Antibody response in patients admitted to the hospital with suspected SARS-CoV-2 infection: results from a multicenter study across Spain

Aim: To evaluate the serological response against SARS-CoV-2 in a multicenter study representative of the Spanish COVID pandemic. Methods: IgG and IgM + IgA responses were measured on 1466 samples from 1236 Spanish COVID-19 patients admitted to the hospital, two commercial ELISA kits (Vircell SL, Spain) based on the detection of antibodies against the viral spike protein and nucleoprotein, were used. Results: Approximately half of the patients presented antibodies (56.8% were IgM + IgA positive and 43.0% were IgG positive) as soon as 2 days after the first positive PCR result. Serological test positivity increased with time from the PCR test, and 10 days after the first PCR result, 91.5% and 88.0% of the patients presented IgM + IgA and IgG antibodies, respectively. Conclusion: The high values of sensitivity attained in the present study from a relatively early period of time after hospitalization support the use of the evaluated serological assays as supplementary diagnostic tests for the clinical management of COVID-19

Incorporating clinical guidelines through clinician decision-making

<p>Abstract</p> <p>Background</p> <p>It is generally acknowledged that a disparity between knowledge and its implementation is adversely affecting quality of care. An example commonly cited is the failure of clinicians to follow clinical guidelines. A guiding assumption of this view is that adherence should be gauged by a standard of conformance. At least some guideline developers dispute this assumption and claim that their efforts are intended to inform and assist clinical practice, not to function as standards of performance. However, their ability to assist and inform will remain limited until an alternative to the conformance criterion is proposed that gauges how evidence-based guidelines are incorporated into clinical decisions.</p> <p>Methods</p> <p>The proposed investigation has two specific aims to identify the processes that affect decisions about incorporating clinical guidelines, and then to develop ad test a strategy that promotes the utilization of evidence-based practices. This paper focuses on the first aim. It presents the rationale, introduces the clinical paradigm of treatment-resistant schizophrenia, and discusses an exemplar of clinician non-conformance to a clinical guideline. A modification of the original study is proposed that targets psychiatric trainees and draws on a cognitively rich theory of decision-making to formulate hypotheses about how the guideline is incorporated into treatment decisions. Twenty volunteer subjects recruited from an accredited psychiatry training program will respond to sixty-four vignettes that represent a fully crossed 2 × 2 × 2 × 4 within-subjects design. The variables consist of criteria contained in the clinical guideline and other relevant factors. Subjects will also respond to a subset of eight vignettes that assesses their overall impression of the guideline. Generalization estimating equation models will be used to test the study's principal hypothesis and perform secondary analyses.</p> <p>Implications</p> <p>The original design of phase two of the proposed investigation will be changed in recognition of newly published literature on the relative effectiveness of treatments for schizophrenia. It is suggested that this literature supports the notion that guidelines serve a valuable function as decision tools, and substantiates the importance of decision-making as the means by which general principles are incorporated into clinical practice.</p

Data used in 'March-Salas et al. 2021 Effects of intrinsic precipitation-predictability on root traits, allocation strategies, and the selective regimes acting on them. Oikos"

Climate change affects means, variances and the intrinsic predictability of the climate. However, experimental tests of how changes in intrinsic climatic predictability affects plant traits, allocation strategies, and the selective regime acting on them are scarce, as well as evidence for the importance of root functional traits to cope with climatic uncertainty. Here, we experimentally manipulated intrinsic daily and inter-seasonal precipitation-predictabilities and tested their effect on root traits, root allocation strategies, the selective regime acting on them, and transgenerational root responses, using a four-year field experiment and Onobrychis viciifolia. More predictable precipitation led to lower root biomass and a lower overall plant performance, and to higher allocation to roots and higher within-root allocation (i.e. allocation to root branching and maximum rooting depth relative to allocation to roots). Differences in intrinsic daily and inter-seasonal predictability induced differences in the strength of selection acting on the studied traits, but did not affect the type of the selective regime, nor the transgenerational responses. The results indicate that higher predictability constrained a plant’s performance, while plants were able to cope with lower predictability. Absence of transgenerational responses in root traits with respect to the predictability treatments, points to slow or no inter-generational changes of root traits in unpredictable habitats. Thus, adjustments in root allocation strategies and changes therein might be key to deal with increasing climatic uncertainty.Peer reviewe

Rapid and positive responses of plants to lower precipitation predictability

[EN] Current climate change is characterized by an increase in weather variability, which includes altered means, variance and predictability of weather parameters, and which may affect an organism's ecology and evolution. Few studies have experimentally manipulated the variability of weather parameters, and very little is known about the effects of changes in the intrinsic predictability of weather parameters on living organisms. Here, we experimentally tested the effects of differences in intrinsic precipitation-predictability on two herbaceous plants (Onobrychis viciifolia and Papaver rhoeas). Lower precipitation-predictability led to phenological advance and to an increase in reproductive success, and population growth. Both species exhibited rapid transgenerational responses in phenology and fitness-related traits across four generations that mitigated most effects of precipitation-predictability on fitness proxies of ancestors. Transgenerational responses appeared to be the result of changes in phenotypic plasticity rather than local adaptation. They mainly existed with respect to conditions prevailing during early, but not during late growth, suggesting that responses to differences in predictability during late growth might be more difficult. The results show that lower short-term predictability of precipitation positively affected fitness, rapid transgenerational responses existed and different time scales of predictability (short-term, seasonal and transgenerational predictability) may affect organisms differently. This shows that the time scale of predictability should be considered in evolutionary and ecological theories, and in assessments of the consequences of climate change.Funding was provided by the Spanish Ministry of Economy and Competitiveness (grant no. CGL2012-32459 to P.S.F.), Ministerio de Ciencias, Investigación, y Universidades (grant no. CGL2016-76918 AEI/FEDER, UE to P.S.F.) and the Swiss National Foundation(grant nos. PPOOP3_128375, PP00P3_152929/1 to P.S.F.). M.M.-S.was supported by a PhD grant (grant no. BES-2013-062910) financedby the Spanish Ministry of Economy and Competitiveness and a travel grant of the Universidad Rey Juan Carlo