Effect of age and care organization on sources of variation in kidney transplant waiting list registration

Despite national guidelines, medical practices and kidney transplant waiting list registration policies may differ from one dialysis/transplant unit to another. Benefit risk assessment variations, especially for elderly patients, have also been described. The aim of this study was to identify sources of variation in early kidney transplant waiting list registration in France. Among 16 842 incident patients during the period 2016–2017, 4386 were registered on the kidney transplant waiting list at the start of, or during the first year after starting, dialysis (26%). We developed various log-linear mixed effect regression models on three levels: patients, dialysis networks, and transplant centers. Variability was expressed as variance from the random intercepts (± standard error). Although patient characteristics have an important impact on the likelihood of registration, the overall magnitude of variability in registration was low and shared by dialysis networks and transplant centers. Between-transplant center variability (0.23 ± 0.08) was 1.8 higher than between-dialysis network variability (0.13 ± 0.004). Older age was associated with a lower probability of registration and greater variability between networks (0.04, 0.20, & 0.93 in the 18–64, 65–74, and 75–84 age groups). Targeted interventions should focus on elderly patients and/or certain regions with greater variability in waiting list access.     

Applying Andersen’s Model to Explain Service Use and Quality of Life Among Australian Caregivers of Children with Autism Spectrum Disorder

Access to necessary supports and services is extremely important for the wellbeing and, ultimately, quality of life (QOL) of family caregivers. By understanding patterns of health service utilization, we can better tailor current services to meet caregivers’ needs. Framed by Andersen’s Behavioral Model, predisposing, enabling and need factors associated with service utilization, and their relation to QOL, were examined in a cross-sectional sample of 156 Australian caregivers of children and adolescents with autism spectrum disorder (ASD). Participants completed an online survey to assess services accessed, QOL (Quality of Life in Autism - Part A), health beliefs (Health Opinions Questionnaire), ASD symptom severity (Quality of Life in Autism - Part B), and caregiver distress (Depression Anxiety Stress Scales – 21 item). Multivariate regression analyses confirmed the role of predisposing (i.e. higher education), and enabling (i.e. higher income) variables, although family structure (i.e. having more than one children with ASD; OR?=?7.22, CI: 1.77–29.54, p?<?.01) and caregiver distress (OR?=?1.04, CI: 1.0–1.07, p?<?.05) were identified as the strongest predictors of service access. Both of these variables also helped to explain a sizeable portion of the variance in QOL scores (R²?=?.32, adj. R²?=?.24, p?<?.001). Personal barriers to health care utilization exist for parents of children with ASD which impact their decision to access help. There is, however, a need for further research to expand Andersen’s model by examining subjective and objective QOL indicators applicable to the caregiver cohort.     

Engineered CaM2 modulates nuclear calcium oscillation and enhances legume root nodule symbiosis

The key physiological event essential to the establishment of nitrogen-fixing bacteria and phosphate-delivering arbuscular mycorrhizal symbioses is the induction of nuclear calcium oscillations that are required for endosymbioses. These regular fluctuations in nucleoplasmic calcium concentrations are generated by ion channels and a pump located at the nuclear envelope, including the CYCLIC NUCLEOTIDE GATED CHANNEL 15 (CNGC15). However, how the CNGC15s are regulated in planta to sustain a calcium oscillatory mechanism remains unknown. Here, we demonstrate that the CNGC15s are regulated by the calcium-bound form of the calmodulin 2 (holo-CaM2), which, upon release of calcium, provides negative feedback to close the CNGC15s. Combining structural and evolutionary analyses of CaM residues with bioinformatic analysis, we engineered a holo-CaM2 with an increased affinity for CNGC15s. In planta, the expression of the engineered holo-CaM2 accelerates the calcium oscillation frequency, early endosymbioses signaling and is sufficient to sustain over time an enhanced root nodule symbiosis but not an increased arbuscular mycorrhization. Together, these results reveal that holo-CaM2 is a component of endosymbiosis signaling required to modulate CNGC15s activity and the downstream root nodule symbiosis pathway.

Nutrient acquisition is fundamental to life. Plants have evolved strategies to overcome soil phosphate limitation and gain access to atmospheric dinitrogen by developing beneficial associations with arbuscular mycorrhizal (AM) fungi and nitrogen-fixing bacteria, respectively. Unlike other crops, the vast majority of legumes have mastered associations with both endosymbionts, positioning them as key crops to develop sustainable agricultural practices in both developed and developing countries (1).The entry of nitrogen-fixing bacteria, known as rhizobia, and AM fungi into legume roots is initiated by the recognition of the endosymbiont. Host plants have plasma-membrane receptor-like kinases (2–6) that recognize rhizobial elicitors, lipochitooligosaccharides (LCOs), also known as Nod factors (7), and mycorrhizal factors composed of derivatives of LCOs and shorter chain chitooligosaccharides (8, 9). Although rhizobial and AM elicitors are recognized by different complexes of receptor-like kinases (10, 11), both symbionts require the activation of calcium oscillations in root epidermal nuclei (9, 12, 13) to set off the endosymbiosis program. In the model legume Medicago truncatula, two types of nuclear envelope localized ion channels are required to generate the calcium oscillation; the DOESN’T MAKE INFECTIONS1 (DMI1) channel and paralogs of CYCLIC NUCLEOTIDE GATED CHANNEL 15 (CNGC15) (14), and the calcium pump, MCA8 (15). Similar to the animal CNGCs, plant CNGCs are tetrameric ion channels that can include different CNGC units (16, 17). In M. truncatula, CNGC15a, CNGC15b, and CNGC15c are all involved in nuclear calcium oscillation in the root epidermis, nodulation, and arbuscular mycorrhization, suggesting that the three units could assemble into a heterocomplex at the nuclear envelope (14). However, how CNGC15s are regulated in planta to sustain a calcium oscillatory mechanism remains unknown.In this study, we demonstrate that CNGC15s are regulated by the calcium-bound form of the calmodulin 2 (holo-CaM2) in planta, which shapes the oscillatory pattern of nucleoplasmic calcium concentration by providing negative feedback on CNGC15s to cause its closure. By engineering CaM2 to generate CaM2^R91A, which specifically increased holo-CaM2 binding affinity to each CNGC15 unit, we accelerated closure of CNGC15s and increased the calcium oscillation frequency. We further show that accelerating the calcium oscillation frequency was sufficient to accelerate the early endosymbiosis signaling and that the expression of CaM2^R91A resulted in an enhanced root nodule symbiosis but not enhanced AM colonization. Our data reveal differential regulation of rhizobia and AM endosymbioses by CaM2^R91A and suggest that modulating calcium signaling can be used as a strategy to positively impact symbiosis with nitrogen-fixing bacteria.     

Spatiotemporal precision and hemodynamic mechanism of optical point spreads in alert primates

In functional brain imaging there is controversy over which hemodynamic signal best represents neural activity. Intrinsic signal optical imaging (ISOI) suggests that the best signal is the early darkening observed at wavelengths absorbed preferentially by deoxyhemoglobin (HbR). It is assumed that this darkening or “initial dip” reports local conversion of oxyhemoglobin (HbO) to HbR, i.e., oxygen consumption caused by local neural activity, thus giving the most specific measure of such activity. The blood volume signal, by contrast, is believed to be more delayed and less specific. Here, we used multiwavelength ISOI to simultaneously map oxygenation and blood volume [i.e., total hemoglobin (HbT)] in primary visual cortex (V1) of the alert macaque. We found that the hemodynamic “point spread,” i.e., impulse response to a minimal visual stimulus, was as rapid and retinotopically specific when imaged by using blood volume as when using the initial dip. Quantitative separation of the imaged signal into HbR, HbO, and HbT showed, moreover, that the initial dip was dominated by a fast local increase in HbT, with no increase in HbR. We found only a delayed HbR decrease that was broader in retinotopic spread than HbO or HbT. Further, we show that the multiphasic time course of typical ISOI signals and the strength of the initial dip may reflect the temporal interplay of monophasic HbO, HbR, and HbT signals. Characterizing the hemodynamic response is important for understanding neurovascular coupling and elucidating the physiological basis of imaging techniques such as fMRI.