This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (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 supplementary 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.

Laser–plasma interaction (LPI) at intensities $10^{15}{-}10^{16}~\text{W}\cdot \text{cm}^{-2}$ is dominated by parametric instabilities which can be responsible for a significant amount of non-collisional absorption and generate large fluxes of high-energy nonthermal electrons. Such a regime is of paramount importance for inertial confinement fusion (ICF) and in particular for the shock ignition scheme. In this paper we report on an experiment carried out at the Prague Asterix Laser System (PALS) facility to investigate the extent and time history of stimulated Raman scattering (SRS) and two-plasmon decay (TPD) instabilities, driven by the interaction of an infrared laser pulse at an intensity ${\sim}1.2\times 10^{16}~\text{W}\cdot \text{cm}^{-2}$ with a ${\sim}100~\unicode[STIX]{x03BC}\text{m}$ scalelength plasma produced from irradiation of a flat plastic target. The laser pulse duration (300 ps) and the high value of plasma temperature (${\sim}4~\text{keV}$) expected from hydrodynamic simulations make these results interesting for a deeper understanding of LPI in shock ignition conditions. Experimental results show that absolute TPD/SRS, driven at a quarter of the critical density, and convective SRS, driven at lower plasma densities, are well separated in time, with absolute instabilities driven at early times of interaction and convective backward SRS emerging at the laser peak and persisting all over the tail of the pulse. Side-scattering SRS, driven at low plasma densities, is also clearly observed. Experimental results are compared to fully kinetic large-scale, two-dimensional simulations. Particle-in-cell results, beyond reproducing the framework delineated by the experimental measurements, reveal the importance of filamentation instability in ruling the onset of SRS and stimulated Brillouin scattering instabilities and confirm the crucial role of collisionless absorption in the LPI energy balance.

Introduction: NSAIDS offer more effective analgesia than opioids, require less rescue medication, and decrease the incidence of nausea and vomiting in renal colic patients. Alpha blockers and Opioids are also prescribed frequently, but doses used and treatment durations are not well described. Our objective was to investigate ED prescribing decisions and medication compliance by patients with acute renal colic. Methods: In this prospective two-city cohort study, we invited patients with a first ED visit for image-confirmed 2-10 mm ureteric stones to consent to a telephone survey 10 days after their ED visit. During follow-up interviews, patients were asked what drugs they were prescribed and how many doses they required. This study was REB approved. Results: A convenience sample of 224 patients, including 152 males (67.9%) and 72 females (median age= 52.4 years) completed 10-day surveys. NSAIDS were prescribed for 48.7%, tamsulosin for 65.2% and opioids for 81.7%. One-third received a tamsulosin-NSAID combination, 40% an opioid-NSAID combination and 28% a tamsulosin-NSAID-opioid combination. Of 109 patients prescribed an NSAID, only 70 (64.2%) took 1 dose/day; however an additional 28 who were not prescribed NSAIDs took 1 NSAID dose/day. Mean (sd) NSAID intake in the overall study group was 1.1 (1.5) doses/day from day 1-5 and 0.6 (1.1) doses/day on days 6-10, with 90%ile values of 3.0 and 2.0 doses/day. NSAID compliance was more common in patients who stated they received high quality discharge instructions (63.8% vs. 32.6%; RR=1.95; 95% CI 1.47-2.60). Mean opioid intake in the overall study group was 1.2 (1.7) doses/day from day 1-5 and 0.5 (1.3) doses/day on days 6-10, with 90%ile values of 4.0 and 2.0 doses/day. Among patients prescribed tamsulosin, the average was 4.0 days of compliance (sd=4.3), with a 90%ile value of 10 days. Conclusion: This study provides estimates for the amount of drug actually used by renal colic patients during the 10-days after their ED visit. Patients used fewer opioid doses than expected, and NSAID and tamsulosin compliance appears relatively poor. NSAID compliance was better in patients who perceived high quality discharge instructions. This study suggests there is room for improvement in medication prescribing and discharge instructions for ED patients with an acute episode of ureteral colic.

In humans, maximum brain development occurs between the third trimester of gestation and 2 years of life. Nutrition during these critical windows of rapid brain development might be essential for later cognitive functioning and behaviour. In the last few years, trends on protein recommendations during infancy and childhood have tended to be lower than that in the past. It remains to be demonstrated that lower protein intakes among healthy infants, a part of being able to reduce obesity risk, is safe in terms of mental performance achievement. Secondary analyses of the EU CHOP, a clinical trial in which infants from five European countries were randomised to be fed a higher or a lower protein content formula during the 1st year of life. Children were assessed at the age of 8 years with a neuropsychological battery of tests that included assessments of memory (visual and verbal), attention (visual, selective, focused and sustained), visual-perceptual integration, processing speed, visual-motor coordination, verbal fluency and comprehension, impulsivity/inhibition, flexibility/shifting, working memory, reasoning, visual-spatial skills and decision making. Internalising, externalising and total behaviour problems were assessed using the Child Behaviour Checklist 4–18. Adjusted analyses considering factors that could influence neurodevelopment, such as parental education level, maternal smoking, child’s gestational age at birth and head circumference, showed no differences between feeding groups in any of the assessed neuropsychological domains and behaviour. In summary, herewith we report on the safety of lower protein content in infant formulae (closer to the content of human milk) according to long-term mental performance.

We present VLA 21-cm observations of the spiral galaxy ESO 481-G017 to determine the nature of remote star formation traced by an Hii region found 43 kpc and ∼800 km s−1 from the galaxy center (in projection). ESO 481-G017 is found to have a 120 kpc Hi disk with a mass of 1.2 × 1010M⊙ and UV GALEX images reveal spiral arms extending into the gaseous disk. Two dwarf galaxies with Hi masses close to 108M⊙ are detected at distances of ∼200 kpc from ESO 481-G017 and a Hi cloud with a mass of 6 × 107M⊙ is found near the position and velocity of the remote Hii region. The Hii region is somewhat offset from the Hi cloud spatially and there is no link to ESO 481-G017 or the dwarf galaxies. We consider several scenarios for the origin of the cloud and Hii region and find the most likely is a dwarf galaxy that is undergoing ram pressure stripping. The Hi mass of the cloud and Hi luminosity of the Hii region (1038.1 erg s−1) are consistent with dwarf galaxy properties, and the stripping can trigger the star formation as well as push the gas away from the stars.

The paleoclimatic record of Juréia Paleolagoon, coastal southeastern Brazil, includes cyclic and gradual changes with different intensities and frequencies through geological time, and it is controlled by astronomical, geophysical, and geological phenomena. These variations are not due to one single cause, but they result from the interaction of several factors, which act at different temporal and spatial scales. Here, we describe paleoenvironmental evidence regarding climatic and sea level changes from the last 9400 cal yr BP at the Juréia Paleolagoon – one of the main groups of protected South Atlantic ecosystems. Geochemical evidences were used to identify anomalies from multi-proxy analyses of a paleolagoon sediment core. The anomalies of centennial scale were correlated to climate and transgression–regression cycles from the Holocene period. Decadal scale anomalous oscillations in the Quaternary paleolagoon sediments occur between 9400 and 7500 cal yr BP, correlated with long- and short-term natural events, which generated high sedimentation rates, mainly between 8385 and 8375 cal yr BP (10 cm/yr). Our results suggest that a modern-day short-duration North Atlantic climatic event, such as the 8.2 ka event, could affect the environmental equilibrium in South America and intensify the South American Summer Monsoon.