Feasibility of Noninvasive Positive Pressure Ventilation in the Treatment of Oxygen-Dependent COVID-19 Patients in Peru

Intensive care is expensive, and availability is limited. Low- and middle-income countries in particular have struggled to cope with the large influx of critically ill patients during the COVID-19 pandemic. Noninvasive respiratory support devices delivering continuous positive airways pressure (CPAP) require less resource and staff expertise compared with invasive mechanical ventilators and can be routinely used outside of intensive care units. This study assessed the use of the UCL-Ventura Wayrachi CPAP device in hospitalized patients with COVID-19 in Peru. A secondary analysis of data collected for a feasibility study commissioned by the Peruvian Ministry of Health was conducted. Data were collected from three hospitals, including patient demographics, clinical data, and outcomes. Forty-five patients were enrolled from July 16 to September 1, 2020. Eight patients (18%) were intolerant of the CPAP mask. Of the remainder, 18 (48.7%) improved and were discharged from hospital after 6 days. Eight (21.6%) died while on CPAP and 11 (29.7%) were eventually intubated, of whom two died. In total, 27 (60%) survived to hospital discharge. Participating physicians noted the device was easy to use and provided patient benefit, though voiced concerns about the strain on hospital oxygen supplies. In conclusion, the UCL Ventura Wayrachi CPAP device proved feasible in COVID-19 patients in Peru, and offered a bridging therapy for patients who required a ventilator when none were available

The homotopy theory of dg-categories and derived Morita theory

The main purpose of this work is the study of the homotopy theory of dg-categories up to quasi-equivalences. Our main result provides a natural description of the mapping spaces between two dg-categories $C$ and $D$ in terms of the nerve of a certain category of $(C,D)$-bimodules. We also prove that the homotopy category $Ho(dg-Cat)$ is cartesian closed (i.e. possesses internal Hom's relative to the tensor product). We use these two results in order to prove a derived version of Morita theory, describing the morphisms between dg-categories of modules over two dg-categories $C$ and $D$ as the dg-category of $(C,D)$-bi-modules. Finally, we give three applications of our results. The first one expresses Hochschild cohomology as endomorphisms of the identity functor, as well as higher homotopy groups of the \emph{classifying space of dg-categories} (i.e. the nerve of the category of dg-categories and quasi-equivalences between them). The second application is the existence of a good theory of localization for dg-categories, defined in terms of a natural universal property. Our last application states that the dg-category of (continuous) morphisms between the dg-categories of quasi-coherent (resp. perfect) complexes on two schemes (resp. smooth and proper schemes) is quasi-equivalent to the dg-category of quasi-coherent complexes (resp. perfect) on their product.Comment: 50 pages. Few mistakes corrected, and some references added. Thm. 8.15 is new. Minor corrections. Final version, to appear in Inventione

Spatial Connectivity and Drivers of Shark Habitat Use Within a Large Marine Protected Area in the Caribbean, The Bahamas Shark Sanctuary

Marine protected areas (MPAs) have emerged as potentially important conservation tools for the conservation of biodiversity and mitigation of climate impacts. Among MPAs, a large percentage has been created with the implicit goal of protecting shark populations, including 17 shark sanctuaries which fully protect sharks throughout their jurisdiction. The Commonwealth of the Bahamas represents a long-term MPA for sharks, following the banning of commercial longlining in 1993 and subsequent designation as a shark sanctuary in 2011. Little is known, however, about the longterm behavior and space use of sharks within this protected area, particularly among reef-associated sharks for which the sanctuary presumably offers the most benefit. We used acoustic telemetry to advance our understanding of the ecology of such sharks, namely Caribbean reef sharks (Carcharhinus perezi) and tiger sharks (Galeocerdo cuvier), over two discrete islands (New Providence and Great Exuma) varying in human activity level, over 2 years. We evaluated which factors influenced the likelihood of detection of individuals, analyzed patterns of movement and occurrence, and identified variability in habitat selection among species and regions, using a dataset of 23 Caribbean reef sharks and 15 tiger sharks which were passively monitored in two arrays with a combined total of 13 acoustic receivers. Caribbean reef sharks had lower detection probabilities than tiger sharks, and exhibited relatively low habitat connectivity and high residency, while tiger sharks demonstrated wider roaming behavior across much greater space. Tiger sharks were associated with shallow seagrass habitats where available, but frequently transited between and connected different habitat types. Our data support the notion that large MPAs afford greater degrees of protection for highly resident species such as Caribbean reef sharks, shark, acoustic telemetry, marine protected area, MPA, seagrass, coral reef, Bahamas, Caribbea

Detectionof gas hydrates infaults using azimuthal seismic velocity analysis,Vestnesa Ridge, W-Svalbard Margin

Accepted for publication in Journal of Geophysical Research. Solid Earth. Copyright 2020 American Geophysical Union. Further reproduction or electronic distribution is not permitted.Joint analysis of electrical resistivity and seismic velocity data is primarily used to detect the presence of gas hydrate‐filled faults and fractures. In this study, we present a novel approach to infer the occurrence of structurally‐controlled gas hydrate accumulations using azimuthal seismic velocity analysis. We perform this analysis using ocean‐bottom seismic (OBS) data at two sites on Vestnesa Ridge, W‐Svalbard Margin. Previous geophysical studies inferred the presence of gas hydrates at shallow depths (up to ~190‐195 m below the seafloor) in marine sediments of Vestnesa Ridge. We analyze azimuthal P‐wave seismic velocities in relation with steeply‐dipping near surface faults to study structural controls on gas hydrate distribution. This unique analysis documents directional changes in seismic velocities along and across faults. P‐wave velocities are elevated and reduced by ~0.06‐0.08 km/s in azimuths where the raypath plane lies along the fault plane in the gas hydrate stability zone (GHSZ) and below the base of the GHSZ, respectively. The resulting velocities can be explained with the presence of gas hydrate‐ and free gas‐filled faults above and below the base of the GHSZ, respectively. Moreover, the occurrence of elevated and reduced (>0.05 km/s) seismic velocities in groups of azimuths bounded by faults, suggests compartmentalization of gas hydrates and free gas by fault planes. Results from gas hydrate saturation modelling suggest that these observed changes in seismic velocities with azimuth can be due to gas hydrate saturated faults of thickness greater than 20 cm and considerably smaller than 300 cm

What will the cardiovascular disease slowdown cost? Modelling the impact of CVD trends on dementia, disability, and economic costs in England and Wales from 2020-2029.

To model the health impact and economic costs of the recent slowing of the historical decline in cardiovascular disease (CVD) incidence

Integrating omics to characterize eco‐physiological adaptations: How moose diet and metabolism differ across biogeographic zones

1. With accelerated land conversion and global heating at northern latitudes, it becomes crucial to understand, how life histories of animals in extreme environments adapt to these changes. Animals may either adapt by adjusting foraging behavior or through physiological responses, including adjusting their energy metabolism or both. Until now, it has been difficult to study such adaptations in free‐ranging animals due to methodological constraints that prevent extensive spatiotemporal coverage of ecological and physiological data. 2. Through a novel approach of combining DNA‐metabarcoding and nuclear magnetic resonance (NMR)‐based metabolomics, we aim to elucidate the links between diets and metabolism in Scandinavian moose Alces alces over three biogeographic zones using a unique dataset of 265 marked individuals. 3. Based on 17 diet items, we identified four different classes of diet types that match browse species availability in respective ecoregions in northern Sweden. Individuals in the boreal zone consumed predominantly pine and had the least diverse diets, while individuals with highest diet diversity occurred in the coastal areas. Males exhibited lower average diet diversity than females. 4. We identified several molecular markers indicating metabolic constraints linked to diet constraints in terms of food availability during winter. While animals consuming pine had higher lipid, phospocholine, and glycerophosphocholine concentrations in their serum than other diet types, birch‐ and willow/aspen‐rich diets exhibit elevated concentrations of several amino acids. The individuals with highest diet diversity had increased levels of ketone bodies, indicating extensive periods of starvation for these individuals. 5. Our results show how the adaptive capacity of moose at the eco‐physiological level varies over a large eco‐geographic scale and how it responds to land use pressures. In light of extensive ongoing climate and land use changes, these findings pave the way for future scenario building for animal adaptive capacity

Peroxisome Proliferator-Activated Receptor alpha (PPAR alpha) down-regulation in cystic fibrosis lymphocytes

Background: PPARs exhibit anti-inflammatory capacities and are potential modulators of the inflammatory response. We hypothesized that their expression and/or function may be altered in cystic fibrosis (CF), a disorder characterized by an excessive host inflammatory response. Methods: PPARα, β and γ mRNA levels were measured in peripheral blood cells of CF patients and healthy subjects via RT-PCR. PPARα protein expression and subcellular localization was determined via western blot and immunofluorescence, respectively. The activity of PPARα was analyzed by gel shift assay. Results: In lymphocytes, the expression of PPARα mRNA, but not of PPARβ, was reduced (-37%; p < 0.002) in CF patients compared with healthy persons and was therefore further analyzed. A similar reduction of PPARα was observed at protein level (-26%; p < 0.05). The transcription factor was mainly expressed in the cytosol of lymphocytes, with low expression in the nucleus. Moreover, DNA binding activity of the transcription factor was 36% less in lymphocytes of patients (p < 0.01). For PPARα and PPARβ mRNA expression in monocytes and neutrophils, no significant differences were observed between CF patients and healthy persons. In all cells, PPARγ mRNA levels were below the detection limit. Conclusion: Lymphocytes are important regulators of the inflammatory response by releasing cytokines and antibodies. The diminished lymphocytic expression and activity of PPARα may therefore contribute to the inflammatory processes that are observed in CF

Systematically missing confounders in individual participant data meta-analysis of observational cohort studies.

One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an exposure and disease either are restricted to cohorts with full confounder information, or use all cohorts but do not fully adjust for confounding. We propose using a bivariate random-effects meta-analysis model to use information from all available cohorts while still adjusting for all the potential confounders. Our method uses both the fully adjusted and the partially adjusted estimated effects in the cohorts with full confounder information, together with an estimate of their within-cohort correlation. The method is applied to estimate the association between fibrinogen level and coronary heart disease incidence using data from 154,012 participants in 31 cohort