Background
Patient‐reported outcome measures (PROMs) are questionnaires that collect health outcomes directly from the people who experience them. This review critically synthesizes information on ...generic and selected condition‐specific PROMs to describe trends and contemporary issues regarding their development, validation and application.
Methods
We reviewed academic and grey literature on validated PROMs by searching databases, prominent websites, Google Scholar and Google Search. The identification of condition‐specific PROMs was limited to common conditions and those with a high burden of disease (eg cancers, cardiovascular disorders). Trends and contemporary issues in the development, validation and application of PROMs were critically evaluated.
Results
The search yielded 315 generic and condition‐specific PROMs. The largest numbers of measures were identified for generic PROMs, musculoskeletal conditions and cancers. The earliest published PROMs were in mental health‐related conditions. The number of PROMs grew substantially between 1980s and 2000s but slowed more recently. The number of publications discussing PROMs continues to increase. Issues identified include the use of computer‐adaptive testing and increasing concerns about the appropriateness of using PROMs developed and validated for specific purposes (eg research) for other reasons (eg clinical decision making).
Conclusions
The term PROM is a relatively new designation for a range of measures that have existed since at least the 1960s. Although literature on PROMs continues to expand, challenges remain in selecting reliable and valid tools that are fit‐for‐purpose from the many existing instruments.
Patient or public contribution
Consumers were not directly involved in this review; however, its outcome will be used in programmes that engage and partner with consumers.
•Carbon elastic and inelastic electron scattering cross sections are measured vs. energy.•Elastic scattering is compared to energy deposition and radiation damage.•An optimal energy for cryoEM of a ...given biological specimen thickness is determined.
We have measured the dependence on electron energy of elastic and inelastic scattering cross-sections from carbon, over the energy range that includes 100 keV to 300 keV. We also compared quantitatively the radiation damage to bacteriorhodopsin and paraffin (C44H90) at 100 keV and 300 keV by observing the fading of the diffraction spots from two-dimensional crystals as a function of electron fluence. The elastic cross-section is 2.01 - fold greater at 100 keV than at 300 keV, whereas the radiation damage increased by only 1.57. This implies that the amount of useful information from diffraction patterns or images of most biological structures should be 25% greater using 100 keV rather than 300 keV electrons. Using these measurements, we calculate the energy dependence of the available information per unit damage for a specimen of a particular thickness, which we call the “information coefficient.” This allows us to determine the optimal energy for imaging a biological specimen of a given thickness. We find that for most single particle cryoEM specimens, 100 keV provides not only the highest potential for information per unit damage, but would also simplify the instrument while retaining the potential to reach high resolution with a minimum of data. These measurements will help guide the development and use of electron cryomicroscopes for biology.
•A method for correcting for the curvature of the Ewald sphere is presented.•We demonstrate the algorithm using gold nanoparticles embedded in ice.•The algorithm automatically determines the absolute ...hand of the specimen.•It allows higher resolution imaging of thicker specimens at lower energies.•It should also improve all high resolution structures determined by cryoEM.
Curvature of the Ewald sphere limits the resolution at which Fourier components in an image can be approximated as corresponding to a projection of the object. Since the radius of the Ewald sphere is inversely proportional to the wavelength of the imaging electrons, this normally imposes a limit on the thickness of specimen for which images can be easily interpreted to a particular resolution. Here we present a computational method for precisely correcting for the curvature of the Ewald sphere using defocused images that delocalise the high-resolution Fourier components from the primary image. By correcting for each approximately Friedel-symmetry-related sideband separately using two distinct complex transforms that effectively move the displaced Fourier components back to where they belong in the structure, we can determine the amplitude and phase of each of the Fourier components separately. This precisely accounts for the effect of Ewald sphere curvature over a bandwidth defined by the defocus and the size of the particle being imaged. We demonstrate this processing algorithm using: 1. simulated images of a particle with only a single, high-resolution Fourier component, and 2. experimental images of gold nanoparticles embedded in ice. Processing micrographs with this algorithm will allow higher resolution imaging of thicker specimens at lower energies without any image degradation or blurring due to errors made by the assumption of a flat Ewald sphere. Although the procedure will work best on images recorded with higher defocus settings than used normally, it should still improve 3D single-particle structure determination using images recorded at any defocus and any electron energy. Finally, since the Ewald sphere curvature is in a known direction in the third dimension which is parallel to the direction of view, this algorithm automatically determines the absolute hand of the specimen without the need for pairs of images with a known tilt angle difference.
•A physical account of charge accumulation in low-dose cryoEM is presented.•We describe electrostatic micro-lenses that are extremely sensitive charge detectors.•These micro-lenses allow the direct ...measurement of charge accumulation.•Charge build-up saturates within the first millisecond of a typical micrograph.
When irradiated in a transmission electron microscope, plunge-frozen, amorphous water ice specimens accumulate a pattern of static charge that changes dynamically as the specimen is irradiated, and which can deflect the transmitted electrons and blur the resultant micrographs. Here we provide a physical description of this charge accumulation and characterise its dynamic behaviour in the context of low-dose electron cryomicroscopy (cryoEM). We observe the accumulation of positive charge in the primary irradiation area as expected from earlier work. To our surprise, we also observed a build-up of negative charge in nearby unirradiated regions of the specimen. Using a standard carbon support foil containing a pure water ice specimen, we collect a portion of this negative charge in the micrometer sized specimen holes which act as electrostatic lenses. These unusual, diverging micro-lenses are extremely sensitive charge detectors that allow us to directly measure the magnitude and dynamics of charge accumulation and neutralisation that occur during cryoEM imaging. Using these measurements, we find that the build-up of charge on the specimen saturates to a dynamic equilibrium at an electron fluence which is orders of magnitude lower than required for a typical low-dose micrograph. The measurements here will guide the development of optimal imaging conditions for biological specimens and contribute to a complete theory of information loss in electron cryomicroscopy.
Targeted mutant models are common in mechanistic toxicology experiments investigating the absorption, metabolism, distribution, or elimination (ADME) of chemicals from individuals. Key models include ...those for xenosensing transcription factors and cytochrome P450s (CYP). Here we investigated changes in transcript levels, protein expression, and steroid hydroxylation of several xenobiotic detoxifying CYPs in constitutive androstane receptor (CAR)-null and two CYP-null mouse models that have subfamily members regulated by CAR; the Cyp3a-null and a newly described Cyp2b9/10/13-null mouse model. Compensatory changes in CYP expression that occur in these models may also occur in polymorphic humans, or may complicate interpretation of ADME studies performed using these models. The loss of CAR causes significant changes in several CYPs probably due to loss of CAR-mediated constitutive regulation of these CYPs. Expression and activity changes include significant repression of Cyp2a and Cyp2b members with corresponding drops in 6α- and 16β-testosterone hydroxylase activity. Further, the ratio of 6α-/15α-hydroxylase activity, a biomarker of sexual dimorphism in the liver, indicates masculinization of female CAR-null mice, suggesting a role for CAR in the regulation of sexually dimorphic liver CYP profiles. The loss of Cyp3a causes fewer changes than CAR. Nevertheless, there are compensatory changes including gender-specific increases in Cyp2a and Cyp2b. Cyp2a and Cyp2b were down-regulated in CAR-null mice, suggesting activation of CAR and potentially PXR following loss of the Cyp3a members. However, the loss of Cyp2b causes few changes in hepatic CYP transcript levels and almost no significant compensatory changes in protein expression or activity with the possible exception of 6α-hydroxylase activity. This lack of a compensatory response in the Cyp2b9/10/13-null mice is probably due to low CYP2B hepatic expression, especially in male mice. Overall, compensatory and regulatory CYP changes followed the order CAR-null > Cyp3a-null > Cyp2b-null mice.
Productivity of ruminant livestock depends on the rumen microbiota, which ferment indigestible plant polysaccharides into nutrients used for growth. Understanding the functions carried out by the ...rumen microbiota is important for reducing greenhouse gas production by ruminants and for developing biofuels from lignocellulose. We present 410 cultured bacteria and archaea, together with their reference genomes, representing every cultivated rumen-associated archaeal and bacterial family. We evaluate polysaccharide degradation, short-chain fatty acid production and methanogenesis pathways, and assign specific taxa to functions. A total of 336 organisms were present in available rumen metagenomic data sets, and 134 were present in human gut microbiome data sets. Comparison with the human microbiome revealed rumen-specific enrichment for genes encoding de novo synthesis of vitamin B
, ongoing evolution by gene loss and potential vertical inheritance of the rumen microbiome based on underrepresentation of markers of environmental stress. We estimate that our Hungate genome resource represents ∼75% of the genus-level bacterial and archaeal taxa present in the rumen.
The combination of CDK4/6 inhibitors with antiestrogen therapies significantly improves clinical outcomes in ER-positive advanced breast cancer. To identify mechanisms of acquired resistance, we ...analyzed serial biopsies and rapid autopsies from patients treated with the combination of the CDK4/6 inhibitor ribociclib with letrozole. This study revealed that some resistant tumors acquired RB loss, whereas other tumors lost PTEN expression at the time of progression. In breast cancer cells, ablation of
, through increased AKT activation, was sufficient to promote resistance to CDK4/6 inhibition
and
. Mechanistically,
loss resulted in exclusion of p27 from the nucleus, leading to increased activation of both CDK4 and CDK2. Because
loss also causes resistance to PI3Kα inhibitors, currently approved in the post-CDK4/6 setting, these findings provide critical insight into how this single genetic event may cause clinical cross-resistance to multiple targeted therapies in the same patient, with implications for optimal treatment-sequencing strategies. SIGNIFICANCE: Our analysis of serial biopsies uncovered RB and PTEN loss as mechanisms of acquired resistance to CDK4/6 inhibitors, utilized as first-line treatment for ER-positive advanced breast cancer. Importantly, these findings have near-term clinical relevance because
loss also limits the efficacy of PI3Kα inhibitors currently approved in the post-CDK4/6 setting.
.
Morphine and related µ-opioid receptor (MOR) agonists remain among the most effective drugs known for acute relief of severe pain. A major problem in treating painful conditions is that tolerance ...limits the long-term utility of opioid agonists. Considerable effort has been expended on developing an understanding of the molecular and cellular processes that underlie acute MOR signaling, short-term receptor regulation, and the progression of events that lead to tolerance for different MOR agonists. Although great progress has been made in the past decade, many points of contention and controversy cloud the realization of this progress. This review attempts to clarify some confusion by clearly defining terms, such as desensitization and tolerance, and addressing optimal pharmacological analyses for discerning relative importance of these cellular mechanisms. Cellular and molecular mechanisms regulating MOR function by phosphorylation relative to receptor desensitization and endocytosis are comprehensively reviewed, with an emphasis on agonist-biased regulation and areas where knowledge is lacking or controversial. The implications of these mechanisms for understanding the substantial contribution of MOR signaling to opioid tolerance are then considered in detail. While some functional MOR regulatory mechanisms contributing to tolerance are clearly understood, there are large gaps in understanding the molecular processes responsible for loss of MOR function after chronic exposure to opioids. Further elucidation of the cellular mechanisms that are regulated by opioids will be necessary for the successful development of MOR-based approaches to new pain therapeutics that limit the development of tolerance.
•A physical account of charge fluctuations in low-dose cryoEM is presented.•We quantify the bee swarm charging phenomenon on cryoEM specimen.•We measure the envelope function caused by charge ...fluctuations.•The effects of these fluctuations are negligible in cryoEM.
The fluctuating granularity or “bee swarm” effect seen in highly defocussed transmission electron micrographs is caused by microscopic charge fluctuations in the specimen created by the illuminating beam. In the field of high-resolution single particle electron cryomicroscopy (cryoEM), there has been a concern that this fluctuating charge might cause defocus-dependent Thon ring fading which would degrade the final image. In this paper, we have analysed the 2.35 Å fringes from the (111) reflection in images of gold nanoparticles embedded in amorphous ice. We show that there is a small, yet detectable amount of defocus-dependent blurring of the lattice fringes when compared with those from a pure gold foil. The transverse electric field associated with the fluctuating charges on the insulating frozen water specimen deflects the electron beam locally and causes image blurring. The perturbation is small, decreasing the amplitude of the 2.35 Å reflection at 10 µm defocus by about 7% (intensity by 14%). For smaller defocus values in the range 2–4 µm and for resolutions that are typical in cryoEM, the effects of source incoherence and the bee swarm effect are negligible for all reasonable cryoEM imaging conditions, assuming that a field emission gun (FEG) is used for illumination. This leaves physical movement of the specimen due to radiation damage as the outstanding problem and the major source of contrast loss in cryoEM micrographs.
PDF
