Entire Period Research Articles

Does an electronic pathology ordering system change the volume and pattern of routine testing in hospital? An interrupted time series analysis

AimsIdentifying and reducing low-value care is a vital issue in Australia, with pathology test ordering a common focus in this field. This study builds on previous research and aimed to...

Molecular Characterization, Expression and In Situ Hybridization Analysis of a Pedal Peptide/Orcokinin-type Neuropeptide in Cuttlefish Sepiella japonica.

Neuropeptide pedal peptide (PP) and orcokinin (OK), which are structurally related active peptides, have been widely discovered in invertebrates and constitute the PP/OK neuropeptide family. They have complex structures and play myriad roles in physiological processes. To date, there have been no related reports of PP/OK-type neuropeptide in cephalopods, which possess a highly differentiated multi-lobular brain. Rapid Amplification of cDNA Ends (RACE) was employed to obtain the open reading frame (ORF) of PP/OK-type neuropeptide in Sepiella japonica (termed as Sj-PP/OK). Various software were used for sequence analysis. Semi-quantitative PCR was applied to analyze the tissue distribution profile, quantitative real-time PCR (qRT-PCR) was used to study spatio-temporal expression throughout the entire growth and development period, and in situ hybridization (ISH) was employed to observe the tissue location of Sj-PP/OK. in the present study, we identified the ORF of Sj-PP/OK. The putative precursor of Sj-PP/ OK encodes 22 mature peptides, of which only tridecapeptides could undergo post-translationally amidated at C-terminus. Each of these tridecapeptides possesses the most conserved and frequent N-terminus Asp-Ser-Ile (DSI). Sequence analysis revealed that Sj-PP/OK shared comparatively low identity with other invertebrates PP or OK. The tissue distribution profile showed differences in the expression level of Sj-PP/OK between male and female. qRT-PCR data demonstrated that Sj-PP/OK was widely distributed in various tissues, with its expression level increasing continuously in the brain, optic lobe, liver, and nidamental gland throughout the entire growth and development stages until gonad maturation. ISH detected that Sj-PP/OK positive signals existed in almost all regions of the optic lobe except the plexiform zone, the outer edge of all functional lobes in the brain, epithelial cells and the outer membrane layer of the accessory nidamental gland. These findings suggest that Sj-PP/OK might play a role in the regulation of reproduction, such as vitellogenin synthesis, restoration, and ova encapsulation. The study indicated that Sj-PP/OK may be involved in the neuroendocrine regulation in cephalopods, providing primary theoretical basis for further studies of its regulation role in reproduction.

Higher Frequency of Premature Atrial Contractions Correlates With Atrial Fibrillation Detection after Cryptogenic Stroke.

Covert atrial fibrillation (AF) is a major cause of cryptogenic stroke. This study investigated whether a dose-dependent relationship exists between the frequency of premature atrial contractions (PACs) and AF detection in patients with cryptogenic stroke using an insertable cardiac monitor (ICM). We enrolled consecutive patients with cryptogenic stroke who underwent ICM implantation between October 2016 and September 2020 at 8 stroke centers in Japan. Patients were divided into 3 groups according to the PAC count on 24-hour Holter ECG: ≤200 (group L), >200 to ≤500 (group M), and >500 (group H). We defined a high AF burden as above the median of the cumulative duration of AF episodes during the entire monitoring period. We evaluated the association of the frequency of PACs with AF detection using log-rank trend test and Cox proportional hazard model and with high AF burden using logistic regression model, adjusting for age, sex, CHADS2 score. Of 417 patients, we analyzed 381 patients with Holter ECG and ICM data. The median age was 70 (interquartile range, 59.5-76.5), 246 patients (65%) were males, and the median duration of ICM recording was 605 days (interquartile range, 397-827 days). The rate of new AF detected by ICM was higher in groups with more frequent PAC (15.5%/y in group L [n=277] versus 44.0%/y in group M [n=42] versus 71.4%/y in group H [n=62]; log-rank trend P<0.01). Compared with group L, the adjusted hazard ratios for AF detection in groups M and H were 2.11 (95% CI, 1.24-3.58) and 3.23 (95% CI, 2.07-5.04), respectively, and the adjusted odds ratio for high AF burden in groups M and H were 2.57 (95% CI, 1.14-5.74) and 4.25 (2.14-8.47), respectively. The frequency of PACs was dose-dependently associated with AF detection in patients with cryptogenic stroke.

Measuring the Performance of KSE100: The Impact of Demutualization

The purpose of this study is to assess how the demutualization process has affected the performance of the KSE100 Benchmark Index. The study utilized Descriptive Statistics and a Paired sample t-test, as well as daily data from KSE-100 spanning 2009 to 2019. This data was analysed in terms of market capitalization, traded value, daily stock returns, and trading volume. Our results show that, overall, market capitalization increased significantly during the period, except in the second phase. Daily stock returns for the KSE100 Index did not improve over the entire period, though the decrease was not statistically significant. Trading volume did not improve and decreased significantly in both the first and second phases, but increased after the listing of the Pakistan Stock Exchange on its own exchange. The overall conclusion is that the performance of the Index improved, which is a crucial finding for foreign investors looking to invest in the Pakistani stock market. The study is also significant for institutional investors, local investors, potential investors, and portfolio managers who are interested in the growth and development of the stock market. This study is a valuable addition to existing literature, as a significant portion of the existing literature on the demutualization of the Pakistan Stock Exchange is qualitative.

On the superior performance of SRI funds

We compare the performance of 1126 US mutual funds deemed socially responsible to that of a matching sample of conventional funds over the three-decade period January 1980–December 2019. The comparisons are made over the entire period as well as the descending (bear) and ascending (bull) market subperiods, classified either according to the NBER method or the regime switching model. Our results indicate that SRI funds outperform their peers over the entire sample period. Additionally, regardless of the method used to the identify market condition or the asset pricing model employed, SRI funds as a group significantly outperform their conventional counterparts during bull markets but insignificantly so during bear markets. However, all-equity SRI funds and those that includes Equity and Fixed Income funds, significantly outperform their peers under either regime, with both methods and for all asset pricing specifications. Further examination indicates that the main driver of differences in the performance of SRI funds and their conventional peers can be attributed to their superior selection ability.

Driving STEM learning effectiveness: dropout prediction and intervention in MOOCs based on one novel behavioral data analysis approach

AbstractWith the full application of MOOCs online learning, STEM multidisciplinary and knowledge structures have been achieved, but it has also resulted in a massive number of dropouts, seriously affected the learning sustainability of STEM education concepts, and made it difficult to achieve learning effectiveness. Based on the massive STEM learning behavior instances generated by MOOCs, as well as the entire learning periods, this study considers some key explicit and implicit features associated with learning behavior, and achieves the fusion of convolutional neural network and recurrent neural network through data-driven approaches, incorporates long short-term memory mechanism to develop dropout prediction methods and models. Based on the experimental results, we also discuss the relevant problems of dropouts related to STEM learning behavior, explore the key dropout temporal sequences of the learning process, identify related factors that have key impacts on learning behavior, and deduce intervention measures and early warning suggestions. The entire study can provide effective methods and decisions for researching the STEM learning behavior of MOOCs and has strong research feasibility and urgency.

Net Isotopic Signature of Atmospheric CO2 Sources and Sinks: No Change since the Little Ice Age

Recent studies have provided evidence, based on analyses of instrumental measurements of the last seven decades, for a unidirectional, potentially causal link between temperature as the cause and carbon dioxide concentration ([CO2]) as the effect. In the most recent study, this finding was supported by analysing the carbon cycle and showing that the natural [CO2] changes due to temperature rise are far larger (by a factor &gt; 3) than human emissions, while the latter are no larger than 4% of the total. Here, we provide additional support for these findings by examining the signatures of the stable carbon isotopes, 12 and 13. Examining isotopic data in four important observation sites, we show that the standard metric δ13C is consistent with an input isotopic signature that is stable over the entire period of observations (&gt;40 years), i.e., not affected by increases in human CO2 emissions. In addition, proxy data covering the period after 1500 AD also show stable behaviour. These findings confirm the major role of the biosphere in the carbon cycle and a non-discernible signature of humans.

European Stop Tyrosine Kinase Inhibitor Trial (EURO-SKI) in Chronic Myeloid Leukemia: Final Analysis and Novel Prognostic Factors for Treatment-Free Remission.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The European Stop Kinase Inhibitors (EURO-SKI) study is the largest clinical trial for investigating the cessation of tyrosine kinase inhibitors (TKIs) in patients with chronic myeloid leukemia in stable deep molecular remission (DMR). Among 728 patients, 434 patients (61%; 95% CI, 57 to 64) remained in major molecular response (MMR) at 6 months and 309 patients of 678 (46%; 95% CI, 42 to 49) at 36 months. Duration of TKI treatment and DMR before TKI stop were confirmed as significant factors for the prediction of MMR loss at 6 months. In addition, the type of BCR::ABL1 transcript was identified as a prognostic factor. For late MMR losses after 6 months, TKI treatment duration, percentage of blasts in peripheral blood, and platelet count at diagnosis were significant factors in multivariate analysis. For the entire study period of 36 months, multiple logistic regression models confirmed duration of treatment, blasts, and transcript type as independent factors for MMR maintenance. In addition to the duration of treatment, transcript type as well as blasts in peripheral blood at diagnosis should be considered as important factors to predict treatment-free remission.

Persistence comparison of two Shiga-toxin producing Escherichia coli (STEC) serovars during long-term storage and thermal inactivation in various wheat flours.

Foodborne outbreaks associated with Shiga toxin-producing Escherichia coli (STEC) contaminated wheat flour have been an increasing food safety concern in recent decades. However, there is little literature aimed at investigating the impact of different flour types on the persistence of STEC during storage and thermal inactivation. Therefore, two serovars of STEC, O121 and O157, were selected to inoculate each of five different types of common wheat flours: whole wheat, bleached, unbleached, bread, and self-rising. Inoculated flours were examined for the stability of STEC during storage for up to 42 days at room temperature (RT) and aw ~0.56. Additionally, the thermal resistance of O121 and O157 under isothermal conditions at 60, 70, 80, and 90°C was analyzed for the inoculated flours. STEC storage persistence at RT was generally not affected by flour type, however, decreases of 1.2 and 2.4 log CFU/day within whole wheat flour for O121 and O157, respectively, were significantly lower than other flours. Though few differences were identified in relation to flour type, O121 exhibited significantly better survival rates than O157 during both equilibrium and storage periods. Compared to an approximate 6 log reduction in the population of O157, O121 population levels were reduced by a significantly lower amount (~3 log) during the entire storage period at RT. At each isothermal temperature, the impact of flour type on the thermal resistance capabilities of O121 or O157 was not a significant factor and resulted in similar survival curves regardless of serovar. Instead of exhibiting linear survival curves, both O121 and O157 displayed nonlinear curves with some shoulder/tail effect. Similar for both O121 and O157, the predicted decimal reduction time (D-value) decreased from approximately 25 min to around 8 min as the isothermal temperature increased from 60°C to 90°C. Results reported here can contribute to risk assessment models concerning contamination of STEC in wheat flour and add to our understanding of the impacts of flour type and STEC serovar on desiccation stability during storage and isothermal inactivation during thermal treatment.

Evolution of drought characteristics and propagation from meteorological to agricultural drought under the influences of climate change and human activities.

Understanding the propagation of agricultural droughts (AD) is important to comprehensively assess drought events and develop early warning systems. The present study aims to assess the impacts of climate change and human activities on drought characteristics and propagation from meteorological drought (MD) to AD in the Yellow River Basin (YRB) over the 1950-2021 period using the Standardized Precipitation Evapotranspiration Index (SPEI) and Standardized Soil Moisture Index (SSMI). In total, the YRB was classified into three groups of catchments for spring wheat and four groups of catchments for winter wheat based on different human influence degrees (HId). In addition, the entire study period was divided into periods with natural (NP), low (LP), and high (HP) impacts of human activities, corresponding to 1950-1971, 1972-1995, and 1996-2021, respectively. The results demonstrated the significance and credibility of the application of the natural and human-impacted catchment comparison method for drought characteristics and propagation from meteorological to agricultural drought in the YRB. Winter wheat showed a more pronounced drying trend than spring wheat under both MD and AD. The results showed meteorological drought intensity (MDI) and agricultural drought intensity (ADI) intensified for spring and winter wheat in NP, with correspondingly a short propagation time, followed by those in the LP and HP in catchments minimally impacted by human activities. On the other hand, increases in the MDI and ADI, as well as in their times, for both spring and winter wheat were observed from the LP to the HP in all catchments. The MDI, ADI, and their propagation times for winter wheat generally showed greater fluctuations than those for spring wheat. Human activities increasingly prolonged the drought propagation time. In contrast, climate change insignificantly shortened the drought propagation time.

Oviposition preferences and larval survival of the marsh fritillary butterfly: The adverse impact of grazing

Abstract Species‐rich semi‐natural grasslands have been lost during the last century due to agricultural intensification. This has had large negative consequences for many specialised species, including grassland butterflies. To prevent further loss, management regimes in the remaining grasslands must maintain habitat quality over time, and we therefore need to understand the habitat preferences of specialised species and how different management regimes affect their survival. We studied the egg‐laying preferences of the threatened marsh fritillary butterfly in relation to host plant properties, microclimate and management (grazing) on Gotland, Sweden. Moreover, we followed the survival of eggs and larvae from 27 egg batches during a period of 8 months (from June 2020 to March 2021) in grazed and ungrazed areas. We found 92 egg batches in total and the average number of eggs was 184.5. Egg‐laying probability increased with increasing host plant size and abundance, and environmental variables associated with a warm microclimate (low grass cover, low vegetation height and south‐facing edges). The 27 egg batches that were followed over time had on average 203 eggs in June. Roughly 28% of the eggs developed into larvae, and about 17% of these survived over the entire study period, resulting in an overall 4.7% survival. Egg survival was higher in ungrazed habitats compared with grazed; in March (post‐hibernation), there were almost nine times more eggs in ungrazed habitats. This study highlights the complex habitat ecology of specialised butterflies and underscores the detrimental impact of intense grazing, advocating for rotational grazing or mowing regimes.

Trends in social inequality in breastfeeding duration in Denmark 2002-2019.

The aim of the present study was to analyse trends in full breastfeeding for at least 4 months across socioeconomic position in Denmark over a 17-year-long period from 2002 to 2019 using parental education as the indicator of socioeconomic position. The study used data on full breastfeeding collected between 2002 and 2019 by community health nurses in the collaboration Child Health Database, n=143,075. Data were linked with five categories of parental education from population registers. Social inequality was calculated as both the relative (odds ratio) and absolute social inequality (slope index of inequality). A trend test was conducted to assess changes in social inequality over time. A social gradient in full breastfeeding was found for the entire study period. The odds ratio for not being fully breastfed for at least 4 months ranged from 3.30 (95% confidence interval 2.83-3.84) to 5.09 (95% confidence interval 4.28-6.06) during the study period for infants of parents with the lowest level of education (primary school) compared with infants of parents with the highest level of education (5+ years of university education). The slope index of inequality was between -38.86 and -48.81 during the entire study period, P=0.80. This indicated that both the relative and absolute social inequality in full breastfeeding to at least 4 months of age was unchanged in the study period from 2002 to 2019. This study showed a persistent relative and absolute social inequality in full breastfeeding for at least 4 months from 2002 to 2019 in Denmark.

Evaluation of Land Cover Dynamics and Landscape Fragmentation in Ijebu Ode, Nigeria

Landscape fragmentation has been found to be a major consequence of urbanization and land use/cover (LULC) changes. Thus, this study analyzed the spatiotemporal land use/land cover changes in Ijebu Ode, Nigeria, between 1986 and 2021. This is with a view to assessing the pattern of landscape fragmentation in the study area. The study used data obtained through a Global Positioning System (GPS) receiver and satellite imagery (Landsat 5 MSS/TM, 1986; Landsat 7 ETM+, 2000 and 2014; and Landsat 8 OLI/TIR, 2021). The data were analyzed using spatial landscape metrics. Results indicated that Ijebu Ode has witnessed a dramatic increase in built-up areas between 1986 and 2000 by 11.03%, 2000 to 2014 (65.24%), and 2014 to 2021 by 131.25%. Expansion of the built-up area was aided by reductions in bare land (1986 to 2000, 15.78%; 2014 to 2021, 98.27%), and the cultivated area by 47.74% between 1986 and 2014. Landscape metrics were estimated over the four epochs of the study. The results revealed that most of the metrics suggest similar trends over the entire period of study. However, the Largest Patch Index (LPI), Landscape Shape Index (LSI) and Normalized Landscape Shape Index (NLSI) were useful in capturing the spatio-temporal variations in landscape transformation. Also, Class Area (CA) was useful to show the degree of land cover change. The study concluded that the location of spatial structures influenced the landscape patterns and urbanization processes in the study area. Hence, the study recommended regular monitoring of the expansion of the built-up area to check for imminent urban sprawl in the study area.

Post-fire soil greenhouse gas fluxes in boreal Scots pine forests–Are they affected by surface fires with different severities?

Although forest fires are one of the main natural disturbance types in boreal forests, there is limited information regarding surface fires (dominant in Northern Europe), and how surface fires of different severities could affect post-fire soil greenhouse gas emissions. The results of our study show that fire severity, time since fire and post-fire changes in soil temperature were the main factors driving soil carbon dioxide (CO2) flux (forest floor ecosystem respiration) from burned boreal forest soils. Approximately two hours after the fire, soil CO2 emissions from burned areas were significantly higher compared to pre-fire conditions, and areas with high-severity fires had significantly higher soil CO2 emissions compared to those with low-severity fires. Later (days, months) after the fire, the unburned control areas always had higher soil CO2 emission values compared to burned areas. In the case of methane (CH4), time since fire and post-fire changes in soil temperatures were the main factors driving soil CH4 fluxes. Unburned study areas were sinks of CH4 through the entire measurement period, while immediately after the fire, the burned areas turned from CH4 sink to CH4 source. For nitrous oxide (N2O) measurements, time since fire was the only factor that significantly affected soil N2O fluxes. Shortly after the fire, N2O emissions increased significantly from both low- and high-intensity study plots. Two days after the fire, post-fire soil C and N content decreased in the O-horizon and increased within the first 5 cm of the soil mineral layer, and the trend was visible both in low- and high-severity fire plots. Samples collected four months after the fire, showed similar total soil C and N content as there was before the fire.

Investigating the Association Between Dynamic Driving Pressure and Mortality in COVID-19-Related Acute Respiratory Distress Syndrome: A Joint Modeling Approach Using Real-Time Continuously-Monitored Ventilation Data.

COVID-19-related acute respiratory distress syndrome (ARDS) is associated with high mortality and often necessitates invasive mechanical ventilation (IMV). Previous studies on non-COVID-19 ARDS have shown driving pressure to be robustly associated with ICU mortality; however, those studies relied on "static" driving pressure measured periodically and manually. As "continuous" automatically monitored driving pressure is becoming increasingly available and reliable with more advanced mechanical ventilators, we aimed to examine the effect of this "dynamic" driving pressure in COVID-19 ARDS throughout the entire ventilation period. This retrospective, observational study cohort study evaluates the association between driving pressure and ICU mortality in patients with concurrent COVID-19 and ARDS using multivariate joint modeling. The study cohort (n = 544) included all adult patients (≥ 18 yr) with COVID-19 ARDS between March 1, 2020, and April 30, 2021, on volume-control mode IMV for 12 hours or more in a Mass General Brigham, Boston, MA ICU. Of 544 included patients, 171 (31.4%) died in the ICU. Increased dynamic ΔP was associated with increased risk in the hazard of ICU mortality (hazard ratio [HR] 1.035; 95% credible interval, 1.004-1.069) after adjusting for other relevant dynamic respiratory biomarkers. A significant increase in risk in the hazard of death was found for every hour of exposure to high intensities of driving pressure (≥ 15 cm H2O) (HR 1.002; 95% credible interval 1.001-1.003). Limiting patients' exposure to high intensities of driving pressure even while under lung-protective ventilation may represent a critical step in improving ICU survival in patients with COVID-19 ARDS. Time-series IMV data could be leveraged to enhance real-time monitoring and decision support to optimize ventilation strategies at the bedside.

A Randomized Trial Comparing Standard of Care to Bayesian Warfarin Dose Individualization.

The quality of warfarin treatment may be improved if management is guided by the use of models based upon pharmacokinetic-pharmacodynamic theory. A prospective, two-armed, single-blind, randomized controlled trial compared management aided by a web-based dose calculator (NextDose) with standard clinical care. Participants were 240 adults receiving warfarin therapy following cardiac surgery, followed up until the first outpatient appointment at least 3 months after warfarin initiation. We compared the percentage of time spent in the international normalized ratio acceptable range (%TIR) during the first 28 days following warfarin initiation, and %TIR and count of bleeding events over the entire follow-up period. Two hundred thirty-four participants were followed up to day 28 (NextDose: 116 and standard of care: 118), and 228 participants (114 per arm) were followed up to the final study visit. Median %TIR tended to be higher for participants receiving NextDose guided warfarin management during the first 28 days (63 vs. 56%, P = 0.13) and over the entire follow-up period (74 vs. 71%, P = 0.04). The hazard of clinically relevant minor bleeding events was lower for participants in the NextDose arm (hazard ratio: 0.21, P = 0.041). In NextDose, there were 89.3% of proposed doses accepted by prescribers. NextDose guided dose management in cardiac surgery patients requiring warfarin was associated with an increase in %TIR across the full follow-up period and fewer hemorrhagic events. A theory-based, pharmacologically guided approach facilitates higher quality warfarin anticoagulation. An important practical benefit is a reduced requirement for clinical experience of warfarin management.

Chemical composition, sources and formation mechanism of urban PM2.5 in Southwest China: a case study at the beginning of 2023

Abstract. Despite significant improvements in air quality in recent years, the Sichuan Basin (SCB) is still facing frequent haze pollution in winter, and the causes of severe haze formation have not yet been fully investigated. In this study, the chemical components of PM2.5 (i.e., particulate matter with an aerodynamic diameter of less than 2.5 µm) in a typical pollution period at the beginning of 2023 in Chengdu, a megacity in the SCB, were characterized by bulk-chemical and single-particle analysis, and the PM2.5 sources and formation mechanism of pollution were analyzed. The average mass concentration of PM2.5 during the study period was 95.6 ± 28.7 µg m−3. Organic matter (OM) was the most abundant component (35.3 %), followed by nitrate (22.0 %), sulfate (9.2 %) and ammonium (7.8 %). The individual aerosol particles were classified into five categories, i.e., mineral, OM, secondary inorganic aerosol (SIA), soot and fly ash/metal particles, and most of them were in the state of being internally mixed. The entire observation period could be divided into two non-pollution periods (NP-1 and NP-2) and two haze periods (Haze-1 and Haze-2). With the evolution of pollution, the bulk-chemical and single-particle analysis exhibited similar characteristics, suggesting that Haze-1 was mainly caused by pollutants related to fossil fuel combustion, especially local mobile sources, while Haze-2 was triggered by the rapidly increasing secondary pollutants, which mainly came from regional transmission. The PM2.5 sources included dust (8.5 %), biomass burning (3.5 %), coal combustion (15.4 %), industrial processes (6.5 %), vehicular emissions (25.6 %) and secondary sources (40.5 %). Analysis of Weather Research and Forecasting model with Chemistry (WRF-Chem) model results showed that the average contributions of local sources and regional transmission to pollution in Chengdu were the same (50 % vs. 50 %). In addition, the source composition and WRF-Chem simulation results in different periods confirmed our analysis of the formation mechanisms of the two haze events. This study confirms that further significant reductions in PM2.5 in Chengdu are still needed, and more effective policies for local emission reduction or joint prevention and control of regional air pollution will be necessary in the future.

Changes in End-of-Life Symptom Management Prescribing among Long-Term Care Residents during COVID-19

ObjectiveTo examine changes in the prescribing of end-of-life symptom management medications in long-term care (LTC) homes during the COVID-19 pandemic. DesignRetrospective cohort study using routinely collected health administrative data in Ontario, Canada. Setting and ParticipantsWe included all individuals who died in LTC homes between January 1, 2017, and March 31, 2021. We separated the study into 2 periods: before COVID-19 (January 1, 2017, to March 17, 2020) and during COVID-19 (March 18, 2020, to March 31, 2021). MethodsFor each LTC home, we measured the percentage of residents who died before and during COVID-19 who had a subcutaneous symptom management medication prescription in their last 14 days of life. We grouped LTC homes into quintiles based on their mean prescribing rates before COVID-19, and examined changes in prescribing during COVID-19 and COVID-19 outcomes across quintiles. ResultsWe captured 75,438 LTC residents who died in Ontario's 626 LTC homes during the entire study period, with 19,522 (25.9%) dying during COVID-19. The mean prescribing rate during COVID-19 ranged from 46.9% to 79.4% between the lowest and highest prescribing quintiles. During COVID-19, the mean prescribing rate in the lowest prescribing quintile increased by 9.6% compared to before COVID-19. Compared to LTC homes in the highest prescribing quintile, homes in the lowest prescribing quintile experienced the highest proportion of COVID-19 outbreaks (73.4% vs 50.0%), the largest mean outbreak intensity (0.27 vs 0.09 cases/bed), the highest mean total days with a COVID-19 outbreak (72.7 vs 24.2 days), and the greatest proportion of decedents who were transferred and died outside of LTC (22.1% vs 8.6%). Conclusions and ImplicationsLTC homes in Ontario had wide variations in the prescribing rates of end-of-life symptom management medications before and during COVID-19. Homes in the lower prescribing quintiles had more COVID-19 cases per bed and days spent in an outbreak.

Validation and genetic parameters of the X-ray method for phenotyping individual feed intake in Atlantic salmon

Feed efficiency is a highly desirable breeding goal trait as it can potentially reduce the relative economic cost of feed and concurrently reduce the environmental footprint of fish production. However, recording feed intake is a bottleneck in Atlantic salmon production. We recorded feed intake in 700 Atlantic salmon parr from 34 full sibling families using the X-ray method, where fish were fed feed containing radio-opaque beads and subsequently X-ray imaged one time after a full meal corresponding to the daily ration. In parallel, we cultured siblings from the same 35 families in duplicate family tanks of 25 individuals per tank and recorded the daily feed intake of each family at the tank level, which is known as the gold standard tank-based method. The heritability estimate for daily feed intake in Atlantic salmon using the X-ray method was significantly different from zero (0.19 ± 0.06) and was genetically correlated to growth-related traits (rg = 0.48–0.81). Daily feed intake at the family level with the X-ray method was highly genetically correlated to the daily feed intake traits using the tank-based feeding method at 0.78–0.82, depending on whether the comparison was made at a common time, common weight, or cumulative feed intake for the entire period. Whilst the X-ray method holds promise for research on the genetic background of feed intake and feed efficiency, more studies are needed to investigate the feasibility during the sea phase of Atlantic salmon production.

Putting Patients First.

They were some of the hardest phone calls I'd ever had to make. After more than 25 years of practice, I had to tell patients I'd been seeing for that entire period that I could no longer be their doctor.