The evolutionary ecology of fungal killer phenotypes.

Ecological interactions influence evolutionary dynamics by selecting upon fitness variation within species. Antagonistic interactions often promote genetic and species diversity, despite the inherently suppressive effect they can have on the species experiencing them. A central aim of evolutionary ecology is to understand how diversity is maintained in systems experiencing antagonism. In this review, we address how certain single-celled and dimorphic fungi have evolved allelopathic killer phenotypes that engage in antagonistic interactions. We discuss the evolutionary pathways to the production of lethal toxins, the functions of killer phenotypes and the consequences of competition for toxin producers, their competitors and toxin-encoding endosymbionts. Killer phenotypes are powerful models because many appear to have evolved independently, enabling across-phylogeny comparisons of the origins, functions and consequences of allelopathic antagonism. Killer phenotypes can eliminate host competitors and influence evolutionary dynamics, yet the evolutionary ecology of killer phenotypes remains largely unknown. We discuss what is known and what remains to be ascertained about killer phenotype ecology and evolution, while bringing their model system properties to the reader's attention.

Fast and Versatile Functionalization of Glassy Carbon.

A rapid procedure for the functionalization of glassy carbon surfaces (GCSs) is disclosed. A three-step sequence of bromomethylation, azide displacement, and copper(I)-catalyzed azide-alkyne cycloaddition (CuAAC) allows ethynylated molecules to be attached covalently to the carbon surface through a methylene functional group. Redox-active ethynyl ferrocene and [RuII(Cl)(DMSO)(ethynyl-TPA)]1+ (DMSO = dimethylsulfoxide; TPA = tris(2-pyridylmethyl)amine) are attached with high coverages as assessed by cyclic voltammetry, and the elemental composition of the surface is confirmed by X-ray photoelectron spectroscopy. In less than 1 h, surface coverages of 1 × 1014 molecules/cm2 are possible that exhibit good durability in both acidic and basic media. Attached [RuII(Cl)(DMSO)(ethynyl-TPA)]1+ catalytically oxidizes alcohols, yet the currents and potentials are less impressive compared to an attachment without the intervening methylene group. The advantages of this covalent attachment procedure for GCSs are its short reaction times, mild reaction conditions, and the use of standard laboratory reagents and glassware, allowing for many types of ethynylated molecules to be attached rapidly to the surface.

How Consistently Do 13 Clearinghouses Identify Social and Behavioral Development Programs as "Evidence-Based"?

Clearinghouses develop scientific criteria that they then use to vet existing research studies on a program to reach a verdict about how evidence-based it is. This verdict is then recorded on a website in hopes that stakeholders in science, public policy, the media, and even the general public, will consult it. This paper (1) compares the causal design and analysis preferences of 13 clearinghouses that assess the effectiveness of social and behavioral development programs, (2) estimates how consistently these clearinghouses rank the same program, and then (3) uses case studies to probe why their conclusions differ. Most clearinghouses place their highest value on randomized control trials, but they differ in how they treat program implementation, quasi-experiments, and whether their highest program ratings require effects of a given size that independently replicate or that temporally persist. Of the 2525 social and behavioral development programs sampled over clearinghouses, 82% (n = 2069) were rated by a single clearinghouse. Of the 297 programs rated by two clearinghouses, agreement about program effectiveness was obtained for about 55% (n = 164), but the clearinghouses agreed much more on program ineffectiveness than effectiveness. Most of the inconsistency is due to clearinghouses' differences in requiring independently replicated and/or temporally sustained effects. Without scientific consensus about matters like these, "evidence-based" will remain more of an aspiration than achievement in the social and behavioral sciences.

Missing data and sensitivity analysis for binary data with implications for sample size and power of randomized clinical trials.

Despite our best efforts, missing outcomes are common in randomized controlled clinical trials. The National Research Council's Committee on National Statistics panel report titled The Prevention and Treatment of Missing Data in Clinical Trials noted that further research is required to assess the impact of missing data on the power of clinical trials and how to set useful target rates and acceptable rates of missing data in clinical trials. In this article, using binary responses for illustration, we establish that conclusions based on statistical analyses that include only complete cases can be seriously misleading, and that the adverse impact of missing data grows not only with increasing rates of missingness but also with increasing sample size. We illustrate how principled sensitivity analysis can be used to assess the robustness of the conclusions. Finally, we illustrate how sample sizes can be adjusted to account for expected rates of missingness. We find that when sensitivity analyses are considered as part of the primary analysis, the required adjustments to the sample size are dramatically larger than those that are traditionally used. Furthermore, in some cases, especially in large trials with small target effect sizes, it is impossible to achieve the desired power.

Carotid Plaque Strain Indices Were Correlated With Cognitive Performance in a Cohort With Advanced Atherosclerosis, and Traditional Doppler Measures Showed no Association.

OBJECTIVES: Traditional Doppler measures have been used to predict cognitive performance in patients with carotid atherosclerosis. Novel measures, such as carotid plaque strain indices (CPSIs), have shown associations with cognitive performance. We hypothesized that lower mean middle cerebral artery (MCA) velocities, higher bulb-internal carotid artery (ICA) velocities, the MCA pulsatility index (PI), and CPSIs would be associated with poorer cognitive performance in individuals with advanced atherosclerosis. METHODS: Neurocognitive testing, carotid ultrasound imaging, transcranial Doppler imaging, and carotid strain imaging were performed on 40 patients scheduled for carotid endarterectomy. Kendall tau correlations were used to examine relationships between cognitive tests and the surgical-side maximum peak systolic velocity (PSV; from the bulb, proximal, mid, or distal ICA), mean MCA velocity and PI, and maximum CPSIs (axial, lateral, and shear strain indices used to characterize plaque deformations with arterial pulsation). Cognitive measures included age-adjusted indices of verbal fluency, verbal and visual learning/memory, psychomotor speed, auditory attention/working memory, visuospatial construction, and mental flexibility. RESULTS: Participants had a median age of 71.0 (interquartile range, 9.75) years; 26 were male (65%), and 14 were female (35%). Traditional Doppler parameters, PSV, mean MCA velocity, and MCA PI did not predict cognitive performance (all P > .05). Maximum CPSIs were significantly associated with cognitive performance (P < .05). CONCLUSIONS: Traditional velocity measurements of the maximum bulb-ICA PSV, mean MCA velocity, and PI were not associated with cognitive performance in patients with advanced atherosclerotic disease; however, maximum CPSIs were associated with cognitive performance. These findings suggest that cognition may be associated with unstable plaque rather than blood flow.

Manifesto for new directions in developmental science.

Although developmental science has always been evolving, these times of fast-paced and profound social and scientific changes easily lead to disorienting fragmentation rather than coherent scientific advances. What directions should developmental science pursue to meaningfully address real-world problems that impact human development throughout the lifespan? What conceptual or policy shifts are needed to steer the field in these directions? The present manifesto is proposed by a group of scholars from various disciplines and perspectives within developmental science to spark conversations and action plans in response to these questions. After highlighting four critical content domains that merit concentrated and often urgent research efforts, two issues regarding "how" we do developmental science and "what for" are outlined. This manifesto concludes with five proposals, calling for integrative, inclusive, transdisciplinary, transparent, and actionable developmental science. Specific recommendations, prospects, pitfalls, and challenges to reach this goal are discussed.

Safety and efficacy of helminth treatment in relapsing-remitting multiple sclerosis: Results of the HINT 2 clinical trial.

BACKGROUND: The hygiene hypothesis suggests that microbial replacement may be therapeutic in allergic and autoimmune diseases. Nevertheless, the results of helminth treatment, including in multiple sclerosis (MS), have been inconclusive. OBJECTIVE: To assess safety and brain magnetic resonance imaging (MRI) activity in subjects with relapsing-remitting multiple sclerosis (RRMS) during oral administration of ova from the porcine whipworm, Trichuris suis (TSO). METHODS: A total of 16 disease-modifying treatment (DMT) naive RRMS subjects were studied in a baseline versus treatment (BVT) controlled prospective study. MRI scans were performed during 5 months of screening-observation, 10 months of treatment, and 4 months of post-treatment surveillance. RESULTS: No serious symptoms or adverse events occurred during treatment. For the cohort, there was a trend consistent with a 35% diminution in active lesions when observation MRIs were compared to treatment MRIs ( p = 0.08), and at the level of individuals, 12 of 16 subjects improved during TSO treatment. T regulatory lymphocytes were increased during TSO treatment. CONCLUSION: TSO is safe in RRMS subjects. Potentially favorable MRI outcomes and immunoregulatory changes were observed during TSO treatment; however, the magnitude of these effects was modest, and there was considerable variation among the responses of individual subjects.

The Impact of Supplemental Intraoperative Air Decontamination on the Outcome of Total Joint Arthroplasty: A Pilot Analysis.

BACKGROUND: During the early era of arthroplasty, the concept of ultraclean operating room (OR) was introduced based on the principle that the number of airborne particles in the OR directly influences incidence of device-related infections. The hypothesis of this pilot study was that use of an innovative UV-C air decontamination technology would lead to a reduction in the incidence of periprosthetic joint infection (PJI) following total joint arthroplasty. METHODS: A retrospective, observational, surveillance study was conducted with a consecutive series of patients who underwent total joint arthroplasty (n = 496) between January 2016 and August 2017. All perioperative and postoperative care protocols were identical for both groups, only study variable was that in 231 arthroplasty patients (OR B), an innovative supplemental UV-C air decontamination technology was used, whereas in the remaining 265 patients, arthroplasty was performed with standard turbulent HVAC (OR A). RESULTS: There was no significant difference between patient groups regarding age, body mass index, diabetes diagnosis, smoking status, length of surgery, or revision status. The rate of PJI was documented to be 1.9% in the turbulent air group, and no infections were documented in the cohorts operated under UV-C air decontamination, which was statistically significant (P < .044). CONCLUSION: While PJI is multifactorial in nature, the present retrospective pilot study suggests that use of an intraoperative supplemental air decontamination significantly reduced the overall risk of PJI. The findings of this study are encouraging and should be examined in a larger-scale, prospective, multicenter study.

The Set of Assumptions Randomized Control Trials Make and Their Implications for the Role of Such Experiments in Evidence-Based Child and Adolescent Development Research.

This chapter highlights the key assumptions underlying Randomized Control Trials (RCTs) and illustrates them with regard to the practice of RCTs in the realm of child and adolescent development. Given the prominence of RCTs in policy research, we analyze the possible ways in which these assumptions might not be met by single randomized experiments, thereby making it difficult to draw valid causal inference from single studies. We frame this discussion within the categories of internal validity, statistical conclusion validity, construct validity, and external validity and address the debate about the "gold standard" status accorded to RCTs.

The CardiAMP Heart Failure trial: A randomized controlled pivotal trial of high-dose autologous bone marrow mononuclear cells using the CardiAMP cell therapy system in patients with post-myocardial infarction heart failure: Trial rationale and study design.

BACKGROUND: Heart failure following myocardial infarction is a common, disabling, and deadly condition. Direct injection of autologous bone marrow mononuclear cells into the myocardium may result in improved functional recovery, relieve symptoms, and improve other cardiovascular outcomes. METHODS: CardiAMP-HF is a randomized, double-blind, sham-controlled, pivotal trial designed to investigate the safety and efficacy of autologous bone marrow mononuclear cells treatment for patients with medically refractory and symptomatic ischemic cardiomyopathy. The primary end point is change in 6-minute walk distance adjusted for major adverse cardiovascular events at 12 months following treatment. Particularly novel aspects of this trial include a cell potency assay to screen subjects who have bone marrow cell characteristics that suggest a favorable response to treatment, a point-of-care treatment method, a high target dose of 200 million cells, and an efficient transcatheter intramyocardial delivery method that is associated with high cell retention. CONCLUSIONS: This novel approach may lead to a new treatment for those with ischemic heart disease suffering from medically refractory heart failure.

Local Competition Amplifies the Corrosive Effects of Inequality.

Inequality is widely believed to incite conflict, but the evidence is inconsistent. We argue that the spatial scale of competition-the extent to which individuals compete locally, with their interaction partners, or globally, with the entire population-can help settle the question. We built a mathematical model of the evolution of conflict under inequality and tested its predictions in an experimental game with 1,205 participants. We found that inequality increases conflict, destroys wealth, and engenders risk taking. Crucially, these effects are amplified by local competition. Thus, inequality is at its most damaging when it arises between close competitors. Indeed, at the extremes, the combined effects of inequality and the scale of competition are very large. More broadly, our findings suggest that disagreements in the literature may be the result of a mismatch between the scale at which inequality is measured and the scale at which conflict occurs.

Pretest Measures of the Study Outcome and the Elimination of Selection Bias: Evidence from Three Within Study Comparisons.

This paper examines how pretest measures of a study outcome reduce selection bias in observational studies in education. The theoretical rationale for privileging pretests in bias control is that they are often highly correlated with the outcome, and in many contexts, they are also highly correlated with the selection process. To examine the pretest's role in bias reduction, we use the data from two within study comparisons and an especially strong quasi-experiment, each with an educational intervention that seeks to improve achievement. In each study, the pretest measures are consistently highly correlated with post-intervention measures of themselves, but the studies vary the correlation between the pretest and the process of selection into treatment. Across the three datasets with two outcomes each, there are three cases where this correlation is low and three where it is high. A single wave of pretest always reduces bias across the six instances examined, and it eliminates bias in three of them. Adding a second pretest wave eliminates bias in two more instances. However, the pattern of bias elimination does not follow the predicted pattern-that more bias reduction ensues as a function of how highly the pretest is correlated with selection. The findings show that bias is more complexly related to the pretest's correlation with selection than we hypothesized, and we seek to explain why.

Plantation performance of chestnut hybrids and progenitors on reclaimed Appalachian surface mines.

Reclamation of surface mined sites to forests is a preferred post-mining land use option, but performance of planted trees on such sites is variable. American chestnut (Castanea dentata (Marsh.) Borkh.) is a threatened forest tree in the eastern USA that may become an important species option for mine reclamation. Chestnut restoration using backcross hybrids that incorporate blight resistance may be targeted to the Appalachian coal mining region, which corresponds closely with the species' native range. Thus, it is important to understand how chestnut hybrids perform relative to progenitors on reclamation sites to develop restoration prescriptions. Seeds of parents and three backcross generations of chestnut (100% American, 100% Chinese, and BC1F3, BC2F3, and BC3F2 hybrids) were planted into mine soils in West Virginia, USA with shelter treatments. Survival for all stock types was 44% after 8 years (American 39%, Chinese 77%, BC1F3 40%, BC2F3 28%, and BC3F2 35%). Height for all stock types was 33 cm after 8 years (American 28 cm, Chinese 67 cm, BC1F3 30 cm, BC2F3 21 cm, and BC3F2 20 cm). At another site a year later, seedlings of the chestnut stock types were planted into brown (pH 4.6) or gray sandstone (pH 6.3) mine soils and seedling survival across all stock types was 58% after 7 years. Chinese had the highest survival at 82%, while the others ranged from 38 to 66%. Height was 63 cm for all stock types after 7 years. More advanced backcross hybrids (BC2F3 and BC3F2) had the lowest vigor ratings at both sites after 7-8 years. Our results indicate that surface mines in Appalachia may provide a land base for planting blight-resistant chestnuts, although Chinese chestnut outperformed American chestnut and later generation backcross hybrids. As blight-resistant chestnuts establish and spread after planting, chestnut trees may become a component of the forest canopy again and possibly occupy its former niche, but their spread may alter future forest stand dynamics.

Kynurenine and Tryptophan Levels in Patients With Schizophrenia and Elevated Antigliadin Immunoglobulin G Antibodies.

OBJECTIVE: Several studies have reported an association between nonceliac gluten sensitivity and schizophrenia. Immune and kynurenine (KYN) pathways have also been implicated in the pathophysiology of schizophrenia, and certain proinflammatory immune mediators may increase KYN and reduce tryptophan (TRP) levels. METHODS: We measured serum antigliadin immunoglobulin G (IgG), KYN, and TRP in 950 patients with schizophrenia. Patients with antibody level at the 90th percentile or higher of control participants (21.9% of all patients) were classified as having elevated antigliadin IgG. Independent t tests and linear regression models were used to compare TRP, KYN, and KYN-TRP ratio (indicator of TRP metabolism) between patients with and those without elevated antigliadin IgG. The correlation between antigliadin IgG and TRP, KYN, and the ratio was also evaluated in the patients. RESULTS: KYN and KYN-TRP ratio were higher in patients with elevated antigliadin IgG (geometric mean [standard deviation {SD}] = 2.65 [0.25] µmol/L versus 2.25 [0.23] µmol/L [p < .001] and 0.05 [0.26] versus 0.04 [0.25; p = .001] respectively), findings robust to adjustment for potential demographic and clinical confounders. Antigliadin IgG positively correlated with KYN and KYN-TRP ratio (r = 0.12, p < .001; r = 0.11, p = .002). TRP did not differ between the two groups and did not correlate with antigliadin IgG. CONCLUSIONS: Our results connect nonceliac gluten sensitivity with the KYN pathway of TRP metabolism in psychotic illness and hint toward potential individualized treatment targets.

An Inexpensive and Easy Ultrasound Phantom: A Novel Use for SPAM.

Ultrasound models, commonly referred to as "phantoms," are simulation tools for ultrasound education. Commercially produced phantoms are available, but there are "homemade" alternatives such as raw poultry and gelatin molds. Precooked, processed meat, better known as SPAM (Hormel Foods Corporation, Austin, MN), can be used as an ultrasound phantom to teach several ultrasound applications. It is a versatile, hygienic, and easily manipulated medium that does not require refrigeration or preparatory work and can be easily discarded at the end of use.

Ethical considerations of transparency, informed consent, and nudging in a patient with paediatric aortic stenosis and symptomatic left ventricular endocardial fibroelastosis.

A 9-year-old boy who was born with bicuspid aortic stenosis underwent two unsuccessful aortic valvuloplasty interventions, and by 2 years of age he developed restrictive cardiomyopathy caused by left ventricular endocardial fibroelastosis and diastolic dysfunction. The attending cardiologist referred the patient to a high-volume, high-profile congenital cardiac surgical programme 1000 miles away that has a team with considerable experience with left ventricular endocardial fibroelastosis resection and a reputation of achieving good results. Owing to problems with insurance coverage, the parents sought other options for the care of their child in their home state. Dr George Miller is a well-respected local congenital and paediatric cardiac surgeon with considerable experience with the Ross operation as well as with right ventricular endocardial fibroelastosis resection. When talking with Dr Miller, he implied that there is little difference between right ventricular endocardial fibroelastosis and left ventricular endocardial fibroelastosis resection, and stated that he would perform the operation with low mortality based on his overall experience. Dr Miller stated that the local institution could provide an equivalent surgical procedure with comparable outcomes, without the patient and family having to travel out of state. A fundamental dilemma that often arises in clinical surgical practice concerns the conduct of assessing and performing new procedures, especially in rare cases, for which the collective global experience is scant. Although Dr Miller has performed right ventricular endocardial fibroelastosis resection, this procedure differs from left ventricular endocardial fibroelastosis resection, and he cannot be sure that he will indeed be able to perform the procedure better than the high-volume surgeon. This ethical situation is best understood in terms of the principles of respect for patient autonomy, beneficence, non-maleficence, and justice. The tension between the imperatives of beneficence and the obligation to respect the autonomy of the patient by acting only with the patient's best interest in mind is discussed.

Next Generation Mesh Fixation Technology for Hernia Repair.

Laparoscopic ventral hernia repair (LVHR) remains a safe, reproducible, and popular method employed by surgeons to repair abdominal wall hernias. Patient selection, operative technique, instrumentation, and implant choice all remain surgeon dependent. Inherent in the technique is the option of using mesh. The decision of where to place the mesh and how to optimally fixate the mesh in the onlay, sublay, or intraabdominal positions also remain surgeon dependent and has been the subject of ongoing debates for the past two decades. In an ongoing effort to develop new methods for securing mesh to minimize pain without increased recurrence rates, novel mesh fasteners and mesh textiles have been developed. With increasing surgeon responsibility to improve value, surgeons should concentrate more on choosing the novel options that not only improve outcomes, but also reduce overall costs. This chapter reviews some of the emerging markets for these technologies.

Reciprocal moderation by Toxoplasma gondii seropositivity and blood phenylalanine - tyrosine ratio of their associations with trait aggression.

We previously reported that trait aggression, proposed as an endophenotype for suicidal behavior, is positively associated with Toxoplasma gondii (T. gondii) seropositivity in females, but not in males. Additionally, older males seropositive for T. gondii had lower scores on measures of trait aggression, including self-aggression. Trait aggression may be influenced by dopaminergic signaling, which is known to be moderated by gender and age, and potentially enhanced in T. gondii positives through the intrinsic production of dopamine by the microorganism. Therefore, we investigated associations between trait aggression and interactions between T. gondii enzyme-linked immunoabsorbant assay (ELISA) IgG titer-determined seropositivity and high-performance liquid chromatography- (HPLC-) measured blood levels of dopamine precursors phenylalanine (Phe), tyrosine (Tyr), and their ratio in a sample of 1000 psychiatrically healthy participants. Aggressive traits were assessed using the questionnaire for measuring factors of aggression (FAF), the German version of the Buss-Durkee hostility questionnaire. We found that 1) the decrease in trait aggression scores in T. gondii-positive older males was only present in individuals with a low Phe:Tyr ratio, and 2) that there was a positive correlation between Phe:Tyr ratio and total aggression and selected subscales of aggression in T. gondii-positive males, but not in T. gondii-negative males. These findings point toward a gender-specific reciprocal moderation by Phe:Tyr ratio and T. gondii seropositivity of their associations with aggression scores, and lead to experimental interventions geared to manipulating levels of dopamine precursors in selected T. gondii positive individuals with increased propensity for aggression.

Persistence of racial disparities in prescription of first-generation antipsychotics in the USA.

PURPOSE: The aim of this study was to estimate the prevalence of first-generation antipsychotics (FGA) prescribed for treatment of psychiatric and neurological conditions and use of benztropine to reduce extrapyramidal side effects (EPS) by patient race/ethnicity in a nationally representative sample of adult outpatient visits. METHODS: The study sample included all outpatient visits (N = 8154) among patients aged 18-69 years where a prescription for one or more antipsychotics was recorded across 6 years of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2005-2010). Use of FGA was compared by race/ethnicity using multiple logistic regression models accounting for patient and clinical characteristics stratified by neighborhood poverty rate. Frequency of EPS was determined by use of benztropine to reduce or prevent EPS. RESULTS: Black patients were significantly more likely than White patients to use FGA (odds ratio = 1.48, p = 0.040) accounting for psychiatric and neurological diagnoses, treatment setting, metabolic factors, neighborhood poverty, and payer source. Black patients were more than twice as likely as White patients to receive higher-potency FGA (haloperidol or fluphenazine), particularly in higher-poverty areas (odds ratio = 2.50, p < 0.001). Use of FGA, higher among Black than White patients, was positively associated with use of benztropine to reduce EPS. CONCLUSIONS: Racial disparities in the pharmacological treatment of severe mental disorders persist 30 years after the introduction of second-generation antipsychotics. The relatively high frequency of FGA of use among Black patients compared with White patients despite more Food and Drug Administration-approved indications and lower EPS risk for second-generation antipsychotics requires additional research.