Background
Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on the degree and ...patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified barium swallow (MBS) study. Since its implementation in 2016, areas for the refinement of grading mild safety impairments have been identified by clinical and research users. The objective of this study was to assess the performance and validity of refined DIGESTsafety grading criteria (per DIGEST version 2 DIGESTv2).
Methods
Refined safety criteria were developed and vetted with clinical and research users. DIGESTv2 included 2 changes to the safety criteria. All MBSs with blinded DIGEST version 1 grading were sampled from a registry database (1331 patients underwent MBS over the period of December 2005 to July 2019). New criteria were applied to derive DIGESTsafety grading version 2. Measures of criterion validity, including the MD Anderson Dysphagia Inventory MDADI composite score, the Modified Barium Swallow Impairment Profile (MBSImP) pharyngeal total, the MBSImP hyolaryngeal components (items 8‐11), and the Performance Status Scale for Head and Neck Cancer Patients PSS‐HN diet, were correlated with DIGESTsafety and overall DIGEST grades from versions 1 and 2 and were compared pairwise between reassigned grades.
Results
With the application of version 2 safety criteria, 112 of 1331 examinations (8.4%) and 79 of 1331 examinations (5.9%) changed in their DIGESTsafety and overall grades, respectively. The safety and overall DIGEST grades (versions 1 and 2) significantly correlated with criterion measures, including the MBSImP pharyngeal total, laryngeal MBSImP parameters of interest, MDADI, and PSS‐HN (P < .0001); correlations maintained a similar magnitude between versions 1 and 2. Forty‐six upgraded examinations (reassigned from safety grade 1 per version 1 to grade 2 per version 2) performed similarly to other safety grade 2 examinations (version 1), and this was likewise true for 66 downgraded examinations (reassigned from safety grade 1 per version 1 to grade 0 per version 2).
Conclusions
Refined criteria defining mild safety impairments with the DIGEST methodology changed grades in small numbers of examinations. DIGESTv2 criteria maintained criterion validity, demonstrated ordinality, and improved the performance of the method in these rare scenarios.
Lay Summary
Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a method developed and validated by the investigators in 2016 to grade the severity of pharyngeal swallowing dysfunction (dysphagia) with a decision tree or flowsheet to guide the clinician's review of a standard radiographic modified barium swallow study.
This work reports on the validity of updated DIGEST criteria (version 2) that incorporate 2 modifications to the decision tree.
Version 2 of Dynamic Imaging Grade of Swallowing Toxicity (DIGESTv2) incorporates 2 modifications to the decision tree used by clinicians to grade mild (grade 1) safety impairments based on patterns of laryngeal penetration/aspiration on a radiographic modified barium swallow study. Key findings of this work include 1) the criterion validity of DIGESTv2 with respect to reference measures of clinician‐graded pharyngeal swallowing impairment and patient‐reported dysphagia and 2) the ordinality of DIGESTv2.
Background
Surgical mortality data are collected routinely in high‐income countries, yet virtually no low‐ or middle‐income countries have outcome surveillance in place. The aim was prospectively to ...collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).
Methods
This was a prospective, multicentre, cohort study. Self‐selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2‐week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.
Results
Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high‐, 2889 from middle‐ and 1318 from low‐HDI settings. The overall mortality rate was 1·6 per cent at 24 h (high 1·1 per cent, middle 1·9 per cent, low 3·4 per cent; P < 0·001), increasing to 5·4 per cent by 30 days (high 4·5 per cent, middle 6·0 per cent, low 8·6 per cent; P < 0·001). Of the 578 patients who died, 404 (69·9 per cent) did so between 24 h and 30 days following surgery (high 74·2 per cent, middle 68·8 per cent, low 60·5 per cent). After adjustment, 30‐day mortality remained higher in middle‐income (odds ratio (OR) 2·78, 95 per cent c.i. 1·84 to 4·20) and low‐income (OR 2·97, 1·84 to 4·81) countries. Surgical safety checklist use was less frequent in low‐ and middle‐income countries, but when used was associated with reduced mortality at 30 days.
Conclusion
Mortality is three times higher in low‐ compared with high‐HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov).
Higher in low‐income countries
We report an original noise-like pulse dynamics observed in a figure-eight fiber laser, in which fragments are continually released from a main waveform that circulates in the cavity. Particularly, ...we report two representative cases of the dynamics: in the first case the released fragments drift away from the main bunch and decay over a fraction of the round-trip time, and then vanish suddenly; in the second case, the sub-packets drift without decaying over the complete cavity round-trip time, until they eventually merge again with the main waveform. The most intriguing result is that these fragments, as well as the main waveform, are formed of units with sub-ns duration and roughly the same energy.
Background
Gallbladder mucocele (GBM) is an increasingly recognized extrahepatic biliary disease in dogs.
Objectives
To investigate cases of GBM and identify variables associated with survival and ...the sensitivity and specificity of ultrasonography to identify gallbladder rupture.
Animals
Two hundred and nineteen client‐owned dogs with GBM.
Methods
Multicenter, retrospective study of dogs with GBM, presented from January 2007 to November 2016 to 6 academic veterinary hospitals in the United States. Interrogation of hospital databases identified all cases with the inclusion criteria of a gross and histopathologic diagnosis of GBM after cholecystectomy and intraoperative bacteriologic cultures of at least 1 of the following: gallbladder wall, gallbladder contents, or abdominal effusion.
Results
Two hundred and nineteen dogs fulfilled the inclusion criteria. Dogs with GBM and gallbladder rupture with bile peritonitis at the time of surgery were 2.7 times more likely to die than dogs without gallbladder rupture and bile peritonitis (P = 0.001; 95% confidence interval CI, 1.50–4.68; n = 41). No significant associations were identified between survival and positive bacteriologic cultures, antibiotic administration, or time (days) from ultrasonographic identification of GBM to the time of surgery. The sensitivity, specificity, positive, and negative likelihood ratios for ultrasonographic identification of gallbladder rupture were 56.1% (95% CI, 39.9–71.2), 91.7% (95% CI, 85.3–95.6), 6.74, and 0.44, respectively.
Conclusion and Clinical Importance
Dogs in our study with GBM and intraoperative evidence of gallbladder rupture and bile peritonitis had a significantly higher risk of death. Additionally, abdominal ultrasonography had low sensitivity for identification of gallbladder rupture.
Gangliosides induced a smelting process in nanostructured amyloid fibril-like films throughout the surface properties contributed by glycosphingolipids when mixed with ...1-palmitoyl-2-oleoyl-phosphatidylcholine (POPC)/Aβ(1–40) amyloid peptide. We observed a dynamical smelting process when pre-formed amyloid/phospholipid mixture is laterally mixed with gangliosides. This particular environment, gangliosides/phospholipid/Aβ(1–40) peptide mixed interfaces, showed complex miscibility behavior depending on gangliosides content. At 0% of ganglioside covered surface respect to POPC, Aβ(1–40) peptide forms fibril-like structure. In between 5 and 15% of gangliosides, the fibrils dissolve into irregular domains and they disappear when the proportion of gangliosides reach the 20%. The amyloid interfacial dissolving effect of gangliosides is taken place at lateral pressure equivalent to the organization of biological membranes.
Domains formed at the interface are clearly evidenced by Brewster Angle Microscopy and Atomic Force Microscopy when the films are transferred onto a mica support. The domains are thioflavin T (ThT) positive when observed by fluorescence microscopy.
We postulated that the smelting process of amyloids fibrils-like structure at the membrane surface provoked by gangliosides is a direct result of a new interfacial environment imposed by the complex glycosphingolipids. We add experimental evidence, for the first time, how a change in the lipid environment (increase in ganglioside proportion) induces a rapid loss of the asymmetric structure of amyloid fibrils by a simple modification of the membrane condition (a more physiological situation).
Display omitted
•Pure and confined Aβ(1–40) peptide does not form amyloid aggregates at air-water interface.•POPC induces nanostructured ThT positive fibril-like assembles of Aβ(1–40) at low peptide/lipid proportion.•Physiological mixture of gangliosides prevents the formation of amyloids formed in phospholipid mixed monolayers.•Gangliosides dynamically smelt Aβ(1–40) amyloids induced by POPC in a membrane environment.
Seascape ecology, the marine-centric counterpart to landscape ecology, is rapidly emerging as an interdisciplinary and spatially explicit ecological science with relevance to marine management, ...biodiversity conservation, and restoration. While important progress in this field has been made in the past decade, there has been no coherent prioritisation of key research questions to help set the future research agenda for seascape ecology. We used a 2-stage modified Delphi method to solicit applied research questions from academic experts in seascape ecology and then asked respondents to identify priority questions across 9 interrelated research themes using 2 rounds of selection. We also invited senior management/conservation practitioners to prioritise the same research questions. Analyses highlighted congruence and discrepancies in perceived priorities for applied research. Themes related to both ecological concepts and management practice, and those identified as priorities include seascape change, seascape connectivity, spatial and temporal scale, ecosystem-based management, and emerging technologies and metrics. Highest-priority questions (upper tercile) received 50% agreement between respondent groups, and lowest priorities (lower tercile) received 58% agreement. Across all 3 priority tiers, 36 of the 55 questions were within a ±10% band of agreement. We present the most important applied research questions as determined by the proportion of votes received. For each theme, we provide a synthesis of the research challenges and the potential role of seascape ecology. These priority questions and themes serve as a roadmap for advancing applied seascape ecology during, and beyond, the UN Decade of Ocean Science for Sustainable Development (2021-2030).
We present a study of the magnetic properties of chemically disordered ferromagnetic FePt films of 100 nm thickness that have been grown by sputtering with different Ar pressures ( mTorr). We found ...that the residual stress can be controlled by the sputtering pressure, which in turn allows to tune the perpendicular magnetic anisotropy due to magnetoelastic effects. Films deposited at lower Ar pressures display an in-plane compressive stress that favors an out of plane component of the magnetization and the formation of a magnetic domain structure in the form of stripes. For higher pressures the stress is relaxed and the magnetic configuration changes to planar domains. These results show the possibility to accurately tune the initial magnetic state in films with potential applications in magnetoelectrically coupled devices.
The practice of prophylactic administration of a macrolide antimicrobial with rifampin (MaR) to apparently healthy foals with pulmonary lesions identified by thoracic ultrasonography (i.e., ...subclinically pneumonic foals) is common in the United States. The practice has been associated epidemiologically with emergence of R. equi resistant to MaR. Here, we report direct evidence of multi-drug resistance among foals treated with MaR. In silico and in vitro analysis of the fecal microbiome and resistome of 38 subclinically pneumonic foals treated with either MaR (n = 19) or gallium maltolate (GaM; n = 19) and 19 untreated controls was performed. Treatment with MaR, but not GaM, significantly decreased fecal microbiota abundance and diversity, and expanded the abundance and diversity of antimicrobial resistance genes in feces. Soil plots experimentally infected with Rhodococcus equi (R. equi) and treated with MaR selected for MaR-resistant R. equi, whereas MaR-susceptible R. equi out-competed resistant isolates in GaM-treated or untreated plots. Our results indicate that MaR use promotes multi-drug resistance in R. equi and commensals that are shed into their environment where they can persist and potentially infect or colonize horses and other animals.
The early stages of the palladium electrodeposition process onto a vitreous carbon (VC) substrate as well as the deposition of Cu on such Pd/VC modified surface were investigated using classical ...electrochemical techniques, atomic force microscopy (AFM) and scanning electron microscopy (SEM). Within the potential range considered the kinetics of the Pd electrodeposition from a PdCl
2 acid solution can be described by a model involving progressive nucleation on active sites and diffusion-controlled 3D growth. The nucleation rate constant,
A
0, and the number of active sites of the substrate,
N
0, were determined from the analysis of potentiostatic current transients on the basis of an existing theoretical model. The AFM images corroborated the progressive nucleation mechanism showing irregular palladium crystals randomly distributed over the VC surface, with different sizes and 3D morphological characteristics. The electrodeposition of Cu was carried out onto the characterized Pd/VC modified surface from a Cu
2+ containing solution using a well defined polarization routine. The SEM/EDX images confirmed the formation of Cu/Pd bimetallic crystals uniformly distributed on the VC surface and the in situ AFM images obtained during this process corroborated that Cu formed a core–shell structure with the Pd crystals. Nevertheless, the subsequent anodic stripping produced only a partial dissolution of the Cu deposits, and therefore, the formation of a Cu/Pd alloy could be inferred.
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