Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

INTRODUCTION

The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.

METHODS

In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.

FINDINGS

Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.

INTERPRETATION

After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Correlation of bioimpedance changes after compressive loading of murine tissues in vivo

OBJECTIVE

Rises in the incidence of pressure ulcers are increasingly prevalent in an aging population. Pressure ulcers are painful, are associated with increased morbidity and mortality, increase the risk for secondary infections and inpatient stay, and adds $26.8 billion annually to the healthcare costs of the USA. Evidence suggests that a change in the bioimpedance of living tissue in response to continuous local contact pressure can be a useful indicator for the onset of pressure injuries.

APPROACH

Thirty-five Sprague Dawley rats were subjected to various skin pressures for differing periods of time via a surgically inserted steel disk and an externally applied magnet. Contact pressure and bioimpedance were measured and correlated with tissue loading intensity and compared to clinical ulcer grading.

MAIN RESULTS

Moderate relationships between bioimpedance changes and tissue loading intensity were found. Stronger correlations were found by utilizing a combination of bioimpedance and phase angle. Thresholds were applied to the bioimpedance parameters and the usefulness of bioimpedance in classifying different ulcer stages is demonstrated.

SIGNIFICANCE

These results indicate that bioimpedance may be useful as an early indicator of pressure ulcer formation and has practical significance in the development of early pressure injury detection devices.

Inter-observer reliability of preoperative cardiopulmonary exercise test interpretation: a cross-sectional study

BACKGROUND

Despite the increasing importance of cardiopulmonary exercise testing (CPET) for preoperative risk assessment, the reliability of CPET interpretation is unclear. We aimed to assess inter-observer reliability of preoperative CPET.

METHODS

We conducted a prospective, multi-centre, observational study of preoperative CPET interpretation. Participants were professionals with previous experience or training in CPET, assessed by a standardized questionnaire. Each participant interpreted 100 tests using standardized software. The CPET variables of interest were oxygen consumption at the anaerobic threshold (AT) and peak oxygen consumption (VO₂ peak). Inter-observer reliability was measured using intra-class correlation coefficient (ICC) with a random effects model. Results are presented as ICC with 95% confidence interval, where ICC of 1 represents perfect agreement and ICC of 0 represents no agreement.

RESULTS

Participants included 8/28 (28.6%) clinical physiologists, 10 (35.7%) junior doctors, and 10 (35.7%) consultant doctors. The median previous experience was 140 (inter-quartile range 55-700) CPETs. After excluding the first 10 tests (acclimatization) for each participant and missing data, the primary analysis of AT and VO₂ peak included 2125 and 2414 tests, respectively. Inter-observer agreement for numerical values of AT [ICC 0.83 (0.75-0.90)] and VO₂ peak [ICC 0.88 (0.84-0.92)] was good. In a post hoc analysis, inter-observer agreement for identification of the presence of a reportable AT was excellent [ICC 0.93 (0.91-0.95)] and a reportable VO₂ peak was moderate [0.73 (0.64-0.80)].

CONCLUSIONS

Inter-observer reliability of interpretation of numerical values of two commonly used CPET variables was good (>80%). However, inter-observer agreement regarding the presence of a reportable value was less consistent.

Health Care Cost Analysis in a Population-based Inception Cohort of Inflammatory Bowel Disease Patients in the First Year of Diagnosis

BACKGROUND

There are limited prospective population-based data on the health care cost of IBD in the post-biologicals era. A prospective registry that included all incident cases of inflammatory bowel disease [IBD] was established to study disease progress and health cost.

AIM

To prospectively assess health care costs in the first year of diagnosis among a well-characterised cohort of newly diagnosed IBD patients.

METHOD

Incident cases of IBD were prospectively identified in 2007-2008 and 2010-2013 from multiple health care providers, and enrolled into the population-based registry. Health care resource utilisation for each patient was collected through active surveillance of case notes and investigations including specialist visits, diagnostic tests, medications, medical hospitalisation, and surgery.

RESULTS

Off 276 incident cases of IBD, 252 [91%] were recruited to the registry, and health care cost was calculated for 242 (146 Crohn's disease [CD] and 96 ulcerative colitis [UC] patients). The median cost in CD was higher at A$5905 per patient (interquartile range [IQR]: A$1571-$91,324) than in UC at A$4752 [IQR: A$1488-A$58,072]. In CD, outpatient resources made up 55% of all cost, with medications accounting for 32% of total cost [15% aminosalicylates, 15% biological therapy], followed by surgery [31%], and diagnostic testing [21%]. In UC, medications accounted for 39% of total cost [of which 37% was due to 5-aminosalicylates, and diagnostics 29%; outpatient cost contributed 71% to total cost.

CONCLUSION

In the first year of diagnosis, outpatient resources account for the majority of cost in both CD and UC. Medications are the main cost driver in IBD.

Highly saline fluids from a subducting slab as the source for fluid-rich diamonds

The infiltration of fluids into continental lithospheric mantle is a key mechanism for controlling abrupt changes in the chemical and physical properties of the lithospheric root, as well as diamond formation, yet the origin and composition of the fluids involved are still poorly constrained. Such fluids are trapped within diamonds when they form and so diamonds provide a unique means of directly characterizing the fluids that percolate through the deep continental lithospheric mantle. Here we show a clear chemical evolutionary trend, identifying saline fluids as parental to silicic and carbonatitic deep mantle melts, in diamonds from the Northwest Territories, Canada. Fluid-rock interaction along with in situ melting cause compositional transitions, as the saline fluids traverse mixed peridotite-eclogite lithosphere. Moreover, the chemistry of the parental saline fluids--especially their strontium isotopic compositions--and the timing of host diamond formation suggest that a subducting Mesozoic plate under western North America is the source of the fluids. Our results imply a strong association between subduction, mantle metasomatism and fluid-rich diamond formation, emphasizing the importance of subduction-derived fluids in affecting the composition of the deep lithospheric mantle.

Prospective population-based cohort of inflammatory bowel disease in the biologics era: Disease course and predictors of severity

BACKGROUND AND AIM

We have previously found high incidence of inflammatory bowel disease (IBD) in Australia. A population-based registry was established to assess disease severity, frequency of complications, and prognostic factors.

METHODS

Incident cases were prospectively identified over 4 years. Early disease severity was assessed according to need for hospitalization and resective surgery and medication use.

RESULTS

We report on the early outcomes (median 18 months, range 12-60 months) for 252 patients comprising 146 with Crohn's disease (CD), 96 with ulcerative colitis (UC), and 10 IBD undifferentiated. Eighty-seven percent of CD patients had inflammatory disease at diagnosis, and this reduced to 73% at 5 years (n = 38). Immunomodulators were prescribed in 57% of CD patients and 19% with UC. A third of all CD patients were hospitalized, the majority (77%) in the first 12 months. Risk factors for hospitalization included penetrating, perianal, and ileocolonic disease (P < 0.05). Twenty-four percent of UC patients were hospitalized, most within the first 12 months. Intestinal resection rates were 13% at 1 year in CD and 26% at 5 years. Risk factors include penetrating and stricturing disease (P < 0.001) and ileal involvement (P < 0.05). Colectomy rates in UC were 2% and 13% at 1 and 5 years. High C-reactive protein (CRP) at diagnosis was associated with colectomy.

CONCLUSIONS

A high rate of inflammatory disease, frequent immunomodulator use in CD, and a low rate of surgery in both CD and UC were identified. In CD, ileal involvement and complex disease behavior are associated with a more severe disease course, while in UC a high CRP predicted this outcome.

Hydrous mantle transition zone indicated by ringwoodite included within diamond

The ultimate origin of water in the Earth's hydrosphere is in the deep Earth--the mantle. Theory and experiments have shown that although the water storage capacity of olivine-dominated shallow mantle is limited, the Earth's transition zone, at depths between 410 and 660 kilometres, could be a major repository for water, owing to the ability of the higher-pressure polymorphs of olivine--wadsleyite and ringwoodite--to host enough water to comprise up to around 2.5 per cent of their weight. A hydrous transition zone may have a key role in terrestrial magmatism and plate tectonics, yet despite experimental demonstration of the water-bearing capacity of these phases, geophysical probes such as electrical conductivity have provided conflicting results, and the issue of whether the transition zone contains abundant water remains highly controversial. Here we report X-ray diffraction, Raman and infrared spectroscopic data that provide, to our knowledge, the first evidence for the terrestrial occurrence of any higher-pressure polymorph of olivine: we find ringwoodite included in a diamond from Juína, Brazil. The water-rich nature of this inclusion, indicated by infrared absorption, along with the preservation of the ringwoodite, is direct evidence that, at least locally, the transition zone is hydrous, to about 1 weight per cent. The finding also indicates that some kimberlites must have their primary sources in this deep mantle region.

Names of fungal species with the same epithet applied to different morphs: how to treat them

The abolition of the separate naming of different morphs of the same fungal species in 2011 will inevitably result in many name changes in some genera. The working practices commended here are intended to minimize one category of these changes, that which can arise as a consequence of an author using the epithet of an asexual morph when describing the sexual morph of the same species. We consider that name proposed for the sexual morph in such cases should be treated as a formal error for a new combination and not as a new species, and so be corrected. This is interpreted as applying even where the author indicated that a new species was being described and designated a type. We argue that those formalities were a result of the requirements of the rules then in force, as the author recognized that a morph of a named species was being described, and not a new hitherto unnamed species was being reported – but was barred from making a new combination so used the same epithet for the new morph name instead. Where a type with the sexual morph was designated for the sexual morph, under this interpretation that no longer has nomenclatural status, the type being that of the basionym. The material for the sexual morph indicated as a type, would be available for designation as an epitype, though a modern sequenced sample with both sexual and asexual morphs would be more informative as an epitype in many cases. A proposal to regularize the working practice commended here, and also the converse situation where the sexual morph typified name is the earlier, will be made to the 2017 Shenzhen Congress.

Biological nomenclature terms for facilitating communication in the naming of organisms

A set of terms recommended for use in facilitating communication in biological nomenclature is presented as a table showing broadly equivalent terms used in the traditional Codes of nomenclature. These terms are intended to help those engaged in naming across organism groups, and are the result of the work of the International Committee on Bionomenclature, whose aim is to promote harmonisation and communication amongst those naming life on Earth.

Changes to publication requirements made at the XVIII International Botanical Congress in Melbourne-what does e-publication mean for you?

Changes to the International Code of Botanical Nomenclature are decided on every 6 years at Nomenclature Sections associated with International Botanical Congresses (IBC). The XVIII IBC was held in Melbourne, Australia; the Nomenclature Section met on 18-22 July 2011 and its decisions were accepted by the Congress at its plenary session on 30 July. Several important changes were made to the Code as a result of this meeting that will affect publication of new names. Two of these changes will come into effect on 1 January 2012, some months before the Melbourne Code is published. Electronic material published online in Portable Document Format (PDF) with an International Standard Serial Number (ISSN) or an International Standard Book Number (ISBN) will constitute effective publication, and the requirement for a Latin description or diagnosis for names of new taxa will be changed to a requirement for a description or diagnosis in either Latin or English. In addition, effective from 1 January 2013, new names of organisms treated as fungi must, in order to be validly published, include in the protologue (everything associated with a name at its valid publication) the citation of an identifier issued by a recognized repository (such as MycoBank). Draft text of the new articles dealing with electronic publication is provided and best practice is outlined.

Translation into Turkish of: "Changes to publication requirements made at the XVIII International Botanical Congress in Melbourne - what does e-publication mean for you?". Translated by Ali A. Dönmez, Yusuf Menemen and Zübeyde Uğurlu. "Onsekizinci (XVIII) Uluslararası Botanik Kongresi'nde (Melbourne) Yayın ile I˙lgili Gereklilikler Konusunda Yapılan Değişiklikler; e-yayın size ne ifade ediyor"

Uluslararası Botanik Adlandırma Kuralları'nda yapılan değişikliklere, her altı yılda bir gerçekleştirilen ve Uluslararası Botanik Kongresi (IBC) ile beraber yapılan Adlandırma Seksiyonlarında karar verilmektedir. On sekizinci (XVIII.) Uluslararası Botanik Kongresi, Avustralya'nın Melborn şehrinde yapılmıştır. Adlandırma Seksiyonu 18-22 Temmuz 2011 tarihleri arasında toplanmış olup, kararlar 30 Temmuzdaki genel kurul toplantısında kongre tarafından kabul edilmiştir. Bu toplantıda yeni isimlerin yayınlanması ile ilgili olarak Yasa'da bazı önemli değişiklikler yapılmıştır. Bu değişikliklerden iki tanesi Melborn Yasası basılmadan bir süre önce, 1 Ocak 2012 tarihinden itibaren geçerli olacaktır. 1- Elektronik ortamda Uluslararası Standart Seri Numarası (ISSN) ya da Uluslararası Standart Kitap Numarası (ISBN)'na sahip Taşınabilir Belge Biçiminde (PDF) çevrimiçi olarak yayınlanan elektronik materyal gerçek yayın kabul edilecektir. 2- Yeni takson isimleri için aranan Latince betim ya da diyagnoz gerekliliği, Latince veya İngilizce yazılmış betim veya diyagnoz gerekliliği şeklinde değiştirilecektir. Bunlara ek olarak, 1 Ocak 2013'ten itibaren uygulanmak üzere, mantar olarak kabul edilen organizmaların yeni isimlerinin geçerli olarak basılabilmesi için, tanınmış (MycoBank gibi) bir veri bankası tarafından verilen bir tanımlayıcının (seri numarasının) protologta (bir ismin geçerli basımında onunla ilgili verilen her türlü bilgi) belirtilmesi gerekmektedir. Elektronik yayın ile ilgili yeni maddelerin taslak metinleri ve bunların en iyi şekilde nasıl uygulanacağı aşağıda sunulmuştur. Uluslararası Alg, Mantar ve Bitki Adlandırma Yasası'nda yapılan bu değişikliklerin geniş kitlelere duyurulmasını sağlamak amacıyla bu makale BMC Evolutionary Biology, Botanical Journal of the Linnean Society, Brittonia, Cladistics, MycoKeys, Mycotaxon, New Phytologist, North American Fungi, Novon, Opuscula Philolichenum, PhytoKeys, Phytoneuron, Phytotaxa, Plant Diversity and Resources, Systematic Botany ve Taxon dergilerinde yayınlanacaktır.

Translation into French of: "Changes to publication requirements made at the XVIII International Botanical Congress in Melbourne - what does e-publication mean for you?". Translated by Christian Feuillet and Valéry Malécot Changements des conditions requises pour la publication faits au XVIII Congrès International de Botanique à Melbourne - qu'est-ce que la publication électronique représente pour vous?

RésuméLes changements au CodeInternational de Nomenclature Botanique sont décidés tous les 6 ans aux Sections de Nomenclature associées aux Congrès Internationaux de Botanique (CIB). Le XVIII(e) CIB se tenait à Melbourne, Australie; la Section de Nomenclature s'est réunie les 18-22 juillet 2011 et ses décisions ont été acceptées par le Congrès en session plénière le 30 juillet. Suite à cette réunion, plusieurs modifications importantes ont été apportées au Code et vont affecter la publication de nouveaux noms. Deux de ces changements prendront effet le 1(er) janvier 2012, quelques mois avant que le Code de Melbourne soit publié. Les documents électroniques publiés en ligne en 'Portable Document Format' (PDF) avec un 'International Standard Serial Number' (ISSN) ou un 'International Standard Book Number' (ISBN) constitueront une publication effective, et l'exigence d'une description ou d'une diagnose en latin pour les noms des nouveaux taxa sera changée en l'exigence d'une description ou d'une diagnose en latin ou en anglais. De plus, à partir du 1(er) janvier 2013, les noms nouveaux des organismes traités comme champignons devront, pour que la publication soit valide, inclure dans le protologue (tous ce qui est associé au nom au moment de la publication valide) la citation d'un identifiant ('identifier') fourni par un dépôt reconnu (tel MycoBank). Une ébauche des nouveaux articles concernant la publication électronique est fournie et des conseils de bon usage sont esquissés.Pour encourager la diffusion des changements adoptés au Code International de Nomenclature pour les algues, les champignons et les plantes, cet article sera publié dans BMC Evolutionary Biology, Botanical Journal of the Linnean Society, Brittonia, Cladistics, MycoKeys, Mycotaxon, New Phytologist, North American Fungi, Novon, Opuscula Philolichenum, PhytoKeys, Phytoneuron, Phytotaxa, Plant Diversity and Resources, Systematic Botany et Taxon.

Changes to publication requirements made at the XVIII International Botanical Congress in Melbourne - what does e-publication mean for you?

Changes to the International Code of Botanical Nomenclature are decided on every 6 years at Nomenclature Sections associated with International Botanical Congresses (IBC). The XVIII IBC was held in Melbourne, Australia; the Nomenclature Section met on 18-22 July 2011 and its decisions were accepted by the Congress at its plenary session on 30 July. Several important changes were made to the Code as a result of this meeting that will affect publication of new names. Two of these changes will come into effect on 1 January 2012, some months before the Melbourne Code is published. Electronic material published online in Portable Document Format (PDF) with an International Standard Serial Number (ISSN) or an International Standard Book Number (ISBN) will constitute effective publication, and the requirement for a Latin description or diagnosis for names of new taxa will be changed to a requirement for a description or diagnosis in either Latin or English. In addition, effective from 1 January 2013, new names of organisms treated as fungi must, in order to be validly published, include in the protologue (everything associated with a name at its valid publication) the citation of an identifier issued by a recognized repository (such as MycoBank). Draft text of the new articles dealing with electronic publication is provided and best practice is outlined.

To encourage dissemination of the changes made to the International Code of Nomenclature for algae, fungi, and plants, this article will be published in BMC Evolutionary Biology, Botanical Journal of the Linnean Society, Brittonia, Cladistics, MycoKeys, Mycotaxon, New Phytologist, North American Fungi, Novon, Opuscula Philolichenum, PhytoKeys, Phytoneuron, Phytotaxa, Plant Diversity and Resources, Systematic Botany and Taxon.

Changes to publication requirements made at the XVIII International Botanical Congress in Melbourne - what does e-publication mean for you?

Changes to the International Code of Botanical Nomenclature are decided on every 6 years at Nomenclature Sections associated with International Botanical Congresses (IBC). The XVIII IBC was held in Melbourne, Australia; the Nomenclature Section met on 18-22 July 2011 and its decisions were accepted by the Congress at its plenary session on 30 July. Several important changes were made to the Code as a result of this meeting that will affect publication of new names. Two of these changes will come into effect on 1 January 2012, some months before the Melbourne Code is published. Electronic material published online in Portable Document Format (PDF) with an International Standard Serial Number (ISSN) or an International Standard Book Number (ISBN) will constitute effective publication, and the requirement for a Latin description or diagnosis for names of new taxa will be changed to a requirement for a description or diagnosis in either Latin or English. In addition, effective from 1 January 2013, new names of organisms treated as fungi must, in order to be validly published, include in the protologue (everything associated with a name at its valid publication) the citation of an identifier issued by a recognized repository (such as MycoBank). Draft text of the new articles dealing with electronic publication is provided and best practice is outlined.To encourage dissemination of the changes made to the International Code of Nomenclature for algae, fungi, and plants, this article will be published in BMC Evolutionary Biology, Botanical Journal of the Linnean Society, Brittonia, Cladistics, MycoKeys, Mycotaxon, New Phytologist, North American Fungi, Novon, Opuscula Philolichenum, PhytoKeys, Phytoneuron, Phytotaxa, Plant Diversity and Resources, Systematic Botany and Taxon.

The Anthropocene: conceptual and historical perspectives

The human imprint on the global environment has now become so large and active that it rivals some of the great forces of Nature in its impact on the functioning of the Earth system. Although global-scale human influence on the environment has been recognized since the 1800s, the term Anthropocene, introduced about a decade ago, has only recently become widely, but informally, used in the global change research community. However, the term has yet to be accepted formally as a new geological epoch or era in Earth history. In this paper, we put forward the case for formally recognizing the Anthropocene as a new epoch in Earth history, arguing that the advent of the Industrial Revolution around 1800 provides a logical start date for the new epoch. We then explore recent trends in the evolution of the Anthropocene as humanity proceeds into the twenty-first century, focusing on the profound changes to our relationship with the rest of the living world and on early attempts and proposals for managing our relationship with the large geophysical cycles that drive the Earth's climate system.

An MMPI-Based Behavior Descriptor/Personality Trait List

Descriptive terms associated with elevated MMPI scales were abstracted from 10 MMPI reference works. Those corresponding to the 300-word Gough Adjective Check List were retained to construct a new behavior descriptor/personality trait list.

Current trends in Antenatal Screening Services: Results from a regional survey

OBJECTIVE

To identify variations in current antenatal screening programmes across one region and compare results with a previous survey.

DESIGN

A cross section descriptive survey.

SETTING

All maternity units within the region of Northern Ireland.

SAMPLE

Eleven maternity units were invited and ten agreed to participate.

MAIN OUTCOME MEASURES

The number of written policies for individual screening tests; the range of screening tests offered; the frequency of training opportunities for health professionals; and the information systems in place to record data.

RESULTS

There is variation in service provision across maternity units and, in particular, inconsistency in the offer of serum screening tests for Down syndrome. A lack of training opportunities for health professionals involved in offering screening was highlighted, and no common information system employed.

CONCLUSION

While improvements have been made since 2002, variations persist. This is leading to inequalities in the provision of antenatal screening services across Northern Ireland.

Gold nanoparticles as a contrast agent for in vivo tumor imaging with photoacoustic tomography

Photoacoustic tomography (PAT) is a rapidly emerging non-invasive imaging technology that integrates the merits of high optical contrast with high ultrasound resolution. The ability to quantitatively and non-invasively image nanoparticles has important implications for the development of nanoparticles as in vivo cancer diagnostic and therapeutic agents. In this study, the ability of systemically administered poly(ethylene glycol)-coated (PEGylated) gold nanoparticles as a contrast agent for in vivo tumor imaging with PAT has been evaluated. We demonstrate that gold nanoparticles (20 and 50 nm) have high photoacoustic contrast as compared to mouse tissue ex vivo. Gold nanoparticles can be visualized in mice in vivo following subcutaneous administration using PAT. Following intravenous administration of PEGylated gold nanoparticles to tumor-bearing mice, accumulation of gold nanoparticles in tumors can be effectively imaged with PAT. With gold nanoparticles as a contrast agent, PAT has important potential applications in the image guided therapy of superficial tumors such as breast cancer, melanoma and Merkel cell carcinoma.

Quantitative analysis of trace element concentrations in some gem-quality diamonds

The geochemical signature of diamond-forming fluids can be used to unravel diamond-forming processes and is of potential use in the detection of so-called 'conflict' diamonds. While fluid-rich fibrous diamonds can be analyzed by a variety of techniques, very few data have been published for fluid-poor, gem-quality diamonds because of their very low impurity levels. Here we present a new ICPMS-based (ICPMS: inductively coupled plasma mass spectrometry) method for the analysis of trace element concentrations within fluid-poor, gem-quality diamonds. The method employs a closed-system laser ablation cell. Diamonds are ablated and the products trapped for later pre-concentration into solutions that are analyzed by sector-field ICPMS. We show that our limits of quantification for a wide range of elements are at the sub-pg to low pg level. The method is applied to a suite of 10 diamonds from the Cullinan Mine (previously known as Premier), South Africa, along with other diamonds from Siberia (Mir and Udachnaya) and Venezuela. The concentrations of a wide range of elements for all the samples (expressed by weight in the solid) are very low, with rare earth elements along with Y, Nb, Cs ranging from 0.01 to 2 ppb. Large ion lithophile elements (LILE) such as Rb and Ba vary from 1 to 30 ppb. Ti ranges from ppb levels up to 2 ppm. From the combined, currently small data set we observe two kinds of diamond-forming fluids within gem diamonds. One group has enrichments in LILE over Nb, whereas a second group has normalized LILE abundances more similar to those of Nb. These two groups bear some similarity to different groups of fluid-rich diamonds, providing some supporting evidence of a link between the parental fluids for both fluid-inclusion-rich and gem diamonds.

The SV stent study: a prospective, multicentre, angiographic evaluation of the BiodivYsio phosphorylcholine coated small vessel stent in small coronary vessels

OBJECTIVE

To evaluate the use of the phosphorylcholine (PC) coated BiodivYsio small vessel (SV) stent in native coronary vessels of small calibre.

DESIGN AND SETTING

Prospective, multi-centre, multi-national registry with 6-month clinical and core-lab angiographic follow-up. Adverse events were adjudicated by a Clinical Events Committee (CEC) and included peri-procedural analysis of cardiac enzymes.

PATIENTS

Patients with signs or symptoms of ischaemia with an identified target lesion in an epicardial vessel with reference diameter 2.0-2.75 mm were enrolled. Intervention in other epicardial territories in the same patient was permitted.

RESULTS

Recruitment of 150 consecutive lesions (in 143 patients) was completed in 19 centres in Europe and Israel. The stent was deployed successfully in all but one lesion. At 6 months, 1 patient (1%) had experienced sudden cardiac death, 4 further patients (3%) had a non-Q wave MI, and a further 24 patients (17%) had repeat revascularisation of a study target vessel. The mean reference vessel diameter prior to stenting was 2.2 mm (S.D. 0.4). Mean minimal luminal diameters at pre-procedure, post procedure and follow-up were 0.6 mm (S.D. 0.3), 2.0 mm (S.D. 0.4) and 1.2 mm (S.D. 0.6), respectively. The late lumen loss index was 0.55 (S.D. 0.53) with a binary restenosis rate of 32%.

CONCLUSIONS

In stenting of selected lesions in small vessels, the BiodivYsio SV stent demonstrated high rates of implant success. The rates of major adverse cardiac events (MACE), angiographic restenosis and repeat revascularisation are similar to those reported in other small vessel bare metal stent studies.

The economic impact of incorporating flexible endoscopy into a community general surgery practice

BACKGROUND

Flexible endoscopy is a vital component of gastrointestinal surgery. It has and will replace many of the surgical procedures now commonly performed. Flexible endoscopy, unfortunately, is not an integral part of surgical residency training based on resident operative experience as reported by the Residency Review Committee. Moreover, general surgeons have deferred the practice of flexible endoscopy to the gastroenterologists because of concerns over turf battles and referral patterns. The purpose of this study was to assess the overall case load and the economic impact of flexible endoscopy on the practice of general surgery in a community hospital setting.

METHODS

This retrospective review was performed over a 6-month period. The total cases and the total billings of inpatient and outpatient procedures for a group practice of five general surgeons in a community hospital were evaluated. The billings were the actual charges based on current procedural terminology (CPT) codes for these procedures using the Medicare fee schedule.

RESULTS

Of the 2,159 procedures performed, 1,154 involved flexible endoscopy cases accounting for 54% of all cases (1,154 of 2,159) performed from February 1, 2003 to July 31, 2003. Flexible endocopy accounted for 43% of the total charges. A. total of 46 surgical procedures and 216 future endoscopies were generated from the flexible endoscopic procedures. Future endoscopic cases were for surveillance of colonic neoplasia and Barrett's esophagus.

CONCLUSIONS

Flexible endoscopy contributed to a major portion of the caseload and revenue generated by the general surgery group studied. The overall impact of flexible endoscopy is even greater than reported because of the future endoscopic surveillance cases or surgical interventions generated on the basis of endoscopic findings.

Multicenter Comparison of Processes of Care Between Stroke Units and Conventional Care Wards in Australia

BACKGROUND AND PURPOSE

Approximately 23% of Australian hospitals provide Stroke Units (SUs). Evidence suggests that clinical outcomes are better in SUs than with conventional care. Reasons may include greater adherence to processes of care (PoC). The primary hypothesis was that adherence to selected PoC is greater in SUs than in other acute care models.

METHODS

Prospective, multicenter, single-blinded design. Models of care investigated: SUs, mobile services, and conventional care. Selected PoC were related to care models and participant outcomes. Data were collected at acute hospitalization (median 9 days) and at medians of 8 and 28 weeks after stroke.

RESULTS

1701 patients were screened from 8 hospitals, 823 were eligible, and 468 participated. Response rate was 96% at final follow-up. Mean age was 73 years (SD 14). Overall PoC adherence rates for individual care models were SU 75%, mobile service 65%, and conventional care 52% (P<0.001). The adjusted odds of participants being alive at discharge if adhering to all or all but 1 PoC was significant (aOR 3.63; 95% CI: 1.04 to 12.66; P=0.043). Important trends at 28 weeks were found for being at home (aOR 3.09; 95% CI: 0.96 to 9.87; P=0.058) and independent (aOR 2.61; 95% CI: 0.96 to 7.10; P=0.061), with complete PoC adherence.

CONCLUSIONS

Adherence to key PoC was higher in SUs than in other models. For all patients, adherence to PoC was associated with improved mortality at discharge and trends found with independence at home, providing support for the need to increase access to stroke units.

Quality criteria for cardiac images in diagnostic and interventional cardiology

The quality of cardiac imaging plays a pivotal role in clinical decision-making and depends mainly on the technical performance of the imaging system and on angiographic technique. The Italian Society of Invasive Cardiology and The Italian Society of Physics in Medicine have set quality criteria giving precise guidelines regarding how an angiogram should appear provided that good equipment and correct angiographic technique are used. The criteria have been reviewed by the European Concerted Action DIMOND Cardiology group and are reported here to provide a reference standard for images for the most common procedures in daily practice.

A method based on DIMOND quality criteria to evaluate imaging in diagnostic and interventional cardiology

Image quality criteria (IQC) for cine-angiography were recently settled. The aim of this study was to test whether these criteria allow a measurement of the quality of cine-angiograms. A questionnaire was derived from IQC where a binary response was required regarding the degree of visibility of anatomic or pathologic structures. Scores were given on a ranking scale. Two quality scores were defined (total score and minimum score) and standard deviation (SD) was assumed to be an indicator of the method's reproducibility. Data of the total score are presented for the first nine angiograms. Six experts obtained thirty-nine readings. The total scores ranged between 83 and 99% (SD 0.8-18.7%); 89% of the readings were within 4% of SD. This preliminary experience indicates that quality criteria can be translated into a scoring system that yields reproducible data in most instances. The analysis of the remaining angiograms will help in understanding how to improve these results.