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Clinical and Translational Science Award (CTSA) TL1 trainees and KL2 scholars were surveyed to determine the immediate impact of the COVID-19 pandemic on training and career development. The most negative impact was lack of access to research facilities, clinics, and human subjects, plus for KL2 scholars lack of access to team members and need for homeschooling. TL1 trainees reported having more time to think and write. Common strategies to maintain research productivity involved time management, virtual connections with colleagues, and shifting to research activities not requiring laboratory/clinic settings. Strategies for mitigating the impact of the COVID-19 pandemic on training and career development are described.
In 2019, a 42-year-old African man who works as an Ebola virus disease (EVD) researcher traveled from the Democratic Republic of Congo (DRC), near an ongoing EVD epidemic, to Philadelphia and presented to the Hospital of the University of Pennsylvania Emergency Department with altered mental status, vomiting, diarrhea, and fever. He was classified as a “wet” person under investigation for EVD, and his arrival activated our hospital emergency management command center and bioresponse teams. He was found to be in septic shock with multisystem organ dysfunction, including circulatory dysfunction, encephalopathy, metabolic lactic acidosis, acute kidney injury, acute liver injury, and diffuse intravascular coagulation. Critical care was delivered within high-risk pathogen isolation in the ED and in our Special Treatment Unit until a diagnosis of severe cerebral malaria was confirmed and EVD was definitively excluded.
This report discusses our experience activating a longitudinal preparedness program designed for rare, resource-intensive events at hospitals physically remote from any active epidemic but serving a high-volume international air travel port-of-entry.
Animals that are small, cryptic, nocturnal and arboreal are difficult to survey with accuracy. The relative neglect of elusive species is partly due to the additional time, money and effort required to undertake successful studies. This is likely to have contributed to the lorisiforms being named the ‘least known of all the primates’ (Nekaris and Bearder, 2011). Prior to the 1990s, few data existed on the distribution and abundance of slender lorises (Loris spp.), leading to their being listed by the IUCN Red List as Least Concern or Data Deficient. The first contemporary surveys of the distribution of Loris led to identification of one new species and the uncovering of low densities that elevated their threat level (Nekaris and Jayewardene, 2004a; Singh et al., 1999, 2000). Abundance estimates found that slender lorises are patchily distributed, even within a single forest reserve, and despite significant survey efforts some forest patches yielded no sightings (Nekaris and Jayewardene, 2004a). The heterogeneous distribution of Loris has been documented (Kumara et al., 2006; Nekaris and Jayewardene, 2004a; Nekaris et al 2013c; Singh et al., 1999). Encounter rates vary by location, habitat and species (2008). While a number of Loris surveys have now been conducted, the sites, survey modes, sampling techniques and data recorded vary across studies; consequently, results are not directly comparable (Table 26.1).
Vitamin D deficiency has been commonly reported in elite athletes, but the vitamin D status of UK university athletes in different training environments remains unknown. The present study aimed to determine any seasonal changes in vitamin D status among indoor and outdoor athletes, and whether there was any relationship between vitamin D status and indices of physical performance and bone health. A group of forty-seven university athletes (indoor n 22, outdoor n 25) were tested during autumn and spring for serum vitamin D status, bone health and physical performance parameters. Blood samples were analysed for serum 25-hydroxyvitamin D (s-25(OH)D) status. Peak isometric knee extensor torque using an isokinetic dynamometer and jump height was assessed using an Optojump. Aerobic capacity was estimated using the Yo-Yo intermittent recovery test. Peripheral quantitative computed tomography scans measured radial bone mineral density. Statistical analyses were performed using appropriate parametric/non-parametric testing depending on the normality of the data. s-25(OH)D significantly fell between autumn (52·8 (sd 22·0) nmol/l) and spring (31·0 (sd 16·5) nmol/l; P < 0·001). In spring, 34 % of participants were considered to be vitamin D deficient (<25 nmol/l) according to the revised 2016 UK guidelines. These data suggest that UK university athletes are at risk of vitamin D deficiency. Thus, further research is warranted to investigate the concomitant effects of low vitamin D status on health and performance outcomes in university athletes residing at northern latitudes.
To investigate the manipulation of electromagnetic properties of two-dimensional materials, this effort characterizes charge transfer behavior of colloidal COF-5 (covalent organic framework) in the presence of various metal ions. A series of metal chloride compounds was introduced to COF-5 in solution and solid film phases and the interaction of the material with electromagnetic radiation was monitored across the visible region using electronic absorption spectroscopy. Notable changes were observed, quantified, and discussed for copper (II) chloride (CuCl2), chromium (III) chloride (CrCl3), and iron (III) chloride (FeCl3) with COF-5. Ligand-to-metal and metal-to-ligand charge transfer are explored as a possible mechanism for the observed electronic behaviors.
With ageing there is a reduction in muscle mass and strength, termed sarcopenia. A further consequence of ageing is a reduction in appetite and this can result in a reduced energy intake and malnutrition. Increased dietary protein intake may reduce the risk of sarcopenia, however, protein is particularly satiating. Increasing protein intake in the older adult population, without a reduction of overall energy intake and appetite is desirable. The primary aim of this study was to investigate the effect of protein supplementation on dietary intake and appetite. A further aim was to explore whether the time of consumption (morning vs evening) modified the impact of protein on energy intake and appetite.
Materials and methods
Twenty-four middle-older aged (50–75 years) participants were recruited to a randomised cross-over trial. In phase 1 (pre-supplementation) participants completed a 3d food diary and were asked to report hunger and appetite using visual analogue scale questionnaires. In the second and third phases, participants consumed a whey protein gel (containing 20 g protein and 376kJ of energy) for 4 days at either the evening (before bed) or in the morning (after breakfast) and completed the same tasks as phase 1. There was a 1-week wash-out period before crossing over to the alternative time point. Repeated measures ANOVA was used to analyse the data.
There was no significant difference in average daily energy and macronutrient intake provided by the habitual diet in the pre-supplementation phase compared to the whey protein supplementation phases, irrespective of timing (p > 0.05). Similarly, no significant differences were observed in reported feelings of hunger and appetite (p > 0.05).
Contrary to expectations, the addition of a 20g/day whey protein supplement did not alter subsequent energy and macronutrient intake when consumed over a 4-day period in this middle-older adult population. This may be due to the low-calorie composition of the supplement, or the timing of the intake. This research helps to inform protein delivery strategies, however different product formulations need to be explored, and studies of longer duration are required to understand the impact of prolonged supplementation on eating behaviour.
Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico.
We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period.
The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category.
The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings.
To determine accessibility of the primary healthcare system for patients with stroke recently discharged from hospital.
This project mapped retrospective patient location data and the location of primary healthcare services in the same region. Patient location data were from all patients with stroke (N = 1595: January 2011–January 2017) discharged from one metropolitan hospital to the local Primary Health Network. Geographic Information System technology was used to map the patient discharge locations and the spatial distribution of primary healthcare services (general practitioner, pharmacy, allied health) across the region. Road network data were used to measure the level of access from each patient’s discharge location to the services.
Access to primary healthcare services was variable. Areas with larger proportions of patients with stroke did not necessarily have good service access. With an increase in travel time, the number of services accessible to patients also increased. However, the spatial variation of access to services remained largely unchanged.
Access to primary healthcare services for patients with stroke varies spatially, with a trend towards relatively low levels of accessibility for many patients. There is an urgent need for future planning to consider geographical access to primary healthcare services for patients with stroke.
OBJECTIVES/SPECIFIC AIMS: Early life stress is known to greatly impact neurodevelopment during critical periods, conferring risk for various psychopathologies, including the onset and exacerbation of schizophrenia and anxiety disorders. The endocannabinoid system is highly integrated into the stress response and may be one means by which early life stress produces such deleterious effects. Using a naturalistic, ecologically valid animal model, this study explored interactions between the stress response and endocannabinoid systems within the cerebellum, a region dense with the CB1 endocannabinoid receptors and shown to be susceptible to stress. METHODS/STUDY POPULATION: This study explored behavioral and neural impacts of early life stress in Long-Evans rats reared with or without limited access to bedding material during postnatal day (PND) 2-9. Corticosterone (CORT) levels were measured at PND8 and 70. During PND50-70, rats were assessed on Novel Object Recognition to test memory, Rotarod to evaluate cerebellar integrity, Elevated Plus Maze to assay anxiety, Social Preference, and Eyeblink Conditioning, a cerebellar-dependent and endocannabinoid-mediated task. Lipid analysis was performed on PND70 tissue samples of cerebellar interpositus (IP) nucleus via high-performance liquid chromatography and tandem mass spectrometry. RESULTS/ANTICIPATED RESULTS: Both male and female rats experiencing early life stress exhibited significantly impaired recognition memory (N = 16-20/group). Female rats having undergone stress exhibited decreased social preference compared to normally reared females (N = 11/group). Stressed males showed facilitated eyblink conditioning compared to normally reared males (N = 7-9/group). There were no group differences in rotarod or elevated plus maze performance or CORT levels at PND8 or 70 across rearing groups. At PND70, male rats experiencing early life stress exhibited a significant decrease in 2-arachidonoyl glycerol (2-AG) and arachidonic acid levels in the IP nucleus compared to normally reared males (N = 8-9/group). Compared to normally reared females, those experiencing early life stress exhibited a significant increase in prostaglandin E2 levels in the IP nucleus (N = 6-7/group). DISCUSSION/SIGNIFICANCE OF IMPACT: Early life stress, induced by limited bedding, resulted in sex-specific behavioral and lipid impairments. Results suggest that stress causes long-term alterations in endocannabinoid dynamics in males in the cerebellar IP nucleus and sex-related lipids in female cerebellum. These changes may contribute to observed long-term behavioral aberrations. Moreover, findings suggest these behavioral changes may be the result of negative-feedback dysfunction (as evidenced by decreased endocannabinoids in males) or increased neural inflammation or proliferation (as evidenced by increased prostaglandins in females). Future analysis will quantify mRNA and protein for cannabinoid receptors to better characterize aberrations to this system. Moreover, other neural regions dense with cannabinoid receptors (i.e., PFC, hippocampus) will be investigated. This work provides a basis for understanding stress impacts on the development of cognitive deficits observed in psychotic and anxiety disorders. Specifically, facilitation of eyblink conditioning complements research in humans with anxiety disorders. Broadly, understanding stress-related endocannabinoid dysregulation may provide insights into risks for, and the development of, psychopathology and uncover novel therapeutic targets with high translational power.
Depression in palliative advanced cancer patients is common, but often goes unrecognized. One of the first steps toward improving detection is the development of tools that are valid in the specific language and setting in which they are to be used. The Brief Edinburgh Depression Scale (BEDS) is a sensitive case-finding tool for depression in advanced cancer patients that was developed in the United Kingdom. There are no validated instruments to identify depression in Mexican palliative patients. Our aim was to validate the Spanish-language version of the BEDS in Mexican population with advanced cancer.
We conducted a cross-sectional study with outpatients from the palliative care unit at the Instituto Nacional de Cancerología in Mexico City. The Mexican BEDS was validated against a semistructured psychiatric clinical interview according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, classification criteria for major depressive disorder. The interviewer was blind to the BEDS score at the time of the assessment.
Seventy subjects completed the scale and interview. Women represented 71.4% of the sample and median age of subjects was 56.5 years (range, 20–85 years). The prevalence of major depressive disorder according to the psychiatric interview was 20%. The most valid cutoff for defining a case of depression was a score ≥5 of 18 on the Mexican BEDS, which gave a sensitivity of 85.7% and specificity of 62.5%. The scale's Cronbach's alpha was 0.71.
Significance of results
Major depressive disorder is frequent in Mexican palliative patients. The Spanish-language Mexican version of the BEDS is the first valid case-finding tool in advanced cancer patients in this setting.
This Research Communication describes an investigation into the viability of an Intermittently Aerated Sequencing Batch Reactor (IASBR) for the treatment of dairy processing wastewater at laboratory-scale. A number of operational parameters have been varied and the effect has been monitored in order to determine optimal conditions for maximising removal efficiencies. These operational parameters include Hydraulic Retention Time (HRT), Solids Retention Time (SRT), aeration rate and cycle length. Real dairy processing wastewater and synthetic wastewater have been treated using three laboratory-scale IASBR units in a temperature controlled room. When the operational conditions were established, the units were seeded using sludge from a municipal wastewater treatment plant for the first experiment, and sludge from a dairy processing factory for the second and third experiment. In experiment three, the reactors were fed on real wastewater from the wastewater treatment plant at this dairy processing factory. These laboratory-scale systems will be used to demonstrate over time that the IASBR system is a consistent, viable option for treatment of dairy processing wastewater in this sector. In this study, the capacity of a biological system to remove both nitrogen and phosphorus within one reactor will be demonstrated. The initial operational parameters for a pilot-scale IASBR system will be derived from the results of the study.
This Review describes the objectives and methodology of the DairyWater project as it aims to aid the Irish dairy processing industry in achieving sustainability as it expands. With the abolition of European milk quotas in March 2015, the Republic of Ireland saw a surge in milk production. The DairyWater project was established in anticipation of this expansion of the Irish dairy sector in order to develop innovative solutions for the efficient management of water consumption, wastewater treatment and the resulting energy use within the country's dairy processing industry. Therefore, the project can be divided into three main thematic areas: dairy wastewater treatment technologies and microbial analysis, water re-use and rainwater harvesting and environmental assessment. In order to ensure the project remains as relevant as possible to the industry, a project advisory board containing key industry stakeholders has been established. To date, a number of large scale studies, using data obtained directly from the Irish dairy industry, have been performed. Additionally, pilot-scale wastewater treatment (intermittently aerated sequencing batch reactor) and tertiary treatment (flow-through pulsed ultraviolet system) technologies have been demonstrated within the project. Further details on selected aspects of the project are discussed in greater detail in the subsequent cluster of research communications.
In this Research Communication we investigate potential correlations between key bacterial groups and nutrient removal efficiency in an Intermittently Aerated Sequencing Batch Reactor (IASBR) treating synthetic dairy processing wastewater. Reactor aeration rates of 0·6 and 0·4 litre per minute (LPM) were applied to an 8 l laboratory scale system and the relative impacts on IASBR microbial community structure and orthophosphate (PO4-P) and ammonium (NH4-N) removal efficiencies compared. Aeration at 0·6 LPM over several sludge retention times (SRTs) resulted in approximately 92% removal efficiencies for both PO4-P and NH4-N. Biomass samples subjected to next-generation sequencing (NGS), 16S rRNA profiling revealed a concomitant enrichment of Polaromonas under 0·6 LPM conditions, up to ~50% relative abundance within the reactor biomass. The subsequent shift in reactor aeration to 0·4 LPM, over a period of 3 SRTs, resulted in markedly reduced nutrient removal efficiencies for PO4-P (50%) and NH4-N (45%). An 85·7% reduction in the genus level relative abundance of Polaromonas was observed under 0·4 LPM aeration conditions over the same period.
Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88) presented a critique of our recently published paper in Cell Reports entitled ‘Large-Scale Cognitive GWAS Meta-Analysis Reveals Tissue-Specific Neural Expression and Potential Nootropic Drug Targets’ (Lam et al., Cell Reports, Vol. 21, 2017, 2597–2613). Specifically, Hill offered several interrelated comments suggesting potential problems with our use of a new analytic method called Multi-Trait Analysis of GWAS (MTAG) (Turley et al., Nature Genetics, Vol. 50, 2018, 229–237). In this brief article, we respond to each of these concerns. Using empirical data, we conclude that our MTAG results do not suffer from ‘inflation in the FDR [false discovery rate]’, as suggested by Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88), and are not ‘more relevant to the genetic contributions to education than they are to the genetic contributions to intelligence’.
This review will outline the role of visiting cardiac surgical teams in low- and middle-income countries drawing on the collective experience of the authors in a wide range of locations. Requests for assistance can emerge from local programmes at a beginner or advanced stage. However, in all circumstances, careful pre-trip planning is necessary in conjunction with clinical and non-clinical local partners. The clinical evaluation, surgical procedures, and postoperative care all serve as a template for collaboration and education between the visiting and local teams in every aspect of care. Education focusses on both common and patient-specific issues. Case selection must appropriately balance the clinical priorities, safety, and educational objectives within the time constraints of trip duration. Considerable communication and practical challenges will present, and clinicians may need to make significant adjustments to their usual practice in order to function effectively in a resource-limited, unfamiliar, and multilingual environment. The effectiveness of visiting trips should be measured and constantly evaluated. Local and visiting teams should use data-driven evaluations of measurable outcomes and critical qualitative evaluation to repeatedly re-assess their interim goals. Progress invariably takes several years to achieve the final goal: an autonomous self-governing, self-financed, cardiac programme capable of providing care for children with complex CHD. This outcome is consistent with redundancy for the visiting trips model at the site, although fraternal, professional, and academic links will invariably remain for many years.
To examine how the introduction of intensive community support (ICS) affected admissions to community hospital (CH) and to explore the views of patients, carers and health professionals on this transition.
ICS was introduced to provide an alternative to CH provision for patients (mostly very elderly) requiring general rehabilitation.
Routine data from both services were analysed to identify the number of admissions and length of stay between September 2012 and September 2014. In total, 10 patients took part in qualitative interviews. Qualitative interviews and focus groups were undertaken with 19 staff members, including managers and clinicians.
There were 5653 admissions to CH and 1710 to ICS between September 2012 and September 2014. In the five months before the introduction of ICS, admission rates to CH were on average 217/month; in the final five months of the study, when both services were fully operational, average numbers of patients admitted were: CH 162 (a 25% reduction), ICS 97, total 259 (a 19% increase). Patients and carers rated both ICS and CH favourably compared with acute hospital care. Those who had experienced both services felt each to be appropriate at the time; they appreciated the 24 h availability of staff in CH when they were more dependent, and the convenience of being at home after they had improved. In general, staff welcomed the introduction of ICS and appreciated the advantages of home-based rehabilitation. Managers had a clearer vision of ICS than staff on the ground, some of whom felt underprepared to work in the community. There was a consensus that ICS was managing less complex and dependent patients than had been envisaged.
ICS can provide a feasible adjunct to CH that is acceptable to patients. More work is needed to promote the vision of ICS amongst staff in both community and acute sectors.
Nexus is the official publication of the biennial German Jewish Studies Workshop, which was inaugurated at Duke University in 2009, and is now held at the University of Notre Dame. Together, Nexus and the Workshop constitute the first ongoing forum in North America for German Jewish Studies. Nexus publishes innovative research in German Jewish Studies, introducing new directions, analyzing the development and definition of the field, and considering its place vis-à-vis both German Studies and Jewish Studies. Additionally, it examines issues of pedagogy and programming at the undergraduate, graduate, and community levels. Nexus 3 features special forum sections on Heinrich Heine and Karl Kraus. Renowned Heine scholar Jeffrey Sammons offers a magisterial critical retrospective on this towering "German Jewish" author, followed by a response from Ritchie Robertson, while the dean of Kraus scholarship, Edward Timms, reflects on the challenges and rewards oftranslating German Jewish dialect into English. Paul Reitter provides a thoughtful response.
Contributors: Angela Botelho, Jay Geller, Abigail Gillman, Jeffrey A. Grossman, Leo Lensing, Georg Mein, Paul Reitter, Ritchie Robertson, Jeffrey L. Sammons, Egon Schwarz, Edward Timms, Liliane Weissberg, Emma Woelk.
William Collins Donahue is the John J. Cavanaugh Professor of the Humanities at the University of Notre Dame, where he chairs the Department of German and Russian. Martha B. Helfer is Professor of German and an affiliate member of the Department of Jewish Studies at Rutgers, The State University of New Jersey.