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Pyramidal neurons proportionately alter the identity and survival of specific cortical interneuron subtypes.

The mammalian cerebral cortex comprises a complex neuronal network that maintains a precise balance between excitatory pyramidal neurons and inhibitory interneurons. Accumulating evidence indicates that specific interneuron subtypes form stereotyped microcircuits with distinct pyramidal neuron classes. Here we show that pyramidal neurons play an active role in this process by promoting the survival and terminal differentiation of their associated interneuron subtypes. In wild-type cortex, interneuron subtype abundance mirrors the prevalence of their pyramidal neuron partners. In Fezf2 mutants, which lack layer 5b pyramidal neurons and are expanded in layer 6 intratelencephalic neurons, corresponding subtype-specific shifts occur through two distinct mechanisms: somatostatin interneurons adjust their programmed cell death, whereas parvalbumin interneurons switch their subtype identity. Silencing neuronal activity or blocking vesicular release in L5b pyramidal neurons revealed that their communication with interneurons does not require voltage-gated synaptic activity and engages both tetanus toxin-sensitive and -insensitive pathways. Moreover, a targeted bioinformatic screen for ligand-receptor pairs displaying subtype-specific expression and reduced expression of pyramidal neuron-derived ligand in Fezf2 mutants identified candidate secreted factors and adhesion molecules. These findings reveal distinct, pyramidal neuron-driven mechanisms for sculpting interneuron diversity and integrating them into local cortical circuits.

Journal Article↗

Strengthening supply chains for pathogen genomic surveillance in Asia.

INTRODUCTION: While pathogen genomics using next-generation sequencing (NGS) has been recommended by the WHO as an essential tool for national communicable disease surveillance programmes, procurement and supply chain management (PSM) systems for this new technology are still evolving. To assess the status of PSM systems for pathogen genomics, we examined perspectives from end-users and manufacturers across South and Southeast Asia. METHODS: Between 2022 and 2023, a cross-sectional survey was conducted among institutional partners supporting pathogen genomics among primarily low- and middle-income countries in South and Southeast Asia. This was complemented by qualitative interviews with the major regional NGS manufacturers. A PSM framework was employed to assess sales, procurement, production, distribution and post-sales support. Analyses are expressed as proportions and means or medians for continuous variables. RESULTS: A total of 42 partners across 13 countries, 3 genomics manufacturers and 22 laboratory personnel contributed data to this assessment. PSM challenges were reported by all countries and for all sequencing platforms. High costs of equipment and consumables were identified by 85% of respondents. Long equipment purchasing lead times and reagent re-supply times were reported by 69% and 77% of countries, respectively, with reagent resupply times averaging 8 weeks (IQR 6.2-9.0). Additional barriers included customs clearance, variability of import procedures, taxes and duties. Manufacturers reported a range of strategies to respond to PSM bottlenecks, including establishing regional hubs, distributor networks and financing schemes. CONCLUSION: Coordinated national and regional efforts are required to improve PSM systems for pathogen genomic sequencing to enhance timely early disease detection and response capacity in South and Southeast Asia.

Humans↗

Microglial GRB2 is essential for brain ventriculogenesis and CSF homeostasis.

Microglia play essential yet poorly understood roles in brain development, including axon guidance, regulation of neurogenesis, and pruning of neuronal projections. Congenital hydrocephalus (CH), characterized by enlarged cerebrospinal fluid (CSF)-filled ventricles, is a leading cause of pediatric brain surgery, but its molecular mechanisms remain unclear. We have identified what we believe to be novel, recurrent, damaging missense variants in the SH3-binding domain of the adaptor protein Growth Factor Receptor-Bound Protein 2 (GRB2) in unrelated patients with CH. GRB2 is significantly co-expressed with one of its known upstream receptor tyrosine kinase partners, CSF1R, in the developing human brain, particularly in a microglial subtype associated with regulation of neural stem cells. Immunoprecipitation validated GRB2-CSF1R binding in mouse microglial cells and human monocyte cell line. Cx3cr1-Grb2fl/fl mice engineered with conditional deletion of Grb2 in microglia exhibit congenital absence of microglia and early postnatal severe communicating (non-obstructive) hydrocephalus, mimicking GRB2-mutant patients. The severe ventriculomegaly of Cx3cr1-Grb2fl/fl mice is associated with both depletion of cerebral cortical neurons and impairment of glia-lymphatic-mediated CSF flow. Together, these findings implicate a role of GRB2 in microglia that could be essential for brain development and CSF homeostasis.

Genetics↗

Telemedicine in Kansas: the successes and the challenges.

Based on our experience of telemedicine in Kansas, we have identified several key factors in the success of a telemedicine practice. Very early in any project, it is important to bring together all participants (especially the physicians who are expected to refer patients) to define the need, outline specific goals, analyse and test the technology, and develop a plan for the implementation. As with traditional health-care, many partners must come together, including primary-care practitioners willing to shoulder day-to-day responsibility for management of complex patients, nurses with special expertise and consultants willing to work with a remote team using telemedicine. These individuals must accept the challenges and appreciate the rewards of working in a different practice model, in which communication and interdependence are critical for success. The telemedicine consultant is only as good as the local health-care team. The technology itself is only a small part of the equation.

Academic Medical Centers↗

Men's experiences during the acute phase of their partners' myocardial infarction.

The men's narratives about the women reveal a disturbance in the balance of their daily life, showing how they, the men, perceive powerlessness, and also how they passively adapted themselves to what happened. The narratives reveal that the women are 'ignoring and withholding' their feelings and that they want to be as 'responsible and independent' as they used to be. The women are disclosed as 'not wanting to face reality': there is an enervating lack of communication.

Adaptation, Psychological↗

Learning to work together: developing academic and community research partnerships.

BACKGROUND: Community-based participatory research (CBPR) has been promoted as an important collaborative methodology for addressing local health concerns. However, academic physicians and researchers usually are not trained to work with communities as partners. METHODS: Key characteristics of effective community-academic partnerships are examined based on experiences with 2 CBPR projects in Wisconsin. RESULTS: These 2 projects increasingly have involved the respective communities and researchers in a collaboration. The steps they have taken illustrate the qualities of successful CBPR partnerships: ongoing development of joint community and researcher analysis, communication, and mobilization to search for relevant solutions to important community health problems. To sustain this kind of partnership, it is critical for researchers using the CBPR approach to understand how their academic-scientific perspective differs as well as converges with the community members' practical-experiential perspective. CONCLUSIONS: Health care researchers can effectively make use of partnerships with communities by following defined CBPR steps for developing mutually agreed upon research agendas, timelines, and goals. This, in turn, builds the capacity of communities to initiate and engage in future collaborative research projects concerning health issues.

Academic Medical Centers↗

A technique of sexual counselling.

A method of sexual counselling based on the technique originally proposed by Masters and Johnson but modified to suit local conditions is described. The method is basically "client-centred" and depends on interviewing both partners of a sexually inadequate relationship so that the clients themselves set the level of desired sexual achievement. Factors which may inhibit a sexual relationship are explored, particularly those involving cultural, moral, religious, education or financial matters. Ejaculatory problems and orgasmic dysfunction are treated in the manner described by Masters and Johnson, whilst other interpersonal and communicative problems are handled by making use of Kagan's Interpersonal Recall snselling clinics are discussed.

Communication↗

A categorical and dimensional perspective on depression within a nonclinical sample of couples.

The present study investigated the role of psychosocial variables that are indicators for depressive symptomatology within a couple. The variables chosen for this study were conflict communication, marital adjustment, attachment, attribution style, and personality traits--all potentially specific indicators. A global factor analysis on all our measures revealed that our individual and relational measures were stable findings. We wanted to compare a dimensional and categorical view of depression. First, we focused on the total nonclinical sample, considering depression on a continuum, and studying the selected characteristics along with the varying degree of depressive complaints. The results highlighted the importance of individual characteristics (neuroticism and life satisfaction) covarying with the level of depressive symptomatology in the nonclinical sample (n = 186 couples). Second, in addition to this correlational design, we compared the group of most depressed subjects and their partners with a control sample (n = 34). Both approaches pointed to the same conclusion: individual characteristics covaried with mild depression, whereas couple characteristics only came into the picture with a higher level of depressive complaints. The lowest levels of depressive complaints were associated with individual co-morbidity only, whereas increasing complaints went along with additional relational complaints. Implications for assessment and future research are discussed.

Adaptation, Psychological↗

Merging, partnering, and restructuring: coping with the culture clashes.

Turmoil in the health-care industry caused by restructuring, mergers, and acquisitions shows no sign of letting up. This condition will continue as the industry adjusts to government and marketplace pressures. To ensure that you can carry out a merger successfully, you should look to creating a new, blended organizational culture. By viewing a model of culture as having three layers, you can develop an action plan to increase trust and open communications between the groups. An examination of organizations involved in complex changes such as a merger or acquisition shows that those who succeed focus on the human part of the equation.

Adaptation, Psychological↗

Do African-American men and women differ in their knowledge about AIDS, attitudes about condoms, and sexual behaviors?

This study identified a sample of young African-American men and women classified as having multiple sex partners or one sex partner. Of the 149 men, 71 (47%) were classified as having multiple sex partners and 78 (53%) as having one sex partner. Of the 165 women, 29 (19%) were classified as having multiple sex partners and 126 (81%) as having one sex partner. Results indicated that the groups did not differ in their knowledge about acquired immunodeficiency syndrome (AIDS). However, attitudes about condom use differed significantly by gender (P less than .01) and by multiple sex status (P less than .001). Angry reactions regarding the negotiation of condom use occurred more with men than with women (P less than .05). Men and members of the multiple sex partners group tended to engage in more risky sexual behavior. These two groups also had a significantly (P less than .001) higher incidence of gonorrhea. While the multiple sex partners group had significantly more smokers (P less than .01), drinkers (P less than .01), and crack users (P less than .05), men were significantly higher consumers of marijuana (P less than .001) and alcohol (P less than .01). Overall, the results indicate that African Americans are knowledgeable about AIDS, but there appears to be a gap between knowledge and risky sexual behaviors. Prospective studies are needed to clarify the factors that determine the relationship (or lack of) between knowledge and risky sexual behaviors. Without such studies, a major part of the foundation that is needed for the development of sensitive and effective AIDS prevention programs for African Americans will be missing.

Acquired Immunodeficiency Syndrome↗

General practice awareness of notifiable infectious diseases.

The Acheson Report concluded that the process of infectious disease notification in England and Wales was unsatisfactory and recommended that it should be reviewed. However, the success of any notification system will depend on the knowledge and motivation of general practitioners, who are responsible for a large proportion of infectious disease notifications. A district-wide telephone survey was conducted in Croydon among general practitioners to assess the level of awareness of which diseases are on the statutory notification list. Respondents' opinions were also sought on the composition of the present list. Results indicated that a generally high level of awareness contrasted with a relative paucity in knowledge of certain of the more common diseases. Differences in knowledge were not associated with the sex, the length of time since the doctor qualified or the number of partners in the particular practice. Motivation may be a particularly important factor underlying the present incompleteness of notifications. A large proportion of doctors stated that legionellosis, AIDS, brucellosis and listeriosis merited statutory notification.

Communicable Disease Control↗

Social support as conversation: analysing breast cancer patients' interactions with their partners.

This paper demonstrates an alternative approach to studying the process of social support in close relationships by examining three tape-recorded conversations between breast cancer patients and their partners. We argue that existing research fails to take account of the "social" aspects of social support, and that new methods, sensitive to the complexities of human interaction, are needed. One promising method, tape-assisted recall (in which an audiotape of an interaction is played back to participants), allows researchers to examine the help-intended communication within a dyad as well as each participant's view of that communication. The conversations of the three couples and the participants' moment-by-moment perceptions of these conversations illustrate the complexities of help-intended communication. The commentaries in the tape-assisted recall sessions yielded insights into the interactions that were not always apparent on the surface: the personal meanings of the interactions, in the context of the couple's relationship, were necessary for understanding how support attempts are delivered effectively and why they sometimes fail. The strengths and limitations of the method for the study of social support are discussed. Implications for community health interventions to optimize support for couples coping with illness are also addressed.

Adaptation, Psychological↗

"Speaking for another": the management of participant frames in aphasia.

A sociolinguistic analysis of an interaction between a woman with aphasia and a nonaphasic speaking partner was conducted to investigate participant framing in aphasia. Participant frames, or the stances that people take in conversation, help conversational participants structure their talk and collaboratively negotiate meaning (I. Goffman, 1974). This analysis revealed a configuration in which a person with severe aphasia enlisted her speaking partner to speak for her. That is, the interaction was framed such that the nonaphasic speaking partner served as the "spokesperson" for messages that were authored by the person with aphasia. The clinical requirements of adopting a "speaking for another" framework are discussed.

Adult↗

Using the eXtensible Markup Language (XML) in a regional electronic patient record for patients with malignant diseases.

Communication between different institutions which are responsible for the treatment of the same patient is of outstanding significance, especially in the field of tumor diseases. Regional electronic patient records could support the co-operation of different institutions by providing ac-cess to all necessary information whether it belongs to the own institution or to a partner. The Department of Medical Informatics, University of Heidelberg is performing a project in co-operation with the Thoraxclinic-Heidelberg and the Department of Clinical Radiology, University of Heidelberg with the goal: to define an architectural concept for interlinking the electronic patient record of the two clinical institutions to build a common virtual electronic patient record and carry out an exemplary implementation, to examine composition, structure and content of medical documents for tumor patients with the aim of defining an XML-based markup language allowing summarizing overviews and suitable granularities, and to integrate clinical practice guidelines and other external knowledge with the electronic patient record using XML-technologies to support the physician in the daily decision process. This paper will show, how a regional electronic patient record could be built on an architectural level and describe elementary steps towards a on content-oriented structuring of medical records.

Computer Security↗

Computers in patient education and monitoring.

Computing technologies offer much promise in the field of medicine. Every discipline in medicine has been affected by the proliferation of computerized technology. Clinicians face challenges in balancing constraints of time and personnel resources when caring for and educating patients. The potential value of computer technology is tremendous and expectations run high among providers and patients. Computers can help patients to synthesize knowledge from information and to retain information about diseases. Computer and communication technologies can extend the caregiver's reach with remote patient monitoring. Health care providers' roles are changing because of the availability of health information on the Internet. Computer-based patient education can help improve the patient's awareness and understanding of his or her disease(s), which can help make the patient more of a partner in the patient-physician relationship. Currently, there are some limitations to and issues about using computers for patient education and monitoring, but I expect those limitations and issues to be substantially mitigated in the future.

Computer-Assisted Instruction↗

Acceptability of routine enquiry regarding domestic violence in the antenatal clinic.

Domestic Violence poses a significant health risk for the woman and her baby. We wished to determine the acceptability of routine questioning for domestic violence in the maternity hospital setting. A non-anonymised questionnaire was completed by 481 women attending for booking antenatal appointment in a maternity hospital antenatal clinic. The doctor asked four questions regarding experience of partner abuse, The acceptability of these questions was determined. 468 (99%) patients found the questions acceptable and said it would be helpful to ask all patients. Sixty-one (12.9%) women gave a history of at least one form of partner abuse. We concluded that routine enquiry about domestic violence during hospital antenatal visits is acceptable to women and perceived by them to be worthwhile.

Communication↗

AIDS prevention: legislative options.

This article reviews legislative options to prevent the transmission of HIV infection. It distinguishes between pre-exposure measures designed to prevent initial exposure, and post-exposure measures aimed at preventing infected individuals from exposing others. Part I identifies education as the key component of a comprehensive prevention program, and reviews options for pre-exposure education programs designed to avoid or minimize exposure. Part II reviews post-exposure prevention measures, focusing on reporting and contact tracing provisions. Mandatory reporting by name of individuals testing HIV positive and mandatory contact tracing are opposed as counterproductive prevention measures; voluntary partner notification is supported. Part III examines various prevention efforts for settings where there may be either a real or perceived risk of transmission of HIV infection. Part IV sets out conclusions.

Acquired Immunodeficiency Syndrome↗

Expression pattern of different gap junction connexins is related to embryo implantation.

Successful implantation in mammals requires a close interaction between the embryo and the uterus. Direct cell-cell communication via gap junctions seems to play an important role in the preparation of the uterus for embryo implantation and in the regulation of trophoblast invasion. During preimplantation in the rat the gap junctional proteins connexin (cx) 26 and cx43 are suppressed. This loss of cell-cell communication seems to be important for transformation of the endometrium into the receptive phase. The suppressive effect is mediated by progesterone as demonstrated by the application of antigestagens. At implantation, however, a spatial and temporal pattern of connexin expression is induced in response to embryo recognition. cx26 is locally expressed in the uterine epithelium of the implantation chamber, cx43 in the surrounding decidua prior to invasion. With progressing invasion, the decidual cells surrounding the invading trophoblast in addition to cx43 reveal cx26. In this phase, the invasive partner, the blastocyst, is characterized by coexpression of cx43 and cx31. During trophoblast invasion however, cx31 becomes restricted to the cells of the invasive ectoplacental cone, cx43 to the embryo proper. It seems that compartmentalization of the trophoblast and the inner cell mass is established by two different connexins. During placental differentiation connexin expression switches from cx31 to cx26 and cx43, indicating the end of the invasive phase. The highly regulated pattern of connexin expression in the endometrium as well as in the trophoblast suggests a key role of this different intercellular pathways in regulating the invasion process of the trophoblast into its host tissue, the endometrium.

Animals↗