Search

Objective: Central and obstructive apneas are sources of morbidity and mortality associated with primary patient conditions as well as secondary to medical care such as sedation/analgesia in post-operative patients. This research investigates the predictive value of the respirophasic variation in the noninvasive photoplethysmography (PPG) waveform signal in detecting airway obstruction.Methods: PPG data from 20 consenting healthy adults (12 male, 8 female) undergoing anesthesia were collected directly after surgery and before transfer to the Post Anesthesia Care Unit (PACU). Features of the PPG waveform were calculated and used in a neural network to classify normal and obstructive events.Results: During the postoperative period studied, the neural network classifier yielded an average (+/-standard deviation) 75.4 (+/-3.7)% sensitivity, 91.6 (+/-2.3)% specificity, 84.7 (+/-3.5)% positive predictive value, 85.9 (+/-1.8)% negative predictive value, and an overall accuracy of 85.4 (+/-2.0)%.Conclusions: The accuracy of this method shows promise for use in real-time monitoring situations. [ABSTRACT FROM AUTHOR]

Se is an essential element for animals. In man low dietary Se intakes are associated with health disorders including oxidative stress-related conditions, reduced fertility and immune functions and an increased risk of cancers. Although the reference nutrient intakes for adult females and males in the UK are 60 and 75 microg Se/d respectively, dietary Se intakes in the UK have declined from >60 microg Se/d in the 1970s to 35 microg Se/d in the 1990s, with a concomitant decline in human Se status. This decline in Se intake and status has been attributed primarily to the replacement of milling wheat having high levels of grain Se and grown on high-Se soils in North America with UK-sourced wheat having low levels of grain Se and grown on low-Se soils. An immediate solution to low dietary Se intake and status is to enrich UK-grown food crops using Se fertilisers (agronomic biofortification). Such a strategy has been adopted with success in Finland. It may also be possible to enrich food crops in the longer term by selecting or breeding crop varieties with enhanced Se-accumulation characteristics (genetic biofortification). The present paper will review the potential for biofortification of UK food crops with Se. [ABSTRACT FROM AUTHOR]

Competing Interests: Conflicts of Interest: Dr G. T. Blike has consulting relationships with the I-Pass Institute and the Family Heart Foundation. Consultative activity is related to past expertise as an organizational chief quality officer and is not related to this review. Dr Blike also has an indirect relationship with Masimo involving surveillance analytics support to Dartmouth-Hitchcock Medical Center. Dr S. P. McGrath has a consulting relationship with Masimo. Engagements through that agreement have been related to educational sessions about clinical monitoring and were not focused on specific Masimo products. Dr B. Gali is on a data monitoring committee for Takeda, which is unrelated to this article.

Objectives: To evaluate the efficacy of ChatGPT 4 (GPT-4) in delivering genetic information about BRCA1, HFE, and MLH1, building on previous findings with ChatGPT 3.5 (GPT-3.5). To focus on assessing the utility, limitations, and ethical implications of using ChatGPT in medical settings., Materials and Methods: A structured survey was developed to assess GPT-4's clinical value. An expert panel of genetic counselors and clinical geneticists evaluated GPT-4's responses to these questions. We also performed comparative analysis with GPT-3.5, utilizing descriptive statistics and using Prism 9 for data analysis., Results: The findings indicate improved accuracy in GPT-4 over GPT-3.5 (P < .0001). However, notable errors in accuracy remained. The relevance of responses varied in GPT-4, but was generally favorable, with a mean in the "somewhat agree" range. There was no difference in performance by disease category. The 7-question subset of the Bot Usability Scale (BUS-15) showed no statistically significant difference between the groups but trended lower in the GPT-4 version., Discussion and Conclusion: The study underscores GPT-4's potential role in genetic education, showing notable progress yet facing challenges like outdated information and the necessity of ongoing refinement. Our results, while showing promise, emphasizes the importance of balancing technological innovation with ethical responsibility in healthcare information delivery., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

This study addresses the effect of using animal excreta on the nutritional content of forages, focusing on macro- and micro-element concentrations (nitrogen; N, phosphorus; P, sulphur; S, copper; Cu, zinc; Zn, manganese; Mn, selenium; Se) from animal feed to excreta, soil, and plants. Data were collected from pot and field trials using separate applications of sheep or cattle urine and faeces. Key findings indicate that soil organic carbon (SOC) and the type of excreta significantly influences nutrient uptake by forages, with varied responses among the seven elements defined above. Although urine contributes fewer micronutrients compared to faeces (as applied at a natural volume/mass basis, respectively), it notably improves forage yield and micronutrient accumulation, thus potentially delivering positive consequences at the farm level regarding economic performance and soil fertility when swards upon clayey soil types receive said urine in temperate agro-climatic regions (i.e., South West England in the current context). In contrast, faeces application in isolation hinders Se and Mn uptake, once again potentially delivering unintended consequences such as micronutrient deficiencies in areas of high faeces deposition. As it is unlikely that (b)ovine grazing fields will receive either urine or faeces in isolation, we also explored combined applications of both excreta types which demonstrates synergistic effects on N, Cu, and Zn uptake, with either synergistic or dilution effects being observed for P and S, depending largely on SOC levels. Additionally, interactions between excreta types can result in dilution or antagonistic effects on Mn and Se uptake. Notably, high SOC combined with faeces reduces Mn and Se in forages, raising concerns for grazed ruminant systems under certain biotic situations, e.g., due to insufficient soil Se levels typically observed in UK pastures for livestock growth. These findings underscore the importance of considering SOC and excreta nutritional composition when designing forage management to optimize nutrient uptake. It should be noted that these findings have potential ramifications for broader studies of sustainable agriculture through system-scale analyses, as the granularity of results reported herein elucidate gaps in knowledge which could affect, both positively and negatively, the interpretation of model-based environmental impact assessments of cattle and sheep production (e.g., in the case of increased yields [beneficial] or the requirement of additional synthetic supplementation [detrimental])., (© 2024. The Author(s).)

Enhanced rock weathering (EW) is an emerging atmospheric carbon dioxide removal (CDR) strategy being scaled up by the commercial sector. Here, we combine multiomics analyses of belowground microbiomes, laboratory-based dissolution studies, and incubation investigations of soils from field EW trials to build the case for manipulating iron chelators in soil to increase EW efficiency and lower costs. Microbial siderophores are high-affinity, highly selective iron (Fe) chelators that enhance the uptake of Fe from soil minerals into cells. Applying RNA-seq metatranscriptomics and shotgun metagenomics to soils and basalt grains from EW field trials revealed that microbial communities on basalt grains significantly upregulate siderophore biosynthesis gene expression relative to microbiomes of the surrounding soil. Separate in vitro laboratory incubation studies showed that micromolar solutions of siderophores and high-affinity synthetic chelator (ethylenediamine- N , N '-bis-2-hydroxyphenylacetic acid, EDDHA) accelerate EW to increase CDR rates. Building on these findings, we develop a potential biotechnology pathway for accelerating EW using the synthetic Fe-chelator EDDHA that is commonly used in agronomy to alleviate the Fe deficiency in high pH soils. Incubation of EW field trial soils with potassium-EDDHA solutions increased potential CDR rates by up to 2.5-fold by promoting the abiotic dissolution of basalt and upregulating microbial siderophore production to further accelerate weathering reactions. Moreover, EDDHA may alleviate potential Fe limitation of crops due to rising soil pH with EW over time. Initial cost-benefit analysis suggests potassium-EDDHA could lower EW-CDR costs by up to U.S. $77 t CO 2 ha -1 to improve EW's competitiveness relative to other CDR strategies.

In this Pro-Con commentary article, we discuss use of continuous physiologic monitoring for clinical deterioration, specifically respiratory depression in the postoperative population. The Pro position advocates for 24/7 continuous surveillance monitoring of all patients starting in the postanesthesia care unit until discharge from the hospital. The strongest arguments for universal monitoring relate to inadequate assessment and algorithms for patient risk. We argue that the need for hospitalization in and of itself is a sufficient predictor of an individual's risk for unexpected respiratory deterioration. In addition, general care units carry the added risk that even the most severe respiratory events will not be recognized in a timely fashion, largely due to higher patient to nurse staffing ratios and limited intermittent vital signs assessments (e.g., every 4 hours). Continuous monitoring configured properly using a "surveillance model" can adequately detect patients' respiratory deterioration while minimizing alarm fatigue and the costs of the surveillance systems. The Con position advocates for a mixed approach of time-limited continuous pulse oximetry monitoring for all patients receiving opioids, with additional remote pulse oximetry monitoring for patients identified as having a high risk of respiratory depression. Alarm fatigue, clinical resource limitations, and cost are the strongest arguments for selective monitoring, which is a more targeted approach. The proponents of the con position acknowledge that postoperative respiratory monitoring is certainly indicated for all patients, but not all patients need the same level of monitoring. The analysis and discussion of each point of view describes who, when, where, and how continuous monitoring should be implemented. Consideration of various system-level factors are addressed, including clinical resource availability, alarm design, system costs, patient and staff acceptance, risk-assessment algorithms, and respiratory event detection. Literature is reviewed, findings are described, and recommendations for design of monitoring systems and implementation of monitoring are described for the pro and con positions., Competing Interests: Conflicts of Interest: See Disclosures at the end of the article., (Copyright © 2024 International Anesthesia Research Society.)

Objective: Given the importance AI in genomics and its potential impact on human health, the American Medical Informatics Association-Genomics and Translational Biomedical Informatics (GenTBI) Workgroup developed this assessment of factors that can further enable the clinical application of AI in this space., Process: A list of relevant factors was developed through GenTBI workgroup discussions in multiple in-person and online meetings, along with review of pertinent publications. This list was then summarized and reviewed to achieve consensus among the group members., Conclusions: Substantial informatics research and development are needed to fully realize the clinical potential of such technologies. The development of larger datasets is crucial to emulating the success AI is achieving in other domains. It is important that AI methods do not exacerbate existing socio-economic, racial, and ethnic disparities. Genomic data standards are critical to effectively scale such technologies across institutions. With so much uncertainty, complexity and novelty in genomics and medicine, and with an evolving regulatory environment, the current focus should be on using these technologies in an interface with clinicians that emphasizes the value each brings to clinical decision-making., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Given the importance of soil for the global carbon cycle, it is essential to understand not only how much carbon soil stores but also how long this carbon persists. Previous studies have shown that the amount and age of soil carbon are strongly affected by the interaction of climate, vegetation, and mineralogy. However, these findings are primarily based on studies from temperate regions and from fine-scale studies, leaving large knowledge gaps for soils from understudied regions such as sub-Saharan Africa. In addition, there is a lack of data to validate modeled soil C dynamics at broad scales. Here, we present insights into organic carbon cycling, based on a new broad-scale radiocarbon and mineral dataset for sub-Saharan Africa. We found that in moderately weathered soils in seasonal climate zones with poorly crystalline and reactive clay minerals, organic carbon persists longer on average (topsoil: 201 ± 130 years; subsoil: 645 ± 385 years) than in highly weathered soils in humid regions (topsoil: 140 ± 46 years; subsoil: 454 ± 247 years) with less reactive minerals. Soils in arid climate zones (topsoil: 396 ± 339 years; subsoil: 963 ± 669 years) store organic carbon for periods more similar to those in seasonal climate zones, likely reflecting climatic constraints on weathering, carbon inputs and microbial decomposition. These insights into the timescales of organic carbon persistence in soils of sub-Saharan Africa suggest that a process-oriented grouping of soils based on pedo-climatic conditions may be useful to improve predictions of soil responses to climate change at broader scales., (© 2023 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

Background: Community health centers and patients in rural and agricultural communities struggle to address diabetes and hypertension in the face of health disparities and technology barriers. The stark reality of these digital health disparities were highlighted during the coronavirus disease 2019 pandemic., Objectives: The objective of the ACTIVATE (Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity) project was to codesign a platform for remote patient monitoring and program for chronic illness management that would address these disparities and offer a solution that fit the needs and context of the community., Methods: ACTIVATE was a digital health intervention implemented in three phases: community codesign, feasibility assessment, and a pilot phase. Pre- and postintervention outcomes included regularly collected hemoglobin A1c (A1c) for participants with diabetes and blood pressure for those with hypertension., Results: Participants were adult patients with uncontrolled diabetes and/or hypertension ( n  = 50). Most were White and Hispanic or Latino (84%) with Spanish as a primary language (69%), and the mean age was 55. There was substantial adoption and use of the technology: over 10,000 glucose and blood pressure measures were transmitted using connected remote monitoring devices over a 6-month period. Participants with diabetes achieved a mean reduction in A1c of 3.28 percentage points (standard deviation [SD]: 2.81) at 3 months and 4.19 percentage points (SD: 2.69) at 6 months. The vast majority of patients achieved an A1c in the target range for control (7.0-8.0%). Participants with hypertension achieved reductions in systolic blood pressure of 14.81 mm Hg (SD: 21.40) at 3 months and 13.55 mm Hg (SD: 23.31) at 6 months, with smaller reductions in diastolic blood pressure. The majority of participants also reached target blood pressure (less than 130/80)., Conclusion: The ACTIVATE pilot demonstrated that a codesigned solution for remote patient monitoring and chronic illness management delivered by community health centers can overcome digital divide barriers and show positive health outcomes for rural and agricultural residents., Competing Interests: None declared., (Thieme. All rights reserved.)

Competing Interests: K.M. discloses no conflict of interest. S.P.M. declares a consultative relationship with Masimo, Inc, unrelated to this commentary article. There was no direct support from Masimo, Inc, related to this commentary. G.T.B. declares a consultative relationship with the iPASS Institute and the Family Heart Foundation, unrelated to this work. There was no direct or indirect support from the iPASS Institute or the Family Heart Foundation for this commentary article.

The form (organic versus inorganic) of minerals (Se, Zn, Cu and Mn), supplemented to sheep (Charolais × Suffolk-Mule (mean weight = 57 ± 2.9 kg) at two European industrial doses, on the return of micronutrients to pasture via nutrient partitioning and composition in sheep urine and faeces was investigated. This gave four treatments in total with 6 animals per treatment (n = 24). The form of the supplemented minerals did not influence the excretory partitioning of micronutrients (Se, Zn, Cu and Mn) between urine and faeces, nor on their concentrations in the excreta. The two doses trialed however, may influence the Se flux in the environment through altering the ratios of Se:P and Se:S ratios in the faeces and Se:S ratio in the urine. Administration of the mineral supplements also improved the retention of P in sheep reducing its excretion via urine. Although the concentrations of readily bioavailable micronutrients in the faeces were not affected by the mineral forms, there were differences in the more recalcitrant fractions of Se, Zn and Cu (as inferred via a sequential extraction) in faeces when different forms of supplemental minerals were offered. The potential impact of these differences on micronutrient flux in pasture requires further investigation., (© 2023. The Author(s).)

Background and Aims: The intake of selenium, an essential element for animals and humans, in ruminants is largely determined by selenium concentration in ingested forages, which take up selenium mainly from soil. Ruminant excreta is a common source of organic fertilizer, which provides both nutrients and organic matter. This study aims to unentangle the unclear effect of applying different types of ruminant excreta in soils of different organic matter contents on selenium uptake by forage., Methods: Perennial ryegrass ( Lolium perenne ) was grown in soils of different organic matter contents. Urine and/or feces collected from sheep fed with organic or inorganic mineral supplements, including selenium, were applied to the soils. The selenium in the collected samples were analyzed using ICP-MS. The associated biogeochemical reactions were scrutinized by wet chemistry., Results: The application of urine and/or feces resulted in either the same or lower selenium concentrations in perennial ryegrass. The excreta type did not affect total selenium accumulation in grass grown in low organic matter soil, whereas in high organic matter soil, feces resulted in significantly lower total selenium accumulation than urine, which was attributed to a possible interaction of selenium sorption in soil and microbial reduction of Se., Conclusion: This one-time excreta application did not increase, but further decrease in some treatments, selenium concentration and accumulation in the perennial ryegrass. Consequently, to increase ruminant selenium intake, supplementing selenium directly to animals is more recommended than applying animal manure to soil, which might drive selenium reduction and decrease selenium uptake by grass., Supplementary Information: The online version contains supplementary material available at 10.1007/s11104-023-05898-8., Competing Interests: Competing interestsAlltech Ltd., who provided funding for the lead author (Pei-Tzu Kao)’s PhD, which involves the work included in the current study., (© The Author(s) 2023.)

The use of multispecies swards on livestock farms is growing due to the wide range of benefits they bring, such as improved biomass yield and animal performance. Preferential uptake of micronutrients by some plant species means the inclusion of legumes and forbs in grass-dominated pasture swards could improve micronutrient provision to livestock via careful species selection. However, although soil properties affect plant micronutrient concentrations, it is unknown whether choosing 'best-performing' species, in terms of their micronutrient content, needs to be soil-specific or whether the recommendations can be more generic. To address this question, we carried out an experiment with 15 common grass, forb and legume species grown on four soils for five weeks in a controlled environment. The soils were chosen to have contrasting properties such as texture, organic matter content and micronutrient concentrations. The effect of soil pH was tested on two soils (pH 5.4 and 7.4) chosen to minimise other confounding variables. Yield was significantly affected by soil properties and there was a significant interaction with botanical group but not species within a botanical group (grass, forb or legume). There were differences between botanical groups and between species in both their micronutrient concentrations and total uptake. Micronutrient herbage concentrations often, but not always, reflected soil micronutrient concentrations. There were soil-botanical group interactions for micronutrient concentration and uptake by plants, but the interaction between plant species (within a botanical group) and soil was significant only for forbs, and predominantly occurred when considering micronutrient uptake rather than concentration. Generally, plants had higher yields and micronutrient contents at pH 5.4 than 7.4. Forbs tended to have higher concentrations of micronutrients than other botanical groups and the effect of soil on micronutrient uptake was only significant for forbs., Competing Interests: The authors have declared that no competing interests exist.

Objectives: The primary objective of this study was to develop hospital-level metrics of major complications associated with mortality that allows for the identification of opportunities for improvement. The secondary objective is to improve upon current metrics for failure to rescue (i.e., death from serious but treatable complications.)., Methods: Agency for Healthcare Research and Quality metrics served as the basis for identifying specific complications related to major organ system morbidity associated with death. Complication-specific occurrence rates, observed mortality, and risk-adjusted mortality indices were calculated for the study institution and 182 peer organizations using component International Classification of Disease, Tenth Revision codes. Data were included for adults over a 4-year period, with exclusion of hospice patients and complications present on admission. Temporal visualizations of each metric were used to compare past and recent performance at the study hospital and in comparison to peers., Results: The complication-specific method showed statistically significant differences in the study hospital occurrence rates and associated mortality rates compared with peer institutions. The monthly control-chart presentation of these metrics provides assessment of hospital-level interventions to prevent complications and/or reduce failure to rescue deaths., Conclusions: The method described supplements existing metrics of serious complications that occur during the course of acute hospitalization allowing for enhanced visualization of opportunities to improve care delivery systems. This method leverages existing measure components to minimize reporting burden. Monthly time-series data allow interventions to prevent and/or rescue patients to be rapidly assessed for impact., Competing Interests: K.M.M. and I.M.P. disclose no conflict of interests. S.P.M. declares a relationship with Masimo, Inc, unrelated to this work. There was no direct or indirect support from Masimo, Inc, related to this study. G.T.B. declares a relationship with the I-PASS Institute, unrelated to this work. There was no direct or indirect support from the I-PASS Institute for this study., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Growth at increased concentrations of CO 2 induces a reduction in seed zinc (Zn) and iron (Fe). Using Arabidopsis thaliana, we investigated whether this could be mitigated by reducing the elevated CO 2 -induced decrease in transpiration. We used an infrared imaging-based screen to isolate mutants in At1g08080 that encodes ALPHA CARBONIC ANHYDRASE 7 (ACA7). aca7 mutant alleles display wild-type (WT) responses to abscisic acid (ABA) and light but are compromised in their response to elevated CO 2 . ACA7 is expressed in guard cells. When aca7 mutants are grown at 1000 ppm CO 2 they exhibit higher transpiration and higher seed Fe and Zn content than WT grown under the same conditions. Our data show that by increasing transpiration it is possible to partially mitigate the reduction in seed Fe and Zn content when Arabidopsis is grown at elevated CO 2 ., (© 2022 The Authors. New Phytologist © 2022 New Phytologist Foundation.)

Study Aim: The aim of this study is to investigate the impact of alarm configuration tactics in general care settings., Methods: Retrospective analysis of over 150,000 hours of medical/surgical unit continuous SpO2 and pulse rate data were used to estimate alarm rates and impact on individual nurses., Results: Application of an SpO2 threshold of 80% vs 88% produced an 88% reduction in alarms. Addition of a 15 second annunciation delay reduced alarms by an additional 71% with an SpO2 threshold of 80%. Pulse rate alarms were reduced by 93% moving from a pulse rate high threshold of 120-140 bpm, and 95% by lowering the pulse rate low threshold from 60 to 50 bpm. A 15 second annunciation delay at thresholds of 140 bpm and 50 bpm resulted in additional reductions of 80% and 81%, respectively. Combined alarm frequency across all parameters for every 24 hours of actual monitored time yielded a rate of 4.2 alarms for the surveillance configuration, 83.0 alarms for critical care monitoring, and 320.6 alarms for condition monitoring. Total exposure time for an individual nurse during a single shift ranged from 3.6 min with surveillance monitoring, to 1.2 hours for critical care monitoring, and 5.3 hours for condition monitoring., Conclusions: Continuous monitoring can eliminate unwitnessed/unmonitored arrests associated with significant increased mortality in the general care setting. The "alarm problem" associated with these systems is manageable using alarm settings that signify severely abnormal physiology to alert responsible clinicians of urgent situations., (© 2022 The Author(s).)

Objectives: To identify and summarize the top bioinformatics and translational informatics papers published in 2021 for the IMIA Yearbook., Methods: We performed a broad literature search to retrieve Bioinformatics and Translational Informatics (BTI) papers and coupled this with a series of editorial and peer reviews to identity the top papers in the area., Results: We identified a final candidate list of 15 BTI papers for peer-review; from these candidates, the top three papers were chosen to highlight in this synopsis. These papers expand the integration of multi-omics data with electronic health records and use advanced machine learning approaches to tailor models to individual patients. In addition, our honorable mention paper foreshadows the growing impact of BTI research on precision medicine through the continued development of large clinical consortia., Conclusion: In the top BTI papers this year, we observed several important trends, including the use of deep-learning approaches to analyse diverse data types, the development of integrative and web-accessible bioinformatics pipelines, and a continued focus on the power of individual genome sequencing for precision health., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (IMIA and Thieme. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The dataset comprises primary data for the concentration of 29 mineral micronutrients in cereal grains and up to 84 soil chemistry properties from GeoNutrition project surveys in Ethiopia and Malawi. The work provided insights on geospatial variation in the micronutrient concentration in staple crops, and the potential influencing soil factors. In Ethiopia, sampling was conducted in Amhara, Oromia, and Tigray regions, during the late-2017 and late-2018 harvest seasons. In Malawi, national-scale sampling was conducted during the April-June 2018 harvest season. The concentrations of micronutrients in grain were measured using inductively coupled plasma mass spectrometry (ICP-MS). Soil chemistry properties reported include soil pH; total soil nitrogen; total soil carbon (C); soil organic C; effective cation exchange capacity and exchangeable cations; a three-step sequential extraction scheme for the fractionation of sulfur and selenium; available phosphate; diethylenetriaminepentaacetic acid (DTPA)-extractable trace elements; extractable trace elements using 0.01 M Ca(NO 3 ) 2 and 0.01 M CaCl 2 ; and isotopically exchangeable Zn. These data are reported here according to FAIR data principles to enable users to further explore agriculture-nutrition linkages., (© 2022. The Author(s).)

Dietary zinc (Zn) deficiency is widespread globally, and in particular among people in sub-Saharan Africa (SSA). In Malawi, dietary sources of Zn are dominated by maize and spatially dependent variation in grain Zn concentration, which will affect dietary Zn intake, has been reported at distances of up to ~ 100 km. The aim of this study was to identify potential soil properties and environmental covariates which might explain this longer-range spatial variation in maize grain Zn concentration. Data for maize grain Zn concentrations, soil properties, and environmental covariates were obtained from a spatially representative survey in Malawi (n = 1600 locations). Labile and non-labile soil Zn forms were determined using isotopic dilution methods, alongside conventional agronomic soil analyses. Soil properties and environmental covariates as potential predictors of the concentration of Zn in maize grain were tested using a priori expert rankings and false discovery rate (FDR) controls within the linear mixed model (LMM) framework that informed the original survey design. Mean and median grain Zn concentrations were 21.8 and 21.5 mg kg -1 , respectively (standard deviation 4.5; range 10.0-48.1). A LMM for grain Zn concentration was constructed for which the independent variables: soil pH (water) , isotopically exchangeable Zn (Zn E ), and diethylenetriaminepentaacetic acid (DTPA) extractable Zn (Zn DTPA ) had predictive value (p < 0.01 in all cases, with FDR controlled at < 0.05). Downscaled mean annual temperature also explained a proportion of the spatial variation in grain Zn concentration. Evidence for spatially dependent variation in maize grain Zn concentrations in Malawi is robust within the LMM framework used in this study, at distances of up to ~ 100 km. Spatial predictions from this LMM provide a basis for further investigation of variations in the contribution of staple foods to Zn nutrition, and where interventions to increase dietary Zn intake (e.g. biofortification) might be most effective. Other soil and landscape factors influencing spatially dependent variation in maize grain Zn concentration, along with factors operating over shorter distances such as choice of crop variety and agronomic practices, require further exploration beyond the scope of the design of this survey., (© 2022. The Author(s).)

Realistic targets for soil organic carbon (SOC) concentrations are needed, accounting for differences between soils and land uses. We assess the use of SOC/clay ratio for this purpose by comparing changes over time in (a) the National Soil Inventory of England and Wales, first sampled in 1978-1983 and resampled in 1994-2003, and (b) two long-term experiments under ley-arable rotations on contrasting soils in the East of England. The results showed that normalising for clay concentration provides a more meaningful separation between land uses than changes in SOC alone. Almost half of arable soils in the NSI had degraded SOC/clay ratios (< 1/13), compared with just 5% of permanent grass and woodland soils. Soils with initially large SOC/clay ratios (≥ 1/8) were prone to greater losses of SOC between the two NSI samplings than those with smaller ratios. The results suggest realistic long-term targets for SOC/clay in arable, ley grass, permanent grass and woodland soils are 1/13, 1/10, and > 1/8, respectively. Given the wide range of soils and land uses across England and Wales in the datasets used to test these targets, they should apply across similar temperate regions globally, and at national to sub-regional scales., (© 2022. The Author(s).)

With the increasing popularity of local blending of fertilisers, the fertiliser industry faces issues regarding quality control and fertiliser adulteration. Another problem is the contamination of fertilisers with trace elements that have been shown to subsequently accumulate in the soil and be taken up by plants, posing a danger to the environment and human health. Conventional characterisation methods necessary to ensure the quality of fertilisers and to comply with local regulations are costly, time consuming and sometimes not even accessible. Alternatively, using a wide range of unamended and intentionally amended fertilisers this study developed empirical calibrations for a portable handheld X-ray fluorescence (pXRF) spectrometer, determined the reliability for estimating the macro and micro nutrients and evaluated the use of the pXRF for the high-throughput detection of trace element contaminants in fertilisers. The models developed using pXRF for Mg, P, S, K, Ca, Mn, Fe, Zn and Mo had R2 values greater or equal to 0.97. These models also performed well on validation, with R2 values greater or equal to 0.97 (except for Fe, R2val = 0.55) and slope values ranging from 0.81 to 1.44. A second set of models were developed with a focus on trace elements in amended fertilisers. The R2 values of calibration for Co, Ni, As, Se, Cd and Pb were greater than or equal to 0.80. At concentrations up to 1000 mg kg-1, good validation statistics were also obtained; R2 values ranged from 0.97-0.99, except in one instance. The regression coefficients of the validation also had good prediction in the range of 0-100 mg kg-1 (R2 values were from 0.78-0.99), but not as well at lower concentrations up to 20 mg kg-1 (R2 values ranged from 0.10-0.99), especially for Cd. This study has demonstrated that pXRF can measure several major (P, Ca) and micro (Mn, Fe, Cu) nutrients, as well as trace elements and potential contaminants (Cr, Ni, As) in fertilisers with high accuracy and precision. The results obtained in this study is good, especially considering that loose powders were scanned for a maximum of 90 seconds without the use of a vacuum pump., Competing Interests: The authors have declared that no competing interests exist.

Background: Sepsis remains a leading cause of death among inpatients. Scoring systems designed to identify inpatients with sepsis currently have limited effectiveness. This single institution, retrospective, case-control study aims to improve sepsis decision support tool performance using temporal analyses of sepsis-specific and general deterioration scoring systems., Methods: Sequential Organ Failure Assessment, National Early Warning Scores (NEWS), and Modified Early Warning Scores were calculated using four years of inpatient data. Sensitivity and specificity analyses compared performance of each score, calculated as a function of both various score cut-off values and time before sepsis diagnosis using established proxies for identifying clinical suspicion for sepsis., Results: NEWS had the best sensitivity-specificity performance (AUROC 82.7) when examining various score cutoffs and time intervals during which diagnosis criteria were met. Comparison of false positives/negatives with various score thresholds showed a low rate of false positives with a NEWS of 7. Score trends in the hours leading up to sepsis criteria being met showed a marked increase for the sepsis group while for the cases there was a decrease during a comparable period., Conclusions: Temporal analyses of scores for patients coded as having sepsis provides novel insights into patterns of deterioration. The methods and results provide practical details demonstrating how general deterioration algorithms can be used to alert trained responders to potential cases of sepsis to improve sepsis recognition and treatment opportunities., Competing Interests: Declaration of Competing Interest Authors Perreard, Mackenzie and Calderwood declare no competing interests. Author McGrath declares a relationship with Maismo, Inc. and Knobbe-Martens., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: The primary study objective was to investigate the impact of surveillance monitoring (i.e., continuous monitoring optimized for deterioration detection) on mortality and severe morbidity associated with administration of sedative/analgesic medications in the general care setting. A second objective was consideration of the results in the context of previous investigations to establish practice recommendations for this approach to patient safety., Methods: Retrospective review of available rescue event and patient safety data from a tertiary care hospital in a rural setting was performed for a 10-year period. Systematic analysis of all adult general care inpatient data followed by chart review for individual patients was used to identify patient death or permanent harm (i.e., ventilator dependency, hypoxic encephalopathy) related to administration of sedative/analgesics., Results: Of 111,488 patients in units with surveillance monitoring available, none died or were harmed by opioid-induced respiratory depression when surveillance monitoring was in use. One patient died from opioid-induced respiratory depression in a unit where surveillance monitoring was available; however, the patient was not monitored at the time of the adverse event. In unmonitored units (15,209 patients during 29 months of incremental implementation), three patients died from opioid overdose (19.73 deaths per 100,000 at risk patients). The reduced death rate when surveillance monitoring was available (0.0009%) versus not available (0.02%) was significant (P = 0.03)., Conclusions: For a 10-year period, the rescue system with continuous surveillance monitoring had a profound effect on death from sedative/analgesic administration in the general care setting. This approach to patient safety can help address the risk of sedative/analgesic-related respiratory arrests in hospitals., Competing Interests: The other authors disclose no potential conflict of interest., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Allocation of limited resources to improve quality, patient safety, and outcomes is a decision-making challenge health care leaders face every day. While much valuable health care management research has concentrated on administrative data analysis, this approach often falls short of providing actionable information essential for effective management of specific system implementations and complex systems. This comprehensive performance analysis of a hospital-wide system illustrates application of various analysis approaches to support understanding specific system behaviors and identify leverage points for improvement. The study focuses on performance of a hospital rescue system supporting early recognition and response to patient deterioration, which is essential to reduce preventable inpatient deaths., Methods: Retrospective analysis of tertiary care hospital inpatient and rescue data was conducted using a systems analysis approach to characterize: patient demographics; rescue activation types and locations; temporal patterns of activation; and associations of patient factors, including complications, with post-rescue care disposition and outcomes., Results: Increases in bedside consultations (20% per year) were found with increased rescue activations during periods of resource limitations and changes (e.g., shift changes, weekends). Cardiac arrest, respiratory failure, and sepsis complications present the highest risk for rescue and death. Distributions of incidence of rescue and death by day of patient stay may suggest opportunities for earlier recognition., Conclusions: Specific findings highlight the potential of using rescue-related risk and targeted resource deployment strategies to improve early detection of deterioration. The approach and methods applied can be used by other institutions to understand performance and allow rational incremental improvements to complex care delivery systems., (© 2021. The Author(s).)

Objectives: Provide an overview of the emerging themes and notable papers which were published in 2020 in the field of Bioinformatics and Translational Informatics (BTI) for the International Medical Informatics Association Yearbook., Methods: A team of 16 individuals scanned the literature from the past year. Using a scoring rubric, papers were evaluated on their novelty, importance, and objective quality. 1,224 Medical Subject Headings (MeSH) terms extracted from these papers were used to identify themes and research focuses. The authors then used the scoring results to select notable papers and trends presented in this manuscript., Results: The search phase identified 263 potential papers and central themes of coronavirus disease 2019 (COVID-19), machine learning, and bioinformatics were examined in greater detail., Conclusions: When addressing a once in a centruy pandemic, scientists worldwide answered the call, with informaticians playing a critical role. Productivity and innovations reached new heights in both TBI and science, but significant research gaps remain., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (IMIA and Thieme. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Plastics are ubiquitous contaminants that leak into the environment from multiple pathways including the use of treated sewage sludge (biosolids). Seven common plastics (polymers) were quantified in the solid fraction of archived biosolids samples from Australia and the United Kingdom from between 1950 and 2016. Six plastics were detected, with increasing concentrations observed over time for each plastic. Biosolids plastic concentrations correlated with plastic production estimates, implying a potential link between plastics production, consumption and leakage into the environment. Prior to the 1990s, the leakage of plastics into biosolids was limited except for polystyrene. Increased leakage was observed from the 1990s onwards; potentially driven by increased consumption of polyethylene, polyethylene terephthalate and polyvinyl chloride. We show that looking back in time along specific plastic pollution pathways may help unravel the potential sources of plastics leakage into the environment and provide quantitative evidence to support the development of source control interventions or regulations., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Precision medicine is increasingly incorporated into clinical practice via three primary data conduits: environmental, lifestyle, and genetic data. In this manuscript we take a closer look at the genetic tier of precision medicine. The volume and variety of data provides a more robust picture of health for individual patients and patient populations. However, this increased data may also have an adverse effect by muddling our understanding without the proper pedagogical tools. Patient genomic data can be challenging to work with. Physicians may encounter genetic results which are not fully understood. Genetic tests may also lead to the quandary of linking patients with diseases or disorders where there are no known treatments. Thus, physicians face a unique challenge of establishing the proper scope of their duty to patients when dealing with genomic data. Some of those scope of practice boundaries have been established as a result of litigation, while others remain an open question. In this paper, we map out some of the legal challenges facing the genomic component of precision medicine, both established and some questions requiring additional guidance. If physicians begin to perceive genomic data as falling short in overall benefit to their patients, it may detrimentally impact precision medicine as a whole. Helping to develop guidance for physicians working with patient genomic data can help avoid this fate of faltering confidence., Competing Interests: AP was employed by the company Hooper, Lundy & Bookman, and DW was employed by the company Walton Legal PLLC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 McGrath, Peabody, Walton and Walton.)

Micronutrient deficiencies (MNDs) remain widespread among people in sub-Saharan Africa 1-5 , where access to sufficient food from plant and animal sources that is rich in micronutrients (vitamins and minerals) is limited due to socioeconomic and geographical reasons 4-6 . Here we report the micronutrient composition (calcium, iron, selenium and zinc) of staple cereal grains for most of the cereal production areas in Ethiopia and Malawi. We show that there is geospatial variation in the composition of micronutrients that is nutritionally important at subnational scales. Soil and environmental covariates of grain micronutrient concentrations included soil pH, soil organic matter, temperature, rainfall and topography, which were specific to micronutrient and crop type. For rural households consuming locally sourced food-including many smallholder farming communities-the location of residence can be the largest influencing factor in determining the dietary intake of micronutrients from cereals. Positive relationships between the concentration of selenium in grain and biomarkers of selenium dietary status occur in both countries. Surveillance of MNDs on the basis of biomarkers of status and dietary intakes from national- and regional-scale food-composition data 1-7 could be improved using subnational data on the composition of grain micronutrients. Beyond dietary diversification, interventions to alleviate MNDs, such as food fortification 8,9 and biofortification to increase the micronutrient concentrations in crops 10,11 , should account for geographical effects that can be larger in magnitude than intervention outcomes.

The study objective was to understand if features derived from continuous pulse oximetry data can provide advanced warning of pulseless electrical activity arrest in the general care inpatient setting. Retrospective analysis of SpO2 and pulse rate data derived from continuous pulse oximetry was performed for pulseless electrical activity (n = 38) and control (n = 42) patient cohorts. Measures of central tendency and variation over time intervals ranging from 1 min to 1 h were used for inter- and intra-group comparisons. Logistic regression was applied to understand ability of features to predict pulseless electrical activity in future time intervals. Overall, the pulseless electrical activity arrest group tended to have lower mean SpO2 and higher mean pulse rate values than the control group. SpO2 and pulse rate variability was higher in the pulseless electrical activity arrest cohort. Changes in variability were observed beginning several hours prior to the rescue event. Up to 20 min before rescue events, pulse rate features were significantly different from feature values for the preceding 30-min interval (> 10% difference in mean, > 46% difference in range). Similar results were found for SpO2 features 10 min before the event (> 4% difference in mean, > 60% difference in range). There is a significant difference in SpO2 and pulse rate features derived from continuous pulse oximetry between pulseless electrical activity and control groups. Integration of automated feature calculation and clinician notification into clinical monitoring and information systems may increase patient safety by supporting early detection of such events.

Soil property and class maps for the continent of Africa were so far only available at very generalised scales, with many countries not mapped at all. Thanks to an increasing quantity and availability of soil samples collected at field point locations by various government and/or NGO funded projects, it is now possible to produce detailed pan-African maps of soil nutrients, including micro-nutrients at fine spatial resolutions. In this paper we describe production of a 30 m resolution Soil Information System of the African continent using, to date, the most comprehensive compilation of soil samples ([Formula: see text]) and Earth Observation data. We produced predictions for soil pH, organic carbon (C) and total nitrogen (N), total carbon, effective Cation Exchange Capacity (eCEC), extractable-phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg), sulfur (S), sodium (Na), iron (Fe), zinc (Zn)-silt, clay and sand, stone content, bulk density and depth to bedrock, at three depths (0, 20 and 50 cm) and using 2-scale 3D Ensemble Machine Learning framework implemented in the mlr (Machine Learning in R) package. As covariate layers we used 250 m resolution (MODIS, PROBA-V and SM2RAIN products), and 30 m resolution (Sentinel-2, Landsat and DTM derivatives) images. Our fivefold spatial Cross-Validation results showed varying accuracy levels ranging from the best performing soil pH (CCC = 0.900) to more poorly predictable extractable phosphorus (CCC = 0.654) and sulphur (CCC = 0.708) and depth to bedrock. Sentinel-2 bands SWIR (B11, B12), NIR (B09, B8A), Landsat SWIR bands, and vertical depth derived from 30 m resolution DTM, were the overall most important 30 m resolution covariates. Climatic data images-SM2RAIN, bioclimatic variables and MODIS Land Surface Temperature-however, remained as the overall most important variables for predicting soil chemical variables at continental scale. This publicly available 30-m Soil Information System of Africa aims at supporting numerous applications, including soil and fertilizer policies and investments, agronomic advice to close yield gaps, environmental programs, or targeting of nutrition interventions.

Zinc (Zn) is an important element determining the grain quality of staple food crops and deficient in many Ethiopian soils. However, farming systems are highly variable in Ethiopia due to different soil types and landscape cropping positions. Zinc availability and uptake by plants from soil and fertilizer sources are governed by the retention and release potential of the soil, usually termed as adsorption and desorption, respectively. The aim of this study was to characterize the amount of plant available Zn at different landscape positions. During the 2018/19 cropping season, adsorption-desorption studies were carried out on soil samples collected from on-farm trials conducted at Aba Gerima, Debre Mewi and Markuma in the Amhara Region. In all locations and landscape positions, adsorption and desorption increased with increasing Zn additions. The amount of adsorption and desorption was highly associated with the soil pH, the soil organic carbon concentration and cation exchange capacity, and these factors are linked to landscape positions. The Freundlich isotherm fitted very well to Zn adsorption (r 2 0.87-0.99) and desorption (r 2 0.92-0.99), while the Langmuir isotherm only fitted to Zn desorption (r 2 0.70-0.93). Multiple regression models developed by determining the most influential soil parameters for Zn availability could be used to inform Zn fertilizer management strategies for different locations and landscape positions in this region, and thereby improve plant Zn use efficiency.

Spectroscopic methods for the determination of soil texture are faster and cheaper than the standard methods, but how do the results compare? To address this question, laser diffraction analysis (LDA) and mid-infrared spectroscopy (MIRS) analysis have been compared to conventional sieve-pipette measurements of texture in diverse European and Kenyan soils. To our knowledge this comparison between LDA and MIRS has not been made previously. It has used soils with a broad range of organic carbon (OC) contents to investigate whether, as in other techniques, clay-OC aggregation affects the estimation of clay with MIRS. The MIRS predictions of clay content were much better than the LDA measurements, but both techniques gave good measurements of sand content. The MIRS over-estimated clay at low clay content and under-estimated at high clay content (calibration set R 2  = 0.83). The LDA over-estimated clay by ~ 60% (calibration set R 2  = 0.36), indicating that the widely used clay threshold of < 8 µm was too high, and < 4 µm was found to be more accurate. In samples with < 5% OC content, both the LDA and MIRS gave very good clay predictions (R 2  = 0.88 and 0.81, respectively). But in predictions of clay content in samples with > 5% OC the LDA under-estimated (R 2  =  < 0.1) and MIRS over-estimated (R 2  = 0.34) clay content. In soils with OC removed, the MIRS prediction of clay content improved, indicating interference between over-lapping spectral regions for organic and mineral constituents. Unlike granulometric measurements of texture such as the LDA, MIRS analysis is not subject to the limitations imposed by the shape and density of particles. It was concluded that in typical agricultural soils with < 5% OC and < 60% clay content, both techniques could be used for cheap, fast and reliable estimates of soil texture.

Liming has widespread and significant impacts on soil processes and crop responses. The aim of this study was to describe the relationships between exchangeable cation concentrations in soil and the relative yield of spring barley. The hypothesis was that yield is restricted by the concentration of a single exchangeable cation in the soil. For simplicity, we focused on spring barley which was grown in nine years of a long-term experiment at two sites (Rothamsted and Woburn). Four liming rates were applied and in each year the relative yield (RY) and the concentrations of exchangeable cations were assessed. Liming had highly significant effects on the concentrations of most exchangeable cations, except for Cu and K. There were significant negative relationships (either linear or exponential) between the exchangeable concentrations of Mn, Cd, Cr, Al, Fe, Cu, Co, Zn and Ni in soil and soil pH. The relationships between RY and the concentrations of selected exchangeable cations (Mn, Ca and Al) were described well using log-logistic relationships. For these cations a significant site effect was probably due to fundamental differences in soil properties. At both sites the concentrations of exchangeable soil Al were excessive (> 7.5 mg kg -1 ) and were most likely responsible for reduced barley yields (where RY ≤ 0.5) with soil acidification. At Rothamsted barley yield was non-limited (where RY ≥ 1) at soil exchangeable Mn concentrations (up to 417 mg kg -1 ) greater than previously considered toxic, which requires further evaluation of critical Mn concentrations., Supplementary Information: The online version of this article (10.1007/s10705-020-10117-2) contains supplementary material, which is available to authorized users., (© The Author(s) 2021.)

The current study focuses on yield and nutritional quality changes of wheat grain over the last 166 years. It is based on wheat grain quality analyses carried out on samples collected between 1850 and 2016. Samples were obtained from the Broadbalk Continuous Wheat Experiment (UK) and from herbaria from 16 different countries around the world. Our study showed that, together with an increase in carbohydrate content, an impoverishment of mineral composition and protein content occurred. The imbalance in carbohydrate/protein content was specially marked after the 1960's, coinciding with strong increases in ambient [CO 2 ] and temperature and the introduction of progressively shorter straw varieties. The implications of altered crop physiology are discussed.

Portable X-ray fluorescence (pXRF) and Diffuse Reflectance Fourier Transformed Mid-Infrared (DRIFT-MIR) spectroscopy are rapid and cost-effective analytical tools for material characterization. Here, we provide an assessment of these methods for the analysis of total Carbon, Nitrogen and total elemental composition of multiple elements in organic amendments. We developed machine learning methods to rapidly quantify the concentrations of macro- and micronutrient elements present in the samples and propose a novel system for the quality assessment of organic amendments. Two types of machine learning methods, forest regression and extreme gradient boosting, were used with data from both pXRF and DRIFT-MIR spectroscopy. Cross-validation trials were run to evaluate generalizability of models produced on each instrument. Both methods demonstrated similar broad capabilities in estimating nutrients using machine learning, with pXRF being suitable for nutrients and contaminants. The results make portable spectrometry in combination with machine learning a scalable solution to provide comprehensive nutrient analysis for organic amendments., Competing Interests: The authors have declared that no competing interests exist.

Grain and soil were sampled across a large part of Amhara, Ethiopia in a study motivated by prior evidence of selenium (Se) deficiency in the Region's population. The grain samples (teff, Eragrostis tef, and wheat, Triticum aestivum) were analysed for concentration of Se and the soils were analysed for various properties, including Se concentration measured in different extractants. Predictive models for concentration of Se in the respective grains were developed, and the predicted values, along with observed concentrations in the two grains were represented by a multivariate linear mixed model in which selected covariates, derived from remote sensor observations and a digital elevation model, were included as fixed effects. In all modelling steps the selection of predictors was done using false discovery rate control, to avoid over-fitting, and using an α-investment procedure to maximize the statistical power to detect significant relationships by ordering the tests in a sequence based on scientific understanding of the underlying processes likely to control Se concentration in grain. Cross-validation indicated that uncertainties in the empirical best linear unbiased predictions of the Se concentration in both grains were well-characterized by the prediction error variances obtained from the model. The predictions were displayed as maps, and their uncertainty was characterized by computing the probability that the true concentration of Se in grain would be such that a standard serving would not provide the recommended daily allowance of Se. The spatial variation of grain Se was substantial, concentrations in wheat and teff differed but showed the same broad spatial pattern. Such information could be used to target effective interventions to address Se deficiency, and the general procedure used for mapping could be applied to other micronutrients and crops in similar settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)