During the current coronavirus disease 2019 epidemic, many outpatient chemical dependency treatment programs and clinics are decreasing their number of in-person patient contacts. This has widened an ...already large gap between patients with substance use disorders (SUDs) who need treatment and those who have actually received treatment. For a disorder where group therapy has been the mainstay treatment option for decades, social distancing, shelter in place, and treatment discontinuation have created an urgent need for alternative approaches to addiction treatment. In an attempt to continue some care for patients in need, many medical institutions have transitioned to a virtual environment to promote safe social distancing. Although there is ample evidence to support telemedical interventions, these can be difficult to implement, especially in the SUD population. This article reviews current literature for the use of telehealth interventions in the treatment of SUDs and offers recommendations on safe and effective implementation strategies based on the current literature.
European data support the use of low high-sensitivity troponin (hs-cTn) measurements or a 0/1-hour (0/1-h) algorithm for myocardial infarction to exclude major adverse cardiac events (MACEs) among ...patients in the emergency department with possible acute coronary syndrome. However, modest US data exist to validate these strategies. This study evaluated the diagnostic performance of an initial hs-cTnT measure below the limit of quantification (LOQ: 6 ng/L), a 0/1-h algorithm, and their combination with history, ECG, age, risk factors, and initial troponin (HEART) scores for excluding MACE in a multisite US cohort.
A prospective cohort study was conducted at 8 US sites, enrolling adult patients in the emergency department with symptoms suggestive of acute coronary syndrome and without ST-elevation on ECG. Baseline and 1-hour blood samples were collected, and hs-cTnT (Roche; Basel, Switzerland) was measured. Treating providers blinded to hs-cTnT results prospectively calculated HEART scores. MACE (cardiac death, myocardial infarction, and coronary revascularization) at 30 days was adjudicated. The proportion of patients with initial hs-cTnT measures below the LOQ and risk according to a 0/1-h algorithm was determined. The negative predictive value (NPV) was calculated for both strategies when used alone or with a HEART score.
Among 1462 participants with initial hs-cTnT measures, 46.4% (678 of 1462) were women and 37.1% (542 of 1462) were Black with an age of 57.6±12.9 (mean±SD) years. MACEs at 30 days occurred in 14.4% (210 of 1462) of participants. Initial hs-cTnT measures below the LOQ occurred in 32.8% (479 of 1462), yielding an NPV of 98.3% (95% CI, 96.7-99.3) for 30-day MACEs. A low-risk HEART score with an initial hs-cTnT below the LOQ occurred in 20.1% (294 of 1462), yielding an NPV of 99.0% (95% CI, 97.0-99.8) for 30-day MACEs. A 0/1-h algorithm was complete in 1430 patients, ruling out 57.8% (826 of 1430) with an NPV of 97.2% (95% CI, 95.9-98.2) for 30-day MACEs. Adding a low HEART score to the 0/1-h algorithm ruled out 30.8% (441 of 1430) with an NPV of 98.4% (95% CI, 96.8-99.4) for 30-day MACEs.
In a prospective multisite US cohort, an initial hs-cTnT below the LOQ combined with a low-risk HEART score has a 99% NPV for 30-day MACEs. The 0/1-h hs-cTnT algorithm did not achieve an NPV >99% for 30-day MACEs when used alone or with a HEART score. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02984436.
Terpenoids are a large and diverse class of plant metabolites that also includes volatile mono- and sesquiterpenes which are involved in biotic interactions of plants. Due to the limited natural ...availability of these terpenes and the tight regulation of their biosynthesis, there is strong interest to introduce or enhance their production in crop plants by metabolic engineering for agricultural, pharmaceutical and industrial applications. While engineering of monoterpenes has been quite successful, expression of sesquiterpene synthases in engineered plants frequently resulted in production of only minor amounts of sesquiterpenes. To identify bottlenecks for sesquiterpene engineering in plants, we have used two nearly identical terpene synthases, snapdragon (
Antirrhinum majus
) nerolidol/linalool synthase-1 and -2 (AmNES/LIS-1/-2), that are localized in the cytosol and plastids, respectively. Since these two bifunctional terpene synthases have very similar catalytic properties with geranyl diphosphate (GPP) and farnesyl diphosphate (FPP), their expression in target tissues allows indirect determination of the availability of these substrates in both subcellular compartments. Both terpene synthases were expressed under control of the ripening specific
PG
promoter in tomato fruits, which are characterized by a highly active terpenoid metabolism providing precursors for carotenoid biosynthesis. As
AmNES/LIS-2
fruits produced the monoterpene linalool,
AmNES/LIS-1
fruits were found to exclusively produce the sesquiterpene nerolidol. While nerolidol emission in
AmNES/LIS-1
fruits was 60- to 584-fold lower compared to linalool emission in
AmNES/LIS-2
fruits, accumulation of nerolidol-glucosides in
AmNES/LIS-1
fruits was 4- to 14-fold lower than that of linalool-glucosides in
AmNES/LIS-2
fruits. These results suggest that only a relatively small pool of FPP is available for sesquiterpene formation in the cytosol. To potentially overcome limitations in sesquiterpene production, we transiently co-expressed the key pathway-enzymes hydroxymethylglutaryl-CoA reductase (HMGR) and 1-deoxy-D-xylulose 5-phosphate synthase (DXS), as well as the regulator isopentenyl phosphate kinase (IPK). While HMGR and IPK expression increased metabolic flux toward nerolidol formation 5.7- and 2.9-fold, respectively, DXS expression only resulted in a 2.5-fold increase.
We present ReDU ( https://redu.ucsd.edu/ ), a system for metadata capture of public mass spectrometry-based metabolomics data, with validated controlled vocabularies. Systematic capture of knowledge ...enables the reanalysis of public data and/or co-analysis of one's own data. ReDU enables multiple types of analyses, including finding chemicals and associated metadata, comparing the shared and different chemicals between groups of samples, and metadata-filtered, repository-scale molecular networking.
In vegetated filter strips (VFS) the presence of perennial vegetation, rhizodeposition of labile organic substrates and the accumulation of an organic residue thatch layer may enhance microbial ...numbers and activity, thereby increasing the potential for mineralisation of herbicides and herbicide metabolites retained during run-off events. The objective of this laboratory experiment was to compare the mineralisation of atrazine and metolachlor with that of their respective metabolites in VFS and cultivated soil. With the exception of total bacteria, propagule density of the microbial groups, endogenous soil enzymes and microbial diversity were higher in the VFS soil. This correlated with increased mineralisation of metolachlor and its metabolites in the VFS soil and indicates potential for VFS to curtail the subsequent transport of these compounds. In contrast, the mineralisation of atrazine and the majority of its metabolites was substantially reduced in VFS soil relative to cultivated soil. Consequently, the potential for subsequent transport of atrazine and many of its metabolites may be greater in VFS soil than in cultivated soil if reduced mineralisation is not offset by increased sorption in the VFS.
Nannochloris oculata (Droop) D.J. Hibberd has attracted attention as a potential source of biofuels because of high oil content and rapid growth rate. The effect of selected herbicides on algal ...growth and total lipid content was examined. Twenty-two herbicides representing 14 modes of action were assayed. Photosystem II inhibitor diuron was the most toxic herbicide to algal growth. At low concen- trations, sethoxydim was not toxic to algae but decreased its lipid content significantly. Photosystem I inhibitor diquat at low concentration did not affect algal growth, but algal growth inhibition increased with increasing concentration. Diquat at 0.1 and 1 mg L super(whitesquare-1) decreased lipid content to 8.66 and 8.53%, respectively. At 5 mg L super(-1), glyphosate stimulated algal growth but decreased lipid content to 5.60% of dry weight. S-metolachlor had a significant effect on both algal biomass and lipid content. S- metolachlor at 0.1 mg L super(-1) decreased algal biomass to 75% of untreated control and decreased lipid content from 13.33 to 6.21% of dry weight. Fluridone at 0.1 mg L super(-1) decreased algal biomass to 84% of untreated and com- pletely killed algae when the concentration increased to 1 mg L super(-1). Simazine at 0.1 mg L super(-1) had no significant effect on algal growth but decreased lipid content from 13.33 to 5.15% of dry weight. Pendimethalin and dinoterb had no significant effect on algal growth but reduced lipid content to 6.19 and 6.03%, respectively. The use of algae as a source of fuel will undoubtedly require the use of outdoor, open- pond systems. These results will be useful for developing management systems to control invasive algal species in outdoor, open-pond systems, ultimately keeping the oil-producing algae pure.
These essays seek to reorient the Just War tradition around its core concerns of preventing the unjust use of force by states and limiting the harm inflicted on vulnerable populations such as ...civilian noncombatants. Contributors argue that the tradition needs to be updated to deal with substate actors within the realm of legitimate authority, private military companies, and the questionable moral difference between the use of conventional and nuclear weapons. Additionally, as recent policy makers and scholars have tried to make the Just War criteria legalistic, they have weakened the tradition’s ability to draw from and adjust to its contemporaneous setting.
Overwhelmingly, preservice teachers indicate a benefit of having a practicum in their teacher preparation program. Yet, with a shortage of highly effective special education teachers, there is ...limited research about the effectiveness of practicum experiences on preservice special education teacher's preparation. The purpose of this study was to examine preservice special education teacher's perception of acquiring a practicum experience in their master's program and determine if there was a gain in clinical expertise. Preservice teachers were evaluated using the clinical evaluation continuum (CEC) at the beginning and end of their practicum; reflections were gathered regarding their perception of the added experience. Results show gains in clinical expertise, knowledge, and approval for the practicum. Limitations and implications are discussed.
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