The hydroxycinnamic acids p‐coumaric acid (pCA) and ferulic acid (FA) add diversity to the portfolio of products produced by using grass‐fed lignocellulosic biorefineries. The level of lignin‐bound ...pCA in Zea mays was modified by the alteration of p‐coumaroyl‐CoA monolignol transferase expression. The biomass was processed in a lab‐scale alkaline‐pretreatment biorefinery process and the data were used for a baseline technoeconomic analysis to determine where to direct future research efforts to couple plant design to biomass utilization processes. It is concluded that future plant engineering efforts should focus on strategies that ramp up accumulation of one type of hydroxycinnamate (pCA or FA) predominantly and suppress that of the other. Technoeconomic analysis indicates that target extraction titers of one hydroxycinnamic acid need to be >50 g kg−1 biomass, at least five times higher than observed titers for the impure pCA/FA product mixture from wild‐type maize. The technical challenge for process engineers is to develop a viable process that requires more than 80 % reduction of the isolation costs.
Stream on: A competitive lignocellulosic biorefinery will need to produce multiple product streams that include liquid fuel, solid fuel, and commodity chemicals. In this study, some key parameters are identified for the extraction of the valuable commodity chemicals p‐coumaric acid and ferulic acid from one of the waste streams in an alkaline‐pretreatment‐based biorefinery.
In response to physiological demand, the pituitary gland generates new hormone-secreting cells from committed progenitor cells throughout life. It remains unclear to what extent pituitary stem cells ...(PSCs), which uniquely express SOX2, contribute to pituitary growth and renewal. Moreover, neither the signals that drive proliferation nor their sources have been elucidated. We have used genetic approaches in the mouse, showing that the WNT pathway is essential for proliferation of all lineages in the gland. We reveal that SOX2
stem cells are a key source of WNT ligands. By blocking secretion of WNTs from SOX2
PSCs in vivo, we demonstrate that proliferation of neighbouring committed progenitor cells declines, demonstrating that progenitor multiplication depends on the paracrine WNT secretion from SOX2
PSCs. Our results indicate that stem cells can hold additional roles in tissue expansion and homeostasis, acting as paracrine signalling centres to coordinate the proliferation of neighbouring cells.
The object of this study was to determine the effect of EAS (Equine-Assisted Services) on arthritis conditions, as measured by the sTnT (Skeletal troponin) and COMP (cartilage oligomeric matrix ...proteins) biomarkers, compared to an exercise attention control intervention.
This was a secondary analysis of a randomized clinical trial comparing equine-assisted therapy to exercise education attention-control on cartilage and skeletal biomarkers in adults with arthritis. Twenty-one adults (Mage = 64 years) with arthritis who attended rheumatology clinics in the midwestern United States participated.
No changes were found in sTnT from baseline to week six within either intervention nor were there differences in changes between the two groups (p = 0.91). COMP increased from baseline to week six for both conditions, suggesting increased deterioration of cartilage and joints. Although the attention-control condition demonstrated larger increases in cartilage oligomeric matrix proteins level, compared to the EAS condition, these differences were not statistically (p = 0.58) or clinically significant (i.e., trivial effect, d = −0.16). When 3 outliers were removed, the differences in changes between EAT and attention-control group could be arguably of clinical significance (d = - 0.33), suggesting that the attention-control group demonstrated larger increases in levels of COMP than those in the EAS condition, though this difference was not statistically significant (p = 0.28).
Although equine-assisted therapy may reduce pain and improve quality of life for adults with arthritis, findings here are not fully corroborated with biomarkers.
•EAS did not change skeletal troponin T after 6 weeks.•COMP increased from baseline to week six for both groups but not significantly.•EAS is tolerable yet findings here are not fully corroborated with biomarkers.
Neural stem/progenitor cells (NSCs) in the hippocampus produce new neurons throughout adult life. NSCs are maintained in a state of reversible quiescence and the failure to maintain the quiescent ...state can result in the premature depletion of the stem cell pool. The epigenetic mechanisms that maintain this quiescent state have not been identified. Using an inducible knockout mouse model, we show that the chromatin remodeling factor chromodomain–helicase‐DNA‐binding protein 7 (CHD7) is essential for maintaining NSC quiescence. CHD7 inactivation in adult NSCs results in a loss of stem cell quiescence in the hippocampus, a transient increase in cell divisions, followed by a significant decline in neurogenesis. This loss of NSC quiescence is associated with the premature loss of NSCs in middle‐aged mice. We find that CHD7 represses the transcription of several positive regulators of cell cycle progression and is required for full induction of the Notch target gene Hes5 in quiescent NSCs. These findings directly link CHD7 to pathways involved in NSC quiescence and identify the first chromatin‐remodeling factor with a role in NSC quiescence and maintenance. As CHD7 haplo‐insufficiency is associated with a range of cognitive disabilities in CHARGE syndrome, our observations may have implications for understanding the basis of these deficits. Stem Cells 2015;33:196–210
Background
Critical care nurses experience higher rates of mental distress and poor health than other nurses, adversely affecting health care quality and safety. It is not known, however, how ...critical care nurses’ overall health affects the occurrence of medical errors.
Objective
To examine the associations among critical care nurses’ physical and mental health, perception of workplace wellness support, and self-reported medical errors.
Methods
This survey-based study used a cross-sectional, descriptive correlational design. A random sample of 2500 members of the American Association of Critical-Care Nurses was recruited to participate in the study. The outcomes of interest were level of overall health, symptoms of depression and anxiety, stress, burnout, perceived worksite wellness support, and medical errors.
Results
A total of 771 critical care nurses participated in the study. Nurses in poor physical and mental health reported significantly more medical errors than nurses in better health (odds ratio 95% CI: 1.31 0.96-1.78 for physical health, 1.62 1.17-2.29 for depressive symptoms). Nurses who perceived that their worksite was very supportive of their well-being were twice as likely to have better physical health (odds ratio 95% CI, 2.16 1.33-3.52; 55.8%).
Conclusion
Hospital leaders and health care systems need to prioritize the health of their nurses by resolving system issues, building wellness cultures, and providing evidence-based wellness support and programming, which will ultimately increase the quality of patient care and reduce the incidence of preventable medical errors.
As a central regulator of major physiological processes, the pituitary gland is a highly dynamic organ, capable of responding to hormonal demand and hypothalamic influence, through adapting secretion ...as well as remodelling cell numbers among its seven populations of differentiated cells. Stem cells of the pituitary have been shown to actively generate new cells during postnatal development but remain mostly quiescent during adulthood, where they persist as a long-lived population. Despite a significant body of research characterising attributes of anterior pituitary stem cells, the regulation of this population is poorly understood. A better grasp on the signalling mechanisms influencing stem proliferation and cell fate decisions can impact on our future treatments of pituitary gland disorders such as organ failure and pituitary tumours, which can disrupt endocrine homeostasis with life-long consequences. This minireview addresses the current methodologies aiming to understand better the attributes of pituitary stem cells and the normal regulation of this population in the organ, and discusses putative future avenues to manipulate pituitary stem cells during disease states or regenerative medicine approaches.
The incidence and determinants of hepatic decompensation have been incompletely examined among patients co-infected with HIV and hepatitis C virus (HCV) in the antiretroviral therapy (ART) era, and ...few studies have compared outcome rates with those of patients with chronic HCV alone.
To compare the incidence of hepatic decompensation between antiretroviral-treated patients co-infected with HIV and HCV and HCV-monoinfected patients and to evaluate factors associated with decompensation among co-infected patients receiving ART.
Retrospective cohort study.
Veterans Health Administration.
4280 co-infected patients who initiated ART and 6079 HCV-monoinfected patients receiving care between 1997 and 2010. All patients had detectable HCV RNA and were HCV treatment-naive.
Incident hepatic decompensation, determined by diagnoses of ascites, spontaneous bacterial peritonitis, or esophageal variceal hemorrhage.
The incidence of hepatic decompensation was greater among co-infected than monoinfected patients (7.4% vs. 4.8% at 10 years; P < 0.001). Compared with HCV-monoinfected patients, co-infected patients had a higher rate of hepatic decompensation (hazard ratio HR accounting for competing risks, 1.56 95% CI, 1.31 to 1.86). Co-infected patients who maintained HIV RNA levels less than 1000 copies/mL still had higher rates of decompensation than HCV-monoinfected patients (HR, 1.44 CI, 1.05 to 1.99). Baseline advanced hepatic fibrosis (FIB-4 score >3.25) (HR, 5.45 CI, 3.79 to 7.84), baseline hemoglobin level less than 100 g/L (HR, 2.24 CI, 1.20 to 4.20), diabetes mellitus (HR, 1.88 CI, 1.38 to 2.56), and nonblack race (HR, 2.12 CI, 1.65 to 2.72) were each associated with higher rates of decompensation among co-infected patients.
Observational study of predominantly male patients.
Despite receiving ART, patients co-infected with HIV and HCV had higher rates of hepatic decompensation than HCV-monoinfected patients. Rates of decompensation were higher for co-infected patients with advanced liver fibrosis, severe anemia, diabetes, and nonblack race.
National Institutes of Health.
After heart transplantation (HTx), non-adherence to immunosuppressants (IS) is associated with poor outcomes; however, intentional non-adherence (INA) is poorly understood regarding its international ...variability in prevalence, contributing factors and impact on outcomes. We investigated (1) the prevalence and international variability of INA, (2) patient-level correlates of INA, and (3) relation of INA with clinical outcomes. Secondary analysis of data from the BRIGHT study-an international multi-center, cross-sectional survey examining multi-level factors of adherence in 1,397 adult HTx recipients. INA during the implementation phase, i.e., drug holiday and dose alteration, was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale
(BAASIS
). Descriptive and inferential analysis was performed with data retrieved through patient interview, patient self-report and in clinical records. INA prevalence was 3.3% (
= 46/1,397)-drug holidays: 1.7% (
= 24); dose alteration: 1.4% (
= 20); both: 0.1% (
= 2). University-level education (OR = 2.46, CI = 1.04-5.83), insurance not covering IS costs (OR = 2.21, CI = 1.01-4.87) and barriers (OR = 4.90, CI = 2.73-8.80) were significantly associated with INA; however, clinical outcomes were not. Compared to other single-center studies, this sample's INA prevalence was low. More than accessibility or financial concerns, our analyses identified patient-level barriers as INA drivers. Addressing patients' IS-related barriers, should decrease INA.
This study determined if a SystemCHANGE™ intervention was more efficacious than attention control in increasing immunosuppressive medication adherence and improving outcomes in adult kidney ...transplant recipients during a 6‐month intervention phase and subsequent 6‐month (no intervention) maintenance phase. The SystemCHANGE™ intervention taught patients to use person‐level quality improvement strategies to link adherence to established daily routines, environmental cues, and supportive people. Eighty‐nine patients (average age 51.8 years, 58% male, 61% African American) completed the 6‐month intervention phase. Using an intent‐to‐treat analysis, at 6 months, medication adherence for SystemCHANGE™ (median 0.91, IQR 0.76‐0.96) and attention control (median 0.67, IQR 0.52‐0.72) patients differed markedly (difference in medians 0.24, 95% CI 0.13‐0.30, P < .001). At the conclusion of the subsequent 6‐month maintenance phase, the gap between medication adherence for SystemCHANGE™ (median 0.77, IQR 0.56‐0.94) and attention control (median 0.60, IQR 0.44‐0.73) patients remained large (difference in medians 0.17, 95% CI 0.06‐0.33, P = .004). SystemCHANGE™ patients evidenced lower mean creatinine and BUN at 12 months and more infections at 6 and 12 months. This first fully powered RCT testing SystemCHANGE™ to improve and maintain medication adherence in kidney transplant recipients demonstrated large, clinically meaningful improvements in medication adherence.
Clinical Trial Registration: NCT02416479.
This randomized controlled trial demonstrates the efficacy of a novel intervention in achieving clinically meaningful improvement in immunosuppressive medication adherence in adult kidney transplant patients who were medication nonadherent. See Foster's commentary on page 5.
PDF
