Outcomes for Adults With Intellectual and Developmental Disabilities Receiving Long-Term Services and Supports: A Systematic Review of the Literature

The impact of long-term services and supports on the quality of life of adults with intellectual and developmental disabilities (IDD) is not well understood given the highly complex nature of researching this topic. To support future research addressing this topic, we conducted a systematic literature review of studies addressing outcomes of adults with IDD receiving long-term services and supports. Results of this review describe current outcomes for adults with IDD who receive long-term services and supports and can be used to inform program evaluation, policy development, and future research.

Mechanisms of RNF168 nucleosome recognition and ubiquitylation

RNF168 plays a central role in the DNA damage response (DDR) by ubiquitylating histone H2A at K13 and K15. These modifications direct BRCA1-BARD1 and 53BP1 foci formation in chromatin, essential for cell-cycle-dependent DNA double-strand break (DSB) repair pathway selection. The mechanism by which RNF168 catalyzes the targeted accumulation of H2A ubiquitin conjugates to form repair foci around DSBs remains unclear. Here, using cryoelectron microscopy (cryo-EM), nuclear magnetic resonance (NMR) spectroscopy, and functional assays, we provide a molecular description of the reaction cycle and dynamics of RNF168 as it modifies the nucleosome and recognizes its ubiquitylation products. We demonstrate an interaction of a canonical ubiquitin-binding domain within full-length RNF168, which not only engages ubiquitin but also the nucleosome surface, clarifying how such site-specific ubiquitin recognition propels a signal amplification loop. Beyond offering mechanistic insights into a key DDR protein, our study aids in understanding site specificity in both generating and interpreting chromatin ubiquitylation.

Computer Vision Analysis of Rheumatoid Arthritis Synovium Reveals Lymphocytic Inflammation Is Associated With Immunoglobulin Skewing in Blood

OBJECTIVE

We sought to develop computer vision methods to quantify aggregates of cells in synovial tissue and compare these with clinical and gene expression parameters.

METHODS

We assembled a computer vision pipeline to quantify five features encompassing synovial cell density and aggregates and compared these with pathologist scores, disease classification, autoantibody status, and RNA expression in a cohort of 156 patients with rheumatoid arthritis (RA) and 149 patients with osteoarthritis (OA).

RESULTS

All five features were associated with pathologist scores of synovial lymphocytic inflammation (P < 0.0001). Three features that related to the cells per unit of tissue were significantly increased in patients with both seronegative and seropositive RA compared with those with OA; on the other hand, aggregate features (number and diameter) were significantly increased in seropositive, but not seronegative, RA compared with OA. Aggregate diameter was associated with the gene expression of immunoglobulin heavy-chain genes in the synovial tissue. Compared with blood, synovial immunoglobulin isotypes were skewed from IGHM and IGHD to IGHG3 and IGHG1. Further, patients with RA with high levels of lymphocytic infiltrates in the synovium demonstrated parallel skewing in their blood with a relative decrease in IGHGM (P < 0.002) and IGHD (P < 0.03) and an increase in class-switched immunoglobulin genes IGHG3 (P < 0.03) and IGHG1 (P < 0.002).

CONCLUSION

High-resolution automated identification and quantification of synovial immune cell aggregates uncovered skewing in the synovium from naïve IGHD and IGHM to memory IGHG3 and IGHG1 and revealed that this process is reflected in the blood of patients with high inflammatory synovium.

Molecular evidence of anteroposterior patterning in adult echinoderms

The origin of the pentaradial body plan of echinoderms from a bilateral ancestor is one of the most enduring zoological puzzles1,2. Because echinoderms are defined by morphological novelty, even the most basic axial comparisons with their bilaterian relatives are problematic. To revisit this classical question, we used conserved anteroposterior axial molecular markers to determine whether the highly derived adult body plan of echinoderms masks underlying patterning similarities with other deuterostomes. We investigated the expression of a suite of conserved transcription factors with well-established roles in the establishment of anteroposterior polarity in deuterostomes3-5 and other bilaterians6-8 using RNA tomography and in situ hybridization in the sea star Patiria miniata. The relative spatial expression of these markers in P. miniata ambulacral ectoderm shows similarity with other deuterostomes, with the midline of each ray representing the most anterior territory and the most lateral parts exhibiting a more posterior identity. Strikingly, there is no ectodermal territory in the sea star that expresses the characteristic bilaterian trunk genetic patterning programme. This finding suggests that from the perspective of ectoderm patterning, echinoderms are mostly head-like animals and provides a developmental rationale for the re-evaluation of the events that led to the evolution of the derived adult body plan of echinoderms.

An autoinhibited state of 53BP1 revealed by small molecule antagonists and protein engineering

The recruitment of 53BP1 to chromatin, mediated by its recognition of histone H4 dimethylated at lysine 20 (H4K20me2), is important for DNA double-strand break repair. Using a series of small molecule antagonists, we demonstrate a conformational equilibrium between an open and a pre-existing lowly populated closed state of 53BP1 in which the H4K20me2 binding surface is buried at the interface between two interacting 53BP1 molecules. In cells, these antagonists inhibit the chromatin recruitment of wild type 53BP1, but do not affect 53BP1 variants unable to access the closed conformation despite preservation of the H4K20me2 binding site. Thus, this inhibition operates by shifting the conformational equilibrium toward the closed state. Our work therefore identifies an auto-associated form of 53BP1-autoinhibited for chromatin binding-that can be stabilized by small molecule ligands encapsulated between two 53BP1 protomers. Such ligands are valuable research tools to study the function of 53BP1 and have the potential to facilitate the development of new drugs for cancer therapy.

An autoinhibited state of 53BP1 revealed by small molecule antagonists and protein engineering

The recruitment of 53BP1 to chromatin, mediated by its recognition of histone H4 dimethylated at lysine 20 (H4K20me2), is important for DNA double-strand break repair. Using a series of small molecule antagonists, we demonstrate a conformational equilibrium between an open and a pre-existing lowly populated closed state of 53BP1 in which the H4K20me2 binding surface is buried at the interface between two interacting 53BP1 molecules. In cells, these antagonists inhibit the chromatin recruitment of wild type 53BP1, but do not affect 53BP1 variants unable to access the closed conformation despite preservation of the H4K20me2 binding site. Thus, this inhibition operates by shifting the conformational equilibrium toward the closed state. Our work therefore identifies an auto-associated form of 53BP1 - autoinhibited for chromatin binding - that can be stabilized by small molecule ligands encapsulated between two 53BP1 protomers. Such ligands are valuable research tools to study the function of 53BP1 and have the potential to facilitate the development of new drugs for cancer therapy.

The Impact of Administration Formats on SIS-A Scores

Many U.S. states use the Supports Intensity Scale-Adult Version (SIS-A; Thompson et al., 2015) to inform the distribution of public funds for long-term services and supports. Throughout the COVID-19 pandemic, many states began administering the SIS-A virtually instead of in person. Because administration format has the potential to influence SIS-A scores and, consequently, impact the funding people receive for long-term services and supports, this study examined the stability of support need scores, as measured by the SIS-A, over two time periods: (a) when assessments were conducted in person and (b) when assessments were conducted virtually using remote technology. Specifically, the influence of assessment administration formats on SIS-A scores and on the perceptions of SIS-A assessors were investigated. Results revealed that the virtual administration format impacted SIS-A scores, but the impact was of little to no practical importance.

Measurement and initial characterization of leukocyte telomere length in 474,074 participants in UK Biobank

Leukocyte telomere length (LTL) is a proposed marker of biological age. Here we report the measurement and initial characterization of LTL in 474,074 participants in UK Biobank. We confirm that older age and male sex associate with shorter LTL, with women on average ~7 years younger in 'biological age' than men. Compared to white Europeans, LTL is markedly longer in African and Chinese ancestries. Older paternal age at birth is associated with longer individual LTL. Higher white cell count is associated with shorter LTL, but proportions of white cell subtypes show weaker associations. Age, ethnicity, sex and white cell count explain ~5.5% of LTL variance. Using paired samples from 1,351 participants taken ~5 years apart, we estimate the within-individual variability in LTL and provide a correction factor for this. This resource provides opportunities to investigate determinants and biomedical consequences of variation in LTL.

Rheumatoid Arthritis Synovial Inflammation Quantification Using Computer Vision

Objective

We quantified inflammatory burden in rheumatoid arthritis (RA) synovial tissue by using computer vision to automate the process of counting individual nuclei in hematoxylin and eosin images.

Methods

We adapted and applied computer vision algorithms to quantify nuclei density (count of nuclei per unit area of tissue) on synovial tissue from arthroplasty samples. A pathologist validated algorithm results by labeling nuclei in synovial images that were mislabeled or missed by the algorithm. Nuclei density was compared with other measures of RA inflammation such as semiquantitative histology scores, gene‐expression data, and clinical measures of disease activity.

Results

The algorithm detected a median of 112,657 (range 8,160‐821,717) nuclei per synovial sample. Based on pathologist‐validated results, the sensitivity and specificity of the algorithm was 97% and 100%, respectively. The mean nuclei density calculated by the algorithm was significantly higher (P < 0.05) in synovium with increased histology scores for lymphocytic inflammation, plasma cells, and lining hyperplasia. Analysis of RNA sequencing identified 915 significantly differentially expressed genes in correlation with nuclei density (false discovery rate is less than 0.05). Mean nuclei density was significantly higher (P < 0.05) in patients with elevated levels of C‐reactive protein, erythrocyte sedimentation rate, rheumatoid factor, and cyclized citrullinated protein antibody.

Conclusion

Nuclei density is a robust measurement of inflammatory burden in RA and correlates with multiple orthogonal measurements of inflammation.

Impact of Different Pairings of Respondents on Scores on the Supports Intensity Scale-Adult Version (SIS-A)

This secondary analysis examined the impact of respondent-level factors on scores on the Supports Intensity Scale-Adult Version (SIS-A) to determine if there were patterns of differences in SIS-A scores based on the number of respondents and the pairings of respondents that were included in SIS-A interviews. Results indicated that having fewer respondents led to a greater variability in SIS-A scores whereas having more respondents led to higher mean, overall support need scores. When respondents included an adult with intellectual disability (ID) the mean score was significantly lower. However, there were complex influences of pairing an adult with ID with either a professional or family member on SIS-A scores. Implications for administering and using the SIS-A are discussed.

Mussismilia braziliensis White Plague Disease Is Characterized by an Affected Coral Immune System and Dysbiosis

Infectious diseases are one of the major drivers of coral reef decline worldwide. White plague-like disease (WPL) is a widespread disease with a complex etiology that infects several coral species, including the Brazilian endemic species Mussismilia braziliensis. Gene expression profiles of healthy and WPL-affected M. braziliensis were analyzed in winter and summer seasons. The de novo assembly of the M. braziliensis transcriptome from healthy and white plague samples produced a reference transcriptome containing 119,088 transcripts. WPL-diseased samples were characterized by repression of immune system and cellular defense processes. Autophagy and cellular adhesion transcripts were also repressed in WPL samples, suggesting exhaustion of the coral host defenses. Seasonal variation leads to plasticity in transcription with upregulation of intracellular signal transduction, apoptosis regulation, and oocyte development in the summer. Analysis of the active bacterial rRNA indicated that Pantoea bacteria were more abundant in WPL corals, while Tistlia, Fulvivirga, and Gammaproteobacteria Ga0077536 were more abundant in healthy samples. Cyanobacteria proliferation was also observed in WPL, mostly in the winter. These results indicate a scenario of dysbiosis in WPL-affected M. braziliensis, with the loss of potentially symbiotic bacteria and proliferation of opportunistic microbes after the start of the infection process.

The potential for coronavirus transmission in waters: what do we know?

Background

Although the main route of transmission of SARS-CoV2 is via droplets and close contact, concerns about the possible secondary transmission via waters is growing given evidence for SARS-CoV2 faecal elimination. Here we review studies on coronavirus in water environments.

Methods

A review was carried out of papers writen in English on PubMed, Scopus and Web of Science. Papers were identified using the keywords: coronavirus, SARS, MERS, Covid-19 associated with water, surface water, drinking water, wastewater, sewage, slurry, sludge, biosolid. Papers were screened using their title and abstract to confirm their relevance. They were then reviewed to identify: coronavirus type and strain, type of water sample, type of study, detection methods, monitoring data, survival data, effect of disinfection and treatments.

Results

Since 1978, only 18 papers met the selection criteria. Of these, 11 reported experimental studies, 6 field studies, and one included both field and experimental work. Experimental studies were carried out using samples spiked with SARS-CoV or surrogates: 4 addressed the recovery efficiency of detection methods; 3 reported studies on virus removal from waters by different treatments; 7 were focussed on survival in water samples with results ranging from 2 to > 100 days, depending on virus, type of water, temperature, and detection method. Field studies monitored the presence of coronavirus in waters, sewage, slurry or biosolid. The included in total no more than 200 samples and used different detection methods. Some samples tested positive in 5 studies.

Conclusions

While knowledge of coronavirus in waters appears very scarce and fragmentary, the recent SARS-CoV2 emergency demands new attention be focussed on its survival in natural conditions and following treatment in order to assess the risk of waterborne and food borne transmission as well as developing monitoring within sewage treatment facilities.

Key messages

The potential spread of SARS-CoV2 through waters cannot be excluded without better knowledge.

Urgent research on this topic is required.

Artificial neural network discovery of a switchable metasurface reflector

Optical materials engineered to dynamically and selectively manipulate electromagnetic waves are essential to the future of modern optical systems. In this paper, we simulate various metasurface configurations consisting of periodic 1D bars or 2D pillars made of the ternary phase change material Ge₂Sb₂Te₅ (GST). Dynamic switching behavior in reflectance is exploited due to a drastic refractive index change between the crystalline and amorphous states of GST. Selectivity in the reflection and transmission spectra is manipulated by tailoring the geometrical parameters of the metasurface. Due to the immense number of possible metasurface configurations, we train deep neural networks capable of exploring all possible designs within the working parameter space. The data requirements, predictive accuracy, and robustness of these neural networks are benchmarked against a ground truth by varying quality and quantity of training data. After ensuring trustworthy neural network advisory, we identify and validate optimal GST metasurface configurations best suited as dynamic switchable mirrors depending on selected light and manufacturing constraints.

COVID-19 and the Field of Intellectual and Developmental Disabilities: Where Have We Been? Where Are We? Where Do We Go?

The coronavirus (COVID-19) pandemic has affected, and will continue to affect, every aspect of the intellectual and developmental disabilities (IDD) community. We provide recommendations to (a) support people with IDD and the broader of field of IDD during the course of the pandemic, and (b) place the IDD community in a strong position when the health threats associated with the pandemic abate and post-pandemic social and policy structures are formed.

The Supports Intensity Scale Children's Version-Icelandic Translation: Examining Measurement Properties

An innovation in developing the Supports Intensity Scale-Children's Version (SIS-C) was the adoption of latent variable modeling approaches to norm development. In regard to translated versions of the SIS-C, the latent modeling approaches provided opportunities to leverage the large standardization sample generated in the United States (n = 4,015) to generate translation-specific norms from data collected on smaller samples in other countries and enable future cross-cultural analyses. In this study, data were collected on children in Iceland who received special education services (as defined and delivered in Iceland), a more diverse group of children with disabilities than the U.S. sample. This provided a unique context to explore cross-cultural differences. Findings indicated the structure of the SIS-C (i.e., seven support need domains organized under an overall support needs construct), was supported in the Icelandic context. However, findings also suggested that supports planning teams in Iceland must consider specific age-related factors that differ from other cultural contexts.

Design and Evaluation of PEGylated Liposomal Formulation of a Novel Multikinase Inhibitor for Enhanced Chemosensitivity and Inhibition of Metastatic Pancreatic Ductal Adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) has one of the highest mortality rates among cancers. Chemotherapy is the standard first-line treatment, but only modest survival benefits are observed. With the advent of targeted therapies, epidermal growth factor receptor (EGFR) has been acknowledged as a prospective target in PDAC since it is overexpressed in up to 60% of cases. Similarly, the tyrosine-protein kinase Met (cMET) is also overexpressed in PDAC (27-60%) and is a prognostic marker for poor survival. Interestingly, EGFR and cMET share some common signaling pathways including PI3K/Akt and MAPK pathways. Small molecule inhibitors or bispecific antibodies that can target both EGFR and cMET are therefore emerging as novel options for cancer therapy. We previously developed a dual EGFR and cMET inhibitor (N19) that was able to inhibit tumor growth in nonsmall cell lung cancer models resistant to EGFR tyrosine kinase inhibitors (TKI). Here, we report the development of a novel liposomal formulation of N19 (LN19) and showed significant growth inhibition and increased sensitivity toward gemcitabine in the pancreatic adenocarcinoma orthotopic xenograft model. Taken together, our results suggest that LN19 can be valued as an effective combination therapy with conventional chemotherapy such as gemcitabine for PDAC patients.

Detecting Changes in Support Needs Over Time

Assessment of support needs has received significant attention in the disability field, however, little is known about the stability of support needs scores over time. Data from 82 adults with intellectual and developmental disabilities (IDD) who were reassessed with the Supports Intensity Scale-Adult (SIS-A) version as well as the SIS-A Annual Review Protocol (SIS-A ARP) were analyzed. The findings suggest stability of SIS-A scores over a one- to three-year period in adults with IDD. Several sections of the SIS-A ARP showed discriminative power, particularly sections that asked if there had been changes in a subset of specific life activities assessed on the SIS-A and in medical and behavioral needs. Implications for further research and practice are discussed.

Mechanism of 53BP1 activity regulation by RNA-binding TIRR and a designer protein

Dynamic protein interaction networks such as DNA double-strand break (DSB) signaling are modulated by post-translational modifications. The DNA repair factor 53BP1 is a rare example of a protein whose post-translational modification-binding function can be switched on and off. 53BP1 is recruited to DSBs by recognizing histone lysine methylation within chromatin, an activity directly inhibited by the 53BP1-binding protein TIRR. X-ray crystal structures of TIRR and a designer protein bound to 53BP1 now reveal a unique regulatory mechanism in which an intricate binding area centered on an essential TIRR arginine residue blocks the methylated-chromatin-binding surface of 53BP1. A 53BP1 separation-of-function mutation that abolishes TIRR-mediated regulation in cells renders 53BP1 hyperactive in response to DSBs, highlighting the key inhibitory function of TIRR. This 53BP1 inhibition is relieved by TIRR-interacting RNA molecules, providing proof-of-principle of RNA-triggered 53BP1 recruitment to DSBs.

A Cross-Over Trial Comparing Once Daily Levobunolol with Once and twice Daily Timolol

The intraocular pressure (IOP) lowering efficacy of once-daily levobunolol 0.5% was compared with timolol 0.5% twice-daily and timolol 0.5% once-daily in 20 chronic open angle glaucoma and 5 ocular hypertensive patients. The design used was a randomised double blind cross-over trial with three periods each of 8 weeks separated by 2 weeks of no treatment.

We found that following levobunolol a two week washout was not sufficient for the IOP to return to its original baseline level suggesting that levobunolol is a longer acting drug than timolol. Adjusting for this carryover effect, we found no significant difference in the IOP lowering effect among the three regimes (p=0.53). Reduced cost, less ocular discomfort and better compliance are the main potential advantages of the once daily treatments.

Examining Measurement Invariance and Differences in Age Cohorts on the Supports Intensity Scale-Children's Version-Catalan Translation

Data from 949 children and adolescents with intellectual disability ages 5 to 16 for whom the Supports Intensity Scale-Children's Version-Catalan Translation was completed was used, in combination with data from the U.S. standardization sample, to examine measurement invariance and latent differences in the Catalonian sample. Results suggest that the same set of items can be used to measure support needs across U.S. and Catalonia samples and that there are age-related differences in support needs in the Catalonia sample, particularly between children ages 5 to 10 and 11 to 16 years of age. This differs from findings with the U.S. sample, where differences were found in a greater number of age cohorts. Implications for future research and practice are discussed.

Defining the Architecture of the Core Machinery for the Assembly of Fe-S Clusters in Human Mitochondria

Although Fe-S clusters may assemble spontaneously from elemental iron and sulfur in protein-free systems, the potential toxicity of free Fe2+, Fe3+, and S2- ions in aerobic environments underscores the requirement for specialized proteins to oversee the safe assembly of Fe-S clusters in living cells. Prokaryotes first developed multiprotein systems for Fe-S cluster assembly, from which mitochondria later derived their own system and became the main Fe-S cluster suppliers for eukaryotic cells. Early studies in yeast and human mitochondria indicated that Fe-S cluster assembly in eukaryotes is centered around highly conserved Fe-S proteins (human ISCU) that serve as scaffolds upon which new Fe-S clusters are assembled from (i) elemental sulfur, provided by a pyridoxal phosphate-dependent cysteine desulfurase (human NFS1) and its stabilizing-binding partner (human ISD11), and (ii) elemental iron, provided by an iron-binding protein of the frataxin family (human FXN). Further studies revealed that all of these proteins could form stable complexes that could reach molecular masses of megadaltons. However, the protein-protein interaction surfaces, catalytic mechanisms, and overall architecture of these macromolecular machines remained undefined for quite some time. The delay was due to difficulties inherent in reconstituting these very large multiprotein complexes in vitro or isolating them from cells in sufficient quantities to enable biochemical and structural studies. Here, we describe approaches we developed to reconstitute the human Fe-S cluster assembly machinery in Escherichia coli and to define its remarkable architecture.

Risk of hip fracture following a wrist fracture-A meta-analysis

AIMS

This purpose of this meta analysis was to investigate and quantify the relative risk of hip fracture in patients who have sustained a wrist fracture.

METHOD

Studies were identified by searching Medline, Embase, Cochrane CENTRAL database and CINAHL from their inception to August 2015. Studies reporting confirmed hip fracture following wrist fracture were included. Data extraction was carried out using a modified Cochrane data collection form by two reviewers independently. Quality assessment was carried out using a modified Coleman score and the Newcastle Ottawa scale for cohort studies. An assessment of bias was performed for each study using a modified Cochrane Risk of Bias tool. A pooled relative risk(RR) was estimated with 95% CI from the RR/HRs and CIs reported in the studies.

RESULTS

12 studies were included in the final meta-analysis (4 male, 8 female only). Relative risk of hip fracture following wrist fracture for women was 1.43 (CI 1.27 to 1.60). In men it was not significantly increased (RR 2.11, 95% CI: 0.93-4.85). Heterogeneity was low (I squared 0%) for both groups so a fixed effects model was used.

CONCLUSION

Risk of a subsequent hip fracture is increased for women who suffer a wrist fracture (RR 1.43). Resources and preventative measures should be targeted towards these high risk patients to prevent the catastrophic event of a hip fracture. This meta analysis confirms and quantifies the increased relative risk of hip fracture after wrist fracture in women.

Carpal Tunnel Decompression. Is Lengthening of the Flexor Retinaculum Better than Simple Division?

This prospective randomized double-blind control trial compared lengthening and simple division of the flexor retinaculum in carpal tunnel decompression. Twenty-six patients with bilateral carpal tunnel syndrome were randomly allocated to have the flexor retinaculum divided on one side and lengthened on the other. All 52 hands were reviewed at regular intervals up to 25 weeks. The patients, therapists and the final reviewer were unaware of treatment allocation. The Levine symptom and function scores were used to assess the severity of the carpal tunnel syndrome and showed that the two treatments were comparable for relief of carpal tunnel symptoms. The two treatments were also similar for function measured with the Jebsen–Taylor test. There is no identifiable benefit in lengthening the flexor retinaculum when decompressing the carpal tunnel. Moderate or severe pillar and scar pain is common, occurring in 13 of 52 hands after surgery, but only in four by the 12th week and two by the 25th week.

Construct Validation of the Supports Intensity Scale - Children and Adult Versions: An Application of a Pseudo Multitrait-Multimethod Approach

This study examined the convergent validity of the Supports Intensity Scale - Adult Version (SIS-A; Thompson et al., 2015a ) and Supports Intensity Scale - Children's Version (SIS-C; Thompson et al., 2016a ). Data from SISOnline (n = 129,864) for the SIS-A and from the SIS-C standardization sample (n = 4,015) were used for analyses. Using a pseudo multitrait-multimethod model, we estimated observed support needs scores as shared trait (support needs concept) and method (type, frequency, and daily support time) variances. Overall, trait variances more strongly influenced support needs scores than method variances, supporting the convergent validity of both versions of SIS. Findings also suggested that each of three methods of measuring support needs uniquely contributed to observed support needs ratings although different patterns existed between the SIS-A and SIS-C.

Architecture of the Human Mitochondrial Iron-Sulfur Cluster Assembly Machinery

Fe-S clusters, essential cofactors needed for the activity of many different enzymes, are assembled by conserved protein machineries inside bacteria and mitochondria. As the architecture of the human machinery remains undefined, we co-expressed in Escherichia coli the following four proteins involved in the initial step of Fe-S cluster synthesis: FXN42-210 (iron donor); [NFS1]·[ISD11] (sulfur donor); and ISCU (scaffold upon which new clusters are assembled). We purified a stable, active complex consisting of all four proteins with 1:1:1:1 stoichiometry. Using negative staining transmission EM and single particle analysis, we obtained a three-dimensional model of the complex with ∼14 Å resolution. Molecular dynamics flexible fitting of protein structures docked into the EM map of the model revealed a [FXN42-210]24·[NFS1]24·[ISD11]24·[ISCU]24 complex, consistent with the measured 1:1:1:1 stoichiometry of its four components. The complex structure fulfills distance constraints obtained from chemical cross-linking of the complex at multiple recurring interfaces, involving hydrogen bonds, salt bridges, or hydrophobic interactions between conserved residues. The complex consists of a central roughly cubic [FXN42-210]24·[ISCU]24 sub-complex with one symmetric ISCU trimer bound on top of one symmetric FXN42-210 trimer at each of its eight vertices. Binding of 12 [NFS1]2·[ISD11]2 sub-complexes to the surface results in a globular macromolecule with a diameter of ∼15 nm and creates 24 Fe-S cluster assembly centers. The organization of each center recapitulates a previously proposed conserved mechanism for sulfur donation from NFS1 to ISCU and reveals, for the first time, a path for iron donation from FXN42-210 to ISCU.

Do Individualized Transition Plans Match the Postschool Projections of Students with Learning Disabilities and Their Parents?

Information recorded on Transition Planning Guides (TPGs) was compared with student and parent perceptions regarding postschool goals and anticipated support needs. Findings revealed little relationship between the postschool outcomes and support needs recorded on TPGs and the postschool outcomes and support needs expressed by students and parents during interviews. Although results indicated that most students and parents concurred that students with learning disabilities would need more support in their postschool lives than would young adults from the general population, there was little agreement regarding the types of supports needed. Data further showed that, although most students and parents expected professionals from adult service agencies to assist students after graduation, these professionals were rarely involved in the transition planning process. Results are discussed in relation to the nature of postschool support needed by young adults with learning disabilities, strategies that actively involve students and parents in the development of transition plans, and procedures by which compliance with the transition planning requirements of public laws can be monitored.

Examining age-related differences in support needs on the Supports Intensity Scale-Children's Version-Spanish translation

Background: Interest in the support needs of people with intellectual disability has directed attention to developing assessments to measure of the pattern and intensity of supports which people need to participate in valued life activities. Assessments of the support needs of children must account for the influence of age. Method: Four hundred fifty (450) Spanish children with intellectual disability (ages 5-16) were assessed with the SIS-C Spanish. To test for measurement invariance and latent differences, the SIS-C Spanish standardization sample was linked to the SIS-C English normative sample. Models developed during the norming process were used to investigate measurement equivalence across age groups, differences in latent means, and differences in latent variances and standard deviations. Results: Findings suggested that all items on the SIS-C Spanish could reliably be used to measure support needs of children ages 5-16. When exploring age-related differences at the latent level, however, data showed latent mean differences in support need domain scores across age cohorts. Conclusions: The same set of items can be used to measure support needs in children ages 5-16, but age-related influences must be considered in developing norms for the SIS-C Spanish as well as in planning supports for children.

Creating a SIS-A Annual Review Protocol to Determine the Need for Reassessment

The Supports Intensity Scale - Adult Version (SIS-A) has been widely adopted throughout North America and the world since its publication a little over a decade ago. Many organizations and jurisdictions operate under regulations that require an annual assessment of people who receive services and supports that are financed through public funds. The time and energy devoted to an annual SIS-A reassessment has become a concern in cases where the resulting information is largely redundant with information from a prior assessment. This article presents findings from an investigation of two approaches to creating a protocol to assist SIS-A users in distinguishing situations where there is a high likelihood that support needs have not changed in meaningful ways from situations where there is a reasonable possibility that support needs have changed. The SIS-A Annual Review Protocol was created based on these analyses as well as consideration of conceptual issues associated with support needs assessment. Ways in which this protocol might be used, as well as data that need to be collected to evaluate its usefulness, are discussed.

Architecture of the Yeast Mitochondrial Iron-Sulfur Cluster Assembly Machinery: THE SUB-COMPLEX FORMED BY THE IRON DONOR, Yfh1 PROTEIN, AND THE SCAFFOLD, Isu1 PROTEIN

The biosynthesis of Fe-S clusters is a vital process involving the delivery of elemental iron and sulfur to scaffold proteins via molecular interactions that are still poorly defined. We reconstituted a stable, functional complex consisting of the iron donor, Yfh1 (yeast frataxin homologue 1), and the Fe-S cluster scaffold, Isu1, with 1:1 stoichiometry, [Yfh1]24·[Isu1]24 Using negative staining transmission EM and single particle analysis, we obtained a three-dimensional reconstruction of this complex at a resolution of ∼17 Å. In addition, via chemical cross-linking, limited proteolysis, and mass spectrometry, we identified protein-protein interaction surfaces within the complex. The data together reveal that [Yfh1]24·[Isu1]24 is a roughly cubic macromolecule consisting of one symmetric Isu1 trimer binding on top of one symmetric Yfh1 trimer at each of its eight vertices. Furthermore, molecular modeling suggests that two subunits of the cysteine desulfurase, Nfs1, may bind symmetrically on top of two adjacent Isu1 trimers in a manner that creates two putative [2Fe-2S] cluster assembly centers. In each center, conserved amino acids known to be involved in sulfur and iron donation by Nfs1 and Yfh1, respectively, are in close proximity to the Fe-S cluster-coordinating residues of Isu1. We suggest that this architecture is suitable to ensure concerted and protected transfer of potentially toxic iron and sulfur atoms to Isu1 during Fe-S cluster assembly.

Impact of the Protection and Advocacy Subscale on the Factorial Validity of the Supports Intensity Scale-Adult Version

The Supports Intensity Scale-Adult Version is a standardized assessment of support needs. This study examined the factorial validity of the standardized portion of the scale, finding that the six-factor model (Home Living, Community Living, Lifelong Learning, Employment, Health and Safety, Social Activities) demonstrated good fit, and that the inclusion of the Protection and Advocacy Scale did not affect fit and contributed unique information. Age and gender impacted intensity of support needs, with those of transition age and in late adulthood having the highest intensities. Gender also impacted support needs, but in fewer instances. Implications for future research are discussed.

Limited Genetic Variability Among American Isolates of Grapevine virus E from Vitis spp

A survey for the presence of Grapevine virus E (GVE, genus Vitivirus, family Betaflexiviridae) in vineyards in New York and California was conducted using macroarray hybridization or reverse-transcription polymerase chain reaction (RT-PCR) assays. In New York, GVE was detected in 10 of 46 vines of Vitis labrusca, one V. riparia, and one Vitis hybrid. All GVE-infected New York vines were coinfected with Grapevine leafroll-associated virus-3. In California, GVE was detected in 8 of 417 vines of V. vinifera. All GVE-infected California vines were also coinfected by one of the leafroll-associated viruses and other vitiviruses. In order to assess the genetic diversity among GVE isolates, a viral cDNA was amplified by RT-PCR, and a 675-nucleotide region that included the 3' terminus of the coat protein gene, a short intergenic region, and the 5' terminus of the putative nucleic acid binding protein gene was sequenced. All 20 GVE isolates sequenced in this study were very closely related, with >98% nucleotide identity to the SA94 isolate from South Africa. These findings confirm the presence of GVE in major grape-growing regions of the United States and indicate a very low level of genetic diversity.

Glucose transport machinery reconstituted in cell models

Here we demonstrate the production of a functioning cell model by formation of giant vesicles reconstituted with the GLUT1 glucose transporter and a glucose oxidase and hydrogen peroxidase linked fluorescent reporter internally. Hence, a simplified artificial cell is formed that is able to take up glucose and process it.

Recovery of phosphorus from dairy manure: a pilot-scale study

Phosphorus was recovered from dairy manure via a microwave-enhanced advanced oxidation process (MW/H2O2-AOP) followed by struvite crystallization in a pilot-scale continuous flow operation. Soluble phosphorus in dairy manure increased by over 50% after the MW/H2O2-AOP, and the settleability of suspended solids was greatly improved. More than 50% of clear supernatant was obtained after microwave treatment, and the maximum volume of supernatant was obtained at a hydrogen peroxide dosage of 0.3% and pH 3.5. By adding oxalic acid into the supernatant, about 90% of calcium was removed, while more than 90% of magnesium was retained. As a result, the resulting solution was well suited for struvite crystallization. Nearly 95% of phosphorus in the treated supernatant was removed and recovered as struvite.

Timed Sollerman hand function test for analysis of hand function in normal volunteers

This study describes the development and application of the timed Sollerman hand function test in normal volunteers and the effect of age, gender, dominance and handedness on hand function. A total of 100 volunteers (50 men and 50 women) aged between 20 to 70 years were asked to complete the Sollerman hand function test. We measured the time taken to complete the 20 tasks using seven grips. Volunteers completed the tasks a mean of 20 seconds quicker with the dominant than with the nondominant hand. Individuals who are strongly right-handed showed a pronounced difference taking less time with the dominant hand. Women took less time to complete all tasks in age groups 30 to 40 years, than women in age groups 20 to 30 years and beyond 40 years using the dominant hand. Men also showed worsening performance with age. The centile curves of the total time taken to complete all 20 Sollerman tasks between the ages of 20 to 70 years will allow investigators to adjust their findings for age before attributing observed differences to disease or its treatment.

Cardiovascular safety of conjugated estrogens plus bazedoxifene: meta-analysis of the SMART trials

OBJECTIVES

Five randomized, phase-3 trials demonstrated the efficacy and safety of conjugated estrogens/bazedoxifene (CE/BZA) in treating menopausal symptoms and preserving bone. This pooled analysis of these studies describes the cardiovascular safety of CE/BZA.

METHODS

We pooled cardiovascular adjudicated safety data from healthy, non-hysterectomized, postmenopausal women who received ≥ 1 dose of CE 0.45 mg/BZA 20 mg (n = 1585), CE 0.625 mg/BZA 20 mg (n = 1583), any CE/BZA dose (n = 4868), or placebo (n = 1241) for up to 2 years in five trials. Venous thromboembolic events (VTEs), coronary heart disease (CHD), and cerebrovascular events were reviewed by three different independent adjudication committees and summarized using a meta-analytic approach.

RESULTS

The rate of VTEs per 1000 woman-years (95% confidence interval, CI) was 0.3 (0.0-2.0) in women taking CE 0.45 mg/BZA 20 mg, 0 (0.0-1.5) in those taking CE 0.625 mg/BZA 20 mg, 0.7 (0.0-1.5) among women taking any CE/BZA dose, and 0.6 (0.0-2.9) with placebo. The incidence of stroke per 1000 woman-years (95% CI) was 0.4 (0.0-2.4), 0.2 (0.0-1.9), 0.44 (0.0-1.1), and 0.0 (0.0-1.7), respectively. The CHD rate per 1000 woman-years was 2.6 (0.0-5.6), 1.4 (0.0-3.9), 2.4 (1.00-3.7) and 2.0 (0.0-5.2). Compared with placebo, relative risk (95% CI) with any CE/BZA dose was 0.5 (0.1-1.8) for VTE, 0.5 (0.1-2.6) for stroke, and 0.63 (0.23-1.74) for CHD.

CONCLUSIONS

Up to 2 years of CE 0.45 or CE 0.625 mg with BZA 20 mg had an acceptable cardiovascular safety profile, with rates of stroke and CHD comparable to placebo in healthy postmenopausal women. VTE risk was low.

Grapevine red blotch-associated virus Is Widespread in the United States

Grapevine red blotch disease has been recognized since 2008 as affecting North American grape production. The presence of the newly described Grapevine red blotch-associated virus (GRBaV) is highly correlated with the disease. To more effectively detect and monitor the presence of the virus, a sample processing strategy and multiplex polymerase chain reaction assay were developed. A total of 42 of 113 vine samples collected in or received from seven of the United States were shown to harbor the virus, demonstrating the virus is widely distributed across North America. Phylogenetic analyses of a viral replication-associated protein (Rep) gene fragment from the 42 isolates of GRBaV demonstrated distinct clades of the virus (1 and 2), with clade 1 showing the greatest variability. The full-length genome of six virus isolates was sequenced, and phylogenetic analyses of 14 whole genomes recapitulated results seen for the Rep gene. A comparison of GRBaV genomes revealed evidence of recombination underlying some of the variation seen among GRBaV genomes within clade 1. Phylogenetic analyses of coat and replicase-associated protein sequences among single-stranded DNA viruses showed GRBaV to group within the family Geminiviridae. This grouping is distinct from members of the families Nanoviridae and Circoviridae, with limited significant affinities to both recognized genera and novel plant-infecting, gemini-like viruses.

Retrospective TREC testing of newborns with Severe Combined Immunodeficiency and other primary immunodeficiency diseases

In Manitoba, Canada, the overall incidence of Severe Combined Immunodeficiency (SCID) is three-fold higher than the national average, with SCID overrepresented in two population groups: Mennonites and First Nations of Northern Cree ancestries. T-cell receptor excision circle (TREC) assay is being used increasingly for neonatal screening for SCID in North America. However, the majority of SCID patients in Manitoba are T-cell-positive. Therefore it is likely that the TREC assay will not identify these infants. The goal of this study was to blindly and retrospectively perform TREC analysis in confirmed SCID patients using archived Guthrie cards. Thirteen SCID patients were tested: 5 T-negative SCID (3 with adenosine deaminase deficiency, 1 with CD3δ deficiency, and 1 unclassified) and 8 T-positive SCID (5 with zeta chain-associated protein kinase (ZAP70) deficiency and 3 with inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase beta (IKKβ) deficiency). As a non-SCID patient group, 5 Primary Immunodeficiency Disease (PID) patients were studied: 1 T-negative PID (cartilage-hair hypoplasia) and 4 T-positive PID (2 common immune deficiency (CID), 1 Wiskott–Aldrich syndrome, and 1 X-linked lymphoproliferative disease). Both patient groups required hematopoietic stem cell transplantation. In addition, randomly-selected de-identified controls (n = 982) were tested. Results: all T-negative SCID and PID had zero TRECs. Low-TRECs were identified in 2 ZAP70 siblings, 1 CID patient as well as 5 preterm, 1 twin, and 4 de-identified controls. Conclusions: TREC method will identify T-negative SCID and T-negative PID. To identify other SCID babies, newborn screening in Manitoba must include supplemental targeted screening for ethnic-specific mutations.

How the Supports Paradigm Is Transforming the Developmental Disabilities Service System

The supports paradigm is based on the premise that the most relevant difference between people with intellectual disability and related developmental disabilities (ID/DD) and the general population is that people with ID/DD need different types and intensities of support to fully participate in and contribute to society. The supports paradigm is changing professional work and public policies in the field of ID/DD by providing a conceptual basis for aligning the work of researchers, policymakers, and professionals at micro (individual), meso (organizational), and macro (jurisdictional) levels. The potential of the supports paradigm to transform the adult service system is discussed.

The Supports Intensity Scale–Children's Version: Preliminary Reliability and Validity

This article introduces the Supports Intensity Scale–Children's Version (SIS-C) designed and normed to be used with children across multiple contexts, including home, school, and community life. Steps taken to develop the scale are described, and findings from data collected on a field test version of the SIS-C are shared. Preliminary findings in regard to reliability and validity suggest that the SIS-C has strong psychometric properties.

Reliability and Validity of the Supplemental Protection and Advocacy Scale of the Supports Intensity Scale

Three separate studies were undertaken to examine the reliability and validity of the Supplemental Protection and Advocacy Scale (P&A Scale) of the Supports Intensity Scale (SIS). In Study 1, the interrater reliability of the P&A Scale was investigated when interviewers were trained in SIS administration and scoring. Pearson's product moment coefficients were considerably higher than coefficients reported in a previous study conducted with untrained interviewers. In Study 2, the reliability (internal consistency, standard error of measurement, and interrater reliability) and validity (content and construct validity) of the P&A Scale when administered by trained interviewers with a sample of individuals with intellectual disability and related developmental disabilities (ID/DD) receiving services from a state ID/DD agency were examined. Results indicated strong reliability and validity of the P&A Scale, comparable to other domains of the SIS. In Study 3, additional psychometric properties of the P&A Scale were examined in a large sample of trained interviewers from across the United States and Canada using the SIS Online, with findings again showing strong psychometric properties. Collectively, findings from these three investigations suggested that the P&A Scale is a reliable and valid measure of support needs. In future revisions of the SIS, the P&A Scale should be considered for inclusion in the section of the SIS that yields standard scores reflecting an individual's relative intensity of support need.

Assessment and Planning in K-12 Schools: A Social-Ecological Approach

The Support Needs Assessment and Problem-Solving (SNAP) process is intended to assist educational teams in identifying and implementing supports for children with intellectual disability and related developmental disabilities (ID/DD) in K-12 schools. Each phase of the SNAP process is described, including identification of high priority support needs based on information derived from the Supports Intensity Scale–Children's Version (SIS-C). Two case studies of school teams using the SNAP process to identify and implement supports that enhanced opportunities for learning and participation of children in inclusive settings are presented. The importance of understanding children with ID/DD by their support needs and implications for team planning in K-12 schools are discussed.

Distribution and abundance of human-specific Bacteroides and relation to traditional indicators in an urban tropical catchment

AIMS

The study goals were to determine the relationship between faecal indicator bacteria (FIB), the HF183 marker and land use, and the phylogenetic diversity of HF183 marker sequences in a tropical urban watershed.

METHODS AND RESULTS

Total coliforms, Escherichia coli, and HF183 were quantified in 81 samples categorized as undeveloped, residential and horticultural from the Kranji Reservoir and Catchment in Singapore. Quantitative-PCR for HF183 followed by analysis of variance indicated that horticultural areas had significantly higher geometric means for marker levels (4·3 × 10(4) HF183-GE 100 ml(-1)) than nonhorticultural areas (3·07 × 10(3) HF183-GE 100 ml(-1)). E. coli and HF183 were moderately correlated in horticultural areas (R = 0·59, P = 0·0077), but not elsewhere in the catchment. Initial upstream surveys of candidate sources revealed elevated HF183 in a wastewater treatment effluent but not in aquaculture ponds. The HF183 marker was cloned, sequenced and determined by phylogenetic analysis to match the original marker description.

CONCLUSION

We show that quantification of the HF183 marker is a useful tool for mapping the spatial distribution and potential sources of human sewage contamination in tropical environments such as Singapore.

SIGNIFICANCE AND IMPACT

A major challenge for assessment of water quality in tropical environments is the natural occurrence and nonconservative behaviour of FIB. The HF183 marker has been employed in temperate environments as an alternative indicator for human sewage contamination. Our study supports the use of the HF183 marker as an indicator for human sewage in Singapore and motivates further work to determine HF183 marker levels that correspond to public health risk in tropical environments.

Cost-effectiveness of Telaprevir combination therapy for chronic hepatitis C

Objective

To explore the expected long-term health and economic outcomes of telaprevir (TVR) plus peginterferon alfa-2a and ribavirin (PR), a regimen that demonstrated substantially increased sustained virologic response (SVR) compared with PR alone in adults with chronic genotype 1 hepatitis C virus (HCV) and compensated liver disease in the Phase III studies ADVANCE (treatment-naïve patients) and REALIZE (relapsers, partial responders, and null responders to previous PR treatment).

Study Design

A decision-analytic model was developed to assess the cost-effectiveness of TVR+PR vs. PR in the United States (US).

Methods

Patients first moved through the 72-week decision-tree treatment phase of the model and then entered the cyclic Markov post-treatment phase. Clinical data (patient characteristics, SVR rates, and adverse event rates and durations) were obtained from ADVANCE and REALIZE. Health-state transition probabilities, drug and other costs (in 2012/2013 US dollars), and utility values were obtained from the trials, published studies, and publicly available sources. Outcomes were discounted at 3% per year.

Results

Regardless of treatment history, patients receiving TVR+PR were projected to experience fewer liver-disease complications, more life-years, and more quality-adjusted life-years (QALYs) than patients receiving PR. In prior relapsers, TVR+PR was dominant, with lower total medical costs and more QALYs. For the other patient subgroups, incremental costs per QALY gained were between $16,778 (treatment-naïve patients) and $34,279 (prior null responders). Extensive sensitivity analyses confirmed robust model results.

Conclusions

At standard willingness-to-pay thresholds, TVR+PR represents a cost-effective treatment option compared with PR alone for patients with chronic genotype 1 HCV and compensated liver disease in the US. Future analyses are needed to compare TVR+PR with all existing HCV treatment options.