bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing length of hospital stay during COVID-19 pandemic in the USA, Italy and Germany
Authors: Jamshidi Babak , Jamshidi Zargaran Shahriar , Bekrizadeh Hakim , Rezaei Mansour , Najafi Farid
Published: March 2021

Background

COVID-19 is the most informative pandemic in history. These unprecedented recorded data give rise to some novel concepts, discussions and models. Macroscopic modeling of the period of hospitalization is one of these new issues.

Methods

Modeling of the lag between diagnosis and death is done by using two classes of macroscopic analytical methods: the correlation-based methods based on Pearson, Spearman and Kendall correlation coefficients, and the logarithmic methods of two types. Also, we apply eight weighted average methods to smooth the time series before calculating the distance. We consider five lags with the least distance. All the computations are conducted on Matlab R2015b.

Results

The length of hospitalization for the fatal cases in the USA, Italy and Germany are 2–10, 1–6 and 5–19 days, respectively. Overall, this length in the USA is 2 days more than that in Italy and 5 days less than that in Germany.

Conclusion

We take the distance between the diagnosis and death as the length of hospitalization. There is a negative association between the length of hospitalization and the case fatality rate. Therefore, the estimation of the length of hospitalization by using these macroscopic mathematical methods can be introduced as an indicator to scale the success of the countries fighting the ongoing pandemic.
Low Persistence of Genetic Rescue Across Generations in the Arctic Fox (Vulpes lagopus)
Authors: Lotsander Anna , Hasselgren Malin , Larm Malin , Wallén Johan , Angerbjörn Anders , Norén Karin
Published: March 2021

Genetic rescue can facilitate the recovery of small and isolated populations suffering from inbreeding depression. Long-term effects are however complex, and examples spanning over multiple generations under natural conditions are scarce. The aim of this study was to test for long-term effects of natural genetic rescue in a small population of Scandinavian Arctic foxes (Vulpes lagopus). By combining a genetically verified pedigree covering almost 20 years with a long-term dataset on individual fitness (n = 837 individuals), we found no evidence for elevated fitness in immigrant F2 and F3 compared to native inbred foxes. Population inbreeding levels showed a fluctuating increasing trend and emergence of inbreeding within immigrant lineages shortly after immigration. Between 0–5 and 6–9 years post immigration, the average number of breeding adults decreased by almost 22% and the average proportion of immigrant ancestry rose from 14% to 27%. Y chromosome analysis revealed that 2 out of 3 native male lineages were lost from the gene pool, but all founders represented at the time of immigration were still contributing to the population at the end of the study period through female descendants. The results highlight the complexity of genetic rescue and suggest that beneficial effects can be brief. Continuous gene flow may be needed for small and threatened populations to recover and persist in a longer time perspective.
Technological Advances to Address Current Issues in Entomology: 2020 Student Debates
Authors: Bernaola Lina , Darlington Molly , Britt Kadie , Prade Patricia , Roth Morgan , Pekarcik Adrian , Boone Michelle , Ricke Dylan , Tran Anh , King Joanie , Carruthers Kelly , Thompson Morgan , Ternest John J , Anderson Sarah E , Gula Scott W , Hauri Kayleigh C , Pecenka Jacob R , Grover Sajjan , Puri Heena , Vakil Surabhi Gupta
Published: March 2021

The 2020 Student Debates of the Entomological Society of America (ESA) were live-streamed during the Virtual Annual Meeting to debate current, prominent entomological issues of interest to members. The Student Debates Subcommittee of the National ESA Student Affairs Committee coordinated the student efforts throughout the year and hosted the live event. This year, four unbiased introductory speakers provided background for each debate topic while four multi-university teams were each assigned a debate topic under the theme ‘Technological Advances to Address Current Issues in Entomology’. The two debate topics selected were as follows: 1) What is the best taxonomic approach to identify and classify insects? and 2) What is the best current technology to address the locust swarms worldwide? Unbiased introduction speakers and debate teams began preparing approximately six months before the live event. During the live event, teams shared their critical thinking and practiced communication skills by defending their positions on either taxonomical identification and classification of insects or managing the damaging outbreaks of locusts in crops.
Transarterial management of advance lung cancer
Authors: Hori Shinichi , Nakamura Tatsuya , Kennoki Norifumi , Dejima Ikuo , Hori Atsushi
Published: March 2021

Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control with less doses of anti-neoplastic agents was warranted by trying transarterial administration to lung and mediastinal tumors. It is reported that both primary and metastatic tumors are fed by bronchial or other systemic arteries. The bronchial arterial embolization for hemoptysis has been introduced for clinical practice since 1973. Hemoptysis by not only benign but also malignant diseases has been well controlled by embolization. In recent decades, the technical elements for transarterial treatments have markedly improved. They make it possible to carry out precise procedures of selective catheter insertion to the tumor relating arteries. Current concepts of transarterial treatment, technical aspects and treatment outcomes are summarized. Tentative result from chemo-embolization for advanced lung cancer using recent catheter techniques was also described. It provides favorable local control and survival merits. It is considered that a population of lung cancer patients can benefit from transarterial management using small doses of anti-neoplastic agents, with less complications and less medical costs.
Deep convolutional neural network image processing method providing improved signal-to-noise ratios in electron holography
Authors: Asari Yusuke , Terada Shohei , Tanigaki Toshiaki , Takahashi Yoshio , Shinada Hiroyuki , Nakajima Hiroshi , Kanie Kiyoshi , Murakami Yasukazu
Published: March 2021

An image identification method was developed with the aid of a deep convolutional neural network (CNN) and applied to the analysis of inorganic particles using electron holography. Despite significant variation in the shapes of α-Fe2O3 particles that were observed by transmission electron microscopy, this CNN-based method could be used to identify isolated, spindle-shaped particles that were distinct from other particles that had undergone pairing and/or agglomeration. The averaging of images of these isolated particles provided a significant improvement in the phase analysis precision of the electron holography observations. This method is expected to be helpful in the analysis of weak electromagnetic fields generated by nanoparticles showing only small phase shifts.
Particle acceleration and magnetic field amplification in massive young stellar object jets
Authors: Araudo Anabella T , Padovani Marco , Marcowith Alexandre
Published: March 2021

Synchrotron radio emission from non-relativistic jets powered by massive protostars has been reported, indicating the presence of relativistic electrons and magnetic fields of strength ∼0.3–5 mG. We study diffusive shock acceleration and magnetic field amplification in protostellar jets with speeds between 300 and 1500 km s−1. We show that the magnetic field in the synchrotron emitter can be amplified by the non-resonant hybrid (Bell) instability excited by the cosmic ray streaming. By combining the synchrotron data with basic theory of Bell instability we estimate the magnetic field in the synchrotron emitter and the maximum energy of protons. Protons can achieve maximum energies in the range 0.04–0.65 TeV and emit γ rays in their interaction with matter fields. We predict detectable levels of γ rays in IRAS 16547−5247 and IRAS 16848−4603. The γ ray flux can be significantly enhanced by the gas mixing due to Rayleigh–Taylor instability. The detection of this radiation by the Fermi satellite in the GeV domain and the forthcoming Cherenkov Telescope Array at higher energies may open a new window to study the formation of massive stars, as well as diffusive acceleration and magnetic field amplification in shocks with velocities of about 1000 km s−1.
pion: simulating bow shocks and circumstellar nebulae
Authors: Mackey Jonathan , Green Samuel , Moutzouri Maria , Haworth Thomas J , Kavanagh Robert D , Zargaryan Davit , Celeste Maggie
Published: March 2021

Expanding nebulae are produced by mass-loss from stars, especially during late stages of evolution. Multidimensional simulation of these nebulae requires high resolution near the star and permits resolution that decreases with distance from the star, ideally with adaptive time-steps. We report the implementation and testing of static mesh-refinement in the radiation-magnetohydrodynamics (R-MHD) code pion, and document its performance for 2D and 3D calculations. The bow shock produced by a hot, magnetized, slowly rotating star as it moves through the magnetized ISM is simulated in 3D, highlighting differences compared with 2D calculations. Latitude-dependent, time-varying magnetized winds are modelled and compared with simulations of ring nebulae around blue supergiants from the literature. A 3D simulation of the expansion of a fast wind from a Wolf–Rayet star into the slow wind from a previous red supergiant phase of evolution is presented, with results compared with results in the literature and analytic theory. Finally, the wind–wind collision from a binary star system is modelled with 3D MHD, and the results compared with previous 2D hydrodynamic calculations. A python library is provided for reading and plotting simulation snapshots, and the generation of synthetic infrared emission maps using torus is also demonstrated. It is shown that state-of-the-art 3D MHD simulations of wind-driven nebulae can be performed using pion with reasonable computational resources. The source code and user documentation is made available for the community under a BSD3 licence.
Investigation of γ-ray variability and glitches of PSR J1420−6048
Authors: Lin Lupin Chun-Che , Wang Hui-Hui , Hui C Y , Takata Jumpei , Yeung Paul K H , Hu Chin-Ping , Kong A K H
Published: March 2021

PSR J1420−6048 is a young γ-ray pulsar with recurrent glitches. Utilizing long-term monitoring data obtained from the Fermi Gamma-ray Space Telescope, we found that PSR J1420−6048 has shown γ-ray flux variation and we also detected four glitches between 2008 and 2019. Two of the glitches are previously unknown, and their γ-ray spectrum also shows variability between each glitch. Because the results might be contaminated by background sources, we discuss whether the observed changes in flux and spectra were caused by artificial misallocations of photons from a nearby pulsar wind nebula (HESS J1420−607) and a pulsar (PSR J1418−6058), or by a change of the emission geometry from the target pulsar itself. We examine the correlation of the flux changes and the alternating pulse structure to investigate whether the emission geometry in the outer magnetosphere was changing. By assuming that the observational features did not totally result from the background environment, we compare our results with similar phenomena observed in other γ-ray pulsars. We propose that a strong crust crack can cause timing anomaly of a neutron star, which can affect the particle accelerations or pair creation regions, resulting in the changes of emission behaviours.
Chandra large-scale mapping of the Galactic Centre: probing high-energy structures around the central molecular zone
Authors: Wang Q Daniel
Published: March 2021

Recent observations have revealed interstellar features that apparently connect energetic activity in the central region of our Galaxy to its halo. The nature of these features, however, remains largely uncertain. We present a Chandra mapping of the central 2° × 4° field of the Galaxy, revealing a complex of X-ray-emitting threads plus plume-like structures emerging from the Galactic Centre (GC). This mapping shows that the northern plume or fountain is offset from a well-known radio lobe (or the GCL), which however may represent a foreground H ii region, and that the southern plume is well wrapped by a corresponding radio lobe recently discovered by MeerKAT. In particular, we find that a distinct X-ray thread, G0.17−0.41, is embedded well within a non-thermal radio filament, which is locally inflated. This thread with a width of ∼1.6 arcsec (FWHM) is ∼2.6 arcmin or 6 pc long at the distance of the GC and has a spectrum that can be characterized by a power law or an optically-thin thermal plasma with temperature ≳ 3 keV. The X-ray-emitting material is likely confined within a strand of magnetic field with its strength ≳ 1 mG, not unusual in such radio filaments. These morphological and spectral properties of the radio/X-ray association suggest that magnetic field re-connection is the energy source. Such re-connection events are probably common when flux tubes of antiparallel magnetic fields collide and/or become twisted in and around the diffuse X-ray plumes, representing blowout superbubbles driven by young massive stellar clusters in the GC. The understanding of the process, theoretically predicted in analog to solar flares, can have strong implications for the study of interstellar hot plasma heating, cosmic ray acceleration and turbulence.
Phylogenetic Permulations: A Statistically Rigorous Approach to Measure Confidence in Associations in a Phylogenetic Context
Authors: Saputra Elysia , Kowalczyk Amanda , Cusick Luisa , Clark Nathan , Chikina Maria
Published: March 2021

Many evolutionary comparative methods seek to identify associations between phenotypic traits or between traits and genotypes, often with the goal of inferring potential functional relationships between them. Comparative genomics methods aimed at this goal measure the association between evolutionary changes at the genetic level with traits evolving convergently across phylogenetic lineages. However, these methods have complex statistical behaviors that are influenced by nontrivial and oftentimes unknown confounding factors. Consequently, using standard statistical analyses in interpreting the outputs of these methods leads to potentially inaccurate conclusions. Here, we introduce phylogenetic permulations, a novel statistical strategy that combines phylogenetic simulations and permutations to calculate accurate, unbiased P values from phylogenetic methods. Permulations construct the null expectation for P values from a given phylogenetic method by empirically generating null phenotypes. Subsequently, empirical P values that capture the true statistical confidence given the correlation structure in the data are directly calculated based on the empirical null expectation. We examine the performance of permulation methods by analyzing both binary and continuous phenotypes, including marine, subterranean, and long-lived large-bodied mammal phenotypes. Our results reveal that permulations improve the statistical power of phylogenetic analyses and correctly calibrate statements of confidence in rejecting complex null distributions while maintaining or improving the enrichment of known functions related to the phenotype. We also find that permulations refine pathway enrichment analyses by correcting for nonindependence in gene ranks. Our results demonstrate that permulations are a powerful tool for improving statistical confidence in the conclusions of phylogenetic analysis when the parametric null is unknown.
Functional and Adaptive Significance of Promoter Mutations That Affect Divergent Myocardial Expressions of TRIM72 in Primates
Authors: Feng Yuanqing , Xu Hongzhan , Liu Jinghao , Xie Ning , Gao Lei , He Yanyun , Yao Yuan , Lv Fengxiang , Zhang Yan , Lu Jian , Zhang Wei , Li Chuan-Yun , Hu Xinli , Yang Ziheng , Xiao Rui-Ping
Published: March 2021

Cis-regulatory elements play important roles in tissue-specific gene expression and in the evolution of various phenotypes, and mutations in promoters and enhancers may be responsible for adaptations of species to environments. TRIM72 is a highly conserved protein that is involved in energy metabolism. Its expression in the heart varies considerably in primates, with high levels of expression in Old World monkeys and near absence in hominids. Here, we combine phylogenetic hypothesis testing and experimentation to demonstrate that mutations in promoter are responsible for the differences among primate species in the heart-specific expression of TRIM72. Maximum likelihood estimates of lineage-specific substitution rates under local-clock models show that relative to the evolutionary rate of introns, the rate of promoter was accelerated by 78% in the common ancestor of Old World monkeys, suggesting a role for positive selection in the evolution of the TRIM72 promoter, possibly driven by selective pressure due to changes in cardiac physiology after species divergence. We demonstrate that mutations in the TRIM72 promoter account for the differential myocardial TRIM72 expression of the human and the rhesus macaque. Furthermore, changes in TRIM72 expression alter the expression of genes involved in oxidative phosphorylation, which in turn affects mitochondrial respiration and cardiac energy capacity. On a broader timescale, phylogenetic regression analyses of data from 29 mammalian species show that mammals with high cardiac expression of TRIM72 have high heart rate, suggesting that the expression changes of TRIM72 may be related to differences in the heart physiology of those species.
Structures of Neisseria gonorrhoeae MtrR-operator complexes reveal molecular mechanisms of DNA recognition and antibiotic resistance-conferring clinical mutations
Authors: Beggs Grace A , Ayala Julio C , Kavanaugh Logan G , Read Timothy D , Hooks Grace M , Schumacher Maria A , Shafer William M , Brennan Richard G
Published: March 2021

Mutations within the mtrR gene are commonly found amongst multidrug resistant clinical isolates of Neisseria gonorrhoeae, which has been labelled a superbug by the Centers for Disease Control and Prevention. These mutations appear to contribute to antibiotic resistance by interfering with the ability of MtrR to bind to and repress expression of its target genes, which include the mtrCDE multidrug efflux transporter genes and the rpoH oxidative stress response sigma factor gene. However, the DNA-recognition mechanism of MtrR and the consensus sequence within these operators to which MtrR binds has remained unknown. In this work, we report the crystal structures of MtrR bound to the mtrCDE and rpoH operators, which reveal a conserved, but degenerate, DNA consensus binding site 5′-MCRTRCRN4YGYAYGK-3′. We complement our structural data with a comprehensive mutational analysis of key MtrR-DNA contacts to reveal their importance for MtrR-DNA binding both in vitro and in vivo. Furthermore, we model and generate common clinical mutations of MtrR to provide plausible biochemical explanations for the contribution of these mutations to multidrug resistance in N. gonorrhoeae. Collectively, our findings unveil key biological mechanisms underlying the global stress responses of N. gonorrhoeae.
The emerging role of the apelinergic system in kidney physiology and disease
Authors: Janssens Peter , Decuypere Jean-Paul , Bammens Bert , Llorens-Cortes Catherine , Vennekens Rudi , Mekahli Djalila
Published: March 2021

The apelinergic system (AS) is a novel pleiotropic system with an essential role in renal and cardiovascular physiology and disease, including water homeostasis and blood pressure regulation. It consists of two highly conserved peptide ligands, apelin and apela, and a G-protein-coupled apelin receptor. The two ligands have many isoforms and a short half-life and exert both similar and divergent effects. Vasopressin, apelin and their receptors colocalize in hypothalamic regions essential for body fluid homeostasis and interact at the central and renal levels to regulate water homeostasis and diuresis in inverse directions. In addition, the AS and renin–angiotensin system interact both systemically and in the kidney, with implications for the cardiovascular system. A role for the AS in diverse pathological states, including disorders of sodium and water balance, hypertension, heart failure, pre-eclampsia, acute kidney injury, sepsis and diabetic nephropathy, has recently been reported. Furthermore, several metabolically stable apelin analogues have been developed, with potential applications in diverse diseases. We review here what is currently known about the physiological functions of the AS, focusing on renal, cardiovascular and metabolic homeostasis, and the role of the AS in associated diseases. We also describe several hurdles and research opportunities worthy of the attention of the nephrology community.
Physical Therapy Management of an Individual With Post-COVID Syndrome: A Case Report
Authors: Mayer Kirby P , Steele Angela K , Soper Melissa K , Branton Jill D , Lusby Megan L , Kalema Anna G , Dupont-Versteegden Esther E , Montgomery-Yates Ashley A
Published: March 2021

Objective

The purpose of this case report is to provide the clinical presentation and physical therapist management for a patient with post–COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in patients with post–COVID syndrome.

Methods (Case Description)

A 37-year-old woman tested positive for SARS-CoV-2 and developed mild COVID-19 disease but did not require supplemental oxygen or hospitalization. The patient experienced persistent symptoms, including dyspnea, headaches, and cognitive fog. On day 62, they participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, obtaining 50% of their age-predicted 6-minute walk distance. They had minor reductions in muscle strength and cognitive function. Self-reported quality of life was 50, and they scored above established cut-off scores for provisional diagnosis of posttraumatic stress disorder (PTSD).

Results

The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Metabolic equivalent for task levels increased with variability over the course of the program. The patient’s muscle strength, physical function, and exercise capacity improved. 6-Minute walk distance increased by 199 m, equating to 80% of their age-predicted distance. Quality of life and PTSD scores did not improve. At evaluation after physical therapy, the patient was still experiencing migraines, dyspnea, fatigue, and cognitive dysfunction.

Conclusion

This case report described the clinical presentation and physical therapist management of a person with post–COVID syndrome, a novel health condition for which little evidence exists to guide rehabilitation examination and interventions. Physical therapists should consider cognitive function and emotional health in their plan of care for patients with post–COVID syndromes.

Impact

This case alerts physical therapists to post–COVID syndrome—which can include debilitating symptoms of decreased aerobic tolerance, anxiety, PTSD, and cognitive dysfunction—and to the role that therapists can play in assessing these symptoms and managing these patients.
Cardiopulmonary Exercise Testing to Assess Persistent Symptoms at 6 Months in People With COVID-19 Who Survived Hospitalization: A Pilot Study
Authors: Debeaumont David , Boujibar Fairuz , Ferrand-Devouge Eglantine , Artaud-Macari Elise , Tamion Fabienne , Gravier Francis-Edouard , Smondack Pauline , Cuvelier Antoine , Muir Jean-François , Alexandre Kevin , Bonnevie Tristan
Published: March 2021

Objective

The aim of this pilot study was to assess physical fitness and its relationship with functional dyspnea in survivors of COVID-19 6 months after their discharge from the hospital.

Methods

Data collected routinely from people referred for cardiopulmonary exercise testing (CPET) following hospitalization for COVID-19 were retrospectively analyzed. Persistent dyspnea was assessed using the modified Medical Research Council dyspnea scale.

Results

Twenty-three people with persistent symptoms were referred for CPET. Mean modified Medical Research Council dyspnea score was 1 (SD = 1) and was significantly associated with peak oxygen uptake (VO2peak; %) (rho = −0.49). At 6 months, those hospitalized in the general ward had a relatively preserved VO2peak (87% [SD = 20]), whereas those who had been in the intensive care unit had a moderately reduced VO2peak (77% [SD = 15]). Of note, the results of the CPET revealed that, in all individuals, respiratory equivalents were high, power-to-weight ratios were low, and those who had been in the intensive care unit had a relatively low ventilatory efficiency (mean VE/VCO2 slope = 34 [SD = 5]). Analysis of each individual showed that none had a breathing reserve <15% or 11 L/min, all had a normal exercise electrocardiogram, and 4 had a heart rate >90%.

Conclusion

At 6 months, persistent dyspnea was associated with reduced physical fitness. This study offers initial insights into the mid-term physical fitness of people who required hospitalization for COVID-19. It also provides novel pathophysiological clues about the underlaying mechanism of the physical limitations associated with persistent dyspnea. Those with persistent dyspnea should be offered a tailored rehabilitation intervention, which should probably include muscle reconditioning, breathing retraining, and perhaps respiratory muscle training.

Impact

This study is the first, to our knowledge, to show that a persistent breathing disorder (in addition to muscle deconditioning) can explain persistent symptoms 6 months after hospitalization for COVID-19 infection and suggests that a specific rehabilitation intervention is warranted.
Steroid-sparing effect of anakinra in giant-cell arteritis: a case series with clinical, biological and iconographic long-term assessments
Authors: Deshayes Samuel , Ly Kim-Heang , Rieu Virginie , Maigné Gwénola , Martin Silva Nicolas , Manrique Alain , Monteil Jacques , de Boysson Hubert , Aouba Achille ,   the French Study Group for Large Vessel Vasculitis (GEFA)
Published: March 2021

Objectives

The treatment of GCA relies on corticosteroids but is burdened by a high rate of relapses and adverse effects. Anti-IL-6 treatments show a clear benefit with a significant steroid-sparing effect, but late relapses occur after treatment discontinuation. In addition to IL-6, IL-1 also appears to play a significant role in GCA pathophysiology. We report herein the efficacy of anakinra, an IL-1 receptor antagonist, in six GCA patients exhibiting corticosteroid dependence or resistance, specifically analysing the outcome of aortitis in four of them.

Methods

This retrospective study analysed the cases of all GCA patients treated with anakinra from the French Study Group for Large Vessel Vasculitis.

Results

After a median duration of anakinra therapy of 19 (18–32) months, all six patients exhibited complete clinical and biological remission. Among the four patients with large-vessel involvement, one had a disappearance of aortitis under anakinra and three showed a decrease in vascular uptake. After a median follow-up of 56 (48–63) months, corticosteroids were discontinued in four patients, and corticosteroid dosage could be decreased to 5 mg/day in two patients. One patient relapsed 13 months after anakinra introduction in the context of increasing the daily anakinra injection interval to every 48 h. Three patients experienced transient injection-site reactions, and one patient had pneumonia.

Conclusion

In this short series, anakinra appears to be an efficient and safe steroid-sparing agent in refractory GCA, with a possible beneficial effect on large-vessel involvement.
No Evidence of Resistance to Trifloxystrobin, Triflumizole, and Boscalid in Podosphaera leucotricha Isolates From U.S. Commercial Apple Orchards
Authors: Gañán-Betancur Lederson , Peever Tobin L. , Amiri Achour
Published: March 2021

Apple powdery mildew, caused by Podosphaera leucotricha, continues to be a challenge in commercial apple orchards in the U.S. Pacific Northwest and worldwide. In this study, P. leucotricha isolates were collected in 2018 and 2019 from two organic (baseline) and eight conventional (exposed) apple orchards in Washington, New York, and Virginia, and assessed for their sensitivity to trifloxystrobin (TRI, n = 232), triflumizole (TFZ, n = 217), and boscalid (BOS, n = 240) using a detached leaf assay. Effective concentrations inhibiting 50% growth (EC50) were not significantly different between baseline and exposed isolates, and ranged from 0.001 to 0.105, 0.09 to 6.31, and 0.05 to 2.18 µg/ml, for TRI, TFZ, and BOS, respectively. Reduction in sensitivity by factors of 105, 63, and 22 to TRI, TFZ, and BOS, respectively, were observed in some isolates, but all isolates were controlled by the commercial label rates of the three fungicides on detached leaves. Sequencing of the cytochrome b (cytb), cytochrome P450 sterol 14α-demethylase (CYP51), and the iron-sulfur protein subunit (SdhB) genes in isolates with high EC50 revealed no mutation previously reported to confer resistance to these fungicides in other fungi, and presence of a group I intron after codon 143 in the cytb gene. Significant (P < 0.001) moderate positive correlations (r = 0.38) observed between sensitivity to TRI and TFZ warrant continuous rotations of fungicides with different modes of action in conventional orchards. The established baseline sensitivities and the molecular markers will help in selecting discriminatory doses and bypassing the challenging in vivo testing for future sensitivity monitoring in P. leucotricha.
Changes in Stress and Workplace Shortages Reported by U.S. Critical Care Physicians Treating Coronavirus Disease 2019 Patients*
Authors: Gray Bradley M. , Vandergrift Jonathan L. , Barnhart Brendan J. , Reddy Siddharta G. , Chesluk Benjamin J. , Stevens Jennifer S. , Lipner Rebecca S. , Lynn Lorna A. , Barnett Michael L. , Landon Bruce E.
Published: March 2021

OBJECTIVES:

Eleven months into the coronavirus disease 2019 pandemic, the country faces accelerating rates of infections, hospitalizations, and deaths. Little is known about the experiences of critical care physicians caring for the sickest coronavirus disease 2019 patients. Our goal is to understand how high stress levels and shortages faced by these physicians during Spring 2020 have evolved.

DESIGN:

We surveyed (October 23, 2020 to November 16, 2020) U.S. critical care physicians treating coronavirus disease 2019 patients who participated in a National survey earlier in the pandemic (April 23, 2020 to May 3, 2020) regarding their stress and shortages they faced.

SETTING:

ICU.

PATIENTS:

Coronavirus disease 2019 patients.

INTERVENTION:

Irrelevant.

MEASUREMENT:

Physician emotional distress/physical exhaustion: low (not at all/not much), moderate, or high (a lot/extreme). Shortage indicators: insufficient ICU-trained staff and shortages in medication, equipment, or personal protective equipment requiring protocol changes.

MAIN RESULTS:

Of 2,375 U.S. critical care attending physicians who responded to the initial survey, we received responses from 1,356 (57.1% response rate), 97% of whom (1,278) recently treated coronavirus disease 2019 patients. Two thirds of physicians (67.6% [864]) reported moderate or high levels of emotional distress in the Spring versus 50.7% (763) in the Fall. Reports of staffing shortages persisted with 46.5% of Fall respondents (594) reporting a staff shortage versus 48.3% (617) in the Spring. Meaningful shortages of medication and equipment reported in the Spring were largely alleviated. Although personal protective equipment shortages declined by half, they remained substantial.

CONCLUSIONS:

Stress, staffing, and, to a lesser degree, personal protective equipment shortages faced by U.S. critical care physicians remain high. Stress levels were higher among women. Considering the persistence of these findings, rising levels of infection nationally raise concerns about the capacity of the U.S. critical care system to meet ongoing and future demands.
Postintensive Care Syndrome in Survivors of Critical Illness Related to Coronavirus Disease 2019: Cohort Study From a New York City Critical Care Recovery Clinic*
Authors: Martillo Miguel A. , Dangayach Neha S. , Tabacof Laura , Spielman Lisa A. , Dams-O’Connor Kristen , Chan Christy C. , Kohli-Seth Roopa , Cortes Mar , Escalon Miguel X.
Published: March 2021

OBJECTIVE:

Determine the characteristics of postintensive care syndrome in the cognitive, physical, and psychiatric domains in coronavirus disease 2019 ICU survivors.

DESIGN:

Single-center descriptive cohort study from April 21, to July 7, 2020.

SETTING:

Critical care recovery clinic at The Mount Sinai Hospital in New York City.

PATIENTS:

Adults who had critical illness due to coronavirus disease 2019 requiring an ICU stay of 7 days or more and who agreed to a telehealth follow-up in the critical care recovery clinic 1-month post hospital discharge.

INTERVENTIONS:

None.

MEASURES AND MAIN RESULTS:

Patient-reported outcome measures assessing physical and psychiatric domains were collected electronically, a cognitive test was performed by a clinician, and clinical data were obtained through electronic medical records. Outcome measures assessed postintensive care syndrome symptoms in the physical (Modified Rankin Scale, Dalhousie Clinical Frailty Scale, Neuro-Quality of Life Upper Extremity and Lower Extremity Function, Neuro-Quality of Life Fatigue), psychiatric (Insomnia Severity Scale; Patient Health Questionnaire-9; and Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and cognitive (Telephone Montreal Cognitive Assessment) domains. The 3-Level Version of Euro-QoL-5D was used to assess the physical and psychiatric domains. A diagnosis of postintensive care syndrome was made in cases with evidence of impairment in at least one postintensive care syndrome domain. We included 45 patients with a mean (sd) age of 54 (13) years, and 73% were male. Ninety-one percent of coronavirus disease 2019 ICU survivors fit diagnostic criteria for postintensive care syndrome. 86.7 % had impairments in the physical domain, 22 (48%) reported impairments in the psychiatric domain, and four (8%) had impairments on cognitive screening. We found that 58% had some degree of mobility impairment. In the psychiatric domain, 38% exhibited at least mild depression, and 18 % moderate to severe depression. Eighteen percent presented Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, scores suggestive of posttraumatic stress syndrome diagnosis. In the Telephone Montreal Cognitive Assessment, 9% had impaired cognition.

CONCLUSIONS:

Survivors of critical illness related to coronavirus disease 2019 are at high risk of developing postintensive care syndrome. These findings highlight the importance of planning for appropriate post-ICU care to diagnose and treat this population.
Examination of mechanism effects in cognitive behavioral therapy and pain education: analyses of weekly assessments
Authors: Burns John W. , Gerhart James , Van Dyke Benjamin P. , Morais Calia A. , Newman Andrea K. , Thorn Beverly
Published: March 2021

Psychosocial treatments for chronic pain produce favorable outcomes. However, we still do not know precisely by what mechanisms or techniques these outcomes are wrought. In secondary analyses of a 10-week group intervention study comparing the effects of literacy-adapted cognitive behavioral therapy (CBT) with literacy-adapted pain education (EDU) among patients with chronic pain, low-socioeconomic status, and low literacy, the Learning About My Pain trial, we examined whether pain catastrophizing was a mechanism specific to CBT. Participants (N = 168) completed mechanism and outcome measures weekly for the 10 weeks of group treatment. Analyses revealed that (1) pain catastrophizing was reduced similary across CBT and EDU; (2) lagged analyses indicated that previous week reductions in pain catastrophizing predicted next week reductions in pain intensity and pain interference; (3) cross-lagged analyses indicated that previous week reductions in pain intensity and interference predicted next week reductions in pain catastrophizing; and (4) the relationships between pain catastrophizing and pain intensity and interference were moderated by session progression such that these links were strong and significant in the first third of treatment, but weakened over time and became nonsignificant by the last third of treatment. Results suggest the existence of reciprocal influences whereby cognitive changes may produce outcome improvements and vice versa. At the same time, results from analyses of changes in slopes between pain catastrophizing and outcomes indicated that CBT and EDU were successful in decoupling pain catastrophizing and subsequent pain intensity and interference as treatment progressed. Results provide further insights into how psychosocial treatments for chronic pain may work.
Comparative differences in musculoskeletal pain consultation and analgesic prescription for people with dementia: a UK-wide matched cohort study
Authors: Bullock Laurna , Bedson John , Chen Ying , Chew-Graham Carolyn A. , Campbell Paul
Published: March 2021

Painful musculoskeletal conditions are common in older adults; however, pain identification, assessment, and management are reported to be suboptimal for people with dementia. Adequate pain management is an integral aspect of care for people with dementia to prevent or delay negative outcomes, such as behavioural and psychological changes, emergency department attendance, and premature nursing home admission. This study aims to examine musculoskeletal consultations and analgesic prescriptions for people with dementia compared with those for people without dementia. A dementia cohort (n = 36,582) and matched cohort were identified in the Clinical Practice Research Datalink (a UK-wide primary care database). Period prevalence for musculoskeletal consultations and analgesic prescriptions was described, and logistic regression applied to estimate associations between dementia and musculoskeletal consultation or analgesic prescription from the time of dementia diagnosis to 5 years after diagnosis. People with dementia had a consistently (over time) lower prevalence and odds of musculoskeletal consultation and analgesic prescription compared with people without dementia. The evidence suggests that pain management may be suboptimal for people with dementia. These results highlight the need to increase awareness of pain and use better methods of pain assessment, evaluation of treatment response, and acceptable and effective management for people with dementia, in primary care.
Spinal cord stimulation for the management of painful diabetic neuropathy: a systematic review and meta-analysis of individual patient and aggregate data
Authors: Duarte Rui V. , Nevitt Sarah , Maden Michelle , Meier Kaare , Taylor Rod S. , Eldabe Sam , de Vos Cecile C.
Published: March 2021

Spinal cord stimulation (SCS) has been suggested as a treatment option for patients with painful diabetic neuropathy (PDN). We conducted a systematic review and undertook a meta-analysis on individual patient data from randomised controlled trials (RCTs) to assess the effectiveness of SCS for the management of PDN. Electronic databases were searched from inception to May 2020 for RCTs of SCS for PDN. Searches identified 2 eligible RCTs (total of 93 patients with PDN) and 2 long-term follow-up studies of one of the RCTs. Individual patient data were obtained from the authors of one of these RCTs. Meta-analysis showed significant and clinically meaningful reductions in pain intensity for SCS compared with best medical therapy alone, pooled mean difference (MD) −3.13 (95% confidence interval [CI]: −4.19 to −2.08) on a 10-point scale at the 6-month follow-up. More patients receiving SCS achieved at least a 50% reduction in pain intensity compared with best medical therapy, pooled risk ratio 0.08 (95% CI: 0.02-0.38). Increases were observed for health-related quality of life assessed as EQ-5D utility score (pooled MD 0.16, 95% CI: 0.02-0.30) and visual analogue scale (pooled MD 11.21, 95% CI: 2.26-20.16). Our findings demonstrate that SCS is an effective therapeutic adjunct to best medical therapy in reducing pain intensity and improving health-related quality of life in patients with PDN. Large well-reported RCTs with long-term follow-up are required to confirm these results.
Cannabinoids, the endocannabinoid system, and pain: a review of preclinical studies
Authors: Finn David P. , Haroutounian Simon , Hohmann Andrea G. , Krane Elliot , Soliman Nadia , Rice Andrew S.C.
Published: March 2021

This narrative review represents an output from the International Association for the Study of Pain's global task force on the use of cannabis, cannabinoids, and cannabis-based medicines for pain management, informed by our companion systematic review and meta-analysis of preclinical studies in this area. Our aims in this review are (1) to describe the value of studying cannabinoids and endogenous cannabinoid (endocannabinoid) system modulators in preclinical/animal models of pain; (2) to discuss both pain-related efficacy and additional pain-relevant effects (adverse and beneficial) of cannabinoids and endocannabinoid system modulators as they pertain to animal models of pathological or injury-related persistent pain; and (3) to identify important directions for future research. In service of these goals, this review (1) provides an overview of the endocannabinoid system and the pharmacology of cannabinoids and endocannabinoid system modulators, with specific relevance to animal models of pathological or injury-related persistent pain; (2) describes pharmacokinetics of cannabinoids in rodents and humans; and (3) highlights differences and discrepancies between preclinical and clinical studies in this area. Preclinical (rodent) models have advanced our understanding of the underlying sites and mechanisms of action of cannabinoids and the endocannabinoid system in suppressing nociceptive signaling and behaviors. We conclude that substantial evidence from animal models supports the contention that cannabinoids and endocannabinoid system modulators hold considerable promise for analgesic drug development, although the challenge of translating this knowledge into clinically useful medicines is not to be underestimated.
Hospital Policies During COVID-19: An Analysis of Visitor Restrictions
Authors: Jaswaney Rohit , Davis Arlene , Cadigan R. Jean , Waltz Margaret , Brassfield Elizabeth R. , Forcier Bex , Joyner Benny L.
Published: March 2021

Objective:

In response to the COVID-19 pandemic, hospitals have developed visitor restriction policies in order to mitigate spread of infection. We reviewed hospital visitor restriction policies for consistency and to develop recommendations to highlight fair and transparent restrictions, exceptions, and appeals in policy development and implementation.

Design:

Collection and analysis of public-facing visitor restriction policies during the first 3 months of the pandemic.

Setting:

General acute care hospitals representing 23 states across all 4 major regions of the United States.

Participants:

A cohort of the 70 largest hospitals by total bed capacity.

Measurements:

Characteristics of visitor restriction policies including general visitor restriction statement, changes/updates to policies over time, exceptions to policies, and restrictions specific to COVID-19–positive patients.

Results:

Sixty-five of the 70 hospitals reviewed had public-facing visitor restriction policies. Forty-nine of these 65 policies had general “no-visitor” statements, whereas 16 allowed at least 1 visitor to accompany all patients. Sixty-three of 65 hospitals included exceptions to their visitor restriction policies. Setting-specific exceptions included pediatrics, obstetrics/gynecology, emergency department, behavioral health, inpatient rehabilitation, surgery, and outpatient clinics. Exceptions that applied across settings included patients at end of life and patients with disabilities.

Conclusion:

Visitor restriction policies varied significantly among hospitals in this review. These variances create challenges in that their fair application may be problematic and ethical issues related to allocation may arise. Five recommendations are offered for hospitals revising or creating such policies, including that offering transparent, accessible, public-facing policies can minimize ethical dilemmas. In addition, hospitals would benefit from communicating with each other in the development of visitor policies to ensure uniformity and support patients and family members as they navigate hospital visitation.
Lessons Learned From Miami-Dade County's COVID-19 Epidemic: Making Surveillance Data Accessible for Policy Makers
Authors: Williams Roy , Bursac Zoran , Trepka Mary Jo , Odom Gabriel J.
Published: March 2021

Introduction:

COVID-19 represents an unprecedented challenge to policy makers as well as those entrusted with capturing, monitoring, and analyzing COVID-19 data. Effective public policy is data-informed policy. This requires a liaison between public health scientists and public officials.

Objective:

This article details the experience, challenges, and lessons learned advising public officials in a large metropolitan area from March to October 2020.

Methods:

To effectively do this, an R Markdown report was created to iteratively monitor the number of COVID-19 tests performed, positive tests obtained, COVID-19 hospitalization census, intensive care unit census, the number of patients with COVID-19 on ventilators, and the number of deaths due to COVID-19.

Results:

These reports were presented and discussed at meetings with policy makers to further comprehension.

Discussion:

To facilitate the fullest understanding by both the general public and policy makers alike, we advocate for greater centralization of public health surveillance data, objective operational definitions of metrics, and greater interagency communication to best guide and inform policy makers. Through consistent data reporting methods, parsimonious and consistent analytic methods, a clear line of communication with policy makers, transparency, and the ability to navigate unforeseen externalities such as “data dumps” and reporting delays, scientists can use information to best support policy makers in times of crises.