Safety and Outcome of High-Flow Nasal Oxygen Therapy Outside ICU Setting in Hypoxemic Patients With COVID-19∗

OBJECTIVE: High-flow nasal oxygen (HFNO) therapy is frequently applied outside ICU setting in hypoxemic patients with COVID-19. However, safety concerns limit more widespread use. We aimed to assess the safety and clinical outcomes of initiation of HFNO therapy in COVID-19 on non-ICU wards. DESIGN: Prospective observational multicenter pragmatic study. SETTING: Respiratory wards and ICUs of 10 hospitals in The Netherlands. PATIENTS: Adult patients treated with HFNO for COVID-19-associated hypoxemia between December 2020 and July 2021 were included. Patients with treatment limitations were excluded from this analysis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Outcomes included intubation and mortality rate, duration of hospital and ICU stay, severity of respiratory failure, and complications. Using propensity-matched analysis, we compared patients who initiated HFNO on the wards versus those in ICU. Six hundred eight patients were included, of whom 379 started HFNO on the ward and 229 in the ICU. The intubation rate in the matched cohort (n = 214 patients) was 53% and 60% in ward and ICU starters, respectively (p = 0.41). Mortality rates were comparable between groups (28-d [8% vs 13%], p = 0.28). ICU-free days were significantly higher in ward starters (21 vs 17 d, p &lt; 0.001). No patient died before endotracheal intubation, and the severity of respiratory failure surrounding invasive ventilation and clinical outcomes did not differ between intubated ward and ICU starters (respiratory rate-oxygenation index 3.20 vs 3.38; Pao2:Fio2ratio 65 vs 64 mm Hg; prone positioning after intubation 81 vs 78%; mortality rate 17 vs 25% and ventilator-free days at 28 d 15 vs 13 d, all p values &gt; 0.05). CONCLUSIONS: In this large cohort of hypoxemic patients with COVID-19, initiation of HFNO outside the ICU was safe, and clinical outcomes were similar to initiation in the ICU. Furthermore, the initiation of HFNO on wards saved time in ICU without excess mortality or complicated course. Our results indicate that HFNO initiation outside ICU should be further explored in other hypoxemic diseases and clinical settings aiming to preserve ICU capacity and healthcare costs.</p

Neuropsychological intervention in kindergarten children with subtyped risks of reading retardation

Kindergarten children at risk of developing language problems were administered the Florida Kindergarten Screening Battery. A principal components analysis revealed a verbal and a visual-spatial component and subsequent discriminant function analyses a high verbal/low visual-spatial group (LAL: Latent L) and a high visual-spatial/low verbal group (LAP: Latent P). LAL- and LAP-children were considered at risk for developing an L- or P-type of dyslexia, respectively. As is common practice with children suffering from manifest L- or Pdyslexia, the LAL- and LAP-kindergartners received right and left hemisphere stimulation, respectively. The outcomes were compared with those of bilateral hemispheric stimulation and no intervention. Reading tests were administered in primary school Grades 1 and 5/6; teachers' evaluation of reading took place in Grade 5/6. Overall, the LAL- and LAP- groups showed significant backwardness in word and text reading, both at early and late primary school. Types of intervention made a difference though: not significantly backward in early word, late word, and late text reading were the LAL-children who had received right hemisphere stimulation. Nonintervened LAP-children did not show significant backwardness in early word reading and late text reading, nor did LAP-children who had received left hemisphere or bilateral stimulation. Early text reading was not affected by any treatment. Teacher's evaluations were in support of these findings. Copyright © 2005 by The International Dyslexia Association®

Potential impacts of prolonged absence of influenza virus circulation on subsequent epidemics

BACKGROUND: During the first two years of the COVID-19 pandemic, the circulation of seasonal influenza viruses was unprecedentedly low. This led to concerns that the lack of immune stimulation to influenza viruses combined with waning antibody titres could lead to increased susceptibility to influenza in subsequent seasons, resulting in larger and more severe epidemics. METHODS: We analyzed historical influenza virus epidemiological data from 2003-2019 to assess the historical frequency of near-absence of seasonal influenza virus circulation and its impact on the size and severity of subsequent epidemics. Additionally, we measured haemagglutination inhibition-based antibody titres against seasonal influenza viruses using longitudinal serum samples from 165 healthy adults, collected before and during the COVID-19 pandemic, and estimated how antibody titres against seasonal influenza waned during the first two years of the pandemic. FINDINGS: Low country-level prevalence of influenza virus (sub)types over one or more years occurred frequently before the COVID-19 pandemic and had relatively small impacts on subsequent epidemic size and severity. Additionally, antibody titres against seasonal influenza viruses waned negligibly during the first two years of the pandemic. INTERPRETATION: The commonly held notion that lulls in influenza virus circulation, as observed during the COVID-19 pandemic, will lead to larger and/or more severe subsequent epidemics might not be fully warranted, and it is likely that post-lull seasons will be similar in size and severity to pre-lull seasons. FUNDING: European Research Council, Netherlands Organization for Scientific Research, Royal Dutch Academy of Sciences, Public Health Service of Amsterdam. RESEARCH IN CONTEXT: Evidence before this study: During the first years of the COVID-19 pandemic, the incidence of seasonal influenza was unusually low, leading to widespread concerns of exceptionally large and/or severe influenza epidemics in the coming years. We searched PubMed and Google Scholar using a combination of search terms (i.e., "seasonal influenza", "SARS-CoV-2", "COVID-19", "low incidence", "waning rates", "immune protection") and critically considered published articles and preprints that studied or reviewed the low incidence of seasonal influenza viruses since the start of the COVID-19 pandemic and its potential impact on future seasonal influenza epidemics. We found a substantial body of work describing how influenza virus circulation was reduced during the COVID-19 pandemic, and a number of studies projecting the size of future epidemics, each positing that post-pandemic epidemics are likely to be larger than those observed pre-pandemic. However, it remains unclear to what extent the assumed relationship between accumulated susceptibility and subsequent epidemic size holds, and it remains unknown to what extent antibody levels have waned during the COVID-19 pandemic. Both are potentially crucial for accurate prediction of post-pandemic epidemic sizes.Added value of this study: We find that the relationship between epidemic size and severity and the magnitude of circulation in the preceding season(s) is decidedly more complex than assumed, with the magnitude of influenza circulation in preceding seasons having only limited effects on subsequent epidemic size and severity. Rather, epidemic size and severity are dominated by season-specific effects unrelated to the magnitude of circulation in the preceding season(s). Similarly, we find that antibody levels waned only modestly during the COVID-19 pandemic.Implications of all the available evidence: The lack of changes observed in the patterns of measured antibody titres against seasonal influenza viruses in adults and nearly two decades of epidemiological data suggest that post-pandemic epidemic sizes will likely be similar to those observed pre-pandemic, and challenge the commonly held notion that the widespread concern that the near-absence of seasonal influenza virus circulation during the COVID-19 pandemic, or potential future lulls, are likely to result in larger influenza epidemics in subsequent years

White-Tailed Deer Browsing on Six Shrub Species of Tallgrass Prairie

White-tailed deer (Odocoileus virginianus) populations have in the past, and continue today, to increase in the Great Plains and North America. However, their impact on native plant species and endangered ecosystems such as the tallgrass prairie is poorly documented. To better understand the consequences of increasing deer numbers for native shrubs in grasslands, we assessed the extent of their summer browsing activity on six shrub species (wild plum, rough-leaved dogwood, smooth sumac, fragrant sumac, and coralberry) along transects that spanned riparian margins to upland tallgrass prairie. The proportion of terminal shoots browsed was quantified along established white-tail deer trails and in parallel transects off trails in watersheds that varied in fire history at the Konza Prairie Biological Station (Kansas). Proximity to deer trails was a strong determinant of deer browsing activity. Along trails, 20% of the twigs surveyed (N = 60,032) were browsed, whereas off trails less than I % of twigs (N = 14,785) were browsed. Coralberry and rough-leaved dogwood comprised 80% of the shrub cover along trails, whereas wild plum, prickly ash, smooth sumac, and fragrant sumac had less cover, in that order. However, browsing was greatest on wild plum and rough-leaved dogwood (between 40% and 50% of available twigs), and the proportion of twigs browsed out of the total twigs used was highest for rough-leaved dogwood. Based on preference ratios (use/ abundance), white-tail deer are likely to have the greatest impact on the less common wild plum and smooth sumac as well as rough-leaved dogwood. Interestingly, white-tail deer avoided the most common shrub, coralberry, at this time of year. Our results suggest that even in summer, when deer tend also to forage on herbaceous species in grasslands, deer browsing may have significant local impacts on woody species of tallgrass prairies in the Great Plains. Concurrent increases in woody plant cover and abundance in grasslands throughout the Great Plains suggest that deer browsing is not yet intense enough to prevent shrub expansion into tallgrass prairie

Opportunity Maps for Sustainable Use of Natural Capital

The Dutch government has the ambition to make its policies more “nature-inclusive”. Nature-inclusive policy recognises the wide range of services provided by ecosystems and biodiversity, aiming for sustainable use of these services. Hence, an important objective of the Dutch government is to more explicitly address these benefits and the effects of interventions on natural capital in decision-making processes. Our study contributes to this objective by identifying areas with opportunities for sustainable use of natural capital. It helps policymakers and other stakeholders to focus their policies and to set priorities.We developed a method for making opportunity maps that identify potential areas to use natural capital in a sustainable way. This method was applied to three cases: sustainable food production, flood safety improvement, and sustainable drinking water productio

Kansenkaarten voor duurzaam benutten natuurlijk kapitaal

Lokaal uitgevoerde praktijkprojecten in het kader van het programma Natuurlijk Kapitaal Nederland laten zien dat er kansen zijn voor de wederzijdse versterking van natuur en economie. Dit leidt tot de volgende vragen: welke kansen zijn er om de opgedane kennis binnen deze praktijkprojecten op te schalen naar andere gebieden in Nederland? Waar liggen deze kansrijke gebieden. Wat zijn mogelijke maatregelen en relevante stakeholders om deze kansen daadwerkelijk in winst om te zetten? Om antwoorde te krijgen op deze vragen zijn de praktijkprojecten met behulp van 'kansenkaarten' in landelijk perspectief geplaatst

Opportunity Maps for Sustainable Use of Natural Capital

The Dutch government has the ambition to make its policies more “nature-inclusive”. Nature-inclusive policy recognises the wide range of services provided by ecosystems and biodiversity, aiming for sustainable use of these services. Hence, an important objective of the Dutch government is to more explicitly address these benefits and the effects of interventions on natural capital in decision-making processes. Our study contributes to this objective by identifying areas with opportunities for sustainable use of natural capital. It helps policymakers and other stakeholders to focus their policies and to set priorities.We developed a method for making opportunity maps that identify potential areas to use natural capital in a sustainable way. This method was applied to three cases: sustainable food production, flood safety improvement, and sustainable drinking water productio

Aanbevelingen voor verbetering van de landelijke analyse van effect herstelmaatregelen op biodiversiteit : Verdiepende analyse in zes natuurgebieden

In 2020 a nationwide analysis was carried out of the effectiveness of ecological restoration measures on biodiversity. The study was carried out for the second Reflexive Evaluation of the Nature Pact by Netherlands Environmental Assessment Agency (PBL) and Wageningen University & Research. The results of the analysis were not entirely in line with expectations. In view of the scale and complexity of this first nationwide analysis, certain aspects of the method could possibly be improved. To identify points for improvement, an in-depth study was carried out in which the results of the nationwide analysis for six protected areas were discussed with the relevant conservation managers. It was concluded that improvements can be made to the maps of restoration measures and biodiversity and in the analysis of the link between restoration measures and biodiversity. The maps of restoration measures are not always complete and may contain sites where no restoration measures have been carried out. The biodiversity maps for breeding birds and vascular plants do not always match the local knowledge of the conservation managers, and the species groups selected in the analysis are sometimes too limited. The analyses of the link between restoration measures and biodiversity trends can more accurately take account of the timing of the implementation of restoration measures and the collection of biodiversity data, while also ensuring that the management types (ecosystem types or biotopes for which a specific conservation management regime and objectives apply) are up to date

Psychosis risk for parents and siblings of Dutch and Moroccan-Dutch patients with non-affective psychotic disorder

Background: Studies in the UK compared psychosis risks for first-degree relatives of White and African-Caribbean patients and found "normal" risks for the parents of Caribbean patients, but very high risks for sibling of second-generation Caribbean patients. Aim: To compare the risk of non-affective psychotic disorder (NAPD) for the parents and siblings of Moroccan-Dutch patients to that for the parents and siblings of Dutch patients. The "Moroccan-Dutch" are Dutch residents of Moroccan origin (first or second generation). Method: Informants related to 29 Moroccan-Dutch and 63 Dutch patients were interviewed about the presence of psychiatric disorders in first-degree relatives (N=508), by means of the Family Interview for Genetic Studies. Results: The risks for NAPD in both parent groups Were similar (age and sex-adjusted odds ratio 1.0; 95% CI: 0.3-3.8). However, among the siblings, the risk for NAPD was significantly higher for the Moroccan-Dutch than for the Dutch (sex-adjusted hazard ratio 4.5; 95% Confidence Interval: 1.5-14.0). This was due to a large number of cases among the brothers of the Moroccan-Dutch patients (N=14), not among their sisters (N=1). Owing to small numbers separate hazard ratios for the first and the second generation were not calculated. Conclusion: These preliminary results suggest that environmental factors in the Netherlands have a great impact on the psychosis risk for male immigrants from Morocco. (C) 2008 Elsevier B.V. All rights reserved