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The rapid spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) throughout key regions of the United States in early 2020 placed a premium on timely, national surveillance of hospital patient censuses. To meet that need, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), the nation’s largest hospital surveillance system, launched a module for collecting hospital coronavirus disease 2019 (COVID-19) data. We present time-series estimates of the critical hospital capacity indicators from April 1 to July 14, 2020.
From March 27 to July 14, 2020, the NHSN collected daily data on hospital bed occupancy, number of hospitalized patients with COVID-19, and the availability and/or use of mechanical ventilators. Time series were constructed using multiple imputation and survey weighting to allow near–real-time daily national and state estimates to be computed.
During the pandemic’s April peak in the United States, among an estimated 431,000 total inpatients, 84,000 (19%) had COVID-19. Although the number of inpatients with COVID-19 decreased from April to July, the proportion of occupied inpatient beds increased steadily. COVID-19 hospitalizations increased from mid-June in the South and Southwest regions after stay-at-home restrictions were eased. The proportion of inpatients with COVID-19 on ventilators decreased from April to July.
The NHSN hospital capacity estimates served as important, near–real-time indicators of the pandemic’s magnitude, spread, and impact, providing quantitative guidance for the public health response. Use of the estimates detected the rise of hospitalizations in specific geographic regions in June after they declined from a peak in April. Patient outcomes appeared to improve from early April to mid-July.
Wilderness medicine is plagued by myths and dogmatic teachings not supported by evidence. This article focuses particularly on those teachings and tools that would be most likely used in archaeological fieldwork. It lays out 10 of the most common and concerning myths taught in wilderness medicine and wilderness emergency medical services, both in terms of first aid and preparation of medical kits. The myths described are provide a structure for the main purpose of the article: to explain interventions and medical kit contents that are more evidence based and supported by modern understandings of wilderness medicine and fieldwork risk management. The list of top 10 myths includes (1) the use of medications other than epinephrine for anaphylaxis and (2) the availability and proper use of epinephrine auto-injectors, (3) the use of suction devices and tourniquets for snakebites, (4) the use of spinal immobilization for neck injuries, (5) the identification and treatment of heat illnesses, (6) the use of CPR in remote areas, (7) the appropriateness of dislocation reduction in remote areas, (8) the use and choice of tourniquets for arterial bleeding, (9) the initial definition and management of drowning patients, and (10) wound management myths.
Immigration is a highly polarized issue in the United States, and negative attitudes toward immigrants are common. Yet, almost all Americans are descended from people who originated outside the country, a narrative often evoked by the media and taught in school curricula. Can this narrative increase inclusionary attitudes toward migrants? We draw from scholarship showing that perspective-taking decreases prejudice toward out-groups to investigate whether reminding Americans about their own immigration history increases support for immigrants and immigration. We propose that priming family experiences can indirectly stimulate perspective-taking and induce empathy toward the out-group, which we test with three separate survey experiments conducted over two years. Our findings show that priming family history generates small but consistent inclusionary effects. These effects occur even among partisan subgroups and Americans who approve of President Trump. We provide evidence that increased empathy for immigrants constitutes one mechanism driving these effects.
Nearly 1 in 5 children in the United States lives in a household whose income is below the official federal poverty line, and more than 40% of children live in poor or near-poor households. Research on the effects of poverty on children's development has been a focus of study for many decades and is now increasing as we accumulate more evidence about the implications of poverty. The American Academy of Pediatrics recently added “Poverty and Child Health” to its Agenda for Children to recognize what has now been established as broad and enduring effects of poverty on child development. A recent addition to the field has been the application of neuroscience-based methods. Various techniques including neuroimaging, neuroendocrinology, cognitive psychophysiology, and epigenetics are beginning to document ways in which early experiences of living in poverty affect infant brain development. We discuss whether there are truly worthwhile reasons for adding neuroscience and related biological methods to study child poverty, and how might these perspectives help guide developmentally based and targeted interventions and policies for these children and their families.
To test the effects of talker variability and explicit instruction on the statistical learning of lexical tone, 80 monolingual English listeners were taught an artificial language that mimicked Mandarin’s asymmetric distribution of syllable-tone co-occurrences. Training stimuli consisted of either speech from one talker or speech from four talkers. Participants were either never instructed or explicitly taught associations between phonemes (CVs), tones, and nonce symbols across four consecutive days. Learning was assessed by the accuracy of mouse clicks and eye movements to visual nonce symbols. Critical trials induced competition between the target symbol, which matched the acoustic input, and a competitor symbol that had a statistically more probable tone (but mismatched the acoustic input). Eye fixations indicated that participants were sensitive to syllable-tone co-occurrence probabilities even without explicit instruction of tone. The degree to which statistical knowledge was used to recognize words appeared to increase when participants processed more variable speech.
New evidence allows us to demonstrate that a regional trade connected North Syria with both central Anatolia and Babylonia well into the 17th-Century bc. Archaeological evidence indicates that a specific type of vessel, the globular flask, was produced at Zincirli Höyük in the mid-17th century for the purpose of storing and transporting wine. The simultaneous appearance of these vessels as far afield as Kültepe and Sippar-Amnānum lines up with Late Old Babylonian attestations of alluḫarum-pots in 17th-c. texts from Sippar, Babylon, and Dūr-Abiešuḫ. These, we argue, must refer to the same vessels called aluārum in earlier Old Assyrian texts from Kültepe from the 19th century. Taken together, this evidence points towards the existence of a previously unsuspected trade network centered on the ancient Syrian state of Mamma that thrived in the decades between the collapse of the Old Assyrian Trade Network and the accession of Hattušili I. Through a dialogue between textual and archaeological materials, we are not only able to reveal the persistence of long-distance exchange for a century previously believed to lack it, but provide more context for the political transformations taking place at the end of the Middle Bronze Age.
To determine the radiological prevalence of frontal cells according to the International Frontal Sinus Anatomy Classification in patients undergoing computed tomography of the paranasal sinuses for clinical symptoms of chronic rhinosinusitis, and to examine the association between cell classification and frontal sinusitis development.
A total of 180 (left and right) sides of 90 patients were analysed. The prevalence of each International Frontal Sinus Anatomy Classification cell was assessed. Logistic regression analysis was used to compare the distribution of various cells in patients with and without frontal sinusitis.
The agger nasi cell was the most commonly occurring cell, seen in 95.5 per cent of patients. The prevalence rates for supra agger cells, supra agger frontal cells, supra bullar frontal cells, supra bullar cells, supra-orbital ethmoid cells and frontal septal cells were 33.3 per cent, 22.2 per cent, 21.1 per cent, 36.1 per cent, 39.4 per cent and 21.1 per cent, respectively. There was no significant difference in the occurrence of any of the cell types in patients with frontal sinusitis compared to those without (p > 0.05).
The presence of any of the International Frontal Sinus Anatomy Classification cells was not significantly associated with frontal sinusitis.
Reducing global warming will require enacting strong climate policies, which is unlikely to happen without public support. While prior research has identified varied predictors of climate change policy support, it is unclear which predictors are strongest for the American electorate as a whole, and which predictors are strongest for Democrats and Republicans. In a nationally representative sample of registered voters (n = 2063), we use relative weight analysis to identify the strongest predictors of public climate policy support. We find that, among registered voters in the USA, the five most important predictors of climate policy support are: worry about global warming; risk perceptions; certainty that global warming is happening; belief that global warming is human-caused; and general affect toward global warming. Collectively, these five variables account for 51% of the variance in policy support. Results split by political party indicate that pro-climate injunctive norms and global warming risk perceptions are the variables that differ most between Republicans and Democrats, accounting for significantly more variance in policy support among Republicans. These findings can inform policymakers and advocates seeking to build public support for climate action.
Posttraumatic stress disorder (PTSD) is often complicated by the after-effects of mild traumatic brain injury (mTBI). The mixture of brain conditions results in abnormal affective and cognitive functioning, as well as maladaptive behavior. To better understand how brain activity explains cognitive and emotional processes in these conditions, we used an emotional N-back task and functional magnetic resonance imaging (fMRI) to study neural responses in US military veterans after deployments to Iraq and Afghanistan. Additionally, we sought to examine whether hierarchical dimensional models of maladaptive personality could account for the relationship between combat-related brain conditions and fMRI responses under cognitive and affective challenge. FMRI data, measures of PTSD symptomatology (PTSS), blast-induced mTBI (bmTBI) severity, and maladaptive personality (MMPI-2-RF) were gathered from 93 veterans. Brain regions central to emotion regulation were selected for analysis, and consisted of bilateral amygdala, bilateral dorsolateral prefrontal (dlPFC), and ventromedial prefrontal/subgenual anterior cingulate (vmPFC-sgACC). Cognitive load increased activity in dlPFC and reduced activity in emotional responding brain regions. However, individuals with greater PTSS showed blunted deactivations in bilateral amygdala and vmPFC-sgACC, and weaker responses in right dlPFC. Additionally, we found that elevated emotional/internalizing dysfunction (EID), specifically low positive emotionality (RC2), accounted for PTSS-related changes in bilateral amygdala under increased cognitive load. Findings suggest that PTSS might result in amygdala and vmPFC-sgACC activity resistant to moderation by cognitive demands, reflecting emotion dysregulation despite a need to marshal cognitive resources. Anhedonia may be an important target for interventions that improve the affective and cognitive functioning of individuals with PTSD.
We developed a tilt sensor for studying ice deformation and installed our tilt sensor systems in two boreholes drilled close to the shear margin of Jarvis Glacier, Alaska to obtain kinematic measurements of streaming ice. We used the collected tilt data to calculate borehole deformation by tracking the orientation of the sensors over time. The sensors' tilts generally trended down-glacier, with an element of cross-glacier flow in the borehole closer to the shear margin. We also evaluated our results against flow dynamic parameters derived from Glen's exponential flow law and explored the parameter space of the stress exponent n and enhancement factor E. Comparison with values from ice deformation experiments shows that the ice on Jarvis is characterized by higher n values than that is expected in regions of low stress, particularly at the shear margin (~3.4). The higher n values could be attributed to the observed high total strains coupled with potential dynamic recrystallization, causing anisotropic development and consequently sped up ice flow. Jarvis' n values place the creep regime of the ice between basal slip and dislocation creep. Tuning E towards a theoretical upper limit of 10 for anisotropic ice with single-maximum fabric reduces the n values by 0.2.
Evidence on whether nutritional supplementation affects physical activity (PA) during early childhood is limited. We examined the long-term effects of lipid-based nutrient supplements (LNS) on total PA, moderate-to-vigorous PA (MVPA) and sedentary behaviour (SB) of children at 4–6 years using an accelerometer for 1 week. Their mothers were enrolled in the International Lipid-based Nutrient Supplement-DYAD randomised controlled trial in Ghana, assigned to daily LNS or multiple micronutrients (MMN) during pregnancy through 6 months postpartum or Fe and folic acid (IFA) during pregnancy and placebo for 6 months postpartum. From 6 to 18 months, children in the LNS group received LNS; the other two groups received no supplements. Analysis was done with intention to treat comparing two groups: LNS v. non-LNS (MMN+ IFA). Of the sub-sample of 375 children fitted with accelerometers, 353 provided sufficient data. Median vector magnitude (VM) count was 1374 (interquartile range (IQR) 309), and percentages of time in MVPA and SB were 4·8 (IQR 2) and 31 (IQR 8) %, respectively. The LNS group (n 129) had lower VM (difference in mean −73 (95 % CI −20, −126), P = 0·007) and spent more time in SB (LNS v. non-LNS: 32·3 v. 30·5 %, P = 0·020) than the non-LNS group (n 224) but did not differ in MVPA (4·4 v. 4·7 %, P = 0·198). Contrary to expectations, provision of LNS in early life slightly reduced the total PA and increased the time in SB but did not affect time in MVPA. Given reduced social-emotional difficulties in the LNS group previously reported, including hyperactivity, one possible explanation is less restless movement in the LNS group.
Field trials were conducted near Lubbock, TX, in 2013, 2014, and 2015 to evaluate non–2,4-D–resistant cotton response to low rates of glyphosate plus 2,4-D choline. Cotton was treated with five rates of glyphosate plus 2,4-D choline (0.0183, 0.183, 1.83, 18.3, and 183 g ae ha−1) at two application timings (nine leaf and first bloom). These rates correspond to contamination rates of 0.0008%, 0.008%, 0.08%, 0.8%, and 8%, respectively. Visual cotton injury, boll retention, lint yield, and fiber properties were recorded. When averaged over contamination rates, visual injury after applications made to nine-leaf cotton was greater than for first-bloom cotton in three of 3 yr and yield loss was greater when applications were made to nine-leaf cotton when compared with first-bloom cotton in two of 3 yr. Averaged over application timing, lint yield in 2013, 2014, and 2015 after glyphosate plus 2,4-D choline contamination rates of 0.0008% and 0.008% were not different than that of the nontreated control, whereas contamination rates of 0.08%, 0.8%, and 8% decreased yield by 3% to 20%, 45% to 58%, and 80% to 96%, respectively. Contamination rates of 0.0008%, 0.008%, 0.08%, and 0.8% rarely affected fiber quality; however, a contamination rate of 8% frequently decreased micronaire, fiber length, fiber length uniformity, and fiber strength. This decrease in fiber quality also resulted in a reduction in cotton loan value and potential financial return. Although decreases in fiber quality parameters were not observed with the 0.8% contamination rate, significant reductions in financial return occurred due to yield loss caused by injury from glyphosate plus 2,4-D choline.
Organismal metabolic rates reflect the interaction of environmental and physiological factors. Thus, calcifying organisms that record growth history can provide insight into both the ancient environments in which they lived and their own physiology and life history. However, interpreting them requires understanding which environmental factors have the greatest influence on growth rate and the extent to which evolutionary history constrains growth rates across lineages. We integrated satellite measurements of sea-surface temperature and chlorophyll-a concentration with a database of growth coefficients, body sizes, and life spans for 692 populations of living marine bivalves in 195 species, set within the context of a new maximum-likelihood phylogeny of bivalves. We find that environmental predictors overall explain only a small proportion of variation in growth coefficient across all species; temperature is a better predictor of growth coefficient than food supply, and growth coefficient is somewhat more variable at higher summer temperatures. Growth coefficients exhibit moderate phylogenetic signal, and taxonomic membership is a stronger predictor of growth coefficient than any environmental predictor, but phylogenetic inertia cannot fully explain the disjunction between our findings and the extensive body of work demonstrating strong environmental control on growth rates within taxa. Accounting for evolutionary history is critical when considering shells as historical archives. The weak relationship between variation in food supply and variation in growth coefficient in our data set is inconsistent with the hypothesis that the increase in mean body size through the Phanerozoic was driven by increasing productivity enabling faster growth rates.
We aimed to identify factors (child diet, physical activity; maternal BMI) associated with body composition of Ghanaian pre-school children.
Longitudinal analysis of the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana randomized trial, which enrolled 1320 pregnant women at ≤20 weeks’ gestation and followed them and their infants until 6 and 18 months postpartum, respectively. At follow-up, child age 4–6 years, we collected data on body composition (by 2H dilution), physical activity and diet, extracted dietary patterns using factor analysis, and examined the association of children’s percentage body fat with maternal and child factors by regression analysis.
Eastern Region, Ghana.
Children 4–6 years of age.
The analysis included 889 children with percentage body fat and dietary data at follow-up. We identified two major dietary patterns, a snacking and a cooked foods pattern. Percentage body fat was positively associated (standardized β (se)) with maternal BMI at follow-up (0·10 (0·03); P = 0·003) and negatively associated with physical activity (−0·15 (0·05); P = 0·003, unadjusted for child gender), but not associated with the snacking (0·06 (0·03); P = 0·103) or cooked foods (−0·05 (0·07); P = 0·474) pattern. Boys were more active than girls (1470 v. 1314 mean vector magnitude counts/min; P < 0·0001) and had lower percentage body fat (13·8 v. 16·9 %; P < 0·0001).
In this population, maternal overweight and child physical activity, especially among girls, may be key factors for addressing child overweight/obesity. We did not demonstrate a relationship between the dietary patterns and body fatness, which may be related to limitations of the dietary data available.
Nuclear star clusters hosted by dwarf galaxies exhibit similar characteristics to high-mass, metal complex globular clusters. This type of globular clusters could, therefore, be former nuclei from accreted galaxies. M54 resides in the photometric center of the Sagittarius dwarf galaxy, at a distance where resolving stars is possible. M54 offers the opportunity to study a nucleus before the stripping of their host by the tidal field effects of the Milky Way. We use a MUSE data set to perform a detailed analysis of over 6600 stars. We characterize the stars by metallicity, age, and kinematics, identifying the presence of three stellar populations: a young metal-rich (YMR), an intermediate-age metal-rich (IMR), and an old metal-poor (OMP). The evidence suggests that the OMP population is the result of accretion of globular clusters in the center of the host, while the YMR population was born in-situ in the center of the OMP population.
The aim of this study was to compare the effect of Hurricane Maria on internalizing and posttraumatic stress disorders (PTSD) among Puerto Ricans who moved to Florida after the storm versus those who stayed on the island.
In March through April 2018 (6 months after Hurricane Maria), an online survey was used to assess the effects of the storm on mental health. A sample of 213 displaced Puerto Ricans living in urban and rural/suburban areas in Florida, as well as urban and rural areas of Puerto Rico, participated in the study.
Rates of PTSD were high in both sites (Florida, 65.7%; Puerto Rico, 43.6%); however, participants in Florida were far more likely than those in Puerto Rico to meet diagnostic criteria for PTSD (OR, 2.94; 95% CI, 1.67-5.26). Among participants in both Florida and Puerto Rico, those living in urban areas were more likely than those in rural/suburban areas to meet criteria for PTSD and generalized anxiety disorder.
Results suggest that post-Hurricane Maria adjustment and adaptation may have been more psychologically taxing for Puerto Ricans who moved to Florida than it was for those who remained on the island, and more difficult for those in urban areas than it was for those in suburban or rural areas. (Disaster Med Public Health Preparedness. 2019;13:24–27)
Metal–insulator–metal (MIM) resonant absorbers comprise a conducting ground plane, a dielectric of thickness t, and thin separated metal top-surface structures of dimension l. The fundamental resonance wavelength is predicted by an analytic standing-wave model based on t, l, and the dielectric refractive index spectrum. For the dielectrics SiO2, AlN, and TiO2, values for l of a few microns give fundamental resonances in the 8-12 μm long-wave infrared (LWIR) wavelength region. Agreement with theory is better for t/l exceeding 0.1. Harmonics at shorter wavelengths were already known, but we show that there are additional resonances in the far-infrared 20 - 50 μm wavelength range in MIM structures designed to have LWIR fundamental resonances. These new resonances are consistent with the model if far-IR dispersion features in the index spectrum are considered. LWIR fundamental absorptions are experimentally shown to be optimized for a ratio t/l of 0.1 to 0.3 for SiO2- and AlN-based MIM absorbers, respectively, with TiO2-based MIM optimized at an intermediate ratio.