Transcriptional control of visual neural circuit development by GS homeobox 1.

As essential components of gene expression networks, transcription factors regulate neural circuit assembly. The homeobox transcription factor encoding gene, gs homeobox 1 (gsx1), is expressed in the developing visual system; however, no studies have examined its role in visual system formation. In zebrafish, retinal ganglion cell (RGC) axons that transmit visual information to the brain terminate in ten arborization fields (AFs) in the optic tectum (TeO), pretectum (Pr), and thalamus. Pretectal AFs (AF1-AF9) mediate distinct visual behaviors, yet we understand less about their development compared to AF10 in the TeO. Using gsx1 zebrafish mutants, immunohistochemistry, and transgenic lines, we observed that gsx1 is required for vesicular glutamate transporter, Tg(slc17a6b:DsRed), expression in the Pr, but not overall neuron number. gsx1 mutants have normal eye morphology, yet they exhibit impaired visual ability during prey capture. RGC axon volume in the gsx1 mutant Pr and TeO is reduced, and AF7 that is active during feeding is missing which is consistent with reduced hunting performance. Timed laser ablation of Tg(slc17a6b:DsRed)-positive cells reveals that they are necessary for AF7 formation. This work is the first to implicate gsx1 in establishing cell identity and functional neural circuits in the visual system.

Airborne Nanoparticle Concentrations Are Associated with Increased Mortality Risk in Canada's Two Largest Cities.

RATIONALE: Outdoor fine particulate air pollution (PM2.5) contributes to millions of deaths around the world each year, but much less is known about the long-term health impacts of other particulate air pollutants including ultrafine particles (a.k.a. nanoparticles) which are in the nanometer size range (<100 nm), widespread in urban environments, and not currently regulated. OBJECTIVES: Estimate the associations between long-term exposure to outdoor ultrafine particles and mortality. METHODS: Outdoor air pollution levels were linked to the residential addresses of a large, population-based cohort from 2001 - 2016. Associations between long-term exposure to outdoor ultrafine particles and nonaccidental and cause-specific mortality were estimated using Cox proportional hazards models. MEASUREMENTS: An increase in long-term exposure to outdoor ultrafine particles was associated with an increased risk of nonaccidental mortality (Hazard Ratio = 1. 073, 95% Confidence Interval = 1. 061, 1. 085) and cause-specific mortality, the strongest of which was respiratory mortality (Hazard Ratio = 1.174, 95% Confidence Interval = 1.130, 1.220). MAIN RESULTS: Long-term exposure to outdoor ultrafine particles was associated with increased risk of mortality. We estimated the mortality burden for outdoor ultrafine particles in Montreal and Toronto, Canada to be approximately 1100 additional nonaccidental deaths every year. Furthermore, we observed possible confounding by particle size which suggests that previous studies may have underestimated or missed important health risks associated with ultrafine particles. CONCLUSIONS: As outdoor ultrafine particles are not currently regulated, there is great potential for future regulatory interventions to improve population health by targeting these common outdoor air pollutants.

Dicarboxylic Acid Dietary Supplementation Protects against AKI.

SIGNIFICANCE STATEMENT: In this study, we demonstrate that a common, low-cost compound known as octanedioic acid (DC 8 ) can protect mice from kidney damage typically caused by ischemia-reperfusion injury or the chemotherapy drug cisplatin. This compound seems to enhance peroxisomal activity, which is responsible for breaking down fats, without adversely affecting mitochondrial function. DC 8 is not only affordable and easy to administer but also effective. These encouraging findings suggest that DC 8 could potentially be used to assist patients who are at risk of experiencing this type of kidney damage. BACKGROUND: Proximal tubules are rich in peroxisomes, which are damaged during AKI. Previous studies demonstrated that increasing peroxisomal fatty acid oxidation (FAO) is renoprotective, but no therapy has emerged to leverage this mechanism. METHODS: Mice were fed with either a control diet or a diet enriched with dicarboxylic acids, which are peroxisome-specific FAO substrates, then subjected to either ischemia-reperfusion injury-AKI or cisplatin-AKI models. Biochemical, histologic, genetic, and proteomic analyses were performed. RESULTS: Both octanedioic acid (DC 8 ) and dodecanedioic acid (DC 12 ) prevented the rise of AKI markers in mice that were exposed to renal injury. Proteomics analysis demonstrated that DC 8 preserved the peroxisomal and mitochondrial proteomes while inducing extensive remodeling of the lysine succinylome. This latter finding indicates that DC 8 is chain shortened to the anaplerotic substrate succinate and that peroxisomal FAO was increased by DC 8 . CONCLUSIONS: DC 8 supplementation protects kidney mitochondria and peroxisomes and increases peroxisomal FAO, thereby protecting against AKI.

Cluster Analysis to Identify Long COVID Phenotypes Using 129Xe Magnetic Resonance Imaging: A Multi-centre Evaluation.

BACKGROUND: Long COVID impacts ∼10% of people diagnosed with COVID-19, yet the pathophysiology driving ongoing symptoms is poorly understood. We hypothesised that 129Xe magnetic resonance imaging (MRI) could identify unique pulmonary phenotypic subgroups of long COVID, therefore we evaluated ventilation and gas exchange measurements with cluster analysis to generate imaging-based phenotypes. METHODS: COVID-negative controls and participants who previously tested positive for COVID-19 underwent 129XeMRI ∼14-months post-acute infection across three centres. Long COVID was defined as persistent dyspnea, chest tightness, cough, fatigue, nausea and/or loss of taste/smell at MRI; participants reporting no symptoms were considered fully-recovered. 129XeMRI ventilation defect percent (VDP) and membrane (Mem)/Gas, red blood cell (RBC)/Mem and RBC/Gas ratios were used in k-means clustering for long COVID, and measurements were compared using ANOVA with post-hoc Bonferroni correction. RESULTS: We evaluated 135 participants across three centres: 28 COVID-negative (40±16yrs), 34 fully-recovered (42±14yrs) and 73 long COVID (49±13yrs). RBC/Mem (p=0.03) and FEV1 (p=0.04) were different between long- and COVID-negative; FEV1 and all other pulmonary function tests (PFTs) were within normal ranges. Four unique long COVID clusters were identified compared with recovered and COVID-negative. Cluster1 was the youngest with normal MRI and mild gas-trapping; Cluster2 was the oldest, characterised by reduced RBC/Mem but normal PFTs; Cluster3 had mildly increased Mem/Gas with normal PFTs; and Cluster4 had markedly increased Mem/Gas with concomitant reduction in RBC/Mem and restrictive PFT pattern. CONCLUSION: We identified four 129XeMRI long COVID phenotypes with distinct characteristics. 129XeMRI can dissect pathophysiologic heterogeneity of long COVID to enable personalised patient care.

A Bayesian non-stationary heteroskedastic time series model for multivariate critical care data.

We propose a multivariate GARCH model for non-stationary health time series by modifying the observation-level variance of the standard state space model. The proposed model provides an intuitive and novel way of dealing with heteroskedastic data using the conditional nature of state-space models. We follow the Bayesian paradigm to perform the inference procedure. In particular, we use Markov chain Monte Carlo methods to obtain samples from the resultant posterior distribution. We use the forward filtering backward sampling algorithm to efficiently obtain samples from the posterior distribution of the latent state. The proposed model also handles missing data in a fully Bayesian fashion. We validate our model on synthetic data and analyze a data set obtained from an intensive care unit in a Montreal hospital and the MIMIC dataset. We further show that our proposed models offer better performance, in terms of WAIC than standard state space models. The proposed model provides a new way to model multivariate heteroskedastic non-stationary time series data. Model comparison can then be easily performed using the WAIC.

[Interface Communication and Information Transfer in Medical Care for People with Intellectual Disabilities: Qualitative Expert Interviews]. / Schnittstellenkommunikation und Informationstransfer in der medizinischen Versorgung von Menschen mit intellektueller Entwicklungsstörung: Qualitative Expert*innen-Interviews.

BACKGROUND: The aim of this study was to investigate the experiences, barriers, and solutions in communication during the provision of care for people with intellectual developmental disabilities in Germany. As there are approximately 350,000 people living with intellectual or developmental disabilities in Germany, who rely on assistance when communicating with healthcare providers, this study was conducted to examine the communication challenges and potential solutions in this population. The analysis especially focused on the potentials of digital applications facilitating information transfer. METHODS: Thirteen expert interviews were conducted using a structured interview guide with caregivers and medical providers to people with intellectual developmental disabilities. The interviews were analyzed using an inductive and deductive content analysis approach, according to Meuser and Nagel. RESULTS: The results revealed that the provision of care for people with intellectual developmental disabilities was characterized by time constraints and uncertainty when caregivers lack experience in caring for this population. Additionally, information transfer increased in complexity due to an overload of individual information provided by caregivers verbally or paper-based as well due to the passive role of patients who were usually not actively involved in the communication process. With regard to the potential for integrating digital applications for information transfer, a controversy between opportunity and risk emerged. CONCLUSION: The findings demonstrate that there is a need to implement training programs for professionals to enable them to offer improved health care for people with intellectual developmental disabilities. It is essential that caregivers are given sufficient time to communicate with patients, and that digital applications are utilized to support information transfer. Moreover, other research shows that digital applications offer new possibilities to communicate with people with intellectual developmental disabilities, such as the use of simplified or pictorial language. By addressing these communication challenges, healthcare professionals may be able to provide more effective and efficient care to this population. However, this requires further research, which addresses the controversial results regarding digital applications outlined in this paper.

Metatranscriptomics reveals contrasting effects of elevation on the activity of bacteria and bacterial viruses in soil.

Soil microbial diversity affects ecosystem functioning and global biogeochemical cycles. Soil bacterial communities catalyse a diversity of biogeochemical reactions and have thus sparked considerable scientific interest. One driver of bacterial community dynamics in natural ecosystems has so far been largely neglected: the predator-prey interactions between bacterial viruses (bacteriophages) and bacteria. To generate ground level knowledge on environmental drivers of these particular predator-prey dynamics, we propose an activity-based ecological framework to simultaneous capture community dynamics of bacteria and bacteriophages in soils. An ecological framework and specifically the analyses of community dynamics across latitudinal and elevational gradients have been widely used in ecology to understand community-wide responses of innumerable taxa to environmental change, in particular to climate. Here, we tested the hypothesis that the activity of bacteria and bacteriophages codeclines across an elevational gradient. We used metatranscriptomics to investigate bacterial and bacteriophage activity patterns at five sites across 400 elevational metres in the Swiss Alps in 2015 and 2017. We found that metabolic activity (transcription levels) of bacteria declined significantly with increasing elevation, but activity of bacteriophages did not. We showed that bacteriophages are consistently active in soil along the entire gradient, making bacteriophage activity patterns divergent from that of their putative bacterial prey. Future efforts will be necessary to link the environment-activity relationship to predator-prey dynamics, and to understand the magnitude of viral contributions to carbon, nitrogen and phosphorus cycling when infection causes bacterial cell death, a process that may represent an overlooked component of soil biogeochemical cycles.

[Costs of potentially outpatient endoscopic procedures in cases with a 1-day hospital stay versus a longer stay]. / Kosten potenziell ambulant erbringbarer endoskopischer Leistungen in Fällen mit 1-Tages-Verweildauer gegenüber einer längeren Verweildauer.

INTRODUCTION: The transfer of patient care and medical interventions that was previously provided on an inpatient basis to outpatient settings is a stated goal of health politics. It is unclear to what extent costs of an endoscopic procedure and the disease severity depend on the duration of inpatient treatment. We therefore examined whether endoscopic services for cases with a one-day length of stay (VWD) are comparably expensive to cases with a longer VWD. METHODS: Outpatient services were selected from the DGVS service catalog. Day cases with exactly one such gastroenterological endoscopic (GAEN) service were compared with cases with VWD>1 day regarding their patient clinical complexity levels (PCCL) and mean costs. Data from the DGVS-DRG project with §21-KHEntgG cost data from a total of 57 hospitals from 2018 and 2019 served as the basis. Endoscopic costs were taken from cost center group 8 of the InEK cost matrix and plausibility checked. RESULTS: A total of 122,514 cases with exactly one GAEN service were identified. Statistically equal costs were shown in 30 of 47 service groups. In 10 groups, the cost difference was not relevant (<10%). Cost differences >10% existed only for EGD with variceal therapy, insertion of a self-expanding prosthesis, dilatation/bougienage/exchange with PTC/PTCD in place, non-extensive ERCP, endoscopic ultrasound in the upper gastrointestinal tract, and colonoscopy with submucosal or full thickness resection, or foreign object removal. PCCL differed in all but one group. CONCLUSION: Gastroenterology endoscopy services provided as part of inpatient care but potentially performable on an outpatient basis are predominantly equally expensive for day cases as for patients with a length of stay greater than one day. The disease severity is lower. Calculated §21-KHEntgG cost data thus form a reliable basis for the calculation of appropriate reimbursement for hospital services to be provided as outpatient services under the AOP in the future.

A Novel Transgenic Mouse Model Implicates Sirt2 as a Promoter of Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer deaths globally. Incidence rates are steadily increasing, creating an unmet need for new therapeutic options. Recently, the inhibition of sirtuin-2 (Sirt2) was proposed as a potential treatment for HCC, despite contradictory findings of its role as both a tumor promoter and suppressor in vitro. Sirt2 functions as a lysine deacetylase enzyme. However, little is known about its biological influence, despite its implication in several age-related diseases. This study evaluated Sirt2's role in HCC in vivo using an inducible c-MYC transgene in Sirt2+/+ and Sirt2-/- mice. Sirt2-/- HCC mice had smaller, less proliferative, and more differentiated liver tumors, suggesting that Sirt2 functions as a tumor promoter in this context. Furthermore, Sirt2-/- HCCs had significantly less c-MYC oncoprotein and reduction in c-MYC nuclear localization. The RNA-seq showed that only three genes were significantly dysregulated due to loss of Sirt2, suggesting the underlying mechanism is due to Sirt2-mediated changes in the acetylome, and that the therapeutic inhibition of Sirt2 would not perturb the oncogenic transcriptome. The findings of this study suggest that Sirt2 inhibition could be a promising molecular target for slowing HCC growth.

Identifying deprived "slum" neighbourhoods in the Greater Accra Metropolitan Area of Ghana using census and remote sensing data.

Background: Identifying urban deprived areas, including slums, can facilitate more targeted planning and development policies in cities to reduce socio-economic and health inequities, but methods to identify them are often ad-hoc, resource intensive, and cannot keep pace with rapidly urbanizing communities. Objectives: We apply a spatial modelling approach to identify census enumeration areas (EAs) in the Greater Accra Metropolitan Area (GAMA) of Ghana with a high probability of being a deprived area using publicly available census and remote sensing data. Methods: We obtained United Nations (UN) supported field mapping data that identified deprived "slum" areas in Accra's urban core, data on housing and population conditions from the most recent census, and remotely sensed data on environmental conditions in the GAMA. We first fitted a Bayesian logistic regression model on the data in Accra's urban core (n=2,414 EAs) that estimated the relationship between housing, population, and environmental predictors and being a deprived area according to the UN's deprived area assessment. Using these relationships, we predicted the probability of being a deprived area for each of the 4,615 urban EAs in GAMA. Results: 899 (19%) of the 4,615 urban EAs in GAMA, with an estimated 745,714 residents (22% of its urban population), had a high predicted probability (≥80%) of being a deprived area. These deprived EAs were dispersed across GAMA and relatively heterogeneous in their housing and environmental conditions, but shared some common features including a higher population density, lower elevation and vegetation abundance, and less access to indoor piped water and sanitation. Conclusion: Our approach using ubiquitously available administrative and satellite data can be used to identify deprived neighbourhoods where interventions are warranted to improve living conditions, and track progress in achieving the Sustainable Development Goals aiming to reduce the population living in unsafe or vulnerable human settlements.

GM3 synthase deficiency increases brain glucose metabolism in mice.

GM3 synthase (GM3S) deficiency is a rare neurodevelopmental disorder caused by an inability to synthesize gangliosides, for which there is currently no treatment. Gangliosides are brain-enriched, plasma membrane glycosphingolipids with poorly understood biological functions related to cell adhesion, growth, and receptor-mediated signal transduction. Here, we investigated the effects of GM3S deficiency on metabolism and mitochondrial function in a mouse model. By indirect calorimetry, GM3S knockout mice exhibited increased whole-body respiration and an increased reliance upon carbohydrate as an energy source. 18F-FDG PET confirmed higher brain glucose uptake in knockout mice, and GM3S deficient N41 neuronal cells showed higher glucose utilization in vitro. Brain mitochondria from knockout mice respired at a higher rate on Complex I substrates including pyruvate. This appeared to be due to higher expression of pyruvate dehydrogenase (PDH) and lower phosphorylation of PDH, which would favor pyruvate entry into the mitochondrial TCA cycle. Finally, it was observed that blocking glucose metabolism with the glycolysis inhibitor 2-deoxyglucose reduced seizure intensity in GM3S knockout mice following administration of kainate. In conclusion, GM3S deficiency may be associated with a hypermetabolic phenotype that could promote seizure activity.

Within city spatiotemporal variation of pollen concentration in the city of Toronto, Canada.

BACKGROUND: The exacerbation of asthma and respiratory allergies has been associated with exposure to aeroallergens such as pollen. Within an urban area, tree cover, level of urbanization, atmospheric conditions, and the number of source plants can influence spatiotemporal variations in outdoor pollen concentrations. OBJECTIVE: We analyze weekly pollen measurements made between March and October 2018 over 17 sites in Toronto, Canada. The main goals are: to estimate the concentration of different types of pollen across the season; estimate the association, if any, between pollen concentration and environmental variables, and provide a spatiotemporal surface of concentration of different types of pollen across the weeks in the studied period. METHODS: We propose an extension of the land-use regression model to account for the temporal variation of pollen levels and the high number of measurements equal to zero. Inference is performed under the Bayesian framework, and uncertainty of predicted values is naturally obtained through the posterior predictive distribution. RESULTS: Tree pollen was positively associated with commercial areas and tree cover, and negatively associated with grass cover. Both grass and weed pollen were positively associated with industrial areas and TC brightness and negatively associated with the northing coordinate. The total pollen was associated with a combination of these environmental factors. Predicted surfaces of pollen concentration are shown at some sampled weeks for all pollen types. SIGNIFICANCE: The predicted surfaces obtained here can help future epidemiological studies to find possible associations between pollen levels and some health outcome like respiratory allergies at different locations within the study area.

The impact of implementing patient-reported measures in routine maternity care: a systematic review.

INTRODUCTION: While there is growing interest in applying patient-reported measures (PRMs) in clinical routine, limited collective evidence of the impact of PRMs hinder their widespread use in specific contexts, such as maternity care. Our objective was to synthesize existing emperical evidence on the impact of implementing PRMs in routine maternity care. MATERIAL AND METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (version 2020). We electronically searched six databases for the literature on the implementation of PRMs in maternity care. A multi-level (woman, clinical, organizational, national and societal) analytic framework for analyzing and synthesizing emperically proven impacts of PRMs was developed. Quality was assessed using the Mixed Method Appraisal Tool. The GRADE-CERQual approach was used to assess the confidence in the review findings and arguments. The protocol was registered in PROSPERO (CRD42021234501). RESULTS: Overall, 4971 articles were screened. The emperical evidence, collected from 11 relevant studies, showed that the use of PRMs in routine maternity care could produce positive effects on clinical process (assessment and detection of health problems, clinical visit preparation, resource use, woman-professional communication, decision-making, woman-professional relationship, and care quality), and health behavior and outcomes (women's health and wellbeing, quality of life, health behavior, experiences and satisfaction with healthcare services), awareness, engagement and self-management of own health, and disclosure of health issues. The confidence in the review findings was low to moderate due to a limited number of studies, inadequate data and methodological limitations of included studies. CONCLUSIONS: The limited emperical evidence available suggested that the use of PRMs may have positive effects at the individual health level and clinical process level. However, the evidence was not strong enough to provide policy recommendations on the use of PRMs in routine maternity care. This review revealed limitations of currently available research, such as lack of generalizability and narrow scopes in investigating impact. Efforts are needed to improve the quality of research on the use of PRMs in routine maternity care by widening the study population, including different types of PRMs, and considering the effects of PRMs at different levels and domains of healthcare.

Estimating the lagged effect of price discounting: a time-series study on sugar sweetened beverage purchasing in a supermarket.

BACKGROUND: Price discount is an unregulated obesogenic environmental risk factor for the purchasing of unhealthy food, including Sugar Sweetened Beverages (SSB). Sales of price discounted food items are known to increase during the period of discounting. However, the presence and extent of the lagged effect of discounting, a sustained level of sales after discounting ends, is previously unaccounted for. We investigated the presence of the lagged effect of discounting on the sales of five SSB categories, which are soda, fruit juice, sport and energy drink, sugar-sweetened coffee and tea, and sugar-sweetened drinkable yogurt. METHODS: We fitted distributed lag models to weekly volume-standardized sales and percent discounting generated by a supermarket in Montreal, Canada between January 2008 and December 2013, inclusive (n = 311 weeks). RESULTS: While the sales of SSB increased during the period of discounting, there was no evidence of a prominent lagged effect of discounting in four of the five SSB; the exception was sports and energy drinks, where a posterior mean of 28,459 servings (95% credible interval: 2661 to 67,253) of excess sales can be attributed to the lagged effect in the target store during the 6 years study period. CONCLUSION: Our results indicate that studies that do not account for the lagged effect of promotions may not fully capture the effect of price discounting for some food categories.

Socioeconomic factors and bacillary dysentery risk in Jiangsu Province, China: a spatial investigation using Bayesian hierarchical models.

Bacillary dysentery (BD) is an acute diarrheal disease prevalent in areas affected by socioeconomic disparities. We investigated BD risk and its associations with socioeconomic factors at the county-level in Jiangsu province, China using epidemiological and socioeconomic data from 2011-2014. We fitted four Bayesian hierarchical models with various prior specifications for random effects. As all model comparison criteria values were similar, we presented results from a reparameterized Besag-York-Mollié model, which addressed issues with the identifiability of variance captured by spatial and independent effects. Our model adjusted for year and socioeconomic status showed 18-65% decreased BD risk compared to 2011. We found a high relative risk in the northwestern and southwestern counties. Increasing the percentage of rural households, rural income per capita, health institutions per capita, or hospital beds per capita decreases the relative risk of BD, respectively. Our findings can be used to improve infectious diarrhea surveillance and enhance existing public health interventions.

Extended Bayesian endemic-epidemic models to incorporate mobility data into COVID-19 forecasting.

Forecasting the number of daily COVID-19 cases is critical in the short-term planning of hospital and other public resources. One potentially important piece of information for forecasting COVID-19 cases is mobile device location data that measure the amount of time an individual spends at home. Endemic-epidemic (EE) time series models are recently proposed autoregressive models where the current mean case count is modelled as a weighted average of past case counts multiplied by an autoregressive rate, plus an endemic component. We extend EE models to include a distributed-lag model in order to investigate the association between mobility and the number of reported COVID-19 cases; we additionally include a weekly first-order random walk to capture additional temporal variation. Further, we introduce a shifted negative binomial weighting scheme for the past counts that is more flexible than previously proposed weighting schemes. We perform inference under a Bayesian framework to incorporate parameter uncertainty into model forecasts. We illustrate our methods using data from four US counties.

La prévision du nombre de cas quotidiens de COVID­19 est cruciale pour la planification à court terme de ressources hospitalières et d'autres ressources publiques. Les données de localisation des téléphones mobiles qui mesurent le temps passé à la maison peuvent constituer un élément d'information important pour prédire les cas de COVID­19. Les modèles de séries chronologiques endémiques­épidémiques sont des modèles auto­régressifs récents où le nombre moyen de cas en cours est modélisé comme une moyenne pondérée du nombre de cas antérieurs multipliée par un taux auto­régressif (reproductif), plus une composante endémique. Les auteurs de ce travail généralisent les modèles endémiques­épidémiques pour y inclure un modèle à décalage distribué, et ce, dans le but de tenir compte du lien entre la mobilité et le nombre de cas de COVID­19 enregistrés. Pour saisir les variations de temps supplémentaires, ils y incorporent une marche hebdomadaire aléatoire d'ordre supérieur. De plus, ils proposent un schéma de pondération binomiale négative décalée pour les dénombrements passés, qui est plus flexible que les schémas de pondération existants. Ils utilisent l'inférence bayésienne afin d'intégrer l'incertitude des paramètres aux prédictions du modèle et ils illustrent les méthodes proposées avec des données provenant de quatre comtés américains.

Commentary: "How's It Going?" Training Experiences of Pediatric Postdoctoral Fellows During COVID-19.

The COVID-19 pandemic has impacted the lives and workplaces of individuals across the world substantially, in ways that are yet largely unknown. This commentary aims to provide an early snapshot of the experiences of pediatric postdoctoral fellows in academic medical settings; specifically, we will explore the impact of the pandemic on developing mastery within several competencies (e.g., research, professional development, clinical, interdisciplinary). These competencies are critical elements to fellowship to prepare for independent practice. Several models of training competencies for professional psychology and pediatric psychology exist, which focus on trainee skill development. Measures taken to minimize the spread of COVID-19 have directly impacted hospital systems and training, requiring programs to adapt competencies in various domains, such as increased familiarity with telehealth and virtual supervision. Additionally, fellows experienced an impact of the pandemic on securing employment following fellowship, conducting research and program development activities, and on cognitive flexibility and self-care. Governing bodies, such as the APA and Council of Chairs of Training Councils, have released statements and guidelines on addressing training of postdoctoral fellows including increasing flexibility of training methods, limiting in-person contact, and adjusting educational and licensing requirements. This paper offers informed commentary and diverse perspectives from current postdoctoral fellows engaged in a variety of clinical and research responsibilities regarding how the COVID-19 pandemic has impacted their training. We hope this paper will provide important insight into the unique experiences of postdoctoral fellows during the capstone year(s) of training prior to independent work and inform recommendations for postdoctoral training programs.

Generating community measures of food purchasing activities using store-level electronic grocery transaction records: an ecological study in Montreal, Canada.

OBJECTIVE: Geographic measurement of diets is generally not available at areas smaller than a national or provincial (state) scale, as existing nutrition surveys cannot achieve sample sizes needed for an acceptable statistical precision for small geographic units such as city subdivisions. DESIGN: Using geocoded Nielsen grocery transaction data collected from supermarket, supercentre and pharmacy chains combined with a gravity model that transforms store-level sales into area-level purchasing, we developed small-area public health indicators of food purchasing for neighbourhood districts. We generated the area-level indicators measuring per-resident purchasing quantity for soda, diet soda, flavoured (sugar-added) yogurt and plain yogurt purchasing. We then provided an illustrative public health application of these indicators as covariates for an ecological spatial regression model to estimate spatially correlated small-area risk of type 2 diabetes mellitus (T2D) obtained from the public health administrative data. SETTING: Greater Montreal, Canada in 2012. PARTICIPANTS: Neighbourhood districts (n 193). RESULTS: The indicator of flavoured yogurt had a positive association with neighbourhood-level risk of T2D (1·08, 95 % credible interval (CI) 1·02, 1·14), while that of plain yogurt had a negative association (0·93, 95 % CI 0·89, 0·96). The indicator of soda had an inconclusive association, and that of diet soda was excluded due to collinearity with soda. The addition of the indicators also improved model fit of the T2D spatial regression (Watanabe-Akaike information criterion = 1765 with the indicators, 1772 without). CONCLUSION: Store-level grocery sales data can be used to reveal micro-scale geographic disparities and trends of food selections that would be masked by traditional survey-based estimation.

Fluoroquinolone Use and Seasonal Patterns of Ciprofloxacin Resistance in Community-Acquired Urinary Escherichia coli Infection in a Large Urban Center.

Urinary tract infections caused by the bacterium Escherichia coli are among the most frequently encountered infections and are a common reason for antimicrobial prescriptions. Resistance to fluoroquinolone antimicrobial agents, particularly ciprofloxacin, has increased in recent decades. It is intuitive that variation in fluoroquinolone resistance is driven by changes in antimicrobial use, but careful study of this association requires the use of time-series methods. Between April 2010 and December 2014, we studied seasonal variation in resistance to ciprofloxacin, trimethoprim-sulfamethoxazole, and ampicillin in community-acquired urinary E. coli isolates in Montreal, Quebec, Canada. Using dynamic linear models, we investigated whether seasonal variation in resistance could be explained by seasonal variation in community antimicrobial use. We found a positive association between total fluoroquinolone use lagged by 1 and 2 months and the proportion of isolates resistant to ciprofloxacin. Our results suggest that resistance to ciprofloxacin is responsive to short-term variation in antimicrobial use. Thus, antimicrobial stewardship campaigns to reduce fluoroquinolone use, particularly in the winter when use is highest, are likely to be a valuable tool in the struggle against antimicrobial resistance.

Dipyrrolyldiketonato Titanium(IV) Complexes from Monomeric to Multinuclear Architectures: Synthesis, Stability, and Liquid-Crystal Properties.

Dipyrrolyldiketone ligands (dpkH) are used with Ti(OiPr)4 to afford monomeric titanium(IV) complexes displaying the general formula C2-[Ti(dpk)2(OiPr)2]. The dpkH ligands employed consist of two dipyrrolyldiketone compounds (2H and 3H) and three diphenyl-substituted analogues (4H-6H). The behavior of these octahedral [Ti(dpk)2(OiPr)2] species in solution was investigated by 1H NMR at variable temperatures. Dynamic phenomena were evidenced, and the activation parameters associated with these processes (ΔH⧧, ΔS⧧, and ΔG⧧) were retrieved. [Ti(dpk)2(OiPr)2] complexes are precursors for the formation of high-nuclearity aggregates whose structures depend on the substituents on the diketone backbone. The crystal structures of monomeric ([Ti(1)2(OiPr)2]; 1 is the 1,3-diphenyl-1,3-propanedionato ligand) and [Ti(2)2(OEt)2]), dimeric ([Ti2(1)4(µ2-O)2]), and tetrameric ([Ti4(4)8(µ2-O)4]) species have been established, and the origin of this structural diversity is discussed. The solid-state optical properties of several complexes were determined and interpreted with the help of DFT calculations. Finally, the dinuclear complex [Ti(6)2(µ2-O)2] was synthesized, where ligand 6 incorporates six long alkyl chains (C16H33). This complex shows rich mesomorphic properties, with an original room-temperature plastic crystal phase followed by a hexagonal columnar liquid-crystalline phase.