Oral dosing for antenatal corticosteroids in the Rhesus macaque.

Antenatal corticosteroids (ACS) are standard of care for women at risk of preterm delivery, although choice of drug, dose or route have not been systematically evaluated. Further, ACS are infrequently used in low resource environments where most of the mortality from prematurity occurs. We report proof of principle experiments to test betamethasone-phosphate (Beta-P) or dexamethasone-phosphate (Dex-P) given orally in comparison to the clinical treatment with the intramuscular combination drug beta-phosphate plus beta-acetate in a Rhesus Macaque model. First, we performed pharmacokinetic studies in non-pregnant monkeys to compare blood levels of the steroids using oral dosing with Beta-P, Dex-P and an effective maternal intramuscular dose of the beta-acetate component of the clinical treatment. We then evaluated maternal and fetal blood steroid levels with limited fetal sampling under ultrasound guidance in pregnant macaques. We found that oral Beta is more slowly cleared from plasma than oral Dex. The blood levels of both drugs were lower in maternal plasma of pregnant than in non-pregnant macaques. Using the pharmacokinetic data, we treated groups of 6-8 pregnant monkeys with oral Beta-P, oral Dex-P, or the maternal intramuscular clinical treatment and saline controls and measured pressure-volume curves to assess corticosteroid effects on lung maturation at 5d. Oral Beta-P improved the pressure-volume curves similarly to the clinical treatment. Oral Dex-P gave more variable and nonsignificant responses. We then compared gene expression in the fetal lung, liver and hippocampus between oral Beta-P and the clinical treatment by RNA-sequencing. The transcriptomes were largely similar with small gene expression differences in the lung and liver, and no differences in the hippocampus between the groups. As proof of principle, ACS therapy can be effective using inexpensive and widely available oral drugs. Clinical dosing strategies must carefully consider the pharmacokinetics of oral Beta-P or Dex-P to minimize fetal exposure while achieving the desired treatment responses

Carbon cycling in mesohaline Chesapeake Bay sediments 1: POC deposition rates and mineralization pathways

Organic carbon cycling in sediments at two locations in the mesohaline Chesapeake Bay was analyzed using available data on sediment sulfate reduction, sediment oxygen consumption, and particulate organic carbon (POC) deposition and burial. Estimates of POC deposition based on the sum of integrated sediment metabolism and POC burial compared well with direct estimates derived from chlorophyll-a collection rates in mid-water column sediment traps. The range of POC deposition estimates (15–31 mol C m−2 yr−1) accounted for a large fraction (36–74%) of average annual net primary production in the mesohaline Bay. The difference between rates of POC deposition and permanent burial indicated that 70–85% of deposited carbon is mineralized on the time scale of a year. Carbon mineralization through sulfate reduction accounted for 30–35% of average net primary production, and was likely responsible for 60–80% of total sediment carbon metabolism. Oxidation of reduced sulfur accounted for a large but quantitatively uncertain portion of SOC in mid-Bay sediments. Our results highlight the quantitative significance of organic carbon sedimentation and attendant anaerobic sediment metabolism in the carbon cycle of a shallow, highly productive estuary

Analyzing the Role of Model Uncertainty for Electronic Health Records

In medicine, both ethical and monetary costs of incorrect predictions can be significant, and the complexity of the problems often necessitates increasingly complex models. Recent work has shown that changing just the random seed is enough for otherwise well-tuned deep neural networks to vary in their individual predicted probabilities. In light of this, we investigate the role of model uncertainty methods in the medical domain. Using RNN ensembles and various Bayesian RNNs, we show that population-level metrics, such as AUC-PR, AUC-ROC, log-likelihood, and calibration error, do not capture model uncertainty. Meanwhile, the presence of significant variability in patient-specific predictions and optimal decisions motivates the need for capturing model uncertainty. Understanding the uncertainty for individual patients is an area with clear clinical impact, such as determining when a model decision is likely to be brittle. We further show that RNNs with only Bayesian embeddings can be a more efficient way to capture model uncertainty compared to ensembles, and we analyze how model uncertainty is impacted across individual input features and patient subgroups.Comment: Published in the ACM Conference on Health, Inference, and Learning (CHIL) 2020. Code available at https://github.com/Google-Health/records-researc

Structural basis of allosteric and synergistic activation of AMPK by furan-2-phosphonic derivative C2 binding

The metabolic stress-sensing enzyme AMP-activated protein kinase (AMPK) is responsible for regulating metabolism in response to energy supply and demand. Drugs that activate AMPK may be useful in the treatment of metabolic diseases including type 2 diabetes. We have determined the crystal structure of AMPK in complex with its activator 5-(5-hydroxyl-isoxazol-3-yl)-furan-2-phosphonic acid (C2), revealing two C2-binding sites in the γ-subunit distinct from nucleotide sites. C2 acts synergistically with the drug A769662 to activate AMPK α1-containing complexes independent of upstream kinases. Our results show that dual drug therapies could be effective AMPK-targeting strategies to treat metabolic diseases

Temperature Regulation of Bacterial Production, Respiration, and Growth Efficiency in a Temperate Salt-marsh Estuary

There is consensus that temperature plays a major role in shaping microbial activity, but there are still questions as to how temperature influences different aspects of bacterioplankton carbon metabolism under different environmental conditions. We examined the temperature dependence of bacterioplankton carbon metabolism, whether this temperature dependence changes at different temperatures, and whether the relationship between temperature and carbon metabolism varies among estuarine sub-systems differing in their degree of enrichment. Two years of intensive sampling in a temperate estuary (Monie Bay, Chesapeake Bay, USA) revealed significant differences in the temperature dependence of bacterial production (BP) and respiration (BR), which drove a strong negative temperature response of bacterial growth efficiency (BGE). Accordingly, BGE was lower in summer (\u3c 0.2) and higher in winter (\u3e 0.5). For all measured metabolic processes, the most pronounced temperature response was observed at lower temperatures, with Q10 values generally 2-fold greater than in warmer waters. Despite significant differences in resource availability, both the temperature dependence and magnitude of BR and bacterioplankton carbon consumption (BCC) were remarkably similar among the 4 estuarine sub-systems. Although temperature dependencies of BP and BGE were also similar, their magnitude differed significantly, with highest values in the nutrient-enriched sub-system and lowest in the open bay. This pattern in carbon metabolism among sub- systems was present throughout the year and was confirmed by temperature manipulation experiments, suggesting the temperature effects on BP and BGE did not override the influence of resource availability. We conclude that temperature is the dominant factor regulating seasonality of BR and BCC in this system, whereas BP and BGE are influenced by both temperature and organic matter quality, with variation in the relative importance of each of these factors throughout the year

Contralateral Hemispheric Cerebral Blood Flow Measured With Arterial Spin Labeling Can Predict Outcome in Acute Stroke.

Background and Purpose- Imaging is frequently used to select acute stroke patients for intra-arterial therapy. Quantitative cerebral blood flow can be measured noninvasively with arterial spin labeling magnetic resonance imaging. Cerebral blood flow levels in the contralateral (unaffected) hemisphere may affect capacity for collateral flow and patient outcome. The goal of this study was to determine whether higher contralateral cerebral blood flow (cCBF) in acute stroke identifies patients with better 90-day functional outcome. Methods- Patients were part of the prospective, multicenter iCAS study (Imaging Collaterals in Acute Stroke) between 2013 and 2017. Consecutive patients were enrolled after being diagnosed with anterior circulation acute ischemic stroke. Inclusion criteria were ischemic anterior circulation stroke, baseline National Institutes of Health Stroke Scale score ≥1, prestroke modified Rankin Scale score ≤2, onset-to-imaging time <24 hours, with imaging including diffusion-weighted imaging and arterial spin labeling. Patients were dichotomized into high and low cCBF groups based on median cCBF. Outcomes were assessed by day-1 and day-5 National Institutes of Health Stroke Scale; and day-30 and day-90 modified Rankin Scale. Multivariable logistic regression was used to test whether cCBF predicted good neurological outcome (modified Rankin Scale score, 0-2) at 90 days. Results- Seventy-seven patients (41 women) met the inclusion criteria with median (interquartile range) age of 66 (55-76) yrs, onset-to-imaging time of 4.8 (3.6-7.7) hours, and baseline National Institutes of Health Stroke Scale score of 13 (9-20). Median cCBF was 38.9 (31.2-44.5) mL per 100 g/min. Higher cCBF predicted good outcome at day 90 (odds ratio, 4.6 [95% CI, 1.4-14.7]; P=0.01), after controlling for baseline National Institutes of Health Stroke Scale, diffusion-weighted imaging lesion volume, and intra-arterial therapy. Conclusions- Higher quantitative cCBF at baseline is a significant predictor of good neurological outcome at day 90. cCBF levels may inform decisions regarding stroke triage, treatment of acute stroke, and general outcome prognosis. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT02225730

Redox reactions and weak buffering capacity lead to acidification in the Chesapeake Bay

The combined effects of anthropogenic and biological CO2 inputs may lead to more rapid acidification in coastal waters compared to the open ocean. It is less clear, however, how redox reactions would contribute to acidification. Here we report estuarine acidification dynamics based on oxygen, hydrogen sulfide (H2S), pH, dissolved inorganic carbon and total alkalinity data from the Chesapeake Bay, where anthropogenic nutrient inputs have led to eutrophication, hypoxia and anoxia, and low pH. We show that a pH minimum occurs in mid-depths where acids are generated as a result of H2S oxidation in waters mixed upward from the anoxic depths. Our analyses also suggest a large synergistic effect from river-ocean mixing, global and local atmospheric CO2 uptake, and CO2 and acid production from respiration and other redox reactions. Together they lead to a poor acid buffering capacity, severe acidification and increased carbonate mineral dissolution in the USA\u27s largest estuary

Testing the magnetar scenario for superluminous supernovae with circular polarimetry

Superluminous supernovae (SLSNe) are at least ∼5 times more luminous than common supernovae (SNe). Especially hydrogen-poor SLSN-I are difficult to explain with conventional powering mechanisms. One possible scenario that might explain such luminosities is that SLSNe-I are powered by an internal engine, such as a magnetar or an accreting black hole. Strong magnetic fields or collimated jets can circularly polarize light. In this work, we measured circular polarization of two SLSNe-I with the FOcal Reducer and low dispersion Spectrograph (FORS2) mounted at the ESO’s Very Large Telescope (VLT). PS17bek, a fast evolving SLSN-I, was observed around peak, while OGLE16dmu, a slowly evolving SLSN-I, was observed 100 days after maximum. Neither SLSN shows evidence of circularly polarized light, however, these non-detections do not rule out the magnetar scenario as the powering engine for SLSNe-I. We calculate the strength of the magnetic field and the expected circular polarization as a function of distance from the magnetar, which decreases very fast. Additionally, we observed no significant linear polarization for PS17bek at four epochs, suggesting that the photosphere near peak is close to spherical symmetry