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Sex-disaggregated data for coronavirus disease 2019 (COVID-19) reported higher hospitalized fatality rates among men than women.
To determine whether the risk factors for in-hospital mortality from COVID-19, present at the time of hospital admission, differed by patient sex.
Design and setting:
Single-center, retrospective cohort study at a tertiary-care urban academic center.
We reviewed the electronic medical records of patients positive for COVID-19 via qualitative polymerase chain reaction (PCR) assay, admitted between March 8 and June 14, 2020. Patients were stratified by sex to assess the association of variables present on admission with in-hospital mortality.
The overall inpatient case fatality rate (CFR) was 30.4% (172 of 565). The CFR among male patients was higher than among female patients: 99 (33.7%) versus 73 (26.9%), respectively (P = .08). Among males, comorbid conditions associated with in-hospital mortality were chronic pulmonary disease (P = .02) and connective tissue disease (P = .03). Among females, these comorbid conditions were congestive heart failure (P = .03), diabetes with complication (P = .05), and hemiplegia (P = .02). Variables that remained independently associated with death in males included age >70 years, public insurance, incremental increase in quick sepsis-related organ failure assessment (qSOFA) and C-reactive protein (CRP), lymphocytopenia, and thrombocytopenia. Among females, variables that remained independently associated with mortality included public insurance, incremental increase in Charlson weighted index of comorbidity (CWIC) score, qSOFA, and CRP.
Risk factors for in-hospital mortality by sex included public insurance type, incremental increase in qSOFA and CRP in both sexes. For male patients, older age, lymphocytopenia and thrombocytopenia were also associated with mortality, whereas a higher Charlson score was associated with in-hospital mortality in female patients.
Disturbances are critical for maintaining environmental heterogeneity and biodiversity across landscapes. Hurricanes represent a common disturbance in the Caribbean Sea. These storms are predicted to become more frequent and severe as climate shifts. Understanding how island communities respond to disturbances is critical to their conservation. We surveyed Virgin Islands National Park located on the island of St. John in the Caribbean Sea in 2016 and 2018 to evaluate prolonged herpetofauna community response and resistance to hurricanes. These surveys occurred in March 2016, and June 2018, before and after the 2017 hurricane season, when hurricanes Irma and Maria struck St. John. Using visual encounter surveys, vocalisation surveys, and opportunistic encounters, we surveyed trails within the park through five landscape cover types pre- and post-hurricane. We used linear regression to determine differences in diversity and species richness among landscape cover types and between pre- and post-hurricane surveys and non-metric multidimensional scaling to observe associations among species and landscape cover types pre- and post-hurricane surveys. We determined that there were no significant changes in landscape cover and herpetofauna community associations before and after the 2017 hurricane season, indicating that the herpetofauna communities of Virgin Islands National Park are well adapted to hurricane-related disturbance.
If African American poets have achieved a new kind of freedom in the twenty-first century, they have also pursued multiple styles through their modes of introspection. This broader inward-turning is continuous with the defining priorities of the Black Arts Movement, a principle that might be more aptly named self-determination. Contemporary African American poets have embraced black culture as a historical and cultural landscape to be mapped into new frontiers in order to make the individual black self and then to develop terms for the liberation of that self. These pursuits of self-examination and self-determination comprise at least four broad and overlapping realms of practice: apolitical introspection; a rethinking of African American history and heritage beyond the terms of simple affirmation; a personalized mode of collectivist protest in line with Black Arts Movement practices; and a black literary collective action enacted by the numerous African American writers collectives and workshops that have arisen since the 1960s. Poets discussed include Gregory Pardlo, Natasha Trethewey, Tyehimba Jess, Patricia Smith, Nikky Finney, Nathaniel Mackey, alongside groups such as Cave Canem and movements like #BlackPoetsSpeakOut.
Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
To what extent is it possible for American Jews to maintain a deep emotional connection to Israel while criticizing the actions of the Israeli government? This long-debated question echoes earlier investigations of different forms of patriotism toward one's home country. Drawing on two 2019 surveys of American Jews, we find that, like Americans in general, Jewish liberals and conservatives express different forms of patriotism toward both Israel and America. Jewish conservatives tend to oppose criticism of Israel and America for any reason, while Jewish liberals view criticism as an important part of “caring” about both countries. Both forms of patriotism are positively associated with stronger emotional connections to the relevant country. These results suggest that emotional connection to Israel represents a form of social identification with Israel and that lower levels of connection to Israel among some American Jews are driven more by apathy than active criticism or hostility.
Shock oscillations within a model two-dimensional axisymmetric inlet with a constant area isolator are investigated under the condition of maintaining an unseparated boundary layer throughout the inlet/isolator section. Power spectral densities of the wall-pressure fluctuations beneath each shock leg intersecting the isolator surface exhibited a very low frequency broadband oscillation in the 10–100 Hz range as well as a very high frequency broadband oscillations above 10 kHz. Whereas the high frequency oscillations are attributed to the incoming boundary layer fluctuations, detailed investigations into the pressure fluctuation communication pathways within the isolator and their length scale of communication are made to elucidate the origin of the low frequency fluctuations. It was found that the downstream propagation of pressure fluctuations is primarily by the convection of the boundary layer structures and this communication occurred over several boundary layer thicknesses. The upstream propagation occurs through acoustic waves that extend over a distance of one local boundary layer thickness. Based on this understanding, a physical model is constructed, which makes an accurate prediction of pressure power spectrum of the low frequency shock wave oscillations; the model predictions also favourably compare with the shock oscillations in external shock boundary layer interactions without shock-induced flow separation.
Many formerly glaciated valleys in the western United States preserve detailed glacial features that span the penultimate glaciation through the last deglaciation; however, numerical age control is limited in many of these systems. We report 35 new cosmogenic 10Be surface exposure ages of moraine boulders in the Sawatch Range, Colorado. Eight ages suggest Bull Lake moraines in Lake Creek (range: 132–120 ka, n = 4) and Clear Creek (range: 187–133 ka, n = 4) valleys may correlate with Marine Isotope Stage 6. In Lake Creek valley, 22 10Be ages from Pinedale end moraines average 20.6 ± 0.6 ka, and 5 10Be ages from a recessional moraine average 15.6 ± 0.7 ka, indicating that glaciers occupied two extended positions at ~21–20 and ~16 ka. The glacial extent dated to ~16 ka was nearly as great as that of the earlier glacial phase, suggesting that climate conditions in the Colorado Rocky Mountains at this time were similar to those of the last glacial maximum. Combining these moraine ages with seven previously published 10Be ages from cirque and valley-bottom bedrock reveals that the Lake Creek paleoglacier lost 82% of its full glacial length in ~1.5 ka and was completely deglaciated by ~14 ka.
This was a metabolic study of bulimia nervosa required to design short-term cognitive-behavioural therapy (CBT) beginning with a brief admission to a psychiatric ward. The treatment produced significant improvements in eating behaviour and results are compared with those of previously published studies. The comparisons do not suggest that brief admission at the onset of therapy might enhance its effectiveness. In other respects, increase in normal meal intake was found to correlate significantly with decrease in hinging. This supports the notion that appropriate food intake at meal times should be an important issue in CBT for bulimia nervosa.
OBJECTIVES/SPECIFIC AIMS: Triple-negative breast cancer (TNBC) accounts for one-fifth of the breast cancer patient population. The heterogeneous nature of TNBC and lack of options for targeted therapy make its treatment a constant adventure. The deficiency of tumor suppressors p53 and ARF is one of the known genetic signatures enriched in TNBC. Crucial questions remain about how TNBC is regulated by these genetic alterations. METHODS/STUDY POPULATION: In order to address this issue, we established p53/ARF-defective murine embryonic fibroblast and mammary epithelial cell to study the molecular and phenotypic consequences. Moreover, transgenic mice were generated to investigate the effect of p53/ARF deficiency on mammary tumor development in vivo. RESULTS/ANTICIPATED RESULTS: Increased proliferation and transformation capability were observed in p53/ARF-defective cells, and an aggressive form of mammary tumor was also seen in p53−/−ARF−/− mice. Gene expression profiling and knock-down experiments using shRNAs were conducted to identify inflammatory marker ISG15 and RNA-editing enzyme ADAR1 as potential culprits for the elevated oncogenic potential. Interestingly, we found that the overexpression of ISG15 and ADAR1 is also prevalent in human TNBC cell lines. Reducing ADAR1 expression abrogated the oncogenic potential of human TNBC cell lines, while non-TNBC cells are less susceptible. DISCUSSION/SIGNIFICANCE OF IMPACT: These results indicate critical roles played by the tumor suppressors p53 and ARF in the pathogenesis of TNBC, likely through regulating ADAR1-mediated RNA modifications. Further understanding of this pathway promises to shed light on genetics-driven vulnerabilities of TNBC and inform development of more effective therapeutic strategies.
Network analysis is an emerging approach in the study of psychopathology, yet few applications have been seen in eating disorders (EDs). Furthermore, little research exists regarding changes in network strength after interventions. Therefore the present study examined the network structures of ED and co-occurring depression and anxiety symptoms before and after treatment for EDs.
Participants from residential or partial hospital ED treatment programs (N = 446) completed assessments upon admission and discharge. Networks were estimated using regularized Graphical Gaussian Models using 38 items from the Eating Disorders Examination-Questionnaire, Quick Inventory of Depressive Symptomatology, and State-Trait Anxiety Inventory.
ED symptoms with high centrality indices included a desire to lose weight, guilt about eating, shape overvaluation, and wanting an empty stomach, while restlessness, self-esteem, lack of energy, and feeling overwhelmed bridged ED to depression and anxiety symptoms. Comparisons between admission and discharge networks indicated the global network strength did not change significantly, though symptom severity decreased. Participants with denser networks at admission evidenced less change in ED symptomatology during treatment.
Findings suggest that symptoms related to shape and weight concerns and guilt are central ED symptoms, while physical symptoms, self-esteem, and feeling overwhelmed are links that may underlie comorbidities in EDs. Results provided some support for the validity of network approaches, in that admission networks conveyed prognostic information. However, the lack of correspondence between symptom reduction and change in network strength indicates that future research is needed to examine network dynamics in the context of intervention and relapse prevention.
The aim of this study was to explore the support needs of Dutch informal caregivers of patients with amyotrophic lateral sclerosis (ALS).
Individual semi-structured interviews were conducted with 21 caregivers of ALS patients. Audio-taped interviews were transcribed and data were analyzed thematically.
A total of four global support needs emerged: “more personal time”, “assistance in applying for resources”, “counseling”, and “peer contact”. Despite their needs, caregivers are reluctant to apply for and accept support. They saw their own needs as secondary to the needs of the patients.
Significance of results
ALS seems to lead to an intensive caregiving situation with multiple needs emerging in a short period. This study offers targets for the development of supportive interventions. A proactive approach seems essential, acknowledging the importance of the role of the caregivers in the care process at an early stage, informing them about the risk of burden, monitoring their wellbeing, and repeatedly offering support opportunities. Using e-health may help tailor interventions to the caregivers’ support needs.
Out-of-home foods (takeaway, take-out and fast foods) have become increasingly popular in recent decades and are thought to be a key driver in increasing levels of overweight and obesity due to their unfavourable nutritional content. Individual food choices and eating behaviours are influenced by many interrelated factors which affect the results of nutrition-related public health interventions. While the majority of research based on out-of-home foods comes from Australia, the UK and USA, the same issues (poor dietary habits and increased prevalence of non-communicable disease) are of equal concern for urban centres in developing economies undergoing ‘nutrition transition’ at a global scale. The present narrative review documents key facets, which may influence out-of-home food consumption, drawn from biological, societal, environmental, demographic and psychological spheres. Literature searches were performed and references from relevant papers were used to find supplementary studies. Findings suggest that the strongest determinants of out-of-home food availability are density of food outlets and deprivation within the built environment; however, the association between socio-economic status and out-of-home food consumption has been challenged. In addition, the biological and psychological drives combined with a culture where overweight and obesity are becoming the norm makes it ‘fashionable’ to consume out-of-home food. Other factors, including age group, ethnicity and gender demonstrate contrasting effects and a lack of consensus. It is concluded that further consideration of the determinants of out-of-home food consumption within specific populations is crucial to inform the development of targeted interventions to reduce the impact of out-of-home foods on public health.
Depression and metabolic syndrome (MetS) are frequently comorbid disorders that are independently associated with premature mortality. Conversely, cardiorespiratory fitness (CRF) is associated with reduced mortality risk. These factors may interact to impact mortality; however, their effects have not been assessed concurrently. This analysis assessed the mortality risk of comorbid depression/MetS and the effect of CRF on mortality in those with depression/MetS.
Prospective study of 47 702 adults in the Cooper Center Longitudinal Study. Mortality status was attained from the National Death Index. History of depression was determined by patient response (yes or no) to a standardized medical history questionnaire. MetS was categorized using the American Heart Association/National Heart, Lung, and Blood Institute criteria. CRF was estimated from the final speed/grade of a treadmill graded exercise test.
13.9% reported a history of depression, 21.4% met criteria for MetS, and 3.0% met criteria for both MetS and history of depression. History of depression (HR = 1.24, p = 0.003) and MetS (HR = 1.28, p < 0.001) were independently associated with an increased mortality risk, with the greatest mortality risk among individuals with both a history of depression and MetS (HR = 1.59, p < 0.001). Higher CRF was associated with a significantly lower risk of mortality (p < 0.001) in all individuals, including those with MetS and/or a history of depression.
Those with higher levels CRF had reduced mortality risk in the context of depression/MetS. Interventions that improve CRF could have substantial impact on the health of persons with depression/MetS.
Oxtotitlán Cave paintings have been considered among the earliest in Mesoamerica on stylistic grounds, but confirmation of this hypothesis through absolute dating has not been attempted until now. We describe the application of advanced radiocarbon strategies developed for situations such as caves with high carbon backgrounds. Using a low-temperature plasma oxidation system, we dated both the ancient paint and the biogenic rock coatings that cover the paint layers at Oxtotitlán. Our research has significantly expanded the time frame for the production of polychrome rock paintings encompassing the Early Formative and Late Formative/Early Classic periods, statistically spanning a long era from before ca. 1500 cal B.C. to cal A.D. 600.
Conventional bedside tests of visuospatial function such as the clock drawing (CDT) and intersecting pentagons tests (IPT) are subject to considerable inconsistency in their delivery and interpretation. We compared performance on a novel test – the letter and shape drawing (LSD) test – with these conventional tests in hospitalised elderly patients.
The LSD, IPT, CDT and the Montreal Cognitive Assessment (MoCA) were performed in 40 acute elderly medical inpatients at University Hospital Limerick The correlation between these tests was examined as well as the accuracy of the visuospatial tests to identify significant cognitive impairment on the MoCA.
The patients (mean age 81.0±7.71; 21 female) had a median MoCA score of 15.5 (range=1–29). There was a strong, positive correlation between the LSD and both the CDT (r=0.56) and IPT (r=0.71). The correlation between the LSD and MoCA (r=0.91) was greater than for the CDT and IPT (both 0.67). The LSD correlated highly with all MoCA domains (ranging from 0.54 to 0.86) and especially for the domains of orientation (r=0.86), attention (0.81) and visuospatial function (r=0.73). Two or more errors on the LSD identified 90% (26/29) of those patients with MoCA scores of ⩽20, which was substantially higher than for the CDT (59%) and IPT (55%).
The LSD is a novel test of visuospatial function that is brief, readily administered and easily interpreted. Performance correlates strongly with other tests of visuospatial ability, with favourable ability to identify patients with significant impairment of general cognition.
Objectives: The aim of this study was to describe cognitive, academic, and psychosocial outcomes after an incident demyelinating event (acquired demyelinating syndromes, ADS) in childhood and to investigate the contribution of brain lesions and confirmed MS diagnosis on outcome. Methods: Thirty-six patients with ADS (mean age=12.2 years, SD=2.7, range: 7–16 years) underwent brain MRI scans at presentation and at 6-months follow-up. T2-weighted lesions on MRI were assessed using a binary classification. At 6-months follow-up, patients underwent neuropsychological evaluation and were compared with 42 healthy controls. Results: Cognitive, academic, and behavioral outcomes did not differ between the patients with ADS and controls. Three of 36 patients (8.3%) were identified with cognitive impairment, as determined by performance falling ≤1.5 SD below normative values on more than four independent tests in the battery. Poor performance on a visuomotor integration task was most common, observed among 6/32 patients, but this did not differ significantly from controls. Twelve of 36 patients received a diagnosis of MS within 3 years post-ADS. Patients with MS did not differ from children with monophasic ADS in terms of cognitive performance at the 6-months follow-up. Fatigue symptoms were reported in 50% of patients, irrespective of MS diagnosis. Presence of brain lesions at onset and 6 months post-incident demyelinating event did not associate with cognitive outcome. Conclusions: Children with ADS experience a favorable short-term neurocognitive outcome, even those confirmed to have MS. Longitudinal evaluations of children with monophasic ADS and MS are required to determine the possibility of late-emerging sequelae and their time course. (JINS, 2016, 22, 1050–1060)
Leonard Neidorf, Junior Fellow at the Harvard Society of Fellows, Harvard University,Rafael J. Pascual, Postdoctoral Research Fellow at Harvard University.,Tom Shippey, Professor Emeritus at Saint Louis University
Leonard Neidorf, Junior Fellow at the Harvard Society of Fellows, Harvard University,Rafael J. Pascual, Postdoctoral Research Fellow at Harvard University.,Tom Shippey, Professor Emeritus at Saint Louis University