Photo-identification and satellite telemetry connect southern right whales from South Georgia Island (Islas Georgias del Sur) with multiple feeding and calving grounds in the southwest Atlantic

The sub-Antarctic waters of South Georgia Island (Islas Georgias del Sur, SG/IG) are a regularly visited feeding ground for southern right whales (Eubalaena australis, SRW) in the southwest Atlantic. Satellite telemetry and photo-identification records were compared to better understand the role of SG/IG in the SRW migratory network. We present the first insights from SRW satellite-tracked from the SG/IG feeding ground, habitat use patterns in the Scotia Arc, and movements to Antarctic habitats. Photo-identification comparisons to calving and feeding areas across the South Atlantic and a review of sightings of cetaceans reported from Bird Island (west of SG/IG) since 1979 illuminate long-term habitat use patterns in SG/IG. We present the first recorded migratory movement between SG/IG and multiple countries: Argentina, Uruguay, and Brazil. Photo-identification (1) linked SG/IG to a female SRW with a long-term sighting history in Brazil, and (2) provided the first match between SG/IG and the western Antarctic Peninsula, suggesting the latter could extend the feeding area for southwest Atlantic SRW. Satellite tracking and opportunistic sightings suggest that shelf and coastal waters west of SG/IG represent an important multi-season SRW feeding habitat and add to our overall understanding of habitats and ranges occupied by recovering southwest Atlantic SRW.     

Structural classification of αββ and ββα supersecondary structure units in proteins

We present a fully automatic structural classification of supersecondary structure units, consisting of two hydrogen-bonded β strands, preceded or followed by an α helix. The classification is performed on the spatial arrangement of the secondary structure elements, irrespective of the length and conformation of the intervening loops. The similarity of the arrangements is estimated by a structure alignment procedure that uses as similarity measure the root mean square deviation of superimposed backbone atoms. Applied to a set of 141 well-resolved nonhomologous protein structures, the classification yields 11 families of recurrent arrangements. In addition, fragments that are structurally intermediate between the families are found; they reveal the continuity of the classification. The analysis of the families shows that the α helix and β hairpin axes can adopt virtually all relative orientations, with, however, some preferable orientations; moreover, according to the orientation, preferences in the left/right handedness of the α–β connection are observed. These preferences can be explained by favorable side by side packing of the α helix and the β hairpin, local interactions in the region of the α–β connection or stabilizing environments in the parent protein. Furthermore, fold recognition procedures and structure prediction algorithms coupled to database-derived potentials suggest that the preferable nature of these arrangements does not imply their intrinsic stability. They usually accommodate a large number of sequences, of which only a subset is predicted to stabilize the motif. The motifs predicted as stable could correspond to nuclei formed at the very beginning of the folding process. Proteins 30:193–212, 1998. © 1998 Wiley-Liss, Inc.     

Low-dose whole thorax radiation therapy for COVID-19 pneumonia: inpatient onboarding process for a randomized controlled trial

BackgroundThe mortality of the SARS-CoV-2 virus (COVID-19) has been associated with a pulmonary inflammatory response resulting in hypoxemia and rapid clinical decline. PREVENT is an ongoing prospective multicenter Phase II randomized controlled trial where patients hospitalized with COVID-19 pneumonia are randomized to low dose radiation therapy (RT) versus control (clinicaltrials.gov, {"type":"clinical-trial","attrs":{"text":"NCT04466683","term_id":"NCT04466683"}}NCT04466683). We describe the inpatient onboarding process of the center contributing the largest number of patients to this trial.Materials and methodsCOVID-19 hospital admissions were attained by the clinical research manager and radiation oncologist daily. Text message contact was made with infectious disease, critical care, and nursing staff with reciprocal discussion of the trial protocol and approval for virtual consulting of the patient. Witnessed informed consent was obtained first by telephone and later in person. Simulation and treatment (performed without a computer plan) was performed on a linear accelerator with one personal protective equipment-protected therapist moving in and out of the treatment room, and a second therapist manning the console. Following on-site dose calculation by physics, the radiation oncologist approved the fields prior to treatment delivery.ResultsBetween August 28, 2020 and October 6, 2020, the first 10 enrolled patients on this multicenter trial were randomized and treated at our institution; no team member (research staff, radiation oncology) contracted COVID-19 while employing this protocol.ConclusionThis represents the first published protocol to address efficient and safe recruitment of COVID-19 patients for a radiation oncology trial, serving as a model for conducting recruitment of COVID-19 patients for clinical trials.     

关于患者权利与义务体系构建的探讨

目前我国法律多注重对医生权利义务的规定,缺乏对患者权利义务的规定。文章从伦理和法律的角度对患者的权利和义务进行探讨,分析如何构建患者的权利与义务体系,以促进我国医疗卫生事业的稳定发展。     

患者欺凌行为对护士职业使命感及护理质量的影响

目的 探讨公立医院中患者欺凌行为对护士职业使命感及护理质量的影响。方法 采用问卷调查法收集数据。运用描述性统计、相关分析及多元线性阶层回归分析法处理数据。结果 患者欺凌行为对护士职业使命感（β= -0.148, P＜0.01）和主观护理质量（β= -0.123, P＜0.01）具有显著的负向预测作用,职业使命感在二者之间扮演部分中介效应（β= -0.028, P＜0.01）。结论 患者欺凌行为降低了护士职业使命感,进而威胁到护士的服务质量。     

Best Practice Guidelines on Informed Consent for Weight Loss Surgery Patients

Objective: To provide evidence‐based guidelines on informed consent and the education that underlies it for legally competent, severely obese weight loss surgery (WLS) patients. Research Methods and Procedures: We conducted a systematic review of the scientific literature published on MEDLINE between 1984 and 2004. Three articles focused on informed consent for WLS; none was based on empirical studies. We summarized each paper and assigned evidence categories according to a grading system derived from established evidence‐based models. We also relied on informed consent and educational materials from six WLS programs in Massachusetts. All evidence is Category D. Recommendations were based on a review of the available literature, informed consent materials from WLS programs, and expert opinion. Results: This Task Group found that the informed consent process contributes to long‐term outcome in multiple ways but is governed by limited legal requirements. We focused our report on the legal and ethical issues related to informed consent, i.e., disclosure vs. comprehension. Recommendations centered on the importance of assessing patient comprehension of informed consent materials, the content of those materials, and the use of active teaching/learning techniques to promote understanding. Discussion: Although demonstrated comprehension is not a legal requirement for informed consent in Massachusetts or other states, the members of this Task Group found that the best interests of WLS patients, providers, and facilities are served when clinicians engage patients in active learning and collaborative decision making.     

Diaphragmatic stimulation: a case of atrial lead dislodgement and right atrium perforation

We report a 48 year old male who presented with diaphragmatic stimulation. The biventricular implantable cardioverter and defibrillator (CRT-D) was implanted two weeks before admission and active fixation lead caused perforation of the right atrial wall. Echocardiography did not demonstrate pericardial effusion but Chest X-ray and computed tomography (CT) visualized the atrial screw helix outside the right atrial wall, penetrating through the right lung middle lobe. There was no atrial capture. After changing the pace mode DDDR to VVIR, diaphragmatic stimulation was disappeared. The atrial lead was repositioned and fixed again. During the hospital admission and after that the patient was well and free of any symptoms.     

North Pacific right whale (Eubalaena japonica) seasonal and diel calling patterns from long‐term acoustic recordings in the southeastern Bering Sea, 2000–2006

We assessed North Pacific right whale (Eubalaena japonica) seasonal and daily calling patterns in the southeastern Bering Sea (SEBS) using long‐term hydrophone recordings from October 2000 through January 2006. We detected right whale calls on the SEBS middle shelf (<100 m depth) as early as May, intermittently throughout summer and fall, and as late as December. Calls also were detected on one day in June 2005 on the SEBS slope (>1,000 m), but were not detected near Kodiak Island from April to August 2003. In months with calls, detections occurred on more days in July–October (≥6 d/mo), than from May to June or November to December (≤3 d/mo). Calls were clustered in time and were usually detected on 1–3 consecutive days with a median interval of 6.5 d for calls >1 d apart. Hourly calling rates were significantly higher at night than during the day. These data indicate that right whales occur in the SEBS later in the year than previously known, intermittently pass through the middle‐shelf study region, and usually remain there no longer than a few days. Right whale habitat use in the SEBS may intensify in mid‐summer through early fall based on higher monthly and daily call detection rates.