BACKGROUND & AIMS: :Polo-like kinases (PLKs) are marked by C-terminal polo box modules with critical protein interaction and subcellular targeting roles. Slevin et al. in this issue of Structure reveal the architecture of a hidden set of polo boxes from the divergent PLK4, a critical player in centrosome duplication, shedding new light on the evolution of PLKs and their functionally related kinase ZYG-1.

背景与目标： ：Polo样激酶（PLKs）的C末端polo盒模块具有关键的蛋白质相互作用和亚细胞靶向作用。 Slevin等在本期《结构》中，我们揭示了来自不同PLK4的一组隐藏的马球盒的结构，PLK4是质体复制的关键角色，为PLK及其功能相关激酶ZYG-1的进化提供了新的思路。

BACKGROUND & AIMS: :In this paper, we examine the effects of recent parental Medicaid eligibility expansions on Medicaid participation and private insurance coverage. We present a new approach for estimating these policy effects that explicitly models the particular policy instrument over which legislators have control-income eligibility thresholds. Our approach circumvents estimation problems stemming from misclassification or measurement error. Moreover, it allows us to assess how the policy effects may vary at different initial threshold levels. Using data from the Survey of Income and Program Participation, we find three main results. First, the eligibility expansions result in significant increases in Medicaid participation; a "typical" expansion increases Medicaid participation by about four percent of baseline coverage rates. Second, the participation effect is larger for lower initial thresholds and the effect decreases as Medicaid thresholds increase. Third, we find no statistically significant evidence of crowd out regardless of initial threshold level.

背景与目标： ：在本文中，我们研究了最近的父母医疗补助资格扩展对医疗补助参与和私人保险覆盖范围的影响。我们提出了一种估计这些政策影响的新方法，该方法明确地对立法者具有控制收入资格阈值的特定政策工具进行建模。我们的方法规避了由于分类错误或测量错误而引起的估计问题。此外，它使我们能够评估政策效果在不同的初始阈值水平下可能如何变化。使用收入和计划参与调查的数据，我们发现了三个主要结果。首先，资格的扩大导致医疗补助的参与显着增加。 “典型”的扩张使医疗补助计划的参与率增加了基线覆盖率的约4％。其次，对于较低的初始阈值，参与效应较大，并且随着医疗补助阈值的增加，参与效应减小。第三，我们发现无论初始阈值水平如何，都没有统计学上显着的证据表明存在排挤现象。

BACKGROUND & AIMS: OBJECT:Quality and safety are basic concerns in any medical practice. Especially in daily surgical practice, with increasing turnover and shortened procedure times, attention to these topics needs to be assured. Starting in 2007, the authors used a perioperative checklist in all elective procedures and extended the checklist in January 2011 according to the so-called team time-out principles, with additional assessment of patient identity and the planned surgical procedure performed immediately before skin incision, including the emergency cases. METHODS:The advanced perioperative checklist includes parts for patient identification, preoperative assessments, team time-out, postoperative treatment, and imaging controls. All parts are signed by the responsible physician except for the team time-out, which is performed and signed by the theater nurse on behalf of the surgeon immediately before skin incision. RESULTS:Between January 2007 and December 2010, 1 wrong-sided bur hole in an emergency case and 1 wrong-sided lumbar approach in an elective case (of 8795 surgical procedures) occurred in the authors' department. Using the advanced perioperative checklist including the team time-out principles, no error occurred in 3595 surgical procedures (January 2011-June 2012). In the authors' department all team members appreciate the chance to focus on the patient, the surgical procedure, and expected difficulties. The number of incomplete checklists and of patients not being transferred into the operating room was lowered significantly (p = 0.002) after implementing the advanced perioperative checklist. CONCLUSIONS:In the authors' daily experience, the advanced perioperative checklist developed according to the team time-out principles improves preoperative workup and the focus of the entire team. The focus is drawn to the procedure, expected difficulties of the surgery, and special needs in the treatment of the particular patient. Especially in emergency situations, the team time-out synchronizes the involved team members and helps to improve patient safety.

背景与目标： 对象：质量和安全性是任何医学实践中的基本问题。尤其是在日常外科手术中，随着人员流动的增加和手术时间的缩短，需要确保对这些主题的关注。从2007年开始，作者根据所谓的小组超时原则在所有选修程序中使用了围手术期检查表，并于2011年1月扩展了检查表，并进一步评估了患者的身份，并在皮肤切开之前立即进行了计划的手术程序，包括紧急情况。
方法：围手术期高级检查表包括患者识别，术前评估，团队超时，术后治疗和影像控制的部分。除团队超时外，所有部件均由负责的医生签名，团队超时是由手术室护士在皮肤切开之前代表外科医生执行并签名的。
结果：在2007年1月至2010年12月期间，在提交人的科室发生了1例紧急情况下的错牙钻洞和1例选择性情况下的腰椎错位入路手术（共8795次手术）。使用包括团队超时原则在内的高级围手术期检查表，在3595例外科手术程序中未发生任何错误（2011年1月至2012年6月）。在作者部门，所有团队成员都很高兴有机会专注于患者，手术程序和预期的困难。实施高级围手术期检查清单后，不完整检查清单的数量和未转移到手术室的患者的人数显着降低（p = 0.002）。
结论：根据作者的日常经验，根据团队超时原则制定的高级围手术期检查清单可改善术前检查和整个团队的工作重点。重点放在手术过程，手术的预期困难以及对特定患者的治疗中的特殊需求。尤其是在紧急情况下，团队超时可以同步参与团队的成员，并有助于提高患者的安全性。

BACKGROUND & AIMS: :This study, conducted over two time periods, aimed to evaluate the effectiveness of the diffusion of data, implementation of correctives measures and updated protocols in reducing time to reperfusion in acute myocardial infarction (AMI) management in the out-of-hospital setting. Mean (SD) time to hospital admission and to arterial puncture improved (58 (13) vs 67 (18) min, p = 0.03; and 82 (16) vs 95 (29) min, p = 0.02). The study, performed according to quality control programme methodology, showed that the chronology of AMI management could be improved by appropriate interventions and monitoring of intervention times.

背景与目标： ：这项研究历时两个时间，旨在评估院外环境下急性心肌梗死（AMI）管理中数据传播，实施纠正措施和更新协议以减少再灌注时间的有效性。入院和动脉穿刺的平均（SD）时间得到改善（58（13）vs 67（18）分钟，p = 0.03；和82（16）vs 95（29）min，p = 0.02）。根据质量控制程序方法进行的研究表明，可以通过适当的干预和干预时间的监视来改善AMI管理的时间顺序。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :Loss of function mouse models comprise knock-out mice, where a gene is deleted in the germline, and conditional knock-out mice with somatic deletion of a floxed allele in defined tissues. Both types of mice are used for comprehensive studies of gene functions in vivo. Here, we describe a simple method for simultaneous generation of mice with conditional or knock-out alleles for the transcription factor fra-2 (Fos-related antigen 2) using a single embryonic stem (ES) cell clone. ES cells with a floxed fra-2 allele were transiently transfected with a Cre-recombinase expression plasmid and plated at low density. Most of the resulting ES cell colonies consisted of a mixture of cells that have either retained or lost the conditional allele. We demonstrate that these mixed ES cell clones can be directly used for generation of chimeras that give rise to offspring with conditional or knock-out alleles simultaneously. This strategy shortens the time and reduces the number of germline transmission events to generate genetically modified mice.

背景与目标： 功能丧失的小鼠模型包括敲除小鼠（其中种系中的基因缺失）和条件性敲除小鼠，其在定义的组织中体细胞性等位基因缺失。两种类型的小鼠都用于体内基因功能的综合研究。在这里，我们描述了使用单个胚胎干（ES）细胞克隆同时生成具有转录因子fra-2（Fos相关抗原2）的条件或敲除等位基因的小鼠的简单方法。用Cre-重组酶表达质粒瞬时转染带有fra-2等位基因的ES细胞，并以低密度铺板。产生的大多数ES细胞集落由保留或丢失条件等位基因的细胞混合物组成。我们证明，这些混合的ES细胞克隆可直接用于产生嵌合体，这些嵌合体同时产生条件等位基因或敲除等位基因。该策略缩短了时间并减少了产生遗传修饰小鼠的种系传播事件的数量。

BACKGROUND & AIMS: :Mice lacking T cell receptor alpha chain (TCRalpha(-/-)) develop inflammation of the colon. We have examined the effect of this inflammation on the colonic epithelium by studying markers of epithelial cuff, enteroendocrine, and immune cell differentiation. Using immunohistochemical techniques, colons were compared in normal C57/BL6 and murine TCR alpha(-/-) mice aged 2 and 3 weeks and 3-11 months. TCR alpha(-/-) mice aged 3-11 months had histologic evidence of inflammation with increased expression of CD45, CD4+, CD8+, and B220+ cells and a decrease in expression of IgA+ cells. There was a decrease in the number of cholecystokinin, serotonin, and neurotensin enteroendocrine expressing cells in the colon of TCR alpha(-/-) mice. These changes were not present in 2-3-week-old suckling/weaning mice. In contrast, peptide tyrosine tyrosine (PYY), glucagon-like peptide-1, and gastrin expression did not change and small intestinal enteroendocrine cells remained unaltered. The change in colonic enteroendocrine cell expression appears to be a specific response, since only a subset of these cells was altered, and the epithelium was intact by histologic analysis. The absence of functional T cells in TCR alpha(-/-) colon has a marked effect on differentiation of a specific subpopulation of enteroendocrine cells, prior to loss of integrity of the epithelium.

背景与目标： ：缺乏T细胞受体α链（TCRalpha（-/-））的小鼠发展成结肠的炎症。我们已经通过研究上皮袖带，肠内分泌和免疫细胞分化的标志物检查了这种炎症对结肠上皮的影响。使用免疫组织化学技术，比较了2周，3周和3-11个月大的正常C57 / BL6和鼠TCR alpha（-/-）小鼠的结肠。 3-11个月大的TCR alpha（-/-）小鼠具有炎症的组织学证据，CD45，CD4，CD8和B220细胞表达增加，而IgA细胞表达减少。在TCR alpha（-/-）小鼠结肠中，胆囊收缩素，血清素和神经降压素肠内分泌表达细胞的数量有所减少。这些变化在2至3周大的哺乳/断奶小鼠中不存在。相反，肽酪氨酸酪氨酸（PYY），胰高血糖素样肽-1和胃泌素的表达没有改变，小肠肠内分泌细胞保持不变。结肠肠内分泌细胞表达的变化似乎是一种特异性反应，因为这些细胞中只有一部分被改变，并且通过组织学分析完整上皮。在失去上皮的完整性之前，TCR alpha（-/-）结肠中功能性T细胞的缺失对肠内分泌细胞特定亚群的分化具有明显的影响。

BACKGROUND & AIMS: :Chromosome breaks, often with damaged or missing DNA flanking the break site, are an important threat to genome stability. They are repaired in vertebrates primarily by nonhomologous end joining (NHEJ). NHEJ is unique among the major DNA repair pathways in that a continuous template cannot be used by DNA polymerases to instruct replacement of damaged or lost DNA. Nevertheless, at least 3 out of the 17 mammalian DNA polymerases are specifically employed by NHEJ. Biochemical and structural studies are further revealing how each of the polymerases employed by NHEJ possesses distinct and sophisticated means to overcome the barriers this pathway presents to polymerase activity. Still unclear, though, is how the resulting network of overlapping and nonoverlapping polymerase activities contributes to repair in cells.

背景与目标： ：染色体断裂，通常是断裂位点两侧的DNA受损或缺失，是对基因组稳定性的重要威胁。它们主要通过非同源末端连接（NHEJ）在脊椎动物中修复。 NHEJ在主要的DNA修复途径中是独一无二的，因为DNA聚合酶不能使用连续的模板来指示替换受损或丢失的DNA。尽管如此，NHEJ专门采用了17种哺乳动物DNA聚合酶中的至少3种。生化和结构研究进一步揭示了NHEJ所采用的每种聚合酶如何具有独特而复杂的方法来克服该途径对聚合酶活性造成的障碍。不过，仍然不清楚的是，重叠和不重叠的聚合酶活性所形成的网络如何促进细胞修复。

BACKGROUND & AIMS: BACKGROUND:Out-of-hospital cardiac arrest (OHCA) is a common reason for calls for intervention by emergency medical teams (EMTs) in Poland. Regardless of the mechanism, OHCA is a state in which the chance of survival is dependent on rapid action from bystanders and responding health professionals in emergency medical services (EMS). We aimed to identify factors associated with return of spontaneous circulation (ROSC). METHODS:The medical records of 2137 EMS responses to OHCA in the city of Wroclaw, Poland between July 2017 and June 2018 were analyzed. RESULTS:The OHCA incidence rate for the year studied was 102 cases per 100,000 inhabitants. EMS were called to 2317 OHCA events of which 1167 (50.4%) did not have resuscitation attempted on EMS arrival. The difference between the number of successful and failed cardiopulmonary resuscitations (CPRs) was statistically significant (p < 0.001). Of 1150 patients in whom resuscitation was attempted, ROSC was achieved in 250 (27.8%). Rate of ROSC was significantly higher when CPR was initiated by bystanders (p < 0.001). Patients presenting with asystole or pulseless electrical activity (PEA) had a higher risk of CPR failure (86%) than those with ventricular fibrillation/ventricular tachycardia (VF/VT). Patients with VF/VT had a higher chance of ROSC (OR 2.68, 1.86-3.85) than those with asystole (p < 0.001). The chance of ROSC was 1.78 times higher when the event occurred in a public place (p < 0.001). CONCLUSIONS:The factors associated with ROSC were occurrence in a public place, CPR initiation by witnesses, and presence of a shockable rhythm. Gender, age, and the type of EMT did not influence ROSC. Low bystander CPR rates reinforce the need for further efforts to train the public in CPR.

背景与目标： 背景：院外心脏骤停（OHCA）是波兰紧急医疗小组（EMT）呼吁进行干预的常见原因。无论采用哪种机制，OHCA的生存机会都取决于旁观者和应急医疗服务（EMS）中响应卫生专业人员的迅速行动。我们旨在确定与自然循环恢复（ROSC）相关的因素。
方法：分析了2017年7月至2018年6月在波兰弗罗茨瓦夫市发生的2137例OHCA对EMS的EMS病历。
结果：本研究年度的OHCA发病率为每100,000居民102例。 EMS被召集到2317 OHCA事件中，其中1167（50.4％）没有在EMS到达时进行复苏尝试。心肺复苏成功次数与失败次数之间的差异具有统计学意义（p <0.001）。在尝试进行复苏的1150例患者中，有250例达到了ROSC（27.8％）。由旁观者发起心肺复苏术时，ROSC率显着更高（p <0.001）。表现为无搏动或无脉搏电活动（PEA）的患者发生CPR失败的风险（86％）高于发生室颤/室性心动过速（VF / VT）的患者。 VF / VT患者的ROSC发生机率（OR 2.68，1.86-3.85）高于无搏动的患者（p <0.001）。当事件发生在公共场所时，ROSC的机会要高1.78倍（p <0.001）。
结论：与ROSC相关的因素包括在公共场所发生，证人进行心肺复苏术以及出现令人震惊的心律。性别，年龄和EMT类型不会影响ROSC。旁观者的心肺复苏术率低，这表明需要进一步努力对公众进行心肺复苏术培训。

BACKGROUND & AIMS: BACKGROUND:The routine application of whole-body CT after extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) has not been extensively investigated. We aimed to evaluate the benefit of CT in this context. METHODS:We retrospectively analyzed all OHCA patients who had received ECPR between January 2006 to May 2019. Electronic records were reviewed to filter out patients who had a whole-body CT as their first clinical evaluation after ECPR. CT findings and major hospital outcomes were evaluated. RESULTS:From January 2006 to May 2019, 700 patients had received ECPR in our institution. We identified 93 OHCA patients who received whole-body CT as the first clinical evaluation after ECPR. 22.6% of those had no acute findings detected on CT requiring immediate treatment. In the remaining 77.4%, CT had findings that might lead to alterations in clinical course. Most important findings were myocardial infarction (57.0%), hypoxic brain injury (29.0%), sternal/rib fractures (16.1%), aortic dissection (7.5%), pulmonary embolism (5.4%), and cardiac tamponade (5.4%). There were no significant differences in ICU/hospitalization days, time on ECMO support, survival and neurological outcomes between those with and without immediate CT. In our OHCA cohort, there were 27 patients with CT evidence of hypoxic brain injury, of whom 22.2% (n = 2) managed to wean from ECMO support, 14.8% (n = 4) survived to discharge, but only 3.7% (n = 1) survived with good neurological outcome. Hypoxic brain injury on CT has a 95% specificity in predicting poor neurological outcome, with a false positive rate of only 3.7%. Logistic regression suggested a potential correlation between CT findings of hypoxic brain injury and poor neurological outcome [Odds ratio (OR) = 12.53 (1.55 to 10.1), p = 0.02)]. CONCLUSIONS:Routine whole-body CT after ECPR in OHCA patients appears to have a limited role, as the majority is caused by ACS. However, it may be a useful tool when CPR-related injury or non-ACS causes of OHCA are suspected, as well as in cases where the cause of OHCA is unknown. On the contrary, routine brain CT may be a valuable tool in guiding anticoagulant therapy during ECMO and in aiding outcome prediction.

背景与目标： 背景：体外循环心脏复苏（ECPR）在院外心脏骤停（OHCA）中全身CT的常规应用尚未得到广泛研究。我们旨在评估在这种情况下CT的好处。
方法：我们回顾性分析了2006年1月至2019年5月间所有接受ECPR的OHCA患者。审查了电子记录以筛选出全身CT作为ECPR后的首次临床评估的患者。评估CT表现和主要医院结局。
结果：从2006年1月到2019年5月，我们机构有700名患者接受了ECPR。我们确定了93例接受全身CT的OHCA患者，这是ECPR后的首次临床评估。 22.6％的患者未在CT上发现急性症状，需要立即治疗。在其余的77.4％中，CT的发现可能会导致临床过程的改变。最重要的发现是心肌梗塞（57.0％），低氧性脑损伤（29.0％），胸骨/肋骨骨折（16.1％），主动脉夹层（7.5％），肺栓塞（5.4％）和心脏压塞（5.4％）。有和没有立即CT的患者之间的ICU /住院天数，ECMO支持时间，生存率和神经系统结局无显着差异。在我们的OHCA队列中，有27例具有缺氧性脑损伤的CT证据，其中22.2％（n = 2）设法从ECMO支持中撤离，14.8％（n = 4）幸存了下来，但只有3.7％（n = 1）存活，神经功能良好。 CT缺氧性脑损伤在预测不良神经功能方面具有95％的特异性，假阳性率仅为3.7％。 Logistic回归表明，缺氧性脑损伤的CT表现与不良的神经系统预后之间存在潜在的相关性[几率（OR）= 12.53（1.55至10.1），p = 0.02）]。
结论：OHCA患者ECPR后常规的全身CT检查似乎作用有限，因为多数是ACS引起的。但是，当怀疑与CPR相关的损伤或OHCA的非ACS原因以及未知的OHCA原因时，它可能是有用的工具。相反，常规脑部CT可能是指导ECMO期间抗凝治疗以及帮助预测结果的有价值的工具。

BACKGROUND & AIMS: :We examine the impact of the accessibility of an older individual's house on her use of nursing home care. We link administrative data on the accessibility of all houses in the Netherlands to data on long-term care use of all older persons from 2011 to 2014. We find that older people living in more accessible houses are less likely to use nursing home care. The effects increase with age and are largest for individuals aged 90 or older. The effects are stronger for people with physical limitations than for persons with cognitive problems. We also provide suggestive evidence that older people living in more accessible houses substitute nursing home care by home care.

背景与目标： ：我们研究了老年人的住房对他们使用养老院护理的影响。我们将有关荷兰所有房屋的可及性的行政数据与2011年至2014年所有老年人的长期护理使用数据相关联。我们发现，居住在更容易接近的房屋中的老年人不太可能使用养老院护理。效果会随着年龄的增长而增加，并且对于90岁或90岁以上的个体影响最大。对于身体有局限性的人，其影响要强于对认知有障碍的人。我们还提供了暗示性的证据，表明居住在更容易接近的房屋中的老年人用家庭护理代替了家庭护理。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :Hearing or visual impairments may negatively affect child's development and participation. Yet the literature about participation of children with hearing or visual impairments is insufficient. The present study aimed to compare participation patterns of children with visual impairments to those of children with hearing impairments and to typical peers and to examine the correlations between participation and socio-demographic parameters in each group. Participants were 70 children between the ages of 6-11: 25 with hearing impairments, 20 with visual impairments and 25 typical peers. All children filled the Children's Assessment of Participation and Enjoyment (CAPE). This self-report refers to participation in daily out of school activities. Children with hearing or visual impairments showed significant limited participation compared to typical peers, expressed in lower number of activities, lower participation intensity; more activities performed at home and with someone else. The limited participation was more emphasized among children with visual impairments. Socio-demographic variables (age, mother's education and socio-economic level) correlated with participation dimensions in both study groups. In conclusion, children with hearing or visual impairments may have restricted participation in out of school activities. Socio-demographic parameters may play a role in encouraging child's participation. Participation among these populations should be further studied in order to assist service providers to create intervention programs together with the child, for enhancing his/her inclusion in the community.

背景与目标： ：听力或视力障碍可能会对孩子的发育和参与产生负面影响。然而，有关听力或视力障碍儿童参与的文献不足。本研究旨在比较视力障碍儿童，听力障碍儿童和典型同龄人的参与模式，并检验每组中参与度和社会人口统计学参数之间的相关性。参加者为70名6至11岁的儿童：25名听力障碍儿童，20名视力障碍儿童和25名典型同伴。所有儿童都填写了儿童参与和娱乐评估（CAPE）。此自我报告是指参加每天的校外活动。与典型的同龄人相比，有听力或视觉障碍的儿童表现出明显的受限参与，表现为较少的活动，较低的参与强度；在家里以及与其他人一起进行的更多活动。视力障碍儿童更加强调了有限的参与。社会人口统计学变量（年龄，母亲的受教育程度和社会经济水平）与两个研究组的参与程度相关。总之，听力或视力障碍的儿童可能会限制参加校外活动。社会人口统计学参数可能在鼓励儿童参与方面发挥作用。应进一步研究这些人群的参与情况，以帮助服务提供者与儿童一起制定干预计划，以增强他/她在社区中的包容性。

BACKGROUND & AIMS: :T-box transcription factor genes are widely conserved in metazoan development and widely involved in developmental processes. With the phase of T-box gene discovery winding down, the phase of transcriptional target discovery for T-box transcription factors is finally taking off and yielding rich rewards. Mutant phenotypes in mouse and zebrafish as well as morpholino studies in zebrafish have helped to link the T-box genes to a variety of signaling pathways through diverse target genes and feedback loops. Particularly in early mesoderm development, it is emerging that a network of T-box genes interacts with Wnt/beta-catenin and Notch/Delta signaling pathways, among others, to control the important processes of mesoderm specification, somite segmentation, and left/right body axis determination.

背景与目标： ：T-box转录因子基因在后生动物的发育中广泛保守，并广泛参与发育过程。随着T-box基因发现阶段的结束，T-box转录因子的转录靶点发现阶段终于开始，并产生了丰厚的回报。小鼠和斑马鱼中的突变表型以及斑马鱼中的吗啉代研究已帮助通过不同的靶基因和反馈环将T-box基因与多种信号通路联系起来。特别是在中胚层的早期发展中，正在出现T-box基因网络与Wnt /β-catenin和Notch / Delta信号通路相互作用等，以控制中胚层规格，体节分割和左/右的重要过程。体轴确定。