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The COVID-19 pandemic has disproportionally affected traditionally marginalized groups. Both the Delta and Omicron variants raised concern amongst public health officials due to potentially higher infectivity rates and disease severity than prior variants. This study sought to compare disease severity between adults infected with the Omicron variant and adults infected with the Delta variant who presented to the Emergency Department at an academic, safety-net hospital in Virginia.
Methods:
This retrospective cohort study used electronic medical record data of patients who presented to the Emergency Department and received a positive SARS-CoV-2 test between September 1, 2021, and January 31, 2022. Positive tests were stratified by genotypic variant through whole genome sequencing. Participants with the Omicron variant were propensity scores matched with individuals with the Delta variant.
Results:
Among 500 Delta and 500 Omicron participants, 279 propensity score-matched pairs were identified. Participants were predominantly unvaccinated, with medical comorbidities, and self-identified as Black. Individuals infected with the Delta variant had more severe disease compared to those with the Omicron variant, regardless of vaccination status. Patients with kidney, liver, and respiratory disease, as well as cancer, are at higher risk for severe disease. Patients with 2 doses of COVID-19 immunization trended toward less severe disease.
Conclusions:
Overall, these data further support the literature regarding the disproportionate effects of the COVID-19 pandemic on vulnerable patient populations – such as those with limited access to care, people of color, and those with chronic medical conditions – and can be used to inform public health interventions.
Species can respond to climate change by migrating to track their suitable climate space, and/or through adaptation (across generations) or acclimation (by individuals) to a changed in situ environment. Lichens provide an excellent model for studying acclimation; being poikilohydric, there is strong evidence that their phenotype presents an adaptation to different moisture regimes, and that key aspects of the phenotype, notably specific thallus mass (STM), have plasticity towards effective acclimation that maximizes water storage in drier environments. In this study we quantified acclimation of STM for Lobaria pulmonaria across a regional climatic gradient, and within sites for different microclimates, using a one-year common garden growth experiment. We found that STM tended to increase with thallus growth; however, when accounting for growth, STM shifted to be lower than average in wetter environments, higher than average in intermediate environments, and failed to respond in the driest environment where growth was compromised. The possibility of phenotypic acclimation in Lobaria pulmonaria appears to be functionally linked to the propensity for growth, and we present a scheme coupling growth with STM to define the limits of the species realized niche.
Complex human–environmental processes form identifiable, lasting features on the landscape that can illuminate past human behavior and human–environment interactions. We examine the anthropogenic landscape of the ancient port of Macurany, located along the middle Amazon River in Parintins, Brazil, and identify four classes of anthropogenic landscape features at the site: wharfs, middens, terra preta (dark or black earths), and cultural forests. Middens, terra preta, and cultural forests have been found at archaeological sites in regions surrounding Macurany, but wharfs have not previously been reported in Amazonian contexts predating European contact. Taken together, these features are clearly the result of anthropogenesis and represent a range of subsistence, settlement, and infrastructure-building activities pointing to an ancient society that was actively engaged in modifying the surrounding landscape for purposes beyond settlement and subsistence. Evidence for a permanent, extensive, continuously settled society practicing intensive landscape engineering in this region of Amazonia reinforces findings of dense habitation, infrastructure, and early urbanization in Amazonia prior to European contact. This research helps expand our understanding of human–environment interactions, landscape formation processes, and settlement organization in ancient Amazonia.
Certain lichen epiphytes are restricted to old-growth forest stands with long ‘ecological continuity’, explained by i) niche specialism and their dependence on microhabitats associated with old stands including veteran or senescent trees, and/or ii) dispersal limitation with probabilities of colonization being relaxed over extended time periods. ‘Calicioid’ species are among the most important old-growth indicators, yet they reproduce sexually via small spores that appear widely dispersed at ecological scales. This suggests that they should have a high level of niche specialism compared to lichen epiphytes in general, explaining their role as old-growth indicators. However, comparisons of niche specialism are challenging, and this study uses epiphytic, corticolous calicioid species as an appropriate test case. Having measured 20 variables that constrain the lichen epiphyte niche, these were collapsed into a ‘hypervolume’ representing the sampled environmental space available for occupancy by lichens in Scotland as a study system. It was then possible to examine the occupancy of this hypervolume by individual lichens (niche breadth), with the proportion/percent occupied used to estimate a niche specialism score. Consequently, epiphyte calicioid species are confirmed to have a high degree of niche specialism compared to lichen epiphytes in general, and compared to other old-growth indicators, with their niche position directed towards drier climates including locally sheltered microhabitats associated with old-growth forest structure.
Hemiparetic walking after stroke is typically slow, asymmetric, and inefficient, significantly impacting activities of daily living. Extensive research shows that functional, intensive, and task-specific gait training is instrumental for effective gait rehabilitation, characteristics that our group aims to encourage with soft robotic exosuits. However, standard clinical assessments may lack the precision and frequency to detect subtle changes in intervention efficacy during both conventional and exosuit-assisted gait training, potentially impeding targeted therapy regimes. In this paper, we use exosuit-integrated inertial sensors to reconstruct three clinically meaningful gait metrics related to circumduction, foot clearance, and stride length. Our method corrects sensor drift using instantaneous information from both sides of the body. This approach makes our method robust to irregular walking conditions poststroke as well as usable in real-time applications, such as real-time movement monitoring, exosuit assistance control, and biofeedback. We validate our algorithm in eight people poststroke in comparison to lab-based optical motion capture. Mean errors were below 0.2 cm (9.9%) for circumduction, −0.6 cm (−3.5%) for foot clearance, and 3.8 cm (3.6%) for stride length. A single-participant case study shows our technique’s promise in daily-living environments by detecting exosuit-induced changes in gait while walking in a busy outdoor plaza.
There is growing evidence that species and communities are responding to, and will continue to be affected by, climate change. For species at risk, vulnerability can be reduced by ensuring that their habitat is extensive, connected and provides opportunities for dispersal and/or gene flow, facilitating a biological response through migration or adaptation. For woodland epiphytes, vulnerability might also be reduced by ensuring sufficient habitat heterogeneity, so that microhabitats provide suitable local microclimates, even as the larger scale climate continues to change (i.e. microrefugia). This study used fuzzy set ordination to compare bryophyte and lichen epiphyte community composition to a large-scale gradient from an oceanic to a relatively more continental macroclimate. The residuals from this relationship identified microhabitats in which species composition reflected a climate that was more oceanic or more continental than would be expected given the prevailing macroclimate. Comparing these residuals to features that operate at different scales to create the microclimate (landscape, stand and tree-scale), it was possible to identify how one might engineer microrefugia into existing or new woodland, in order to reduce epiphyte vulnerability to climate change. Multimodel inference was used to identify the most important features for consideration, which included local effects such as height on the bole, angle of bole lean and bark water holding capacity, as well as tree species and tree age, and within the landscape, topographic wetness and physical exposure.
We exploit the expiring nature of hedge fund lockups to create a new measure of funding liquidity risk that varies within funds. We find that hedge funds with lower funding risk generate higher returns, and this effect is driven by their increased exposure to equity-mispricing anomalies. Our results are robust to a variety of sampling criteria, variable definitions, and control variables. Further, we address endogeneity concerns in various ways, including a placebo approach and regression discontinuity design. Collectively, our results support a causal link between funding risk and the ability of managers to engage in risky arbitrage.
The criteria for objective memory impairment in mild cognitive impairment (MCI) are vaguely defined. Aggregating the number of abnormal memory scores (NAMS) is one way to operationalise memory impairment, which we hypothesised would predict progression to Alzheimer’s disease (AD) dementia.
Methods:
As part of the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing, 896 older adults who did not have dementia were administered a psychometric battery including three neuropsychological tests of memory, yielding 10 indices of memory. We calculated the number of memory scores corresponding to z ≤ −1.5 (i.e., NAMS) for each participant. Incident diagnosis of AD dementia was established by consensus of an expert panel after 3 years.
Results:
Of the 722 (80.6%) participants who were followed up, 54 (7.5%) developed AD dementia. There was a strong correlation between NAMS and probability of developing AD dementia (r = .91, p = .0003). Each abnormal memory score conferred an additional 9.8% risk of progressing to AD dementia. The area under the receiver operating characteristic curve for NAMS was 0.87 [95% confidence interval (CI) .81–.93, p < .01]. The odds ratio for NAMS was 1.67 (95% CI 1.40–2.01, p < .01) after correcting for age, sex, education, estimated intelligence quotient, subjective memory complaint, Mini-Mental State Exam (MMSE) score and apolipoprotein E ϵ4 status.
Conclusions:
Aggregation of abnormal memory scores may be a useful way of operationalising objective memory impairment, predicting incident AD dementia and providing prognostic stratification for individuals with MCI.
Implantable neural interfaces are important tools to accelerate neuroscience research and translate clinical neurotechnologies. The promise of a bidirectional communication link between the nervous system of humans and computers is compelling, yet important materials challenges must be first addressed to improve the reliability of implantable neural interfaces. This perspective highlights recent progress and challenges related to arguably two of the most common failure modes for implantable neural interfaces: (1) compromised barrier layers and packaging leading to failure of electronic components; (2) encapsulation and rejection of the implant due to injurious tissue–biomaterials interactions, which erode the quality and bandwidth of signals across the biology–technology interface. Innovative materials and device design concepts could address these failure modes to improve device performance and broaden the translational prospects of neural interfaces. A brief overview of contemporary neural interfaces is presented and followed by recent progress in chemistry, materials, and fabrication techniques to improve in vivo reliability, including novel barrier materials and harmonizing the various incongruences of the tissue–device interface. Challenges and opportunities related to the clinical translation of neural interfaces are also discussed.
We analyze the strategic considerations inherent in legislative subsidies and develop an informational lobbying model with costly policy reforms. In contrast to other models of informational lobbying, we focus on the implications of a policymaker’s and a lobby’s resource constraints for lobbying activities. We allow both a policymaker and a lobby to gather information, and each can either fund or subsidize policymaking. Our analysis highlights that legislative subsidies are both chosen strategically by lobbyists and strategically induced by policymakers, dependent on the circumstances. These involve which resource constraints bind the policymaker’s prior beliefs, the salience of policy, and the policymaker’s and lobby’s expertise in information gathering. Our results highlight five distinct motives for informational lobbying and demonstrate that for both a lobby and policymaker, there can be strategic advantages arising from being resource-constrained.
The aim of this study was to assess the impact of a urinary tract infection (UTI) management bundle to reduce the treatment of asymptomatic bacteriuria (AB) and to improve the management of symptomatic UTIs.
Design
Before-and-after intervention study.
Settings
Tertiary-care hospital.
Patients
Consecutive sample of inpatients with positive single or mixed-predominant urine cultures collected and reported while admitted to the hospital.
Methods
The UTI management bundle consisted of nursing and prescriber education, modification of the reporting of positive urine cultures, and pharmacists’ prospective audit and feedback. A retrospective chart review of consecutive inpatients with positive urinary cultures was performed before and after implementation of the management bundle.
Results
Prior to the implementation of the management bundle, 276 patients were eligible criteria for chart review. Of these 276 patients, 165 (59·8%) were found to have AB; of these 165 patients with AB, 111 (67·3%) were treated with antimicrobials. Moreover, 268 patients met eligibility criteria for postintervention review. Of these 268, 133 patients (49·6%) were found to have AB; of these 133 with AB, 22 (16·5%) were treated with antimicrobials. Thus, a 75·5% reduction of AB treatment was achieved. Educational components of the bundle resulted in a substantial decrease in nonphysician-directed urine sample submission. Adherence to a UTI management algorithm improved substantially in the intervention period, with a notable decrease in fluoroquinolone prescription for empiric UTI treatment.
Conclusions
A UTI management bundle resulted in a dramatic improvement in the management of urinary tract infection, particularly a reduction in the treatment of AB and improved management of symptomatic UTI.
We provide the first examination of hedge fund boards and their directors. The majority of directorships are held by extremely busy independent directors. These directors are sought by funds because they have more reputational capital at stake, making them independent and credible monitors whose presence can certify fund quality to investors. Busy independent directors are more likely to be hired by high-quality funds, and their departure from the board is associated with investor withdrawals. Moreover, funds with busy independent directors are less likely to commit fraud, abuse discretionary liquidity restrictions, or engage in performance-based risk shifting.
Within the NHS health check (NHSHC) programme, there is evidence of marked inconsistencies and challenges in practice-level self-reporting of uptake. Consequently, we explored the perceptions of those involved in commissioning of NHSHC to better understand the implications for local and national monitoring and evaluation of programme uptake. Semi-structured, one-to-one, telephone interviews (n=15) were conducted with NHSHC commissioners and leads, and were analysed using inductive thematic analysis. NHSHC data were often collected from practices using online extraction systems but many still relied on self-reported data. Performance targets and indicators used to monitor and feedback to general practices varied between localities. Participants reported a number of issues when collecting and reporting data for NHSHC, namely because of opportunistic checks. Owing to the perceived inaccuracies in reporting, there was concern about the credibility and relevance of national uptake figures. The general practice extraction service will be important to fully understand uptake of NHSHC.
Recent evidence suggests that exercise plays a role in cognition and that the posterior cingulate cortex (PCC) can be divided into dorsal and ventral subregions based on distinct connectivity patterns.
Aims
To examine the effect of physical activity and division of the PCC on brain functional connectivity measures in subjective memory complainers (SMC) carrying the epsilon 4 allele of apolipoprotein E (APOE 4) allele.
Method
Participants were 22 SMC carrying the APOE ɛ4 allele (ɛ4+; mean age 72.18 years) and 58 SMC non-carriers (ɛ4–; mean age 72.79 years). Connectivity of four dorsal and ventral seeds was examined. Relationships between PCC connectivity and physical activity measures were explored.
Results
ɛ4+ individuals showed increased connectivity between the dorsal PCC and dorsolateral prefrontal cortex, and the ventral PCC and supplementary motor area (SMA). Greater levels of physical activity correlated with the magnitude of ventral PCC–SMA connectivity.
Conclusions
The results provide the first evidence that ɛ4+ individuals at increased risk of cognitive decline show distinct alterations in dorsal and ventral PCC functional connectivity.