Diagnoses and mortality among prehospital emergency patients calling 112 with unclear problems:a population-based cohort study from Denmark

BACKGROUND: Patients calling for an emergency ambulance and assessed as presenting with ‘unclear problem’ account for a considerable part of all emergency calls. Previous studies have demonstrated that these patients are at increased risk for unfavourable outcomes. A deeper insight into the underlying diagnoses and outcomes is essential to improve prehospital treatment. We aimed to investigate which of these diagnoses contributed most to the total burden of diseases in terms of numbers of deaths together with 1- and 30-day mortality. METHODS: A historic regional population-based observational cohort study from the years 2016 to 2018. Diagnoses were classified according to the World Health Organisation ICD-10 System (International Statistical Classification of Diseases and Related Health Problems, 10th edition). The ICD-10 chapters, R (‘symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified)’ and Z (‘factors influencing health status and contact with health services”) were combined and designated “non-specific diagnoses”. Poisson regression with robust variance estimation was used to estimate proportions of mortality in percentages with 95% confidence intervals, crude and adjusted for age, sex and comorbidities. RESULTS: Diagnoses were widespread among the ICD-10 chapters, and the most were ‘non-specific diagnoses’ (40.4%), ‘circulatory diseases’ (9.6%), ‘injuries and poisonings’ (9.4%) and ‘respiratory diseases’ (6.9%). The diagnoses contributing most to the total burden of deaths (n = 554) within 30 days were ‘circulatory diseases’ (n = 148, 26%) followed by ‘non-specific diagnoses’ (n = 88, 16%) ‘respiratory diseases’ (n = 85, 15%), ‘infections’ (n = 54, 10%) and ‘digestive disease’ (n = 39, 7%). Overall mortality was 2.3% (1-day) and 7.1% (30-days). The risk of mortality was highly associated with age. CONCLUSION: This study found that almost half of the patients brought to the hospital after calling 112 with an ‘unclear problem’ were discharged with a ‘non-specific diagnosis’ which might seem trivial but should be explored more as these contributed the second-highest to the total number of deaths after 30 days only exceeded by ‘circulatory diseases’. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13049-022-01052-y

Fast Two-Robot Disk Evacuation with Wireless Communication

In the fast evacuation problem, we study the path planning problem for two robots who want to minimize the worst-case evacuation time on the unit disk. The robots are initially placed at the center of the disk. In order to evacuate, they need to reach an unknown point, the exit, on the boundary of the disk. Once one of the robots finds the exit, it will instantaneously notify the other agent, who will make a beeline to it. The problem has been studied for robots with the same speed~\cite{s1}. We study a more general case where one robot has speed $1$ and the other has speed $s \geq 1$. We provide optimal evacuation strategies in the case that $s \geq c_{2.75} \approx 2.75$ by showing matching upper and lower bounds on the worst-case evacuation time. For $1\leq s < c_{2.75}$, we show (non-matching) upper and lower bounds on the evacuation time with a ratio less than $1.22$. Moreover, we demonstrate that a generalization of the two-robot search strategy from~\cite{s1} is outperformed by our proposed strategies for any $s \geq c_{1.71} \approx 1.71$.Comment: 18 pages, 10 figure

Changes in IgA-targeted microbiota following fecal transplantation for recurrent Clostridioides difficile infection

Secretory immunoglobulin A (IgA) interacts with intestinal microbiota and promotes mucosal homeostasis. IgA-bacteria interactions are altered during inflammatory diseases, but how these interactions are shaped by bacterial, host, and environmental factors remains unclear. In this study, we utilized IgA-SEQ to profile IgA-bound fecal bacteria in 48 recurrent Clostridioides difficile patients before and after successful fecal microbiota transplantation (FMT) to gain further insight. Prior to FMT, Escherichia coli was the most highly IgA-targeted taxon; following restoration of the microbiota by FMT, highly IgA-targeted taxa included multiple Firmicutes species. Post-FMT IgA-targeting was unaffected by the route of FMT delivery (colonoscopy versus capsule), suggesting that both methods lead to the establishment of healthy immune–bacterial interactions in the gut. Interestingly, IgA-targeting in FMT recipients closely resembled the IgA-targeting patterns of the donors, and fecal donor identity was significantly associated with IgA-targeting of the recipient microbiota. These data support the concept that intrinsic bacterial properties drive IgA recognition across genetically distinct human hosts. Together, this study suggests that IgA-bacterial interactions are reestablished in human FMT recipients to resemble that of the healthy fecal donor

A Systematic Review of Longitudinal Trajectories of Mental Health Problems in Children with Neurodevelopmental Disabilities

YesTo review the longitudinal trajectories – and the factors influencing their development – of mental health problems in children with neurodevelopmental disabilities. Systematic review methods were employed. Searches of six databases used keywords and MeSH terms related to children with neurodevelopmental disabilities, mental health problems, and longitudinal research. After the removal of duplicates, reviewers independently screened records for inclusion, extracted data (outcomes and influencing factors), and evaluated the risk of bias. Findings were tabulated and synthesized using graphs and a narrative. Searches identified 94,662 unique records, from which 49 publications were included. The median publication year was 2015. Children with attention deficit hyperactivity disorder were the most commonly included population in retrieved studies. In almost 50% of studies, trajectories of mental health problems changed by Swedish Research Council (2018-05824_VR

Accurate identification and quantification of commensal microbiota bound by host immunoglobulins

Background Identifying which taxa are targeted by immunoglobulins can uncover important host-microbe interactions. Immunoglobulin binding of commensal taxa can be assayed by sorting bound bacteria from samples and using amplicon sequencing to determine their taxonomy, a technique most widely applied to study Immunoglobulin A (IgA-Seq). Previous experiments have scored taxon binding in IgA-Seq datasets by comparing abundances in the IgA bound and unbound sorted fractions. However, as these are relative abundances, such scores are influenced by the levels of the other taxa present and represent an abstract combination of these effects. Diversity in the practical approaches of prior studies also warrants benchmarking of the individual stages involved. Here, we provide a detailed description of the design strategy for an optimised IgA-Seq protocol. Combined with a novel scoring method for IgA-Seq datasets that accounts for the aforementioned effects, this platform enables accurate identification and quantification of commensal gut microbiota targeted by host immunoglobulins. Results Using germ-free and Rag1−/− mice as negative controls, and a strain-specific IgA antibody as a positive control, we determine optimal reagents and fluorescence-activated cell sorting (FACS) parameters for IgA-Seq. Using simulated IgA-Seq data, we show that existing IgA-Seq scoring methods are influenced by pre-sort relative abundances. This has consequences for the interpretation of case-control studies where there are inherent differences in microbiota composition between groups. We show that these effects can be addressed using a novel scoring approach based on posterior probabilities. Finally, we demonstrate the utility of both the IgA-Seq protocol and probability-based scores by examining both novel and published data from in vivo disease models. Conclusions We provide a detailed IgA-Seq protocol to accurately isolate IgA-bound taxa from intestinal samples. Using simulated and experimental data, we demonstrate novel probability-based scores that adjust for the compositional nature of relative abundance data to accurately quantify taxon-level IgA binding. All scoring approaches are made available in the IgAScores R package. These methods should improve the generation and interpretation of IgA-Seq datasets and could be applied to study other immunoglobulins and sample types. Video abstractMedicine, Faculty ofScience, Faculty ofNon UBCBiochemistry and Molecular Biology, Department ofMicrobiology and Immunology, Department ofReviewedFacultyResearche

Phylogenetic analysis of phenotypic characters of Tunicata supports basal Appendicularia and monophyletic Ascidiacea

With approximately 3000 marine species, Tunicata represents the most disparate subtaxon of Chordata. Molecular phylogenetic studies support Tunicata as sister taxon to Craniota, rendering it pivotal to understanding craniate evolution. Although successively more molecular data have become available to resolve internal tunicate phylogenetic relationships, phenotypic data have not been utilized consistently. Herein these shortcomings are addressed by cladistically analyzing 117 phenotypic characters for 49 tunicate species comprising all higher tunicate taxa, and five craniate and cephalochordate outgroup species. In addition, a combined analysis of the phenotypic characters with 18S rDNA ‐sequence data is performed in 32 OTU s. The analysis of the combined data is congruent with published molecular analyses. Successively up‐weighting phenotypic characters indicates that phenotypic data contribute disproportionally more to the resulting phylogenetic hypothesis. The strict consensus tree from the analysis of the phenotypic characters as well as the single most parsimonious tree found in the analysis of the combined dataset recover monophyletic Appendicularia as sister taxon to the remaining tunicate taxa. Thus, both datasets support the hypothesis that the last common ancestor of Tunicata was free‐living and that ascidian sessility is a derived trait within Tunicata. “Thaliacea” is found to be paraphyletic with Pyrosomatida as sister taxon to monophyletic Ascidiacea and the relationship between Doliolida and Salpida is unresolved in the analysis of morphological characters; however, the analysis of the combined data reconstructs Thaliacea as monophyletic nested within paraphyletic “Ascidiacea”. Therefore, both datasets differ in the interpretation of the evolution of the complex holoplanktonic life history of thaliacean taxa. According to the phenotypic data, this evolution occurred in the plankton, whereas from the combined dataset a secondary transition into the plankton from a sessile ascidian is inferred. Besides these major differences, both analyses are in accord on many phylogenetic groupings, although both phylogenetic reconstructions invoke a high degree of homoplasy. In conclusion, this study represents the first serious attempt to utilize the potential phylogenetic information present in phenotypic characters to elucidate the inter‐relationships of this diverse marine taxon in a consistent cladistic framework.Peer Reviewe

Wadden Sea Quality Status Report: Marine Mammals

The aim of the quality status report is to inform about the actual status of the harbour seal, grey seal and harbour porpoise within the Wadden Sea Area of Denmark, Germany and the Netherlands. As top predators, they are sentinels for ecosystem health. A variety of marine mammal experts of all three countries have evaluated and assessed the research data collected during the current reporting period to provide an overview of the status of the three species within the Wadden Sea region. For seals, research methods include surveys following established monitoring methods to provide information on abundance and distribution. For porpoises, information was collated from aerial survey work, passive acoustic monitoring, tagging, and stranding networks. Population biology and health parameters were collected during necropsies of stranded marine mammals. Monitoring methods and coverage differed between regions and countries. Area-wide and continuous monitoring are essential for being able to observe changes and possible negative developments and allow for timely measures for the conservation of the three marine mammal species within the Wadden Sea Area. Marine mammals in the North Sea face a wide range of threats: underwater noise, fishing and pollution (contaminants and litter) which can affect their health and influence their distribution. Despite the current anthropogenic impacts, harbour seal counts during moult revealed the highest numbers since the first assessment in 2000. The same is true for the grey seal population: here, a constant rise since their return to the Wadden Sea in the mid-20th century was observed. For harbour porpoises, a southward shift was detected during large scale SCANS surveys between 1994 and 2016. German aerial surveys revealed a decreasing trend in porpoise density in the Natura2000 site “Sylt Outer Reef” west of Sylt as well as a decline in the entire German North Sea. Telemetry data on six harbour porpoises indicated residency in the Wadden Sea waters. Based on the current status of the harbour seal, grey seal and harbour porpoise, recommendations for the protection of these marine mammal species were formulated