Cytomegalovirus (CMV) infection and disease are important causes of morbidity and mortality in transplant recipients. For the purpose of developing consistent reporting of CMV outcomes in clinical trials, definitions of CMV infection and disease were developed and most recently published in 2002. Since then, there have been major developments in its diagnosis and management. Therefore, the CMV Drug Development Forum consisting of scientists, clinicians, regulators, and industry representatives has produced an updated version incorporating recent knowledge with the aimto support clinical research and drug development. The main changes compared to previous definitions are the introduction of a "probable disease" category and to incorporate quantitative nucleic acid testing in some end-organ disease categories. As the field evolves, the need for updates of these definitions is clear, and collaborative efforts between scientists, regulators, and industry can provide a platform for this work.
Face recognition is of major social importance and involves highly selective brain regions thought to be organized in a distributed functional network. However, the exact architecture of interconnections between these regions remains unknown. We used functional magnetic resonance imaging to identify face-responsive regions in 22 participants and then employed diffusion tensor imaging with probabilistic tractography to establish the white-matter pathways between these functionally defined regions. We identified strong white-matter connections between the occipital face area (OFA) and fusiform face area (FFA), with a significant right-hemisphere predominance. We found no evidence for direct anatomical connections between FFA and superior temporal sulcus (STS) or between OFA and STS, contrary to predictions based on current cognitive models. Instead, our findings point to segregated processing along a ventral extrastriate visual pathway to OFA-FFA and another more dorsal system connected to STS and frontoparietal areas. In addition, early occipital areas were found to have direct connections to the amygdala, which might underlie a rapid recruitment of limbic brain areas by visual inputs bypassing more elaborate extrastriate cortical processing. These results unveil the structural neural architecture of the human face recognition system and provide new insights on how distributed face-responsive areas may work together.
We present an economic model of systemic risk in which undercapitalization of the financial sector as a whole is assumed to harm the real economy, leading to a systemic risk externality. Each financial institution's contribution to systemic risk can be measured as its systemic expected shortfall (SES), that is, its propensity to be undercapitalized when the system as a whole is undercapitalized. SES increases in the institution's leverage and its marginal expected shortfall (MES), that is, its losses in the tail of the system's loss distribution. We demonstrate empirically the ability of components of SES to predict emerging systemic risk during the financial crisis of 2007-2009.
Background. Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain. Methods. A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence. The evidence was then used as the basis for recommendations about the diagnosis of tuberculosis disease and LTBI in adults and children. The recommendations were formulated, written, and graded using the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results. Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. Six of the recommendations are strong, whereas the remaining 17 are conditional. Conclusions. These guidelines are not intended to impose a standard of care. They provide the basis for rational decisions in the diagnosis of tuberculosis in the context of the existing evidence. No guidelines can take into account all of the often compelling unique individual clinical circumstances.
In fish schools the density varies per location and often individuals are sorted according to familiarity and/or body size. High density is considered advantageous for protection against predators and this sorting is believed to be advantageous not only to avoid predators but also for finding food. In this paper, we list a number of mechanisms and we study, with the help of an individual-based model of schooling agents, which spatial patterns may result from them. In our model, schooling is regulated by the following rules: avoiding those that are close by, aligning to those at intermediate distances, and moving towards others further off. Regarding kinship/familiarity, we study patterns that come about when agents actively choose to be close to related agents (i.e., 'active sorting'). Regarding body size, we study what happens when agents merely differ in size but behave according to the usual schooling rules ('size difference model'), when agents choose to be close to those of similar size, and when small agents avoid larger ones ('risk avoidance'). Several spatial configurations result: during 'active sorting' familiar agents group together anywhere in the shoal, but agents of different size group concentrically, whereby the small agents occupy the center and the large ones the periphery ('size difference model' and 'active sorting'). If small agents avoid the risk of being close to large ones, however, small agents end up at the periphery and large ones occupy the center ('risk avoidance'). Spatial configurations are also influenced by the composition of the group, namely the percentage of agents of each type. Furthermore, schools are usually oblong and their density is always greatest near the front. We explain the way in which these patterns emerge and indicate how results of our model may guide the study of spatial patterns in real animals.
We introduce SRISK to measure the systemic risk contribution of a financial firm. SRISK measures the capital shortfall of a firm conditional on a severe market decline, and is a function of its size, leverage and risk. We use the measure to study top financial institutions in the recent financial crisis. SRISK delivers useful rankings of systemic institutions at various stages of the crisis and identifies Fannie Mae, Freddie Mac, Morgan Stanley, Bear Stearns, and Lehman Brothers as top contributors as early as 2005-Q1. Moreover, aggregate SRISK provides early warning signals of distress in indicators of real activity.
The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections
Neolamprologus pulcher is a cooperatively breeding cichlid fish, in which helpers stay in their natal territory and help with brood care, territory defense, and maintenance. In this study we investigated helper effects by an experimental group size reduction in the field. After this manipulation, focal helpers in reduced groups tended to feed less, and small helpers visited the breeding shelter significantly more often than same-sized helpers in control groups. No evidence was found that remaining helpers compensated for the removed helpers by increasing territory defense and maintenance behavior. Breeders, however, did show a lower defense rate, possibly caused by an increase in brood care effort. Survival of fry was significantly lower in removal than control groups, which provides the first experimental proof in a natural population of fish that brood care helpers do effectively help. The data suggest that in small, generally younger, helpers, kin selection may be an important evolutionary cause of cooperation. Large helpers, however, who are generally older and less related to the breeders than small helpers are suggested to pay to be allowed to stay in the territory by helping. All group members benefit from group augmentation.
The cognitive phenotype of autism has been correlated with an altered balance of excitation to inhibition in the cerebral cortex, which could result from a change in the number, function, or morphology of GABA-expressing interneurons. The number of GABAergic interneuron subtypes has not been quantified in the autistic cerebral cortex. We classified interneurons into 3 subpopulations based on expression of the calcium-binding proteins parvalbumin, calbindin, or calretinin. We quantified the number of each interneuron subtype in postmortem neocortical tissue from 11 autistic cases and 10 control cases. Prefrontal Brodmann Areas (BA) BA46, BA47, and BA9 in autism and age-matched controls were analyzed by blinded researchers. We show that the number of parvalbumin+ interneurons in these 3 cortical areas-BA46, BA47, and BA9-is significantly reduced in autism compared with controls. The number of calbindin+ and calretinin+ interneurons did not differ in the cortical areas examined. Parvalbumin+ interneurons are fast-spiking cells that synchronize the activity of pyramidal cells through perisomatic and axo-axonic inhibition. The reduced number of parvalbumin+ interneurons could disrupt the balance of excitation/inhibition and alter gamma wave oscillations in the cerebral cortex of autistic subjects. These data will allow development of novel treatments specifically targeting parvalbumin interneurons.
A multicenter case-control study was conducted to evaluate the relations between antioxidant status assessed by biomarkers and acute myocardial infarction. Incidence cases and frequency matched controls were recruited from 10 European countries to maximize the variance in exposure within the study. Adipose tissue needle aspiration biopsies were taken shortly after the infarction and analyzed for levels of carotenoids and tocopherols. An examination of colinearity including all covariates and the three carotenoids, alpha-carotene, p-carotene, and lycopene, showed that the variables were sufficiently independent to model simultaneously. When examined singularly, each of the carotenoids appeared to be protective. Upon simultaneous analyses of the carotenoids, however, using conditional logistic regression models that controlled for age, body mass index, socioeconomic status, smoking, hypertension, and maternal and paternal history of disease, lycopene remained independently protective, with an odds ratio of 0.52 for the contrast of the 10th and 90th percentiles (95% confidence interval 0.33-0.82, rho = 0.005). The associations for alpha- and beta-carotene were largely eliminated. We conclude that lycopene, or some substance highly correlated which is in a common food source, may contribute to the protective effect of Vegetable consumption on myocardial infarction risk.