bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of VTILVOT variation rate on the assessment of fluid responsiveness in septic shock patients
Authors: Wang Jinzhong , Zhou Dexing , Gao Yi , Wu Zhongyong , Wang Xiaozhi , Lv Chuanzhu
Published: November 2020

This study aimed to assess the predictive value of velocity time integral (VTI) of the left ventricular outflow tract (LVOT) on volume expansion test (VET) as an indicator of volume responsiveness in septic shock patients. Septic shock patients undergoing mechanical ventilation were recruited. The hemodynamic parameters before and after VE were monitored by pulse indicated continuous cardiac output (PiCCO) and echocardiography. Heart rate, cardiac index (CI), mean arterial pressure (MAP), central venous pressure, stroke volume variation (SVV), CI and variation of pulse pressure (PPV), and the changes in cardiac parameters (Dheart rate, Dmean arterial pressure, Dcentral venous pressure, DSVV, DCI, and DPPV) were determined. The relationships of hemodynamic parameters and their changes with DVTI were further evaluated with Pearson relation analysis. The value of these parameters in fluid responsiveness prediction was evaluated by using the receiver operating characteristic (ROC) curve analysis. Results showed that 44 VETs were performed in 44 septic shock patients with responsiveness in 24 patients and non-responsiveness in 20. The CI increased by ≥ 15% in responsive patients, but by<15% in non-responsive patients after VET. There were significant differences in the SVV and PPV after VET between responsive and non-responsive groups. DSVV, DPPV, and DCI were positively related to DVTI. The area under ROC curve (AUC) for SVV in fluid responsiveness prediction was 0.80, and the sensitivity and specificity of SVV were 66.5% and 95%, respectively, when the cut-off value was 24.8%. The AUC for PPV in fluid responsiveness prediction was 0.843, and the sensitivity and specificity of PPV were 83.3% and 75%, respectively, when the cut-off value was 25.8%. The AUC for DVTILVOT in fluid responsiveness prediction was 0.956, and the sensitivity and specificity were 87.5% and 95%, respectively, when the cut-off value was 15.9%. In conclusion, DVTILVOT is effective to predict fluid responsiveness after VET in mechanical ventilation patients with septic shock. It may serve as a new, noninvasive and functional hemodynamic parameter with the same accuracy to SVV.
Comparative efficacy of seven exercise interventions for symptoms of depression in college students
Authors: Guo Shengyu , Liu Feiyue , Shen Jing , Wei Min , Yang Yan
Published: November 2020

Background:

Depression among college students is common, exercise interventions are valued as one of the most widely prescribed interventions for depressed college students, however, it is especially difficult for university administrators to determine which exercise intervention is most effective, and efficacy of exercise interventions among depressed college students have not been evaluated.

Objectives:

To systematically review and compare the efficacy of 7 exercise interventions for decrease symptoms of depression in college students.

Method:

A network of meta-analysis (NMA) was conducted to fill the objectives. Five relatived electronic databases were searched for the related articles.

Eligibility criteria:

Randomized controlled trials comparing the efficacy of 7 Exercise interventions with usual care of college students with depression were included in the review.

Main outcomes:

The primary outcome of the present study was standardized mean difference (SMD) and the mean change of depressive symptoms.

Results:

Fourteentrials were identified, including 2010 depressed college students. The result of direct meta-analysis of this review indicated exercise interventions overall had a significantly lower mean depression scores (SMD = −1.13) when compared with usual care. The result of NMA indicated when comparing with badminton intervention, yoga (SMD = −7.7, 95%CI: −14 to −0.93) and Tai chi (SMD = −9.4, 95%CI: −16 to −2.7) can significantly decrease depression scores of the depressed college students. The rank of 7 exercise interventions with respect to efficiently decrease symptom of depressed undergraduates was Tai chi > Yoga > Volleyball > Dance > Run > Basketball > Badminton, respectively.

Conclusions:

Tai chi exhibited the highest probability that became the most efficacy intervention among the comparions, and Yoga showed the second most effectiveness to alleviate depressive symptoms of depressed college students, and dance ranks the third, followed by run, volleyball, basketball, and badminton respectively.
Image quality improvement of single-shot turbo spin-echo magnetic resonance imaging of female pelvis using a convolutional neural network
Authors: Misaka Tomofumi , Asato Nobuyuki , Ono Yukihiko , Ota Yukino , Kobayashi Takuma , Umehara Kensuke , Ota Junko , Uemura Masanobu , Ashikaga Ryuichiro , Ishida Takayuki
Published: November 2020

We have developed a deep learning-based approach to improve image quality of single-shot turbo spin-echo (SSTSE) images of female pelvis. We aimed to compare the deep learning-based single-shot turbo spin-echo (DL-SSTSE) images of female pelvis with turbo spin-echo (TSE) and conventional SSTSE images in terms of image quality.

One hundred five and 21 subjects were used as training and test sets, respectively. We performed 6-fold cross validation. In the training process, low-quality images were generated from TSE images as input. TSE images were used as ground truth images. In the test process, the trained convolutional neural network was applied to SSTSE images. The output images were denoted as DL-SSTSE images. Apart from DL-SSTSE images, classical filtering methods were adopted to SSTSE images. Generated images were denoted as F-SSTSE images. Contrast ratio (CR) of gluteal fat and myometrium and signal-to-noise ratio (SNR) of gluteal fat were measured for all images. Two radiologists graded these images using a 5-point scale and evaluated the image quality with regard to overall image quality, contrast, noise, motion artifact, boundary sharpness of layers in the uterus, and the conspicuity of the ovaries. CRs, SNRs, and image quality scores were compared using the Steel-Dwass multiple comparison tests.

CRs and SNRs were significantly higher in DL-SSTSE, F-SSTSE, and TSE images than in SSTSE images. Scores with regard to overall image quality, contrast, noise, and boundary sharpness of layers in the uterus were significantly higher on DL-SSTSE and TSE images than on SSTSE images. There were no significant differences in the CRs, SNRs, and respective scores between DL-SSTSE and TSE images. The score with regard to motion artifacts was significantly higher on DL-SSTSE, F-SSTSE, and SSTSE images than on TSE images. The score with regard to the conspicuity of ovaries was significantly higher on DL-SSTSE images than on F-SSTSE, SSTSE, and TSE images (P < .001).

DL-SSTSE images showed higher image quality as compared with SSTSE images. In comparison with conventional TSE images, DL-SSTSE images had acceptable image quality while keeping the advantage of the motion artifact-robustness and acquisition time efficiency in SSTSE imaging.
Monokine induced by gamma interferon for detecting pulmonary tuberculosis
Authors: Li Yang , He Dengqi , Che Yinfu , Zhao Xinchen
Published: November 2020

Backgrounds:

Pulmonary tuberculosis (PTB) is an oldest-known and most formidable disease. The standard microbiology culture is time-wasting. Monokine induced by gamma interferon (MIG) has been reported as a new biomarker to auxiliarily detect PTB. In our study, we used meta-analysis to assess the diagnostic value of MIG for PTB.

Methods:

PubMed, Embase, Web of Science, and Cochrane Library were searched for relative records up to April 2, 2020. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, area under the curve, and summary receiver operating characteristic curve were estimated.

Results:

Eight studies including 1487 participants were included. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of MIG for detecting PTB were 84%, 84%, 5.19, and 0.19, respectively. The diagnostic odds ratio and area under the curve were 27.88 and 0.90, respectively, indicating a good diagnostic ability of MIG. Meta-regression analysis showed that human immunodeficiency virus status might be a source of heterogeneity (P = .02).

Conclusions:

Our results showed that MIG had a good diagnostic value for PTB.
Roles, Training, and Qualifications of a Case Manager in the Canadian Health Care Industry
Authors: Mwandala Tobias
Published: November 2020

Purpose:

The purpose of this article is to explore primary roles, training, competencies, and qualifications of a case manager in the Canadian health care industry and how to improve case management practice in Canada.

Primary Practice Setting:

Case managers' primary practice setting investigated in this article is the Canadian health care industry, which includes clinics, hospitals, continuing care, short-term and long-term care facilities, as well as palliative and end-of-life care settings.

Conclusion:

The main role of case managers is to help clients meet their goals. Assessment, monitoring, interpersonal communication, and collaboration are essential roles and competencies of case managers. Many case managers come from regulated health care professions and have prior years of professional experience, and many of them come from a nursing profession. This article is a narrative review based on the current literature about case managers' roles, training, and competencies in the Canadian health care industry and how to improve Canadian case management practice. Certification and standardization of case managers in Canada are needed to better understand the roles, training, and qualifications of case managers in the Canadian health care industry.

Implications for Case Management Practice:

Case managers require skills in assessment, monitoring, cultural competency, interpersonal communication, collaboration, coordinating, and advocating for resources and services to meet clients' goals in the health care industry. Case managers must also consider how to combat and address other social determinants of health such as a client's social economic status, literacy, income, employment, and working conditions that influence client's health. Ongoing professional development for case managers is fundamental in achieving effective case management practice. Finally, it is important to have case management certification in Canada in order to better understand case manager's roles and qualifications in the Canadian health care industry.
Reducing Frequency of Emergency Department and Inpatient Visits Through Focused Case Management
Authors: Sathyanarayanan Shrieraam , Zhou Biting , Maxey Matthew
Published: November 2020

Purpose of Study:

To evaluate whether the Oklahoma State University (OSU) Health Access Network's (HAN's) case management program is effective in reducing the attendance of frequent users to the emergency department (ED) and inpatient department.

Primary practice setting:

This is a 2-year retrospective pre/post-case management analysis. Emergency department usage data from 2013 to 2016 of the OSU HAN contracted clinics are used in this study. This study involves case management interventions for high ED users and high-risk patients. The patients in the study must be enrolled in SoonerCare choice to be case managed.

Methodology and Sample:

Patients who visited the ED 3 times or more in 12 months prior to their HAN enrollment and patients with 12 months of data preenrollment and postenrollment were included in the study. A historical control was used to compare ED and inpatient use per patient per month pre- and post-HAN case management. Chi-square and Wilcoxon's signed-rank tests were used to assess the data.

Results:

A total of 29 patients met the inclusion criteria. The number of ED and inpatient visits was reduced after HAN intervention (181 vs. 110, p < .001; 35 vs. 11, p < .001). The ED and inpatient use per patient per month reduced significantly from 0.52 to 0.31 (p < .001) and 0.10 to 0.03 (p < .01), respectively.

Implications for Case Management Practice:

This study suggests that continuous case management and implementation of various care plans with frequent follow-up are effective in reducing the cost of care and subsequent ED and inpatient visits.
Community and Case Management Interventions to Address Social Determinants of Health in Infectious Disease
Authors: Moreo Kathleen
Published: November 2020

Purpose/Objectives:

Professional case managers are responsible to conduct education, counseling, and other interventions that address the unique needs and gaps of the patients and families they serve. Social determinants of health (SDH) can impact barriers to patient care and outcomes that may go undetected among underserved populations without reliable data. This article describes an implementation science study using patient and provider-informed data and designed interventions to mitigate barriers in SDH related to hepatitis B virus (HBV).

Primary Practice Settings:

Case managers and other health care team members in community health clinics examined discordances in their own patients' and providers' beliefs about patients' barriers to HBV care. Data were then used to help identify and engage unique strategies in education, counseling, and clinic outreach to improve outcomes in HBV and lessen barriers to care among at-risk minority populations.

Findings/Conclusions:

Findings from data and information conducted among the clinic patients and health care team members revealed many important barriers in key aspects of SDH occurring in each clinic. As a result, case managers and other health care team members were able to examine distinct differences in what they predicted their patients would say versus what patients actually answered about SDH aspects of their care experiences, including barriers in access to care, health monitoring, and treatment of HBV.

Implications for Case Management Practice:

The study and data results have implications for case management practice that may also be applied to other infectious diseases. Implications include patient and community outreach strategies to improve access to care; resource management techniques to improve referrals and disease monitoring; and ongoing and improved education and counseling to change behaviors associated with infectious disease prevention, screening, and linkage to care.
Acute Care Management During a Pandemic
Authors: Chovanec Kelli , Howard Nicole R.
Published: November 2020

Purpose/Objectives:

During the global pandemic of Covid-19, the hospital setting transitional care management was challenged by the complexities of the rapidly changing health care environment, requiring the implementation of an innovative approach to hospital discharge planning. The purpose of this article is to review the experiences of an integrated urban health system, exploring the strategic tactics to ensure effective communication between team members, patient and family engagement in discharge planning, establishing and maintaining trust, connecting patients to appropriate next level of care services, and providing transitional care management support.

Primary Practice Settings:

The Covid-19 pandemic response stimulated the rapid transformation of the acute care management model amidst the tremendous challenge of meeting the discharge planning needs of the hospitalized population in one large, urban, integrated health care system.

Findings/Conclusions:

Patients transitioning to the community setting following discharge are vulnerable and at risk for adverse sequelae, and transitional care management that does not end when the patient leaves the hospital setting is integral to promoting positive patient outcomes (Naylor, Aiken, Kurtzman, Olds, & Hirschman, 2011). The care management approach during the pandemic in one health care system precipitously shifted to an entirely virtual, remote model, and the team continued to provide transitional care support for hospitalized patients to avoid the common pitfalls that are associated with unfavorable outcomes.

Implications for Case Management Practice:

The insights gleaned from one health system's experiences during the pandemic are transferable to other facets of care management in routine circumstances, with emphasis on the avoidance of the common care management snares that lead to less than optimal patient outcomes. The development and implementation of multifaceted interventions, with the goals of supporting health-promoting behavior changes and self-care capacity for at risk populations, are relevant in the current health care environment.
A Survey of Hospice and Palliative Care Nurses' and Holistic Nurses' Perceptions of Spirituality and Spiritual Care
Authors: Lukovsky Julia , McGrath Elizabeth , Sun Carolyn , Frankl Daniel , Beauchesne Michelle A.
Published: November 2020

The provision of spiritual care is referred to in professional practice guidelines and mandated in nurses' ethical codes. Still, a gap exists regarding essential training in spiritual conversation and assessment, leaving some health care providers feeling uncomfortable when assessing spiritual support needs. The purpose of this study was to assess hospice and palliative nurses' and holistic nurses' perceptions of spirituality and spiritual care. It was assumed that the standards of care for hospice and palliative nurses and holistic nurses stipulate that spiritualty is addressed within the framework of their specialties and provide education for spiritual care, thus making these nurses proficient in providing spiritual care. This exploratory, descriptive study utilized a web-based survey to measure perception of spirituality and spiritual care giving using a modified Spirituality and Spiritual Care Rating Scale. A convenience sample was recruited from members of the Hospice and Palliative Nurses Association and the American Holistic Nurses Association (n = 250). Descriptive statistics summarized data as well as qualitative analysis of written narratives. Content analysis of open-ended survey questions was used to identify themes until saturation. This study found that given adequate resources and education, nurses can be positioned to address the spiritual needs of patients and provide appropriate care. This study adds to an emerging body of evidence suggesting that training in spiritual care should be an important component of the foundational nursing curriculum.
Mesh Sling Arm Removal for Persistent Pain After an Initial Vaginal Suburethral Mesh Sling Removal Procedure
Authors: Fuentes Jorge L. , Finsterbusch Carlos , Christie Alana L. , Zimmern Philippe E.
Published: November 2020

Objectives

Pain is a recognized complication of mid-urethral slings (MUS), which may lead to suburethral sling removal (SSR) alone, or to a more extensive removal approach. We report on the outcomes of women who required an SSR or an additional secondary MUS arm removal for pain only.

Methods

After Institutional Review Board (IRB) approval, the charts of nonneurogenic women who underwent SSR for pain only were reviewed. Demographic information, MUS type, self-reported pain resolution, and preoperative and postoperative questionnaires, including Urogenital Distress Inventory-Short form question 6 (UDI-6 Q6) scores, were collected for the SSR (group 1) and secondary removal (group 2) groups.

Results

Of 52 women who underwent SSR for pain only between 2005 and 2018, 16 (31%) required a secondary procedure to remove the extension arms due to persistent pain after SSR. All women in group 2 experienced pain immediately after SSR (UDI-6 Q6 score of 2 to 3). Patients whose pain improved after SSR presented at a median 61 months after MUS whereas those in group 2 underwent SSR at median 34 months after MUS. Median duration of follow-up in group 2, after the secondary procedure, was 34 months. Over one half of those in group 2 (54%) noticed pain cure/improvement. Seven were left with persistent pain.

Conclusions

In women who underwent SSR for pain only, 67% reported pain resolution. An additional procedure to remove the extension arms of the mesh was performed in one third of women for persistent pain after SSR.
The Effect of a Diagnosis on Patients With Interstitial Cystitis/Bladder Pain Syndrome: A Qualitative Approach
Authors: Volpe Katherine A. , Komatsu Emi , Rodriguez Larissa V. , Dancz Christina E. , Pahwa Avita K.
Published: November 2020

Introduction

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain condition that significantly affects patient quality of life. We investigated whether receiving a formal medical diagnosis of IC/BPS was perceived by patients to improve symptoms and disease-specific quality of life.

Methods

Participants with self-reported IC/BPS completed publicly available online surveys. Surveys included demographic information, validated questionnaires, and a free-text response. Participants were asked to comment on the utility of obtaining a diagnosis. Investigators coded the responses and analyzed the results using grounded theory methodology.

Results

Six hundred seventy-three participants who responded to the free-text were analyzed. The mean age of respondents was 52 years, with an average of 10 years since IC/BPS diagnosis. The IC/BPS pain syndrome diagnosis had wide ranging effects on both symptoms and coping. These effects were often mediated by improvements in perceived control and empowerment after diagnosis. Although most participants noted benefit after diagnosis of IC/BPS, some reported harmful effects ranging from stigmatization by providers to desperation when told that there was not a cure.

Conclusions

A formal medical diagnosis of IC/BPS has a significant effect on patients who experience the condition. Although diagnosis usually improves symptoms and coping, a universal experience was not described by all IC/BPS patients. Given that most patients report improvement, more work is needed to expedite diagnosis. In addition, we must better understand factors associated with lack of symptom and quality of life improvement after an IC/BPS diagnosis has been made by medical providers.
Postoperative Admission, Readmission, and Complications for Patients 60 Years and Older Who Are Undergoing an Isolated Sling Procedure for Stress Incontinence: A Database Study
Authors: Winkelman William D. , Jaresova Andrea , Modest Anna M. , Richardson Monica L.
Published: November 2020

Objective

The aim of the study was to determine the effect of increasing age on postoperative admission, readmission, and complications for patients 60 years and older who underwent a synthetic or autologous sling procedure for stress incontinence.

Methods

A retrospective cohort study of surgical cases from 2012 to 2017 from the American College of Surgeons National Surgical Quality Improvement Program database was conducted. Eligible patients were at least 60 years old and underwent an isolated sling procedure for stress incontinence identified by Current Procedural Terminology code 57288. Baseline demographics, preoperative comorbidities, and postoperative complications were obtained. Risk ratios (RRs) and 95% confidence intervals were calculated using log-binomial regressions.

Results

Of 3,960 eligible patients, 634 (16.0%) were admitted postoperatively. Admission rates differed across age groups (P = 0.04). For example, compared with patients aged 60–64 years, those aged 70–74 years had 1.3 times the risk of admission (95% confidence interval, 1.04–1.6). Other risk factors for admission included diabetes (RR, 1.3) and hypertension (RR, 1.2). Patients who had general anesthesia had 6.3 times the risk of admission compared with those who had monitored anesthesia/intravenous sedation. There were 72 patients (1.8%) readmitted within 30 days. There was no association between age and readmission. Risk factors for readmission included diabetes (RR, 1.8), bleeding disorders (RR, 3.4), severe chronic obstructive pulmonary disease (RR, 3.7), and congestive heart failure (RR, 11.3). There were 192 complications (4.8%), including 45 major complications (1.1%).

Conclusions

Among patients 60 years and older, the risk of postoperative admission and readmission for patients undergoing a synthetic or autologous sling procedure is low and complications are uncommon.
Unanticipated Uterine and Cervical Malignancy in Women Undergoing Hysterectomy for Uterovaginal Prolapse
Authors: Andiman Sarah E. , Bui Anthony H. , Hardart Anne , Xu Xiao
Published: November 2020

Objective

This study aimed to determine the prevalence of unanticipated uterine cancer and cervical cancer in women undergoing hysterectomy for uterovaginal prolapse.

Methods

Using data from the 2015–2018 American College of Surgeons National Surgical Quality Improvement Program, we identified adult women who underwent a hysterectomy with a concurrent procedure for uterovaginal prolapse. Patients who underwent a radical hysterectomy or had other procedures or diagnoses suggestive of preoperatively suspected or known gynecologic cancer were excluded. Our outcome measures were pathology-confirmed diagnoses of uterine cancer and cervical cancer. Bivariate statistical tests and multivariable logistic regression were used to identify patient characteristics associated with the likelihood of having unanticipated uterine cancer.

Results

Among 9,687 patients meeting the sample eligibility criteria (median age, 60 years), 51 (0.53%; 95% confidence interval, 0.39%–0.69%) had a diagnosis of uterine cancer. Forty-three (84.3%) were stage I-IB. Multivariable logistic regression showed that older age (adjusted odds ratio, 2.75; 95% confidence interval, 1.47–5.51, for age >60 vs 41–60 years) and uterine weight greater than 250 g (adjusted odds ratio, 4.34; 95% confidence interval, 1.48–10.79) were associated with a significantly higher likelihood of having unexpected uterine malignancy. In addition, in a subsample of 7,908 patients who underwent a total hysterectomy, 7 (0.09%; 95% confidence interval, 0.04%–0.18%) had a diagnosis of cervical cancer.

Conclusions

The risk of unexpected uterine cancer and cervical cancer in women undergoing hysterectomy for uterovaginal prolapse was relatively low but should be appropriately considered when counseling patients desiring uterine- or cervix-sparing procedures.
Home Biofeedback Versus Physical Therapy for Stress Urinary Incontinence: A Randomized Trial
Authors: Barnes Kara Lauren , Cichowski Sara , Komesu Yuko M. , Jeppson Peter C. , McGuire Brenna , Ninivaggio Cara S. , Dunivan Gena C.
Published: November 2020

Objective

The aim of the study was to assess whether home biofeedback is noninferior to supervised pelvic floor physical therapy (PFPT) for the treatment of stress urinary incontinence (SUI) in women.

Methods

The study used a randomized controlled noninferiority trial to compare a home biofeedback device with PFPT. Women older than 18 years with SUI and no history of a prior incontinence surgery or PFPT were eligible. Forty-two participants were required to determine noninferiority for the primary outcome, improvement in quality of life as measured by the International Consultation on Incontinence Questionnaire Short Form. The noninferiority margin was 4 points. Secondary outcomes included sexual function, overactive bladder symptoms, and patient impression of improvement.

Results

From June 2018 to October 2019, 54 women with SUI were recruited (27 biofeedback, 27 PFPT) and 43 (21 biofeedback, 22 PFPT) completed follow-up. The groups had comparable baseline characteristics. For the primary outcome of change in mean International Consultation on Incontinence Questionnaire–Short Form scores (where lower scores indicate less incontinence), home biofeedback was found to be noninferior to PFPT with a mean decrease from baseline of −3.95 (95% confidence interval [CI] = −2.21 to −5.70) in the home biofeedback group versus −4.73 (95% CI = −3.21 to −6.25) and −3.95 (95% CI = −2.21 to −5.70) in the PFPT group (P = 0.009). The PFPT group showed more improvement in overactive bladder symptoms, but not in incontinence severity without difference in sexual function.

Conclusions

Home biofeedback was noninferior to PFPT for the primary treatment of SUI in women at 3 months. These results support the use of personal biofeedback devices for the treatment of SUI.

Clinical Trial Registration: ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT03443687.
Leaf hydraulic safety margin and safety–efficiency trade-off across angiosperm woody species
Authors: Yan Chao-Long , Ni Ming-Yuan , Cao Kun-Fang , Zhu Shi-Dan
Published: November 2020

Leaf hydraulic conductance and the vulnerability to water deficits have profound effects on plant distribution and mortality. In this study, we compiled a leaf hydraulic trait dataset with 311 species-at-site combinations from biomes worldwide. These traits included maximum leaf hydraulic conductance (
K
leaf
), water potential at 50% loss of
K
leaf
(P50
leaf
), and minimum leaf water potential (
Ψ
min
). Leaf hydraulic safety margin (HSM
leaf
) was calculated as the difference between
Ψ
min
and P50
leaf
. Our results indicated that 70% of the studied species had a narrow HSM
leaf
(less than 1 MPa), which was consistent with the global pattern of stem hydraulic safety margin. There was a positive relationship between HSM
leaf
and aridity index (the ratio of mean annual precipitation to potential evapotranspiration), as species from humid sites tended to have larger HSM
leaf
. We found a significant relationship between
K
leaf
and P50
leaf
across global angiosperm woody species and within each of the different plant groups. This global analysis of leaf hydraulic traits improves our understanding of plant hydraulic response to environmental change.
Landscape-level toxicant exposure mediates infection impacts on wildlife populations
Authors: Sánchez Cecilia A. , Altizer Sonia , Hall Richard J.
Published: November 2020

Anthropogenic landscape modification such as urbanization can expose wildlife to toxicants, with profound behavioural and health effects. Toxicant exposure can alter the local transmission of wildlife diseases by reducing survival or altering immune defence. However, predicting the impacts of pathogens on wildlife across their ranges is complicated by heterogeneity in toxicant exposure across the landscape, especially if toxicants alter wildlife movement from toxicant-contaminated to uncontaminated habitats. We developed a mechanistic model to explore how toxicant effects on host health and movement propensity influence range-wide pathogen transmission, and zoonotic exposure risk, as an increasing fraction of the landscape is toxicant-contaminated. When toxicant-contaminated habitat is scarce on the landscape, costs to movement and survival from toxicant exposure can trap infected animals in contaminated habitat and reduce landscape-level transmission. Increasing the proportion of contaminated habitat causes host population declines from combined effects of toxicants and infection. The onset of host declines precedes an increase in the density of infected hosts in contaminated habitat and thus may serve as an early warning of increasing potential for zoonotic spillover in urbanizing landscapes. These results highlight how sublethal effects of toxicants can determine pathogen impacts on wildlife populations that may not manifest until landscape contamination is widespread.
Shrinking before our isles: the rapid expression of insular dwarfism in two invasive populations of guttural toad (
Sclerophrys gutturalis
)
Authors: Baxter-Gilbert James , Riley Julia L. , Wagener Carla , Mohanty Nitya P. , Measey John
Published: November 2020

Island ecosystems have traditionally been hailed as natural laboratories for examining phenotypic change, including dramatic shifts in body size. Similarly, biological invasions can drive rapid localized adaptations within modern timeframes. Here, we compare the morphology of two invasive guttural toad (
Sclerophrys gutturalis
) populations in Mauritius and Réunion with their source population from South Africa. We found that female toads on both islands were significantly smaller than mainland counterparts (33.9% and 25.9% reduction, respectively), as were males in Mauritius (22.4%). We also discovered a significant reduction in the relative hindlimb length of both sexes, on both islands, compared with mainland toads (ranging from 3.4 to 9.0%). If our findings are a result of natural selection, then this would suggest that the dramatic reshaping of an amphibian's morphology—leading to insular dwarfism—can result in less than 100 years; however, further research is required to elucidate the mechanism driving this change (e.g. heritable adaptation, phenotypic plasticity, or an interaction between them).
The impact of DNA adenine methyltransferase knockout on the development of triclosan resistance and antibiotic cross-resistance in Escherichia coli
Authors: Hughes Lewis , Roberts Wayne , Johnson Donna
Published: November 2020

Background. DNA adenine methyltransferase (dam) has been well documented for its role in regulation of replication, mismatch repair and transposition. Recent studies have also suggested a role for dam in protection against antibiotic stress, although this is not yet fully defined. We therefore evaluated the role of dam in the development of antibiotic resistance and triclosan-associated cross-resistance.

Results. A significant impact on growth rate was seen in the dam knockout compared to the parental strain. Known triclosan resistance-associated mutations in fabI were seen regardless of dam status, with an additional mutation in lrhA seen in the dam knockout. The expression of multiple antibiotic resistance-associated genes was significantly different between the parent and dam knockout post-resistance induction. Reversion rate assays showed that resistance mechanisms were stable.

Conclusions.
dam knockout had a significant effect on growth, but its role in the development of antibiotic resistance is likely confined to those antibiotics using acrAD-containing efflux pumps.
Arachidicoccus soli sp. nov., a bacterium isolated from soil
Authors: Lee Shin Ae , Kim Tae-Wan , Sang Mee-Kyung , Song Jaekyeong , Kwon Soon-Wo , Weon Hang-Yeon
Published: November 2020

A Gram-stain-negative, aerobic, non-motile and rod-shaped bacterium, designated KIS59-12T, was isolated from a soil sample collected on Hodo island, Boryeong, Republic of Korea. The strain grew at 10–33 °C, pH 6.0–7.5 and with 0–4 % NaCl (w/v). Results of phylogenetic analysis based on 16S rRNA gene sequences showed that strain KIS59-12T was in the same clade as

Arachidicoccus rhizosphaerae

Vu-144T and

Arachidicoccus ginsenosidivorans

Gsoil809T with 97.5 and 97.2 % sequence similarity, respectively. Comparative genome analysis between strain KIS59-12T and

A. rhizosphaerae

Vu-144T showed that average nucleotide identity value was 69.4 % and the digital DNA–DNA hybridization value was 19.1 %. The major respiratory quinone was menaquinone-7. The major polar lipids were phosphatidylethanolamine and an unknown polar lipid. The predominant cellular fatty acids were iso-C15 : 0, iso-C15 : 1 G and iso-C17 : 0 3-OH, which supported the affiliation of strain KIS59-12T with the genus

Arachidicoccus

. The major polyamines were homospermidine and putrescine. The genomic DNA G+C content was 36.4 mol%. On the basis of phylogenetic, physiological and chemotaxonomic characteristics, strain KIS59-12T represents a novel species of the genus

Arachidicoccus

, for which the name Arachidicoccus soli sp. nov. is proposed. The type strain of Arachidicoccus soli is KIS59-12T (=KACC 17340T=NBRC 113161T).
Nasopharyngeal Panbio COVID-19 antigen performed at point-of-care has a high sensitivity in symptomatic and asymptomatic patients with higher risk for transmission and older age
Authors: Masiá Mar , Fernández-González Marta , Sánchez Manuel , Carvajal Mar , García José Alberto , Gonzalo Nieves , de la Tabla Victoria Ortiz , Agulló Vanesa , Candela Inmaculada , Guijarro Jorge , Gutiérrez José Antonio , de Gregorio Carlos , Gutiérrez Félix
Published: November 2020

Background

Performance of point-of-care tests in clinical practice remains undetermined. We aimed to evaluate the performance of the nasopharyngeal Panbio COVID-19 antigen Rapid Test Device in real-life conditions in different clinical scenarios.

Method

Prospective study conducted in three primary care centers (PCC) and an emergency department. The antigen test was performed at point-of-care in nasopharyngeal and nasal swabs, and in saliva. Positive and negative percent agreement (PPA, NPA) were calculated with the RT-PCR assay as reference standard.

Results

Of 913 patients included, 296 (32.3%) were asymptomatic and 690 (75.6%) came from the PCC. Nasopharyngeal swabs were collected from 913, nasal swabs from 659, and saliva from 611 patients. RT-PCR was positive in 196 (21.5%) nasopharyngeal samples (NPS). Overall PPA (95% CI) in NPS was 60.5% (53.3-67.4), and it was lower in nasal swabs (44.7%) and saliva (23.1%). Test performance in NPS was largely dependent on the cycle threshold (Ct) in RT-PCR, with PPA>90% for Ct≤25 and ≥80% for Ct<30. In symptomatic patients, the PPA was 95% for Ct≤25; ≥85% for Ct<30, and 89% for the symptom triad of fever, cough and malaise. Performance was also dependent on age, with PPA of 100% in symptomatic patients >50 years with Ct<25. In asymptomatic patients, the PPA was 86% for Ct<25. In all cases, NPA was 100%.

Conclusion

The nasopharyngeal Panbio COVID-19 antigen test performed at point-of-care is highly sensitive in symptomatic patients, particularly with Ct<30 and older age. The test was useful to identify asymptomatic patients with lower Ct values and therefore with contagious risk.

Key points

The nasopharyngeal Panbio-COVID-19 antigen test performed in real-life conditions at point-of-care is highly sensitive in symptomatic patients, particularly with Ct<30 and older age. The test is useful to identify asymptomatic patients with lower Ct values and therefore with contagious risk.
Lossless Distributed Linear Mixed Model with Application to Integration of Heterogeneous Healthcare Data
Authors: Luo Chongliang , Islam Md. Nazmul , Sheils Natalie E. , Reps Jenna , Buresh John , Duan Rui , Tong Jiayi , Edmondson Mackenzie , Schumie Martijn J. , Chen Yong
Published: November 2020

Linear mixed models (LMMs) are commonly used in many areas including epidemiology for analyzing multi-site data with heterogeneous site-specific random effects. However, due to the regulation of protecting patients’ privacy, sensitive individual patient data (IPD) are usually not allowed to be shared across sites. In this paper we propose a novel algorithm for distributed linear mixed models (DLMMs). Our proposed DLMM algorithm can achieve exactly the same results as if we had pooled IPD from all sites, hence the lossless property. The DLMM algorithm requires each site to contribute some aggregated data (AD) in only one iteration. We apply the proposed DLMM algorithm to analyze the association of length of stay of COVID-19 hospitalization with demographic and clinical characteristics using the administrative claims database from the UnitedHealth Group Clinical Research Database.
Simple Accurate Regression-Based Forecasting of Intensive Care Unit Admissions due to COVID-19 in Ontario, Canada
Authors: Fisman David N. , Tuite Ashleigh R.
Published: November 2020

The pandemic caused by SARS-CoV-2 has proven challenging clinically, and at the population level, due to heterogeneity in both transmissibility and severity. Recent case incidence in Ontario, Canada (autumn 2020) has outstripped incidence in seen during the first (spring) pandemic wave; but has been associated with a lower incidence of intensive care unit (ICU) admissions and deaths. We hypothesized that differential ICU burden might be explained by increased testing volumes, as well as the shift in mean case age from older to younger. We constructed a negative binomial regression model using only three covariates, at a 2-week lag: log10(weekly cases); log10(weekly deaths); and mean weekly case age. This model reproduced observed ICU admission volumes, and demonstrated good preliminary predictive validity. Furthermore, when admissions were used in combination with ICU length of stay, our modeled estimates demonstrated excellent convergent validity with ICU occupancy data reported by the Canadian Institute for Health Information. Our approach needs external validation in other settings and at larger and smaller geographic scales, but appears to be a useful short-term forecasting tool for ICU resource demand; we also demonstrate that the virulence of SARS-CoV-2 infection has not meaningfully changed in Ontario between the first and second waves, but the demographics of those infected, and the fraction of cases identified, have.
Clinical Profile of First 1000 COVID-19 Cases Admitted at Tertiary Care Hospitals and the Correlates of their Mortality: An Indian Experience
Authors: Budhiraja Sandeep , Soni Aakriti , Jha Vinitaa , Indrayan Abhaya , Dewan Arun , Singh Omender , Singh Yogendra Pal , Chugh Indermohan , Arora Vijay , Pande Rajesh , Ansari Abdul , Jha Sujeet
Published: November 2020

Objective

To describe the clinical profile and factors leading to increased mortality in coronavirus disease (COVID-19) patients admitted to a group of hospitals in India.

Design

A records-based study of the first 1000 patients with a positive result on real-time reverse transcriptase-polymerase-chain-reaction assay for SARS-CoV-2 admitted to our facilities. Various factors such as demographics, presenting symptoms, co-morbidities, ICU admission, oxygen requirement and ventilator therapy were studied.

Results

Of the 1000 patients, 24 patients were excluded due to lack of sufficient data. Of the remaining 976 in the early phase of the epidemic, males were admitted twice as much as females (67.1% and 32.9%, respectively). Mortality in this initial phase was 10.6% and slightly higher for males and steeply higher for older patients. More than 8% reported no symptoms and the most common presenting symptoms were fever (78.3%), productive cough (37.2%), and dyspnea (30.64%). More than one-half (53.6%) had no co-morbidity. The major co-morbidities were hypertension (23.7%), diabetes without (15.4%), and with complications (9.6%). The co-morbidities were associated with higher ICU admissions, greater use of ventilators as well as higher mortality. A total of 29.9% were admitted to the ICU, with a mortality rate of 32.2%. Mortality was steeply higher in those requiring ventilator support (55.4%) versus those who never required ventilation (1.4%). The total duration of hospital stay was just a day longer in patients admitted to the ICU than those who remained in wards.

Conclusion

Male patients above the age of 60 and with co-morbidities faced the highest rates of mortality. They should be admitted to the hospital in early stage of the disease and given aggressive treatment to help reduce the morbidity and mortality associated with COVID-19.
Locus coeruleus integrity is related to tau burden and memory loss in autosomal-dominant Alzheimer’s disease
Authors: Dahl Martin J. , Mather Mara , Werkle-Bergner Markus , Kennedy Briana L. , Guzman Samuel , Hurth Kyle , Miller Carol A. , Qiao Yuchuan , Shi Yonggang , Chui Helena C. , Ringman John M.
Published: November 2020

Abnormally phosphorylated tau, an indicator of Alzheimer’s disease, accumulates in the first decades of life in the locus coeruleus (LC), the brain’s main noradrenaline supply. However, technical challenges in reliable in-vivo assessments have impeded research into the role of the LC in Alzheimer’s disease.

We studied participants with or known to be at-risk for mutations in genes causing autosomal-dominant Alzheimer’s disease (ADAD) of early onset, providing a unique window into the pathogenesis of Alzheimer’s largely disentangled from age-related factors. Using high- resolution MRI and tau PET, we revealed lower rostral LC integrity in symptomatic participants. LC integrity was associated with individual differences in tau burden and memory decline. Post- mortem analyses in a separate set of carriers of the same mutation confirmed substantial neuronal loss in the LC.

Our findings link LC degeneration to tau burden and memory in Alzheimer’s and highlight a role of the noradrenergic system in this neurodegenerative disease.
Community Detection in a Weighted Directed Hypergraph Representation of Cell-to-cell Communication Networks
Authors: Hou Rui , Small Michael , Forrest Alistair R. R.
Published: November 2020

Cell-to-cell communication is mainly triggered by ligand-receptor activities. Through ligandreceptor pairs, cells coordinate complex processes such as development, homeostasis, and immune response. In this work, we model the ligand-receptor-mediated cell-to-cell communication network as a weighted directed hypergraph. In this mathematical model, collaborating cell types are considered as a node community while the ligand-receptor pairs connecting them are considered a hyperedge community. We first define the community structures in a weighted directed hypergraph and develop an exact community detection method to identify these communities. We then modify approximate community detection algorithms designed for simple graphs to identify the nodes and hyperedges within each community. Application to synthetic hypergraphs with known community structure confirmed that one of the proposed approximate community identification strategies, named HyperCommunity algorithm, can effectively and precisely detect embedded communities. We then applied this strategy to two organism-wide datasets and identified putative community structures. Notably the method identifies non-overlapping edge-communities mediated by different sets of ligand-receptor pairs, however node-communities can overlap.