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This study aimed to explore the reciprocal relationships between implementation leadership and practitioner implementation citizenship behavior during the implementation of evidence-based practices (EBPs). Data were collected at two timepoints with a time lag of six months during a national implementation of evidence-based treatment for post-traumatic stress disorder in Norwegian mental health clinics. Data from 72 leaders and 346 practitioners were analyzed with a two-wave cross-lagged panel model, accounting for the nested structure and adjusting for demographic variables. Significant positive autoregressive effects for both implementation leadership and implementation citizenship behavior indicated some stability in ratings across time. Significant cross-lagged effects in both directions indicated that practitioners who experienced greater implementation leadership from their leaders demonstrated greater implementation citizenship behavior six months later, and vice versa. Findings hence supported both the social exchange hypothesis and the followership hypothesis, suggesting reciprocal associations between the constructs. The findings underscore the mutually influential relationship between leaders' behavior and practitioners' engagement in citizenship behavior during EBP implementation. The study emphasizes the importance of interventions focusing on leadership behaviors that encourage practitioner engagement and mutually beneficial behavior patterns, highlighting the reciprocal and vital roles that both leaders and practitioners play in successful EBP implementation. [ABSTRACT FROM AUTHOR]

Coastal wetlands adapt to rising seas via feedbacks that build soil elevation, which lead to wetland stability. However, accelerated rates of sea-level rise can exceed soil elevation gain, leading to wetland instability and loss. Thus, there is a pressing need to better understand regional and landscape variability in rates of wetland soil elevation change. Here, we conducted a regional synthesis of surface elevation change data from mangrove forests and coastal marshes in the iconic Greater Everglades region of south Florida (USA). We integrated data from 51 sites in which a total of 122 surface elevation table-marker horizon (SET-MH) stations were installed. Several of these sites have been periodically monitored since the 1990s and are among the oldest SET-MH datasets in the world. Rates of surface elevation change ranged from −9.8 to 15.2 mm year−1, indicating some wetlands are keeping pace with sea-level rise while others are at risk of submergence and conversion to open water. Vertical accretion rates ranged from 0.6 to 12.9 mm year−1, and subsurface change rates ranged from −13.5 to 8.6 mm year−1. Rates of surface elevation change were positively related to subsurface change but not vertical accretion. There were no significant relationships between rates of surface elevation change and elevation (NAVD 88) or rates of sea-level rise. Site-specific examples indicate that hurricanes, plant productivity, hydrologic exchange, and proximity to sediment and nutrient inputs are critical but confounding drivers of surface elevation change dynamics in the Greater Everglades region. Collectively, our results reinforce the value of long-term SET-MH data that incorporate spatial variability for advancing understanding of surface elevation change dynamics in coastal wetlands. [ABSTRACT FROM AUTHOR]

In the face of accelerating climate change and rising sea levels, quantifying surface elevation change dynamics in coastal wetlands can help to develop a more complete understanding of the implications of sea-level rise on coastal wetland stability. The surface elevation table-marker horizon (SET-MH) approach has been widely used to quantify and characterize surface elevation change dynamics in coastal marshes and mangrove forests. Whereas past studies that utilized the SET-MH approach have most often quantified rates of surface elevation change using simple linear regression analyses, several recent studies have shown that elevation patterns can include a diverse combination of linear and non-linear patterns. Generalized additive models (GAMs) are an extension of generalized linear models (GLMs) that have previously been used to analyze a variety of complex ecological processes such as cyclical changes in water quality, species distributions, long-term patterns in wetland area change, and palaeoecological time series. Here, we use long-term SET data to demonstrate the value of generalized additive models for analyzing non-linear patterns of surface elevation change in coastal wetlands. Additionally, we illustrate how the GAM approach can be used to effectively quantify rates of elevation change at both landscape- and local site-level scales. [ABSTRACT FROM AUTHOR]

Emergent marsh and open water have been identified as alternate stable states in tidal marshes with large, relative differences in hydrogeomorphic conditions. In the Florida coastal Everglades, concern has been raised regarding the loss of non-tidal, coastal peat marsh via dieback of emergent vegetation and peat collapse. To aid in the identification of alternate stable states, our objective was to characterize the variability of hydrogeomorphic and biologic conditions using a field survey and long-term monitoring of hydrologic and geomorphic conditions across a range of vegetated (emergent, submerged) and unvegetated (open water) communities, which we refer to as "ecosystem states," in a non-tidal, brackish peat marsh of the coastal Everglades. Results show (1) linear relationships among field-surveyed geomorphic, hydrologic, and biologic variables, with a 35-cm mean difference in soil surface elevation between emergent and open water states, (2) an overall decline in soil elevation in the submerged state that was related to cumulative dry days, and (3) a 2× increase in porewater salinity during the dry season in the emergent state that was also related to the number of dry days. Coupled with findings from previous experiments, we propose a conceptual model that describes how seasonal hydrologic variability may lead to ecosystem state transitions between emergent and open water alternate states. Since vegetative states are only moderately salt tolerant, as sea-level rise pushes the saltwater front inland, the importance of continued progress on Everglades restoration projects, with an aim to increase the volume of freshwater being delivered to coastal wetlands, is the primary management intervention available to mitigate salinization and slow ecosystem state shifts in non-tidal, brackish peat marshes. [ABSTRACT FROM AUTHOR]

Historically, the prognosis of allogeneic hematopoietic stem cell transplant (allo-HCT) recipients who require intensive care unit (ICU) admission has been poor. We aimed to describe the epidemiological trends of ICU utilization and outcomes in allo-HCT patients. We conducted a retrospective cohort study including adults (≥ 18) undergoing allo-HCT between 01/01/2005 and 31/12/2020 at Mayo Clinic, Rochester. Temporal trends in outcomes were assessed by robust linear regression modelling. Risk factors for hospital mortality were chosen a priori and assessed with multivariable logistic regression modelling. Of 1,249 subjects, there were 486 ICU admissions among 287 individuals. Although older patients underwent allo-HCT (1.64 [95% CI: 1.11 to 2.45] years per year; P = 0.025), there was no change in ICU utilization over time (P = 0.91). The ICU and hospital mortality rates were 19.2% (55/287) and 28.2% (81/287), respectively. There was a decline in ICU mortality (-0.38% [95% CI: -0.70 to -0.06%] per year; P = 0.035). The 1-year post-HCT mortality for those requiring ICU admission was 56.1% (161/287), with no significant difference over time, versus 15.8% (141/891, 71 missing) among those who did not. The frequency and duration of invasive mechanical ventilation (IMV) declined. In multivariable analyses, higher serum lactate, higher sequential organ failure assessment (SOFA) scores, acute respiratory distress (ARDS), and need for IMV were associated with greater odds of hospital mortality. Over time, rates of ICU utilization have remained stable, despite increasing patient age. Several trends suggest improvement in outcomes, notably lower ICU mortality and frequency of IMV. However, long-term survival remains unchanged. Further work is needed to improve long-term outcomes in this population. [ABSTRACT FROM AUTHOR]

Background: Our preclinical work revealed tumour hypoxia induces homologous recombination deficiency (HRD), increasing sensitivity to Poly (ADP-ribose) polymerase inhibitors. We aimed to induce tumour hypoxia with ramucirumab thereby sensitising tumours to olaparib. Patients and methods: This multi-institution single-arm Phase 1/2 trial enrolled patients with metastatic gastroesophageal adenocarcinoma refractory to ≥1 systemic treatment. In dose escalation, olaparib was evaluated at escalating dose levels with ramucirumab 8 mg/kg day 1 in 14-day cycles. The primary endpoint of Phase 1 was the recommended Phase 2 dose (RP2D), and in Phase 2 the primary endpoint was the overall response rate (ORR). Results: Fifty-one patients received ramucirumab and olaparib. The RP2D was olaparib 300 mg twice daily with ramucirumab 8 mg/kg. In evaluable patients at the RP2D the ORR was 6/43 (14%) (95% CI 4.7–25.6). The median progression-free survival (PFS) was 2.8 months (95% CI 2.3–4.2) and median overall survival (OS) was 7.3 months (95% CI 5.7–13.0). Non-statistically significant improvements in PFS and OS were observed for patients with tumours with mutations in HRD genes. Conclusions: Olaparib and ramucirumab is well-tolerated with efficacy that exceeds historical controls with ramucirumab single agent for gastric cancer in a heavily pre-treated patient population. [ABSTRACT FROM AUTHOR]

This article reports findings from a qualitative study of New York City faith leaders' efforts to mitigate the effects of the COVID-19 pandemic on their communities during the first two years of the pandemic. Faith leaders were recruited via reputational case sampling to participate in individual, key informant interviews. This study used a social-contextual approach to health promotion by exploring the influence of faith leaders and religious communities on health behaviors. Results suggest that engaged faith leaders worked individually and collaboratively to support the changing physical, emotional, and spiritual needs of their religious communities and those in the surrounding area. This study highlights the importance of faith leaders as supporters, communicators, and advocates, and provides directions for future research on the impact of faith leaders on individuals' experiences and health behaviors during a pandemic. [ABSTRACT FROM AUTHOR]

Patients with hematological malignancies (HM) are at risk of acute respiratory failure (ARF). Malnutrition, a common association with HM, has the potential to influence ICU outcomes. Geriatric nutritional risk index (G-NRI) is a score derived from albumin and weight, which reflects risk of protein-energy malnutrition. We evaluated the association between G-NRI at ICU admission and ICU mortality in HM patients with ARF. We conducted a single center retrospective study of ventilated HM patients between 2014 and 2018. We calculated G-NRI for all patients using their ICU admission albumin and weight. Our primary outcome was ICU mortality. Secondary outcomes included duration of mechanical ventilation and ICU length of stay. Two hundred eighty patients were admitted to the ICU requiring ventilation. Median age was 62 years (IQR 51–68), 42% (n = 118) were females, and median SOFA score was 11 (IQR 9–14). The most common type of HM was acute leukemia (54%) and 40% underwent hematopoietic cell transplant. Median G-NRI was 87 (IQR 79–99). ICU mortality was 51% (n = 143) with a median duration of ventilation of 4 days (IQR 2–7). Mortality across those at severe malnutrition (NRI < 83.5) was 59% (65/111) compared to 46% (76/164) across those with moderate-no risk (p = 0.047). On multivariable analysis, severe NRI (OR 2.34, 95% CI 1.04–5.27, p = 0.04) was significantly associated with ICU mortality. In this single center, exploratory study, severe G-NRI was prognostic of ICU mortality in HM patients admitted with respiratory failure. [ABSTRACT FROM AUTHOR]

Introduction: Helmet noninvasive support may provide advantages over other noninvasive oxygenation strategies in the management of acute hypoxemic respiratory failure. In this narrative review based on a systematic search of the literature, we summarize the rationale, mechanism of action and technicalities for helmet support in hypoxemic patients. Main results: In hypoxemic patients, helmet can facilitate noninvasive application of continuous positive-airway pressure or pressure-support ventilation via a hood interface that seals at the neck and is secured by straps under the arms. Helmet use requires specific settings. Continuous positive-airway pressure is delivered through a high-flow generator or a Venturi system connected to the inspiratory port of the interface, and a positive end-expiratory pressure valve place at the expiratory port of the helmet; alternatively, pressure-support ventilation is delivered by connecting the helmet to a mechanical ventilator through a bi-tube circuit. The helmet interface allows continuous treatments with high positive end-expiratory pressure with good patient comfort. Preliminary data suggest that helmet noninvasive ventilation (NIV) may provide physiological benefits compared to other noninvasive oxygenation strategies (conventional oxygen, facemask NIV, high-flow nasal oxygen) in non-hypercapnic patients with moderate-to-severe hypoxemia (PaO2/FiO2 ≤ 200 mmHg), possibly because higher positive end-expiratory pressure (10–15 cmH2O) can be applied for prolonged periods with good tolerability. This improves oxygenation, limits ventilator inhomogeneities, and may attenuate the potential harm of lung and diaphragm injury caused by vigorous inspiratory effort. The potential superiority of helmet support for reducing the risk of intubation has been hypothesized in small, pilot randomized trials and in a network metanalysis. Conclusions: Helmet noninvasive support represents a promising tool for the initial management of patients with severe hypoxemic respiratory failure. Currently, the lack of confidence with this and technique and the absence of conclusive data regarding its efficacy render helmet use limited to specific settings, with expert and trained personnel. As per other noninvasive oxygenation strategies, careful clinical and physiological monitoring during the treatment is essential to early identify treatment failure and avoid delays in intubation. [ABSTRACT FROM AUTHOR]

Although temperature is known to influence individual traits such as growth, body size, and fecundity, few studies have examined how these relationships influence population-level secondary production in natural settings. We quantified life history traits and production of three dominant aquatic insects (Ephemeroptera: Ephemerella infrequens; Drunella doddsii; Trichoptera: Hydropsyche cockerelli) along an elevation-driven thermal gradient in the northern Rockies. We predicted that production would be highest at sites where temperature regimes lead to the largest terminal body size, individual fecundity, and reproductive potential (i.e., eggs per female x abundance of mature nymphs or larvae). In general, we found that temperature had idiosyncratic effects on life history traits of the study taxa, with no consistent effect of temperature on production. Although growth rates were generally highest during the warm months, growth did not consistently covary with temperature among sites along the elevation gradient. Terminal body size also differed among sites and was inconsistently related to mean temperature and reproductive potential. One of three taxa, D. doddsii, showed patterns entirely consistent with predictions, including smallest body size, reproductive potential, and secondary production at the warmest, low-elevation sites. Our findings suggest that connections among temperature regime, life history characteristics, and secondary production may not be straightforward, and are likely influenced by characteristics unmeasured in our study, including factors that influence survivorship throughout the larval phase, as well as adult mating or oviposition success. Such additional information will enrich our understanding of thermal effects on aquatic insects, and may contribute to predicting how these taxa may respond to ongoing changes in climate. [ABSTRACT FROM AUTHOR]

The Leadership and Organizational Change for Implementation (LOCI) strategy is a multifaceted implementation strategy that aims to support successful evidence-based practice (EBP) implementation by fostering effective general leadership, implementation leadership, and implementation climate. How implementation strategies are experienced by participants is important for their utilization and effectiveness in supporting EBP implementation. The current study is the first in-depth qualitative study exploring first-level leaders' experiences of participating in the LOCI strategy. Data were collected as part of a trial where Norwegian child and adult mental health outpatient clinics implemented EBPs for posttraumatic stress disorder (PTSD). Eleven first-level leaders from adult and child clinics participated in semi-structured interviews after completing the LOCI strategy. Data were analyzed through reflexive thematic analysis. The analysis generated four themes related to leaders' experiences of participating in the LOCI strategy: (1) structuring the EBP implementation, (2) taking responsibility for the EBP implementation, (3) interacting with others about the EBP implementation, and (4) becoming aware of EBP implementation and their own leadership. Most participants experienced the LOCI strategy as beneficial for implementing EBPs for PTSD in their clinic. The strategy succeeded in raising awareness of leadership for EBP implementation, and simultaneously provided participants with tools and support for leading the implementation in their clinic. Two participants experienced LOCI as less beneficial than the others. Our results support the strategy's potential to engage and empower first-level leaders to get involved in implementation processes and point to important challenges for future research on implementation strategies. [ABSTRACT FROM AUTHOR]

The correction notice addresses an error in the original article "Symphony of Success: Leader-Practitioner Reciprocity during Evidence-Based Practice Implementation" published in the journal Administration & Policy in Mental Health & Mental Health Services Research. The correction pertains to the incorrect structuring of the given and family names of all authors. The corrected version of the article can be accessed online, and the author group has been updated accordingly. The publisher, Springer Nature, maintains neutrality regarding jurisdictional claims and institutional affiliations. [Extracted from the article]

Background: Metabolic predictors and potential mediators of survival in sepsis have been incompletely characterized. We examined whether machine learning (ML) tools applied to the human plasma metabolome could consistently identify and prioritize metabolites implicated in sepsis survivorship, and whether these methods improved upon conventional statistical approaches. Methods: Plasma gas chromatography–liquid chromatography mass spectrometry quantified 411 metabolites measured ≤ 72 h of ICU admission in 60 patients with sepsis at a single center (Brigham and Women's Hospital, Boston, USA). Seven ML approaches were trained to differentiate survivors from non-survivors. Model performance predicting 28 day mortality was assessed through internal cross-validation, and innate top-feature (metabolite) selection and rankings were compared across the 7 ML approaches and with conventional statistical methods (logistic regression). Metabolites were consensus ranked by a summary, ensemble ML ranking procedure weighing their contribution to mortality risk prediction across multiple ML models. Results: Median (IQR) patient age was 58 (47, 62) years, 45% were women, and median (IQR) SOFA score was 9 (6, 12). Mortality at 28 days was 42%. The models' specificity ranged from 0.619 to 0.821. Partial least squares regression-discriminant analysis and nearest shrunken centroids prioritized the greatest number of metabolites identified by at least one other method. Penalized logistic regression demonstrated top-feature results that were consistent with many ML methods. Across the plasma metabolome, the 13 metabolites with the strongest linkage to mortality defined through an ensemble ML importance score included lactate, bilirubin, kynurenine, glycochenodeoxycholate, phenylalanine, and others. Four of these top 13 metabolites (3-hydroxyisobutyrate, indoleacetate, fucose, and glycolithocholate sulfate) have not been previously associated with sepsis survival. Many of the prioritized metabolites are constituents of the tryptophan, pyruvate, phenylalanine, pentose phosphate, and bile acid pathways. Conclusions: We identified metabolites linked with sepsis survival, some confirming prior observations, and others representing new associations. The application of ensemble ML feature-ranking tools to metabolomic data may represent a promising statistical platform to support biologic target discovery. [ABSTRACT FROM AUTHOR]

Octopuses have keen vision and are generally considered visual predators, yet octopuses predominantly forage blindly in nature, inserting their arms into crevices to search and detect hidden prey. The extent to which octopuses discriminate prey using chemo- versus mechano-tactile sensing is unknown. We developed a whole-animal behavioral assay that takes advantage of octopuses' natural searching behavior to test their ability to discriminate prey from non-prey tastes solely via contact chemoreception. This methodology eliminated vision, mechano-tactile sensing and distance chemoreception while testing the contact chemosensory discriminatory abilities of the octopus arm suckers. Extracts from two types of prey (crab, shrimp) and three types of non-prey (sea star, algae, seawater) were embedded in agarose (to control for mechano-tactile discrimination) and presented to octopuses inside an artificial rock dome; octopuses reached their arms inside to explore its contents – imitating natural prey-searching behavior. Results revealed that octopuses are capable of discriminating between potential prey items using only contact chemoreception, as measured by an increased amount of sucker contact time and arm curls when presented with prey extracts versus non-prey extracts. These results highlight the importance of contact chemoreception in the multi-modal sensing involved in a complex foraging behavior. [ABSTRACT FROM AUTHOR]

Background: While opioid use disorder (OUD) is prevalent, little is known about what patients with OUD in sustained remission think about the chronic disease model of OUD and their perspectives of the cause, course, and ongoing treatment needs of their OUD. Objective: To (1) examine patient perceptions of the chronic disease model of addiction and disease identity and (2) use an explanatory model framework to explore how these perceptions inform ongoing treatment needs and help maintain abstinence. Design: Qualitative study of a cross-sectional cohort of patients with OUD in long-term sustained remission currently receiving methadone or buprenorphine. Participants completed a single in-depth, semi-structured individual interview. Participants: Twenty adults were recruited from two opioid treatment programs and two office-based opioid treatment programs in Baltimore, MD. Half of the participants were Black, had a median (IQR) age of 46.5 (43–52) years and the median (IQR) time since the last non-prescribed opioid was 12 (8–15) years. Approach: Hybrid deductive-inductive thematic analysis of the transcribed interviews. Key Results: Some participants described a chronic OUD disease identity where they continue to live with OUD. Participants who maintain an OUD identity describe inherent traits or predetermination of developing OUD. Maintaining a disease identity helps them remain vigilant against returning to drug use. Others described a post-OUD/survivor identity where they no longer felt they had OUD, but the experience remains. Each perspective informed attitudes about continued treatment with methadone or buprenorphine and strategies to remain in remission. Conclusions: The identity that people with OUD in sustained remission maintain was the lens through which they viewed other aspects of their OUD including cause and ongoing treatment needs. An alternative, post-OUD/survivorship model emerged or was accepted by participants who did not identify as currently having OUD. Understanding patient perspectives of OUD identity might improve patient-centered care and improve outcomes. [ABSTRACT FROM AUTHOR]

Humans exhibit complex arithmetic skills, often attributed to our exceptionally large neocortex. However, the past decade has provided ample evidence that the functional domain of the subcortex extends well beyond basic functions. Using a sensitive behavioral method, for the first time, we explored the contributions of lower-order visual monocular channels to symbolic arithmetic operations, addition and subtraction. The pattern of results from 4 different experiments provides converging evidence for a causal relation between mental arithmetic and primitive subcortical regions. The results have major implications for our understanding of the neuroevolutionary development of general numerical abilities–subcortical regions, which are shared across different species, are essential to complex numerical operations. In a bigger conceptual framework, these findings and others call for a shift from the modal view of the exclusive role of the neocortex in high-level cognition to a view that emphasizes the interplay between subcortical and cortical brain networks. [ABSTRACT FROM AUTHOR]

The original article can be found online at https://doi.org/10.1007/s12237-024-01364-5.Correction: Estuaries and Coastshttps://doi.org/10.1007/s12237-024-01364-5In the original online version of this article, one of Lukas Lamb-Wotton's affiliations was incorrect. This was caused by a typesetting error.The original article was corrected.By Lukas Lamb-Wotton; Tiffany G. Troxler; Carlos Coronado-Molina; Stephen E. Davis; Daniel Gann; Khandker S. Ishtiaq; Sparkle L. Malone; Paulo Olivas; David T. Rudnick and Fred H. SklarReported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author [Extracted from the article]

Childhood cancer survivors are a growing population with high morbidity and many healthcare needs. As time from treatment lengthens, these patients are more and more likely to be followed in community primary care. Yet, studies suggest that primary care providers are unprepared (although not unwilling) to care for childhood cancer survivors. The 1-year fellowship in childhood cancer survivorship presented herein represents an educational intervention designed to prepare clinical leaders in survivorship. Ultimately, this effort may help address current gaps in care for childhood cancer survivors. [ABSTRACT FROM AUTHOR]

Veno-venous extracorporeal membrane oxygenation (ECMO) is a helpful intervention in patients with severe refractory hypoxemia either because mechanical ventilation cannot ensure adequate oxygenation or because lung protective ventilation is not feasible. Since ECMO is a highly invasive procedure with several, potentially devastating complications and its implementation is complex and expensive, simpler and less invasive therapeutic options should be first exploited. Low tidal volume and driving pressure ventilation, prone position, neuromuscular blocking agents and individualized ventilation based on transpulmonary pressure measurements have been demonstrated to successfully treat the vast majority of mechanically ventilated patients with severe hypoxemia. Veno-venous ECMO has a place in the small portion of severely hypoxemic patients in whom these strategies fail. A combined analysis of recent ARDS trials revealed that ECMO was used in only 2.15% of patients (n = 145/6736). Nevertheless, ECMO use has sharply increased in the last decade, raising questions regarding its thoughtful use. Such a policy could be harmful both for patients as well as for the ECMO technique itself. This narrative review attempts to describe together the practical approaches that can be offered to the sickest patients before going to ECMO, as well as the rationale and the limitations of ECMO. The benefit and the drawbacks associated with ECMO use along with a direct comparison with less invasive therapeutic strategies will be analyzed. [ABSTRACT FROM AUTHOR]

Compared to intubation with a cuffed endotracheal tube, extraglottic airway devices (EGDs), such as laryngeal mask airways, are considered less definitive ventilation conduit devices and are therefore often exchanged via endotracheal intubation (ETI) prior to obtaining CT images. With more widespread use and growing comfort among providers, reports have now described use of EGDs for up to 24 h including cases for which clinicians obtained CT scans with an EGD in situ. The term EGD encompasses a wide variety of devices with more complex structure and CT appearance compared to ETI. All EGDs are typically placed without direct visualization and require less training and time for insertion compared to ETI. While blind insertion generally results in functional positioning, numerous studies have reported misplacements of EGDs identified by CT in the emergency department or post-mortem. A CT-based classification system has recently been suggested to categorize these misplacements in six dimensions: depth, size, rotation, device kinking, mechanical blockage of the ventilation opening(s), and injury from EGD placement. Identifying the type of EGD and its correct placement is critically important both to provide prompt feedback to clinicians and prevent inappropriate medicolegal problems. In this review, we introduce the main types of EGDs, demonstrate their appearance on CT images, and describe examples of misplacements. [ABSTRACT FROM AUTHOR]

Proportional modes of ventilation assist the patient by adapting to his/her effort, which contrasts with all other modes. The two proportional modes are referred to as neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation with load-adjustable gain factors (PAV+): they deliver inspiratory assist in proportion to the patient's effort, and hence directly respond to changes in ventilatory needs. Due to their working principles, NAVA and PAV+ have the ability to provide self-adjusted lung and diaphragm-protective ventilation. As these proportional modes differ from 'classical' modes such as pressure support ventilation (PSV), setting the inspiratory assist level is often puzzling for clinicians at the bedside as it is not based on usual parameters such as tidal volumes and PaCO2 targets. This paper provides an in-depth overview of the working principles of NAVA and PAV+ and the physiological differences with PSV. Understanding these differences is fundamental for applying any assisted mode at the bedside. We review different methods for setting inspiratory assist during NAVA and PAV+ , and (future) indices for monitoring of patient effort. Last, differences with automated modes are mentioned. [ABSTRACT FROM AUTHOR]

Low concordance between studies that examine the role of microbiota in human diseases is a pervasive challenge that limits the capacity to identify causal relationships between host-associated microorganisms and pathology. The risk of obtaining false positives is exacerbated by wide interindividual heterogeneity in microbiota composition1, probably due to population-wide differences in human lifestyle and physiological variables2 that exert differential effects on the microbiota. Here we infer the greatest, generalized sources of heterogeneity in human gut microbiota profiles and also identify human lifestyle and physiological characteristics that, if not evenly matched between cases and controls, confound microbiota analyses to produce spurious microbial associations with human diseases. We identify alcohol consumption frequency and bowel movement quality as unexpectedly strong sources of gut microbiota variance that differ in distribution between healthy participants and participants with a disease and that can confound study designs. We demonstrate that for numerous prevalent, high-burden human diseases, matching cases and controls for confounding variables reduces observed differences in the microbiota and the incidence of spurious associations. On this basis, we present a list of host variables that we recommend should be captured in human microbiota studies for the purpose of matching comparison groups, which we anticipate will increase robustness and reproducibility in resolving the members of the gut microbiota that are truly associated with human disease. The authors use a machine-learning approach to uncover confounding variables in studies that seek to establish an association between the gut microbiota and human disease. [ABSTRACT FROM AUTHOR]

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We describe utilization of clinical genetic services among survivors of childhood and young adult cancer after participation in a genetic registry. Clinical genetic counselors flagged 162 out of 1069 pedigrees (15.2%) as suggestive of inheritable cancer susceptibility, resulting in 126 (11.8%) referral letters. Following delivery of the referral letters, 19 (15.1%) participants completed clinical genetic counseling, 16 (12.7%) received testing, and four (3.2%) were found to have actionable results. Our results suggest a discordance between reported willingness to undergo genetic counseling and real-world utilization. [ABSTRACT FROM AUTHOR]

Coastal freshwater and brackish wetlands are exposed to pulses of saltwater during times of reduced freshwater flows (i.e., dry seasons, droughts), periodic storm surges, and increased tidal extent associated with rising seas. The effects of saltwater pulses on belowground processing rates of detrital organic matter as mediated by microbial activities are uncertain. Our objectives were to quantify whether and how pulses of saltwater (i) change soil porewater physicochemistry, (ii) change soil microbial extracellular enzyme activities, and (iii) change root litter breakdown over time in freshwater and brackish marshes. From 2014 to 2016, we simulated saltwater intrusion as monthly in situ pulsed additions of artificial seawater in experimental dosing chambers (1.4 m diameter) within freshwater and brackish marshes of Everglades National Park. At monthly intervals, we collected soil porewater chemistry, and measured microbial extracellular enzymes, elemental stoichiometric ratios, and breakdown rates (k) of incubated (0–30 cm depth) root litter and compared these responses over time. Saltwater pulses increased sulfate and nitrogen concentrations in porewater at the freshwater site. However, saltwater pulses generally decreased porewater constituents (e.g., dissolved organic carbon, dissolved nitrogen and phosphorus species) at the brackish site. One saltwater pulse increased root litter k by 1.25-fold in the brackish marsh. However, long-term (740 days) k in brackish wetlands, and both short- and long-term k in freshwater wetlands, were not affected by 24 monthly pulses of saltwater. Enzyme activities fluctuated with time and did not respond to multiple saltwater pulses. Our results suggest that detrital organic matter stocks and associated soil microbial activities are relatively resistant to single and multiple (n = 24) pulses of saltwater. [ABSTRACT FROM AUTHOR]

Loss of gut mucosal integrity and an aberrant gut microbiota are proposed mechanisms contributing to chronic inflammation and increased morbidity and mortality during antiretroviral-treated HIV disease. Sexual practice has recently been uncovered as a major source of microbiota variation, potentially confounding prior observations of gut microbiota alterations among persons with HIV (PWH). To overcome this and other confounding factors, we examine a well-powered subset of AGEhIV Cohort participants comprising antiretroviral-treated PWH and seronegative controls matched for age, body-mass index, sex, and sexual practice. We report significant gut microbiota differences in PWH regardless of sex and sexual practice including Gammaproteobacteria enrichment, Lachnospiraceae and Ruminococcaceae depletion, and decreased alpha diversity. Men who have sex with men (MSM) exhibit a distinct microbiota signature characterized by Prevotella enrichment and increased alpha diversity, which is linked with receptive anal intercourse in both males and females. Finally, the HIV-associated microbiota signature correlates with inflammatory markers including suPAR, nadir CD4 count, and prevalence of age-associated noncommunicable comorbidities. The role of sexual practice in HIV-associated gut microbiota remains poorly understood. Here, in a cohort of chronically treated HIV-infected people, the authors show microbiome signatures to be independent of sex and sexual practice and that the extent of dysbiosis correlates with nadir CD4, inflammatory markers, and comorbidities. [ABSTRACT FROM AUTHOR]

Background: The optimal method of screening for thyroid cancer in survivors of childhood and young adult cancer exposed to neck radiation remains controversial. Outcome data for a physical exam-based screening approach are lacking.Methods: We conducted a retrospective review of adult survivors of childhood and young adult cancer with a history of neck radiation followed in the Adult Long-Term Follow-Up Clinic at Memorial Sloan Kettering between November 2005 and August 2014. Eligible patients underwent a physical exam of the thyroid and were followed for at least 1 year afterwards. Ineligible patients were those with prior diagnosis of benign or malignant thyroid nodules.Results: During a median follow-up of 3.1 years (range 0-9.4 years), 106 ultrasounds and 2277 physical exams were performed among 585 patients. Forty survivors had an abnormal thyroid physical exam median of 21 years from radiotherapy; 50% of those with an abnormal exam were survivors of Hodgkin lymphoma, 60% had radiation at ages 10-19, and 53% were female. Ultimately, 24 underwent fine needle aspiration (FNA). Surgery revealed papillary carcinoma in seven survivors; six are currently free of disease and one with active disease is undergoing watchful waiting. Among those with one or more annual visits, representing 1732 person-years of follow-up, no cases of thyroid cancer were diagnosed within a year of normal physical exam.Conclusions: These findings support the application of annual physical exam without routine ultrasound for thyroid cancer screening among survivors with a history of neck radiation.Implications For Cancer Survivors: Survivors with a history of neck radiation may not require routine thyroid ultrasound for thyroid cancer screening. Among adult survivors of childhood and young adult cancer with a history of radiation therapy to the neck, annual physical exam is an acceptable thyroid cancer screening strategy. [ABSTRACT FROM AUTHOR]

Increasing rates of sea-level rise (SLR) threaten to submerge coastal wetlands unless they increase soil elevation at similar pace, often by storing soil organic carbon (OC). Coastal wetlands face increasing salinity, marine-derived nutrients, and inundation depths from increasing rates of SLR. To quantify the effects of SLR on soil OC stocks and fluxes and elevation change, we conducted two mesocosm experiments using the foundation species sawgrass (Cladium jamaicense) and organic soils from freshwater and brackish Florida Everglades marshes for 1 year. In freshwater mesocosms, we compared ambient and elevated salinity (fresh, 9 ppt) and phosphorus (ambient, + 1 g P m−2 year−1) treatments with a 2 × 2 factorial design. Salinity addition reduced root biomass (48%), driving 2.8 ± 0.3 cm year−1 of elevation loss, while soil elevation was maintained in freshwater conditions. Added P increased root productivity (134%) but also increased breakdown rates (k) of roots (31%) and leaves (42%) with no effect on root biomass or soil elevation. In brackish mesocosms, we compared ambient and elevated salinity (10, 19 ppt) and inundated and exposed conditions (water level 5-cm below and 4-cm above soil). Elevated salinity decreased root productivity (70%) and root biomass (37%) and increased k in litter (33%) and surface roots (11%), whereas inundation decreased subsurface root k (10%). All brackish marshes lost elevation at similar rates (0.6 ± 0.2 cm year−1). In conclusion, saltwater intrusion in freshwater and brackish wetlands may reduce net OC storage and increase vulnerability to SLR despite inundation or marine P supplies. [ABSTRACT FROM AUTHOR]

Periphyton plays key ecological roles in karstic, freshwater wetlands and is extremely sensitive to environmental change making it a powerful tool to detect saltwater intrusion into these vulnerable and valuable ecosystems. We conducted field mesocosm experiments in the Florida Everglades, USA to test the effects of saltwater intrusion on periphyton metabolism, nutrient content, and diatom species composition, and how these responses differ between mats from a freshwater versus a brackish marsh. Pulsed saltwater intrusion was simulated by dosing treatment chambers monthly with a brine solution for 15 months; control chambers were simultaneously dosed with site water. Periphyton from the freshwater marsh responded to a 1-ppt increase in surface water salinity with reduced productivity and decreased concentrations of total carbon, nitrogen, and phosphorus. These functional responses were accompanied by significant shifts in periphytic diatom assemblages. Periphyton mats at the brackish marsh were more functionally resilient to the saltwater treatment (~ 2 ppt above ambient), but nonetheless experienced significant shifts in diatom composition. These findings suggest that freshwater periphyton is negatively affected by small, short-term increases in salinity and that periphytic diatom assemblages, particularly at the brackish marsh, are a better metric of salinity increases compared with periphyton functional metrics due to functional redundancy. This research provides new and valuable information regarding periphyton dynamics in response to changing water sources in the southern Everglades that will allow us to extend the use of periphyton, and their diatom assemblages, as tools for environmental assessments related to saltwater intrusion. [ABSTRACT FROM AUTHOR]

Introduction: Extracorporeal carbon dioxide removal (ECCO2R) has been proposed for hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD) exacerbations, to avoid intubation or reduce length of invasive ventilation. Balance of risks, efficacy, and benefits of ECCO2R in patients with COPD is unclear.Methods: We systematically searched MEDLINE and EMBASE to identify all publications reporting use of ECCO2R in COPD. We looked at physiological and clinical efficacy. A favorable outcome was defined as prevention of intubation or successful extubation. Major and minor complications were compiled.Results: We identified 3123 citations. Ten studies (87 patients), primarily case series, met inclusion criteria. ECCO2R prevented intubation in 65/70 (93%) patients and assisted in the successful extubation of 9/17 (53%) mechanically ventilated subjects. One case-control study matching to noninvasively ventilated controls reported lower intubation rates and hospital mortality with ECCO2R that trended toward significance. Physiological data comparing pre- to post-ECCO2R changes suggest improvements for pH (0.07-0.15 higher), PaCO2 (25 mmHg lower), and respiratory rate (7 breaths/min lower), but not PaO2/FiO2. Studies reported 11 major (eight bleeds requiring blood transfusion of 2 units, and three line-related complications, including one death related to retroperitoneal bleeding) and 30 minor complications (13 bleeds, five related to anticoagulation, and nine clotting-related device malfunctions resulting in two emergent intubations).Conclusion: The technique is still experimental and no randomized trial is available. Recognizing selection bias associated with case series, there still appears to be potential for benefit of ECCO2R in patients with COPD exacerbations. However, it is associated with frequent and potentially severe complications. Higher-quality studies are required to better elucidate this risk-benefit balance. [ABSTRACT FROM AUTHOR]

The power of human induced pluripotent stem cell (hiPSC)-based studies to resolve the smaller effects of common variants within the size of cohorts that can be realistically assembled remains uncertain. We identified and accounted for a variety of technical and biological sources of variation in a large case/control schizophrenia (SZ) hiPSC-derived cohort of neural progenitor cells and neurons. Reducing the stochastic effects of the differentiation process by correcting for cell type composition boosted the SZ signal and increased the concordance with post-mortem data sets. We predict a growing convergence between hiPSC and post-mortem studies as both approaches expand to larger cohort sizes. For studies of complex genetic disorders, to maximize the power of hiPSC cohorts currently feasible, in most cases and whenever possible, we recommend expanding the number of individuals even at the expense of the number of replicate hiPSC clones. [ABSTRACT FROM AUTHOR]

Background: The relationship between hormone exposure and breast cancer risk in women treated with chest radiotherapy for childhood cancer is uncertain.Methods: Participants included 1108 females from the Childhood Cancer Survivor Study who were diagnosed with childhood cancer 1970-1986, treated with chest radiotherapy, and survived to ages ⩾20 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) from Cox models adjusted for chest radiation field, delivered dose, anthracycline exposure, and age at childhood cancer estimated risk.Results: Among 195 women diagnosed with breast cancer, 102 tumours were oestrogen-receptor positive (ER+). Breast cancer risk increased with ⩾10 years of ovarian function after chest radiotherapy vs <10 years (HR=2.89, CI 1.56-5.53) and for radiotherapy given within 1 year of menarche vs >1 year from menarche (HR=1.80, CI 1.19-2.72). Risk decreased with decreasing age at menopause (Ptrend=0.014). Risk factors did not differ for ER+ breast cancer. Survivors with an age at menopause <20 years treated with hormone therapy had a lower breast cancer risk than premenopausal survivors (HR=0.47, CI 0.23-0.94).Conclusions: Endogenous hormones are key contributors to breast cancer observed among childhood cancer survivors. Hormone therapy given for premature ovarian insufficiency does not fully replace the function that endogenous hormones have in breast cancer development. [ABSTRACT FROM AUTHOR]

The role of leadership in the management and delivery of health and allied health services is often discussed but lacks empirical research. Discrepancies are often found between leaders' self-ratings and followers' ratings of the leader. To our knowledge no research has examined leader-follower discrepancies and their association with organizational culture in mental health clinics. The current study examines congruence, discrepancy, and directionality of discrepancy in relation to organizational culture in 38 mental health teams (N = 276). Supervisors and providers completed surveys including ratings of the supervisor transformational leadership and organizational culture. Polynomial regression and response surface analysis models were computed examining the associations of leadership discrepancy and defensive organizational culture and its subscales. Discrepancies between supervisor and provider reports of transformational leadership were associated with a more negative organizational culture. Culture suffered more where supervisors rated themselves more positively than providers, in contrast to supervisors rating themselves lower than the provider ratings of the supervisor. Leadership and leader discrepancy should be a consideration in improving organizational culture and for strategic initiatives such as quality of care and the implementation and sustainment of evidence-based practice. [ABSTRACT FROM AUTHOR]

Purpose: The project aimed to evaluate the completeness of drug-drug interaction (DDI)-related information in package inserts (PIs) and develop a systematic approach to conduct the evaluation. Methods: DDI-related information in the branded PIs of statins, macrolides, protease inhibitors and selected drugs of narrow therapeutic index (DNTI) were evaluated against the criteria distilled from the Food and Drug Administration (FDA) labelling recommendation guidance document. Decision trees were crafted and employed in the evaluation process. Scores were computed to give each PI an overall completeness score and individual criterion completeness score. The Kruskal-Wallis test and Dunn's multiple comparison test were used to assess the differences in the completeness scores. Results: The mean overall completeness score of the 21 PIs was 35.7 ± 13.4 % (range 12.2-62 %). Eight out of the 11 individual evaluation criterion had a mean completeness score below 50 %. A subclass analysis conducted revealed that PIs from the different drug classes differed in the type of DDI-related information, such that they are more complete or less complete. Conclusion: The completeness score of DDI-related information in the PIs varied extensively amongst and within drug classes. A consensus between the authorities and drug companies on the type and quality of DDI-related information to be included could improve their completeness in PIs and make PIs a valuable source of DDI reference. Decision trees, albeit not validated yet, lay the groundwork for a valuable tool to evaluate DDI-related or other drug information. [ABSTRACT FROM AUTHOR]

Transpiration- driven ion accumulation in soil has been invoked as a biological and physical feedback mechanism in wetlands that governs topographic differences by regulating soil accretion-with greater transpiration, ion accumulation and soil accretion occurring on tree islands as compared to the surrounding marsh. The strength of this mechanism is hypothesized to be controlled by the ratio of evapotranspiration (ET) to precipitation (P), where under greater ET to P conditions soil accretion may move from organic to mineral in nature. We tested the existence of this mechanism on tree islands in a subtropical wetland, determined if it supports mineral soil formation, and assessed its control on the development of nutrient resource contrasts (tree islands-marsh). To test our hypotheses, biannual measurements of groundwater, surface water and aboveground biomass were made from 2007 to 2012. Water samples were analyzed for water isotopes, concentrations of major ions, and total and dissolved nutrients on constructed tree islands. We found that tree transpiration led to the advective movement of water and associated ions toward the center of the tree islands, supporting CaCO precipitation. CaCO accretion on the tree islands was estimated at roughly 1 mm per decade, and represented 5 % of the total soil accretion since the islands' planting. We also observed depletion in groundwater nutrient concentrations as tree biomass accumulated, indicative of tight nutrient cycling. This work provides direct evidence that trees can act as powerful geomorphic agents in wetland systems, forming mineral soils that support landscape heterogeneity on time scales of centuries to millennia. [ABSTRACT FROM AUTHOR]

Background: Bioassay data analysis continues to be an essential, routine, yet challenging task in modern drug discovery and chemical biology research. The challenge is to infer reliable knowledge from big and noisy data. Some aspects of this problem are general with solutions informed by existing and emerging data science best practices. Some aspects are domain specific, and rely on expertise in bioassay methodology and chemical biology. Testing compounds for biological activity requires complex and innovative methodology, producing results varying widely in accuracy, precision, and information content. Hit selection criteria involve optimizing such that the overall probability of success in a project is maximized, and resource-wasteful "false trails" are avoided. This "fail-early" approach is embraced both in pharmaceutical and academic drug discovery, since follow-up capacity is resource-limited. Thus, early identification of likely promiscuous compounds has practical value. Results: Here we describe an algorithm for identifying likely promiscuous compounds via associated scaffolds which combines general and domain-specific features to assist and accelerate drug discovery informatics, called Badapple: bioassay-data associative promiscuity pattern learning engine. Results are described from an analysis using data from MLP assays via the BioAssay Research Database (BARD) http://bard.nih.gov. Specific examples are analyzed in the context of medicinal chemistry, to illustrate associations with mechanisms of promiscuity. Badapple has been developed at UNM, released and deployed for public use two ways: (1) BARD plugin, integrated into the public BARD REST API and BARD web client; and (2) public web app hosted at UNM. Conclusions: Badapple is a method for rapidly identifying likely promiscuous compounds via associated scaffolds. Badapple generates a score associated with a pragmatic, empirical definition of promiscuity, with the overall goal to identify "false trails" and streamline workflows. Unlike methods reliant on expert curation of chemical substructure pat- terns, Badapple is fully evidence-driven, automated, self-improving via integration of additional data, and focused on scaffolds. Badapple is robust with respect to noise and errors, and skeptical of scanty evidence. [ABSTRACT FROM AUTHOR]

A 12-week study compared Clindagel, a unique water-based gel formulation of clindamycin phosphate 1%, administered once daily, and Cleocin T, a slightly different gel formulation indicated for twice-daily use, in the treatment of acne vulgaris. Clindagel was safe and effective and equivalent to Cleocin T gel, albeit with a better tolerability profile. Clindagel is a viable alternative to Cleocin T gel. [ABSTRACT FROM AUTHOR]