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Roads affect wildlife in a variety of negative ways. Road ecology studies have mostly concentrated on areas in the northern hemisphere despite the potentially greater impact of roads on biodiversity in tropical habitats. Here, we examine 4 years (January 2016–December 2019) of opportunistic observations of mammalian roadkill along a road intersecting Jozani-Chwaka Bay National Park, Unguja, Zanzibar. In particular, we assess the impact of collisions on the population of an endemic primate, the Endangered Zanzibar red colobus Piliocolobus kirkii. Primates accounted for the majority of roadkill in this dataset. Monthly rainfall was not associated with roadkill frequency for mammals generally, nor for the Zanzibar red colobus. No single age–sex class of colobus was found dead more often than expected given their occurrence in the local population. The overall effect of roadkill on colobus populations in habitats fragmented by roads is unknown given the lack of accurate, long-term life history data for this species. Our findings suggest that mortality from collisions with vehicles in some groups of colobus is within the range of mortality rates other primates experience under natural predation. Unlike natural predators, however, vehicles do not kill selectively, so their impact on populations may differ. Although a comparison with historical accounts suggests that the installation of speedbumps along the road near the Park's entrance has led to a significant decrease in colobus roadkill, further actions to mitigate the impact of the road could bring substantial conservation benefits.
Iron and/or iodine deficiencies can have multiple serious adverse health outcomes, but examination of incidence rates of these deficiencies have rarely been conducted in any large population. This study examined incidence rates, temporal trends, and demographic factors associated with medically-diagnosed iron and iodine deficiencies/disorders in United States (US) military service members (SMs).
The Defense Medical Epidemiological Database (DMED) was queried for medical visits of active duty SMs to obtain specific International Classification of Diseases, Version 9, codes involving clinically-diagnosed iron and iodine deficiencies/disorders.
Analysis of existing database (DMED).
Entire population of US military service members from 1997 to 2015 (average N per yr=1,382,266, 15% women).
Overall incidence rates for iron and iodine were 104 and 36 cases/100,000 person-years, respectively. Over the 19-year period, rates for iron disorders increased steadily (108% for men, 177% for women). Rates for iodine disorders also increased steadily for men (91%), but for women there was an initial rise followed by a later decline. Overall, women’s rates were 12 and 10 times higher than men’s for iron and iodine, respectively. Compared to whites, blacks and those of other races had higher rates of deficiencies of both minerals. Incidence rates for iodine deficiency increased substantially with age.
The overall incidence of clinically-diagnosed iron and iodine deficiency among SMs was low, but increased over the 19 years examined and certain demographic groups were at significantly greater risk. Given the unexpected increases in incidence of these mineral disorders increased surveillance may be appropriate.
Systemic venous hypertension and low cardiac output are believed to be important mediators of liver injury after the Fontan procedure. Pulmonary vasodilators have the potential to improve such haemodynamics. The aim of this study was to assess the acute effects of exercise on liver stiffness and venous pressures and to assess the impact of inhaled Treprostinil on this response.
In this prospective, double-blind, placebo-controlled, crossover trial, 14 patients with a Fontan circulation were randomised to inhalation of placebo and Treprostinil. Incremental and constant work rate exercise tests were performed to assess the effect of Treprostinil on exercise tolerance. Venous pressures were measured throughout and liver stiffness at rest and immediately after peak exercise.
Mean age was 27.8 ± 7.9 years and 66% were females. Exercise acutely increased liver stiffness by 30% (mean shear wave speed: 2.38 ± 0.71 versus 2.89 ± 0.51 ms, p = 0.02). Peripheral venous pressures increased acutely during both incremental (12.1 ± 2.4 versus 22.6 ± 8.0 mmHg, p < 0.001) and constant work rate exercise (12.5 ± 2.5 versus 23.4 ± 5.2 mmHg, p < 0.001). Overall, Treprostinil failed to attenuate exercise-induced increases in liver stiffness. Compared with placebo, Treprostinil did not significantly impact venous pressure responses, VO2peak, nor exercise endurance times.
Peripheral venous pressure increased acutely during exercise by an average of 88% above baseline and was not altered by administration of inhaled Treprostinil. Liver stiffness measured immediately post-exercise increased acutely by an average of 30%, with no attenuation following Treprostinil inhalation.
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to COVID-19 with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplemental materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
Congenital heart disease (CHD) is the most common birth defect for infants born in the United States, with approximately 36,000 affected infants born annually. While mortality rates for children with CHD have significantly declined, there is a growing population of individuals with CHD living into adulthood prompting the need to optimise long-term development and quality of life. For infants with CHD, pre- and post-surgery, there is an increased risk of developmental challenges and feeding difficulties. Feeding challenges carry profound implications for the quality of life for individuals with CHD and their families as they impact short- and long-term neurodevelopment related to growth and nutrition, sensory regulation, and social-emotional bonding with parents and other caregivers. Oral feeding challenges in children with CHD are often the result of medical complications, delayed transition to oral feeding, reduced stamina, oral feeding refusal, developmental delay, and consequences of the overwhelming intensive care unit (ICU) environment. This article aims to characterise the disruptions in feeding development for infants with CHD and describe neurodevelopmental factors that may contribute to short- and long-term oral feeding difficulties.
Children are important transmitters of infection. Within schools they encounter large numbers of contacts and infections can spread easily causing outbreaks. However, not all schools are affected equally. We conducted a retrospective analysis of school outbreaks to identify factors associated with the risk of gastroenteritis, influenza, rash or other outbreaks. Data on reported school outbreaks in England were obtained from Public Health England and linked with data from the Department for Education and the Office for Standards in Education, Children's Services and Skills (Ofsted). Primary and all-through schools were found to be at increased risk of outbreaks, compared with secondary schools (odds ratio (OR) 5.82, 95% confidence interval (CI) 4.50–7.58 and OR 4.66, 95% CI 3.27–6.61, respectively). School size was also significantly associated with the risk of outbreaks, with higher odds associated with larger schools. Attack rates were higher in gastroenteritis and influenza outbreaks, with lower attack rates associated with rashes (relative risk 0.17, 95% CI 0.15–0.20). Deprivation and Ofsted rating were not associated with either outbreak occurrence or the subsequent attack rate. This study identifies primary and all-through schools as key settings for health protection interventions. Public health teams need to work closely with these schools to encourage early identification and reporting of outbreaks.
It is unclear if mild-to-moderate dehydration independently affects mood without confounders like heat exposure or exercise. This study examined the acute effect of cellular dehydration on mood. Forty-nine adults (55 % female, age 39 (sd 8) years) were assigned to counterbalanced, crossover trials. Intracellular dehydration was induced with 2-h (0·1 ml/kg per min) 3 % hypertonic saline (HYPER) infusion or 0·9 % isotonic saline (ISO) as a control. Plasma osmolality increased in HYPER (pre 285 (sd 3), post 305 (sd 4) mmol/kg; P < 0·05) but remained unchanged in ISO (pre 285 (sd 3), post 288 (sd 3) mmol/kg; P > 0·05). Mood was assessed with the short version of the Profile of Mood States Questionnaire (POMS). The POMS sub-scale (confusion-bewilderment, depression-dejection, fatigue-inertia) increased in HYPER compared with ISO (P < 0·05). Total mood disturbance score (TMD) assessed by POMS increased from 10·3 (sd 0·9) to 16·6 (sd 1·7) in HYPER (P < 0·01), but not in ISO (P > 0·05). When TMD was stratified by sex, the increase in the HYPER trial was significant in females (P < 0·01) but not in males (P > 0·05). Following infusion, thirst and copeptin (surrogate for vasopressin) were also higher in females than in males (21·3 (sd 2·0), 14·1 (sd 1·4) pmol/l; P < 0·01) during HYPER. In conclusion, cellular dehydration acutely degraded specific aspects of mood mainly in women. The mechanisms underlying sex differences may be related to elevated thirst and vasopressin.
This Element provides the first in-depth study of the present-day all-boy company, Edward's Boys, who are based at King Edward VI School ('Shakespeare's School') in Stratford-upon-Avon. Since 2005, the company has produced a wide array of early modern plays, providing the most substantial repertory of early modern drama available for examination by scholars. The Element provides a comprehensive account of the company's practices, drawing on extensive rehearsal and performance observation, evidence from the company's archive, and interviews with actors and key company personnel. The Element takes account of the company's particular educational and strongly interpersonal environment, suggesting that these factors have a distinctive shaping force on their performance practice. In the hands of Edward's Boys, the Element argues, early modern drama becomes the source of company creation, ensemble practice, and virtuosic physical play, inviting us to reimagine what it means – and takes – to perform these plays today.
This essay traces the careers of thirty-two early modern actors, recorded as having begun as boy players, who transferred from one acting company to the other at least once, considering how the arrival of star players such as Nathan Field and Stephen Hammerton might have affected a company’s repertory.
What explains why some Latinos feel strongly tied to their coethnics while others do not? Demographic context is one of the most cited predictors of identity strength, but the size and direction of its effects are disputed. Geographic differences in policy environments may explain the phenomenon. We argue that high levels of immigration enforcement indirectly lead to increased feelings of ethnic linked fate by determining where and how demographic context—in this case, the size of the immigrant population—will be salient. To test this, we combine information from local immigration-enforcement data (obtained via Freedom of Information Act requests) with the Latino Decisions' 2016 Collaborative Multiracial Post-Election Survey. The results suggest native-born Latinos have a stronger sense of ethnic linked fate when they live near large immigrant populations and rates of enforcement are high. When enforcement is low, the presence of immigrants has a negligible effect on native-born attitudes. Foreign-born Latinos' sense of linked fate is unaffected by policy context. These results suggest that as immigration enforcement becomes intensifies, conservative politicians may see increased backlash, at least in certain communities, from native-born Latinos. This is because feelings about ethnic linked fate correlate with increased participation and more proimmigrant policy stances.
To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection.
We collected data from international participants via an online survey.
In total, 1,130 HCP (244 cases with laboratory-confirmed COVID-19, and 886 controls healthy throughout the pandemic) from 67 countries not meeting prespecified exclusion (ie, healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation) were included in this study.
Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated using multivariable logistic regression and sensitivity analyses controlling for confounders and known biases.
HCP infection was associated with non–aerosol-generating contact with COVID-19 patients (adjusted OR, 1.4; 95% CI, 1.04–1.9; P = .03) and extra-occupational exposures including gatherings of ≥10 people, patronizing restaurants or bars, and public transportation (adjusted OR range, 3.1–16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR, 0.4; 95% CI, 0.2–0.8, P = .005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted OR range, 0.4–0.7).
COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, and exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.
Evidence that racial minorities are targeted for searches during police traffic stops is widespread, but observed differences in outcomes following a traffic stop between white drivers and people of color could potentially be due to factors correlated with driver race. Using a unique dataset recording over 5 million traffic stops from 90 municipal police departments, we control for and evaluate alternative explanations for why a driver may be searched. These include: (1) the context of the stop itself, (2) the characteristics of the police department including the race of the police chief, and (3) demographic and racial composition of the municipality within which the stop occurs. We find that the driver's race remains a robust predictor: black male drivers are consistently subjected to more intensive police scrutiny than white drivers. Additionally, we find that all drivers are less likely to be subject to highly discretionary searches if the police chief is black. Together, these findings indicate that race matters in multiple and varied ways for policing outcomes.
Clinical diagnosis has been shown to be unreliable compared to structured diagnostic schedules. However, clinicians rarely use structured diagnostic schedules due to concerns about the feasibility in clinical practice and about patient acceptance. Mini International Neuropsychiatric Schedule is a short diagnostic instrument validated against SCID and CIDI but its feasibility and patient acceptance has not been studied.
Subjects and methods. –
One hundred and eleven patients admitted to a partial program were administered Mini International Neuropsychiatric Schedule and the interview was timed. A short questionnaire was administered to assess patients’ views about the interview. For a subgroup of patients, diagnoses by both open interviews and Mini International Neuropsychiatric Interview (MINI) were available. These were compared to look for agreement in primary diagnoses and co-morbid conditions.
MINI took an average of 16.4 min to administer. Patients’ views of MINI were positive. It was considered comprehensive enough to cover all patient symptoms and at the same time not unduly lengthy. Patients were not bothered by the interview format. There was disagreement between MINI primary diagnosis and open diagnosis in 42% cases. In 33% the disagreement was of substantial clinical significance. MINI diagnosed more co-morbid conditions (average 2.05 compared to 0.5 in open interview).
MINI is a short diagnostic interview schedule that can be easily incorporated into routine clinical interviews. It has good acceptance by patients.
To identify risk factors of patients placed in airborne infection isolation (AII) for possible pulmonary tuberculosis (TB) to better predict TB diagnosis and allow more judicious use of AII.
Case-control, retrospective study at a single tertiary-care academic medical center. The study included all adult patients admitted from October 1, 2014, through October 31, 2017, who were placed in AII for possible pulmonary TB. Cases were defined as those ultimately diagnosed with pulmonary TB. Controls were defined as those not diagnosed with pulmonary TB. Those with TB diagnosed prior to admission were excluded. In total, 662 admissions (558 patients) were included.
Overall, 15 cases of pulmonary TB were identified (2.7%); of these, 2 were people living with human immunodeficiency virus (HIV; PLWH). Statistical analysis was limited by low case number. Those diagnosed with pulmonary TB were more likely to have been born outside the United States (53% vs 13%; P < .001) and to have had prior positive TB testing, regardless of prior treatment (50% vs 19%; P = .015). A multivariate analysis using non–US birth and prior positive TB testing predicted an 18.2% probability of pulmonary TB diagnosis when present, compared with 1.0% if both factors were not present.
The low number of pulmonary TB cases indicated AII overuse, especially in PLWH, and more judicious use of AII is warranted. High-risk groups, including those born outside the United States and those with prior positive TB testing, should be considered for AII in the appropriate clinical setting.
This experimental study explores the physical mechanisms by which a transverse jet’s upstream shear layer can transition from being a convective instability to an absolute/global instability as the jet-to-cross-flow momentum flux ratio
is reduced. As first proposed in computational studies by Iyer & Mahesh (J. Fluid Mech., vol. 790, 2016, pp. 275–307), the upstream shear layer just beyond the jet injection may be analogous to a local counter-current shear layer, which is known for a planar geometry to become absolutely unstable at a large enough counter-current shear layer velocity ratio,
. The present study explores this analogy for a range of transverse jet momentum flux ratios and jet-to-cross-flow density ratios
, for jets containing differing species concentrations (nitrogen, helium and acetone vapour) at several different jet Reynolds numbers. These studies make use of experimental data extracted from stereo particle image velocimetry as well as simultaneous stereo particle image velocimetry and acetone planar laser-induced fluorescence imaging. They provide experimental evidence for the relevance of the counter-current shear layer analogy to upstream shear layer instability transition in a nozzle-generated transverse jet.
Schoenaster carterensis new species, is an asteroid-like ophiuroid (Echinodermata) from Upper Mississippian (Chesterian) shallow-water carbonates in the Ramey Creek Member of the Slade Formation in northeastern Kentucky. First described in the 1860s from Lower and Middle Mississippian rocks, Schoenaster Meek and Worthen, 1860 is not a well-known fossil genus, but the 39 specimens in this collection permitted further definition of the genus and extended its range by ca. 17 Ma into Late Mississippian (Chesterian) time. The number of specimens also permitted differentiation of growth stages based on average arm length and showed that arm length, disk perimeter, and disk area are interrelated in statistically significant ways. Although replaced by chert, the specimens are nearly intact due to rapid burial as rare constituents in habitat communities distributed among four once-contiguous habitats, including shoal, shoal margin, transitional, and basinal. Most of the ophiuroids were concentrated on firm grounds or hardgrounds in shoal and transitional environments, concentrations that probably reflect substratum stability and the ability to support the ophiuroid's generalist feeding strategy. Many fossil ophiuroid species are known from only a few specimens, severely limiting interpretations about their detailed taxonomy, individual variation, and ecology. In contrast, the greater number of specimens and extensive knowledge of geologic occurrence in this study permitted detailed interpretations regarding the taxonomic, intraspecific, and ecologic attributes of this species, which might be useful in the study of other fossil ophiuroids.