Detection of vertebral fracture in an acute hospital setting: an intervention to reduce future fracture risk through fracture liaison service intervention?

We introduced a standardised reporting system in the radiology department to highlight vertebral fractures and to signpost fracture prevention services. Our quality improvement project achieved improved fracture reporting, access to the FLS service, bone density assessment and anti-fracture treatment. PURPOSE: Identification of vertebral fragility fractures (VF) provides an opportunity to identify individuals at high risk who might benefit from secondary fracture prevention. We sought to standardise VF reporting and to signpost fracture prevention services. Our aim was to improve rates of VF detection and access to our fracture liaison service (FLS). METHODS: We introduced a standardised reporting tool within the radiology department to flag VFs with signposting for referral for bone densitometry (DXA) and osteoporosis assessment in line with Royal Osteoporosis Society guidelines. We monitored uptake of VF reporting during a quality improvement phase and case identification within the FLS service. RESULTS: Recruitment of individuals with VF to the FLS service increased from a baseline of 63 cases in 2017 (6%) to 95 (8%) in 2018 and 157 (8%) in 2019 and to 102 (12%) in the first 6 months of 2020 (p = 0.001). One hundred fifty-three patients with VFs were identified during the QI period (56 males; 97 females). Use of the terminology 'fracture' increased to 100% (mean age 70 years; SD 13) in computed tomography (n = 110), plain X-ray (n = 37) or magnetic resonance imaging (n = 6) reports within the cohort. Signposting to DXA and osteoporosis assessment was included in all reports (100%). DXA was arranged for 103/153; 12 failed to attend. Diagnostic categories were osteoporosis (31%), osteopenia (36%) or normal bone density (33%). A new prescription for bone protection therapy was issued in 63/153. Twelve of the series died during follow-up. CONCLUSIONS: Standardisation of radiology reporting systems facilitates reporting of prevalent vertebral fractures and supports secondary fracture prevention strategies.

Complement Factor B Is a Determinant of Both Metabolic and Cardiovascular Features of Metabolic Syndrome.

CFB (complement factor B) is elevated in adipose tissue and serum from patients with type 2 diabetes mellitus and cardiovascular disease, but the causal relationship to disease pathogenesis is unclear. Cfb is also elevated in adipose tissue and serum of the spontaneously hypertensive rat, a well-characterized model of metabolic syndrome. To establish the role of CFB in metabolic syndrome, we knocked out the Cfb gene in the spontaneously hypertensive rat. Cfb-/- rats showed improved glucose tolerance and insulin sensitivity, redistribution of visceral to subcutaneous fat, increased adipocyte mitochondrial respiration, and marked changes in gene expression. Cfb-/- rats also had lower blood pressure, increased ejection fraction and fractional shortening, and reduced left ventricular mass. These changes in metabolism and gene expression, in adipose tissue and left ventricle, suggest new adipose tissue-intrinsic and blood pressure-independent mechanisms for insulin resistance and cardiac hypertrophy in the spontaneously hypertensive rat. In silico analysis of the human CFB locus revealed 2 cis-regulated expression quantitative trait loci for CFB expression significantly associated with visceral fat, circulating triglycerides and hypertension in genome-wide association studies. Together, these data demonstrate a key role for CFB in the development of spontaneously hypertensive rat metabolic syndrome phenotypes and of related traits in humans and indicate the potential for CFB as a novel target for treatment of cardiometabolic disease.

From Checklist to Awareness: Hearing God's Call to Missions.

This student experience of international community health nursing in Cape Town, South Africa, illustrates the value of missions that provide health training and education to lay persons, and the calling of God to serve him through nursing.

Developing the eHistology Atlas.

The eMouseAtlas project has undertaken to generate a new resource providing access to high-resolution colour images of the slides used in the renowned textbook 'The Atlas of Mouse Development' by Matthew H. Kaufman. The original histology slides were digitized, and the associated anatomy annotations captured for display in the new resource. These annotations were assigned to objects in the standard reference anatomy ontology, allowing the eHistology resource to be linked to other data resources including the Edinburgh Mouse Atlas Gene-Expression database (EMAGE) an the Mouse Genome Informatics (MGI) gene-expression database (GXD). The provision of the eHistology Atlas resource was assisted greatly by the expertise of the eMouseAtlas project in delivering large image datasets within a web environment, using IIP3D technology. This technology also permits future extensions to the resource through the addition of further layers of data and annotations to the resource. Database URL: www.emouseatlas.org/emap/eHistology/index.php.

The atlas of mouse development eHistology resource.

There was an error published in Development 142, 1909-1911. Author Yogmatee Roochun was omitted. The corrected author list appears above. The authors apologise to readers for this mistake.

The atlas of mouse development eHistology resource.

The Atlas of Mouse Development by Professor Mathew Kaufman is an essential text for understanding mouse developmental anatomy. This definitive and authoritative atlas is still in production and is essential for any biologist working with the mouse embryo, although the last revision dates back to 1994. Here, we announce the eHistology online resource that provides free access to high-resolution colour images digitized from the original histological sections (www.emouseatlas.org/emap/eHistology/index.php) used by Kaufman for the Atlas. The images are provided with the original annotations and plate numbering of the paper atlas and enable viewing the material to cellular resolution.

Discovering the healthcare beliefs and practices of rural mestizo Ecuadorians. An ethnonursing study.

OBJETIVE: To discover and understand the healthcare beliefs and practices of mestizo Ecuadorians within rural Ecuador. METHODOLOGY: An ethnonursing method developed by Leininger was used to guide this study and four phases of qualitative data analysis. 28 informants were interviewed in Tosagua, Ecuador. RESULTS: . Data analysis revealed four themes (a) Spirituality and prayer necessary for health and well-being, (b) Sharing life with people positively affects health and well-being, (c) Incorporation of both traditional and modern medicine is essential to health (d) Environmental context beyond the control of the people greatly affect health and well-being. CONCLUSION: The findings are consistent with the cultural life ways of rural mestizo Ecuadorians who live in community with one another. These results can be used to enable nurses and other healthcare workers to provide care that is acceptable, culturally congruent and promotes health in rural Ecuador.

Discovering the healthcare beliefs and practices of rural mestizo Ecuadorians. An ethnonursing study / Creencias y prácticas del cuidado de salud de mestizos que habitan en zona rural de Ecuador: Un estudio de etnoenfermería / Crenças e práticas do cuidado de saúde de mestiços que habitam em zona rural do Equador: Um estudo de etno-enfermagem

Objetivo. Describir y entender las creencias y prácticas del cuidado de salud de mestizos que habitan en zona rural de Ecuador. Metodología. Se desarrolló un estudio con el método de etnoenfermería de Leininger. Fueron entrevistados 28 informantes en Tosagua, Ecuador. Resultados. El análisis de los datos reveló cuatro temas: (a) la espiritualidad y la oración son necesarias para la salud y el bienestar, (b) Compartir la vida con la gente afecta positivamente la salud y el bienestar, (c) La incorporación de la medicina tradicional y la moderna es esencial para la salud (d) el contexto ambiental está más allá del control de las personas y afecta en gran medida la salud y el bienestar. Conclusión. Los resultados son consistentes con la cultura de los ecuatorianos mestizos que habitan zonas rurales y que viven en comunidad. Las enfermeras y otros trabajadores de la salud deben proveer un cuidado que sea aceptable, culturalmente congruente y que promueva la salud en el Ecuador rural.

Objetive. To discover and understand the healthcare beliefs and practices of mestizo Ecuadorians within rural Ecuador. Methodology. An ethnonursing method developed by Leininger was used to guide this study and four phases of qualitative data analysis. 28 informants were interviewed in Tosagua, Ecuador. Results. Data analysis revealed four themes (a) Spirituality and prayer necessary for health and well-being, (b) Sharing life with people positively affects health and well-being, (c) Incorporation of both traditional and modern medicine is essential to health (d) Environmental context beyond the control of the people greatly affect health and well-being. Conclusion. The findings are consistent with the cultural life ways of rural mestizo Ecuadorians who live in community with one another. These results can be used to enable nurses and other healthcare workers to provide care that is acceptable, culturally congruent and promotes health in rural Ecuador.

Objetivo. Descrever e entender as crenças e práticas do cuidado de saúde de mestiços que habitam em zona rural do Equador. Metodologia. Desenvolveu-se um estudo com o método de etno-enfermagem de Leininger. Foram entrevistados 28 informantes em Tosagua, Equador. Resultados. A análise dos dados revelou quatro temas (a) a espiritualidade e a oração são necessárias para a saúde e o bem-estar, (b) Compartilhar a vida com as pessoas afeta positivamente à saúde e ao bem-estar, (c) A incorporação da medicina tradicional e a moderna é essencial para a saúde (d) o contexto ambiental está além do controle das pessoas e afeta em grande parte à saúde e ao bem-estar. Conclusão. Os resultados são consistentes com a cultura dos equatorianos mestiços que habitam zonas rurais e que vivem em comunidade. As enfermeiras e outros trabalhadores da saúde devem prover um cuidado que seja aceitável, culturalmente congruente e que promova a saúde no Equador rural.

EMAGE mouse embryo spatial gene expression database: 2014 update.

EMAGE (http://www.emouseatlas.org/emage/) is a freely available database of in situ gene expression patterns that allows users to perform online queries of mouse developmental gene expression. EMAGE is unique in providing both text-based descriptions of gene expression plus spatial maps of gene expression patterns. This mapping allows spatial queries to be accomplished alongside more traditional text-based queries. Here, we describe our recent progress in spatial mapping and data integration. EMAGE has developed a method of spatially mapping 3D embryo images captured using optical projection tomography, and through the use of an IIP3D viewer allows users to view arbitrary sections of raw and mapped 3D image data in the context of a web browser. EMAGE now includes enhancer data, and we have spatially mapped images from a comprehensive screen of transgenic reporter mice that detail the expression of mouse non-coding genomic DNA fragments with enhancer activity. We have integrated the eMouseAtlas anatomical atlas and the EMAGE database so that a user of the atlas can query the EMAGE database easily. In addition, we have extended the atlas framework to enable EMAGE to spatially cross-index EMBRYS whole mount in situ hybridization data. We additionally report on recent developments to the EMAGE web interface, including new query and analysis capabilities.

eMouseAtlas, EMAGE, and the spatial dimension of the transcriptome.

eMouseAtlas (www.emouseatlas.org) is a comprehensive online resource to visualise mouse development and investigate gene expression in the mouse embryo. We have recently deployed a completely redesigned Mouse Anatomy Atlas website (www.emouseatlas.org/emap/ema) that allows users to view 3D embryo reconstructions, delineated anatomy, and high-resolution histological sections. A new feature of the website is the IIP3D web tool that allows a user to view arbitrary sections of 3D embryo reconstructions using a web browser. This feature provides interactive access to very high-volume 3D images via a tiled pan-and-zoom style interface and circumvents the need to download large image files for visualisation. eMouseAtlas additionally includes EMAGE (Edinburgh Mouse Atlas of Gene Expression) (www.emouseatlas.org/emage), a freely available, curated online database of in situ gene expression patterns, where gene expression domains extracted from raw data images are spatially mapped into atlas embryo models. In this way, EMAGE introduces a spatial dimension to transcriptome data and allows exploration of the spatial similarity between gene expression patterns. New features of the EMAGE interface allow complex queries to be built, and users can view and compare multiple gene expression patterns. EMAGE now includes mapping of 3D gene expression domains captured using the imaging technique optical projection tomography. 3D mapping uses WlzWarp, an open-source software tool developed by eMouseAtlas.

Esrrg functions in early branch generation of the ureteric bud and is essential for normal development of the renal papilla.

Congenital anomalies of the kidney and urinary tract (CAKUTs) are common disorders of human development affecting the renal parechyma, renal pelvis, ureter, bladder and urethra; they show evidence of shared genetic aetiology, although the molecular basis of this remains unknown in the majority of cases. Breakpoint mapping of a de novo, apparently balanced, reciprocal translocation associated with bilateral renal agenesis has implicated the gene encoding the nuclear steroid hormone receptor ESRRG as a candidate gene for CAKUT. Here we show that the Esrrg protein is detected throughout early ureteric ducts as cytoplasmic/sub-membranous staining; with nuclear localization seen in developing nephrons. In 14.5-16.5 dpc (days post-conception) mouse embryos, Esrrg localizes to the subset of ductal tissue within the kidney, liver and lung. The renal ductal expression becomes localized to renal papilla by 18.5 dpc. Perturbation of function was performed in embryonic mouse kidney culture using pooled siRNA to induce knock-down and a specific small-molecule agonist to induce aberrant activation of Esrrg. Both resulted in severe abnormality of early branching events of the ureteric duct. Mouse embryos with a targeted inactivation of Esrrg on both alleles (Esrrg(-/-)) showed agenesis of the renal papilla but normal development of the cortex and remaining medulla. Taken together, these results suggest that Esrrg is required for early branching events of the ureteric duct that occur prior to the onset of nephrogenesis. These findings confirm ESRRG as a strong candidate gene for CAKUT.

Trans fat labeling and levels in U.S. foods: assessment of gas chromatographic and infrared spectroscopic techniques for regulatory compliance.

Trans fatty acids are found in a variety of foods like dairy and meat products, but the major dietary sources are products that contain commercially hydrogenated fats. There has been a renewed need for accurate analytical methods for the quantitation of total trans fat since mandatory requirements to declare the amount of trans fat present in food products and dietary supplements were issued in many countries. Official capillary GC and IR methodologies are the two most common validated methods used to identify and quantify trans fatty acids for regulatory compliance. The present article provides a comprehensive discussion of the GC and IR techniques, including the latest attenuated total reflection (ATR)-FTIR methodology called the negative second derivative ATR-FTIR procedure, which is currently being validated in an international collaborative study. The identification and quantitation of trans fatty acid isomers by GC is reviewed and an alternative GC method is proposed using two temperature programs and combining their results; this proposed method deals more effectively with the resolution of large numbers of geometric and positional monoene, diene, and triene fatty acid isomers present in ruminant fats. In addition, the different methylation procedures that affect quantitative conversion to fatty acid methyl esters are reviewed. There is also a lack of commercial chromatographic standards for many trans fatty acid isomers. This review points to potential sources of interferences in the FTIR determination that may lead to inaccurate results, particularly at low trans levels. The presence of high levels of saturated fats may lead to interferences in the FTIR spectra observed for trans triacylglycerols (TAGs). TAGs require no derivatization, but have to be melted prior to IR measurement. While GC is currently the method of choice, ATR-FTIR spectroscopy is a viable, rapid alternative, and a complementary method to GC for a more rapid determination of total trans fats for food labeling purposes.

Genetic background influences embryonic lethality and the occurrence of neural tube defects in Men1 null mice: relevance to genetic modifiers.

Germline mutations of the multiple endocrine neoplasia type 1 (MEN1) gene cause parathyroid, pancreatic and pituitary tumours in man. MEN1 mutations also cause familial isolated primary hyperparathyroidism (FIHP) and the same MEN1 mutations, in different families, can cause either FIHP or MEN1. This suggests a role for genetic background and modifier genes in altering the expression of a mutation. We investigated the effects of genetic background on the phenotype of embryonic lethality that occurs in a mouse model for MEN1. Men1(+/-) mice were backcrossed to generate C57BL/6 and 129S6/SvEv incipient congenic strains, and used to obtain homozygous Men1(-/-) mice. No viable Men1(-/-) mice were obtained. The analysis of 411 live embryos obtained at 9.5-16.5 days post-coitum (dpc) revealed that significant deviations from the expected Mendelian 1:2:1 genotype ratio were first observed at 12.5 and 14.5 dpc in the 129S6/SvEv and C57BL/6 strains respectively (P<0.05). Moreover, live Men1(-/-) embryos were absent by 13.5 and 15.5 dpc in the 129S6/SvEv and C57BL/6 strains respectively thereby indicating an earlier lethality by 2 days in the 129S6/SvEv strain (P<0.01). Men1(-/-) embryos had macroscopic haemorrhages, and histology and optical projection tomography revealed them to have internal haemorrhages, myocardial hypotrophy, pericardial effusion, hepatic abnormalities and neural tube defects. The neural tube defects occurred exclusively in 129S6/SvEv embryos (21 vs 0%, P<0.01). Thus, our findings demonstrate the importance of genetic background in influencing the phenotypes of embryonic lethality and neural tube defects in Men1(-/-) mice, and implicate a role for genetic modifiers.

Labeling of trans fatty acid content in food, regulations and limits-the FDA view.

With the scientific evidence associating trans fatty acid (TFA) intake with an increased risk of coronary heart disease (CHD), the U.S. Food and Drug Administration (FDA) issued a final rule that requires the declaration of the amount of TFA present in foods, including dietary supplements, on the nutrition label by January 1, 2006. The addition of TFA to the nutrition label will lead to the prevention of 600 to 1200 cases of CHD and 240-480 deaths each year saving Dollars 900 million to Dollars 1.8 billion per year in medical costs, lost productivity, and pain and suffering. For the purpose of nutrition labeling, TFA are defined as the sum of all unsaturated fatty acids that contain one or more isolated (i.e. non-conjugated) double bonds in a trans configuration. There are many issues that FDA has yet to resolve: (1) defining nutrient content claims for "free" and "reduced" levels of trans fat, (2) placing limits on the amount of TFA in conjunction with saturated fat limits for nutrient content claims, health claims, and disclosure and disqualifying levels, (3) a daily value, and (4) a possible footnote or disclosure statement to enhance consumer understanding of cholesterol raising lipids. FDA issued an Advanced Notice of Proposed Rulemaking (ANPR) requesting comments on the unresolved issues. FDA will also be conducting consumer research to determine consumer understanding of various TFA labeling possibilities. Comments to the ANPR, results of consumer research and current science will be used by FDA to resolve these issues and to determine future rulemaking for TFA labeling.

Oriented clonal cell growth in the developing mouse myocardium underlies cardiac morphogenesis.

During heart morphogenesis, cardiac chambers arise by differential expansion of regions of the primitive cardiac tube. This process is under the control of specific transcription factors such as Tbx5 and dHAND. To gain insight into the cellular mechanisms that underlie cardiogenesis, we have used a retrospective clonal approach based on the spontaneous recombination of an nlaacZ reporter gene targeted to the murine alpha-cardiac actin locus. We show that clonal growth of myocardial cells is oriented. At embryonic day (E) 10.5, the shape of clones is characteristic of a given cardiac region and reflects its morphology. This is already detectable in the primitive cardiac tube at E8.5, and is maintained after septation at E14.5 with additional modulations. The clonal analysis reveals new subdivisions of the myocardium, including an interventricular boundary region. Our results show that the myocardium, from the time of its formation, is a polarized and regionalized tissue and point to the role of oriented clonal cell growth in cardiac chamber morphogenesis.