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The limitations of self-report measures of dietary intake are well known. Novel, technology-based measures of dietary intake may provide a more accurate, less burdensome alternative to existing tools. The first objective of this study was to compare participant burden for two technology-based measures of dietary intake among school-age children: the Automated-Self Administered 24-hour Dietary Assessment Tool-2018 (ASA24-2018) and the Remote Food Photography Method (RFPM). The second objective was to compare reported energy intake for each method to the Estimated Energy Requirement for each child, as a benchmark for actual intake. Forty parent-child dyads participated in 2, 3-day dietary assessments: a parent proxy-reported version of the ASA24 and the RFPM. A parent survey was subsequently administered to compare satisfaction, ease of use and burden with each method. A linear mixed model examined differences in total daily energy intake (TDEI) between assessments, and between each assessment method and the EER. Reported energy intake was 379 kcal higher with the ASA24 than the RFPM (p=0.0002). Reported energy intake with the ASA24 was 231 kcal higher than the EER (p = 0.008). Reported energy intake with the RFPM did not differ significantly from the EER (difference in predicted means = −148 kcal, p = 0.09). Median satisfaction and ease of use scores were 5 out of 6 for both methods. A higher proportion of parents reported that the ASA24 was more time consuming than the RFPM (74.4% vs. 25.6%, p = 0.002). Utilization of both methods is warranted given their high satisfaction among parents.
The occurrence, chemical composition and structural characterisation of the new mineral kernowite, ideally Cu2Fe(AsO4)(OH)4⋅4H2O, the Fe3+-analogue of liroconite, Cu2Al(AsO4)(OH)4⋅4H2O, are described. Kernowite (IMA2020-053) occurs on specimens probably sourced from the Wheal Gorland mine, St Day, Cornwall, UK, in the cavities of a quartz-gossan rich in undifferentiated micro-crystalline grey sulfides and poorly crystalline arsenic phases including both pharmacosiderite and olivenite-group minerals. The average composition of kernowite determined from several holotype fragments by electron microprobe analysis is Cu1.88(Fe0.79Al0.09)Σ0.88(As1.12O4)(OH)4⋅3.65H2O. The structure of kernowite has been determined in monoclinic space group I2/a (a non-standard setting of C2/c) by single-crystal X-ray diffraction (SCXRD) to R1 = 0.025, wR2 = 0.051 and Goodness-of-fit = 1.112. Unit-cell parameters from SCXRD are a = 12.9243(4) Å, b = 7.5401(3) Å, c = 10.0271(3) Å, β = 91.267(3)°, V = 976.91(6) Å3 and Z = 4. The chemical formula of this crystal indicated by SCXRD from refined site-scattering is Cu2(Fe3+0.84(1)Al0.16)AsO4(OH)4⋅4H2O. The network of hydrogen bonding has been determined and is similar to that reported for liroconite from Wheal Gorland by Plumhoff et al. (2020).
The Chronos 14Carbon-Cycle Facility is a new radiocarbon laboratory at the University of New South Wales, Australia. Built around an Ionplus 200 kV MIni-CArbon DAting System (MICADAS) Accelerator Mass Spectrometer (AMS) installed in October 2019, the facility was established to address major challenges in the Earth, Environmental and Archaeological sciences. Here we report an overview of the Chronos facility, the pretreatment methods currently employed (bones, carbonates, peat, pollen, charcoal, and wood) and results of radiocarbon and stable isotope measurements undertaken on a wide range of sample types. Measurements on international standards, known-age and blank samples demonstrate the facility is capable of measuring 14C samples from the Anthropocene back to nearly 50,000 years ago. Future work will focus on improving our understanding of the Earth system and managing resources in a future warmer world.
Diaphragmatic eventration is an anomaly of the diaphragm. In Scimitar syndrome, a curved-shaped anomalous pulmonary venous drainage is seen. Association between these conditions is rare. We present a newborn with diaphragmatic eventration, whose diagnosis of Scimitar syndrome was made after surgical repair. Scimitar syndrome is a congenital disorder often associated with other heart and lungs anomalies. Diagnosis can be fortuitous but with important prognostic features.
In the era of widespread resistance, there are 2 time points at which most empiric prescription errors occur among hospitalized adults: (1) upon admission (UA) when treating patients at risk of multidrug-resistant organisms (MDROs) and (2) during hospitalization, when treating patients at risk of extensively drug-resistant organisms (XDROs). These errors adversely influence patient outcomes and the hospital’s ecology.
Design and setting:
Retrospective cohort study, Shamir Medical Center, Israel, 2016.
Adult patients (aged >18 years) hospitalized with sepsis.
Logistic regressions were used to develop predictive models for (1) MDRO UA and (2) nosocomial XDRO. Their performances on the derivation data sets, and on 7 other validation data sets, were assessed using the area under the receiver operating characteristic curve (ROC AUC).
In total, 4,114 patients were included: 2,472 patients with sepsis UA and 1,642 with nosocomial sepsis. The MDRO UA score included 10 parameters, and with a cutoff of ≥22 points, it had an ROC AUC of 0.85. The nosocomial XDRO score included 7 parameters, and with a cutoff of ≥36 points, it had an ROC AUC of 0.87. The range of ROC AUCs for the validation data sets was 0.7–0.88 for the MDRO UA score and was 0.66–0.75 for nosocomial XDRO score. We created a free web calculator (https://assafharofe.azurewebsites.net).
A simple electronic calculator could aid with empiric prescription during an encounter with a septic patient. Future implementation studies are needed to evaluate its utility in improving patient outcomes and in reducing overall resistances.
We aimed to evaluate the association between eating context patterns and ultraprocessed food consumption at two main meal occasions in a representative sample of UK adolescents. Data were acquired from 4-d food records of adolescents aged 11–18 years, who participated in the 2014–2016 UK National Diet and Nutrition Survey (n 542). The eating context was assessed considering the location of the meal (lunch and dinner) occasion, the individuals present, whether the television was on and if the food was consumed at a table. Ultraprocessed foods were identified using the NOVA classification. Exploratory factor analysis was used to identify eating context patterns for lunch and dinner. Linear regression models adjusted for the covariates were utilised to test the association between eating context patterns and the proportion of total daily energy intake derived from ultraprocessed foods. Their contribution was about 67 % to energy intake. Three patterns were retained for lunch (‘At school with friends’, ‘TV during family meal’ and ‘Out-of-home (no school)’), and three patterns were retained for dinner (‘Watching TV alone in the bedroom’, ‘TV during family meal’ and ‘Out-of-home with friends’). At lunch, there was no significant association between any of the three patterns and ultraprocessed food consumption. At dinner, the patterns ‘Watching TV alone in the bedroom’ (coefficient: 4·95; 95 % CI 1·87, 8·03) and ‘Out-of-home with friends’ (coefficient: 3·13; 95 % CI 0·21, 6·14) were associated with higher consumption of ultraprocessed food. Our findings suggest a potential relationship between the immediate eating context and ultraprocessed food consumption by UK adolescents.
COVID-19 physical distancing measures can potentially increase the likelihood of mental disorders. It is unknown whether these measures are associated with depression and anxiety.
To investigate meta-analytic global levels of depression and anxiety during the COVID-19 pandemic and how the implementation of mitigation strategies (i.e. public transportation closures, stay-at-home orders, etc.) impacted such disorders.
PubMed, MEDLINE, Web of Science, BIOSIS Citation Index, Current Content Connect, PsycINFO, CINAHL, medRxiv, and PsyArXiv databases for depression and anxiety prevalences; Oxford Covid-19 Government Response Tracker for the containment and closure policies indexes; Global Burden of Disease Study for previous levels of depression and anxiety.
Study eligibility criteria
Original studies conducted during COVID-19 pandemic, which assessed categorical depression and anxiety, using PHQ-9 and GAD-7 scales (cutoff ⩾10).
Participants and interventions
General population, healthcare providers, students, and patients. National physical distancing measures.
Study appraisal and synthesis methods
Meta-analysis and meta-regression.
In total, 226 638 individuals were assessed within the 60 included studies. Global prevalence of both depression and anxiety during the COVID-19 pandemic was 24.0% and 21.3%, respectively. There were differences in the prevalence of both anxiety and depression reported across regions and countries. Asia (17.6% and 17.9%), and China (16.2% and 15.5%) especially, had the lowest prevalence of both disorders. Regarding the impact of mitigation strategies on mental health, only public transportation closures increased the prevalence of anxiety, especially in Europe.
Country-level data on physical distancing measures and previous anxiety/depression may not necessarily reflect local (i.e. city-specific) contexts.
Conclusions and implications of key findings
Mental health concerns should not be viewed only as a delayed consequence of the COVID-19 pandemic, but also as a concurrent epidemic. Our data provide support for policy-makers to consider real-time enhanced mental health services, and increase initiatives to foster positive mental health outcomes.
Assessing the impacts of invasive predators on the demography and distribution of native species is critical for understanding mechanisms of species persistence and informing the design of recovery programmes. On the oceanic island of Guam, the introduction of the predatory brown treesnake Boiga irregularis after World War II caused the near-total loss of the native forest avifauna. Localised snake control measures have been implemented since the early 1990s, yet it remains poorly understood how they have impacted Guam’s remaining native bird populations. To address this question, we combined intensive area searches of Andersen Air Force Base (AAFB) with island-wide transect surveys and opportunistic sightings to provide a comprehensive update on the distribution and abundance of Såli (Micronesian Starling, Aplonis opaca) – one of Guam’s last extant native bird species. Area searches of AAFB, where the largest remnant of the Såli population persists, revealed a 15-fold population increase since the last survey in the early 1990s, and transect surveys and opportunistic sightings indicate incipient recolonisation of other urbanised areas of northern and central Guam. We estimate the current island-wide population size at ~1,400 individuals. The population increase can likely be attributed to a combination of snake control measures and the Såli’s ability to exploit urban refugia for nesting and roosting. Although these trends demonstrate some population recovery, a skewed age ratio (>90% adults and subadults) at AAFB and a highly urbanised distribution and low abundance outside AAFB indicate that snake predation continues to strongly impact the population. More intensive snake suppression efforts, particularly in forested areas, may allow for the Såli population to attain its former distribution and abundance on Guam. More broadly, our findings reinforce the importance of urban areas as refugia for some threatened species.
ABSTRACT IMPACT: This study is designed to address a critical gap in our understanding of how aging patients and caregivers recognize and respond to clinically important changes in heart failure symptoms during vulnerable transitions. OBJECTIVES/GOALS: Research on family involvement in heart failure (HF) symptom response is limited. Our objective is to examine HF symptom monitoring processes in couples after HF hospitalization, and quantify how coupled symptom assessments predict symptom response, patient clinical events, care strain, and dyad health during the high-risk post-discharge period. METHODS/STUDY POPULATION: This is an ongoing T2 translational study that employs an intensive longitudinal design. Adults aged ≥65 years hospitalized for HF and their caregiving spouse/partner are enrolled. The target n is 48 dyads. Over 5 weeks of follow-up, dyads complete daily diaries assessing patient HF symptoms. Clinical biomarkers of HF severity (NTproBNP, ST2) are also collected. Primary study endpoints are dyads’ HF symptom response behaviors and caregiver strain; secondary endpoints are dyads’ health status and patient clinical events. Dyadic dynamics of symptom assessment will first be characterized using dyadic autoregressive time series models. Subsequently, we will extract cross-partner effect parameters from the time series models and test whether dyadic effects predict the trajectories of each of our endpoints. RESULTS/ANTICIPATED RESULTS: This study is currently underway. In line with our study hypotheses, we anticipate that couples who assess patient symptoms similarly (dyadic agreement), and whose symptom assessments accurately reflect clinical severity, will be more likely to respond to symptoms appropriately with lower stress to the caregiving partner, and have better trajectories of health (self-reported and clinical). Characterizing dyadic symptom dynamics will provide important insight into the day-to-day process of symptom recognition in couples. Further, quantifying dyadic symptom dynamics in relation to our endpoints will provide information on the clinical value of dyadic symptom agreement, and whether it might be a target for future interventions to support better symptom response and health outcomes for both dyad members. DISCUSSION/SIGNIFICANCE OF FINDINGS: This project innovates on existing paradigms by applying family-level theory and techniques to better understand and support interventions for couples during post-discharge HF transitions - a vulnerable period for older adults that has traditionally been studied almost exclusively at the patient-level, with marginal success.
The objective of this study was to analyse the dynamics of spatial dispersion of the coronavirus disease 2019 (COVID-19) in Brazil by correlating them to socioeconomic indicators. This is an ecological study of COVID-19 cases and deaths between 26 February and 31 July 2020. All Brazilian counties were used as units of analysis. The incidence, mortality, Bayesian incidence and mortality rates, global and local Moran indices were calculated. A geographic weighted regression analysis was conducted to assess the relationship between incidence and mortality due to COVID-19 and socioeconomic indicators (independent variables). There were confirmed 2 662 485 cases of COVID-19 reported in Brazil from February to July 2020 with higher rates of incidence in the north and northeast. The Moran global index of incidence rate (0.50, P = 0.01) and mortality (0.45 with P = 0.01) indicate a positive spatial autocorrelation with high standards in the north, northeast and in the largest urban centres between cities in the southeast region. In the same period, there were 92 475 deaths from COVID-19, with higher mortality rates in the northern states of Brazil, mainly Amazonas, Pará and Amapá. The results show that there is a geospatial correlation of COVID-19 in large urban centres and regions with the lowest human development index in the country. In the geographic weighted regression, it was possible to identify that the percentage of people living in residences with density higher than 2 per dormitory, the municipality human development index (MHDI) and the social vulnerability index were the indicators that most contributed to explaining incidence, social development index and the municipality human development index contributed the most to the mortality model. We hope that the findings will contribute to reorienting public health responses to combat COVID-19 in Brazil, the new epicentre of the disease in South America, as well as in other countries that have similar epidemiological and health characteristics to those in Brazil.
The direct carbonate procedure for accelerator mass spectrometry radiocarbon (AMS 14C) dating of submilligram samples of biogenic carbonate without graphitization is becoming widely used in a variety of studies. We compare the results of 153 paired direct carbonate and standard graphite 14C determinations on single specimens of an assortment of biogenic carbonates. A reduced major axis regression shows a strong relationship between direct carbonate and graphite percent Modern Carbon (pMC) values (m = 0.996; 95% CI [0.991–1.001]). An analysis of differences and a 95% confidence interval on pMC values reveals that there is no significant difference between direct carbonate and graphite pMC values for 76% of analyzed specimens, although variation in direct carbonate pMC is underestimated. The difference between the two methods is typically within 2 pMC, with 61% of direct carbonate pMC measurements being higher than their paired graphite counterpart. Of the 36 specimens that did yield significant differences, all but three missed the 95% significance threshold by 1.2 pMC or less. These results show that direct carbonate 14C dating of biogenic carbonates is a cost-effective and efficient complement to standard graphite 14C dating.
Drug classes are grouped based on their chemical and pharmacological properties, but prescription and illicit drugs differ in other important ways. Potential differences in genetic and environmental influences on the (mis)use of prescription and illicit drugs that are subsumed under the same class should be examined. Opioid and stimulant classes contain prescription and illicit forms differentially associated with salient risk factors (common route of administration, legality), making them useful comparators for addressing this etiological issue.
A total of 2410 individual Australian twins [Mage = 31.77 (s.d. = 2.48); 67% women] were interviewed about prescription misuse and illicit use of opioids and stimulants. Univariate and bivariate biometric models partitioned variances and covariances into additive genetic, shared environmental, and unique environmental influences across drug types.
Variation in the propensity to misuse prescription opioids was attributable to genes (41%) and unique environment (59%). Illicit opioid use was attributable to shared (71%) and unique (29%) environment. Prescription stimulant misuse was attributable to genes (79%) and unique environment (21%). Illicit stimulant use was attributable to genes (48%), shared environment (29%), and unique environment (23%). There was evidence for genetic influence common to both stimulant types, but limited evidence for genetic influence common to both opioid types. Bivariate correlations suggested that prescription opioid use may be more genetically similar to prescription stimulant use than to illicit opioid use.
Prescription opioid misuse may share little genetic influence with illicit opioid use. Future research may consider avoiding unitary drug classifications, particularly when examining genetic influences.
Direct numerical simulations at $Re=200$ have been conducted of the flow past rows of tandem cylinders. It is shown that when the pitch between the two upstream cylinders is large, the wake downstream is characterised by a two-row vortex structure. Placing a third body on the wake centreline in the majority of this two-row structure has basically no impact both upstream and downstream – the third body is cloaked. However, a region is identified where the placement of a body suppresses vortex shedding from the first cylinder and the two-row structure is destroyed, globally broadcasting the presence of the third body. The effect is shown to occur for different third-body shapes. To understand the existence of this broadcasting region, local instability analysis is conducted which shows the majority of the two-row structure to be convectively unstable, with only a small region adjacent to the rear of the second cylinder that is absolutely unstable. This suggests only bodies placed close to the second body will trigger the global change, and this is supported by a global sensitivity analysis and observation from the simulations. However, neither the local analysis nor the global sensitivity analysis explains the presence of a lower limit for the third-body position that will trigger a global change. However the simulation results clearly show that a third body placed very close to the second body does not trigger this change.
Geomorphological studies of the hidden and protected subsurface environments are crucial to obtain a greater insight into the evolution of planetary landforms, hydrology, climate, geology and mineralogy. From an astrobiological point of view subsurface environments are of interest for their potential habitability as they are local environments that are partially or fully shielded from the high levels of space and solar radiation. Furthermore, in the case of Mars, there is an increasing interest in searching for the presence of past or extant life in its subsurface. These applications make it mandatory to investigate equipment and instrumentation that allow for the study of subsurface geomorphology, as well as organic chemical biomarkers, such as biomolecules, carbon, nitrogen and sulphur isotopes, and other biologically significant minerals and gases. Mines on Earth can be used as analogues to investigate the geomorphology of Martian subsurface environments and perform astrobiology studies. With that goal, we have developed a low-cost, robust, remotely operable subsurface rover called KORE (KOmpact Rover for Exploration). This work illustrates the studies of a terrestrial analogue for the exploration of Mars using KORE during the Mine Analogue Research 6 (MINAR 6) campaign with the low-cost 3D mapping technology InXSpace 3D (In situ 3D mapping tool eXploration of space 3D). InXSpace 3D utilizes an RGB-D camera that captures depth information in addition to the RGB data of an image, operating based on the structured light principle capable of providing depth information in mm scale resolution at sub 3 m mapping range. InXSpace 3D is used to capture point clouds of natural and artificial features, thereby obtaining information about geologically relevant structures and also to incorporate them in earth mining safety. We tested two of the dense simultaneous localization and mapping (SLAM) algorithms: Kintinuous and Real-Time Appearance-Based Mapping (RTAB-Map) to check the performance of InXSpace 3D in a dark mine environment. Also, the air accumulation of volatiles such as methane and formaldehyde due to thermogenic and mining process was measured with the environmental station payload on the rover platform, which caters to both astrobiological significance and mine safety. The main conclusions of this work are: (1) a comparison made between the RTAB-Map algorithm and Kintinuous algorithm showed the superiority of Kintinuous algorithm in providing better 3D reconstruction; although RTAB-Map algorithm captured more points than the Kintinuous algorithm in the dark mine environment; (2) a comparison of point cloud images captured with and without lighting conditions had a negligible effect on the surface density of the point clouds; (3) close-range imaging of the polygonal features occurring on the halite walls using InXSpace 3D provided mm-scale resolution to enable further characterization; (4) heuristic algorithms to quickly post-process the 3D point cloud data provided encouraging results for preliminary analyses; (5) we successfully demonstrated the application of KORE to mine safety; and (6) the multi-sensors platform on KORE successfully monitored the accumulated volatiles in the mine atmosphere during its operation. The findings obtained during this KORE campaign could be incorporated in designing and planning future subsurface rover explorations to potential planetary bodies such as Mars with synergistic applications to subsurface environments in mines on Earth.
Few studies provide clear rationale for and the reception of adaptations of evidence-based interventions. To address this gap, we describe the context-dependent adaptations in critical time intervention-task shifting (CTI-TS), a manualized recovery program for individuals with psychosis in Rio de Janeiro, Brazil and Santiago, Chile. Implications of the adaptations – incorporating a task-shifting approach and modifying the mode of community-based service delivery – are examined from users' perspectives.
A secondary analysis of in-depth interviews with CTI-TS users (n = 9 in Brazil; n = 15 in Chile) was conducted. Using the framework method, we thematically compared how participants from each site perceived the main adapted components of CTI-TS.
Users of both sites appreciated the task-shifting worker pair to provide personalized, flexible, and relatable support. They wanted CTI-TS to be longer and experienced difficulty maintaining intervention benefits in the long-term. In Chile, stigma and a perceived professional hierarchy toward the task-shifting providers were more profound than in Brazil. Engagement with community-based services delivery in homes and neighborhoods (Chile), and at community mental health centers (Brazil) were influenced by various personal, familial, financial, and social factors. Uniquely, community violence was a significant barrier to engagement in Brazil.
CTI-TS’ major adaptations were informed by the distinct mental health systems and social context of Santiago and Rio. Evaluation of user experiences with these adaptations provides insights into implementing and scaling-up task-shifting and community-oriented interventions in the region through the creation of specialized roles for the worker pair, targeting sustained intervention effects, and addressing socio-cultural barriers.
The 2020 COVID-19 pandemic has had a profound impact on the clinical research enterprises at the 60 Clinical and Translational Science Award (CTSA) Hubs throughout the nation. There was simultaneously a need to expand research to obtain crucial data about disease prognosis and therapy and enormous limitations on conducting research as localities and institutions limited travel and person-to-person contact. These imperatives resulted in major changes in the way research was conducted, including expediting Institutional Review Board review, shifting to remote interactions with participants, centralizing decision-making in prioritizing research protocols, establishing biobanks, adopting novel informatics platforms, and distributing study drugs in unconventional ways. National CTSA Steering Committee meetings provided an opportunity to share best practices and develop the idea of capturing the CTSA program experiences in a series of papers. Here we bring together the recommendations from those papers in a list of specific actions that research sites can take to strengthen operations and prepare for similar future public health emergencies. Most importantly, creative innovations developed in response to the COVID-19 pandemic deserve serious consideration for adoption as new standards, thus converting the painful trauma of the pandemic into “post-traumatic growth” that makes the clinical research enterprise stronger, more resilient, and more effective.
Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity.
We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year.
The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854).
The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.