Quantifying early life movements is essential to understanding migratory pathways and habitat use that can impact individuals’ success later in life. To gauge how neonatal movements set the stage for ...later habitat use, we tracked neonate leatherback turtles (n=94) with acoustic tags from Pacuare, Costa Rica, in 2016 and 2018. We analyzed movements using a first passage time analysis and random walk models, the results of which indicated neonates followed a fixed compass direction as they traveled away from shore and that strong currents in these areas resulted in advection. We combined the tracking data with concurrent environmental variables in a generalized additive mixed model framework. Our results showed the south-east current flow in this area has spatial and temporal structure that was not driven by the tidal current or local wind speed. Accounting for advection by the currents, in-water neonate swimming speed was significantly related to current speed, first passage time, and the year. Neonates had three main response strategies to currents above 0.5 m s-1, with most increasing their swimming speed and the rest maintaining either a constant or decreased swimming speed. Neonates were significantly larger in 2018 than in 2016 but their average swimming speed was not significantly related to body size, indicating that environmental factors were more important contributors to their dispersal. We conclude that abiotic factors, including the strength and direction of the currents, significantly affect the swimming and dispersal strategy of neonate leatherback turtles and these results can help to inform strategies for releases of neonate turtles from hatcheries, future tracking studies, and conservation efforts.
Sodium-glucose cotransporter 2 inhibitors have been demonstrated to promote reverse cardiac remodeling in people with diabetes or heart failure. Although it has been theorized that sodium-glucose ...cotransporter 2 inhibitors might afford similar benefits in people without diabetes or prevalent heart failure, this has not been evaluated. We sought to determine whether sodium-glucose cotransporter 2 inhibition with empagliflozin leads to a decrease in left ventricular (LV) mass in people without type 2 diabetes or significant heart failure.
Between April 2021 and January 2022, 169 individuals, 40 to 80 years of age, without diabetes but with risk factors for adverse cardiac remodeling were randomly assigned to empagliflozin (10 mg/d; n=85) or placebo (n=84) for 6 months. The primary outcome was the 6-month change in LV mass indexed (LVMi) to baseline body surface area as measured by cardiac magnetic resonance imaging. Other measures included 6-month changes in LV end-diastolic and LV end-systolic volumes indexed to baseline body surface area and LV ejection fraction.
Among the 169 participants (141 men 83%; mean age, 59.3±10.5 years), baseline LVMi was 63.2±17.9 g/m
and 63.8±14.0 g/m
for the empagliflozin- and placebo-assigned groups, respectively. The difference (95% CI) in LVMi at 6 months in the empagliflozin group versus placebo group adjusted for baseline LVMi was -0.30 g/m
(-2.1 to 1.5 g/m
;
=0.74). Median baseline (interquartile range) NT-proBNP (N-terminal-pro B-type natriuretic peptide) was 51 pg/mL (20-105 pg/mL) and 55 pg/mL (21-132 pg/mL) for the empagliflozin- and placebo-assigned groups, respectively. The 6-month treatment effect of empagliflozin versus placebo (95% CI) on blood pressure and NT-proBNP (adjusted for baseline values) were -1.3 mm Hg (-5.2 to 2.6 mm Hg;
=0.52), 0.69 mm Hg (-1.9 to 3.3 mm Hg;
=0.60), and -6.1 pg/mL (-37.0 to 24.8 pg/mL;
=0.70) for systolic blood pressure, diastolic blood pressure, and NT-proBNP, respectively. No clinically meaningful between-group differences in LV volumes (diastolic and systolic indexed to baseline body surface area) or ejection fraction were observed. No difference in adverse events was noted between the groups.
Among people with neither diabetes nor significant heart failure but with risk factors for adverse cardiac remodeling, sodium-glucose cotransporter 2 inhibition with empagliflozin did not result in a meaningful reduction in LVMi after 6 months.
URL: https://www.
gov; Unique identifier: NCT04461041.
SUMMARY
We report analytic and consensus processes that produced recommendations for clinical stage groups (cTNM) of esophageal and esophagogastric junction cancer for the AJCC/UICC cancer staging ...manuals, 8th edition. The Worldwide Esophageal Cancer Collaboration (WECC) provided data on 22,123 clinically staged patients with epithelial esophageal cancers. Risk‐adjusted survival for each patient was developed using random survival forest analysis from which (1) data‐driven clinical stage groups were identified wherein survival decreased monotonically and was distinctive between and homogeneous within groups and (2) data‐driven anatomic clinical stage groups based only on cTNM. The AJCC Upper GI Task Force, by smoothing, simplifying, expanding, and assessing clinical applicability, produced (3) consensus clinical stage groups. Compared with pTNM, cTNM survival was “pinched,” with poorer survival for early cStage groups and better survival for advanced ones. Histologic grade was distinctive for data‐driven grouping of cT2N0M0 squamous cell carcinoma (SCC) and cT1‐2N0M0 adenocarcinoma, but consensus removed it. Grouping was different by histopathologic cell type. For SCC, cN0‐1 was distinctive for cT3 but not cT1‐2, and consensus removed cT4 subclassification and added subgroups 0, IVA, and IVB. For adenocarcinoma, N0‐1 was distinctive for cT1‐2 but not cT3‐4a, cStage II subgrouping was necessary (T1N1M0 IIA and T2N0M0 IIB), advanced cancers cT3‐4aN0‐1M0 plus cT2N1M0 comprised cStage III, and consensus added subgroups 0, IVA, and IVB. Treatment decisions require accurate cStage, which differs from pStage. Understaging and overstaging are problematic, and additional factors, such as grade, may facilitate treatment decisions and prognostication until clinical staging techniques are uniformly applied and improved.
Purpose:
The work presented here demonstrates an application of diffuse optical tomography (DOT) to the problem of breast‐cancer diagnosis. The potential for using spatial and temporal variability ...measures of the hemoglobin signal to identify useful biomarkers was studied.
Methods:
DOT imaging data were collected using two instrumentation platforms the authors developed, which were suitable for exploring tissue dynamics while performing a simultaneous bilateral exam. For each component of the hemoglobin signal (e.g., total, oxygenated), the image time series was reduced to eight scalar metrics that were affected by one or more dynamic properties of the breast microvasculature (e.g., average amplitude, amplitude heterogeneity, strength of spatial coordination). Receiver‐operator characteristic (ROC) analyses, comparing groups of subjects with breast cancer to various control groups (i.e., all noncancer subjects, only those with diagnosed benign breast pathology, and only those with no known breast pathology), were performed to evaluate the effect of cancer on the magnitudes of the metrics and of their interbreast differences and ratios.
Results:
For women with known breast cancer, simultaneous bilateral DOT breast measures reveal a marked increase in the resting‐state amplitude of the vasomotor response in the hemoglobin signal for the affected breast, compared to the contralateral, noncancer breast. Reconstructed 3D spatial maps of observed dynamics also show that this behavior extends well beyond the tumor border. In an effort to identify biomarkers that have the potential to support clinical aims, a group of scalar quantities extracted from the time series measures was systematically examined. This analysis showed that many of the quantities obtained by computing paired responses from the bilateral scans (e.g., interbreast differences, ratios) reveal statistically significant differences between the cancer‐positive and ‐negative subject groups, while the corresponding measures derived from individual breast scans do not. ROC analyses yield area‐under‐curve values in the 77%–87% range, depending on the metric, with sensitivity and specificity values ranging from 66% to 91%. An interesting result is the initially unexpected finding that the hemodynamic‐image metrics are only weakly dependent on the tumor burden, implying that the DOT technique employed is sensitive to tumor‐induced changes in the vascular dynamics of the surrounding breast tissue as well. Computational modeling studies serve to identify which properties of the vasomotor response (e.g., average amplitude, amplitude heterogeneity, and phase heterogeneity) principally determine the values of the metrics and their codependences. Findings from the modeling studies also serve to clarify the influence of spatial‐response heterogeneity and of system‐design limitations, and they reveal the impact that a complex dependence of metric values on the modeled behaviors has on the success in distinguishing between cancer‐positive and ‐negative subjects.
Conclusions:
The authors identified promising hemoglobin‐based biomarkers for breast cancer from measures of the resting‐state dynamics of the vascular bed. A notable feature of these biomarkers is that their spatial extent encompasses a large fraction of the breast volume, which is mainly independent of tumor size. Tumor‐induced induction of nitric oxide synthesis, a well‐established concomitant of many breast cancers, is offered as a plausible biological causal factor for the reported findings.
Vertical movements can expose individuals to rapid changes in physical and trophic environments—for aquatic fauna, dive profiles from biotelemetry data can be used to quantify and categorize vertical ...movements. Inferences on classes of vertical movement profiles typically rely on subjective summaries of parameters or statistical clustering techniques that utilize Euclidean matching of vertical movement profiles with vertical observation points. These approaches are prone to subjectivity, error, and bias. We used machine learning approaches on a large dataset of vertical time series (N = 28,217 dives) for 31 post‐nesting leatherback turtles (Dermochelys coriacea). We applied dynamic time warp (DTW) clustering to group vertical movement (dive) time series by their metrics (depth and duration) into an optimal number of clusters. We then identified environmental covariates associated with each cluster using a generalized additive mixed‐effects model (GAMM). A convolutional neural network (CNN) model, trained on standard dive shape types from the literature, was used to classify dives within each DTW cluster by their shape. Two clusters were identified with the DTW approach—these varied in their spatial and temporal distributions, with dependence on environmental covariates, sea surface temperature, bathymetry, sea surface height anomaly, and time‐lagged surface chlorophyll a concentrations. CNN classification accuracy of the five standard dive profiles was 95%. Subsequent analyses revealed that the two clusters differed in their composition of standard dive shapes, with each cluster dominated by shapes indicative of distinct behaviors (pelagic foraging and exploration, respectively). The use of these two machine learning approaches allowed for discrete behaviors to be identified from vertical time series data, first by clustering vertical movements by their movement metrics (DTW) and second by classifying dive profiles within each cluster by their shapes (CNN). Statistical inference for the identified clusters found distinct relationships with environmental covariates, supporting hypotheses of vertical niche switching and vertically structured foraging behavior. This approach could be similarly applied to the time series of other animals utilizing the vertical dimension in their movements, including aerial, arboreal, and other aquatic species, to efficiently identify different movement behaviors and inform habitat models.
Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care.
To implement and evaluate a palliative care ...professional development program for ICU bedside nurses.
From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds.
Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all
< .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them.
Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs.
SUMMARY
We report analytic and consensus processes that produced recommendations for neoadjuvant pathologic stage groups (ypTNM) of esophageal and esophagogastric junction cancer for the AJCC/UICC ...cancer staging manuals, 8th edition. The Worldwide Esophageal Cancer Collaboration provided data for 22,654 patients with epithelial esophageal cancers; 7,773 had pathologic assessment after neoadjuvant therapy. Risk‐adjusted survival for each patient was developed. Random forest analysis identified data‐driven neoadjuvant pathologic stage groups wherein survival decreased monotonically with increasing group, was distinctive between groups, and homogeneous within groups. An additional analysis produced data‐driven anatomic neoadjuvant pathologic stage groups based only on ypT, ypN, and ypM categories. The AJCC Upper GI Task Force, by smoothing, simplifying, expanding, and assessing clinical applicability, produced consensus neoadjuvant pathologic stage groups. Grade and location were much less discriminating for stage grouping ypTNM than pTNM. Data‐driven stage grouping without grade and location produced nearly identical groups for squamous cell carcinoma and adenocarcinoma. However, ypTNM groups and their associated survival differed from pTNM. The need for consensus process was minimal. The consensus groups, identical for both cell types were as follows: ypStage I comprised ypT0‐2N0M0; ypStage II ypT3N0M0; ypStage IIIA ypT0‐2N1M0; ypStage IIIB ypT3N1M0, ypT0‐3N2, and ypT4aN0M0; ypStage IVA ypT4aN1‐2, ypT4bN0‐2, and ypTanyN3M0; and ypStage IVB ypTanyNanyM1. Absence of equivalent pathologic (pTNM) categories for the peculiar neoadjuvant pathologic categories ypTisN0‐3M0 and ypT0N0‐3M0, dissimilar stage group compositions, and markedly different early‐ and intermediate‐stage survival necessitated a unified, unique set of stage grouping for patients of either cell type who receive neoadjuvant therapy.
Stable Isotopes in Tree Rings Siegwolf, Rolf T. W; Brooks, J. Renée; Roden, John ...
2022, 2022-06-06, Volume:
8
eBook
Open access
This Open Access volume highlights how tree ring stable isotopes have been used to address a range of environmental issues from paleoclimatology to forest management, and anthropogenic impacts on ...forest growth. It will further evaluate weaknesses and strengths of isotope applications in tree rings. In contrast to older tree ring studies, which predominantly applied a pure statistical approach this book will focus on physiological mechanisms that influence isotopic signals and reflect environmental impacts. Focusing on connections between physiological responses and drivers of isotope variation will also clarify why environmental impacts are not linearly reflected in isotope ratios and tree ring widths. This volume will be of interest to any researcher and educator who uses tree rings (and other organic matter proxies) to reconstruct paleoclimate as well as to understand contemporary functional processes and anthropogenic influences on native ecosystems. The use of stable isotopes in biogeochemical studies has expanded greatly in recent years, making this volume a valuable resource to a growing and vibrant community of researchers.
Although health, development, and environment challenges are interconnected, evidence remains fractured across sectors due to methodological and conceptual differences in research and practice. ...Aligned methods are needed to support Sustainable Development Goal advances and similar agendas. The Bridge Collaborative, an emergent research-practice collaboration, presents principles and recommendations that help harmonize methods for evidence generation and use. Recommendations were generated in the context of designing and evaluating evidence of impact for interventions related to five global challenges (stabilizing the global climate, making food production sustainable, decreasing air pollution and respiratory disease, improving sanitation and water security, and solving hunger and malnutrition) and serve as a starting point for further iteration and testing in a broader set of contexts and disciplines. We adopted six principles and emphasize three methodological recommendations: (1) creation of compatible results chains, (2) consideration of all relevant types of evidence, and (3) evaluation of strength of evidence using a unified rubric. We provide detailed suggestions for how these recommendations can be applied in practice, streamlining efforts to apply multi-objective approaches and/or synthesize evidence in multidisciplinary or transdisciplinary teams. These recommendations advance the necessary process of reconciling existing evidence standards in health, development, and environment, and initiate a common basis for integrated evidence generation and use in research, practice, and policy design.
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