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The late spring cold spell severely affects the growth of litchi flower buds. Melatonin, as a signaling molecule, can enhance the plant’s ability to resist abiotic stress by regulating multiple physiological processes. However, there are few studies on the function of melatonin in litchi under cold stress. In the present study, 100 μM of melatonin was selected based on the ABA content in litchi seedlings. To identify genes potentially involved in melatonin and cold stress conditions in litchi, four RNA-seq libraries of litchi leaves under melatonin and cold conditions were constructed. In total, 6.4–8.5 Gb of trimmed bases were generated in each library. Thirty-five genes were randomly selected for qRT-PCR analysis. The results showed a strong positive correlation between the data from qRT-PCR and RNA-seq. A total of 4590 differentially expressed genes (DEGs) were identified in the treatment of melatonin (1845) and melatonin in cold condition (2745). The expression of several genes belonging to starch and sucrose metabolism, plant hormones (auxin, ABA), MAPK, and alpha-linolenic acid metabolism pathways were differentially expressed. The enhanced carbohydrate metabolism might lead to litchi seedlings treated with melatonin to produce more metabolic energy. Abscisic acid can improve cold tolerance. Collectively, our results reveal that pretreatment with melatonin (100 μM) protects litchi seedlings from cold stress through plant hormones and carbohydrate metabolism and provides potential genes for future research.

【Objective】Endophytic bacteria exert an important role in plant growth and development. The study aims to analyze the community structure and diversity of endophytic bacteria in pulp of different litchi varieties, and screen and utilize the potential endophytic bacteria resources, which would provide references for further research on the interaction between litchi and endophytic bacteria.【Method】The pulp tissues of 6 different litchi varieties were used as materials. MiSeq high-throughput sequencing technology was used to compare and analyze the community composition and dominant flora of endophytic bacteria at phylum, family, genus and species classification levels in pulp tissues after the V3~V4 region of 16S rDNA was amplified by PCR. The diversity of endophytic bacteria was evaluated combined with Alpha diversity analysis.【Result】A total of 2 139 086 sequences of endophytic bacteria 16S rDNA were obtained in the V3~V4 region of 6 litchi varieties, and the average length of amplified sequences was 376 bp. There was no significant difference in the abundance and diversity of endophytic bacteria in different litchi varieties. At the phylum classification level, Proteobacteria was the main dominant bacterial group in litchi pulp tissue, followed by Actinomyces. At the levels of family, genus and species classification, the endophytic bacterial community structure of different litchi varieties was similar, but the bacterial abundance proportion was different. Differential bacterial community analysis showed that the Pseudomonas, Pectobacterium, Ochrobactrum and Dickeya were significantly enriched in the high-quality varieties of 'Edanli', 'Nuomici' and 'Guanyinlv'. In addition, Bradyrhizobium and Snodgrassella were only enriched in the 'Edanli'. The clustering analysis of relative abundance of bacteria showed that 'Guanyinlv', 'Nuomici' and 'Edanli', had higher similarity. Alpha diversity analysis showed that there were differences in the abundance and diversity of endophytic flora in pulps of 6 litchi varieties, but the differences were not significant.【Conclusion】In this study, the community structure of endophytic bacteria in the pulp of six different litchi varieties was analyzed, and some unique microbial genera were enriched in the high-quality litchi varieties. The results could provide a theoretical basis and important references for the development and utilization of endophytic bacteria to improve litchi quality.

【Objective】Xianjinfeng litchi is a new variety introduced in recent years. It is characterized by high quality and late ripening and has significant economic and social benefits in the middle and late ripening litchi producing areas, however, its efficient and high-yield cultivation technology needs to be studied. Shoot bending is an important shaping and pruning method in orchard management, which can effectively reduce the apex dominance and facilitate flowering and fruiting. Here, the effects of different bending treatments on Xianjinfeng litchi were explored in order to provide references for the application of shoot bending technology as well as the establishment of technology for stable and high yield.【Method】Xianjinfeng litchi grafted for four years was used as the test material, and three bending treatments were set: vertical (0°, CK), horizontal (90 °) and drooping (110 °). After treatments, the indicators including growth, flowering rate, and fruit setting rate were counted.【Result】Compared with the vertical treatment (CK), drooping and horizontal treatments had limited effects on the vegetative growth of the first and second shoots, but delayed the germination of the third shoot (the last autumn shoot) for more than seven days, and dramatically reduced germination number of shoots at the same time. In addition, drooping treatment had the strongest inhibitory effect. When the leaves of the last autumn shoot were mature, the branch diameter under bending treatments was slightly lower than that under CK, however, and there were no significant difference among all treatments. Both drooping and horizontal bending treatments could effectively control the length of the last autumn shoot to about 15 cm, promote the growth of short and medium shoots, which was conducive to flowering and fruiting. In the coming spring, the flowering rate and fruit setting rate of drooping and horizontal treatments were notably higher than those of vertical treatment (CK). The flowering rate of droop treatment reached 100%, and all of them were pure flowers with high quality, while vertical treatment (CK) produced more panicles with leaves in comparison with the other two treatments. There was no significant difference in the length of panicle among different treatments, however, the base diameter of panicle were observably reduced and vigorous growth of panicles were inhibited by bending treatments. Fifty days after blooming of pistillate flowers, the fruit setting rates under drooping and horizontal treatments were 9.81% and 7.61%, respectively, markedly higher than that under vertical treatment (CK, 5.54%).【Conclusion】For Xianjinfeng litchi, drooping and horizontal branch bending can effectively control the excessive growth of parent branches, improve the quality of flowers, and significantly increase fruit setting rate. The best results are obtained under drooping treatment (110°).

Lychee downy blight (LDB) is an oomycete pathogen (Peronophythora litchi) disease, which affects the fruits and leaves of lychee, resulting in economic losses. Chemical fungicides are commonly used for disease control, while for eco-safety measures, the study of molecular mechanisms involved in lychee resistance against LDB is necessary. Non-coding RNAs (ncRNAs), including long ncRNAs (lncRNAs), circular (circRNAs), and microRNAs (miRNAs), play a crucial role in plant disease resistance. To examine lychee response (fruits and leaves) to LDB, we studied the expression patterns of ncRNAs and mRNAs under LDB treatment. By whole transcriptome sequencing analyses, a total of 36,885 mRNAs, 2627 lncRNAs, 4682 circRNAs, and 525 miRNAs were identified in lychee. A differential expression (DE) analysis revealed that there were 1095 DEmRNAs, 89 DElncRNAs, 28 DEcircRNAs, and 28 DEmiRNAs in the LDB-treated fruits, as well as 1158 DEmRNAs, 132 DElncRNAs, 13 DEcircRNAs, and 197 DEmiRNAs in the LDB-treated leaves. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses revealed that the potential function of DEmRNAs and the targets of ncRNAs were involved in plant defense. Furthermore, co-expression networks of putative interacting ncRNAs and mRNAs were developed, in which mRNAs encoded some receptor proteins, pointing to potential ncRNAs associated with LDB infection. Our study provided a new, brief insight to the putative role of ncRNAs in lychee response to LDB.

The primary cause for the limited shelf life of litchi fruit is rapid pericarp browning and decay. This study aims to evaluate the storability of 50 litchi varieties and establish a linear regression model for pericarp browning and decay based on 11 postharvest physical and chemical indices after 9 days of storage at room temperature. The results indicated that the average value of the browning index and decay rate significantly increased to 3.29% and 63.84% of 50 litchi varieties at day 9, respectively. Different litchi varieties showed different variations in appearance indicators, quality indicators, and physiological indicators. Furthermore, principal component analysis and cluster analysis revealed that Liu Li 2 Hao exhibited the highest resistance to storage, whereas Dong Long Mi Li, Jiao Pan Li, E Dan Li 2 Hao, and Ren Shan Li were not resistant. Stepwise multiple regression analysis further demonstrated that the factors were highly correlated with the decay index, with a partial correlation coefficient of 0.437 between the effective index and the decay index. Therefore, pericarp thickness, relative conductivity, pericarp laccase activity, and total soluble solids were significant indicators for the comprehensive evaluation of litchi browning and decay, and relative conductivity was the significant determinant causing fruit browning. These findings provide a new perspective on the sustainable development of the litchi industry.

Background: Low back pain (LBP) is the most common medical cause of disability among adults 65 or older. No previous study has characterized health care costs and treatment patterns of LBP among Medicare beneficiaries. Methods: This retrospective cohort study quantifies health care utilization costs among Medicare beneficiaries with newly diagnosed LBP, compares costs between patients managed operatively and nonoperatively, identifies costs associated with treatment guideline nonadherence, and characterizes opioid prescribing patterns. Patients were queried via ICD codes from a 20% random sample of Medicare claims records. Patients with concomitant or previous “red flag” diagnoses, neurological deficits, or diagnoses that could cause nondegenerative LBP were excluded. Total costs of care in the year of diagnosis were calculated and stratified by operative versus nonoperative management. To assess for guideline adherence, utilization and costs of different services were tabulated. Opioid prescription patterns were characterized by quantity, cost, duration, and medication type. Results: About 1,269,896 patients were identified; 23,919 (1.8%) underwent surgery. These accounted for 7% of the cohort's total cost ($514 million total, $21,496 per person). Patients treated nonoperatively accounted for over $7 billion in costs ($5,880 per person; p

Abstract Background We identified that Stanford Health Care had a significant number of patients who after discharge are found by the utilization review committee not to meet Center for Mediare and Medicaid Services (CMS) 2-midnight benchmark for inpatient status. Some of the charges incurred during the care of these patients are written-off and known as Medicare 1-day write-offs. This study which aims to evaluate the use of a Best Practice Alert (BPA) feature on the electronic medical record, EPIC, to ensure appropriate designation of a patient’s hospitalization status as either inpatient or outpatient in accordance with Center for Medicare and Medicaid services (CMS) 2 midnight length of stay benchmark thereby reducing the number of associated write-offs. Method We incorporated a best practice alert (BPA) into the Epic Electronic Medical Record (EMR) that would prompt the discharging provider and the case manager to review the patients’ inpatient designation prior to discharge and change the patient’s designation to observation when deemed appropriate. Patients who met the inclusion criteria (Patients must have Medicare fee-for-service insurance, inpatient length of stay (LOS) less than 2 midnights, inpatient designation as hospitalization status at time of discharge, was hospitalized to an acute level of care and belonged to one of 37 listed hospital services at the time of signing of the discharge order) were randomized to have the BPA either silent or active over a three-month period from July 18, 2019, to October 18, 2019. Result A total of 88 patients were included in this study: 40 in the control arm and 48 in the intervention arm. In the intervention arm, 8 (8/48, 16.7%) had an inpatient status designation despite potentially meeting Medicare guidelines for an observation stay, comparing to 23 patients (23/40, 57.5%) patients in the control group (p = 0.001). The estimated number of write-offs in the control arm was 17 (73.9%, out of 23 inpatient patients) while in the intervention arm was 1 (12.5%, out of 8 inpatient patient) after accounting for patients who may have met inpatient criteria for other reasons based on case manager note review. Conclusion This is the first time to our knowledge that a BPA has been used in this manner to reduce the number of Medicare 1-day write-offs.

Background : The mechanism for possible association between obesity and poor clinical outcomes from Coronavirus Disease 2019 (COVID-19) remains unclear. Methods : We analyzed 22,915 adult COVID-19 patients hospitalized from March 2020 to April 2021 to non-intensive care using the American Heart Association National COVID Registry. A multivariable Poisson model adjusted for age, sex, medical history, admission respiratory status, hospitalization characteristics, and laboratory findings was used to calculate length of stay (LOS) as a function of body mass index (BMI). We similarly analyzed 5,327 patients admitted to intensive care for comparison. Results : Relative to normal BMI subjects, overweight, class I obese, and class II obese patients had approximately half-day reductions in LOS (-0.469 days, P

Abstract Introduction: COVID-19 has caused tremendous death and suffering since it first emerged in 2019. Soon after its emergence, models were developed to help predict the course of various disease metrics, and these models have been relied upon to help guide public health policy. Methods: Here we present a method called COVIDNearTerm to “forecast” hospitalizations in the short term, two to four weeks from the time of prediction. COVIDNearTerm is based on an autoregressive model and utilizes a parametric bootstrap approach to make predictions. It is easy to use as it requires only previous hospitalization data, and there is an open-source R package that implements the algorithm. We evaluated COVIDNearTerm on San Francisco Bay Area hospitalizations and compared it to models from the California COVID Assessment Tool (CalCAT). Results: We found that COVIDNearTerm predictions were more accurate than the CalCAT ensemble predictions for all comparisons and any CalCAT component for a majority of comparisons. For instance, at the county level our 14-day hospitalization median absolute percentage errors ranged from 16 to 36%. For those same comparisons, the CalCAT ensemble errors were between 30 and 59%. Conclusion: COVIDNearTerm is a simple and useful tool for predicting near-term COVID-19 hospitalizations.

Abstract Background The American Society of Anesthesiologists Physical Status (ASA-PS) classification system was developed to categorize the fitness of patients before surgery. Increasingly, the ASA-PS has been applied to other uses including justification of inpatient admission. Our objectives were to develop and cross-validate a statistical model for predicting ASA-PS; and 2) assess the concurrent and predictive validity of the model by assessing associations between model-derived ASA-PS, observed ASA-PS, and a diverse set of 30-day outcomes. Methods Using the 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data File, we developed and internally cross-validated multinomial regression models to predict ASA-PS using preoperative NSQIP data. Accuracy was assessed with C-Statistics and calibration plots. We assessed both concurrent and predictive validity of model-derived ASA-PS relative to observed ASA-PS and 30-day outcomes. To aid further research and use of the ASA-PS model, we implemented it into an online calculator. Results Of the 566,797 elective procedures in the final analytic dataset, 8.9% were ASA-PS 1, 48.9% were ASA-PS 2, 39.1% were ASA-PS 3, and 3.2% were ASA-PS 4. The accuracy of the 21-variable model to predict ASA-PS was C = 0.77 +/− 0.0025. The model-derived ASA-PS had stronger association with key indicators of preoperative status including comorbidities and higher BMI (concurrent validity) compared to observed ASA-PS, but less strong associations with postoperative complications (predictive validity). The online ASA-PS calculator may be accessed at https://s-spire-clintools.shinyapps.io/ASA_PS_Estimator/ Conclusions Model-derived ASA-PS better tracked key indicators of preoperative status compared to observed ASA-PS. The ability to have an electronically derived measure of ASA-PS can potentially be useful in research, quality measurement, and clinical applications.

Objective: The study was designed to compare intentions to receive COVID-19 vaccination by race–ethnicity, to identify beliefs that may mediate the association between race–ethnicity and intention to receive the vaccine and to identify the demographic factors and beliefs most strongly predictive of intention to receive a vaccine. Design: Cross-sectional survey conducted from November 2020 to January 2021, nested within a longitudinal cohort study of the prevalence and incidence of SARS-CoV-2 among a general population-based sample of adults in six San Francisco Bay Area counties (called TrackCOVID). Study Cohort: In total, 3161 participants among the 3935 in the TrackCOVID parent cohort responded. Results: Rates of high vaccine willingness were significantly lower among Black (41%), Latinx (55%), Asian (58%), Multi-racial (59%), and Other race (58%) respondents than among White respondents (72%). Black, Latinx, and Asian respondents were significantly more likely than White respondents to endorse lack of trust of government and health agencies as a reason not to get vaccinated. Participants’ motivations and concerns about COVID-19 vaccination only partially explained racial–ethnic differences in vaccination willingness. Concerns about a rushed government vaccine approval process and potential bad reactions to the vaccine were the two most important factors predicting vaccination intention. Conclusions: Vaccine outreach campaigns must ensure that the disproportionate toll of COVID-19 on historically marginalized racial–ethnic communities is not compounded by inequities in vaccination. Efforts must emphasize messages that speak to the motivations and concerns of groups suffering most from health inequities to earn their trust to support informed decision making.

Introduction We evaluated the impact of a ‘Team-Based Goals and Incentives’ (TBGI) intervention in Bihar, India, designed to improve front-line (community health) worker (FLW) performance and health-promoting behaviours related to reproductive, maternal, newborn and child health and nutrition.Methods This study used a cluster randomised controlled trial design and difference-in-difference analyses of improvements in maternal health-related behaviours related to the intervention’s team-based goals (primary), and interactions of FLWs with each other and with maternal beneficiaries (secondary). Evaluation participants included approximately 1300 FLWs and 3600 mothers at baseline (May to June 2012) and after 2.5 years of implementation (November to December 2014) who had delivered an infant in the previous year.Results The TBGI intervention resulted in significant increases in the frequency of antenatal home visits (15 absolute percentage points (PP), p=0.03) and receipt of iron-folic acid (IFA) tablets (7 PP, p=0.02), but non-significant changes in other health behaviours related to the trial’s goals. Improvements were seen in selected attitudes related to coordination and teamwork among FLWs, and in the provision of advice to beneficiaries (ranging from 8 to 14 PP) related to IFA, cord care, breast feeding, complementary feeding and family planning.Conclusion Results suggest that combining an integrated set of team-based coverage goals and targets, small non-cash incentives for teams who meet targets and team building to motivate FLWs resulted in improvements in FLW coordination and teamwork, and in the quality and quantity of FLW–beneficiary interactions. These improvements represent programmatically meaningful steps towards improving health behaviours and outcomes.Trial registration number NCT03406221