Solar Energy-driven Land-cover Change Could Alter Landscapes Critical to Animal Movement in the Continental United States.

The United States may produce as much as 45% of its electricity using solar energy technology by 2050, which could require more than 40,000 km2 of land to be converted to large-scale solar energy production facilities. Little is known about how such development may impact animal movement. Here, we use five spatially explicit projections of solar energy development through 2050 to assess the extent to which ground-mounted photovoltaic solar energy expansion in the continental United States may impact land-cover and alter areas important for animal movement. Our results suggest that there could be a substantial overlap between solar energy development and land important for animal movement: across projections, 7-17% of total development is expected to occur on land with high value for movement between large protected areas, while 27-33% of total development is expected to occur on land with high value for climate-change-induced migration. We also found substantial variation in the potential overlap of development and land important for movement at the state level. Solar energy development, and the policies that shape it, may align goals for biodiversity and climate change by incorporating the preservation of animal movement as a consideration in the planning process.

ipcoal: an interactive Python package for simulating and analyzing genealogies and sequences on a species tree or network.

SUMMARY: ipcoal is a free and open source Python package for simulating and analyzing genealogies and sequences. It automates the task of describing complex demographic models (e.g. with divergence times, effective population sizes, migration events) to the msprime coalescent simulator by parsing a user-supplied species tree or network. Genealogies, sequences and metadata are returned in tabular format allowing for easy downstream analyses. ipcoal includes phylogenetic inference tools to automate gene tree inference from simulated sequence data, and visualization tools for analyzing results and verifying model accuracy. The ipcoal package is a powerful tool for posterior predictive data analysis, for methods validation and for teaching coalescent methods in an interactive and visual environment. AVAILABILITY AND IMPLEMENTATION: Source code is available from the GitHub repository (https://github.com/pmckenz1/ipcoal/) and is distributed for packaged installation with conda. Complete documentation and interactive notebooks prepared for teaching purposes, including an empirical example, are available at https://ipcoal.readthedocs.io/. CONTACT: p.mckenzie@columbia.edu.

Safety of endoscopist-directed nurse-administered balanced propofol sedation in patients with severe systemic disease (ASA class III).

BACKGROUND AND AIMS: The safety of endoscopist-directed nurse-administered propofol sedation (EDNAPS) has been demonstrated in low-risk patients (American Society of Anesthesiologists [ASA] class I and II). There are limited data regarding the safety of EDNAPS for endoscopic procedures in ASA class III patients. The purpose of this study was to determine the safety of EDNAPS for routine outpatient endoscopy in this population. METHODS: We retrospectively reviewed all outpatient EGDs and colonoscopies performed with EDNAPS at the University of Utah from January 2015 to November 2018. Exclusion criteria were inpatient procedures, combined procedures, ASA IV or higher, use of continuous or bilevel positive airway pressure at the start of the procedure, or procedures performed by a nongastroenterologist. Major adverse events were defined as intubation or death. Minor adverse events were defined as hypoxia, hypotension, bradycardia, or need for airway interventions. Patients were stratified by procedure type and ASA I/II status and were compared with patients with ASA III status and matched according to age, gender, and the involvement of a fellow in a 3 to 1 fashion. RESULTS: The final sample size was 18,910 colonoscopy procedures (17,205 patients) and 9178 EGD procedures (6827 patients). In both colonoscopy and EGD procedures, there were no major adverse events such as intubation, need for resuscitation, or death. The rates of any airway intervention, jaw thrust, oral nasal airway, or use of positive pressure ventilation were low in both procedure types and not different between ASA I/II and ASA III patients. CONCLUSION: EDNAPS is safe in both ASA I/II and ASA class III patients undergoing routine outpatient endoscopy.

The Effect of Gastric Electrical Stimulation on Small Bowel Motility in Patients With Gastroparesis and Concomitant Pancreatic and Small Bowel Dysfunction: From Animal Model to Human Application.

BACKGROUND/AIMS: Patients with gastroparesis often have biliary/pancreatic and small bowel symptoms but the effects of gastric electrical stimulation on small bowel electrical activity of the mid-gut have not been studied. Animal model aim: Establish gastric and upper small bowel/biliary slow wave activity relationships with electrical stimulation. Human study aim: Demonstrate improvement in symptoms associated with proximal small bowel dysmotility in gastric stimulated patients. MATERIALS AND METHODS: Animal model: In vivo evoked responses of duodenal and Sphincter of Oddi measures recorded during gastric electrical stimulation in a nonsurvival swine model (N = 3). High-resolution electrical slow wave mapping of frequency, amplitude, and their ratio, for duodenal and Sphincter of Oddi electrical activity were recorded. Human study: Patients (N = 8) underwent temporary gastric stimulation with small bowel electrodes. Subjective and objective data was collected before and after temporary gastric stimulation. Symptom scores, gastric emptying times, and mucosal electrograms via low-resolution mapping were recorded. RESULTS: Animal gastric stimulation resulted in some changes in electrical activity parameters, especially with the highest energies delivered but the changes were not statistically significant. Human study revealed improvement in symptom and illness severity scores, and changes in small bowel mucosal slow wave activity. CONCLUSIONS: Gastric electrical stimulation in an animal model seems to show nonsignificant effects small bowel slow wave activity and myoelectric signaling, suggesting the existence of intrinsic neural connections. Human data shows more significance, with possible potential for therapeutic use of electrical stimulation in patients with gastroparesis and pancreato-biliary and small bowel symptoms of the mid-gut. This study was limited by the nonsurvival pig model, small sample size, and open label human study.

The incidence and etiology of overactive bladder in patients after cerebrovascular accident.

Cerebrovascular accident or stroke is a devastating neurologic event that can have both short and long term urologic complications. The purpose of this article is to provide an up-to-date review of the incidence and causes of voiding dysfunction after stroke, the evaluation of voiding dysfunction in patients after stroke, and the recommendations on the management of voiding dysfunction following stroke. The reported incidence of urinary incontinence varies from 28-79 % and the causes of urinary incontinence following stroke are multifactorial. Detrusor overactivity is predominant and detrusor underactivity is somewhat less prevalent. Urodynamic findings in patients with stroke vary depending upon timing of the study and associated comorbidities. Currently there are no large longitudinal studies linking urodynamic findings with location or degree of infarct. Based on current studies, we conclude that patients with detrusor underactivity should be managed with clean intermittent catheterization or indwelling Foley catheter, while timed voiding with or without anticholinergic therapy may be an effective treatment for patients with detrusor overactivity after stroke.

Is tissue engineering and biomaterials the future for lower urinary tract dysfunction (LUTD)/pelvic organ prolapse (POP)?

The fields of tissue engineering and regenerative medicine have seen major advances over the span of the past two decades, with biomaterials playing a central role. Although the term "regenerative medicine" has been applied to encompass most fields of medicine, in fact urology has been one of the most progressive. Many urological applications have been investigated over the past decades, with the culmination of these technologies in the introduction of the first laboratory-produced organ to be placed in a human body.1 With the quality of life issues associated with urinary incontinence, there is a strong driver to identify and introduce new technologies and the potential exists for further major advancements from regenerative medicine approaches using biomaterials, cells or a combination of both. A central question is why use biomaterials? The answer rests on the need to make up for inadequate or lack of autologous tissue, to decrease morbidity and to improve long-term efficacy. Thus, the ideal biomaterial needs to meet the following criteria: (1) Provide mechanical and structural support, (2) Maintain compliance and be biocompatible with surrounding tissues, and (3) Be "fit for purpose" by meeting specific application needs ranging from static support to bioactive cell signaling. In essence, this represents a wide range of biomaterials with a spectrum of potential applications, from use as a supportive or bulking implant alone, to implanted biomaterials that promote integration and eventual replacement by infiltrating host cells, or scaffolds pre-seeded with cells prior to implant. In this review we shall discuss the structural versus the integrative uses of biomaterials by referring to two key areas in urology of (1) pelvic organ support for prolapse and stress urinary incontinence, and (2) bladder replacement/augmentation.

Citizens of local jurisdictions enhance plant community preservation through ballot initiatives and voter-driven conservation efforts.

Open space areas protected by local communities may augment larger scale preservation efforts and may offer overlooked benefits to biodiversity conservation provided they are in suitable ecological condition. We examine protected areas established by local communities through ballot initiatives, a form of direct democracy, in California, USA. We compare ecological conditions of wooded habitats on local ballot protected sites and on sites protected by a state-level conservation agency. Collectively, we found few differences in ecological conditions on each protected area type. Ballot sites had greater invasive understory cover and larger trees. Community dissimilarity patterns suggested ballot sites protect a complementary set of tree species to those on state lands. Overall, geographic characteristics influenced onsite conditions more than details of how sites were protected. Thus, community-driven conservation efforts contribute to protected area networks by augmenting protection of some species while providing at least some protection to others that might otherwise be missed.

Genetic influences on stress urinary incontinence.

PURPOSE OF REVIEW: The purpose of this review is to summarize the current evidence for the genetic basis of stress urinary incontinence (SUI). RECENT FINDINGS: Based on epidemiologic data, there appears to be a genetic predisposition for the development of SUI. One thought is that there are abnormalities in expression of extracellular matrix (ECM) proteins leading to alterations in the composition of the ECM. Several studies have identified candidate genes encoding ECM proteins as well as inducers/inhibitors of these proteins, which are thought to lead to the development of SUI. Also, there is increasing evidence to suggest expression of these candidate genes may be influenced by the presence or absence of estrogen and progesterone. Pelvic organ prolapse is closely related to SUI, and the genes thought to be involved in the development of pelvic organ prolapse may also be linked to the development of SUI. SUMMARY: There is increasing evidence to support a genetic basis for the development of SUI, but some of the evidence is contradictory. Several candidate genes have been identified and these may lead to alterations in the composition of the ECM, ultimately predisposing some women to develop SUI. Future studies are needed to identify other candidate genes that may be involved in SUI and to study the influence of estrogen and progesterone on ECM proteins thought to be involved in SUI. The identification of genes involved in the development of SUI could lead to new therapies for the treatment of SUI.

A community-maintained standard library of population genetic models.

The explosion in population genomic data demands ever more complex modes of analysis, and increasingly, these analyses depend on sophisticated simulations. Recent advances in population genetic simulation have made it possible to simulate large and complex models, but specifying such models for a particular simulation engine remains a difficult and error-prone task. Computational genetics researchers currently re-implement simulation models independently, leading to inconsistency and duplication of effort. This situation presents a major barrier to empirical researchers seeking to use simulations for power analyses of upcoming studies or sanity checks on existing genomic data. Population genetics, as a field, also lacks standard benchmarks by which new tools for inference might be measured. Here, we describe a new resource, stdpopsim, that attempts to rectify this situation. Stdpopsim is a community-driven open source project, which provides easy access to a growing catalog of published simulation models from a range of organisms and supports multiple simulation engine backends. This resource is available as a well-documented python library with a simple command-line interface. We share some examples demonstrating how stdpopsim can be used to systematically compare demographic inference methods, and we encourage a broader community of developers to contribute to this growing resource.

Glass half empty? Lessons learned about gastroparesis.

Gastroparesis is defined as a combination of chronic dyspeptic symptoms and delayed emptying of a solid test meal. It remains a difficult-to-treat disorder with a significant impact on quality of life. Although gastroparesis is defined by delayed emptying, several important studies did not find a correlation between this biomarker and symptom severity or treatment success. Thus, some of the more recent trials explored strategies that ranged from antiemetics to antidepressants. Although dietary management showed benefit, most of the other interventions were barely superior to placebo or were not superior at all. Placebo responses were often quite high and this complicates the assessment of active agents. While it complicates the design and interpretation of clinical trials, high response rates for active and sham interventions indicate that we can achieve symptom relief in many patients and thus give them some reassurance. If indeed most therapies are only marginally better than placebo, the differences in adverse effects should be weighed more strongly, a point that is especially important in view of the controversy surrounding metoclopramide. Mechanistic studies introduced the network of macrophages as another potentially important player in the development of gastroparesis. Results are too preliminary and are largely based on preclinical data but show up- and downregulation of cellular elements controlling gastric function. Thus, future developments may teach us how they interfere with some of these mechanisms in clinical settings, potentially making gastroparesis a reversible process.

Phylogenomic analysis of vertebrate thrombospondins reveals fish-specific paralogues, ancestral gene relationships and a tetrapod innovation.

BACKGROUND: Thrombospondins (TSPs) are evolutionarily-conserved, extracellular, calcium-binding glycoproteins with important roles in cell-extracellular matrix interactions, angiogenesis, synaptogenesis and connective tissue organisation. Five TSPs, designated TSP-1 through TSP-5, are encoded in the human genome. All but one have known roles in acquired or inherited human diseases. To further understand the roles of TSPs in human physiology and pathology, it would be advantageous to extend the repertoire of relevant vertebrate models. In general the zebrafish is proving an excellent model organism for vertebrate biology, therefore we set out to evaluate the status of TSPs in zebrafish and two species of pufferfish. RESULTS: We identified by bioinformatics that three fish species encode larger numbers of TSPs than vertebrates, yet all these sequences group as homologues of TSP-1 to -4. By phylogenomic analysis of neighboring genes, we uncovered that, in fish, a TSP-4-like sequence is encoded from the gene corresponding to the tetrapod TSP-5 gene. Thus, all TSP genes show conservation of synteny between fish and tetrapods. In the human genome, the TSP-1, TSP-3, TSP-4 and TSP-5 genes lie within paralogous regions that provide insight into the ancestral genomic context of vertebrate TSPs. CONCLUSION: A new model for TSP evolution in vertebrates is presented. The TSP-5 protein sequence has evolved rapidly from a TSP-4-like sequence as an innovation in the tetrapod lineage. TSP biology in fish is complicated by the presence of additional lineage- and species-specific TSP paralogues. These novel results give deeper insight into the evolution of TSPs in vertebrates and open new directions for understanding the physiological and pathological roles of TSP-4 and TSP-5 in humans.

Critical appraisal of the Spanner™ prostatic stent in the treatment of prostatic obstruction.

The Spanner™ stent was first used in patients to relieve bladder outlet obstruction (BOO), and has recently been used in patients following transurethral microwave thermotherapy and men unfit for surgical intervention. We review the current literature on the role of the Spanner stent in treating prostatic obstruction compared to previously reported cases involving the use of temporary stents. The Spanner stent has been found to be successful in treating patients with bladder outlet obstruction from benign prostatic hyperplasia and following high-energy transurethral microwave thermotherapy (TUMT). Patients with the Spanner stent had an increase in peak flow rate and a decrease in post void residual and International Prostate Symptom Scores. In patients treated with TUMT, quality of life measures indicate that the Spanner stent shows increased ease of bladder drainage, decreased leakage, and no adverse effect on daily activities. In patients unfit for surgery, however, there was increased retention and pain requiring stent removal in 63% of cases. The Spanner stent offers ease of insertion with a decrease in voiding symptoms in selected patients. Based on limited data, the Spanner stent has been recommended as a treatment option for men with BOO following TUMT. However, it is not a good treatment option for men unfit for surgery based on an increased incidence of urinary retention and dysuria. The Spanner stent is the only currently approved temporary stent and, based on a literature review, it does not offer significant advantage over previously used temporary stents. It is notable that most researchers have not evaluated the role of detrusor function on the outcomes.

Gene expression profile of human airway epithelium induced by hyperoxia in vivo.

Hyperoxia leads to oxidative modification and damage of macromolecules in the respiratory tract with loss of biological functions. Given the lack of antioxidant gene induction with acute exposure to 100% oxygen, we hypothesized that clearance pathways for oxidatively modified proteins may be induced and serve in the immediate cellular response to preserve the epithelial layer. To test this, airway epithelial cells were obtained from individuals under ambient oxygen conditions and after breathing 100% oxygen for 12 h. Gene expression profiling identified induction of genes in the chaperone and proteasome-ubiquitin-conjugation pathways that together comprise an integrated cellular response to manage and degrade damaged proteins. Analyses also revealed gene expression changes associated with oxidoreductase function, cell cycle regulation, and ATP synthesis. Increased HSP70, protein ubiquitination, and intracellular ATP were validated in cells exposed to hyperoxia in vitro. Inhibition of proteasomal degradation revealed the importance of accelerated protein catabolism for energy production of cells exposed to hyperoxia. Thus, the human airway early response to hyperoxia relies predominantly upon induction of cytoprotective chaperones and the ubiquitin-proteasome-dependent protein degradation system to maintain airway homeostatic integrity.