Objective. We compared differences in the hospital charges, length of hospital stay, and mortality between patients with healthcare- and community-associated bloodstream infections, urinary tract ...infections, and pneumonia due to antimicrobial-resistant versus -susceptible bacterial strains. Methods. A retrospective analysis of an electronic database compiled from laboratory, pharmacy, surgery, financial, and patient location and device utilization sources was undertaken on 5699 inpatients who developed healthcare-or community-associated infections between 2006 and 2008 from 4 hospitals (1 community, 1 pediatric, 2 tertiary/quaternary care) in Manhattan. The main outcome measures were hospital charges, length of stay, and mortality among patients with antimicrobial-resistant and -susceptible infections caused by Staphylococcus aureus, Enterococcus faecium, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Results. Controlling for multiple confounders using linear regression and nearest neighbor matching based on propensity score estimates, resistant healthcare- and community-associated infections, when compared with susceptible strains of the same organism, were associated with significantly higher charges ($15 626; confidence interval CI, $4339–$26 913 and $25 573; CI, $9331–$41 816, respectively) and longer hospital stays for community-associated infections (3.3; CI, 1.5–5.4). Patients with resistant healthcare-associated infections also had a significantly higher death rate (0.04; CI, 0.01–0.08). Conclusions. With careful matching of patients infected with the same organism, antimicrobial resistance was associated with higher charges, length of stay, and death rates. The difference in estimates after accounting for censoring for death highlight divergent social and hospital incentives in reducing patient risk for antimicrobial resistant infections.
Abstract
Sensitivity of ecosystem productivity to climate variability is a critical component of ecosystem resilience to climate change. Variation in ecosystem sensitivity is influenced by many ...variables. Here we investigate the effect of bedrock lithology and weathering products on the sensitivity of ecosystem productivity to variation in climate water deficit using Bayesian statistical models. Two thirds of terrestrial ecosystems exhibit negative sensitivity, where productivity decreases with increased climate water deficit, while the other third exhibit positive sensitivity. Variation in ecosystem sensitivity is significantly affected by regolith porosity and permeability and regolith and soil thickness, indicating that lithology, through its control on water holding capacity, exerts important controls on ecosystem sensitivity. After accounting for effects of these four variables, significant differences in sensitivity remain among ecosystems on different rock types, indicating the complexity of bedrock effects. Our analysis suggests that regolith affects ecosystem sensitivity to climate change worldwide and thus their resilience.
Nutrition during the first years of life has a significant impact on brain development. This study characterized differences in brain maturation from birth to 6 months of life in infant macaques fed ...formulas differing in content of lutein, β-carotene, and other carotenoids using Magnetic Resonance Imaging to measure functional connectivity. We observed differences in functional connectivity based on the interaction of diet, age and brain networks. Post hoc analysis revealed significant diet-specific differences between insular-opercular and somatomotor networks at 2 months of age, dorsal attention and somatomotor at 4 months of age, and within somatomotor and between somatomotor-visual and auditory-dorsal attention networks at 6 months of age. Overall, we found a larger divergence in connectivity from the breastfeeding group in infant macaques fed formula containing no supplemental carotenoids in comparison to those fed formula supplemented with carotenoids. These findings suggest that carotenoid formula supplementation influences functional brain development.
Wetlands provide many ecosystem services, including sediment and carbon retention, nutrient transformation, and water quality improvement. Although all wetlands are biogeochemical hotspots, ...geographically isolated wetlands (GIWs) receive fewer legal protections compared with other types of wetlands because of their apparent isolation from jurisdictional waters. Here, we consider controls on biogeochemical functions that influence water quality, and estimate changes in ecosystem service delivery that would occur if these landscape features were lost following recent US Supreme Court decisions (i.e., Rapanos, SWANCC). We conclude that, despite their lack of persistent surfacewater connectivity or adjacency to jurisdictional waters, GIWs are integral to biogeochemical processing on the landscape and therefore maintaining the integrity of US waters. Given the likelihood that any GIW contributes to downstream water quality, we suggest that the burden of proof could be shifted to assuming that all GIWs are critical for protecting aquatic systems until proven otherwise.
Rivers and streams are control points for CO2 emission to the air (fCO2), with emission rates often exceeding internal metabolism (net ecosystem production, NEP). The difference is usually attributed ...to CO2‐supersaturated groundwater inputs from upland soil respiration and rock weathering, but this implies a terrestrial‐to‐aquatic C transfer greater than estimated by terrestrial mass balance. One explanation is that riparian zones—rich in organic and inorganic C but mostly neglected in terrestrial mass balances—contribute disproportionately to fCO2. To test this hypothesis, we measured fCO2, NEP, and the lateral CO2 contributions from both terrestrial uplands (TER) and riparian wetlands (RIP) for seven reaches in a lowland river network in Florida, USA. NEP contributed about half of fCO2, but the remaining CO2 emission was generally much larger than measured TER. The relative importance of RIP versus TER varied markedly between contrasting hydrogeologic settings: RIP contributed 49% of fCO2 where geologic confinement forced lateral drainage through riparian soils, but only 12% where unconfined karst allowed deeper groundwater flowpaths that bypassed riparian zones. On a land area basis, the narrow riparian corridor yielded far more CO2 than the terrestrial uplands (33.1 vs. 1.4 g‐C m−2 yr−1), resulting in river corridors (i.e., stream channel plus adjacent wetlands, NEP + RIP) sourcing 87% of fCO2 to streams. Our findings imply that true terrestrial CO2 subsidies to streams may be smaller than previously estimated by aquatic mass balance and highlight the importance of explicitly integrating riparian zones into the conceptual model for terrestrial‐to‐aquatic C transfer.
Plain Language Summary
Globally, rivers and streams emit a similar amount of carbon dioxide (CO2) to the atmosphere as the land retains. To help curb CO2 emissions that cause climate change, we need to understand what is generating these high rates of stream CO2 emissions. While biological processes in the stream can generate CO2, the bulk of stream CO2 is thought to come from upland soils, carried by run‐off from the land to the streams where it off‐gases. In this study of seven streams of varying sizes in the same river network, we measured CO2 fluxes from both the stream and land to better understand where the CO2 emissions come from. We observed that a large fraction—sometimes all—of the CO2 delivered to the stream channel from groundwater comes from the wetlands next to the stream. Indeed, about half of CO2 emissions came from stream organisms consuming organic carbon, and one‐third from the thin band of riparian wetlands bordering the stream. Thus, we conclude that the narrow river corridor (the stream plus adjacent wetlands) is the source of 87% of the CO2 emitted by streams, and that the uplands that comprise most of the land area are a much smaller source than expected.
Key Points
River corridors can source most of CO2 emitted by streams through in‐stream metabolic production and lateral transport of riparian soil CO2
The dominance of riparian versus upland sources to stream CO2 emissions depends on lateral drainage flowpath
Terrestrial uplands yield far less CO2 to streams than suggested by aquatic mass balance, implying a need to partition lateral C fluxes
Randomized trials support the use of transcatheter aortic valve replacement (TAVR) for the treatment of aortic stenosis in high- and intermediate-risk patients, but the generalizability of those ...results in clinical practice has been challenged.
The aim of this study was to determine the safety and effectiveness of TAVR versus surgical aortic valve replacement (SAVR), particularly in intermediate- and high-risk patients, in a nationally representative real-world cohort.
Using data from the Transcatheter Valve Therapy Registry and Society of Thoracic Surgeons National Database linked to Medicare administrative claims for follow-up, 9,464 propensity-matched intermediate- and high-risk (Society of Thoracic Surgeons Predicted Risk of Mortality score ≥3%) U.S. patients who underwent commercial TAVR or SAVR were examined. Death, stroke, and days alive and out of the hospital to 1 year were compared, as well as discharge home, with subgroup analyses by surgical risk, demographics, and comorbidities.
In a propensity-matched cohort (median age 82 years, 48% women, median Society of Thoracic Surgeons Predicted Risk of Mortality score 5.6%), TAVR and SAVR patients experienced no difference in 1-year rates of death (17.3% vs. 17.9%; hazard ratio: 0.93; 95% confidence interval CI: 0.83 to 1.04) and stroke (4.2% vs. 3.3%; hazard ratio: 1.18; 95% CI: 0.95 to 1.47), and no difference was observed in the proportion of days alive and out of the hospital to 1 year (rate ratio: 1.00; 95% CI: 0.98 to 1.02). However, TAVR patients were more likely to be discharged home after treatment (69.9% vs. 41.2%; odds ratio: 3.19; 95% CI: 2.84 to 3.58). Results were consistent across most subgroups, including among intermediate- and high-risk patients.
Among unselected intermediate- and high-risk patients, TAVR and SAVR resulted in similar rates of death, stroke, and DAOH to 1 year, but TAVR patients were more likely to be discharged home.
Entry of herpes simplex virus (HSV) into a target cell requires complex interactions and conformational changes by viral glycoproteins gD, gH/gL, and gB. During viral entry, gB transitions from a ...prefusion to a postfusion conformation, driving fusion of the viral envelope with the host cell membrane. While the structure of postfusion gB is known, the prefusion conformation of gB remains elusive. As the prefusion conformation of gB is a critical target for neutralizing antibodies, we set out to describe its structure by making genetic insertions of fluorescent proteins (FP) throughout the gB ectodomain. We created gB constructs with FP insertions in each of the three globular domains of gB. Among 21 FP insertion constructs, we found 8 that allowed gB to remain membrane fusion competent. Due to the size of an FP, regions in gB that tolerate FP insertion must be solvent exposed. Two FP insertion mutants were cell-surface expressed but non-functional, while FP insertions located in the crown were not surface expressed. This is the first report of placing a fluorescent protein insertion within a structural domain of a functional viral fusion protein, and our results are consistent with a model of prefusion HSV gB constructed from the prefusion VSV G crystal structure. Additionally, we found that functional FP insertions from two different structural domains could be combined to create a functional form of gB labeled with both CFP and YFP. FRET was measured with this construct, and we found that when co-expressed with gH/gL, the FRET signal from gB was significantly different from the construct containing CFP alone, as well as gB found in syncytia, indicating that this construct and others of similar design are likely to be powerful tools to monitor the conformation of gB in any model system accessible to light microscopy.
Wetlands provide valuable hydrological, ecological, and biogeochemical functions, both alone and in combination with other elements comprising the wetlandscape. Understanding the processes and ...mechanisms that drive wetlandscape functions, as well as their sensitivity to natural and man‐made alterations, requires a sound physical understanding of wetland hydrodynamics. Here, we develop and apply a single reservoir hydrologic model to a low‐relief karst wetlandscape in southwest Florida (≈103 km2 of Big Cypress National Preserve) using precipitation P and potential evapotranspiration PET as climatic drivers. This simple approach captures the dynamics of storage for individual wetlands across the entire wetlandscape and accurately predicts landscape discharge. Key model insights are the importance of depth‐dependent extinction of evapotranspiration ET and the negligible effects of depth‐dependent specific yield, the effects of which are diluted by landscape relief. We identify three phases of the wetlandscape hydrological regime: dry, wet‐stagnant, and wet‐flowing. The model allowed a simple steady‐state analysis, which demonstrated the sudden seasonal shift between wet‐stagnant and wet‐flowing states, indicating a consistent threshold at P ≈ PET. Notably, stage data from any single wetland appears sufficient for accurate whole‐landscape discharge prediction because of the relative homogeneity in timing and duration of local wetland hydrologic connectivity in this landscape. We also show that this method will be transferable to other wetlandscapes, where individual storage elements respond hydrologically synchronously, whereas model performance is expected to deteriorate for hydrologically more heterogeneous wetlandscapes.
Key Points
We extend a reduced‐complexity catchment model framework to wetlandscapes and demonstrate it for Big Cypress National Preserve, Florida
Depth‐dependent extinction of evapotranspiration controls wetlandscape stage and discharge dynamics driven by hydroclimatic fluctuation
Hydrological regime shifts between wet‐stagnant and wet‐flowing landscape states are explained by steady‐state stage stability analysis
Perinatal mood and anxiety disorders are a leading cause of morbidity and mortality for childbearing women. Current treatments, such as cognitive behavioral therapy and interpersonal therapy, have ...demonstrated modest success in addressing perinatal psychiatric symptoms; however, additional treatment options are needed to address the limitations of current approaches, particularly for women experiencing moderate to severe perinatal mental illness during pregnancy or postpartum. We discuss the use of acceptance and commitment therapy (ACT) as a promising treatment approach that may be uniquely suited for perinatal women due to its emphasis of values, mindfulness, and acceptance; these psychological constructs notably address the significant psychiatric and behavioral health condition comorbidity, somatic symptoms, and stigma associated with perinatal mood and anxiety disorders. In addition, we describe the development of a four-session ACT-based group intervention at the Perinatal Psychiatry Inpatient Unit at the University of North Carolina at Chapel Hill. Sessions focus on core ACT processes of acceptance, cognitive defusion, present-moment awareness, value identification, and goal setting, and we describe how each of these processes is relevant to the perinatal population. Implications for future clinical applications and research investigations are discussed.
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