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Racially and ethnically minoritized individuals, first-generation college students, and women are significantly underrepresented in science, technology, engineering, and mathematics (STEM) careers. This lack of equal representation limits creativity and progress in these fields and perpetuates systemic barriers that discourage students from pursuing STEM pathways. This special communication introduces the three-tiered mentorship model employed in the Teen Science Ambassador Program (TSAP), which incorporates senior mentors, near-peer mentors, and high school ambassadors (i.e., mentees) to promote education, hands-on research, and career development in STEM for underrepresented students. We discuss the benefits and challenges of the three-tiered model and offer recommendations for optimizing its effectiveness to enhance mentorship experiences for all participants. Findings from the TSAP program suggest that the three-tiered approach benefited all participants: high school ambassadors gained STEM skills and confidence, near-peer mentors developed leadership and communication abilities, and senior mentors improved mentorship skills. However, the effectiveness of near-peer mentorship is highly dependent on clearly defined roles and structured involvement. Thus, feedback collected from each mentorship tier was used to inform subsequent iterations of the program. The layered mentorship structure fostered a sense of community and belonging, which is crucial for retaining individuals from underrepresented groups in STEM.
The majority of studies of mental health interventions for young adolescents have only evaluated short-term benefits. This study evaluated the longer-term effectiveness of a non-specialist delivered group-based intervention (Early Adolescent Skills for Emotions; EASE) to improve young adolescents’ mental health.
Methods
In this single-blind, parallel, controlled trial, Syrian refugees aged 10-14 years in Jordan who screened positive for psychological distress were randomised to receive either EASE or enhanced usual care (EUC). Primary outcomes were scores on the Paediatric Symptom Checklist (PSC) assessed at Week 0, 8-weeks, 3-months, and 12 months after treatment. Secondary outcomes were disability, posttraumatic stress, school belongingness, wellbeing, and caregivers’ reports of distress, parenting behaviour, and their perceived children’s mental health.
Results
Between June, 2019 and January, 2020, 185 adolescents were assigned to EASE and 286 to EUC, and 149 (80.5%) and 225 (78.7%) were retained at 12 months, respectively. At 12 months there were no significant differences between treatment conditions, except that EASE was associated with less reduction in depression (estimated mean difference -1.6, 95% CI –3.2 to -0.1; p=.03; effect size, -0.3), and a greater sense of school belonging (estimated mean difference -0.3, 95% CI –5.7 to -0.2; p=.03; effect size, 5.0).
Conclusions
Although EASE led to significant reductions in internalising problems, caregiver distress, and harsh disciplinary parenting at 3-months, these improvements were not maintained at 12 months relative to EUC. Scalable psychological interventions for young adolescents need to consider their ongoing mental health needs. Prospectively registered: ACTRN12619000341123.
Post-procedural antimicrobial prophylaxis is not recommended by professional guidelines but is commonly prescribed. We sought to reduce use of post-procedural antimicrobials after common endoscopic urologic procedures.
Design:
A before-after, quasi-experimental trial with a baseline (July 2020–June 2022), an implementation (July 2022), and an intervention period (August 2022–July 2023).
Setting:
Three participating medical centers.
Intervention:
We assessed the effect of a bundled intervention on excess post-procedural antimicrobial use (ie, antimicrobial use on post-procedural day 1) after three types of endoscopic urologic procedures: ureteroscopy and transurethral resection of bladder tumor or prostate. The intervention consisted of education, local champion(s), and audit-and-feedback of data on the frequency of post-procedural antimicrobial-prescribing.
Results:
1,272 procedures were performed across all 3 sites at baseline compared to 525 during the intervention period; 644 (50.6%) patients received excess post-procedural antimicrobials during the baseline period compared to 216 (41.1%) during the intervention period. There was no change in the use of post-procedural antimicrobials at sites 1 and 2 between the baseline and intervention periods. At site 3, the odds of prescribing a post-procedural antimicrobial significantly decreased during the intervention period relative to the baseline time trend (0.09; 95% CI 0.02–0.45). There was no significant increase in post-procedural unplanned visits at any of the sites.
Conclusions:
Implementation of a bundled intervention was associated with reduced post-procedural antimicrobial use at one of three sites, with no increase in complications. These findings demonstrate both the safety and challenge of guideline implementation for optimal perioperative antimicrobial prophylaxis.
This trial was registered on clinicaltrials.gov, NCT04196777.
The effect of varying concentrations of Al3+ and H+ upon the simultaneous diffusion of 85Sr and 86Rb was measured in salt-free aliquots of clay having different Al:H ratios. The Sr and Rb saturation of the CEC was held constant while the exchangeable Al and H were varied from Al52:H1 to Al12:H34. Aliquots of each clay-treatment were dually tagged with 85Sr and 86Rb. Self-diffusion of Sr and Rb was measured at 4, 24, 48, and 75°C. Radioassay of 85Sr and 86Rb was made with an automatic gamma-detection system equipped with a 400 channel analyzer and card punch unit. The selfdiffusion equation was programmed for the 7040 computer to permit the simultaneous calculation of 85Sr and 86Rb self-diffusion coefficients. Rb diffusion was not significantly altered as the Al3+ concentration was increased from 12 to 52 per cent. The diffusion of Sr was significantly increased as Al3+ increased from 12 to 52 per cent. The faster diffusing Rb ion had a greater energy of activation than Sr (4·8 to 3·6 kcal/mole), however the Arrhenius frequency factor for Rb (a measure of the probability of ion exchange) was much greater for Rb than Sr (28·8 and 0·4 × 10−4, respectively). Altering the Rb and Sr saturation and the complementary ions resulted in changes in the diffusivity, the energy of activation, and the frequency factor for these ions, but not always in the same direction or to the same degree.
Suicide is a leading cause of death in the United States, particularly among adolescents. In recent years, suicidal ideation, attempts, and fatalities have increased. Systems maps can effectively represent complex issues such as suicide, thus providing decision-support tools for policymakers to identify and evaluate interventions. While network science has served to examine systems maps in fields such as obesity, there is limited research at the intersection of suicidology and network science. In this paper, we apply network science to a large causal map of adverse childhood experiences (ACEs) and suicide to address this gap. The National Center for Injury Prevention and Control (NCIPC) within the Centers for Disease Control and Prevention recently created a causal map that encapsulates ACEs and adolescent suicide in 361 concept nodes and 946 directed relationships. In this study, we examine this map and three similar models through three related questions: (Q1) how do existing network-based models of suicide differ in terms of node- and network-level characteristics? (Q2) Using the NCIPC model as a unifying framework, how do current suicide intervention strategies align with prevailing theories of suicide? (Q3) How can the use of network science on the NCIPC model guide suicide interventions?
Hot brewed coffee is the most popular hot beverage in the world, and its health properties have been published in the literature(1). Conversely, over the past decade, cold-brewed coffee has gained popularity, but its eventual nutritional properties are unclear. Both hot and cold brewed coffee produces over 6 million tons of spent coffee grounds (SCG) yearly disposed in landfills(1). Interestingly, studies have shown that SCG can improve several metabolic parameters via changes in the gut microbiome in obese and diabetic rats(2), and reduce energy consumption in overweight humans(3). However, studies investigating the nutritional properties of SCG are lacking in the literature. Hence, in this study, we aimed to identify, quantify and compare two main bioactive compounds in hot- and cold-brewed coffee as a beverage, as well as in the SCG. Samples from hot and cold coffee beverages and SCG were obtained from a local coffee shop (n = 3 per group). The coffee beans were composed of Coffea arabica from Papa New Guinea, Brazil, Ethiopia, and Colombia (in order from highest to lowest proportion). All samples were analysed by high-performance liquid chromatography and mass spectrometry (HPLC-MS). The analyses focused on two main bioactive compounds; trigonelline and chlorogenic acid (CGA). Statistical analyses were performed using an unpaired t-test with Welch’s correction and two-way ANOVA with Tukey’s post-hoc test (p<0.05). When compared to hot-brewed coffee beverages, cold-brewed coffee beverages have shown lower (p<0.05) levels of trigonelline (17.26 mg/g + 1.305 vs. 8.46 mg/g + 0.74, respectively) and CGA (9.82 mg/g + 0.93 vs. 5.31 mg/g + 0.48, respectively). In SCG obtained from hot-brewed coffee, a higher concentration of CGA was found (0.12 mg/g + 0.006), when compared to SCG obtained from cold-brewed coffee (0.10 mg/g + 0.03). However, trigonelline in cold-brewed SCG was found in higher (p<0.05) concentration, when compared to hot-brewed SCG (0.11 mg/g + 0.03 vs. 0.09 mg/g + 0.017, respectively). Moreover, hot-brewed coffee beverages showed higher (p<0.05) concentrations of trigonelline and CGA, when compared to hot-brewed SCG. Similarly, cold-brewed coffee beverages showed higher (p<0.05) concentrations of both bioactive compounds, when compared to cold-brewed SCG. Our results indicated that hot brewed coffee beverage contains high concentrations of bioactive compounds (CGA and trigonelline), which possibly explain its health properties. Although SCG obtained from hot and cold-brewed coffee showed lower concentrations of both bioactive compounds than coffee beverages, our results shed light on the possible health benefits of SCG consumption. In a world seeking more sustainable solutions, further studies investigating the potential use of SCG as a functional food are required.
Acute Appendicitis (AA) is an inflammatory condition of the vermiform appendix in the caecum of the colon. Genetic polymorphisms have been suggested as risk factors predisposing to AA susceptibility but have remained relatively unknown, due to insufficient sample size in previous analyses. Therefore, the primary research aim was to identify genetic variants associated with AA. It was hypothesised that gene polymorphisms associated with AA will provide a connection to other diet-related inflammatory diseases. Genetic variants associated with AA were studied via a Genome-Wide Association Scan (GWAS) using the Global Biobank Meta-Analysis Initiative (GBMI). The GBMI is a collaborative consortium of 23 biobanks with a publicly released repository of de-identified genetic data linked with digital health records spanning 4 continents with a study population size of over 2.2 million consented individuals of multiple ancestral backgrounds1. A linear regression model was used to estimate the association between single nucleotide polymorphisms (SNPs), across the human genome, and AA by each contributing biobank. The results were then meta-analysed with a total of 32,706 cases and 1,075,763 controls. In the present study, the free open-source Complex Traits Genetic Virtual Lab (CTG-VL) platform was used to access, analyse, and visualise the GWAS summary statistics of AA2. Genome-wide significantly associated SNPs (p-value < 5 x 10-8) were further searched for their associations with health-related traits in publicly available GWAS summary statistics. Upon analysis, significantly associated SNPs for AA were identified within or nearby nine genes. HLX, NKX2-3, LTBR, and DLEU1 are genes involved in immune responses; IRF8 associated with maturation of myeloid cells; OSR-1 responsible for transmembrane ion transporter activity; NCALD a regulator of G protein-coupled signal transduction. In addition, based on the hypothesis, the SNP of key clinical importance was the HLA-C rs2524046 (p-value = 2.38 x 10-8), with the AA risk-increasing allele C being also strongly associated with a higher risk of coeliac disease (CD). The CD is an autoimmune condition where gluten, a protein present in grains such as barley, rye, and wheat, elicits an inflammatory response that results in damage to the small intestine lining. Considering how both AA and CD share the same SNP, it is possible to speculate whether gluten initiates a similar pathophysiological mechanism that exacerbates inflammation in the vermiform appendix in AA. In conclusion, the top AA associated SNPs suggests its development could be due to immunological responses influenced by dietary nutrient intake. The HLA-C SNP is common to AA and CD, suggesting that the gluten protein found in certain cereal grains possibly contributes to the pathophysiology of AA like CD. This warrants further investigations into whether dietary gluten could play a key role in AA development.
We demonstrate the importance of radio selection in probing heavily obscured galaxy populations. We combine Evolutionary Map of the Universe (EMU) Early Science data in the Galaxy and Mass Assembly (GAMA) G23 field with the GAMA data, providing optical photometry and spectral line measurements, together with Wide-field Infrared Survey Explorer (WISE) infrared (IR) photometry, providing IR luminosities and colours. We investigate the degree of obscuration in star-forming galaxies, based on the Balmer decrement (BD), and explore how this trend varies, over a redshift range of $0<z<0.345$. We demonstrate that the radio-detected population has on average higher levels of obscuration than the parent optical sample, arising through missing the lowest BD and lowest mass galaxies, which are also the lower star formation rate (SFR) and metallicity systems. We discuss possible explanations for this result, including speculation around whether it might arise from steeper stellar initial mass functions in low mass, low SFR galaxies.
Cardiovascular disease (CVD) is largely preventable, and the leading cause of death for men and women. Though women have increased life expectancy compared to men, there are marked sex disparities in prevalence and risk of CVD-associated mortality and dementia. Yet, the basis for these and female-male differences is not completely understood. It is increasingly recognized that heart and brain health represent a lifetime of exposures to shared risk factors (including obesity, hyperlipidemia, diabetes, and hypertension) that compromise cerebrovascular health. We describe the process and resources for establishing a new research Center for Women’s Cardiovascular and Brain Health at the University of California, Davis as a model for: (1) use of the cy pres principle for funding science to improve health; (2) transdisciplinary collaboration to leapfrog progress in a convergence science approach that acknowledges and addresses social determinants of health; and (3) training the next generation of diverse researchers. This may serve as a blueprint for future Centers in academic health institutions, as the cy pres mechanism for funding research is a unique mechanism to leverage residual legal settlement funds to catalyze the pace of scientific discovery, maximize innovation, and promote health equity in addressing society’s most vexing health problems.
Cognitive function may underlie the use of more adaptive as compared to maladaptive coping strategies to manage pandemic-related stress in older adults. As the composition of coping strategies varies with context, we investigated the factor structure of 14 established coping strategies. We then aimed to determine whether specific coping strategies were associated with cognitive function.
Participants and Methods:
141 adults aged 50-90 years old completed the study via Zoom. The National Alzheimer’s Coordinating Center TCog battery assessed cognitive function. The Brief Cope, adapted to evaluate COVID-19, measured 14 specific coping strategies.
Results:
Based on our factor analyses, Avoidant (e.g., denial and substance use) and Approach (e.g., planning, instrumental and emotional support systems) coping composite scores were formed. Regression analyses, adjusted for age and education, indicated that 12.9% of the variance in the use of Avoidance coping strategies was explained by worse performance on measures of episodic memory, executive attention/processing speed, working memory, and verbal fluency. A closer examination indicated that verbal fluency was not a statistically significant contributor to the model. 9.1% of the variance in Approach coping strategies was related to cognitive function with working memory and verbal fluency being statistically significant contributors to the model.
Conclusions:
Older adults with better performance on higher-order cognitive testing may utilize more effective coping strategies in older adults. These results have implications for attenuating pandemic-related stress and warrant developing brief interventions to help facilitate problem-solving and reduce emotional distress in those with lower cognitive resources.
Female fertility is a complex trait with age-specific changes in spontaneous dizygotic (DZ) twinning and fertility. To elucidate factors regulating female fertility and infertility, we conducted a genome-wide association study (GWAS) on mothers of spontaneous DZ twins (MoDZT) versus controls (3273 cases, 24,009 controls). This is a follow-up study to the Australia/New Zealand (ANZ) component of that previously reported (Mbarek et al., 2016), with a sample size almost twice that of the entire discovery sample meta-analysed in the previous article (and five times the ANZ contribution to that), resulting from newly available additional genotyping and representing a significant increase in power. We compare analyses with and without male controls and show unequivocally that it is better to include male controls who have been screened for recent family history, than to use only female controls. Results from the SNP based GWAS identified four genomewide significant signals, including one novel region, ZFPM1 (Zinc Finger Protein, FOG Family Member 1), on chromosome 16. Previous signals near FSHB (Follicle Stimulating Hormone beta subunit) and SMAD3 (SMAD Family Member 3) were also replicated (Mbarek et al., 2016). We also ran the GWAS with a dominance model that identified a further locus ADRB2 on chr 5. These results have been contributed to the International Twinning Genetics Consortium for inclusion in the next GWAS meta-analysis (Mbarek et al., in press).
Although anesthesiology and endocrinology are two distinct branches of medicine, some recent breakthrough treatments have brought together both medical specialties, particularly those concerned with surgical sciences and critical care. Related to the use of various traditional surgical techniques, the lack of newer and safer drugs, the lack of monitoring tools, and the scarcity of critical care services in the past, managing patients with various endocrine disorders has always been perceived as being more difficult by practicing anesthesiologists.
The quenching of cluster satellite galaxies is inextricably linked to the suppression of their cold interstellar medium (ISM) by environmental mechanisms. While the removal of neutral atomic hydrogen (H i) at large radii is well studied, how the environment impacts the remaining gas in the centres of galaxies, which are dominated by molecular gas, is less clear. Using new observations from the Virgo Environment traced in CO survey (VERTICO) and archival H i data, we study the H i and molecular gas within the optical discs of Virgo cluster galaxies on 1.2-kpc scales with spatially resolved scaling relations between stellar ($\Sigma_{\star}$), H i ($\Sigma_{\text{H}\,{\small\text{I}}}$), and molecular gas ($\Sigma_{\text{mol}}$) surface densities. Adopting H i deficiency as a measure of environmental impact, we find evidence that, in addition to removing the H i at large radii, the cluster processes also lower the average $\Sigma_{\text{H}\,{\small\text{I}}}$ of the remaining gas even in the central $1.2\,$kpc. The impact on molecular gas is comparatively weaker than on the H i, and we show that the lower $\Sigma_{\text{mol}}$ gas is removed first. In the most H i-deficient galaxies, however, we find evidence that environmental processes reduce the typical $\Sigma_{\text{mol}}$ of the remaining gas by nearly a factor of 3. We find no evidence for environment-driven elevation of $\Sigma_{\text{H}\,{\small\text{I}}}$ or $\Sigma_{\text{mol}}$ in H i-deficient galaxies. Using the ratio of $\Sigma_{\text{mol}}$-to-$\Sigma_{\text{H}\,{\small\text{I}}}$ in individual regions, we show that changes in the ISM physical conditions, estimated using the total gas surface density and midplane hydrostatic pressure, cannot explain the observed reduction in molecular gas content. Instead, we suggest that direct stripping of the molecular gas is required to explain our results.
OBJECTIVES/GOALS: Adolescence represents a critical period for substance use initiation. Various factors may contribute to trying a sip or single puff of a substance, that could lead to more frequent use. However, less is known about how predictors from multiple domains converge to impact risk for general substance use initiation. METHODS/STUDY POPULATION: The Adolescent Brain Cognitive Development (ABCD) study is a multi-site longitudinal study following youth into early adulthood. The present study included 7,644 ABCD children who reported no lifetime substance use (including any experimentation) at baseline (ages 9–10). Our primary aim was to use a random forest classification model to predict binary substance use initiation, defined as trying any non-prescribed substance (e.g., alcohol, tobacco, cannabis, non-prescribed medications), during a 2-year follow-up after baseline. A total of 402 variables from the following categories were examined as predictors: demographics, peer substance use and availability, mental and physical health, culture and environment, biospecimens, neurocognitive functioning, and structural neuroimaging variables. RESULTS/ANTICIPATED RESULTS: Over a two-year follow-up, 751 (9.8%) of substance-naïve children reported trying a substance by age 11. The most common substance was alcohol, followed by cannabis and tobacco. Mean Decrease Accuracy (MDA) values were used to assess the relative importance of each predictor. The overall accuracy of the model in accurately predicting group membership (no substance use initiation vs. substance use initiation) was 57.66%. Of the top 5 predictors, the most important predictor was intent to use alcohol (MDA = .002). The following top predictors were structural neuroimaging variables: volume and surface area of right lateral occipital lobe (MDA = .0009 and .0008, respectively), surface area of right inferior temporal lobe (MDA = .0007), and surface area of left superior frontal lobe (MDA = .0007). DISCUSSION/SIGNIFICANCE: A combination of intent to use alcohol and structural neuroimaging indices were among the top predictors of substance use initiation. Understanding predictors of early substance use experimentation is important for identifying at-risk youth that may require targeted intervention approaches.
Postpartum depression (PPD) affects up to one in five mothers and birthing parents, yet as few as 10% access evidence-based treatment. One-day cognitive behavioral therapy (CBT)-based workshops for PPD have the potential to reach large numbers of sufferers and be integrated into stepped models of care.
Methods
This randomized controlled trial of 461 mothers and birthing parents in Ontario, Canada with Edinburgh Postnatal Depression Scale (EPDS) scores ⩾10, age ⩾18 years, and an infant <12 months of age compared the effects of a 1-day CBT-based workshop plus treatment as usual (TAU; i.e. care from any provider(s) they wished) to TAU alone at 12-weeks post-intervention on PPD, anxiety, the mother–infant relationship, offspring behavior, health-related quality of life, and cost-effectiveness. Data were collected via REDCap.
Results
Workshops led to meaningful reductions in EPDS scores (m = 15.77 to 11.22; b = −4.6, p < 0.01) and were associated with three times higher odds of a clinically significant decrease in PPD [odds ratio (OR) 3.00, 95% confidence interval (CI) 1.93–4.67]. Anxiety also decreased and participants had three times the odds of clinically significant improvement (OR 3.20, 95% CI 2.03–5.04). Participants reported improvements in mother–infant bonding, infant-focused rejection and anger, and effortful control in their toddlers. The workshop plus TAU achieved similar quality-adjusted life-years at lower costs than TAU alone.
Conclusions
One-day CBT-based workshops for PPD can lead to improvements in depression, anxiety, and the mother–infant relationship and are cost-saving. This intervention could represent a perinatal-specific option that can treat larger numbers of individuals and be integrated into stepped care approaches at reasonable cost.
An experiment was conducted to investigate the incidence of travel sickness in pigs, specific hormone concentrations at exsanguination and subsequent meat quality. Fifty, 80kg slaughter pigs were transported on a lorry for 4.5h. During the journey, behavioural observations of the individually marked pigs were made by scanning every 8min to establish whether the pigs exhibited certain symptoms of travel sickness (foaming at the mouth and chomping) and incidences of retching and vomiting were noted as they occurred. Upon arrival at the slaughterhouse, pigs were unloaded, slaughtered immediately and a blood sample was taken at exsanguination for analysis of plasma Cortisol, beta-endorphin and lysine vasopressin concentrations. On the day following slaughter, the chilled carcase of each pig was assessed for meat quality (using pH, Fibre Optic Probe, and Tecpro Pork Quality Meter measurements) in the longissimus dorsi, semimembranosus and adductor muscles to determine the incidence of PSE (pale, soft, exudative) or DFD (dark, firm, dry) meat quality. Twenty-six per cent of the pigs (a total of 13 individuals) vomited or retched during the journey. There was no relationship between the incidence of travel sickness and either the concentrations of the hormones analysed at exsanguination or subsequent meat quality. Correlations revealed no significant relationship between concentrations of the hormones and meat quality measurements.
Humpback whales (Megaptera novaeangliae) exhibit maternally driven fidelity to feeding grounds, and yet occasionally occupy new areas. Humpback whale sightings and mortalities in the New York Bight apex (NYBA) have been increasing over the last decade, providing an opportunity to study this phenomenon in an urban habitat. Whales in this area overlap with human activities, including busy shipping traffic leading into the Port of New York and New Jersey. The site fidelity, population composition and demographics of individual whales were analysed to better inform management in this high-risk area. Whale watching and other opportunistic data collections were used to identify 101 individual humpback whales in the NYBA from spring through autumn, 2012–2018. Although mean occurrence was low (2.5 days), mean occupancy was 37.6 days, and 31.3% of whales returned from one year to the next. Individuals compared with other regional and ocean-basin-wide photo-identification catalogues (N = 52) were primarily resighted at other sites along the US East Coast, including the Gulf of Maine feeding ground. Sightings of mother-calf pairs were rare in the NYBA, suggesting that maternally directed fidelity may not be responsible for the presence of young whales in this area. Other factors including shifts in prey species distribution or changes in population structure more broadly should be investigated.
A system for examination of the peripheral nerves of the upper limb is described in this chapter. This includes the ulnar, median, radial, axillary and musculocutaneous nerves. The steps are inspection followed by a screen test to decide if the lesion is likely to be radial, median or ulnar. Then the nerve is examined in more detail by testing sensation and movement in relation to that nerve. Provocation tests are performed if necessary. This chapter also describes nerve compression as a result of thoracic outlet syndrome, as this may be a differential diagnosis. In the ‘Advanced corner’ Tinel’s sign and Valleix phenomenon as well as ‘double crush’ are described.
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.