Diversity of yeasts in Indian fermented foods and alcoholic beverages.

Ethnic Indian people have been domesticating beneficial microorganisms (bacteria, yeasts, and moulds) by their wisdom of ethno-microbiological knowledge for production of flavoured and socio-culturally preferred fermented foods and alcoholic beverages for more than 8000 years. The purpose of this review is to collate the available literatures of diversity of Saccharomyces and non-Saccharomyces species associated with Indian fermented foods and alcoholic beverages. A colossal diversity of enzyme- and alcohol-producing yeasts under the phylum Ascomycota has been reported from Indian fermented foods and alcoholic beverages. The distributions of yeast species show 13.5% of Saccharomyces cerevisiae and 86.5% of some non-Saccharomyces spp. in Indian fermented foods and alcoholic beverages, based on the reported literatures available till date. There is a research gap on prospect of yeasts research in India. Hence, we suggest that validation of traditional knowledge of domestication of functional yeasts needs to be studied to develop the functional genomics platforms for Saccharomyces and non-Saccharomyces spp. in Indian fermented foods and alcoholic beverages.

Probiotic properties of yeasts in traditional fermented foods and beverages.

The interest in potentiality and functionality of probiotic yeasts from fermented foods has increased drastically over the years. In many fermented foods and beverages, lactic acid bacteria and yeasts exist synergistically by stimulating their growth and survival. Probiotic strains of lactic acid bacteria are more widely studied than potential probiotic yeasts. Saccharomyces cerevisiae variety boulardii is the only commercialized probiotic yeast, which are extensively studied. This review article provides information on the presence of potential probiotic yeasts in some traditional fermented foods and beverages.

Clinical Decision Support Systems to Reduce Unnecessary Clostridioides difficile Testing Across Multiple Hospitals.

BACKGROUND: Inappropriate Clostridioides difficile testing has adverse consequences for patients, hospitals, and public health. Computerized clinical decision support (CCDS) systems in the electronic health record (EHR) may reduce C. difficile test ordering; however, effectiveness of different approaches, ease of use, and best fit into healthcare providers' (HCP) workflow are not well understood. METHODS: Nine academic and 6 community hospitals in the United States participated in this 2-year cohort study. CCDS (hard stop or soft stop) triggered when a duplicate C. difficile test order was attempted or if laxatives were recently received. The primary outcome was the difference in testing rates pre- and post-CCDS interventions, using incidence rate ratios (IRRs) and mixed-effect Poisson regression models. We performed qualitative evaluation (contextual inquiry, interviews, focus groups) based on a human factors model. We identified themes using a codebook with primary nodes and subnodes. RESULTS: In 9 hospitals implementing hard-stop CCDS and 4 hospitals implementing soft-stop CCDS, C. difficile testing incidence rate (IR) reduction was 33% (95% confidence interval [CI]: 30%-36%) and 23% (95% CI: 21%-25%), respectively. Two hospitals implemented a non-EHR-based human intervention with IR reduction of 21% (95% CI: 15%-28%). HCPs reported generally favorable experiences and highlighted time efficiencies such as inclusion of the patient's most recent laxative administration on the CCDS. Organizational factors, including hierarchical cultures and communication between HCPs caring for the same patient, impact CCDS acceptance and integration. CONCLUSIONS: CCDS systems reduced unnecessary C. difficile testing and were perceived positively by HCPs when integrated into their workflow and when displaying relevant patient-specific information needed for decision making.

Effect of disturbances and habitat fragmentation on an arboreal habitat specialist mammal using GPS telemetry: a case of the red panda.

CONTEXT: Habitat specialists residing in human-modified landscapes are likely to be more vulnerable to disturbance because of a functional reliance on very particular habitat features. However, there have been few studies designed to specifically address that issue. OBJECTIVES: This study aimed to explore how the red panda, an iconic endangered habitat specialist, behaves when faced with disturbances and habitat fragmentation. In particular, we attempted to examine the effect of anthropogenic disturbances and fragmentation on home-range size, activity patterns, and recursion. METHODS: Using GPS telemetry we monitored 10 red pandas and documented disturbances using camera trapping for one year in eastern Nepal. We performed spatial analysis, analysed activity patterns and evaluated the effect of habitat fragmentation and disturbances on home-range size and residence time using Linear Mixed Models. RESULTS: Home-range size increased in areas with low availability of forest cover whilst home ranges were smaller in areas with a high road density. Red pandas spent more time in large habitat patches away from roads and cattle stations. Crossing rates suggested that roads acted as a barrier for movement across their habitat. Red pandas also partitioned their activity to minimize interactions with disturbances. CONCLUSIONS: Red pandas seem to make a trade-off to co-exist in human-dominated landscapes which may have adverse long-term effects on their survival. This indicates that current patterns of habitat fragmentation and forest exploitation may be adversely affecting red panda conservation efforts and that landscape-scale effects should be considered when planning conservation actions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10980-021-01357-w.

Movement and dispersal of a habitat specialist in human-dominated landscapes: a case study of the red panda.

BACKGROUND: Habitat specialists living in human-dominated landscapes are likely to be affected by habitat fragmentation and human disturbances more than generalists. But there is a paucity of information on their response to such factors. We examined the effect of these factors on movement patterns of red pandas Ailurus fulgens, a habitat and diet specialist that inhabits the eastern Himalaya. METHODS: We equipped 10 red pandas (six females, four males) with GPS collars and monitored them from September 2019 to March 2020 in Ilam, eastern Nepal. We collected habitat and disturbance data over four seasons. We considered geophysical covariates, anthropogenic factors and habitat fragmentation metrics, and employed linear -mixed models and logistic regression to evaluate the effect of those variables on movement patterns. RESULTS: The median daily distance travelled by red pandas was 756 m. Males travelled nearly 1.5 times further than females (605 m). Males and sub-adults travelled more in the mating season while females showed no seasonal variation for their daily distance coverage. Red pandas were relatively more active during dawn and morning than the rest of the day, and they exhibited seasonal variation in distance coverage on the diel cycle. Both males and females appeared to be more active in the cub-rearing season, yet males were more active in the dawn in the birthing season. Two sub-adult females dispersed an average of 21 km starting their dispersal with the onset of the new moon following the winter solstice. The single subadult male did not disperse. Red pandas avoided roads, small-habitat patches and large unsuitable areas between habitat patches. Where connected habitat with high forest cover was scarce the animals moved more directly than when habitat was abundant. CONCLUSIONS: Our study indicates that this habitat specialist is vulnerable to human disturbances and habitat fragmentation. Habitat restoration through improving functional connectivity may be necessary to secure the long-term conservation of specialist species in a human-dominated landscape. Regulation of human activities should go in parallel to minimize disturbances during biologically crucial life phases. We recommend habitat zonation to limit human activities and avoid disturbances, especially livestock herding and road construction in core areas.

Distribution and habitat attributes associated with the Himalayan red panda in the westernmost distribution range.

The Himalayan red panda (Ailurus fulgens), a recently confirmed distinct species in the red panda genus, is distributed in Nepal, India, Bhutan, and south Tibet. Nepal represents the westernmost distribution of the Himalayan red panda. This study aims to determine important habitat features influencing the distribution of red panda and recommend possible habitat corridors. This manuscript described current potential habitat of 3,222 km2 with the relative abundance of 3.34 signs/km in Nepal. Aspect, canopy cover, bamboo cover, and distance to water were the important habitat attributes. It suggested five potential corridors in western Nepal. Overall, the study has important implications for conservation of the Himalayan red panda in western distribution range.

Improved Trapping and Handling of an Arboreal, Montane Mammal: Red Panda Ailurus fulgens.

It is sometimes essential to have an animal in the hand to study some of their ecological and biological characteristics. However, capturing a solitary, cryptic, elusive arboreal species such as the red panda in the wild is challenging. We developed and successfully tested a protocol for tracking, trapping, immobilization, and handling of red pandas in the wild in eastern Nepal. We established a red panda sighting rate of 0.89 panda/day with a capture success rate of 0.6. We trapped and collared one animal in 3.7 days. On average, we took nearly 136 (range 50-317) min to capture an animal after spotting it. Further processing was completed in 38.5 (21-70) min. Before capture, we found it difficult to recognize the sex of the red panda and to differentiate sub-adults above six months from adults. However, body weight, body length, tail length, shoulder height, and chest girth can be used for diagnosis, as these attributes are smaller in sub-adults. Our method is a welfare-friendly way of trapping and handling wild red pandas. We report new morphometric data that could serve as a guide for field identification.

Reaching over the gap: A review of trends in and status of red panda research over 193 years (1827-2020).

The red panda is a unique species taxonomically known for its peculiar biological and ecological characteristics, and extreme attractiveness. Despite being highly significant from conservation, scientific and economic perspectives, this species has experienced a declining population in the wild. Thus, to direct further research priorities and conservation actions and assess gaps in the current research trend of this species, a systematic literature review was conducted covering 175 journal articles published in English over 193 years (1827-2020). This review revealed that (1) the biological aspect was highly studied compared to other thematic areas of red panda (2) captive-based studies are relatively higher than the studies based in wild populations (3) China is leading the red panda studies amongst all red panda range (4) The universities were found contributing more to red panda studies than other institutions. Surprisingly, we found that the researchers from the non-range country were leading red panda study than those from range countries. Our review highlighted the need of prioritising studies in underrepresented locations and understudied thematic areas focusing on the assessment of climate change impact, bamboo distribution status, ecosystem services of red panda habitat, behavior and movement ecology, population estimation, and metapopulation dynamics. We urge landscape-level studies and long-term population monitoring. Besides, we also suggest the documentation and evaluation of the effectiveness of ongoing red panda-focused conservation programs. We also stress the need for strengthening the capacity of institutions and people from range countries.

Administrative Claims Measure for Profiling Hospital Performance Based on 90-Day All-Cause Mortality Following Coronary Artery Bypass Graft Surgery.

BACKGROUND: Coronary artery bypass graft (CABG) surgery is a focus of bundled and alternate payment models that capture outcomes up to 90 days postsurgery. While clinical registry risk models perform well, measures encompassing mortality beyond 30 days do not currently exist. We aimed to develop a risk-adjusted hospital-level 90-day all-cause mortality measure intended for assessing hospital performance in payment models of CABG surgery using administrative data. METHODS: Building upon Centers for Medicare and Medicaid Services hospital-level 30-day all-cause CABG mortality measure specifications, we extended the mortality timeframe to 90 days after surgery and developed a new hierarchical logistic regression model to calculate hospital risk-standardized 90-day all-cause mortality rates for patients hospitalized for isolated CABG. The model was derived from Medicare claims data for a 3-year cohort between July 2014 to June 2017. The data set was randomly split into 50:50 development and validation samples. The model performance was evaluated with C statistics, overfitting indices, and calibration plot. The empirical validity of the measure result at the hospital level was evaluated against the Society of Thoracic Surgeons composite star rating. RESULTS: Among 137 819 CABG procedures performed in 1183 hospitals, the unadjusted mortality rate within 30 and 90 days were 3.1% and 4.7%, respectively. The final model included 27 variables. Hospital-level 90-day risk-standardized mortality rates ranged between 2.04% and 11.26%, with a median of 4.67%. C statistics in the development and validation samples were 0.766 and 0.772, respectively. We identified a strong positive correlation between 30- and 90-day risk-standardized mortality rates, with a regression slope of 1.09. Risk-standardized mortality rates also showed a stepwise trend of lower 90-day mortality with higher Society of Thoracic Surgeons composite star ratings. CONCLUSIONS: We present a measure of hospital-level 90-day risk-standardized mortality rates following isolated CABG. This measure complements Centers for Medicare and Medicaid Services' existing 30-day CABG mortality measure by providing greater insight into the postacute recovery period. It offers a balancing measure to ensure efforts to reduce costs associated with CABG recovery and rehabilitation do not result in unintended consequences.

Landscape variables affecting the Himalayan red panda Ailurus fulgens occupancy in wet season along the mountains in Nepal.

The Himalayan red panda is an endangered mammal endemic to Eastern Himalayan and South Western China. Data deficiency often hinders understanding of their spatial distribution and habitat use, which is critical for species conservation planning. We used sign surveys covering the entire potential red panda habitat over 22,453 km2 along the mid-hills and high mountains encompassing six conservation complexes in Nepal. To estimate red panda distribution using an occupancy framework, we walked 1,451 km along 446 sampled grid cells out of 4,631 grid cells in the wet season of 2016. We used single-species, single-season models to make inferences regarding covariates influencing detection and occupancy. We estimated the probability of detection and occupancy based on model-averaging techniques and drew predictive maps showing site-specific occupancy estimates. We observed red panda in 213 grid cells and found covariates such as elevation, distance to water sources, and bamboo cover influencing the occupancy. Red panda detection probability [Formula: see text] estimated at 0.70 (0.02). We estimated red panda site occupancy (sampled grid cells) and landscape occupancy (across the potential habitat) [Formula: see text] at 0.48 (0.01) and 0.40 (0.02) respectively. The predictive map shows a site-specific variation in the spatial distribution of this arboreal species along the priority red panda conservation complexes. Data on their spatial distribution may serve as a baseline for future studies and are expected to aid in species conservation planning in priority conservation complexes.

Timely estimation of National Admission, readmission, and observation-stay rates in medicare patients with acute myocardial infarction, heart failure, or pneumonia using near real-time claims data.

BACKGROUND: To estimate, prior to finalization of claims, the national monthly numbers of admissions and rates of 30-day readmissions and post-discharge observation-stays for Medicare fee-for-service beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. METHODS: The centers for Medicare & Medicaid Services (CMS) Integrated Data Repository, including the Medicare beneficiary enrollment database, was accessed in June 2015, February 2017, and February 2018. We evaluated patterns of delay in Medicare claims accrual, and used incomplete, non-final claims data to develop and validate models for real-time estimation of admissions, readmissions, and observation stays. RESULTS: These real-time reporting models accurately estimate, within 2 months from admission, the monthly numbers of admissions, 30-day readmission and observation-stay rates for patients with AMI, HF, or pneumonia. CONCLUSIONS: This work will allow CMS to track the impact of policy decisions in real time and enable hospitals to better monitor their performance nationally.

Trends in Publicly Reported Quality Measures of Hospital Imaging Efficiency, 2011-2018.

OBJECTIVE. In 2011, the Centers for Medicare & Medicaid Services (CMS) initiated public reporting of outpatient imaging efficiency measures to reduce potentially inappropriate imaging and unnecessary exposure to ionizing radiation performed in hospital outpatient departments. Three CMS quality measures were designed to reduce duplicative CT in the Medicare population: OP-10, which CMS lists as "Abdomen Computed Tomography-Use of Contrast Material"; OP-11, which CMS lists as "Thorax CT-Use of Contrast Material"; and OP-14, which CMS lists as "Simultaneous Use of Brain CT and Sinus CT." We describe trends in hospital performance on these national hospital outpatient imaging efficiency measures since the inception of their public reporting. MATERIALS AND METHODS. This observational analysis used standard Medicare fee-for-service administrative claims to calculate hospital-specific scores for OP-10, OP-11, and OP-14. Consistent with CMS specifications, each measure was calculated as a percentage with appropriate exclusions and minimum case count requirements to ensure measure score validity and reliability. We report national performance as well as distributions of hospital performance scores for each annual public reporting period. Trend analyses were performed to examine changes in annual mean performance over time. Secondary analyses assessed trends and hospital performance by location (rural vs urban) and hospital characteristics. RESULTS. Between 2011 and 2018, the national mean rate of duplicate imaging declined for all three measures (OP-10, 18.9% vs 7.7%; OP-11, 5.6% vs 2.0%; OP-14, 2.5% vs 1.0%). For OP-10 and OP-11, most outlier hospitals were rural, small, and government-owned. For OP-10, rural facilities accounted for 32.2% of all facilities but 46.0% of outliers by the end of the study period. Similarly, for OP-11, rural facilities accounted for 30.1% of all facilities but 47.0% of outliers by the end of the study period. In general, the proportion of outliers located in rural areas decreased over time. CONCLUSION. National performance on CMS quality measures of duplicative CT has improved over time, with reduced variation observed between hospitals since the inception of public reporting. These successes support recent CMS policy initiatives to retire duplicative imaging measures from public reporting. Future work should seek to identify opportunities to use national public reporting initiatives to yield similar improvements across broader indications and settings.

Detection of elder abuse: Exploring the potential use of the Elder Abuse Suspicion Index© by law enforcement in the field.

There are no known instruments to aid law enforcement officers in the assessment of elder abuse (EA), despite officers' contact with older adults. This study aimed to identify: 1) officers' perceptions and knowledge of EA, 2) barriers in detecting EA in the field, 3) characteristics officers value in a detection tool, and to explore 4) the potential for officers to use the Elder Abuse Suspicion Index (EASI)©. Data was collected from 69 Connecticut officers who confirmed that barriers to effectively detecting EA included a lack of EA detection instruments, as well as a lack of training on warning signs and risk factors. Officers indicated that the important elements of a desirable tool for helping to detect EA included ease of use, clear instructions, and information on follow-up resources. Approximately 80% of respondents could see themselves using the EASI

Distribution and habitat use of red panda in the Chitwan-Annapurna Landscape of Nepal.

In Nepal, the red panda (Ailurus fulgens) has been sparsely studied, although its range covers a wide area. The present study was carried out in the previously untapped Chitwan-Annapurna Landscape (CHAL) situated in central Nepal with an aim to explore current distributional status and identify key habitat use. Extensive field surveys conducted in 10 red panda range districts were used to estimate species distribution by presence-absence occupancy modeling and to predict distribution by presence-only modeling. The presence of red pandas was recorded in five districts: Rasuwa, Nuwakot, Myagdi, Baglung and Dhading. The predictive distribution model indicated that 1,904.44 km2 of potential red panda habitat is available in CHAL with the protected area covering nearly 41% of the total habitat. The habitat suitability analysis based on the probability of occurrence showed only 16.58% (A = 315.81 km2) of the total potential habitat is highly suitable. Red Panda occupancy was estimated to be around 0.0667, indicating nearly 7% (218 km2) of the total habitat is occupied with an average detection probability of 0.4482±0.377. Based on the habitat use analysis, altogether eight variables including elevation, slope, aspect, proximity to water sources, bamboo abundance, height, cover, and seasonal precipitation were observed to have significant roles in the distribution of red pandas. In addition, 25 tree species were documented from red panda sign plots out of 165 species recorded in the survey area. Most common was Betula utilis followed by Rhododendron spp. and Abies spectabilis. The extirpation of red pandas in previously reported areas indicates a need for immediate action for the long-term conservation of this species in CHAL.

Evaluation of Nutrition Interventions in Children in Conflict Zones: A Narrative Review.

Food and nutrition insecurity becomes increasingly worse in areas affected by armed conflict. Children affected by conflict, or in war-torn settings, face a disproportionate burden of malnutrition and poor health outcomes. As noted by humanitarian response reviews, there is a need for a stronger evidence-based response to humanitarian crises. To achieve this, we systematically searched and evaluated existing nutrition interventions carried out in conflict settings that assessed their impact on children's nutrition status. To evaluate the impact of nutrition interventions on children's nutrition and growth status, we identified published literature through EMBASE, PubMed, and Global Health by using a combination of relevant text words and Medical Subject Heading terms. Studies for this review must have included children (aged ≤18 y), been conducted in conflict or postconflict settings, and assessed a nutrition intervention that measured ≥1 outcome for nutrition status (i.e., stunting, wasting, or underweight). Eleven studies met the inclusion and exclusion criteria for this review. Five different nutrition interventions were identified and showed modest results in decreasing the prevalence of stunting, wasting, underweight, reduction in severe or moderate acute malnutrition or both, mortality, anemia, and diarrhea. Overall, nutrition interventions in conflict settings were associated with improved children's nutrition or growth status. Emergency nutrition programs should continue to follow recent recommendations to expand coverage and access (beyond refugee camps to rural areas) and ensure that aid and nutrition interventions are distributed equitably in all conflict-affected populations.

Community-Based Supports and Services for Older Adults: A Primer for Clinicians.

Although 20% of adults 60 years and older receive community-based supports and services (CBSS), clinicians may have little more than a vague awareness of what is available and which services may benefit their patients. As health care shifts toward more creative and holistic models of care, there are opportunities for CBSS staff and primary care clinicians to collaborate toward the goal of maintaining patients' health and enabling them to remain safely in the community. This primer reviews the half-century history of these organizations in the United States, describes the most commonly used services, and explains how to access them.

Piloting a Text Message-based Social Support Intervention for Patients With Chronic Pain: Establishing Feasibility and Preliminary Efficacy.

OBJECTIVES: To examine preliminarily the effectiveness of a short message service (SMS) text message-based social support intervention for reducing daily pain and pain interference levels, improving affect and perceptions of social support in patients with chronic noncancer pain, and exploring the feasibility of a novel mobile application to track perceptions of pain and pain interference. MATERIALS AND METHODS: Participants (17 men, 51 women) from 2 pain clinics in New York City downloaded a pain tracking application (App) on their Smartphone and used it to record twice-daily pain, pain interference, and affect scores over the 4-week study period. Participants were randomly assigned to receive standard care (control) or standard care along with receipt of twice-daily supportive SMS text messages delivered during the second and third week of the study (intervention). Demographic and clinical data were obtained at baseline, and social support measures were administered at baseline and at 4 weeks. Statistical analysis was carried out using general linear mixed models, taking into account variances associated with time of assessments and with patients. RESULTS: The social support intervention reduced perceptions of pain and pain interference and improved positive affect for chronic noncancer pain patients assigned to the intervention condition in comparison with controls. Participants completed approximately 80% of the daily measurements requested. DISCUSSION: These findings establish the feasibility of collecting daily pain data using a mobile tracking App and provide significant implications and insight into a nuanced approach to reducing the daily experience of pain through mobile technology, especially because of its accessibility.

Meeting the public health challenge of pain in later life: what role can senior centers play?

Interest in nonpharmacologic approaches for managing pain continues to grow. The aim of this study was to determine the types of pain-relevant programs offered by senior centers and whether the programs varied by clients' race/ethnicity status and center size. A telephone survey was conducted. Respondents were presented with a list of 15 programs and the option to choose "other" and asked (1) whether the activity was offered and, if so, how often; (2) if they believed the programs had value for seniors with pain; and (3) whether the classes were advertised as a means of achieving pain relief. Of 204 center staff contacted, 195 (95.6%) participated. The most common programs offered were movement-based, including exercise (by 91.8% of the centers), dance (72.3%), walking clubs (71.8%), yoga (65.6%), and Tai Chi (53.3%) classes. Creative arts programs were also frequently offered, including music (58.5%) and fine arts (47.7%). Programs such as stress management (27%) and relaxation (26%) classes were less commonly offered. Most respondents identified movement-based programs as helpful for seniors with pain, but few identified creative arts classes as potentially beneficial. The programs/classes offered were infrequently advertised as a means of helping seniors manage pain and varied by clients' race/ethnicity status and center size. Programs that have potential utility for older adults with pain are commonly offered by senior centers. Future research should determine optimal strategies for engaging older adults in these programs in the senior center setting.