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Psychological distress has been repeatedly quantified over the course of the pandemic, however this has not always included broader healthcare workers, and has mostly focused on prevalence and occupational factors. This study investigated intolerance of uncertainty (IOU), fear of contamination and perceived social support as key predictors of psychological distress in healthcare professionals, between the 10

Variation among host-associated microbiomes is well documented across species, populations, and individuals. Understanding relationships between host-genetic and microbial variation is important for predicting coevolutionary dynamics between hosts and their microbiota and is also biomedically relevant to understanding why some humans are more susceptible to chronic disorders like Inflammatory Bowel Diseases (IBD). Unfortunately, the relative contributions of host genetics and the environment to microbiome variation have been difficult to study. Human research shows that genetic variation influences microbiome differences but confounding environmental effects cannot be controlled experimentally. Isogenic laboratory models can be used in controlled environments but often focus on large-effect mutations and do not recapitulate genetic variation observed in nature. Thus, although important factors impacting the microbiome have been identified, few studies have tested for the direct influence of natural host-genetic variation on microbiome differences within a controlled environment. To address this, we performed a common garden experiment using laboratory lines of genetically divergent populations of threespine stickleback fish - an outbred model organism commonly used for determining the genetic basis of complex traits in the context of natural genetic variation. Using germ-free derivation of divergent lines and hybrids between them in this experimental framework, we detected a clear, positive association between stickleback genetic dissimilarity and microbiome dissimilarity. With RAD-seq data we identified regions of the genome that contributed most significantly to this relationship. Importantly, we also highlight that heritable morphological traits like body size -when correlated with microbiome composition - need consideration in future host-associated microbiome studies.

Discussion of patient expectations for recovery is a component of intensive care unit (ICU) follow-up clinics. However, few studies have formally evaluated recovery-related expectations of ICU survivors.To estimate the prevalence of unmet expectations for recovery six months after hospital discharge among adult survivors of acute respiratory failure (ARF).Prospective, longitudinal, cohort study of ARF survivors discharged to home from five U.S. medical centers. Expectations for functional recovery were assessed by asking which activities and instrumental activities of daily living (I/ADLs) survivors expected to perform independently at six months. Survivors' expectations for overall health status were assessed using a visual analogue scale (VAS) ranging from 0 - 100. At 6-month follow-up, participants reported which I/ADLs they could perform independently and rated their overall health status using a 100-point VAS. We defined a participant's Functional Expectations as being met if they reported independently performing I/ADLs as expected at hospital discharge. Health Expectations were considered to be met when self-rated health status at six months was no more than eight points lower than expected at enrollment.Among 180 enrollees, 169 (94%) were alive and 160 of these (95%) participated in 6-month follow-up. Functional Expectations were met for 71% of participating survivors, and overall Health Expectations were met for 50%. Expectations for functional independence were high, ranging from 87% (housekeeping) to 99% (using a telephone). General health expectations were variable (median = 85, Interquartile range [IQR] = 75, 95). At 6-month follow-up, self-rated, overall health ranged from 2 to 100 (median = 80, IQR = 60, 85). In exploratory analyses, participants with met vs unmet expectations differed most in formal education (Functional Expectations standardized difference d = 0.88, Health Expectations d = 0.41).ARF survivors' expectations about independent functioning were high and generally met, but half had unmet general health expectations six months after discharge. It is difficult to predict whose health expectations will be unmet, but possessing less formal education may be a risk factor.

108 Background: In 2013 the US Preventative Services Task Force recommended lung cancer screening (LCS) with low-dose CT (LDCT) scans in high-risk populations. Eight VA Medical Centers (VAMC) successfully piloted LCS in a demonstration project and several additional VA sites have since launched LCS programs, including the Salt Lake City VAMC. These systems utilize the “Clinical Reminder System” (CRS) in the electronic medical record to enroll patients into the LCS program which allows LDCTs to be tracked by a nurse coordinator. As these programs are relatively new, improvements and shared knowledge is imperative to optimizing the success of LCS programs. Methods: Our intervention was to change the radiology ordering menu to encourage providers to order LDCTs through the CRS, thus enrolling patients in the LCS program. We examined the percentage of LDCTs performed within the LCS screening program as our process measure. We then chose three outcome measures based on recommendations proposed by a national cancer roundtable: 1) Percentage of Lung-RADS 1 or 2 diagnoses with follow-up within 15 months, 2) Percentage of Lung-RADS 3 diagnoses with follow-up within 8 months and 3) Percentage of Lung-RADS 4 diagnoses with follow-up within 18 weeks. We compared outcome measures between LDCTs performed within the LCS program and those performed outside of the program. Results: We compared a total of 492 LDCTs during a pre-intervention six-month period to the 544 LDCTs performed in the first 6 months after our intervention. Pre-intervention, 54% of LDCTs were performed through the LCS program, compared to 79% post-intervention (p < 0.001). The percentage of Lung-RADS 1 or 2 scans with appropriate follow-up time was significantly better within the LCS program (70%), compared to scans performed outside the program (49%, p < 0.001). There was no statistical difference in follow-up of Lung-RADS 3 or 4 scans. Conclusions: Through this work we learned the CRS is non-intuitive and used with variable comfort within the VAMC. As such, a simple intervention guiding ordering providers from the radiology ordering menu to the CRS was effective in increasing enrollment and adherence to follow up in a VA system LCS program. LCS is complex compared to other cancer screening programs. Many primary care providers and radiologists alike are uncomfortable managing these patients. As such, enrollment in a standardized LCS program and early involvement of a multi-disciplinary team is imperative. Not only did we demonstrate this with our outcome measures, but while examining the system we uncovered many inappropriate follow-up scans, biopsies, and oncology consults that contribute to waste. As lung cancer screening programs continue to evolve, quality improvement projects such as this will help improve lung cancer care and outcomes.

Metastatic cancer has a poor prognosis. Novel pharmacologic targets need to be identified. The receptor for advanced glycation endproducts (RAGE) is a pattern recognition receptor constitutively expressed in the lungs. Absence of overt disease in RAGE null mice suggests that RAGE is unnecessary or redundant in health. We report that RAGE null tumor-bearing mice have reduced lung metastasis and improved survival. Bone marrow chimera studies suggest that hematopoietic cell RAGE is an important contributor to these effects. Deletion of RAGE reduces both the quantity and suppressive activity of tumor-induced MDSC. Protein and mRNA studies suggest that RAGE contributes to the generation and function of MDSC including expression of the alarmins S100A8/A9 and activity of inducible nitric oxide synthase, arginase-1, and NF-κB. These findings demonstrate the important role of RAGE in determining the quantity and function of tumor-associated MDSC and suggest RAGE as a pharmacologic target for patients with metastatic disease.

Purpose of Review This review focuses on the therapeutic management and individualized approach to Group 1 pulmonary arterial hypertension (PAH), utilizing Food and Drug Administration-approved PAH-specific therapies and various interventional and surgical options for PAH. Recent Findings The paradigm for the optimal management of PAH has shifted in recent years. Upfront combination therapy with an endothelin receptor antagonist and a phosphodiesterase 5 inhibitor is now widely accepted as standard of care. In addition, there is increasing emphasis on starting prostanoids early in order to delay time to clinical worsening. However, less is known regarding which prostanoid agent to initiate and the optimum time to do so. In order to facilitate shared decision-making, there is an increasing need for decision tools based on guidelines and collective clinical experiences to navigate between pharmacologic and interventional treatments, as well as explore innovative, therapeutic pathways for PAH. Summary The management of PAH has become increasingly complex. With a growing number of PAH-specific therapies, intimate knowledge of the therapeutics and the potential barriers to adherence are integral to providing optimal care for this high-risk patient population. While current PAH-specific therapies largely mediate their effects through pulmonary vasodilation, ongoing research efforts are focused on ways to disrupt the mechanisms leading to pulmonary vascular remodeling. By targeting aberrations identified in the metabolism and proliferative state of pulmonary vascular cells, novel PAH treatment pathways may be just on the horizon.

Critical illness can be lethal and devastating to survivors. Improvements in acute care have increased the number of intensive care unit (ICU) survivors. These survivors confront a range of new or worsened health states that collectively are commonly denominated post-intensive care syndrome (PICS). These problems include physical, cognitive, psychological, and existential aspects, among others. Burgeoning interest in improving long-term outcomes for ICU survivors has driven an array of potential interventions to improve outcomes associated with PICS. To date, the most promising interventions appear to relate to very early physical rehabilitation. Late interventions within aftercare and recovery clinics have yielded mixed results, although experience in heart failure programs suggests the possibility that very early case management interventions may help improve intermediate-term outcomes, including mortality and hospital readmission. Predictive models have tended to underperform, complicating study design and clinical referral. The complexity of the health states associated with PICS suggests that careful and rigorous evaluation of multidisciplinary, multimodality interventions-tied to the specific conditions of interest-will be required to address these important problems.

Rapeseed is being considered as a potential feedstock for hydrotreated renewable jet (HRJ) fuel in the USA through its cultivation in rotation with wheat. The goal of this research was to determine the impact of soil C changes, induced through replacing the fallow period with rapeseed in rotation with wheat, and the effects it would have on emission of greenhouse gases (GHG) of rapeseed HRJ. The Intergovernmental Panel on Climate Change (IPCC) (Tier 1) method was used with modifications to determine the changes in soil C of wheat–wheat–rapeseed (WWR) relative to the reference wheat–wheat–fallow (WWF) rotation for 20 years of cultivation. The 27 case scenarios were conducted to study the impacts of changes in management practices (tillage practice and residue input) on changes in soil C for WWR rotation in multiple locations in 10 US states. The CO2 emissions resulting from soil C changes were incorporated into the rapeseed HRJ pathway in order to evaluate the GHG emissions. Introducing rapeseed to replace the fallow period with wheat could either increase or decrease changes in soil C, depending on management practices. Soil C is predicted to increase with increased residue input and reduced tillage. The greatest gain of soil C was found when using high residue input for wheat and rapeseed under no tillage, resulting in the best management practice. Conversely, adding low residue input to both crops with full tillage created the highest loss of soil C, referring to as the worst management practice. Soil C changes varied across locations from −0.22 to 0.32 Mg C ha−1 year−1. Consequently, the GHG emissions of rapeseed HRJ ranged from 4 to 70 g CO2 eq./MJ, comparing to 46 g CO2 eq./MJ for excluding soil C change. The rapeseed HRJ exhibited the GHG savings of 65–96 % for the best practice and 20–42 % for the worst practice when compared to petroleum jet fuel. Based on results using the modified IPCC method, adoption of high residue input with no tillage for the rotation cropping of rapeseed with wheat had the potential to increase soil C. However, the method has limitations for predicting soil C changes regarding crop management practices. Biogeochemical-based models that have a potential to capture processes of C and N dynamics in soil and yield may be better suited to quantify regional variations in soil C changes for the rotation cropping of rapeseed with wheat.

Continuous renal replacement therapy (CRRT) is commonly used to support critically ill patients with acute kidney injury or chronic renal disease whose condition is too unstable for them to tolerate intermittent hemodialysis. Current publications related to CRRT programs in the United States and Canada note key themes related to the development and maintenance of CRRT training programs. A successful CRRT training program should consider and incorporate adult learning principles whenever possible. A variety of teaching methods to deliver information to nurses, including online learning modules, didactic lecture, return demonstration, and high-fidelity patient simulation are key to training programs for this high-risk complex therapy. This article outlines the approach to training nurses to care for patients receiving CRRT at a health care system in Arizona.

Hydrotreated Renewable Jet (HRJ) fuel has increasingly become important for the aviation sector to address energy security and climate change mitigation. Rapeseed ( Brassica Napus ) is a favored candidate feedstock for HRJ because of its high quality oil content and agroeconomic benefit to replace the fallow period in wheat/fallow rotations. We conducted research to evaluate regional differences in nitrous oxide (N 2 O) emissions for rapeseed cultivation in several counties in 10 states in the United States (U.S.). The Roundtable on Sustainable Biofuels (RSB) methodology was applied, and results were compared to the Intergovernmental Panel on Climate Change (IPCC) guidelines. In this study, yield, nitrogen fertilizer rate, and types were held constant for all locations in order to understand the similarities and differences in the RSB and IPCC methods for estimating N 2 O emissions. From the results, the RSB-calculated N 2 O emissions varied for different U.S. states, though regional differences were very small, 0.72–0.73 kg N 2 O Mg −1 seed, while N 2 O emissions from IPCC method were the same for all sites, 0.87 kg N 2 O Mg −1 seed. The difference between the RSB and IPCC methods is caused by the indirect N 2 O emissions from ammonia emissions and nitrate leaching. However, the influence of indirect effect is relatively small compared to overall N 2 O emissions. The utilization of the RSB method may not be justified for estimating regional variations in N 2 O emissions. As a consequence, the preliminary greenhouse gas (GHG) of rapeseed HRJ fuel using the RSB method in several locations had small differences in result, 42.7–43.0 g CO 2 eq/MJ compared to 45.9 g CO 2 eq/MJ using the IPCC method.

New, sophisticated tools are being used to advance our knowledge of PAH and facilitate individualised treatment based on phenotypeshttp://ow.ly/qP6h30ocllp

On-column solvent exchange, using many of the principles of solid-phase extraction, has been implemented to significantly reduce evaporation cycle time following reverse-phase preparative HPLC. Additional benefits, such as a reduced potential for salt formation, thermal decomposition, and residual solvent, are also described. Fractions obtained from preparative separations, typically in a large volume of acetonitrile:water, are injected into the preparative HPLC and then eluted in acetonitrile, creating a new fraction in a volatile organic solvent. Minimal modification to the instrument was required, and unattended operation is possible. Acetonitrile evaporation is achieved within 3 h, compared with 17 h for aqueous-based fractions; lower temperatures can be used during the evaporation step; mobile-phase additives, likely to form salts with the target compound if concentrated in the fraction, are removed before evaporation; sample recovery and purity are unaffected.