BACKGROUND

The Hospital Admission Risk Program (HARP) Cardiac Coach Program at Royal Melbourne Hospital has evolved to include a Greek and Italian service, developed in response to the diverse local community and supported by evidence that Culturally and Linguistically Diverse (CALD) groups both perceive health and respond to health care services and information, differently. This paper aims to evaluate if a phone-based cardiac coaching program can be adapted to the Greek and Italian populations using the English cohort as a comparator.

METHODS

We retrospectively analysed cardiovascular risk profiles at recruitment into and at discharge from the program. Patients (n=383) were recruited after an acute coronary event or intervention between June 2011 and June 2013. Recruitment was into the English (n=301 patients (79%)) Greek (40 (10%)) or Italian (42 (11%)) model. Data was collected on demographic information and risk factor status at entry and discharge from the program: waist circumference, weight, height, lipid profile, HbA1c, smoking status and physical activity. A comparison of the proportion of patients meeting the defined targets across the English, Italian and Greek cohorts was performed, with multivariate logistic regression analysis applied to adjust for differences in baseline variables.

RESULTS

There were baseline differences in age, smoking history, total cholesterol and cholesterol fractions, diastolic blood pressure, weight and physical activity between the cohorts. At discharge, the proportion of patients meeting targets within each cohort were similar.

CONCLUSIONS

A phone-based integrated disease management program can be adapted to CALD patients, achieving comparable outcomes as compared with an English-speaking cohort. Health services need to respond to their local needs and be flexible in program delivery in order to benefit as many patients as possible.

Photoacoustic (PA) imaging is an attractive technology for imaging biological tissues because it can capture both functional and structural information with satisfactory spatial resolution. Current commercially available PA imaging systems are limited by their bulky size or inflexible user interface. We present a new handheld real-time ultrasound/photoacoustic imaging system (HARP) consisting of a detachable, high-numerical-aperture (NA) fiber bundle-based illumination system integrated with an array-based ultrasound (US) transducer and a data acquisition platform. In this system, different PA probes can be used for different imaging applications by switching the transducers and the corresponding jackets to combine the fiber pads and transducer into a single probe. The intuitive user interface is a completely programmable MATLAB-based platform. In vitro phantom experiments were conducted to test the imaging performance of the developed PA system. Furthermore, we demonstrated (1) in vivo brain vasculature imaging, (2) in vivo imaging of real-time stimulus-evoked cortical hemodynamic changes during forepaw electrical stimulation, and (3) in vivo imaging of real-time cerebral pharmacokinetics in rats using the developed PA system. The overall purpose of this design concept for a customizable US/PA imaging system is to help overcome the diverse challenges faced by medical researchers performing both preclinical and clinical PA studies.

The article presents data on mean age of death of 49 064 representatives of various creative professions: visual artists (painters, sculptors, architects, n = 8 458), musicians (composers, conductors, singers, pianists, violinists, etc. n = 7 883), writers and poets (n = 11 488), scientists (n = 21 235). The mean age of death among writers and poets was significantly (p < 0.001) less than that in visual artists, musicians and scientists whereas scientists lived longer than representatives of other categories (p < 0.001). Women lived longer than men of any studied categories (p < 0.02). It was shown that the mean age of death gradually but irregularly increased since the 1st century A. C. until the 20th century in any professional cohort. Visual artists-men in 20th century lived longer than in previous historical periods (p < 0.001). Scientists both females and males in 20th century lived longer then these in 19th century (p < 0.001). The first five places of long-livers among men belong to Nobel prize winners (78,8 yrs.), academicians (72,7 yrs.) and corresponding members of the Russian Academy of Sciences (71,7 yrs.), conductors (71,1 yrs.) and scientists (71,0 yrs.). Rock-musicians, author's song singer and poets lived less than other categories (43,6; 53,6 and 61,6 yrs. respectively). Among women leading long-livers were conductors (83,2 yrs.), harp-players (80,9 yrs.), academicians of the RAS (80,3 yrs.), clavesin-players (79,1 yrs.) and violinists (78,2 yrs.). Among women, less lived rock-musicians (37,6 yrs.), author's songs singers (51,4), horns and woodwinds instruments players (59,0 yrs.). Relative number of nonagenarians (90+) was much higher among women as compared to men. The values were as 43.75% of harp-players, 33.33% of conductors, 29.17% of architects, 20% of violinists and viola-players and 18.99% sculptors for women, and 16.67% of Nobel prize winners, 12.12% of conductors, 7.51% of academicians, 7.44% of violinists and 7.0% of scientists survived 90+ years among men. Centenarians were 8.33% of academicians and architects, 6.25% of harp-players and 4.22% of writers-poets among women, and only 0.76% of pianists, 0.45% of scientists and 0.42% of violinists were centenarians among men. Our data are in agreement with the opinion that high intellect and education directly correlate with longer life span and longevity.

Little is known about herpesviruses in Canadian pinnipeds. We measured prevalence of antibodies to herpesviruses in the sera from Canadian phocid seals by an indirect enzyme-linked immunosorbent assay. Wild harbor seals (Phoca vitulina) and captive harbor seals were positive for antibodies to Phocid herpesvirus 1 (PhoHV-1) at prevalences of 91% and 100%, respectively. Sera from wild hooded seals (Cystophora cristata), harp seals (Pagophilus groenlandica), and grey seals (Halichoerus grypus) were positive for antibodies to PhoHV-1 antigenically related herpesvirus antigens at 73%, 79%, and 96%, respectively. We isolated new herpesviruses in cell culture from two hunter-harvested ringed seals (Pusa hispida) in poor body condition from Ulukhaktok, Northwest Territories, Canada; one lethargic hooded seal from the St. Lawrence Estuary, Québec, Canada; and one captive, asymptomatic harp seal from the Magdalen Islands, Québec. Partial sequencing of the herpesvirus DNA polymerase gene revealed that all four virus isolates were closely related to PhoHV-2, a member of the Gammaherpesvirinae subfamily, with nucleotide similarity ranging between 92.8% and 95.3%. The new seal herpesviruses were genetically related to other known pinniped herpesviruses, such as PhoHV-1, Otariid herpesvirus 3, Hawaiian monk (Monachus schauinslandi) seal herpesvirus, and Phocid herpesvirus 5 with 47-48%, 55%, 77%, and 70-77% nucleotide similarities, respectively. The harp seal herpesvirus and both ringed seal herpesviruses were almost identical to each other, whereas the hooded seal herpesvirus was genetically different from the three others (92.8% nucleotide similarity), indicating detection of at least two novel seal herpesviruses. These findings are the first isolation, partial genome sequencing, and identification of seal gammaherpesviruses in three species of Canadian phocid seals; two species of which were suspected of exposure to one or more antigenically related herpesviruses based on serologic analyses.

Zoonotic parasites of seals that are harvested for food may pose a health risk when seal meat or organ tissues of infected animals are eaten raw or undercooked. In this study, 124 tissue samples from 81 seals, comprising four species, were collected from northern and eastern Canada. Tissues from 23 ringed seals (Pusa hispida), 8 hooded seals (Cystophora cristata), 21 harp seals (Pagophilus groenlandicus), and 29 grey seals (Halichoerus grypus) were tested for parasites of the Sarcocystidae family including Toxoplasma gondii, Sarcocystis spp., and Neospora spp. using nested PCR followed by Sanger sequencing. Toxoplasma gondii DNA was present in 26% of ringed seals, 63% of hooded seals, 57% of harp seals, and 31% of grey seals. Sarcocystis sp. DNA was found in 9% of ringed seals, 13% of hooded seals, 14% of harp seals, and 4% of grey seals, while N. caninum-like DNA was present in 26% of ringed seals. While it is unclear how pinnipeds may become infected with these protozoans, horizontal transmission is most likely. However, one harp seal pup (4 days old) was PCR-positive for T. gondii, suggesting vertical transmission may also occur. Phylogenetic analysis of the 18S gene region indicates that Sarcocystis sp. in these seals belongs to a unique genotype. Furthermore, this study represents a new host report for T. gondii in harp seals, a new host and geographic report for N. caninum-like parasites in ringed seals, and four new hosts and geographic reports for Sarcocystis sp. These results demonstrate that parasites of the Sarcocystidae family are prevalent in northern and eastern Canadian seals. While the zoonotic potential of Sarcocystis sp. and the N. caninum-like parasite are unclear, consumption of raw or undercooked seal meat or organ tissues pose a risk of T. gondii infection to consumers.

Background: Few studies have investigated the learning curves of minimally invasive donor nephrectomy (MIDN) using the cumulative sum (CUSUM) analysis. In addition, no study has compared the learning curves of the different surgical MIDN techniques in one cohort study using the CUSUM analysis. This study aims to evaluate and compare learning curves for several MIDN using the CUSUM analysis.

Methods: A retrospective review of consecutive donors, who underwent MIDN between 1997 and 2019, was conducted. Three laparoscopic-assisted techniques were applied in our institution and included for analysis: laparoscopic (LDN), hand-assisted retroperitoneoscopic (HARP), and robot-assisted laparoscopic (RADN) donor nephrectomy. The outcomes were compared based on surgeon volume to develop learning curves for the operative time per surgeon.

Results: Out of 1,895 MIDN, 1,365 (72.0%) were LDN, 427 (22.5%) were HARP, and 103 (5.4%) were RADN. The median operative time and median blood loss were 179 (IQR, 139-230) minutes and 100 (IQR, 40-200) mL, respectively. The incidence of major complication was 1.2% with no mortality, and the median hospital stay was three (IQR, 3-4) days. The CUSUM analysis resulted in learning curves, defined by decreased operative time, of 23 cases in LDN, 45 cases in HARP, and 26 cases in RADN.

Conclusions: Our study shows different learning curves in three MIDN techniques with equal post-operative complications. The LDN and RADN learning curves are shorter than that of the hand-assisted donor nephrectomy. Our observations can be helpful for informing the development of teaching requirements for fellows to be trained in MIDN.

Keywords: Hand-assisted laparoscopy; Kidney transplantation; Laparoscopy; Learning curve; Living donors; Nephrectomy; Robotic Surgical Procedures; Teaching.

Single-stranded DNA (ssDNA) forms continuously during DNA replication and is an important intermediate during recombination-mediated repair of damaged DNA. Replication protein A (RPA) is the major eukaryotic ssDNA-binding protein. As such, RPA protects the transiently formed ssDNA from nucleolytic degradation and serves as a physical platform for the recruitment of DNA damage response factors. Prominent and well-studied RPA-interacting partners are the tumor suppressor protein p53, the RAD51 recombinase and the ATR-interacting proteins ATRIP and ETAA1. RPA interactions are also documented with the helicases BLM, WRN and SMARCAL1/HARP, as well as the nucleotide excision repair proteins XPA, XPG and XPF-ERCC1. Besides its well-studied roles in DNA replication (restart) and repair, accumulating evidence shows that RPA is engaged in DNA activities in a broader biological context, including nucleosome assembly on nascent chromatin, regulation of gene expression, telomere maintenance and numerous other aspects of nucleic acid metabolism. In addition, novel RPA inhibitors show promising effects in cancer treatment, as single agents or in combination with chemotherapeutics. Since the biochemical properties of RPA and its roles in DNA repair have been extensively reviewed, here we focus on recent discoveries describing several non-canonical functions.

Fog harvesting is a useful technique for obtaining fresh water in arid climates. The wire meshes currently utilized for fog harvesting suffer from dual constraints: coarse meshes cannot efficiently capture microscopic fog droplets, whereas fine meshes suffer from clogging issues. Here, we design and fabricate fog harvesters comprising an array of vertical wires, which we call "fog harps". Under controlled laboratory conditions, the fog-harvesting rates for fog harps with three different wire diameters were compared to conventional meshes of equivalent dimensions. As expected for the mesh structures, the mid-sized wires exhibited the largest fog collection rate, with a drop-off in performance for the fine or coarse meshes. In contrast, the fog-harvesting rate continually increased with decreasing wire diameter for the fog harps due to efficient droplet shedding that prevented clogging. This resulted in a 3-fold enhancement in the fog-harvesting rate for the harp design compared to an equivalent mesh.

Endonucleolytic removal of 5'-leader sequences from tRNA precursor transcripts (pre-tRNAs) by RNase P is essential for protein synthesis. Beyond RNA-based RNase P enzymes, protein-only versions of the enzyme exert this function in various Eukarya (there termed PRORPs) and in some bacteria (Aquifex aeolicus and close relatives); both enzyme types belong to distinct subgroups of the PIN domain metallonuclease superfamily. Homologs of Aquifex RNase P (HARPs) are also expressed in some other bacteria and many archaea, where they coexist with RNA-based RNase P and do not represent the main RNase P activity. Here we solved the structure of the bacterial HARP from Halorhodospira halophila by cryo-EM revealing a novel screw-like dodecameric assembly. Biochemical experiments demonstrate that oligomerization is required for RNase P activity of HARPs. We propose that the tRNA substrate binds to an extended spike-helix (SH) domain that protrudes from the screw-like assembly to position the 5'-end in close proximity to the active site of the neighboring dimer. The structure suggests that eukaryotic PRORPs and prokaryotic HARPs recognize the same structural elements of pre-tRNAs (tRNA elbow region and cleavage site). Our analysis thus delivers the structural and mechanistic basis for pre-tRNA processing by the prokaryotic HARP system.

Keywords: E. coli; biochemistry; chemical biology; molecular biophysics; structural biology.

Ribonuclease P (RNase P) is an endoribonuclease that catalyzes the processing of the 5'-leader sequence of precursor tRNA (pre-tRNA). Ribonucleoprotein (RNP) RNase P and protein-only RNase P (PRORP) in eukaryotes have been extensively studied, but the mechanism by which a procalyotic nuclease recognizes and cleaves pre-tRNA is unclear. To gain insights into this mechanism, we studied homologs of Aquifex RNase P (HARPs), thought to be enzymes of approximately 23 kDa comprising only this nuclease domain. We determined the cryo-EM structure of Aq880, the first identified HARP enzyme. The structure unexpectedly revealed that Aq880 consists of both the nuclease and protruding helical (PrH) domains. Aq880 monomers assemble into a dimer via the PrH domain. Six dimers form a dodecamer with a left-handed one-turn superhelical structure. The structure also revealed that the active site of Aq880 is analogous to that of eukaryotic PRORPs. The pre-tRNA docking model demonstrated that 5'-processing of pre-tRNAs is achieved by two adjacent dimers within the dodecamer. One dimer is responsible for catalysis, and the PrH domains of the other dimer are responsible for pre-tRNA elbow recognition. Our study suggests that HARPs measure an invariant distance from the pre-tRNA elbow to cleave the 5'-leader sequence, which is analogous to the mechanism of eukaryotic PRORPs and the RNP RNase P. Collectively, these findings shed light on how different types of RNase P enzymes utilize the same pre-tRNA processing.

Keywords: cryo-electromicroscopy; molecular evolution; oligomerization; precursor tRNA (pre-tRNA); ribonuclease P (RNase P).

Condensin I is a multi-protein complex that plays an essential role in mitotic chromosome assembly and segregation in eukaryotes. It is composed of five subunits: two SMC (SMC2 and SMC4), a kleisin (CAP-H), and two HEAT-repeat (CAP-D2 and CAP-G) subunits. Although balancing acts of the two HEAT-repeat subunits have been demonstrated to enable this complex to support the dynamic assembly of chromosomal axes in vertebrate cells, its underlying mechanisms remain poorly understood. Here, we report the crystal structure of a human condensin I subcomplex comprising hCAP-G and hCAP-H. hCAP-H binds to the concave surfaces of a harp-shaped HEAT-repeat domain of hCAP-G. Physical interaction between hCAP-G and hCAP-H is indeed essential for mitotic chromosome assembly recapitulated in Xenopus egg cell-free extracts. Furthermore, this study reveals that the human CAP-G-H subcomplex has the ability to interact with not only double-stranded DNA, but also single-stranded DNA, suggesting functional divergence of the vertebrate condensin I complex in proper mitotic chromosome assembly.

A wire harp is a well known instrument used in ion beam profile measurement and beam diagnostics. Till date, for beam instrumentation, the harp is placed inside the vacuum chamber or beam line in direct exposure to the beam profile to be measured, whereas the related readout electronics is placed outside somewhere at a convenient place. Here, a harp has been developed along with the readout electronics as an integrated part of it and both were placed inside the beam line vacuum (order of 10(-7) Torr) to make the system much simpler, easy to operate, and measure small beam current more accurately. The entire signal conversion and processing is done inside the vacuum unlike other systems; hence, the electronics is kept inside. This results in a lesser number (only 4 pin) of electrical connections (feedthrough) including power which otherwise would have required 32 feedthrough pins only for signal readout for a 13 × 13 (X × Y) channel harp. This paper describes a completely new approach to the design of a conventional beam harp widely used for beam instrumentation.

A little more than 10 years ago Andreas Manz and Harp Minhas launched the Lab on a Chip journal. Their adventurous initiative has developed into a very successful and high-ranked journal, now established as THE reference journal for lab on chip research, and clearly they, and we, all may be very proud of this achievement!

In this paper, a model of the harp plucking is developed. It is split into two successive time phases, the sticking and the slipping phases, and uses a mechanical description of the human finger's behavior. The parameters of the model are identified through measurements of the finger/string displacements during the interaction. The validity of the model is verified using a configurable and repeatable robotic finger, enhanced with a silicone layer. A parametric study is performed to investigate the influence of the model's parameters on the free oscillations of the string. As a result, a direct implementation of the model produces an accurate simulation of a string response to a given finger motion, as compared to experimental data. The set of parameters that govern the plucking action is divided into two groups: Parameters controlled by the harpist and parameters intrinsic to the plucking. The former group and to a lesser extent the latter highly influence the initial conditions of the string vibrations. The simulations of the string's free oscillations highlight the large impact the model parameters have on the sound produced and therefore allows the understanding of how different players on the same instrument can produce a specific/personal sound quality.

The purpose of this study was to provide safe anesthesia for bronchoalveolar lavage and assess the utility of premedication with i.m. midazolam for short-duration anesthesia with isoflurane in harp seals (Phoca groenlandica). Fourteen yearling harp seal pups were anesthetized three times each as part of a prospective, cross-over, blinded study. Each animal received i.m. premedication with saline, low-dose, or high-dose midazolam (respectively 0.1 and 0.2 mg/ kg). Following premedication, anesthesia was induced with 4% isoflurane in oxygen delivered through a mask and connected to a Bain non-rebreathing system. A significantly longer time was taken from the end of general anesthesia to head movement in the high-dose group compared with the saline group (P = 0.002). A significantly longer time was taken from the end of general anesthesia to ambulation in the high-dose group compared with the saline group (P = 0.006). There were no significant differences between groups in the subjective assessment of anesthetic quality or ease of intubation. Premedication with i.m. midazolam at the dosages used did prolong recovery from anesthesia, although to a degree unlikely to be significant clinically.

Electronic Health Records (EHR) are moving towards the core application of health information systems. Enabling informational interoperability of shared care environment including EHR, structure and function of components used have to follow open standards and publicly available specifications. This comprises also methods and tools applied. Security services needed have to be an integral part of architecture and operation of the specified and implemented components. Starting with basic architectural paradigms the Magdeburg Medical Informatics Department was involved in at the early nineties, the secure behaviour of components has been derived. For establishing the required trustworthiness, security models have been introduced and presented in the paper. Beside communication security services based on standardised Public Key Infrastructure (PKI) and security token such as Health Professional Cards (HPC), policy-defined application security services such as authorisation, access control, accountability, etc., of information recorded, stored and processed must be guaranteed. In that context, appropriate resource access decision services have to be established. As the HARP project result, a component-based EHR architecture has been specified and demonstrated for enforcing fine-grained security services by binding certificates to application components, by the way enforcing policies.

UNASSIGNED

The objective of this review is to synthesize the best available evidence related to the effectiveness of music as pain relieving method among preterm infants during painful procedures in the neonatal intensive care unit.Review questions are: Among preterm infants in the neonatal intensive care unit, is music effective in reducing BACKGROUND: Preterm infants (i.e. babies born at or before 37 gestational weeks) compose a patient group of the most vulnerable to pain. Infants treated in a neonatal intensive care unit (NICU) are exposed to a variety of painful procedures (e.g. heel prick, iv cannula insertion, endotracheal suctioning) and to environmental stress (e.g. noise, light). Simons et al., for example, described an average 14 +/- 4 painful procedures during the first 2 weeks of life within a period of 24 hours among 151 neonates. Many studies have shown that repeated and sustained pain can have direct and long-term consequences on the neurological and behavior-oriented development of the neonates during the rapid development phase of the central nervous system. Pain can cause detectable physiological, behavioral and hormonal changes and contribute to the altered development of the pain system during later childhood and adolescence. Instead, live music such as singing is excellent type of music when it is steady, constant, quiet, soothing and directed to the infants. Graven emphasizes that recorded sound should not replace human voice exposure in the NICU; therefore, health care providers should provide ample opportunity for the infant to hear parent's voices live, such as singing or humming, in interactions between the parent and the infant at the bedside.The AmericanAcademy of Pediatrics Committee on Environmental Health has recommended safe levels of sound, and these recommendations have been updated by an expert team of practitioners. Recommendations specify that continuous sound should not exceed an hourly equivalent sound level of 50 A-weighted decibels (dBA), and music as an auditory stimulus not exceed 75 dB in NICU. If earphones or other devices are used, sound sources should be kept at reasonable distances from the infant's ear, played for brief periods and at levels below 55 dB.Music listening can be initiated with or without the involvement of a music therapist. In this review, music can be implemented for premature infants by a music therapist or any health care providers and it will include both recorded and live music.

RESULTS

Regardless of the type of music, several studies have investigated the short term effects of music on preterm infants, including the improvement in physiological outcomes (e.g. oxygen saturation, heart rate, respiratory rate, and blood pressure), as well as in behavioural state (e.g. crying, facial expression, body movements) and pain scores. For example, Chou et al. showed that premature infants receiving recorded music, that was the combination of womb sounds and the mother singing, with endotracheal suctioning had significantly higher oxygen saturation than when they did not receive music. Butt & Kisilewsky compared recorded music involving both the vocal and instrumental version of Brahms lullaby versus no music, and found that infants older than 31 weeks demonstrated significant reduction in heart rate, behavioral state and pain.In the study of Arnon et al. the infants receiving live music, compared with infants receiving recorded music or no music, had significantly reduced heart rate and behavioral scores during the post-intervention period. Live music comprised of a lullaby sang by the female voice with frame drum and an accompanying harp. The same music was played by a tape recorder. Live music showed significant benefits, whereas no statistically significant changes were found for the recorded music and control groups. Teckenberg-Jansson et al. indicated that music therapy combined with kangaroo care decreased the pulse, slowed down the respiration and increased the transcutaneous oxygen saturation in preterm infants. The musical instruments used were a lyre and a female human voice, which hummed or sang.There is evidence that music has also positive consequences on long-term outcomes, including length of hospitalization, weight gain, and non-nutritive sucking. For example, in the study of Caine the preterm infants received music stimulation which consisted of recorded vocal music (including lullabies and children's music) and routine auditory stimulation. Exposure to the music stimulation had many positive effects on preterm infants, such as it increased daily average weight, formula and caloric intake, and significantly reduced total hospital stays and stress behaviors for the experimental group. In addition, according to Lubetzky et al. exposure to music by Mozart significantly lowered energy expenditure among healthy preterm infants.Hartling et al. have published a systematic review on the efficacy of music for medical indicators in term and preterm neonates. Nine randomized trials (1989-2006) were included. According to the results of this review music may have positive effects on physiological parameters and behavioral states, and may reduce pain and improve oral feeding rates among the premature infants. The effects of music were evaluated during medical procedures (circumcision, heel prick) and for other indicators. In addition, Cignacco et al. conducted a systematic literature review on the efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates during the period from 1984 to 2004. According to this review there was no clear evidence that the method of music could have a pain-alleviating effect on neonates. In the Cochrane Library, one systematic review is also available up to year of 2011 concerning non-pharmacological management of infants and young children (preterm, neonate, older up to three years) during procedural pain, but this review did not consider music as an intervention.To date, there is also one meta-analysis published by Standley concerning the efficacy of music therapy for premature infants during the period from 1950 to 1999. It concluded that music was beneficial for many outcomes among the preterm infants in the NICU. However, the results of this review were limited by the poor methodological quality of the included studies, and unclear reporting on the phases of review.In our systematic review, studies published in 2000 and after will be considered for inclusion in the review. The number of the RCT's concerning the effectiveness of music among the preterm infants in NICU is especially increased during the last few years, and these studies have not included in the previous systematic reviews and meta-analysis.