Diazotrophs, both Bacteria and Archaea, capable of fixing nitrogen (N
), are present in the tissues and mucous, of corals and can supplement the coral holobiont nitrogen budget with fixed nitrogen ...(N) in the form of ammonia (NH
). Stylophora pistillata from Heron Island on the Great Barrier Reef collected at 5 and 15 m, and experimentally manipulated in the laboratory, showed that the rates of net photosynthesis, steady state quantum yields of photosystem II (PSII) fluorescence (∆F
/F
') and calcification varied based on irradiance as expected. Rates of N
fixation were, however, invariant across treatments while the amount of fixed N contributing to Symbiodinium spp. N demand is irradiance dependent. Additionally, both the Symbiodinium and diazotrophic communities are significantly different based on depth, and novel Cluster V nifH gene phylotypes, which are not known to fix nitrogen, were recovered. A functional analysis using PICRUSt also showed that shallow corals were enriched in genes involved in nitrogen metabolism, and N
fixation specifically. Corals have evolved a number of strategies to derive nitrogen from organic (e.g., heterotrophic feeding) and inorganic sources (e.g., N
fixation) to maintain critical pathways such as protein synthesis to succeed ecologically in nitrogen-limited habitats.
Abstract
Sexual and gender minority (SGM) older adults experience greater health disparities compared to non-SGM older adults. The SGM older adult population is growing rapidly. To address this ...disparity and gain a better understanding of their unique challenges in healthcare relies on accurate data collection. We conducted a secondary data analysis of 2018–2022 electronic health record data for older adults aged ≥50 years, in 1 large academic health system to determine the source, magnitude, and correlates of missing sexual orientation and gender identity (SOGI) data among hospitalized older adults. Among 153 827 older adults discharged from the hospital, SOGI data missingness was 67.6% for sexual orientation and 63.0% for gender identity. SOGI data are underreported, leading to bias findings when studying health disparities. Without complete SOGI data, healthcare systems will not fully understand the unique needs of SGM individuals and develop tailored interventions and programs to reduce health disparities among these populations.
The number of patients with suspected COVID-19 presenting to Australian EDs continues to impose a burden on healthcare services. Isolation is an important aspect of infection prevention and control, ...but has been associated with undesirable consequences among hospital inpatients. The aim of the present study was to determine if isolation is associated with an increased length of stay (LOS) in the ED.
The Registry for Emergency Care Project is a prospective cohort study with a series of nested sub-studies. The present study was a retrospective analysis of adult patients allocated an Australasian Triage Scale category of 1 or 2 who presented to a tertiary ED between 18 and 31 May 2020. The primary outcome was ED LOS. Regression methods were used to determine the independent association between ED isolation and LOS.
There were 447 patients who met inclusion criteria, of which 123 (28%) were managed in isolation. The median (interquartile range) ED LOS was 259 (210-377) min for the isolation group and 204 (126-297) min for the non-isolation group, a difference in median ED LOS of 55 min (P < 0.001). Isolation was independently associated with a 23% increase in ED LOS (P = 0.002) and doubled the odds of an ED stay of more than 4 h (adjusted odds ratio 2.2 1.4-3.4, P = 0.001).
Consistent with the anecdotal experience of Australian ED clinicians, the present study demonstrated an increased ED LOS for patients managed in isolation. Enhanced infection prevention and control precautions will be required during and beyond the current pandemic, creating significant ongoing challenges for emergency care systems.
The COVID-19 Emergency Department (COVED) Quality Improvement Project aims to provide regular and real-time clinical information to ED clinicians caring for patients with suspected and confirmed ...COVID-19. The present study summarises data from the first 2 weeks of the study.
COVED is an ongoing prospective cohort study that commenced on 1 April 2020. It includes all adult patients presenting to a participating ED who undergo testing for SARS-CoV-2. Data are collected prospectively and entered into a bespoke registry. Outcomes include a positive SARS-CoV-2 polymerase chain reaction test result and requirement for intensive respiratory support.
In the period 1-14 April 2020, 240 (16%) of 1508 patients presenting to The Alfred Emergency and Trauma Centre met inclusion criteria. Of these, 11 (5%) tested positive for SARS-CoV-2. The mean age of patients was 60 years and the commonest symptoms were acute shortness of breath (n = 122 67%), cough (n = 108 56%) or fever (n = 98 51%). Overseas travel or known contact with a confirmed case was reported by 24 (14%) and 16 (10%) patients, respectively. Fever or hypoxia was recorded in 23 (10%) and 11 (5%) patients, respectively. Eleven (5%) patients received mechanical ventilation in the ED, of whom none tested positive for SARS-CoV-2.
Among patients presenting to a tertiary ED with suspected COVID-19, only a small proportion tested positive for SARS-CoV-2. Although the low incidence of positive cases currently precludes the development of predictive tools, the COVED Project demonstrates that the rapid establishment of an agile clinical registry for emergency care is feasible.
In Australia, the current ED burden related to COVID-19 is from 'suspected' rather than 'confirmed' cases. The initial aim of the Registry for Emergency Care (REC) Project is to determine the impact ...of isolation processes on the emergency care of all patients.
The REC Project builds on the COVID-19 Emergency Department Quality Improvement (COVED) Project. Outcomes measured include times to critical assessment and management.
Clinical tools will be generated to inform emergency care, both during and beyond the COVID-19 pandemic.
The REC Project will support ED clinicians in the emergency care of all patients.
There is an urgency to support Australian ED clinicians with real-time tools as the COVID-19 pandemic evolves. The COVID-19 Emergency Department (COVED) Quality Improvement Project has commenced and ...will provide flexible and responsive clinical tools to determine the predictors of key ED-relevant clinical outcomes.
The COVED Project includes all adult patients presenting to a participating ED and meeting contemporary testing criteria for COVID-19. The dataset has been embedded in the electronic medical record and the COVED Registry has been developed.
Outcomes measured include being COVID-19 positive and requiring intensive respiratory support. Regression methodology will be used to generate clinical prediction tools.
This project will support EDs during this pandemic.
A Grammar of Lango Noonan, Michael
2011, 1992, 1992-01-01, Letnik:
7
eBook
The series builds an extensive collection of high quality descriptions of languages around the world. Each volume offers a comprehensive grammatical description of a single language together with ...fully analyzed sample texts and, if appropriate, a word list and other relevant information which is available on the language in question. There are no restrictions as to language family or area, and although special attention is paid to hitherto undescribed languages, new and valuable treatments of better known languages are also included. No theoretical model is imposed on the authors; the only criterion is a high standard of scientific quality. To discuss your book idea or submit a proposal, please contact Birgit Sievert.
Haemorrhagic shock is a life-threatening complication of trauma, but remains a preventable cause of death. Early recognition of retroperitoneal haemorrhage (RPH) is crucial in preventing deleterious ...outcomes including mortality. Injury to the 9-11th intercostal arteries (i.e. arteries of the lower thoracic region) are complicit in RPH. However, the associated injuries, implications and management of such bleeds remain poorly characterised.
We performed a retrospective review of the medical records of patients diagnosed with RPH who presented to our level-1 trauma centre (2009-2019). We described the associated injuries, management and outcomes relating to RPH of the lower thoracic region (the 9-11th intercostal arteries) from this cohort to identify potential predictors and evaluate the impact of early identification and management of non-cavitary bleeds.
Haemorrhage of the lower intercostal arteries (LIA) into the retroperitoneal space is associated with an increased number of posterior lower rib fractures and pneumothorax/haemothorax. A higher proportion of patients in the LIA group required massive transfusion, angioembolisation or surgical ligation when compared to other causes of RPH.
The present study highlights the importance of injury patterns, particularly posterior lower rib fractures, as predictors for early recognition and management of RPH in the prevention of deleterious patient outcomes. RPH secondary to bleeding of the LIA may require early and aggressive management of haemorrhage through massive transfusion, and angioembolisation or surgical ligation when compared to RPH because of other causes.
The aim of the present study was to describe the epidemiological and clinical features of ED patients with suspected and confirmed COVID-19.
The COVID-19 Emergency Department (COVED) Project is an ...ongoing prospective cohort study that includes all adult patients presenting to The Alfred Hospital ED who undergo testing for SARS-CoV-2. Current guidelines recommend testing for patients with fevers or chills, acute respiratory symptoms or a high-risk exposure history, as well as implementation of infection prevention and control precautions for all suspected and confirmed cases. Study outcomes include a positive SARS-CoV-2 test result and intensive respiratory support.
In the period 1-30 April 2020, 702 of 3453 ED patients (20%; 95% CI 19-22) were tested, with a significant increase during the study period (incident rate ratio 1.019; 95% confidence interval 1.017-1.021, P < 0.001). The primary outcome of a positive SARS-CoV-2 test was recorded in 14 patients (2%; 95% confidence interval 1-3). Shortness of breath (77%), fatigue (100%), myalgia (67%) and diarrhoea (67%) were common among positive cases, while close contact (9%), fever (0%) and healthcare occupation (0%) were not. No positive cases required intensive respiratory support in the ED.
The volume of ED patients with suspected COVID-19 is increasing. Low numbers of positive cases precluded development of accurate predictive tools, but the COVED Project is fulfilling an important role in monitoring the burden of infection prevention and control requirements on the ED. The increasing number of patients meeting isolation criteria has the potential to impact on patient flow and may lead to ED overcrowding.
Ferric citrate (FC) is an approved therapy for chronic kidney disease (CKD) patients as a phosphate (Pi) binder for dialysis‐dependent CKD, and for iron deficiency anemia (IDA) in non‐dialysis CKD. ...Elevated Pi and IDA both lead to increased FGF23, however, the roles of iron and FGF23 during CKD remain unclear. To this end, iron and Pi metabolism were tested in a mouse model of CKD (0.2% adenine) ± 0.5% FC for 6 weeks, with and without osteocyte deletion of Fgf23 (flox‐Fgf23/Dmp1‐Cre). Intact FGF23 (iFGF23) increased in all CKD mice but was lower in Cre+ mice with or without FC, thus the Dmp1‐Cre effectively reduced FGF23. Cre+ mice fed AD‐only had higher serum Pi than Cre− pre‐ and post‐diet, and the Cre+ mice had higher BUN regardless of FC treatment. Total serum iron was higher in all mice receiving FC, and liver Tfrc, Bmp6, and hepcidin mRNAs were increased regardless of genotype; liver IL‐6 showed decreased mRNA in FC‐fed mice. The renal 1,25‐dihydroxyvitamin D (1,25D) anabolic enzyme Cyp27b1 had higher mRNA and the catabolic Cyp24a1 showed lower mRNA in FC‐fed mice. Finally, mice with loss of FGF23 had higher bone cortical porosity, whereas Raman spectroscopy showed no changes in matrix mineral parameters. Thus, FC‐ and FGF23‐dependent and ‐independent actions were identified in CKD; loss of FGF23 was associated with higher serum Pi and BUN, demonstrating that FGF23 was protective of mineral metabolism. In contrast, FC maintained serum iron and corrected inflammation mediators, potentially providing ancillary benefit.
Chronic kidney disease (CKD) affects 10% of the world population and results in many patient complications, including iron deficiency and hyperphosphatemia, both potent stimulators of the phosphaturic hormone FGF23. An iron‐containing phosphate binder, ferric citrate (FC), was developed to alleviate these manifestations, however, the impact of FC on FGF23‐ and iron‐mediated effects in CKD are not completely understood. This study provides novel insight into the FGF23‐ and iron‐mediated effects in CKD. We demonstrate that FGF23 is necessary to control phosphate and disease progression (monitored by BUN) in CKD. This study also supports that FC may improve 1,25D metabolism independent of FGF23 and lower markers of inflammation due to iron repletion. Therefore, FC may provide ancillary benefits which could lead to improved CKD patient outcomes.
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