Non-invasive respiratory support in the management of acute COVID-19 pneumonia: considerations for clinical practice and priorities for research

Non-invasive respiratory support (NIRS) has increasingly been used in the management of COVID-19-associated acute respiratory failure, but questions remain about the utility, safety, and outcome benefit of NIRS strategies. We identified two randomised controlled trials and 83 observational studies, compromising 13 931 patients, that examined the effects of NIRS modalities-high-flow nasal oxygen, continuous positive airway pressure, and bilevel positive airway pressure-on patients with COVID-19. Of 5120 patients who were candidates for full treatment escalation, 1880 (37%) progressed to invasive mechanical ventilation and 3658 of 4669 (78%) survived to study end. Survival was 30% among the 1050 patients for whom NIRS was the stated ceiling of treatment. The two randomised controlled trials indicate superiority of non-invasive ventilation over high-flow nasal oxygen in reducing the need for intubation. Reported complication rates were low. Overall, the studies indicate that NIRS in patients with COVID-19 is safe, improves resource utilisation, and might be associated with better outcomes. To guide clinical decision making, prospective, randomised studies are needed to address timing of intervention, optimal use of NIRS modalities-alone or in combination-and validation of tools such as oxygenation indices, response to a trial of NIRS, and inflammatory markers as predictors of treatment success

Scaling Regimes, Crossovers, and Lattice Corrections in 2D Heisenberg Antiferromagnets

We study scaling behavior in 2D, S=1/2 and S=1 Heisenberg antiferromagnets using the data on full q-dependences of the equal time structure factor and the static susceptibility, calculated through high temperature expansions. We also carry out comparisons with a model of two coupled S=1/2 planes with the interlayer coupling tuned to the T=0 critical point. We separately determine the spin-wave velocity c and mass $m=c/\xi$, in addition to the correlation length, $\xi$, and find that c is temperature dependent; only for T\alt JS, it approaches its known T=0 value $c_0$. Despite this temperature dependent spin-wave velocity, full q- and $\omega$-dependences of the dynamical susceptibility $\chi(\bf q,\omega)$ agree with the universal scaling functions computable for the $\sigma$-model, for temperatures upto $T_0 \sim 0.6c_0/a$. Detailed comparisons show that below $T_0$ the S=1 model is in the renormalized classical (RC) regime, the two plane model is in the quantum critical (QC) regime, and the S=1/2 model exhibits a RC-QC crossover, centered at T=0.55J. In particular, for the S=1/2 model above this crossover and for the two-plane model at all T, the spin-wave mass is in excellent agreement with the universal QC prediction, $m\simeq 1.04\,T$. In contrast, for the S=1/2 model below the RC-QC crossover, and for the S=1 model at all T, the behavior agrees with the known RC expression. For all models nonuniversal behavior occurs above $T\sim 0.6c_0/a$. Our results strongly support the conjecture of Chubukov and Sachdev that the S=1/2 model is close to the T=0 critical point to exhibit QC behavior.Comment: 13 pages, REVTeX with attached PostScript (see file for addl info

Spin Gaps and Bilayer Coupling in YBa2_2Cu3_3O7−δ_{7-\delta} and YBa2_2Cu4_4O8_8

We investigate the relevance to the physics of underdoped YBa$_2$Cu$_3$O$_{\rm 6+x}$ and YBa$_2$Cu$_4$O$_8$ of the quantum critical point which occurs in a model of two antiferromagnetically coupled planes of antiferromagnetically correlated spins. We use a Schwinger boson mean field theory and a scaling analysis to obtain the phase diagram of the model and the temperature and frequency dependence of various susceptibilities and relaxation rates. We distinguish between a low $\omega ,T$ coupled-planes regime in which the optic spin excitations are frozen out and a high $\omega ,T$ decoupled-planes regime in which the two planes fluctuate independently. In the coupled-planes regime the yttrium nuclear relaxation rate at low temperatures is larger relative to the copper and oxygen rates than would be naively expected in a model of uncorrelated planes. Available data suggest that in YBa$_2$Cu$_4$O$_8$ the crossover from the coupled to the decoupled planes regime occurs at $T 700K$ or $T \sim 200K$. The predicted correlation length is of order 6 lattice constants at $T=200K$. Experimental data related to the antiferromagnetic susceptibility of YBa$_2$Cu$_4$O$_8$ may be made consistent with the theory, but available data for the uniform susceptibility are inconsistent with the theory.Comment: RevTex 3.

Mutation at the Evi1 locus in Junbo mice causes susceptibility to otitis media

Otitis media ( OM), inflammation of the middle ear, remains the most common cause of hearing impairment in children. It is also the most common cause of surgery in children in the developed world. There is evidence from studies of the human population and mouse models that there is a significant genetic component predisposing to OM, yet nothing is known about the underlying genetic pathways involved in humans. We identified an N-ethyl-N-nitrosourea-induced dominant mouse mutant Junbo with hearing loss due to chronic suppurative OM and otorrhea. This develops from acute OM that arises spontaneously in the postnatal period, with the age of onset and early severity dependent on the microbiological status of the mice and their air quality. We have identified the causal mutation, a missense change in the C-terminal zinc finger region of the transcription factor Evi1. This protein is expressed in middle ear basal epithelial cells, fibroblasts, and neutrophil leukocytes at postnatal day 13 and 21 when inflammatory changes are underway. The identification and characterization of the Junbo mutant elaborates a novel role for Evi1 in mammalian disease and implicates a new pathway in genetic predisposition to OM

SONIC Students Online in Nursing Integrated Curricula A reflective account of a teaching and learning journey

Why develop online resources for problem-based learning? PBL is a pedagogy which requires students to seek resources for themselves. Providing students with easily accessible resources must surely run counter to the philosophy. PBL is first and foremost a strategy for learning; its overriding purpose is to assist learners to acquire, not only factual knowledge, but the transferable learning, critical thinking, and reflective skills necessary for professional life. PBL is thus ideally suited to the education of nurses.In nurse education a tension exists between the need to develop critical thinking skills and the requirement to acquire, simultaneously, the clinical proficiencies set by the Nursing and Midwifery Council. Meeting these demands within the time frame of an undergraduate nursing programme presents a considerable challenge. This monograph details the journey of the SONIC project group as they met this challenge, maximising student study time by combining the benefits offered by PBL with online resources targeted to topics which nursing students traditionally find difficult. At journey’s end their resources, offered freely, without the barrier of complex entry procedures, fit not only with the programmes run by the four partner institutions and other Schools of Nursing but also with programmes offered by other health care discipline

Conserving, Distributing and Managing Genetically Modified Mouse Lines by Sperm Cryopreservation

Sperm from C57BL/6 mice are difficult to cryopreserve and recover. Yet, the majority of genetically modified (GM) lines are maintained on this genetic background.Reported here is the development of an easily implemented method that consistently yields fertilization rates of 70+/-5% with this strain. This six-fold increase is achieved by collecting sperm from the vas deferens and epididymis into a cryoprotective medium of 18% raffinose (w/v), 3% skim milk (w/v) and 477 microM monothioglycerol. The sperm suspension is loaded into 0.25 mL French straws and cooled at 37+/-1 degrees C/min before being plunged and then stored in LN(2). Subsequent to storage, the sperm are warmed at 2,232+/-162 degrees C/min and incubated in in vitro fertilization media for an hour prior to the addition of oocyte cumulus masses from superovulated females. Sperm from 735 GM mouse lines on 12 common genetic backgrounds including C57BL/6J, BALB/cJ, 129S1/SvImJ, FVB/NJ and NOD/ShiLtJ were cryopreserved and recovered. C57BL/6J and BALB/cByJ fertilization rates, using frozen sperm, were slightly reduced compared to rates involving fresh sperm; fertilization rates using fresh or frozen sperm were equivalent in all other lines. Developmental capacity of embryos produced using cryopreserved sperm was equivalent, or superior to, cryopreserved IVF-derived embryos.Combined, these results demonstrate the broad applicability of our approach as an economical and efficient option for archiving and distributing mice

Life Cycle-Dependent Cytoskeletal Modifications in Plasmodium falciparum Infected Erythrocytes

10.1371/journal.pone.0061170PLoS ONE84

Melatonin protects rats from radiotherapy-induced small intestine toxicity

Radiotherapy-induced gut toxicity is among the most prevalent dose-limiting toxicities following radiotherapy. Prevention of radiation enteropathy requires protection of the small intestine. However, despite the prevalence and burden of this pathology, there are currently no effective treatments for radiotherapy-induced gut toxicity, and this pathology remains unclear. The present study aimed to investigate the changes induced in the rat small intestine after external irradiation of the tongue, and to explore the potential radio-protective effects of melatonin gel. Male Wistar rats were subjected to irradiation of their tongues with an X-Ray YXLON Y.Tu 320-D03 irradiator, receiving a dose of 7.5 Gy/day for 5 days. For 21 days post-irradiation, rats were treated with 45 mg/day melatonin gel or vehicle, by local application into their mouths. Our results showed that mitochondrial oxidative stress, bioenergetic impairment, and subsequent NLRP3 inflammasome activation were involved in the development of radiotherapy-induced gut toxicity. Oral treatment with melatonin gel had a protective effect in the small intestine, which was associated with mitochondrial protection and, consequently, with a reduced inflammatory response, blunting the NF-κB/NLRP3 inflammasome signaling activation. Thus, rats treated with melatonin gel showed reduced intestinal apoptosis, relieving mucosal dysfunction and facilitating intestinal mucosa recovery. Our findings suggest that oral treatment with melatonin gel may be a potential preventive therapy for radiotherapy-induced gut toxicity in cancer patients.This study was partially supported by grant no. SAF2009-14037 from the Spanish Ministry of Economy and Competitivity (MINECO), GREIB.PT_2010_04 from the CEIBiotic Program of the University of Granada, Spain, and CTS-101 from the Consejería de Innovación, Ciencia y Empresa, Junta de Andalucía, Spain