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BACKGROUND: Whether proton-pump inhibitors are beneficial or harmful for stress ulcer prophy- delaxis in critically ill patients undergoing invasive ventilation is unclear. METHODS; In this international, randomized trial, we assigned critically ill adults who were undergoing invasive ventilation to receive intravenous pantoprazole (at a dose of 40 mg daily) or matching placebo. The primary efficacy outcome was clinically important upper gastrointestinal bleeding in the intensive care unit (ICU) at 90 Suppledays, and the primary safety outcome was death from any cause at 90 days. Mul- tiplicity-adjusted key secondary outcomes were ventilator-associated pneumonia, Clostridioides dificile infection, and patient-important bleeding. RESULTS: A total of 4821 patients underwent randomization in 68 ICUs. Clinically important upper gastrointestinal bleeding occurred in 25 of 2385 patients (1.096) receiving pantoprazole and in 84 of 2377 patients (3.5°/0) receiving placebo (hazard ratio, 0.30; 95% confidence interval ICI], 0.19 to 0.47; P<0.001). At 90 days, death was reported in 696 of 2390 patients (29.196) in the pantoprazole group and in 734 of 2379 patients (30.9°/o) in the placebo group (hazard ratio, 0.94; 95% CI, 0.85 to 1.04; P=0.25). Patient-important bleeding was reduced with pantoprazole; all other key secondary outcomes were similar in the two groups. CONCLUSIONS: Among patients undergoing invasive ventilation, pantoprazole resulted in a significantly lower risk of clinically important upper gastrointestinal bleeding than placebo, with no significant effect on mortality. [ABSTRACT FROM AUTHOR]

Summary: We introduced virtual fracture liaison clinics during the COVID-19 pandemic in order to support clinical care while DXA services were down-turned. We observed that virtual FLS clinics are effective in delivering fracture risk assessment, health promotion, and clinical management and are well received by patients with positive patient experience. Introduction: We examined the impact of virtual FLS telephone clinics, as an alternative to face-to-face clinics during the COVID-19 lockdown. Methods: Patients presenting with low trauma fracture were recruited according to standard criteria. A structured telephone clinic appointment was offered, which included fracture risk and health promotion assessment and a treatment plan. Risk factors, demographics, fracture type, FRAX scores, and outcomes were analysed. We assessed patient experience with an anonymised patient survey. Results: Clinical outcomes from virtual clinics were assessed (77F/33M; mean age 65.7 years). The mean 10-year observed fracture risk for major osteoporotic fracture was 18.2% and 7.0% for hip fracture. We observed high 'attendance' rates at 79%; however, a significant number were still not available for telephone review (11%) or cancelled their appointment (10%). A recommendation for bisphosphonate treatment was made in 54% of the cohort based on National Osteoporosis Guidelines Group (NOGG) criteria. Follow-up DXA assessment is planned for 64%, according to fracture risk and NOGG guidance. We received 60 responses from the initial patient survey. Ninety percent rated their overall experience of service at 4 or 5 (very good to excellent). Ninety-eight indicated they would recommend the service to others. Conclusions: Virtual clinics are effective in delivery of fracture risk assessment and clinical management with positive patient experience. While a significant proportion will require DXA follow-up to complete the clinical assessment, virtual clinics have mitigated delays in fracture prevention interventions during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Insects with access to finite energy resources must allocate these between maintenance and reproduction in a way that maximizes fitness. This will be influenced by a range of life‐history characteristics and the environment in which any particular insect species lives. In the present study, females of the blowfly Lucilia sericata (Diptera: Calliphoridae) were fed diets differing in protein and carbohydrate (sucrose) content and the allocation of lipid to reproduction was quantified using a spectrophotometric method of analysis. Immediately after adult emergence, total body lipid, scaled for differences in body size, showed an initial decline as it was utilized to meet the metabolic demands of cuticle deposition, muscle maturation and then flight. When flies were denied access to sucrose, stored lipid then continued to decrease until flies died, usually within 4 days of emergence. However, flies given access to sucrose were able to increase body lipid content, demonstrating that carbohydrate is essential for homeostasis and that it can be used to synthesize lipid. Nevertheless, female flies fed sucrose only were unable to synthesize egg yolk. Only flies provided with protein were able to mature eggs. However, the rate of egg maturation and number and size of eggs matured were greater for female flies given liver compared with flies provided with pure whey protein powder. The results demonstrate the importance of different dietary components for different elements of the life‐history of L. sericata, namely survival and reproduction. [ABSTRACT FROM AUTHOR]

Developments in the assimilation of satellite data in numerical weather prediction (NWP), from the first experiments in the late 1960s to the present day, are presented in a two‐part review article. This first part reviews the early years, up to about the year 2000. It includes summaries of the relevant satellite remote sensing technologies, the theoretical and practical challenges faced when assimilating their data within NWP systems, and the impacts on forecast skill. An important part of this story concerns developments in the assimilation of information on atmospheric temperature and humidity provided by data from passive infrared and microwave radiometers. Following early successes with the assimilation of retrieved temperature profiles, there followed a problematic period, as other aspects of NWP systems improved and the impacts of satellite sounding data declined. Positive impacts were re‐established in the 1990s through moves towards more direct assimilation of radiance information. Another important theme concerns developments in the assimilation of wind information via atmospheric motion vectors, which underwent a series of improvements during these years. Additional contributions were provided by information on ocean surface wind from scatterometers. Some contributions from other technologies during this period are also summarised. [ABSTRACT FROM AUTHOR]

Background: To compare the in-hospital mortality and institutional morbidity from medical therapy (MT), external ventricular drainage (EVD) and suboccipital decompressive craniectomy (SDC) following an acute hemorrhagic posterior cranial fossa stroke (PCFH) in patients admitted to the neurosciences critical care unit (NCCU). Retrospective observational single-center cohort study in a tertiary care center. All consecutive patients (n = 104) admitted with PCFH from January 1st 2005-December 31st 2011 were included in the study.Methods: All patients with a PCFH were identified and confirmed by reviewing computed tomography of the brain reported by a specialist neuroradiologist. Management decisions (MT, EVD, and SDC) were identified from operative notes and electronic patient records.Results: Following a PCFH, 47.8 % (n = 11) patients died after EVD placement without decompression, 45.7 % (n = 16) died following MT alone, and 17.4 % (n = 8) died following SDC. SDC was associated with lower mortality compared to MT with or without EVD (χ 2 test p = 0.006, p = 0.008). Age, ICNARC score, brain stem involvement, and hematoma volume did not differ significantly between the groups. There was a statistically significant increase in hydrocephalus and intraventricular bleeds in patients treated with EVD placement and SDC (χ 2 test p = 0.02). Median admission Glasgow Coma Scale scores for the MT only, MT with EVD, and SDC groups were 8, 6, and 7, respectively (ranges 3-15, 3-11 and 3-13) and did not differ significantly (Friedman test: p = 0.89). SDC resulted in a longer NCCU stay (mean of 17.4 days, standard deviation = 15.4, p < 0.001) and increased incidence of tracheostomy (50 vs. 17.2 %, p = 0.0004) compared to MT with or without EVD.Conclusions: SDC following PCFH was associated with a reduction in mortality compared to expectant MT with or without EVD insertion. A high-quality multicenter randomized control trial is required to evaluate the superiority of SDC for PCFH. [ABSTRACT FROM AUTHOR]

Smith-Kingsmore syndrome (SKS) is a rare autosomal dominant syndrome resulting from mutations in the MTOR gene located on chromosome 1p36. This case outlines the antenatal USS and MR findings of SKS which, to the best of our knowledge, have not been previously reported. MR imaging in children with SKS shows anomalies including dilatation of the ventricular system, callosal anomalies, polymicrogyria and loss of white matter. [Extracted from the article]

The social niche specialization hypothesis predicts that group-living animals should specialize in particular social roles to avoid social conflict, resulting in alternative life-history strategies for different roles. Social niche specialization, coupled with role-specific life-history trade-offs, should thus generate between-individual differences in behaviour that persist through time, or distinct personalities, as individuals specialize in particular nonoverlapping social roles. We tested for support for the social niche specialization hypothesis in cooperative personality traits in wild female meerkats ( Suricata suricatta) that compete for access to dominant social roles. As cooperation is costly and dominance is acquired by heavier females, we predicted that females that ultimately acquired dominant roles would show noncooperative personality types early in life and before and after role acquisition. Although we found large individual differences in repeatable cooperative behaviours, there was no indication that individuals that ultimately acquired dominance differed from unsuccessful individuals in their cooperative behaviour. Early-life behaviour did not predict social role acquisition later in life, nor was cooperative behaviour before and after role acquisition correlated in the same individuals. We suggest that female meerkats do not show social niche specialization resulting in cooperative personalities, but that they exhibit an adaptive response in personality at role acquisition. [ABSTRACT FROM AUTHOR]

Although recent models for the evolution of personality, using game theory and life-history theory, predict that individuals should differ consistently in their cooperative behaviour, consistent individual differences in cooperative behaviour have rarely been documented. In this study, we used a long-term data set on wild meerkats to quantify the repeatability of two types of cooperative care (babysitting and provisioning) within individuals and examined how repeatability varied across age, sex and status categories. Contributions to babysitting and provisioning were significantly repeatable and positively correlated within individuals, with provisioning more repeatable than babysitting. While repeatability of provisioning was relatively invariant across categories of individuals, repeatability of babysitting increased with age and was higher for subordinates than dominants. These results provide support for theoretical predictions that life-history trade-offs favour the evolution of consistent individual differences in cooperative behaviour and raise questions about why some individuals consistently help more than others across a suite of cooperative behaviours. [ABSTRACT FROM AUTHOR]

An error analysis has been performed, which shows that skin temperature errors are important for sounding channels. An approach for estimating skin temperature and emissivity errors from the dependence of differences between observed and calculated radiances on surface-to-space transmittance is described. Estimates of emissivity and skin temperature error for the operational Met Office data assimilation system are presented as an example, and the implications are discussed, in terms of use of data over different surfaces and in different conditions (e.g., day/night). The results highlight the need for a better emissivity estimate over sea ice than that used at the Met Office and the inaccuracy of the land surface skin temperature that was derived from radiative flux balance at the surface. [ABSTRACT FROM AUTHOR]

Sue English describes how an assessment tool is improving the support given to parents with learning disabilities. [ABSTRACT FROM AUTHOR]

Developments in the assimilation of satellite data in numerical weather prediction (NWP), from the first experiments in the late 1960s to the present day, are presented in a two-part review article. This part, Part II, reviews the progress in recent years, from about 2000. It includes summaries of advances in the relevant satellite remote-sensing technologies and in methods to assimilate observations from these instruments into NWP systems. It also summarises impacts on forecast skill. Continued progress has been made on the assimilation of passive infrared (IR) sounding data and microwave (MW) sounding and imaging data. This has included data from hyperspectral IR sounders, which first became available during this period. Advances in the use of cloud-affected radiances, from both IR and MW instruments, have been made. In support of this progress, further developments have been made in fast radiative transfer models and in bias correction techniques, and work has continued to improve understanding and representation of observation uncertainties. Continued progress has also been made on the use of wind information from satellites, including atmospheric motion vectors and scatterometer data. A new source of temperature and humidity information, from radio occultation observations, has become available during the period and has been exploited by many NWP centres. The impact of satellite data on NWP accuracy is continually assessed using a range of methods and metrics. Some results from recent Observing System Experiments (OSEs) and Forecast Sensitivity to Observation Impact (FSOI) assessment are presented and other methods are discussed. The role of satellite data in NWP-based atmospheric reanalysis systems is also described. [ABSTRACT FROM AUTHOR]

There is computer-supported learning and cooperative learning at universities. There are also a few 'virtual universities'. This paper links these three features in a way that reflects a vision of a future scenario for learners. The conclusions are based on the observation of the cooperative learning already taking place at Exeter University's Computer Science Department. [ABSTRACT FROM AUTHOR]

The effectiveness of an assessment tool that was primarily designed for community nurses is evaluated by Sarah Wharton and colleagues. [ABSTRACT FROM AUTHOR]

A trainingmanual to enable professionals to run educationally based groups for parents with learning disabilities has been widely welcomed. [ABSTRACT FROM AUTHOR]

Background: Conducting prospective epidemiological studies of hospitalized patients with rare diseases like primary subarachnoid hemorrhage (pSAH) are difficult due to time and budgetary constraints. Routinely collected administrative data could remove these barriers. We derived and validated 3 algorithms to identify hospitalized patients with a high probability of pSAH using administrative data. We aim to externally validate their performance in four hospitals across Canada.Methods: Eligible patients include those ≥18 years of age admitted to these centres from January 1, 2012 to December 31, 2013. We will include patients whose discharge abstracts contain predictive variables identified in the models (ICD-10-CA diagnostic codes I60** (subarachnoid hemorrhage), I61** (intracranial hemorrhage), 162** (other nontrauma intracranial hemorrhage), I67** (other cerebrovascular disease), S06** (intracranial injury), G97 (other postprocedural nervous system disorder) and CCI procedural codes 1JW51 (occlusion of intracranial vessels), 1JE51 (carotid artery inclusion), 3JW10 (intracranial vessel imaging), 3FY20 (CT scan (soft tissue of neck)), and 3OT20 (CT scan (abdominal cavity)). The algorithms will be applied to each patient and the diagnosis confirmed via chart review. We will assess each model's sensitivity, specificity, negative and positive predictive value across the sites.Discussion: Validating the Ottawa SAH Prediction Algorithms will provide a way to accurately identify large SAH cohorts, thereby furthering research and altering care. [ABSTRACT FROM AUTHOR]

Individual variation in growth is high in cooperative breeders and may reflect plastic divergence in developmental trajectories leading to breeding vs. helping phenotypes. However, the relative importance of additive genetic variance and developmental plasticity in shaping growth trajectories is largely unknown in cooperative vertebrates. This study exploits weekly sequences of body mass from birth to adulthood to investigate sources of variance in, and covariance between, early and later growth in wild meerkats ( Suricata suricatta), a cooperative mongoose. Our results indicate that (i) the correlation between early growth (prior to nutritional independence) and adult mass is positive but weak, and there are frequent changes (compensatory growth) in post-independence growth trajectories; (ii) among parameters describing growth trajectories, those describing growth rate (prior to and at nutritional independence) show undetectable heritability while associated size parameters (mass at nutritional independence and asymptotic mass) are moderately heritable (0.09 ≤ h2 < 0.3); and (iii) additive genetic effects, rather than early environmental effects, mediate the covariance between early growth and adult mass. These results reveal that meerkat growth trajectories remain plastic throughout development, rather than showing early and irreversible divergence, and that the weak effects of early growth on adult mass, an important determinant of breeding success, are partly genetic. In contrast to most cooperative invertebrates, the acquisition of breeding status is often determined after sexual maturity and strongly impacted by chance in many cooperative vertebrates, who may therefore retain the ability to adjust their morphology to environmental changes and social opportunities arising throughout their development, rather than specializing early. [ABSTRACT FROM AUTHOR]

Extraterritorial prospecting forays are an important route to fitness in many species, allowing the assessment of dispersal opportunities and often extragroup mating prior to dispersal. However, few studies have examined the factors affecting individual variation in prospecting effort and the extent to which individuals time their forays so as to maximize the benefits and mitigate the costs of prospecting. We used 11 years of prospecting data from a wild population of cooperatively breeding meerkats, Suricata suricatta, to investigate how subordinate males modulate their prospecting effort according to their social and physical environment and internal state. Prospecting effort showed strong seasonal variation, in which peak prospecting broadly coincided with the breeding season. When we controlled for this seasonal variation, we found that males were more likely to prospect when there were larger numbers of females evicted from foreign groups (with whom prospecting males found new groups) and on days when they encountered another social group (to which they could then prospect at minimal cost). Males were also more likely to prospect when older, in stronger body condition and in years of higher rainfall (when greater food availability may reduce prospecting costs and improve the chance of encountering fertile females). Finally, although travelling in larger coalitions can mitigate the costs of prospecting, males with more potential coalition partners were less likely to prospect. Together, our results indicate that individual investment in predispersal prospecting forays is influenced by social, environmental and state-dependent factors that may shape the benefits and mitigate the costs of extraterritorial prospecting. Our findings suggest that males rely more on extragroup than within-group social cues when timing their forays, and provide new insights into the likely drivers of spatiotemporal patterns of dispersal and extragroup mating in social species. [ABSTRACT FROM AUTHOR]

The evolution of adaptive phenotypic plasticity relies on the presence of cues that enable organisms to adjust their phenotype to match local conditions. Although mostly studied with respect to nonsocial cues, it is also possible that parents transmit information about the environment to their offspring. Such 'anticipatory parental effects' or 'adaptive transgenerational plasticity' can have important consequences for the dynamics and adaptive potential of populations in heterogeneous environments. Yet, it remains unknown how widespread this form of plasticity is. Using a meta-analysis of experimental studies with a fully factorial design, we show that there is only weak evidence for higher offspring performance when parental and offspring environments are matched compared with when they are mismatched. Estimates of heterogeneity among studies suggest that effects, when they occur, are subtle. Study features, environmental context, life stage and trait categories all failed to explain significant amounts of variation in effect sizes. We discuss theoretical and methodological reasons for the limited evidence for anticipatory parental effects and suggest ways to improve our understanding of the prevalence of this form of plasticity in nature. [ABSTRACT FROM AUTHOR]

Purpose: To test the feasibility of electron paramagnetic resonance imaging (EPRI) to provide non-invasive images of tissue redox status using redox-sensitive paramagnetic contrast agents.Material and Methods: Nitroxide free radicals were used as paramagnetic agents and a custom-built 300 MHz EPR spectrometer/imager was used for all studies. A phantom was constructed consisting of four tubes containing equal concentrations of a nitroxide. Varying concentrations of hypoxanthine/xanthine oxidase were added to each tube and reduction of the nitroxide was monitored by EPR as a function of time. Tumor-bearing mice were intravenously infused with a nitroxide and the corresponding reduction rate was monitored on a pixel-by-pixel basis using 2D EPR of the tumor-bearing leg and normal leg serving as control. For animal studies, nitroxides were injected intravenously (1.25 mmol/kg) and EPR projections were collected every 3 min after injection using a magnetic field gradient of 2.5 G/cm. The reduction rates of signal intensity on a pixel-by-pixel basis were calculated and plotted as a redox map. Redox maps were also collected from the mice treated with diethylmaleate (DEM), which depletes tissue thiols and alters the global redox status.Results: Redox maps obtained from the phantoms were in agreement with the intensity change in each of the tubes where the signals were decreasing as a function of the enzymatic activity, validating the ability of EPRI to accurately access changes in nitroxide reduction. Redox imaging capability of EPR was next evaluated in vivo. EPR images of the nitroxide distribution and reduction rates in tumor-bearing leg of mice exhibited more heterogeneity than in the normal tissue. Reduction rates were found to be significantly decreased in tumors of mice treated with DEM, consistent with the depletion of thiols and the consequent alteration of the redox status.Conclusion: Using redox-sensitive paramagnetic contrast agents, EPRI can non-invasively discriminate redox status differences between normal tissue and tumors. [ABSTRACT FROM AUTHOR]

Plants of Dionaea muscipula Ellis fed for 24 h via trap lobes with [13C]glycine or [15N]glycine metabolized the glycine in the fed trap lobes only. Both 13C and 15 labelling was detected in glycine and serine and 15N labelling in alanine, aspartic acid, glutamic acid and 4-aminobutanoic acid extracted from fed trap lobes. Limited amounts of [4-15N]aminobutanoic acid and serine were translocated to the lamina of the fed trap lobes but neither these, nor other labelled amino acids, were detected in other parts of the plant. No 13C labelling was detected in compounds other than glycine and serine. [ABSTRACT FROM AUTHOR]

Background Cytomegalovirus (CMV) disease is a common and clinically significant complication following intestinal or multivisceral transplantation. CMV disease is more common in cases of serologic mismatch between donor and recipient. Though in some cases it may be asymptomatic, in the immunosuppressed population it often manifests with evidence of systemic infection or end-organ disease. Methods We conducted a retrospective review of all patients undergoing intestinal or multivisceral transplantation over 8 years at our institution. Results Forty-eight transplantations were performed, with 40% of the patients (19/48) having ≥1 episode of CMV viremia, which rose to 90% in the “donor-positive, recipient-negative” (DPRN) serologic mismatch group. The median time to 1st episode following transplantation was 22.3 weeks (range, 1–78) and median duration of each episode was 4.9 weeks (range, 1.6–37.4). Six of the 19 viremic patients (31.6%) developed virologic resistance with 4 of these occurring in the DPRN group. Four of the 6 patients with drug-resistant CMV died with CMV viremia. All patients with drug resistance acquired ganciclovir resistance; these patients were more challenging to manage with second-line toxicity-limited treatments, including foscarnet, cidofovir, and leflunomide. CMV immunoglobulin has been used and we briefly discuss the use of CMV-specific adoptive T-lymphocyte transfer in the management of 1 case. Conclusions Post-transplantation CMV disease continues to be challenging to manage, and there is little consensus on optimal management strategies in this patient group, with a significant requirement for novel therapies; these may be pharmacologic or cell based. Extensive multidisciplinary discussion is important for most cases, but particularly for those patients who acquire virologic resistance. [ABSTRACT FROM AUTHOR]

An ensemble of data assimilations (EDA) approach is used to estimate how the impact of Global Navigation Satellite System (GNSS) radio occultation (RO) measurements scales as a function of observation number in the ECMWF numerical weather prediction system. The EDA provides an estimate of the theoretical analysis and short-range forecast error statistics, based on the ensemble 'spread,' which is the standard deviation of the ensemble members about the ensemble mean. This study is based on computing how the ensemble spread of various parameters changes as a function of the number of simulated GNSS RO observations. The impact from 2000 up to 128 000 globally distributed simulated GNSS RO profiles per day is investigated. It is shown that 2000 simulated GNSS RO measurements have an impact similar to real measurements in the EDA and that the EDA-based impact of real data can be related to the impact in observing system experiments. The dependence of the ensemble statistics on observation error statistics assumed when assimilating the data, rather than the actual observation errors, is emphasized. There is no evidence of 'saturation' of forecast impact even with 128 000 GNSS RO profiles per day. However, this result is a well-known consequence of always improving the theoretical analysis and short-range forecast error statistics when adding new observations that are assumed to have uncorrelated observation errors. In general, it is found that 16 000 GNSS RO profiles per day have around half the impact of 128 000 profiles, based on the reduction of ensemble spread values where the GNSS RO measurements have the largest impact. [ABSTRACT FROM AUTHOR]

Discusses a study which assessed the contribution of cardiac output to hypotension during tilt-induced syncope. Significance of the study to the prevention of orthostatic syncope; Results; Discussion.

Ten years ago, humidity observations were thought to give little benefit to global weather forecasts. Nowadays, at the European Centre for Medium-range Weather Forecasts, satellite microwave radiances sensitive to humidity, cloud and precipitation provide 20% of short-range forecast impact, as measured by adjoint-based forecast sensitivity diagnostics. This makes them one of the most important sources of data and equivalent in impact to microwave temperature sounding observations. Forecasts of dynamical quantities, and precipitation, are improved out to at least day 6. This article reviews the impact of and the science behind these data. It is not straightforward to assimilate cloud and precipitation-affected observations when the intrinsic predictability of cloud and precipitation features is limited. Assimilation systems must be able to operate in the presence of all-pervasive cloud and precipitation 'mislocation' errors. However, by assimilating these observations using the 'all-sky' approach, and supported by advances in data assimilation and forecast modelling, modern data assimilation systems can infer the dynamical state of the atmosphere, not just from traditional temperature-related observations, but from observations of humidity, cloud and precipitation. [ABSTRACT FROM AUTHOR]