Clinical practice guidelines are essential for promoting evidence-based healthcare. While diversification of panel members can reduce disparities in care, processes for panel selection lack ...transparency. We aim to share our approach in forming a diverse expert panel for the updated Adult Critical Care Ultrasound Guidelines.
This process evaluation aims to understand whether the implementation of a transparent and intentional approach to guideline panel selection would result in the creation of a diverse expert guideline panel.
This study was conducted in the setting of creating a guideline panel for the updated Adult Critical Care Ultrasound Guidelines.
Understanding that family/patient advocacy in guideline creations can promote the impact of a clinical practice guideline, patient representation on the expert panel was prioritized.
Interventions included creation of a clear definition of expertise, an open invitation to the Society of Critical Care Medicine membership to apply for the panel, additional panel nomination by guideline leadership, voluntary disclosure of pre-identified diversity criteria by potential candidates, and independent review of applications including diversity criteria. This resulted in an overall score per candidate per reviewer and an open forum for discussion and final consensus.
The variables of diversity were collected and analyzed after panel selection. These were compared with historical data on panel composition. The final guideline panel comprised of 33 panelists from six countries: 45% women and 79% historically excluded people and groups. The panel has representation from nonphysician professionals and patients advocates. Of the healthcare professionals, there is representation from early, mid, and late career stages.
Our intentional and transparent approach resulted in a panel with improved gender parity and robust diversity along ethnic, racial, and professional lines. We hope it can serve as a starting point as we strive to become a more inclusive and diverse discipline that creates globally representative guidelines.
The circulation of Aichi virus in a major urban area was demonstrated using molecular detection with samples recovered from a major river polluted with sewage discharges in Caracas, Venezuela. Five ...out of 11 water samples studied were positive, being classified by phylogenetic analysis as genotype B. Analysis of sewage waters appears to be a useful methodology to uncover the presence of a hitherto undetected fecal pathogen in a given geographical area.
Abstract
Objectives
To evaluate the biologic impact of polydioxanone (PDO) stenting in an animal model of inflammatory tracheal stenosis (TS). Additionally, to compare these results with those ...obtained in the same model without a stent and after placing one PDO stent in a healthy trachea.
Methods
40 adult NZ rabbits were distributed into 3 groups: Group A, 8 animals with a healthy trachea and a PDO stent; group B, 17 rabbits with a TS and no stent; and group C, 15 animals with TS and a PDO stent. Histopathological studies included Masson’s trichrome staining for submucosal fibrosis and Safranin O to assess structural integrity of cartilage. Morphometric analyses were performed in the 3 groups.
Results
Stent placement was successful in every case. Histological studies did not show a significant increase in tracheal wall collagen area and cartilage structure was not modified in those rabbits with a PDO stent, even in a TS scenario. Stent implantation permitted recovery of normal tracheal lumen levels in the TS model.
Conclusions
PDO stenting in the normal trachea and in a model of TS neither caused increase in the collagen matrix nor modification of the cartilaginous support. Additionally, radial force exhibited by PDO stents was effective in restoring normal tracheal lumen when placed in a stenotic lesion. These findings suggest that they may be safe and useful in the setting of an acquired TS.
Tracheal stenosis (TS) is a rare disease in children and is usually classified as congenital or acquired.
Familial Hypercholesterolemia (FH) is characterized by elevated LDL-cholesterol (LDL-C) and high atherosclerosis risk. The impact of different dietary patterns on atherosclerosis biomarkers has been ...poorly studied in FH.
This study verified the association of adherence to a Mediterranean diet with biomarkers of dyslipidemia and low-grade inflammation in molecularly proven FH adults from Brazil (BR) and Spain (SP).
In this cross-sectional study adherence to the Mediterranean diet was assessed by a validated score and generalized estimating equations were used to evaluate its association with plasma LDL-C, apolipoprotein-B (ApoB) and high sensitivity C-reactive protein (hs-CRP) concentrations. We included 92 (mean age 45 years, 58.7% females) and 98 FH individuals (mean age 46.8 years, 60.2% females) respectively from BR and SP. FH causing variants did not differ between countries. LDL-C, ApoB and hs-CRP concentrations were higher in BR than in SP: 179 (135–250) and 161 (133–193) mg/dL; 141 (109–181) and 103 (88–134) mg/dL; and 1.6 (0.8–4.0) and 0.8 (0.4–1.5) mg/L respectively (all p < 0.001). Most of BR had low adherence (n = 77, 83.7%), while the majority of SP were divided into moderate (n = 35, 35.7%) and strong adherence to the Mediterranean diet (n = 37, 37.8%), p < 0.001. There was a significant inverse association of adherence to the Mediterranean diet score with higher LDL-C, ApoB, and hs-CRP after adjusting for socio economic parameters, caloric and fatty acid intakes as well as pharmacological lipid lowering therapies.
Higher adherence to a Mediterranean diet was associated with better dyslipidemia and low-grade inflammation profiles in FH.
•The impact of different dietary patterns on atherosclerosis biomarkers has been poorly studied in FH.•Dyslipidemia and inflammation were higher in Brazilian FH patients.•Spanish FH patients had greater adherence to a Mediterranean diet.•Adherence to a Mediterranean diet was associated with less dyslipidemia and inflammation.•Diet may influence cardiovascular risk in FH.
The target of rapamycin (TOR) is a conserved Ser/Thr kinase that controls cell growth by activating an array of anabolic processes including protein synthesis, transcription, and ribosome biogenesis, ...and by inhibiting catabolic processes such as mRNA degradation and autophagy. Control of autophagy by TOR occurs primarily at the induction step, and involves activation of the ATG1 kinase, a conserved component of the autophagic machinery. A substantial number of genes participating in autophagy have been originally identified in yeast. Most of these genes have mammalian homologues and many have apparent homologues in plants, indicating that autophagy is conserved among eukaryotes. The recent identification of TOR as a key element in cell growth control in plants and algae opens the way for future studies to investigate whether this signaling pathway may also control autophagy in photosynthetic organisms.
Despite its key role in population dynamics and evolutionary ecology, little is known about factors shaping survival in long-lived territorial species. Here, we assessed several hypotheses that might ...explain variability in survival in a migratory Spanish population of a long-lived territorial species, the Egyptian vulture Neophron percnopterus, using a 16- year monitoring period and live-encounter histories of 835 individually marked birds. Cormack-Jolly-Seber capture-recapture models showed no evidence for effects of sex or nestling body condition on survival. However, the normalized difference vegetation index (NDVI; an indicator of primary productivity) of natal territories had positive effects on juvenile survival, indicating that environmental conditions experienced early in life can determine survival prospects. Survival increased with age (0.73 + 0.02 in the first 2 years to 0.78 + 0.03 in years 3 and 4) to later decrease when birds were five years old (0.60 + 0.05), the age at which they acquire the adult plumage, abandon the communal lifestyle of juveniles, and may look for a breeding territory. At older ages, survival was higher for non-breeding (0.75+ 0.02) and breeding adults (0.83 + 0.02). Among the latter, birds that recruited into better territories had higher survival prospects. Age-specific variation in survival in this species may be related to behavioural changes linked to dispersal and recruitment into the breeding population, while survival prospects of adult birds strongly depend on breeding territory selection. These results suggest a tradeoff between recruiting soon, and thus reducing mortality costs of a long and extensive dispersal period, and trying to recruit into a good quality territory. Finally, annual survival rates for birds of all age classes were positively related with the NDVI in their African wintering grounds. Although this relationship was probably mediated by food availability, further research is needed to properly identify the limiting factors that are affecting trans-Saharan migrants, especially in light of global climate change.
Since the 1980s, cetacean morbillivirus (CeMV) has caused mass mortality events worldwide. However, no epizootics had been recorded in the South Atlantic, until an unusual mortality event (UME) ...linked to Guiana dolphin cetacean morbillivirus (GD‐CeMV) began in Ilha Grande Bay, southeastern Brazil, in November 2017. In a five‐month period, the UME spread to neighboring Sepetiba Bay and accounted for the death of at least 277 Guiana dolphins (Sotalia guianensis). Prevalence of morbillivirus positive dolphins, as estimated from RT‐PCR diagnostics, was 92.3% (24/26) in Ilha Grande Bay and 91.9% (57/62) in Sepetiba Bay. Females had higher mortality rates during the UME (1.5:1), in contrast with historical mortality data from both bays that showed a 2:1 male to female death ratio. Calf mortality rates also increased in both bays. These results suggest that females and calves were more vulnerable to morbilliviral infection. Herein, we discuss possible explanations for such sex‐biased death pattern during the UME and their implication for the conservation of endangered Guiana dolphins. We also speculate about the origin and spread of morbillivirus in the South Atlantic Ocean.
Compound databases of natural products have a major impact on drug discovery projects and other areas of research. The number of databases in the public domain with compounds with natural origins is ...increasing. Several countries, Brazil, France, Panama and, recently, Vietnam, have initiatives in place to construct and maintain compound databases that are representative of their diversity. In this proof-of-concept study, we discuss the first version of BIOFACQUIM, a novel compound database with natural products isolated and characterized in Mexico. We discuss its construction, curation, and a complete chemoinformatic characterization of the content and coverage in chemical space. The profile of physicochemical properties, scaffold content, and diversity, as well as structural diversity based on molecular fingerprints is reported. BIOFACQUIM is available for free.
Maize crop production is constrained worldwide by nitrogen (N) availability and particularly in poor tropical and subtropical soils. The development of affordable high-throughput crop monitoring and ...phenotyping techniques is key to improving maize cultivation under low-N fertilization. In this study several vegetation indices (VIs) derived from Red-Green-Blue (RGB) digital images at the leaf and canopy levels are proposed as low-cost tools for plant breeding and fertilization management. They were compared with the performance of the normalized difference vegetation index (NDVI) measured at ground level and from an aerial platform, as well as with leaf chlorophyll content (LCC) and other leaf composition and structural parameters at flowering stage. A set of 10 hybrids grown under five different nitrogen regimes and adequate water conditions were tested at the CIMMYT station of Harare (Zimbabwe). Grain yield and leaf N concentration across N fertilization levels were strongly predicted by most of these RGB indices (with R (2)~ 0.7), outperforming the prediction power of the NDVI and LCC. RGB indices also outperformed the NDVI when assessing genotypic differences in grain yield and leaf N concentration within a given level of N fertilization. The best predictor of leaf N concentration across the five N regimes was LCC but its performance within N treatments was inefficient. The leaf traits evaluated also seemed inefficient as phenotyping parameters. It is concluded that the adoption of RGB-based phenotyping techniques may significantly contribute to the progress of plant breeding and the appropriate management of fertilization.
PDF
