Reliability and reproducibility of the venous excess ultrasound (VExUS) score, a multi-site prospective study: validating a novel ultrasound technique for comprehensive assessment of venous congestion.

Though the novel venous excess ultrasound (VExUS) score is increasingly used as a noninvasive means of venous congestion measurement, the inter-rater reliability (IRR), inter-user reproducibility (IUR), and utility of concurrent ECG have not been evaluated. We conducted a multicenter study of the IRR, IUR, and utility of ECG for VExUS interpretation between four attending physicians of diverse specialties, reporting the Kappa statistic (KS) and Intraclass Correlation Coefficient (ICC) for IRR and IUR for scans with and without ECG. Eighty-four paired VExUS exams from 42 patients, 60 of which had a concurrent ECG tracing, were interpreted. They showed substantial IRR, with a KS of 0.71 and ICC of 0.83 for the overall VExUS grade (p < 0.001), and IUR, with a KS 0.63 and ICC of 0.8. There was greater agreement among images with an ECG tracing. These results suggest that ECG-augmented VExUS may be a reliable and reproducible measure interpretable by clinicians with diverse backgrounds.

Venous excess ultrasonography (VExUS) captures dynamic changes in volume status surrounding hemodialysis: A multicenter prospective observational study.

Background: The evaluation of volume status is essential to clinical decision-making, yet multiple studies have shown that physical exam does not reliably estimate a patient's intravascular volume. Venous excess ultrasound score (VExUS) is an emerging volume assessment tool that utilizes inferior vena cava (IVC) diameter and pulse-wave Doppler waveforms of the portal, hepatic and renal veins to evaluate venous congestion. A point-of-care ultrasound exam initially developed by Beaubein-Souligny et al., VExUS represents a reproducible, non-invasive and accurate means of assessing intravascular congestion. VExUS has recently been validated against RHC-the gold-standard of hemodynamic evaluation for volume assessment. While VExUS scores were shown to correlate with elevated cardiac filling pressures (i.e., right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP)) at a static point in time, the ability of VExUS to capture dynamic changes in volume status has yet to be elucidated. We hypothesized that paired VExUS examinations performed before and after hemodialysis (HD) would reflect changes in venous congestion in a diverse patient population. Methods: Inpatients with end-stage renal disease undergoing intermittent HD were evaluated with transabdominal VExUS and lung ultrasonography before and following HD. Paired t-tests were conducted to assess differences between pre-HD and post-HD VExUS scores, B-line scores and dyspnea scores. Results: Fifty-six patients were screened for inclusion in this study. Ten were excluded due to insufficient image quality or incomplete exams, and forty-six patients (ninety-two paired ultrasound exams) were included in the final analysis. Paired t-test analysis of pre-HD and post-HD VExUS scores revealed a mean VExUS grade change of 0.82 (p<0.001) on a VExUS scale ranging from 0 to 4. The mean difference in B-line score following HD was 0.8 (p=0.001). There was no statistically significant difference in subjective dyspnea score (p=0.41). Conclusions: Large-volume fluid removal with HD was represented by changes in VExUS score, highlighting the utility of the VExUS exam to capture dynamic shifts in intravascular volume status. Future studies should evaluate change in VExUS grade with intravenous fluid or diuretic administration, with the ultimate goal of evaluating the capacity of a standardized bedside ultrasound protocol to guide inpatient volume optimization.

Parental determinants associated with early growth after the first year of life by race and ethnicity.

Objective: To investigate maternal and parental factors associated with changes in children's body mass index percentile (BMI-P) from 12 to 24 months. Methods: Data from a prospective cohort of racially and ethnically diverse mothers, fathers, and children (n = 245) were used. Changes in BMI-P from 12 to 24 months of age were examined using height and weight measurements collected at both times. Separate longitudinal mixed-effects models with maximum likelihood were introduced to examine the determinants introduced by mothers and determinants from both parents among all children, and by race and ethnicity. Results: Models that examine maternal and parental factors showed that children's overall BMI-P decreased from 12 to 24 months [ß = -4.85, 95% confidence interval (CI), -7.47 to -2.23]. Stratified tests showed that White children whose parents graduated high school or completed a 4-year college degree or higher had greater decreases in BMI-P than White children born to parents with less than high school education (ß = -60.39, 95% CI, -115.05 to -5.72; ß = -61.49, 95% CI, -122.44 to -0.53). Among Hispanic/Latinx children, mean BMI-P significantly decreased from 12 to 24 months (ß = -7.12, 95% CI, -11.59 to -2.64). Mother's older age (ß = 1.83, 95% CI, 0.29-3.36) and child female sex (ß = 11.21, 95% CI, 1.61-20.82) were associated with gains in children's BMI-P, while father's older age was associated with decreases (ß = -1.19, 95% CI, -2.30 to -0.08). Conclusions: Parental determinants associated with children's early growth varied by children's sex and racial and ethnic background. Results highlight the importance of understanding racial and ethnicity-specific obesity risks and including fathers in research.

Building a safety culture for infection prevention and control adherence at Howard Springs: A workplace survey.

BACKGROUND: Building a safety culture is essential to facilitate infection prevention and control (IPC) adherence in workplaces. We aimed to explore perceptions, barriers and facilitators to IPC procedures by the Australian Medical Assistance Team (AUSMAT) at Howard Springs International Quarantine Facility (HSIQF). METHODS: We performed a descriptive analysis of a cross-sectional survey administered to the AUSMAT employed at HSQIF from October 2020 to April 2021. We described motivation, training and compliance to IPC adherence and Likert scales described the level of agreement to the success of IPC procedures across the domains of communication, risk, trust, safety and environment, from the individual, team and organisational perspective. RESULTS: There were 101 participants (response rate 59%, 101/170) and 70% (71/101) were clinical. There was strong agreement to the success of IPC procedures, with a median 4 (agree) or 5 (strongly agree) across each domain and perspective of the 67 Likert items. Clinical staff reported slightly higher agreement than non-clinical staff across Likert items. To improve IPC compliance, most reported that daily training should be provided (77/97, 79%) and daily training was very or extremely effective (91/97, 93%). Participants were motivated by protecting self, friends, family and the community rather than workplace pressures. Barriers to IPC compliance were the ambient environment and fatigue. CONCLUSIONS: A safety culture was successfully built at HSQIF to optimise IPC adherence whilst managing multiple hazards including prevention of COVID-19 transmission. Strategies implemented by AUSMAT at the quarantine facility may inform the development of safety culture in other settings.

Publisher Correction: Open Science principles for accelerating trait-based science across the Tree of Life.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Open Science principles for accelerating trait-based science across the Tree of Life.

Synthesizing trait observations and knowledge across the Tree of Life remains a grand challenge for biodiversity science. Species traits are widely used in ecological and evolutionary science, and new data and methods have proliferated rapidly. Yet accessing and integrating disparate data sources remains a considerable challenge, slowing progress toward a global synthesis to integrate trait data across organisms. Trait science needs a vision for achieving global integration across all organisms. Here, we outline how the adoption of key Open Science principles-open data, open source and open methods-is transforming trait science, increasing transparency, democratizing access and accelerating global synthesis. To enhance widespread adoption of these principles, we introduce the Open Traits Network (OTN), a global, decentralized community welcoming all researchers and institutions pursuing the collaborative goal of standardizing and integrating trait data across organisms. We demonstrate how adherence to Open Science principles is key to the OTN community and outline five activities that can accelerate the synthesis of trait data across the Tree of Life, thereby facilitating rapid advances to address scientific inquiries and environmental issues. Lessons learned along the path to a global synthesis of trait data will provide a framework for addressing similarly complex data science and informatics challenges.

Regional scale patterns of fine root lifespan and turnover under current and future climate.

Fine root dynamics control a dominant flux of carbon from plants and into soils and mediate potential uptake and cycling of nutrients and water in terrestrial ecosystems. Understanding of these patterns is needed to accurately describe critical processes like productivity and carbon storage from ecosystem to global scales. However, limited observations of root dynamics make it difficult to define and predict patterns of root dynamics across broad spatial scales. Here, we combine species-specific estimates of fine root dynamics with a model that predicts current distribution and future suitable habitat of temperate tree species across the eastern United States (US). Estimates of fine root lifespan and turnover are based on empirical observations and relationships with fine root and whole-plant traits and apply explicitly to the fine root pool that is relatively short-lived and most active in nutrient and water uptake. Results from the combined model identified patterns of faster root turnover rates in the North Central US and slower turnover rates in the Southeastern US. Portions of Minnesota, Ohio, and Pennsylvania were also predicted to experience >10% increases in root turnover rates given potential shifts in tree species composition under future climate scenarios while root turnover rates in other portions of the eastern US were predicted to decrease. Despite potential regional changes, the average estimates of root lifespan and turnover for the entire study area remained relatively stable between the current and future climate scenarios. Our combined model provides the first empirically based, spatially explicit, and spatially extensive estimates of fine root lifespan and turnover and is a potentially powerful tool allowing researchers to identify reasonable approximations of forest fine root turnover in areas where no direct observations are available. Future efforts should focus on reducing uncertainty in estimates of root dynamics by better understanding how climate and soil factors drive variability in root dynamics of different species.