCT to the complexity of the tested interventions, and at overcoming some of its limits. Others are alternative methods. The objective is not to remove RCT from the range of evaluation methodologies, but to resituate it within this range. The aim is to encourage choosing between different methods according to the features and the level of the intervention to evaluate, thereby calling for methodological pluralism.

Effect of concomitant vitamin D deficiency or insufficiency on lumbar spine volumetric bone mineral density and trabecular bone score in primary hyperparathyroidism

Lower vitamin D and higher parathyroid hormone (PTH) levels are associated with higher volumetric BMD and bone strength at the lumbar spine as measured by central quantitative computed tomography in primary hyperparathyroidism (PHPT), but there are no differences in bone microarchitecture as measured by trabecular bone score (TBS).

INTRODUCTION

The purpose of this study was to evaluate the association between 25-hydroxyvitamin D (25OHD) and volumetric bone mineral density (vBMD) and the TBS at the lumbar spine (LS) in PHPT.

METHODS

This is a cross-sectional analysis of PHPT patients with and without low 25OHD. We measured vBMD with quantitative computed tomography (cQCT) and TBS by dual-energy X-ray absorptiometry (DXA) at the LS in 52 and 88 participants, respectively.

RESULTS

In the cQCT cohort, those with lower vitamin D (<20 vs. 20-29 vs. ≥30 ng/ml) tended to be younger (p = 0.05), were less likely to use vitamin D supplementation (p < 0.01), and had better renal function (p = 0.03). Those with 25OHD <20 ng/ml had 80 and 126 % higher serum PTH levels respectively vs. those with 25OHD 20-29 ng/ml (p = 0.002) and 25OHD ≥30 ng/ml (p < 0.0001). Covariate-adjusted integral and trabecular vBMD were higher in those with 25OHD 20-29 vs. those with 25OHD ≥30 ng/ml, but those with 25OHD <20 did not differ. Because there were few participants with 25OHD deficiency, we also compared those with vitamin D <30 vs. ≥30 ng/ml. Covariate-adjusted integral and trabecular vBMD were 23 and 30 % higher respectively (both p < 0.05) in those with vitamin D <30 vs. ≥30 ng/ml. TBS was in the partially degraded range but did not differ by vitamin D status.

CONCLUSION

In mild PHPT, lower 25OHD is associated with higher PTH, but vitamin D deficiency and insufficiency using current clinical thresholds did not adversely affect lumbar spine skeletal health in PHPT. Further work is needed to determine if higher vBMD in those with lower vitamin D is due to an anabolic effect of PTH.

Are bone turnover markers associated with volumetric bone density, size, and strength in older men and women? The AGES-Reykjavik study

Association between serum bone formation and resorption markers and bone mineral, structural, and strength variables derived from quantitative computed tomography (QCT) in a population-based cohort of 1745 older adults was assessed. The association was weak for lumbar spine and femoral neck areal and volumetric bone mineral density.

INTRODUCTION

The aim of this study was to examine the relationship between levels of bone turnover markers (BTMs; osteocalcin (OC), C-terminal cross-linking telopeptide of type I collagen (CTX), and procollagen type 1N propeptide (P1NP)) and quantitative computed tomography (QCT)-derived bone density, geometry, and strength indices in the lumbar spine and femoral neck (FN).

METHODS

A total of 1745 older individuals (773 men and 972 women, aged 66-92 years) from the Age, Gene/Environment Susceptibility (AGES)-Reykjavik cohort were studied. QCT was performed in the lumbar spine and hip to estimate volumetric trabecular, cortical, and integral bone mineral density (BMD), areal BMD, bone geometry, and bone strength indices. Association between BTMs and QCT variables were explored using multivariable linear regression.

RESULTS

Major findings showed that all BMD measures, FN cortical index, and compressive strength had a low negative correlation with the BTM levels in both men and women. Correlations between BTMs and bone size parameters were minimal or not significant. No associations were found between BTMs and vertebral cross-sectional area in women. BTMs alone accounted for only a relatively small percentage of the bone parameter variance (1-10 %).

CONCLUSION

Serum CTX, OC, and P1NP were weakly correlated with lumbar spine and FN areal and volumetric BMD and strength measures. Most of the bone size indices were not associated with BTMs; thus, the selected bone remodeling markers do not reflect periosteal bone formation. These results confirmed the limited ability of the most sensitive established BTMs to predict bone structural integrity in older adults.

The relationship between parental attitudes and behaviours in the context of paediatric chronic pain

BACKGROUND

Within the context of paediatric chronic pain, parental attitudes are of particular importance given that they have the potential to impact on how parents respond to their child. The current study was designed to assess whether parental attitudes, such as parental confidence and beliefs in their child's ability to function in spite of pain, and parental catastrophising about their child's pain, are associated with parental pain-related behaviours known to be associated with poor child outcomes, such as protectiveness and high levels of monitoring.

METHODS

Participants were 138 child-parent dyads recruited from a tertiary chronic pain clinic. Patients were aged 8- to 17-years. Prior to the initial clinic appointment, parents completed validated measures of parental pain catastrophising and parental responses to their child's pain. Patients completed measures of functional disability and pain intensity.

RESULTS

Parents who reported lower confidence in their child's ability to cope with the pain engaged in significantly more protective, monitoring and distracting behaviours, even when controlling for the child's recent level of functioning. They also took more days off work due to their child's pain. Parents who catastrophised more about their child's pain engaged in significantly more protective and monitoring behaviours, even when controlling for the child's recent level of functioning.

CONCLUSIONS

Parental behaviours in response to their child's pain are significantly related to parental confidence in their child's coping and parental pain-related catastrophising. Clinical interventions may benefit from addressing parental attitudes, especially their confidence in their child's ability to function.

Multipass OPCPA system at 100 kHz pumped by a CPA-free solid-state amplifier

We present a compact few-cycle 100 kHz OPCPA system pumped by a CPA-free picosecond Nd:YVO₄ solid-state amplifier with all-optical synchronization to an ultra-broadband Ti:sapphire oscillator. This pump approach shows an exceptional conversion rate into the second harmonic of almost 78%. Efficient parametric amplification was realized by a two stage double-pass scheme with following chirped mirror compressor. The amount of superfluorescence was measured by an optical cross-correlation. Pulses with a duration of 8.7 fs at energies of 18 µJ are demonstrated. Due to the peak power of 1.26 GW, this simple OPCPA approach forms an ideal high repetition rate driving source for high-order harmonic generation.

[Same words, different meanings: How epidemiological terminology struggles with population health intervention research]

Public health research differs from clinical epidemiological research in that its focus is primarily on the population level social and structural determinants of individual health and the interventions that might ameliorate them, rather than having a primary focus on individual-level risks. It is typically concerned with the proximal and distal causes of health problems, and their location within complex systems, more than with single exposures. Thus, epidemiological terms and concepts may have very different implications when used in the context of population health. This paper considers some key differences in relation to terms like 'population', 'baseline', 'control group' 'outcome' and 'adverse effects'. Even the concept of an 'intervention' often needs careful handling. The paper concludes that there is a need for an expanded, and more realistic use of these terms in the population health intervention research context.

Toll-IL1 receptor-mediated innate immune responses vary across HBV genotype and predict treatment response to pegylated-IFN in HBeAg-positive CHB patients

Patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) have suppressed TLR2 expression, function and cytokine production. The aim of this study was to explore the importance of hepatitis B virus (HBV) genotype in innate immune responses and investigate whether Toll-like receptor (TLR) expression/function has potential roles as predictive biomarkers of successful therapy with pegylated interferon (Peg-IFN) therapy of HBeAg seroconversion in HBeAg-positive patients. We showed that as early as 4 weeks after initiation of Peg-IFN, future HBeAg seroconverters had significantly elevated levels of TLR2 expression on monocytes. TLR2-associated IL-6 production at baseline and week 4 of therapy and TLR4 IL-6 production at week 4 were also markedly elevated in HBeAg seroconverters. HBV genotype also influenced treatment response, with genotypes A and B more likely to seroconvert than D. We were able to demonstrate that these differences were due in part to the interaction of the specific HBeAg proteins with TLR pathway adaptor molecules, and these interactions were genotype dependent. HBeAg-mediated modulation of TLR signalling was also observed in Huh7 cells, following stimulation with Pam3Cys. Importantly, the addition of IFN-α to TLR2-stimulated cells cotransfected with an HBeAg expression plasmid reversed HBeAg-mediated suppression of hepatocytes. These findings demonstrate that patients with an activated inflammatory response are much more likely to respond to IFN therapy, with TLR responses showing promise as potential biomarkers of HBeAg seroconversion in this setting. Furthermore, our findings suggest there is differential genotype-specific HBeAg suppression of innate signalling pathways which may account for some of the clinical differences observed across the CHB spectrum.