Spirometra is a genus of zoonotic cestodes with an ambiguous species-level taxonomic history. Previously, Spirometra mansonoides was considered the only species present in North America. However, recent molecular data revealed the presence of at least three distinct species in the USA: Spirometra sp. 2 and 3, and Spirometra mansoni. This study aimed to elucidate the diversity and potential host associations of Spirometra species among companion animals in the USA. Samples (N = 302) were examined from at least 13 host species, including mammals, amphibians and reptiles. Sample types included eggs isolated from faeces (n = 222), adult specimens (n = 71) and plerocercoids (n = 9) from 18 different states and 2 territories across the USA. Extracted genomic DNA was subjected to PCR targeting a fragment of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Generated sequences (n = 136) were included in a phylogenetic analysis. Spirometra mansoni was detected in domestic cats (n = 76), dogs (n = 12), a White’s tree frog (n = 1), a Cuban knight anole (n = 1), a green iguana (n = 1) and a serval (n = 1) across 15 states and Puerto Rico. Spirometra sp. 2 was found only in dogs (n = 3) from Florida and Spirometra sp. 3 was found only in cats (n = 41) from 17 states. All plerocercoid samples were consistent with S. mansoni. The results confirm that at least three distinct Spirometra species are present and established in companion animals, such as dogs and cats, and likely are using various native and exotic species as paratenic hosts within the USA.

Contrary to traditional thought in linguistics and editing, recent studies using corpus-based evidence suggest that historical English usage patterns influenced prescriptive usage manuals’ guidelines more than the other way around. To explore the modern relationship between English language prescriptions and usage, this study focuses on the wide-reaching genre of written online news and the topic of gender-fair language. It compares changes regarding gender-specific titles in the Associated Press's stylebooks to actual usage trends as documented by the News on the Web (NOW) corpus. Results from NOW show -man title variants as the dominant form in the early 2010s, consistent with AP style at that time. However, many gender-neutral (including -person) variants saw rapid uptake in usage in the mid-2010s to become the most frequent forms by 2021, contrasting AP guidelines that only started listing -person and other neutral forms as ‘acceptable' around 2017 and as the prescribed forms more recently. These results indicate both an increased cultural consciousness for changing gender equity standards as well as a willingness of many news writers, editors, and publishers to defer to culturally significant language trends even if authoritative guides do not yet endorse them.

Medical researchers are increasingly prioritizing the inclusion of underserved communities in clinical studies. However, mere inclusion is not enough. People from underserved communities frequently experience chronic stress that may lead to accelerated biological aging and early morbidity and mortality. It is our hope and intent that the medical community come together to engineer improved health outcomes for vulnerable populations. Here, we introduce Health Equity Engineering (HEE), a comprehensive scientific framework to guide research on the development of tools to identify individuals at risk of poor health outcomes due to chronic stress, the integration of these tools within existing healthcare system infrastructures, and a robust assessment of their effectiveness and sustainability. HEE is anchored in the premise that strategic intervention at the individual level, tailored to the needs of the most at-risk people, can pave the way for achieving equitable health standards at a broader population level. HEE provides a scientific framework guiding health equity research to equip the medical community with a robust set of tools to enhance health equity for current and future generations.

Protein-rich animal foods are highly digestible, high-quality sources or protein, whereas the protein quality of plant-based foods can vary considerably. Given the growing interest in alternative non-animal-based sources of protein, it is important to establish the protein digestibility of these new foods and protein concentrates which have important health implications especially for vulnerable groups who don’t consume sufficient dietary protein. The human ileostomy model is ideal for measuring protein digestibility as it enables protein digestion to be quantified independent of protein degradation in the large intestine. The aim of this study was to determine the protein digestibility and quality of a wheat-based food containing legume flours. This randomised, double-blinded, controlled cross-over intervention was conducted in 4 proctocolectomised adults with conventional and well-functioning permanent ileostomies. The study was conducted over 2 weeks and on each testing day, the participant consumed 2 test muffins (125 g each) or 2 protein-free cookies in the morning (breakfast and morning tea) followed by a standardised low-protein lunch and afternoon tea. Test muffins were made using a standard muffin recipe using wheat flour and for 2 of the test muffins 50% of the flour was substituted with soy or lupin flour. An indigestible marker, titanium dioxide was added to the muffins so that the completeness of muffin recovered in ileal digesta could be calculated. The digestible indispensable amino acid score (DIAAS) was determined by comparing concentrations of true ileal digestible indispensable amino acids to recommended amino acid requirements(1). Data was reported as mean ± SD and repeated measures ANOVA was used to compare means between treatment groups with significance reported at P < 0.05. Substituting 50% of wheat flour in muffins with soy or lupin flour doubled the protein content of muffins (soy 11.8 g/100g and lupin 10.6 g/100g) compared to muffins that only contained wheat flour (wheat 5.1 g/100g). However, substituting wheat with legume flour did not affect protein digestibility which was similar for all muffin types; wheat (76.8 ± 7.0%), soy (77.9 ± 7.4%) and lupin (81.6 ± 6.9%) (P = 0.181). The DIAAS values for all muffins were below 75% which is classified as the cut off for a good quality protein food. In conclusion, substitution of wheat-based muffins with soy and lupin flour increased the protein content of wheat-based muffins but protein digestibility and overall protein quality was similar.

Climate change is increasing the frequency of extreme weather events, such as drought and heat waves. In this paper, we assess the impact of drought and high temperatures on the employment outcomes of working-age individuals in South Africa between 2008 and 2017. We merge high-resolution weather data with detailed individual-level survey data on labor market outcomes, and estimate causal impacts using a fixed effects framework. We find that increases in the occurrence of drought reduce overall employment. These effects are concentrated in the tertiary sector, amongst informal workers, and in provinces with a higher reliance on tourism. Taken together, our results suggest that the impacts of climate change will be felt unequally by South Africa's workers.

Ethnohistoric accounts indicate that the people of Australia's Channel Country engaged in activities rarely recorded elsewhere on the continent, including food storage, aquaculture and possible cultivation, yet there has been little archaeological fieldwork to verify these accounts. Here, the authors report on a collaborative research project initiated by the Mithaka people addressing this lack of archaeological investigation. The results show that Mithaka Country has a substantial and diverse archaeological record, including numerous large stone quarries, multiple ritual structures and substantial dwellings. Our archaeological research revealed unknown aspects, such as the scale of Mithaka quarrying, which could stimulate re-evaluation of Aboriginal socio-economic systems in parts of ancient Australia.

Herbivore distribution throughout Africa is strongly linked to mean annual precipitation. We use that relationship to predict functional group composition of herbivore communities during the last glacial maximum (ca. 21 ka) on the now submerged Palaeo-Agulhas Plain (PAP), South Africa. We used metabolic large herbivore biomass (MLHB) from 39 South African protected areas, in five functional groups (characterized by behavior and physiology). We examined how modern factors influenced MLHB and considered the effects of biome, annual rainfall, percentage winter rainfall, and protected area size. Overall, biome was the most important factor influencing the relationship between MLHB and rainfall. In general, MLHB increased with rainfall, but not for the grassland biome. Outside grasslands, most functional groups’ metabolic biomass increased with increasing rainfall, irrespective of biome, except for medium-sized social mixed feeder species in savanna and thicket. Protected area size was influential for medium-sized social mixed feeders and large browsers and rainfall influenced medium-sized social mixed feeders, offering some perspectives on spatial constraints on past large herbivore biomass densities. These results improve our understanding of the likely herbivore community composition and relative biomass structure on the PAP, an essential driver of how early humans utilized large mammals as a food resource.

ABSTRACT IMPACT: This is the first examination of risk factors for prolonged opioid use after an ICU stay and will inform efforts to strengthen prescribing guidelines and care transition models for patients after critical illness. OBJECTIVES/GOALS: The majority of patients in intensive care units (ICU) receive opioids during admission, and up to 25% receive a prescription at discharge. However, transitions of care and prolonged use after discharge remain unknown. We aim to characterize risk factors for prolonged opioid use after an ICU stay. METHODS/STUDY POPULATION: A retrospective study using insurance claims from Optum Clinformatics ®Data Mart was conducted for opioid-naive adult patients (18-64 years) with an ICU admission from 2010 to 2019. The primary outcome was new persistent opioid use, defined as a continued prescription fill 91-180 days after discharge, in addition to a fill in the first 90 days. The primary exposure was an opioid fill at discharge. The ICU admission was characterized using the Clinical Classification System from the Agency of Healthcare Research and Quality, based on patients’primary diagnosis code. Diagnoses were combined into 11 groups highlighting the affected organ system/mechanism of injury. Logistic regression evaluated the associations of patient demographic and clinical characteristics with the probability of persistent opioid use. RESULTS/ANTICIPATED RESULTS: In this cohort of 90,721 patients discharged from the ICU, 3.3% continued to fill opioids at 6 months. An opioid prescription fill (OR 3.1; 95% CI 28 - 3.3) and benzodiazepine prescription fill (OR 1.6; 95% CI 1.4 - 1.8) within 3 days of ICU discharge were each significantly associated with the development of new persistent opioid use. Patient diagnosis groups of Musculoskeletal/Trauma (OR 2.3; 95% CI 2.0 - 2.6), Neoplasms (OR 1.6; 95% CI 1.5 - 1.9), and GI/Hepatobiliary (OR 1.5; 95% CI 1.3 - 1.8) were significantly more likely to develop new persistent use when compared to the Cardiovascular diagnosis group. DISCUSSION/SIGNIFICANCE OF FINDINGS: Opioid prescriptions at discharge after an ICU stay increase the odds of prolonged opioid use. These results will inform efforts to strengthen prescribing guidelines and care models after a critical illness. Further work will characterize the trajectory of prescribing and patient exposure to high-risk prescribing after ICU discharge.

Colleges and universities around the world engaged diverse strategies during the COVID-19 pandemic. Baylor University, a community of ˜22,700 individuals, was 1 of the institutions which resumed and sustained operations. The key strategy was establishment of multidisciplinary teams to develop mitigation strategies and priority areas for action. This population-based team approach along with implementation of a “Swiss Cheese” risk mitigation model allowed small clusters to be rapidly addressed through testing, surveillance, tracing, isolation, and quarantine. These efforts were supported by health protocols including face coverings, social distancing, and compliance monitoring. As a result, activities were sustained from August 1 to December 8, 2020. There were 62,970 COVID-19 tests conducted with 1435 people testing positive for a positivity rate of 2.28%. A total of 1670 COVID-19 cases were identified with 235 self-reports. The mean number of tests per week was 3500 with approximately 80 of these positive (11/d). More than 60 student tracers were trained with over 120 personnel available to contact trace, at a ratio of 1 per 400 university members. The successes and lessons learned provide a framework and pathway for similar institutions to mitigate the ongoing impacts of COVID-19 and sustain operations during a global pandemic.