AbstractThe historic processes which have led to the present‐day patterns of genetic structure in the marine coastal fauna of the Northeast Atlantic are still poorly understood. While tectonic uplifts and changes in sea level may have caused large‐scale vicariance, warmer conditions during glacial maxima may have allowed pockets of diversity to persist to a much wider extent than in the Northwestern Atlantic. The large‐scale geographic distribution of deeply divergent lineages of the coastal polychaete tubeworms Pectinaria koreni (two clades) and Owenia fusiformis (three clades) were compared using a fragment of the mitochondrial cytochrome oxidase I gene (mtCOI). All lineages were present along the biogeographic transition zone on the north coast of Brittany (France) and we found evidence pointing towards congruence in the timing of cladogenic events between Pectinaria sp. (P. auricoma/P. belgica and P. koreni) and Owenia sp., suggesting a shared history of vicariant events. More conserved 16SrRNA sequences obtained from four species of Pectinariidae together with mtCOI sequences of P. koreni seem consistent with an initial establishment of pectinariids in the north, and a southward colonization of the Northeast Atlantic. Phylogeographic patterns in O. fusiformis were also consistent with a north/south pattern of lineage splitting and congruent levels of divergence were detected between lineages of both species. We observed signatures of both persistence in small northern glacial refugia, and of northwards range expansion from regions situated closer to the Mediterranean. However, whether the recolonization of the Northeast Atlantic by both species actually reflects separate interglacial periods is unclear with regards to the lack of molecular clock calibration in coastal polychaete species.

Breast cancer susceptibility gene 1 (BRCA1) has a central role in chemotherapy-induced DNA damage response. The protein inhibitor of activated STAT (PIAS) family of proteins, PIAS1 and PIAS4, are also necessary for adequate DNA damage repair. To further understand the role of BRCA1 in DNA repair, we examined the mRNA expression of these genes in 133 advanced (stage III-IV) gastric cancer patients using quantitative reverse transcription polymerase chain reaction. All P values were two-sided. The median overall survival was 12.5 months (95% confidence interval [CI] = 9.8 to 13.4 months). Among 59 patients receiving second-line docetaxel, the median overall survival was 25.8 months (95% CI = 9.2 to 42.4 months) for patients with high BRCA1 expression, 19.1 months (95% CI = 3.4 to 34.8 months) for those with intermediate expression, and 9.5 months (95% CI = 8.7 to 10.2 months) for those with low expression (P = .0062). The risk of mortality was higher in patients with low BRCA1 levels compared with high BRCA1 levels (hazard ratio of death = 2.49, 95% CI = 1.03 to 5.97, P = .037). Survival in patients receiving second-line docetaxel-based chemotherapy showed a similar trend with PIAS1 and PIAS4 mRNA expression levels, although the associations for PIAS4 were not statistically significant.

AbstractOver the course of training, physicians develop significant knowledge and expertise. We review dual-process theory, the dominant theory in explaining medical decision making: physicians use both heuristics from accumulated experience (System 1) and logical deduction (System 2). We then discuss how the accumulation of System 1 clinical experience can have both positive effects (e.g., quick and accurate pattern recognition) and negative ones (e.g., gaps and biases in knowledge from physicians’ idiosyncratic clinical experience). These idiosyncrasies, biases, and knowledge gaps indicate a need for individuals to engage in appropriate training and study to keep these cognitive skills current lest they decline over time. Indeed, we review converging evidence that physicians further out from training tend to perform worse on tests of medical knowledge and provide poorer patient care. This may reflect a variety of factors, such as specialization of a physician’s practice, but is likely to stem at least in part from cognitive factors. Acquired knowledge or skills gained may not always be readily accessible to physicians for a number of reasons, including an absence of study, cognitive changes with age, and the presence of other similar knowledge or skills that compete in what is brought to mind. Lastly, we discuss the cognitive challenges of keeping up with standards of care that continuously evolve over time.

<p>Differentially abundant microbial enzyme classes (EC) and metabolic pathways (MaAsLin2).</p>

AbstractThe ideal model of care in general medicine remains elusive, perhaps because of interhospital heterogeneity in patient population and resource allocation to both general medicine and the medical subspecialties. We explain why successful interventions at one site are not easily applied in another and recommend a nationally coordinated examination of the best general medicine departments' methods of clinical practice improvement.

BACKGROUND Anthropometric measurements are vital for safe care in pediatric intensive care units. OBJECTIVE To identify barriers to anthropometric measurements and determine if perceptions of barriers differ between ordering providers and nurses. METHODS A 21-item survey to elicit perceptions of barriers to obtaining anthropometric measurements was distributed via e-mail to societies with members who provide care in pediatric intensive care units. RESULTS Most of the 258 eligible respondents (46% ordering providers) were from North America (90%). Although 84% agreed that anthropometric measurements are important, only 3% knew if these measurements were obtained upon admission to their unit. Estimates of patients' measurements by parents or caregivers were commonly used (72%) when actual measurements were not obtained. Leading barriers were presence of medical devices (57%), use of extracorporeal life support (54%), and unstable hemodynamic status (52%). More ordering providers than nurses considered osteopenia/fragile bones as a barrier to weight measurement (46% vs 29%; P = .007) and traumatic brain injury a barrier to measurement of head circumference (42% vs 24%; P = .002). More nurses than ordering providers perceived dialysis (21% vs 9%; P = .01) and obesity (26% vs 15%; P = .04) as barriers to measurement of stature. Ordering providers more than nurses perceived nurses' workload (51% vs 33%; P < .001) and lack of importance (43% vs 20%; P < .001) as barriers. CONCLUSIONS Barriers to obtaining anthropometric measurements exist in pediatric intensive care units; ordering providers and nurses have different perceptions of what constitutes a barrier.

Relationships between bacteria, microphytobenthos and extracellular polymeric substances (EPS) that make up microbial biofilms over bare mudflats were investigated at an hourly frequency during two 14-day spring– neap cycles in winter and summer 2008. Bacterial abundance and total chl a concentration were lower in summer (0.78 × 108 ± SD 0.39 × 108 cell.m−2 and 59.0 ± SD 10.42 mgchla.m−2) than in winter (3.7 × 108 ± SD 1.9 × 108 cell.m−2 and 106.64 ± SD 11.29 mgchla.m−2), coinciding with a high abundance of the gastropod Peringia ulvae in summer, which subsequently impacted 1st-cm chl a concentration by intense grazing. Bound and colloidal EPS carbohydrate temporal patterns were similar in winter (5.71 ± SD 3.95 and 4.67 ± SD 3.45 μg.g−1, respectively) butwere different in summer (14.9±SD 4.05 and 5.60±SD 4.50 μg.g−1, respectively). Carbohydrate colloidal EPS appeared to be related to light and salinity, while 1st-mm chl a concentration was negatively affected by strong salinities and predation pressure by P. ulvae. The fluctuations of colloidal carbohydrates were remarkably similar in the two seasons with peaks just after spring tideswhen the highest irradiance was received by microphytobenthic cells. Apparently, colloidal EPS carbohydrates can protect cells against the high salinity values ranging from 32.3 to 50.4 PSU. The presence of bound EPS carbohydrates may be linked to sediment colonization and resistance of biofilm activity. Proteins in EPS were absent in winter and represented a small proportion in summer (10%), but they appeared to be a good indicator of potential synergistic effects between MPB and bacteria in summer. Conversely, bound EPS carbohydrates reached high levels in winter, while the number of bacteria decreased simultaneously, suggesting a negative effect on bacterial growth in the absence of proteins in EPS. There was a lower proportion (31%) of low molecular weight EPS in summer than in winter (83%), possibly in relation to desiccation.