Ecological connectivity in fragmented agricultural landscapes and the importance of scattered trees and small patches

Background Fragmentation and habitat loss can restrict species movement and reduce connectivity, negatively impacting biodiversity. Characterising the overall connectivity of an area can inform better management of human modified landscapes. Contemporary connectivity modelling methods seldom incorporate fine-scale movement patterns associated with movement between fine-scaled structural connectivity elements such as scattered trees, roadside corridors and small patches of habitat. This study aims to characterise connectivity within the Karuah-Myall catchments, a typical woodland ecosystem that is fragmented by agriculture, using least-cost path analysis and a graph-theoretic approach; it focuses on how fine-scaled vegetation such as scattered trees support connectivity. We mapped scattered (and paddock) trees within this agricultural landscape where the main human modified land use was pasture. We modelled connectivity for a general representative woodland species using an interpatch dispersal distance and gap crossing threshold, and resistance from different land cover types. The gap crossing distance threshold was used to model movement between fine-scaled vegetation features. We compared the least-cost paths modelled with and without scattered trees. Results Our results show that by excluding scattered trees, least-cost paths across the cleared pasture landscape did not reflect the types of movement patterns typically observed from field studies, such as those associated with a foray-search strategy used by small and medium mammals and birds. The modelling also shows that the Karuah-Myall catchments are well connected and provide value to biodiversity beyond the catchment borders, by connecting coastal vegetation to the Great Eastern Ranges national wildlife corridor initiative. Conclusion Connectivity models that exclude fine-scale landscape features such as scattered trees and small, linear patches risk misrepresenting connectivity patterns. Models of regional-scale connectivity can be influenced by the presence or absence of even the smallest features, such as scattered trees

Patient selection for high sensitivity cardiac troponin testing and diagnosis of myocardial infarction: prospective cohort study

Objective: To evaluate how selection of patients for high sensitivity cardiac troponin testing affects the diagnosis of myocardial infarction across different healthcare settings. Design: Prospective study of three independent consecutive patient populations presenting to emergency departments. Setting: Secondary and tertiary care hospitals in the United Kingdom and United States. Participants: High sensitivity cardiac troponin I concentrations were measured in 8500 consecutive patients presenting to emergency departments: unselected patients in the UK (n=1054) and two selected populations of patients in whom troponin testing was requested by the attending clinician in the UK (n=5815) and the US (n=1631). The final diagnosis of type 1 or type 2 myocardial infarction or myocardial injury was independently adjudicated. Main outcome measures: Positive predictive value of an elevated cardiac troponin concentration for a diagnosis of type 1 myocardial infarction. Results: Cardiac troponin concentrations were elevated in 13.7% (144/1054) of unselected patients, with a prevalence of 1.6% (17/1054) for type 1 myocardial infarction and a positive predictive value of 11.8% (95% confidence interval 7.0% to 18.2%). In selected patients, in whom troponin testing was guided by the attending clinician, the prevalence and positive predictive value were 14.5% (843/5815) and 59.7% (57.0% to 62.2%) in the UK and 4.2% (68/1631) and 16.4% (13.0% to 20.3%) in the US. Across both selected patient populations, the positive predictive value was highest in patients with chest pain, with ischaemia on the electrocardiogram, and with a history of ischaemic heart disease. Conclusions: When high sensitivity cardiac troponin testing is performed widely or without previous clinical assessment, elevated troponin concentrations are common and predominantly reflect myocardial injury rather than myocardial infarction. These observations highlight how selection of patients for cardiac troponin testing varies across healthcare settings and markedly influences the positive predictive value for a diagnosis of myocardial infarction

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Cellulose nanopapers as tight aqueous ultra-filtration membranes

Recently, we have demonstrated the use of wood-derived nanocellulose papers, herein termed nanopapers, for organic solvent nanofiltration applications. In this study, we extend the use of these nanopapers to tight ultrafiltration (UF) membranes. The feasibility of such nanopaper-based UF membranes intended for use in water purification is shown. Four types of nanocelluloses, namely bacterial cellulose, wood-derived nanocellulose, TEMPO-oxidized cellulose nanofibrils and cellulose nanocrystals, were used as raw materials for the production of these nanopaper-based membranes. The resulting nanopapers exhibit a transmembrane permeance in the range of commercially available tight UF membranes with molecular weight cut-offs ranging from 6 to 25 kDa, which depends on the type of nanocellulose used. These molecular weight cut-offs correspond to average pore sizes of a few nanometres. The rejection performance of the nanopapers is on the border of nanofiltration and UF. We demonstrate that the pore size of the nanopapers can be controlled by using different types of nanocellulose fibrils