Background
Deranged physiology in trauma complicates the clinical identification of sepsis, resulting in overscreening for bacteremia. No clinical signs or biomarkers accurately diagnose sepsis in ...this population. Our objective was to evaluate the accuracy of the current criteria used to prompt screening for bacteremia in trauma patients and determine independent predictors of bacteremia.
Materials and Methods
Adult trauma patients admitted to our level I academic trauma center who had blood cultures (BCs) drawn were identified. Those with positive BCs were compared to those with negative or false positive BCs. False positive was defined as a BC deemed contaminated and not treated at the discretion of the attending physician.
Results
Over a 2-year period, 366 trauma patients had BCs drawn. After excluding surveillance cultures (those drawn to demonstrate bacteremia clearance), 492 unique BC sets were evaluated; 104 (21.1%) BC sets were positive; 30 (28.8%) of these were falsely positive, resulting in a true-positive rate of 15% in the screened population. Univariate analysis suggested temperature and heart rate were associated with positive BC, while multivariable analysis found only the presence of a central line and lactic acid to be predictive. Procalcitonin (PCT) was poorly predictive, with a positive predictive value of 18% and a negative predictive value of 91%.
Conclusion
Current tools for identifying bacteremia in trauma patients result in overscreening. PCT may have a limited role as a negative predictor for bacteremia. Given that false-positive BCs have negative patient and economic consequences, future study should focus on development of alternative screening modalities.
• Premise of the study: An association between polyploidy and gender dimorphism has been noted in several plant lineages. Whereas the majority of Lycium species are diploid and have hermaphroditic ...flowers in cosexual populations, gender dimorphism (gynodioecy, dioecy) has been shown to be uniformly associated with polyploidy in previous studies. Preliminary field observations suggested that some populations of Lycium carolinianum were dimorphic, providing a test of this association.• Methods: We assessed sexual systems and cytotype variation (to infer ploidy) across 17 populations of L. carolinianum. Comparison of flowers in cosexual and dimorphic populations were used to infer changes in reproductive morphology associated with the evolution of gynodioecy.• Key results: The majority of populations were cosexual in gender expression, but dimorphism was present in the Yucatán and in some populations in Hawaii. Populations varied in ploidy and were either diploid or tetraploid. Floral sexual dimorphism was present in all gynodioecious populations, though the magnitude differed and was cryptic in some cases. Our results are consistent with the hypothesis that following the evolution of gynodioecy, flowers on hermaphrodites increased in size.• Conclusions: Dimorphic sexual systems have likely evolved convergently in L. carolinianum. In contrast to previous studies, dimorphism is not perfectly associated with polyploidy. Although our sample from the Yucatán was both tetraploid and dimorphic, all populations in Hawaii were diploid regardless of sexual system. Ongoing phylogeographic and mating system studies will contribute to our understanding of reproductive evolution in this widespread, polymorphic species.
The marine gastropod, Coralliophila abbreviata, is an obligate corallivore that causes substantial mortality in Caribbean Acropora spp. Considering the imperiled status of Acropora cervicornis and A. ...palmata, a better understanding of ecological interactions resulting in tissue loss may enable more effective conservation strategies. We examined differences in susceptibility of A. cervicornis to C. abbreviata predation based on coral tissue condition. Coral tissue condition was a strong determinant of snail prey choice, with snails preferring A. cervicornis fragments that were diseased or mechanically damaged over healthy fragments. In addition, snails always chose fragments undergoing active predation by another snail, while showing no preference for a non-feeding snail when compared with an undisturbed prey fragment. These results indicate that the condition of A. cervicornis prey influenced foraging behavior of C. abbreviata, creating a potential feedback that may exacerbate damage from predation in coral populations compromised by other types of disturbance.
Identifying objectively measurable seasonal changes in 24-h activity patterns (rest-activity rhythms or RARs) that occur in seasonal affective disorder (SAD) could help guide research and practice ...towards new monitoring tools or prevention targets. We quantified RARs from actigraphy data using non-parametric and extended cosine based approaches, then compared RARs between people with SAD and healthy controls in the summer (n = 70) and winter seasons (n = 84). We also characterized the within-person seasonal RAR changes that occurred in the SAD (n = 19) and control (n = 26) participants who contributed repeated measures. Only controls had significant winter increases in RAR fragmentation (intra-daily variability; in controls mean winter-summer changes (log scale) = 0.05, 0.21 standard deviation, p = 0.03). In SAD participants only, estimated evening settling times (down-mesor) were an average of 30 min earlier in the winter compared with the summer (1-h standard deviation, p = 0.045). These RAR characteristics correlated with greater fatigue (Spearman r = 0.36) but not depression symptom severity. Additional research is needed to ascertain why healthy controls, but not people with SAD, appear to have increased RAR fragmentation in the winter. People with SAD lacked this increase in RAR fragmentation, and instead had earlier evening setting in the winter. Prospective and intervention studies with greater temporal resolution are warranted to ascertain how these seasonal behavioral differences relate to fatigue pathophysiology in SAD. Future research is needed to determine whether extending the winter active period, even in relatively fragmented bouts, could help reduce the fatigue symptoms common in SAD.
Corallivorous snail feeding is a common source of tissue loss for the threatened coral, Acropora palmata, accounting for roughly one-quarter of tissue loss in monitored study plots over seven years. ...In contrast with larger threats such as bleaching, disease, or storms, corallivory by Coralliophila abbreviata is one of the few direct sources of partial mortality that may be locally managed. We conducted a field experiment to explore the effectiveness and feasibility of snail removal. Long-term monitoring plots on six reefs in the upper Florida Keys were assigned to one of three removal treatments: (1) removal from A. palmata only, (2) removal from all host coral species, or (3) no-removal controls. During the initial removal in June 2011, 436 snails were removed from twelve 150 m(2) plots. Snails were removed three additional times during a seven month "removal phase", then counted at five surveys over the next 19 months to track recolonization. At the conclusion, snails were collected, measured and sexed. Before-After-Control-Impact analysis revealed that both snail abundance and feeding scar prevalence were reduced in removal treatments compared to the control, but there was no difference between removal treatments. Recolonization by snails to baseline abundance is estimated to be 3.7 years and did not differ between removal treatments. Recolonization rate was significantly correlated with baseline snail abundance. Maximum snail size decreased from 47.0 mm to 34.6 mm in the removal treatments. The effort required to remove snails from A. palmata was 30 diver minutes per 150 m(2) plot, compared with 51 min to remove snails from all host corals. Since there was no additional benefit observed with removing snails from all host species, removals can be more efficiently focused on only A. palmata colonies and in areas where C. abbreviata abundance is high, to effectively conserve A. palmata in targeted areas.
Ocular Monkeypox - United States, July-September 2022 Cash-Goldwasser, Shama; Labuda, Sarah M; McCormick, David W ...
MMWR. Morbidity and mortality weekly report,
2022-Oct-21, 2022-10-21, 20221021, Letnik:
71, Številka:
42
Journal Article, Newsletter
Odprti dostop
As of October 11, 2022, a total of 26,577 monkeypox cases had been reported in the United States.* Although most cases of monkeypox are self-limited, lesions that involve anatomically vulnerable ...sites can cause complications. Ocular monkeypox can occur when Monkeypox virus (MPXV) is introduced into the eye (e.g., from autoinoculation), potentially causing conjunctivitis, blepharitis, keratitis, and loss of vision (1). This report describes five patients who acquired ocular monkeypox during July-September 2022. All patients received treatment with tecovirimat (Tpoxx)
; four also received topical trifluridine (Viroptic).
Two patients had HIV-associated immunocompromise and experienced delays between clinical presentation with monkeypox and initiation of monkeypox-directed treatment. Four patients were hospitalized, and one experienced marked vision impairment. To decrease the risk for autoinoculation, persons with monkeypox should be advised to practice hand hygiene and to avoid touching their eyes, which includes refraining from using contact lenses (2). Health care providers and public health practitioners should be aware that ocular monkeypox, although rare, is a sight-threatening condition. Patients with signs and symptoms compatible with ocular monkeypox should be considered for urgent ophthalmologic evaluation and initiation of monkeypox-directed treatment. Public health officials should be promptly notified of cases of ocular monkeypox. Increased clinician awareness of ocular monkeypox and of approaches to prevention, diagnosis, and treatment might reduce associated morbidity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Grassland birds are highly imperiled because of historical habitat loss and ongoing conversion of grasslands to agricultural and urban land uses. Therefore, prioritizing and further justifying ...conservation action in remaining grasslands is critical to protecting what remains. Grassland bird conservation has focused on identifying and protecting large grassland complexes referred to as Grassland Bird Conservation Areas (GBCAs). We identified and classified GBCAs in a region highly impacted by both agricultural and urban land conversion using previously developed methods. Then, we extended the analysis to include estimated relative abundance of five grassland focal species in each GBCA. Models of relative abundance were built using eight years of monitoring data collected by citizen scientists. Finally, we quantified the value of ecosystem services provided by each GBCA. There were nearly 55,000 ha of grassland habitats in the Chicago Metropolitan Region that met GBCA criteria, 33% (18,415 ha) of which were protected. Proportion of abundance in protected versus unprotected areas was similar for Bobolink (Dolichonyx oryzivorus; 46%), Grasshopper Sparrow (Ammodramus savannarum; 52%), and Sedge Wren (Cistothorus platensis; 48%), whereas, Henslow's Sparrow (Ammodramus henslowii; 75%) had a higher proportion of relative abundance in protected GBCAs and Eastern Meadowlark (Sturnella magna) had lower proportions (37%). GBCAs provisioned just under $900 million annually in ecosystem services, 73% of which is because of flood control. Outputs of this comprehensive approach will inform grassland bird conservation by providing detailed information about the value for birds and people of grassland habitats.Original Abstract: Les oiseaux de prairie sont grandement menaces en raison des pertes d'habitat subies dans le passe et de la conversion continuelle des prairies a des fins d'agriculture ou d'urbanisation. Ainsi, la priorisation et la justification des mesures de conservation des prairies restantes sont critiques si on veut les proteger. Les mesures actuelles de conservation des oiseaux de prairie reposent surtout sur l'identification et la protection de vastes complexes de prairies, aussi nommes Grassland Bird Conservation Areas (GBCA). Nous avons identifie et classe les GBCA d'une region fortement touchee par la conversion des terres a des fins d'agriculture et d'urbanisation au moyen de methodes elaborees precedemment. Nous avons ensuite elargi l'analyse pour inclure l'abondance relative de cinq especes d'oiseaux de prairie estimee dans chaque GBCA. Les modeles d'abondance relative ont ete construits a partir de huit annees de donnees recoltees par des citoyens participant a des projets scientifiques. Finalement, nous avons mesure la valeur des ecoservices rendus par chaque GBCA. Pres de 55 000 ha de milieux de prairie dans la region metropolitaine de Chicago correspondaient aux criteres d'un GBCA, dont 33 % (18 415 ha) etaient proteges. L'abondance dans les regions protegees se comparait a celle dans les regions non protegees pour le Goglu des pres (Dolichonyx oryzivorus; 46 %), le Bruant sauterelle (Ammodramus savannarum; 52 %) et le Troglodyte a bec court (Cistothorus platensis; 48 %), tandis qu'elle etait plus elevee pour le Bruant de Henslow (Ammodramus henslowii; 75 %) et plus faible pour la Sturnelle des pres (Sturnella magna; 37 %) dans les GBCA proteges. Les ecoservices fournis par les GBCA se chiffraient tout juste sous la barre des 900 millions de dollars, dont 73 % dans la regulation des inondations. Les resultats de cette approche comprehensive peuvent contribuer a la conservation des oiseaux de prairie en fournissant des renseignements detailles sur la valeur qu'ont les milieux de prairie sur les oiseaux et les humains.
To examine the association between ethnicity and disease activity in patients with juvenile idiopathic arthritis (JIA), and to determine the association of ethnicity with disease severity and ...disability in this population. CARRAnet, a US database containing information (collected between May 2010 and June 2011) on almost 3,000 subjects with JIA, was used. Demographic variables were compared between Hispanic patients and non-Hispanic patients. Mann–Whitney and chi-square tests were used to compare indicators of disease activity, as well as imaging evidence of joint damage, and Childhood Health Assessment Questionnaire (CHAQ) scores between ethnicities. Two linear regression models were used to determine the association of ethnicity with number of active joints in JIA, and the association between ethnicity and disability (CHAQ scores). A total of 2,704 patients with JIA (277 Hispanic; 2,427 non-Hispanic) were included. Income and health insurance coverage were higher in non-Hispanics. RF-positive polyarticular JIA, positive RF and anti-CCP, as well as use of systemic steroids were more frequent in Hispanics. Imaging evidence of joint damage was present in 32 % of the Hispanic patients compared to 24 % of the non-Hispanic patients (
p
= 0.008). In multivariate linear regression analyses, the number of active joints was significantly higher in Hispanics than in non-Hispanics (
p
= 0.03), as well as CHAQ scores (
p
= 0.003), after adjusting for confounders. Hispanic patients with JIA had higher disease activity than non-Hispanic patients, as well as higher disease severity and disability. Since ethnicity influences disease activity, severity, and disability, different management and treatment plans should be planned accordingly.
Non-adherence to treatments for chronic diseases may jeopardize patients’ health, increase costs of care, and cause unnecessary clinic appointments and diagnostic studies, as well as additional ...treatments with potentially serious side effects. Little is known about adherence to methotrexate in pediatric rheumatology. Because this medication is commonly used in JIA, we assessed adherence among children receiving methotrexate in two countries. A total of 76 outpatients (M:F 21:55) with JIA seen in Rio de Janeiro (Brazil) and in Boston (US) taking methotrexate for >2 months were enrolled. Questionnaires were completed by the parents from both centers. Non-adherence was defined as omission of ≥3 prescribed doses in the previous 8 weeks. Patients’ ages ranged from 1 to 17 years. Mean time on methotrexate was 20.5 months (±25). Overall rate of non-adherence was 18%. The rate of reported non-adherence was 8% in Boston and 24% in Rio de Janeiro (
P
= 0.012). The main reason for non-adherence in Boston was “child refused”; in Rio de Janeiro, the main reason was inability to obtain medication. Age had a negative association with adherence (
P
< 0.0001). Sex, time on methotrexate, route of administration, or concomitant use of other medications were not associated with adherence. Eighteen percent of children with JIA prescribed methotrexate were non-compliant. The difference in reasons for poor adherence between patients in Rio de Janeiro and Boston suggests that different strategies may be needed to improve adherence in these 2 settings. The rate of non-adherence warrants further investigation.
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