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Concerns about the impact of plastics pollution on the environment have been growing since the 1970s. Marine debris has reportedly entangled and (or) been ingested by 914 marine species ranging from microinvertebrates to large marine mammals. Shorebirds have a high potential to be exposed to and ingest plastics pollution, as many species migrate long distances and periodically concentrate around shorelines, coastal areas, and estuaries that can have elevated levels of plastics pollution. Currently, little is understood about plastics exposure, frequency of occurrence (FO), and potential impacts relating to shorebirds. In this study, we catalogued and reviewed available studies across the globe that examined plastics pollution in shorebirds. We then quantified relevant traits of species and their environments to explore how shorebirds may be exposed to plastics pollution. Of 1106 samples from 26 shorebird species described within 16 studies that examined plastic ingestion, 53% of individuals contained some form of plastics pollution. Overall, Haematopodidae (oystercatchers) had the highest FO of plastics, followed by Recurvirostridae (avocets), Scolopacidae (sandpipers, phalaropes, godwits, and curlews), and Charadriidae (plovers). Plastics FO was much greater among species that migrated across marine areas (either oceanic or coastal) than those species that used continental flyways. Species that foraged at sea, on mudflats, or on beaches had higher average FO of plastic ingestion than species that foraged in upland or freshwater environments. Finally, species that used a sweeping foraging mode showed higher levels of ingested plastics and contained a far greater number of plastic pieces than all other techniques. These conclusions are based on a limited number of species and samples, with the distribution of samples skewed taxonomically and geographically. Using the combined knowledge of known shorebirds-plastics interactions and shorebird ecology, we present a hierarchical approach to identifying shorebirds that may be more vulnerable and susceptible to plastic ingestion. We provide recommendations on sampling protocols and future areas of research. Key words: plastic, pollution, marine litter, waders, shorebirds Les preoccupations en matiere d'impact de la pollution plastique sur l'environnement se sont accrues depuis les annees 1970. Les debris marins auraient entrave ou ete ingeres par 914 especes marines allant des micro-invertebres aux grands mammiferes marins. Les oiseaux de rivage sont tres susceptibles d'etre exposes a la pollution plastique et de lingerer, car de nombreuses especes migrent sur de longues distances et se concentrent periodiquement autour des rivages, des zones cotieres et des estuaires qui peuvent presenter des niveaux eleves de pollution plastique. A l'heure actuelle, on connait peu de choses sur l'exposition aux plastiques, la frequence et les impacts potentiels sur les oiseaux de rivage. Dans cette etude, les auteurs ont catalogue et synthetise les etudes disponibles a travers le monde qui se sont penchees sur la pollution plastique chez les oiseaux de rivage. Ils ont ensuite quantifie les caracteristiques pertinentes des especes et de leurs environnements afin d'explorer comment les oiseaux de rivage peuvent etre exposes a la pollution plastique. Sur 1106 echantillons provenant de 26 especes d'oiseaux de rivage decrites dans 16 etudes qui ont examine l'ingestion de plastiques, 53 % des individus comportaient une certaine forme de pollution plastique. Dans l'ensemble, les Haematopodidae (huitriers) presentaient la frequence d'occurrence (FO) la plus elevee de plastiques, suivis des Recurvirostridae (avocettes), des Scolopacidae (becasseaux, phalaropes, barges, courlis) et des Charadriidae (pluviers). La FO de plastiques etait beaucoup plus importante chez les especes qui migraient a travers les zones marines (oceaniques ou cotieres) que chez les especes qui utilisaient les voies de migration continentales. Les especes qui se nourrissaient en mer, dans les vasieres ou sur les plages presentaient une FO moyenne d'ingestion de plastiques plus elevee que les especes qui se nourrissaient dans les environnements de hautes terres ou d'eau douce. Enfin, les especes qui utilisaient un mode de recherche de nourriture par balayage presentaient des niveaux plus eleves d'ingestion de plastiques et contenaient un nombre beaucoup plus important de morceaux de plastique que celles qui utilisaient toutes les autres techniques. Ces conclusions sont basees sur un nombre limite d'especes et d'echantillons, la distribution des echantillons etant biaisee sur le plan taxonomique et geographique. En utilisant les connaissances combinees des interactions connues entre les oiseaux de rivage et les plastiques et de l'ecologie des oiseaux de rivage, les auteurs presentent une approche hierarchique pour identifier les oiseaux de rivage qui pourraient etre plus vulnerables et susceptibles d'ingerer des plastiques. Ils formulent des recommandations sur les protocoles d'echantillonnage et les futurs domaines de recherche. [Traduit par la Redaction] Mots-cles : plastique, pollution, dechets marins, echassiers, oiseaux de rivage, Introduction Concerns about the impact of plastics pollution on the environment have been growing since the 1970s. Initially, plastics pollution was thought to be primarily distributed around heavily populated areas; [...]

The Arctic Council working group, the Conservation of Arctic Flora and Fauna (CAFF) established the Circumpolar Biodiversity Monitoring Programme (CBMP), an international network of scientists, governments, Indigenous organizations, and conservation groups working to harmonize and integrate efforts to extend and develop monitoring and assessment of the Arctic's biodiversity. Its relevance stretches beyond the Arctic to a broad range of regional and global initiatives and agreements. This paper describes the process and approach taken in the last two decades to develop and implement the CBMP. It documents challenges encountered, lessons learnt, and solutions, and considers how it has been a model for national, regional, and global monitoring programmes; explores how it has impacted Arctic biodiversity monitoring, assessment, and policy and concludes with observations on key issues and next steps. The following are overarching prerequisites identified in the implementation of the CBMP: effective coordination, sufficient and sustained funding, improved standards and protocols, co-production of knowledge and equitable involvement of IK approaches, data management to facilitating regional analysis and comparisons, communication and outreach to raising awareness and engagement in the programme, ensuring resources to engage in international fora to ensuring programme implementation. [ABSTRACT FROM AUTHOR]

This article examines the opportunities and challenges within academic labor of operating an off-campus space using the STEAM Factory as a case study. The STEAM Factory supports research collaborations across all disciplines and engages in community outreach that shares research outcomes and seeks to understand impact in a local context. Third-space labor makes the STEAM Factory model possible and drives collaboration, especially with community partners. The STEAM Factory has a membership made up of faculty, postdoctoral scholars, and staff supported by a program director, a faculty director, and a member-elected board of directors. As an organization, STEAM has been a detailed archiver of its own history, providing a public report annually. To better understand the perspective of STEAM Factory members, and the nature of mentorship and workplace collaborations, the membership was surveyed on three different occasions: January 2018, January 2020, and January 2021. Surveys were followed up with structured interviews that addressed the rationale for collaboration among faculty. During the interviews, we found that for those conducting community research, the space and staff support has been integral not only to their ability to engage in community research but also their enthusiasm for community engagement. Through a discussion of the organizational history of the STEAM Factory, in combination with insights from membership feedback, this paper recognizes the role of third space labor, workers whose labor blends academic and support roles, in support of third places, places to gather that are not-home and not-work. [ABSTRACT FROM AUTHOR]

The article from the American Journal of Veterinary Research discusses Texas A&M University's Veterinary Education, Research, & Outreach team's innovative strategies to study bovine respiratory disease (BRD). By comparing microbial samples with the host transcriptome, the team gains detailed insights into cattle respiratory systems, identifying factors affecting susceptibility. The research aims to develop new strategies, including vaccines, to prevent, detect, and treat BRD, which is a significant issue in North American cattle feedlots, costing the industry around $1 billion annually. The team collaborates with other institutions to improve animal welfare and the livelihoods of those in the industry. [Extracted from the article]

Introduction Medical institutions are using barrier enclosure devices during intubation procedures and other aerosol-generating medical procedures without evidence of their effectiveness or usability, potentially compromising patient care, and provider safety. Our objective was to determine the degree of protection offered by these devices and explore other usability factors for two popular barrier systems. Methods A simulated trial comparing an intubation box, a frame and plastic tarp system, and unprotected intubation was performed in an academic emergency department. Ten emergency physicians were recruited to participate. Our primary outcome was the degree of contamination from secretions measured by average surface area exposed to phosphorescent material. Secondary outcomes included: laryngoscopy time and time to barrier application, unsuccessful intubation attempts, and usability ratings for each system. Descriptive statistics were reported for all variables of interest and a linear mixed model was used to analyze contamination and laryngoscopy time. Usability was captured through electronic questionnaires using a five-point Likert scale. Results Contamination was more prevalent with the box, compared to the frame and tarp, and no device, however, this did not achieve statistical significance (13.2% versus 8.1% versus 12.2%, P = 0.17). A barrier system delayed intubation when compared to using no system (no system = 24.4 s [95% CI 17.3–27.5], frame = 54.4 s [95% CI 13.8–95.0], box = 33.8 s [95% CI 21.4–46.1], P = 0.02). In assessing usability, 30% of users preferred the use of a box barrier, 40% of users preferred the frame, and 30% would not use either in future intubation. Conclusions Compared to no barrier protection, an intubation box enclosure offers limited additional protection. A frame and tarp system reduces exposure at the expense of visibility and operator comfort. Finally, barrier systems do not appear to have a clinically significant impact on airway management. [ABSTRACT FROM AUTHOR]

Introduction: Barrier enclosure devices were introduced to protect against infectious disease transmission during aerosol generating medical procedures (AGMP). Recent discussion in the medical community has led to new designs and adoption despite limited evidence. A scoping review was conducted to characterize devices being used and their performance.Methods: We conducted a scoping review of formal databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, Scopus), grey literature, and hand-searched relevant journals. Forward and reverse citation searching was completed on included articles. Article/full-text screening and data extraction was performed by two independent reviewers. Studies were categorized by publication type, device category, intended medical use, and outcomes (efficacy - ability to contain particles; efficiency - time to complete AGMP; and usability - user experience).Results: Searches identified 6489 studies and 123 met criteria for inclusion (k = 0.81 title/abstract, k = 0.77 full-text). Most articles were published in 2020 (98%, n = 120) as letters/commentaries (58%, n = 71). Box systems represented 42% (n = 52) of systems described, while plastic sheet systems accounted for 54% (n = 66). The majority were used for airway management (67%, n = 83). Only half of articles described outcome measures (54%, n = 67); 82% (n = 55) reporting efficacy, 39% (n = 26) on usability, and 15% (n = 10) on efficiency. Efficacy of devices in containing aerosols was limited and frequently dependent on use of suction devices.Conclusions: While use of various barrier enclosure devices has become widespread during this pandemic, objective data of efficacy, efficiency, and usability is limited. Further controlled studies are required before adoption into routine clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Computerized clinical decision support systems (CCDSSs) promise improvements in care quality; however, uptake is often suboptimal. We sought to characterize system use, its predictors, and user feedback for the Electronic Asthma Management System (eAMS)-an electronic medical record system-integrated, point-of-care CCDSS for asthma-and applied the GUIDES checklist as a framework to identify areas for improvement.Materials and Methods: The eAMS was tested in a 1-year prospective cohort study across 3 Ontario primary care sites. We recorded system usage by clinicians and patient characteristics through system logs and chart reviews. We created multivariable models to identify predictors of (1) CCDSS opening and (2) creation of a self-management asthma action plan (AAP) (final CCDSS step). Electronic questionnaires captured user feedback.Results: Over 1 year, 490 asthma patients saw 121 clinicians. The CCDSS was opened in 205 of 1033 (19.8%) visits and an AAP created in 121 of 1033 (11.7%) visits. Multivariable predictors of opening the CCDSS and producing an AAP included clinic site, having physician-diagnosed asthma, and presenting with an asthma- or respiratory-related complaint. The system usability scale score was 66.3 ± 16.5 (maximum 100). Reported usage barriers included time and system accessibility.Discussion: The eAMS was used in a minority of asthma patient visits. Varying workflows and cultures across clinics, physician beliefs regarding asthma diagnosis, and relevance of the clinical complaint influenced uptake.Conclusions: Considering our findings in the context of the GUIDES checklist helped to identify improvements to drive uptake and provides lessons relevant to CCDSS design across diseases. [ABSTRACT FROM AUTHOR]

Objectives Care gaps in asthma may be highly prevalent but are poorly characterised. We sought to prospectively measure adherence to key evidence-based adult asthma practices in primary care, and predictors of these behaviours. Design One-year prospective cohort study employing an electronic chart audit. Setting Three family health teams (two academic, one community-based) in Ontario, Canada. Participants 884 patients (72.1% female; 46.0±17.5 years old) (4199 total visits; 4.8±4.8 visits/patient) assigned to 23 physicians (65% female; practising for 10.0±8.6 years). Main outcome measures The primary outcome was the proportion of visits during which practitioners assessed asthma control according to symptom-based criteria. Secondary outcomes included the proportion of: patients who had asthma control assessed at least once; visits during which a controller medication was initiated or escalated; and patients who received a written asthma action plan. Behavioural predictors were established a priori and tested in a multivariable model. Results Primary outcome: Providers assessed asthma control in 4.9% of visits and 15.4% of patients. Factors influencing assessment included clinic site (p=0.019) and presenting symptom, with providers assessing control more often during visits for asthma symptoms (35.0%) or any respiratory symptoms (18.8%) relative to other visits (1.6%) (p<0.01). Secondary outcomes: Providers escalated controller therapy in 3.3% of visits and 15.4% of patients. Factors influencing escalation included clinic site, presenting symptom and prior objective asthma diagnosis. Escalation occurred more frequently during visits for asthma symptoms (21.0%) or any respiratory symptoms (11.9%) relative to other visits (1.5%) (p<0.01) and in patients without a prior objective asthma diagnosis (3.5%) relative to those with (1.3%) (p=0.025). No asthma action plans were delivered. Conclusions Major gaps in evidence-based asthma practice exist in primary care. Targeted knowledge translation interventions are required to address these gaps, and can be tailored by leveraging the identified behavioural predictors. [ABSTRACT FROM AUTHOR]

This essay examines the use of binary juxtapositions within William Shakespeare's most famous tragedy, Hamlet, and how those binaries act as catalysts in the character Hamlet's transformation into an avenger. As Hamlet seeks to preserve his unique identity while being commanded to do something which goes against his conscience, he is presented with three sets of opposing concepts: sanity and madness, one's true self versus one's false, projected self, and play-acting in comparison to real action. Coming to understand each pair of oppositions drives Hamlet further from his original identity and closer to becoming capable of murdering his uncle. In light of the often-misused quote, "To thine own self be true," Shakespeare's Hamlet offers an example of how attempting to change one's true nature in order to please others often comes at a high cost, not only to oneself, but to others as well. Analyzing the playwright's use of the genre of English revenge drama gives the reader an unparalleled comprehension of the nature and loss of selfhood. [ABSTRACT FROM AUTHOR]

Strongyloides stercoralis is a widely distributed parasite that infects 30 to 100 million people worldwide. In the United States strongyloidiasis is recognized as an important infection in immigrants and refugees. Public health and commercial reference laboratories need a simple and reliable method for diagnosis of strongyloidiasis to identify and treat cases and to prevent transmission. The recognized laboratory test of choice for diagnosis of strongyloidiasis is detection of disease specific antibodies, most commonly using a crude parasite extract for detection of IgG antibodies. Recently, a luciferase tagged recombinant protein of S. stercoralis, Ss-NIE-1, has been used in a luciferase immunoprecipitation system (LIPS) to detect IgG and IgG4 specific antibodies. To promote wider adoption of immunoassays for strongyloidiasis, we used the Ss-NIE-1 recombinant antigen without the luciferase tag and developed ELISA and fluorescent bead (Luminex) assays to detect S. stercoralis specific IgG4. We evaluated the assays using well-characterized sera from persons with or without presumed strongyloidiasis. The sensitivity and specificity of Ss-NIE-1 IgG4 ELISA were 95% and 93%, respectively. For the IgG4 Luminex assay, the sensitivity and specificity were 93% and 95%, respectively. Specific IgG4 antibody decreased after treatment in a manner that was similar to the decrease of specific IgG measured in the crude IgG ELISA. The sensitivities of the Ss-NIE-1 IgG4 ELISA and Luminex assays were comparable to the crude IgG ELISA but with improved specificities. However, the Ss-NIE-1 based assays are not dependent on native parasite materials and can be performed using widely available laboratory equipment. In conclusion, these newly developed Ss-NIE-1 based immunoassays can be readily adopted by public health and commercial reference laboratories for routine screening and clinical diagnosis of S. stercoralis infection in refugees and immigrants in the United States. Author Summary: Strongyloidiasis is a neglected tropical disease that affects millions worldwide and needs more attention and better diagnostic methods. Strongyloides stercoralis can undergo an autoinfection cycle and can cause hyperinfection involving the pulmonary and gastrointestinal systems and disseminated infection in other organs. Although endemic areas are mostly developing countries in tropical and subtropical regions with only sporadic transmission in temperate areas, the disease is a threat to developed world populations through immigrants, refugees, travelers, and military personnel. The disease can have catastrophic effects when a patient is immunocompromised or when an infected organ is transplanted into a vulnerable recipient. Due to the threat to public health, the intricate life cycle of S. stercoralis, the need to perform multiple follow-up diagnostics to ensure treatment success, and the necessity to rule out multiple co-endemic parasitic infections, it is imperative to develop new diagnostic assays that are simple and efficient while retaining maximal sensitivity and specificity. In this study, we use a well-known recombinant protein, Ss-NIE-1, to optimize assays using both an ELISA format and a multiplex platform to meet these needs. [ABSTRACT FROM AUTHOR]

US university-based technology transfer has grown exponentially since the passage of the Bayh–Dole Act in 1980. As a result, invention disclosures and technology commercialisation initiatives have significantly increased, creating the need for a standardised, qualitative method of screening proposals that might have commercial potential. Successful academic bioscience technology commercialisation is difficult at best because of early stage bioscience inventions, faulty concepts, long lead times, high risk technologies, and working with physicians and medical researchers who frequently have little or no interest in the commercialisation process. We describe an easy-to-use, standardised, web-based technology assessment instrument that was used to better evaluate bioscience invention disclosures at the University of Kansas School of Medicine Technology Transfer Office. After implementing the new system and eliminating backlogged invention disclosures, staff reported that they migrated from very qualitative discussions taking many months to more quantitative, fact-based evaluations and discussions focusing on commercial value. Consequently, they reported making quicker and improved Go-No-go decisions investing further resources in only those technologies with the highest potential for commercialisation. In addition, they improved inventor satisfaction and strengthened their relationships with physicians, inventors, and researchers.Journal of Commercial Biotechnology (2008) 14, 96–102. doi:10.1057/jcb.2007.38; published online 15 January 2008 [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) is a heritable, multiorgan disease that impacts all tissues that normally express cystic fibrosis transmembrane conductance regulator (CFTR) protein. While the importance of the airway microbiota has long been recognized, the intestinal microbiota has only recently been recognized as an important player in both intestinal and lung health outcomes for persons with CF (pwCF). Here, we summarize current literature related to the gut-lung axis in CF, with a particular focus on three key ideas: (i) mechanisms through which microbes influence the gut-lung axis, (ii) drivers of microbiota alterations, and (iii) the potential for intestinal microbiota remediation. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) patients chronically infected with both Pseudomonas aeruginosa and Staphylococcus aureus have worse health outcomes than patients who are monoinfected with either P. aeruginosa or S. aureus. We showed previously that mucoid strains of P. aeruginosa can coexist with S. aureus in vitro due to the transcriptional downregulation of several toxic exoproducts typically produced by P. aeruginosa, including siderophores, rhamnolipids, and HQNO (2-heptyl-4-hydroxyquinoline N-oxide). Here, we demonstrate that exogenous alginate protects S. aureus from P. aeruginosa in both planktonic and biofilm coculture models under a variety of nutritional conditions. S. aureus protection in the presence of exogenous alginate is due to the transcriptional downregulation of pvdA, a gene required for the production of the iron-scavenging siderophore pyoverdine as well as the downregulation of the PQS (Pseudomonas quinolone signal) (2-heptyl-3,4-dihydroxyquinoline) quorum sensing system. The impact of exogenous alginate is independent of endogenous alginate production. We further demonstrate that coculture of mucoid P. aeruginosa with nonmucoid P. aeruginosa strains can mitigate the killing of S. aureus by the nonmucoid strain of P. aeruginosa, indicating that the mechanism that we describe here may function in vivo in the context of mixed infections. Finally, we investigated a panel of mucoid clinical isolates that retain the ability to kill S. aureus at late time points and show that each strain has a unique expression profile, indicating that mucoid isolates can overcome the S. aureus-protective effects of mucoidy in a strain-specific manner. [ABSTRACT FROM AUTHOR]

CRISPR (clustered regularly interspaced short palindromic repeat)-Cas (CRISPR-associated protein) systems are diverse and found in many archaea and bacteria. These systems have mainly been characterized as adaptive immune systems able to protect against invading mobile genetic elements, including viruses. The first step in this protection is acquisition of spacer sequences from the invader DNA and incorporation of those sequences into the CRISPR array, termed CRISPR adaptation. Progress in understanding the mechanisms and requirements of CRISPR adaptation has largely been accomplished using overexpression of cas genes or plasmid loss assays; little work has focused on endogenous CRISPR-acquired immunity from viral predation. Here, we developed a new biofilm-based assay system to enrich for Pseudomonas aeruginosa strains with new spacer acquisition. We used this assay to demonstrate that P. aeruginosa rapidly acquires spacers protective against DMS3vir, an engineered lytic variant of the Mu-like bacteriophage DMS3, through primed CRISPR adaptation from spacers present in the native CRISPR2 array. We found that for the P. aeruginosa type I-F system, the cas1 gene is required for CRISPR adaptation, recG contributes to (but is not required for) primed CRISPR adaptation, recD is dispensable for primed CRISPR adaptation, and finally, the ability of a putative priming spacer to prime can vary considerably depending on the specific sequences of the spacer. [ABSTRACT FROM AUTHOR]

Previous work from our group indicated an association between the gastrointestinal microbiota of infants with cystic fibrosis (CF) and airway disease in this population. Here we report that stool microbiota of infants with CF demonstrates an altered but largely unchanging within-individual bacterial diversity (alpha diversity) over the first year of life, in contrast to the infants without CF (control cohort), which showed the expected increase in alpha diversity over the first year. The beta diversity, or between-sample diversity, of these two cohorts was significantly different over the first year of life and was statistically significantly associated with airway exacerbations, confirming our earlier findings. Compared with control infants, infants with CF had reduced levels of Bacteroides, a bacterial genus associated with immune modulation, as early as 6 weeks of life, and this significant reduction of Bacteroides spp. in the cohort with CF persisted over the entire first year of life. Only two other genera were significantly different across the first year of life: Roseburia was significantly reduced and Veillonella was significantly increased. Other genera showed differences between the two cohorts but only at selected time points. In vitro studies demonstrated that exposure of the apical face of polarized intestinal cell lines to Bacteroides species supernatants significantly reduced production of interleukin 8 (IL-8), suggesting a mechanism whereby changes in the intestinal microbiota could impact inflammation in CF. This work further establishes an association between gastrointestinal microbiota, inflammation, and airway disease in infants with CF and presents a potential opportunity for therapeutic interventions beginning in early life. [ABSTRACT FROM AUTHOR]

Persons with cystic fibrosis (CF), starting in early life, show intestinal microbiome dysbiosis characterized in part by a decreased relative abundance of the genus Bacteroides. Bacteroides is a major producer of the intestinal short chain fatty acid propionate. We demonstrate here that cystic fibrosis transmembrane conductance regulator-defective (CFTR-/-) Caco-2 intestinal epithelial cells are responsive to the anti-inflammatory effects of propionate. Furthermore, Bacteroides isolates inhibit the IL-1β-induced inflammatory response of CFTR-/- Caco-2 intestinal epithelial cells and do so in a propionate-dependent manner. The introduction of Bacteroides- supplemented stool from infants with cystic fibrosis into the gut of Cftr F508del mice results in higher propionate in the stool as well as the reduction in several systemic pro-inflammatory cytokines. Bacteroides supplementation also reduced the fecal relative abundance of Escherichia coli , indicating a potential interaction between these two microbes, consistent with previous clinical studies. For a Bacteroides propionate mutant in the mouse model, pro-inflammatory cytokine KC is higher in the airway and serum compared with the wild-type (WT) strain, with no significant difference in the absolute abundance of these two strains. Taken together, our data indicate the potential multiple roles of Bacteroides -derived propionate in the modulation of systemic and airway inflammation and mediating the intestinal ecology of infants and children with CF. The roles of Bacteroides and the propionate it produces may help explain the observed gut-lung axis in CF and could guide the development of probiotics to mitigate systemic and airway inflammation for persons with CF.IMPORTANCEThe composition of the gut microbiome in persons with CF is correlated with lung health outcomes, a phenomenon referred to as the gut-lung axis. Here, we demonstrate that the intestinal microbe Bacteroides decreases inflammation through the production of the short-chain fatty acid propionate. Supplementing the levels of Bacteroides in an animal model of CF is associated with reduced systemic inflammation and reduction in the relative abundance of the opportunistically pathogenic group Escherichia / Shigella in the gut. Taken together, these data demonstrate a key role for Bacteroides and microbially produced propionate in modulating inflammation, gut microbial ecology, and the gut-lung axis in cystic fibrosis. These data support the role of Bacteroides as a potential probiotic in CF., Competing Interests: We have filed and have been issued a patent relevant to this work: U.S. Provisional Application No. 16/979,824, filed 28 March 2018, issued 27 June 2022: Altering the Intestinal Microbiome In Cystic Fibrosis; inventors: J. C. Madan and G. A. O'Toole.

The healthy human infant gut microbiome undergoes stereotypical changes in taxonomic composition between birth and maturation to an adult-like stable state. During this time, extensive communication between microbiota and the host immune system contributes to health status later in life. Although there are many reported associations between microbiota compositional alterations and disease in adults, less is known about how microbiome development is altered in pediatric diseases. One pediatric disease linked to altered gut microbiota composition is cystic fibrosis (CF), a multi-organ genetic disease involving impaired chloride secretion across epithelia and heightened inflammation both in the gut and at other body sites. Here, we use shotgun metagenomics to profile the strain-level composition and developmental dynamics of the infant fecal microbiota from several CF and non-CF longitudinal cohorts spanning from birth to greater than 36 months of life. We identify a set of keystone species whose prevalence and abundance reproducibly define microbiota development in early life in non-CF infants, but are missing or decreased in relative abundance in infants with CF. The consequences of these CF-specific differences in gut microbiota composition and dynamics are a delayed pattern of microbiota maturation, persistent entrenchment in a transitional developmental phase, and subsequent failure to attain an adult-like stable microbiota. We also detect the increased relative abundance of oral-derived bacteria and higher levels of fungi in CF, features that are associated with decreased gut bacterial density in inflammatory bowel diseases. Our results define key differences in the gut microbiota during ontogeny in CF and suggest the potential for directed therapies to overcome developmental delays in microbiota maturation.

Currently, no dressings are utilized after removal of polyps during a colonoscopy rendering these tissue sites susceptible to bleeding, sepsis, and perfusion. We report the design specifications, synthesis, and ex vivo evaluation of in situ polymerized hydrogels as colon wound dressings post polypectomy. The hydrogels exhibited varied properties to include moduli between 100 and 16 000 Pa, dissolution times between 4 h to 7 days or longer, swelling up to 200%, and adhesion to colon tissue from 0.1 to 0.4 N/cm 2 . The hydrogels displayed minimal cytotoxicity, prevented the migration/spread of bacteria, and exhibited rapid gelation, a requirement for application to the lumen of the colon via an endoscope. This work highlights the structure-property relationship of hydrogels prepared from N -hydroxysuccinimide functionalized PEG cross-linkers and hyperbranched polyethylenimines or 4-arm PEG-NH 2 star polymers, and their potential as colon wound dressings.

Objective: Computerized clinical decision support systems (CCDSSs) promise improvements in care quality; however, uptake is often suboptimal. We sought to characterize system use, its predictors, and user feedback for the Electronic Asthma Management System (eAMS)-an electronic medical record system-integrated, point-of-care CCDSS for asthma-and applied the GUIDES checklist as a framework to identify areas for improvement., Materials and Methods: The eAMS was tested in a 1-year prospective cohort study across 3 Ontario primary care sites. We recorded system usage by clinicians and patient characteristics through system logs and chart reviews. We created multivariable models to identify predictors of (1) CCDSS opening and (2) creation of a self-management asthma action plan (AAP) (final CCDSS step). Electronic questionnaires captured user feedback., Results: Over 1 year, 490 asthma patients saw 121 clinicians. The CCDSS was opened in 205 of 1033 (19.8%) visits and an AAP created in 121 of 1033 (11.7%) visits. Multivariable predictors of opening the CCDSS and producing an AAP included clinic site, having physician-diagnosed asthma, and presenting with an asthma- or respiratory-related complaint. The system usability scale score was 66.3 ± 16.5 (maximum 100). Reported usage barriers included time and system accessibility., Discussion: The eAMS was used in a minority of asthma patient visits. Varying workflows and cultures across clinics, physician beliefs regarding asthma diagnosis, and relevance of the clinical complaint influenced uptake., Conclusions: Considering our findings in the context of the GUIDES checklist helped to identify improvements to drive uptake and provides lessons relevant to CCDSS design across diseases., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Enacted in 2000, the Canadian Personal Health Information Protection and Electronics Documents Act is an important piece of legislation aimed at safeguarding an individual's right to control their personal health information. Since this time, the world of data and analytics has shifted in terms of our potential to collect, integrate, and analyze both structured and unstructured data. The implications for these data advancements are endless for our healthcare system; however, challenges influenced by our approach to collecting, accessing, and analyzing data as well as patient consent to share personal health information mean public entities lag behind commercial players in harnessing these potential benefits. While there are examples of data analytics application successes, Canadian healthcare continues to lag behind other countries and commercial sectors. We are at a pivot point for system improvements requiring a collective approach to collection, storage, linkage, and application of personal healthcare data. In the chasm of this rests how we address patient consent. All health leaders can play a central role in advancing our application of data for system improvements. Strategies to support health leaders in achieving this potential are outlined in this article.

A high prevalence of suboptimal asthma control is attributable to known evidence-practice gaps. We developed a computerised clinical decision support system (the Electronic Asthma Management System (eAMS)) to address major care gaps and sought to measure its impact on care in adults with asthma.This was a 2-year interrupted time-series study of usual care (year 1) versus eAMS (year 2) at three Canadian primary care sites. We included asthma patients aged ≥16 years receiving an asthma medication within the last 12 months. The eAMS consisted of a touch tablet patient questionnaire completed in the waiting room, with real-time data processing producing electronic medical record-integrated clinician decision support.Action plan delivery (primary outcome) improved from zero out of 412 (0%) to 79 out of 443 (17.8%) eligible patients (absolute increase 0.18 (95% CI 0.14-0.22)). Time-series analysis indicated a 30.5% increase in physician visits with action plan delivery with the intervention (p<0.0001). Assessment of asthma control level increased from 173 out of 3497 (4.9%) to 849 out of 3062 (27.7%) eligible visits (adjusted OR 8.62 (95% CI 5.14-12.45)). Clinicians escalated controller therapy in 108 out of 3422 (3.2%) baseline visits versus 126 out of 3240 (3.9%) intervention visits (p=0.12). At baseline, a short-acting β-agonist alone was added in 62 visits and a controller added in 54 visits; with the intervention, this occurred in 33 and 229 visits, respectively (p<0.001).The eAMS improved asthma quality of care in real-world primary care settings. Strategies to further increase clinician uptake and a randomised controlled trial to assess impact on patient outcomes are now required., Competing Interests: Conflict of interest: S. Gupta has nothing to disclose. Conflict of interest: C. Price has nothing to disclose. Conflict of interest: G. Agarwal has nothing to disclose. Conflict of interest: D. Chan has nothing to disclose. Conflict of interest: S. Goel has nothing to disclose. Conflict of interest: L-P. Boulet reports grants from AstraZeneca, Boston Scientific, GlaxoSmithKline, Hoffman La Roche, Novartis, Ono Pharma, Sanofi and Takeda, support for research projects from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck and Takeda, consultancy and advisory board work for AstraZeneca, Novartis and Methapharm, grants for production of educational materials from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck Frosst and Novartis, conference fees from AstraZeneca, GlaxoSmithKline, Merck and Novartis, support for participation in conferences and meetings from Novartis and Takeda; is past president and member of the Canadian Thoracic Society Respiratory Guidelines Committee; chair of the board of directors of the Global Initiative for Asthma (GINA); chair of GINA guidelines dissemination and implementation committee; Laval University chair on knowledge transfer, prevention and education in respiratory and cardiovascular health; member of scientific committees for the American College of Chest Physicians, American Thoracic Society, European Respiratory Society and the World Allergy Organization; First Vice-President of the global asthma organisation “Interasma”. Conflict of interest: A.G. Kaplan has nothing to disclose. Conflict of interest: G. Lebovic has nothing to disclose. Conflict of interest: M. Mamdani reports advisory board work for NovoNordisk, Allergan and Neurocrine, and has lectured at an educational event for Amgen, outside the submitted work. Conflict of interest: S.E. Straus has nothing to disclose., (Copyright ©ERS 2019.)