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Following the end of universal testing in the UK, hospital admissions are a key measure of COVID-19 pandemic pressure. Understanding leading indicators of admissions at the National Health Service (NHS) Trust, regional and national geographies help health services plan for ongoing pressures. We explored the spatio-temporal relationships of leading indicators of hospitalisations across SARS-CoV-2 waves in England. This analysis includes an evaluation of internet search volumes from Google Trends, NHS triage calls and online queries, the NHS COVID-19 app, lateral flow devices (LFDs), and the ZOE app. Data sources were analysed for their feasibility as leading indicators using Granger causality, cross-correlation, and dynamic time warping at fine spatial scales. Google Trends and NHS triages consistently temporally led admissions in most locations, with lead times ranging from 5 to 20 days, whereas an inconsistent relationship was found for the ZOE app, NHS COVID-19 app, and LFD testing, which diminished with spatial resolution, showing cross-correlation of leads between –7 and 7 days. The results indicate that novel surveillance sources can be used effectively to understand the expected healthcare burden within hospital administrative areas though the temporal and spatial heterogeneity of these relationships is a key determinant of their operational public health utility.
New SARS-CoV-2 variants causing COVID-19 are a major risk to public health worldwide due to the potential for phenotypic change and increases in pathogenicity, transmissibility and/or vaccine escape. Recognising signatures of new variants in terms of replacing growth and severity are key to informing the public health response. To assess this, we aimed to investigate key time periods in the course of infection, hospitalisation and death, by variant. We linked datasets on contact tracing (Contact Tracing Advisory Service), testing (the Second-Generation Surveillance System) and hospitalisation (the Admitted Patient Care dataset) for the entire length of contact tracing in the England – from March 2020 to March 2022. We modelled, for England, time delay distributions using a Bayesian doubly interval censored modelling approach for the SARS-CoV-2 variants Alpha, Delta, Delta Plus (AY.4.2), Omicron BA.1 and Omicron BA.2. This was conducted for the incubation period, the time from infection to hospitalisation and hospitalisation to death. We further modelled the growth of novel variant replacement using a generalised additive model with a negative binomial error structure and the relationship between incubation period length and the risk of a fatality using a Bernoulli generalised linear model with a logit link. The mean incubation periods for each variant were: Alpha 4.19 (95% credible interval (CrI) 4.13–4.26) days; Delta 3.87 (95% CrI 3.82–3.93) days; Delta Plus 3.92 (95% CrI 3.87–3.98) days; Omicron BA.1 3.67 (95% CrI 3.61–3.72) days and Omicron BA.2 3.48 (95% CrI 3.43–3.53) days. The mean time from infection to hospitalisation was for Alpha 11.31 (95% CrI 11.20–11.41) days, Delta 10.36 (95% CrI 10.26–10.45) days and Omicron BA.1 11.54 (95% CrI 11.38–11.70) days. The mean time from hospitalisation to death was, for Alpha 14.31 (95% CrI 14.00–14.62) days; Delta 12.81 (95% CrI 12.62–13.00) days and Omicron BA.2 16.02 (95% CrI 15.46–16.60) days. The 95th percentile of the incubation periods were: Alpha 11.19 (95% CrI 10.92–11.48) days; Delta 9.97 (95% CrI 9.73–10.21) days; Delta Plus 9.99 (95% CrI 9.78–10.24) days; Omicron BA.1 9.45 (95% CrI 9.23–9.67) days and Omicron BA.2 8.83 (95% CrI 8.62–9.05) days. Shorter incubation periods were associated with greater fatality risk when adjusted for age, sex, variant, vaccination status, vaccination manufacturer and time since last dose with an odds ratio of 0.83 (95% confidence interval 0.82–0.83) (P value < 0.05). Variants of SARS-CoV-2 that have replaced previously dominant variants have had shorter incubation periods. Conversely co-existing variants have had very similar and non-distinct incubation period distributions. Shorter incubation periods reflect generation time advantage, with a reduction in the time to the peak infectious period, and may be a significant factor in novel variant replacing growth. Shorter times for admission to hospital and death were associated with variant severity – the most severe variant, Delta, led to significantly earlier hospitalisation, and death. These measures are likely important for future risk assessment of new variants, and their potential impact on population health.
Considered a part of neither Central America nor the Gran Colombian area, and too small to claim a loyal following among scholars, Panama remains virtually unstudied by contemporary historians. Consequently, sources for the study of Panamanian history have been neglected, a situation this research note seeks to correct in part by identifying the principal holdings in Panamanian archives and libraries.
Early in the COVID-19 pandemic, the World Health Organization stressed the importance of daily clinical assessments of infected patients, yet current approaches frequently consider cross-sectional timepoints, cumulative summary measures, or time-to-event analyses. Statistical methods are available that make use of the rich information content of longitudinal assessments. We demonstrate the use of a multistate transition model to assess the dynamic nature of COVID-19-associated critical illness using daily evaluations of COVID-19 patients from 9 academic hospitals. We describe the accessibility and utility of methods that consider the clinical trajectory of critically ill COVID-19 patients.
Electronic health records (EHRs) are a significant contributor to physicians’ low satisfaction, reduced engagement and increased burnout. Yet the majority of evidence around EHR and physician harms is based on self-reported screen time, which may both over- and underreport actual exposure.
The purpose of this study was to examine how objective EHR use correlates with physician well-being and to develop preliminary recommendations for well-being-based EHR interventions.
Prior to the onset of COVID-19, psychiatry residents and attending physicians working in an out-patient clinic at an academic medical centre provided consent for access to EHR-usage logs and completed a well-being assessment made up of three scales: the Maslach Burnout Inventory, the Urecht Work Engagement Scale and the Professional Quality of Life Measure. Survey responses and objective EHR data were analysed with descriptive statistics.
Responses were obtained from 20 psychiatry residents (total eligible residents n = 27; 74% participation) and 16 clinical faculty members (total eligible faculty n = 24; 67% participation) with an overall response rate of 71% (total eligible residents and faculty n = 51 and total residents and faculty who completed survey n = 36). Moderate correlations for multiple well-being domains emerged in analysis for all participants, especially around the time spent per note and patient visits closed the same day.
EHR-usage logs represent an objective tool in the evaluation and enhancement of physician well-being. Results from our pilot study suggest that metrics for note writing efficiency and closing patient visits the same day are associated with physician well-being. These metrics will be important to study in ongoing efforts involving well-being-based EHR interventions.
This study describes a procedural blank assessment of the ultraviolet photochemical oxidation (UV oxidation) method that is used to measure carbon isotopes of dissolved organic carbon (DOC) at the National Ocean Sciences Accelerator Mass Spectrometry Facility (NOSAMS). A retrospective compilation of Fm and δ13C results for secondary standards (OX-II, glycine) between 2009 and 2018 indicated that a revised blank correction was required to bring results in line with accepted values. The application of a best-fit mass-balance correction yielded a procedural blank of 22.0 ± 6.0 µg C with Fm of 0.30 ± 0.20 and δ13C of –32.0 ± 3.0‰ for this period, which was notably higher and more variable than previously reported. Changes to the procedure, specifically elimination of higher organic carbon reagents and improved sample and reactor handling, reduced the blank to 11.0 ± 2.75 µg C, with Fm of 0.14 ± 0.10 and δ13C of –31.0 ± 5.5‰. A thorough determination of the entire sample processing blank is required to ensure accurate isotopic compositions of seawater DOC using the UV oxidation method. Additional efforts are needed to further reduce the procedural blank so that smaller DOC samples can be analyzed, and to increase sample throughput.
This study provides a morphological and phylogenetic characterization of two novel species of the order Haplosporida (Haplosporidium carcini n. sp., and H. cranc n. sp.) infecting the common shore crab Carcinus maenas collected at one location in Swansea Bay, South Wales, UK. Both parasites were observed in the haemolymph, gills and hepatopancreas. The prevalence of clinical infections (i.e. parasites seen directly in fresh haemolymph preparations) was low, at ~1%, whereas subclinical levels, detected by polymerase chain reaction, were slightly higher at ~2%. Although no spores were found in any of the infected crabs examined histologically (n = 334), the morphology of monokaryotic and dikaryotic unicellular stages of the parasites enabled differentiation between the two new species. Phylogenetic analyses of the new species based on the small subunit (SSU) rDNA gene placed H. cranc in a clade of otherwise uncharacterized environmental sequences from marine samples, and H. carcini in a clade with other crustacean-associated lineages.
The current review aimed to synthesise the literature on food literacy interventions among adolescents in secondary schools, the attitudes and perceptions of food literacy interventions in secondary schools, and their effects on dietary outcomes.
The systematic review searched five electronic databases from the earliest record to present.
The studies selected for the review were from sixteen countries: Australia (n 10), Canada (n 1), China (n 1), France (n 1), Greece (n 2), Iran (n 1), South Africa (n 1), South India (n 1), Kenya (n 1), Norway (n 2), Portugal (n 1), Denmark (n 1), Northern Ireland (n 1), USA (n 17), UK (n 1) and Sweden (n 2).
Adolescents aged 10–19 years.
Forty-four studies were eligible for inclusion. Adolescents with greater nutritional knowledge and food skills showed healthier dietary practices. Studies found a mixed association between food literacy and long-term healthy dietary behaviour. Two studies showed an improvement in adolescents’ cooking skills and food safety knowledge; six studies showed an improvement in overall food safety knowledge; six studies showed an improvement in overall food and nutritional knowledge; and two studies showed an improvement in short-term healthy dietary behaviour.
Food literacy interventions conducted in a secondary-school setting have demonstrated a positive impact on healthy food and nutritional knowledge. However, there appears to be limited evidence supporting food literacy interventions and long-term dietary behaviours in adolescents. More evidence-based research is required to adequately measure all domains of food literacy and more age-specific food literacy interventions.
Glacial seismicity provides important insights into glacier dynamic processes. We study the temporal distribution of cryogenic seismic signals (icequakes) at Holtedahlfonna, Svalbard, between April and August 2016 using a single three-component sensor. We investigate sources of observed icequakes using polarization analysis and waveform modeling. Processes responsible for five icequake categories are suggested, incorporating observations of previous studies into our interpretation. We infer that the most dominant icequake type is generated by surface crevasse opening through hydrofracturing. Secondly, bursts of high-frequency signals are presumably caused by repeated near-surface crevassing due to high strain rates during glacier fast-flow episodes. Furthermore, signals related to resonance in water-filled cracks, fracturing or settling events in dry firn or snow before the melt season, and processes at the glacier bed are observed. Amplitude of seismic background noise is clearly related to glacier runoff. We process ambient seismic noise to invert horizontal-to-vertical spectral ratios for a sub-surface seismic velocity model used to model icequake signals. Our study shows that a single seismic sensor provides useful information about seasonal ice dynamics in case deployment of a network is not feasible.
In this study, we combine remote sensing, in situ and model-derived datasets from 1966 to 2014 to calculate the mass-balance components of Kronebreen, a fast-flowing tidewater glacier in Svalbard. For the well-surveyed period 2009–2014, we are able to close the glacier mass budget within the prescribed errors. During these 5 years, the glacier geodetic mass balance was −0.69 ± 0.12 m w.e. a−1, while the mass budget method led to a total mass balance of −0.92 ± 0.16 m w.e. a−1, as a consequence of a strong frontal ablation (−0.78 ± 0.11 m w.e. a−1), and a slightly negative climatic mass balance (−0.14 ± 0.11 m w.e. a−1). The trend towards more negative climatic mass balance between 1966–1990 (+0.20 ± 0.05 m w.e. a−1) and 2009–2014 is not reflected in the geodetic mass balance trend. Therefore, we suspect a reduction in ice-discharge in the most recent period. Yet, these multidecadal changes in ice-discharge cannot be measured from the available observations and thus are only estimated with relatively large errors as a residual of the mass continuity equation. Our study presents the multidecadal evolution of the dynamics and mass balance of a tidewater glacier and illustrates the errors introduced by inferring one unmeasured mass-balance component from the others.
Good education requires student experiences that deliver lessons about practice as well as theory and that encourage students to work for the public good—especially in the operation of democratic institutions (Dewey 1923; Dewy 1938). We report on an evaluation of the pedagogical value of a research project involving 23 colleges and universities across the country. Faculty trained and supervised students who observed polling places in the 2016 General Election. Our findings indicate that this was a valuable learning experience in both the short and long terms. Students found their experiences to be valuable and reported learning generally and specifically related to course material. Postelection, they also felt more knowledgeable about election science topics, voting behavior, and research methods. Students reported interest in participating in similar research in the future, would recommend other students to do so, and expressed interest in more learning and research about the topics central to their experience. Our results suggest that participants appreciated the importance of elections and their study. Collectively, the participating students are engaged and efficacious—essential qualities of citizens in a democracy.
Twin researchers face the challenge of accurately determining the zygosity of twins for research. As part of the annual questionnaire between 1999 and 2006, 8,307 twins from the TwinsUK registry were asked to complete five questions (independently from their co-twin) to ascertain their self-perceived zygosity during childhood on up to five separate occasions. This questionnaire is known as the ‘peas in the pod’ questionnaire (PPQ), but there is little evidence of its validation. Answers were scored and classified as monozygotic (MZ), dizygotic (DZ), or unknown zygosity (UZ) and were compared with 4,484 twins with genotyping data who had not been selected for zygosity. Of these, 3,859 individuals (46.5% of those who had a zygosity from PPQ) had zygosity classified by both the PPQ and genotyping. Of the 708 individual twins whose answers meant that they were consistently classed as MZ in the PPQ, 683 (96.5%) were MZ within the genotype data. Of the 945 individual twins consistently classed as DZ within questionnaire, 936 (99.0%) were DZ in the genotype data. Where both twins scored MZ consistently across multiple questionnaires, 99.6% were MZ on genotyping, 99.7% were DZ on genotyping if both twins consistently scored DZ. However, for the initial questionnaire, 88.6% of those scoring as MZ were genotypically MZ and 98.7% DZ. For twin pairs where both scored UZ, 94.7% were DZ. Using the PPQ on a single occasion provided a definitive classification of whether the twin was MZ or DZ with an overall accuracy of 86.9%, increasing to 97.9% when there was a consistent classification of zygosity across multiple questionnaires. This study has shown that the PPQ questionnaire is an excellent proxy indicator of zygosity in the absence of genotyping information.
Direct ink writing of silicone elastomers enables printing with precise control of porosity and mechanical properties of ordered cellular solids, suitable for shock absorption and stress mitigation applications. With the ability to manipulate structure and feedstock stiffness, the design space becomes challenging to parse to obtain a solution producing a desired mechanical response. Here, we derive an analytical design approach for a specific architecture. Results from finite element simulations and quasi-static mechanical tests of two different parallel strand architectures were analyzed to understand the structure-property relationships under uniaxial compression. Combining effective stiffness-density scaling with least squares optimization of the stress responses yielded general response curves parameterized by resin modulus and strand spacing. An analytical expression of these curves serves as a reduced order model, which, when optimized, provides a rapid design capability for filament-based 3D printed structures. As a demonstration, the optimal design of a face-centered tetragonal architecture is computed that satisfies prescribed minimum and maximum load constraints.
The inheritance of resistance to the auxinic herbicide dicamba was examined in a kochia population from Nebraska. An inbred, resistant line was developed by selection and selfing over seven generations to ensure any resistance alleles would be homozygous in the parents. An inbred, susceptible line was similarly developed, but without selection. Dose–response experiments with dicamba determined a glyphosate-resistant concentration required to inhibit dry weight accumulation by 50% (GR50) of 45 and 1,331 g ae ha−1 for the susceptible and resistant populations, respectively. F1 crosses were made between resistant and susceptible inbred individuals by hand-pollination, and the F1 plants were selfed to produce F2 plants. The F2 population was screened with 280 g ha−1 dicamba, a rate that could discriminate between susceptible and resistant plants. A total of eight F2 families were screened twice. In the first screen, seven F2 families segregated in a 3:1 ratio, consistent with a single dominant allele controlling resistance, and in the second screen six F2 families segregated in a 3:1 ratio. F2 individuals were selfed, the F3 progeny were tested with 280 g ha−1 dicamba, and the genotype of each F2 parent was determined based on F3 progeny segregation. F3 family segregation was consistent with the F2 parents having a 1:2:1 homozygous-susceptible:heterozygote:homozygous-resistant pattern, confirming that resistance to dicamba in kochia is likely conferred by a single allele with a high degree of dominance.
The Inquisitions post mortem (IPMs) are a truly wonderful source for many different aspects of late medieval countryside and rural life. They have recently been made digitally accessible and interrogatable by the Mapping the Medieval Countryside project, and the first fruits of these developments are presented here. The chapters examine IPMs in connection with the landscape and topography of England, in particular markets and fairs and mills; and consider the utility of proofs of age for everyday life on such topics as the Church, retaining, and the wine trade.
Michael Hicks is Emeritus Professor of Medieval History at the University of Winchester.
Contributors: Katie A. Clarke, William S. Deller, Paul Dryburgh, Christopher Dyer, Janette Garrett, Michael Hicks, Matthew Holford, Gordon McKelvie, Stephen Mileson, Simon Payling, Matthew Tompkins, Jennifer Ward.