Bimanual coordination and spinal cord neuromodulation: how neural substrates of bimanual movements are altered by transcutaneous spinal cord stimulation.

Humans use their arms in complex ways that often demand two-handed coordination. Neurological conditions limit this impressive feature of the human motor system. Understanding how neuromodulatory techniques may alter neural mechanisms of bimanual coordination is a vital step towards designing efficient rehabilitation interventions. By non-invasively activating the spinal cord, transcutaneous spinal cord stimulation (tSCS) promotes recovery of motor function after spinal cord injury. A multitude of research studies have attempted to capture the underlying neural mechanisms of these effects using a variety of electrophysiological tools, but the influence of tSCS on cortical rhythms recorded via electroencephalography remains poorly understood, especially during bimanual actions. We recruited 12 neurologically intact participants to investigate the effect of cervical tSCS on sensorimotor cortical oscillations. We examined changes in the movement kinematics during the application of tSCS as well as the cortical activation level and interhemispheric connectivity during the execution of unimanual and bimanual arm reaching movements that represent activities of daily life. Behavioral assessment of the movements showed improvement of movement time and error during a bimanual common-goal movement when tSCS was delivered, but no difference was found in the performance of unimanual and bimanual dual-goal movements with the application of tSCS. In the alpha band, spectral power was modulated with tSCS in the direction of synchronization in the primary motor cortex during unimanual and bimanual dual-goal movements and in the somatosensory cortex during unimanual movements. In the beta band, tSCS significantly increased spectral power in the primary motor and somatosensory cortices during the performance of bimanual common-goal and unimanual movements. A significant increase in interhemispheric connectivity in the primary motor cortex in the alpha band was only observed during unimanual tasks in the presence of tSCS. Our observations provide, for the first time, information regarding the supra-spinal effects of tSCS as a neuromodulatory technique applied to the spinal cord during the execution of bi- and unimanual arm movements. They also corroborate the suppressive effect of tSCS at the cortical level reported in previous studies. These findings may guide the design of improved rehabilitation interventions using tSCS for the recovery of upper-limb function in the future.

UK doctors' strikes 2023: not only justified but, arguably, supererogatory.

The 2023 doctors' strikes in the UK have elicited a familiar moral outcry that such strikes are morally wrong. We consider five arguments that might be thought to show doctors' strikes are morally impermissible but show that they all fail. The most we can conclude from such arguments is that doctors' strikes are morally permissible in a narrower range of circumstances than strikes in other sectors.We then outline two independent but compatible justifications for doctors' strikes, one that appeals to doctors' interests in fair pay and working conditions and one that appeals to doctors' duty to protect public health. We also suggest that doctors' strikes can be supererogatory when they aim to correct a government failing in its own duty to protect public health. Finally, we assess the 2023 UK doctors' strikes. We conclude that they are justified and there is a case for considering them supererogatory.

Ancient Human Genomes and Environmental DNA from the Cement Attaching 2,000-Year-Old Head Lice Nits.

Over the past few decades, there has been a growing demand for genome analysis of ancient human remains. Destructive sampling is increasingly difficult to obtain for ethical reasons, and standard methods of breaking the skull to access the petrous bone or sampling remaining teeth are often forbidden for curatorial reasons. However, most ancient humans carried head lice and their eggs abound in historical hair specimens. Here we show that host DNA is protected by the cement that glues head lice nits to the hair of ancient Argentinian mummies, 1,500-2,000 years old. The genetic affinities deciphered from genome-wide analyses of this DNA inform that this population migrated from north-west Amazonia to the Andes of central-west Argentina; a result confirmed using the mitochondria of the host lice. The cement preserves ancient environmental DNA of the skin, including the earliest recorded case of Merkel cell polyomavirus. We found that the percentage of human DNA obtained from nit cement equals human DNA obtained from the tooth, yield 2-fold compared with a petrous bone, and 4-fold to a bloodmeal of adult lice a millennium younger. In metric studies of sheaths, the length of the cement negatively correlates with the age of the specimens, whereas hair linear distance between nit and scalp informs about the environmental conditions at the time before death. Ectoparasitic lice sheaths can offer an alternative, nondestructive source of high-quality ancient DNA from a variety of host taxa where bones and teeth are not available and reveal complementary details of their history.

Enabling health information exchange at a US Poison Control Center.

OBJECTIVE: The objective of this project was to enable poison control center (PCC) participation in standards-based health information exchange (HIE). Previously, PCC participation was not possible due to software noncompliance with HIE standards, lack of informatics infrastructure, and the need to integrate HIE processes into workflow. MATERIALS AND METHODS: We adapted the Health Level Seven Consolidated Clinical Document Architecture (C-CDA) consultation note for the PCC use case. We used rapid prototyping to determine requirements for an HIE dashboard for use by PCCs and developed software called SNOWHITE that enables poison center HIE in tandem with a poisoning information system. RESULTS: We successfully implemented the process and software at the PCC and began sending outbound C-CDAs from the Utah PCC on February 15, 2017; we began receiving inbound C-CDAs on October 30, 2018. DISCUSSION: With the creation of SNOWHITE and initiation of an HIE process for sending outgoing C-CDA consultation notes from the Utah Poison Control Center, we accomplished the first participation of PCCs in standards-based HIE in the US. We faced several challenges that are also likely to be present at PCCs in other states, including the lack of a robust set of patient identifiers to support automated patient identity matching, challenges in emergency department computerized workflow integration, and the need to build HIE software for PCCs. CONCLUSION: As a multi-disciplinary, multi-organizational team, we successfully developed both a process and the informatics tools necessary to enable PCC participation in standards-based HIE and implemented the process at the Utah PCC.

Sexual selection predicts the persistence of populations within altered environments.

The effect of sexual selection on species persistence remains unclear. The cost of bearing ornaments or armaments might increase extinction risk, but sexual selection can also enhance the spread of beneficial alleles and increase the removal of deleterious alleles, potentially reducing extinction risk. Here we investigate the effect of sexual selection on species persistence in a community of 34 species of dung beetles across a gradient of environmental disturbance ranging from old growth forest to oil palm plantation. Horns are sexually selected traits used in contests between males, and we find that both horn presence and relative size are strongly positively associated with species persistence and abundance in altered habitats. Testes mass, an indicator of post-copulatory selection, is, however, negatively linked with the abundance of species within the most disturbed habitats. This study represents the first evidence from a field system of a population-level benefit from pre-copulatory sexual selection.

Tropical dung beetle morphological traits predict functional traits and show intraspecific differences across land uses.

Functional traits and functional diversity measures are increasingly being used to examine land use effects on biodiversity and community assembly rules. Morphological traits are often used directly as functional traits. However, behavioral characteristics are more difficult to measure. Establishing methods to derive behavioral traits from morphological measurements is necessary to facilitate their inclusion in functional diversity analyses. We collected morphometric data from over 1,700 individuals of 12 species of dung beetle to establish whether morphological measurements can be used as predictors of behavioral traits. We also compared morphology among individuals collected from different land uses (primary forest, logged forest, and oil palm plantation) to identify whether intraspecific differences in morphology vary among land use types. We show that leg and eye measurements can be used to predict dung beetle nesting behavior and period of activity and we used this information to confirm the previously unresolved nesting behavior for Synapsis ritsemae. We found intraspecific differences in morphological traits across different land use types. Phenotypic plasticity was found for traits associated with dispersal (wing aspect ratio and wing loading) and reproductive capacity (abdomen size). The ability to predict behavioral functional traits from morphology is useful where the behavior of individuals cannot be directly observed, especially in tropical environments where the ecology of many species is poorly understood. In addition, we provide evidence that land use change can cause phenotypic plasticity in tropical dung beetle species. Our results reinforce recent calls for intraspecific variation in traits to receive more attention within community ecology.

Enhancing a Commercial EMR with an Open, Standards-Based Publish-Subscribe Infrastructure.

Intermountain Healthcare has designed and implemented a publish-subscribe (PubSub) infrastructure to support essential event processing workflows across our organization. A recent implementation of a commercial EMR highlighted the need to provide this capability on top of the EMR to support external applications and services that require access to triggering events within the EMR. A description of the PubSub architecture is presented. Use cases for health information exchange, public health reporting, and pulmonary embolism diagnosis that utilize PubSub are described, along with benefits of using the paradigm. Besides providing support for these external applications, the PubSub infrastructure allows additional event handling functionality not available in the commercial EMR. The open, standards-based nature of the design should allow other organizations to implement the system in their information systems environment.

Who Is Your Doctor? Analysis of Patient-Reported and EHR-Imputed Primary Care Physician.

Significant efforts have been made to improve physician-to-physician communication and care coordination during transition of care in order to reduce adverse events and readmissions. As electronic health records (EHRs) become widely available, many hospitals have implemented physician collaboration and hand-off tools to automatically send admission notifications, discharge summaries, and pending laboratory results to a patient's primary care physician (PCP). However, the effectiveness of such tools depends on a fundamental question that remains unstudied: who is the patient's PCP? Missing or outdated PCP information may become the bottleneck to effective patient-centered care coordination regardless of existing efforts on promoting interoperability among healthcare providers. In this paper, we characterized patient-reported PCPs and experimented with an imputation algorithm that automatically infers a patient's primary provider based on patient-provider encounter data. We compared the imputation results with patient-reported PCPs and suggested practical uses of our findings.

Developing and enhancing biodiversity monitoring programmes: a collaborative assessment of priorities.

Biodiversity is changing at unprecedented rates, and it is increasingly important that these changes are quantified through monitoring programmes. Previous recommendations for developing or enhancing these programmes focus either on the end goals, that is the intended use of the data, or on how these goals are achieved, for example through volunteer involvement in citizen science, but not both. These recommendations are rarely prioritized.We used a collaborative approach, involving 52 experts in biodiversity monitoring in the UK, to develop a list of attributes of relevance to any biodiversity monitoring programme and to order these attributes by their priority. We also ranked the attributes according to their importance in monitoring biodiversity in the UK. Experts involved included data users, funders, programme organizers and participants in data collection. They covered expertise in a wide range of taxa.We developed a final list of 25 attributes of biodiversity monitoring schemes, ordered from the most elemental (those essential for monitoring schemes; e.g. articulate the objectives and gain sufficient participants) to the most aspirational (e.g. electronic data capture in the field, reporting change annually). This ordered list is a practical framework which can be used to support the development of monitoring programmes.People's ranking of attributes revealed a difference between those who considered attributes with benefits to end users to be most important (e.g. people from governmental organizations) and those who considered attributes with greatest benefit to participants to be most important (e.g. people involved with volunteer biological recording schemes). This reveals a distinction between focussing on aims and the pragmatism in achieving those aims. Synthesis and applications. The ordered list of attributes developed in this study will assist in prioritizing resources to develop biodiversity monitoring programmes (including citizen science). The potential conflict between end users of data and participants in data collection that we discovered should be addressed by involving the diversity of stakeholders at all stages of programme development. This will maximize the chance of successfully achieving the goals of biodiversity monitoring programmes.

The importance of microhabitat for biodiversity sampling.

Responses to microhabitat are often neglected when ecologists sample animal indicator groups. Microhabitats may be particularly influential in non-passive biodiversity sampling methods, such as baited traps or light traps, and for certain taxonomic groups which respond to fine scale environmental variation, such as insects. Here we test the effects of microhabitat on measures of species diversity, guild structure and biomass of dung beetles, a widely used ecological indicator taxon. We demonstrate that choice of trap placement influences dung beetle functional guild structure and species diversity. We found that locally measured environmental variables were unable to fully explain trap-based differences in species diversity metrics or microhabitat specialism of functional guilds. To compare the effects of habitat degradation on biodiversity across multiple sites, sampling protocols must be standardized and scale-relevant. Our work highlights the importance of considering microhabitat scale responses of indicator taxa and designing robust sampling protocols which account for variation in microhabitats during trap placement. We suggest that this can be achieved either through standardization of microhabitat or through better efforts to record relevant environmental variables that can be incorporated into analyses to account for microhabitat effects. This is especially important when rapidly assessing the consequences of human activity on biodiversity loss and associated ecosystem function and services.

Onthophagus cervicornis Kirby, 1825, new synonym under Onthophagus dama (Fabricius, 1798) (Coleoptera, Scarabaeidae, Scarabaeinae).

After examining syntypes of Onthophagus cervicornis Kirby, 1825, previously considered to be a synonym of the North American Onthophagus striatulus (Palisot de Beauvois, 1809), we confirm the true identity and new synonymy under South Asian Onthophagus dama (Fabricius, 1798).

Do riparian reserves support dung beetle biodiversity and ecosystem services in oil palm-dominated tropical landscapes?

Agricultural expansion and intensification are major threats to global biodiversity, ecological functions, and ecosystem services. The rapid expansion of oil palm in forested tropical landscapes is of particular concern given their high biodiversity. Identifying management approaches that maintain native species and associated ecological processes within oil palm plantations is therefore a priority. Riparian reserves are strips of forest retained alongside rivers in cultivated areas, primarily for their positive hydrological impact. However, they can also support a range of forest-dependent species or ecosystem services. We surveyed communities of dung beetles and measured dung removal activity in an oil palm-dominated landscape in Sabah, Malaysian Borneo. The species richness, diversity, and functional group richness of dung beetles in riparian reserves were significantly higher than in oil palm, but lower than in adjacent logged forests. The community composition of the riparian reserves was more similar to logged forest than oil palm. Despite the pronounced differences in biodiversity, we did not find significant differences in dung removal rates among land uses. We also found no evidence that riparian reserves enhance dung removal rates within surrounding oil palm. These results contrast previous studies showing positive relationships between dung beetle species richness and dung removal in tropical forests. We found weak but significant positive relationships between riparian reserve width and dung beetle diversity, and between reserve vegetation complexity and dung beetle abundance, suggesting that these features may increase the conservation value of riparian reserves. Synthesis and applications: The similarity between riparian reserves and logged forest demonstrates that retaining riparian reserves increases biodiversity within oil palm landscapes. However, the lack of correlation between dung beetle community characteristics and dung removal highlights the need for further research into spatial variation in biodiversity-ecosystem function relationships and how the results of such studies are affected by methodological choices.

Improving Clinical Data Integrity by using Data Adjudication Techniques for Data Received through a Health Information Exchange (HIE).

Growing participation in Healthcare Information Exchange (HIE) has created opportunities for the seamless integration of external data into an organization's own EHR and clinical workflows. The process of integrating external data has the potential to detect data integrity issues. Lack of critiquing external data before its incorporation can lead to data unfit for use in the clinical setting. HIE data adjudication, by detecting inconsistencies, physiological and temporal incompatibilities, data completeness and timeliness issues in HIE data, facilitates corrective actions and improves clinical data integrity.

Elevational distribution and conservation biogeography of phanaeine dung beetles (Coleoptera: Scarabaeinae) in Bolivia.

Insect macroecology and conservation biogeography studies are disproportionately scarce, especially in the Neotropics. Dung beetles are an ideal focal taxon for biodiversity research and conservation. Using distribution and body size data on the ecologically important Phanaeini, the best-known Neotropical dung beetle tribe, we determined elevational patterns of species richness, endemism, body size, and elevational range in Bolivia, specifically testing Bergmann's and Rapoport's rule. Richness of all 39 species and of 15 ecoregional endemics showed a hump-shaped pattern peaking at 400 m, but overall declined strongly with elevation up to 4000 m. The relationship between endemic and total species richness appeared to be curvilinear, providing only partial support for the null hypothesis that species-rich areas are more likely to be centers of endemism by chance alone. An elevational increase in the proportion of ecoregional endemics suggests that deterministic factors also appear to influence endemism in the Andes. When controlling for the effect of area using different species-area relationships, the statistically significant richness peak became more pronounced and shifted upslope to 750 m. Larger species did not have higher elevational mid-points, and mean body size decreased significantly with elevation, contradicting Bergmann's rule. Rapoport's rule was supported: species with higher elevational mid-points had broader elevational ranges, and mean elevational range increased significantly with elevation. The elevational decrease of phanaeine richness is in accordance with studies that demonstrated the combined influence of temperature and water availability on species diversity, but also is consistent with niche conservatism. For invertebrates, confirmation of Rapoport's and refutation of Bergmann's rule appear to be scale-invariant general patterns. Analyses of biogeographic patterns across elevational gradients can provide important insights for identifying conservation priorities. Phanaeines with narrow elevational ranges on isolated low-elevation mountains in eastern Bolivia are at greatest climate-change related extinction risk from range-shift gaps and mountaintop extinctions.

Experimental evidence for the effects of dung beetle functional group richness and composition on ecosystem function in a tropical forest.

Much of the literature on the relationship between species richness or functional group richness and measures of ecosystem function focuses on a restricted set of ecosystem function measures and taxonomic groups. Few such studies have been carried out under realistic levels of diversity in the field, particularly in high diversity ecosystems such as tropical forests. We used exclusion experiments to study the effects of dung beetle functional group richness and composition on two interlinked and functionally important ecological processes, dung removal and secondary seed dispersal, in evergreen tropical forest in Sabah, Malaysian Borneo. Overall, both dung and seed removal increased with dung beetle functional group richness. However, levels of ecosystem functioning were idiosyncratic depending on the identity of the functional groups present, indicating an important role for functional group composition. There was no evidence for interference or competition among functional groups. We found strong evidence for overyielding and transgressive overyielding, suggesting complementarity or facilitation among functional groups. Not all mixtures showed transgressive overyielding, so that complementarity was restricted to particular functional group combinations. Beetles in a single functional group (large nocturnal tunnellers) had a disproportionate influence on measures of ecosystem function: in their absence dung removal is reduced by approximately 75%. However, a full complement of functional groups is required to maximize ecosystem functioning. This study highlights the importance of both functional group identity and species composition in determining the ecosystem consequences of extinctions or altered patterns in the relative abundance of species.

Metabolic control patterns in acute phase and regenerating human liver determined in vivo by 31-phosphorus magnetic resonance spectroscopy.

OBJECTIVE: To elucidate the metabolic changes occurring within hepatocytes during acute phase reaction and liver regeneration. SUMMARY BACKGROUND DATA: The metabolic events occurring within the liver during the hepatic stress response are poorly understood. The authors used in vivo 31-phosphorus magnetic resonance spectroscopy to study hepatic metabolism after surgical trauma with and without loss of liver cell mass. METHODS: Three groups were studied: five patients undergoing partial hepatectomy; five patients in whom laparotomy and colonic resection was performed; and five patients treated by thyroidectomy. Hepatic metabolism was evaluated by 31-phosphorus magnetic resonance spectroscopy before surgery and serially thereafter on postoperative days 2, 4, 6, 14, and 28. Estimation of liver volume by magnetic resonance imaging and blood sampling for biochemistry were performed at the same time points. RESULTS: The authors found that alterations in hepatocyte phospholipid metabolism occurred after surgery that were correlated with changes in circulating acute phase proteins. Liver regeneration after hepatectomy was also associated with a derangement in energy metabolism, measured by a decrease in the ratio of ATP to its hydrolysis product inorganic phosphate. The depleted energy status was mirrored in biochemical indices of liver function, and restitution paralleled the course of restoration of hepatic cell mass. CONCLUSIONS: These findings indicate that changes in liver metabolism after surgery reflect the magnitude of tissue injury and the quantity of functioning liver cells. Acute phase responses dominate the initial recovery period at the expense of less important endergonic functions. When liver parenchyma is lost, the acute phase reaction is maintained and further supported by a rapid replenishment of hepatocytes, which can even be considered a continuation of acute phase physiology. Modulation of liver function within the framework of overall hepatic energy economy is one mechanism for matching energy supply with increased demands during these processes.