Humanitarian crises often require urgent medical care to people of concern. Such medical aid includes assessing and treating acute medical needs and ongoing chronic health conditions. Among the people of concern there are children, who are often the most vulnerable population in humanitarian contexts because they often lack the experience, independence, and cognitive and verbal skills to deal with the ordeals they are facing. These limitations might prevent identification and diagnosis of pain. The under-diagnosis and under-treated pain by health care providers might be also due to the perceived urgency of more acute or life-threatening medical needs with limited medical equipment and personnel, lack of awareness, or assessment tools in such contexts. Additionally, due to issues of anonymity and lack of formal guidelines, there is a severe lack of standardized registration of children’s pain conditions in humanitarian crises. Finally, acute pain is also a predictor of post-traumatic stress disorder, a common outcome in such disasters. We call on health care providers to use standardized scales to assess children’s pain intensity, frequency, and duration, and to treat it appropriately. These will not only reduce children’s physical suffering but may also prevent subsequent risk of PTSD.

Precision Medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle. Autoimmune diseases are those in which the body’s natural defense system loses discriminating power between its own cells and foreign cells, causing the body to mistakenly attack healthy tissues. These conditions are very heterogeneous in their presentation and therefore difficult to diagnose and treat. Achieving precision medicine in autoimmune diseases has been challenging due to the complex etiologies of these conditions, involving an interplay between genetic, epigenetic, and environmental factors. However, recent technological and computational advances in molecular profiling have helped identify patient subtypes and molecular pathways which can be used to improve diagnostics and therapeutics. This review discusses the current understanding of the disease mechanisms, heterogeneity, and pathogenic autoantigens in autoimmune diseases gained from genomic and transcriptomic studies and highlights how these findings can be applied to better understand disease heterogeneity in the context of disease diagnostics and therapeutics.

The United Nations (UN) established an umbrella of organizations to manage distinct clusters of humanitarian aid. The World Health Organization (WHO) oversees the health cluster, giving it responsibility for global, national, and local medical responses to natural disasters. However, this centralized structure insufficiently engages local players, impeding robust local implementation. The Gorkha earthquake struck Nepal on April 25, 2015, becoming Nepal’s most severe natural disaster since the 1934 Nepal-Bihar earthquake. In coordinated response, 2 organizations, Empower Nepali Girls and International Neurosurgical Children’s Association, used a hybrid approach integrating continuous communication with local recipients. Each organization mobilized its principal resource strengths—material medical supplies or human capital—thereby efficiently deploying resources to maximize the impact of the medical response. In addition to efficient resource use, this approach facilitates dynamic medical responses from highly mobile organizations. Importantly, in addition to future earthquakes in Nepal, this medical response strategy is easily scalable to other natural disaster contexts and other medical relief organizations. Preemptively identifying partner organizations with complementary strengths, continuous engagement with recipient populations, and creating disaster- and region-specific response teams may represent viable variations of the WHO cluster model with greater efficacy in local implementation of treatment in acute disaster scenarios.

The Ending the HIV Epidemic initiative aims to decrease new HIV infections and promote test-and-treat strategies. Our aims were to establish a baseline of HIV outcomes among newly diagnosed PWH in Washington, DC (DC), a ‘hotspot’ for the HIV epidemic. We also examined sociodemographic and clinical factors associated with retention in care (RIC), antiretroviral therapy (ART) initiation and viral suppression (VS) among newly diagnosed PWH in the DC Cohort from 2011–2016. Among 455 newly diagnosed participants, 92% were RIC at 12 months, ART was initiated in 65% at 3 months and 91% at 12 months, VS in at least 17% at 3 months and 82% at 12 months and 55% of those with VS at 12 months had sustained VS for an additional 12 months. AIDS diagnosis was associated with RIC (aOR 2.99; 1.13–2.28), ART initiation by 3 months (aOR 2.58; 1.61–4.12) and VS by 12 months (aOR4.87; 1.69–14.03). This analysis contributes to our understanding of the HIV treatment dynamics of persons with recently diagnosed HIV infection in a city with a severe HIV epidemic.

Field studies were conducted to assess the efficacy of physical weed management of Palmer amaranth management in cucumber, peanut, and sweetpotato. Treatments were arranged in a 3 × 4 factorial in which the first factor included a treatment method of electrical, mechanical, or hand-roguing Palmer amaranth control and the second factor consisted of treatments applied when Palmer amaranth was approximately 0.3, 0.6, 0.9, or 1.2 m above the crop canopy. Four wk after treatment (WAT), the electrical applications controlled Palmer amaranth at least 27 percentage points more than the mechanical applications when applied at the 0.3- and 0.6-m timings. At the 0.9- and 1.2-m application timings 4 WAT, electrical and mechanical applications controlled Palmer amaranth by at most 87%. Though hand removal generally resulted in the greatest peanut pod count and total sweetpotato yield, mechanical and electrical control resulted in similar yield to the hand-rogued plots, depending on the treatment timing. With additional research to provide insight into the optimal applications, there is potential for electrical control and mechanical control to be used as alternatives to hand removal. Additional studies were conducted to determine the effects of electrical treatments on Palmer amaranth seed production and viability. Treatments consisted of electricity applied to Palmer amaranth at first visible inflorescence, 2 wk after first visible inflorescence (WAI) or 4 WAI. Treatments at varying reproductive maturities did not reduce the seed production immediately after treatment. However, after treatment, plants primarily died and ceased maturation, reducing seed production assessed at 4 WAI by 93% and 70% when treated at 0 and 2 WAI, respectively. Treatments did not have a negative effect on germination or seedling length.

During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, paediatric heart centres were forced to rapidly alter the way patient care was provided to minimise interruption to patient care as well as exposure to the virus. In this survey-based descriptive study, we characterise changes that occurred within paediatric cardiology practices across the United States and described provider experience and attitudes towards these changes during the pandemic. Common changes that were implemented included decreased numbers of procedures, limiting visitors and shifting towards telemedicine encounters. The information obtained from this survey may be useful in guiding and standardising responses to future public health crises.

Laboratory and greenhouse studies were conducted to evaluate the effects of chemical treatments applied to Palmer amaranth seeds or gynoecious plants that retain seeds to determine seed germination and quality. Treatments applied to physiologically mature Palmer amaranth seed included acifluorfen, dicamba, ethephon, flumioxazin, fomesafen, halosulfuron, linuron, metribuzin, oryzalin, pendimethalin, pyroxasulfone, S-metolachlor, saflufenacil, trifluralin, and 2,4-D plus crop oil concentrate applied at 1× and 2× the suggested use rates from the manufacturer. Germination was reduced by 20% when 2,4-D was used, 15% when dicamba was used, and 13% when halosulfuron and pyroxasulfone were used. Use of dicamba, ethephon, halosulfuron, oryzalin, trifluralin, and 2,4-D resulted in decreased seedling length by an average of at least 50%. Due to the observed effect of dicamba, ethephon, halosulfuron, oryzalin, trifluralin, and 2,4-D, these treatments were applied to gynoecious Palmer amaranth inflorescence at the 2× registered application rates to evaluate their effects on progeny seed. Dicamba use resulted in a 24% decrease in seed germination, whereas all other treatment results were similar to those of the control. Crush tests showed that seed viability was greater than 95%, thus dicamba did not have a strong effect on seed viability. No treatments applied to Palmer amaranth inflorescence affected average seedling length; therefore, chemical treatments did not affect the quality of seeds that germinated.

The protected Tel-Dor coastal embayment in the eastern Mediterranean preserves an unusually complete stratigraphic record that reveals human–environmental interactions throughout the Holocene. Interpretation of new seismic profiles collected from shallow marine geophysical transects across the bay show five seismic units were correlated with stratigraphy and age dates obtained from coastal and shallow-marine sediment cores. This stratigraphic framework permits a detailed reconstruction of the coastal system over the last ca. 77 ka as well as an assessment of environmental factors that influenced some dimensions of past coastal societies. The base of the boreholes records lowstand aeolian deposits overlain by wetland sediments that were subsequently flooded by the mid-Holocene transgression. The earliest human settlements are submerged Pottery Neolithic (8.25–7 ka) structures and tools, found immediately above the wetland deposits landward of a submerged aeolianite ridge at the mouth of the bay. The wetland deposits and Pottery Neolithic settlement remains are buried by coastal sand that records a middle Holocene sea-level rise ca. 7.6–6.5 ka. Stratigraphic and geographic relationships suggest that these coastal communities were displaced by sea-level transgression. These findings demonstrate how robust integration of different data sets can be used to reconstruct the geomorphic evolution of coastal settings as well as provide an important addition to the nature of human–landscape interaction and cultural development.

Field studies were conducted to evaluate linuron for POST control of Palmer amaranth in sweetpotato to minimize reliance on protoporphyrinogen oxidase (PPO)-inhibiting herbicides. Treatments were arranged in a two by four factorial in which the first factor consisted of two rates of linuron (420 and 700 g ai ha−1), and the second factor consisted of linuron applied alone or in combinations of linuron plus a nonionic surfactant (NIS; 0.5% vol/vol), linuron plus S-metolachlor (800 g ai ha−1), or linuron plus NIS plus S-metolachlor. In addition, S-metolachlor alone and nontreated weedy and weed-free checks were included for comparison. Treatments were applied to ‘Covington’ sweetpotato 8 d after transplanting (DAP). S-metolachlor alone provided poor Palmer amaranth control because emergence had occurred at applications. All treatments that included linuron resulted in at least 98% and 91% Palmer amaranth control 1 and 2 wk after treatment (WAT), respectively. Including NIS with linuron did not increase Palmer amaranth control compared to linuron alone, but it resulted in greater sweetpotato injury and subsequently decreased total sweetpotato yield by 25%. Including S-metolachlor with linuron resulted in the greatest Palmer amaranth control 4 WAT, but increased crop foliar injury to 36% 1 WAT compared to 17% foliar injury from linuron alone. Marketable and total sweetpotato yields were similar between linuron alone and linuron plus S-metolachlor or S-metolachlor plus NIS treatments, though all treatments resulted in at least 39% less total yield than the weed-free check resulting from herbicide injury and/or Palmer amaranth competition. Because of the excellent POST Palmer amaranth control from linuron 1 WAT, a system that includes linuron applied 7 DAP followed by S-metolachlor applied 14 DAP could help to extend residual Palmer amaranth control further into the critical period of weed control while minimizing sweetpotato injury.

Field studies were conducted in 2019 and 2020 to compare the effects of shade cloth light interception and Palmer amaranth (Amaranthus palmeri S. Watson) competition on ‘Covington’ sweetpotato [Ipomoea batatas (L.) Lam.]. Treatments consisted of a seven by two factorial arrangement, in which the first factor included shade cloth with an average measured light interception of 41%, 59%, 76%, and 94% and A. palmeri thinned to 0.6 or 3.1 plants m−2 or a nontreated weed-free check; and the second factor included shade cloth or A. palmeri removal timing at 6 or 10 wk after planting (WAP). Amaranthus palmeri light interception peaked around 710 to 840 growing degree days (base 10 C) (6 to 7 WAP) with a maximum light interception of 67% and 84% for the 0.6 and 3.1 plants m−2 densities, respectively. Increasing shade cloth light interception by 1% linearly increased yield loss by 1% for No. 1, jumbo, and total yield. Yield loss increased by 36%, 23%, and 35% as shade cloth removal was delayed from 6 to 10 WAP for No. 1, jumbo, and total yield, respectively. F-tests comparing reduced versus full models of yield loss provided no evidence that the presence of yield loss from A. palmeri light interception caused yield loss different than that explained by the shade cloth at similar light-interception levels. Results indicate that shade cloth structures could be used to simulate Covington sweetpotato yield loss from A. palmeri competition, and light interception could be used as a predictor for expected yield loss from A. palmeri competition.

Background: Norovirus causes a significant disease burden of 20 million cases per year in the United States. Hospitals and long-term care facilities constitute the most commonly reported settings for noroviral outbreaks and clusters and thus represent a critically important site for prevention. Our institutional surveillance and response system identified 10–14 clusters or outbreaks of gastrointestinal viral disease per year, predominantly affecting staff. We sought to develop a compartmental mathematical model to examine the potential efficacy of various infection control practices in the management of noroviral clusters. Methods: We developed a set of parallel compartments representing both patient and staff categories (nursing, nurse assistants, etc) involved in a prototypical outbreak, using a 38-bed mixed medium- and high-acuity medical unit as the model basis. A susceptible–exposed–infected–recovered/immune (SEIR) model structure was used (Fig. 1). We conducted interviews with infection preventionists and nursing management to parameterize the model with data on (1) staff-to-patient ratios, (2) staff-patient contact time, (3) staff-staff contact time, (4) spatial distribution of patient assignments, and (5) baseline and intraoutbreak infection prevention practices. With these data, we proceeded to develop submodels, building on the primary model, that examined the effects of additional parallel compartmentalization of granular groups of staff, including resident physicians, environmental services, and clinical nursing assistants. Model parameters for these subanalyses were informed by interviews with clinical experts and review of internal data. Results and Conclusions: An SEIR model was developed that allowed for examination of a modeled outbreak of norovirus and comparison with a known prior outbreak on the same modeled unit for fidelity. Submodeling was performed with more staffing detail, allowing for the addition of further parallel SEIR tracks that delineated more granular staffing patterns. Staff interviews proved critical in the parameterization of these submodels, allowing for a more faithful representation of real-world dynamics. This work, through modification of model parameterization, can be used to assess the efficacy of hypothetical infection control interventions (eg, earlier unit closure, longer staff furlough) in altering transmission dynamics during an outbreak.

Funding: None

Disclosures: None

Field studies were conducted to determine sweetpotato tolerance to and weed control from management systems that included linuron. Treatments included flumioxazin preplant (107 g ai ha−1) followed by (fb) S-metolachlor (800 g ai ha−1), oryzalin (840 g ai ha−1), or linuron (280, 420, 560, 700, and 840 g ai ha−1) alone or mixed with S-metolachlor or oryzalin applied 7 d after transplanting. Weeds did not emerge before the treatment applications. Two of the four field studies were maintained weed-free throughout the season to evaluate sweetpotato tolerance without weed interference. The herbicide program with the greatest sweetpotato yield was flumioxazin fb S-metolachlor. Mixing linuron with S-metolachlor did not improve Palmer amaranth management and decreased marketable yield by up to 28% compared with flumioxazin fb S-metolachlor. Thus, linuron should not be applied POST in sweetpotato if Palmer amaranth has not emerged at the time of application.