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Abstract Background Venous thromboembolism (VTE) is a preventable medical condition which has substantial impact on patient morbidity, mortality, and disability. Unfortunately, adherence to the published best practices for VTE prevention, based on patient centered outcomes research (PCOR), is highly variable across U.S. hospitals, which represents a gap between current evidence and clinical practice leading to adverse patient outcomes. This gap is especially large in the case of traumatic brain injury (TBI), where reluctance to initiate VTE prevention due to concerns for potentially increasing the rates of intracranial bleeding drives poor rates of VTE prophylaxis. This is despite research which has shown early initiation of VTE prophylaxis to be safe in TBI without increased risk of delayed neurosurgical intervention or death. Clinical decision support (CDS) is an indispensable solution to close this practice gap; however, design and implementation barriers hinder CDS adoption and successful scaling across health systems. Clinical practice guidelines (CPGs) informed by PCOR evidence can be deployed using CDS systems to improve the evidence to practice gap. In the Scaling AcceptabLE cDs (SCALED) study, we will implement a VTE prevention CPG within an interoperable CDS system and evaluate both CPG effectiveness (improved clinical outcomes) and CDS implementation. Methods The SCALED trial is a hybrid type 2 randomized stepped wedge effectiveness-implementation trial to scale the CDS across 4 heterogeneous healthcare systems. Trial outcomes will be assessed using the RE2-AIM planning and evaluation framework. Efforts will be made to ensure implementation consistency. Nonetheless, it is expected that CDS adoption will vary across each site. To assess these differences, we will evaluate implementation processes across trial sites using the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework (a determinant framework) using mixed-methods. Finally, it is critical that PCOR CPGs are maintained as evidence evolves. To date, an accepted process for evidence maintenance does not exist. We will pilot a “Living Guideline” process model for the VTE prevention CDS system. Discussion The stepped wedge hybrid type 2 trial will provide evidence regarding the effectiveness of CDS based on the Berne-Norwood criteria for VTE prevention in patients with TBI. Additionally, it will provide evidence regarding a successful strategy to scale interoperable CDS systems across U.S. healthcare systems, advancing both the fields of implementation science and health informatics. Trial registration Clinicaltrials.gov – NCT05628207. Prospectively registered 11/28/2022, https://classic.clinicaltrials.gov/ct2/show/NCT05628207 .

Abstract Risk assessments are common in multiple domains, from finance to medicine. They require evaluating an event’s potential severity and likelihood. We investigate the possible dependence of likelihood and severity within the domain of impact-based weather forecasting (IBF), following predictions derived from considering asymmetric loss functions. In a collaboration between UK psychologists and partners from four meteorological organisations in Southeast Asia, we conducted two studies (N = 363) eliciting weather warnings from forecasters. Forecasters provided warnings denoting higher likelihoods for high severity impacts than low severity impacts, despite these impacts being described as having the same explicit numerical likelihood of occurrence. This ‘Severity effect’ is pervasive, and we find it can have a continued influence even for an updated forecast. It is additionally observed when translating warnings made on a risk matrix to numerical probabilities.

Abstract We vary greatly in our perception of risk, not just because of differences between risks themselves, but also because of individual, contextual and cultural differences too. To better understand and predict responses to risk, we need to (a) integrate these components, combining approaches from different psychological disciplines and (b) also consider risk tolerance – how individuals trade-off between risks and benefits. We therefore developed an ICONS (individual, contextual, cognitive, social) framework; using it across two empirical studies (n = 4228) to examine how individuals perceive and respond to the quotidian risks associated with consumer products. Three dimensions underlined risk perceptions: benefits, dread and individual responsibility. Risk tolerance was typically predicted by interactions between individual (demographic, cultural worldview, personality) and contextual (product type/category, harm information) factors. In turn, perceived dread, benefits and individual differences shaped how likely participants were to communicate risk information. Our results demonstrate for the first time how the interaction between individual, cognitive (risk tolerance, intensity), contextual, and social (risk communication) factors is key to understanding and predicting risk perceptions. Together, our findings help explain why societal responses to risks are often difficult to predict and have implications for the spread, and amplification, of risk information.

Abstract Coccidiosis, an intestinal disease caused by Eimeria parasites, is responsible for major losses in the poultry industry by impacting chicken health. The gut microbiota is associated with health factors, such as nutrient exchange and immune system modulation, requiring understanding on the effects of Eimeria infection on the gut microbiota. This study aimed to determine the effects of Eimeria acervulina infection on the luminal and mucosal microbiota of the cecum (CeL and CeM) and ileum (IlL and IlM) at multiple time points (days 3, 5, 7, 10, and 14) post-infection. E. acervulina infection decreased evenness in CeL microbiota at day 10, increased richness in CeM microbiota at day 3 before decreasing richness at day 14, and decreased richness in IlL microbiota from day 3 to 10. CeL, CeM, and IlL microbiota differed between infected and control birds based on beta diversity at varying time points. Infection reduced relative abundance of bacterial taxa and some predicted metabolic pathways known for short-chain fatty acid production in CeL, CeM, and IlL microbiota, but further understanding of metabolic function is required. Despite E. acervulina primarily targeting the duodenum, our findings demonstrate the infection can impact bacterial diversity and abundance in the cecal and ileal microbiota.

Eimeria maxima (APU1 and APU2) differ in virulence for chickens, due in part to the greater fecundity of the former. In a previous study, RNA-seq was used to identify a transcripts upregulated in E. maxima APU1 compared to E. maxima APU2. In this study, 2 of these upregulated genes (EMWEY 23530 and EMWEY 48910) were characterized by first confirming upregulation using quantitative RT-PCR. For both EMWEY 23530 and EMWEY 48910, RNA transcription was fairly consistent during sporulation. The extent of differential expression was about 2-fold log2 higher in APU-1 compared to APU-2 (peaking at 18 h for EMWEY 23530 and 0 h for EMWEY 48910). EMWEY 23530 and EMWEY 48910 cDNA were cloned and expressed as polyHis-fusion proteins in Escherichia coli. The observed size of recombinant EMWEY 23530 was 24 kDa; the observed size of recombinant EMWEY 48910 was 35 kDa, which are consistent with the predicted size based on the coding sequences. Immunostaining 2D gel blots of E. maxima APU1 and APU2 oocyst/sporocyst protein with antisera specific for EMWEY 23530 identified a 33.5 kDa protein with a pH 7.4 isoelectric point (Emax p33.5). Similar 2D gel blot analysis with EMWEY 48910 identified a 41 kDa protein with a pH 7.2 isoelectric point (Emax p41). The intensity of Emax p33.5 and Emax p41 was noticeably greater in oocyst/sporocyst proteins from E. maxima APU1 compared to E. maxima APU2. This was corroborated by ELISA wherein equal amounts of total E. maxima APU1 and APU2 protein were probed with serial dilutions of anti-rEmax p33.5 or anti-rEmax p41. Immunofluorescence (IFA) staining of permeabilized unsporulated E. maxima APU1 and APU2 oocysts revealed Emax p33.5 to be localized in one end of oocysts, while Emax p41 appeared on the surface of oocysts. After sporulation, the p33.5 and p41 antigens appeared loosely associated with sporocysts. Taken together, these data confirm excess expression of two proteins in the E. maxima strain characterized by greater fecundity and virulence, and may provide insight into basis for phenotypic differences among different E. maxima.

Summary: RNA degradation is a central process required for transcriptional regulation. Eventually, this process degrades diribonucleotides into mononucleotides by specific diribonucleases. In Escherichia coli, oligoribonuclease (Orn) serves this function and is unique as the only essential exoribonuclease. Yet, related organisms, such as Pseudomonas aeruginosa, display a growth defect but are viable without Orn, contesting its essentiality. Here, we take advantage of P. aeruginosa orn mutants to screen for suppressors that restore colony morphology and identified yciV. Purified YciV (RNase AM) exhibits diribonuclease activity. While RNase AM is present in all γ-proteobacteria, phylogenetic analysis reveals differences that map to the active site. RNase AMPa expression in E. coli eliminates the necessity of orn. Together, these results show that diribonuclease activity prevents toxic diribonucleotide accumulation in γ-proteobacteria, suggesting that diribonucleotides may be utilized to monitor RNA degradation efficacy. Because higher eukaryotes encode Orn, these observations indicate a conserved mechanism for monitoring RNA degradation.

Abstract Background Watchful waiting management for acute otitis media (AOM), where an antibiotic is used only if the child’s symptoms worsen or do not improve over the subsequent 2–3 days, is an effective approach to reduce antibiotic exposure for children with AOM. However, studies to compare the effectiveness of interventions to promote watchful waiting are lacking. The objective of this study is to compare the effectiveness and implementation outcomes of two pragmatic, patient-centered interventions designed to facilitate use of watchful waiting in clinical practice. Methods This will be a cluster-randomized trial utilizing a hybrid implementation-effectiveness design. Thirty-three primary care or urgent care clinics will be randomized to one of two interventions: a health systems-level intervention alone or a health systems-level intervention combined with use of a shared decision-making aid. The health systems-level intervention will include engagement of a clinician champion at each clinic, changes to electronic health record antibiotic orders to facilitate delayed antibiotic prescriptions as part of a watchful waiting strategy, quarterly feedback reports detailing clinicians’ use of watchful waiting individually and compared with peers, and virtual learning sessions for clinicians. The hybrid intervention will include the health systems-level intervention plus a shared decision-making aid designed to inform decision-making between parents and clinicians with best available evidence. The primary outcomes will be whether an antibiotic was ultimately taken by the child and parent satisfaction with their child’s care. We will explore the differences in implementation effectiveness by patient population served, clinic type, clinical setting, and organization. The fidelity, acceptability, and perceived appropriateness of the interventions among different clinician types, patient populations, and clinical settings will be compared. We will also conduct formative qualitative interviews and surveys with clinicians and administrators, focus groups and surveys of parents of patients with AOM, and engagement of two stakeholder advisory councils to further inform the interventions. Discussion This study will compare the effectiveness of two pragmatic interventions to promote use of watchful waiting for children with AOM to reduce antibiotic exposure and increase parent satisfaction, thus informing national antibiotic stewardship policy development. Clinical trial registration NCT06034080.

RESUMO: As normas internacionais para o tratamento da asma brônquica recomendam que os doentes com sintomatologia mal controlada com doses baixas/ /intermédias de corticosteróides (CT) inalados sejam submetidos a doses mais elevadas de CT e, se necessário, deverá ser adicionado um β2 agonista de longa duração. No entanto, estudos mais recentes demonstraram que a adição deste fármaco a doses baixas/moderadas de CT inalados permite um melhor controlo da sintomatologia do que a duplicação da dose de CT. O formoterol constitui o β2 agonista de eleição devido ao seu início de acção rápida.O objectivo do presente trabalho foi comparar a eficácia da associação do β2 agonista formoterol a doses médias/elevadas de CT inalados com a duplicação da dose do CT em indivíduos com asma moderada/grave mal controlada.Foram avaliados doentes com idade superior a 18 anos com asma moderada e grave que apresentavam um FEV1â¥50% do previsto e um aumentoâ¥15% do referido parâmetro após inalação de um broncodilatador de curta duração, tendo sido submetido a terapêutica com CT inalados diariamente (dipropionato de beclometasona 1000 μ - budesonida 800 μg) no mês que precedeu o início do estudo em análise. A existência de, pelo menos, dois dos parâmetros seguintes, nos últimos 7 dias do período de run-in, foi imprescindível: sintomatologia interferindo com as actividades de vida diária; interrupção do sono por sintomas nocturnos, necessidade de terapêutica de alívio numa doseâ¥4 puffs salbutamol/dia; variabilidade diária do PEF (Peak Expiratory Flow)â¥15%.Foram critérios de exclusão: doentes cuja dose do CT inalado diária foi alterada no último mês; indivíduos submetidos a CT oral ou β2 agonista de longa duração no mês precedente; doentes com dificuldade de utilizar o aerolizer apesar da instrução adequada.Tratou-se de um estudo randomizado, duplamente cego, envolvendo 203 indivíduos: 102 submetidos a formoterol 12 μg e dipropionato de beclometasona 500 μg duas vezes/dia; 101 sob este corticosteróide na dose de 1000 μg duas vezes/dia e placebo. Ambos os grupos foram tratados com os referidos fármacos durante 12 semanas. Os doentes estudados apresentavam um FEV1 72% do previsto, uma reversibilidade desencadeada pelo (β2 agonista de curta duração de 27%, scores de sintomas moderados e necessidade de terapêutica de alívio na doseâ¥5 puffs de salbutamol/ dia.A diferença do PEF entre os dois grupos foi de 27,78 1/minuto, sendo favorável à associação formoterol/beclometasona (p=0,0002). Foi observada, também, uma diferença estatisticamente significativa na relação cortisol/ creatinina urinário após o tratamento de 12 semanas (p=0,001), indicando supressão do eixo hipotalâmico-hipofisário nos doentes sob 1000 μg de dipropionato de beclometasona duas vezes/ dia. Os scores de sintomas foram significativamente mais baixos nos doentes sob terapêutica combinada, sendo a proporção de doentes livres de sintomas durante o dia duas vezes superior neste grupo e a utilização de terapêutica de alívio inferior. COMENTÃRIO: Este estudo demonstra que, no tratamento de doentes com asma moderada/grave não controlada com dipropionato de beclometasona 1000 μg/dia, a adição de formoterol 12 μg duas vezes/dia é mais eficaz do que a duplicação da dose de beclometasona.A terapêutica combinada melhora significativamente os parâmetros objectivos da obstrução das vias aéreas quando comparada com altas doses de corticosteróides inalados. O efeito benéfico de adição de formoterol na função pulmonar tornou-se evidente após quatro semanas de tratamento e permaneceu inalterada até ao fim do estudo. Este efeito pode dever-se ao antagonismo funcional do formoterol à contracção do músculo liso, à sua capacidade de estabilizar os mastócitos ou de reduzir o edema da parede brônquica.As exacerbações ligeiras e moderadas ocorreram com maior frequência no grupo sob altas doses de CT inalados. Estes resultados foram sobreponíveis aos observados anteriormente em doentes com asma ligeira submetidos à associação formoterol/budesonido (dose baixa/intermédia) ou a doses elevadas deste último fármaco. Também neste estudo se verificou um maior número de exacerbações no segundo grupo.Elevadas doses de CT inalados estão relacionadas com significativos efeitos suprarrenais. Assim, a associação de um β2 agonista de longa acção (formoterol) permite o controlo da doença sem necessidade de doses altas de CT inalados. Neste estudo, o quociente cortisol/creatinina urinário foi significativamente menor no grupo sob corticoterapia em dose elevada do que nos indivíduos submetidos a terapêutica combinada, traduzindo uma maior supressão do risco hipotalâmico-hipofisário no primeiro caso. Estes achados vieram confirmar a observação de que o dipropionato de beclometasona na doseâ¥1500 μg/dia exerce um efeito supressor significativo na libertação de cortisol endógeno.A terapêutica combinada de CT inalados e β2 agonistas de longa acção permitiu um bom controlo da asma brônquica, comparativamente a baixas doses de CT, e conduziu à administração dos fármacos inalados em doses fixas através de um dispositivo único. Ringdal e colaboradores compararam a eficácia do salmeterol 50 μg/ fluticasona 250 μg utilizando Diskus duas vezes/dia com o formoterol 12 μg/ budesonido 500 μg administrados separadamente através do Turbohaler duas vezes/ /dia. A primeira associação foi significativamente superior na redução das exacerbações de asma e dos sintomas nocturnos, apesar da dose mais baixa de fluticasona comparada com a de budesonido. Estes resultados não são, no entanto, inesperados, visto a fluticasona ser mais potente do que o budesonido.Apesar de a administração de fármacos em doses fixas num único dispositivo ter vantagens adicionais em termos de aderência ao tratamento e conveniência, não apresenta grande flexibilidade no ajuste da dose durante as exacerbações. São, assim, necessários novos estudos para avaliar os dispositivos mais apropriados, de forma a obter o maior sinergismo de acção entre β2 agonista de longa duração e os CT inalados. Palavras-chave: Asma moderada/grave, β2 agonista de longa acção, formoterol, corticosteróides inalados, beclometasona

Recurring outbreaks of cyclosporiasis linked to fresh produce demonstrate the need to develop interventions to reduce C. cayetanensis in irrigation water. C. cayetanensis is resistant to commonly used irrigation water treatments, such as chemical sanitizers, making removal of oocysts by filtration the most suitable intervention. This study evaluated the reduction of Eimeria tenella and E. acervulina, as surrogates for C. cayetanensis, in water using filters packed with sand alone or mixtures of sand and zero-valent iron (ZVI). Water inoculated with Eimeria spp. oocysts was filtered through laboratory-scale (PVC column) and field-scale (swimming pool filter) filters packed with either 100% sand or 50% ZVI/50% sand (v/v). Filtered and backflush water was examined microscopically for oocysts. Laboratory-scale filters with 50% ZVI significantly (p < 0.05) reduced 99.9% of E. tenella oocysts compared to 55.3% with filters containing 100% sand. At the field-scale level, 50% ZVI filters significantly (p < 0.05) reduced 70.5% of E. acervulina oocysts compared to 54.5% by 100% sand filters. Filters were backflushed to examine the recovery of these parasites during routine filter-media cleaning procedures. Backflush recovery of oocysts ranged from 4.42–16.7%. The addition of ZVI significantly improved the reduction of Eimeria spp. oocysts at both filter scales. and should be further investigated as a potential irrigation water intervention to reduce C. cayetanensis.

Coccidiosis in broiler chickens continues to be a major disease of the gastrointestinal tract, causing economic losses to the poultry industry worldwide. The goal of this study was to generate a symptomatic Eimeria maxima (1000 oocysts) infection to determine its effect on the luminal and mucosal microbiota populations (L and M) in the jejunum and ileum (J and IL). Samples were taken from day 0 to 14 post-infection, and sequencing of 16S rRNA was performed using Illumina technology. Infected birds had significantly (p < 0.0001) lower body weight gain (BWG), higher feed conversion ratio (FCR) (p = 0.0015), increased crypt depth, and decreased villus height (p < 0.05). The significant differences in alpha and beta diversity were observed primarily at height of infection (D7). Analysis of taxonomy indicated that J-L and M were dominated by Lactobacillus, and in IL-M, changeover from Candidatus Arthromitus to Lactobacillus as the major taxon was observed, which occurred quicky in infected animals. LEfSe analysis found that in the J-M of infected chickens, Lactobacillus was significantly more abundant in infected (IF) chickens. These findings show that E. maxima infection affects the microbiota of the small intestine in a time-dependent manner, with different effects on the luminal and mucosal populations.

Including dietary fat can increase the energy density of diets fed to ruminants, reducing dry matter intake (DMI). Effects of different fat sources on nutrient digestion and fermentation can vary depending on dietary fat concentration and the forage-to-concentrate ratio (F:C). Therefore, this study’s objective was to screen the effects of fat sources supplemented at different concentrations to high- and low-forage diets on in vitro digestibility and fermentation. Treatments included either low forage (LF; 35%) or high forage (HF; 70%) with two fat levels (6 or 9% DM) using six different fat sources, plus control. The control diet (CON) had a basal level of fat in the diet (3% fat; 0% fat inclusion), and fat sources were added to attain 6% or 9% dietary fat and consisted of the following: Coconut oil, CO; Poultry fat, PF; Palm oil, PO; Palm kernel oil, PKO; Soybean oil, SOY; and Ca Salts, MEG. In vitro Gas Production (GP) modules were randomly assigned to treatments in a 2 × 2 × 7 factorial design and were incubated for four 24 h runs. The CO-fed module had the highest dry matter (DM) apparent digestibility (AD) (p < 0.01), followed by SOY and PF. The true DM digestibility (TDMD) and organic matter (OM) AD were the highest in CO (p < 0.01) than the other fat types. The AD for DM, OM, neutral detergent fiber (NDF), and acid detergent fiber (ADF) was higher in LF (p < 0.01). The 6% fat inclusion had a higher GP (109 vs. 103 mL ± 2.09; p < 0.03). Total volatile fatty acid (VFA) concentration was lower in different fat types than the CON and the acetate molar proportion (p > 0.01). The propionate was the lowest for the CON, which increased the acetate to propionate (A:P) ratio (p < 0.01). These results suggest that LF diets with high fat concentrations can be utilized, and different fat sources may improve DM and fiber digestibility.

RESUMO: As normas internacionais para o tratamento da asma brônquica recomendam que os doentes com sintomatologia mal controlada com doses baixas/ /intermédias de corticosteróides (CT) inalados sejam submetidos a doses mais elevadas de CT e, se necessário, deverá ser adicionado um β2 agonista de longa duração. No entanto, estudos mais recentes demonstraram que a adição deste fármaco a doses baixas/moderadas de CT inalados permite um melhor controlo da sintomatologia do que a duplicação da dose de CT. O formoterol constitui o β2 agonista de eleição devido ao seu início de acção rápida.O objectivo do presente trabalho foi comparar a eficácia da associação do β2 agonista formoterol a doses médias/elevadas de CT inalados com a duplicação da dose do CT em indivíduos com asma moderada/grave mal controlada.Foram avaliados doentes com idade superior a 18 anos com asma moderada e grave que apresentavam um FEV1â¥50% do previsto e um aumentoâ¥15% do referido parâmetro após inalação de um broncodilatador de curta duração, tendo sido submetido a terapêutica com CT inalados diariamente (dipropionato de beclometasona 1000 μ - budesonida 800 μg) no mês que precedeu o início do estudo em análise. A existência de, pelo menos, dois dos parâmetros seguintes, nos últimos 7 dias do período de run-in, foi imprescindível: sintomatologia interferindo com as actividades de vida diária; interrupção do sono por sintomas nocturnos, necessidade de terapêutica de alívio numa doseâ¥4 puffs salbutamol/dia; variabilidade diária do PEF (Peak Expiratory Flow)â¥15%.Foram critérios de exclusão: doentes cuja dose do CT inalado diária foi alterada no último mês; indivíduos submetidos a CT oral ou β2 agonista de longa duração no mês precedente; doentes com dificuldade de utilizar o aerolizer apesar da instrução adequada.Tratou-se de um estudo randomizado, duplamente cego, envolvendo 203 indivíduos: 102 submetidos a formoterol 12 μg e dipropionato de beclometasona 500 μg duas vezes/dia; 101 sob este corticosteróide na dose de 1000 μg duas vezes/dia e placebo. Ambos os grupos foram tratados com os referidos fármacos durante 12 semanas. Os doentes estudados apresentavam um FEV1 72% do previsto, uma reversibilidade desencadeada pelo (β2 agonista de curta duração de 27%, scores de sintomas moderados e necessidade de terapêutica de alívio na doseâ¥5 puffs de salbutamol/ dia.A diferença do PEF entre os dois grupos foi de 27,78 1/minuto, sendo favorável à associação formoterol/beclometasona (p=0,0002). Foi observada, também, uma diferença estatisticamente significativa na relação cortisol/ creatinina urinário após o tratamento de 12 semanas (p=0,001), indicando supressão do eixo hipotalâmico-hipofisário nos doentes sob 1000 μg de dipropionato de beclometasona duas vezes/ dia. Os scores de sintomas foram significativamente mais baixos nos doentes sob terapêutica combinada, sendo a proporção de doentes livres de sintomas durante o dia duas vezes superior neste grupo e a utilização de terapêutica de alívio inferior. COMENTÃRIO: Este estudo demonstra que, no tratamento de doentes com asma moderada/grave não controlada com dipropionato de beclometasona 1000 μg/dia, a adição de formoterol 12 μg duas vezes/dia é mais eficaz do que a duplicação da dose de beclometasona.A terapêutica combinada melhora significativamente os parâmetros objectivos da obstrução das vias aéreas quando comparada com altas doses de corticosteróides inalados. O efeito benéfico de adição de formoterol na função pulmonar tornou-se evidente após quatro semanas de tratamento e permaneceu inalterada até ao fim do estudo. Este efeito pode dever-se ao antagonismo funcional do formoterol à contracção do músculo liso, à sua capacidade de estabilizar os mastócitos ou de reduzir o edema da parede brônquica.As exacerbações ligeiras e moderadas ocorreram com maior frequência no grupo sob altas doses de CT inalados. Estes resultados foram sobreponíveis aos observados anteriormente em doentes com asma ligeira submetidos à associação formoterol/budesonido (dose baixa/intermédia) ou a doses elevadas deste último fármaco. Também neste estudo se verificou um maior número de exacerbações no segundo grupo.Elevadas doses de CT inalados estão relacionadas com significativos efeitos suprarrenais. Assim, a associação de um β2 agonista de longa acção (formoterol) permite o controlo da doença sem necessidade de doses altas de CT inalados. Neste estudo, o quociente cortisol/creatinina urinário foi significativamente menor no grupo sob corticoterapia em dose elevada do que nos indivíduos submetidos a terapêutica combinada, traduzindo uma maior supressão do risco hipotalâmico-hipofisário no primeiro caso. Estes achados vieram confirmar a observação de que o dipropionato de beclometasona na doseâ¥1500 μg/dia exerce um efeito supressor significativo na libertação de cortisol endógeno.A terapêutica combinada de CT inalados e β2 agonistas de longa acção permitiu um bom controlo da asma brônquica, comparativamente a baixas doses de CT, e conduziu à administração dos fármacos inalados em doses fixas através de um dispositivo único. Ringdal e colaboradores compa-raram a eficácia do salmeterol 50 μg/ fluticasona 250 μg utilizando Diskus duas vezes/dia com o formoterol 12 μg/ budesonido 500 μg administrados separadamente através do Turbohaler duas vezes/ /dia. A primeira associação foi significativamente superior na redução das exacerbações de asma e dos sintomas nocturnos, apesar da dose mais baixa de fluticasona comparada com a de budesonido. Estes resultados não são, no entanto, inesperados, visto a fluticasona ser mais potente do que o budesonido.Apesar de a administração de fármacos em doses fixas num único dispositivo ter vantagens adicionais em termos de aderência ao tratamento e conveniência, não apresenta grande flexibilidade no ajuste da dose durante as exacerbações. São, assim, necessários novos estudos para avaliar os dispositivos mais apropriados, de forma a obter o maior sinergismo de acção entre β2 agonista de longa duração e os CT inalados. Palavras-chave: Asma moderada/grave, β2 agonista de longa acção, formoterol, corticosteróides inalados, beclometasona

Abstract Objective We estimate annual hospital expenditures to achieve high emergency department (ED) pediatric readiness (HPR), that is, weighted Pediatric Readiness Score (wPRS) ≥ 88 (0–100 scale) across EDs with different pediatric volumes of children, overall and after accounting for current levels of readiness. Methods We calculated the annual hospital costs of HPR based on two components: (1) ED pediatric equipment and supplies and (2) labor costs required for a Pediatric Emergency Care Coordinator (PECC) to perform pediatric readiness tasks. Data sources to generate labor cost estimates included: 2021 national salary information from U.S. Bureau of Labor Statistics, detailed patient and readiness data from 983 EDs in 11 states, the 2021 National Pediatric Readiness Project assessment; a national PECC survey; and a regional PECC survey. Data sources for equipment and supply costs included: purchasing costs from seven healthcare organizations and equipment usage per ED pediatric volume. We excluded costs of day‐to‐day ED operations (ie, direct clinical care and routine ED supplies). Results The total annual hospital costs for HPR ranged from $77,712 (95% CI 54,719–100,694) for low volume EDs to $279,134 (95% CI 196,487–362,179) for very high volume EDs; equipment costs accounted for 0.9–5.0% of expenses. The total annual cost‐per‐patient ranged from $3/child (95% CI 2–4/child) to $222/child (95% CI 156–288/child). After accounting for current readiness levels, the cost to reach HPR ranged from $23,775 among low volume EDs to $145,521 among high volume EDs, with costs per patient of $4/child to $48/child. Conclusions Annual hospital costs for HPR are modest, particularly when considered per child.

Abstract Eimeria tenella is a major cause of caecal coccidiosis in commercial poultry chickens worldwide. Here, we report chromosomal scale assembly of Eimeria tenella strain APU2, a strain isolated from commercial broiler chickens in the U.S. We obtained 100× sequencing Oxford Nanopore Technology (ONT) and more than 800× Coverage of Illumina Next-Seq. We created the assembly using the hybrid approach implemented in MaSuRCA, achieving a contiguous 51.34 Mb chromosomal-scale scaffolding enabling identification of structural variations. The AUGUSTUS pipeline predicted 8060 genes, and BUSCO deemed the genomes 99% complete; 6278 (78%) genes were annotated with Pfam domains, and 1395 genes were assigned GO-terms. Comparing E. tenella strains (APU2, US isolate and Houghton, UK isolate) derived Houghton strain of E. tenella revealed 62,905 high stringency differences, of which 45,322 are single nucleotide polymorphisms (SNPs) (0.088%). The rate of transitions/transversions among the SNPs are 1.63 ts/tv. The strains possess conserved gene order but have profound sequence heterogeneity in a several chromosomal segments (chr 2, 11 and 15). Genic and intergenic variation in defined gene families was evaluated between the two strains to possibly identify sequences under selection. The average genic nucleotide diversity of 2.8 with average 2 kb gene length (0.145%) at genic level. We examined population structure using available E. tenella sequences in NCBI, revealing that the two E. tenella isolates from the U.S. (E. tenella APU2 and Wisconsin, “ERR296879”) share a common maternal inheritance with the E. tenella Houghton. Our chromosomal level assembly promotes insight into Eimeria biology and evolution, hastening drug discovery and vaccine development.

Abstract The Laser Interferometer Space Antenna (LISA) has two scientific objectives of cosmological focus: to probe the expansion rate of the universe, and to understand stochastic gravitational-wave backgrounds and their implications for early universe and particle physics, from the MeV to the Planck scale. However, the range of potential cosmological applications of gravitational-wave observations extends well beyond these two objectives. This publication presents a summary of the state of the art in LISA cosmology, theory and methods, and identifies new opportunities to use gravitational-wave observations by LISA to probe the universe.

Introduction: Increases in vaccine hesitancy continue to threaten the landscape of public health. Literature provides recommendations for vaccine communication and highlights the importance of patient trust, yet few studies have examined medical student perspectives on vaccine hesitancy in clinical settings. Therefore, we aimed to explore medical student experiences encountering vaccine hesitancy, mistrust, and personal biases, with the goal of informing medical student education. Methods: A health disparities course including simulated clinical scenarios required students to complete a written reflection. We sorted reflections written in 2014-2016 to identify common topics and used inductive thematic analysis to identify themes relevant to vaccine hesitancy by group consensus. Results: Our sample included 84 de-identified essays sorted into three non-exclusive topics: vaccine hesitancy (n=42), mistrust (n=34), and personal bias (n=39). We identified four themes within medical students’ reflections: 1) Building a Relationship, including emphasis on patient-centred approaches; 2) Preparedness and Need to Prepare for Future Encounters, including highlighting gaps in medical education; 3) Reactions to Encountering Hesitant Patients, including frustration; 4) Insights for Providing Information and Developing a Plan with Hesitant Patients, including approaches to presenting knowledge. Conclusion: Reflections in the context of simulated encounters and discussion are useful in students identifying their preparedness for vaccine discussion with patients. Student reflections can assist educators in identifying missing educational frameworks for particular scenarios such as vaccine hesitancy. Without a structured framework regarding addressing vaccine hesitancy, students draw upon other skills that may contradict recommended practices.

The COVID-19 pandemic has exposed some of our best and worst qualities as a country. This commentary on “Domestic Firearm Violence Against Women (2018-2021)” discusses weaknesses in federal legislation and proposes ways for states to fill these gaps.

ABSTRACT: Vaccination of chickens against avian coccidiosis in chickens often involves storing Eimeria oocysts for months after oocyst propagation and sporulation. The purpose of this study was to determine how long E. acervulina, E. maxima, and E. tenella oocysts remained viable when stored at refrigeration (4°C) or egg room (20°C) temperatures. Separate tubes containing E. acervulina, E. maxima, or E. tenella oocysts were stored at these temperatures and a sample removed every 3 mo for inoculating chickens for evidence of a patent infection. Also, an aliquot of each Eimeria species at each time–temperature combination was subjected to in vitro excystation to quantify the relative number of released sporozoites to intact (nonexcysted) sporocysts. Eimeria tenella appeared to be most susceptible to storage in that no oocyst production was observed at 9 mo at either temperature. Although E. maxima oocysts were viable at 9 mo, no oocyst production was observed at 12 mo storage at these 2 temperatures. Quite unexpected was that E. acervulina was much more stable than E. tenella and E. maxima remaining viable up to and including 27 mo at 4°C and up to and including 12 mo at 20°C. No consistent correlation was observed between in vivo oocyst production and in vitro excystation arising from these 2 respective temperatures (E. acervulina r = 0.58, r = 0.54; E. maxima r = 0.90, r = 0.54; E. tenella r = 0.38, r = 0.90). These data indicate that attention must be paid to time and temperature of Eimeria oocyst storage, and that sporozoite excystation may not be a good indicator of oocyst viability, particularly at later timepoints in incubation.

Aim: Preventing unnecessarily long durations of antibiotic therapy is a key opportunity to reduce antibiotic overuse in children 2 years of age and older with acute otitis media (AOM). Pragmatic interventions to reduce durations of therapy that can be effectively scaled and sustained are urgently needed. This study aims to fill this gap by evaluating the effectiveness and implementation outcomes of two low-cost interventions of differing intensities to increase guideline-concordant antibiotic durations in childrenwith AOM. Methods: The higher intensity intervention will consist of clinician education regarding guidelinerecommended short durations of antibiotic therapy; electronic health record (EHR) prescription field changes to promote prescribing of recommended short durations; and individualized clinician audit and feedback on adherence to recommended short durations of therapy in comparison to peers, while the lower intensity intervention will consist only of clinician education and EHR changes. We will explore the differences in implementation effectiveness by patient population served, clinician type, clinical setting and organization as well as intervention type. The fidelity, feasibility, acceptability and perceived appropriateness of the interventions among different clinician types, patient populations, clinical settings and intervention type will be compared. We will also conduct formative qualitative interviews with clinicians and administrators and focus groups with parents of patients to further inform the interventions and study. The formative evaluation will take place over 1.5 years, the interventions will be implemented over 2 years and evaluation of the interventions will take place over 1.5 years. Discussion: The results of this study will provide a framework for other healthcare systems to address the widespread problem of excessive durations of therapy for AOM and inform national antibiotic stewardship policy development.

Necrotic enteritis (NE) is a disease of the gastrointestinal tract that is common in broiler chickens and causes substantial economic losses to the poultry industry worldwide. The removal of many antimicrobials in poultry diets has driven the search for alternatives. The purpose of this study was to determine the microbiota changes in the cecal luminal (CE-L) and mucosal (CE-M) populations of broiler chickens undergoing clinical NE (co-infected with Eimeria maxima and Clostridium perfringens) while fed a diet containing a flavonoid rich corn (PennHFD1) or control diet using commercial corns. It was previously shown that chickens fed a diet high in flavonoids had improved performance parameters, lower mortality rate, and lower incidence of intestinal lesions. Flavonoids have been shown to have anti-bacterial, immuno-modulatory, and anti-inflammatory activity. The current study included four experimental groups: infected chickens fed commercial corn diet (CTRL-A) or PennHFD1 (CTRL-B) and infected chickens fed commercial corn diet (IF-A) or PennHFD1 (IF-B). We found that most of the microbiota changes were due to infection rather than diet. The alpha diversity in the IF chickens was lower in both CE-L and CE-M. The beta diversity of microbial communities was different between IF and CTRL chickens, as well as between CTRL-A and CTRL-B. The beta diversity of CTRL birds was more homogenous compared to IF samples. Taxonomic analysis showed a decrease in short chain fatty acid producing bacteria in IF birds. An increase in lactic acid producing bacteria, Escherichia coli, and Enterococcus cecorum was also observed in IF birds. It is possible that the effect of the high flavonoid corn on the microbiota was overcome by the effect of NE, or that the positive effects of increased flavonoids in NE-challenged birds are a result of mechanisms which do not involve the microbiota. The effects of high flavonoid corn on NE infections may be further investigated as a possible alternative to antimicrobials.

The overall objective of this study was to determine the dose response to four levels of cashew nut shell extract in a granulated form (CNSE, containing 59% anacardic acid and 18% cardol) on culture pH, rumen fermentation metabolites, and apparent nutrient digestibility in continuous culture fermenters. The study was conducted as a generalized randomized complete block design with four treatments and four replications per treatment. The four treatments were randomly assigned to eight fermenters for two incubation runs of 10 d. Treatments consisted of (1) Control (CO, no CNSE), (2) Control plus 100 ppm of CNSE, (3) Control plus 200 ppm of CNSE, and (4) Control plus 300 ppm of CNSE. Fermenters were fed 52 g/d (DM basis) of a total mixed ration (TMR; 17.0% crude protein (CP), 29.7% NDF, and 29.9% starch), divided between two feedings at 0800 and 2000 h. The apparent digestibility of dry matter (DM), organic matter (OM), and neutral detergent fiber (NDF) were not affected by CNSE supplementation. Similarly, CNSE had no effect on culture pH, total volatile fatty acids (VFA) or individual VFA molar proportions. These results suggest that at the dosages evaluated in this study, CNSE has no impact on the rumen fermentation profile and the apparent nutrient digestibility under continuous culture conditions.

Abstract Background Studies have not systematically compared the ability to verify performance of prognostic transcripts in paired bulk mononuclear cells versus viable CD34-expressing leukemic blasts from patients with acute myeloid leukemia. We hypothesized that examining the homogenous leukemic blasts will yield different biological information and may improve prognostic performance of expression biomarkers. Methods To assess the impact of cellular heterogeneity on expression biomarkers in acute myeloid leukemia, we systematically examined paired mononuclear cells and viable CD34-expressing leukemic blasts from SWOG diagnostic specimens. After enrichment, patients were assigned into discovery and validation cohorts based on availability of extracted RNA. Analyses of RNA sequencing data examined how enrichment impacted differentially expressed genes associated with pre-analytic variables, patient characteristics, and clinical outcomes. Results Blast enrichment yielded significantly different expression profiles and biological pathways associated with clinical characteristics (e.g., cytogenetics). Although numerous differentially expressed genes were associated with clinical outcomes, most lost their prognostic significance in the mononuclear cells and blasts after adjusting for age and ELN risk, with only 11 genes remaining significant for overall survival in both cell populations (CEP70, COMMD7, DNMT3B, ECE1, LNX2, NEGR1, PIK3C2B, SEMA4D, SMAD2, TAF8, ZNF444). To examine the impact of enrichment on biomarker verification, these 11 candidate biomarkers were examined by quantitative RT/PCR in the validation cohort. After adjusting for ELN risk and age, expression of 4 genes (CEP70, DNMT3B, ECE1, and PIK3CB) remained significantly associated with overall survival in the blasts, while none met statistical significance in mononuclear cells. Conclusions This study provides insights into biological information gained/lost by examining viable CD34-expressing leukemic blasts versus mononuclear cells from the same patient and shows an improved verification rate for expression biomarkers in blasts.

For reasons unknown, Eimeria maxima is unique among Eimeria species infecting chickens in the immunovariability it displays among isolates from different geographical areas. Eimeria maxima oocysts (named EmaxAPU3) were isolated late in grow-out (6 weeks) from litter in a commercial broiler operation that was using Eimeria vaccination as the coccidiosis control program. Cross-protection studies (n = 4) were conducted in immunologically naïve chickens between EmaxAPU3 and two E. maxima lab strains (EmaxAPU1, EmaxAPU2) by immunizing with one E. maxima strain and challenging with either the homologous or heterologous E. maxima. As measured by oocyst output, immunization with EmaxAPU1 protected against homologous challenge (EmaxAPU1) and against heterologous challenge with EmaxAPU3, but not against EmaxAPU2. Similarly, immunization with EmaxAPU3 protected against homologous challenge (EmaxAPU3) and against heterologous challenge with EmaxAPU1, but not against EmaxAPU2. Immunization of chickens with EmaxAPU2 elicited a protective response against homologous challenge (EmaxAPU2), but not against EmaxAPU1 nor EmaxAPU3. The most plausible explanation for the appearance of this immunovariant late in grow-out is that E. maxima APU3 escaped immunity directed to E. maxima antigenic types in the commercial vaccine.

Abstract The overuse and expansion of artificial light at night (ALAN) has emerged from complex social, economic, and political factors, making it a societal problem that negatively impacts wildlife and people. We propose that a convergence research approach combining ecological forecasting with community engagement and public policy is needed to address this diverse societal problem. To begin this convergence research approach, we hosted a workshop to strengthen connections among key biodiversity‐oriented ALAN stakeholders and to better understand how stakeholder groups function across the United States through facilitated discussions. We have prioritized the input of stakeholders early in our research design by including them in the formulation of a national survey on public perceptions surrounding ALAN and received their input on existing ecological forecasting tools to improve those research products for their future use.

Strains of Eimeria maxima, an enteric parasite of poultry, vary in virulence. Here, we performed microscopy and RNA sequencing on oocysts of strains APU-1 (which exhibits more virulence) and APU-2. Although each underwent parallel development, APU-1 initially approached maturation more slowly. Each strain sporulated by hour 36; their gene expression diverged somewhat thereafter. Candidate biomarkers of viability included 58 genes contributing at least 1000 Transcripts Per Million throughout sporulation, such as cation-transporting ATPases and zinc finger domain-containing proteins. Many genes resemble constitutively expressed genes also important to Eimeria acervulina. Throughout sporulation, the expression of only a few genes differed between strains; these included cyclophilin A, EF-1α, and surface antigens (SAGs). Mature and immature oocysts uniquely differentially express certain genes, such as an X-Pro dipeptidyl-peptidase domain-containing protein in immature oocysts and a profilin in mature oocysts. The immature oocysts of each strain expressed more phosphoserine aminotransferase and the mature oocysts expressed more SAGs and microneme proteins. These data illuminate processes influencing sporulation in Eimeria and related genera, such as Cyclospora, and identify biological processes which may differentiate them. Drivers of development and senescence may provide tools to assess the viability of oocysts, which would greatly benefit the poultry industry and food safety applications.

The third Gravitational-Wave Transient Catalog (GWTC-3) describes signals detected with Advanced LIGO and Advanced Virgo up to the end of their third observing run. Updating the previous GWTC-2.1, we present candidate gravitational waves from compact binary coalescences during the second half of the third observing run (O3b) between 1 November 2019, 15∶00 Coordinated Universal Time (UTC) and 27 March 2020, 17∶00 UTC. There are 35 compact binary coalescence candidates identified by at least one of our search algorithms with a probability of astrophysical origin p_{astro}>0.5. Of these, 18 were previously reported as low-latency public alerts, and 17 are reported here for the first time. Based upon estimates for the component masses, our O3b candidates with p_{astro}>0.5 are consistent with gravitational-wave signals from binary black holes or neutron-star–black-hole binaries, and we identify none from binary neutron stars. However, from the gravitational-wave data alone, we are not able to measure matter effects that distinguish whether the binary components are neutron stars or black holes. The range of inferred component masses is similar to that found with previous catalogs, but the O3b candidates include the first confident observations of neutron-star–black-hole binaries. Including the 35 candidates from O3b in addition to those from GWTC-2.1, GWTC-3 contains 90 candidates found by our analysis with p_{astro}>0.5 across the first three observing runs. These observations of compact binary coalescences present an unprecedented view of the properties of black holes and neutron stars.

The intestinal disease coccidiosis, caused by Eimeria parasites, impacts nutrient absorption in broiler chickens, leading to weight gain depression and major losses in the poultry industry. To develop alternatives to antibiotics for treating infected chickens, the gut microbiota has been researched because of its association with health factors such as nutrient exchange, immune system modulation, digestive system physiology, and pathogen exclusion. The aim of this study was to determine the effect of Eimeria acervulina infection on the luminal and mucosal microbiota of both the duodenum (DuoL and DuoM) and jejunum (JejL and JejM) at multiple time points (days 3, 5, 7, 10, and 14) post-infection. 16S rRNA amplicon sequencing was utilized to characterize the microbiota and analyze differences in alpha and beta diversity between infected (IF) and control (C) birds at each time point. Alpha diversity differed between IF and C birds in DuoM and JejM microbiota. Combined with beta diversity results, DuoM microbiota appeared to be affected by infection in the longer-term, while JejM microbiota were affected in the shorter-term. Relative abundances of bacterial taxa known for short-chain fatty acid (SCFA) production, such as Lachnospiraceae, Subdoligranulum, and Peptostreptococcaceae, tended to be lower in IF birds for all four microbiota. Moreover, predicted functional abundances showed MetaCyc pathways related to SCFA production, especially butyrate, may be influenced by these differences in bacterial relative abundance. Our findings expand understanding of how Eimeria infection affects luminal and mucosal microbiota in the duodenum and jejunum, and further research on metagenomic function may provide insights on the degree of influence duodenal and jejunal bacteria have on chicken health.

ObjectivesPro-inflammatory molecules are thought to underpin the development of chronic low back pain (LBP). Although research has begun to explore the association between pro-inflammatory molecules in acute LBP and long-term outcome, no study has explored the role of anti-inflammatory molecules. We aimed to explore whether levels of systemic pro- and anti-inflammatory molecules 1) changed over a period of six months from the onset of acute LBP; 2) differed between people who were recovered (N = 11) and unrecovered (N = 24) from their episode of LBP at six months; 3) baseline psychological factors were related to inflammatory molecule serum concentrations at baseline, three and six months.MethodsWe retrospectively included participants with acute LBP included from a larger prospective trial and examined blood samples for the measurement of pro- and anti-inflammatory molecules and measures of pain, disability, and psychological factors at baseline, three and six months.ResultsThe serum concentrations of pro- and anti-inflammatory molecules did not differ over time when compared between participants who recovered and those who did not recover at six-month follow-up. At three months, the unrecovered group had higher interleukin (IL)-8 and IL-10 serum concentrations than the recovered group. Baseline psychological factors were not related to inflammatory molecules at any time point.DiscussionThis exploratory study showed that levels of systemic inflammatory molecules did not change over the course of LBP, irrespective of whether people were recovered or unrecovered at six months. There was no relationship between acute-stage psychological factors and systemic inflammatory molecules. Further investigation is needed to elucidate the contribution of pro- and anti-inflammatory molecules to long-term LBP outcome.

Organ-on-a-chip platforms are utilized in global bioanalytical and toxicological studies as a way to reduce materials and increase throughput as compared to in vivo based experiments. These platforms bridge the infrastructure and regulatory gaps between in vivo animal work and human systems, with models that exemplify active biological pathways. In conjunction with the advent of increased capabilities associated with next generation sequencing and mass spectrometry based '-omic' technologies, organ-on-a-chip platforms provide an excellent opportunity to investigate the global changes at multiple biological levels, including the transcriptome, proteome and metabolome. When investigated concurrently, a complete profile of cellular and regulatory perturbations can be characterized following treatment with specific agonists. In this study, global effects were observed and analyzed following liver chip exposure to the chemical warfare agent, VX. Even though the primary mechanism of action of VX (i.e. acetylcholinesterase inhibition) is well characterized, recent in vivo studies suggest additional protein binding partners that are implicated in metabolism and cellular energetic pathways. In addition, secondary toxicity associated with peripheral organ systems, especially in human tissues, is not well defined. Our results demonstrate the potential of utilizing an organ-on-a-chip platform as a surrogate system to traditional in vivo studies. This is realized by specifically indicating significant dysregulation of several cellular processes in response to VX exposure including but not limited to amino acid synthesis, drug metabolism, and energetics pathways.

Background: Acute uncomplicated cystitis is common among outpatients and frequently leads to antibiotic prescriptions, making urinary tract infections (UTIs) an important area for antimicrobial stewardship initiatives. Infectious Disease Society of America (IDSA) guidelines promote alternative agents in place of fluoroquinolones for acute uncomplicated cystitis. Despite IDSA guidance, adherence to the guideline remains low in the United States (US). Several studies have described interventions to improve guideline-concordant prescribing for UTIs. However, the long-term sustainability and impact of fluoroquinolone (FLQ)-sparing strategies on community antimicrobial resistance and treatment outcomes are unknown. The objectives of this study were to characterize current antibiotic prescribing patterns, treatment failures and Escherichia coli resistance rates in a setting which instituted FLQ sparing strategies for UTIs in 2007. Methods: Retrospective cohort study of women aged ⩾ 18 diagnosed with acute uncomplicated cystitis based on International Classification of Diseases, 10th Revision (ICD-10) codes were included. Data were abstracted for ambulatory visits over a 6-month period, January 2018 to June 2018, at a large urban health care system. Treatment decisions were made by individual providers, and data were analyzed retrospectively. Nitrofurantoin (NFT) resistance was obtained from the institutional antibiogram and patient-level data. Treatment failure was defined as the need for a different antibiotic for UTI within 28 days of the original prescription. Results: NFT was the most frequently prescribed antibiotic ( n = 386, 71.6%) of empiric antibiotic prescriptions for UTIs. FLQs comprised 4.6% of all antibiotic prescriptions ( n = 25). Treatment failure rate was 2.3% in patients treated with NFT. Urine culture was ordered for only 26.8% of patients. Among the small group of patients with cultures ordered, E. coli remained 98.5% susceptible to NFT. Conclusions: This study is the first to report significantly low rates (4.6%) of FLQ prescribing for acute uncomplicated cystitis. Treatment failure rate was low with empiric NFT. Increased NFT resistance among E. coli was not observed at the institution or among the subset of patients with E. coli positive urine cultures. These findings support current IDSA treatment guidance for uncomplicated cystitis.

The objective of this study was to assess the effects of feeding gelatin capsules containing fish oil, treated with alcoholic solutions of flavoring agents followed by drying, on lactation performance, rumen fatty acids content and milk enrichment of fatty acids. In Trial 1, four multiparous ruminally fistulated Holstein cows were randomly assigned to one of four dietary treatments sequences in a 4 × 4 Latin square design. Treatments consisted of (1) Control with no capsules, (2) Control plus 200 untreated capsules per cow/day, mixed with the TMR, (3) Control plus 200 treated capsules per cow/day placed directly into the rumen, (4) Control plus 200 treated capsules per cow/day, mixed with the TMR. In Trial 2, three fistulated Holstein and three fistulated Jersey multiparous cows were randomly assigned to three dietary treatments sequences in a replicated 3 × 3 Latin square design. Treatments consisted of (1) Control with no capsules fed to the cows, (2) Control plus 180 untreated capsules per cow/day, (3) Control plus 180 treated capsules per cow/day. Compared to control, feeding fish oil capsules significantly (Trial 1) or numerically (Trial 2) reduced milk fat concentration and yield. Furthermore, in both trials, the feeding of untreated or treated capsules had no effect on animal performance or milk composition. In both trials, compared to controls, supplementing the diet with fish oil capsules consistently increased total trans C18:1 isomers and DHA concentration in the rumen and milk fat. However, for both trials, capsule protection treatment had a minimal effect on the concentration of any of the reported rumen and milk fatty acids. When assessed under laboratory control conditions, due to water absorption, the treated capsule weight was increased by 40% while resistance to pressure decreased by 84% after 2 h of incubation in water. The results of this study suggest that due to a reduction in the capsule shell’s resistance to abrasion, treated capsules marginally prevented the release of fish oil in the rumen.

Abstract Background Since 2012, several states have legalized non-medical cannabis, and cannabis businesses have used social media as a primary form of marketing. There are concerns that social media cannabis exposure may reach underage viewers. Our objective was to identify how cannabis businesses cultivate an online presence and exert influence that may reach youth. Methods We chose a cyber-ethnographic approach to explore cannabis retailers on social media. We searched cannabis retailers with Facebook and Instagram presence from Alaska, Oregon, Colorado, and Washington, and identified 28 social media business profiles. One year of content was evaluated from each profile. In-depth, observational field notes were collected from researchers immersed in data collection on business profiles. Field notes were analyzed to uncover common themes associated with social media cannabis marketing. Results A total of 14 businesses were evaluated across both Facebook and Instagram, resulting in 14 sets of combined field notes. A major theme was Normalization of Cannabis, involving both Broad Appeal and Specific Targeting. Conclusions It is concerning that Normalization of Cannabis by cannabis businesses may increase cannabis acceptability among youth. In a digital world where the majority of youth are spending time online, it is important for policymakers to examine additional restrictions for cannabis businesses marketing through social media.

BackgroundDigital technology use is nearly ubiquitous among young adults; this use provides both benefits and risks. The risks of technology use include maladaptive technology use or technology addiction. Several conceptualizations of these addictions have emerged, each with its own assessment tools. These conditions include problematic internet use (PIU), internet gaming disorder (IGD), and social media addiction (SMA). These conditions have been associated with health outcomes such as problematic alcohol use, sleep disorders, and mental illness. These maladaptive technology conditions have been most commonly studied in isolation from each other. ObjectiveThe aim of this study is to examine PIU, IGD, and SMA together to better inform future research approaches and provider screening practices for young adults. MethodsThis cross-sectional survey study was conducted using Qualtrics panel-based recruitment and survey hosting. We recruited US young adults aged 18-25 years. The survey assessed PIU, IGD, and SMA. Survey measures also included assessments of problematic alcohol use, sleep, depression, and anxiety. We evaluated the frequency of and overlap in positive screening scores among PIU, IGD, and SMA and modeled each condition using multivariate logistic regression. Finally, we calculated sensitivity and specificity, as well as the positive predictive value and negative predictive value of the screening tools using the most prevalent maladaptive technology type. ResultsOur 6000 participants had an average age of 21.7 (SD 2.5) years. Of these 6000 participants, 3062 (51.03%) were female, 3431 (57.18%) were Caucasian, 1686 (28.1%) were in a 4-year college program, and 2319 (38.65%) worked full time. The mean PIU score was 3.5 (SD 3.1), and 53.58% (3215/6000) of participants met the criteria for PIU. The mean IGD score was 2.7 (SD 2.6), and 24.33% (1460/6000) of participants met the criteria for IGD. The mean SMA score was 7.5 (SD 5.7), and 3.42% (205/6000) met the criteria for SMA. Across all 3 maladaptive technology use diagnoses, there were varied associations with demographic variables and similar overlap with health outcomes. The sensitivity of PIU screening to detect IGD was 82% and to detect SMA was 93%, whereas the specificity and positive predictive value were much lower (37%-54% specificity; 6%-37% positive predictive value). ConclusionsThis cross-sectional survey screened a large national sample of adolescents and young adults for PIU, IGD, and SMA to determine prevalence and overlap, demographic associations with each, and associations between these technology-related conditions and health outcomes. There was overlap across PIU, IGD, and SMA in some associated demographic variables and health outcomes. However, the patterns in the associated variables demonstrated unique qualities of each of these conditions.

People regularly make decisions about how often and with whom to interact. During an epidemic of communicable disease, these decisions gain new weight, as individual choices exert more direct influence on collective health and wellbeing. While much attention has been paid to how people’s concerns about the health impact of the COVID-19 pandemic affect their engagement in behaviors that could curb (or accelerate) the spread of the disease, less is understood about how people’s concerns about the pandemic’s impact on their social lives affect these outcomes. Across three studies (total N = 654), we find that individuals’ estimates of the pandemic’s social (vs. health) impact are associated with an unwillingness to curtail social interaction and follow other Centers for Disease Control guidelines as the pandemic spreads. First, these associations are present in self-report data of participants’ own behaviors and behavior across hypothetical scenarios; second, participants’ estimates of the pandemic’s impact on social life in their location of residence are associated with movement data collected unobtrusively from mobile phones in those locations. We suggest that perceptions of social impact could be a potential mechanism underlying, and therefore potential intervention target for addressing, disease-preventing behavior during a pandemic.

We report on the population properties of compact binary mergers inferred from gravitational-wave observations of these systems during the first three LIGO-Virgo observing runs. The Gravitational-Wave Transient Catalog 3 (GWTC-3) contains signals consistent with three classes of binary mergers: binary black hole, binary neutron star, and neutron star–black hole mergers. We infer the binary neutron star merger rate to be between 10 and 1700 Gpc^{−3} yr^{−1} and the neutron star–black hole merger rate to be between 7.8 and 140 Gpc^{−3} yr^{−1}, assuming a constant rate density in the comoving frame and taking the union of 90% credible intervals for methods used in this work. We infer the binary black hole merger rate, allowing for evolution with redshift, to be between 17.9 and 44 Gpc^{-3} yr^{-1} at a fiducial redshift (z=0.2). The rate of binary black hole mergers is observed to increase with redshift at a rate proportional to (1+z)^{κ} with κ=2.9_{-1.8}^{+1.7} for z≲1. Using both binary neutron star and neutron star–black hole binaries, we obtain a broad, relatively flat neutron star mass distribution extending from 1.2_{-0.2}^{+0.1} to 2.0_{-0.3}^{+0.3}M_{⊙}. We confidently determine that the merger rate as a function of mass sharply declines after the expected maximum neutron star mass, but cannot yet confirm or rule out the existence of a lower mass gap between neutron stars and black holes. We also find the binary black hole mass distribution has localized over- and underdensities relative to a power-law distribution, with peaks emerging at chirp masses of 8.3_{-0.5}^{+0.3} and 27.9_{-1.8}^{+1.9}M_{⊙}. While we continue to find that the mass distribution of a binary’s more massive component strongly decreases as a function of primary mass, we observe no evidence of a strongly suppressed merger rate above approximately 60M_{⊙}, which would indicate the presence of a upper mass gap. Observed black hole spins are small, with half of spin magnitudes below χ_{i}≈0.25. While the majority of spins are preferentially aligned with the orbital angular momentum, we infer evidence of antialigned spins among the binary population. We observe an increase in spin magnitude for systems with more unequal-mass ratio. We also observe evidence of misalignment of spins relative to the orbital angular momentum.

We search for gravitational-wave (GW) transients associated with fast radio bursts (FRBs) detected by the Canadian Hydrogen Intensity Mapping Experiment Fast Radio Burst Project, during the first part of the third observing run of Advanced LIGO and Advanced Virgo (2019 April 1 15:00 UTC–2019 October 1 15:00 UTC). Triggers from 22 FRBs were analyzed with a search that targets both binary neutron star (BNS) and neutron star–black hole (NSBH) mergers. A targeted search for generic GW transients was conducted on 40 FRBs. We find no significant evidence for a GW association in either search. Given the large uncertainties in the distances of our FRB sample, we are unable to exclude the possibility of a GW association. Assessing the volumetric event rates of both FRB and binary mergers, an association is limited to 15% of the FRB population for BNS mergers or 1% for NSBH mergers. We report 90% confidence lower bounds on the distance to each FRB for a range of GW progenitor models and set upper limits on the energy emitted through GWs for a range of emission scenarios. We find values of order 10 ^51 –10 ^57 erg for models with central GW frequencies in the range 70–3560 Hz. At the sensitivity of this search, we find these limits to be above the predicted GW emissions for the models considered. We also find no significant coincident detection of GWs with the repeater, FRB 20200120E, which is the closest known extragalactic FRB.

Cyclospora cayetanensis is an enigmatic human parasite that sickens thousands of people worldwide. The scarcity of research material and lack of any animal model or cell culture system slows research, denying the produce industry, epidemiologists, and regulatory agencies of tools that might aid diagnosis, risk assessment, and risk abatement. Fortunately, related species offer a strong foundation when used as surrogates to study parasites of this type. Species of Eimeria lend themselves especially well as surrogates for C. cayetanensis. Those Eimeria that infect poultry can be produced in abundance, share many biological features with Cyclospora, pose no risk to the health of researchers, and can be studied in their natural hosts. Here, we overview the actual and potential uses of such surrogates to advance understanding of C. cayetanensis biology, diagnostics, control, and genomics, focusing on opportunities to improve prevention, surveillance, risk assessment, and risk reduction. Studying Eimeria surrogates accelerates progress, closing important research gaps and refining promising tools for producers and food safety regulators to monitor and ameliorate the food safety risks imposed by this emerging, enigmatic parasite.

ABSTRACT Burkholderia pseudomallei is an opportunistic pathogen that is responsible for the disease melioidosis in humans and animals. The microbe is a tier 1 select agent because it is highly infectious by the aerosol route, it is inherently resistant to multiple antibiotics, and no licensed vaccine currently exists. Naturally acquired infections result from contact with contaminated soil or water sources in regions of endemicity. There have been few reports investigating the molecular mechanism(s) utilized by B. pseudomallei to survive and persist in ecological niches harboring microbial competitors. Here, we report the isolation of Gram-positive bacteria from multiple environmental sources and show that ∼45% of these isolates are inhibited by B. pseudomallei in head-to-head competition assays. Two competition-deficient B. pseudomallei transposon mutants were identified that contained insertion mutations in the hmqA-G operon. This large biosynthetic gene cluster encodes the enzymes that produce a family of secondary metabolites called 4-hydroxy-3-methyl-2-alkylquinolines (HMAQs). Liquid chromatography and mass spectrometry conducted on filter-sterilized culture supernatants revealed five HMAQs and N-oxide derivatives that were produced by the parental strain but were absent in an isogenic hmqD deletion mutant. The results demonstrate that B. pseudomallei inhibits the growth of environmental Gram-positive bacteria in a contact-independent manner via the production of HMAQs by the hmqA-G operon. IMPORTANCE Burkholderia pseudomallei naturally resides in water, soil, and the rhizosphere and its success as an opportunistic pathogen is dependent on the ability to persist in these harsh habitats long enough to come into contact with a susceptible host. In addition to adapting to limiting nutrients and diverse chemical and physical challenges, B. pseudomallei also has to interact with a variety of microbial competitors. Our research shows that one of the ways in which B. pseudomallei competes with Gram-positive environmental bacteria is by exporting a diverse array of closely related antimicrobial secondary metabolites.