Higher Proportion Research Articles

Bacterial rarity in a subarctic stream network: Biodiversity patterns, assembly mechanisms and types of rarity.

Dendritic stream networks are an intriguing subject for exploring the spatial and temporal variability of the rare and common bacterial biosphere, yet very few such studies have been conducted. We sampled riverine bacterioplankton at 13 sites in a subarctic riverine network across 3 years, with five sampling times each year. Ordinations showed a consistent pattern of downstream shift for both rare and abundant subcommunities. We also detected a temporal signal, with seasonal community shifts reflecting changes in water temperature and groundwater contribution, and an inter-annual pattern where the year 2018 differed from other years. Phylogenetic turnover of the rare subcommunity indicated homogeneous selection, whereas the abundant subcommunity was mainly stochastically structured. Transiently rare taxa were the dominant type of rarity with the highest proportion at the headwater regions. The bacterioplankton community was characterized by a small group of core taxa that occurred at most sites with little temporal variation, a very large number of permanently or transiently rare taxa, and taxa shifting through time between the rare and abundant biosphere. While this basic structure could have been detected with less extensive temporal replication, a comprehensive understanding of the rare biosphere in riverine bacterioplankton can only be achieved via inter-annual, spatially replicated sampling that covers the whole stream network.

Characteristics, treatment patterns and burden of illness in US patients with asthma newly initiating multiple-inhaler triple therapy

IntroductionFor patients with asthma who remain symptomatic on medium-dose inhaled corticosteroid/long-acting β2-agonist, add-on long-acting muscarinic antagonist is a treatment option, which can be administered as multiple-inhaler triple therapy (MITT). A...

Comparing Clinical Outcomes of Steroid-Sparing Therapy With Rituximab Versus Rituximab Alone in Pemphigus.

Previous clinical trials have demonstrated that rituximab therapy combined with conventional steroid-sparing therapy (SST) has increased rates of disease control for mucous membrane pemphigoid compared with rituximab alone. However, limited data is available regarding the role of SST with rituximab therapy in pemphigus. This study aimed to examine clinical outcomes in pemphigus patients treated with rituximab with SST versus without the addition of SST. A retrospective chart review was performed for adult pemphigus patients in the Southeastern US at Emory between January 1, 2011, and December 31, 2021. Primary outcomes, including time to remission, time to prednisone dose of 10 mg or less, time to cessation of prednisone therapy, and time to relapse after a rituximab cycle, were compared between patients on SST and patients without SST.  Results: Following rituximab therapy, there was no difference in time to remission, time to prednisone dose of 10 mg or less, time to cessation of prednisone therapy, or time to relapse for patients with or without SST. Our study is limited by its retrospective decline, setting at a single academic center, and inclusion of a high proportion of patients with moderate disease. The use of SST with rituximab dosing did not improve clinical outcomes related to time to remission, reduction in prednisone dosing, or relapse. These data provide further evidence for the use of rituximab in the majority of pemphigus patients without the need for SST. J Drugs Dermatol. 2024;23(3):e97-e99    doi:10.36849/JDD.7949e.

The oral health situation and treatment need of schoolchildren Afghanistan: a cross-sectional study.

The present study explores the treatment need for dental caries in schoolchildren in Herat, Afghanistan. A convenience sample of 13 schools were selected for the study. All schools were located in the urban areas near Herat and were selected through allocation by the Ministry of Health, which also approved the study protocol. In the schools, classes were allocated by the principal of the school. All the children in the allocated classes were included in the survey. Data collection was performed in the school setting by trained Afghan dentist examiners. To measure caries experience, DMFT/dmft scores were used, counting the number of decayed (measured at both white spot (D≥1) and cavitation level (D≥3), according to WHO criteria), missing and filled teeth. Dental caries is a considerable oral health problem in the study population. The present sample has a high proportion of untreated carious lesions and a very low level of restorative care. Moreover, significant differences were shown in relation to gender and age groups. The present survey results confirm the need for professional operative and preventive oral health care in this region.

Self-Reported Everyday Functioning After COVID-19 Infection

Changes in everyday functioning are crucial to assessing the long-term impact of COVID-19 infection. To examine the impact of COVID-19 infection on everyday functioning 18 months after infection among veterans with and without histories of COVID-19 infection. This cohort study used data from the US Veterans Affairs (VA) and included 186 veterans who had COVID-19 between October 2020 and April 2021 (ie, COVID-19 cohort) and 186 matched comparators who did not have documented COVID-19 infections (ie, control cohort). This match balanced the risk of COVID-19 based on 39 variables measured in the 24 months before infection or match, using principles of target trial emulation. Data were analyzed from December 2022 to December 2023. First documented COVID-19. The differences in self-reported everyday functioning 18 months after COVID-19 infection were estimated and compared with their matched comparators. Within-matched pair logistic and linear regressions assessed differences in outcomes and were weighted to account for sampling and nonresponse. Among the 186 matched pairs of participants, their weighted mean age was 60.4 (95% CI, 57.5 to 63.2) years among veterans in the COVID-19 cohort (weighted sample, 91 459 of 101 133 [90.4%] male; 30 611 [30.3%] Black or African American veterans; 65 196 [64.4%] White veterans) and 61.1 (95% CI, 57.8 to 64.4) years among their comparators in the control cohort (91 459 [90.4%] male; 24 576 [24.3%] Black or African American veterans; 70 157 [69.4%] White veterans). A high proportion of veterans in the COVID-19 cohort (weighted percentage, 44.9% [95% CI, 34.2% to 56.2%]) reported that they could do less than what they felt they could do at the beginning of 2020 compared with the control cohort (weighted percentage, 35.3%; [95% CI, 25.6% to 46.4%]; within-matched pair adjusted odds ratio [OR], 1.52 [95% CI, 0.79 to 2.91]). There was no association of documented COVID-19 infection with fatigue, substantial pain, limitations in either activities of daily living and instrumental activities of daily living, severely curtailed life-space mobility, employment, or mean health-related quality of life on a utility scale. In this cohort study of veterans with and without documented COVID-19, many reported a substantial loss of everyday functioning during the pandemic regardless of whether or not they had a documented infection with COVID-19. Future work with larger samples is needed to validate the estimated associations.

Atlantic salmon Salmo salar do not prioritize digestion when energetic budgets are constrained by warming and hypoxia.

During summer, farmed Atlantic salmon (Salmo salar) can experience prolonged periods of warming and low aquatic oxygen levels due to climate change. This often results in a drop in feed intake; however, the physiological mechanism behind this behaviour is unclear. Digestion is a metabolically expensive process that can demand a high proportion of an animal's energy budget and might not be sustainable under future warming scenarios. We investigated the effects of elevated temperature and acute hypoxia on specific dynamic action (SDA; the energetic cost of digestion), and how much of the energy budget (i.e. aerobic scope, AS) was occupied by SDA in juvenile Atlantic salmon. AS was 9% lower in 21°C-acclimated fish compared to fish reared at their optimum temperature (15°C) and was reduced by ~50% by acute hypoxia (50% air saturation) at both temperatures. Furthermore, we observed an increase in peak oxygen uptakerate during digestion which occupied ~13% of the AS at 15°C and ~20% of AS at 21°C, and increased the total cost of digestion at 21°C. The minimum oxygen tolerance threshold in digesting fish was ~42% and ~53% at 15 and 21°C, respectively, and when digesting fish were exposed to acute hypoxia, gut transit was delayed. Thus, these stressors result in a greater proportion of the available energy budget being directed away from digestion. Moderate environmental hypoxia under both optimal and high temperatures severely impedes digestion and should be avoided to limit exacerbating temperature effects on fish growth.

DNA-metabarcoding supports trophic flexibility and reveals new prey species for the Galapagos sea lion.

Tropical ecosystems are challenging for pinnipeds due to fluctuating food availability. According to previous research, the Galapagos sea lion (GSL, Zalophus wollebaeki) adopts trophic flexibility to face such conditions. However, this hypothesis comes from studies using traditional methods (hard-parts analysis of scat and isotopic analysis from tissue). We studied the diet of five rookeries in the southeastern Galapagos bioregion (which harbors the highest GSL density), via DNA-metabarcoding of scat samples. The DNA-metabarcoding approach may identify consumed prey with a higher taxonomic resolution than isotopic analysis, while not depending on hard-parts remaining through digestion. Our study included five different rookeries to look for evidence of trophic flexibility at the bioregional level. We detected 98 prey OTUs (124 scats), mostly assigned to bony-fish taxa; we identified novel prey items, including a shark, rays, and several deep-sea fish. Our data supported the trophic flexibility of GSL throughout the studied bioregion since different individuals from the same rookery consumed prey coming from different habitats and trophic levels. Significant diet differentiations were found among rookeries, particularly between Punta Pitt and Santa Fe. Punta Pitt rookery, with a more pronounced bathymetry and lower productivity, was distinguished by a high trophic level and consumption of a high proportion of deep-sea prey; meanwhile, Santa Fe, located in more productive, shallow waters over the shelf, consumed a high proportion of epipelagic planktivorous fish. Geographic location and heterogeneous bathymetry of El Malecon, Española, and Floreana rookeries would allow the animals therein to access both, epipelagic prey over the shelf, and deep-sea prey out of the shelf; this would lead to a higher prey richness and diet variability there. These findings provide evidence of GSL adopting a trophic flexibility to tune their diets to different ecological contexts. This strategy would be crucial for this endangered species to overcome the challenges faced in a habitat with fluctuating foraging conditions.

False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series

Introduction The use of transcutaneous pacing (TCP) for unstable bradycardia has a class 2B recommendation from the American Heart Association. Prior studies have not adequately described the frequency or possible causes of treatment failure. EMS clinicians and leaders have reported false electrical capture as a potential cause. In this study, we aimed to describe the frequency of true electrical capture, documented verification of mechanical capture, and its association with systolic blood pressure (SBP) and survival. Methods This was a retrospective study of patients treated by an urban, hospital-based EMS network comprising two EMS agencies between March 2021 and March 2023. Inclusion criteria were adults with a heart rate of <60 bpm and attempted TCP. Variables included: initial electrocardiogram rhythm, SBP, current applied, neurological status at discharge, and diagnosis. The primary outcome was true electrical capture, defined as the presence of a visible wide QRS and T wave. This enabled calculation of false electrical capture. Additional outcomes included change in SBP and neurological status at discharge. Results 19 of the 23 (82.6%) patients who underwent TCP had false electrical capture despite all 23 having documented mechanical capture by palpated pulse. For patients with true electrical capture, the median change in SBP was +40 mmHg (IQR = 24.25, range= −12 to +49 mmHg). For patients with false electrical capture, the median change in SBP was −1 mmHg (IQR = 58.50, range= −90 to +23 mmHg). Median current for patients with true electrical capture was 95 mA (IQR = 13.75, range = 85–110) versus 70 mA (IQR = 30, range = 55–160) in those with false electrical capture. 16 (69.6%) had outcome data available. Patients with true electrical capture and outcome data (n = 2) survived to admission but only one survived to discharge with good functional capacity. Of 14 with false electrical capture and outcome data, 10 (71.4%) survived to admission; none survived to discharge with functional capacity. Conclusions These findings suggest a high proportion of patients undergoing TCP are at risk of false electrical capture despite a recorded palpable pulse. While our analysis is limited to a single EMS network, these data raise concerns regarding the incidence of prehospital false electrical capture. Further research is warranted to calculate the incidence of false electrical capture and evaluate mitigation strategies.

Observational Properties of 155 β Cephei Pulsating Variable Stars

β Cephei pulsating variable (BCEP) stars are the most massive pulsating variable stars in the main sequence, exhibiting both p- and g-mode pulsations. In this study, we identified 155 BCEP stars or candidates using data from TESS and Gaia, of which 83 were first confirmed as BCEP stars. They have visual magnitudes ranging from 8 to 12 mag and effective temperatures between approximately 20,000 and 30,000 K, while the parallaxes of most targets are between 0.2 and 0.6 mas. The study indicates that these BCEP stars have pulsation periods ranging from 0.06 to 0.31 days, with amplitudes ranging from 0.1 to 55.8 mmag in the TESS band. Additionally, the number of BCEP stars increases as the pulsation amplitude decreases. These targets align with the distribution region of BCEP stars in the luminosity–period (L–P) and temperature–period diagrams. We have updated the L–P relation of BCEP stars. The Hertzsprung–Russell diagram indicates that these targets are in the main-sequence evolutionary phase, with masses ranging from 7 to 20 M ⊙ and luminosities between 2800 and 71,000 L ⊙. They are almost in the theoretical instability region of BCEP stars but as previously reported, this region at the low-mass end (red) is not filled. The distribution of the pulsation constant indicates that the dominant pulsation periods of BCEP stars consist mainly of low-order p-mode pulsations with a high proportion of radial fundamental modes. These BCEP stars are excellent objects for enhancing our understanding of the structure and evolution of massive stars through asteroseismology.

Optimal Operation Scheduling of Multi-energy Complementary Systems Including Offshore Wind Power

Background: With the rapid development of offshore wind power in China, offshore wind power is accounting for an increasing proportion of the whole installed power generation in China, which put forward higher requirements for operation scheduling of multi-energy complementary systems including offshore wind power. However, existing studies have paid little attention to the complementary output scheduling of multi-energy systems with a high proportion of offshore wind power, this phenomenon is not conducive to the realization of reasonable operation scheduling. Objective: To realize the reasonable operation scheduling of multi-energy systems with a high proportion of offshore wind power. Methods: Firstly, the output characteristics of offshore wind power were analyzed and summarized, and modeling was conducted from the perspectives of time distribution, spatial correlation, volatility and randomness, which would serve as the theoretical basis for subsequent researches. Secondly, the complementary rule among offshore wind power and the multi-energy system was analyzed, and the complementary characteristic index was put forward. Then the safety operation was taken as the constraint, and the two-stage operation model of the integrated energy system was established, which considers the auxiliary service costs. In the first stage, the initial generation scheduling was developed according to the day-ahead forecast values of the offshore wind power; in the second stage, the more accurate intra-day operation scheduling was further achieved by considering the intra-day forecast values of offshore wind power and the day-ahead scheduling results. Costs of rotating reserve capacity could be reduced by correcting the deviation of generating capacity, then the revenue-maximizing scheduling strategies were obtained and the output of the pumped-storage power plants was optimized. Results: The effectiveness of the model proposed in this paper was verified based on the simulation examples. Compared with the traditional scheduling strategy, the scheduling strategy considering auxiliary service cost proposed in this paper can promote the consumption of offshore wind power, reduce the wind curtailment proportion and improve the electricity sales revenues in the end. Conclusion: The research results in this paper provide a reference for the reasonable consumption of multi-energy complementary systems with a high proportion of offshore wind power and improving electricity sales revenues

Study on the synergistic mechanism of N[sbnd]H[sbnd]S[sbnd]O co-doping in diamonds

Nitrogen impurity remains a crucial focus in diamond impurity research. To address difficulties associated with excessive nitrogen impurities during the synthesis of high-quality diamonds under high-pressure and high-temperature conditions and to increase the proportion of aggregated nitrogen impurities in diamonds, we explored the multi-element growth environment of natural diamonds. In this study, we used N–H–S–O multi-component co-doping to increase the proportion of aggregated nitrogen impurities in diamond. Through Fourier-transform infrared spectroscopy characterization, we successfully used the synergistic mechanism of N–H–S–O co-doping to achieve a 47.9% proportion of aggregated nitrogen impurities in diamond in a single synthesis and successfully synthesized the type IaA + Ib diamond. Raman tests revealed a lower residual stress in the high-quality large single-crystal diamond synthesized. Moreover, we comprehensively analyzed the mechanism of N–H–S–O co-doping to increase the proportion of nitrogen impurities in diamond aggregates and proposed an optimal ratio principle based on the experimental results. This study presents a method for synthesizing diamonds with a high proportion of aggregated nitrogen impurities and provides valuable guidance for elucidating the origin of natural diamonds and synthesizing multi-doped functional diamonds.

Physicianreported treatment patterns and outcomes in metastatic bladder cancer in the USA: the CancerMPact® Survey 2020.

Aim: This study assessed physician-reported treatment patterns for metastatic bladder cancer. Materials & methods: A total of106 USA-based physicians were surveyed in 2020 using the CancerMPact® online survey. Results: Among cisplatin-eligible patients, 86.1% received first-line (1L) platinum-containing chemotherapy, most commonly cisplatin plus gemcitabine, and 9.8% received immune checkpoint inhibitor monotherapy. Among cisplatin-ineligible patients, 46.5% received 1L platinum-containing chemotherapy, most commonly carboplatin plus gemcitabine and 46.2% received 1L immune checkpoint inhibitor therapy. Approximately 44% of patients who received 1L treatment received second-line (2L) therapy after progression. Conclusion: Platinum-containing chemotherapy was the most widely reported 1L treatment approach. A high proportion of patients received no 2L therapy. Validation in an updated dataset is warranted following the practice-changing approvals of avelumab 1L maintenance and additional 2L options.

ALUMNI TRACKING AND INTERACTION PLATFORM

Alumni connections are important resources that contribute to university evaluation. Even though alumni connections represent networks, they have been mostly evaluated as tabular data (e.g. by providing average salary, employment rate, etc.). This ironically disregards all qualities of a network, from which an alumni network gets its name. It is desirable to evaluate an alumni network as a network, because networks have the potential to provide very insightful information. Evaluation of alumni networks as a network has not been feasible in the past due to data fragmentation (neither universities nor companies willing to share meaningfully significant data in its entirety). Recently the feasibility of such analysis has changed, due to new trends towards democratization of information, accelerated by the Web 2.0 user- generated content phenomenon and crowd-sourcing mentality. Utilizing web-crawlers, we actively harvested data and assembled a dataset on alumni in leadership positions in technology-based industries. Moreover, we included a high proportion of startup companies, which allowed us to evaluate alumni networks with respect to entrepreneurial as well as technology involvement. We show that by analyzing alumni connections as networks, it is possible to uncover new patterns, as well as provide a new way of examining the old. Key Words: alumni system, centralized alumni system, alumni networks

A multicentre case series of analytically confirmed gamma-hydroxybutyrate intoxications in Western Australian emergency departments: Pre-hospital circumstances, co-detections and clinical outcomes.

Gamma-hydroxybutyrate (GHB) use is associated with high risk of accidental overdose. This study examined the pre-hospital circumstances, demographic characteristics and clinical outcomes of analytically confirmed GHB emergency department (ED) presentations in Western Australia (WA). This case series was conducted across three WA EDs involved in the Emerging Drugs Network of Australia, from April 2020 to July 2022. Patient demographics, pre-hospital drug exposure circumstances and ED presentation and outcome characteristics were collected from ambulance and hospital medical records of GHB-confirmed cases. GHB was detected in 45 ED presentations. The median age was 34 years and 53.3% (n = 24) were female. Most patients arrived at the ED by ambulance (n = 37, 85.7%) and required immediate emergency care (Australasian Triage Score 1 or 2 = 97.8%). One-third of patients were admitted to intensive care (n = 14, 31.1%). Methylamphetamine was co-detected in 37 (82.2%) GHB-confirmed cases. Reduced conscious state was indicated by first recorded Glasgow Coma Scale of ≤8 (n = 29, 64.4%) and observations of patients becoming, or being found, 'unresponsive' and 'unconscious' in various pre-hospital settings (n = 28, 62.2%). 'Agitated' and/or 'erratic' mental state and behavioural observations were recorded in 20 (44.4%) cases. Analytically verified data from ED presentations with acute toxicity provides an objective information source on drug use trends and emerging public health threats. In our study, patients presenting to WA EDs with GHB intoxication were acutely unwell, often requiring intensive care treatment. The unexpectedly high proportion of female GHB intoxications and methylamphetamine co-ingestion warrants further exploration.

Durability of COVID-19 humoral immunity post infection and different SARS-COV-2 vaccines

BackgroundThe global challenge posed by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has been a major concern for the healthcare sector in recent years. Healthcare workers have a relatively high risk of encountering COVID-19 patients, making protective immunity against SARS-CoV-2 is a priority for them. This study aims to evaluate the longitudinal measurement of SARS-CoV-2 IgG spike protein antibodies in healthcare workers (HCWs) after COVID-19 infection and after receiving the first and second doses of SARS-CoV-2 vaccines, including Pfizer-BioNTech (BNT162b2) and Oxford-AstraZeneca (AZD1222). MethodsThis longitudinal cohort study involved 311 healthcare workers working in two tertiary hospitals in Saudi Arabia. All participants were followed between July 2020 and July 2022 after completing the study questionnaire. A total of 3 ml of the blood samples were collected at four intervals: before/after vaccination. ResultsHCWs post-infection had lower mean SARS-CoV-2 IgG levels three months post-infection than post-vaccination. 92.2% had positive IgG levels two weeks after the first dose and reached 100% after the second dose. Over 98% had positive antibodies nine months after the second dose, regardless of vaccine type. The number of neutralizing antibodies decreased and was around 50% at nine months after the second dose. ConclusionThe results show different antibody patterns between infected and vaccinated HCWs. A high proportion of participants had positive antibodies after vaccination, with high levels persisting nine months after the second dose. Neutralizing antibodies decreased over time, with only about 50% of participants having positive antibodies nine months after the second dose. These results contribute to our understanding of immunity in healthcare workers and highlight the need for the continuous monitoring and possible booster strategies.

Hepatotoxicity of newer antiseizure medications in children: an overview and disproportionality analysis of VigiBase

ABSTRACT Background We aimed to characterize newer antiseizure medications (ASMs)-induced hepatotoxicity in children and identify signals of disproportionate reporting of hepatotoxicity-related adverse drug events (ADEs). Research Design and Methods Case reports reported to VigiBase were accessed using Empirica™ Signal software. To summarize characteristics of the retrieved cases, descriptive statistics were used. A disproportionality analysis was conducted using the Multi-item Gamma Poisson Shrinker algorithm, which calculates Empirical Bayesian Geometric Mean value and its lower and upper 95% confidence limits (EB05 and EB95, respectively). EB05 > 2, N > 0 was considered a signal. Results Based on 870 analyzed cases, a higher proportion of cases was reported in girls than in boys and in patients aged 2–11 years than in other age groups. Most cases were serious. In 25 cases, hepatotoxicity resulted in death. A high proportion of patients (n = 275, 31.61%) experienced hypersensitivity reactions, mostly due to lamotrigine. The disproportionality analysis yielded 17 signals concerning felbamate, lamotrigine, levetiracetam, oxcarbazepine, stiripentol, and topiramate. Four signals were for severe liver injury and concerned felbamate, lamotrigine, levetiracetam, and topiramate. Gender-biased reporting frequency was detected for four ASM-ADE combinations. Conclusion Our results should serve to raise clinicians’ awareness about the potential association between several newer ASMs and drug-induced liver injury in children.

Characteristics of Dissolved Organic Matter in Uranium Hosting Aquifers and Potential Molecular Transformation During Neutral In Situ Leaching

AbstractDissolved organic matter (DOM) is widespread in uranium (U) hosting aquifer, a key substance affecting CO2 + O2 in situ leaching (ISL) of U by consuming injected O2. However, molecular composition and molecular transformation of DOM are poorly understood in this aquifer during the U mining. To address this issue, Fourier transform ion cyclotron resonance mass spectrometry was applied to investigate DOM molecules in groundwater samples and rock samples collected from a U mining aquifer. The high proportion of labile tyrosine‐like component and BIX value in monitoring wells (BM) indicated the biological origin of DOM. CHOS and aliphatic were the major components of water‐soluble organic matter (WSOM) in U‐bearing rocks, but CHO and highly unsaturated structures with high oxygen (HUSHO) were the main components of DOM in BM. The ISL led to the release of WSOM and the oxidation of DOM, which accounted for 24.5%–57.4% and 39.1%–65.7% of expected DOM, respectively. Potential molecular transformations (PMTs) results showed that the intragroup transformations dominated, and remarkable transformations from CHON and CHONS to CHO occurred during ISL. The positive net PMTs of condensed aromatic structure (CAS), aromatic structures (AS), and aliphatic suggested that they were transformed from HUSLO and HUSHO. A gradual decrease in (DBE−O)/Cwa and a gradual increase in NOSCwa indicated that the saturated degree and oxidation state of DOM increased during mining. This work successfully identified molecular characteristics of DOM in U hosting aquifer, and proposed a paradigm of DOM transformation pathways during ISL.

Diagnostic Accuracy of JES Classification for Prediction of Invasion Depth in Superficial Esophageal Squamous Carcinoma: Meta-Analysis.

Prediction of the depth of invasion in superficial oesophageal squamous carcinoma (SESC) is an important factor for choosing the treatment. Recently, the Japan Esophageal Society (JES) designed a magnifying endoscopy classification based on the Inoue and Arima classifications. The aim of this study was to conduct a meta-analysis of the published literature on JES classification. Meta-Disc version 1.4, Review Manager 5.4 as well as stata 14.0 were used. The analysis combined sensitivity and specificity with the respective 95% CI, to draw a summary receiver operating characteristic curve (SROC), and estimated the area under curve (AUC) for overdiagnosis and underdiagnosis for each type B. Eight studies were included in the meta-analysis comprising 1279 patients. Type B1 has high sensitivity (0.86, 95%CI: 0.83-0.88) and specificity (0.84, 95%CI: 0.81-0.88) for the prediction of EP/LPM classifications. The AUC was calculated to be 0.92 with a high proportion of underdiagnosis (17%). The sensitivity and specificity of type B2 were 0.66 (95% CI, 0.6-0.72) and 0.84 (95% CI, 0.82-0.86) respectively. The overdiagnosis and underdiagnosis of type B2 were 14% and 39%. Type B3, sensitivity was low (0.49, 95% CI: 0.41-0.56), with high specificity and AUC (specificity: 0.99; AUC: 0.95). JES classification is a useful and reliable modality for predicting the depth of invasion of SESC, but other modalities should be considered for additional assessment when type B2 is detected. Key Words: JES classification, Superficial oesophageal squamous carcinoma, Depth of invasion, Magnifying endoscopy, Meta-analysis.

Species Distribution, Typical Clinical Features and Risk Factors for Poor Prognosis of Super-Elderly Patients with Bloodstream Infection in China.

Bloodstream infection (BSI) is characterized by high mortality, especially among these increasing super-elderly patients (≥85 years), and this study was conducted to understand the species distribution, typical clinical features and risk factors for poor prognosis of super-elderly patients with BSI. Based on previous work, this retrospective study was performed by reviewing an ongoing prospective medical database in a comprehensive tertiary center in China, and all super-elderly patients with BSI in the past 6 years were enrolled in this study. Out of 5944 adult-patients with BSI, there were totally 431 super-elderly patients (≥85 years old) enrolled in this study and age ≥90 years accounted for 31.1% (134/431). Among these 431 super-elderly patients with BSI, 40 patients (9.3%) were diagnosed with BSI and the remained 401 super-elderly patients (90.7%) were defined as hospital-acquired BSI. The typical feature of these super-elderly patients with BSI was the high proportion of patients with various comorbidities, such as cardiovascular disease (83.8%), ischemic cerebrovascular disease (63.3%) and pulmonary infection (61.0%). The other typical feature was that most (60.1%) of these patients had been hospitalized for long time (≥28 days) prior to the onset of BSI, and most patients had received various invasive treatments, such as indwelling central venous catheter (53.1%) and indwelling urinary catheter (47.1%). Unfortunately, due to these adverse features above, both the 7-day short-term mortality (13.2%, 57/431) and the 30-day long-term mortality (24.8%, 107/431) were high. The multivariate analysis showed that both chronic liver failure (OR 7.9, 95% CI 2.3-27.8, P=0.001) and indwelling urinary catheter (OR 2.3, 95% CI 1.1-4.7, P=0.023) were independent risk factors for 7-day short-term mortality, but not for 30-day long-term mortality. In addition, the microbiology results showed that the most common species were associated with nosocomial infection or self-opportunistic infection, such as Staphylococcus hominis (18.3%), Staphylococcus epidermidis (11.8%), Escherichia coli (9.7%), Klebsiella pneumoniae (9.3%) and Candida albicans (8.6%, fungi). Super-elderly patients with BSI had typical features, regardless of the pathogenic species distribution and their drug resistance, or clinical features and their risk factors for poor prognosis. These typical features deserved attention and could be used for the prevention and treatment of BSI among super-elderly patients.

Nutrition and Dietetics Professionals Sustainable Food Systems Knowledge Seeking Behaviour

ABSTRACT Sustainable food system (SFS) competence is a new and recognized knowledge area for nutrition and dietetics professionals (NDP). This research seeks to describe the SFS knowledge seeking behavior of NDP. Secondary data analysis of 231 anonymous self-assessments collected between September 2020 to December 2021 indicate a high proportion (41%) of self-assessed “beginners” in this topic at a mixture of career stages. There was a preference for learning about topics that already have significant public attention globally. More advanced practitioners sought more applied information. These results are informative for updating education and professional development tools for NDP.