International Journal of Clinical Pediatric Dentistry is 5 years old and over this period of time has achieved the reputation of a well-managed clinical journal cited by many authors around the world. International Journal of Clinical Pediatric Dentistry is 5 years old and over this period of time has achieved the reputation of a well-managed clinical journal cited by many authors around the world. This journal is unique in providing complete, definitive and authoritative reviews on many aspects of clinical pediatric dentistry and continues to be a significant contribution to the art of this speciality. At the same time, we know that there will always be room for improvement. The Editor and the Editorial Board have worked with the outstanding publishing staff to design the journal with a very contemporary and easy to follow outlook. All figures and photographs are of high color quality and could be found in the online version of the manuscript, enabling easy access to a number of very relevant clinical conditions. To further broaden the outreach and appeal of the topics published, we try to emphasize the need for multidisciplinary approach in clinical pediatric dentistry aiming at integrating research in this field with other oral health and general health disciplines. In this way, we hope to cross many bridges that will broaden the impact of the International Journal of Clinical Pediatric Dentistry in both the basic and clinical research domains. It is important to add that the Editorial Board of the journal is international-based which provides a real international outreach. We are certain that the international expertize of our board members will keep the journal up to date in regard to the clinical and scientific significance of the topics discussed. In closing this message I would like to thank the Editor and the Board members for their continued efforts in having the International Journal of Clinical Pediatric Dentistry provide an important contribution to the art and science of pediatric dentistry.Charles LekicDDM, MSc, PhD, FRCD(C)Associate and Managing Editor


The decade after the draft Human genome was published has seen tremendous developments in the technologies that can sequence genomes of individual Humans in a fast and affordable and accurate way. Reading 3 billion odd bases which comprise of the Human genome is today possible in realistic timelines and costs. This improvement was primarily brought about by the significant advances in the throughput and technology to sequence DNA and computational methods and resources to assemble and interpret the data. In addition to the improvements in technology, the miniaturization of technology that enables sequencing of human genomes on bench top sequencers has been thought to be one of the game-changers which could potentially accelerate the widespread application of genome sequencing. The availability of the reference human genome sequence has also in the last one decade accelerated the discovery of human genetic variations and their associations with traits which has provided a basis of annotating human genomes for predictive/personalized medicine.The availability of effective tools, resources and datasets has poised genome sequencing in a unique position which could see its regular use in clinical settings. The application of genomics in clinical settings would primarily help in accurate and evidence based care, which encompass a new field of medicine called Precision Medicine. Precision medicine encompasses use of accurate clinical information and evidence to appropriately manage a patient at an individual level or at a community level. One of the major challenges which preclude the widespread application of genome sequences in clinical settings is the lack of know-how and expertise in analyzing and interpreting genome data in clinical settings. This would require a new breed of clinicians who have good clinical acumen, and are equally well versed with genomics and computational tools and methodologies.Towards accelerating the implementation of Precision medicine we have established a pipeline for human genome/exome sequencing and analysis in our laboratory and have developed a gamut of resources and tools for discovery, modeling and annotation of clinically actionable variants in genomes including Pharmacogenetic variations. In addition, we have implemented a pipeline for validation of functional variations in zebrafish, a popular vertebrate model system. Case studies and examples would be detailed during the lecture.


Cytokines are pleiotropic mediators that play a major role in inducing and orchestrating the inflammatory and the immune response. They play a major role in the response to damage or infections. In some pathological condition abnormal regulation of the production of cytokines leads to pathological events and subsequent damage to target tissues. Dissecting the role of each single mediator in the plethora of cytokines and in the complex networks has been one of the aims of biomedical research that has led to relevant applications in rheumatic diseases. In the presentation we will briefly review the evidence leading to the identification of the role of some cytokines  as key mediators and therapeutic targets in pediatric rheumatic diseases.None declared.


The COMET Initiative recognises the expertise and crucial contribution of patients and carers in developing core outcome sets and research more generally. Core outcome sets need to include outcomes that are most relevant to patients and carers, and the best way to do this is to involve patients and carers in their development. COMET is developing resources to help patients and carers to get involved in this work.In March 2014 COMET hosted a collaborative meeting between core outcome set developers, UK public involvement organisations and the COMET Initiative. The aims of the meeting were to: Raise awareness amongst attending public involvement organisations about the work of COMET; identify resources that are relevant to facilitate public involvement in the work of COMET and discuss a strategy for engaging patient organisations in the work of COMET. The COMET initiative is also developing plain language resources to support patient and public involvement in COS studies. It is also piloting a tool to help involve patients in the design of a COS study.As a result of the Involving People event COMET has developed an initial Patient and Public Involvement strategy and is establishing a People and Patient Participation, Involvement and Engagement (PoPPIE) working group to take forward the strategy and action plan. Two plain language resources have so far been developed with the involvement of patients and the public, these include a summary of what core outcome sets are and the work of the COMET Initiative and a description of what a Delphi process is. Piloting is underway for the tool to support researchers in designing their core outcome set study with the involvement of patients. COMET worked collaboratively with EURO-DIS (European rare disease patient organisation) and presented a webinar about COS and COMET.


To analyze the perception of parents regarding their return to the hospital where their children died to participate in a conversation with doctors and to analyze the feelings of parents about their participation in a study evaluating the care provided in the moments leading up to the death of children.A descriptive exploratory qualitative study. The study sites were the pediatric ICUs of the Hospital São Lucas and Hospital de Clinicas de Porto Alegre. Fifteen parents of children who died in the PICUs studied participated in the study. Data collection occurred in 2010 and was conducted through semistructured interviews. Data were analyzed using thematic content analysis. The research was approved by the research ethics committees of both hospitals.The ability to return to the hospital and talk to medical assistants was considered by parents as a positive and enlightening opportunity. Parents who participated in the study understood this moment as an opportunity to be heard and demonstrated the intention to contribute with their experiences in order to improve care in the hospitals studied.We conclude that there is a need to implement measures to provide palliative care to parents after the death of their children. It is necessary to consider the possibility of providing families with follow-up meetings with the multidisciplinary team after the death of children.


Dear Editor,,We have read with great attention the paper by Fernandes and colleagues aboutelectrodiagnosis as a monitoring tool in ulnar nerve recovery after surgical treatment ofnerve lesion Dear Editor and authors of the referred letter,We thank the authors (Coraci and colleagues) for your interest in our paper and for thegreat contribution to this important research topic. The authors of the letterdemonstrate a good perception of the relevance of our study (Fernandes et al.We understand the value of numerous neurophysiological techniques and nerve ultrasoundto guarantee a more complex visualization of the lesion and its progress. We know thatthese approaches are helpful for diagnosis, prognosis, and treatment of nerve lesions.We opted to use stimulus electrodiagnosis because it is the only instrument thatphysical therapists can use in clinics. We can receive the results of the othertechniques, but we cannot conduct evaluations such as ultrasound andelectroneuromyography. Therefore, we tried to reinforce the importance of stimuluselectrodiagnosis as a physical therapy tool, which obviously has to be combined with theresults of other exams. We agree with the authors of the letter that this broad approachcan contribute to the correct diagnosis and to a better follow-up of all nervelesions.The impact of future studies on this area, as suggested by the authors of the letter,can promote significant changes in clinical practice. We believe that each technique hasits value, and all techniques can point out important and different aspects of thelesion and its recovery. We also agree that collaboration between physicians andphysical therapists might allow a comprehensive appraisal of the pathological conditionand a correct management tailored to the patient.We are grateful for our opportunity, as physical therapists, to reflect on ourapproaches and on the combination of methods of evaluation in order to attain a betterunderstanding of nerve lesions and the recovery of patients.


To be familiar with the diffusion tensor sequence acquisition used to delineate the tracts of the prostatic neurovascular bundles.To understand the method for seeding and identifying the tracts and displaying the anatomy for surgical planning.To be familiar with the potential imaging and interpretation pitfalls.Diffusion tensor imaging (DTI) may be used for tractography of the peri-prostatic neurovascular bundles (NVBs). We will describe the MR acquisition technique that may be used to demonstrate the NVB’s. The method used for seeding the tracts will be illustrated with examples in healthy volunteers and in cases of prostate cancer. Correlation of the tractography with the histological sites of NVB’s will be demonstrated. Pitfalls related to the MR acquisition will be discussed and potential difficulties with interpretation will be presented.Tractography of the prostatic NVB’s is feasible and has the potential to demonstrate the anatomical position of the NVBs in relation to prostate cancer. This information could in future influence surgical decision-making.


This Postgraduate Forum was originally a platform for postgraduate students in health systems and policy of Gadjah Mada University, Universiti Kebangsaan Malaysia, United Nations University International Institute for Global Health and Naresuan University to meet annually to exchange their research studies to strengthen their capacities in involving health policies in their countries. In 2013, the forum is taking place at Naresuan University to set the agenda for the 2015 target of economic integration among member countries of the Association of Southeast Asian Nations. The target is imminent, but the groundwork for the health systems and policy research of the AEC is limited. More collaborative works should be mapped to enhance good integration of economic policy with good health impacts especially for the vulnerable groups. More countries are welcome to join the forum for the most attainable health benefits of all members.


The members of the Genomics Workgroup in the Electronic Medical Records and Genomics (eMERGE) network  is an important focus for biomedical, clinical and translational informatics in the current era. The manuscripts presented in this special topic are well positioned to educate and demonstrate the potential study designs, methods, strategies, and applications where this type of research can be performed successfully. The ultimate goal is to improve diagnostics and provide better, more targeted care to the patient.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


This survey was undertaken as part of the work of the Consumer Information Working Party within the Hume Diabetes Service Improvement Collaborative HDSIC. The HDSIC is part of the implementation of the National Chronic Disease Strategy. The task of the HDSIC is to apply the National Diabetes Service Improvement Framework in the Hume region to increase the access to high quality diabetes service.Provide clear and consistent information for people with chronic conditions and their carers (Hume Regions Chronic Care Strategy HRCCS 2012-2022). This information will then be used by the collaborative to develop consumer information recommendations and support service providers to address issues relating to health literacy.The objective of this survey was to understand podiatrists' decision-making and behaviour regarding consumer information given to clients with diabetes. This would identify gaps between current practice and Priority 4 A total of 30 podiatrists from the public, private and education sector responded to an emailed a survey monkey questionnaire. It was designed to investigate clinicians' attitudes, source of information, selection criteria and any existing policies with regard to consumer information. Responses were collated and used to inform the work of the collaborative.With the exception of the two public health services in Hume there were no existing policies relating to the selection/provision of consumer information. The main sources of consumer information were Australian Podiatry Council and Diabetes Australia. Health Literacy was identified as the single most important factor in determining what consumer information was used with pictorial information rating highly.Podiatrists in the Hume Region have little formalised policy documentation regarding consumer information for clients with diabetes. They choose information from peak bodies and look for information, which is appropriate for their client's health literacy level. A possible area of improvement in health literacy is in the tailoring of information with regards to clients' cultural diversity.


There are errors in the second and third sentence of the Abstract. The second sentence should be removed completely, while the correct third sentence should read: The association between migraines and spinal cord injury (SCI) is intriguing to consider from the perspective that migraine headaches may be acquired in response to damage in the spinal cord.There is an error in


Previous studies have highlighted the magnitude of risky drinking among Swedish students; finding that at least 50% of the students could be classified as risky drinkers. Human rThe content development will be an interactive process in which theory guided content is modelled and qualitatively evaluated by the users in line with guidance on the development of complex intervention. The process will begin with a revisit of the literatures on theory-based approaches to behaviour change across behavioural targets, with focus on alcohol. In the next step the structure and content of tentative text messages will be discussed by students in focus group interviews.Three focus group interviews will be conducted during spring 2015 in three regions in Sweden in order to investigate the students reasoning on the theoretical informed content. The students will be asked to formulate new messages and disregard existing messages. Preliminary results from the interviews will be presented.The responses of the students will enable us to understand how students think about the structure and content of a text message based alcohol intervention in order to increase uptake, compliance and effectiveness of the intervention.The study is funded by the Swedish Public Health Agency.Preben Bendtsen is partly owner of a software company that distributes life style interventions.


The human sensorimotor system can be readily entrained to environmental rhythms, through multiple sensory modalities. In this review, we provide an overview of theories of timekeeping that make this neuroentrainment possible. First, we present recent evidence that contests the assumptions made in classic timekeeper models. The role of state estimation, sensory feedback and movement parameters on the organization of sensorimotor timing are discussed in the context of recent experiments that examined simultaneous timing and force control. This discussion is extended to the study of coordinated multi-effector movements and how they may be entrained. Entrainment is a broadly used term that refers to the process of alignment between systems. In the context of human behavior and physiology, entrainment refers to the adaptive function by which we voluntarily or involuntarily synchronize our brains and bodies to the environment. As this encompasses the coupling of brain and behavior, this phenomenon is often referred to as neuroentrainment. A commonly used paradigm in neuroentrainment research is to study the temporal relationship between the body and the rhythmic stimulation in the environment , basal ganglia and the cerebellum  was applied to the motor cortex. cTBS is a relatively new technique that has been shown to reliably depress cortical excitability following stimulation. Applying cTBS to M1 has been shown to interrupt typical force attenuation , equal attention should be paid to the coordination between various parts of the body that is achieved by entraining the human sensorimotor apparatus to these variables.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


In the Italian Neonatal intensive care Units the positioning of Peripherally Inserted Central Catheters (PICC) is strictly a medical competence, neonatal nurses are the ones fully entrusted of the PICCsmanagement. In 2014 a group of neonatologists and nurses established at the Civil Hospital in Brescia a PICC group; the aim was to review and update the internal procedures but, also to ponder the idea of training nurses to place PICCs. Many were the reasons for this last consideration; to improve the quality and safety of neonatal critical care, to standardize the procedures to reduce errors and complications but also to make neonatal nurses fully aware of their role in PICCs correct management. A course was organized in two phases (lessons and practice) with the aim to provide participants with the knowledge and skills to safely position and manage PICCs. A careful work of review of national and international scientific literature regarding PICCs was carried out, the NICU procedures were updated prior the course onset . All the


Studies are now needed to determine the signals involved in the regulation of the functional programing of immune cells in early life and to define how these signals could be targeted to protect against infectious diseases as well as chronic inflammatory disorders. The objective of the Research Topic is to provide an overview of the current state of knowledge of the ontogeny of the immune system and of the pathogenesis of important infectious and inflammatory diseases in early life. Four themes emerged from the excellent contributions that have been assembled here.Understanding the ontogeny of the human immune system is a prerequisite to developing efficient and safe interventions aimed at providing long-term protection against infectious pathogens or inflammatory disorders originating early in life. The immune system of the fetus and the newborn infant had long been considered as “immature.” This insight is based on the observation that infectious diseases are often more severe or more prolonged in early life. However, studies performed in the 80s have shown that cells involved in innate immune responses develop as early as the fourth week of gestation in humans and that mature fetal T and B lymphocytes can be detected by the end of the first trimester of gestation already. More recent evidence indicates that fetal precursors are at the origin of adult tissue-resident macrophages. In addition, studies of immune responses to alloantigens and pathogens in utero and an adult system predominating later in life  campaign  and the The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


We have known for many decades that lead exposure in children causes long-lasting cognitive dysfunction . A greatThe removal of lead from gasoline and paint was one of the great successes of the environmental health movement , and leaNew England Journal of Medicine  clear of toxics pales in comparison to the cost of our impaired brain and health function over the decades to come. It is quite short-sighted to say that we cannot afford to maintain our infrastructure and environment, when in fact we cannot afford not to do so. Can we learn the lesson of Flint and come clean with our environment? Lead intoxication during development causes cognitive impairment. However, even those of us older folks who grew up in the era of higher lead levels should be able to learn the lesson of Flint and develop cleaner solutions for the drinking water of our children.


Rib stress injury is the development of pain due to bone oedema caused by overload along the rib shaft and is commonly seen in rowers ,2. At thA detailed literature search was conducted reviewing the diagnosis and management of rib stress injury. Detailed discussions between the authors and the rest of the Great Britain rowing medical team took place to highlight the key issues in treating rib stress injury. An up-to-date and evidence based approach to managing rib stress injury was created using both expert knowledge and the current literature.The outcome from the expert meetings and literature review was the creation of a new guideline for management of rib stress injuries. The guideline was created to be user friendly, informative and logical and to direct the reader through diagnosis, investigations and management of rib stress injury. A separate section is included in the guidance which helps identify both intrinsic and extrinsic factors that may predispose to injury. The guideline has deliberately been kept to two pages long so as not to overwhelm the reader or complicate the guidance.A new clinical guideline for management of rib stress injuries has been developed to facilitate clinicians and in identifying rib stress injury and aid accurate diagnosis and management. This guideline is to be disseminated to clinicians, rowing coaches and clubs throughout the UK.


Critical Care, we read with interest the article by Blankman and colleagues [In the previous issue of lleagues , who stuOne of the EIT measures used to characterize ventilation distribution is the center of ventilation (COV), first introduced in . The autIt is important for the understanding of EIT findings to appreciate that Figure one  does notEIT is currently at an important stage of its development. Its clinical use might be fostered by implementation of accurate analysis tools.


As two of the authors are employed by Bode Chemie GmbH, a competing company of the French companies that manufactured the ABHR tested, there are real competing interests as mentioned at the end of the paper. We want to underscore also that this kind of paper is able to discredit some widely used products, represents a threat to hand hygiene promotion and the confidence in disinfectants if it is misunderstood and misused.We read with interest but also with some astonishment the paper of Kampf et al. comparina want to remind that independent testing of disinfectants is an important criterion to select active from non- active substances and therefore an essential instrument for quality assurance for disinfectants. To guarantee the activity and reliability under practical conditions the education of healthcare workers in the application of efficient hand disinfectants is a key point. The role of hospital hygiene societies is to promote efficient hand rub use for better hand hygiene in healthcare settings. In 2010, the SFHH choose to end the positive list and begin the writing of guidelines to help healthcare settings to choose disinfectants. The SFHH (now named SF2H) never claimed to be able to control completely the validity of the tests performed and always reminded the readers that the manufacturers and the laboratories that tested the products were responsible for the results of the efficacy tests. On the contrary of Germany, the French Society for Hospital Hygiene do not evaluated on its own responsibility the efficacy of the products. The analyses of the test reports provided by the manufacturer were free and independent. We think that the French positive list has had a positive impact to promote handrub use and despite its limitations permitted to select adequate products for use in healthcare settings [As for some other controversial papers about the efficacy of ABHR -4 the Frsettings . These eet al. to improve the validity of products and efficacy claims. We agree with the fulfilling of European pertinent norms and with the necessity to revise regularly the European norms to take into account the observed bias as for example the type of columns in the virucidal test. A better public control of norms and biocide authorizations is needed notably because of the increasing number of news ABHR products.To come back to scientific purpose, this study suggests that the norm methods to test ABHR efficacy must be improved for better standardization, but we don’t agree with all priorities proposed by Kampf aThe Association for Applied Hygiene is an Association of different German Societies for Hygiene including the German Society for Hospital Hygiene.


In order to understand the physiology of the neonatal heart, one must have an understanding of both the fetal circulation and the cardiac function of the adult heart. Transitional changes occur in the neonatal period, where the function of one ventricle has important effects on the function of the contralateral ventricle . In the Giovanni Biglino and Adelaide De Vecchi have organized a research topic entitled “Ventricular mechanics in congenital heart disease” in order to increase the current knowledge on the physiology of the neonatal and infant heart, particularly in relationship to the coupling of the ventricular function with the systemic and pulmonary resistance. This research topic will concentrate on myocardial function in complex congenital heart defects, including conditions with a morphologic right ventricle sustaining the systemic circulation and hearts with functionally a single ventricle.Biglino et al.). This research topic will be of particular interest to those who involved in the treatment of complex congenital heart defects.The ventricular interactions in the presence of congenital heart defects have been primarily investigated for the past few decades using ultrasound and radioisotopes . This reResearch articles stimulated by this research topic will improve the understanding of the ventricular function in congenital heart defects and will facilitate the decision-making process related to the timing and type of intervention.An improved knowledge of the degree of myocardial dysfunction as a result of ventricular pressure and/or volume overload due to the presence of cardiac malformations should result in improved comprehensive management strategies for each type of congenital heart defect.The author confirms being the sole contributor of this work and approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The Opioid Treatment Accreditation Course (OTAC) is a mandatory accreditation requirement in New South Wales, Australia, and aims to prepare medical practitioners for the provision of safe and effective Opioid Substitution Treatment to people with opioid dependence. The course has a strong focus on safe prescribing practices and the course design includes a Professional Practice Forum that is engaging for participants and effective at imparting complex ideas and concepts that do not place additional time constraints on already time-poor health professionals.The study aimed to use participatory action research methods to develop and evaluate an online Professional Practice Forum that is a key component of the OTAC teaching and learning experience.Three evaluation cycles were implemented with three cohorts of participants (N=40) to inform the design and review of the updated OTAC course. Overall, the study relied on participatory action research methods to enhance a sense of online community and to revise the Professional Practice Forum component of the course. Findings from survey feedback and an examination of Web metrics were used to monitor participant learning and were subsequently subject to thematic analysis in order to identify key themes.The use of participatory action techniques in the redesign of the OTAC course was a successful means of engaging with participants and resulted in four revisions based on feedback from facilitators and participants. The Professional Practice Forum was rated highly and received positive feedback from both moderators and participants.The use of interactive forums in online learning in an educational module for adult learners can prove extremely valuable as a means for participants to share their expertise and improve their learning outcomes. In particular, the use of sticky and welcome threads were significant features that enhanced interactions between participants and facilitators and resulted in increased quantity and quality of postings. These findings can help inform future researchers on how to develop peer engagement modules that are amenable to assessment and that build an online sense of community. Over the last decade, there has been increasing demand for continuing medical education programs that enhance the clinical skills and knowledge of medical specialists and general practitioners ,2. This The use of online forums and peer-to-peer learning approaches are now commonplace in e-learning because of their capacity to engage participants and to promote interactive learning environments ,10. In aNevertheless, the literature identifies high rates of attrition from online courses and that educators need to ensure the online environment is engaging and promotes a sense of community between participants . AlthougThe treatment of opioid dependence is often challenging for medical practitioners and prescribing opioids in NSW occurs within a regulatory framework that requires clinicians to have approval from the NSW Health Department to prescribe to each patient . The OTAThe OTAC course primarily targets general practitioners, who are already heavily targeted for continuing medical education, much of which is online. Hence, medical practitioners have high expectations in relation to the quality of online materials and are well placed as informants for the design and application of online learning programs . In 2011Providing participants with opportunities to consult experts and collaborate with their peers was seen as instrumental in exploring their attitudes to prescribing and in developing support and knowledge networks that could be sustained subsequent to their participation in the course. Hence, the updated OTAC consisted of three modules that allowed participants to be self-directed in attaining their learning objectives over the 4-week course duration and a Professional Practice Forum (the third module) that was a mandatory component for satisfactory course completion. This forum was designed to enable participants to be assessed by experienced prescribers (referred to as facilitators) to ensure they had achieved key learning outcomes and to allow participants an opportunity to reflect on and demonstrate the knowledge they had acquired.The forum provided a platform for participants to collaborate and to reflect on their learning in an online community environment. Two experienced facilitators were recruited to moderate the forum and to formatively assess the extent to which participants had developed their knowledge and skills in line with the core learning principles of the wider course. Given the challenges involved in recruiting busy practitioners for lengthy periods of time, participants were only required to interact with peers and moderators for a maximum of 4 hours. The forum was a largely asynchronous activity, and this allowed participants to access the discussion at a time of their convenience. The forum was made available for a 4-week period and participants had a 5-day period in which they could interact with, and be assessed by, the moderators.This paper reports on the modification and evaluation of the Professional Practice Forum designed to increase the knowledge and confidence of medical practitioners to become accredited prescribers in the OTAC program. In addition to reviewing and redesigning the course, the study used participatory action research (PAR) approaches in order to identify the salient factors for sustaining an online collaborative network in the field of opioid substitution. The study hypothesized that the use of PAR to design the Professional Practice Forum would enhance the learning experience and retention of participants in the course. PAR has been described as a collective and self-reflective inquiry that researchers and participants undertake in order to understand and improve on the practices in which they participate and the situations in which they find themselves . In the The current study involved three evaluation cycles of the OTAC with three cohorts of participants (N=40) and two facilitators who were also accredited and experienced prescribers. Participants were recruited primarily via email mail-out of course flyers, but some promotion was done via phone. Process and impact evaluations were undertaken after each of the three course iterations. In particular, observational techniques were used to assess processes such as peer interaction and the use of online resources. Analysis of website metrics was also undertaken, including the time that elapsed between the commencement of the forum module and when participants posted their first response. Interactions on the Professional Practice Forum were observed and recorded by the course coordinator in order to review the extent of interaction between participants and between participants and facilitators. Outcome measures were assessed using self-report surveys that asked participants to rate their learning experiences and to comment on their online sense of community. Permission to conduct this study was received from the University of Sydney’s Human Research and Ethics Committee.The Professional Practice Forum was piloted during 2011. At the completion of the first two modules, all participants were emailed by the course coordinator and invited to submit a short scenario to the forum that demonstrated their understanding and application of the previous course modules. In addition, participants were asked to comment on the scenarios of at least 2 peers in order to foster engagement and team problem solving. Subsequent to their completion of the OTAC, participants were asked to respond to an evaluation on their experiences with the forum via an online survey. The survey measured their interest in the Professional Practice Forum format as well as the ease of use and any changes they would recommend. In addition, the forum facilitators were asked to provide feedback on the challenges and benefits of the forum in relation to its utility and how effective it was for enhancing participant knowledge and confidence.The findings from the pilot study informed revisions to the Professional Practice Forum and the revised OTAC was subsequently implemented with (N=13) participants. This iteration of the course included four “sticky” threads that linked to exemplars of case scenarios, and participants were invited to respond to at least one scenario prior to submitting their own case studies. All other evaluation methods were consistent with the pilot study. A final iteration of the OTAC course was developed and tested in mid-2011 (N=13) This version of the course included a welcome thread that provided participants with an opportunity to access information on the backgrounds and expertise of course facilitators and to post their own biographical information. In addition, a feedback thread was included to enable an accessible and ongoing evaluation tool for future OTAC participants.Overall, the study used PAR methods to identify strategies for creating a sense of community and to revise the Professional Practice Forum. Feedback from each of the three course iterations was subject to thematic analysis that was undertaken until saturation was reached and clear themes emerged. See A total of 40 participants completed all aspects of the OTAC and provided process and impact feedback. Course participants included 14 general practitioners, 6 registrars, 1 psychiatrist, and 2 chief medical officers; 15 participants indicated they were from rural and regional NSW and the remainder were based in urban centers. Findings that emerged from the feedback (surveys and Web metrics) demonstrate that the use of participatory action techniques in the re-design of the OTAC program was a successful means of engaging with participants and resulted in four revisions based on feedback from both facilitators and participants.In the pilot OTAC, the open-interfaced design of the Professional Practice Forum appeared to discourage participants from making initial posts, which meant the course coordinator had to repeatedly email instructions and reminders to participants. The inclusion of four “sticky” threads in the second iteration of the course reduced the time participants took between commencing the course and posting their first discussion thread. It also allowed more discussion time for moderators and participants and a longer timeframe for peer interaction. In addition, the guidance provided by the sticky cases resulted in more pertinent responses and content between participants as well as lengthier posts that contained more detailed information about treatment options and management.Feedback from facilitators’ observations of the Professional Practice forum indicated that some participants remained hesitant about fully engaging with their peers. This resulted in a third iteration of the OTAC that included a welcome thread. Participants reported that this had a notable impact on their engagement and sense of online community, which was demonstrated by their increased number of posts as well as the frequency and depth of their interactions with each other. The welcome thread allowed participants to introduce themselves and build rapport with their peers. As one participant stated, “I enjoyed this component and it was interesting to see the various challenges that all clinicians have at their point of treatment or engagement”.Overall, participants reported that they enjoyed the OTAC course and that it resulted in improved knowledge about prescribing and managing people with opioid dependence. In particular, they enjoyed the opportunity of engaging with facilitators who had extensive experience in the field. As one participant stated, “It is an excellent teaching session, I learned a lot from seniors”. Nevertheless, facilitators did report that their engagement with and observations of the Professional Practice Forum were time consuming and that some participants required considerable encouragement to complete all forum activities. The use of PAR methods resulted in three changes to the OTAC and provided important information on the factors that enabled participation in the forum.The re-design of the OTAC Professional Practice Forum was informed by literature on autonomous learning ,2 and coAt the same time, facilitators reported challenges in facilitating the forum, particularly in relation to the administration burden of following up with participants in the first two iterations of the OTAC. Previously, participants had a tendency to post only what was required and to post directly to facilitators, without drawing on the expertise of their peers. The fact that participants increased their engagement with each other in the final OTAC demonstrates that when they are able to familiarize themselves with each other and when they are provided with exemplars of the work that is required, they are much more likely to actively contribute to the forum.Another challenge with the creation of online forums is ensuring that participants post enough detail in their responses to make them amenable to both formative and summative assessment processes. The incorporation of the four sticky cases into the Professional Practice Forum after the initial pilot was an effective tool for encouraging participants to post comments on the forum with sufficiently detailed responses. This allowed facilitators to more accurately assess participant knowledge and meant there was more time for them to interact with participants and to request additional information. In the first iteration of the OTAC, participants were disinclined to post to the forum and this challenge is consistent with the literature that identifies participant engagement as a significant challenge in online learning .In subsequent revisions of the OTAC that used guided and exemplar cases, participants were observed to make earlier postings and provided more detailed answers, which were noticeably longer and contained more detailed information on patient history and other diagnostic criteria. This demonstrated their depth of knowledge in regard to symptoms, treatment planning, and management. In the final revision of the Professional Practice Forum, the inclusion of a welcome thread had a noticeable impact on peer interaction. The use of the welcome thread provided participants with immediate access to the Professional Practice Forum and enhanced the growth of an online community. This highlights the importance of encouraging early online interaction between participants and recognizing that learning is also a social process. This is consistent with learner- and community-centered approaches to teaching and learning that emphasize the importance of building on participant knowledge, providing and receiving feedback, and self-evaluation.Several limitations to the current study must be acknowledged. The use of purposive sampling and the diverse discipline backgrounds of participants means that the findings are not generalizable and further dissemination and evaluation of the OTAC course is warranted. In particular, future evaluations of the course should include follow-up information on whether participants go on to become active prescribers. At the same time, the sample was sufficient for the development and piloting of the Professional Practice Forum. The reliance on qualitative feedback from participants is another limitation, and the use of validated measures for online sense of community would be beneficial for quantifying the sense of connection between and within participants and facilitators. Furthermore, future evaluations of OTAC should include long-term follow-up with participants to ascertain if changes in their knowledge are sustained.The use of PAR methods did, however, provide rich feedback on modifications that were required of the OTAC and resulted in an increased number and quality of interactions in the Professional Practice Forum. Given that the study aimed to build and sustain an online learning community and to enhance retention of busy clinicians, the methods used were adequate for the pilot implementation and refinement of the OTAC.The challenges of developing and sustaining a sense of community in online learning environments are well documented in the literature. However the literature has a particular focus on strategies for enhancing the sense of connection between participants and facilitators. There is still limited research on how to generate peer-to-peer interactions and harness them as a vehicle for developing and implementing online forums. The findings from this study contribute to better understanding of the factors that encourage peer-to-peer learning.Peer-to-peer engagement in an educational module for adult learners can prove extremely valuable as a means for participants to share their expertise and improve their learning outcomes. The use of a forum module allowed the course designers to use both formative and summative assessment and evaluation processes. Given the relatively small number of participants, however, it is important that the OTAC is tested with a larger cohort of participants to further explore its utility across different geographical contexts where the use of online education may be less familiar. The use of participatory action approaches in the conduct of the current study was highly effective for allowing participants to engage actively in the construction of the Professional Practice Forum.


Discuss presentation and assessment of pain syndromes, including CRPS2. Present the bio - psychosocial model of management for these complex patients3. Provide a review of different approaches to the therapy managementPain syndromes often provide the clinician with the most complex challenges in understanding the condition as well as working out the maintaining factors and therefore how to support these patients back to function and recovery. These young people are often very disabled by these conditions and struggle to function in all aspects of their life including school and socially. The bio-psychosocial model of management involving all aspects of their life is the most successful and this often requires an effective multidisciplinary team in order for the outcome to be effective. The most important aspects of treatment are for the clinicians to be clear about the diagnosis and to stop investigations looking for a cause. Secondly the child and family need to realise that the most effective approach is based on 'active participation' in all aspects of the therapy with the goal being self-management and participation in all aspects of life fully.Treatment should focus upon the young person completing exercises in order to regain movement, strength and stamina resulting in increased function. Work with desensitisation is also important, but not alone from regaining movement and strength. Learning specific pain management techniques, active relaxation and how to pace activities is also important. It is important to focus on solutions, recovery and independent self -management rather than causes as this can prevent recovery. Reintegration into normal activity is important and school attendance should be prioritised followed by returning to sport and other physical activities. The outcomes of effective management is very positive in young people providing they engage with the understanding that they are the solution to the management of the pain.None declared.


Molecular phenotypes are important phenotypes that informs about genetic and environmental effects on cellular state. The elucidation of the genetics of gene expression and other cellular phenotypes are highly informative of the impact of genetic variants in the cell and the subsequent consequences in the organism. In this talk, I will discuss recent advances in three key areas of the analysis of the genomics of gene expression and cellular phenotypes in human populations and multiple tissues and how this assists in the interpretation of regulatory networks and human disease variants. I will also discuss how the recent advances in next generation sequencing and functional genomics are bringing closer our hopes for personalized medicine.


The foundations of synthetic biology rely on the concept that all living systems are constituted by functional and structural modules that could be rationally engineered to build organisms that are not easily generated by evolution. However, the cellular complexity and metabolic diversity found in organisms present both a significant challenge and opportunity to foster this interdisciplinary scientific area. Secondary metabolism is a group of biological processes which are dispensable for cell growth. In microorganisms such as fungi and filamentous bacteria, secondary metabolism is an important source of biologically active compounds , constituting a pool of novel metabolites waiting to be mined and characterized. Within this context, the article described rational strategies and tools to be used in the development of chassis structures for the heterologous expression of biosynthetic gene clusters in filamentous bacteria. Finally, the topic also includes an article by Gimpel et al. which discusses the strategies for rational metabolic engineering of microalgae, a very promising tool for the production of several products including biofuels, carotenoids, and bio-hydrogen.Several practical applications of synthetic biology principles were discussed by We hope that this research topic will be interesting and useful to the general audience of Frontiers in Microbiology journal, and that the treated topics act as crystallization nuclei for new ideas and future applications of the principles of synthetic biology to the design of new secondary metabolites with improved biological activities.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


This set of class lecture notes provides a good list and description of widely used methods for controlling microbial populations in water, foods and on surfaces.This class site gives a general overview of microbial control methods.This online textbook covers all of the standard methods for killing and controlling microbes.Chlorine is one of the standard methods for water disinfection, and this Web brochure provides excellent information on how chlorine works and details of its spectrum of action.This commercial site provides links to information on many different types of water disinfection, comparing and contrasting different methods.This patent relates to a method of enzymatically removing cyanuric acid from waters in which it builds up as a disinfection by-product and diminishes the disinfecting action of chlorine (hypochlorite).Biocides are very important in the oil and gas industry to prevent fouling and souring of gas (reduction of sulfate to hydrogen sulfide). This is especially important with the advent of hydraulic fracturing in which large amounts of water are injected into shale for producing oil and gas.There are many ways to prepare surfaces to prevent the adherence and growth of microorganisms. A new field of study in this area is on the surface nanotopography of natural surfaces that are antibacterial, and this is addressed in the review article.This website deals with a large number of antimicrobial surfaces with a major focus on the types of materials employed.Environmental Science and Technology that suggests some bacteria become dormant upon treatment with ozone and can subsequently revive and proliferate.This news article refers to a paper published in This report contains much detail and describes the balance between introducing chemicals into water to kill bacteria but simultaneously avoiding chemical production of disinfection by-products that are injurious to human health.The chlorine that is used to kill bacteria, viruses and protozoa can also react with chemicals introduced into pools by humans; for example, the insect repellent DEET  can react to make potentially harmful products.With the advent of microbiome studies, some are considering that the skin is best cleaned by adding microbes rather than deleting them, and products are emerging to introduce desirable microbes onto the skin.As discussed in this wiki, wastewater treatment is largely a microbial process, but it is desirable to kill off dangerous bacteria and viruses.This Wikipedia entry deals with the use of bacteriophages to kill off bacteria that are involved in causing human infections.This news article discusses the use of specific bacteriophages to treat specific bacterial infections.This review deals with the use of copper on surfaces to kill bacteria. This is used in clinical, household and business settings.


HIV/AIDS has systematically permeated the entire Nigerian social fabric, affecting males and females in both urban and rural areas, as well as adolescent young people.This paper presents findings from an evaluation of a HIV prevention program designed to determine the effects of HIV prevention intervention (HPI) on in school youths in AMAM Local Government Area Abuja Nigeria.Data were collected from 75 trained peer educators from three Schools in AMAC Local Government Area FCT Abuja Nigeria and also 100 in school youths who were not trained. Data were also collected at the beginning and end of the intervention among 950 in school youths that were reached with peer education in three Schools and also among other 1100 in school youths from three other schools that were not reached with the program using qualitative and quantitative research methods.The findings revealed that the programme had several positive effects on the students such as increase in knowledge of HIV/AIDS, adoption of preventive behavior and acquisition of life skills. The quantitative data shows the knowledge of the respondents have increased by 71% at the end of the intervention and the result also shows that the students trained as peer educators have higher knowledge of HIV prevention and life skills than those who were not trained.The quantitative and qualitative data show that the project has produced several positive multiplier effects on the knowledge and behavior of youths. The findings also show It is necessary to focus on young people because they are at the center of the HIV/AIDS epidemic. The project shows that Peer education is one of the best approaches to providing comprehensive knowledge on HIV/AIDS/STIs and related issues, as it provide an excellent environment for effective peer-to-peer learning.None declared.


The prevalence of obesity in the Hispanic preschool population remains elevated, particularly among children in low income families below the poverty level. Obesity leads to the early onset of metabolic syndrome and Type 2 diabetes. The Head Start population of Texas is largely comprised of this high risk group. Their physical activity level is suboptimal in part due to lack of available outside play areas and time spent watching television and playing sedentary video games. Dietary intake is frequently high in sugar sweetened beverages and low in vegetables. The group is frequently bilingual with limited vocabulary and has not learned to read. Preserving their Mexican American culture is a concern. This article describes the development and assessment of a group of bilingual interactive video interventions to improve age appropriate physical activity while providing basic nutrition education focusing on increasing vegetable and water intake and decreasing sugar sweetened beverages. Suggestions for development and assessment of content were provided by focus groups of Head Start teachers, managers and dietitians in the Texas counties of Bastrop, Hidalgo and McLennon. A demonstration of the videos was conducted in Bastrop County. Teachers, students and managers felt that the videos provided excellent information, improved exercise participation and engaged the children. Dietaryet al. . The dieet al. .Targeting both the exercise and nutritional aspects of the problem of obesity early on, when children are establishing their eating and exercise patterns, is important. Head Start is a United States government funded locally operated preschool program providing basic education for children of low income families. Most of the children are from 3–5 years of age. The Head Start setting is ideally structured to provide both exercise and nutrition education options that are participatory, age appropriate, and culturally relevant. The purpose of this article is to describe the development and evaluation of a bilingual interactive video providing exercise and nutrition education for a Head Start population. The video combining nutrition education with exercise is novel. It is a link to our previous nutritional intervention allowing a review of the most important aspects of the previous nutritional education during exercise and allows the children to discuss nutrition during their rest breaks in the video so there is continuing focus on healthy living being a combination of nutrition and exercise. The objectives of the nutrition education portion are to decrease the consumption of sugar containing beverages, and increase fruit, vegetable, water and milk intake. The nutrition education section of the video builds on the bilingual pictorial nutrition “bingo” game described previously in this journal  and usedThe Spanish dialog for the audio portions of the discs was translated and approved by the director of the Scott & White Spanish interpreter service and read by the interpreters and English dialog was approved and read by the author. The Scott & White audio division recorded the sound tracks. There is also one audio only exercise using dogs, to test comprehension without the visual stimulus. Both the video and audio discs may be used with computerized exercise pads that record the amount and level of exercise of the child using the pad. These are sent to a computer program which stores the information so that a comparison can be made for the group at the beginning and end of the study. The dance pads can also be used to look at individual performance. The pad has lights that flash when the child moves. The lights in the pads also provide motivation for the children to increase their participation. This exercise pad is shown in The project was approved by the Scott and White Institutional Review Board. The teachers and managers who formed the focus groups were >75 % Hispanic and fluent in English and Spanish. The focus groups lasted an average of 1–2 h. The concept of the videos was initially discussed with 25 managers and teachers and the dietitian of the Bastrop County Head Start and 10 teachers and the manager of Hidalgo County Head Start who formed the first focus groups for development of the interactive video. The first video was demonstrated for the Bastrop and McLennon County focus groups consisting of teachers and managers and teachers aids. Each group contained 30–40 people and was tasked with testing the usability of the game for the preschool population. The first pilot video was then tested with 20 Head Start children from Bastrop county where their teachers and audiovisual assistant, as well as a representative from the Nanohmics corporation, and the author were present to assess the reaction of the children who were the target audience and identify technical problems. The group felt that the teachers were able to adequately evaluate the response of the children. They work with the same group of children for long periods of time and get to know them well. Revisions were made and the final focus group was from Bastrop County consisting of a manager and two teachers and the audiovisual assistant to evaluate the games for ease of incorporation into the Head Start educational day.et al. for the development of games for behavioral change: concept development, demonstration of usability, use with the target audience, and identifying technical problems [The focus groups were set up to follow the steps suggested by Barnowski problems . The resThe videos were well received and it was felt that they would be useful for classroom teaching particularly on days when outdoor play was not possible. As a result of the demonstration pilot, the dance pads were reconfigured with shorter cables and simplified connections.Although the children were not surveyed, we felt that the teachers were able to adequately evaluate the response of the children. They work with the same group of children for long periods of time and get to know them well. The teachers reported that the children were not only attentive but were more active than in their usual play and added their own movements to those of the animals. They looked forward to the video interaction.The study population is at risk for not only obesity, but the hypertension, diabetes, metabolic syndrome that are consequences of excess weight. If they are obese in childhood, they are likely to become obese adults. The economic status of their families increases the risk further. Preschool is an ideal time to intervene to prevent obesity since at this age they are developing their food and exercise preferences . The chiet al. reviewed nutritional interventions some coupled with physical activity [et al. reviewed preschool based obesity prevention interventions including games based interventions [et al.: five of the studies featured health education games, two focused on both nutrition and physical activity and two contained narratives. In the younger age group although most of the studies showed an increase in physical activity the change in obesity related outcomes such as BMI was only partially significant in one study or not significant in three studies [et al. reviewed school based obesity interventions primarily in low income elementary schools in the United States. Nutritional education and increased physical activity were emphasized [Games are an accepted format for interventions to promote nutrition and physical activity for both obesity prevention and intervention. Educational, informational games reinforce health eating principles that will hopefully provide skills to improve future food choices. Likewise, exercise instruction as an interactive game can allow children to learn that exercise should be a part of everyday. Games are an accepted format for obesity prevention and intervention and recently interactive games and some with video components for the preschool population have been reviewed. Mikkelsen activity . Most weactivity . Nixon eventions . The conventions . Health  studies . Ickes ephasized . Five ofphasized . Althouget al. for the development of school based obesity interventions [et al. [The interactive game in this study developed for the Head Start groups incorporates the recommendations of Ickes ventions : it is t [et al. . The focPresently, partners in Head Start areas are being sought to use the game. Parental involvement is critical if long term changes are to be achieved. When the educational intervention is put in place at a Head Start center, the parents are invited to participate. Parents periodically attend education programs about Head Start activities. When the nutrition game  was implThe problem of obesity in preschool children is significant and this study describes an engaging educational video which is satisfactory as judged by the teachers and fun for the children. Hopefully, some interested partners can be found in the future to conduct a larger scale study.


The neural network that contributes to the suffering which accompanies persistent pain states involves a number of brain regions. Of primary interest is the contribution of the cingulate cortex in processing the affective component of pain. The purpose of this review is to summarize recent data obtained using novel behavioral paradigms in animals based on measuring escape and/or avoidance of a noxious stimulus. These paradigms have successfully been used to study the nature of the neuroanatomical and neurochemical contributions of the anterior cingulate cortex (ACC) to higher order pain processing in rodents. In 1968, Melzack and Casey , this crThe neuromatrix theory of pain Melzack, , 2005 inreflexive behavioral response to acute noxious stimulation. Indeed, activation of various subcortical, brainstem, and spinal cord systems produce antinociception as revealed by an increase in the threshold or latency to respond to noxious stimulation. In these studies, it is assumed that manipulations of limbic system structures alter pain processing through selective modulation of pain affect  has been shown to be sensitive to pharmacological treatments such that manipulations which decrease mechanical hypersensitivity  also decrease escape/avoidance behavior . Research investigating this system indicates that activation of the ACC might recruit the pain suppression system at the level of the PAG. Indeed, focal brain stimulation of the ACC has been shown to inhibit the response of dorsal horn neurons to mechanical stimulation Figure , althougThis work suggests that one possible mechanism of action by which the ACC selectively modulates pain affect is via the mu-opioid receptor system. This idea is based on the evidence that the ACC has a high density of opioid receptors (Lewis et al., Clinically, early research indicated that cingulotomies or cingulectomies have a minimal impact on intelligence (Foltz and White, Given the reduction in aversion behavior produced by manipulations of the ACC, we have proposed that the effect of ACC lesions on tests of learning and memory most likely reflect a reduced affective response to noxious footshock, a stimulus commonly used to examine learning and memory in rodents. Bilateral cingulate cortex aspiration in rats significantly impairs the acquisition of a two-way conditioned avoidance behavioral response to noxious footshock Peretz, . Rats wiActivation of the ACC by electrical stimulation has been shown to reduce the aversive quality of tactile stimulation to the allodynic hindpaw in the PEAP. It is speculated that ACC stimulation produces its effects by inhibiting normal activity within a system that we (LaBuda and Fuchs, An understanding of pain in the context of higher order cognitive processing has been suggested to provide a framework for the comparative assessment of anatomy, physiology and behavior Allen, . The recRelated to these ideas of learning are questions currently unanswered regarding the role pain may have in motivational drives. Humans suffering from chronic pain experience a multitude of personal issues (Gatchel et al., Future research will no doubt address these questions and also add to our understanding of the cellular changes occurring in the ACC and how these changes impact the pain neuromatrix. Previous research had indicated that painful stimuli can lead to increases in NMDA receptors in the ACC and that these increases are related to the formation of formalin-induced conditioned place avoidance (Lei et al., The goal of translational research is ultimately to use what is learned from basic research to improve the health and wellbeing of society. One recent advancement is that of optogenetics, a technique which allows for the expression of light-sensitive proteins in selected neurons through either breeding genetically modified rodents or the use of a viral vector in developed subjects. Early work in this field has demonstrated that this experimental technique can be used to activate or deactivate affected specific neurons simply by exposing the tissue to a specific frequency of blue light. Researchers examining the memory formation in the hippocampus reported that optogenetic inactivation of the ACC impaired fear memory recall in mice (Goshen et al., The most parsimonious explanation of the behavioral studies in rodents is that the ACC is involved in the modulation and processing of pain affect, and that manipulations of the ACC alter the affective component of pain processing. Of primary interest is that recent behavioral paradigms in animals have measured escape and/or avoidance of a noxious stimulus, assuming that escape/avoidance behavior is evidence that animals find the noxious stimulus aversive. These paradigms have successfully been used to study the nature of the neuroanatomical and neurochemical mechanisms that underlie the processing of higher order pain processing in rodents and have strongly implicated the ACC as a critical brain structure.One very important outcome of the recent findings is the indication that it is inappropriate to examine the role of the ACC in nociceptive processing in animals by relying on measures of reflexive behavior as a means to examine the aversive nature of persistent pain conditions. Experiments using only quantified mechanical thresholds or acute formalin injection behaviors can lead to the erroneous conclusion that the ACC does not affect supraspinal pain processing. Clearly, functional alterations of the ACC by lesion and neurochemical methods reduce the avoidance of noxious mechanical hindpaw stimulation as measured using the PEAP and formalin conditioned place avoidance paradigm. Sensory mechanisms of pain processing are clearly important but fail to highlight the mechanisms underlying the affect that accompanies many persistent pain conditions. Clinically, the sensation of pain can be treated by reducing the sensory input as well as by manipulating affective-motivational and cognitive factors (Melzack and Casey, All authors conceptualized the manuscript and were involved in the writing and editing the document.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


In the original manuscript, an affiliation for Jyoti Dubey as Manipal University was missing. In addition we would prefer to write expanded name of InStem as Institute for Stem Cell Biology and Regenerative Medicine. This correction does not affect scientific integrity of the review.All authors listed, have made substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Strategies to prevent nosocomial infections and the spreading of multi drug resistant organisms (MDRO) are broadly discussed in the context of hospital care. But MDRO do not only affect hospitals, but also a variety of other health care institutions and medical professions.The conference of German health ministers recommended in 2006 to form regional networks led by the local public health authorities. The aim of these networks was to address all parties involved in the management of MDRO and to promote the implementation of existing guidelines on prevention and infection control measures.In Bavaria the Ministry of Health initiated in cooperation with the Bavarian Health and Food Safety Authority a two-fold strategy to meet this recommendation. In a first step the Bavarian State Working Group on Antibiotic Resistant Pathogens (LARE) was established in 2008. In a second approach the Bavarian Ministry of Health requested the local public health offices to form networks with all relevant professions and institutions at the regional level.Almost all health care associations at the state level participate in this network and strive to implement consistent strategies in the battle against MDRO. Subordinate working groups have successfully prepared and published information for the management of patients with resistant bacteria in the area of occupational health and safety as well as in hospitals and rehabilitation clinics, for patient transportation and in general practice or at home. The annual LARE meetings are well attended by health care workers of all relevant professions. Twice a year the representatives of the participating associations and Bavarian experts get together to discuss actual topics and to consent new publications.The established networks at the regional as well as at the state level have led to marked improvements in the communication and collaboration between participating relevant institutions, organisations and various groups of medical professions. However, the challenges for the LARE and the regional networks still stay diverse and will continue in the future.None declared.


ExAblate Neuro is the only technology that enables clinical treatment of transcranial MR guided focused ultrasound. It is CE approved for the treatment of certain neurological disorders and is under evaluation for additional regulatory approval.We will review the existing applications and the limitations of the current technology. Two of the key limitations are the treatment envelope and the effects of different skull on the effectiveness of the transcranial ultrasound delivery.Expanding the treatment envelope requires to overcome technological barriers. The current clinical experience is limited to anatomical targets that are limited to deep and centralized locations in the brain. This is a significant limitation since there are compelling clinical targets that are located beyond the existing treatment envelope. We will suggest treatment concepts which are being developed to overcome these limitations and enable to extend the treatment envelope.The accumulated clinical experience with transcranial focusing shows as significant variability of the acoustic parameters which are applied during the treatments. It is assumed that the skull is the most significant contributor to this variability due to its non-homogenous and quite variable characteristics. The variability has been studied and found to be correlated with skull density parameters. We will describe how patient selection criteria may be applied to optimize the treatment for different patient selection criteria.


Environmental enrichment has become increasingly utilized in rodent models of aging and neurodegenerative disease in order to prevent or reverse cognitive decline and neuronal dysfunction. However, the potential application of this body of work to human cognitive aging has rarely been discussed. The present article provides an overview of the rodent research that has tested the effects of environmental enrichment on hippocampal and neocortical function, and the types of memories mediated by these brain regions. Although data from models of neurodegenerative disease are presented, primary emphasis is given to studies of aging rodents and to methodological issues  central to the mnemonic effectiveness of enrichment treatment. The implications of this work for human cognitive aging are discussed.


Falls in older people often occur during ambulation, frequently due to trips or slips , they may have excluded some relevant between-group differences by not including the familiarization trials, and hence, startle responses in the analysis which may have influenced the conclusions  of Maastricht University Medical Center and by the NUTRIM School of Nutrition and Translational Research in Metabolism NWO Graduate Programme financially supported by the Netherlands Organisation for Scientific Research.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


An increasing number of Clinical Trial Web Portals now include systems to manage endpoint adjudication. These cover the entire process from the initial identification of potential endpoints, the creation of electronic endpoint packages, and assignment of endpoints to members of the relevant Clinical Endpoint Committee (CEC) to the final adjudication verdict being entered into the system. The number and types of users involved at each stage and the number and size of Endpoint Committees varies across trials, depending on the trial design and requirements of the Sponsor, so the challenge has been to create generic systems that can handle the variations in design.By separating the roles that the system performs from the roles a user may have within a trial the differences in the users that are involved can be dealt with and a generic flow created. Handling differences in the adjudication process, such as how many committee members are initially assigned, what happens if they are not in agreement etc., are more complex but can be mostly overcome. Additional complexity is introduced where the actual processes involved are different or not required at all for a particular trial.We will discuss the different models and technological solutions applied to overcome complex trial specific processes in order to achieve a generic system. Serious gain can now be made with the provision of generic systems that reduce programming effort and training. The use of electronic adjudication also saves a considerable amount of time in determining trial outcomes.


Rick Steele makes a passionate case for a more community-based system of managed health care with the overall goal of decentralization of services and the expectation that this will result in lower costs without lowering of services.Drawing on his long and rich experiences as a practicing physician in Denmark and with public health training in the United States, Rick Steele has a broad perspective on the various forms used for delivery of health care in both Europe and the United States. He finds both positives and inadequacies in the delivery of health care in both continents and makes specific proposals for the development of a managed care system which is responsive to local needs and consists of an amalgamation of health and social services. This proposes that much of managed care delivery be done at the local level, and that this can be accomplished if communities set priorities, work to coordinate service, and promote inter-sector cooperation. He repeatedly emphasizes the problems that result when medical care is not adequately coordinated with social services. The result of failure to integrate health and social services delivery is both increased costs and reduced patient satisfactory and care.Steele provides chapters on staffing and development of a model program with specific suggestions for implementation and evaluation. These are presented with a clear understanding that an optimal system must be responsive to local needs, which will not be the same in every community.This book is a must read for anyone who is concerned about improving health care while at the same time reducing costs.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The spatial information encoded in local elevation of cAMP can be transmitted to downstream components such as MAP-kinases  The production of cAMP is controlled by the expression of multiple adenylyl cyclases within a neuron that integrate signals from different receptor types and channels in a mix and match format (Pieroni et al., The role of the direct binding of cAMP to HCNs and regulating the activity of these channels is particularly relevant for its ability to act as a scaling agent. HCN channels are hyperpolarizing and are activated by a combination of membrane depolarization and cAMP binding. Local changes in cAMP levels in dendrites coupled with differential distribution of HCNs that are localized in the distal dendrites in pyramidal neurons Magee,  can reguFor the relationship between local cAMP levels and the overall electrophysiological response of the neuron to be scalable, the altered excitability of the individual neuron needs to be reflected in the overall electrical behavior of the circuit of which the neuron is a part. At this level there is little experimental data that would allow us to build specific conjectures that one can turn into experimental or computationally testable hypothesis. For this, two classes of data are needed anatomical/physiological connectivity between neurons and biochemical activity in individual cells as part of a functional tissue.The first class of data that is part anatomical and part electrophysiological is being called connectomics. We need to get a first–pass description of the organization of the circuit at the level of individual neurons and their connections. So far this is only known in the worm (Jarrell et al., in vitro such as in brain slices but eventually we are going to need information regarding biochemical activities at the cellular level in vivo. The cAMP network can serve as a prototype for such studies since the cAMP live cell imaging probes that are used in cultured neuron experiments also work in the tissues (Castro et al., The second class of data we need is measurements of biochemical activities in individual cells when cells are part of functional circuitries and how such biochemical activity is related to cellular electrophysiology. Initially such cell-based measurements within tissue may be conducted If the experimental technologies are developed to get connectomics data in the various brain regions and imaging advances allow us to follow biochemical activities of one or a few neurons as they function within tissue, in combination with multielectrode recording of circuits, then we should be able to obtain scalable information of how and when computation within signaling networks are manifested in changes in circuit behavior. Such studies beyond providing fundamental understanding of information processing in the brain may help us understanding ageing as well as pathophysiology induced cognitive decline. A number of components of the cAMP signaling pathways and cAMP regulated genes such as BDNF change with age and such changes are associated with cognitive deficits both in normal ageing and pathophysiology such as Alzheimer's disease (Hansen and Zhang, The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


In Malaysia, biotechnology is identified as one of enablers to accelerate the transformation of the country into knowledge based economy and industrialised country by 2020. Since 2005, the government has established national strategic plans, funding mechanisms and implementation agencies to develop this sector. Aim of this research was to examine the development of this industry and to evaluate the capabilities and resources that can be leveraged to address the local and global health needs while ensuring the economic benefit to the country.Health innovation ecosystem framework was applied and case study approach was used for this research. Quantitative and qualitative information were gathered through intensive literature reviews, face to face interviews, expert group discussions and survey questionnaires. Respondents were selected by convenient sampling method from the public and private health biotechnology related sectors in Malaysia.The findings from this research were summarised into four major points which were: 1) success stories and factors influencing the success in Malaysia context; 2) main features and niche areas of the sector; 3) main challenges and weaknesses of Malaysian health biotechnology sector 4) identification of opportunities and strategic recommendations for the sustainable development of health biotechnology sector in Malaysia.Biotechnology sector is at its infant stage of development due to the remaining challenges and weaknesses in the health innovation system. Thus, enormous work and efforts are needed from various sectors in all aspects to achieve the nation’s 2020 targets. The main priority should be given to the development of the basic or fundamental research areas by adjusting the education system and to provide the necessary skill sets for the sustainable development of this knowledge driven industry.


Germany has participated in this development and recently created the NKLM, which is a catalogue of the learning objectives for medical education [Implementation of CBME requires appropriate alignment of the learning objectives specified in the NKLM with the curriculum, particularly with the instructional methods and assessment strategies. A number of institutions have been experimenting with ways of making the appropriate changes within the resources available. These exciting developments have been driven by enlightened initiatives in association with the German community of medical educators and it has generated a new culture for the academy. Central to CBME is the ability to determine when students have achieved the competencies specified in the NKLM and that requires advances in the way we do assessment. It is in this context that we have assembled the papers for this special issue. One critical feature of this new culture is the increased involvement of the students. An example of this is the article by Wagener et al. that reports the results of student-driven competency-based progress test . Not onlStudents are often concerned about the fairness in their assessment. One area of on-going concern is the great variability in the grades assigned by various examiners. The paper by Schickler et al. demonstrates the importance of rater training . This caThe paper by Tekian and Norcini focuses on setting standards  for examinations . This toAs we go forward, it is important to look to our colleagues worldwide of how to improve assessment. The paper by Berendonk et al. describes the introduction of the clinical skills examination into the national licensing examination . These are only a few of the topics in assessment that are addressed in this special issue. These studies provide the first steps in achieving the goal of implementing CBME based NKLM. As we go into the future, additional progress will require collaboration, networking, and sharing of resources. Assessment is the means for improving the quality of care provided by individual practitioners. The next step is to ensure the quality of the educational programs themselves.The authors declare that they have no competing interests.


Proximal interphalangeal joint fracture dislocations are challenging injuries that can be managed in a wide variety of ways. The fracture dislocations of the PIP joints are classified by their mechanical stability and the percentage of joint involved in the fracture. Fracture dislocations that remain stable with less than 30 degree of flexion of the PIP Joint and those that have less than 20% of the articular surface involvement are generally considered stable and can be treated with extension block splinting.The methods of treatment that will be discussed in this presentation include extension block splinting, traction of various kinds, pinning, and open reduction internal fixation.When the PIP joint is very unstable and the fracture at the base of the middle phalanx so comminuted as to be unreconstructible, the state of the art management method is to use hemi hamate transfer that was described by Hill Hastings. This method of bringing stability to an unstable joint with the use of a unique osteochondral graft has revolutionized the management of PIP fracture dislocations. In this presentation, I will discuss the indications, detailed technique and outcomes of the hemi hamate transfer for fracture dislocations with appropriate case illustrations.


Thermal comfort evaluation based on the Comfort zone diagram is relatively new and promising method  developeeq sensors, the main hardware units for sensor net controlling and data processing, the data interfaces connected to the HVAC control unit and the data visualization unit. The sensors have to be calibrated first to obtain a calibration function that describes the relation between a surface temperature of the sensor and the corresponding equivalent temperature. Another reason for the calibration is the fact that the typical control mode of the sensor is constant heat flux thus the surface temperature of the sensor is a result of surrounding environmental parameters and the Teq cannot be calculated without calibration function/curve.The functional scheme of the proposed sensing system that measures equivalent temperature and links the data from the sensors to thermal comfort is shown in Figure The iHVAC project is now in a phase of hardware and software demonstrator system development. In following two years a phase of integration, calibration and validation with test subjects is planned. The main aim of the project is to demonstrate that the relatively simple measurement system can supply relevant data about local thermal comfort. If the validation is successful then the system will provide useful feedback for the HVAC control unit. We expect more accurate control inputs of the HVAC system regarding the individual passenger needs, as well as resulting in lower energy demands.The research is supported by the project Innovative Control of HVAC as the Part of Driver Assistance System, TA04031094.


The journal is retracting the 29 March 2011 article cited above. Based on information reported after publication, this article was found to contain incorrect data and invalid statistical analyses.The journal and chief editor have therefore decided to retract the article in its entirety and apologize to the readers of Frontiers in Pharmacology.The corresponding author agrees with the retraction of the article and also apologizes to the readers.