Exploring the potential for online data sources to enhance species threat mapping through the case study of global bat exploitation.

Expanding digital data sources, including social media and online news, provide a low-cost way to examine human-nature interactions, such as wildlife exploitation. However, the extent to which using such data sources can expand or bias understanding of the distribution and intensity of threats has not been comprehensively assessed. To address this gap, we quantified the geographical and temporal distribution of online sources documenting the hunting and trapping, consumption, or trade of bats (Chiroptera) and compared these with the distribution of studies obtained from a systematic literature search and species listed as threatened by exploitation on the International Union for Conservation of Nature Red List. Online records were collected using automated searches of Facebook, Twitter, Google, and Bing and were filtered using machine classification. This yielded 953 relevant social media posts and web pages, encompassing 1099 unique records of bat exploitation from 84 countries. Although the number of records per country was significantly predicted by the number of academic studies per country, online records provided additional locations and more recent records of bat exploitation, including 22 countries not present in academic literature. This demonstrates the value of online resources in providing more complete geographical representation. However, confounding variables can bias the analysis of spatiotemporal trends. Online bat exploitation records showed peaks in 2020 and 2014, after accounting for increases in internet users through time. The second of these peaks could be attributed to the COVID-19 outbreak, and speculation about the role of bats in its epidemiology, rather than to true changes in exploitation. Overall, our results showed that data from online sources provide additional knowledge on the global extent of wildlife exploitation, which could be used to identify early warnings of emerging threats and pinpoint locations for further research.

Sondeo del potencial de las fuentes virtuales de datos para mejorar el mapeo de amenazas para las especies por medio del estudio de caso de la explotación mundial de murciélagos Resumen La expansión de las fuentes virtuales, incluidas las redes sociales y las noticias en línea, proporciona una forma asequible de analizar las interacciones entre el humano y la naturaleza, como la explotación de fauna. Sin embargo, no se ha analizado por completo el rango al que dichas fuentes pueden expandir o sesgar el conocimiento de la distribución e intensidad de las amenazas. Para abordar este vacío cuantificamos la distribución geográfica y temporal de las fuentes virtuales que documentan la caza, captura, consumo o mercado de murciélagos (Chiroptera) y las comparamos con la distribución de los estudios obtenidos de una búsqueda sistemática en la literatura y con las especies catalogadas como amenazadas por la explotación según la Lista Roja de la Unión Internacional para la Conservación de la Naturaleza. Recolectamos los registros virtuales por medio de búsquedas automatizadas en Facebook, Twitter, Google y Bing y después las filtramos con clasificaciones automatizadas. Esto arrojó 953 publicaciones relevantes en redes sociales y sitios web que englobaban 1099 registros únicos de la explotación de murciélagos en 84 países. Aunque pronosticamos de forma significativa el número de registros por país con el número de estudios académicos por país, los registros virtuales proporcionaron localidades adicionales y registros más recientes de la explotación de murciélagos, incluyendo a 22 países que no se encuentran en la literatura académica. Lo anterior demuestra el valor que tienen los recursos en línea para proporcionar una representación geográfica más completa. Sin embargo, las variables confusas pueden sesgar el análisis de las tendencias espaciotemporales. Los registros virtuales de la explotación de murciélagos mostraron picos en 2020 y en 2014, esto después de considerar el incremento de usuarios de internet con el tiempo. El segundo pico podría atribuirse al brote de COVID­19 y la especulación en torno al papel que tenían los murciélagos en su epidemiología y no tanto a un verdadero cambio en la explotación. En general, nuestros resultados mostraron que los datos de las fuentes virtuales proporcionan conocimiento adicional sobre el alcance mundial de la explotación de fauna, el cual podría usarse para identificar señales tempranas de amenazas emergentes y ubicar localidades para su mayor investigación.

Gut microbiome as a key monitoring indicator for reintroductions of captive animals.

Reintroduction programs seek to restore degraded populations and reverse biodiversity loss. To examine the hypothesis that gut symbionts could be used as an indicator of reintroduction success, we performed intensive metagenomic monitoring over 10 years to characterize the ecological succession and adaptive evolution of the gut symbionts of captive giant pandas reintroduced to the wild. We collected 63 fecal samples from 3 reintroduced individuals and 22 from 9 wild individuals and used 96 publicly available samples from another 3 captive individuals. By microbial composition analysis, we identified 3 community clusters of the gut microbiome (here termed enterotypes) with interenterotype succession that was closely related to the reintroduction process. Each of the 3 enterotypes was identified based on significant variation in the levels of 1 of 3 genera: Clostridium, Pseudomonas, and Escherichia. The enterotype of captive pandas was Escherichia. This enterotype was gradually replaced by the Clostridium enterotype during the wild-training process, which in turn was replaced by the Pseudomonas enterotype that resembled the enterotype of wild pandas, an indicator of conversion to wildness and a successful reintroduction. We also isolated 1 strain of Pseudomonas protegens from the wild enterotype, a previously reported free-living microbe, and found that its within-host evolution contributed to host dietary adaptation in the wild. Monitoring gut microbial structure provides a novel, noninvasive tool that can be used as an indicator of successful reintroduction of a captive individual to the wild.

Microbiomas intestinales como indicadores clave de monitoreo para la reintroducción de animales cautivos Resumen Los programas de reintroducción buscan restaurar las poblaciones degradadas y revertir la pérdida de la biodiversidad. Realizamos un monitoreo metagenómico intensivo durante más de diez años para caracterizar la sucesión ecológica y la evolución adaptativa de los simbiontes intestinales de pandas reintroducidos en la naturaleza y así comprobar la hipótesis de que estos simbiontes pueden usarse como indicadores de una reintroducción exitosa. Recolectamos 63 muestras fecales de tres individuos reintroducidos y 22 de nueve individuos silvestres y usamos 96 muestras disponibles al público de otros tres individuos cautivos. Mediante el análisis de la composición microbiana identificamos tres grupos comunitarios del microbioma intestinal (denominados como enterotipos) con una sucesión entre enterotipos relacionada cercanamente al proceso de reintroducción. Identificamos cada uno de los tres enterotipos con base en la variación significativa en los niveles de uno de los tres géneros: Clostridium, Pseudomonas, y Escherichia. El enterotipo de los pandas cautivos fue Escherichia. A este enterotipo lo reemplazó gradualmente el enterotipo de Clostridium durante el proceso de adaptación a la naturaleza, y a su vez fue reemplazado por el enterotipo de Pseudomonas similar al de los pandas silvestres, un indicador de la conversión a la vida silvestre y de una reintroducción exitosa. También aislamos una cepa de Pseudomonas protegens del enterotipo silvestre, un microbio reportado previamente como de vida libre, y descubrimos que su evolución dentro del hospedero contribuyó a que este se adaptara a la naturaleza de la dieta. El monitoreo de la estructura microbiana intestinal proporciona una herramienta novedosa y no invasiva que puede usarse como indicador del éxito de la reintroducción de un individuo cautivo a la naturaleza.

Development and Promotion of an mHealth App for Adolescents Based on the European Code Against Cancer: Retrospective Cohort Study.

BACKGROUND: Mobile health technologies, underpinned by scientific evidence and ethical standards, exhibit considerable promise and potential in actively engaging consumers and patients while also assisting health care providers in delivering cancer prevention and care services. The WASABY mobile app was conceived as an innovative, evidence-based mobile health tool aimed at disseminating age-appropriate messages from the European Code Against Cancer (ECAC) to adolescents across Europe. OBJECTIVE: This study aims to assess the outcomes of the design, development, and promotion of the WASABY app through a 3-pronged evaluation framework that encompasses data on social media promotion, app store traffic, and user engagement. METHODS: The WASABY app's content, cocreated with cancer-focused civil society organizations across 6 European countries, drew upon scientific evidence from the ECAC. The app's 10 modules were designed using the health belief model and a gamification conceptual framework characterized by spaced repetition learning techniques, refined through 2 rounds of testing. To evaluate the effectiveness of the app, we conducted a retrospective cohort study using the WASABY app's user database registered from February 4 to June 30, 2021, using a 3-pronged assessment framework: social media promotion, app store traffic, and user engagement. Descriptive statistics and association analyses explored the relationship between sociodemographic variables and user performance analytics. RESULTS: After extensive promotion on various social media platforms and subsequent traffic to the Apple App and Google Play stores, a sample of 748 users aged between 14 and 19 years was included in the study cohort. The selected sample exhibited a mean age of 16.08 (SD 1.28) years and was characterized by a predominant representation of female users (499/748, 66.7%). Most app users identified themselves as nonsmokers (689/748, 92.1%), reported either no or infrequent alcohol consumption (432/748, 57.8% and 250/748, 33.4%, respectively), and indicated being physically active for 1 to 5 hours per week (505/748, 67.5%). In aggregate, the app's content garnered substantial interest, as evidenced by 40.8% (305/748) of users visiting each of the 10 individual modules. Notably, sex and smoking habits emerged as predictors of app completion rates; specifically, male and smoking users demonstrated a decreased likelihood of successfully completing the app's content (odds ratio 0.878, 95% CI 0.809-0.954 and odds ratio 0.835, 95% CI 0.735-0.949, respectively). CONCLUSIONS: The development and promotion of the WASABY app presents a valuable case study, illustrating the effective dissemination of evidence-based recommendations on cancer prevention within the ECAC through an innovative mobile app aimed at European adolescents. The data derived from this study provide insightful findings for the implementation of Europe's Beating Cancer Plan, particularly the creation of the EU Mobile App for Cancer Prevention.

The importance of equity in payments to encourage coexistence with large mammals.

Large mammals often impose significant costs such as livestock depredation or crop foraging on rural communities, and this can lead to the retaliatory killing of threatened wildlife populations. One conservation approach-payments to encourage coexistence (PEC)-aims to reduce these costs through financial mechanisms, such as compensation, insurance, revenue sharing, and conservation performance payments. Little is known about the equitability of PEC, however, despite its moral and instrumental importance, prevalence as a conservation approach, and the fact that other financial tools for conservation are often inequitable. We used examples from the literature to examine the capability of PEC-as currently perceived and implemented-to be inequitable. We recommend improving the equitability of current and future schemes through the cooperative design of schemes that promote compensatory equity and greater consideration of conservation performance payments and by changing the international model for funding PEC to reduce global coexistence inequalities. New and existing programs must address issues of equitability across scales to ensure that conservation efforts are not undermined by diminished social legitimacy.

Importancia de la equidad de pago para alentar la coexistencia con mamíferos mayores Resumen Con frecuencia, los grandes mamíferos acarrean costes importantes para las comunidades rurales, como resultado de la depredación del ganado o por daños a cultivos, lo que puede derivar en la caza de cierta fauna amenazada como represalia. Una de las posibles estrategias para la protección de esta fauna-los llamados 'pagos para alentar la coexistencia' (PEC por sus siglas en inglés)-busca reducir estos costes a través de mecanismos financieros como los seguros de compensación, el reparto de ingresos y el 'pago por resultados'. Actualmente se conoce muy poco sobre aspectos relacionados con la equidad en relación a los PECs, a pesar de la importancia moral e instrumental de este asunto, y de la prevalencia de estos instrumentos, especialmente considerando que otras herramientas financieras para la conservación suelen no ser equitativas. En este artículo usamos ejemplos de la literatura para examinar la (in)equidad potencial de los PECs - de acuerdo a como están siendo percibidos e implementados actualmente. En las conclusiones, recomendamos que los programas actuales y futuros sean mejorados mediante diseños cooperativos que promuevan la equidad compensatoria y una mayor consideración del pago por resultados de conservación. Así mismo, debe cambiarse modelo internacional de financiamiento de los PECs para reducir las desigualdades globales en cuanto a la coexistencia con grandes mamíferos. Tanto los programas nuevos como los ya existentes deben abordar los temas de equidad a todas las escalas para asegurar que los esfuerzos de conservación no se vean perjudicados por una legitimidad social disminuida.

Teen Well Check: an e-health prevention program for substance use, sexual assault, and sexual risk behaviors for adolescents in primary care.

Objective: Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours; however, to date no integrated prevention programmes address all three risk behaviours. The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings.Methods: The current study included content analysis of interviews with adolescents in primary care (aged 14-18; n = 25) in the intervention development process, followed by usability and acceptability testing with qualitative interviews among adolescents in primary care (aged 14-18; n = 10) and pediatric primary care providers (n = 11) in the intervention refinement process. All data were collected in the Southeastern U.S.Results: Feedback on Teen Well Check addressed content, engagement and interaction, language and tone, aesthetics, logistics, inclusivity, parent/guardian-related topics, and the application of personal stories. Overall, providers reported they would be likely to use this intervention (5.1 out of 7.0) and recommend it to adolescents (5.4 out of 7.0).Conclusions: These findings suggest preliminary usability and acceptability of Teen Well Check. A randomized clinical trial is needed to assess efficacy.

Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours.The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings.Providers and adolescents rated Teen Well Check as usable and acceptable, and providers indicated that they would recommend it to their adolescent patients.

Attenuated psychotic symptoms, substance use and self-reported PTSD in adolescence.

Background: The occurrence of attenuated psychotic symptoms (APS) is a major concern in populations with substance use disorders (SUDs). However, APS also frequently develop in the course of Post-Traumatic Stress Disorder (PTSD). This study explores how the prevalence of APS differs between adolescent patients with only SUD, SUD with a history of traumatic experiences (TEs), and with SUD and self-reported PTSD.Methods: We recruited n = 120 treatment-seeking adolescents at a German outpatient clinic for adolescents with SUD. All participants filled out questionnaires assessing APS (PQ-16, YSR schizoid scale), trauma history, PTSD symptoms (both UCLA PTSD Index), and SUD severity (DUDIT) next to an extensive substance use interview. We performed a multivariate analysis of co-variance with the four PQ-16 scales and the YSR scale as outcomes and PTSD status as predictor. Additionally, we performed five linear regressions predicting each PQ-16 score and YSR score based on tobacco, alcohol, cannabis, ecstasy, amphetamine, and methamphetamine use.Results: Participants with co-occurring SUD and self-reported PTSD showed significantly higher APS prevalence rates (PQ-16 score, p = .00002), more disturbed thought content (p = .000004), more perceptual disturbances (p = .002), more negative symptoms (p = .004) and more thought problems (p = .001) compared to adolescents with SUD and a history of trauma and adolescents with only SUD. Past-year substance use was not predictive for APS prevalence (F(75) = 0.42; p = .86; R2 = .04).Conclusion: Our data suggests that the occurrence of APS in adolescents with SUD is better explained by co-occurring self-reported PTSD than by substance use frequency or substance class. This finding might indicate that APS might be reduced through treating PTSD or focusing on TEs in SUD therapy.

Adolescents with co-occurring substance use disorders and PTSD show increased rates of Attenuated Psychotic Symptoms (APS).A history of traumatic experiences and PTSD are stronger predictors for APS than substance use.APS in adolescents with substance use disorders may be an indication of undiagnosed and/or untreated co-occurring PTSD.

The intergenerational transmission of relationship instability: A focus on emerging adult on-off relationships.

This study extends prior research on the intergenerational transmission of relationship instability by examining parents' history of on-off relationships as a predictor of emerging adults' own cycling (i.e., breaking up and renewing with the same romantic partner). Data were collected at a large mid-western university from 702 emerging adults (18-25 years old). Multinomial logistic regression was used to predict the likelihood that participants had cycled in a past or current relationship. Results show that parental cycling increased the likelihood of offspring cycling in a past or current relationship relative to never cycling, and greater uncertainty about the future of the relationship was a mechanism through which such transmission occurred. Findings from this study demonstrate that parental relationship instability can even be consequential for the transient relationships within emerging adulthood, making family history a productive area to explore for practitioners working with cyclical partners and/or emerging adults.

Development and validation of a goal attainment scale for families affected by maternal substance use.

The Team for Infants Exposed to Substance use (TIES) Program is a longstanding home-based family support program that provides a multidisciplinary, community-facing model to address the complex needs of families with young children affected by maternal substance use. The model required a comprehensive assessment tool to guide creation of individualized family goals with steps to achievement and measurement of progress on those goals. This article describes the development of a goal attainment scale and the analysis conducted to validate the scale for the service population. TIES model developers and community partners developed the goal attainment scale to assess outcomes in key domains: maternal substance use, parenting, child and maternal health, income, and housing. Data were collected from 2012 to 2019 from 220 participants and analyzed in 2020. Exploratory factor analysis (EFA) and confirmatory factor analysis were conducted. Twenty-five of the original 30 items were retained in a six-factor structure. The total percentage of variance explained was 64.44% with six factors, and Cronbach's alpha was .90. For the split-half method, the reliability of scale was .90 for unbiased conditions. Therefore, the scale reached acceptable reliability and validity. The scale provides a comprehensive approach to measure family outcomes across multiple domains addressing key risk and protective factors. This family-centered scale serves both therapeutic and evaluation purposes, acting as an intervention guide and a goal attainment measurement tool.

El Programa del Equipo para los Infantes Expuestos al Uso de Sustancias (TIES) es un programa de apoyo familiar con base en el hogar que ha existido mucho tiempo y que ofrece un multidisciplinario método de cara a la comunidad que se ocupa de las complejas necesidades de familias con niños pequeños afectados por el uso materno de sustancias. Quienes desarrollaron el modelo TIES crearon una herramienta comprensiva de evaluación para guiar la creación de metas familiares individualizadas, pasos para alcanzar y el progreso en cuanto a esas metas. Esta escala de alcance de logros evalúa los resultados en dominios claves: uso materno de sustancias, crianza, salud del niño y de la madre, entradas económicas y vivienda. Este artículo describe el desarrollo y la validez de la escala de alcance de metas. Los datos recogidos del 2012 al 2019 y de 220 participantes se analizaron en 2020. Se llevaron a cabo análisis exploratorios y confirmatorios de factores. Veinticinco de los 30 puntos originales se mantuvieron en una estructura de seis factores. El porcentaje total de variación explicado fue de 64.44% con seis factores y el factor Alpha de Cronbach fue de .90. En cuanto al método dividido en mitades, la confiabilidad de la escala fue de .90 en el caso de condiciones no prejuiciadas. Por tanto, la escala alcanzo una confiabilidad y validez aceptable. La escala ofrece un acercamiento comprensivo para medir los resultados familiares a lo largo de múltiples dominios, ocupándose de factores claves de riesgo y protección. Esta escala centrada en la familia sirve propósitos terapéuticos evaluación y actúa como una guía de intervención y medida de alcance de metas.

Le Programme de l'Equipe pour les Nourrissons Exposés à la Toxicomanie (abrégé TIES, suivant l'anglais The Team for Infants Exposed to Substance use) est un programme de soutien à la famille à domicile mis en place de longue date qui offre un modèle pluridisciplinaire et tourné vers la communauté afin de répondre aux besoins complexes des familles avec de jeunes enfants affectées par la toxicomanie maternelle. Les personnes ayant conçu et développé le modèle TIES ont créé un outil d'évaluation complet afin de guider le développement d'objectifs familiaux individualisés, d'étapes de réussite et de progrès quant à ces objectifs. L'échelle d'étape de réussite évalue les résultats dans des domaines clés: la toxicomanie maternelle, le parentage, la santé de l'enfant et la santé maternelle, les revenus, et le domicile. Cet article décrit le développement et la validation de l'échelle de réussite. Les données ont été recueillies de 2012 à 2019 de 220 participantes et elles ont été analysées en 2020. Des analyses factorielles exploratoires et des analyses factorielles confirmatoires ont été faites. Vingt-cinq des 30 éléments d'origine ont été retenus dans une structure à six facteurs. Le pourcentage total de variance expliquée était de 64,44% avec six facteurs, et l'alpha de Cronbach était de 0,90. Pour la méthode à demi-fraction la fiabilité de l'échelle était de,90 pour des conditions impartiales. L'échelle a donc atteint la fiabilité et la validité. L'échelle offre une approche complète afin de mesurer les résultats de la famille au travers de multiples domaines traitant le risque clé et les facteurs de protection. Cette échelle centrée sur la famille sert un but à la fois thérapeutique et d'évaluation, agissant comme un guide d'intervention et une mesure d'atteinte du but.

Remote work: Aircraft noise implications, prediction, and management in the built environment.

The COVID-19 pandemic has greatly changed workplace management. Most workplaces have adopted the work-from-home policy to minimize the risk of community spread. Consequently, housing estates remain largely occupied during office hours. Since some housing estates are situated in the vicinity of an airport, noise pollution resulted from the takeoff and landing of aircraft is now more noticed by residents, causing annoyance. This problem would be most acute for those located directly under the flight path. Before the pandemic, such aircraft operations had lower effect on the residents because most of them were not at home but at workplaces. Evidently, it is timely that more emphasis should now be placed during urban planning to predict and minimize aircraft noise in the built environment. This article first defines the aircraft noise metrics commonly used to assess environmental impact. Preceded by an overview of how aircraft noise affects the built environment, this article reviews how various aircraft noise prediction models have been used in urban planning. Lastly, this article reviews how aircraft noise can be managed for better acoustic comfort of the residents. Anticipating the adoption of hybrid work arrangement moving forward, this article aims to provide urban planning professionals with an avenue to understand how aircraft noise can negatively affect the built environment, which, in turn, justify why prediction and management of aircraft noise should be emphasized from the outset of urban planning.

Telehealth adaptation of perinatal mental health mother-infant group programming for the COVID-19 pandemic.

The COVID-19 pandemic and ensuing isolation stressed pregnant and postpartum women and their families pervasively. This necessitated addressing young families' mental health needs while protecting both patients and providers from COVID-19 exposure. Our experience of rapidly adapting Pregnancy, Maternal Postpartum Peer Support, and Mother-Infant Postpartum Group interventions to high-quality telehealth modalities elucidates benefits and challenges of mother-infant dyadic treatment amidst the pandemic. This study compares 2019 in-person and 2020 telehealth services during the period from mid-March through mid-December in each year. Initial program Warmline contacts were similar across years despite pandemic-related restrictions, with 2020 program contacts surpassing the 147 unique patient outreaches during the commensurate 2019 period. Pregnancy Group enrollment remained consistent. Maternal Postpartum Peer Support Group participation increased with transition to telehealth with 27 individuals with over 100 group-based visits in 2020. Twenty-five mother-infant Postpartum pairs initially enrolled in the 12-week multicomponent Mother-Infant Therapy Group (M-ITG) during 2019 in-person services, and 16 completed the program (36% non-completion rate). During 2020 telehealth, 15 of 18 mother-infant pairs completed the program (17% non-completion rate); a greater than 50% reduction in non-completion. We further compare pre-/post-pandemic onset M-ITG participant demographics, enrollment, and Edinburgh Postnatal Depression Scale (EPDS) scores.

La pandemia COVID-19 y el consecuente aislamiento estresó a mujeres embarazadas y en postparto y a sus familias de manera generalizada. Esto requirió abordar asuntos de salud mental de familias jóvenes mientras que se protegía tanto a pacientes como proveedores de estar expuestos al COVID-19. Nuestra experiencia de adaptar rápidamente el Embarazo, el Apoyo entre Iguales al Postparto Materno y las intervenciones de grupo Madre-Infante en Postparto, a modalidades de telesalud de alta calidad, esclarece beneficios y retos del tratamiento a la díada madre-infante en medio de la pandemia. El estudio compara el servicio presencial en 2019 y de telesalud en 2020 durante el período de mitad de marzo a mitad de diciembre en cada año. Los contactos iniciales de programas de apoyo emocional telefónico con alguien en igual circunstancia (Warmline) fueron similares a lo largo de los dos años a pesar de las restricciones de la pandemia, con más contactos de programas de 2020 que las específicas 147 actividades de contacto a pacientes durante el período similar en 2019. La inscripción en grupos de embarazo se mantuvo consistente. La participación en grupos de Apoyo entre Iguales al Postparto Materno aumentó con la transición a la telesalud, con 27 individuos y más de 100 visitas con base en el grupo en 2020. Veinticinco pares de Madre-Infante en Postparto se inscribieron al inicio en el Grupo de Terapia Madre-Infante de 12 semanas y múltiples componentes (M-ITG) durante los servicios en persona de 2019 y 16 completaron el programa (36% tasa de incompletos). Durante la telesalud del 2020, 15 de los 18 pares de madre-infante completaron el programa (17% tasa de incompletos); una reducción de más del 50% en incompletos. Además, comparamos, antes y después de la pandemia, datos demográficos, inscripción y puntajes en la Escala de Edimburgo de Depresión Postnatal de participantes que iniciaron el M-ITG.

La pandémie du COVID-19 et l'isolation qui s'en est suivie a stressé les femmes enceintes et postpartum et leurs familles de façon générale. Il a donc fallu prendre en compte les besoins de santé mentale des jeunes familles tout en protégeant à la fois les patients et les praticiens de toute exposition au COVID-19. Notre expérience d'adaptation rapide du Soutien Maternel par Pair à la Grossesse et Postpartum ainsi que des interventions de groupe Postpartum Mère-Bébé en modalités de télésanté de haute qualité illustrent les bénéfices et les défis du traitement dyadique mère-bébé en pleine pandémie. Cette étude compare l'année 2019 en personne et les services de télésanté de 2020 durant la période de la mi-mars jusqu'à la mi-décembre de chaque année. Les contacts du programme initial Warmline ont été les mêmes au fil de ces deux années en dépit des restrictions liées à la pandémie, avec des contacts du programme de 2020 surpassant la communication à 147 patients uniques durant la même période de 2019. Le groupe de grossesse enregistré est demeuré constant. La participation de groupe de Soutien par Pair Postpartum a augmenté avec la transition à la télésanté avec 27 individus avec plus de 100 visites basées sur le groupe en 2020. Vingt-cinq paires Postpartum Mère-Bébé se sont initialement inscrites dans le Groupe de Thérapie Mère-Bébé de 12 semaines à plusieurs composants (M-ITG) durant les services en personne de 2019 et 16 ont terminé le programme (36% de taux d'inachèvement). Durant la télésanté 2020, 15 des 18 paires mère-bébé ont complété le programme (17% de taux d'inachèvement); un taux de réduction de 50% plus grand pour l'inachèvement). Nous comparons par ailleurs les données démographiques des participants M-ITG avant et après le début de la pandémie, les inscriptions et les scores de l'Echelle de Dépression Postnatale d'Edinbourg.

Transitioning to telehealth due to COVID-19: Maintaining model fidelity in a home visiting program for parents of vulnerable infants.

Maintaining treatment fidelity when implementing evidence-based interventions is a significant challenge. The inability to deliver in-person services due to the COVID-19 pandemic critically challenged the foundation of implementation fidelity for home visiting programs across the globe. The Attachment and Biobehavioral Catch-Up (ABC) program is an evidence-based home visiting intervention designed to increase sensitivity in parents of infants who have experienced early adversity. ABC's community effectiveness is due to rigorous fidelity monitoring and supervision. Fidelity is measured by microanalytic coding of parenting opportunities and "in-the-moment" commenting, the active ingredient of ABC. In this study, we examined intervention fidelity among parent coaches implementing ABC through telehealth. Random 5-min clips from 510 telehealth ABC session videos conducted by 91 parent coaches at 48 agencies were coded for their frequency and quality of in-the-moment comments. On average, parent coaches were able to exceed in-person commenting fidelity standards when implementing ABC through the telehealth format. The active fidelity monitoring and supervision inherent to ABC's dissemination afforded a smooth transition to implementing ABC through telehealth while adhering to fidelity standards. Procedural and clinical challenges to telehealth implementation are discussed, along with future directions for telehealth program effectiveness.

Mantener la fidelidad al tratamiento cuando se implementan intervenciones con base en la evidencia es un reto significativo. La inhabilidad de ofrecer servicios en persona debido a la pandemia del COVID-19 representó un reto crítico a la base de la fidelidad de implementación para los programas de visitas a casa en el mundo. El programa de Afectividad y Bio-conducta de Ponerse el Día (ABC) es una intervención de visitas a casa con base en la evidencia diseñada para aumentar la sensibilidad en los progenitores de infantes que han experimentado temprana adversidad. La eficacia comunitaria de ABC se debe a la rigurosa inspección y supervisión de la fidelidad (Caron et al., 2016). La fidelidad se mide por medio de codificación micro analítica de las oportunidades de crianza y por el comentario " en el momento," ingrediente activo de ABC. En este estudio, examinamos la fidelidad de intervención entre progenitores entrenadores que implementaban ABC a través de salud a distancia. Segmentos de video de 5 minutos de 510 sesiones de salud a distancia ABC al azar, llevadas a cabo por 91 progenitores entrenadores en 48 agencias se codificaron en cuanto a su frecuencia y calidad de los comentarios del momento. En promedio, los progenitores entrenadores pudieron exceder los estándares de fidelidad de comentarios en persona cuando implementaban ABC a través del formato de salud a distancia. La activa inspección y supervisión de la fidelidad inherente a la divulgación de ABC permitió una transición fluida a la implementación de ABC a través de salud a distancia, manteniendo la adhesión a los estándares de fidelidad. Se discuten los retos de procedimiento y clínicos a la implementación de salud a distancia, junto con futuras directrices para la eficacia de programas de salud a distancia.

Le maintien de la fidélité au traitement en mettant en place des interventions basées sur des données factuelles est un défi important. L'incapacité à offrir des services en personne du fait de la pandémie du Covid19 a présenté un défi critique pour la fondation de la mise en place de la fidélité pour les programmes de visite domicile dans le monde entier. Le programme ABC (selon l'anglais Attachment and Biobehavioral Catch-Up, soit Rattrapage de l'Attachement et Rattrapage Biocomportemental) est une intervention de visites à domicile basée sur des données factuelles conçue pour augmenter la sensibilité chez les parents de bébés ayant fait l'expérience d'une adversité précoce. L'efficacité de la communauté de l'ABC est attribuable à un contrôle rigoureux de la fidélité et de la supervision (Caron et al., 2016). La fidélité est mesurée par un codage micro-analytique des opportunités de parentage et des commentaires "au moment", l'ingrédient actif de l'ABC. Dans cette étude nous avons examiné la fidélité de l'intervention chez les entraîneurs de parents mettant en place l'ABC au travers de la télésanté. Des clips de 5-minute randomisés de 510 sessions vidéos de télésanté ABC faites avec 91 entraîneurs de parents de 48 agences ont été codé pour leur fréquence et la qualité des commentaires "au moment". En moyenne les entraîneurs de parent étaient capables d'excéder les standards de fidélité de commentaire en personne en mettant en place l'ABC au travers du format de télésanté. Le contrôle actif de fidélité et de la supervision propre ã la dissémination de l'ABC a permis une transition facile à la mise en place de l'ABC au travers de la télésanté tout en adhérant aux standards de fidélité. Les défis de procédure et les défis cliniques à la mise en place par télésanté sont discutés ainsi que les directions futures pour l'efficacité du programme par télésanté.

Large carnivore hunting and the social license to hunt.

The social license to operate framework considers how society grants or withholds informal permission for resource extractors to exploit publicly owned resources. We developed a modified model, which we refer to as the social license to hunt (SLH). In it we similarly consider hunters as operators, given that wildlife are legally considered public resources in North America and Europe. We applied the SLH model to examine the controversial hunting of large carnivores, which are frequently killed for trophies. Killing for trophies is widespread, but undertaken by a minority of hunters, and can pose threats to the SLH for trophy-seeking carnivore hunters and potentially beyond. Societal opposition to large carnivore hunting relates not only to conservation concerns but also to misalignment between killing for trophies and dominant public values and attitudes concerning the treatment of animals. We summarized cases related to the killing of grizzly bears (Ursus arctos), wolves (Canis lupus), and other large carnivores in Canada, the United States, and Europe to illustrate how opposition to large carnivore hunting, now expressed primarily on social media, can exert rapid and significant pressure on policy makers and politicians. Evidence of the potential for transformative change to wildlife management and conservation includes proposed and realized changes to legislation, business practice, and wildlife policy, including the banning of some large carnivore hunts. Given that policy is ultimately shaped by societal values and attitudes, research gaps include developing increased insight into public support of various hunting policies beyond that derived from monitoring of social media and public polling. Informed by increased evidence, the SLH model can provide a conceptual foundation for predicting the likelihood of transient versus enduring changes to wildlife conservation policy and practice for a wide variety of taxa and contexts.

Cacería de Grandes Carnívoros y la Licencia Social para Cazar Resumen El marco de trabajo de la licencia social para operar considera cómo la sociedad otorga o restringe permisos informales para que los extractores de recursos puedan explotar los recursos públicos. Desarrollamos un modelo modificado, al cual nos referimos como la licencia social para cazar (LSC). En este modelo consideramos a los cazadores como símiles de los operadores puesto que en América del Norte y en Europa a la fauna se le considera legalmente como recurso público. Aplicamos el modelo de la LSC en un análisis de la cacería controversial de grandes carnívoros, a los cuales con frecuencia se les caza para convertirlos en trofeos. La cacería para trofeos es común pero sólo la realiza una minoría de los cazadores y puede presentar una amenaza para la LSC para los cazadores que cazan carnívoros para trofeos e incluso para otros tipos de cazadores. La oposición social a la cacería de grandes carnívoros se relaciona no sólo con el interés de conservación sino también con la discordancia entre la caza para trofeos y las actitudes y valores públicos dominantes con respecto al trato hacia los animales. Resumimos algunos casos relacionados con la muerte de osos pardos (Ursus arctos), lobos (Canis lupus) y otros grandes carnívoros en Canadá, los Estados Unidos y Europa para mostrar cómo la oposición a la cacería de grandes carnívoros, hoy en día expresada principalmente en las redes sociales, puede ejercer una presión rápida y significativa sobre los políticos y los formuladores de políticas. La evidencia de un potencial de cambio transformador en el manejo y conservación de fauna incluye los cambios propuestos y realizados a la legislación, la práctica comercial y las políticas para la fauna, incluyendo la prohibición de la caza de algunos grandes carnívoros. Ya que las políticas están finalmente moldeadas por las actitudes y los valores sociales, las lagunas en la investigación incluyen el desarrollo de un conocimiento mejorado del respaldo público para varias políticas de cacería más allá del conocimiento derivado del monitoreo de las redes sociales y las encuestas públicas. Si se informa con mucha más evidencia, el modelo de la LSC puede proporcionar una base conceptual para predecir la probabilidad de los cambios transitorios versus los duraderos en las políticas y las prácticas de conservación de fauna para una gama amplia de taxones y contextos.

Exploring the internal and external wildlife gradients created by conservation fences.

Spillover effects are an expansion of conservation benefits beyond protected areas through dispersal of species that reside within. They have been well documented in marine but not terrestrial systems. To understand the effects on wildlife created by conservation fences, we explored the internal and external gradients of activity in mammal, reptile, and bird species at a conservation reserve in arid Australia that is fenced to exclude invasive rabbits (Oryctolagus cuniculus), cats (Felis catus), and foxes (Vulpes vulpes). Two methods were used: counts of animal tracks along transects on sand dunes and captures at pitfall-trapping sites. In both cases, sites were spaced at different distances from the reserve fenceline inside and outside the reserve. We recorded a range of spillover, source-sink, step, and barrier effects that combined to create a zone within and around the reserve with fence-induced species-specific wildlife gradients. Two endemic rodents but none of the 4 mammal species reintroduced to the reserve showed positive spillover effects. Barrier effects, where activity was highest close to the fence, were recorded for the feral cat and native bettong (Bettongia lesueur), species that could not breach the fence. In comparison, some reptiles and native mammal species that could permeate the fence displayed source-sink effects; that is, their activity levels were reduced close to the fence likely due to constant emigration to the side with lower density. Activity of some reptiles was lowest at sites inside the reserve and gradually increased at outside sites with distance from the fence, a gradient likely related to trophic cascades triggered by predator exclusion. Our result shows that fenced reserves can create overlapping layers of species-specific gradients related to each species' ability to permeate the fence and its varying susceptibility to threats. Managers should be aware that these gradients may extend for several kilometers either side of the fence and that not all contained species will increase in abundance. Creating wider conservation benefits may require increased fence permeability and threat reduction outside the fence.

Exploración de los gradientes de vida silvestre internos y externos creados por las vallas de conservación. Resumen Los efectos de derrame son una expansión de los beneficios de conservación más allá de las áreas protegidas a través de la dispersión de especies que residen en su interior. Han sido bien documentados en sistemas marinos, pero no terrestres. Para entender los efectos de las vallas de exclusión sobre la vida silvestre, exploramos los gradientes internos y externos de la actividad de especies de mamíferos, reptiles y aves en una reserva de conservación en la región árida de Australia que está cercada para excluir conejos invasivos (Oryctolagus cuniculus), gatos (Felis catus) y zorros (Vulpes vulpes). Se utilizaron dos métodos: conteo de huellas de animales a lo largo de transectos en dunas de arena y captura con trampas pitfall. En ambos casos, los sitios fueron espaciados a distintas distancias dentro y fuera de la valla de la reserva. Registramos una gama de efectos de derrame, fuente-sumidero, escalón y barrera que se combinaron para crear una zona dentro y alrededor de la reserva con gradientes de vida silvestre inducidos por la valla. Dos roedores endémicos, pero ninguna de 4 especies de mamíferos reintroducidas a la reserva, mostraron efectos de derrame positivos. Los efectos de barrera, donde la actividad era mayor cerca de la valla, fueron registrados para el gato feral y la rata canguro nativa (Bettongia lesueur), especies que no pudieron franquear la valla. En contraste, algunas especies de reptiles y mamíferos nativos que pudieron permear la valla mostraron efectos de fuente-sumidero; esto es, sus niveles de actividad fueron bajos cerca de la valla probablemente debido a la emigración constante hacia el lado con menor densidad. La actividad de algunos reptiles fue menor en los sitios núcleo de la reserva e incrementaron a medida que incrementó la distancia hacia afuera, un gradiente relacionado probablemente con las cascadas tróficas desencadenadas por la exclusión de depredadores. Nuestros resultados muestran que las reservas cercadas pueden crear capas sobrepuestas de gradientes específicos relacionados con la habilidad de cada especie para permear la valla y su susceptibilidad a las amenazas. Los manejadores deber ser conscientes de que esos gradientes pueden extenderse varios kilómetros a ambos lados de la valla y que no todas las especies contenidas aumentarán en abundancia. La creación de beneficios de conservación más amplios puede requerir una mayor permeabilidad de la vallas y la reducción de amenazas fuera de la reserva.

A framework to measure the wildness of managed large vertebrate populations.

As landscapes continue to fall under human influence through habitat loss and fragmentation, fencing is increasingly being used to mitigate anthropogenic threats and enhance the commercial value of wildlife. Subsequent intensification of management potentially erodes wildness by disembodying populations from landscape-level processes, thereby disconnecting species from natural selection. Tools are needed to measure the degree to which populations of large vertebrate species in formally protected and privately owned wildlife areas are self-sustaining and free to adapt. We devised a framework to measure such wildness based on 6 attributes relating to the evolutionary and ecological dynamics of vertebrates (space, disease and parasite resistance, exposure to predation, exposure to limitations and fluctuations of food and water supply, and reproduction). For each attribute, we set empirical, species-specific thresholds between 5 wildness states based on quantifiable management interventions. We analysed data from 205 private wildlife properties with management objectives spanning ecotourism to consumptive utilization to test the framework on 6 herbivore species representing a range of conservation statuses and commercial values. Wildness scores among species differed significantly, and the proportion of populations identified as wild ranged from 12% to 84%, which indicates the tool detected site-scale differences both among populations of different species and populations of the same species under different management regimes. By quantifying wildness, this framework provides practitioners with standardized measurement units that link biodiversity with the sustainable use of wildlife. Applications include informing species management plans at local scales; standardizing the inclusion of managed populations in red-list assessments; and providing a platform for certification and regulation of wildlife-based economies. Applying this framework may help embed wildness as a normative value in policy and mitigate the shifting baseline of what it means to truly conserve a species.

Un Marco de Trabajo para Medir el Estado Salvaje de Poblaciones de Vertebrados Mayores bajo Manejo Resumen Conforme los paisajes siguen cayendo bajo la influencia del humano por causa de la pérdida del hábitat y la fragmentación, cada vez se usa más el encercado para mitigar las amenazas antropogénicas o incrementar el valor comercial de la fauna. La intensificación subsecuente del manejo tiene el potencial para erosionar el estado salvaje al desincorporar a las poblaciones de los procesos a nivel de paisaje, desconectando así a las especies del proceso de selección natural. Por lo tanto, se necesitan herramientas para medir el grado al cual las poblaciones de especies de vertebrados mayores dentro de áreas de fauna protegidas y privadas son autosostenibles y libres de adaptarse. Diseñamos un marco de trabajo para medir dicho estado salvaje con base en seis atributos relacionados con las dinámicas evolutivas y ecológicas de los vertebrados (espacio, resistencia a las enfermedades y a los parásitos, exposición a la depredación, exposición a las limitaciones y fluctuaciones en las reservas de agua y alimentos, y reproducción). Para cada atributo, establecimos umbrales empíricos y específicos por especie entre cinco estados salvajes basados en las intervenciones de manejo cuantificables. Usamos datos de 205 propiedades privadas de fauna con objetivos de manejo que abarcan desde el ecoturismo hasta el uso para consumo para probar el marco de trabajo en seis especies de herbívoros con una gama de estados de conservación y valores comerciales. Los puntajes de estado salvaje entre las especies difirieron significativamente y la proporción de poblaciones identificadas como salvajes osciló del 12% al 84%, lo que indica que la herramienta detectó diferencias a escala de sitio entre las poblaciones de diferentes especies y las poblaciones de la misma especie bajo diferentes regímenes de manejo. Si cuantificamos el estado salvaje, este marco de trabajo les proporciona a los practicantes las unidades de medida estandarizadas que vinculan a la biodiversidad con el uso sostenible de la fauna. Las aplicaciones de este marco de trabajo incluyen informar a los planes de manejo de las especies a escalas locales; estandarizar la inclusión de las poblaciones manejadas en las evaluaciones de listas rojas; y proporcionar una plataforma para la certificación y regulación de las economías basadas en la fauna. La aplicación de este marco de trabajo puede ayudar a insertar a la fauna como un valor normativo dentro de la política y a mitigar la línea base cambiante de lo que significa conservar verdaderamente a una especie.

Trends in medication utilization, glycemic control and outcomes among type 2 diabetes patients in a tertiary referral center in Singapore from 2007 to 2017.

BACKGROUND: Use of glucose-lowering agents is a cornerstone in combating type 2 diabetes (T2DM). Treatment guidelines have changed significantly over the past decade. We report temporal trends in medication utilization, glycemic control and rate of severe hypoglycemia in T2DM patients at a tertiary referral center in Singapore. METHODS: We analyzed data of 36 924 T2DM patients seen at Singapore General Hospital from 2007 to 2017. Annual age-, sex- and racially-standardized proportions of patients (a) prescribed with each class of glucose-lowering agent, (b) on various glucose-lowering regimens, and (c) had an HbA1c of less than 6%, 6% to less than 7%, 7% to less than 8%, 8% to less than 9%, or 9% or more were estimated using logistic regression. Poisson regression was used to estimate standardized rate of severe hypoglycemia. RESULTS: From 2007 to 2017, use of metformin (45.9% to 59.6%) and insulin (24.4% to 57.9%) increased, while utilization of sulfonylureas (52.0% to 44.9%) decreased (all P < 0.001). Utilization of dipeptidyl peptidase-4 inhibitors (1.2% to 31.2%) and sodium-glucose cotransporter-2 inhibitors (0.5% to 7.4%) increased from 2008 to 2017 and 2012 to 2017, respectively (all P < 0.001). More patients were prescribed a combination of insulin and oral agents (17.3% to 46.0%, P < 0.001). The proportion of patients with HbA1c of 8% or more increased (33.7% to 36.0%, P < 0.001). Rates of severe hypoglycemia (5.0 to 8.4 per 100 patient-years, P < 0.001) also rose. CONCLUSION: Medication utilization patterns have changed significantly over the past 11 years with a shift towards newer agents. Glycemic control has remained stable, and rate of severe hypoglycemia increased. Further analysis is required before causal relationships can be inferred.

Mechanisms of Ca2+ uptake in freshwater and seawater-acclimated killifish, Fundulus heteroclitus, and their response to acute salinity transfer.

Killifish (Fundulus heteroclitus) has been extensively used as a model for ion regulation by euryhaline fishes. Na+ and Cl- dynamics have been well studied in killifish, but few studies have addressed that of Ca2+. Therefore, this study aimed to characterize Ca2+ fluxes in freshwater (FW) and seawater (SW)-acclimated killifish, their response to salinity transfer, and to elucidate the mechanisms of Ca2+ influx in FW and SW. SW killifish displayed a significantly higher Ca2+ influx rate than that of FW fish, while Ca2+ efflux rates were comparable in both salinities. Ca2+ influx was saturable in FW (Km = 78 ± 19 µmol/L; Jmax = 53 ± 3 nmol/g/h) and influx by SW killifish was linear up to 7 mmol/L Ca2+. In SW-acclimated fish, 36% of Ca2+ influx was attributed to "intestinal Ca2+ intake", likely caused by drinking, whereas intestinal Ca2+ intake in FW contributed to < 2% of total. Throughout the study, results suggested that "cation competition" in SW modulates Ca2+ influx. Therefore, we hypothesized that SW-acclimated fish actually have a higher affinity Ca2+ influx system than FW-acclimated fish but that it is competitively inhibited by competing SW cations. In agreement with this cation competition hypothesis, we demonstrated for the first time that "extra-intestinal" Ca2+ influx was inhibited by Mg2+ in both FW and SW-acclimated killifish. Following acute salinity transfer, extra-intestinal Ca2+ influx was rapidly regulated within 12-24 h, similar to Na+ and Cl-. Ca2+ influx in FW was inhibited by La3+, an epithelial Ca2+ channel blocker, whereas La3+ had no significant effect in SW.

Predicting Substance Use Patterns Among Rural Adults: The Roles of Mothers, Fathers, and Parenthood.

This study examined the role of parenthood and parental influences on substance use patterns for 710 stimulant users age 18-61 living in the rural Midwest and Mid-south U.S. Longitudinal growth analyses showed that a maternal history of drug use was associated with increased baseline drug use severity, lesser declines in severity, and greater plateau of drug use severity over time. Parental conflict was associated with lesser declines in drug use severity, and drug use severity declined more steeply for participants who were themselves parents. Participants with two parents having a history of alcohol use had a greater baseline severity of alcohol use, with paternal history of drug use associated with lower baseline alcohol use severity. These findings demonstrate the importance of identifying parental influences in evaluating adult substance use, and point to the inclusion of parents in efforts to prevent and treat substance use disorders.

Este estudio analizó el papel que desempeñan la paternidad y las influencias de los padres en los patrones de consumo de sustancias de 710 consumidores de estimulantes de entre 18 y 61 años que viven en el Medio Oeste y Centro-Sur rural de Estados Unidos. Los análisis longitudinales de crecimiento demostraron que los antecedentes maternos de consumo de drogas estuvieron asociados con una mayor gravedad inicial de consumo de drogas, una menor disminución de la gravedad y una mayor estabilidad de la gravedad del consumo de drogas con el tiempo. El conflicto parental estuvo asociado con menos disminuciones de la gravedad del consumo de drogas y la gravedad del consumo de drogas disminuyó más abruptamente en los participantes que eran padres. Los participantes que tenían dos padres con antecedentes de consumo de alcohol tuvieron una mayor gravedad inicial de consumo de alcohol, con antecedentes paternos de consumo de drogas asociados con una menor gravedad inicial de consumo de alcohol. Estos resultados demuestran la importancia de reconocer las influencias de los padres a la hora de evaluar el consumo de sustancias de los adultos e indican la inclusión de los padres en los esfuerzos para prevenir y tratar los trastornos por consumo de sustancias.

Current concepts in severe adult tracheobronchomalacia: evaluation and treatment.

There is increasing recognition of tracheobronchomalacia (TBM) in patients with respiratory complaints, though its true incidence in the adult population remains unknown. Most of these patients have an acquired form of severe diffuse TBM of unclear etiology. The mainstays of diagnosis are dynamic (inspiratory and expiratory) airway computed tomography (CT) scan and dynamic flexible bronchoscopy with forced expiratory maneuvers. While the prevailing definition of TBM is 50% reduction in cross-sectional area, a high proportion of healthy volunteers meet this threshold, thus this threshold fails to identify patients that might benefit from intervention. Therefore, we consider complete or near-complete collapse (>90% reduction in cross-sectional area) of the airway to be severe enough to warrant potential intervention. Surgical central airway stabilization by posterior mesh splinting (tracheobronchoplasty) effectively corrects malacic airways and has been shown to lead to significant improvement in symptoms, health-related quality of life, as well as functional and exercise capacity in carefully selected adults with severe diffuse TBM. A short-term stent trial clarifies a patient's candidacy for surgical intervention. Coordination of care between experienced interventional pulmonologists, radiologists, and thoracic surgeons is essential for optimal outcomes.

Airway stenting in excessive central airway collapse.

In tracheobronchomalacia (TBM) and other disorders, weakened airway walls lead to expiratory central airway collapse (ECAC) and can cause symptoms of cough, dyspnea, retained secretions, and recurrent pulmonary infections. Diagnosis of severe ECAC is based on the presence of >90% expiratory airway collapse on dynamic computed tomography (CT) and/or bronchoscopy. We offer patients with severe ECAC a trial of airway stenting to determine whether splinting of the central airways leads to improvements in symptoms, quality of life, exercise capacity, or respiratory function. Patients who respond positively to airway stenting are considered for tracheobronchoplasty.

Inhibition of calcium uptake during hypoxia in developing zebrafish is mediated by hypoxia-inducible factor.

The present study investigated the potential role of hypoxia-inducible factor (HIF) in calcium homeostasis in developing zebrafish (Danio rerio). It was demonstrated that zebrafish raised in hypoxic water (30 mmHg; control, 155 mmHg PO2 ) until 4 days post-fertilization exhibited a substantial reduction in whole-body Ca2+ levels and Ca2+ uptake. Ca2+ uptake in hypoxia-treated fish did not return to pre-hypoxia (control) levels within 2 h of transfer back to normoxic water. Results from real-time PCR showed that hypoxia decreased the whole-body mRNA expression levels of the epithelial Ca2+ channel (ecac), but not plasma membrane Ca2+-ATPase (pmca2) or Na+/Ca2+-exchanger (ncx1b). Whole-mount in situ hybridization revealed that the number of ecac-expressing ionocytes was reduced in fish raised in hypoxic water. These findings suggested that hypoxic treatment suppressed the expression of ecac, thereby reducing Ca2+ influx. To further evaluate the potential mechanisms for the effects of hypoxia on Ca2+ regulation, a functional gene knockdown approach was employed to prevent the expression of HIF-1αb during hypoxic treatment. Consistent with a role for HIF-1αb in regulating Ca2+ balance during hypoxia, the results demonstrated that the reduction of Ca2+ uptake associated with hypoxic exposure was not observed in fish experiencing HIF-1αb knockdown. Additionally, the effects of hypoxia on reducing the number of ecac-expressing ionocytes was less pronounced in HIF-1αb-deficient fish. Overall, the current study revealed that hypoxic exposure inhibited Ca2+ uptake in developing zebrafish, probably owing to HIF-1αb-mediated suppression of ecac expression.