Large Region Research Articles

Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection

BackgroundClostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +).MethodsWe used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research.ResultsA total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals.ConclusionsUse of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.

Assessing Potential Evapotranspiration Methods in Future Drought Projections across Canada

abstract Recently, concerns have arisen as to whether temperature-based proxy methods used to estimate potential evapotranspiration (PET) are reliable when examining future drought severity, especially in the context of a warmer climate. The objective of this study was to assess the effect of different PET approaches, focusing on proxies for radiation and humidity, on future Standardized Precipitation Evapotranspiration Index (SPEI) calculations across Canada. Using output from 22 CMIP6 global climate models (GCMs), seasonal and annual SPEI comparisons were carried out between the physically-based Penman-Monteith (PM) method and two approaches that incorporate temperature proxies to calculate radiation and/or humidity. These included the temperature-based Hargreaves (HG) approach and a PM method with derived humidity (PM-m). Results revealed that although the general patterns of SPEI projections across Canada were consistent among the methods, notable spatial and temporal differences were apparent. Specifically, both median and extreme SPEI projections based on the two temperature proxy methods revealed less annual and summer drying in much of central, eastern, and northern regions of Canada when compared to the physically based SPEI-PM. In extreme western regions (British Columbia, Yukon) these two methods, particularly HG, projected drier conditions. Differences of using temperature derived radiation and humidity were also most apparent in spring (and to a lesser degree, autumn), where the HG approach overestimated spring drying (and autumn wetting) over large regions of the country. Overall, differences tended to be more pronounced for the fully temperature-based HG approach during all periods considered. Results from this study strongly suggest that when possible, a physically-based approach be used when estimating PET to assess future drought projections. If a temperature proxy is used, the differences to a physically-based method should be understood and resultant implications be evaluated.

Cost-effectiveness of endovascular therapy for acute stroke with a large ischemic region in Japan: impact of the Alberta Stroke Program Early CT Score on cost-effectiveness

BackgroundAlthough randomized clinical trials (RCTs) demonstrated short-term benefits of endovascular therapy (EVT) for acute ischemic stroke (AIS) with a large ischemic region, little is known about the long-term cost-effectiveness or...

10220-NI-9 PREDICTION OF AN EFFECT OF ELIMINATING HIGH INTENSITY AREAS ON FLAIR IMAGING AFTER ONE-SHOT BEVACIZUMAB FOR GLIOBLASTOMA

Abstract PURPOSE Bevacizumab (BEV) demonstrates an affect of alleviating high intensity areas (HIA) on FLAIR imaging in glioblastoma, although it shows differences between patients. We investigated prediction factors of alleviating HIA after one-shot BEV. METHODS Twenty patients with glioblastoma enrolled in this study. MRI including arterial spin labeling (ASL) were performed before and after administrating BEV (one-shot at 10 mg/kg). From eliminating volume of HIA on FLAIR between before and after BEV, we assessed the eliminating rates (1-pre-volume/post-volume%). All patients were divided into two groups, either less or more than the mean of the eliminating rate. We compared results of plausible factors before BEV, including HIA volume, enhancing volume on T1WI with contrast media, tumor locations, presence of central necrosis, and CBF T/N on ASL, between two groups. RESULTS The mean of the eliminating rate of HIA volume on FLAIR between before and after BEV was 40.7%. Between two groups less than and more than eliminating rate of 40.7%. only CBF T/N at a large region of interest surrounding entire tumor showed a significant difference, which patients with larger eliminating rate showed smaller CBF T/N. CONCLUSION The results in this study suggested a possibility that CBF T/N on ASL is a predction factor of alleviating HIA after one-shot BEV. CBF T/N on ASL has been reported to correlates to the amount of expression of VEGF. In patients with smaller CBF T/N, the VEGF-neutralizing effect from one-shot BEV is likely to be relatively high.

Genetic basis of ear length in sheep breeds sampled across the region from the Middle East to the Alps.

Ear length in sheep (Ovis aries) shows a wide range of natural variation, from the absence of an outer ear structure (anotia), to small outer ears (microtia), to regular ear length. Up until now, the underlying genetics of this phenotype has been studied in four sheep breeds from China, Jordan and Italy. These studies revealed a broad range of genes significantly associated with ear length, potentially indicating genetic heterogeneity across breeds or geographic regions. In the current study, we performed genome-wide SNP genotyping and haplotype-based mapping, in a population of 340 individuals, to identify loci influencing ear length variation in additional sheep breeds from Slovenia, Croatia, Cyprus and Greece. Additionally, two previously described candidate variants were also genotyped in our mapping population. The mapping model without candidate variant genotypes revealed only one genome-wide significant signal, which was located next to HMX1 on OAR6. This region was previously described as being associated with ear length variation in the Altay and Awassi sheep breeds. The mapping model including the candidate duplication genotype near HMX1 as a fixed effect explained the phenotypic variance on OAR6 and revealed an additional genome-wide significant locus on OAR13 associated with ear length. Our results, combined with published evidence, suggest that a duplication in the evolutionarily conserved region near HMX1 is the major regulator of ear length in sheep breeds descended from a larger region from Central Asia, to the Middle East, Cyprus, Greece and to the Alps. This distribution suggests an ancient origin of the derived allele.

Mesoporous Nickel Sulfide Microsphere Encapsulated in Nitrogen, Sulfur Dual-Doped Carbon with Large Subsurface Region for Enhanced Sodium Storage.

Nickel sulfides are promising anode candidates in sodium ion batteries (SIBs) due to high capacity and abundant reserves. However, their applications are restricted by poor cycling stability and slow reaction kinetics. Thus, mesoporous nickel sulfide microsphere encapsulated in nitrogen, sulfur dual-doped carbon (MNS@NSC) is prepared. The packaged structure and carbon matrix restrain the volume variation together, the N, S dual-doping improves the electronic conductivity and offers extra active sites for sodium storage. Ex-situ X-ray diffraction appeals copper collector adsorbs polysulfide to inhibit the polysulfide accumulation and enhance conductivity. Moreover, the large subsurface attributed to C-S-S-C bonding further boosts pseudocapacitive capacity, conducive to charge transfer. As a result, MNS@NSC delivers a high reversible capacity of 640.2 mAh g-1 after 100 cycles at 0.1 A g-1, an excellent rate capability (569.8 mAh g-1 at 5 A g-1), and a remained capacity of 513.8 mAh g-1 after undergoing 10000 circulations at 10 A g-1. The MNS@NSC|| Na3V2(PO4)3 full cell shows a cycling performance of specific capacity of 230.8 mAh g-1 after 100 cycles at 1 A g-1. This work puts forward a valid strategy of combing structural design and heteroatom doping to synthesize high-performance nickel sulfide materials in SIBs.

Comparative and phylogenetic analysis of Chiloschista (Orchidaceae) species and DNA barcoding investigation based on plastid genomes

BackgroundChiloschista (Orchidaceae, Aeridinae) is an epiphytic leafless orchid that is mainly distributed in tropical or subtropical forest canopies. This rare and threatened orchid lacks molecular resources for phylogenetic and barcoding analysis. Therefore, we sequenced and assembled seven complete plastomes of Chiloschista to analyse the plastome characteristics and phylogenetic relationships and conduct a barcoding investigation.ResultsWe are the first to publish seven Chiloschista plastomes, which possessed the typical quadripartite structure and ranged from 143,233 bp to 145,463 bp in size. The plastomes all contained 120 genes, consisting of 74 protein-coding genes, 38 tRNA genes and eight rRNA genes. The ndh genes were pseudogenes or lost in the genus, and the genes petG and psbF were under positive selection. The seven Chiloschista plastomes displayed stable plastome structures with no large inversions or rearrangements. A total of 14 small inversions (SIs) were identified in the seven Chiloschista plastomes but were all similar within the genus. Six noncoding mutational hotspots (trnNGUU–rpl32 > rpoB–trnCGCA > psbK–psbI > psaC–rps15 > trnEUUC–trnTGGU > accD–psaI) and five coding sequences (ycf1 > rps15 > matK > psbK > ccsA) were selected as potential barcodes based on nucleotide diversity and species discrimination analysis, which suggested that the potential barcode ycf1 was most suitable for species discrimination. A total of 47–56 SSRs and 11–14 long repeats (> 20 bp) were identified in Chiloschista plastomes, and they were mostly located in the large single copy intergenic region. Phylogenetic analysis indicated that Chiloschista was monophyletic. It was clustered with Phalaenopsis and formed the basic clade of the subtribe Aeridinae with a moderate support value. The results also showed that seven Chiloschista species were divided into three major clades with full support.ConclusionThis study was the first to analyse the plastome characteristics of the genus Chiloschista in Orchidaceae, and the results showed that Chiloschista plastomes have conserved plastome structures. Based on the plastome hotspots of nucleotide diversity, several genes and noncoding regions are suitable for phylogenetic and population studies. Chiloschista may provide an ideal system to investigate the dynamics of plastome evolution and DNA barcoding investigation for orchid studies.

Black hole regions containing no trapped surfaces

A simple criterion is given to rule out the existence of closed trapped surfaces in large open regions inside black holes.

A new approach for gridded risk assessment of rainfall-triggered flood and landslide hazards over a large region based on coupled flood-landslide modelling and ensemble simulation

The assessment of rainfall-triggered flood and landslide hazards is crucial in mitigating the potential damages to both human lives and property. In this study, we conducted a gridded risk assessment of flood and landslide hazards in Shaanxi Province, utilizing an ensemble simulation of a coupled model. The ensemble simulation intervals of discharges met the observed discharges well at the four hydrological stations, and the global accuracies of landslide modeled results were mostly greater than 0.9. The flood hazard rating was low in most areas while the landslide hazard rating was high in south. The high integrated vulnerability area was mainly concentrated in the central region. Flood risk was low in almost the entire area, while landslide risk was high in south and low in the central and northern regions. The methods proposed in this study provide a new perspective on regional risk assessment.

Phase diagram of QCD matter with magnetic field: domain-wall Skyrmion chain in chiral soliton lattice

QCD matter in strong magnetic field exhibits a rich phase structure. In the presence of an external magnetic field, the chiral Lagrangian for two flavors is accompanied by the Wess-Zumino-Witten (WZW) term containing an anomalous coupling of the neutral pion π0 to the magnetic field via the chiral anomaly. Due to this term, the ground state is inhomogeneous in the form of either chiral soliton lattice (CSL), an array of solitons in the direction of magnetic field, or domain-wall Skyrmion (DWSk) phase in which Skyrmions supported by π3[SU(2)] ≃ ℤ appear inside the solitons as topological lumps supported by π2(S2) ≃ ℤ in the effective worldvolume theory of the soliton. In this paper, we determine the phase boundary between the CSL and DWSk phases beyond the single-soliton approximation, within the leading order of chiral perturbation theory. To this end, we explore a domain-wall Skyrmion chain in multiple soliton configurations. First, we construct the effective theory of the CSL by the moduli approximation, and obtain the ℂP1 model or O(3) model, gauged by a background electromagnetic gauge field, with two kinds of topological terms coming from the WZW term: one is the topological lump charge in 2+1 dimensional worldvolume and the other is a topological term counting the soliton number. Topological lumps in the 2+1 dimensional worldvolume theory are superconducting rings and their sizes are constrained by the flux quantization condition. The negative energy condition of the lumps yields the phase boundary between the CSL and DWSk phases. We find that a large region inside the CSL is occupied by the DWSk phase, and that the CSL remains metastable in the DWSk phase in the vicinity of the phase boundary.

Characterization of chloroplast genome and phylogenetic analysis of the Elaeagnus hybrid variety E. ‘viridis’ (Elaeagnaceae)

Elaeagnus ‘viridis’, an artificial hybrid of E. macrophylla (♂) Thunb. (1784) × E. pungens (♀) Thunb. (1784), is known for its economic and ecological value. In this study, we sequenced and assembled the whole chloroplast (cp) genome of E. ‘viridis’. The results showed that its cp genome was 152,284 bp long, showing a typical quadripartite structure and containing a large single-copy region (LSC, 82,299 bp), a small single-copy region (SSC, 18,239 bp), and a pair of inverted repeats (IRs, 51,746 bp). The cp genome contains 132 genes, including 86 protein-coding genes (PCGs), 38 tRNA genes, and 8 rRNA genes. Phylogenetic analysis based on 66 common PCGs revealed that E. ‘viridis’ is most closely related to its maternal parent E. pungens. The chloroplast genomic information reported in this study will shed some useful light for further genetic studies in the genus Elaeagnus.

The complete chloroplast genome sequence of Rosa ‘Limoncello’ (Rosales: Rosaceae)

Rosa ‘Limoncello’ finds applications in gardening and landscaping. In this study, we assembled and annotated the complete chloroplast genome of this variety for the first time. The length of its chloroplast genome was 156,493 bp, containing two short inverted repeat regions of 26,052 bp, each separated by a large single-copy region of 85,649 bp and a small single-copy region of 18,740 bp. The chloroplast DNA of R. ‘Limoncello’ consisted of 135 genes, including 90 protein-coding genes, eight ribosomal RNA genes, and 37 transfer RNA genes. On comparing the complete chloroplast sequence of R. ‘Limoncello’ with that of other Rosa species, R. ‘Limoncello’ was found to be closely related to Rosa cymosa. Thus, information on the chloroplast genome sequence of this rose variety can facilitate phylogenetic studies of the genus Rosa.

The complete chloroplast genome of Hordeum marinum ssp. marinum

Hordeum marinum ssp. marinum (Huds.) R. J. Soreng (2003) is a halophyte wild relative of barley and wheat, which exhibits remarkable salt tolerance characteristics. In this study, we presented the first characterization of the complete chloroplast genome of H. marinum ssp. marinum. Our findings reveal that the chloroplast genome of H. marinum ssp. marinum consists of a small single-copy region (SSC: 12,715 bp), a large single-copy region (LSC: 81,130 bp), and a pair of inverted repeat regions (IRs: 21,517 bp), amounting to a total length of 136,989 bp. The chloroplast genome encodes 139 genes, including 91 protein-coding genes, 38 tRNA genes, and ten rRNA genes. By utilizing phylogenetic analysis, we determine the evolutionary position of H. marinum in Triticeae. Our study provides valuable insights into the chloroplast genome of H. marinum ssp. marinum, which may have important implications for the improvement of cereal crops.

Characterization of the chloroplast genome of the marine microalga Tetraselmis marina (Cienkowski) R.E.Norris, Hori & Chihara 1980

Tetraselmis marina (Cienkowski) R.E.Norris, Hori & Chihara 1980, a costal green microalga, is considered as a promising animal feed in aquaculture due to the high content of fatty acids and carotenoid. Furthermore, T. marina plays important roles in bioremediation. In this study, we assembled the complete chloroplast genome of T. marina. Results showed that the full length of the complete chloroplast genome was 96,151 bp, containing a large single-copy region of 62,574 bp, a small single-copy region of 1261 bp, and a pair of inverted repeat regions of 16,158 bp. The GC content of the genome was 36.6%. A total of 125 genes were annotated, including 81 protein coding genes, 38 tRNA genes, and six rRNA genes. Phylogenetic analysis based on 22 chloroplast genomes suggested that T. marina was closely related to Tetraselmis sp. CCMP 881.

The first complete chloroplast genome sequence of Pentaphragma spicatum Merr. (Pentaphragmataceae) and phylogenetic analysis

Pentaphragma spicatum Merr. is an endemic wild edible plant of China belonging to the Pentaphragmataceae family. It is widely consumed by Shangsi County resident in Guangxi Fangchenggang. Initially, Pentaphragma was classified as a genus within the Campanulaceae family, but, later it was treated as part of the Pentaphragmataceae family. However, the chloroplast genome of Pentaphragmataceae has not yet been reported. In this study, we sequenced the first complete chloroplast (cp) genome of P. spicatum from Guangxi, China. The whole genome was 154,229 bp in length, consisting of a pair of inverted repeats (IR each 25,572 bp), a large single-copy region (LSC 84,884 bp), and a small single-copy region (SSC 18,201 bp). The complete genome contained 129 genes, including 87 protein-coding genes, 34 tRNA, and 8 rRNA genes. The overall GC content of the whole genome was 37.71%. Based on a maximum-likelihood phylogenetic analysis, it has been determined that P. spicatum is not phylogenetically related to Campanulaceae and supports the decision to classify it as a separate family, Pentaphragmataceae. The complete chloroplast genome of P. spicatum will help enhance and integrate the existing genome data of Asterales. This will provide insights into the phylogenetic relationship within Campanulaceae.

The complete chloroplast genome of Goodyera yunnanensis Schltr.

The family Orchidaceae is renowned for its extensive diversity. Within this family, the genus Goodyera R. Br. is classified under the subtribe Goodyerinae, comprising approximately 99 species. In this study, a species Goodyera yunnanensis Schltr., its plastid genome was characterized. The plastid genome of G. yunnanensis is 146,197 bp in size and exhibits a typical quadripartite structure with a pair of inverted repeat regions (IRs) of 25,611 bp, a large single-copy region (LSC) of 81,300 bp and a small single-copy region (SSC) of 13,675 bp. A total of 126 genes were identified, containing 80 protein-coding genes, 38 tRNA genes and 8 rRNA genes. The overall GC content is 37.2%, with corresponding values of 43.3%, 34.7% and 29.1% in IR, LSC and SSC regions, respectively. Forty-seven simple sequence repeats (SSRs) are found in G. yunnanensis plastome, and the frequency of mononucleotide repeats is significantly higher than other repeat types. Phylogenetic analysis indicates that Goodyera is resolved into four clades. G. yunnanensis belongs to the monophyletic clade A, and its phylogenetic position can be reasonably supported by morphological and molecular data.

The complete chloroplast genome sequence of Zygophyllum brachypterum (Zygophyllaceae) reveals its distinctive characteristics and evolutionary implication

Zygophyllum brachypterum Karelin & Kirilov belongs to Zygophyllaceae and is mainly distributed in the desert regions of Central Asia, Mongolia, and Northwest China. The species is valuable in exploring the adaptations of Zygophyllaceae plants to salt stress in ecological environments. In this study, we report the complete chloroplast (cp) genome of Z. brachypterum. The entire cp genome was 104590 bp in length, with a large single-copy region (LSC, 79170 bp), a small single-copy region (SSC, 16778 bp), and two inverted repeats (IRa/IRb) of 4321 bp each. A total of 106 genes were detected, among which seven were located in the IRs, and 65, 30, and 4 were protein-coding, tRNA, and rRNA genes, respectively. Notably, eleven genes encoding the subunits of NAD(P)H dehydrogenase complex (NDH) were absent. Phylogenetic analysis indicated that Z. brachypterum belonged to Zygophylloideae (Zygophyllaceae). Furthermore, it was closely related to Z. fabago and Z. kansuense.

Bronze Art, Cultural Norms, and Group Identity: A Group of Late Western Zhou and Early Spring and Autumn He Vessels Analyzed in Their Temporal and Spatial Contexts

A new generation of scholars has called into question the homogeneous nature of Western Zhou culture and the sweeping imposition of this culture over a large region that covers much of present-day China. Our study contributes to this debate by focusing on a coherent group of bronze vessels dated to the end of the Western Zhou and beginning of the Spring and Autumn periods. He (盉) vessels with drum-shaped bodies, bird-like lids, and human-like legs are among the most unique and artistically innovative artifacts of this period. While these unique artifacts have been found in and near the center of the Western Zhou polity, they are not associated with the rituals of the royal house, but rather with those of other aristocratic lineages. We argue that the artistic style of the vessels was part of the culture developed around the royal Zhou house and in areas close to it, although it is not strictly representative of the royal culture of the Western Zhou, being instead associated with minor lineages. A multi-dimensional analysis of this group of vessels, addressing their geographical distribution, location within their archaeological context, and social associations, combined with an analysis of their decorative scheme and the inscriptions cast inside them, enables us to better understand the socio-cultural landscape of this period. Our study suggests that diversity existed not only in remote border areas or among the lower strata of society, but also within the cultural core of the Western Zhou polity and among the highest echelons of the aristocracy. Such processes of diversification are associated with the development of local and regional identities and with the growth of the political independence of aristocratic lineages during the final years of the transition from the Western Zhou to the Spring and Autumn periods. KEYWORDS: homogeneous culture, ritual and identity, bronze art, he vessels, winged animal and human figurines, Western Zhou and Spring and Autumn periods

Mortality and healthcare assessment among patients with chronic disease over 2 years of COVID-19: a population-based study in a large hard-hit Italian region

ObjectivesWe aimed to provide a region-wide comprehensive account of the indirect effects of COVID-19 on patients with chronic disease, in terms of non-COVID-19 mortality, and access to both inpatient and...

The Kelch13 compartment contains highly divergent vesicle trafficking proteins in malaria parasites.

Single amino acid changes in the parasite protein Kelch13 (K13) result in reduced susceptibility of P. falciparum parasites to artemisinin and its derivatives (ART). Recent work indicated that K13 and other proteins co-localising with K13 (K13 compartment proteins) are involved in the endocytic uptake of host cell cytosol (HCCU) and that a reduction in HCCU results in reduced susceptibility to ART. HCCU is critical for parasite survival but is poorly understood, with the K13 compartment proteins among the few proteins so far functionally linked to this process. Here we further defined the composition of the K13 compartment by analysing more hits from a previous BioID, showing that MyoF and MCA2 as well as Kelch13 interaction candidate (KIC) 11 and 12 are found at this site. Functional analyses, tests for ART susceptibility as well as comparisons of structural similarities using AlphaFold2 predictions of these and previously identified proteins showed that vesicle trafficking and endocytosis domains were frequent in proteins involved in resistance or endocytosis (or both), comprising one group of K13 compartment proteins. While this strengthened the link of the K13 compartment to endocytosis, many proteins of this group showed unusual domain combinations and large parasite-specific regions, indicating a high level of taxon-specific adaptation of this process. Another group of K13 compartment proteins did not influence endocytosis or ART susceptibility and lacked detectable vesicle trafficking domains. We here identified the first protein of this group that is important for asexual blood stage development and showed that it likely is involved in invasion. Overall, this work identified novel proteins functioning in endocytosis and at the K13 compartment. Together with comparisons of structural predictions it provides a repertoire of functional domains at the K13 compartment that indicate a high level of adaption of endocytosis in malaria parasites.