Epidermolysis bullosa:evidence for linkage to genetic markers on chromosome 1 in a family with the autosomal dominant simplex form

DNA from members of a three-generation pedigree of Irish origin, displaying an autosomal dominant simplex form of epidermolysis bullosa of the epidermolytic, simplex, or Koebner variety (EBS2), was analyzed for linkage with a set of markers derived from the long arm of chromosome 1. Two-point analysis revealed positive lod scores for five of these markers, AT3 (Z = 2.107, theta = 0), APOA2 (Z = 1.939, theta = 0.15), D1S66 (Z = 1.204, theta = 0), D1S13 (Z = 1.026, theta = 0.15), and D1S65 (Z = 0.329, theta = 0.15). Multilocus analysis, incorporating the markers D1S19, D1S16, D1S13, APOA2, D1S66, AT3, and D1S65, resulted in a lod score of 3 maximizing at AT3. These data strongly support previous tentative indications of linkage between EBS2 and genetic markers on the long arm of chromosome 1.

Autosomal dominant retinitis pigmentosa (ADRP):localization of an ADRP gene to the long arm of chromosome 3

Members of a large pedigree of Irish origin presenting with early onset Type I autosomal dominant retinitis pigmentosa (ADRP) have been typed for D3S47 (C17), a polymorphic marker from the long arm of chromosome 3. Significant, tight linkage of ADRP to D3S47, with a lod score of 14.7 maximizing at 0.00 recombination, has been obtained, hence localizing the ADRP gene (RP1) segregating in this pedigree to 3q.

Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative-evidence synthesis

Background:
Prolonged mechanical ventilation is associated with a longer intensive care unit (ICU) length of stay and higher mortality. Consequently, methods to improve ventilator weaning processes have been sought. Two recent Cochrane systematic reviews in ICU adult and paediatric populations concluded that protocols can be effective in reducing the duration of mechanical ventilation, but there was significant heterogeneity in study findings. Growing awareness of the benefits of understanding the contextual factors impacting on effectiveness has encouraged the integration of qualitative evidence syntheses with effectiveness reviews, which has delivered important insights into the reasons underpinning (differential) effectiveness of healthcare interventions.

Objectives:
1. To locate, appraise and synthesize qualitative evidence concerning the barriers and facilitators of the use of protocols for weaning critically-ill adults and children from mechanical ventilation;

2. To integrate this synthesis with two Cochrane effectiveness reviews of protocolized weaning to help explain observed heterogeneity by identifying contextual factors that impact on the use of protocols for weaning critically-ill adults and children from mechanical ventilation;

3. To use the integrated body of evidence to suggest the circumstances in which weaning protocols are most likely to be used.

Search methods:
We used a range of search terms identified with the help of the SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) mnemonic. Where available, we used appropriate methodological filters for specific databases. We searched the following databases: Ovid MEDLINE, Embase, OVID, PsycINFO, CINAHL Plus, EBSCOHost, Web of Science Core Collection, ASSIA, IBSS, Sociological Abstracts, ProQuest and LILACS on the 26th February 2015. In addition, we searched: the grey literature; the websites of professional associations for relevant publications; and the reference lists of all publications reviewed. We also contacted authors of the trials included in the effectiveness reviews as well as of studies (potentially) included in the qualitative synthesis, conducted citation searches of the publications reporting these studies, and contacted content experts.

We reran the search on 3rd July 2016 and found three studies, which are awaiting classification.

Selection criteria:
We included qualitative studies that described: the circumstances in which protocols are designed, implemented or used, or both, and the views and experiences of healthcare professionals either involved in the design, implementation or use of weaning protocols or involved in the weaning of critically-ill adults and children from mechanical ventilation not using protocols. We included studies that: reflected on any aspect of the use of protocols, explored contextual factors relevant to the development, implementation or use of weaning protocols, and reported contextual phenomena and outcomes identified as relevant to the effectiveness of protocolized weaning from mechanical ventilation.

Data collection and analysis:
At each stage, two review authors undertook designated tasks, with the results shared amongst the wider team for discussion and final development. We independently reviewed all retrieved titles, abstracts and full papers for inclusion, and independently extracted selected data from included studies. We used the findings of the included studies to develop a new set of analytic themes focused on the barriers and facilitators to the use of protocols, and further refined them to produce a set of summary statements. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to arrive at a final assessment of the overall confidence of the evidence used in the synthesis. We included all studies but undertook two sensitivity analyses to determine how the removal of certain bodies of evidence impacted on the content and confidence of the synthesis. We deployed a logic model to integrate the findings of the qualitative evidence synthesis with those of the Cochrane effectiveness reviews.

Main results:
We included 11 studies in our synthesis, involving 267 participants (one study did not report the number of participants). Five more studies are awaiting classification and will be dealt with when we update the review.

The quality of the evidence was mixed; of the 35 summary statements, we assessed 17 as ‘low’, 13 as ‘moderate’ and five as ‘high’ confidence. Our synthesis produced nine analytical themes, which report potential barriers and facilitators to the use of protocols. The themes are: the need for continual staff training and development; clinical experience as this promotes felt and perceived competence and confidence to wean; the vulnerability of weaning to disparate interprofessional working; an understanding of protocols as militating against a necessary proactivity in clinical practice; perceived nursing scope of practice and professional risk; ICU structure and processes of care; the ability of protocols to act as a prompt for shared care and consistency in weaning practice; maximizing the use of protocols through visibility and ease of implementation; and the ability of protocols to act as a framework for communication with parents.

Authors' conclusions:
There is a clear need for weaning protocols to take account of the social and cultural environment in which they are to be implemented. Irrespective of its inherent strengths, a protocol will not be used if it does not accommodate these complexities. In terms of protocol development, comprehensive interprofessional input will help to ensure broad-based understanding and a sense of ‘ownership’. In terms of implementation, all relevant ICU staff will benefit from general weaning as well as protocol-specific training; not only will this help secure a relevant clinical knowledge base and operational understanding, but will also demonstrate to others that this knowledge and understanding is in place. In order to maximize relevance and acceptability, protocols should be designed with the patient profile and requirements of the target ICU in mind. Predictably, an under-resourced ICU will impact adversely on protocol implementation, as staff will prioritize management of acutely deteriorating and critically-ill patients.

Cell Coverage Optimization for the Multicell Massive MIMO Uplink

We investigate the cell coverage optimization problem for the massive multiple-input multiple-output (MIMO) uplink. By deploying tilt-adjustable antenna arrays at the base stations, cell coverage optimization can become a promising technique which is able to strike a compromise between covering cell-edge users and pilot contamination suppression. We formulate a detailed description of this optimization problem by maximizing the cell throughput, which is shown to be mainly determined by the user distribution within several key geometrical regions. Then, the formulated problem is applied to different example scenarios: for a network with hexagonal shaped cells and uniformly distributed users, we derive an analytical lower bound of the ergodic throughput in the objective cell, based on which, it is shown that the optimal choice for the cell coverage should ensure that the coverage of different cells does not overlap; for a more generic network with sectoral shaped cells and non-uniformly distributed users, we propose an analytical approximation of the ergodic throughput. After that, a practical coverage optimization algorithm is proposed, where the optimal solution can be easily obtained through a simple one-dimensional line searching within a confined searching region. Our numerical results show that the proposed coverage optimization method is able to greatly increase the system throughput in macrocells for the massive MIMO uplink transmission, compared with the traditional schemes where the cell coverage is fixed.

I/Q imbalance in AF dual-hop relaying: Performance analysis in Nakagami-m fading

We analyze the performance of amplify-and-forward dual-hop relaying systems in the presence of in-phase and quadrature-phase imbalance (IQI) at the relay node. In particular, an exact analytical expression for and tight lower bounds on the outage probability are derived over independent, non-identically distributed Nakagami-m fading channels. Moreover, tractable upper and lower bounds on the ergodic capacity are presented at arbitrary signal-to-noise ratios (SNRs). Some special cases of practical interest (e.g., Rayleigh and Nakagami-0.5 fading) are also studied. An asymptotic analysis is performed in the high SNR regime, where we observe that IQI results in a ceiling effect on the signal-to-interference-plus-noise ratio (SINR), which depends only on the level of I/Q impairments, i.e., the joint image rejection ratio. Finally, the optimal I/Q amplitude and phase mismatch parameters are provided for maximizing the SINR ceiling, thus improving the system performance. An interesting observation is that, under a fixed total phase mismatch constraint, it is optimal to have the same level of transmitter (TX) and receiver (RX) phase mismatch at the relay node, while the optimal values for the TX and RX amplitude mismatch should be inversely proportional to each other.

Plasticity varies with boldness in a weakly-electric fish

The expression of animal personality is indicated by patterns of consistency in  individual behaviour. Often, the differences exhibited between individuals are consistent across situations. However, between some situations, this can be biased by variable levels of individual plasticity. The interaction between individual plasticity and animal personality can be illustrated by examining situation-sensitive personality traits such as boldness (i.e. risk-taking and exploration tendency). For the weakly electric fish Gnathonemus petersii, light condition is a major factor influencing behaviour. Adapted to navigate in low-light conditions, this species chooses to be more active in dark environments where risk from visual predators is lower. However, G. petersii also exhibit individual differences in their degree of behavioural change from light to dark. The present study, therefore, aims to  examine if an increase of motivation to explore in the safety of the dark, not only affects mean levels of boldness, but also the variation between individuals, as a result of differences  in individual plasticity.  Results: Boldness was consistent between a novel-object and a novel-environment situation in bright light. However, no consistency in boldness was noted between a bright (risky) and a  dark (safe) novel environment. Furthermore, there was a negative association between boldness and the degree of change across novel environments, with shier individuals  exhibiting greater behavioural plasticity.  Conclusions: This study highlights that individual plasticity can vary with personality. In  addition, the effect of light suggests that variation in boldness is situation specific. Finally,  there appears to be a trade-off between personality and individual plasticity with shy but  plastic individuals minimizing costs when perceiving risk and bold but stable individuals  consistently maximizing rewards, which can be maladaptive.

Secure 5G Wireless Communications: A Joint Relay Selection and Wireless Power Transfer Approach

In this paper, we investigate the secrecy performance of an energy harvesting relay system, where a legitimate source communicates with a legitimate destination via the assistance of multiple trusted relays. In the considered system, the source and relays deploy the time-switching-based radio frequency energy harvesting technique to harvest energy from a multi-antenna beacon. Different antenna selection and relay selection schemes are applied to enhance the security of the system. Specifically, two relay selection schemes based on the partial and full knowledge of channel state information, i.e., optimal relay selection and partial relay selection, and two antenna selection schemes for harvesting energy at source and relays, i.e., maximizing energy harvesting channel for the source and maximizing energy harvesting channel for the selected relay, are proposed. The exact and asymptotic expressions of secrecy outage probability in these schemes are derived. We demonstrate that applying relay selection approaches in the considered energy harvesting system can enhance the security performance. In particular, optimal relay selection scheme outperforms partial relay selection scheme and achieves full secrecy diversity order, regardless of energy harvesting scenarios.

Performance of downlink massive MIMO in Ricean fading channels with ZF precoder

We investigate the achievable sum rate and energy efficiency of zero-forcing precoded downlink massive multiple-input multiple-output systems in Ricean fading channels. A simple and accurate approximation of the average sum rate is presented, which is valid for a system with arbitrary rank channel means. Based on this expression, the optimal power allocation strategy maximizing the average sum rate is derived. Moreover, considering a general power consumption model, the energy efficiency of the system with rank-1 channel means is characterized. Specifically, the impact of key system parameters, such as the number of users N, the number of BS antennas M, Ricean factor K and the signal-to-noise ratio (SNR) ρ are studied, and closed-form expressions for the optimal ρ and M maximizing the energy efficiency are derived. Our findings show that the optimal power allocation scheme follows the water filling principle, and it can substantially enhance the average sum rate in the presence of strong line-of-sight effect in the low SNR regime. In addition, we demonstrate that the Ricean factor K has significant impact on the optimal values of M, N and ρ.