Seasonal changes in phytoplankton biomass on the Western Agulhas bank, South Africa

Data on temporal and spatial changes in phytoplankton biomass and distribution on the western Agulhas Bank during the main spawning season of pelagic fish were obtained from monthly cruises conducted betweenAugust and March in 1993/94 and September and March in 1994/95. The period was divided into three oceanographic seasons based on different levels of upwelling activity: late winter (August and September), spring(October–December) and summer (January–March). Cross-shelf and vertical distribution patterns of chlorophyll changed markedly during these seasonal periods, reflecting changes in hydrographic structure and in nutrient availability. During late winter, chlorophyll was evenly distributed in the deep, upper-mixed layer (>40 m) across the shelf. A clump-forming Thalassiosira sp. contributed to the moderately high mean chlorophyllconcentration (1.9 mg·m–3) in the upper 30 m. In October and/or September, warming of surface waters inshore gave rise to a modest (2–5 mg chl·m–3) spring bloom, typical of the temperate zone. This was terminated in November by an influx across the shelf of warm, nutrient-impoverished water. Upwelling was sporadic and weak in spring. Summer was characterized by intense, episodic upwelling inshore, with pronounced cross-shelf thermal gradients, intensified by the presence of water of Agulhas origin along the shelf-edge. During an upwelling cycle, rapid hydrographic and biological changes occur over four phases: onset of upwelling, sustained upwelling, quiescence and downwelling. The upwelling productive zone, bounded by the 20°C isotherm, varied fro

Tobacco cessation outcomes: The case for milestone-based services

NTRODUCTION This study focuses on a Midwest State\u27s tobacco quitline. The purpose was to understand possible relationships between services provided and cessation rates.METHODS The data examined in this study came from aggregated intake/treatment data and follow-up interview data. The overall response rate was 22.9%. Measures included quit rate, quit duration, length of services, number of services, stage of change, confidence to quit, and source of referral.RESULTS The dataset included 1452 cases; 77% enrolled in services only once, 17% enrolled twice and 6% enrolled three or more times. Use of medication was higher among those who quit [chi(2)(1)=7.1, p=0.009, Cramer\u27s V=0.07] than among those who did not. Use of e-cigarettes was lower among those who quit at the time of follow-up [chi(2)(1)=31.5, p\u3c0.001, Cramer\u27s V=0.15]. Respondents who had quit at the time of the follow-up were significantly more likely to have reported a higher confidence to quit at intake [chi(2)(1)=24.1, p\u3c0.001, Cramer\u27s V=0.13]. Among those who improved their stage of change during treatment, 35% had quit at follow-up, compared with 18% among those who did not improve.CONCLUSIONS Study findings related to stage of change and associations between confidence and cessation may have meaningful implications. Cessation success may depend on what is accomplished during treatment and the intersection of clients\u27 motivation, satisfaction, confidence, and cessation status at the end of treatment

What is the impact of dexamethasone on postoperative pain in adults undergoing general anaesthesia for elective abdominal surgery: a systematic review and meta-analysis

BACKGROUND: Previous meta-analysis of heterogeneous surgical cohorts demonstrated reduction in postoperative pain with perioperative intravenous dexamethasone, but none have addressed adults undergoing elective abdominal surgery. The aim of this study was to determine the impact of intravenous perioperative dexamethasone on postoperative pain in adults undergoing elective abdominal surgery under general anaesthesia. METHODS: This review was prospectively registered on the international prospective register of systematic reviews (CRD42020176202). Electronic databases Medical Analysis and Retrieval System Online (MEDLINE), Exerpta Medica Database (EMBASE), (CINAHL) Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and trial registries were searched to January 28 2021 for randomised controlled trials, comparing dexamethasone to placebo or alternative antiemetic, that reported pain. The primary outcome was pain score, and secondary outcomes were time to first analgesia, opioid requirements and time to post-anaesthesia care unit (PACU) discharge. RESULTS: Fifty-two studies (5768 participants) were included in the meta-analysis. Pain scores ≤ 4 hour (h) were reduced in patients who received dexamethasone at rest (mean difference (MD), - 0.54, 95% confidence interval (CI) - 0.72 to - 0.35, I2 = 81%) and on movement (MD - 0.42, 95% CI - 0.62 to - 0.22, I2 = 35). In the dexamethasone group, 4-24 h pain scores were less at rest (MD - 0.31, 95% CI - 0.47 to - 0.14, I2 = 96) and on movement (MD - 0.26, 95% CI - 0.39 to - 0.13, I2 = 29) and pain scores ≥ 24 h were reduced at rest (MD - 0.38, 95% CI - 0.52 to - 0.24, I2 = 88) and on movement (MD - 0.38, 95% CI - 0.65 to - 0.11, I2 = 71). Time to first analgesia (minutes) was increased (MD 22.92, 95% CI 11.09 to 34.75, I2 = 98), opioid requirements (mg oral morphine) decreased (MD - 6.66, 95% CI - 9.38 to - 3.93, I2 = 88) and no difference in time to PACU discharge (MD - 3.82, 95% CI - 10.87 to 3.23, I2 = 59%). CONCLUSIONS: Patients receiving dexamethasone had reduced pain scores, postoperative opioid requirements and longer time to first analgesia. Dexamethasone is an effective analgesic adjunct for patients undergoing abdominal surgery

Dominant Role of Nucleotide Substitution in the Diversification of Serotype 3 Pneumococci over Decades and during a Single Infection

Streptococcus pneumoniae of serotype 3 possess a mucoid capsule and cause disease associated with high mortality rates relative to other pneumococci. Phylogenetic analysis of a complete reference genome and 81 draft sequences from clonal complex 180, the predominant serotype 3 clone in much of the world, found most sampled isolates belonged to a clade affected by few diversifying recombinations. However, other isolates indicate significant genetic variation has accumulated over the clonal complex’s entire history. Two closely related genomes, one from the blood and another from the cerebrospinal fluid, were obtained from a patient with meningitis. The pair differed in their behaviour in a mouse model of disease and in their susceptibility to antimicrobials, with at least some of these changes attributable to a mutation that upregulated the patAB efflux pump. This indicates clinically important phenotypic variation can accumulate rapidly through small alterations to the genotype

Do temperature changes cause eczema flares? An English cohort study.

BACKGROUND: It is unclear if ambient temperature changes affect eczema. It is also unclear if people with worse disease are more susceptible to weather-related flares, or specific types of emollient offer protection. Substantiating these links may help inform action plans and patients self-management. OBJECTIVE: To investigate the effect of short-term temperature variations on eczema symptoms in children. METHODS: Data from a UK cohort of 519 children (6 months-12 years) with at least mild eczema, participating in a randomised trial comparing four types of emollients on eczema symptoms, were combined with observed temperature data from the Hadley Centre's Integrated Surface Database.Hot & cold weeks were defined by average regional temperature >75th or <25th percentile, January 2018-February 2020. Eczema flares were defined as ≥3 point change in patient-oriented eczema measure (POEM). Random effects logistic regression models were used to estimate the odds ratios of flares in hot & cold weeks (reference group: temperate weeks). The likelihood ratio test assessed for evidence of effect modification by disease severity and emollient type. RESULTS: The baseline mean age was 4.9 years (SD 3.2) and POEM score was 9.2 (SD 5.5), indicating moderate eczema. 90% of participants lived within 20 km of their nearest weather station. From the 519 participants there were 6,796 consecutively paired POEMs and 1,082 flares.Seasonal variation in POEM scores was observed, suggesting symptoms worsening with colder weather in winter and improving with warmer weather in summer. Odds ratios of flares were: 1.15 (p = 0.136, 95%CI 0.96-1.39) in cold weeks, 0.85 (p = 0.045, 95%CI 0.72-1.00) in hot weeks. Likelihood ratio test showed no evidence of this differing by disease severity (p = 0.53) or emollient type used (p = 0.55). CONCLUSIONS: Our findings are consistent with previous studies demonstrating either improvements in eczema symptoms or reduced flares in hot weather. Worse disease and different emollient types did not increase susceptibility or provide protection against temperature changes. Further work should investigate the role of sunlight, humidity, air pollution and other environmental factors

A qualitative study of patients’ feedback about Outpatient Parenteral Antimicrobial Therapy (OPAT) services in Northern England: implications for service improvement

Objective Outpatient parenteral antimicrobial therapy (OPAT) provides opportunities for improved cost savings, but in the UK, implementation is patchy and a variety of service models are in use. The slow uptake in the UK and Europe is due to a number of clinical, financial and logistical issues, including concern about patient safety. The measurement of patient experience data is commonly used to inform commissioning decisions, but these focus on functional aspects of services and fail to examine the relational aspects of care. This qualitative study examines patients’ experiences of OPAT. Design In-depth, semistructured interviews. Setting Purposive sample of OPAT patients recruited from four acute National Health Service (NHS) Trusts in Northern England. These NHS Trusts between them represented both well-established and recently set-up services running nurse at home, hospital outpatient and/or selfadministration models. Participants We undertook 28 semistructured interviews and one focus group (n=4). Results Despite good patient outcomes, experiences were coloured by patients' personal situation and material circumstances. Many found looking after themselves at home more difficult than they expected, while others continued to work despite their infection. Expensive car parking, late running services and the inconvenience of waiting in for the nurse to arrive frustrated patients, while efficient services, staffed by nurses with the specialist skills needed to manage intravenous treatment had the opposite effect. Many patients felt a local, general practitioner or community health centre based service would resolve many of the practical difficulties that made OPAT inconvenient. Patients could find OPAT anxiety provoking but this could be ameliorated by staff taking the time to reassure patients and provide tailored information. Conclusion Services configurations must accommodate the diversity of the local population. Poor communication can leave patients lacking the confidence needed to be a competent collaborator in their own care and affect their perceptions of the service

The effect of sea temperature and food availability on the spawning success of Cape Anchovy engraulis capensis in the Southern Benguela

Data on the thermal structure, copepod biomass and production, and total number of eggs of the Cape anchovy Engraulis capensis were obtained from monthly surveys during the periods August 1993 – March1994 and September 1994 – March 1995 on the western Agulhas Bank and off the South-Western Cape, South Africa. Previous work suggested that anchovy spawn on the western Agulhas Bank in temperaturesbetween 16 and 19°C, where they feed predominantly on copepods. This study shows that the western Bank is a more suitable spawning area for anchovy, having greater thermal stability, a larger area of 16–19°Cwater and a more consistent food environment than off the South-Western Cape. Also, copepod production on the western Bank was highest in 16–19°C water. To identify factors controlling the area of this watermass, a cluster analysis was used on a suite of hydrographic variables. Three periods were identified: winter (August-September), spring (October-December) and summer (January-March), reflecting changes in theextent of the 16–19°C water and anchovy spawning, both of which peaked during spring. Spring was further characterized by infrequent surface upwelling. During summer, upwelling frequently reached the surface andthe upwelling front migrated offshore, constricting the area of 16–19°C water. It is hypothesized that spawning success in anchovy is dependent upon the extent of suitable spawning habitat, both spatially (16–19°Cwater) and temporally (spring). To put this concept into a predictive framework, the number of anchovy eggs was regressed against the area of 16–19°C water; a significant, positive relationship (p < 0.001, r2 = 0.56, n = 17) was found. An implication of the hypothesis is that the duration of spawning may be important to recruitment

Lineage-Independent Tumors in Bilateral Neuroblastoma

Childhood tumors that occur synchronously in different anatomical sites usually represent metastatic disease. However, such tumors can be independent neoplasms. We investigated whether cases of bilateral neuroblastoma represented independent tumors in two children with pathogenic germline mutations by genotyping somatic mutations shared between tumors and blood. Our results suggested that in both children, the lineages that had given rise to the tumors had segregated within the first cell divisions of the zygote, without being preceded by a common premalignant clone. In one patient, the tumors had parallel evolution, including distinct second hits in SMARCA4, a putative predisposition gene for neuroblastoma. These findings portray cases of bilateral neuroblastoma as having independent lesions mediated by a germline predispositio