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Pangolins are some of the most overexploited but least studied mammals. The giant pangolin Smutsia gigantea is the largest of the eight pangolin species, measuring up to 180 cm in length and weighing up to 40 kg. It is a nocturnal, solitary species that occurs at low densities and little is known regarding its biology and ecology. It is distributed widely across the rainforests and forest savannah mosaics of equatorial Africa but its exact range extent is unknown. Apart from a single record in Kenya predating 1971, the eastern limit of its range was thought only to extend to central Uganda and western Tanzania. Here we present three spatially separate records confirming the presence of this species in Kenyan Afromontane forests. The three records are c. 120 km apart and c. 500 km east of the nearest confirmed giant pangolin population in Uganda. These records represent a significant range extension for the species and highlight the biodiversity and conservation importance of the Afromontane forests of western Kenya.
Coronavirus disease 2019 (COVID-19) has disproportionately affected people with mental health conditions.
We investigated the association between receiving psychotropic drugs, as an indicator of mental health conditions, and COVID-19 vaccine uptake.
We conducted a cross-sectional analysis of a prospective cohort of the Northern Ireland adult population using national linked primary care registration, vaccination, secondary care and pharmacy dispensing data. Univariable and multivariable logistic regression analyses investigated the association between anxiolytic, antidepressant, antipsychotic, and hypnotic use and COVID-19 vaccination status, accounting for age, gender, deprivation and comorbidities. Receiving any COVID-19 vaccine was the primary outcome.
There were 1 433 814 individuals, of whom 1 166 917 received a COVID-19 vaccination. Psychotropic medications were dispensed to 267 049 people. In univariable analysis, people who received any psychotropic medication had greater odds of receiving COVID-19 vaccination: odds ratio (OR) = 1.42 (95% CI 1.41–1.44). However, after adjustment, psychotropic medication use was associated with reduced odds of vaccination (ORadj = 0.90, 95% CI 0.89–0.91). People who received anxiolytics (ORadj = 0.63, 95% CI 0.61–0.65), antipsychotics (ORadj = 0.75, 95% CI 0.73–0.78) and hypnotics (ORadj = 0.90, 95% CI 0.87–0.93) had reduced odds of being vaccinated. Antidepressant use was not associated with vaccination (ORadj = 1.02, 95% CI 1.00–1.03).
We found significantly lower odds of vaccination in people who were receiving treatment with anxiolytic and antipsychotic medications. There is an urgent need for evidence-based, tailored vaccine support for people with mental health conditions.
Autism and autistic traits are risk factors for suicidal behaviour.
To explore the prevalence of autism (diagnosed and undiagnosed) in those who died by suicide, and identify risk factors for suicide in this group.
Stage 1: 372 coroners’ inquest records, covering the period 1 January 2014 to 31 December 2017 from two regions of England, were analysed for evidence that the person who died had diagnosed autism or undiagnosed possible autism (elevated autistic traits), and identified risk markers. Stage 2: 29 follow-up interviews with the next of kin of those who died gathered further evidence of autism and autistic traits using validated autism screening and diagnostic tools.
Stage 1: evidence of autism (10.8%) was significantly higher in those who died by suicide than the 1.1% prevalence expected in the UK general alive population (odds ratio (OR) = 11.08, 95% CI 3.92–31.31). Stage 2: 5 (17.2%) of the follow-up sample had evidence of autism identified from the coroners’ records in stage 1. We identified evidence of undiagnosed possible autism in an additional 7 (24.1%) individuals, giving a total of 12 (41.4%); significantly higher than expected in the general alive population (1.1%) (OR = 19.76, 95% CI 2.36–165.84). Characteristics of those who died were largely similar regardless of evidence of autism, with groups experiencing a comparably high number of multiple risk markers before they died.
Elevated autistic traits are significantly over-represented in those who die by suicide.
Decorated cists have been identified at three burial cairns in Kilmartin Glen, Mid Argyll. The paper provides a new analysis of the cover slab at Nether Largie North, which features a series of pecked axeheads. Previous studies suggested that they replaced an array of cup marks, but the evidence of photogrammetry suggests a longer sequence and a more complex scheme. The same approach was taken to the decorated cists beneath the Nether Largie Mid cairn and a comparable structure at Ri Cruin. Additional depictions were identified. The carvings within all three cists are organised in similar ways. They date from a period in the Early Bronze Age when metal was imported from Ireland. At the same time, the reuse of older structures suggests a new concern with the past.
Many policy decisions take input from collections of scientific models. Such decisions face significant and often poorly understood uncertainty. We rework the so-called confidence approach to tackle decision-making under severe uncertainty with multiple models, and we illustrate the approach with a case study: insurance pricing using hurricane models. The confidence approach has important consequences for this case and offers a powerful framework for a wide class of problems. We end by discussing different ways in which model ensembles can feed information into the approach, appropriate to different collections of models.
Recent research has established that south Scandinavia during the Nordic Bronze Age was entirely dependent on imported metal. It was obviously in contact with other parts of Europe and must have participated in a system of long-distance exchange. It is not clear how it would have operated, but it helps to explain the importance of watercraft and drawings of distinctive artefacts in the rock art on the Baltic and Atlantic coasts. A different group of images can be associated with inland areas where the art has a more restricted lexicon. Can the borderland between these traditions shed any light on the relationship between the seashore and the interior, and might this help to identify places where artefacts changed hands? This paper presents the results of fieldwork between Lakes Vänern and Vättern in Västra Götaland county, southern Sweden. It considers the character of inland rock art and whether some locations with more complex panels were used as ‘aggregation sites’.
The seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG antibody was evaluated among employees of a Veterans Affairs healthcare system to assess potential risk factors for transmission and infection.
All employees were invited to participate in a questionnaire and serological survey to detect antibodies to SARS-CoV-2 as part of a facility-wide quality improvement and infection prevention initiative regardless of clinical or nonclinical duties. The initiative was conducted from June 8 to July 8, 2020.
Of the 2,900 employees, 51% participated in the study, revealing a positive SARS-CoV-2 seroprevalence of 4.9% (72 of 1,476; 95% CI, 3.8%–6.1%). There were no statistically significant differences in the presence of antibody based on gender, age, frontline worker status, job title, performance of aerosol-generating procedures, or exposure to known patients with coronavirus infectious disease 2019 (COVID-19) within the hospital. Employees who reported exposure to a known COVID-19 case outside work had a significantly higher seroprevalence at 14.8% (23 of 155) compared to those who did not 3.7% (48 of 1,296; OR, 4.53; 95% CI, 2.67–7.68; P < .0001). Notably, 29% of seropositive employees reported no history of symptoms for SARS-CoV-2 infection.
The seroprevalence of SARS-CoV-2 among employees was not significantly different among those who provided direct patient care and those who did not, suggesting that facility-wide infection control measures were effective. Employees who reported direct personal contact with COVID-19–positive persons outside work were more likely to have SARS-CoV-2 antibodies. Employee exposure to SARS-CoV-2 outside work may introduce infection into hospitals.
The Element summarises the state of knowledge about four styles of prehistoric rock art in Europe current between the late Mesolithic period and the Iron Age. They are the Levantine, Macroschematic and Schematic traditions in the Iberian Peninsula; the Atlantic style that extended between Portugal, Spain, Britain and Ireland; Alpine rock art; and the pecked and painted images found in Fennoscandia. They are interpreted in relation to the landscapes in which they were made. Their production is related to monument building, the decoration of portable objects, trade and long distance travel, burial rites, and warfare. A final discussion considers possible connections between these separate traditions and the changing subject matter of rock art in relation to wider developments in European prehistoric societies.
OBJECTIVES/GOALS: Face transplant can offer functional and aesthetic restoration to patients who have exhausted reconstructive options. Ethical issues in face transplant still abound, including that of patient selection. The goal of this study was to assess ethicists’ viewpoints on face transplant. METHODS/STUDY POPULATION: A large-scale online survey of attendees of the International Conference on Clinical Ethics Consultation (N = 401) was performed to assess ethicists’ opinions on issues in face transplant. Questions were asked regarding the risk-benefit ratio of immunosuppression, permissibility of face transplant for more recipient subpopulations (including children and blind patients), donor-recipient age, gender, and ethnicity mismatches, and ethics committee make-up. RESULTS/ANTICIPATED RESULTS: Among 84 respondents, 84% agreed it is permissible to perform a face transplant on an adult with no medical contraindications. The majority of respondents agreed that it is permissible to perform a face transplant on a child or blind recipient. An issue of continued concern was risk of immunosuppression. Respondents had a high threshold of permissibility for ethnic mismatches between donor and recipient, and 43% reported it is permissible to have a gender mismatch. A 10 year age difference between donor and recipient was the most commonly accepted. Questions regarding the ideal composition of a face transplant ethics committee demonstrated consensus on the roles that should be represented. DISCUSSION/SIGNIFICANCE OF IMPACT: This study provides insight into ethicists’ viewpoints on face transplant, which demonstrates a high level of permissibility towards the procedure. This may be due to the early success of face transplants and the shifting ethical issues in the field to practical aspects of the procedure. This research also provides guidance to programs regarding questions of donor and recipient selection, ethics committee composition, and offers insight into strengthening the ethical framework of the field.
Analysis of radiocarbon dates has established the chronological contexts of three kinds of Neolithic monument in Britain: long mounds or long cairns, causewayed enclosures, and cursuses. It is more difficult to appreciate how such structures developed over time. The building of a barrow or cairn was sometimes the final act in a place that had already experienced a longer history. The construction of the monument brought activities to an end, and the site was effectively closed. Individual sequences were shorter than once thought but might be repeated at different locations over several hundred years.
On the other hand, the construction of causewayed enclosures according to a widely accepted template occurred almost simultaneously. Once those earthworks were established some went out of use, but a few others were adapted and changed so that they could play an increasing variety of roles over a longer period. The same contrasts are illustrated by cursuses. Timber structures in the north had finite histories before they decayed or were destroyed by fire, whilst earthworks had a wider distribution and enjoyed a longer currency. A similar approach might shed light on later monuments, including henges, stone circles, and round barrows. It is important to consider how the chronologies of all these structures are related to past conceptions of time.
Vascular cognitive impairment (VCI) post-stroke is frequent but may go undetected, which highlights the need to better screen cognitive functioning following a stroke.
We examined the clinical utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment against a gold-standard neuropsychological battery.
We assessed cognitive status with a comprehensive battery of neuropsychological tests in 161 individuals who were at least 3-months post-stroke. We used receiver operating characteristic (ROC) curves to identify two cut points for the MoCA to maximize sensitivity and specificity at a minimum 90% threshold. We examined the utility of the Symbol Digit Modalities Test, a processing speed measure, to determine whether this additional metric would improve classification relative to the MoCA total score alone.
Using two cut points, 27% of participants scored ≤ 23 and were classified as high probability of cognitive impairment (sensitivity 92%), and 24% of participants scored ≥ 28 and were classified as low probability of cognitive impairment (specificity 91%). The remaining 48% of participants scored from 24 to 27 and were classified as indeterminate probability of cognitive impairment. The addition of a processing speed measure improved classification for the indeterminate group by correctly identifying 65% of these individuals, for an overall classification accuracy of 79%.
The utility of the MoCA in detecting cognitive impairment post-stroke is improved when using a three-category approach. The addition of a processing speed measure provides a practical and efficient method to increase confidence in the determined outcome while minimally extending the screening routine for VCI.
The rock art of southern Scandinavia is characterized by depictions of watercraft. The majority are close to the coast, and they have been the primary focus of research. Less attention has been paid to similar representations associated with two large inland lakes in southern Sweden. In this article we present the results of fieldwork around Lake Vänern and Lake Vättern and consider the relationship of this rock art to the better-known images on the coast. We explore the practicalities of navigating between the sea and the interior and suggest that there was an important contrast between an early eastern sphere extending to Lake Vättern from the Baltic and a later western sphere connecting Lake Vänern with the Atlantic.
New radiocarbon (14C) dates suggest a simultaneous appearance of two technologically and geographically distinct axe production practices in Neolithic Britain; igneous open-air quarries in Great Langdale, Cumbria, and from flint mines in southern England at ~4000–3700 cal BC. In light of the recent evidence that farming was introduced at this time by large-scale immigration from northwest Europe, and that expansion within Britain was extremely rapid, we argue that this synchronicity supports this speed of colonization and reflects a knowledge of complex extraction processes and associated exchange networks already possessed by the immigrant groups; long-range connections developed as colonization rapidly expanded. Although we can model the start of these new extraction activities, it remains difficult to estimate how long significant production activity lasted at these key sites given the nature of the record from which samples could be obtained.
Within sight of the Neolithic axe quarries on the Langdale Pikes is a group of massive boulders at Copt Howe. The two largest command a direct view of the stone source where the sun sets into the mountainside at the midsummer solstice. Both are decorated by pecked motifs which resemble features of Irish passage tomb art. Small-scale excavation in 2018 showed that a rubble platform had been built at the foot of the main decorated surface and sealed two further motifs of similar character. New work has established an important sequence in Great Langdale. Recently obtained radiocarbon dates indicate that the main period of axe production was between 3800 and 3300 bc, whilst Irish megalithic art is later and was made between about 3300 and 2900 bc, suggesting that Copt Howe achieved its importance after axe-making had ceased or was in decline. That is consistent with an increasing emphasis on relations between northern Britain and Ireland during the Late Neolithic period. Perhaps Copt Howe itself was treated as a ‘natural’ passage tomb.