Tracheal intubation in traumatic brain injury

Background: We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. Methods: Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. Results: In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79–1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65–1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. Conclusion: The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. Clinical trial registration: NCT02210221

Informed consent procedures in patients with an acute inability to provide informed consent

Purpose: Enrolling traumatic brain injury (TBI) patients with an inability to provide informed consent in research is challenging. Alternatives to patient consent are not sufficiently embedded in European and national legislation, which allows procedural variation and bias. We aimed to quantify variations in informed consent policy and practice. Methods: Variation was explored in the CENTER-TBI study. Policies were reported by using a questionnaire and national legislation. Data on used informed consent procedures were available for 4498 patients from 57 centres across 17 European countries. Results: Variation in the use of informed consent procedur

Efforts by Small-Scale Farmers to Maintain Soil Fertility and Their Impacts on Soil Properties, Luwero District, Uganda

Low soil fertility remains a major reason for rural poverty in sub-Saharan Africa. In light of the need to set priorities and formulate development policies, this study investigates efforts by farmers in central Uganda to maintain soil fertility, factors affecting their capacity to act and impacts on soil fertility parameters. Using questionnaire-based interviews and soil chemical analyses, information from 60 randomly selected farms was collected in four subcounties. Farmers use traditional conservation methods like legumes, crop rotation, cover crops, fallow and agroforestry in addition to applying manure, ash, mineral fertilizers and concoctions to improve soil fertility. Most farmers construct some soil bunds. Limited access to supplies, markets, credit and extension service, labor and organic materials are limitations to their ability to maintain soil fertility. Present application of fertility measures are clearly insufficient and are not reflected in soil fertility parameter

Call diversity in the North Pacific killer whale populations: implications for dialect evolution and population history

Although killer whale, Orcinus orca, dialects have been studied in detail in several populations, little attempt has been made to compare dialect characteristics between populations. In this study we investigated geographical variation in monophonic and biphonic calls among four resident populations from the North Pacific Ocean: Northern and Southern residents from British Columbia and Washington State, southern Alaska residents, and eastern Kamchatka residents. We tested predictions generated by the hypothesis that call variation across populations is the result of an accumulation of random errors and innovation by vertical cultural transmission. Call frequency contours were extracted and compared using a dynamic time-warping algorithm. We found that the diversity of monophonic calls was substantially higher than that of biphonic calls for all populations. Repertoire diversity appeared to be related to population size: in larger populations, monophonic calls were more diverse and biphonic calls less diverse. We suggest that the evolution of both monophonic and biphonic calls is caused by an interaction between stochastic processes and directional selection, but the relative effect of directional selection is greater for biphonic calls. Our analysis revealed no direct correlation between call repertoire similarity and geographical distance. Call diversity within predefined call categories, types and subtypes, showed a high degree of correspondence between populations. Our results indicate that dialect evolution is a complex process influenced by an interaction among directional selection, horizontal transmission and founder effects. We suggest several scenarios for how this might have arisen and the implications of these scenarios for call evolution and population history

Hepatocytic expression of human sodium-taurocholate cotransporting polypeptide enables hepatitis B virus infection of macaques.

Hepatitis B virus (HBV) is a major global health concern, and the development of curative therapeutics is urgently needed. Such efforts are impeded by the lack of a physiologically relevant, pre-clinical animal model of HBV infection. Here, we report that expression of the HBV entry receptor, human sodium-taurocholate cotransporting polypeptide (hNTCP), on macaque primary hepatocytes facilitates HBV infection in vitro, where all replicative intermediates including covalently closed circular DNA (cccDNA) are present. Furthermore, viral vector-mediated expression of hNTCP on hepatocytes in vivo renders rhesus macaques permissive to HBV infection. These in vivo macaque HBV infections are characterized by longitudinal HBV DNA in serum, and detection of HBV DNA, RNA, and HBV core antigen (HBcAg) in hepatocytes. Together, these results show that expressing hNTCP on macaque hepatocytes renders them susceptible to HBV infection, thereby establishing a physiologically relevant model of HBV infection to study immune clearance and test therapeutic and curative approaches