Acquisition and retention of lung ultrasound skills by respiratory therapists: A curriculum for respiratory therapists

Purpose: Lung point-of-care ultrasound (POCUS) is a versatile bedside tool. The utility of POCUS has grown during the coronavirus disease 2019 pandemic, as it allows clinicians to obtain real-time images without requiring transport of the patient outside the intensive care unit. As respiratory therapists (RTs) are involved in caring for those with respiratory failure, there is a good rationale for their adoption of lung ultrasound. However, no training standards have been defined. Our objective was to develop and implement a training programme for RTs to achieve and sustain competence in lung ultrasound. Methods: This was a single-centre, prospective, single-cohort observational study. A total of 10 RTs completed our curriculum and were tasked with independently completing and interpreting 10 initial lung ultrasound exams and 3 subsequent exams after a 6-week interim period. All exams were blindly overread by a local expert in lung ultrasound. Results: After completing the curriculum, RTs were able to acquire and accurately interpret their images over 85% of the time. They were more successful in the upper lung zone image acquisition and interpretation compared with the lower lung zones. After 6 weeks, the RTs’ lung POCUS skills remained stable, and their lower lung zone image interpretation improved. The RTs reported that their confidence improved throughout the study. Conclusion: The RTs in our study have demonstrated competence in acquisition and interpretation of upper lung zone images. They have also reported confidence in acquiring and interpreting upper lung zone images. More experience appears to be required to gain competence and confidence in lower lung zone ultrasound. Next steps would be to repeat the present study with a higher number of RTs completing at least 20 lung POCUS studies

Constructing and evaluating a continent‐wide migratory songbird network across the annual cycle

Determining how migratory animals are spatially connected between breeding and non‐breeding periods is essential for predicting the effects of environmental change and for developing optimal conservation strategies. Yet, despite recent advances in tracking technology, we lack comprehensive information on the spatial structure of migratory networks across a species’ range, particularly for small‐bodied, long‐distance migratory animals. We constructed a migratory network for a songbird and used network‐based metrics to characterize the spatial structure and prioritize regions for conservation. The network was constructed using year‐round movements derived from 133 archival light‐level geolocators attached to Tree Swallows (Tachycineta bicolor) originating from 12 breeding sites across their North American breeding range. From these breeding sites, we identified 10 autumn stopover nodes (regions) in North America, 13 non‐breeding nodes located around the Gulf of Mexico, Mexico, Florida, and the Caribbean, and 136 unique edges (migratory routes) connecting nodes. We found strong migratory connectivity between breeding and autumn stopover sites and moderate migratory connectivity between the breeding and non‐breeding sites. We identified three distinct “communities” of nodes that corresponded to western, central, and eastern North American flyways. Several regions were important for maintaining network connectivity, with South Florida and Louisiana as the top ranked non‐breeding nodes and the Midwest as the top ranked stopover node. We show that migratory songbird networks can have both a high degree of mixing between seasons yet still show regionally distinct migratory flyways. Such information will be crucial for accurately predicting factors that limit and regulate migratory songbirds throughout the annual cycle. Our study highlights how network‐based metrics can be valuable for identifying overall network structure and prioritizing specific regions within a network for conserving a wide variety of migratory animals

Do Gravity-Related Sensory Information Enable the Enhancement of Cortical Proprioceptive Inputs When Planning a Step in Microgravity?

International audienceWe recently found that the cortical response to proprioceptive stimulation was greater when participants were planning a step than when they stood still, and that this sensory facilitation was suppressed in microgravity. The aim of the present study was to test whether the absence of gravity-related sensory afferents during movement planning in microgravity prevented the proprioceptive cortical processing to be enhanced. We reestablished a reference frame in microgravity by providing and translating a horizontal support on which the participants were standing and verified whether this procedure restored the proprioceptive facilitation. The slight translation of the base of support (lateral direction), which occurred prior to step initiation, stimulated at least cutaneous and vestibular receptors. The sensitivity to proprioceptive stimulation was assessed by measuring the amplitude of the cortical somatosensory-evoked potential (SEP, over the Cz electrode) following the vibration of the leg muscle. The vibration lasted 1 s and the participants were asked to either initiate a step at the vibration offset or to remain still. We found that the early SEP (90–160 ms) was smaller when the platform was translated than when it remained stationary, revealing the existence of an interference phenomenon (i.e., when proprioceptive stimulation is preceded by the stimulation of different sensory modalities evoked by the platform translation). By contrast, the late SEP (550 ms post proprioceptive stimulation onset) was greater when the translation preceded the vibration compared to a condition without pre-stimulation (i.e., no translation). This suggests that restoring a body reference system which is impaired in microgravity allowed a greater proprioceptive cortical processing. Importantly, however, the late SEP was similarly increased when participants either produced a step or remained still. We propose that the absence of step-induced facilitation of proprioceptive cortical processing results from a decreased weight of proprioception in the absence of balance constraints in microgravity

A long-period transiting substellar companion in the super-Jupiters to brown dwarfs mass regime and a prototypical warm-Jupiter detected by TESS

We report on the confirmation and follow-up characterization of two long-period transiting substellar companions on low-eccentricity orbits around TIC 4672985 and TOI-2529, whose transit events were detected by the TESS space mission. Ground-based photometric and spectroscopic follow up from different facilities, confirmed the substellar nature of TIC 4672985 b, a massive gas giant, in the transition between the super-Jupiters and brown-dwarfs mass regime. From the joint analysis we derived the following orbital parameters: P = 69.0480+0.0004−0.0005 d, Mp = 12.74+1.01−1.01 MJ, Rp =1.026+0.065−0.067 RJ and e = 0.018+0.004−0.004 . In addition, the RV time series revealed a significant trend at the ∼ 350 m s−1 yr−1level, which is indicative of the presence of a massive outer companion in the system. TIC 4672985 b is a unique example of a transiting substellar companion with a mass above the deuterium-burning limit, located beyond 0.1 AU and in a nearly circular orbit. These planetary properties are difficult to reproduce from canonical planet formation and evolution models. For TOI-2529 b, we obtained the following orbital parameters: P = 64.5949+0.0003−0.0003 d, Mp =2.340+0.197−0.195 MJ, Rp = 1.030+0.050−0.050 RJ and e = 0.021+0.024−0.015 , making this object a new example of a growing population of transiting warm giant planets

A long-period transiting substellar companion in the super-Jupiters to brown dwarfs mass regime and a prototypical warm-Jupiter detected by TESS

We report on the confirmation and follow-up characterization of two long-period transiting substellar companions on low-eccentricity orbits around TIC 4672985 and TOI-2529, whose transit events were detected by the TESS space mission. Ground-based photometric and spectroscopic follow-up from different facilities, confirmed the substellar nature of TIC 4672985 b, a massive gas giant, in the transition between the super Jupiters and brown dwarfs mass regime. From the joint analysis we derived the following orbital parameters: P = 69.0480 d, Mp = 12.74 Mjup, Rp = 1.026 Rjup and e = 0.018. In addition, the RV time series revealed a significant trend at the 350 m/s/yr level, which is indicative of the presence of a massive outer companion in the system. TIC 4672985 b is a unique example of a transiting substellar companion with a mass above the deuterium-burning limit, located beyond 0.1 AU and in a nearly circular orbit. These planetary properties are difficult to reproduce from canonical planet formation and evolution models. For TOI-2529 b, we obtained the following orbital parameters: P = 64.5949 d, Mp = 2.340 Mjup, Rp = 1.030 Rjup and e = 0.021, making this object a new example of a growing population of transiting warm giant planets.Comment: Accepted in A&

A circulating antibody panel for pretransplant prediction of FSGS recurrence after kidney transplantation

Recurrence of focal segmental glomerulosclerosis (rFSGS) after kidney transplantation is a cause of accelerated graft loss. To evaluate pathogenic antibodies (Abs) in rFSGS, we processed 141 serum samples from 64 patients with and without primary rFSGS and 34 non-FSGS control patients transplanted at four hospitals. We screened about 9000 antigens in pretransplant sera and selected 10 Abs targeting glomerular antigens for enzyme-linked immunosorbent assay (ELISA) validation. A panel of seven Abs (CD40, PTPRO, CGB5, FAS, P2RY11, SNRPB2, and APOL2) could predict posttransplant FSGS recurrence with 92% accuracy. Pretransplant elevation of anti-CD40 Ab alone had the best correlation (78% accuracy) with rFSGS risk after transplantation. Epitope mapping of CD40 with customized peptide arrays and rFSGS sera demonstrated altered immunogenicity of the extracellular CD40 domain in rFSGS. Immunohistochemistry of CD40 demonstrated a differential expression in FSGS compared to non-FSGS controls. Anti-CD40 Abs purified from rFSGS patients were particularly pathogenic in human podocyte cultures. Injection of anti-CD40/rFSGS Ab enhanced suPAR (soluble urokinase receptor)-mediated proteinuria in wild-type mice, yet no sensitizing effect was noted in mice deficient in CD40 or in wild-type mice that received blocking Ab to CD40. In conclusion, a panel of seven Abs can help identify primary FSGS patients at high risk of recurrence before transplantation. Intrarenal CD40 (and possibly other specific glomerular antigens) is an important contributor to FSGS disease pathogenesis. Human trials of anti-CD40 therapies are warranted to evaluate their efficacy for preventing rFSGS and improving graft survival

Constructing and evaluating a continent‐wide migratory songbird network across the annual cycle

Determining how migratory animals are spatially connected between breeding and non‐breeding periods is essential for predicting the effects of environmental change and for developing optimal conservation strategies. Yet, despite recent advances in tracking technology, we lack comprehensive information on the spatial structure of migratory networks across a species’ range, particularly for small‐bodied, long‐distance migratory animals. We constructed a migratory network for a songbird and used network‐based metrics to characterize the spatial structure and prioritize regions for conservation. The network was constructed using year‐round movements derived from 133 archival light‐level geolocators attached to Tree Swallows (Tachycineta bicolor) originating from 12 breeding sites across their North American breeding range. From these breeding sites, we identified 10 autumn stopover nodes (regions) in North America, 13 non‐breeding nodes located around the Gulf of Mexico, Mexico, Florida, and the Caribbean, and 136 unique edges (migratory routes) connecting nodes. We found strong migratory connectivity between breeding and autumn stopover sites and moderate migratory connectivity between the breeding and non‐breeding sites. We identified three distinct “communities” of nodes that corresponded to western, central, and eastern North American flyways. Several regions were important for maintaining network connectivity, with South Florida and Louisiana as the top ranked non‐breeding nodes and the Midwest as the top ranked stopover node. We show that migratory songbird networks can have both a high degree of mixing between seasons yet still show regionally distinct migratory flyways. Such information will be crucial for accurately predicting factors that limit and regulate migratory songbirds throughout the annual cycle. Our study highlights how network‐based metrics can be valuable for identifying overall network structure and prioritizing specific regions within a network for conserving a wide variety of migratory animals.This article is published as Knight, Samantha M., David W. Bradley, Robert G. Clark, Elizabeth A. Gow, Marc Bélisle, Lisha L. Berzins, Tricia Blake et al. "Constructing and evaluating a continent‐wide migratory songbird network across the annual cycle." Ecological Monographs (2018). doi: 10.1002/ecm.1298. Posted with permission.</p

Data from: A range-wide domino effect and resetting of the annual cycle in a migratory songbird

Latitudinal differences in timing of breeding are well documented but how such differences carry over to influence timing of events in the annual cycle of migratory birds is not well understood. We examined geographic variation in timing of events throughout the year using light-level geolocator tracking data from 133 migratory tree swallows (Tachycineta bicolor) originating from 12 North American breeding populations. A swallow’s breeding latitude influenced timing of breeding, which then carried over to affect breeding ground departure. This resulted in subsequent effects on the arrival and departure schedules at fall stopover locations and timing of arrival at non-breeding locations. This “domino effect” between timing events was no longer apparent by the time individuals departed for spring migration. Our range-wide analysis demonstrates the lasting impact breeding latitude can have on migration schedules but also highlights how such timing relationships can reset when individuals reside at non-breeding sites for extended periods of time

Gow et al. tres timing data supplement

Gow et al. tres timing data supplemen