Discovering novel barriers to eBook implementation

BACKGROUND

Medical errors when managing inpatient paediatric patients with diabetes mellitus can lead to significant morbidity and mortality, necessitating improvement in training of medical trainees. Previous educational interventions have focused on time and resource intensive methods, restricting their applicability to teaching in time-limited scenarios. We chose a blended learning approach to create and implement a novel eBook for use by trainees and then aimed to determine the efficacy and potential barriers to that implementation.

APPROACH

We grounded our work in complex adaptive systems theory and used the framework of complex adaptive blended learning system (CABLS) to shape both our implementation and evaluation. We utilised an embedded mixed methodology to quantitatively evaluate efficacy via knowledge acquisition and self-reported confidence and to qualitatively evaluate barriers via open-ended questions.

EVALUATION

Between 2022 and 2023, the study enrolled 72 learners and 12 educators. There was no statistically significant difference in change in knowledge acquisition and self-reported confidence between learners who did and did not have access to the eBook. Learners and educators identified several unique and novel barriers to eBook implementation, which were mapped to the CABLS framework.

IMPLICATIONS

Our results on the efficacy of implementation are inconclusive, possibly due to the small participant size and implying a need for multi-institutional evaluation. Our qualitative results demonstrated previously unknown barriers to eBook implementation. This knowledge can assist other medical specialties as they implement their own eBooks. We also hope to use these barriers to improve implementation in our next iteration: the outpatient setting.

The Impact of a Gamified Curriculum Using Kahoot! on Musculoskeletal Knowledge and Skill Acquisition Among Pediatric Residents

OBJECTIVE

To determine whether a musculoskeletal curriculum involving gamification via Kahoot! (an online classroom response system) was acceptable and more effective at teaching pediatric residents musculoskeletal knowledge and skills than a nongamified curriculum.

METHODS

A prospective, randomized controlled trial was conducted at an urban, academic pediatric clinic. All participants received a curriculum that included brief didactics and knowledge questions. The knowledge questions were delivered via Kahoot! to the intervention group and administered via paper to the control group. The primary outcome was knowledge and skill acquisition following curriculum participation.

RESULTS

A total of 73 of 85 (86%) residents completed the study (intervention group: 46; control group: 27). Following participation in the curriculum, intervention and control residents demonstrated an improvement in musculoskeletal knowledge (P < .05) measured via questionnaire, as well as an improvement in physical exam skills during a standardized patient encounter (P < .05). There was no difference in knowledge or skill improvement between groups. Intervention participants indicated positive attitudes toward Kahoot!.

CONCLUSIONS

Our musculoskeletal curriculum demonstrated improvements in knowledge and skills among residents, though inclusion of Kahoot! did not enhance the experimental effect. Further research is needed to identify strategies to optimize gamification for learning.

The earliest known reported occurrence of dentigerous cyst in a six-month-old child

The earliest reported case of the occurrence of a dentigerous cyst is described; the cyst surrounded an unerupted permanent tooth bud in a 6-month-old infant. Most commonly these lesions present between the second and third decades of life. They rarely occur before 10 years of age and have not been documented prior to 1 year of age. In the case reported here, the treatment instituted was extraction of the adjacent deciduous tooth and enucleation of the cyst along with the permanent molar tooth bud. Clinicians should be aware of the potential for this lesion to occur across a wide range of ages and the importance of prompt diagnosis and treatment to prevent complications and reduce morbidity.

POS1202 B-CELL RECONSTITUTION IS STRONGLY ASSOCIATED WITH A POSITIVE SEROLOGIC RESPONSE TO THE COVID-19 BOOSTER VACCINE IN PREVIOUSLY SEROLOGICALLY UNRESPONSIVE RITUXIMAB TREATED RHEUMATIC DISEASE PATIENTS

Background

Booster doses of SARS-CoV-2 vaccines have emerged as an important strategy for containing the pandemic and may be especially important to rituximab treated patients. B-cell depletion has been associated with worse outcomes from COVID-19 infection, and many rituximab treated patients demonstrate an inadequate serologic response to the initial vaccine series (1). Strategies to optimize serologic response to COVID-19 vaccine boosters in previously serologically unresponsive patients is, therefore, of particular relevance.

Objectives

To assess factors associated with serologic response to COVID-19 booster vaccines in rituximab treated patients previously serologically unresponsive to the initial vaccine series.

Methods

A retrospective chart review of rituximab treated patients who failed to demonstrate a serologic response to the first SARS-CoV-2 vaccination series and subsequently received an mRNA vaccine booster was performed. Serologic response four weeks or more after the booster was the primary outcome. T-tests, Fisher’s exact tests, and Wilcoxon rank sum tests were used for comparisons. Box and whisker plots were constructed to visualize differences between serologic response.

Results

In 31 rituximab treated patients who were seronegative following the initial vaccine series, demographic characteristics, concurrent therapies, rheumatologic diagnosis, and vaccine type were not associated with serologic positivity to the booster vaccine (Table 1). B-cell reconstitution was significantly different between those with positive (median, IQR 1.785 (0.65, 3)) and negative (median, IQR 0 (0,0)) serologic responses to the booster (p-value<0.001) as was time from last rituximab exposure (p-value = 0.030) (Figure 1). Positive predictive value of B-cell presence was 90.9% (95% CI: 70.8%, 98.9%) and negative predictive value was 100% (95% CI: 59%, 100%) for serologic response to the mRNA booster. Positive predictive value of time >6 months from last rituximab to the booster was 78.3% (95% CI 56.3%, 92.5%) and the negative predictive value was 62.5% (95% CI 24.5%, 91.5%).

Table 1.

Bivariate comparisons between seronegative and seropositive patients to the COVID-19 booster vaccine by patient characteristics and demographics

FactorValueNegativePositivep-valueaN311021Age, median (IQR)64 (51, 72)63 (51, 69)65 (51, 73)0.75Sex1.00 Female23 (74%)7 (70%)16 (76%) Male8 (26%)3 (30%)5 (24%)Any immunosuppressantb9 (29%)3 (30%)6 (29%)1.00Corticosteroid5 (16%)1 (10%)4 (19%)1.003rdVaccine dose type0.24 Pfizer19 (61%)8 (80%)11 (52%) Moderna12 (39%)2 (20%)10 (48%)Dichotomous B-cell status around booster dose<0.001 No detectable B-cells7 (23%)7 (70%)0 (0%) Detectable B-cells22 (71%)2 (20%)20 (95%) Missing2 (6%)1 (10%)1 (5%)Time from last RTX infusion to booster, median (IQR)260 (216, 379)188 (169, 245)301 (251, 368)0.030Time from last RTX infusion to booster dose0.10 <6months8 (25.81%)5 (50%)3 (14%) 6-12 months15 (48.39%)3 (30%)12 (57%) >12 months8 (25.81%)2 (20%)6 (29%)

aP-values are from Fisher’s exact test, Student’s T-test and Wilcoxon rank sum tests

bImmunosuppressants included Leflunomide, Azathioprine, Methotrexate, Mycophenolate Mofetil, and Tocilizumab

IQR= Interquartile range

Conclusion

Presence of detectable B-cells and longer time from last rituximab were associated with the development of SARS-CoV-2 spike protein antibodies following the booster vaccine. These factors should be considered in timing of administration of booster vaccine doses in previously unresponsive rituximab treated patients.

References

[1]Levavi H, Lancman G, Gabriolove J. Impact of rituximab on COVID-19 outcomes. Ann Hematol 2021;100:2805-12.

Disclosure of Interests

Kaitlin Schultz: None declared, Deanna Jannat-Khah Shareholder of: Cytodyn, Astrazeneca, Walgreens, Robert Spiera Consultant of: AbbVie, Regeneron, Sanofi, Chemomab, Formation Biologics, GSK, Janssen Pharmaceuticals, Chemocentryx, Grant/research support from: GSK, Boehringer Ingelheim Pharmaceuticals, Corbus Pharmaceuticals, Formation Biologics, InflaRx, Kadmon, Astrazeneca, AbbVie, Sanofi, Genentech/Roche, Principia, Novartis

The aquaculture supply chain in the time of covid-19 pandemic: Vulnerability, resilience, solutions and priorities at the global scale

The COVID-19 global pandemic has had severe, unpredictable and synchronous impacts on all levels of perishable food supply chains (PFSC), across multiple sectors and spatial scales. Aquaculture plays a vital and rapidly expanding role in food security, in some cases overtaking wild caught fisheries in the production of high-quality animal protein in this PFSC. We performed a rapid global assessment to evaluate the effects of the COVID-19 pandemic and related emerging control measures on the aquaculture supply chain. Socio-economic effects of the pandemic were analysed by surveying the perceptions of stakeholders, who were asked to describe potential supply-side disruption, vulnerabilities and resilience patterns along the production pipeline with four main supply chain components: a) hatchery, b) production/processing, c) distribution/logistics and d) market. We also assessed different farming strategies, comparing land- vs. sea-based systems; extensive vs. intensive methods; and with and without integrated multi-trophic aquaculture, IMTA. In addition to evaluating levels and sources of economic distress, interviewees were asked to identify mitigation solutions adopted at local / internal (i.e., farm-site) scales, and to express their preference on national / external scale mitigation measures among a set of a priori options. Survey responses identified the potential causes of disruption, ripple effects, sources of food insecurity, and socio-economic conflicts. They also pointed to various levels of mitigation strategies. The collated evidence represents a first baseline useful to address future disaster-driven responses, to reinforce the resilience of the sector and to facilitate the design reconstruction plans and mitigation measures, such as financial aid strategies.

The "can do, do do" concept in individuals with chronic obstructive pulmonary disease: an exploration of psychological mechanisms

Background

The “can do, do do” concept aims at identifying subgroups among persons with chronic obstructive pulmonary disease (COPD). Following a two-dimensional categorization, individuals are binarily classified with respect to their levels of physical capacity (“can’t do” or “can do”) and physical activity (“don’t do” or “do do”), resulting in four disjunct quadrants. The approach has been debated recently and the latest articles have concluded that the quadrants should be specifically examined in terms of psychological aspects of physical activity. Therefore, the goal of the present study was to explore the role of psychological variables in physical activity in the context of the “can do, do do” quadrant concept.

Methods

Within the scope of secondary data analyses of the “Stay Active After Rehabilitation” (STAR) randomized controlled trial, a total of 298 COPD rehabilitants of an inpatient pulmonary rehabilitation program were grouped into the suggested quadrants. We set fixed cut-offs at 70% of relative 6-min walking test performances for healthy individuals (physical capacity dimension) and 5.000 steps per day (physical activity dimension). Univariate and multivariate logistic regression analyses served to analyze whether depression scores, fear avoidance behaviors, disease-specific anxiety, self-concordance for physical activity, and five indicators of physical activity-related health competence (PAHCO) effectively discriminated between the “don’t do” and “do do” groups.

Results

Among persons with lower relative physical capacity, depression scores, fear avoidance behaviors, and disease-specific anxiety (univariate case) significantly differentiated between the more and the less active. Among persons with higher relative physical capacity, fear avoidance behaviors, disease-specific anxiety, as well as three PAHCO indicators (physical activity-specific self-efficacy, self-control, and affect regulation) significantly separated the more and the less active. In multivariate analyses, only fear avoidance behaviors and affect regulation discriminated among individuals with better relative physical capacity.

Conclusion

The findings identified important psychological and competence-oriented variables that explain discrepancies in the quadrant concept. Based on this, we discuss implications for physical activity promotion in individuals with COPD. Respiratory research can benefit from future studies complementing the quadrant concept through further behavioral analyses.

Trial registration Clinicaltrials.gov, ID: NCT02966561. Registered 17 November, 2016, https://clinicaltrials.gov/ct2/show/NCT02966561.

Implementation of a virtual ward as a response to the COVID-19 pandemic

Objective The aim of this study was to describe and evaluate the implementation of a virtual ward as a COVID-19 hospital avoidance response strategy and identify opportunities for improvement and future applicability. Methods A mixed-method observational study was conducted of a centralised virtual ward, which operated in a large metropolitan Australian health service from 23 March to 1 June 2020. Results In total, 238 unique patients were admitted to the virtual ward, accounting for 264 individual admission episodes and 2451 virtual bed days. Twenty (7.6%) episodes resulted in transfer to hospital and 136 patients provided responses to feedback surveys and reported their experience as very good (61.7%, n=87) or good (34.8%, n=49). Implementation success was high, with the model widely accepted and adopted across the health service. The service delivery model was considered to be low-cost in comparison to inpatient hospital-based care. Conclusions Overall, as a rapidly developed and implemented low-tech model of care, the virtual ward was found to provide an effective, accessible and low-cost solution to managing low-acuity COVID-19-positive patients in the community. This model should be considered in future pandemics as a hospital-avoidance response, with the ability to minimise patient-to-healthcare worker transmission, reduce personal protective equipment use and enhance patient adherence with isolation requirements. Targeted remote telemonitoring should be considered as a future modification to improve patient care. What is known about this topic? Virtual wards aim to reduce hospital demand by providing hospital-level care in community settings such as the patients' home. The COVID-19 pandemic has seen a rapid increase in the utilisation of virtual wards as an acute healthcare response that facilitates contactless care of infectious patients. Despite this rapid adoption, there is limited literature on the effectiveness of virtual ward models of care in a pandemic context. What does this paper add? This study provides a detailed description of the implementation of a virtual ward in a large metropolitan health service. It evaluates the effectiveness of the virtual ward as a COVID-19 response strategy and identifies opportunities for improvement and future applicability. This study contributes to the growing body of literature on the COVID-19 healthcare response and virtual wards. What are the implications for practitioners? This study details the implementation of a virtual ward and highlights potential facilitators and barriers to successful implementation and sustained applicability. Findings provide a comparative benchmark for other health services implementing virtual wards as a pandemic response strategy.

[Guideline for the Diagnosis and Treatment of Asthma - Addendum 2020 - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]

The present addendum of the guideline for the diagnosis and treatment of asthma (2017) complements new insights into the diagnosis and management of asthma as well as for the newly approved drugs for the treatment of asthma. Current, evidence-based recommendations on diagnostic and therapeutic approaches are presented for children and adolescents as well as for adults with asthma.

To Flip or Not to Flip: Learning Style Preferences among Millennial Physician Assistant Students

Introduction: Presenting material in a manner that is most palatable to students is important to improve the learning process. We evaluated the efficacy of different teaching styles including the flipped classroom and assessed the learning style preferences of a cohort of medical learners in a preclinical obstetrics and gynecology course.

Methods: We conducted three teaching sessions with 35 physician assistant students. A different teaching style was implemented for each session including a traditional lecture with interactive learning technology augmentation, a flipped classroom, and a hybrid approach incorporating lecture and group work. Students were surveyed using a Likert scale regarding the efficacy of the format, clinical relevance of the material, and their learning preference for future sessions.

Results: Students rated the traditional approach as the most effective, most relevant, and most preferred method. Students preferred the flipped classroom least, but they rated it as slightly more effective and relevant than the hybrid approach.

Conclusion: The teaching style of various coursework including the preclinical obstetrics and gynecology curriculum may not need to be altered for millennial learners. This study showed the flipped classroom was the least favored teaching style and that there was a marked preference by students for a more traditional didactic lecture.

[Group Training of Patients with Chronic Lung Diseases under Outpatient Conditions - Recommendations of the Working Group Lung Sports in Germany and the German Airways League]

To improve acceptance and use of physical training by patients with chronic lung diseases, recommendations for performing lung exercises on an outpatient basis in a group setting are given by experts in physical training, sports therapists and pulmonologists. The evidence-based positive effects of physical training were analyzed for asthma , COPD, interstitial lung diseases, cystic fibrosis, lung carcinoma, and pulmonary hypertension. The requirements for lung exercises in outpatient groups as well as compensation by care providers were given on the basis of legal regulations. Furthermore, the main items of the training units as well as supervision by specially trained group leaders in relation to the severity of the underlying lung disease are described. Finally, aspects of safety of the participating patients are discussed, including the prevention of infection with corona-2-virus.

[Recommendations from the German Respiratory Society for Pulmonary Rehabilitation in Patients with COVID-19]

Vor dem Hintergrund der Pandemie durch Infektionen mit dem SARS-CoV-2 hat die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP e. V.) die Sektion 12 „Rehabilitation, Prävention und Tabakkontrolle“ beauftragt, Empfehlungen zur Umsetzung pneumologischer Rehabilitation bei Patienten nach COVID-19 zu erstellen. Dieses Positionspapier basiert auf dem momentanen aktuellen Wissen, das sich täglich weiterentwickelt. Neben einer Beschreibung der gesundheitlichen Folgen von COVID-19 wird die Indikationsstellung aufgezeigt. Rehabilitative Therapien bei COVID-19 sind bereits auf der Normalstation bzw. Intensivstation indiziert, setzen sich fort als pneumologische Frührehabilitation im Akutkrankenhaus und als Anschlussheilbehandlung oder Reha-Heilverfahren in pneumologischen Rehabilitationskliniken. Im Fokus dieses Positionspapiers stehen Empfehlungen zur inhaltlichen Durchführung einer multimodalen, interdisziplinären pneumologischen Rehabilitation bei COVID-19.

Trends in Gender Authorship and Collaborations: A 30-Year Comparative Bibliometric Analysis of Manuscripts from The Journal of Bone and Joint Surgery and The Bone and Joint Journal

Publishing original peer-reviewed research is essential for advancement through all career stages. Fewer women than men hold senior-level positions in academic medicine and, therefore, examining publication trends relative to gender is important. The goal of this study was to examine and compare publication trends in The Journal of Bone and Joint Surgery (JBJS) and The Bone and Joint Journal (BJJ) with a particular emphasis on trends regarding author gender. Data was collected and analyzed for manuscripts published in JBJS and BJJ over the past 30 years. For manuscripts published in 1986, 1996, 2006, and 2016, we recorded the numbers of authors, manuscript pages, references, collaborating institutions, the position in the byline of the corresponding author, the country of the corresponding author, and the names of the first and corresponding author. We also calculated the normalized number of citations and corresponding author position. The number of authors, institutions, and countries collaborating on manuscripts published in both JBJS and BJJ increased over time. JBJS published more manuscripts from North America and BJJ published more manuscripts from Europe. In both journals, the percentage of women as first and/or corresponding author increased over time. Trends over the past 30 years have shown increased collaborations with greater citations in manuscripts published in JBJS and BJJ. In the same time period, both journals demonstrated a rise in the percentage of manuscripts with women first and/or corresponding authors, suggesting a decrease in the gender gap.

Identification of service improvement opportunities in an Australian community transition care program

BACKGROUND

Transition care programs (TCPs) are designed to optimise functional recovery and independence in older adults post-hospitalisation. These programs are under high demand, and understanding inefficiencies in patient flow are a key step towards service improvement.

AIMS

To identify service improvement opportunities in an Australian community TCP service.

METHODS

An in-depth retrospective study of 113 community TCP clients.

RESULTS

TCP occupancy was high (94%) and client functional level improved across the program. Inefficiencies experienced included: admission delays to the program; low completion rates (61%) predominantly due to re-hospitalisation; variable response times by Allied Health services (5-20 days); and discharge delays-the latter attributed to waiting for services such as Home Care Packages through Non-Government Organisations.

DISCUSSION

This study identified several opportunities for service improvement in a community TCP service. Health practitioners should be regularly provided with up-to-date information on efficiency of TCP services.

Preventable Patient Harm: a Multidisciplinary, Bundled Approach to Reducing Clostridium difficile Infections While Using a Glutamate Dehydrogenase/Toxin Immunochromatographic Assay/Nucleic Acid Amplification Test Diagnostic Algorithm

Health care facility-onset Clostridium difficile infections (HO-CDI) are an important national problem, causing increased morbidity and mortality. HO-CDI is an important metric for the Center for Medicare and Medicaid Service's (CMS) performance measures. Hospitals that fall into the worst-performing quartile in preventing hospital-acquired infections, including HO-CDI, may lose millions of dollars in reimbursement. Under pressure to reduce CDI and without a clear optimal method for C. difficile detection, health care facilities are questioning how best to use highly sensitive nucleic acid amplification tests (NAATs) to aid in the diagnosis of CDI. Our institution has used a two-step glutamate dehydrogenase (GDH)/toxin immunochromatographic assay/NAAT algorithm since 2009. In 2016, our institution set an organizational goal to reduce our CDI rates by 10% by July 2017. We achieved a statistically significant reduction of 42.7% in our HO-CDI rate by forming a multidisciplinary group to implement and monitor eight key categories of infection prevention interventions over a period of 13 months. Notably, we achieved this reduction without modifying our laboratory algorithm. Significant reductions in CDI rates can be achieved without altering sensitive laboratory testing methods.

Assessing health status over time: impact of recall period and anchor question on the minimal clinically important difference of copd health status tools

Background

The Minimal Clinically Important Difference (MCID) assesses what change on a measurement tool can be considered minimal clinically relevant. Although the recall period can influence questionnaire scores, it is unclear if it influences the MCID. This study is the first to examine longitudinally the impact of the recall period of an anchor question and its design on the MCID of COPD health status tools using the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and the St. George’s Respiratory Questionnaire (SGRQ).

Methods

Moderate to very severe COPD patients without respiratory co-morbidities were recruited during 3-week Pulmonary Rehabilitation (PR). CAT, CCQ and SGRQ were completed at baseline, discharge, 3, 6, 9 and 12 months. A 15-point Global Rating of Change scale (GRC) was completed at each follow-up. A five-point GRC was used as second anchor at 12 months. Mean change scores of a subset of patients indicating a minimal improvement on each of the anchor questions were considered the MCID. The MCID estimates over different time periods were compared with one another by evaluating the degree of overlap of Confidence Intervals (CI) adjusted for dependency.

Results

In total 451 patients were included (57.9 ± 6.6 years, 65% male, 50/39/11% GOLD II/III/IV), of which 309 completed follow-up. Baseline health status scores were 20.2 ± 7.3 (CAT), 2.9 ± 1.2 (CCQ) and 50.7 ± 17.3 (SGRQ). MCID estimates for improvement ranged − 3.1 to − 1.4 for CAT, − 0.6 to − 0.3 for CCQ, and − 10.3 to − 7.6 for SGRQ. Absolute higher – though not significant – MCIDs were observed for CAT and CCQ directly after PR. Significantly absolute lower MCID estimates were observed for CAT (difference − 1.4: CI -2.3 to − 0.5) and CCQ (difference − 0.2: CI -0.3 to −0.1) using a five-point GRC.

Conclusions

The recall period of a 15-point anchor question seemed to have limited impact on the MCID for improvement of CAT, CCQ and SGRQ during PR; although a 3-week MCID estimate directly after PR might lead to absolute higher values. However, the design of the anchor question was likely to influence the MCID of CAT and CCQ.

Trial registration

RIMTCORE trial #DRKS00004609 and #12107 (Ethik-Kommission der Bayerischen Landesärztekammer).

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0950-7) contains supplementary material, which is available to authorized users.

Changing practice for hip arthroplasty and its implications

This overview provides insight into changes in clinical practice and the implications for nursing staff and clinicians who are involved in the management of patients undergoing primary total hip arthroplasty. The review highlights commonly used surgical approaches, their advantages, their associated risks and how to manage complications if they occur.

[Guideline for the Diagnosis and Treatment of Asthma - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]

The present guideline is a new version and an update of the guideline for the diagnosis and treatment of asthma, which replaces the previous version for german speaking countries from the year 2006. The wealth of new data on the pathophysiology and the phenotypes of asthma, and the expanded spectrum of diagnostic and therapeutic options necessitated a new version and an update. This guideline presents the current, evidence-based recommendations for the diagnosis and treatment of asthma, for children and adolescents as well as for adults with asthma.

Flight-Test of a Tactile Situational Awareness System in a Land-based Deck Landing Task

The National Research Council of Canada and Defence Research and Development Canada flight-tested the U.S. Naval Aerospace Medical Research Laboratory's Tactile Situational Awareness System (TSAS) in a dynamic task. The TSAS vest uses small pneumatic actuators or ‘tactors’ to transmit information to the pilot. Eleven pilots used the TSAS to cue horizontal axis performance in a land-based deck landing task flown in the NRC Bell 205 helicopter. Pilots tracked a vertically moving target with and without the TSAS in good and degraded visual conditions. The TSAS effectively cued longitudinal fore/aft drifts and reduced RMS error. It had less effect on lateral positioning error, possibly due to the presence of strong visual cues. Pilot situational awareness during degraded visual environment conditions in high sea states was significantly improved by the TSAS, as measured by the China Lake situational awareness rating scale. No change in workload, as measured by Modified Cooper Harper Workload Scale, was attributable to the TSAS use. The improvements in situational awareness and the reduction in longitudinal error suggest that the TSAS would be beneficial for helicopter ship deck landing.

Complexity of gap junctions between horizontal cells of the carp retina

In the vertebrate retina, horizontal cells (HCs) reveal homologous coupling by gap junctions (gj), which are thought to consist of different connexins (Cx). However, recent studies in mouse, rabbit and zebrafish retina indicate that individual HCs express more than one connexin. To provide further insights into the composition of gj connecting HCs and to determine whether HCs express multiple connexins, we examined the molecular identity and distribution of gj between HCs of the carp retina. We have cloned four carp connexins designated Cx49.5, Cx55.5, Cx52.6 and Cx53.8 with a close relationship to connexins previously reported in HCs of mouse, rabbit and zebrafish, respectively. Using in situ hybridization, Cx49.5 expression was detected in different subpopulations of retinal neurons including HCs, whereas the Cx52.6 transcript was localized exclusively in HCs. Using specific antibodies, Cx55.5 and Cx53.8 were detected on dendrites of all four HC subtypes and axon terminals. Immunoelectron microscopy confirmed the presence of Cx55.5 and Cx53.8 in gap junctions between these processes and Cx55.5 was additionally observed in HC dendrites invaginating cone pedicles, suggesting its participation in the modulation of photoreceptor output in the carp retina. Furthermore, using single-cell RT-PCR, all four connexins were detected in different subtypes of HCs, suggesting overlapping expression patterns. Thus, the composition of gj mediating homologous coupling between subtypes of carp HCs appears to be more complex than expected. Moreover, BLAST searches of the preliminary carp genome, using novel sequences as query, suggest that most of the analyzed connexin genes are duplicated in carp.

Molecular Mechanisms of Resistance to First- and Second-Generation ALK Inhibitors in ALK-Rearranged Lung Cancer

Advanced, anaplastic lymphoma kinase (ALK)-positive lung cancer is currently treated with the first-generation ALK inhibitor crizotinib followed by more potent, second-generation ALK inhibitors (e.g., ceritinib and alectinib) upon progression. Second-generation inhibitors are generally effective even in the absence of crizotinib-resistant ALK mutations, likely reflecting incomplete inhibition of ALK by crizotinib in many cases. Herein, we analyzed 103 repeat biopsies from ALK-positive patients progressing on various ALK inhibitors. We find that each ALK inhibitor is associated with a distinct spectrum of ALK resistance mutations and that the frequency of one mutation, ALK^G1202R, increases significantly after treatment with second-generation agents. To investigate strategies to overcome resistance to second-generation ALK inhibitors, we examine the activity of the third-generation ALK inhibitor lorlatinib in a series of ceritinib-resistant, patient-derived cell lines, and observe that the presence of ALK resistance mutations is highly predictive for sensitivity to lorlatinib, whereas those cell lines without ALK mutations are resistant.

SIGNIFICANCE

Secondary ALK mutations are a common resistance mechanism to second-generation ALK inhibitors and predict for sensitivity to the third-generation ALK inhibitor lorlatinib. These findings highlight the importance of repeat biopsies and genotyping following disease progression on targeted therapies, particularly second-generation ALK inhibitors. Cancer Discov; 6(10); 1118-33. ©2016 AACRSee related commentary by Qiao and Lovly, p. 1084This article is highlighted in the In This Issue feature, p. 1069.

The Use and Development of Sex-typed Language

Fifteen males and fifteen females in each of three age groups (children, adolescents, and adults) described a stimulus photograph for up to five minutes. These descriptions were transcribed and scored for the frequency of both language form and content categories. Analyses revealed significant sex differences in both the form and the content of spoken language. No evidence was found for the contention that sex-typed speech develops differently in male and female children. There were, however, significant age differences in speech form and content, independent of sex.

Stellenwert ambulanter, gerätegestützter Trainingstherapie bei Atemwegs- und Lungenkrankheiten

Die körperliche Trainingstherapie gilt als eine der wichtigsten Therapieoptionen für Patienten mit chronischen Atemwegs- und Lungenkrankheiten: Die Effekte des Ausdauer- und Krafttrainings auf Atemnot, körperliche Leistungsfähigkeit und Lebensqualität sind unbestritten. Dennoch wird die Trainingstherapie im ambulanten Bereich durch die Rahmenvereinbarungen der Bundesarbeitsgemeinschaft für Rehabilitation (BAR) limitiert: Nur der in Gruppen angeleitete Lungensport wird über längere Zeiträume von den Kostenträgern finanziert, das gerätegestützte Training bleibt ausgeschlossen, obwohl sich dessen herausragende Effizienz durch zahlreiche randomisiert kontrollierte Studien nachweisen lässt.

In diesem Übersichtsartikel werden neben der Methodik und den Effekten auch die aktuellen organisatorischen Strukturen einer ambulanten, gerätegestützten Trainingstherapie für Patienten mit chronischen Atemwegs- und Lungenkrankheiten in Deutschland aufgezeigt und kritisch diskutiert.