Objectives: Understanding how the importance of modifiable risk factors for dementia varies by cognitive status and sex is vital for the development of effective approaches to dementia prevention. We aimed to calculate population attributable fractions (PAFs) for incident dementia associated with sets of risk factors while exploring sex differences in individuals who are cognitively normal (CN) or has mild cognitive impairment (MCI).

Methods: Longitudinal data from the Rush University Memory and Aging Project (MAP) were analysed. Included participants were aged over 50 years and were CN or with a diagnosis of MCI at their baseline assessment. Analyses considered fifteen potential dementia risk factors covering cardiometabolic, lifestyle, psychosocial and sensory domains. We used Cox proportional hazard models to estimate the hazard ratios for incident dementia associated with dementia risk factors and calculated weighted PAFs. All analyses were repeated stratified by sex.

Results: The analytical sample comprised 754 cognitively normal participants (77.2% female) and 242 participants with a diagnosis of MCI (71.9% female), of whom 214 (28.4%) and 120 (49.6%) were diagnosed with dementia across the follow-up, respectively. Although the weighted overall PAF was similar for CN (24.7%) and MCI (25.2%) subgroups, sex differences were present in both. Compared to in females, PAFs were higher in males in both CN (42.5% vs. 25.1%) and MCI (51.6% vs 12.3%) subgroups. The profiles of contributing risk factors also varied by sex. In males, the highest PAFs were smoking (11.1%), vision impairment (6.2%) and stroke (6.0%) in CN and smoking (13.3%), physical inactivity (12.9%) and heart attack (7.9%) in MCI. In females, the highest PAFs were unmarried marital status (4.9%), depression (4.1%) and social isolation (3.8%) in CN and vision impairment (4.4%), increased alcohol intake (3.5%) and depression (2.6%) in MCI.

Conclusions: These findings support the notion that dementia risk is modifiable after the onset of MCI. They also highlight the potential benefits of considering an individual’s cognitive status and sex when formulating dementia prevention strategies.

Crested floating heart [Nymphoides cristata (Roxb.) Kuntze] is an invasive aquatic plant in the southeastern United States. For clonal plants like N. cristata, clonal diversity may influence response to control tactics and/or evolutionary potential. However, little is known about the diversity of introduced N. cristata. In this study, we used genotyping by sequencing to quantify N. cristata diversity in the southeastern United States and determine how that diversity is distributed across the invaded range. Our results show that at least three distinct genetic lineages of N. cristata are present in the southeastern United States. Geographic distribution of the lineages varied, with one widespread lineage identified across several states and others only found in a single water body. There is also evidence of extensive asexual reproduction, with invaded water bodies often host to a single genetic lineage. The genetic diversity reported in this study likely results from multiple introductions of N. cristata to the southeastern United States and should be considered by managers when assessing control tactics, such as screening for biocontrol agents or herbicide testing. The extent and distribution of genetic diversity should also be considered by researchers studying the potential for invasive spread of N. cristata within the United States or hybridization with native Nymphoides species.

Geotechnical drilling for a tunnel between Port Moody and Burnaby, BC, Canada, uncovered a buried fjord. Its sedimentary fill has a thickness of at least 130 m and extends more than 37 m below present mean sea level. Recovered sediments record cyclical growth and decay of successive Cordilleran ice sheets. The oldest sediments comprise 58 m of almost stoneless silt conformably overlying ice-proximal sediments and till, which in turn overlie bedrock. These sediments may predate Marine Isotope Stage (MIS) 4. Glacial sediments assigned to MIS 4 overlie this basal succession and, in turn, are overlain by MIS 3 interstadial sediments and sediments from two MIS 2 glacial advances. Indicators of relative sea-level elevations that bracket glacial deposits of MIS 4 and 2 indicate the cyclic existence of moat-like isostatic depressions in the front of expanding ice sheets. Compared with present sea level, these depressions were at least 160 m during the onsets of MIS 4 and MIS 2. Assuming a maximum eustatic drawdown of 120 m during MIS 2, isostatic depression may have exceeded 200 m during retreat of glacial ice from the Evergreen tunnel area. This is consistent with region-specific low mantle viscosity and rapid Cordilleran Ice Sheet buildup and wasting.

Marine litter poses a complex challenge in Indonesia, necessitating a well-informed and coordinated strategy for effective mitigation. This study investigates the seasonality of plastic concentrations around Sulawesi Island in central Indonesia during monsoon-driven wet and dry seasons. By using open data and methodologies including the HYCOM and Parcels models, we simulated the dispersal of plastic waste over 3 months during both the southwest and northeast monsoons. Our research extended beyond data analysis, as we actively engaged with local communities, researchers and policymakers through a range of outreach initiatives, including the development of a web application to visualize model results. Our findings underscore the substantial influence of monsoon-driven currents on surface plastic concentrations, highlighting the seasonal variation in the risk to different regional seas. This study adds to the evidence provided by coarser resolution regional ocean modelling studies, emphasizing that seasonality is a key driver of plastic pollution within the Indonesian archipelago. Inclusive international collaboration and a community-oriented approach were integral to our project, and we recommend that future initiatives similarly engage researchers, local communities and decision-makers in marine litter modelling results. This study aims to support the application of model results in solutions to the marine litter problem.

Following the end of universal testing in the UK, hospital admissions are a key measure of COVID-19 pandemic pressure. Understanding leading indicators of admissions at the National Health Service (NHS) Trust, regional and national geographies help health services plan for ongoing pressures. We explored the spatio-temporal relationships of leading indicators of hospitalisations across SARS-CoV-2 waves in England. This analysis includes an evaluation of internet search volumes from Google Trends, NHS triage calls and online queries, the NHS COVID-19 app, lateral flow devices (LFDs), and the ZOE app. Data sources were analysed for their feasibility as leading indicators using Granger causality, cross-correlation, and dynamic time warping at fine spatial scales. Google Trends and NHS triages consistently temporally led admissions in most locations, with lead times ranging from 5 to 20 days, whereas an inconsistent relationship was found for the ZOE app, NHS COVID-19 app, and LFD testing, which diminished with spatial resolution, showing cross-correlation of leads between –7 and 7 days. The results indicate that novel surveillance sources can be used effectively to understand the expected healthcare burden within hospital administrative areas though the temporal and spatial heterogeneity of these relationships is a key determinant of their operational public health utility.

The COVID-19 pandemic triggered the adoption of online education across all sectors worldwide, which was particularly challenging for disciplines that rely on hands-on learning such as bioarchaeology. Although the impacts of this rapid transition have been well investigated in fields such as anatomy and forensic anthropology, there has been little research into its effects within bioarchaeology. We address this deficit by investigating two common perceptions around online learning from a bioarchaeological perspective: (1) online techniques are inadequate for teaching practical skills, and (2) online learning environments lack a sense of community, thereby negatively affecting learner experiences. To gauge learner perceptions around online practical education in this field, we conducted a qualitative survey of participants in a bioarchaeology masterclass series. Results suggest that students perceive online learning to be as effective for practical training as in-person alternatives and that online learning may engender a sense of community when offered using a collaborative, interactive approach. Based on our results we provide several key recommendations for online education in bioarchaeology, including an active emphasis on social engagement and relationship building, culturally appropriate teaching, and the use of resources to encourage flexibility in learning. A Thai-language abstract is available as Supplemental Text 1.

Three polyphagous pest Liriomyza spp. (Diptera: Agromyzidae) have recently invaded Australia and are damaging horticultural crops. Parasitic wasps are recognized as effective natural enemies of leafmining species globally and are expected to become important biocontrol agents in Australia. However, the hymenopteran parasitoid complex of agromyzids in Australia is poorly known and its use hindered due to taxonomic challenges when based on morphological characters. Here, we identified 14 parasitoid species of leafminers based on molecular and morphological data. We linked DNA barcodes (5′ end cytochrome c oxidase subunit I (COI) sequences) to five adventive eulophid wasp species (Chrysocharis pubicornis (Zetterstedt), Diglyphus isaea (Walker), Hemiptarsenus varicornis (Girault), Neochrysocharis formosa (Westwood), and Neochrysocharis okazakii Kamijo) and two braconid species (Dacnusa areolaris (Nees) and Opius cinerariae Fischer). We also provide the first DNA barcodes (5′ end COI sequences) with linked morphological characters for seven wasp species, with three identified to species level (Closterocerus mirabilis Edwards & La Salle, Trigonogastrella parasitica (Girault), and Zagrammosoma latilineatum Ubaidillah) and four identified to genus (Aprostocetus sp., Asecodes sp., Opius sp. 1, and Opius sp. 2). Phylogenetic analyses suggest C. pubicornis, D. isaea, H. varicornis, and O. cinerariae are likely cryptic species complexes. Neochrysocharis formosa and Aprostocetus sp. specimens were infected with Rickettsia. Five other species (Cl. mirabilis, D. isaea, H. varicornis, Opius sp. 1, and Opius sp. 2) were infected with Wolbachia, while two endosymbionts (Rickettsia and Wolbachia) co-infected N. okazakii. These findings provide background information about the parasitoid fauna expected to help control the leafminers.

Background. Primary care providers play a key role in screening for tobacco use and assessing desire to quit. Tobacco treatment specialists (TTS) are certified in helping patients who desire tobacco cessation. A primary care nurse practitioner within one Midwestern healthcare organization obtained TTS certification and integrated specialized tobacco cessation visits within a primary care clinic from February 2021 to February 2022. Purpose. To determine the efficiency and effectiveness of an integrated TTS-certified nurse practitioner (TTS-NP) in a primary care setting 1-year postimplementation. Method. This program evaluation utilized retrospective electronic health record review and included thirty-three patients. The logic model served as a framework to define efficiency and effectiveness. Results. Patients were referred by a provider (57.6%), nurse (15.2%), or self (27.3). Patients opted for in-person initial visits (81.8%) more than virtual (18.2%). Of a total of 73 scheduled visits, 8 (11%) were no-showed. Patients who self-referred had the lowest no-show rate (5.6%) compared to those referred by a provider (12.8%) or nurse (12.5%). Of the patients included, 87.9% set a goal quit date. Average time until first and second follow-up was 34.6 and 130.4 days after goal quit date. Follow-up was defined as the date of the patient’s first message reply to the TTS-NP, or first visit following the goal quit date. A total of 51.9% (n = 14) and 63% (n = 17) reported cessation at the first and second follow-up. TTS-NP visit’s cost, independent of any other coverage, was less than other specialty visits in primary care. Conclusion. TTS-NP visits in primary care enabled patients to benefit from lower cost and longitudinal follow-up within a familiar setting. Over half of patients achieved cessation. Results of this program evaluation suggest support for TTS-certified providers in primary care.

New SARS-CoV-2 variants causing COVID-19 are a major risk to public health worldwide due to the potential for phenotypic change and increases in pathogenicity, transmissibility and/or vaccine escape. Recognising signatures of new variants in terms of replacing growth and severity are key to informing the public health response. To assess this, we aimed to investigate key time periods in the course of infection, hospitalisation and death, by variant. We linked datasets on contact tracing (Contact Tracing Advisory Service), testing (the Second-Generation Surveillance System) and hospitalisation (the Admitted Patient Care dataset) for the entire length of contact tracing in the England – from March 2020 to March 2022. We modelled, for England, time delay distributions using a Bayesian doubly interval censored modelling approach for the SARS-CoV-2 variants Alpha, Delta, Delta Plus (AY.4.2), Omicron BA.1 and Omicron BA.2. This was conducted for the incubation period, the time from infection to hospitalisation and hospitalisation to death. We further modelled the growth of novel variant replacement using a generalised additive model with a negative binomial error structure and the relationship between incubation period length and the risk of a fatality using a Bernoulli generalised linear model with a logit link. The mean incubation periods for each variant were: Alpha 4.19 (95% credible interval (CrI) 4.13–4.26) days; Delta 3.87 (95% CrI 3.82–3.93) days; Delta Plus 3.92 (95% CrI 3.87–3.98) days; Omicron BA.1 3.67 (95% CrI 3.61–3.72) days and Omicron BA.2 3.48 (95% CrI 3.43–3.53) days. The mean time from infection to hospitalisation was for Alpha 11.31 (95% CrI 11.20–11.41) days, Delta 10.36 (95% CrI 10.26–10.45) days and Omicron BA.1 11.54 (95% CrI 11.38–11.70) days. The mean time from hospitalisation to death was, for Alpha 14.31 (95% CrI 14.00–14.62) days; Delta 12.81 (95% CrI 12.62–13.00) days and Omicron BA.2 16.02 (95% CrI 15.46–16.60) days. The 95th percentile of the incubation periods were: Alpha 11.19 (95% CrI 10.92–11.48) days; Delta 9.97 (95% CrI 9.73–10.21) days; Delta Plus 9.99 (95% CrI 9.78–10.24) days; Omicron BA.1 9.45 (95% CrI 9.23–9.67) days and Omicron BA.2 8.83 (95% CrI 8.62–9.05) days. Shorter incubation periods were associated with greater fatality risk when adjusted for age, sex, variant, vaccination status, vaccination manufacturer and time since last dose with an odds ratio of 0.83 (95% confidence interval 0.82–0.83) (P value < 0.05). Variants of SARS-CoV-2 that have replaced previously dominant variants have had shorter incubation periods. Conversely co-existing variants have had very similar and non-distinct incubation period distributions. Shorter incubation periods reflect generation time advantage, with a reduction in the time to the peak infectious period, and may be a significant factor in novel variant replacing growth. Shorter times for admission to hospital and death were associated with variant severity – the most severe variant, Delta, led to significantly earlier hospitalisation, and death. These measures are likely important for future risk assessment of new variants, and their potential impact on population health.

Avian influenza (AI) is an important disease that has significant implications for animal and human health. High pathogenicity AI (HPAI) has emerged in consecutive seasons within the UK to cause the largest outbreaks recorded. Statutory measures to control outbreaks of AI virus (AIV) at poultry farms involve disposal of all birds on infected premises. Understanding of the timing of incursions into the UK could facilitate decisions on improved responses. During the autumnal migration and wintering period (autumn 2019– spring 2020), three active sampling approaches were trialled for wild bird species considered likely to be involved in captive AI outbreaks with retrospective laboratory testing undertaken to define the presence of AIV.

Faecal sampling of birds (n = 594) caught during routine and responsive mist net sampling failed to detect AIV. Cloacal sampling of hunter-harvested waterfowl (n = 146) detected seven positive samples from three species with the earliest detection on the 17 October 2020. Statutory sampling first detected AIV in wild and captive birds on 3 November 2020. We conclude that hunter sourced sampling of waterfowl presents an opportunity to detect AI within the UK in advance of outbreaks on poultry farms and allow for early intervention measures to protect the national poultry flock.

Dementia, a global health priority, poses a disproportionately high risk to lesbian, gay, bisexual and trans plus (LGBT+)/gender and sexuality diverse people. Despite this, little research has explored the lived experience of LGBT+ people with dementia or their care partners. This scoping review aims to understand what the literature reveals about their experiences, the ways in which their lives have been investigated, to inform future research, policy and practice. Using an established scoping review methodology, we identified seven papers that reported empirical research on the lived experience of LGBT+ people with dementia and their care partners. Only a single study reported on in two of the papers included people who were trans. This in itself reveals how rarely LGBT+ people are asked to speak about how dementia has shaped their lives in academic research. Our reflexive thematic analysis indicates that LGBT+ people with dementia and their care partners endure overlapping forms of disadvantage. This results in heightened experiences of fear and discrimination, lack of services and compounded social isolation. Importantly, while dementia was embodied as interference and loss by LGBT+ people, it was their gender and sexuality differences that provided solace, even in the face of disadvantage. Importantly, people's relationships with LGBT+ identities were framed as fundamental for safety, resilience and wellbeing, rather than a complicating or confounding factor in living with dementia.

Early in the COVID-19 pandemic, the World Health Organization stressed the importance of daily clinical assessments of infected patients, yet current approaches frequently consider cross-sectional timepoints, cumulative summary measures, or time-to-event analyses. Statistical methods are available that make use of the rich information content of longitudinal assessments. We demonstrate the use of a multistate transition model to assess the dynamic nature of COVID-19-associated critical illness using daily evaluations of COVID-19 patients from 9 academic hospitals. We describe the accessibility and utility of methods that consider the clinical trajectory of critically ill COVID-19 patients.

Dicamba is a synthetic auxin herbicide that may be applied over the top of transgenic dicamba-tolerant crops. The increasing prevalence of herbicide-resistant weeds has resulted in increased reliance on dicamba-based herbicides in soybean production systems. Because of the high volatility of dicamba it is prone to off-target movement, and therefore concern exists regarding its drift onto nearby specialty crops. The present study evaluates 12 mid-Atlantic vegetable crops species for sensitivity to sublethal rates of dicamba. Soybean, snap bean, lima bean, tomato, eggplant, bell pepper, cucumber, summer squash, watermelon, pumpkin, sweet basil, lettuce, and kale were grown in a greenhouse and exposed to dicamba at 0, 0.056, 0.11, 0.28, 0.56, 1.12, 2.24 g ae ha−1, which is, respectively, 0, 1/10,000, 1/5,000, 1/2,000, 1/1,000, 1/500, and 1/250 of the maximum recommended label rate for soybean application (560 g ae ha−1). Vegetable crop injury was evaluated 4 wk after treatment using visual rating methods and leaf deformation index measurements. Overall, snap bean was the most sensitive crop, with dicamba rates as low as 0.11 g ae ha−1 resulting in significantly higher leaf deformation levels compared with the nontreated control. Other Fabaceae and Solanaceae species also demonstrated high sensitivity to sublethal rates of dicamba with rates ranging 0.28 to 0.56 g ae ha−1 causing higher leaf deformation compared with the nontreated control. While cucumber, pumpkin, and summer squash were no or moderately sensitive to dicamba, watermelon showed greater sensitivity with unique symptoms at rates as low as 0.056 g ae ha−1 based on visual evaluation. Within the range of tested dicamba rates, sweet basil, lettuce, and kale demonstrated tolerance to dicamba with no injury observed at the maximum rate of 2.24 g ae ha−1.