Hospital re-admission after critical care survival: a systematic review and meta-analysis

Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3-21.2%) at 30 days; 31.0% (95%CI: 24.3-38.6%) at 90 days; 29.6% (95%CI: 24.5-35.2%) at six months; and 53.3% (95%CI: 44.4-62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.

Which factor is more important: Intensity or duration of episodic heat stress on broiler chickens?

With the current global warming, there is a predicted increase in frequency, intensity and duration of heat waves in future. Little is known of how this could affect the welfare of broiler chickens. Sixty-four broiler chickens were subjected to either high heat stress (HHS; 32 °C, 70% RH for 3 h), moderate heat stress (MHS; 30 °C, 70% RH for 6 h), or normal conditions (NC: 20 °C, 50% RH for 6 h) for two consecutive days. On both days, the temperature-ID chips on all chipped birds were scanned during pre-heat stress (PrHS), end of 3 h (3HS) and 6 h (6HS) of heat stress using a pocket reader. Half of the chip birds' CBT was measured at the end of each hour of heat stress (HS: 1^st -3^rd hour). Surface body temperatures (SBTs) from under the wing (WT), feet (FT), cloaca (CLT) and comb (CT) were measured. Blood samples, feed intake, daily weight gain and mortality was also monitored. Data was analysed using General Linear Model and simple linear regression. At 3HS, CBT/ΔCBT and all SBTs showed this trend: HHS>MHS>NC (P<0.001). The regression equations to predict ΔCBT in HHS and MHS are ΔCBT = 0.917 + 0.663 h, P<0.05 and ΔCBT = 0.371 + 0.338 h, P<0.05 respectively. Blood pH, pCO₂, iCa, HCO₃^- and TCO₂ showed same trend: HHS, MHS > NC (P<0.05). Comparing HHS for 3 h with MHS and NC for 6 h shows that CBT/ΔCBT, WT and CLT in HHS, MHS>control (P<0.001) while FT and CT showed a different trend (HHS > MHS > NC, P<0.001). pCO_2, feed intake and daily weight gain showed same trend (HHS, MHS > control). Temperature-ID chip (a less invasive technique) gave CBT/ΔCBT values that corresponded with the degree of heat stress experienced by the birds. Broilers were more tolerant to MHS than HHS after 3 h but MHS for 6 h and HHS for 3 h had similar impact.

Constrained Domain Adaptation for Image Segmentation

Domain Adaption tasks have recently attracted substantial attention in computer vision as they improve the transferability of deep network models from a source to a target domain with different characteristics. A large body of state-of-the-art domain-adaptation methods was developed for image classification purposes, which may be inadequate for segmentation tasks. We propose to adapt segmentation networks with a constrained formulation, which embeds domain-invariant prior knowledge about the segmentation regions. Such knowledge may take the form of anatomical information, for instance, structure size or shape, which can be known a priori or learned from the source samples via an auxiliary task. Our general formulation imposes inequality constraints on the network predictions of unlabeled or weakly labeled target samples, thereby matching implicitly the prediction statistics of the target and source domains, with permitted uncertainty of prior knowledge. Furthermore, our inequality constraints easily integrate weak annotations of the target data, such as image-level tags. We address the ensuing constrained optimization problem with differentiable penalties, fully suited for conventional stochastic gradient descent approaches. Unlike common two-step adversarial training, our formulation is based on a single segmentation network, which simplifies adaptation, while improving training quality. Comparison with state-of-the-art adaptation methods reveals considerably better performance of our model on two challenging tasks. Particularly, it consistently yields a performance gain of 1-4% Dice across architectures and datasets. Our results also show robustness to imprecision in the prior knowledge. The versatility of our novel approach can be readily used in various segmentation problems, with code available publicly.

Predictive Modeling of Tacrolimus Dose Requirement Based on High-Throughput Genetic Screening

Any biochemical reaction underlying drug metabolism depends on individual gene-drug interactions and on groups of genes interacting together. Based on a high-throughput genetic approach, we sought to identify a set of covariant single-nucleotide polymorphisms predictive of interindividual tacrolimus (Tac) dose requirement variability. Tac blood concentrations (Tac C₀ ) of 229 kidney transplant recipients were repeatedly monitored after transplantation over 3 mo. Given the high dimension of the genomic data in comparison to the low number of observations and the high multicolinearity among the variables (gene variants), we developed an original predictive approach that integrates an ensemble variable-selection strategy to reinforce the stability of the variable-selection process and multivariate modeling. Our predictive models explained up to 70% of total variability in Tac C₀ per dose with a maximum of 44 gene variants (p-value <0.001 with a permutation test). These models included molecular networks of drug metabolism with oxidoreductase activities and the multidrug-resistant ABCC8 transporter, which was found in the most stringent model. Finally, we identified an intronic variant of the gene encoding SLC28A3, a drug transporter, as a key gene involved in Tac metabolism, and we confirmed it in an independent validation cohort.

Using body temperature, food and water consumption as biomarkers of disease progression in mice with Eμ-myc lymphoma

Background:

Non-invasive biomarkers of disease progression in mice with cancer are lacking making it challenging to implement appropriate humane end points. We investigated whether body temperature, food and water consumption could be used to predict tumour burden.

Methods:

Thirty-six male, wild-type C57Bl/6 mice were implanted with subcutaneous RFID temperature sensors and inoculated with Eμ-myc tumours that infiltrate lymphoid tissue.

Results:

Decrease in body temperature over the course of the study positively predicted post-mortem lymph node tumour burden (R²=0.68, F(1,22)=44.8, P<0.001). At experimental and humane end points, all mice that had a mean decrease in body temperature of 0.7 °C or greater had lymph nodes heavier than 0.5 g (100% sensitivity), whereas a mean decrease in body temperature <0.7 °C always predicted lymph nodes lighter than 0.5 g (100% specificity). The mean decrease in food consumption in each cage also predicted mean post-mortem lymph node tumour burden at 3 weeks (R²=0.89, F(1,3)=23.2, P=0.017).

Conclusion:

Temperature, food and water consumption were useful biomarkers of disease progression in mice with lymphoma and could potentially be used more widely to monitor mice with other forms of cancer.

Risk-sensitivity: crossroads for theories of decision-making

Most actions result in one of a set of possible outcomes. To understand how this uncertainty, or risk, affects animals' decision-making some researchers take a normative approach, asking how an animal should respond to risk if it is maximizing its fitness. Others focus on predicting responses to risk by generalizing from regularities in behavioural data, without reference to cognitive processes. Yet others infer cognitive processes from observed behaviour and ask what actions are predicted when these processes interact with risk. The normative approach (Risk-sensitivity Theory; RST) is unique in predicting a shift in a subject's response to risk as a function of its resource budget, but the predictions of this theory are not yet widely confirmed. In fact, evidence suggests a strong bias towards risk-proneness when delay to reward is risky and risk-aversion when amount of reward is risky, a pattern not readily explained by RST. Extensions of learning theory and of Scalar Expectancy Theory provide process-based explanations for these findings but do not handle preference shifts or provide evolutionary justification for the processes assumed. In this review we defend the view that risk-sensitivity must be studied with theoretical plurality.

Construction of bacterial artificial chromosome libraries and their application in developing PCR-based markers closely linked to a major locus conditioning bruchid resistance in mungbean (Vigna radiata L. Wilczek)

Bacterial artificial chromosome (BAC) libraries have been widely used in different aspects of genome research. In this paper we report the construction of the first mungbean (Vigna radiata L. Wilczek) BAC libraries. These BAC clones were obtained from two ligations and represent an estimated 3.5 genome equivalents. This correlated well with the screening of nine random single-copy restriction fragment length polymorphism probes, which detected on average three BACs each. These mungbean clones were successfully used in the development of two PCR-based markers linked closely with a major locus conditioning bruchid (Callosobruchus chinesis) resistance. These markers will be invaluable in facilitating the introgression of bruchid resistance into breeding programmes as well as the further characterisation of the resistance locus.

Synergistic effect of PEG-400 and cyclodextrin to enhance solubility of progesterone

PEG-400, polysorbate 80, and 2 CDs (Trappsol HPB and Captisol) were used in an attempt to improve the aqueous solubility of a model hydrophobic drug, progesterone. The aqueous solubility of progesterone improved significantly from 0.007 mg/mL by the addition of PEG-400, CDs, and polysorbate 80. In systems containing various amounts of PEG-400 and 3% Trappsol HPB in water (% wt/wt), the theoretical solubility was calculated by adding the solubilities in the individual systems. The observed solubility values were up to 96% higher than the theoretical values. The effect of synergism was significant in 5% to 50% PEG-400/water systems containing Trappsol HPB. Systems containing Captisol did not show such synergistic effects. In general, the addition of polysorbate 80 to the PEG-400/water systems containing CDs affected synergism negatively.

High-yielding repetitive somatic embryogenesis and plant recovery in a selected tea clone, 'TRI-2025', by temporary immersion

 Methods for improving the efficiency of repetitive somatic embryogenesis and plant recovery from somatic embryos of clonal tea, TRI 2025 [Camellia sinensis (L.) O. Kuntze] were investigated by optimising the immersion frequencies of the explants using a modified temporary immersion system (TIS). The relative efficiencies of three conventional methods for multiplying embryos were compared with the temporary immersion method. The highest rate of multiplication of secondary embryos (24-fold) was achieved using the TIS. By controlling the immersion cycles, we achieved more consistent, synchronised multiplication and embryo development with a high level of plant recovery. A one-step computer-programmed immersion protocol based on a single, simple medium with no growth regulators was developed, enabling multiplication, maturation, germination and plant recovery within 17 weeks. Plantlets recovered through this method were hardy, with 2- to 5-cm-long shoots containing a minimum of 2-4 lush green leaves and a well-formed taproot. Callus formation, hyperhydricity and other developmental abnormalities were not observed at any stage in the process. Plantlets produced using this method were successfully acclimatised to glasshouse conditions. This protocol avoids culture transfers, and thus minimises the risk of contamination and reduces labour costs. This technique could have significant commercial implications in tea propagation as it has the potential for large-scale production with considerably reduced production costs.

The use of timing behaviors in animals and humans to detect drug and/or toxicant effects

Behavioral paradigms applicable for use in both human and nonhuman subjects for investigating aspects of timing behavior are presented with a view towards exploring their strengths, weaknesses, and utility in a variety of experimental situations. Tri-peak, peak interval, differential reinforcement of low rate responding, and temporal response differentiation procedures are highlighted. In addition, the application of timing tasks in preclinical and clinical settings is discussed: pharmacological manipulations are providing information on the neurotransmitters involved and species differences; normative data for children are being developed; and noninvasive imaging procedures are being employed in adult human subjects to explore the involvement of specific brain areas.

Single copies of subunits d, oligomycin-sensitivity conferring protein, and b are present in the Saccharomyces cerevisiae mitochondrial ATP synthase

In the mitochondrial ATP synthase (mtATPase) of the yeast Saccharomyces cerevisiae, the stoichiometry of subunits d, oligomycin-sensitivity conferring protein (OSCP), and b is poorly defined. We have investigated the stoichiometry of these subunits by the application of hexahistidine affinity purification technology. We have previously demonstrated that intact mtATPase complexes incorporating a Hex6-tagged subunit can be isolated via Ni2+-nitrilotriacetic acid affinity chromatography (Bateson, M., Devenish, R. J., Nagley, P., and Prescott, M. (1996) Anal. Biochem. 238, 14-18). Strains were constructed in which Hex6-tagged versions of subunits d, OSCP, and b were coexpressed with the corresponding wild-type subunit. This coexpression resulted in a mixed population of mtATPase complexes containing untagged wild-type and Hex6-tagged subunits. The stoichiometry of each subunit was then assessed by determining whether or not the untagged wild-type subunit could be recovered from Ni2+-nitrilotriacetic acid purifications as an integral component of those complexes absorbed by virtue of the Hex6-tagged subunit. As only the Hex6-tagged subunit was recovered from such purifications, we demonstrate that the stoichiometry of subunits d, OSCP, and b in yeast is 1 in each case.

A novel fluorescent marker for assembled mitochondria ATP synthase of yeast. OSCP subunit fused to green fluorescent protein is assembled into the complex in vivo

We have shown that OSCP, a subunit of yeast mitochondrial ATP synthase, can be incorporated into the intact enzyme as a fusion protein representing OSCP fused at its C-terminus to the green fluorescent protein (GFP) of Aequorea victoria. The relevant fusion OSCP-GFP-h6 additionally contains a hexahistidine tag at the C-terminus. Expression of OSCP-GFP-h6 in yeast cells lacking endogenous OSCP led to the efficient restoration of growth of cells on the non-fermentable substrate, ethanol. Confocal laser scanning microscopy revealed fluorescence due to GFP in mitochondria of cells expressing OSCP-GFP-h6. Use of immobilised metal ion affinity chromatography enabled the recovery of assembled ATP synthase complexes which contained OSCP-GFP-h6 identified by its mobility on SDS-PAGE and immunoreactivity to anti-OSCP and anti-GFP antibodies. The successful isolation of the assembled multisubunit ATP synthase containing GFP fused to one of the essential subunits of the complex widely expands the potential applications of GFP. In principle, these include the spatial and temporal monitoring of ATP synthase complexes in vivo, and the exploration of interactions involving ATP synthase subunits by fluorescence resonance energy transfer (FRET).

Starlings' preferences for predictable and unpredictable delays to food

Risk-sensitive foraging theory is based on the premise that unpredictable runs of good or bad luck can cause a variable food source to differ in fitness value from a fixed food source yielding the same average rate of gain but no unpredictability. Thus, risk-sensitive predictions are dependent on the food intake from variable sources being not only variable but also unpredictable or 'risky' in outcome. This study tested whether unpredictability is a component of the value that foraging starlings, Sturnus vulgarisattribute to food sources that are variable in the delay to obtain food. Two groups of birds chose between a fixed and a variable delay option; the variable option was unpredictable in the risky group and predictable in the risk-free group in the overall rate of intake it yielded. In both groups the fixed option was adjusted by titration to quantify the magnitude of preference for predictable and unpredictable variance. On negative energy budgets both groups were significantly risk-prone, with the risky group being significantly more risk-prone than the risk-free group. Switching the birds to positive budgets by doubling the size of each food reward had no significant effect on preference, and similar trends to those found with negative budgets were observed. These results are not readily explained by risk-sensitive foraging theory, but may be explained by the algorithm used by the birds to attribute value to average expected rewards.

Entrapment by immobilized metal ion affinity chromatography of assembled yeast mitochondrial ATP synthase containing individual subunits tagged with hexahistidine

We demonstrate the use of immobilized metal ion affinity chromatography for isolating the constituent subunits of assembled mitochondrial ATP synthase (mtATPase) wherein a single subunit of the complex has been modified to contain hexahistidine. Genes encoding subunit d or OSCP of mtATPase from Saccharomyces cerevisiae were modified each to encode a polypeptide having a C-terminal addition of six consecutive histidines. Expression of plasmid-borne modified genes, in host yeast cells lacking a functional copy of the relevant endogenous gene, generated functional mtATPase complexes as judged by growth of rescued cells on the nonfermentable substrate ethanol. Significantly, the oligomycin-sensitive ATP hydrolase activity in mitochondria from cells expressing tagged subunits was similar to that of cells expressing unmodified subunits, indicating that there had been no impairment of the functional integrity of mtATPase. Mitochondrial lysates were prepared from each strain and subjected to chromatography under nondenaturing conditions on a resin containing immobilized Ni2+. It is likely that the mtATPase complexes adsorbed by immobilized metal ion affinity chromatography are fully assembled because their subunit composition closely matches that of a preparation of assembled mtATPase conventionally isolated from mitochondrial lysates by ammonium sulfate precipitation and purification by sucrose gradient centrifugation. Furthermore, assembled mtATPase containing a tagged subunit could be adsorbed, albeit at lower yield, when the relevant modified gene was expressed in wild-type host cells. The general application of this novel isolation procedure greatly simplifies and reduces the number of steps required for the isolation of assembled multi-subunit complexes. Moreover, the approach may be used for studying subunit-subunit interactions within the mtATPase complex.

Preferences for fixed and variable food sources: variability in amount and delay

Much research has focused on the effects of environmental variability on foraging decisions. However, the general pattern of preference for variability in delay to reward and aversion to variability in amount of reward remains unexplained a either a mechanistic or a functional level. Starlings' preferences between a fixed and a variable option were studied in two treatments, A and D. The fixed option was the same in both treatments (20-s fixed-interval delay, five units food). In Treatment A the variable option gave two equiprobable amounts of food (20-s delay, three or seven units) and in D it gave two equiprobable delays to food (2.5-s or 60.5-s delays, five units). In both treatments the programmed ratio [amount/(intertrial interval+latency+delay)] in the fixed option equaled the arithmetic mean of the two possible ratios in the variable option (ITI = 40 s, latency = 1 s). The variable option was strongly preferred in Treatment D and was weakly avoided in Treatment A. These results are discussed in the light of two theoretical models, a form of constrained rate maximization and a version of scalar expectancy theory. The latter accommodates more of the data and is based on independently verifiable assumptions, including Weber's law.

The nucleotide sequence of the coat protein gene and 3' untranslated region of papaya ringspot virus type W (Aust)

The nucleotide sequence of the 3' terminal region of the Australian isolate of papaya ringspot virus type W [PRSV-W (Aust)] was determined. An open reading frame (864 bp), encoding the putative coat protein gene, occurs upstream of the putative 3' untranslated region (206 bp) and poly(A) tail. A 23 amino acid sequence was obtained from N-terminal analysis of the coat protein from purified virions. This sequence has 100% homology with a region of the amino acid sequence inferred from the nucleic acid sequence of the coat protein gene. However, this region is 13 amino acids downstream from the N terminus predicted for two American isolates of PRSV. The coat protein gene of PRSV-W (Aust) was shown to have 96.8% and 96.4% nucleotide sequence similarity with American isolates of PRSV-W and PRSV-P, respectively.