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The heterogeneity of chronic post-COVID neuropsychiatric symptoms (PCNPS), especially after infection by the Omicron strain, has not been adequately explored.
Aims
To explore the clustering pattern of chronic PCNPS in a cohort of patients having their first COVID infection during the ‘Omicron wave’ and discover phenotypes of patients based on their symptoms’ patterns using a pre-registered protocol.
Method
We assessed 1205 eligible subjects in Hong Kong using app-based questionnaires and cognitive tasks.
Results
Partial network analysis of chronic PCNPS in this cohort produced two major symptom clusters (cognitive complaint–fatigue and anxiety–depression) and a minor headache–dizziness cluster, like our pre-Omicron cohort. Participants with high numbers of symptoms could be further grouped into two distinct phenotypes: a cognitive complaint–fatigue predominant phenotype and another with symptoms across multiple clusters. Multiple logistic regression showed that both phenotypes were predicted by the level of pre-infection deprivation (adjusted P-values of 0.025 and 0.0054, respectively). The severity of acute COVID (adjusted P = 0.023) and the number of pre-existing medical conditions predicted only the cognitive complaint–fatigue predominant phenotype (adjusted P = 0.003), and past suicidal ideas predicted only the symptoms across multiple clusters phenotype (adjusted P < 0.001). Pre-infection vaccination status did not predict either phenotype.
Conclusions
Our findings suggest that we should pursue a phenotype-driven approach with holistic biopsychosocial perspectives in disentangling the heterogeneity under the umbrella of chronic PCNPS. Management of patients complaining of chronic PCNPS should be stratified according to their phenotypes. Clinicians should recognise that depression and anxiety cannot explain all chronic post-COVID cognitive symptoms.
Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
Biostatisticians increasingly use large language models (LLMs) to enhance efficiency, yet practical guidance on responsible integration is limited. This study explores current LLM usage, challenges, and training needs to support biostatisticians.
Methods:
A cross-sectional survey was conducted across three biostatistics units at two academic medical centers. The survey assessed LLM usage across three key professional activities: communication and leadership, clinical and domain knowledge, and quantitative expertise. Responses were analyzed using descriptive statistics, while free-text responses underwent thematic analysis.
Results:
Of 208 eligible biostatisticians (162 staff and 46 faculty), 69 (33.2%) responded. Among them, 44 (63.8%) reported using LLMs; of the 43 who answered the frequency question, 20 (46.5%) used them daily and 16 (37.2%) weekly. LLMs improved productivity in coding, writing, and literature review; however, 29 of 41 respondents (70.7%) reported significant errors, including incorrect code, statistical misinterpretations, and hallucinated functions. Key verification strategies included expertise, external validation, debugging, and manual inspection. Among 58 respondents providing training feedback, 44 (75.9%) requested case studies, 40 (69.0%) sought interactive tutorials, and 37 (63.8%) desired structured training.
Conclusions:
LLM usage is notable among respondents at two academic medical centers, though response patterns likely reflect early adopters. While LLMs enhance productivity, challenges like errors and reliability concerns highlight the need for verification strategies and systematic validation. The strong interest in training underscores the need for structured guidance. As an initial step, we propose eight core principles for responsible LLM integration, offering a preliminary framework for structured usage, validation, and ethical considerations.
Stauffer (2021) shows that when Americans perceive their legislatures as having more gender diversity, they perceive these institutions to be more responsive. In this letter, we use an independently fielded survey to validate Stauffer’s findings and investigate whether her findings extend to race. We successfully replicate Stauffer’s analyses. We also newly demonstrate that perceptions of Black representation in legislatures are related to increased external efficacy, and perceptions of gender descriptive representation are associated with increased trust. Such findings underscore the importance of studying citizens’ perceptions of descriptive representation to understand their attitudes toward government.
Digital twins are a new paradigm for our time, offering the possibility of interconnected virtual representations of the real world. The concept is very versatile and has been adopted by multiple communities of practice, policymakers, researchers, and innovators. A significant part of the digital twin paradigm is about interconnecting digital objects, many of which have previously not been combined. As a result, members of the newly forming digital twin community are often talking at cross-purposes, based on different starting points, assumptions, and cultural practices. These differences are due to the philosophical world-view adopted within specific communities. In this paper, we explore the philosophical context which underpins the digital twin concept. We offer the building blocks for a philosophical framework for digital twins, consisting of 21 principles that are intended to help facilitate their further development. Specifically, we argue that the philosophy of digital twins is fundamentally holistic and emergentist. We further argue that in order to enable emergent behaviors, digital twins should be designed to reconstruct the behavior of a physical twin by “dynamically assembling” multiple digital “components”. We also argue that digital twins naturally include aspects relating to the philosophy of artificial intelligence, including learning and exploitation of knowledge. We discuss the following four questions (i) What is the distinction between a model and a digital twin? (ii) What previously unseen results can we expect from a digital twin? (iii) How can emergent behaviours be predicted? (iv) How can we assess the existence and uniqueness of digital twin outputs?
Multi-layer networks arise when more than one type of relation is observed on a common set of actors. Modeling such networks within the exponential-family random graph (ERG) framework has been previously limited to special cases and, in particular, to dependence arising from just two layers. Extensions to ERGMs are introduced to address these limitations: Conway–Maxwell–Binomial distribution to model the marginal dependence among multiple layers; a “layer logic” language to translate familiar ERGM effects to substantively meaningful interactions of observed layers; and nondegenerate triadic and degree effects. The developments are demonstrated on two previously published datasets.
Negative human–wildlife interactions are a growing problem, particularly for people living near protected areas and wildlife refuges. In Kenya, African savannah elephants Loxodonta africana threaten food security for subsistence farmers by crop foraging, which can jeopardize conservation efforts if farmers retaliate against elephants. To inform conservation and management, this study had three objectives: (1) to evaluate stakeholder participatory models of human–elephant conflict; (2) to note any novel or underrepresented variables in the models; and (3) to determine if there were indicators for assessing the success of mitigation programmes using a biocultural approach. We conducted participatory modelling sessions in six villages in rural Kenya using fuzzy cognitive mapping (n = 206 participants). Farmers created group visual models with variables related to conflict with elephants. A total of 14 variables were common across all six villages, with the two highest centrality scores (a measure of importance to overall dynamics) associated with income and feelings of security. Most variables fell into two categories: environmental interactions, and policy and management. Multiple variables such as road infrastructure (drivers) and soil compaction (consequences) were identified as aspects of conflicts that are under-reported or absent in scientific literature, as well as potential socio-cultural indicators. The participatory method used is a tool for gaining more refined insights into interactions with elephants, with implications for other complex conservation issues or wildlife interactions. A more holistic view of the impacts of human–elephant interactions as demonstrated here can lead to sustainable, co-developed programmes that benefit both farmer livelihoods and elephant conservation.
We provide scaling relations for the Nusselt number $Nu$ and the friction coefficient $C_{S}$ in sheared Rayleigh–Bénard convection, i.e. in Rayleigh–Bénard flow with Couette- or Poiseuille-type shear forcing, by extending the Grossmann & Lohse (J. Fluid Mech., vol. 407, 2000, pp. 27–56, Phys. Rev. Lett., vol. 86, 2001, pp. 3316–3319, Phys. Rev. E, vol. 66, 2002, 016305, Phys. Fluids, vol. 16, 2004, pp. 4462–4472) theory to sheared thermal convection. The control parameters for these systems are the Rayleigh number $Ra$, the Prandtl number $Pr$ and the Reynolds number $Re_S$ that characterises the strength of the imposed shear. By direct numerical simulations and theoretical considerations, we show that, in turbulent Rayleigh–Bénard convection, the friction coefficients associated with the applied shear and the shear generated by the large-scale convection rolls are both well described by Prandtl's (Ergeb. Aerodyn. Vers. Gött., vol. 4, 1932, pp. 18–29) logarithmic friction law, suggesting some kind of universality between purely shear-driven flows and thermal convection. These scaling relations hold well for $10^6 \leq Ra \leq 10^8$, $0.5 \leq Pr \leq 5.0$, and $0 \leq Re_S \leq 10^4$.
Children with left aortic arch and aberrant right subclavian artery may present with either respiratory or swallowing symptoms beyond the classically described solid-food dysphagia. We describe the clinical features and outcomes of children undergoing surgical repair of an aberrant right subclavian artery.
Materials and methods:
This was a retrospective review of children undergoing repair of an aberrant right subclavian artery between 2017 and 2022. Primary outcome was symptom improvement. Pre- and post-operative questionnaires were used to assess dysphagia (PEDI-EAT-10) and respiratory symptoms (PEDI-TBM-7). Paired t-test and Fisher’s exact test were used to analyse symptom resolution. Secondary outcomes included perioperative outcomes, complications, and length of stay.
Results:
Twenty children, median age 2 years (IQR 1–11), were included. All presented with swallowing symptoms, and 14 (70%) also experienced respiratory symptoms. Statistically significant improvements in symptoms were reported for both respiratory and swallowing symptoms. Paired (pre- and post-op) PEDI-EAT-10 and PEDI-TBM-7 scores were obtained for nine patients, resulting in mean (± SD) scores decreasing (improvement in symptoms) from 19.9 (± 9.3) to 2.4 (± 2.5) p = 0.001, and 8.7 (± 4.7) to 2.8 (± 4.0) p = 0.006, respectively. Reoperation was required in one patient due to persistent dysphagia from an oesophageal stricture. Other complications included lymphatic drainage (n = 4) and transient left vocal cord hypomobility (n = 1).
Conclusion:
Children with a left aortic arch with aberrant right subclavian artery can present with oesophageal and respiratory symptoms beyond solid food dysphagia. A thorough multidisciplinary evaluation is imperative to identify patients who can benefit from surgical repair, which appears to be safe and effective.
Knowledge of snow and firn-density change is needed to use elevation-change measurements to estimate glacier mass change. Additionally, firn-density evolution on glaciers is closely connected to meltwater percolation, refreezing and runoff, which are key processes for glacier mass balance and hydrology. Since 2016, the U.S. Geological Survey Benchmark Glacier Project has recovered firn cores from a site on Wolverine Glacier in Alaska's Kenai Mountains. We use annual horizons in repeat cores to track firn densification and meltwater retention over seasonal and interannual timescales, and we use density measurements to quantify how the firn air content (FAC) changes through time. The results suggest the firn is densifying due primarily to compaction rather than refreezing. Liquid-water retention in the firn is transient, likely due to gravity-fed drainage and irreducible-water-content decreases that accompany decreasing porosity. We show that the uncertainty (±60 kg m−3) in the commonly used volume-to-mass conversion factor of 850 kg m−3 is an underestimation when glacier-wide FAC variability exceeds 12% of the glacier-averaged height change. Our results demonstrate how direct measurements of firn properties on mountain glaciers can be used to better quantify the uncertainty in geodetic volume-to-mass conversions.
Background: Nursing home (NH) residents are at high risk of COVID-19 from exposure to infected staff and other residents. Understanding SARS-CoV-2 viral RNA kinetics in residents and staff can guide testing, isolation, and return to work recommendations. We sought to determine the duration of antigen test and polymerase chain reaction (PCR) positivity in a cohort of NH residents and staff. Methods: We prospectively collected data on SARS-CoV-2 viral kinetics from April 2023 through November 2023. Staff and residents could enroll prospectively or upon a positive test (identified through routine clinical testing, screening, or outbreak response testing). Participating facilities performed routine clinical testing; asymptomatic testing of contacts was performed within 48 hours if an outbreak or known exposure occurred and upon (re-) admission. Enrolled participants who tested positive for SARS-CoV-2 were re-tested daily for 14 days with both nasal antigen and nasal PCR tests. All PCR tests were run by a central lab with the same assay. We conducted a Kaplan-Meier survival analysis on time to first negative test restricted to participants who initially tested positive (day zero) and had at least one test ≥10 days after initially testing positive with the same test type; a participant could contribute to both antigen and PCR survival curves. We compared survival curves for staff and residents using the log-rank test. Results: Twenty-four nursing homes in eight states participated; 587 participants (275 residents, 312 staff) enrolled in the evaluation, participants were only tested through routine clinical or outbreak response testing. Seventy-two participants tested positive for antigen; of these, 63 tested PCR-positive. Residents were antigen- and PCR-positive longer than staff (Figure 1), but this finding is only statistically significant (p=0.006) for duration of PCR positivity. Five days after the first positive test, 56% of 50 residents and 59% of 22 staff remained antigen-positive; 91% of 44 residents and 79% of 19 staff were PCR-positive. Ten days after the first positive test, 22% of 50 residents and 5% of 22 staff remained antigen-positive; 61% of 44 residents and 21% of 19 staff remained PCR-positive. Conclusions: Most NH residents and staff with SARS-CoV-2 remained antigen- or PCR-positive 5 days after the initial positive test; however, differences between staff and resident test positivity were noted at 10 days. These data can inform recommendations for testing, duration of NH resident isolation, and return to work guidance for staff. Additional viral culture data may strengthen these conclusions.
Disclosure: Stefan Gravenstein: Received consulting and speaker fees from most vaccine manufacturers (Sanofi, Seqirus, Moderna, Merck, Janssen, Pfizer, Novavax, GSK, and have or expect to receive grant funding from several (Sanofi, Seqirus, Moderna, Pfizer, GSK). Lona Mody: NIH, VA, CDC, Kahn Foundation; Honoraria: UpToDate; Contracted Research: Nano-Vibronix
Inpatient antibiotic use increased during the early phases of the COVID-19 pandemic. We sought to determine whether these changes persisted in persons with and without COVID-19 infection.
Design:
Retrospective cohort analysis.
Setting:
108 Veterans Affairs (VA) facilities.
Patients:
Persons receiving acute inpatient care from January 2016 to October 2022.
Methods:
Data on antibacterial use, patient days present, and COVID-19 care were extracted from the VA Corporate Data Warehouse. Days of therapy (DOT) per 1000 days present (DP) were calculated and stratified by Centers for Disease Control and Prevention-defined antibiotic classes.
Results:
Antibiotic use increased from 534 DOT/1000 DP in 11/2019–2/2020 to 588 DOT/1000 DP in 3/2020–4/2020. Subsequently, antibiotic use decreased such that total DOT/1000 DP was 2% less in 2020 as a whole than in 2019. Driven by treatment for community acquired pneumonia, antibiotic use was 30% higher in persons with COVID-19 than in uninfected persons in 3/2020–4/2020, but only 4% higher for the remainder of 2020. In 2022 system-wide antibiotic use was 9% less in persons with COVID-19; however, antibiotic use remained higher in persons with COVID-19 in 25% of facilities.
Discussion:
Although antibiotic use increased during the early phases of the COVID-19 pandemic, overall use subsequently decreased to below previous baseline levels and, in 2022, was less in persons with COVID-19 than in persons without COVID-19. However, further work needs to be done to address variances across facilities and to determine whether current levels of antibiotic use in persons with COVID-19 are justified.
We present radio observations of the galaxy cluster Abell S1136 at 888 MHz, using the Australian Square Kilometre Array Pathfinder radio telescope, as part of the Evolutionary Map of the Universe Early Science program. We compare these findings with data from the Murchison Widefield Array, XMM-Newton, the Wide-field Infrared Survey Explorer, the Digitised Sky Survey, and the Australia Telescope Compact Array. Our analysis shows the X-ray and radio emission in Abell S1136 are closely aligned and centered on the Brightest Cluster Galaxy, while the X-ray temperature profile shows a relaxed cluster with no evidence of a cool core. We find that the diffuse radio emission in the centre of the cluster shows more structure than seen in previous low-resolution observations of this source, which appeared formerly as an amorphous radio blob, similar in appearance to a radio halo; our observations show the diffuse emission in the Abell S1136 galaxy cluster contains three narrow filamentary structures visible at 888 MHz, between $\sim$80 and 140 kpc in length; however, the properties of the diffuse emission do not fully match that of a radio (mini-)halo or (fossil) tailed radio source.
Knowledge of sex differences in risk factors for posttraumatic stress disorder (PTSD) can contribute to the development of refined preventive interventions. Therefore, the aim of this study was to examine if women and men differ in their vulnerability to risk factors for PTSD.
Methods
As part of the longitudinal AURORA study, 2924 patients seeking emergency department (ED) treatment in the acute aftermath of trauma provided self-report assessments of pre- peri- and post-traumatic risk factors, as well as 3-month PTSD severity. We systematically examined sex-dependent effects of 16 risk factors that have previously been hypothesized to show different associations with PTSD severity in women and men.
Results
Women reported higher PTSD severity at 3-months post-trauma. Z-score comparisons indicated that for five of the 16 examined risk factors the association with 3-month PTSD severity was stronger in men than in women. In multivariable models, interaction effects with sex were observed for pre-traumatic anxiety symptoms, and acute dissociative symptoms; both showed stronger associations with PTSD in men than in women. Subgroup analyses suggested trauma type-conditional effects.
Conclusions
Our findings indicate mechanisms to which men might be particularly vulnerable, demonstrating that known PTSD risk factors might behave differently in women and men. Analyses did not identify any risk factors to which women were more vulnerable than men, pointing toward further mechanisms to explain women's higher PTSD risk. Our study illustrates the need for a more systematic examination of sex differences in contributors to PTSD severity after trauma, which may inform refined preventive interventions.
OBJECTIVES/GOALS: In this study, we aim to report the role of porins and blaCTX-M β-lactamases among Escherichia coli and Klebsiella pneumoniae, focusing on emerging carbapenem resistant Enterobacterales (CRE) subtypes, including non-carbapenemase producing Enterobacterales (NCPE) and ertapenem-resistant but meropenem-susceptible (ErMs) strains. METHODS/STUDY POPULATION: Whole genome sequencing was conducted on 76 carbapenem-resistant isolates across 5 hospitals in San Antonio, U.S. Among these, NCP isolates accounted for the majority of CRE (41/76). Identification and antimicrobial susceptibility testing (AST) results were collected from the clinical charts. Repeat speciation was determined through whole genome sequencing (WGS) analysis and repeat AST, performed with microdilution or ETEST®. Minimum inhibitory concentrations (MIC) were consistent with Clinical and Laboratory Standards Institute (CLSI M100, ED33). WGS and qPCR were used to characterize the resistome of all clinical CRE subtypes, while western blotting and liquid chromatography with tandem mass spectrometry (LC-MS-MS) were used to determine porin expression and carbapenem hydrolysis, respectively. RESULTS/ANTICIPATED RESULTS: blaCTX-Mwas found to be most prevalent among NCP isolates (p = 0.02). LC-MS/MS analysis of carbapenem hydrolysis revealed that blaCTX-M-mediated carbapenem hydrolysis, indicating the need to reappraise the term, “non-carbapenemase (NCP)®” for quantitatively uncharacterized CRE strains harboring blaCTX-M. Susceptibility results showed that 56% of all NCPE isolates had an ErMs phenotype (NCPE vs. CPE, p < 0.001), with E. coli driving the phenotype (E. coli vs. K. pneumoniae, p < 0.001). ErMs strains carrying blaCTX-M, had 4-fold more copies of blaCTX-M than ceftriaxone-resistant but ertapenem-susceptible isolates (3.7 v. 0.9, p < 0.001). Immunoblot analysis demonstrated the absence of OmpC expression in NCP-ErMs E. coli, with 92% of strains lacking full contig coverage ofompC. DISCUSSION/SIGNIFICANCE: Overall, this work provides evidence of a collaborative effort between blaCTX-M and OmpC in NCP strains that confer resistance to ertapenem but not meropenem. Clinically, CRE subtypes are not readily appreciated, potentially leading to mismanagement of CRE infected patients. A greater focus on optimal treatments for CRE subtypes is needed.
Natural zeolites may represent one of the greatest under-utilized resources of the mineral world. Even with their unique character and properties, issues of consistency, homogeneity and purity preclude them from many premium applications. We report a simple method to upgrade mineral sedimentary Na-chabazite from the well known Bowie, Arizona, deposit to near synthetic purity and consistency. During this alkaline-silicate digestion process, initially soft chabazite ore granules gain substantial mechanical strength. This may allow direct employment in adsorption and purification processes without the need for binding and forming. These granules manifest significantly improved adsorption properties, including enhanced water and CO2 adsorptivity.
Mineral chabazite has shown the unusual ability to surface template nanometal particles, especially Ag. A chabazite analog was synthesized from delaminated metakaolin. The chabazite formed retained the platy morphology of the base clay. This morphology is ideal for displaying surface-supported nanometal particles. The synthetic chabazite analog demonstrated the ability to form and support large concentrations of Ag nanoparticles, as observed in the related natural mineral. Due to greater Al content, the synthetic chabazite manifests significantly improved capacity for the formation of such Ag nanoparticles. As in the case of the mineral chabazite, surface Ag nanoparticles of high uniformity were observed in the range of 5–6 nm.
Fetal alcohol spectrum disorder (FASD) is a life-long condition, and few interventions have been developed to improve the neurodevelopmental course in this population. Early interventions targeting core neurocognitive deficits have the potential to confer long-term neurodevelopmental benefits. Time-targeted choline supplementation is one such intervention that has been shown to provide neurodevelopmental benefits that emerge with age during childhood. We present a long-term follow-up study evaluating the neurodevelopmental effects of early choline supplementation in children with FASD approximately 7 years on average after an initial efficacy trial. In this study, we examine treatment group differences in executive function (EF) outcomes and diffusion MRI of the corpus callosum using the Neurite Orientation Dispersion and Density Index (NODDI) biophysical model.
Participants and Methods:
The initial study was a randomized, double-blind, placebo-controlled trial of choline vs. placebo in 2.5- to 5-year-olds with FASD. Participants in this long-term follow-up study included 18 children (9 placebo; 9 choline) seen 7 years on average following initial trial completion. The mean age at follow-up was 11 years old. Diagnoses were 28% fetal alcohol syndrome (FAS), 28% partial FAS, and 44% alcohol-related neurodevelopmental disorder. The follow-up evaluation included measures of executive functioning (WISC-V Picture Span and Digit Span; DKEFS subtests) and diffusion MRI (NODDI).
Results:
Children who received choline early in development outperformed those in the placebo group across a majority of EF tasks at long-term follow-up (effect sizes ranged from -0.09 to 1.27). Children in the choline group demonstrated significantly better performance on several tasks of lower-order executive function skills (i.e., DKEFS Color Naming [Cohen's d = 1.27], DKEFS Word Reading [Cohen's d = 1.13]) and showed potentially better white matter microstructure organization (as indicated by lower orientation dispersion; Cohen's d = -1.26) in the splenium of the corpus callosum compared to the placebo group. In addition, when collapsing across treatment groups, higher white matter microstructural organization was associated with better performance on several EF tasks (WISC-V Digit Span; DKEFS Number Sequencing and DKEFS Word Reading).
Conclusions:
These findings highlight long-term benefits of choline as a neurodevelopmental intervention for FASD and suggest that changes in white matter organization may represent an important target of choline in this population. Unique to this study is the use of contemporary biophysical modeling of diffusion MRI data in youth with FASD. Findings suggest this neuroimaging approach may be particularly useful for identifying subtle white matter differences in FASD as well as neurobiological responses to early intervention associated with important cognitive functions.
The north coast of Peru is among the most extensively surveyed regions in the world, yet variation in research questions, sampling strategies and chronological and geospatial controls among survey projects makes comparison of disparate datasets difficult. To contextualise these issues, the authors present a systematic survey of satellite imagery focusing on hilltop fortifications in the Jequetepeque and Santa Valleys. This digital recontextualisation of pedestrian survey data demonstrates the potential of hybrid methodologies to substantially expand both the identification of archaeological sites within difficult terrain and, consequently, our understanding of the function of defensive sites.