Application of validated mapping algorithms between generic PedsQL scores and utility values to individuals with sickle cell disease.

PURPOSE: There is a paucity of empirically estimated health state utility (HSU) values to estimate health-related quality of life among individuals with sickle cell disease (SCD). This study aims to map the Pediatric Quality of Life Inventory generic core scales (PedsQL GCS) to HSUs for children and adolescents with SCD in the United States, using published algorithms, and to assess the construct validity of these HSUs against SCD-specific PedsQL scores. METHODS: We used the published mapping algorithms identified in four published articles, in which the PedsQL GCS was mapped to either the EuroQol-5 Dimension 3-Level, Youth Version or the Child Health Utility 9-Dimension to obtain HSUs. We employed the algorithms to calculate HSUs for a sample of children and adolescents from the Sickle Cell Clinical Research and Intervention Program. To assess the construct validity of the mapped HSUs in SCD patients, we computed Spearman's correlation coefficient comparing the HSUs with the PedsQL SCD total score and separately with each PedsQL SCD dimension-specific score. RESULTS: The mean mapped HSU across published algorithms was 0.792 (95% CI: 0.782-0.801). It was significantly higher among children aged 5-12 years than children aged 13-17 years. The Spearman's correlation coefficient for HSUs versus PedsQL SCD total scores was 0.64 (95% CI: 0.57-0.71). Correlations ranged from 0.40 (95% CI: 0.32-0.48) to 0.60 (95% CI: 0.54-0.66) for HSUs versus PedsQL SCD dimension-specific scores. CONCLUSIONS: The existing mapping algorithms show acceptable construct validity in children and adolescents with SCD. Additional algorithms are needed for adults and for specific SCD comorbidities.

Why and How to Create Nighttime Warming Treatments for Ecological Field Experiments.

While average global temperatures are increasing, a disproportionate amount of warming can be attributed to increasing nighttime temperatures rather than increasing daytime temperatures. Theory predicts that the timing of warming can generate different effects on organisms and their interactions within ecosystems. This occurs because an organism's response to warming depends on the current temperature. For example, warming when temperatures are low may have positive effects on an organism, while warming when temperatures are already high may have negative effects on an organism. Most field experiments that examine the ecological effects of climate warming employ warming methodologies that disproportionately elevate daytime warming treatments. The bias towards daytime warming treatments may arise because daytime temperatures can be manipulated with relatively simple and inexpensive technology that capitalizes on solar energy, such as open-top chambers that create a "greenhouse effect" or shade structures that reduce temperatures. However, these popular methods are ineffective when solar radiation is absent, and thus do not create warming treatments that accurately mimic the temporal patterns of climate warming. To encourage the investigation of nighttime warming's effect on ecosystems, we discuss why daytime and nighttime warming may have different effects on organisms, then present a review of methods that can be employed to elevate nighttime temperature in terrestrial field experiments. For each method, we offer a brief explanation, an evaluation of its pros and cons, and citations for further reference, as well as empirical data when possible. While some are impractical, we attempt to provide a comprehensive list of potential nighttime warming methods in hopes of stimulating ideas and discussions.

First discovery of the charophycean green alga Lychnothamnus barbatus (Charophyceae) extant in the New World.

PREMISE OF THE STUDY: Although some species of Characeae, known as stoneworts, can be found on every continent except Antarctica, many species and some genera have limited geographic distributions. The genus Lychnothamnus, represented by a single extant species L. barbatus, was known only from scattered localities in Europe and Australasia until it was recently discovered in North America. METHODS: Morphological identifications were made from specimens collected in Minnesota and Wisconsin, USA. DNA sequences were obtained for three plastid-encoded genes (atpB, psbC, rbcL) from seven putative Lychnothamnus samples from two states in the USA Distribution and abundance were estimated in each lake using point intercept surveys where surveyors sampled aquatic vegetation. KEY RESULTS: Fourteen lakes in Wisconsin and two lakes in Minnesota, USA, were found to harbor Lychnothamnus barbatus. These represent the first report of this rare charophycean extant in the New World. The North American specimens matched the morphological description for L. barbatus and were compared directly with the neotype. Phylogenetic results using three plastid-encoded genes confirmed the identification placing New World samples with those from Europe and Australasia. Our phylogenetic analyses also confirmed the sister relationship between L. barbatus and Nitellopsis obtusa. CONCLUSIONS: Because this taxon is not known for aggressive invasiveness in its native range, it may have existed in heretofore-undiscovered native populations, although the possibility that it is a recent introduction cannot be eliminated. The potential for discovery of novel lineages of green algae in even well-studied regions is apparently far from exhausted.

A macrophyte bioassessment approach linking taxon-specific tolerance and abundance in north temperate lakes.

Bioassessment methods are critically needed to evaluate and monitor lake ecological condition. Aquatic macrophytes are good candidate indicators, but few lake bioassessment methods developed in North America use them. The few macrophyte bioassessment methods that do exist suffer from problems related to subjectivity and discernibility along disturbance gradients. We developed and tested a bioassessment approach for 462 north temperate lakes. The approach links macrophyte abundance to lake ecological condition via estimates of taxon-specific abundance-weighted tolerance to anthropogenic disturbance. Using variables related to eutrophication, urban development and agriculture, we calculated abundance-weighted tolerance ranges for 59 macrophyte taxa and clustered them according to their tolerance to anthropogenic disturbance. We also created a composite index of anthropogenic disturbance using 20 variables related to population density, land cover and water chemistry. We used a statistical approach to set ecological condition thresholds based on the observed abundance of sensitive, moderately tolerant and tolerant taxa in each lake. The resulting lake condition categories were usually stable across multiple survey events and largely agreed with condition rankings assigned using expert judgment. We suggest using this macrophyte bioassessment method for federal water quality reports, restoration and management on north temperate lakes.

Proinflammatory state promotes red blood cell alloimmunization in pediatric patients with sickle cell disease.

We examined risk factors for red blood cell (RBC) alloimmunization in pediatric patients with sickle cell disease, focusing on the recipients' inflammatory state at the time of transfusion and anti-inflammatory role of hydroxyurea (HU). Among 471 participants, 55 (11.70%) participants were alloimmunized and formed 59 alloantibodies and 17 autoantibodies with an alloimmunization rate of 0.36 alloantibodies per 100 units. Analysis of 27 participants in whom alloantibodies were formed with specificities showed 23.8% (30/126) of units transfused during a proinflammatory event resulting in alloantibody formation compared with 2.8% (27/952) of units transfused at steady state. Therefore, transfusion during proinflammatory events increased the risk for alloimmunization (odds ratio [OR], 4.22; 95% confidence interval [CI], 1.64-10.85; P = .003). Further analysis of all the 471 participants showed that alloimmunization of patients who received episodic transfusion, mostly during proinflammatory events, was not reduced with HU therapy (OR, 6.52; 95% CI, 0.85-49.77; P = .071), HU therapy duration (OR, 1.13; 95% CI, 0.997-1.28; P = .056), or HU dose (OR, 1.06; 95% CI, 0.96-1.16; P = .242). The analysis also identified high transfusion burden (OR, 1.02; 95% CI, 1.003-1.04; P = .020) and hemoglobin S (HbSS) and HbSß0-thalassemia genotypes (OR, 11.22, 95% CI, 1.51-83.38; P = .018) as additional risk factors for alloimmunization. In conclusion, the inflammatory state of transfusion recipients affects the risk of RBC alloimmunization, which is not modified by HU therapy. Judicious use of transfusion during proinflammatory events is critical for preventing alloimmunization.

A polygenic score for acute vaso-occlusive pain in pediatric sickle cell disease.

Individuals with monogenic disorders can experience variable phenotypes that are influenced by genetic variation. To investigate this in sickle cell disease (SCD), we performed whole-genome sequencing (WGS) of 722 individuals with hemoglobin HbSS or HbSß0-thalassemia from Baylor College of Medicine and from the St. Jude Children's Research Hospital Sickle Cell Clinical Research and Intervention Program (SCCRIP) longitudinal cohort study. We developed pipelines to identify genetic variants that modulate sickle hemoglobin polymerization in red blood cells and combined these with pain-associated variants to build a polygenic score (PGS) for acute vaso-occlusive pain (VOP). Overall, we interrogated the α-thalassemia deletion -α3.7 and 133 candidate single-nucleotide polymorphisms (SNPs) across 66 genes for associations with VOP in 327 SCCRIP participants followed longitudinally over 6 years. Twenty-one SNPs in 9 loci were associated with VOP, including 3 (BCL11A, MYB, and the ß-like globin gene cluster) that regulate erythrocyte fetal hemoglobin (HbF) levels and 6 (COMT, TBC1D1, KCNJ6, FAAH, NR3C1, and IL1A) that were associated previously with various pain syndromes. An unweighted PGS integrating all 21 SNPs was associated with the VOP event rate (estimate, 0.35; standard error, 0.04; P = 5.9 × 10-14) and VOP event occurrence (estimate, 0.42; standard error, 0.06; P = 4.1 × 10-13). These associations were stronger than those of any single locus. Our findings provide insights into the genetic modulation of VOP in children with SCD. More generally, we demonstrate the utility of WGS for investigating genetic contributions to the variable expression of SCD-associated morbidities.