Mean Length Research Articles

First Report of Rust Caused by Phakopsora nishidana on Creeping Fig, Ficus pumila, in South Africa.

Phakopsora nishidana has recently been reported as the causal organism of rust on edible fig, Ficus carica in South Africa (SA) (Boshoff et al. 2022). This contradicted reports by Doidge (1927, 1950) and Verwoerd (1929) who listed Cerotelium fici as the causal organism of the disease in SA. Similarities in urediniospore morphology and differing taxonomic interpretations most likely contributed to the use of both pathogen names as the causal agents for fig rust (Boshoff et al. 2022; Padamsee and McKenzie 2024). In January 2023 rust was commonly observed on nursery specimens of creeping fig, Ficus pumila, a popular evergreen and fast-growing garden plant in SA. Ficus pumila is native to southern China, Indochina, and eastern Asia but has been introduced to many countries worldwide (https://powo.science.kew.org/ accessed 20 March 2024). The F. pumila rust isolate collected in Somerset West (34°07'00.70"S, 18°52'41.75"E; Western Cape (WC) province) was identified using the sequenced 5.8S rRNA-ITS2-28S rRNA locus. When used in a BLAST analysis, this F. pumila isolate (GenBank accession number OR835538) shared the best homology with the Vermont P. nishidana isolate (34°24'33.37"S, 19°08'59.24"E) (MZ047090; e-value 0.0, 99.7% identity, 1400/1404 bp) reported on edible fig by Boshoff et al. (2022). Other P. nishidana isolates with excellent homology were KY764080 (e-value 0.0, 99.8% identity, 1012/1014 bp), KY764081 (e-value 0.0, 99% identity, 882/885 bp) and MF580676 (e-value 0.0, 99.3% identity, 981/988 bp). Accessions were used in a phylogenetic study that included four other rust samples collected from F. carica trees in Somerset West, WC (OR835534; 34°03'37.26"S, 18°51'02.18"E), Onrus River, WC (OR835535; 34°24'43.10"S, 19°09'57.99"E), Elgin, WC (OR835536; 34°14'31.37"S, 19°03'05.38"E), and Bloemfontein, Free State province (OR835537; 29°05'05.1"S 26°09'09.5"E). Reference sequences were as described in Boshoff et al. (2022). Despite limited variation, all six South African isolates, including the F. pumila isolate, grouped with the three P. nishidana reference isolates, but separate from the three P. myrtacearum isolates collected from eucalyptus trees (Maier et al. 2016). Uredinia on F. pumila leaves were mostly hypophyllous and surrounded by a halo of brown, necrotic tissue. On the upper leaf surface, the lesions appeared as small, dark leaf spots with infrequent sporulation. Urediniospores were echinulate, mostly obovoid or elliptical and their cell walls pale-yellow to yellowish-brown. The mean width and length of urediniospores were 16.7 x 21.3 µm. No telia were observed. Applying standard rust inoculation and incubation procedures (Boshoff et al. 2022), F. pumila plants inoculated with P. nishidana isolate PREM63073 produced sporulating uredinia on the abaxial surface of leaves. Likewise, inoculation of F. carica cv. Kadota leaves with the F. pumila isolate OR835538 yielded sporulating lesions containing urediniospores typical of P. nishidana, on the lower surface. Based on both the DNA sequence data and controlled infection studies, our study confirmed the host status of F. pumila for P. nishidana. The occurrence of rust on creeping fig plants in nurseries, the evergreen status of the creeper, and thus the potential to harbor the pathogen during winter, are likely to contribute to the spread of fig rust in SA.

Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study

Background The goal was to measure the piriform sinus, epiglottis, and thyroid cartilage in our sample population. Methods This study included 22 adult embalmed cadavers available in the Department of Anatomy. Dimensions were measured using a digital Vernier caliper. Results The mean height of the thyroid laminae was 27 ± 1.4 mm at the right side and 25.5 ± 1.4 mm at the left side. Mean width of the thyroid lamina was 27.1 ± 1.3 mm at the right side and 27.4 ± 0.9 mm at the left side. The mean thickness of thyroid cartilage was found to be 4.4 ± 0.4 mm and 3.9 ± 0.5 mm over the right and left sides. The mean length, width and thickness of the epiglottis were 29.1 ± 0.5 mm, 22.2 ± 0.6 mm and 2.6 ± 0.3 mm correspondingly. The height, width and thickness of the right piriform sinus were 25 ± 0.5 mm, 14.2 ± 0.5 mm and 12.6 ± 0.5 mm, the same parameters were 25.3 ± 1.3 mm, 15.1 ± 0.7 mm and 13.3 ± 0.4 mm for the left side. Conclusions The height and thickness of the thyroid cartilage were greater on the right side than on the left side (p<0.05). It was statistically observed that the width and thickness were greater on the left side than on the right side (p < 0.05). The data about the height, width and thickness of the thyroid cartilage, epiglottis and piriform sinus are essential during the laryngeal and other neck surgeries. They guide in the preoperative positioning, predicting the difficulty of intraoperative exposure and retractor pulling.

Short waits, happy patients and expert care, moving basic musculoskeletal care from the emergency department to a physiotherapist-led diversion pathway.

Patients with musculoskeletal conditions (MSKCs) are highly prevalent in ED. This project explores the impact of the pilot phase of a 'diversion pathway', which directed patients with MSKCs from the ED waiting room to an outpatient clinic led by advanced-scope physiotherapists. A prospective intervention study comparing care outcomes between patients in the 'diversion pathway' with usual ED care. The characteristics of patients considered eligible and non-eligible are described. Between May and December 2022, 1099 patients were diverted. For diverted patients, mean length of stay (LOS) in ED was reduced by 110 (95% confidence interval [CI]: 99-120) min and 4 h rule compliance improved by 19.3% compared to usual ED care. There were fewer patients who 'did not wait' (DNW) with the diversion pathway. The diverted group was young (median age 22 years and 41% paediatric), mostly low urgency, self-referred and arrived by private transport with minor limb trauma. The diversion pathway triage process appropriately identified 182 patients ineligible for diversion. 96.7% of patients reported satisfaction with care received from the diversion pathway. There was no change in ED representation rates for diverted patients. A new pathway resulted in reduced LOS, reduced DNW, high patient satisfaction and more people being discharged within 4 h for diverted patients compared to usual ED care. The pathway increased ED capacity, improved key ED performance metrics and safely expedited care delivery for patients.

Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal: A Post Hoc Subgroup Analysis of the ESC-NOW Randomized Clinical Trial.

The function-based eat, sleep, console (ESC) care approach substantially reduces the proportion of infants who receive pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS). This reduction has led to concerns for increased postnatal opioid exposure in infants who receive pharmacologic treatment. However, the effect of the ESC care approach on hospital outcomes for infants pharmacologically treated for NOWS is currently unknown. To evaluate differences in opioid exposure and total length of hospital stay (LOS) for pharmacologically treated infants managed with the ESC care approach vs usual care with the Finnegan tool. This post hoc subgroup analysis involved infants pharmacologically treated in ESC-NOW, a stepped-wedge cluster randomized clinical trial conducted at 26 US hospitals. Hospitals maintained pretrial practices for pharmacologic treatment, including opioid type, scheduled opioid dosing, and use of adjuvant medications. Infants were born at 36 weeks' gestation or later, had evidence of antenatal opioid exposure, and received opioid treatment for NOWS between September 2020 and March 2022. Data were analyzed from November 2022 to January 2024. Opioid treatment for NOWS and the ESC care approach. For each outcome (total opioid exposure, peak opioid dose, time from birth to initiation of first opioid dose, length of opioid treatment, and LOS), we used generalized linear mixed models to adjust for the stepped-wedge design and maternal and infant characteristics. In the ESC-NOW trial, 463 of 1305 infants were pharmacologically treated (143/603 [23.7%] in the ESC care approach group and 320/702 [45.6%] in the usual care group). Mean total opioid exposure was lower in the ESC care approach group with an absolute difference of 4.1 morphine milligram equivalents per kilogram (MME/kg) (95% CI, 1.3-7.0) when compared with usual care (4.8 MME/kg vs 8.9 MME/kg, respectively; P = .001). Mean time from birth to initiation of pharmacologic treatment was 22.4 hours (95% CI, 7.1-37.7) longer with the ESC care approach vs usual care (75.4 vs 53.0 hours, respectively; P = .002). No significant difference in mean peak opioid dose was observed between groups (ESC care approach, 0.147 MME/kg, vs usual care, 0.126 MME/kg). The mean length of treatment was 6.3 days shorter (95% CI, 3.0-9.6) in the ESC care approach group vs usual care group (11.8 vs 18.1 days, respectively; P < .001), and mean LOS was 6.2 days shorter (95% CI, 3.0-9.4) with the ESC care approach than with usual care (16.7 vs 22.9 days, respectively; P < .001). When compared with usual care, the ESC care approach was associated with less opioid exposure and shorter LOS for infants pharmacologically treated for NOWS. The ESC care approach was not associated with a higher peak opioid dose, although pharmacologic treatment was typically initiated later. ClinicalTrials.gov Identifier: NCT04057820.

First Report of powdery mildew of Quercus guyavifolia (Fagaceae) Caused by Erysiphe quercicola.

Oaks are the most abundant trees in naturally regenerated forests in China, play a crucial role in preventing soil erosion and maintaining ecological stability (Du et al. 2022). Quercus guyavifolia H. Léveillé (Fagaceae family, Subgenus Cerris, section Ilex), is endemic in China, distributed in the southeastern boundary of the Qinghai-Tibet Plateau, with elevations from 2, 000 - 4, 500 m a.s.l. (Denk et al. 2018; Sun et al. 2016). Powdery mildew is a prevalent disease of oaks with up to 60% of foliage infection, which can induce leaf necrosis or deformation and might contribute to oak decline (Marçais and Desprez-Loustau 2014). In September 2023, we found leaves of Q. guyavifolia near Yunnan Baima Snow Mountain covered with white fungal colonies. Diseased Q. guyavifolia plants were transplanted into a greenhouse at Yunnan University for pathogenicity tests. Conidia from diseased plants were blown into twenty healthy Q. guyavifolia seedlings by cold air blower and five non-inoculated healthy seedlings were used as control. The inoculated seedlings developed powdery mildew symptoms within ten days on both sides of the leaves. Trypan blue staining was used to identify the pathogen that infects Q. guyavifolia (Xiao et al. 2017). Microscopic examination revealed abundant conidia and extensive branched hyphae on leaves, similar to the characteristics of powdery mildew fungi. The mean length and width of conidia were 29.06 ± 3.96 × 9.52 ± 1.36 μm (n = 50). We collected fungi (YNBAIMAXS01) and extracted genomic DNA from five diseased plants (from the same location) using the CTAB method. We amplified and sequenced the ITS (Gardes and Bruns, 1993), MS294, and MS447 (two nuclear protein-encoding genes; Feau et al. 2011; GenBank numbers: PP079015, PP083693, PP083694). BLAST analysis revealed 100% identity of above three sequences with the ITS of Erysiphe quercicola isolate DACA010 (GenBank accession MT569439), MS294 of E. quercicola isolate GEM09_11_FRTB1 (GenBank accession KY348509), and MS447 of E. quercicola isolate A1I1.5 (GenBank accession KY466619). Therefore, the isolate YNBAIMAXS01 was identified as E. quercicola based on its morphological and molecular characteristics. Sequences from the above three regions for YNBAIMAXS01 and five Erysiphe species were used to construct a Maximum likelihood (ML) tree. In addition, we constructed a ML tree using only the ITS region of YNBAIMAXS01 and eight Erysiphe species from GenBank to better distinguish E. quercicola from these species. Both trees were constructed using MEGA X with K2 + G as best model. The ML trees confirmed the powdery mildew fungi isolated from Q. guyavifolia is closely related to E. alphitoides. To date, thirty-four powdery mildew species belonging to genus Erysiphe have been found affecting Quercus and nine oak species can be infected by E. quercicola (https://fungi.ars.usda.gov/). To our knowledge, this is the first report of powdery mildew caused by E. quercicola on Q. guyavifolia, thus the development of control strategies and disease management is urgently needed.

Ultrasonographic measurements of the normal adrenal glands in guinea pigs (Cavia Porcellus).

Hyperadrenocorticism is an uncommon but important endocrine disease in guinea pigs, but due to its subtle clinical signs and the limited information in veterinary literature, it can be underdiagnosed or misdiagnosed. Ultrasound of the adrenal glands in patients with suspected hyperadrenocorticism can help in identifying adrenomegaly. The purpose of this prospective study was to identify ultrasonographic adrenal gland dimensions in presumed healthy guinea pigs using the same standardized method described for dogs and cats. A conscious ultrasound scan was conducted on twenty client-owned, presumed healthy guinea pigs, and their adrenal glands were measured. A possible correlation between adrenal dimensions with age, sex, and body weight was investigated. The mean length, cranial and caudal pole thickness for the left and right adrenal glands were, respectively, 12.64±2.11mm and 11.55±1.52mm; 4.83mm±1.03mm and 4.69±1.34mm; 4.8±1.23mm and 4.04±0.75mm. The thickness of the left caudal pole was significantly higher than the right (P=0.02). A significant positive correlation was found between the length of the left adrenal gland and both age (r=0.46; P=.03) and weight (r=0.59; P=.01). Statistical correlation between the thickness of each cranial and caudal pole, with age, sex, or weight, was not found. The dimensions provided could prove a useful tool in the clinical evaluation of guinea pigs with suspected hyperadrenocorticism.

Pulmonary Tuberculosis in the Elderly: Epidemiological, Clinical, and Evolutionary Aspects

Aims: this study aimed to investigate the epidemiological, clinical, and evolutionary aspects of pulmonary tuberculosis in the elderly and to determine the factors associated with death. &#x0D; Study Design:  This was an exhaustive, descriptive, and analytical retrospective study.&#x0D; Place and Duration of Study: Pneumo-phtisiology department of Fann National Teaching Hospital Center over three years, from January 1, 2019, to December 31, 2021.&#x0D; Methodology: This was a study using medical records of patients aged 60 and over hospitalized in the pneumo-phtisiology department. Data were collected on a pre-established from patient medical records entered with Microsoft Excel 2019 software. Data analysis was performed with Statistical Package for Sciences Socials (SPSS) version 18&#x0D; Results: we collected 620 medical records of hospitalized patients aged 60 and over, 69 of whom were diagnosed with pulmonary tuberculosis, standing for a prevalence of 11.12%. The average age was 67.13 [60;85] years, with a sex ratio of 3.92. The 60 to 65 age group was the most represented (n=36 or 52.17%). Smoking and alcoholism were frequent, 82% and 17.4% respectively. A previous history of TB infection was found in 23.19% of cases and TB contagion in 20.3% of cases. An underlying condition was at least observed in 50.72% of patients, dominated by diabetes (29%) and hypertension (23%). Co-infection with HIV-1 and tuberculosis was found in 2 patients (3%). The time to consultation was 75 days [3-180 days]. Symptomatology was polymorphic, dominated by cough (n=65; 94.20%), altered general condition (n=63; 91.30%), sputum (n=58; 84.06%), fever (n=53; 76.81%) and dyspnea (n=47; 68.12%). 46 patients (66.7%) had a BMI &lt; 18.5 kg/m2. Physical signs were dominated by pulmonary condensation (n=52; 75.36%), and a fold of undernutrition was noted in 21.74% of cases. Microbiological evidence was 92.75% and 64 patients (92.75%) were susceptible to rifampin. A rifampin-resistant strain was detected in 5 patients (7.25%) hospitalized in the MDR-TB unit. CRP (75.36%), anemia (68.18%), hyperleukocytosis (47.7%), and hyponatremia (27.54%) were the most frequent biological signs.&#x0D; Alveolar syndrome (n=48 or 70%) and cavitary images (n=34 or 50%) were most frequently found on lung radiography, and for those who benefited from thoracic CT (n=36 or 52.17%), cavitary images were found in 24 cases (66.66%).&#x0D; Pulmonary embolism (n=9 cases, i.e. 40.9%), superinfection (n=4), and excessive hemoptysis (n=3) were the most frequent complications. The mean length of hospital stay was 17 days [3-58 days]. The 2RHZE/4RH protocol was used for 87%. Two patients were placed on a second-line anti-tuberculosis treatment protocol. Treatment was not specified in 7 patients (10.14%). The progression was favorable in 48 patients (69.56% of cases), with a case fatality rate of 30.44%.  Dyspnea, chest pain, anemia, hyperleukocytosis, and hyponatremia were associated with the risk of death.&#x0D; Conclusion: The elderly are particularly exposed to tuberculosis, due to physiological aging of the immune system and co-morbidities. This study highlighted the diagnostic and evolutionary particularities of pulmonary tuberculosis in the elderly, as well as the associated fatal factors.

Non–High-Density Lipoprotein Cholesterol Levels From Childhood to Adulthood and Cardiovascular Disease Events

Elevated non-high-density lipoprotein cholesterol (non-HDL-C; a recommended measure of lipid-related cardiovascular risk) is common in children and increases risk of adult cardiovascular disease (CVD). Whether resolution of elevated childhood non-HDL-C levels by adulthood is associated with reduced risk of clinical CVD events is unknown. To examine the associations of non-HDL-C status between childhood and adulthood with incident CVD events. Individual participant data from 6 prospective cohorts of children (mean age at baseline, 10.7 years) in the US and Finland. Recruitment took place between 1970 and 1996, with a final follow-up in 2019. Child (age 3-19 years) and adult (age 20-40 years) non-HDL-C age- and sex-specific z scores and categories according to clinical guideline-recommended cutoffs for dyslipidemia. Incident fatal and nonfatal CVD events adjudicated by medical records. Over a mean length of follow-up of 8.9 years after age 40 years, 147 CVD events occurred among 5121 participants (60% women; 15% Black). Both childhood and adult non-HDL-C levels were associated with increased risk of CVD events (hazard ratio [HR], 1.42 [95% CI, 1.18-1.70] and HR, 1.50 [95% CI, 1.26-1.78] for a 1-unit increase in z score, respectively), but the association for childhood non-HDL-C was reduced when adjusted for adult levels (HR, 1.12 [95% CI, 0.89-1.41]). A complementary analysis showed that both childhood non-HDL-C levels and the change between childhood and adulthood were independently associated with the outcome, suggesting that from a preventive perspective, both childhood non-HDL-C levels and the change into adulthood are informative. Compared with those whose non-HDL-C levels remained within the guideline-recommended range in childhood and adulthood, participants who had incident non-HDL-C dyslipidemia from childhood to adulthood and those with persistent dyslipidemia had increased risks of CVD events (HR, 2.17 [95% CI, 1.00-4.69] and HR, 5.17 [95% CI, 2.80-9.56], respectively). Individuals who had dyslipidemic non-HDL-C in childhood but whose non-HDL-C levels were within the guideline-recommended range in adulthood did not have a significantly increased risk (HR, 1.13 [95% CI, 0.50-2.56]). Individuals with persistent non-HDL-C dyslipidemia from childhood to adulthood had an increased risk of CVD events, but those in whom dyslipidemic non-HDL-C levels resolve by adulthood have similar risk to individuals who were never dyslipidemic. These findings suggest that interventions to prevent and reduce elevated childhood non-HDL-C levels may help prevent premature CVD.

A CONSTRAINED CONSTRUCTIVE OPTIMIZATION MODEL OF BRANCHING ARTERIOLAR NETWORKS IN RAT SKELETAL MUSCLE.

Blood flow regulation within the microvasculature reflects a complex interaction of regulatory mechanisms and varies spatially and temporally according to conditions such as metabolism, growth, injury, and disease. Understanding the role of microvascular flow distributions across conditions is of interest to investigators spanning multiple disciplines; however, data collection within networks can be labour-intensive and challenging due to limited resolution. To overcome these experimental challenges, computational network models which can accurately simulate vascular behavior are highly beneficial. Constrained Constructive Optimization (CCO) is a commonly used algorithm for vascular simulation, particularly well known for its adaptability towards vascular modelling across tissues. The present work demonstrates an implementation of CCO aimed to simulate a branching arteriolar microvasculature in healthy skeletal muscle, validated against literature including comprehensive rat gluteus maximus vasculature datasets, and reviews a list of user-specified adjustable model parameters to understand how their variability affects the simulated networks. Network geometric properties, including mean element diameters, lengths, and numbers of bifurcations per order, Horton's Law ratios, and fractal dimension, demonstrate good validation once model parameters are adjusted to experimental data. This model successfully demonstrates hemodynamic properties such as Murray's Law and the network Fahraeus effect. Application of centrifugal and Strahler ordering schemes results in divergent descriptions of identical simulated networks. This work introduces a novel CCO-based model focused on generating branching skeletal muscle microvascular arteriolar networks based on adjustable model parameters, thus making it a valuable tool for investigations into skeletal muscle microvascular structure and tissue perfusion.

User Information Sharing and Hospital Website Privacy Policies

Hospital websites frequently use tracking technologies that transfer user information to third parties. It is not known whether hospital websites include privacy policies that disclose relevant details regarding tracking. To determine whether hospital websites have accessible privacy policies and whether those policies contain key information related to third-party tracking. In this cross-sectional content analysis of website privacy policies of a nationally representative sample of nonfederal acute care hospitals, hospital websites were first measured to determine whether they included tracking technologies that transferred user information to third parties. Hospital website privacy policies were then identified using standardized searches. Policies were assessed for length and readability. Policy content was analyzed using a data abstraction form. Tracking measurement and privacy policy retrieval and analysis took place from November 2023 to January 2024. The prevalence of privacy policy characteristics was analyzed using standard descriptive statistics. The primary study outcome was the availability of a website privacy policy. Secondary outcomes were the length and readability of privacy policies and the inclusion of privacy policy content addressing user information collected by the website, potential uses of user information, third-party recipients of user information, and user rights regarding tracking and information collection. Of 100 hospital websites, 96 (96.0%; 95% CI, 90.1%-98.9%) transferred user information to third parties. Privacy policies were found on 71 websites (71.0%; 95% CI, 61.6%-79.4%). Policies were a mean length of 2527 words (95% CI, 2058-2997 words) and were written at a mean grade level of 13.7 (95% CI, 13.4-14.1). Among 71 privacy policies, 69 (97.2%; 95% CI, 91.4%-99.5%) addressed types of user information automatically collected by the website, 70 (98.6%; 95% CI, 93.8%-99.9%) addressed how collected information would be used, 66 (93.0%; 95% CI, 85.3%-97.5%) addressed categories of third-party recipients of user information, and 40 (56.3%; 95% CI, 44.5%-67.7%) named specific third-party companies or services receiving user information. In this cross-sectional study of hospital website privacy policies, a substantial number of hospital websites did not present users with adequate information about the privacy implications of website use, either because they lacked a privacy policy or had a privacy policy that contained limited content about third-party recipients of user information.

Excessive androgen exposure and risk of malignancies: A cohort study.

A link between androgen use and the risk of cancers, especially prostate and breast cancer, has been suggested. The knowledge about a possible association is limited. The study aimed to investigate cancer incidence rates, particularly those related to prostate and breast cancer, in male androgen users and compare them to a control group. We included male androgen users identified through a nationwide anti-doping testing program in Danish fitness centers from 2006 to 2018. We paired each case with 50 male controls of the same age, selected randomly. The cohort was followed from baseline and until 2023. The outcome was the incidence of prostate cancer, breast cancer, or any cancer excluding non-melanoma skin cancer. The study included 1,189 androgen users and 59,450 controls, with a mean age of 27 years at enrolment. During the follow-up period with a mean length of 11 years, 13 androgen users, and 612 controls were diagnosed with cancer. This resulted in an incidence rate ratio of 1.05 (95% CI: 0.55-1.81). None of the androgen users were diagnosed with prostate or breast cancer. Male androgen users did not face an increased short-term risk of cancer, neither overall nor related to prostate or breast cancer. Our study indicates that the absolute risk of malignancies in androgen users is comparable to that in the background population. However, we cannot exclude androgens as a cancer risk factor due to the limited sample size, relatively short follow-up period, and subject age.

Central nervous system medication use around hospitalization.

Central nervous system (CNS) medication use is common among older adults, yet the impact of hospitalizations on use remains unclear. This study details CNS medication use, discontinuations, and user profiles during hospitalization periods. Retrospective cohort study using electronic health records on patients ≥65 years, from three hospitals (2018-2020), and prescribed a CNS medication around hospitalization (90 days prior to 90 days after). Latent class transitions analysis (LCTA) examined profiles of CNS medication class users across four time points (90 days prior, admission, discharge, 90 days after hospitalization). Among 4666 patients (mean age 74.3 ± 9.3 years; 63% female; 70% White; mean length of stay 4.6 ± 5.6 days (median 3.0 [2.0, 6.0]), the most commonly prescribed CNS medications were antidepressants (56%) and opioids (49%). Overall, 74% (n = 3446) of patients were persistent users of a CNS medication across all four time points; 7% (n = 388) had discontinuations during hospitalization, but of these, 64% (216/388) had new starts or restarts within 90 days after hospitalization. LCTA identified three profile groups: (1) low CNS medication users, 54%-60% of patients; (2) mental health medication users, 30%-36%; and (3) acute/chronic pain medication users, 9%-10%. Probability of staying in same group across the four time points was high (0.88-1.00). Transitioning to the low CNS medication use group was highest from admission to discharge (probability of 9% for pain medication users, 5% for mental health medication users). Female gender increased (OR 2.4, 95% CI 1.3-4.3), while chronic kidney disease lowered (OR 0.5, 0.2-0.9) the odds of transitioning to the low CNS medication use profile between admission and discharge. CNS medication use stays consistent around hospitalization, with discontinuation more likely between admission and discharge, especially among pain medication users. Further research on patient outcomes is needed to understand the benefits and harms of hospital deprescribing, particularly for medications requiring gradual tapering.

The Relationship between Mean Length at Maturity and Maximum Length in Coral Reef Fish

This article proposes a mechanism that triggers first maturation and spawning in coral reef (bony) fish, which allows for predicting their length at first maturity. Thus, mean lengths at first maturity (Lm) and the corresponding maximum lengths (Lmax) in 207 populations of 131 species of coral reef fish were assembled and used to test the hypotheses that (a) there is, in coral reef fish, a single value of a size-related parameter acting as a trigger for their maturation and eventual spawning, and (b) that this single value is statistically the same as that published previously for other bony fish. The results, based on the assembled Lm and Lmax data and on estimates of the parameter D, which link the length of fish with the relative surface of their gills, covered 44 families and Lmax values ranging from 1.8 to 181.6 cm and confirmed that the threshold in (a) exists. Also, we assessed (in b) that this threshold value, i.e., LmaxD/LmD = 1.35 (±0.02), is not statistically different from similar estimates for other groups of teleosts, notably semelparous salmonids, cichlids, sturgeons and Chinese and Turkish freshwater and marine fish. One implication is that given ocean warming and deoxygenation, coral reef fish will not only be smaller than they currently are, but also mature and spawn at smaller sizes, and thus produce fewer, smaller eggs.

Temperature-related increase in growth rate in four freshwater lake fish species.

Growth is one of the most direct and common ways fish respond to climate change, as fish growth is intimately linked to the temperature of the environment. Observational studies on the effect of shifts in temperature on fish growth are scarce for freshwater fish, and particularly lacking for lake populations. Here, changes in growth rate of bream (Abramis brama), perch (Perca fluviatilis), pikeperch (Sander lucioperca), and roach (Rutilus rutilus) over three decades were studied and compared with changes in temperature in the two largest lakes of western Europe: Lake IJsselmeer and Lake Markermeer in the Netherlands. In the autumnal survey catches of bream, perch, and roach, the mean length of YOY increased significantly between 1992 and 2021 in both lakes, but for YOY pikeperch, no temporal changes were found. In a length-stratified dataset of age groups of bream, roach, and perch, the relationship between length and age differed significantly between time periods. In the more recent time periods, indications for higher growth rates across multiple ages were found. Temperature during the growth season increased in the same decades and showed significant correlations with the YOY mean length, for bream, perch, and roach in both lakes, and for pikeperch in Lake Markermeer. These results point toward consistent temperature-induced increases in growth over the age groups for bream, roach, and perch. These increases were found despite the simultaneous process of de-eutrophication in this water system and its potential negative effect on food production. For pikeperch, it is hypothesized that the absence of temporal increase in YOY growth rate is related to its necessary switch to piscivory and subsequent food limitation; the lower thermal range of its main prey smelt, Osmerus eperlanus, is hypothesized to have inhibited food availability for YOY pikeperch and its opportunity to achieve higher growth rates.

Target strength measurements of yellowfin tuna (Thunnus albacares) and acoustic discrimination of three tropical tuna species

Abstract Tropical tuna fisheries support some of the largest artisanal and industrial fisheries worldwide. Approximately 37% of the tropical tuna catch by industrial purse seiners is obtained from tuna associated with drifting fish aggregating devices (DFADs), where three tuna species coexist: skipjack (Katsuwonus pelamis), bigeye (Thunnus obesus), and yellowfin tuna (Thunnus albacares), with stocks subject to different health status. Purse seine fishers heavily rely on acoustic technology to detect and assess the quantity of tuna at DFADs. Yet, accurately distinguishing between species using solely acoustic methods is limited by insufficient knowledge about each species' acoustic response across frequencies. This study was carried out on six swimbladdered individuals belonging to two sets with mean lengths of 51.9 ± 9.5 and 52.9 ± 2 cm. It focuses on the frequency response obtained from ex situ measurements of yellowfin tuna recorded at 38, 70, 120, and 200 kHz, which revealed a flat response across frequencies, with b20 values of −72.4 ± 9, −73.2 ± 8, -72.3 ± 8, and −72.3 ± 9 dB, respectively. These results, contrast with previous findings on bigeye and skipjack, demonstrating the discrimination potential of acoustics in these three species. To harness this potential, a discrimination algorithm was developed.

Closed incision negative pressure therapy use as a strategy to reduce sternal wound infection in identified high-risk patients: A multicentre propensity-matched study.

The premise of this retrospective study was to evaluate the intraoperative use of closed incision negative pressure therapy (ciNPT) to help reduce the incidence of postoperative sternal wound infections (SWI) in multimorbid patients with an elevated risk of developing an SWI post cardiac surgery versus a cohort that received standard of care dressings. Data of all adult patients were collected from each cardiothoracic surgery units across three hospitals in the United Kingdom. High-risk patients had two or more recognised risk factors. Fisher's exact test (two-tailed) and unpaired t-test helped analyse categorical and continuous data. Propensity matching was performed to compare the two groups. A total of 5,288 patients who had cardiac surgery were included. Propensity matching led to 766 matched cases. There were significantly fewer sternal wound infections in the ciNPT group (43 [5.6%] versus 119 [15.5%] cases; p = 0.0001), as well as fewer deep sternal wound infections (14 [1.8%] versus 31 [4.0%] cases; p = 0.0149) and superficial sternal wound infections (29 [3.8%] versus 88 [11.4%] cases; p = 0.0001). A higher mean length of stay in the ciNPT group was statistically significant (11.23±13 versus 9.66±10 days; p = 0.0083) as well as a significantly higher mean logistic EuroSCORE (11.143±13 versus 8.094±11; p = 0.0001). A statistically significant higher readmission to intensive care due to sternal wound infection was noted for the Control (16 [2.08%] versus 3 [0.39%] readmissions; p = 0.0042). ciNPT appears to be an effective intervention to help reduce the incidence of sternal wound infection in high-risk individuals undergoing cardiac surgery.

Reliability of the picture description task of the Western Aphasia Battery – revised in Laurentian French persons without brain injury

Objective: Limited normative data (including psychometric properties) are currently available on discourse tasks in non-dominant languages such as Laurentian (Quebec) French. The lack of linguistic and cultural adaptation has been identified as a barrier to discourse assessment. The main aim of this study is to document inter-rater and test-retest reliability properties of the picnic scene of the Western Aphasia Battery – Revised (WAB-R), including the cultural adaptation of an information content unit (ICU) list, and provide a normative reference for persons without brain injury (PWBI). Method: To do so, we also aimed to adapt an ICU checklist culturally and linguistically for Laurentian French speakers. Discourse samples were collected from 66 PWBI using the picture description task of the WAB-R. The ICU list was first adapted into Laurentian French. Then, ICUs and thematic units (TUs) were extracted manually, and microstructural variables were extracted using CLAN. Inter-rater reliability and test-retest reliability were determined. Results: Excellent inter-rater reliability was obtained for ICUs and TUs, as well as for all microstructural variables, except for mean length of utterance, which was found to be good. Conversely, test-retest reliability ranged from poor to moderate for all variables. Conclusion: The present study provides a validated ICU checklist for clinicians and researchers working with Laurentian French speakers when assessing discourse with the picnic scene of the WAB-R. It also addresses the gap in available psychometric data regarding inter-rater and test-retest reliability in PWBI.

Utility of intracranial pressure monitoring as a diagnostic tool in pediatric ventriculomegaly

ObjectiveIntracranial pressure (ICP) monitoring is commonly utilized for identifying pathologic ICP in cases of traumatic brain injury; however, its utility in hydrocephalic children has not been elucidated. Although patients with typical (pressure-active) hydrocephalus present with clear signs and/or symptoms and the need for cerebrospinal fluid (CSF) diversion is often clear, others may have arrested or pressure-compensated hydrocephalus with pathologic ICP elevation masked by ambiguous signs or are completely asymptomatic. Without treatment these pathologic ICP elevations may affect neurologic development or crescendo over time leading to neurological decline. The purpose of this study is to investigate the utility of ICP monitoring as a diagnostic tool in this relatively common patient population and identify ventriculomegaly patients with and without pathologic ICP, thus improving accuracy of identifying those with and without surgical needs. Methods36 patients (≤ 17 years old) underwent 41 inpatient ICP recording sessions between 2016 and 2022 and were retrospectively reviewed. This included patients with a history of severe, nonprogressive ventriculomegaly and normal fundoscopic examinations lacking traditional signs and symptoms concerning for elevated ICP. Nighttime pathological plateau waves were defined as sustained elevations of ICP ≥ 2x baseline for a duration of ≥ 5 minutes. ResultsThe mean age of patients was 5.5 years old (range 0–17 years old). 46.3% of patients had prior endoscopic third ventriculostomy (ETV), 14.6% had prior ventriculoperitoneal shunt (VPS), and 39% were without prior surgical intervention. Roughly half (51.2%) of patients had congenital ventriculomegaly while other patients had ventriculomegaly due to other pathologies such as germinal matrix hemorrhage/intraventricular hemorrhage (GMH/IVH) (29.3%), stroke (4.9%), cerebral infections/meningitis (2.4%), or unknown etiology (12.2%). The average procedure time was 19.1 ± 10.5 minutes, and mean length of stay was 2.8 ± 0.7 days. Pathologic ICP was demonstrated in 12 cases (29.3%), 4 (33.3%) of which were asymptomatic. Pathologic ICP was found in 7 of 19 (36.8%) in the prior ETV group, 1 of 6 (16.7%) in prior shunt group, and 4 of 16 (25%) in the non-surgical group (p = 0.649). Among those with pathologic ICP, 6 (50%) cases received an ETV, 5 (41.7%) cases underwent VPS placement, and 1 (8.3%) case underwent a VPS revision. There were no infectious complications or cases of hemorrhage. 4 patients required repositioning of the ICP monitor due to dislodgement. ConclusionInpatient ICP monitoring is a safe and effective diagnostic tool for evaluating the presence of pathologic ICP in severe, persistent non-progressive ventriculomegaly. The use of ICP monitoring may aid in identifying patients with pressure-compensated hydrocephalus who demonstrate pathologic ICP where surgical intervention may be warranted, while preventing unnecessary CSF diversion in those without pathology.

A Novel Digital Health Platform With Health Coaches to Optimize Surgical Patients: Feasibility Study at a Large Academic Health System.

Pip is a novel digital health platform (DHP) that combines human health coaches (HCs) and technology with patient-facing content. This combination has not been studied in perioperative surgical optimization. This study's aim was to test the feasibility of the Pip platform for deploying perioperative, digital, patient-facing optimization guidelines to elective surgical patients, assisted by an HC, at predefined intervals in the perioperative journey. We conducted an institutional review board-approved, descriptive, prospective feasibility study of patients scheduled for elective surgery and invited to enroll in Pip from 2.5 to 4 weeks preoperatively through 4 weeks postoperatively at an academic medical center between November 22, 2022, and March 27, 2023. Descriptive primary end points were patient-reported outcomes, including patient satisfaction and engagement, and Pip HC evaluations. Secondary end points included mean or median length of stay (LOS), readmission at 7 and 30 days, and emergency department use within 30 days. Secondary end points were compared between patients who received Pip versus patients who did not receive Pip using stabilized inverse probability of treatment weighting. A total of 283 patients were invited, of whom 172 (60.8%) enrolled in Pip. Of these, 80.2% (138/172) patients had ≥1 HC session and proceeded to surgery, and 70.3% (97/138) of the enrolled patients engaged with Pip postoperatively. The mean engagement began 27 days before surgery. Pip demonstrated an 82% weekly engagement rate with HCs. Patients attended an average of 6.7 HC sessions. Of those patients that completed surveys (95/138, 68.8%), high satisfaction scores were recorded (mean 4.8/5; n=95). Patients strongly agreed that HCs helped them throughout the perioperative process (mean 4.97/5; n=33). The average net promoter score was 9.7 out of 10. A total of 268 patients in the non-Pip group and 128 patients in the Pip group had appropriate overlapping distributions of stabilized inverse probability of treatment weighting for the analytic sample. The Pip cohort was associated with LOS reduction when compared to the non-Pip cohort (mean 2.4 vs 3.1 days; median 1.9, IQR 1.0-3.1 vs median 3.0, IQR 1.1-3.9 days; mean ratio 0.76; 95% CI 0.62-0.93; P=.009). The Pip cohort experienced a 49% lower risk of 7-day readmission (relative risk [RR] 0.51, 95% CI 0.11-2.31; P=.38) and a 17% lower risk of 30-day readmission (RR 0.83, 95% CI 0.30-2.31; P=.73), though these did not reach statistical significance. Both cohorts had similar 30-day emergency department returns (RR 1.06, 95% CI 0.56-2.01, P=.85). Pip is a novel mobile DHP combining human HCs and perioperative optimization content that is feasible to engage patients in their perioperative journey and is associated with reduced hospital LOS. Further studies assessing the impact on clinical and patient-reported outcomes from the use of Pip or similar DHPs HC combinations during the perioperative journey are required.

Writing in L2 Greek: Exploring the effect of L2 proficiency and learning context on complexity, accuracy, and fluency

Complexity, accuracy, and fluency (CAF) have been proposed as measures of L2 performance and are fundamental variables of written analysis. Empirical studies have shown how written production is developed across proficiency levels and have highlighted the impact of language learning context (second versus foreign) on such development. Despite research that analyzes L2 written production in relation to L2 proficiency or L2 context, few studies examine both in combination. This study explores the role of proficiency and learning context in the written production of L2 Modern Greek learners. Three hundred twenty-four (N = 324) L2 Modern Greek learners of different proficiency levels (A2 to C1) studying in two different learning contexts (second: Greece versus foreign: Spain) carried out a written task (opinion essay). The results showed that two indices of the length of production (mean length of sentence and clause), one index of subordination (dependent clauses per clause), accuracy, and fluency were good indicators of proficiency level. Also, learning context affected the length of production, sentence complexity, and subordination. While differences were observed between the two settings, no superiority of one context over the other was found. Significant interaction effects between context and proficiency were detected in syntactic complexity (coordination) and fluency.