Abstract
Background
To date, no study has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy.
Methods
The Pregnancy ...Influenza Vaccine Effectiveness Network (PREVENT) consisted of public health or healthcare systems with integrated laboratory, medical, and vaccination records in Australia, Canada (Alberta and Ontario), Israel, and the United States (California, Oregon, and Washington). Sites identified pregnant women aged 18 through 50 years whose pregnancies overlapped with local influenza seasons from 2010 through 2016. Administrative data were used to identify hospitalizations with acute respiratory or febrile illness (ARFI) and clinician-ordered real-time reverse transcription polymerase chain reaction (rRT-PCR) testing for influenza viruses. Overall IVE was estimated using the test-negative design and adjusting for site, season, season timing, and high-risk medical conditions.
Results
Among 19450 hospitalizations with an ARFI discharge diagnosis (across 25 site-specific study seasons), only 1030 (6%) of the pregnant women were tested for influenza viruses by rRT-PCR. Approximately half of these women had pneumonia or influenza discharge diagnoses (54%). Influenza A or B virus infections were detected in 598/1030 (58%) of the ARFI hospitalizations with influenza testing. Across sites and seasons, 13% of rRT-PCR-confirmed influenza-positive pregnant women were vaccinated compared with 22% of influenza-negative pregnant women; the adjusted overall IVE was 40% (95% confidence interval = 12%–59%) against influenza-associated hospitalization during pregnancy.
Conclusion
Between 2010 and 2016, influenza vaccines offered moderate protection against laboratory-confirmed influenza-associated hospitalizations during pregnancy, which may further inform the benefits of maternal influenza vaccination programs.
In this retrospective study of hospitals in Australia, Canada, Israel, and the United States from 2010 to 2016, influenza vaccines were 40% effective in preventing laboratory-confirmed influenza-associated hospitalizations during pregnancy.
A combination is presented of the inclusive deep inelastic cross sections measured by the H1 and ZEUS Collaborations in neutral and charged current unpolarised
e
±
p
scattering at HERA during the ...period 1994-2000. The data span six orders of magnitude in negative four-momentum-transfer squared,
Q
2
, and in Bjorken
x
. The combination method used takes the correlations of systematic uncertainties into account, resulting in an improved accuracy. The combined data are the sole input in a NLO QCD analysis which determines a new set of parton distributions, HERAPDF1.0, with small experimental uncertainties. This set includes an estimate of the model and parametrisation uncertainties of the fit result.
Propofol reduces cerebral blood flow (CBF) secondary to cerebral metabolic depression. However, in vitro and in vivo studies demonstrate that propofol directly dilates the vascular smooth muscle. ...This study investigates the effects of propofol-induced changes in bispectral index (BIS) on cerebral microcirculation and oxygenation during craniotomies.
In 21 craniotomy patients undergoing routine craniotomy, anaesthesia was maintained with propofol 4–10 mg kg−1 h−1 and remifentanil 0.1–0.4 µg kg−1 min−1. Propofol concentration was adjusted to achieve higher BIS (target 40) or lower BIS (target 20). Regional measurements of capillary venous blood flow (rvCBF), oxygen saturation (srvO2), and haemoglobin amount (rvHb) at 2 mm (grey matter) and 8 mm (white matter) cerebral depth were randomly performed at higher and lower BIS by combined laser-Doppler flowmetry and spectroscopy. Calculations: approximated arteriovenous difference in oxygen content (avDO2) and cerebral metabolic rate of oxygen (aCMRO2). Results: mean values (sd). Statistics: Mann–Whitney test (*P<0.05).
Human cerebral microcirculation and oxygen saturation were assessed at propofol dosages 5.1 (2.3) mg kg−1 h−1 BIS 40 (9) and 7.8 (2.1) mg kg−1 h−1 BIS 21 (7). Propofol-induced reduction in BIS resulted in increased srvO2 (P=0.018), and decreased avDO2 (P=0.025) and aCMRO2 (P=0.022), in 2 mm cerebral depth, while rvCBF and rvHb remained unchanged. In 8 mm cerebral depth, srvO2, rvCBF, rvHb, and also calculated parameters avDO2 and aCMRO2 remained unaltered.
Findings suggest alteration of the CBF/CMRO2 ratio by propofol in cortical brain regions; therefore, it might be possible that propofol affects coupling of flow and metabolism in the cerebral microcirculation.
Summary
Anaemia is common before cardiac surgery and is associated with increased morbidity and mortality. The World Health Organization (WHO) definition of anaemia is lower for women than for men by ...10 g.l−1, potentially putting women at a disadvantage compared with men with regard to pre‐operative optimisation. Our hypothesis was that women with borderline anaemia (defined by us as haemoglobin concentration 120–129 g.l−1) would have a higher rate of red cell transfusion, morbidity and mortality than non‐anaemic women (haemoglobin ≥ 130 g.l−1). This retrospective observational study included all adult patients admitted for elective cardiac surgery from January 2013 to April 2016. During the study period, 1388 women underwent cardiac surgery. Pre‐operatively, 333 (24%) had a haemoglobin level < 120 g.l−1; 408 (29%) 120–129 g.l−1; and 647 (47%) ≥ 130 g.l−1. Compared with non‐anaemic women, women with borderline anaemia were more likely to be transfused (68.6% vs. 44.5%; RR 1.5, 95%CI 1.4–1.7; p < 0.0001) and were transfused with more units of red cells, mean (SD) 1.8 (2.8) vs. 1.3 (3.0); p < 0.0001. Hospital length of stay was significantly longer in the borderline anaemia group compared with non‐anaemic women, median (IQR range) 8 (6–12 3–45) vs. 7 (6–11 4–60); p = 0.0159. Short‐ and long‐term postoperative survival was comparable in both groups. Borderline anaemia is associated with increased red cell transfusion and prolonged hospital stay. Future research should address whether correction of borderline anaemia results in improved outcomes.
We sought to create contemporary models for predicting mortality risk following percutaneous coronary intervention (PCI).
There is a need to identify PCI risk factors and accurately quantify ...procedural risks to facilitate comparative effectiveness research, provider comparisons, and informed patient decision making.
Data from 181,775 procedures performed from January 2004 to March 2006 were used to develop risk models based on pre-procedural and/or angiographic factors using logistic regression. These models were independently evaluated in 2 validation cohorts: contemporary (n = 121,183, January 2004 to March 2006) and prospective (n = 285,440, March 2006 to March 2007).
Overall, PCI in-hospital mortality was 1.27%, ranging from 0.65% in elective PCI to 4.81% in ST-segment elevation myocardial infarction patients. Multiple pre-procedural clinical factors were significantly associated with in-hospital mortality. Angiographic variables provided only modest incremental information to pre-procedural risk assessments. The overall National Cardiovascular Data Registry (NCDR) model, as well as a simplified NCDR risk score (based on 8 key pre-procedure factors), had excellent discrimination (c-index: 0.93 and 0.91, respectively). Discrimination and calibration of both risk tools were retained among specific patient subgroups, in the validation samples, and when used to estimate 30-day mortality rates among Medicare patients.
Risks for early mortality following PCI can be accurately predicted in contemporary practice. Incorporation of such risk tools should facilitate research, clinical decisions, and policy applications.
In line with the B-lymphotropic nature of Epstein-Barr virus (EBV), the virus is present in several types of B-cell lymphomas. EBV expresses a different set of latent genes in the associated tumors, ...such as EBV nuclear antigen 1 (EBNA-1) and latent membrane proteins (LMPs; type II latency) in classical Hodgkin lymphomas (HLs). We previously reported that exposure of in vitro EBV-converted, HL-derived cell line KMH2-EBV to CD40-ligand and interleukin-4 (IL-4) induced the expression of LMP-1. Here, we show that exposure to IL-4 or IL-13 alone induced LMP-1 in the absence of EBNA-2. Induction of LMP-1 by IL-4 and IL-13 was mediated by the signal transducer signal transducer and activator of transcription 6 (STAT6) and a newly defined high-affinity STAT6-binding site in the LMP-1 promoter. IL-4 induced LMP-1 also in Burkitt lymphoma–derived lines and in tonsillar B cells infected with the EBNA-2–deficient EBV strain P3HR-1. Furthermore, coculture of EBV-carrying Burkitt lymphoma cells with activated CD4+ T cells resulted in the induction of LMP-1 in the absence of EBNA-2. Because Hodgkin/Reed-Sternberg cells are known to secrete IL-13, to have constitutively activated STAT6, and to be closely surrounded by CD4+ T cells, these mechanisms may be involved in the expression of LMP-1 in EBV-positive chronic HLs.
We conducted a meta-analysis of Parkinson's disease genome-wide association studies using a common set of 7,893,274 variants across 13,708 cases and 95,282 controls. Twenty-six loci were identified ...as having genome-wide significant association; these and 6 additional previously reported loci were then tested in an independent set of 5,353 cases and 5,551 controls. Of the 32 tested SNPs, 24 replicated, including 6 newly identified loci. Conditional analyses within loci showed that four loci, including GBA, GAK-DGKQ, SNCA and the HLA region, contain a secondary independent risk variant. In total, we identified and replicated 28 independent risk variants for Parkinson's disease across 24 loci. Although the effect of each individual locus was small, risk profile analysis showed substantial cumulative risk in a comparison of the highest and lowest quintiles of genetic risk (odds ratio (OR) = 3.31, 95% confidence interval (CI) = 2.55-4.30; P = 2 × 10(-16)). We also show six risk loci associated with proximal gene expression or DNA methylation.
The terrestrial biosphere plays a major role in the global carbon cycle, and there is a recognized need for regularly updated estimates of land‐atmosphere exchange at regional and global scales. An ...international ensemble of Dynamic Global Vegetation Models (DGVMs), known as the “Trends and drivers of the regional scale terrestrial sources and sinks of carbon dioxide” (TRENDY) project, quantifies land biophysical exchange processes and biogeochemistry cycles in support of the annual Global Carbon Budget assessments and the REgional Carbon Cycle Assessment and Processes, phase 2 project. DGVMs use a common protocol and set of driving data sets. A set of factorial simulations allows attribution of spatio‐temporal changes in land surface processes to three primary global change drivers: changes in atmospheric CO2, climate change and variability, and Land Use and Land Cover Changes (LULCC). Here, we describe the TRENDY project, benchmark DGVM performance using remote‐sensing and other observational data, and present results for the contemporary period. Simulation results show a large global carbon sink in natural vegetation over 2012–2021, attributed to the CO2 fertilization effect (3.8 ± 0.8 PgC/yr) and climate (−0.58 ± 0.54 PgC/yr). Forests and semi‐arid ecosystems contribute approximately equally to the mean and trend in the natural land sink, and semi‐arid ecosystems continue to dominate interannual variability. The natural sink is offset by net emissions from LULCC (−1.6 ± 0.5 PgC/yr), with a net land sink of 1.7 ± 0.6 PgC/yr. Despite the largest gross fluxes being in the tropics, the largest net land‐atmosphere exchange is simulated in the extratropical regions.
Plain Language Summary
Around one third of human‐induced CO2 emissions are absorbed by land ecosystems and thus act to mitigate climate change. It is essential to understand the processes, ecosystems and regions responsible for this natural carbon sink, to inform on the efficiency of the sinks into the future. These sinks are susceptible to year‐to‐year variation in response to climate variations and extremes. At the same time deforestation and other forms of land management are changing the land surface, which overall adds significantly to the human‐induced CO2 emissions. There is a need to regularly update our estimate of land carbon dynamics to aid global stock takes for the Paris agreement to avoid dangerous climate change. Here we present an international initiative that on an annual basis assesses “Trends and drivers of the regional scale terrestrial sources and sinks of carbon dioxide” (TRENDY) using computer models of the land carbon cycle. We quantify the land sink during the contemporary period (2012–2021), and attribute to processes, mainly the large opposing effects of CO2 fertilization enhancing plant productivity and land‐use change. Forests and semi‐arid ecosystems are largely responsible for the mean and trend in the land sink, with the latter most important for its year‐to‐year variation.
Key Points
We quantify and attribute land carbon dynamics to underlying processes at regional scales, contributing bottom‐up estimates to RECCAP‐2
Models simulate a contemporary net land sink of 1.7 ± 0.6 PgC/yr, with large opposing effects of CO2 fertilization and land‐use change
Despite the largest gross fluxes being in the tropics, the largest net land‐atmosphere exchange is simulated in the extratropical regions
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