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A prior randomized controlled trial (RCT) showed no significant difference in wrong-patient errors between clinicians assigned to a restricted electronic health record (EHR) configuration (limiting to 1 record open at a time) versus an unrestricted EHR configuration (allowing up to 4 records open concurrently). However, it is unknown whether an unrestricted EHR configuration is more efficient. This substudy of the RCT compared clinician efficiency between EHR configurations using objective measures. All clinicians who logged onto the EHR during the substudy period were included. The primary outcome measure of efficiency was total active minutes per day. Counts were extracted from audit log data, and mixed-effects negative binomial regression was performed to determine differences between randomized groups. Incidence rate ratios (IRRs) were calculated with 95% confidence intervals (CIs). Among a total of 2556 clinicians, there was no significant difference between unrestricted and restricted groups in total active minutes per day (115.1 vs 113.3 min, respectively; IRR, 0.99; 95% CI, 0.93–1.06), overall or by clinician type and practice area. [ABSTRACT FROM AUTHOR]

Background Many regions have experienced successive epidemic waves of coronavirus disease 2019 (COVID-19) since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with heterogeneous differences in mortality. Elucidating factors differentially associated with mortality between epidemic waves may inform clinical and public health strategies. Methods We examined clinical and demographic data among patients admitted with COVID-19 during the first (March–August 2020) and second (August 2020–March 2021) epidemic waves at an academic medical center in New York City. Results Hospitalized patients (n = 4631) had lower overall and 30-day in-hospital mortality, defined as death or discharge to hospice, during the second wave (14% and 11%) than the first (22% and 21%). The wave 2 in-hospital mortality decrease persisted after adjusting for several potential confounders. Adjusting for the volume of COVID-19 admissions, a measure of health system strain, accounted for the mortality difference between waves. Several demographic and clinical patient factors were associated with an increased risk of mortality independent of wave: SARS-CoV-2 cycle threshold, do-not-intubate status, oxygen requirement, and intensive care unit admission. Conclusions This work suggests that the increased in-hospital mortality rates observed during the first epidemic wave were partly due to strain on hospital resources. Preparations for future epidemics should prioritize evidence-based patient risks, treatment paradigms, and approaches to augment hospital capacity. [ABSTRACT FROM AUTHOR]

Background Most antibiotics are prescribed in the ambulatory setting with estimates that up to 50% of use is inappropriate. Understanding factors associated with antibiotic misuse is essential to advancing better stewardship in this setting. We sought to assess the frequency of unnecessary antibiotic use for upper respiratory infections (URIs) among primary care providers and identify patient and provider characteristics associated with misuse. Methods Unnecessary antibiotic prescribing was assessed in a descriptive study by using adults ≥18 years seen for common URIs in a large, Upper Midwest, integrated health system, electronic medical records from June 2017 through May 2018. Individual provider rates of unnecessary prescribing were compared for primary care providers practicing in the departments of internal medicine, family medicine, or urgent care. Patient and provider characteristics associated with unnecessary prescribing were identified with a logistic regression model. Results A total of 49 463 patient encounters were included. Overall, antibiotics were prescribed unnecessarily for 42.2% (95% confidence interval [CI], 41.7–42.6) of the encounters. Patients with acute bronchitis received unnecessary antibiotics most frequently (74.2%; 95% CI, 73.4–75.0). Males and older patients were more likely to have an unnecessary antibiotic prescription. Provider characteristics associated with higher rates of unnecessary prescribing included being in a rural practice, having more years in practice, and being in higher volume practices such as an urgent care setting. Fifteen percent of providers accounted for half of all unnecessary antibiotic prescriptions. Conclusions Although higher-volume practices, a rural setting, or longer time in practice were predictors, unnecessary prescribing was common among all providers. [ABSTRACT FROM AUTHOR]

Illegal hunting is a major threat to the elephants of Africa, with more elephants killed by poachers than die from natural causes. DNA from tusks has been used to infer the source populations for confiscated ivory, relying on nuclear genetic markers. However, mitochondrial DNA (mtDNA) sequences can also provide information on the geographic origins of elephants due to female elephant philopatry. Here, we introduce the Loxodonta Localizer (LL; www.loxodontalocalizer.org), an interactive software tool that uses a database of mtDNA sequences compiled from previously published studies to provide information on the potential provenance of confiscated ivory. A 316 bp control region sequence, which can be readily generated from DNA extracted from ivory, is used as a query. The software generates a listing of haplotypes reported among 1917 African elephants in 24 range countries, sorted in order of similarity to the query sequence. The African locations from which haplotype sequences have been previously reported are shown on a map. We demonstrate examples of haplotypes reported from only a single locality or country, examine the utility of the program in identifying elephants from countries with varying degrees of sampling, and analyze batches of confiscated ivory. The LL allows for the source of confiscated ivory to be assessed within days, using widely available molecular methods that do not depend on a particular platform or laboratory. The program enables identification of potential regions or localities from which elephants are being poached, with capacity for rapid identification of populations newly or consistently targeted by poachers. [ABSTRACT FROM AUTHOR]

This article aims to provide a nuanced articulation of the quickly evolving and largely converging legislative approaches to combatting the phenomenon colloquially referred to as 'revenge porn' from a multijurisdictional perspective. Through comparative doctrinal analyses, this article argues that while there has been increased legislative activity aimed at curtailing this image-based scourge of the 21st century, particularly in the United Kingdom, Australia, Canada and New Zealand, a number of outstanding theoretical and operational challenges and complexities nonetheless remain, which necessarily require further research and analysis, given the multifaceted nature of the phenomenon. The article concludes by exploring how recent developments in more developed jurisdictions can inform the reform of existing laws in lesser developed jurisdictions, such as the Commonwealth Caribbean. [ABSTRACT FROM AUTHOR]

Basic helix-loop-helix (bHLH) transcription factors play essential roles in regulating eukaryotic developmental and physiological processes such as neuron generation, myocyte formation, intestinal tissue development, and response to environmental stress. In this study, the diamondback moth, Plutella xylostella (L.) (Lepidoptera: Plutellidae), genome was found to encode 52 bHLH genes. All 52 P. xylostella bHLH (PxbHLH) genes were classified into correspondent bHLH families according to their orthology with bHLHs from fruit fly and other insect species. Among these 52 PxbHLH genes, 19 have been annotated consistently with our classification in GenBank database. The remaining 33 PxbHLH genes are either annotated as general bHLH genes or as hypothetical genes. Therefore, our data provide useful information for updating annotations to PxbHLH genes. P. xylostella has four stem cell leukemia (SCL) genes (one of them has three copies), two Dys genes, two copies of MyoR, Mitf, and Sima genes, and three copies of Sage genes. Further studies may be conducted to elucidate functions of these specific bHLH genes in regulating P. xylostella growth and development. [ABSTRACT FROM AUTHOR]

Despite the development of newer anti-seizure medications over the past 50 years, 30-40% of patients with epilepsy remain refractory to treatment. One explanation for this lack of progress is that the current screening process is largely biased towards transmembrane channels and receptors, and ignores intracellular proteins and enzymes that might serve as efficacious molecular targets. Here, we report the development of a novel drug screening platform that harnesses the power of zebrafish genetics and combines it with in vivo bioenergetics screening assays to uncover therapeutic agents that improve mitochondrial health in diseased animals. By screening commercially available chemical libraries of approved drugs, for which the molecular targets and pathways are well characterized, we were able to reverse-identify the proteins targeted by efficacious compounds and confirm the physiological roles that they play by utilizing other pharmacological ligands. Indeed, using an 870-compound screen in kcna1-morpholino epileptic zebrafish larvae, we uncovered vorinostat (Zolinza™; suberanilohydroxamic acid, SAHA) as a potent anti-seizure agent. We further demonstrated that vorinostat decreased average daily seizures by ∼60% in epileptic Kcna1-null mice using video-EEG recordings. Given that vorinostat is a broad histone deacetylase (HDAC) inhibitor, we then delineated a specific subset of HDACs, namely HDACs 1 and 3, as potential drug targets for future screening. In summary, we have developed a novel phenotypic, metabolism-based experimental therapeutics platform that can be used to identify new molecular targets for future drug discovery in epilepsy. [ABSTRACT FROM AUTHOR]

SSc is clinically and pathogenetically heterogeneous. Consensus standards for trial design and outcome measures are needed. International experts experienced in SSc clinical trial design and a researcher experienced in systematic literature review screened the PubMed and Cochrane Central Register of Controlled Trials in order to develop points to consider when planning a clinical trial for muscle involvement in SSc. The experts conclude that SSc-associated muscle involvement is heterogeneous and lacks a universally accepted gold-standard for measuring therapeutic response. Although outcome studies are currently limited by the inability to clearly distinguish active, reversible muscle inflammation from irreversible muscle damage and extramuscular organ involvement, strong consideration should be given to enrolling patients with a myopathy that features several elements of likely reversibility such as muscle weakness, biopsy-proven active inflammation, an MRI indicating muscle inflammation and a baseline serum creatinine kinase above three times the upper limit of normal to prevent floor effect. Randomized controlled trials are preferred, with a duration of at least 24 weeks. Outcome measures should include a combination of elements that are likely to be reversible, such as muscle weakness, biopsy-proven active inflammation, creatinine kinase/aldolase and a quality of life questionnaire. The individual measurements might require a short pre-study for further validation. A biological sample repository is recommended. [ABSTRACT FROM AUTHOR]

Review on the potential contribution of myeloid‐derived cells to prostate cancer, mechanisms for myeloid cell recruitment, and emerging myeloid‐cell targeted therapies in the clinic. Prostate cancer is the second most common cause of cancer mortality in men in the United States. As is the case for other tumor types, accumulating evidence suggests an important role for myeloid‐derived cells in the promotion and progression of prostate cancer. Here, we briefly describe myeloid‐derived cells that interact with tumor cells and what is known about their immune suppressive function. We next discuss new evidence for tumor cell–mediated myeloid infiltration via the PI3K/PTEN/AKT signaling pathway and an alternative mechanism for immune evasion that may be regulated by an endoplasmic reticulum stress response. Finally, we discuss several interventions that target myeloid‐derived cells to treat prostate cancer. [ABSTRACT FROM AUTHOR]

Aims: Biotic homogenization results in novel communities containing multiple exotic species. Many attributes that contribute to the dominance of invaders and increase invasibility of communities have been identified, but rarely have factors governing the dominance of co-occurring invaders been considered. Here we assess the presence and performance of five exotic and one native C4 grass species across local (microsite) and more broad-scale variation in fire history, soil age, altitude and precipitation. We ask whether species show preferences for the same conditions, whether all are constrained by poor soil development, and how their performance changes when alone versus co-occurring. In addition to providing information useful to managers who want to control some of these species, such information can help to predict how distributions might change with climate change. Methods: We measured percent cover and plant height of each grass species in 64 plots in each of 15 sites, located in young volcanic substrates across environmental gradients in Hawai'i Volcanoes National Park, Hawai'i, USA. Sites varied in fire history and soil age, across altitudinal and precipitation gradients. We estimated microsite heterogeneity by measuring rock cover and soil depth, where each species was present and in plots as a whole. We analyzed effects of possible controlling variables using chi-square tests and Generalized Additive Mixed Models. Important Findings: Two species (Schizachyrium condensatum and Hyparrhenia rufa) were absent in shallow soil, restricted to more mesic sites and showed increasing performance with soil depth. By contrast, two other species (Andropogon virginicus and Melinis repens) tended to occur in shallow soil with high rock cover across a wide range of sites. One additional species (Melinis minutiflora) was weakly affected by soil depth and was the dominant at higher elevation (more mesic) and on burned sites, especially in old soil. This species was largely absent from lower elevation sites, where the more widespread and opportunistic congener, M. repens, and a drought tolerant native grass, Heteropogon contortus, were more abundant. The latter was confined to this low hot zone. Introduced C4 grasses in this region of Hawai'i are distributed according to an interaction between soil requirements, climate (correlated with elevation), competitive ability and fire response. No one strategy can explain the distributions, which will likely persist unless climate changes toward warmer and drier conditions or new fires occur. The latter would promote dominance of M. minutiflora in more mesic sites, while the former would promote either native (H. contortus) or other exotic grasses (M. repens, A. virginicus). [ABSTRACT FROM AUTHOR]

Exotic plants can alter habitat composition and reduce the diversity of pollinators by competing with native species for resources. In a forest fragment surrounded by coffee crops, Coffea arabica L. (Rubiaceae), in southeastern Brazil, the life history of the oil-collecting bee Tetrapedia diversipes Klug (Apidae) was studied. Besides providing data on the phenology, nesting biology, and natural enemies of this bee species, we aimed to investigate if the intense mass flowering of coffee trees would attract T. diversipes specimens rather than native plants in bloom. As T. diversipes females nest in preexisting cavities, we displayed in the study site two types of trapnests: bamboo canes and 5.8- by 0.6-cm black cardboard tubes. The trap-nests were inspected once a month from June 2011 to May 2013 and 494 nests were collected. Tetrapedia diversipes is a multivoltine species. Prepupal diapause occurred in nests collected at the end of the hot and wet season and during the cold and dry season. Nests were attacked by 14 species of natural enemies, and the most abundant species were the cuckoo bee Coelioxoides waltheriae Ducke (Apidae); the bee fly Anthrax oedipus F. (Bombyliidae); and the beetle Nemognatha cf. plaumanni Borchmann (Meloidae). Despite the mass flowering of coffee trees, pollen grains of C. arabica were not found in the pollen analysis. Our study reveals that even in the presence of an abundant source of floral resources of exotic origin, the studied population of T. diversipes preferred to use the native plant species to obtain the necessary resources for their survival. [ABSTRACT FROM AUTHOR]

Objectives The objective of this narrative review was to examine recent evidence and, when necessary, past evidence on the association between pain and suicidality. Design Fifty-eight research reports were found on this topic, which had not previously been reviewed. These reports were divided into groups by whether they addressed suicide ideation ( SI), suicide attempts ( SAs), or suicide completion ( SC), and what population they represented (acute pain patients [ APPs], chronic pain patients [ CPPs], other than APPs/ CPPs) and whether they controlled for relevant confounders. Information as to whether the results of these studies supported/did not support the association of pain and suicidality was abstracted. For each group of studies (above), a vote counting method was utilized to determine the overall percentage of studies supporting/not supporting the association of pain and suicidality. According to this percentage, the consistency of the data supporting this association was rated according to Agency for Healthcare Research and Quality guidelines. Results The following groups of studies received an A consistency rating (consistent evidence from multiple studies): SI, SA, and SC for other than APPs/ CPPs; and SI, SA, and SC for CPP prevalence greater than an appropriate control group. Also, a subgroup of the SI, SA, and SC studies for other than APPs/ CPPs had controlled for behavioral issues (potential confounders). These three subgroups also received an A consistency rating. The 58 studies also identified a number of new predictor variables for SI, SA, and SC in CPPs. Conclusions These studies solidify the evidence for an association between pain and SI, SA, and SC in both CPPs and other than APPs/ CPPs. [ABSTRACT FROM AUTHOR]

The lichen genus Solenopsora occurs predominantly in temperate and subtropical regions of the world, and the centre of diversity and distribution is in the Mediterranean, Macaronesian, and Madrean floristic regions. Taxonomic treatment of several taxa has varied over time and the concepts lack clarity. Focusing on multilocus sequence data, morphology, anatomy, chemistry, and ecological preferences, the present study investigates European Solenopsora taxa to obtain the first insights into their genetic variation and relationships. Our results show discrepancy between the number of currently recognized taxa in Europe and the number of genetic entities identified. We recognize eight species in the genus in Europe: Solenopsora candicans, Solenopsora cesatii (including Solenopsora carpatica), Solenopsora grisea, Solenopsora holophaea, Solenopsora liparina, Solenopsora marina, Solenopsora olivacea, and Solenopsora vulturiensis. We gathered evidence to recognize S. liparina, an edaphic vicariant of S. candicans confined to ultramafic rocks, as a separate species. We disclosed a previously unknown sister relationship between S. grisea and S. vulturiensis. Taxonomic synopses, geographical distribution, and an identification key for the treated taxa are provided. Phylogenetic analyses revealed two major lineages among the European Solenopsora spp., differentiated by thallus organization, the presence/absence of rhizines on lower side of the thallus, secondary chemistry, and anatomy of upper cortex. The generic circumscription and phylogenetic position, however, appear problematic and additional studies with increased sampling including related genera are needed. © 2014 The Linnean Society of London, Botanical Journal of the Linnean Society, 2014, 176, 203-223. [ABSTRACT FROM AUTHOR]

In many parts of Europe, close-to-nature silviculture (CNS) has been widely advocated as being the best approach for managing forests to cope with future climate change. In this review, we identify and evaluate six principles for enhancing the adaptive capacity of European temperate forests in a changing climate: (1) increase tree species richness, (2) increase structural diversity, (3) maintain and increase genetic variation within tree species, (4) increase resistance of individual trees to biotic and abiotic stress, (5) replace high-risk stands and (6) keep average growing stocks low. We use these principles to examine how three CNS systems (single-tree selection, group selection and shelterwood) serve adaptation strategies. Many attributes of CNS can increase the adaptive capacity of European temperate forests to a changing climate. CNS promotes structural diversity and tree resistance to stressors, and growing stocks can be kept at low levels. However, some deficiencies exist in relation to the adaptation principles of increasing tree species richness, maintaining and increasing genetic variation, and replacing high-risk stands. To address these shortcomings, CNS should make increased use of a range of regeneration methods, in order to promote light-demanding tree species, non-native species and non-local provenances. [ABSTRACT FROM PUBLISHER]

Abstract: Some researchers have found that day-of-injury alcohol intoxication is associated with worse outcome following traumatic brain injury (TBI). The purpose of this study is to examine the effects of day-of-injury intoxication on the acute neuropsychological outcome from TBI. Participants were 36 patients with TBI (18 sober, 18 intoxicated) matched on injury severity characteristics and demographic variables. A larger group of 146 patients (112 sober, 36 intoxicated) with TBI was also selected for analyses; not matched on injury severity or demographic variables. Patients had no history of pre-injury alcoholism and were assessed within 10 days post-injury on 13 cognitive measures. Unexpectedly, patients who were sober at the time of injury performed lower on many of the cognitive measures compared to those who were intoxicated. In contrast to the research literature, these results suggest that individuals who were intoxicated at the time of injury performed similarly, and in some cases, better than those who were sober at the time of injury. [Copyright &y& Elsevier]

Radionuclides in the environment are one of the major concerns to human health and ecotoxicology. The explosion at the Chernobyl nuclear power plant renewed interest in the role played by fungi in mediating radionuclide movement in ecosystems. As a result of these studies, our knowledge of the importance of fungi, especially in their mycorrhizal habit, in long-term accumulation of radionuclides, transfer up the food chain and regulation of accumulation by their host plants was increased. Micro-fungi have been found to be highly resilient to exposure to ionizing radiation, with fungi having been isolated from within and around the Chernobyl plant. Radioresistance of some fungal species has been linked to the presence of melanin, which has been shown to have emerging properties of acting as an energy transporter for metabolism and has been implicated in enhancing hyphal growth and directed growth of sensitized hyphae towards sources of radiation. Using this recently acquired knowledge, we may be in a better position to suggest the use of fungi in bioremediation of radioactively contaminated sites and cleanup of industrial effluent. [ABSTRACT FROM AUTHOR]

In this AIDS Commentary, Dr. Catherine Wilfert addresses the issue of vertical transmission of the human immunodeficiency virus type 1 (HIV-1). She reviews the results of the recently completed trial conducted by the AIDS Clinical Trials Group that evaluated the effectiveness of administering zidovudine to pregnant women in reducing the incidence of vertical transmission. In view of the success of this trial, Dr. Wilfert addresses the problem of the efficacy of voluntary counseling and testing of pregnant women. Identification and treatment of HIV-1 infected women could potentially reduce the incidence of pediatric HIV-1 infection and increase the number of women receiving appropriate therapy. She makes the point that legislative mandates have been necessary to produce rates of childhood immunization that are effective in reducing the occurrence of vaccine-preventable diseases. This suggests that such mandates are an option to consider in the effort to control vertical transmission of HIV-1 infection. Her cost-benefit analysis indicates that universal screening of pregnant women for HIV infection would result in enormous overall savings for the health care system. Obviously, making the testing of pregnant women mandatory raises a number of difficult issues and is controversial. Dr. Wilfert has provided a service by raising this issue; further discussion is needed. [ABSTRACT FROM PUBLISHER]